LIPPINCOTT'S NURSING MANUALS THE ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS BY JOHN FOOTE, M.D. Assistant Professor of Therapeutics and Materia Medica, George Town University School of Medicine,- Instructor in Materia Medica and Therapeutics, Providence Hospital Train- ing School for Nurses LIPPINCOTT'S NURSING MANUALS FULL CATALOGUE FREE ON REQUEST Ninth Edition Revised COOKE'S HANDBOOK OF OBSTETRICS Revised by CAROLYN E. GRAY, and MARY ALBERTA BAKER, of City Hospital, New York. 475 pages. 188illustrations. $2.25 net. CARE AND FEEDING OF INFANTS AND CHILDREN A TEXT-BOOK FOR TRAINED NURSES By WALTER REEVE RAMSEY, M.D., of University of Min- nesota. 290 pages. 123 illustrations. $2.00 net. SURGICAL AND GYNECOLOGICAL NURSING By EDWARD MASON PARKER, M.D., and SCOTT DUDLEY BRECKINRIDGE, M.D., of Providence Hospital, Washing- ton, D. C. 425 pages. 134 illustrations. $2.50 net. ESSENTIALS OF MEDICINE Third Edition By CHARLES PHILLIPS EMERSON, M.D., of University of Indiana. 401 pages. 117 illustrations. $2.50 net. Second Edition Revised PHYSICS AND CHEMISTRY FOR NURSES By A. R. BLISS, M.D., Grady Hospital, Atlanta, Ga., and A. H. OLIVE, A.B., Ph.D., Hillman Hospital, Birmingham. 239 pages. 49 illustrations. Si.75 net. Third Edition Revised MATERIA MEDICA AND THERAPEUTICS By JOHN FOOTE, M.D., of Providence Hospital, Washington, D. C. 310 pages. Si.75 net. FEVER NURSING Eighth Edition By J. C. WILSON, M.D., of Jefferson Hospital, Philadelphia. 264 pages. Si.so net. PRACTICAL BANDAGING By ELDRIDGE L. ELIASON, M.D., University of Pennsylvania Hospital. 124 pages. 155 illustrations. Si.50 net. NURSING AND CARE Third Edition OF THE NERVOUS AND THE INSANE By CHAS. K. MILLS, M.D., and N. S. YAWGER, M.D. 142 pages. 12 illustrations. Si.50 net. HOW TO COOK Fifth Edition FOR THE SICK AND CONVALESCENT By HELENA V. SACHSE. 337 pages. Si.sonet. Second Edition PRIVATE DUTY NURSING CATHERINE DEWITT, R.N., Assistant Editor of American Journal of Nursing. 244 pages. Si.7S net. LIPPINCOTT'S NURSING MANUALS THE ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS FOR NURSES BY JOHN FOOTE, M.D. ASSISTANT PROFESSOR OF THERAPEUTICS AND MATERIA MEDICA, GEORGE TOWN UNIVERSITY SCHOOL OF MEDICINE; INSTRUCTOR IN MATERIA MEDICA AND THERAPEUTICS, PROVIDENCE HOSPITAL TRAIN- ING SCHOOL FOR NURSES THIRD EDITION, REVISED, ENLARGED AND RESET PHILADELPHIA & LONDON J. B. LIPPINCOTT COMPANY Copyright, 1910 By J. B. Lippincott Company Copyright, 1912 By J. B. Lippincott Company Copyright, 1918 By J. B. Lippincott Company The use in this volume of certain portions of the text of the United States Pharmacopoeia is by virtue of permission received from the Board of Trustees of the United States Pharmacopoeial Convention. The said Board of Trustees is not responsible for any inaccuracy of quotation nor for any errors in the statement of quantities or percentage strengths. Electrolyped and Printed by J. B. Lippincott Company The Washington Square Press, Philadelphia, U. S. A. PREFACE TO THE THIRD EDITION The gratifying reception accorded this small text-book, attested by numerous reprintings and two editions, have encouraged the writer and the publishers to issue a new, completely revised edition, conforming to the standards of the U. S. Pharmacopoeia, IX Revision. In addition, the opportunity has been taken to embody many suggestions received from Training School Superintendents in adapting this work to the practical needs of the student-nurse, as well as the deductions drawn from an exhaustive study of the requirements of the State Examining Boards for Nurses, as shown in the questions submitted by thirty such organiza- tions in the last two years. The Latin official names of drugs and preparations have been added in this revision, and in the Reference Table the official name of each drug or preparation recognized in the European pharmacopoeias is included-this last as a result of an unanticipated foreign demand for the earlier editions. A rearrangement of the drug classification, the addition of new material, especially concerning the newer remedies, amplified sections on the mathematics of solutions and fractional dosage, and the introduction of much general reference material, including formulas of preparations useful in hospital and private nursing, as well as condensed information about the newer antiseptics used in European military surgery, practical dis- infection, toxicology and therapeutic action, have added to the bulk of the volume, without, we hope, seriously im- pairing its original virtue of compactness and simplicity. The " U. S. Pharmacopoeia," " New and Non-Official Reme- dies," and Wood's " Pharmacology and Therapeutics," have been used freely in this revision, as authorities. March, 1918 J. F. v PREFACE This little work is intended to simplify the study of therapeutics for nurses by limiting the number of important remedies to be studied and appending a reference list to cover the other frequently used drugs and preparations. The physiological action described in the second part is based on experimental pharmacology, and is, therefore, not in conflict with the therapeutic applications of the remedies considered. In the reference table, the " Pharmacopoeia," " Merck's Index," " The Manual of Therapeutics, Relating Especially to Biological Products," and various other sources have been freely used to make a suitable list. The more ambitious text-books for nurses are based on a classification according to chemical and botanical groups. This, it seems to me, is needless, and imposes upon the student the task of culling the necessary knowledge from a confusing mass of facts. For this reason the author has considered a list of drugs, necessarily limited, in his lectures to students of medicine and nursing, and these lecture notes have furnished a basis for the present work. Special atten- tion has been given to the untoward action of drugs, to aid the nurse in noting and recording these actions when they occur. Acknowledgment is due to Dr. R. M. Le Comte for assistance in preparing the manuscript, and to the Sister Superintendent of Nurses of Providence Hospital Training School for suggestions as to the scope of the work. J. F. VI CONTENTS PART I. CHAPTER PAGE I. Definitions and Weights 3 II. Dosage 13 III. Methods of Administering Medicines 18 IV. The Preparation of Antiseptic and Other Solutions 27 V. How Medicines Act 39 PART II. VI. Drugs and Medicines 47 Ready Reference Tables of Information Concerning Special Disinfection 143 PART III. Reference List of Commonly Used Drugs, Chemicals, Propri- etary Medicines 155 Synopsis of the Principal Actions and Uses of Drugs 220 Ready Reference Table of Poisons and Antidotes 233 Tables of Doses 250 The Nurse and the Harrison Narcotic Act 259 Antiseptic Solutions Used in Military Surgery 262 Other Formulae and General Reference Material 265 VII PART I DEFINITIONS AND WEIGHTS-DOSAGE- METHODS OF ADMINISTERING MEDICINES -THE PREPARATION OF ANTISEPTIC AND OTHER SOLUTIONS-HOW MEDICINES ACT. materia medica and therapeutics CHAPTER I DEFINITIONS AND WEIGHTS DEFINITIONS Materia Medica (medical material) treats of the natural and commercial history of drugs, their physical and chemical properties, and their doses. Therapeutics treats of the action of medicines in re- lieving or curing disease. A remedy is an agency used in the treatment of disease. A medicine is any substance used in the treatment of disease. A drug is any raw material used to compose or com- pound a medicine. (A remedy may be a drug, a medicine, or an agency such as electricity, sunshine, or bathing.) A prescription is a written order for a remedy ad- dressed to a pharmacist. In a prescription the sign J^, an abbreviation of the Latin recipe (take), appears first, fol- lowed by the names of the ingredients written in Latin and the quantities expressed in a standard system of weights and measures. The directions to the pharmacist are also written in Latin. The directions to the patient are written in Eng- lish or the language the patient speaks. 3 4 MATERIA MEDICA AND THERAPEUTICS Example of a prescription; In Latin: B Sodii Bromidi Aquae Syrupi quantum sufficiat ad Misce. Signetur: One teaspoonful every three hours. John Smith, M.D. In English: Take of bromide of soda, one drachm of water, one-half an ounce of syrup, a sufficient quantity to make two ounces. Mix. Write. One teaspoonful every three hours. John Smith, M.D. PRESCRIPTION LATIN The following Latin terms, or their abbreviations, have long been used in writing prescriptions. Many of the phrases are practically obsolete nowadays. Ad Ad To, or up to. Ad lib Ad libitum .....At pleasure. Admov Admoveatur Apply. Alt. hor Alterius horis Every other hour. A. or aa Ana .....Of each. Aq. bull Aqua bulliens .. ... .Boiling water. Aq.ferv Aqua fervens Hot water. Aq. font Aqua fontana ..Spring water. Arg Argentum Silver. Au Aurum Gold. Aut Aut .. Or. Bene , Bene Well. Bib Bibe ...Drink. DEFINITIONS AND WEIGHTS 5 Bis Bis Twice. B.i.d Bis in die Twice a day. Bull , Bulliat Let it boil. C...................Cum ...With. Cap , Capiat Let him take. Capsul. Capsula ..... A capsule. Chart Charta Paper. C. m Cras mane To-morrow morning. C. n _ Cras node To-morrow night. Coch, parv Cochleare parvum . .A teaspoonful. Coch, amp Cochleare amplum ..A dessertspoonful. Coch, mag Cochleare magnum ..A tablespoonful. Cong Congius A gallon. Dil Dilue , Dilute. Dividatur in partes oequales Let it be divided into equal parts. D. in p Emp . Emplastrum A plaster. F. pit. xii Fac pilulas duodecim. Make twelve pills. Ft Fiat Let it be made. Filt Filtra Filter. Gtt.................. Guttce Drops. Hor. som Hora somni At the hour of sleep. Mane Mane In the morning. M , Misce Mix. O. D Ocuius dexter Right eye. O. S...............Oculus sinister Left eye. Omn. hor Omni hora Every hour. Post cib , Post cibum ...., After eating. Q. S Quantum sufficiat .. A sufficient quantity. Red. in pulv Redactus in pulverem , Let it be reduced to powder. Sig Signetur Let it be labeled. Tab Tabella A lozenge, or tablet. T. i. d. .., Ter in die Three times a day. Ter. sim Tere simul .... Rub together. Trit Tritura Triturate. Ut diet ....... Ut dictum As directed. 6 MATERIA MEDICA AND THERAPEUTICS Pharmacy treats of the preparation of drugs and medi- cines so that they may be most efficacious and least disagree- able. The Pharmacopoeia is a book compiled by authorities in medicine and pharmacy as a national standard for the purity and accuracy of drugs and medicines. The book gives names and descriptions of crude drugs, tests for purity, and doses and formulae for certain standard preparations. Drugs and preparations included in the Pharmacopoeia are said to be " official." Commonly Used Preparations of the Pharmacopceia. Waters (aqu^) are weak solutions of volatile sub- stances (as oil of peppermint) in water. They are used principally as flavoring agents. Solutions (liquores) are powerful solutions of non- volatile substances (chemicals such as arsenic, chloride of iron, etc.) in water. They are usually potent remedies. Syrups (syrupi) are solutions of sugar in water, usually with medicinal substances added (as syrup of tar). Spirits (spiriti) are solutions of volatile substances (camphor, oil of peppermint, etc.) in alcohol. Elixirs (elixires) are sweetened aromatic prepara- tions containing alcohol and other medicinal substances. Mixtures (mistutle) are watery preparations contain- ing finely divided solid matter, not dissolved but in sus- pension. Emulsions (emulsje) are milk-like preparations in which oily matter is held in suspension by the aid of some viscid substance. Infusions (infuste) are preparations made by extract- ing the properties of vegetable drugs with hot water. Example-tea. DEFINITIONS AND WEIGHTS 7 Tinctures (tincture) are preparations of vegetable drugs, not weaker than io per cent., made by extracting the properties of the drug with an alcoholic liquid. Fluidextracts (fluidextracta) resemble tinctures but are of 100 per cent, strength. Extracts (extracta) are made like fluidextracts, but the alcoholic medium has been evaporated so that the product is a solid or semi-solid mass. Powders (pulveres) are mixtures of powdered drugs intended for internal use. Example-Seidlitz powders. Pills, capsules, tablets, cachets, etc., are various de- vices for giving single doses of solid drugs in an acceptable form. Suppositories are suitably-shaped medicated solids, which melt at the body temperature, intended to be inserted into the rectum or other apertures of the body. Ointments (unguenta) are fatty medicated substances which melt at body temperature, intended principally for local action. Liniments (linimenta) are oily liquids for external use, to be applied with friction. Plasters (emplastra) are semisolid medicated sub- stances, spread on a fabric, which adhere to the body at the body temperature. WEIGHTS AND MEASURES Two systems of weights and measures are employed by physicians and pharmacists. The old or apothecaries' sys- tem is best known and most generally employed in English- speaking countries. The metric or decimal system, corre- sponding to our system of currency, has many advantages, and is employed in the Pharmacopoeia and generally used in Europe. 8 MATERIA MEDICA AND THERAPEUTICS Each system has a unit, and this unit is the starting point or quantity in each system, which, when multiplied or divided, gives the greater or lesser quantities or weights of that system. The unit of the apothecaries' system is the grain; of the metric system, the gramme. Apothecaries' Weight and Measure In this system the unit of weight is the grain; the unit of capacity is the minim. Certain symbols are used to desig- nate the various quantities. The minim of water at ordinary temperatures weighs one grain. The symbol of the grain is gr. The symbol of the minim is TR. Apothecaries' Weight Twenty grains make one scruple, gr.xx = ® i Three scruples make one drachm. ® iii = 5i Eight drachms make one ounce. Sviii = Ji Twelve ounces make one pound.1 Jxii = tb.i Apothecaries' Measure Sixty minims make one fluidrachm. IRlx - Si or fl. Si Eight fluidrachms make one fluidounce. Sviii = Sixteen fluidounces make one pint. 5xvi = Oi 1 The pound is seldom used. DEFINITIONS AND WEIGHTS 9 Thus it will be seen that, omitting the scruple and the pint, the quantities and the symbols are the same in both the apothecaries' weight and measure. An ordinary drop of water at 6o° F. temperature is about one minim. The symbol gtt. (abbreviation of gutta) indicates the drop. The drop does not correspond to the minim in fluids heavier or lighter than water. The abbreviation means one half. Thus, gr. vss reads grains five and a half. It will be observed that in this system the quantities are written in Roman numerals, as on a clock dial. Also that the symbol is written before the quantity-as gr. xviii, not 18 gr. In the metric system ordinary numerals are used and the symbol is written after the quantity. The Metric System In this system the unit of capacity, for all practical pur- poses, is the cubic centimetre (c.c.), or as it is now known the millilitre (mil) ; the unit of weight, the gramme (Gm.). In the metric system, however, the unit of length is the metre, a measure a little greater than thirty-nine inches. In multiplying this unit, we simply say, one, ten, or several hundred metres (abbreviation M.), writing the symbol after the quantity. When a thousand metres is reached we call it a kilometre or kilo, and we multiply all the other units,-grammes and cubic centimetres,-in the same manner. In dividing the metre, and, likewise, all the other units of the metric system, we do so by decimals, in the tenths, hundredths, or thousandths. For example, in the old system we may write " x/10 of an inch," or " gr. 1/4" if it be a fraction of the unit of weight. In the metric system we write 10 MATERIA MEDICA AND THERAPEUTICS I M. (metre). o.i M. would be read i decimetre. o.oi M. would be read I centimetre. o.ooi M. would be read 1 millimetre. It will be easily seen that o.i M. is io centimetres or ico millimetres. The centimetre, the measure most used, is roughly 2/B of an inch. To make this plainer, let us take our currency system. The dollar is the unit. Supposing we have $1.25. We would read one dollar and twenty-five cents, not one dollar and 250 mills or one dollar two dimes and five cents. And, so, if for dollars we substitute metres, grammes or cubic centimetres (the units of measure, weight, and capacity of the metric system) we would read "one metre and twenty- five centimetres," or " one gramme and twenty-five centi- grammes," or " one mil and twenty-five centimils." So it is sufficient to remember that: 1000 metres or grammes metre or gramme make a kilo- 1000 cubic centimetres or millilitres make a litre. That Ttf, TO> and TW a metre or gramme is one deci- centi- milli- metre or gramme A tIt Wo of a cubic centimetre or millilitre are not read as if they were written in fractions; not "a decicubic centimetre " but " decimil," " centimil," or " millimil." The equivalent of one mil in minims is 16.23. One gramme in grains is 15.48+. Equivalent of one grain in grammes is DEFINITIONS AND WEIGHTS 11 .0648-f-. The equivalents in the following rules are exact enough for ordinary purpose, however. To Convert Weights of the Apothecaries' System into the Metric System I. Multiply the quantity of grains or minims by 0.06 to give Gm. or mil. II. Multiply the number of fluid or liquid drachms by 4 to give Gm. or mil. III. Multiply the number of ounces by 30 to give Gm. or mil. Examples.-How many Gm. in gr. x of Dover's powder? Rule I.-0.06 X 10 = .6 Gm. How many mils in fl.5x of paregoric? Rule II.- 4 X 10 - 40 mils. How many mils in §ii of alcohol ? Rule HI.-30 X 2 = 60 mils. To Convert the Metric System into the Old System I. Multiply decimals of three figures (as milligrammes') by 1/60 to obtain grains or minims. II. Multiply grammes, cubic centimetres and their deci- mals by 15 to obtain grains or minims. HI. Divide grammes, cubic centimetres and their deci- mals by 4 to obtain drachms, fluid or solid. IV. Multiply litres by 2.1 to obtain pints. Examples.-A physician writes, " Morphine sulphate, .006 Gm." What part of a grain is this? Rule I.-0.006 is six milligrammes; 6 X 7eo = 7eo or gr. 710. Spiritus Ammoniae Aromatica, 1.2 mils. How many minims is this? Rule II.-1.2 X 15 - 18 minims. 12 MATERIA MEDICA AND THERAPEUTICS Sugar of milk, 16 Gm. How many drachms is this? Rule III.-16 -j- 4 - 4 or 5iv. A patient is directed to take five litres of milk a week. How many pints? Rule IV.-2.1 X 5 = 10.5 or Oxss. Domestic Equivalents in Measure (A drop of water at ordinary temperature weighs a grain and measures a minim.) 1 drop (abbreviation is gtt.)... m,i or 0.06 mil. 1 teaspoonful 5i or 4 mil. 1 dessertspoonful 5ii or 8 mil. 1 tablespoonful §ss or 16 mil. 1 wineglassful $ii or 64 mil. QUESTIONS I. Define a remedy: an "official" preparation. What is the dif- ference between a water and a spirit? between a solution and a mixture? between an infusion and a tincture? How do tinc- tures differ from fluidextracts and extracts? 2. What are the units of weight and capacity of the apothe- caries' system? of the metric system? Write, properly, the sign for the units of both systems and their abbreviations. How are these units divided and multiplied to obtain the other quan- tites? Write the table for each system. 3. Write the three rules for converting the apothecaries' into the metric and give an example of the application of each. Write the four rules for converting metric quantities into the old system and give an example of each. 4. Give the equivalents in the metric and old system of a drop, a teaspoonful, dessertspoonful, tablespoonful wineglassful. Write the quantites in each system. CHAPTER II DOSAGE Dosage is modified and is greater or lesser, depending on various conditions. CONDITIONS WHICH MODIFY DOSAGE i. Age and Weight.-a. Large and heavy individuals require larger doses than small persons. b. Females require, generally, smaller doses than males. c. The young and very old require smaller doses than the adult. RULES TO DETERMINE FRACTIONAL DOSES FOR CHILDREN Young's rule consists in using the age at nearest birth- day for the numerator, and the age plus twelve for the de- nominator of the fraction. Example.-What is the dose of Basham's mixture for a child of eight. Taking the child's age, eight, and adding 12, we have 20, the denominator, and 8 the numerator; 8/20 - 2/5 of the adult dose. Cowlings' Rule.-Add one year to the child's age to make the numerator of your fraction. Take 25 as the denominator. Example.-What is the dose of Basham's mixture for a child of five years? The child's age is five years, then, 5 plus 1 equals 6, the numerator; 25 is the denominator. The fraction, therefore, is e/25 or about x/4. The adult dose of Basham's mixture is 5iv; x/4 of 3iv is 3i-the dose for a child of five years. 13 14 MATERIA MEDICA AND THERAPEUTICS Children over six months old may be considered one year old by this rule. To determine the dosage for a child less than six months old take the weight of the child for the numerator and 200 for the denominator. Example.-A child weighs 10 pounds; 10/200 or 1/20 of the usual adult dose would be required. Note.-Opium, morphine, and codeine arc given in half the dosage required by above rules; cathartics, in relatively larger doses. 2. Disease may cause larger or smaller doses to be given than the average; i.e., large doses of morphine are required for excessive pain. 3. Personal peculiarities and habits of life may so modify the action of drugs as to require larger or smaller doses. 4. The method of administering modifies the dose mark- edly. Taking the dose as given by the mouth as normal, we may safely say that the hypodermatic or intravenous method requires less and the rectal method twice as much as the dosage by mouth. THE PREPARATION OF FRACTIONAL DOSES FROM TABLETS AND SOLUTIONS Potent drugs are frequently found to be dispensed in stock solutions. For instance, the official solutions of arsenic contain 1 per cent, arsenic. This means 1/100 of a grain in every minim. In 1 per cent, solutions in water the minim is approximately one drop. Potent drugs in tablet form are frequently used, especially in hypodermic medication. FRACTIONAL DOSES IN SOLUTIONS To estimate the number of minims of a stock solution required to contain a prescribed dose: DOSAGE 15 I. Ascertain the amount of medicament in one minim of the solution. 2. Divide this fraction into the fraction or figure repre- senting the required dose. Example.-How much i per cent, solution of arsenate of soda should be given to administer 1/2Q grain ? Answer.-One per cent, solution is V100 grain in each drop or minim. The required dose 1/20 grain is equivalent to 5/100 grain; 5/100 is 5 times so 5 minims should be given. If this formula produces a fraction of a drop, dilute the solution sufficiently to secure a whole number of drops. FRACTIONAL DOSES IN TABLETS Hypodermic tablets and tablet triturates usually contain fractional doses of potent drugs. The nurse is often called upon to reduce the dose contained in one of these tablets. If the dose is to be given by the hypodermic method she must not use too much water as a solvent. The steps to follow are: 1. Reduce the required dose and the dose in the tablet to a common denominator. 2. Make a fraction of which the numerator of the re- quired dose is the numerator and that of the dose in the tablet the denominator. 3. Dissolve the tablet in a sufficient number of minims of water, not to exceed 25, choosing a number easily divisible by the numerator of the fraction, and multiply this number of minims by the fraction. The product will be the num- ber of minims containing the required dosage. Example.-Having tablets of strychnia sulphate, gr. 1/80, to give gr. 7150. 16 MATERIA MEDICA AND THERAPEUTICS Answer.-30 30 X 1 X 5 equals 150, the least common denominator. 780 equals 7160; 7160 equals 7150; 7i5o is 7s of 7iso- Dissolve the tablet gr. 7S0 m 25 minims of water. Take 7s of this, or 5 minims. GENERAL RULES OF DOSAGE FOR OFFICIAL PREPARATIONS Each mil of a fluidextract represents one gramme (1 Gm.) of the drug. Each minim represents one grain of the dry drug. Therefore they are of 100 per cent, strength. All potent or poisonous tinctures are 10 per cent, in strength or 7io the strength of the fluidextract or dry drug. Extracts (solid) are usually four times the strength of the fluidextracts. The important potent tinctures are aconite, belladonna, cannabis indica, cantharides, capsicum, digitalis, ferric chloride, gelsemium, hyoscyamus, iodine, lobelia, nux vomica, opium, squills, strophanthus, and veratrum. These are given in doses ranging from 0.5 to 1 mil (Tqviii to xv). Fluidextracts, corresponding, would be given in 710 this dose, or 0.5 to 0.1 mil (TTti to ii). Extracts (solid) of potent drugs usually have 7* this strength and a dosage of 0.015 Gm. or gr. 1/4. Most other tinctures, excepting a few seldom-used potent ones, are given in doses of 2 to 4 mils (5ss to 5i). All syrups may be given in doses of 2 to 4 mils (5ss to i) excepting the syrups of iodide of iron, ipecac, squills and squill compound, each of these being given in a dosage of 1 to 2 mils (fitxv to 5ss). All spirits have a dosage of 1 to 2 mils (iTtxv to xxx) excepting spirit of nitroglycerin, the dose of which is 0.06 mil (Uli). DOSAGE 17 All mixtures have a dose of 4 to 8 mils (5i to 3ii). All pills have a dosage of two pills, excepting pill of phosphorus and pill of opium, the dose of each of these being one pill. QUESTIONS 1. Having a tablet of gr. how would you give gr. %*? 2. How much 2 per cent, solution will contain Vm of a grain? 3. Given a solution gr.v to Si how could you give gr. 7M? 4. Name some of the conditions which modify dosage. What is Young's rule? Give an example of its application. What drugs are not subject to this rule? 5. What is the percentage strength of the fluidextracts? of the potent tinctures? of the extracts? Name the important potent tinctures. Give the general rule for the dosage of official syrups, spirits, mixtures, pills, tinctures, fluidextracts and extracts of potent drugs. CHAPTER III METHODS OF ADMINISTERING MEDICINES A medicine applied to only one certain part of the body is said to have a local action. Others have a general action. METHODS BY WHICH MEDICINES ARE MOST FREQUENTLY USED FOR LOCAL ACTION LOCAL APPLICATIONS (i) To the Skin.-Consist of lotions, baths, oint- ments, paints, plasters and collodions. (2) To the Mucous Membranes.-(a) The conjunctiva is medicated chiefly by " eye drops " used with a medi- cine dropper or irrigator. In using drops or irrigation the patient throws his head back, the nurse draws the lower eyelid down and instils a drop or two of the medicated solu- tion. In irrigating the eye a special irrigating vessel may be used, using a fine stream of fluid, poured very slowly. The fluid should be warm, should be poured without force. (b) The ■nasal membrane is medicated by instillations, sprays, or irrigation. A medicine dropper is used to instil medicines, an atomizer or nebulizer for spraying. The ordi- nary douche can or a special irrigator or a syringe may be used for irrigation. The fluid should be warm, should not be used with any force and the patient must be cautioned not to swallow or attempt to talk while the irrigation is going on. The fluid should pass in one nostril and out of the other. The mucous membrane of the nose is very sensitive. 18 METHODS OF ADMINISTERING MEDICINES 19 (c) The mouth and pharynx are medicated by means of lozenges, or troches, mouth-washes, gargles, or sprays. Medicines are sometimes painted on the pharynx with a camel's hair-brush. (J) The larynx is medicated chiefly by means of in- halations. Either inhalation of medicated air, medicated steam or atomized or nebulized fluids may be employed for local medication of the larynx. (e) The stomach and intestines. See below, " Medica- tion by Mouth." (/) The rectum. See below, " Rectal Medication." (g) The vagina is medicated by suppositories or douches. Direct applications of medicines on gauze or cotton tam- pons are also made. METHODS BY WHICH MEDICINES ARE MOST FRE- QUENTLY GIVEN FOR GENERAL ACTION i. By mouth. 2. By rectum. 3. By injection under the skin (hypodermic). 4. By inunction into the skin with a fatty base. 5. By injection into a vein (intravenous). 6. By inhalation. ADMINISTRATION BY MOUTH This is the most usual method of administering medicines. The medicinal substance, if soluble, is absorbed with the products of digestion in the stomach and intestines and passes into the blood- and lymph-streams, producing certain chemical and physical reactions with the cells of the body, either at that time or later, which result in what we term drug action. When a drug seems to have a marked action on one special group of body cells, as for example the depression 20 MATERIA MEDICA AND THERAPEUTICS of the nerve cells by narcotic drugs, we speak of the selective action of the drug. When drugs are used externally on the skin, or in the cavities of the body, or when they are given by mouth in order to act rather on the mucous membranes of the stomach and intestines than on the body cells after absorption, we speak of their use for local action. Time and Frequency of Administration by Mouth A. FOR LOCAL ACTION a. On the mouth and throat must be used frequently- every hour or so. No food immediately afterwards. b. On the Stomach.-To medicate the stomach walls give % to I hour before meals. To act on stomach contents, give during or after meals. c. On the Intestine.-Must be given two or three hours after meals. d. On the Rectum.-After the bowels have been emptied. B. FOR GENERAL ACTION To obtain a single, rapid action, give the remedy, if pos- sible, in hot concentrated solution on an empty stomach. Remedies must be given with regard to the time of their action; slow acting cathartics, as pills, at night; rapidly acting ones, as Epsom salt, in the morning. To obtain a more or less continued action, give the remedy three times a day, after meals. ADMINISTRATION BY INHALATION Inhalation of medicated vapors or of gases, in order to saturate the blood through the capillaries of the lung, is little used for general action excepting in the case of the anaes- thetics and in the use of pure oxygen. Medication locally of the upper respiratory tract by inhalation of essential oils METHODS OF ADMINISTERING MEDICINES 21 and other volatile substances has a limited application in respiratory diseases. THE HYPODERMIC METHOD In administration of medicines under the skin, every precaution should be taken to insure perfect cleanliness of the skin, the instrument, and the needle. i. Scrub the skin well, preferably the outer part of the arm, with soap and water, followed by alcohol, or at least with alcohol alone. 2. Place the needle in a teaspoon filled with water and boil it for two minutes over a flame from a stove or gas jet. 3. Draw the hot water into the barrel of the syringe and return it to the spoon several times, to clean the syringe barrel. Boil the water again for a minute, fill the syringe barrel with it, and hold the latter in one hand while the spoon is emptied of the remaining water, leaving the needle. 4. Screw the needle into the syringe barrel, being careful to hold the former by its base and not to touch the needle proper. 5. Lay the syringe down in such a manner that its point will not be soiled, place a hypodermatic tablet in the spoon, and expel the water in the syringe on the tablet and draw the solution into the syringe. 6. Hold the syringe, needle up, and push the piston until the air is expelled from the needle and a well-formed drop appears at the tip. Pinch up a portion of the cleaned skin which does not show any veins, insert the needle with a quick sure movement under the fold of skin so raised, and expel the contents slowly, gently massaging the elevation produced. 7. Withdraw the needle and rinse both it and the syringe in water, followed by alcohol. Medicines frequently given by the hypodermic method 22 MATERIA MEDICA AND THERAPEUTICS are the salts of atropine, caffeine, strychnine, sparteine, mor- phine, heroin, codeine, hyoscine, pilocarpine, physostigmine, cocaine, apomorphine, and quinine. Also adrenalin, pitui- trin, camphorated oil, extract of ergot, strophanthin, nitro- glycerin, ether, and brandy. Normal salt solution and the various vaccines and antitoxins are given in this way, but not in the ordinary small syringe. INTRAVENOUS INJECTION In giving intravenous injections unusual care should be taken to secure aseptic technic. While this opera- tion is usually performed by the physician, the nurse may be called upon in an emergency, when familiarity with its technic will be valuable. A vein on the anterior surface of the elbow is usually chosen-the median, median-basilic or median-cephalic. Having carefully prepared the skin, as for a hypodermic injection, a ligature or tourniquet is drawn snugly but not tightly over the biceps, to obstruct venous, but not arterial, flow. The veins then become en- gorged and stand out prominently. Being sure all air is expelled from the syringe, the point of the needle is inserted into the vein, taking care not to pass through it. The liga- ture is immediately released by an assistant, and slight suc- tion made in the syringe, which should be of the all-glass type. The quick appearance of blood in the syringe barrel shows that the lumen of the vein is occupied. The injection should then be made very slowly, about a minim at a time. The needle should be withdrawn rapidly and a sterile com- press placed over the puncture, followed by a bandage. INTRAMUSCULAR INJECTION The technic is the same as for hypodermic injection, excepting that the needle is plunged deeply, through the skin METHODS OF ADMINISTERING MEDICINES 23 and into the muscle. The gluteal muscles are probably most frequently injected, although the pectoral and deltoid muscles are sometimes used for this operation. INUNCTION Medicines dissolved or suspended in fatty vehicles are sometimes given by inunction, being absorbed by the intact skin. This method has the disadvantage of uncertainty of dosage, tediousness, and lack of cleanliness. Its chief advan- tage lies in the free use of medicaments which irritate the digestive tract. Mercury in the form of ointment and the oleate is the most frequently used medicament employed in this manner for general action. In administering inunctions the skin must have been washed with soap and water and the oint- ment applied with a gentle, friction for at least ten minutes. The fatty base must not be so stiff than good lubrication is not obtainable. The thin skinned portions of the body, as the axilla, groin, abdomen, etc., are preferable spots for inunction. A new spot should be chosen each day so that the same place will not receive medication twice in one week. The ointment should remain on the skin for 24 hours. MEDICATION BY BATHS, POULTICES, ETC. The use of baths, poultices, etc., belong more properly to the sphere of general nursing measures, and so will not be included here. RECTAL MEDICATION AND ENEMATA The two most used methods of medication by way of the rectum are the use of suppositories and enemata. Supposi- tories are pencil-shaped masses that melt at body tempera- ture, with a fatty or glycerinated base into which the medi- cines are incorporated. 24 MATERIA MEDICA AND THERAPEUTICS Three kinds of enemata are given; the nutritive and the medicated, to be retained and absorbed; the purgative, to stimulate the action of the bowels and cause expulsion of the intestinal contents. Rectal irrigations are in the nature of enemata, but in this treatment the fluid is allowed to run till a sufficient quantity to wash the bowel has entered, and then it is allowed to return through the same or another tube. Enemata may be either high or low. The former can be given through a long soft rubber rectal tube, which passes into the large bowel for six inches or more. The low enema may be given with an ordinary hard rubber tip just reaching into the rectum. As the lower portion of the rectum is very sensitive, low enemata are expelled more rapidly than high ones. Nutritive Enemata.-Important points in the administra- tion of nutritive enemata are: i. Let the bowel be cleansed by a purgative enema sev- eral times previously-at least once daily. 2. Let the bulk of the enema not exceed six ounces. 3. Let the consistency be less than semi-fluid. 4. Let the temperature be about ioo° F. 5. Let the enema be given through a small, soft tube, very slowly. A typical nutritive enema is the following: Beat up an egg and add it to half a pint of milk. Warm to blood-heat and add the contents of a peptonizing tube (Fairchild's). Set aside in a warm place for an hour. A tablespoonful of brandy or of sugar may be added. Half of this quantity, mixed with 2 ounces of thick gruel or flower paste, should be given by high rectal enema every three hours, having first irrigated the bowel with salt solution. Purgative Enemata.-A much used enema is the ordi- nary soapsuds (SS.) enema. It is given hot, about a quart METHODS OF ADMINISTERING MEDICINES 25 being used for an adult, and turpentine, 5i to 5iv, is often added. Glycerin is often added to water or suds as an enema. One-half an ounce of glycerin added to one or two ounces of hot water is used as a purgative enema for infants. The 1-2-3 enema, a powerful irritating compound, is often used in hospitals. It consists of Epsom salt §i, glycerin gii, water §iii,-with or without turpentine, one or two teaspoonfuls. A turpentine enema may be prepared by adding oil of tur- pentine in the proportion of % to 1 ounce to a pint of hot soap-suds, beating it up well, and administering immediately in the usual way. This should be followed by a pint of plain soap-suds enema. One pint each of molasses and milk with turpentine, a tablespoonful, is credited by some surgeons with special vir- tue in abdominal distention following operation. A cleaner preparation consists in beating up an egg, adding turpentine 1 teaspoonful, drop by drop, glycerin 3 ounces, and soapsuds to make a pint. In both of these formulas, the object is to emulsify the turpentine in order to get its full effect. Oil enemata are often used in chronic constipation. Olive or cotton seed oil, warmed, is given high in quantities of from 4 to 6 ounces in the evening, the patient remaining on his face with hips elevated for half an hour afterwards in order to retain the oil. A starch enema may be prepared by stirring a teaspoonful of starch in a little cold water until smooth, and then adding slowly 6 to 8 ounces of boiling water. Boil for one or two minutes and add hot water if needed to make the mixture of the consistency of cream. Allow enema to cool to 1020 F. before giving it. As this mixture is rather viscid it is best 26 MATERIA MEDICA AND THERAPEUTICS administered by a bulb or piston syringe attached to a rectal tube. Starch water enemata, i to 2 ounces, with opium in proper dosage, are often given to children with diarrhoea and irritable rectum. Strained gruel may be used instead of starch water with good effect A turpentine enema is given for its carminative action to relieve meteorism or intestinal distention. A starch enema is given for its emollient action in irri- table or inflamed conditions of the intestinal mucous mem- brane, or as a vehicle for the rectal administration of drugs. The Murphy drip, or proctoclysis, is the administration of warm salt solution through a permanently retained, soft rectal tube, at a very slow fixed rate of flow (30 to 60 drops a minute) for continuous periods varying in duration from several hours to a day, or longer. In proctoclysis with an ordinary can the flow may be ascertained by watching the level of the liquid in the can, which should be only slightly raised above the patient's pelvis. An ordinary artery forceps clamped about the outflow tube will stop the flow, while raising or lowering of the can will control the rate of flow. The liquid may be kept warm by tying a couple of hot water bags about the can, and covering it with a small blanket. CHAPTER IV THE PREPARATION OF ANTISEPTIC AND OTHER SOLUTIONS The nurse is very often called upon to prepare solutions of various chemicals in water for use in medicine and sur- gery. She may be told: (i) to make a solution of a certain percentage strength; (2) to make a solution of a certain number of parts to 1000 parts, or (3) to make a saturated solution. SOLUBILITY Various salts have various rates of solubility in water- thus iodide of potassium will dissolve in less than its own weight of water, while boric acid requires about eighteen times its own weight to make a solution. Heat will make a sparingly soluble salt more soluble, but the excess over the normal amount will fall as a sediment when the solution cools. The addition of more soluble salts to the less soluble will make the latter dissolve more readily,-for instance, mercury, bichloride, soluble one part in fifteen of water, will, on the addition of ammonium chloride, become soluble in proportion of two parts to fifteen of water. Definitions and Rules A solution is a clear, homogeneous liquid, having mole- cules of a solid, another liquid, or a gas, uniformly diffused through it, so that they are invisible and do not separate on standing. The liquid which holds the dissolved substance in solution is called the solvent. 27 28 MATERIA MEDICA AND THERAPEUTICS TABLE OF SOLUBILITY N ame of Chemical Water 2S°C. (77° F.) Boiling Water Alcohol 94 9 per cent. 2S°C. (77°F.) (One part is soluble in) Acidum Benzoicum 281 15 1.8 " Boricum 18 3 15-3 " Citricum 0-54 0.4 1.55 " Gallicum 83-86 3 4.14 " Salicylicum 308 14 2 " Tannicum 0-34 v.s. 0.23 " Tartaricum 0.71 0-5 1.67 Alumen 9 0-3 INS. Ammonii Benzoas 10.5 1.2 25 " Bromidum 1.2 0.7 12.5 " Carbonas 4 DEC. DEC. " Chloridum 2 I 50 " lodidum 0.6 0-43 9 " Phosphas 4 - INS. Antimonii et Potassii Tartras 15-5 3 INS. Antipyrinae I - I Apomorphinas Hydrochloridum 39-5 DEC. 38.2 Argenti Nitras 0-54 O.I 24 Arseni Trioxidum 100 15 SP. Atropinae Sulphas 0.38 V.S. 3-7 Caffeina Citrata 32 - 22 Calcii Chloridum i-3 v.s. 8 " Hypophosphis 6-5 6 INS. Calx 760 1600 INS. Chloralfor mamidum 18.7 DEC. 1.3 Chloralum Hydratum v.s. V.S. V.S. Cinchonidinse Sulphas 63 - 72 Cinchoninae Sulphas 58 - 10 Cocainas Hydrochloridum 0.4 - 2.6 Codeina 88 - 1.6 Codeinae Phosphas 2.25 - 261 Cupri Sulphas Eucainae Hydrochloridum 2.2 22 0.5 12.5 400 14 " Lactas 4 - 8 Ferri Sulphas Heroin Hydrochloridum 0-9 2 o-3 INS. II Abbreviations: abt. about; alm. almost; dec. decomposed; ins. insoluble; s. soluble; SP. sparingly; v. very Glycerin dissolves Boric Acid, i in 4.6: Phenol, 3.3 in 1; Iodine, 1 in 65 Morphine Acetate, 1 in 5.2; Potassium Iodide, 1 in 2.5. ANTISEPTIC AND OTHER SOLUTIONS 29 TABLE OF SOLUBILITY- Continued. Name of Chemical Water 25°C. (77° F.) Boiling Water Alcohol 94 9 per cent. 25°C. (77° F.) Hydrargyri Chloridum Corrosivum.... (One J 13 jart is solu 2 ble in) 3 lodoformum 939i - 46.7 lodum 5000 -- 10 Lithii Benzoas 3 2.5 13 *' Carbonas 75 140 INS. " Citras 2 1.5 ALM. INS " Salicylas v.s. v.s. V.S. Magnesii Sulphas 0.85 0.13 INS. Morphinae Acetas 2.25 - 21.6 Morphinae Hydrochloridum 17.2 I 42 Phosphas 6.75 0.5 700 Sulphas 15.3 0.75 465 Tartras II -- ALM. INS. Phenol 19.6 V.S. Plumbi Acetas 2 0.5 30 Potassii Acetas O.4 v.s. 2 " Bicarbonas 3 DEC. ALM. INS. " Bitartras 200 16.7 V.SP. " Bromidum 1-5 I l80 " Chloras 16 1.7 ALM. INS. " lodidum 0.7 0.5 12 " Nitras 3-6 0.4 V.SP. " Permanganas 15 3 Dec. Quininae Bihydrochloridum " Bisulphas 0-75 5 8-5 - 18 " Hydrobromidum 40 - 0.67 " Hydrochloridum 18 v.s. 0.6 " Sulphas 720 30 86 Saccharin 400 24 25 Saccharum 0.46 0.2 137-2 Lactis 4-79 I INS. Salicinum 21 - 71 Sodii Acetas 1 v.s. 23 " Benzoas 1.6 i-3 43 " Bicarbonas 12 DEC. INS. " Boras 20.4 0-5 INS. " Bromidum 1-7 0.8 12.5 " Chloridum 2.8 2-5 ALM. INS. " Citras 1.1 O.4 SP. " Hypophosphis 1 0.12 25 30 MATERIA MEDICA AND THERAPEUTICS TABLE OF SOLUBILITY- Continued. Name of Chemical Water 2S°C. (77° F.) Boiling Water Alcohol 94 9 per cent. 35*C. (77° F.) (One part is soluble in) Sodii lodidum 0-5 0-33 3 " Phosphas 5-5 INS. " Sahcylas 0.8 v.s. 5-5 " Sulphas Strontii Bromidum 2.8 1 0.47 0.4 INS. V.S. Strychnina 6400 2500 IIO Strychninae Hydrochloridum 35 - 60 Nitras 42 - 120 Sulphas 3i - 65 Sulphonal (Sulphonmethanum) 360 15 47 Thymol 1100 - v.s. Veronal 160 - 8.5 Zinci Acetas 2-5 1.5 36 " Sulphas 0-53 0.2 INS. The solutions most commonly employed in nursing meas- ures are solutions of antiseptic chemicals, liquids or solids. Solutions are made by: (a) dissolving the substance in the required amount of solvent, or (&) diluting a stock solu- tion of the substance with the required amount of solvent. A saturated solution is a solution in which the solvent has taken up all of the dissolved matter that it can hold. Heat increases the saturation capacity of the solvent; cold dimin- ishes it When it is said that a substance is soluble in a definite number of parts of a solvent, it means that this ratio prevails at a definite temperature, usually about 6o° F. When a solvent is heated and an amount of the substance is dissolved in excess of that required to make a saturated solution, the result is a supersaturated solution. The excess of dissolved substance is precipitated as soon as the solution cools. ANTISEPTIC AND OTHER SOLUTIONS 31 The strength of solutions is usually expressed in a ratio, as i to 1000, i to 5000, etc. Percentage solutions are solutions in which the ratio is always a certain number of parts in 100-I, 3, or 5 per cent., are 1, 3, or 5 parts in a hundred. Excepting where this ratio of a certain number of parts to 100 (the percentage method) is employed, the usual ratio is 1 to a definite number of parts of the solvent, as 1 to 1000, 1 to 6000, 1 to 250, etc.-the amount of substance to be dis- solved always remaining at 1-and the amount of solvent varying with the required dilution. The metric system of weights and measures is almost in- variably employed in the preparation of solutions, because of its decimal arrangement and greater simplicity. But occa- sionally the apothecaries' system is designated. Whichever system is employed, it is important to remember that the term ratio means that a given weight or a given measure of a substance is to be dissolved in 100, 1000, 5000-or whatever the Ratio may be-times that weight or measure. You cannot make a 1 to 1000 solution of salt by dissolving an apothecaries' drachm in a metric litre, for a litre is 1000 times a gramme, or millilitre of water-you would instead of a gramme have to multiply a drachm 1000 times to arrive at a proper result. The first and last terms of the ratio must be the same kind of a unit of weight or measure. A grain to an ounce is not a mathematical ratio at all for the first and last terms are unlike; but a grain to 500 grains, or minims of water, would be a 1 to 500 solution. PROBLEMS IN THE PREPARATION OF SOLUTIONS The most usual problems in the preparation of solutions are: 32 MATERIA MEDICA AND THERAPEUTICS I. To make solutions of a definite ratio from the original substance in powder, solution or tablet. 2. To make solutions from concentrated solutions of the original substance. 3. To determine the ratio of solutions, knowing the quantities of the ingredients to be used. SOLUTIONS FROM THE ORIGINAL SUBSTANCE A simple and rational method to employ in the prepara- tion of solutions is to begin all problems with an estimation of a 1 to 1000 solution. One gramme or mil of the substance in 1000 mils always makes a 1 to 1000 solution. To Make Solutions of a Ratio Greater or Less Than 1 to 1000 The amount of substance required to make 1000 mils, or 1 L. of a higher or lower dilution will be represented by a fraction of which 1000 is the numerator and the required dilution the denominator. For instance, if a litre of 1 to 5000 solution is desired it will take or V5 of 1.0 Gm. 5000 or 0.20 Gm. If a solution of 1 to 250 is desired, it will require i®00 or 4 times the amount required for a 1 to 1000 solution, or 4 Gm. or mils. Multiply or divide this result proportionally to obtain the amount of substance required to make more or less than one litre of solution. Example.-How much carbolic acid is used to make 3 litres of a 1 per cent, solution? Answer.-One per cent, is 1 part to 100, or 10 parts to 1000. To make a litre, or 1000 mils, or 10 times 100 mils, ANTISEPTIC AND OTHER SOLUTIONS 33 we must take io X I, or io mils, of carbolic acid. To make 3 litres, which is 3 times 1 litre, we must take 3 times 10 mils, or 30 mils of carbolic acid. SOLUTIONS BY DILUTION To estimate the amount of a concentrated solution needed to make a solution of less concentration: In doing this use the method just outlined in which the quantity of the substance required to make a given amount of solution of a given strength is estimated. Then multiply this result by the last figure of the ratio of the concentrated solution which you wish to use. Example.-How would you make 2 litres of 1 to 2000 solution of bichloride of mercury from a 1 to 10 solution? One Gm. in 1000 mils makes a 1 to 1000 solution. 2222, 2000 or y2y or 0.5 Gm., will be required for 1000 mils of a 1 to 2000 solution. Two times 0.5 Gm., or 1 Gm., will be required to make 2000 mils, or 2 litres of a 1 to 2000 solution. Since a 1 to 10 solution contains 1 Gm. in 10 mils, then 10 times 1, or 10 mils, will be required. Example in the Apothecaries' system: How would you make a pint of 0.1 per cent, solution of carbolic acid from a 5 per cent, solution? First reduce a pint to its lowest terms-i.e., minims. One pint has 16 times 480, or 7680 minims ;.i per cent., or 1/10 to TOO = I tO IOOO. The amount of carbolic acid necessary to make 1/iooo of 7680 is represented by 788o/iOoo, or 7-68 minims of acid. Since the solution to be used is 5 per cent, strength, or 5 parts to 100, or 1 part to 20, then the amount of solution required will be 20 times 7.68 minims, or 153.6 minims, or 5ii n- 33+- 34 MATERIA MEDICA AND THERAPEUTICS SOLUTIONS IN PERCENTAGE RATIOS Rule.-To find the amount of substance necessary to make a litre of any percentage, or I to 100 solution, multiply the per cent, given by io, simply inserting a cipher, and the result will be the required number of grammes or mils per litre. Example.-How much boric acid will be required to make a litre of 2 per cent, solution? Answer.-The percentage required is 2. Aplying the rule, we add a cipher, making 20 (10 X 2). This is the num- ber of Gm. required. 20 to 1000 is 2 to 100, or 2 per cent. ESTIMATING SOLUTIONS BY MATHEMATICAL PROPORTION The proportion method furnishes an easy and rapid way to compute quantities required in solution. In stating the proportion be sure your statement is correct. Example.-To make 2000 mils of a solution 1 to 1000 what quantity of 1 to 20 solution must be used? We have the proportion: One to 20 is to 1 to 1000 as the unknown quantity of the 1 to 20 solution is to 1 to 2000. Let x equal this unknown quantity. Then, 20: 1000:: x: 2000. Multiplying the extremes and dividing by the means 20X2000 1000 x equals 40,000. we have. IOOO x or x equals 40 mils. When the quantity of drug is given, to make a solution of a given ratio. Here the quantity of solvent to be added is the unknown quantity. For instance, take the problem: How much water will be required to make a 1 to 2000 solution from 0.6 Gm. of drug? ANTISEPTIC AND OTHER SOLUTIONS 35 It will require i Gm. of drug to i L., or 1000 mils, to make a i to 1000 solution, hence 0.5 Gm. to 1000 mils to make a 1 to 2000 solution. If 0.5 Gm. makes 1000 mils of this strength, 0.1 Gm. will make 1/5 of 1000 mils, or 200 mils, and 0.6 Gm. will make 6 times 200, or 1200 mils, or 1 L. 200 mils. Or by proportion: The quantity of water is to 0.6 as 2000 is to 1. x: 0.6:: 2000: 1. x equals 0.6 X 2000, or 1200 mils. To convert percentage to its lowest terms of ratio, divide 100 by the percentage. Example.-One per cent, is 1 to 100, but 5 per cent, is 5 parts to 100, or 100/6 1 part to 20. To estimate the percentage which is equivalent to a given ratio, multiply the first term by 100 and divide by the second term. Example.-One to 500 is 0.2 per cent. One X 100 equals 100. equals or 2/10, or 0.2 per cent. RECAPITULATION 1. To make solutions from the original substance in powder, tablet or solution, it is well to use the Metric system and use as a starting point the 1 to 1000 ratio, or 1 gramme or mil to the litre, or 1000 mils. Then make a frac- tion of which the numerator is 1000 and the denominator the second term of the ratio. This will represent the fraction of a gramme or mil required to make 1000 mils. Increase or decrease this quantity proportionately to the amount, greater or lesser, than 1000 mils required. 2. When concentrated solutions are used instead of orig- 36 MATERIA MEDICA AND THERAPEUTICS inal substances, multiply the net result obtained above by the last term of the ratio of the concentrated solution. 3. To estimate the number of grammes or mils of the original substance to be used in making a litre of any given percentage strength, simply add a cipher to the figure indicat- ing the required percentage. 4. To estimate the amount of solvent to be added to a given amount of original substance to make a ratio of a certain strength, multiply the given amount of original sub- stance by the last term of the desired ratio. 5. Any of the foregoing problems may be solved also by the method of mathematical proportion, letting x repre- sent the unknown quantity. EXAMPLES IN PROPORTION (1) How much borax will be required to make a litre of a 1 to 5000 solution ? The amount required is to the desired amount of solution as 1 is to the last term of the desired ratio. A': 1000:: 1: 5000. 5000 x equals 1000. x equals 0.2 Gm. (2) How much borax solution 1 to 20 would be required in the foregoing formula ? The ratio of the stock solution is to the desired ratio as the unknown quantity is to the required total. 20: 5000:: x\ 1000. 5000 x equals 20,000, x equals or 4 mils. (3) How much water must be added to 5 Gm. of sodium chloride to make a 1 to 1000 solution? The amount of original substance is to the unknown amount of solvent as the first term of the desired ratio is to the last term. 5: x:: 1: 1000. x equals 5000 mils. ANTISEPTIC AND OTHER SOLUTIONS 37 (4) What strength solution would 7.3 gr. bichloride of mercury tablets make in 4 quarts of water? One tablet of 7.3 gr. dissolved in a pint of water, which contains something less than 8000 grains (the weight of a given volume being dependent on the temperature of the water), would give a solution of about 1 to 1000; dissolved in 4 quarts, or 8 pints of water, the dilution would be about 8 X 1000 or 8000. (5) How many grains of salt will be required to make one quart of normal salt solution? Normal, or physiological, salt solution contains from 0.6 to 0.9 per cent, sodium chloride. As a pint may be con- veniently supposed to contain 8000 minims or grains, and as 0.8 per cent, means 8 grains in 1000 minims, we will have the ratio 8: 1000:: x: 8000. 1000 x = 64,000. x = 64 grains to a pint. 2 X 64 or 128 grains to a quart. (6) 1 in 20 - ? per cent. ? As per cent, means " in 100," 1 is to 20 as the unknown percentage is to 100. 1:20::^: 100. 20 x = IOO. x - 5 per cent. (7) 1 in 1 = ? per cent.? 1:1:: x:ioo. 1 x = 100. x - 100 per cent. (8) 1 in 100 = ? per cent. ? 1: 100:: x: 100. 100 x = 100. x = 1 per cent. (9) 1 in 8000 - ? per cent. ? 1: 8000::^: IOO. 8000 x = 100. x = or 1/80 per OOOO * x cent. (10) 1 in 10,000 = ? per cent. ? 1:10,000:: x: 100. 10,000 x = x - per cent. (11) The pure drug in bulk is what per cent. ? The undissolved drug is 100 per cent, strength. 38 MATERIA MEDICA AND THERAPEUTICS APPROXIMATIONS IN THE APOTHECARIES' SYSTEM In the Apothecaries' system, i teaspoonful to a quart makes about I to 250; to 2 quarts, 1 to 500. One grain to the ounce makes a solution of 1 to 480, roughly 1 to 500. Five grains to the ounce may be considered approximately a 1 per cent, solution. Remedies frequently employed in solution strengths of 1 to 1000 and over are: Bichloride of mercury, permanganate of potash, argyrol, nitrate of silver, iodine, and formaldehyde. The drugs usually employed in percentage strengths are carbolic acid, lysol, formaldehyde, argyrol, nitrate of silver, cocaine hydrochloride, sodium chloride (salt), and boric acid. TABLE OF PERCENTAGE SOLUTIONS Quantity of Medicament Required for Making- Percentage i fluidrachm 1 fluidounce I pint U.S.A. Parta I gr. 0.571 gr. 4-564 gr. 73-02 I in 100 2 gr. 1.141 gr. 9.128 gr. 146.05 i in 50 3 gr. 1.712 gr. 13.692 gr. 219.07 1 m 33.33 4 gr. 2.282 gr. 18.256 gr. 292.10 I m 25 5 gr- 2.853 gr. 22.820 gr. 365.12 1 in 20 6 gr. 3-423 gr. 27.384 gr. 438.14 1 in 16.66 7 gr- 3-994 gr. 3I-948 gr. 5II-I7 1 in 14.28 8 gr. 4-564 gr. 36.512 gr. 584-19 1 in 12.5 9 gr. 5-135 gr. 41.076 gr. 657.22 1 in 11.11 IO gr- 5-705 gr. 45.640 gr. 730.24 1 in 10 The table is arranged on the basis of 73.02 grains of solid in one pint (approx, one grain in 105 minims) of solvent to form a 1 per cent, solution. Dissolve the substance in three-quarters of the total quantity of solvent. Adjust volume to pre- scribed amount. CHAPTER V HOW MEDICINES ACT In order to understand the action of drugs, it is needful to remember much of the physiology of the body and of its organs. Disease is a departure from the normal, and the aim of the physician in giving a medicine is to change an abnormal function into a normal one. So we must under- stand the normal action of our organs and tissues in order to appreciate the effect of medicines in disease. Why do our hearts beat, our arteries throb, our nerves carry sensa- tion, our kidneys secrete urine ? One must know the why and wherefore of these functions in order to understand the manner in which drugs alter them. A symptom is an abnormal manifestation of some func- tion or other. Symptomatic treatment is the giving of a drug which will produce an effect just opposite to the effect produced by the disease. THE NERVOUS SYSTEM Many drugs act on the nervous system, and modify func- tion through this action. It will be remembered that the central nervous system consists of the brain and spinal cord, with the cranial and spinal nerves. The sympathetic ner- vous system consists of a number of ganglia. All through the nervous system we find nerve-cells, little cells which originate nerve impulses. Attached to these cells are little fibres which conduct these impulses always away from the cell. Cells which impulse away from the brain and cord are largely motor nerves governing motion; cells which 39 40 MATERIA MEDICA AND THERAPEUTICS carry sensation to the brain and cord are largely sensory nerves carrying sensation. A nerve-cell with its fibres is called a neuron. There are some cells in the brain called psychic cells, which seem to have something to do with mental activity. All nerve-cells may have their functions increased or diminished by the action of drugs. The drugs may act on the cells themselves, or on the nerve-fibres, or on the ter- minations of the nerve-fibres. A drug stimulating or de- pressing any one of these parts of a neuron would have a corresponding action on the function of the nerve. In the central nervous system, and especially in that lower part of the brain called the medulla, are several collections of nerve-cells which are the starting point of some nerves with very important functions. Here we find the " centres " for the pneumogastric nerve, the vasomotor centre, which regulates the calibre of arteries, the centre for respiration, and the centre for vomiting, and other important centres, especially those of the special senses. The pneumogastric nerve sends fibres to the larynx, lungs, heart, stomach, and intestine. The vasomotor centre sends out vasoconstrictor and vasodilator fibres, the former when stimulated tightening, the latter relaxing, the arterial calibre. The constrictor fibres predominate, and their stimulation causes a rise of blood-pressure. THE SPINAL CORD The cord is able to perform many automatic functions of the body without the intervention of the thinking brain. These acts are termed reflex. A reflex, therefore, is an in- voluntary action excited by a stimulus conveyed by an affer- ent nerve to a nerve-centre and transmitted to the periphery by an efferent nerve. When drugs stimulate the cells of the HOW MEDICINES ACT 41 spinal cord, these reflexes are increased. A very great increase of these reflexes causes convulsions. THE HEART AND CIRCULATION THE HEART The regular beat of the heart is dependent upon at least three factors; first, the ability of heart muscle to contract when stimulated; second, the influence of the pneumogastric nerve in slowing this beat; third, the probable influence of the sympathetic nerve in quickening this beat. A drug would slow the heart by, (i) depressing either the heart muscle-impairing its irritability or conductivity- or by depressing the sympathetic nerves, (2) by stimulating the pneumogastric centre, or (3) by increasing the resist- ance in the arteries. A drug would quicken the heart by (1) stimulating the heart muscle or sympathetic, (2) para- lyzing the pneumogastric, especially its terminations, or (3) decreasing the resistance in the arteries. THE PULSE AND ARTERIES All the arteries and veins contain muscle which is sup- plied with vasomotor nerves. These nerves originate in the vasomotor centre. The calibre of the arteries may be les- sened or increased by the action of a drug on this centre. Stimulation of the vasoconstrictor centre will decrease the calibre of the vessels, and depression will increase it. The drug may also act directly on the muscle of the vessel and produce the same effect. A pulse of high tension is usually slow in rate; a pulse of low tension is usually fast in rate. THE BLOOD The blood is composed of formed and liquid elements which may be altered by disease. The formed elements are the red and white blood-cells. The liquid element is the 42 MATERIA MEDICA AND THERAPEUTICS plasma. The red cells contain a substance called haemo- globin which carries oxygen to the tissues of the body constituting our " internal respiration." Alterations in the number of these cells, or in the quantity of haemoglobin in each one, or chemical substances changing the haemo- globin, cause disease. Certain drugs are used to stimulate the formation of, and the haemoglobin content of, these red cells. The white cells may also be increased or diminished in number and activity by the administration of drugs. An increase over the normal of these white cells is called a leucocytosis; a decrease is termed a leucopenia. The plasma may vary in its chemical reaction, due to changes in the amounts of carbonates and bicarbonates and carbon dioxide in solution-even up to the point of causing an absolute or relative acidosis. RESPIRATION Respiration is an automatic process only partly under the control of the will. In the medulla is the respiratory centre which is very sensitive to various stimuli, nearly all of the sensory nerves being able to influence it. A proper amount of carbon-dioxide gas in the blood has probably the greatest influence in keeping this centre active. Certain drugs stimulating this group of nerve-cells make the respirations deeper, more rapid, and more effective; other drugs depressing it render respiration shallow and slow. Coughing, sneezing, etc., are all reflex acts originating in this centre, and depending on irritability of the centre. DIGESTION AND ABSORPTION The hydrochloric acid and pepsin in the stomach, the bile and pancreatic juice in the small intestine are necessary HOW MEDICINES ACT 43 for digestion. Deficiency of any of these elements may be remedied by proper drugs. The absorption of water in the alimentary tract takes place largely in the last third of the large intestine. Medicinal substances are absorbed in the stomach and intestines, passing by diffusion, osmosis, and selective cell action, into the lymph- and blood-vessels, there affecting the body cells through their individual chemical and physical properties. PERISTALSIS Peristalsis is the worm-like movement of the digestive tube by which the liquid food is slowly pushed along and churned until it reaches the last part of the large intestine. Here it becomes more or less solid because of the absorption of its water. This peristalsis is due to the action of muscle in the walls of the alimentary tract, and this muscle is sup- plied with sympathetic nerves. Certain drugs may stimulate or diminish peristalsis by their corresponding action on these "plexuses" of nerves. Thus most irritant cathartics act partly through stimulation of these nerve plexuses. HEAT The heat of the body is produced through the activity of its organs and tissues, especially the muscles. The dis- tribution and regulation of this heat is controlled by the blood-vessels and the sweat-glands. It is believed that at the base of the brain is a so-called "heat centre" which automatically regulates the production and distribution of heat, so that the body remains at a constant temperature. Drugs increasing perspiration or acting on this centre may influence the body temperature. 44 MATERIA MEDICA AND THERAPEUTICS GLANDS The activity of the glands is dependent upon their blood supply, and also upon the action of certain secretory nerves which seem to stimulate the little gland cells to action. Drugs acting on these nerves, especially their terminations, may increase or decrease the function of the glands, according as they stimulate or depress these nerves. PAIN Pain is due to an irritation of the end of a sensory nerve. Pain impulses are conveyed through the gray matter of the spinal cord. So drugs may cause cessation of pain by depressing the ends of the nerves, by depressing the cells in the gray matter of the spinal cord, or by depressing the termination of the cells in the brain. Sleep is induced by using drugs which diminish or abolish the activity of sensory nerve-cells in the brain. The sense centres are rendered less irritable, and sleep follows. QUESTIONS I. What is the central nervous system? the sympathetic nervous system? What is a neuron? How may drugs act on the neurons? 2. What are the important nerve-centres in the medulla? De- scribe their function. 3. What is the vasomotor centre and how does it act? What is a reflex? 4. In what different ways could a drug slow the heart or quicken the heart? How may drugs affect the pulse? 5. In what way may drugs act on the blood ? How may respira- tion be affected by drugs ? Describe how these drugs may act. 6. What is peristalsis and how may drugs affect it? pt How may drugs affect the body heat ? Describe the process in detail. 8. How may pain be abolished by drugs ? Describe the mode of action of these drugs. PART II DRUGS AND MEDICINES-CONSIDERED UNDER THERAPEUTIC GROUPINGS- READY REFERENCE TABLES OF INFOR- MATION CONCERNING SPECIAL DIS- INFECTION. CHAPTER VI DRUGS AND MEDICINES CLASSIFICATION Drugs and medicines may be classified either according to their origin and chemical or physical properties, or accord- ing to their action in disease. For the sake of clearness and brevity, and to facilitate condensation and memorization, the latter method will be followed in the pages following. CHIEF USES OF DRUGS AND MEDICINES The three most important purposes for which drugs and medicines are given in disease are: (I) to avert collapse or death; (2) to eradicate, if possible, the cause of the disease; (3) to relieve pain or other symptoms of disease. Most drugs and remedies belong to the first and third classes. Very few drugs, of themselves, can eradicate the cause of a disease. Remedies that act as curative agents on the cause of the disease are said to be specific remedies. Example, quinine cures malaria by killing the malaria para- site in the blood. Remedies that simply modify symptoms, and most drugs are of this class, are called symptomatic remedies. Example, morphia causes insensibility to pain, but does not cure the cause of the pain. The physiological action of a remedy is the condition its administration in non-poisonous doses will bring about in a normal organism. The therapeutic action of a remedy is its action in an- tagonizing the symptoms of disease. 47 48 MATERIA MEDICA AND THERAPEUTICS When two remedies produce opposite physiological effects they are said to have an antagonistic action; when they have the same action they are said to be synergistic. Toxic action is the action of a drug in such dosage that symptoms of poisoning are produced. Cumulative action is the toxic action produced by too rapid absorption or too slow excretion of a remedy after it has been given for some time. Idiosyncrasy is an unusual or exaggerated effect from a drug not produced by the same dose of the drug in the average individual, the term being used to indicate the susceptibility of the individual to this reaction and not the reaction itself. The therapeutic limit is the borderland in dosage and medication between toxic and therapeutic effects of a remedy. It is usually indicated by mild toxic symptoms. Untoward effect is a term used to describe any unfavor- able action of a drug produced by idiosyncrasy, cumulative action, arrival at the therapeutic limit, or any other cause. THE SOURCES OF MEDICINES Any substance not of animal or vegetable origin is said to be inorganic. In medicine, many inorganic substances are used, and among them we frequently hear of acids, bases, salts, and metals. We must remember that salts are formed by the union of metals, or compounds of metals called bases, with either acids or certain elemental substances, such as iodine, bromine, etc. When an acid forms a salt the name of that salt ends in ate or ite, as when sulphuric acid unites with iron, it makes iron sulphate, or sulphite, as the case may be. But when an elemental substance, not an acid, unites with a metal to form a salt, the name of the salt ends in DRUGS AND MEDICINES 49 ide, as when the metal potassium unites with iodine to form potassium iodide. Ide then means " nothing else "-potas- sium, and nothing else. For example, certain metallic elements known as sodium, potassium, lithium, and strontium, and a base known as ammonium, form compounds with iodine and bromine which are called iodides and bromides. The iodine and bromine are the predominating elements, from a therapeutic stand- point, in all of these salts. But in other compounds of these alkali metals, such as the hydroxide, the base is so alkaline as to be the predominating element. Besides substances from the mineral kingdom, medicine draws supplies from both the animal and vegetable kingdoms. Vegetable drugs have been used from earliest times, but modern pharmacy has enabled us to extract and isolate from these organic materials the principles which are active in a medicinal way. ACTIVE PRINCIPLES The active principles of most medicinal plants are either alkaloids, glucosides, fixed oils, volatile oils, acids or resinous or balsamic substances. Very many plants contain in addi- tion tannin compounds. Alkaloids are organic substances containing nitrogen which have alkaline properties, and unite, like ammonia, with acids to form salts. While alkaloids are not usually soluble in water, their salts are. Familiar examples of alka- loids are morphine, obtained from opium, and strychnine, from nux vomica. Glucosides are neutral organic substances, which when boiled with a mineral acid form grape-sugar (glucose) and water instead of salts. Aloin, from aloes, and digitalin, from digitalis, are glucosides. 50 MATERIA MEDICA AND THERAPEUTICS Fixed oils are heavy oils which do not evaporate and which saponify readily forming fat soaps and glycerine. Castor oil and olive oil are examples. Volatile oils are light-bodied oils which do not saponify, but evaporate readily, and have a marked odor. Oil of peppermint and oil of turpentine are examples. Acids, such as citric, tartaric, malic and oxalic, are found in many plants and fruits. Resins are alcohol-soluble exudations of trees and plants, solid in consistency. Mixtures of oils with resins are called oleoresins; when certain odorous principles and cinnamic and benzoic acid are also present the product is called a balsam. Animal products used in medicine include the dried glands, or their extracted active principles, obtained from certain domestic animals. Examples are dried thyroid, epi- nephrin, pepsin, pancreatin, etc. So-called biological products, the result of interaction of animal hosts and bacterial toxins, are seen in the curative sera and antitoxins obtained from the blood of immunized animals. And in the borderland between the animal and plant kingdoms are the vaccine and rabies virus as well as the bacterial vaccines-suspensions of killed bacteria. THERAPEUTIC GROUPINGS When it was believed that remedies could be found to act specifically on any disease and on any set of symptoms, a great many terms grew up in medical lore to describe these effects. While many of our ideas have changed, most of these terms still remain, though their appropriateness has suffered with our increased knowledge of drug actions. Very few drugs have only one action-most drugs act differently under various conditions, especially as regards dosage. Tn DRUGS AND MEDICINES 51 the classification of drugs it is necessary to include the same drug under more than one therapeutic heading. But before doing that it will be necessary to consider a number of therapeutic definitions. THERAPEUTIC DEFINITIONS Alteratives: Drugs which, when taken internally, produce a healthy reaction in abnormal tissues. Analgesics: Drugs which diminish pain. Anaphrodisiacs: Drugs depressing the sexual centres. Anaesthetics: Drugs abolishing sensation. Anodynes: See Analgesics. Antacids: Drugs diminishing acidity of stomach contents. Anthelmintics: Drugs which kill intestinal worms. Anti-emetics: Drugs preventing vomiting. Antigalactogogues: Drugs decreasing milk secretion. Antihydrotics: Drugs diminishing the excretion of sweat. Antiperiodics: Drugs used in malaria. Antiphlogistics: Applications which reduce inflammation. Antipyretics: Remedies that reduce fever. Antirheumatics: Remedies to combat rheumatism. Antisialagogues: Drugs decreasing salivary secretion. Antispasmodics: Drugs depressing the spinal cord. Antiseptics: Drugs which prevent contagion or sepsis. Astringents: Drugs which cause tissues to contract. Cardiac Sedatives: Drugs which diminish the work done by the heart. Carminatives: Drugs causing a feeling of warmth in the stomach and causing flatus to be expelled. Cathartics: Drugs which cause a vigorous and copious bowel evacuation. Caustics: See Escharotics. Cerebral Stimulants: Drugs which stimulate the higher brain centres. Counterirritants: Drugs which redden or blister the skin when applied locally. 52 MATERIA MEDICA AND THERAPEUTICS Demulcents: Drugs which have a sedative action on the mucous membrane of the alimentary tract. Deodorants: Drugs which remove or obscure offensive odors. Depilatories: Drugs which remove hair. Diaphoretics: See Sudorifics. Digestives: Drugs which aid digestion. Disinfectants: Drugs which prevent infection by destroying germs. Diuretics: Drugs which increase the urinary flow. Ecbolics: See Oxytocics. Emetics: Drugs which produce vomiting. Emmenagogues: Drugs inducing or increasing menstrual flow. Escharotics: Drugs destroying tissue by local application. Caustics. Expectorants: Drugs increasing bronchial secretion. Galactogogues: Drugs increasing the secretion of milk. Germicides: See Disinfectants. Haematinics: Drugs increasing the haemoglobin of the blood. Haemostatics: Drugs controlling hemorrhage. Laxatives: Drugs producing a mild cathartic action. Mydriatics: Drugs producing dilatation of the pupil of the eye. Myotics: Drugs producing contraction of the pupil of the eye. Narcotics: Drugs causing extreme depression of the activity of the brain shown by stupor. Nervines: Drugs having a beneficial action on nerve function. Nutrients: Foods. Oxytocics: Drugs inducing uterine contractions. Parasiticides: Drugs killing animal parasites. Purgatives: See Cathartics. Refrigerants: Saline drugs usually used to combat fever. Respiratory Depressants: Drugs depressing the respiratory cen- tre in the medulla. Rubefacients: Mild counterirritants, intended to be applied with friction. DRUGS AND MEDICINES 53 Somnifacients: Drugs which produce sleep. Stomachics: Drugs intended to improve the tone of the stomach. Styptics: Drugs locally applied to control hemorrhage. Sudorifics: Drugs inducing perspiration. Taenifuges: See Anthelmintics. Tonics: Drugs increasing the functional activity of the body or any of its organs. Vascular Tonics or Sedatives: See Cardiac Sedatives. Vasoconstrictors: Drugs causing a constriction of the blood- vessels of the body. Vasodilators: Drugs causing a dilatation of the blood-vessels of the body. Vesicants: See Counterirritants. DRUGS AND MEDICINES CONSIDERED UNDER THERAPEUTIC GROUPINGS I. Drugs Which Affect Secretion. II. Drugs Acting on the Nervous System. III. Drugs Which Affect the Circulation. IV. Drugs Which Affect the Alimentary Function. V. Alteratives and Drugs Modifying Metabolism. VI. Drugs Which Destroy the Causes of Disease. I. DRUGS WHICH AFFECT SECRETION A. Drugs which increase Stimulating expectorants, secretion: Diuretics: B. Drugs which diminish Saline diuretics. secretion: Water. The Belladonna Group: Stimulating diuretics. Belladonna. Diaphoretics: Hyoscyamus. Pilocarpine. The astringents: Expectorants: Vegetable astringents. Nauseating expectorants. Mineral astringents. 54 MATERIA MEDICA AND THERAPEUTICS A. DRUGS WHICH INCREASE SECRETION Diuretics Diuretics are used: (i) to maintain the action of the kidneys, (2) to evacuate the fluid from the tissues, and (3) to eliminate poisons from the blood. The secretion of the kidney may be stimulated by drugs which (1) increase the volume of the blood, as the saline diuretics, by reason of their salt action; (2) or stimulate the secreting epithelium of the kidney as the stimulating diu- retics; (3) or increase the blood-pressure in the kidney. This last group really belongs to the cardiac and vasomotor stimulant groups. A very important diuretic which does not fit into this grouping is water. SALINE DIURETICS The following are some of the best known and most used of the saline diuretics: Potassium Acetate (Potassii Acetatis) ... .15 to 30 grains (1-2 Gm.) Potassium Bitartrate, Cream of Tartar (Potassii Bitartras), 15 to 45 grains (1-3 Gm.) Potassium Citrate (Potassii Citras) 15 to 45 grains (1-3 Gm.) WATER Water helps to eliminate waste products, and will stimu- late excretion of both perspiration and urine, but should not be used as a diuretic when the patient is dropsical. Administration.-Water may be given by mouth, by rectum, subcutaneously or intravenously. A common prac- tice is to give water as normal salt solution, intravenously, under the skin or by rectum. Proctoclysis, or the Murphy drip, has been described (page 26). A teaspoonful of salt to a pint of water approximates the strength appropriate for DRUGS AND MEDICINES 55 rectal injection. In surgical shock, hemorrhage, sepsis, in- toxications from poisons either manufactured in the body or absorbed, salt solution is indicated. It is not beneficial in primary cardiac failure or dropsy. STIMULATING DIURETICS CAFFEINE (CAFFEINA) This is a basic principle found in tea, coffee, and kola. It is sparingly soluble in water. Physiological Action.-Caffeine is a powerful drug which stimulates the functions of the brain, the heart, the lungs, and the kidneys. On the nervous system, caffeine has a remarkable action. While it stimulates the spinal cord in a manner similar to the action of strychnia, it stimulates also the brain-in short, it increases our powers of perception and helps our reception of ideas. On the medulla, it stimulates the vasomotor cen- tre, raising blood-pressure, and, like strychnia, has a tonic action on the respiratory centre. Muscles respond more quickly, contract more fully, and fatigue less easily after caffeine has been given. The heart beats more forcibly and more rapidly, for caf- feine acts on heart muscle as it does on voluntary muscle, increasing its efficiency. The pulse is increased in tension as well as in rate. The respiration is quickened, and strengthened, after caffeine. The secretion of urine is increased by a direct action of the drug on the secreting cells of the kidney, increasing the elimination of waste products. In this, caffeine differs from digitalis, which increases the amount of urine only by in- creasing the blood-pressure in the kidney. 56 MATERIA MEDICA AND THERAPEUTICS THEOBROMINE (tHEOBROMINA) This is an alkaloid obtained from the chocolate bean. Its action on the kidney and the circulation resembles that of caffeine, but it does not affect so markedly the brain or the blood-pressure. It is also more irritating to the stomach. A mixture of theobromine with salicylate of soda, known as diuretin, has a wide use. Therapeutic Uses and Administration.-Caffeine is a useful drug in poisoning from narcotics-opium, carbolic acid, and alcohol-on account of its action on the heart and respiration. In dropsy and oedema, whether from disease of the heart or kidneys, caffeine and theobromine are use- ful as stimulants to the circulation. In kidney diseases, the diuretic action of theobromine and diuretin is superior to that of caffeine. Preparations and Dosage.-Caffeine (Caffeina), the alkaloid, is not soluble. Its dose is 0.06 to 0.30 Gm. (gr. i-iv). Citrated caffeine (Caffeina Citrato) is a soluble prepara- tion of caffeine, given in a dosage of 0.12 Gm. (gr. ii). Caffeine-sodium-benzoate (Caffeina Sodii Benzoas) has a similar dose but may be given hypodermatically-a valu- able point in coma. Diuretin (Theobromines Sodii Salicylatis) is given in doses of 1 Gm. (gr. xv) well diluted with water. Coffee and Tea.-Coffee of average strength contains one to two grains of caffeine in every cupful. Tea contains, in its dry state, more caffeine than coffee, but less of the material is used to a cup. On account of the stimulating action of these beverages on the brain, heart, and spinal cord, they are harmful to nervous individuals. Cocoa and choco- late owe their stimulating properties to theobromine. Theo- DRUGS AND MEDICINES 57 retically, they are less harmful than coffee, but this advan- tage is offset by their tendency to irritate the stomach. See also Agurin, Theocin, Digitalis, Squill. Diaphoretics The glands of the skin, like the kidneys, are rendered more active by agents which increase the volume of the blood by salt action, as well as by drugs which directly stimulate these glands themselves. Thus any of the saline diuretics may also act as diaphoretics. Emetics, such as ipecac, by increasing the blood circulation in the skin in the flushing which invariably accompanies nausea, also promote diapho- resis. And in a similar way alcohol, opium, spirit of nitre, aconite and similar substances may act as diaphoretics because they, too, cause a dilatation of the vessels of the skin. PILOCARPINE Pilocarpine is an alkaloid derived from the leaflets of of the Pilocarpus jaborandi. This drug stimulates the nerves supplying many glands, notably the bronchial, salivary and sweat-glands. Profuse sweating and secretion of mucous and saliva may follow its use even in small dosage. It also contracts the pupil of the eye. It is a dangerous drug, owing to its tendency to produce cedema of the lungs. Seldom should more than % grain be given. Atropine is its physio- logical antagonist. All the emetic drugs are expectorants and diaphoretics in small doses. The opium preparations, especially the well- known Dover's powder (powder of ipecac and opium), occupy a prominent place in the list of diaphoretics. Dia- phoretics are used principally in diminished kidney secretion to promote excretion by the skin, and in the beginning of colds. Hot packs or baths promote their action. 58 MATERIA MEDICA AND THERAPEUTICS Preparations of Pilocarpine Fluidextract of pilocarpine (Fluidextractum Pilocarpi), 3ss to 3i (2-4 mils). Hydrochloride of pilocarpine (Pilocarpinae Hydrochloridum), 7m to % grain (0.005-0.015 Gm.). Nitrate of pilocarpine (Pilocarpinae Nitras), 7m to % grain (0.005-0.0015 Gm.). Expectorants Two large classes of expectorants are met with-those which relax the tone of the blood-vessels supplying the bronchi and those which stimulate the tone of these vessels. The former increasing bronchial secretion, are called seda- tive expectorants-and include all those drugs which cause mild nausea, the nauseating expectorants-while the latter group decrease secretion; the reason for their action is not so well established, though they are named stimulating expectorants. The nauseating expectorants include many drugs which will be treated under Emetics, such as ipecac, the carbonate and chloride of ammonia (discussed with am- monia), and the iodide of potash (also discussed elsewhere). The stimulating expectorants include turpentine and some of the balsams, as copaiba, some oils, as eucalyptus and creosote. Uses.-Nauseating expectorants are given in the first stage of acute bronchitis when secretion is scanty and the cough is " tight." The stimulating expectorants are useful in the latter stages of acute coughs, or in chronic bronchitis. Untoward Effects.-The production of nausea and vomiting is not unusual when the nauseating type of ex- pectorants is used. Diminished appetite is a frequent re- sult. None of these remedies should be given on an empty stomach, or before meals. DRUGS AND MEDICINES 59 NAUSEATING EXPECTORANTS See Ipecac (pagei86). Tartar Emetic (page 216). Squill (page 212). Iodide of Potash (page 202). STIMULATING EXPECTORANTS TURPENTINE Oil of turpentine (oleum terebinthinae) is distilled from the exudate obtained by wounding various species of pine and fir trees. When turpentine is treated with nitric acid colorless crystals of terpin hydrate are obtained. Rectified Oil of Turpentine (Oleum Terebinthinae Rectificatum), Dose, 5 to 15 M. (0.3-1 mil). Liniment of turpentine (Linimentum Terebinthinae) externally. Emulsion of turpentine (Emulsum Olei Terebinthinae). .5i (4 mils). Terpin hydrate (Terpini Hydras) 2 to 3 grains (0.15-0.2 Gm.). Uses.-Turpentine is used (1) as a carminative, (2) as a counterirritant, (3) as a diuretic, (4) as an expectorant. Its carminative action is used in typhoid fever, to pro- mote the expulsion of flatus. As a counterirritant it is chiefly employed as a turpentine stupe in abdominal tym- pany, pieces of flannel being wrung out in hot water, sprinkled with turpentine and applied to the abdomen. It is also added to enemata (see Enemata, p. 23). Its use as a diuretic is limited, as is also its expectorant uses. The latter purpose seems better filled by terpin hydrate. Administration.-Turpentine is best given in emulsion, after food. In large doses it irritates the kidneys and may cause blood to appear in the urine. Terpin hydrate is usually given in an alcohol-glycerin elixir. 60 MATERIA MEDICA AND THERAPEUTICS SALTS OF AMMONIUM Ammonia is a gas formed by nitrogen and hydrogen. Water forms a base with this gas, which in turn, like the metallic bases (sodium, potassium, iron, etc.), unites with acids or certain elements to form salts. In addition to the iodide and bromide of ammonium there is a chloride and a carbonate of ammonium, both of which have a wide use in medicine, as well as an official water of ammonium. CARBONATE OF AMMONIUM (AMMONII CARBONAS) This is a pearly-white substance with a strong odor of ammonia. It is commonly known as baker's ammonia or hartshorn, and is soluble in water. Physiological Action.-Carbonate of ammonium neu- tralizes acids. When inhaled, the free gas is very irritating, and through this action on the terminals of the fifth nerve in the nose, it raises blood-pressure and slows the heart, acting reflexly. When taken into the stomach in sufficient quantity, it causes some irritation of the pneumogastric nerve and so slows the heart and raises the blood-pressure in the same way. Its use by hypodermic injection is there- fore of doubtful value. It causes mild nausea also, and hence liquefies bronchial secretion. Therapeutic Uses.-In coughs, carbonate of ammonium acts as a nauseating epectorant and increases the secretion of the bronchial tubes. The aromatic spirit of ammonia is a solution of carbonate of ammonium in water of ammonia and alcohol, with certain aromatic oils added. This prepa- ration is given in conditions of the stomach where there is excessive acidity, loss of tone, and flatulence. It is also used as a reflex heart stimulant in sudden fainting spells and in certain diseases. Water of ammonia (aqua ammoniae) DRUGS AND MEDICINES 61 is used to make ammonia liniment (linimentum ammonise), or " hartshorn liniment," and is seldom given internally. Administration.-Carbonate of ammonium should be given in solution, well diluted, in a dose of 0.3 to 0.5 Gm. (gr. v to viii). The aromatic spirits of ammonia (spiritus ammoniae aromaticus) should always be given in iced or cold water, in the dose of 1 to 2 mils (ntxv to xxx). CHLORIDE OF AMMONIUM AMMONII CHLORIDUM, SAL AMMONIAC This salt occurs as an odorless, fine, or granular powder with a cold salty taste. It has few of the reflex effects of the carbonate on the heart, although large doses produce nausea. It has been credited with the property of decreas- ing bronchial secretion, and is used for that purpose in bronchitis. Some authorities hold that in small doses it increases the bronchial secretion and that in large doses it decreases it. It is used rather extensively and is fre- quently combined with the compound licorice mixture (brown mixture). The average dose is 0.5 Gm. (gr. viii). B. DRUGS WHICH DIMINISH SECRETION Two large main classes of drugs diminish secretion, one group, taken internally and acting after absorption through the nervous system, typified by atropine; the other, the astringents, being used externally and locally. The Belladonna Group BELLADONNA (DEADLY NIGHTSHADE) The leaves of the Atropa Belladonna are used internally in medicine. These contain the active principle, an alkaloid, atropine. Physiological Action.-Belladonna or atropine, in 62 MATERIA MEDICA AND THERAPEUTICS sufficient doses, causes a stimulation of the motor area of the cerebrum, resulting in a quick-moving and talking de- lirium. It has also another distinctive action on nervous tissue-it paralyzes the end-fibres of various nerves, nota- bly those governing secretion, and the pneumogastric nerve, and the third cranial, or motor nerve of the eye. As a result of the paralyzing action on the nerves in glands, salivary, mucous, sweat, and milk glands are rendered less active, the mouth and throat become dry, the skin hot. The third cranial nerve controls the tension of the muscle in the iris of the eye and the muscle which controls accommo- dation for far or distant vision, and so, after its paralysis by atropine, the pupil is dilated and accommodation is lost- we cannot see nearby objects. The pneumogastric nerve sends branches to the intestinal plexus through the splanch- nic nerve. Atropine paralyzing these endings prevents intestinal spasm or " cramps." Since this pneumogastric nerve is also the nerve which slows the heart, atropine, by paralyzing it, quickens the heart. It also acts on the vasoconstrictor centre in the medulla, raising the blood- pressure and especially constricting the large veins of the abdomen. This brings a compensatory dilatation of the ves- sels of the skin, causing the flushed face. Like strychnia, it stimulates the respiratory centre in the medulla. Therapeutic Uses.-Atropine and belladonna are used to lessen the excessive secretion of sweat in tuberculosis, and to lessen the milk secretion by a plaster (belladonna plaster) applied to the breast. When it is deemed necessary to quicken the heart and to determine whether an intermittent pulse is due to nervous influence or to disease of the heart muscle, atropine is useful. As a respiratory stimulant in opium and other narcotic poisonings, and to paralyze the accommodation and dilate DRUGS AND MEDICINES 63 the pupil in certain eye diseases, it has a frequent use. The antispasmodic effect of atropine on the intestine is taken advantage of in the well-known pill of aloin, strychnia, and belladonna. The local action of atropine or belladonna is very doubtful. Both belladonna and atropine are frequently used in irritable conditions of the bladder-cystitis, incon- tinence, etc. Preparations and Administrations.-Atropine sul- phate (atropinae sulphas), 0.0004 Gm. (gr. 1/150), is best administered by hypodermatic injection. Homatropine, sel- dom given internally, has the same dose. One per cent, solutions are used in the eye for the purposes above men- tioned. Tincture of belladonna leaves (tinctura belladonnae foliorum) 0.5 mil (nt viii). Extract of belladonna leaves (extractum belladonnae) 0.01 Gm. (gr. %). The ointment (unguentum) and plaster (emplastrum) are frequently-used external remedies. HYOSCYAMUS (HENBANE) The dried leaves of the Hyoscyamus niger. This drug and its active alkaloid, hyoscine (now called scopolamine) has the same physiological action as atropine, excepting as to its effect on the blood-pressure and on the cerebrum. Hyoscine, unlike atropine, lowers the blood-pressure, some- times alarmingly, when given in large doses. On the cere- brum, especially when combined with morphine, it has a sedative action. In the so-called " twilight-slumber " tech- nic this drug was used jvith morphine to bring about loss of memory. Scopolamine hydrobromide (scopolaminae hydrobromi- dum) is given by hypodermic injection in doses of 0.0005 Gm. (gr. V^). Of the preparations of the drug itself, there is the tincture (tinctura hyoscyami) (irtxv), extract (ex- 64 MATERIA MEDICA AND THERAPEUTICS tractum hyoscyami) 0.065 Gm. (gr. i), and the fluidextract (fluidextractum hyoscyami) (TTLiii). Untoward Effects.-Scopolamine and atropine may, in susceptible individuals, cause dryness of the throat, flush- ing of the face, and dilated pupils even in small doses. Sometimes delirium occurs, with rapid pulse. In poisonous doses there is a wild talking delirium, sometimes with col- lapse. Give hot coffee by rectum and small doses of mor- phine. The stomach may be washed with potassium permanganate, 1 Gm. to 1000 mils of water, if the poison has been recently swallowed. Cases of absorption from the eye with poisonous symptoms are not rare. The Astringents Two groups of astringents are used; the (a) vegetable astringents, depending for their virtues on some variety of tannin, and the (&) mineral astringents. Among the vegetable astringents are tannic acid, derived from nutgalls, gallic acid, galls and gambir, or catechu. The mineral astringents include alum, iron salts, the acetate of lead (sugar of lead), and the solution of acetate of lead (lead-water), the sulphate and the chloride of zinc, and the stearate and oxide of zinc, as well as the sulphate of copper. Few of these are used internally, although acetate of lead is sometimes employed in diarrhoeas in dosage of 1 to 3 grains (0.06-0.2 Gm.). The familiar ointment of oxide of zinc and the stearate of zinc have a use in skin diseases. Lead poisoning, or chronic plumbism, occurs in workers in lead-painters, etc. It is characterized by a blue line about the gums, wrist-drop and abdominal pain. Acute poisoning with the mineral astringents has the symptoms of the irritant poisons-vomiting, pain, and prostration. DRUGS AND MEDICINES 65 Action.-The astringents have the power of contracting tissue. Their action is attributed to their ability to coagu- late the albumin on the surface of the tissues with which they come in contact. The contraction of this coagulum is supposed to also diminish the calibre of the adjacent blood- vessels, and also to diminish secretion. Therapeutics.-They are used in subacute or chronic inflammatory conditions, as in the form of gargles in pharyngitis, and the use of the lead water in inflammatory swellings of the extremities. Internally various astringents are employed for their local action in the intestine in diar- rhoeas, lead acetate, and various tannin compounds as tannal- bin, tannigen, etc., being used. In chronic urethritis, vagi- nitis, etc., astringent douches and injections of alum, zinc sulphate, etc., are employed. (See separate headings, Reference Table.) Names and Dosage of Astringents Alum (Alumen) Dose 8 gr. (0.5 Gm.) Lead Acetate (Plumbi Acetas), Sugar of Lead, Dose 1 gr. (0.065 Gm.) Solution of Acetate of Lead (Liquor Plumbi Subacetatis), Goulard's Extract Externally Sulphate of Zinc (Zinci Sulphas), White Vitriol, Dose 15 gr. (1 Gm.) as an emetic Sulphate of Copper (Cupri Sulphas), Blue Vitriol, Dose % gr. astringent, 4 gr. emetic (0.01-0.25 Gm.) Tannic Acid (Acidum Tannicum) Tannin... .Dose 8 gr. (0.50 Gm.) Glycerite of Tannic Acid (Glyceritum Acidi Tannici). .Externally Gallic Acid (Acidum Gallicum) Dose 15 grains (1 Gm.) Tincture of Kino (Tinctura Kino) Dose 3i (4 mils) Tincture of Gambir Compound (Tinctura Gambir Composita), Dose 3i (4 mils) Galls (Galla), Nutgall Dose gr. viii (0.5 Gm.) Tannigen (Tannin Albuminate) Dose gr. xxx (2 Gm.) Tannabalin (Tannyl Acetate) Dose gr. v (0.3 Gm.) 66 MATERIA MEDICA AND THERAPEUTICS Many of the astringents when used in concentrated form, especially on mucous membranes, erode tissues sufficiently to be classed as caustics. Most astringents act as styptics. QUESTIONS I. Name two saline diuretics and give doses. 2. Caffeine stimulates the functions of what organs? How does it affect the nervous system? the muscles? the heart? the pulse? the respiration? the urinary secretion? 3. What is theobromine? How does its action compare with caffeine? What is diuretin? 4. Name three therapeutic uses of caffeine and theobromine. What preparation of caffeine may be used hypodermically? What is its dose? What is the dose of citrated caffeine? of diuretin? Why should the latter be given well diluted ? Why are coffee and tea injurious to nervous individuals? 5. For what are diaphoretics used? Name one. 6. What are two main classes of expectorants? Name two with doses. 7. What unusual effects may come from overdosage with ex- pectorants ? 8. How does carbonate of ammonia affect the heart, the stom- ach, the bronchi ? What are its therapeutic uses ? How is it given ? What spirit contains carbonate of ammonia? What is sal ammo- niac? What are its therapeutic uses? 9. What is belladonna? What alkaloid does it contain? How does it act on the brain? on the nerves? What result does it bring about in the glands? How does it affect the eye? the intestine? the heart-beat? the blood-pressure? the respiration? 10. What are the therapeutic uses of atropine? Give names and doses of several preparations. 11. What is hyoscyamus? What alkaloid does it contain? How does it resemble and differ from atropine? What is its dose and how is it given ? Name two other preparations and give doses. 12. What untoward effect may occur in certain individuals from even small doses of these drugs? What are the symptoms of over- dosage or poisoning? What is the treatment of poisoning? 13. Name three astringents. For what purpose are they used? From what is tannic acid obtained ? DRUGS AND MEDICINES 67 IL DRUGS ACTING ON THE NERVOUS SYSTEM A. Cerebral sedatives : Coal-tar analgesics and antipy- Somnifacients and hypnotics reties: Chloral hydrate. Acetanilid, phenacetin, antipy- Trional. rin. Alcohol and the anaesthetics: D. Drugs that stimulate the spi- Alcohol. nal cord: Chloroform and ether: Caffeine. Nitrous oxide. Strychnine. Analgesics and narcotics: E. Drugs used to paralyze Opium. the termination of sensory B. Drugs that stimulate the nerves: brain: Local anaesthetics: Caffeine. Cocaine, orthoform, etc. C. Spinal sedatives: The bromides. A. CEREBRAL SEDATIVES Somnifacients and Hypnotics CHLORAL HYDRATE (CHLORALUM HYDRATUM) Chloral occurs in colorless crystals with a peculiar odor and taste. The crystals are very soluble in water. Physiological Action.-In large doses, chloral has a very depressing effect on the blood-pressure, making the pulse soft and rapid. It is depressing to the heart and respiratory centre when not used with discretion. In moder- ate doses it produces a quiet, dreamless sleep. Nausea and depression, however, may follow this peaceful slumber. All of the reflexes are diminished by chloral, and it depresses the motor as well as the sensory part of the brain. Long- continued use may cause degenerative changes in internal organs, and even aside from this, a habit resembling alcohol- ism may be formed. Other and presumably safer hypnotics are: 68 MATERIA MEDICA AND THERAPEUTICS TRIONAL (SULPHONETYLMETHANUM) AND SULPHONAL (sulphonmethanum) These, as is the case with chloral, may be given in doses of i Gm. (gr. xv). Veronal (Diethyl-barbituric acid) and chloretone have a smaller dosage, 0.5 Gm. (gr. viii). Chloral is usually given well diluted in syrup or water; chloretone in capsule or powder; trional, sulphonal, and veronal in hot milk. Hypnotics should always be given an hour or so before the time when sleep is desired. In long-continued use of trional or sulphonal the urine becomes stained red, and lassitude, nausea and vomiting occur, with ataxic gait. Poisoning.-In poisoning by chloral or other hypnotics, wash out the stomach, keep the patient recumbent, give strong hot coffee by rectum, and strychnia sulphate, gr. by hypodermic injection. Veronal is a rather dangerous drug, fatal poisoning occurring from relatively small doses. The bowels should be thoroughly emptied by vigorous catharsis when acute or chronic poisoning occurs with either trional, sulphonal or veronal. Bromidia, Somnos, etc., are proprietary solutions of chloral, and poisoning by them should be treated as chloral poisoning. Alcohol and the Anaesthetics alcohol Alcohol is used in medicine in the form of brandy, whiskey, various wines, and the malted liquors such as ale and beer. Whiskey and brandy are about 50 per cent, alco- rol, wines 6 to 20 per cent, and the malt liquors 4 to 7 per cent. The so-called fermented malt extracts contain about 5 per cent, alcohol. Alcohol made from grain is used in many official preparations, spirits, elixirs, tinctures, etc., and so is very important in pharmacy. DRUGS AND MEDICINES 69 The dose of alcohol is from 4 to 16 mils (3i to 3iv). Diluted alcohol or brandy may be given hypodermically. Physiological Action.-Alcohol affects first the higher centres of the brain, paralyzing, so to speak, the will power. The early signs of intoxication are symp- toms of lessened self-control, talkativeness, and an apparent stimulation of the mental energies. But alcohol does not stimulate-it paralyzes the brain. As its effect continues, drunkenness ensues, with staggering gait and partial anaes- thesia. Large quantities result in alcoholic coma, which must be treated like opium poisoning or poisoning with other narcotics. The circulation is affected by alcohol insomuch as its use helps the heart indirectly. It dilates some of the peripheral vessels and causes a quickened pulse. But it is not a real heart stimulant in the same sense as digitalis or caffeine. On the digestive system, alcohol, well diluted and in small quantities, increases the stomach secretion and aids the movements of the stomach. In 50 per cent, strength it is an irritant to the gastric mucous membranes. As a food alcohol is burned in the body, producing heat and energy. It is a quickly absorbed food suitable only in extreme cases of exhaustion. It acts in this capacity by spar- ing body tissues that otherwise might be broken down to furnish heat and energy. Its general effect, however, is to cause the loss of more heat than it generates. Therapeutic Uses.-Alcohol is used as a food and to assist the heart in exhausting fevers, typhoid, pneumonia, etc. In chills and threatened cold, hot whiskey dilates the vessels of the skin and gives a feeling of warmth and com- fort. It is a much-used stimulant in shock and collapse from any cause. 70 MATERIA MEDICA AND THERAPEUTICS Gastric atony is often combated by the use of some light wine with the food, or the digestive elixirs which contain 20 per cent, alcohol are used in the same condition. The habit of alcoholism is very easily formed by neuras- thenic and hysterical individuals. Many patent medicines, such as " Peruna " and the like, owed much of their popular- ity to the alcohol which they contained. CHLOROFORM AND ETHER Both of these anaesthetics are derived from alcohol by a chemical transformation. Internally in small doses they have much the same effect as alcohol on the brain and diges- tion although their action is far more powerful. Alcohol, too, it will be remembered, produces an anaesthetic condition when taken in excessive doses. Chloroform (chloroformum) is used internally very often as the spirit of chloroform (spiritus chloroformi), the dose of which is from I to 2 mils. (H|,xv-xxx). The spirit of ether (spiritus aetheris) and the compound of ether are given in the same dose and for the same conditions. In gastric flatulence and in certain spasmodic conditions, such as asthma, these preparations are used. They should be given well diluted. Chloroform liniment (linimentum chloroformi) is popu- lar for its counterirritant properties. As anesthetics, chloroform and ether are given by inhala- tion. Chloroform is the more effective of the twro, is less irritating to the nose and throat, but collapse of the respira- tion and heart appears more frequently after its use than after the use of ether. From seven to ten minutes >s usually required to produce complete anaesthesia. Both of these drugs may cause profound disturbance of the liver and kid- DRUGS AND MEDICINES 71 ney function following their use. Nausea is more frequent after ether than chloroform, but it is not unknown after the latter. The urine should always be preserved for exam- ination both before and after the administration of either of these anesthetics. In collapse from ether or chloroform: (i) lower the patient's head and chest; (2) give artificial respiration; (3) give adrenalin, THxx, with caffeine sodium benzoate, gr. ii, or strychnine sulphate, gr. V30, by hypodermic injection deep in the buttock. NITROUS OXIDE (n2o) Nitrous oxide gas is now a much employed anaesthetic agent, given in combination with oxygen, either as a pre- liminary to ether anaesthesia or in combination with local anaesthesia. The relaxation is less than with ether or chloro- form and the anaesthesia even less is more irregular. Nitrous oxide, while more asphyxiating than ether, does not combine chemically with the blood elements, being held only in solution in the plasma-hence is believed to have fewer sequelae than the other anaesthetic agents. It is, how- ever, less flexible in its application, and its field is therefore limited to selected cases. Recently it has had a vogue for obtunding the pain of childbirth. Analgesics and Narcotics opium Opium is the concrete, milky exudate from the seed capsule of the poppy plant-the Papaver somniferum. It contains nineteen alkaloids, of which morphine and codeine are the most important. Dried opium contains from nine to twelve per cent, of morphine. Besides these two men- 72 MATERIA MEDICA AND THERAPEUTICS tioned alkaloids, there are two other modifications of mor- phine used in medicine, one called heroin, the other apomorphine. They are, so-called, artificial alkaloids. Physiological Action.-Small quantities of opium or morphine produce a condition of mental abstraction; large doses result in a drowsy condition from which the patient is easily awakened; but, if still larger doses are given, sleep comes, sleep which is deep, merging into torpor as the poisonous dose is reached. Poison Symptoms.-A deep, torpid sleep, from which the patient can with difficulty be awakened-perhaps even a comatose condition, in which no effort at rousing the patient succeeds-is characteristic of opium poisoning. The respiration is slow, and may be reduced to three or four a minute; the pulse is full and somewhat slow, and the pupils are very much contracted. The face is usually pur- plish and congested. As a fatal termination is approached, the respiration becomes slower, then intermittent; the pulse becomes more rapid and more feeble; the face more and more congested, and, finally, respiration ceases. Special Effects. Nervous System.-Morphine abol- ishes pain by depressing the areas of the cerebrum which govern sensation and thought. It slightly stimulates the spinal cord at the same time, in a manner similar to strychnia. On the medulla it has the effect of depressing the respiratory centre and the vasoconstrictor centre. It has no local action on sensory nerves. Circulation.-As an effect of the depressed vasocon- strictor action just mentioned, there is a slight dilatation of the superficial blood-vessels. The drug has little or no direct action on the heart. Alimentary Canal.-Morphine and opium cause a con- traction of the portion of the stomach which is joined to the DRUGS AND MEDICINES 73 intestine. After hypodermic injection, morphine is soon found in the stomach and intestine, passing into these organs through the mucous membrane. A marked action in impair- ing the secretion and movements of the intestine follows the use of morphine and opium in man. Codeine and heroin produce less depression of the cere- brum and a greater stimulation of the spinal cord than morphine. Their sedative action, especially in the case of heroin, on the respiratory centre is more marked, while their intestinal action is much less than that of morphine. Therapeutics.-Nothing can take the place of morphine and opium for the relief of pain. Small doses, frequently repeated, are most desirable, for no drug engenders the habit of its use more quickly than morphine. It should never be used for any length of time in acute conditions, nor at all, if avoidable, in chronic cases, unless a cure is hopeless. In insomnia due to pain, morphine or opium will be effective where chloral or the bromides would fail. In coughs, especially when the secretion is scanty, mor- phine, opium, and especially codeine and heroin, dull the sensibility of the respiratory centre, so that the impulse to cough is not felt so frequently. In diarrhoea, peritonitis, typhoid hemorrhage, and similar conditions, opium as well as morphine is used to check the intestinal movements and secretions. In colds, and fevers, Dover's powder is used as a diaphoretic. Opium or its preparations should seldom be used in neurasthenic or hysterical patients. The lessened self-con- trol which characterizes these patients easily makes them slaves to the drug. In a certain number of individuals, opium and morphine produce violent nausea and vomiting. Apomorphine.-Apomorphine is used as an emetic, and 74 MATERIA MEDICA AND THERAPEUTICS is usually given hypodermically. It generally produces, after an ordinary dose, an effective and energetic emptying of the stomach, with little nausea, within ten minutes. In some cases, however, it has a purely sedative effect, similar to morphine. Treatment of Poisoning.-Keep the patient breathing and awake, if possible. To do this, dash cold water on him or hit him with ice-water towels, if necessary. Give very strong coffee by rectum. For the respiratory paralysis, give atropine sulphate, 0.0005 Gm. (gr. 1/120), by hypodermic injection, and repeat it if needed. Since morphine is ex- creted in the stomach and often absorbed a second time in the intestine, wash out the stomach at intervals of half an hour with solution of potassium permanganate, 1 to 1000. If the patient is breathing very slowly, and the face is purplish, give artificial respiration, seventeen movements to the minute. Even if breathing stops, keep this up for one hour or longer, being assisted by relays of helpers. Per- sistence in artificial respiration has saved many a victim of opium poisoning, when other means have failed. Administration and Dosage.-Opium is given in doses of 0.1 Gm. (gr. iss) ; powdered opium (opii pulvis), 0.06 Gm. (gr. i) ; extract of opium (extractum opii), 0.03 Gm. (gr. ss) ; camphorated tincture of opium (tinctura opii camphorata or paregoric), 12 mils (5iii). All other preparations of opium contain 10 per cent, of the drug. Since the dose of the powdered drug is one grain (0.06 Gm.), these preparations have a dosage of ten grains or ten minims (0.6 Gm. or 0.6 mil). This refers to tincture of opium (tinctura opii, laudanum), deodorized tincture of opium (tinctura opii deodorata), and powder of ipecac and opium (Pulvis Ipecacuanhas et Opii-Dover's powder). DRUGS AND MEDICINES 75 Alkaloids.-Morphine sulphate and hydrochloride (mor- phinae sulphas-morphinae hydrochloridum) have a dosage of 0.015 Gm. (gr. %); codeine phosphate and sulphate (codeina phosphas-codeina sulphas), 0.03 Gm. (gr. ss); apomorphine hydrochloride (apomorphinae hydrochloridum), expectorant, 0.002 Gm. (gr. 1/30); emetic, 0.006 Gm. (gr. Wo)- All of these salts may be given by hypodermic in- jection. Heroin (diacetyl morphine) is given as the soluble hydrochloride in 1/16 to V10 gr. (0.0035-0.006 Gm.). B. DRUGS THAT STIMULATE THE BRAIN Caffeine Caffeine is a remedy that stimulates the psychic area of the brain. It is discussed on page 55. Belladonna and atro- pine stimulate the motor area of the brain (p. 61). C. SPINAL SEDATIVES The Bromides Sodium. Potassium. Ammonium. Lithium. Strontium. Strontii Potassii Ammonii Lithii Sodii Bromide of .Bromidi. All of these are freely soluble in water and have a salty taste. Physiological Action.-Large doses produce drowsi- ness and apathy but not actual stupor. The individual is not able to think, or talk, or move so rapidly as before. The mucous membranes, especially of the throat and pharynx, will be found to have partially lost sensation. The action on the circulation is to slow the pulse. The reflexes (see physiology or definition) are lessened in intensity, and this is evidence that the drug depresses the nerve-centres in the 76 MATERIA MEDICA AND THERAPEUTICS spinal cord as well as in the brain. Large quantities, espe- cially of the bromide of potassium, will depress the heart. Untoward Effects.-When any bromide is given for a long time, or in unusually large doses, or even in moderate doses to certain individuals who are unusually sensitive to its action, symptoms of the accumulation of the salt in the body tissues are seen, and this condition is known as bromism. Bromism is shown usually by a skin eruption, blotches and pustules appearing in considerable numbers. Patients tak- ing bromides should be watched carefully for these eruptions. The skin troubles are due to imperfect elimination of the bromide through the skin, and careful and regular bathing will usually prevent their appearance. Indigestion and loss of appetite are also symptoms of the excess of bromide medi- cation. Loss of memory, apathy, and a fine tremor of the hands and fingers are sometimes seen, even up to the point of marked unsteadiness of gait. Therapeutic Uses.-Since bromides depress the brain and spinal cord and retard thought, they are used to counter- act conditions in which the brain and spinal cord are irritated, as the irritability following mental shock, the delirium of intoxications, in insomnia, and other irritable conditions of the nervous system. Their chief use, however, is antispas- modic, being used to control spasms of epilepsy, of tetanus, and of strychnia poisoning. In vomiting due to brain irri- tation, they are sometimes useful. Their hypnotic use is confined to cases in which the loss of sleep is due to some cause other than pain. Dose and Administration.-All of the bromides may be given in doses of 0.5 to 2 Gm. (gr. viii to xxx). They are usually given in an aromatic elixir. If dispensed in powder or solution in water, milk will frequently disguise their salty taste, if the dose given is not too large. DRUGS AND MEDICINES 77 Coal-Tar Analgesics and Antipyretics ACETANILID, PHENACETIN, ANTIPYRIN The first two are white powders practically insoluble in water. Antipyrin is freely soluble in water. Physiological Action. Antipyretic.-These drugs when given to an individual with fever cause a prompt fall of temperature by a supposed action on the heat centre of the brain. They do not lower the temperature of a normal individual. Analgesic.-They retard the passage of painful sensa- tions to the brain by acting on the cells of the spinal cord. Unlike morphine, they do not relieve pain by dulling the sensibility of the brain. Consciousness is not lost with the use of these drugs. Large doses gravely affect the composition of the blood and depress the heart muscle. Poisoning.-Collapse similar to shock often follows the use of these preparations. It is marked by a remarkable cyanosis or bluing of the skin, shallow respiration, flutter- ing pulse, and great mental apprehension. The skin is clammy and covered with cold perspiration. Therapeutic Uses.-To reduce very high fever, these drugs are now only occasionally employed. They are best given when a fall in body temperature is expected. They are valuable to relieve purely nerve pains of whatever char- acter,-as neuralgia, headache, etc.,-but they are of little use when the pain is due to acute inflammation. Acetanilid has some use as an antiseptic and styptic. Phenacetin or acetanilid is the principal ingredient of the many widely-sold headache tablets, powders, salts, etc. Their use is dangerous. Preparations and Doses.-Antipyrin and acetanilid (Acetanilidum) may be given in tablet or powder, dose 0.25 78 MATERIA MEDICA AND THERAPEUTICS Gm. (gr. iv). Phenacetin (Acetphenetidinum) and the Compound Powder of Acetanilid (acetanilid 7, soda bicar- bonate 2, caffeine 1) are given in doses of 0.5 Gm. (gr. viii). These preparations are best given in powdered form with sugar, or in pill, tablet, or capsule. D. DRUGS THAT STIMULATE THE SPINAL CORD Caffeine (p. 55) and strychnine (p. 86) are active stimu- lants of the spinal nerve centres and their ability to increase reflex activity has been described. E. DRUGS USED TO PARALYZE THE TERMINATIONS OF SENSORY NERVES Local Anesthetics COCAINE (COCAINA), ORTHOFORM, ETC. Cocaine is an alkaloid obtained from coca leaves, the leaves of the Erythroxylon Coca, a shrub growing in Bolivia. The hydrochloride is very soluble in water, readily absorbed, and strong solutions when injected, often bring about toxic symptoms. Alpyn, eucaine, novocaine, and many similar drugs are alleged to be less toxic than cocaine. Orthoform is sparingly soluble. It is used most frequently as a dusting powder for painful or itching surfaces, as it gives a pro- longed action. Physiological Action and Uses.-The local anaes- thetics relieve pain and itching by paralyzing the terminal nerves in the tissues. Cocaine hydrochloride (cocainac hy- drochloridum) is frequently combined with adrenalin in solutions varying in strength from 1 per cent, to 0.1 per cent, for infiltration anaesthesia. It is also used in eye, ear, nose, and throat surgery. Five grains of cocaine hydrochloride to an ounce of normal salt solution will make a 1 per cent. DRUGS AND MEDICINES 79 solution of the alkaloid. One-half a grain to an ounce will make I to 1000 strength. Five minims of adrenalin will be sufficient to add to these solutions to secure the local action of adrenalin on the blood-vessels and to prevent the absorp- tion of the cocaine. Cocaine Poisoning.-Acute cocaine poisoning is seldom fatal. Quick pulse, increased excitability, and nervousness are the symptoms of cocaine absorption. The hydrochloride is sometimes given internally to allay vomiting, in a dose of 0.03 Gm. (gr. %). Cocaine, like morphine, often makes its users the victims of an enslaving habit, and many States have laws to prevent its promiscuous sale. QUESTIONS 1. What percentage of alcohol does whiskey contain? wines? beer and ales? What is the dose of alcohol? How does alcohol affect the brain? the circulation? Is it a real heart stimulant? How does it affect digestion? 2. What are the therapeutic uses of alcohol? Name and give dose of a preparation of ether; of chloroform. What are these preparations used for? Compare the anaesthetic action of ether and chloroform. Why is it necessary to preserve a sample of urine both before and after anaesthesia? What three things should be done in collapse during anaesthesia? 3. How does chloral occur? How does it affect the heart and respiratory centre in large doses? What is the effect of small doses? How does it affect the reflexes? What is the dose of chloral, trional and sulphonal ? of chloretone and veronal ? How are these drugs best given? 4. How would you treat poisoning by chloral or other hyp- notics? What do Bromidia and Somnos contain? 5. What is opium? What are its two most important alkaloids? What artificial alkaloids are obtained from it? What symptoms do small doses of opium or morphine bring about? What are the symptoms of poisoning on the respiration? the pulse? the pupils and appearance of the face? 80 MATERIA MEDICA AND THERAPEUTICS 6. How do morphine and opium affect the nervous system? the circulation? the alimentary canal? How does the action of codeine and heroin differ from the foregoing? 7. What is the chief use of opium and morphine in therapeutics? Name several conditions in which it is used. What are the dangers of its use in nervous individuals? 8. Describe the action of apomorphine. What advantage does it have in its mode of administration ? How would you treat opium or morphine poisoning? Persistence in what measure is important? 9. What is the dose of powdered opium? of camphorated tinc- ture of opium? of tincture of opium? What are the common names of the two foregoing preparations ? What is Dover's powder ? Give its dose. What is the dose of morphine sulphate? of codeine sul- phate? of apomorphine hydrochloride? 10. Name three bromides of the alkali metals. What effect do bromides have on the brain, the throat, the circulation and heart, the reflexes? What is brotnism? How is it to be avoided? For what therapeutic uses are bromides employed? How are they given and in what doses? III. DRUGS AFFECTING THE CIRCULATION A. Heart sedatives and depres- Ergot sants: Suprarenal glands. Aconite. Pituitary gland. Veratrum. D. Drugs which lower blood- B. Heart stimulants: pressure: Digitalis. The vasodilators: Strophanthus. Amyl nitrite; Camphor. Nitroglycerine. C. Drugs which raise blood- Sodium nitrite. pressure: Sweet spirit of nitre. Nux vomica. A. HEART SEDATIVES AND DEPRESSANTS Aconite (Aconitum-Monkshood) This is the root of the Aconitum Napellus. It owes its therapeutic virtues to an alkaloid, aconitine. This is so powerful that the dose is 0.00015 Gm. (gr. 7SB0). The fluidextract of aconite (Fluidextractum Aconiti) is given in DRUGS AND MEDICINES 81 doses of 0.065 mil (Tr[i), the tincture (Tinctura Aconiti) 0.6 mil (TT],x). Physiological Action.-Aconite first stimulates and later paralyzes the sensory nerves, acting on the end organs and producing local anaesthesia. It stimulates the vasodila- tor centre, dilating the blood-vessels of the body. On the heart it acts by stimulating the pneumogastric nerve and slowing the pulse. Later, if the dose is large enough, it para- lyzes the heart muscle. From its action in reducing fever it is believed to depress that part of the brain which is supposed to regulate the loss of body heat-the heat centre. Therapeutic Uses.-Aconite is used in neuralgia to abolish pain in the affected sensory nerves, both through its local and general action. In fever accompanied by a strong, rapid, bounding pulse, it is sometimes used to slow the heart, promote perspiration through its vasodilator action, and reduce the temperature by its effect on the heat centre. But it is a powerful drug, and must be used with caution. Poisoning.-Numbness and a tingling of the throat and skin are first noticed. The heart at first beats slowly; later, as the heart muscle becomes paralyzed, weakly and rapidly. In treatment, keep the patient on his back, give strong coffee by rectum, promote vomiting or wash the stomach, and give atropine sulphate 0.001 Gm. (gr. 1/60) by hypoder- mic injection. Veratrum (Hellebore) This drug is the root of the Veratrum viride. It contains an alkaloid, veratrine. The preparations employed are the tincture (tinctura veratri), dose 0.5 to 1 mil (ntviii to xv), and the fluidextract (fluidextractum veratri), 0.1 mil (Tr[i). Excepting that it does not dilate the blood-vessels so 82 MATERIA MEDICA AND THERAPEUTICS markedly, the physiological action of this drug is almost identical with that of aconite. It is used for the same thera- peutic purposes, and is frequently employed in the convul- sions of child-birth (eclampsia), to lower the tension of the pulse. In poisoning with this drug, vomiting is an early symptom. B. HEART STIMULANTS Digitalis (Foxglove) The leaves of the Digitalis purpurea. Digitalis contains five glucosides, the most important being digitalin and digi- toxin. Digitalin is insoluble in water, hence it is not well adapted for hypodermatic use. A proprietary solution of digitoxin called digalen is given in doses of i mil (TTLxv) by hypodermic injection. The official preparations are: fluid- extract (fluidextractum digitalis), 0.065 (^lO • tincture (tinctura digitalis), 0.5 to 1 mil (ntviii to xv) ; infusion (infusum digitalis), 16 mils (§ss). Physiological Action.-Digitalis and its preparations, when given in proper doses for a sufficient length of time, stimulate the circulation, and, especially, the heart. This action of digitalis is threefold: 1. It slows the heart by increasing the length of the diastole or resting period of the organ. 2. It increases the strength of the contraction of both the auricles and ventricles, and this increased pumping force increases the output of blood. 3. It raises the pressure in the arteries by a direct action on the muscular coats of these vessels, and probably, also, by stimulating the vasoconstrictor centre in the medulla, and, finally, by keeping the vessels more completely filled with blood. The slowing of the heart, due to an increased diastole or resting period, is brought about by a tonic action of the DRUGS AND MEDICINES 83 drug on the nerve which normally slows the heart-the pneumogastric; while the increased force of the heart's contraction is due to a tonic action of digitalis on the heart muscle itself. The pulse is, therefore, slower and more firm after digitalis. Another effect of giving this drug is to increase the quantity of urine excreted. It is especially efficient when dropsy or oedema from deficient heart action, has occurred. This oedema is due to a lack of sufficient pressure in the heart to drive the blood through the capillaries and into the veins. The back pressure in the veins and capillaries forces lymph into the tissue spaces, and the individual is water- logged. Digitalis acts by allowing the heart sufficient time to drain its veins more effectually, while it also increases the force of the heart-beat and the pressure in the smaller arter- ies. This action promotes the absorption of the lymph into the capillaries and drains the water-saturated tissues. The blood-pressure in the arteries of the kidney is also raised to a marked degree, so that more force is given to the filtration of the watery constituents from the blood, and their elimination in the form of urine. Thus, the action of digitalis on the urinary secretion seems to be more dependent on its action on blood-pressure than on any stimulating effect on the cells of the kidney itself. Cumulative Effect.-When digitalis is taken for too long a period, or in excessive doses, it produces a cumulative effect. This is because the active principles of this drug are absorbed and excreted very slowly. It takes from twelve to thirty-six hours to produce the characteristic action from an ordinary dose by mouth. So it is that when the drug has been administered for some time, excretion proceeds too slowly or absorption occurs too rapidly. This is the reason for the occurrence of the cumulative effect. The symptoms 84 MATERIA MEDICA AND THERAPEUTICS of cumulation are a small, slow, and intermittent pulse, accompanied by feelings of weakness and faintness, and sometimes nausea and vomiting. The production of this condition is favored by constipation or gastritis. When these symptoms occur in a patient who has been taking digi- talis for some time, they should always be recorded. Therapeutics and Administration.-Digitalis is the crutch of the disabled heart. It is used in valvular heart disease, in conditions affecting the nutrition of the heart, such as occur in certain fevers, and as a diuretic, especially when dropsy or oedema occur. The slowness of action of digitalis does not commend its use as an emergency heart stimulant. The comparative in- solubility of digitalin makes its hypodermic use unreliable. It is therefore used more frequently for chronic than for acute conditions. Given for long periods, it usually produces some irritation of the stomach; its cumulative action is not uncommon. Its most important use is in those heart conditions occurring when the heart valves are imperfect, the organ dilated and unable to empty itself, and the pulse small and rapid. Here, it slows the heart, allowing the auricles to fill more com- pletely and increases the force of its contraction or systole. The auricles after its use are emptied more rapidly, and in this way the heart is rested and strengthened. The tincture, fluidextract, and infusion are the prepara- tions most frequently used. They are given in water, after food, in the doses mentioned at the beginning of this chapter. Strophanthus The seeds of the Strophanthus Kombe. The active prin- ciple is a glucoside, strophanthin (strophanthinum), which is soluble in water. The physiological action of this drug DRUGS AND MEDICINES 85 corresponds to that of digitalis; yet it does not raise the ten- sion of the pulse or increase the urinary secretion to the same degree as the former drug. The tincture (Tinctura Strophanthi) is given in doses of 0.5 to 1 mil (rq viii to xv). The glucoside, strophanthin, may be given hypodermi- cally in doses of 0.0003 Gm. (gr. y^). Poisoning.-Acute poisoning by digitalis or strophan- thus is rare. Patients who take excessive doses usually vomit as a result. For other remedies directly or indirectly stimulating the heart, see Ammonia, Strychnine, Caffeine, Alcohol. Camphor (Camphora) Camphor has long been employed as a stimulant to the heart and circulation when given by hypodermic injection in oil. Experimental evidence seems rather against its use- fulness in these cases, and whatever its action may be its slow absorption renders it more or less uncertain as an emergency drug. Given by mouth, in collapse from various causes and the depression of fevers, etc., it seems to quicken the pulse and dilate the smaller blood-vessels. It is believed to act reflexly in these cases through its action on the stomach. Large doses may produce convulsions and coma. Exter- nally it is used as a rubefacient. The preparations used are: camphor-water (aqua cam- phorae.), 15 to 30 mils (3iv to §i) J spirit of camphor (spiritus camphorae), 1 to 2 mils (TQxv to Ttxxx) ; liniment of cam- phor (camphorated oil-linimentum camphorae) used ex- ternally and by hypodermic injection up to 2 mils (n],xxx). C. DRUGS WHICH RAISE BLOOD-PRESSURE Nux Vomica (Poison Nut) This is the seed of the Strychnos Nux-vomica. Its active principle is an alkaloid called strychnine. 86 MATERIA MEDICA AND THERAPEUTICS Strychnine slows the heart, acts as a vasomotor stimulant increasing the tension of the pulse and increases the depth of respiration through its action on the nervous centres in the medulla and spinal cord. Small doses of strychnia im- prove the appetite, slow and strengthen the pulse and sharpen the special senses. Poisonous doses produce stiffness in the muscles of the neck, contractions of the face muscles often resulting in a ghastly grinning expression, and marked con- vulsions frequently arching the body till only the head and feet touch the bed (opisthotonos). Death usually results from exhaustion and paralysis of the muscles of respira- tion. It is preceded by cyanosis. Therapeutic Uses and Administration.-Strychnia and nux vomica are given as stimulants to the circulation and digestion. Unlike digitalis, strychnia has no direct nutritive action on the heart muscle; its effects come chiefly through the nervous system. It is a much-used drug in general lack of tone, as it has a marked effect in such con- ditions. Nux vomica is frequently employed in diseases of the stomach and intestines. As an emergency heart tonic and respiratory stimulant, strychnia is frequently used, espe- cially by hypodermic injection. The effects of overdoses are shown in muscular twitching and quick involuntary " starts." The preparations most frequently used are: strychnia sulphate (Strychnias Sulphas), o.ooi Gm. (gr. x/60); Fluid- extract of nux vomica (Fluidextractum Nucis Vomicae), 0.06 mil (nfi); extract of nux vomica (Extractum Nucis Vomicae), o.oi Gm. (gr. %) ; tincture of nux vomica (Tinc- tura Nucis Vomicae), 0.5 to 1 mil (iTtviii to xvi). Treatment of Poisoning.-If convulsions have not begun, produce vomiting with mustard water. If the patient has convulsions, give chloroform and wash the stomach with DRUGS AND MEDICINES 87 a solution of tannic acid, a teaspoonful to a pint, or strong tea, or permanganate of potash solution, I to 6000. Chloral and the bromides should be given in double doses, by mouth or rectum. The patient should be frequently catheterized, and kept in a quiet, dark room. Ergot A fungus obtained from rye; contains one or more alkaloids. Physiological Action.-In moderate doses it raises the blood-pressure by stimulating the vasoconstrictor centre in the medulla, and also by a direct action on the smooth muscle of the blood-vessels themselves. This action on smooth muscle accounts for its effect in producing contrac- tions of the uterus. In large doses it may cause nausea and vomiting. Long-continued use may bring about gangrene of the extremities, especially in the aged, ergotism. Therapeutic Uses and Administration.- Ergot is used to increase blood-pressure, especially in certain forms of alcoholism, as delirium tremens, when the pulse tension is low. It has a wide field in ttterine hemorrhage on account of its action on uterine muscle. The fluidextract (fluidextractum ergotae) is given in doses of 2 to 4 mils (5ss to 5i); the extract (extractum ergotse), 0.25 Gm. (gr. iv). Several proprietary forms intended for hypodermic use -Ergotole and the like-are given in doses of 1 mil. Suprarenal Glands (Adrenalin, Suprarenalin, Etc.) These solutions of the active principle of the suprarenal gland are of a strength of 1 to 1000. An exactly similar preparation is now made from a coal-tar derivative-pyro- catechin. Injected deeply into a muscle or into a vein in a 88 MATERIA MEDICA AND THERAPEUTICS dose of i mil (lltxv), these solutions give a brief action simi- lar to that of digitalis-slowing and strengthening the heart and raising the blood-pressure. Their use by mouth gives no such action, and some authorities assert that they are equally inert when given under the skin. Applied locally to mucous membranes, these preparations contract the blood- vessels and blanch the part by their local action. Therapeutics.-Suprarenal gland (suprarenalum sic- cum) and adrenalin are much used in eye, ear, nose, and throat conditions. They are a valuable addition to cocaine in local anaesthesia,-I to 300,000 is sufficient for infiltration. As a heart stimulant adrenalin acts rapidly but has a tran- sient effect. For local hemorrhage it is sometimes efficient. Administration.-For local use 1 to 1000 to 1 to 50,000 solutions are used. The solutions of adrenalin, suparenalin, etc., on the market are 1 to 1000 strength. Adrenalin is said to lose its virtues by boiling; suprarenalin may be boiled. When given by hypodermic, it should be injected deep in the muscle; under the skin it is rarely efficient. Gangrene of the skin may follow its use. Pituitary Gland (Pituitrin) Pituitrin (liquor hypophysis) is a substance isolated from the posterior lobe of the pituitary body of the sheep. The action and uses of pituitrin resemble those of adrena- lin, a marked rise of blood-pressure accompanying its intravenous injection, but lasting longer-from 10 to 30 minutes. After repeated doses the blood-pressure is low- ered. The heart is not stimulated by it. A direct action on the muscular coats of the blood-vessels accounts for its action Milk secretion is temporarily stimulated, diuresis is produced, and the uterine contractility is increased. Its use in large doses causes collapse. DRUGS AND MEDICINES 89 Uses.-Pituitrin has its greatest field in delayed labor, where it is used to stimulate contractions of the fatigued uterus. It is also used to combat surgical shock. It is given by hypodermic, intramuscularly of intravenously, in solution -the dose being 16 to 20 M. (0.6-1.3 mils). D. DRUGS WHICH LOWER BLOOD-PRESSURE THE VASODILATORS Amyl Nitrite (Amylis Nitris) This is a clear yellow liquid with an unmistakable, pun- gent odor. It is given by inhalation in a dose of 0.18 mil (Tqiii). Nitroglycerin has an action similar to amyl nitrite. It is given by hypodermic injection or by mouth in the form of the 1 per cent, spiritus glycerylis nitratis, in a dosage of about one minim (0.06 mil) containing 0.0006 Gm. (gr. 1/x00). A tablet containing this amount is much used. Sodium nitrite gives a result more lasting than nitro- glycerine. It is given in a dosage of 1 to 3 grains (0.06 to 0.20 Gm.) It is somewhat irritating to the stomach. Sweet spirit of nitre (Spiritus Cheris Nitrosi) is a well known household remedy. It contains 4 per cent, of ethyl nitrite in alcohol. The dose is 30 to 90 minims (2 to 6 mils) given in water. Physiological Action.-When amyl nitrite is inhaled or nitroglycerin given by hypodermic injection, a flushing of the face and a throbbing of the temporal arteries occur. The pulse and respiration become hurried, and the blood- pressure falls and remains low for a little while. The effect of nitrite of amyl comes in about thirty seconds; of nitro- glycerin in about ten minutes. The lowering of the blood-pressure occurs because these 90 MATERIA MEDICA AND THERAPEUTICS drugs, being absorbed, act on the nerves and muscle in the walls of the smaller arteries, causing the muscle to relax and increasing the calibre of the vessels, especially the ves- sels of the abdomen and brain. It is held by some authorities that they have an opposite effect on the vessels of the lung, contracting them till they are practically bloodless. These drugs do not act on the heart. They help the heart by lessen- ing the pressure against which it works when that pressure is too high. Therapeutic Uses.-These drugs are used in diseases accompanied by high blood-pressure-Bright's disease, uraemic coma, angina pectoris, and asthma. In pneumonia and in the hemorrhage from tuberculosis, the nitrites are also used. QUESTIONS i. What is aconite? To what does it owe its properties? Name two preparations and give doses. 2. How does aconite act on the sensory nerves? on the blood- vessels? on the heart? on the temperature? 3. What are the therapeutic uses of aconite? What are the symptoms and treatment of aconite poisoning? 4. What is hellebore? Does it contain an alkaloid? Give two preparations and doses. Compare the physiological action of this drug with aconite. What are its therapeutic uses? 5. What is digitalis? What important principle does it contain? Name three important preparations and their doses. 6. In what three ways does digitalis act on the heart? How does it relieve dropsy? How does it affect the kidney? What may occur when digitalis has been taken over a long period and why? How would you detect this condition ? 7. For what purposes is digitalis given in therapeutics? Is it a good emergency heart stimulant? What are its disadvantages? How are the preparations given? 8. What is strophanthus? What is'its active principle? How does it compare with digitalis in its physiological action? What are its properties? How should they be given and in what doses? DRUGS AND MEDICINES 91 g. Name three drugs that primarily increase blood-pressure. What is ergot? How does it act in moderate doses? in large doses? What may occur after long-continued use of ergot? io. What are the therapeutic uses of ergot? For what condition is it used in obstetrical practice? What is the use of the fluid- extract ? li. How do adrenalin and suprarenalin act? How are they given and in what doses? Are they effective when given by mouth? How do they act locally? What uses do they have in surgery? 12. What parts of the nervous system does strychnia affect most markedly? How does its action affect the heart? the pulse? the respiration? What is the effect of small doses of strychnia? of poisonous doses? How is death produced in strychnia poisoning? 13. For what purpose are strychnia and nux vomica used in therapeutics? How does the effect of strychnia on the heart differ from that of digitalis? Is strychnia a good emergency heart stimu- lant? What effect does overdosage produce? Give the names and doses of four preparations. 14. Give the treatment of strychnia poisoning. IV.-DRUGS USED TO AFFECT THE ALIMENTARY FUNCTION (A) Drugs Acting on the Purgative oils. Stomach : Mineral oils and enemata. Bitter stomachics. Peristaltic tonics : The aromatics or carmin Eserine and hormonal. The aromatics or carmin- (2) Drugs decreasing peristal- atives. sis: Emetics. Opium. (B) Drugs Acting on the In- (C) Drugs Acing Locally on testine: the Alimentary Tract (1) Drugs increasing peri- andon Its Contents: stalsis: Digestants: Cathartics. Pepsin. Saline cathartics and Pancreatin. " salt action." The antacids. Vegetable purgatives : The acids. Senna. Hydrochloric acid. Cascara sagrada. Protectives: Aloe. Bismuth and cerium. 92 MATERIA MEDICA AND THERAPEUTICS Among the drugs given for the purpose of affecting the alimentary tract the emetics and cathartics are the most important. The stomachics, which include the bitters and the aromatics are of less value medically. A. DRUGS ACTING ON THE STOMACH Bitter Stomachics The bitter stomachics include practically all of the bitter vegetable drugs. Their bitter taste is believed to stimulate the secretion of gastric juice and to induce hunger. Gentian, with its compound tincture, calumba, with its tincture, and quassia, also with an official tincture, are the best known of the bitters. Important Preparations Tincture of Gentian (Tinctura Gentiana Composita), 3i to iv (4-16 mils). Tincture of Calumba (Tinctura Calumbae) 3i to ii (4-8 mils). Tincture of Quassia (Tinctura Quassiae) 3ss to i (2-4 mils). The bitters should be given on an empty stomach before meals. An infusion of quassia made from two ounces of quassia wood to a pint of hot water is used as an injection in the treatment of pin-worms. The Aromatics or Carminatives The aromatics are a large group of plant derivatives, including most of the volatile oils and many oleoresins. A list of the aromatics would include practically all of the spices and flavoring materials used in pharmacy and in the household. These remedies are used for the same purpose as the bitters, but are believed to be especially useful in promoting stomach and intestinal peristalsis when flatus is DRUGS AND MEDICINES 93 present. They are also useful as vehicles and flavoring agents and have antiseptic and anaesthetic properties. Among the more important aromatics are peppermint and its products, oil of peppermint and menthol, oil of winter- green, capsicum, ginger and the flavoring oils and spices. These will be found under separate headings in the Refer- ence Table. Important Preparations Tincture of Capsicum (Tinctura Capsicii) . .5 to 15 M. (0.06-0.2 Gm.) Menthol 1 to 2 gr. (0.06-0.12 Gm.) Essence of Peppermint (Spiritus Menthae Piperitae). .30 M. (2 mils) Menthol, combined with various other aromatics, is much employed in the treatment of catarrhal affections of the nose and throat, being usually used in a solution in liquid petrolatum of 1 per cent, or less. As a counterirritant for neuralgia and headache it is a basic constituent of the many " analgesic balms " sold in the pharmacies. Emetics Emetics are of two general classes: those which empty the stomach through action on the vomiting centre in the medulla, and those which act by irritating the mucous mem- brane of the stomach. Most emetics belong to the latter class. Emetics are employed to empty the stomach of noxious or poisonous material and sometimes to relieve laryngeal spasm, as in the croup of children. As mentioned before, the emetic drugs in small doses increase bronchial secretion and act as expectorants. Emetics should not be used when a rise of blood-pressure would be dangerous, as in senility, obesity, and arterio- sclerosis, and should be used with caution in pregnancy. 94 MATERIA MEDICA AND THERAPEUTICS Apomorphine Hydrochloride (apormorphinae hydro- chloridi) is an emetic acting on the vomiting centre. It is discussed fully with the preparations of opium. Ipecac (ipecacuanha) is the root of the cephalis ipe- cacuanha and other species of the ipecac family, small shrubs which are native to South America. Ipecac contains three alkaloids, the most active of which is emetine. Preparations Ipecac (Ipecacuanha)... as an emetic 30 gr. (2 Gm.). Hydrochloride of Emetine (Emetinae Hydrochloridum), gr. % to 54 (0.03-0.06 Gm ). Powder of Ipecac and Opium (Pulvis Ipecacuanhas et Opii (Dover's powder) gr. x (0.6 Gm.). Syrup of Ipecac (Syrupus Ipecacuanhas). .as an emetic, 3iv (15 mils) ; expectorant, M. xv (1 mil). A number of mineral substances used as emetics are considered with " Astringents." A familiar household remedy often used as an emetic is mustard water, made by stirring a heaping teaspoonful of mustard into a glass of cold water. Concentrated salt water is another available emergency emetic. The hydrochloride of emetine given by hypodermic in- jection, or in a tablet form not soluble in the stomach, has been very successfully used in amoebic dysentery and in the treatment of pyorrhoea alveolaris of amoebic origin. B. DRUGS ACTING ON THE INTESTINES (1) Drugs Increasing Peristalsis CATHARTICS The primary action of cathartics is to empty the bowels. The secondary effects to be obtained from this action include the lessening of intestinal intoxication, the depletion of the circulation, especially in the case of dropsical effusions, and DRUGS AND MEDICINES 95 the removal of locally irritating substances from the bowel and rectum. Cathartics act by stimulating the peristaltic action of the intestine and at the same time increase the bulk and fluidity of intestinal contents. Peristaltic tonics simply increase the intensity of peri- stalsis and being given hypodermically have no local action on the mucous membrane of the intestine or on its contents. The cathartics will be divided here into four main groups: (i) the saline cathartics; (2) the vegetable cathartics; (3) the purgative oils; (4) the mercurials. (Discussed under " Mercury.") SALINE CATHARTICS AND " SALT ACTION " Sulphate of Magnesia, Sulphate of Soda, Phosphate of Soda, Tartrate of Potassium and Soda We have found that certain substances known as salts are much used in medicine. Physiology teaches that similar substances also exist in all of the tissues and fluids of the animal body. Of course all of these substances are absorbed through the stomach and intestine, and the rate of absorp- tion of different chemical salts depends upon certain well- known physical laws, and also on certain less-known prop- erties of living tissue. In general, it may be said that the constant effort of the body is to keep the amount of salts in the tissues at a certain definite concentration. It has been found that, normally, 9 parts of sodium chloride or common salt exist in every 1000 parts of human blood. So the sen- sation of thirst after taking an unusual amount of common salt in food is a wise provision of the body in calling for water to dilute the over-concentrated body fluids. Plainly, then, the various salts have various rates of absorption; some of them are readily absorbed, others not at all, and the 96 MATERIA MEDICA AND THERAPEUTICS changes in the tissues of the body which result from these differences of absorption are known as " salt action." To illustrate: If a dog with an open wound in his large intestine should be fed a normal salt (0.9 per cent.) solution, it will be found that little or no fluid will escape through the wound; most of it will have been absorbed before reaching that portion of the intestine. Let, however, a weak solution of magnesium sulphate or any of the other saline cathartics be fed to the animal, and very soon fluid will flow freely from the wound, showing that it is not easily absorbed. But, still further, if a concentrated solution of magnesium sulphate be administered, the fluid escaping from the wound will be greater than the amount ingested. The concentrated saline, therefore, not only is not absorbed itself, but pre- vents the absorption of the rest of the fluid portion of the intestinal contents. So, chlorides, as also iodides and bro- mides, and some other salts, are absorbed with more or less ease; but sulphates, phosphates, tartrates, and especially the salts of magnesia, are absorbed with difficulty and pass with the water dissolving them to the large intestine. If given in concentrated solution, these salts may even deplete the intestinal blood-vessels by robbing them of water. Since most of the fluid of the body is absorbed in the last portion of the small and one-half of the large intestine, the giving of a saline cathartic, which prevents this absorption, or even increases the secretion of fluid from the intestinal wall, pro- duces the same effect, mechanically, as a high enema, and flushes the intestine from above. Physiological Action.-The mechanical action of these drugs has already been explained, and also their power of absorbing water from the blood-vessels of the intestine. The vegetable cathartics act in a different way, that is, by irritating the nerves of the intestinal membrane and DRUGS AND MEDICINES 97 increasing the contractions of the intestine (peristalsis, see physiology). Therapeutic Uses.-These saline drugs are used as cathartics when a quick-acting and non-irritating purgative is needed, as in the headache and fever due to constipation and putrefaction of intestinal contents (so-called " bilious attacks ") and in the beginning of various infections and contagious diseases. Given in concentrated solution on an empty stomach, many of these purgatives will flush out the intestine within an hour. When there is dropsy, as in heart, kidney, or liver disease, these remedies deplete the circulation of the abdomen by the evacuation of the fluid through the bowel. Mode of Administration and Dose.-Sulphate of Mag- nesia (Magnesii Sulphas-Epsom Salt).-Occurs as coarse crystals, soluble in 0.85 parts of water. The dose is 16 Gm. (5iv-J^ to 1 tablespoon) in solution, preferably given in the morning in hot water, concentrated, and on an empty stomach. Tartrate of Potassium and Sodium (Sodii et Potassii Tartaras-Rochelle Salt).-A white powder soluble in 1.2 parts of water. Dose 8 Gm. (5ii)-2 teaspoonfuls. A well- known preparation is the compound effervescing powder or Seidlitz pozvder. The blue paper contains bicarbonate of soda, 2.58 Gm. (gr. xi) ; Rochelle Salt, 7.75 Gm. (5ii). The white paper contains tartaric acid, 2.25 Gm. (gr. xxxv). On dissolving each in one-half glass of water and mixing the solutions, an effervescing draught is produced. Phosphate of Soda (Sodii Phosphas).-Occurs as a granular powder. The dose is the same as Epsom Salt. Another favorite saline purgative is the solution of the citrate of magnesia. This is given in a dose of to 1 bottle, i.e., 180 to 360 mils. " Milk of magnesia " is a tasteless 98 MATERIA MEDICA AND THERAPEUTICS liquid preparation used especially for infants in the dose of one to four teaspoonfuls. VEGETABLE PURGATIVES. SENNA, CASCARA, AND ALOES Senna is the dried leaves of the Cassia acutifolia and is raised extensively in Egypt. It contains a glucoside, cathar- tinic acid. The best known preparation of senna is the compound licorice powder (pulvis glycyrrhizae compositus), which con- tains in addition sulphur, sugar, licorice, and aromatics. The dose of compound licorice powder is 4 Gm. (5i). There is a fluidextract, a syrup, and also the compound infusion of senna. Cascara Sagrada, the dried bark of Rhamnus Purshiana, contains a glucoside called cascarin. The fluidextract and aromatic fluidextract are given in doses of 1 mil (in,xv). The extract has a dosage of 0.25 Gm. (gr. iv). Aloe.-The evaporated juice of the leaves of several species of aloe. This also contains a neutral principle called aloin, which has the properties of the drug. Its preparations are as follows: purified aloes, 0.25 Gm. (gr. iv) ; extract of aloes, 0.125 Gm. (gr. ii) ; tincture of aloes, 2 mils (5ss); aloin, 0.0065 Gm. (gr. %). There are several official pills containing aloes. The pill laxative compound, known also as pill of aloin, strych- nia, and belladonna, is much used. The compound cathartic pill (Pilulae Catharticae Com- positae) contains calomel with colocynth, podophyllin, and other actively cathartic drugs. Phenolphthalein, a coal-tar derivative, has recently been added to the list of purgatives. It is given in a dose of 0.06 Gm. (gr. i), preferably in pill or tablet. DRUGS AND MEDICINES 99 PURGATIVE OILS Castor Oil (Oleum Ricini).-A fixed oil expressed from the seed of the Ricinus communis. It contains a cathartic principle called ricinolein. The dose is 15 mils (gss). Croton Oil (Oleum Tiglii).-A fixed oil expressed from the seed of the Croton tiglium. This oil contains crotonoleic acid, and the dose is 0.06 mil (iqi). Physiological Action.-On another page attention was called to the fact that saline cathartics act by preventing the absorption of water and keeping the intestinal contents liquid. Vegetable cathartics act in a different way. They irritate the terminations of the delicate nerves in the mucous membrane of the intestine. As a result, there is an in- creased blood supply to this membrane, and increased out- pouring of the watery secretion of the glands, and also an increased vigor in the peristalsis, or movement, of the intes- tines through the greater irritability of its coat of muscle fibres. Certain other remedies used in treating constipation, while not active purgatives, must be considered here. MINERAL OIL AND ENEMATA The use of mineral oil (also called Russian oil, and offi- cially known as Petrolatum Liquidum, liquid petrolatum), in constipation introduces a class of remedies which may be said to act mechanically. Petrolatum is not absorbed, and softens up fecal masses in the colon and rectum, so as to allow of their easier expulsion. The average dose is 5iv (16 mils) once to three times daily. Enemata were considered under " Medication," and their technic is adequately covered in nursing manuals. Agar, a dried mucilaginous substance extracted from certain Asiatic sea-weeds, has the property of absorbing 100 MATERIA MEDICA AND THERAPEUTICS water very slowly and thus carrying fluid into the large bowel and rectum. It is fully considered in the Reference Table. Its average dose is 3iiss (io Gm.), to be eaten mixed with cereal, preferably in the evening. There are no satisfactory purgatives that may be given by hypodermic injection. Purgatives have been arbitrarily divided into laxatives, cholagogues, cathartics, etc. But this division is only a question of the relative strength of the various drugs. A laxative given in a large dose will have a cathartic action; a cathartic given in a small dose will act as a laxative. Therapeutic Uses.-In ordinary constipation the vege- table purgatives, singly or combined, have a frequent use. For habitual constipation, a laxative pill of a purgative with belladonna and strychnia is most frequently employed. Purgatives are much employed at the onset of fevers (see calomel), in disease of the brain, and in conditions in which dropsy or oedema is found. When diarrhoea is caused by irritants in the intestine, purgatives aid the natural effort of the bowel to expel the irritating substance. Castor oil has a frequent use in this form of diarrhoea. When a drug of small bulk is desired, as in mania, uraemic coma, eclampsia, etc., croton oil is fre- quently mixed with olive oil and dropped on the tongue. Aloes is given in amenorrhoea to increase the blood supply of the pelvis. The use of the liquid petrolatum, or mineral oil, together with agar has many advocates in the treatment of chronic constipation. All purgatives act as intestinal antiseptics and remove from the intestine decomposing food, the absorption of which causes the well-known autointoxication, symptoms of lassitude, furred tongue, headache, etc., commonly known as " biliousness." As a matter of fact, few purgatives increase DRUGS AND MEDICINES 101 the flow of bile; there are few true cholagogues. Bile is necessary in the intestine to make resinous purgatives active. Time Required to Act.-Large doses of croton oil act inside of two or three hours. An eruption and violent intes- tinal irritation may follow excessive doses. Cascara, castor oil and senna require from five to ten hours. Aloes and aloin take twelve hours or longer to give their full action. The saline purgatives, it will be remem- bered, act in one or two hours. Contra-indications.-Mild purges should not be given in obstinate constipation, for here they only produce unpro- ductive intestinal spasm and colic. An effective enema should be given when this result occurs. In menstruation and in pregnancy, violent purges, especially of aloes, etc., may cause increased uterine congestion, even up to the point of abortion. In collapse and intense anaemia, drastic purgatives are not to be used; enemas or mild purgatives are preferable. The property of aloes in increasing the pelvic and especially the rectal blood supply, renders the use of aloes inadvisable in persons suffering from hemorrhoids. Administration.-Many of the vegetable purgatives are given in pill form. The compound licorice powder gives senna in an agreeable form for children. Castor oil is best given floated on the foam of carbonated water after being chilled by ice or in orange juice or brandy. Many, so-called, tasteless castor oils are sold for the use of children; also castor oil is furnished in flexible gelatin capsules. THE PERISTALTIC TONICS ESERINE AND HARM0N0L Physostigmine or eserine (see p. 131) is used by hypoder- mic injection in intestinal atony to increase the peristalsis by stimulating the smooth muscle of the intestine. 102 MATERIA MEDICA AND THERAPEUTICS Hormonol, a fluid rich in cholin, prepared from the spleen of an overfed rabbit, has a similar action and use. It is not official. Hormonol is given by hypodermic injection in rather large doses (see p. 184). (2) Drugs Decreasing Peristalsis opium Opium and its alkaloids decreases both the secretion and peristaltic action of the intestines. Its action is described on p. 72. C. DRUGS ACTING LOCALLY ON THE ALIMENTARY TRACT AND ON ITS CONTENTS A number of drugs are used to modify the nature of the contents of the alimentary tract, as the digestants, pepsin, pancreatin, etc., the acids, as hydrochloric acid, and the antacids, as sodium bicarbonate, etc., while others act locally as protectives to the mucous membranes, usually also with a slight astringent action. Digestants pepsin Pepsin occurs in the form of yellowish scales. It is obtained by scraping the lining of the pig's stomach and drying the resulting glutinous material on glass plates. It is used in combination with diluted hydrochloric acid when the stomach secretions are known to be deficient. The dose of pepsin is 0.3 to 0.6 Gm. (gr. v to x). Several palatable preparations of pepsin are largely and often needlessly used as vehicles for other medicines, as essence of pepsin, elixir of lactated pepsin, etc. These are given in dosage of 4 to 16 mils (Si to 5iv) after meals. PANCREATIN Pancreatin is a grayish powder obtained by drying the juice of the pancreas of the pig. It is used in indigestion DRUGS AND MEDICINES 103 of intestinal origin, in doses of o.i to 0.3 Gm. (gr. ii to v), given two hours after meals. The Antacids The carbonate and bicarbonates of sodium and potas- sium are alkaline in reaction and decompose acids. The carbonate of calcium, or chalk, is one of the insoluble mild alkalies, while the oxide and carbonate of magnesia are laxative as well as antacid. The bicarbonate of soda and the carbonate of calcium (or prepared chalk) are much used in gastric hyperacidity, having a purely chemical action in neutralizing the over- acid stomach contents. The familiar lime-water is also used for the same purpose. The heavy calcined magnesia and the milk of magnesia are laxative as well as antacid. Bicarbonate of soda has come into use recently as the most reliable remedy in the treatment of acidosis, given either by mouth, or in 4 to 5 per cent, solution intravenously, or by rectum. As a preventive of acidosis following anaes- thesia it is frequently given in 4 per cent, solution together with 4 per cent, dextrose, per rectum, before and after operation. When a solution of bicarbonate of soda is boiled it changes into the carbonate, which is a much more irri- tating salt. The bicarbonate should be sterilized by dry heat and dissolved in sterile water as needed, especially if the solution is to be used intravenously. Important Preparations and Doses Bicarbonate of Soda (Sodia Bicarbonatas) ... .Dose gr. xv (1 Gm.) Prepared Chalk (Creta Praeparata) Dose gr. xv (1 Gm.) Lime-water (Liquor Calcis) Dose 5iv (15 mils) Heavy Magnesia (Magnesii Oxidum Ponderosum), Dose gr. xxx (2 Gm.) Milk of Magnesia (Magma Magnesiae) Dose 3iiss (10 mils) 104 MATERIA MEDICA AND THERAPEUTICS The Acids HYDROCHLORIC ACID Hydrochloric acid is used in medicine in the form of the diluted hydrochloric acid, which contains io per cent, abso- lute acid, about one-third the strength of the concentrated. The stomach normally contains in the gastric juice about 0.2 per cent, of hydrochloric acid. In cases of deficient acid secretion this remedy is administered after meals, well diluted, through a tube, as otherwise the teeth may be cor- roded. The mouth should be well rinsed afterward. The average dose is mxv (i mil). Protectives BISMUTH AND CERIUM Subcarbonate of bismuth is a white, heavy, insoluble powder. It is a protective and mild astringent, and is used in therapeutics to protect irritated mucous membranes. Hence, it is given by mouth in irritable vomiting, gastric ulcer, and as a protective and astringent in diarrhoea. Locally, " bismuth paste " is injected into tuberculous sinuses, and large a.counts of bismuth are given by mouth by the radiographer in order to obtain details of the ali- mentary tract in X-ray plates. Dose 0.5 to 4 Gm. (gr. viii to 5i) in powder or sus- pended in mucilage. It colors the stools black. After exten- sive use of bismuth salts, either internally in large doses, or locally, as bismuth paste, certain toxic symptoms have been noticed, including gastric and intestinal irritation, a black line around the gums, and prostration with great depression of the circulation. These symptoms should not go unob- served ; they are more noticeable when the subnitrate is used. DRUGS AND MEDICINES 105 Oxalate of cerium resembles bismuth subnitrate in its physical as well as its therapeutic properties, but its dose is 0.06 to 0.3 Gm. (gr. i to v). QUESTIONS 1. What is meant by salt action? How does salt action affect the saline cathartics? Name three saline cathartics and state briefly how they act. What are their therapeutic uses ? How do they relieve " bilious attacks " ? Give the doses and mode of administering three saline cathartics. 2. Name two emetics easily obtained. 3. Name three vegetable purgatives. What vegetable purgative does compound licorice powder contain? What is the active prin- ciple of cascara? Give doses of two preparations of the latter. What is the active principle of aloe? What is the dose of aloe? of its active principle? What is the compound laxative pill? 4. Name two purgative oils. Give the dose of each. How does the action of vegetable purgatives differ from that of saline purga- tives? Give several conditions in which vegetable purgatives are useful. Why are they used in " biliousness " ? 5. How long a time is required for the action of croton, oil? of castor oil and cascara? of aloes and aloin? When are purgatives contra-indicated? Give the best method of administration of senna, of castor oil, of cascara and aloin. ALTERATIVES AND DRUGS MODIFYING METABOLISM A. Alteratives: B. Hematinics: The iodides. Iron. Arsenic. Arsenic. Iron. C. Drugs which increase im- Mercury. munity: Thyroid extract. Antitoxins and vaccines. Tuberculins. A. Alteratives A number of drugs have been grouped together as " alteratives," or " tonics," whose beneficial action is based 106 MATERIA MEDICA AND THERAPEUTICS more on clinical experience than exact physiological knowl- edge. There is, of course, a chemical reason for the action of iron, and, for the antisyphilitic remedies, a biological reason-but to explain the action of arsenic and mercury in non-specific anaemia, for example, is not so easy. The Iodides Iodide of Potassium. Sodium. Ammonium. Potassii Sodii Ammonii lodidum. All of these salts resemble their sister salts, the bromides, in many respects. All possess a salty taste and are freely soluble in water. One hundred Gm. of iodide of potassium will dissolve in 75 mils of water at ordinary temperature. Physiological Action. Excretion.-Iodides are ex- creted by the skin and mucous membranes, and are supposed to owe their virtues to the liberation of iodine in these and other tissues of the body. It is for this reason that iodides are known as alteratives,-from their supposed ability to stimulate tissues to healthy reaction. lodism.-Some individuals cannot tolerate even small doses of the iodides-they are said to have an idiosyncrasy toward this drug, which means an unexplained susceptibil- ity to its action. In such individuals, or when fairly large doses have been taken, symptoms referable to iodism, i.e., iodide saturation, appear. First, the patient complains of frontal headache, then a catarrh of the nose may appear, with reddened eyelids, or sneezing, or sore throat. Very often skin eruptions similar to those seen in bromism appear. These symptoms are due to the irritating and stimulating action of iodine on the lining membrane of the nose, throat, and trachea. When a patient is taking iodides, the fore- DRUGS AND MEDICINES 107 going symptoms should be carefully watched for and placed on the record w'hen they appear. Therapeutic Uses. Antisyphilitic.-Iodides are almost specific in their action in the later stages of syphilis. Doses even up to 4 Gm. (5i) three times daily are used in this dis- ease, especially when the brain is involved. Expectorant.-Their stimulating action on the bronchial mucous membrane render iodides invaluable in coughs and asthma where the bronchial secretion is scanty. Alterative.-In the so-called chronic rheumatisms and in pleurisy with effusion, iodides have long been credited with curative or palliative virtues. The many patented " sarsa- parilla " nostrums contain iodides. Also in thyroid gland diseases, in arteriosclerosis, and in lead and mercury poison- ing, iodides have been used extensively. Precautions.-Since iodides are excreted by the skin and mucous membranes, they are liable to irritate these membranes. Therefore, patients should be carefully and frequently bathed, and their teeth and mouths cleansed and frequently examined. Gastric irritation is not uncommon among those who take iodides. Administration.-All the iodides may be given in doses of from 0.5 to 4 Gm. (gr. viii to 5i). They are usually given in a saturated solution, one drop of which contains about one grain of the drug. The dose is increased by one drop daily until the desired amount is given, or symptoms of iodism appear. Milk is a good fluid in which to give iodides. Iodides should be given about an hour after food. Two syrups containing iodine are used in medicine: syrup of hydriodic acid, dose 2 to 4 mils (TQxxx to 5i), and syrup of iodide of iron, dose 0.5 to 1 mil (TQ,viii to xv). Tincture of iodine (tinctura iodi), about 7 per cent, iodide-dose "Bliss (0.1 mil)-is used as a counterirritant and antiseptic externally; internally in thyroid disease. 108 MATERIA MEDICA AND THERAPEUTICS Arsenic (Arseni Trioxidum) ARSENIC TRIOXIDE, ARSENOUS ACID, WHITE ARSENIC The metal arsenic of itself is not used in medicine. The trioxide, one of its salts which has a very extensive use, is a white lumpy powder, very slightly soluble in water, and with a slightly sweetish taste. Physiological Action.-On the skin, when applied for some time, it acts as an irritant or corrosive. The nervous system shows disease of the nerves, especially of the extremities (neuritis) after poisonous doses, proving that the drug stimulates or irritates these nerves. On the stomach it acts as an irritant, increasing the blood supply. On the blood it is believed to exert an influence through the red bone-marrow, influencing the latter to form more red cells. On the viscera, fatty degeneration of the liver, kidney, etc., has been noticed after large doses. However, in spite of its powerful irritant and caustic effects on the body tissues, a decided tolerance may be established for arsenic by gradually increasing the dosage. In certain parts of the Tyrol and Styria natives eat an earth containing arsenic to improve their personal appearance, and consume large quantities of the poison with apparently no ill effects. Therapeutic Uses.-As a caustic, on account of its cor- rosive action, it is used as a paste in cancer, to destroy the nerve pulp of teeth in dentistry, and whenever a slow-acting caustic is needed. In the various blood conditions known as ancemias, especially those in which the number of red cells is diminished, arsenic is used extensively. In neuralgia and chorea it is employed for its supposed stimulating effect on nervous tissue, and in certain chronic skin diseases it is also given internally. The well-nigh specific effects of salvarsan (606) and neosalvarsan in syphilis, especially in removing DRUGS AND MEDICINES 109 the secondary lesions, are well known. It must be used in repeated doses, alternating with mercurial treatment. In disease of the kidneys and the blood-vessels its use is not advised, as sudden fatalities have occurred following injec- tion in these conditions. Untoward Effects.-When arsenic has been given for a while and the dose is gradually increased, most individuals show a peculiar puffiness of the eyelids. This symptom should be looked for and recorded on the chart if seen, whenever a patient is given an arsenic preparation. This oedema of the eyelids, like iodism and bromism, is evidence that the therapeutic limit has been reached in the dose of the drug. Preparations, Doses, and Administration.-Solution of Arsenite of Potassium (Liquor Potassii Arsenitis-Fow- ler's Solution). Solution of Arsenate of Sodium (Liquor Sodii Arsenatis). Solution of Iodide of Arsenic and Mer- cury (Liquor Arseni et Hydrargyri lodidi-Donovan's Solu- tion).-All of these preparations contain I per cent, of arsenic. They are best given in water after meals, in increas- ing doses, till the desired effect is obtained. The dose to begin with is usually 0.2 mil (TTLiii), increased by one drop daily. Fowler's solution is used almost to the exclusion of the other preparations. The arsenic trioxide, in its original form, is given in pill or tablet 0.002 Gm. (gr. 1/30), gradually increased. Three non-official pills, Blaud's compound pill, pill of quinine com- pound, and pill of sumbul compound, contain arsenic. Salvarsan (606) is an organic compound of arsenic. It occurs as a sulphur-yellow powder in small sealed glass tubes, which is rendered easily soluble in water by the addi- tion of an alkali. The average dose is 0.6 Gm. in alkalinized solution given intravenously. It is too irritating to be used 110 MATERIA MEDICA AND THERAPEUTICS subcutaneously. Neosalvarsan, a soluble modification, is given in an initial dose of 0.8 Gm. Poisonous Doses, Symptoms and Treatment.-Two kinds of arsenical poisoning may occur, the acute and the chronic. The acute usually occurs from the swallowing of rough-on-rats, Paris green, or the ordinary white arsenic or its official preparations, through mistake or with suicidal intent; the chronic, through inhalation of arsenic dust from wall-paper, or in certain occupations. Acute Arsenic Poisoning.-The patient complains of a tightness in the throat, and great pain in the stomach region. Diarrhoea occurs, culminating in typical rice-water stools. There is much prostration, retching, and vomiting, and often complete suppression of the urinary secretion. Violent head- ache and pains in the muscles, followred by collapse and coma, occur in fatal cases. Death may ensue in twenty-four hours or may be delayed some days. Treatment of Acute Poisoning.-Evacuate the stomach immediately, either by the administration of mustard water, or apomorphine, gr. 1/10, by hypodermic, or by the stomach tube. Wash the stomach out well if the latter is used. The hydrated oxide of iron and magnesia is the official antidote for arsenic, but it is seldom available and there is much doubt as to its efficiency, or the efficiency of any chemical antidote for arsenic. Keep the patient quiet, and if the diarrhoea has not commenced, give by rectum 250 mils of coffee (§viii) made very strong. Morphine may be required for the pain and diarrhoea. Iron Iron differs from most metals in being found in, and being essential to, the structure of many if not all forms of living matter, both animal and vegetable. There are, DRUGS AND MEDICINES 111 therefore, two kinds of iron compounds-the organic and the inorganic. The ordinary salts of iron are types of the inorganic iron; the haemoglobin of the blood, the type of the organic or albumin iron. Physiological Action.-When a solution of a soluble iron salt, such as the chloride, is added to albumin, it pre- cipitates the latter, forming a compound known as an albu- minate. Mercury preparations destroy and corrode albu- min ; iron, however, simply makes the albumin insoluble, and has no corrosive action. Therefore when a soluble preparation of iron is taken by mouth, an astringent metallic taste is produced, and in ordinary doses, no other effect is observed. Disturbance of the stomach and bowels may come from large quantities of iron at one time, and vomiting, gastritis, etc., may be the result. Constipation and dyspepsia may follow the long- continued use of iron salts, but the chief use of iron, thera- peutically, is its long-reputed ability to increase the content of haemoglobin in the red blood-cells, as well as its stimulating action in increasing the number of white cells. How and where iron is absorbed has long been a problem. Absorption.-Iron is changed to an albuminate of iron in the stomach, and as such passes to the small intestine. Here, and in the large bowel, part of it is absorbed and passes into the portal circulation. By this route the organic iron passes to the spleen and then to the liver, and perhaps later, through the general circulation, to the bone-marrow. It is most likely that haemoglobin is manufactured in the liver from the ingested iron. The normal amount of iron absorbed in a day by an adult person is o.oi Gm. or gr. %, hence the uselessness of large doses which may irritate the large bowel or cause constipation. Therapeutic Action.-As a hamatinic or blood builder, 112 MATERIA MEDICA AND THERAPEUTICS iron is used in chlorosis and other anaemias, especially when the haemoglobin is deficient. It should not be used in fever nor in persons of a plethoric constitution, nor in patients with a gastritis of a severe grade. As an astringent, the tincture of chloride of iron is used in combination with glycerin as an application in tonsillitis. Various salts and solutions of iron have been used to apply to bleeding points as a styptic, but have fallen into disfavor in recent years. The sulphate (copperas) has some use as a disinfectant of vaults, etc. Important Preparations and Administration.- Pills of carbonate of iron (Pilula Ferri Carbonatis-Blaud's pills), dose 2 pills; tincture of chloride of iron (Tinctura Ferri Chloridi-muriated tincture), 0.5 mils (ntviii) ; solu- tion of acetate of iron and ammonia (Liquor Ferri Am- monii Acetatis-Basham's mixture), 16 mils (5iv) ; elixir of phosphate of iron, quinine, and strychnia (elixir F. Q. & S), 4 mils (5i) ; sulphate of iron (Ferri Sulphas-copperas), 0.125 Gm. (gr. ii). All iron preparations should be given after meals to avoid stomach irritation. They should not be given in milk, except the unofficial peptonate of iron and manganese, which may be so given. Iron salts color the stools black when given internally and may discolor the teeth if the mouth is not well rinsed afterwards. Tincture of chloride of iron and syrup of iodide of iron should be well diluted and taken through a glass tube. Mercury The very soluble salts of mercury are very poisonous; the less soluble and insoluble salts are less poisonous. Mer- cury salts combine rapidly with albumin, destroying it and forming an albuminate which is quickly absorbed. By this DRUGS AND MEDICINES 113 property, which is shared by most germicides, the soluble salts of mercury kill germs and prevent their growth, hence they are germicides and antiseptics. Locally applied in strong solution, soluble salts of mercury are caustic. Preparations.-Mercury (Hydrargyrum-quicksilver) in its metallic form is used as the mass of mercury (blue pill) and mercury with chalk (gray powder), both of which are given in doses of 0.25 Gm. (gr. iv). Externally an ointment (blue ointment), a plaster, and the ointment of ammoniated mercury (white precipitate) are used. Corrosive Chloride of Mercury (Hydrargyri Chloridum Corrosivum-Corrosive Sublimate, Bichloride of Mercury, Mercuric Chloride).-This white crystalline powder is solu- ble in water and alcohol, about one part dissolving in six- teen of water. The addition of common salt or sal ammoniac makes it more soluble. The dose for internal use is 0.003 Gm. (gr. 1/20). Calomel (Hydrargyri Chloridum Mite-mild chloride of mercury, mercurowj chloride) is almost insoluble. It acts as an antiseptic on the stomach and intestinal contents, preventing fermentation and putrefaction. It is the most satisfactory intestinal antiseptic. By its irritant action on the walls of the intestine it stimulates intestinal secretion and intestinal movements, and hence is a violent cathartic, but has no action in increasing the secretion of bile by the liver. It relieves the liver by emptying the intestine. The green color of the stools is characteristic of calomel purgation even when bile is absent. Calomel also acts as a stimulant to the kidneys by a direct action on the secreting tubules (see physiology). * All the salts of mercury stimulate the building-up and breaking-down processes of the body tissues, known as metabolism, and are believed to have an especially beneficial 114 MATERIA MEDICA AND THERAPEUTICS action on the blood. Calomel is a white, insoluble, tasteless powder. As a purgative it is given in four to eight fractional doses every half hour to a total of 0.06 Gm. (gr. i), or in a single dose up to 0.5 Gm. (gr. viii). The Compound Cathartic Pill contains calomel. Green Iodide of Mercury (Hydrargyri Protoiodi-Proto- Iodide of Mercury).-This is an insoluble salt used princi- pally in pill form in doses of 0.01 Gm. (gr. %), gradually increased to the point of extreme toleration. The ointment of mercury (Ungentum Hydrargyri) is frequently given by inunction, rubbing a certain quantity on a portion of the skin surface of the body at intervals of a day to a few days, to obtain the constitutional effects of mercury. Poisoning.-The soluble salts of mercury may cause acute poisoning; the insoluble ones most frequently cause the chronic form of poisoning. The bichloride (corrosive subli- mate), taken in concentrated solution, will cause great pain, vomiting, a sense of burning in the stomach, and even con- vulsions and death. The antidote is milk or eggs in large quantities, the promotion of vomiting, and strong coffee by rectum. Chronic mercurial poisoning (salivation) sometimes fol- lows the administration of the mild chloride or other more or less insoluble salts of mercury, when they are allowed to remain for too long a period in the intestinal canal. For this reason a saline purgative is usually prescribed to follow calomel. Some individuals are very susceptible to mercury. The symptoms of salivation are a metallic taste, sore gums, ulcer- ations, loose teeth, loss of appetite, skin eruptions, etc. Often increasing doses of mercury are given till the therapeutic limit is reached. Tn patients taking mercury, DRUGS AND MEDICINES 115 soreness of the teeth on biting hard should always be looked for and placed on record when found. Therapeutic Uses.-As an antisyphilitic, especially in the earlier stages of the disease, the green iodide, the gray powder, the method of inunction, and the " mixed " treat- ment are used. The " mixed " treatment consists of a com- bination of bichloride of mercury in solution with iodide of potassium. As a diuretic, calomel in the form of Niemeyer's pill, a combination of calomel, digitalis, and squill, is much used in chronic Bright's disease, cirrhosis of the liver, and similar conditions. As an antiseptic and germicide, the bichloride is used in solutions of I to 500 to 1 to 10,000 in strength. To kill parasitic insects, lice, etc., the ointment of ammoniated mer- cury and the blue ointment are used. As a purgative and intestinal antiseptic, calomel has the greatest use. Children of any age may be given relatively large fractional doses, without ill effects. Gray powder is much in favor as an antisyphilitic for children. Thyroid Extract (Thyroideum Siccum) Thyroid gland and its extract when given in sufficient quantities have a marked action on the circulation and ner- vous system, as well as on the general nutrition. The pulse is quickened, the blood-pressure falls, while tremors in the limbs, loss of appetite, and diarrhoea, loss of flesh, excessive perspiration, and thirst are not unusual symptoms. Sugar and albumin often are found in the urine after thyroid treat- ment. The dried gland is used in medicine in dosage of 0.2 to 0.3 Gm. (gr. iii to v). lodothyrin, an iodine compound, is believed to represent the active principle of the gland. Therapeutics.-The dried gland is administered when, 116 MATERIA MEDICA AND THERAPEUTICS through disease or other injury, the normal secretion of the thyroid gland is lessened in amount. It seems that this gland gives to the blood substances necessary to the proper nutrition and nervous tone of our bodies. Certain rare forms of goitre and the diseases known as cretinism and myxoedema are conditions in which thyroid treatment accom- plishes good results. Many advertised obesity cures contain thyroid extract. Its indiscriminate use, however, is danger- ous, and it is also not very effective in reducing weight. C. REMEDIES WHICH INCREASE IMMUNITY Antitoxins and Vaccines When a bacterium produces an infection in an animal and proceeds to multiply and manufacture its particular poison or toxin, one of two things happen; either the bacteria in- crease in great numbers very rapidly and overwhelm the animal with a large amount of toxin, and death results, or they do not increase so rapidly, and the animal gradually recovers from the disease. Assuming for both animals an equal virulence of the infection, it would seem that the " resistance " of the recovered animal was better than that of the one that died. If the body has sufficient time and vitality for the work, it will manufacture its own antitoxin and recover from the disease. The power to neutralize the poison of the disease will remain in the animal's blood for a considerable time after recovery has taken place. These immunizing or antitoxic principles may also be generated in an animal either by injecting small quantities of attenuated bacterial cultures, or cultures of dead bacteria, or by simply injecting solutions of bacterial toxins. The practical utiliza- tion of this principle is seen in diphtheria antitoxin. DRUGS AND MEDICINES 117 DIPHTHERIA AND OTHER ANTITOXINS This antitoxin is the purified blood serum from a horse that has been rendered immune to the disease by gradual inoculation. Diphtheria antitoxin is obtained by injecting into a healthy horse an amount of filtered culture of the diphtheria bacillus, sufficient to make him ill, but not to produce death. When the animal has recovered from this injection, twice the amount is given to him, and this procedure is kept up until a dose one thousand times as strong as the original one has been given. The horse's blood is now loaded with antitoxic substances. From three to six litres of blood are withdrawn from the horse's veins; the blood is allowed to clot; the serum decanted and preserved by the addition of cresol or phenol. The strength of this serum is expressed in antitoxic units. A unit is that amount of serum which will completely neutra' lize the effect of 100 lethal doses of toxin in a guinea-pig weighing 250 grammes. Diphtheria antitoxin is given in order to produce in the affected individual a passive immunity against the toxin produced by the invading diphtheria bacillus. When this serum is injected into another animal, it renders diphtheria toxin harmless to that particular animal. Analogous preparations are used with good effect in epidemic meningitis and in tetanus. Tetanus antitoxin has an extensive use as a preventive measure against tetanus in deep infected wounds. It is also used, but not so successfully, in the treatment of acute tetanus. Antistreptococcus serum has been used in strepto- coccus infections, but the results have not been encourag- ing. The Rockefeller Institute has developed two types 118 MATERIA MEDICA AND THERAPEUTICS of serum corresponding to two large type groups of pneumococci. Cultures of sputum from the pneumonia patient injected into the peritoneum of a mouse are used to develop the type of coccus prevailing, and the type of serum which will agglutinate this culture is used. 100 mils or more are given daily intravenously. Marked serum reactions often follow. Antimeningococcus serum is a serum used in the treat- ment of meningococcus meningitis. When the infection is caused by exactly the same type of this organism as that used to cause the immunity in the animal from which the serum was obtained, the results of treatment are excellent. But it is believed that there are a good many " strains " or varie- ties of the bacteria of cerebrospinal meningitis. Vaccines Various bacterial vaccines, being emulsions of known quantities of killed bacteria, have come into use in the last few years. Their administration is believed to stimu- late the various resisting forces of the diseased body to the production of antibodies, " opsonins," etc. Those of the pus-producing organisms are the most in vogue and are used in gonorrhoeal arthritis, abscesses, acne, septicaemia, etc. Typhoid vaccine is used very successfully to produce immunity from the disease in the United States army, but its use in treatment seems limited and uncertain. The Pasteur treatment for rabies is practically a vaccine treatment. Tuberculins Tuberculins are filtrates, extracts, or suspensions of cultures of tubercule bacilli. They are used in the treatment of tuberculosis and in diagnosis. Very small quantities are given at first, the dose being started at fractions of a milli- gramme. Large doses produce very dangerous local and DRUGS AND MEDICINES 119 general reactions. As a diagnostic agent the tuberculin is injected and a general febrile reaction is then looked for. Or it is rubbed into a tiny skin abrasion (Von Pirquet's test) or rubbed in an ointment on the unbroken skin (Moro's test), or dropped in the eye (Calamette's test), a slight inflammation in each case showing the reaction. Bouillon filtrate, a 6 weeks' culture filtered; Old tuberculin, a 6 weeks' culture concentrated by evaporation and New tuberculin, (T.R.) or tuberculin residue, an extract of killed bacteria, and New tuberculin (B.E.), an emulsion of killed pulverized bacilli are among the various modifi- cations that are used. Administration of Vaccines and Antitoxins. Vaccines and serums are given by subcutaneous in- jection. In diphtheria, antitoxin is most frequently given between the shoulder-blades in doses of from 3000 to 10,000 units, repeated every eight hours if necessary until the temperature drops to at least ioo° and other symp- toms abate. The antitoxins are given either hypodermically or intra- venously, excepting in the case of the tetanus and meningitis sera, which in treatment are given by injection into the spinal canal. Immunizing doses of all of these sera are given hypodermically. The immunizing dose of diphtheria antitoxin is about 1000 units. This gives a brief immunity-usually a few weeks. Many individuals have in their blood normally an immunity against diphtheria. A simple test, in which fresh toxin is injected between the layers of the skin and known as the Shick test, will show conclusively whether a person has a natural or acquired immunity. A red spot appears within 24 hours in the susceptible individual. 120 MATERIA MEDICA AND THERAPEUTICS In the treatment of diphtheria many authorities recom- mend large initial doses of from 5000 to 10,000 units. Mix- tures of toxin and antitoxin are sometimes used to produce a longer period of immunity. Tetanus antitoxin is given in an immunizing dose of about 1500 units. In treatment from 25,000 to 200,000 units are injected into the spinal canal daily. The vaccines are given with an ordinary hypodermic syringe, from 10 to 3000 millions of bacteria in each dose according to the requirements of the case, and repeated not oftener than every third day. Untoward Effects.-Anaphylactic reactions or serum sickness, often appear in individuals who have been sensi- tized by previous injections of seruni from animals or in susceptible persons. Alarming asthma, urticaria, oedema, headache, and collapse-any or all of these symptoms may occur in individuals with a natural or acquired sensi- tization. QUESTIONS 1. Name three iodides. Why are they called alteratives ? What is iodismT Describe its symptoms. What are the therapeutic uses of the iodides? What precautions should be observed in giving them? Give doses and administration. 2. What is the action of arsenic on the skin? the nervous sys- tem? the stomach? the blood? What is its use in therapeutics? What unusual effects may be produced by its continued use? Name three solutions of arsenic, and how and in what doses are they given? Describe the symptoms and treatment of acute arsenic poisoning. What is Fowler's solution? 3. Name a well-known form of organic iron. How does iron affect the blood? How is it absorbed and in what daily quantity? What are its therapeutic uses? Give the proper name and dosage of Blaud's pill, muriated tincture of iron, Basham's mixture, cop- peras, elixir of F. Q. & S. 4. How should iron be given in relation to food? How do iron preparations affect the stools? DRUGS AND MEDICINES 121 5- How do mercury salts kill bacteria? Why are some salts of mercury more poisonous than others? What is the common name for mild chloride of mercury? What is the common name for the bichloride? Which causes acute poisoning? which chronic? De- scribe each form of poisoning. What is the treatment of acute poisoning? Name three preparations of metallic mercury, giving doses. What is the dose of the corrosive chloride? the mild chloride? the green iodide? 6. Name four therapeutic uses of mercury and its preparations. How used as a germicide? as a parasiticide? What is gray pow- der? Niemeyer's pill? VI. DRUGS WHICH DESTROY THE CAUSES OF DISEASE A. Anthelmintics: B. Drugs which destroy proto- Male fern (aspidium). zoa: Wormseed (santonica). Quinine (Quinina). Quassia. C. The disinfectants and Thymol. germicides. A number of diseases are caused or transmitted by living organisms, by bacteria, by the small parasites living in the body-fluids or tissues known as protozoa, and by animal parasites, usually worms, which inhabit the intestinal tract. Certain drugs and chemicals act on these organisms and destroy them, and are valued for this action rather than for any effect on the body-cells or fluids. We divide these reme- dies, therefore, into three main groups: I. Drugs which destroy intestinal parasites-anthel- mintics. 2. Drugs which destroy protozoa and other animal parasites. 3. Drugs which destroy bacteria-germicides. Certain of these remedies are so poisonous to man that they can be used only outside the body; others are used internally, being more toxic to the parasites than to the bodv-cells. 122 MATERIA MEDICA AND THERAPEUTICS A. ANTHELMINTICS Anthelmintics, or vermifuges, cause the death or expul- sion of intestinal worms. They usually act as muscle poisons to the parasitic worms, so that the latter are more easily expelled. It is essential, therefore, that in administering these remedies, the stomach and intestines should be almost empty, and they should be followed by a brisk purgative. It is best to give them in the morning and to allow the patient to take no food until noon. Calomel is frequently given with' the anthelmintic medicine, or a saline purgative adminis- tered about four hours afterward. Male Fern (Aspidium) The European male fem (Dryopterus filix-mas) and the native (Dryopterus marginal) are used to obtain the official oleoresin of male fern {Oleoresin aspidii). This is a thick black liquid, with a disagreeable taste. Action.-The male fern is a pronounced muscle poison, and while not usually absorbed, occasionally will produce convulsive movements, vomiting and purging. Blindness has resulted from excessive doses. Uses.-Oleoresin of male fem is employed in the cure of tapeworm. It is usually given in a single dose, while fasting, followed by a saline-never an oily purgative-the average single dose being gr. xxv (2 Gm.). Pumpkin seed and pomegranate are also used for this parasite. Wormseed (Santonica) Levant wormseed consists of the unexpended flower- heads of the Artemisia paucidora, and its active principle is Santonin. Santonin, although neutral in reaction, forms salts like an acid. It occurs in crystals which are soluble in alka- DRUGS AND MEDICINES 123 line solutions. While it is not usually harmful in ordinary dosage, it may produce marked toxic symptoms when given in excess, or when absorbed too rapidly. Vomiting, pallor, epileptiform convulsions and a peculiar yellow vision are the poison symptoms. Free evacuation of the bowels should be used when these symptoms appear. Uses.-Santonin is a specific remedy for the destruction of the ascarides or round worms. It is best given in tablet or capsule in the dose of gr. i to gr. iv (0.06 to 0.24 Gm.) on an empty stomach, followed by calomel or a saline purgative. The urine is usually stained yellow by santonin. Quassia Quassia, used as an infusion for rectal injection in the treatment of pin-worm, is considered elsewhere. Thymol Thymol is a camphor-like substance occurring in several essential oils, particularly the oil from Thymus vulgaris. It has a peculiar penetrating odor and taste. It is much used as an antiseptic in combination with other aromatic anti- septics in watery or oily solution in the treatment of nose and throat diseases. As a vermifuge it has been used with great success in the treatment of hook-worm disease, caused by the Anchylostoma duodenalis, as attested by the work of Ashford in Porto Rico. Ten to 30 grains (0.6-2 Gm.) are given in capsule every hour for three doses, followed by a saline purgative. Poison symptoms are pallor, subnormal temperature, ringing in the ears, sweating and delirium. The urine be- comes green. Absolute rest, stimulation and free evacuation is the treatment for poisoning with thymol. 124 MATERIA MEDICA AND THERAPEUTICS B. DRUGS WHICH DESTROY PROTOZOA A limited number of medicines when given by mouth in doses not poisonous to man are effective in destroying the small parasitic organisms which cause disease by propagat- ing in the body-fluids. The uses of emetin in amoebic dysen- tery and of mercury and salvarsan and neosalvarsan in syphilis have been considered in other chapters. One of the most important remedies of the specific class remains to be considered-cinchona bark (cinchona, or in Europe, Cortex Chinae) and its alkaloid, quinine. Quinine (Quinina) Quinine is an alkaloid obtained from various species of Cinchona, a tree native to South America, but cultivated in tropical climates. Several other alkaloids are found in cinchona, but quinine is most important. Physiological Action and Therapeutics.-Quinine lessens the movements of the white cells of the blood, and lessens the activity of all of the cells of the body. Less body heat is produced on this account, so this drug has some antipyretic action. Malarial fever is due to a little parasite which multiplies in the red blood-cells. Quinine kills these parasites, having a specific effect on the cause of the disease, and causes the temperature to drop. Its antipyretic action is of less value in fever due to other causes. Taken by mouth, it acts as a bitter tonic and promotes gastric secretion. It is used with great success in all forms of malaria, and in certain malnutritive conditions. It has become a household remedy in colds and influenza, but its use in these conditions does not seem warranted by its physio- logical action. Administration.-The dose of quinine sulphate, bisul- phate, and hydrochloride as a tonic is 0.06 Gm. (gr. i) three DRUGS AND MEDICINES 125 times daily. In malaria it is given in doses of 0.25 Gm. (gr. iv) three or more times daily. The Elixir of Phosphate of Iron, Quinine, and Strychnia is given in the dose of 4 mils (5i). Quinine is most frequently given in capsule or pill. For children, euquinine, tannate of quinine, and various vehicles such as syrup of licorice are used to eliminate the bitter taste. Untoward Effects.-Even small doses of quinine will cause ringing of the ears in certain individuals. This is due to the congestion of the blood-vessels of the middle ear. Quinine should, therefore, never be given when earache is present. Gastric irritation and a papular or vesicular skin eruption may appear after its use. Ringing of the ears, known as cinchonism, is present in nearly every case when the drug is given in full dosage, and if moderate in degree should cause no apprehension. C. THE DISINFECTANTS AND GERMICIDES Mercury. Manganese. Chlorine. Salicylic acid and the sali- Hydrogen dioxide. cylates. Solution of formaldehyde. Sulphur. Phenol (carbolic acid). Iodine. Urinary disinfectants: Silver. Urotropin. A large number of chemicals are known to be able to kill bacteria, and this includes many metallic salts, many compounds of bromine, chlorine and iodine and sulphur, oxidizing agents such as hydrogen peroxide, and a num- ber of organic compounds such as phenol, alcohol, etc.,- so many that it is impossible to consider, or even to mention all of them here. 126 MATERIA MEDICA AND THERAPEUTICS Mercury While mercury is considered elsewhere as a remedy, its use, and especially the utility of its bichloride as a disin- fectant cannot be overemphasized. A solution of I to 20,000 will destroy most bacteria and cocci, and 1 to 1000 will destroy the spores of the anthrax bacillus. The presence of albumin greatly lessens the germicidal power of bichloride of mercury. It is exceedingly corrosive to metals. Its greatest value is, perhaps, in rendering the operative field and the hands of the surgeon sterile, and in its use as a disinfectant for various utensils and articles of furniture, etc. For this purpose a solution of 1 to 1000 is frequently employed. The specific action of mercury in killing the spirochaete of syphilis has already been discussed, and should not be forgotten. Chlorine Chlorine is a yellow gas, very irritating to the respiratory passages, and was employed in the European war as an asphyxiating agent for that reason. It is extremely toxic to bacteria and the lower forms of animal and vegetable life, ranking next only to bichloride of mercury in effective- ness. It is used most frequently and most successfully in the disinfection of excreta. As chlorine is a powerful bleaching agent its other fields are limited. Either the Labar- raques solution or chlorinated lime are used to disinfect stools and urine. The Dakin-Carrel solution used in mili- tary surgery as a dressing for infected wounds consisted in one of the early formulas of Labarraques solution, 200 mils, in which the strongly alkaline reaction had been neutralized by the addition of boric acid .4 Gm. and sterile water 800 mils. A less irritating preparation of chlorine is Dichloramine- T., a 7 per cent, solution of an organic salt of chlorine in chlorinated oil of Eucalyptus mixed with chlorinated liquid DRUGS AND MEDICINES 127 petrolatum, which is now being used in military hospitals. A 2 per cent, solution is used in the nose and throat in acute infections, colds, etc. Liquor soda chlorinatse (Labarraques solution)-Solu- tion of Chlorinated Soda) is seldom used internally. Calx Chlorinata (chlorinated lime-improperly called " chloride of lime ") is not used internally. Mixed with water it is available for use in stool disinfection and to dis- infect privy vaults. Hydrogen Dioxide (Aqua Hydrogenii Dioxidi) This solution of dioxide of hydrogen contains about 3 per cent, by weight of pure dioxide, equivalent to 10 volumes of oxygen. In the presence of organic matter it decomposes with the liberation of free, nascent oxygen, coagulating albumin, and in this way destroying bacteria. It is much used in infections of mucous membranes, especially of the mouth and throat, because of its non-toxic- ity, and as a cleansing agent for suppurating ulcers, etc., and as a deodorant. It is an active bleaching agent, and so cannot be used to disinfect clothing. Solution of Formaldehyde (Liquor Formaldehydi) Formaldehyde, or formol, is a gas produced by the oxidation of methylic alcohol. The official solution contains not less than 30 per cent, of the gas. Formaldehyde is extremely irritating to the skin and mucous membranes, and coagulates albumin very rapidly when in concentrated solution. It does not decolorize, nor corrode metals, and is very effective in gaseous form, about 2 per cent, in the atmosphere effectively destroying bacteria in a room. For this reason it is a much used substance for fumigating rooms and clothing after contagious diseases. Many processes are in use to accomplish this purpose- various lamps are sold to utilize the solution as a vapor, 128 MATERIA MEDICA AND THERAPEUTICS or to oxidize alcohol directly or to use the solidified " para- form " as a source of the gas. To Fumigate a Room.-A popular method is to add potassium permanganate to the solution of formaldehyde, intense heat and ready vaporization ensuing. Moisture in the room favors its action. Having moved furniture to the centre of the room, sus- pended rugs and draperies, opened closets, drawers, etc., and sealed all cracks, keyholes, openings, etc., with paper, prepare a washtub by placing 6 inches of water in it and setting it in the middle of the floor. In this tub place a 5-gallon pail and place in the pail crystals of permanganate of potash proportionate to the air space of the room-250 grammes of the crystals to every 1000 cubic feet of air space. On these crystals pour formalin, 500 mils to every 1000 cubic feet of air space. A violent ebullition occurs with the dis- charge of quantities of formaldehyde gas. The room should remain sealed for twelve hours. Sulphur Sulphur is employed as a fumigating agent, being burned to produce sulphur dioxide. It is a very corrosive and irri- tating gas. The familiar sulphur candle is a ready means of generating the gas. Moisture favors the action of sulphur dioxide gas. Sulphur is also used as an ointment in various parasitic diseases, and as a local application. Iodine Iodine, in the form of tincture of iodine is used to pre- pare the field of operation in surgical work. The official Tincture of Iodine, about 7 per cent, strength, is usually diluted with an equal bulk of alcohol, and the operative field, having been previously kept dry, is painted with the solution. Iodoform (considered in the Reference Table) is a DRUGS AND MEDICINES 129 stimulating dusting powder, which has a limited use in sur- gery because of its disagreeable odor. The use of iodine externally in some individuals causes a dermatitis. The use of iodoform in cavities where it is readily absorbed will sometimes result in fever, delirium, a scarlet-fever-like eruption and other alarming symptoms. Silver The two forms of silver most used in medicine are the nitrate and the various albuminates. The latter are pro- prietary preparations, and are, therefore, not in the Pharmacopoeia. Nitrate of Silver.-This occurs in the form of crystals, with a sharp, caustic, metallic taste. It causes whitening of the tongue when tasted. It is very soluble in water. It unites readily with albumin to form albuminates, and its caustic action is, therefore, not very deeply seated. It is much used in dilute solution as an astringent for mucous membranes. Moulded into sticks it is called lunar caustic and is used to cauterize ulcers and granulating tissue. In colitis and ulcers of the rectum, nitrate of silver, 0.5 Gm. (gr. viii) to 500 mils, is frequently used as an injection, followed by salt solution. Internally, nitrate of silver is used in ulcer of the stomach. It is possessed of marked anti- septic and germ-killing properties, but it is rather irritating, and the fact that it stains the skin an indelible black makes its general use unpopular. Poisoning.-In concentrated solution, nitrate of silver acts as an irritant poison, producing vomiting, cramps, and prostration. The chemical antidote is common salt in tea- spoonful doses. Chronic poisoning, characterized by dark- ening of the skin to a bluish tint, is called argyria. This comes from the too long-continued administration, internally, of silver nitrate. 0 130 MATERIA MEDICA AND THERAPEUTICS The dose of nitrate of silver is o.oi to 0.015 Gm. (gr. % to %) given in pill form. The stools are colored black after its internal use. Albuminates of Silver.-Several combinations of silver with albumin are extensively used in diseases of the eye, urethra, and other mucous membranes, since they are found to be less irritating than the other salts of silver and have valuable germicidal and astringent properties. Argyrol is used in 10 per cent, solution to prevent oph- thalmia in new-born infants; a few drops are instilled in each eye at birth. Strengths of 10 to 25 per cent, may be used in infections of the eye and urethra. For irrigation of the urethra or bladder, 1 to 1000 is the usual strength employed. Protargol is more irritating than argyrol. Solutions stronger than 2 per cent, should not be freely used on mucous membranes. Manganese The compound of manganese most used in medicine is permanganate1 of potassium. This is a purple, crystalline substance, dissolving in water to form a violet colored liquid, which in saturated solution stains the skin yellow. When this solution is brought in contact with organic substances, it yields up its oxygen and becomes colorless. Therapeutic Uses.-This property of yielding up its oxygen makes potassium permanganate of use as an anti- septic and deodorant. In addition it has astringent proper- ties. It is seldom used internally. Its principal uses are: As an irrigation in gonorrhoea, beginning with a solution 1 to 6000 and increasing the strength up to 1 to 3000. In poisoning from alkaloids such as morphine and strychnine, to wash the stomach with a I to 1000 solution in the hope of oxidizing the alkaloid. DRUGS AND MEDICINES 131 In snake-bite, a saturated solution is injected in the tissues about the wound. As a germicide, a saturated solution is applied to the hands in the operating room, followed by a saturated solu- tion of oxalic acid. The oxalic acid removes the yellow stain of the permanganate and liberates oxygen in the skin. It is also used in a process for generating formaldehyde gas for the disinfection of rooms after contagious disease, by adding one part of the salt to three of formalin. Salicylic Acid and the Salicylates Salicylic acid may be made from the oil of wintergreen or willow leaves, but it is most frequently made from phenol or carbolic acid. All of the official salicylates excepting two, salol and oil of wintergreen, are pinkish-white powders with a sickening sweetish taste. Phenyl salicylate or salol is a grayish-white crystalline powder with a peculiar odor, and is not so soluble as the other salicylates. Salicylic acid is practically insoluble in water, and is a white powder made up of long glistening crystals. The salicylates of ammonia, strontium, and sodium are official. These are all soluble in water, dose 0.5 to 1 Gm. (gr. viii to xv). Methyl salicylate, the chemical name for oil of winter- green, dose 0.5 to 1 mil (niviii to xv) ; phenyl salicylate or salol, dose 0.5 Gm. (gr. viii). Physostigmine salicylate, given usually by hypodermic injection, has a trade name -eserine. It does not possess the characteristic therapeutic properties of the other salicylates. Its dose is 0.001 Gm. (gr. 750). Physiological Action.-Salicylic acid and the salicy- lates are antiseptic and germicidal. They cause a dilatation of the skin vessels and a lowering of the body temperature. They are irritant to the alimentary tract, and have a caustic action on epithelium. 132 MATERIA MEDICA AND THERAPEUTICS Therapeutic Uses. Antiseptic.-Salicylic acid and salol are antiseptic. They have been used extensively as intestinal antiseptics in typhoid fever and other conditions. Antipyretic.-These remedies lower temperature by dilat- ing the skin vessels and causing perspiration. Caustic.-The softening action of salicylic acid on epi- thelium is taken advantage of in the many corn salves and com paints on the market. Antirheumatic.-The salicylates are almost specific in alleviating the pain and lowering the fever of acute articu- lar rheumatism. In the so-called muscular rheumatism, and in tonsillitis, they are also efficacious, but have little effect on the various affections called chronic rheumatism. A modified salicylic acid known as " aspirin " is much used for its less irritating action on the stomach. The salicylates do not depress the heart in ordinary doses, but they are very irritant to the kidney and to the stomach. Untoward Effects.-Vomiting may follow the use of salicylic acid or the salicylates, and loss of appetite is not uncommon. Often a peculiar delirium follows the use of these drugs, and a ringing in the ears is not an unusual danger signal. These manifestations should be anticipated and record made of any tendency toward them. Irritation of the kidneys following the use of salol is shown by the dark, smoky urine. Administration.-Salol is best given in capsule or tab- let. The other salicylates are best given in solution on account of their irritant action on the stomach. They should not be given on an empty stomach; preferably after meals. Phenol (Carbolic Acid) This acid occurs in colorless needles which are soluble in twenty parts of water. These needles easily become liquid DRUGS AND MEDICINES 133 on the addition of alcohol, water, or glycerin, therefore, most of the acid sold is in a liquid form. Physiological Action.-Phenol is caustic to the skin and lessens sensation locally. Taken internally, it paralyzes the brain and acts as a general poison to all the body tissues. Its direct poisonous action on the heart slows that organ. It irritates the kidneys and renders the urine smoky in color. It destroys bacteria very rapidly. Therapeutic Uses. Sedative.-In vomiting it is used for its local anaesthetic action 0.06 mils (TTLi) in pill or solution. Caustic.-In surgery phenol is used to cauterize infected wounds. Antiseptic.-In surgery it is used as an antiseptic in 2 to 5 per cent, strength. It is not to be used in wet dress- ings, especially of the extremities, since its use in this way may result in gangrene. Antipruritic.-The anaesthetic action of phenol makes it of use in itching. Disinfectant.-For stools in typhoid fever and other diseases, phenol is a much used disinfectant, a solution of 5 per cent, strength being used. Compound solution of cresol, lysol, creolin, etc., are impure cresol compounds used for the purposes for which carbolic acid is used. Creosote and ichthyol are similar in some respects to the various members of this group. Poisoning.-The odor and characteristic white stains and face are telltale of carbolic acid poisoning. The later effects resemble opium poisoning,-contracted pupils, slow pulse, and failing respiration, followed by rapid pulse, Cheyne-Stokes respiration, and death. The treatment of poisoning consists in washing out the stomach with diluted 134 MATERIA MEDICA AND THERAPEUTICS alcohol or whiskey, and using supportive measures as in opium poisoning. URINARY DISINFECTANTS Urotropin (hexamethylenamina, hexamina, hexa- methylentetramine) Urotropin, cystogen, hexamethylenamine are various names applied to a substance which is formed when for- maldehyde gas is brought in contact with ammonia. This drug occurs as a white powder, soluble in water, with a not disagreeable taste. It has been found to liberate for- maldehyde compounds in the urine and prevent the multipli- cation of bacteria in the urinary tract, in the fluid of the spinal canal, and in the gall-bladder. Barton has proven that it is excreted in a notable amount within a very short time after its administration in discharge from disease of the middle ear. These observations extend the field of this drug's effectiveness. Therapeutics.-Urotropin is used as a urinary anti- septic and disinfectant in renal colic, pyelitis, cystitis, and infections of the urinary tract from any cause. In suppura- tive gall-stone disease and meningitis it has also been used; in the former condition large doses being given after opera- tion. Its use in ear diseases will probably cause it to be given in infectious diseases, such as scarlet fever, tonsillitis, measles, etc., to prevent ear involvement, as well as in acute and chronic forms of middle-ear disease. It is given in powder or tablet form, 0.3 to 1 Gm. (gr. v to xv), well diluted, after food. Urotropin renders the urine acid and is not so effective in alkaline urine. Benzoic acid, methylene blue and salol are among the other important urinary disinfectants. DRUGS AND MEDICINES 135 PRACTICAL DISINFECTION * THE PURPOSE OF DISINFECTION* I. The purpose of disinfection is to kill the germs which cause any case of contagious disease after they leave the body of the patient before they enter the body of the victim. In practice we either cook such germs to death by boiling, baking, or burning, or poison them by the use of disinfect- ants, such as carbolic acid. THE ESSENTIALS OF DISINFECTION 2. Germs can be killed by heat or disinfectants only under the following conditions: (a) The heat must be sufficiently intense or the disin- fectant sufficiently strong. (&) The germs must be thoroughly exposed to the heat or to the disinfectant. (c) The germs must remain exposed to the heat or to the disinfectant for a sufficient length of time. Cooking germs to death we call disinfection by heat. Poisoning germs we call chemical disinfection. Substances used to kill germs by poisoning are called disinfectants or germicides. " PATENTED " OR " PROPRIETARY " DISINFECTANTS 3. Never try to disinfect with any material whose disin- fecting properties have not been vouched for by men quali- fied by study and experience to express opinion upon the subject and who do not make a profit out of the sale of such material. Disinfectants sold like " patent " medicines are usually both expensive and practically worthless. ♦ Based on the procedure of District of Columbia Health Department. 136 MATERIA MEDICA AND THERAPEUTICS SUNLIGHT AS A DISINFECTANT 4. Sunlight kills disease germs and should be admitted freely to the sick-room unless the patient is suffering from some condition which renders darkness necessary. FRESH AIR AS A DISINFECTANT 5. Proper ventilation diminishes the number of disease germs in the sick room by carrying some such germs into the open air. The number of germs liable to pass from an ordi- nary well-kept sick-room into the open air by means of ventilation is so small that such germs cannot be regarded as dangerous to people on the outside. Moreover, such organisms speedily die because they are not adapted to live in the open air. The ventilation of a sick-room should not, however, be such as to permit air to pass from the sick-room into the rest of the house. APPARATUS AND MATERIALS USED IN DISINFECTION 6. Have all utensils and materials necessary for disin- fection placed where they can be used with the least pos- sible trouble. Failure to disinfect is often due to the fact that proper facilities for disinfecting, are not conveniently at hand. DISINFECTANTS TO BE PROPERLY LABELED 7. See that every bottle and box containing a disinfect- ant is properly labelled and see that all such bottles and boxes are kept apart from bottles and boxes containing medicines for internal use. Accidental poisoning may be thus avoided. HEAT AS A DISINFECTANT 8. Heat may be used as a disinfectant in the form of fire, boiling water, or live steam. No special apparatus is needed if fire or boiling water is used. In the first place the articles to be disinfected are simply burned and in the second they DRUGS AND MEDICINES 137 are simply boiled, being weighted if necessary so as to keep them constantly under the surface of the boiling water. Some disease germs are killed by heat more easily than others, but as a safe rule articles to be disinfected by boiling water should be kept under the water while actually boiling for not less than one-half hour. The addition of common washing soda to the water used for this purpose (one mod- erate tablespoonful of soda to each gallon of water) increases its efficiency. For instructions as to disinfection of particular articles, see pages 144-151. Steam disinfection cannot be employed without special apparatus. Rules for operating such apparatus always accompany it and should be strictly complied with. Heat tends to fix stains. If a stained article is to be disinfected by boiling water or by steam, the stains should be removed by appropriate processes before disinfection. CARBOLIC ACID 9. Carbolic acid is the most generally useful disinfectant in the sick-room. It is, however, rather expensive when properly used and is objectionable to some persons because of its odor. An aqueous solution of carbolic acid of approxi- mately five per cent, strength solution is made by adding six ounces of pure carbolic acid to one gallon of hot water. This solution can be diluted if weaker strengths are called for. For instructions as to disinfection of particular articles, see pages 144-151. Carbolic Acid Bums.-Pure carbolic acid burns the skin if it comes in contact with it. Should an accident of this kind happen the burn is best treated by the immediate appli- cation of ordinary alcohol, or whiskey, brandy, or cologne water. 138 MATERIA MEDICA AND THERAPEUTICS Carbolic Acid Poisoning.-Carbolic acid, either pure or mixed with other substances, is poisonous if taken internally. In case of accidents of this sort, diluted alcohol is the best antidote. This may be given in the form of whiskey, brandy, or cologne water, if the pure alcohol is not at hand. Epsom salts and Glauber's salts, in doses of one tablespoon, rank next to alcohol as antidotes. All cases, however, require the immediate attendance of a physician. "BICHLORIDE SOLUTION," SOLUTION OF CORROSIVE SUBLIMATE io. A standard " bichloride solution," as it is commonly called, contains one part of bichloride of mercury (some- times known as corrosive sublimate) to each one thousand part of water. Other substances as sal ammoniac and com- mon table salt, are usually added to make the solution keep better and to make it more efficient; others, as blue vitriol, are added to color the solution so as to make it more easily recognized and to prevent accidents. Bichloride solution can be most conveniently prepared for domestic use by using compressed tablets known as bichloride tablets, which can be purchased at any first-class drug store. The directions for using these tablets accompany the packages in which they are sold. If large quantities of bichloride solution are to be used, it will be found cheaper to have a strong solution prepared by a druggist, and to add at home the water necessary to reduce it to a one- thousandth solution. For instructions as to disinfection of particular articles, see pages 144-151. Bichloride solutions corrode metals and tarnish even gold. They lose their disinfecting power in doing so. Such solutions must not be put in metal receptacles. Rings must be removed from the hands which are to be put in bichloride solutions. DRUGS AND MEDICINES 139 Bichloride solutions tend to fix stains. If a stained article is to be disinfected by such a solution, the stains should be removed by appropriate processes before disinfection. Poisoning by Bichloride Solution.-Bichloride of mer- cury, either in its solid form or in mixtures, is poisonous. In cases of poisoning by it give freely white of egg mixed with water, or if this is not at hand give wheat dour mixed with water, or give milk. Send for a physician at once. FORMALDEHYDE ii. Formaldehyde is a gas. It is sold in a solution con- taining forty per cent, of formaldehyde occasionally under the simple designation, " Forty per cent, solution of for- maldehyde," and at times under the proprietary designations, " Formalin " and " Formol." For disinfecting, it may be used either in solution or in gaseous form. In household disinfection it is generally used as a gas. If used in liquid form a ten per cent, solution is most generally serviceable, made by adding twelve ounces of the ordinary " formalde- hyde," as purchased in the drug store, to one gallon of water. Formaldehyde tends to fix stains. If a stained article is to be disinfected by formaldehyde, the stains should be removed by appropriate processes before disinfection. Formaldehyde in gaseous form does not injure even the most delicate fabrics. It has a slightly corrosive action on polished steel, but does not affect other metals. For domestic use in gaseous form, formaldehyde may be obtained by evaporating the ordinary formaldehyde solu- tion, such as is purchased at the drug store. Formaldehyde will not kill germs unless there is enough of it in the air of the room or closet undergoing disinfection, and the failure of disinfection resulting from the absence of a sufficient quantity of formaldehyde cannot be made good by leaving 140 MATERIA MEDICA AND THERAPEUTICS the room closed for a longer time. Rapidity of evaporation of the formaldehyde solution is, therefore, essential. The most satisfactory method of liberating formaldehyde gas rapidly is by mixing a forty per cent, solution of formalde- hyde with permanganate of potassium. The quantities to be used in a given room are determined by the number of cubic feet of air space contained therein. One pint of for- maldehyde solution and one-half pound of permanganate of potassium are sufficient for each 1000 cubic feet of air space. After all openings in the room are closed, place several layers of old newspapers on the floor in the centre of the room, as far removed as possible from all articles of furniture; then place a galvanized iron bucket or other simi- lar receptacle in the centre of the papers which have been spread upon the floor. First place in the receptacle the potassium permanganate, and then pour over it the proper quantity of the formaldehyde solution. A receptacle of ample capacity, not less than that mentioned above, should always be used, as the effervescence resulting from the reaction between the two substances may carry the mixture or some of it over the sides of the receptacle and stain the carpet or floor, if too small a receptacle be used; and the use of newspapers under the receptacle is recommended as an additional precaution against stains, even when recep- tacles of considerable size are used. As permanganate of potassium is liable to stain anything with which it comes into contact, great care should be exercised in handling it. The fairly rapid liberation of gas may be secured by sprinkling a forty per cent, formaldehyde solution over sheets hung in the room requiring disinfection and containing the articles to be disinfected. One pint of formaldehyde should be used for every 1000 cubic feet of air space in the apartment, if there is not too much opportunity for the escape DRUGS AND MEDICINES 141 of the gas through cracks, windows, doors, etc. If the gas can find easy escape, proportionately more of the solution must be used. Since either by the permanganate method or by the sheet method formaldehyde gas is rapidly liberated, it is essential that all preparations be made in advance for the operator to leave the room promptly. The door should be closed and sealed and the room left closed for not less than six hours, after which the door and windows may be opened and the room aired. If the odor of formaldehyde persists so as to be objection- able, it can be removed, or at least moderated, by hanging up towels or sheets in the room and sprinkling them with ammonia water. When such disinfection is done, as in hospitals, special apparatus is sometimes used for the rapid generation of formaldehyde, either from solutions or from ordinary wood alcohol. Those methods are not available for use by the householder. For instructions as to disinfection of particular articles, see pages 144-151. Danger from Formaldehyde Formaldehyde is intensely irritating to the eyes, nose, and mouth, and kills the upper layers of the skin if applied to it in too strong solutions. The inhalation in ordinary quantities of such formaldehyde as is given off while sprinkling sheets in a room about to be disinfected, is uncomfortable, but not dangerous. The discomfort may be lessened by tying a moist towel over the mouth and nose while engaged in such work. Injury to the hands can be avoided by greasing them well before they come into contact with the formaldehyde solution, or by wear- ing rubber gloves. 142 MATERIA MEDICA AND THERAPEUTICS If by chance formaldehyde solution is swallowed, give at once one to two tablespoonfuls of solution of acetate of ammonia (Spirit of mindcrerus), or one teaspoonful of aromatic spirits of ammonia, diluted with water; or ten to twenty drops of ordinary ammonia, well diluted with cold water. Send for a physician at once. The doses stated are for adults. Doses for children must be in proportion ta their age, but none of the antidotes mentioned are poisonous, and they can be given in any approximately correct quantity without fear. QUESTIONS i. What two forms of silver preparations are most used in medicine? Which form is used internally? Give its doses. What are the therapeutic uses of the nitrate? What is the anti- dote for silver nitrate poisoning? Name two albuminates of silver. In what strength are their solutions used and for what purposes? 2. Describe potassium permanganate. On what properties do its therapeutic values depend? What are its principal uses in medicine? 3. Name three salicylates and give their dosage. What is methyl salicylate? phenyl salicylate? How does these drugs act physiologically? 4. What is the principal therapeutic use of the salicylates? Name two other uses in therapeutics. Mention the untoward effects that may follow their uses. What kidney symptoms may occur? Why should salicylates not be given on an empty stomach? 5. What is phenol? Give its physiological action on the skin; the brain; body tissues; heart; kidneys. How does it affect bacteria? What are its therapeutic uses in medicine? in surgery? How is it used as a disinfectant? 6. Give symptoms and treatment of phenol poisoning. 7. How would you disinfect a room 10 x 12 x 15 and its con- tents after scarlet fever? 8. What is the principal alkaloid of cinchona? How does quinine act on the body-cells? on the malarial parasite? What are its therapeutic uses? How is it given and in what doses? What unusual effects may it produce? READY REFERENCE TABLES OF INFORMATION CONCERN- ING SPECIAL DISINFECTION PROCEDURE OF THE DISTRICT OF COLUMBIA HEALTH DEPARTMENT 144 MATERIA MEDICA AND THERAPEUTICS Article to be disinfected Disinfectant to be used Form and strength Minimum duration of exposure ♦ Remarks Atomizers Carbolic acid Formaldehyde Corrosive sublimate It is safest, after dis- infection, to throw* the atomizer into the trash receptacle Bed Linen Use same methods for body linen, table linen, and towels Bed Pans. (See toilet sets, etc.) Boiling water Carbolic acid Corrosive sublimate Formaldehyde Aqueous solution, 5 per cent. Aqueous solution, i to 1,000 Aqueous solution, io per cent. Thirty minutes One hour One hour One hour As to danger of fixing stains, see sections 8, IO, II Blankets Carbolic acid Corrosive sublimate Formaldehyde Boiling water (for cotton blankets only) Aqueous solution, 5 per cent. Aqueous solution, I to 1,000 Aqueous solution, io per cent. One hour One hour One hour Thirty minutes As to the danger of fixing stains, see sec- tions 8. io, ii * A disinfectant of any kind requires time to act. The minimum duration of exposure is the least time that can elapse after the thing to be disinfected has been first placed in the disinfectant, whether liquid or gas, before the disease-producing germs may safely be regarded as having been killed. SPECIAL DISINFECTION Body Linen Use same method as for bed linen o Bolsters Use same methods for Formaldehyde Steam Use as a gas Six hours If interior of bolster is probably infected, the bolster should be disinfected by for- maldehyde or steam at the municipal dis- infection station by the Health Depart- ment pillows tresses and mat- Books Fire Books used in sick- room, or used by pa- tient after onset of illness, cannot be dis- infected. They should be destroyed Set books on edge so as to hold leaves apart Bottles Use same method as for dishes Formaldehyde Use as a gas Six hours Brushes Fire Boiling water Carbolic acid Corrosive sublimate Formaldehyde Aqueous solution, 5 per cent. Aqueous solution, I to 1,000 Aqueous solution, io per cent. . Thirty minutes One hour One hour One hour Tooth brushes should always be destroyed. Hair brushes used in case of scarlet fever should be treated like- wise DRUGS AND MEDICINES 145 146 MATERIA MEDICA AND THERAPEUTICS Article to be disinfected Disinfectant to be used Form and strength Minimum duration of exposure Remarks Carpet Chinaware (See dishes and toilet sets) Formaldehyde Formaldehyde Use as a gas 40 per cent, solu- tion • Six hours Carpets may be disin- fected by going over them with a cloth saturated with 40 per cent. formaldehyde solution. The odor of the gas may, how- ever, persist for days after such disinfec- tion If probably badly in- fected, carpets should be taken to the mu- nicipal disinfecting station for disinfection Combs, Metal Comforts Use same method as for bolsters, etc. Curtains, Lace Boiling water Carbolic acid Boiling water Formaldehyde Formaldehyde Aqueous solution, 5 per cent. Use as a gas Aqueous solution, 10 per cent. Thirty minutes One hour Thirty minutes Six hours One hour As to danger of fixing stains, see section 8 10, 11 SPECIAL DISINFECTION- Continued DRUGS AND MEDICINES 147 Carbolic acid Aqueous solution, One hour Cushions Use same methods as for bolsters, etc. Dishes Dressings Excreta Boiling water Formaldehyde Fire Boiling water Carbolic acid Formaldehyde Carbolic acid 5 per cent. Aqueous solution, io per cent. Aqueous solution, 5 per cent. Aqueous solution, io per cent. Aqueous solution, Thirty minutes One hour Destroy Thirty minutes Two hours Two hours Two hours Use an amount of car- Feather Beds Use same methods as for bolsters, etc. Fecal matter (see ex- creta) Food (remnants of solid food) Fire Carbolic acid 5 per cent. Aqueous solution, Destroy One hour bolic solution equal to the amount of ex- creta to be disin- fected Use an amount of car- Forks Boiling water Carbolic acid 5 per cent. Aqueous solution, 5 per cent. Thirty minutes One hour bolic solution equal to the amount of food to be disinfected 148 MATERIA MED1CA AND THERAPEUTICS Article to be disinfected Disinfectant to be used Form and strength Minimum duration of exposure Remarks Forks Formaldehyde Aqueous solution, io per cent. One hour Furniture Carbolic acid Aqueous solution, 5 per cent. Carbolic acid solution may be used for the Formaldehyde Use as a gas Six hours woodwork and furni- ture upholstered in leather; wipe off the furniture with a cloth Hands Hassocks Use same methods as for carpets Hot Water Bags Corrosive sublimate Compound solution of creosol Boiling water Corrosive sublimate Carbolic acid Formaldehyde Aqueous solution, I to 1,000 Aqueous solution, 2 per cent. Aqueous solution, I to 1,000 Aqueous solution, 5 per cent. Aqueous solution, io per cent. Thirty minutes One hour One hour One hour dampened with a 5 per cent, solution Knives Carbolic acid Formaldehyde Aqueous solution, 5 per cent. Aqueous solution, io per cent. One hour One hour SPECIAL DISINFECTION- Continued DRUGS AND MEDICINES 149 Boiling water (for knives wholly of Thirty minutes Mattings Use same methods as for carpets Mattresses Use same methods as for bolsters, etc. Pillows Use same methods as for bolsters, etc. Pillow Cases (see bed linen) metal) • Six hours If portieres are prob- ably much infected, they should be disin- fected by formalde- hyde at the municipal disinfecting station by the Health Depart- ment Portieres Formaldehyde Use as a gas Privies Carbolic acid Aqueous solution, 5 per cent. Two hours Use the carbolic acid solution or milk of Quilts Use same methods as for bolsters Rugs Use same methods as for carpets Milk of lime * Full strength Two hours lime in an amount equal to the contents of privy box Shades Formaldehyde Use as a gas Six hours * Milk of lime.-Slake one quart of finely divided,freshly burned lime in one quart of water, and stir the mass thoroughly. Mix fresh daily. Add three quarts of water 150 MATERIA MEDICA AND THERAPEUTICS Article to be disinfected Disinfectant to be used Form and strength Minimum duration of exposure Remarks Sheets. (See bed linen) Shoes Formaldehyde Use as a gas Six hours Wash surface with the Silverware Spoons Use same methods as for silverware Sputum Corrosive sublimate Boiling water Formaldehyde Carbolic acid Carbolic acid Aqueous solution, I to 1,000 Aqueous solution, io per cent. Aqueous solution, 5 per cent. Aqueous solution, Thirty minutes One hour One hour Two hours solution named Use an amount of car- Table Linen Use same methods as for bed linen Toilet Sets, etc. Tooth Brushes. (See brushes) Boiling water Carbolic acid Formaldehyde 5 per cent. Aqueous solution, 5 per cent. Aqueous solution, io per cent. Thirty minutes One hour One hour bolic solution equal to the amount of sputum to be disinfected SPECIAL DISINFECTION- Continued DRUGS AND MEDICINES 151 Towels Use same methods as for bed linen Toys Urinals. (See toilet sets, etc.) Urine Fire Carbolic acid Corrosive sublimate Formaldehyde Corrosive sublimate Aqueous solution, 5 per cent. Aqueous solution, I to 1,000 Aqueous solution, io per cent. Aqueous solution, Destroy One hour One hour One hour One hour Use an amount of dis- Walls Carbolic acid Formaldehyde Formaldehyde I to 1,000 Aqueous solution, 5 per cent. Aqueous solution, io per cent. Use as a gas One hour Six hours infecting solution equal to the amount of urine to be disin- fected Unpapered walls may Wash Goods Use same methods as for bed linen Wood-work Woolen Goods Corrosive sublimate Milk of lime Corrosive sublimate Carbolic acid Formaldehyde Aqueous solution, I to 1,000 Aqueous solution, I to 1,000 Aqueous solution, 5 per cent. Use as a gas Six hours be washed down with the corrosive sublimate solution, or white- washed with milk of lime Whether colors are or are not changed de- pends upon character of fabric Corrosive sublimate is liable to remove the polish from wood- work. It is suited to painted and plain wood PART III REFERENCE LIST OF COMMONLY USED DRUGS-PHYSIOLOGICAL ACTIONS AND USES OF DRUGS-POISONS AND ANTIDOTES-DOSES OF DRUGS-THE NURSE AND THE HARRISON NARCOTIC ACT-ANTISEPTIC SOLUTIONS USED IN MILITARY SURGERY-OTHER FORMULAE AND GENERAL REFERENCE MATERIAL. A REFERENCE LIST OF COMMONLY USED DRUGS, CHEMICALS, PROPRIETARY MEDICINES This list includes official drugs and preparations, and also a number of preparations made by private concerns which have a more or less wide use. In this list, the thera- peutic indications of the remedies are given as recommended by various writers, and no attempt has been made to recon- cile the therapeutic indications with the physiological action of each remedy, as is done in the first portion of this book. The writer does not guarantee the claims made for these preparations: they are given simply for reference. Pro- prietary preparations have a " P " following the name. The name in English is first given. Drugs in the U. S. Pharmacopoeia or National Formulary have the official Latin title given in brackets. The name as given in the European pharmacopoeias comes next in italics, when the U. S. and European medicines are identical. The names of the drugs, chemicals, and proprietary remedies, exclusive of official preparations, which are not followed by a sub-title in italics, have, in most cases, international usage. ACETANILID (Acetanilidum.) Antifebrinum. Phenylacetamide. Antifebrin. White scales of powder; odor- less; burning taste. Soluble in about 200 parts of water, 5 of alcohol. Antipyretic; analgesic; antirheumatic; antiseptic. Uses: internally, fever, rheumatism, headache, neuralgia, etc.; externally, like iodoform and as a preservative of hypodermic solutions (1:500). Dose: 3-6 gr. (0.2-O.4 Gm.), in powder, alcoholic solution, or hot water cooled down and sweetened to taste; maximum dose, 10 gr. (0.6 Gm.) single; 30 gr. (2 Gm.) daily. 155 156 MATERIA MEDICA AND THERAPEUTICS ACID, ACETIC, GLACIAL. (Acidum Aceticum Glaciate.) Caustic (in warts or corns) and vesicant. Not used internally. Antidote: magnesia, chalk, soap and water, lime water, milk, oil, etc. ACID, ACETIC. (36 per cent.) (U.S.P.) (Acidum Aceticum.) Refrigerant, astringent. Uses : chiefly externally as an inhalant in syncope, asphyxia, and headache, and as application as a rube- facient. Dose: 15-40 minims (1-2.5 mils) well diluted. ACID, ACETIC. DILUTED. (Acidum Aceticum Dilutum.) Dose: 2-4 fldr. (8-15 mils). (6 per cent.). ACID, AGARICIC. (Agaricin.) Agaric, or agaricinic acid. Powder; odorless; almost tasteless. Soluble slightly in water; in boiling alcohol and water. Anti- hydrotic. Uses: night-sweats of phthisis. Dose: gr. (0.01-0.03 Gm.). ACID, ARSENOUS. (Arseni Trioxidum) White Arsenic. Acidum Arsenicosum. White powder or lumps; odorless; tasteless. Soluble in about 100 parts of water; aqueous solubility is increased by tartaric or hydrochloric acid. Antiperiodic; alterative. Uses: internally, malarial fever, skin diseases, chorea, neuralgia, gastralgia, dia- betes, phthisis; externally, to remove warts, cancers, etc. Dose: Vw-'/m gr. (0.001-0.003 Gm.) 4 times daily. Maximum dose: about 7n gr. (0.005 Gm.) single; about % gr. (0.001 Gm.) daily. Preparation: solution of 1 per cent. ACID, BENZOIC. (Acidum Benzoicum.) Pearly plates or needles; aromatic odor; warm acid taste. Solu- ble in about 2 parts of alcohol and 500 of water. Borax or sodium phosphate increases the solubility in water. Antiseptic, diuretic; expectorant. Uses: internally, to acidify phosphatic urine, to reduce acidity of uric acid urine, to control urinary incontinence, also in chronic bronchitis and jaundice; exter- nally, wound dressing (1-100), in urticaria, etc. Dose: 10-30 gr. (0.6-2 Gm.) six times daily. Preparation: camphorated tinc- ture of opium. REFERENCE LIST OF DRUGS 157 ACID, BORIC. (Acidum Boricum.) Boracic Acid. Soluble in about 18 parts of water, 15 of alcohol. Antiseptic; preservative. Uses: internally, cystitis; tuberculosis; diarrhoea; externally, as a dressing for wounds and sores in 5-10 per cent, petrolatum ointment, as insufflation in powder form, in eye lotions, and in nasal and aural washes in 1-4 per cent, aqueous solution, in ringworm, eczema, and other skin diseases. Dose: 5-15 gr. (0.3-1 Gm.). Preparation: liquor antisepticus. ACID, CARBOLIC. (Phenol.) Acidum Carbolicum. Soluble in about 15 parts of water; freely in alcohol. Anti- septic; antipyretic; caustic; topical anaesthetic. Uses: For mak- ing disinfecting solutions, aborting boils and carbuncles, as application to ulcers, venereal sores, naevi, hemorrhoids, tooth- ache, diphtheria, etc. Dose: %-2 gr. (0.03-0.12 Gm.) well diluted or in pills. Injection into urethra or bladder in solution of 1: 2-1000; as wash, 1-3: 500; as caustic, pure or concentrated. ACID, CARBOLIC, LIQUEFIED. (Phenol Liquefactum.) Acidum Carbolicum Liquefactum. Contains 87 per cent, phenol. Dose: % to 2 mils (0.03-0.12 mils) well diluted. Preparations: glycerite (20 per cent.) ; oint- ment (5 per cent.). ACID, CHROMIC. (Chromii Trioxidum.) Small dark purplish red, deliquescent needles or pencils. Solu- ble freely in water. Astringent; caustic. Uses: externally, in syphilitic ulcers, hyperplasia or ulcers, condylomata, exuberant granulations, hemorrhage, sweating feet, leucorrhoea, etc. Appli- cation, as caustic in 20 per cent, solution; for sweating feet, 5 per cent, solution. ACID, CITRIC. (Acidum Citricum.) Soluble freely in water, alcohol, or glycerin. Antiseptic; anti- scorbutic ; refrigerant. Uses : externally, pruritus; diphtheria, angina, or gangrenous sore mouth; internally, cooling beverage to assuage fever, and as remedy in scurvy. ACID, GALLIC. (Acidum Gallicum.) Whitish interlaced needles; odorless; astringent; slightly acidu- lous taste. Soluble in about 100 parts of water and 5 of alcohol, antisudorific; hemostatic; astringent; antiseptic. Uses: exter- 158 MATERIA MEDICA AND THERAPEUTICS nally, epistaxis, alopecia, purpura, menorrhagia, and hemor- rhoids ; internally, haematemesis, haematuria, night-sweats, pyrosis, and intestinal hemorrhage. Preferred to tannin in action; does not constipate. Dose: 5-20 gr. (0.3-1.3 Gm.). ACID, HYDROBROMIC. DILUTED. (Acidum Hydrobromi- cum Dilutum.) Nervine. Uses: in nervous affections; vomiting, whooping- cough, bronchial and nasal catarrahs, cerebral hyperaemia, epi- lepsy, muscular spasm, hemiplegic chorea, neuralgia, tinnitus, and headache after quinine, etc. Dose: 30-90 minims (2-6 mils) in sweetened water. ACID, HYDROCHLORIC. (31.9 per cent. HC1.) (Acidum Hy- drochloricum.) Acidum Hydrochloratum. Antiseptic, antipyretic; and caustic. Uses : internally in fevers, dyspepsia, syphilis, eczema, psoriasis, etc.; externally, in mouth washes and gargles in 1-2 per cent, solution. Dose : 5-10 minims (0.3-0.6 mil) well diluted. ACID, HYDROCHLORIC. DILUTED. (10 per cent). (Acidum Hydrochloricum Dilutum). Dose: 10-30 minims (0.6-2 mil) well diluted in sweetened water. ACID, HYDROCYANIC. DILUTED. (2 per cent. HCN.) (Acidum Hydrocyanicum Dilutum.) Antispasmodic. Uses : internally, to allay pain and spasms, re- lieve nervous cough; externally, to control itching of the skin. Dose: 2-5 minims (0.12-0.3 mil) ; maximum dose, 10 minims (0.6 mil) ; externally, 1.8-16 as lotion. Only on unbroken skin. ACID, HYDRIODIC. DILUTED. (Acidum, Hydriodicuni Di- lutum.) Brown liquid. Antirheumatic; alterative. Uses: rheumatism, bronchitis (acute or chronic), asthma, syphilis, obesity, psoriasis, to eliminate mercury or arsenic from the system, etc. Dose: 5-10 minims (0.3-O.6 mil) well diluted with sweetened water, after meals. Preparation: syrup, 4 mils (3i). ACID, HYPOPHOSPHOROUS. DILUTED. (Acidum Hypophosphorosum Dilutum.) (10 per cent.). Stimulant and tonic in nervous disease. Dose: 10-60 minims (0.6-4 mils). REFERENCE LIST OF DRUGS 159 ACID, LACTIC. (75 per cent.) (Acidum Lacticum.) Caustic; astringent; digestive. Uses: mostly externally in carcinoma, croup, etc.; internally, dyspepsia, diarrhoea, diabetes, etc. Dose: 15-30 minims (1-2 mils), well diluted. Applied externally, 50-80 per cent, paint. ACID, NITRIC. (68 per cent. HNO,.) (Acidum Nitricum.) Uses : externally, as caustic and stimulant in foot baths (30-50 Gm.); also as paint for frost-bites; as an escharotic, applied pure; internally, in lepra. Very little used. Dose: 1-5 drops in mixtures well diluted. ACID, NITRIC. DILUTED. (10 per cent. HNOS.) (Acidum Nitricum Dilutum.) Tonic; antiseptic; astringent. Uses: intestinal indigestion, syph- ilis, chronic hepatitis. Dose: 5-30 drops (0.3-2 mils) well diluted. ACID, NITROHYDROCHLORIC. DILUTED. (Acidum Nitrohydrochloricum Dilutum.) One-fifth strength of concentrated, which is not used thera- peutically. Uses: internally, jaundice, biliary calculi, dyspepsia, chronic rheumatism, etc.; externally, diluted as sponge or foot bath, two or three times a week. Dose: 5-20 minims (0.03-1.3 mils) well diluted. ACID, PHOSPHORIC. DILUTED. (10 per cent.) (Acidum Phosphoricum Dilutum.) Tonic and refrigerant. Uses: dyspepsia, scrofula, caries, night- sweats of phthisis, disturbances of nutrition of the teeth, etc. Dose: 20-60 minims (1.3-4 mils). ACID, PHENYLCINCHONIC. (Acidum Phenylcinchonicum.) Atophan. Phenyl-quinoline-carboxylic-acid. A demobilizer of uric acid. Practically insoluble in water, but soluble in alkaline solutions. Disagreeable taste. Uses : internally in gout. Dose : 0.5 Gm. or 8 grains, usually in tablet. ACID, PICRIC. (Trinitrophenol.) Picronitric, picrinic, or carbazotic acid. Yellow crystals; odor- less ; intensely bitter. Slightly soluble in water and alcohol. 160 MATERIA MEDICA AND THERAPEUTICS Antiseptic; astringent. Uses: internally, in trichiniasis, etc.; externally, burns, J4-I per cent, hydro-alcoholic solutions for 5 minutes then dressing with cotton (to be renewed only every 7 or io days) ; sore nipples, per cent, solution; eczema, etc. l/3~y3 per cent, solution as paint. Dose: %-2 gr. (0.03-0.12 Gm.) in alcoholic solution; maximum daily dose, 5 gr. (0.3 Gm.). Antidote: albumin. ACID, PYROGALLIC. (Pyrogallol.) Pyrogallol. Soluble in about 2 parts of water and 1 of alcohol. Used only externally, usually in 5-10 per cent, ointment, in psoriasis and other cutaneous affections. ACID, SALICYLIC. (Acidum Salicylicum.) Soluble in about 308 parts of water and 2% of alcohol; 20 gr. are rendered soluble in 1 ounce of water by the addition of 25 gr. of borax or 40 gr. potassium citrate. Antiseptic; antirheu- matic; antipyretic; antineuralgic. Uses: internally, in rheuma- tism, migraine, neuralgia, and febrile infectious diseases; exter- nally, in 2-5 per cent, alcoholic solution or mixed with talcum, for perspiring feet. Dose: 10-40 gr. (0.6-2.6 Gm.). ACID, SULPHURIC, AROMATIC. (20 per cent. H.SOJ (Acidum Sulphuricum Aromaticum.) Best form for administration. Uses : like the diluted acid. Dose: 10-20 minims (0.6-1.3 mils). ACID, SULPHURIC. DILUTED. (10 per cent. H,SOJ (Acidum Sulphuricum Dilutum.) Concentrated sulphuric acid is not used medicinally. Uses : internally, gastro-intestinal disorders, phthisical sweats, exoph- thalmic goitre, etc.; also as solvent for quinine sulphate, etc. Dose: 15-30 minims (1-2 mils), well diluted. ACID, TANNIC. (Acidum Tannicum) Tannin. Acidum Gallo- tannicum. Soluble in about 1 part of water or alcohol. Astringent; styp- tic ; antiseptic. Uses : externally, in hemorrhages, applied pure, as enema, in 1-10 per cent, solution in mouth washes, gargles, collyria, injections, inhalations, and as application wherever a powerful astringent action is desired; internally, in diarrhoea, renal hemorrhage, and night-sweats. Dose: 2-20 gr. (0.12-1.3 Gm.). Preparations: styptic collodion (20 per cent.) ; glycerite (20 per cent.) ; ointment (20 per cent.) ; troches 1 gr. REFERENCE LIST OF DRUGS 161 ACID, TARTARIC. (Crystals or powder.) (Acidum Tartari- cum.) Soluble in about i part of water and 3 of alcohol. Refrigerant and antiscorbutic. Dose: 10-30 gr. (0.6-2 Gm.). ACID, TRICHLORACETIC. (Acidum Trichloraceticum.) Deliquescent crystals; pungent suffocating odor; caustic. Freely soluble in water and alcohol. Escharotic; astringent; haemo- static. Uses: venereal and cutaneous warts, papillomata, vascu- lar naevi, pigmented patches, corns, nasopharyngeal affections, and indolent ulcers. Applied, as escharotic, pure or in concen- trated solution; astringent and haemostatic, 1-3 per cent, solu- tion. Antidotes; same as for mineral acids. ACONITE ROOT. (Aconitum)-Aconiti Tuber. Uses : see Part II. Preparations: extract. Dose : gr. (0.015-0.03 Gm.), fluidextract, dose %-i minim (0.015-0.06 mil) ; tincture, 1-3 minims (0.06-0.2 mil). ADALIN. P. Sedative and hypnotic. Uses : in insomnia, especially of aged and insane. Dose: 8-30 gr. (0.5-2 Gm.) in tablet. ADRENALIN. P. (See Part II.) Blood-pressure raising principle of suprarenal gland. Haemo- static and astringent. Used in 1:10,000-10:10,000 solution (as chloride) in hay fever, inflammation of tonsils, larynx, etc., and in conjunctivitis, iritis, etc. Dose: i mil (nixv) by intramuscu- lar injection. AGAR-AGAR. (Agar.) A substance extracted by means of water and evaporated to dryness from several species of East Indian sea weeds, and occurring in shreds or powder commercially. Is insoluble in cold water but soluble in hot; a solution of 1.5 per cent, on cooling yields a stiff jelly. Uses: Absorbs water in the stomach and intestines, forming a jelly, and for this reason acts mechani- cally, bringing water into the lower bowel in constipation, in the treatment of which it is used. Dose: 5 to 15 Gm. (75 to 240 grains) given in substance, mixed with food. 162 MATERIA MEDICA AND THERAPEUTICS AGURIN. P. Acet-theobromine sodium. White hygroscopic powder. Solu- ble in water. Diuretic. Uses: cardiac and renal diseases. Dose: 8-15 gr. (0.5-1 Gm.) 3 to 4 times a day. ALCOHOL. (92.3 per cent. C,HeO.) (Alcohol)-Spiritus. Specific gravity 0.816. Stimulant; irritant. Uses: internally low fevers, debility from acute diseases, aid to digestion, to warm the chilled, and as an antidote to poisoning by carbolic acid; externally, hardening the skin, removing desiccated epi- thelium, antiseptic application in wounds, and application in lini- ments, etc. Dose: 1-4 fldr. (4-15 mils), with 2-6 times the volume of water. Antidotes: cold douche, stomach siphon, fresh air, ammonia, atropine or belladonna, hot-water bags, ice to the head, irritants, etc. ALETRIS, CORDIAL. P. Uterine tonic and diuretic. Dose: i fldr. (4 mils) 3 or 4 times daily. ALKALITHIA. P. Uric acid solvent. Dose: heaping teaspoonful 3 or 4 times daily, in warm water. ALOES, SOCOTRINE. (Aloe.) Cathartic; drastic; emmenagogue; vermifuge, stomachic. Uses: costiveness, atonic dyspepsia, amenorrhcea. Dose: i-io gr. (0.06-0.5 Gm.). Preparations: pills, 2 gr. (0.12 Gm.) ; pills, aloes and asafetida; pills, aloes and iron ; pills, aloes and mastic; pills, aloes and myrrh; tincture, dose 15-60 minims (1-4 mils) ; tincture aloes and myrrh, dose J^-2 fldr. (2-8 mils) ; extract dose, 1-5 gr. (0.06-0.3 Gm.). ALOIN. (Aloin.) Barbaloin. Soluble in about 60 parts of water and 20 of alcohol. Action and uses: like socotrine aloes. Dose: $4-2 gr. (0.03- 0.12 Gm.) ; maximum dose, 4 gr. (0.25 Gm.), single; 10 gr. (0.6 Gm.), daily. Injection 34 gr. (0.045 Gm.) dissolved in forma- mide. ALPYN. P. An artificial alkaloid similar in action to cocaine but less toxic. Used in the same manner as novocaine. (See p. 192 ). AMMONIA WATER, (io per cent. NH,.) (Aqua Ammonise.) Liquor Ammonii Caustici. Rubefacient; stimulant. Uses: internally, stimulant in collapse and fainting; externally, by inhalation in fainting, in combina- tion with carbolic acid in coryza, as an antidote in poisoning with chlorine gas; as application in form of wash and com- presses in stings of poisonous insects; in rheumatic pains and neuralgias, in form of liniment (i: 10-5: 10 per cent, of lanum, oil or fat). Dose: 10-30 minims (0.6-2 mils). Preparations: liniment (3 per cent. NH3) ; aromatic spirits 1-2 fldr. (4-8 mils). AMMONIA WATER, STRONGER. (28 per cent. NH,.) (Aqua Ammoniae Fortior.) Dose: 4-10 minims (0.25-0.6 mil) well diluted. Antidotes: vine- gar; vapor of acetic or chlorine water by inhalation. Prep- arations: spirit, 10-30 minims (0.6-2 mils). AMMONIUM BENZOATE. (Ammonii Benzoas.) Soluble in about 6 parts of water and 28 of alcohol. Expec- torant; antiseptic; antipyretic; diuretic. Uses: in bronchitis, asthma, gastro-intestinal disturbances, rheumatism, gout, and nephritis. Dose: 10-30 gr. (0.6-2 Gm.) 3 or 4 times daily in syrup or water. AMMONIUM BROMIDE. (Ammonii Bromidum.) Ammonium Bromatum. Soluble in about 2 parts of water, 30 of alcohol. Sedative. Uses : epilepsy, delirium tremens, nervous headache, etc. Dose : 15-30 gr. (1-2 Gm.). AMMONIUM CARBONATE. (Ammonium Carbonas.) Am- monium Carbonicum. Soluble in about 5 parts of water, 200 of alcohol. Rubefacient; cardiac stimulant; expectorant. Uses : internally, in syncope, heart failure, pneumonia, phthisis, and hysteria; externally, by inhalation in fainting. Dose: 5-20 gr. (0.3-1.3 Gm.). Prepara- tions; Spts. Ammon. Aromat. AMMONIUM CHLORIDE. (Ammonii Chloridum.) Ammo- nium Chloratum. Slightly soluble in alcohol, in about 3 parts of water. Stimu- lant ; expectorant. Uses : bronchial affections, hepatic conges- tions, museular rheumatism. Dose: 5-20 gr. (0.3-1.3 Gm.), REFERENCE LIST OF DRUGS 163 164 MATERIA MEDICA AND THERAPEUTICS AMMONIUM IODIDE. (Ammonii lodidum.) Ammonium lo- datum. Deliquescent, unstable powder. Soluble in about i part of water, 9 of alcohol. Alterative; resolvent. Uses: syphilis, scrofula, rheumatism, and phthisis; externally, in lepra and psoriasis. Dose: 3-10 gr. (0.2-0.6 Gm.). AMMONOL. P. Analgesic. Dose: 5-20 gr. (0.3-1.3 Gm.) 3-6 times daily. AMYL NITRITE. (Amylis Nitris.) Atnylium Nitrosum. Very volatile unstable liquid. Insoluble in water; soluble in alcohol. Antispasmodic; vasodilator. Uses: angina pectoris, asthma, tetanus, epilepsy, syncope, dyspnoea, and as an antidote to poisoning by cocaine. Dose: 2-5 drops. Used mostly by inhalation. AN^STHESIN. P. A local anaesthetic similar in its origin and action to Orthoform but slightly more soluble. Used internally in gastric ulcer in doses of 0.3 to 0.5 Gm. (gr. v to gr. viii). ANALGINE. P. Analgesic; antipyretic; nerve sedative. Uses: neuralgia, mi- graine, headache, grip, rheumatism. Dose: 5-10 gr. ANTIFEBRIN. P.-See Acetanilid. ANTIMONY AND POTASSIUM TARTRATE. (Antimonii et Potassii Tartras.) Tartarus Stibiatus. Tartar emetic. Insoluble in alcohol, soluble in about 17 parts of water. Emetic; expectorant; diaphoretic. Uses : bronchial catarrh, pneumonia, pulmonary emphysema. Dose: alterative, 1/K-/U gr. (0.002-0.004 Gm.) ; diaphoretic and expectorant, Vm-7. gr. (0.0025-0.008 Gm.) ; emetic, % gr. (0.03 Gm.) every 20 minutes. Preparations : Compound Licorice Mixture; Com- pound Syrup of Squills. ANTIPYRIN. (Antipyrina.) Pyrazolonum Phenyldimethylicum. Dimethyloxyquinizine. Soluble in about 1 part of water, 2 of alcohol. Antipyretic; analgesic; sedative; styptic; antiseptic. Uses : Rheumatism, cephalalgia, lumbago, sciatica, infantile con- REFERENCE LIST OF DRUGS 165 vulsions, nervous urticaria, chorea, whooping-cough, epilepsy, influenza, etc. Dose: 10-20 gr. (0.6-1.2 Gm.), per enema in double the dose; subcutaneously, (1:1) in water, 15-30 minims 1-2 mils) in neuralgia, myalgia and renal and biliary colic; in hemorrhoids 2:15 ointment. Applied as styptic in 20 per cent, solution or pure. ANTITOXIN, DIPHTHERIA. (Serum Antidiphthericum.) From serum of blood of a horse that has been subjected to the toxin of diphtheria. Limpid liquid that has generally been pre- served in % per cent, carbolic acid or other preservative. Dose : prophylactic, 1000 antitoxic units; ordinary cases, 5000-10,000 units; severe cases (or those seen late, or of nasal or laryngeal type), 10,000-20,000 units; given hypodermically and repeated in about 12-24 hours. As much as 30,000 units have been in- jected at a dose. ANTITOXIN, DIPHTHERIA, CONCENTRATED. (Serum Antidiphthericum Purificatum.) A solution in physiologic salt solution of immunizing proteins for diphtheria. Dosage and use: same as diphtheria antitoxin. ANTITOXIN, DIPHTHERIA, DRIED. (Serum Antidiphtheri- cum Siccum.) A dried preparation of diphtheria antitoxin. APIOL. P. Greenish, oily liquid. Soluble in alcohol and ether. Em- menagogue; antiperiodic. Uses : dysmenorrhoea, malaria. Dose: 5-10 minims (0.3-0.6 Gm.) 2 or 3 times daily, in capsules; in malaria 15-30 minims (1-2 mils). APIOLINE. P. Emmenagogue. Dose: 2-3 capsules. APOMORPHINE HYDROCHLORIDE. (Apomorphins Hy- drochloridum.) Apomorphinum Hydrochloridum. Soluble in about 50 parts of water and 50 of alcohol. Hypnotic; emetic; expectorant. Dose: expectorant */»-/» gr. (0.001- 0.003 Gm.); emetic, '1^/^ gr. (0.004-0.008 Gm.). Injected, emetic, '/*,-/* gr. (0.003-0.006 Gm.) ; hypnotic, gr. (0.0015-0.002 Gm.). 166 MATERIA MEDICA AND THERAPEUTICS ARGONIN. P. Silver casein compound; 4.25 per cent, silver. White powder. Soluble in hot water; ammonia increases solubility. Antiseptic. Uses : Chiefly in gonorrhoea, in 1-2 per cent, solution; also in blenorrhcea neonatorum, in 3 per cent, solution. ARGYROL. P. Silver vitellin. Antiseptic. Uses : like silver nitrate in diseases of the eye, throat, nose, ear, and genito-urinary organs. Ap- plication, as irrigation in endometritis, gonorrhoea, etc., in 1 : 1000- 4:1000 solution; as injection in gonorrhoea, in 3-5 per cent, solution. ARISTOL. (Thymolis lodidum.) Ar is to turn. Dithymol diiodide; annidalin; thymotol. Reddish brown, taste- less powder, about 46 per cent, iodine. Insoluble in water, sparingly so in alcohol. Succedaneum for iodoform externally. Applied like the latter in 10 per cent, solution, ointment, supposi- tory, etc. ARSENAURO. P. Alterative tonic. Dose: 5-15 minims (0.3-1 mils), in water after meals. ASAFETIDA. (Asafoetida) Gum Asafetida. Asa F&tida. Expectorant; stimulant; antispasmodic; emmenagogue; anthel- mintic. Uses : hysteria, convulsions, spasms, asthma, whooping- cough, catarrhs, etc. Dose: 5-15 gr. (0.3-1 Gm.). Prepa- rations: emulsion, 2-6 fldr. (8-24 c.c.) ; pills, 3 gr. (0.2 Gm.); tincture, 20-60 minims (1.3-4 mils). ASPIRIN. P. Acetylsalicylic acid. White needles. Soluble in 100 parts of water. Antipyretic; antirheumatic. Uses and doses: Same as sodium salicylate; best taken in capsules. Incompatible with alkalies. ATOXYL. P. Arsenic-acid anilid. White, crystalline, odorless powder. Solu- ble in water. Uses: like all arsenicals. Dose: gr. (0.045- O.18 Gm.), per day subcutaneously. REFERENCE LIST OF DRUGS 167 ATROPINE. (Atropina.) White crystals. Soluble freely in alcohol and slightly in water. Antispasmodic; analgesic; mydriatic; respiratory and cardiac stimulant; antisialagogue; antihydrotic. Uses: internally, anti- dote to pilocarpine, chloral, chloroform, hydrocyanic acid, fungus poison, and morphine; angina pectoris, shock, colliquative sweats, gastric ulcer, etc.; externally, ointment (i per cent, or oleate as analgesic; mydriatic, *4 per cent, solution). Dose: 71w-7«» gr. (0.0005-0.001 Gm.); maximum dose, 7ao gr. (0.001 Gm.) single; and 7» gr. (0.003 Gm.) per day. ATROPINE SULPHATE. (Atropinae Sulphas.) Soluble in part of water, 6 parts alcohol. Uses and dose: Same as of atropine. BACILLUS, BULGARIAN.-See Bulgarian Bacillus. BALSAM PERU. (Balsamum Peruvianum.) Dark, molasses-like liquid; aromatic odor. Insoluble in water, soluble in absolute alcohol. Expectorant; stimulant; stomachic; antiseptic. Uses : internally, chronic catarrh, gonorrhoea, leucor- rhoea, etc.; externally, tuberculous affections of bone, skin, etc., chronic indolent ulcers, scabies, sore nipples, lice, chilblains, etc. Dose: 15 gr. (1 Gm.). BELLADONNA LEAVES. (Belladonnae Folia.) Preparations: extract, 0.01 Gm. (gr. %) ; tincture (10 per cent.) 0.5 mil (gr. viii) ; ointment, 10 per cent.; plaster 30 per cent. BELLADONNA ROOT. (Belladonnse Radix.) Preparations: extract 0.01 Gm. (gr. 7«) ; tincture (10 per cent.) of fluidextract, 5 per cent, camphor. BENZOIN. (Benzoinum.) Benzoe. Preparations: tincture (20 per cent.) 1 mil (15 minims); compound tincture (10 per cent.) 2 mils (1^ xxx) ; benzoinated lard. BISMUTH BETA-NAPHTHOLATE. (Bismuthi Betanaph- tholas.) Orphol. Grayish-yellow powder becoming darker in time. In- soluble in water, slightly so in alcohol. 76-77 per cent. BiO. Intestinal antiseptic like salol. Dose: 0.3-1 Gm. (5-15 gr.) 3-5 times daily, in tablet or powder; children, 012-0.3 Gm. (2-5 gr.). 168 MATERIA MEDICA AND THERAPEUTICS BISMUTH, FORMIC IODID. P. Mixture of formaldehyde, gelatin, thymol iodide, and bismuth suboxide. Surgical antiseptic; astringent; alterative, analgesic: Uses: as a stimulant dry dressing to wounds, ulcerations, and skin diseases. BISMUTH SALICYLATE. (Bismuthi Subsalicylas.) Bismuthum Subsalicylicum. White, odorless, tasteless powder. Insoluble in water or alcohol. External and internal intestinal antiseptic and astringent. Uses : internally, phthisical diarrhoea, summer complaint, typhoid fever, etc.; externally, like iodoform. Dose: 0.3-1 Gm. (5-15 gr.). BISMUTH SUBCARBONATE. (Bismuthi Subcarbonas.) White, insoluble powder. Stomachic astringent. Uses: inter- nally, diarrhoea, vomiting, and disordered condition of the ali- mentary canal; externally, face powder, etc. Dose: 0.5 Gm. (gr. viii). BISMUTH SUBGALLATE. (Bismuthi Subgallas.) Subgallas Bismuthicus. Dermatol. Odorless yellow powder. Insoluble in water or alcohol. Siccative antiseptic, and substitute for bismuth sub- nitrite internally. Uses : externally, on wounds, ulcers, eczemas, etc.; internally, in gastro-intestinal affections. Dose: 0.25 Gm. (gr. iv) several times daily. Incompatible with acids. BISMUTH SUBNITRATE. (Bismuthi Subnitras.) Bismut hum Subnitricum. White, heavy, insoluble powder. Insoluble in water. Anti- septic ; astringent. Uses : internally, in acute gastric affections, intestinal catarrh, dysentery, round gastric ulcer, etc.; exter- nally, in eczema, ulcers, and fissures as dusting powder; in gonor- rhoea in aqueous suspension as injection. Dose: 0.5 Gm. (gr. viii). BISMUTH AND AMMONIUM CITRATE. (Bismuthi et Am- monii Citras.) Soluble in water, slightly in alcohol. Stomachic and astrin- gent. Uses: in dyspepsia, gastric disturbances, and diarrhoea; externally as urethral wash in gonorrhoea in 1:2000-500 solu- tion. Dose: 0.12-0.3 Gm. (gr. ii-v). REFERENCE LIST OF DRUGS 169 BLACK HAW. (Viburnum Prunifolium.) Cortex Viburnum. Viburnum pruni foliorum. Nervine; oxytocic; astringent. Prep- aration: fluidextract, 2 mils (Hl xxx). BOROLYPTOL. P. Antiseptic. Dose: 2-4 mils (%-i fldr.), diluted; externally, in 5-50 per cent, solution. BORNYVAL. P. (Bornyval Isovalerate.) A derivative of the oil of valerian, used in hysteria and nerv- ous disorders. It is given in capsule, 0.25-0.75 c.c. (HLiv-xii). BROMIDIA. P. Hypnotic; sedative. Dose: 4-8 mils (1-2 fldr.). BROMINE. (Bromum.) Soluble in alcohol, and in about 30 parts of water. Antiseptic; disinfectant. Uses: externally, caustic, pure or in 1.5-10 per cent, solution; by inhalation, as spray, in form of mixture of bromide solution and potassium bromide each 0.2 parts, with water 100 parts, in diphtheria and croup; internally, rarely in diphtheria in dose of Vu-V, minims (0.005-0.02 mil) several times a day. Dose: 0.06-0.02 Gm. (nU-iii) well diluted. BROMOFORM. (Bromoformum.) Heavy liquid, odor and taste similar to chloroform; darkens on exposure. Soluble in alcohol, insoluble in water. Anti- spasmodic ; sedative. Uses : chiefly in whooping-cough Doss: 0.2 mil (Hliii). BROMURAL. P. (Monobrom-isovaleryl urea.) A urea compound of bromine with an action similar to veronal. Given in tablet or powder 0.3 to 0.6 Gms. (5 to 10 gr.) at bedtime. BROVALOL. P. A valerianic compound of bromine, used in nervous excitement and hysteria. Dose: 0.25-0.75 Gm. (grs. iv-xii). BUCHU. (Buchu.) Stimulant; tonic, diuretic; diaphoretic. Uses: diseases of kid- ney, bladder, urethra, etc. Preparation: fluidextract, 2 mils (IR xxx). 170 MATERIA MEDICA AND THERAPEUTICS BULGARIAN BACILLUS. Bulgara, bacillus Bulgaricus, etc. A lactic-acid producing bacil- lus, which ferments milk and sugar solution. Used in autoin- toxication of intestinal origin and to produce so-called " Bul- garian " buttermilk when added to milk and incubated. Sold in tablets and vials of pure bouillon culture. CAFFEINE. (Caffeina.) Caffeinum. Theine, Guaranine. White needles, bitter taste. Soluble in about 80 parts of water, solubility is increased by addition of sodium benzoate or salicylate. Diuretic; cardiac and cerebral stimulant; muscle invigorator. Uses: nervous headache, neu- ralgia, heart failure, cardiac dropsy, nephritis, collapse, senile pneumonia, enteritis, etc. Dose: 0.065 Gm. (gr. i) ; maximum; 0.6 Gm. (gr. x) single; 2 Gm. (gr. xxx) daily. CAFFEINE, CITRATED. (Caffeina Citrata.) Caffe inum Citricum. Improperly called " citrate of caffeine "; 50 per cent, caffeine. White powder with an acid taste. Soluble in about 25 parts of water. Uses: as in caffeine. Dose: 0.125 Gm. (gr. ii). CAFFEINE AND SODIUM BENZOATE. (Caffeinae Sodio- Benzoas.) 45.8 per cent, caffeine. White powder. Soluble in about 2 parts of water. Uses: by injection, 2-10 gr. (0.12-0.6 Gm.). CALCIUM BROMIDE. (Calcii Bromidum.) White granules, very deliquescent; sharp, saline taste. Freely soluble in water and alcohol. Nerve sedative like potassium bromide. Uses: epilepsy, hysteria, etc. Dose: i Gm. (gr. xv). CALCIUM CARBONATE, PRECIPITATED. (Calcii Car- bonas Praecipitatus.) Calcium Carbanicum Pra'cipitatum. Precipitated chalk. Antacid. Uses : diarrhoea and acid con- ditions of intestine and stomach. Dose: i Gm. (gr. xv). CALCIUM CARBONATE, PREPARED. (Creta Praeparata.) Prepared Chalk. Drop chalk. Uses and dose: as precipitated chalk. Prepara- tions: compound powder, 0.6-2 Gm (gr. x-xxx) ; mercury REFERENCE LIST OF DRUGS 171 with chalk, 0.2-0.6 Gm. (gr. iii-x) ; chalk mixture, 4-16 mils (1-4 fldr.). CALCIUM LACTATE. (Calcii Lactas.) Lactate of Lime. Metabolic adjuvant. Coagulant. Uses: internally in rickets, hemophilia, tetany. Dose: 0.5 Gm. (grs. viii). CALCIUM CHLORIDE. (Calcii Chloridum.) Colorless, deliquescent crystals. Soluble in about 2 parts of water, 8 of alcohol. Internally in large doses, 1.2-2.3 Gm. (gr. xviii-xxxv), 3 times a day in chronic itching; also internally and externally in hemorrhages. Dose : 0.5 Gm. (gr. viii) 3 times daily in solution, in rhachitis and arthritis. CALUMBA. (Calumba.) Radix Columbo. Columbo. Bitter tonic. Uses : dyspepsia, debility, flatulence. Dose: 2 Gm. (dr. ss). Preparations: fluidextract, 2 mils (fldr. ss) ; tincture (20 per cent.), 4 mils (fldr. i). CAMPHOR. (Camphora.) Soluble in about 1 part of alcohol; insoluble in water. Stimu- lant; diaphoretic; sedative; carminative; expectorant; antisep- tic ; analgesic; antipruritic. Uses : nervous diarrhoea, flatulence, colic, headache, chorea, cramps, asthma, collapse, spasmodic cough, etc. Dose: 0.125 Gm. (gr. ii) ; maximum dose, 1.3 Gm. (gr. xx). Preparations: cerate (1:50); liniment, (1:5); spirits, 1 mil (TR xv) ; water, as vehicle. CAMPHOR, MONOBROMATED. (Camphora Monobromata.) Soluble in alcohol, almost insoluble in water. Soporific; anti- neuralgic ; antispasmodic. Uses : delirium tremens, hysteria, in- somnia, whooping-cough, epilepsy, neuralgia, chorea, etc. Dose : 0.125 Gm. (gr. ii), in pill or emulsion; injection, Ij4 gr. (0.1 Gm. in oil.) CANNABIS INDICA. (Cannabis.) Indian hemp. Narcotic; sedative; analgesic; aphrodisiac. Uses: headache, summer diarrhoea, anorexia, chorea, hysteria, mental depression, delirium tremens, etc. Preparations: extract, 0.01 Gm. (gr. *4) ; fluidextract, 0.05 Gm. (TR i) ; tincture (10 per cent.), 1 mil (ITt xv). 172 MATERIA MEDICA AND THERAPEUTICS CANTHARIDES. (Cantharis.) Spanish Flies. Irritant; vesicant; diuretic; aphrodisiac; rubefacient Uses: internally, lupus, tuberculosis; externally, neuralgia (as vesi- cant), and for promoting growth of hair. Dose: 0.03 Gm. (gr. J4). Preparations: cerate (32 per cent.); collodion; tincture (10 per cent.), 0.3 mil (1R v). CAPSICUM. (Capsicum.) Fructus Capsici. Cayenne pepper; African pepper. Rubefacient; stimulant; car- minative. Uses : internally, diarrhoea, dyspepsia, colic, alcohol- ism, etc.; externally, rheumatism, neuralgia, lumbago, etc. Dose: 0.065 Gm. (gr. i). Preparations: oleoresin, 0.03 Gm. (gr. ; fluidextract, 0.05 mil (1R i); tincture, (10 per cent.) 0.5 mil (IR viii) ; plaster. CARDAMON. Cardamonii Semen.) Fructus Cardamonii. Carminative; aromatic tonic. Dose: i Gm. (gr. xv). Prepara- tions: tincture (20 per cent.), 4 mils (fldr. i) ; compound tinc- ture (2.5 per cent.), 4 mils (fldr. i). CASCARA SAGRADA. (Cascara Sagrada.) Cortex Rhamni Purshiana. Laxative; cathartic; hepatic; intestinal tonic. Uses: chronic constipation, rheumatism. Preparations: extract, 0.25 Gm.; (gr. iv) ; fluidextract, I mil (Hlxv); aromatic fluidextract, 1 mil (TTlxv). CATECHU. (Gambir.) Astringent; haemostatic. Uses : diarrhoea, leucorrhoea, gonor- rhoea, gleet, hemorrhage, relaxed uvula, spongy gums, etc. Dose: i Gm. (gr. xv). Preparations: compound tincture (5 per cent), 4 mils (fldr. i) ; troches (0.06 Gm. each). CERIUM OXALATE. (Cerii Oxalas.) White powder, odorless and tasteless. Insoluble in water and alcohol. Sedative. Uses : vomiting of pregnancy, sea-sickness, gastric crises in tabes, migraine, chronic diarrhoea. Dose: 0.065 Gm. (gr. i), maximum dose 0.3 Gm. (gr. v), single; I Gm. (gr. xv) daily. CHALK.-See Calcium Carbonate. REFERENCE LIST OF DRUGS 173 CHALK MIXTURE. (Mistura Cretx.) Chalk suspended in cinnamon water. Given as an antacid. Dose: 15 to 30 c.c. (5ss to Si). CHARCOAL.-(Carbo Ligni.) Carbo Ligni Pulveratus. Wood charcoal. Uses: dyspepsia, flatulence, etc. Dose: i Gm. gr. xv). Incompatible with chlorates, permanganates, and other oxidizers. CHLORAL HYDRATE. (Chloralum Hydratum.) Soluble in about 1 part of water. Hypnotic; antispasmodic; analgesic; antiseptic. Uses: internally, insomnia, puerperal eclampsia, mania, delirium tremens, convulsions, chorea, tetanus. Dose: i Gm. (gr. xv), in sweetened solution, well diluted; in nervous dyspepsia, 0.12-0.3 Gm. (gr. ii-v) after meals; maxi- mum dose, 5 Gm. (dr. iJ4) per day. Contra-indicated in gas- tritis ; large doses must not be given in heart disease; in children and the aged, use with caution. CHLORETONE. P. Acetone-chloroform. White crystals of camphoraceous odor and taste. Soluble in 100 parts of water, 7 of glycerin. Local ansesthetic, hypnotic, antiseptic. Uses : painful wounds, burns, etc.; insomnia in the aged, etc. Dose: 0.3-1 Gm. (gr. v-xv) ; externally, in saturated aqueous solution, 10 per cent, ointment, or dusting powder. CHLOROFORM. (Chloroformum.) Chloroformium. Soluble in all proportions of alcohol or ether, in about 200 parts of water. Antiseptic; anaesthetic; analgesic. Uses: internally, in colic, asthma, cramps, cough, hiccough, tic douloureux, etc.; by inhalation, as an anaesthetic in surgery; externally, as a lini- ment for rheumatism, colic, neuralgia, etc. Dose: 0.3 mil (1R v), preferably as the spirit; maximum dose, 1.3 mils (gr. xx). Prep- arations : water, 16 mils (fldr. iv) ; spirit, 2 mils (TR xxx) ; emul- sion, 8 mils (fldr. ii) ; liniment. CHRYSAROBIN. (Chrysarobinum.) So-called chrysophanic acid; purified goa powder. Yellow pow- der. Soluble in boiling alcohol. Antiparasitic; alterative. Uses: Psoriasis, herpes tonsurans, pityriasis versicolor, hemor- rhoids. Dose: 0.03 Gm. (gr. J4). Preparation; ointment (6 per cent.). 174 MATERIA MEDICA AND THERAPEUTICS CIMICIFUGA. (Cimicifuga.) Black snakeroot; black cohosh. Sedative; alterative; analgesic; emmenagogue. Uses: chorea, heart disease (where digitalis is contra-indicated), rheumatism, myalgia, hysteria, dysmenorrhoea, amenorrhoea. Dose: i Gm. (gr. xv). Preparations: extract, 0.25 Gm. (gr. iv) ; fluidextract, 1 mil (Bl xv) ; tincture (20 per cent.), 4 mils (fldr. i). CINCHONA. (Cinchona.) Cortex China. Antiperiodic, bitter tonic. Uses : malaria, anorexia, debility, etc. Dose: i Gm. (gr. xv). Preparations: fluidextract, 1 mil (Bl xv) ; tincture (20 per cent.), 4 mils (fldr. i.). CINCHONIDINE. White crystals. Soluble in dilute acids, insoluble in water. Antiperiodic, and bitter tonic like quinine. Uses : malaria, anorexia. Dose: 0.25 Gm. (gr. iv) in pills or syrup. COCAINE HYDROCHLORATE. (Cocainae Hydrochloridum.) Cocainum Hydrochloridum. , Soluble in about % part of water, 3% parts of alcohol. Local and general anaesthetic; stimulant; antipruritic; mydriatic. Uses: local anaesthetic on all mucous membranes, toothache, catarrh, whooping-cough, tonsillitis, vomiting, ringing in the ears, etc. Dose: 0.03 Gm. (gr. J4) ; best given in powder; maxi- mum dose, 0.12 Gm. (gr. ii), single; 0.36 Gm. (gr. vi), daily. CODEINE. (Codeina.) Codeinum. Methylmorphine. Soluble in about 120 parts of water. Hyp- notic; analgesic; sedative. Uses: instead of morphine but not in severe pain; particularly in bronchitis, irritating coughs, dia- betes mellitus, diseases of the respiratory organs, and in cure of morphine habit. Dose: 0.03 Gm. (gr. J4) ; maximum dose, 0.1 Gm. (gr. 1/4), single; 0.3 Gm. (gr. v), daily. COLCHICINE. (Colchicina.) Yellow crystals or amorphous powder; very bitter taste. Solu- ble in water or alcohol. Uses : rheumatism, gout, asthma, cere- bral congestion. Dose: 0.0005 Gm. (gr. 2 or 3 times daily; maximum dose, 0.002 Gm. (gr. 730), single; 0.005 Gm. (gr- 7»), daily. REFERENCE LIST OF DRUGS 175 COLCHICUM ROOT. (Colchici Cormus.) Alterative; sedative; diuretic; expectorant. Uses: rheumatism, gout, dropsy, asthma, and ascites from hepatic obstruction. Dose: 0.25 Gm. (gr. iv). COLCHICUM SEED. (Colchici Semen.) Semen Colchici. Action, uses, and dose like those of the root. Preparations: fluidextract, 0.2 c.c. (TR iii) ; tincture (10 per cent), 2 mils (TR xxx) ; wine, 2 mils (TR xxx). COLCHI-SAL. P. Antirheumatic; antipodagric. Dose: 2-4 capsules with meals and at bedtime. COLLARGOL. P. Argentum Crede; colloidal silver. Soluble metallic silver. Anti- septic. Uses: sepsis, lymphangitis, cellulitis, etc. Dose: 0.01 -0.02 Gm. (gr. %-%) 2 or 3 times daily; externally, mostly in 15 per cent, ointment ("Unguentum Crede), 12 Gm. (dr. iii) of this by inunction; also in 1:1000-1: 5000 lotion. COLLODION, CANTHARIDAL. (Collodium Cantharidatum.) Collodium Vesicant. Blistering or vesicating collodion. Olive-green, syrupy liquid. Represents 60 per cent, cantharides. Uses : as blister instead of cantharides. COLLODION, STYPTIC. (Collodium Stypticum.) 20 per cent, tannic acid. Uses : bleeding wounds. COLOCYNTH. (Colocynthis.) Fructus Colocynthidis. Drastic cathartic; diuretic. Uses: obstinate constipation and dropsical conditions. Dose: 0.065 Gm. (gr. i). Preparations: extract, 0.03 Gm. (gr. }4) ; compound extract, 0.5 Gm. (gr. viii) ; compound cathartic pill, 2 pills; vegetable cathartic pill, 2 pills. CONIUM. (Conium.) Hemlock. Antispasmodic; sedative; anondyne. Uses: inter- nally, maniacal excitement, whooping-cough, chorea; externally, neuralgia, rectal diseases, pruritus. Dose: 0.2 Gm. (gr. iii). Preparation: fluidextract, 0.2 mil (1R iii). 176 MATERIA MEDICA AND THERAPEUTICS COPAIBA. (Capaiba.) Balsamum Copaiba. Balsam, copaiba or copaiva. Soluble in ether. Stimulant; ex- pectorant; diuretic; laxative. Uses: externally, locally in indo- lent ulcers and chilblains; internally, gonorrhoea, cystitis, leucor- rhoea, etc. Dose: i mil (TR xv). Preparation: oil, 0.5 mil (nt viii). COPPER SULPHATE. (Cupri Sulphas.) Cuprum Sulphuricum. Soluble in about 3 parts of water, insoluble in alcohol. Escha- rotic; styptic; astringent; emetic; alterative; nervine. Uses: internally, chronic diarrhoea, hemorrhage, croup, etc.; externally, ulcers, gonorrhoea, hyperidrosis, warts, fungous granulations, edges of callous wounds, bleeding surfaces, etc. Dose: as astringent 0.01 Gm. (gr. %) ; as emetic, 0.25 Gm. (gr. iv). CORROSIVE SUBLIMATE.-See Mercury Bichloride. COTARNINE.-See Stypticin. CREOLIN, PEARSON. P. Saponified coal-tar creosose, Pearson. Dark syrupy liquid; tar odor. Soluble in alcohol, in water to 2% per cent, yielding a milky emulsion. Disinfectant; deodorizer. Uses: substi- tute for carbolic acid, etc., in general disinfection-apart- ments, hospitals, school-rooms, etc. Removes odor of iodo- form. Externally in *4-2 per cent, solution. Caution : aqueous solution should be freshly made when wanted. CREOSOTAL.-See Creosote Carbonate. CREOSOTE. (Creosotum.) Kreosotum. Soluble in about 150 parts of water, miscible in all proportions with alcohol. Antitubercular; antiseptic; antipyretic; anthel- mintic Uses : phthisis, toothache, vomiting, diarrhoea, cholera morbus, dysentery, etc. Diluted applied locally in chilblains, burns, diphtheria, fetid leucorrhoea. Dose: 0.2 mil (TR iii). Preparation: water, 8 mils (dr. ii). CREOSOTE CARBONATE. P. Creosotal. Colorless to yellowish, odorless, slightly bitter liquid. Soluble in alcohol, insoluble in ether. Antitubercular. Uses: like creosote. Dose: 1.3 mils (1R xx), gradually in- creased to 5.5 mils (dr. i %) 3 times a day. REFERENCE LIST OF DRUGS 177 CUBEBS. (Cubeba.) Fructus Cubeba. Carminative; sedative; diuretic. Uses: gonorrhoea, leucorrhcea; bronchial, pharyngeal, and nasal catarrhs; urethritis; prostatitis. Dose: I Gm. (gr. xv). Preparations: fluidextract, i mil (Hl xv) ; oleoresin, 0.5 Gm. (gr. viii) ; troches; oil, 0.5 mil (Hl viii). DERMATOL. P.-See Bismuth Subgallate. DEXTROSE. (See Glucose.) DIGITALIN. (Merck's Amorphous.) White yellowish powder. Soluble in water. Reliable heart tonic; diuretic; adapted for injection. Uses: cardiac diseases, dropsy, pulmonary oedema. Dose: 0.006-0.03 Gm. (gr. V,*-'/,) 3 or 4 times daily, in pills, tablets, or subcutaneously. DIGITALIS. (Digitalis.) Folium Digitalis. Uses as in digitalin. Dose: 0.065 Gm. (gr. i). Preparations: extract, 0.01 Gm. (gr. %) ; fluidextract, 0.05 mil (Hl i) ; tincture, 1 mil (Hl xv) ; infusion, 8 mils (dr. ii). DIMAZON. P. A colorless substance similar chemically to Scarlet Red. Uses : in an ointment in indolent ulcers and eczema. Not used internally. DIOXYGEN. P.-See Perhydrol. DIURETIN. P. (Theobrominae Sodio-Salicylas.) Theobromitio Natrium Salicylicium. White odorless powder, decomposing on exposure. Soluble in water. Diuretic. Uses : dropsy, Bright's disease, especially that following scarlet fever. Dose: i Gm. (gr. xv), 5 or 6 times daily in powder or capsule followed by water; maximum dose, 6 Gm. (dr. 1^) daily. DOVER'S POWDER.-See under Opium, Powdered. EMETINE HYDROCHLORIDE. (Emetinae Hydrochloridum.) A specific in conditions caused by parasitic amoebae. Used in amoebic dysentery and in pyorrhoea alveolaris-in the latter con- dition locally as well as internally. Occurs usually in ampules in a Vu per cent, sterile solution. It is given in doses of from 178 MATERIA MEDICA AND THERAPEUTICS % to % a grain daily for about a week. Unless given internally in pills not soluble in the stomach will cause violent vomiting. DUOTAL. P.-See Guaiacol Carbonate. ELATERIN. (Elaterinum.) Crystal powder with very bitter taste. Soluble in about 300 parts of alcohol, insoluble in water. Drastic purgative. Uses: ascites, uraemia, pulmonary oedema, poisoning by narcotics, etc. Dose: 0.005 Gm. (gr. */u) ; maximum dose, 0.01 Gm. (gr. %), daily, in trituration with a trace of saccharin. Preparation: tri- turation (10 per cent.), 0.03 Gm. (gr. ERGOT. (Ergota.) Emmenagogue; oxytocic; haemostatic. Uses: to promote labor; menorrhagia, metrorrhagia, and other internal hemorrhages; night-sweats, migraine, epilepsy, chronic cerebral congestion, enuresis, etc. Dose: 2 Gm. (gr. xxx). Preparations: extract (syn. ergotin), 0.5 Gm. (gr. viii) ; fluidextract, 2 mils (IR xxx). ERGOTIN. Alcohol-purified aqueous extract of ergot. Soluble in water. Action and uses: like ergot. Dose: 0.2-0.6 Gm. (gr. iii-x). ERIODICTYON. (Eriodictyon.) Yerba santa. Expectorant; alterative; anticatarrhal. Uses: coughs, colds, inflammation of the genito-urinary organs, etc., and to disguise the taste of quinine and other disagreeable reme- dies. Dose: i Gm. (gr. xv). Preparation: fluidextract, 1 mil m xv). ERYTHROL TETRANITRATE. Crystalline mass exploding on percussion; therefore, on the market only in tablets with chocolate, each containing gr. y2 of the medicament. Vasodilator and antispasmodic, like nitro- glycerin. Uses : angina pectoris, asthma, cardiac diseases, chronic inflammation of the kidneys, etc.; reported especially useful as a prophylactic in preventing anginal pain. Dose : 1-2 tablets every 4 hours. ETHER. (/Ether.) Sulphuric ether. Inhalation anaesthetic; analgesic; antispas- modic. Uses: internally, by inhalation as anaesthetic in surgical REFERENCE LIST OF DRUGS 179 operations; gastrodynia, colic, tetanus, nervous affections, dysp- noea, etc.; externally, earache, toothache, neuralgia, local pains. Dose: i mil (nt xv). Preparations: spirit, 4 mils (fldr. i) ; com- pound spirit, 4 mils (fldr. i). ETHYL CHLORIDE. (^Ethylis Chloridum.) Gas at ordinary temperatures and pressures; when compressed, colorless liquid. Soluble in alcohol. Local anaesthetic. Uses: minor and dental surgery, and neuralgia, as spray; heat of hand forcing spray from the tubes. Hold 6-10 inches away from the part. Caution : highly inflammable. EUCAINE, BETA. (Betaeucainae Hydrochloridum.) White powder. Soluble in about 30 parts of water, 14 of alcohol. Local anaesthetic, specially intended for ophthalmic use; also in dentistry. Applied in 2-3 per cent, solution in ophthalmic and dental work; in 5-10 per cent, solution for nose and throat; also in Schleich's infiltration anaesthesia; in 5-10 per cent, ointment with 2 per cent, menthol in hemorrhoids. EUCALYPTOL. (Eucalyptol.) Cineol. Soluble in ether, insoluble in water. Antiseptic; ex- pectorant; antispasmodic; antiperiodic. Uses: inhalation in diphtheria, asthma; internally, colds, bronchitis, pneumonia; externally, rhinitis, scarlet fever, measles, and chicken-pox. Dose: 0.3 mil (Bl v), 4 or 5 times daily, in capsules or sweet- ened emulsion or on sugar. Injection: 0.5-1 mil (HI &-15) of mixture of 2-5 eucalyptol and 10 liquid paraffin. EUCALYPTUS. Antiperiodic; antiseptic; tonic; haemostatic. Uses: hemor- rhage, asthma, dyspepsia, malaria. Dose: 2 Gm. (gr. xxx). Preparation: fluidextract, 2 mils (nt xxx). EUQUININE. P. Quinine carbonic ether. Zimber. Tasteless, light, fleecy con- glomerations of white needles. Slightly soluble in water. Anti- malarial; febrifuge; tonic. Uses: malaria, febrile infectious diseases, whooping-cough, neuralgia, prophylactic, for malaria, and especially in idiosyncrasy against quinine. Dose: 0.25 Gm. gr, iv) in powder or tablet, or with soup, milk, or cocoa. 180 MATERIA MEDICA AND THERAPEUTICS EUTHYMOL. P. Antiseptic; germicide. Each fluidounce is stated to contain: oil of eucalyptus, IR; oil of gaultheria, */„ TR; fluidextract of wild indigo, ^R; boric acid, io18/„ gr.; thymol, "/M gr. EXTRACT, BONE MARROW. P. Haematinic; nutrient. Dose: 4-8 mils (fldr. 1-2), in water, milk, or wine, three times daily. EXTRACT, MALE FERN. (Oleoresina Aspidii.) Extractum Filicis. Oleoresin male fern; oleoresin aspidium. Thick brown liquid; bitter unpleasant taste. Efficacious and safe anthelmintic. Dose : 4 Gm. (dr. i), taken in three portions at intervals of % hour, in capsules, followed if necessary in 1-2 hours by calomel and jalap. Caution : shake well before dispensing. Oleoresin, 2 Gm. (gr. xxx). EXTRACT, OPIUM. (Extractum Opii.) Opii Extractum. Dose: 0.03 Gm. (gr. %) ; maximum dose, 0.12 Gm. (gr. ii), single; 0.3 Gm. (gr. v), daily. EXTRACT, THYROID.-See Thyroidin. FORMALDEHYDE. (Liquor Formaldehydi.) Formaldehydum Solutum. Aqueous solution of formaldehyde gas; about 30 per cent. Colorless, volatile liquid with a pungent odor. Non-corrosive surgical and general antiseptic (in wounds, abscesses, etc., for clothing, bed-linen, walls, etc.); antihydrotic; preservative of anatomical and botanical specimens. Applied in vapor or solu- tion : in surgery, per cent, solution; general antisepsis per cent, solution or in vapor; phthisis, whooping-cough, etc., 2 per cent, spray or inhalation ; excessive perspiration, 1-2 per cent, solution ; for hardening anatomical specimens, 4-10 per cent, solution. FORMALIN OR FORMOL.-See Formaldehyde. FORMIN. P. (Hexamethylenetetramine.) Hexamethylenamina. (Urotropin.) Minute crystals. Soluble in water, slightly soluble in alcohol. REFERENCE LIST OF DRUGS 181 Uric acid solvent; diuretic; and urinary antiseptic. Uses : gout, cystitis, etc. Dose: 0.3-1 Gm. (gr. v-xv) 2 or 3 times daily, as tablets taken in the morning or morning and evening, in lithia water or carbonated water. FRANGULA. (Frangula.) Cortex Frangulce. Buckthorn. Laxative; cathartic. Uses: chronic constipation. Preparation: fluidextract, 1-2 mils (15-30 1R). GALL, OX, PURIFIED. (Extractum Fellis Bovis.) Laxative; digestive. Uses : dropsy, chronic constipation. Dose : 0.125 Gm. (gr. ii). GELSEMININE. White, microscopic crystals. Soluble in alcohol (salts are solu- ble in water). Antineuralgic; antispasmodic. Uses: neuralgia, rheumatism, dysmenorrhcea, etc.; also antidote to strychnia. Dose: 0.0005-0.002 Gm. (Vim-Vw gr.) ; maximum dose, 0.002 Gm. (gr. Vm), single; 0.012 Gm. (gr. '/,), daily. GELSEMIUM. (Gelsemium.) Rhizome Gelsemii. Yellow jasmine. Antineuralgic; nerve sedative; antispasmodic. Uses : neuralgia, coryza, dysuria, hysteria, dysmenorrhcea, whooping-cough, asthma, etc. Dose: 0.065 Gm. (gr. i). Prep- arations: fluidextract, 0.05 Gm. (TH. i) ; tincture (10 per cent.), 0.5 mil (Hl viii). GENTIAN. (Gentiana.) Radix Gentiance. Bitter tonic; alterative. Uses : anorexia, dyspepsia, amenorrhcea, atonic gout, etc. Dose: i Gm. (gr. xv). Preparations: extract, 0.25 Gm. (gr. iv) ; fluidextract, 1 mil (HI xv) ; tincture (10 per cent.), 4 mils (fldr. i). GINGER. (Zingiber.) Rhizoma Zingiberis. Aromatic carminative. Uses: dyspepsia, flatulence, diarrhoea, colic. Dose: i Gm. (gr. xv). Preparations: oleoresin, 0.03 Gm. (gr. )4) ; fluidextract, I mil (1R xv) ; tincture (20 per cent.), 2 mils (Hl xxx) ; syrup, 16 mils (fldr. iv). GLUCOSE. (Glucosum.) Liquid glucose, corn syrup. A syrupy product obtained by the incomplete hydrolysis of starch, consisting chiefly of dex- 182 MATERIA MEDICA AND THERAPEUTICS trose and dextrins. Uses: as a diluent in certain official ex- tracts; as a test for diabetes and as a food stimulant and diuretic, given by rectum or intravenously. A 5% per cent, solution is given intravenously or by rectum in shock or hemorrhage, or in diabetic coma or acidosis. Dose: Up to 3vi in 24 hours by mouth or injection. GLYCO-THYMOLINE. P. Antiseptic. Dose: 4 mils (fldr. i), diluted: externally in about 20 per cent, solution. Contains borax, thymol, glycerin, etc. GLYCOZONE. P. Disinfectant; antizymotic. Dose: 4-8 mils (fldr. i-ii) ; enema; 15-30 mils (floz. J4-I) in 1-2 pints of water. GLYCYRRHIZA. (Glycyrrhiza.) Radix Liqueriti<r. Liquorice root. Demulcent; expectorant; corrigent. Uses : chiefly to cover unpleasant taste of bitter preparations. Dose : 2 Gm. (gr. xxx). Preparations: extract, I Gm. (gr. xv) ; pure extract, I Gm. (gr. xv) ; fluidextract, 2 mils (TR xxx); elixir adjuvans, ad lib.; compound powder, 4 Gm. (dr. i) ; compound mixture, 8 mils (fldr. ii) ; troches, of licorice and opium. GOLD AND SODIUM CHLORIDE. (Auri et Sodii Chlori- dum.) Auro-natrium Chloratum. Soluble freely in water. Alterative; nervine. Uses: syphilis, whooping-cough, cancer, hysteria, neuralgia, rheumatism, dipso- mania, etc. Dose: 0.005 Gm. (gr. */»). GRINDELIA. (Grindelia.) Antispasmodic; sedative; anticatarrhal. Uses: asthma, hay fever, whooping-cough, catarrh of the bladder, etc. Dose: 2 Gm. (gr. xxx). Preparation: fluidextract, 2 mils (1R xxx). GUAIAC. (Guaiacum.) Resina Guajaci. Resin guaiac. Soluble in alcohol, insoluble in water. Dia- phoretic; alterative; stimulant; laxative. Uses: scrofula, syph- ilis, chronic rheumatism, gout, amenorrhoea, scarlet fever. Dose : I Gm. (gr. xv). Preparations: tincture (20 per cent.), 4 mils (fldr. i) ; ammoniated tincture (20 per cent.), 2 mils (TR xxx). GUAIACOL. (Guaiacol.) Guajacolum. Faintly yellowish, limpid, oily liquid; characteristic aromatic REFERENCE LIST OF DRUGS 183 odor. Soluble in alcohol and about 100 parts of water. Anti- tubercular; antiseptic; antipyretic; local anodyne. Uses: inter- nally, phthisis, lupus, and intestinal tuberculosis, etc.; exter- nally epididymitis, surgical tuberculosis, pleurisy, etc. Dose: 0.5 Gm. (gr. viii). GUAIACOL CARBONATE. (Guaiacolis Carbonas.) Guaja- colum Carbonicum. Duotal. Small, white, odorless crystals. Slightly soluble in alcohol, insoluble in water. Antitubercular. Dose: i Gm. (gr. xv). GUARANA. (Guarana.) Antineuralgic; astringent; stimulant; tonic; anodyne. Uses : sick-headache, diarrhoea, etc. Dose: 2 Gm. (gr. xxx). Prepa- ration; fluidextract, 2 mils (tfl, xxx). HAMAMELIS. (Hamamelidis Folia.) Witchhazel. Antiseptic; astringent; styptic. Uses: hemor- rhoids, gonorrhoea, leucorrhcea, varicose veins, etc. Dose : 2 Gm. (gr. xxx). Preparation: water, 8 mils (fldr. ii). HELMITOL. P. Hexamethylenetetramine-anhydromethylene citrate. Colorless crystals. Soluble in water, insoluble in alcohol. Urinary anti- septic. Uses: cystitis, urethritis, pyelitis, etc. Dose: i Gm. (gr. xv) 3-4 times a day. HEMATOXYLON. (Haematoxylon.) Logwood. Astringent. Uses : chronic diarrhoea, dysentery, and relaxed condition of the intestines. Preparation: extract, 1 Gm. (gr. xv). HEROIN. P. Diacetyl morphine. White bitter powder. Insoluble in water. Cough sedative; antispasmodic. Uses: phthisis, bronchitis, asthma, etc. Dose: 0.005-0.01 Gm. (gr. Yu-1/,). HEROIN HYDROCHLORATE. (Diacetylmorphinse Hydro- chloridum.) White bitter powder. Soluble in water and alcohol. Uses and dose: same as heroin. 184 MATERIA MEDICA AND THERAPEUTICS HEXAMETHYLENETETRAMINE.-See Formin. HOLOCAINE HYDROCHLORIDE. P. White crystalline powder. Soluble in about 50 parts of water, 6 of alcohol. Local anaesthetic like cocaine. Uses : chiefly in eye diseases, in 1 per cent, solution, prepared in porcelain (not in glass). HOMATROPINE HYDROBROMIDE. (Homatropinae Hydro- bromidum.) Small white crystals. Soluble in about 10 parts of water, 133 of alcohol. Mydriatic; antihydrotic; sedative. Uses : chiefly as mydriatic; night-sweats, psychoses, etc. Dose: 0.0005 Gm. (gr. '/no) ; externally to eye, in 1 per cent, solution. HORMONAL. P. An extract of the spleen of a recently fed rabbit Contains cholin. Uses : In intestinal atony and obstruction to promote peristalsis. Dose: Given by hypodermic injection, 15 to 30 mils (5ss-5i). HYDRASTINE HYDROCHLORIDE. (Hydrastinae Hydro- chloridum.) Hydrastininum Hydrochloridutn. White powder. Freely soluble in water or alcohol. Astringent; dermic; haemostatic. Uses: internally, uterine hemorrhage, dyspepsia, hemorrhoids, etc.; externally, gonorrhoea, conjunc- tivitis, endometritis, leucorrhoea, cervical erosions, seborrhoea, etc. Dose: 0.01 Gm. (gr. %) every 2 hours if necessary; exter- nally, conjunctivitis, per cent, solution; in skin diseases, 1 per cent, ointment or lotion ; maximum dose; 0.1 Gm. (gr. 1%), single; 0.3 Gm. (gr. v), daily. HYDRASTIS. (Hydrastis.) Rhizoma Hydrastis. Golden seal. Haemostatic; cholagogue; antihydrotic; astrin- gent. Uses: uterine hemorrhage, jaundice, leucorrhoea, piles, gonorrhoea, spinal irritation, night-sweats, and internal hemor- rhage. Dose: 2 Gm. (gr. xxx). Preparations: fluidextract, 2 mils (TTl xxx) ; glycerite, 2 mils (IR xxx) ; tincture (20 per cent.), 4 mils (fldr. ii). HYDROGEN PEROXIDE.-See Solution Hydrogen Peroxide. REFERENCE LIST OF DRUGS 185 HYDROZONE. P. Antiseptic. Dose: 4 mils (fldr. i), well diluted; externally in 2-3 per cent, solution. HYOSCINE HYDROBROMIDE. Scopolamine Hydrobro- midum.) Scopolamicum. Hydrobromicum. Brometum Scopolamicum. Colorless crystals. Hypnotic; sedative; mydriatic. Uses: to quiet and give sleep to insane and others. Dose: 0.0005 Gm. (gr. 7w). HYOSCYAMUS. (Hyoscyamus.) Folium Hyoscyami. Henbane. Antispasmodic; hypnotic; sedative; analgesic. Uses: internally, spasmodic cough, irritated bladder, insomnia, hysteria, delirium tremens; externally, hemorrhoids. Dose: 0.25 Gm. (gr. iv). Preparations: extract, 0.065 Gm. (gr. i) ; fluidextract, 0.2 mil (JR iv) ; tincture (10 per cent.), 1 mil (TR xv). ICHTHYOL. P. Ammonium sulpho-ichthyolate. Thick brown liquid from bituminous shale found in Tyrol; bituminous odor; contains easily assimilable sulphur. Soluble in water. Antiphlogistic; antiseptic; alterative. Uses: internally, phthisis, skin diseases, gout, scrofula, nephritis, etc.; externally, 5-50 per cent, oint- ments, lotions, etc., in erysipelas, burns, carbuncles, chilblains, rheumatism, peritonitis, etc.; 10 per cent, with glycerin, on tam- pons or in suppository, in uterine or vaginal inflammation; 1-3 per cent, solution or 0.06-0.12 mil (^ i-ii) bougies in gonor- rhoea; pure in ivy poisoning. Dose: 0.2-2 mils (TTI iii-xxx), in pills or capsules, or in water. INGLUVIN. P. Digestive ferment obtained from gizzard of chicken. Yellowish powder. Uses: vomiting of pregnancy, dyspepsia, etc. Dose: 0.3-1.3 Gm. (gr. v-xx). IODINE. (lodum.) Jodum. Almost insoluble in water. Antiseptic; alterative; caustic. Uses : externally, by inhalation in croup and bronchitis, and in ointment in skin diseases; internally, in scrofula, struma, syph- ilis, etc. Dose: 0.005 Gm. (gr. Vu). Preparations: compound liquor, 0.2 mil (Hl iii) ; tincture (7 per cent.), 0.1 mil (ni ii) ; ointment. 186 MATERIA MEDICA AND THERAPEUTICS IODOFORM. (lodoformum.) Jodoformium. Almost insoluble in water. Antiseptic; alterative; anaesthetic; antitubercular. Uses : internally, usually in combination with tannin, in pulmonary and intestinal hemorrhage, and in scrofula and diseases of the liver; externally, as surgical antiseptic for wounds, sores, etc. Dose: 0.25 Gm. (gr. iv). Preparation: ointment (10 per cent.) ; in tuberculosis and diseases of the joints, injections of a 10 per cent, oily emulsion are practised. IPECAC. (Ipecacuanha.) Ipecacuanha Radix. Emetic; diaphoretic; expectorant. Uses : as emetic in poison- ing, croup, etc.; bronchitis, coughs, pulmonary hemorrhage, hiccough, etc. Dose: expectorant, 0.065 Gm. (gr. i) ; emetic, 1 Gm. (gr. xv). Preparations; fluidextract, expectorant, 0.05 mil (nt i), emetic, 1 mil (111 xv) ; wine, 1 mil (TH, xv) ; syrup, expectorant, 1 mil; emetic, 15 mils (fldr. iv) ; powder of ipecac and opium, 0.5 Gm. (gr. viii) ; tincture of ipecac and opium (10 per cent.), 0.5 mil (UI viii). IRON BY HYDROGEN. (Ferrum Reductum.) Ferrum Re- da c turn. Reduced iron; Quevenne's iron. Chalybeate. Uses: anaemia, chlorosis, hysteria, neuralgia, scrofula, debility, etc. Dose: 0.065 Gm. (gr. i), in pill or tablets. IRON CARBONATE MASS. (Massa Ferri Carbonatis.) Vallets mass. 20 per cent. FeCO. Haematinic. Uses: anaemia, etc. Dose: 0.2-0.3 Gm. (gr. iii-v), in pill. IRON SULPHATE. (Ferri Sulphas.) Ferrum Sulphuricum. Soluble in about 2 parts of water, insoluble in alcohol. Tonic; astringent; chalybeate. Uses: internally, anaemia and chlorosis, especially with tendency to hemorrhage, night-sweats; externally leucorrhoea, eczema, etc. Dose: 0.2 Gm. (gr. iii). Preparations: dried sulphate, 0.125 Gm. (gr. ii) ; granulated sulphate, 0.2 Gm. (gr. iii). IRON AND AMMONIUM CITRATE. (Ferri et Ammonii Citras.) Citras Ferrico-Ammonicus. Reddish brown, transparent, hygroscopic scales. Soluble freely in water, insoluble in alcohol. Chalybeate like other iron com- pounds. Dose: 0.25 Gm. (gr. iv). Preparation: wine or iron, 8 mils (fldr. ii). REFERENCE LIST OF DRUGS 187 IRON AND QUININE CITRATE. (Ferri et Quininae Citras.) Chininum Ferro-Citricum. Freely soluble in water, partially in alcohol. Tonic; emmena- gogue; astringent; antipyretic. Uses: where quinine and iron are indicated. Dose: 0.25 Gm. (gr. iv). JALAP. (Jalapa.) Tubera Jalapa. Diuretic; hydragogue; cathartic, anthelmintic. Uses: dropsy, cerebral hyperemia, constipation, worms, etc. Dose : 1 Gm. (gr. xv). Preparations: resin, 0.125 Gm. (gr. ii); compound powder, 2 Gm. (gr. xxx). KINO. (Kino.) Astringent; styptic. Uses : diarrhoea, pyrosis, leucorrhcea, pas- sive hemorrhages, diabetes, etc. Dose: 0.5 Gm. (gr. viii). Preparation: tincture (5 per cent.), 4 mils (fldr. i). LACTOPEPTINE. P. Digestive. Dose: 0.6-1.3 Gm. (gr. x-xx). LACTOSE.-See Milk Sugar. LACTUCARIUM. (Lactucarium.) Partly soluble in alcohol and water. Anodyne; hypnotic; seda- tive. Uses: nervousness, cough. Dose: i Gm. (gr. xv). Preparations: tincture, 2 mils (Hl xxx) ; syrup, 8 mils (fldr. ii). LANOLIN. P.-See Lanum. LANUM. (Adeps Lanae Hydrosus.) Lanolinum. Hydrous wool fat. A superior wool fat especially prepared for medical and pharmaceutical uses. Yellowish-white unctuous mass; freely takes up water and aqueous solutions. Neutral, non-irritating, permanent emollient, and base for ointments and creams; absorbed very rapidly from the skin. LAPACTIC PILLS. Pills of aloes, strychnia and belladonna with ipecac. Uses : Chronic constipation. Dose: 1 to 2 pills. LEAD ACETATE. (Plumbi Acetas.) Soluble in about 3 parts of water, 25 of alcohol. Astringent; styptic; antihydrotic. Uses: internally, diarrhoea, dysentery, 188 MATERIA MEDICA AND THERAPEUTICS gastric and intestinal hemorrhage, phthisical night-sweats, etc.; externally, astringent eye lotion and injection or wash (i: 100- i: 500) in gonorrhoea. Dose: 0.065 Gm. (gr. i). LIME, SULPHURATED. (Calcii Sulphidum Crudum.) (So-called calcium sulphide.) Slightly soluble in water, insolu- ble in alcohol. Alterative; depilatory. Uses : chiefly in boils, car- buncle, acne, scrofula, phthisis. Dose: 0.015-0.12 Gm. (gr. 54-2). LIME WATER.-See Solution Calcium Hydrate. LIQUOR.-See Solution. LISTERINE. P. Antiseptic. Doses 4 mils (fldr. i), diluted. Uses: externally in solution up to 20 per cent. Contains boric acid, menthol, etc. LITHIUM CITRATE. (Lithii Citras.) Colorless crystals. Soluble in about 5 parts of water, insolu- ble in alcohol. Uses : like other lithium salts but more agree- able and less irritating to the stomach. Dose: 0.5 Gm. (gr. viii). Preparation: effervescent citrate, 8 Gm. (dr. ii). LITHIUM SALICYLATE. (Lithii Salicylas.) White powder. Freely soluble in water and alcohol. Anti- arthritic; antirheumatic. Uses: gout and articular rheumatism instead of sodium salicylate. Dose: i Gm. (gr. xv). LOBELIA. (Lobelia.) Herba Lobelia. Antispasmodic; expectorant. Uses: spasmodic asthma, whoop- ing-cough, croup, pneumonia, and colds. Dose: 0.5 Gm. (gr. viii). Preparations: fluidextract, 0.5 mil (Hl viii); tincture (10 per cent.), expectorant, 1 mil (IR xv), emetic, 4 mils (fldr. i). LUNAR CAUSTIC.-See Silver Nitrate. LYSOL. P. Brown, oily liquid. Soluble in water and alcohol. Antiseptic; disinfectant. Application: %-2 per cent, solution. MAGNESIUM CARBONATE. (Magnesii Carbonas.) Magnes- ium Carbonicum. Insoluble in water or alcohol. Antacid; laxative; antilithic. Uses : constipation, sour stomach, heartburn, stone in bladder. Dose: 3 Gm. (dr. ij4). REFERENCE LIST OF DRUGS 189 MAGNESIUM OXIDE. (Magnesii Oxidum.) Light or calcined magnesia. Light white powder; slightly alka- line taste. Soluble in carbonic acid water. Antacid; laxative; antilithic. Uses : internally, sick-headache, gout, dyspepsia, sour stomach, constipation; externally, ulcers and abraded surfaces, in tooth powders, etc. Dose: 2 Gm. (gr. xxx). MAGNESIUM SULPHATE. (Magnesii Sulphas.) Magnesium Sulphuricum. Epsom salt. Soluble in 1% parts of water, insoluble in alcohol. Cathartic; refrigerant. Uses: constipation, lead colic, fevers, inflammatory afflictions. Dose: 16 Gm. (dr. iv). Preparation: effervescent magnesium sulphate, 16 Gm. (dr. iv). MENTHOL. (Menthol./ Soluble in less than its weight of alcohol, insoluble in water. Analgesic; anaesthetic; antiseptic; stimulant. Uses: internally, nervous diarrhoea, vomiting; externally, toothache, headache, neuralgia, insects' bites, pruritus, inhalation in hay fever, asthma, and chronic bronchitis. Dose: 0.065 Gm. (gr. i) ; maximum dose, 6 Gm. (dr. Ij4), daily. For toothache, put a crystal into cavity. Tampons, 1 in 5 of oil. MERCURY. (Hydrargyrum.) Preparations: mercury with chalk, 0.25 Gm. (gr. iv) ; mass of mercury, 0.25 Gm. (gr. iv) ; ointment (50 per cent.); dilute ointment; plaster. MERCURY AMMONIATED. (Hydrargyrum Ammoniatum.) Hydrargyrum Pros cipit atuni Album. MERCURY BICHLORIDE. (Hydrargyri Chloridum Corrosi- vum.) Hydrargyrum Bichloratum. Corrosive sublimate. Soluble in 20 parts of water, 5 of alco- hol. Tonic; antiseptic; caustic; alterative; germicide. Uses: internally, syphilis, chronic rheumatism, and skin diseases; ex- ternally, in collodion as caustic; naevi, etc.; in alcohol, in ring- worm; in leprosy, ulcers, various skin diseases, antiseptic dress- ings, surgical operations, diphtheria, disinfection, etc. Dose: 0.003 Gm. (gr. Vjo) ; maximum dose, 0.02 Gm. (gr. single; 0.065 Gm. (gr. i), daily. 190 MATERIA MEDICA AND THERAPEUTICS MERCURY CHLORIDE, MILD. (Hydrargyri Chloridum Mite.) Hydrargyrum Chloratum. Calomel. Insoluble in water or alcohol. Cathartic; alterative; diuretic; antiseptic; anthelmintic. Uses : internally, constipation, cholera, dysentery, cardiac dropsy, pleurisy, malaria, syphilis, worms, infectious diseases, gout, etc.; externally, smallpox pit- ting, pruritus, warts, etc. Dose: laxative, 0.125 Gm. (gr. ii) ; alterative, 0.065 Gm. (gr. i). Preparation: compound cathartic pill. MERCURY CYANIDE. Colorless crystals. Soluble in about 15 parts of water, 20 of alcohol. Alterative; antiseptic; tonic; antisyphilitic. Uses: instead of corrosive sublimate; much less irritating. Recom- mended in syphilis. Dose: 0.005-0.01 Gm. (gr. 7j,-7«) in solu- tion; externally (gargle), i-xo,ooo solution; hypodermatically, 0.005-0.01 Gm. (gr. 7u-7«). MERCURY IODIDE, RED. (Hydrargyri lodidum Flavum.) Hydrargyrum lodatum Flavum. Mercury biniodide. Almost insoluble in water, soluble in 300 parts of olive oil. Alterative; germicide; antiseptic; antisyph- ilitic ; emmenagogue. Uses : internally and externally, in syphilis, scrofula, lupus. Dose: 0.003 Gm. (gr. V*). Preparation: Solu- tion of arsenic and mercury iodide, 0.1 mil (Hl ii). MERCURY IODIDE, YELLOW. (Hydrargyri lodidum Rub- rum.) Hydrargyrum Bijodatum. Mercury proto-iodide; green mercurius iodide. Insoluble in water and alcohol. Antisyphilitic; emmenagogue; alterative. Uses: advanced syphilis, scrofula, etc. Dose: o.oi Gm. (gr. %). MERCURY SALICYLATE. (Hydrargyri Salicylas.) White powder; about 50 per cent, mercury. Insoluble in water and alcohol. Antisyphilitic; antigonorrhoeic, alterative. Uses : externally, chancre, gonorrhoea, and venereal affections; 1 per cent, powder or ointment; injection in urethra, 1: 10,000-5 : 10,000 solution. Dose: 0.02-0.06 Gm. (gr. ^$-1). MERCURY SUCCINAMIDE. Mercury imido-succinate. White powder. Soluble in about 25 parts of water with the aid of heat, slightly soluble ir. alcohol. REFERENCE LIST OF DRUGS 191 Antisyphilitic; alterative; antiseptic. Dose: 0.012-0.02 Gm. (gr. Vs-TVs) daily hypodermatically. MESOTAN. P. Methyloxymethylester of salicylic acid. Yellow liquid. Solu- ble in alcohol. Local antirheumatic. Uses: gout, rheumatism, etc. Application: 4 mils (fldr. i) of a mixture of equal parts of mesotan and olive oil. METHYL SALICYLATE. (Methylis Salicylas.) Synthetic oil of wintergreen (oil of gaultheria). Freely solu- ble in alcohol. Uses: inflammatory articular rheumatism. Dose: i mil (gr. xv), gradually increased. Also applied locally in chronic articular rheumatism. METHYLENE BLUE. (Methylthioninae Chloridum.) Tetramethylthionine hydrochloride. Bluish crystals or blue powder. Soluble in about 50 parts of water. Anodyne; anti- periodic; antipyretic. Uses: gonorrhoea, rheumatism. Dose: 0.25 Gm. (gr. iv) ; injection; 0.06 Gm. (gr. i) ; maximum dose, 1 Gm. (gr. xv), single or daily. METHYLMORPHINE.-See Codeine. MILK OF MAGNESIA. (Magma Magnesiae.) Liquid magnesia, each 30 mils (floz. i) representing 1.5 Gm. (gr. xxiv) magnesium hydrate in permanent suspension. Ant- acid. Dose: 4-15 mils (fldr. i-iv). MILK SUGAR. (Saccharum Lactis.) Lactose. Soluble in about six parts of water, insoluble in alcohol. Nutritive; diuretic. Uses: consumption, cardiac dropsy, and wasting diseases; also in infant nutrition. Dose : 30-180 Gm. (oz. i-vi) per day. MINERAL OIL, OR RUSSIAN MINERAL OIL. (See Petro- latum Liquid.) A name applied to a filtered and purified light petroleum oil somewhat lighter than liquid petrolatum. It is, when pure, color- less and tasteless. Does not digest or absorb and promotes bowel movements by softening and lubricating the faeces. Dose: one or two tablespoonfuls daily. 192 MATERIA MEDICA AND THERAPEUTICS MORPHINE SULPHATE. (Morphine Sulphas.) Soluble in about 21 parts of water. Uses : to relieve pain, nervous excitement, etc. Dose: 0.015 Gm. (gr. %). Prepara- tion : compound powder, 0.5 Gm. (gr. viii). MUSK. (Moschus.) Stimulant and antispasmodic. Uses : nervous affections, typhus and typhoid fever, convulsions, etc. Dose: 0.25 Gm. (gr. iv). Preparation: tincture (5 per cent.). MYRRH. (Myrrha.) Gummi-resina Myrrha. Astringent; carminative; cathartic; emmenagogue. Uses : in- ternally, dyspepsia, general debility, chronic catarrh, amenor- rhcea, chlorosis, and pectoral troubles; externally, unhealthy sores, sore gums, and sore mouth. Dose: 0.5 Gm. (gr. viii). Preparations: tincture (20 per cent.), 1 mil (IR xv) ; tincture of aloes and myrrh (10 per cent.), 2 mils (1R xxx) ; pill of aloes and myrrh, 2 pills. NOVOCAINE. P. Colorless needles, soluble in their weight of water. Local anaes- thetic, less toxic than cocaine. Uses: I per cent, solution infil- trated by injection to produce anaesthesia. May be boiled. NAPHTHOL BETA. (Bethanaphthol.) Naphtholum. Soluble in about 1 part of alcohol, insoluble in water. Anti- septic; parasticide. Uses: internally, typhoid, chronic diarrhoea; externally, psoriasis, eczema, scabies, and other skin diseases, in 2-10 per cent, ointment. Dose: O.2-0.5 Gm. (gr. iii-viii) ; maximum dose, 1 Gm. (gr. xv), single; 4 Gm. (dr. i), daily. NEOSALVARSAN. P. A soluble modification of Salvarsan, used in the same manner and for the same conditions as the latter. Is less irritating, but not so efficacious, unless used in larger, or more frequent doses. Dose: 0.6 to 0.9 Gm. (grs. ix-xiv), intravenously or intra- muscularly, in twice distilled water. NUTGALL. (Galla.) Galla?. Galls. Astringent. Uses: internally, chronic dysentery, diar- rhoea, poisoning by strychnine and other alkaloids; externally, prolapsus ani, hemorrhoids, and as gargle in ulcerated fauces REFERENCE LIST OF DRUGS 193 and relaxed uvula. Dose: 0.5 Gm. (gr. viii). Preparations: tincture, 20 per cent.), 4 mils (dr. i) ; ointment. NUTMEG. (Myristica.) Semen Myristica. Aromatic; carminative. Dose: 0.5 Gm. (gr. viii). Preparation: oil, 0.2 mil (IR iii). NUX VOMICA. (Nux Vomica.) Strychni Semen. Stomachic; tonic; respiratory stimulant. Uses : chronic con- stipation, dyspepsia, nervous diseases, neuralgia, and as antidote to poisoning by opium, chloral, and other narcotics. Dose : 0.065 Gm. (gr. i). Preparations: extract, 0.015 Gm. (gr. )4) J fluidextract, 0.05 mil (HL i) ; tincture (10 per cent.), 0.6 mil (fll iv). OIL, ALMOND, BITTER. (Oleum Amygdalae Amarae.) Aethe- roleum Amygdala Amara. Soluble in all proportions of alcohol, in about 300 parts of water. Nerve sedative. Uses : internally, coughs; externally, to allay severe itching and in neuralgia. Dose: 0.03 mil (TH. %). OIL, BETULA. (See Methylis Salicylatis.) Oil sweet birch. Uses, dose, etc., as of oil of gaultheria. OIL, CADE. (Oleum Cadinum.) Juniper tar. Uses : in psoriasis, favus, gout, rheumatism, chronic skin eruptions, etc. OIL, CAJUPUT. (Oleum Cajuputi.) Stimulant; diaphoretic. Uses: internally, bronchitis, catarrh, toothache, colic, flatulence, asthma, and tapeworms; externally, psoriasis, acne, pityriasis, and neuralgia. Dose: 0.5 mil (nt viii). OIL, CASTOR. (Oleum Ricini.) Cathartic. Uses : constipation, colic, diarrhoea, and dysentery. Dose: 16 mils (fldr. iv). OIL, COD-LIVER. (Oleum Morrhuae.) Oleum Jecoris Aselli. Alterative; nutrient. Uses: tuberculosis, scrofula, rheumatism, etc. Dose: 16 mils (fldr. iv). OIL, CROTON. (Oleum Tiglii.) Purgative; rubefacient. Uses: internally, obstinate constipation, dropsy; externally, rheumatism, neuralgia, and indolent swel- lings; hypodermically to naevi. Dose: 0.05 mil (ni i). 194 MATERIA MEDICA AND THERAPEUTICS OIL, EUCALYPTUS. (Oleum Eucalypti.) Antiseptic; antipyretic; disinfectant. Uses: internally, remit- tent fever, bronchitis, and by inhalation in asthma and catarrh; externally, skin diseases (in 1:5 oily solution). Dose: 0.5 mil (q. viii). OIL, GAULTHERIA. (Methylis Salicylas.) Oil wintergreen. Analgesic; antirheumatic; antiseptic. Uses: rheumatic affections, pleurisy pericarditis; externally, orchitis, epididymitis, articular rheumatism, etc. Dose: i mil (Hl xv). Preparation: spirit, flavoring. OIL, JUNIPER BERRIES. (Oleum Juniperi.) Aetheroleum Juniperi. Diuretic; carminative; stimulant. Uses : internally, dropsy and suppression of urine. In surgery, for preserving surgical liga- tures. Dose: 0.2 mil (R iii). Preparations: spirit, 2 mils (TR xxx) ; compound spirit, 8 mils (fldr. ii). OIL, MUSTARD. (Oleum Sinapis Volatile.) Oleum Sinapis Aethereum. Rubefacient; stimulant. Uses: instead of mustard plaster in pleuritic neuralgia or rheumatic pains. Dose: 0.008 mil (gr. %). Preparation: compound liniment. OIL, OLIVE. Emollient; nutritive; laxative. Uses: internally, constipation, worms, poisoning, gall-stones, etc.; externally, blistered or in- jured surfaces, etc. Doses 30 mil (fldr. viii). OIL, PINUS. (Oleum Pini Pumilionis.) Oil dwarf pine. Fragrant oil; terbinthinous taste. Soluble in alcohol. Antiseptic; expectorant. Uses: inhalation in pectoral affections; internally, as stimulating expectorant; externally, employed in skin diseases. Doses 0.3-0.6 mil (iRv-x). OIL, SANTAL. (Oleum Santali.) Oil sandalwood. Internal antiseptic; anticatarrhal. Uses: gonor- rhoea, gleet, bronchitis, and inflammation of mucous membranes generally. Dose: 0.5 mil (Hl viii). OIL, TAR. (Oleum Picis Liquidae Rectificatum.) Antiseptic. Uses: internally, bronchial affections; chiefly used externally in skin diseases. Dose: 0.2 mil (M iii). REFERENCE LIST OF DRUGS 195 OIL, TURPENTINE. (Oleum Terebinthinae.) Anthelmintic; antiseptic; diuretic; rubefacient. Uses: rheuma- tism, sciatica, lumbago, gonorrhoea, haemoptysis, worms, am- menorrhoea, and as antidote in phosphorus poisoning. For in- ternal use only the rectified oil answers. Dose: i mil (1R xv). OIL, WINTERGREEN, ARTIFICIAL.--See Methyl Salicylate. OIL, WINTERGREEN, TRUE.-See Oil, Gaultheria. OINTMENT, MERCURIC NITRITE. (Unguentum Hydrargyri Nitratis.) Citrine ointment. Stimulant and alterative dermic. Applied in 10-50 per cent, dilution with a fatty vehicle. OLEATE, MERCURY. (25 per cent.) (Oleatum Hydrargyri.) Alterative; antiparasitic; antisyphilitic. Uses: externally, skin diseases, pediculi.'also for endermic administration of mercury. OLEORESIN, CAPSICUM. Soluble in alcohol and ether. Rubefacient; stimulant. Uses : internally, flatulence, and to arouse appetite; externally, diluted with soap liniment or olive oil, in lumbago, neuralgia, and rheumatic affections. Dose: 0.03 Gm. (gr. *4). OLEORESIN, MALE FERN.-See Extract, Male Fern. OPIUM. (Opium.) Not less than 9.5 per cent, morphine. For action, uses, etc., see opium, powdered. OPIUM, POWDERED. (Opii Pulvis.) Pulwis Opii. Morphine, 10-10.5 per cent. Stimulant; narcotic; antispas- modic; hypnotic; anodyne. Uses: insomnia, neuralgia, colic, dyspepsia, diabetes, pleurisy, peritonitis, tetanus, delirium tre- mens, cholera, dysentery, etc.; ease pain, give rest and sleep, check morbid secretions, relieve cough, and allay irritability. Dose: 0.1 Gm. (gr. ii). Modifications: powdered opium, granu- lated opium, and deodorized opium, dose of all, 0.065 Gm. (gr. i). Preparations: extract, 0.03 Gm. (gr. J4) ; tincture (10 per cent.), 0.5 mil (Hl viii) ; deodorized tincture (10 per cent.), 0.5 mil (Hl viii); wine, 0.5 mil (TFt viii); vinegar, 0.5 mil (Hl viii); 196 MATERIA MEDICA AND THERAPEUTICS tincture of ipecac and opium, 0.5 mil (Hl viii) ; powder of ipecac and opium, 0.5 Gm. (gr. viii) ; camphorated tincture, 8 mils (fldr. ii) ; pill, 1 pill; troches of licorice and opium (0.005 Gm. in each) ; plaster. ORPHOL.-See Bismuth Betanaphtholate. ORTHOFORM. P. White odorless powder. Slightly soluble in water, soluble in alcohol. Local and internal anodyne, antiseptic. Uses: chiefly externally on painful burns, wounds, toothache, etc. Applied pure or in 10-20 per cent, mixtures with starch talcum, etc., or in 10-20 per cent, ointment. Dose: 0.5-1 Gm. (gr. viii-xv). OVARIAN EXTRACT. A powder prepared from dried ovaries of pigs. Uses: In premature menopause, etc. Dose: 0.1-0.2 Gm. (gr. ii-iv). OVOFERRIN. P. An iron salt combined with albumin. Uses : As a hematinic in anemia. Dose: 8-16 mils (3ii-3iv). PANCREATIN. (Pancreatinum.) Amylolytic; proteolytic; emulsifiant. Uses: aid to duodenal digestion. Dose: 0.3-1 Gm. (gr. v-xv). PAPAIN. P. Papayotin. Concentrated active principle of juice of Carica Papaya (pawpaw). Enzyme similar to pepsin but acting in alka- line, acid, or neutral solution. Whitish, slightly hygroscopic powder. Soluble in water, insoluble in alcohol. Digestive. Uses: for dissolving false membrane and for aiding digestion. Dose: 0.12-0.3 Gm. (gr. ii-v), with sodium bicarbonate; exter- nally in 5 per cent, solution equal parts of glycerin and water, for diphtheria and croup. PARALDEHYDE. (Paraldehydum.) Colorless fluid; crystal below 10.50 C.; aromatic, suffocating odor; warm taste. Soluble in alcohol and about 10 parts of water. Hypnotic; antispasmodic; stimulant. Uses: insomnia, asthma, phthisis, chorea, alcoholism, delirium tremens, insanity, mental exhaustion, etc. Dose: 2-6 mils (fldr. well REFERENCE LIST OF DRUGS 197 diluted in elixir, sweet water, brandy, or rum; maximum dose, io mils (fldr. 2^4). PASTE, LASSARS. A zinc oxide ointment made stiff with starch. For formula see p. 268. Uses: In eczema, applied to the skin. PASTE, UNNAS. A gelatin paste of zinc oxide. For formula see p. 268. Uses : In leg ulcers, eczema, etc., as a dressing. Applied melted and painted over a gauze bandage. PELLETIERINE TANNATE. (Pelletierinae Tannas.) Grayish-brown, hygroscopic, tasteless powder. Soluble in about 80 parts of alcohol, 700 of water. Anthelmintic; teniafuge. Dose: 0.25 Gm. (gr. iv) in 30 mils (floz. i) of water, followed in 2 hours by a cathartic. PEPPERMINT. (Mentha Piperita.) Folio Mentha Piperita. Carminative, diffusible stimulant; nervine. Uses : flatulence, colic, dysentery, nausea, and nervous affections; externally (usually as oil of peppermint), in headache, toothache, neuralgia, rheumatism, catarrh, hay fever, asthma, etc. PEPSIN. (Pepsinum.) Soluble in about 100 parts of water (with turbidity) ; insoluble in alcohol. Proteolytic. Uses : internally, dyspepsia, digesting false membranes; externally, digesting gangrenous tissue from unhealthy wounds. Dose: 0.25 Gm. (gr. iv). PEPSIN, SACCHARATED. (Pepsinum Saccharatum.) Dose: 4-10 Gm. (dr. 1-1^2). PEPTENZYME. P. Digestant. Dose: 0.2-0.6 Gm. (gr. iii-ix). PEPTO-MANGAN (GUDE). P. Haematinic. Dose: 4-15 mils (fldr. i-iv). PERHYDROL. P. Hydrogen peroxide, 30 per cent, by weight (or 100 per cent, by volume), H2O2. Miscible in all proportions with water or alcohol. Disinfectant; deodorant; styptic; antizymotic. Use: 198 MATERIA MEDICA AND THERAPEUTICS chiefly externally, in diphtheria, sore throat, wounds, gonorrhoea, abscesses, etc.; internally, in flatulence, gastric affections, phthisical sweats, etc.; hypodermically (0.2 per cent, solution), in cyanide poisoning. Dose: 4 mils (fldr. i). PETROLATUM, LIQUID. (Petrolatum Liquidum.) Mineral oil. A clear oily liquid, almost tasteless. Two varieties, light and heavy. Used as an intestinal lubricant in chronic con- stipation. Dose: 15-30 mils (fldr. iv to Si) PHENACETIN. (Acetphenetidinum.) Phenacetinum. Para-acetphenetidin. White tasteless powder. Soluble in about 1700 parts of water, 20 of alcohol. Antipyretic; antineuralgic; analgesic. Uses : internally, neuralgia, rheumatism, whooping- cough, chorea, influenza, tonsillitis, scarlatina. Dose: 0.5 Gm. (gr. viii). PHENALGIN. P. Analgesic; febrifuge. Dose: 0.6-1.3 Gm. (gr. x-xx). PHENAZONE.-See Antipyrin. PHENOL.-See Carbolic Acid. PHENYLACETAMIDE.-See acetanilid. PHENYL SALICYLATE.-See Salol. PHOSPHORUS. (Phosphorus.) Soluble in oils. Stimulant to the nervous system. Uses : melan- cholia, sexual exhaustion, neuralgia, rhachitis, caries, osteo- malacia, etc. Dose: 0.0005 Gm. (gr. */„>). Preparation: pill, containing 0.0006 Gm. (gr. 'Aoo). PHYSOSTIGMA. (Physostigma.) Calabar bean. Action and uses: like physostigmine. Dose: 0.1 Gm. (gr. ii). Preparations: extract, 0.008 Gm. (gr. %) ; tincture (10 per cent.), 1 mil (Hl xv). PHYSOSTIGMINE SALICYLATE. (Physostigmine Salicylas.) Physostigminum Salicylicum. Eserine salicylate. Slightly yellowish crystals. Soluble in about 150 parts of water, 15 of alcohol. Antitetanic; spinal REFERENCE LIST OF DRUGS 199 depressant; peristaltic; stimulant; laxative; analgesic; myotic. Uses: strychnine poisoning, tetanus, tonic convulsions, consti- pation, muscular rheumatism, phantom tumors, chronic bron- chitis, etc.; in solution to contract pupil. Dose: o.ooi Gm. (gr. '/„); maximum dose, 0.002 Gm. (gr. Vso), single; 0.003 Gm. (gr- Vjo) daily. Application in 0.2-0.5 per cent, solution as eye- drops in ophthalmia neonatorum, to overcome midriasis of atro- pine, breaking posterior adhesions, in prolapse of the iris, cataract, glaucoma, and corneal ulcers. PICROTOXIN. Cocculin. Soluble in about 300 parts of water, 10 of alcohol. Antihydrotic; nervine; antispasmodic. Uses: night-sweats of phthisis; also paralysis, epilepsy, chorea, flatulent dyspepsia, dysmenorrhcea; also antidote to chloral. Dose: 0.0006-0.002 Gm. (gr. Vn,-/*); Maximum dose, 0.006 Gm. (gr. 'A,). PILOCARPINE HYDROCHLORIDE. (Pilocarpine Hydro- chloridum.) Pilocarpinum Hydrochloricutn. Freely soluble in water or alcohol. Sialagogue; galactagogue; myotic; diaphoretic; diuretic. Uses: internally, dropsy, coryza, laryngitis, bronchitis, asthmatic dyspnoea, uraemic convulsions, croup, atropine poisoning, etc.; externally, 1-2 per cent, aqueous solution for collyrium. Contra-indicated in heart failure and during fasting. Dose: 0.01 Gm. (gr. */„) ; maximum dose, 0.02 Gm. (gr. 7W), single; 0.04 Gm. (gr. 'A), daily. PILOCARPUS. (Pilocarpus.) Jaborandi. Action and uses: like pilocarpine hydrochlorate. Dose: 2 Gm. (gr. xxx). Preparation: fluidextract, 2 mils (Til xxx). PIPERAZINE. P. Diethylenediamine. Colorless alkaline crystals. Freely soluble in water. Antipodagric; antirheumatic. Dose: 0.3-0.6 Gm. (gr. v-x) 3 times a day well diluted. PITUITRIN. P. (Liquor Hypophysis.) An extract of the posterior portion of the pituitary gland of certain animals. It occurs in a watery solution. Physiological Action : It is reputed to cause a rise of blood-pressure lasting 200 MATERIA MEDICA AND THERAPEUTICS for an hour or more, it has a marked diuretic action and increases the contractility of the muscle of the uterus. Uses: In circulatory collapse accompanied by low blood-pressure, in prolonged or difficult labor, and in uterine hemorrhage it is recommended in doses of I mil (15 m.) given preferably subcutaneously. PODOPHYLLIN.-See Resin, Podophyllum. PODOPHYLLUM. (Podophyllum.) May apple. Cathartic; cholagogue, tonic, alterative. Uses: hepatic congestion, constipation, rheumatism, scrofula, and bilious fevers. Dose: 0.5 Gm. (gr. viii). Preparations: resin, purgative, 0.015 Gm. (gr. %), laxative, 0.005 Gm. (gr. 7U) ; fluidextract, 0.5 Gm. (gr. viii) ; pill, I pill. POMEGRANATE. (Granatum.) Anthelmintic; astringent; antiperiodic. Uses: tapeworms, diar- rhoea, night sweats and intermittent fever. Dose: 2 Gm. (gr. xxx). Preparation: fluidextract, 2 mils (U. ii). POTASSA.-See Potassium Hydrate. POTASSA, SULPHURATED. (Potassa Sulphurata.) Soluble readily and almost completely in water, partially solu- ble in alcohol. Alterative; antacid; emetic; local irritant. Uses: internally, rheumatism, gout, scrofula, painter's colic, skin dis- ease, catarrh, croup, lead and mercury poisoning; externally, lotion in parasitic skin diseases. Dose: 0.12-0.6 Gm. (gr. ii-x). POTASSIUM ACETATE. (Potassi Acetas.) Very deliquescent. Soluble in less than 1 part of water, 2 of alcohol. Diuretic; aperient; cathartic. Uses: gout, lithiasis, rheumatism, dropsy, eczema, and psoriasis. Dose: 2 Gm. (gr. xxx). POTASSIUM BICARBONATE. (Potassii Bicarbonas.) Kalium Bicarbonicum. Soluble in about 4 parts of water, almost insoluble in alcohol. Diuretic, antilithic; antacid. Uses: dyspepsia, dropsy, lithiasis, sour stomach, jaundice, etc. Usually taken effervescent with tartaric or citric acid. Dose: 2 Gm. (gr. xxx). REFERENCE LIST OF DRUGS 201 POTASSIUM BITARTRATE. (Potassi Bitartras.) Kalium Bitartaricum. Cream of tartar. Soluble in about 200 parts of water, insoluble in alcohol. Cathartic; diuretic; aperient. Uses: dropsy and as refrigerant drink in febrile affections. Dose: diuretic, 2 Gm. (gr. xxx) ; cathartic, 15 Gm. (dr. iv). POTASSIUM BROMIDE. (Potassii Bromidum.) Kalium Bro- matum. Soluble in about 2 parts of water. Antiepileptic; sedative; hyp- notic. Uses: epilepsy, neurasthenia, convulsions, delirium tremens, tetanus, syphilis, scrofula, semi-impotence, nyphomania, urethral fever, and poisoning by iodoform and strychnia. Dose: 1 Gm. (gr. xv). POTASSIUM CARBONATE. (Potassii Carbonas.) Kalium Car- bonicum. Soluble in 2 parts of water, insoluble in alcohol. Antacid; solvent. Uses: internally, acid stomach, lithiasis, dropsy, jaun- dice ; externally, as 16 per cent, ointment or bath in cutaneous affections. Dose: i Gm. (gr. xv). POTASSIUM CHLORATE. (Potassii Chloras.) Kalium Chloricum. Soluble in 17 parts of water, insoluble in alcohol. Antiseptic. Uses : internally, all forms of stomatitis, diphtheria, mercurial poisoning, and diseases of mucous membranes; also as mouth washes and gargles in 3-5 per cent, solution. Dose: 0.25 Gm. (gr. iv). POTASSIUM CITRATE. (Potassii Citras.) Soluble in about 1 part of water, slightly in alcohol. Diapho- retic; refrigerant. Uses: lithiasis, fevers, and bronchial affec- tion. Dose: i Gm. (gr. xv). Preparations: effervescent citrate, 4 Gm. (dr. i) ; solution, 16 mils (fldr. iv). POTASSIUM GLYCERINOPHOSPHATE. Thick liquid or a mass. Soluble in water. Nerve tonic. Uses : neurasthenia, phosphaturia, convalescence from influenza, deficient nerve nutrition, Addison's disease, etc. Dose: 0.25-0.6 mil (ifl. iv-x) 3 or 4 times daily in mixture. Injection, 0.2-0.25 mil (Tfl, iii-iv) once daily in water containing sodium chloride. 202 MATERIA MEDICA AND THERAPEUTICS POTASSIUM HYDRATE. (Potassi Hydroxidum.) Kali Caus- ticum Fusum. Caustic potassa; potassium hydroxide. Freely soluble in water and alcohol. Escharotic; antacid; diuretic. Uses: internally, lithiasis, gonorrhoea, acid dyspepsia, and cutaneous affection; externally, destroying warts, gangrenous tissue, etc. Dose : 0.015-0.06 Gm. (gr. %-i). Preparation: solution, 1 mil (Hl xv). POTASSIUM HYPOPHOSPHITE. (Potassii Hypophosphis.) Soluble in about 1 part of water. Nerve stimulant. Uses: phthisis, scrofula, deficient nerve power. Dose: 0.5 Gm. (gr. viii). POTASSIUM IODIDE. (Potassii lodidum.) Kalium Jodatum. Soluble in about 1 part of water. Alterative; uric acid solvent; antisyphilitic. Uses : internally, phthisis, rheumatism, peri- carditis, syphilis, aneurisms, scrofulous swellings, lead poison- ing, angina pectoris, asthma. Dose: 0.5 Gm. (gr. viii). Prep- aration: ointment (10 per cent.). POTASSIUM NITRATE. (Potassii Nitras.) Kalium Nitricum. Saltpetre; nitre. Soluble in about 4 parts of water, slightly soluble in alcohol. Antiseptic; refrigerant; diuretic; diaphoretic. Uses: fevers, dropsy, asthma, rheumatism, diseases of gastric and intestinal mucosa. Fumes of burning potassium nitrate paper also used in asthma. Dose: 0.5 Gm. (gr. viii). POTASSIUM PERMANGANATE. (Potassii Permanganas.) Kalium Permanganicum. Soluble in about 18 parts of water, decomposed by alcohol. Dis- infectant; deodorant, emmenagogue. Uses: morphine poison- ing, diphtheria; also as 1:16 wash in diphtheria and scarlatina, and in carcinoma, foul ulcers, fetid breath, and perspiring feet. Dose: 0.065 Gm. (gr. i), in solution or pills made with kaolin and petrolatum, or with cacao butter, after meals. POTASSIUM AND SODIUM TARTRATE. (Potassi et Sodii Tartras.) Kalium Natrio-tartaricum. Rochelle salt. Soluble in about 1% parts of water, insoluble in alcohol. Purgative, refrigerant. Uses: constipation, headache, dropsy, rheumatism; preferred laxative in hemorrhoids. Dose: 8 Gm. (dr. ii). REFERENCE LIST OF DRUGS 203 PROTARGOL. P. Proteid compound of silver; 8 per cent, silver. Yellow powder. Soluble in water. Uses : chiefly gonorrhoea, and ophthalmia neonatorum. Applied in J4-2 per cent, solution. PUMPKIN SEED. (Pepo.) Anthelmintic. Dose: 30 Gm. (dr. viii). PYROGALLOL.-See Acid, Pyrogallic. QUASSIA. (Quassia.) Lignum Quassia. Bitter tonic; anthelmintic; antipyretic; antiparasitic. Uses: to stimulate digestive organs and create appetite; chronic con- stipation; worms, fever, etc. Dose: 0.5 Gm. (gr. viii). Prep- arations: tincture (20 per cent.), 2 mils (TT], xxx). QUININE. (Quinina.) Chininum. Soluble in about 6 parts of alcohol, 2000 parts of water. Anti- pyretic; antiperiodic; ecbolic; tonic. Uses: febrifuge in typhus and typhoid fever, remittent and intermittent fevers, malaria, amenorrhcea; to hasten labor, and as a general bitter tonic. The salts are usually prescribed. For hypodermic use the bisul- phate, dihydrochlorate, or carbamidated hydrochlorate is to be preferred. Dose: 0.25 Gm. (gr. iv). Injection, the salts men- tioned below. QUININE BISULPHATE. (Quinins Bisulphas.) Soluble in about 10 parts of water, 32 of alcohol; eligible for subcutaneous use. Nasal injection (in hay fever) : 0.2 per cent, aqueous solution. Dose : as of quinine. QUININE SULPHATE. (Quininae Sulphas.) Chininum Sul- phuricum. Soluble in about 740 parts of water, 65 of alcohol. Dose: as of quinine. QUININE TANNATE. (Quininae Tannas.) Chininum Tan- nicum. Light brown insoluble powder. Used chiefly for children. Dose: (for children) 0.3-1 Gm. (gr. v-xv) with chocolate in powder or tablets. 204 MATERIA MEDICA AND THERAPEUTICS QUININE AND UREA HYDROCHLORATE. (Quinine et Ureae Hydrochloridum.) Carbamidated quinine dihydrochlorate. Colorkss crystals. So- luble freely in water or alcohol. Used by injection: 0.12-0.5 Gm. (gr. ii-viii) in malaria. Also injected in solution to produce local anaesthesia. RESIN, JALAP. (Resina Jalapa:.) Heavy jalap resin. Soluble in alcohol. Hydragogue cathartic. Uses : chronic constipation, dropsy, etc.; usually with other remedies. Dose: 0.125 Gm. (gr. ii). RESIN, PODOPHYLLUM.-See Podophyllum. RESIN, SCAMMONY. (Resina Scammoniae.) Hydragogue cathartic. Uses: with other cathartics to increase their energy. Dose: 0.2 Gm. (gr. iii). RESINOL. P. Unguentum resinol. Antipruritic; antiphlogistic. Externally, pure, night and morning. RESORCIN. (Resorcinol.) Resorcinum. Resorcinol. White crystals; reddish on exposure; unpleasant sweet taste. Soluble in about 1 part of alcohol, and 1 part of water. Antiseptic; antipyretic; anti-emetic. Uses: internally, in vomiting, sea-sickness, dyspepsia, cholera infantum, diarrhoea, and diphtheria. Dose: 0.125 Gm. (gr. ii). RHUBARB. (Rheum.) Rhizoma Rhei. Cathartic; astringent; tonic; stomachic. Uses: diarrhoea, con- stipation, hepatic disease and to promote appetite. Dose : 1 Gm. (gr. xv). Preparations: extract, 0.25 Gm. (gr. iv) ; fluidextract, 1 mil Cnt xv) ; tincture (20 per cent.), 4 mils (fldr. i) ; syrup, 8 mils (fldr. ii) ; aromatic tincture (20 per cent.), 2 mils (Hl xxx) ; aromatic syrup, 8 mils (fldr. ii) ; mixture of rhubarb and soda, 4 mils (fldr. i); compound powder, 2 Gm. (gr. xxx); compound rhubarb pill, 2 pills. ROCHELLE SALT.-See Potassium and Sodium Tartrate. RUBUS. (Rubus.) Blackberry. Astringent; tonic. Uses: diarrhoea, dysentery, etc. REFERENCE LIST OF DRUGS 205 Dose: I Gm. (gr. xv). Preparations: fluidextract, I mil (TR xv) ; syrup, 4 mils (fldr. i). SACCHARIN. (Benzosulphinidum.) Saccharinum. Garantose; glucoside. White powder fully 550 times as sweet as cane-sugar. Soluble in about 30 parts of alcohol, 400 parts of water. Uses : to sweeten the food of diabetics and dyspeptics; to cover taste of bitter and acrid medicines. Gr. % tablet corre- sponds to about 2 lumps of sugar. SALICIN. (Salicinum.) Soluble in about 30 parts of water, 60 of alcohol. Tonic, anti- periodic ; antirheumatic. Uses : rheumatism, malaria, puerperal fever, chorea, etc. Dose: i Gm. (gr. xv). SALOL. (Phenylis Salicylas.) Salolum. Phenyl salicylate. Almost insoluble in water. Antiseptic; anti- pyretic; antirheumatic, etc. Uses: internally, typhoid fever, diarrhoea, dysentery, fermentative dyspepsia, rheumatism, grip and cystitis; coating for enteric pills, such pills being taken one hour or more after meals and no oil with them. Dose : 0.5 Gm. (gr. viii). SALOPHEN. P. Acetylparamidophenol salicylate. White, odorless, tasteless leaflets or powder; 51 per cent, salicylic acid. Soluble in alcohol, insoluble in water. Antirheumatic; antiseptic; antipyretic; anal- gesic. Uses: rheumatism, gout, chorea; externally, in psoriasis and other itching skin diseases, as 1: 10 ointment. Dose : 0.3-1 Gm. (gr. v-xv) ; maximum dose, 1.3 Gm. (gr. xx), single; 6 Gm. dr. ij4) daily. SALT, EPSOM.-See Magnesium Sulphate. SALT, GLAUBER'S.-See Sodium Sulphate. SALT, ROCHELLE.-See Potassium and Sodium Tartrate. SALTPETRE.-See Potassium Nitrate. SALVARSAN. P. Ehrlich's 606. An organic substitution compound of arsenic. It occurs as a sulphur-yellow powder marketed in small sealed glass tubes, 206 MATERIA MEDICA AND THERAPEUTICS which is soluble in water but may be rendered more soluble by the addition of an alkali. Uses : Has a specific action on the parasite of syphilis and causes a rapid disappearance of the symptoms of the disease, especially in the early stages. An apparent cure results, which may be followed by a relapse unless further treat- ments and mercurial medication are given. Dose : 0.6 Gm. given intramuscularly in oil or solution, or intravenously in solution. SANGUINARIA. (Sanguinaria.) Bloodroot. Expectorant; emetic. Uses: chiefly in cough mix- tures as expectorant. Dose: 0.125 Gm. (gr. ii). Preparations: fluidextract, 0.1 mil (1R ii) ; tincture (10 per cent.), 1 mil (TR xv). SANTONIN. (Santoninum.) Anhydrous santoninic acid. Soluble in about 40 parts of alcohol, insoluble in water. Anthelmintic; tonic. Uses: worms. Dose: 0.065 Gm. (gr. i). Preparation: troches, containing 0.03 Gm. (gr- 54). SARSAPARILLA. (Sarsaparilla.) Radix Sarsaparilla. Alterative; tonic. Uses : in syphilis, scrofula, rheumatism, and skin diseases. Usually with mercury and potassium iodide. Dose: 2 Gm. (gr. xxx). Preparations: fluidextract, 2 mils (TR xxx) ; compound fluidextract, 2 mils (1R xxx) ; compound syrup, 16 mils (fldr. iv). SCAMMONY. (Scammoniae Radix.) Hydragogue cathartic. Uses : with other cathartics to increase their power. Dose: 0.25 Gm. (gr. iv). Preparations: resin, 0.2 Gm. (gr. iii). SCARLET RED. An analine stain used in 8 per cent, ointment to stimulate granulations. Uses : In ulcers and burns, etc. Not used in- ternally. SCOPARIUS. Broom. Diuretic; purgative. Uses: dropsy. Dose: i Gm. (gr. xv). SCOPOLAMINE HYDROBROMIDE.-See Hyoscin Hydro- bromide. REFERENCE LIST OF DRUGS 207 SENEGA. (Senega.) Radix Senega. Expectorant; diuretic; alterative; sedative. Uses: coughs, colds, catarrhal affections, croup, dropsy, rheumatism, asthma, etc. Dose: i Gm. (gr. xv). Preparations: fluidextract, i mil (iff xx); syrup, 4 mils (fldr. i). SENNA. (Senna.) Cathartic. Uses: constipation and febrile diseases. Dose: 4 Gm. (dr. i). Preparations: fluidextract, 2 mils (iff xxx) ; syrup, 4 mils (fldr. i) ; compound infusion, 120 mils (floz. iv) ; compound licorice powder, 4 Gm. (dr. i). SILVER NITRATE. (Argenti Nitras.) Nitras Argenticus. Soluble in about 1 part of water, 26 of alcohol. Antiseptic; alterative; stimulant; escharotic; irritant. Uses: internally, chronic diarrhoea, subacute gastritis, gastric ulcer, intestinal affections; externally, in 2 per cent, solution in gonorrhoea; caustic for ulcers, warts, etc.: ophthalmic practice; odontalgia; external hemorrhoids, etc. Dose: 0.01 Gm. (gr. %). Prepara- tions : fused nitrate in form of pencils; mitigated silver nitrate. SILVER NITRATE (Molded).-See Silver Nitrate. SILVER NITRATE (Diluted).-See Silver Nitrate. SODIUM ACETATE. (Sodii Acetas.) Natricum Aceticum. Soluble in about 2 parts of water, 30 of alcohol. Uses : cystitis, dropsy, and diseases of the urinary organs. Dose: 1.0 Gm. (gr. xv)... SODIUM ARSENATE. (Sodii Arsenas.) Natrium Arsenicum. Soluble in about 4 parts of water, slightly soluble in alcohol. Alterative; tonic; antiseptic; antiperiodic. Uses : internally, malaria, debility, anaemia, chorea, nervous diseases; also in cigarettes for asthma and phthisis; externally, in baths for rheumatism and gout. Dose: 0.005 Gm. (gr. VM). Preparations: dried drug, 0.003 Gm. (gr. 1/w) ; solution 0.2 mil (Iff iii). SODIUM BENZOATE. (Sodii Benzoas.) Natrium Benzoicum. Soluble in about 2 parts of water, 45 of alcohol. Antirheumatic; antipyretic; antiseptic. Uses : rheumatism, gout, uraemia, cystitis, lithaemia, tonsillitis, colds, etc. Dose: t Gm. (gr. xv). 208 MATERIA MEDICA AND THERAPEUTICS SODIUM BICARBONATE. (Sodii Bicarbonas.) Natrium Bicarbonicum. Soluble in about 12 parts of water, insoluble in alcohol. Antacid ; antiseptic. Uses: acid stomach, lithiasis, cystitis, etc. Dose: i Gm. (gr. xv). Preparation: troches. SODIUM BORATE. (Sodii Boras.) Borax. Borax; so-called sodium biborate or tetraborate. Soluble in about 25 parts of water, insoluble in alcohol. Antiseptic; em- menagogue. Uses : internally, amenorrhoea, dysmenorrhoea ; ex- ternally, sore mouth, conjunctivitis, urethritis, skin diseases, aphthae, etc. «Dose: 0.5 Gm. (gr. viii). SODIUM BROMIDE. (Sodii Bromidum.) Natrium Bromatum. Soluble in about 2 parts of water, 16 of alcohol. Sedative; mild hypnotic. Uses : epilepsy, headache, hysteria, nymphomania, satyriasis, delirium tremens, insomnia, scrofula, nervousness. Less depressing than potassium bromide. Dose: i Gm. (gr. xv). SODIUM CACODYLATE. (Sodii Cacodylas.) Sodium dimethylarsenate. White powder. Soluble in water. Alterative; haematinic like arsenous acid. Uses : chiefly obstinate psoriasis, pseudoleukaemia, diabetes, anaemia, chlorosis, chorea, Basedow's disease, tuberculosis. Dose: 0.06-0.12 Gm. (gr. i-ii). SODIUM CITRATE. (Sodii Citras.) White powder. Freely soluble in water, slightly soluble in alcohol. Diuretic; antilithic; refrigerant. Uses : gout, cystitis, rheumatism, fevers, etc. Dose: i Gm. (gr. xv). SODIUM GLYCERINOPHOSPHATE. (Sodii Glycerophos- phas.) Thick liquid or mass. Soluble in water. Reconstructive. Uses : Deficient nerve nutrition, neurasthenia phosphaturia, con- valescence from influenza, exophthalmic goitre, Addison's dis- ease, lumbago, etc. Dose: 0.25-0.6 Gm. (gr. iv-x), 3 or 4 times daily. SODIUM HYDRATE. (Sodii Hydroxidum.) Natrium Caus- ticum. Sodium hydroxide; caustic soda. Freely soluble in water or alcohol. Caustic; antacid. Dose: 0.03-0.6 Gm. (gr. J4~i) freely diluted. Preparation: solution: 1 mil (^l xv). REFERENCE LIST OF DRUGS 209 SODIUM HYPOPHOSPHITE. (Sodii Hypophosphis.) Soluble in about i part of water, 30 of alcohol. Tonic; altera- tive. Uses : Phthisis, scrofula, defects in bony structure, and wasting diseases. Dose: i Gm. (gr. xv). Preparations: syrup, 8 mils (fldr. ii) ; compound syrup, 8 mils (fldr. ii). SODIUM HYPOSULPHITE.-See Sodium Thiosulphate. SODIUM NITRITE. (Sodii Nitris.) Natrium Nitrosum. White crystals or sticks; mildly saline taste. Soluble in about 2 parts of water; slightly soluble in alcohol. Antispasmodic, dia- phoretic, diuretic. Uses: angina pectoris, dropsy, and diseases of the genito-urinary organs. Dose: 0.065 Gm. (gr. i). SODIUM PERBORATE. (Sodii Perboras.) White powder, soluble in water. Antiseptic, germicide. Uses: same as hydrogen dioxide. Dose: 0.06 Gm. (1 grain). SODIUM PHOSPHATE. (Sodii Phosphas.) Natrium Phos- phoricum. Colorless crystals. Soluble in about 6 parts of water, insoluble in alcohol. Cathartic; antilithic. Uses: mild laxative and in vesical calculi. Dose: 2 Gm. (gr. xxx). Preparations: dried sodium phosphate, 1 Gm. (gr. xv) ; effervescent, 8 Gm. (dr. ii) ; compound solution, 8 mils (fldr. ii). SODIUM SALICYLATE. (Sodii Salicylas.) Natrium Salicyli- cum. Soluble in about 1 part of water, 6 of alcohol. Antirheumatic, antiseptic; antipyretic. Uses: rheumatism, neuralgia, pleurisy, chorea, pericarditis, migraine, etc. Dose: i Gm. (gr. xv); maximum dose, 4 Gm. (dr. i). SODIUM SULPHATE. (Sodii Sulphas.) Natrium Sulfuricum. Glauber's salt. Soluble in about 3 parts of water, insoluble in alcohol. Cathartic; aperient; diuretic. Uses : constipation, dropsy, torpid liver, cystitis. Dose: 16 Gm. (dr. iv). SODIUM THIOSULPHATE. (Sodii Thiosulphas.) Natrium T hiosulphuricum. Sodium hyposulphite. Soluble in about I part of water, in- soluble in alcohol. Antiseptic; germicide. Uses: parasitic skin phoricum. 210 MATERIA MEDICA AND THERAPEUTICS disease, sore mouth, diarrhoea, flatulent dyspepsia, etc. Dose: 0.3-1.3 Gm. (gr. v-xx). SOLUTION OF ALUM ACETATE. (Liquor Alumini Acetatis.) Burrows' Solution. Astringent, antiseptic, and disinfectant solution. Used locally in full strength (4.5 to 5.5 per cent.) or diluted. SOLUTION, AMMONIUM ACETATE. (Liquor Ammonii Acetatis.) Ammonium Aceticum Solutum. Spirit Mindererus. Diaphoretic; antipyretic; diuretic. Uses: fevers, dysmenorrhcea, mumps, scarlatina, etc. Dose : 16 mils (fldr. iv). SOLUTION, ANTISEPTIC. (Liquor Antisepticus.) A preparation similar to Listerine. SOLUTION, ARSENIC AND MERCURIC IODIDE.-See Mercuric Iodide, Red. SOLUTION, CALCIUM HYDRATE. (Liquor Calcis.) Liquor Calcaricr. Lime water. Antacid; astringent. Uses : sour stomach, diar- rhoea, dysentery, diabetes, vomiting, dyspepsia; also externally as liniment (with linseed or other oil) for burns, etc. Dose : 16 mils (fldr. iv). Preparation: liniment. SOLUTION, DAKIN-CARREL.-See pages 126, 263. SOLUTION, DOBELLS. (Liquor Sodii Boratis Compo- situs.) An alkaline gargle and mouth-wash, containing sodium bicarbonate (1.5), sodium borate (1.5), carbolic acid (0.3), glycerin (3.5), and water (to make 100). SOLUTION, DONOVAN'S.-See Solution, Arsenic and Mer- curic Iodides. SOLUTION, FOWLER'S. (Liquor Potassi Arsenitis.) Solution of potassium arsenite. Alterative; antiperiodic; tonic. Uses: chorea, skin disease; intermittent fever, malarial affections, periodic neuralgia, chronic rheumatism, etc. Never give on an empty stomach. Dose: 0.2 mil (TR iii). REFERENCE LIST OF DRUGS 211 SOLUTION, HYDROGEN PEROXIDE. (Liquor Hydrogenii Dioxidi.) Hydrogenium Hyperoxidatum Solutum. 3 per cent H,O, (io volumes available O). For action and uses see Perhydrol. SOLUTION, IODINE, COMPOUND.-See Iodine. (Liquor lodi Compositus.) SOLUTION, IRON AND AMMONIUM ACETATE. (Liquor Ferri et Ammonii Acetatis.) Basham's mixture. Haematinic; astringent. Dose: 16 mils (fldr. iv). SOLUTION, LEAD SUBACETATE. (Liquor Plumbi Sub- acetatis.) Plumbum Subacetaticum Solution. Goulard's acetate. 25 per cent. Astringent; antiseptic. Used chiefly to make diluted solution (lead water) and cerate (20 per cent.) for application to burns, sprains, bruises, and for use in eye washes, and for erysipelas, gonorrhoea, etc. SOLUTION, MAGNESIUM CITRATE. Laxative; refrigerant. Dose: 360 mils (floz. xii). SOLUTION, LUGOL'S.-See Solution of Iodine Compound. SOLUTION, POTASSIUM ARSENITE.-See Fowler's Solu- tion. SOLUTION, POTASSIUM HYDRATE.-See Potassium Hy- drate. SOLUTION, SALT.-See Solution, Sodium Chloride, Physio- logical. SOLUTION, SODA, CHLORINATED. (Liquor Soda Chlo- rinatae.) Labarraque's solution. 2.6 per cent, available chlorine. Disin- fectant; antizymotic. Uses: malignant scarlatina, typhoid fever, putrid sore throat, glandular enlargements. Dose: i mil (1R xv). SOLUTION, SODIUM ARSENATE.-See Sodium Arsenate. SOLUTION, SODIUM CHLORIDE, PHYSIOLOGICAL. (Liquor Sodii Chloridi Physiologicus.) Normal salt solution. Sodium chloride (0.85) in distilled water (to make 100). 212 MATERIA MEDICA AND THERAPEUTICS SOLUTION, SODIUM HYDRATE.-See Sodium Hydrate. SPARTEINE SULPHATE. (Sparteinae Sulphas.) Sparteinum Sulfuricuwi. Soluble in water or alcohol. Diuretic; heart remedy. Uses : internally, where digitalis fails or is contra-indicated. Dose : o.oi Gm. (gr. %). SPEARMINT. (Mentha Viridis.) Carminative; stimulant. Uses : flatulence, colic, dysentery, rheumatism, neuralgia, etc. Dose: 4 Gm. (dr. i). Prepara- tions: water, 16 mils (fldr. iv); spirit, 2 mils (TR xxx). SPIGELIA. (Spigelia.) Pinkroot. Anthelmintic. Dose: 4 Gm. (dr. i). Preparation: fluidextract, 4 mils (fldr. i). SPIRIT, GLONOIN. (Spiritus Glycerylis Nitratis.) Spirit (solution) of nitroglycerin (trinitrin) 1 per cent. Anti- spasmodic; vasodilator; arterial stimulant. Uses: angina pec- toris, convulsions, asthma, heart disease, poisoning by carburetted hydrogen, headache, neuralgia, etc. Dose: 0.05 mil (Til i). SPIRIT, MINDERERUS.-See Solution, Ammonium Acetate. SPIRIT, NITROUS ETHER. (Spiritus Athens Nitrosi.) Sweet spirit of nitre. Diaphoretic; diuretic; antipyretic; stimulant; antispasmodic. Uses: fevers, dropsy, diseases of the genito-urinary organs, flatulent colic, colds, etc. Dose : 2 mils (TR xxx). SQUILL. (Scilla.) Bulbus Scillce. Expectorant; emetic; diuretic. Uses: coughs, colds, croup, dropsy. Dose: 0.125 Gm. (gr. ii). Preparations: fluidextract, 0.1 Gm. (gr. xv) ; tincture (10 per cent.), 1 mil (TR xv) ; vinegar, 1 mil (TR xv) ; syrup, 2 mils (TR xxx) ; compound syrup, 2 mils (TR xxx). STAPHISAGRIA. (Staphisagria.) Stavesacre. Parasiticide. Uses : externally in substance or 1: 16 solution of fluidextract in dilute acetic acid in itch, and for pediculi. Preparation; fluidextract. REFERENCE LIST OF DRUGS 213 STILLINGIA. (Stillingia.) Queen's root. Alterative; resolvent. Uses: syphilis, skin dis- eases, scrofula, etc. Dose: 2 Gm. (1R xxx). Preparation: fluid- extract, 2 mils (TR xxx). STRAMONIUM. (Stramonium.) Folium Stramonii. Narcotic; sedative; analgesic. Uses: internally, epilepsy, rheumatism, dysmenorrhcea, spasmodic asthma, chorea; extern- ally, as ointment in ulcers and hemorrhoids; also in cigarettes in asthma. Dose: 0.065 Gm. (gr. i). Preparations: extract, 0.01 Gm. (gr. %) ; fluidextract, 0.05 mil (1R i) ; tincture (10 per cent.), 0.5 mil (TR viii) ; ointment. STRONTIUM BROMIDE. (Strontii Bromidum.) Colorless, odorless, deliquescent crystals; bitter saline taste. Soluble in about 2 parts of water, freely in alcohol. Gastric tonic; nerve sedative; antiepileptic. Uses: hyperacidity of stom- ach, gout, epilepsy, nervousness, hysteria, headache, etc. Dose : 1 Gm. (gr. xv). STRONTIUM SALICYLATE. (Strontii Salicylas.) Soluble in about 55 parts of water, soluble in alcohol. Anti- rheumatic; intestinal antiseptic. Uses: rheumatism, chorea, mus- cular pains, pleurisy, intestinal fermentation. Dose: i Gm. (gr. xv). STROPHANTHIN. (Strophanthinum.) White powder, very bitter taste. Soluble in water or alcohol. Heart tonic; vasoconstrictor; non-diuretic. Use: see Digitalin. Dose: 0.0005-0.001 Gm. (gr. Vuo-Vw) by mouth; 0.0008 Gm. (gr. Vso) intravenously. STROPHANTHUS. (Strophanthus.) Semen Strophanthi. Action and uses: as strophanthin. Dose: 0.065 Gm. (gr. i). Preparation: tincture (10 per cent.), 0.5 mil (TRviii). STRYCHNINE. (Strychnina.) Strychninum. Soluble in no parts of water, 6700 of alcohol. Bitter tonic; stimulant; stomachic. Uses : internally, palsy, chronic alcoholism, dyspepsia, anaemia, insomnia from mental overwork, etc. Dose: 0.001 Gm. (gr. 214 MATERIA MEDICA AND THERAPEUTICS STRYCHNINE NITRATE. (Strychnine Nitras.) Strychninum Nitricum. White needles or powder. Soluble in about 50 parts of water, 60 of alcohol. Uses : dose, etc.: as of strychnine. Most frequently used in dipsomania. STRYCHNINE SULPHATE. (Strychnine Sulphas.) Soluble in about 50 parts of water, no of alcohol. Uses: dose, etc.: as of strychnine. STYPTICIN. P. (Cotarnine Hydrochloridum.) Cotarnine hydrochlorate. Yellow powder. Soluble in water or alcohol. Hemostatic; uterine sedative; styptic. Uses: highly extolled in atypical uterine hemorrhages not dependent upon neoplasms or retained fragments of ovum or upon marked endometritis. Reported excellent also in prolonged or excessive menstruation, particularly in young girls, as effective in purely climateric hemorrhages, dysmenorrhoea, and haemoptysis; also to be efficacious in nose-bleed and in hemorrhage following tooth extraction. Dose: 0.1-0.25 Gm. (gr. ij4-iv) 4 or 5 times daily. SULFONAL. (Sulphon methanum.) Sulfonalum. Colorless tasteless crystals. Soluble in about 500 parts of water, no of dilute alcohol. Hypnotic; sedative. Uses: insomnia, epilepsy, night-sweats, hiccough, chordee, etc. Dose: i Gm. (gr. xv). SULPHUR, PRECIPITATED. (Sulphur Praecipitatum.) Lac sulphuris ; milk of sulphur. Laxative ; alterative; antiseptic; diaphoretic. Uses : internally, rheumatism, catarrh, asthma, hemorrhoids, sciatica, skin diseases; externally, in ointment, in scabies, and other skin affections. Dose: 4 Gm. (dr. i). SULPHUR, SUBLIMED. (Sulphur Sublimatum.) Flowers of sulphur. Intended for external use only in scabies, skin diseases, etc. Preparation: ointment (15 per cent.). SULPHUR, WASHED. (Sulphur Lotum.) Sulfur Depuratum. Action and uses: as sulphur, pure. Dose: 4 Gm. (dr. i). SUPRARENAL CAPSULE, DRIED. (Suprarenalum Siccum.) 1 part represents 5 parts fresh capsule. Alterative; nervine. REFERENCE LIST OF DRUGS 215 Uses : Addison's disease, diabetes insipidus, neurasthenia, rha- chitis, cyclic albuminuria, climacteric disturbances, etc. Dose: 0.25 Gm. (gr. iv). SYRUP, HYDRIODIC ACID.-See Acid, Hydriodic. SYRUP, HYPOPHOSPHITES.-See Sodium Hypophosphite. SYRUP, IRON IODIDE. (Syrupus Ferri lodidi.) Syrupus Jodeti Ferrosi, Ferri lodidi Sirupus. 10 per cent, ferrous iodide. Alterative; haematinic. Uses : scrofulous affections, tuberculosis, chronic rheumatism, leuco- cythaemia, chlorosis, anaemia. Dose: i mil (1R xv). TAKA DIASTASE. P. (Diastase takamine.) Brownish powder; almost tasteless. Soluble in water, insoluble in alcohol. Starch digestant (1 part stated to convert over 100 parts of dry starch). Uses: in amylaceous dyspepsia. Dose: 0.06-0.3 Gm. (gr. i-v). TANNALBIN. P. Tannin albuminate exsiccated, Knoll. Light brown, odorless, tasteless powder; 50 per cent, tannin. Insoluble in water. Dose : 1-4 Gm. (dr. %-i). TANNIGEN. P. Diacetyl tannin. Gray, hygroscopic powder; almost odorless and tasteless. Soluble in alkaline fluids or alcohol, insoluble in water. Intestinal astringent. Dose: 0.3-2 Gm. (gr. v-xxx). TANNOFORM. P. Tannin formaldehyde. Loose, reddish powder. Soluble in alcohol, insoluble in water. Siccative antiseptic and deodorant. Uses : hyperidrosis, bromidrosis, weeping eczema, ozena, etc. Applied pure or in 25-50 per cent, triturations. TAR. (Pix Liquida.) Pix Pini. Antiseptic; antispasmodic. Uses: internally, bronchial affec- tions, colds, fevers, diarrhoea, etc.; externally, skin diseases. Dose: 0.5 Gm. (gr. viii). Preparations: syrup, 4 mils (fldr. i) ; ointment (50 per cent.). 216 MATERIA MEDICA AND THERAPEUTICS TARAXACUM. (Taraxacum.) Dandelion. Bitter tonic; hepatic stimulant. Uses: liver disease with dyspepsia, and constipation. Dose: 8 Gm. (dr. ii). Prep- arations: extract, I Gm. (gr. xv) ; fluidextract, 8 mils (fldr. ii). TARTAR EMETIC.-See Antimony and Potassium Tartrate. TEREBENE. (Terebenum.) Colorless or slightly yellowish liquid ; thyme-like odor ; resinifies in light. Soluble in alcohol, slightly soluble in water. Expec- torant; antiseptic; antifermentative. Uses: internally, in chronic bronchitis, flatulent dyspepsia, genito-urinary diseases, phthisis, bronchitis, etc.; externally, skin diseases; in phthisis by inhala- tion (about 2 oz. a week). Dose: 0.25-1.3 Gm. (gr. iv-xx), externally, in 1 per cent, solution. TERPIN HYDRATE. (Terpini Hydras.) Terpinum Hydratum. Colorless prisms; slightly bitter taste. Soluble in about 10 parts of alcohol, 250 of water. Expectorant; antiseptic ; diuretic; diaphoretic. Uses: bronchial affections, whooping-cough, throat affections, tuberculosis. Dose: 0.125 Gm. (gr. ii). THEINE.-See Caffeine. THEOBROMINE. White powder; bitter taste. Insoluble in water. Diuretic; nerve stimulant. Uses: cardiac dropsy. Dose: 0.3-1 Gm. (gr. v-xv.) THEOBROMINE AND SODIUM SALICYLATE. (Theo- brominae Sodio-Salicylate.) White odorless powder; decomposed by exposure. Diuretic. Uses: cardiac dropsy; nephritis, especially after scarlatina. Dose: i Gm. (gr. xv), 5 or 6 times daily. THEOCIN. P. Theophyllin. Colorless crystals. Soluble with difficulty in cold water and alcohol. Diuretic. Dose: 0.2-0.5 Gm. (gr. iii-viii). THYROIDIN. P. Dried extract of sheep's thyroid; 1 part represents 6 parts of fresh gland. Whitish powder. Alterative, antifat. Uses: myxoedema, cretinism, psoriasis, obesity, etc. Dose: 0.25 Gm. (gr. iv). REFERENCE LIST OF DRUGS 217 TINCTURE, ACONITE.-See Aconite. TINCTURE, ARNICA FLOWERS. (Tinctura Arnica.) Antiseptic. Uses : externally, chiefly in bruises and other injuries. TINCTURE, HYDRASTIS.-See Hydrastis. TINCTURE, HYOSCYAMUS.-See Hyoscyamus. TINCTURE, IRON CHLORIDE. (Tinctura Ferri Chloridi.) Solutio Chloreti Ferrici Spirituosa. Hamatinic; astringent. Uses : chlorosis, anaemia, etc. Dose: 0.5 Gm. (gr. viii). TINCTURE, NUX VOMICA.-See Nux Vomica. TINCTURE, PULSATILLA. Antispasmodic; sedative; anodyne. Uses: internally, asthma, whooping-cough, spasmodic dysmenorrhoea, orchitis, etc. Dose: 0.3-1.3 mils (1R v-xv). TINCTURE, STRAMONIUM.-See Stramonium. TINCTURE, STROPHANTHUS.-See Strophanthus. TINCTURE, VERATRUM VIRIDE.-See Veratrum Viride. TRIKRESOL. P. Clear liquid; cresolic odor. Soluble in 40 parts of water. Dis- infectant. Application: in J4-I per cent, solution. TRIONAL. P. Diethylsulphonemethylethylmethane. White powder; faint bitter taste. Soluble in about 320 parts of water. Hypnotic; sedative. Uses : for producing sleep, especially where there is no pain. Dose: i Gm. (gr. xv). TRITICUM. (Triticum.) Couch-grass. Demulcent; diuretic. Uses: cystitis and other diseases of the genito-urinary organs. Dose: 8 Gm. (dr. ii). Preparation: fluidextract, 8 mils (fldr. ii). URETHANE. (2Ethylis Carbamas.) Ethyl urethane: ethyl carbamate. Colorless crystals; faint 218 MATERIA MED1CA AND THERAPEUTICS peculiar odor; saltpetre like taste. Soluble in about i part of alcohol or water. Hypnotic; antispasmodic; sedative. Uses: insomnia, eclampsia, nervous excitement, tetanus; and as anti- dote in strychnine, resorcin, or picrotoxin poisoning. In eclampsia it should be given per enema. Dose: 2-3 Gm. (dr. 54-^4). VALERIAN. (Valeriana.) Nerve sedative; antispasmodic; anodyne. Uses: hysteria, epi- lepsy, hypochondria, headache, etc. Dose: 2 Gm. (gr. xxx). Preparations: tincture (20 per cent.), 4 mils (fldr. i); am- moniated tincture, 2 mils (Tit xxx). VERATRUM VIRIDE. (Veratrum Viride.) American hellebore. Cardiac depressant; diaphoretic; diuretic. Uses : fevers, acute inflammations as pneumonia, mania, puer- peral convulsions, etc. Dose: 0.002 Gm. (gr. */*). Preparations: oleate; ointment. VERONAL. P. Diethylmalomylurea. White crystalline powder; faintly bitter taste. Soluble in about 12 parts of boiling water. Hypnotic. Uses : simple agrypnia, and in insomnia accompanying hys- teria, neurasthenia, and mental disturbances. Dose: 0.3-1 Gm. (gr. v-xv). VIBURNUM COMPOUND. P. Antispasmodic; nervine. Uses: dysmenorrhcea, menorrhagia, metrorrhagia. Dose: 4-8 mils (fldr. i-ii). VIBURNUM PRUNIFOLIUM.-See Black Haw. WHITE PRECIPITATE.-See Mercury-ammoniated. WILD CHERRY BARK. (Prunus Virginiana.) Astringent; tonic; sedative. Uses: bronchitis, general or local irritation, debility, coughs, colds, etc. Dose: 2 Gm. (gr. xxx). Preparations: syrup, 4 mils (fldr. i). ZINC CARBONATE, PRECIPITATED. (Zinci Carbonas Praecipitatus.) Uses: Wounds, ulcers, skin diseases, etc., also face powder; externally, pure or in 20 per cent, ointment or powder. REFERENCE LIST OF DRUGS 219 ZINC CHLORIDE. (Zinci Chloridum.) Zincum Chloratum. Soluble in about % part of water, i part of alcohol. Alterative; antispasmodic; escharotic. Uses: internally, epilepsy, chorea, scrofula, syphilis, etc.; externally caustic in naevi, cancerous affections, superabundant granulations, aneurisms, etc. Dose: 0.006 Gm. (gr. 7m). ZINC OXIDE. (Zinci Oxidum.) Zincum Oxidatum. Antispasmodic; antiseptic; mild sedative. Uses: internally, chorea, epilepsy, chronic diarrhoea, etc.; externally (in 5-20 per cent, solution), wounds, skin diseases, etc. Dose: 0.25 Gm. (gr. iv). Preparation: ointment. ZINC STEARATE. (Zinci Stearas.) White agglutinating powder; turns darker on exposure. In- soluble in water. Antiseptic; astringent. Uses : gonorrhoea, atrophic rhinitis, etc. Applied in substance or combined in form of the official ointment. ZINC SULPHATE. (Zinci Sulphas.) Zincum Sulfuricum. White vitriol; zinc vitriol. Soluble in about 1 part of water; insoluble in alcohol. Emetic; astringent; antiseptic; escharotic. Uses : internally, gastric catarrh, nervous affections, night- sweats, etc.; externally, in gonorrhoea (%-2 per cent, solution) ; ophthalmia (1:1000), skin diseases (1:10-1:20 ointment). Dose: i Gm. (gr. xv) as emetic. ZINC SULPHOCARBOLATE. (Zinci Phenolsulphonas.) Colorless crystals. Soluble in about 5 parts of water or alcohol. Antiseptic; astringent. Uses: gonorrhoea, foul ulcers, etc.; in- ternally, typhoid, fermentative diarrhoea, etc. Dose: 0.125 Gm. (gr. ii). ZINC VALERIANATE. (Zinci Valeras.) Zincum Valerianicum. Decomposes on exposure. Soluble in about 40 parts of alcohol, 120 of water. Antispasmodic; tonic. Uses: diabetes insipidus, nervous affections, neuralgia, etc. Dose: 0.125 Gm. (gr. ii). SYNOPSIS OF THE PRINCIPAL ACTIONS AND USES OF DRUGS I. Drugs Applied to Skin or Mucous Membrane for Local Action : (a) Astringents (the soluble salts being also styptics and acting through their power to coagulate protein) : Tannic acid and compounds. Iron preparations. Bismuth preparations. Lead acetate. Zinc sulphate. Copper sulphate. Alum. To contract vessels and reduce hemorrhage and swelling: Cocaine and suprarenalin. (b) Protectives (forming protective layers) : Plasters, collodia, starch, talc, etc. (c) Local anodynes for pain and itching: Bicarbonate potassium. Acting on terminals of sensory nerves. Cocaine, eucaine, orthoform. Carbolic acid. Chloretone. Atropine, veratrine and aconite. (d) Local anaesthetics (same action as local anodynes) : Cocaine and eucaine. Orthoform. II. To Affect Alimentary Tract: Mouth and Throat: To lessen local inflammation: Chlorates, ammonium chloride, cubebs. To lessen salivation, by action on nerve terminals: Atropine. Stomach: (a) Digestives: Pepsin, papaine, etc., hydrochloric acid (act on con- tents of stomach causing digestion of proteins). 220 REFERENCE LIST OF DRUGS 221 (b) Emetics: By peripheral irritation of stomach membranes: Common salt, mustard, warm water, ipecac, copper and zinc sulphates. By central action on vomiting centre: Apomorphine (c) To lessen local irritation and vomiting by acting on ter- minations of sensory nerves in stomach: Opium, chloral, bismuth, cerium, oxalate cold, cocaine, carbonic acid water, prussic acid. (d) To lessen acidity by acting on stomach contents: Potassium, sodium and lithium carbonates and bicar- bonates. Magnesia and magnesia carbonate. Lime water and chalk. Act chemically, forming salts of the acid. (e) To increase secretion of HCl and Pepsin: Simple bitters, gentian, calumba, etc. Nux vomica and strychnine. Cinchona and quinine, hydrastis and salicin. Alcohol (diluted). All except alcohol act reflexly through taste nerves. Alcohol probably increases blood supply. (/) Carminatives: Volatile oils-Cardamon, cloves, etc. Camphor, charcoal, chloroform. Alcohol. Aid peristalsis by overcoming spasm: give feeling of well being. III. Dbugs Acting on the Intestine: (a) To promote digestion: Pancreatin, diastase. Given before eating or in enteric pills. (6) To promote evacuation (purgatives): Calomel and mercury, podophyllin. Mainly on the small intestine. Hydragogues, salines, enemata, purgative oils, aloes, senna, etc. Mainly on the large intestine. 222 MATERIA MEDICA AND THERAPEUTICS (c) To lessen peristalsis and relax spasm: Opium and morphine. Acts on local nerve mechanism. Tannic acid series, bismuth. Act as astringents and protectives. Atropine. To relax spasm through paralysis of pneumogastric endings. (d) To destroy parasites by acting as muscle poisons to the parasites: Male fern, pomegranate, pumpkin seed. (Tape-worm.) Santonin. (Round worm.) Thymol. (Hook-worm.) Quassia enema. (Pin-worm.) (e) Disinfectants and antiseptics: Mercurials and calomel. (True antiseptics.) Saline cathartics. Flush out offending matter. Naphthol and betanaphthol. Doubtful efficiency as antiseptics, but good deodorants. Salol and salicylic acid, guaiacol and guaiacol carbonate. Absorbed rather too rapidly. Salol is partly broken up in stomach. IV. Drugs Used for Their Effects on Circulation: i. Heart: (o) To strengthen contraction: Digitalis, strophanthus. By stimulating pneumogastric, as well as heart muscle. (b) To accelerate pulse: Atropine. Paralyzes ends of pneumogastric releasing its inhibition. Caffeine. A direct stimulating action on heart muscle. (c) To slow the pulse: Digitalis, strophanthus, squills and strychnine. Stimulate inhibitory cardiac and vasoconstrictor centres. REFERENCE LIST OF DRUGS 223 Aconite and veratrine. Stimulate inhibitory centre, and depress vasomo- tor centre and depress heart muscle. 2. Vessels: (a) To contract calibre and raise blood-pressure: Ergot Stimulates vasoconstrictor centre, also vessel zvalls. Strychnine. Stimulates vasoconstrictor centre and pneumo- gastric. Caffeine. Stimulates vasoconstrictor centre and heart muscle. Digitalis. Stimulates vasoconstrictor centre, pneumogastric and vessel walls. (b) To relax vessels and lower blood pressure: Nitro-glycerin, amyl nitrite, sodium nitrite. Act on vessel walls alone. Depress the heart in large doses. (c) To arrest internal hemorrhage: Ergot acts on constrictor centre and vessel walls. Hydrastine and hydrastinine, similar to above. Opium and morphine. To allay restlessness. Pituitrin. Contracts blood-vessels-by central and local action-especially of uterus. (d) To remove fluid (dropsy, anasarca) : Digitalis and squills. Diuresis due to increased blood supply of kidney and higher pressure. Caffeine and theobromine-see below. Saline cathartics and hydragogues. By fluid depletion of splanchnic vessels. Diaphoretics (see Skin). 224 MATERIA MEDICA AND THERAPEUTICS V. Drugs Used for Their Effects on the Genito-urinary System. I. The kidneys: (a) To increase the secretion of urine: Caffeine and theobromine. Stimulate kidney epithelium. Digitalis and squills. Diuresis due to increased blood supply of kidney. Nitrates and acetates. Probably stimulate renal epithelium. Carbonates and citrates of alkaline metals. Increase metabolism and flushing of tissues. Calomel and mercurials. Stimulate renal epithelium. (&) To render urine less acid: Alkali carbonates and bicarbonates. Acetates, citrates. Broken up into bicarbonates. (c) To render urine antiseptic: Copaiba, santal and cubebs. Salol and salicylates. Salol excreted as phenol and salicylate potash. Sodium sulphocarbolate. Urotropin. Free formaldehyde compounds excreted in urine. 2. The uterus: (a) To stimulate muscular contractions: Ergot. Through spinal centre and on intrinsic nerves and muscles. Quinine. Uterine muscle probably effected directly. Hydrastis. Stimulates spinal centre (?). Pituitrin. Direct muscle-nerve action. Pilocarpine. Stimulates motor nerve terminations. (&) To promote menstruation: Vegetable purgatives-aloes, etc., by increasing pelvic turgidity. Iron. To relieve accompanying chlorosis. REFERENCE LIST OF DRUGS 225 VI. Drugs Used for Their Effects on the Respiratory System : (a) To stimulate the respiratory centre: Atropine. Quickens and deepens respirations; stimulates centre directly. Caffeine: Central stimulation, most noticeable after de- pression by narcotics. Strychnine. Central stimulation, most noticeable after de- pression by narcotics. Camphor. Weak action as compared with foregoing. (b) To reduce irritability of the respiratory centre in cough: Opium, morphine and codeine. Heroin. Chloral compounds and bromides. (c) To increase and liquefy bronchial secretion: Ipecac. Acts reflexly, producing mild nausea. Tartar emetic. Acts reflexly, producing mild nausea. Squills. Acts reflexly-heart tonic as well as expectorant. Ammonium carbonate and iodides of alkalies. Ammonium carbonate a nauseating expectorant. Iodides in sufficient doses are excreted through the respiratory tract and cause increased secre- tion of mucous. Later iodism. (d) To lessen bronchial secretion (?) (of doubtful utility) : Benzoic acid, benzoin, tolu. Ammonium chloride. Cubebs, terpin hydrate, terebene. (e) To relax bronchial spasm in asthma: Lobelia. Acts probably by depressing ganglia of bronchial muscles. 226 MATERIA MEDICA AND THERAPEUTICS Atropine. Acts probably by paralyzing motor nerve ter- minals of bronchial muscles. Amyl nitrite. Acts directly on unstriped muscle of bronchi. VII. Drugs Used for Their Effects on the Central Nervous System : I. Stimulants: (a) The spinal cord: Strychnine. Increases irritability of nerve cells by decreasing resistance to afferent impulses. (b) The brain and medulla: Atropine and cocaine. Cerebral cortex-deleriants. Caffeine. Increases psychic activity, but inimical to mental concentration. 2. Depressants: (a) To paralyze sensation-general anaesthetics: Ether, chloroform, nitrous oxide. Affect cerebral cortex. (b) To induce sleep and rest-hypnotics or narcotics: Opium and morphine. Used when pain is present. Alcohol. Depresses cortex first, then rest of nervous sys- tem, but may cause excitement. Chloral and compounds. Used when insomnia is due to psychomotor irritability. Bromides. Depress entire nervous system. Useful only when due to anxiety-not to pain. Hyoscin. Depresses cortex, especially psychic area. Cannabis Indica. Resembles morphia, mingled cortical depression and stimulation. REFERENCE LIST OF DRUGS 227 Paraldehyde and suiphonal, etc. Resemble alcohol-minus excitement stage. (c) To relieve pain-analgesics or anodynes: Opium. Relieves sensation centrally at first, then peri- pherally. No local action. Cannabis. Non-stimulant and less anaesthetic than opium. Unreliable. Antipyrine, etc. Sedative to central system; do not produce any psychic depression. Useless in acute inflam- matory conditions, but helpful in neuralgia, etc. Nitrites. Sometimes of value in headache due to high blood-pressure. Salicylates. Of value in muscle and acute joint pains. VIII. Drugs Used to Reduce Fever Temperature: (a) Antipyrin, acetanilide, etc. Affect heat regulating mechanism in fever, lower- ing point at which temperature has been main- tained and causing increased heat loss. (b) Quinine. Does not affect heat regulating mechanism, more likely prevents abnormal katabolism. (c) Aconite. Causes heat loss by action on circulation. Also believed to have an action through the heat centre. (d) Salicylic acid, etc. Causes heat loss by dilating skin vessels. Central action in doubt. Not so efficient as antipyrin, etc. (?) Diaphoretics. (See below.) (/) Guaiacol. Local application causes fall in temperature by producing after absorption a condition bordering on collapse. 228 MATERIA MEDICA AND THERAPEUTICS IX. Drugs Used for Their Effects on the Liver: To increase the secretion of bile: (a) Ox-gall, sodium glycocholate. Direct stimulants to gland through action on liver cells after absorption. (b) Salicylic acid. Slight stimulant effect on liver cells. X. Drugs Used for Effects on the Blood: (a) To increase the haemoglobin : Iron. Principally in chlorosis. Absorbed from large intestine. (b) Arsenic. Stimulates bone-marrow and red-cell forming func- tion in pernicious and symptomatic anaemia. (c) To increase alkalinity: Alkaline carbonates. Absorbed as carbonates. Acetates and citrates. Become carbonates and bicarbonates. XI. Drugs Used for Specified Diseases : (a) Malaria: Quinine. Kills the plasmodium. Arsenic. Corrects cachexia. (b) Syphilis: Salvarsan and neosalvarsan. Kill the parasite. Mercury and iodides. Believed to unite with toxic substances. (c) Rheumatic -fever: Salicylic acid, salicylates, salol. Taken up as sodium salicylate by inflamed tissues. Excess of HsCOs in tissues releases free salicylic acid which exerts a specific action in eliminat- ing the inflammatory products? REFERENCE LIST OF DRUGS 229 (d) Amoebic dysentery: Emetine. Destroys Amoeba histolytica. (e) Myxcedema and some other thyroid diseases. Thyroid extract. Supplies the necessary iodothyrin for animal metabolism. (/) Gout: Atophan and salicylates. Demobilize urates. Colchicum. No reason for its supposed effects. XII. Drugs Used for Their Effects on the Skin: (a) Irritants: Mustard, cantharides, iodine, etc. (b) Disinfectants: Tar, ichthyol, sulphur, mercury, etc. (c) Drugs administered internally to increase the secre- tion of perspiration: Ipecacuanha, and other nauseating expectorants. Increase of sweat and saliva a reflex from stom- ach irritation. Not so profuse as that follow- ing pilocarpin. Ipecacuanha and opium. Dover's powder. Opium aids by dilating periph- eral vessels. Camphor. Dilates peripheral vessels slightly. Pilocarpin. Stimulates the brush-like endings of the secretory nerves. Most efficient diaphoretic. Not to be used when right heart is weak. (d) Drugs administered internally to lessen secretion of perspiration (night sweats of phthisis, etc.) : Atropine and belladonna. Paralyze terminations of all secretory nerves. Agaricin. Paralyzes terminations of secretory nerves to sweat glands alone. 230 MATERIA MEDICA AND THERAPEUTICS (r) Drugs applied locally and internally to arrest secre- tion of milk: Atropine. Paralyzes secretory nerve terminations. XIII. Drugs Used Locally for Their Effect on the Eye: (a) Drugs dilating the pupil, and relaxing accommoda- tion : Atropine and homatropine. Paralyze the terminations of oculi motor nerve in iris and ciliary muscle. Cocaine. Stimulates terminations of nerve to dilator fibres. In large quantities acts on ciliary muscle like atropine. (b) Drugs contracting the pupil and ciliary muscle: Physostigmine or eserine. Stimulates the terminations of motor nerves in unstriped muscle-antagonist to atropine. Pilocarpin. Action similar, though weaker. DRUGS WHICH CAUSE ERUPTIONS AND CHANGES IN EXCRETIONS DRUG ERUPTIONS Drugs which, when administered-some externally, some internally, and some either externally or internally-may cause skin eruptions: Aconite, antifebrin, antimony, antipyrine, arnica, arsenic, balsam of peru, belladonna, boric acid and borax, bromine and its compounds, cade oils, cannabis indica, cantharides, carbolic acid, chloral hydrate, chrysarobin, chrysophanic acid, copaiba, croton oil, cubebs, ergot, iodine and its com- pounds, iron, lead (acetate and carbonate), mercury, nux vomica and strychnine, opium (morphine and other deriva- REFERENCE LIST OF DRUGS 231 tives), phenacetin, pix liquida (tar), podophyllin, quinine, salicylic acid and salicylates, silver nitrate, stramonium, sul- phonal, sulphur, terebene, turpentine, thyroid gland substance and veronal. Less commonly, eruptions follow the use of bitter almond, calcium sulphide, capsicum, chinolin, conium, hyoscyamus, ipecacuanha, cod liver oil, phosphorus, santonin, tannin and veratrum viride; but these are so rare as to be of little practical importance. Serum injection may be followed by eruptions. DRUGS WHICH COLOR THE STOOLS Bismuth, iron, lead and most metallic salts color the stools black. Mercury colors the stools green. Phenolphthalein sometimes gives a red tint to alkaline stools. Rhubarb colors the stools yellow. Colchicum colors the stools yellow. Purgatives usually darken the stools. Milk of magnesia makes them gray. DRUGS WHICH CHANGE THE COLOR OF URINE Diuretics make it paler. Irritants make it darker. Methylene-blue colors acid urine green. Phenol and salol make it dark and smoky. Rhubarb may color it brown-bile color. Santonin, yellow if acid-purple if alkaline. Senna, red if acid-yellow if alkaline. Sulphonal, dark red or smoky. Trional, same as sulphonal. 232 MATERIA MEDICA AND THERAPEUTICS DRUGS THAT ARE EXCRETED WITH MILK Arsenic compounds Quinine Bromides Sulphur Iodides Vegetable cathartics Lead salts Salol Mercury salts Volatile oils Opiates READY REFERENCE TABLE OF POISONS AND ANTIDOTES THE FOLLOWING TABULATED INFORMA- TION IS BASED ON THE TEXTS FORMULATED BY WELLCOME, WOOD, AND OTHER TOXI- COLOGISTS. THE POISONS ARE GROUPED AS (a) CORROSIVE ACIDS, (5) POISONOUS ACIDS, (t) CAUSTIC ALKALIS, (d) MINERAL AND OTHER INORGANIC POISONS, (#) ORGANIC POISONS. 234 MATERIA MEDICA AND THERAPEUTICS Poison Symptoms Treatment Hydrochloric Acid Nitric Acid Sulphuric Acid (Oil of Vitriol) Oxalic Acid Salt of Lemons CORROSIVE ACIDS Those of corrosive poisoning: i. Pain in mouth, throat and abdomen, the mucous membrane being partially de- stroyed 2. Intense thirst 3. Difficulty in speaking and swallowing 4. Vomiting of altered blood-brown or black, with coagulated mucous and shreds of mucous membrane 5. Constipation and suppression of urine 6. Convulsions 7. Profound collapse (a) Skin-pale, cold, clammy (6) Face-cyanosed (c) Eyes-sunk, wild-looking, pupils often dilated (d) Pulse-rapid, thready, low tension («) Respiration-labored (/) Temperature-subnormal 8. If perforation occur, symptoms of peritonitis 9. Staining of tissues and clothing 1. Do not use stomach tube or emetic, but neutralize the acid by giving one of the following: (a) whiting, (b) chalk, (c) wall plaster, (d) sodium carbonate (washing soda), (e) potassium car- bonate, mixed with, or dissolved in, plenty of water, (/) magnesium carbonate, X to 1 oz. in a tumbler- ful of water, or (g) soap and water in large draughts 2. Next give one of the following: (a) milk and egg, (6) olive oil, X pint in 1 pint of water, or (c) thick gruel 3. Diminish shock and ease pain with morphine sulphate (hypodermic) gr. 1/3 4. To sustain patient, rectal feeding 1. Do not use stomach tube or emetic, but give (a) whiting, (b) chalk, (c) wall plaster, or (d) lime water, freely; or (e) saccharated solution of lime in drachm doses, frequently repeated. A full dose of castor oil should be given afterwards 2. Milk should be freely given 3. To sustain patient, rectal feeding A TABLE OF POISONS AND ANTIDOTES TAELES OF POISONS AND ANTIDOTES 235 Action of Corrosive Acids On skin and mucous membrane On clothing Hydrochloric Nitric Sulphuric Oxalic Greyish-white Bright yellow White or char- ring to brown or black White or brown Bright red Yellow, orange- red, or brown Dirty brown, edges may be red Brown to orange-red Poison Symptoms Treatment Carbolic Acid (Phenol) POISONOUS ACIDS I. Those of corrosive poisoning 2. Lips and mouth, white and hardened 3. Urine greenish, dark or suppressed 4. Nervous symptoms-reflexes abolished, mus- cles relaxed, stupor, anaesthesia. There may be return to consciousness, with apparent great improvement, and then some hours after, death may occur sud- denly from collapse 1. Insert stomach tube with care, and wash out the stomach with succes- sive quantities of one of the follow- ing, until there is no smell of car- bolic acid in fluid coming from the stomach: (a) sodium sulphate, X oz. in 1 pint of warm water; (6) magnesium sulphate, X oz., in one pint of warm water; or (c) saccharated solution of lime, 1 drachm, in one pint of warm water; (d) alcohol 20 per cent. 2. Empty the stomach and give one of the following: (a) olive oil, about pi pint, in one pint of water; (6) milk freely; or (c) white of egg in water, freely 3. Give sodium or magnesium sulphate, pi oz., in warm water 236 MATERIA MEDICA AND THERAPEUTICS Poison Symptoms Treatment Carbolic Acid (Phenol) Hydrocyanic Acid (Prussic Acid) Cyanides Symptoms come on in the act of swallowing, or immediately afterwards I. Giddiness, staggering, loss of motor oower 2. Insensibility 3. Respiration-panting 4. Convulsions may occur 5. Profound collapse: (a) Skin-cold, clammy (t) Eyes-fixed, glistening, pupils dilated, no reaction (c) Limbs-flaccid (d) Pulse-imperceptible 6. The breath may have the odour of bitter almonds 4, Give general stimulants, and apply warmth to extremities 5. Artificial respiration, and intravenous or rectal injection of saline solution 1. Place patient in open air 2. (a) Stomach tube or (&) emetic 3. Cold douche (from height) to head and spine, or cold water dashed on continuously 4. Artificial respiration (20 to minute), and Ammonia inhalation by the nostrils 5. Dissolve about gr. 15 of iron sulphate and about min. 20 of tincture of ferric chloride in a wineglassful of water, then add 1 to 2 drachms of magnesium carbonate previously made into a thin cream with water. Mix and administer, and repeat if necessary (Note: The above quantities are equivalent to about min. 100 of acid hydrocyan, dil., U. S. P.) 6. Stimulants, hypodermically or inter- nally A TABLE OF POISONS AND ANTIDOTES- Continued TABLES OF POISONS AND ANTIDOTES 237 Strong Ammonia CA USTIC ALKA LIES I. Gastro-intestinal symptoms, as in corrosive 1. Do not use stomach pump or emetic, Caustic Potash Caustic Soda Lye poisoning 2. Purging usual, with pain and straining 3. Body cold, with cold sweat 4. Countenance anxious 5. Pulse rapid and weak MINERAL AND OTHER INORGANIC POISONS but neutralize alkali by giving one of the following: (a) vinegar, freely diluted with water; (ft) lemon juice in water; (c) citric acid in water; (d) tartaric acid, % drachm, in half pint of water repeated 2. When the alkali is neutralized, give one of the following: (a) milk, very freely; or (ft) olive oil, X pint in one pint of water; (c) white of egg 3. To lessen shock and ease pain, use morphine sulphate (hypodermic) gr- i/3 4. Give stimulants Antimony Com- pounds: Antimony and Po- tassium Tartrate (Tartar Emetic) Symptoms usually appear in from a quarter of an hour to one hour 1. Burning heat, and constriction or choking in throat, rendering swallowing difficult 2. Nausea, and incessant vomiting and purging. The vomited matter may be green from bile, or, in the case of arsenic, black from the admixture of soot, or blue from indigo 3. Pain in the stomach and abdomen 4. Cramps in calves of legs 5. Urine may be suppressed 6. There may be delirium or paralysis 1. Incessant vomiting is usually a symp- tom of poisoning by antimony com- pounds. In such cases the vomit- ing should be encouraged by draughts of tepid water. Should vomiting not have occurred, use (a) stomach tube, or (ft) emetic 2. (a) strong tea; or (ft) tannin, gr. 30 in warm water, and repeat draughts as often as vomiting occurs 3. When vomiting subsides, give (a) white of egg in water, or (ft) milk, freely 238 MATERIA MEDICA AND THERAPEUTICS Poison Symptoms Treatment Antimony Com- pounds Antimony and Po- tassium Tartrate (Tartar Emetic) 7. Collapse-skin cold, clammy, and may show eczematous rash; pulse small, quick, irreg- ular or imperceptible 4. Relieve pain with morphine sulphate (hypodermic), gr. 1/3 5. Treat collapse with stimulants in- ternally. Hot water bottles to extremities, and intravenous or rectal injection of saline solution Arsenic and its Preparations (Acute poisoning) See Antimony 1. (a) stomach tube, or (6) emetic. The complete removal of contents is important 2. (a) ferric hydrate, prepared as fol- lows: Dilute iX oz. of tincture of ferric chloride with a wineglassful of water, and add it to a solution of oz. of sodium carbonate (washing soda), or oz. water of ammonia, in about half a tumbler- ful of water. Mix and administer. Repeat the draught if necessary. (b) dialysed iron in frequently re- peated tablespoonfuls until ten have been taken, each followed by a little common salt dissolved in water 3. Give (a) milk and eggs; (&) olive oil, % pint, in one pint of water; (c) barley water A TABLE OF POISONS AND ANTIDOTES- Continued TABLES OF POISONS AND ANTIDOTES 239 Copper Salts: Verdigris Blue Vitrol (Acute Poison- ing) Iodine Prepara- tions: Iodine Iodides Iodoform i. Salivation 2. Gastro-intestinal irritation, vomiting (bluish or greenish), griping Late symptoms are: 3. Giddiness and headache 4. Delirium and convulsions, which may be very violent 5. Pulse rapid 6. Jaundice and suppression of urine 7. Coma Iodine or Tincture: 1. Pain and heat in throat and stomach 2. Vomiting and purging, vomit being yellow, or blue if starchy matter be present in the stomach. Stools may contain blood 3. Intense thirst 4. May be giddiness, faintness and convulsions 4. Stimulants for prostration; ice for thirst; hot water bottles to ex- tremities 5. When all acute symptoms have sub- sided, morphine sulphate (hypo- dermic), gr. 1/3 Vomiting usually occurs in cases of poisoning by copper salts. When this is not the case, 1 and 2 should be used 1. Before emptying stomach, give large quantities of milk and eggs 2. (a) Stomach tube, or (b) emetic 3. One-half drachm of potassium ferro- cyanide in half a tumblerful of water 4. Demulcent drinks 5. (a) Morphine sulphate (hypodermic), gr. 1/3, or (b) opium tincture, min. 20, in X oz. of water, by mouth 1. (a) Stomach tube, or (b) emetic 2. (a) Sodium bicarbonate, dr. 2, in half a tumblerful of water. If the poison be iodine, large quantities of starch made into draughts with cold water 3. Demulcents: and (a) milk and eggs, or (b) milk, and flour boiled with water 240 MATERIA MEDICA AND THERAPEUTICS Poison Symptoms Treatment Iodine Preparations Iodine Iodides Iodoform Iodides:- Large doses may give acute irritant symp- toms, like iodine Chronic poisoning, iodism is shown by: I. Frontal headache 2. Lachrymation, coryza 3. Salivation 4. Inflammation about the fauces, which may extend to the gums or to the trachea 5. Skin-erythema and acne Iodoform:- Symptoms vary much in severity, and usu- ally only two or three are present at one time 1. Giddiness 2. Gastro-intestinal irritation, vomiting 3. Erythema 4. Temperature high, pulse rapid 5. Pupils dilated 6. Persistent drowsiness 7. Mental symptoms-melancholia, hallucina- tions, delirium-especially at night 4. Relieve pain with morphine sulphate (hypodermic), gr. 1/3 Iodism: Curative 1. Stop the administration 2. Give sodium bicarbonate 3. Starch demulcents and large quanti- ties of water 4. Warm baths 5. Symptomatic treatment Mercury and Salts 1. Metallic taste, choking sensation 1. Do not empty stomach before giving (Acute Poison- ing) 2. Pain in stomach, vomiting and purging of stringy mucus and blood large quantities of (a) white of egg mixed with milk and water, much Corrosive Subli- 3. Tongue may be white and shrivelled to be preferred to (ft) flour and mate 4. Skin cold, clammy water Vermilion 5. Pulse feeble, rapid 2. (a) Stomach tube, or (ft) emetic A TABLE OF POISONS AND ANTIDOTES- Continued TABLES OF POISONS AND ANTIDOTES 241 Red Precipitate White Precipitate o Lead and Salts: (Acute Poison- ing) Phosphorus: /Rat Paste Matches 6. Urine suppressed i. Metallic taste, dry throat, intense thirst 2. Abdominal colic 3. Constipation, faeces dark, vomiting may occur 4. Giddiness, stupor, convulsions, death Symptoms usually occur in three stages: I. A few hours after administration 1. Garlic taste 2. Gastro-intestinal irritation-burning pain, thirst, swelling of abdomen, vom- iting of blood (green or black). Vomit has garlic odour and in the dark is phosphorescent The patient may die or there may be: II. Intermission of symptoms for three days or more, with feeling of malaise, followed by: III. Final state: 1. Intense jaundice 2. Enlarged liver and distended abdo- men 3. For pain and purging, opium tincture, min. 20 in one oz. of water 4. Demulcents, and stimulants if much depression 1. (a) Stomach tube, or (ft) emetic 2. Give (a) magnesium sulphate, oz. yi, in a tumblerful of water, or (ft) sodium sulphate, oz. in a tum- blerful of water; or (c) dilute sul- phuric acid, min. 30, in a tumbler- ful of water 3. (a) Milk; (ft) white of egg; or (c) demulcent drinks, all freely 4. Relieve pain with morphine sulphate (hypodermic), gr. 1/3 1. (a) Stomach tube, or (ft) emetic 2. Copper sulphate, gr. 3, dissolved in 4 oz. of water, every five minutes until vomiting is induced, then every fifteen to thirty minutes 3. Old, or French turpentine, min. 40, in 1 oz. of water every % hour, for one hour, then three times a day Avoid American or German Turpen- tine 4. Magnesium sulphate, % oz., as a purge 5. Demulcents, especially milk and eggs A void oils and fats 6. Morphine sulphate (hypodermic), gr. 1/3, for pain 242 MATERIA MEDICA AND THERAPEUTICS Poison Symptoms Treatment Phosphorus: Rat Paste Matches Silver Nitrate: 3. Great prostration-cold sweat, anxi- ous look, feeble pulse, muscular twitchings, coma 1. Pain in throat and stomach 1. Two tablespoonfuls of common salt (Lunar Caustic) Zinc Salts: 2. Vomiting of whitish, flaky matter, which blackens on exposure to light 1. Lips and mouth corroded in a tumblerful of water, repeated if necessary 2. Emetic to remove precipitated silver chloride 3. Large draughts of white of egg in water Do not use stomach lube or emetic, because of corrosion of membranes, but give: 1. Large draughts of white of egg and White Vitriol Aconite 2. Pain in throat and stomach, and difficulty in swallowing 3. Vomiting-blood-stained 4. Pulse and respiration rapid 5. Convulsions, paralysis, coma ORGANIC POISONS 1. Tingling and numbness of tongue and mouth, milk 2. Large quantities of sodium carbonate or potassium carbonate, dissolved in warm water 3. (a) Tannin, or (b) strong tea 4. Demulcents 5. For pain: (a) opium tincture, min. 30, or (b) morphine sulphate (hy- podermic), gr. 1/3 1. (a) Stomach tube, or (b) emetic Aconitine and sense of formication of the body 2. Nausea and vomiting, with epigastric pain 3. Dyspnoea 4. Pulse irregular, weak 5. Skin cold, clammy, features bloodless 2. Digitalin (hypodermic), gr. 1/100 3. Stimulants. Warmth to extremities intravenous or rectal injections of saline solution 4. Artificial respiration and friction A TABLE OF POISONS AND ANTIDOTES-Continued TABLES OF POISONS AND ANTIDOTES 243 Alcohol: (Acute Poison- ing) Antipyrine' Antiferrin Phenacetin ■ Exalgine Resorcin Belladonna: Atropine Nightshade . Berries 6. Giddiness, staggering walk, limbs feel weighty 7. The mind remains clear 5, Recumbent position to be maintained 6. Strychnine sulphate (hypodermic), gr. 1/60 1. Face flushed usually, lips vivid 2. Eyes congested, pupils usually dilated and fixed 3. Skin-sweating 4. Giddiness, tottering gait 5. Confusion of thought, vacant expression 6. Convulsions, stupor, coma There may be apparent recovery, then after some hours or days, sudden death 1. Vomiting 2. Face cyanosed 3. Skin-profuse sweat. Sometimes rash simu- lating measles, scarlatina or pemphigus 4. Collapse-feeble irregular pulse, slow respir- ation 1. Secretions paralyzed, hence throat and skin are dry, and urine is suppressed 2. Skin flushed 3. Temperature raised 4. Pulse quick 5. Respiration slow and deep 6. Pupils widely dilated 7. Delirium 1. 2. 3- 4- 5- 1. 2. 3- 4- 5- 1. 2. 3. 4- Ammonium carbonate, gr. 30, dis- solved in half a tumblerful of water If necessary, (a) stomach tube. If patient delirious, produce emesis with (6) apomorphine hydrochlor- ide (hypodermic), gr. 1/10 Rouse patient; cold douches; hot coffee Artificial respiration J Warmth to extremities Stimulants Warmth to extremities Strychnine sulphate (hypodermic), gr. 1/30 to gr. 1/10 Artificial respiration Recumbent position to be maintained (a) Stomach tube, or (b) emetic (a) Pilocarpine nitrate (hypodermic), gr. X; or W morphine sulphate (hypodermic), gr. 1/3 Stimulants and hot coffee Artificial respiration. Warmth Cantharides: Blistering Fluid Spanish Fly 1. Burning pain in throat and stomach, diffi- culty in swallowing 2. Vomiting and diarrhoea-mucus and blood may contain shining particles of the powder 3. Salivation and swelling of salivary glands 1. (a) If patient be seen shortly after poison is swallowed, and mucus membranes are not yet blistered, use stomach tube; (&) if throat blistered, produce emesis with 244 MATERIA MEDICA AND THERAPEUTICS Poison Symptoms Treatment Cantharides: 4. Incessant desire to micturate, only a little apomorphine hydrochloride, gr. Blistering Fluid blood or albuminous urine being passed 1/10, and strychnine hydrochloride Spanish Fly 5. Peritonitis, with headache, quick pulse, high temperature 6. Convulsions and stupor (hypodermic), gr. 1/60 2. White of egg in milk or barley water, or (ft) thick gruel 3. Stimulants 4. Relieve pain with morphine sulphate (hypodermic), gr. 1/3 Avoid oils and fats Castor Oil Seeds See Croton Oil Same as Croton Oil Chloral, Hydrated 1. Skin cold, face livid 1. (a) Stomach tube, or (ft) emetic Chloralformamide Chloroform: Failure of heart or respiration in Anaesthesia 2. Temperature subnormal 3. Pulse and respiration slow 4. Deep coma 2. Strychnine sulphate (hypodermic) gr. 1/60 3. Warmth; friction; hot coffee 4. Stimulants 5. Artificial respiration 6. Oxygen inhalation 1. Pull out tongue, place head lower than body; fresh air 2. Artificial respiration (20 to minute) 3. (a) Caffeine sodio-benzoate; (ft) strych- nine sulphate (hypodermic), gr. i/3°; (c) brandy, diluted, per rec- tum; and (d) atropine sulphate intravenously 4. Venesection of jugular vein 5. As a last resource, massage of heart Cocaine 1. Pallor, dry skin 2. Giddiness and fainting 1. Stomach tube 2. Stimulants (brandy or smelling salts) A TABLE OF POISONS AND ANTIDOTES- Continued TABLES OF POISONS AND ANTIDOTES 245 3- Pulse and respiration quick 3. Strychnine sulphate (hypodermic), Colchicum and Cro- ton Oil and Vio- 4- Nervous symptoms-tremors, delusions, convulsions Gastro-intestinal irritation, followed by collapse gr. 1/30 4. Digitalin (hypodermic), gr. 1/50 5. Inhalations of amyl nitrate, or aro- matic ammonia 6. Artificial respiration 1. (a) Stomach tube, or (b) emetic. If stomach tube be employed, wash lent Purgatives I. 2. 3- 4- 5- 6. 7- Abdominal colic Vomiting, purging, matter sometimes blood- stained or watery Features pale and pinched Skin-perspiration Pulse, small, weak, thready Urine, diminished or suppressed May be delirium stomach out with milk, or olive-oil, 4 oz. in one pint of water 2. Demulcent drinks, especially white of egg in milk 3. Relieve pain by (a) morphine sulphate (hypodermic), gr. 1/3 or (b) opium tincture, min. 20 4. Stimulants Conium (Hemlock) i. 2. 3- Motor paralysis, shown by: (a) Weakness of limbs, staggering gait (b) Inability to swallow (c) Paralysis of muscles of respiration, causing asphyxia Pupils dilated and fixed, loss of sight Consciousness is preserved 1. (a) Stomach tube, or (b) emetic 2. Strychnine sulphate (hypodermic), gr. 1 /60 3. Warmth and stimulants 4. Artificial respiration Digitalis I. Abdominal pain, vomiting 1. (a) Stomach tube, or (6) emetic, the best being apomorphine hydro- chloride, gr. 1/10 2. (0) Tannin, gr. 10, in 2 oz. of water, repeated frequently; or (b) large draughts of strong tea or coffee, or (c) 1 to 4000 solution of perman- ganite of potash (Foxglove) 2. 3- 4- 5- 6. Headache, lethargy, delirium, convulsions, coma Pulse, slow, small, irregular Pupils dilated Skin cold, pale, covered with sweat Urine suppressed 246 MATERIA MEDICA AND THERAPEUTICS Poison Symptoms Treatment Digitalis (Foxglove) Elaterinum Elaterium Fungi, Poisonous (Muscarine) Gases, Poisonous: Acetylene Carbon Dioxide Carbon Mon- oxide Coal Gas Marsh Gas Pit Gas Hyoscyamus Jalap Nicotine: Tobacco Weed Killer See Croton Oil i. Thirst 2. Colic, vomiting, purging 3. Mental excitement, followed by coma 4. Extremities cold 5. Pulse slow, respiration stertorous 6. Pupils dilated 1. Giddiness and singing in ears 2. Lividity of face and body, in most cases 3. Loss of muscular power 4. Heart and respiration-violent action 5. Pupils dilated, no reaction 6. Convulsions, coma or asphyxia See Belladonna See Croton Oil 1. Burning acrid sensation in mouth and throat 2. Depression, giddiness, nausea, vomiting, coldness of surface, clammy sweat 3. Loss of consciousness, sighing respiration 4. Coma 3. Stimulants; warmth to extremities 4. Aconite to control rapidity of the heart-beat 5. Recumbent position to be maintained Same as Croton Oil 1. (a) Stomach tube, or (d) emetic 2. Purgatives, e.g., castor oil, 1 oz. 3. Stimulants. Warmth to extremities 4. Atropine sulphate (hypodermic), gr. 1/60 5. Relieve pain with morphine sulphate (hypodermic), gr. 1/8 1. Fresh air, artificial respiration; fric- tion 2. Oxygen inhalation. Ammonia to nostrils 3. Warmth and stimulants 4. Intravenous, or rectal injection of saline solution 5. Respiratory and cardiac tonics 6. Cold douche to head and chest Same as Belladonna Same as Croton Oil *1. (a) Stomach tube, or (b) emetic 2. Stimulants. External warmth 3. Artificial respiration 4. Hypodermic injection of strychnine sulphate, gr. 1/30 A TABLE OF POISONS AND ANTIDOTES- Continued TABLES OF POISONS AND ANTIDOTES 247 Opium: Chlorodyne Codeine Dionin Dover Powder Heroin Laudanum Morphine Paregoric Soothing Syrup After preliminary stage of mental excitement i. Headache, weariness, sleepiness 2. Diminution of sensibility 3. Pupils contract to "pin point," and later, have no reaction 4. Face pale or cyanosed, skin cold 5. Muscular relaxation 6. Respiration slow, irregular, stertorous 7. Pulse feeble 8. Coma 1. (a) Stomach tube, or (6) emetic 2. Hot coffee 3. Potassium permanganate, 8 to 10 gr. dissolved in half a tumblerful of water, should be given. In case of laudanum poisoning, six grains of potassium permanganate, dissolved in plenty of water, should be taken for each ounce of laudanum. It should be dissolved in from four to eight ounces of water, and the stomach afterwards washed out two or three times, at intervals of half-an-hour, with a weak solution of potassium permanganate. In poisoning by hypodermic injection of morphine, the stomach should also be washed out with a weak solution of potassium permanganate 4. Rouse patient and dash cold water in face 5. Atropine sulphate (hypodermic), gr. 1/30, repeated if necessary, until gr. X has been taken 6. Warmth to extremities. Coffee by rectum 7. Artificial respiration. Inhalation of oxygen 8. (a) Strychnine sulphate (hypodermic), gr. 1/30; or (b) caffeine sodio- benzoate (hypodermic), gr. X 248 MATERIA MEDICA AND THERAPEUTICS Poison Symptoms Treatment Gasoline I. Burning in mouth, oesophagus and stomach 1. (a) Stomach tube, or (ft) emetic Kerosene 2. Vomiting, matter shows layer of oil, and has 2. Stimulants; warmth; friction Petroleum odor of paraffin 3. Thirst and restlessness, especially at night 4. Breath smells of oil 5. Body cold, face pale and anxious 6. Pulse feeble but regular 7. Respiration sighing 8. Coma may ensue 3. Strychnine sulphate (hypodermic), gr. 1/30 Ptomaines: 1. Vomiting and purging 1. (a) Stomach tube, or (ft) emetic Animal Alkaloids 2. Colic 2. Stimulants for collapse Poisonous Fish 3. Headache 3. Purgatives Poisonous Meat 4. Great muscular weakness 4. Atropine sulphate (hypodermic) Cheese and Ice Cream Poison- ing 5. Tongue often brown 6. Temperature raised 7. Pulse quick gr. 1/60 Snake Bite 1. Locally-pain, swelling, inflammation 1. Ligature the part above the bite 2. Faintness, depression, exhaustion 2. Incise and cauterise 3. Vomiting 4. Cold sweats 3. Strychnine nitrate (hypodermic), gr. 1/10 5. Paralysis, first of limbs, then of whole body 6. Unconsciousness 7. Albuminuria and convulsions may occur 4. (a) inject into wound (or, if there be much swelling, at two or three spots around the wound) potassium per- manganate (hypodermic), gr. 2; or, (ft) if case be less serious, place potassium permanganate, gr. 5, powdered, directly in the wound 5. Anti-venom serum, by hypodermic, or, preferably, intravenous injection 6. Stimulants; ammonium carbonate, or aromatic spirits of ammonia, well diluted, in full doses, repeated A TABLE OF POISONS AND ANTIDOTES-Concluded TABLE OF POISONS AND ANTIDOTES 249 Strychnine: i. Feeling of suffocation, and lividity of face 1. (a) wash out stomach with stomach Nux Vomica Brucine 2. Tetanic convulsions, with short intermis- sions, causing (a) Sweating and exhaustion (b) Opisthotonos (c) Risus sardonicus (d) Starting eyeballs (e) Fixed chest and hard abdominal muscles 3. Hearing and sight are acute, and conscious- ness is retained 4. The jaw muscles are not affected until late tube, if condition of patient permits; (ft) emetic; apomorphine hydro- chloride (hypodermic), gr. 1/10, is best in this case 2. (a) tannin, gr. 20 to gr. 40, in 2 oz. of water; or (6) iodine tincture, dr. X> in half a tumblerful of water, followed by emetic or stomach tube 3. Potassium bromide, dr. 2, in a tumblerful of water, to be repeated every quarter of an hour if necessary 4. Inhalation of chloroform to control convulsions. In severe cases this is the first step in treatment 5. Artificial respiration in the stage of collapse and respiratory failure Sulphonal 1. Pain in stomach, and vomiting 1. (a) Stomach tube or (b) emetic Trional 2. Constipation 2. Stimulants and purgatives Veronal 3. Nervous symptoms-confusion of mind, ataxia and partial paralysis 4. Pupils normal and react to light 5. Red urine later, suppression of urine 6. Profound collapse and unconsciousness 3. Warmth to extremities 4. (a) Strychnine sulphate (hypoder- mic), gr. 1/30 to gr. 1/10; or (b) digitallin (hypodermic), gr. 1/100 5. Artificial respiration 6. Recumbent position to be maintained Turpentine 1. Turpentine odor in breath 2. Respiration stertorous 3. Pupils contracted 4. Tetanic convulsions, and coma 5. Irritability of bladder, urine having odor of violets. Has some semblance to opium poisoning 1. (a) Stomach tube, or (b) emetic 2. Magnesium sulphate, oz. 1, in half a tumblerful of water, as a purge 3. Morphine sulphate (hypodermic), gr- i/3 4. Demulcent drinks 250 MATERIA MEDICA AND THERAPEUTICS Apothecaries Metric Acetanilidum ... gr. 4 0.2s gm. Acetphenetidinum ... gr. 7^ 0.5 gm. Acidum Aceticum Dil . .. min. 30 2 mils. Acidum Benzoicum ... gr. 7% 0.5 gm. Acidum Boricum ... gr. 1% 0.5 gm. Acidum Camphoricum ... gr. 15 1 gm. Acidum Carbolicum (Phenol) ... gr. 1 0.06s gm. Acidum Carbolicum Liqucfactum ... . . .. min. 1 0.05 mil. Acidum Citricum ... gr. 0.5 gm. Acidum Gallicum ... gr. is 1 gm. Acidum Hydriodicum Dil . .. min. 8 o.s mil. Acidum Hydrobromicum Dil ... fl. dr. 1 4 mils. Acidum Hydrochloricum Dil ... min. 15 1 mil. Acidum Hydrocyanicum Dil ... min. 1 % 0.1 mil. Acidum Lacticum . .. min. 30 2 mils. Acidum Nitricum Dil . .. min. 30 2 mils. Acidum Nitro-hydrochlor. Dil . .. min. 15 1 mil. Acidum Phosphoricum Dil . .. min. 30 2 mils. Acidum Salicylicum ... gr. 7% 0.5 gm. Acidum Sulphuricum Aromat ... min. 15 1 mil. Acidum Sulphuricum Dil . .. min. 30 2 mils. Acidum Sulphurosum . .. min. 30 2 mils. Acidum Tannicum ... gr. 7% 0.5 gm. Acidum Tartaricum ... gr. 7% , 0.5 gm. Aconitina ... gr. I/400 0.000is Km. Aconitum ... gr. 1 0.065 gm. Aether ... min. is 1 mil. Aether Aceticus ... min. 15 1 mil. Aethylis Carbamas ... gr. IS 1 gm. Aloe ... gr. 4 0.25 gm. Aloinum ... gr. 1 0.06s gm. Alumen ... gr. 7% 0.5 gm. Ammonii Benzoas ... gr. is 1 gm. Ammonii Bromidum ... gr. is 1 gm. Ammonii Carbonas • gr . 4 0.25 gm. Ammonii Chloridum ... gr. 7% 0.5 gm. Ammonii lodidum ... gr. 4 0.25 gm. Ammonii Salicylas ... gr . 4 0.25 gm. Ammonii Valeras ... gr. 7% o.s gm. Amylis Nitris . .. min. 3 0.2 mil. Antifebrinum (Acetanilidum) ... gr. 4 0.25 gm. Antimonii et Potassii (expectorant).. ... gr. 1/10 0.005 gm. Tartras (emetic) ... gr. y 0.03 gm. Antipyrina ... gr. 4 0.25 gm. Apomorphinae (expectorant) .. .. gr. 1/30 0.002 gm. Hydrochloridum (emetic) ... gr. 1/10 0.005 gm. Argenti Nitras ... gr. 1/5 0.01 gm. Arseni lodidum .... gr. 1/10 0.005 gm. Arseni Trioxidum ... gr. 1/30 0.002 gm. Asafoetida ... gr. 4 0.25 gm. Aspirin ... gr. 5 to gr. 15 0.3 gm. to 1 gm. Atropina ... gr. 1/160 0.0004 gm. Atropinae Sulphas ... gr. 1/160 0.0004 gm. Benzonaphthol Bismuthi Citras ... gr. 4 ... gr. 2 0.25 gm. 0.125 gm. Bismuthi et Ammonii Citras ... gr. 2 0.125 gm. Bismuthi et Ferri Citras ... gr. 5 to gr. 10 0 3 gm. to 0.6 gm. Bismuthi et Lithii Citras ... gr. 2 to gr. s 0.13 gm. to 0.3 gm. Bismuthi Subcarbonas ... gr. 7% 0.5 gm. Bismuthi Subgallas ... gr. 4 0.25 gm. Bismuthi Subnitras .. • gr. 7J^ 0.5 gm. Bismuthi Subsalicylas ... gr. 4 0.25 gm. TABLE OF DOSES TABLE OF DOSES 251 TABLE OF DOSES-Continued. Apothecaries Metric Bismuthi Tartras ... gr. 2 to gr. 5 0.13 gm. to 3 gm. Borax (Sodii Boras) ... gr. 7^ 0.5 gm. Bromoformum . .. min. 3 0.2 mil. Butyl-Chloral Hydras ... gr. 5 to gr. 20 0.3 gm. to 1.3 gm. Caffeina ... gr. i 0.065 gm. Caffeina Citrata ... gr. 2 0.125 gm. Caffeina Citrata Efferves ... gr. 6o 4 gm. Calcii Bromidum ... gr. 15 1 gm. Calcii Carbonas Praicip ... gr. 15 1 gm. Calcii Chloridum ... gr. 7 % 0.5 gm. Calcii Glycerophosphas . .. gr. 2 to gr. 5 0.13 gm to 0.3 gm. Calcii Hypophosphis • ■ • gr. 7H 0.5 gm. Calcii lodo-ricinoleas . . . gr. 3 to gr. 9 0.2 gm. to 0.6 gm. Calcii Lactas ... gr. 5 and upwards 0.3 gm. and upwards Calcii Phosphas Praecip . .. gr. 15 1 gm. Calcii Sulphidum (Calx Sulphurata) .. .... gr. i 0.065 gm. Calomelas (laxative) ... gr. 2 0.125 gm. (exalterative) ... gr. i 0.065 gm. Camphora ... gr. 2 0.125 gm. Camphora Monobromata . .. gr. 2 0.125 gm. Cannabinae Tannas . . . gr. 3 to gr. io 0.2 gm. to 0.6 gm. Cannabis Indica ... gr. i 0.065 gm. Capsi cinum ... gr. i/8 to gr. M 0.008 gm. to 0.015 gm. Capsicum ... gr. i 0.065 gm. Carbo Ligni .. . gr. 15 1 gm. Cerebrin . . . gr. 5 to gr. 20 0.3 gm. to 1.3 gm. Cerii Oxalas ... gr. i 0.065 gm. Chloralum Hydratum ... gr. 15 1 gm. Chloralformamidum . .. gr. 15 1 gm. Chloroformum . .. min. 5 0.3 mil. Cocaina ... gr. y2 0.03 gm. Cocainae Hydrochloridum ... gr. 0.03 gm. Codeina . .. gr. % 0.03 gm. Codeinae Phosphas ... gr. % 0.03 gm. Codeinae Sulphas . .. gr. X 0.03 gm. Colchici Cormus . .. gr. 4 0.25 gm. Colchici Semen . .. gr. 3 0.20 gm. Colchicina ... gr. 1/128 0.0005 gm. Cotarninae Hydrochloridum • • • gr. Ji to gr. y 0.015 gm. to 0.05 gm. Creosotum . .. min. 3 0.2 mil. Cubeba ... gr. 15 1 gm. Cupri Sulphas (astringent) ... gr. 1/5 0.01 gm. Cupri Sulphas (emetic) ... gr. 4 0.25 gm. Didymin ... gr. 5 and upwards 0.03 gm. and upwards Digitalinum (amorph.) ... gr. 1/100 to gr. 0.0006 gm. to 1/30 0.002 gm. Digitalinum (cryst.) ... gr. 1/500 to gr. 1/130 0.00013 gm. to 0.0005 gm. Elaterinum ... gr. 1/10 0.005 gm. Emetina (expectorant) ... gr. 1/200 to gr. 1/50 0.0003 gm. to 0.0013 gm. Emetina (emetic) ... gr. 1/6 to gr. 1/3 0.01 gm. to 0.02 gm. Emetinae (expectorant) ... gr. 1/200 to gr. i/SO 0.0003 gm. to 0.0013 gm. Hydrobrom (emetic) ... gr. 1/6 to gr. 1/3 0.01 gm. to 0.02 gm. Ergota ... gr. 30 2 gm. Ergotininae C/tras ... gr. 1/200 to gr. 1/50 0.0003 gm. to 0.0013 gm. Ergotoxina ... gr. i/iootogr.1/50 0.00065 gm. to 0.0013 gm. Erythrol Tetranitras ... gr. % to gr. 1 0.03 gm. to 0.06 gm. Eucainae Hydrochloridum ... gr. 1/5 to gr. ya 0.013 gm. to 0.03 gm. 252 MATERIA MEDICA AND THERAPEUTICS TABLE OF DOSES-Continued. Apothecaries Metric Eucain® Lactaa . gr. 1/5 to gr. % 0.013 gm. to 0.03 gm. Eucalyptol . min. 5 0.3 mil. Ext. Aloes . gr. 2 0.125 gm. Ext, Belladonna Folioruin • gr- i/S 0.01 gm. Ext. Cannabis Indic® • gr. i/S 0.01 gm. Ext. Cascar® Sagrad® ■ gr. 4 0.25 gm. Ext. Cimicifug® • gr- 4 0.25 gm. Ext. Cojchici Cornu . gr. i 0.065 gm. Ext. Colocynthidis • gr. % 0.03 gm. Ext. Colocynthidis Comp ■ gr. 7X 0.5 gm. Ext. Digitalis . gr. 1/5 0.01 gm. Ext. Ergotae (Ergotinum) Ext. Euonymi (Euonymmum) • gr. 4 . gr. 2 0.25 gm. 0.125 gm. Ext. Hyoscyami . gr. 1 0.065 gm. Ext. Krameri® • gr. 7% 0.5 gm. Ext. Nucis Vomicae • gr- X 0.015 gm. Ext. Opii • gr. x 0.03 gm. Ext. Physostigmatis . gr. 1/8 0.008 gm. Ext. Rhami Purshian® • gr. 4 0.25 gm. Ext. Sumbul • gr. 4 0.25 gm. Fei Bovis Purificatum ■ gr. 7% 0.5 gm. Ferri Arsenas . gr. 1/16 to gr. 0.004 gm. to 0.016 gm. Ferri Carbonas Saccharatus • gr- 4 0.25 gm. Ferri Chloriduin . gr. 1 0.065 gm. Ferri Citras • gr. 4 0.25 gm. Ferri et Ammonii Citras • gr. 4 0.25 gm. Ferri et Potassii Tartras • gr. 4 0.25 gm. Ferri et Quinine Citras Solubilis • gr. 4 0.25 gm. Ferri Glycerophosphas . gr. 3 to gr. 6 0.2 gm. to 0.4 gm. Ferri Hypophosphis • gr. 3 0.2 gm. Ferri lodidum . gr. 1 to gr. S 0.06 gm. to 0.3 gm. Ferri Phosphas Solubilis • gr. 4 0.2s gm. Ferri PyYophosphas Solubilis • gr. 4 0.25 gm. Ferri Sulphas • gr. 3 0.2 gm. Ferri Sulphas Exsiccatus . gr. 2 0.125 gm. Ferri Valeras • gr. 3 to gr. 15 0.2 gm. to 1 gm. Ferrum Reductum . gr. 1 0.06s gm. Fluidextractum Aconiti . min. 1 0.0s mil. Fluidextractum Cannabis Indic® . min. 1 0.0s mil. Fluidextractum Cascar® Sagrad® . (See Fluidextractum Rhamni Purshian®) Fluidextractum Cimicifug® . min. 15 1 mil. Fluidextractum Cinchon® . min. 15 1 mil. Fluidextractum Digitalis . min. 1 0.0s mil. Fluidextractum Ergot® . min. 30 2 mils. Fluidextractum Hamamelidis Foliorum. . min. 30 2 mils. Fluidextractum Hydrastis . min. 30 2 mils. Fluidextractum Hyoscyami . min. 3 0.2 mil. Fluidextractum (emetic) . min. 15 1 mil. Ipecacuanh® (expectorant) . min. 1 0.0s mil. Fluidextractum Nucis Vomic® . min. 1 0.05 mil. Fluidextractum Rhamni Purshian®.... . min. 15 1 mil. Fluidextractum Rhamni Purshian® (Aromaticum) min. 15 1 mil. Gelsemin® Hydrochloridum . gr. 1/120 to 0.0005 gm. to gr. 1/130 0.002 gm. Glycyrrhizinum Ammoniatum • gr. 4 0.25 gm. Guaiacol . min. 8 0.5 mil. Guaiacolis Carbonas . gr. is 1 gm. Guaiacum • gr. 15 i gm. Hemoglobin gr. 5 to gr. 20 0.3 gm. to 1.3 gm. TABLE OF DOSES 253 TABLE OF DOSES-Continued. Apothecaries Metric Heroin Hydrochloridum .. gr. 1/25 to gr. 1/6 0.0025 gm. to 0.01 gm. Hexamethylenamina . • gr. 4 0.25 gm. Homatropinae Hydrobromidum .. gr. 1/128 0.000s gm. Homatropinae Hydrochloridum .. gr. 1/80 to 0.0008 gm. to gr. 1/20 0.003 gm. Homatropinae Salicylas .. gr. 1/80 to 0.0008 gm. 8b gr. 1/20 0.003 gm. Hydrarg. Chloridum Corrosivum .. gr. 1/20 0.003 gm. Hydrarg. Chloridum (laxative) .. gr. 2 0.125 gm. Hydrarg. Mite (alterative) .. gr. 1 0.065 gm. Hydrarg. lodidum Flavum • ■ gr. i/S 0.01 gm. Hydrarg. lodidum Rubrum .. gr. 1/20 0.003 gm. Hydrarg. lodidum Viride .. gr. 1/8 to gr. 1 0.008 gm. to 0.06 gm. Hydrarg. cum Creta .. gr. 4 0.25 gm. Hydrastina . . gr. 1/5 0.01 gm. Hydraetinae Hydrochloridum .. gr. to gr. 1 0.015 gm. to 0.06 gm. Hydrastininae Hydrochloridum . • gr. Ji 0.03 gm. Hyoscinae Hydrobromidum .. gr. 1/128 0.0005 gm. Hyoscyamina .. gr. 1/200 to 0.0003 gm. to gr. 1/100 0.0006 gm. Hyoscyaminae Hydrobromidum .. gr. 1/128 0.0005 gm. Hyoscyaminae Sulphas Ichthyol .. gr. 1/128 0.0005 gm. .. gr. 2 Ji to gr. 10 0.1 gm. to 0.6 gm. lodoformum • • gr. 4 0.25 gm. Ipecacuanha (expectorant) .. gr. 1 0.065 gm. Ipecacuanha (emetic) .. gr. is 1 gm. Ipecacuanha sine Emetina .. gr. 10 to gr. 30 0.6 gm. to 2 gm. .. gr. 15 - • gr. 7 Ji 1 gm. 0.5 gm. Leptandra • - gr. IS 1 gm. Liquor Acidi Arsenosi .. min. 3 0.2 mil. Liquor Ammonii Acetatis Liquor Arseni et Hydrarg. lodidi .. fl. dr. 4 16 mils. (Donovan) .. min. 1 Ji 0.1 mil. Liquor Calcis .. fl. dr. 4 16 mils. Liquor Ferri Chloridi . . min. 1 % 0.1 mil. Liquor Ferri et Ammonii Acetatis .. fl. dr. 4 16 mils. Liquor lodi Compositus .. min. 3 0.2 mil. Liquor Potassii Arsenitis .. min. 3 0.2 mil. Liquor Potassii Citratis .. fl. dr. 4 16 mils. Liquor Potassii Hydroxidii .. min. 15 1 mil. Liquor Sodae Chlorinatae .. min. 15 1 mil. Liquor Sodii Arsenatis .. min. 3 0.2 mil. Liquor Sodii Hydroxidi .. min. is 1 mil. Liquor Sodii Phosphatis Compositus. . Litnii Benzoas .. fl. dr. 2 8 mils, j .. gr. is 1 gm. Lithii Bitartras • • gr. 7 Ji 0.5 gm. Lithii Bromidum • • gr. IS 1 gm. Lithii Carbonas • • gr. 7 Ji 0.5 gm. Lithii Citras .. gr. 7 Ji 0.5 gm. Lithii Citras Effervescence .. gr. 120 8 gm. Lithii Salicylas ■ • gr. is 1 gm. Lupulinum ■ • gr- 7 Ji o.s gm. Magnesii Carbonas • • gr. 45 3 gm. Magnesii Oxidum .. gr. 30 2 gm. Magnesii Oxidum Ponderosum .. gr. 30 2 gm. Magnesii Sulphas .. gr. 240 16 gm. Magnesii Sulphas Effervescence .. gr. 240 16 gm. Manganii Citras .. gr. 4 0.25 gm. Manganii Dioxidum Praecipitatum.... • • gr. 4 0.25 gm. 254 MATERIA MEDICA AND THERAPEUTICS TABLE OF DOSES-Continued. Apothecaries Metric Manganii et Ferri Citras .... gr. 4 0.25 gm. Manganii Hypophosphis .... gr. 3 0.3 gm. Manganii Sulphas .... gr. 4 0.25 gm. Medulla Ossis .... gr. is 1 gm. Menthol .... gr. i 0.065 gm. Morphina .... gr. i/s 0.01 gm. Morphin® Acetas ... gr. 14 0.01s gm. Morphin® Hydrochloridum .... gr. 0.015 gm. Morphin® Sulphas Napnthalenum .... gr. W 0.01s gm. .... gr. 2 0.125 gm. Nux Vomica .... gr. i 0.065 gm. Oleum Cajuputi .... min. 8 0.5 mil. Oleum Copaibae 0.5 mil. o.s mil. Oleum Cubeb® .... min. 8 Oleum Eucalypti Oleum Gaultheri® .... min. 8 0.5 mil. .... min. is 1 mil. Oleum T uniperi .... min. 3 0.2 mil. Oleum Morrhu® .... fl. dr. 4 16 mils. Oleum Ricini .... fl. dr. 4 16 mils. Oleum Sabin® .... min. i 0.0s mil. Oleum Santali .... min. 8 0.5 mil. Oleum Terebinthin® Rectificatum.. min. is 1 mil. Opium gr. i>4 0.1 gm. Ovarian Substance gr. 7/4 0.5 gm. Pancreatinum gr. 7/4 0.5 gm. Papain um .... gr. 4 c.25 gm. Paraldehydum min. 30 2 mils. Pelletierin® Tannas gr. 4 0.25 gm. Pepsinum gr. 4 0.25 gm. Phenacetinum ... gr. 7/4 0.5 gm. Phenol gr. I 0.065 gm. Phenylis Salicylas gr. 7/4 0.5 gm. Phosphorus ... gr. 1/128 0.0005 gm. Physostigmine Hvdrobromidum. . . gr. 1/64 0.001 gm. Physostigmin® Salicylas gr. 1/64 0.001 gm. Physostigmine Sulphas .... gr. 1/64 0.001 gm. Picrotoxinum gr. 1/60 0.001 gm. Pilocarpin® Hydrochloridum gr. i/s 0.013 gm. Pilocarpin® Nitras gr. i/S 0.013 gm. Pilocarpus gr. 30 2 gm. Pilule Aloes a pills Pilul® Aloes et Ferri 2 pills Pilule Aloes et Myrrh® ,. ... 2 pills Pilul® Asafatid® ... 2 pills Pilul® Cathartic® Composite 2 pills Pilul® Carthartic® Vegetabiles 2 pills Pilul® Ferri Carbonatis .... 2 pills Pilul® Ferri lodidi .... 2 pills Pilul® Laxative Composite .... 2 pills Pilul® Opii .... 1 pill Pilul® Opii et Plumbi Pilulae Pnosphori .... 1 pill Pilul® Podophylli. Belladonn® et Capsici Pilule khei Composite .... 2 pills Piperazinum gr. 754 0.5 gm. Piperina .... gr. 3 0.2 gm. Pix Liquids gr. 7/4 0.5 gm. Plumbi Acetas . ... gr. 1 0.065 gm. Podophyllum gr. 7 54 0.5 gm. Potassii Acetas gr. 30 2 gm. Potassii Bicarbonas gr. 30 2 gm. Potassii Bitartras gr. 30 2 gm. TABLE OF DOSES 255 Potassii Bromidum Apothecaries Metric . .. gr. 15 1 gm. Potassii Carbonas . .. gr. 15 I gm. Potassii Chloras . . . gr. 4 0.2s gm. Potassii Citras . .. gr. 15 I gm. Potassii Citras Effervescence .... . . . gr. 60 4 gm. Potassii Cyanidum . . . gr. 1/5 0.01 gm. Potassii Dichromas . .. gr. 1/5 0.01 gm. Potassii et Sodii Tartras .. . gr. 120 8 gm. Potassii Ferrocyanidum • • gr. 7)4 0.5 gm. Potassii Hypophosphis - • gr. 7)4 0.5 gm. Potassii lodidum . .. gr. 1% 0.5 gm. Potassii Nitras . .. gr. 7)4 0.5 gm. Potassii Permanganas ... gr. 1 0.065 gm. Potassii Sulphas . .. gr. 30 2 gm. Prostate Gland Substance . .. gr. 4 0.2s gm. Pulvis Acetanilidi Compositus ... ■ ■ • gr. 7)4 o.s gm. Pulvis Cretas Compositus ... gr. 30 2 gm. Pulvis Glycyrrhiz® Compositus. . . . gr. 60 4 gm. Pulvis Ipecacuanh® et Opii • ■ • gr. 7)4 o.s gm. Pulvis Jalapae Compositus Pulvis Morphin® Compositus .... .... ... gr. 30 . .. gr. 7)4 2 gm. o.s gm. Pulvis Rhei Compositus . .. gr. 30 2 gm. Quinina . .. gr. 4 0.2s gm. Quinin® Bihydrochloridum ... gr. 4 0.2s gm. Quinin® Bisulphas . .. gr. 4 0.2s gm. Quininae Hydrobromidum ... gr. 4 0.2s gm. Quininae Hydrochloridum . . . gr. 4 0.25 gm. Quininae Hypophosphis . .. gr. 2 0.125 gm. Quininae Phosphas . .. gr. 4 0.25 gm. Quininae Salicylas ... gr. 4 0.25 gm. Quininae Sulphas ... gr. 4 o.is gm. Quinin® Valeras . .. gr. 2 0.125 gm. Residuum Rubrum • • • gr. S 0.3 gm. Resina Jalap® 0.125 gm. 0.015 gm. Resina Podophylli (Purgative) ... . .. gr. % Resina Podophylli (Laxative) .... . .. gr. 1/10 0.005 gm. Resina Scammonii . .. gr. 3 0.2 gm. Resorcinol . .. gr. 2 0.125 gm. Rhamnus Purshiana . . . gr. IS 1 gm. Rheum . . • gr. is 1 gm. Salicinum . .. gr. 15 1 gm. Salol (see Phenylis Salicylas).... . . . gr. 15 1 gm. Santoninum . .. gr. 1 0.065 gm. Scopolamin® Hydrobromidum ... "Soamin" . .. gr. 1/128 0.0005 gm. . . . gr. )4 0.03 gm. Sodii Acetas . .. gr. 15 1 gm. Sodii Arsenas . . . gr. 1/10 0.005 gm. Sodii Arsenas Exsiccatus . . . gr. 1/20 0.003 gm. Sodii Benzoas . .. gr. IS 1 gm. Sodii Bicarbonas . .. gr. IS 1 gm. Sodii Bisulphis ... gr. 7)4 0.5 gm. Sodii Boras ... gr. 7)4 0.5 gm. Sodii Bromidum . .. gr. IS 1 gm. Sodii Cacodylas • • • gr. Ji o.ois gm. Sodii Carbonas Monohydratus ... ... gr. 4 0.25 gm. Sodii Chloras . . . gr. 4 0.25 gm. Sodii Chloridum (as Emetic) .... . .. gr. 240 16 gm. Sodii Citras . .. gr. is 1 gm. Sodii Glycerophosphas . .. gr. 3 0.2 gm. Sodii Hypophosphis . .. gr. is 1 gm. Sodii lodidum ... gr. 7)4 0.5 gm. Sodii Nitras . .. gr. 15 i gm. Sodii Nitris . .. gr. 1 0.065 gm. TABLE OF DOSES-Continued. 256 MATERIA MEDICA AND THERAPEUTICS TABLE OF DOSES-Continued. Apothecaries Metric Sodii Phenolsulphonas • • gr. 4 0.2s gm. Sodii Phosphas .. gr. 30 2 gm. Sodii Phosphas Effervescence ,. gr. 120 8 gm. Sodii Phosphas Exsiccatus . gr. IS 1 gm. Sodii Pyrophosphas . gr. 30 2 gm. Sodii Salicylas .. gr. 15 1 gm. Sodii Sulphas .. gr. 240 16 gm. Sodii Sulphas Effervescence . . gr. 240 16 gm. Sodii Sulphis Sodii Sulphocarbolas (see Sodii Phenolsulphonas Sodii Thiosulphas Sparteinae Sulphas .. gr. is I gm. • • gr. IS .. gr. 1 I gm. 0.01 gm. Spigelia .. gr. 60 4 gm. Spiritus /Etheris .. fl. dr. 1 4 mils. Spiritus /Etheris Compositus .. fl. dr. 1 4 mils. Spiritus Aitheris Nitrosi . . min. 30 2 mils. Spiritus Ammoniae . min. IS 1 mil. Spiritus Ammoniae Aromaticus . min. 30 2 mils. Spiritus Camphorae .. min. 15 1 mil. Spiritus Chloroform! .. min. 30 2 mils. Spleen Substance • • gr- 7^ 0.5 gm. Strontii Bromidum • gr. IS 1 gm. Strontii lodidum . gr. 7>£ 0.5 gm. Strontii Salicylas . . gr. 15 1 gm. Strophanthinum .. gr. 1/200 0.0003 gm. Strophanthus .. gr. 1 0.065 gm. Strychnina . . gr. 1/64 0.001 gm. Strychninae Hydrochloridum .. gr. 1/64 0.001 gm. Strychninae Nitras ■ gr. 1/64 0.001 gm. Strychninae Sulphas Strychninae Sulphonal ■ • gr. 1/64 0.001 gm. (Sulphonmethanum) .. gr. IS 1 gm. Sulphur Praecipitatum .. gr. 60 4 gm. Sulphur Subhmatum . . .gr. 60 4 gm. Suprarenal Gland .. gr. 5 0.3 gm. Syrupus Calcii Lactophosphatis .. n. dr. 2 8 mils. Syrupus Ferri lodidi .. min. is 1 mil. Syrupus Ferri Quininae et Strychninae 4 mils. Phosphatum .. fl. dr. 1 Syrupus Ferri Phosphatis .. fl. dr. 1 4 mils. Syrupus Ferri Phosphatis Compositus. .. fl. dr. 2 8 mils. Syrupus Hypophosphitum Compositus. Syrupus Ipecacuannae (emetic) . fl. dr. 2 .. fl. dr. 4 8 mils. 15 mils. Syrupus Ipecacuanhae (expectorant) ... Terebenum .. min. 15 . . min. 8 1 mil. 0.5 mil. Terpini Hydras . • gr. 2 0.125 gm. Thymol •. gr. 2 0.125 gm. Tinctura Aconiti . . min. 10 0.6 mil. Tinctura Aloes . . min. 30 2 mils. Tinctura Aloes et Myrrhae . . min. 30 2 mils. Tinctura Arnicae , . min. is 1 mil. Tinctura Asafcetidae . . min. 15 1 mil. Tinctura Belladonnas Foliorum . . min. 8 0.5 mil. Tinctura Benzoini .. min. 15 1 mil. Tinctura Benzoini Composita . min. 30 2 mils. Tinctura Calumbae . fl. dr. 1 4 mils. Tinctura Cannabis Indicae .. min. 10 0.6 mil. Tinctura Cantharidis . . min. s 0.3 mil. Tinctura Capsici .. min. 8 0.5 mil. Tinctura Cimicifugae ,. fl. dr. 1 4 mils. Tinctura Cinchonee . fl. dr. 1 4 mils. Tinctura Cinchonas Composita . fl. dr. 1 4 mils. TABLE OF DOSES 257 Tinctura Colchici Seminis Tinctura Digitalis Tinctura Ferri Chloridi Tinctura (jallse Apothecaries .. min. 30 .. min. 15 .. min. 8 . . fl. dr. 1 Metric 2 mils. 1 mil. 0.5 mil. 4 mils. Tinctura Gambi Composita Tinctura Gelsemii Tinctura Gentiana Composita Tinctura Guaiaci Ammoniata Tinctura Hamamelidis TSr»+,«ith TTvHrARtIS ......... .. fl. dr. i .. min. 8 .. fl. dr. i .. min. 30 .. fl. dr. I .. fl. dr. i 4 mils. 0.5 mil. 4 mils. 2 mils. 4 mils. 4 mils. AAAAULUAcS iAy lai caolao • ••••••••••••••• Tinctura Hyoscyami Tinctura ToHi .. min. 30 .. min. 1 }4 2 mils. 0.1 mil. Tinctura Ipecacuanha et Opii .. min. 8 . . fl. dr. 1 o.s mil. 4 mils. T fpTnpctorant^ ..... . . .. min. 15 1 mil. 1 lllClUia DUUCllcC uiAu; ..... • • Tinctura Lobelia (emetic) Tinctura Nucis Vomica Tinctura Opu. .. fl. dr. 1 .. min. 10 .. min. 8 4 mils. 0.6 mil. 0.5 mil. Tinctura Opii Camphorata .. fl. dr. 2 .. min. 8 8 mils. 0.5 mil. Tinctura Physostigmatis Tinctura Stramonii .. min. 15 .. min. 15 .. min. 8 .. min. 8 1 mil. 1 mil. 0.5 mil. 0.5 mil. A inctuid Oil UpiAdlt LAAA . . min. 30 2 mils. 1 Haul u.1 a a ••••••••••••••• 'T'i«r'+'iird ValpTUvnflP .. fl. dr. 1 4 mils. A 1I1U LUI <A V c*1U1 Tinctura; Valeriana Ammoniata .. min. 30 .. min. 30 2 mils. 1 mil. A AIAULUia V ClaLU ncf 117ancnhpTlS .. min. 30 2 mils. A lIAULLlAc* . • ••••••••••• Trinitrinum (Nitroglycerinum). . Trional (Sulphonethylmethanum) .. gr. 1/100 .. gr. IS • gr- 0.00065 gm. 1 gm. 0.03 gm. A ropacocaillce iiyuiuvui'Jii'aum . • • . • . • gr. 5 0.3 gm. U 11X11 A LA A V cC 1»A UVliagc/, •••••••• • • Urethane (see ^Ethylis Carbamas) Urotropine (see Hexamethylenamma) .. gr. S .. gr. 30 0.3 gm. 2 gm. . . gr. 1/30 0.002 gm. .. gr. 2 0.125 gm- .. gr. S to gr. 10 0.3 gm. to 0.6 gm. . - gr. 30 2 gm. V IL) LA111 LUU x 1 laaaaauaalaaa* . • ••••••••••• Vinum Anti^mQii .. min. 15 1 mil. Vinum Colchici Seminis .. min. 30 . . fl. dr. 2 2 mils. 8 mils. V 111 Lill 1 LylgUtts. ,.••••••••••••••• Vimim Pp-m . . fl. dr. 2 8 mils. \7<nnm AtnaniTn . . . .. fl. dr. 2 8 mils. vinuiu .rcm axaaac*auaxa••• .. min. 15 1 mil. Warburg Tincture Vinpi A .. min. 8 .. dr. to dr. 4 .. gr. 2 o.s mil. 1.8 mils to 14 mils. 0.125 gm. ZylliLl nvciao Rrnmidnm .. gr. 2 0.125 gm. A/UICI Dl UlAAAULLAAAX ..♦.•••••••••••• .. gr. 1 0.065 gm. Zinci • • gr- 4 0.25 gm. Zinci Sulphas (prnptic^ .. gr- IS 1 gm. Zinci Valeras .. gr. 2 ... gr. IS 0.125 gm. 1 gm. TABLE OF DOSES-Continued. Aconitine Nitras Apothecaries .. gr. 1/640 to gr. 1/400 Metric 0.0001 gm. to 0.00015 gm. Apomorphinae Hydrochlor. . . Atropinae Sulphas .. gr. 1/20 to gr. 1/10 ., gr. 1/200 to gr. 1/100 0.003 gm. to 0.005 gm. 0.0003 gm. to 0.0006 gm. TABLE OF DOSES BY HYPODERMIC 258 MATERIA MEDICA AND THERAPEUTICS TABLE OF DOSES BY HYPODERMIC-Continued Apothecaries Metric Cafieins Sodio-Salicylas gr. l/» to gr. 4. 0.03 gm. to 0.25 gm. Caffeins Sodio-benzoas gr. % to gr. 4 0.03 gm. to 0.25 gm. Cocains Hydrochloridum gr. i/io to gr. % 0.005 gm. to 0.03 gm. Codeins Phosphas gr. Ji to gr. a 0.015 gm. to 0.125 gm. Cotarinns Hydrochloridum.... gr. Ji to gr. Ji 0.015 gm. to 0.03 gm. Curara gr. 1/12 to gr. Ji 0.005 gm. to 0.03 gm. Digitalinum (Amorph.) gr. i/ioo to gr. 1/30 0.0006 gm. to 0.002 gm. Ergotinins Citras gr. 1/200 to gr. 1/50 0.0003 gm. to 0.0013 gm. ErgOtoxina gr. 1/100 to gr. 1/50 0.0003 gm. to 0.0013 gm. Eucains Hydrochloridum gr. 1/10 to gr. y» 0.005 gm. to 0.03 gm. Eucains Lactas gr. 1/10 to gr. Ji 0.005 gm. to 0.03 gm. Heroin Hydrochloridum gr. 1/25 to gr. 1/12 0.0025 gm. to 0.005 gm. Homatropins Hydrochlor gr. 1/250 to gr. 1/20 0.00025 gm. to 0.003 gm. Hydrarg. Chloridum Corrosivum gr. 1/60 to gr. 1/30 0.001 gm. to 0.002 gm. Hydrarg. Succinimidum gr. 1/6 to gr. Ji 0.011 gm. to 0.015 gm. Hyoscins Hydrobromidum.... gr. 1/200 to gr. 1/100 0.0003 gm. to 0.0006 gm. Hyoscyamins Sulphas gr. 1/200 to gr. 1/100 0.0003 gm. to 0.0006 gm. Morphins Hydrochloridum.... gr. 1/8 to gr. Ji 0.008 gm. to 0.015 gm. Morphins Meconas gr. 1/8 to gr. Ji 0.008 gm. to 0.015 gm. Morphins Phosphas gr. 1/8 to gr. Ji 0.008 gm. to 0.015 gm. Morphins Sulphas gr. 1/8 to gr. Ji 0.008 gm. to 0.015 gm. Morphins Tartras gr. 1/8 to gr. Ji 0.008 gm. to 0.015 gm. Physostigmins Salicylas gr. 1/100 to gr. 1/25 0.0006 gm. to 0.0025 gm. Picrotoxinum gr. 1/100 to gr. 1/25 0.0006 gm. to 0.0025 gm. Pilocarpins Nitras gr. 1/20 to gr. Ji 0.003 gm. to 0.03 gm. Potassii Permanganas gr. 1 to gr. 3 0.06 gm. to 0.2 gm. Quinins Bihydrochloridum.... gr. 1 to gr. 5 0.065 gm. to 0.3 gm. Quinins Bisulphas gr. 1 to gr. $ 0.065 gm. to 0.3 gm. Quinins Hydrobromidum gr. Ji to gr. 2 0.03 gm. to 0.125 gm. "Soamin" gr. 1 to gr. 3 0.065 gm. to 0.2 gm. Sparteins Sulphas gr. Ji to gr. 1 0.03 gm. to 0.065 gm. Strophanthinum gr. 1/500 to gr. 1/100 0.00013 gm. to 0.0006 gm. Strychnins Hydrochloridum . .. gr. 1/150 to gr. 1/10 0.0004 gm. to 0.005 gm. Strychnins Nitras gr. 1/150 to gr. 1/10 0.0004 gm. to 0.005 gm. Strychnins Sulphas Trinitrinum (Nitroglycerinum). gr. 1/150 to gr. 1/10 0.0004 gm. to 0.005 gm. gr. x/350 to gr. 1/50 0.00025 gm. to 0.0013 gm. THE NURSE AND THE HARRISON NARCOTIC ACT An act of Congress which went into effect March 1, 1915, known as the Harrison Act, is a Federal regulation of the sale of narcotic drugs, the purpose being to allow none but properly authorized and responsible persons to sell or have in their possession habit-forming drugs, and to establish a system of tracing all these drugs through legally established channels to the ultimate consumer. For this purpose annual registration of every whole- sale and retail dealer in drugs of this sort is required, a license being issued through the Deputy Collector of Internal Revenue of the District in which the applicant is located. Application is made on specified forms sworn to before a notary, and the registration fee is one dollar. Physicians and dentists are allowed to prescribe or order these drugs only when registered and when certain conditions are observed. To order narcotics from a drug- gist for personal use in practice the physician or dentist must obtain a license giving his registry number and must use special blanks furnished by the Department of Internal Revenue, duplicate records of which must be kept. When the wholesale or retail druggist receives this blank, he must file it away, make a record of the sale and furnish the buyer with a duplicate. All these records both by buyer and seller must be kept for a period of two years from date, so that the Internal Revenue Inspectors may exam- ine them when they deem it necessary. To prescribe any of these drugs for a patient the phy- sician or dentist must use a prescription blank containing the name, age and address of the patient, the prescriber's 259 260 MATERIA MEDICA AND THERAPEUTICS registry number and his full name and address and the date of the prescription, which must be dated on the day it is written. This prescription must also be filled on the date it is written. The druggist is required to keep all such prescriptions on a special file for inspection. The physician is allowed, however, to give single doses of these drugs to a patient without such an order, but these doses must be given personally, and a record kept of them. Any person not so licensed-and the nurse is not licensed -who is found to have any of the substances listed under the law in his or her possession, and cannot show that they have been legally placed there by a registered physician's registered prescription, is subject to a fine of $2000 or five years imprisonment, or both, at the discretion of the court. It will be seen that the physician has no right to leave morphine tablets in the hands of the nurse for use after he has left, without ordering them on proper blanks through the proper channels, and the nurse has no right to give such medication unless the medicines have been properly registered when purchased. All dealers, dentists and physicians are obliged to make an inventory return to the Internal Revenue Department each year. HOSPITALS AND NARCOTIC DRUGS The hospital nurse finds a certain routine necessary in observing the narcotic law, since hospitals are registered just as physicians are. Physicians are obliged to order drugs either on their own registry blanks or on those containing the hospital number. The ward nurse is required to keep a strict inventory of these drugs used from ward supplies, just as the pharmacist is required to file records of such drugs taken from the pharmacy. Breakage of containers THE NURSE AND THE HARRISON ACT 261 of liquids or powders entailing waste, should be recorded for the purpose of balancing the inventory at the end of the year. The purpose of the law is to be able to trace these drugs from the importer to the consumer, and every care should be observed to make this work easy for the Government officials. DRUGS AND PREPARATIONS SPECIFIED IN THE NARCOTIC ACT Opium and coca and its preparations are specified in the Harrison law as follows: Opium Opium-excepting preparations contain- Coca Coca leaves ing 2 grains to the ounce or less. Fluidextract of Coca Powdered opium Cocaine and its salts in Tincture of Opium (Laudanum) all tablets and in every Deodorized Tincture of Opium combination Powder of Ipecac and Opium (Dover's Codrenin Powder) Eucaine Morphine and all its salts, excepting Holocaine preparations containing % grain to Novocaine the ounce or less T ropococaine Magendies solution Anaesthesin Codeine and its salts, excepting prepa- rations containing i grain or less to the ounce Dionin Codeonal Heroin, excepting preparations contain- ing % grain to the ounce or less Papaverin Pantopan Apomorphine Hydrochloride Stypticin Orthoform Single quantities, or tablets of any of the above preparations of whatever strength, are controlled by the law. 262 MATERIA MEDICA AND THERAPEUTICS Prescriptions or combinations or preparations contain- ing coca, opium or any derivatives are also included, except- ing such as contain opium not more than grain 2 to the ounce, morphine not more than grain% to the ounce, codeine not more than grain 1 to the ounce or heroin not more than grain % to the ounce. All mixtures or combinations of coca or cocaine or its derivatives are regulated by the law. Liniments or ointments for external use containing opium or its products are not so regulated, but no exception is made in the case of coca, cocaine or its derivatives. HOSPITAL SUPPLIES AND ANTISEPTICS USED IN MILITARY SURGERY Paraffin Burn Wax In addition to the emollient and protective substances (such as petrolatum, lanoline, etc.) used to treat burns, frost bite and other skin ulcerations, the European war has seen the development of several paraffin waxes, known as " Am- berine," "bum-wax," etc., of which the No. 7 Paraffin of Lt. Col. Hall, R.A.M.C., is perhaps the best example. Am- berine, a proprietary preparation, is paraffin with 5 per cent, oil of amber. Oil of cedar is used in other formulas. No. 7 Paraffin-Hall Resorcin (or, Betanaphthol % part) .... 1 part Oil Eucalyptus 2 parts Olive Oil 5 parts Soft paraffin 25 parts Hard paraffin 67 parts Absolute alcohol q. s. Melt the hard paraffin. Cut up the soft paraffin and stir it in the melted mixture till dissolved, also adding the ANTISEPTICS USED IN MILITARY SURGERY 263 olive oil. Add the resorcin dissolved in one-half its weight of absolute alcohol and when the wax has cooled to 1330 F., stir in the oil of eucalyptus. This wax is melted and applied with a camel's-hair brush or sprayed with an atomizer to the ulcerated surface, which must have been previously made dry with a stream of heated air. Cleansing the surface, if infected, with Dakin- Carrel solution or Dichloramine-T solution is a necessary preliminary. A thin layer of the wax is formed over the surface, which is removed when the treatment is repeated. Solution of Dichloramine-T Ten grammes of Dichloramine-T (Abbot Aik. Co.) is dissolved in 75 mils of Chlorinated Eucalyptol. To this is added 100 mils. Chlorinated Liquid Petrolatum (light). This preparation is decomposed by light and heat and should be made up freshly when possible, and not used when over 72 hours old. For use in the nose and throat the above formula should be diluted with 4 parts of Albolene. It is sprayed on wounds with a hand atomizer, or used in the nose with a nebulizer. Dakin-Carel Solution or Hypochlorite Solution (Dakin) 1. Chlorinated lime (bleaching powder) 200 Gm. Sodium carbonate, dry 100 Gm. Sodium bicarbonate 80 Gm. 2. Put the chlorinated lime in a 12-litre flask with 5 litres of ordinary water, and let it stand over night. 3. Dissolve the sodium carbonate and bicarbonate in 5 litres of cold water. 4. Pour (3) into the flask containing (2), shake it vigor- ously for a minute, and let it stand to permit the calcium carbonate to settle. 264 MATERIA MEDICA AND THERAPEUTICS 5. After half an hour siphon off the clear liquid and filter it through paper to obtain a perfectly limpid product. This must be kept protected from the light. The antiseptic solution is then ready for surgical use; it contains about 0.5 gm. per cent, of sodium hypochlorite with small amounts of neutral soda salts; it is practically isotonic with blood serum. It should meet the following tests: Test.-Put about 20 mils of the solution in a glass and pour on its surface a few centigrams of phenolphthalein in powder; shake it with a circular movement, as in rinsing; the liquid should remain colorless. A more or less marked red discoloration indicates the presence of a notable quan- tity of free alkali, or incomplete carbonation, imputable to an error in technic. Errors to Be Avoided.-Never heat the solution. If in an emergency it is necessary to triturate the chlorinated lime in a mortar, do so only with water, never with the solution of the soda salts. Titration.-To 10 mils of the solution add 10 mils of dis- tilled water, 2 gm. of potassium iodid and 2 mils of acetic acid. Pour into this mixture a decinormal (2.48 per cent.) solution of sodium thiosulphate (hyposulphite) until it is decolorized. The number of cubic centimetres of thiosul- phate employed multiplied by 0.003725 equals the percentage of sodium hypochlorite in the solution. (Jr. A. M. A.) Harrington's Solution Mercuric chloride 0.8 Gm. Hydrochloric acid 60.0 mils Water 3000 mils Alcohol 640.0 mils For hand preparation and skin incision preparation should be preceded by ether and followed by sterile water. MISCELLANEOUS FORMULAS 265 MISCELLANEOUS FORMULAS TOOTHACHE DROPS (LUNDGREN) Phenol 2 parts Menthol 2 parts Eugenol I part Mix. FIREPROOFING SOLUTION FOR FABRICS Boric acid 50 Gm. Borax 60 Gm. Water 1000 mils To be painted on fabrics, or fabrics may be soaked in solution. (Formula of Municipal Laboratory of Paris for use in theatres.) DEODORIZER FOR SICK ROOM Coumarin 2 Gm. Oil lavender 2 mils Oil bitter almond 4 mils Oil clove 12 mils Oil Eucalyptus 16 mils Oil Patchouli 10 drops Mix. Use as a spray. RAUBENHEIMER'S MOTH LIQUID Phenol 10 Gm. Camphor 30 Gm. Carbon tetrachloride, Benzin, of each 500 mils This is non-inflammable. Cupboards or chests are to be painted with the liquid, or blotting paper saturated with it. It may also be used as a spray. 266 DISINFECTANT FOR TELEPHONE MOUTHPIECES (Bellevue Formulary) Thymol 2 Gm. Oil of pine needles, Oil of peppermint, of each 2 mils Alcohol 60 mils Water, a sufficient quantity. To be used in scrubbing telephone mouthpieces. BLUE WRITING FLUID (Journ. A. Ph. A.) Methylene blue 1 Gm. Glycerin 5 mils Water 500 mils URINE REAGENTS Haines Solution (for Sugar Test) Copper sulphate 2 Gm. Potassium hydroxide 9 Gm. Glycerin 20 Gm. Distilled water to make 175 mils Robert's Reagent (for Albumin) Nitric acid (U. S. P.) 100 mils Sat. sol. magnesium sulphate 500 mils LUBRICATING JELLY (German Hospital Formula) Tragacanth, whole 3 Gm. Glycerin 25 mils Phenol 1.5 Gm. Distilled water g.s. ad 300 mils Break the tragacanth in small pieces and place in a wide- mouthed bottle, add other ingredients and shake the bottle frequently. MATERIA MEDICA AND THERAPEUTICS MISCELLANEOUS FORMULAS 267 LIBRARY PASTE Wheat flour 4 ounces Alum, powdered, i drachm Glycerine 6 drachms Oil winter green % drachm Water 12 ounces Blend the flour, water and alum to a smooth paste, boil till paste thickens (avoid burning) and add oil and glycerine and mix thoroughly. Keep in screw-topped jars. MISCELLANEOUS TOILET PREPARATIONS Perspiration Deodorant Hydrogen dioxide 2 ounces Spirits of lavender (flowers) % ounce Alcohol % ounce Rose water, to make 4 ounces Mix. Apply when needed. For Perspiring Feet Formalin 4 ounces Water 1 quart Mix. Bathe feet at night. In daytime shake the following powder in shoes: Foot Powder Sodium perborate % ounce Powdered starch % ounce Powdered alum 7M ounce Powdered talc ounces Mix and keep in a stoppered bottle. For Axillary Perspiration Potassium bichromate % ounce Rose water 1 pint Mix. Apply once or twice a day. 268 MATERIA MEDICA AND THERAPEUTICS EXTERNAL APPLICATIONS UNNA'S PASTE (IMPROVED) Water 3x. Gelatine Siv. Boil until dissolved, add: Glycerine Sx. Zinc Oxide Siv. Oil Wintergreen 3i. Salicylic Acid 3i. This paste is heated in a water bath till liquid and painted on the skin with a brush. Used as a dressing for indolent leg ulcers, wanned and painted on bandage. LASSAR'S ZINC-SALICYL PASTE Salicylic Acid gr.ii. Zinc Oxide gr.xxiv. Starch gr.xxiv. White Petrolatum gr. 1 (50) Thoroughly mix the Zinc Oxide with a portion of the petrolatum; then add the Salicylic, the Starch, and the remaining Petrolatum, and triturate until a perfectly smooth mixture is obtained. (Used in eczema of children.) CALAMINE LOTION (FOX) Calamine gr.xl. Zinc Oxide gr.xx. Glycerine min.xx. Rose Water Si. Used in acute eczema. LOTION FOR PRICKLY HEAT Bismuth subnitrate 3iij. Zinc oxid 3i. Glycerin fl.Siss Rose water q. s., ad. fl. Svj. MISCELLANEOUS FORMULAS 269 Mix bismuth and zinc with glycerin and rub well. Then add the rose water. Shake well before using. Sig.: Apply twice a day after the body has been thor- oughly cleansed with hot ten per cent, sodium bicarbonate solution. SURGICAL LIQUID SOAP Sodium hydrate 40 gms. Potassium hydrate 40 gms. Cotton seed oil 500 c.c. Alcohol 250 c.c. Distilled water q. s. to make 2500 c.c. Dissolve the hydrates, preferably in a glass-stoppered bottle, in 250 mils of the distilled water; next add the alcohol and then the cotton-seed oil in three or four portions, shak- ing vigorously after each addition. Agitate the mixture occasionally until complete saponification has taken place, then add, but not before, the balance of distilled water. (Wilbert.) EMERGENCY INFANT FEEDING The new-born infant requires no food for the first 24 hours. Afterward he may be offered 2 ounces of a mixture of one part of boiled milk with two parts of water, 7 feed- ings at 3-hour intervals. A level teaspoonful of lactose or granulated sugar may be added to the total mixture (14 ounces), increasing by a teaspoonful daily until eight are being given. The tenth day 7 feedings of 3 ounces of a mixture of equal parts of water and boiled milk with one ounce of sugar is offered every 3 hours. All of this will not be taken at first. After the second week or third week estimate the formula as follows: 1. Weigh the infant. 2, To obtain the quantity of milk needed for the 24-hour 270 MATERIA MEDICA AND THERAPEUTICS quantity, multiply the weight of the baby by ij4; the result is the number of ounces of milk required. To estimate the quantity required at a feeding, take the age in months and add to it i, if the feeding interval is three hours; 2 if it is four hours, and this will give the quantity in ounces required at each feeding. 3. To obtain the total quantity of the mixture, multiply the quantity to be given at each feeding by the number of feedings, which number is 7 up to the fifth month, at 3-hour intervals, and 5 after the fifth month at 4-hour intervals. 4. To estimate the quantity of water needed, subtract the number of ounces of milk from the total quantity required for the entire mixture. 5. When a baby weighs 12 pounds or less, 1 ounce of sugar will be sufficient. When it weighs more, the sugar may be proportionally increased to two ounces. The quan- tity of milk required may gradually be increased from iy2 ounces to 2 ounces per pound of weight in the 24 hours. Sodium bicarbonate^ a grain to the ounce or lime-water, y2 a drachm to the ounce of the total mixture may be added. Example.-A baby 3 months old weighs 10 pounds. How should it be fed ? Quantity of milk: 10 times 1% equals 15 15 ounces milk Number of feedings: 7 X (age plus 1^2 = 414) = 3114 ounces, Water: 3114 less 15 equals i614 ounces water to add Sugar (weight less than 12 pounds) 1 ounce 7 feedings, 414 ounces at a feeding. SPECIAL FORMULA ALBUMIN MILK (EIWEISS MILCH) Milk one quart. Heat to ioo° F., and add Essence of Pepsin or Liquenzyme one tablespoonful. Set in a warm place for y2 an hour. Then drain through a sterile cheese- MISCELLANEOUS FORMULAS 271 cloth bag for two hours, or until all the whey has dripped off. Throw the whey away. Press the curd through a fine sieve, using a wooden spoon for the purpose, adding meanwhile one pint of warm water and one pint of buttermilk, and repeat this pressing through the sieve until the curd is broken up into very fine particles. Some authorities at this stage, heat the mixture to about 120° F., causing it to separate, and then repeatedly press it through the sieve, believing that this process pre- vents coagulation later. Unless this is done this milk must be given to the infant very slightly warmed, else it will coagulate. A nipple with a specially large orifice must always be used to administer it. It is usual to add from 3 to 6 per cent, dextri-maltose, Mellin's food or other sugar to this mixture before adminis- tering it. MALT SOUP To prepare Malt Soup, sometimes called Kellar's Malt Soup, the following formula will prove satisfactory. Malt Soup Extract is obtainable in almost every pharmacy. It is a malt extract rendered slightly alkaline by the addition of carbonate of soda. Mixture No. 1.-Take 5 tablespoonfuls of Malt Soup Extract and dissolve in 1% pints of warm water. Mixture No. 2.-Take 5% tablespoonfuls of wheat flour, mix with % pint of milk and strain through a clean sieve. Add mixture No. 2 to mixture No. 1 and boil for 3 min- utes, stirring constantly. Cool quickly and pour into clean (preferably sterilized) bottles holding 6 ounces each. Plug them tightly with absorbent cotton, or if corks are used they should be absolutely clean and close-fitting. Keep in a cool place. INDEX Acet-theobromine sodium, 162 Acetanilid, 67, 77, 155 physiological action of, 77 poisoning from, 77 preparations and doses, 77 therapeutic uses of, 77 Acetanilide, to reduce fever temperature, 227 Acetanilidum, 155 Acetphenetidinum, 198 Acetate of lead, 64 uses of, 64 Acetates, as diuretics, 224 effect on the blood, 228 Acetylparamidophenol salicylate, 205 Acid, acetic, 156 diluted, 156 glacial, 156 agaricic, 156 arsenous, 156 benzoic, 156 boric, 157 carbolic, 157 liquefied, 157 chromic, 157 citric, 157 gallic, 157 hydriodic, 158 hydrobromic, diluted, 158 hydrochloric, 158 diluted, 158 hydrocyanic, diluted, 158 hypophosphorous, diluted, 158 lactic, 159 nitric, 159 diluted, 159 nitrohydrochloric, 159 Acid, phenylcinchonionic, 159 phosphoric, diluted, 159 picric, 159 pyrogallic, 160 salicylic, 160 sulphuric, aromatic, 160 diluted, 160 tannic, 160 tartaric, 161 trichloracetic, 161 Acids, 48, 49, 50, 91, 102, 104 Acidosis, 42 Acidum aceticum, 156 dilutum, 156 glaciale, 156 benzoicum, 156 boricum, 157 carbolicum, 157 liquef actum, 157 citricum, 157 gallicum, 157 dose of, 65 gallotannicum, 160 hydriodicum dilutum, 158 hydrobromicum dilutum, 158 hydrochloratum, 158 hydrochloricum, 158 hydrocyanicum dilutum, 158 hypophosphorosum dilutum, 158 lacticum, 159 nitricum, 159 dilutum, 159 nitrohydrochloricum dilutum, 159 phenylcinchonicum, 159 phosphoricum dilutum, T59 salicylicum, 160 273 274 INDEX Acidum sulphuricum aromati- cum, 160 dilutum, 160 tannicum, 160 dose of, 65 tartaricum, 161 trichloraceticum, 161 Aconite, 80 administration of, 80 as local anodyne, 220 dose of, 80 physiological action of, 81 poisoning, 81 preparations of, 80 root, 161 therapeutic uses of, 81 to reduce fever temperature, 227 Aconiti, physiological action of, 81 therapeutic uses of, 81 tuber, 161 Aconitine, dose of, 80 Aconitum, 161 Aconitum-monkshood, 80 Action, physiological, 47 therapeutic, 47 Active principles, 49 Acts, reflex, 40 Adalin, 161 Adeps lanae hydrosus, 187 Administration of medicines, 19 by inhalation, 20 Adrenalin, 87, 161 administration, 88 therapeutics, 88 ^ther, 178 /Etheroleum, amygdalae amarae, 193 j uniperi, 194 ^thylis carbamas, 217 chloridum, 179 Agar, 99, 161 Agar-agar, 161 Agaricin, 156 to lessen perspiration, 229 Agurin, 57, 162 Albumin milk, 270 Alcohol, 67, 68, 152 action on digestion, 221 and the anaesthetics, 67 as carminative, 221 as a food, 69 dose of, 69 in patent medicines, 70 physiological action, 69 on the circulation, 69 on the digestive system, 69 therapeutic uses of, 69 to induce sleep and rest, 226 Alcoholism, habit of, 70 Aletris, cordial, 162 Alkali carbonates, as diuretics, 224 Alkaline carbonates, effect on the blood, 228 Alkalithia, 162 Alkaloids, 49 Aloe, 91, 98, 162 Aloes, 98 action, 98 preparations, 98 purgative action, 221 socotrine, 162 Aloin, 162 Alpyn, 78, 162 physiological action of, 78 uses of, 78 Alteratives, 51, 105 and drugs modifying metabo- lism, 53 Alum, as astringent, 220 dose of, 65 Alumen, dose of, 65 action, 98 Aloin, 162 INDEX 275 Amberine, 262 Ammonia, 60 salicylate, 131 water, 60, 163 stronger, 163 Ammonii benzoas, 163 bromidii, 75 bromidum, 163 carbonas, 60 physiological action of, 60 therapeutic uses of, 60 chloridum, administration of, 61, 163 uses of, 61 iodidum, 106, 164 administration of, 107 precautions in, 107 physiological action of, 106 preparations of, 107 therapeutic uses, 107 Ammonium aceticum solution, 210 action on mouth and throat, 220 benzoate, 163 bromatum, 163 bromide of, 75, 163 dose and administration of, 76 physiological action of, 75 therapeutic uses of, 76 untoward effects of, 76 carbonas, 163 carbonate of, 60, 163 to increase and liquefy bron- chial secretion, 225 carbonicum, 163 chloratum, 163 chloride, 163 to lessen bronchial secretion, 225 iodatum, 164 Ammonium, iodide and bromide of, 60, 164 salts of, 60 sulpho-ichthyolate, 185 Ammonol, 164 Amoebic dysentery, drugs used in, 229 Amyl nitrite, 80, 89, 164 physiological action, 89 therapeutic uses, 90 action on blood-vessels, 223 nitritis, to relax bronchial spasm, 226 Amylis nitris, 89, 164 physiological action, 89 therapeutic uses, 90 Amylium nitrosum, 164 Anaesthesia, urine before and after, 71 Anaesthesin, 164 Anaesthetics, 51, 68 general, 226 local, 78 Analgesics, 51, 71 to relieve pain, 227 and narcotics, 67 Analgine, 164 Anaphrodisiacs, 51 Anchylostoma duodcnalis, 123 Animal products, 50 Anodynes, 51 to relieve pain, 227 Antacids, 51, 91, 102, 103 preparations and doses, 103 Antagonistic action, 48 Anthelmintics, 51, 122 methods of administration, 122 Anti-emetics, 51 Antifebrin, 155, 164 Antifebrinum, 155 Antigalactogogues, 51 Antihydrotics, 51 Antimonii et potassii tartras, 164 276 INDEX Antimony and potassium tar- trate, 164 Antiperiodics, 51 Antiperiodics, 51 Antipyrin, 67, 77, 164 physiological action of, 77 poisoning from, 77 preparations and doses, 77 therapeutic uses of, 77 to reduce fever temperature, 227 Antipyrina, 1O4 Antipyrene, to relieve pain, 227 Antipyretics, 51, 77 physiological action of, 77 poisoning from, 77 preparations and doses, 77 therapeutic uses of, 77 Antirheumatics, 51 Antiseptics, 51, 113 Antisialagogues, 51 Antispasmodics, 51 Antitoxic units, 117 Antitoxin, 116, 117 diphtheria, 117, 165 concentrated, 165 dried, 165 method of preparation, 117 tetanus, 117 and immunity, 116 Antitoxins, 50, 119 administration of, 119 immunizing doses, 119 anaphylactic reactions, 120 untoward effects, 120 and vaccines, 105 Apiol, 165 Apioline, 165 Apomorphinae hydrochloridum. 75, 165 Apomorphine, action of. 73 emetic action of, 221 Apomorphine hydrochloride, 94, 165 uses of, 73 Apomorphinum hydrochloridum, 165 Apothecaries' System, approxi- mations in the, 38 Applications, local, 18 to the conjunctiva, 18 to the larynx, 19 to the mouth and pharynx, 19 to the mucous membranes, 18 to the nasal membrane, 18 to the rectum, 19 to the skin, 18 to the stomach and intes- tines, 19 to the vagina, 19 Aqua ammoniac, 163 fortier, 163 Aqua hydrogenii dioxidi, 127 action of, 127 as active bleaching agent, 127 as a cleansing agent, 127 in infections of mu- cous membranes, 127 Aquae, 6 Argenti nitras, 207 Argonin, 166 Argyria, 129 Argyrol, 130, 166 Aristol, 166 Aromatics, 92 important preparations, 93 or carminatives, 91 Arsenauro, 166 Arseni trioxidum, 156 Arsenic, 105, 108 doses and administration of, 109 effect on the blood, 228 in malaria, 228 INDEX 277 Arsenic, physiological action of, 108 poisoning, no acute, no treatment of, no chronic, no symptoms and treatment, no poisonous doses, no preparations, 109 therapeutic uses of, 108 trioxide, 108 untoward effects of, 109 Arsenous acid, 108 Artemisia pauciflora, 122 Asafcetida, 166 Ascarides, or round worm, 123 Aspidium, 121, 122 action, 122 uses, 122 Aspirin, 166 Asthma, from antitoxins, 120 from serums, 120 Astringents, 51, 53, 61, 64, 220 action of, 65 mineral, 53, 64 names and dosage of, 65 therapeutics of, 65 vegetable, 53, 64 Atomizers, disinfection of, 144 Atophan, in gout, 229 Atoxyl, 166 Atrophanthus, action on heart, 222 Atropina, 167 Atropinae sulphas, 63, 167 Atropine, 61, 167, 226 action of, 62 on heart, 222 administration of, 63 as local anodyne, 220 effect on the eye, 230 poisonous symptoms of, 64 Atropine, sulphate, 63, 167 therapeutic uses of, 62 to arrest secretion of milk, 230 to lessen peristalsis, 222 to lessen perspiration, 229 to lessen salivation, 220 to relax bronchial spasm, 226 to stimulate, 225 untoward effects of, 64 Auri et sodii chloridum, 182 Auro-natrium chloratum, 182 Bacillus, Bulgarian, 167 Bacteria, emulsions of, 118 killed, 50 Balsam, 50 Peru, 167 Balsamum copaibae, 176 Peruvianum, 167 Barbaloin, 162 Bases, 48 Bashman's mixture, 112 Bed linen, disinfection of, 144 Bed pans, disinfection of, 144 Belladonna, 53, 61 action of, 62 administration of, 63 group, 51, 53 leaves, 167 physiological action of, 61 poisonous symptoms of, 64 root, 167 to lessen perspiration, 229 therapeutic uses of, 62 untoward effects of, 64 Belladonnae, emplastrum, 63 folia, 167 radix, 167 unguentum, 63 Benzoe, 167 Benzoic acid, to lessen bronchial secretion, 225 278 INDEX Benzoin, 167 to lessen bronchial secretion, 225 Benzoinum, 167 Benzosulphinidum, 205 Beta - eucainae hydrochloridum, 179 Betanaphthol, as intestinal anti- septics, 222 Bethanaphthol, 192 Bicarbonate, potassium, as local anodyne, 220 of soda, 103 dose of, 103 Bicarbonates, as diuretics, 224 in stomach acidity, 221 Bichloride of mercury, 113 as an antiseptic and germi- cide, 115 solution, 138 poisoning by, 139 Bile, 42 to increase secretion of, 228 Biological products, 50 Bismuth, 91, 104 betanaphtholate, 167, 196 formic iodide, 168 in vomiting, 221 preparations, as astringents, 220 salicylate, 168 subcarbonate, 168 subgallate, 168, 177 subnitrate, 168 to lessen peristalsis, 222 and ammonium citrate, 168 Bismuthi betanaphtholas, 167 subcarbonas, 168 subgallas, 168 subnitras, 168 subsalicylas, 168 et ammonii citras. 168 Bismuthum subnitricum, 168 subsalicylicum, 168 Bitter stomachics, 91, 92 Black haw, 169 Blankets, disinfection of, 144 Blaud's pills, 112 Blood, carbon dioxide, 42 carbonates and bicarbonates, 42 chemical reaction, 42 drugs used to affect the, 228 haemoglobin, 42 plasma, 42 red cells, 42 relative acidosis, 42 to increase alkalinity of, 228 vessels, 223 white cells, 42 Blue ointment, 113, 115 as parasiticide, 115 Blue pill, 113 vitriol, dose of, 65 Body linen, disinfection of, 145 Bolsters, disinfection of, 145 Books, disinfection of, 145 Boracic acid, 157 Borax, 208 Bornyval, 169 Borolyptol, 169 Bottles, disinfection of, 145 Bouillon filtrate, 119 Brain, action of drugs on, 39 and medulla, 226 stimulants to, 226 Brandy, 68 alcohol percentage, 68 Brometum scopolamicum, 185 Bromides, 67, 75 to induce sleep and rest, 226 to reduce irritability of res piratory centre, 225 Bromidia, 68, 169 Bromine, 169 INDEX 279 Bromism, 76 Bromoform, 169 Bromum, 169 Bromural, 169 Brovalol, 169 Brushes, disinfection of, 145 Buchu, 169 Bulbus scillae, 212 Bulgarian bacillus, 170 Burn wax, 262 Burns, carbolic acid, 137 Burrow's solution, 210 Cachets, 7 Caffeina, 56, 170 citrata, 56, 170 physiological action on the heart, 55 on the muscles, 55 on the nervous system, 55 on the pulse, 55 on the respiration, 55 sodii benzoas, 56 Caffeinae sodio-benzoas, 170 Caffeine, 55, 56, 67, 75, 78, 170, 226 action on blood-vessels, 223 on heart, 222 as diuretic, 224 citrated, 170 in dropsy, 223 physiological action on the se- cretion of urine, 55 preparations and dosage, 56 to stimulate, 225 -sodium-benzoate, 56 and sodium benzoate, 170 Caffeinum, 170 citricum, 170 Calamine lotion, 268 Calcii bromidum, 170 carbonas praecipitatus, 170 chloridum, 171 Calcii lactas, 171 sulphidum crudum, 18, 188 Calcium bromide, 170 carbonate, precipitated, 170 prepared, 170 carbonicum praecipitatum, 170 chloride, 171 lactate, 171 Calomel, 113 as diuretic, 115, 224 as intestinal antiseptic, 222 dose of, 114 in Bright's disease, 115 purgative action, 221 Calumba, 171 action on digestion, 221 Calx chlorinata, 127 Camphor, 80, 85, 171 as carminative, 221 dosage of, 85 monobromated, 171 preparations of, 85 to increase perspiration, 229 to stimulate, 225 uses of, 85 Camphora, 85, 171 monobromata, 171 Camphorated tincture of opium, 74 Cannabis, 171 indica, 171 to induce sleep and rest, 226 to relieve pain, 227 Cantharides, 172 effect on the skin, 229 Cantharis, 172 Capacity, unit of, 8 Capsicum, 93, 172 Capsules, 7 Carbo ligni, 173 pulveratus, 173 Carbolic acid, 125, 132, 137 280 INDEX Carbolic Acid, as an antipruritic, M3 as an antiseptic, 133 as a caustic, 133 as a disinfectant, 133, 137 as local anodyne, 220 as a sedative, 133 physiological action, 133 poisoning, 133, 138 symptoms of, 133 therapeutic uses, 133 Carbonate of ammonium, admin- istration of, 61 of calcium, 103 of sodium, 103 Carbonates, as diuretics, 224 Carbonic acid water, in vomit- ing, 221 Cardamom, 172 as carminative, 221 Cardamomi semen, 172 Cardiac sedatives, 51 Carminatives, 51, 92 Carpet, disinfection of, 146 Cascara, 98 action, 98 preparations, 98 sagrada, 91, 98, 172 Castor oil, 99 Catechu, 172 Cathartics, 51, 91, 94, 95 administration, 101 contra-indications, 101 irritants, 43 irritant, mode of action, 43 therapeutic uses, 100 time required to act, 101 vegetable, 95 Caustics, 51, 66 lunar, 129 Cells, psychic, action of drugs on, 40 Central nervous system, action of drugs on, 39 Centre for respiration, action of drugs on, 40 for vomiting, action of drugs on, 40 respiratory, action of drugs on, 42 vasomotor, action of drugs on, 40 Cerebral sedatives, 67 poisoning by, 68 stimulants, 51 Cerii oxalas, 172 Cerium, 91, 104 in vomiting, 221 oxalate, 172 Chalk, 103, 172 mixture, 173 Charcoal, 173 as carminative, 221 Chinaware, disinfection of, 146 Chininum, 203 ferro-citricum, 187 sulphuricum, 203 tannicum, 203 Chloral, doses of, 68 in vomiting, 221 to induce sleep and rest, 226 compounds, to reduce irrita- bility of respiratory centre, 225 hydrate, 67, 173 physiological action, 67 Chloralum hydratum, 67, 173 Chlorates, action on mouth and throat, 220 Chloretine, as local anodyne, 220 Chloretone, 173 Chloride, action on mouth and throat, 220 INDEX 281 Chloride of ammonium, 61 administration of, 61 uses of, 61 of zinc, 64 Chlorinated lime, 127 liquid petrolatum, 126 oil of Eucalyptus, 126 Chlorine, 125, 126 as bleaching agent, 126 Chloroform, 70, 173 action of, 70 as anaesthetic, 70 as carminative, 221 collapse from, 71 from, treatment of, 71 doses of, 70 nausea after anaesthesia with, 7i to paralyze sensation, 226 uses of, 70 and ether, 67 Chloroformum, 173 Chromii trioxidum, 157 Chronic mercurial poisoning, 114 Chrysarobin, 173 Chrysarobinum, 173 Cimicifuga, 174 Cinchona, 124, 174 action on digestion, 221 bark, 124 Cinchonidine, 174 Cinchonism, 125 Circulation, 41 Citras ferrico ammonicus, 186 Citrated caffeine, 56 Citrates, as diuretics, 224 effect on the blood, 228 Cloves, as carminative, 221 Coal-tar analgesics, 67, 77 physiological action of, 77 poisoning from, 77 preparations and doses, 77 therapeutic uses of, 77 Coca and anti-narcotic act, 261 Cocaina, 78 physiological action of, 78 uses of, 78 Cocainae hydrochloridum, 174 Cocaine, 67, 78, 226 as local anaesthetic, 220 as local anodyne, 220 effect on the eye, 230 habit, 79 hydrochlorate, 174 in vomiting, 221 physiological action of, 78 poisoning, 79 uses of, 78 Cocainum hydrochloridum, 174 Codeina, 174 phosphas, 75 Codeine, 174 action of, 73 administration and dosage, 74 contra-indication of, 73 phosphate, 75 therapeutics of, 73 in colds, 73 in coughs, 73 in diarrhoea, 73 in fevers, 73 in hemorrhage, 73 in insomnia, 73 in peritonitis, 73 in typhoid, 73 to reduce irritability of res- piratory centre, 225 uses of, 73 Codeinum, 174 Coffee, action of, 56 caffeine in, 56 Colchi-sal, 175 Colchici cormus, 175 semen, 175 Colchicina, 175 Colchicine, 174 282 INDEX Colchicum, in gout, 229 root, 175 seed, 175 Collapse from antitoxins, 120 from serums, 120 Collargol, 175 Collodia, as protectives, 220 Collodion, cantharidal, 175 styptic, 175 Coilodium cantharidatum, 175 stypticum, 175 vesicans, 175 Colocynth, 175 Colocynthis, 175 Combs, metal, disinfection of, 146 Comforts, disinfection of, 146 Common salt, emetic action of, 221 Compound cathartic pill, 98, 114 solution of cresol, 133 Conium, 175 Convulsions, 41 Copaiba, 176 as diuretic, 224 Copper, emetic action of, 221 sulphate, 176 as astringent, 220 Corrosive acids, action of, on clothing, 235 on skin and mucous mem- brane, 235 Corrosive chloride of mercury, 113 sublimate, 113, 176 Cortex chinae, 124, 174 frangula, 181 rhamni purshiana, 172 viburnum, 169 Cotarinae hydrochloridum, 214 Cotarnine, 176 Coughing, 42 Counter-irritants, 51 Cowling's Rule, 13 Cream of tartar, 54 Creolin, Pearson, 133, 176 Creosotal, 176 Creosote, 133, 176 carbonate, 176 Creosotum, 176 Creta praeparata, 103, 170 Croton oil, 99 Cubeba, 177 Cubebs, 177 action on mouth and throat, 220 as diuretic, 224 to lessen bronchial secretion, 225 Cubic centimetre, 9 Cumulative action, of drug, 48 Cupri sulphas, 176 dose of, 65 Curtains, lace, disinfection of, 146 Cushions, disinfection of, 147 Cystogen, 134 therapeutics, 134 Dakin-Carrel solution, 126 formula of, 263 Deadly nightshade, 61 Definitions, 3 therapeutic, 51 Demulcents, 52 Deodorants, 52 Deodorized tincture of opium, 74 Deodorizer for sick room, 265 Depilatories, 52 Dermatol, 177 Dessertspoonful, domestic equiv- alent of, 12 Dextrose, 177 Diacetyl, 75 Diacetylmorphinae hydrochlori- dum, 183 INDEX 283 Diarrhoeas, astringents in, 65 Diastase, as digestives, 221 Diaphoretics, 52, 53, 57 emetics as, 57 in dropsy, 223 mode of action, 57 saline diuretics as, 57 to reduce fever temperature, 227 uses of, 57 Dichloramine-T, 126 in the nose and throat, 127 solution, formula of, 263 Diethyl-barbituric acid, doses of, 68 Digalen, 82 Digestants, 91, 102 administration and doses, 102 uses, 102 Digestives, 52, 220 Digitalin, 82, 177 Digitalis, 57, 80, 82, 177 action on blood-vessels, 223 on heart, 222 as diuretics, 224 cumulative effect, 83 in dropsy, 223 physiological action of, 82 on heart, 82 on kidney, 83 preparations of, 82 therapeutics and administra- tion, 84 Digitoxin, 82 Dimazon, 177 Dimethyloxyquinizine, 164 Dioxygen, 177 Diphtheria, 117, 119 antitoxin, therapeutics of, 117 bacillus, 117 normal test for, 119 and other antitoxins, 117 Dishes, disinfection of, 147 Disinfectant, fresh air as a, 136 heat as a, 136 sunlight as a, 136 Disinfectants, 52, 125 for telephone mouthpiece, 266 patented or proprietary, 135 to be labeled, 136 to the skin, 229 Disinfection, apparatus and ma- terials used in, 136 of atomizers, 144 of bed linen, 144 of bed pans, 144 of blankets, 144 of body linen, 145 of bolsters, 145 of books, 145 of bottles, 145 of brushes, 145 of carpet, 146 of chinaware, 146 of combs, metal, 146 of comforts, 146 of curtains, lace, 146 of cushions, 147 of dressings, 147 of dishes, 147 essentials of, 135 of excreta, 147 of featherbeds, 147 of fecal matter, 147 of food, 147 of forks, 147 of furniture, 148 of hands, 148 of hassocks, 148 of hot water bags, 148 of knives, 148 of mattings, 149 of mattresses, 149 of pillows, 149 of pillow cases, T49 of portieres, 149 284 INDEX Disinfection, of privies, 149 purpose of, 135 of quilts, 149 of rugs, 149 of shades, 149 of sheets, 150 of shoes, 150 of silverware, 150 of spoons, 150 of sputum, 150 of table linen, 150 of toilet sets, 150 of tooth brushes, 150 of towels, 151 of toys, 151 of urinals, 151 of urine, 151 of walls, 151 of wash goods, 151 of wool-work, 151 of woolen goods, 151 Diuretics, 52, 53 action of, 54 saline, 54 doses of, 54 stimulating, 54, 55 vasomotor, 54 water, 54 Diuretin, 56, 177 action, 56 therapeutic uses, 56 Donovan's solution, 109 Dosage, 13 conditions which modify, 13 for children less than six months old, 14 over six months old, 14 fractional, for children, 13 from tablets and solutions, 14, 15 rules for, 15' in disease, 14 questions in, 17 Dosage, rules of, for official preparations, 16 Doses, hypodermic, table of, 257, 258 table of, 250, 257 Dover's powder, 74, 177 to increase perspiration, 229 Douches, 19 Dressings, disinfection of, 147 Drop, domestic equivalent of, 12 and minim, 9 Drug, 3 action, antagonistic, 48 cumulative, 48 idiosyncrasy, 48 questions on, 44 synergistic, 48 toxic, 48 Drugs, 121, 124 acting locally on alimentary tract, 91, 102 on the intestine, 91, 94, 221 to lessen peristalsis, 222 to promote digestion, 221 to promote evacuation, 221 on the nervous system, 53, 67 questions on, 79, 80 on the stomach, 91, 92 action of, on the blood, 41 on digestion and absorption, 42 on glands, 44 on heart and circulation, 41 on heat, 43 on nervous system, 39 on pain, 44 on peristalsis, 43 , on pulse and arteries, 41 on perspiration, 42 on spinal cord, 40 affecting the circulation, 80 questions on, 90, 91 secretion, questions on, 66 INDEX 285 Drugs, applied to skin and mu- cous membrane for local action, 220 contracting the pupil, 230 decreasing peristalsis, 91, 102 dilating the pupil, 230 excreted with milk, 232 increasing peristalsis, 9, 94 modifying metabolism, 105 on spinal cord, action of, 40 reference list of, 155 specific, 228 that stimulate the brain, 67, 75 the spinal cord, 67, 78 used as carminatives, 221 as disinfectants and antisep- tics, 222 as digestives, 220 for effects on the blood, 228 on the central nervous system, 226 on the circulation, 222 on the eye, 230 on the genito-urinary sys- tem, 224 on the liver, 228 on the skin, 229 for specified diseases, 228 to accelerate pulse, 222 to affect the alimentary func- tion, 91 questions on, 105 alimentary tract, 220 mouth and throat, 220 stomach, 220 uterus, 224 to arrest internal hemor- rhage of blood-vessels, 223 secretion of milk, 230 to contract calibre of blood- vessels, 223 to destroy parasites, 222 Drugs used to increase secretion, 221 of urine, 224 to increase and liquefy bron- chial secretion, 225 to lessen acidity by acting on stomach contents, 221 bronchial secretion, 225 local inflammation, 220 irritation and vomit- ing, 221 perspiration, 229 salivation, 220 to paralyze terminations of sensory nerves, 67, 78 to promote menstruation, 224 to reduce fever temperature, 227 irritability of respiratory centre, 225 to relax blood-vessels, 223 bronchial spasm, 225 to relieve pain, 227 to remove fluid, 223 to render urine antiseptic, 224 less acid, 224 to slow the pulse, 222 to stimulate, 225 the respiratory centre, 225 to strengthen contraction of the heart, 222 vegetable, 49 which affect the alimentary functions, 53 the circulation, 53 secretions, 53 which cause changes in excre- tions, 230 eruptions, 230 which change the color of urine, 231 286 INDEX Drugs which color the stools, 231 which destroy the causes of disease, 53, 121 germs, 121 protozoa, 121, 124 worms, 121 which diminish secretion, 53, 61 which increase immunity, 105 secretions, 53 which lower blood-pressure, 80, 89 which raise blood-pressure, 80, 85 and medicines, 45 chief uses of, 47 classification, 47 important purposes, 47 Duotal, 178 Ecolics, 52 Eiweiss milch, 270 Elaterin, 178 Elaterinum, 178 Elements, metallic, 49 Elixir of phosphate of iron, 112, 125 of quinine, 112, 125 of strychnia, 112, 125 Elixires, 6 Elixirs, 6 Emetic emergency, 94 Emetics, 52, 91, 93, 221 Emetin, 124, 177 in amoebic dysentery, 124, 229 Emetinae hydrochloridum, 124, 177, 229 Emetine hydrochloride, 124, 177, 229 in amoebic dysentery, 124, 229 Emmenagogues, 52 Emplastra, 7 Emulsae, 6 Emulsion of turpentine. 59 Emulsuin terebinthinae, 59 Emulsions, 6 Enema, starch, 25, 26 turpentine, 26 Enemata, 99 nutritive, 24 oil, 25 purgative, 24 action, 221 starch water, 26 Ergot, 80, 87, 178 action on blood-vessels, 223 administration, 87 in internal hemorrhage, 223 physiological action of, 87 therapeutic uses, 87 Ergota, 178 Ergotin, 178 Ergotole, 87 Eriodictyon, 178 Eruptions, drug, 230 Erythrol tetranitrate, 178 Escharotics, 52 Eserine, 91, 101 effect on the eye, 230 salicylate, 198 Essence of peppermint, 93 Ether, 70, 178 action of, 70 as anaesthetic, 70 collapse from, 71 treatment of, 71 doses of, 70 nausea after anaesthesia with,71 to paralyze sensation, 226 uses of, 70 Ethyl chloride, 179 Eucaine, 78 as local anaesthetic, 220 anodyne, 220 beta, 179 physiological action of, 78 uses of, 78 INDEX 287 Eucalyptol, 179 Eucalyptus, 179 Euquinine, 125, 179 for children, 124 Euthymol, 180 Excreta, disinfection of, 147 Expectorants, 52, 53, 58 nauseating, 58 stimulating, 58, 59 untoward effects of, 58 uses of, 58 Extract, bone-marrow, 180 male fern, 180 of aloes, 98 of belladonna, 63 of opium, 74, 180 Extracta, 7 Extracts, 7 dose of, 16 strength of, 16 Extractum belladonnae, 63 fellis bovis, 181 filicis, 180 hyoscyamii, 64 opii, 74, 180 Feather bed, disinfection of, 147 Fecal matter, disinfection of, 147 Feet, perspiring, 267 Ferri iodidi sirupus, 215 sulphas, 186 et ammonii citras, 186 etquininae citras, 187 Ferric chloride, dose of, 16 Ferrum reductum, 186 sulphuricum, 186 Fireproofing solutions, 265 Fixed oils, 49, 50 Fluidextracts, 7 dose of, 16 of hyoscyamus, 64 strength of, 16 Fluidextracta, 7 Fluidextractum pilocarpi, 58 Folio mentha piperita, 197 Folium digitalis, 177 hyoscyami, 185 stramonii, 213 Food, disinfection of, 147 Foot powder, 267 Forks, disinfection of, 147, 148 Formaldehyde, 127, 139, 180 action of, 127 as a disinfectant, 139 uses of, 139 danger from, 141 for fumigating rooms, 127 processes, 127 poisoning, 142 to fumigate a room with, 128 Formaldehydum solutum, 180 Formalin, 180 Formin, 180 Formol, 127, 180 Formulas, miscellaneous, 265 Fowler's solution, 109 Foxglove, 82 Frangula, 181 Fructus capsici, 172 cardamomii, 172 cubebae, 177 colocynthidis, 175 Furniture, disinfection of, 148 Galactogogues, 52 Gall, ox, purified, 181 Galla, 65, 192 dose of, 65 Gallae, 192 Gallic acid, dose of, 65 Galls, dose of, 65 Gambir, 172 Gargles, 19 Gelseminine, 181 Gelsemium, 181 General anaesthetics, 70 288 INDEX Gentian, 181 action on digestion, 221 Gentiana, 181 Germicides, 52, 113, 125 Ginger, 93, 181 Glucose, 177, 181 Glucosides, 49 Glucosum, 181 Glycerite of tannic acid, dose of, 65 Glyceritum acidi tannici, dose of, 65 Glyco-thymoline, 182 Glycozone, 182 Glycyrrhiza, 182 Gold and sodium chloride, 182 Goulard's extract, dose of, 65 Gout, drugs used in, 229 Grain, apothecaries' system, unit of, 8 Gramme, 9 equivalent of, in grains, 10 metric system, unit of, 8 Granatum, 200 Gray powder, 113 Green iodide of mercury, 114 Grindelia, 182 Guaiac, 182 Guaiacol, 182 as intestinal antiseptics, 222 to reduce fever temperature, 227 carbonate, 183 as intestinal antiseptics, 222 Guaiacolis carbonas, 183 Guaiacum, 182 Guajacolum, 182 carbonicum, 183 Guarana, 183 Gummi-resina myrrha, 192 Haematinics, 52 Haematoxylon, 183 Haemoglobin, 42 to increase, 228 Haemostatics, 52 Haines solution, 266 Hamamelidis folia, 183 Hamamelis, 183 Hands, disinfection of, 148 Hormonal, 101 Harrington's solution, formula of, 264 Harrison narcotic act, drugs and preparations specified in, 261 penalty for violation of, 260 purpose of, 261 and hospitals, 260 and physicians and den- tists, 259 and wholesale or retail druggist, 259 Hassocks, disinfection of, 148 Headache from antitoxins, 120 from serums, 120 Heart, 41 action of drugs on, 41 beat, factors of, 41 sedatives and depressants, 80 stimulants, 80, 82 Heat centre, 43 Heavy magnesia, 103 dose of, 103 Hellebore, 81 administrations, 8r preparations and doses, 8t uses of, 81 Helmitol, 183 Hematinics, 105 Hematoxylon, 183 Hemlock, 175 Henbane, 63 Herba lobeiia, 188 Heroin, 75, 183 administration and dosage, 74 INDEX 289 Heroin, contra-indications of, 73 hydrochlorate, 183 to reduce irritability of res- piratory centre, 225 therapeutics of, 73 in coughs, 73 in diarrhoea, 73 in fevers, 73 in hemorrhage, 73 in insomnia, 73 in peritonitis, 73 in typhoid, 73 Hexamina, 134 therapeutics, 134 Hexamethylenamina, 134, 180 therapeutics, 134 Hexamethylenamine, 134 therapeutics, 134 Hexamethylentetramine, 134, 180, 184 therapeutics, 134 Holocaine hydrochloride, 184 Homatropinae hydrobromidum, 184 Homatropine, 63 effect on the eye, 230 hydrobromide, 184 Hormonal, 91, 184 Hospital supplies, 262 Hot water bags, disinfection of, 148 How medicines act, 39 Hydragogues, purgative action, 221 Hydrargyri chloridum corrosi- vum, 113, 189 mite, 113, 190 iodidum flavum, 190 rubrum, 190 protoiodi, 114 salicylas, 190 Hydrargyrum, 189 ammoniatum, 189 bichloratum, 189 Hydrargyrum bijodatum, 190 chloratum, 190 iodatum flavum, 190 praecipitatum album, 189 Hydrastinae hydrochloridum, 184 Hydrastine hydrochloride, 184 in internal hemorrhage, 223 Hydrastinine, in internal hemor- rhage, 223 Hydrastininum hydrochloridum, 184 Hydrastis, 184 action on digestion, 221 uterine action, 224 Hydrochloric acid, 42, 91, 104 administration, 104 dose of, 104 uses, 104 Hydrochloride of emetine, 94 Hydrogen dioxide, 125, 127 action of, 127 as an active bleaching agent, 127 as a cleansing agent, 127 in infections of mucous membranes, 127 peroxide, 184, 197 Hydrogenium hyperoxidatum solution, 211 Hydrozone, 185 Hyoscine, action of, 63 administration of, 63 hydrobromide, 185 poisonous symptoms of, 64 to induce sleep and rest, 226 untoward effects of, 64 uses of, 63 Hyoscyamus, 53, 63, 185 action of, 63 administration of, 63 extract of, 63 poisonous symptoms of, 64 tincture of, 63 290 INDEX Hyoscyamus, untoward effects of. 64 uses of, 63 Hypnotics, 67 method of administration, 68 poisoning by, 68 to induce sleep and rest, 226 Hypochlorite solution, formula of, 263 Ichthyol, 133, 185 effect on skin, 229 Idiosyncrasy, from a drug, 48 Immunity, acquired, 116 passive, 117 remedies which increase, 116 resistance, 116 and bacteria, 116 and infection, 116 Infant feeding, emergency, 269 Infusae, 6 Infusions, 6 Infection in an animal, 116 Ingluvin, 185 Inhalations, 19 Intestine, to medicate, 20 Iodide of ammonium, 106 administration of, 107 precautions in, 107 physiological action of, 106 preparations of, 107 therapeutic uses, 107 potassium, 106 administration of, 107 precautions in, 107 physiological action of, 106 preparations of, 107 therapeutic uses, 107 of sodium, 106 administration, 107 precautions in, 107 physiological action of, 106 preparations of, 107 therapeutic uses, 107 Iodides, 105, 106 administration of, 107 precautions in, 107 in syphilis, 228 physiological action of, 106 preparations of, 107 therapeutic uses, 107 to increase and liquefy bron- chial secretion, 225 Iodine, 125, 128, 185 effect on the skin, 229 tincture of, 128 and the operative field, 128 uses of, 129 externally, 129 lodism, 106 Iodoform, 128, 186 poisoning with, 129 use of, externally, 129 uses of, 129 lodoformium, 186 lodoformum, 186 lodothyrin, 115 lodum, 185 Ipecac, 94, 186 administration of, 94 emetic action of, 221 opium powder of, 94 preparations of, 94 syrup of, 94 to increase and liquefy bron- chial secretion, 225 Ipecacuanha, 186 to increase perspiration, 229 and opium, to increase perspi- ration, 229 Ipecacuanha radix, 186 Iron, 105, no absorption, m by hydrogen, 186 carbonate mass, 186 effect on the blood, 228 important preparations and ad- ministration, 112 INDEX 291 Iron, physiological action, 111 preparations, as astringents, 220 sulphate, 186 therapeutic action, in to promote menstruation, 224 and ammonium citrate, 186 and quinine citrate, 187 Irritants to the skin, 229 Jalap, 187 Kali causticum fusum, 202 Kalium bicarbonicum, 200 bromatum, 201 carbonicum, 201 chloricum, 201 iodatum, 202 natrio-tartaricum, 202 nitricum, 202 permanganicum, 202 Kidneys, drugs used to affect the, 224 Kilo, 9 Kilometre, 9, 10 Kino, 187 Knives, disinfection of, 148, 149 Kreosotum, 176 Labarraques solution, 127 Lactopeptine, 187 Lactose, 187 Lactucarium, 187 Lanolin, 187 Lanolinum, 187 Lanum, 187 Lapactic pills, 187 Lassar's paste, 268 Laudanum, 74 Laxatives, 52 Lead acetate, 187 as astringent, 220 dose of, 65 Lead poisoning, 64 symptoms of, 64 water, 64 Leucocytosis, 42 Leucopenia, 42 Library paste, 267 Lignum quassia, 203 Lime, chlorinated, 127 sulphurated, 188 water, 103, 188 dose of, 103 Liniment of turpentine, 59 Linimenta, 7 Liniments, 7 Linimentum terebinthinae, 59 Liquid petrolatum, 99 Liquor, 188 alumini acetatis, 210 ammonii acetatis, 210 caustici, 163 arseni et hydrargyri iodidi, 109 calcariae, 210 calcis, 103, 210 ferri et ammonii acetatis, 112, 211 formaldehydi, 127, 180 hydrogenii dioxidi, 211 hypophysis, 88, 199 iodi compositus, 211 plumbi subacetatis, 65, 211 dose of, 65 potassii arsenitis, 109, 210 soda chlorinate, 127 sodii arsenatis, 109 boratis compositus, 210 Liquores, 6 List, reference of drugs, etc., 45 Listerine, 188 Lithii, bromidii, 75 citras, 188 salicylas, 188 Lithium, bromide of, 75' dose and administration, 76 physiological action of, 75 292 INDEX Manganese, therapeutic uses, 130 Mass of mercury, 113 Massa ferri carbonatis, 186 Materia medica, 3 Mattings, disinfection of, 149 Mattresses, disinfection of, 149 Measure, Apothecaries', 8 Medication, rectal, 23 Medicine, 3 Medicines, action of, 39 administration by inhalation, 20 for general action, 19 methods of administration, 18, 19 by baths, poultices, etc., 23 by hypodermic, 21 by inhalation, ig by injection into a vein, 19 by injection under the skin, 19 by intramuscular injection, 22 by intravenous injection, 22 by inunction into the skin, 19, 23 by mouth, 19 by rectum, 19 for general action, 18 for local action, 18 and drugs, 47 Medulla, action of drugs on, 40 Mentha piperita, 197 viridis, 212 Menthol, 93, 189 Mercurials, 95 as diuretics, 224 as intestinal antiseptics, 222 Mercurous chloride, 113 Mercury, 105, 112, 124, 125, 126 189 ammoniated, 113, 189 as an antiseptic, 126 bichloride, 113, 126, 176, 189 Lithium, bromide of, therapeutic uses of, 76 untoward effects of, 76 carbonate, in stomach acidity, 221 citrate, 188 salicylate, 188 Litre, 10 Lobelia, 188 to relax bronchial spasm, 225 Local anaesthetics, 67, 220 anodynes, 220 Lotion, calamine, 268 for prickly heat, 268 Lozenges, 19 Lubricating jelly, 266 Lunar caustic, 129, 188 Lysol, 133, 188 Magma magnesiae, 103, 191 Magnesia carbonate, 188 milk of, 103, 191 oxide, 189 sulphate of, 95 Magnesii carbonas, 188 oxidum, 189 ponderosum, 103 sulphas, 189 Magnesium carbonate, 188 carbonicum, 188 oxide, 189 sulphate, 96, 189 physiological action, 96 therapeutic uses, 96 sulphuricum, 189 Malaria, drugs used in, 228 Malarial fever, quinine in, 124 Male fern, 121, 122 action, 122 uses, 122 Malt soup, 271 Malted liquors. 68 Manganese, 125, 130 INDEX 293 Mercury, bichloride, as an anti- septic and germicide, 115 chloride, 113 mild, 190 cyanide, 190 effect on the skin, 229 in syphilis, 228 iodide, red, 190 yellow, 190 methods of administration, 115 poisoning by, 114 acute, 114 chronic, 114 preparations of, 113 purgative action, 221 salicylate, 190 soluble salts, 114 succinamide, 190 therapeutic limit of, 114 uses of, 115 with chalk, 113 Mesotan, 191 Metabolism, 113 Metals, 48 Methyl salicylate, 131, 191 Methylene blue, 191 Methylis salicylas, 191, 194 Methylmorphine, 191 Methylthionnae hydrochloridum, 191 Metre, 9 Metric system, 9 unit of capacity, 9 Mil, 9 equivalent of, 10 in minims, 10 Mild chloride of mercury, 113 Military surgery, antiseptics used in, 262 Milk of magnesia, 103, 191 dose of, 103 sugar, 191 Millilitre, 9, 10 Mineral oil, 99, 191 oils and enemata, 91 Minim, 8, 9 Mistura cretae, 173 Misturae, 6 Mixtures, 6 dose of, 17 Morphinae sulphas, 75, 192 Morphine, 75 administration and dosage, 74 contra-indications of, 73 hydrochloridum, 75 in internal hemorrhage, 223 sulphate, 75, 192 to induce sleep and rest, 226 to lessen peristalsis, 222 to reduce irritability of respira- tory centre, 225 therapeutics of, 73 in colds, 73 in coughs, 73 in diarrhoea, 73 in fevers, 73 in hemorrhage, 73 in insomnia, 73 in peritonitis, 73 in typhoid, 73 Moschus, 192 Moth liquid, 265 Mouth-washes, 19 Mouth and throat, 220 to medicate, 20 Muriated tincture, 112 Murphy drip, 54 method of administering, 26 Musk, 192 Mustard, effect on the skin, 229 emetic action of, 221 Mydriatics, 52 Myotics, 52 Myristica, 193 Myrrh, 192 Myrrha, 192 Myxoedema, drugs used in, 229 294 INDEX Naphthol, as intestinal antisep- tic, 222 beta, 192 Naphthoium, 192 Narcotic drugs, hospitals and, 260 Narcotics, 52, 71 Harrison act and, 259 nurse and, 259 to induce sleep and rest, 226 Natrium aceticum, 207 arsenicum, 207 benzoicum, 207 bicarbonicum, 208 bromatum, 208 causticum, 208 nitrosum, 209 phosphoricum, 209 salicylicum, 209 sulfuricum, 209 thiosulphuricum, 209 Nauseating expectorants, 53, 58, 59 to increase perspiration, 229 Neosalvarsan, no, 124, 192 in syphilis, 228 Nerve, pneumogastric, action of drugs on, 40 Nerve-cells, action of drugs on, 39, 40 Nerves, motor, action of drugs on, 39 sensory, action of drugs on, 40 Nervines, 52 Nervous system, action of drugs on, 39 depressants to, 226 central, action of drugs on, 39 sympathetic action of drugs on, 39 stimulants to, 226 Neuron, action of drugs on, 40 New tuberculin, 119 (B. E.), 119 Niemeyer's pill, 115 Nitras argenticus, 207 Nitrate of silver, 129 chronic poisoning from, 129 dose of, 130 in colitis, 129 in ulcers of the rectum, 129 of the stomach, 129 methods of administration, 130 poisoning, 129 acute, 129 chemical antidote, 129 stools after, 130 uses of, 129 Nitrates, as diuretics, 224 to relieve pain, 227 Nitroglycerin, 89 action on blood-vessels, 223 physiological action, 89 therapeutic uses, 90 Nitroglycerine, 80 Nitrous oxide, 67, 71 action of, 71 in anaesthesia, 71 in obstetrics, 71 to paralyze sensation, 226 uses of, 71 Normal salt solution, administra- tion of, 54 Novocaine, 78, 192 physiological action of, 78 uses of, 78 Nutgall, 192 dose of, 65 Nutmeg, 193 Nutrients, 52 Nux vomica, 80, 85, 193 action of, 86 on digestion, 221 administration of, 86 poisoning, treatment of, 86 INDEX 295 Nux vomica, preparations of, 86 uses of, 86 CEdema, from serums, 120 from antitoxins, 120 Oil, almond, bitter, 193 betula, 193 • cade, 193 cajuput, 193 castor, 193 cod-liver, 193 croton, 193 eucalyptus, 194 gaultheria, 194 juniper berries, 194 mustard, 194 olive, 194 peppermint, 93 pinus, 194 santal, 194 tar, 194 turpentine, 59, 195 wintergreen, 93 artificial, 195 true, 195 Oils, 93 fixed, 50 purgative, 95 volatile, 50 Ointment of ammoniated mer- cury, 113, 115 as parasiticide, 115 belladonna, 63 mercuric nitrite, 195 mercury, 114 Ointments, 7 Old tuberculin, 119 Oleate, mercury, 195 Oleatum hydrargyri, 195 Oleoresin capsicum, 195 male fern, 195 Oleoresina aspidii, 180 Oleoresins, 50 Oleum amygdalae amarae, 193 cadinum, 193 cajuputi, 193 eucalypti, 194 j ecoris aselli, 193 juniper, 194 morrhuae, 193 picis liquidae rectificatum, 194 pini pumilionis, 194 ricini, 99, 193 santali, 194 sinapis aethereum, 194 colatile, 194 terebinthinae, 195 rectificatum, 59 tiglii, 99, 193 Opii extractum, 180 pulvis, 74, 195 Opium, 67, 71, 91, 195 administration and dosage, 74 alkaloids of, 75 contra-indications of, 73 dried, 71 in internal hemorrhage, 223 in vomiting, 221 physiological action of, 72 on the alimentary canal, 72 on the circulation, 72 on the nervous system, 72 poison, symptoms of, 72 treatment of, 74 powdered, 195 to induce sleep and rest, 226 to lessen peristalsis, 222 to reduce irritability of respira- tory centre, 225 therapeutics of, 73 in colds, 73 in coughs, 73 in diarrhoea, 73 in fevers, 73 in hemorrhage, 73 in insomnia, 73 in peritonitis, 73 296 INDEX Opium, therapeutics of, in ty- phoid, 73 and anti-narcotic act, 261 Opsonins, 118 Orphol, 196 Orthoform, 67, 78, 196 as local anaesthetic, 220 anodyne, 220 physiological action of, 78 uses of, 78 Ovarian extract, 196 Ovoferrin, 196 Ox-gall, to increase secretion of bile, 228 Oxalate, in vomiting, 221 Oxide of magnesia, 103 of zinc, 64 ointment of, 64 Oxytocics, 52 Pancreatic juice, 42 Pancreatin, 91, 102, 196 administration and doses, 102 as digestives, 221 uses, 102 Pancreatinum, 196 Papain, 196 digestive action of, 220 Papayotin, 196 Paraffin burn wax, 262 No. 7, Hall, formula of, 262 Paraldehyde, 196 to induce sleep and rest, 227 Paraldehydum, 196 Parasiticides, 52 Paregoric, 74 Paste, Lassar's, 197, 268 Unna's, 197, 268 Pelletierinae tannas, 197 Pelletierine tannate, 197 Pepo, 203 Peppermint, 93, 197 Pepsin, 42, 91, 102, 197 administration and dosage, 102 Pepsin,digestive action of, 220 saccharated, 197 uses, 102 Pepsinum, 197 saccharatum, 197 Peptenzyme, 197 Pepto-mangan, 197 Percentage solutions, table of, 3; Perhydrol, 197 Peristalsis, cause of, 43 Peristaltic tonics, 91, 95, 101 Permanganate of potash, 128 of potassium, 130 Perspiration, axillary, 267 deodorant, 267 drugs increasing, 43 to increase, 229 Petrolatum liquidum, 99, 198 Pharmacopoeia, 6 preparations of, definitions, 6 Pharmacy, 6 Pharyngitis, astringents in, 65 Phenacetin, 67, 77, 198 physiological action of, 77 poisoning from, 77 preparations and doses, 77 therapeutic uses of, 77 Phenacetinum, 198 Phenalgin, 198 Phenazone, 198 Phenol, 125, 132, 157, 198 as an antipruritic, 133 as an antiseptic, 133 as a caustic, 133 as a disinfectant, 133 as a sedative, 133 liquefaction, 157 physiological action, 133 poisoning, symptoms of, 133 with, 133 therapeutic uses, 133 Phenolphthalein, 98 Phenyl salicylate, 131, 108 Phenylacetamide, 155, 198 INDEX 297 Phenylis salicylas, 205 Phosphate of soda, 95 mode of administration and dose, 97 Phosphorus, 198 Physiological action, 47 Physostigma, 198 Physostigminae salicylas, 198 Physostigmine, effect on the eye, 230 salicylate, 131, 198 Physostigminum salicylicum, 198 Picrotoxin, 199 Pill, cathartic compound, 114 laxative compound, 98 Niemeyer's, 115 of aloin, strychnia and bella- donna, 98 Pills, 7 dose of, 17 of carbonate of iron, 112 Pillow cases, disinfection of, 149 Pillows, disinfection of, 149 Pilocarpin, effect on the eye, 230 to increase perspiration, 229 Pilocarpinae hydrochloridum, 58, 199 nitras, 58 Pilocarpine, action of, 57 dose of, 57 fluidextract of, 58 hydrochloride, 58, 199 nitrate of, 58 preparations of, 58 uterine action, 224 Pilocarpinum hydrochloridum, 199 Pilocarpus, 199 Pilula ferri carbonatis, 112 Pilulae catharticae compositae, 98 Piperazine, 199 Pituitary glands, 80, 88 action, 88 uses, 88 Pituitrin, 88, 199 action, 88 in intestinal hemorrhage, 225 uses, 89 uterine action, 224 Pix liquida, 215 pini, 215 Plasters, 7, 113 as protectives, 220 Plexuses, intestinal, 43 Plumbi acetas, 65, 187 dose of, 65 Plumbism, acute, 64 chronic, 64 Plumbum subacetaticum solution, 211 Podophyllin, 200 purgative action, 221 Podophyllum, 200 Poison nut, 85 Poisoning, arsenic, no by acetylene, symptoms and treatment, 246 aconite, symptoms and treat- ment, 242, 243 by aconitine, symptoms and treatment, 242, 243 by alcohol, symptoms and treatment, 243 by animal alkaloids, symptoms and treatment, 248 antiferrin, symptoms and treat- ment, 243 antimony compounds, symp- toms and treatment, 237 238 and potassium tartrate, symptoms and treatment, 237 by antipyrine, symptoms and treatment, 243 by arsenic and its preparations, symptoms and treatment, 238 298 INDEX Poisoning, by atropine, symp- toms and treatment, 243 by belladonna, symptoms and treatment, 243 by blistering fluid, symptoms and treatment, 243, 244 by blue vitriol, symptoms and treatment, 239 by brucine, symptoms and treatment, 249 by cantharides, symptoms and treatment, 243, 244 by carbolic acid, symptoms and treatment, 138, 235, 236 by carbon dioxide, symptoms and treatment, 246 by monoxide, symptoms and treatment, 246 by castor oil, symptoms and treatment, 244 by caustic alkalies, 237 by potash, symptoms and treatment, 237 by soda, symptoms and treat- ment, 237 by cheese, symptoms and treat- ment, 248 by chloral hydrated, symptoms and treatment, 244 by chloralformamide, symp- toms and treatment, 244 by chlorodyne, symptoms and treatment, 247 by chloroform, symptoms and treatment, 244 by coal gas, symptoms and treatment, 246 by cocaine, symptoms and treatment, 79, 244, 245 by codeine, symptoms and treatment, 247 by colchicum, symptoms and treatment, 245 Poisoning, by conium, symptoms and treatment, 245 by copper salts, symptoms and treatment, 239 by corrosive sublimate, symp- toms and treatment, 240 by croton oil, symptoms and treatment, 245 by cyanides, symptoms and treatment, 236 by digitalis, symptoms and treatment, 85, 245, 246 by dionin, symptoms and treatment, 247 by Dover's powder, symptoms and treatment, 247 by elaterinum, symptoms and treatment, 246 by elaterium, symptoms and treatment, 246 by exalgine, symptoms and treatment, 243 by fish, poisonous, symptoms and treatment, 248 by formaldehyde, symptoms and treatment, 142 by foxglove, symptoms and treatment, 245, 246 by fungi, poisonous, symp- toms and treatment, 246 by gases, poisonous, symptoms and treatment, 246 by gasoline, symptoms and treatment, 248 by hemlock, symptoms and treatment, 245 by heroin, symptoms and treat- ment, 247 by hydrochloric acid, symp- toms and treatment, 234 by hydrocyanic acid, symp- toms and treatment, 236 by hyoscyamus, symptoms and treatment, 246 INDEX 299 Poisoning, by ice cream, symp- toms and treatment, 248 by iodides, symptoms and treatment, 239, 240 by iodine, symptoms and treat- ment, 239, 240 preparations, symptoms and treatment, 239, 240 by iodoform, symptoms and treatment, 129, 239, 240 by jalap, symptoms and treat- ment, 246 by kerosene, symptoms and treatment, 248 by laudanum, symptoms and treatment, 247 by lead and salts, symptoms and treatment, 64, 241 by lunar caustic, symptoms and treatment, 242 by lye, symptoms and treat- ment, 237 by marsh gas, symptoms and treatment, 246 by matches, symptoms and treatment, 241, 242 by meat, poisonous, symptoms and treatment, 248 by mercury, symptoms and treatment, 114 acute, 114 chronic, 114 salts, symptoms and treat- ment, 240 by mineral and other inorganic poisons, 237 by morphine, symptoms and treatment, 247 by muscarine, symptoms and treatment, 246 by nicotine, symptoms and treatment, 246 by nightshade berries, symp- toms and treatment, 243 Poisoning, by nitric acid, symp- toms and treatment, 234 by nux vomica, symptoms and treatment, 249 by oil of vitriol, symptoms and treatment, 234 by opium, symptoms and treat- ment, 247 by organic poisons, 242 by oxalic acid, symptoms and treatment, 234 by paregoric, symptoms and treatment, 247 by petroleum, symptoms and treatment, 248 by phenacetin, symptoms and treatment, 243 by phenol, symptoms and treat- ment, 235, 236 by phosphorus, symptoms and treatment, 241, 242 by pit gas, symptoms and treat- ment, 246 by prussic acid, symptoms and treatment, 236 by ptomaines, symptoms and treatment, 248 by rat paste, symptoms and treatment, 241, 242 by red precipitate, symptoms and treatment, 241 by resorcin, symptoms and treatment, 243 by salt of lemons, symptoms and treatment, 234 by silver nitrate, symptoms and treatment, 242 by snake bite, symptoms and treatment, 248 by soothing syrup, symptoms and treatment, 247 by Spanish fly, symptoms and treatment, 243, 244 300 INDEX Poisoning, by strong ammonia, symptoms and treatment, 237 by strophanthus, 85 by strychnine, symptoms and treatment, 249 by sulphonal, symptoms and treatment, 249 by sulphuric acid, symptoms and treatment, 234 by tartar emetic, symptoms and treatment, 237 by thymol, 123 by tobacco, symptoms and treatment, 246 by trional, symptoms and treat- ment, 249 by turpentine, symptoms and treatment, 249 by verdigris, symptoms and treatment, 239 by vermilion, symptoms and treatment, 240 by veronal, symptoms and treatment, 249 by violent purgatives, symp- toms and treatment, 245 by weed killer, symptoms and treatment, 246 by white precipitate, symptoms and treatment, 241 by vitriol, symptoms and treat- ment, 242 by zinc salts, symptoms and treatment, 242 Pomegranate, 200 to destroy parasites, 222 Portieres, disinfection of, T49 Potash and soda, tartrate of, 95 Potassa, 200 sulphurata, 200 sulphurated, 200 Potassi acetas, 200 Potassii acetatis, 54 bicarbonas, 200 Potassii bitartras, 54, 201 bromidii, 75 bromidium, 201 carbonas, 201 chloras, 201 citras, 54, 201 hydroxidum, 202 hypophosphis, 202 iodidum, 106, 202 administration of, 107 precautions in, 107 physiological action of, 106 preparations of, 107 therapeutic uses, 107 nitras, 202 permanganas, 202 et sodii tartras, 202 Potassium acetate, 54, 200 bicarbonate, 200 bromide of, 75, 201 dose and administration, 76 physiological action of, 75 therapeutic uses of, 76 untoward effects of, 76 carbonate, 201 chlorate, 201 citrate, 54, 201 glycerinophosphate, 201 hydrate, 202 hypophosphate, 202 in stomach acidity, 221 iodide, 202 nitrate, 202 permanganate, 130, 202 as an antiseptic, 130 as an astringent, 130 as a germicide, 131 as an irrigation, 130 in poisoning from alkaloids, 130 in snake bite, 131 and sodium tartrate, 202 Powder of ipecac and opium, 74, 94 INDEX 301 Powdered opium, 74 Powders, 7 Practical disinfection, 135 Preparations of mercury, 113 Official, Rules of dosage for, 16 Prepared chalk, 103, 170 dose of, 103 Prescription, 3 directions to the patient, 3 to the pharmacist, 3 example of, in English, 4 in Latin, 4 Prescriptions, Latin terms used in, 4 Prickly heat, lotion for, 268 Principles, active, 49 antitoxic, 116 immunizing, 116 Privies, disinfection of, 149 Proctoclysis, 26, 54 method of administering, 26 Proportion, examples in, 36, 37 Protargol, 130, 203 Protectives, 91, 104, 220 doses, 104 uses, 104 Protoiodide of mercury, 114 Prussic acid, in vomiting, 221 Pulveres, 7 Pulvis ipecacuanhae et opii, 75 opii, 195 Pumpkin seed, 203 to destroy parasites, 222 Purgative oils, 91, 95, 99 administration, 101 contra-indications, 101 physiological action, 99 purgative action, 221 therapeutic uses, 100 time required to act, 101 Purgatives, 52 Purified aloes, 98 Pyrazolonum phenyldimethyl- icum, 164 Pyrogallic, 203 Pyrogallol, 160 Quassia, 121, 123, 203 enema, to destroy parasites, 222 Questions on alteratives, etc., 120, 121 on drugs which destroy the causes of disease, 142 on preparation of solutions, 36, 37 Quilts, disinfection of, 149 Quinina, 121, 124, 203 administration, 124 physiological action, 124 therapeutics, 124 Quininae bisulphas, 203 sulphas, 203 tannas, 203 et ureae hydrochloridum, 204 Quinine, 121, 124, 203 action on digestion, 221 administration, 124 bisulphate, 203 in malaria, 228 physiological action, 124 tannate, 125, 203 therapeutics, 124 to reduce fever temperature, 227 untoward effects of, 125 uterine action, 224 and urea hydrochlorate, 204 Rabies, Pasteur treatment for, 118 virus, 50 Radix gentiane, 181 liqueritiae, 182 sarsaparillae, 206 senegae, 207 302 INDEX Ready Reference Tables of In- formation Concerning Special Disinfection, 143 Recipe, 4 Rectified oil of turpentine, 59 Rectum, to medicate, 20 Reference list of drugs, 155 chemicals, proprietary medi- cines, 45 Reflex, action of drugs on, 40 Refrigerants, 52 Remedies, specific, 47 symptomatic, 47 which increase immunity, 116 Remedy, 3 Resin, jalap, 204 podophyllum, 204 scammony, 204 Resina guajaci, 182 jalapae, 204 Resinol, 204 Resins, 50 Resorcin, 204 Resorcinol, 204 Resorcinum, 204 Respiration, 42 drugs depressing, 42 stimulating, 42 Respiratory depressants, 52 system to stimulate, 225 Rhamnus purshiana. 98 Rheum, 204 Rheumatic fever, drugs used in, 228 Rhizoma gelsemii, 181 hydrastis, 184 rhei, 204 zingiberis, 181 Rhubarb, 204 Robert's reagent, 266 Rochelle salt, 204 physiological action, 96 therapeutic uses, 96 Rubefacients, 52 Rubus, 204 Rugs, disinfection of, 149 Rule, Cowling's, 13 Young's, 13 Rules, for fractional doses from solutions, 15 from tablets, 15 for solutions, summary of, 35 of dosage, for Official Prepara- tions, 16 Russian mineral oil, 191 oil, 99 Saccharin, 205 Saccharinum, 205 Saccharum lactis, 191 Sal ammoniac, administration of, 61 uses of, 61 Salicin, 205 action on digestion, 221 Salicinum, 205 Salicylates, the, 125, 131, 224 as diuretics, 224 in gout, 229 in rheumatic fever, 228 of ammonia, 131 physiological action, 131 to relieve pain, 227 Salicylic acid. 125, 131 administration, 132 as an antipyretic, 132 as an antirheumatic, 132 as an antiseptic, 132 as a caustic, 132 as an intestinal antiseptic, 222 in rheumatic fever, 228 physiological action, 131 therapeutic uses, 132 to increase secretion of bile, 228 to reduce fever temperature, 227 INDEX 303 Salicylic acid, untoward effects, 132 Saline cathartics, 91, 95 administration, 101 as intestinal antiseptics, 222 contra-indications, 101 in dropsy, 223 therapeutic uses, too time required to act, 101 diuretics, 53, 54 Salines, purgative action, 221 Salivation, 114 Salol, 131, 205 as diuretics, 224 as intestinal antiseptics, 222 in rheumatic fever, 228 Salolum, 205 Salophen, 205 Salt action, 91, 95 Epsom, 205 Glauber's, 205 Rochelle, 205 solutions, in cardiac failure, 55 in dropsy, 55 in hemorrhage, 55 in intoxications, 55 in sepsis, 55 in surgical shock, 55 strength of, for rectal injec- tion, 55 Saltpetre, 205 Salts, 48 rates of solubility, 27 Salvarsan, 109, 124, 205 dose of, 109 in syphilis, 228 uses, 109 Sanguinaria, 206 Santal, as diuretics, 224 Santonica, 121, 122 Santonin, 122, 206 to destroy parasites, 222 urine after, 123 uses, 123 Santonium, 206 Sarsaparilla, 206 Saturated solution, 30 Scammoniae radix, 206 Scammony, 206 Scarlet red, 206 Scilla, 212 Scoparius, 206 Scopolamicum hydrobromicum, 63, 185 Scopolaminae hydrobromidum, 63, 185 Scopolamine, action of, 63 administration of, 63 hydrobromide, 63, 206 poisonous symptoms of, 64 uses of, 63 untoward effects of, 64 Secretion, drugs which affect, 53 which increase, 54 Sedative, 58 Sedatives, cerebral, 67 Semen colchici, 175 myristicae, 193 Senega, 207 Senna, 91, 98, 207 action of, 98 preparations, 98 purgative action, 221 Sera, 50 Serum antidiphthericum, 165 purificatum, 165 siccum, 165 antimeningococcus, 118 antipneumococcus, 118 method of use, 118 antistreptococcus, 117 sickness, 120 Shades, disinfection of, 149 Sheets, disinfection of, 150 Shick test, 119 Shoes, disinfection of, 150 Silver, 125, 129 albuminates of, 130 304 WDEX Silver, albuminates of, in dis- eases of the eye, etc., 130 nitrate, 207 as an astringent, 129 (diluted), 207 (molded), 207 Silverware, disinfection of, 150 Simple bitters, action on diges- tion, 221 606, 109 Skin, drugs used to effect, 229 Sneezing, 42 Spanish flies, 172 Sparteinae sulphas, 212 Sparteine sulphate, 212 Sparteinum sulfuricum, 212 Spearmint, 212 Special Disinfection, Ready Ref- erence Table of, 143 Spices, 93 Spigelia, 212 Spinal cord, 226 action of drugs on, 39, 40 drugs that stimulate, 78 sedatives, 67, 75 Spirit, Glonoin, 212 mindererus, 212 nitrous ether, 212 Spiriti, 6 Spirits, 6 dose of, 16 Spiritus, 162 aetheris nitrosi, 89, 212 physiological action, 90 therapeutic uses, 90 glycerylis nitratis, 212 Spirochetae, 126 Spoons, disinfection of, 150 Sprays, 19 Sputum, disinfection of, 150 Squill, 57, 212 Squills, action on heart, 222 as diuretics, 224 in dropsy, 223 Squills, to increase and liquefy bronchial secretion, 225 Soap, liquid, surgical, 269 Soda, phosphate of, 95 sulphate of, 95 Sodia bicarbonatas, 103 Sodii acetas, 207 arsenas, 207 benzoas, 207 bicarbonas, 208 boras, 208 bromidi, 75 bromidum, 208 cacodylas, 208 citras, 208 glycerophosphas, 208 hydroxidum, 208 hypophosphis, 209 iodidum, 106 administration of, 107 precautions in, 107 physiological action of, 106 preparations of, 107 therapeutic uses, 107 nitris, 209 perboras, 209 phosphas, 209 salicylas, 209 sulphas, 209 thiosulphas, 209 Sodium acetate, 207 arsenate, 207 benzoate, 207 bicarbonate, 208 borate, 208 bromide of, 75, 208 dose and administration, 76 physiological action of, 75 therapeutic uses of, 76 untoward effects of, 76 cacodylate, 208 citrate, 208 glycerinophosphate, 208 INDEX 305 Sodium glycocholate, to increase secretion of bile, 228 hydrate, 208 hypophosphate, 209 hyposulphate, 209 in stomach acidity, 221 nitrate, 80, 209 nitrite, 89 action on blood-vessels, 223 physiological action, 89 therapeutic uses, 90 perborate, 209 phosphate, 209 physiological action, 96 therapeutic uses, 96 salicylate, 209 sulphate, 209 sulphocarbolate, as diuretic, 224 thiosulphate, 209 Solubility, 27 table of, 28, 29 Solutio chloreti ferrici spiritu- osa, 217 Solution, 27 alkaline antiseptic, 210 ammonium acetate, 2 to antiseptic, 210 arsenic and mercuric iodide, 210 calcium hydrate, 210 corrosive, 138 Dakin-Carrel, 126, 210 Dobells, 210 Donovan's, 210 Fowler's, 210 hydrogen peroxide, 211 iodine, compound, 211 iron and ammonium acetate, 211 Labarraques, 126 lead subacetate, 211 Lugol's, 211 magnesium citrate, 211 Solution of acetate of iron and ammonium, 112 of lead, dose of, 65 of alum acetate, 210 of arsenate of potassium, 109 of sodium, 109 of alum acetate, 210 of sodium, 109 of chlorinated soda, 127 of formaldehyde, 125, 127 of iodide of arsenic and mer- cury, 109 of percentage, 31 of potassium arsenite, 21T hydrate, 211 ratio, 31 remedies employed in, 38 salt, 211 saturated, 30 soda chlorinated, 211 sodium arsenate, 211 chloride, physiological ac- tion, 211 hydrate, 212 supersaturated, 30 Solutions, 6, 30 antiseptic, preparation of, 27 by dilution, 33 by mathematical proportion, 34 commonly employed in nurs- ing, 30 definitions and rules, 27 from concentrated solutions, 32 from the original substance, 32 in percentage ratios, 34 problems in the preparations of, 31 ratio, 32 strength of, 31 summary of rules for, 35, 36 to determine the ratio of, 32 Solvent, 27 Sominfacients, 53, 67 and hypnotics, 67 306 INDEX Somnos, 68 Stains, heat to fix, 137 Staphisagria, 212 Starch, as protectives, 220 Steam, disinfection, 137 Stearate, 64 of zinc, 64 Stillingia, 213 Stimulating diuretics, 53 expectorants, 58 Stomach, 220 to medicate, 20 Stomachics, 53 bitter, 92 important preparations, 92 Stramonium, 213 Strontii bromidum, 75, 213 salicylas, 213 Strontium, bromide of, 75, 213 dose and administration, 76 physiological action of, 75 therapeutic uses of, 76 untoward effects of, 76 salicylate, 213 Strophanthin, 84, 85, 213 Strophanthinum, 84, 213 Strophanthus, 80, 84, 213 Strychni semen, 193 Strychnime nitras, 214 sulphas, 214 Strychnine, 67, 78, 85, 213 action of, 86 on blood-vessels, 223 on digestion, 221 on heart, 222 administration of, 86 nitrate, 214 poisoning, treatment of, 86 preparations of, 86 sulphate, 214 to stimulate, 225 uses of, 86 Strychninum, 213 nitricum, 214 Strychnos nux vomica, 85 Stypticin, 176, 214 Styptics, 53, 66 Subcarbonate of bismuth, 104 uses, 104 uses, 104 Subgallas bismuthicus, 168 Sudorifics, 53 Sugar of lead, 64 dose of, 65 Sulfonal, 214 Sulfonalum, 214 Sulfur depuratum, 214 Sulphate of copper, 64 dose of, 65 of iron, 112 of magnesia, 95 mode of administration and dose, 97 of soda, 95 of zinc, dose of, 65 Sulphon methanum, 214 Sulphonal, doses of, 68 to induce sleep and rest, 227 Sulphonetylmethanum, doses of, 68 Sulphonmethanum, doses of, 68 Sulphur, 125, 128 as an ointment, 128 candle, 128 dioxide, 128 effect on the skin, 229 lotum, 214 precipitated, 214 praecipitatum, 214 sublimatum, 214 sublimed, 214 washed, 214 Suppositories, 7, 19 Suprarenalin, 87 administration, 88 therapeutics, 88 Supersaturated solution, 30 INDEX 307 Suprarenal capsule, dried, 214 glands, 80, 87 administration, 88 therapeutics, 88 Suprarenalum siccum, 88, 214 Surgical liquid soap, 269 Sweet spirits of nitre, 80, 89 physiological action, 89 therapeutic uses, 90 Sympathetic nervous system, action of drugs on, 39 Symptom, 39 Symptomatic treatment, 39 Synergistic, 48 Synopsis of Principal Actions and the Uses of Drugs, 220 Syphilis, 124, 228 drugs used in, 228 Syrup of hydriodic acid, 107, 215 of hypophosphites, 215 of ipecac, 94 of iron iodide, 107, 215 Syrupi, 6 Syrups, 6 dose of, 16 Syrupus ferri iodidi, 215 jodeti ferrosi, 215 System, nervous, action of drugs on, 39 Table linen, disinfection of, 150 of doses, 250, 257 by hypodermic, 257, 258 percentage solutions, 38 of solubility, 28, 29 Reference of Poisons and An- tidotes, 233 Tablespoonful, domestic equiva- lent of, 12 Tablets, 7 fractional doses in, 15 Taenifuges, 53 Taka diastase, 215 Talc, as protectives, 220 Tannabalin, dose of, 65 Tannalbin, 215 Tannate of quinine, 124 for children, 124 Tannic acid, as astringents, 220 dose of, 65 to lessen peristalsis, 222 Tannigen, 215 dose of, 65 Tannin, 160 albuminate, dose of, 65 dose of, 65 Tannoform, 215 Tannyl acetate, dose of, 65 Tar, 215 effect on the skin, 229 Taraxacum, 216 Tartar emetic, 216 to increase and liquefy bron- chial secretion, 225 Tartarus stibiatus, 164 Tartrate of potash and soda, 95 of potassium and sodium, 97 of soda, 95 Tea, action of, 56 caffeine in, 56 Teaspoonful, domestic equivalent of, 12 Terebene, 216 to lessen bronchial secretion, 225 Terpin hydrate, 59, 216 to lessen bronchial secretion, 225 Terpini hydras, 59, 216 Test, Shick, 119 Tetanus, antitoxin, 117 Theine, 216 Theobromina, 56 Theobrominae sodii salicylatis, 56 sodio-salicylas, 177 salicylate, 216 Theobromine, 56, 216 308 INDEX Theobromine, action on the cir- culation, 56 on the kidney, 56 administration, 56 as diuretics, 224 compared with diuretic action of caffeine, 56 in dropsy, 56, 223 in kidney diseases, 56 in poisoning, 56 preparations and dosage, 56 salicylate of soda, 56 therapeutic uses, 56 and sodium salicylate, 216 Theobromino natrium salicyli- cium, 177 Theocin, 57, 216 Therapeutic action, 47 definitions, 51 groupings, 50 of drugs and medicines, 53 limit, in dosage, 48 Therapeutics, 3 Thymol, 121, 123 as a vermifuge, 123 in treatment of hook-worm, 123 poison symptoms, 123 to destroy parasites, 222 uses of, 123 Thyroid diseases, drugs used in, 229 extract, 105, 115 in myxoedema, 229 in thyroid diseases, 229 gland, 115 action of, 115 doses of, 115 extract, 115 in cretinism, 116 in goitre, 116 in myxoedema, 116 in obesity, 116 therapeutics of, 115 Thyroideum siccum, 115 Thyroidin, 216 Thyroidism, 115 Tinctura aconitii, 81 arnicae, 217 belladonnae foliorum, 63 calumbae, 92 ferri chloridi, 112, 217 gambir composita, dose of, 65 gentiana composita, 92 hyoscyami, 63 kino, dose of, 65 opii, 74 camphorata, 74 deodorata, 74 quassiae, 92 strophanthi, 85 dosage of, 85 Tincturas, 7 Tincture, aconite, 217 dose of, 16 aloes, 98 arnica flowers, 217 belladonna, 63 dose of, 16 calumba, 92 cannabis, 16 cantharides, 16 capsicum, 93 dose of, 16 digitalis, 16 gambir compound, 65 gelsemium, 16 gentian, 92 Hydrastis, 217 hyoscyamus, 217 dose of, 16 iodine, 107 dose of, 16 iron chloride, 217 kino, 65 lobelia, 16 nux vomica, 217 dose of, 16 INDEX 309 Tincture, opium, 74 dose of, 16 pulsatilla, 217 quassia, 92 squills, 16 stramonium, 217 strophanthus, 217 dose of, 16 veratrum, 16 viride, 217 Tinctures, 7 potent, doses of, 16 strength of, 16 Toilet preparations, 267 sets, disinfection of, 150 Tolu, 225 Tonics, 53 Tooth brushes, disinfection of, 150 Toothache drops, 265 Towels, disinfection of, 151 Toxic action, of drug, 48 Toxin, 116 Toys, disinfection of, 151 Treatment, symptomatic, 39 Trikresol, 217 Trinitrophenol, 159 Trional, 67, 217 doses of, 68 Triticum, 217 Troches, 19 Tubera jalapa, 187 Tuberculin as a diagnostic agent, 119 Calamette's test, 119 Moro's test, 119 Von Pirquet's test, 119 Tuberculins, 105, 118 doses of, 118 general reactions, 119 in diagnosis, 118 in treatment, 118 Turpentine, 59 administration of, 59 Turpentine, oil of, 59 uses of, 59 Unguentum hydrargyri, 114 Unguenta, 7 Unguentum hydrargyri nitratis, 195 Unit, antitoxic, 117 Unna's paste, 268 Untoward effect, of a drug, 48 Urethane, 217 Urinals, disinfection of, 151 Urinary, 125 disinfectants, 134 Urine after santonin, 123 disinfection of, 151 reagents, 266 drugs increasing secretion of, 224 Urotropin, 125, 134, 180 action of, 134 as diuretics, 224 as a urinary antiseptic, 134 therapeutics, 134 Urticaria, from antitoxins, 120 from serums, 120 Uterus, 224 action of drugs on, 224 Vaccine, typhoid, 118 in immunity, 118 in treatment, 118 Vaccines, 50, 118, 119 administration of, 119 immunizing doses, 119 anaphylactic reactions, 120 in abscesses, 118 in acne, 118 in gonorrhoeal arthritis, 118 in septicaemia, 118 method of use, 118 untoward effects, 120 and antitoxins, 105 Valerian, 218 310 INDEX Valeriana, 218 Vallets mass, 186 Vascular tonics or sedatives, 53 Vasoconstrictors, 53 Vasodilators, 53, 80, 89 Vasomotor centre, action of drugs on, 40 Vegetable cathartics, 95 administration, 101 contra-indications, 101 therapeutic uses, 100 time required to act, 101 purgatives, 91, 98 action, 98 preparations, 98 to promote menstruation, 224 Veratrine, as local anodyne, 220 Veratrum, 80, 81 administration of, 81 preparations and doses, 81 uses of, 81 viride, 218 Veronal, 68, 218 doses of, 68 Vesicants, 53 Viburnum compound, 218 prunifolium, 169, 218 Volatile oils, 49, 50 as carminative, 221 Walls, disinfection of, 151 Warm water, emetic action of, 221 Wash goods, disinfection of, 151 Water, 53 administration of, 54 Waters, 6 Weight, Apothecaries', 8 to convert into metric, 11 metric, to convert into Apothe- caries', II unit of, 8 Weights and measures, 7 Apothecaries' system, 7 metric system, 7 questions on, 12 Whiskey, 68 alcohol percentage, 68 White arsenic, 108, 156 precipitate, 113, 218 vitriol, dose of, 65 Wild cherry bark, 218 Wineglassful, domestic equiva- lent of, 12 Wines, 68 Wool-work, disinfection of, 151 Woolen goods, disinfection of, 151 Wormseed, 121, 122 Writing fluid, blue, 266 Young's rule, 13 Zinc carbonate, precipitated, 218 chloride, 219 oxide, 219 stearate, 219 sulphate, 219 as astringent, 220 emetic action of, 221 sulphocarbolate, 219 valerianate, 219 Zinci carbonas praecipitatus, 218 chloridum, 219 oxidum, 219 phenolsulphonas, 219 sulphas, 219 dose of, 65 stearas, 219 valeras, 219 Zincum chloratum, 219 oxidatum, 219 sulfuricum, 219 valerianicum, 219 Zingiber, 181