Materia Medica 
Pharmacology and Therapeutics 
for Nurses 
By 
ELIZABETH POPE 
U 4 
Graduate of the School of Nursing of the Presbyterian Hospital in the 
City of New York; Special Diploma in Education from Teachers 
College, Columbia University, New York; Formerly Superintendent 
of the Insular School of Nursing, San Juan, Porto Rico; Visiting 
Instructor in Schools of Nursing, San Francisco, California. Author 
of "Practical Nursing", "Manual of Nursing Procedure", "A Quiz 
Book for Nurses", "Physics and Chemistry for Nurses", "Essentials 
of Dietetics", "A Dietary Computer", "A Medical Dictionary for 
Nurses", "Anatomy and Physiology for Nurses". 
Philadelphia and London 
W. B. SAUNDERS COMPANY 
1921 Copyright, 1921, by W. B. Saunders Company 
PRINTED IN AMERICA 
PRE88 OF 
W. B. 8AUNDER8 COMPANY 
PHILADELPHIA PREFACE 
The plan of this book resulted from many trials of 
various ways of teaching Materia Medica to students 
of nursing and was developed gradually in connection 
with the author's class work. 
In the primary writing of the manuscript almost all 
the drugs in the U. S. Pharmacopoeia and in "New and 
Non-Official Remedies" were included, but it was evident 
that this would make a book of more than 600 pages and 
therefore a large number of those not included in "Use- 
ful Drugs" or in common use were omitted or merely 
their preparations and dosage mentioned; for, on con- 
sideration, it did not seem necessary to require students of 
nursing to study the action of drugs that are seldom used 
or which the American Medical Association does not 
consider essential for students of medicine to memorize. 
Blank pages are inserted at the end of this book for 
a memorandum of new drugs that come into such frequent 
use that they are worth remembering. 
In compiling this book a large number of medical books 
and magazines were consulted, but those most frequently 
referred to were: The American Journal of the Medi- 
cal Sciences; Progressive Medicine; The Journal of the 
American Medical Association; Useful Drugs; New and 
Non-Official Remedies; The Pharmacology of Useful 
Drugs, Robert A. Hatcher, and Martin I. Wilbert; 
Materia Medica, Pharmacology, and Therapeutics, 
Bastedo; Pharmacology and Therapeutics of The Action 
of Drugs, Arthur R. Cushny; A Manual of Pharmacology, 
Sollmann; The Action of Drugs, Sollmann; Handbook 
of Antiseptics, Dakin and Dunham; The National 
Formulary; Serum and Vaccine Therapy, Hewlett. 
Amy E. Pope. 
San Francisco, California. 
January, 1921. 
13 CONTENTS 
Page 
Introductory 17 
Names of the Branches of Science Concerned with the 
Study and Uses of Medical Material 17 
Standard Books Devoted to the Above Subjects .... 17 
What Students of Nursing Should Learn About Drugs . 18 
How the Study of Drugs May be Facilitated 19 
Drugs and Their Preparation 21 
Derivation and Nature of Medicines 21 
Drug Constituents 22 
Pharmaceutical Preparations 24 
Names and Nature of Special Containers for Inclosing 
Medicine 27 
The Administration of Drugs 29 
Dosage 33 
Computing Dosage 35 
Weights and Measures 36 
Percentage Strength of Liquids 39 
Prescriptions 42 
The Action of Drugs 45 
Terms Used in Designating the Site of a Drug's Actions 45 
How Drugs May Act as Remedies 46 
Some Typical Actions of Drugs 47 
Classification of Drugs According to Their Effects.... 50 
Toxicology 62 
The Nervous System 70 
Drugs Which Obtain Their Chief Effects by Stimulating 
Nerve Centers 85 
Drugs Which Produce Their Chief Effects by Depress- 
ing Nerve Centers 98 
Drugs Which Produce Their Chief Therapeutic Effects 
by Their Actions on Peripheral Nerve-endings. . . . 162 
Drugs Which Obtain Their Principal Therapeutic Ef- 
fects by Their Action on Muscle Tissue 207 
Demulcents, Emollients and Other Protectives . . . 220 
15 16 
CONTENTS 
Page 
Absorbents 224 
Bitters 226 
Digestants 227 
Acids 230 
Antacids 240 
Cathartics 254 
Volatile Oils. Stearoptens. Spices and Drugs Which 
Owe Their Properties to Such Compounds. Counter- 
irritants 274 
Anthelmintics, Vermicides and Vermifuges 287 
Astringents 293 
Salts of the Heavy Metals That are More Commonly 
Used for Other Effects Than Those Due to Their As- 
tringent Qualities 308 
Arsenic (Arsenum) 321 
Phosphorus 329 
Antimony 332 
Iodine (Iodum) and Its Compounds 334 
Ipecac (Ipecacuanha) Emetine 341 
Cinchona and Quinine 343 
Salicylic Acid, Salicylates 351 
Antiarthritics 357 
The Phenol Compounds 358 
Balsams of Benzoin, Peru and Tolu 366 
Tar (Pix Liquida) 368 
Chlorine Compounds 369 
Oxidizing Agents 373 
Reducing Agents 374 
Sulphides, Thiol, Ichthyol 375 
Formaldehyd 376 
Dyes 379 
Special Uses of the Various Antiseptics and Disinfec- 
tants 380 
Diuretics 383 
Vaccines and Serums 386 
Organotherapy. Extracts of Animal Endocrine Glands 395 
Nutrients 401 
Oxygen 403 
Classification of the More Important Drugs According 
to Their Therapeutic Uses 405 
Index 411 MATERIA MEDICA, PHARMACOLOGY 
AND THERAPEUTICS 
A TEXT-BOOK FOR NURSES 
INTRODUCTORY 
NAMES OF THE BRANCHES OF SCIENCE CONCERNED 
WITH THE STUDY AND USES OF MEDICAL MATERIAL 
Materia medica is the science or study of the origin 
and of the chemical and physical properties of medical 
material, i.e., the substances used for the cure and preven- 
tion of disease, such as drugs, antitoxin serums, and 
vaccines. In the past, the term materia medica has been 
very commonly used to include the study of the action of 
drugs, but, according to the accepted meanings of the 
terms materia medica and pharmacology, this is not correct. 
Pharmacology is the science or study of the action of medi- 
cal materials upon living organisms. 
Therapeutics implies the treatment of disease and, as 
there are many methods of treatment, there are several 
branches of therapeutics; e.g., drug therapy-treatment 
with drugs; serum therapy-treatment with serum; 
heliotherapy-treatment with light; hydrotherapy-treat- 
ment with water; psychotherapy-treatment by influencing 
mental conditions, this includes suggestion and hypnosis. 
Toxicology is the science which treats of poisons-their 
nature, the symptoms they produce and the means of 
overcoming or preventing their ill effects. 
STANDARD BOOKS DEVOTED TO THE ABOVE SUBJECTS 
The Pharmacopoeia is a book that has for its object the 
standardizing of the drugs in common use by physicians. 
17 18 
MATERIA MEDICA AND PHARMACOLOGY 
Most of the nations whose physicians have contributed to 
the advance of medical science have a national pharma- 
copoeia so that there is the British Pharmacopoeia, the 
French Pharmacopoeia, the United States Pharmacopoeia, 
etc. The latter is usually designated in writing as the 
U.S.P. This is revised every ten years by the U. S. 
Pharmacopoeial Convention. The word non-official after 
a drug signifies that it is not as yet listed in the 
Pharmacopoeia. 
The National Formulary is a book issued by the Ameri- 
can Pharmaceutical Association to standardize some drugs 
in common use that are not as yet in the Pharmacopoeia. 
New and Non-official Remedies is the name of a book 
published by the American Medical Association in order 
to make known new drugs that physicians have stated to 
be of value. 
Useful Drugs is a book published by the American 
Medical Association and revised yearly. It contains a list 
and short description of drugs, old and new, that investi- 
gators have found to be of value. One purpose for its 
publication is to direct the attention of medical students 
to those drugs which it is most important for them to 
study. 
WHAT STUDENTS OF NURSING SHOULD LEARN 
ABOUT DRUGS 
1. Students should learn the dosage of the important 
drugs, especially the more poisonous ones and those which 
are likely to be prescribed in emergency. This knowledge 
is necessary, not that nurses may know how much to give 
without a doctor's order, but because it will prevent 
misunderstanding orders. 
2. They should learn the symptoms of overdosing and 
of poisoning induced by all important drugs in common use 
and also the remedies for poisoning. 
3. They should have some knowledge of the physiolog- 
ical effects of the more important drugs and of their 
therapeutic uses. There are at least two reasons for such INTRODUCTORY 
19 
knowledge: (1) Unless nurses know the action of the drugs 
they give, they will not know what symptoms to watch 
for nor be able to give an intelligent report of the results 
following the administration of a drug. (2) There are 
few people who can do really good intelligent work unless 
they are enough interested in it to know what they are 
doing. 
4. It is exceedingly important for nurses to know how to 
make solutions of different percentages and how to 
estimate the quantity of a drug to use when the dose 
ordered is of a different strength from that of the prepara- 
tion on hand. 
5. Of interest, though of less importance than the other 
items mentioned, is a knowledge of the origin of drugs 
(whether they are derived from plants, animals, minerals, 
etc.) and of the nature of the different preparations, 
e.g., extracts, fluidextracts, tinctures. 
HOW THE STUDY OF DRUGS MAY BE FACILITATED 
The class-work for the study of drugs is purposely left 
until that of chemistry and of physiology have been 
completed, but the students in the meantime, as well as 
while they are actually studying the subject, should read 
the descriptions of the actions of the drugs they hear 
about and give and be on the alert to observe the results 
on those taking the drugs. Making a mental note of 
the dosage when administering drugs and looking up that 
of drugs heard about is a far easier way of memorizing 
dosage than of studying it for class. A very important 
point for students to realize with regard to the study of 
drugs is that there is no other study that is more helped 
by concentrated thinking and by comparison, for the 
physiological effects of a drug give the clue to both its 
therapeutic uses and the symptoms of poisoning so that 
if the physiological effects are thought of it will be easy 
to recall the other two items. As will be seen in the sec- 
tion on Toxicology, there is very little difference in the 20 
MATERIA MEDICA AND PHARMACOLOGY 
symptoms of poisoning by drugs of the same class and 
noting the differences and similarities, rather than study- 
ing the symptoms and treatment of each poison as a 
separate item, will facilitate memorizing the essentials. 
Usually the terms action and effect are used as synonyms 
but, in this book, the word action is applied to what might 
be called the drugs' primary results upon the affected 
tissues, and effects, to the consequences of these results. 
As far as possible, the actions of the important drugs are 
described before their effects and the pupils are advised, 
when they begin to study a lesson, to read the whole 
section describing the drug and then, turning to the 
description of its action, see if they remember the thera- 
peutic and toxic effects of each action and if they under- 
stand the reason for each effect. In the case of a number 
of drugs, it will then only be necessary to actually memo- 
rize the actions and those effects which were not thought of, 
because recalling these will usually bring back to memory 
the other important data. When reference is made to a 
drug previously described, the students, before turning 
to the article referred to, should try and recall it, because 
the effort of recall is likely to give rise to a more lasting 
memory than mere rereading. DRUGS AND THEIR PREPARATION 
DERIVATION AND NATURE OF MEDICINES 
Medicines are obtained from both organic and inorganic 
matter. Those of organic origin are derived both from 
plants and animals. The plant substances used as drugs 
are obtained from different parts of plants, e.g., some drugs 
are obtained from the leaves, others from roots, others 
from seeds, etc. Those of animal origin with a few excep- 
tions, such as cantharides, which is prepared from a species 
of fly, are preparations of glands or their extracts, or of 
blood serum. 
A large number of the newer drugs are prepared from 
coal and wood tars and from crude petroleum. 
The tars are dark, semi-solid products of the destructive 
distillation1 of coal and wood. They consist of mixtures 
of a large number of substances that can be separated 
from each other by fractional distillation,1 for they all 
have different boiling points. The majority of the con- 
stituents of tar are hydrocarbons (compounds of hydrogen 
and carbon) such as benzene, napthalene and anthracene, 
but they also contain some compounds which have small 
amounts of other elements, from which carbolic acid, 
anilin and other important substances are derived. Most 
of the tar derivatives are very active chemically, i.e., 
they can be easily made to unite with different elements 
or compounds and thus a very large number of drugs 
and other substances have been prepared from them 
synthetically. 
1 The process of boiling and thus vaporizing a substance and 
condensing the vapor. Destructive distillation is that in which a 
substance is decomposed and new products formed during the 
decomposition. Fractional distillation is that in which a con- 
stituent of a mixture that has a different boiling point from the 
other constituents is removed by maintaining the mixture at the 
boiling point of that constituent. 
21 22 
MATERIA MEDICA AND PHARMACOLOGY 
Crude petroleum, like coal, has been formed in the 
depths of the earth by the decomposition of organic matter. 
It is a physical mixture of substances, similar to those of 
the tars which, like them, can be separated by fractional 
distillation. 
A number of substances which resemble or are identical 
with the products of the distillation of the tars and 
petroleum can be obtained by the distillation of certain 
balsams, resins, and volatile oils of plants. Thus, toluene 
is obtained by distillation of tolu balsam, as well as that 
of coal tar; thymol, which is similar to carbolic acid, is 
obtained from the oil of thyme; and salicylic acid, which 
also resembles carbolic acid, may be obtained from the 
oils of wintergreen and birch-bark or prepared synthetic- 
ally from coal tar products. 
DRUG CONSTITUENTS 
Drugs may consist of simple chemical compounds, such 
as salts, acids, etc., or of combinations of compounds. 
All the constituents of some compounds are active but 
others contain both inert and active substances. The 
inert substances (i.e., those which are not chemically 
active) may be either substances that are used to dilute 
the drug or to facilitate its administration or, in the case 
of drugs of plant origin, they may be substances such as 
the cellulose and mineral matter of the plant. Substances 
which act either upon the body tissues or other ingredients 
of the drug are termed active constituents and, of these, 
those to which the physiological actions of a drug are due 
are called active principles. 
The active principles are sometimes extracted from the 
crude drug and used separately, but, sometimes the whole 
drug is used. Some drugs of plant origin, contain more 
than one active principle and, in some of these, the active 
principles have different actions. In such cases the action 
of the whole drug is more or less different from any of its 
active principles, but, if all the active principles have the 
same action, that of the whole drug will be similar, but, DRUGS AND THEIR PREPARATION 
23 
unless taken in large amounts, weaker because of the inert 
substances present. 
The more important active principles of drugs are 
classed as: Alkaloids, acids, salts, glucosides, saponins, 
volatile oils, stearoptens, resins, oleoresins, balsams, 
enzymes, tannins and oils. 
Alkaloids are organic, nitrogenous substances with an 
alkaline reaction. They combine with acids to form salts 
and it is in this form that, when extracted from the crude 
drug, they are used in medicine. 
Acids are substances with a sour taste that turn blue 
litmus red and combine or interact with metals, metal 
oxids, hydroxids, alkalies and alkaloids to form salts. 
All acids have one or more hydrogen atoms in loose com- 
bination and they part with this hydrogen when they 
interact with other compounds. It is to this replaceable 
hydrogen that they owe their acid characteristics. The 
acids derived from organic substances all have what is 
known as an organic acid radicle,1 which is COOH. This 
when oxidized breaks down to carbon dioxid and water. 
Hydroxids are compounds that contain an OH radicle. 
The majority of hydroxids, but not all, are alkalies, the 
alcohols, for example, have not an alkaline reaction, but 
they have one or more OH radicles and they combine with 
acids to form what are known as ethereal salts or esters. 
An alkali is generally defined as a substance that forms 
salts with acids and soaps with fats and turns red litmus 
blue. 
The salts formed by the interaction of an acid and an 
alkali may be either acid, alkaline or neutral, (i.e., neither 
acid nor alkaline). Some of these salts owe their prop- 
erties to their acid radicle-e.g., the bromides and iodides 
-others to their alkaline radicle, e.g., sodium carbonate. 
The neutral salts of the alkalies generally owe their effects 
to what is known as a salt action, described page 47. 
1 By a radicle, it will be remembered, is meant a group of 
elements forming a part of a molecule that act as a single atom in 
a chemical reaction and are not easily divided. 24 
MATERIA MEDICA AND PHARMACOLOGY 
The salts of the metals owe their effects chiefly to their 
metal element and the alkaloids to their alkaloid com- 
pound, but the acid modifies the nature of these salts to 
some extent, especially as regards their solubility and, 
therefore, some salts with similar bases, but different 
acids, may be more readily absorbed and more active than 
others. 
Glucosides are substances that, when decomposed, 
yield glucose or other sugar in addition to other substances. 
Saponins are glucosides that have soap-like properties, 
i.e., they foam when mixed with water and they are 
irritant to mucous membranes. 
Volatile oils, the resins, stearoptens and balsams are 
described later, pages 274 and 366. 
Tannins are described under astringents (p. 293) and 
enzymes on page 227. 
PHARMACEUTICAL PREPARATIONS 
Some drugs are employed in their natural form, but 
others are prepared for use in various ways. The names 
and nature of the important preparations are as follows:1 
Solid Preparations 
Bougie-a taper-shaped preparation of medicated wax, 
used in the same manner as a suppository. 
Cerate (ceratum, cerati)-a preparation for external use 
in which the drug is incorporated in white wax. 
Confection (confectio, confecti)-the drug is mixed with 
aromatic substances and honey or syrup in order to 
disguise its taste. 
Extract (extractum, extract!)-a preparation made by 
extraction; i.e., the crude drug is mixed with a liquid in 
which the cellulose and woody fiber are not soluble, but 
the active principles are. This is filtered, in order to 
remove the insoluble material, and the liquid of the filtrate 
is then evaporated. The solid material remaining 
1 The English name is given first, then the Latin name and then 
the genitives of Latin names commonly used in prescription 
writing. DRUGS AND THEIR PREPARATION 
25 
represents the extract. This contains the active principles, 
but also other soluble material extracted from the crude 
drug, and thus the action of an extract is not as powerful 
as that of active principles, but it is generally four or five 
times more so than that of the crude drug. 
Lozenge-a flat disc consisting of tragacanth or other 
demulcent material in which a drug is incorporated. It 
is intended to be dissolved in the mouth. 
Ointment (unguentum, unguenti}-a soft preparation in 
which the drug is held in a fatty base, such as lard, lanolin 
(fat obtained from the wool of sheep) or vaselin, which 
is melted at or about the temperature of the body. 
Most ointments are used to obtain the effect of the drug 
at the point of its application but a few contain drugs that 
can be absorbed through the skin. 
Pill (pilula)-a small, rounded or oval preparation of a 
drug in solid adhesive substance. Pills are often coated 
with some substance to disguise their flavor, as sugar or 
chocolate, or, when their action is not wanted until they 
reach the intestine, with a substance such as keratin, 
which is not readily soluble in the gastric juice. Pills 
are likely to become very hard and insoluble when they are 
kept for any length of time and, in such case, they may be 
expelled undissolved in the feces. 
Plaster (emplastrum, emplastri)-a preparation in which 
the drug is incorporated in some adhesive substance which 
is spread in a thin layer on muslin, paper, moleskin or 
similar substance. Plasters are intended for application 
to the skin. 
Powder (pulvis, pulveris)-a finely powdered drug. 
Suppository (suppositoria, suppositorium)-a prepara- 
tion in which the drug is incorporated in some substance, 
usually cocoa-butter, which maintains its shape at ordinary 
temperatures, but . will melt at the temperature of body 
cavities. Suppositories are shaped according to the cavity 
into which they are to be inserted, those for rectal use are 
cone-shaped, those for the urethra, thin pencil-shaped; 
those for the vagina, round or elliptic shaped. The drug 26 
MATERIA MEDICA AND PHARMACOLOGY 
of a suppository is generally intended for its local effects, 
but, occasionally, a drug that is readily absorbed through 
mucous membranes is given in a rectal suppository. 
Tablet (labella)-a small moulded, compressed prepara- 
tion of a powdered drug. Tablets in which the drug is 
mixed with sugar of milk are termed triturates. Those of 
effervescing salts are called vescettes. 
Troche (trochiscus)-same as lozenge. 
Collodion (collodium)-a solution of a drug in collodion. 
Collodion is a solution of gun-cotton in ether and alcohol. 
It evaporates readily leaving a contractile film over the 
surface to which it is applied. 
Decoction (decoctum, decocti)-a liquid preparation of a 
drug prepared by boiling the crude drug in water and 
straining it to remove the residue. 
Elixir (elixir)-a sweetened, aromatic, hydro-alcoholic 
liquid. 
Emulsion (emulsum, emulsi)-a solution of an oily 
substance in which the oil is broken into fine globules and 
held in suspension in water by means of some viscous sub- 
stance such as acacia. 
Fluidextract (fluidextractum, fluidextr acti)-an alcoholic 
or hydro-alcoholic preparation of a drug made by extrac- 
tion, of which each c.c. contains 1 gram of the drug or, 
each minim, 1 grain. 
Glycerite (glyceritum, glyceriti)-a solution of a drug 'in 
glycerine. 
Infusion (infusum, infusi)-a solution of a drug made by 
steeping the crude drug in boiling water and, when cold, 
straining it. (Compare with decoction. What is the 
difference between the two preparations?) 
Liniment (linimentum, linimenti)-a preparation for 
external use consisting of, as a rule, irritant drugs in an 
oily or alcoholic liquid. 
Mixture (mistura, misturce)-a preparation in which an 
insoluble drug is held suspended in water by means of a 
Liquid Preparations DRUGS AND THEIR PREPARATION 
27 
viscid substance. A mixture must always be shaken 
before being poured. 
Solution (liquor, liquoris)-a preparation in which one 
or more non-volatile substances are dissolved in water. 
The term solution, but not liquor, is used also for any 
liquid containing dissolved material. 
Spirit (spiritus)-a solution of a volatile substance in 
alcohol. 
Tincture (tinctura, tinctures')-an alcoholic or hydro- 
alcoholic extract of a drug. Unless otherwise stated, the 
strength of a tincture is 10 per cent. Thus, except that 
they are weaker, tinctures are the same as fluidextracts 
and, in the case of most drugs, the dose of a tincture is 
ten times larger than that of the fluidextract. Two so- 
called tinctures, tincture of iodine and tincture of ferric 
chloride, are incorrectly named for they are not prepared 
by extraction, the drugs being merely dissolved in the 
alcohol and, therefore, the iodine is a spirit and the ferric 
chloride an alcoholic solution. 
Water (aqua, aquoe) a solution of a volatile substance in 
water. (Compare: Solution (liquor) spirit, and water.) 
Wine ( vinum, vini)-a solution of a drug in white 
wine. 
NAMES AND NATURE OF SPECIAL CONTAINERS FOR 
INCLOSING MEDICINE 
Cachet-two small lens-shape pieces of rice paper, the 
borders of which can be stuck together after a dose of 
medicine is placed in the center. The paper is dissolved 
by the gastric juice and the drug set free. 
Capsule-a small case for inclosing a dose of medicine. 
Those in common use for internal administration are made 
of gelatin, which is dissolved by the gastric juice, but when 
a drug is to be used that would be changed by the gastric 
juice or which would have an undesirable effect upon the 
stomach, the drug is sometimes enclosed in capsules made 
of keratin (a substance obtained from horn) which, though 28 
MATERIA MEDICA AND PHARMACOLOGY 
dissolved by the alkaline intestinal juices, is not readily 
affected by the acid gastric juice. 
Ampule-a capsule of thin glass in which a dose of 
medicine is enclosed, the top can be easily broken off 
when the drug is required. Sterile doses of drugs for 
hypodermic use are sometimes put up in this way. 
Sterule-same as ampule. THE ADMINISTRATION OF DRUGS 
Drugs are used both for their local effects and for their 
effects after absorption. 
By local effect is meant the results of a drug's action 
at the site of its application. The parts to which a drug 
can be applied locally are: The skin; the conjunctiva and 
cornea; the mucous membranes of the respiratory, alimen- 
tary and genito-urinary tracts; wounds; tissues that can 
be reached by a liquid forced through a hypodermic 
needle. For use on the exterior of the body drugs are 
often incorporated in ointments, cerates and plasters, 
because these adhere to the skin and do not dry readily. 
For use in the rectum and genito-urinary passages drugs 
are very commonly applied in the form of bougies and 
suppositories, these preparations being easily inserted 
and having the same advantages as ointments and cerates. 
For treatment of the throat and mouth, medicines are 
often used in lozenges or troches for, as these dissolve 
slowly, they allow of the drug being kept in contact with 
the parts for a longer time than if it is swallowed; also, in 
these parts, drugs are very commonly used in washes, 
gargles, sprays and the like and volatile drugs are used as 
inhalations, either with or without steam. For action 
in the stomach and intestines, drugs may be swallowed or, 
as in the treatment of all accessible body cavities, given in 
some form of irrigation (e.g., douche, clysis, enema, lavage). 
Absorption of Drugs.'-If a drug is not readily absorbed 
its value for local effects will, as a rule, be increased, for it 
will then remain longer in the part where its action is 
desired. On the contrary, properties that allow of ready 
1 The pupils should read the section on absorption in their text- 
books of Physiology or Physics, if they are unable to recall what 
they have learned of this process. 
29 30 
MATERIA MEDICA AND PHARMACOLOGY 
absorption are valuable for drugs that are to act after 
their absorption. The nature of these properties, in 
the case of some drugs is not entirely understood but the 
properties of diffusibility and solubility are influential 
factors and practically all volatile drugs are readily 
absorbed and, other things being equal, the more soluble 
a drug is the more readily it is absorbed, while insoluble 
substances are very imperfectly absorbed, if at all, through 
animal membranes. 
The absorption of even soluble matter is hindered by: 
(1) The insoluble substances,1 such as cellulose and gums, 
present in crude vegetable drugs, thus crude drugs, and 
even extracts, are not absorbed as quickly as the separated 
active principles and, therefore, will take longer to produce 
systemic effects (those occurring after absorption) but, if 
they have any local actions, these will be prolonged; 
(2) mixture with mineral oils and mucilaginous substances 
such as acacia and tragacanth. Alcoholic preparations 
are absorbed quicker than aqueous, both because alcohol 
is absorbed more readily than water and because, as will 
be seen later, alcohol increases the amount of blood in 
tissue with which it comes in contact, which favors 
absorption. Solution in vegetable and animal oils 
increase the absorbability of some drugs. 
The different tissues vary considerably in their power 
of absorption: Very few drugs are absorbed through the 
skin; they are absorbed more readily through mucous 
membranes, but the membranes of different parts show 
differences in their power of absorption; for instance, when 
given by rectum, drugs are not as readily absorbed as 
when given by mouth. It is only the membranes of the re- 
spiratory and alimentary tracts that are utilized as channels 
for the absorption of drugs, but it must not be forgotten 
that absorption takes place through that of the genito- 
urinary tract, for patients have been poisoned by excessive 
1 In materia medica, the term insoluble substances is applied to 
matter that cannot be dissolved by the solutes commonly used for 
dissolving drugs nor by the gastric nor intestinal juices. THE ADMINISTRATION OF DRUGS 
31 
amounts of drugs used in these parts for their local effects. 
Absorption takes place more rapidly from subcutaneous 
tissues than from mucous membranes and from deeper 
(intramuscular) tissues than from subcutaneous. Gaseous 
drugs are rapidly absorbed through the lungs, but, of 
course, these are the only kind that can be administered 
in this way. 
For their effects after absorption, drugs may be ad- 
ministered in any of the following ways: 
1. Through the skin: For this method of administration, 
the drugs are used in oils or as ointments. Their absorp- 
tion through this channel is aided by rubbing (i.e., inunc- 
tion) but it is limited and uncertain. 
2. By inhalation: Only gaseous drugs are given by 
this method. 
3. By mouth. 
4. By rectum: This method of administration, however, 
is not commonly used, except for local treatment and, 
occasionally, in proctoclysis, for the drugs are likely to be 
expelled and their absorption is uncertain. 
5. By hypodermic and intramuscular injections. The 
latter method is used for the more irritant drugs, because, 
(1) as they are more rapidly absorbed from the deeper 
tissues, they are less likely to injure the cells; (2) they 
cause less pain for there are fewer sensory nerve-endings 
in the deeper parts than in, and directly under, the derma. 
However, very irritant drugs cannot be given even intra- 
muscularly, because irritation, beyond a limited degree, 
destroys tissue. Drugs are given in these ways when: 
(1) Rapid effects are required; (2) the patient can not or 
will not swallow, or is nauseated or has diarrhea; (3) the 
gastric or intestinal juices change the drug, either by 
digesting it, or by the action of the hydrochloric acid of 
the gastric juice or of the alkaline matter in the intestine; 
or (4) the drug, after absorption, is retained or destroyed 
in the liver. It will be remembered that, with the excep- 
tion of fats, material absorbed from the stomach and 
intestine passes, via the portal vein, to the Ever. 32 
MATERIA MEDICA AND PHARMACOLOGY 
6. Intravenously: Only drugs that investigation has 
shown will not coagulate the blood or cause disintegration 
of blood-cells can be given in this manner. Those which 
can be so used are given in this way when instant effects 
are required and when, as in the case of a few drugs, such 
as salvarsan, it has been found that they are very irritat- 
ing to the tissues but do not injure the blood-cells. 
As the methods of giving medicine in these various ways 
and the precautions necessary in their use are described in 
all text-books of nursing procedures, space will not be 
taken to do so here, but the pupils should review the 
chapters devoted to such description in their other text- 
book and be prepared to answer questions. 
In the case of a few groups of drugs the time of adminis- 
tration is of importance when they are given by mouth 
and, though the doctor usually specifies the time of ad- 
ministration, it is well for nurses to know the more im- 
portant facts that have to be considered; viz.: Drugs 
which are altered undesirably by acid1 and those intended 
for local effects in the stomach and intestines (this includes 
cathartics) are usually given while the stomach is empty, 
i.e., between meals; cathartics which act slowly are gen- 
erally given at night and those which act rapidly, in the 
morning before breakfast. Drugs intended to improve 
the appetite and increase the secretion of digestive juices 
are given shortly before meals. Irritant drugs intended 
for absorption, such as digitalis, arsenic, iron and quinine, 
are given after meals (while there is food to protect the 
membrane from too severe irritation) and also, as a rule, 
drugs used to lessen the acidity of the gastric juice.2 Some 
authorities believe that when the rapid absorption of 
drugs is desired they should be given after meals, because 
there is then an increased amount of blood in the gastro- 
intestinal membrane, which favors absorption, but others 
believe that the presence of undigested food hinders ab- 
sorption, and this is certainly true of alcohol. 
1 Normally hydrochloric acid is only secreted during digestion. 
2 There are exceptions to this rule that will be seen under antacids. THE ADMINISTRATION OF DRUGS 
33 
Points regarding the dilution of drugs that require any 
special preparation by the nurse are given in the sections 
describing the drugs, there are certain rules however that 
it is well to emphasize; viz.: Irritant drugs should be 
well diluted and those not intended for local effects, when 
given by mouth, are very commonly diluted with a demul- 
cent such as milk or syrup. The diluents used should be 
either cold or hot, not tepid. When rapid absorption is 
wanted, drugs are to be diluted in a large amount of water 
or, if used in solid form, a copious drink should be taken 
afterward. On the contrary, when absorption is to be 
delayed, a smaller amount of diluent is used as a rule, and 
mucilaginous ones are sometimes prescribed. Syrups, 
such as cough mixtures, are not diluted. For use by chil- 
dren, solid preparations are best powdered and given in 
jelly or in flavored syrup. Drugs should be given only 
in liquid form to the unconscious and insane. As a rule, 
under such conditions, drugs are given by hypodermic 
but a small quantity of medicine can generally, if neces- 
sary, be given to an unconscious patient by dropping it on 
the back of the tongue from a spoon. 
By the dose of a drug is meant the amount ordinarily 
required to produce therapeutic effects in an adult. The 
smallest dose that has been generally found to be capable 
of doing so is termed the minimum dose and the largest 
dose that can ordinarily be used without risk of inducing 
too pronounced effects is known as the maximum dose. 
Factors upon which the choice of the size of the dose 
depend and which, in some cases, call for even larger or 
smaller doses than those within the therapeutic range 
are as follows: 
1. Size of the Individual.-The smaller the person, other 
things being equal, the smaller the dose required. 
2. Temperament.-People with emotional temperaments 
are usually more easily affected by drugs, and thus require 
smaller doses than those of phlegmatic dispositions. 
DOSAGE 34 
MATERIA MEDICA AND PHARMACOLOGY 
3. Age.-Elderly people generally require smaller doses 
than adults of middle age and small children may be 
poisoned by doses that are therapeutic for an adult and, 
the younger the child, the more easily will it be poisoned. 
Therefore, for patients under sixteen, or thereabouts, 
the age must be taken into consideration. There are a 
number of methods used for estimating the dosage for 
children. The following one, known as Young's rule is 
very commonly used. 
Young's Rule for Estimating the Dosage for Children. 
Make a fraction taking the child's age for the numera- 
tor and the child's age plus 12 for the denominator and 
this will give the proportion of the adult dose that is to be 
used. For example, if the child is 6 years of age this will 
be the equivalent of this is thus, for a child of 6, 
with the majority of drugs, of the adult dose will be 
used. For example, if the dose of a drug for an adult is 
15 grains, that for a child of 6 will be 5 grains. A few 
drugs, especially opium and its derivatives, have to be 
given in proportionately smaller doses to children and 
there are a few that can be given in relatively larger doses. 
4. Sex.-Women usually require smaller doses than 
men, this is partly because they are of smaller stature, 
but also because they are more susceptible to most physio- 
logical influences. 
Susceptibility and Idiosyncrasy.-For reasons already 
given and others, the cause of which is often not apparent, 
some individuals are much more susceptible to the influ- 
ence of drugs than others; take the well known example of 
coffee; some people can drink two or three cups before 
retiring and then sleep soundly while others will be kept 
awake if they take a very small amount. Some people are 
so susceptible to the influence of some drug or drugs that 
toxic symptoms will develop from even moderate thera- 
peutic doses. In such case the individual is said to have 
an idiosyncrasy for the drug. 
5. Tolerance.-The system becomes accustomed to the 
action of most drugs and thus, if a drug is used continu- THE ADMINISTRATION OF DRUGS 
35 
ously, unusually large doses will be required after a time 
to get any effect. 
6. Certain diseases and conditions allow of some drugs 
being used in larger amounts than usual, for example, a 
person in pain can take larger amounts of morphine than 
otherwise; in malaria, larger doses than usual of quinine 
can generally be taken without experiencing unpleasant 
effects. On the other hand, some conditions increase the 
possibility of bad results from a drug, for example, if a 
person is cyanosed or dyspneic, morphine or any other 
drug which interferes with breathing may have a bad 
effect. 
7. Method of Administration.-In the case of the few 
drugs that can be given intravenously, smaller doses are 
likely to be used than for other methods of administration; 
but this is not always the case for, when this method of 
administration is resorted to, prompt and strong action is 
likely to be desired. Larger doses are generally used for 
rectal than for oral (mouth) administration. Some books 
advise smaller doses for hypodermic than for oral use, but 
this is not always customary. 
8. The Nature of the Preparation.-The active princi- 
ples of a drug are used in much smaller doses than other 
preparations, and extracts are used in smaller amounts 
than preparations of the crude drug. Of the liquid 
preparations, fluidextracts which, as previously stated, 
are 100 per cent., are the most potent and, it will be noticed 
that those of the more toxic drugs are used in very small 
amounts, usually 1-3 minims; tinctures of the more toxic 
drugs are 10 per cent.; thus the dose of the majority of 
tinctures is ten times larger than that of fluid extracts. 
Infusions, decoctions, syrups, mixtures, etc. are all weaker 
preparations than tinctures and are thus used in larger 
amounts. 
COMPUTING DOSAGE 
Accuracy in the administration of medicines necessitates 
a vivid remembrance of the tables of weights and measures 
used in pharmacy and of the rules followed in computing 36 
MATERIA MEDICA AND PHARMACOLOGY 
dosage. A few easy rules to remember for the calculations 
that nurses have most frequently to make are given on 
pages 39 to 42. Pupils who need more help than this 
and the examples given them in class are advised to get 
the small book entitled "Solutions in Ten Lessons" by 
Elsie M. Smith. 
WEIGHTS AND MEASURES 
In pharmacy, both the apothecaries' and the metric 
systems of weights and measures are used. The latter, 
however, being more convenient and accurate, is gradually 
being generally adopted. It originated in France in 1795. 
According to it, the meter is the unit of length, the liter 
of volume and the gram of weight. A meter is the tenth- 
millionth part of the distance from the equator to the 
north pole. The space of a cube1 one meter long, one meter 
wide and one meter high, is called a cubic meter. A liter 
represents the volume (i.e., the amount of space occupied) 
of a cube of water at its greatest density (i.e., when it 
is 4°C.),2 each side of which measures one decimeter (i.e., 
one-tenth of a meter); thus the size of a cube representing 
the quantity known as a liter would be one-tenth of that of 
a cubic meter. A gram represents the weight of a cube 
of water at 4°C. each side of which measures one centi- 
meter (i.e., one-hundredth part of a meter). Thus a 
cube representing the weight of a gram would be one-tenth 
the size of the cube representing the volume of a liter and 
one-hundredth that of a meter. 
1 A body with six square sides of equal size. 
2 It will be remembered that water, like all other matter is ex- 
panded by heat and its density thus reduced and that water also 
expands when its temperature goes below 4°C., which is why ice 
is lighter than water and, therefore, floats. Similar weights of 
different kinds of substances occupy different amounts of space; 
a pound of lead, for example, is of smaller proportion and will 
therefore take up less space than a pound of wood. Thus it is 
necessary to have a standard for comparison and' water being the 
standard used by physicists for other measurements and cal- 
culations has been chosen. THE ADMINISTRATION OF DRUGS 
37 
The prefixes deca, hecto, kilo (derived from the Greek) 
are used to denote increases, and the prefixes deci, centi, 
milli (derived from the Latin, are used to denote decreases). 
For example: 
Millimeter = 0.001 of a meter 
Centimeter =0.01 of a meter 
Decimeter =0.1 of a meter 
Meter =1.0 
Decimeter =10 meters 
Hectometer =100 meters 
Kilometer = 1000 meters 
Myriameter = 10000 meters 
The term cubic centimeter and its abbreviation c.c. are 
more commonly used than the other terms denoting 
decrease; e.g., it is customary to say 10 c.c. or one-tenth 
of a c.c., instead of 1 decimeter and 1 millimeter. The 
term c.c. is also used, though incorrectly, when referring to 
volume measures of smaller amounts than the liter, 
but in the Pharmacopoeia the term milliliter (the milli- 
meter being the equivalent of one-tenth of a c.c.) and its 
abbreviation mil have been substituted for fractional 
quantities of a liter. 
TABLES OF WEIGHTS AND MEASURES 
METRIC 
Approximate 
Weight Written equivalent 
1 milligram (mg.) 0.001 ^5 grain 
10 milligrams = 1 centigram (eg.).... 0.01 % grain 
10 centigrams = 1 decigram (dg.) 0.1 1)^ grains 
10 decigrams = 1 gram (gm.) 1.0 15 grains 
1000 grams = 1 kilogram (kilo.)... .1000.0 2% pounds 
Volume 
1 cubic centimeter (c.c.) 1.0 15 minims 
(1 c.c. of water weighs 1 gm.) 
1000 cubic centimeters = 1 liter (L) 1000.0 34 fluidounces 
Length 
1 millimeter (mm.) ^5 inch 
10 millimeters = 1 centimeter (cm.) % inch 
10 centimeters = 1 decimeter (dm.) 4 inches 
10 decimeters = 1 meter (m.) 40 inches 38 
MATERIA MEDICA AND PHARMACOLOGY 
Apothecaries 
Weight (Troy Weight) 
1 grain (gr.) 0.06 gm. 
lOgrains 0.6 gm. 
20 grains = 1 scruple O) 1.3 gm. 
3 scruples = 1 dram (5) 4.0 gm. 
8 drams = 1 ounce (5) 30.0 gm. 
12 ounces = 1 pound (lb.) 372.0 gm. 
Volume 
1 minim (m.; 0.06 c.c. 
60 minims = 1 dram 4.0 c.c. 
8 drams = 1 ounce 30.0 c.c. 
16 ounces = 1 pint (O) 472.0 c.c. 
2 pints = 1 quart (qt.) 950.0 c.c. 
8 pints = 1 gallon (Cong.) 
Length 
1 inch (in.) 2.5 cm. 
12 inches = 1 foot 30.48 cm. 
Exact Equivalents of Metric and Apothecaries' Weights and 
Measures According to the U. S. Pharmacopoeia 
Volume 
1 c.c 16.23 minims 
1 liter (1000 c.c.) 33.8 ounces 
1 minim 0.061 c.c. 
1 fluidram 3.696 c.c. 
1 fluidounce 29.57 c.c. 
1 pint 473.18 c.c. 
Weight 
1 milligram 0.0154 grain 
1 centigram 0.1543 grain 
1 gram 15.4324 grain 
1 grain 0.065 grams 
15 grains 0.972 grams 
1 dram 3.89 grams 
1 ounce troy weight 31.1 grams 
1 ounce avoirdupois weight 28.35 grams THE ADMINISTRATION OF DRUGS 
39 
Approximate Equivalent of Domestic, Metric and Apothecaries* 
Measures 
1 teaspoonful = 4 c.c. = 1 dram 
1 desertspoonful = 8 c.c. = 2 drams 
1 tablespoonful = 15 c.c. = 4 drams 
1 teacupful = 120 c.c. = 4 ounces 
1 large cup = 240 c.c. = 8 ounces 
1 tumbler = 180-240 c.c. = 6-8 ounces 
1 sherry glass = 30 c.c. = 1 ounce 
1 claret glass = 120 c.c. = 4 ounces 
1 champagne glass = 135 c.c. = 4J^ ounces 
PERCENTAGE STRENGTH OF LIQUIDS 
By per cent., it will be remembered, is meant parts in 
one hundred. In the preparation of drugs solids are 
weighed and liquids are measured, so that in making a 
20 per cent, pharmaceutic solution 20 grams of the drug 
to be dissolved are mixed with enough solvent to make 
the total measure 100 c.c. Of such a solution, 100 c.c. 
will contain 20 grams of the drug. To make a one per 
cent, solution 1 gram of the drug would be used; for a 
10 per cent., 10 grams; for a 15 per cent., 15 grams and so 
on, and in each case enough solvent is used to make the 
total measure 100 c.c. 
To give one gram of a drug that is in a 1 per cent, 
solution will necessitate giving 100 c.c., while H gram 
will be represented by 50 c.c.; %o of a gram by 2 c.c. and 
/-"loo of a gram by 1 c.c. Of a 2 per cent, solution, 50 c.c. 
will contain 1 gram; of a 3 per cent., 33 c.c.; of a 4 per cent., 
25 c.c. 
To find out how much of a drug to use to make larger 
quantities than 100 c.c. multiply the per cent, required 
by the number of hundred c.c. wanted; thus to make a liter 
(1000 c.c.) of a 5 per cent, solution, it will require 50 grams 
of a drug, because 5 X 10 = 50. To make 1500 c.c. of a 
five per cent, solution, it will require 75 grams, because 
5 X 15 = 75. To make 2 hters (2000 c.c.) of a 2 per cent, 
solution, it will require 40 grams, because 2 X 20 = 40. 40 
MATERIA MEDICA AND PHARMACOLOGY 
Means of Reckoning the Amount of Drug Required 
Using Apothecaries' Measure.-According to the apothe- 
caries' measure, there are 480 minims or grains in an ounce, 
but, to facilitate reckoning, in the making of solutions, the 
ounce is generally considered as having 500 minims or 
grains and the pint 8000. Therefore, as 1 per cent, means 
1 part in one hundred parts, whatever the system used, 
5 minims or grains of a drug with enough solvent to make 
the total measure 500 minims will be required to make one 
ounce of a 5 per cent, solution. To calculate how much 
drug to use to make solutions of different percentages, 
multiply the required per cent, by 5 thus. 
To make one ounce of a 2 per cent, solution, 10 grains are 
required. 
To make one ounce of a 5 per cent, solution, 25 grains 
are required. 
To make one ounce of a 10 per cent, solution, 50 grains 
are required. 
Table Showing the Amount of Drug to Use in Making One 
Pint of Solution, the Pint being Considered as Contain- 
ing 8000 Grains, or 500 Grains to the Ounce 
Per cent 
Which is equivalent to 
Amount of drug 
1 part in 400 
20 grains 
1 part in 200 
40 grains 
1 
1 part in 100 
80 grains 
2 
1 part in 50 
160 grains 
3 
1 part in 33 % 
240 grains 
4 
1 part in 25 
320 grains 
5 
1 part in 20 
400 grains 
10 
1 part in 10 
800 grains 
20 
1 part in 5 
1600 grains 
25 
1 part in 4 
2000 grains 
In connection with solutions, it is necessary to differ- 
entiate between such terms as 1 in 20 and 1 to 20; the 
former term implies 1 part to 19, e.g., 1 c.c. of carbolic 
and 19 c.c. of water, while the second term implies 1 part 
of solute1 and 20 parts of solvent.2 Bichlorid of mercury, 
1 The substance dissolved. 
2 The liquid used to dissolve the solute. THE ADMINISTRATION OF DRUGS 
41 
1-32, for example, would signify 1 part by weight of 
bichlorid of mercury in enough water or other solvent 
to make 32 parts by volume. 
A method of estimating how much of a medicine to give 
when the preparation on hand contains a different fractional 
part of a grain of the drug from that ordered; e.g., the dose 
ordered is Ks of a grain of strychnine and the solution 
on hand is one in which each 10 minims contains Ko 
of a grain. To find out how much to give, multiply the 
denominator of the fraction of the amount of drug con- 
tained in the solution on hand by the number of minims 
containing it and divide the result by the denominator 
of the fraction of the amount of drug that is to be given. 
Thus: 30 X 10 = 300 4- 25 = 12. Therefore, 12 minims 
of a solution, of which each 10 minims contains Ko 
of a grain of the drug, will contain Ks of a grain of the 
drug. 
For another example, the solution on hand contains Ko 
of a grain in each 10 minims (i.e., 10 minims = Ko of a 
grain) and a dose of Ko grain is wanted. Following the 
rule in the last example, 30 X 10 = 300 4- 60 - 5. 
Five minims of the solution will be required. 
When necessary to give a different fractional part of a solid 
drug from the one at hand, it is usually better to dissolve 
the solid. Thus, if the strychnine in the first example were 
in solid form, two K 0 of a grain tablets could be dissolved 
in enough water to make 20 minims and, as in that ex- 
ample, 12 minims would give ^5 of a grain. If, in 
example two, the strychnine had been in solid form, one 
Ko of a grain tablet could have been dissolved in enough 
water to make 10 minims and 5 minims of this used. 
To estimate the amount to use in making a weaker from a 
stronger solution: 
Divide the number of minims in the required amount 
of solution by the number representing the denominator 
of the weaker solution and multiply the result by the 
number representing the denominator of the stronger 
solution. Thus, to make a pint of 1-1000 (Ko00) bi- 42 
MATERIA MEDICA AND PHARMACOLOGY 
chloride from a solution 1-32 (^j2), the pint being con- 
sidered as containing 8000 minims: 
8000 4- 1000 = 8 X 32 = 256. 256 minims (4 drams, 
16 minims) of bichlorid solution 1-32 will be required to 
make a solution 1-1000. 
PRESCRIPTIONS 
It is advisable for a nurse to be able to read a doctor's 
prescription and thus the ordinary prescription form and 
abbreviations commonly used are given here. 
According to custom, a prescription is written in six 
parts, viz.: 
1. The name of the patient and the date. The name is 
usually omitted, however when the prescription is for the 
treatment of a venereal disease or where it is best for 
esthetic reasons, as in prescribing a vaginal douche. Also, 
the pharmacist is expected to put the name on the label 
as this lessens the danger of his sending the wrong bottle or 
of mistakes if there is more than one patient in the family. 
2. The symbol 1} (pronounced R X) which is used as an 
abbreviation of the Latin word recipe which signifies 
take thou. 
3. The name and quantity of each ingredient. 
4. Direction to the pharmacist for compounding the 
drug, i.e., whether he is to mix (M. or Misce) the ingred- 
ients, or make them into an emulsion, or into pills, etc., 
or put them into capsules. 
5. The directions that the pharmacist is to place on the 
label. These are preceded by the symbol S or Sig., used 
as abbreviations of the Latin word signa, meaning write or 
label. 
6. The physician's signature. 
A typical form of an ordinary prescription is as follows: 
For Mrs. Brown, March 24, 1920 
Bismuthi subnitratis 5ii 
Misturse cretae q.s. ad giii 
M. et Sig. gii with a little water every three hours 
B. B. Smith, M.D. THE ADMINISTRATION OF DRUGS 
43 
Interpreted, this would read: Take two drams of bis- 
muth subnitrate and a sufficient quantity of chalk mixture 
to make the total measure three ounces, mix them together. 
Write on the label "Two teaspoonfuls with a little water 
every three hours." 
Abbreviations and Symbols Commonly Used in Writing 
Prescriptions and Orders 
Abbreviation 
aa 
Derivation 
.ana 
Meaning 
. .of each 
A. c 
. ante cibum 
. . before meals 
Ad lib 
.ad libitum 
.. as much as desired 
Alt. dieb 
. alterius diebus.... 
.. every other day 
Alt. hor 
.alterius horis 
. every other hour 
Alt. noc 
. alterius nocta 
.. every other night 
Aq. dest 
. aqua destillata.... 
. . distilled water 
Aq. pur 
.aqua pura 
. . pure water 
B. i. d 
.bis in die 
.. twice a day 
C 
. congius 
. . a gallon 
C 
. .centigrade 
Cum 
. cum 
. .with 
C. or c.c 
.. cubic centimeter 
Cap 
.capiat 
. . let him take 
Decub 
.decubitus 
. .lying down 
Dil 
. dilutus 
. .dilute 
F 
. . Fahrenheit 
F 
.fac 
. .make 
Fid 
.fluidus 
. . fluid 
Ft 
.fiat 
. . let it be made 
Ft 
. fiant 
. .let them be made 
Gm 
. gram 
. . gram or grams 
Gr 
.granum or grana.. 
.. grain or grains 
HCL 
.chemical symbol.. 
.. hydrochloric acid 
KI 
.chemical symbol.. 
.. potassium iodide 
Lb 
. libra 
. .pound 
Liq 
.liquor 
. .liquid 
M 
.misce, mistura.... 
.. mix, mixture 
M 
. minimum 
. . a minim 
NaCl 
. chemical symbol.. 
..sodium chlorid, i.e., common 
table salt 
0 
.octarius 
. . a pint 
0 
.ovum 
• - egg 
P.c 
.post cibum 
. . after meals 
P. r. n 
.pro re nata 
. . as occasion arises 44 
MATERIA MEDICA AND PHARMACOLOGY 
Abbreviation 
Derivation 
Meaning 
Pulv 
.pul vis 
.. a powder 
Q. h 
.quaque bora 
.. every hour 
Q. s 
.quantum sufficit 
as much as is sufficient 
3 
.recipe 
. . take 
S. or sig 
.signa 
. . give the following directions 
S. o. s 
.si opus sit 
. . if necessary 
Sp.gr 
. . specific gravity 
Ss 
.semi, semissis 
.. one-half 
T. i. d 
.ter in die 
. . three times a day 
Tinct. 
tinctura 
. .tincture 
Ung 
.unguentum 
. . ointment 
M 
. micron 
. . the millionth part of a meter 
3 
. drachma 
. .dram 
3 
.uncia. 
. .ounce 
9 
.scrupulum 
.. a scruple THE ACTION OF DRUGS 
TERMS USED IN DESIGNATING THE SITE OF A DRUG'S 
ACTIONS 
The actions of a drug at the site of its application 
(whether this be the skin, the alimentary tract, the respira- 
tory tract, or the mucous membrane of other parts, or 
subcutaneous tissue) are spoken of as its local actions. 
Actions produced after absorption are termed remote 
actions, because they occur at a distance from the site 
of application, and systemic actions, because they only 
take place after the drug has been absorbed into the 
system. Some drugs are used for their local actions only, 
others for both local and systemic actions. Some drugs 
have no local action and, on the other hand, some drugs 
are not absorbed or else they are so much diluted after 
absorption that they have no remote actions. 
The actions of a drug on tissue with which it conies in 
contact, whether before or after absorption, are spoken 
of as its direct actions while the effects that a drug produces 
on organs that it does not act upon directly, but influences 
through some other organ or system, are termed indirect 
actions. For example, a drug may indirectly influence 
practically every part of the body by its direct action on 
the heart or some part of the nervous system. 
The activities which a drug induces by stimulating 
afferent nerve-endings are termed reflex actions. 
When a drug acts only upon one or a few organs it is 
said to have a selective action, but if it affects most of the 
tissues of the body it is said to have a general action 
and if this action tends to be harmful, even though only in 
poisonous doses of the drug, the latter is called a general 
protoplasmic poison. 
That many drugs affect certain tissues and not others 
is supposed to depend upon electrical attraction between 
45 46 
MATERIA MEDICA AND PHARMACOLOGY 
the drugs and some constituent of the protoplasm of the 
tissues they affect. Formerly, this attraction was spoken 
of as chemical affinity, but, it is now believed, the attraction 
that causes elements to unite and to remain together in a 
compound, as well as many other similar phenomena, 
depends upon electrical charge. 
Drugs may act as remedies by: (1) Destroying or remov- 
ing some disturbing influence, e.g., bacteria or their toxins; 
(2) providing some lacking body constituent (e.g., hydro- 
chloric acid, when the gastric glands are not manufacturing 
a sufficient supply; (3) changing the distribution of the 
fluids in the body, see under salt action; (4) changing 
abnormal reaction of body fluids; (5) softening or lubricat- 
ing tissue with which they come in contact, by virtue of 
their own properties, and not by promoting any change in 
the tissue; (6) protecting the tissues from irritation by 
forming a coating on their surface or by absorbing 
irritating material; (7) causing some chemical or physical 
change1 in the protoplasm of the organs they act upon and 
thereby inducing either stimulation, irritation or depres- 
sion; (8) unknown means; for some time it was thought 
that such effects as stimulation and depression were 
practically always the result of some physical or chemical 
change in protoplasm, but investigation has not upheld 
this theory and it is now believed that some drugs alter 
the activities of cells in other ways, possibly, in some 
cases, by their presence, changing the electrical equilibrium 
or altering the adsorption properties of the tissue cells. 
HOW DRUGS MAY ACT AS REMEDIES 
1 A physical change, it will be remembered, is one in which the 
state of matter (solid, liquid or gaseous) is changed and a chemical 
change one in which the composition of matter is altered. An 
example of a physical change wrought by drugs is the liquefying, 
by ether and chloroform, of certain fat-like substances in the cere- 
bral protoplasm to which the narcotic action of these drugs is 
partly due. An example of a chemical change is the coagulation 
of the protein of protoplasm by combining with it and forming a 
new compound. THE ACTION OF DRUGS 
47 
Astringent Action.-This is produced chiefly on mucous 
membranes and raw tissues and implies shrinking or 
contraction of the affected tissues and usually involves 
lessening of secretion and, sometimes, of the sensitiveness 
of nerve-endings in the area. Drugs will act as astringents 
by: (1) Contracting the arterioles in the part, thus dimin- 
ishing the amount of blood in the vessels; (2) extracting 
water from the superficial cells; (3) coagulating the protein 
in the outer cells. If astringents are used in concentrated 
form they will cause irritation and those which coagulate 
protein will cause inflammation and even destroy tissue. 
Salt Action.-This implies (1) the effects that many 
substances, such as the mineral salts, sugar, urea, and other 
solids that can circulate in the blood in sufficient quantity, 
have upon osmosis. It will be remembered that osmosis 
signifies the passage of fluid through a membrane and 
that, if two solutions of unequal density are divided by a 
permeable membrane, the less concentrated one will pass 
through the membrane more rapidly than the other until 
the solutions on both sides of the membrane are of equal 
concentration. For example, if the concentration of the 
blood is raised by the injection, or the absorption, of a 
hypertonic1 salt solution, a greater amount of fluid than 
usual will pass from the tissues into the blood and the 
transudation of fluid from the blood into the tissues will 
be less than usual until the blood and the fluid in the tissues 
(tissue lymph) are of equal density. (2) The term salt 
action is also used to express the tendency common to 
many soluble substances in the body, as elsewhere, to 
diffuse (spread out) until they are equally distributed in a 
part. For example, if the lymph surrounding the cells 
contains more sugar and less salt than the fluid within 
the cells there will be a passage of sugar into the cells and 
SOME TYPICAL ACTIONS OF DRUGS 
1 Salt solutions of the same concentration as the blood are said 
to be isotonic with the blood, those with a greater concentration 
(i.e., containing a larger amount of solid matter) are termed 
hypertonic and those of lesser density, hypotonic. 48 
MATERIA MEDICA AND PHARMACOLOGY 
of salt from the cells until the fluids within and without 
the cells have about the same composition. As any 
considerable change in the constituents of the intracellular 
fluid will affect the activities of the cells, a lack of normal 
diffusible substances in the tissue lymph (which comes 
from the blood) or their presence in excess, or the addition 
of unusual ones, may affect the cells, even though the 
substances are themselves inactive, i.e., they cause no 
change in the chemical or physical constituents of the cell 
protoplasm. 
Stimulation.-By this is meant to excite to functional 
activity; for example, when receptors are stimulated they 
transmit impulses to nerve-centers; when nerve-centers are 
stimulated they send out impulses to the muscles or glands 
which they control; when glands are stimulated they 
secrete; when muscles are stimulated, they contract, and 
all cells probably respond to stimulation by increasing 
the chemical activities upon which their metabolism 
depends. Irritation is a common cause of stimulation, 
but a number of non-irritant drugs also stimulate different 
organs, especially the heart and parts of the nervous 
system. How they do so is not known. Poisonous doses 
of non-irritant stimulants may cause death by over- 
stimulating some vital organ, because overstimulation 
results in depression, but such drugs do not permanently 
injure the tissues they affect and, if the patient can be 
kept alive until the poison is eliminated and the de- 
pressed cells have time to rest and assimilate material 
for their repair, there will be no permanent harmful 
after-effects. 
Irritation is a term often used as a synonym for stimula- 
tion, but this is incorrect, because though, as stated in the 
preceding paragraph, irritation induces stimulation, stimu- 
lation is not dependent upon irritation and severe irritation 
induces inflammation and even corrosion of tissue and, 
when the injury is severe, leaves permanent lesions similar 
to the scar tissues which form in wounds due to other 
causes. The local reaction which follows irritation is one THE ACTION OF DRUGS 
49 
of nature's ways of protecting the body from harmful 
substances and consists in increased secretion, if there be 
glands in the part, dilation of the local blood-vessels and 
the consequent inflow of a larger amount of blood and 
exudation of fluid from the blood-vessels into the tissues. 
Such a reaction, it can be appreciated, supplies fluid to 
wash away or dilute the irritant, extra phagocytes to fight 
or carry it away, if necessary, and extra nutritive material 
to repair any damage done. Such a reaction is also of 
value to physiological processes such as digestion, and to 
those which occur on the repair of wounds and of some 
other abnormal conditions of tissue. The presence of an 
irritant also stimulates sensory nerve-endings in the part. 
The result of this on the skin is described under Counter- 
irritants and the results in the alimentary canal under 
Carminatives, Cathartics and Emetics. Most of the drugs 
which act as irritants do so by promoting some change in 
the protoplasm of the affected cells, such as extracting 
water or fat or coagulating protein, but the cause of 
irritation by some drugs is unknown. 
Depression is the opposite of stimulation and implies 
lessened activity or, if intense, paralysis or inability to 
function. The reason for the depressant action of some 
drugs is unknown. It is associated in some cases with 
change in the protoplasm; also, depression follows over- 
stimulation of the affected organs; in such case the con- 
ditions produced are thought to be similar to those induced 
by ordinary fatigue, but very much intensified. 
Other terms in common use to describe drug actions 
are as follows: 
Antagonistic Action.-This implies that the drugs in 
question interfere with the action of each other. They 
may do so by producing opposing effects on the same organ 
or upon different organs; for example, if one drug stimu- 
lates the cardiac accelerator center and the other depresses 
the heart muscle very little effect will be obtained from 
either drug, unless the action of one is stronger than 
that of the other. 50 
MATERIA MEDICA AND PHARMACOLOGY 
Synergistic Action or Synergism.-These terms are used 
when drugs with similar actions help one another. For 
example, certain cathartics when used together will act 
better than when used alone, this is true also of some 
narcotics and analgesics. It is thought that, synergists, 
at least in some cases, may act upon different parts of the 
organs they affect. 
Therapeutic Action.-This term is generally used to 
signify the effects of a drug that are of value in the cure of 
the symptoms that the drug is used to alleviate. 
Physiologic or Physiological Action.-When applied to 
drugs, these words generally indicate all the effects of a 
drug, whether they are curative or not. 
Pharmacologic Action.-This signifies what is known of 
the action of a drug and thus it has practically the same 
significance as physiologic action. 
Cumulative Action.-This is a term used for the pro- 
pensity of certain drugs to accumulate in the system. 
Accumulation is generally the result of slow elimination of 
the drug. The drugs most likely to accumulate in the 
system are: Digitalis, arsenic, mercury, lead and silver. 
CLASSIFICATION OF DRUGS ACCORDING TO THEIR 
EFFECTS 
Drugs are sometimes classified according to their most 
pronounced effects. The important classes needing any 
explanation are as follows: 
Absorbents-substances used to absorb excessive secre- 
tions, bacterial toxins, and gas. 
Abortifacients-agents which produce abortion. Any 
drug which contracts the uterine muscle or changes the 
circulation in the uterus, if taken during pregnancy, 
may cause abortion. 
Alteratives-drugs which produce favorable changes in 
the processes of nutrition and repair. The class includes 
all drugs which aid metabolism. 
Anesthetics-remedies that induce insensibility to pain. 
They are classed as general anesthetics and local anesthetics. 
The former being those which depress nerve-centers and THE ACTION OF DRUGS 
51 
induce general insensibility and unconsciousness and the 
latter those which depress sensory nerve-endings with 
which they come in contact and induce local anesthesia. 
Analgesics and anodynes-remedies that relieve pain, 
but do not produce the degree of insensibility caused by 
anesthetics. The term analgesic is applied to drugs which 
act after absorption and their effect is generally the result 
of depression of sensory areas in the brain or of relay 
centers leading to those areas. The term anodyne is 
used more especially for external applications that relieve 
pain by their local action. 
Anhydrotics-drugs which check the secretion of sweat. 
Most of the drugs do so act by depressing the nerve- 
endings in the sweat glands. 
Antacids-substances that neutralize acids. They may 
be used (1) to act upon the gastric juice, or, after absorp- 
tion, (2) to overcome systemic acidosis, or (3) to lessen 
the acidity of the urine. 
Anthelmintics include vermicides and vermifuges. 
Antiemetics-remedies which check vomiting. As vom- 
iting is induced in many ways, drugs with different ac- 
tions are used as antiemetics; e.g., antacids, to check irrita- 
tion due to hyperacidity of the gastric juice; carminatives, 
see page 53, counterirritants; protectives, see page 60, 
remedies such as ice and local anesthetics which lessen the 
sensitiveness of nerve-endings in the stomach; analgesics. 
Antiarthritics-drugs which relieve conditions present 
in gout. 
Antiperiodics-drugs which prevent the periodic recur- 
rence of symptoms such as the chill in malaria. 
Antipyretics-remedies that reduce fever. Many drugs 
that reduce the temperature in fever will not, except in 
excessive doses have any effect upon it when normal. 
This is because the thermotaxic or heat-regulating centers 
are stimulated by changes in the blood temperature and, 
if anything occurs to increase heat loss, they induce the 
stimulation of the oxidative processes of the body and thus 
increase heat production. On the other hand, if oxidation 52 
MATERIA MEDICA AND PHARMACOLOGY 
is increased as, for example, during exercise, chills, or con- 
vulsions, the thermotaxic centers stimulate the mechan- 
isms causing loss of heat. Heat loss is due chiefly to the 
radiation of heatfrom the blood in the skin and the evapora- 
tion of perspiration and thus is increased by dilation of the 
skin vessels and diaphoresis. When there is fever, it is 
believed, the thermotaxic centers are depressed, usually 
by toxins that have been formed in the body, and thus 
only respond to temperatures higher than normal. Drugs 
that act as antipyretics do so either by stimulating the 
centers, or by protecting them from the influence of 
toxins, or by direct action upon centers or nerve-endings 
that promote the dilations of the skin blood-vessels or 
those which induce perspiration. The chief cause of heat 
production in the body is the oxidation of material derived 
from food, but hormones formed by the ductless glands are 
essential for the process and the rate of oxidation depends 
upon the degree of muscular contraction, and muscular 
contraction upon nerve-impulses. Therefore, any drug 
which inhibits the activity of the hormones concerned with 
metabolism, or that depresses the nervous system will 
tend to reduce the temperature. Drugs with these 
actions are not used intentionally as antipyretics, but a 
few used for other purposes have such effects. 
Antiseptics-substances which inhibit the growth and 
activity of bacteria. 
Antisialogogues-drugs which check the secretion of 
saliva. This is usually the result of depression of the 
secretory nerve-endings in the salivary glands. 
Antispasmodics-drugs which tend to overcome mus- 
cular spasms and convulsions. This effect may be produced 
by depression of nerve-centers or of motor nerve-endings, 
or of muscle tissue. 
Aperients-mild cathartics. 
Astringents-described page 47. 
Bitters-drugs with a bitter taste that, by stimulating 
the taste buds, increase the flow of saliva and gastric juice 
and improve the appetite and in this way aid digestion. THE ACTION OF DRUGS 
53 
Carminatives-drugs which by their local action on the 
alimentary canal cause the expulsion of gas from the stom- 
ach and intestines. Some drugs do this by increasing the 
peristaltic action of the intestines and others by overcom- 
ing spasmodic contractions. The drugs having carmi- 
native action also stimulate the olfactory nerve-endings 
and thereby increase the secretion of saliva and gastric 
juice. Also, they irritate the membrane of the alimentary 
canal and thus increase the amount of blood in the mem- 
brane and, by stimulating afferent nerve-endings, they 
cause a transitory stimulation of important medullary 
centers, viz., the vasoconstrictor, cardiac accelerator, 
and respiratory centers. Thus they tend to cause a tem- 
porary rise of blood-pressure which may improve the 
circulation in the brain sufficiently to overcome faintness. 
Cathartics-agents which promote the evacuation of 
the bowels. This is commonly brought about either by 
increasing the bulk of the intestinal contents, by irritating 
the intestinal membrane, or by stimulating the contrac- 
tion of the muscle tissue of the intestines, either directly 
or by stimulating the part of the vagus nerve supplying 
the intestines. 
Caustics or escharotics-agents which destroy tissue. 
Cholagogues-drugs which increase the flow of bile. 
Formerly the drugs which have this effect were thought 
to stimulate the liver cells to secrete bile, but it is now con- 
sidered that, with a very few exceptions, the increased 
excretion of bile depends upon the contraction of the 
muscle tissue in the bile ducts which forces out the stored 
bile 
Circulatory stimulants-remedies which improve the 
circulation. 
As one of the most common and important uses of drugs is to 
overcome conditions interfering with the circulation it will be well 
to recall those which are essential for normal circulation; viz.: 
(1) The heart must be contracting properly; (2) the caliber of the 
blood-vessels and (3) the amount and condition of the blood 
must be normal. In order that the heart may contract properly, 54 
MATERIA MEDICA AND PHARMACOLOGY 
the following properties of its muscle must be normal: (1) Irri- 
tability, i.e., its sensitiveness or readiness to respond to stimuli- 
if its irritability is below par the muscle will not react well to 
stimuli, if irritability is excessive, what is known as fibrillation 
may occur, i.e., all the muscle fibers will not contract equally 
and at the same time; (2) tonicity, i.e., the state of partial con- 
traction persisting even during diastole, which prepares the heart 
to respond to stimuli and prevents it being dilated while it is not 
in active contraction by the blood pouring into it from the large 
veins; (3) contractility, or the power to contract and force the 
blood onward; (4) conductivity or the transmission of nerve 
impulses from the sinus node (where they discharge into the 
heart) over the entire organ. It will be remembered that the 
rhythmic contraction (systole) and relaxing (diastole) of the heart 
muscle is maintained by the salts of the blood, especially the 
sodium and potassium salts, which cause contraction, and those 
of calcium, which cause relaxation, but the rate and strength 
of its action is regulated by impulses coming over the cardiac 
accelerator and vagus nerves, the former increasing the rate and 
strengthening the contraction and those from the vagus inhibiting 
the results of the accelerator impulses and preventing excessive 
rate and contraction. The nerve-fibers enter the heart at what is 
known as the sinus node or the pacemaker, which is in the region 
where the large veins enter the right auricle. The impulses pass 
from here over the fibers of the auricles and are transmitted to 
the ventricles over minute bundles of muscle fibers, known as the 
bundles of His or the auriculo-ventricular bundles. Over-doses 
of certain drugs and disease of the heart may so reduce the property 
of conductivity as to interfere with the passage of impulses over 
these bundles and create a condition known as heart-block in 
which the ventricles act only in response to the salts of the blood 
and, not being controlled by nerve impulses, beat at a rate of 30 to 
40 beats per minute, even when the auricles are acting unusually 
rapidly. As the pulse in the arteries results from the ventricular 
contraction, its rate will be that of the ventricles. 
The accelerator mechanism is stimulated by all conditions calling 
for an increased amount of nutrient and oxygen in the tissues 
(e.g., exercise and fever), by stimuli that affect the sympathetic 
system, and by certain drugs, and the resulting impulses strengthen 
the contractions of the heart muscle and also increase the rate of 
its action, chiefly by lessening the time of diastole, i.e., relaxation. 
As it is during diastole that the heart muscle gets its supply of 
nutrient oxygen, etc., the coronary vessels being emptied during 
systole (contraction) if the rate of the heart continues fast for any 
length of time, as in fever, its contractions (and consequently the 
pulse) will become weak, though the latter may remain rapid, but THE ACTION OF DRUGS 
55 
the increased rate is no longer a sign of stimulation. Under such 
circumstances a drug which stimulates the cardiac accelerator 
mechanism, especially if it also stimulates the heart muscle or 
increases the contraction of the blood-vessels, may, by forcing 
the heart to take stronger contractions, slow the rate. 
When the heart's action is abnormally rapid, a drug which 
stimulates the vagus, by slowing the rate and thus allowing the 
heart to get more nourishment, etc., may act as a stimulus, though, 
ordinarily, stimulation of the vagus tends to weaken the heart's 
action by prolonging and intensifying relaxation and lessening the 
irritability and conductivity of the heart muscle. It will be 
noticed in the study of the drugs that some of the most important 
circulatory stimulants stimulate both the vagus and the heart 
muscle and, by the latter action, they tend to overcome the bad 
effects of the vagus stimulation, for a true stimulant of cardiac 
muscle will increase its irritability, tonicity and contractility. 
The normal caliber of the blood-vessels is maintained by some 
unknown intrinsic property of their muscle tissue and by nerve 
impulses. With the exception of the vessels in the brain, lungs 
and heart, the motor nerve supply of the vessels is controlled by 
the vasoconstrictor centers. The centers controlling the vessels 
in different parts, as the skin, muscles, and abdominal viscera are 
not usually affected by the same stimuli, at any rate to the same 
extent, and thus a drug that causes contraction of the vessels 
in the abdominal viscera (the splanchnic vessels) increases the 
amount of blood in the brain, lungs and heart and,, though to a 
lesser degree, in the skin, muscles and kidneys. Conditions 
which depress the heart action, either by their influence on the 
vaso-constrictor mechanism or the tissues of the blood-vessels, also 
tend to cause relaxation of the vessels with a consequent low blood- 
pressure and this further interferes with the heart's action, 
because, the heart needs a certain amount of resistance. There- 
fore, when the blood pressure is abnormally low, a drug that 
stimulates the vasoconstrictor mechanism will improve the 
heart's action, even though it does not directly affect the heart or 
its nerve supply. Blood pressure rarely becomes dangerously 
high, except in some abnormal conditions of the heart, kidneys or 
blood-vessels, because of the depressor nerve (an afferent branch 
of the vagus) which is stimulated when the blood pressure rises 
above normal and then transmits impulses to the vasoconstrictor 
center and lessens its activity. However, in diseases of the organs 
just mentioned blood pressure may be abnormally increased and 
then drugs which relax the vessels may be prescribed. Blood- 
vessels may be relaxed by depressing their muscle tissue, or by 
depressing some part of the vasoconstrictor mechanism or, pre- 
sumably, in some cases, by stimulating vasodilator nerves; but 56 
MATERIA MEDICA AND PHARMACOLOGY 
only the vessels in a few parts of the body have been proven to 
have dilator nerves and the cause of vasodilation in many cases 
is unknown, especially vasodilation due to irritation and physio- 
logical activity. It is thought, however, that irritation produces 
activity and activity from any cause results in the decomposition 
of material in the tissues thus giving rise to chemical substances 
that, it is believed, either by direct effect upon the tissue of the 
blood-vessels or, indirectly, by influencing nerve-endings, cause 
the vessels in the part to become relaxed. Temporary localized 
relaxing of blood-vessels, when those of other parts are in a state 
of normal contraction, will cause the area to become warm and 
red and, if there are glands in the part, it will favor secretion. 
Change in the volume of blood, except as a very transitory condi- 
tion is nearly always a decrease because, if an unusual amount of 
liquid is injected or absorbed into the blood-vessels, the kidneys 
and, sometimes, the sweat glands are stimulated and quickly 
get rid of the excess, also there may be increased osmosis into the 
tissues. A decrease in the amount of blood circulating in the 
vessels may be due to (1) general dilation of the blood-vessels, 
in which case there will be an abnormal amount in the abdominal 
vessels; (2) excessive loss of fluid from the body as by hemorrhage, 
purging, vomiting and diaphoresis. A slight loss will soon be made 
good as far as the blood is concerned, because its concentration will 
be raised and this will induce osmosis of fluid from the tissues as 
explained under salt action. However, unless there is an excessive 
amount of fluid in the tissues, as in dropsy, the removal of fluid 
will be injurious to the tissue cells and, consequently, the loss 
must be made good as quickly as possible. 
To summarize the ways in which remedies may improve 
the circulation: By; (1) directly stimulating the heart 
muscle; (2) stimulating some part of the cardie accelerator 
mechanism; (3)depressing some part of the vagus mech- 
anism, which has the same effect as stimulating the 
accelerator; (4) stimulating the vagus when the pulse is 
excessively rapid; (5) improving the circulation in the 
coronary vessels and, thereby, the nutrition of fhe heart 
muscle; (6) stimulating some part of the vasoconstrictor 
mechanism; (8) relaxing the blood-vessels when blood- 
pressure is abnormally high; (9) increasing the amount 
of blood by transfusion, etc., when the amount in circu- 
lation is depleted either as the result of loss of blood or 
its fluid or of relaxed vessels. THE ACTION OF DRUGS 
57 
Counterirritants-agents which, by irritating the skin, 
counter or relieve irritation or pain in viscera and muscles. 
Theories regarding the reasons for their effects are given in 
the section on Volatile Oils. 
Cycloplegics-drugs which paralyze the ciliary muscles 
of the eyes and thus prevent accommodation for viewing 
objects near at hand. 
Demulcents-mucilaginous or bland substances which 
lubricate and coat a surface and thus protect it from 
irritation. 
Depilatories-agents that remove hair. 
Detergents-cleansing agents. 
Diaphoretics-agents which increase the secretion of 
sweat. Drugs may increase this secretion either by 
stimulating the heat regulating center, or the sweat 
centers, or the secretory nerve-endings in the sweat glands; 
also, drugs which increase the amount of blood in the skin, 
and thus around the sweat glands, favor diaphoresis, 
but the secretion of sweat is not as much influenced by the 
amount of blood present as are the secretions of other 
glands. Other means employed to induce diaphoresis are 
(1) active exercise which increases heat production; 
(2) the use of heavy covers or clothing, which inhibits 
loss of heat; (3) surrounding the body with heat. The 
more common therapeutic uses of diaphoretics are: 
(1) In edema, to raise the concentration of the blood 
(by removal of fluid) and thus favor the absorption of the 
excess fluid in the tissues; (2) when the kidneys are not 
functioning properly, to remove some of the salts and 
nitrogenous matter usually eliminated through those 
organs; (3) to relieve internal congestion that favors 
the activity of bacteria which cause 11 colds;" (4) to lessen 
obesity (depriving the body of water favors the oxidation 
of fat); (5) to reduce temperature. 
Digestants or digestives-agents that aid digestion. 
The drugs of this class act either by stimulating the diges- 
tive juices or they themselves contain ferments which aid 
digestion. 58 
MATERIA MEDICA AND PHARMACOLOGY 
Disinfectants-agents that destroy germs. 
Diuretics-agents which cause diuresis, i.e., increased 
secretion of urine. The kidneys are not furnished with 
secretory nerves and, therefore, diuresis is caused either 
by (1) direct non-irritant stimulation of the kidney cells; 
(2) irritation of the kidneys; (3) increasing the blood pres- 
sure in the renal vessels. The latter effect may be induced 
by: (1) Improving the circulation; (2) contracting the 
blood-vessels in the other abdominal viscera and, thereby, 
forcing more blood into the renal vessels; (3) increasing 
the amount of fluid in the blood. The amount of fluid 
in the blood may be augmented either by (a) increasing 
the intake of fluid or (6) by using substances, such as min- 
eral salts and urea, that raise the osmotic pressure of the 
blood and thereby promote the osmosis of fluid from the 
tissues into the blood, as described under Salt Action. 
A large number of drugs used for other therapeutic pur- 
poses cause diuresis and in most cases the diuresis has no 
influence upon the effects for which the drug is used but it 
is important to remember that almost all irritant drugs 
during elimination irritate the kidneys and, in toxic doses, 
they will not only cause diuresis, but injure the kidney 
cells and, both for this reason and because of the loss 
of water from the body, the diuresis is likely to be followed 
by anuria and, if the cells are badly injured, there will be 
albumin and casts and, sometimes, blood in the urine. 
To lessen the danger of these conditions, water must be 
given freely in the treatment of poisoning by irritant 
drugs. 
Drastics-cathartics which induce excessive purging 
and griping. 
Ecbolics-drugs which produce contractions of the 
uterus. They may do so either by stimulating the muscle 
tissue of the uterus or by stimulating the sympathetic 
nervous system. 
Emetics-drugs used to produce emesis or vomiting. 
Vomiting results from many causes, but the drugs used 
purposely to produce emesis do so either by irritating the THE ACTION OF DRUGS 
59 
stomach or by stimulating the vomiting center in the 
medulla. Those which act in the former manner are 
classed as reflex or indirect emetics and those which stimu- 
late the center, as central or direct emetics. 
Emmenagogues-agents which bring on the menstrual 
flow. Drugs used for this purpose are either tonics which 
improve the general health, including the condition and 
the circulation of the blood; drugs which cause contraction 
of the uterine muscle; drugs which increase the amount 
of blood in the uterus, as described under the Volatile 
Oils and the Drastics Cathartics. 
Emollients-fatty substances used to soften and protect 
the skin and wounded surfaces. 
Epispastics or vesicants-irritants used to induce 
blisters. 
Escharotics-agents which destroy tissue. 
Expectorants-substances used to facilitate the expec- 
toration of bronchial mucus. This effect is usually pro- 
duced by increasing the secretion of mucus and saliva and 
such stimulation is generally the result of reflexes induced 
by stimulating nerve-endings in the mouth or by a naus- 
eant (irritant action) in the stomach. Mucus secreted 
under such stimulation is generally thin and watery and 
helps to wash off the tenacious mucus. Also irritant drugs 
which promote coughing and those which improve the 
tone of the bronchial muscle will aid in the expulsion of 
mucus. Drugs may act directly upon their administra- 
tion or (when they are eliminated through the bronchial 
membrane) during excretion. Alkalies put into a test- 
tube with mucus will liquefy the latter and, for this 
reason, were much used in expectorant mixtures, but is 
now thought doubtful if they come into sufficient contact 
with the mucus to be of value, except when they are used 
in throat and nasal douches. Drugs which lessen the 
secretion of mucus are sometimes classed as sedative 
expectorants. 
Galactagogues-agents which increase the secretion of 
milk. Drugs are rarely used for this purpose. 60 
MATERIA MEDICA AND PHARMACOLOGY 
Hematinics-drugs which increase the amount of hemo- 
globin in the blood. 
Hypnotics-drugs which induce a condition resembling 
sleep. 
Hydragogues-cathartics which cause watery stools. 
Laxatives-mild cathartics. 
Lubricants-oily substances which lubricate, soften, 
soothe and protect surfaces from irritation. 
Mydriatics-drugs which dilate the pupils of the eyes. 
This action may be induced by depressing the muscle tissue 
of the iris; by depressing some part of the portion of the 
third nerve supplying the circular muscle of the iris; by 
stimulating the sympathetic nerve supplying the radial 
muscle of the iris. In addition to dilating the pupils, 
mydriatics are likely to increase intraocular tension (i.e., 
the tension of the fluid within the eyeball). They do so 
because excess fluid escapes from the eyeballs through 
minute lymph-channels which open at the margin of the 
pupil and when the latter is dilated the channels are more 
or less blocked. 
Miotics-drugs which contract the pupils. Their 
action is generally caused by stimulation of the portion 
of the third nerve supplying the circular muscle of the 
iris. 
Prophylactics-remedies used to prevent disease. 
Protectives-substances used to protect the skin, 
wounds and mucous membranes. This class includes 
absorbents, collodions, demulcents, emolients, and lubri- 
cants. 
Purgatives-cathartics which produce free evacuation 
of the bowels, but are not drastic. 
Rubefacients-mild counterirritants. 
Soporifics-same as hypnotics. 
Stomachics-drugs which aid digestion. They may do 
this by stimulating the taste-buds and olfactory nerve- 
endings and thus inducing a reflex flow of saliva and 
gastric juice and by slightly irritating the mucous mem- 
brane of the stomach and thus increasing the amount of THE ACTION OF DRUGS 
61 
blood in the membrane and inducing reflexes which 
increase the motor and secretory activities of the stomach. 
Specifics-drugs which cure a disease by acting directly 
upon the germ or special condition to which the malady 
is due. 
Styptics-drugs which check local hemorrhage. 
Teniacides-drugs which destroy tape worms. 
Tonics-remedies which increase the health and tone 
of the body. They may do this in several ways, as, for 
example, by improving the appetite and digestion; by 
improving the circulation; by increasing the amount of 
hemoglobin in the body; by stimulating the tissue cells 
and thereby the chemical activities upon which their 
nutrition depends; by stimulating the endocrine glands 
which control metabolism; by stimulating the nervous 
system and thus increasing muscle tone and the activity 
of the various organs. 
Vermicides-drugs which destroy worms. 
Vermifuges-drugs which expel worms. 
Vesicants-drugs which produce blisters. TOXICOLOGY 
As previously stated, Toxicology is the science or study 
of poisons. A poison has been defined as any substance 
that in small amounts will cause death or seriously injure 
the health. Poisoning by drugs may be the result of 
criminal or suicidal intent or accident. 
The symptoms of poisoning by drugs with actions that 
are at all similar are very alike and also the treatment for 
poisoning, therefore the study of the toxicology of the 
individual drugs will be very much facilitated if the follow- 
ing facts are remembered: 
The majority of drug poisons can be classified as follows: 
Irritants-these include corrosives, which destroy tissue 
and simple irritants, which cause inflammation, but not 
corrosion. 
Nerve poisons or neurotics-these include nerve stimu- 
lants of convulsants, which cause spasms and convulsions, 
and nerve depressants or somnifacients, which induce 
sleep and coma. 
Cardiac poisons, those which cause death by paralyzing 
the action of the heart. 
Blood poisons, those which alter the hemoglobin or the 
corpuscles or interfere with the coagulable property of 
the blood. 
Whatever the cause of poisoning one of the most 
dangerous conditions induced is that known as collapse, 
in which there is a deficiency of blood in the general 
circulation. This deficiency can be due to many causes 
some of which are very imperfectly understood. Ex- 
amples are: Loss of blood or of fluid from the blood by 
continued vomiting and purging; dilation of the splanchnic 
arteries, or dilation of the capillaries. The arterioles may 
become dilated as the result of direct depression of their 
muscle tissue, or of their nerve-supply and the nerve 
62 63 
TOXICOLOGY 
depression may be brought about by depressant drugs 
or by over-stimulation; for any intense stimulation of 
nervous mechanisms is likely to be followed by their 
depression. Dilation of the capillaries is thought to be 
brought about by chemical substances that are produced 
when tissue is injured and, when absorbed by the blood 
and carried through the body, depress the tissue of the 
capillary walls. Whatever the cause of the condition, the 
circulation of the blood is interfered with and the brain, 
lungs, and heart may not get enough blood to enable them 
to carry on their functions and then death ensues. 
The symptoms of collapse depend upon the severity 
of the condition. In a mild form, there will be dizziness, 
faintness, a slight increase in the rate, and decrease in the 
strength of the pulse, and there may be nausea and 
vomiting, and the individual may faint. In severe col- 
lapse, the pulse becomes exceedingly weak and very rapid, 
except when the poison directly depresses the heart 
muscle, in which case, the pulse may be slow, though 
excessively weak; the skin becomes cold and clammy 
and covered with perspiration; it is usually cyanotic, 
except in poisoning by chloroform, when it is pale; the 
muscles are relaxed and weak; the temperature falls; the 
breathing becomes labored, slow, shallow, and inefficient, 
which causes a condition of partial asphyxia and, as the 
result of this, convulsions may occur. 
Death from poisoning by drugs is very frequently 
due to cessation of breathing, for this may result from 
several causes, the more common ones being: (1) Direct 
depression of the respiratory center, which prevents 
it being stimulated by the carbon dioxid in the blood, 
this may be the result of depressant drugs or of fatigue 
from over-stimulation; (2) interference with the circulation 
which prevents sufficient blood reaching the center to 
promote its stimulation; (3) interference with the action 
of the muscles concerned with breathing either as the result 
of their paralysis or of their spasmodic contractions during 
convulsions. 64 
MATERIA MEDICA AND PHARMACOLOGY 
In poisoning by most nerve depressants the typical 
symptoms are those of collapse with profound stupor. 
In poisoning by nerve stimulants, twitching of the muscles 
and convulsions will precede the depression. In poisoning 
by irritants, in addition to the symptoms of collapse, there 
will be the local ones caused by the irritation, these, if the 
drug has been taken by mouth, as is usually the case, will 
be vomiting, diarrhea, abdominal pain; the vomitus and 
feces are likely to contain mucus and blood and, when the 
drug is corrosive, shreds of membrane. Also, as more or 
less of all irritant drugs are eliminated through the kidneys, 
there is likely to be diuresis, followed, in some cases, by 
anuria or suppression, and, due to injury of the kidney 
cells, the urine may contain blood and casts and, if the 
cells do not function properly, albumin. Convulsions 
may occur as the result of the excessive reflex nervous 
irritation caused by the local injury and, possibly, due to 
the action of the drug on nerve centers after absorption. 
In poisoning by drugs which cause changes in the hemo- 
globin, asphyxia will be pronounced and will be shown 
by extreme dyspnea and cyanosis and convulsions. 
Many drugs with various actions cause skin rashes in 
overdoses. The causes of this, in some cases, are not 
known but irritant drugs that are eliminated in the 
perspiration and those which cause changes in the circu- 
lation of the blood in the skin are particularly likely to 
do so. 
Treatment.-Poisoning by certain drugs requires special 
treatment and this is mentioned in the sections devoted 
to the description of such drugs, but certain principles 
are applicable to the treatment of poisoning by nearly 
all drugs. These are: (1) Prompt action is necessary, in 
some cases chiefly to prevent the local effects of the drugs 
and, in others to inhibit absorption. (2) The poison is 
removed if possible. (3) A chemical antidote is used if 
there is one and the substances formed by the interaction 
of the antidote and the poison washed away. (4) Physio- 
logical antidotes are employed. (4) Irritant drugs are TOXICOLOGY 
65 
diluted and, as a rule, this is one of the first things to be 
done in the treatment of poisoning by irritants. 
The measures used for the removal of the poison 
depend upon the way in which the drug has been taken. 
If it has been administered hypodermically its removal is 
difficult but if the mistake is noticed at once, cupping may 
have some result and, if a ligature is applied tightly 
around the limb above the point of administration, the 
absorption of the drug may be delayed sufficiently to allow 
a portion of the dose to be excreted before the whole 
amount has been taken up by the blood. Means must be 
taken at once to hasten excretion as described later. The 
removal of poisons from the skin, wounds, and accessible 
body cavities is affected by irrigations or lavage and from 
the stomach, in some cases, also by inducing vomiting. 
As soon as the treatment for the acute conditions have 
been attended to, measures are taken to hasten the 
removal of the drug through the excretory organs by 
giving a purgative and a diuretic and, if urine is not voided, 
catheterizing the bladder. In the case of drugs that, 
after absorption, are excreted into the alimentary canal 
a purgative is given even when the drug has been adminis- 
tered by hypodermic. Irritant cathartics and diuretics 
should not be used, especially in the treatment of poison- 
ing by irritant drugs. An important point to bear in 
mind in the treatment of poisoning by irritant drugs is 
that the alimentary canal and kidneys are seriously in- 
flamed by the poisons and, if the latter is corrosive, the 
stomach especially may be so corroded that the organ 
can be easily ruptured. For this reason, emetics, which 
would add to the irritation, are not used for the removal 
of irritants and lavage must be performed with exceedingly 
great caution, t.e., the tube must be very thoroughly 
lubricated, it must be inserted without force, and the solu- 
tion must be poured in slowly and the stomach must not 
be overdistended; it is better under such circumstances to 
siphon off the fluid as soon as a small quantity has been 
introduced, but to continue the lavage for some time. 66 
MATERIA MEDICA AND PHARMACOLOGY 
When possible, the fluid used is a chemical antidote. 
When extensive corrosion of the stomach is feared it is 
better not to give lavage, but to depend upon the dilution 
and neutralization of the drug. 
The substances used for diluting irritant drugs are milk; 
raw eggs only very slightly beaten; boiled starch water 
or other demulcent solution; but, if these are not at hand, 
water must be used; the physician frequently prescribes 
oils, but it is better for nurses not to give oil without a 
prescription, for oil increases the solubility of a number 
of drugs and thus hastens their absorption. 
Emetics are not used in the treatment of poisoning by 
irritants; nor in advanced stages of strychnine poisoning; 
nor by depressants after symptoms of collapse are evident; 
for, in such case, the drug must have been absorbed, and 
an emetic is likely to increase the harmful effects of the 
drug. Emetics in common use are: Apomorphine, given 
by hypodermic; ipecac; copper sulphate; zinc sulphate; 
and mustard. 
Chemical antidotes are substances that will combine 
with the poison to form a relatively harmless substance. 
The majority of antidotes act either by neutralizing, 
precipitating or oxidizing the poison. 
For poisoning by acids, weak alkalies, such as magnesia 
oxid are used; this is discussed in the section devoted to 
acids; for alkalies, weak acids, such as vinegar and lemon 
juice are used. Acids and alkalies neutralize each other. 
For metal salts, especially those of mercury, albumin, 
usually in the form of milk or raw eggs, is used. 
For alkaloids, oxidizing agents such as hydrogen peroxid 
or, preferably, potassium permanganate1 may be used 
or else substances which precipitate the alkaloids; these 
are iodine and tannin. For convenience, the latter is 
generally used in the form of strong boiled tea. It is not 
of much use for morphine, cocaine, atropine and aconite. 
1 These substances hold oxygen in loose combination and this 
unites with the poison and decomposes it. The dosage for this 
and the other drugs will be found in the sections describing them. TOXICOLOGY 
67 
For glucosides, oxidizing agents, especially potassium 
permanganate. 
Special antidotes used for certain drugs will be found 
in the sections describing the actions and uses of the 
drugs. 
An important point to remember is that in many cases 
the compounds formed with the antidotes are not stable 
nor entirely harmless and thus they should be removed by 
lavage. 
The physiological antidotes for poisons include every- 
thing that combats the symptoms or physiological effects 
produced by the poison. Examples are: (1) The treatment 
for collapse; (2) artificial respiration and other means 
taken to stimulate breathing; (3) the use of alkaline salts, 
usually given intravenously, to counteract systemic acid- 
osis; this is described on page 241; (4) drugs and other 
means taken to arouse the patient in poisoning by nerve 
depressants; (5) nerve sedatives used to lessen nervous 
irritability in poisoning by nerve-stimulants; (6) demul- 
cents and emollients used to soothe and lubricate irritated 
tissue in poisoning by irritants. 
The usual treatment to prevent and overcome collapse 
is: 1. Keep the patient quiet, in order to give the heart 
as little work to do as possible. An exception to this rule 
will be seen in the treatment for poisoning by opium and 
its alkaloids. 
2. Keep the patient warm. To do so, it is usually neces- 
sary to put hot water-bags in the bed and, if possible to 
give hot drinks and sometimes hot enemata. External 
heat is usually very important, because except when the 
patient has convulsions, the temperature is likely to be- 
come very much reduced for (1) the diaphoresis (excessive 
perspiration) increases the loss of heat while the weak 
circulation, by lessening the amount of oxygen taken to 
the tissues, and the muscular relaxation, tend to lessen the 
production of heat. 
3. If the collapse is at all severe the patient's head 
should be lowered so as to favor the flow of the blood to 68 
MATERIA MEDICA AND PHARMACOLOGY 
the brain. This is generally done by raising the foot of 
the bed. 
4. The doctor is likely to give a blood transfusion or 
an intravenous infusion of a salt solution containing adren- 
aline and he may prescribe inhalations of oxygen, or the 
administration of camphor, strychnine, caffeine, atropine 
or pituitrin by hypodermic. It is always better for 
nurses not to give drugs without a doctor's order, except 
in extreme urgency, and, when the collapse follows 
over-stimulation of the nervous system, they should 
not give nerve stimulants such as caffeine, camphor, and 
strychnine. 
The usual means taken to avert cessation of-breathing 
are: Artificial respiration, inhalations of carbon dioxid 
with oxygen, stretching the rectum (which gives rise to 
reflexes), hot strong coffee is generally given by rectum, 
and caffeine and atropine by hypodermic. 
To Summarize.-In the treatment of poisoning by all 
toxic drugs means must be taken to prevent collapse and 
the breathing must be watched and if its rate becomes 
much reduced (15 to 12 breaths per minute) means must 
be taken to prevent its cessation. If possible the drug is 
to be washed away; this, when it has been taken by mouth, 
is done by lavaging the stomach; if, however, the poison 
is a concentrated corrosive, it may be better to omit the 
lavage. When the implements for lavage1 cannot be 
obtained at once, emetics are used, except in case of poison- 
ing by concentrated irritants, and in advanced stages of 
poisoning by strychnine and depressants. If possible a 
chemical antidote is given, and the lavage repeated. 
Means are taken to hasten the excretion of the drug; these 
consist in giving all the fluid possible, a quickly acting, 
but non-irritant cathartic, and, sometimes, a non-irritant 
diuretic, and if the patient does not void urine, catheteriz- 
1 If a stomach tube cannot be obtained, ordinary soft rubber 
tubing of similar caliber to the stomach can be used after the end to 
be inserted has been made smooth; this can be done by holding it 
in a flame. TOXICOLOGY 
69 
ing the bladder. In addition to this general treatment, 
nerve depressants are used in the treatment of poisoning by 
convulsants, and nerve stimulants are used in the treat- 
ment of nerve depressants. Irritants are diluted as 
quickly as possible and demulcents used to lessen the 
irritation. Cathartics are not given after poisoning by 
irritants if, as is usually the case, they induce purging. THE NERVOUS SYSTEM 
Such a large number of drugs obtain their effects by their 
actions on the nervous system that it will be well to ante- 
cede their study with a brief review of the structure and 
functioning of this system. 
The nervous system is considered under two main divi- 
sions, known as the cerebrospinal or voluntary system 
and the autonomic or involuntary system. 
The cerebro-spinal division includes the portions of the 
brain and spinal cord and their nerves which are concerned 
with mental or psychic activities (including sensation) 
and the control of the skeletal muscles. The autonomic 
system comprises the portions of the brain, spinal cord 
ganglia and nerves that control the heart's action and that 
of plain muscle tissue and glandular organs. Plain 
muscle tissue is contained in: The true skin or derma; the 
walls of the trachea and bronchi; the alimentary canal 
from the esophagus to the anus of the rectum; the spleen; 
uterus; urinary and gall bladders and the canals and ducts 
leading from these organs and from glands. 
The unit of nerve tissue is the nerve-cell or neurone A 
neurone consists of a mass of protoplasmic matter known 
as the cell-body (but commonly referred to as the cell) 
and processes, termed dendrites and axis-cylinders or 
axons. 
Dendrites are branching, usually short, outgrowths from 
cell bodies. Axons are straight, elongated processes, 
usually of some length. Axons that extend beyond what 
is known as gray matter acquire a sheath, known as the 
neurilemma and are then called nerve fibers. Some nerve 
fibers have a white semi-liquid substance between the neuri- 
lemma and the axon and such are termed medullated 
fibers. Fibers of this variety constitute the white matter 
of the brain and cord and the fibers of spinal and cranial 
70 THE NERVOUS SYSTEM 
71 
nerves which supply the skeletal muscles and sense organs 
and stimulate ganglia but, it is thought, only non-medul- 
lated fibers enter plain muscle tissue and glands. 
Depending upon their function neurones are classed 
as afferent, efferent and connecting or association neurones. 
Afferent neurones are those over which impulses pass 
from the periphery to the brain and spinal cord; efferent, 
those over which impulses pass outward. Connecting 
neurones are those placed between afferent and efferent 
neurones. The branches of the majority of association 
neurones are short but numerous. The special purpose 
of these neurones is to diffuse passing impulses so that a 
relatively small number of afferent impulses can be 
discharged over many efferent neurones; for example, a 
small crumb in the larynx will only stimulate a few afferent 
fibers but the stimulus will be diffused over thousands of 
efferent fibers. 
Afferent neurones that form part of sense organs- 
eyes, ears, etc.-are often called sensory neurones and, 
likewise, efferent neurones are sometimes given special 
names that suggest their function, those which transfer 
the impulses to muscles that cause them to contract being 
called motor neurones; those which transmit impulses to 
glands that cause secretion, secretory neurones; those which 
transmit impulses that inhibit either muscular activity or 
secretion, inhibitory fibers. 
The peripheral endings of nerve-fibers with different 
functions vary in their character. The nature of these 
variations need not be gone into here further than to state 
that some (efferent) are adapted for the discharge of 
impulses into muscles and glands, and others (afferent) 
known as receptors, for the reception of different kinds of 
stimuli, e.g., light, sound vibrations, cold, heat, pressure. 
Since there are differences in the structure of the different 
kinds of endings, certain drugs may affect some and not 
others or may affect the different ones in dissimilar ways. 
The nerve-fibers extending between the central part of 
the nervous system and the skin, muscles and internal 72 
MATERIA MEDICA AND PHARMACOLOGY 
organs are grouped together in cord-like structures known 
as nerves. 
Some nerves consist of afferent fibers only and some of 
efferent, but the majority have both afferent and efferent 
and are known as mixed nerves. Fibers that unite to form 
a nerve may arise from different masses of gray matter 
(usually termed roots or nuclei or ganglia) or from cells 
that are all grouped in one mass, and in either case the 
fibers constituting the nerve may branch from it and 
supply quite distant parts of the body that have dissimilar 
functions. 
The structure of the nerve cell-bodies in different parts 
varies and, therefore, as in the case of the peripheral 
endings, ■ drugs that affect one group may not act upon 
others or may do so with dissimilar effects. The proto- 
plasm of the dendrites is similar to that of the cell bodies 
from which they arise, but that of the fibers and endings 
are different and, therefore, drugs may act upon the cells 
without affecting the fibers or their peripheral endings or, 
if they act upon both, the effects may vary. But the 
results of stimulation or of depression upon cells or 
peripheral endings will be the same. 
As the gray matter contains the cell-bodies and their 
dendrites and axons and branches of the latter, known as 
collaterals, it is in the gray matter that nerve impulses 
pass from the axons of afferent fibers to the dendrites of 
connecting and efferent fibers. This functional union 
of the processes of different neurones is termed a synapse. 
The term functional union is used because it is thought 
the processes of different neurones do not come into actual 
contact with each other. 
It is believed that it is at the synapses that the passage 
of impulses is regulated. This regulation involves 
several factors: (1) It prevents impulses passing back over 
the neurones by which they have been transmitted. 
(2) It determines the facility with which impulses pass. 
Normally, the synapses offer a slight amount of resistance 
to the passage of impulses, but under some conditions, THE NERVOUS SYSTEM 
73 
both physiologic and pathologic, and by the influence of 
drugs which depress the neurones, the resistance to the 
passage of impulses is increased and the individual does 
not respond readily to stimuli, while other conditions, and 
the influence of drugs such as caffeine and strychnine, 
lessen the resistance to the passage of impulses and the 
individual then exhibits the condition known as nervous 
and responds too readily and forcefully to stimuli; e.g., 
jumps or exclaims at a slight noise. Such a condi- 
tion may, probably, also be caused by primary stages 
of depression because this affects self-control. The con- 
ditions responsible for affecting the passage of impulses 
are unknown but the brains of animals which have 
been fatigued, and those which have not, show differ- 
ences in the condition of the cell-bodies and dendrites 
and fatigue is one of the conditions that retards the passage 
of impulses. (3) It is thought that it is chiefly at the 
synapses that nerve-impulses make the impression on the 
brain and cord which compel the passage of later impulses, 
arising from similar stimuli, to take the same course, thus 
making it almost inevitable that an act which is repeated 
a few times in the same way will always be done in like 
manner on future occasions. In other words, it is probably 
at the synapses that nerve-impulses make the modifications 
which constitute the basis for habits and, to some extent, 
for characters. 
Masses of gray matter containing the cell-bodies of the 
fibers which transmit impulses to organs and, thereby, 
control their functions are known as nerve-centers. 
Fibers do not as a rule extend directly from centers to 
organs, but form synapses with neurones in other masses 
of gray matter which constitute, as it were, relay centers or 
stations. For example fibers from centers in the part of 
the brain known as the medulla oblongata form synapses 
with neurones in the cord and the fibers from those form 
synapses with neurones in the masses of gray matter in the 
abdominal and thoracic cavities known as ganglia. Also, 
some so-called centers are merely indispensable distrib- 74 
MATERIA MEDICA AND PHARMACOLOGY 
uting stations. For example, if the mass of gray matter 
known as the center of vision is destroyed, sight will be 
lost, even though the eyes are perfectly normal, but, never- 
theless, this center, it is thought, is merely the location 
where the fibers of the optic nerve form synapses with 
other fibers which, like those in the center of sight, or 
vision, have been acted upon in some unknown manner 
by previous impulses so that the associations (memories) 
of things seen have been formed. 
The tissue of the brain is so distributed that definite, 
but connected, divisions are observed. The main ones 
are known as: The cerebrum, which is the upper portion; 
the cerebellum, below the dorsal portion of the cerebrum; 
the midbrain, under the central portion of the cerebrum; 
the pons, under the latter; the medulla below the pons 
and continuous with the spinal cord. 
The outer surface of the cerebrum, known as the cor- 
tex, consists chiefly of gray matter. This includes centers 
that are necessary for (1) the reception and distribution 
of sensory impulses; (2) the coordination of muscular 
movements; (3) mental or psychic phenomena. The 
centers governing these three classes of functions are 
grouped in fairly definite masses and those which are 
specially concerned with sensation are termed sense areas; 
those concerned with movement, motor areas; those essen- 
tial for consciousness, association areas. 
The centers in the association areas are connected by 
nerve-fibers with each other and with sense and motor 
areas but not, except through the intervention of sense 
and motor areas, with the periphery. The sense areas 
thus act as doors for the entrance of impulses to the asso- 
ciation areas and the motor areas as doors for their exit. 
It is probably in the association areas that the impres- 
sions are made in the protoplasm by things heard, seen 
and thought which constitute our intellectual memories. 
Also, these areas are thought to be the seat of the activities 
known as imagination, judgment, reasoning, self-control 
and other acts of consciousness. THE NERVOUS SYSTEM 
75 
By imagination is meant the synthesis of memories into 
original combinations or ideas or, in other words, mental 
pictures, formed from memories, but not exact reproduc- 
tions of the data of the memories. Such mental activity 
does not necessarily require concentration of the attention. 
In its lowest form it consists simply in trains of images, 
suggested by one another or by outward stimuli, with 
little attempt at reconstruction. Examples of higher 
types are, the imaginings of plots, conversations and the 
like, and the mental visions of scenery that form in the 
author's brain; and the picturing of physical forces that 
the scientist indulges in, but, so long as the process is 
purely that of imagination there is no attempt at the selec- 
tion of ideas, or of verification of their truth. The latter 
processes belong to the faculties known as judgment and 
reasoning, both of which require more or less conscious 
effort and concentration of the attention and are likely 
to check the freedom of the imaginative process. Self 
control implies conscious inhibition of response to stimuli. 
The powers of judgment, reasoning and self control de- 
velop later in life than the faculty of imagination and are 
more dependent upon exercise; also, they require more 
conscious effort. Such faculties are often referred to as 
the higher intellectual capacities and it is such capacities 
that are first reduced by physiologic (as tiredness), 
pathologic (disease) or drug depressants. 
Nerve centers are only active when they are stimulated 
and, therefore, as stimuli enter the association areas 
through the sensory centers, the former will be rendered 
inactive, and unconsciousness thus induced, by drugs that 
depress the sensory centers, as well as by those that act 
upon the association centers directly. In fact, when 
unconsciousness is due to depression of the association 
areas only, unless the depression is very profound, the 
individual will be aroused by strong stimuli, such as pain. 
Also, depression of sensory centers will render the per- 
ception of sensation-pain, sight, hearing, touch, etc.-less 
acute. It will have much" the same effect as the reduction 76 
MATERIA MEDICA AND PHARMACOLOGY 
of external stimuli; for example, a mild depression will 
have about the same result as when an individual reclines 
at rest in a warm, quiet, dark room. Stimulation of 
sensory centers, of course, heightens the appreciation of 
sensation. 
The motor areas of the cerebrum, it is thought, contain 
centers that are of importance to the incitement of volun- 
tary movement and to muscular coordination, i.e., the 
control of the muscles which makes the right ones for the 
performance of an act work in unison. 
The cerebellum also helps to control muscular coordi- 
nation and its activity is essential for muscle tone. De- 
pression of the cerebellum and the motor areas of the 
cerebrum will thus result in imperfect muscular coordina- 
tion; an example of the result of this is the staggering gait 
of a drunken man. 
The midbrain consists chiefly of fibers passing to and 
from different parts of the brain and between the brain 
and cord, and of small separated masses of gray matter 
that serve as relay stations for many of these fibers; i.e., 
many of the fibers terminate in this gray matter but form 
synapses with other neurones which transmit their im- 
pulses onward. There is also in the midbrain a mass of 
gray matter that is influenced by the temperature of the 
blood passing through it and, in response to such influence, 
sends impulses to the centers which influence heat pro- 
duction and heat loss. This is known as the heat regulat- 
ing center. There are also other centers in what are known 
as the thalami (small masses of gray matter in the under 
surface of the cerebrum, just above the midbrain) that 
are affected and react in the same manner. The action 
of these heat regulating centers has been already discussed 
in the paragraph on Antipyretics. 
The pons, like the midbrain, consists chiefly of nerve- 
fibers and scattered masses of gray matter some of which 
contain the cell-bodies of cranial nerves. 
The medulla consists of bundles of nerve-fibers, passing 
to and from the brain, and of masses of gray matter THE NERVOUS SYSTEM 
77 
(some of which are the nuclei of cranial nerves) which 
control the vital body functions, such as the rate of the 
heart action, respiration, the caliber of the blood-vessels, 
the activity of many of the secretory glands, swallowing, 
and sucking, also coughing and vomiting. 
There are twelve pair of cranial nerves. They pass 
through foramina in the skull and innervate the sense 
organs, skin, muscles and glands of the head and neck, 
and the tenth nerve, known as the pneumogastric and as the 
vagus, innervates the viscera designated in the section 
describing the autonomic system. 
The spinal cord is contained in the spinal canal, i.e., 
the canal of which the bodies of the vertebrae form the 
front wall and the vertebral arches the back wall. The 
interior of the cord consists of gray matter, massed 
around a minute central canal, and its exterior chiefly 
of columns of nerve-fibers. 
The fibers in the columns on the ventral or anterior 
(front) surface have their origin in the brain and terminate 
in the ventral gray matter. This gray matter contains 
the cell-bodies (with their dendrites) from which the fibers 
arise that pass through the openings between the vertebral 
arches and constitute the efferent fibers of the spinal 
nerves. 
The columns on the dorsal or posterior surface of the 
cord contain the afferent fibers that have their origin in 
the gray matter of the dorsal portion and form synapses 
in gray matter in different parts of the brain. The dorsal 
gray matter contains the cell-bodies (with their dendrites) 
from which these fibers arise and also axons of the afferent 
spinal nerves. The cell-bodies of the latter constitute 
the spinal ganglia, small masses of gray matter in the 
vertebral foramen (spaces between the arches). The 
fibers extending from these ganglia (they are not to be 
confused with the sympathetic ganglia) to the periphery 
constitute the afferent fibers of the spinal nerves. Thus 
an afferent fiber of a spinal nerve has no dendrites, but 
two axons, one of which, as a nerve-fiber, extends to the 78 
MATERIA MEDICA AND PHARMACOLOGY 
periphery and the other enters the gray matter of the 
cord. 
The sides of the cord consist chiefly of connecting 
neurones over which impulses coming into the cord over 
the afferent fibers of spinal nerves are transmitted to the 
efferent fibers and to cells in different levels of the cord. 
If, as the result of a drug, injury or disease, cells in the 
gray matter of the posterior surface of the cord or their 
fibers are depressed, sensation in the parts of the body 
below the affected area will be lost, but unless anterior 
neurones are also affected there will be no paralysis. 
The chief functions of the spinal cord are: (1) The 
transmission of impulses between the brain and the spinal 
nerves and the rami (branches which connect the volun- 
tary and involuntary systems). (2) Reflex action. (3) 
It contains centers which help in the control of the viscera. 
By reflex action is meant an involuntary act or physio- 
logical response produced by nerve impulses that have 
travelled over afferent fibers to nerve-centers and been 
discharged thence over efferent fibers to the affected 
muscles or glands. Though a reflex is involuntary, it 
will be associated with consciousness if the impulses are 
also transmitted to the association areas of the cerebrum. 
There is a constant inflow of nerve impulses from the 
exterior of the body-the skin, eyes, ears, muscles-that 
induce no observable response, but which result in the dis- 
charge of light impulses into the muscles and thus help to 
maintain the condition of light contraction or readiness to 
contract that is known as muscle tone. When the tissue 
of the cord is in a depressed condition, impulses do not 
pass as readily as usual. 
Stimulation of the cord usually means that some 
unknown conditions are caused which facilitate the pas- 
sage of impulses through and from the cord. Over 
stimulation will result in such free passage of impulses 
that very slight stimuli will induce muscular twitching and, 
if very pronounced, convulsions. 
The regions of the cord and the spinal nerves are named 79 
THE NERVOUS SYSTEM 
to correspond with the vertebrae through which the latter 
pass. Thus there are the cervical, thoracic, lumbar and 
sacral regions. 
The autonomic portion of the nervous system, as pre- 
viously stated, controls the action of plain muscle tissue 
and of the glands that are under nervous control. Knowl- 
edge of the relationship of the actions of the nervous 
system and the glands of internal secretion other than the 
suprarenal capsules, is still indefinite. The parts of the 
body containing plain muscle tissue were mentioned on 
page 70. 
Before reviewing the functions of this system it will be 
well to recall the distribution of the ganglia and nerves 
comprising it. 
There are, it will be remembered, three sets of ganglia 
in the thoracic and abdominal cavities. (1) The vertebral 
ganglia, known also as the sympathetic ganglia and the 
ganglionic chain, (2) the prevertebral ganglia, (3) the 
terminal ganglia. 
The vertebral ganglia consist of masses of gray matter, 
connected to each other with nerve fibers, that extend, like 
a chain, on either side of the spinal column, in the thoracic 
and abdominal cavities. White nerve-fibers, some of 
which have their origin in cells of the gray matter of the 
cord and others in the ganglia serve to connect the ganglia 
in the thoracic and upper lumbar regions with the cord. 
These fibers, known as the white rami (branches) serve as 
a passage way for impulses, afferent and efferent, passing 
between the cord and ganglia. Non-medullated fibers 
that have their origin in these ganglia (the gray rami) 
pass out and join the spinal nerves or those from the 
cervical ganglia, upward to join certain cranial nerves. 
These are the route for the passage of impulses from the 
ganglia to the plain muscle tissue and glands outside of the 
trunk cavities. Other non-medullated fibers that have 
their origin in these ganglia pass into the cavities and help 
form the splanchnic (visceral) nerves. Some fibers pass 
directly into the organs and others form synapses with 80 
MATERIA MEDICA AND PHARMACOLOGY 
neurones in the prevertebral and terminal ganglia. The 
prevertebral ganglia are scattered through the thoracic 
and abdominal cavities and are the origin of a large 
number of fibers that extend between the different ganglia 
and organs. They are so numerous and widely distributed 
that they appear as networks (plexuses). Those arising 
in any one ganglia may supply several organs and thus 
they coordinate the activity of organs so that those 
engaged with the same function are influenced by the 
same stimuli. Some of the cells of these ganglia receive 
their efferent stimuli from the vertebral ganglia and others 
from the vagus nerve, or some of those supplying the pelvic 
organs, from the pelvic nerve. The terminal ganglia 
are situated in the walls of the organs they supply and 
fibers pass from them into the organs. They are stimu- 
lated by impulses passing through either of the other 
ganglia or over the vagus or pelvic nerves. 
The parts of the nervous mechanism constituting the 
autonomic system are classified in two subdivisions named 
the sympathetic and the parasympathetic systems; the 
latter is known also as the enteral system and as the great 
vagus-after the vagus nerve which constitutes a large 
portion of this division. 
The parts classified as the sympathetic system are those 
which are stimulated by the drug adrenaline and by strong 
unpleasant emotions, such as rage and fear, and by severe 
pain. 
The physiological reactions to such emotions as rage 
and fear are: The bronchial tubes are relaxed (this favors 
rapid breathing); the heart beats more strongly; the 
blood-vessels of the abdominal viscera are contracted and 
more blood is thus forced to the brain, heart, lungs and 
muscles;'the secretion of perspiration and adrenaline is 
increased; the liver yields more glucose to the blood 
(these reactions are nature's provision for the natural 
animal response to such stimuli as rage and fear; viz., 
fight or flight; for they tend to provide the muscles with 
energy material and to facilitate the removal of the excess 81 
THE NERVOUS SYSTEM 
waste and heat that increased muscular activity involves). 
Also, the radial muscles of the irises are contracted and this 
dilates the pupils; and alternate contraction and relaxation 
of the uterine muscle may be induced. At the same time, 
the contraction of the muscle tissue of the stomach and 
intestines, of the bladder, external genital organs and, as 
previously implied, of the larynx and bronchial tubes is 
reduced; and the secretions necessary for digestion, other 
than sometimes saliva, are inhibited. 
The parts of the nervous system involved in these reac- 
tions are: The cardiac accelerator and vasoconstrictor 
centers in the medulla, neurones in the thoracic and lumbar 
sections of the cord, the sympathetic ganglia and their 
nerves and some of the other ganglia. 
The remainder of the nerve supply to the viscera con- 
stitutes the para-sympathetic system. There are two 
main divisions of this system, termed the cranial and the 
sacral divisions. The former consists of the vagus nerve and 
some neurones associated with the third, seventh and ninth 
cranial nerves. The sacral division consists of neurones 
that have their origin in the sacral portion of the cord, 
the fibers of which constitute what is known as the pelvic 
nerve. The vagus nerve supplies: Both efferent and 
afferent inhibitory fibers to the heart (the afferent fibers 
arise from cell bodies contained in minute ganglia situated 
in the heart muscle; these are stimulated when blood pres- 
sure becomes extreme and the consequent impulses are 
transmitted to both the vagus and vasoconstrictor centers 
and, therefore, tend to slow the heart action and lessen 
the contraction of the blood vessels); afferent and motor 
fibers to the pharynx, esophagus, stomach, small intestine, 
larynx, bronchi and lungs; motor fibers to the muscle tis- 
sue in the spleen and liver; secretory and vasodilator 
fibers to the mucous membrane and glands of the stomach 
and small intestine. The third cranial nerve supplies the 
ciliary muscles of the eyes and the circular muscles of the 
irises with motor fibers. The seventh and ninth cranial 
nerves supply the mucous membranes of the nose and 82 
MATERIA MEDICA AND PHARMACOLOGY 
mouth and the salivary glands with secretory and vaso- 
dilator fibers. The pelvic nerve supplies motor fibers to 
the large intestine and bladder. It is thought probable 
that all the fibers of these nerves which supply the viscera 
form synapses in the prevertebral or terminal ganglia and 
do not themselves enter the organs. 
Stimulation of the 
sympathetic 
Stimulation of the 
para-sympathetic 
Strengthens and increases the 
rate of the heart action. 
Contracts the blood-vessels ex- 
cept those of the brain, heart 
and lungs. 
Increases the change of glycogen 
to glucose. 
Lessens the secretion of the gas- 
tric and intestinal juices and 
possibly the pancreatic juice 
and bile and usually the saliva.1 
Lessens the motor activity of the 
stomach and intestines but con- 
tracts the sphincter muscles. 
Lessens the contraction of the 
bladder. 
Relaxes the muscle tissue of the 
trachea and bronchial tubes. 
Dilates the pupils and relaxes the 
ciliary muscles of the eyes. 
Slows and weakens the heart 
action. (See page 55.) 
Probably dilates blood-vessels 
in the alimentary canal and 
possibly some others. (See 
page 56.) 
Inhibits the change of glycogen 
to glucose. 
Increases the secretion of saliva, 
the gastric and intestinal 
juices and, slightly, the pan- 
creatic juice. 
Increases the motor activity of 
the stomach and intestines and 
relaxes the sphincters. 
Promotes contraction of the 
bladder. 
Contracts the trachea and 
bronchial tubes. 
Contracts the pupils and the 
ciliary muscles. 
In all cases stimulation of inhibitory fibers supplying 
an organ lessens the activity of the latter and depression of 
hSome drugs that stimulate the sympathetic do not check the 
mouth secretions but its stimulation by unpleasant feelings, as 
worry and vexation, and strong emotions, as fear and anger, are 
likely to do so. A practical application of this was made in olden 
times in India, in what was known as "the ordeal of rice." The 
suspected persons were given rice to chew and after a time were 
required to spit it out. If any one ejected it dry, he was judged 
guilty it being considered that fear of discovery had stopped the 
flow of the liquid which keeps the mouth moist. THE NERVOUS SYSTEM 
83 
the inhibitory mechanism has the same effect as stimula- 
tion of the motor or secretory mechanism, namely, in- 
creased activity. Very little is as yet positively known 
regarding the manner in which inhibition is promoted. 
By comparing the results of stimulation of the sympa- 
thetic and para-sympathetic divisions of the autonomic 
system it will be seen that the action of each one in most 
cases, antagonizes that of the other. Important examples 
are seen in the foregoing table: 
Parts of the body that, as far as known, are supplied 
only with fibers belonging to the sympathetic system: 
The sweat gland, the pilo-motor muscles, the uterus and 
the suprarenal capsules, but the sweat glands and the 
uterus are affected by some drugs that act upon the para- 
sympathetic system. 
The only nerves supplying the kidneys are those in- 
nervating the blood-vessels. 
In order to understand the action of drugs upon the 
viscera it is necessary to appreciate the following facts: 
(1) The ganglia through which impulses pass to the vis- 
cera are never stimulated directly by afferent impulses, 
i.e., all impulses reaching them are transmitted through 
centers in the cord and brain and, therefore, any drug 
that acts as a general stimulant or depressant to these 
organs may affect the viscera to some extent. (2) The 
centers of the autonomic system receive stimuli from 
fibers belonging to the sense organs and, thus, the cerebro- 
spinal system. (3) Pronounced stimulation of one 
division of the autonomic system is likely to influence 
some part of the other; for example, (1) pronounced con- 
traction of the blood-vessels stimulates the vagus, as 
described on page 55; (2) strong stimulation of the vagus 
fibers supplying the trachea and bronchi gives rise to the 
spasmodic contractions seen in asthma, and the distress 
and pain thus occasioned stimulates the sympathetic 
system. (4) Depression of one division of the autonomic 
system will have the same results as stimulation of the 
other on organs in which the systems oppose each other. 84 
MATERIA MEDICA AND PHARMACOLOGY 
(5) Especially in the case of the para-sympathetic division, 
all parts are not necessarily affected by a stimulant or 
depressant, e.g., the vagus supply to the heart can be 
stimulated without affecting the supply to the alimentary 
tract, and the vasoconstrictor supply to the skin can be 
stimulated without affecting that of the viscera and vice 
versa. DRUGS WHICH OBTAIN THEIR CHIEF EFFECTS 
BY STIMULATING NERVE CENTERS 
The drugs which obtain the majority of their important 
effects by stimulating nerve-centers are caffeine and strych- 
nine. There are a number of other medicines which pro- 
duce some important effects in like manner, but, as they 
are more commonly used for the results of their other 
actions, they are generally otherwise classified. 
CAFFEINE 
Caffeine or trimethylxanthin is a mildly basic alkaloid 
that, in its chemical structure, is similar to waste sub- 
stances found in the urine and in animal tissues. It is 
prepared chiefly from damaged tea leaves, but it is also 
contained in a number of other plants, especially the 
berry of the coffee tree and in the cola (or kola) nut. 
Preparations and dosage: 
Caffeine, 1-5 grs. (0.06-0.3 gm.). 
Caffeine citrate, 2-8 grs. (0.13-0.5 gm.). 
Effervescent caffeine citrate, 15 (4.0 gm.). 
Caffeine sodium benzoate (2-5 grs. (0.12-0.3 gm.) 
unofficial). 
Guarana, fluidextract of, 30 m.-2 (2.0-8.0 c.c.). This 
contains caffeine and tannin. 
Fate in the Body.-Caffeine is fairly readily absorbed 
from the stomach and intestines, its effects being evident 
in about from M to 1 hour. It is changed to urea in the 
body and in this form eliminated rapidly by the kidneys. 
Actions: 
Caffeine Stimulates: The cerebrum, including (a) the 
association areas, i.e., those which control intellectual 
functions,. as judgment, reasoning, imagination, will 
power, etc.; (6) sensory areas; (c) motor areas. The res- 
85 86 
MATERIA MEDICA AND PHARMACOLOGY 
piratory center, and, slightly, the vasoconstrictor and 
vagus centers and the spinal cord. Also, it stimulates the 
skeletal muscles and in large doses it may stimulate the 
heart muscle to a slight degree. It increases the activity 
of the kidneys by, it is thought, stimulating the tubule 
cells and dilating the renal blood-vessels. 
Results of actions: 
As the result of its action on the cerebrum, caffeine will 
overcome mental fatigue, it will promote wakefulness 
and render the mind more alert so that memory is aided, 
the imagination quickened, ideas and the words in which 
to express them are more readily conceived. Moderate 
doses of caffeine will increase the power of self-control and 
facilitate judgment and concentration of the attention, 
but large doses interfere with these faculties, because the 
mind becomes so active that concentration, which is 
necessary for judgment and reasoning, is interfered with. 
If caffeine is taken when the brain is in its normal condi- 
tion and not fatigued, even moderate doses may have the 
effect of large doses. The stimulation of the sensory areas 
of the cerebrum renders the perception of sensory stimuli, 
such as sight, hearing, smell and pain, more acute. It 
can be easily appreciated that many of the effects of cere- 
bral stimulation may be undesirable in illness. 
The stimulation of the respiratory center causes an 
increase in the rate and depth of breathing. This is one 
of the most valuable therapeutic effects of caffeine. 
The stimulation of the vasoconstrictor center, though 
slight, tends to favor contraction* of most of the vessels 
that are under the control of the vasoconstrictor center 
(those of the brain, lungs and heart are not) and thus to 
cause a slight, transitory rise of blood pressure. The 
renal blood-vessels are relaxed; the reason for this is not 
known, but it is thought to be the result of the increased 
activity of the kidney cells. There will be an increased 
amount of blood in the organs in which the vessels are 
not contracted. 
The stimulation of the vagus tends to slow the heart STIMULATING NERVE CENTERS 
87 
action, but, sometimes, especially in susceptible individ- 
uals, the general nerve stimulation will overcome the vagus 
effect, which is not very strong, and the rate of the heart 
may be accelerated and, occasionally, palpitation is induced. 
As a rule the heart action, and thus the pulse, becomes 
slightly stronger. This may sometimes, possibly, be due 
to a direct stimulation of the heart muscle, but it is 
thought to be more commonly the result of the increased 
blood supply (and thus nourishment and oxygen) that 
the heart receives and the increased blood pressure. 
The stimulation of the spinal cord facilitates the passage 
of impulses to and from the brain and between the cord 
and muscles and the viscera. The increased flow of im- 
pulses to the muscles improves their tone and, after over- 
doses of caffeine, may cause muscular twitching. Caffeine, 
however, does not stimulate the spinal cord to as great an 
extent as strychnine. 
The direct action of caffeine on the skeletal muscles also 
serves to promote their tone and it favors an increase in 
the speed and accuracy of muscular movements and tends 
to retard the onset of fatigue. If an excessive amount 
of caffeine is taken, however, eventually muscle fatigue 
may be increased. 
As the result of its action on the kidneys, caffeine causes 
diuresis. 
To summarize: 
The more important good effects of caffeine may be 
classified under two headings, (1) those for which it is 
used by practically normal individuals and (2) those for 
which it is used in illness. They are: (1) For a relatively 
normal person: Lessening of fatigue; stimulation of the 
intellectual faculties, when these are depressed; relief of 
headache, especially that due to mental strain. Such 
relief is thought to be the result of the improved circula- 
tion in the brain and of the relief of the mental strain 
afforded by the increased ease of thought and power to 
concentrate the attention which follows the cerebral 
stimulation. (2) In illness: Stimulation of breathing; 88 
MATERIA MEDICA AND PHARMACOLOGY 
increased blood-pressure with consequent improvement 
in the circulation and strengthened pulse beat, the rate 
of the pulse may undergo little change, but it may be 
either slightly increased or slowed; increased excretion of 
urine. 
Bad effects that may follow the use of caffeine are: 
Wakefulness, restlessness, palpitation and other nervous 
symptoms; hyperacidity of the gastric juice; nausea; if a 
patient has pain, its perception will be intensified; the 
cerebral stimulation may render a sick person more con- 
scious of the precariousness of his condition. 
The more common therapeutic uses of caffeine are: To 
stimulate the respiratory center when it is depressed or 
when breathing is difficult from any cause. To improve 
the circulation in shock and collapse. To induce diuresis. 
To stimulate the cerebrum in some cases of mental depres- 
sion. To prevent or overcome excessive fatigue. As an 
antidote for poisoning by drugs which depress the nerve- 
centers. Even the effects of caffeine that, under ordinary 
conditions, are unfavorable are of service for this purpose. 
Overdosing and Poisoning.-Acute poisoning by caf- 
feine is very rare because the drug is not strongly toxic and 
it is rapidly excreted. If it is taken in large amounts, 
however, or even in more than slightly moderate doses 
for an extended period (either as the drug or in coffee) 
some or all of the following symptoms may follow: 
Restlessness; insomnia; inability to concentrate the 
attention; headache; frequent pulse; palpitation; profuse 
diuresis; too free response to reflexes which is shown by 
twitching of the muscles and, for example, the individual 
jumps or exclaims on hearing a noise and gives evidence 
of irritation on the slightest provocation. Both of these 
examples show a lack of inhibition which, it will be remem- 
bered, caffeine, in moderate doses, tends to stimulate. 
If poisonous doses are taken, the above symptoms may 
be followed by delirium, convulsion and, finally collapse, 
due to the depression of nerve centers which almost in- 
variably follows their excessive stimulation. STIMULATING NERVE CENTERS 
89 
COFFEE AND TEA 
Roasted coffee contains about 0.6 to 2.0 per cent, 
caffeine, a small amount of caffeole, a volatile oil to which 
its flavor and odor are due, and a varying, but relatively 
large, amount of caffeotannic acid and extractives. 
Tea contains 1-4 per cent, caffeine, a small amount of 
theophyllin, a volatile oil to which its flavor and odor are 
due, tannic acid. Green teas have less caffeine and more 
tannin than black teas. 
Though tea leaves contain more caffeine than coffee, 
there is, as the beverages from these substances are 
ordinarily prepared, less caffeine in a cup of tea than in a 
cup of coffee; a cup of tea containing about 1-2 grains 
(0.06-0.12 gm.) and coffee 1)^-3 grains (0.1-0.2 gm.) of 
caffeine. 
The volatile oil of coffee is slightly stimulating to the 
cerebrum and thus a slight stimulant effect may be ex- 
pected even from preparations such as Kaffee Hag from 
which the caffeine has been extracted. Also, the volatile 
oil and extractives have a slight irritant action in the 
alimentary canal and thus tend to exert a slight laxative 
effect and, in susceptible people, they may promote hyper- 
acidity of the gastric juice and, when a person is indisposed, 
increase nausea. The caffeotannic acid does not precipi- 
tate albumins and alkaloids, as does the tannic acid in tea, 
and thus coffee cannot be used as a substitute for tannin 
in poisoning by alkaloids. It does, however, tend to re- 
tard absorption and digestion, but, unless the coffee is 
boiled, there will be very little of this present in the 
beverage. 
The volatile oil of tea is less irritating to the alimen- 
tary tract than that of coffee and tea can often be taken 
when coffee causes nausea. In fact, a cup of hot tea, with- 
out cream or sugar, will often overcome nausea, especially 
if the patient likes tea. Tea has no laxative effect. 
The tannic acid of tea is astringent and it precipitates 
protein, thus it tends to retard digestion and absorption, 90 
MATERIA MEDICA AND PHARMACOLOGY 
but if the beverage is properly prepared it will not contain 
enough tannin to do this to a harmful degree. The tannic 
acid also precipitates alkaloids and thus strong, boiled 
tea (preferably green) is used in poisoning by alkaloids 
when the pure tannin cannot be obtained. 
NUX VOMICA AND STRYCHNINE 
Nux vomica is obtained from the seeds of several species 
of the trees classed as the Strychnos which grow in the 
East Indies and some other tropical Oriental countries. 
The seeds are known as poison nut and, because they are of 
a gray color and button-shape, Quaker buttons. 
The active principles of nux vomica are the alkaloids 
strychnine and brucine. These both have the same ac- 
tions, but brucine is only about as strong as strychnine. 
As the therapeutic actions of nux vomica are, of course, 
due to its active principles, they are practically the same 
as those of strychnine, but weaker. 
Preparations and dosage: 
Extract of nux vomica, %-l gr. (0.01-0.06 gm.). 
Fluidextract of nux vomica, 1-5 m. (0.06-0.3 o.c.). 
Tincture of nux vomica, 5-15 m. (0.3-1.0 c.c.). 
Strychnine, gf- (0.0016-0.004 gm.). 
Strychnine sulphate, gr. (0.0016-0.004 gm.). 
Strychnine nitrate, gr. (0.0016-0.004 gm.). 
N on-official preparations: 
Iron and strychnine citrate 2 grains (0.13 gm.). 
Elixir of iron, quinine and strychnine phosphate, 1-2 
drams (4.0-8.0 gm.). 
Syrup of iron, quinine and strychnine phosphate, 1-2 
drams (4.0-8.0 gm.). 
Compound laxative pills (containing aloin, belladonna 
and strychnine), 1-2 pills. 
Administration.-When used as tonics, strychnine and 
nux vomica are given by mouth and before meals and 
nothing must be done to disguise their taste. When used 
for other purposes the time of administration is not of 
importance. STIMULATING NERVE CENTERS 
91 
Fate in the Body.-Strychnine is readily absorbed. 
Part of a dose is oxidized in the tissues and the remainder 
is eliminated in the urine. Its excretion is moderately 
rapid, traces being detected in the urine soon after a dose 
is given, but, if large doses are taken for any length of time, 
enough may be retained in the body to cause cumulative 
poisoning. 
Actions: 
In the mouth, strychnine stimulates those taste-buds 
which are influenced by bitter substances. 
After absorption, it stimulates the spinal cord and, 
slightly the cerebrum, especially the sense areas; sometimes 
it tends to stimulate the vagus, vasoconstrictor, and respi- 
ratory centers and apparently the vasodilator centers 
supplying the vessels in the skin. Some investigators 
believe that, in therapeutic doses, strychnine merely 
increases the sensitiveness of the vasoconstrictor and 
respiratory centers, thus rendering them more easily 
stimulated by other drugs and by the physiological 
stimuli which normally affect these centers. Toxic doses 
first stimulate and then depress the respiratory center. 
Strychnine stimulates the cord more, and the brain less, 
than caffeine. 
Effects of actions of therapeutic doses: 
By its action on the taste-buds, strychnine promotes the 
secretion of saliva and gastric juice and stimulates the 
appetite and thus aids digestion. This is further discussed 
under bitters. 
The stimulation of the spinal cord permits impulses to 
pass more readily through this organ and out along motor 
nerves. The increased amount of stimulus thus thrown 
into the muscles increases their tone. Plain muscle 
tissue, especially that of the stomach, intestines and 
bronchi, is similarly affected; thus the motor activity of 
the stomach and intestines is increased and digestion, 
absorption and defecation favored. The effect on the 
bronchial muscle is of value when this is relaxed, but, it 
is undesirable in conditions such as asthma. 92 
MATERIA MEDICA AND PHARMACOLOGY 
The increased muscular contraction augments metab- 
olism. Ordinarily, this would cause a rise of tempera- 
ture, but, as the superficial blood-vessels tend to become 
somewhat relaxed, the amount of blood near the surface 
of the body is increased and the extra loss of heat which 
this involves is proportionate to the increased heat 
production, provided this is not excessive, as is the case 
following toxic doses of the drug. 
The pulse tends to become somewhat slower, due to the 
stimulation of the vagus, and, after several doses of strych- 
nine have been taken, the circulation may be improved. 
This is thought to be due chiefly to the increased muscle 
tone. 
Ordinarily, therapeutic doses have not much effect upon 
breathing, but the rate and depth may be slightly in- 
creased, especially if they have been below normal, and 
strychnine is thought to aid the action of other drugs in 
overcoming depression of the respiratory center due to 
narcotic drugs. 
The results of cerebral stimulation are similar to those 
induced by caffeine, but much less marked. 
To Summarize the Good Effects that may be Obtained 
from the Use of Strychnine.-There may be improvement 
in the appetite and digestion; in the action of the bowels; 
in general muscle tone and the circulation of the blood 
and lymph with a consequent improvement in body 
nutrition. In order to derive such benefit from strych- 
nine, however, it is necessary for the individual to have an 
adequate supply of nutritious food and to be in a state to 
respond to the increased metabolism which the heightened 
muscular tone involves. The use of strychnine without 
these requirements has been likened to " whipping a 
horse to make it get up after it has fallen from 
exhaustion." 
The more common therapeutic uses of strychnine are: 
As a general tonic. 
To increase the appetite and aid digestion; nux vomica 
is generally used for this purpose. STIMULATING NERVE CENTERS 
93 
To increase muscle tone in some forms of paralysis and 
the tone of the intestine in chronic constipation. 
As a physiological antidote in the treatment of poisons 
which depress the spinal cord and respiratory center. 
Toxicology: 
The chief symptoms of overdosing by strychnine are 
due to the lowered resistance1 to the passage of impulses 
in the cord and the excessive discharge of impulses into 
the muscles. They are: Restlessness; nervousness, which 
is shown especially by intense reflex response to stimuli;2 
stiffness and twitching of muscles, particularly those of 
the face; and, especially when overdosing is due to cumula- 
tive effects, diarrhea. 
Following toxic doses there will be: Stiffness of the mus- 
cles of the face and neck and spasmodic twitching of these 
and other muscles followed by a convulsion in which all 
the voluntary muscles are involved, but, as the extensor 
muscles are stronger than their opponents, their action is 
most evident and the legs and arms become rigid and ex- 
tended and the back and head drawn backward so that 
the body becomes arched. The eyes are open and the 
muscles of the face drawn up in such a manner that a 
ghastly grin is caused. At first the convulsion is tonic 
(i.e., the muscles remain constantly rigid), but after a time 
it becomes clonic (i.e., the muscles periodically relax and 
contract) and this condition is followed by extreme 
relaxation of the muscles and the patient lies exhausted, 
but the slightest stimulus, such as a light, a jar of the 
bed, even movement of the covers or a draft of air, may 
cause another convulsion, for the convulsions are the 
result of the abnormal ease with which impulses pass 
through and from the cord. The face becomes cyanotic 
because the spasms of the chest muscles interfere with 
breathing. Due to the increased metabolism, as the 
result of the'excessive muscular contraction, the tempera- 
ture may become exceedingly high. As the cerebrum is 
1 This was explained on page 73. 
2 This was explained on page 78. 94 
MATERIA MEDICA AND PHARMACOLOGY 
stimulated, the patient is likely to be conscious and his 
perception of pain so increased that he may suffer agony 
during the convulsions. 
Unless treatment is effectual, convulsions become more 
and more frequent and the patient dies either from exhaus- 
tion or from asphyxia and the latter may be due either to 
interference with breathing during a convulsion, or to 
exhaustion of the respiratory center. 
Treatment for Poisoning.-If the drug has been taken 
by mouth, the stomach is lavaged and strong tea or 
preferably tannic acid is given and in a few minutes re- 
moved by lavage. This is essential because the tannate 
of strychnine that is formed is not altogether harmless 
and it will be absorbed, though not as readily as the 
medicinal strychnine salts. If tea is used the lavage must 
be particularly thorough because the caffeine in the latter, 
if absorbed, will stimulate the already over-stimulated 
nerve-centers. 
The patient is catheterized at relatively short intervals 
to prevent the reabsorption of any strychnine from the 
bladder. 
The doctor is likely to give an intravenous infusion, to 
hasten the elimination of the drug, and an intraspinal in- 
jection of magnesium sulphate, this drug having the 
opposite of effect of strychnine on the spinal cord. 
Drugs that act as nerve sedatives, especially bromides 
and paraldehyde, are prescribed. Morphine cannot be 
used because of its depressing action on the respiratory 
center. 
Absolute quiet is one of the most essential items in the 
treatment and the room must be dimly lighted and free 
from draughts, though well aired. 
If treatment is not started before the symptoms of 
poisoning are evident, which will be in from 10 to 20 
minutes from the time the dose is taken, the patient is 
generally anesthetized before giving lavage, etc., for, 
otherwise, the treatments may induce a convulsion. STIMULATING NERVE CENTERS 
95 
CARBON DIOXID (CO2) 
Though carbon dioxid is very rarely used to stimulate 
nerve-centers, and very frequently employed for the 
effects of its local actions and, therefore, according to the 
classification followed in this book, should be grouped with 
drugs that are used chiefly for the effects of their irritant 
action on mucous membranes, it is described here because 
knowledge of the symptoms that follow the administra- 
tion of an excessive amount by inhalation, or without an 
adequate quantity of oxygen, will be of help in under- 
standing the symptoms of poisoning by a large number of 
drugs discussed later; for, as stated in the section on 
Toxicology, poisonous doses of almost all drugs interfere 
to some extent with, either or both, the elimination of 
carbon dioxid from the system and the intake of oxygen. 
Another fact that makes its description here appropriate 
is that, though it is used to stimulate nerve-centers, its 
actions are very similar to those of the general anesthetics 
described in the section following, an important difference 
being that carbon dioxid can be so administered that a 
moderate degree of stimulation can be maintained for 
some time and depression need not be induced. Like the 
anesthetics, carbon dioxid can only be given by inhalation 
by those who are specially instructed. 
Carbon dioxid is a heavy, tasteless, odorless, colorless 
gas. At a low temperature it can be readily condensed to 
a liquid and even solidified. It is freely soluble in water 
and it combines with water to form an unstable compound 
with a slightly acid reaction, that is known as carbonic 
acid. 
Carbon dioxid is formed whenever organic matter is 
burned or otherwise decomposed in the presence of air or 
of free oxygen and also when the inorganic salts known as 
carbonates are heated or interact with acids. 
Actions.-In more than moderate concentrations, 
carbon dioxid is irritant to the skin and mucous mem- 
branes. Its actions after absorption are only produced 96 
MATERIA MEDICA AND PHARMACOLOGY 
when it is given by inhalation, in such case moderate 
amounts stimulate nerve-centers, especially the respira- 
tory center, and the heart muscle, larger amounts are 
depressant. 
Effects of Actions.-Liquid and solid carbon dioxid act as 
escharotics. 
If a person remains for some time in a bath of water that 
is charged with carbon dioxid the skin may be sufficiently 
irritated to cause a slight dilation of the superficial blood- 
vessels and a consequent increase in the amount of blood 
in the skin, which is shown by a slight flushing of the 
latter. 
Mucous membranes are more easily affected than the 
skin and thus beverages containing carbon dioxid increase 
the amount of blood in the membrane of the mouth and 
stomach, stimulate the secretion of mucus, saliva and 
gastric juice and cause the expulsion of gas from the 
stomach, in other words, they act as carminatives, as 
described on page 53. The extra blood in the membrane 
creates a sensation of warmth and well-being; digestion 
and absorption are aided, nausea may be overcome and 
patients with gastric disturbances who vomit other 
foods are often able to retain carbonated beverages, such 
as champagne, milk to which a carbonated water has been 
added or milks in which carbon dioxid has been developed 
by fermentation as koumiss and matzoon. 
The carbon dioxid in beverages is readily absorbed from 
the stomach and intestines but it is so quickly eliminated 
through the lungs that the small amounts taken in this 
way have practically no effect after absorption, but 
when carbon dioxid is given by inhalation, diluted with 
oxygen or air to 6 per cent., there may be some intellectual 
stimulation, the breathing movements become deeper and 
easier, there is a rise of blood pressure and slowing of the 
heart action. If the inhalations are too long continued, 
but an adequate supply of oxygen is given, the breathing 
becomes relatively slow and shallow; the pulse becomes 
weak, but remains slow; consciousness is lost; the muscles STIMULATING NERVE CENTERS 
97 
relax. The conditions of this stage are very similar to 
those existing in ether and chloroform anesthesia. If they 
are allowed to progress collapse and death will ensue. 
If the oxygen supply is limited when carbon dioxid is given 
in excess, and in poisoning by drugs that in any way inter- 
fere with the absorption of sufficient oxygen, the stage of 
stimulation is transient and, in addition to the symptoms 
of depression just described, dyspnea and cyanosis become 
extreme, convulsions then follow and, unless the condition 
is ameliorated, collapse and death. 
Therapeutic Uses.-Liquid and solid carbon dioxid are 
used to remove warts and similar growths. 
Baths of carbonated water are used for the relief of 
chronic congestions. 
Carbonated beverages and drugs, such as sodium 
bicarbonate, that release carbon dioxid when they come in 
contact with the acid of the gastric juice are used to relieve 
nausea. Carbonated food beverages are often used 
when other food is vomited and effervescent preparations 
are made of many drugs that are likely to cause nausea; 
as previously stated the effervescence is due to carbon 
dioxid that in the majority of such preparations, is formed 
by the interactions of an acid and an alkali. 
Carbon dioxid is occasionally given by inhalation to 
stimulate the respiratory center, especially in the treat- 
ment of poisoning by drugs, such as opium, that depress it. DRUGS WHICH PRODUCE THEIR CHIEF EFFECTS 
BY DEPRESSING NERVE CENTERS 
NARCOTICS 
Drugs which will depress the cerebrum sufficiently to 
produce unconsciousness without causing death, are classed 
as narcotics.1 
The narcotics are usually considered in four sub-groups, 
viz.; (1) general anesthetics, those used to produce a 
sufficiently profound narcosis to allow surgical operations 
to be performed without causing pain; (2) alcohol; (3) 
hypnotics or soporifics, those which, in therapeutic doses, 
produce a state of stupor resembling sleep; (4) analgesics, 
those which relieve pain by depressing sensory centers 
the more powerful analgesics will also act as hypnotics. 
General Anesthetics 
The general anesthetics in common use are: Ether, 
chloroform, ethyl chlorid, ethyl bromide, nitrous oxid, 
pental, magnesium sulphate. Also various mixtures of 
these anesthetics are used, the most common ones being 
(1) what is known as A.C.E., which is a mixture of alcohol, 
chloroform and ether; (2) Anesthol, a mixture of chloro- 
form, ether and ethyl chlorid. 
HISTORY OF ANESTHETICS 
Alcohol, in intoxicating quantities was, as far as is 
known, the first drug used to lessen pain during surgical 
operations. The use of nitrous oxid for the purpose was 
suggested by Dr. Davy in 1798, but his suggestion was not 
followed and a Dr. Wells, who advocated its use in 1844, 
is generally given credit for the discovery of the anesthetic 
properties of this gas. Ether was used by Dr. Long in 
1 From, the Greek narke = numbness. 
98 GENERAL ANESTHETICS 
99 
1842, but he did not publish an account of his work and 
thus Drs. Morton and Jackson, who demonstrated the 
use of ether in 1845, are generally credited with its dis- 
covery. Chloroform was introduced by Dr. Simpson 
in 1847.1 
ETHER 
Ether is produced by the action of sulphuric acid on 
alcohol. It evaporates rapidly and the vapor, when mixed 
with air, is exceedingly inflammable. Therefore, ether 
must be kept in a cool place and it must never be brought 
near a flame. 
Preparations and dosage: 
For the therapeutic uses of ether other than anesthesia: 
Ether, 10-15 m. (0.6-1.0 c.c.). 
Spirits of ether, ^-13 (2.0-4.0 c.c.). 
Compound spirits of ether (Hoffmann's anodyne), 
13 (4.0 c.c.). 
(This contains ether, alcohol and ethereal oil.) 
Spirits of nitrous ether (Sweet spirit of niter) 30 m. 
(2.0 c.c.). 
The amount of ether used for anesthesia depends upon 
the nature of the operation. As ether is eliminated very 
rapidly its use can be continued for some hours without 
bad effects if it is sufficiently diluted and only enough used 
to keep the patient in the condition known as the third 
stage of anesthesia. 
Methods of Administration.-Small doses of ether and 
its compounds are given by mouth to obtain the effects 
of their action on the mucous membrane of the alimentary 
tract. Small doses of ether are also, occasionally, given 
by hypodermic to stimulate the heart action. To induce 
anesthesia, ether is usually given by inhalation, but it is 
also given by rectum, intravenously, and by intratracheal 
and intrapharyngeal insufflation. 
As ether irritates body tissues, it must be diluted before 
1 This data was obtained from Pharmacology and Therapeutics 
or the action of Drugs. Cushny, Lea and Febiger. 100 
MATERIA MEDICA AND PHARMACOLOGY 
or during administration. Water is the diluent used for 
administration by mouth; oil, for rectal administration; 
normal saline or Ringer's solution, for intravenous; and 
air, for inhalation and insufflation. 
Fate in the Body.-Ether is rapidly absorbed by the 
blood from the mucous membranes of the alimentary tract, 
the lungs and subcutaneous tissues. It is distributed by 
the blood throughout the body, but is taken up chiefly 
by the cells of the cerebrum. The reason for this is 
thought to be a special affinity for certain lipoid substances 
that are far more abundant in the cerebral protoplasm 
than that of other tissues. Ether is rapidly excreted, 
chiefly through the lungs, but, also through the kidneys. 
A small dose will have left the body in about hour and 
the amount used for anesthesia, during even an extensive 
operation, within 24 hours. 
Actions : 
Ether stimulates olfactory nerve-endings and certain 
taste buds. 
Ether is very volatile and, when a part to which it is 
applied is exposed, the ether passes away so quickly that 
it does not affect the tissue otherwise than by abstracting 
the heat that it requires to further its evaporation. But 
ether dissolves fat and fat-like substances and, in this and 
other unknown ways, it affects protoplasm with which it 
remains in contact, for even a short time, with the follow- 
ing results: It causes local irritation, this, when the drug 
is taken by mouth or inhalation, includes the mucous 
membrane of the alimentary canal and, in the latter form 
of administration, the respiratory tract. It irritates the 
organs through which it is excreted (lungs and kidneys); 
and sometimes the heart muscle. If taken in large enough 
amounts it depresses nerve centers, some more readily 
than others, so that, the depression occurs in the following 
order: First the psychic centers, and their intellectual and 
inhibitory faculties are primarily affected; next the sensory 
centers; then the cerebral motor and the spinal reflex 
centers; the medullary centers are affected last and to the GENERAL ANESTHETICS 
101 
least extent; in fact, these centers, as a rule, if the ether is 
properly administered, show few, if any, signs of depres- 
sion and there is evidence of at least a temporary stimu- 
lation. Whether this stimulation is due to direct irritation 
of the centers by the ether or to reflexes induced by the 
irritation of the mucous membrane, is not known. The 
vasodilator centers supplying the skin and the sweat cen- 
ters are apparently stimulated throughout the anesthesia, 
as the result of the local irritation. 
Ether tends to disintegrate red-blood corpuscles by 
abstracting their fat, but the amount generally absorbed 
during anesthesia is not sufficient to do this to a harmful 
degree. 
When small amounts are taken by mouth, the effects 
of its local action are practically the only ones observed. 
Ether has a slight depressant action on the protoplasm 
of bacteria. 
Effects of Actions: 
Ether is an antiseptic and, because of its action on fat, 
a good detergent. 
If ether is applied to the skin and allowed to evaporate 
it will, by abstracting heat, cool it and, as cold depresses 
protoplasm and thereby lessens the sensitiveness of nerve- 
endings, ether has a slight local anesthetic effect. But, as 
ether causes irritation of tissue with which it remains in 
contact, if it is applied to the skin and covered, so that 
its immediate escape is hindered, it has the effects of a 
rubefacient counterirritant, described page 57. 
When a small amount of ether is given by mouth the 
stimulation of the nerve-endings of taste and smell in- 
creases the secretion of saliva, while the irritation of the 
mucous membrane, increases the amount of blood in the 
membrane and gives rise to reflexes that have both local 
and systemic effects. The local effects are increased 
secretion of mucus and contraction of the muscle tissue of 
the alimentary canal. As the result of the contraction 
of the muscle tissue, gas may be expelled from the stomach 
and intestine and, if a large, but not anesthetic, amount 102 
MATERIA MEDICA AND PHARMACOLOGY 
of ether is taken, it may cause vomiting. The systemic 
effects are due chiefly to reflex stimulation of the respira- 
tory, vasoconstrictor, vasodilator, and cardiac accelerator 
centers, and, possible psychic centers. As is typical of 
reflex stimulation, the effects are instantaneous, but tran- 
sitory. They are: Increase in the rate and depth of breath- 
ing, and in the rate and force of the heart action; a slight 
rise of blood pressure, due to the effect on the heart and 
the contraction of the deeper arteries; a slight dilation of 
some of the skin-vessels. These effects may help to over- 
come faintness. The stimulation of psychic centers may 
possibly increase their inhibitory power sufficiently to 
help a person control an inclination to give way to emotion. 
The heart muscle may be temporarily stimulated by a 
small amount of ether after its absorption but, otherwise 
it is not as a rule directly affected to any extent, except 
by poisonous doses or prolonged anesthesia when it tends 
to be depressed. 
When ether is given by inhalation in sufficient quan- 
tities to produce anesthesia, the irritation of the mucous 
membrane is excessive and, until the centers are de- 
pressed, the effects just described, except the stimula- 
tion of the higher cerebral centers, are very pronounced. 
The pychic centers are so quickly depressed by large 
amounts of ether that their primary reflex stimulation is 
not apparent. The results are as follows: 
The local congestion of the mucous membrane of the 
throat involves the Eustachian tubes. This changes the 
circulation and the air pressure within the ears and tends 
to promote sensations of ringing, buzzing and dizziness. 
The excessive mucus in the throat and the presence of 
the inhalation mask interfere with the free interchange 
of respiratory gases and thus a state of partial asphyxia 
is produced. This condition is likely to be increased, if 
the patient struggles, for the breathing will then be in- 
terfered with. The patient becomes cyanosed in propor- 
tion to the degree of asphyxia produced. 
The distress occasioned by the irritation, congestion, GENERAL ANESTHETICS 
103 
asphyxia and, sometimes, fear, cause very pronounced 
stimulation of sympathetic and other reflex centers with 
the following results: The rate and force of the heart 
action are increased. There is a decided rise of blood 
pressure, due to the effect on the heart and the contraction 
of the majority of blood-vessels. The vessels in the skin, 
however, are dilated and, therefore, the latter is flushed 
and, if properly protected, warm. Perspiration is pro- 
fuse. The breathing, if not interrupted by the patient 
struggling, is quicker and deeper than usual. The pupils 
are dilated, due to the stimulation of the sympathetic 
nerve supplying the radial muscles of the irises. Muscle 
tone is increased. 
The partial depression of psychic centers involves loss 
of memory, the power of self-control and ability to reason, 
and the patient is likely to become very excited and 
emotional and to cry, shout, laugh, sing, struggle. Con- 
sciousness is dulled at this stage but not entirely lost. 
As soon as enough ether has been absorbed to produce 
unconsciousness the effects of reflex stimulation cease, 
because the nerve-centers are too depressed to respond to 
the stimuli coming in over the afferent fibers. Breathing 
becomes slower and more shallow though, normally, not 
more so than before the administration of the anesthetic 
was commenced. As more air and less ether is given at 
this stage, there is less asphyxia and thus little, or no, 
cyanosis. Blood pressure and the rate of the pulse also 
become about what they were previous to their stimula- 
tion. The skin vessels remain dilated, but those of the 
kidney may be constricted for some time, especially if 
there was a marked degree of asphyxia. Perspiration 
continues to be profuse. Muscle tone becomes dimin- 
ished. The skeletal muscles, except those concerned 
with respiration (these continue to receive impulses from 
the respiratory center) are more affected than the plain 
muscle tissue. The tone of the muscle tissue of the iris 
is an exception, this, normally, is not diminished. The 
pupils, as excitement subsides, contract to the degree 104 
MATERIA MEDICA AND PHARMACOLOGY 
that is usual in natural sleep. All reflexes that can be 
tested, except the response of the pupils to light, are 
abolished by the time that sensation is sufficiently dulled 
to allow cutting to be done without causing pain. The 
last reflex to be lost, with the exception of that just men- 
tioned, is the response of the eyeball to pressure. 
As the result of the depressed condition of the nervous 
system and muscular relaxation, metabolism is inhibited 
and this, and the excessive loss of heat (resulting from the 
extra amount of blood in the dilated skin vessels and the 
free perspiration) cause a decided reduction of 
temperature. 
The extra loss of water from the blood through the 
sweat glands and the lessened amount of blood in the renal 
vessels (due to their contraction and to the unusual amount 
of blood in the skin vessels) inhibits the secretion of urine. 
The kidney cells are sometimes harmfully affected. 
Whether this is due to their direct irritation by the ether 
or to the interference with their blood supply is not 
definitely known, but the latter is thought to be at least 
partly responsible, if the kidneys are thus affected there 
will be albumin and, sometimes, casts in the urine. Oc- 
casionally there is acetone in the urine for a day or two 
after operation, this indicates defective metabolism. 
The various results of the peripheral irritation and the 
central depression that ether induces give rise to fairly 
distinct phases in the process of anesthetization. These 
are termed the three stages of anesthetization or, some au- 
thorities count the final condition of the third stage, that 
in which the operation is performed, as a fourth stage. 
The first stage includes the period in which the patient 
is fully conscious of the distress occasioned by the condi- 
tions brought about by the irritation of the ether and the 
partial asphyxia, but, unless very nervous, is able to exert 
self control. 
The second stage is the interval in which the effects of 
peripheral irritation and the stimulation of the sympa- 
thetic system (by distress, fear, etc.) and the depression GENERAL ANESTHETICS 
105 
of the higher psychic powers are most marked. It is 
often termed the stage of excitement, because of the intense 
excitement and lack of self-control commonly exhibited, as 
described on page 103. The patient is still conscious 
during this stage, though consciousness is blunted and, 
apparently, the condition of the brain tissue does not 
allow the production of the unknown effects which con- 
stitute the formation of memories for, upon recovery from 
the anesthetic, the patient does not remember anything 
that occurs from the beginning of this stage until the 
effects of the ether upon the brain subside. This stage may 
last only a few minutes, but it is likely to be prolonged if 
the patient is nervous or addicted to the overuse of 
alcohol. 
The third stage is considered to begin with the loss of 
consciousness and the cessation of the signs of stimulation, 
as described on page 103. Ordinarily, if the ether is 
properly administered and the patient is not in a serious 
condition, this stage can be maintained for an hour or 
two or even longer, without bad effects, but, if the depres- 
sion of nerve-centers, especially those of the medulla, 
exceeds that described as normal in this stage, collapse is 
likely to follow. 
When death occurs as the result of ether anesthesia it 
is nearly always due to depression of the respiratory center. 
Symptoms of danger are: Slow, shallow, or irregular 
breathing, cyanosis, increasing rapidity and weakness of 
the pulse, dilation of the pupils without other symptoms 
of returning consciousness. This effect on the pupils 
indicates the depression of the nerve-centers controlling 
the muscles of the irises and it has been found that when 
these centers are depressed, fatal depression of the vital 
centers is imminent. 
Treatment.-The anesthetic is discontinued and the 
head of the table lowered. Drugs which have the oppo- 
site action of ether on the brain and spinal cord-as 
caffeine, strychnine, and atropine-are generally given 
and, if necessary a saline infusion and artificial respiration. 106 
MATERIA MEDICA AND PHARMACOLOGY 
Also, if the latter is necessary, the rectum is usually 
stretched by the introduction of a speculum, because 
this causes reflex stimulation of the respiratory center. 
It is particularly important that the patient be kept 
covered and warm during this treatment. 
Prophylactic Measures.-Untoward effects are far more 
likely to occur if a patient is in poor health or weak from 
want of rest and food, or if the first and second stages of 
anesthetization are prolonged-the excitement in these 
stages by overstimulating the nerve-centers- favors their 
subsequent depression. For these reasons, it is customary, 
if the patient is in poor health, unless an immediate 
operation is required, to postpone it until measures to 
build up the health have been tried. To prevent bad 
effects from lack of food, glucose is sometimes administered 
by rectum or intravenously and, to lessen acidosis from 
delayed metabolism, sodium bicarbonate may be given 
with it. To shorten the primary stages, morphine is 
commonly given and, to prevent the depressant action 
of the morphine on the respiratory center as well as to 
check the secretion of saliva and mucus, atropine or 
scopolamine is given with the morphine. 
After the anesthetic is discontinued and the centers 
begin to regain their sensitiveness, conditions similar to 
those that occur in the second stage again become more or 
less evident. Also the patient is likely to be nauseated 
and the excessive amount of mucus, which is saturated 
with the irritant ether, is largely responsible for this as it 
falls into the stomach and acts as an emetic. The degree 
of excitement and nausea vary greatly in different indivi- 
duals. They are likely to be greater in nervous people 
and when a large amount of ether has been given. If the 
patient is not disturbed by nausea, pain or excitement, he 
is likely to sleep the greater part of the time until the ether 
has been eliminated. 
As the care that a patient requires before, during and 
after anesthesia is described in all text-books of nursing 
procedures, space will not be taken to discuss it here. GENERAL ANESTHETICS 
107 
When ether is administered by rectum there will be 
the same inflow of impulses from the irritated membrane 
as when it is given by inhalation, but the choking sensa- 
tions, ringing in the ears, etc., due to excess mucus and 
the congestion of the membrane in the throat will be 
lacking. The irritation of the intestinal membrane, 
however is apt to be very severe. When the ether is 
given intravenously, the reflex stimulation is lacking 
and anesthesia is produced in a few minutes. 
CHLOROFORM 
Chloroform is a colorless, non-inflammable, very volatile 
liquid. It is formed by the chemical interaction of alcohol 
and chloral. It has a sweetish, burning taste. It is 
readily decomposed by light and thus must be kept in dark 
colored bottles. 
Preparations and Dosage: 
For external use: 
Chloroform liniment, this consists of chloroform 30 per 
cent, and soap liniment 70 per cent. 
For internal administration: 
Chloroform, 3-10 m. (0.2-0.6 c.c.). 
Emulsion of chloroform, ^-1 5 (2.0-4.0 c.c.). 
Spirits of chloroform, ^-1 3 (2.0-4.0 c.c.). 
Chloroform water, 2-4 3 (8.0-15.0 c.c.). 
Comparison of the Effects of Chloroform with Those of 
Ether.-With the exceptions here mentioned the actions 
of chloroform are similar to those of ether: 
1. Chloroform is more irritant than ether. It is a 
general protoplasmic poison and, if concentrated, will 
destroy any tissue with which it remains in contact. If 
it is dropped on the skin and its evaporation interfered 
with, it is likely to cause blistering. For this reason the 
skin of the face is protected with vaseline or similar sub- 
stance before giving chloroform inhalations. 
2. The destructive action of chloroform on bacteria is 
much greater than that of ether. Chloroform is antiseptic 108 
MATERIA MEDICA AND PHARMACOLOGY 
in solutions as dilute as per cent. Its irritant and 
volatile properties, however, limits its use as a disinfectant. 
3. Chloroform does not evaporate as quickly as ether 
and thus it does not chill the skin to the same extent nor 
does it act as a local anesthetic. 
4. Chloroform in concentrations above 0.5 per cent, will 
inhibit the action of enzymes, including those which aid 
digestion and metabolism. In concentrations below 0.5 
per cent., however, it aids the action of rennin and pepsin. 
5. Though chloroform is more irritant than ether to 
mucous membranes, so much less is used to promote 
anesthesia, and so much more air is given with it, its 
irritant action on the mucous membrane of the respiratory 
tract and alimentary canal is less marked. Therefore, it 
causes less hypersecretion of saliva and mucus; less 
asphyxia and the conditions that asphyxia promotes, 
especially cyanosis and diaphoresis; also, nausea and 
vomiting are not as likely to occur. 
6. Chloroform promotes anesthesia more rapidly than 
ether; its depressant action on the cerebrum being 3 to 3^ 
times greater than the latter. Thus, the first and second 
stages of anesthesia are passed through more rapidly 
than when ether is used. 
7. Chloroform has a much more depressant action on 
the heart muscle. 
8. Chloroform after temporarily stimulating the vaso- 
constrictor center depresses it and thus reduces blood 
pressure. Because of this action and the effect on the 
heart muscle, the pulse, during chloroform anesthesia, 
is likely to be weak and slow and death from heart failure 
is not uncommon. Also the relaxed conditions of the 
blood-vessels limits the amount of blood sent to the skin 
and, consequently, it is pale. 
9. Chloroform has a much more depressant effect upon 
the respiratory center and thus breathing is relatively slow 
and shallow during chloroform anesthesia. 
10. Chloroform interferes with metabolism to a much 
greater degree than ether and it is more injurious to the GENERAL ANESTHETICS 
109 
tissues. Therefore, following chloroform anesthesia, the 
urine is likely to contain products of imperfect oxidation 
as acetone, an increased amount of ammonia salts and a 
corresponding decrease of urea (which is a product of the 
decomposition of ammonia compounds resulting from the 
catabolism of proteins); also, as the result of the ill effects 
of chloroform on the liver, there may be bile and glucose 
in the urine; and, in consequence of injury to the kidneys, 
albumin and casts. The reason that there is glucose in 
the urine, is that the liver cannot store the glycogen as 
usual. 
If too much chloroform is used, or if it is administered 
several times at short intervals, its injurious action on the 
tissues is likely to cause fatty degeneration of some or all 
of the internal organs and thus promote the conditions de- 
scribed in the paragraph on delayed chloroform poisoning. 
Thus it can be seen that, though chloroform has some 
advantages over ether as an anesthetic, it has several 
serious disadvantages. 
To summarize: Its advantages are: 1. Chloroform 
anesthesia is produced and recovered from more rapidly 
than ether. 
2. There is practically no irritation of the bronchi, 
lungs and alimentary tract and thus there is less hyper- 
secretion of saliva and mucus, less congestion of the mucous 
membrane, and, consequently, fewer unpleasant sensations, 
and less neasea and vomiting. 
Its chief disadvantages are: 1. Its depressant action 
on the heart muscle and the vasoconstrictor and respira- 
tory centers; 2. Its tendency to cause delayed chloroform 
poisoning. 
Toxicology: 
Sudden death from heart failure is not uncommon during 
chloroform anesthesia and it is particularly likely to occur 
during the first and second stages; because the weakened 
heart muscle is unable to stand the resistance offered to 
it by the primary contraction of the blood-vessels, that 
is caused by the temporary stimulation of the vasocon- 110 
MATERIA MEDICA AND PHARMACOLOGY 
stricter center. In the third stage death may occur 
either as the result of the reduced blood pressure or paral- 
ysis of the respiratory center. 
Death may occur almost without warning, but it is 
generally preceded by the following symptoms of poisoning: 
The pulse becomes slow and weak, the breathing slow and 
shallow, the skin assumes a bluish pallor; the pupils dilate 
widely. 
The treatment for acute poisoning is the same as for 
that by ether and other depressant drugs, except that, as 
a rule, the patient's position (lowering the head) is not 
changed at first, because even this much disturbance is 
likely to precipitate collapse. 
Delayed chloroform poisoning, as previously stated, is 
the result of the interference with metabolism in conse- 
quence of which the tissues of some or all of the internal 
organs become degenerated and there is an accumulation 
of the products of defective metabolism in the body 
The symptoms, which may appear in a few hours or not 
for several days, are: Delirium alternating, as a rule, with 
periods of stupor. Continued vomiting with, possibly, 
after a time, blood in the vomitus. The pulse becomes 
slow and weak and the breathing slow and shallow and, 
consequently, there is marked cyanosis. There is a 
sweetish odor to the breath, due to the acetone in the- 
blood. The urine is scanty and, generally, contains al- 
bumin, blood, casts (due to injury to the kidneys), acetone, 
diacetic acid, and other products of defective metabolism. 
Collapse, followed by death, in from one to three days 
after the appearance of the symptoms is the usual result 
of this condition. It is rarely recovered from. It is more 
likely to occur in children than in adults, and anemia, 
diabetes, diseases of the kidneys or liver, and alcoholism 
are predisposing causes. 
Ethyl chlorid is an exceedingly volatile, inflammable 
gas that is prepared by the action of hydrochloric acid on 
ETHYL CHLORID GENERAL ANESTHETICS 
111 
alcohol. It can be condensed (and thus made liquid) at 
a temperature of 55.4°F. and, if kept under pressure, as 
in a sealed tube, it can be maintained in liquid form. 
As soon as the pressure is released, however, the ethyl 
chlorid (following the usual behavior of condensed gases) 
begins to volatilize. Heat is necessary for the volatiliza- 
tion and the ethyl chlorid takes what it requires from 
anything upon which it strikes. Therefore, if enough is 
sprayed upon any part of the body, it will freeze the area. 
This action will be further discussed in connection with 
local anesthetics, it is not made use of for general 
anesthesia. 
When ethyl chlorid is used to induce general anesthesia, 
it is volatilized into an inhaler and the gas is then 
inhaled. 
When it is inhaled, ethyl chlorid acts in very much the 
same manner as chloroform, but it causes general anes- 
thesia more rapidly than the latter (in 1-2 minutes). 
It does not, however, cause as complete muscular relaxa- 
tion and it depresses the heart to an even greater degree. 
Because of the two last actions, ethyl chlorid is rarely used 
as a general anesthetic, except for short operations that 
do not require muscular relaxation and as a preliminary 
to ether anesthesia. 
ETHYL BROMIDE 
The action of ethyl bromide is similar to that of ethyl 
chlorid but it is not so volatile and it does not produce 
anesthesia as quickly as the latter. It is very seldom used. 
PENTAL 
Pental is prepared from fusel oil. It produces anesthe- 
sia very quickly and it does not affect the heart or respira- 
tion, but it does not depress the motor centers to the degree 
that ether and chloroform do and therefore muscular 
relaxation is very incomplete and muscular twitching, and 
even convulsions, may occur, thus it is rarely used. 112 
MATERIA MEDICA AND PHARMACOLOGY 
NITROUS OXID GAS (N2O) 
Nitrous oxide gas is much more frequently used as a 
general anesthetic than the three drugs last mentioned, 
but it is placed after them because it does not, like them, 
belong to the same chemical group as ether and chloro- 
form. 
It is prepared by the distillation of salts of ammonium 
nitrate (NH4NO3) as the gas (nitrous oxid) is evolved it is 
collected in steel cylinders. 
Action.-Nitrous oxid has no local action. After ab- 
sorption it depresses the central nervous system, espe- 
cially the psychic and sensory centers. It has very little 
effect upon motor centers. While it is in the blood it 
inhibits the combination of oxygen with hemoglobin and 
thus, even when it is given with oxygen, it tends to 
promote more or less asphyxia and the other effects of 
nitrous oxid anesthesia are due to the asphyxia, and not 
to the direct action of the drug. The conditions and re- 
sults of asphyxia are discussed on page 96. 
Nitrous oxid depresses the psychic and sensory centers 
even more rapidly than chloroform, in about 2 or 3 
minutes. The depression of the psychic centers occurs 
in the usual gradation, as described under ether. 
Nitrous oxid is eliminated through the lungs very rap- 
idly. There will not be enough left in the blood to con- 
tinue the effects upon the nervous system 3 or 4 minutes 
after its administration is discontinued. 
Effects of Action.-The patient is likely to be emo- 
tional and to talk and laugh for a minute or two. At the 
end of this time sensation and consciousness are lost, 
but muscular relaxation is very incomplete. 
As the result of the asphyxia, the pulse will be rela- 
tively slow and strong, the blood-pressure high, the 
breathing deep and stertorous; and the color flushed and 
somewhat cyanotic. 
The changes in the blood pressure and the breathing 
affect the circulation and the air pressure in the ears GENERAL ANESTHETICS 
113 
are thus probably responsible for the ringing and other 
noises that the patient generally hears before losing 
consciousness. 
Uses.-Nitrous oxid in combination with oxygen is 
now much used in obstetrical work and for short opera- 
tions in which muscular relaxation is not necessary, and 
as a preliminary to ether anesthesia. 
It is generally considered that, if this combination is 
properly given, it is about the safest anesthetic that can 
be used, provided its use is not continued too long-much 
above hour. 
The people who are most easily detrimentally affected 
by it are: Young children, in whom asphyxia is very 
easily produced; people with high blood pressure, heart 
lesions or arteriosclerosis. 
Danger signals are increasing cyanosis and high blood 
pressure (indicated by slow, forceful pulse), dyspnea and, 
sometimes, if the premonitory symptoms are not ob- 
served, convulsions. These symptoms are due to the 
asphyxia and will as a rule disappear as soon as the in- 
haler is removed. 
This salt is very commonly found in springs and salt 
deposits. 
Dosage.-For intravenous administration a 6 per cent, 
solution is generally used; for subcutaneous and intraspinal 
injections, and for injection into nerve-trunks, a 25 per cent, 
solution is commonly employed. The amount used 
depends upon the object of the administration. The 
maximum dose, to prevent convulsions, is about for adults 
1.2 c.c. for each 20 pounds of body weight; and for chil- 
dren 0.5 c.c. for each 20 pounds. For external use, a 
saturated solution (15 per cent.) is employed. The 
dosage for use by mouth is given in the section on 
Cathartics. 
Actions.-When magnesium sulphate is administered 
by mouth it does not, as a rule, have any effect upon the 
MAGNESIUM SULPHATE (EPSOM SALT) 114 
MATERIA MEDICA AND PHARMACOLOGY 
nervous system because, as it is slowly absorbed from the 
intestine and readily excreted by the kidneys, unless it is 
taken in poisonous amounts, there is not sufficient accumu- 
lation in the blood. Its action when administered by 
mouth will be found in the section on Cathartics. 
If a saturated solution of magnesium sulphate is kept 
in contact with a part, especially raw tissue, it will act as 
an astringent (described on page 47) and it lessens the 
sensitiveness of nerve-endings in the area. 
Magnesium sulphate depresses both sensory and motor 
nerve-endings with which it comes in contact, but the 
former to a greater degree than the latter. If magnesium 
sulphate is injected into a nerve-trunk, its action upon 
the fibers will prevent the passage of impulses. When it 
is given intravenously and intraspinally it acts chiefly 
upon the synapses of neurones, more especially afferent 
neurones, with which it comes in contact. Thus its ac- 
tion on nerve centers is the opposite of that of strychnine. 
Effects of Action.-As the result of its action on sensory 
nerve-endings magnesium sulphate either when applied 
externally or injected subcutaneously, will lessen pain and, 
when saturated solutions are kept in contact with abraded 
surfaces, there will also be some shrinking and drying 
of the tissue from the salt action. Also, when injected 
into a nerve, magnesium sulphate lessens pain. 
As the result of its action on the synapses, magnesium 
sulphate blocks the passage of impulses through the cen- 
ters and thus it prevents consciousness of pain and lessens 
muscular contractions (which are due to impulses dis- 
charged from nerve centers) and, in large enough doses, 
it checks convulsions. In still larger doses, it produces a 
general anesthesia resembling that of chloroform, but in 
such doses the interference with the passage of impulses 
in the cord is likely to inhibit breathing. 
When it is given intraspinally, the effects will last for 
from 24 to 48 hours. 
The chief therapeutic uses of magnesium sulphate by 
the methods of administration described here are: ALCOHOL 
115 
As a local external application to lessen pain in der- 
matitis, burns, cellulitis, ulcers and the like. 
Injected into a nerve to lessen pain such as that due to 
neuralgia and sciatica. 
Intraspinal or intravenous injections are used to pre- 
vent convulsions, especially those due to tetanus and 
strychnine poisoning. The former are sometimes used to 
block the passage of afferent impulses through the cord 
and thus promote anesthesia in parts of the body supplied 
with nerve fibers that enter the cord below the site of 
injection. 
Untoward effects are the result of interference with 
breathing and the symptoms are those of asphyxia. 
The treatment for poisoning consists in giving artificial 
respiration until breathing is resumed. Drugs which have 
the opposite action, strychnine, physostigmine and 
caffeine are likely to be prescribed and an intravenous 
injection of calcium chlorid 2.5 per cent, is given. Cal- 
cium chlorid has an affinity for the same structures (the 
synapses) that the magnesium sulphate effects and will 
displace the magnesium. It is customary, when a large 
dose of magnesium sulphate is to be used, to prepare a 
solution of calcium chlorid that may be ready in case 
of emergency. 
ALCOHOL 
Ethyl alcohol is prepared by fermenting sugar solutions 
with yeast. The sugar solution may be that of fruit 
juices or it may be derived from starch by its preliminary 
fermentation with yeast or with a ferment known as 
diastase of malt. 
There are a number of alcohols, but ethyl alcohol is the 
only one used as a beverage. It is employed for this 
purpose in the form of wines and similar liquors, which 
contain some of the other ingredients of the solutions 
fermented to produce the alcohol. 
Fermentation will not yield a liquor with more than about 
15 per cent, alcohol, because higher per cents, than this 116 
MATERIA MEDICA AND PHARMACOLOGY 
kill the yeast. Thus, alcohol and what are known as 
distilled liquors are obtained by distilling the fermented 
material, and wines with a higher percentage, have alcohol 
added to them and are therefore known as fortified wines. 
In the preparation of distilled liquors, water and volatile 
substances are allowed to remain in the distillate, but, for 
pure alcohol, these substances are removed as far as 
possible. 
Alcohol is Sold in Three Strengths.-Absolute alcohol 
which is 99 per cent, (by volume); alcohol, 95 per cent, 
dilute alcohol, 50 per cent. Denatured alcohol is ethyl 
alcohol plus some substance, such as wood alcohol, or other 
poison, which renders it unfit for drinking. It is tax-free 
and therefore, cheaper than pure alcohol. 
Alcoholic beverages are usually classified as: Malt 
liquors, wines, distilled liquors, liqueurs. 
Malt liquors include beers, ales, porter and stout. 
They are made from grains which are prepared for fer- 
mentation by preliminary exposure to the action of dias- 
tase of malt (a ferment prepared from barley). They 
contain alcohol, 3-10 per cent., starches and sugars, and 
also extractive matter from hops which gives them a bitter 
flavor and a slight narcotic effect. In cheap beers, bitter 
substances, such as gentian and quassia, are often sub- 
stituted for the hops. 
Wines are classed, according to their color, as white and 
red; those with sugar, as sweet wines; those with little or 
no sugar, as dry wines; those containing carbon dioxid as 
sparkling wines; those with more than 15 per cent, alcohol 
as fortified wines. 
The white wines are made by fermenting the juice and 
pulp of grapes; they contain, as a rule, from 7-12 per cent, 
alcohol. Champagnes are white, sparkling wines. They 
contain about 10-15 per cent, alcohol and, as stated above, 
carbon dioxid, which increases their carminative 
properties. 
Red wines are made by fermenting the whole grape, 
including skins and seeds. As there is tannin in these ALCOHOL 
117 
substances, red wines are somewhat astringent. The 
clarets and non-fortified red wines contain about the same 
amount of alcohol as the white wines but port wine contains 
about 20-40 per cent, alcohol; sherry, 15-20 per cent, 
and some of the burgundies and other sweet red wines 
contain as much as 20 per cent, alcohol. 
The usual dose of the wines is 1 wine glass full. Cham- 
pagne, when used to relieve nausea, is given in dram 
doses, at short intervals, and the bottle must be kept 
tightly corked, and upside down, on ice, so as to avoid 
loss by carbon dioxid. 
The distilled liquors are: 
American, made by distilling fer- 
mented rye, corn or wheat. 
Scotch, made by distilling barley. 
Irish, made by distilling fermented 
potatoes. 
1. Whiskey 
(Spiritus frumenti) 
Whiskey contains from 45-55 per cent, alcohol. It 
should not be used until at least four years old as, while 
fresh, it is too irritating to the tissues. The flavor is also 
improved by age. 
2. Brandy or cognac {Spiritus vini gallici), this is made 
by distilling fermented grape juice. It contains about the 
same percentage of alcohol as whiskey and, like whiskey, 
it should not be used until it is at least four years old. 
Brandy also contains tannic acid and thus has a slight 
astringent action on the mucous membrane of the stomach 
and intestine and promotes constipation. 
So called brandies are also made by distilling fermented 
juices of fruits other than grapes. These are known by the 
name of the fruit from which they have been prepared, 
e.g., blackberry brandy, peach brandy. Their alcohol 
percentage varies greatly. 
3. Rum, this is the distillate of fermented molasses. 
It contains about the same amount of alcohol as whiskey. 
4. Gin, this is the distillate of fermented rye mash 
redistilled with juniper berries. Gin contains about 118 
MATERIA MEDICA AND PHARMACOLOGY 
60-70 per cent, alcohol and, usually, some oil of juniper, 
which gives it diuretic effects and adds to its carminative 
properties. 
The usual therapeutic dose of the liquors is % ounce. 
Liqueurs, known as cordials and elixirs, are syrups 
containing various aromatic substances and alcohol in 
amounts of from 50-70 per cents. Examples are: Char- 
treuse, absinthe, creme de menthe. 
Fate in the Body.-Alcohol is not absorbed through the 
skin, but it is readily absorbed through mucous membranes 
and, if taken by mouth while the stomach is empty, the 
systemic effects of a dose will be observed in about 20-25 
minutes. When there is food in the stomach, however, 
the absorption of the alcohol is retarded. After absorp- 
tion, alcohol passes through the portal vein to the liver 
and from thence into the general circulation. Between 
90 and 95 per cent, of the alcohol absorbed is oxidized 
in the body to carbon dioxid and water, the remainder is 
eliminated in the breath, urine and perspiration. 
Actions.-Alcohol abstracts water from protoplasm with 
which it comes in contact and coagulates its protein. 
Thus, it acts as an astringent causing shrinking of tissues 
and irritation. 
If the irritation is slight, it will, as usual, have a mild 
stimulant action on most tissues, but, if severe, it will 
depress them and cause inflammatory changes. 
Hard tissues, like the skin, are not as much affected by 
alcohol as the softer ones and, as alcohol evaporates 
readily, if it is applied to the skin and left uncovered, it 
passes away so quickly that it does not induce irritation, 
but it takes the heat that it requires for its evaporation 
from the skin. 
The action of alcohol upon mucous membranes is very 
marked and solutions as dilute as 2 per cent, will produce 
slight irritation. This is the case also with subcutaneous 
tissues when alcohol is given by hypodermic. 
When it is taken by mouth, alcohol stimulates the olfac- 
tory nerve-endings and some taste-buds and it irritates ALCOHOL 
119 
the membrane of the mouth, throat, esophagus and 
stomach but, unless large doses are taken, the membrane 
of the intestine is not likely to be irritated because a con- 
siderable portion of the alcohol is absorbed through the 
stomach and the remainder is diluted by the gastric and 
intestinal contents. 
The actions of alcohol after absorption are so modified 
by the reflexes induced by the irritation of the mucous 
membrane that its nature has been much disputed, but 
it is now generally believed that, possibly after a very 
transitory stimulation, nerve-centers are depressed, the 
higher psychic centers first and to the greatest degree; also, 
apparently, either the vasoconstrictor center supplying 
the vessels in the skin is depressed very quickly or else 
vasodilator centers are stimulated, and there is evidence 
of slight stimulation of the respiratory center, but some 
authorities believe that these results are not due to the 
direct action of the alcohol. Small doses may, some 
authorities think, stimulate the heart muscle but large 
doses depress it. Large amounts apparently irritate the 
kidneys and the immoderate use of alcohol for an ex- 
tended period may produce a nephritis and also injure the 
tissue of other organs, especially the blood-vessels, heart 
and liver. 
In its actions before absorption it is the concentration 
rather than the amount of alcohol that is of importance; 
e.g., one ounce of a beverage containing 20 per cent, 
alcohol will have a much stronger effect upon the gastric 
mucous membrane than 10 ounces of a 2 per cent, bever- 
age; but, as the concentration of alcohol in the blood will 
be in proportion to the quantity absorbed, the amount of 
alcohol taken is of as much importance as the concentra- 
tion of a beverage in the production of effects after 
absorption. 
In considering the effects of the concentration of 
beverages, it is necessary to make allowance for the 
stomach's contents; e.g., a 20 per cent, beverage taken 
with a meal will probably not have any more effect than a 120 
MATERIA MEDICA AND PHARMACOLOGY 
2 per cent, one taken when the stomach is empty.. Food 
in the stomach also retards the absorption of alcohol and 
thus the systemic effects of a beverage are not as pro- 
nounced when it is taken with, or shortly after, a meal as 
when the stomach is empty. 
As previously stated, alcohol is, ordinarily, only used 
internally in the form of wines, liquors, etc. and, in con- 
sidering the effects of these, their other ingredients must 
be taken into account. The most important ones are: 
(1) The tannin in red wines and brandy, which, because 
of its astringency, retards digestion and absorption and 
promotes constipation; (2) the extractive matter in malt 
beverages, which also tends to retard digestion; (3) the 
bitter principle in malt beverages and the aromatic sub- 
stances in wines and liquors, which stimulate the appe- 
tite and the secretion of saliva and gastric juice and thus 
aid digestion; (3) the sugars in malt beverages and sweet 
wines, which sometimes undergo fermentation and cause 
flatulence; (4) the carbon dioxid in sparkling wines, which 
has a carminative action. 
Effects of Actions.-As alcohol has the same astringent 
effect upon the protoplasm of bacteria that it has upon 
human tissue, it, in concentrations between 50 and 70 
per cent., is a disinfectant; between 15 and 50 and above 70 
per cent, it is antiseptic. Its lessened power to destroy 
bacteria in the higher percentages is due to the rapidity 
with which it coagulates the superficial protein of the 
organisms, for the coagulum thus formed inhibits the 
penetration of the alcohol to their vital tissue. 
When alcohol is applied to the skin and the part cov- 
ered, it produces sufficient irritation to act as a rube- 
facient, as described under counterirritation. If the skin 
is left uncovered so that the alcohol can evaporate readily, 
the only effect of the latter's action on protoplasm will be 
a slight drying and hardening of the skin, but, as the 
alcohol takes the heat that it requires to further its evap- 
oration from the skin, it cools it and thus stimulates the 
nerve-endings in it that respond to cold. This, if a large ALCOHOL 
121 
area of skin is involved, as in an alcohol bath, produces the 
usual physiologic reactions to cold. 
The results of the irritant action of alcohol on mucous 
membranes are: (1) Increased secretion of mucus; (2) 
dilation of the blood-vessels in the part with a conse- 
quent sensation of warmth and well-being; (3) if the irrita- 
tion is at least moderately strong (as that produced by a 
20 per cent, beverage, taken while the stomach is empty) 
reflexes are produced that (a) promote peristalsis and 
thus aid in the expulsion of gas; (b) stimulate the medul- 
lary centers, especially the respiratory, vasoconstrictor 
and cardiac accelerator centers; and it is thought that the 
dilation of the skin blood-vessels that follows the use 
of even small doses of alcohol may be partly due to re- 
flexes. Excessive irritation, especially if frequently re- 
peated, will cause inflammation of the mucous membrane 
and the secretion of a thick tenacious mucus. 
Results of the Action of Alcohol on Digestion.-The 
secretion of saliva and gastric juice is increased and also 
the hydrochloric acid of the gastric juice; thus the latter 
is unusually acid after the use of alcohol. As the result 
of this it is thought the pancreas receives extra stimulus, 
because, it will be remembered, acid entering the intes- 
tine is supposed to change a substance, known as pro- 
secretin, which is manufactured by intestinal glands, to 
a hormone-secretin-which, when carried by the blood to 
the pancreas, activates it. Beverages containing about 
2 per cent, alcohol, or if reduced to this in the stomach, 
increase the activity of the pepsin, those with concentra- 
tions between 5 and 10 per cent, have almost no effect 
upon the digestive ferments; those with higher concen- 
trations inhibit the activity of the ferments. 
Beverages with less than 10 per cent, alcohol have 
practically no effect upon the food material in the stomach, 
but alcohol in higher concentrations coagulates the protein 
of food. 
Thus the alcohol in beverages, if diluted to between 2 
and 10 per cent., favors digestion and (because of the 122 
MATERIA MEDICA AND PHARMACOLOGY 
extra amount of blood in the alimentary mucous mem- 
brane) absorption, but higher concentrations retard 
digestion. 
As, however, alcohol makes the gastric juice unusually 
acid, alcoholic beverages will be harmful when a person has 
hyperchlorhydria (excessive secretion of hydrochloric 
acid) gastric ulcer, or gastritis. 
Effects of Alcohol on the Nervous System.-In addition 
to the transitory reflex stimulation, induced by the irrita- 
tion of the mucous membranes, there may possibly be 
an even more transient stimulation of nerve-centers 
induced by the direct irritant action of alcohol after 
absorption, but the almost immediate effect is that of 
depression the degree of which will depend upon the 
amount of alcohol taken and the individual's tolerance for 
alcohol. As previously stated, the psychic centers are 
most easily affected and the medullary centers least. 
Of the medullary centers, the vagus supply for the heart 
is apparently the first depressed. 
As the result of moderate amounts of alcohol upon 
psychic centers, intellectual activities that require concen- 
tration of attention are inhibited, but the activity of the 
imagination may be increased. This is particularly likely 
to be the case with people, such as writers and inventors, 
who are used to exercising this faculty. The increased 
action of the imagination, however, is not due to stimula- 
tion, but to the inhibition of activities which interfere 
with its freedom. The ideas conceived while under the 
influence of alcohol can seldom be properly expressed or 
systematized (because of inability to concentrate the 
attention) until the effects of the alcohol have subsided. 
The depression of the psychic centers also tends to lessen 
any propensity to worry or grieve or to indulge in intro- 
spection.) It lessens self-consciousness and nervousness 
and it increases confidence in one's capacities; for these 
reasons, drinking a small amount of an alcoholic beverage 
makes it easier for some people to speak, play or sing in 
public. It was largely because of this that, until recently, ALCOHOL 
123 
alcohol in a small amount was considered a cerebral 
stimulant, but, as a matter of fact, if a person is in quiet 
surroundings, even a small amount of alcohol acts as a 
sedative. 
When a moderate quantity of alcohol is taken in the 
midst of gay surroundings, the lights, music, and other 
stimuli will induce exhilaration, and the drinkers are likely 
to behave in much the same manner as excited children, 
for it is the faculties that have been acquired since child- 
hood that are depressed. 
Larger amounts of alcohol will so depress the psychic 
centers that power of self-control is lost and the person is 
likely to become very emotional or quarrelsome, gross 
and sensual. Such a condition is likely to be followed 
by narcosis. 
The depression of the reflex centers and the cerebellum, 
that follows the use of large amounts of alcohol, reduces 
muscular contraction and prevents muscular coordination, 
thus the individual staggers when walking and sometimes 
cannot even hold anything. The lessened muscular con- 
traction, by reducing the tension at which the bones are 
held, lessens the tendency to fractures from falls and blows. 
The rate of breathing is increased. The cause of this is 
not definitely known, for experiments do not seem to show 
any increase in the sensitiveness of the respiratory center 
to stimuli. 
The effect of moderate doses of alcohol on the circulation 
is not at all pronounced. As previously stated, the irrita- 
tion of mucous membrane causes a slight reflex stimulation 
of the cardiac accelerator and vasoconstrictor centers and 
this causes a transitory increase in the rate and strength 
of the pulse and a temporary rise of blood pressure. After 
the alcohol has been absorbed it has a very slight direct 
stimulant effect upon the heart muscle1 and this, with the 
1 The action of alcohol upon the heart has been a much debated 
question; at one time, it was thought to be a strong stimulant, 
then it was. said to have no stimulant action whatever, but 
the theory given above seems to be the common one at present. 124 
MATERIA MEDICA AND PHARMACOLOGY 
depression of the vagus center, may possibly increase the 
rate and, to a slight degree, the strength of the heart 
action and, consequently, the pulse. Large doses, by 
depressing the heart muscle, weaken the pulse. 
The blood-vessels in the skin are dilated by alcohol 
after absorption, as well as by the reflexes, thus the skin 
remains warm and flushed, also there is slight diaphoresis. 
The reason for these effects is unknown. 
Due to the extra amount of blood near the surface and 
the increased perspiration evaporated, the temperature 
tends to be reduced, even though the alcohol, by being 
oxidized, yields heat to the body. For, when the alcohol 
is oxidized, the oxidation of glucose and other food con- 
stituents is proportionately reduced and, as soon as the 
individual is quiet and there is muscular relaxation, 
catabolism is diminished. 
Though alcohol, by being oxidized, will serve as fuel for 
the body, it cannot be synthesized into tissue and, because 
of this, and of the unfavorable effects of more than moder- 
ate amounts, it cannot be considered a true food. 
Because alcohol favors loss of heat, it lessens the body's 
powers of resistance to the effects of cold. 
The secretion of urine is increased under the influence of 
alcohol, but it is not known if this is due to irritation of 
the kidney cells or to dilation of the kidney blood-vessels. 
Following intoxicating doses of alcohol, in spite of the 
extra amount of urine secreted, there may be retention, 
because of the depression of the spinal reflexes which con- 
trol the evacuation of the bladder. 
Because of the action on protoplasm, if large doses are 
used continuously, destructive changes in the tissues of 
organs take place and give rise to such conditions as 
chronic gastritis, cirrhosis of the liver, nephritis, fatty 
degeneration of the heart, arteriosclerosis, neuritis and 
insanity. The stomach and liver are particularly likely 
to be affected as they are exposed to higher concentrations, 
the alcohol, after absorption, passing directly through 
the portal vein to the liver. Alcohol also lessens the ALCOHOL 
125 
body's powers of resisting disease and infection and it 
apparently affects the gonads for the offspring of parents 
addicted to the overuse of alcohol are very commonly 
neurotic or otherwise unhealthy. It has been stated 
that "alcoholic intoxication even in the father at the time 
of impregnation may result in an epileptic child even when 
there is but a single indulgence in alcohol."1 
Summary of the Results of Moderate Doses of Prop- 
perly Diluted Alcohol.-If the individual is in quiet sur- 
roundings, a state of tranquility conducive to dreaming and 
sleep is produced; if in a gay environment, excitement and 
conviviality are promoted. The pulse becomes somewhat 
stronger and more rapid and the breathing quickened; 
these effects are more pronounced when the individual is 
active. The skin is flushed and warm, and perspiration 
is slightly increased. Digestion and absorption are 
aided, but the gastric juice is unusually acid and thus 
will be harmful in many abnormal conditions. Bever- 
ages containing about 20 per cent, alcohol will promote the 
expulsion of gas. Every gram of alcohol oxidized yields 
7 calories of heat. A slight diuresis is promoted. 
The chief therapeutic uses of alcohol are: 
(For external purposes.} 
To harden and dry the skin and thus prevent bed-sores. 
To induce the physiologic reactions of cold (alcohol 
bath). 
To clean and disinfect the skin. 
(For internal uses.} 
As a sedative and hypnotic in restlessness and insomnia 
due to nervousness and fatigue. 
To overcome faintness, but, because it depresses nerve- 
centers, alcohol is not used when there are pronounced 
symptoms of shock. 
To act as an appetizer and to furnish fuel when an ade- 
quate supply of food is not used. 
To (by increasing perspiration and the amount of blood 
'■Pharmacology of useful drugs: Robert A. Hatcher, Ph. G., 
M. D. and Martin I. Wilbert, Ph. M., Phar. D. 126 
MATERIA MEDICA AND PHARMACOLOGY 
at the surface of the body) lessen congestion caused by 
exposure of the body to cold, and thus, by reducing 
conditions that are favorable for infection, check a cold. 
To prevent the local effects of carbolic acid in poison- 
ing. The mixture must be removed from the stomach 
immediately, for the alcohol hastens the absorption of the 
carbolic. 
Toxicology.-The symptoms of acute alcohol poisoning 
are usually classed in two stages, viz., the stage of excite- 
ment and the stage of stupor. 
In the stage of excitement the individual is excitable 
and emotional, ready to cry and laugh for little or no cause, 
he is often talkative and boisterous, but, sometimes, mor- 
ose, sullen, and quarrelsome. His speech is thick and 
incoherent and his gait staggering. His muscles are 
relaxed. His skin, especially that of his face, is red and 
moist. His breathing and pulse are rapid. 
In the second stage, the intoxicated person passes into 
a state of narcosis from which it is difficult to arouse him. 
His breathing becomes slow and stertorous and, conse- 
quently, his color grows cyanotic. If a fatal amount of 
alcohol has been taken, unless antidotal treatment is 
effectual, the narcosis becomes profound and merges into 
coma, collapse and death. 
The treatment for acute poisoning depends upon the 
severity of the condition. If the pulse and breathing do 
not indicate danger all that is usually done is to lavage 
the stomach (this may be omitted if the patient vomits 
profusely and a fatal amount of alcohol has not been taken), 
provide warmth and fresh air, and let the individual sleep. 
If the pulse becomes weaker or the breathing dyspneic, 
stimulants such as caffeine, hot coffee, and strychnine are 
usually prescribed. 
The symptoms of chronic poisoning (alcoholism) are: 
Mental deterioration with lack of energy, self-control, 
will power and memory. Nervous manifestations such 
as irritability of temper, tremor of the muscles, especially 
those of the fingers, lips and tongue; disturbed sensation, ALCOHOL 
127 
this may be either hyper or hypo acute; insomnia; delirium; 
also, neuritis is common. Digestive disturbances (these 
are likely to be exceptionally severe because of the injury 
to the gastric membrane), constipation and, consequently, 
coated tongue and foul breath. A mottled appearance 
of the skin, especially that of the face, and purple lines, 
particularly on the nose and cheeks; both of these condi- 
tions are the result of permanently relaxed veins, the 
relaxation being due to their frequent dilation. 
The delirium of alcoholism, known as delirium tremens, 
is a form of insanity, characterized by hallucinations of 
sight, hearing, and sensations that fill the individual with 
fear and horror. It is most likely to occur when an alco- 
hol habitu6 is suddenly deprived of alcohol or subjected 
to unusual strain, such as is occasioned by the shock of an 
accident, or a surgical operation, or the sudden onset of 
disease, especially pneumonia. 
The premonitory symptoms of an attack are: Growing 
restlessness, picking at the bed covers, nervous tremors, 
muttering, and the patient may call for protection from 
people, animals, snakes, etc. that he imagines he sees 
coming to attack him. 
Unless the patient is quieted, these symptoms will be 
followed by violent delirium, in which he will shriek and 
struggle in terror and try to get out of bed, in order to 
escape from his vision enemies, and if opposed, he is 
likely to become exceedingly violent. 
It is very important that the early symptoms be recog- 
nized, because if the patient is given a dose of whiskey or 
other alcoholic beverage, and an hypnotic, the threatened 
attack may be aborted. 
The treatment of alcohol habitues, as far as the nursing 
care is concerned, is practically the same as that of those 
addicted to the use of other narcotics; viz.: To try to 
keep the patient amused or engaged in some interesting 
occupation, to maintain unceasing vigilance in order to 
prevent him getting alcohol, except that ordered by the 
physician; to do everything that will increase his strength, 128 
MATERIA MEDICA AND PHARMACOLOGY 
this necessitates special attention to the diet, for the con- 
dition of the patient's stomach makes it difficult to give 
him as much food as he should have. 
The drugs and special procedures used by different 
physicians vary, but an essential item in all treatments is 
the stimulation of elimination and thus cathartics and, 
sometimes, diuretics and diaphoretics are used liberally. 
METHYL (WOOD) ALCOHOL 
Methyl or wood alcohol is made by the destructive 
distillation of wood. It is not used in therapeutics for it 
is very poisonous. It is, however, a very common cause 
of poisoning, because, as it is employed in a number of 
industries, it is easily obtained and it is cheaper than ethyl 
alcohol. Its action upon protoplasm is the same, as that 
of ethyl alcohol, but much more pronounced, and an 
amount of methyl alcohol, that would be a moderate dose 
of the ethyl will cause nausea, vomiting, delirium, and, 
sometimes, death or, if the patient recovers, blindness is 
likely to follow, due to the destruction of some part of the 
optic nerve, and there may be various other abnormal 
conditions due to injury to the tissues of the organs 
involved. 
Hypnotics or Soporifics 
As previously stated, hypnotics or soporifics are drugs 
that induce a state of unconsciousness (termed hypnosis) 
that resembles sleep. 
SLEEP, INSOMNIA AND HYPNOSIS 
Sleep has been defined as 11 that condition of inactivity 
of the parts of the brain associated with consciousness which 
follows the withdrawal of excitory stimuli," and conscious- 
ness, as "a compound of intellectual action and sensation." 
The withdrawal of excitory stimuli is partly voluntary 
and partly a physiological process. 
The usual voluntary means of lessening stimuli are: 
Retiring to a quiet and darkened room, relaxing the mus- 
cles by lying down in a comfortable position; ceasing to HYPNOTICS OR SOPORIFICS 
129 
think, at least of anything exciting or that requires 
attention. 
The primary cause of the physiological lessening of 
cerebral stimulation is undecided. One theory is that the 
condition in the cerebrum, whatever it may be, is at least 
partly brought about by the so-called fatigue poisons 
(acids, etc. produced as the result of activity). Some of 
the physiologists who believe this theory consider that 
the toxins act by lessening the irritability of nerve-cells 
so that the latter do not respond readily to stimuli, and 
others think it possible that the toxins cause some change 
in the synapses of the neurones, which interferes with the 
passage of nerve-impulses. Another theory is that sleep 
is induced by fatigue of the cells resulting from their 
own activity. 
Condition During Sleep.-The muscles are somewhat 
relaxed; the amount of blood in the limbs is increased and 
that in the brain diminished; the breathing is relatively 
slow and shallow; consciousness is more depressed than 
other nervous functions and stimulation of sensory 
nerve-endings will, without waking the individual, induce 
reflexes and, sometimes, stimulate subconscious activity 
and thus cause dreams. 
Whatever may be the cause of sleep, lessening sensory 
impulses is, except in cases of extreme fatigue, an essential 
and anything that arouses cerebral stimulation, e.g., pain, 
discomfort of any kind, mental excitement, especially 
that due to unpleasant experiences, is likely to prevent it. 
It is said that insomniphobia (fear of not sleeping) is one 
of the most common causes of insomnia for it causes the 
maintenance of mental tension and restlessness which are 
antagonistic to the muscular relaxation that promotes 
the conditions conductive to sleep 
Hypnosis1 is not true sleep, but is a condition of un- 
consciousness promoted, it is thought by some chemical 
or physical change in the protoplasm of the cerebral cells. 
1 From the Greek hypnos = sleep. The term is also used for the 
state of unconsciousness induced by suggestion, i.e., hypnotism. 130 
MATERIA MEDICA AND PHARMACOLOGY 
The main fundamental difference between the anesthetics 
and hypnotics is that the latter are so volatile that they 
leave the system quickly and thus can be used in greater 
concentration and to produce a deeper narcosis than it 
would be safe to induce with a less volatile substance. 
Some drugs that produce hypnosis act directly upon the 
psychic centers of the association areas, but others act 
upon the sensory areas and, by depressing these, prevent 
the stimulation of the association areas, which, it will be 
remembered, receive all their stimuli through the cerebral 
sensory areas. Drugs which act in this way are analgesics, 
as well as hypnotics. 
After the hypnotic is removed from contact with the 
cerebral cells by the blood, the conditions of sleep may 
exist for some time and, during the period, the cerebral 
cells will have a chance to repair the damage done to them 
by the drug. Unless they are thus recuperated, the indivi- 
dual, on awakening, will be exceedingly depressed, drowsy 
and tired. Even when the cells do have a chance to 
recover from the effects of the drug the individual is not 
likely to feel as refreshed as by natural sleep. 
Hypnotics, by their action on nerve protoplasm, if 
constantly used, will interfere with the functioning of the 
nervous system. The higher capacities of the psychic 
centers-e.g., the powers of reasoning, of self-control, 
the formation of memories-will be diminished; the reflex 
centers will be depressed and, thereby, muscle tone and 
secretion lessened. Consequently the function of all the 
body organs may be interfered with. There may be 
digestive disturbances and constipation with resultant 
coated tongue and foul breath, headache, faulty nutrition 
and, consequent, emaciation and anemia. 
Some drugs, especially alcohol, opium and cocaine have, 
apparently, a more deleterious effect upon psychic cen- 
ters than other drugs and are likely, if they are taken con- 
stantly, to so reduce the individual's will-power and 
moral sense that it becomes almost impossible for him to 
stop the use of the drug. HYPNOTICS OR SOPORIFICS 
131 
The use of hypnotics during illness is probably one of 
the most common causes for the formation of a "drug 
habit" and nurses should therefore do everything possible 
to induce a patient who is not in severe pain or suffering 
from an incurable disease to go to sleep without a hypnotic. 
The main things to be considered in the treatment of 
insomnia are: (1) Everything necessary must be done to 
improve the patient's health so that (a) there may be no 
excuse for the use of a drug and (6) the condition of the 
cerebral tissue will be improved and thus better able to 
exert self control. (2) The patient should avoid excite- 
ment during the evening, this includes exciting plays and 
reading. (3) Tea and coffee should only be taken in small 
amounts, if at all, and not after luncheon. (4) The sleep- 
ing-room should be quiet, dark, cool, but not too cold, 
and well ventilated, though without draughts over the 
bed; the bed clothing should be sufficient to prevent the 
patient being cold but not enough to cause a sensation of 
warmth, nor heavy enough to promote discomfort. Heat, 
cold, discomfort of any kind will stimulate nerve-centers 
and thus induce conditions that may retard sleep. The 
patient should be warned that fear of not going to sleep 
or the belief that she will not sleep, will keep her awake. 
She should be instructed to lie quietly in a comfortable 
position and either to close her eyes or else to look fixedly 
at some one thing; to breath slowly, as is natural during 
sleep, to stop thinking and, sometimes, fixing the atten- 
tion on a low monotonous sound, as the ticking of a 
clock that is at a distance, is a help. (6) Measures that 
tend to induce cerebral anemia are often of use, examples 
of these are, taking a fight meal or even a glass of warm 
milk, before going to bed; lying quietly in a warm bath 
for about half an hour; this, especially if the bathroom is 
dark, will not only, by dilating the skin blood-vessels, 
lessen the amount of blood in the brain, but, by reducing 
the inflow of impulses to the nerve centers, act as a nerve 
sedative. (7) When there is no physical reason for a 
patient not sleeping an empty capsule or a hypodermic 132 
MATERIA MEDICA AND PHARMACOLOGY 
injection of sterile water, that the patient believes to be a 
hypnotic, will often promote sleep quite as effectively as 
though it were and, if the substitute can be used for two or 
three nights with good results, there will be no better way 
of persuading the patient that a hypnotic is unnecessary. 
Of course^ especially for the hypodermic injection, the 
doctor's permission should be had for the trial as it comes 
under the head of treatment. 
The treatment for insomnia forms the basis of that for 
overcoming drug habits. Also constant watchfulness is 
necessary to prevent a habitue obtaining the "habit 
drug" and every possible endeavor must be made to 
interest such a patient in work or amusement. 
CLASSIFICATION OF HYPNOTICS 
Dr. Cushny classifies the majority of hypnotics under 
three headings, viz.: The chloral, bromide and opium 
groups. 
The chloral group of hypnotics consists of compounds 
prepared from such substances as chlorine, alcohols, alde- 
hydes, ethereal salts and certain acids. The drugs of this 
class contain somewhat similar chemical combinations to 
which their action on nerve-tissue is due and thus their 
effects are similar to those of chloral hydrate. 
CHLORAL 
Chloral is an oily, colorless liquid made by passing chlo- 
rine through absolute alcohol. Pure chloral is not used in 
medicine for it is very destructive to tissue and, unless 
otherwise stated, it is chloral hydrate that is meant when 
chloral is prescribed or its action discussed. Chloral 
hydrate, as its name implies, is made by the interaction 
of chloral and water. 
Dosage.-Chloral hydrate 15-30 grs. (1-2 gm.;. The 
dosage of other chloral compounds will be found with 
those of the other drugs belonging to this group on pages 
136 to 139 HYPNOTICS OR SOPORIFICS 
133 
Administration.-To avoid irritating the mucous mem- 
brane of the alimentary canal, it is well to dilute chloral 
hydrate with syrup. It should be given about 15-20 
minutes before the time for sleep and after conditions have 
been secured that will allow of uninterrupted sleep. 
Chloral should never be given with whiskey or other 
alcoholic beverage because the combination forms a sub- 
stance that is exceedingly depressing to the brain. This 
mixture constitutes what is known as "knock-out drops." 
Fate in the Body.-Chloral is readily absorbed from the 
stomach and intestines, its effects being apparent in about 
20 minutes. The greater part of a dose is changed in the 
body to urochloric acid and, as such, excreted, chiefly 
through the kidneys, but a small amount may pass back 
into the stomach and be excreted in the feces. Its excre- 
tion is slow. 
Actions: 
Chloral is a general protoplasmic irritant poison. It 
affects the protoplasm of bacteria as well as that of animal 
tissues. 
Applied to the skin, chloral acts as a counterirritant. 
Unless it is properly diluted, chloral is very irritant to 
mucous membranes. 
After absorption, chloral depresses nerve-centers, 
both those of the brain and cord. Therapeutic doses 
only induce a moderate degree of depression and have not 
much effect upon the medullary centers; except, ap- 
parently, the portion of the vasoconstrictor supplying 
the blood-vessels in the skin. Doses much above the 
maximum therapeutic dose, however, may promote a 
condition similar to chloroform anesthesia, but this is 
almost invariably followed by collapse. 
Occasionally, the depression of the nerve-centers is 
preceded by a period of stimulation, comparable to the 
second stage of chloroform anesthesia. This, ordinarily, 
if it does occur, is very transitory. 
After exerting a momentary stimulation (due to its 
irritant action) chloral depresses the muscle tissue of the 134 
MATERIA MEDICA AND PHARMACOLOGY 
heart and blood-vessels. Except in susceptible individ- 
uals, the depression induced by therapeutic doses is slight, 
but amounts very little above the maximum therapeutic 
dose may induce intense depression. 
Chloral, by its irritant action on tissue protoplasm, 
increases the destruction of protein, but, otherwise, it 
tends to interfere with metabolism in somewhat the same 
way as chloroform. The action of single therapeutic 
doses is not intense enough to be harmful but such inter- 
ference with metabolism is sometimes one of the factors 
in producing the conditions of chronic chloral poisoning. 
Effects of Actions: 
Chloral is an antiseptic. When it is applied to the skin, 
chloral has the effects of a rubefacient (these are described 
in the section on counter-irritation) but, if a concentrated 
preparation is used in excess, it will act as a vesicant. 
Unless chloral is well diluted, when it is given by 
mouth, its irritant action on the mucous membrane may 
cause nausea and vomiting. 
After a therapeutic dose of chloral has been absorbed 
the patient becomes drowsy and, usually, soon passes 
into a condition resembling sleep in which the skeletal 
muscles are somewhat relaxed, the breathing is slower and 
more shallow, the pulse slower and rather weaker, and the 
skin blood-vessels are somewhat dilated so that the skin 
is flushed. Sensation becomes much less acute and thus 
the patient may not be disturbed by mild discomfort, 
slight noises and the like, but therapeutic doses of chloral 
do not depress the centers sufficiently to prevent their 
stimulation by acute pain, loud noises, and, other strong 
stimuli, and, therefore, such things may prevent sleep. 
The extra amount of blood at the surface of the body 
favors loss of heat and the lessened metabolism (due to 
the direct action of the drug and to muscular relaxation) 
decreases heat production, thus the temperature is lowered. 
Because of its depressant action on the reflex centers of 
the cord, chloral will lessen spasmodic contractions such 
as occur in convulsions. HYPNOTICS OR SOPORIFICS 
135 
If chloral is given during the first stage of labor it 
will relax the cervix without interfering to a marked 
extent with the rhythmical uterine contractions that occur 
during parturition. 
Chloral is used to promote sleep, more especially when 
wakefulness is due to intense excitement or extreme 
nervousness, and during the first stage of labor, when this 
is prolonged; also it is used to prevent or check convulsions. 
Due to idiosyncrasy, unusual effects sometimes follow 
even moderate therapeutic doses of chloral. The most 
common ones being: Excitement that resembles alcohol 
intoxication, this may persist for a considerable time and 
it may, or may not, be followed by sleep; headache; 
nausea; vomiting; extreme flushing of the skin and, 
sometimes, a rash; such extreme depression of the heart 
and nerve-centers that the pulse becomes exceedingly 
slow, weak and irregular, the breathing slow and shallow; 
and, unless the condition is relieved, collapse may occur. 
Toxicology: 
Symptoms of acute poisoning are: The breathing 
becomes very slow and shallow; the pulse weak, slow and 
irregular; the muscles extremely relaxed; sensibility to 
pain, as well as consciousness, is lost; the pupils are some- 
what contracted; the temperature is subnormal. 
The treatment is the same as for other depressant drugs. 
There is no chemical antidote. The special physiological 
antidotes are: Atropine, caffeine, strong coffee, strychnine, 
camphor. An enteroclysis or intravenous infusion of 
saline solution is commonly given, both to stimulate the 
circulation and to hasten the elimination of the drug. 
Artificial respiration is given if necessary. 
It is particularly important to keep the patient quiet, 
not only during the first-aid treatment, but until the pulse 
shows that the effects of the drug on the heart action 
have ceased; for poisonous doses of chloral depress the 
heart muscle to such an extent that the slightest exertion 
may be fatal. 
Chronic poisoning, i.e., the chloral habit, is not uncom- 136 
MATERIA MEDICA AND PHARMACOLOGY 
mon. In addition to the symptoms mentioned on page 
130, the chloral habitue is subject to skin eruptions, due, 
it is thought at least in part, to changes in the circulation 
in the superficial blood-vessels as the result of their 
frequent dilation. The symptoms of defective metabolism 
are likely to be particularly marked, because chloral 
interferes with metabolic processes by its direct action on 
protoplasm, as well as through its influence on the nervous 
system. Therefore, if the habit is continued for a long 
time, fatty degeneration of the organs, such as occurs in 
chloroform poisoning, is likely to result. 
The chloral habitue acquires a tolerance for the drug so 
that relatively large doses can be taken without causing 
acute poisoning. 
When treating a patient for chronic poisoning the use of 
theVhloral has to be stopped gradually, for, if it is suddenly 
withheld a condition similar to delirium tremens may occur. 
Otherwise, the treatment is about as described on page 131. 
OTHER DRUGS BELONGING TO THE CHLORAL GROUP 
The various drugs of this group have been prepared in 
the endeavor to secure a preparation that would have the 
hypnotic effects of chloral without its tendency to depress 
the heart muscle and to interfere with metabolism. The 
ones most commonly used are: Veronal and its sodium 
salt, medinal; paraldehyde; trional and sulphonal. 
Veronal, known also as barbital, dose, 5-15 grs. (0.3-1.0 
gm.) 
Medinal (the sodium salt of veronal) 5-10 grs. (0.3-0.6 
gm.) 
Veronal is not very soluble in cold solvents and is, there- 
fore, generally administered in hot milk or other hot drink. 
Medinal is more soluble than veronal and can be given 
hypodermically or by rectum, as well as by mouth. 
Suppositories can be had for rectal administration. 
These drugs are thought to act solely upon the central 
nervous system, chiefly the psychic centers, and the 
condition they produce very closely resembles that of HYPNOTICS OR SOPORIFICS 
137 
natural sleep. They will, as a rule, if the patient is not in 
pain, induce unconsciousness in from 20 minutes to half 
an hour, but they do not depress the sensory centers suffi- 
ciently to act as analgesics. The patient on awakening 
is likely to be less depressed than after the use of most 
other narcotics. 
If poisonous doses are taken the individual will gradu- 
ally pass into a state of coma and death will occur from 
paralysis of the respiratory center. Death has been 
reported from a dose of 150 grains. The treatment for 
poisoning is the same as for that by chloral. 
Paraldehyde, dose, 15-60 minims (1-4 c.c.) or, to over- 
come the excitement of delirium tremens, it is sometimes 
given by rectum in doses of from 23-^ oz. (8-15 c.c.) 
Paraldehyde has a very unpleasant flavor and thus 
should be given in capsules or diluted with flavored 
syrup. 
Paraldehyde irritates the mucous membranes and thus 
may cause a slight transitory reflex stimulation of the 
breathing and circulation. Also, partly because of this 
action but chiefly on account of its unpleasant taste, it 
may cause nausea and vomiting. 
Otherwise, the action of paraldehyde is similar to that 
of veronal and it is even less likely to cause depression 
and poisoning, so that, when necessary, it can be used in 
comparatively large doses. For this reason it is very 
frequently used to overcome sleeplessness due to intense 
excitement. When large doses are needed they are 
generally given by rectum as, if given by mouth, they are 
likely to cause vomiting. 
Trional, tetronal and sulphonal are all used in doses of 
10-30 grs. (0.6-2.0 gm.) 
These drugs, especially sulphonal, are not either readily 
absorbed or excreted. As they are more soluble in hot 
than in cold solvents they are given with hot drinks. 
They do not produce their effects quickly and thus trional 
and tetronal must be given about to 1 hour, and sul- 
phonal 2-3 hours before the time for sleep. 138 
MATERIA MEDICA AND PHARMACOLOGY 
The action of these drugs after absorption is very- 
similar to that of veronal, but, as. they are slowly excreted, 
drowsiness and lack of energy are likely to be experienced 
the day following their use. For the same reason, then- 
constant use is more likely, after a time, to promote the 
conditions mentioned on page 130. 
Adaline (not official), dose 15 grains (1 gm.). 
The action of adaline is similar to that of veronal, but 
weaker. 
Acetal (not official), dose 1-25 (4.0-8.0 gm.). The 
action of acetal resembles that of sulphonal. 
Amylene hydrate (not official), dose 30-60 minims 
(2.0-4.0 c.c.). This resembles chloral in its action, but 
it is only about half as strong and it does not depress 
the heart muscle as much as chloral. Its narcotic action 
is quite frequently preceded by a stage of excitement. 
Bromal hydrate (not official), dose 3-5 grs. (0.2-0.3 gm.). 
This resembles chloral in its action, but it is more 
poisonous. 
Bromoform (not official), 2-3 minims (0.13-0.2 c.c.). 
This acts like chloral but it is more depressing and it has 
a greater tendency to interfere with metabolism. Also, it 
depresses the sensory areas of the cerebrum, and thus 
lessens pain. It is rarely used as a hypnotic, but is 
occasionally employed to overcome the spasmodic con- 
tractions of whooping cough. 
Bromural (not official), dose 5-15 grs. (0.3-1.0 gm.). 
This acts like veronal, but it is weaker. 
Butyl chloral hydrate or croton chloral (not official), dose 
5-20 grs. (0.3-1.3 gm.). 
The action of this drug is practically the same as that 
of chloral hydrate, from which it is prepared. It was 
formerly thought to have a specific analgesic action on the 
nerves of the face and was therefore much used in the 
treatment of facial neuralgia, but experiments have shown 
that it has no such action. 
Chloralamide or chloralformamide (not official), dose 
15-30 grs. (1.0-2.0 gm.). HYPNOTICS OR SOPORIFICS 
139 
This acts like chloral, but it is less irritating to the 
stomach. Its narcotic action, however, is slower and less 
certain. 
Chloral camphor is used externally as a counterirritant. 
Chloralose (not official), dose 5-10 grs. 
This acts like chloral but it does not depress the reflex 
centers nor, to the same extent that chloral does, the heart 
muscle. Large doses may be followed by muscular twitch- 
ing and convulsions will occur in poisoning. 
Chloretone, dose 10-15 grs. (0.6-1.0 gm.). 
hen applied to abraided surfaces, as ulcers, or mucous 
membranes, chloretone depresses the sensory nerve- 
endings in the part and thus relieves pain and checks 
irritation. After absorption, it acts like chloral, but is 
rather weaker. It is sometimes used to check vomiting, 
which it does by lessening the sensitiveness of the stomach 
and by its sedative action on nerve-centers. 
Dormiol or amylene chloral (not official), dose 20 m.-l 
(1.3-4.0 c.c.). 
The action of dormiol is the same as that of amylene 
hydrate. 
Hedonal (not official), dose 30 grains (2 gm.). 
This acts like veronal, but is not as reliable, for it often 
fails to produce hypnosis. 
Hypnone (not official), dose 10-15 m. (0.6-1.0 c.c.). 
This is a mild, but not very efficient, hypnotic. 
Isopral (not official), dose 5-8 grains (0.3-0.5 gm.). 
This acts like chlorotone. 
Methylal (not official), dose 1-23 (4.0-8.0 c.c.). 
This acts like sulphonal. 
Neuranol (not official), dose 5-30 grs. (0.3-2.0 gm.). 
This acts like veronal. 
Proponal (not official), dose 5-15 grs. (0.3-1.0 gm.). 
This acts like veronal. 
Urethan, dose 30 grs.-15 (2.0-4.0 gm.). 
This acts like veronal, but is less powerful and often fails 
to produce hypnosis. It is changed to urea in the system 
and thus acts as a diuretic. 140 
MATERIA MEDIC A AND PHARMACOLOGY 
THE BROMIDES 
The bromides are salts of hydrobromic acid and one or 
other of the alkalies, such as potassium, sodium, ammon- 
ium. The alkali of a bromide is indicated by the name 
of the salt. Hydrobromic acid (HBr) is a combination 
of the elements hydrogen and bromine. 
All the bromides have a salty, bitter taste. 
Preparations and dosage: 
Potassium bromide, 10-60 grs. (0.6-4.0 gm.). 
Sodium bromide, 10-60 grs. (0.6-4.0 gm.). 
Ammonium bromide, 10-30 grs. (0.6-2.0 gm.). 
Lithium bromide, 10-30 grs. (0.6 2.0 gm.). 
Calcium bromide, 30-60 grs. (2.0-4.0 gm.). 
Strontium bromide, 30-60 grs. (2.0-4.0 gm.). 
Hydrobromic acid (10% solution) 30 m.-25 (2.0-8.0 c.c.). 
New and Unofficial Preparations.-Bromipin or bromiol 
(a compound of bromine and sesame oil). 
This is put up in different strength solutions and conse- 
quently the dosage varies considerably. It fs best adminis- 
tered in a flavored syrup and shaken or beaten until the oil 
is emulsified. When given in this way it does not irritate 
the mucous membrane and, for this reason, it is sometimes 
substituted for an alkaline bromide when its use has to be 
continued for some time. 
Brovalol (a compound of bromine and valeric acid) 
5-10 grs. (0.3-0.6 gm.) 
There are some bromide compounds mentioned with the 
chloral group for, because of their other constituents, they 
resemble the drugs of that series more than the inorganic 
bromides. 
Administration.-The bromides should be well diluted. 
Fate in the Body.-The bromides are absorbed rapidly 
through mucous membranes. They are eliminated chiefly 
through the kidneys, but traces may be found in the sweat, 
feces and, when the mammary glands are active, the milk. 
Elimination is slow, it is hastened by the administration 
of excess sodium chlorid and, on the other hand, it is HYPNOTICS OR SOPORIFICS 
141 
retarded by the withdrawal of sodium chlorid from the 
diet. The reason for this is that most of the tissues and 
the kidneys react to the bromides in the same manner that 
they do to sodium chloride, and, if there is less sodium 
chloride in the blood than usual, the kidneys do not 
remove the bromide, while if the quantity of sodium 
chloride is increased, excretion of salts, both chloride 
and bromide, is accelerated until the gross per centage of 
salts in the blood is normal. 
The actions of the bromides before absorption are due 
to their salt characteristics described on page 47, and, 
after absorption to their bromine ion. Thus, with slight 
exceptions mentioned later, the actions of the different 
bromides are almost identical. 
Actions: 
Bromides do not affect the unbroken skin but, when 
they are applied to surfaces denuded of skin or to mucous 
membranes, they cause irritation and a slight depression 
of sensory nerve-endings in the area. 
After absorption, the bromides, in therapeutic doses, 
have a slight, but prolonged, depressant action on nerve- 
centers, except those in the medulla. It is thought that 
they cause depression by some, as yet unknown, action 
upon the synapses of the neurones which interferes with 
the passage of impulses. 
Very large doses may also depress medullary centers 
and, possibly, the muscle tissue of the heart and arteries. 
The bromides have the usual action of diffusible salts 
upon the excretion of urine. This was discussed in the 
section on diuretics. 
Effects of Actions: 
If a concentrated solution of a bromide is applied to a 
raw surface or mucous membrane it will induce irritation 
which will be followed by a slight anesthesia. 
When taken by mouth, the bromides increase the flow 
of saliva and, because of their salt action (described 
page 47) they tend to cause thirst. If concentrated 
enough to have a strong salt action, and thus promote 142 
MATERIA MEDICA AND PHARMACOLOGY 
irritation, they are likely io cause nausea and vomiting, 
otherwise, by their action after absorption, they tend to 
check these conditions. 
After the absorption of bromides, as the direct result of 
their action upon the cord and brain, the following effects 
occur.-1. Reflex response to stimulation is retarded and 
diminished; e.g., irritation is not as likely to induce 
coughing, vomiting or convulsions. 2. Muscle tone is 
diminished. 3. Muscular coordination is interfered with. 
This, following small doses, is not always very obvious 
but, after large doses, it shows in awkwardness and un- 
certainty of movements. 3. The perception of sensations 
(sight, hearing, taste, touch, etc.) is less keen, but sensory 
centers are not sufficiently depressed, even by large doses 
of bromides to prevent the perception of pain if it is severe. 
4. Psychic powers are diminished and a condition of drowsi- 
ness, apathy, and lassitude is promoted and, if conditions 
are favorable, a state resembling sleep will follow, but the 
bromides are not as likely to induce unconsciousness as 
most of the drugs of the chloral group. Even when sleep 
does occur, the individual upon awakening is likely to be 
still mentally and physically depressed, because the drug 
is so slowly eliminated. 
As the result of lessened muscle tone catabolism is 
below par and thus the temperature is likely to be some- 
what reduced. 
As the result of general depression breathing is slowed 
and the heart action is slowed and somewhat weakened. 
Sexual instinct is lessened. It is not known if this is due 
to the general depression or to direct action upon special 
nerve centers. 
The excretion of urine is slightly increased. 
After even a few doses of bromide, various forms of 
eruptions may appear on the skin, especially on the face 
and neck. The reason for this is not known; formerly, it 
was attributed to irritation during excretion, by the sweat 
glands but, it is now considered, the quantity excreted in 
this way is not large enough to induce such irritation. HYPNOTICS OR SOPORIFICS 
143 
Nevertheless, frequent bathing of the threatened parts 
tends to prevent the condition and when, as in the treat- 
ment of nervous conditions, such as epilepsy and chorea, it 
is desired to continue the use of a bromide for some time, 
it is most important to prevent such eruptions for they 
may be very annoying to the patient. 
Differences in Action.-The bromides, sodium, potas- 
sium and ammonium, are generally considered more 
efficacious than the lithium, strontium and calcium salts. 
The potassium ion of potassium bromide tends to have a 
slight depressant effect upon heart muscle. The ammonia 
of ammonium bromide is said to induce a slight reflex 
stimulation of the heart action and breathing. The 
lithium may possibly increase the excretion of urine more 
than the other salts. 
Common therapeutic uses of the bromides are: To 
lessen reflex response to irritation, as coughing, vomiting, 
convulsions. 
To check excessive nervous irritability, as in exoph- 
thalmic goiter and chorea, and extreme excitement, as in 
delirium tremens. 
To inhibit convulsions such as occur in strychnine 
poisoning, tetanus and epilepsy. 
To lessen sexual excitement such as sometimes occurs in 
the insane and as the result of irritation of the external 
sex organs by disease or following operations upon these 
parts. 
To lessen pain that is due to hypersensitiveness, as in 
neurasthenia. 
Toxicology.-As the excretion of bromides is slow, they 
are likely to cause cumulative poisoning, known as 
bromism, if they are taken for any length of time. 
The symptoms are: Apathy and drowsiness; the patient 
is depressed and melancholy; unable to remember readily, 
even for a short time, or to do mental work; muscular 
coordination is so defective that movements are uncertain 
and the individual is likely to stagger when walking; 
reflex response is diminished and thus irritation will not 144 
MATERIA MEDICA AND PHARMACOLOGY 
induce the usual degree of muscular contraction or secre- 
tion. The depressed condition of the nervous system 
gradually interferes with the functioning of the other 
organs and the abnormal conditions described on page 130, 
appear. Also there will be an eruption usually of the 
acne type, which may be confined to the face and neck, 
but, especially if the use of the drug is not discontinued, 
is likely to become scattered over the body. 
The treatment consists in stopping the use of the drug, 
and giving all the sodium chloride and water possible, so as 
to hasten its elimination. Strychnine and caffeine are 
likely to be prescribed, if the bromic has not been used to 
check convulsions, as in the treatment of epilepsy. 
The symptoms of acute poisoning are.-Profound apathy 
even stupor. Slow, shallow breathing and slow weak 
pulse; the condition may persist for some time, but the 
drug is not very toxic and thus death has seldom, if ever, 
occurred. 
The treatment for acute poisoning is the same as for 
bromism. 
THE OPIUM SERIES OF NARCOTICS AND ANALGESICS 
OPIUM AND ITS ALKALOIDS 
Opium is derived from the dried juice of the Papaver 
somniferum, a species of poppy which grows principally 
in Asia Minor, Turkey, Persia, China and India. It 
contains a number of alkaloids the more important of 
which are: Morphine, codeine, papaverine, narcotine 
and thebaine. Of these only the four first mentioned 
are extracted for medicinal use. Opium also contains 
several acids, but these have no important action, and 
gums and other inert substance. 
Preparations and dosage of opium and its alkaloids: 
Opium.-Powdered opium, grs. (0.015-0.13 gm.) 
contains 12% morphine. 
Deodorized opium, ^-2 grs. (0.015-0.13 gm.) The 
substances which give opium its disagreeable odor and the HYPNOTICS OR SOPORIFICS 
145 
narcotine have been removed, otherwise this is the same as 
powdered opium. 
Extract of opium, ^-1 gr. (0.008-0.06 gm.) contains 
20% morphine. 
Pills of opium, each pill contains 1 gr. (0.06 gm.) of 
powdered opium. 
Dover's powder, 5-10 grs. (0.3-0.6 gm.) each 10 grs. 
powder contains 1 gr. of opium, 1 gr. ipecac, and 5 grs. of 
sugar of milk. 
Tincture of opium (laudanum), 3-15 m. (0.2-1.0 c.c.) 
contains 10% opium). 
Deodorized tincture of opium, 3-15 m. (0.2-1.0 c.c.). 
Camphorated tincture of opium (paregoric), 1-45 
(4.0-16.0 c.c.). 
Each dram contains gr. of opium {which is equivalent 
to 132 gr. of morphine) oil of anise, camphor, benzoic acid 
and glycerine. 
Tincture of ipecac and opium, 5-15 m. (0.3, 1.0 c.c.) 
contains 10% opium. 
Opium vinegar (Black drop) 3-15 m. (0.2-1.0 c.c.). 
This is opium extract dissolved in dilute acetic acid. 
Wine of opium 3-15 m. (0.2-1.0 c.c.). 
Compound tincture of opium (Squibb's diarrhea mix- 
ture) 15 (4.0 c.c.). 
Mistura glycyrrhizse composita (Brown's cough mix- 
ture) 30 m-15 (2.0-4.0 c.c.). Contains 12 parts paregoric. 
Pantopon gr. (0.015-0.03 gm.). A non-official 
preparation of the alkaloids of opium. 
Pleistopon gr. (0.015-0.03 gm.). Similar to 
pantopon, but minus narcotine. 
Morphine preparations: 
Morphine gr. (0.008-0.03 gm.). 
Morphine sulphate, same as morphine. 
Morphine hydrochloride, same as morphine. 
Morphine meconate, same as morphine. 
Majendie's solution (not official) 5-10 m. (0.3-0.6 c.c.). 
Each ounce contains 16 grs. of morphine. This preparation 
is sometimes used for hypodermic administration. It must 146 
MATERIA MEDICA AND PHARMACOLOGY 
be kept in dark colored bottles and an old solution should 
not be used, for the preparation soon loses its strength and 
the morphine may be changed to apomorphine. Solutions 
that have undergone change are usually of a brownish color 
and sometimes contain a fungus. 
Apomorphine hydrochloride (an artificial alkaloid pre- 
pared from morphine'). Emetic dose, gr. (0.006 gm.). 
Expectorant dose, o gr- (0.002 gm.). 
Analgesic dose, gr- (0.003 gm.). 
Narcophine (non-official) gr. (0.015-0.03 gm.). 
This consists of 33 per cent, morphine meconate and 67 per 
cent, narcotine meconate. 
Heroine hydrochloride (an artificial alkaloid of morphine) 
^4-Mgr. (0.0025-0.01 gm.). 
Heroine hydrobromate, same as above. 
Peronine or benzyl morphine (an artificial alkaloid of 
morphine) J4-1 gr. (0.015, 0.06 gm.). 
Dionine or ethyl-morphine, same dosage as peronine and 
it is also used in the eyes in, usually, a 5 per cent, solution. 
Codeine preparations: 
Codeine ^--1 gr. (0.015-0.06 gm.). 
Codeine sulphate, same as codeine. 
Codeine phosphate, same as codeine. 
Eucodeine (methyl-codeine-bromide) J^-l gr. (0.03- 
0.06 gm.). 
Apocodeine hydrochloride (a non-official alkaloid pre- 
pared from codeine) ^-1 gr. (0.03-0.06 gm.). 
Papaverine preparations: 
Papaverine hydrochloride )^-2 grs. (0.03-0.12 gm.). 
For local use 2-4 per cent, solutions are employed. 
Papaverine sulphate, same as above. 
A tolerance for opium and its alkaloids is readily estab- 
lished so that the habitue can take amounts which would 
be highly poisonous to people not addicted to their use. 
On the other hand, some people, especially the old and 
the very young, are exceedingly susceptible to the influence 
of opium and its alkaloids. For this reason, the dosage HYPNOTICS OR SOPORIFICS 
147 
for children is always somewhat smaller than the amount 
computed by the rules given in the section on Dosage. 
OPIUM AND MORPHINE 
Fate in the Body.-Morphine is readily absorbed 
through mucous membranes and from subcutaneous tis- 
sues. The effects of a dose being observed in from 2-5 
minutes. Opium is not absorbed as quickly as morphine 
because its gums and some of the other inert constituents 
retard its absorption. Neither of the drugs is absorbed 
through the unbroken skin. After absorption, a small 
amount of a dose is oxidized, the remainder is excreted 
fairly rapidly. A small amount passes through the kidneys 
and traces are sometimes found in the saliva, sweat and 
milk, but the greater part of a dose is eliminated through 
the stomach and intestine. After being excreted into the 
latter organs, there is some reabsorption of the drug and 
the processes of absorption and excretion will continue un- 
til all the drug is destroyed or eliminated. 
Actions.-The actions of morphine and opium are sim- 
ilar, those of opium being mainly due to its morphine. 
Were it not that narcotine intensifies the action of mor- 
phine on nerve-centers, opium would be less depressant 
than the latter but, because of its narcotine, it is, if any- 
thing, more narcotic. Opium, "because of some of its 
minor alkaloids, also depresses intestinal action more than 
morphine. Otherwise, the following description of mor- 
phine actions can be applied to opium. 
Morphine has no action upon the unbroken skin. 
When applied to mucous membranes and wounds it will 
check pain in the part, but, it is thought, this is almost, 
if not entirely, due to the action of the drug upon the 
nerve-centers after it has been absorbed. 
Actions after absorption: 
On the Cerebrum.-Morphine depresses the sensory 
centers, especially those in which impulses which give 
rise to a sensation of pain are transmitted to the centers 
of consciousness. Also, it depresses the psychic areas to 148 
MATERIA MEDICA AND PHARMACOLOGY 
a slight degree. Moderate doses have little or no direct 
effect upon the motor areas, large doses may cause slight 
depression. 
On the Cerebellum.-Large doses cause slight 
depression. 
On the Medulla.-Morphine depresses: The respira- 
tory center; the secretory centers, except the sweat cen- 
ter; and the cough center. Following moderate doses, 
the vagus, vasoconstrictor, sweat, and pupil-contracting 
centers are stimulated, but some authorities consider 
that this stimulation is due to the partial asphyxia pro- 
moted by the depression of the respiratory center.1 
Occasionally the vomiting center is stimulated, but, it is 
thought, this is done by substances, probably apomor- 
phine, into which the morphine is changed in the tissues. 
On the Spinal Cord.-Morphine lessens the sensitiveness 
of the reflex centers. 
On the Intestine.-It is thought that morphine depresses 
ganglia on motor neurones situated in the intestinal wall. 
Of the above actions, the most important ones are: 
The depression of the sensory and respiratory centers and 
of the intestinal ganglia and, as a means of observing 
overdosing, the stimulation of the pupil contracting center. 
Effects of Actions.-Pain that is continuous is overcome, 
but any new, sharp sensation will be felt temporarily. 
All the senses (e.g., sight, hearing, touch) are rendered less 
acute and the pathway of impulses to the psychic centers 
is more or less blocked. If the blocking is extreme, a state 
of unconsciousness resembling sleep occurs, if not, the 
condition induced will be simply one of quiet and drowsi- 
ness such as one may experience when reclining at rest in a 
quiet and dimly lighted place. 
The psychic powers of concentration, reasoning, judg- 
ment, will, are reduced, but, unless profound narcosis 
is produced, the depression of the psychic centers, is not, 
as a rule, sufficient to interfere with the conditions of their 
protoplasm that constitute memories and are thus the 
1 The nature and results of asphyxia are described on page 96. HYPNOTICS OR SOPORIFICS 
149 
basis of imagination; this faculty consisting in using the 
impressions (memories) that have been made in the 
cerebrum to form the pictures or thoughts that we call 
ideas and dreams and, as previously stated, depression 
of the intellectual capacities which require mental con- 
centration for their exercise allows the imagination to 
become unusually active. This effect of morphine is more 
pronounced in some individuals than others. A person 
who is thus influenced may be so entertained with his 
imaginations that he becomes oblivious of his surroundings 
and is able to forget worries, annoyances and disappoint- 
ments; even when sleep is not induced. Some authors 
are said to have conceived the plots of their novels and 
scientists the ideas which led to inventions or important 
discoveries while under the influence of morphine, but 
it is improbable that the ideas conceived were utilized 
until the effects of the drug had subsided because, until 
they did, the energy and the powers of application, con- 
ecntration and judgment, necessary for such work, must 
have been lacking. 
The quiet and lethargy induced promote muscular re- 
laxation, but single therapeutic doses of morphine do not 
depress the motor areas of the cerebrum or the reflex 
centers of the brain and cord sufficiently to cause much 
reduction of muscle tone and even poisonous doses do not 
cause as much muscular depression as chloral and the 
bromides. Thus, though morphine will lessen and retard 
response to some reflexes, as, for examples, coughing 
and vomiting that is due to irritation, it will not check 
convulsions. The continuous use of morphine, however, 
will result in a gradual loss of tone. 
Large doses of morphine will, because of their action on 
the cerebellum and cerebral motor areas, interfere with 
proper muscular coordination, so that the individual 
may stagger when walking. 
Morphine tends to make the breathing slow and shallow 
and death from morphine poisoning is almost invariably 
due to paralysis of the respiratory center. Therefore the 150 
MATERIA MEDICA AND PHARMACOLOGY 
rate of the breathing is the most important thing to observe 
when watching for symptoms of overdosing. 
The blood-vessels of the skin are dilated and thus the 
skin is flushed, but, after moderate doses of morphine, the 
other vessels, except those of the brain, heart and lungs,1 
are contracted. This tends to make the heart action 
slow and stronger, and the former effect (slowing) is 
accentuated by the stimulation of the vagus. Even after 
poisonous doses, when artificial respiration is necessary, 
the pulse may remain fairly strong. 
After moderate doses of morphine, the pupils become 
somewhat contracted and, after poisonous doses, the con- 
traction becomes so extreme that the term pin-point pupils 
has been applied to the condition. 
The secretion of sweat is slightly increased, but all other 
secretions are checked. 
The lessened secretion of intestinal mucus and the 
diminished peristalsis, (resulting from the depression of 
the motor ganglia in the intestinal wall) cause constipation. 
This effect is induced to a greater degree by opium than 
morphine. 
The bodily inactivity and consequent muscular relaxa- 
tion abate metabolism and so lessen heat production; the 
increased amount of blood at the surface of the body and 
the excess perspiration favor loss of heat, thus the tempera- 
ture is lowered. 
The reduction of the body's supply of oxygen (due to 
the effect on breathing) interferes with oxidation and 
causes an increase of lactic acid and glucose in the blood 
and urine. Nevertheless, for some unknown reason, in 
diabetes, morphine tends to lessen the amount of glucose 
in the urine. 
The various effects of morphine on the body promote a 
general physical and mental depression of which the 
individual becomes acutely aware as soon as the effect of 
the drug on the sensory centers has subsided. 
1 These vessels, it will be remembered, are not controlled by the 
vasoconstrictor center. HYPNOTICS OR SOPORIFICS 
151 
To Summarize the Usual Results of Therapeutic Doses 
of Morphine.-A state of drowsiness and lethargy is 
promoted in which the higher intellectual capacities are 
depressed, but the imagination is unusually active, even, 
as a rule, when so-called sleep occurs. Pain and anxiety 
are relieved. The breathing is considerably slower and 
more shallow than in normal sleep, also, the pulse is slower, 
though it is strong. The skin, especially that of the face, 
is slightly flushed and somewhat moist, but mucous 
membranes are dry. The pupils are contracted. 
After the primary effects of the drug subside, the patient 
is depressed, exceedingly thirsty, and may be nauseated 
and have a headache. 
Due to some unknown idiosyncrasies, some of the 
following untoward effects occasionally follow the use of 
morphine: The conditions of acute poisoning are caused 
by ordinary therapeutic doses. Heart block, described 
page 54. Nausea and vomiting. Pronounced constipa- 
tion or diarrhea. Fever. Rash. Diminished secretion of 
urine, this is particularly likely to occur, as well as other 
bad effects when the individual has nephritis. 
Common therapeutic uses of opium and morphine are: 
To relieve pain. 
To check intestinal peristalsis in such conditions as 
peritonitis, intestinal hemorrhage, severe diarrhea, and 
following operations on the bowel. Opium is most com- 
monly used for this purpose. 
To check severe vomiting and cough. 
To cause diaphoresis, Dover's powder is used. 
To lessen worry and quiet the heart action in such con- 
ditions as hemorrhage, asthma and angina pectoris. 
As a preliminary to general anesthesia. 
Toxicology.-The symptoms of acute poisoning are 
manifested in three degrees. If the dose taken is not 
excessive only the conditions of the first or second degree 
will be induced, but after a very large dose, unless anti- 
dotal measures are successful, the patient will pass through 
the two first stages to the third quite rapidly. 152 
MATERIA MEDICA AND PHARMACOLOGY 
The symptoms of the first degree consist simply in the 
accentuation of the ordinary effects of the drug, thus: 
The breathing becomes slower and more shallow; the 
pupils more contracted; the face very flushed; perspiration 
profuse; the pulse slower, but it usually remains strong. 
The patient is in a state of lethargy, but can be quite 
easily aroused and will answer questions sensibly. Some- 
times there is nausea and vomiting. 
In the second degree of poisoning these symptoms are 
still more pronounced. The breathing may become as 
slow as 5 or 8 movements per minute, or there may be 
Cheyne-Stokes breathing, and there is cyanosis. The 
pupils are so contracted that the condition is known as 
pin-point pupils. The patient is in a state of stupor, but 
can still be aroused, though he can only be kept awake 
with difficulty. Perspiration is profuse. The pulse, as 
a rule, is still slow and strong. 
The third stage is that of narcosis or coma. The patient 
cannot be aroused. The breathing movements are irreg- 
ular, and reduced to 3 or 4 per minute and tend to cease, 
thus artificial respiration is necessary to maintain life. 
Cyanosis is extreme. The pulse gradually becomes weak 
and, unless treatment is successful, the pupils dilate 
widely and collapse occurs. 
There are certain differences between the conditions 
in morphine poisoning and other depressant drugs which 
make it necessary to modify the treatment for morphine 
poisoning. These are: (1) The heart action is not weak- 
ened in the early stages and, therefore, as it is most im- 
portant to keep the patient awake and breathing, the 
patient is not kept quiet. (2) As the result of the action 
of the drug on the sensory centers, any one form of stim- 
ulus ceases to be perceived after a short time and thus, 
when the patient fails to respond to a stimulus, another 
should be tried. (3) As the drug passes back and forth 
between the stomach and intestines and the blood, periodic 
lavage of the stomach and intestines is indicated. 
The treatment for acute poisoning consists in giving: (1) HYPNOTICS OR SOPORIFICS 
153 
An emetic and gastric lavage. The latter is repeated at 
intervals of from to 1 hour. Sometimes potassium 
permanganate is prescribed for the lavage, in order to 
oxidize the morphine; but many investigators have not 
found that it does this and consider that it is injurious to 
the gastric mucous membrane. (2) Colon irrigation, 
which is repeated at intervals of about 4 hours. (3) Hot 
coffee, by mouth, if possible, if not by rectum. (4) Caff- 
eine and atropine by hypodermic. 
The patient should be kept in a cool, well aired, light 
room and, if possible, walking about. If the poisoning is 
so advanced that walking is impossible, artificial respira- 
tion will probably be necessary and various forms of 
stimula are used, e.g., the rectum is stretched; vigorous 
percussion is applied; large applications of mustard paste 
are made to the skin; the faradic current is sometimes 
used. Formerly cold douches were given, but they are 
rarely used now, because chilling the patient increases the 
danger of pneumonia, a not uncommon sequence of 
morphine poisoning when artificial respiration is necessary. 
The symptoms of chronic poisoning in the early stages 
vary according to the amount of drug that the individual 
uses. Many habitues, for a time, only take large enough 
doses to stimulate their imagination and give them the 
characteristic sensation of well-being. In such case, the 
bad results of the drug's action may be slow in appearing, 
but morphine cannot be used, even in small doses, for any 
length of time without the onset of physical and mental 
deterioration and thus, sooner or later, the symptoms 
described on page 130 appear. Also, the pupils of the 
eyes remain more contracted than usual and the individual 
is likely to perspire profusely and to suffer from intestinal 
cramps-due largely to the accumulation of gas, as the 
result of the constipation. When not under the influence 
of the drug, the habitue is likely to be exceedingly de- 
pressed and melancholy, nervous and irritable, unable to 
concentrate the attention either upon work or pleasure, 
and the craving for the drug becomes so great that he will f54 
MATERIA MEDICA AND PHARMACOLOGY 
lie and steal to get it. As the habitu^ usually takes the 
drug by hypodermic his skin is likely to show marks of the 
needle and he frequently has hypodermic abscesses, for 
he becomes careless and slovenly as his mental capacities 
diminish and ceases to be even cleanly, much less to take 
aseptic precautions. 
There are several special treatments for chronic mor- 
phine poisoning. Whatever the special points, those men- 
tioned on page 131 are considered of importance. As a 
rule the drug is either withdrawn gradually, smaller doses 
being given each day, or another drug with somewhat 
similar action, as codeine or hyoscine, is substituted for a 
time; because sudden cessation of the morphine effects 
causes the patient to suffer intensely from physical and 
psychic depression. In all treatments cathartics are used 
freely in order to hasten the elimination of the drug. 
NARCOPHINE AND ARTIFICIAL ALKALOIDS OF 
MORPHINE 
Narcophine is said to depress the respiratory center less 
than morphine and to have greater analgesic power. The 
latter effect is due to the narcotine which, as previously 
stated, intensifies the action of morphine on the sensory 
centers. 
Heroine acts like morphine but it does not relieve pain 
nor induce sleep as readily and it is more depressing to the 
respiratory center and, therefore, more likely to cause 
poisoning. 
It induces "habit" and the habitues take it by mouth, 
hypodermically and by snuffing. When it is used as 
snuff, it produces atrophy of the nasal membrane. 
The common therapeutic use of heroine is to relieve 
cough. Dionine and peronine act like codeine. Dionine 
also, when applied to the eye, acts as a local anesthetic and 
it dilates the pupil. 
Apomorphine in small doses may have a mild morphine 
action, but it stimulates the vomiting center and the 
conditions thereby produced overcome the sedative action HYPNOTICS OR SOPORIFICS 
155 
on the cerebrum. Even in doses too small to induce emesis 
it has a nauseant action and, as the result of this, increases 
and fluidifies the bronchial mucus, therefore, it acts as 
an expectorant. When used as an emetic it is given by 
hypodermic and will almost invariably produce profuse 
emesis in a few minutes. 
Codeine, as previously stated, is one of the alkaloids of 
opium. 
Codeine acts like morphine but it is only about one- 
fourth as powerful a drug and, even in relatively large doses 
has the following differences: 
Codeine does not depress the respiratory center to the 
same extent as morphine, nor is it as likely to induce con- 
stipation, not to overcome severe pain. Neither does it 
stimulate the imagination in the same way as morphine 
and its use is not followed by as great depressing and 
therefore, it does not induce the craving which is probably 
largely responsible for habit. Doses even moderately 
larger than those commonly used in therapeutics will 
stimulate the spinal cord and cause restlessness and, 
sometimes, twitching of the muscles. 
Codeine is used chiefly to check cough and to overcome 
mild pain. 
CODEINE 
APO CODEINE 
Apocodeine is prepared from codeine in the same manner 
as apomorphine is from morphine, but its action is not at 
all the same as either apomorphine or codeine. It is 
described with the depressants of sympathetic nerve- 
endings. 
PAPAVERINE 
Papaverine, as previously stated, is an alkaloid of opium. 
When applied to mucous membrane or injected under 
the skin, papaverine causes a local mild irritation that is 
followed by a moderate degree of analgesia. 156 
MATERIA MEDICA AND PHARMACOLOGY 
After absorption, papaverine acts upon nerve-centers 
in about the same manner as morphine, but it is only about 
one-half as powerful and, even in relatively large doses, it 
does not depress the respiratory center to a great degree. 
Papaverine also has a direct depressant effect upon 
cardiac tissue and upon the plain muscle tissue of the 
bronchial tubes, arteries, stomach, intestines, gall-bladder, 
bile passages, urinary ducts. 
As the result of its action on plain muscle tissue pap- 
averine tends to overcome spasmodic contractions such as 
occur in asthma, angina pectoris, intestinal and renal colic 
and it is used chiefly for such.purposes and to check cough 
and vomiting, which it does, like morphine and codeine, 
by its central action. 
Cannabis Indica (Indian hemp) is obtained from hemp 
grown in the East Indies and other warm climates. Var- 
ious preparations of the drug, hashish, bhang, etc. are 
much used in the Orient because of their pleasurable 
effects, which resemble those of morphine. 
Preparations and dosage: 
Extract of cannabis indica ^-1 gr. (0.015-0.06 gm.). 
Fluidextract of cannabis indica 1-5 m. (0.06, 0.3 c.c.). 
Tincture of cannabis indica, 10-30 m. (0.6-2.0 c.c.). 
Cannabis indica tends to have the same depressant ac- 
tion upon nerve-centers as morphine and, like morphine, 
it will relieve pain, but it does not produce sleep as readily; 
it causes less subsequent depression; and it is not as likely 
to cause nausea and vomiting. Unfortunately, the drug 
deteriorates rapidly and thus, in countries at a distance 
from its origin, its action is not reliable. 
CANNABIS INDICA 
LUPULIN OR HUMULUS 
Lupulin or humulus is prepared from hops. It has a mild 
sedative action on nerve-centers. 
Fluidextract of lupulin (unofficial) 3 m. (0.2 c.c.). ANALGESIC ANTIPYRETICS 
157 
LACTUCARIUM 
Lactucarium is obtained from the Lactura virosa or garden 
lettuce. 
Dosage: 
Syrup of Lactucarium 1-2 5 (4.0-8.0 c.c.). 
Tincture of Lactucarium 10-30 m. (0.6-2 c.c.). 
Lactucarium has a mild sedative action upon nerve-centers. 
It is used chiefly for children, as a substitute for morphine, to 
relieve pain, and the syrup is used to relieve cough. 
Analgesic Antipyretics 
The drugs classed under this heading are prepared from 
coal tar or coal tar derivatives. The principal ones are 
acetanilid or antifebrine, antipyrine, and acetphenetidin 
or phenacetine. 
Preparations and dosage: 
Acetanilid, 2-10 grs. (0.13-0.6 gm.). 
Antipyrine, 5-20 grs. (0.3-1.3 gm.). 
Antipyrine salicylate, 5-20 grs. (0.3-1.3 gm.). 
Phenacetine, 5-15 grs. (0.3-1.0 gm.). 
Non-official, preparations that resemble acetanilid. 
Antikamnia, 5-15 grs. (0.6-1.0 gm.). 
Antinervine, 5-15 grs. (0.6-1.0 gm.). This consists of 
acetanilid, ammonium bromide, and salicylic acid. 
Exalgine, 2-10 grs. (0.13-0.6 gm.). 
Thalline, 5-10 grs. (0.3-0.6 gm.). 
Non-official preparations that resemble antipyrine: 
Migrainin, 5-15 grs. (0.3-1.0 gm.). This consists of 
antipyrine, caffeine and citric acid. 
Pyramidon, 1-5 grs. (0.06-0.3 gms.). 
Pyramidon camphorate, 5-15 grs. (0.3-1.0 gm.). 
Tussol, 1-5 grs. (0.6-0.3 gm.). 
Non-official preparations that resemble phenacetine. 
Analgen, 3-10 grs. (0.2-0.6 gm.). 
Asaprol, 5-30 grs. (0.3-2.0 gm.). 
Benzanilide, 3-10 grs. (0.2, 0.6 gm.). 
Exodyne, 3-10 grs. (0.2, 0.6 gm.). 
Hydracetine, 3-10 grs. (0.2, 0.6 gm.). 158 
MATERIA MEDICA AND PHARMACOLOGY 
lodophenine, 3-10 grs. (0.2, 0.6 gm.). 
Methacetine, 3-10 grs. (0.2, 0.6 gm.). 
Phenocoll hydrochloride, 5-20 grs. (0.3-1.3 gm.). 
Phenocoll salicylate, 10-30 grs. (0.6-2.0 gm.). 
Phenolid, 3-10 grs. (0.2-0.6 gm.). 
Thermodine or phenacetine urethan, 5-15 grs. (0.3-1.0 
gm.). 
Triphenin, 5-15 grs. (0.3-1.0 gm.). 
Thymacetine, 5-10 grs. (0.3-0.6 gm.). 
There are also a number of compounds and derivatives 
of salicylic acid, which have both analgesic and anti- 
pyretic properties that are given under salicylic acid. 
Administration.-Antipyrine should not be given at the 
same time as calomel for the two drugs combine and form 
a poisonous compound. 
Sodium bicarbonate is sometimes prescribed with the 
drugs of this group, because it is thought to inhibit their 
tendency to depress the heart muscle. Formerly caffeine 
was much used for the purpose but it has been found to 
further, rather than prevent, bad effects. 
Fate in the Body.-The analgesic antipyretics are readily 
absorbed from mucous membranes, their effects being 
observed in about 20 to 30 minutes. They are decom- 
posed to simpler substances in the body and these are 
slowly eliminated, chiefly in the urine. 
Actions: 
These drugs have a mild depressant action upon the 
protoplasm of bacteria. 
When applied to mucous membranes and raw surfaces, 
antipyrine stimulates vasoconstrictor nerve-endings and, 
after a transitory stimulation, depresses sensory nerve- 
endings slightly. Acetanilid is irritant to mucous mem- 
branes and raw surfaces and phenacetine has practically 
no effect upon them. 
After absorption these drugs, with the exceptions 
mentioned, have, apparently, the same actions but these 
are not as well understood. It is thought, however, that 
the drugs: (1) Depress the portions of the thalami (masses ANALGESIC ANTIPYRETICS 
159 
of gray matter in the under surface of the cerebrum) in 
which impulses which give rise to a sensation of pain are 
transmitted to the sensory areas of the cerebrum. (2) 
Either stimulate the heat regulating centers (which also are 
in the thalami and in the corpora striata) or else protect 
them from the action of toxins, which, it is believed, 
depress the centers so that they do not respond as readily 
as usual to increase in the temperature of the blood, as 
described on page 51. (3) Depress the centers of the 
cerebrum controlling consciousness to a slight degree and 
acetanilid also depresses the motor areas slightly. (4) 
First, stimulate the heart muscle very slightly and later 
depress it to some extent, acetanilid is particularly likely 
to do this. (5) Their decomposition products tend to 
unite with the hemoglobin of the red cells of the blood 
forming methemoglobin, and large doses destroy the red 
cells. The derivatives of the antipyrine members of the 
group are not as likely to do this as those of the other 
drugs. 
Effects of Actions.-These drugs are all slightly 
antiseptic. 
Antipyrine, when applied to mucous membranes and 
raw surfaces, causes contraction of the blood-vessels and 
consequent shrinking and drying of the tissues in the part, 
and it may check capillary hemorrhage, also, it acts as 
an anodyne. Acetanilid irritates such tissues and will 
increase the amount of blood in the area of its application, 
as described on page 49. 
After absorption, all the drugs of this series have a slight 
analgesic effect and may overcome pain that is not severe, 
especially headache, neuralgia and neuritis. Also, they 
tend to lessen nervous irritability and, by so doing, if 
taken at bed-time, they favor the onset of sleep, but they 
are not hypnotic and, if taken when an individual is busy, 
they will not interfere even with intellectual work. 
Phenacetine has the most pronounced sensory sedative 
effect and antipyrine the least, but antipyrine, by depres- 
sing motor centers, tends to lessen spasmodic contractions 160 
MATERIA MEDICA AND PHARMACOLOGY 
such as occur in whooping cough and chorea. Poisonous 
doses of any of these drugs may cause muscular twitching 
or even convulsions, but the stimulation of the motor 
centers, which is responsible for the muscular contractions, 
is thought to be due to asphyxia (induced by the changes 
in the blood and its circulation) and not to the direct action 
of the drugs. 
The temperature is reduced when it is abnormally high, 
but it is not affected, except by very large doses, when it is 
normal. The fall of temperature is brought about by 
increased loss of heat from the body, as the result of an 
increased amount of blood in the skin and increased per- 
spiration; and the centers which produce these effects are 
stimulated by impulses going to them from the heat 
regulating centers. 
The pulse is slightly accelerated for a short time but, 
after large doses and, in some individuals, even after moder- 
ate doses, it becomes slower and weaker. 
The changes in the blood are not evident from thera- 
peutic doses, except when the drugs are taken constantly, 
but methemoglobin does not combine readily with oxygen 
and thus, if it is formed, cyanosis and dyspnea will follow. 
Untoward effects, due to some unknown idiosyncrasy, 
sometimes follow the use of even therapeutic doses of these 
drugs. Common ones are: Weak, slow pulse and faint- 
ness; nausea and vomiting. A skin rash, this is especially 
common after antipyrine. Excessive perspiration; cya- 
nosis and dyspnea, these are not as likely to be caused by 
antipyrine as by acetanilid and phenacetine. 
Therapeutic Uses.-Antipyrine is used locally to check 
capillary hemorrhage and, in a spray, in solutions of about 
15 per cent., to lessen pain and congestion in the throat. 
It is used internally to check spasmodic contractions. 
All the drugs of this series are used to lessen mild pain 
and nervousness and, occasionally, to lower the tempera- 
ture in fever. 
Toxicology: 
Symptoms of Acute Poisoning are.-Burning sensation 
and congestion of the alimentary canal, this is especially ANALGESIC ANTIPYRETICS 
161 
severe in acetanilid poisoning, nausea and vomiting. 
Cyanosis and dyspnea, these are less marked in poisoning 
by antipyrine and its compounds than the other drugs of 
the group. Slow weak pulse. Subnormal temperature 
and, sometimes shivering. There may be muscular 
twitching and even convulsions. Stupor and collapse. 
The treatment consists in giving lavage; keeping the 
patient quiet and warm; supplying fresh air and, if pos- 
sible, oxygen; giving demulcent drinks, as white of egg, 
milk and bland oils. Atropine is sometimes prescribed. 
Chronic poisoning is quite common because many 
people, especially those who are nervous or subject to 
headaches form the habit of taking them. The symptoms 
are: Digestive disturbances; anemia; proneness to cyanosis 
and dyspnea on exertion; irritability; headache; and in- 
somnia. The habit is not nearly as difficult to break as 
the morphine, alcohol and cocaine habits and the abnormal 
conditions and craving soon disappear when the drugs 
are withheld. DRUGS WHICH PRODUCE THEIR CHIEF THERA- 
PEUTIC EFFECTS BY THEIR ACTIONS ON 
PERIPHERAL NERVE-ENDINGS 
Drugs which obtain their chief therapeutic effects by 
their actions on peripheral nerve-endings (known also as 
end-organs) are, like those which act upon nerve-centers, 
classified in two sub-groups, viz., stimulants and 
depressants. 
Stimulation and depression of nerve-endings will have 
the same effects upon the organs with which they are 
connected as the stimulation and depression of nerve- 
centers. Thus, if a group of motor end-organs are stimu- 
lated, the contraction of the muscle in the part they 
supply will be more pronounced while, if the end-organs 
are depressed, the contraction will be lessened. If secre- 
tory end-organs are stimulated, the activity of the glands 
they supply will be increased and more secretion will be 
manufactured, but, if the end-organs are depressed, secre- 
tion will be lessened. If the inhibitory end-organs in 
muscle tissue are stimulated, contraction will be lessened, 
and, if those in a gland are stimulated, secretion will be 
inhibited; but, if the inhibitory end-organs ate depressed, 
the activity of the parts they supply will be increased, 
because the motor or secretory impulses will have freer 
control of the part since there will be fewer or no inhibitory 
impulses discharged into it. If the receptors of the affer- 
ent fibers forming part of a reflex arc are stimulated, the 
activity of the muscle or gland in which the efferent fibers 
of the arc terminate will be increased, while, if the recep- 
tors are depressed, the activity of the organs will be less- 
ened. If the receptors of a sense organ are stimulated, 
the sensation which the organ controls will be more acute, 
162 ACTING ON PERIPHERAL NERVE-ENDINGS 
163 
but if the sensory receptors are depressed, the sensation 
they control, whether it be sight, smell, taste, pain, heat, 
cold, etc., will be diminished or lost, according to the 
degree of depression. 
The manner in which drugs help or interfere with the 
functioning of the end-organs is unknown. 
Some drugs only affect end-organs at their junction with 
muscle and these are said to act upon the myox-neural2 
junctions or neuro-muscular junctions. 
END-ORGAN DEPRESSANTS 
The principal drugs belonging to this series are: The 
belladonna group and some local anesthetics and ano- 
dynes. Less important ones are: Agaricin, conium, gel- 
semium, spartein, nicotine, lobelia. 
THE BELLADONNA SERIES 
This group of drugs includes belladonna (deadly night- 
shade) stramonium (thornapple) hyoscyamus (henbane) 
and scopola. 
The various plants from which these drugs are derived 
belong to the same botanical family as the potato and the 
egg plant. 
The active principles of these drugs are the alkaloids 
atropine, hyoscyamine and hyoscine or scopolamine. 
Preparations and Dosage of Belladonna Preparations. 
Prepared from belladonna leaves: 
Extract of belladonna, grain (0.005-0.03). 
Tincture of belladonna, minims 5-15 (0.3-1.0 c.c.). 
Rhinitis tablets, (unofficial) contain belladonna grain 
camphor grain quinine bisulphate grain 
Belladonna ointment (this contains about 10 per cent, 
belladonna extract). 
Belladonna plaster. 
1 From the Greek, myos = a muscle. 
2 From the Greek neuron = a nerve. 164 
MATERIA MEDICA AND PHARMACOLOGY 
Prepared from the belladonna root'. 
Fluidextract of belladonna, minims 1-2 (0.06-0.12 c.c J. 
Belladonna liniment. 
Atropine Preparations: 
Atropine, grain Heo_Mo (0.0004-0.001 gm.). 
Atropine sulphate, grain Heo-Koo (0.0004-0.001 gm.). 
Atropine oleate, for external use. 
Atropine ointment. 
Homatropine (an artificial alkaloid of atropine) grain 
Hoo"Ko (0.0006-0.001 gm.). 
Methylatropine or Eumydrine (unofficial) grain, Ho~ 
Ho (1-3 mg.). 
Stramonium preparations: 
Extract of stramonium, grain (0.015-0.03 gm.). 
Fluidextract of stramonium, minims, 1-2 (0.06-1.12 c.c.). 
Tincture of stramonium, minims, 5-15 (0.3-1.0 c.c.). 
Stramonium ointment. 
Hyoscyamus preparations: 
Extract of hyoscyamus, grains H~3 (0.03-0.2 gm.). 
Fluidextract of hyoscyamus, minims 5-15 (0.3-1.0 c.c.). 
Tincture of hyoscyamus, minims 15-31 (1.0-4.0 c.c.). 
Hyoscyamine preparations: 
Hyoscyamine sulphate, grain K20-K0 (0.0005-0.001 
gm.). 
Hyoscyamine hydrobromide, grain X2O"Ko (0.0005- 
0.00 gm.). 
Hyoscine preparation: 
Hyoscine (scopolamine) hydrobromide, grain Hoo~ 
Hoo (0.0003-0.0006 gm.). 
Scopola: 
Extract of scopola, grain y~y2 (0.015-0.03 gm.). 
Fluidextract of scopola, minims 1-2 (0.06-0.12 c.c.). 
The alkaloids and, consequently, the crude drugs of 
this group all resemble each other in their action; there 
are, however, a few points of difference and, therefore, the 
action of atropine will be described first and then the 
dissimilarities in the actions of the other drugs. THE BELLADONNA SERIES 
165 
ATROPINE 
Fate in the Body.-Atropine is readily absorbed through 
mucous membranes and from subcutaneous tissues, the 
effects of a dose being evident in from about ten to thirty 
minutes. Also, when it is in a fatty or alcoholic medium, 
atropine is slightly absorbed through the skin. Part of a 
dose may be oxidized in the body. The remainder is 
eliminated, mainly through the kidneys, but a small 
amount may be excreted in the milk when the mammary 
glands are active. 
Actions.-Atropine produces its chief therapeutic effects 
by depressing certain nerve-endings the majority of which 
belong to the para-sympathetic system. It also tends to 
stimulate some nerve-centers but, except when large doses 
are taken, this action is not very obvious. 
The centers that are affected are.-1. Cerebral centers, 
but the higher psychic functions are not stimulated. 
2. In the medulla, the respiratory center is stimulated to 
some extent by moderate doses and the vagus and vaso- 
constrictor by large doses, but these centers are all de- 
pressed by toxic doses. The vasodilator centers controlling 
the vessels of the skin are, apparently, stimulated by very 
moderate doses. 
3. The spinal cord is stimulated by large doses, but not 
to anything like the extent that it is by strychnine. 
The nerve-endings depressed by atropine are: 1. The 
ends of the third nerve in the eye which supply the circular 
muscle of the irises and the ciliary muscles. 
2. Sensory nerve-endings, this action is slight and that 
upon nerve-endings concerned with the sense of pain 
is confined to the endings with which the drug comes in 
contact in considerable amounts, as by local applications. 
3. The secretory nerve-endings supplying the secretory 
cells of the mucous membranes, the sweat glands and the 
glands which secrete the digestive juices. 
4. Motor nerve-endings in the plain muscle tissue of the 
trachea, bronchi, esophagus, stomach, intestines, spleen, 166 
MATERIA MEDICA AND PHARMACOLOGY 
bile passages, ureters, bladder, urethra, uterus. These 
motor nerve-endings are not as much influenced as the 
secretory end-organs. 
5. The vagus nerve-endings in the heart. 
With the exception of the sensory nerve-endings and 
those in the sweat glands and uterus, all the endings af- 
fected by atropine belong to the para-sympathetic system. 
Effects of Local Action.-When atropine is dropped in 
the eye (1) it lessens pain; (2) it acts as a cycloplegic, 
i.e., it inhibits the contraction of the ciliary muscles and 
thus prevents the curvature of the crystalline lens which is 
necessary to see near objects clearly, in other words, 
atropine paralyzes ocular accommodation; (3) it acts as a 
mydriatic, i.e., it causes dilation of the pupil. When the 
pupil dilates, the minute openings around its margin are 
closed and this prevents the escape of fluid from the 
interior of the eyeball and thus (4) atropine increases 
intra-ocular tension (the pressure of the fluid within the 
eyeball). These effects may persist for several days. 
When fatty or alcoholic preparations of atropine are 
applied to the unbroken skin, enough of the drug may be 
absorbed into the underlying structures to slightly depress 
the sensory and secretory nerve-endings in the part and 
thus check pain in the area and, when an application is 
made to the breasts during lactation, lessen the secretion 
of milk. If a large area of skin is kept covered with 
ointment or a plaster, for a long time, enough atropine 
may be absorbed by the blood to produce systemic effects, 
even to cause poisoning. 
When it is applied to surfaces denuded of skin or to 
mucous membranes, atropine, by its depressant action on 
sensory nerve-endings, will cause numbness and lessen pain 
in the area and (as atropine is readily absorbed from such 
surfaces) the conditions that occur after absorption. 
Effects of Actions that Occur After Absorption.-The 
effects on the eyes are similar to those produced by 
local applications, but they are only obvious when very 
large doses are taken. THE BELLADONNA SERIES 
167 
The secretions, mucus, sweat, saliva and gastric juice 
are markedly decreased, but intestinal and pancreatic 
juices, bile and milk are only slightly diminished, because, 
it will be remembered, the glands which manufacture these 
secretions are stimulated by chemic substances formed in 
the body, to a greater extent than they are by nerve 
impulses. The secretion of urine is only checked by large 
doses, but suppression is likely to occur in poisoning. 
Even small doses of atropine may check the secretion of 
saliva and mucus sufficiently to make the mouth and 
throat unpleasantly dry and large doses or, sometimes, 
due to idiosyncrasy, small doses will cause such excessive 
dryness that swallowing will be difficult and thirst extreme. 
As perspiration is checked, the skin is dry, also it is 
warm and, especially that of the face and neck, more or less 
red, because of the increased amount of blood present as 
the result of the dilation of the skin blood-vessels. 
The depressant action of atropine upon motor nerve- 
endings in plain muscle tissue may overcome spasmodic 
contractions such as occur, for example, (1) in bronchial 
muscle, during asthma and whooping cough and, some- 
times when breathing is difficult from other causes; (2) 
in the urinary organs and bile passages when they are 
irritated by the presence of stones, etc., and in some in- 
flammatory conditions; (3) in the uterus, in some forms 
of dysmenorrhea; (4) in the intestines, when they are 
unduly irritated. Nevertheless, atropine, unless taken 
in large doses, does not reduce the normal tone and con- 
traction of plain muscle tissue to any extent. For 
example, the normal peristaltic action of the intestines 
is not actually checked, except by large doses, and the 
action of cathartics will not, as a rule, be interfered with, 
in fact, that of those which cause griping may be aided, 
because the spasmodic contractions which give rise to the 
sensation of griping often retard the passage of material 
through the intestine and, therefore, anything that lessens 
unnatural contractions will facilitate evacuation. The 
reason why the effects of atropine on motor nerve-endings 168 
MATERIA MEDICA AND PHARMACOLOGY 
is so much more pronounced when there is abnormal con- 
traction is not known. 
The heart action is strengthened and somewhat acceler- 
ated by atropine, even when the vagus center is stimu- 
lated, because, as the vagus nerve-endings are depressed, 
vagus impulses which, it will be remembered, inhibit the 
force and rate of contraction, are not readily discharged 
into the heart muscle and this allows the impulses from 
the cardiac accelerator center freer play. These impulses, 
if not in excess, strengthen, as well as quicken, the heart ac- 
tion and a greater amount of blood is thus forced from 
the heart into the arteries. This causes a rise of blood- 
pressure and improves the circulation. Apart from this, 
the only effect of moderate doses upon the blood-vessels 
is the dilation of those in the skin. Large doses may, 
possibly, occasionally stimulate the vasoconstrictor center 
sufficiently to cause contraction of the arterioles in the 
splanchnic area, but poisonous doses depress the center 
and cause a fall of blood-pressure. By its action on 
vagus nerve-endings, atropine will counteract the effect 
known as heart-block which poisonous doses of digitalis 
produce. 
A rise of temperature is likely to follow the use of 
atropine. This, after very large doses, can be accounted 
for by the increased muscular contractions, induced by the 
stimulation of nerve-centers, but its cause after moderate 
doses is not understood, because, though the loss of 
heat by the evaporation of sweat is diminished, there is 
increased loss by radiation, on account of the extra 
amount of blood in the skin. Therefore it is thought that 
metabolism and, consequently, heat production must be 
increased due to some unknown effect upon the heat 
regulating centers. 
Breathing is facilitated and generally slightly quick- 
ened. This, until recently was attributed to direct stimu- 
lation of the respiratory center by the atropine, but it is now 
thought that this center is only stimulated by fairly large 
therapeutic doses and that the effect on breathing follow- THE BELLADONNA SERIES 
169 
ing a moderate dose is due to a slightly relaxed condition 
of the bronchi. After a large dose, however, the center is 
stimulated both by the drug and by the extra carbon di- 
oxid that is in the blood as the result of the increased 
metabolism, but if the dose is excessive, this stimulation 
is likely to be followed by depression. 
The effects of the stimulation of cerebral centers is 
only manifested after large doses, or in individuals who 
are easily affected by the drug. It shows in a general 
restlessness and wakefulness and the patient becomes 
talkative and, as a rule, rather cheerful, but there is no 
real intellectual stimulation similar to that induced by 
caffeine. Poisonous doses will induce delirium and, some- 
times, even maniacal excitement. Eventually, if the 
effects of the drug are not overcome, the centers will be 
exhausted and stupor and coma will follow. 
The effects of the stimulation of the cord, also, is only 
evident after large doses and is shown chiefly in reflex 
excitability which promotes twitching of the muscles and, 
when poisonous doses are taken, convulsions. 
Summary of the Principal Effects of a Moderate Dose 
of Atropine.-Dropped in the eyes; atropine dilates the 
pupils, increases intraocular tension, inhibits accommoda- 
tion for viewing near objects. Applied externally, it may 
have a very slight anodyne effect and, on the breasts, it 
tends to check the secretion of milk. Taken internally, it 
checks secretion, especially perspiration, mucus, saliva 
and gastric juice; it dilates the blood-vessels in the skin 
and the latter becomes somewhat flushed, warm and dry; 
spasmodic contractions of the bronchi, urinary and bile 
ducts, uterus and intestines will be overcome; the heart's 
action is strengthened and the circulation thus improved; 
breathing is facilitated and may become deeper and 
quicker; there may be a slight rise of temperature and a 
slight dilation of the pupils. 
The principal therapeutic uses of atropine are: In the 
eye, (1) to dilate the pupil in order to facilitate the 
examination of the interior of the eyeball and, in some 170 
MATERIA MEDICA AND PHARMACOLOGY 
inflammatory conditions of the iris, to prevent or over- 
come adhesions; (2) to paralyze accommodation when 
fitting glasses and to enforce the rest of the ciliary muscles; 
(3) to lessen pain in the eye. 
On the skin it is used, generally in the form of ointment, 
to lessen pain and itching occasioned by some skin affec- 
tion and ulcers, and, usually incorporated in plasters, it is 
sometimes used to check pain in underlying, but super- 
ficial tissue, but the anodyne action of atropine is very 
slight, especially when it is applied to the broken skin. 
It is applied to the breasts, usually in ointment, to 
check the secretion of milk. 
It is applied to mucous membranes to lessen pain in the 
area of its application. 
For its effects after absorption it is used: To overcome 
spasmodic contractions of the plain muscle tissue of the 
viscera, in conditions such as those mentioned on the 
preceding page. Also it is frequently given with drastic 
cathartics to prevent griping. 
To check excessive secretion, for examples: (1) Saliva 
and mucus, atropine is very frequently given for this 
purpose before the anesthetics ether and chloroform 
which, it will be remembered, stimulate excessive secre- 
tion); (2) perspiration, as in the night-sweats of tuber- 
culosis; (3) gastric juice when there is hyperacidity 
and hypersecretion; (4) milk. Also, atropine has been 
used to check thyroid secretion in exophthalmic goiter, 
but it is not positively known that it does this, though it 
does sometimes relieve some of the symptoms. 
To facilitate breathing: It is very commonly used with 
morphine for this purpose in order that the depressant 
action of the latter on the respiratory center may have 
less effect. In poisoning by narcotic drugs, atropine is 
often used in large doses in order to stimulate the respira- 
tory center and, in such case, the symptoms of atropine 
poisoning must be watched for. 
To stimulate the heart action, especially when it is 
abnormally slow. THE BELLADONNA SERIES 
171 
Toxicology.-People show different degrees of tolerance 
for atropine. Children, as a rule, are less easily affected 
by it than adults, but some children, as well as adults, 
have an unknown idiosyncrasy which causes even small 
doses of the drug to produce symptoms of overdosing. 
The symptoms of overdosing are: Excessive thirst and 
such dryness of the mouth and throat that it is difficult 
to swallow and talk. 
The pupils are dilated and ocular accommodation in- 
terfered with. 
The skin is very dry and red and, sometimes, a rash 
that resembles the eruption of scarlet fever appears (this 
is thought to be at least partly due to interference with the 
circulation in the skin, on account of the dilated blood- 
vessels). 
The pulse becomes increasingly rapid and weak. 
The breathing is rapid. 
The patient may be sleepless, and restless, and very 
much excited. 
In poisoning, in addition to the above symptoms, there 
will be twitching of the muscles and, finally, convulsions. 
The excitement becomes intense, and delirium, some- 
times of a very violent form, is common. This, unless 
the condition is relieved, is followed by stupor and coma. 
The pulse becomes exceedingly rapid and weak, blood- 
pressure fails and the symptoms of collapse occur. 
The temperature may rise exceedingly high. 
The breathing becomes slow and shallow and cyanosis is 
extreme. Death is generally due to paralysis of the 
respiratory center and consequent cessation of breathing. 
The treatment for poisoning includes the general routine 
described on page 64, for the removal of the drug and the 
prevention of collapse. The chemical antidote is tannin, 
which, for convenience, is generally given in the form of 
strong boiled tea. A sedative, such as a bromide, is used to 
lessen the excitement, but morphine and other drugs which 
tend to depress the respiratory center are never used, 
because they would hasten the depression of the center and 172 
MATERIA MEDICA AND PHARMACOLOGY 
this, as previously stated, is the usual cause of death from 
atropine poisoning. The doctor usually gives inhalations 
of ether to check convulsions and may prescribe caffeine 
in the stage of collapse. Artificial respiration is given 
when necessary. 
HOMATROPINE 
This is an artificial alkaloid prepared from atropine. Its 
effects are similar to those of atropine, but weaker. It is 
used principally as a mydriatic, for which purpose it is 
often preferred to atropine, because it acts quicker and its 
effects are not as lasting and, when it is dropped in the eye, 
it is not as apt to cause systemic effects. 
METHYLATROPINE OR EUMYDRINE 
This is an artificial compound of atropine. Its action 
is similar to that of atropine, but weaker, it is, however, 
somewhat stronger than that of homatropine. 
HYOSCYAMINE 
Hyoscyamine acts upon the central nervous system 
in the same manner and with about the same intensity as 
atropine, but its effects upon nerve-endings are more 
pronounced. 
As it is difficult to obtain a pure preparation of this 
alkaloid, it is little used. 
HYOSCINE OR SCOPOLAMINE 
Hyoscine acts upon nerve-endings in much the same 
manner as atropine, but more powerfully. 
The effects upon the muscles of the irises and the ciliary 
muscles develop and pass away more rapidly than when 
they are induced by atropine. 
As a rule, hyoscine, unlike atropine, causes a mild, 
but prolonged, depression of nerve-centers, especially 
motor and psychic centers, and moderate doses will 
induce sleep that is likely to last for from 5-8 hours and a THE BELLADONNA SERIES 
173 
sensation of drowsiness may persist for several hours 
longer. Hyoscine does not depress the sensory centers 
very strongly and thus it will not abolish pain, but, due 
probably to its action on psychic areas, it has a peculiar 
amnesic effect which causes a patient to forget things, 
including pain, that occur while under the influence of the 
drug. Occasionally, especially when large doses are used, 
hyoscine may cause delirium and excitement in the same 
manner as atropine. 
Due to the depressant action upon nerve-centers, the 
rate of the pulse is not increased by hyoscine, as it is by 
atropine. 
Hyoscine, even in moderate doses, will sometimes 
depress the respiratory and vasoconstrictor centers and 
thus its use is not without danger. 
The chief therapeutic uses of hyoscine are: As a 
mydriatic and cycloplegic. 
To quiet restlessness and induce sleep especially in 
insanity and delirium. 
Hyoscine hydrobromide with morphine (commonly 
referred to as scopolamine-morphine) or with narcophine 
(scopolamine-narcophine) is employed (1) as a preliminary 
to general anesthesia, in order to shorten the stage of 
excitement induced by the general anesthetics and to lessen 
the secretion of mucus and saliva; (2) as a substitute for 
general anesthetics in minor operations and obstetrics. 
It is these preparations that are used in the so-called 
twilight-sleep. 
The term twilight-sleep was applied to the use of the 
above preparations in obstetrics because, in order to favor 
the action of the drug, the patient's room is kept darkened 
and the surroundings very quiet. The regime commonly 
employed is as follows: When the patient is in active labor, 
upon the physician's direction she is given a dose of either 
scopolamine-morphine or scopolamine-narcophine; about 
an hour later, she is given hyoscine alone and this is 
repeated in smaller doses, at regular intervals of, usually, 
an hour until the patient does not remember things she 174 
MATERIA MEDICA AND PHARMACOLOGY 
has seen or heard within half an hour. The doses used are 
only large enough to produce a semi-narcosis. The great- 
est care is necessary when giving this treatment, in fact, 
there have been so many accidents, that it is not now used 
as frequently as it was when first introduced. 
BELLADONNA, HYOSCYAMUS, STRAMONIUM, SCOPOLA 
The alkaloids atropine, hyoscyamine, and hyoscine are 
contained in different amounts and in different relative 
proportions in the crude drugs from which they are ob- 
tained (i.e., belladonna, hyoscyamus, stramonium and 
scopola) and thus there are some differences in the action 
of these drugs. 
The alkaloid in belladonna is nearly all atropine and, 
therefore, its action is that of atropine, though, of course, 
weaker. The preparations made from the leaves of the 
plant (deadly nightshade) contain a higher proportion of 
alkaloid than those prepared from the root. 
The principal alkaloids in hyoscyamus are hyoscyamine 
and hyoscine, it contains only traces of atropine, thus it 
tends to be somewhat narcotic, but, as its alkaloid content 
is small, only 0.065 per cent., its action is weak. It is used 
chiefly to lessen irritability and contraction of the bladder 
in cystitis. 
Hyoscyamine is the chief alkaloid in stramonium, but 
the latter also contains small amounts of atropine and 
enough hyoscine to give it a slight sedative effect. It is 
very frequently used to relax spasmodic contraction of the 
bronchial tubes, especially in the treatment of asthma, 
and it is very commonly employed for this purpose as an 
ingredient of cigarettes and, sometimes, dried leaves of the 
plants from which stramonium is obtained (the species of 
the datura stramonium or thornapple) are set on fire and the 
smoke inhaled. 
The principal alkaloid of scopola is hyoscine, but it 
contains only a small amount and thus the action of 
scopola is similar to that of hyoscine, but much weaker. local anesthetics and anodynes 
175 
Sensory End-organ depressants or Local 
Anesthetics and Anodynes 
Local anesthetics and anodynes are terms applied to drugs 
which lessen pain by their depressant action on sensory 
nerve-endings, i.e., receptors, or fibers. The term ano- 
dyne is used more especially for preparations that are 
employed as external applications. 
Most of the local anesthetics, to be effectual, must be 
injected under the skin or mucous membrane in such a 
manner that they will come in direct contact with the 
end-organs they are to depress, but a few will act if they are 
applied externally. Ethyl chloride is an important example 
of the latter 
ETHYL CHLORIDE 
The origin and nature of ethyl chloride were mentioned 
in connection with the description of its use as a general 
anesthetic. When used as a local anesthetic the tube in 
which the ethyl chlorid is contained is held about 12 inches 
above the part that is to be anesthetized and the cap of the 
tube opened. Whereupon, the liquid strikes upon the 
part and at once evaporates. As heat is necessary for 
evaporation, it is taken from the area on which the ethyl 
chloride strikes and the tissue will be frozen in a few seconds, 
and, cold being a protoplasmic depressant, the nerve- 
endings in the part lose their sensitiveness. As soon as the 
skin assumes a white appearance, the tube-cap is closed. 
Too much ethyl chloride must not be used or the part will 
be so badly frozen that the tissues will slough. Nobody 
should attempt to use ethyl chloride until shown how to do 
so by some one accustomed to using it. 
COCAINE 
Cocaine is an alkaloid obtained from the leaves of the 
coca shrub, a plant that is extensively cultivated in the 
countries of the northern part of South America and to 
some extent in Mexico and the West Indies. 176 
MATERIA MEDICA AND PHARMACOLOGY 
Preparations and Dosage.-Cocaine, grain 
(0.008-0.03 gm.). 
Cocaine hydrochloride, grain (0.008-0.03 gm.). 
This is the preparation most commonly employed. The 
strengths of the solutions generally used are as follows: 
For hypodermic injection, 2-4 per cent. 
For use in the eye, ^-2 per cent. 
For sprays and swabs on mucous membranes, 2-10 per 
cent. 
For what is commonly known as the infiltration method 
of administration, the required dose is generally dissolved 
in 100 c.c. of the diluent that is used. 
Fate in Body.-Cocaine is not absorbed from the un- 
broken skin, but it is readily absorbed from abraided sur- 
faces, mucous membranes, and subcutaneous tissues. Its 
effects being evident in about 10 minutes. A considerable 
portion of every dose is destroyed in the body and the 
remainder is excreted by the kidneys. 
Actions.-Cocaine is .a general protoplasmic irritant 
poison. It does not affect the unbroken skin, but solutions 
over 6 per cent., injected subcutaneously, or those about 
20 per cent., applied to mucous membranes, will cause 
necrosis of the tissue with which they come in contact. 
After a temporary irritation, cocaine depresses those 
nerve-endings which, when stimulated, give rise to a 
sensation of pain; also, it depresses, though in a lesser 
degree, the tactile nerve-endings (those concerned with 
the sensation of touch) but it does not affect those con- 
cerned with the temperature sense. If cocaine is put in 
the nose, it depresses the olfactory end-organs. When 
taken by mouth it causes a momentary stimulation of the 
taste-buds connected with the sensation of bitter and then 
depresses them, but it does not affect other gustatory 
end-organs. 
When cocaine is injected into nerve-trunks or the 
spinal canal, it has the same depressant action upon the 
sensory fibers with which it comes in contact that it has 
upon end-organs. LOCAL ANESTHETICS AND ANODYNES 
177 
Cocaine stimulates vasoconstrictor end-organs with 
which it comes in contact. 
After Absorption, Cocaine Stimulates: The cerebral 
centers controlling the higher intellectual function, those 
concerned with memory, and imagination, and motor 
activity; the respiratory vasoconstrictor, and cardiac 
accelerator centers of the medulla; and the spinal reflex 
centers. The stimulation, especially that of psychic 
centers, is likely to be followed by depression. 
Large doses will have a direct stimulant effect upon 
muscle tissue, especially plain muscle tissue, but such 
stimulation is likely to be followed by depression. This 
effect upon muscle tissue is particularly evident upon that 
in the irises of the eyes. 
Effects of Local Actions.-When cocaine is applied to 
the eyes, or to a mucous membrane, or to a surface from 
which the skin has been removed, or when it is injected 
under the skin, a momentary smarting sensation is felt, 
but this is almost at once followed by abolition of sensation 
of pain in the part, except when the pain is due to heat, as 
when the cautery is used; the blood-vessels in the area are 
so contracted that the tissue becomes bloodless and 
shrunken, though not to quite such an extent as when 
epinephrine (adrenaline) is used. 
Pain is only abolished as long as the drug remains in 
contact with the nerve-endings and this, unless large doses 
are used, will only be about 15 minutes. The blood-vessels, 
however, remain contracted for a considerably longer 
period, because of the stimulation of the vasoconstrictor 
center after the drug is absorbed. 
When cocaine is dropped in the eyes, the pupils first 
contract and then, almost at once, dilate. This is thought 
to be due to the action of the drug on the radial muscle 
tissue in the iris, and, probably, after absorption, stimu- 
lation of some part of the sympathetic nerve supplying 
the radial muscle. The dilation may persist for an hour 
or more. 
When cocaine is taken by mouth, the bitter taste of the 178 
MATERIA MEDICA AND PHARMACOLOGY 
drug is appreciated for a few seconds, but, after that, 
bitter substances will not be tasted. 
In the stomach, the drug, by its depressant action on 
nerve-endings, lessens irritation and may thus check 
nausea, vomiting and hiccough. As cocaine is almost 
entirely absorbed from the stomach, the only effects upon 
the intestine are those that occur after absorption. 
The Effects of the Action of Cocaine after Absorption. 
As the result of the action on the cerebrum, the recipient 
is brighter, memory improved, the ability to reason is 
increased, the imagination is stimulated, the person is 
likely to be talkative and somewhat restless. The stimu- 
lation is usually followed by depression and the individual 
feels melancholy and dispirited. 
The rate and depth of breathing and increased. 
The heart beats more rapidly, but its action is strength- 
ened and blood pressure is raised. These effects are usu- 
ally the result of the stimulation of the cardiac accelerator 
and vasoconstrictor centers but, when large doses are 
taken, they may be partly due to direct stimulation of the 
heart muscle and the muscle tissue in the walls of the 
blood-vessels; however, when doses large enough to stimu- 
late the muscle to these parts are used, their depression 
is likely to follow and, in such case, the arteries will 
dilate widely and collapse occur. 
The stimulation of spinal centers is largely responsible 
for the effects upon muscles described in the paragraph 
following and, in overdoses, it causes muscular twitching 
and convulsions. 
Muscle tone is increased and fatigue lessened, but it is 
thought that, except when large doses are taken, this is 
chiefly due to impulses coming from the cord. In South 
American countries, where the coca shrub is grown, many 
of the natives chew the leaves and, when they are supplied 
with these, they can go for days without food and, 
apparently, not feel hunger or exhaustion, even when 
doing hard work. 
The increased muscle tone of the intestine favors peris- LOCAL ANESTHETICS AND ANODYNES 
179 
talsis and large doses of cocaine will cause diarrhea but 
this is likely to be followed by intestinal paralysis. 
The excretion of urine is increased as the result of the 
rise of blood-pressure in the renal vessels. 
Cocaine is not used in therapeutics for its effects 
after absorption, because its favorable ones can be also 
obtained with caffeine and the latter does not have as 
many undesirable effects as cocaine. Nevertheless, it is 
very important for nurses to remember the systemic 
actions of cocaine, because they occur, sometimes to a 
very extreme degree, when the drug is used for its local 
action. 
The undesirable effects of cocaine are: (1) the intense 
psychic depression that frequently follows stimulation. 
(2) Due to idiosyncrasy, even moderate doses of cocaine 
will poison some individuals. (3) There is no drug habit 
that is more easily contracted, nor more difficult to break, 
than the cocaine habit. 
Cocaine is used chiefly: (1) To promote local anesthesia 
when an incision is to be made. For this purpose it is 
usually injected hypodermically and, as it only induces 
anesthesia w'hile it is in contact with the nerve-endings or 
fibers, some means is usually taken to prevent its absorp- 
tion. The most common one being to use epinephrine 
(adrenaline) with the cocaine, for the former contracts the 
blood-vessels in the area of its application to such an 
extent that absorption is delayed. When adrenaline is 
not to be had an ice cap is sometimes applied to the part 
or, if the part to be operated on is a limb or finger, an 
elastic bandage is put around the part, just above the 
point where the incision is to be made in order to limit 
the flow of blood, and, with it, the anesthetic, from the 
area. Restricting the absorption of cocaine tends also to 
lessen the danger of poisoning. Cocaine is sometimes 
injected into a part that is to be operated upon, even 
when a general anesthetic is given, in order to, by lessen- 
ing the stimulation of nerve-endings, reduce the inflow of 
impulses to nerve-centers for, as previously stated, ex- 180 
MATERIA MEDICA AND PHARMACOLOGY 
cessive stimulation of nerve-centers causes their depression 
and is thus conducive to shock. 
(2) To promote a diffused anesthesia previous to opera- 
tion. For this purpose, the cocaine is sometimes injected 
into the nerve-trunk supplying the area that is to be 
operated upon, or into the spinal canal, or into the tissues 
in the same way as a hypodermoclysis. 
(3) To lessen congestion and sensitiveness in canals 
(as the nostril, larynx, urethra) in order to facilitate the 
passage of a speculum or other instrument. For this pur- 
pose the drug is generally either sprayed or swabbed over 
the part or, in the rectum, it is sometimes incorporated in 
ointment or a suppository. 
(4) It is dropped in the eye \a) to cause anesthesia for 
slight operations; (&) to dilate the pupils for examination of 
the eyes when it is desired to avoid causing changes in the 
accommodation apparatus. 
Toxicology.-Symptoms of acute poisoning are: The pa- 
tient becomes very excited and restless and may become 
delirious or the excitement may pass into stupor and coma. 
The pulse becomes very rapid and weak. The breathing is 
rapid and at first deep, but, eventually, panting or shallow. 
The throat is dry, but perspiration is likely to be profuse. 
The pupils become widely dilated. There may be nausea, 
vomiting, diarrhea, muscular twitching and, finally, 
convulsions. The patient may complain of various 
sensations, as of worms crawling upon the skin, this is 
known as Magnan's sign. Unless the symptoms are 
relieved-collapse finally occurs and the patient may die 
either from failure of the heart action or paralysis of the 
respiratory center. Occasionally, the period of excitation 
is short and collapse and death occurs almost immediately. 
If too strong solutions are dropped in the eye, conjunc- 
tivitis and ulceration of the cornea are likely to follow. 
The special points in the treatment of acute poisoning 
are: To keep the patient as quiet as possible and if, as is 
usually the case, he is anxious about his condition, reassure 
him. An ice cap is generally kept on the head and the LOCAL ANESTHETICS AND ANODYNES 
181 
doctor generally prescribes large doses of bromide to over- 
come the nervous excitement and muscular twitching. 
The Symptoms of Chronic Poisoning.-The individual 
is particularly bright, cheerful and talkative, while under 
the influence of the drug, and moody, despondent, and 
irritable when he does not get his dose. For a long time 
these may be the only symptoms but, gradually, the harm- 
ful effects of the drug upon the nervous tissue interfere 
with its functioning and then the individual's mental 
capacity deteriorates; moral sense becomes perverted; and, 
finally, as the nerve-centers governing the digestive organs 
and metabolism cease to function normally, gastro-intes- 
tinal disturbances become common, and there will be 
anemia, and emaciation. Also there will be insomnia and, 
usually, twitching of the muscles and other manifestations 
of nervous irritability such as the perverted skin sensations 
experienced in acute poisoning. Insanity is a common 
sequence. 
In addition to the systemic symptoms there will be local 
ones the nature of which depend upon the way in which the 
habitu^ takes the drug. This varies somewhat, for it may 
be taken by hypodermic, snuffed up into the nose, rubbed 
on the gums or taken by mouth. A mucous membrane 
that is frequently exposed to the action of the drug will, 
in time, become atrophied and ulcerated; and, when the 
drug is injected hypodermically, necrotic areas may de- 
velop at the sites of injection and, as habitues generally 
grow careless in the matter of asepsis, [abscesses are 
common. 
Treatment for Chronic Poisoning.-This consists in the 
rapid withdrawal of the drug and the isolation of the pa- 
tient where it will be impossible to obtain it. Hydro- 
therapy is very commonly used to overcome the nervous 
symptoms and sleeplessness. Nutritious food, of a land to 
appeal to the patient, properly regulated exercise and 
entertainment are all exceedingly important items of the 
treatment. For the patient's tissues must be brought to 
a healthy condition and his mind diverted. 182 
MATERIA MEDICA AND PHARMACOLOGY 
Cocaine Substitutes 
In the search for a substance that would be as efficient 
a local anesthetic as cocaine, without producing its un- 
desirable effects, a number of drugs have been prepared, 
many of them from cocaine. Of these novocaine and 
eucaine are probably the most used. 
NOVOCAINE 
The advantages of novocaine over cocaine are: Its 
solutions can be sterilized; it produces no irritation of the 
tissues; it is only about one-third as poisonous as cocaine. 
Its anesthetic action, however is neither as strong nor as 
lasting as that of cocaine. One reason for the relative 
transitory action is that it does not contract the blood- 
vessels and thus is rapidly absorbed from the area into 
which it is injected; therefore, if adrenaline (which does 
contract the vessels) is used with the novocaine this ob- 
jection may be overcome. 
Novocaine tablets of different strengths are sold (be- 
tween and 3 grains (0.02 and 0.2 gm.) and some contain 
adrenaline. A tablet is dissolved in sufficient sterile water 
to make a solution the desired strength. This is generally, 
about 3 per cent. 
EUCAINE OR BETA-EUCAINE 
Eucaine or, more correctly, beta-eucaine, of which there 
are two preparations, a lactate and a chloride, is only 
about half as poisonous as cocaine and its anesthetic 
power is about the same. It does not dilate the pupils 
nor contract the blood-vessels but it has a depressant 
action on the heart muscle and, thereby, is likely to cause 
a relatively slow and weak pulse, otherwise, its action is 
the same as cocaine. Its solutions can be sterilized. 
Both beta-eucaine lactate and beta-eucaine chloride are 
used in solutions of the following strengths: 
^-2 per cent, for the eye. LOCAL ANESTHETICS AND ANODYNES 
183 
2-5 per cent, for mucous surfaces, and hypodermic 
injections. 
0.2-1 per cent, for infiltration anesthesia. 
Dosage.-Grains (0.008-0.03 gm.). 
TROPOCAINE 
Tropocaine is more irritant locally than cocaine, it does not 
dilate the pupils nor contract the blood-vessels, otherwise, its 
action is similar to that of cocaine. Its solutions can be sterilized. 
Tropocaine is not readily absorbed from mucous surfaces and 
thus is given only by hypodermic. 
Dosage.-J^-l grain (0.03-0.06 gm.) diluted, as a rule to form 
3-10 per cent, solutions. 
STOVAINE 
Stovaine is said to be somewhat less poisonous than cocaine, 
but is more irritant locally and is thus more prone to cause "hypo- 
dermic abscesses." Its local anesthetic effect is about equal to 
that of cocaine. It dilates blood-vessels. Because of its irritant 
properties, it is rarely used in the eyes. 
Dosage-Grain (0.002 gm.). This is usually diluted suffi- 
ciently to make J^-l per cent, solutions for hypodermic use. 5-10 
per cent, for application to mucous membranes. 
Alypine solutions cannot be boiled and they are irritant locally. 
Alypine dilates blood-vessels, but it has no effect upon the pupils. 
Some authorities state that it is as poisonous as cocaine and 
others that it is less so. It is rarely given by hypodermic. 
Dosage.-Gr. ^-3 (0.02-0.2 gm.). This is generally diluted 
sufficiently to make solutions: 
% per cent, for the eye. 
1-10 per cent, for mucous membranes. 
ALYPINE 
HOLOCAINE 
Holocaine is an artificial alkaloid prepared from phenacetine. 
Its action is similar to that of cocaine. Some authorities state 
that it is more, and others that it is less, poisonous. Its anesthetic 
power is somewhat greater than that of cocaine and it is some- 
what antiseptic. It does not dilate the pupils. Its chief use is 
as a local anesthetic in the eye for which a 1 per cent, solution is 
employed. 184 
MATERIA MEDICA AND PHARMACOLOGY 
Quinine and urea hydrochloride, as the name implies 
is a combination of quinine (described page 343) and urea, 
a synthetically prepared nitrogenous compound with the 
same chemical structure as the urea in urine. 
Quinine and urea hydrochloride is used as a local 
anesthetic injected hypodermically and as an application 
to mucous membranes. It is usually dissolved in normal 
salt solution and strengths from 0.25-3 per cent, are 
employed. 
QUININE AND UREA HYDROCHLORIDE 
MAGNESIUM SULPHATE 
The use of magnesium sulphate as a local anesthetic was 
described in connection with its use for intraspinal injec- 
tions under General Anesthetics. 
ORTHOFORM 
Orthoform is an ethereal salt or ester of methyl alcohol and 
amidobenzoic acid. It is used in the form of dusting powders, 
ointments, lozenges, and the powder is also given in capsules by 
mouth. It is employed chiefly as an anodyne for painful ulcers 
including ulcer of the stomach, for hemorrhoids, and to overcome 
cough (the lozenges). 
Orthoform acts as a mild local anesthetic; at the point of its 
application it is not readily absorbed and thus produces prac- 
tically no systemic effects. 
Dose, 5-15 gr. (0.3-1.0 gm.). 
PROP^SIN. ANESTHESIN. CYCLOFORM 
These drugs all have about the same action as orthoform. 
Propaesin, in addition, contracts mucous membranes. Cycloform 
is slightly antiseptic. 
Dosage.-Propaesin, 5-8 gr. (0.3-0.5 gm.). 
Anesthesin, same as propaesin. 
Cycloform, 1^-3 (0.1-0.2 gm.). 
HYDROCYANIC (PRUSSIC) ACID (HCN) 
Hydrocyanic acid is a very volatile, inflammable, color- 
less liquid. It has a peculiar odor, similar to bitter al- 
monds. It is usually obtained by the decomposition of 
one or other of its salts but it may be prepared from: The LOCAL ANESTHETICS AND ANODYNES 
185 
kernels of certain fruits, sucn as the cherry, apple, and 
plum; bitter almonds; bark of the wild cherry; and the 
leaves of the cherry laurel. It does not exist in these 
substances preformed, but they all contain certain gluco- 
sides, the principal one of which is amygdaline and a fer- 
ment which, when the kernels, etc., are macerated in 
water, changes the glucosides to hydrocyanic acid. Thus 
the official oil of bitter almonds (amygdala amara) con- 
tains 2-4 per cent. HCN and there may be traces of it in 
some of the other preparations mentioned, all of which 
contain amygdaline. 
Preparations and dosage: 
Dilute hydrocyanic acid, (2per cent.) 2-5Hl. (0.10-3 c.c.). 
Potassium cyanide, gr. (0.005-0.01 gm.). 
Oil of bitter almond, 1TTL. (0.06 c.c.). 
Syrup of bitter almond, 30 TTl. (2.0 c.c.). 
Syrup of wild cherry, 1-4 drams (4.0-15.0 c.c.). 
Fluidextract of wild cherry, 15-30 HL. (1.0-2.0 c.c.). 
Actions and Effects.-When applied either to the skin, 
mucous membranes, or raw surfaces, hydrocyanic acid 
depresses sensory nefve-endings with which it comes in 
contact and thereby lessens irritation and produces a 
sensation of numbness. 
If taken by mouth, hydrocyanic acid will inhibit the ac- 
tion of the digestive ferments and after absorption it will 
have the same effect upon those concerned with meta- 
bolism, including the oxidases, i.e., those which promote 
oxidation and, it is thought that the principal results of the 
drug after absorption are due to this action. The primary 
result is that the tissues cannot use the oxygen that is in 
the blood to the normal degree and a condition of partial 
asphyxia results. This, if not excessive will cause stimula- 
tion of the central nervous system, especially the respira- 
tory, vasoconstrictor and vagus centers and, consequently, 
the breathing increases in rate and depth, the heart action 
becomes slow and there is a rise of blood-pressure, due to 
the contracted arteries. If the asphyxia is extreme, as 
after a poisonous dose, the vomiting center will be stimu- 186 
MATERIA MEDICA AND PHARMACOLOGY 
lated and also the pupil dilator center and reflex centers and 
the excessive stimulation will be followed by depression. 
The syrup preparations are used to allay irritation in 
the throat and thus check coughing, but, as they only 
contain minute amounts of the active principle, their 
value depends chiefly upon the demulcent action of 
the syrup. The other preparations are rarely used 
now for they are excessively poisonous. Nevertheless 
they, and similar compounds, are fairly common causes 
of poisoning, as they are used in a number of industries. 
Death may occur instantly after the absorption of even 
minute amounts or it may be preceded by symptoms of 
asphyxia (see page 97) and collapse (page 63), also there 
is a typical odor to the breath and vomitus and, on 
autopsy, irom rhe interior of the body. The treatment 
for poisoning is the same as for other depressants; atro- 
pine is given to stimulate breathing. 
ACONITE (MONKSHOOD OR WOLFSBANE) 
Dosage: Tincture of aconite, 1-4 m. (0.06-0.3 c.c.). 
Aconitine, /4oo~/'ioo gr- (0.00015-0.0006 gm.). 
For external use aconite liniment and ointment. 
Actions and Effects: Applied locally, aconite first stimu- 
lates and then depresses sensory nerve-endings thereby 
causing a sensation of tingling followed by numbness. 
When the drug is swallowed the sensory stimulation also 
induces a reflex flow of saliva and may cause sneezing, 
coughing, nausea and vomiting. After absorption, the 
chief actions of a moderate dose are stimulation of the 
respiratory and vagus centers, so that the breathing is 
quickened and the heart action slowed and weakened 
and blood pressure thus reduced. For unknown rea- 
sons, the temperature may be lowered. After absorp- 
tion, the sensory nerve-endings may be affected in the 
same way as by local applications but, except after 
poisonous doses, less noticeably. Formerly aconite was 
often used to reduce blood pressure and as an anti- 
pyretic, but, at present, its chief use is as a local ano- 
dyne. Poisonous doses depress the vital medullary MOTOR END-ORGAN DEPRESSANTS 
187 
centers and the heart muscle and, therefore, the 
breathing becomes slow and shallow and the symptoms 
of asphyxia (see page 97) and collapse (page 63) are 
pronounced. Also there will be sensations of tingling 
and numbness. The treatment for poisoning is the 
same as for other depressants. 
Drugs Which Depress Secretory End-Organs 
The Belladonna group of drugs, which have been 
described and agaricin are the only drugs of importance 
used for this effect. 
AGARICIN 
Agaricin is obtained from the Agaricus, a white fungus 
which grows on the European larch tree. 
Its active principle is agaric acid. 
Preparations and Dosage.-Agaricin Ho~l Sr- (0.006- 
0.06 gm.). 
Agaric acid (not official), gr. (0.015-0.03 gm.). 
Agaricin is absorbed slowly and its effects are not lasting. 
Action.-Agaricin depresses the terminations of the 
secretory nerves in the sweat glands but, unlike atropine, 
not those of other glands. It is slightly irritant to mucous 
membranes but, as a rule, this action is only evident when 
large doses are taken. 
Effects of Action.-The secretion of sweat is checked; in 
other words, the drug acts as an anhidrotic. 
Large doses will cause nausea, vomiting and diarrhea 
and, if these conditions are pronounced, they will induce 
symptoms of collapse and, in such case, the anhidrotic 
action of the drug will be interfered with as, for unknown 
reasons, sweating is commonly associated with extreme 
nausea and collapse. 
Agaricin is used chiefly to inhibit the night sweats of 
tuberculosis. Because of its slow absorption and transi- 
tory action, agaricin should be administered about 4 to 5 
hours before the time that the sweating generally occurs. 
MOTOR END-ORGAN DEPRESSANTS 
The drugs belonging to this group-curara, conium, 
gelsemium, nicotine and lobelia-are rarely used in thera- 188 
MATERIA MEDICA AND PHARMACOLOGY 
peutics at present, but some of them are of interest for 
other reasons. 
CURARA 
Curara is obtained from various South American trees and is 
used by the Indians on the tips of their arrows to render them 
poisonous. 
Curara is of interest because it is much used in experimental 
work in physiological laboratories and the curara action is often 
referred to in books on physiology, pathology and materia medica. 
It consists in depressing the myo-neural junctions in the skeletal 
muscles and thus inhibiting the discharge of impulses into the 
muscles. This lessens their tone and, in large doses, causes 
paralysis. Curara was formerly used to arrest convulsions, 
especially those occurring in tetanus and strychnine poisoning, 
but when employed in large enough doses to be of value for the 
purpose, it tended to depress the respiratory muscles and induced 
asphyxia and, consequently, death. 
The venom of the cobra and some other snakes have much the 
same effect as curara. Such venom can be sucked from a wound 
with impunity, if there are no abrasions in the mucous membrane 
and the poison is not swallowed. 
CONIUM (POISON HEMLOCK) 
This drug is of interest because it was used by the ancient Greeks 
as a means of killing criminals and it was the poison by which the 
Greek philosopher Socrates was put to death. 
It has a relatively mild curara-like action and, in addition, it 
tends to depress sensory nerve-endings slightly. It is occasion- 
ally used to inhibit spasmodic contractions such as occur in whoop- 
ing cough. It causes death in the same manner as curara. 
Dose of fluidextract 2-6 m, (0.1-0.4 c.c.). 
GELSEMIUM 
Gelsemium is obtained from the yellow jasmine, a climbing 
plant of the southern United States. 
Dosage.-Fluidextract 1-5 TO,. (0.06-0.3 c.c.). Tincture 10-15 TH.. 
(0.06-1.0 c.c.). 
When applied locally to the eye, gelsemium dilates the pupil by, 
it is thought, depressing the endings of the third nerve in the iris. 
After absorption its actions are similar to those of conium and it 
tends to lessen neuralgic pains. The cause of the latter effect 
is not known. 
Spartein is an alkaloid obtained from scoparius or broom plant. 
Dosage.-Spartein sulphate Ho-2 gr. (0.006-0.1 gm.). Decoc- 
tion of scoparius 1 oz. (30.0 c.c.). 
SPARTEIN AND SCOPARIUS MOTOR END-ORGAN DEPRESSANTS 
189 
Spartein depresses motor end-plates in the same manner as 
conium and it also depresses the heart muscle and stimulates vagus 
and vasoconstrictor ganglia. Because of the effects of its action 
on the ganglia, spartein was formerly thought to act in the same 
manner as digitalis and was sometimes used as a substitute. At 
present it is rarely used, except, occasionally to relax spasmodic 
contraction of the bronchial muscle in asthma. 
TOBACCO. NICOTINE 
Tobacco consists of the prepared leaves of the Nicotiana tabacum, 
a plant common in southern countries. Tobacco contains several 
alkaloids and a volatile oil to which its aroma is due. Its chief 
active principle, the alkaloid nicotine, is a highly poisonous sub- 
stance, but when tobacco is smoked, much of the nicotine is 
changed to pyridine and similar substances which, though their 
action is the same as that of nicotine, are not as powerful poisons. 
Also, people who smoke only inhale a small amount of these sub- 
stances and they soon establish a tolerance for them and thus their 
action is only marked the first few times that a person smokes. 
Actions.-Nicotine irritates the mucous membrane with which 
it comes in contact. 
After absorption, it first stimulates and then depresses: the 
cerebrum; the medullary centers, especially the vagus; and motor 
nerve-endings, both those in the skeletal muscles and plain muscle 
tissue. 
Effects of Actions.-The secretion of saliva and mucus is 
stimulated by the irritation of the mucous membrane. This 
action is particularly marked in those not accustomed to smoking 
and it is partly responsible for the nausea, vomiting and diarrhea 
that sometimes follow smoking until the person becomes habit- 
uated. The irritation of the alimentary canal will be increased 
if the saliva, which is of course impregnated with the smoke, is 
swallowed. 
As the results of the action of nicotine, etc., after absorption, 
the heart action is, at first slowed and then, as the vagus becomes 
depressed, quickened, it is also weakened. 
Breathing is first quickened and then slowed. 
The contraction of the muscles and the muscle tissue of the 
viscera is increased and then more or less relaxed. 
There is transitory psychic stimulation but this is followed 
by more or less depression so that a smoke has a slight sedative 
effect on those accustomed to the practice and, in the unhabituated, 
after the nausea and vomiting subside, a narcotic. 
The only therapeutic use of nicotine, etc., is to relax the bronch- 
ial muscles in asthma. For this purpose, cigarettes containing 
tobacco and, as a rule stramonium or lobelia, are smoked. 190 
MATERIA MEDICA AND PHARMACOLOGY 
The symptoms of acute poisoning occur as a rule after the 
"first smoke" and even the habitue may experience them after 
smoking an unusually large quantity of tobacco. They are: 
Nausea, vomiting, diarrhea, headache, dizziness, faintness, pallor 
of the skin, profuse perspiration. 
The treatment consists in making the person lie down where 
he will get pure air. Aromatic spirits of ammonia and similar 
carminatives will help in overcoming the condition. 
Chronic poisoning is likely to result when an individual smokes 
to excess. The symptoms vary somewhat but common ones 
are: Derangement of digestion; nervousness which shows in 
various ways, such as irritability and restlessness; impairment 
of intellectual ability; rapid heart action and palpitation; chronic 
inflammation of the throat which may extend through the 
Eustachian tube to the ears. 
LOBELIA 
Lobelia is obtained from, the Indian tobacco plant. Its active 
principle, lobeline, is a volatile alkaloid that resembles nicotine 
in its nature and action. 
Preparations and Dosage.-Fluidextract of lobelia, 1-5 TH.. (0.06 
-0.3c.c.). 
Tincture of lobelia, 10 TH,-15 (0.6-4.0 c.c.). 
Lobelia is used to relieve the spasmodic contractions of the 
bronchial muscle in asthma. The leaves are now more frequently 
used (as a constituent of cigarettes) than the liquid preparations 
because poisoning has frequently followed the use of the latter. 
The symptoms of poisoning are practically the same as those of 
nicotine. If the poisoning is due to a fluid preparation taken 
by mouth, the stomach must be lavaged, otherwise, the treatment 
is the same as described for nicotine poisoning. 
Drugs Which Stimulate Peripheral End- 
organs 
The principal drugs owing their important effects to 
this action are: Pilocarpine, physostigma, epinephrine or 
adrenaline, ergot. 
PILOCARPUS 
Pilocarpus is obtained from the Pilocarpus jaborandi, a 
Brazilian shrub. Its chief active principle is the alkaloid 
pilocarpine. DRUGS STIMULATING PERIPHERAL END-ORGANS 
191 
Pilocarpus, 20-30 gr. (1.25-2.0 c.c.) 
Fluidextract of pilocarpus, 20-30 TH. (1.25-2.0 c.c.). 
Pilocarpine hydrochloride, gr. (0.006-0.03 gm.). 
Pilocarpine nitrate, gr- (0.006-0.03 gm.) 
Fate in Body.-Pilocarpine is readily absorbed from the 
skin and mucous membranes. It is excreted by the 
kidneys, sweat and salivary glands. 
Actions.-Pilocarpine acts only after absorption. It 
then stimulates most of the nerve-endings which atropine 
depresses, i.e., the parasympathetic nerve-endings and the 
nerve-endings in the sweat glands. Also, it stimulates 
the motor nerve-endings in the pregnant uterus. The 
nerves of the sweat glands and the uterus belong, it will 
be remembered, to the sympathetic system. If the parts 
which the parasympathetic system supplies cannot be 
recalled, see the table on page 82. Pilocarpine affects 
the secretory nerve-endings to a greater degree than the 
motor or than the vagus supply to the heart. 
In large doses, pilocarpine depresses vital medullary 
and spinal centers. 
Effects of Actions.-All external secretions, except bile, 
urine and milk, are increased. There is lessened secretion 
of bile, urine and milk, but this is thought to be the result of 
loss of water on account of the excessive secretion of sweat 
and saliva. A single dose of pilocarpine may induce the 
secretion of as much as a pint of saliva and a much larger 
amount of sweat. In fact, enough water is often lost from 
the body to reduce the weight as much as between 4 and 
9 pounds. The loss of fluid from the body will lessen 
edema if this exists. 
The activity of the sweat glands induces the flow of an 
extra amount of blood into the skin vessels so that the skin 
is likely to become somewhat red and the loss of heat from 
the body by radiation is increased. The evaporation of 
the extra amount of sweat also increases the loss of body 
heat and thus the temperature tends to be reduced. 
The increase of the scalp secretions promotes the growth 
of hair. Unfortunately, the new hair is likely to be lighter 
in color than the rest. 192 
MATERIA MEDICA AND PHARMACOLOGY 
Especially when the drug is applied directly to the eyes, 
the pupils become contracted and the accommodation 
apparatus fixed to view near objects. The continued 
contraction of the ciliary muscles, which this change in 
accommodation involves, may give rise to a sensation of 
pain. Intraocular tension, after a preliminary rise, due 
to increased secretion, is reduced because of the escape of 
fluid through the spaces of Fontana, which are opened by 
the contraction of the pupils. This was explained in the 
section describing the action of atropine on intraocular 
tension, which is exactly the opposite of pilocarpine. 
Large doses of pilocarpine, by promoting excessive con- 
traction of the muscle tissue of the stomach and intestines, 
may cause vomiting and diarrhea, and abortion has fol- 
lowed the use of large doses during pregnancy, because of 
the contraction of the uterine muscles. 
Following large doses of pilocarpine there will be an 
increase of leucocytes in the blood. This is thought to be 
due to the contraction of the muscle tissue of the spleen, 
which forces leucocytes from that organ into the blood- 
stream. 
The heart action is slowed by large doses and, usually, 
will continue slow, even when large enough doses are taken 
to depress the vagus center because, in such case, the 
heart muscle is also depressed. Occasionally, however, the 
pulse may become rapid after vagus depression, especially 
when there is much nausea and vomiting. Whether slow 
or rapid the pulse will be weak. 
Breathing is not affected by any direct action of pilo- 
carpine on the respiratory mechanism, except when the 
drug is taken ih large doses, but nevertheless it may be 
seriously interfered with by the excessive secretion of 
bronchial mucus. Following large doses there will be 
additional trouble from the contraction of the bronchial 
muscle and the aeration of the blood may be imperfect 
because of this and of the interference with the circulation 
of blood in the lungs, due to the slowing of the heart 
action. Thus there is likely to be more or less dyspnea and DRUGS STIMULATING PERIPHERAL END-ORGANS 
193 
a tendency to cyanosis, and there is danger of edema of 
the lungs. After poisonous doses, as the respiratory cen- 
ter becomes depressed, breathing becomes slow and 
shallow and death is generally the result of failure of res- 
piration or of asphyxia due to the air-sacs of the lungs 
becoming filled with fluid (edema of the lungs). 
The chief therapeutic uses of pilocarpine are: To cause 
miosis (contraction of the pupil). 
As an ingredient of hair tonics. 
To promote diaphoresis (excessive sweating) in order to 
reduce edema, the way in which it does this is explained in 
the section describing the action of diaphoretics. 
To overcome conditions in the inner ear due to lack of 
secretion. 
It is important to remember that patients receiving 
pilocarpine must be carefully watched because of the 
dangers of interference with the respiration and of cardiac 
depression. 
Toxicology: 
The symptoms of poisoning are: The pupils are con- 
tracted. The pulse is weak and irregular and, usually, 
slow. The skin is flushed and covered with perspiration. 
There is also excessive secretion of tears, saliva, and 
mucus. There will be dyspnea and cyanosis and there 
is likely to be edema of the lungs. Loud moist rales will 
be heard being due both to the fluid in the air-sacs and 
excess mucus in the bronchi and throat. 
Muscular twitching and convulsions are likely to occur 
as the result of the asphyxia, produced by the blocking 
of the air-tubes and the interference with the circulation 
in the lungs. As a rule, the patient remains conscious 
until shortly before death. 
Treatment for Poisoning.-The usual means to remove 
the drug from the stomach and prevent collapse are taken. 
Caffeine and camphor are very commonly prescribed for the 
latter purpose. Artificial respiration is given if necessary. 
Atropine is the physiological antidote, because it has 
the opposite action upon peripheral nerve-endings and it 194 
MATERIA MEDICA AND PHARMACOLOGY 
makes breathing easier. (Pilocarpine, however, is useless 
in the treatment of atropine poisoning because death from 
the latter drug is due to its central action, which pilocar- 
pine does not antagonize.) 
MUSCARINE 
The alkaloid muscarine is the active principle of many of the 
poisonous species of mushrooms. Its action is very similar to 
pilocarpine, but it induces vomiting and diarrhea in much smaller 
amounts and, for this reason, it is no longer used as a substitute 
for pilocarpine, and is only of interest because it is a common 
cause of poisoning. The symptoms of, and treatment for poison- 
ing are the same as pilocarpine. 
PHYSOSTIGMA (CALABAR BEAN) 
Physostigma is procured from the seeds of the Physo- 
stigma venenosum or Calabar bean, a vine which is indigen- 
ous in Western Africa. It is of special interest because it 
was used by the natives of the countries in which it grows 
as a means of deciding the guilt or innocence of those 
accused of crime. The accused were made to eat the 
paste and, if they died, they were deemed guilty; if they 
survived, they were declared innocent. 
The alkaloid eserine or physostigmine is the active 
principle. 
Preparations and dosage: Extract of physostigma, 
^-1 gr. (0.008-0.06 gm.) 
Tincture of physostigma, 15-40 m. (1.0-2.50 c.c.). 
Eserine salicylate, o gr- (0.001-0.002 gm.). 
Eserine sulphate, ^tsp-Mo gr- (0.001-0.002 gm.). 
Fate in Body.-Eserine is very rapidly absorbed into 
the blood from mucous membranes and subcutaneous 
tissues, its effects being evident in from 15 to 30 minutes. 
A considerable portion of each dose is destroyed in the 
body and all that is not destroyed is rapidly eliminated, 
chiefly in the urine, but, to some extent, in the saliva and 
bile. DRUGS STIMULATING PERIPHERAL END-ORGANS 
195 
Action: 
Physostigmine or eserine acts only after absorption. 
Its action is similar to that of pilocarpine, but it stim- 
ulates some nerve-endings that pilocarpine does not 
affect and, it is thought, physostigmine does not actually 
stimulate the nerve-endings, as pilocarpine does, but 
renders them more efficient in transmitting impulses 
descending the efferent fibers; the effect, however is that 
of stimulation. The nerve-endings thus acted upon are:1 
(1) The secretory nerve-endings in the sweat, lachrymal, 
salivary, gastric, intestinal glands, the pancreas, and the 
secretory cells of the mucous membranes. 
(2) The endings of the third nerve in the irises and the 
ciliary muscles of the eyes. 
(3) The motor nerve-endings in the plain muscle tissue 
of the bronchial tubes, the stomach, intestines, spleen, 
ureters, bladder, uterus and, unlike pilocarpine, physo- 
stigmine acts, it is thought, upon the vasoconstrictor 
nerve-endings, because the arterioles become contracted. 
The action of physostigmine on the nerve-endings of the 
intestinal muscle is particularly marked. 
(4) The vagus nerve-endings in the heart; this action is 
very slight. 
(5) The motor end-organs in the skeletal muscles 
(pilocarpine does not affect these nerve-endings). 
Large doses depress the heart muscle and first stimulate 
and then depress the vital medullary centers, and the 
reflex centers of the cord, but the psychic centers of the 
cerebrum are not directly affected by the drug. 
Effects of Actions: 
When dropped in the eye and, though to a less extent, 
when taken internally, eserine causes contraction of the 
pupils and the ciliary muscles. As the result of the latter 
action, the lens becomes more convex and the eye is thus 
accommodated for viewing objects near at hand. The 
contraction of the pupil widens the spaces of Fontana and 
1 The students should be required to state which of these nerve- 
endings are not affected by pilocarpine. 196 
MATERIA MEDIC A AND PHARMACOLOGY 
thus facilitates the escape of intraocular fluid and thus 
intraocular tension is lessened. Physostigmine opposes 
the action of atropine upon the eyes to an even greater 
extent than pilocarpine. 
As the result of the action of the secretory nerve- 
endings, there is increased secretion of tears, saliva, gastric, 
intestinal and pancreatic juices; perspiration and mucus, 
but the increase of secretions is not nearly as pronounced 
as when pilocarpine is used, because physostigmine, by 
contracting the arterioles in the glands, lessens the blood 
supply in the glands and this interferes with secretion. 
The heart beats more slowly and, due to the contraction 
of the arterioles, blood pressure is raised, thus the pulse 
tends to become relatively slow and strong. 
The rate of breathing is increased by small doses, 
in the endeavor to overcome the interference with the 
passage of air promoted by the contracted bronchi, but, 
following large doses, breathing may become slow and 
weak as the result of depression of the respiratory center. 
There is increased contraction of both plain and striated 
muscle tissue. After moderate doses, this is most evident 
in the intestinal muscle for physostigmine, whether given 
by mouth or hypodermic, will increase peristalsis suffici- 
ently to have • a cathartic action and it is valuable in 
overcoming intestinal paralysis. Following large doses 
there is likely to be twitching of the muscles of the face 
and limbs, and, after poisonous doses, there is extreme 
muscular weakness resulting from the depression of the 
reflex centers and the motor end-organs. 
The chief therapeutic uses of eserine are: To reduce in- 
traocular tension in glaucoma and to counteract the effect 
of atropine on the pupil and accommodation apparatus of 
the eye. As a cathartic. 
Toxicology: 
Symptoms of poisoning are: Nausea, vomiting and 
diarrhea associated with intense abdominal cramps. Slow, 
weak, irregular pulse and slow, labored breathing with 
consequent cyanosis. Contracted pupils. Twitching of DRUGS STIMULATING PERIPHERAL END-ORGANS 
197 
the muscles and extreme loss of muscular power, beginning 
in the legs and ascending gradually upward. Excessive 
secretion of saliva and sweat. Death is very likely to 
occur from interference with breathing. 
The treatment is the same as for pilocarpine poisoning. 
EPINEPHRINE OR ADRENALINE 
Epinephrine, commonly known as adrenaline, is an 
alkaloid obtained from the suprarenal capsules of cattle, 
sheep or pigs. It is thought to be the same as the internal 
secretion manufactured by the human glands. 
Preparations and Dosage.-Dried suprarenal gland, 4 
gr. (0.25 gm. adrenaline). 
Epinephrine chlorid, (1:1000 solution) 5-30 m. (0.3- 
2.0 c.c.). 
Adrenaline tablets each contain Moo gr- (0.001 gm.) of 
adrenaline borate. A tablet dissolved in 15 m. (1.0 c.c.) 
of water will make a Hooo solution. 
Also there are a number of proprietary preparations, 
some of them synthetic, that are known by various 
names as supracap suline, adnephrin, etc. And there are 
preparations of adrenaline for local use in ointments and 
suppositories. 
Fate in Body.-Epinephrine does not penetrate the skin 
at all, it penetrates mucous membranes slightly, but it is 
not absorbed, and it is thought that its absorption is 
inhibited because it constricts the blood-vessels in the parts 
with which it comes in contact and some investigators 
believe that, when epinephrine is taken by mouth, it is 
digested by the gastric juice. When injected into the 
tissues it is absorbed by the blood, but slowly, for when 
given in this way, its effects will only be obtained in about 
half an hour, while, when it is injected into a vein, results 
will be observed in from 5 to 10 minutes. What becomes 
of adrenaline after it is absorbed is not definitely known, 
but, it is thought, it is rapidly decomposed because it is 
rarely found in the urine or other excreta and its effects 
are very transitory. 198 
MATERIA MEDICA AND PHARMACOLOGY 
Actions.-Adrenaline has no effect upon the unbroken 
skin. When applied to abraded surfaces or mucous 
membranes, it penetrates as far as the superficial blood- 
vessels and stimulates the myoneural junctions of the 
vasoconstrictor nerve-endings. 
When adrenaline is dropped into the eyes and, to some 
extent, when it is injected into a vein, it stimulates the 
myoneural junctions of the sympathetic nerve-endings in 
the radial muscles of the irises. 
When adrenaline is injected into the tissues or a vein 
it stimulates the myoneural junctions of the sympathetic 
end-organs and the results, except those upon the secre- 
tory glands, which are less marked, are the same as when 
the sympathetic system is stimulated by natural causes. 
These are described on pages 80 to 82 and, if they are 
not remembered, the description should be studied before 
considering the effects of adrenaline action. 
Effects of Actions.-When applied to abraded surfaces 
and to mucous membranes, epinephrine acts as an as- 
tringent, causing such contraction of the local arterioles 
that the part is rendered bloodless and, consequently, 
the tissues become white and shrunken and superficial 
bleeding is arrested. As the effects of the drug on the 
vasoconstrictor wear off, however, excessive contraction 
of the vessels is likely to be followed by an abnormal 
degree of relaxation. For this reason, it is necessary to 
watch for hemorrhage after adrenaline has been used dur- 
ing operations on mucous-lined cavities, as the nose and 
throat. For the same reason, though an application of 
epinephrine will cause temporary relief in the congested 
conditions characteristic of acute rhinitis and hay fever, 
the congestion is likely to be intensified later. 
When epinephrine is dropped in the eyes, it causes 
contraction of the blood-vessels in the conjunctivae; thus 
this membrane becomes shrunken and white (the blood 
being squeezed from the vessels) and, as the result of the 
shrinking, the eyelids become retracted, which makes the 
eyeball appear more prominent. Both from local applica- DRUGS STIMULATING PERIPHERAL END-ORGANS 
199 
tion and intravenous injections, the pupils become dilated, 
because of the retraction of the irises, brought about by the 
stimulation of the sympathetic endings in the radial muscles. 
After the drug is absorbed it causes contraction of most 
arterioles that are supplied with vasoconstrictor nerves, 
but the splanchnic vessels (those in the abdominal viscera) 
are contracted to a much greater degree than others and 
thus more blood is forced into the vessels in the muscles, 
heart, lungs and brain.1 The extra amount of blood 
forced to these parts, especially the brain, is of great 
value in overcoming the conditions of shock, but, under 
some abnormal conditions mentioned in a subsequent 
paragraph, it may have bad effects. 
The rate of the heart action is, at first increased, be- 
cause of the stimulation of the myoneural junctions of 
the sympathetic (accelerator) end-organs in the heart, 
but the rate is soon slowed because the rise of blood 
pressure induced by the vasoconstriction stimulates the 
cardiac endings of an afferent branch of the vagus and 
this, of course, carries impulses to the vagus center. 
Therefore, after a brief acceleration, the pulse becomes 
relatively slow, though stronger. 
The effects of adrenaline on the plain muscle tissue of 
the viscera coincides with the effects of sympathetic stim- 
ulation from other causes; viz., the movements of the 
stomach and intestines are inhibited, but the contraction 
of the pylorus and anus sphincters is increased; uterine con- 
tractions are stimulated; the muscle tissue of the bladder 
and that of the bronchial tubes and associated parts relaxed. 
A valuable characteristic of adrenaline's action on myo- 
neural junctions is that it affects those of muscle tissue 
that is in an abnormal state to a greater extent than those 
of tissue in a normal condition; for example, if the bron- 
chial muscle tissue is contracted, as in asthma, a dose of 
1 The vessels of the heart, lungs and brain, it will be remembered, 
are so little influenced by the vasoconstrictor mechanism that 
some investigators consider that their nerve-supply is not con- 
nected with the vasoconstrictor centers. 200 
MATERIA MEDICA AND PHARMACOLOGY 
epinephrine that will relax it will have very little effect 
upon blood-vessels that are in a normal condition and, 
on the other hand, when blood-vessels are relaxed, con- 
traction will be brought about without any pronounced 
effects upon bronchial muscle that is in a normal state. 
Secretion is not as much influenced by adrenaline as 
it is by ordinary stimulation of the sympathetic system; 
it is thought that this may be because the drug induces a 
greater degree of vasoconstriction. There is however 
some increase of saliva, mucus and tears. The excretion 
of urine is at first inhibited, due to contraction of the renal 
vessels, but later, increased, for the renal vessels relax 
sooner than the splanchnic and thus more blood is forced 
into them and, as stated in the section on diuretics, the 
degree of blood pressure in the renal vessels is one of the 
most influential factors in regulating the excretion of 
urine. After adrenaline has been administered slowly 
in an intravenous infusion, glucose is likely to be found 
in the urine. This is thought to be due to the stimulation 
of the sympathetic nerve-endings in the liver which control 
the change of glycogen to glucose. 
The more common therapeutic uses of adrenaline are: 
It is applied to mucous membranes and abraded surfaces 
to: Check bleeding and to cause shrinking of the tissues 
as, for example, in the nasal cavities, to facilitate the in- 
sertion of a speculum or other instrument. 
It is injected with local anesthetics to, by contracting 
the blood-vessels in the area, retard the absorption of the 
anesthetic and thus keep it where it is required and lessen 
the danger of its causing poisoning. 
It is used in intrauterine douches and in irrigation of 
other cavities, as the bladder, to check local hemorrhage. 
It is given as an intravenous infusion to cause a rise of 
blood pressure and thus act as a circulatory stimulant. 
It is given by hypodermic injection to cause dilation of 
overcontracted bronchi. 
It is sometimes used when the suprarenal capsules are 
diseased. DRUGS STIMULATING PERIPHERAL END-ORGANS 
201 
Bad Effects that Sometimes Follow the Use of Epine- 
phrine.-The continued local use of adrenaline on mucous 
membranes, as, for example, to relieve congestion in the 
nose, may induce a chronic congestion. 
After a local application or injection, the contraction of 
the arterioles in the part is likely to be followed by their 
dilation and, if there is any reason for it, hemorrhage. 
Especially when the drug is given intravenously, it may, 
by contracting the majority of blood-vessels, cause a 
harmful degree of pressure in the cerebral and pulmonary 
vessels, which are not contracted, and, if any predisposition 
exists, it may thereby induce cerebral or pulmonary 
hemorrhage or edema of the lungs. Also, especially if an 
intravenous injection is given quickly, the sudden rise of 
blood-pressure (due to the contraction of the arteries) 
may offer more resistance to the heart than it can stand, 
thus precipitating heart failure. Occasionally, for some 
and unexplained reason, an injection of adrenaline is fol- 
lowed by nervous excitement and restlessness. 
Thus, though there is no drug that will cause a rise of 
blood pressure more rapidly and thereby overcome con- 
ditions existing in shock and collapse, the use of adrenaline 
is not without danger and patients to whom it is given 
must be watched, and adverse symptoms reported to the 
physician at once. 
Toxicology: 
The symptoms of, and treatment for poisoning by ad- 
renaline, are the same as those of collapse, as described 
on page 63. In addition there may be symptoms of some 
special untoward action, such as the symptoms of apoplexy 
(cerebral hemorrhage) or moist rales indicating pulmonary 
edema. 
Ergot is a parasitic fungus that sometimes grows on rye 
and very occasionally, on other grains and even other 
plants. 
ERGOT. ERGOTOXIN. TYRAMINE. ERGAMINE 202 
MATERIA MEDICA AND PHARMACOLOGY 
It contains several alkaloids and other chemical sub- 
stances some of which are similar to those formed in 
putrefying meat, but the only ones that are of importance 
from a therapeutical standpoint are the alkaloids ergo- 
toxin, tyramine and ergamine. 
Preparations and Dosage.-Ergot, 15-60 grs. (1.0-4.0 
gm.) 
Extract of ergot, 4 grs. (0.25 gm.) 
Fluidextract of ergot, 1-23 (4.0-8.0 gm.) 
Alkaloids of ergot: 
Ergotoxin, Moo-^5 0 gr. (0.0006-0.0012 gm.) 
Tyramine, ^-1 gr. (0.03 0.06 gm.) 
Non-official preparations of ergot: 
Ergotole, 5-30 m. (0.3-2.0 c.c.) 
Purified extract of ergot or Bonjean's ergotin, 3-8 grs. 
(0.2-0.5 g.) 
Ernutin by mouth, ^-15 (2.0-4.0 c.c.); by hypodermic, 
5-15 m. (0.3-1.0 c.c.) 
Cornutol by mouth, ^-13 (2.0-4.0 c.c.); by hypodermic 
15-30 m. (1.0-2.0 c.c.) 
The new preparations of ergot, which are still non- 
official, are less irritant locally than the older ones, except 
the alkaloids. 
Fate in the Body.-Ergot and its active principles are 
readily absorbed from the stomach and intestines and 
subcutaneous tissues, their effects being evident in about 
half an hour after a dose is taken by mouth. Their fate 
after absorption and the channel through which they are 
excreted are not positively known, but they are thought 
to be excreted in the urine. 
As there are some differences in the actions of ergot's 
active principles, its action is not quite identical with 
that of any of its active principles. 
Actions.-In the mouth, ergot has an unpleasant flavor. 
It is irritant to mucous membranes and raw tissues, but 
its active principles-ergotoxin, tyramine and ergamine- 
are not. 
When injected subcutaneously, ergot and tyramine DRUGS STIMULATING PERIPHERAL END-ORGANS 
203 
stimulate the myoneural junctions of the vasoconstrictor 
nerves with which they come in contact and ergot also 
causes irritation. 
After absorption, ergotoxin and tyramine produce their 
effects chiefly by stimulating the myoneural junctions of 
some of the sympathetic nerve-endings, especially those 
in the blood-vessels, heart, uterus, stomach and intestines; 
thus their action is somewhat similar to that of adrenaline, 
but there are some points of difference, viz., (1) adrenaline 
stimulates inhibitory and motor myoneural junctions al- 
most equally and ergotoxin only stimulates the junctions 
of motor nerve-endings and, though tyramine stimulates 
both inhibitory and motor, its action upon the motor- 
endings is very slight; (2) neither tyramine nor ergotoxin 
act as quickly nor as powerfully as adrenaline, but (3) 
their effects last longer. In large doses, ergotoxin para- 
lyzes the myoneural junctions which it stimulates. Ergo- 
toxin stimulates the muscle tissue of the iris. 
Ergamine acts directly upon unstriated muscle cells 
and its action varies, not only in different species of 
animals, but on the tissue of different organs in the same 
animal. It has a slight stimulant action on the heart 
muscle and on that of some blood-vessels, especially those 
of the lungs and heart, but nevertheless, by some unknown 
action it sometimes causes dilatation of the peripheral 
blood-vessels and a fall of blood-pressure. It stimulates 
the uterine muscle. It has a slight stimulant effect upon 
the bronchial muscle and upon that of the stomach and 
intestines. 
The action of ergot, of course, combines that of all three 
alkaloids, but it is much less powerful, except perhaps 
upon the uterus. 
Effects of Local Action.-When ergot is injected into 
the tissues it causes irritation and a moderate, but pro- 
longed, constriction of blood-vessels in the area. By 
these means it sometimes induces local necrosis of the 
tissue and it is conducive to abscess formation. 
When taken by mouth, on account of its unpleasant 204 
MATERIA MEDICA AND PHARMACOLOGY 
taste ergot increases the secretion of saliva and, especially 
in large doses, may cause nausea and vomiting. 
Intestinal peristalsis is lessened by moderate doses of 
ergot in spite of the stimulant action of ergamine on 
the intestinal muscle, because this is less strong than 
the stimulant action of tyramine and ergotoxin on the in- 
hibitory1 myoneural-junctions. Doses large enough to 
allow ergotoxin to paralyze these junctions will cause 
diarrhea. 
Effects of Actions after Absorption.-Moderate doses of 
ergotoxin and tyramine cause contraction of the blood- 
vessels (except those of the heart, lungs and brain) and 
a consequent rise of blood-pressure. This and the stimu- 
lation of the sympathetic (accelerator) nerve-endings in 
the heart increase the strength and, at first, the rate of 
the heart action, but, for reasons given on page 55, the 
increased blood-pressure stimulates the vagus center and 
thus the heart action is slowed. Therefore moderate doses 
of these drugs cause a slower and a stronger pulse. 
The effect of ergot on the pulse is not usually very 
marked and tends to vary according to the proportion of 
ergotoxin and ergamine that it contains for, it will be 
remembered, that the latter tends to induce a fall of 
blood-pressure. 
Excessive doses of either ergot or its alkaloids will 
reduce blood-pressure. 
The most important effect of ergot is that on the uterus. 
In moderate doses, ergot induces alternate contraction 
and relaxation. All three alkaloids take part in this effect, 
ergotoxin causing contraction by stimulating the motor 
myoneural junctions, ergamine having the same effect 
by direct stimulation of the muscle cells, and tyramine, 
by stimulating both motor and inhibitory myoneural 
junctions, tends to promote relaxation, as well as con- 
1 It will be remembered that the motor nerve supply to the 
alimentary canal and thus the nerves which, when stimulated, 
increase peristalsis belong to the para-sympathetic portion of the 
autonomic system and these are not stimulated. DRUGS STIMULATING PERIPHERAL END-ORGANS 
205 
traction. Thus, during labor, moderate doses will stimu- 
late the normal rhythmic contraction but large doses will 
cause the uterus to become very firmly contracted and to 
remain so for some time. For this reason, if a large dose 
is given while there is a fetus in the uterus, the latter may 
be killed and it may not even be expelled at the time, but 
large doses are of value in arresting uterine hemorrhage 
and in promoting post-partum contraction of the uterus. 
When either ergot or ergotoxin is injected intravenously, 
it causes a transitory dilation of the pupils and this is 
followed by their contraction. 
Therapeutic Uses.-Ergot is used chiefly to hasten con- 
traction of the uterus after labor an dthus avert hemor- 
rhage; also it is used to check uterine hemorrhage; and, 
in small doses, it is sometimes used during the later stages 
of labor to strengthen the normal rhythmic contractions 
when these are inefficient. Formerly ergot was used to 
check hemorrhage in other parts of the body but it was 
found that its vasoconstriction action on the blood-vessels 
is not sufficiently strong to arrest hemorrhage in parts of 
the body where the drug did not also promote strong 
contraction of the muscle tissue of the organ as it does in 
the uterus. 
Ergotoxin and tyramine are used to cause a rise of 
blood-pressure in shock and collapse. 
Toxicology.-Acute poisoning by ergot is nearly always 
the result of the use of the drug to produce abortion or of 
its ill-advised use during labor. When used in large enough 
amounts to induce poisoning, ergot, frequently, by causing 
tonic contraction of the uterus, fails to produce abortion 
and causes the death of the fetus and, sometimes, conse- 
quent sepsis, or uterine hemorrhage. Even if given in 
therapeutic doses during labor, ergot may cause asphyxia of 
the child if there is any obstruction to its passage through 
the birth-canal. 
The symptoms of acute poisoning are: Vomiting, 
diarrhea, abdominal pain (due to the irritation of the 
alimentary canal). Various nervous manifestations, such 206 
MATERIA MEDICA AND PHARMACOLOGY 
as tingling and itching of the skin and convulsions. The 
usual symptoms of collapse, brought about by the fall in 
blood pressure resulting from the direct action of the drug 
after absorption (chiefly the paralysis of the vasocon- 
strictor junctions by ergotoxin) and to the vomiting. 
The treatment for poisoning consists in lavaging the 
stomach and taking means to avert collapse. 
Chronic poisoning has never been common in this 
country. It is nearly always due to eating food prepared 
from infected rye and, until its cause was discovered, it 
was very common indeed among the poor in European 
countries, in which rye is much used. In fact, it is 
thought, that some of the plagues that occurred in Europe, 
in early days were ergot poisoning. 
There are two types of chronic poisoning one known as 
the gangrenous and the other as the convulsive or nervous. 
In the gangrenous form, as the name implies, parts of 
the body become gangrenous and atrophied. The limbs 
are most frequently affected, but the eyes, and even the 
internal organs, are sometimes involved. The fingers and 
toes may drop off. 
In the nervous type, the predominating symptoms are: 
Headache, dizziness, progressive mental dullness, itching 
of the skin and hyperesthesia, painful cramps and con- 
tractions of the limbs and, in severe cases, convulsions. 
Both forms of poisoning are due to the contraction of the 
arterioles. In the nervous type it is the vessels of the 
brain that are chiefly affected and the various symptoms 
result from the coonsequent injury to the nerve-tissue. 
Death is the common outcome of severe poisoning. DRUGS WHICH OBTAIN THEIR PRINCIPAL 
THERAPEUTIC EFFECTS BY THEIR 
ACTION ON MUSCLE TISSUE 
MUSCLE TISSUE STIMULANTS 
PITUITARY EXTRACT 
Pituitary extract is prepared from the posterior lobe of 
the pituitary gland of cattle. Further description of the 
gland and also of its preparations and uses will be found 
in the section on Glands and Their Secretions. 
Administration.-Pituitary extract is generally given 
either intravenously, intramuscularly or subcutaneously. 
Actions.-These are not well understood but most of 
the effects of pituitary extract are the result of direct 
stimulation of plain muscle tissue and the heart tissue. 
Effect of Action.-The blood-vessels are contracted 
and blood-pressure thus raised. As the drug acts directly 
upon their muscle tissue and not as adrenaline does, on 
nerve-endings, the contraction of the blood-vessels is 
more general than when the latter drug is used, the vessels 
of the brain, heart, and lungs being included. The 
vessels of the kidney, however, are dilated, the supposed 
reason for this will be mentioned later. The contraction 
of the vessels takes place more slowly than when it is 
induced by adrenaline and it is not as pronounced, but it 
lasts longer. 
As the result of the contraction of the blood-vessels and 
stimulation of the heart muscle, the pulse becomes slower 
and stronger. 
The stimulation of the intestinal muscle increases peri- 
stalsis and aids in the expulsion of gas. 
The stimulation of the uterine muscle will hasten labor 
and the involution of the uterus after parturition. 
207 208 
MATERIA MEDICA AND PHARMACOLOGY 
In a woman who is nursing her child a dose of pituitrin 
will be followed by an increase in flow of milk, but the 
actual amount of milk secreted during the day is not 
increased and thus, it is thought, that the temporary 
increase is due to the stimulation of the plain muscle 
tissue around the glands, the consequent contraction of 
which forces out the milk. 
Ordinarily, the excretion of urine is increased, but in the 
disease diabetes insipidus, it is lessened. The reasons 
for these effects are not positively known. Some authori- 
ties consider that the cause of the diuresis is the increased 
amount of blood in the renal vessels, due to then- dilation 
at a time when the other vessels are contracted, but others 
believe that the pituitary extract irritates and thus stimu- 
lates the kidney cells and thereby induces excretion and 
that the dilation of the vessels is the result of the extra 
activity of the cells. Whatever the primary cause, the 
increased pressure in the renal vessels favors diuresis. As 
autopsies on individuals who have had diabetes insipidus 
have revealed that the disease is usually associated with 
some defect of the pituitary gland it is believed that the 
secretion of this gland may in some way regulate the secre- 
tion of urine. 
The chief therapeutic uses of pituitary extract are: 
To expel gas from the stomach and intestines. To hasten 
labor. To improve the circulation. 
Hydrastis will be considered here because its chief 
therapeutic use is for the effects of its action on the uterine 
muscle; it has, however, a variety of actions. 
It is prepared from the roots of the golden seal or 
Hydrastis canadensis. It contains three alkaloids, viz., 
hydrastine, berberine and canadine. An alkaloid hydras- 
tinine is prepared from hydrastine and is more efficacious 
than hydrastine. 
Preparations and Dosage.-Fluidextract of hydrastis, 
30 m. (2.0 c.c.). 
HYDRASTIS ACTING ON MUSCLE TISSUE 
209 
Tincture of hydrastis, 15 (4.0 c.c.). 
Glycerite of hydrastis, 13 (4.0 c.c.). 
Hydrastinine hydrochloride, % gr. (0.01 gm.). 
Actions and Effects.-Hydrastis has a bitter taste, 
due chiefly to its berberine, and produces the same effects 
as other bitters, see page 52. 
When applied locally to mucous membranes it, by some 
obscure action, has the effect of an astringent, causing 
local concentration of the tissues and tending, in some 
cases, to lessen catarrhal inflammation. 
After absorption hydrastis has: (1) mild strychnine-like 
action upon the spinal cord and the medulla, but large 
doses quickly depress the medullary centers. (2) It 
stimulates all kinds of muscle tissue, but the consequent 
contraction is sometimes followed by more or less marked 
relaxation especially when large doses are used. The 
uterine muscle, however, is not as readily depressed as 
others. As the result of these effects, hydrastis tends to. 
cause a slight rise of blood pressure and to slow and 
strengthen the heart action, but its action in this respect is 
variable and slightly larger doses than the average will 
cause a fall of blood pressure and weakening of the pulse, 
and, also, general muscular weakness, incoordination of 
movement and dyspnea. Poisonous doses will induce 
strychnine-like convulsions and subsequent collapse. 
The most valuable effects of hydrastis are due to its 
stimulant action on the muscle tissue of the uterus. 
As the result of this, the tone of the muscle is improved 
and subinvolution favored; also, partly due to its action 
on the uterine muscle and partly to its action on the 
muscle tissue of the blood-vessel walls, hydrastis tends to 
check uterine hemorrhage. Hydrastinine effects the 
uterus more powerfully than hydrastis, but even hydras- 
tinine is not as effectual in checking severe hemorrhage 
as ergot. 
Hydrastis is used occasionally as a local application to 
mucous membranes to reduce inflammatory conditions. 
It is used as a bitter tonic, and to check menorrhagia 210 
MATERIA MEDICA AND PHARMACOLOGY 
(abnormally profuse menstruation) and metrorrhagia 
(uterine hemorrhage). Hydrastinine is more commonly 
used than hydrastis for the purpose last mentioned. 
There are a number of drugs, derived from various 
plants, the active principles of which are glucosides of 
similar composition and action to those of digitalis. They 
are known collectively as the digitalis allies or digitalis 
series. 
The names of the principal ones are shown in the 
following list of preparations; there are several others but 
they are so seldom used it is not necessary to consider 
them. 
The active principles of digitalis are: Digitoxin, digi- 
talin, digitalein. It also contains a saponin, termed 
digitonin, that is thought to be at least partly responsible 
for the nauseating action that digitalis sometimes has. 
Preparations and dosage: 
Digitalis {purple foxglove}.-Powdered leaves, grs. 
(0.03-0.2 gm.). 
Extract, ^-1 gr. (0.015-0.06 gm.). 
Fluidextract, 1-3 m. (0 0-0.2 c.c.). 
Tincture, 5-30 m. (0.3-2.0 c.c.). 
Infusion, 5- (4.0-16.0 c.c.). 
Unofficial preparations: 
Digitalin, Mo~Mo gr. (0.002-0.006 gm.). 
Digitoxin, ^5o gr. (0.00025 gm.). 
Digalen, 10-30 m. (0.6-2.0 c.c.). The solution contains 
M2 5 gr- in each 15 minims and the tablets each contain 
Mi2 gr. 
Digipuratum, 1M gr. (0.1 gm.). This is digitalis freed 
of digitonin and other objectionable matter. It is sold in 
tablet form and in solution and 1 tablet, or 15 minims 
of solution, is the equivalent of 1M 9r- °f digipuratum. 
Digitol, 5-15 m. (0.3-1.0 c.c.). 
Strophanthus. 
Tincture, 5-10 m. 
DIGITALIS AND ITS ALLIES ACTING ON MUSCLE TISSUE 
211 
Strophanthin, H5O_Mo gr- (0.0012-0.001 gm.). The 
active principle of strophanthus. 
Ouabain, gr. (0.002 gm.). This is a crystalline 
strophanthin obtained from certain species of the Strophan- 
thus. 
Squill (Scilla or Sea onion). 
Fluidextract, 1-5 m. (0.06-0.3 c.c.). 
Tincture, 5-20 m. (0.3-1.3 c.c.). 
Syrup, 15 m-1 3 (1.0-4.0 c.c.). 
Compound syrup, 5-30 m. (0.3-2.0 c.c.). This contains 
squill, senega and tartar emetic. 
Mistura Pectoralis (Stokes' expectorant), ^-13 (2.0- 
4.0 c.c.). 
Convallaria (Lily-of-the-valley). 
Fluidextract, 5-15 m. (0.3-1.0 c.c.). 
Convallarin, ^-1 gr. (0.03-0.06 gm.). This is the active 
principle. 
Apocynum (Dogbane or Canadian hemp). 
Fluidextract, 10-30 m. (0.6-20 c.c.). 
Adonis vernalis, (not official). 
Fluidextract, 5-10 m. (0.3-0.6 c.c.). 
Adonidin, gr. (0.005) the active principle. 
Administration.-When immediate effects are desired 
it is usually either digipuratum, digalen, strophanthin or 
ouabain that is given and, as a rule, the drug is then 
injected into a vein. As a rule the minimum doses are 
used for intravenous administration. All preparations 
of digitalis should be well diluted. For administration 
by mouth between at least 1 and 2 ounces of water should 
be used. Acids are incompatible with digitalis and its 
glucosides and, therefore, when taken by mouth, these 
drugs are generally given about 3 hours after meals when 
there is not much acid in the stomach. 
Digitalis and its Glucosides 
Fate in the Body.-These drugs are absorbed, though 
not readily, from the intestine. Following oral adminis- 
tration, it will be at least 12 hours and, possibly, longer 212 
MATERIA MEDICA AND PHARMACOLOGY 
before the effects of a dose are obtained. When given 
by hypodermic or intramuscular injection, they will be 
absorbed more rapidly, but even in these forms of admin- 
istration, absorption is slow and it may be some hours 
before systemic effects are observed. Elimination takes 
place partly through the kidneys, but largely through the 
intestines. Excretion is very slow and thus cumulative 
poisoning is not uncommon. 
Actions.-Digitalis is irritant to mucous membranes 
and to subcutaneous tissues, but the active principles, 
especially digitalin, and the new preparations are decidedly 
less irritant. 
Digitalis has a bitter unpleasant taste. 
After its absorption digitalis stimulates the cells of the 
muscle tissue of the heart. This is its most important 
action and it is because of this that it is classified with 
drugs that obtain their chief effects by stimulating muscle 
tissue. 
Of the nerve-centers digitalis stimulates the cardiac 
inhibitory (vagus) center and, in large doses, the vaso- 
constrictor and respiratory centers, and, sometimes, when 
there is fever, the heat-regulating center; also, especially 
when the drug has been taken for some time, it tends to 
stimulate the vomiting center. Poisonous doses stimu- 
late motor reflex centers and, finally, depress the vital 
centers. 
Also, digitalis stimulates the vagus nerve-endings in 
the heart and tends to retard the transmission of impulses 
over the auriculo-ventricular bundles (described on page 
54) and, in large doses, it tends to stimulate vasocon- 
strictor nerve-endings. 
Effects of actions: 
The effects of the local irritant action of digitalis are 
unfavorable for, due to it, when the drug is injected into 
the tissues it causes local pain and congestion and is 
injurious to the cells in the area on injection, thus it 
favors abscess formation. The irritation of the mucous 
membrane of the alimentary tract and the unpleasant ACTING ON MUSCLE TISSUE 
213 
flavor help to cause nausea and vomiting'at times, though 
this effect is chiefly due to stimulation of the vomiting 
center, and may be induced when the drug is given by 
subcutaneous or intravenous injections. Occasionally, 
when digitalis has been taken for some time, it induces 
diarrhea but it is not known if this is due to the irritation 
of the intestinal mucous membrane or to stimulation of 
the vagus, which, it will be remembered, is the motor 
nerve for the small intestine. 
The active principles, especially digitalein and the new 
preparations are not as likely to produce the above effects 
as digitalis. 
The stimulant action of digitalis upon the heart muscle 
increases its irritability, i.e., its sensitiveness and readiness 
to respond to stimuli'), tonicity (i.e., state of partial contrac- 
tion which prepares it to respond to stimuli and prevents 
its becoming dilated by the pressure of the blood poured into it 
while it is not in active contraction), contractility (its power 
to contract and force the blood from it). 
When these properties of heart muscle (irritability, 
tonicity, and contractility) are below par, the heart does 
not'force the blood energetically nor thoroughly into the 
arteries and thus the circulation through the tissues is 
retarded and there is likely to be more or less congestion 
in the veins and, consequently, increased transudation of 
fluid into the tissues. Nevertheless, owing to the dimin- 
ished circulation through the lungs and intestines, the 
tissues will not get their required supply of food and 
oxygen. Therefore, by its action on the heart, digitalis 
tends to promote the nutrition of the tissues, including 
that of the heart. 
Ordinarily, stimulation of the heart muscle tends to 
increase the rate of the heart action, but the stimulation 
of the vagus and the retardation of the transmission of 
impulses over the bundle of His prevents this and the 
tendency of digitalis is to slow the heart action. This is 
of particular value to the heart muscle when the pulse 
has been abnormally rapid because, in such case, for 214 
MATERIA MEDICA AND PHARMACOLOGY 
reasons given in the review of the physiology of the circu- 
lation, the heart then gets more nourishment and oxygen. 
When the blood-vessels are abnormally relaxed, they 
tend to return to their normal condition, but otherwise 
digitalis in therapeutic doses does not, as a rule, induce 
vasoconstriction. For some unknown reason the blood- 
vessels in the skin of the face and neck are dilated. 
As the result of the improvement in the circulation, 
the tissues receive a better supply of the various materials 
they require (food, oxygen, hormones) and thus their 
condition is improved and the organs are better able to 
carry on their functions. (2) Venous congestion is reduced 
and, as a result, the excess fluid in the tissues is absorbed. 
(3) the excretion of urine is increased. As the diuresis 
is due to the extra amount of fluid in the blood-vessels 
(chiefly because of the absorption from the tissues) excre- 
tion returns to normal when the dropsy is relieved. Digi- 
talis does not, as might be expected, irritate the kidneys 
during excretion, unless taken in very large dosds, because 
its elimination is so slow and takes place to such an extent 
through the intestine that it does not pass through the 
kidneys in irritant concentrations. 
Therapeutic Uses.-Digitalis is used in many types of 
organic heart disease and also when the properties of 
heart muscle previously mentioned are below par from 
other causes, as during fever, following debilitating dis- 
eases, and in collapse. For the latter purpose it has to be 
given intravenously or intramuscularly. Digitalis should 
not be used in emergency without a physician's prescrip- 
tion, because in some conditions, notably that known as 
heart-block, it is dangerous. It is used as a diuretic when 
there is edema. 
Toxicology.-Acute poisoning by digitalis is not com- 
mon, but as the drug is so slowly eliminated, cumulative 
poisoning is very likely to occur if symptoms of over- 
dosing are not watched for. 
The symptoms of overdosing are abnormal slowing of 
the pulse, nausea, vomiting and sometimes diarrhea. ACTING ON MUSCLE TISSUE 
215 
That first mentioned is the most important symptom for 
some people are nauseated after a very few doses, and 
slowing of the pulse may be due to interference with the 
passage of impulses over the bundle of His (heart-block), 
a very serious condition. 
Symptoms of more pronounced stages of poisoning 
either cumulative or from a single large dose are: Alarming 
slowing and irregularity of the pulse followed (as over- 
stimulated the vagus becomes depressed) by tachycardia. 
Feelings of discomfort and oppression around the heart. 
Slow deep breathing and, later, dyspnea and cyanosis. 
There may be convulsions. Muscular weakness becomes 
profound. Death may result from collapse or from failure 
of respiration. 
The treatment for overdosing is to stop the drug and 
to keep the patient very quiet, this is most important. 
If the poisoning is pronounced, sodium bromide is likely 
to be prescribed in order to check nervous irritability, and 
also morphine, except when there is dyspnea. Atropine 
is prescribed to overcome the excessive vagus stimulation. 
An ice-cap is put over the heart region as the cold some- 
times relieves the sensations of discomfort. 
THE DIGITALIS ALLIES 
Strophanthus acts like digitalis with the following 
exceptions: (1) It has a very pronounced stimulant action 
on the muscle tissue of the intestine and is therefore 
prone to cause diarrhea; (2) Its action upon the heart 
muscle is about twice as strong as that of digitalis and 
thus, if the drug is injected into a vein, it will produce 
effects more rapidly and forcefully than digitalis, but, 
as it is absorbed even less readily than digitalis, especially 
from the intestine, and is more rapidly excreted it is not 
as likely to produce cumulative poisoning. 
The active principles, strophanthin and ouabain, are the 
preparations used for intravenous injections. 
Squill acts like digitalis but its effects upon the heart 
are less reliable and less powerful. Due, it is thought, to a 216 
MATERIA medica and pharmacology 
pronounced nauseant action it stimulates the secretion 
of a thin mucus and therefore acts as an expectorant. It 
is for this effect that it is most commonly used in thera- 
peutics. 
Convallaria is less reliable and more toxic than digitalis 
and is now seldom used. 
The other preparations also have not been found reliable 
and are rarely employed. 
Muscle Tissue Depressants 
nitrites 
The nitrites are salts formed by the interaction of nitrous 
acid with either an alkali or an organic substance of the 
alcohol type. 
Preparations and Dosage.-Amyl nitrite, 2-5 m. 
(0.13-0.3 c.c.). 
Nitroglycerine (1% alcoholic solution, known also as 
spirits of glonoin and spirits of glyceryl trinitrate), 1-3 m. 
(0.06-0.2 c.c.). 
Nitroglycerine or trinitrine tablets (non-official), 1-2 
tablets (each tablet contains ^oo of nitroglycerine). 
Sodium nitrite, 1-2 grs. (0.06-0.13 gm.). 
Potassium nitrate (saltpeter), this is used in cigarettes 
with other drugs employed for the relief of asthma. 
Spirits of nitrous ether or sweet spirits of niter, 
15) 2.0-4.0 c.c.). 
Erythrol tetranitrate (non-official), 1 gr. (0.06 gm.). 
Mannitol hexanitrate (non-official), 1 gr. (0.06 gm.). 
Care and Administration of Preparations.-Old prepara- 
tions of nitrites should not be used because the compounds 
are unstable and deteriorate rapidly. This is especially 
true of the liquid preparations. Nitroglycerine, erythrol 
and mannitol are explosive and must therefore be handled 
with care; they should not be brought near heat nor sub- 
jected to friction. 
Amyl nitrite is given by inhalation, the drug being 
dropped on a piece of folded gauze or a handkerchief and ACTING ON MUSCLE TISSUE 
217 
held over the nostrils until the desired effects are produced. 
Amyl nitrite, for convenience, is generally purchased in 
small thin glass ampules, termed pearls, each one of which 
contains the number of minims required for a dose. 
Nitroglycerine is administered both by mouth and hypo- 
dermic and the other preparations are given by mouth. 
Fate in the Body.-Amyl nitrite is almost instantly 
absorbed from the lungs and it is also rapidly eliminated 
through the same organs; thus its effects are observed 
almost at once but last only about 15 or 20 minutes. 
Nitroglycerine is also rapidly absorbed, whether given 
by mouth or hypodermic, and it is likewise rapidly ex- 
creted, but through the kidneys. Its effects are observed 
in 2 or 3 minutes and, as a rule, last about an hour. The 
other preparations are neither absorbed nor eliminated 
quite as readily as nitroglycerine. Their effects are 
apparent in from 5 to 30 minutes and last for about 3 to 
4 hours. Sodium nitrate is sometimes partly decomposed 
by the gastric juice and nitrous acid is then liberated. 
Actions.-If nitrous acid is liberated it will irritate the 
stomach and intestines but, apart from this, the nitrites 
have almost no local action and their therapeutic value 
depends upon their power, after absorption, to depress 
plain muscle tissue. It is the muscle tissue in the arteries 
and the bronchial tubes that is chiefly affected. The tissue 
in the blood-vessels of the limbs is not as much influenced 
as that in the arteries of other parts. 
The nitrites also tend to depress the vagus center and 
to stimulate the respiratory center. In poisonous doses 
they will combine with the hemoglobin of the blood 
and lessen its power to absorb oxygen. 
Effects of Actions.-The arteries and, to some extent, 
the veins become relaxed and dilated, but the vessels in 
the limbs are not as much affected as those in other parts 
of the body. Dilation of the vessels when they are in a 
normal condition interferes with the action of the heart 
and the circulation of blood, but, when the condition 
of the vessels is causing an abnormally high blood-pressure, 218 
MATERIA MEDICA AND PHARMACOLOGY 
their dilation lessens the work of the heart and improves 
the circulation. It also tends to promote a relatively soft 
and bounding pulse and, combined with the depression 
of the vagus, to increase the rate of the pulse. Therefore, 
shortly after the administration of a nitrite, the pulse 
should become comparatively soft, bounding and rapid. 
The dilation of the coronary vessels relieves the pain of 
angina pectoris, which is due to spasmodic contraction of 
the coronary arteries. 
The dilation of the blood-vessels causes a temporary 
disturbance in the cerebral circulation and gives rise to a 
throbbing sensation, and a feeling as though the head were 
bursting and it induces faintness, dizziness and blurring 
of the sight. These effects are more marked when amyl 
nitrite and nitroglycerine are used and are much more 
pronounced if the drug is taken when it is not required. 
In any case, however, they are only momentary, but 
persistent headache is very likely to follow the continued 
use of any of the nitrites. 
The bronchial muscle tissue is relaxed and spasmodic 
contractions such as occur in asthma may be relieved. 
The breathing becomes faster and deeper. 
The excretion of urine is usually increased. This is due 
to the extra amount of blood in the renal vessels and not 
to any direct effect of the drug upon the kidneys. 
Therapeutic Uses.-To lower abnormally high blood 
pressure such as occurs in nephritis and arteriosclerosis. 
To relax the coronary vessels in angina pectoris. 
To relax the bronchial muscle in asthma. 
Sweet spirits of niter is used as a mild diaphoretic and 
diuretic. The alcohol and ether contained in the com- 
pound accentuate these actions of the nitrite, while, as the 
nitrite content of the drug is only small, the other nitrite 
actions are not pronounced. 
Toxicology.-The nitrites are so rapidly eliminated that 
a fatal outcome from poisoning is not at all probable, but 
overdoses, especially of amyl nitrite, may cause an alarm- 
ing and distressing condition. ACTING ON MUSCLE TISSUE 
219 
The symptoms are: Intense flushing of the skin, espe- 
cially that of the face and neck. Headache and a sensation 
as though the head were bursting. Dilation of the pupils 
and disturbance of vision. Dizziness. Faintness. Weak, 
irregular pulse. There may be cyanosis. 
The treatment consists in reassuring the patient and 
keeping her quiet and warm in the recumbent position. 
PAPAVERINE 
This alkaloid of opium is sometimes used as a substitute 
for the nitrites. It is described on page 155. DEMULCENTS, EMOLLIENTS AND OTHER 
PROTECTIVES 
The term demulcent signifies to smooth and the word 
emollient, to soften. Therefore, as mucous membranes, 
except, sometimes, those of the lips, rarely require to be 
softened, but, not infrequently, need to be smoothed, 
substances used to soothe irritated membranes are classed 
as demulcents. The skin, on the contrary, especially 
that of the hands and face, often requires to be softened 
and, therefore, the fatty substances used on roughened 
and irritated skin are classed as emollients. The fixed oils 
and fats used as emollients will act as demulcents on mu- 
cous membranes, except those of the intestines. But in 
these organs they are changed to soaps, which are irritant. 
Though classed as emollients both the fixed and mineral 
oils and fats, when used on mucous membranes, are com- 
monly referred to as demulcents. 
In addition to being employed to soothe irritated mu- 
cous membranes, demulcents are used: (1) to protect 
membrane from irritating substances as, for example, 
poisons, either those that have been inhaled or swallowed 
or those formed in the irritated organ; (2) they are used 
as diluents for irritating drugs, to prevent them irritating 
the stomach and thus causing nausea or, when given by 
rectum, to prevent their expulsion; (3) mucilaginous de- 
mulcents are used as diluents to retard the absorption of 
drugs; and (4) to hold insoluble substances in suspension 
in water. 
Demulcents in common use are: The gums of acacia, 
slippery elm and tragacanth; Irish moss, starch paste, 
glycyrrhiza, albolene, syrups, white of egg and milk. 
The gums for use in the throat are often combined 
with volatile oils in the form of lozenges. For use in the 
220 DEMULCENTS, EMOLLIENTS, PROTECTIVES 
221 
alimentary canal they are employed as mucilages, i.e., 
they are soaked in water, which they absorb thus forming 
a gummy paste that, if necessary, is diluted to the con- 
sistency of a thick syrup. The usual dose of the unpre- 
pared gum is 1-2 5 (4.0-8.0 gm.) and of the mucilage 2-4 5 
(8.0-16.0 c.c.). 
Irish moss is a seaweed found chiefly on the Irish coast, 
it can be prepared for use in the same way as the mucilages. 
Starch paste, for rectal administration, is usually made 
from cornstarch, a teaspoonful of the starch being used 
to from 1-2 cups of water, according to the consistency 
required. The starch is mixed with about 2 tablespoon- 
fuls of cold water and about the required amount of 
boiling water is then added slowly and the mixture is 
cooked for five minutes, then the remainder of the water 
is added and the mixture recooked for five minutes, if 
over a flame, or fifteen, if in a double boiler. Barley, rice 
and other starches are very commonly used for oral 
administration. 
Glycyrrhiza or licorice root is a bland substance with a 
pleasant flavor prepared from the roots of certain plants. 
The dose of the extract is 15 grs. (1.0 gm.), of the fluidex- 
tract, 30 m. (2.0 c.c.). Glycyrrhiza is also combined with 
other drugs both for its demulcent and flavoring properties. 
Albolene, a mineral fat or oil, is used for local applica- 
tions to mucous membranes. It is not saponified in the 
intestine and it does not become rancid, as the organic 
fixed fats do. 
Milk and white of egg are very commonly used for dilut- 
ing irritant medicines and in the first aid treatment for 
poisoning by irritant drugs. For the latter purpose they 
are not as efficient as the mucilages, but they can usually 
be more readily obtained. When used as a demulcent, 
white of egg should be swallowed in its natural form or 
only very slightly beaten. 
Syrups are used as ingredients of cough medicines as 
they tend to allay irritation of the throat. 
The emollients in common use are: The vaselines 222 
MATERIA MEDICA AND PHARMACOLOGY 
(petrolatum) white and yellow, obtained from petroleum. 
The petroleum oils, as albolene. Lard (adeps). Lano- 
line, fat obtained from the wool of sheep. Cocoa-butter, 
obtained from the same source as cocoa and chocolate, i.e., 
the cacao bean, it is a firm solid at ordinary temperatures, 
but is melted at body temperature and it is therefore very 
commonly used as a base for suppositories. Yellow wax 
(cera flava) prepared from the honeycomb of the bee. 
White wax (cere alba) bleached yellow wax. Ointment 
(unguentum) this is a mixture of lard and wax, it is used as 
a base for medicated ointments. Spermaceti (cetaceum), 
this is obtained from the head of the sperm-whale, it is 
used as a substitute for fats and waxes in ointments and 
cold-creams. Cold-cream (unguentum aqua rosa), the 
cold-cream of the U.S.P., consists of white wax, oil of 
almonds and borax, scented with rose water, but many of 
the cold-creams in common use have other perfumes and 
sometimes spermaceti is substituted for wax. Pure fixed 
oils, such as that of olive, cotton and flaxseed and the fixed 
oil of almonds (this is not to be confused with the volatile 
oil of almonds). Glycerine, as mentioned under cathar- 
tics, abstracts water from tissue and, therefore, though it 
softens the skin it dries it and is temporarily irritating, to 
abraded or chapped surfaces. 
In addition to softening the skin, emollients serve as 
protectives by, when rubbed into skin that is exposed, as 
that of the face, protecting it from irritation from the 
chemical rays of the sun and wind; and, when used on 
burns, ulcers and sores of like nature, preventing the 
dressing sticking to the wound; when employed for this 
purpose the emollient usually contains some additional 
therapeutic agent, such as an astringent or antiseptic. 
The hydrocarbon fats and oils (petroleums) do not pene- 
trate the skin as well as the organic fats and oils and, there- 
fore, are not as effective emollients, but they do not become 
rancid nor favor the development of bacteria and thus 
they are of more value to protect the skin around wounds 
from irritating secretions and antiseptics. They, like DEMULCENTS, EMOLLIENTS, PROTECTIVES 
223 
other fats, are not miscible with water and prevent the 
penetration of secretions, etc. flowing over them. 
Other protectives are: The paraffines, the powders 
mentioned under absorbents, insoluble metal salts such as 
those of bismuth, zinc, and cerium, and collodion. Of these, 
the'following are the only ones not discussed elsewhere. 
The paraffines are solid preparations derived from 
petroleum. They are melted and sprayed over the surface 
of ulcers, burns and the like. They quickly become solid 
and form a protective covering which can be readily lifted 
and removed without irritating the surface as a dressing 
which sticks to a wound does. The method of using 
paraffine for this purpose is described in all modern text- 
books of nursing procedure. 
Cerium oxalate, the only salt of cerium used in thera- 
peutics, is insoluble in water and it is practically inert, thus 
it has no action other than that of a protective. When 
swallowed, it is precipitated on the walls of the stomach 
and intestines and is only slowly rubbed off and eliminated. 
In the meantime it protects the mucous membrane of these 
organs from irritating material which they contain and, 
in this way, it lessens nausea and diarrhea. Though 
cerium and bismuth salts have no demulcent action, they 
are often preferred to the demulcents for use in the ali- 
mentary canal when the irritation is due to bacterial 
products, because the demulcents afford food for the 
bacteria and favor their multiplication. The usual dose 
of cerium oxalate is 2-15 grs. (0.13-1.0 gm.). It is usually 
given in a glass of milk. 
Collodion is a solution of pyroxylin or gun cotton in 
ether and alcohol. It is used to cover small cuts and sur- 
faces denuded of skin, and punctures. Flexible collodion 
contains a small amount of either camphor or Canadian 
turpentine and castor oil. The oil makes the film which 
the collodion forms over a surface more elastic and 
tenacious. Styptic collodion contains tannin 20 per cent, 
and therefore it has a slight astringent effect and tends to 
check bleeding in the surface to which it is applied. ABSORBENTS 
Absorbents are used to: (1) Absorb moisture and 
sebaceous matter from the skin. Those used for this 
purpose are: Dry starches and various powders such as 
talcum (magnesium silicate),1 lycopodium (prepared from 
the spores of the lycopodium or club moss) and boric acid. 
(2) Absorb secretions from wounds. Those used for 
this purpose are described under astringents and antiseptics. 
(3) Absorb bacterial toxins. 
(4) Absorb gas from the alimentary tract. 
KAOLIN 
Kaolin is commonly known as fullers' earth, because it is 
used by fullers (certain cloth workers) to absorb grease 
from wool. 
Dose for internal use (for adults), 4 ounces (120 gm.). 
It is generally mixed with an equal amount of either milk 
or water. 
The dose for infants is 1 ounce per day, given in divided 
doses. When the baby is fed with prepared food, the 
kaolin is usually given with it, the day's dose being equally 
divided between the feedings. 
As an absorbent, kaolin is used chiefly (1) in intestinal 
diseases of bacterial origin and (2) in diphtheria, as a local 
application to the throat. It tends to absorb bacteria 
and their toxins, as well as gas and secretions. When 
taken by mouth, as it is not absorbed, it carries off the 
toxins, etc., in the feces. Also, it forms a temporary 
coating on the walls of the intestines and protects them 
from irritation. 
1 Salts of silicic acid and magnesium or aluminum. These 
salts may be prepared by chemical reactions, but they are also 
found in certain clays and sand. 
224 ABSORBENTS 
225 
Kaolin is generally applied to the throat by means of a 
powder blower, enough being used to cover the affected 
parts. Applications are usually made every two hours 
and, before each one, the throat and, when necessary, 
the nose are irrigated with a solution of, usually, sodium 
bicarbonate and sodium borate, a.a., 2 per cent. This 
removes the previous application of kaolin and, with it, a 
considerable amount of toxins and bacteria. 
Kaolin is also used as an ingredient of what is'known as 
clay poultice or antiphlogistine, which also contains thymol, 
peppermint, methyl salicylate, and glycerine and is used 
as a counterirritant. The value of kaolin for the purpose 
depends upon its power of, after being heated, retaining 
the heat for a considerable length of time. 
CHARCOAL 
Charcoal is prepared from burnt wood and bones. 
Dosage: 15-60 grs. (1.0-4.0 gm.). 
When used as an absorbent, charcoal is given dry in 
capsules, because its absorbent power is diminished by 
dilution. 
Charcoal absorbs secretions, gas and, to some extent, 
bacterial toxins. Its chief use as an absorbent is to 
relieve flatulence by absorbing gas that is causing distress. 
Charcoal is also used to time the passage of food mater- 
ial through the alimentary canal (as an aid to diagnosis, 
etc.). It answers this purpose because it colors food with 
which it is mixed and the color is retained by the food resi- 
due discharged as feces. Thus the time intervening be- 
tween the intake and elimination of the food can be 
determined. BITTERS 
The term bitters is used to include a group of drugs 
used for the effects of their bitter flavor. Certain sub- 
stances, such as serpentaria and bitter orange peel contain 
volatile oil, as well as their bitter principle, and these are 
termed aromatic bitters. Formerly a large number of 
drugs were listed under this heading, but the only ones in 
common use at the present time are gentian, hydrastis, 
the aromatic bitters mentioned above, cinchona, nux 
vomica and strychnine. Hydrastis and the three drugs 
last mentioned, having more important effects, are 
described elsewhere. 
Preparations and dosage: 
Gentian, extract, 4 grs. (0.25 gm.). 
Gentian, fluidextract, 5-30 m. (0.3-2.0 c.c.). 
Gentian, compound tincture, 13 (4 c.c.). This con- 
tains gentian, and the aromatics bitter orange peel and 
cardamom. 
Compound tincture of cinchona, 13 (4.0 c.c.). This 
contains cinchona, serpentaria and bitter orange peel. 
Administration.-Bitters are administered 10 to 20 
minutes before meals. As their effects are dependent 
upon their flavor, nothing must be done to disguise this. 
Action and Effects.-Bitters stimulate certain taste 
buds and thereby induce a reflex flow of saliva and gastric 
juice and, if the appetite is poor, they tend to improve it. 
As the result, they aid digestion and may thus have a 
tonic effect upon the body. The aromatics also stimu- 
late the olfactory nerve-endings and they have a slight 
irritant action upon the mucous membrane of the ali- 
mentary canal, which gives rise to mild carminative 
effects, as described under volatile oils. 
226 DIGESTANTS 
Digestants are chemical substances, known as ferments 
or enzymes, which aid in the digestion of food. They are 
obtained both from the digestive glands of animals and 
from certain plants. 
Preparations and dosage of digestants prepared from 
animal glands: 
Gastric enzymes: 
Pepsin, 5-10 grs. (0.3-0.6 gm.). 
Pepsin, essence of, 1-25 (4.0-8.0 c.c.). 
Pepsin, glycerite of, 30 m. (2.0 c.c.). 
(Pepsin is obtained from the membrane lining the stomach 
of pigs. . 
Rennin (rennet). This is extracted from the mucous 
membrane lining the stomach of (as a rule) calves. It is 
used for the preparation of junket and whey. 
Pancreatic enzymes: 
Pancreatin, 5 grs. (0.3 gm.). 
Peptonizing powder. This contains 5 grs. of pancreatin 
and 15 grs. of sodium bicarbonate. It is used for pepton- 
izing milk. 
Holadin, 3 grs. (0.2 gm.). 
Pankreon (tannin pancreatin compound), 5-15 grs. 
(0.3-1.0 gm.). 
Panase, 3-5 grs. (0.2-0.4 gm.). 
(The above preparations contain all the enzymes of the 
pancreatic juice.) 
Diazyme essence, 15 (0.4 c.c.). This contains the 
amylopsin of the pancreatic juice). 
Trypsin, 2-5 grs. (0.12-0.3 gm.). 
Administration.-Pepsin preparations are only active 
in an acid medium and thus they are given during or after 
a meal and, if the gastric cells are not furnishing sufficient 
227 228 
MATERIA MEDICA AND PHARMACOLOGY 
acid, hydrochloric acid is usually given with the pepsin. 
Pancreatic ferments on the contrary, are only active in an 
alkaline medium. For this reason, when taken by mouth, 
a pancreatic preparation will act only after it reaches the 
intestine, where the contents are alkaline, and when a 
pancreatic extract is used for predigesting food or dis- 
integrating tissue, it is used with an alkali, usually sodium 
bicarbonate. 
Actions and Uses.-The most common use of these 
ferments is to digest foods, especially milk and, for in- 
fants, starches, before they are used. However, if the 
stomach or pancreas fails to secrete sufficient juice the 
lacking ferments may be given by mouth. The ferments 
which digest proteins have been considerably used in the 
treatment of cancer, and for the removal of abnormal 
membrane, such as that which forms in diphtheria, under 
the supposition that, as they facilitated the digestion of 
animal tissue, they would, if injected into cancerous 
growths or abnormal membrane, promote their digestion 
in like manner; unfortunately they have not given the 
results expected. 
The ferments are thought to have the same action as 
those manufactured in the body, viz., rennin coagulates 
milk. Pepsin digests proteins; the preparations contain- 
ing all the pancreatic ferments will have trypsin (which 
digests proteins'), amylopsin (which digests starches) and 
steapsin (which digests fats). Diazyme acts only upon 
starches and trypsin upon proteins. 
The principal digestive preparations obtained from 
plants are: Extracts of malt and diastase. 
Extracts of malt, of which there are a number of different 
ones on the market, are prepared from barley malt. They 
are supposed to contain diastase, the ferment which de- 
velops in malted barley and gives it the power to change 
starch to dextrin and maltose. It has been shown, 
however, that these extracts have very little power of 
digesting starch, because the ferment is rendered more or 
less inactive by the heat used in their preparation, but, as DIGESTANTS 
229 
they contain dextrin and maltose, they have considerably 
nutritive value. They are used chiefly to increase the 
amount of carbohydrate in milk mixtures for infant feed- 
ing and as diluents for drugs such as cod liver oil. 
Diastase is a ferment obtained from barley malt. It 
digests starch and is used chiefly in the preparation of 
cereal waters and gruels for infants. ACIDS 
The characteristics of acids were described in the sec- 
tion devoted to the nature of drugs. 
Acids are classified under two main headings, namely, 
inorganic acids and organic acids. 
INORGANIC ACIDS 
Preparations and Dosage.-With the exceptions men- 
tioned, the preparations of inorganic acids provided for 
internal use are 10 per cent, solutions. 
Dilute hydrochloric acid, 5-20 m. (0.3-1.3 c.c.). 
Dilute nitric acid, 5-10 m. (0.3-1.3 c.c.). 
Dilute nitrohydrochloric acid, 5-15 m. (0.3-1.0 c.c.). 
This contains approximately 4 per cent, nitric acid and 15 
per cent, hydrochloric acid. 
Dilute sulphuric acid, 5-15 m. (0.3-1.0 c.c.). 
Aromatic sulphuric acid, 5-10 m. (0.3-0.6 c.c.). This 
contains sulphuric acid, 20 per cent, ginger, cinnamon and 
alcohol. 
Boric acid, which is a very weak acid, is not used for 
the same purposes as the others and will be described 
separately. 
Administration.-Acids are prescribed to be taken before 
or with meals. They should be diluted with at least 2-4 
ounces of water and taken slowly through a tube. The 
tube is used to avoid injury to the teeth, which will be 
caused by the acid combining with the alkaline material 
of the latter. 
Fate in the Body.-Acids interact with alkaline and 
protein substances in the stomach and intestines and the 
soluble compounds formed are absorbed by the blood. 
As the blood always tends to keep substances that it re- 
quires, much of the alkaline material of the salts thus pro- 
duced is split off before excretion, and retained, and the re- 
sidue, which consists of acid salts, is eliminated in the urine. 
230 ACIDS 
231 
Actions.-Acids abstract water and combine with the 
proteins and alkaline substances of protoplasm, including 
that of bacteria. The potency of their action depends 
upon their concentration and the nature of the tissue. 
The dry outer skin is less affected than the soft moist tis- 
sues or than the teeth, which contain a large amount of 
alkaline material. 
When acids are taken by mouth they stimulate those 
taste-buds which respond to acids. 
Acids are too thoroughly neutralized in the intestines 
and blood to affect the tissues after absorption, except, in 
large doses, those of the urinary organs, but, if taken in 
excess, they will reduce the alkalescence of the blood and 
render the urine so acid that it will irritate, not only the 
kidneys, but the membrane lining the whole urinary tract. 
Effects of Actions-On Bacteria.-Dilute acids act as 
antiseptics; concentrated acids, as disinfectants. 
On the skin, dilute acids have practically no effect, 
but they cause a slight shrinkage of mucous membranes 
and raw surfaces, i.e., they act as astringents. 
When taken by mouth, acids, by stimulating the taste- 
buds, increase the flow of saliva to such an extent that, in 
spite of their action on mucous membrane, they assuage 
thirst. 
In the stomach, if there is a deficiency of natural hydro- 
chloric acid, dilute acids act as a substitute for the latter 
and, if not taken in too large amounts, they (1) aid in the 
digestion of proteins, (2) help regulate the passage of food 
from the stomach1 and (3) after entering the intestine, 
1 It will be remembered that, normally, acid is only secreted 
after food enters the stomach and that secreted at once combines 
with the protein of the food. Thus it is only after the protein 
has taken up all the acid with which it can combine that there is 
any free acid in the stomach. As soon as this occurs, the sphincter 
muscle of the pylorus relaxes and some of the chyme passes into 
the intestine, but acid has the opposite effect on the intestinal 
side of the pylorus and therefore, as soon as the duodenal con- 
tents are acid, the sphincter closes and remains closed until the 
acid is neutralized. 232 
MATERIA MEDICA AND PHARMACOLOGY 
by activating the prosecretin1, they aid indirectly in the 
stimulation of pancreatic secretion. 
If taken in too large amounts, acids delay diges- 
tion2 and interfere with the passage of food from the 
stomach. 
Concentrated acids, by their action on protoplasm, 
cause tissues, even the skin, with which they come in 
contact, to become shrunken and hard, and to slough, 
and they cause pain. In other words, concentrated acids 
act as corrosives. Sulphuric and nitric acids are more 
corrosive than hydrochloric. Sulphuric acid causes ac- 
tual charring of the tissues and forms a black slough. 
Nitric acid stains tissues to which it penetrates a yellow or 
yellowish-brown color. Hydrochloric acid causes blisters 
and white discoloration. 
Mineral acids produce practically no effects after 
absorption unless they are taken in large enough amounts 
to reduce the alkalescence of the blood.3 In such case, 
whether taken in concentrated or dilute form, they, by 
interfering with absorption of carbon dioxi d from the 
tissues, promote more or less marked symptoms of 
asphyxia. This condition is known as acidosis. 
1 A substance called prosecretin is manufactured by certain 
glands in the intestinal wall. This prosecretin is changed to 
secretin by acids and the secretin is absorbed and carried by the 
blood to the pancreas, which it stimulates, thereby increasing the 
secretion of pancreatic juice. 
2 Pepsin is only active in dilute acid solutions about 0.2-0.4 
per cent. The intestinal ferments are rendered inactive by acids. 
3 There is no physiological demand for extra acid in the blood or 
tissues, because acids are being constantly formed in the tissues 
as the result of catabolism and all not further oxidized to carbon 
dioxid and water must be neutralized by the alkaline salts and 
nitrogenous substances contained in the blood. Diminished 
alkalescence of the blood, whether due to acids absorbed from the 
alimentary tract or to defective metabolism, interferes with the 
passage of carbon dioxid from the tissues into the blood and thus 
it is most important the normal reaction of the blood be main- 
tained. Normally the blood is about neutral, but it has a small 
excess of potential alkaline radicles. ACIDS 
233 
If enough acid is taken to irritate the urinary tract, 
there will be frequent micturition and pain and, if the 
irritation is pronounced the urine will contain albumin 
and possibly blood. 
Therapeutic Uses.-(Local), a drop or two of concen- 
trated acid is sometimes used to destroy warts or to check 
local infection. 
Dilute acids, especially hydrochloric, are given by 
mouth when there is not enough acid secreted by the 
gastric cells and they are also sometimes used to assuage 
thirst and as antidotes in the treatment of poisoning 
by alkalies, but organic acids are better for these 
purposes. 
Toxicology.-The symptoms of poisoning depend upon 
the concentration of the acid. Large amounts of even 
dilute acid will, for reasons previously given, cause a 
condition of asphyxia, and will not have any pronounced 
local effects, but concentrated acids taken by mouth will 
also cause corrosion of the alimentary tract and the usual 
symptoms promoted by such action. If the corrosion is 
severe, death from shock may occur before the effect of 
the acid in the blood (acidosis) is apparent. 
The symptoms due to local action are: Intense abdom- 
inal pain, vomiting and diarrhea. There will be blood 
and shreds of mucus and of membrane in the vomitus and 
feces and the intense stimulation of nerve-endings, in- 
volved in the injury to the tissue, will cause such an 
inflow of impulses to the centers, that convulsions, fol- 
lowed by collapse, are likely to occur. 
The symptoms promoted by acidosis are: Dyspnea, 
followed by shallow, slow breathing, extreme cyanosis, 
convulsions, coma and collapse. Breathing is likely to 
stop before the heart action, because of an insufficient 
amount of carbon dioxid in the blood to maintain the 
activity of the respiratory center. 
If the vapor of a fuming acid is inhaled, death may be 
almost instantaneous, because the fumes are so irritant 
that they are likely to induce asphyxia by promot- 234 
MATERIA MEDICA AND PHARMACOLOGY 
ing spasmodic closure of the glottis and edema of the 
larynx. 
If the patient recovers from poisoning by a concentrated 
acid, the scar tissue formed as healing occurs is likely to 
interfere with swallowing and with the action of the 
stomach and intestines, also, following poisoning by a 
large amount of acid, whether concentrated or dilute, 
there may be nephritis, due to injury of the kidney 
cells. 
The treatment for the local effects of acid poisoning 
consist in (1) giving a mild alkali at once, magnesia is the 
best, but lime water, soap or wall-plaster can be used in 
emergency; it is imperative that the acid be neutralized 
immediately if corrosion is to be avoided. Soda carbonate 
and bicarbonate and magnesium carbonate are good 
alkalinizers, but when they come in contact with acid, 
they liberate carbon dioxid, and the gas thus evolved will 
distend the stomach and, if it is corroded, may cause 
rupture. (2) Lavage is usually performed, but must be 
done with caution, or the tube may perforate the injured 
wall of the stomach. Caution implies that the tube must 
be well lubricated and introduced slowly, the water 
(lime water is used if possible) must also be introduced 
slowly. (3) Demulcents such as white of egg, oil, cream, 
milk, are given freely and as soon as possible. 
The usual treatment for the prevention of collapse is 
carried out. 
To lessen danger of acidosis, sodium bicarbonate, about 
% ounce in a quart of water, is given by rectum and 
the doctor is likely to give sodium carbonate solution 
intravenously. 
BORIC ACID 
Boric or boracic acid is a very mild inorganic acid 
formed by the combination of the elements boron and 
hydrogen. It occurs in nature in considerable quantities, 
both in the free state and in the form of salts, especially 
the sodium salt known as borax or sodium borate. ACIDS 
235 
Actions and Effects.-Boric acid, like other inorganic 
acids, is astringent and antiseptic, but, as its acid proper- 
ties are not marked, it is not corrosive, and it is only 
poisonous when relatively large amounts are absorbed. 
As the result of its astringent action, boric acid tends to 
dry surfaces to which it is applied and to lessen local 
congestion and sensation. 
It is used: (1) On the skin, chiefly as a dusting powder, 
either alone or combined with starch or other powders; 
(2) on abraded and irritated surfaces in the form of 
ointment, powder, or solution; (3) as a lotion for the eyes, 
in the treatment of conjunctivitis, usually in a 2 per cent, 
solution; (4) for the irrigation of any of the mucous- 
lined cavities, in the treatment of inflammatory conditions, 
and of ulcers and similar sores; usually in from 2-4 per 
cent, solutions. 
Preparations of boric acid and the ingredients men- 
tioned, widely used as mouth washes and gargles in 
normal, as well as abnormal, conditions, are: Dobell's 
solution (described with the carbolic acid preparations') 
glycothymoline or liquor antisepticus (boric and benzoic 
acid, the volatile oils of eucalyptus, peppermint and thyme, 
and water)', listerine (boric and benzoic acids, thymol, 
eucalyptol, the volatile oils oj wintergreen and peppermint, 
alcohol, tincture of baptista and water). 
Boro-glycerine is a preparation of boric acid and glycer- 
ine that is used chiefly in the treatment of inflammatory 
conditions of the vagina and uterus, but also as a local 
application to other mucous membranes. As glycerine 
abstracts water from tissue, it adds to the effects of the 
astringent action of the boric acid. 
Organic Acids 
The organic acids used in therapeutics for their acid 
properties are citric, tartaric, acetic and lactic. 
Citric acid is contained in many fruits, but it occurs in 
largest quantities in the citrus fruits, viz., lemons, oranges 236 
MATERIA MEDICA AND PHARMACOLOGY 
and grape fruit; tartaric acid occurs in grapes; acetic acid 
is prepared in several ways, it can be made from ethyl 
alcohol or by the fermentation of the same kind of sub- 
stances used in making ethyl alcohol, because it is the 
product of the oxidation of this alcohol. Acetic acid is 
the essential constituent of vinegar. Good vinegar con- 
tains 6 per cent, acetic acid. Lactic acid is prepared chiefly 
from lactose-the sugar of milk-but it is also made from 
other sugars. 
Ordinarily, fruit juices containing citric and tartaric 
acids are used when the effects of these acids are desired 
and buttermilk, fermented by special strains of bacteria, 
is used to obtain lactic acid effects. However, the follow- 
ing preparations are occasionally substituted. 
Preparations and dosage: 
Citric acid, ^-13 (15.0-30.0 gm.). For administration 
by mouth ounce is used to a glass of water; it is prepared 
in the same manner as lemonade. 
Lactic acid (70 per cent.), 5-30 m. (0.3-2.0 c.c.). 
Lactic acid diluted to from 20-50 per cent., usually with 
glycerine, is used externally. 
Acetic acid (36 per cent.), 10-30 m. (0.6-2.0 c.c.). 
Acetic acid (6 per cent.), ^-25 (2.0-8.0 c.c.). 
For External Use.-Glacial acetic acid (99 per cent.) 
and trichloracetic acid, a crystalline substance. 
Fate in the Body.-The organic acids, like the inorganic, 
unite with alkaline material in the intestine and are there- 
by changed to salts. The acetates and lactates are readily 
absorbed but the citrates and tartrates are not. All the 
salt absorbed is oxidized to alkaline carbonates and as 
such excreted in the urine. 
Actions and Effects.-Organic acids have the same ac- 
tion on protoplasm as the inorganic acids, but, with the 
exception of concentrated acetic acid, it is much less 
marked; therefore, though the organic acids will have 
astringent effects, they, with the exception of concentrated 
acetic acid and, to a slight degree, concentrated lactic 
acid, are not caustic. ACIDS 
237 
When taken by mouth, the organic acids, like the 
inorganic, induce a copious flow of saliva and have about 
the same effects as the latter upon digestion, but beyond 
this their actions differ. 
In the intestine the citrates and tartrates have a mild 
laxative action because the salt not absorbed pre- 
vents the absorption of the liquid in which it becomes 
dissolved in the intestine, this is further discussed under 
saline cathartics, page 265. Lactic acid was for some 
time believed to inhibit the action of putrefactive bacteria 
in the intestine, but it is now considered doubtful if it does 
so to any extent. 
As the salts of the organic acids are changed to alkaline 
carbonates after their absorption, they increase the alkales- 
cence of the blood and decrease the acidity of the urine. 
Also, they raise the osmotic pressure of the blood and thus 
induce the osmosis of fluid from the tissues and, as this 
increases the amount of fluid in the blood-vessels, including 
those of the kidneys, it favors diuresis. 
Citric acid tends to unite with the calcium salts of the 
blood when it is injected intravenously and this lessens 
the blood's property of coagulability, because the normal 
calcium salts are essential for this process. 
To Summarize.-Applied locally, concentrated acetic 
acid and to a slight degree, concentrated lactic acid will 
destroy tissue. All the acids here considered have an 
astringent effect upon mucous membrane, though, in dilute 
solutions, this is not pronounced. They increase the flow 
of saliva and thus lessen thirst; if not taken in too large 
amounts, they aid digestion and, especially tartaric and 
citric acid, catharsis. After absorption they increase the 
alkalescence of the blood, decrease the acidity of the 
urine and tend to increase the excretion of urine. Citric 
acid, injected intravenously, lessens the power of the 
blood to coagulate. 
Fruit juices overcome scurvy and it was formerly 
thought that this antiscorbutic property was due to their 
salts and acids, but, investigation has shown that it is due 238 
MATERIA MEDICA AND PHARMACOLOGY 
to chemical substances in the fruit juices, known as vita- 
mines,1 that aid metabolism. 
Therapeutic Uses.-Glacial acetic and trichloracetic 
acids are used to remove warts and similar growths. 
Acetic acid in about 2 per cent, solutions is used as an 
intrauterine douche to, by its astringent effects, check 
hemorrhage. 
Concentrated lactic acid, up to about 50 per cent., is 
used for its astringent effects in some abnormal conditions 
of the throat. Dilute lactic acid is used internally to 
check intestinal putrefaction but it is considered doubtful 
if it does so. 
Citric acid and tartaric acid, especially, are used to 
relieve thirst, improve the appetite and aid digestion, and 
to provide the blood with alkaline material. Citric acid 
is used, generally in the form of hot lemonade, to induce 
diaphoresis and thus, by lessening congestion, avert 
colds, but it is really the hot drink that is responsible for 
the diaphoresis; however, the tendency of the citrates to 
induce diuresis adds to the results of the diaphoresis. 
Citric acid is injected intravenously to inhibit thrombosis. 
Toxicology.-Poisoning is only caused by concentrated 
acetic acid and, possibly, by large amounts of concentrated 
lactic acid. The ill effects are due to the local action of the 
acids on the alimentary tract and, therefore, the symptoms 
1 Little is known of the nature of these substances or of the way in 
which they produce their effects, but they are contained in all 
living tissue and fresh food and they are destroyed by a high tem- 
perature, by alkalies and nearly all substances used for the pres- 
ervation of food and by drying. There are thought to be three 
distinct varieties and a lack of one variety is likely to interfere with 
nutrition in a manner to cause scurvy, a lack of another predis- 
poses to rickets and of the third, to neurotic conditions such as 
exist in the disease known as beri-beri. The antiscorbutic vita- 
mine is present in greatest amounts in acid fruits, tomatoes, 
cabbage and turnips. The antirachitic, in green vegetables, the 
germs of seeds, potatoes, especially sweet potatoes, carrots, 
bananas, and the fat and milk of carnivorous animals which feed 
on such things. The antineurotic vitamine is especially abundant 
in yeast, the seeds of plants and eggs of animals. ACIDS 
239 
are the same as those induced by the local action of the 
mineral acids. Also, the treatment is the same as that 
used to counteract the local action of the inorganic acids. 
OXALIC ACID 
Oxalic acid is an organic acid that is contained in a 
number of plants and is manufactured for commerce by 
heating wood shavings with caustic potash or by subject- 
ing carbohydrates to the action of nitric acid. It is not 
used in therapeutics but is mentioned here because it is 
such a common cause of poisoning, being taken either in 
mistake for Epsom salts, the crystals of which it resembles, 
or with intent to commit suicide. 
Oxalic acid has the same corrosive effect as the inorganic 
acids and, therefore, the symptoms of poisoning are sim- 
ilar. Also, the treatment for poisoning is the same, 
except that sodium or potassium compounds should not 
be used to neutralize the acid, for sodium and potassium 
oxalates are poisonous. The best neutralizers are the 
calcium salts, either calcium lactate or calcium chlorid, 
but lime water, chalk, or wall-plaster can be used in 
emergency. ANTACIDS 
An antacid is, as the name implies, a remedy that neu- 
tralizes an acid. 
The body conditions that call for the use of an antacid 
are: (1) Hyperacidity of the gastric juice; (2) systemic 
acidosis-this may be the result of the absorption of 
poisonous amounts of acids or of defective metabolism, 
as in diabetes, uremia, and chloroform poisoning; (3) 
hyperacidity of the urine. 
In order that a drug may act as an antacid it must be 
either an alkali or else of a nature to be changed to an 
alkaline substance in the body. 
NON-ALKALINE antacids. 
These are the sodium and potassium acetates, the so- 
dium and potassium tartrates, and sodium, potassium and 
lithium citrates. The acid ions of these salts are acetic, 
tartaric and citric. 
Preparations and dosage: 
Acetates, 10-40 grs. (0.6-2.6 gm.). 
Citrates, 10-20 grs. (0.6-1,3 gms.). 
Effervescent potassium citrate, )^-l 5 (2.0-4.0 gms. 
This contains sodium bicarbonate. 
Potassium bitartrate (cream of tartar), 2^3 (10.0 gm.). 
These salts do not, in their natural form, unite with 
acids and thus they will not affect the reaction of the gas- 
tric juice. 
After absorption, they are acted upon in the same man- 
ner as the salts formed in the intestine from acetic acid 
and the fruit acids (described in the preceding section, 
under Organic Acids) and thus they tend to increase the 
alkalescence in the blood and to decrease the acidity 
240 ANTACIDS 
241 
of the urine. The acetates are the most efficient in 
this respect, because they are more completely absorbed 
than the citrates and tartrates. The latter, for reason 
given under Saline Cathartics, have a slight laxative 
effect. 
Sodium citrate is sometimes added to milk to prevent 
it forming a hard curd. It does this by its action on the 
calcium salts for changes in these salts, in either blood or 
milk, interfere with the clotting properties of these fluids. 
ALKALINE ANTACIDS 
The alkaline antacids are: The alkaline compounds of 
(1) the metal elements sodium, potassium and lithium; 
(2) ammonium; (3) the alkaline earths calcium and 
magnesium. 
SODIUM, POTASSIUM, LITHIUM 
These alkaline elements are never found free in nature 
but their salts are widely distributed, they are especially 
abundant in sea and mineral waters and in salt beds. 
Preparations and dosage: 
Sodium hydroxid sticks, for external use. 
Solution of sodium hydroxid (5 per cent.), 5-15 m. (0.3- 
1.0 c.c.). 
Sodium carbonate, 5-10 grs. (0.3-0.6 gm.). Larger doses, 
in very dilute solutions, are sometimes given by intravenous 
infusion to patients with severe acidosis. 
Sodium bicarbonate, 5-15 grs. (0.3-2.0 gm.). Larger 
doses, up to about 2 oz. per day, are given to patients with 
severe acidosis. They are then usually given by rectum or 
intravenously in about 3 per cent, solutions. 
The dosage of potassium compounds and lithium salts 
is the same as that of the sodium. 
Administration.-When the caustic sticks are used, as 
soon as the desired degree of corrosion has been obtained, 
the area must be washed with vinegar per cent, or other 
dilute acid. Hydroxids and carbonates must be very well 242 
MATERIA MEDICA AND PHARMACOLOGY 
diluted for internal administration. When an alkali is 
used to overcome gastric hyperacidity, it is sometimes 
given directly after eating but, frequently, the prescrip- 
tion calls for its administration between one and two 
hours after a meal, because, as a rule, the acidity of the 
gastric juice is greatest at this time. Sometimes, when 
one of the reasons for the use of the alkali is to liquefy the 
mucus in the stomach, the drug is given before breakfast. 
When an alkali is intended for its effects after absorption, 
if given by mouth, it is generally administered before 
meals (while the gastric contents are neutral) in order to 
prevent its neutralization. 
Fate in the Body.-The preparations of the alkaline 
metals that are used as antacids are readily absorbed 
through mucous membranes. They are excreted chiefly 
through the kidneys, but also to some extent through 
mucous membranes. 
Actions.-In addition to neutralizing acids, the alkalies 
tend to abstract water, saponify fats, and dissolve the al- 
bumin of protoplasm with which they come in contact. 
The degree of their action will be in proportion to their 
concentration and the nature of the tissue. They affect 
the soft tissues more readily than the skin. The hydroxids 
are the most strongly alkaline and the bicarbonates the 
least. 
Effects of actions: 
On Bacteria.-Even dilute solutions of hydroxids and 
carbonates are disinfectant and the bicarbonates are 
antiseptic. 
On the Skin and Mucous Membranes.-Even moder- 
ately dilute solutions of the hydroxids will destroy the 
skin and solutions as dilute as 5 per cent, are destructive 
to mucous membranes. The carbonates are less caustic 
and will only destroy the skin if concentrated solutions are 
kept in contact with it for some time, but even moderately 
concentrated solutions are destructive to mucous mem- 
branes. Under the influence of corrosive concentrations ANTACIDS 
243 
of these alkalies, the affected parts become soft, swollen 
and inflamed and then necrosed; a soft crust usually forms 
over the surface, but drops off in a few days leaving an 
ulcerated area. 
Dilute solutions of the hydroxids and carbonates when 
applied to the skin, dissolve its outer layer of cells and the 
sebaceous matter on its surface and thus soften and 
cleanse it, also, they soften dried exudates and crusts 
and promote an irritation that is sometimes of value in 
relieving itching such as exists in urticaria. They affect 
mucous membranes in the same way as the skin, but more 
readily, and they also dissolve mucus. Concentrated 
solutions of the bicarbonates have about the same effects 
as dilute solutions of the other alkalies except that they, 
especially sodium bicarbonate, are practically non-irritant 
and their other properties make them soothing to the skin 
when it is irritated, as in some forms of erythema, or 
injured, as by burns. 
When they are taken by mouth, these drugs, in addition 
to their effects on mucous membrane and mucus, lessen 
the acidity of the gastric juice and promote contractions 
of the stomach muscle. The carbon dioxid, liberated 
from the carbonates and bicarbonates when they come in 
contact with acid, aids in the latter action. As the results 
of these effects, nausea is likely to be relieved and also 
pain that is due to hyperacidity of the gastric juice, and 
gas is expelled. When there is an excess of acid in the 
stomach, digestion will be aided by the judicious use of an 
alkali, but, otherwise, the digestion of proteins will be 
retarded, because the pepsin, which promotes their diges- 
tion, is only active in a solution that is about 0.2-0.4 per 
cent. acid. Some investigators believe that, though these 
alkalies are effective antacids for hyperacidity due to 
fermentation, they are not beneficial in the condition 
known as hyperchlorhydria (excessive secretion of hydro- 
chloric acid) because the irritation (due in the case of 
sodium bicarbonate to the carbon dioxid) stimulates 
the secretion of hydrochloric acid and also hastens the 244 
MATERIA MEDICA AND PHARMACOLOGY 
passage of the salt from the stomach so that its effect 
is not as lasting as that of the alkaline earths. 
The salts formed in the stomach by the interaction of 
these alkalies with the acid of the gastric juice are readily 
absorbed and, therefore, if no more alkali is taken than 
required to reduce the acidity of the gastric juice to its 
normal degree, they will have practically no effect in the 
intestine; except that, if the latter has been irritated by 
the excessive acidity of the chyme entering it from the 
stomach, the abnormal conditions induced by the irrita- 
tion (e.g., catarrh and pain) will gradually subside when 
the chyme is kept normal. If, however, so much alkali 
is taken that the chyme is alkalinized, or even neutralized, 
intestinal digestion will be delayed because some acid is 
necessary to activate the hormone -which stimulates the 
pancreas. 
After their absorption the alkaline salts: (1) Increase 
the amount of alkaline material in the blood and thus 
help to overcome the conditions present in acidosis (de- 
scribed under acids); (2) they raise the osmotic pressure 
of the blood and, thereby, increase the osmosis of fluid 
from the tissues into the vessels and thus favor increased 
excretion of urine, as described on page 47; (3) they reduce 
the acidity of the urine. 
Potassium hydroxid and carbonate are said to be more 
destructive to tissue than the sodium compounds and the 
potassium ion tends to depress the heart muscle. 
Lithium salts were formerly much used in the treatment 
of gout with the belief that they dissolved urates, but 
this has been proved an error and they are rarely used at 
present. 
Therapeutic Uses. External.-The caustic sticks are 
used occasionally to remove warts and similar growths. 
Solutions of the carbonate and bicarbonate are used as 
wet applications to the skin and to abraded surfaces to 
loosen dried exudates and to relieve itching and especially 
sodium bicarbonate to lessen pain due to burns. 
A bicarbonate is often added to solutions for douching ANTACIDS 
245 
mucous membranes and gargling the throat when there 
is tenacious mucus present. 
Internal.-These drugs, especially sodium bicarbonate, 
are used to overcome (1) gastric hyperacidity; (2) acidosis; 
(3) excessive acidity of the urine. 
They are used in emergency as antidotes for poisoning 
by acids but, for reason already mentioned, they should 
only be given by mouth if other alkalies cannot be obtained 
and they must be well diluted. 
The bicarbonates, especially potassium, are used in 
expectorant mixtures, because of their effects on mucus. 
Toxicology.-The symptoms of poisoning are almost 
entirely due to corrosion of the gastro-intestinal tract 
and thus are similar to those produced by the local effects 
of corrosive acids. The danger of collapse is especially 
great when the poisoning is due to potassium compounds. 
The treatment is the same as for poisoning by acids, 
except that dilute acids are substituted for alkalies (the 
organic acids-acetic (vinegar), citric and tartaric are best 
for the purpose) and alkalies are not given intravenously. 
AMMONIA OR AMMONIUM 
Ammonia (NH3) is a gaseous compound of nitrogen and 
hydrogen. It is derived chiefly from coal, by heating the 
latter in an appliance from which air is excluded, but 
it is one of the several compounds of nitrogen and hydrogen 
produced during the decay of dead animal and vegetable 
matter. 
Ammonia gas is easily condensed to a colorless liquid 
and can be purchased in this form, but the liquid prepara- 
tions ordinarily used are solutions of the gas in water. 
Preparations and dosage: 
For external use: 
Ammonia liniment. 
Strong ammonia water, this contains 28 per cent. 
For internal use: 
Ammonia water (aqua ammonia or spirit of hartshorn), 
10-30 m. (0.6-2.0 c. c.). This contains 10 per cent. ammonia. 246 
MATERIA MEDICA AND PHARMACOLOGY 
Aromatic spirits of ammonia, ^-15 (2.0-4.0 c.c.). 
Ammonia carbonate 5-20 grs., (0.3-1.3 gm.). 
Ammonia acetate (spirit of Mindererus}, 1-45 (4.0- 
16 c.c.). 
Ammonia chlorid 5-20 grs., (0.3-1.3 gm.). 
There are also a number of salts, of which ammonia 
forms the base, that owe their principal properties to their 
acid ion. They are described under the headings of the 
more important principle. 
The acetate and the chlorid liberate ammonia so slowly 
that they have not a typical ammonia action and will 
be discussed separately. 
Administration.-For its reflex effects ammonia may be 
given by inhalation or by mouth. For administration by 
inhalation the stronger water or smelling salts may be 
used, the container being held in such position that the 
gas can be inhaled. Care must be taken when giving 
inhalations to an unconscious person or intense local 
irritation may be induced. To neutralize the gastric 
juice the drug must be given by mouth. For oral admin- 
istration ammonia compounds should be moderately 
diluted, if too concentrated, they may cause nausea and 
vomiting, if too dilute, their reflex effects will be minimized. 
Fate in Body.-A portion of a dose of any of the am- 
monia compounds under discussion will be changed to the 
neutral salt ammonium chlorid by interaction with the 
hydrochloric acid of the gastric juice and, as such, ab- 
sorbed and excreted in the urine and possibly the sputum. 
All that is not neutralized is changed to urea in the liver 
and as such excreted through the kidneys. 
Actions.-Ammonia acts upon protoplasm in the same 
manner as the metal alkalies but, owing to its volatile nature, 
its effects are less enduring and, therefore, less caustic. For 
this reason it can be used in concentrations that will pro- 
duce sufficient irritation to induce characteristic carmina- 
tive reflexes without injury to the tissues. When given by 
mouth it acts like other alkalies upon the acid in the stom- 
ach, but after absorption, as it passes directly through the 
portal vein to the liver where, all that has not been neu- ANTACIDS 
247 
tralized is changed to urea, it does not act as antacid and 
its effects are due to the presence of the urea and neutral 
salt-ammonium chlorid-in the blood. 
Effects of Action.-On the skin, the only effects, if the am- 
monia is allowed to evaporate, will be the removal of fat and 
other soiling matter, and softening of the skin and, possibly, 
if the solution is concentrated, reddening. If evaporation 
is prevented, however, blisters will form and the tissue may 
be destroyed. 
Mucous membranes are more easily irritated than the 
skin and thus when ammonia is taken, either by mouth or 
inhalation, the irritation increases the amount of blood 
in the affected membrane and gives rise to reflexes that 
(1) stimulate the secretion of a thin mucus and saliva; 
(2) cause the breathing to become quicker and deeper; 
(3) the pulse to become stronger and, usually, more rapid, 
though, if abnormally fast at the time, it may be slowed 
for reasons given on page 55. These effects, like all re- 
flexes, take place almost instantaneously, but they are 
transitory; however, they are often of value in overcoming 
conditions that cause fainting. 
When the drug is swallowed, in addition to the above 
effects, it neutralizes acid in the stomach, liquefies mucus 
and promotes muscular contractions of the stomach and 
intestines which favor the expulsion of gas. These effects, 
as well as the reflexes help to overcome nausea, when the 
drug is taken in moderate doses and dilutions, but too large 
or concentrated doses will induce nausea and vomiting. 
The presence of the ammonia chlorid and extra urea in 
the blood raises its osmotic pressure and this, for reasons 
given on page 47, favors diuresis. This is practically the 
only effect after absorption, unless the ammonia is taken 
in larger amounts than can be neutralized or changed to 
urea at the time, in which case there may be a temporary 
stimulation of the heart muscle and medullary centers, 
followed, if the dose is excessive, by their depression. 
Therapeutic Uses.-The liniment and, very rarely, the 
stronger water are used as external counterirritants. 248 
MATERIA MEDICA AND PHARMACOLOGY 
The gas of liquid preparations is given by inhalation to 
overcome the conditions causing fainting. The aromatic 
spirits, carbonate and water, are given by mouth for the 
same purpose and also, especially the aromatic spirits, 
to relieve nausea and flatulence and hyperacidity of the 
gastric juice. The carbonate is used in expectorant 
mixtures. 
Toxicology.-The symptoms of poisoning are the same as 
those of the metal alkalies with, as a rule, extreme irritation of 
the throat and upper air passages. The treatment also is the 
same as that for poisoning by other alkalies and, if neces- 
sary oil sprays are used to lessen the irritation of the throat. 
AMMONIA CHLORIDE 
Fate in the Body.-Ammonia chloride is readily ab- 
sorbed through mucous membranes. It is excreted by 
ammonia chloride in the urine and, especially when the 
individual has a cold and the bronchial mucous glands are 
unusually active, the sputum. 
Actions and their Effects.-Ammonia chloride does not 
liberate ammonia quickly enough to act as an alkali and thus 
all its effects are due to its salt action. These are: Ex- 
traction of water with consequent shrinking of mucous 
membranes with which it comes in contact and irritation. 
The irritation in the mouth increases the flow of saliva 
and this and the extra water taken from the membrane 
fluidifies mucus. 
The only effect after absorption is a tendency to cause 
diuresis. 
AMMONIA ACETATE 
This salt has practically no effect until after absorp- 
tion. It is changed to urea in the Ever and therefore it 
raises the osmotic pressure of the blood and thereby, for 
reasons already given, increases the excretion of urine and 
to some extent, of perspiration. 
It is used as a mild diuretic and diaphoretic. ANTACIDS 
249 
THE ALKALINE EARTH ANTACIDS 
The alkaline earths used as antacids are, as previously 
stated, alkaline compounds of magnesium and calcium. 
Compounds of these elements are very common in nature 
for they comprise a considerable percentage of the rocks 
and earth, and they, especially calcium, occur inorganic 
matter and calcium compounds are essential constituents of 
the human body. Their distribution in the body will be 
discussed later. 
MAGNESIUM 
Preparations and dosage of alkaline magnesium com- 
pounds : 
Magnesium carbonate, 45 grs. (3 gr.). 
Magnesium hydroxid (milk of magnesium), 1-35 (4.0- 
12.0 g.). 
Magnesium oxid, 5 grs.-15 (0.3-4.0 gm.). 
Important, but non-alkaline, salts of magnesium are 
magnesium sulphate, described under Cathartics and 
Anesthetics, and a cathartic, magnesium citrate. 
Magnesium compounds, especially magnesium carbon- 
ate, are common ingredients of the alkaline mineral 
waters. 
The actions of magnesium antacids differ from those 
of the alkaline metals in the following respects: (1) Though 
they combine readily with acids, their other alkaline prop- 
erties are feeble and thus they are not at all caustic. (2) 
They and the salts formed from them in the stomach are 
very imperfectly absorbed and thus their use as antacids 
is limited almost entirely to the gastric juice. (3) As they 
prevent the absorption of the water in which they are 
dissolved, they act as laxatives, the reason for this is stated 
under Saline Cathartics. 
CALCIUM OR LIME 
Preparations and dosage: 
For external use: 250 
MATERIA MEDICA AND PHARMACOLOGY 
Calcium oxide (unslaked lime). 
Lime liniment (Carron oil). A mixture of equal parts 
of lime water and linseed or olive oil. It was so named be- 
cause it was first used at the Carron Iron Works for the 
first-aid treatment of burns. 
Precipitated chalk, an ingredient of tooth powders. 
For internal use: 
Calcium carbonate (chalk, cretse), 10-60 grs. (0.6-4.0 
gm.) This is insoluble in water. 
Chalk mixture, 1-45 (4.0-20.0 gm.). Calcium carbonate 
suspended in water by means of gums. 
Compound chalk mixture, 30 grs. (2.0 gm.). Calcium 
carbonate, acacia, and sugar. 
Lime water (liquor calcis), 1-4 oz. (30-0-120.0 c.c.). 
A saturated solution of calcium hydroxid. As the hydroxid 
is only very slightly soluble in water, this solution is only 
about 0.14 per cent., i.e., it contains approximately % gr. 
(0.02 gm.} to the ounce. 
Syrup of lime, 30-60 m. (2.0-4.0 c.c.). Contains 5 per 
cent. lime. 
Calcium chloride, 5 grs. 1 oz. (0.3-30.0 gm.). 
Calcium lactate, 5 grs.-^ oz. (0.3-15.0 gm.). 
There are also a number of salts of which calcium is the 
base that owe their most important properties to their 
acid ion. 
Administration.-Calcium preparations used to reduce 
gastric hyperacidity are usually given about one hour after 
meals. It is the carbonate preparations, the syrup of lime 
and the hydroxid that are used for this purpose. The 
relatively soluble salts-the chloride and lactate, which are 
neutral salts do not serve as antacids, but they are used 
for their systemic effects. They, especially the lactate, 
are sometimes given by hypodermic or intravenous in- 
jections. In whatever manner the chloride is used it 
must be well diluted. 
Fate in the Body.-Even the soluble salts of calcium, 
those of food, as well as the medicinal preparations, are 
absorbed with difficulty. The calcium not absorbed is ANTACIDS 
251 
eliminated in the feces. That absorbed circulates in 
the blood and, if there is a deficiency of calcium in the 
body, as much as is required will, normally, be taken by 
the parts requiring it. All not utilized is slowly excreted 
in the urine or back into the intestine. 
Actions and the Effects.-Calcium oxide or unslaked 
lime is only used in therapeutics as a disinfectant for 
cesspools and the like. It is highly corrosive. 
The other preparations have no effect upon the unbroken 
skin, but calcium chloride extracts water from mucous 
membranes and subcutaneous tissues and thus is irritant 
and astringent. The syrup of lime and lime water also 
have a slight transitory irritant action and they and the 
carbonates are astringent, because of their tendency to 
coagulate surface proteins. By these actions, these 
compounds contract mucous membranes and raw surfaces 
and lessen the sensitiveness of nerve-endings. The 
lactate is less irritant than the other preparations. 
In the stomach, in addition to their action on mucous 
membranes, preparations of the carbonates and hydroxids 
neutralize the acid of the gastric juice. Lime water 
contains so little lime that it requires about ounce to 
neutralize 1 minum of hydrochloric acid and, therefore, 
its antacid effects are very mild. 
By their interaction with the hydrochloric acid, the 
carbonates and hydroxids are changed to calcium chloride 
and, in this form, enter the intestine. A small amount, 
about 20-40 per cent., may be absorbed, but the greater 
part is thrown out of solution on coming into contact with 
the alkaline secretions in the intestine and the precipitate 
tends to adhere to the wall of the bowel and protects it 
from irritation by its contents, also, it lessens the irrit- 
ability of the nerve-endings. Thus calcium salts promote 
constipation. 
As the uses of the medicinal calcium salts after absorp- 
tion are the same as those of food it will be well to recall 
the important physiological uses of calcium in the body. 
These are: Calcium is an important constituent of nearly 252 
MATERIA MEDICA AND PHARMACOLOGY 
all body tissues, but it occurs in largest proportion in the 
bones and the teeth, of which, chiefly in the form of cal- 
cium phosphate, it constitutes about 85 per cent, of the 
mineral matter that is necessary for their rigidity. (2) 
Calcium is essential for the development of thrombin, 
one of the substances required for the clotting of blood. 
(3) It plays an important part in sealing the blood-vessels, 
i.e., in preventing excessive transudation through their 
walls. (4) It opposes the action of sodium and potassium 
salts in the body; this property is especially marked on 
the heart muscle, the sodium and potassium salts promot- 
ing contraction and the calcium relaxation. (5) It is 
of importance in the regulating of nerve conduction and it 
lessens nervous irritability. Convulsions and other nerv- 
ous manifestations are common occurrences when the 
body's supply is deficient or when the body is unable to 
utilize calcium, a condition that occurs in certain diseases 
as rickets, scurvy and tetany. 
The chief therapeutic uses of calcium preparations are: 
Externally, lime water is a common ingredient of lotions used 
to relieve itching and irritation in eczema, burns and the Eke. 
For the latter purpose it is used in the form of Carron oil 
(a mixture of lime water and olive or linseed oil) as the oil 
prevents the primary irritation of the lime. 
Internally, for local effects, the carbonate preparations 
and the syrup of Erne, but especially the former, are used 
to lessen gastric hyperacidity when the condition is 
associated with diarrhea or nervousness; they are also 
used in the treatment of poisoning by acids. Lime water 
is added to milk to, by lessening the acidity of the gastric 
juice, prevent the milk being clotted into a hard curd. 
For their effects after absorption, the chloride and lac- 
tate are used: (1) To lessen nervous excitabihty such as 
exists in chorea, epEepsy, and diseases of the parathyroid 
glands; (2) to inhibit the response to local irritation, e.g. 
sneezing as the result of irritation by the pollen of plants, 
as occurs in hay fever; (3) to overcome the depressant 
action of poisonous doses of magnesium sulphate on the ANTACIDS 
253 
spinal cord;1 (4) to favor the clotting of blood when there 
is a tendency to hemorrhage, as in typhoid fever and 
scurvy; (5) to lessen the permeability of blood-vessels 
when there is excessive transudation, as in scurvy. 
Formerly calcium salts were much used in the treatment 
of hemophilia, purpuras, scurvy, rickets and tetany, under 
the supposition that these diseases were due to deficiency 
of calcium in the affected tissues, but it is now known that 
the two diseases first mentioned are almost always due to 
some abnormality of the blood-platelets and the other 
diseases are more frequently due to the existence of some 
abnormal condition which prevents the calcium being 
utilized by the body than to a deficient supply of calcium. 
One of the causes of such lack of assimilation is thought 
to be the defective metabolism of carbohydrates which 
gives rise to substances that combine with the calcium and 
unfit it for use by the cells. The defective metabolism, 
it is believed, is caused by a lack of either some internal 
secretion or of food vitamines. 
1 It is thought that magnesium sulphate, under conditions 
mentioned on page 114, enters between the synaptic membrane 
of afferent neurones of the cord and inhibits the transmission of 
impulses, and calcium is thought to relieve the condition by dis- 
placing the magnesium, not by stimulating the cord. CATHARTICS 
Cathartics are agents that increase and quicken evacua- 
tion from the bowels. Before considering their action it 
will be well to review briefly the physiology of normal 
defecation. 
PHYSIOLOGY OF DEFECATION 
Ordinarily, all food material not absorbed is gradually 
propelled onward through first the small and then the 
large intestine by the so-called peristaltic action of these 
organs. 
Peristalsis consists in the formation of series of localized 
rings or waves of constriction below each one of which is 
a portion of intestine in a relaxed condition. These waves 
are, ordinarily, the result of nerve impulses coming from 
centers in the sacral region of the spinal cord, in response 
to the stimulation of the centers by afferent impulses, 
started in the intestine by the material entering it. Thus, 
normally, a wave of constriction occurs as soon as food is 
forced to a part of the intestine and this wave, in turn, 
forces the food onward thereby promoting other waves. 
The material discharged from the small, into the large 
intestine, is in a liquid condition, water not being as 
readily absorbed from the small intestine as from the 
colon, but, after the food residue enters the latter, the water 
is gradually taken up and thus, if the feces are not evacu- 
ated at the normal rate, they become dry and hard, while 
if they are hurried through the intestine at an unusually 
rapid rate they will be soft and even watery. 
When the feces reach the sigmoid flexure of the colon 
their passage is temporarily retarded until reflexes are stim- 
ulated which pass them onward into the rectum. The 
necessary reflexes are initiated in various ways but the 
254 CATHARTICS 
255 
more potent ones are (1) the taking of food when the 
stomach is empty and (2) the first movements of the body 
after a period of rest as upon arising in the morning. 
When material is forced into the rectum the latter is 
thrown into peristaltic waves, but the sphincters remain 
contracted. The result is an inflow of impulses to the 
brain with the resultant sensation of discomfort which 
constitutes the desire for defecation. The desire can be 
overcome, as a rule, because the sympathetic center in the 
cord which controls the sphincters is, by some unknown 
connection, influenced by the voluntary system. If the 
desire is not responded to, the rectum relaxes and the 
stimulation of the nerves ceases and the desire is not 
again experienced until more material enters the rectum. 
The act of defecation is initiated by the voluntary con- 
traction of the abdominal muscles, the sphincters then 
relax and the peristalsis of the colon and rectum is in- 
creased, both of which actions are reflexes. When the 
response to the desire to defecate is repeatedly neglected 
the rectum loses its sensitiveness and then the initiation 
of adequate reflexes is interfered with and chronic con- 
stipation results. 
The more common causes of chronic constipation are: 
Failure to respond to the desire for defecation; abnormal 
conditions of the intestine such as frequently follow acute 
enteritis; the presence of hemorrhoids; lack of tone of the 
intestinal and abdominal muscles; an insufficient amount 
of cellulose in the diet; the constant use of irritant cathar- 
tics, which accustom the nerve-endings to strong stimu- 
lation and thus lessen their sensitiveness to the milder 
stimulation of food substances. 
The best means to prevent and overcome constipation 
are: To go to the toilet as soon as possible when the 
desire for defecation is experienced and to have a regular 
hour for doing so, after breakfast is generally considered 
the best time; to use a liberal amount of fruit, coarse cereals 
and vegetables; to take exercises that will call the abdom- 
inal muscles into play, and to maintain healthy body tone. 256 
MATERIA MEDICA AND PHARMACOLOGY 
PHYSIOLOGY OF CATHARSIS 
With a few exceptions, mentioned later, the drugs used 
as cathartics produce their effects by their local action 
in the intestine and, as they are not readily absorbed, few 
of them have much, if any, systemic effects beyond those 
occasionally induced by their local action. These drugs 
produce catharsis chiefly either by increasing the amount 
of material in the intestine or by irritating the intestinal 
mucous membrane. As will be seen later, those which act 
by irritation also increase the quantity of fluid in the 
intestine. 
Drugs which act solely by increasing the intestinal con- 
tents promote peristalsis in the same manner as food. The 
increase in the intestinal material may be due chiefly to 
the presence of the drug itself or to interference with the 
absorption of water and, in some cases, food. 
Drugs which irritate the intestinal membrane induce 
reflexes which increase peristaltic contractions of the in- 
testinal muscle and thus hurry food residue through the 
bowel allowing less time for the absorption of water. The 
irritation of the membrane also increases the amount of 
blood in the membrane and stimulates the secretion of 
mucus. Extreme irritation may cause severe congestion 
and the transudation of fluid from the intestinal blood- 
vessels. 
Cathartics, some more readily than others, are likely to 
cause griping pains or colic, due, it is thought, to the 
spasmodic contractions of the intestinal muscle induced 
by the irritation. Either carminatives, described under 
Volatile Oils, or Belladonna, which lessen spasmodic 
contractions without interfering with the normal peri- 
staltic contractions, are often given with cathartics that 
are particularly likely to do this. 
The more irritant cathartics are likely to cause conges- 
tion of the pelvic organs, including, in the female, the 
uterus. The reason for the congestion of organs not in 
direct contact with the drugs is unknown. CATHARTICS 
257 
Classification.-Cathartics which are not irritant, or 
only mildly so, and only hasten defecation to a slight de- 
gree are classed as laxatives or aperients. Those which are 
moderately stimulant are termed purgatives and those 
which are decidedly irritant are classed as drastics. This 
classification is not at all arbitrary'however, because the 
mildest laxatives in excessive doses may act as purgatives 
and large doses of purgatives may have a decidedly drastic 
effect. Also there is very little difference between the 
potency of the stronger laxatives and the milder purga- 
tives and their classification by different authorities varies. 
Cathartics which produce particularly watery stools, 
especially the salines, are often referred to as hydragogues 
(from the Greek hydor = water and ago = to drive). 
Those which tend to increase the elimination of bile 
(calomel, castor oil, podophyllum and bile salts) were 
formerly termed cholagogues because they were thought to 
stimulate the secretion of bile, but it has been found that, 
with the exception of large doses of bile salts, these drugs 
do not stimulate the liver to secrete bile, but they, unlike 
most cathartics, cause forceful contractions of the duo- 
denum and, by doing so, cause contraction also of the bile 
ducts and the consequent expulsion of the bile stored in the 
ducts and the gall bladder. 
Preparations and dosage: 
Laxatives or aperients: 
Agar-agar, 1-45 (0.06-15.0). 
Euonymus or Wahoo, extract, 1-3 grs. (0.06-0.2 gm.). 
Glycerine, 1-2 oz. (30.0-60.0 c.c.). 
Leptandra, extract of, 2-5 gm. (0.13-0.3 gm.). 
Liquid petroleum or mineral oil, ^-1 oz. (15.0-30.0 c.c.). 
Manna, 1-25 (4.0-8.0 c.c.). 
Olive oil, 1-3 oz. (30.0-90.0 c.c.). 
Sulphur, sublimed, 1-35 (4.0-12.0 gm.). 
Tamarind, the preserved fruit is used like other jams. 
Purgatives: 
Anthracene group. 
Aloes, 2-4 grs. (0.13, 0.25 gm.). 258 
MATERIA MEDICA AND PHARMACOLOGY 
Aloes, tincture, ^-25 (0.5-8.0 c.c.). 
Aloin (active principle), 1-4 grs. (0.06-0.25 gm.). 
There are also a number of pills of aloes combined 
with other substances, with the exception of the A. B. S. 
pills the ingredients are indicated by the names of the pills. 
The A. B. S. pills consist of aloes, belladonna and strych- 
nine. 
Cascara sagrada, 15 grs. (1.0 gm.). 
extract, 4 grs. (0.25 gm.). 
fluidextract, 15.0-60.0 m. (1.0-4.0 c.c.). 
aromatic fluid extract, 30-60 m. (2.0-4.0 c.c.). 
This contains cascara, glycerin and several aromatic 
substances. 
Regulin, 1-35 (4.0-12.0 gm.). This consists of cas- 
cara and agar-agar. 
Frangula, fluidextract, 15-30 m. (1.0-2.0 c.c.). 
Phenolphthalein, 2-3 grs. (0.1-0.2). 
Phenolphthalein and agar-agar, 1-35 (4.0-12.0 gm.). 
Rhubarb, 15 grs. (1.0 gm.). 
Rhubarb extract, 4-8 grs. (0.25-0.5 gm.). 
Rhubarb fluidextract, 15 m. (1.0 c.c.). 
Rhubarb tincture, (20 per cent.) 15 (4.0 c.c.). 
Rhubarb aromatic tincture, 30 m. (2.0 c.c.). This 
contains cinnamon, cloves and nutmeg. 
Rhubarb syrup, (10 per cent.) 2 (8.0 c.c.). 
Rhubarb compound powder or Gregory's powder, 30 
grs. (1.0 gm.). This contains rhubarb, magnesium and 
ginger. 
Rhubarb compound pills, 1-5 pills. Contain rhubarb, 
myrrh, oil of peppermint. 
Rhubarb Mistura rhei et soda (rhubarb and soda 
mixture), 1-2 (4.0-8.0 c.c.). 
Senna, 15 (4.0 gm.). 
Senna confection, 1-25 (4.0-8.0 c.c.). Contains sen- 
na, cassia fistula, tamarind, prune, fig, oil of coriander. 
Senna compound infusion (Black draught), 2 oz. 
(60.0 c.c.). Contains senna, fennel and magnesium 
sulphate. CATHARTICS 
259 
Senna fluidextract, 30 m. (2.0 c.c.). 
Senna syrup (20 per cent.), 25 (8.0 c.c.). 
Mercury group. 
Calomel, ^-5 grs. (0.03-0.3 gm.). 
Blue mass, 1-5 grs. (0.06-0.3 gm.). 
Mercury with chalk or gray powder 5 grs. (0.3 gm.). 
Salines: 
Carlsbad salt. A mixture of salts, chiefly the chlorid, 
bicarbonate, and sulphate of sodium and potassium 
sulphate. 
Magnesium citrate, 6-12 oz. (180-360 c.c.). 
oxide, 30 grs. (2.0 gm.). 
sulphate (Epsom salt), 2-85 (8.0-30.0). 
sulphate (effervescent), )^-l oz. (15.0-30.0 gm.). 
Potassium bitartrate (cream of tartar), 30-60 grs. (2.0- 
4.0 gm.). 
Potassium citrate, 30 grs. (2.0 gm.). 
Potassium citrate (effervescent), 60 grs. (4.0 gm.). 
Potassium sulphate, 30 grs. (2.0 gm.). 
Rochelle salt (potassium and sodium tartrate) 2-45 
(8.0-15.0 gm.). 
Seidlitz powder. (This is prepared in two packages, 
one, in blue paper, contains Rochelle salt 2 (8.0 gm.) 
and sodium bicarbonate; the other, in white paper, con- 
tains tartaric acid. For administration, each powder is 
dissolved in glass of water and one solution poured 
into the other just before giving it to the patient. 
Sodium citrate, 30 grs. (2.0 gm.). 
Sodium phosphate (Glauber's salt), 25 (8.0 gm.). 
Sodium phosphate (effervescent), 2-45 (8.0-16.0 gm.). 
Lithium citrate (effervescent), 25 (8.0 gm.). 
The mineral waters such as Apenta, Carlsbad, Hun- 
yadi, Pluto owe their cathartic properties to some of the 
above salts. Some of the mineral waters are obtained 
from springs, but many of them are prepared artificially. 
Castor oil (oleum ricini), ^-1 oz. (15.0-30.0 c.c.). (For 
a young child) 1-3 (4.0-12.0 c.c.). 
Castor-lax, 1-2 oz. (30.0-60.0 gm.) (not official). This 
is a powder made with castor oil and magnesia. 260 
MATERIA MEDICA AND PHARMACOLOGY 
Compound licorice powder (Pulvis glycyrrhizae), 15 
(4.0 gm.). This contains senna, licorice root, sulphur, 
fennel and sugar. 
Fei bovis (ox-gall), 5-20 grs. (0.3-1.3 gm.). 
Podophyllum, resin of, % gr. (0.01 gm.). 
Drastics: 
Colocynth, extract, 2-5 grs. (0.13-0.3 gm.). 
compound extract, 4-10 grs. (0.25-0.6 gm.) con- 
tains colocynth, aloes, cardamom, scammony. 
Colocynthin (active principle, not official), ffo gr. 
(1.006 gm.). 
Compound cathartic pill, 1-3 pills. Each pill con- 
tains calomel and compound extract of colocynth a.a. 
1 gr., resin of jalap 9r-, gamboge gr. 
Croton oil (oleum tiglii), 1-2 m. (0.02-0.13 c.c.). 
Elaterine, Xo gf- (0.006 gm.). 
triturate, gr. (0.03 gm.). 
Euonymus (non-official), 7 grs. (0.45 gm.). 
Gamboge, 2 grs. (0.13 gm.). 
Jalap, resin of, 2 grs. (0.13 gm.). 
compound powder of, 30 grs. (2.0 gm.). This con- 
tains jalap and potassium bitartrate. 
Scammony, resin of, 2 grs. (0.13 gm.). 
Vegetable cathartic pill, 1-3 pills. Each pill contains 
jalap, •podophyllum, leptandra, colocynth, hyoscyamus, 
oil of peppermint. 
Drugs which act as cathartics by their effects after absorp- 
tion: 
Apocodeine, gr. (0.03 gm.). 
Hormonol, ^-1 oz. (15-30 c.c.). 
Physostigmine salicylate, gr. (0.001 gm.). 
Pituitary extract, 15 m. (1.0 c.c.). 
Derivation.-With the exceptions mentioned in the 
text, the cathartics are derived from plants. As knowl- 
edge of the names of the plants is not of importance to 
nurses, space will not be taken to give them. 
The drugs which act chiefly by increasing the bulk of 
the intestinal contents are: agar-agar, glycerine, the 
mineral oils, the salines and sulphur. CATHARTICS 
261 
AGAR-AGAR 
Agar-agar is a gelatinous-like substance which is de- 
rived from various seaweeds. It absorbs water and swells, 
but it is insoluble in water and it is not absorbed from the 
intestine. It is usually taken with cereal or mixed with 
milk or cream. It may be two or three days before a dose 
has any effect, but if agar-agar is taken regularly, it is 
likely to cause a soft stool daily so long as its use is con- 
tinued. There are some objections to its constant use 
however, viz., (1) it favors the production of putrefactive 
products in the intestine, both because it provides excellent 
food material for the intestinal bacteria and because if it 
is decomposed by bacteria, it yields such products; (2) 
it tends to prevent the absorption of food; (3) it acts as a 
demulcent and protects the intestine from irritation by 
food. To obviate the last objection slightly irritant 
drugs are sometimes combined with the agar-agar. 
GLYCERINE 
Glycerine is obtained from fat as a by-product in the 
making of soap. It acts as a laxative both by increasing 
the intestinal contents and by a slight irritation of the 
intestinal mucosa. Both of these effects are due to its 
power of abstracting water from the tissues. 
THE MINERAL OILS 
The mineral oils are derived from petroleum. There 
are a number of brands, known by different trade names, 
some of which are obtained from Russian and some from 
American wells. The Russian oils are thicker than the 
American. These oils are not saponified in the intestine, 
as are the fixed oils, and they are not absorbed. They 
act as laxatives by increasing the intestinal contents and 
by lubricating the intestinal walls. The former action is 
due to (1) interference with the absorption of water, (2) 
softening and consequently expanding the food residue, 
(3) increasing the amount of residue by protecting the 262 
MATERIA MEDICA AND PHARMACOLOGY 
food from the digestive juices and thus retarding its 
digestion. It is thought that these oils also act as in- 
testinal antiseptics, but this has not been proven. Ob- 
jections to their use are: Their effect on digestion; they 
are likely to leak from the rectum; they are nauseant to 
some people. The last objection can be overcome by 
adding a little lemon or other fruit juice, wine, peppermint 
or other flavoring extract to the dose. 
SULPHUR 
Sulphur is an element obtained from the vicinity of 
certain volcanoes. It is distilled by the volcanic heat 
from sulphur compounds in the depths of the earth and 
thus the supply is constantly renewed. The sulphur 
preparation used as a cathartic is a gritty substance that 
is insoluble in water. It is best given in syrup. The 
compounds which it forms in the intestine are slightly 
irritating, but its cathartic action, which is mild, is due 
chiefly, it is thought, to increasing the bulk of the intestinal 
contents. 
THE SALINES 
The salines are salts that are not readily absorbed from 
the stomach and intestines. Each salt is formed by 
the interaction of the salt and alkali indicated by its 
name. The effervescent preparations contain, in addi- 
tion to the specified cathartic salt, sodium bicarbonate 
and either or both citric and tartaric acids. These 
ingredients interact when the salt is dissolved and liberate 
CO2. The effervescence which ensues lessens the appre- 
ciation of the flavor of the salt and it has a slight, transi- 
tory carminative action. 
Administration.-An effervescent preparation is not to 
be diluted until the patient is ready to take it, for the gas 
escapes quickly. The dilution of salines is of importance: 
Unless otherwise specified, magnesium sulphate is diluted 
sufficiently to make a 7-8 per cent, solution and the other 
salts to make about a 5 per cent, solution. The taste of CATHARTICS 
263 
most saline cathartics is objectionable to the majority 
of people, but this can be rectified somewhat by diluting 
the salt in a small amount of hot water (the salts are more 
soluble in hot than cold water and thus can be dissolved 
in a smaller amount) and, when cold, adding a carbonated 
water or lemon juice and a few grains of soda bicarbonate. 
Actions and Effects.-As ordinarily diluted (i.e., in 
the concentrations stated above), the salines produce 
catharsis by increasing the bulk of the intestinal contents 
and they do this because they prevent the absorption of 
the water in which they are dissolved, and of the liquid in 
the intestine, derived from drink and food; also, some 
investigators consider, by causing the transudation of 
fluid from the blood-vessels in the intestinal membrane. 
They do this, it is believed, by precipitating the calcium 
salts of these tissues. As seen in the section on Calcium, 
the calcium salts in the tissue of the blood-vessel walls 
lessen the permeability of the latter and, therefore, if the 
salts are removed, more fluid will pass through the vessels. 
Concentrated solutions will, by virtue of their salt action, 
described page 47, extract fluid from the tissues and blood- 
vessels of the stomach and intestines, particularly the 
former and, in this way, promote more or less irritation. 
Salines are sometimes given in concentrated solutions 
when a patient has edema, because a concentrated solu- 
tion, by extracting water from the intestinal blood-vessels 
raises the concentration of the blood, whereupon water is 
absorbed by the blood from the tissues, as described on 
page 47. Even dilute solutions will have these results 
to a slight extent because they inhibit the absorption of 
water taken as beverage and in food. Concentrated 
solutions should not be given unless prescribed for, as 
they irritate the stomach, they are more likely to cause 
nausea than isotonic solutions and they take a longer 
time to induce catharsis. The reason for the delay of 
catharsis will be obvious if it is remembered that catharsis 
depends upon the quantity of water in the intestine and 
it will of course require some time for a concentrated 264 
MATERIA MEDICA AND PHARMACOLOGY 
solution to extract as much water as is given with a 
properly diluted dose. On the other hand, if the solu- 
tions are so dilute that they are hypotonic to the blood a 
considerable portion may be absorbed and thus their 
cathartic effect will be minimized. 
Medicinal doses of the salines in the dilutions mentioned 
on the preceding page will usually take effect in about 
2 to 4 hours and will, as a rule, induce two or more watery 
stools without much, if any, griping. They will wash out 
the entire intestinal tract, though sometimes not very 
thoroughly. Concentrated solutions may not take effect 
for 10 or 12 hours and may induce considerable griping. 
Excessive doses of even dilute solutions may cause purg- 
ing, nausea, tenesmus and, if these results are excessive 
marked prostration with a rapid weak pulse. 
If magnesium sulphate is given in excessive doses enough 
may be absorbed to depress the central nervous system 
and produce the effects described on page 114. 
Following a dose of a saline cathartic, the excretion of 
urine will be diminished for a time, because of the reduced 
blood-pressure resulting from the lessened supply of 
fluid, but though, as previously stated, the cathartic salts 
are not readily absorbed, they are to some extent and 
after absorption, by raising the osmotic pressure of the 
blood they favor the osmosis of liquid from the tissues, as 
described on page 47, which causes a rise of blood pressure 
and consequent diuresis. 
The amount of a saline solution that will be absorbed 
will depend (1) upon the concentration of the solution: 
as a rule, the lower the specific gravity of the solution, the 
greater the amount absorbed; (2) the concentration of 
the blood-the greater the concentration of the blood, the 
larger the amount of solution absorbed, for, it will be 
remembered, the law of osmosis is that when two fluids, of 
unequal concentration are separated by a permeable mem- 
brane, the fluid of lesser density will pass more rapidly 
through the membrane than that of greater density until the 
fluids are of equal concentration, and the rate of osmosis CATHARTICS 
265 
will be in proportion to the differences in density. Condi- 
tions that most commonly increase the concentration 
of the blood are: Restriction of the intake of fluid; un- 
usual loss of water from the body as by hemorrhage, 
nausea, vomiting, diarrhea, excessive perspiration or 
diuresis. 
When a saline cathartic is given a patient who has 
edema, the physician should be notified if catharsis does 
not occur within a reasonable time, because if the solution 
is absorbed and the kidneys are not functioning properly 
(which is very likely to be the case when there is edema), 
the salts may not be excreted and then they will pass into 
the tissues and by raising the osmotic pressure of the 
tissue lymph, further the exudation of fluid from the blood 
and thus increase the edema. This is particularly im- 
portant in the case of magnesium sulphate, because, if its 
elimination does not keep pace with its absorption enough 
may collect in the system to cause the symptoms of poison- 
ing already referred to. 
Reduction of the amount of water in the body inter- 
feres with secretion. This is of particular importance 
when a woman is nursing her baby, for the supply of 
milk may be temporarily much lessened following a dose 
of cathartic salts. 
Loss of water also induces intense thirst and, unless 
there is some reason for limiting the supply of liquids, a 
patient should be given a liberal amount of liquids an 
hour or so after the cathartic. 
THE ANTHRACENE COMPOUNDS 
The drugs of the anthracene group are so classified be- 
cause their active principles are substances that are 
classified in chemistry as anthracene compounds. Those 
of plant origin (all those mentioned except phenol- 
phthalein) also contain resinous material that adds to 
their cathartic value. 
Phenolphthalein is a synthetic substance made from 266 
MATERIA MEDICA AND PHARMACOLOGY 
phenol compounds and sulphuric acid. Long before its 
cathartic properties were known, it was used in laboratories 
to test the reaction of solutions for it turns pink in the 
presence of alkalies. It is now also used to test the func- 
tioning capacity of the kidneys. For this purpose it is 
given subcutaneously and, if the kidneys are functioning 
properly part of a dose will be found in the urine in about 
10 minutes and about 60 per cent, will be eliminated within 
an hour. The presence of the phenolphthalein in the 
urine is ascertained by adding an alkali to the urine. A 
small amount of phenolphthalein is excreted through the 
liver and passes into the intestine in the bile and may have 
a laxative effect. When the drug is given by mouth only 
a very small part of a dose is absorbed. 
The anthracene compounds, including phenolphthalein, 
owe their cathartic properties to a mild irritation of the 
intestinal membrane, even in large doses they will not 
cause harmful inflammation and they do not induce a 
tolerance to their action, which would necessitate giving 
increasingly large doses to get effects. For this reason, 
the drugs of this group, especially phenolphthalein and 
cascara, are much used in chronic constipation. They 
will be effectual in from 8 to 12 hours, inducing one or more 
soft, but not as a rule liquid, stools, with little or no grip- 
ing. They are best taken at night. Those of vegetable 
origin contain small amounts of tannin and, therefore, if 
used in very large doses, their cathartic action may be 
followed by constipation. 
A portion of doses of the anthracene drugs may be 
absorbed, especially when their use is not followed by 
free catharsis, and in such case large doses may cause 
enough depression of the nervous system to give rise to a 
mild prostration. 
Aloes, but not the active principle aloin, tends to cause 
congestion of the rectum and other pelvic organs and 
therefore should not be taken by those who have hemor- 
rhoids nor during menstruation, unless prescribed* to 
relieve amenorrhea. CATHARTICS 
267 
Rhubarb contains a bitter principle as well as its anthra- 
cene compounds and is therefore often used to aid 
digestion. 
Senna and frangula, especially the latter, are more irri- 
tant and thus more apt to cause griping pains than the 
other drugs of this group. 
MERCURY COMPOUNDS 
The derivation and nature of the mercury compounds 
are given under Mercury and thus only their cathartic 
action need be discussed here. 
Calomel is a non-irritating powder, but as soon as it 
enters the duodenum it interacts with alkaline salts there 
present and is changed to mercurial salts that are irritant 
and thus promote peristalsis. The intensified contrac- 
tions of the duodenum induced by the calomel promotes 
contraction of the bile ducts and thus cause the expulsion 
of the bile stored in the ducts and gall-bladder. Calomel, 
however, does not stimulate the colon to such an extent 
as the small intestine and, consequently, a small dose 
may not be effectual, while a large one is likely to cause 
intense griping and, when the calomel does not produce 
adequate catharsis, headache, nausea and sometimes 
vomiting are likely to ensue. For these reasons, a dose of 
calomel is generally followed, in about six horns, by a dose 
of salts and the calomel is sometimes given in divided 
doses, i.e., a small dose or grain) is given at in- 
tervals of about fifteen minutes until the desired amount 
has been administered. Sodium bicarbonate is very com- 
monly given with calomel. Formerly, the intention of 
this was to prevent the hydrochloric acid of the gastric 
juice changing the calomel to bichlorid of mercury, but 
it has been demonstrated that this is not at all likely to 
occur and that sodium bicarbonate, in the amounts in 
which it is used, could not prevent the reaction. How- 
ever, the carminative action of the CO2, which is liberated 
when the soda interacts with the acid gastric juice, helps 268 
MATERIA MEDICA AND PHARMACOLOGY 
to overcome any tendency to nausea. Albuminous foods, 
such as milk and eggs, should not be given soon after a 
dose of calomel, for the albuminate of mercury which 
may be formed is not irritant. 
As calomel tends to hasten the elimination of bile and 
when followed by a dose of salts, the combination causes 
a thorough purge of the entire intestinal tract, it is very 
commonly used when a patient is jaundiced or bilious. 
Blue mass and gray powder, especially the latter, are 
less irritant than calomel and the gray powder is very 
commonly used for children. 
CASTOR OIL 
Castor oil is, like other fixed oils, an ester of glycerine 
and a fatty acid, the fatty acid being ricinoleic acid. The 
oil is split to these constituents in the intestines and the 
fatty acid is saponified, yielding thereby a ricinoleate soap. 
This soap is very much more irritant than the soaps formed 
by food fats and it is not, as they are, easily absorbed, 
thus it acts as an irritant on the entire intestinal tract, 
inducing, in moderate doses, several soft and sometimes 
watery movements in from 3 to 6 hours. It does not, as 
a rule, unless taken in large doses, cause much griping, but 
it does induce congestion of the female pelvic organs and 
therefore should not be taken, unless prescribed by a 
physician, during menstruation or pregnancy. By its 
action on the duodenum, it increases the elimination of 
bile. It causes such a thorough catharsis of the entire 
intestine that its use is likely to be followed by constipa- 
tion for a day or two. 
Though sodium ricinoleate is not readily absorbed, 
enough may be taken up by the blood and excreted through 
the mammary glands to act as a cathartic for a nursing 
infant. The ricinoleate is also excreted in the urine. 
Castor oil is a particularly valuable cathartic when it is 
necessary to rid the. intestine of irritating material that is 
causing diarrhea both because of the thorough purge which CATHARTICS 
269 
it induces and its tendency to promote subsequent con- 
stipation. 
Objections to the use of castor oil are its nauseant taste 
and its tendency to coat the tongue and mucous mem- 
brane of the mouth and throat and thus prolong this sen- 
sation. To overcome these objections a dose must be 
properly prepared. A good method is to rinse a small 
glass with lemon or orange juice, leaving the juice in the 
glass; add a small piece of ice (it should be the size of a 
pea when the dose is given to the patient); add the oil, 
pouring it directly on the ice; add more juice and, just 
before handing the glass to the patient, some carbonated 
water. Have a glass of lemonade at hand to give the 
patient as soon as the dose is taken. Holding a small 
piece of ice in the mouth for a short time before taking 
oil will tend to lessen the appreciation of the obnoxious 
flavor because cold, being a protoplasmic depressant, 
lessens the sensitiveness of the taste-buds. 
Castor oil should never be given children in milk for it 
is likely to make them conceive a distaste for a valuable 
food. 
OLIVE OIL 
If olive oil is taken in amounts (at least 1 ounce) that 
add considerably to the quantity of fat taken as food the 
soap into which it, like all fats, is transformed in the 
intestine, may not all be absorbed and will then act as a 
laxative. Olive oil has been extensively used as a rectal 
injection to soften feces, but it has been found that it 
does not do this as well as water. 
COMPOUND LICORICE POWDER 
(PULVUS GLYCYRRHIZ2E) 
Compound licorice powder owes its cathartic properties 
chiefly to its sulphur and senna, the glucoside glycyrrhizin 
(the active principle of the licorice) is only slightly laxative 270 
MATERIA MEDICA AND PHARMACOLOGY 
and the chief purpose of the fennel (which is a volatile oil) 
is to improve the flavor and prevent griping. The powder 
acts upon the small, as well as the large, intestine. If 
taken while the stomach is fairly empty it will produce 
liquid stools in about 3 to 6 hours, but if the dose becomes 
mixed with food in the stomach, it will take longer to 
produce effects. As a rule, unless taken in large doses, 
compound licorice powder does not cause griping. It is 
frequently prescribed for patients who have hemorrhoids 
because it does not cause much congestion of the intestine 
and, as the stools are liquid, the hemorrhoids are not 
irritated during defecation. 
For administration, the powder should be mixed with 
just enough water to make it easy to drink, but a glass of 
water must be at hand to give the patient as soon as the 
dose is taken. It is best taken at night. 
PEL BOVIS OR OX-GALL OR BILE SALTS 
Fei bovis is prepared from dried bile obtained from the 
ox. It owes its cathartic properties to bile salts. These 
are slightly irritant to the mucous membrane of the 
intestine. A considerable portion of a dose may be 
absorbed and this is excreted through the liver and tends 
to stimulate the secretion of bile. 
PODOPHYLLUM 
The composition of podophyllum resembles that of the 
drastics, but it is less irritant than the latter and is there- 
fore usually classified with the purgatives. It requires 
about 8 hours to produce catharsis. 
DRASTICS 
With the exception of croton oil, the drastic cathartics 
owe their cathartic effects to resinous glucosides and 
acids. They are, except in large doses, only slightly 
irritant to the stomach and duodenum, but after they CATHARTICS 
271 
become mixed with the bile, their irritant action is greatly- 
increased and, even in moderate doses, they will induce 
several profuse, watery stools in from 2 to 4 hours. They 
are likely to cause considerable griping and congestion of 
the intestinal wall and pelvic organs. They affect the 
entire intestinal tract and thus will cause a thorough 
purge. Large doses, or even moderate doses, if they are 
not eliminated, are likely to cause inflammation of the 
intestine and, though they are not readily absorbed, 
enough may be taken up under such circumstances to 
irritate the kidneys. For this reason, if effectual cathar- 
sis does not occur in about 4 hours a saline cathartic or an 
enema is generally prescribed. 
Poisonous doses will induce nausea, vomiting, purging 
and collapse. As these symptoms are due almost entirely 
to the local effects, the treatment is directed to correcting 
these and consists in giving a saline cathartic and enemata 
of first normal salt solution and then a lubricant, as olive 
oil. Fluid is also given liberally, by mouth if possible, 
and, if not, by enteroclysis. It is needed to replace that 
lost by the purging and vomiting and to lessen the irrita- 
tion of the kidneys. 
Drastic cathartics should not be used by a person who 
has hemorrhoids or inflammation or ulcers of the gastro- 
intestinal tract; neither should they be taken during 
menstruation nor pregnancy, for they may cause hemor- 
rhage and, in the latter case abortion unless the need is 
urgent, they should not be given the aged nor those in a 
debilitated condition for their use is then likely to cause 
extreme depression. 
Croton oil (oleum tigli) is used more especially for un- 
conscious patients, when immediate catharsis is essential, 
because such a small amount of oil is necessary that it is 
easily administered. It is usually given on sugar or a few 
drops of melted butter or olive oil which, if the patient is 
not conscious, is dropped on the back of the tongue. 
Croton oil owes its drastic properties to an extremely 
irritant acid-crotonic acid. 272 
MATERIA MEDICA AND PHARMACOLOGY 
SUPPOSITORIES 
Irritation in the rectum produces reflexes that induce 
peristalsis in the colon and, therefore, suppositories of 
substances such as glycerine and soap will, if inserted 
in the rectum, cause catharsis. 
CATHARTIC ENEMATA 
Cathartic enemata are used, as a rule, when immediate 
catharsis is required and when for any reason a cathartic 
cannot be taken by mouth. As their nature and methods 
of administration are described in all text-books of nursing 
procedures, space will not be taken to do so here. 
CATHARTICS WHICH ACT AFTER ABSORPTION 
With the exception of hormonol these drugs are all 
discussed elsewhere and thus only the means by which they 
promote catharsis will be mentioned. 
Hormonol is a liquid prepared from the spleen of a 
rabbit. Its active principle is thought to be a hormone 
(i.e., a chemic substance made by a gland that, after 
absorption, stimulates other organs). Hormonol is occa- 
sionally used to overcome post-operative tympanites or 
constipation. It is given intravenously or intramuscularly. 
It acts as a cathartic by stimulating the intestinal muscle 
tissue. For unknown reasons it occasionally causes 
collapse, thus patients receiving it must be carefully 
watched. 
Apocodeine increases peristalsis by depressing the 
sympathetic (inhibitory) nerve-endings in the intestinal 
muscle, thus allowing the impulses coming over the vagus 
(motor) nerve-fibers free action. 
Physostigmine (eserine) stimulates the vagus nerve- 
endings in the intestinal muscle, thus furthering its 
contractions. 
Pituitrin, like hormonol, stimulates the muscle tissue of 
the intestine. CATHARTICS 
273 
Synopsis of Data Regarding Cathartics That Are Particu- 
larly Important for Nurses to Remember 
1. Time usually required to produce 
effects: 
2. Cathartics 
that promote 
the elimina- 
tion of bile: 
3. Cathartics 
that promote 
thorough 
purging: 
Less than 
4 hours 
4-8 
hours 
8-12 
hours 
Drastics 
Physostigmine 
Isotonic solu- 
tions of salines 
Castor oil 
Mercury ca- 
thartics 
Agar-agar 
Anthracene 
cathartics 
Licorice pow- 
der 
Mineral oils 
Olive oil 
Podophyllum 
Salines in con- 
centrated so- 
lutions 
Sulphur 
Castor oil 
Mercury ca- 
thartics 
Podophyllum 
Castor oil 
Calomel f o 1- 
lowed by salts 
Drastics 
4. Cathartics 
that promote 
congestion of 
the pelvic 
organs: 
5. Cathartics 
that lessen 
the 
secretion 
of milk: 
Aloes 
Castor oil 
Drastics 
Drastics 
Salines VOLATILE OILS. STEAROPTENS. SPICES AND 
DRUGS WHICH OWE THEIR PROPERTIES TO 
SUCH COMPOUNDS. COUNTERIRRITANTS 
Volatile or ethereal oils are volatile, and usually 
aromatic, substances to which fruit and many spices and 
other plant substances owe their odor and flavor. Some of 
the spices and drugs classed under this heading owe their 
properties to resinous compounds, but the actions of these 
are so similar to those of the volatile oils that they need 
not be considered separately. 
In spite of their name, the volatile oils have very little 
in common with the fixed oils. They consist chiefly of 
mixtures of the hydrocarbons known in chemistry as 
terpenes, holding in solution substances, usually solids, 
termed stearoptens. 
The stearoptens can be separated from the oils by 
volatilizing the latter at a low temperature. Some of 
these substances belong to the same chemical group as 
carbolic acid, i.e., the phenols. 
Some volatile oils exist as such in plants and can be 
readily extracted by pressure or distillation, others are 
only developed by special treatment. For example, the 
oil in mustard is evolved from certain constituents of the 
latter when it is mixed with water, by the action of a 
ferment, also a constituent of the mustard. An important 
thing to remember in regard to this ferment is that it is 
destroyed by a high temperature about 140°F. (60°C.) 
and it is rendered inert at an even lower temperature. If 
the ferment is inactive, the oil, and, consequently, the 
flavor and irritant properties of the mustard, will not be 
developed. 
The oils exist in different parts of plants, for example, 
camphor is obtained from the wood of certain species of 
274 VOLATILE OILS 
275 
trees; while some others are obtained from the gum or sap 
of trees, some from the leaves; some from the fruit, etc. 
Nature of Preparations.-For therapeutic purposes, the 
extracted oil or stearopten may be used or, dilutions of 
these, as spirits and waters; or as in the case of asafetida, 
mustard, and the spices, what is almost the crude drug 
may be employed or, when the active principle is a resin, 
fluidextracts or tinctures made from the crude substances. 
Certain volatile oils and their stearoptens contain other 
compounds which give them important special qualities 
and these are classified with drugs having similar proper- 
ties. Important examples are, the oils of birch and winter- 
green and their stearopten, methyl salicylate, which have 
salicylic acid actions, as well as those characteristic of 
volatile oils. 
Preparations and Dosage.-A number of preparations 
belonging to this group are now so seldom used except 
certain of them (anise, almond, orange, etc.), as flavors, 
that it is not necessary to list them. It will be sufficient 
to remember that the average dose of the more irritant 
oils, such as pennyroyal, rue, sage, and tansy, is 1-3 m. 
(0.06-0.2 c.c.), of less irritant ones, as peppermint and 
fennel, 5 m. (0.3 c.c.); of spirits, 15 m.-l3(1.0-4.0 c.c.) 
of waters 1-23 (4.0-8.0 c.c.). 
Aromatic powder, 10-30 grs. (0.6-1.0 c.c.). This con- 
tains cinnamon, cardamom, ginger and nutmeg. 
Asafetida, tincture of, 15-30 m. (1.0-2.0 c.c.). 
emulsion of, ^-1 oz. (15.0-30.0 c.c.). 
pills of, 1-3. Each pill contains 3 grs. of asafetida. 
Apinol oil, 5-15 m. (0.3-1.0 c.c.). Similar to oils of 
nine and eucalyptus. 
Apiol, 3-10 grs. (0.2-0.6 gm.). The stearopten of the 
oil of parsley. 
Apioline, 3-10 grs. (0.2-0.6 gm.). Obtained from apiol. 
Buchu, fluidextract, 3^-13 (2.0-4.0 c.c.). 
Cajuput, oil of, 5-15 m. (0.3-1.0 c.c.). 
Camphor, the stearopten, 3-10 grs. (0.3-0.6 gm.). 
oil of, 5-10 m. (0.3-0.6 c.c.). 276 
MATERIA MEDICA AND PHARMACOLOGY 
spirits of, 15-30 m. (1.0-2.0 c.c.). 
water of, 15m.-15 (1.0-4.0 c.c.). 
Camphorated oil, 30 m.-3^ 5 (2.0-15.0 c.c.). This con- 
tains 20 per cent, of the stearopten in either cotton-seed 
or olive oils. It is the preparation most commonly used. 
Monobromated camphor, 5-15 grs. (0.3-1.0 gm.). 
Capsicum, tincture, 30-m. .15 (2.0-4.0 c.c.). 
Cardamom, tincture, J^-15 (2.0-4.0 c.c.). 
compound tincture, 1-25 (4.0-8.0 c.c.). 
Chenopodium, oil of, 3-5 m. (0.2-0.3 c.c.) 
Cinnamon, oil of, 1-3 m. (0.06-0.2 c.c.). For a tooth 
cavity, 1 drop on cotton. 
Cloves (cardophylus), oil of, 1-3 m. (0.06-0.2 c.c.). For 
a tooth cavity, 1 drop on cotton. 
Copaiba, oil of, 5-30 m. (0.6-2.0 c.c.). 
Cubebs, oil of, 5-15 m. (0.3-1.0 c.c.). 
fluidextract, 10-30 m. (0.6-2.0 c.c.). 
oleoresin of, 10-15 m. (0.6-1.0 c.c.). 
Erigeron, oil of, 5-30 m. (0.3-2.0 c.c.). 
Eucalyptus, oil of, 5-15 m. (0.3-1.0 c.c.). 
Eucalyptol, 5-15 m. (0.3-1.0 c.c.). Obtained from euca- 
lyptus. 
Eugenol, 1-3 m. (0.06-0.2 c.c.). Stearopten of oil of 
cloves. 
Ginger, tincture, M~15 (2.0-4.0 c.c.). 
Juniper, oil of, 5-15 m. (0.3-1.0 c.c.). 
Menthol, 1 gr. (0.06 gm.). Stearopten of oil of pepper- 
mint. 
Mustard {sinapis}, 1-25 (4.0-8.0 gm.) in tepid water as 
emetic. 
Pine, oil of, 1-5 m. (0.06-0.3 c.c.). 
Sandalwood, oil of, 5-15 m. (0.3-1.0 c.c.). 
Terebin, 5-30 m. (0.3-2.0 c.c.). Prepared from oil of 
turpentine. 
Terpin hydrate, 1-5 grs. (0.06-0.3 gm.). Prepared from 
oil of turpentine. 
Thymol, 1-50 grs. (0.06-3.3 gm.). The stearopten of oil 
of thyme. Large doses are used only as anthelmintics and VOLATILE OILS 
277 
with the precautions mentioned in the section describing the 
use of the drug as an anthelmintic. 
Tar, oil of, 1-5 m. (0.06-0.3 c.c.). 
syrup of, 1-23 (4.0-8.0 c.c.). 
ointment, for external use. 
Uva-ursi, fluidextract, 5-15 m. (0.3-1.0 c.c.). 
Valerian, fluidextract of, 30 m. (2.0 c.c.). 
tincture of, 1-25 (4.0-8.0 c.c.). 
ammoniated tincture of, 1-25 (4.0-.80 c.c.). 
New N on-official Preparations. 
Borneol valerate 5-10 m. (0.3-0.6). 
Validol or menthol valerate, 5-15 m. (1.0 c.c.). A com- 
pound of menthol and valevianic acid which is obtained 
from valerian. 
Validol camphorate, 5-15 m. (p, 3-1.0 c.c.). 
Fate in the Body.-The oils and stearoptens mentioned 
in this section are not absorbed through the skin, though 
they may penetrate the outer layers sufficiently to reach 
the superficial nerve-endings and blood-vessels. The 
oils are readily absorbed from the stomach and intestines. 
The stearoptens are absorbed, if they are dissolved in oil 
or alcohol, but not to any extent when in their natural 
state, for they are only very slightly soluble in water and 
the digestive juices and this, of course, interferes with 
their absorption. After absorption, these substances are 
oxidized to simpler compounds and the latter are excreted, 
chiefly in the urine, but also through the respiratory tract 
and sometimes in the sweat. Some of the products of 
oxidation are aromatic and impart an odor to the urine 
or breath, this, in many cases is quite different from that 
of the original compound; for example, the products of 
turpentine oxidation give an odor of violets to the urine. 
Actions.-The drugs of this group are protoplasmic 
irritants, but with a few exceptions they do not, except in 
excessive doses, cause inflammation or destruction of hu- 
man tissue. Their effects, however, are more marked on 
lower forms of life, as bacteria. Like most irritants, they 
are weakened by dilution and thus few of them, unless 278 
MATERIA MEDICA AND PHARMACOLOGY 
taken in excessive amounts, act upon the tissues after 
absorption. Certain of them, however, irritate the organs 
through which they are excreted; in poisonous doses they 
tend to first stimulate and then depress the central nervous 
system. 
Effects and Uses.-There are some slight differences in 
the effects produced by the various drugs of this group, 
but they are due chiefly to different degrees of potency and 
to the tissues upon which they act most strongly. These 
slight differences, however, make certain ones more suit- 
able for some purposes than others, but, in many cases, it 
is not so much difference in the action of a drug that has 
determined its use as its cost or some physical property, 
as its flavor or degree of solubility. 
Effects common to all the drugs of this group with some 
slight variations are as follows: 
1. They are antiseptic, certain of them strongly so, but 
as they are not readily soluble in water, they are not of 
much use in surgery. However, the antiseptic properties 
of a number of them are made use of for special purposes; 
viz.: 
(a) To preserve food-expecially the spices. 
(6) In dentistry, to, especially, disinfect cavities in the 
teeth-the oils of cinnamon and cloves and the stearopten 
eugenol. 
(c) For the nasal cavities, mouth and throat-especially 
the oil of eucalyptus, and the stearoptens camphor, men- 
thol and thymol. 
(d) For the intestines-thymol and it is possible that 
all those used as carminatives may have a strong enough 
antiseptic action, in therapeutic doses, to inhibit the 
activity of bacteria to some extent. 
(e) For the urinary tract-especially the oils of cubebs, 
copaiba and sandalwood. 
(f) In chronic skin diseases-oils of cade and tar. 
(g) As a specific for the pneumococcus-camphor. 
Certain ones, especially, chenopodium, thymol and tur- 
pentine also destroy worms, i.e., they are anthelmintics. VOLATILE OILS 
279 
2. When concentrated preparations of most of these 
drugs are kept in contact with the skin they induce vary- 
ing degrees of irritation with consequent dilation of the 
superficial blood-vessels. As the result of this, there is an 
increased amount of blood in the area, which makes the 
part warm and red. Sensory nerve-endings are stimu- 
lated and this gives rise to sensations of tingling and smart- 
ing and, if pronounced, will have counterirritant effects as 
described on page 285. The drugs of this group most 
commonly used as counterirritants are camphor, capsicum, 
mustard and turpentine. 
Certain members of the group, especially camphor, 
menthol and the oils of apinol, cloves and cinnamon, after 
stimulating sensory nerve-endings, depress them to some 
extent and thus the tingling and smarting that they in- 
duce is followed by numbness and partial anesthesia. 
Peppermint and menthol stimulate the cold spots in the 
skin and thus give rise to a sensation of cold, even when the 
skin is unusually warm. 
3. All the drugs of this group stimulate olfactory nerve- 
endings and, some of them, the taste-buds, thereby induc- 
ing sensations of flavors that, with a few exceptions, are 
pleasant to most people. This stimulation also promotes 
reflexes that increase the secretion of saliva and gastric 
juice and it tends to stimulate the appetite. This action 
of volatile oils and spices, which, in addition to producing 
the physiological effects just mentioned, causes them to 
make food savory and to overcome the obnoxious flavors 
of some drugs, furnishes the common reason for the use 
of the majority of the substances under discussion. Of 
course, when used solely for this purpose, they are em- 
ployed in relatively small amounts. 
Asafetida and valerian have a strong unpleasant flavor 
which, it is thought, is chiefly responsible for the psychic 
stimulation that helps to overcome hysteria. 
4. These substances affect mucous membrane in 
about the same way as the skin, but more readily, also 
they increase the secretion of mucus and, if kept in contact 280 
MATERIA MEDICA AND PHARMACOLOGY 
with a part, they may possibly stimulate the membrane 
cells, which action, with the effect upon the blood-vessels 
and the antiseptic action of the drug, is of value in over- 
coming inflammatory conditions, such as exist in the 
throat and nose in pharyngitis and rhinitis. Eucalyptus, 
thymol, menthol and pine, are the drugs most commonly 
used for this purpose and they are generally employed 
either in ointment, or in oil that is sprayed upon the part, 
or they are inhaled. 
5. In the stomach and intestines the conditions pro- 
duced by moderate irritation of the lining membrane, 
induce a sensation of warmth and well-being and help to 
overcome nausea and to induce the expulsion of gas, i.e., 
they have a carminative action. Different reasons are 
given for the expulsion of gas, some investigators believe 
that it is due to increased peristalsis, induced by the 
irritation, but others think that it is the result of relaxation 
of the muscle tissue of the stomach and intestines, which 
overcomes the spasmodic contractions of the sphincters. 
Some of these drugs certainly do prevent the spasmodic 
contractions (griping) produced by irritant cathartics. 
The antiseptic action of these drugs may also be of some 
slight value in overcoming flatulence. Those chiefly used 
as carminatives, when given by mouth, are cardamom, 
capsicum, ginger and other spices. Asafetida and tur- 
pentine are often added to soap enemata, to increase 
their irritant action and thus help in the expulsion of gas, 
and turpentine is applied externally to the abdomen to 
do so in the manner explained under counterirritants. 
Some of the more irritant drugs of this group,-e.g., 
apiol, apioline, pennyroyal, ginger, rue, sage and tansy- 
by effects not well understood, produce pronounced 
hyperemia of the pelvic organs, including the uterus and 
therefore they have been used as emmenagogues but the 
four last mentioned are rarely employed at present, be- 
cause they, unlike most of the group, tend to produce 
severe inflammation in even moderate doses. They are 
often used to produce criminal abortion. They may do VOLATILE OILS 
281 
so on account of the congestion which they promote in 
the uterus, but death, as the result of irritation of the 
alimentary canal and kidneys, has occurred without 
abortion taking place. 
7. Still another effect in the alimentary canal, is the 
stimulation of receptors and, consequently, in large 
doses, the drugs of this group will produce reflex stimula- 
tion of nerve-centers and this may help a person to over- 
come hysterical tendencies; valerian is especially likely to 
do so. 
8. In excessive doses, all these substances, like other 
irritants, will irritate the organs through which they are 
eliminated, but a few of them do so in moderate doses 
and these are sometimes used to increase the activity of 
the organs they affect. Those which influence the kidneys 
sufficiently to be of value as diuretics are: Oil of juniper, 
the fluidextracts of buchu and uva-ursi and the urinary 
antiseptics mentioned on page 278. Those which affect 
the bronchial membrane sufficiently to act as expectorants 
are the oils of apinol, camphor, copaiba, eucalyptus, pine, 
tar, and the turpentine derivatives terpin hydrate and 
terebene. At one time it was thought that these expecto- 
rants would also act as antiseptics in the respiratory 
tract during their elimination, but it is now believed that 
they are not excreted through the bronchial membrane 
in sufficient quantity to do so to any extent. 
With the exception of camphor, these drugs, in the 
small amounts in which they are used as flavors and in 
therapeutics, have practically no effects after absorption, 
but, if taken in excessive quantities, they will first stimu- 
late and then depress, the nervous system and sometimes 
the heart muscle. 
The stearopten camphor dissolved in oil, can be used 
in large enough amounts to stimulate the central nervous 
system without inducing subsequent depression. Its 
stimulant action is most marked on the medullary centers 
and it is thought that it may also stimulate the heart 
muscle. For some unknown reasons, camphor causes 282 
MATERIA MEDICA AND PHARMACOLOGY 
dilation of the superficial blood-vessels, but, because of 
the stimulation of the vasoconstrictor center, contraction 
of other vessels, except those of the brain, lungs and heart, 
which are not supplied with vasoconstrictor nerves. As 
the result of these actions, blood pressure is raised and the 
circulation improved. The pulse becomes stronger, but 
its rate varies, it may remain unchanged or become either 
faster or slower. Because of the dilation of the vessels on 
which the pulsation is felt, the pulse has a bounding 
character. As the respiratory center is stimulated, breath- 
ing is deepened and facilitated. 
Also, camphor tends to increase the secretion of sweat, 
probably as the result of the increased pressure in the 
blood-vessels around the sweat glands and, in maximum 
therapeutic doses, it inhibits the activity of the pneumo- 
coccus, an organism that causes lobar pneumonia. 
Thus camphor is used: (1) In liniments, as a counter- 
irritant; in local applications to the throat and nasal 
cavities, as an antiseptic stimulant of the mucous mem- 
brane; (2) as a carminative; (3) to stimulate the cir- 
culation; (4) as a specific in pneumonia. 
For the two purposes last mentioned it is, as previously 
stated, the stearopten dissolved in oil that is used and it 
is administered by hypodermic injection, both to get 
quicker results and because the large doses used for these 
purposes are likely to cause nausea and vomiting, if they 
are given by mouth. 
Summary of the chief uses of the volatile oils, etc. 
that are most commonly employed for therapeutic 
purposes: 
Asafetida is used as a carminative and an antihysteric. 
Apinol is employed as an anodyne and antiseptic on 
burns and the like, and as an expectorant. 
Camphor, see above. 
Capsicum is used for the same purposes as the spices. 
Cardamom is employed as a flavoring substance for 
drugs with an unpleasant taste; to aid digestion; and as a 
carminative. VOLATILE OILS 
283 
Chenopodium is used as an anthelmintic. 
Cinnamon, oil of, is used as an analgesic antiseptic in 
dentistry; as a flavoring substance; as a carminative; 
it is combined with irritant cathartics to prevent griping. 
Cloves, oil of, is used for the same purposes as oil of 
cinnamon. 
Copaiba is used as a diuretic and urinary antiseptic; 
as an expectorant; and it has a slight laxative action. 
Eucalyptus is used chiefly as an antiseptic and local 
stimulant for mucous membranes, especially those of the 
nose and throat; and as an expectorant. For use on the 
mucous membranes it is employed as an ingredient of 
lozenges, and in oil solutions and ointments, or it is added 
to boiling water and the vapor inhaled. For internal use 
it is generally given in capsules, or in oil, or on sugar. 
Like most volatile oils, it is only very sparingly soluble 
in water. 
Fennel is combined with irritant cathartics to avoid 
griping. 
Ginger is very commonly used as a carminative and to 
overcome uterine colic during menstruation. For these 
purposes it is generally used as a tincture or combined 
with other spices. 
Juniper is used as a diuretic. 
Menthol is used in solid form, as a cooling counterirri- 
tant, for the relief of headache and neuralgia. In an oil 
solution or in petroleum or as an ointment, it is used as an 
antipruritic (to allay itching) and as an antiseptic and 
local stimulant for inflamed mucous membranes, especially 
those of the nose and throat; and the vapor, which passes 
readily from the crystals, is inhaled to obtain relief in 
rhinitis. It is occasionally taken by mouth, for carmina- 
tive action. 
Mustard is used chiefly as a counterirritant and an 
emetic. 
Peppermint is used as a flavor and a mild carminative. 
Pine oil is used for the same purposes as eucalyptus. 
Sandalwood is employed as a urinary antiseptic. 284 
MATERIA MEDICA AND PHARMACOLOGY 
Spices are occasionally used as counterirritants, but 
they are more commonly employed to stimulate the gas- 
tric juice (in food), and as carminatives and emmena- 
gogues. For the two purposes last mentioned, various 
combinations of the spices are often used, as the aromatic 
powder; and they are also taken in liquid preparations 
containing other carminatives, such as alcohol, ether, and 
ammonia. 
Tar preparations are used externally, as antiseptic tissue 
stimulants, in the treatment of parasitic skin diseases, and, 
internally, as expectorants. 
Terebene and terpin hydrate are used chiefly as expec- 
torants. 
Thymol is used chiefly as an antiseptic mouth wash; an 
intestinal antiseptic and an anthelmintic. For internal use 
it is generally given in capsules, it must not be given in oil 
or alcohol if used in more than minute amounts, because it 
is freely soluble in these liquids and a toxic quantity may be 
absorbed. Thymol is one of the most poisonous drugs 
belonging to this group, its poisonous effects being due 
chiefly to depression of the nervous system and heart. 
Turpentine is used chiefly as a counterirritant, and 
chiefly in enemata, as a carminative; it is occasionally 
used as an expectorant, but its derivatives, terebene and 
terpin hydrate, are more commonly employed for this 
purpose. 
Valerian is employed as an antihysteric. 
Toxicology.-The symptoms of poisoning depend upon 
the excessive irritation of the alimentary tract and the 
kidneys and the excessive stimulation of nerve-centers 
(both from the reflexes and the action of the drug after 
absorption) followed by depression. Thus the usual ones 
are: Nausea, vomiting, diarrhea with, sometimes, blood 
in the vomitus and stools; convulsions, delirium followed 
by unconsciousness and collapse. The treatment for 
poisoning is that described on pages 68 and 69. 
Constant use of excessive amounts of any of these irri- 
tants is likely to produce a chronic gastritis. VOLATILE OILS 
285 
COUNTERIRRITANTS 
Counterirritants are, as previously stated, agents that, 
by irritating the skin, counter or relieve irritation that 
already exists. To be of value as a counterirritant, a drug 
must be able to promote a very decided degree of irrita- 
tion without injuring the tissue. Nearly all substances 
which do so are of a volatile nature. 
Counterirritants are classified, according to the degree 
of irritation which they are generally used to promote, as 
rubefacients and vesicants. 
As their names imply, rubefacients are those used to 
produce reddening and vesicants those employed to induce 
blisters. The reddening is the result of an increased 
amount of blood in the skin, as the result of dilation of the 
blood-vessels by the irritation As previously stated, it 
is not known positively how irritation causes the dilation. 
In addition to this effect, sensory nerve-endings are stim- 
ulated and, it is believed, the impulses arising from this 
stimulus stimulate centers in the cord which promote the 
contraction of blood-vessels in the tissues and viscera 
situated beneath the irritated areas of skin,1 and thus 
relieve congestion (a common cause of pain) in these parts. 
Also, centers which cause contraction of muscle tissue 
beneath the irritated areas may be stimulated; it is in this 
way that hot stupes applied to the abdomen relieve flatu- 
lence. Counterirritants also relieve pain, it is believed, (1) 
because the impulses they start, while passing up the cord, 
modify those passing from the irritated organs; and (2) 
by psychic influence or suggestion. 
The rubefacients in common use are: Heat, various 
members of the volatile oil group, but especially those 
mentioned on page 279, ammonia, antiphlogistine or clay 
poultice, chloroform, iodine, methyl salicylate and guaiacol 
-these are all described elsewhere. Drugs used for this 
1 As previously stated, in the spinal cord, afferent neurones from 
any portion of skin form synapses with efferent neurones that 
innervate the tissues and viscera lying beneath that area. 286 
MATERIA MEDICA AND PHARMACOLOGY 
purpose are generally incorporated in liniments, pastes, 
plasters and poultices. As the method of preparing and 
using these are described in all text-books of nursing pro- 
cedures, space will not be taken to do so here. 
The only vesicant in common use is cantharides or 
Spanish fly. This is prepared from the crushed body of 
a beetle known as the Cantharis vesicatoria, and it is 
employed chiefly incorporated in plasters or mixed with 
collodion (for methods of using these preparations, see a 
text-book of nursing procedure). 
Formerly, a tincture of cantharides was employed as a 
diuretic, but its use has been almost abandoned, because 
the drug is very irritating to mucous membranes and the 
kidneys. Nephritis has been caused even by the amount 
of cantharides absorbed from external applications. For 
this reason the size of a plaster, or other application, must 
not exceed 3 inches and, as a rule, the size prescribed is 
^-1 inch. 
The value of cantharides as a vesicant is that, as it is 
not as irritant to the skin as most of the substances used as 
counterirritants, it acts slowly and thus the effects of a 
moderate degree of irritation can be maintained for several 
hours; also the blister induced, if care is taken to avoid 
infection, heals readily and without producing scar tissue, 
which is not always the case with the blisters caused by 
heat and irritants which cause vesication quickly. 
The reason that irritation causes a blister or vesicle is 
that, as the result of the increased amount of blood in the 
irritated part, there is excessive transudation of fluid from 
the vessels into the skin and this separates the epidermis 
from the derma. ANTHELMINTICS, VERMICIDES AND 
VERMIFUGES 
Anthelmintics are agents used to destroy or remove 
worms infesting the intestines. The species of worms 
with which humans most frequently become infected are: 
Pin- or thread-worms (oxyuris vermicularis); round-worms 
(ascaris lumbricoides); tape-worms (tenia); hookworms 
(undnaria or ankylostoma duodenale). Infection takes 
place as the result of eating food containing the eggs of 
the worms and hookworms also enter the body through 
abrasions in the skin after which they are carried to the 
intestines by the blood. 
Anthelmintics are commonly classed as vermicides- 
those which kill the worms-and vermifuges-those which 
merely affect their removal. They are also classified 
according to the worms upon which they act most 
readily as: Lumbriddes, and lumbrifuges, those which 
act on round-worms, viz., chenopodium, santonin and 
spigelia; teniaddes and teniafuges, those acting on tape- 
worm, viz., aspidium (male-fern); amorphous filicic 
acid; cusso; granatum (pomegranate); kamala; pepo 
(pumpkin-seed); turpentine. 
Anthelmintics most commonly used for hook-worm are: 
Aspidium, chenopodium and thymol. 
The small pin-worms, which may be present in the colon 
in great abundance, do not, as a rule, cling to the intes- 
tinal wall and thus they can sometimes be removed by 
thorough catharsis or colon irrigation. If these means are 
not effectual an enema containing one or other of the 
following substances is given: Alum, lime-water, normal 
salt solution, quassia, tannic acid, vinegar. 
Preparations and dosage of anthelmintics: 
Alum, 30 grs. (2 gm.) to 1 pint (500 c.c.) of water, as a 
colon irrigation. 
287 288 
MATERIA MEDICA AND PHARMACOLOGY 
Aspidium (male-fern} oleoresin of, 1-25 (4.0-8.0 c.c.). 
Amorphous filicic acid, 10 grs. (0.6 gm.). An extract of 
aspidium. 
Chenopodium, oil of, 5-45 m. (0.3-3.0 c.c.). 
Cusso, powdered flowers of, oz. (15.0 gm.). 
Cusso, fluidextract of, 1-45 (4.0-16.0 c.c.). 
Kamala, 1-25 (4.0-8.0 c.c.). 
Lime-water, 1-2 pts. (500-1000 c.c.) as a colon irrigation. 
Pomegranate (granatum} fluidextract of, 30 m. (2.0 c.c.). 
Pelletierine tannate, 4 grs. (0.25 gm.). A tannate of the 
alkaloid of pomegranate. 
Pumpkin-seed (pepo), 2-4 oz. (60-120 gms.). 
Pumpkin-seed, oil of, oz. (15.0 c.c.). 
Quassia, infusion of, 10 per cent., as a colon irrigation. 
Santonin (wormseed}, ^-2 grs. (0.03-0.13 gm.). 
Spigelia (pink-root} fluidextract of, 1-2 (4.0-8.0 c.c.). 
Tannin, 30 grs. (2 gm.) to 1 pt. (500 c.c.) of water, as a 
colon irrigation. 
Thymol, 5-15 grs. (0.3-1.0 gm.) in divided doses. 
Turpentine, oil of, ^-1 oz. (15.0-30.0 c.c.). 
Administration.-It is customary before giving an an- 
thelmintic to limit the diet for 24 hours and to give a pur- 
gative 6 or 8 hours previous to the administration of the 
anthelmintic. This treatment is intended to rid the intes- 
tine of material that would protect the worms from the 
anthelmintic. In order to avoid irritating the stomach and 
causing nausea, most anthelmintics are given in capsules 
or by special methods mentioned later. Unless the anthel- 
mintic itself causes profuse catharsis, a quickly acting 
cathartic, usually a saline, is given about 2 hours after 
the anthelmintic. 
Fate in the Body.-The only drugs used as vermicides 
that are not described elsewhere are certain very 
poisonous ones that are not readily absorbed and thus, 
normally, almost the entire dose is excreted in the feces. 
Actions and Effects.-Some of the vermifuges (alum, 
lime-water, sodium chloride and tannin) owe their effects 
to their astringent action. This causes shrinking of the ANTHELMINTICS, VERMICIDES AND VERMIFUGES 
289 
protoplasm of the worms (which lessens their vitality) 
and of the intestinal membrane (which widens the lumen 
of the bowel) and thus facilitates washing out the parasite. 
The other vermifuges (pepo, quassia, and small doses of 
the vermicides) produce an irritation that results in the 
withdrawal of the worms from the vicinity of the poison. 
The vermicides are irritant poisons and, in addition to 
stupifying or killing the worms, they will cause more or 
less irritation of the alimentary canal and thereby produce 
conditions similar to those induced by the volatile oils, 
described on page 284. Apart from this they normally 
have no marked effect. If, however, their elimination is 
delayed, a sufficient amount may be absorbed to induce 
the poisonous effects mentioned in paragraphs following. 
It is most important that free catharsis follow the use 
of an anthelmintic, both to rid the intestine of the worms 
and the anthelmintic. 
ASPIDIUM OR MALE-FERN AND FILICIC ACID 
These drugs are usually given in capsules. They are 
very commonly prescribed to be given in divided doses of 
5 grains each, at intervals of 15 minutes. The last dose is 
followed, in three hours, by a saline cathartic. Castor 
oil must not be used as the fixed oils favor the absorption 
of the drugs. As aspidium owes its action to filicic acid, 
both drugs have the same poisonous effects, which are due 
to irritation of the alimentary canal and, if the drug is 
absorbed, stimulation and then depression of the central 
nervous system. Thus the common symptoms are: 
Nausea, vomiting, purging, twitching of the muscles and, 
sometimes, convulsions, followed by stupor, collapse and 
coma. If the patient recovers, nephritis is likely to follow 
from irritation of the kidneys during the elimination of 
the drug. 
CHENOPODIUM 
The action and poisonous effects of chenopodium are 
the same as those of other irritant volatile oils. When 290 
MATERIA MEDICA AND PHARMACOLOGY 
used to cause the expulsion or destruction of hookworms, 
chenopodium is very commonly given through a duodenal 
tube. This tube is passed in somewhat the same manner 
as a stomach tube, but into the duodenum.1 This method 
is used because it has been found that the ankylostoma 
infest the jejunum more than other parts of the intestines, 
and as chenopodium, like other volatile oils, is readily 
absorbed from the stomach and duodenum, enough does 
not always reach the jejunum to be effectual when the 
drug is taken by mouth. The oil is injected into the tube 
from a glass syringe and, after about 6 minutes have 
elapsed, which gives the oil time to diffuse through the 
jejunum, 2 or 3 ounces (60-90 c.c.) of a saturated solution 
of magnesium sulphate is injected through the duodenal 
tube, which is then removed. When given by mouth, 
chenopodium is given in capsules or on sugar, in divided 
doses, two hours apart. The last dose is followed in about 
2 hours by a dose of castor oil containing about 30 minims 
of chloroform or else a saline cathartic. 
CUSSO 
Cusso has a bitter taste and is astringent and, because 
of its astringency, it is very irritating in the large doses 
used as a vermicide. Thus, it is likely to cause vomiting 
and diarrhea and, if these conditions are extreme, con- 
sequent collapse. As cusso usually acts as a purgative 
it is not, as a rule, necessary to follow its use with a 
cathartic. 
This is usually administered in syrup. Kamala is 
particularly irritating to the intestinal tract and is likely 
to cause diarrhea. When it does so, the subsequent 
cathartic is usually omitted. Its poisonous effects are 
similar to those induced by aspidium. 
1 The method of passing a duodenal tube is described in most 
of the modern text-books of nursing procedure. It is only done 
by a doctor or a nurse who has been specially instructed in the 
technique of the procedure. 
KAMALA ANTHELMINTICS, VERMICIDES AND VERMIFUGES 
291 
These drugs are very toxic. They produce their poison- 
ous effects chiefly by irritating the alimentary canal and, 
after absorption, paralyzing the motor nerve-endings in 
the muscles. The symptoms of poisoning are: Vomiting, 
purging, stupor, dimness of vision, extreme muscular 
weakness, collapse. The treatment is that used for 
irritant drugs. 
POMEGRANATE (GRANATUM) AND PELLETIERINE 
PUMPKIN-SEED (PEPO) 
These are the seeds of the ordinary pumpkin. 
When the untreated seeds are used they are crushed and 
beaten with honey or syrup until in the form of an emul- 
sion. Such a mixture is a harmless and fairly effec- 
tive vermifuge for tape-worms. Squash-seed can be 
substituted. 
SANTONIN 
This is a very commonly used, but nighly poisonous, 
lumbricide and patients receiving it need to be carefully 
watched. A varying amount of santonin is always 
absorbed and excreted through the kidneys and it gives 
the urine a yellow tinge. 
Most of the symptoms of poisoning are due to 
(1) gastro-intestinal irritation; (2) stimulation of reflex 
centers; (3) some unknown effect upon the sense organs 
or their nerve-centers, it is not known which. The 
symptoms are: Vomiting, diarrhea, twitching and jerking 
of the muscles and, sometimes, convulsions, in which case 
death is likely to occur from interference with the action 
of the respiratory muscles. There are also likely to be 
hallucinations and delirium; derangement of the senses of 
smell, taste, hearing and vision. Partial blindness and a 
peculiar disturbance of color vision, known as yellow sight 
or xanthopsia, that causes all objects to have a yellow 
tinge, are particularly common. The treatment for 
poisoning is the same as for other irritant drugs and, in 292 
MATERIA MEDICA AND PHARMACOLOGY 
addition, a bromide and inhalations of ether may be given 
to check convulsions. 
SPIGELIA (PINK-ROOT) 
This is usually given on sugar and the cathartic senna 
is very commonly given at the same time. If the senna 
is effectual no other cathartic is used, but a thorough 
purge is essential for, if absorbed, spigelia is very poison- 
ous. It causes poisoning chiefly by depressing the central 
nervous system, the symptoms are: Flushing of the skin; 
weak, rapid pulse; muscular weakness and incoordination; 
disturbance of vision; stupor, collapse. 
This is described under Volatile Oils. It is rarely used 
as a vermicide, because if it is given in large enough doses 
to destroy worms it is very irritating to the alimentary 
canal. When it is used, it is usually given beaten into an 
emulsion with olive or other oil, in the proportion of 1 part 
of turpentine to 2 or 3 of oil. To act as a vermifuge, it is 
sometimes used as an enema, in relatively small doses, 
oz. or less, to a quart of soapsuds. 
TURPENTINE 
THYMOL 
Thymol is a stearopten obtained from the oil of thyme. 
Its action is described under Volatile Oils. When used as 
an anthelmintic, it is generally given in divided doses, 
either in capsules or beaten into an emulsion in a syrup, 
never in oil, for this hastens its absorption. The purgative 
is generally given two hours after the last dose. Thymol 
is exceedingly poisonous. The symptoms of poisoning 
and its treatment are described under Volatile Oils. ASTRINGENTS 
Astringent action, as stated on page 47, implies shrink- 
ing or contraction of tissues; a condition that can be 
brought about by (1) contracting the blood-vessels in 
the tissue, as adrenaline and cocaine do; (2) extracting 
water from the tissues, an action characteristic of alcohol, 
glycerine, acids, and mineral salts; (3) combining with the 
protein of the protoplasm and precipitating it. In addi- 
tion to causing contraction of the affected tissues, such an 
action, when not too pronounced, tends to lessen local 
secretions, to diminish the permeability of the superficial 
blood-vessels and to lessen the sensitiveness of sensory 
nerve-endings in the part with which the astringent comes 
in contact. If this action is pronounced, the affected 
tissues will be irritated and pain, inflammation and, some- 
times, corrosion will follow. 
With the exception of potassium chlorate, all the drugs 
usually classed as astringents act in the manner last 
described. Those which owe their astringent effects to 
other actions have more important uses and are elsewhere 
described. 
The drugs classed as astringents are divided under two 
headings; viz., the vegetable or organic astringents, and 
the mineral or inorganic. 
Organic or Vegetable Astringents 
The principal organic astringents are tannic acid, or 
tannin, and myrrh. 
TANNIN (ACIDUM TANNICUM) 
Tannin or tannic acid is a substance with a slightly acid 
reaction. It occurs in a number of plants, but is found 
293 294 
MATERIA MEDICA AND PHARMACOLOGY 
in largest amounts in growths named nutgalls that form on 
a species of oak, known as the Quercus infectoria or gall 
oak-tree. 
Preparations and dosage of tannin: 
For external use: 
Glycerite of tannic acid, tannic acid ointment, styptic 
collodion, all which contain 20 per cent, tannic acid. 
For internal use: 
Tannic acid, 3-10 grs. (0.2-0.6 gm.). 
Tannalbin, 15-60 grs. (0.1-4.0gm.) ' 
Protan, 15-30 grs. (0.1-2.0 gm.) 
Tannacol, 15-30 grs. (1.0-2.0 gm.). 
Combinations of 
tannic acid and 
protein. 
Tannigen, 3-10 grs. (0.2-0.6 gm.) (diacetyltannin). 
Tannoform, 3-10 grs. (0.2-0.6 gm.) (formaldehyd and 
tannic acid). 
Tannopin or tannon, 3-10 grs. (0.2-0.6 gm.) (hexa- 
methylenamine tannin). 
Preparations and dosage of drugs prepared from plants 
containing tannin: 
Blackberry, fluidextract of, 1-2 5 (4.0-8.0 c.c.). 
Gambir, tincture of, 15 (4.0 c.c.). 
Kino, tincture of, 1-25 (4.0-8.0 c.c.). 
Logwood (Hsematoxylon) extract of, 10-30 grs. (0.6- 
2.0 gm.). 
Nutgall, tincture of, 1-25 (4.0-8.0 c.c.). 
Witch hazel, fluidextract of, 25 (8.0 c.c.). This is 
more frequently used as an external application. 
There are a number of other drugs which contain tannin, 
but they are no longer listed in the Pharmacopoeia and are 
rarely used. Tannin is also contained in tea and an in- 
fusion that is allowed to stand for some time or a decoction 
may contain a considerable amount. 
Fate of Tannin in the Body.-Tannin unites with the 
protein of food that is in the stomach, but, as digestion 
progresses, the compounds thus formed are broken up and 
the tannin set free. In the intestines some of the tannin 
is changed to gallic acid and both this and the tannin grad- 
ually unite with alkaline substances, forming gallates and ASTRINGENTS 
295 
tannates. These are slowly, but fairly completely, 
absorbed and, it is thought, oxidized in the tissues. They 
have no effect after absorption. 
Actions and Their ESects.-Tannin combines with: 
Proteins, alkalies, alkaloids, some glucosides, and the salts 
of the heavy metals. Except for its employment as a 
chemical antidote in the treatment of poisoning by alka- 
loids, the therapeutic uses of tannin depend upon the 
effects of its astringent action, which, as previously stated, 
is due to its action on the protein substances of the super- 
ficial cells of the tissues with which it comes in contact. 
Tannin, when applied to the unbroken skin, tends to 
harden and dry the latter and thus it is of use in preventing 
bed-sores. 
Applied to bleeding surfaces it tends to check the 
bleeding by coagulating the protein in the blood at the 
point of application, thus forming clots which block the 
openings of the severed vessels. This is known as styptic 
action. 
Its action on mucous membranes is more pronounced 
than on the skin, and it lessens the secretion of mucus 
and the sensitiveness of the sensory nerve-endings in the 
part. 
In the mouth tannin gives rise to a harsh, bitter taste, 
but in spite of this the secretion of saliva, as well as mucus, 
is lessened, because of the precipitation of the protein of 
the secreting cells; also, the mouth being particularly 
sensitive, there will be sensations of dryness, roughness 
and constriction. 
If there is food in the stomach when tannin is taken, the 
effect on the gastric membrane will be less than in the 
mouth and the digestion of the food will be retarded; but 
as digestion progresses and the tannin is set free, it will 
have the same effect upon the gastric and intestinal mem- 
branes as upon other mucous membranes. As it tends to 
check secretion it makes the feces drier and retards their 
passage through the bowel and this and the lessened sen- 
sitiveness of the nerve-endings, which limits their stimu- 296 
MATERIA MEDICA AND PHARMACOLOGY 
lation by material in the intestines, will overcome diarrhea 
or promote constipation. If, however, tannin is taken in 
large amounts, especially when there is no food in the 
stomach, it will cause so much change in the protoplasm 
of the membranes that it will induce irritation and, con- 
sequently, vomiting and diarrhea. 
The above effects and, possibly, a slight degree of col- 
lapse, as the result of the vomiting and diarrhea, are the 
only results of overdoses of tannin, but, if relatively large 
amounts are taken constantly, as in strong tea that has 
been boiled or allowed to infuse for a long time, harmful 
changes are likely to be caused in the gastro-intestinal 
membrane which may seriously interfere with digestion 
and promote chronic constipation. 
The newer compounds and the drugs containing tannin 
are now more commonly used than the uncombined tannin 
because they interfere less with digestion. 
The principal therapeutic uses of tannin are: It is 
applied locally, in the form of a solution, ointment or 
glycerite to harden the skin and thus lessen the danger of 
pressure-sores; to check local sweating and bleeding; and 
to contract swollen gums. 
As an ingredient of mouth washes and lozenges, it is 
used to contract relaxed membranes of the throat. 
As an ingredient of suppositories or ointments, it is 
used to contract hemorrhoids. 
It is given by mouth as an antidote in poisoning by 
alkaloids. 
It is administered both by mouth and in enemata to 
check diarrhea. 
MYRRH 
Tincture of myrrh, dose, ^-15 (2.0-4.0 c.c.). 
Myrrh is a resinous substance obtained from a species 
of balsam tree. It contains a volatile oil and has both 
astringent and carminative actions. Thus, though it 
contracts tissue as tannin does, it stimulates nerve-endings 
in the part and increases secretion and, if taken by mouth, astringents 
297 
peristalsis. It is used chiefly as an ingredient of cathartics, 
as an expectorant and, generally in the form of a glycerite, 
it is used locally to contract swollen gums. 
Mineral or Inorganic Astringents 
The mineral or inorganic astringents are potassium 
chlorate, alum and salts of the heavy metals. Only a few 
of the latter, however, are used specially for their astrin- 
gent properties, viz.: Bismuth, copper, lead, silver, and 
zinc. 
POTASSIUM CHLORATE 
(Symbol KC1O3) 
Dose, 5-15 grs. (0.3-1.0 gm.). 
As a mouth wash or gargle it is used in 2-6 per cent, 
solutions. 
Troches of potassium chlorate each contain 5 grs. (0.3 
gm.). 
Action and Uses.-Potassium chlorate owes its astrin- 
gent properties to its salt action (extraction of water). 
It is now rarely used except as an astringent mouth wash 
and gargle, in the treatment of catarrhal and relaxed 
conditions of the throat; for, if swallowed, it is readily 
absorbed and, after absorption, it unites with the hemo- 
globin of the blood, forming what is known as methemo- 
globin which interferes with the oxygen carrying property 
of the red cells and, in large amount, it will cause hemolysis 
(destruction of red cells). 
Poisoning by potassium chlorate has occurred as the 
result of swallowing solution used for gargling. A mild 
form of poisoning will cause nausea and diarrhea (as the 
result of the irritation of the mucous membrane by the 
salt action of the drug) and diuresis and the urine may 
contain a reddish deposit, because of the presence of 
material due to the destroyed blood cells. 
More pronounced poisoning, in addition to the above 
symptoms, will cause cyanosis, dyspnea (due to lack of 
oxygen), a rapid feeble, irregular pulse, giddiness, pro- 298 
MATERIA MEDICA AND PHARMACOLOGY 
nounced weakness, and the diuresis may be followed by 
anuria, due to injury to the kidney cells, as well as to loss 
of fluid from the body. 
The treatment for poisoning is the same as for other 
irritant drugs and, in severe poisoning, phlebotomy is some- 
times performed in order to remove some of the useless 
blood, and this is replaced either by transfusing fresh 
blood or an intravenous injection of normal salt solution. 
ALUMINIUM 
(Symbol Al) 
Aluminium is a tin-white, light, metal element. It 
unites readily with acids to form salts. 
Preparations and dosage: 
Alum (aluminium and potassium sulphate), 5-20 grs. 
(0.3-1.3 gm.). 
Aluminium hydroxid, 5-20 grs. (0.3-1.3 gm.). 
Aluminium acetate, Aluminium sulphate, Aluminol 
(Alumini naphthosolsulphonas) and dried or burnt alum 
are all used externally in percentages mentioned under 
Therapeutic Uses. 
Fate in the Body.-Aluminium salts are only very 
slowly absorbed. After absorption they are excreted in 
the urine and bile. 
Action and Effects.-Aluminium salts, like those of 
other metals, precipitate proteins with which they come in 
contact. As the result of this aluminium solutions are 
astringent and, they, thereby, act as antiseptics and, when 
applied to mucous membranes, raw surfaces and, to a 
slight extent, the skin, they contract the involved tissue 
and lessen its secretion. In the alimentary tract, these 
effects, in moderation, tend to overcome diarrhea but, if 
excessive, they will cause nausea, vomiting, and diarrhea. 
Dried alum is more astringent than the other preparations, 
because, in addition to its action on protein, it has a 
great avidity for water and extracts it from tissues with 
which it comes in contact. Aluminium salts are so ASTRINGENTS 
299 
imperfectly absorbed that, even if used in poisonous con- 
centration, they do not affect the tissues after absorption 
and, therefore, the only symptoms of poisoning will be 
those induced by severe local irritation of the part involved. 
Therapeutic Uses.-Dried alum is used, dissolved in 
alcohol, 1:5 parts, to dry and harden the skin and thus 
prevent bed-sores. The other preparations are used, in 
^-5 per cent, solutions, for their astringent and anti- 
septic properties, as douches, moist dressings for ulcers 
and similar conditions, and, as gargles, in the treatment 
of relaxed throat and to overcome salivation; 5-10 per 
cent, solutions of alum are sometimes used for bathing 
patients who perspire profusely. Alum crystals are 
touched to canker sores, such as occur in the mouth, to 
cause their shrinkage. 
BISMUTH 
(Symbol Bi) 
Bismuth is a heavy, crystalline, brittle, metal element 
that, like other metals, combines with acids to form salts. 
Preparations and Dosage: 
Bismuth and ammonium citrate, 2-5 grs. (0.13-0.3 
gm.). 
Bismuth subcarbonate, 5-30 grs. (0.3-2.0 gm.) or for 
z-ray examinations 2-4. oz. (30.0-120.0 gm.). 
Bismuth oxide, for z-ray examinations, 2-4 oz. (30.0- 
120.0 gm.). 
Bismuth oxychloride, for z-ray examinations, 2-4 oz. 
(30.0-120.0 gm.). 
Bismuth subgallate (dermatol), 5-20 grs. (0.3-1.3 gm.). 
Bismuth subnitrate, 5-30 grs. (0.3-2.0 gm.). 
Milk of bismuth (magma bismuthi), 1 (4.0 c.c.). This 
contains bismuth hydroxide and bismuth subcarbonate. 
There are a number of new preparations of these; the 
most important ones are: 
Airol (bismuth oxyiodide gallate). 
Bismuth benzoate. 300 
MATERIA MEDICA AND PHARMACOLOGY 
Bismuth cresolate. 
Bismuth phenolate. 
Bismuth salicylate. 
Bismuth sulphocarbolate. 
Dermol (bismuth chrysophenate). 
Eudoxin (tetraiodophenolphthaleinate). 
Orphol (bismuth naphtholate). 
Thioform (bismuth dithiosalicylate). 
Xeroform (bismuth tribromphenolas). 
The common dosage of these preparations is 15-45 grs. 
(1.0-3.0 gm.). 
Fate in Body.-The bismuth salts used in therapeutics 
are insoluble and therefore only very slightly absorbed 
through mucous membranes; they are absorbed more 
readily, however, from wounds and abraded surfaces such 
as ulcers and burns. The bismuth absorbed is excreted 
through the salivary glands, stomach, intestines and 
kidneys. 
Actions and Effects.-As the salts of bismuth used in 
therapeutics are not soluble they do not combine with 
proteins to anything like the extent that the soluble salts 
of metals do and, therefore, they are only very slightly 
astringent and, if pure, they are not irritant. 
When taken by mouth they form a coating on the walls 
of the stomach and intestines that is only gradually 
expelled, and while present protects them from irritating 
substances within the organs. This lessens nausea and 
diarrhea and, sometimes, it will check the excessive secre- 
tion of hydrochloric acid. 
When applied to sores and wounds the bismuth salts, by 
forming a protective coat, lessen irritation from dressings 
and secretions and, by absorbing the wound secretions, 
they make conditions less favorable for bacteria and thus 
they act as antiseptics, but, because of their insolubility, 
as far as the bismuth is concerned, they do not destroy 
bacteria Many of the new preparations, however, con- 
tain phenols or other substance with germicidal properties 
and these have more decided antiseptic properties and ASTRINGENTS 
301 
have greater power to retard the activity of bacteria in 
wounds and in the intestines. 
Common therapeutic uses are: As protectives and 
absorbents on ulcers and similar sores. As protectives 
in gastric catarrh and ulcer. To lessen nausea and diar- 
rhea. To allow of observing the activity of the gastro- 
intestinal tract-for this purpose the compounds indicated 
in the list of preparations are used, as they are even less 
likely than others to be absorbed or to act as irritants in 
large amounts. They are generally given in buttermilk 
or thick soup. Their value for this purpose depends upon 
their impermeableness to the x-rays, which makes them 
show as a dark shadow in x-ray photographs and thus, if 
photographs are taken at intervals, the rate at which 
material is forced through the gastro-intestinal tract can 
be ascertained. 
Toxicology.-Poisoning is not common but it does occur, 
especially when large amounts of bismuth preparations 
are used on wounds. 
The symptoms of poisoning are chiefly the result of 
conditions produced during the excretion of the bismuth. 
They are: Salivation, swelling and discoloration of the 
gums, tongue and throat; nausea; vomiting and diarrhea; 
sometimes, albuminuria and collapse. 
The treatment consists in washing the part coated with 
bismuth with warm oil and, if necessary, taking means to 
prevent collapse. 
COPPER (CUPRUM) 
(Symbol Cu) 
Copper is a heavy metal element. 
Copper sulphate is the only official salt, dose (as an 
emetic) 4-10 grs. (0.25-0.6 gm.) in enough water to make 
a 1 per cent, solution. 
Action and Effects.-Copper sulphate precipitates the 
protein of protoplasm and, thereby, it destroys bacteria 
and is astringent to mucous membranes and other soft 
tissues. Solutions above 1 per cent, will cause irritation 302 
MATERIA MEDICA AND PHARMACOLOGY 
and concentrated preparations induce corrosion, i.e., they 
are caustic. 
A 1 per cent, solution taken by mouth will give rise to a 
harsh taste and produce a copious flow of saliva and, when 
swallowed, it will irritate the stomach and cause vomit- 
ing, but it will not induce as much nausea and depression 
as the majority of emetics. 
Therapeutic Uses.-The crystals are used to touch 
exuberant granulations in wounds and, in the disease 
known as trachoma, on the eyelids. A solution of about 
1 per cent, is used for irrigation in the treatment of con- 
junctivitis, vaginitis, urethritis, especially when the 
conditions are due to gonorrheal infection, and it is given 
internally as an emetic, especially in phosphorus poisoning. 
The symptoms of poisoning are due to the irritation of 
the alimentary canal for the drug produces vomiting so 
promptly that very little is absorbed. They are: nausea, 
vomiting, purging, severe abdominal pain and, as the 
result of these conditions, more or less pronounced collapse. 
If a concentrated solution has been used, the vomitus and 
stools may contain blood and shreds of mucous membrane. 
The treatment is that described on pages 68 and 69. 
LEAD (PLUMBUM) 
(Symbol Pb) 
Lead is a heavy metal element which has a silvery luster, 
but tarnishes readily to a blue-gray color. 
Preparations and dosage: 
Lead acetate (sugar of lead), 1-5 grs. (0.06-0.3 gm.). 
For external use there are a number of preparations 
the principal ones of which are: Solution of lead acetate; 
solution of lead subacetate (Goulard's extract), lead 
plaster and diachylon ointment. The plaster consists 
of lead oxide, soap and water; the ointment of lead plaster, 
olive oil and oil of lavender. 
Administration.-When lead acetate is used for its 
effects in the intestine, it should be given in pill form, or, ASTRINGENTS 
303 
preferable, in keratin capsules,1 otherwise, it will act upon 
the stomach and, also, it will be partly absorbed and thus 
have less effect in the intestine where its action is needed. 
Fate in the Body.-Lead is absorbed from abraded sur- 
faces and mucous membranes. It passes from the blood 
into the tissues and is only slowly eliminated. It is 
excreted chiefly through the kidneys but also in the saliva 
and bile and through the intestinal wall. 
Action and Effects.-Lead salts coagulate protein and 
are therefore astringent in dilute preparations and irritant 
in concentrated, but they are not as corrosive as some of 
the other metal salts. Because of their astringency they 
will check diarrhea and, when applied to an open sore as 
an ulcer or a burn, they form a coating over the surface 
that protects it from irritation and thus lessens pain and 
promotes healing. 
Lead poisoning is one of the most common forms of 
occupational poisoning, lead being a constituent of paint, 
printers' type and of a number of substances used in a 
variety of industries. Also poisoning has occurred from 
drinking water that has stood for a long time in lead pipes 
and by eating food that has been preserved in cans for 
which lead solder has been used. 
The symptoms, known as plumbism, vary somewhat, 
but common ones are: Loss of appetite, anemia, frequent 
headaches, constipation, attacks of intestinal colic that 
will be associated with nausea, vomiting and faintness; 
congestion of the membrane of the mouth which, unless 
the mouth and teeth are kept very clean, may result in 
inflammation of the gums and caries of the teeth, also a 
blue line (due to the depositing of lead salts) may form at 
the junction of the gums and teeth; tremor, especially 
of the tongue and fingers; and, later paralysis, especially 
of the extensor muscles controlling the wrists, which 
results in the typical condition of the wrists known as 
wrist-drop; neuritis and the inflammation of the optic 
1 The keratin is dissolved by the alkaline juices of the intestine 
but not by the gastric juice as ordinary capsules are. 304 
MATERIA MEDICA AND PHARMACOLOGY 
nerve may result in blindness. Also, as the result of 
injury to the tissues of the organ of the body, conditions 
such as arteriosclerosis and nephritis, may be induced. 
Lead poisoning occurring in a pregnant woman is likely 
to result in abortion from death of the fetus. 
The treatment consists in removing the cause and 
hastening excretion by the use of diuretics, diaphoretics 
and cathartics. Magnesium sulphate and sodium sul- 
phate are the cathartics chiefly used because their sul- 
phate ion combines to form lead sulphide which is inert 
and lemonade containing about 10-15 drops of dilute 
sulphuric acid is given two or three times a day. The 
free use of these antidotes by people whose employment 
exposes them to lead poisoning is advised to prevent poi- 
soning. Other precautionary measures are: To cover 
abraded surfaces through which the lead could be ab- 
sorbed; to wash the hands thoroughly before eating; to 
be especially careful of the mouth and teeth. 
SILVER (ARGENTUM) 
(Symbol Ag) 
Silver is a heavy, rather soft, whitish metal. Like other 
metals it will combine with acids to form salts. The 
official salt of the U.S.P. is that formed with nitric acid-i.e., 
silver nitrate, known also as lunar caustic, a name given 
to it in ancient times by the Arabs, who used this salt in 
the treatment of nervous disorders because they believed 
that both the nervous system and silver were influenced 
by certain similar phases of the moon (luna). 
Preparations and Dosage.-Silver nitrate can be pur- 
chased moulded into sticks, which facilitates its use in 
solid form. What are known as sticks of mitigated silver 
nitrate contain potassium nitrate as well as lunar caustic. 
Silver nitrate is used in 2 per cent, solutions for local 
application to the eyes; in 1-5 per cent, solutions for local 
application to the throat, gums, nipples, and in 0.1-1.0 
per cent, solutions for the irrigation of mucous-lined 
cavities such as the rectum, urethra, bladder, vagina. ASTRINGENTS 
305 
There are also a large number of new organic preparations 
of which the principal ones are: 
Actol (lactate of silver), used in 1: 500 solutions. 
Albargin (gelatose and silver), used in 1-5 per cent, 
solutions. 
Argentamine (silver phosphate and ethylenediamine), used 
in 1-4 per cent, solutions. 
Argonin (casein and silver), used in 2-20 per cent, 
solutions. 
Argyrol (silver oxide and vitellin), usedin 10-25 per 
cent, solutions. 
Coilargol (silver and albumin), 1 gr. (0.06 gm.) diluted 
to per cent., is given intravenously, and, in ointments 
10-15 per cent., it is given by inunction. 
Ichthargan (silver and sulphur), used in per cent, 
solutions. 
Itrol (citrate of silver), used as a disinfectant powder and 
in 1:300-1:500 solutions. 
Novargan (silver and proteins), used in 10-15 per cent, 
solutions. 
Protargol (albumin and silver), used in 1:1000-1:2000 
solutions for irrigations and in 1-10 per cent, solutions for 
local applications. 
Action and Its Effects.-By coagulating the tissue 
protein, silver nitrate in dilute preparations, acts as an 
astringent, but it is also irritant, and, in concentrated 
form, caustic. Its action is superficial, however, as it has 
little penetrating power and it is not readily absorbed. 
Its action is more marked on mucous membranes and in 
wounds than on the skin, but even the latter gives evidence 
of irritation-redness and itching-when exposed to the 
influence of moderately concentrated preparations and 
is blistered by concentrated ones. 
By precipitating the protein of bacterial protoplasm, 
silver nitrate acts as a disinfectant, a 2 per cent, solution 
will destroy streptococci and a 0.1 per cent, solution will 
destroy gonococci in about 5 minutes. 
Silver salts are reduced (i.e., they lose some of their 306 
MATERIA MEDICA AND PHARMACOLOGY 
oxygen) when exposed to light and thereupon become a 
dark gray color, thus they stain tissues, linen, etc. with 
which they come in contact. A stain can be removed by 
covering it with tincture of iodine and washing off the 
latter with a solution of sodium hyposulphate or ammonia 
water. 
Silver salts are only very slowly absorbed and are 
deposited in the tissues in an inert form. When present in 
sufficient quantity under the skin and mucous membranes 
they impart a dark-grayish hue to the body, a condition 
known as argyria. It is incurable because the silver is not 
eliminated. They have no other effect after absorption. 
The organic preparations, especially those combined 
with protein, are less irritating to the tissues than silver 
nitrate but they are not as efficient germicides. 
The chief therapeutic uses of silver preparations are: As 
antiseptic irrigations for mucous-lined cavities, especially 
in the treatment of infection due to the gonococci. 
As local application for the eyes in the treatment of 
ophthalmia and, especially to the eyes of the new-born, 
as a prophylactic measure to prevent ophthalmia. Silver 
nitrate and argyrol are the preparations most commonly 
used. 
Silver nitrate is used to cauterize exuberant granula- 
tions in wounds, and to destroy warts and similar growths. 
Coilargol is sometimes injected intravenously in the 
treatment of septicemia. 
The symptoms of poisoning by silver are due to the 
conditions produced by the local irritation and are the 
same as those described on page 64. 
Sodium chloride is the chemical antidote for silver pois- 
oning because it interacts with other silver salts forming an 
insoluble, non-irritant compound-silver chloride. The 
rest of the treatment is that usual for poisoning by 
irritants. 
Because of the tendency of silver salts to interact with 
sodium chloride, distilled water should be used for diluting 
silver preparations. 307 
ASTRINGENTS 
ZINC (ZINCUM) 
(Symbol Zn) 
Zinc is a rather heavy bluish-white metal element. 
Preparations and dosage: 
Zinc sulphate, 10-30 grs. (0.6-2.0 gm.). It is dissolved 
in sufficient water to make a 1 per cent, solution when 
used as an emetic. 
Zinc bromide, zinc iodide, and zinc valerianate are used 
in doses of 1-2 grs. (0.06-0.12 gm.). These owe their prop- 
erties to their acid iron and are not astringent. 
For external use'. Zinc acetate, zinc carbonate, zinc 
chloride, zinc oxide and zinc stearate. 
The action and uses of zinc sulphate are similar to those 
of copper sulphate. The chloride is more irritant than the 
other preparations and is used chiefly as a caustic and, in 
1 per cent, solutions, as a disinfectant. The acetate, 
carbonate, oxide and stearate are only mildly astringent 
and antiseptic, they are used chiefly as ingredients of 
dusting powders for the skin and in ointments for use on 
burns, ulcers and the like. In this form they serve to 
protect wounded surfaces from irritation by dressings and 
they lessen wound secretions, thus making conditions less 
favorable for the activity of bacteria. 
At one time zinc salts were extensively used internally 
in the treatment of nervous diseases under the supposition 
that they were nerve sedatives, but this has been shown to 
be erroneous except when, as in the case of the bromide 
and valerianate, the acid ion of the salt has such an effect. SALTS OF THE HEAVY METALS THAT ARE 
MORE COMMONLY USED FOR OTHER 
EFFECTS THAN THOSE DUE TO 
THEIR ASTRINGENT QUALITIES 
IRON (FERRUM OR FERRI) 
(Symbol Fe) 
Iron is a metal element found in many ores and minute 
amounts of organic combinations are contained in many 
plant and vegetable cells. In the animal body it occurs 
chiefly in the hemoglobin of the red blood-corpuscles, for 
the formation and functioning of which it is essential. 
The function of the red blood-corpuscles, it will be re- 
membered, is to absorb oxygen while the blood is passing 
through the lungs and part with it to the tissues. 
Preparations and dosage: 
For external use: 
Iron chloride, used in 10-20 per cent, solutions. 
Iron subsulphate (M onset's solution) contains 16 per 
cent. iron. 
For internal use: 
Aloes and iron, 3-10 grs. (0.2-0.6 gm.). 
Blaud's pills, 1-5 pills, (each pill contains 1 gr. iron sul- 
phate with sodium carbonate, tragacanth-sugar and glycerin). 
Compound iron mixture (Griffith's mixture), ^-1 oz. 
(15.0-40.0 c.c.). 
Iron and ammonium acetate solution (Basham's mix- 
ture) (15.0-30.0 c.c.). 
Iron (ferric) carbonate (Vallet's mass), 4 grs. (0.25gm.). 
Iron chloride, tincture of (muriated tincture of iron), 5-30 
m. (0.3-2.0 c.c.). 
Iron citrate, 1-5 grs. (0.06-0.3 gm.). 
Iron iodide, pills of, 1-3 pills (each pill contains gr. 
reduced iron with iodine, acacia, balsam of tolu and licorice). 
308 SALTS OF HEAVY METALS 
309 
Iron iodide, syrup of, 5-30 m. (0.3-2.0 c.c.). 
Iron and potassium tartrate, 5-15 grs. (0.3-1.6 gm.). 
Iron phosphate (soluble) (1-5 grs., 0.06-0.3). 
Reduced iron, 1-5 grs. (0.06-0.3 gm.). 
Iron and quinine citrate, 5-10 grs. (0.3-0.6 gm.). 
Iron quinine and strychnine phosphate, 1-2 3 (4.0-8.0 
c.c.). 
Iron and strychnine citrate, 2-5 grs. (0.13-0.3 gm.). 
New non-offtdal preparations: 
Dialyzed iron, 20-40 m. (1.3-2.6 c.c.). 
Ferratin, 8 grs. (0.5 gm.) (egg albumin and iron). 
Ferro-mangan solution, 1-4 3 (4.0-16.0 c.c.) (iron, 
peptones and manganese). 
Ferrous lactate, 3-15 grs. (0.2-1.0 gm.) (a salt of iron and 
lactic acid). 
Hsemaboloids, oz. (15.0 c.c.) (iron blood-proteins and 
bone marrow). 
Ovoferrin, 2-3 (8.0-12.0) (serum aibumin and iron). 
There are a number of similar preparations but the above 
are the ones that are most commonly used. 
Preparations of iron used as arsenic antidotes: 
Ferric (iron) hydroxide. This is prepared by adding 
ammonia water or a solution of sodium carbonate to tincture 
of iron chloride or iron sulphate, until a precipitate ceases 
to form. The resulting mixture is strained through filter 
paper and the precipitate is washed by pouring water over 
it (to remove the alkali). The washed precipitate is usually 
given in milk. It can be given in large quantities, but its 
use must be followed by lavage. It requires 8 grains of the 
hydroxide to neutralize 1 gr. of arsenic. 
Ferric hydroxide with magnesium oxide. This is pre- 
pared by combining iron sulphate, magnesium oxide and 
water. It can be used freely. 
Administration.-Iron preparations are given after 
meals. They should be well diluted and milk and syrups 
are good diluents. Liquid preparations should be given 
through a tube, for iron discolors the teeth, and, after iron 
is used as a mouth wash, the teeth must be well brushed 310 
MATERIA MEDICA AND PHARMACOLOGY 
immediately. Silver spoons should never be used for 
measuring or mixing iron preparations, for they are dis- 
colored by the iron. 
Fate in the Body.-The fate of inorganic iron in the body 
has been a matter of much difference of opinion for many 
years. For a long time, as the result of experiments it 
was thought that inorganic iron could not be synthesized 
into the necessary organic combinations in the animal 
body and that medicinal preparations merely acted in 
some unknown way as a stimulant to the use of food iron. 
However, more recent experiments have given rise to the 
following theory: The iron preparations used in medicine 
undergo some change either in the stomach or duodenum. 
The resulting compounds are absorbed, though probably 
imperfectly, and pass through the portal vein to the 
spleen. Whether they undergo any change in this organ 
or not is not known, but, if so, it is not an essential one for 
there is no alteration in the use of iron after excision of 
the spleen. Later, the iron is gradually taken up from 
the spleen by the blood and deposited in the liver and bone 
marrow. If the amount of iron in the body is not sufficient 
for the formation of the normal amount of hemoglobin, 
that taken as medicine will be synthesized into ferratin 
and, eventually, hemoglobin, in the liver. If, however, 
the iron supply of the body is adequate, the liver slowly 
yields up this store of iron to the blood and it is carried 
to the intestines and kidneys, especially the former for 
excretion. 
Actions.-Iron coagulates protein and thus is astringent 
and somewhat irritating, though not as much so as some 
of the other metals. 
When taken by mouth, iron gives rise to a metallic taste 
and acts as an astringent and, in large or concentrated 
doses, as an irritant in the alimentary canal. 
Its actions after absorption are indicated in the para- 
graphs describing its occurrence and fate in the body. 
Effects of Actions.-On the unbroken skin, iron has no 
effect. Applied to bleeding areas, it, by coagulating the SALTS OF HEAVY METALS 
311 
protein in the blood at the point of application, favors the 
formation of a clot and thus tends to stop bleeding, i.e., it 
acts as a styptic. 
When taken by mouth, because of the stimulation of 
taste-buds, iron may induce a slight transitory increase 
in the flow of saliva, but its astringent action checks secre- 
tion and causes the contraction of the mucous membrane 
of the alimentary tract. In the intestine these effects 
tend to promote constipation. To avoid this, cathartic 
drugs are sometimes included in iron preparations. 
Excessive or concentrated doses of iron may cause 
nausea and vomiting. 
The effects of the drug after absorption will be evident 
only if anemia exists as, otherwise, the iron will, as pre- 
viously stated, be excreted unused. In anemia the iron 
tends to overcome the condition, by promoting the forma- 
tion and functioning of hemoglobin, and, consequently, 
improving nutrition and the general body health. For 
the body can not be in a healthy condition unless it is 
supplied with enough oxygen for the normal oxidative 
processes to be carried on properly and, under ordinary 
circumstances, the amount of oxygen absorbed depends 
upon the quantity of hemoglobin in the blood. By im- 
proving the condition of the blood and the general body 
health iron helps to overcome amenorrhea. Thus it acts 
as an emmenagogue. 
Iron is used in therapeutics as a hematinic and, because 
of its hematinic properties, as an emmenagogue. 
As the iron of food is the kind that the body needs and 
it does not induce the undesirable effects of inorganic 
iron, it is most important that, when iron is needed, the 
amounts of foods containing relatively large quantities 
of iron be used as freely as possible. These include the 
yolk of eggs and green vegetables. 
The symptoms caused by the excessive use of iron 
preparations are due to the action of the iron on the 
alimentary canal, they are: Nausea, vomiting, and con- 
stipation and, due to these effects, malaise. The combina- 312 
MATERIA MEDICA AND PHARMACOLOGY 
tions of iron and protein are said to be less astringent 
and, therefore, less constipating than others. 
MANGANESE (MANGANUM) 
Manganese is a hard grayish metal that resembles 
iron. It is contained in animal and some vegetable 
tissues in minute quantities, but it does not seem to be an 
essential constituent of protoplasm. 
Preparations and dosage: 
Manganese dioxide, 1-10 grs. (0.06-0.6 gm.). 
Calcium permanganate, used in dilutions of 15 grs. 
(1 gm.) to a pint for antiseptic irrigations. 
Potassium permanganate, ^-3 grs. (0.03-0.2 gm.) and, 
for irrigations, in dilutions of 1:500-1:1000. 
Preparations of iron and manganese are classified with 
the iron preparations. 
Actions and Uses.-Manganese is sometimes given with 
iron because it seems to hasten the absorption and the 
utilization of the former, but how the manganese does this 
is not known. 
The permanganates part with their oxygen readily and 
thus serve as oxidizing agents, i.e., their oxygen unites 
with many substances and thereby decomposes them. 
By this means the permanganates will, to some extent, 
destroy bacteria and act as deodorants and as chemical 
antidotes in opium and morphine poisoning and in poison- 
ing by glucosides. 
MERCURY (HYDRARGYRUM) 
(Symbol Hg) 
Mercury, known also as quicksilver is, in its pure state, 
a silver-colored, heavy, liquid metal that is easily volatil- 
ized. It occurs in nature chiefly as the sulphide (HgS) 
known as cinnabar. Like other metals it will combine 
with acids and form salts; some of its preparations notably 
mercuric chloride (commonly known as corrosive sublimate 
and bichloride of mercury), are made by a process of SALTS OF HEAVY METALS 
313 
sublimation. For example, mercuric chloride (HgCl2) is 
made by heating a mixture of mercuric sulphate and com- 
mon salt (sodium chloride) whereupon a chemical reaction 
takes place in which the mercury combines with the chlor- 
ine (forming mercuric chloride) and the sodium with the 
sulphur. The mercuric chloride, being volatile while hot, 
passes as it forms into the receptacle provided for it 
where, on cooling, it is deposited as a white powder. 
Mercurous chloride (HgCl) or calomel, contains less 
chlorine than the bichloride, but it is easily decomposed 
by light and a portion will then be changed to the more 
stable, but also more poisonous, mercuric chloride. There- 
fore, when calomel is kept in bottles the latter must be of 
colored glass. 
Mercury compounds are incompatible with alkalies, 
soaps, proteins and many salts. For this reason solu- 
tions are best made with distilled water, and before a 
mercurial preparation is used on the skin, the part must 
be thoroughly cleansed, and all trace of soap must be 
washed off. For the same reason a solution is not to be 
used if it becomes contaminated with soap, as it can not 
then be relied upon to serve its purpose. 
Preparations and dosage: 
Bichloride of mercury (corrosive sublimate), gr« 
(0.0011 gm.). As an antiseptic irrigation for accessible 
body cavities a 1:10,000 solution is used; for a skin dis- 
infectant a 1:1000 solution. 
Blue mass, 2-10 grs. (0.13-0.6 gm.). Contains 33 per 
cent, mercury combined with glycerine, honey, licorice and 
flavoring substances. 
Calomel (mild mercurous chloride), common dosage 
1-3 grs. (0.06-0.2 gm.) but larger doses are sometimes 
used. See under Cathartics. 
Mercury with chalk (gray powder), 2-10 grs. (0.13-0.6 
gm.). This is similar to blue mass, but contains chalk 
which makes it less irritant. 
Mercuric iodides and arsenic, Donovan's solution, 5-15 
m. (0.3-1.0 c.c.). 314 
MATERIA MEDICA AND PHARMACOLOGY 
Red iodide, or biniodide, of mercury, J-^o-/dL5 gr- 
(0.002-0.004 gm.). 
Yellow iodide, or protiodide, of mercury, Ho-1 gr- 
(0.6-1.0 gm.). 
Ointments: 
Ointment of ammoniated mercury. Mercurial or blue 
ointment. 
Mercuric nitrate ointment. 
Red mercuric oxide ointment. Ointment of yellow 
mercuric oxide. 
Non-official preparations: 
Mercuric benzoate, gr. (0.015-0.03 gm.). 
Mercuric salicylate, gr- (0.003-0.006). 
Mercuric succinimide, ^o-Ko gf- (0.003-0.006). 
Mercurol (hydrargyri nucleinas), ^-2 grs. (0.03-0.13 
gm.). 
For External Use.-Bichloride of mercury, used in 
solutions of 1:10,000 for irrigation of accessible body 
cavities, and in 1:1000 solutions for disinfection of the 
skin. 
Black wash, this consists of calomel dissolved in lime- 
water in the proportion of 1 dram to 1 pint. 
Harrington's solution, used as a skin disinfectant, 
consists of approximately 7 parts bichloride of mercury; 
1 part hydrochloric acid; distilled water 37 parts; and 
alcohol 80 parts. 
Mercuric cyanide, used in 1:4000 to 1:2000 solutions. 
Mercuric oxycyanide, used in 1:5000 to 1:3000 solutions. 
Potassium mercuric iodide, used in 1:5000 to 1:1000 
solutions. 
Sublamine (mercuric sulphate ethylenediamine) used in 
1:1000 solutions. 
Yellow wash, a solation of bichloride of mercury in lime- 
water, in the proportion of dram to 1 pint (2.0 gm. to 
500 c.c.). 
For intravenous and intraspinal injections: 
Mercurialized seras. These consist of either human or 
horse serum containing the required dose of bichloride, or 
other preparation, of mercury. SALTS OF HEAVY METALS 
315 
Administration.-For internal effects, mercurial prep- 
arations are given by: Mouth; inunction; inhalation; sub- 
cutaneous, intramuscular, and intravenous injections; and, 
in the treatment of tabes, intraspinal injection. 
Fate in the Body.-When volatilized, mercury is readily 
absorbed through the lungs and mucous membranes and 
to some extent through the skin. When it is broken into 
minute globules, as it is in ointments, mercury is fairly 
readily absorbed even through the skin, especially if it is 
rubbed in (inunction). The soluble preparations are 
quickly absorbed from subcutaneous tissues, wounds, 
the mucous membrane of the stomach and intestines and, 
though probably less readily, other mucous membranes. 
The relatively insoluble preparations (calomel, blue mass 
and gray powder) are, unless volatilized, not as easily ab- 
sorbed as the more soluble ones and thus, when taken by 
mouth, a considerable portion of each dose is eliminated 
in the feces without being absorbed. After absorption, 
mercury becomes very generally distributed throughout 
the body and a considerable portion of each dose is retained 
for some time. Thus, though a small amount may be 
found in the urine three or four hours after a dose has 
been taken, it may be several days before the entire 
amount is eliminated. In fact, mercury has been found 
in the tissues of patients who have died of mercurial poison- 
ing when death has not occurred until three weeks after 
the poison was taken. Mercury is eliminated chiefly 
through the kidneys and the wall of the large intestine 
but also in the saliva and sweat and, slightly, in the 
gastric juice and bile. When a woman is pregnant, mer- 
cury may pass through the placental circulation to the 
fetus. 
Actions. 
The most marked property of mercury is its power to 
combine with proteins forming a precipitate known as 
albuminate of mercury. Because of this action, even 
dilute preparations are astringent and irritant and con- 
centrated ones are corrosive. 316 
MATERIA MEDICA AND PHARMACOLOGY 
Single therapeutic doses will have little effect after 
absorption except upon the organs through which they are 
eliminated, which they are likely to irritate, but when, 
as the result of small doses, mercury accumulates in the 
tissues to a moderate degree, it appears to have a slight 
stimulant effect upon cells, especially the red blood cor- 
puscles. Poisonous doses are particularly destructive to 
the organs through which elimination occurs, nerve tissue 
and the red corpuscles. 
There is some difference in the action of the various 
preparations, but this is chiefly dependent upon their 
degree of solubility and thus it varies in degree, rather 
than in nature, the soluble preparations being much more 
irritant than the relatively insoluble ones. 
Mercury affects the protoplasm of bacteria in the same 
manner as human tissue and it, apparently, is especially 
toxic for the Spirochaeta pallidum, the organism that causes 
syphilis. 
Effects of Actions: 
On Bacteria.-Mercury is a germicide. A solution of 
bichloride of mercury has been found to kill bacteria, not 
spores, after an exposure of hour and a solution of 1:500 
to kill most types of spores after an exposure of 1 hour, 
provided the bacteria and spores are not protected in any 
way from the influence of the mercury. A solution of 
1:10,000 acts as an antiseptic. However, the spirochseta 
pallidum is the only organism producing disease in man 
that, up to the present time, it has been found mercury 
can be counted upon to destroy in the interior of the body, 
when used in amounts that will not injure human tissues. 
To destroy the spirochseta it is necessary for the mercury 
or a substitute, as arsenic, to be constantly present 
in the body until the symptoms of syphilis are overcome. 
Though bichloride of mercury is an excellent germicide 
its use as a disinfectant is limited because: It corrodes 
metal, it stains linen, it is too irritant to tissues in disin- 
fectant strengths to be of much service for the irrigation 
of wounds or infected body cavities and it unites with the SALTS OF HEAVY METALS 
317 
protein in the discharges of wounds and in excreta forming 
an albuminate of mercury that is useless as a disinfectant 
and coats the bacteria, thereby protecting them from the 
influence of any uncombined solution. The new prepara- 
tions, potassium mercuric iodide, mercuric cyanide and 
mercury oxy cyanide are not as injurious to the tissues 
as bichloride and they do not corrode metal, but, with the 
exception of the potassium mercuric iodide, they are not as 
efficient disinfectants. The potassium mercuric iodide, 
however, is a more powerful germicide and, as it does not 
form inert compounds with organic matter, it is considered 
more suitable than bichloride for use about the body and 
it will disinfect excreta. 
The mercurial disinfectants, especially the bichloride, 
tend to cause roughness and discoloration of the skin and 
when bichloride is in contact with the skin for any length 
of time it is likely to cause an eruption that may appear, 
not only at the part of application but over a considerable 
area. Such an eruption may persist for weeks and reap- 
pear repeatedly after it has been apparently cured. A 
skin eruption may also follow the internal use of mercury 
due, probably, to the irritation induced by the mercury 
during its excretion. 
Mucous membranes and raw tissues are readily cor- 
roded by concentrated mercurial preparations and they 
become shrunken, contracted and irritated when sub- 
jected to the influence of dilute ones. Therefore, sub- 
cutaneous and intramuscular injections cause pain and, 
in spite of the astringent effect, local congestion. 
In the mouth mercury gives rise to a metallic taste and 
this, as well as the irritant action of the mercury on the 
salivary glands during excretion, increases the flow of 
saliva. 
In the alimentary tract, mercury inhibits the activity of 
bacteria, increases peristalsis and, sometimes, especially 
in large doses, causes nausea and vomiting. Also, it 
increases the excretion, but not the secretion of bile. This 
is thought to be due to the increased vigor of the duodenal 318 
MATERIA MEDICA AND PHARMACOLOGY 
peristalsis which influences the communicating bile ducts, 
causing them to discharge their contents. The soluble 
mercurial preparations, which are readily absorbed, have, 
in therapeutic doses, less effect on the intestine than the 
more insoluble ones-calomel, blue mass and gray powder 
which, though they are less irritating, remain in the bowel 
for some time. Thus, the soluble preparations are more 
commonly used for their effects after absorption and the 
relatively insoluble ones are those chiefly used as cathartics. 
After the absorption of a single therapeutic dose, the 
only effect usually observed is a slight diuresis, due to the 
irritation of the kidney cells by the mercury during its 
excretion; occasionally, the saliva is also increased. 
After therapeutic doses have been used for a short time, 
there is likely to be an increase in the number of red blood- 
corpuscles and, consequently, lessening of anemia, and a 
general improvement of the person's health, but it is not 
known if these effects are due to the stimulation of the 
body cells, which improves their nutrition, or solely to the 
destruction of the organisms causing ill health, for mercury 
is seldom used continuously except in the treatment 
of syphilis. As previously stated, it will, by destroying the 
Spirochaeta, cure the conditions existing in the first and 
second stages of syphilis. Undesirable effects that are 
likely to occur when mercury has been used for some 
time are described under mercurialism. 
Common therapeutic uses of mercurial preparations are: 
As skin disinfectants for surgical purposes and in the 
treatment of parasitic diseases. 
As specifics in the treatment of the first and second 
stages of syphilis. 
In disinfectant douches and irrigations, the potassium 
mercurial iodide is now most commonly used for this 
purpose. 
As cathartics, calomel, blue mass and gray powder. 
Toxicology.-Both acute and chronic poisoning by mer- 
curial preparations are common. Acute poisoning is 
generally due to taking bichloride of mercury, either by SALTS OF HEAVY METALS 
319 
mistake or with suicidal intent. To avoid mistakes, the 
law now requires that bichloride tablets and solutions be 
colored. Acute poisoning has also been caused by the 
retention of solutions used for the irrigation of wounds 
or for vaginal douches. Chronic poisoning or mercurialism 
is generally the outcome of the continued use of a mercurial 
preparation in the treatment of syphilis or of the inhalation 
of mercurial fumes while working in industries in which 
mercury is used. 
The symptoms of poisoning are due chiefly to the action 
of the drug on the organs through which it is excreted 
and, sometimes, its action on nerve tissue and the red 
blood-corpuscles and, if it is taken in concentrated form, 
its local action before absorption. 
The symptoms of acute poisoning when a concentrated 
preparation is taken by mouth are: A harsh, metallic 
taste, pain in the alimentary tract, nausea, vomiting, 
diarrhea and tenesmus, with blood and, after a short time, 
shreds of membrane in the vomitus and stools. There 
may be convulsions and there will be a condition of 
collapse with weak, thready, irregular pulse; irregular, 
shallow, rapid breathing; cold, clammy skin. The in- 
dividual may remain conscious or may pass rapidly into 
coma. Death may occur almost at once from shock, but 
the patient may live for two or three weeks and then die 
from exhaustion or uremia. If death does not occur at 
once conditions similar to those in chronic poisoning will 
follow and, as the result of renal irritation, the urine will 
contain albumin and casts, shreds of epithelium and, 
sometimes, sugar, also the excretion of urine will be much 
diminished and there may be suppression. 
When a poisonous amount of mercury is taken in 
dilute form either by mouth or through other channels 
the corrosion of the alimentary tract is less marked, but, 
as much of the mercury is excreted through this channel, 
there will be an intense inflammation, and the symptoms 
induced will be those of severe chronic poisoning. 
The symptoms of chronic poisoning (mercurialism') are: 320 
MATERIA MEDICA AND PHARMACOLOGY 
A constant metallic taste in the mouth; salivation (ex- 
cessive flow of saliva), stomatitis (inflammation of the 
mouth) which, if severe, may result in discoloration, 
ulceration and gangrene of the gums, tongue, interior of 
the cheeks and lips, with loosening of the teeth. In 
serious cases there will be nausea, colic, diarrhea, digestive 
disturbances (because of the congestion of the alimentary 
tract), the breath is fetid and foul and anemia develops. 
The secretion of urine is generally increased in the early 
stages but, later, it is diminished and the urine is then 
likely to contain albumin and casts. As the result of 
these conditions there will soon be a loss of weight, 
muscular weakness and cachexia. The temperature may 
be subnormal or there may be fever. If the nervous 
tissue becomes affected the individual is likely to be- 
become extremely irritable; to suffer from hallucinations, 
neuritis and tremors and paralysis of groups of muscles, 
especially the extensors of the hands and feet. 
The first aid treatment for acute poisoning consists in 
lavaging the part through which the drug was taken 
(stomach, wround, etc.) and if taken by mouth, administer- 
ing copious drinks of milk and white of egg (the albumin 
unites with mercury thereby forming an albuminate of 
mercury, which is not corrosive) and the usual means 
are taken to prevent shock. The subsequent treatment 
varies. The following description of a regime that is now 
very commonly employed for both acute poisoning and 
severe mercurialism was copied from the December (1916) 
number of Progressive Medicine. 
" (1) The patient is given every other hour 8 ounces of 
the following mixture: Potassium bitartrate, 1 dram; 
sugar, 1 dram; lactose, ounce; lemon juice, 1 ounce; 
boiled water, 16 ounces. 8 ounces of milk are admin- 
istered every alternate hour. (2) The drop method of 
rectal irrigation with a solution of potassium acetate, 1 
dram to the pint, is given continuously. (3) The stomach 
and intestine are lavaged twice daily. (4) The patient is 
given a hot pack daily." ARSENIC 
321 
The care of the mouth is of extreme importance and 
consists in keeping it clean and using astringent mouth 
washes, such as potassium chlorate and myrrh. 
The usual treatment for mild mercurialism includes the 
above care of the mouth, the liberal use of water as a 
beverage, in order to flush the kidneys, and of milk and 
white of egg to soothe the irritated alimentary tract. 
Care of the mouth is also an important prophylactic 
measure because the gums are easily irritated by the mer- 
cury excreted in the saliva and some individuals are 
salivated by a very small amount of mercury. 
ARSENIC (ARSENUM) 
(Symbol As) 
Arsenic is a steel-gray, solid element. It resembles 
metals in appearance, but it is brittle and easily powdered. 
It occurs in considerable quantities in nature both un- 
combined and in the form of sulphides, oxides and other 
compounds. When heated it sublimes, i.e., it becomes 
gaseous without melting and as the vapor cools it con- 
denses to a solid. Arsenic unites with hydrogen and oxy- 
gen in different proportions and thereby gives rise to 
different acids. Of the inorganic acids, it is the arsenous 
or arsenious (AsH3O3) and the arsenic (AsH3O4) acids that 
are used in medicine. Also, an acid known as cacodylic 
add is prepared from arsenic and certain organic com- 
pounds, salts of which (cacodylates) are now much used, 
as well as a number of other compounds of arsenic and 
organic substances. 
Preparations and dosage: 
Arsenous acid preparations: 
Arsenous acid (known also as arsenous acid and arsenic 
trioxide), ^o~H2 Sr- (0.0011-0.005 gm.). 
Arsenous acid solution, 2-8 m. (0.13-0.5 c.c.). 
(This is 1 per cent, arsenous acid in dilute hydrochloric 
acid.') 322 
MATERIA MEDICA AND PHARMACOLOGY 
Arsenous iodide, gr. (0.003-0.3 gm.). 
Donovan's solution (Solution of mercuric and arsenous 
iodides), 5-15 m. (0.3-1.0 c.c.). 
Fowler's solution (Solution of potassium arsenite), 
2-8 m. (0.13-0.5 c.c.). 
Arsenic acid preparations: 
Sodium arsenate, %o~^o gr. (0.0011-0.003 gm.). 
Solution of sodium arsenate (Pearson's solution), 1-10m. 
(0.06-0.6 c.c.). 
Organic preparations: 
Arsacetin (acetyl-atoxyl), % gr. (0.04 gm.). 
Arsenophenylglycin, 12 grs. (0.8 gm.); it is given by 
hypodermic. 
Arsenstriferrin, 5 grs. (0.3 gm.). This is a compound of 
arsenic, iron, phosphorus and albumin. 
Atoxyl (sodium arsanilate or sodium aminophenyl 
arsonate), contains 26 per cent, arsenic, 1-5 grs. (0.06- 
0.3 gm.); it is given by hypodermic. 
Cacodylate of calcium, gr. (0.045 gm.). 
Cacodylate of iron (ferric cacodylate), grs. 
(0.015-0.1 gm.). 
Cacodylate of sodium, 1-3 grs. (0.06-0.2 gm.). 
Elarson, gr. (0.008 gm.). This is a lipoid-like 
combination o] arsenic. 
Neosalvarsan or neo-arsph enamine, 5-15 grs. (0.3-1.0 
gm.). 
Salvarsan, arsenobenzol, arsphenamine, or 606, 5-10 grs. 
(0.3-0.6 gm.). 
Soamin (sodium arsanilate), 1-5 grs. (0.06-0.3 gm.) 
contains 22 per cent, arsenic; it is given by hypodermic. 
Administration.-Arsenic preparations given by mouth 
should be well diluted and given after meals. Fowler's 
solution is very commonly diluted with milk. When 
Fowler's solution is given by hypodermic it should be 
diluted with 2 parts of sterile water. Arsenophenylglycin, 
atoxyl and soamin are always given by hypodermic as 
they are decomposed by the gastric juice. Neosalvarsan 
and salvarsan are usually given intravenously. ARSENIC 
323 
Fate in the Body.-Arsenic preparations are readily 
absorbed from subcutaneous tissues, mucous membranes 
and raw surfaces and slightly through the unbroken 
skin. After its absorption arsenic soon passes from the 
blood into the tissues and is very generally distributed 
throughout the body, it has even been found in the 
spinal fluid when given in large amounts. It is retained 
in the tissues for some time and thus its elimination is 
very slow. For this reason it is likely to cause cumula- 
tive poisoning, though, as shown under toxicology some 
individuals establish a remarkable tolerance for the 
drug. It is excreted chiefly in the urine, but also through 
the wall of the large intestine, and the other excretory 
channels, and in the milk when the mammary glands are 
active. Also it has been found in the secretions of the 
scalp and in the hair. 
Actions.-Most arsenic compounds, including those 
used in therapeutics are protoplasmic irritants that, in 
concentrated preparations, destroy tissues by inducing 
inflammation and fatty degeneration. Their action is 
more inimical to animals and to the higher types of micro- 
organisms, such as the Spirochaeta and protozoa, than to 
bacteria. The arsenous acid preparations are more toxic 
than the arsenic acid compounds and the organic prepa- 
rations, being only slowly decomposed, are less irritant than 
the latter; they are, in fact, the result of much experimental 
work to obtain compounds having the good, without the 
bad, effects of arsenous acid. Salvarsan is commonly 
known as 606 because the inventor (Ehrlich) made 
that many preparations before he obtained a compound 
that contained enough arsenic to destroy the spirochseta 
pallidum (the cause of syphilis) without necessarily in- 
juring human tissues. Though it is customary to refer 
to the arsenic action, the element arsenic has not the 
irritant actions of its compounds and is not toxic. 
Apart from their irritant property, which, in modera- 
tion, may act as a tissue stimulant, and their power to 
destroy certain microorganisms that invade the body, 324 
MATERIA MEDICA AND PHARMACOLOGY 
practically nothing is known of the manner in which the 
arsenic preparations produce their effects. 
Effects.-Arsenic is especially toxic to the organisms caus- 
ing syphilis and malaria and certain tropical diseases caused 
by organisms of similar types, but it does not affect the 
malarial protozoan as readily as quinine. 
Arsenic only affects the unbroken skin when it is kept 
in contact with it for a considerable time, in which case it 
may give rise to congestion and, possibly, the formation of 
vesicles and pustules and even ulceration. 
The mucosa of the alimentary tract of individuals who 
have died of arsenic poisoning has been found swollen 
and inflamed, and infiltrated with fluid and the same con- 
ditions have been found in animals who have been given 
lethal doses of arsenic subcutaneously; thus it is con- 
sidered that these effects are due to the action of the 
arsenic after absorption and that a similar, but very mild 
type of effect is at least partly responsible for the results 
of therapeutic doses on the alimentary canal. These 
are: Increased secretion of saliva and gastric juice, 
improved digestion and increased appetite, and, after large 
doses and in poisoning and, in some individuals, even 
after a few therapeutic doses, nausea, vomiting and 
diarrhea. 
The systemic effects are: Increased permeability of 
the capillaries, which favors the interchange of fluid be- 
tween the blood and the tissues, this, and other imperfectly 
understood actions, improves the nutrition of the tissues, 
including that of the skin and of the bone-marrow, m 
which blood-cells are formed; the number of leucocytes 
is increased and, sometimes, when the person is anemic, 
the red cells. Poisonous doses cause a rapid destruction 
of blood-cells. In pernicious anemia, which is character- 
ized by excessive destruction of red cells, arsenic tends to 
lessen the destruction; in leukemia, in which there is 
excessive increase of leucocytes, arsenic restricts their 
propagation. The cause of these effects in unknown, 
but it is thought that arsenic may destroy some as yet ARSENIC 
325 
undiscovered toxin that, it is believed, induces the ab- 
normal conditions. 
Therapeutic Uses.-As a specific in the treatment of 
syphilis-chiefly salvarsan and neosalvarsan. 
As an aid to quinine in the treatment of persistent 
malaria. 
To overcome the infection in some tropical diseases, 
such as trypanosoma or sleeping sickness. 
In pernicious anemia and leukemia. 
As a tonic in conditions of debility and poor nutrition. 
In the treatment of certain skin diseases. 
Arsenic trioxide is occasionally used by dentists, in the 
form of a paste, to destroy the nerves of teeth. 
Toxicology.-Arsenic has been a common cause of poison- 
ing from early time. It was one of the ingredients of the 
famous Aqua Tofana by which so many murders were 
committed in the sixteenth and seventeenth centuries. At 
the present time it is one of the drugs most commonly used 
for committing suicide, for it can be obtained more easily 
than most poisons as it is the active principle of Paris- 
green and other vermicides and it is used in a number of 
industries. Chronic or cumulative poisoning is less 
common now than formerly, for its causes have been 
recognized and means taken to prohibit them. 
The sources of chronic poisoning are: The dust and 
vapors arising in industries in which arsenic compounds are 
used, food, dyes, and the medicinal use of the drug. 
Arsenic compounds may be in food because of their use 
as preservatives or in sprays to protect fruit from attacks of 
insects, or the employment of arsenic-sulphur compounds 
(which are very common in nature) to make the sulphuric 
acid used for preparing glucose from starch. The sul- 
phuric acid is neutralized in the glucose process and, if 
used with discretion, may do no harm, but, if arsenic 
impurities are left in the acid, they may cause arsenic 
poisoning. 
How arsenic used in dyes causes poisoning is not fully 
understood, some chemists believe that particles of the 326 
MATERIA MEDICA AND PHARMACOLOGY 
dye are rubbed off the dyed materal (clothing, paper, 
etc.) and inhaled, while others think that the dyes are 
decomposed by certain bacteria which liberate hydrogen 
from organic matter and that the hydrogen and arsenic 
combine, forming an exceedingly poisonous gas, arsenic- 
hydride, which is inhaled, 
Cumulative poisoning from the medicinal use of arsenic 
will only occur as the result of carelessness, for there are 
well marked symptoms of overdosing, but the onset of 
poisoning from other sources, may be very insidious and 
the primary symptoms not easily recognized. 
The conditions produced by poisonous amounts of 
arsenic in the body to which the symptoms of accumula- 
tive poisoning are due are: Extreme permeability of the 
capillaries which allows excessive transudation of fluid 
into the tissues and into the alimentary canal; irritation 
of the mucous membrane of the alimentary canal, nose, 
throat, and eyelids; progressive degenerative changes 
of the tissues, especially those of the liver, spleen, heart, 
blood-vessels, walls of the stomach and intestines, nervous 
system, bone-marrow, blood-cells and skin. The blood- 
vessels are abnormally relaxed and this, together with the 
condition of the heart muscle and loss of fluid from the 
blood, causes a great reduction of blood-pressure. 
The symptoms of cumulative poisoning vary according 
to the degree to which the conditions just described are 
allowed to progress. In the early stages, there will be 
languor and a general feeling of depression; loss of 
appetite and nausea and, sometimes, vomiting and diar- 
rhea; puffiness under the eyes, due to the excessive amount 
of fluid exuding from the blood-vessels. The edema shows 
in this part of the body first because the looseness of the 
tissue permits of its being easily distended and it is ob- 
served chiefly when the person first awakes from sleep, 
for movement of the muscles dispels the fluid. The 
edema under the eyes is the most typical symptom of 
the first stages of arsenic poisoning and the one that is 
most especially to be watched for when patients are ARSENIC 
327 
receiving arsenic. In the more advanced stages, there 
will be, in addition to the symptoms just mentioned, 
redness and itching of the eyelids and conjunctiva; 
coryza; constant sneezing; hoarseness of the voice; feel- 
ings of constriction in the throat and of discomfort in 
the stomach; anemia; skin rashes, associated with itching 
of the skin and, sometimes, with areas of discoloration 
known as arsenic melanosis; the hair and, in severe 
cases, even the nails fall. If the poisoning is not checked, 
paralysis, especially of the extensor muscles, develops 
and, consequently, the condition known as drop-feet and 
drop-wrists; also, neuritis is common and hypersensitive- 
ness of the joints and skin, and a more or less general 
edema. 
The treatment consists in (1) eliminating the source of 
poisoning; (2) hastening the excretion of the poison, by 
the use of non-irritant cathartics and diuretics and of hot 
baths; (3) treating the injuries that have developed. 
The symptoms of acute poisoning may not occur for an 
hour or more after the ingestion of the drug; they are: 
Nausea, vomiting, abdominal pain, diarrhea with profuse, 
watery stools that, after a time, contain shreds of mucous 
membrane and, therefore, have the appearance described 
as rice-water stools, also, they may contain blood. Thirst 
is intense, because of the loss of water from the body in the 
stools. These conditions are soon followed by collapse 
and sometimes convulsions. The patient may die in a 
short time, or after two or three days, or may recover and 
pass through a condition characteristic of cumulative 
poisoning. If death does not occur at once, the effect 
of the drug on the kidneys will be shown by the presence 
of blood and, sometimes, albumin in the urine, and the 
excretion of urine will be diminished. 
Atoxyl, in addition to the above symptoms, causes dis- 
turbance of vision, and sometimes, even permanent 
blindness. 
The treatment for acute poisoning consists in washing 
out the stomach repeatedly (the drug sticks to the inflamed 328 
MATERIA MEDICA AND PHARMACOLOGY 
membrane and is very difficult to remove). If lavage 
cannot be performed at once, an emetic is given in the 
interim. One or other of the arsenic antidotes described 
in the list of iron preparations is usually administered as 
soon as possible or else a solution of magnesia. Demul- 
cents, such as white of egg and milk, are given liberally 
and all the fluid possible, for collapse and death are largely 
due to lack of fluid in the blood-vessels. The usual meas- 
ures to prevent collapse are employed. 
Following the injection of even therapeutic doses of 
salvarsan and neosalvarsan some of the following untoward 
symptoms may appear: Headache, giddiness, nausea, vom- 
iting, diarrhea; less commonly, profuse sweating, jaundice, 
exanthemata, dyspnea, cyanosis, edema, great restlessness, 
tremors of the muscles, convulsions. 
Though some individuals are very easily poisoned by 
arsenic, others establish a remarkable tolerance for the 
drug and use it indefinitely to improve the complexion and 
in Stryia and the Tyrol the peasants take arsenic com- 
pounds habitually because they believe that arsenic keeps 
them healthy and retards the onset of fatigue during hard 
labor. PHOSPHORUS 
(Symbol P) 
Properties and Distribution in Nature.-Phosphorus is 
a pale yellowish, translucent, soft solid element. It 
belongs to the same chemical family as arsenic. It vola- 
tilizes readily, giving off fumes that have an odor of garlic, 
are luminous in the dark and take fire at a very moderate 
temperature. Phosphorus is only very slightly soluble 
in water and the body fluids but it is fairly soluble in oils, 
ether and chloroform. Phosphorus will combine with 
oxygen and hydrogen in different proportions, thereby 
forming different acids. It is never found free in nature 
but its compounds, chiefly salts, are widely distributed, 
being found in mineral matter, plants and the animal body. 
In the body, calcium phosphate constitutes about 85 per 
cent, of the mineral matter of the bones and organic phos- 
phorus compounds are essential constituents of other 
tissues. One of these, known as lecithin, is of particular 
importance, it occurs in large quantities in the brain and 
nerves. The body gets its required phosphorus supply 
from both animal and plant foods, the largest amounts are 
obtained from milk, eggs, brains, the outer coats of cereals 
and fruit. 
Preparations and dosage: 
Phosphorus, Moo_/^o gr- (0.0006-0.0012 gm.). 
Pills of phosphorus, 1-2 pills. Each pill contains Moo 
gr. (0.0006 gm.). 
Dilute phosphoric acid (10 per cent.), 10-15 m. (0.6-1.0 
gm.). 
The salts of hypophosphorus acid are known as hypo- 
phosphites, those commonly used are, calcium, sodium, 
potassium and iron. The common dosage of all four salts 
is 15-30 grs. (1.0-2.0 gm.). 
329 330 
MATERIA MEDICA AND PHARMACOLOGY 
Syrup of hypophosphites, 1-2 3 (4.0-8.0 gm.). This 
contains calcium, sodium and potassium hypophosphites. 
Compound syrup of hypophosphites, 1-2 3 (4.0-8.0 c.c.). 
This contains iron hypophosphite as well as calcium, sodium 
and potassium. 
Salts of glycerophosphoric acid are known as glycero- 
phosphates. There are a number of non-official prepara- 
tions, chiefly syrups, of glycerophosphates in common use. 
Calcium glycerophosphate, 2-10 grs. (0.13-0.6 gm.). 
Lecithin, 2-10 grs. (0.13-0.6 gm.). Prepared from yolks 
of eggs. 
Lecithin solution, 2 per cent. 1 3(4.0 c.c.). 
Lecithol, 13 (4.0 c.c.). An emulsion prepared from 
lecithin obtained from the brains of hogs. 
Action and Effects.-If there is a deficiency of phos- 
phorus compounds in the body, the cells may utilize 
medicinal preparations for their requirements, but phos- 
phorus compounds are so common in food that, unless the 
individual's supply of food as a whole is deficient, there is 
not likely to be a lack of phosphorus in the body. 
Apart from its power to improve nutrition by supplying 
a necessary tissue constituent should it be lacking, little is 
known of the action of phosphorus. The good effects that 
it may induce are: Improvement in the condition of the 
bones in diseases such as rickets and osteomalacia and, 
sometimes, in fractures that do not unite readily; increase 
in the number of red cells of the blood, though not of the 
hemoglobin. Bad effects that will be caused by an exces- 
sive amount of phosphorus in the body are: Destruction of 
bone tissue, especially that of the jaw bones; inflammation 
and fatty degeneration of the tissues of the organs, espe- 
cially the liver and the mucous membrane of the stomach 
and intestines, disintegration of red blood-cells. 
The chief therapeutic uses of phosphorus are to obtain 
its effects on bone and as a tonic in anemia and conditions 
of malnutrition. 
Toxicology.-Acute poisoning is usually the result of at- 
tempt to commit suicide with phosphorus compounds PHOSPHORUS 
331 
intended for the destruction of vermin and chronic poison- 
ing by the inhalation of phosphorus fumes, when employed 
in industries, especially match-making, in which phos- 
phorus is used. Chronic poisoning is less common now 
than formerly, because it is illegal to use untreated yellow 
phosphorus for matches and its substitutes are less 
poisonous. 
The symptoms of acute poisoning may not appear for 
several hours after the drug is swallowed. They are ab- 
dominal pain, nausea, vomiting and diarrhea. The 
vomitus and stools will have an odor of garlic and emit 
light in the dark, later they may contain blood and 
hemorrhages may occur from the nose, throat, uterus, and 
under the skin. There will be the usual symptoms of 
shock and there may be convulsions and delirium. 
The treatment consists in lavaging the stomach; giving 
copper sulphate (which acts both as an emetic and a chem- 
ical antidote) permanganate of potash (which tends to 
oxidize the phosphorus) and demulcents such as milk and 
white of egg, but not oils, for oil by increasing the solu- 
bility of phosphorus, hastens its absorption. Later 
alkaline solutions are given to lessen the acidosis caused 
by the abnormal metabolism. 
The symptoms of chronic poisoning are: Caries of the 
teeth, lesions of the gums and, in advanced cases, necrosis 
of the jaw bones and fragility of other bones; a tendency 
to diarrhea, indigestion, and bronchitis; anemia; cachexia; 
jaundice (due to interference with the discharge of bile 
from the ducts by the condition of the liver); and there may 
be albumin in the urine. 
The treatment consists in eliminating the cause and 
treating the abnormal conditions by the usual methods. ANTIMONY 
(Symbol Sb) 
Antimony is a bluish-white metallic-like element that 
exists in many minerals. It belongs to the same chemical 
family as arsenic and phosphorus. The official prepara- 
tions are those, of a salt formed by the action of antimony 
oxide on cream of tartar. 
Preparations and dosage: 
Antimony and potassium tartrate (tartar emetic), Mo- 
Ms gr- (0.002-0.004 gm.) or, as an emetic, M-2 grs. 
(0.03-0.13 gm.). 
Compound syrup of squill, 5-30 m. (0.3-2.0 c.c.). 
This contains tartar emetic 2 per cent, and fluidextracts of 
squill and senega, a.a. 8 per cent. 
Wine of antimony, 5-30 m. (0.3-2.0 c.c.) or, as an 
emetic, 1-2 5 (4.0-8.0 c.c.). This contains 10 per cent, 
tartar emetic. 
Antimony lithium tartrate (non-official), M-3 grs. (0.03- 
0.2 gm.). 
Fate in the Body.-Antimony is absorbed, though not 
very readily, through the skin and mucous membranes; 
it is taken up by the tissues in the same way as arsenic, 
but much more slowly; it is excreted through the kidneys 
and, even when given intravenously, the stomach and 
intestines. 
Action and Effects.-The action of antimony is similar 
to that of arsenic, but it is more irritant. Like arsenic it 
has a particularly destructive effect upon the higher types 
of microorganisms such as spirochseta and protozoa. 
Applied to the skin, dilute solutions act as rubefacients 
and strong ones produce blisters and pustules and even 
ulceration. If given hypodermically, it causes intense 
pain and tends to promote suppuration. 
332 ANTIMONY 
333 
Antimony is so irritant to mucous membranes that even 
in small doses it causes nausea. This effect is more pro- 
nounced when the drug is taken by mouth but, as the ali- 
mentary canal is irritated by the portion excreted through 
it, nausea is likely to follow any method of administration. 
Comparatively large doses cause vomiting and diarrhea. 
The secretions of saliva, bronchial mucus, and perspira- 
tion are increased, but this is the result of the nauseant 
action and is not due to a direct stimulation of the glands 
by the drug. 
Antimony tends to relax the blood-vessels and to de- 
press the heart action, but, in therapeutic doses, this 
depression is due to the nauseant action. 
Therapeutic Uses.-Because of its untoward effects 
antimony is little used in therapeutics except in small 
doses as an expectorant or, occasionally, as a diaphoretic, 
and, intravenously, to destroy organisms causing some 
tropical diseases such as trypanosomiasis or sleeping 
sickness. 
Toxicology.-Poisonous doses produce such intense 
irritation of the alimentary tract that very little of the 
drug is absorbed and thus the symptoms are almost en- 
tirely due to the irritation of the alimentary canal. They 
are: Extreme nausea; vomiting; profuse watery diarrhea 
similar to that of arsenic poisoning; excessive perspira- 
tion; and the usual symptoms of collapse. 
The special points in the treatment are: To give lavage, 
even though vomiting is so profuse, because the drug tends 
to adhere to the inflamed membrane; to give all the fluid 
possible both to replace the water lost from the system 
and to minimize the irritation of the kidneys by any of 
the drug that is absorbed and to give demulcent bever- 
ages to allay the irritation of the alimentary membrane. IODINE (IODUM) AND ITS COMPOUNDS 
(Symbol I) 
Iodine is a purplish-black solid element which crystal- 
lizes in brilliant plates and, even at ordinary temperatures, 
gives off a beautiful violet vapor to which its name is due, 
the term iodine being derived from a Greek word meaning 
violet. Iodine is found combined with other elements 
in the ashes of certain sea plants, in Chili saltpeter and 
in salt springs. It combines readily with a number of 
elements and compounds. In combination with hydrogen 
it forms hydriodic acid and this combines with alkaline 
substances to form salts-iodides. 
Preparations and dosage: 
Tincture of iodine, 3-8 m. (0.2-0.5 c.c.). This is an 
alcoholic solution of iodine 7 per cent., and potassium 
iodide 5 per cent. 
Compound tincture of iodine (Lugol's solution), 5-10 m. 
(0.3-0.6 c.c.). This consists of iodine 5 per cent, in a 10 per 
cent, solution of potassium iodide. 
Hydriodic acid, (10 per cent.), 5-10 m. (0.3-0.5 c.c.). 
Potassium iodide (KI), 5-20 grs. (0.3-1.3 gm.). 
Sodium iodide, 5-20 grs. (0.3-1.3 gm.). 
Iodoform, 1-3 grs. (0.06-0.2 gm.). 
New and non-offidal preparations: 
lodipin, 5-10 grs. (0.3-0.6 gm.). 
lodipin solution, 10 per cent., 1-25 (4.0-8.0 c.c.). 
lodipin solution, 25 per cent. )^-35 (2.0-4.0 c.c.). 
lodival, 10, 30 grs. (0.6, 2.0 gm.). 
Sajodin, 10-30 grs. (0.6-2.0 gm.). 
The above are iodized fats. 
Iodol, 2-4 grs. (0.13-0.25 gm.). This is obtained by the 
action of iodine on mineral oils. 
334 IODINE (lODUM) AND ITS COMPOUNDS 
335 
lodalbin, 5-10 grs. (0.3-0.6 gm.). 
lodocasein, 5-20 grs. (0.3-1.3 gm.) 
Iodized 
proteins 
There are also a number of new preparations for ex- 
ternal use, the most important of which are: Aristol (or- 
thymol iodide); iocamphen (iodine, phenol and camphor); 
and vioform. 
Administration.-Tincture of iodine, hydriodic acid 
and the alkaline iodides must be well diluted for internal 
administration. The iodides are generally given in milk 
or a flavored diluent that will disguise their taste. The 
tincture of iodine is best given in a glass (6 ounces) of 
milk. When used externally, the tincture of iodine must 
not be applied while the skin is moist because moisture 
hinders the absorption of the iodine and makes it more 
irritant. 
Fate in the Body.-The tincture of iodine and other 
preparations for internal use are readily absorbed from 
mucous membranes; the tincture is also absorbed to a 
slight extent through the skin, and this and other com- 
pounds may be absorbed from wounds. Iodine and the 
iodides are excreted readily, traces being found in the 
urine and saliva, under normal conditions, a few minutes 
after the ingestion of the drugs and from 60 to 80 per cent, 
of a dose will have left the body within 24 hours. The 
organic combinations, especially the fat compounds are 
not excreted as quickly as the others. They are decom- 
posed in the body with the liberation of iodides. All 
of these drugs are excreted chiefly through the kidneys, 
but also in the saliva, secretions of mucous membrane and, 
when the mammary glands are active, in the milk. While 
in the body they are retained chiefly in the blood, thyroid 
gland and in abnormal tissues such as those which form 
around tubercular organisms and the Spirochaeta of 
syphilis that invade the body. Iodine is a normal con- 
stituent of the thyroid secretion and thus its absorption 
by this gland is easily understood. The passage of iodine 
compounds into abnormal tissue to a greater extent than 
normal is thought to be due to lack of normal resistance 336 
MATERIA MEDICA AND PHARMACOLOGY 
to the penetration of salts by the poorly nourished cells 
of abnormal tissue. 
Actions.-Io dine combines readily with protein and other 
'constituents of protoplasm and, thereby, except in very 
dilute solutions, it contracts and hardens tissue and acts as 
an irritant. It discolors anything with which it comes in 
contact, but the discoloration can be easily removed by 
washing the stain with soap and water, or ammonia, or 
alcohol. The iodides do not combine with the elements of 
protoplasm, but they have a salt action and thus act as 
irritants to the soft tissues. The organic preparations 
are less irritant than the inorganic iodides. 
All the preparations for internal use after absorption, 
owe their chief therapeutic effects to their iodine. The 
exact nature of the iodine action after absorption (when 
it is much diluted) is not known but its effects are thought 
to be due chiefly to stimulation of the thyroid gland and 
the disintegration of abnormal connective tissue. Also it 
tends to lessen the viscosity of the blood. 
Effects of Actions-On Bacteria.-Iodine is an excellent 
germicide. The tincture has been found to destroy even 
streptococci and gonococci within one minute. It is a 
particularly good disinfectant for the skin as, even in dilute 
solutions-2-3 per cent.-it will destroy the staphylococci 
commonly present on the skin within a minute or two. 
Also, unlike most disinfectants, iodine tends to penetrate 
the outer layer of skin to some extent. 
Iodoform has a slight antiseptic action when in contact 
with wounds, for the secretions of the wound decompose it 
and liberate iodine to which its action upon microorgan- 
isms is due. Most of the other compounds for external use 
contain phenols or similar substances which may possibly 
increase their antiseptic action. However, all of these 
preparations, including iodoform, owe most of their 
antiseptic value to their power of absorbing wound secre- 
tions and thus rendering the surface of the wound dry and 
unsuitable for the life of bacteria. 
When applied to the skin, tincture of iodine acts as a IODINE (lODUM) AND ITS COMPOUNDS 
337 
counterirritant. Its irritant action is less severe, but 
more prolonged, than that of most of the drugs used as 
counterirritants. Concentrated solutions, however, will 
cause blistering and even corrosion if used in excess, especi- 
ally if the part to which the application is made is moist or if 
it is covered, so that the evaporation of the iodine is 
prevented. The other iodine compounds are not irritant 
to the skin in their natural state, but, if iodoform is 
used on wounds in excessive amounts, the iodine liberated 
may cause irritation and a consequent dermatitis. Also, 
skin eruptions of various types are likely to follow the 
internal use of, especially, the alkaline iodides. The 
reason for this is not known, it was formerly thought the 
eruptions were the result of irritation of the skin glands 
during elimination, but such a small amount is excreted 
through these glands that the idea has been abandoned. 
By their irritant action on mucous membranes iodine 
and the iodides increase the secretion of saliva, gastric 
juice and respiratory and alimentary mucus and they tend 
to fluidify the mucus and to make it less tenacious. As 
previously stated, iodine compounds are excreted to some 
extent in the saliva and, when they are taken for some 
time, they are likely to induce salivation, and swelling 
and congestion of the throat, tonsils and gums, and to be 
the cause of a persistent, disagreeable taste. These 
effects are more readily induced by the alkaline iodides 
than other preparations. The tincture of iodine and, 
though to a lesser degree, the alkaline iodides are very 
irritating to the stomach and intestines and, unless prop- 
erly diluted, they will cause nausea, vomiting and some- 
times diarrhea. 
After absorption, iodine, in whatever form it is used, 
tends to improve nutrition. This effect is thought to be 
due chiefly to the stimulation of the thyroid gland, the 
secretion of which is essential for metabolism. Iodine 
has little effect upon the circulation when the blood and 
circulatory organs are normal, but it tends to reduce 
abnormally high blood-pressure under some conditions 338 
MATERIA MEDICA AND PHARMACOLOGY 
by, it is thought, increasing thyroid activity, lessening 
the viscosity of the blood and, improving the condition 
of sclerotic blood-vessels when this is due to syphilis. 
As the result of its effects upon the abnormal tissue (gum- 
ma) that forms in various parts of the body, under the 
influence of the organism that causes syphilis, iodine tends 
to relieve many of the pathological conditions occurring 
in the tertiary stages of that disease. The relief is thought 
to be due to at least two factors: (1) The removal of ab- 
normal tissue which is interfering with the functioning of 
organs; (2) the disintegration of the gummata in which 
the Spirochaeta are encased for they can then be destroyed 
by the syphilitic specifics mercury and arsenic. 
Iodine has the same effect upon the tubercles that form 
around the tubercle bacilli when they invade the body 
that it has on the gumma of syphilis, but, as there is no 
known specific germicide for the tubercle bacilli, most 
investigators consider iodine a dangerous drug to use 
when a person has tuberculosis, since, when the organisms 
are set free by the disintegration of the tubercles, they may 
invade fresh tissue. Some physicians, however, believe 
that iodine tends to destroy the bacilli and that good 
effects may be obtained if the drug is used with caution. 
When it is used, special care must be observed to note 
and record all symptoms that arise. 
The secretion of urine is slightly increased by iodides for 
the same reason that it is by other salts. 
The Principal Therapeutic Uses.-Iodine is employed 
chiefly as a disinfectant for the skin, mucous membranes 
and wounds, and it is occasionally substituted for the 
iodides. 
Iodoform and similar preparations are used as antisep- 
tics on ulcers and sores of like nature and, occasionally, in 
wounds. 
The iodides and other preparations for internal use are 
employed: In the tertiary stage of syphilis; in arteriosclero- 
sis and some other conditions characterized by excessive IODINE (lODUM) AND ITS COMPOUNDS 
339 
connective tissue formation; and the iodides are common 
ingredients of expectorant mixtures. 
Toxicology: 
The symptoms of acute poisoning by iodine are those of 
irritant drugs, with particularly marked symptoms of 
collapse^ and the vomitus will turn blue if starch paste is 
added to it. The treatment is the same as for poisoning 
by other irritants and, in addition, a starch paste is given, 
for the starch unites with the iodine to form a relatively 
harmless iodide of starch. 
Iodoform poisoning is usually the result from the absorp- 
tion of the drug from wounds. The symptoms of poison- 
ing vary considerably. Most of them are thought to be 
due to the action of the iodoform on nerve-centers and to 
increased thyroid activity. In mild degrees of poisoning 
there is likely to be a taste of iodoform in the mouth; 
headache; dizziness; loss of appetite; restlessness; sleep- 
lessness and mental depression. The pulse becomes 
accelerated and there may be a rise of temperature. If 
the intoxication is allowed to proceed, the nerve depres- 
sion will deepen into melancholy or, sometimes, delirium, 
followed in severe poisoning, by coma and collapse. 
Chronic poisoning, known as iodism, is very likely to 
occur, unless care is taken, when iodine compounds are 
used in the treatment of syphilis, because, to be effectual, 
they must, as a rule, be taken for at least three years. 
The symptoms are: Skin lesions, which, unless care is 
taken, may become very serious; congestion of the con- 
junctiva with excessive secretion of tears; salivation; 
congestion and swelling of the mucous membrane of the 
nose and throat with inordinate secretion of mucus and 
frequent attacks of sneezing. The congestion may extend 
to the frontal sinuses and give rise to intense headache. 
There may be nausea and vomiting and, sometimes, diar- 
rhea. In severe cases there are likely to be emaciation, 
tachycardia (rapid heart action) and extreme nervousness 
due, it is thought, to abnormal activity of the thyroid 
gland. 340 
MATERIA MEDICA AND PHARMACOLOGY 
In order to prevent iodism the first appearance of symp- 
toms should be reported to the doctor and the skin and 
mouth must be kept particularly clean. Why frequent 
bathing tends to retard the onset of an eruption is not 
known, because, as previously stated, the drugs are not 
eliminated to any extent through the skin. The throat 
should be gargled with a cleansing fluid, such as a solution 
of sodium bicarbonate, at least three times a day. IPECAC (IPECACUANHA) EMETINE 
Ipecac is prepared from the roots of the Cephaelis Ipe- 
cacuanha and similar species of trees. It contains three 
alkaloids, the principal one of which is emetine. 
Preparations and dosage: 
Ipecac, expectorant dose, 1 gr. (0.06 gm.). 
Ipecac, emetic dose, 15 grs. (1.0 gm.). 
Ipecac, in dysentery, 30-50 grs. (2-4 gm.). 
Fluidextract, expectorant dose, 1 m. (0.06 c.c.). 
Fluidextract, emetic dose, 15 m. (1.0 c.c.). 
Syrup, expectorant dose, 15 m. (1.0 c.c.). 
Syrup, emetic dose, 45 (16.0 c.c.). 
Wine, expectorant dose, 10-30 m. (0.6-2.0 c.c.). 
Wine, emetic dose, 4 (16.0 c.c.). 
Dover's powder, 5-15 grs. (0.3-1.0 gm.). A powder of 
10 grs. contains 1 gr. each of ipecac and opium and 8 grs. of 
sugar of milk. 
Emetine hydrochloride in amoebic dysentery, gr. 
(0.03 gm.). Emetic dose, ^-1 gr. (0.03-0.06 gm.). 
Emetine-bismuth-iodide, 3-4 grs. (0.2-0.25 gm.). 
Administration.-The large doses of ipecac used in the 
treatment of dysentery are given either in keratin capsules, 
salol coated pills or in solution through a duodenal tube, as 
described on page 290. The salol and keratin are not 
readily dissolved by the gastric juice and thus the ipecac 
is not set free until it reaches the intestines where, in dysen- 
tery, its action is required. Emetine hydrochloride is 
given by hypodermic when it is used in amoebic dysen- 
tery, for, if given by mouth, it is likely to cause vomiting 
and then enough of the drug will not reach the intestine 
to be of use, but the emetine-bismuth-iodide preparation 
is given by mouth because it is insoluble in the acid gastric 
juice and only becomes active when it is dissolved by the 
intestinal juice. 
341 342 
MATERIA MEDICA AND PHARMACOLOGY 
Fate in the Body.-Even when given by hypodermic, 
emetine is excreted chiefly through the intestines, but to 
some extent through the kidneys. 
Actions and Effects.-Ipecac and its active principle 
emetine owe their value to their local irritant action and 
to their specific poisonous action on the amoeba that cause 
dysentery. They are not used for their actions after 
absorption and these are not well understood, but it is 
believed that they may add to the general depression that 
occurs in poisoning. 
These drugs have a bitter acrid taste and, when taken 
by mouth, they induce a copious flow of saliva. They 
are very irritant to mucous membrane and therefore a 
small dose taken by mouth will induce a prolonged nausea 
with the conditions that practically always attend nausea, 
viz., increased secretion of saliva and bronchial and ali- 
mentary mucus, increased perspiration, sensations of weak- 
ness and depression, and a relatively rapid and weak 
pulse. Emetic doses will, as a rule, induce vomiting in a 
few minutes and the conditions just mentioned will be 
intensified. Emetine, if given in doses above 1 grain by 
hypodermic will cause vomiting and it was formerly 
thought that it did so by stimulating the vomiting center, 
but it is now believed that this may be due to its irritant 
action in the stomach and intestine during excretion. 
It is because so much of the drug is excreted through the 
intestinal wall that it affects the amoeba when given by 
hypodermic. 
The therapeutic uses of ipecac are: (1) To increase and 
fluidify bronchial mucus, i.e., to act as an expectorant; 
(2) to induce vomiting, i.e., to act as an emetic; (3) to 
increase perspiration, i.e., to act as a diaphoretic, for this 
purpose it is employed chiefly to overcome conditions 
conducive to colds, see page 342, and it is the Dover's 
powder that is generally used; (4) to destroy the amoeba 
that causes amoebic dysentery, for which it is a specific. 
The symptoms of poisoning and the treatment are those 
of irritant drugs. CINCHONA AND QUININE 
Cinchona is obtained from the bark of certain species of 
trees-the cinchona-which grow in several tropical coun- 
tries, but especially those of the northern part of South 
America. It was so called after the Countess of Cinchon- 
a Spaniard whose husband was governor of Peru-because 
its first recorded use was for the countess, in 1638. Knowl- 
edge of its curative effects in the disease then known as 
ague, but now termed malaria, was obtained by the 
Spaniards from the Peruvian Indians. 
Cinchona contains about nineteen alkaloids, of which 
the principal one is quinine. The others have about the 
same action as quinine, but are less powerful. Thus the 
actions of cinchona and the preparations of other alkaloids 
are similar to those of quinine, but weaker. 
Preparations and dosage: 
Fluidextract of cinchona, 15-30 m. (1.0-2.0 c.c.). 
Tincture of cinchona (20 per cent.), 1-23 (4.0-8.0 c.c.). 
Compound tincture of cinchona (10 per cent., with 
bitter orange peel and serpentaria), ^-13 (2.0-4.0 c.c.). 
Quinine, 5-15 grs. (0.3-1.0 gm.). 
Quinine bisulphate, 5-15 grs. (0.3-1.0 gm.). 
Quinine sulphate, 5-15 grs. (0.3-1.0 gm.). 
Quinine hydrobromide, 5-15 grs. (0.3-1.0 gm.). 
Quinine hydrochloride, 5-15 grs. (0.3-1.0 gm.). 
When only one dose of the above quinine salts is given 
per day, in the treatment of malaria, larger doses, usually 
about 30-40 grs. (2.0-2.6 gm.) are sometimes prescribed. 
Iron and quinine citrate, 5-10 grs. (0.3-0.6 gm.). 
Syrup of iron, quinine and strychnine phosphate, 
13 (2.0-4.0 c.c.). 
Elixir of iron, quinine and strychnine phosphate, J^-l 3 
(2.0-4.0 c.c.). 
Warburg's tincture (this contains quinine, a number of 
volatile oils, opium and aloes'), ^-13 (2.0-4.0 c.c.). 
343 344 
MATERIA MEDICA AND PHARMACOLOGY 
Cinchonine sulphate (an alkaloid of cinchona), 5-20 grs. 
(0.3-1.3 gm.). 
Cinchonidine sulphate (an alkaloid of cinchona) ,5-20 grs. 
(0.3-1.3 gm.). 
Non-official compounds and derivatives of quinine: 
Chinaphenin (quinine and phenacetine), 5-10 grs. (0.3- 
0.6 gm.). 
Saloquinine (quinine and salicylic acid), 10-30 grs. 
(0.6-2.0 gm.). 
Saloquinine salicylate (quinine and salicylic acid), 15 grs. 
(1.0 gm.). 
Quinine tannate, 10-30 grs. (0.6-2.0 gm.). 
Quinine and urea chloride, 5-15 grs. (0.3-1.0 gm.). 
Aristochin (prepared from quinine), 5-15 grs. (0.3-1.0 
gm.). 
Euquinine (prepared from quinine), 5-15 grs. (0.3-1.0 
gm.). 
Optochin (this is prepared from hydroquinine and also 
an alkaloid cupreine, which is obtained from the China 
cuprea bark. It resembles quinine. 5 grs. (0.3 gm.). 
Administration.-When used for its bitter effect, quinine 
is given before meals. As a rule, cinchona or only very 
small doses of quinine are prescribed for this purpose and 
nothing must be done to disguise the taste. When 
quinine is used in the treatment of malaria, either one of 
the three following methods of administration is commonly 
used. (1) One large dose is given about three hours before 
the time of the chill1 so that the quinine will be in the 
1 It will be remembered that when the organisms which cause 
malaria are injected into the blood by an infected mosquito 
they enter red blood-corpuscles, where they grow, multiply 
and, finally, cause the rupture of the corpuscles in which they 
have been harbored. Unless the parasites are killed while they 
are free in the blood, they enter new cells and the cycle is re- 
peated. It is while the organisms are free in the blood that the 
malarial chill occurs. The length of time that the parasites 
take to develop and thus the length of the interval between chills 
depends upon the type of organism causing the infection, but 
it is the same for each species and thus after the two first chills 
the hour at which subsequent ones will occur can usually be 
foretold. CINCHONA AND QUININE 
345 
blood when the malarial organisms break free from the 
corpuscles. (2) The total amount is given in divided 
doses the first one about six hours before the expected 
chill, and the last one just about the time that the chill 
usually occurs. (3) The total amount is given in divided 
doses at intervals during the time that the temperature is 
falling after the chill. When not used for the above pur- 
poses quinine is given after meals because the presence of 
food lessens its irritant action on mucous membrane and, 
also quinine sulphate is not very soluble, except in an acid 
medium, and the gastric fluid is normally, only acid during 
digestion. For this reason, when the quinine is given at 
other times, if it is not already in a prepared solution, a 
drop of dilute sulphuric acid is given with it and it should 
be given in or with something that will disguise its bitter- 
ness.1 For rectal irrigations, urea chloride is diluted to 
about 0.5 per cent, and other preparations to between 
1:3000-1:500. 
Fate in the Body.-Quinine is readily absorbed from the 
stomach if the gastric contents are acid, otherwise its solu- 
tion and, consequently, its absorption are slow and im- 
perfect. After absorption a very considerable portion of 
each dose is thought to be destroyed in the tissues for 
only about of a dose is eliminated. Elimination 
takes place chiefly through the kidneys, but traces are 
occasionally found in the perspiration, bile and milk. 
The greater part of a dose will be excreted within 8 or 
10 hours. 
Action.-Quinine is a general protoplasmic poison. It 
first stimulates and then depresses the protoplasm of almost 
all tissues. However, it affects some tissues more readily 
than others and, though some tissues are markedly stimu- 
lated and not readily depressed, others may be depressed 
with little or no evidence of primary stimulation. 
The protoplasm of microorganisms exhibits the same 
1 A drug named Eriodictyon or Yerba Santa which lessens the 
appreciation of bitter flavors is often used for this purpose. The 
dose of the fluidextract is 15-60 m. (1.0-4.0 c.c.). 346 
MATERIA MEDICA AND PHARMACOLOGY 
difference in sensitiveness to the action of quinine as 
animal tissue and thus some forms, especially the protozoa, 
are more readily destroyed than others. 
The skin may be very slightly irritated by local applica- 
tions of quinine. 
Mucous membranes, subcutaneous tissues and pain 
nerve-endings are first irritated and then, especially the 
nerve-endings, depressed upon contact with the drug. 
When quinine is taken by mouth the taste-buds which 
respond to bitter are stimulated and the action of the 
ferments which digest proteins are depressed. 
After its absorption quinine affects chiefly: 
1. The Blood and Ferments.-It depresses the white 
corpuscles; it inhibits the action of the ferment concerned 
in the coagulation of blood and that which promotes 
oxidation and probably other ferments that stimulate 
catabolism. 
2. Muscle Tissue.-The skeletal muscles, cardiac mus- 
cle and the plain muscle tissue of the blood-vessels, bron- 
chi, spleen, and uterus are particularly influenced, being 
slightly stimulated by moderate doses, but depressed by 
large ones. The effects on the muscle of the blood-vessels 
in the inner ears and eyes are especially marked. 
3. Nerve Tissue.-Some part of the sensory mechanism 
that responds to pain is apparently slightly depressed. 
Otherwise, therapeutic doses do not seem to affect the 
nervous system, but poisonous doses will, after a tem- 
porary stimulation, depress nerve centers, especially med- 
ullary centers, and death is usually the result of paralysis 
of the respiratory center. The ganglia in the cochlea of 
the inner ear and the retinal nerve-cells may be destroyed by 
large doses. Formerly it was thought that the heat 
regulating center was stimulated but experiments have 
shown that this is not the case. 
Effects of Actions On Microorganisms.-Quinine, even in 
dilute solutions-1:500-will retard the activity of bacteria, 
but its destructive action is more marked on protozoa, such 
as the malarial organisms and the amoeba, and the malarial CINCHONA AND QUININE 
347 
organisms are more easily destroyed if the quinine reaches 
them while they are free in the blood plasma. 
On the skin, the only effect of local applications is a 
slight increase in the amount of blood at the area of appli- 
cation, especially if this is the scalp and, in such case, the 
increased blood supply may favor the growth of hair. 
A skin rash often follows the continued use of quinine and 
it is thought that this may be partly due to irritation of the 
skin by the quinine that is eliminated in the perspiration. 
When quinine is injected subcutaneously it causes pain, 
but, when the preparation quinine and urea chloride is 
used, the irritation is followed by a local anesthesia that 
may persist for some hours. 
When quinine is taken by mouth it acts as a bitter and 
thereby tends to improve the appetite and increase the 
secretion of saliva and gastric juice but, nevertheless, un- 
less the dose is small and well diluted, the digestion of 
proteins is inhibited, because of the inactivity of the 
ferments. For this reason, cinchona, which is equally 
bitter, but less destructive to the ferments is more com- 
monly used as a bitter than quinine. Large doses of either 
drug, but especially quinine, will cause nausea and 
vomiting. 
Effects of Moderate Doses after Absorption.-If there 
are malarial organisms in the blood, they will be destroyed. 
The power of the blood to coagulate is lessened. The 
number and the activity of the leucocytes is diminished; 
this is a very undesirable effect in infections due to pyo- 
genic bacteria and in other diseases in which leucocytosis 
is depended upon for the body's protection. 
Blood-pressure is slightly raised and the pulse tends to 
become somewhat accelerated. Thus the circulation in 
most parts of the body is improved. Occasionally, how- 
ever, the effect of even moderate doses upon the muscle 
tissue in blood-vessels of the cerebrum, ears and eyes may 
interfere with the circulation in these organs and, by 
causing either anemia or congestion, give rise to the symp- 
toms described under Cinchonism. The interference with 348 
MATERIA MEDICA AND PHARMACOLOGY 
the circulation is also partly responsible for the degeneration 
of the nerve-cells in the cochlea and retina that sometimes 
occur in poisoning. 
The action of quinine (in moderate doses) on skeletal 
muscles, tends to increase their power, but the muscles 
are soon fatigued. As a rule anything which increases 
muscular contraction, increases catabolism but, for some 
undiscovered reason, after a very transitory increase, the 
catabolism of proteins is reduced. As the primary stages 
of catabolism are inhibited there is not, as is usually the 
case when drugs interfere with metabolism, an accumu- 
lation of waste products in the system, but a storing of 
protein, which aids body nutrition in conditions, such as 
fever, when there is a tendency to abnormal destruction. 
Unless quinine is taken in large doses it does not affect 
the normal temperature but moderate doses tend to reduce 
fever. The reason for the influence of quinine upon the 
temperature is uncertain; some investigators consider that 
it is due to the lessened destruction of proteins but others 
believe that the quinine acts by lessening the vitality of 
the organisms causing the fever. 
Quinine reduces the size of the spleen by contracting its 
muscle tissue. 
If quinine is taken during pregnancy it may cause abor- 
tion, and, if taken during labor, it increases the strength 
of the uterine contractions. 
Quinine has some power to relieve mild pain, especially 
that occurring in connection with colds, influenza and 
neuralgia. 
A moderate increase in the secretion of urine may fol- 
low therapeutic doses of quinine, due, to irritation of the 
kidney, but this action is only pronounced when large 
doses are taken and, in such case, there may be albumin 
and even blood in the urine. 
Therapeutic uses of quinine are.-As a gargle, to con- 
tract the throat tissue when it is relaxed. 
In solutions used for irrigations to overcome gonococci 
infection or to rid the intestine of pin-worms or to destroy 
amoeba causing dysentery. CINCHONA AND QUININE 
349 
In hair tonics, to stimulate the growth of hair. 
For its bitter effects, but, for reason already given, 
cinchona is more commonly employed for this purpose. 
Quinine and urea chloride or, sometimes, quinine bisul- 
phate is used as a local anesthetic. The former is also 
injected around hemorrhoids, or used in suppositories, to 
lessen pain and to reduce the size of the enlarged veins. 
Also, it is sometimes injected into enlarged thyroid glands 
in large enough doses (about twice the usual dose) to de- 
stroy some secretory cells. 
For its effects after absorption, quinine is used: To 
destroy the malarial organism. To improve nutrition 
when there has been loss of flesh. As an ecbolic (to hasten 
parturition) in the second stage of labor. To check pro- 
fuse menstruation. To lessen pain and reduce the tem- 
perature in influenza and similar affections. To cause 
contraction of the spleen in diseases associated with its 
enlargement. 
Optochin has a particularly destructive effect upon the 
pneumococci and is therefore used in pneumonia. 
Toxicology: 
Cinchonism is the term applied to certain of the symp- 
toms that quinine induces when it is taken in large 
doses or when it is taken in smaller doses for a consider- 
able time. Occasionally, due to idiosyncrasy, even one 
moderate dose may induce some of the symptoms. These 
are: Ringing in the ears and partial deafness; less commonly, 
disturbance of vision, especially for colors; headache; dizzi- 
ness ; and mental dullness; (these symptoms are thought to 
be due chiefly to interference with the circulation in the 
cerebrum, ears and eyes); muscular weakness; a slow, weak 
pulse due to depression of the heart muscle. Associated 
with cinchonism there may be skin eruptions (due, it is 
thought, to interference with the circulation in the skin 
and to irritation of the skin by the drug in the perspira- 
tion) ; nausea; vomiting; diarrhea. 
The treatment for cinchonism consists in discontinuing 
the use of the drug and giving bromides or analgesics such 350 
MATERIA MEDICA AND PHARMACOLOGY 
as phenacetine. These drugs are often prescribed with 
quinine for susceptible individuals. 
If a poisonous dose is taken the symptoms just men- 
tioned will be very pronounced and deafness or blindness 
may be complete and, if the nerve-cells are destroyed, 
permanent. Also, the breathing becomes slow and 
shallow and collapse is likely to occur. Death, however, 
is not a common outcome; when it does occur, it is nearly 
always due to paralysis of the respiratory center with 
consequent failure of breathing. 
The treatment is the same as for cinchonism, plus la- 
vage, the usual means to avert collapse and, if necessary, 
artificial respiration. SALICYLIC ACID, SALICYLATES 
Salicylic acid is a white crystalline powder. It occurs 
in nature in combination with certain volatile oils, chiefly 
those existing in wintergreen (gaultheria procumbens) 
and birch bark (Betula lenta), also it is prepared synthetic- 
ally from phenol (carbolic acid) with sodium hydroxide 
and carbonic acid. 
The inorganic salicylates are salts of salicylic acid and 
the alkaline substance in each salt is indicated by the name 
of the latter. There are also organic salts, and other com- 
binations of salicylic acid some of which are obtained 
from the volatile oils just mentioned and others are 
synthetical products. Some of the latter are prepared 
from coal tar products, but they liberate salicylic acid 
when they are decomposed in the body and thus have 
about the same, but milder, action as the acid and the 
inorganic salicylates. 
Preparations and dosage: 
Salicylic acid, 5-30 grs. (0.3-2.0 gms.). 
Ammonium salicylate, 3-6 grs. (0.2-0.4 gms.). 
Lithium salicylate, 5-20 grs. (0.3-1.3 gms.). 
Sodium salicylate, 5-30 grs. 0.3-2.0 gms.). 
Strontium salicylate, 15 grs. (1.0 gm.). 
Oil of wintergreen, (Oleum gaultherice), 5-15 m. (0.3-1.0). 
Oil of sweet birch, (Oleum betula), 5-15 m. (0.3-1.0). 
Methyl salicylate, 5-15 m. (0.3-1.0). 
Ethyl salicylate (not official), 5-15 m. (0.3-1.0). 
Salicin, 5-30 grs. (0.3-2.0 gms.). 
Salol, 5-30 grs. (0.3-2.0 gms.). 
Non-official preparations: 
Aspirin (Acetylsalicylicum), 5-15 grs. (0.3-1.0 gm.). 
Novaspirin, 5-15 grs. (0.3-1.0 gm.). 
351 352 
MATERIA MEDICA AND PHARMACOLOGY 
Diaspirin, 5-15 grs. (0.3-1.0 gm.). 
Salophen, 5-15 grs. (0.3-1.0 gm.). 
Saloquinine salicylate, 5-15 grs. (0.3-1.0 gm.). 
Lactophenine, 8-15 grs. (0.5-1.0 gm.). 
Malakine, 8-15 grs. (0.5-1.0 gm.). 
Neurodine, 8-15 grs. (0.5-1.0 gm.). 
For external use: 
Thiersch powder, this consists of boric acid and salicylic 
acid., a. a. §1. In preparation for use a powder is dissolved 
in, usually, 1 quart (1000 c.c.) of boiling water. 
Salicylic ointment. 
Salicylic acid is also one of the most common ingredients 
of the plasters and collodions used as corn cures. 
Mesotan, this is a methyl ester of salicylic acid, it is 
diluted with an equal amount of olive oil in preparation for 
use. 
Spirosal, this also is an ester of salicylic acid. It is 
dissolved in either 3 parts of alcohol or 6-8 parts of oil 
in preparation for use. 
The oil of wintergreen and oil of birch are used externally 
as well as internally. 
In addition to the salicylates here mentioned there are 
some which do not owe their chief effects to the salicylic 
ion. These are classified with the drugs whose action 
they resemble. 
Administration.-For oral administration the drugs of 
this series are best given in capsules. If capsules are not 
to be had, the acid and the volatile oils should be mixed 
with syrup. 
Sodium bicarbonate is often prescribed with the salicy- 
lates in order to, by lessening the acidity of the gastric 
juice, inhibit the decomposition of the salts and the con- 
sequent liberation of the acid, which is much more irritat- 
ing to the mucous membranes. 
When a salicylate is given hypodermically, a local 
anesthetic is generally injected first to prevent pain, and 
the salicylate must be diluted to at least 20 per cent. 
Sodium salicylate is sometimes given in relatively large SALICYLIC ACID, SALICYLATES 
353 
doses (up to 2 drams once a day) by rectum. The usual 
technique of this method of administration is as follows: 
A soap-suds enema is given about an hour previous to the 
administration of the salicylate. The latter is dissolved 
in about 6 ounces of water and 15 minims (1.0 c.c.) of 
opium are added. The enema is administered in the 
usual manner of giving enemata that are to be retained. 
Fate in the Body.-The volatile oils methyl and ethyl 
salicylates, mesotan, and spirosal are absorbed to some 
extent through the skin, but the other preparations are 
not. They are, however, readily absorbed from the 
stomach and intestines. After absorption they are 
retained in the tissues for some time and they are taken 
up by the cells of synovial membranes, and are found in 
the synovial fluid aspirated from joints. Also they seem 
to pass into many types of inflammatory processes, when 
such exist, for they are found in most inflammatory 
exudates. They are excreted chiefly by the kidneys in 
the form of salicyluric acid, but they are also eliminated 
in the perspiration, bile and milk. Their excretion is 
slow. 
Actions.-The drugs of this group depend upon the 
acid (salicylic) ion for their actions and thus these are 
similar. The inorganic salicylates, however, are less 
irritating than the acid and the volatile oils and most of 
the new preparations are less irritating, but also less power- 
ful, than the inorganic salts. 
Beyond, that it is irritating to most tissues, and de- 
structive to microorganisms, so little definite information 
could be found of the ways in which salicylic acid pro- 
duces its chief effects that its actions will not be described 
separately. 
Effects.-Salicylic acid and, though to a less extent, the 
salicylates are antiseptic. Salicylic acid in strengths as 
dilute as 1: 500 will retard the growth of bacteria, moulds 
and yeasts. 
On the skin, methyl and ethyl salicylates, the volatile 
oils of wintergreen and birch, and mesotan act as counter- 354 
MATERIA MEDICA AND PHARMACOLOGY 
irritants and in concentrated preparations, especially if 
their evaporation is prevented, they may cause corrosion. 
Powdered salicylic acid is also irritant to the skin but when 
it is combined with substances such as oil or collodion or 
when in solution it is only slightly so and it tends to 
soften hardened epithelium, such as corns, and to lessen 
inflammatory conditions such as occur in many skin dis- 
eases. Also, it checks local sweating, as of the feet, by 
a local action upon either the secretory cells or nerve- 
endings of the sweat glands. As will be seen later this is 
the opposite effect of its action after absorption. The 
other preparations of the group have no effect upon the 
skin. 
The most valuable effects of salicylic acid after absorp- 
tion are: (1) It tends to relieve the pain and cure the 
conditions in joints affected by acute articular rheumatism. 
Some investigators consider that this is the result of a 
specific action on the microorganisms causing the disease, 
but others believe that the acid acts, not upon the organ- 
isms, but upon their toxins, either causing their destruc- 
tion or hastening their elimination. (2) It may relieve 
pain due to gout and to some of the chronic affections 
commonly spoken of as rheumatism, but it does not cure 
such conditions. (3) It is analgesic in neuritis. (4) 
It induces free perspiration and dilation of the superficial 
blood-vessels and, by these means, even though it stimu- 
lates catabolism, it reduces the temperature when there is 
fever, but not otherwise, unless it is taken in large doses. 
The diaphoresis and increased amount of blood at the sur- 
face of the body also tends to lessen congestions that are 
the forerunners of colds, and in this way, will often avert 
a cold if taken in the early stages. (5) Salicylic acid tends 
to promote the absorption of effusions, but how it does so 
is not known for, though it has a slight diuretic action, 
this is not sufficient to remove enough fluid from the 
blood to favor as much absorption as sometimes occurs. 
The diuresis is supposed to result from a mild irritation 
of the kidneys and the increased amount of urea which is SALICYLIC ACID, SALICYLATES 
355 
in the blood as the result of the augmented catabolism of 
proteins. (6) Salicylic acid acts as an antiseptic in the 
urinary tract. (7) It increases the excretion of uric acid. 
The heart muscle and the vasoconstrictor and respira- 
tory centers may be slightly stimulated by small doses, 
but they are depressed by large doses and, occasionally, 
even moderate doses will have this effect in some individ- 
uals. Thus the pulse is likely to be somewhat stronger 
and faster after moderate doses, but slow and weak after 
large doses; and the rate of breathing may be slightly 
increased after moderate doses, but dyspneic after large 
doses. 
Large doses, and even small ones in some individuals, 
will cause circulatory changes in the brain, ears and eyes 
which are responsible for the symptoms of overdosing 
connected with these organs. The exact nature and cause 
of the interference with the circulation in these organs 
is not well understood. Large doses, or even the long 
continued use of moderate ones may cause degenerative 
changes in the optic and auditory nerves and thereby 
cause blindness or deafness. 
Common therapeutic uses of this group of drugs are: 
Locally, Thiersch solution and a number of non-official 
combinations of salicylic acid are used as antiseptic 
washes. 
Alcoholic solutions of salicylic acid are used as washes 
to check excessive localized perspiration, as of the hands 
or feet, and salicylic acid powder, diluted with equal 
parts of boracic acid is placed in the shoes to inhibit pers- 
piration of the feet. 
In collodion, plasters and pastes, salicylic acid is used to 
soften corns. 
Salicylic ointment is used in skin diseases. 
The volatile oils of wintergreen and birch, methyl and 
ethyl salicylate, mesotan and spirosal are applied to the 
skin both for their counterirritant effects and for their 
salicylic action after absorption. 356 
MATERIA MEDICA AND PHARMACOLOGY 
Internal Uses.-To relieve the conditions present in 
acute articular rheumatism, tonsillitis, pleurisy, and 
similar affections. 
To lessen pain in gout and chronic affections of the 
joints, lumbago, neuritis, etc. 
To reduce congestions that are conducive to colds. 
Toxicology: 
Symptoms of poisoning (which may be induced by 
one excessive dose or the continued use of moderate 
doses) are: nausea, vomiting and sometimes diarrhea; 
ringing in the ears and, in extreme cases, deafness. More 
rarely, there may be disturbance of vision followed, in se- 
vere cases, by blindness. Headache, extreme restlessness 
and delirium or mental dullness and apathy. There may 
be a rash. Albumin and casts will be found in the urine. 
The more pronounced symptoms are particularly likely 
to occur following the use of a poisonous dose and, in such 
case, conditions of collapse are more or less marked, but 
death from poisoning by these drugs is rare. 
The special points in the treatment for poisoning are: 
To take the usual means to prevent collapse and, if neces- 
sary, give sedatives, as bromides, to check nervous 
excitement. 
Salol is decomposed in the intestine into salicylic acid 
and carbolic acid and thus in poisoning there will be symp- 
toms of carbolic acid poisoning, as well as those of salicylic 
acid, and the treatment must include that for carbolic acid 
poisoning. 
Aspirin, which is usually less likely to have untoward 
effects than the alkaline salicylates, will at times, due to 
idiosyncrasy, produce the following effects, even in mod- 
erate doses: Edema of the face and neck and, sometimes, 
the upper part of the chest and the mucous membrane of 
the nose and throat; urticaria, nausea and vomiting; dizzi- 
ness; more or less pronounced collapse. The causes of 
these symptoms are unknown. ANTIARTHRITICS 
Antiarthritics are remedies used to cure or relieve gout. 
Those in common use are: Atophan, known also as cin- 
chophen, phenylquininoline carbonic acid and phenylcin- 
choninic acid, this is described under diuretics. Salicylic 
acid, previously described, and colchicum. 
Colchicum is obtained from the meadow saffron, a 
crocus-like plant. Its active principle is colchicine. 
Preparations made from the corm or bulb are: 
Colchicum corm, 4 grs. (0.25 gm.). 
Extract, 1 gr. (0.06 gm.). 
Wine (40 per cent. ), 10-30 m. (0.6-2.0 c.c.). 
Preparations of the seed are: 
Colchicum seed, 3 grs. (0.2 gm.). 
Fluidextract, 3m. (0.2 c.c.). 
Tincture, 30 m. (2.0 c.c.). 
Wine (10 per cent.), 20 m. -15 (1.0-4.0 c.c.). 
Colchicina, X20 (0.0005 gm.). 
Action and Effects.-Colchicum is very irritant to 
mucous membranes and in susceptible individuals, even 
therapeutic doses will cause nausea and vomiting and 
diarrhea, and, in poisoning, there will be blood in the 
vomitus and feces and intense abdominal pain. It 
irritates the kidneys during elimination and thus causes 
diuresis. It lessens the pain and inflammation around the 
joints in gout, but how it does so is not known. 
In poisoning, in addition to the local symptoms, there 
will be a progressive paralysis associated with apathy 
and symptoms of collapse, and death may occur from 
paralysis of the respiratory muscles. It is not known if 
the depression is due to a direct action on the nervous 
system or if it is the result of the gastro-intestinal condi- 
tions on the nervous system. 
357 THE PHENOL COMPOUNDS 
CARBOLIC ACID OR PHENOL 
Carbolic acid or phenol is obtained from coal tar by 
fractional distillation, also, it is prepared synthetically. 
A number of drugs obtained from the tars resemble 
carbolic acid in their composition and actions and these 
are classed in chemistry as phenols. 
Preparations.-Carbolic acid crystals, 96 per cent. 
Liquefied phenol, 90 per cent., made by heating, and thus 
melting, the crystals and adding 10 parts of water to 90 of 
crystals. This is readily soluble in alcohol, but it will not 
remain in solution in water unless diluted sufficiently to 
make at least a 5 per cent, solution. If less water than this 
is used some of the phenol will separate in oil-like globules. 
Phenol is rarely used internally unless compounded with 
other drugs, as in salol, but, occasionally, it is given in 
a dose of 1 m. (0.06 c.c.) of liquefied phenol or the equivalent 
in its solutions. The dose must be diluted to make a 
per cent, solution. 
As a disinfectant, phenol is used in 2-5 per cent, solu- 
tions, as an antiseptic irrigation it is generally used in 
1 per cent, solutions. 
Ointment, 3 per cent. 
Glycerite of phenol, a 20 per cent, solution of carbolic acid 
in glycerine. 
Dobell's solution which consists of 3 per cent, phenol, 
sodium bicarbonate and borax a.a. 1.5 per cent., water and 
glycerine. This is used as a mouth wash in 2-5 per cent, 
solutions. 
Fate in the Body.-Phenol is readily absorbed from 
wounds and mucous membranes and, to a slight degree, 
through the skin. It is oxidized in the body and the 
358 THE PHENOL COMPOUNDS 
359 
products of oxidation are eliminated in the urine. When 
present in large amounts, as in poisoning, they give the 
urine a smoky greenish, appearance and, if the urine is 
allowed to stand it will become dark brown or black due 
to the further oxidation of these compounds. 
Actions.-Carbolic precipitates protein and, by so doing, 
it acts as a general protoplasmic poison. It does not form 
a hard coagulum with the protein as the metal salts do and, 
therefore, it has greater penetrating power. It tends to 
first stimulate and then depress protoplasm. It destroys 
soft tissues more readily than the skin and, after absorption, 
it is the nerve-centers, heart muscle and kidneys that are 
chiefly affected. 
Effects of Action-On Bacteria.-Phenol will arrest the 
activity of bacteria, i.e., it will act as an antiseptic, in di- 
lutions as weak as 1 : 500, and in a strength of 2 per cent., 
it will destroy non-sporulating organisms in a few minutes, 
if they are exposed to its influence, and not embedded in 
blood, pus, excreta, etc., but even a 5 per cent, solution 
will require from 20-30 minutes to act as a disinfectant 
under such circumstances and will have practically no 
effect upon spores. 
On the skin, even a 5 per cent, solution, if allowed to 
evaporate, will have no other effect (aside from its disin- 
fectant action) than to cause redness and sensations of 
irritation and tingling followed by a tendency to local 
anesthesia. If, however, a solution even as dilute as 
2 per cent, and possibly weaker, is kept in contact with 
the skin for some time and its evaporation prevented, 
as when thick compresses are used for a carbolic dressing 
or when the compresses are covered with oil muslin or 
other fabric that interferes with evaporation, a so-called 
burn may result. Such burns are likely to be very deep 
and difficult to heal and may result in gangrene. As 
the phenol acts as a local anesthetic, the escharotic action 
of the solution may proceed without causing pain. Thus, 
though there are few drugs that will, by their local action, 
relieve itching and lessen pain due to local inflammation, 360 
MATERIA MEDICA AND PHARMACOLOGY 
as readily as carbolic it is now rarely used for these pur- 
poses in aqueous solution. The ointment and glycerite, 
however, are sometimes used as antiseptic antipruritics 
(to allay itching) for the fat and glycerine lessen the 
escharotic tendency of the carbolic. Liquefied phenol 
or the globules that separate from improperly prepared 
solutions will destroy skin almost instantly, unless their 
action is neutralized. 
At one time carbolic solutions were much used for the 
irrigation of wounds but it was found that the phenol 
action on the tissue cells was deleterious and tended to 
retard healing. 
The action on mucous membranes is similar to that on 
the skin but the destruction of the membrane is more 
easily affected. When taken by mouth, a small amount 
of a dilute solution tends, by its local anesthetic action, to 
allay nausea, but a slight overdose will, by its irritant 
action on the membrane, induce nausea and vomiting. 
Carbolic is not used intentionally for its effects after 
absorption, but, as it is readily absorbed, these may occur 
from its external use and in poisoning. They consist 
of a transitory stimulation of the heart muscle and nerve- 
centers followed, if more than a very small amount is ab- 
sorbed, by depression and by irritation of the urinary tract. 
Thus, the absorption of a very small quantity will cause 
an increase in the rate and strength of the pulse and in 
the rate and depth of breathing and a slight reduction of 
temperature, especially if there is fever, (due, it is thought, 
to increased sensitiveness of the heat regulating centers) 
and increased secretion of urine. These effects, if more 
than a small amount is absorbed, are followed by apathy 
and slowing and weakening of the pulse and breathing. 
Carbolic is used: To disinfect excreta, toilets, sinks and 
the like, and linen. It does not destroy fabrics nor corrode 
metal. 
A small amount of the liquefied phenol is sometimes 
swabbed over a small local area when a powerful disin- 
fectant or cautic is needed. After the desired degree of THE PHENOL COMPOUNDS 
361 
action has been obtained the part is swabbed with al- 
cohol or oil to remove the carbolic and prevent its 
penetration. 
Dilute solutions are sometimes used as antiseptic 
douches. 
The ointment especially is sometimes used to lessen 
pruritus (itching). 
Occasionally carbolic is given by mouth to lessen nausea. 
Toxicology: 
The symptoms of poisoning depend upon the con- 
centration of the solution used. If a concentrated 
solution is swallowed, the membrane of the mouth and 
throat becomes white and blanched and there are the usual 
symptoms produced by irritant drugs. As a rule, however, 
convulsions do not occur, because of the rapid depression 
of nerve centers and, also because of this, collapse is likely 
to be pronounced. There will be excessive secretion of 
saliva, tears and perspiration, but this is thought to be the 
result of the nausea. 
If toxic amounts of a dilute solution are taken, the 
symptoms will be due to the effects of the drug after 
absorption and will consist of those mentioned on the 
preceding page followed by profound collapse. Death 
is likely to occur in a very short time from paralysis of the 
heart or of the respiratory center. 
Treatment for Poisoning.-If concentrated carbolic is 
spilled on the skin the part should be at once washed with 
alcohol or, if this cannot be obtained, a bland oil. When 
a concentrated solution (above 1 per cent.) is swallowed, 
whiskey or other beverages containing as much as 20 per 
cent, alcohol-or even ethyl alcohol diluted to 20 per cent. 
-is given, but the stomach must be lavaged at once be- 
cause, though the alcohol will prevent the local corrosive 
action of the carbolic, it will hasten its absorption and it 
does not prevent its actions after absorption. Milk, white 
of egg or other demulcent is given and sometimes a dose 
of either sodium or magnesium sulphate in a glass of 
water, because carbolic has a slight tendency to unite with 
sulphur and the resulting sulphocarbolates are relatively 362 
MATERIA MEDICA AND PHARMACOLOGY 
harmless. Sodium sulphate (not magnesium)1 is added 
to normal saline solution if this is given intravenously to 
help overcome collapse and flush the kidneys. Caffeine, 
strychnine and atropine are sometimes prescribed to pre- 
vent collapse. If a toxic amount of a very dilute solution 
is used, the alcohol is omitted, otherwise the treatment is 
the same as for poisoning by concentrated solutions. If 
the poisoning is due to the absorption of carbolic from 
wounds, the dressing is removed and the wound irrigated 
and the usual means taken to prevent collapse and irrita- 
tion of the kidneys. 
CRESOLS 
The cresols of which there are three isomeric2 forms are 
procured chiefly from coal tar. All three are generally 
contained in the various preparations of cresols as they 
can only be separated by an expensive method. 
Cresol or tricresol, dose for internal use, 1 m. (0.06 c.c.). 
As a disinfectant cresol is generally used in from 1-3 per 
cent, solutions. 
Cresol is a simple preparation of the cresols, it resembles 
phenol in its composition and actions but is said to be less 
poisonous, though it is from three to four times as active 
a germicide. Its value as a disinfectant, however, in its 
natural form is restricted because it does not mix readily 
with water, but, as it is soluble in soap solutions, various 
combinations of soap and cresol are used and they serve 
both as disinfectants and detergents. Cresol is occa- 
sionally used internally, as a gastro-intestinal antiseptic, 
to lessen fermentation and putrefaction. 
The most commonly used compounds of cresol and soap 
are: Compound solution of cresol which is used in 5 per 
cent, solutions as a disinfectant, chiefly for the skin, utensils 
and the like, and in ^-1 per cent, solutions for antiseptic 
vaginal douches. 
1 Why not magnesium sulphate? If unable to answer see de- 
scription of magnesium sulphate under Anesthetics. 
2 Isomers, it will be' remembered, are substances consisting of 
the same elements, in the same proportion, but differently arranged 
in the molecule so that the nature of the isomers is not identical. THE PHENOL COMPOUNDS 
363 
Lysol, which is used in the same per cents, and for the 
same purposes as the compound cresol solution. 
Creoline, which acts as a deodorant, as well as a dis- 
infectant, and is therefore used especially to disinfect 
excreta, toilets, bed-pans and similar utensils. It is also 
used in ^-1 per cent, solutions for vaginal douches. 
Warm (not hot) water must be used for preparing solutions 
of creoline. 
PICRIC ACID OR TRINITROPHENOL 
Picric acid is prepared by nitrating phenol. It resem- 
bles carbolic acid in its action, but it is less caustic, though 
more anesthetic, and it is astringent. It is now very 
commonly used, in about a 5 per cent, alcoholic solution, 
on the skin in preparation for operation, as a substitute for 
iodine, and, in weaker solutions, usually about 1 per cent., 
it is used as an antiseptic, on mucous membranes, for 
vaginal douches, the cleansing of wounds, and as a dress- 
ing for burns. Its special value for such a dressing is that, 
after a very transitory smarting, it acts as an anodyne. 
A common method of using it for the purpose is to saturate 
gauze compresses with the solution and, after applying 
them to the burned area, cover them with cotton and 
bandage the dressing in place. Picric acid can not be 
used in this way for large areas, because enough of the acid 
may be absorbed to cause poisoning. The symptoms of 
poisoning are similar to those of carbolic acid and, in addi- 
tion, the skin and mucous membranes assume a yellow 
tint, resembling jaundice and the urine is likely to have a 
red tinge. Even quite small amounts taken by mouth, 
may cause nausea, vomiting and diarrhea. 
RESORCIN 
Dose, 2 grs. (0.13 gm.). 
Resorcin is prepared from carbolic acid and resembles 
the latter in its actions but it is less caustic. After ab- 
sorption, however, in addition to the systemic effects 
produced by carbolic, resorcin is likely to act upon the 
hemoglobin of the red corpuscles, forming methemoglobin, 364 
MATERIA MEDICA AND PHARMACOLOGY 
and thus interfere with the oxygen carrying power of the 
blood which, if large doses are taken, greatly increases the 
danger of collapse. Resorcin is used chiefly as an external 
application, in solutions of from 1-10 per cent., to relieve 
itching and as an antiparasitic in some skin diseases, 
especially conditions of the scalp which cause dandruff 
and baldness. It is sometimes added to the paraffines 
used in the treatment of burns and, occasionally, it is given 
by mouth to check the activity of bacteria in the alimen- 
tary canal and thus lessen fermentation and putrefaction. 
NAPHTHOLS AND NAPHTHALIN 
The naphthols are derived from naphthalin, a coal tar 
product. They resemble carbolic in their composition 
and actions, but are less caustic though exceedingly irri- 
tating, and more strongly antiseptic. There are two 
distinct naphthols, known as alpha-naphthol and beta- 
naphthol. The former, though a more active germicide 
than the latter, is more poisonous, and it is the beta- 
naphthol that is generally used in therapeutics. It is 
employed chiefly as a local application, usually in oint- 
ment, in the treatment of parasitic skin diseases and as an 
addition to the paraffines used for the treatment of 
burns. It is occasionally given by mouth to act as an 
intestinal antiseptic, either alone or with other drugs for 
similar action as benzoic and salicylic acid. 
Dose, 3-10 grs. (0.2-0.6 gm.). 
PYROGALLOL OR PYRO GALLIC ACID 
This is prepared from gallic acid. Its chemical com- 
position and its actions are similar to those of carbolic 
acid. It is used chiefly in the treatment of parasitic skin 
diseases, usually in ointment in strengths of 5-10 per cent. 
CREOSOTE (CREOSOTUM) AND GUAIACOL 
Creosote is a rather volatile substance obtained by the 
distillation of wood-tar. It is a mixture of phenol and 
phenol derivatives, chiefly cresols and guaiacol. THE PHENOL COMPOUNDS 
365 
Preparations and dosage: 
Creosote, 2, 5 m. (0.13-0.3 c.c.). 
Creosote carbonate, 15 grs. (1.0 gm.). 
Guaiacol, 8 m. (0.5 c.c.). 
Guaiacol carbonate (duotoT), 15 grs. (1.0 gm.). 
For local action in the respiratory organs, creosote is 
commonly given by inhalation, either being added to 
boiling water and the steam inhaled or dropped on the 
sponge in a mask inhaler and the latter placed over the 
mouth. For internal use, these drugs are generally 
given in capsules or else combined with other drugs. 
Their actions are very similar to those of carbolic acid, 
but they are less corrosive. They are used chiefly as 
intestinal antiseptics, but they are excreted through the 
kidneys and may also act as urinary antiseptics. Creo- 
sote is also excreted through the respiratory tract and, 
because of this, it was formerly much used in the treat- 
ment of tuberculosis, but, as the tubercle bacilli are em- 
bedded in the lung substance it is thought that creosote 
cannot reach them. It acts, however, as an expectorant 
and it is thought that the benefit derived from its use in 
tuberculosis is due to. this action and also its antipyretic 
effect and the reduction of fermentation and putrefaction 
in the stomach and intestines. Guaiacol is occasionally 
used, diluted with glycerine, as a counterirritant in the 
treatment of rheumatism. BALSAMS OF BENZOIN, PERU AND TOLU 
BENZOIC AND CINNAMIC ACIDS AND THEIR SALTS 
Balsams are mixtures of resins (gum-like substances) 
benzoic and cinnamic acids and salts of these acids 
(benzoates and cinnamates) and various aromatic sub- 
stances of the volatile oil type. The true balsams1 com- 
monly used in therapeutics are balsam of benzoin, balsam 
of Peru and balsam of Tolu. They are obtained from 
different species of fir trees. 
Preparations of balsam of benzoin are: 
Tincture of benzoin, ^-1 5 (2.0-4.0 c.c.). 
Compound tincture of benzoin, 1-2 5 (4.0-8.0 c.c.). 
This contains the alcohol soluble constituents of balsam of 
benzoin, aloes, storax and balsam of Tolu. 
Benzoic acid, 5-15 grs. (0.3-1.0 gm.). 
Ammonium benzoate, 5-15 grs. (0.3-1.0 gm.). 
Sodium benzoate, 5-15 grs. (0.3-1.0 gm.). 
Cinnamic acid and its salts are rarely used. 
Actions and Effects.-Benzoic and cinnamic acids are 
slightly irritant to the skin and more so to mucous 
membranes and raw surface, but the consequent smarting 
is followed by a slight analgesia, because of the depression 
of sensory nerve-endings. The actions of these acids and 
of their salts after absorption are similar to those of salicylic 
acid and the salicylates. 
Benzoic acid and the benzoates are used chiefly as 
intestinal and urinary antiseptics and, occasionally, as 
substitutes for salicylic acid and the salicylates in the 
treatment of rheumatism. They have also been widely 
used as food preservatives, but their use is now prohibited 
1 Some of the oleoresins, especially copaiba, are often referred to, 
though erroneously, as balsams. 
366 367 
BALSAMS OF BENZOIN, PERU AND TOLU 
because, in small amounts they retard the activity of the 
digestive ferments and thus of digestion and in overdoses 
they are poisonous. The symptoms of poisoning are 
similar to those produced by salicylic acid. 
Benzoin owes its effects chiefly to benzoic and cinnamic 
acids and then- salts, and, therefore, it is somewhat irritant 
(though less so than the acids) and, subsequently, anal- 
gesic. Like most other volatile drugs it is excreted to 
some extent through the lungs. It is used chiefly as an 
expectorant and a stimulant, though soothing, antiseptic, 
application for mucous membranes, ulcers, pressure-sores 
and the like. For its action on the respiratory organs it is 
very commonly added to boiling water and the steam 
inhaled. 
As balsam of Peru has the same active principles as 
benzoin its actions are similar, but it is not as volatile 
and is not excreted through the lungs to the same extent. 
It is used chiefly for local applications to ulcers and similar 
sores as an antiseptic, soothing tissue stimulant.1 
Balsam of Tolu only contains very small amounts of the 
active principles. It is used chiefly as an ingredient of 
expectorant and cough mixtures, but it is thought that its 
agreeable flavor is its chief asset. 
J The reason why slightly irritant substances, that do not induce 
irritation in a manner injurious to tissue cells, will act as tissue 
stimulants, was given on page 49. . TAR (PIX LIQUIDA) 
Dosage: 
Oil of tar, 1-5 m. (0.06-0.3 c.c.). 
Syrup of tar, 15 (4 c.c.). 
Tar is a black, thick, semi-liquid oleoresin obtained by 
the destructive distillation of the wood of certain species 
of pine trees. A number of substances can be separated 
from it by further distillation, such as the volatile oil of 
tar, creosote, and similar compounds. Tar acts as an 
irritant, antiseptic and a parasiticide. Its volatile sub- 
stances are partly excreted through the respiratory organs 
and the volatile oil and a 7 per cent, syrup of the tar are 
used as expectorants. Tar ointment is employed in the 
treatment of various skin diseases of parasitic origin. 
The condition of it must be watched when tar is used, 
because, though it is not as caustic as carbolic, it is suffi- 
ciently irritant, even to the skin, to cause inflammation. 
CHRYSAROBIN 
Chrysarobin is obtained from Goa powder, a substance 
found in the wood of the Andira araroba, a tropical tree. 
The local actions are similar to those of tar and it is used 
externally for the same purpose; i.e., in the treatment of 
skin diseases, especially those of parasitic origin. It is 
used chiefly in ointment and in 2-10 per cent, solutions. 
It is even more irritant than tar and it stains the skin, 
nails, and clothing brown, and the hair a greenish yellow. 
The stain can be removed by washing it with a dilute 
solution of caustic soda or of chlorinated soda. 
368 CHLORINE COMPOUNDS 
Chlorine is a gaseous element. It does not occur free 
in nature, but it is widely distributed in the form of salts, 
especially the chlorides, of sodium, potassium, calcium 
and magnesium. 
Chlorine combines very readily with hydrogen and thus 
forms hydrochloric acid. It also unites with oxygen and 
hydrogen to form four different acids. The names of the 
acids and their salts made by these different combinations 
are: 
Composition 
Acids 
Salts 
HC1 
Hydrochloric 
Chlorides 
HC1O 
Hypochlorous 
Hypochlorites 
HC1O2 
Chlorous 
Chlorites 
HC1O3 
Chloric 
Chlorates 
HC1O4 
Perchloric 
Perchlorates 
Hydrochloric acid and some of its salts (e.g., sodium 
chloride) do not part with their chlorine under ordinary 
circumstances and thus their actions are due solely to 
their acid or salt action, but the other acids and many of 
their salts and other preparations are unstable and part 
readily with their chlorine. Some of those which do are 
very widely used, both in industries and therapeutics, as 
a convenient way of utilizing chlorine, which is too dan- 
gerous in its gaseous form for common use. 
Actions of Chlorine.-Chlorine unites with protein and 
thereby destroys tissue and bacteria. It does not form a 
hard coagulum, like the metal salts, but tends rather to 
dissolve the protein; the result, however, is intensely irri- 
tating and readily fatal. Air containing as small an amount 
as 1 part in 100,000 is exceedingly irritating to the eyes 
369 370 
MATERIA MEDICA AND PHARMACOLOGY 
and respiratory passages and slightly higher concentrations 
will cause intense congestion of the respiratory passages 
and lungs with consequent hemorrhages, pain, dyspane 
and even death, by inducing an asphyxiating degree of 
inflammation and edema of the respiratory organs. Also, 
chlorine is a powerful oxidizing agent, it acts as such because 
it has an intense affinity for hydrogen and will take it from 
steam and boiling water,1 thus setting free the oxygen of 
the water which then combines with organic matter present 
and decomposes it. Because of its oxidizing properties 
chlorine destroys colors and acts as a deodorant. 
The chlorine compounds used in therapeutics for the 
effects of their chlorine are: Chlorinated lime, hypo- 
chlorous acid and hypochlorites, chloramine-T., dichlor- 
amine- T., eupad, eusol and halazone. 
Chlorinated lime, commonly known as chloride of lime, 
sets free chlorine as soon as it is moistened. It is very 
irritant and it destroys most fabrics. In its natural form 
it is used chiefly as a disinfectant for excreta, toilets and the 
like. 
Of the hypochlorites, potassium hypochlorite or eau de 
Javelle and the commercial solution of sodium hypochlor- 
ite, commonly known as Labarraque's solution are too 
irritant for use about the body and are expensive to use 
for the disinfection, of excreta, etc., and thus they are not 
much used in therapeutics, but the former, especially, is 
very widely employed as a bleaching agent in laundries 
and certain manufacturing processes. Neutral sodium 
hypochlorite, commonly known as Dakin's solution,2 how- 
ever, was, during the war, found to be one of the best 
disinfectants for infected wounds. If properly prepared, 
it not only destroys bacteria but it also tends to decom- 
pose their toxins and necrotic tissue, and, nevertheless, is 
not as irritant to healthy tissue as Labarraque's solution. 
1 Neither the extraction of hydrogen from water nor the union of 
oxygen with matter take place readily at low temperatures. 
2 Dr. Dakin was one of the first chemists to find the means of 
preparing a solution of hypochlorites having the advantages, 
without the corrosive action of the other hypochlorites. CHLORINE COMPOUNDS 
371 
It is however sufficiently irritating to make it necessary 
to protect the skin around a wound for which it is used. 
The means of doing this and the Carrel method of using 
Dakin's solution are described in all up-to-date text-books 
of nursing procedure and, therefore space will not be taken 
to do so here. Dakin's solution is generally used for 
wounds in the strength of 0.5 per cent. As the chlorine 
combines with the protein of the blood and tissues in the 
wound, and the resulting compounds have no germicidal 
action, the solution used in a wound is soon rendered inert 
and, therefore must be constantly renewed as it is when 
the Carrel technique is accurately carried out. 
Chloramine-T is an abbreviated name for paratoluenesul- 
phondichloramine. It is less irritating, but more strongly 
germicidal than Dakin's solution, but it does not dissolve 
the necrosed tissue commonly present in infected and con- 
tused wounds as well as the latter. Chloramine-T may 
be used in an aqueous solution, or it may be employed dry, 
impregnated in gauze (which is moistened if necessary), 
or in the form of a paste in which it is mixed with a soap- 
like substance known as sodium stearate. The strength 
of the solution used in wounds is, as a rule, 2 per cent, but 
it may be used in strengths up to 3 per cent. The strength 
of solutions used for irrigation of the eye is usually 1:1000; 
that of solutions for irrigation of mucous lined cavities, 
as the bladder, nose, throat, 1:500, but stronger solutions 
are sometimes employed in severe infections. 
Chlorazene is the name for a proprietary preparation of 
chloramine-T. 
Dichloramine-T is the abbreviated name for paratoluene- 
sulphondichloramine. As its name implies (di signifies two) 
it contains more chlorine than chloramine-T. It is a very 
active germicide and it dissolves necrotic tissue, stimu- 
lates granulation and, as usually prepared, it prevents 
dressings sticking to the wound and, therefore, injury to 
the granulations during the removal of the dressings. 
Dichloramine-T is only sparingly soluble in water and is 
generally dissolved in chlorcosane, which is an oil obtained 372 
MATERIA MEDICA AND PHARMACOLOGY 
by the chlorination of paraffine wax) or in mixtures of euca- 
lyptol and paraffine that have been treated with chlorine. 
Solutions of dichloramine-T must be kept in amber-colored 
bottles for they are decomposed by light and the other 
colored glasses used for bottles do not shut out the rays 
which cause their decomposition. The strengths of the 
solutions commonly used are 5-8 per cent. In the treat- 
ment of wounds, the solution may be poured into the 
wound or, especially for superficial wounds and sores, 
gauze saturated with it may be laid over the part; for such 
cavities as the nose and throat, the solution is generally 
sprayed from an atomizer. An atomizer with a hard- 
rubber tube (and no metal) must be used, as dichloramine- 
T, like other chlorine disinfectants, corrodes metal. 
Halazone, which is parasulphondichloraminobenzoic acid, 
is used for the disinfection of drinking water. It is said 
to be efficacious in the proportion of 1 part to 4,000,000 of 
water. 
Eupad is a powdered preparation of chloride of lime 
and boric acid; when moistened it liberates hydrochlorous 
acid. Eusol is a solution of eupad. Hydrochlorous acid 
is very irritant and thus the same care is necessary in the 
use of these disinfectants as of Dakin's solution. 
Antiformin is a new preparation of sodium hypochlorite 
that dissolves such organic matter as that of feces, sputum, 
disintegrated tissues and the bodies of many species of 
bacteria. It does, however, destroy the bacillus tuber- 
culosis. OXIDIZING AGENTS 
Drugs which act as oxidizing agents do so either because 
they have oxygen in loose combination and part with it 
readily or else, as in the case of chlorine, they liberate 
oxygen from compounds, especially water, with which 
they come in contact. 
The drugs most commonly used in therapeutics for 
their oxidizing properties are hydrogen peroxide, perman- 
ganate of potash (see under Manganese) and chromic acid. 
Hydrogen peroxide (H2O2) is readily decomposed to water 
and oxygen especially in the presence of organic substances, 
such as blood, pus and muscle juice, which contain cataly- 
ses that hasten decomposition. The liberated gas unites 
with the material that it comes in contact with and 
decomposes it. Its action is most marked on such sub- 
stances as pus and necrosed tissue and, especially during 
the decomposition of such substances an active efferves- 
cence occurs. Hydrogen peroxide also destroys bacteria, 
but, in a wound, its germicidal action is quickly lost be- 
cause of its combination with other material. It causes 
temporary sensations of stinging and smarting due to the 
heat evolved in the chemical interaction. Peroxide of 
hydrogen is used chiefly to loosen dried substances and ad- 
hesive plaster and thus facilitate the removal of adherent 
dressings from wounds; to rid the mouth and throat of 
sores and suppurative matter and, occasionally, to rid 
wounds of pus and necrotic tissue. 
Chromic acid {chromium trioxide) either in solid form or 
in aqueous solution is used as a caustic. 
373 REDUCING AGENTS 
The process of reduction is the opposite of oxidation, 
i.e., it is the removal of oxygen from matter. The reduc- 
ing agents used in therapeutics are sulphurous acid and 
sulphur dioxide. By removing oxygen from matter these 
substances act as bleaching agents, antiseptics and parasi- 
ticides. Sulphurous acid is the more powerful reducer of 
the two. It is formed when sulphur dioxide is dissolved 
in water. Sulphur dioxide is formed when the element 
sulphur is burned in air. It is a colorless gas that is very 
easily condensed to a liquid. It is very irritating to mu- 
cous membranes and the eyes. It and sulphurous acid 
are particularly destructive to vermin and, for this reason, 
sulphur is burned in rooms that are infested with bed-bugs. 
The vessel in which the sulphur is placed for the purpose 
is generally stood in a pail of boiling water for the steam 
from the water and the gas from the sulphur (sulphur 
dioxide) unite to form the more active and penetrating 
parasiticide, sulphurous acid. 
374 SULPHIDES, THIOL, ICHTHYOL 
The element sulphur is very active and, in the intestines 
or when it is kept in contact with the skin, it unites readily 
with hydrogen and other elements that it abstracts from 
matter and forms sulphides. The sulphides are somewhat 
irritant to mucous membranes and raw surfaces and they 
are antiseptic and particularly destructive to the organism 
that causes scabies (itch). The use of sulphur as a cathar- 
tic has been already described. For use on the skin it is 
generally employed in the form of ointment or lotion. 
Thiol is prepared by the action of sulphur on tar. It is 
used in powder form and in solution as an antiseptic and 
parasiticide in skin diseases. 
Ichthyol is an asphalt-like material of which deposits 
exist in several parts of the world, but chiefly in the 
Tyrol, where they have developed by the decomposition 
of fossil fish. It contains sulphur, this being an ordinary 
constituent of protein and, therefore, of decomposed 
nitrogenous substances. Various compounds of ichthyol 
are used as antiseptics and parasiticides in the treatment of 
skin diseases. 
375 FORMALDEHYD 
Formaldehyd is a gas that is used for its germicidal 
properties. It is obtained chiefly by the oxidation of 
wood (methyl) alcohol. At a low temperature the gas 
is precipitated as a white powder, known as paraformalde- 
hyd. This is used in compressed forms as a means of 
marketing the formaldehyd for use as a gaseous disin- 
fectant, for; on being heated, it is reconverted into gas. 
Formaldehyd gas is soluble in water in between 37 and 
40 per cent, solution. The solution of formaldehyd is 
very commonly known as formalin. Formaldehyd is very 
irritating to mucous membranes, the eyes and wounds, 
and strong solutions will dry and harden tissue, even the 
skin. Formalin 37-40 per cent, is used chiefly in labora- 
tories, for the preservation of specimens, and as a stock 
solution. Solutions of between 5 and 10 per cents, are 
sometimes used as local bathing lotions to check excessive 
perspiration and they are used to disinfect linen, non- 
metals, utensils and excreta. The material being disin- 
fected must be kept covered (to avoid the escape of the 
gas) and exposed to the influence of the disinfectant for 
from 20-30 minutes. The irritant action of the gas which 
passes from a solution is a great objection to the use of 
formalin and the new phenol and chlorine compounds are 
now more commonly used for most of the above purposes. 
Solutions of formalin as weak as 1:20.00 will inhibit 
the activity of the lactic acid bacilli which cause souring 
of milk and formalin has therefore been much used as a 
milk preservative, but its use for the purpose has been 
condemned for, even in such weak solution, it lessens the 
activity of the digestive ferments and thus may retard 
digestion sufficiently to promote digestive disturbances 
in infants and young .children. Formaldehyd gas has 
376 FORMALDEHYD 
377 
been much used for the disinfection of rooms that have 
been occupied by persons suffering with readily communi- 
cable diseases, but, for the present, bacteriologists believe 
that such disinfection is unnecessary. As formaldehyd 
does not injure the majority of colors nor the fabrics of 
which clothing, blankets and the like are made, it is 
quite commonly used for their disinfection. For the 
purpose, the articles must be placed in a tightly sealed 
room or cupboard and so arranged that all surfaces are 
exposed to the influence of the gas, for the latter has very 
little penetrating power, and exposure to the influence of 
the gas for 12 hours is necessary. The gas may be 
evolved from wood alcohol, or by burning the solid para- 
formaldehyd or by heating formalin and the heat may be 
supplied by adding the formalin to a compound, such as 
potassium permanganate, which reacts readily with the 
latter for, as the result of the reaction intense heat is 
produced. As in the case of sulphur, moisture must be 
provided and the room kept warm. For further informa- 
tion regarding these methods of disinfection see a text- 
book of bacteriology. Formaldehyd is rendered inert 
by alkalies, especially ammonia, and, therefore, exposing 
ammonia in a room that has been fumigated with formalde- 
hyd, will free it of odor and diluted ammonia is used as a 
chemical antidote for poisoning by formaldehyd. The 
symptoms of poisoning and the treatment are the same 
as for other irritants. 
HEXAMETHYLENAMINE OR UROTROPIN 
Formaldehyd is an excellent disinfectant for the urinary 
tract, but formalin is too irritant to the alimentary canal 
to be used and, therefore, hexamethylenamine, commonly 
known by the trade name of urotropin and, sometimes as 
aminoformin and formin, is used. This only liberates 
formaldehyd when it comes in contact with acid. Thus, 
if it is given when there is no free acid in the stomach, as 
when the latter is empty, formaldehyd will not be liberated 378 
MATERIA MEDICA AND PHARMACOLOGY 
until the drug is in the urine. It is given with large 
quantities of water to further its elimination by the kid- 
neys. If, as is often the case when septic conditions of 
the urinary organs exist, the urine is alkaline, acid sodium 
phosphate, which renders the acid, is prescribed, but it 
must not be administered at the same time as the uro- 
tropin. If urotropin is given when there is acid in the 
stomach some of the formaldehyd will be liberated and, 
because of its irritant action, it may induce nausea and 
vomiting. Too large doses of urotropin will induce 
intense irritation of the urinary organs and there may 
be blood, casts and albumin in the urine. 
Preparations and dosages: 
Hexamethylenamine (urotropin), 5-20 grs. (0.3-1.3 gm.). 
Helmitol or hexamethylenamine-methylencitras, 5-15 grs. 
(0.3-1.0 gm.). 
Saliformin or hexamethylenamine salicylas, 5-30 grs. 
(0.3-2.0 gms.). 
Hexalet (hexamethylenamine salicylsulphonic acid), 
15 grs. (1 gm.). DYES 
Many of the dyes used for coloring fabrics are synthe- 
sized from compounds that are similar to phenol and other 
tar and petroleum products. Of these, three have been 
considerably used in therapeutics, viz., flavin, methylene 
blue and scarlet red. 
Flavin, known also as acriflavin, is a yellow dye. It has 
been considerably used lately as a disinfectant for septic 
wounds, usually, in a 1: 1000 solution in an 8 per cent, salt 
solution. 
Methylene blue is used to some extent as an antiseptic 
for the urinary tract in gonorrhea. But its most common 
uses are to test the functional capacity of the kidneys and 
the capacity of the liver to destroy toxins. 
Dosage, for the liver test, % gr. (0.02 gm.) for other 
purposes 2-8 grs. (0.13-0.5 gm.). 
It is given by subcutaneous injection or in capsules. 
The Ever test is based on the fact that, if the liver is 
functioning properly it will be able to take out and elimin- 
ate the small amount of the dye given for the test. Larger 
amounts are eliminated in the urine and if the kidneys are 
functioning properly, the pigment should appear in the 
urine within an hour after its subcutaneous injection 
Scarlet red is used occasionally as an antiseptic tissue 
stimulant for ulcers and sluggish wounds. 
379 SPECIAL USES OF THE VARIOUS ANTISEPTICS 
AND DISINFECTANTS 
By recalling the effects of the various classes of irritant 
drugs it will be appreciated that, whether they induce 
irritation by a simple salt action or by causing some pro- 
nounced chemical change in protoplasm, such drugs act 
as antiseptics and the stronger ones also as disinfectants. 
For various reasons, however, they are not all suited for 
use as antiseptics and disinfectants and, those which 
are, are not all equally efficient for the same purposes. 
Some of the reasons for these facts are: The various species 
of bacteria are not all equally affected by the same chem- 
icals; some disinfectants act more readily upon micro- 
organisms than upon human tissue, while others are only 
germicidal in concentrations that are destructive to 
human tissue or are otherwise poisonous; certain of the 
antiseptics, when applied to sluggish wounds and sores 
stimulate granulation, while others cause changes in pro- 
toplasm that retard healing and some lose their antiseptic 
value when they combine with substances in the wound; 
many of the drugs that are useful disinfectants for certain 
parts of the body, e.g., the gastro-intestinal and the uri- 
nary tracts, also affect other organs in ways that at times 
may be undesirable, while certain ones can be so admin- 
istered that they have little or no action upon other parts 
of the body and these are, therefore, much more commonly 
used; certain disinfectants, because of their action on pro- 
tein, are useless for the disinfection of excreta,1 others 
will destroy or stain metal, fabrics,1 etc.; some disinfectants 
are too expensive for common use and others, while not 
1 The pupils should be required to give examples of disinfectants 
that should not be used for the disinfection of excreta, white 
linen, and colored fabrics. 
380 ANTISEPTICS AND DISINFECTANTS 
381 
themselves particularly expensive, are only soluble in 
liquids, such as alcohol, that are expensive. 
The following lists show the principal uses as anti- 
septics and disinfectants of the drugs commonly used for 
such purposes :x 
For Cesspools and Privy-vaults.-Chlorinated lime, 
milk of lime, unslaked lime, sulphate of iron. 
For Hoppers, Toilets, Bed-pans, and Similar Utensils, 
and Excreta.-Cresol, lysol, creoline, carbolic acid, chlori- 
nated soda, chlorinated lime, and formaldehyd. 
For Instruments.-Alcohol, cresol, lysol, carbolic acid, 
and, as an addition to water in which instruments are 
boiled, sodium carbonate. 
For White Clothing and Bed-linen.-Chlorinated soda, 
chlorinated lime, carbolic acid and formaldehyd. The 
fabrics must be very thoroughly rinsed in several fresh 
supplies of water after the use of chlorine compound. 
For Colored Fabrics.-Formaldehyd gas as described on 
page 377. 
For the Hands.-Alcohol, green soap, lysol, iodine, mer- 
cury, chlorinated lime and soda (when these are rubbed on 
the skin and moistened, chlorine gas is liberated), perman- 
ganate of potash which is followed by the use of oxalic acid 
to remove the stains. 
For the Skin in Preparations for Punctures and Inci- 
sions.-Alcohol, ether, iodine, picric acid, green soap. 
For Use in Wounds.-Dakin's solution and the other 
chlorine preparations mentioned on pages 369-372; iodine 
and the iodine compounds prepared for external use, men- 
tioned on page 334, and potassium mercuric iodide;flavine; 
quinine hydrochloride; hydrogen peroxide; silver com- 
pounds; balsam of Peru; sodium chloride maybe mentioned 
here though, in the percentage in which it is generally 
used for irrigating wounds, it can hardly be called an anti- 
septic, but it is easily sterilized and, being isotonic with 
the blood and tissue fluids, it is non-irritant to tissues. 
1 This book being solely concerned withThe use of drugs, heat 
and other physical means of disinfection are not considered. 382 
MATERIA MEDICA AND PHARMACOLOGY 
For Abrasions, Ulcers and Similar Sores Including those 
Occurring in Parasitic Skin Diseases.-Those used for 
wounds and picric acid, salicylic acid, tar, sulphur, ichthyol, 
thiol, resorcin, chrysarobin, pyrogallol, bismuth com- 
pounds. 
For the Mouth, Etc.-Boric acid, sodium borate, boro- 
glycerine, glycothymoline, listerine, Dobell's solution, euca- 
lyptol, the volatile oils mentioned on page 278, thymol, 
menthol, camphor, creosote, benzoin, potassium chlorate, 
sodium bicarbonate, hydrogen peroxide, potassium per- 
manganate. 
In Vaginal Douches.-Lysol and other cresol prepara- 
tions, green soap, carbolic acid, borosal, boric acid, Dakin's 
solution and other chlorine compounds, iodine, potassium 
mercuric iodide, silver preparations. 
For the Urinary Organs.-Urotropin, and other hexa- 
methylenamine preparations, benzoic acid and its salts, 
salicylic acid and its salts, cubebs, copaiba, sandalwood 
oil, methylene blue. For local irrigations, as of the blad- 
der and urethra, the same antiseptics are used as for 
vaginal douche. 
For Intestinal Antiseptics.-Salol, calomel, the drastic 
cathartics, betanaphthol and compounds of this drug, 
ipecac and emetine are used in amoebic dysentery. For 
local cleansing of the rectum, the antiseptics used as vaginal 
douches. 
For Drinking Water.-Chlorine gas, sodium hypochlor- 
ite and, for small quantities, halazone. Copper sulphate 
is used for the destruction of certain algea, which some- 
times infest reservoirs and other water-supply sources. 
For Food.-Salt, concentrated sugar, spices are the 
legitimate preservatives, but boric acid, borax, salicylic 
acid, formaldehyd and benzoic acid and benzoates are 
commonly, though, illegally, used. DIURETICS 
Diuretics are agents used to increase the secretion of 
urine. The various ways in which they do so were 
mentioned on page 58. As there stated, diuresis is 
induced by a number of drugs that are used for other 
therapeutic purposes; in fact there are very few drugs 
employed exclusively as diuretics. 
The purposes for which diuretics are most commonly 
used intentionally are: (1) To stimulate the kidneys 
when, for any reason, they are inactive; (2) to remove 
water from the blood and thus, by raising its concentration, 
increase the absorption of fluid from the tissues and, there- 
by, reduce dropsy; (3) to further the removal of poisons 
from the body, either those ingested or those formed 
within the body; (4) to dilute the urine in order either to 
lessen the irritant action of poisons on the urinary organs 
or of the urine on the bladder or other urinary passages 
when they are inflamed. 
Preparations and dosage of drugs which stimulate 
without irritating, the kidneys: 
Caffeine, see page 85. 
Theobromine, 5-8 grs. (0.3-0.5 gm.). 
Theobromine sodium sali- 
cylate or diuretin. 
Theobromine sodium ace- 
tate or agurin. 
Theobromine lithium ben- 
zoate or urophen b. 
Theobromine lithium sali- 
cylate or urophen s. 
The usual dosage of 
these double salts of theo- 
bromine is 8-15 grs. (0.5- 
1.0 gm.) but diuretin is 
occasionally used in much 
larger doses up to 120 grs. 
(8.0 gm.). 
Theobromine sodium formate or theophorin, 8 grs. 
(0.5 gm.). 
383 384 
MATERIA MEDICA AND PHARMACOLOGY 
Theophyllin sodium acetate, 3-5 grs. (0.2-0.3 gm.). 
The origin and actions of caffeine have already been 
discussed. 
Theobromine is an alkaloid of similar chemical com- 
position to caffeine. It is derived from the cacao bean and 
is thus a constituent of chocolate and cocoa. Its actions 
are similar to those of caffeine, but it does not affect the 
central nervous system as strongly and its diuretic action 
is more marked. The salts, especially sodium salicylate 
are now more commonly used than the theobromine 
because, as the latter is not very soluble, its absorption is 
uncertain and it is apt to cause gastric disturbances. 
Theophyllin is a similar alkaloid to caffeine and theo- 
bromine. It is obtained from tea leaves and it is made 
synthetically. The synthetic preparation is known as 
theocin. The actions of theophyllin are similar to those 
of theobromine but it is a more powerful diuretic. It is 
likely to cause gastric irritation and, it is thought, in 
large doses renal irritation. 
The drugs which act as diuretics by irritating the kidney 
cells are: Calomel, the urinary antiseptics mentioned on 
page 382, and phenylcinchoninic acid, also a number of 
other drugs are sometimes classified under this heading, 
but, they are so rarely used at present, they need not be 
considered. 
Calomel will produce marked diuresis, especially when 
dropsy exists. Why it does so is not understood, because 
it is not very readily absorbed from the intestines and, 
in the doses that are generally used for the purpose, it can 
hardly promote sufficient irritation to account for the 
copious diuresis. Opium is sometimes used with calomel 
when it is employed as a diuretic in order to lessen peri- 
stalsis and thus allow a larger amount of the calomel to be 
absorbed. For dosage see under Mercury. 
Phenylcinchoninic acid or atophan in addition to in- 
ducing marked diuresis increases the elimination of uric 
acid and, by unknown actions, it lessens the pain of gout. 
It is therefore very commonly used in this disease both DIURETICS 
385 
for its diuretic and analgesic properties. Dose 8 grs. 
(0.5 gm.). It is given with large quantities of water. 
It sometimes cause severe irritation of the alimentary- 
tract with nausea and diarrhea and symptoms of collapse 
and it may induce a skin eruption. 
The drugs commonly used to promote diuresis by 
improving the circulation are those of the digitalis group 
and, when the blood-vessels are abnormally contracted, 
the nitrate salts may act partly in this way. These drugs 
are all discussed elsewhere. 
The drugs commonly used to induce diuresis by in- 
creasing the amount of fluid in the blood-vessels are those 
salts of the alkalies which are most readily absorbed (<e., 
sodium and potassium bicarbonate, and the acetates and 
citrates of sodium, lithium and potassium, especially 
potassium acetate) and urea. The manner in which 
these drugs increase the amount of fluid in the vessels is 
described under Salt Action on page 47. 
The dosage of the salts is given in the section on Antacids. 
The dose of urea is 10-60 grs. (0.5-4.0 gm.). It may 
be given in solution or in capsules. Urea is prepared 
synthetically. It is of similar composition to the urea 
of urine. It is generally given in capsules. 
When diminished excretion of urine is due to some 
functional disturbance that is not associated with any 
organic lesion, as is often the case in fever and post- 
operative anuria, water is the only diuretic required and it 
is a very important diuretic since, by diluting waste and 
toxic material, it lessens irritation of the kidneys by these 
substances. It acts as a diuretic because, merely by its 
presence in the blood, it increases the volume of the latter 
and hence raises the pressure in the renal vessels. VACCINES AND SERUMS 
From early times it has been realized that, in the case of 
many of the diseases now known to be caused by bacteria, 
one attack of a disease confers immunity for that malady, 
but the reason for this immunity (i.e., resistance to disease) 
has only been apprehended in recent years and, even yet, 
is not fully understood. It is believed, however, that, 
when bacteria gain entrance to the body, a fight ensues 
between the bacteria and the body. The bacterial 
weapons consist of the chemical by-products of their 
metabolism, which vary in nature with different species of 
bacteria. Those which produce disease are known as 
toxins. The body has several defences some of which are 
natural constituents of the blood, but others are only 
called into being as the result of bacterial invasion, and 
even the former are normally increased by some infections. 
The body's most important protectives are: (1) The 
white cells of the blood known as phagocytes; (2) anti- 
bacterial substances (i.e., substances which act directly 
upon the bacteria, such as opsonins, bacteriolysins and 
agglutinins) and (3) antitoxins (i.e., substances which 
neutralize the toxins produced by bacteria). 
What is known as the Ehrlich antitoxin theory, though its 
accuracy has not been actually proven, is the generally 
accepted idea regarding the formation of antitoxins. The 
basic facts of this theory are as follows: Cell protoplasm 
contains chemical substances, termed side-chains or 
receptors, that are essential for the assimilation of food 
material by the cells. Toxins of certain bacteria also 
unite with these receptors, but they destroy them. This 
however, stimulates the cells to form new receptors. If 
the quantity of toxin is so great that it combines with the 
receptors as fast as they are made, death will result, but, 
386 VACCINES AND SERUMS 
387 
if the receptors can be formed more rapidly than the toxins 
are produced, the latter will be neutralized and recovery 
is probable. In such case, the cells will not only form 
the receptors needed at the time, but will produce a 
superabundance and the spare ones, which are known as 
antitoxins, are given off to the blood. The latter thereby 
acquires protective properties and, if germs of similar 
species to those which stimulated the formation of the 
antitoxins again invade the body, the antitoxins will 
unite with their toxins and the conditions of disease will 
not develop. The antitoxins produced by different kinds 
of bacteria vary and those formed in response to an attack 
by one species of bacteria will not act upon the toxins of 
other varieties. 
Even less is known of the nature and generation of the 
antibacterial substances than of antitoxins, but, it has 
been found, in the case of some diseases, the blood of an 
infected person and, in some cases, of a person who has 
recovered from a disease, will act in some manner to 
destroy the bacteria causing the disease. For example, 
the serum of the blood taken from a person with typhoid 
will, if added to a culture of the bacilli which cause typhoid, 
cause the latter to become agglutinated, i.e., they become 
precipitated in clumps. 
When a person's own cells form the protective sub- 
stances, the immunity gained is termed active immunity. 
Active immunity may be induced by the use of a vaccine, 
as well as by an attack of a disease. The immunity 
gained by a vaccine is not as enduring as that brought 
about by disease, but it lasts, in most cases, from about 
2 to 4 years. 
A vaccine may consist of toxins, or of dead bacteria, or 
of living organisms the virulence of which has been atten- 
uated in some way as by drying or by growth in the body 
of an animal that does not afford as favorable ground for 
their development as the human being. 
Vaccines are sometimes prepared from bacteria or virus 
taken from the person for whom the vaccine is intended. 388 
MATERIA MEDICA AND PHARMACOLOGY 
These are known as autogenous vaccines, those obtained 
from other sources are usually designated stock vaccines. 
Passive immunity is that gained by the receipt of anti- 
toxins or antibacterial substances that have been formed 
in the body of an animal as the result of the latter's vacci- 
nation with bacteria or their toxins. In such case, the 
individual's own body takes no part in the production of 
the antibodies. Passive immunity is acquired as soon 
as the protective substances are injected, but is transi- 
tory, enduring only a few days, for the injected material 
is excreted or disintegrated in the manner of other drugs 
and the individual's own cells have not gained the power 
of reacting to 'the bacteria or toxin for protection from 
which the injection was made. 
The remedies used for conferring passive immunity 
are called, according to their nature, antitoxin or anti- 
bacterial serum, because their active principles are con- 
tained in blood serum obtained from the animal whose 
body produced them. As a rule, the horse is used for the 
propagation of these protective substances. 
Space will not permit of going into the detail of the 
procedure followed in obtaining these immunizing serums 
but the usual principle is as follows: A horse is injected 
with a small amount of a toxin or a small number of atten- 
uated bacteria, as the case requires, whereupon, the ani- 
mal develops a mild attack of the disease which the toxin 
or bacteria used produce and the specific antibodies are 
formed in its body as previously described. Upon recov- 
ery, the animal is given a larger dose, and so on, until 
even very large doses bring no response, because its blood 
contains a large amount of the specific antibodies. Then 
blood is drawn from, for convenience, the jugular vein. 
This is clotted and the expressed serum is filtered off and 
the amount generally used for a dose put up in sterile 
ampules or syringes. 
Antitoxins, vaccines, etc., are used for prophylactic and 
curative measures and, certain ones to aid in diagnosis. 
By a prophylactic measure is meant, to prevent disease. VACCINES AND SERUMS 
389 
Diphtheria antitoxin is given, as a prophylactic measure, 
to a person who has been exposed to diphtheria; small- 
pox vaccination is performed without even waiting for 
exposure to infection; doses of tetanus antitoxin are used 
if a person has been wounded in a manner likely to cause 
tetanus; and antirabic (hydrophobia) vaccine is given when 
an individual is bitten by an animal that is suspected of 
rabies. Inoculation with these antiserums and vaccines, 
as a rule, produces little or no disturbance and they have 
been proven to be very effective prophylactics against 
particularly fatal and horrible diseases. 
Modes of Administration.-Even the soluble anti- 
bodies of these serums and vaccines are not readily ab- 
sorbed from the alimentary tract and some of them are 
likely to undergo chemical changes if administered by 
mouth, thus they are given either subcutaneously, intra- 
muscularly, intravenously, or, sometimes (smallpox vac- 
cine and certain ones used for diagnosis) by puncture or 
scarification of the skin; and, those used to combat toxins 
or bacteria that affect the central nervous system, may be 
given intraspinally, following lumbar puncture. 
Anaphylaxis.-Following the receipt of vaccines there 
is normally, if the vaccination is successful, a slight degree 
of malaise, but, ordinarily, inoculation with an antitoxin 
or antibacterial serum is not followed by any marked 
discomfort. Some people, however, are very easily 
affected by some proteins and, in such individuals, the 
proteins of the foreign serum may induce what is known 
as serum sickness or anaphylaxis, or, in severe cases, 
anaphylactic shock. It has been found that prophylaxis 
is particularly likely to occur in those who show sensitive- 
ness to other proteins, for example, people who have 
attacks of erythema or asthma following the use of protein 
foods to which they have become sensitized and those 
who have hay-fever if they inhale the pollen of certain 
plants. When there is any reason to fear hypersensitive- 
ness to proteins, a dose of serum is generally given in di- 
vided doses, for example, if the amount of antitoxin, etc. 390 
MATERIA MEDICA AND PHARMACOLOGY 
to be used is contained in 10 c.c. of serum, 0.1 c.c. is admin- 
istered as the initial dose and double this amount is given 
hourly until the full quantity has been administered. 
The patient must be carefully watched and any symptoms 
of disturbance reported at once. 
Common symptoms of mild anaphylaxis are: Slight 
fever, itching and redness of the skin and urticaria. 
Symptoms which indicate a more serious state are: dysp- 
nea, cyanosis, violent coughing, a sense of constriction 
about the chest, marked variations in the pulse, fever and 
skin eruptions. 
Summary of the nature, uses and doses of remedies 
used for conferring immunity: 
For passive immunity: 
1. Antitoxin serum, which consists of serum separated 
from the blood of a horse that has been immunized against 
the toxins of bacteria which produce the specified disease. 
The antitoxin serums in common use are diphtheria anti- 
toxin and tetanus antitoxin. Modifications of antitoxin 
serums are: (a) Concentrated antitoxin, in which the 
protein of the serum with which the antitoxin is combined 
is removed; (6) dried antitoxin, in which the liquid of the 
serum has been evaporated. 
The dosage of the antitoxins is expressed in units; a unit 
being the amount of antitoxin required to neutralize 100 
times the quantity of standard toxin that is required to 
kill a guinea-pig weighing 250 pounds. 
The usual prophylactic dose of diphtheria antitoxins is 
1.000 units; the curative dose, 5.000-40.000 units, the 
larger doses being given when the disease has made con- 
siderable progress. 
The usual prophylactic dose of tetanus antitoxin is 
1500 units, it is given subcutaneously as soon as pos- 
sible after the wound is received. The curative dose is 
3.000-5.000 units, diluted with an equal amount of salt 
solution and given intraspinally, or about 10.000 units 
may be given intravenously. 
2. Antibacterial serum, which consists of serum ob- VACCINES AND SERUMS 
391 
tained from the coagulated blood of a horse that had been 
immunized against a specified strain of bacteria. It 
contains some substance which will destroy the kind of 
bacteria that gave rise to its formation. The names of 
these serums indicate their nature and uses and thus space 
will not be taken to give them here, nor the dosage, for 
this and the value of most of these serums is still somewhat 
undecided. 
For active immunity: 
1. Bacterial vaccines, consisting of suspensions of dead 
bacteria in physiological salt solution with, usually, a 
small amount of a preservative. Certain of the bacterial 
vaccines are known as sensitized vaccines. Sensitized 
vaccines are prepared in the same manner as others, 
except that the bacterial suspensions are treated with the 
serum of an animal that has been immunized against the 
species of bacteria in the vaccine. The serum is then 
removed by centrifugation and the bacterial bodies again 
suspended in salt solution. This treatment is supposed to 
make the bacteria more sensitive to the action of the 
protective forces of the body and thus facilitate their 
destruction. The strength of these vaccines is generally 
specified by the number of bacteria contained in the prep- 
aration. About the most important bacterial vaccines 
in common use are the typhoid, pneumococcus, gonococcus, 
streptococcus, staphylococcus, bacillus coli vaccines. The 
names indicate their nature and uses. The amount of 
a vaccine generally used for a dose is put up in sealed 
ampules or syringes and thus it is not necessary for nurses 
to learn the dosage. 
2. Smallpox virus vaccine is prepared from material 
taken from the pustules of calves who have cowpox or 
vaccinia. The virus is supposed to contain the living 
causative organisms of smallpox the virulence of which 
has been attenuated by growth in the calf, as explained 
on page 387. 
3. Antirabic vaccine or virus consists of the virus of 
rabies (hydrophobia) which has been rendered practi- 392 
MATERIA MEDICA AND PHARMACOLOGY 
cally harmless to man by passage through rabbits. The 
preparation consists of dried sections of spinal cords 
taken from inoculated rabbits, preserved in glycerine 
until required, and then emulsified in physiological salt 
solution. 
4. Diphtheria toxin-antitoxin, commonly termed T.A., 
consists of toxin produced by the bacteria which cause 
diphtheria put up with enough antitoxin to neutralize 
the toxin. The antitoxin, however, does not prevent the 
toxin stimulating the recipient's cells to form antitoxins. 
Thus it produces active immunity. It usually requires 
about three weeks to do so, but, when immunity is estab- 
lished, it is believed to endure for 18 months or, possibly, 
longer. 
Schick's diphtheria immunity test is used to determine 
if a person has sufficient diphtheria antitoxin in their 
blood to render them immune to diphtheria. It consists 
in injecting a small amount of diphtheria toxin intraderm- 
ally. If the person has no free antitoxin in the blood a 
small circumscribed area of redness and infiltration will 
appear at the site of injection within 24 to 48 hours. It 
persists for from 6 to 12 days, is followed by scaling and 
leaves a brown pigmented spot. 
5. Tuberculins.-There are a number of these prepara- 
tions. They are classed as old tuberculins and new 
tuberculins. The so-called old tuberculins resemble the 
original preparation made by Koch and consist of toxins 
produced by tubercle bacilli. Most of the new tuberculins 
are prepared from the dried bacilli. New tuberculins, 
especially, are occasionally used in the treatment of 
tuberculosis, but both varieties are employed chiefly as 
an aid to diagnosis. For this purpose, they are now 
usually given either by hypodermic injection (Koch 
method), or scarification (Pirquet method), or inunction 
(Moro test). The reaction that may occur following 
the Koch method is a slight fever; that to be watched for 
after the other tests is the appearance of small nodules or 
papules at the point of application, within from 24-48 VACCINES AND SERUMS 
393 
hours. A reaction merely indicates that the patient has 
had tuberculosis at some time, and not, necessarily, that 
he is suffering from an active process. 
6. Luetin consists of an extract of killed cultures of 
several strains of the Spirochaeta pallida, the causative 
agent of syphilis. It is used for the diagnosis of syphilis. 
In a normal person an injection will produce no response 
or merely a very slight erythematous area about the point 
of injection, but, if the recipient has syphilis, especially in 
the third stage of the disease, papules, which may develop 
into pustules, are likely to appear. 
Cultures of various strains of bacilli classed as lacto- 
bacilli, because they promote the disintegration of lactose 
(sugar of milk) to lactic acid, are given by mouth either 
in solid (tablet) or liquid form or in milk in which they have 
been grown. Their use is based on the supposition that 
they and their products interfere with the activity of 
putrefactive bacteria always present in the intestine. 
Thus they, especially the strain known as the bacilli 
bulgaricus, have been much used to overcome excessive 
intestinal putrefaction, but it is now thought to be doubt- 
ful if they do so, to any extent, under conditions prevailing 
in the intestine. However, the fermented milks are more 
easily digested than plain milk and afford a nutritious 
food. Slight differences in the preparation of the milk 
in the strain of bacilli used produce preparations with 
slightly different qualities that are known by different 
names, such as Bulgarian milk, matzoon, zoolak, etc. 
Solutions of lacto-bacilli are also used for the irrigation 
of sinuses and cavities, especially the nasal cavity, in the 
treatment of infection by putrefactive bacteria. 
Leucocyte Extract.-This is prepared from exudates pro- 
duced in the pleural cavities of rabbits and other animals 
by the injection of an irritant. 
Dose, not less than 10 c.c. It is usually furnished in syr- 
inges containing this amount and is given subcutaneously. 
Leucocyte extract has been found to increase the im- 
munizing power of the recipient and to aid the action of 394 
MATERIA MEDICA AND PHARMACOLOGY 
antitoxins and vaccines. It will be remembered that 
the leucocytes of the blood and lymph help to protect the 
body from invasion by bacteria. 
Normal horse serum, i.e., serum obtained from the 
clotted blood of normal horses is sometimes given in- 
travenously, in hemorrhage, to hasten clotting of the 
blood. 
Pollen extracts are aqueous solutions of proteins ob- 
tained from the pollen of different plants which are known 
to cause hay-fever. There are a number of such extracts 
made, because, as a rule, the protein obtained from one 
pollen will not overcome sensitiveness due to another; 
for example, if an individual's hay-fever is due to the 
ragweed pollen, it will not be overcome by an extract 
prepared from goldenrod. However, persons subject to 
hay-fever are very likely to be sensitive to most of those 
which occur at certain seasons, as spring or fall. 
These extracts must be used with care and the dose 
regulated according to the individual's sensitiveness, for 
an overdose will cause alarming symptoms, similar to 
those described under anaphylaxis, and possibly death. 
To discover which extract to use, the physician generally 
rubs a small amount of extract into a scratch on the skin, 
if the individual is sensitive to that pollen an urticaria- 
like elevation will result. Small amounts-about 5 to 10 
drops-of a dilution slightly weaker than will produce a 
skin reaction are generally used for the initial doses and, 
first the size of the dose, and then the strength of the 
solution is gradually increased. ORGANOTHERAPY 
EXTRACTS OF ANIMAL ENDOCRINE GLANDS 
By organotherapy is meant the use of extracts of animal 
organs for therapeutic purposes. The extracts are pre- 
pared from the digestive glands and the endocrine (duct- 
less) glands. It is the preparations from the latter source 
that are discussed in this section, those obtained from the 
digestive glands being described under Digestants. 
As yet very little is known of the way in which the secre- 
tions of the various glands produce their effects and, 
therefore, it is of course impossible to account for the 
results following the use of the extracts. 
THYROID EXTRACT 
Thyroid extract is a powder prepared from the thyroid 
gland of animals, usually sheep. The thyroid, it will be 
remembered, is a two-lobed ductless gland so situated 
that there is a lobe on each side of the trachea. It manu- 
factures a secretion that is absorbed by the blood and 
carried about the body. The active principle of the secre- 
tion is an organic compound containing iodine and known 
as iodothyroglobulin and iodothyrin. 
Dose 1-10 grs. (0.06-0.6 gm.). 
The uses of thyroid extract will be better understood if 
the results of abnormal functioning of the gland are re- 
called. It will be remembered that inactivity of the gland 
in a child results in decrease in the growth of the bones in 
length, but not in thickness, so that the child is stunted; 
also, the skull becomes misshapen; the sexual organs do 
not develop; mental deficiency is marked, and the pituitary 
gland becomes enlarged, because the body conditions 
induced by the lack of thyroid secretion stimulate the 
pituitary gland to increased activity. 
The conditions produced in the adult by deficient secre- 
tion are: Muscular weakness, mental apathy, thickened 
skin that has a waxy appearance and is generally cold and 
dry; the hair falls out and a peculiar edema develops under 
395 396 
MATERIA MEDICA AND PHARMACOLOGY 
the skin and mucous membranes which gives an appear- 
ance of obesity to the body; the sexual organs are so 
affected that menorrhagia is common in women and im- 
potence in men. 
In thyroidism-excessive activity of the thyroid-there 
is usually rapid wasting of the tissues and consequent 
emaciation; excessive nervousness; sleeplessness; tachy- 
cardia; digestive disturbances; diarrhea; diuresis; and 
sometimes exophthalmos (protrusion of the eyeball) as 
the result of widening of the eyeslits and retraction of 
the ciliary muscles. 
Thus, it can be seen, a normal quantity of the thyroid 
secretion is essential for normal metabolism, and the 
normal functioning of the nervous system and the organs 
of generation. 
The common therapeutic uses of thyroid extract are: To 
supply the body with the necessary amount of the active 
principle of the secretion when the individual's own gland 
is not functioning properly; to stimulate metabolism and 
thus overcome conditions such as obesity and rickets. 
If thyroid extract is given in too large amounts or when 
the body does not require it, conditions similar to those 
caused by over-activity of the gland will develop. 
Antithyroidin (Moebius) consists of blood-serum ob- 
tained from sheep whose thyroid glands have been re- 
moved. 
Dose, 8-15 m. (0.5-1.0 c.c.). 
Thyreoidectin is a powder prepared from the dried blood 
of animals whose thyroid glands have been removed. 
Dose, 5-10 grs. (0.3-0.6 gm.). Antithyroid prepara- 
tions are used to overcome the effects of thyroidism. 
ANTITHYROID PREPARATIONS 
PITUITARY PREPARATIONS 
These are obtained from the pituitary glands of cattle. 
Preparations and dosage: 
Pituitary extract (desiccated hypophysis), 1-4 grs. (0.06- 
2.6 gm.). ORGANOTHERAPY 
397 
Liquor hypophysis, 15 m. (1.0 c.c.). 
Pituitrin, 5-15 m. (0.3-1.0 c.c.). 
The above preparations are made from the posterior 
lobe of the gland. 
Desiccated pituitary substance, 1-4 grs. (0.06-0.25 gm.), 
this is made from the anterior lobe of the gland. 
Pituitary body desiccated, 1-3 grs. (0.06-0.2 gm.), this 
is made from the whole gland. 
The pituitary, it will be remembered, is a two-lobed 
gland held by a cord-like structure to the under surface 
of the cerebrum. The structure of the two lobes is 
different and also the functions of their secretions. 
The effects of the secretion of the front lobe is somewhat 
similar to that of the thyroid gland and the two secretions 
are thought to be compensatory, to some extent, one to 
the other for, it has been repeatedly found, when the 
thyroid gland is removed or is not furnishing sufficient 
secretion the anterior lobe of the pituitary becomes en- 
larged and vice versa. 
Removal of a portion of this anterior lobe in animals 
has been followed by decreased growth, the persistence 
of infantile characteristics, hypertrophy of the thyroid; 
accumulation of fat, especially in the abdomen; retarded 
development of the sex organs; decrease in the rate of the 
heart action and in breathing; diminished excretion of 
carbon dioxide and, sometimes, glycosuria. 
Hypertrophy of the anterior lobe, if it occurs in child- 
hood, gives rise to the condition known as gigantism in 
which the individual grows to an excessive size and there 
is precocious sexual development followed, after a time, by 
a decrease in the activity of the sexual organs and mental 
impairment. If the condition occurs after body growth 
has ceased, only the feet, hands and features are likely to 
increase in size. This is known as acromegaly. 
The therapeutic uses of the anterior lobe extract are: In 
stunted growth (dwarfism); obesity; premature menopause. 
The posterior lobe of hypophysis, it has been found, can 
be removed without causing any marked symptoms, but 
various experiments have shown that its secretion, known 398 
MATERIA MEDICA AND PHARMACOLOGY 
as pituitrin or hypophysin, stimulates the heart muscle 
and plain muscle tissue, especially that of the arterioles, 
the intestines, uterus and the ducts of the mammary 
glands. It increases protein catabolism, but appears to 
lessen the assimilation of sugar, for glycosuria sometimes 
follows its use. Also, it is thought to antagonize the 
effects of the anterior lobe on sexual development. 
The therapeutic uses of pituitrin were given in the sec- 
tion dealing with drugs that obtain their chief effects by 
stimulating plain muscle tissue. 
OVARIAN EXTRACT 
Ovarian extract is a powder prepared from the ovaries 
of animals, usually pigs. 
Dose 1-3 grs. (0.06-0.2 gm.). 
The internal secretion of the ovaries (in the female) and 
the testes (in the male), it is believed, exercise a direct 
influence on metabolism by increasing the oxidative energy 
of cells, thus favoring catabolism. There is also almost 
conclusive evidence that the differences in the sex char- 
acteristics are due to a very considerable degree to the 
specific actions of these two secretions. The ovarian 
secretion also influences the condition of the uterus and 
menstruation. 
Ovarian extract is used chiefly in the treatment of: 
Circulatory and nervous disturbances that occur at the 
menopause and following removal of the ovaries; amenor- 
rhea; dysmenorrhea; headache, nervousness and abnor- 
mal conditions due to irregular menses; sterility. 
Corpus luteum extract is prepared from the corpora 
lutea of cows' ovaries. 
Dose 2-5 grs. (0.13-0.3 gm.). 
Lutein is prepared from the corpora lutea of hogs. 
Dose 2-10 grs. (0.13-0.6 gm.). 
The corpus luteum, it will be remembered, is the tem- 
porary glandular structure that forms in the Graafian 
CORPUS LUTEUM EXTRACT AND LUTEIN ORGANOTHERAPY 
399 
follicle after the escape of an ovum and undergoes marked 
development when pregnancy occurs. The secretion of 
the corpus luteum influences the uterine mucosa, bringing 
about the changes that occur in menstruation, thus 
preparing the mucosa for the embedding of an ovum. 
Also, it has been suggested, that in pregnancy, this 
secretion may overcome the characteristic nausea, be- 
cause this ceases when the glandular structure reaches its 
acme of development. 
Corpus luteum extract and lutein are used chiefly: 
To relieve the nervous conditions associated with the 
menopause; to overcome dysmenorrhea and amenorrhea; 
and persistent vomiting, especially during pregnancy. 
Following large doses and, sometimes, even small ones 
there may be intense headache and, if given by mouth, 
excessive nausea and vomiting. 
PLACENTAL EXTRACT 
Desiccated placenta is used as a galactagogue, i.e., to 
increase the secretion of milk. 
This is prepared from the mammary gland of sheep, it is 
said to have an effect on the uterus which lessens menor- 
rhagia (abnormally profuse menstruation). 
Dose 2-5 grs. (0.13-0.3 gm.) or 1-3 pills. 
MAMMARY SUBSTANCE 
PARATHYROID AND THYMUS GLANDS 
Other glands of which extracts are being tested to 
ascertain their value in the treatment of conditions which, 
apparently, their secretions prevent are the parathyroids 
and the thymus. 
Dose desiccated parathyroid, gr. (0.006 gm.). 
The parathyroids are small glandular bodies lying in 
close proximity to the thyroid gland. Their function 
is not understood, but they are thought to yield a secre- 
tion that in some way controls metabolism and the use 
of the calcium salts by the nerve and muscular tissues, 
because, it has been found, when the glands are removed, 400 
MATERIA MEDICA AND PHARMACOLOGY 
the elimination of calcium is increased and the condition 
known as tetany induced. Tetany is characterized by 
hyper-excitability of the neuro-muscular mechanism and 
consequent spasmodic contractions of muscles, and cal- 
cium is known to lessen neuro-muscular excitability. 
The thymus is a gland situated in the chest, behind the 
sternum. It gradually atrophies after puberty. When it 
is removed in young animals there will be: imperfect growth 
and defective calcification of the bones, abnormal deposits 
of fat in different parts of the body; instability of the 
nervous system with tremors or convulsions and, finally 
death. It is thought that after puberty the other glands, 
especially the parathyroids compensate the body for the 
gradual inactivity of the thymus, i. 
For preparations of the suprarenal capsules see Epine- 
phrine, pages 197 to 201. 
Thromboplastic Substances.-The so-called thrombo- 
plastic substances are preparations used to hasten the 
clotting of blood. It will be remembered that the clot- 
ting of blood depends upon the change of the soluble 
fibrinogen of the blood to the insoluble fibrin which 
change is brought about by a substance known as 
thrombin that is developed from a substance known as 
prothrombin by the action of the calcium salts of the 
blood and a substance termed thrombokinase and throm- 
boplastin, which is liberated chiefly from red blood plate- 
lets when they are destroyed, but also, under the same 
circumstance, from other tissue cells, especially those 
containing what is known as phosphated kephalin, a 
substance that is particularly abundant in the brain 
and spinal cord. 
The thromboplastic preparations in common use are: 
Brain extract. Brain lipoid. Kephalin. Thrombo- 
plastin. Coagulen. The four first mentioned prepara- 
tions are made from the brain or spinal cord of cattle 
and coagulen from red-blood platelets. They are gen- 
erally used locally, being sprayed over the bleeding part 
or applied on a dressing, but they are sometimes given 
intravenously or intramuscularly. NUTRIENTS 
Certain foods that are made use of in the treatment of 
disease are sometimes considered with drugs. These are: 
(1) Foods specially prepared for the use of diabetics; 
(2) glucose, which is often given by rectum when food 
cannot be taken by mouth, as a rule, however, it can only 
be given in this way in dilute solution, about 5 cent., and 
in small quantities at a time, 5-6 ounces, because large 
amounts and stronger concentrations cause irritation and 
consequent expulsion of the solution; (3) partially di- 
gested foods, such as (a) the malt extracts mentioned on 
page 116, (6) milk preparations such as kumyss, matzoon, 
etc. (e) digested meat products, such as peptones, used 
in nutritive enemata, and panopepton, a preparation of 
beef and wheat predigested with pancreatin and dissolved 
in sherry, dose ounce; (4) cod-liver oil. 
Cod-liver oil (oleum morrhuae), which is extracted from 
the livers of codfish, is the only one of the above nutrients 
not described in text-books of dietetics. The oil, partly 
because of its disagreeable flavor and odor and partly 
because it was formerly supposed to owe its very decided 
nutritional value to the iodine, chlorides, phosphates and 
similar compounds which it contains, has always been 
considered as a medicine rather than a food, but it is now 
believed that the various medicinal substances are present 
in too minute quantities to be of any therapeutic value 
and that the improvement in nutrition which so often 
follows the use of cod-liver oil is due to the fact that the 
oil is an easily digested and readily assimilated'fat that 
contains a larger amount of the vitamine which is particu- 
larly essential for growth and the prevention of rickets 
than most foods, except cream and good, fresh butter.1 
1 See foot-note, page 238. 
401 402 
MATERIA MEDICA AND PHARMACOLOGY 
Preparations and dosage: 
Cod-liver oil, 1-25 (4.0-8.0 c.c.). 
Emulsion of cod-liver oil, 2-45 (8.0-16.0 c.c.). This is 
a 50 per cent, preparation of the oil in acacia, flavored with 
wintergreen and sugar. 
There are also a number of non-official preparations 
of the oil with other substances and of so-called extracts, 
but, it is believed that if any of the latter preparations 
have good effects they owe them to their other constituents 
as the oil contains no valuable extractive matter. OXYGEN 
The oxygen required by the body to maintain the oxida- 
tive processes necessary for life is absorbed by the hemo- 
globin of the red corpuscles as the blood is flowing through 
the lungs. A very small amount of oxygen, about 0.6 
per cent., may go into simple solution in the blood, but 
oxygen is not very soluble in blood plasma. The amount 
of oxygen that hemoglobin can combine with is limited 
but, up to the limit of the latter's capacity,- the degree 
of pressure that the oxygen exerts is, under normal condi- 
tions, the main factor in determining the amount of com- 
bination. The degree of pressure that the oxygen exerts 
depends, of course, upon the quantity inhaled. Under 
ordinary circumstances, except at high altitudes (where 
atmospheric pressure is diminished) and in very badly 
ventilated buildings, the amount of air inhaled contains 
as much oxygen as the hemoglobin can combine with and 
this, if the amount of hemoglobin is normal and there is 
nothing to interfere with its combining power, is as much 
oxygen as the body can utilize. Conditions which inter- 
fere with the power of the hemoglobin to combine with 
oxygen are, reduced alkalescence of the blood and changes 
in the nature of the hemoglobin such as occur in poison- 
ing by carbon monoxide gas and in poisoning by drugs that 
change the hemoglobin to methemoglobin. 
When conditions exist that interfere with breathing, or 
with the ready diffusion of air through the lungs, or with 
the power of the hemoglobin to absorb oxygen, pure 
oxygen given by inhalation may be of great assistance in 
maintaining life, for it diffuses more readily through the 
lungs and the walls of the alveoli into the blood than when, 
as in air, it is mixed with nitrogen, also, it is believed, that, 
due to the increased pressure, a greater amount than usual 
goes into solution in the blood. 
403 404 
MATERIA MEDICA AND PHARMACOLOGY 
Inhalation of pure oxygen is likely to induce slowing of 
the heart action and a slight rise of blood pressure. These 
results are believed to be due to reflexes induced by irri- 
tation of the mucous membrane by the oxygen, for pure 
oxygen causes drying of the mucous membrane and 
irritation. To prevent bad effects from this local action, 
oxygen is passed through water when it is given by inhala- 
tion, for this moistens it and thus lessens its irritant action. 
Also, when oxygen has to be given for any length of time, 
a common prescription is to keep the air over the patient's 
bed moist with steam. 
Oxygen is most commonly used in conditions associated 
with cyanosis and dyspnea, for these phenomena indicate 
an insufficiency of oxygen in the body. Decrease of 
these symptoms and slowing and strengthening of the 
pulse are the indications of beneficial results that are to 
be watched for. CLASSIFICATION OF THE MORE IMPORTANT 
DRUGS ACCORDING TO THEIR THERA- 
PEUTIC USES 
This classification has been based chiefly on the Thera- 
peutic Index in the 1920 reprint of "Useful Drugs" and 
on the list of drugs classified according to their therapeutic 
uses in the seventh edition of "A Text-Book of Pharma- 
cology and Therapeutics," by Arthur R. Cushny. Its 
principal purpose is to afford a basis for recall and review 
and the pupils should be required to state how each drug 
produces the effects for which it is used. 
Drugs Applied for their Local Action to the Skin, Wounds 
or Visible Mucous Membranes 
Local analgesics and an- 
odynes for pain and 
itching: 
Local anesthetics: 
Emollients: 
Protectives: 
Corrosives or caustics: 
Aconite. Aqua ammonia. Atropine. 
Carbolic. Chloretone. Chloroform. 
Cocaine. Menthol. Orthoform. 
Sodium bicarbonate. Some volatile 
oils (in dentistry). 
Cold obtained by the evaporation of 
ether or ethyl chloride. Cocaine. 
Novocaine. Quinine and urea chlor- 
ide. 
Bland oils, such as olive and cotton 
seed. Cold creams. Lanolin. Lard. 
Petroleum. Vaseline. 
Starch and dusting powders. Many 
of the insoluble metallic powders, but 
especially those of bismuth. Collod- 
ion. Wax. Paraffines. Emollients. 
Glacial acetic acid. Trichloracetic acid. 
Mineral acids. Carbolic acid. Burnt 
alum. Silver nitrate. Arsenious acid 
and arsenious anhydride. Ammoni- 
ated mercury. Potassium carbonate. 
Potassium hydroxide. Sodium car- 
bonate. Sodium hydroxide. Zinc 
chloride. 
405 406 
MATERIA MEDICA AND PHARMACOLOGY 
Astringents: 
Styptics: 
To contract vessels and 
reduce hemorrhage and 
swelling: 
Antiseptics and disin- 
fectants : 
Alcohol. Alum. Aluminium acetate. 
Bismuth preparations. Copper sul- 
phate. Iron preparations. Lead acet- 
ate. Silver nitrate. Zinc chloride. 
Burnt alum. Iron perchloride. Silver 
nitrate. 
Adrenaline. 
See page 380. 
Drugs Used for Affections of the Alimentary Tract 
Mouth and throat: 
Demulcents: 
Flavoring substances: 
Astringents: 
Antiseptics: 
To lessen salivation: 
Stomach: 
Digestives: 
To stimulate secretion: 
Carminatives: 
Absorbents: 
Antacids: 
Emetics: 
To lessen irritation and 
vomiting: 
Acacia. Tragacanth. Syrups. 
Glycerine. 
Citric acid. Volatile oils. Spices. 
Syrup of Tolu. Saccharine. Sugars. 
Glycyrrhiza. 
Tannin group. Chlorates. Claret. 
Myrrh. 
See page 380. 
Atropine. 
Hydrochloric acid. Pepsin. 
The bitters: Cinchona, Quinine. Gent- 
ian. Nux vomica. Strychnine. 
Alcoholic beverages. Camphor. Chlo- 
roform. Ether. Capsicum. Spices. 
Volatile oils such as cardamom, 
peppermint, turpentine, asafoetida. 
Carbonated beverages. Carbonates 
and bicarbonates. For infants, anise 
and peppermint water. 
Charcoal. Kaolin. 
Potassium and sodium carbonates and 
hydroxides. Magnesia. Magnesium 
carbonate. Lime-water. Chalk. 
Common salt. Warm water. Must- 
ard. Ipecacuanha. Tartar emetic. 
Copper sulphate. Zinc sulphate. 
Apomorphine. 
Bromides. Chloral. Chloretone. 
Morphine. Opium. Bismuth. Car- 
bonated beverages. Demulcents. 
Lime-water. Ice. Cocaine. MORE IMPORTANT DRUGS 
407 
Intestine: 
Absorbents: 
Antiseptics: 
Anthelmintics: 
Carminatives: 
To promote evacua- 
tion: 
To lessen movement: 
To relax spasms: 
To promote digestion: 
As on page 406. 
See page 380. 
See page 287. 
As above. Also physostigmine and 
pituitrin. 
See list of cathartics on pages 257-260. 
Opium. Morphine. Tannic acid and 
its compounds. Bismuth. Lime- 
water. Lead acetate. Boiled starch. 
Atropine and, especially combined with 
cathartics, volatile oils (see page 283). 
Pancreatin. Diastase. 
To stimulate the respira- 
tory center: 
To reduce the irritability 
of the cough center: 
To increase and liquefy 
the bronchial secretion 
(expectorants): 
To lessen the secretion of 
the bronchi: 
To relax bronchial spasm 
in asthma: 
Drugs Used for Their Effects on the Respiratory System 
Atropine. Carbon dioxide 5-10 per 
cent, with oxygen. Caffeine. Strych- 
nine. 
Bromides of the alkalies. Chloral 
series. Codeine. Heroine. Mor- 
phine. 
Ammonium carbonate. Apomorphine. 
Iodides of the alkalies. Ipecacuanha. 
Eucalyptus. Senega. Squills. Tar- 
tar emetic. 
Ammonium chloride. Balsam of Tolu. 
Benzoic acid. Benzoin. Terpin hy- 
drate. 
Adrenaline. Amyl nitrate. Nitrogly- 
cerine. Atropine. Belladonna. Stra- 
monium. Cubebs. Lobelia. Iodides. 
Stimulants: 
Of spinal cord: 
Of medulla and cere- 
brum: 
Depressants: 
To paralyze sensation: 
To induce sleep and 
rest: 
To relieve pain: 
Drugs Used for Their Effects on the Nervous System 
Strychnine. 
Caffeine. 
General anesthetics. 
Hypnotics mentioned, pages 132 and 
136-140. 
The analgesics mentioned on pages 144- 
147 and 157. The salicylic acid group. 
Local anesthetics and anodynes, men- 
tioned on pages 176 and 182-185. 408 
MATERIA MEDICA AND PHARMACOLOGY 
In epilepsy: 
To relieve headache: 
To relieve cerebral con- 
gestion : 
In cerebral anemia: 
Bromides. 
Analgesic antipyretics. Acetylsalicylic 
acid (aspirin). Caffeine. Quinine. 
Menthol (externally). 
Nitrite group. Hydragogue cathartics. 
Adrenaline. Pituitary extract. Digi- 
talis group. 
Drugs Used for Their Effects on the Circulation 
By effects on the heart: 
To strengthen contrac- 
tion: 
To accelerate pulse: 
To slow the pulse: 
By effects on the vessels: 
To contract caliber 
and raise blood-pres- 
sure: 
To relax vessels and 
lower blood-pressure: 
To arrest internal hemor- 
rhage: 
To remove fluid, as in 
dropsy: 
Drugs Used for 
To increase hemoglobin: 
To reduce leucocytosis: 
To increase the number 
of white cells in the 
blood: 
To increase the alkali: 
Digitalis group and camphor. 
Atropine. Caffeine. 
Digitalis group. Aconite. 
Adrenaline (intravenously). Digitalis. 
Caffeine. Ergotoxin. Pituitary ex- 
tract. Strychnine. 
Nitrite series. Hydragogues. 
Adrenaline. Ergot. Hydrastis. Mor- 
phine. Pituitary extract. 
Digitalis. Diuretics. Diaphoretics. 
Hydragogue cathartics. 
Their Effects on the Blood 
Arsenic. Iron. 
Arsenic. Benzol. Quinine. 
Leucocyte extract. 
Acetates. Citrates. Sodium and po- 
tassium carbonates and bicarbonates. 
Drugs Used to Increase the Secretions oe Sweat 
(Diaphoretics) 
Camphor. Ipecac, usually in the form 
of Dover's powder. Pilocarpine. 
Sweet spirits of niter. Tartar emetic. 
Drugs Used to Lessen Diaphoresis 
Atropine. Belladonna. Agaricin. 
Drugs Used to Reduce Fever Temperature 
(Antipyretics) 
Analgesic antipyretics, see page 157. 
The salicylic acid group. Quinine. MORE IMPORTANT DRUGS 
409 
Drugs Used to Stimulate the Secretion of Bile 
(Cholagogues) 
Salicylic acid. Fei bovis. 
Drugs Used for Their Effects on the Urinary Organs 
To increase the flow of 
urine (diuretics): 
To render the urine less 
acid: 
To render the urine more 
acid: 
To render the urine anti- 
septic : 
Caffeine. Theobromine and its com- 
pounds. Theophyllin. Theocin. 
Calomel. Volatile oils mentioned on 
page 382. Digitalis. Strophanthus. 
Squills. The nitrites. Pituitary ex- 
tract. Urea. Sodium, potassium and 
lithium bicarbonates. Sodium and 
potassium acetates, citrates and 
tartrates. 
Potassium acetate, citrate and bicar- 
bonate. Sodium carbonate and bi- 
carbonate. 
Sodium biphosphate. Mineral acids. 
See urinary antiseptics, page 382. 
Drugs Used for Their Effects on the Uterus 
To promote contraction 
(ecbolics): 
To increase menstruation 
(emmenagogues): 
To lessen the menstrual 
flow: 
To lessen contractions of 
the uterus and thus re- 
lieve painful menstrua- 
tion: 
Ergot. Pilocarpine. Pituitary extract. 
Hydrastinine. Quinine. 
Iron. Aloes. Myrrh. 
Hydrastis. 
Atropine. Analgesics and counter- 
irritants are also used to relieve pain 
during menstruation but these do not 
directly affect the uterus. 
Drugs Used on the Skin to Produce Remote Effects 
To lessen secretion of Atropine and belladonna, 
milk: 
For counterirritation: 
Ammonia. Camphor. Cantharides. 
Iodine. Liniments. Mustard. Tur- 
pentine. Oils of birch and winter- 
green. 
Drugs Used Locally for Their Effects on the Eye 
To diate the pupils and 
relax accommodation ' 
(inydriatics, cycloplegics). 
Atropine. Homatropine. Hyoscine, 
Cocaine. 410 
MATERIA MEDICA AND PHARMACOLOGY 
To contract the pupils 
and ciliary muscles 
(miotics): 
Physostigmine or eserine. Pilocarpine. 
In malaria: 
In syphilis: 
In diphtheria: 
In tetanus: 
In cerebro-spinal fever: 
In amoebic dysentery: 
In rheumatic fever: 
In myxedema and some 
other thyroid diseases: 
In gout: 
In obesity: 
In chronic rheumatism: 
In diseases of the bone 
such as osteomalacia 
and rickets: 
Drugs Used for Specific Diseases 
Quinine. Arsenic. 
Arsenic. Mercury. Iodides. 
Antidiphtheritic serum. 
Antitetanic serum. Bromides. Chloral. 
Magnesium intraspinally. 
Antimeningococcus serum. 
Ipecac. Emetine 
Salicylates. 
Thyroid extract. Iodides. 
Colchicum. Atophan 
Thyroid extract. Saline purgatives. 
Arsenic. Iodides. Alkalies. 
Calcium. Phosphorus. Arsenic. 
Thyroid extracts. NOTES ON NEW DRUGS NOTES ON NEW DRUGS NOTES ON NEW DRUGS NOTES ON NEW DRUGS NOTES ON NEW DRUGS NOTES ON NEW DRUGS NOTES ON NEW DRUGS NOTES ON NEW DRUGS INDEX 
The asterisk* indicates drugs mentioned in "Useful Drugs," 
see page 18. 
Abbreviations used in writ- 
ing prescriptions, 43 
Absorbents, 50, 224, 225 
Absorption of drugs, 29-31 
* Acacia, 220 
Acetal, 138 
*Acetanilid, 157, 161 
Acetates, 237, 240, 241 
*Acetic acid, 236-238 
*Acetphenetidin (phenacetine), 
157-161 
* Acetylsalicylic acid (aspirin), 
351, 356 
Acidol, 230 
Acidosis, 233 
*Acids, inorganic, 230-235 
nature of, 23 
organic, 235-239 
*Aconite, 186, 406, 409 
*Acriflavin, 379 
Action, terms used in describ- 
ing the site of a drug's 
action, 45 
Active principles, what is 
meant by, 32 
Actol, 305 
Adaline. 138 
*Adeps (lard), 221 
Adonidin, 211 
Adonis vernalis, 211 
*Adrenaline, 197-201 
*Agar-agar, 257 
dose? 260, 261 
Agaricin, 187 
Agurin, 383 
Airol, 299 
Albargin, 305 
Albolene, 220 
Alcohol, ethyl or grain, 115- 
129 
methyl or wood, 128 
*Alkalies, 23, 241-248 
Alkaloids, nature of, 23 
* Aloes, 258 
dose, 266 
*Aloin, 258 
dose, 266 
*Alum, use as anthelmintic, 
298 
use as astringent, 287, 288 
* Aluminium, 298, 299 
Alypin, 183 
Aminoformin, 37 
*Ammonia acetate, 246 
actions of, 245-248 
*aromatic spirits of, 246 
*benzoate, 356 
bromide, 140 
carbonate, 246 
chloride, 246 
salicylate, 351 
water, 245 
* Ampules, 28 
*Amyl nitrate, 216 
dose, 219 
Amylene chloral, 139 
hydrate, 138 
Analgen, 157-161 
Analgesic antipyretics, 157- 
161 
Analgesics, nature of, 51 
Anaphylaxis, nature of, 390 
Anesthesin, 184 
Anesthetics, general, 98-115 
history of, 98 
local, 175-186 
nature of, 50 
Anhydrotics, nature of, 51 
Anodynes, nature of, 51 
Antacids, 240, 241 
nature of, 51 
Antagonistic action, 49 
411 412 
INDEX 
Anthelmintics, 287-292 
nature of, 51 
*Anthracene cathartics, 257, 
258 
dosage, 265-267 
Antiarthritics, 357 
nature of, 51 
Antibacterial substances, na- 
ture of, 387 
Antiemetics, 51, 407 
*Antifebrin (acetanilid), 157, 
161 
Antiformin, 372 
Antikamnia, 157-161 
* Antimony, 332-333 
Antinervine, 157 
Antiperiodics, 51 
Antiphlogistine, 285 
Antipyretics, 51, 157-161 
drugs used as, 408 
*Antipyrine, 157 
Antirabic vaccine, 392 
Antiseptics, 52, 380-382 
Antisialogogue, 52, 407 
Antispasmodics, actions of, 52 
drugs, used as, 409 
Antithyroid preparations, 396 
*Antitoxins, 388-390, 411 
Ehrlich's theory of, 386 
Apenta water, 259 
Aperients, 52 
Apinol, 282 
Apiol, 275 
Apioline, 275 
Apocodeine, 145, 155, 260 
dose, 272 
*Apocynum; 211 
Apomorphine, 145 
dose, 154, 155 
Argentamine, 305 
Argonin, 305 
* Argyrol, 395 
Aristochin ,344 
*Aristol, 335 
Aromatic powder, 275 
dose, 284 
Arsacetin, 322 
*Arsenic, 321-328 
antidotes, 309 
preparations and dosage, 
321-322 
Arsenobenzol. See Arsenic. 
*Arsenous acid. See Arsenic. 
Arsphenamine. See Arsenic. 
*Asafetida, 275 
dose, 279, 282, 406 
Asaprol, 157 
*Aspidium, 288, 289 
Aspirin, 351, 356 
Astringent action, 47 
Astringents, inorganic, 297- 
307 
organic, 293-297 
Atophan, 357, 384-385 
Atoxyl. See Arsenic. 
*Atropine, 164-172, 405, 407, 
408, 409 
Bacterial vaccines, 391 
*Balsam of Peru, 366, 367, 382 
*Tolu, 366, 367, 408 
*Balsams, nature of, 366 
*Barbital (veronal), 136, 137 
Barbital-sodium (medinal), 136 
*Belladonna, 163 
preparations and dosage, 
172 
*Benzanilide, 157 
*Benzoates, 366, 382 
*Benzoic acid, 366, 367, 382 
*Benzoin, 366, 367 
*Beta-Eucaine, 182 
Betain hydrochloride, 230 
Betanaphthol, 364, 382 
Bichloride ot mercury, 313, 
316-318, 381 
*Birch, oil of, 351, 352, 353 
*Bismuth, 299 
preparations and dosage, 
301, 382 
Bitter almond, syrup of, 185 
*Bitters, 52, 226 
Black wash, 314 
Blackberry, 299 
*Blaud's pills, 308 
*Blue mass, 259 
dose, 268 
*Boric acid, 230, 234, 235, 
382 
Borneol valerate, 277 
*Boroglycerin, 235 
Borosal (Thiersch's powder), 
352, 382 
Bougie, 24 INDEX 
413 
Brain extract, 400 
lipoid, 400 
♦Brandy, 117 
Bromal hydrate, 138 
♦Bromides, 140-144 
Bromism, 143 
Bromoform, 138 
Bromural, 138 
Brovalol, 140 
Brown's cough mixture, 145 
Buchu, 275 
Bulgarian tablets, 393 
Butyl chloral hydrate, 138 
Cacao (cocoa) butter, 221 
Cachets, nature of, 27 
Cacodylates, 322 
Cacodylic acid, 321 
Cade, oil of, 278 
♦Caffeine, 85-89 
Cajuput, 275 
♦Calcium( lime), 249-253 
preparations and dosage, 
250 
♦Calomel, 259 
as diuretic, 384 
dose, 267, 268 
♦Camphor, 275 
dose, 276, 281, 282 
♦Camphorated oil. See Cam- 
phor. 
Cannabis Indica, 156 
♦Cantharides, 286 
♦Capsicum, 276 
dose, 282 
Capsules, nature of, 27 
Carbolic acid, 358-362, 381, 
382 
Carbon dioxide, 95-97 
♦Cardamom, 276 
dose, 282, 407 
♦Cardophylus. See Cloves. 
♦Carlsbad salt, 259 
Carminatives, action of, 53, 
282, 283 
drugs used as, 407, 408 
♦Carron oil, 252 
♦Cascara sagrada, 258 
dose, 266 
♦Castor oil, 259 
dose, 268 
Castor-lax, 259 
Catharsis, physiology of, 256 
Cathartics, 53, 254-273 
classification of, 257 
data that it is of importance 
for nurses to remember 
regarding, 273 
dosage of, 257-259 
Caustics, action of, 53 
drugs used as, 405 
Cerates, nature of, 24 
Cerium oxalate, 222 
♦Charcoal, 225 
♦Chenopodium, 276, 288 
dose as anthelmintic, 289, 290 
♦Chloral, 132-136 
camphor, 139 
Chloralamide, 138 
Chloralose, 139 
♦Chloramine-T, 371 
Chlorazone, 371 
Chlorcosane, 371 
Chloretone, 139 
♦Chlorinated lime, 370, 381, 382 
♦Chlorine compounds, 369- 
372, 381, 382 
♦Chloroform, 107-110 
Cholagogues, action of, 53 
drugs used, as, 410 
Chromic acid, 373 
♦Chrysarobin, 368 
♦Cinchona, 343 
dosage, 350 
Cinchonidine, 344 
Cinchonine, 344 
Cinchonism, 349 
Cincophen (Novatophan), 384, 
385 
Cinnamic acid, 366, 367 
♦Cinnamon, oil of, 276 
dose, 278, 283 
Circulatory stimulants, drugs 
used as, 408 
how drugs may act as, 
53-56 
♦Citrates, 237, 240-241, 259 
♦Citric acid, 235, 236 
dose, 238 
Classification of drugs ac- 
cording to their effects, 50- 
61 
♦Cloves, oil of, 276 
dose, 278, 283 414 
INDEX 
Coagulation of blood, causes 
of, 401 
Coagulen, 400 
♦Cocaine, 175-181, 405, 406 
substitutes, 182-184 
Cocoa-butter, 221 
*Codeine, 146 
dose, 155 
*Cod-liver oil, 402-403 
Coffee, 89 
*Colchicum, 257, 411 
Cold cream, 221 
Collargol, 305, 306 
*Collodions, 28, 223 
♦Colocynth, 260 
Colocynthin, 260 
Compound cathartic pill, 260 
licorice powder, 260 
dose, 269, 270 
Confections, nature of, 24 
Conium, 188 
Constipation, causes and 
means of preventing, 255 
Convallaria, 211 
dose, 216 
Convallarin, 211 
*Copaiba, 276 
dose, 278, 283, 382 
*Copper, 301, 302 
Cornutol, 202 
Corpus luteum extract, 398, 
399 
Counterirritants, 57, 285 
*Cream of tartar, 240 
Creoline, 363, 381 
♦Creosote, 364, 365, 382 
♦Cresols, 362, 363, 382 
Croton chloral, 138 
♦oil, 260 
dose, 271 
Cubebs, 276 
dose, 278, 382 
Cumulative action, 50 
Curara, 188 
Cusso, 288 
dose, 290 
Cycloform, 184 
Cycloplegics, nature of, 57 
drugs which act as, 410 
♦Dakin's solution, 370, 371 
Decoction, nature of, 26 
Defecation, physiology of, 254 
Demulcents, nature of, 57, 
219-221 
Depilatories, 57 
Depression, nature and causes 
of, 49 
Dermol; 300 
Diasp inn, 351 
Diaphoretics, drugs most com- 
monly used as, 409 
nature and actions of, 57 
Diastase, 229 
Diazyme essence, 227 
♦Dichloramine-T, 371, 372 
Digalen. See Digitalis. 
Digestants, 57, 227-229, 407 
Digipuratum. See Digitalis. 
Digitalin. See Digitalis. 
♦Digitalis, 210 
dose, 215, 409 
Digitol. See Digitalis. 
Digitoxin. See Digitalis. 
Dilution of drugs, 33 
*Dionine, 145 
dose, 154 
*Diphtheria antitoxin, 390 
immunity test, 392 
toxin-antitoxin, 392 
Disinfectants, nature of, 58 
used for special purposes, 
380, 382 
volatile, oils used as, 278 
Diuretics, actions of, 58, 383- 
385 
drugs most commonly used 
as, 410 
*Diuretin, 383 
Dobell's solution, 358 
*Donovan's solution, 322 
Dormiol, 139 
Dosage, factors governing, 33 
for children. Young's rule 
of estimating, 34 
methods of computing, 39- 
42 
♦Dover's powder, 341 
*Drastic cathartics, 58, 260 
preparations and dosage, 
269-271 
Drug habit, 131 
Drugs, absorption of, 29-31, 
action of, 45-61 INDEX 
415 
Drugs, administration of, 29, 
31, 32, 35 
classification according to 
their more important uses, 
406, 411 
constituents of, 22, 23 
derivation and nature of, 
21, 22 
how to facilitate the study 
of, 19, 20 
most commonly used for 
specific diseases, 
411 
for their actions on 
alimentary 
tract, 407, 408 
on blood, 409 
on circulation, 
409 
on eyes, 410, 411 
on nervous sys- 
tem, 408, 409 
on respiratory 
system, 408 
on skin for local 
effects, 406, 
407 _ 
on skin for re- 
mote effects, 
410 
on urinary or- 
gans, 410 
on uterus, 410 
to increase diaphore- 
sis, 410 
to lessen diaphoresis, 
409 
to stimulate secre- 
tion of bile, 410 
pharmaceutical prepara- 
tions of, 24-28 
what students of nursing 
should learn about, 18, 19 
Dyes used as disinfectants, 379 
Ecbolics, drugs used as, 410 
nature of, 58 
Elarson, 322 
*Elaterine, 260 
Elixirs, nature of, 26 
Emetics, action of, 58 
drugs used as, 407 
*Emetine, 341, 342 
Emmenagogues, drugs used 
as, 410 
nature of, 59 
Emollients, 59, 221, 222, 
406 
Emulsions, nature of, 26 
*Endocrine glands, 395-400 
Enemata, 272 
*Epinephrine, 197-201 
Epispastics, 59 
*Epsom salt. See Magnesium 
sulphate. 
Ergamine, 203 
*Ergot, 201-206 410 
preparations and dosage, 
202 
Ergotoxin. See Ergot. 
Erigeron, 276 
Eriodictyon, 345 
Ernutin, 202 
Erythrol tetranite, 216 
dose, 219 
Escharotics, 53, 59, 406 
*Eserine (physostigmine), 194- 
197, 410 
*Ether, 99-107 
Ethyl bromide, 111 
*chloride, as general anes- 
thetic, 110, 111 
as local anesthetic, 175 
*salicylate, 351, 352, 353 
*Eucalyptol, 276 
*Eucalyptus, 276 
dose, 278, 283, 407 
Eucaine, 182 
Eucodeine, 146 
Eudoxin, 300 
Eugenol, 276 
dose, 278 
Eumydrine, 164 
dose, 172 
Euonymus, 257 
dose, 260 
Eupad, 372 
Euquinine, 344 
Eusol, 372 
Exalgine, 157 
dose, 161 
Exodyne, 157 
Expectorants, action of, 59 
drugs used as, 408 416 
INDEX 
Extracts, nature of, 24 
leucocyte, 393 
pollen, 394 
FELbovis, 260 
dose, 270 
Fennel, 283 
Fermentation, 115 
Ferratin, 309 
*Ferric chloride, 308 
hydroxid, 309 
Ferro-mangan, 309 
*Ferrous lactate, 309 
Filicic acid, 288 
dose, 289 
Flavin, 379 
Fluidextracts, nature of, 26 
*Formaldehyd, 376, 378, 381 
*Formalin, 376, 377, 381 
*Formin (urotropin), 377, 378 
*Fowler's solution, 322 
Frangola, 258 
dose, 267 
Galactagogues, action of, 59 
Gambir, 294 
Gamboge, 260 
Gaultheria, oil of, 351 
Gelsemium, 188 
*Gentian, 226 
*Ginger, 276 
dose, 283 
Glauber's salt, 259 
Glonoin (nitroglycerine), 216- 
219 
Glucosides, nature of, 24 
*Glycerine, 221, 257 
dose, 261 
*Glycerites, 26 
Glycerophosphates, 330 
*Glycyrrhiza, 220 
dose, 269, 270 
*Guaiacol, 364, 365 
*Gums, 220 ' 
H/Emaboloids, 309 
Halazone, 372 
Harrington's solution, 314 
Heat regulation, 51 
Hedonal, 139 
Helmitol, 378 
Hematinics, 60, 409 
*Heroine, 145 
dose, 154 
Hexalet, 378 
*Hexamethylenamine, 377 
Holadin, 227 
Holocaine, 183 
*Homatr opine, 164 
dose, 172 
Hormonol, 260 
dose, 272 
Horse serum, 394 
Hamulus, 156 
Hunyadi water, 259 
Hydracetine, 157 
Hydragogues, 60, 257 
*Hydrastinine, 209, 210 
*Hydrastis, 208, 210 
Hydriodic acid. See Iodine. 
*Hydrochloric acid, 230 
dose, 232, 407 
Hydrocyanic acid, 184-186 
*Hydrogen peroxide, 373 
*Hyoscine, 164 
dose, 172-174 
*Hyoscyamine, 164 
dose, 172, 174 
*Hyoscyamus, 164 
dose, 174 
Hypnone, 139 
Hypnosis, nature of, 128 
Hypnotics, 60, 132 
*Hypochlorites, 370 
Hypochlorous acid, 376 
Hypophosphates, 329-331 
*Hypophysis, liquor of, 397 
ICHTHARGAN, 305 
Ichthyol, 371, 382 
Idiosyncrasy, what is meant 
by, 34 
Imagination, 75 
Immunity, active, 387 
passive, 388 
Infusions, nature of, 26 
Insomnia, causes of, 129 
locamphen, 335 
lodalbin, 335 
*Iodides, 334-340, 408, 411 
*Iodine, 334-349, 381 
lodipin, 334 
lodism, 339-340 
lodival, 334 INDEX 
417 
lodocasein, 335 
♦Iodoform, 334 
dose, 336, 339 
Iodol, 334 
lodophine, 158 
Ipecac, 341, 342 
Irish moss, 220 
♦Iron, 308 
preparations and dosage, 
312 
Irritation, nature of, 48 
Isopral, 139 
Itrol, 365 
♦Jalap, 260 
Judgment, 75 
Juniper, 276 
dose, 283 
Kamala, 288 
dose, 290 
Kaolin, 224, 225 
Kephalin, 400 
Kino, 294 
♦Labarraque's solution, 370 
Lactic acid, 236-238 
Lacto-bacilli, 393 
Lactophenine, 352 
Lactucarium, 157 
♦Lanoline, 221 
♦Lard, 221 
Laudanum, 145 
Laxatives, 60, 257 
♦Lead, 302-304 
Lecithin, 330 
Lecithol, 330 
Leptandra, 257 
Leucocyte extract, 393 
Licorice (glycyrrhiza), 220, 
269, 270/ 
♦Lime-water, 250, 252, 288 
Liniments, nature of, 26 
uses of, 410 
Liquors, 117 
Lithium, 241, 244, 251, 259 
Lobelia, 190 
Local effect, what is meant by, 
29 
Logwood, 294 
Lozenges, nature of, 25 
Lubricants, nature of, 60 
Luetin, 393 
Lupulin, 156 
Lutein, 398, 399 
Lycopodium, 224 
♦Lysol, 363, 382 
♦Magnesium antacids, 249 
*cathartics, 259 
dosage, 262 
♦sulphate, use as an anes- 
thetic, 113-115 
Majendie's solution, 145 
Malakine, 352 
Malaria, special methods of 
using quinine in, 344 
Malt extracts, 228 
liquors, 116, 120 
Mammary substance, 339 
Manganese, 312 
Manna, 257 
Mannitol, 216 
dose, 219 
Materia medica, definition of, 
17 
*Medinal, 136 
♦Menthol, 276 
dose, 278, 283 
♦Mercurial cathartics, 259 
preparations and dosage, 
267, 268 
♦Mercury, 312-321 
preparations and dosage, 
313, 314 
Mesotan, 352, 353 
Methacetine, 158 
♦Methyl salicylate, 351 
dose, 352, 353 
Methylal, 139 
Methylatropine, 164 
dose, 172 
Methylene blue, 379 
Migrainin, 157 
♦Milk of magnesia, 249 
♦Mineral oils, 257 
dose, 261, 262 
Miotics, action of, 60 
drugs used as, 410 
Mixtures, nature of, 26 
♦Morphine, 145 
dose, 147-154, 407 
♦Muriatic acid (hydrochloric 
acid), 230, 232, 407 418 
INDEX 
Muscarine, 194 
*Mustard, 276 
dose, 283, 406 
Mydriatics, action of, 60 
drugs used as, 409 
*Myrrh, 296, 297 
Naphthalin, 364 
Naphthol, 364 
Narcophine, 164 
dose, 154 
Narcotics, 98 
*Neo-arsphenamine. See Ar- 
senic. 
*Neosalvarsan. See Arsenic. 
Nervous system, autonomic 
portion of, 79-87 
results of stimulation of 
sympathetic and para- 
sympathetic portions of, 
82 
review of structure and 
functions of, 70 
Neurodine, 352 
Neuronol, 139 
Nicotine, 189, 190 
*Nitrites, 216 
preparations and dosage, 
219 
*Nitrogly cerine, 216-219 
Nitrohydrochloric acid, 200 
Nitrous oxide, 112, 113 
Novargan, 305 
Novaspirin, 351 
Novatophan (phenylcincho- 
ninic acid), 384, 385 
*Novocaine, 182 
Nutgalls, 294 
Nutrients, 402, 403 
*Nux vomica, 90-94 
*Oils, fixed, 221 
* volatile, 274-284 
Ointment, nature of, 22 
Oleum ricini (castor oil), 259, 
268 
*01ive oil, use as cathartic, 257 
dose, 269 
use as emollient, 221 
*0pium, 144 
preparations and dosage, 
147-154 
Optochin, 344 
dose, 349 
Organotherapy, 395-400 
Orphol, 300 
Orthoform, 184 
Ouabain, 211 
dose, 215 
Ovarian extract, 398 
Ovoferrin, 309 
Oxalic acid, 236 
*Oxgall, 260 
dose, 270 
Oxidizing agents, 373 
*Oxygen, 404, 405 
Panase, 227 
Pancreatin, 227, 228 
Pankreon, 227 
Pantopon, 145 
Papaverine, 145 
dose, 155, 156, 219 
Paraffines, 222 
Paraformaldehyd, 376 
Paraldehyde, 137 
Parathyroid glands, 399, 400 
Paregoric, 145 
*Pelleterine, 288 
dose, 291 
Pelvic organs, congestion of, 
256, 280 
Pennyroyal, 275 
Pental, 111 
Pepo, 288 
dose, 291 
*Peppermint, 275 
dose, 283 
*Pepsin, 227, 228 
*Peptonizing powder, 227 
Permanganate of potash, 312, 
373 
*Peronine, 145 
dose, 154 
*Peroxide of hydrogen, 373 
*Petroleum, 22, 221, 261, 262 
dose, 257 
Pharmacologic action, 50 
Pharmacology, definition of, 
17 
Pharmacopceia, 17 
*Phenacetine, 157-161 
Phenocoll, 158 
*Phenol compounds, 358-365 INDEX 
419 
Phenolid, 158 
*Phenolphthalein, 258 
dose, 256, 266 
*Phenylcinchoninic acid (ato- 
phan), 384, 385 
*Phosphorus, 329 
preparations and dosage, 
331 
Physiologic action, 50 
*Physostigma, 194 
dosage, 197 
*Physostigmine, 194-197 
salicylate, as cathartic, 260 
dose, 272 
*Picric acid, 363 
Pills, nature of, 25 
*Pilocarpine, 191 
dose, 194 
*Pilocarpus, 191, 194 
*Pine oil, 276 
dose, 283 
*Pituitary extract, 207, 208 
cathartic dose, 260 
gland, functions of, 397 
*preparations, 396 
Pituitrin, 397, 398 
Placental extract, 399 
Plasters, nature of, 25 
Pluto water, 259 
*Podophyllum, 260 
dose, 270 
Poisoning, common causes of 
death by, 264 
nature of treatment for, 
64-69 
Poisons, chemical antidotes 
for, 66 
classification of, 62 
Pollen extracts, 394 
Pomegranate, 288 
dose, 291 
*Potassium acetate, 240 
*bicarbonate, 241, 244 
*bitartrate (cream of tartar), 
240 
dose, 259 
*bromide, 140 
*carbonate, 241 
*chlorate, 297, 298 
*citrate, 259 
*hydroxid, 241-244 
*iodide. See Iodides. 
*Potassium nitrate (saltpeter), 
216 
*permanganate, 312, 373 
*sulphate, 259 
*sodium tartrate, 240 
Powders, nature of, 25 
Prescriptions, 42, 43 
Propaesin, 184 
Prophylactics, 60 
Proponal, 139 
Protan, 294 
*Protargol, 305 
Protectives, 60, 219-223 
body's natural, 386 
*Protiodide of mercury, 314 
Pumpkin-seed, 288 
dose, 291 
Purgatives, 60, 257, 258 
Pyramidon, 157-161 
Pyrogallol, 364 
Quassia, 288, 289 
*Quinine, 343 
and urea chloride, 184 
preparations and dosage, 
350 
Reasoning, 75 
Reducing agents, 374 
Reflex action, what is meant 
by, 78 
Regulin, 258 
Remedies, how drugs may act 
as, 46 
Rennin, 227 
*Resins, 274 
*Resorcin, 363, 364 
Rhinitis tablets, 163 
*Rhubarb, 258 
dose, 267 
*Rochelle salt, 259 
Rubefacients, 60, 285 
Rue, 275 
dose, 280 
Sage, 280 
Sajodin, 334 
Salicin, 352 
*Salicylates, 351 
preparations and dosage, 
356 420 
INDEX 
*Salicylic acid, 351, 356 
Saliformin, 378 
Saline cathartics, 259 
dosage, 262-265 
*Salol, 351 
dose, 356 
Salophen, 352 
Saloquinine, 344 
salicylate, 352 
*Salt action, nature of, 47 
Salts, origin of, 23 
*Salvarsan. See Arsenic. 
*Sandalwood, oil of, 276 
dose, 278, 283 
*Santonin, 288 
dose, 291 
Saponins, nature of, 24 
Scammony, 266 
Scarlet red, 379 
Schick's immunity test, 392 
Scoparius, 188, 189 
Scopola, 164 
dose, 174 
*Scopolamine, 164 
dose, 172-174 
*Seidlitz powder, 259 
Self-control, 75 
Senna, 258 
dose, 267 
*Serums, antibacterial, 380 
*antitoxin, 386, 387, 390 
horse, 394 
mercurialized, 314 
normal, 394 
*Silver, 304-306 
preparations and dosage, 
305 
Sleep, theories regarding na- 
ture of, 128, 129 
Slippery elm, 220 
Smallpox virus vaccine, 391 
Soamin. See Arsenic. 
*Soap, green, 382 
*Sodium arsenate. See Arsenic. 
*benzoate, 366 
*bicarbonate, 241 
dose, 245 
*borate (borax), 234 
*bromide. See Bromides. 
*carbonate, 241 
dose, 245 
*chloride, 381 
*Sodium citrate, 259 
*hydroxide, 241, 245 
hypochlorite, 376 
*iodide. See Iodine. 
Mitra te, 216 
dose, 219 
*phosphate, 259 
*salicylate, 351 
Solutions, nature of, 27 
Soporifics, 60 
Spartein, 188, 189 
Specifics, drugs used as, 411 
nature of, 60 
Spermaceti, 221 
Spices, 274, 284 
Spigelia, dose, 292 
Spirisal, 352 
Spirits, nature of, 27 
*Squill, 211 
compound syrup of, 322 
Mose, 215, 216 
*Stearoptens. See Volatile 
oils. 
Sterule, nature of, 28 
Stimulation, nature and re- 
sults of, 48 
Stomachics, how remedies may 
act as, 60 
Stovaine, 180 
*Stramonium, 164 
dose, 174 
Strontium salicylate, 351 
*Str ophan thin, 211 
dose, 215 
*Strophanthus, 210 
dose, 215 
*Strychnine, 90 
dose, 94 
Styptics, drugs used as, 407 
nature of, 61 
Subamine, 314 
Sublimation, what is meant 
by, 313 
*Sulphonal, 137 
*Sulphur, as cathartic, 257 
dose, 262 
external use, 371 
Sulphuric acid, 239, 232 
Suppositories, nature of, 25 
use of, 272 
Susceptibility, what is meant 
by, 34 INDEX 
421 
*Sweet spirits of niter, 216 
dose, 218 
Synergistic action, 30 
Tablets, nature of, 26 
Talcum, 224 
Tamarind, 257 
Tannacol, 294 
*Tannalbin, 294 
Tannigen, 294 
*Tannin, use as anthelmintic, 
288 
as astringent, 293, 296 
Tannoform, 294 
Tannon, 294 
Tannopin, 294 
Tansy, 275 
dose, 280 
Tars, nature of, 22 
oil of, 277 
dose, 278, 284, 382 
*Tartar emetic. See Anti- 
mony. 
*Tartrates, 235-237, 240, 241 
Tea, 89 
Teniacides, 61, 287 
*Terebene, 276 
dose, 284 
*Terpin hydrate, 276 
dose, 284 
*Tetanus antitoxin, 390 
Tetronal, 137 
Thalline, 157 
*Theobromine, 383, 384 
Theocine, 384 
Theophorin, 383 
*Theophyllin, 384 
Therapeutic action, definition 
of, 59 
Therapeutics, definition of, 
17 
Thermodine, 158 
Thiersch's powder, 352 
Thioform, 300 
Thiol, 375 
Thromboplastic substances, 
400 
Thymocetine, 158 
*Thymol, 276, 278, 288 
dose, 292 
Thymus glands, 399, 400 
Thyreodectin, 396 
*Thyroid extract, 395 
Thyroidism, 396 
Tincture, nature of, 27 
Tobacco, 189, 190 
Tolerance, what is meant by, 
34 
*Tolu, 366, 367 
Tonics, how remedies act as, 
61 
Toxicology, 17, 62-69 
*Tragacanth, 220 
Tricresol, 362 
*Trinitrin (nitroglycerine), 216- 
219 
*Trinitrophenol (picric acid), 
363 
*Trional, 137 
Triphenin, 158 
Troche, nature of, 26 
Tropocaine, 183 
Trypsin, 227 
*Tuberculins, 392, 393 
*Turpentine, use as anthelmin- 
tic, 288 
dose, 292 
as carminative, 276 
dose, 278, 284 
Tussol, 157 
Twilight-sleep, 173 
Tyramine. See Ergot. 
Urea, 385 
Urethan, 139 
Urophen, 383 
*Urotropin, 377, 378 
Uva-ursi, 277 
* Vaccines, 386-393 
antirabic, 392 
autogenous, 388 
bacterial, 391 
sensitized, 391 
smallpox virus, 391 
* Valerian, 277 
dose, 279, 284 
Validol, 277 
Vegetable cathartic pills, 260 
Vermifuges, 61, 288, 289 
*Veronal, 136 
Vesicants, nature of, 61 
Vioform, 335 422 
INDEX 
*Volatile oils, 274-285 
preparations and dosage 
of, 275-277 
Warburg's tincture, 343 
Waters, nature of, 27 
*Waxes, 24, 221 
Weights and measures, 36-39 
Whiskey, 117 
*Wild cherry, syrup of, 185, 186 
Wines, 21, 116,120 
*Wintergreen, oil of, 351, 352, 
353 
Witch hazel, 294 
Xeroform, 300 
Yellow wash, 314 
*Zinc, 307