A 
TREATISE ON THERAPEUTICS, 
COMPRISING 
MATiim MEDICA AND TOXICOLOGY, 
WITH 
e^Wal reference to the application of 
THE PHYSIOLOGICAL ACTION OF DRUGS 
TO CLINICAL MEDICINE. 
BY 
H. C. WOOD, M.D., LL.D., 
Ilf 7 7 7 
PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS, AND CLINICAL PROFESSOR OF DISEASES OF THE 
NERVOUS SYSTEM IN THE UNIVERSITY OF PENNSYLVANIA; NEUROLOGIST TO THE PHILADEL- 
PHIA HOSPITAL; CONSULTING PHYSICIAN TO THE PHILADELPHIA HOSPITAL FOR 
THE INSANE, AND TO BURN BR2E INSANE ASYLUM; MEMBER OF THE 
NATIONAL ACADEMY OF SCIENCE ; FOREIGN ASSOCIATE 
MEMBER OF THE SOCI^T^ FRAN^AISE 
d'hygiene, ETC. 
SIXTH EDITION, 
PHILADELPHIA: I1I2A 
J. B. LIPPINCOTT COMPAQ? 
LONDON: 15 RUSSELL STREET, COVENT GAUON.- 
188 6. Entered, according to Act of Congress, in the year 1875, by 
J. B. LIPPINCOTT & CO., 
In the Office of the Librarian of Congress, at Washington. 
Copyright, 1879, 1882, and 1883, by J. B. Lippincott & Co. 
Copyright, 1885, by J. B. Lippincott Company. TO 
DR. GEORGE B. WOOD, LL.D., 
THIS BOOK 
IS DEDICATED BY THE AUTHOR, HIS NEPHEW. 
AS A TOKEN OF RESPECT AND AFFECTION. PREFACE TO THE FIRST EDITION. 
At the present time, when the shelves of private and public libraries are 
groaning beneath their ever-increasing loads, when a thousand presses in every 
city send forth day and night their printed messages until the earth is filled 
with them, it seems almost presumptuous for any one to offer new volumes to 
the world. Indeed, art is so long, life is so short, that every student has the 
right to demand of an author by what authority he doeth these things, and 
to challenge every memoir for its raison d'etre. This being so, it assuredly 
will not appear egotistical for the author to state that his voluntary task was 
first suggested by his own wants, and that to its performance he has brought 
the training, labor, and experience of years spent in the laboratory, the study, 
the class-room, and the hospital ward. 
There are a number of excellent treatises upon materia medica and thera- 
peutics ; yet in various attempts at original research, as well as in the ward 
and the lecture-room of the hospital, I have keenly felt the want of something 
more. There are many points of view from which a subject can be looked at; 
there are many paths by which it may be approached; and to me, other points 
of view, other modes of approach, have been far more enticing than those 
adopted in our standard treatises. 
The old and tried method in therapeutics is that of empiricism, or, if the 
term sound harsh, of clinical experience. As stated by one of its most ardent 
supporters, the best possible development of this plan of investigation is to be 
found in a close and careful analysis of cases before and after the administra- 
tion of a remedy, and, if the results be favorable, the continued use of the 
drug in similar cases. It is evident that this is not a new path, but a highway 
already worn with the eager but weary feet of the profession for two thousand 
years. 
That very much has been thus accomplished it were folly to deny. 
Leaving out of sight the growth of the last two decades, almost all of the 
current therapeutic knowledge has been gained in this way. 
Therapeutics developed in this manner cannot, however, rest upon a secure 
foundation. What to-day is believed is to-morrow to be cast aside, certainly 
has been the law of advancement, and seemingly must continue to be so. 
What has clinical therapeutics established permanently and indisputably ? 
Scarcely anything beyond the primary facts that quinia will arrest an inter- 
mittent, that salts will purge, and that opium will quiet pain and lull to sleep. 
To establish therapeutic facts the profession clings as with the heart 
VII VIII 
PREFACE TO THE FIRST EDITION. 
conclusion is a non-sequitur, and difference of susceptibility is no proof of dif- 
ference in the mode of impression. A teaspoonful of Epsom salt may purge 
one man, whilst it may require ounces to affect another. Evidently there is 
a difference of susceptibility; but when the impression is once made it is of 
the same character in each case. As with man and man, so with man and 
the pigeon.-susceptibility is no measure or gauge of the character of the 
impression. 
A large number of drugs-indeed, it may be said, the larger number of 
important drugs-exert in the system antagonistic actions. Thus, atropia 
stimulates the spinal cord, but destroys the conducting power of the nerve- 
trunks. It is evident that as one or the other of these influences predomi 
nates, will there be convulsions or paralysis. Now, if for any reason one 
animal be exceedingly sensitive to the spinal action of atropia, that animal 
will in belladonna-poisoning suffer from convulsions, whilst its fellow, which 
is affected chiefly by the nerve-action of the drug, will, under like circum- 
stances, have paralysis. Here the mere clinician, with his superficial knowl- 
edge, seeing the paralyzed and the convulsed lying side by side, says, What 
a hopeless muddle ! Poor fools, these vivisectors ! they will never come to 
any good! In truth, the differences in symptoms in these and in many 
other cases simply depend upon differences in susceptibility; and the only 
lesson that the circumstance teaches is the importance of discovering the laws 
which govern these susceptibilities. 
A law which governs the susceptibility to the action of drugs is, that the 
more highly specialized any system is, the more readily affected is it by a 
medicine. Thus, the cerebrum of a man is far more highly organized than 
that of any other animal, and consequently he is far more sensitive to the 
action of drugs which affect the cerebrum than are the lower forms. Again, 
in the frog the spinal system is especially developed,-probably, in proportion to 
the cerebrum, more so than in any other of the animals commonly experimented 
with: consequently the batrachian is excessively sensitive to remedies which, 
like strychnia, affect the spinal cord. In obedience to this law, we have 
resulting the action of opium,-an action which has been considered the 
strongest proof of the hopelessness of any attempt to explain the effects of 
drugs upon a man by experiments upon the lower animals. In man, opium 
causes deep stupor and general relaxation; in the frog, it causes tetanic con- 
vulsions. The explanation of these seeming inconsistencies is, however, very 
evident when the whole subject is looked at. Opium in all animals has a 
double action, one upon the cerebrum and one upon the spinal centres. In 
the frog, the latter being the more highly organized, the spinal action over- 
comes the cerebral; in man, the cerebrum being the more sensitive, stupor 
replaces the convulsions: yet in man convulsions sometimes occur in opium- 
poisoning, and in the frog the dose can be so managed as to cause stupor. 
A second law which seems to hold sway over the action of drugs upon 
different animals is that great differences of function in a system affect its PREFACE TO THE FIRST EDITION. 
IX 
relation to drugs: thus, in a herbivorous animal the alimentary canal is very 
different from what it is in the carnivora, whose digestive organs in turn 
differ from those of man,-the omnivore. Medicines which act upon the 
alimentary canal are apt to vary in their effects upon different orders of animals. 
Converse to the above law is that which renders systems which are little 
specialized similarly acted upon by drugs in different classes of animals. 
Thus, the general structure and the functions of the circulatory system are 
very uniform among vertebrates, as is also the action of those drugs which 
affect chiefly the circulation: thus, aconite, or digitalis, or potash, influences 
in the one way the heart of the frog, of the rabbit, and of man. 
There are a very few apparent exceptions to the uniformity of the action 
of drugs upon all animals, which seemingly contravene the laws that have 
been mentioned. These exceptions are so few, however, that without doubt ad- 
vancing knowledge will by-and-by explain them all and show what are the laws 
which for the time being hold in abeyance or overcome those already stated. 
An asserted fact, which has recently been brought forward as revealing 
the worthlessness of animal experimentation, is that some monkeys are not 
susceptible to the action of strychnia, whilst others are. Granting the truth 
of the asserted fact, it certainly is explainable. It is at least conceivable 
that a given species of animal may, by the gradually-acquired habit of feed- 
ing upon a substance containing a narcotic poison, acquire an insusceptibility 
to the influence of that poison, which shall, as it were, belong to its specific 
type, or, in other words, be an acquired specific character. The nervous 
system of the opium-eater becomes accustomed to the stimulant, and it is not 
impossible that a measure of the habit should be transmitted. If the Dar- 
winian law of the gradual evolution by the survival of the fittest have any 
force, these curious apparent freaks of medicines in regard to their physio- 
logical action may be the result of this law, especially since it is species which 
are affected. It is not all monkeys that are proof against strychnia, but, as 
we are distinctly told, only one species of monkey; and, so far as I know, it 
is not all deer that are said to thrive when fed upon tobacco, but only the 
Virginia deer. Whether this conception be or be not a mere fancy, this much 
is to my mind very clear, that the few scattered exceptions ought not to out- 
weigh the immense mass of evidence upon the other side, and that it is incon- 
ceivable that drugs, in their relations to animal organisms, differ from all other 
created things in not being subject to law. 
In the early portion of this preface I stated that the work had grown out 
of a need felt by myself: that need was for a book into which should be 
gathered the many scattered facts in regard to the physiological action of 
medicine,-a book in which an attempt should be made to sift the true from 
the false, to reconcile seeming differences, to point out what we know and 
what we do not know, and to give a platform from which investigators might 
start forward without the necessity of being, as is so often the case, ignorant 
of what was already achieved, or of spending a great deal of time in a wild X 
PREFACE TO THE FIRST EDITION. 
hunt through the almost boundless, but often scattered and inaccessible, 
ranges of Continental literature. 
The plan of the present work has been to make the physiological action of 
remedies the principal point in discussion. A thoroughly scientific treatise 
would in each article simply show what the drug does when put into a healthy 
man, and afterwards point out to what diseases or morbid processes such action 
is able to afford relief. Unfortunately, in the great majority of cases our 
knowledge is not complete enough for this, and the clinical method has to be 
used to supplement the scientific plan. 
I have added to the book a consideration of toxicology, so far as it is of 
interest to the physician. This has been done for several reasons. First, it 
was necessary to study the action of poisonous drugs upon man, in order to 
make out their physiological action; secondly, physicians are constantly re- 
quired to diagnose and to treat cases of poisoning ; thirdly, it is often of the 
greatest importance for a medical man in a court of law to be able to state 
what are the symptoms and post-mortem appearances produced by a given 
poison, what diseases they simulate, and how far and in what they differ from 
the phenomena of these diseases. That part of the science of toxicology 
which treats of the recognition of poisons in the cadaver, or in food and 
drink, belongs to the domain of the chemist, and I have avoided it altogether. 
For a similar reason, in the sections on materia medica, the chemical relations 
of mineral substances have not been discussed at all. 
Preface to the Sixth Edition.-The rapid exhaustion of the successive 
editions has not only stimulated the author to render the volume, as far as 
lay in his power, worthy of the kind judgment and continued favor of his 
co-laborers, but has given him an opportunity to maintain its freshness. 
Comparatively few persons have a full conception of the rapid advancement 
of therapeutic science or the amount of labor involved in keeping up with 
such advance. Although only two years have elapsed since the last edition 
of this treatise, yet nearly four hundred papers have been studied in pre- 
paring the present one. An article upon Cocaine has been added, the 
chapter upon Disinfectants entirely rewritten, old literature restudied, and 
every endeavor made to have the book represent even more thoroughly than 
before the best therapeutic thoughts of the day. TABLE OF CONTENTS. 
Introduction.-Pharmacy-Therapeutics-Materia Medica-Pharmacopoeia 
-Preparations-Effects of Medicines-Classification. 
PART L-DRUGS. 
DIVISION I.-SYSTEMIC REMEDIES. 
SUBDIVISION I.-GENERAL REMEDIES. 
Astringents.- Vegetable Astringents.-Tannic Acid-Gallic Acid-Gfclls- 
Catechu-Kino-Hajmatoxylon-Khatany-Oak Barks-Roses-Geranium 
-Sumach. 
Mineral Astringents.-Alum-Sulphate of Aluminium-Lead and its 
Preparations-Bismuth and its Preparations-Oxalate of Cerium-Zinc 
and its Preparations-Cadmium and its Preparations-Copper and its 
Preparations-Silver and its Preparations. 
Tonics.-Simple Bitters.-Quassia-Simaruba - Gentian - Nectandra-Bar- 
berry-Columbo-Boneset-Chiretta-Dogwood. 
Peculiar Bitters.-Wild Cherry Bark-Cinchona-Sulphate of Quinine 
-Tannate of Quinine-Sulphate of Cinchonine-Sulphate of Quinidine- 
Dextro-Quinine-Sulphate of Cinchonidine-Chinoidine-Picric Acid- 
Carbazotate of Ammonium. 
Aromatic Bitters.-Chamomile-Virginia Snakeroot-Cascarilla-An- 
gustura. 
True Aromatics.-Cinnamon-Cloves-Nutmeg-Allspice-Cardamom 
-Ginger-Black Pepper-Red Pepper-Oil of Cajeput-Eucalyptus, etc. 
Mineral Tonics.-Iron and its Preparations-Sulphuric Acid-Muriatic 
Acid-Nitric Acid-Nitromuriatic Acid-Lactic Acid-Phosphorus. 
Cardiac Stimulants.-Ammonia and its Salts-Alcohol-Brandy-Whisky 
-Wine-Turpentine-Digitalis-Convallaria Majalis. 
Cardiac Sedatives.-Antimony and its Preparations-Veratrum Viride- 
Veratrum Album-Arnica-Sabadilla-Veratria-Aconite Leaves and 
Root-Prussic Acid-Cyanide of Potassium-Vegetable Acids. 
Antispasmodics.-Musk-Castor -Valerian -Valerianic Acid-Assafetida- 
Camphor-Oil of Camphor-Brominated Camphor-Carbolated Camphor 
-Amber-Oil of Amber-Hoffman's Anodyne-Hops-Lactucarium- 
Black Snakeroot-Coffee, Tea, Mate, Caffein, Cocaine. 
XI XII 
TABLE OF CONTENTS. 
Analgesics.- Opium - Morphia-Narcein-Codeia-Narcotina-Thebaia- 
Papaverina-Laudania-Porphyroxia-Cryptopia-Meconia-Hydrocotar- 
nia-Pseudomorphia-Opiania-Meconic Acid-Indian Hemp-American 
Hemp. 
Mydriatics.-Belladonna-Atropia-Hyoscyamus-Hyoscine-Stramonium. 
Anaesthetics.-Nitrous Oxide-Ether-Chloroform-Bichloride of Methyl- 
Bromide of Ethyl. 
Excito-Motors.-Strychnia and Drugs containing it. 
Depresso-Motors.-Calabar Bean-Bromide of Potassium-Bromide of So- 
dium-Bromide of Ammonium-Bromide of Lithium-Bromal Hydrate 
-Chloral-Metachloral-Chloral Camphor-Butyl Chloral-Nitrite of 
Amyl-Nitrite of Potassium-Nitro-Glycerine-Valerianate of Amyl- 
Lobelia-Gelsemium-Tobacco-Conium. 
Alteratives.-Arsenic and its Preparations-Mercury and its Preparations- 
Iodine and its Preparations-Iodoform-Cod-Liver Oil-Phosphoric Acid 
and the Phosphates-Colchicum-Sarsaparilla-Guaiac-Mezereum-Sas- 
safras-Dandelion. 
SUBDIVISION II.-LOCAL REMEDIES. 
Emetics.- Vegetable Emetics.-Ipecacuanha-Bloodroot-Apomorphia-Gille- 
nia-Mustard-Squill. 
Mineral Emetics.-Antimony-Sulphate of Zinc-Sulphate of Copper- 
Alum. 
Cathartics.-Laxatives.-Foods-Tamarinds - Cassia Fistula - Magnesia- 
Sulphur-Potassii Sulphuretum-Sulphide of Calcium. 
Purges.-Castor Oil-Mercury-Rhubarb-Goa Powder-Chrysophanic 
Acid-Butternut-Aloes-Senna-Euonymus-Saline Purgatives. 
Drastics.-Scammony-Colocynth-Compound Cathartic Pills-Podo- 
phyllum-Elaterium-Gamboge-Croton Oil-Black Hellebore. 
Diuretics.-Hydragogue Diuretics.-Squill-Digitalis-Broom-Sweet Spirit 
of Nitre. 
Refrigerant Diuretics.-Potash and its Preparations-Lithium Salts- 
Anthydropin. 
Stimulating Diuretics.-Buchu-Pareira-Uva Ursi-Pipsissewa-Juni- 
per-Carota-Erigeron-Turpentine-Copaiba-Cubeb-Matico-Cantha- 
rides. 
Diaphoretics.-Nauseating Diaphoretics.-Refrigerant Diaphoretics.-Simple 
Diaphoretics.-Jaborandi-Spirit of Mindererus-Sweet Spirit of Nitre- 
Alcohol-Warburg's Tincture. 
Expectorants.-Atomization. 
Nauseating Expectorants.-Lobelia-Ipecacuanha-Tartar Emetic. 
Stimulating Expectorants.-Chloride of Ammonium-Senega-Ammo- 
niac-Benzoin-Benzoic Acid-Balsams of Tolu and Peru-Garlic-Squill 
-Tar. 
Emmenagogues.-Tonic Emmenagogues.-Purgative Emmenagogues.-Stimu- 
lating Emmenagogues. - Savine - Rue-Parsley-Apiol - Cantharides-• 
Guaiac-Tansy. TABLE OF CONTENTS. 
XIII 
Oxytocics.-Ergot-Cotton Root-Smut of Indian Corn. 
Sialagogues.-Pellitory. 
Errhines. 
Epispastics.-Counter-irritation-Cantharides. 
Rubefacients.-Mustard-Spices-Turpentine-Burgundy and Canada Pitch. 
Escharotics.-Potash-Vienna Paste-Arsenic-Chloride of Zinc-Canquoin's 
Paste-Corrosive Sublimate-Acid Nitrate of Mercury-Chromic Acid- 
Bromine, etc. 
Demulcents.-Gum Arabic-Tragacanth-Slippery Elm-Iceland Moss- 
Irish Moss - Liquorice Root-Sassafras-Tapioca-Arrowroot-Sago- 
Barley. 
Emollients.-Glycerine-Poultices. 
Diluents. 
Protectives.-Coilodium-Solution of Gutta-Percha. 
DIVISION IL-NON-SYSTEMIC REMEDIES. 
Antacids.-Sodium and its Preparations-Lime. 
Anthelmintics.-Pinkroot -Wormseed-Koosso-Santonin- Male Fern- 
Pumpkin-Seed, Pomegranate, Cowhage, Kameela, etc. 
Digestants.-Pepsin. 
Absorbents.-Charcoal. 
Disinfectants.-Lead and Iron-Corrosive Sublimate-Permanganate of 
Potassium-Chlorine-Chlorinated Lime-Boric Acid-Sulphurous Acid 
-Carbolic Acid-Salicylic Acid-Salicin-Thymol-Antipyrin-Kairin- 
' Thallin. 
PART II-FORCES. 
Caloric.-Heat: its Use in Shock, Collapse, etc.-Cold: its Local Use; its 
Use as a Tonic; its Use in Pyrexia. 
Electricity.-General Considerations; Diagnostic Use ; Use in Palsies; Use 
in Neuralgias; Application to Motor Apparatus; Application to Sensory 
Apparatus ; Application to Nerve-Centres; Use as a Tonic. 
APPENDIX. 
The Art of Prescribing Medicines. 
Tables. A TREATISE 
ON 
THERAPEUTICS, 
INCLUDING 
MATERIA MEDICA AND TOXICOLOGY. 
INTRODUCTION. 
Although Pharmacy, or the science of preparing medicines, is entirely 
distinct from Therapeutics, or the science of the application of medicines to 
the cure of disease, it is evident that some acquaintance with the former is 
necessary to the correct appreciation of the latter. Further, as the basis of 
both these studies, must first come a knowledge of Materia MedicA, or the 
substances used as medicines. Pharmacology is the general term em- 
ployed to embrace these three divisions. 
In every civilized country there is some recognized official list of drugs and 
their preparations, known as the Pharmacopoeia. In most places, this, being 
prepared with the sanction of the government, partakes of the nature of 'a 
law, but in the United States conformity to it depends upon the voluntary 
action of the professions of Medicine and Pharmacy, by a representative con- 
vention of which it was originally prepared and is decennially revised. 
The United States Pharmacopoeia is divided into three portions: & primary 
and a secondary materia medica list, and a chapter on preparations, with 
directions for their manufacture. The primary list contains medicines whose 
reputation is believed to be assured; the secondary list, those still on trial, 
or those which experience has shown to be not altogether valueless, but yet 
of little importance. It is evident that a knowledge of the officinal or recog- 
nized preparations, of their general mode of manufacture, and of their strength, 
is essential to the therapeutist. The United States Pharmacopoeia recognizes 
twenty-nine classes of them, as follows: 
Decocta.-Decoctions are made by boiling crude drugs for a greater or 
less time in water. It is evident that this method of preparing is ineligible 
17 18 
INTRODUCTION. 
when the active principle is volatile or is easily decomposed by heat, or when 
the drug contains much starch, whose extraction would make the preparation 
very thick and predispose it to rapid decomposition. The method is especially 
adapted to woody, hard substances, and to those containing much albumen 
which is coagulated by the boiling water and left in the drug. 
Infusa.-Infusions are made with water, either cold or hot, without boil- 
ing. They are prepared by maceration, or by displacement. 
Liquores.-Solutions are preparations in which an active, non-volatile 
principle is dissolved in water. 
Aqu^e.- Wafers are solutions of volatile principles in water. 
Mistural-Mixtures are preparations in which one or more medicinal 
substances are held in suspension in water. Of such nature are emulsions, in 
which some oily material is suspended by a gummy or an albuminous body. 
Mucilagines.-Mucilages are solutions of gummy substances in water. 
Syrupi.-Syrups are sugary liquids, the menstruum or basis of which is 
water, with, in some cases, vinegar or alcohol. 
Mellita.-Honeys are preparations whose basis is honey. 
Aceta.- Vinegars are those preparations in which vinegar, or dilute acetic 
acid, is used as the menstruum. 
Tincture.- Tinctures are alcoholic solutions prepared by maceration or 
displacement from the crude drug, or by dissolving non-volatile principles. In 
some of them strong, in others dilute, alcohol is used. 
Spiritus.-Spirits are alcoholic solutions of volatile principles, made by 
direct solution or by distillation from the crude drugs. 
Vina.- Wines are preparations whose menstruum is wine. 
Glycerita.- Glycerites are preparations in which glycerine is the solvent. 
Olea Destillata.- Volatile Oils are active principles of such nature, 
prepared by distillation. 
OleoresiNjE.- Oleoresins are concentrated preparations, composed gen 
erally of a volatile oil and a rosin. They are really ethereal extracts, made by 
the action of ether upon the crude drugs ; in the case of ginger, a mixture of 
alcohol and ether is used. 
Succi.-Fresh juices are obtained by expression of the green plant, enough 
alcohol being added to preserve them. 
Extracta.-Solid extracts are of two kinds; one being prepared by the 
evaporation of the fresh juice, the other being made in various ways from 
the crude drugs. 
Extracta Fluid a.-Fluid extracts are very concentrated fluid prepara- 
tions, generally so made that one minim represents one grain of the crude 
drug. 
Resina.-Resins are purgative resinous principles, obtained by the pre- 
cipitation of saturated tinctures with water. 
Confectiones.- Confections are medicinal substances beaten up with 
sugar into a pasty mass. INTRODUCTION. 
19 
Trochisci.- Troches, or lozenges, are gummy pellets or disks, so made as 
to dissolve slowly in the mouth. 
Suppositoria.-Suppositories are conical bodies, prepared for introduc- 
tion into the rectum, where they melt with the heat of the body. Their 
basis is generally cacao butter. 
Unguenta and Cerata.- Ointments and Cerates wee fatty solid prepara- 
tions for external use. The cerates containing wax (cera) are the firmer of 
the two. 
Emplastra.-Plasters are solid substances spread by the aid of heat upon 
muslin, skin, or other similar material, and of such nature as to be adhesive 
at the temperature of the body. 
Chart.®.-Papers are medicated leaves or sheets of paper for external use. 
The only officinal are those of mustard and of cantharides. 
Linimenta.-Liniments are liquid preparations, generally soapy or oily, 
and always intended to be applied externally by rubbing. 
The names of Pilul® (Pills') and Pulveres (Powders') sufficiently indi- 
cate the character of the preparations. 
The British Pharmacopoeia is not divided as that of the United States, but 
the drugs and their preparations are arranged alphabetically. 
In what way medicines produce changes in the life-actions of various parts 
is, and probably must ever remain, unknown, precisely as it is beyond the 
limit of the human intellect to know why the nerve-cell or the spermatozoon 
performs the prodigies of which it is capable. The fact that various sub- 
stances do possess a selective tendency, so to speak, do act more forcibly on 
one form of tissue than on another, is, however, indisputable. 
The effects of medicine are commonly divided into the primary and second- 
ary, or the immediate and the remote. An example will probably show the 
difference between these in the briefest and most forcible manner. Thus, the 
immediate effect of a diuretic is increased urination: the secondary effect 
may be removal of serous effusion in some part of the body. It is evident 
that the latter is brought about not by the medicine itself, but by the changes 
it induces; the increased excretion causing a diminution of the amount of 
the fluid in the blood-vessels, which in turn predisposes to absorption. 
The term or expression indication for a given remedy, being in constant 
use, ought to be distinctly understood; by it is meant the pointings of 
nature, or, in other words, the evident needs of the system. Thus, hard faeces 
collected in the colon are an indication for a purgative of such character as 
will produce watery discharges to soften them. Relaxation in a part indi- 
cates a remedy of such properties that it will awake into new life the natural 
contractility of the part. Again, the suppression of secretion from over- 
excitement, or from irritation, is an indication for some drug which will allay 
irritation; whilst the same suppression, when dependent upon torpor or loss 
of cell-activity, will call for an excitant,-an irritant. The childish absurdity 
of treating symptoms by any such law as " similia similibus curantur," or 20 
INTRODUCTION. 
" dissimilia dissimilibus curantur," is at once apparent. Symptoms are merely 
the surface-play of disease; and the rational therapeutist always seeks out 
their hidden meaning. 
By far the greater number of remedies are absorbed into the blood, and 
thus find access to the part upon which they act. It is necessary, therefore, 
for them to be so placed that they can be taken into the blood-vessels. 
There are five paths of entrance for medicines into the circulation,-the 
stomach, the cellular tissue, the rectum, the skin, the lungs. By far the most 
frequently employed of these is the first-named. It is evident that, in order 
to pass rapidly and readily into the absorbents, medicines must be in solution. 
When administered by the stomach, however, it is equally plain that solu- 
bility in an ordinary menstruum, such as water, is not a sine qua non, since 
the varying acidities, alkalinities, and organic contents of the alimentary 
juices give to them a solvent power far above that of less complex and vary- 
ing fluids. Thus, a medicine insoluble in water may be dissolved by the acids 
of the gastric juice, while another drug may owe its activity to its solution 
by the alkalies or by the fatty matters of the intestinal fluids. 
The dissolving power of the rectal fluids is very slight: hence, in order to 
act efficiently, medicines when given by the rectum must be in solution or 
readily soluble. Absorption, moreover, does not occur so rapidly from the 
rectum as from the stomach, and greater time is therefore needed to impress 
the system in this wray. In the great majority of cases medicines are thus 
exhibited to obtain peculiar effects more or less local in character. Thus, an 
opium suppository is given in dysentery, or to quiet irritation of the genito 
urinary organs, or to check vomiting. 
The subcutaneous tissue affords the most rapid route to the central organs. 
The substance must, however, always be in perfect solution, and not too irri- 
tating. It is thrown under the skin by means of a small syringe with a sharp 
hollow needle for its nozzle. Great care should be taken to avoid throwing a 
medicine into a vein, and so producing a sudden overwhelming effect. The 
point of the syringe-needle should not be thrust deeply into the tissues, but 
be kept just beneath the skin, and be withdrawn a little, after having been 
pushed along under the skin farther than necessary. The objections to the 
method are the danger of injecting into a vein, the slight pain of the opera- 
tion, and the skill required for the latter, so that the administration cannot 
be left to the nurse, together with the local irritation and, it may be, inflam- 
mation, to which many drugs so used give rise. The pain may be to a great 
extent avoided by slightly freezing the skin by means of a spray-producer, 
yet, for the other reasons mentioned, the hypodermic method should not be 
employed except under certain circumstances. When, as in severe suffering, 
an immediate decided action is required, it is beyond all value,-the system 
coming under the influence of the remedy as if by magic. The dose should 
always be smaller than that by the mouth. 
There are several ways in which medicinal principles are introduced through INTRODUCTION. 
21 
the skin, although the only one in common use is the application of medicated 
fatty preparations, either with or without friction. Absorption takes place, 
of course, most rapidly in those positions at which the skin is thinnest,- 
the inside of the thighs, the surface of the abdomen, and especially the arm- 
pits. Almost the only remedy which is introduced into the system in this 
way is mercury. Absorption will take place through the skin from baths, but 
so slowly that advantage is never taken of it in the constitutional treatment 
of disease,-unless the sulphur baths, sometimes employed in rheumatism, 
impress the general system by absorption, which seems to me doubtful. 
Formerly, medicines were sometimes exhibited by placing them on blistered 
surfaces, beneath the raised cuticle; but, except in the instance of morphia, 
so used in gastric disturbance, at present the endermic method is very rarely 
employed. 
To influence the general system, the lungs are only used for the introduc- 
tion of the vapors of the anaesthetics. 
For local purposes medicines are applied to various parts,-to the skin, to 
the ear, nares, fauces, stomach, larynx, lungs, rectum, vagina, urethra, etc. 
For the last three, liquid preparations known as injections, or solid ones 
known as suppositories, or, in case of the urethra, as bougies, are employed. 
For the purpose of making local applications to the respiratory organs, 
atomization is very commonly practiced. Very many forms of apparatus are 
in use, but the principle in all of them is the same. A rapid current of air, 
or of steam, is forcibly ejected from a horizontal pipe, through a capillary 
orifice, directly across a similar opening in a vertical tube. The rush of the 
vapor over this second orifice forms a vacuum ; the fluid into which the base 
of the vertical tube is set, rushing up to fill this, is sucked or drawn out 
through the orifice, and as it emerges is broken into a fine spray, and is car- 
ried along by the current of air or steam into a mouth-piece, at which sits the 
patient. It cannot be gainsaid that in this way we are able to carry medicinal 
substances not merely into the larynx, but into the lungs themselves. Vola- 
tile medicines vaporized by heat are also sometimes employed in the treatment 
of lung affections. 
There are various classes of agencies which so modify the action of drugs 
as to necessitate their consideration. Such are disease, climate, habit, tem- 
perament, idiosyncrasies, sex, age, time of administration, and emotions. 
Disease often fortifies the system against the action of remedies, so that the 
dose has to be greatly increased to obtain perceptible effects. Thus, pain or 
delirium tremens will interfere greatly with the production of narcotism by 
opium ; or spinal disease with purgation. Disease may altogether prevent the 
action of a remedy. In all these cases two rules should never be lost sight 
of: first, never give the medicine in such doses as would in health cause 
death; second, always be sure, before giving large amounts, that the remedy 
will not make matters worse (as a drastic in intussusception). 
Climate, by giving physical habits or tendencies to the patient, often greatly 22 
INTRODUCTION. 
influences the proper selection and dose of remedies. It is only necessary 
to allude to the great consumption of quinine in malarial regions as an ex- 
ample. 
Habit-including mode of life-seems to alter, as it were, the very consti- 
tution of man. Not only does it give type to disease, by producing habitual 
plethora, or its opposite, but it also fortifies against the action of single reme- 
dies, or whole classes of them. Thus, in the opium-eater, a dose sufficiently 
large to kill an ordinary man serves only to gratify the cravings of appetite. 
Again, a man accustomed to one narcotic, as alcohol or opium, loses, to a 
greater or less degree, his susceptibility to all narcotic influence ; and the 
patient whose bowels require daily to be moved by a cathartic finds himself 
react more and more slowly to medicines of that class. Again, a nervous 
system blunted by exposure and toil in the open air is far less susceptible to 
the action of remedies, and requires larger doses to influence it, than the deli- 
cate organization of a woman weakened by indolence and luxury. 
Temperaments are peculiarities of organization characterizing classes of 
individuals ; idiosyncrasies, peculiarities belonging to single individuals. This 
is scarcely the place to discuss the subject of temperaments, but it is allowable 
to state that while the phlegmatic person is no more easily moved by medicinal 
than by other agencies, the nervous individual answers as quickly to the one 
as to the other. Idiosyncrasies seem at present to be beyond law. They are 
often very remarkable, and a knowledge of them is most important for the 
practitioner. Thus, a relative of the author's is thrown into the most alarm- 
ing fainting-fits by eating even so much butter as would be ordinarily used 
as a dressing for vegetables at dinner. Some persons are poisoned by the 
slightest touch of turpentine, others are frightfully salivated by a mere par- 
ticle of a mercurial. These idiosyncrasies are numerous, cannot be foreseen, 
and are often very important: hence the necessity, in prescribing for an un- 
familiar patient, of always asking as to his or her peculiarities. 
Sex, of course, modifies all diseases connected with the organs or the pro- 
cess of generation, but it does more. Woman is more impressible, less robust, 
with less power of resisting external agencies, than is man. Consequently, 
the dose for her should, as a rule, be less than that for him. It is needless 
to remark here at length on the necessity for abstinence from strongly per- 
turbing remedies during pregnancy or at the menstrual periods. 
Age, of course, modifies materially the dose. The rule of Dr. Young, the 
one which seems to me the most practical and generally useful, is to add 
twelve to the age and divide the age by the result. Thus, a child one year 
old would require one-thirteenth, one three years old three-fifteenths, of the 
amount necessary for an adult. Other rules have been invented, but the 
only one which seems to me practical is the following, proposed by Dr. R. 0. 
Cowling (American Practitioner, vol. i.) : 
" The proportionate dose for any age under adult life is represented by the 
number of the following birthday divided by twenty-fouri.e., for one year INTRODUCTION. 
23 
is fa - T'2 ; for two years, fa = i ; for three years, = I ; for five years, 
= i ; for eleven years, fa = i, etc. 
Prof. Clarke {Boston Med. and Surg. Journal, 1872) has proposed a rule, 
which, although probably more accurate than either of those given, seems too 
cumbersome for ordinary purposes. It is based upon relative weights: 
" Assuming the average weight of an adult to be one hundred and fifty 
pounds, for whom an appropriate dose is 1, or one drachm, the dose of most 
medicines must be increased or diminished in the proportion of the weight of 
the patient to that number of pounds. This proportion is represented by a 
fraction whose numerator is the patient's weight, and whose denominator is 
150. If a child at birth weighs six pounds, the appropriate dose for it would 
be or ; if it weighs ten pounds, y1^, or A child two years old, 
weighing twenty pounds, would require or about of an adult dose ; or, 
more precisely, 7^. A person whose weight is two hundred pounds should 
have or 1| of an average adult dose." 
It must never be lost sight of that children bear narcotics very badly, and 
that the doses of such remedies for them should always be proportionally 
smaller than for the adult. 
Time of Administration.-Absorption takes place most rapidly in an empty 
stomach, and consequently, when rapidity of action is desired, the medicine 
should be given under such circumstances. Thus, a purgative acts soonest 
when given before breakfast. Substances which are irritating to the stomach 
should always be administered not only properly diluted, but also when the 
viscus is filled by a mass of food, which may serve still further to lessen their 
concentration. Hence, such remedies as iodine and arsenic are preferably 
exhibited after meals. Again, some drugs, such as iron, are best dissolved 
by the acid gastric juice, and it is a matter of some importance to place them 
in the stomach after eating, when the process of digestion is most vigorous. 
Mental Emotion.-Space is wanting to discuss at any length the influence 
of the imagination upon the action of remedies; and the reader must be 
referred to the delightful book of Dr. Tuke for illustration. Suffice it to 
state that a positive announcement that a remedy will have a certain effect 
has often a most remarkable influence in producing that effect, especially on 
persons of nervous organization and of not too great culture to have faith. 
I have given a hypodermic injection of a grain of morphia to a man, inducing 
a degree of hypnotism, and the next day, doubling the size of the injection 
but withdrawing all morphia, have caused a much more intense effect. 
It is evident that every treatise upon pharmacology must have some plan 
in accordance with which the various substances treated of are arranged.* 
At present, all that, in my opinion, can be reasonably demanded of any 
system is that it be a convenient row of pegs upon which to hang our ideas 
and facts, so that they may be easily retained, and be easily accessible when 
♦ For a discussion of classification, see the first edition of this work. 24 
INTRODUCTION. 
wanted. Under these circumstances I venture to offer, as the basis of the 
present treatise, without further comment, the following clinico-physiological 
classification, founded upon, but very different from, that of Prof. George B. 
Wood. 
CLASSIFICATION. 
PART I.-DRUGS. 
1. Substances which act on the Solids and Fluids of the Body. 
a. General Remedies. 
Class I.-Astringents. 
" II.-Tonics. 
" III.-Cardiac Stimulants. 
" IV.-Cardiac Sedatives. 
" V.-Antispasmodics. 
" VI.-Analgesics. 
" VII.-Mydriatics. 
" VIII.-Anaesthetics. 
" IX.-Excito-motors. 
" X.-Depresso-motors. 
" XI.-Alteratives. 
b. Local Remedies. 
Class I.-Emetics. 
" II.-Cathartics. 
" III.-Diuretics. 
" IV.-Diaphoretics. 
" V.-Expectorants. 
" VI.-Emmenagogues. 
" VII.-Oxytocics. 
" VIII.-Sialagogues. 
" IX.-Errhines. 
" X.-Epispastics. 
" XI.-Rubefacients. 
" XII.-Escharotics. 
" XIII.-Demulcents. 
" XIV.-Emollients. 
" XV.-Diluents. 
" XVI.-Protectives. 
2. Substances which act externally to the Body. 
Class I.-Antacids. 
" II.-Anthelmintics. 
" III.-Digestants. 
" IV.-Absorbents. 
" V.-Disinfectants. 
•PART II.-REMEDIES WHICH ARE NOT DRUGS FART I. 
DRUGS 
DIVISION L-SYSTEMIC REMEDIES. 
Subdivision I-General Remedies. 
CLASS I.-ASTRINGENTS. 
Astringents are those drugs which cause contraction of living tissues 
That they do not act, as has been supposed, either by coagulating albumen or 
by calling into action the muscular function, is demonstrated by the transi- 
toriness of their effects, and by the fact that they influence tissues containing 
no muscular fibre. Every living soft tissue appears to possess a normal degree 
of condensation, which may be departed from on either hand ; when this hap- 
pens, the part is said to be relaxed in the one case, in the other to have its 
tonicity increased, or to be astringed. The action of astringents is always 
a local one,-i.e., produced not through the intervention of the nervous sys- 
tem, but by direct contact with the part affected. A pure astringent should be 
capable of doing nothing beyond inducing contraction ; but in reality there is 
scarcely such a drug. All astringents are, when applied too freely, irritants; 
indeed, it is doubtful whether their therapeutical property of astringency is 
not due to the exercise of a mild form of irritation. 
Our knowledge of the action of astringents upon blood-vessels is still very 
limited. The only published experiments are those of M. Rosenstein (Aoss- 
bach's Pharmalcolog. Untersuchungen, Bd. ii. p. 80). He placed solutions 
of nitrate of silver, of acetate of lead, of sesquichloride of iron, and of tan- 
nic, gallic, and pyro-gallic acids upon the exposed mesenteric vessels of a 
curarized frog. The first three solutions contracted arterioles, venules, and 
capillaries, nitrate of silver being much the most powerful and the iron salt 
the weakest; the effect on the capillaries was the most permanent. The 
acids instead of contracting enlarged the vessels. This dilatation was not 
reflex, as it occurred after destruction of all of the nerve-centres. It was 
probably due to the irritant action of the acid. 
The indications for the use of an astringent are very evident. 
In the first rank among such indications is the existence of relaxation. 
Local relaxation is almost always the result of previous over-excitement. 
Thus, a throat is relaxed after over-use, or after inflammation. 
Astringents are more efficient as local than as general remedies, but in 
cases of inflammation care must be taken to use them in such way that they 
shall not act as irritants. Applied too soon or too vigorously, they may do 
harm. These remarks are scarcely applicable to some of the mineral astrin 
25 26 
SYSTEMIC REMEDIES. 
gents, such as lead and nitrate of silver, which really appear to have sedative 
properties, and may with care he used advantageously in all stages of inflam- 
mation, whenever there is distention and relaxation of the blood-vessels, 
although the general action of the part be above par. 
Closely allied to relaxation is over-secretion, and astringents are constantly 
used to check morbid discharges. Indeed, these discharges are often simply 
the result of relaxation. Thus, Asp has experimentally proven that division 
of the intestinal nerves and consequent paralysis and relaxation of the vessels 
are followed by free watery secretion. In such cases the indication for astrin- 
gents is very plain. But when a morbid discharge really represents a high 
degree of inflammation, the same care must be practiced in the use of astrin- 
gents as in treating other local inflammations. Especially is this true since 
free secretion is often nature's method of relieving local inflammation. Thus, 
when abnormal alvine discharges are dependent upon intestinal relaxation, the 
astringents are most valuable, but when they are dependent upon enteritis or 
colitis, astringents do harm. 
If the morbid discharge by its profuseness endanger life, as in serous diar- 
rhoea, astringents are urgently demanded. Very rarely, if ever, are these 
discharges other than paralytic in their origin ; even, however, if they be due 
to over-action, an astringent may be necessary to check their excessiveness. 
Another indication for the use of astringents is to check hemorrhage, and 
the same general reasoning is applicable to this as to the other indications. 
Hemorrhage dependent upon over-action demands other treatment than by 
astringents. Sometimes in these cases it is necessary, however, to check the 
hemorrhage at all hazards, and then astringents may be used in conjunction 
with other measures, although they may be to some extent contra-indicated. 
Various astringents are employed locally to check hemorrhage due to trau- 
matic or other ruptures of vessels. In such cases the astringents are employed 
as styptics, and do not act so much by their astringency as by coagulating the 
albumen of the blood, and thus forming a clot and mechanically arresting 
the flow. 
Under certain circumstances there seems to be a general relaxation or loss 
of tone throughout the whole system, which may be best met by a consenta- 
neous use of tonics and astringents. 
VEGETABLE ASTRINGENTS. 
The active principle of the vegetable astringents is tannic acid, and, as it 
is almost their sole therapeutic principle and represents them very closely, it 
seems proper first to consider it, and afterwards to point out any especial 
therapeutic virtues the crude drugs of the class may possess. 
ACIDUM TANNIOUM-TANNIC ACID. U.S. 
There are two kinds of tannic acid, the gallo- and the kino-tannic ; of these 
the former yields, upon exposure to the air in a moist state, gallic acid, the VEGETABLE ASTRINGENTS. 
27 
latter a gelatinous, inert substance. They are further distinguished by the 
color of the precipitates which they yield with the persalts of iron; gallo- 
tannic acid producing a blue-black, kino-tannic a green-black color. 
The officinal tannic acid-the gallo-tannic acid-is obtained by treating 
powdered galls with washed ether, which on standing separates into two strata, 
the upper of which is ethereal, and contains chiefly the coloring-matter and 
other impurities. The lower watery stratum contains the tannic acid, which 
is recovered by evaporation. 
Commercial tannic acid is a light, feathery, non-crystalline powder, of a 
yellowish-white color, a faint odor, and an astringent, somewhat bitter taste. 
When absolutely pure, it is colorless and free from odor or taste other than 
that of astringency. Its reaction is strongly acid, and it unites freely with 
both organic and inorganic bases. It is very freely soluble in water, even 
more so in glycerine, somewhat so in dilute alcohol, scarcely at all in absolute 
alcohol, and not at all in ether free from water. By a heat of from 180° C. 
to 215° C. it is changed into pyro-gallic acid, which crystallizes in white, 
shining plates, of a bitter taste and neutral reaction. With salts of the alka- 
loids it produces a whitish precipitate, very soluble in acetic acid; with per- 
salts of iron, a black (bluish or greenish) precipitate; with lime-water, a 
precipitate which is at first whitish, then gray, dingy greenish, and finally 
brownish ; with gelatine or albumen, a whitish coagulum. All of these sec- 
ondary products are tannates. Tannic acid also dissolves in concentrated 
sulphuric acid, with the production of a black color. By prolonged exposure 
in solution to the air, or by the action of dilute sulphuric acid, it is converted 
into gallic acid. 
Physiological Action.-When applied locally to a part tannic acid 
is a very powerful astringent, causing contraction, and in the case of a 
mucous membrane, great dryness. Sometimes, when it is used very freely, 
its irritant influence seems to overcome its astringent action, and I have 
seen diarrhoea result from its administration. Several experimenters (Ro- 
senstein, Untersuch. Pharmakolog. Institut Wurzburg, 1875; Fikentscher, 
Inaug. Dissert., Erlangen, 1877) have denied that it causes contraction of 
the blood-vessels, because when they applied it to the exposed mesentery 
of a " Cohnheim frog," stasis of the blood with dilatation of the vessels, 
not preceded by contraction, occurred. Daniels, however (Inaug. Dissert., 
Bonn, 1864), using rabbits, obtained different results, and Lewin has 
shown that the method of experimentation is faulty. Clinical experience 
abundantly proves that tannic acid applied to relaxed mucous membranes 
affects their whole substance. 
Tannic acid coagulates albumen with so much avidity that it has been 
supposed incapable of absorption, but the very elaborate investigation of 
Dr. Lewin cast much doubt upon the older views on this subject ( Virchow's 
Archiv, Ixxxi. 74). Thrown rapidly into the blood it undoubtedly causes 
a fatal thrombosis; but Lewin asserts that when it is injected slowly and in 28 
SYSTEMIC REMEDIES. 
moderate quantities the resulting tannate of albumen is held in solution by 
the alkaline carbonates of the blood. He has also discovered that whilst 
tannin, in five per cent, solution, precipitates peptones out of watery solu- 
tion, it is powerless in the presence of muriatic acid. Assuming the correct- 
ness of the investigation of Dr. Lewin, it is plain that tannic acid, when put 
in the stomach in small doses, must to some extent be absorbed unchanged. 
Dr. Lewin also asserts that it is, at least in part, eliminated unaltered, as 
he has frequently recovered it from the urine. At the same time it seems 
(very probable that most of the tannic acid is converted into gallic acid, 
either in the stomach before absorption, or subsequently in the system, 
since in the viscera of a rabbit poisoned with it, Schroff (Die Pflanzenstoffe, 
Drs. Husemann, p. 1005) found only gallic acid; and according to Clarus 
(76t<7.) the greater part of ingested tannic acid can be recovered from the 
stools as tannate of albumen or as gallic acid. Wohler and Frerichs have 
also found gallic acid with pyro-gallic acid in the urine after the exhibition 
of tannic acid. Whether it acts chiefly as tannic or as gallic acid, it seems 
after absorption to exert marked astringent powers. Lewin has shown that 
in frogs poisoned with it the muscles are shortened and narrowed, and when 
loaded stretch less and recover their original length more nearly than do 
normal muscles. Kiichenmeister {Arch. Physiolog. Ileilk., 1851, 493) and 
Hennig {Arch. Pharmak., Febr. 1853) found that in poisoned cats the 
spleen is notably diminished in size and increased in firmness; and Lewin 
has found in rabbits that it causes primary arrest of the urinary secretion, 
followed by a marked increase of the flow. 
Therapeutics.-As tannic acid undergoes in the system conversion 
into gallic acid, the latter is to be preferred to it when the part to be acted 
on can only be reached through the circulation. As a local application, 
tannic acid is much more powerful than gallic acid. Locally applied, it 
may be used to overcome relaxation, as in spongy gums, mercurial sore 
mouth, hemorrhoids, chronic sore throat. To check hemorrhage it may be 
used whenever the source of the flow can be reached directly, as in epis- 
taxis, heematemesis, hemorrhage from the bowels, etc. To arrest excessive 
secretion it may be employed locally in leucorrhoea, diarrhoea, old abscesses, 
chronic ulcers, excessive perspiration, osmidrosis, and various diseases of the 
skin. It is also often very useful for the purpose of hardening parts exposed 
to friction, as in cases of sore nipples and tender feet. 
Toxicology.-Tannic acid can scarcely be called poisonous; although 
Rollett reports the case of a young girl in whom a very large quantity of it 
induced severe gastric and abdominal pains, with obstinate vomiting and con- 
stipation, fever and general malaise. Both Schroff and Judell assert that 
eighty grains of it produce no symptoms of importance in the rabbit. 
As an antidote it is useful in tartar emetic poisoning, forming an insoluble 
tannate of antimony. It is also the best chemical antidote for the poisonous 
alkaloids; but, as the compounds it makes with them are slowly dissolved by VEGETABLE ASTRINGENTS. 
29 
the fluids of the alimentary canal, it must always be followed by emetics and 
cathartics. 
Administration.-When given to act on the stomach, as in haemateme- 
sis, tannic acid should be in powder (ten to twenty grains). When the 
bowel is to be influenced, as in diarrhoea, the drug should be administered 
in pill (three to five grains), so that, if possible, it may pass the pylorus un- 
dissolved. For local use a solution in glycerin may be employed, or the 
officinal ointment (Uhguentum Acidi Tannid, U.S., 1 to 9), or the troche 
(Trochisd Acidi Tannid, U. S., 1 grain each). 
AOIDUM GALLIOUM-GALLIO ACID. U.S. 
Gallic acid is a white, powdery substance, in fine acicular prisms, soluble 
in one hundred parts of cold water, in three parts of boiling water, and freely 
soluble in alcohol and ether. Its taste is acidulous and astringent. 
According to the officinal method, gallic acid is prepared by the exposure 
of moistened powdered nut-galls in a warm place for a month. A species of 
fermentation, with the development of a peculiar fungus, is said to occur, 
during which oxygen is absorbed, carbonic acid evolved, and glucose and 
gallic acid are produced. M. Sacc (Chemical News, July 24, 1871) has 
recently denied this, affirming that the change is simply one of hydration, 
tannic acid being an anhydride of gallic acid. Tannic acid also may be 
rapidly converted into gallic acid by the action of dilute sulphuric acid. 
Gallic acid produces with salts of the alkaloids whitish precipitates, with 
persalts of iron a bluish precipitate, with lime-water a whitish precipitate, 
changing to blue, and then to violet or purplish,-all of these precipitates 
being gallates. It does not coagulate gelatine or albumen, and dissolves in 
concentrated sulphuric acid, with production of a deep-red color. It has the 
power of reducing silver from its solution slowly in the cold, instantaneously 
if warmed. As an astringent it is similar to, but much less powerful than, 
tannic acid. It escapes from the body through the kidneys. 
Therapeutic Action.-Gallic acid is not nearly so efficient as tannic 
acid when applied locally, but, because it does not coagulate albumen, should 
always be preferred when the part is to be reached through the medium of 
the circulation. It is useful as an astringent in haemoptysis, haematuria, 
colliquative sweats, etc. It has been recommended in bronchorrhoea and in 
the profuse expectoration of chronic phthisis. In my hands, however, it has 
completely failed in the latter affections. In certain forms of Bright's dis- 
ease, when there was an abnormally large secretion of highly albuminous 
urine, I have found it to lessen very materially the excretion of albumen. 
Administration.-Gallic acid may be given in powder, or sometimes in 
pill form. The dose of it is from ten to thirty grains, repeated as often as 
may be necessary. An ointment (Unguentum Addi Gallid, 1 to 9) is 
officinal. 30 
SYSTEMIC REMEDIES. 
GALLA-GALLS. U.S. 
Galls are vegetable excrescences, which are produced by the deposition of 
the ova of insects. They occur on almost all kinds of plants, even on fungi, 
but the officinal gall is developed on the Quercus infectoria by the act of the 
fly Cynips {Diplolepis) tinctoria. There are in commerce two varieties of 
galls, derived chiefly from the Levant. The blue or green galls are globular, 
solid bodies, from the size of a pea to that of a hickory-nut, externally smooth, 
or more commonly marked with large tubercles. They are the young galls 
which have been gathered before the ova of the fly have hatched, or before 
the caterpillar has eaten out the interior of its birthplace. The white galls 
are large, light, hollow bodies, with a hole, through which the Cyuips has 
escaped after having fed upon the interior during its whole larval life. They 
contain but little tannic acid, and are of comparatively little value. 
Therapeutics.-The sole value of galls is as the source of tannic acid. 
As galls, they should not be used in medicine; but the United States Phar- 
macopoeia recognizes a tincture (^Tinctura Gallse, 1 to 5), and an ointment 
(Uhguentum Gallee, 1 to 9). 
+ OATEOHU-CATECHU. U.S. 
An extract of the wood of an East Indian tree,-the Acacia Catechu. It 
occurs in masses of various shapes, or in small fragments, of a dull reddish- 
brown color, and having a bitterish, astringent, and, after a time, sweetish 
taste. It contains kino-tannic and catechuic acid. Pale catechu, or gambir, 
which is officinal in the British but not in the United States Pharmacopoeia, 
occurs in small cubes, about an inch in diameter, lighter than water, pale- 
yellowish within, deep-yellowish or reddish-brown externally. Catechu is a 
powerful astringent, which may be used externally, or for diarrhoea, in the 
dose of twenty to thirty grains. 
The U. S. Pharmacopoeia recognizes a compound tincture (Tinctura 
Catechu Composita, Catechu 12, Cinnamon 8, to 100), of which the dose 
is one to three fluidrachms, and a troche (Trochisci Catechu, 1 grain 
each). 
KINO-KINO. U.S. 
The inspissated juice of Pterocarpus marsupium and of other plants. It 
occurs in small, irregular, angular, shining, reddish, brittle fragments, of a 
bitterish, highly astringent, and, after a time, sweetish taste. There are four 
varieties,-the East India, West India, Botany Bay, and African. Of these, 
the first is common, the second rare, and the last two are never seen in our 
market. Kino contains kino-tannic acid, and in its therapeutic powers is 
almost identical with catechu. The dose is twenty to thirty grains. A 
tincture (Tinctura Kino, 1 to 10) is officinal. Dose, one fluidrachm. VEGETABLE ASTRINGENTS. 
31 
ELEMATOXYLON-HjEMATOXYLON. U.S. 
The heart-wood of Haematoxylon Campechianum, or logwood-tree, a native 
of Central America. A dense, heavy wood, of a deep reddish-brown color, 
containing, besides kino-tannic acid, a crystalline principle, Ilxmatin or 
Hematoxylin^ which when pure is yellow, but readily yields red or purple 
dyes. Haematoxylon is a mild efficient astringent, valued on account of its 
sweetish taste. It is readily taken by children, but is sometimes objected 
to on account of the staining of the diapers by the blood-red stools which it 
produces. The following formula offers an efficient and elegant remedy for 
diarrhoeas of relaxation; the proportions may be varied to suit individual 
cases: B Ext. haematoxyli, 5" Acid, sulph. aromat., f5iii; Tinct. opii 
camph., fjiss; Syrupi zingiberis, q. s. ad f^vi. M.-Dose, a tablespoonful, 
properly diluted. The extract (Extraction Hematoxyli) is officinal, dose, 
ten to thirty grains. 
KRAMERIA-RHATANY. U.S. 
The root of Krameria triandra, a native shrub of Peru. This woody root, 
as it occurs in our markets, varies from one-fourth inch to one inch in diam- 
eter, and from half a foot to three feet in length. The readily separable bark 
is of a deep-reddish color. The internal woody portion is of a lighter hue, 
although decidedly reddish. The bark contains a much larger percentage of 
the active principle, kino-tannic acid, than the wood. Rhatany is a powerful 
astringent, similar in virtue to kino and catechu, but is never administered in 
powder. The United States Pharmacopoeia recognizes an extract ( Extraction 
Kramerix), dose, grs. v-x; a tincture (Tinctura Kramerix, 1 gr. to 1 
C.c; and a fluid extract (Extraction Kramerix Fluidum), dose, twenty 
drops. 
+ Quercus alba, U. S., and Quercus tinctoria are the inner barks of 
the trees whose names they bear,-the white and the black oak respectively. 
The latter is a rough, yellowish-brown bark, which is used in dyeing, under 
the name of quercitron. On account of its imparting readily its color, it is 
rarely, if ever, employed in medicine. White-oak bark also stains, but not 
nearly so deeply as does black-oak bark, and, containing largely of gallo- 
tannic acid, is used as a means of making cheap astringent infusions for 
baths, vaginal washes, etc., also in powder for poultices. 
1 Rosa Gallica, U. S., is the dried petals of the halftopened flowers of 
the hundred-leaved rose. They are of a deep-red color, of a pleasant scarcely 
astringent taste, and contain a small percentage of gallo-tannic acid, red color- 
ing-matter, and a trace of volatile oil. Sulphuric acid changes their infusions 
or tinctures to a bright-red color. They are almost destitute of therapeutic 
virtues, but their preparations, except the fluid extract, are used as elegant 
vehicles. The U. S. Pharmacopoeia recognizes a fluid extract (Extraction 32 
SYSTEMIC REMEDIES. 
Rosep. Fluidumf a honey (Mel Rosae, 1 to 12.5), a confection (Confectio 
Rosae), and a syrup (Syrupus Rosae, fluid extract, 1 to 10). 
Rosa Centifolia, U. S., or Pale Rose, contains no tannic acid, but a 
volatile oil, and is used simply on account of its pleasant odor ; out of it are 
prepared rose water (Aqua Rosae, U. S.) and the very elegant, bland emol- 
lient ointment, cold cream ( Unguentum Aquae Rosae, U. S.). 
The rhizome of Geranium maculatum Linn., an herbal plant, which grows 
abundantly in open woods in the middle United States, and may be recognized 
by its light-purplish petals, slender pointed sepals, and five-parted leaves, is 
officinal under the name of Geranium. It occurs in pieces from one to three 
inches long, one-quarter to one-half inch in thickness, wrinkled, contorted, 
tuberculated, often fibrillated, brownish externally, grayish internally. The 
taste is a nearly pure astringent one. It contains largely of gallic and tannic 
acids, and is a somewhat popular astringent, although rarely used by prac- 
titioners. It may be boiled in milk for children needing a mild astringent. 
Dose, grs. xx-xxx. 
Rhus Glabra. U. S.-The fruit or berries of the sumach contain a very 
large percentage of tannic and malic acids. They are not used internally, 
but their fluid extract (Extractum Rhois Glabrae Fluidum, U. S.) affords 
a very superior gargle in anginose affections. It may be diluted with from 
two to four parts of water, and chlorate of potash added to saturation. 
MINERAL ASTRINGENTS. 
ALUMEN-ALUM. U.S. 
Formerly the double salt of alumina and potash constituted the ordinary 
alum as well as the officinal drug. Ammonia as a secondary product in the 
manufacture of coal gas has become so cheap, however, that it is now used 
very largely instead of potash, although the potash alum is alone recognized 
in our officinal standard. The two salts are identical in physical and medical 
qualities, but when the ammonia alum is triturated with lime the odor of 
ammonia is at once evolved. Alum occurs in octahedral colorless crystals, 
which are often aggregated into large masses. Its taste is astringent, acid- 
ulous, and sweetish. It is soluble in about fifteen times its weight of cold 
and in about three-fourths its weight of boiling water. It is slightly efflo- 
rescent, and when heated a little beyond 112° Fahr, parts with its water of 
crystallization, and is converted into a white powder, which is officinal as 
Alumen Exsiccatum, or Dried Alum. The alkalies and their carbonates, 
lime, magnesia and its carbonate, tartrate of potassium, and acetate of lead 
are incompatible with alum. 
Physiological Action.-As alum, even in very dilute solutions, co- 
agulates albumen, it would appear as though it could not be absorbed. Since, 
however, both Drs. Geo. B. Wood and A. Stills assert, on what authority I MINERAL ASTRINGENTS. 
33 
do not know, that alumina can be detected in the urine of persons taking 
it, it or its derivatives must find a way into the blood. What changes it 
undergoes in the alimentary canal, or in what form it enters the blood, is not 
known. 
Applied to a tissue, it acts as a very powerful astringent and irritant. Or-| 
fila found that in dogs one or two ounces of it simply induce violent vomiting 
and purging, whilst in Mitscherlich's experiments two drachms of it produced 
in rabbits fatal gastritis, evidently on account of their inability to vomit. 
In man, large doses internally produce symptoms of violent gastric irritation. 
One ounce and five drachms of the burnt alum caused death in a man in eight 
hours. (A' Union Medicale, No. 64, 1873.) 
Therapeutics.-Alum may be used locally to serve all the purposes of a 
very active astringent. It has been employed very frequently with success 
as a styptic to arrest hemorrhage ; and, applied by the atomization of its satu- 
rated solution, I have found it of signal service in hemoptysis and in bron- 
chorrhea. It also frequently enters into the composition of gargles for sore 
throat; but this practice is to be reprobated, since alum acts very destruc- 
tively on the teeth. In colliquative sweats, sponging at bedtime with alum- 
water, or, still better, the taking of an alum-water bath, will often materially 
aid in restoring the lost tone to the skin. In chronic ulcers with exuberant 
spongy granulations, and in certain conditions of conjunctivitis, alum curd is 
often applied with benefit. When it is desired to exert an astringent action 
upon the internal organs, alum is not nearly so useful as other members of 
the class. 
Owing to its irritant properties, alum when given in sufficient amount acts 
as a mechanical emetic, and may be used as an adjuvant to the sulphate of 
zinc or of copper in narcotic poisoning. Originally introduced by Dr. 0. D. 
Meigs, it is believed to be of service in membranous croup not only by its 
emetic action, but also by modifying the mucous membranes with which it 
conies in contact in its passage down and up. 
So long ago as the last century, Dr. Grashius, of Holland, commended alum 
in colica pictonum, and although for a long time its value was not recognized, 
abundant confirmative testimony has recently been brought forward. Since 
it is a soluble sulphate, it is of course a chemical antidote to any lead salt 
which may be in the alimentary canal. It is, however, of service when there 
is no lead in the primae viae, and must act in some way as yet unknown. It 
has, indeed, been used with asserted success in other neuroses of the ali 
mentary canal,-in gastralgia and in intestinal neuralgia. Dr. Aldredge 
even commends it in habitual constipation. Burnt alum is used as a very 
mild escharotic for exuberant granulations in ulcers. 
Administration.-As an astringent, the dose of alum is from ten to 
twenty grains; as an emetic, a teaspoonful of the powder for a child, a table- 
spoonful for an adult, in syrup, repeated in fifteen minutes ; in colica pictonum, 
twenty to forty grains every three or four hours, combined with morphia. 34 
SYSTEMIC REMEDIES. 
Alum curd may be made by dissolving two drachms in a pint of milk, and 
straining, or by rubbing the alum with white of egg. 
Aluminii Sulphas-Sulphate of Aluminium (A12Os3SO3 + 18H0 
-3SO4,A12 4- 18H0), U.S.-This salt, which occurs as a white powder, or 
in lamellated cakes, or in a crystalline cake, is used externally as a powerful 
astringent and antiseptic. Its solution has also been employed by injection 
for the preservation of cadavers. 
PLUMBUM-LEAD. (Pb.) U.S. 
When a soluble salt of lead is applied to a part in not too concentrated 
solution, it acts as an astringent and sedative. Owing to the contraction of 
the vessels which is induced, the tissue becomes blanched, and any inflam- 
matory action which may be present is remarkably affected. When in con- 
centrated solution, the mildest preparations of lead are capable of acting as 
irritants, increasing or even originating inflammation. When the salts of 
lead are taken internally in therapeutic doses, no decided symptoms are gen- 
erally induced, except a diminution of the secretions, especially of those of 
the alimentary canal. Sometimes, when full therapeutic doses are exhibited, 
a slight lowering of the frequency and force of the pulse (see Laidlaw's Obser- 
vations, quoted by Stille, Therapeutics^ second edition, p. 177, vol. i.) is said 
to result, but I have never witnessed this. The insoluble preparations of lead 
act similarly but less decidedly than the soluble; yet it is doubtful whether 
they can under any circumstances become irritant. 
| Toxicology.-The salt of lead with which intentional or accidental acute 
poisoning is most frequently induced is the acetate.* The first result of a 
toxic dose of this is in most cases a persistent sweet, somewhat metallic taste ; 
this in a few minutes is followed by vomiting, which may or may not be pre 
ceded by nausea. The matters vomited are often milky-white, from the 
presence of chloride of lead. A severe burning persistent pain in the abdo- 
men now comes on, and is accompanied with a craving for drink. There may 
be obstinate constipation, or diarrhoea may ensue; in either case the stools 
are generally black from the sulphuret of lead. In certain cases a state of col- 
lapse is developed ; the pulse falls to forty or fifty per minute, the voice is lost, 
the face is deadly pale, the lips are livid, and syncope seems imminent. In 
other instances the nervous symptoms may predominate, or they may accom- 
pany those of disordered circulation : cramps in the calves of the legs, severe 
neuralgic pains in the extremities, paralysis and anaesthesia, vertigo, stupor, 
may any or all of them be present. In fatal cases, coma, with or without 
convulsions, finally develops. A distinctive mark of lead-poisoning, which 
sometimes is present very early, is the blue line upon the gums. After 
death inflammation of the alimentary mucous membrane is sometimes, but 
not always, found. 
* According to Husemann (Handbuch der Toxicologie), the Poudre de Succession, 30 
famous during the reign of Louis XIV., was composed chiefly of acetate of lead. MINERAL ASTRINGENTS. 
35 
The fatal dose of sugar of lead is between one and two ounces ; the sub- 
acetate of lead is even more poisonous, and the nitrate acts as a violent irri- 
tant. The carbonate appears to be incapable of causing acute poisoning. 
The treatment of acute lead-poisoning consists in the evacuation of the 
stomach, if necessary, the exhibition of the sulphate of sodium or of mag- 
nesium, and the meeting of the indications as they arise. The Epsom and 
Glauber's salts act as chemical antidotes, by precipitating the insoluble sul- 
phate of lead, and also, if in excess, empty the bowel of the compound 
formed. To allay the gastro-intestinal irritation, albuminous drinks should 
be given and opium freely exhibited. 
Of all forms of poisoning, chronic lead-poisoning is the most common. It 
is almost always accidental, and occurs most frequently among those whose 
occupation exposes them to daily contact with some compound of the metal, 
manufacturers of white lead, painters, glaziers, and similar artisans furnishing 
the greater number of victims. It is seen, however, in persons of all condi 
tions of life, for although neither food nor drink is often purposely adulterated 
with it, yet it is frequently introduced into the system accidentally along with 
those necessities. Lead pipes are habitually used for the conveyance of water, 
and when that water contains salts of lime, even in minute proportion, no evil 
results, because through the decomposition which ensues insoluble coatings 
are deposited on the inside of the pipes.* When the water is pure, no such 
reactions occurring, the lead is slowly dissolved in the form of a carbonate, 
and poisoning may result. Poisoning has also frequently resulted from the 
use of cosmetics and hair-dyes, from cooking bread with painted wood (Ze 
Progris Med., 1877, 349), from imperfectly burnt pottery (^Schmidt's Jahr- 
biicher, Bd. cxliv. p. 279; Phila. Med. Times, vol. iv. pp. 241, 483), and 
in other curious ways. 
The most ordinary form of chronic lead-poisoning is that in which colic is 
the first decided symptom. After some days of malaise and wretchedness, 
or sometimes very suddenly, the victim is taken with abdominal colicky 
pains, which increase in intensity until they become very severe. They are 
constant, with occasional exacerbations, are sometimes dull, sometimes sharp, 
are generally described as twisting, and seem to centre around the umbilicus. 
There is very often repeated retching and vomiting. The walls of the abdo- 
men are retracted, rigid, knotted; the bowels are obstinately costive; the 
tongue is contracted and whitish ; the appetite gone; and the thirst some- 
times excessive. Neuralgic pains in the thorax and in the extremities are 
of frequent occurrence. In some cases the conjunctiva is distinctly icterode. 
These symptoms usually abate after a time, but are very apt to recur with 
increasing severity, especially among those who are habitually exposed to the 
cause. In one of these repeated attacks severe cerebral symptoms may come 
* For an elaborate article on the chemical relation of water to lead, see Schmidt's Jahr- 
biicher, Bd. cxliv. p. 279. 36 
SYSTEMIC REMEDIES. 
on suddenly, or after some days of headache; delirium, either mild or 
maniacal, or stupor, is in some such cases the chief manifestation, but epi- 
leptiform convulsions are more common, constituting the condition known 
as enceplialopathia satumina, or saturnine cerebritis. The convulsions 
are often very severe, and end in coma, in which death may take place; 
yet recovery may occur after the most severe symptoms (case, Charite 
Annalen, ix. 159). The nervous symptoms of lead-poisoning may be de- 
veloped after the first attack of colic, or they may occur without marked 
abdominal disturbance. The most common of them is the local paralysis 
known as " drop ivrist." This is a complete palsy of the extensor mus- 
cles of the forearm, which allows the hand to drop forward. It is often 
associated with complete or partial anaesthesia of the part affected, or, in 
some cases, of the still unparalyzed shoulders. Strabismus is sometimes 
present in lead-palsy, due to the paralysis of the external recti. .. (Av 
Among the rarer forms of nervous disturbance induced by lead may be 
mentioned-amaurosis from atrophy of the optic nerve, the atrophy being 
probably the result of an optic neuritis (see Phila. Med. Times, iv. 241 ; 
also Berliner Klin. Wochenschr., 441, 1884, 370)-hemiplegia and hemi- 
anaesthesia-and violent and intractable chorea.* .1 have seen several cases 
in which the symptoms resembled those of an acute poliomyelitis, with 
rapid wasting of all the muscles of the arms and shoulders, the legs also 
being affected. In one instance the bladder and rectum were paralyzed, but 
the patient, long at the point of death, finally recovered. In some cases 
violent neuralgic pains are the chief symptoms of lead-poisoning. 
In some cases of lead-poisoning the kidneys are fatally involved, although 
temporary albuminuria may occur without serious implication of the kidneys. 
On the other hand, fatal nephritis may exist when there is no albumen in 
the urine. (Dr. Lanceraux, Trans. Internal. Med. Congress, 1881, ii. 191.) 
A persistent low specific gravity of the urine in a saturnine patient is of 
very serious import. Geppert iZtschr. Klin. Med., n. p. 161) confirms the 
observation, previously made by Olivier, that in temporary plumbic albumi- 
nuria many isolated kidney epithelial cells may often be found in the urinary 
sediment, and it is evident that a persistence of this condition must end in 
chronic renal disease. After death, which may be induced by uraemia, the 
kidneys are found contracted, granular, with excessive development of the 
fibrous tissue (followed by contraction) and great thickening of the walls 
of the blood-vessels: these changes are identical with those of contracted 
kidney produced by gouty and other irritant poisons. As Ellenberger and 
Hofmeister have shown that the lead is chiefly eliminated by the kidneys, 
the frequency of plumbic nephritis is readily explained ; but it is not 
* For discussion of details of these peculiar conditions, see Beau, Arc/;. Gfn., 1848; 
Maiiouvriez, Arch, de Physiolog. Normal et Patholog., 1870, 411; 1876, p. 762; A. De 
Cours, De I'Hemianesthesia saturnine, Paris, 1875; Proust, Progres Med., 1879, vii. 546; 
Debove, Ibid., 99, 117. MINERAL ASTRINGENTS. 
37 
readily perceived why it is so frequently associated with an arthralgia, 
whose course and lesions closely simulate those of chronic gout. Garrod 
(1859), Dickinson, Lanceraux, Rosenstein, Leyden (Zeitschrift f. Klin. 
Med., .1884, p. 881), and other authors have reported so many cases of this 
association of renal and gouty manifestations, that it can scarcely be doubted 
that the pluinbism is the cause of the gouty symptoms, and not simply a 
complication of gout.* £j 
According to Dr. E. Levy (^Schmidt's Jahrbucher, Bd. clii. p. 250), acute 
asthma is rarely produced by the inhalation of the dust of white lead, and 
chronic saturnine asthma is sometimes seen in feeble, narrow-chested people. 
The epileptiform convulsions produced by lead are in some cases secondary to 
chronic nephritis, but in other instances are due directly to the action of the 
lead (see paper of Dr. Rosenstein, Archiv Path. Anat., Bd. xxxix., 1867, 
p. 4). Upon pregnant women the influence of the poison is very dele- 
terious, and Dr. Constantine Paul (Archives Generales, vol. xv., 1860, p. 
513) has shown that it very commonly produces the early death of the 
foetus. 
As any of these obscure manifestations of lead-poisoning may exist, 
and even prove fatal, without a distinct history of other more characteristic 
phenomena, great care is sometimes necessary to avoid being misled, and 
not rarely the true nature of saturnine epilepsy or of saturnine albuminuria 
is overlooked. Hence the importance of the blue line upon the gums where 
they join the teeth, which probably exists in a greater or less degree in all 
persons suffering from lead-poisoning who have teeth, although very great 
cleanliness may lessen it. It is said to be the result of a formation in the 
walls of the capillaries of the sulphide of lead. Dr. J. J. Putnam affirms, 
however, that he has seen several cases of obscure nervous disease, probably 
due to lead, in which there was no blue line upon the gums, although the 
metal could be detected in the urine. In looking for the metal a quart 
of the urine should be boiled down, as the amount of the lead is very 
small (Trans. Amer. Neurolog. Assoc., 1883, p. 19). 
I have seen in painters a paralysis of one arm and one-sided wrist-drop, 
apparently the result of a local action of the poison; Dr. Manouvriez (7?e- 
cherches cliniques sur I'Intoxication saturnine locale et directe, Paris, 1874) 
has recorded similar observations. (See also La France Med., 1882, i. 892.) 
In those cases of lead-poisoning which pursue a slow course to death, the 
paralysis involves after a time the extensors of the lower as well as of the 
upper extremities, epileptic paroxysms occur at intervals, racking pains shoot 
through the limbs, points of cutaneous anaesthesia appear, and often album!- 
* Consult Deutsch. Med. Wochenschrift, 1883, p. 185, 351; 1884, p. 129; also Dr. 
Paul Musehold, Die Bleivergiftung, eine Ursache chronisch. Nierenerkrankung, Berlin, 
1883. 38 
SYSTEMIC REMEDIES. 
nuria aids in producing the fatal issue. Gradually the patient becomes more 
and more cachectic, general oedema, with the whitened skin, betrays the 
increasing anaemia, the paralysis extends from muscle to muscle, locomotion 
becomes impossible, and, if a convulsion or other accident do not close the 
scene, death at last takes place from loss of power in the respiratory muscles. 
M. Malassez has found that in the anaemia of lead-poisoning the red globules 
are not only diminished in number but also increased in size {Archives de 
Physiologic, 1874, p. 50). 
After death lead has been frequently found in. the tissues. Heubel found 
most of it in the bones, and less in the muscular than in the nervous system 
( Virchow and Hirsch's Jahrbiicher, 1871, vol. i. p. 316). Prof. Chatin 
{Coniptes-Rendus Soc. Biolog., T. iv., 1862, p. 84) obtained from the cer- 
vical spinal cord three in one hundred and fifty parts. In the studies of 
Ellenberger and V. Hofmeister {Arch. Wissen. und Prakt. Thierheilk., x. 
216) the liver and kidneys were found to contain the most lead, after them 
the bones, nerve-centres, and finally the flesh. 
The electro-muscular contractility is affected very early in lead-poison- 
ing, and may be lost before the voluntary movements. It is stated by 
M. Raymond that the short extensor of the thumb preserves its function 
when all the other extensor muscles are paralyzed. The paralyzed muscles 
are finally exceedingly wasted, and their structure may be so totally destroyed 
that scarcely a single striated fibre can be found. The nerve-trunks are 
lessened in size, in many of their tubules the medulla has been replaced by 
fatty granules, and in some cases every trace of the tubules has disappeared 
and the nerve been reduced to a fibrous cord. According to the researches 
of M. Degerine {Compt.-Rend. Soc. Biolog., 1880), the first appearance of 
change in a nerve-trunk consists in the myeline becoming broken up into 
blocks, and the nature of the change is a commingling of a parenchymatous 
and interstitial neuritis, which both Degerine and M. Vulpian have traced 
upwards as far as the anterior spinal roots. Lanceraux {Gaz. Med. de 
Paris, 1862, 1871), Westphal {Arch. . Psych., Bd. iv. 776), Friedlander 
( Virchow's Arch., Ixxv. 24), and others may be cited as having found very 
distinct peripheral lesions in lead-poisoning. Whether these lesions begin in 
the nerve or in the muscles cannot be considered as determined. Birdsall 
{N. Y. Med. Record, March, 1882) reported a case of what he believed to 
be a plumbic myositis, and Gourbault {Le Progris Med., 1880) describes 
primary alteration in the nerves, similar to those seen after section, as 
occurring in poisoned guinea-pigs, whilst MM. Debove and Reaut {Le 
Progris Med., 1876, 151) describe the first changes as resembling those of 
subacute myositis, and Friedlander emphatically asserts that lessening in 
the size of the muscular fibres and multiplication of the muscular nuclei 
precede the nerve-degeneration. On the other hand, Vulpian {Malad. du 
Systeme Nerv., 1879), Monakow {Arch. f. Psychiat. und Nervenkr., Bd. MINERAL ASTRINGENTS. 
39 
x. 495), and Oeller (Festschrift dem Arztl. Verein Munchen, 1883) have 
observed structural changes (poliomyelitis, capillary hemorrhages, etc.) in 
the spinal cord of men dead of plurnbism : whilst Popow ( Virchow's Archiv, 
Bd. xciii. p. 351) found that when guinea-pigs were rapidly poisoned (sixto 
eight days) with lead there was produced a central myelitis, which first 
affected the large cells of the gray matter, and afterwards involved the white 
matter, the peripheral nerve-filaments remaining normal. 
There is, however, no real contradiction, as Popow believes, between his 
observations and those of Goubault, for the latter (Arch, de Physiol. Norm, 
et Path., 1873) poisoned his animals very slowly (six months), and it is not 
improbable that the rapidity of the poisoning should have influence upon 
the seat of the lesion. As already stated, the symptoms of plurnbism may 
exactly simulate those of general poliomyelitis, and Degerine has found de- 
generation of the motor cells. The evidence at present indicates that lead 
is capable of producing a peripheral neuritis, and also a centric poliomyelitis; 
the pro! abilities being in favor of a peculiar peripheral neuritis, as the pri- 
mary lesion of ordinary plumbic wrist-drop. Hemorrhages into the nerve- 
centres sometimes occur (Progrit Med., xii. 827). 
Rudolf Maier ( Virchow's Archiv, Bd. xc. 480) has found that the in- 
testinal mucous membranes and walls suffer, in animals poisoned with 
lead, changes similar in nature to those already detailed as occurring in the 
kidney; and has also shown that there is widespread degeneration of the 
arterioles. It would appear that lead is an almost universal poison to the 
higher tissues, and that at present we are unable to say why in any indi- 
vidual case one part rather than another is attacked. 
The excretion of lead with the gall is very active, but it is probable 
that it chiefly escapes from the body with the urine. The elimina- 
tion seems to be capricious, and much affected by iodide of potassium 
(Meisens, Ann. Phys, et Chem., xxvi.; Pouchet, Arch, de Physiol., xii. p. 
74) and by other influences.* 
The treatment of chronic lead-poisoning evidently arranges itself under 
three indications: 1st, to prevent the ingestion of more of the poison ; 2d, 
to aid in the elimination of that in the system ; 3d, to relieve symptoms and 
restore lost functions. In lead-colic both of the last two indications are met 
by purgatives, to which opium should be added to relieve pain. It is often 
necessary to use the most powerful drastics, such as croton oil; but senna, 
salts, and other of the milder cathartics should always be tried first. Alum, it 
is asserted, acts in some unknown way as a specific in lead-colic, and from 
twenty to sixty grains of it may be given four or five times a day ; but my 
own experience is not favorable to its use. In the more chronic forms of 
* Lead has been found in the urine of man or animals by Orfila, Lewaid (Ausscheidung 
der Arzneimittel, Breslau, 1861), Gusserow ( Virchow's Archiv, Bd. xxi.), Annuschat {Arch. 
Experim. Pathol, und Pharm., x. 260), and Oettinger ( Wiener Wochenschrift, 1858); also 
in my clinical service at the University Hospital. 40 
SYSTEMIC REMEDIES. 
lead-poisoning, to fulfil the second indication baths of sulphuret of potassium 
should be employed, and iodide of potassium be administered internally. 
The bath should be given (Dr. A. Eulenburg, Deutsches Archiv fur Klin. 
Med., Bd. iii. p. 506) in a wooden tub, two or three times a week, and 
should contain six or seven ounces of the salt. The patient, during the 
half-hour of his continuance in it, should be from time to time well rubbed 
with a coarse towel. On coming out he is to be thoroughly washed with 
warm soap-suds. The dose of the iodide should be from fifteen to twenty 
grains, administered after meals, in dilute solution. A case is reported in 
the London Lancet, 1876, ii. 53, in which galvanic baths were used success- 
fully, the patient being placed in the bath and the positive pole of a twenty- 
eight-cell battery applied to nape of neck, the negative to the feet. When 
severe cerebral symptoms arise, treatment is of little avail, and should be 
largely expectant* 
The local use of electricity is exceedingly important to restore the lost 
function of nerve and muscle. When the faradaic current elicits a response it 
should always be employed; but in some cases {Meyer's Electricity, .New 
York, 1869, p. 284) the continued current retains its power after the induced 
has lost all its influence. The rule is always to apply that current which causes 
contraction ; if both fail, the continued current should be used, the poles being 
reversed at intervals of four or five seconds. The electrical seances should be 
tri-weckly, each lasting about fifteen minutes, and they should be persevered 
in for months. I have seen great improvement in a case which for the first 
four months yielded no results ; indeed, long after voluntary movement had 
in great measure returned, no form of electricity would cause contraction of 
the affected muscles. 
Physiological Action.-The symptoms of acute lead-poisoning are 
chiefly due to its local irritant action, but those of chronic poisoning are of 
wider significance. How the lead is absorbed to produce them is uncertain, 
probably as an albuminate. All of the compounds of lead and albumen as 
yet discovered by the chemist are, however, precipitated by alkaline carbon- 
ates, and cannot therefore exist in the blood. 
The symptoms of chronic lead-intoxication to be accounted for are the 
colic, the anaemia and wasting, the palsies, the rare cases of cerebral symp- 
toms, or of kidney degeneration. In explaining them we are chiefly indebted 
to the researches of Dr. Ernest Harnack {Archiv fur Experim. Pathologie, 
1878), who employed the compound of lead and ethyl, first discovered by 
Loewig. When this is injected into animals in large quantities it causes a 
rapidly fatal train of symptoms, evidently due to the action of the compound 
* It seems doubtful whether the sulphur baths really aid elimination, but I have cer- 
tainly seen good follow their use. It has been denied that the iodide acts, but cases are 
reported in which lead was not in the urine before, and was after the administration of 
the drug (see British Med. Journ., 1880, ii. 1034). MINERAL ASTRINGENTS. 
41 
itself. When, however, the introduction into the system has been slow, 
a chronic poisoning is produced by the lead set free in the blood and 
tissues. 
Under these circumstances a constant symptom, both in dogs and rabbits, 
is diarrhoea, due to a violently increased peristalsis, with, in the dog, occa- 
sional attacks of colic. As both the diarrhoea and the excessive peristalsis 
are arrested by atropia, they are probably the result of an action upon the 
intestinal ganglia. The colic in man is probably due to the excitement be- 
coming so intense as to cause spasmodic contraction of the muscular coat of 
the intestine and consequent arrest of peristalsis, obliteration of the in- 
testinal lumen, and constipation. If such be the case, large doses of bella- 
donna should at once give relief. 
Dr. Harnack found that in dogs the lead ethyl produces violent excite- 
ment, with chorea, convulsions, etc., evidently due to an exciting or irritant 
action upon the cerebrum, and believes that this explains the saturnine cere- 
bral cases sometimes seen in man. Curci is stated to have proven that lead 
exerts an irritant influence upon the peripheral branches and ganglionic cen- 
tres of the pneumogastric (Gaz. Hebdom., 1883, 552 ; from Gazze dcgli 
Ospitale, Mars, 1883). 
The chief symptom of the poisoning in frogs was a progressive palsy of 
muscular origin. The muscle became exhausted on repeated galvanization 
much more rapidly than is normal, and after death was incapable of under- 
going complete post-mortem rigidity. The peripheral nerves appeared to 
have escaped entirely. The heart-muscle shared the fate of the voluntary 
muscles. The muscular action of the poison was excessively pronounced in 
rabbits, but was feeble in dogs and cats. Different results have, however, 
been arrived at by Dr. H. v. Wyss ( Virchow's Arch., Bd. xcii.), who found 
that the loss of reflex activity, etc., in the frog was not prevented by tying 
an artery so as to protect the leg from the poison; and that the protected 
muscle lost its power of responding to electrical stimulation just as fast as 
did the one reached by the lead. He concludes, therefore, that the paralysis 
is of centric origin. 
The pulse in lead-colic is usually very hard and tense. Sphygmographic 
studies made of it by August Frank (Deutsch. Arch. f. Klin. Med., xvi. 
422, and Ernest Bardenhewer, Berlin Klin. Wochen., 1877, 126), have been 
thought to indicate a condition of general arterial spasm, and have given rise to 
the very improbable theory that the colic is caused by intestinal anaemia from 
vaso-motor contraction. Bardenhewer found that hypodermic injections of 
pilocarpin relieve simultaneously the pulse and the colic precisely as Harnack 
discovered that atropia does. Harnack, however, found that in rabbits and dogs 
the lead ethyl has no action upon the circulation except by direct influence 
on the cardiac muscle, and that it does not produce vaso-motor spasm. He is 
probably correct in believing that the pulse of lead-colic is due to an over- 
fulness of the blood-vessels, produced by an expulsion of the blood from the 42 
SYSTEMIC REMEDIES. 
intestines by the severe spasm of their coats. According to the researches 
of Bllenberger and Hofmeister, in the sheep toxic doses of lead greatly de- 
press the elimination of urea. 
The following preparations of lead are officinal in the United States Phar- 
macopoeia : 
PLUMBI OXIDUM-OXIDE OF LEAD. U.S. 
Litharge, which is prepared by blowing air through melted lead, occurs in 
small yellowish or orange-colored scales, which are insoluble in all ordinary 
menstrua. It is rarely used as a desiccant astringent powder for ulcers, but 
its chief employment in medicine is as the basis of the following preparations: 
Emplastrurn Plumbi, or Lead Plaster, is made by boiling litharge, olive 
oil, and water together. Glycerine is set free, and the oleo-margarate of lead 
is formed. Lead plaster occurs in grayish, cylindrical rolls, which become 
adhesive at the temperature of the body, and, spread upon kid, is sometimes 
used as a protective to parts exposed to pressure, or to superficial ulcers or 
abrasions. Emplastrurn Resinae, or Resin Plaster, or adhesive or sticking 
plaster, is made by incorporating resin with lead plaster, and, spread upon 
linen, is much used in surgery for mechanical purposes. The Emplastrurn 
Saponis, or Soap Plaster, is made by the addition of soap to lead plaster. 
It is employed chiefly as a protective. 
PLUMBI ACETAS-ACETATE OF LEAD. U. S. 
Sugar of lead is made by the action of acetic acid upon litharge, or upon 
sheets of lead exposed to the air. It occurs in transparent, acicular, often 
aggregated crystals, of a sweet, styptic taste. It is soluble in water, to which 
it usually imparts a slight milkincss. From its solution it is precipitated 
black by sulphuretted hydrogen, white by soluble carbonates, chlorides, and 
sulphates, and bright yellow by the iodide of potassium. It is also incom- 
patible with the mucilage of slippery elm, but scarcely so with that of flaxseed 
or of pith of sassafras. 
/ Therapeutics.-A solution of the acetate of lead is used very largely in 
acute external inflammations as a sedative and astringent lotion. Although 
chemically incompatible, it is frequently combined very advantageously in 
these cases with opium. As a too concentrated solution acts as an irritant, 
the strength for use on the skin should not exceed ten grains to the ounce. 
In diseases of the eye it is condemned by oculists, because when there is 
any abrasion of the cornea it is very prone to deposit an opaque film. 
Internally, acetate of lead has been employed very largely in hemorrhage : 
indeed, Prof. George B. Wood commends it as the most valuable of all 
astringents in haemoptysis (Therapeutics, vol. i. p. 158). I think it is now, 
however, rarelv used for this purpose. Its chief use at present is in diarrhoea. 
On account of its sedative properties, when the purging is attended with in MINERAL ASTRINGENTS. 
43 
flammation it is the most serviceable of all the astringents; and, owing to 
the promptness of its action, it is also very valuable in cases with profuse 
serous discharges. In dysentery it is very useful whenever the discharges 
have become copious. The dose is from two to five grains, always in pill, 
repeated pro re nata. The suppositories (Suppositoria Plumbi, U. S. 1870) 
contain each three grains. 
[ Liquor Plumbi Subacetatis.-The Solution of the Subacetate of Lead, 
or Goulard's Extract, as it is sometimes called, is a colorless, limpid liquid, of 
a sweetish, astringent taste. It is made by boiling litharge in a solution of 
the acetate of lead, and has an alkaline reaction. When exposed to the air, 
it rapidly absorbs carbonic acid and deposits the carbonate of lead, the neu- 
tral acetate being left in solution. In its action upon the human organism, 
Goulard's extract resembles very closely the simple acetate of lead; but it 
is never used internally. Externally, it is a favorite application in cases of 
sprains or bruises, as well as in superficial inflammation. For this purpose 
it requires dilution, and from a fluidounce to four fluidounces of it may be 
added to a pint of water. When used upon a raw surface, the strength 
should not be so great. A sedative poultice, which is very highly recom- 
mended by some physicians in the early stages of inflammation, may be made 
by saturating crumbs of stale bread with Goulard's extract diluted with four 
to six times its bulk of water. This poultice must be applied cold. The 
officinal Liquor Plumbi Subacetatis Dilutus, or Dilute Solution of the Sub- 
acetate of Lead, is of the strength of three parts in a hundred. It is too 
weak to be of much value. 
^/^lumbi Carbonas, U. S., or Carbonate of Lead, is a heavy, white, taste- 
less powder, insoluble in distilled water, but slightly so in water containing 
carbonic acid. It is used solely as an external sedative application. Rubbed 
up with linseed oil, it constitutes white-lead paint, and in this form, or in that 
of the ointment ( Unguent um Plumbi Carbonatis, U. S.), it is a most efficient 
dressing for fresh burns. Care must be taken in its use, however, when a 
large surface is involved, as lead-colic has been caused by its absorption. 
Plumbi Nitras, U. S., or Nitrate of Lead, occurs in white, nearly opaque, 
octahedral, very heavy crystals, soluble in alcohol and in seven and a half 
parts of cold water. It is used chiefly as a disinfectant. Dissolved in water,1 
it forms Ledoyens Disinfectant Solution. It acts by decomposing the sul- 
phuretted hydrogen, itself being converted into a sulphuret of lead. It is 
said to attack actively the soldering of pipes (Report on Hygiene, U. S. Navy, 
1879). Its chemical reactions are similar to those of the acetate, from which 
it may be distinguished by a mixture of it and sulphuric acid striking a red 
color with morphia. The nitrate of lead is frequently used in onychia 
maligna. The dead part of the nail should be cut away, and the powT- 
dered nitrate thickly sprinkled over the surface ; after a few days the slough 44 
SYSTEMIC REMEDIES. 
separates, leaving a clean surface, upon which the new nail usually soon 
forms. Sometimes more than one application of the remedy is required. 
BISMUTHUM-BISMUTH. 
The metal bismuth is never used in medicine in its simple or metallic 
form. 
BISMUTHI SUBCARBONAS-SUBCARBONATE OF BISMUTH. U.S. 
(BiO3CO2,HO - 2Bi2O3CO3,H2O.) 
A white or yellowish-white powder, tasteless and odorless, totally insoluble 
in water, soluble with effervescence in dilute nitric acid. The mode of its 
preparation is too complicated for discussion here, the chief object of the 
various steps being to get rid of the arsenic, which very generally contami- 
nates the metal. The same assertions may be made in regard to the prepa- 
ration of the Bismuthi Subnitras, or Subnitrate of Bismuth, U.S., 
a heavy white powder, odorless, with a faint acid taste, and a decidedly acid 
reaction when applied to moistened litmus-paper, insoluble in water, soluble 
without effervescence in nitric acid. 
Physiological Action.-The actions of the subnitrate and of the sub- 
carbonate of bismuth are so exactly similar that they can practically be con- 
sidered as one thing; and for the sake of brevity I shall speak of these salts 
simply as bismuth, meaning thereby these preparations. Orfila and other 
of the old observers attributed to bismuth violent irritant properties, stating 
that severe symptoms, and even death, sometimes followed its ingestion; 
but these results were due not to the bismuth, but to the arsenic with which 
it was contaminated. When pure, however, it is free from any irritant 
properties, and is a feeble astringent and even a sedative, and can be taken 
without injury in indefinite quantity. 
It has been denied that the subcarbonate and subnitrate of bismuth are 
dissolved in the alimentary canal, but we now know that they are very slowly 
absorbed and eliminated. Harnack affirms (Arzneimittellelire, 1883, p. 
383) that the metal has been found by Orfila in the liver, spleen, and urine, 
and by Lewaid in the milk. MM. Bergeret and Mayengon (Journal de 
I'Anatomie, 1873, p. 242) state that when the subnitrate of bismuth is 
administered the metal can always be detected, after a few hours, in the 
urine. They have also discovered it in the serous exudation of dropsy, and 
have proven that when a few grains of the salt mehtioned are given to rab- 
bits, in from twenty to thirty minutes it can be found in the urine, kidneys, 
spleen, blood, and muscles, and even eight days after the administration can 
be detected in all the tissues. Five days after the exhibition of a gramme 
of the subnitrate to a man, they found traces of the metal in the liver and 
kidneys ; but the analysis of the body of a woman dead sixty-two days after 
the ingestion of two grammes yielded only negative results. Prof. E. 8. MINERAL ASTRINGENTS. 
45 
Wood also has detected bismuth in the urine four weeks after its last exhi- 
bition ( Tr. Amer. Neurolog. Assoc., 1883, p. 23). 
Therapeutics.-The preparations of bismuth are of great service in 
various forms of irritation of the alimentary canal. They are very useful to 
allay vomiting dependent upon gastric irritation. In simple neuralgic gastric 
pain following eating, especially when occurring in feeble, badly-nourished 
subjects, bismuth is often of great service; and even in carcinoma it may 
palliate by alleviating pain and vomiting. In pyrosis it is sometimes success- 
ful. In simple diarrhoea of irritation, and in the chronic diarrhoea of camps, 
the bismuth preparations are often very efficient; and in the chronic bowel 
complaints of children, especially as seen in the summer season, given with 
pepsin, they are almost invaluable. Topically, these preparations may be used 
with advantage as desiccant astringent applications in leucorrhoea, mgonor^ 
rhoea, and in irritable external ulcers. 
Administration.-In order to be efficient, the bismuth preparations must 
be given in much larger doses than they were formerly used in. To infants 
five to ten grains may be administered at a dose, and to adults from twenty 
grains to a drachm. 
Bismutiii Citras. U. S.-The insoluble citrate of bismuth is not used 
in medicine, but has been introduced into the Pharmacopoeia for the pro- 
duction of the Bismuthi et Ammonii Citras, U. S. The citrate of bismuth 
and ammonium is a soluble salt, which is much more astringent than the in- 
soluble preparations of the metal, but at the same time more irritant. It 
lacks the peculiar virtues which grow out of the insolubility of the sub- 
nitrate, but has been used to some extent in doses of five grains in chronic 
diarrhoea and in acute diarrhoeas of relaxation. It should be given in 
watery solution, repeated every three to six hours, according to the exigen- 
cies of the case. 
OEBII OXALAS. U. S. 
The oxalate of cerium is a white powder, insoluble in water, alcohol, and 
ether, but soluble in sulphuric acid. It has been employed in medicine quite 
largely for the relief of vomiting, especially when dependent upon pregnancy 
or other forms of uterine disturbance. Its action on the economy has not 
yet been made out, but it may be tried with some hope of success in cases of 
nervous or dyspeptic vomiting. The dose is one to three grains, in pill, three 
or four times a day. 
ZINOUM-ZINO. 
Zinci Sulphas.-Sulphate of Zinc. U. S.- White vitriol occurs in irreg- 
ular white masses, the pure sulphate of zinc in minute, transparent, four- 
sided, prismatic crystals, which effloresce slightly in dry air, and are soluble 
in two and a half times their weight of cold, and much less of hot, water; 
insoluble in alcohol. The taste is styptic and peculiar. 46 
SYSTEMIC REMEDIES. 
Therapeutics.-The sulphate of zinc is in weak solution a stimulant 
astringent, in concentrated form an active irritant. Taken in doses of thirty 
grains it acts as a prompt, efficient mechanical emetic. In smaller doses, of 
two grains, it is sometimes given in pills as a stimulant astringent in chronic 
diarrhoea with ulceration. 
Toxicology.-Sulphate of zinc in large doses acts as an irritant poison, 
producing violent vomiting, colicky pains, diarrhoea, prostration, etc. The 
symptoms which it causes are almost identical with those produced by the 
corresponding salt of copper. Alkalies and their carbonates are the chemical 
antidotes to it, producing insoluble precipitates. Eggs and milk should also 
be exhibited, and the symptoms treated as they arise. Chronic zinc-poi- 
soning, if it really exists at all, is very rare, and the metal seems to be 
used with impunity in cooking utensils. Dr. Schlockow, however, affirms 
(Deutsches Med. Wochensch., 1879, 208), that the zinc-smelters rarely live 
to be over forty-five; dying, sometimes with catarrh of the bronchial or 
alimentary mucous membranes, or, in other cases, of a peculiar nervous 
affection, which commences with burning superficial pains, exalted sensi- 
bility, and reflex activity in the legs, and afterwards puts on still more 
clearly the features of myelitis. 
Zinci Oxidum Ven ale.- Commercial oxide of zinc is a snow-white 
powder, obtained by burning the metal in the air. It should be used only 
in pharmacy. The pure oxide (Zinci Oxidum, U. S.) is made by heating 
the carbonate until the water and acid are driven off. It is a yellowish- 
white powder, insoluble in water, but soluble without effervescence in dilute 
acids. 
Therapeutics.-The oxide of zinc is used externally as a mildly astrin- 
gent, slightly stimulant, and desiccant application in skin diseases and to ulcers. 
When given continuously in small doses it is believed to act as a tonic and 
alterative upon the nervous system. It has also been commended as an 
astringent in chronic catarrhal diarrhoea of adults and infants, and has been 
largely used in epilepsy and in chorea. The dose is two to fifteen grains. 
The ointment ( Unguentum Zinci Oxidi, U. S.-one part to four of benzoin- 
ated lard) is especially useful in chronic eczema. 
Zinci Carbonas Prjecipitatus. U.S.-Precipitated carbonate of zinc 
is intended to replace the old impure native carbonate, calamine. It is made 
by precipitating the sulphate of zinc by the carbonate of sodium. It is a 
white powder, closely resembling in its properties the oxide of zinc. 
Zinci Acetas. U. S.-Acetate of zinc is made by the action of acetic 
acid upon the commercial oxide of zinc. It occurs in white, micaceous crys- 
tals, which effloresce in a dry atmosphere and are very soluble in water. The 
taste is astringent and metallic. The acetate of zinc resembles in its physio- MINERAL ASTRINGENTS. 
47 
logical and therapeutic qualities the sulphate, but is probably somewhat less 
active. It is chiefly used in collyria (one to two grains to one fluidounce); 
and as an injection (five to twenty grains to one fluidounce) in gonorrhoea. 
Cadmium is employed in medicine to some slight extent in the form of 
its sulphate, which is stated to resemble closely the sulphate of zinc in its 
therapeutic properties. It has been especially used as an astringent stimu- 
lant in collyria, made by dissolving half a grain to four grains in an ounce 
of rose-water. Strangely enough, some physicians who have employed it 
state that it has ten times the strength of the zinc salt, others that it is about 
equivalent to it. 
CUPRUM-COPPER. 
CUPRI SULPHAS-SULPHATE OF COPPER. U.S. 
The sulphate of copper occurs in blue, transparent, slightly efflorescent, 
rhomboidal prisms, or their fragments. It dissolves in four parts of cold and 
in two of boiling water, but is insoluble in alcohol. With ammonia its solu- 
tion precipitates a bluish-white hydrated protoxide of copper, which redissolves 
when an excess of the alkali is added, forming a rich deep-blue solution. 
Physiological Action.-In very dilute solution the sulphate of copper 
acts locally as a stimulant and mild astringent; in a more concentrated form 
it is an irritant; in powder it is a very mild caustic, which is scarcely capable 
of destroying sound tissue. Taken internally in very small amounts and 
continuously, it is thought to have a corroborant influence upon the nervous 
system. Prof. Falck (Deutsches Klinik, xi., 1859) has found that the sul- 
phate of copper acts upon pigeons, dogs, rabbits, etc., as an irritant neurotic 
poison, producing great depression of temperature, with progressive general 
paresis ending in death, apparently from failure of respiration. When the 
copper salt was given hypodermically, vomiting was not produced; although 
when it was exhibited by the mouth, emesis was very violent and persistent. 
In doses of five to fifteen grains it acts upon man as an irritating emetic, and 
in larger amounts is an irritant poison. 
Therapeutics.-The chief internal use of sulphate of copper is as a 
mechanical emetic. As it is more irritating than sulphate of zinc, it acts 
more rapidly and in smaller dose. For the same reason, however, it is not so 
safe as the white vitriol, and cannot be repeated so freely when its action fails. 
As a stimulant and astringent it is occasionally administered, in pill form, 
in chronic diarrhoea with ulceration. In small repeated doses it has been 
used in various nervous affections with doubtful advantage. 
The chief value of the so-called "blue stone" is as an external application. 
When applied in solid form to ulcers, it destroys flabby granulations and 
exerts a powerful excitant influence. Its solution acts more feebly, and is 
sometimes employed as a dressing for indolent ulcers, but more frequently as 
a stimulant and alterant to mucous membranes, as in granular conjunctivitis. 
Toxicology.-The symptoms of acute copper-poisoning generally come on 48 
SYSTEMIC REMEDIES. 
m about a quarter of an hour after the ingestion of the poison, but may be 
postponed for from one to two hours. They consist of violent vomiting and 
purging, accompanied by very severe colicky pains. The matters vomited are 
greenish or bluish, the stools glairy, mucous, and at times bloody. There is 
a very strong taste of copper in the mouth, and often constant expectoration ; 
excessive salivation and bronchial secretion are stated by Galippe (Etude 
toxicol. sur la Cuivre, Paris, 1875) to be characteristic. Death may occur 
in a few hours, preceded by convulsions, paralysis, delirium, anaesthesia, and 
other symptoms of great nervous disturbance, seemingly as the result of a 
direct action of the poison upon the nervous system. Sometimes a tendency 
to syncope is very marked. The urine is usually lessened or suppressed. 
Black urine, due to the presence of haemoglobin without unaltered blood- 
corpuscles, has been noted ; in this case, after death all the tissues were found 
stained with altered blood, and evidently destruction of the blood was an 
important factor in the fatal result (N. K Med. Record, xxi. 567) ; fatty 
degeneration of the liver was also found. If the patient Survive for twenty- 
four hours, jaundice nearly always shows itself. After this, profound depres- 
sion with nervous symptoms may develop and end in death ; but not rarely 
a favorable issue results, in which case the symptoms of gastro-intestinal 
inflammation with fever develop themselves. In the experiments of Ellen- 
berger and V. Hofmeister upon animals, haematuria and fatty degeneration 
of the liver were prominent phenomena (Arch. IFissen. Prakt. Thierhe'dk., 
x. 228). The copper is said to be eliminated more freely with the salivary 
and intestinal secretions than with the urine (Galippe, loc. cit., p. 41). 
As the action of the sulphate of copper is exceedingly rapid, any antidote 
to be of avail must be given at once and act quickly. Milk and eggs are 
almost always at hand, and are the most efficient antidotes. No time should 
be lost in attempting to separate the yolk from the white of the egg, but 
the eggs should be broken into a bowl as quickly as possible, a little water 
added, and the whole stirred up and exhibited. The dose should be repeated 
several times, especially when there is vomiting. Soap or a fixed alkali may 
be given. The yellow prussiate of potash, when pure, is harmless, and pre- 
cipitates instantly an insoluble compound of copper from solutions of its salt. 
When it is to be had in time, it may therefore be used as an antidote to the 
sulphate. The treatment of copper-poisoning after the administration of the 
antidote consists in meeting the indications as they arise; opium should be 
used freely. When death occurs, the results of gastro-intestinal inflammation 
are usually found ; sometimes the intestine has a decided bluish tint, and occa- 
sionally submucous ecchymoses occur. In exceptional cases, it is said, there 
are no evidences of inflammation in the alimentary canal.* Fatty degener- 
ation of the liver has been noted (N. K Med. Rec., xxi. 567). 
* For a fatal case of repeated poisoning by copper, with much information of value to 
chemical experts, see La France Medicale, September, 1874, abstracted in Half- Yearly MINERAL ASTRINGENTS. 
49 
If chronic copper-poisoning ever exist among workers in the metal, it must 
be very rarely. The chief symptoms are asserted to be " a coppery taste in 
the mouth, giddiness, pain in the bowels, vomiting, occasional diarrhoea, 
and wasting of the body." Dr. Clapton {Medical Times and Gazette, June, 
1868) has pointed out, as characteristic, a green line upon the gums; this 
was also observed by Prof. Taylor, but its constancy is not assured. Thus, 
a green line was found on the teeth of all but two or three of a number of 
workers in the metal examined by a committee of the London Clinical Society 
( Transactions, 1870, p. 13), but there was no line on the gums of any of 
them. Galippe {loc. cit.} has brought forward much evidence to prove the 
non-existence of chronic copper-poisoning. Both he and Drs. Burcy and 
Ducom have found the metal almost without influence upon dogs {Archives 
de Physiolog. Norm, et Path., 1877, t. iv. 183). Galippe {Comptes-Rendus, 
t. Ixxxiv. 718) fed himself for one month on food containing a large amount 
of copper without causing any symptoms of intoxication. On the other hand, 
Dr. Faulk {Deutsches Klinik, ix. 376) asserts that the acetate of copper pro- 
duces progressive paralysis, with failure of respiration and death. 
Cupri I cetas. U.S.-Acetate of copper is in deep-green, prismatic 
crystals, yielding a bright-green powder; whilst the impure subacetate, or 
verdigris, occurs in masses of a pale-green color, which are often composed 
of minute silky crystals. Both acetates closely resemble the sulphate in 
physiological, therapeutical, and toxicological properties, but are less active. 
ARGENTUM-SILVER. 
ARGENTI NITRAS-NITRATE OF SILVER. U.S. 
This is oflicinally prepared by heating together silver, nitric acid, and a 
small quantity of water. It is a heavy anhydrous salt, crystallizing in trans- 
lucent, shining, rhombic plates, and having a styptic, exceedingly metallic, 
corrosive taste. It is soluble in its own weight of cold water. Muriatic acid 
or a soluble chloride throws down from its solution a white curdy precipitate 
wholly soluble in ammonia. For external use the crystals are melted and run 
into moulds, where they harden into round, grayish, brittle sticks, about the 
size of a goose-quill, and having a radiated crystalline fracture. These are 
the officinal argenti nitras fusus. As only the pure salt will make well-formed 
crystals, the impure products are always manufactured into the preparations 
just named, which should therefore not be employed internally. When the 
nitrate of silver, either in substance or solution, is exposed to the conjoint 
influence of light and of even a minute portion of organic matter, it turns 
Compendium, Jan. 1875. Bournevette and Yvon (Revue Scientifique, p. 859, 1874) found 
two hundred and ninety-five milligrammes of metallic copper in the liver of a woman 
who had taken the ammoniacal sulphate three months previously. Minute quantities of 
copper exist in the normal human body (Bull, de TMrap., xciii. 88). 50 
SYSTEMIC REMEDIES. 
black, and is converted into an insoluble substance, which has been be- 
lieved to be metallic silver, but is more probably an oxide. For this reason 
the white stains which it first makes when applied to living tissues soon 
blacken. 
Physiological Action.-Nitrate of silver coagulates albumen, and, when 
applied in its pure state to living tissues, acts as a caustic, coating them over 
with a white almost membranous film. The caustic action is, however, not 
a deep one, because penetration of the salt into the tissues is soon prevented 
by the thick and tough skin or stratum which is formed. When applied in 
a dilute solution it acts as an astringent, constringing the vessels and over- 
coming relaxation. Its local action, however, is not simply that of an astrin- 
gent, but is certainly peculiar and apparently alterative to nutrition. 
When taken internally in sufficient dose, this salt, by virtue of its corro- 
sive action, is a poison, producing gastro-enteritis ; but it also acts directly upon 
the nervous system. Orfila and other of the earlier observers experimented 
upon it by injecting it directly into the veins of animals. When exhibited 
in this way, it must, by coagulating the albumen of the blood, produce 
thrombi, to which the subsequent symptoms are in greater or less measure to 
be ascribed. This method of experimentation can therefore throw but little 
light upon the action of nitrate of silver when taken into the stomach. 
It is evident that in the stomach the nitrate of silver cannot long maintain 
its integrity. Dr. Bogolowsky has found ( Virchow's Archiv, Bd. xlvi. p 
413) that when the nitrate is added to a peptone it is readily dissolved, and 
that the solution formed does not coagulate albumen.* That in this or in some 
other analogous form silver is absorbed is proven by its having been found 
in various internal organs and by the discoloration which follows its pro- 
tracted use. When it is exhibited for a long continuous period, the skin 
often acquires a peculiar bluish slate color, which may become very dark, and 
in decided cases the conjunctiva and even the mucous membrane of the mouth 
are involved. The silver is found in all the tissues of the skin below the 
rete Malpighii f (Frommann, Virchow's Archiv, Bd. xvii. 135 ; Riemer, 
Archiv d. Heilkunde, Bd. xvi. 296 ; xvii. 330; Neumann, Medizin. Jahr- 
bucher, 1877, 369). Prof. E. Harnack asserts (Arzneimittellehre, 1883, 
410) that in all recorded cases of argyria at least thirty grammes of the 
♦ For recent studies of this character see Isedon Neumann (loc. cit.), also A. v. Frag- 
stein (Berlin Klin. Wochen., 1877, 294). 
f In an elaborate study of the organs of a case of argyria, Riemer found the silver in 
the glomerules of the kidney, the intima of the aorta, the choroid plexus, and the mes- 
enteric glands. He believes that it is never deposited inside the cells, but in the cellular 
tissue, and that the silver preparation is reduced in the intestines, and the fine particles 
of the silver carried in the blood and lymph. 0. Loew (Pfluger's Archiv, xxxiv. 603) 
asserts, however, that the silver is deposited inside of the renal endothelium cells, and, 
as he has found that protoplasm has reducing powers, believes that the silver is reduced 
in the cells from a solution. MINERAL ASTRINGENTS. 
51 
salt have been taken. According to Dr. William Pepper, the staining of 
the skin is always preceded by a dark line upon the gums ( Trans. Philad. 
Coll. Physicians, 1877). Both Heller and Orfila failed to detect silver in 
the urine of animals taking it; but probably it is eliminated, though slowly 
and in very small quantities, by the kidneys. 
By an elaborate series of experiments, M. Chas. Rouget (Archives de Phy- 
siologic, July, 1873, p. 356) has shown that upon all animals from a crab to 
a dog the soluble salts of silver act as a poison, causing in mammals vomiting 
and purging, and in them and the lower animals violent disturbance of the 
motor functions, as shown by paralysis and convulsions, and of the respiration, 
ending finally in death by asphyxia. This is in accord with the observations 
of other investigators. MM. Rabuteau and Mourier have found that the 
almost instantaneous death which Charoot and Ball first noted as following 
the injection of a large dose of the nitrate of silver into the veins is due to a 
direct paralyzing influence of the drug upon the muscle of the heart. M. 
Rouget has never seen this form of death follow the hypodermic or internal 
administration of the poison, the heart always continuing to beat for a greater 
or less length of time after the cessation of respiration, and also retaining its 
irritability. 
As already stated, both convulsions and paralysis are present in acute argy- 
ria, or silver-poisoning. The convulsions are severe, generally tetanic, and 
according to Rouget are plainly reflex. A peculiarity noted by Rouget is 
the persistence of the convulsions after the complete abolition of voluntary 
movements. M. Curci affirms that they are due to excitation of the motor 
tract of the cord, and that this is preceded by a similar influence upon the 
sensory tracts (London Med. Record, 1877, p. 72). 
The death is due, in argyria, to cessation of the respiration; Rouget (loc. 
cit., p. 351) even states that he has witnessed the suspension of the latter 
function in the frog whilst the activity of the reflex movements was much 
beyond normal. In the dog and in the full-grown cat this asphyxia is accom- 
panied by an outpouring of mucus in the lungs, pulmonary congestion and 
oedema being found on post-mortem examination. Two theories have been 
propounded as to the cause of the asphyxia: one, that it is simply due to 
the choking up of the lungs by the congestion and the excessive secretion 
whose origin is an altered state of the blood ; a second, that both the asphyxia 
and the lesions in the lungs have their origin in a direct action of the poison 
upon the nerve-centres. 
The first view has been especially supported by Krahmer and by MM. Ra 
buteau and Mourier. Unfortunately, I have not seen the original papers of 
these physicians; but, according to Rouget, the basis of argument of Krahmer 
is simply the ecchymoses which he found in horses dead of the poison, whilst 
that of Rabuteau and Mourier is the fluidity of the blood after death, and the 
existence in it of globules which, on account of their solubility in ammonia, 
were believed to be the chloride of silver. The French observers were, how- 52 
SYSTEMIC REMEDIES. 
ever, almost certainly mistaken in their belief that these granules were chloride 
of silver, since ammonia dissolves haematin as freely as it does the chloride. 
In 1864 Charcot and Ball (Gazette Medicale, 1864) made a series of ex- 
periments in which a silver salt that did not coagulate albumen was injected 
directly into the blood. They noted not only the respiratory embarrassment, 
but also that the hinder extremities were suddenly paralyzed, and concluded 
that both the asphyxia and the lung-trouble were due to an affection of the 
central nervous system. In 1869 Dr. Bogolowsky, of Moscow, studied 
( Virchow's Archiv, 1869, Bd. xlvi.) the action of a peptone of the nitrate 
when used hypodermically. He found, on examination of the blood of a 
poisoned animal, that the spectrum analysis (loc. cit., p. 415) betrayed 
nothing abnormal; that the red corpuscles appeared paler and their outline 
more delicate than normal; that the white corpuscles were natural. On the 
other hand, Rouget (loc. cit., p. 361) examined microscopically the blood of 
animals poisoned with the nitrate of silver, and found it perfectly normal. 
The only conclusion to be drawn from all this seems to me to be that at 
present there is no proof whatever that the symptoms of acute argyria are 
due to alterations in the blood. That the embarrassment of respiration is 
not due to local lesions in the lungs is abundantly shown by the experiments 
of Rouget, who found that whilst in all animals these respiratory symptoms 
are very prominent, in only a few species are decided pulmonic lesions found 
after death. From all these facts I think it highly probable, if not altogether 
certain, that the theory propounded by MM. Charcot and Ball is correct. 
That the motor disturbance is centric, not peripheral, in its origin, is shown 
by the fact noted by Rouget (loc. cit., p. 354), that the muscles and nerves 
preserve their excitability after the arrest of the respiration. 
The various facts which have been thus far brought forward in regard to 
the physiological action of silver, although interesting to the toxicologist, 
have very little reference to its therapeutic use, since it is never employed to 
produce an acute constitutional influence. 
The action of the drug when exhibited continuously for a length of time in 
large doses has been investigated by Dr. Bogolowsky upon dogs and rabbits. 
He found that it produced loss of appetite, wasting, slight lowering of bodily 
temperature, diarrhoea, diminution of the quantity of urine passed, with in- 
crease of its specific gravity and often with the presence of albumen, and 
transitory paralysis. Flow far some of these symptoms were due to the direct 
constitutional action of the poison, and how far to derangement of the digestion 
dependent upon its local influence, is perhaps an open question. The local 
action was avoided, however, as much as possible, by the use of an albuminate 
or of the double phosphate of silver and sodium, which does not coagulate 
albumen. Comparative examinations of the blood showed that the haemoglo- 
bin was reduced by more than one-third. The blood was also rendered very 
aplastic, as was betrayed by the constant tendency to the formation of ecchy- 
moses. As some one has suggested that the silver in these cases replaces the MINERAL ASTRINGENTS. 
53 
iron of the blood-corpuscles, Dr. Bogolowsky made a chemical examination 
of the latter, but failed to find any traces of silver in them,-no doubt be- 
cause it was not there. The solid tissues were found, after death from 
chronic argyria, to be in an advanced stage of degeneration, which especially 
affected epithelial structures. The first change was swelling and opacity of 
the cells, with obscuration of the nucleus. After this came fatty degenera- 
tion, fatty globules in the cell, destruction of nucleus, and finally of the cell 
itself. The liver and kidneys were profoundly influenced, as was also the 
muscular structure, especially of the heart. These results obtained by Bo- 
golowsky have been in the main corroborated by A. V. Rdzsahegzi (Arch. 
Exper. Path. Pharm., ix. 295). 
The summary which has been here offered comprises all our knowledge of 
the physiological action of the preparations of silver. Unfortunately, it does 
not throw much light upon their therapeutic use. The results of the chronic 
poisoning are so closely analogous to those produced under similar circum- 
stances by antimony, arsenic, and probably other metallic poisons as to indi- 
cate that silver given internally acts upon the nutrition of the body,-in other 
words, that it is an alterative. 
Therapeutics.-By far the most frequent employment of nitrate of silver 
in therapeutics is for its local action, either upon the surface of the body or 
upon those mucous membranes that can be reached directly by the drug. 
As a simple caustic, the salt may be used whenever only a superficial action 
is required; for reasons already given (page 45), it is useless whenever it is 
necessary to produce a deep eschar. As a caustic and an alterative, it is 
applied in solid form to many ulcerated surfaces, for the purpose of destroy- 
ing superficial diseased tissue and of substituting, when the eschar separates, 
a healthy for an unhealthy action. As an antiphlogistic, nitrate of silver 
acts not only as an astringent, but also in some way not clearly understood. 
In the various inflammations of the mucous membranes, such as conjuncti- 
vitis, faucitis, laryngitis, urethritis, etc., it is employed very frequently, not 
only in the stage of relaxation, but in the beginning of the attack. In con- 
junctivitis, the solution employed should not, under ordinary circumstances, 
be stronger than one or two grains to the ounce; and it should not be used 
at all if any corneal ulceration exists, since a deposit of silver is liable to 
occur and to produce opacity. In faucitis, the strength of the solution may 
vary from thirty to sixty grains to the fluidounce. Even a saturated solu- 
tion can scarcely be looked upon as caustic to the more robust mucous mem- 
branes. In ordinary cases of sore throat, the application once a day or every 
alternate day is generally sufficient. It is best made by means of a good- 
sized camel's-hair brush, each part of the inflamed surface being distinctly 
touched, and not the whole simply daubed or slopped over by means of a very 
large brush or a sponge probang, as is often done. In severe cases it may be 
necessary to use the solution twice a day. Dr. Carl Seiler affirms that 
whilst solutions of nitrate of silver of less than sixty grains to the ounce 54 
SYSTEMIC REMEDIES. 
cause pain when applied to throat, solutions of one hundred and twenty 
to two hundred and fifty grains act as local anaesthetics, relieving soreness, 
and usually arresting acute inflammations at once, if applied in the first 
twenty-four hours before inflammatory exudation has occurred (Jour. Amer. 
Med. Assoc., i. 266). In laryngitis, the solution may contain from ten to 
twenty grains to the ounce, and should be applied with a brush by the aid 
of the laryngoscopic mirror. An attack of urethritis may sometimes be 
aborted in its forming stage by the injection of a strong solution (grs. xii. 
to f^i) of the salt; but the practice is of doubtful expediency, since when 
it fails it greatly aggravates the trouble. In the advanced stages of gon- 
orrhoea, weak injections (grs. i or ii to f$i) are often very serviceable. 
Many years ago (1828) Mr. John Higginbottom originated the practice of 
treating erysipelas by the nitrate of silver, and his plan has received a great 
deal of commendation from authorities, but certainly has not been generally 
adopted by the profession. One or two cases of bad results, from ulceration 
of the skin apparently due to the local application, have deterred me from 
giving the method a fair trial, and I do not feel able to offer any opinion upon 
the practice. Mr. Higginbottom in a recent essay (London Practitioner, vol. 
ii. p. 34, 1869) reaffirms the value of the treatment, stating that its want of 
general adoption is due to its being so often imperfectly carried out, and gives 
the following directions: 
" The affected part should be well washed with soap and water, then with 
water alone to remove every particle of soap, then to be wiped dry with a soft 
towel. The concentrated solution of four scruples of the nitrate of silver to 
four drachms of distilled water is then to be applied two or three times on the 
inflamed surface, and beyond it on the healthy skin to the extent of two 
or three inches. The solution may be applied with a small piece of clean 
linen, attached to the end of a short stick, the linen to be renewed at every 
subsequent application. As the solution of the nitrate of silver is colorless, it 
is necessary to pass a little linen, just moistened, over every part where it has 
been used, in order to be equally diffused, so that no part may be left untouched. 
In about twelve hours it will be seen whether the solution has been well applied. 
If any inflamed part be unaffected, the solution must be immediately reap- 
plied. Sometimes, even after the most decided application of the nitrate of 
silver, the inflammation may spread ; but it is then generally much less severe, 
and is eventually checked by repeated applications. It is desirable to visit the 
patient every twelve hours until the inflammation is subdued." 
In superficial inflammations other than erysipelatous I have frequently 
used nitrate of silver in this way, often with great advantage. Freely applied 
to the skin of the whole finger, it will sometimes even abort a commencing 
felon, or, applied to the scrotum, an epididymitis. 
Internally, the nitrate of silver is exceedingly useful in stomachic and to 
a less extent in enteric diseases, exerting no doubt a purely local influence. 
In that form of dyspepsia characterized by the vomiting of large quantities MINERAL ASTRINGENTS. 
55 
of yeasty fluid, it has yielded in my hands better results than any other 
remedy ; and the same may be said of chronic gastritis and of gastric ulcer. 
The rules of administration are identical in these three diseases. In the first 
place, regulation of the diet is imperative: if the case be a bad one, all 
eating of meals should be suspended, and the patient receive every two or 
three hours a cup of sweet milk, with sound toasted bread broken up and 
thoroughly softened in it. Nitrate of silver should be administered in pill 
form, one-quarter to one-half grain three or four times a day, taken when the 
stomach is empty. In very serious cases, when all food is rejected by the 
stomach, it is sometimes advisable to allow absolute rest for two or three days 
to that viscus, the patient being fed by the rectum, and only a little water and 
pills of silver with opium being taken by the mouth. Under these circum- 
stances, the return to the usual method of taking food must be very gradual, 
at first only a tablespoonful each of milk and of lime-water being administered 
every hour. In chronic enteritis or colitis, nitrate of silver is sometimes of 
great service, especially if there be ulceration. 
For its constitutional effects nitrate of silver is used solely in diseases of the 
nervous system. It was formerly given in epilepsy; but it has passed 
out of use. There is one serious objection to the employment of the salt,- 
namely, the discoloration of the skin which sometimes follows its continuous 
use. Again, it is not understood in what class of cases the drug is of especial 
value, and there is no means of judging as to its applicability to any individual 
case. When other means have failed, however, the nitrate of silver may be tried 
in epilepsy, the patient or his friends being informed that although with proper 
precautions the chances of discoloration are very few, yet it may occur. 
In chronic inflammations of the spinal cord, whether affecting chiefly the 
posterior columns and constituting locomotor ataxia, or the anterior and 
giving rise to paraplegia, the nitrate of silver is one of the few remedies that 
are ever of any service; although it most frequently fails, yet it often does 
good, and in some cases has apparently even permanently arrested the disease. 
Dose, one-quarter to one-half a grain, always given in pill form: if it is desired 
to act on the stomach, the drug should be taken when the viscus is empty. 
Toxicology.-The symptoms produced by the ingestion of large doses of 
nitrate of silver are partly gastro-intestinal and partly cerebro-spinal. In some 
cases the one series of phenomena predominate; in others, those of the other 
class. In a case at the Hopital St.-Louis in 1839 (Beck's Medical Jurispru- 
dence, vol. i. p. 675, Phila., 1863) the symptoms were insensibility, violent 
convulsions, and dilated pupils, with, on a partial return to consciousness, 
intense gastric pain; complete restoration of consciousness did not occur until 
eleven hours after admission into the hospital, and the coma returned at 
intervals during several days. 
Vertigo, coma, convulsions, great muscular weakness, paralysis, with intense 
disturbance of respiration, are in these cases the manifestations of disturbed 
innervation; whilst the abdominal symptoms are those of gastro-enteritis. The 56 
SYSTEMIC REMEDIES. 
diagnosis can generally be made by the discolorations of the lips and skin,-at 
first white, afterwards black,-and by the blackish or brownish vomit; when 
the customary antidote has been given, both vomit and stools are generally 
white and curdy. At post-mortem the stomach and bowels are found cor- 
roded, often ecchymosed and with patches of a white or grayish color. Poison- 
ing by nitrate of silver is not common, and I know of but three fatal cases,- 
one in 1837 (Taylor, Principles and Practice of Medical Jurisprudence, 
second edition, vol. i. p. 319), one in 1861, a woman killed by fifty grains in 
solution in divided doses, one in 1871, a child destroyed by a piece of the solid 
stick three-quarters of an inch long, in spite of the immediate and free admin- 
istration of the antidote (Scattergood, British Medical Journal, May, 1871). 
The treatment consists in the administration at once of large amounts of 
common salt,-the chemical antidote,-the constant use of large draughts of 
milk, and the meeting of symptoms as they arise. 
The fatal dose of silver varies very much, according, no doubt, as to the pres- 
ence of substances capable of decomposing it in the stomach. Thirty grains 
have killed; and recovery has taken place after the ingestion of an ounce 
(case, Husemann, Handbuch der Toxicologie, Berlin, 1862, p. 868). 
Chronic argyria, or discoloration of the skin by silver, is usually unac- 
companied by disturbances of health, although in severe cases the discolora- 
tion affects not only the skin, lips, gums, sclerotic, but even the internal 
organs, such as the liver, spleen, kidneys. It is therefore not due, as has 
been thought, to the chloride of silver, since the latter only becomes dark 
under the influence of the light, but to a deposition of silver itself or of its 
oxide.* The minute quantity of the metal present is shown by the analysis 
of Versmanns ( Virchows Archiv, xvii., 1859), who in 14.1 grammes of 
dried liver found only 0.0068 gramme of metallic silver (0.047 per cent), 
and in 8.6 grammes of dried kidney 0.053 gramme (0.061 per cent.). 
Greater or less success has been claimed for various treatments in argyria, 
but in general they are equally futile. Bogers states that blistering will 
lighten the color very much, and Eichmann asserts (Husemann, Toxicol- 
ogie, 871) that he has cured two cases by the use of potash baths and of 
soap baths, each four times a week. The older authorities commend the 
use of iodide of potassium internally. Dr. L. P. Yandell has reported 
(American Practitioner, June, 1872) two cases in which large doses of the 
iodide were given for many months for syphilis, and the mercurial vapor- 
baths used at the same time for the same purpose, with the result of a 
complete cure of the argyria. The Aiding was gradual. 
Administration.-The nitrate of silver should always be given in pill, 
and, when it is desired to obtain its constitutional influence, after meals, 
* According to Rdzsahegzi, Hermann'has seen one case in which, preceding the depo- 
sition of the silver, there were malaise, emaciation, failure of memory, singing in the 
ears, deafness, and spasms of the ocular muscles. MINERAL ASTRINGENTS. 
57 
during the process of digestion: but when its local action on the alimentary 
canal is required, it should be administered one or two hours before meals; 
and if the bowels are to be reached, the pill should have been made some 
time, so as to be dissolved as slowly as possible. When it is given in epilepsy 
or other chronic disease, its administration should be suspended for one week 
at the end of every third week, and its employment should not extend over a 
longer time than three months without a protracted intermission. 
Argenti nitras dilutus, U. S., is a grayish solid substance, often in crayons, 
composed of equal parts of the nitrates of silver and potassium. It may be 
used as a very mild caustic. 
The oxide of silver (Argenti Oxidum, U. S.) is an olive-brown powder, 
very slightly soluble in water, which the United States Pharmacopoeia directs 
shall be prepared by precipitating the nitrate of silver with solution of potassa. 
It has been introduced into medicine as a substitute for the nitrate, with the 
idea that it would accomplish in diseases of the nervous system all that that 
drug is capable of, and at the same time not discolor the skin. With our 
present knowledge of the method of absorption of the nitrate, this seems 
highly improbable, and it is contradicted by experience. (Case, Philad. 
Med. Times, vi. 204.) Oxide of silver is not caustic when locally applied, 
but probably exerts some astringent action, and has been commended in py- 
rosis. In nervous affections it is probably of equal value with the nitrate. 
The dose is a grain, in pill, three or four times a day. 
The cyanide of silver (Argenti Cyanidum, U. S.) is used solely for the 
preparation of hydrocyanic acid. The iodide (Argenti Iodidum, U. S.) 
has been used as an alterative, but is of very doubtful value. CLASS II-TONICS. 
There are certain substances in nature which, when taken internally, act 
upon the nutrition of the various tissues so as to restore lost tone, not by call- 
ing into play the vital principle of contractility, but by increasing the power 
in the part. Such substances are known as tonics. They differ from astrin- 
gents in that they affect nutrition, and consequently in the slowness and per- 
manence of their action. They differ in a similar manner from simple stim- 
ulants, and as they do not call into sudden action forces already existent in 
the part, but increase power by increasing nutrition, their influence is a per- 
manent one and is not followed by depression. They are, of course, indicated 
by debility dependent upon impaired nutrition,-i.e., debility owing to actual 
loss of power. When the debility is due to a sudden depressing influence, as 
in snake-bite, they are of no service whatever. They are especially valuable 
in convalescence from acute disease; during the progress of the disorder they 
more often do harm than good. 
Tonics should, of course, never be used when plethora exists. Sthenic in- 
flammatory action is also a contra-indication to their employment; but when 
inflammation exists with a general state of debility, these drugs may form an 
essential part of the treatment. 
The tonics are divisible into several sub-classes, which I shall consider 
separately. 
SIMPLE BITTERS. 
Probably all bitter vegetable substances possess tonic properties, but in 
many of them, as in morphia and strychnia, these properties are completely 
overshadowed by other inherent powers. There are, however, bitter vegetable 
substances which so act upon the stomach as to invigorate digestion, and to 
affect thereby the general nutrition, without exerting any direct influence upon 
other portions of the body than the alimentary canal. These are the simple 
bitters. In overdoses they nauseate, and may act slightly on the bowels. 
They appear all to act alike,-differing more in strength than in quality,-so 
that one may be substituted without detriment for another. As they are 
essentially irritants, inflammation or over-sensitiveness of the alimentary 
mucous membrane distinctly contra-indicates their administration. They are 
indicated by loss of appetite and loss of stomachic tone. 
58 TONICS. 
59 
QUASSIA. U.S. 
The wood of Simaruba excelsa, a large tree, native of Jamaica. This wood 
is light both in density and color, somewhat resembling that of the tulip-tree, 
but distinguished by its intensely bitter taste. It is kept in the shops in 
billets and in raspings. The active principle of it appears to be Quassin, an 
intensely bitter, neutral, crystalline principle discovered by Winckler {Repert. 
fur Pharmacie, Bd. liv. 85, Bd. Iv. 85). Simaruba (U. S.), the bark of 
Simaruba officinalis, also contains quassin, and may be substituted for quassia. 
Physiological Action.-Quassin is said in large doses to be actively 
poisonous to insects, and even to mammals (Stille's Therapeutics, i. 472; 
Husemann, Die Pflanzenstoffe, p. 718); but I have met with no detailed 
study of its action except that of I. Hoppe, who experimented upon frogs 
{Deutsches Klinik, xi., 1859). In doses of one grain it usually produced 
death in a short time. The symptoms were great weakness, with, in most 
cases, convulsions and sometimes convulsive tremblings, failure of respiration, 
and finally cessation of cardiac action. The functional activity of the nerve- 
trunks was much impaired, that of the muscles to a less extent. Locally, 
quassin appeared to act as an irritant as well as a powerful poison to both 
nervous and muscular tissues. Dr. Campardon found that in doses of five 
milligrammes of the pure crystalline form, or five centigrammes of the 
commercial amorphous variety, quassine acts upon a man as a powerful 
bitter tonic, notably increasing the secretion of bile and of the urine, and 
causing some looseness of the bowels and stimulation of the bladder. Fif- 
teen milligrammes of the crystalline quassine caused violent frontal head- 
ache, burning pains in the oesophagus and throat, nausea, vomiting, vertigo, 
excessive nervous restlessness, diarrhoea, very frequent micturition, but 
diminished renal secretion {Bull. Gen. de Therap., ciii. 410). 
Therapeutics.-Quassia is probably the most active of all the simple 
bitters, and may be used whenever such remedies are indicated. In cases of 
seat-worms in children, a strong infusion of quassia (gii to Oj) affords a most 
harmless and efficient injection. Its exhibition should be preceded by an 
enema of simple water, after a stool, so as thoroughly to wash out the rectum 
and allow access to every fold of the rectal mucous membrane. The officinal 
preparations are a tincture {Tinctura Quassias-1 to 9, U.S.), dose, twenty 
drops to a teaspoonful; a very excellent watery extract {Extractum Quassias, 
U. S.), which may be given in pills containing from one to three grains ; and 
a fluid extract {Extractum Quassias Eluidum'), dose, five to ten drops. 
GENTIANA-GENTIAN. U.S. 
The root of the Gentiana lutea, or yellow gentian of the Alps. This root 
occurs in the shops either in pieces of various size and shape but generally 
several inches in length, or else in transverse slices. The texture is spongy, 
the odor faint but peculiar, and the taste bitter. It contains gentisic acid, 60 
SYSTEMIC REMEDIES. 
which was discovered by Leconte, and is tasteless and physiologically inert. 
The active principle is probably the gentiopikrin of Kromayer, a neutral, 
crystalline substance, of an intensely bitter taste. ' ■ wUt 
Therapeutics.-Gentian is one of the most efficient of the simple bitters, 
and may be used whenever such a remedy is indicated. It is never given in 
substance, but in one of its preparations. These are the compound tincture 
(Tinctura Gentians Composita, U.S.), which contains gentian (1 to 12.5), 
bitter-orange peel, and cardamom-dose, one fluidrachm to half a fiuidounce; 
the watery extract (Extractum Gentians,, U. S.), dose, two to four grains, 
and the fluid extract (Extractum Gentians Fluidum, U. S.), dose, ten 
minims to half a fluidrachm. The compound infusion, formerly officinal, 
was a valuable preparation, containing some alcohol, and much used in doses 
of one to two fluidounces. 
NEOTANDRA. 
Bebeeru Bark is the bark of the Nectandra Rodiei, a large tree which grows 
in Guiana and the neighboring parts of South America and is used in ship- 
building under the name of Greenheart. It occurs in large flat pieces, and 
contains an alkaloid, which was discovered by Dr. Maclagan, of Edinburgh. 
According to the researches of Walz (^N. Jahrb. Pharm., xii., 1861, 302) and 
of Fliickiger flbid., 1869), this alkaloid is identical not only with Buxia, 
obtained by Faune in 1830 from Buxus sempervirens, but also with Pelo- 
sia, discovered by Wiggers in pareira brava. Bebeeria, or, as it should be 
called, buxia, is whitish, amorphous, inodorous, very bitter, very slightly 
soluble in water, freely so in ether and alcohol, and forms uncrystallizable 
salts. Dr. Maclagan found a second alkaloid, Sipeeria, in bebeeru bark, but 
it is probably only altered bebeeria. 
Physiological Action.-Our knowledge of the influence of bebeeria 
upon the system is exceedingly incomplete. Albers ( Virchow's Archiv, Bd. 
xxiv.) found that three grains introduced beneath the skin of a large frog 
produced death in six and a half hours. There was first a period of quiet 
with accelerated breathing, then tonic and clonic general convulsions, seemingly 
associated with muscular weakness, but with no increase of the reflex activity. 
Prof. Binz ( Virchow's Archiv, Bd. xlvi. p. 130) has determined that bebeeria 
exerts some destructive influence over infusorial forms of life, but that it is 
in this respect not nearly so powerful as the cinchona alkaloids. 
Therapeutics.-Bebeeria was originally proposed by Dr. Maclagan as a 
substitute for quinia in malarial diseases, and has been quite extensively tried. 
It appears to possess some antiperiodic powers; but they very probably are 
not superior to those of the more powerful simple bitters, and are certainly 
very inferior to those of quinia, so that bebeeria is at present very seldom 
if ever used. The sulphate, which is officinal in the British but not in the 
United States Pharmacopoeia, may be given in acidulated solution in doses 
of from two to five grains. TONICS. 
61 
BERBERIS-BARBERRY. 
Under the above title the U. S. Pharmacopoeia of 1870 recognized tho 
bark of the root of Berberis vulgaris, a native of Europe. This drug con- 
tains the alkaloid berberina, which, although not itself officinal, is found in 
so many recognized drugs as to require notice. 
Berberina occurs as a yellow powder, or in fine yellow needles or prisms, 
of a bitter taste and neutral reaction, moderately soluble in cold, freely in hot, 
water, freely soluble in alcohol. With acids it forms mostly crystallizable, 
golden-yellow salts. 
Its effects upon animals have been studied by Falck and by Guenste. In 
dogs it produced, when given in very large doses, restlessness, convulsive 
tremblings, thirst, and diarrhoea, and finally partial paralysis of the hind legs. 
From seven to fifteen grains of it killed rabbits in from eight to forty hours. 
The symptoms were increased frequency of respiration, and tremblings, followed 
by decrease of the rate of breathing, paresis, paralysis of the hind legs, great 
dyspnoea, and finally convulsions. In man, as yet, no serious symptoms have 
been recorded as produced by berberina. Buchner took nearly twenty grains 
without causing anything more serious than a loose stool. As a bitter tonic 
it has been used by various physicians in doses of from two to five grains, and 
its action in this dose appears to be that of a simple bitter. It may be given 
in pill form or dissolved in alcohol. 
CALUMBA-00LUMB0. U.S. 
The root of Cocculus palmatus, a climbing vine of Mozambique. It occurs 
in the shops in transverse disk-like slices, oval or circular in outline, one or 
two inches in diameter, of a spongy texture, having a yellowish surface, very 
bitter taste, and slightly aromatic odor. It contains a great deal of starch, 
besides berberina, and, it is said, in lesser amount, Columbia^ a bitter neutral 
principle crystallizing in rhomboid prisms or needles. \aa-vO CuxI1- 
Therapeutics.-A bitter, slightly aromatic tonic, useful as a stomachic 
in cases in which a simple bitter is indicated. It is not used in substance. Its 
preparations are-a tincture (Tinctura Calumbx-1 to 9, U.S.), dose, one 
to two fluidrachms; and a fluid extract (Extractum Columbae Fluidum, 
U. S.), dose, fifteen minims to half a fluidrachm. 
EUPATORIUM-BONESET. U. S. 
The herbal parts, gathered after flowering, of the indigenous Eupatorium 
perfoliatum, a tall, coarse composite, recognizable by its perfoliate leaves, 
through whose centre grow the stems and branches. This drug given in cold 
infusion ($i to Oj-dose, f$i-ii) is an efficient but disagreeable bitter tonic. 
Its chief employment is as a sudorific. The hot infusion when taken freely 
(five to six ounces), the patient being well covered in bed, produces free 
sweating, and has been very largely used in "general colds," muscular rheu- 62 
SYSTEMIC REMEDIES. 
mutism, etc., for this purpose. The only objection to the remedy is its 
disagreeable taste. In the dose of a pint the infusion has been employed 
as an emetic. The fluid extract QExtractum Eupatorii Fluidum, U. S.) 
may be used in doses of a fluidrachm to a fluidounce. 
Chiretta, U.S., the herb and root of a plant growing in the northern 
part of India, is one of the best of the simple bitters, and is believed by some 
to exert a peculiar influence over the liver. Whenever a simple bitter is 
indicated, this drug may be employed, especially if a cholagogue action be 
desired. The solid extract is an excellent preparation in doses of one to 
two grains; the fluid extract (^Extractum Chirettee Fluidum, U. S.) may 
be given in doses of five to ten minims ; and the tincture (Tinctura Chirettse 
-1 to 9, U. S.) in doses of a fluidrachm. 
Cornus. U. S.-Dogwood, the bark of the Cornus Florida, is feebly 
tonic, and has been supposed to be antiperiodic. It is very rarely, if ever, 
used by regular practitioners of medicine, and may be given in almost 
indefinite doses. 
PECULIAR BITTERS. 
These are bitter vegetable tonics possessing other properties besides those 
of the simple bitter. 
PRUNUS VIRGINIANA-WILD CHERRY BARK, U.S. 
Wild cherry bark is the product of the Prunus (Cerasus) serotina or wild 
cherry tree, not of Prunus Virginiana or Choke cherry, whose name it bears. 
It occurs in pieces of various sizes, usually without epidermis. The color is 
a reddish cinnamon; the taste slightly astringent, bitter, and peculiar, re- 
sembling that of peach-leaves. It contains tannic acid, bitter extractive, 
amygdalin, and emulsin. Amygdalin is a nitrogenous, crystallizable, odorless 
glucoside, of a slightly bitter taste. It is soluble in water and alcohol, but 
not in ether. Emulsin is an albuminous principle, which is soluble in water, 
and, like other forms of albumen, is coagulated by heat, alcohol, acids, etc. 
When amygdalin in watery solution is brought in contact with emulsin, it 
is decomposed, forming prussic and formic acids and a colorless, thin, volatile 
oil, which, when pure, has a peculiar agreeable odor and a burning taste. 
According to Liebig and Wohler (Ann. Chem. Pharm., xxii. 1), seventeen 
grains of amygdalin yield one of hydrocyanic acid: therefore, if thirty-four 
grains of amygdalin be mixed with sixty-six grains of emulsion of sweet 
almonds, a two per cent, solution of hydrocyanic acid will be formed. 
Physiological Action.-Amygdalin administered by itself is nearly, if 
not quite, without effect upon the organism. Widtmann and Denk (Huse- 
mann, Die Pflanzenstoffe, p. 688) took as much as sixty grains of it without 
inducing any effect, and their results have been confirmed by Heil and others. TONICS. 
63 
Lehmann, it is true (Ibid.), found that at times fifteen grains of it by the 
mouth were sufficient to cause death in the rabbit, but Kblliker and Muller 
have shown that this was owing to its being converted into prussic acid by 
the emulsin contained in the green herbage in the stomach of the rabbit. 
Therapeutics.-In wild cherry bark properly administered there are three 
active ingredients,-tannic acid, bitter extractive, and prussic acid; and to 
their combined action the general effect is due. As the tannic acid is in 
small quantity, its influence is not marked; but probably some of the repu- 
tation which the remedy formerly enjoyed as being useful in the night-sweats 
of phthisis was due to it. When given in the ordinary dose, I have never 
been able to detect any sedative effect from wild cherry bark; but the in- 
fusion administered with sufficient freedom certainly ought to exert such 
influence. Prunus Virginiana is therefore slightly astringent, sedative, and, 
owing to its bitter extractive, tonic. It is frequently useful in phthisis when 
a roborant is needed and at the same time a calmative action on the nervous 
system is called for. It may be used in hectic fever from any source. 
The infusion (Infusum Pruni Virginianse-1 to 25, U. S.) is useful as 
an adjuvant to other tonics, especially sulphuric acid, in debility with a 
tendency to night-sweats during convalescence from acute disease. The dose 
is one to two wineglassfuls. On account of its pleasant taste and traditional 
reputation, the syrup (^Syrupus Pruni Virginianx, U. S.) is often employed 
as the basis of cough-mixtures. The fluid extract (Extractum Pruni Vir- 
giuianx Fluidum, U. S.) may be given in doses of from half a fluidrachm 
to a drachm. 
CINCHONA. U.S. 
Under the general term of Cinchona the United States Pharmacopoeia 
recognizes the " bark of all the species of the genus Cinchona containing at 
least two per cent, of the alkaloids which yield crystallizable salts." Under 
the name of Cinchona Flava, or Yellow Cinchona (syn. Calisaya 
Bark), the same standard list includes the bark of Cinchona Calisaya; under 
the name of Cinchona pallida, Pale Cinchona, that of Cinchona 
Condaminea and C. micrantha; under the title of Cinchona rubra, Red 
Cinchona, that of C. succirubra. 
All the trees yielding quinia and its congeneric alkaloids belong to the 
genus Cinchona, and inhabit the slopes of the Andes Mountains from the 
northern extremity of South America to the lower portion of the republic of 
Bolivia, at an altitude of from five to ten thousand feet. The bark is col- 
lected by persons known as Cascarilleros, and is exported in large bundles or 
bales, usually surrounded with raw ox-hide. To these packages the term 
seroons is applied. 
The Pale Bark occurs in quills or cylindrical rolled pieces, with a grayish 64 
SYSTEMIC REMEDIES. 
or brownish adherent epidermis. It derives its name from the light fawn- 
color of its powder. 
The Calisaya or Royal Yellow Bark comes both in quills and flat pieces. 
The epidermis is absent, or, if present, is loosely attached. The powder is 
of a decidedly yellow color, sometimes almost orange. The fracture is short 
and fibrous, presenting semi-transparent, sharp spiculm, which are apt to 
become detached and penetrate the fingers. 
The Cinchona rubra, or Red Cinchona, occurs in quills and flat pieces. 
The epidermis is generally present, and is often very warty. The color of 
the powder is a faint reddish-brown. Beneath the epidermis is in most speci- 
mens a distinct, red, resinous layer, which is very apparent in cross-section. 
Large quantities of bark under the name of Carthagena Bark find their 
way into commerce through the northern ports of South America. For 
descriptions of these the reader is referred to works on Materia Medica. 
Very successful attempts are being made to cultivate cinchona, especially 
in the Himalaya Mountains, Java, and Jamaica, where many millions of the 
trees have been planted and are thriving. The East India bark is already 
arriving in London in considerable quantities, and in a few years the supply 
from this source will doubtless be very large. 
Chemical Constitution.-Besides tannic, kinic, and kinovic acids, and 
other important substances, the cinchona barks contain quinia and quinidia, 
cinchonia and cinchonidia. Out of these alkaloids quinicia and cinchonicia 
are readily formed artificially, but, so far as is known, they do not exist in 
nature. There are therefore two isomeric alkaloidal groups ; quinia, quinidia, 
quinicia ; cinchonia, cinchonidia, cinchonicia. 
QUININA. U.S. 
This alkaloid was first distinctly separated from the other ingredients of 
the bark by Pelletier and Caventou in 1820. When quinia is precipitated 
by an alkali from a solution of its salt, it usually falls as a hydrate, which 
may be crystalline. By sufficient heat the hydrate is melted and the water 
is driven off. On cooling, the alkaloid, now free from water, forms a white, 
opaque, crystalline mass. 
The neutral, officinal sulphate of quinine (Quininse Sulphas, U. S.) occurs 
in light silky crystals, soluble in seven hundred and forty parts of cold or in 
thirty of boiling water, readily soluble in alcohol, very freely so in acidulated 
solutions, nearly insoluble in ether. The aqueous solution, upon the addition 
of chlorine, and afterwards of ammonia, assumes a green color. According to 
Dr. G. Kerner, if the original solution be colorless and clear and in a clean 
test-tube, one-thirty-thousandth part of the alkaloid can be recognized by this 
chlorine-ammonia test. When to one hundred parts of the salt, dissolved in 
nineteen hundred and twenty parts of cold dilute acetic acid (sp. gr. 1.042), 
are added successively four hundred and eighty parts of alcohol (sp. gr. 
0.837) and sixty parts of a saturated alcoholic solution of iodine, crystals TONICS. 
65 
of Herapathite separate, in the form of right-angled quadrate rhombic 
leaves, which when seen by transmitted light are olive-green, but in reflected 
light are bright metallic green, resembling the elytra of Spanish flies. When 
heated, the sulphate of quinia becomes phosphorescent, emitting a pale- 
green light at 155° to 160° C., and at a higher temperature melts with the 
development of purplish vapors. When the neutral sulphate of quinia is 
dissolved in water acidulated with sulphuric acid, it is converted into the 
soluble bisulphate, which may be obtained in orthorhombic prisms by 
evaporation. 
Physiological Action.-Quinine or its salts in powder or solution are, 
when applied upon a part denuded of its epidermis, very active irritants. 
Upon the skin they have little or no influence, but upon the mucous mem- 
branes they exert a very perceptible stimulant or irritant action. 
A. Eulenburg found that when quinia was brought into contact with a 
nerve it did not cause contraction in the tributary muscles, but when placed 
upon the muscles themselves it induced immediate violent action. He there- 
fore concludes that it is not a nerve-irritant, but is a muscle-irritant. When 
it is administered to dogs in sufficient quantity, it produces restlessness, fol- 
lowed by muscular tremblings, which have been compared to those of paralysis 
agitans, loss of power deepening into more or less complete paralysis, great 
dyspnoea, and cerebral symptoms, such as anaesthesia, blindness, stupor, or 
violent delirium, dilated pupils, coma, and convulsions. When the drug is 
introduced by the stomach, vomiting generally occurs, and at times diarrhoea 
also.* Death has been shown by Heubach to be produced, at least in the 
lower animals, by a failure of the respiration.^ 
The first symptoms of cinchonism, as produced by small therapeutic doses 
(ten grains) in man, are usually ringing in the ears, slight fulness in the 
head, and perhaps some deafness. With the use of larger doses these symp- 
toms are intensified: the deafness is very marked, disturbed vision* may 
exist, and the flushed face, with the sense of distention in the head, may 
point towards a cerebral congestion, which is in some cases relieved by spon- 
taneous epistaxis. In decided cinchonism, giddiness and staggering in walk- 
ing are very common. After toxic doses, severe headache, delirium, stupor. 
* See M. F. Melier, Memoires de V Acadimie, t. xii. p. 722, 1843; Win. 0. Baldwin, 
American Journal of the Medical Sciences, April, 1847 ; P. Briquet, Traiti thirapeutique 
de Quinquina, Paris, 1855. 
f The present is perhaps as suitable a position as any to notice certain researches upon 
the relations of alkaloids to protoplasm. The relation between medicinal substances and 
the tissues upon which they act is certainly a very close one, and very probably is chem- 
ical in its nature. Dr. Rossbach (Pharm. Untersuch., Bd. i., Hft. iii.) found that various 
alkaloids sensibly modify the properties of albumen, and believes that they form a chem- 
ical compound with it. Under the influence of the poison the albumen coagulates at a 
much lower temperature, and is deprived of its affinity for ozone. The alkaloids also 
precipitate the albumen from its ozonized solution. 
| I have seen complete temporary amaurosis produced in a lady by twelve grains of 
quinine. 66 
SYSTEMIC REMEDIES. 
complete deafness and blindness, dilated pupils, embarrassment of respiration, 
great weakness, convulsions, paralysis, and finally collapse, may result, 
either comatose or delirious. The deafness produced by large doses of 
quinine usually passes off rapidly ; very rarely is there a permanent impair- 
ment of hearing. Amaurosis, with a peculiar ischaemia of the retinal vessels, 
has in a small number of cases been produced by very large therapeutic 
doses of the alkaloid (see Archives of Ophthalmology, x. 81, 214, 220). 
The minimum fatal dose of quinine is not known, but it must be large, and 
probably varies very much. Dr. Clapton details {Medical Times and Gazette, 
April, 1864) a case in which a soldier took at one dose an ounce of the 
sulphate, stirred up in some water, without the induction of any more serious 
symptoms than a mild stupor; a similar case is mentioned by Dr. Lente, on 
the authority of Dr. Woodhull; and a third is recorded by Taussig (Stille's 
Therapeutics, vol. i. p. 507). Dr. R. G-. Wharton records {Amer. Journ. 
Med. Sci., April, 1844) a case in which during thirty-six hours a half- 
ounce was taken without vomiting and without ill effect. I cannot help sus- 
pecting that in all of these cases much of the drug passed through the intes- 
tines without absorption. In the famous case of Bazire five ounces taken 
in the course of ten days caused death. Von Graefe asserts that he has 
seen two cases of amaurosis caused by quinine ; the sufferer in one instance 
taking half-drachm doses until six drachms were ingested, in the other case 
an ounce altogether of the drug. 
A close physiological study of quinia can best be made by investigating 
its effects upon the different systems of organs seriatim; and this shall now 
be done. 
Cerebrum.-According to the experiments of Briquet, a solution of sulphate 
of quinia injected into the carotid will in some cases produce meningitis. In 
doing this, it is evident, the salt acts rather as an irritant to the membranes 
of the brain than as a nervous stimulant: indeed, experimental evidence 
proving that quinia is a cerebral stimulant seems to me to be wanting. The 
chief proof that the alkaloid does act as a stimulant lies in the fact that per- 
sons who have been taking it regularly for some time will occasionally, upon 
the sudden withdrawal of their daily dose, manifestly be less active without 
than with it. Briquet may be right in his belief that in small doses it acts 
as a nervous stimulant, but the proof of his correctness at present is clinical 
rather than experimental. When given in toxic doses to the lower animals, 
probably all of the cinchona alkaloids produce epileptiform attacks. Dr. 
J. Jakoubowich {Revue des Sciences Med., 1873) has noticed such effect 
with quinine in dogs, and it has been produced with cinchonidine in various 
animals. Chirone and Curci found that in the pigeon this action of cin- 
chonidine is prevented by ablation of the cerebral hemispheres, but Prof. 
Albertoni objects with much force that these observers gave the pigeon the 
alkaloid too soon after the ablation, whilst it was still profoundly affected by 
the shock and hemorrhage of the operation {Arch. f. Exper. Pathol, und TONICS. 
67 
Therap., xv. 278). Prof. Albertoni found that, if the pigeon was allowed 
to recover, the cinchonidine was capable of causing convulsions; also, that in 
dogs with the motor zone of the cerebral cortex destroyed, the alkaloid 
caused epileptiform attacks, and that therapeutic doses do not increase the 
excitability of the cerebral cortex in the dog. The subject is one of great 
interest in connection with the circumstance, noted for quinine by Brown- 
Sequard and confirmed by Albertoni as regards cinchonidine, that in epi- 
leptics the attacks are rendered decidedly more frequent by the cinchona 
alkaloids. The present evidence indicates that this increase is not due to au 
influence upon the cerebral cortex, but can hardly be considered sufficient 
to be conclusive. In very large doses quinia without doubt abolishes the 
functions of the cerebrum. Louis Dupuis (TPActwn physiol, de Quinine, 
Paris, 1877) found that reflex action was normal in poisoned dogs and rab- 
bits, although there was complete loss of sensibility, and he naturally concludes 
that the latter was of cerebral origin. The disorders of special sense pro- 
duced by quinine seem to be the result of a direct or indirect congestive 
action upon the peripheral sense organs; since Dr. Kirchner (Sitzungs- 
berichte Phys.-Med. Gesells. Wurzburg, 1881, 161) found, in rabbits, cats, 
and guinea-pigs which had been poisoned with quinine or with salicylic 
acid, very great congestion of the internal ear and of the labyrinth, with 
bloody exudation, and with, in some cases, the ear-drum swollen into a 
bladder-like body by serous exudation. These observations of Kirchner 
are very interesting, as throwing light upon the cause of the tinnitus aurium 
and deafness of cinchonism ; they are in close accord with the observations 
of Dr. Roosa (Amer. Journ. Med. Sci., 1874), that sufficient doses of the 
alkaloid cause congestion of the blood-vessels connected with the human 
manubrium, i.e., with the middle ear. 
Spinal Nerves and Centres.-Schlockow was the first to notice a stage 
of increased reflex activity produced in the frog by quinia: its existence 
was subsequently denied by A. Eulenburg ^Reichert's Archiv, 1865), but 
has been reaffirmed by H. Heubach (Centralb. Med. Wissensch., 1874, 674), 
and by my pupil, David Cerna, who agree in finding that it occurs only after 
very minute doses. In his investigations made in the Laboratory of the 
University of Pennsylvania, Dr. Cerna found that this stage of excitement is 
probably caused by a stimulant influence upon the peripheral sensory nerves, 
as it did not occur when the abdominal aorta was tied previous to the exhi- 
bition of the alkaloid (Phila. Med. Tinies, x. 493). Two facts, first pointed 
out by Dr. T. A. Chaperon (Pflugers Archiv, 1869, 295), have been so 
abundantly substantiated that we must accept them as established. They 
are-in small doses quinine causes in the frog a lessening of the reflex 
activity, which is removed by section of the medulla, but in large doses it 
produces a permanent palsy of reflex activity. The first of these actions 
has usually been considered to show that the alkaloid stimulates Setsche- 
now's centre in the base of the brain, but Dr. Sedgwick {Jour. of Physi- 68 
SYSTEMIC REMEDIES. 
ology, iii. 22) believes that the inhibition is such as occurs when a sensitive 
nerve is galvanized, and is the result of a stimulation of the peripheral affer- 
ent cardiac pneumogastric nerve endings. He bases his theory chiefly on 
the fact which he has discovered that atropia prevents the primary inhi- 
bition of reflexes by quinia. This is, however, readily explainable without 
the adoption of the theory of Sedgwick, and as the results which he 
obtained after division of the pneumogastrics are scarcely in accord with 
his theory, it is still most probable that quinia is a stimulant of Setsche- 
now's centre. The cause of the permanent influence upon reflex activity 
has not yet been accurately determined. Chaperon has shown that the 
motor nerves are unaffected, but this does not prove that the spinal centres 
are paralyzed. A. Eulenburg (Reichert's Archiv, 1865) asserts that volun- 
tary movements persist after reflex actions, and that the quinized frog will 
turn into its normal position when laid upon its back, although ordinary 
reflex actions are completely abolished. This, if correct, certainly shows 
that it is either the sensory nerves or the receptive centres of the cord 
whose paralysis by quinine puts an end to ordinary reflex movements. So 
that, accepting the various results reached by experimenters, it is probable 
that in frogs quinine first excites and then paralyzes the peripheral sensitive 
nervous system. How far this applies to man is uncertain. According to 
the experiments of H. Robert (Archiv f. Exper. Pathol, und Therap., 
xv. 49), very large doses of cinchonine, and probably therefore of quinine, 
lessen the excitability of the muscles. 
Abdominal Organs.-Upon the stomach and intestines quinia acts very 
much as a simple bitter. In moderate doses it stimulates digestion and in- 
creases the appetite; in large doses it not unfrequently causes nausea and 
vomiting. When there is any morbid irritability of the mucous membrane 
of the stomach or bowels, its irritant action is often very marked, and its 
continued use in large doses has been known to cause gastritis. 
Many years since, M. Piorry asserted that a large dose of quinia would 
produce a distinct immediate lessening of the size of the spleen in cases of 
intermittent; but the testimony of very numerous observers to the contrary 
is so concurrent as to render the truth of his observation highly improbable. 
Several observers* have stated that the exposed spleen of an animal can be 
seen to contract when sulphate of quinia is injected into the stomach, veins, 
or cellular tissue; but other investigators^ have failed in their attempts to 
produce this asserted contraction. The experiment necessitates such abnor- 
* M. Piorry, Archives Ginirales de Midecine, 1847; M. Pages, Gazette Medicate, 1846; 
also Dr. Kiichenmeister, Archiv filr Physiol. Heilkunde, Bd. x.; M. Mosier, Pathologic 
der Leukaemie, Berlin, 1872, p. 451; Jerusalimsky (Centralblatt Med. Wissen., 1876, p. 476). 
The latter observer believes the contraction to be caused chiefly by an action on the periph- 
eral splenic nerves and muscles. 
j- Magendie (Gaz. Mid., 1847), and especially L. T. Bochefontaine, Recherches Experi- 
ment. d la Contractility de la Rate, Paris, 1873. TONICS. 
69 
mal exposure of the organ that only a very pronounced and very constant 
diminution could establish the assertion that quinia produces contraction of 
the spleen, and our present knowledge indicates that the alkaloid has no im- 
mediate decided influence on the size of the organ. 
Organs of Circulation and Blood.-Briquet, who first studied closely 
the action of quinia upon the circulation, found that in large doses it lowers 
the arterial pressure in the lower animals. The experiments have been con- 
firmed by various observers, notably by Schlockow {De Chini Sulf arid, etc., 
Bratisl, 1860), A. Eulenburg (Rdchert's Archie, 1865), and Cerna (foe. dt., 
194). It has been abundantly proven that the alkaloid thrown into the 
jugular vein, introduced into the coronary artery, or in any way brought in 
contact with the heart, lessens the force and frequency of the pulsations, 
and finally produces diastolic arrest; also, that this result is not influenced 
by separation of the mammalian heart from the nerve centres, and occurs in 
the cut-out frog's heart. In man, very large doses of quinia (thirty to sixty 
grains) lower the force and frequency of the pulse; a pulse-rate of forty 
has been noted, and in reported cases of quinia-poisoning the pulse has been 
imperceptible at the wrist. Under the latter circumstances the pulse-rate 
may be increased, but the cardiac force is reduced to a minimum. The 
evidence is conclusive that both in man and the lower animals quinine in 
sufficient amount is a powerful depressant to the heart-muscle or ganglia.* 
Schroff (Medizin Jahrbiicher, 1875) found that in the quinized animal 
neither galvanization of a sensitive nerve nor asphyxia was able to produce 
vascular contraction and rise of blood-pressure, and Jerusalimsky {Centralb. 
Med. Wissensch., 1876, p. 476) asserts that in frogs dilatation of the vessels 
could be seen, so there is some reason for believing that toxic doses of 
quinia paralyze not only the heart, but also the vaso-motor system, f Both 
Schroff and Jerusalimsky noticed that the fall of arterial pressure produced 
by quinia is preceded by a rise of the pressure, accompanied with an in- 
crease of the cardiac action. This observation has been confirmed by G. 
See and Bochefontaine {Compt.-Rend. Acad. Sd., T. xcvi. p. 267) ; but 
no observer seems to have shown that the rise of pressure is more than a 
temporary phenomenon. See and Bochefontaine affirm that the increased 
cardiac action continues some time after the pressure begins to fall. The 
primary rise of pressure may be the result of a stimulant action upon the 
vaso-motor centres, as Jerusalimsky found that it was not produced after 
* Pantellejeff (Centralb. Med. Wissensch., xviii., 1880, 529) states that atropia will cause 
the heart arrested by quinine to recommence its action. 
f M. Chirone believes that by quinia the heart is arrested in active dilatation. The 
theory is very improbable. See Rivista Clinica di Bologna, abstracted in Jour. Physiolog. 
.Norm. et Patholog., 1876, p. 844. 
Heubach, in a series of experiments on the influence of galvanization of a sensitive 
nerve upon the circulation after the exhibition of quinine, failed to prove any paralysant 
action of the drug, although in some of his experiments the reflex activity was paralyzed. 70 
SYSTEMIC REMEDIES. 
division of the cord. Jerusalimsky attributes the increase in the pulse-rate 
to paralysis of the inhibitory apparatus, a view which is supported by the 
assertion of Cerna that previous section of the pneumogastric prevents the 
quickening of the pulse-rate. 
I have never been able to perceive any depressant action upon the circu 
lation in man after ordinary therapeutic doses (three to five grains) of 
quinia, and I believe that in tonic doses quinia produces no perceptible 
sedation of the circulation, but that the largest antiperiodic doses have a 
distinct influence.* 
According to Bonorn and Arvedi, to Magendie, to Monneret, to Melier, and 
to Baldwin, in animals killed with quinia the blood is found to be dark, de- 
fibrinated, fluid, and incapable of forming a clot. Briquet, however, denies 
that this alteration of the blood is constant or even common in quinia-poison- 
mg, as he found it in only four out of twenty-three dogs so sacrificed ; and he 
believes that it is merely an accident dependent upon the method of death. 
In a series of analyses, apparently carefully made, he found that the continued 
use of quinine augments the proportion of fibrin, but lowers that of the red 
corpuscles. 
In 1867f Prof. Binz announced the fact that quinia added to human blood 
in the proportion of one part to four thousand immediately checks and in a 
short time arrests the amoeboid movements of the white blood-cells. Confirma- 
tion of this has been furnished by Scharrenbroich (Das Chinin als Antiphlo- 
gisticum, Inaug. Dissert., Bonn, 1867), by Kerner (quoted in London Practi- 
tioner, vol. vii. p. 321), by Geltowsky (London Practitioner, vol. vii.), and 
by Jerusalimsky (Centralb. Med. IFiss., 1876, p. 476). The minimum ef- 
fective strength of the solution has been found to vary in different species of 
animals, and even in different individuals of the same species. 
It is a matter of great interest to determine whether quinia acts in the 
living organism as on the stage of the microscope ; and, to settle this point, 
Prof. Binz (Virchow's Archiv, Bd. xlvi., 1869, p. 138) has experimented 
according to the method of Cohnheim. He found that when the mesentery 
of curarized frogs to which quinia had been given was exposed upon the 
stage of the microscope, no accumulation of white blood-cells in the small 
vessels, or passage of them out into the tissues, occurred upon irritation; or, 
if after a time these phenomena commenced, they were at once checked by a 
small hypodermic injection of the alkaloid. When the inflammatory process 
had already commenced in a " Cohnheim frog," an injection of quinia would 
cause the wandering out of the corpuscles to cease, and would bring about a 
* Some studies have been made upon the action of the drug on the capillaries of the 
brain, but the evidence is as yet contradictory and insufficient. Consult Psychological 
and Medico-Legal Journal, 1875, p. 33; also, Archives of Medicine, i. 33. 
j- Archiv fur Microscop. Anatomie, iii., 1867. Consult, also, Experimentelle Unter- 
suchungen ilber das Wesen der Chininwirkung, Berlin, 1868; Virchow's Archiv, Bd. xlvi., 
1869, p. 137; Berlin. KlinischeWochenschrift, Nov. 1871. TONICS. 
71 
gradual clearing of the white cells from the choked-up vessels. Prof. Binz 
further took two young cats, and, after poisoning one of them with quinia, 
examined their blood. In the blood of the unpoisoned animal the white cells 
were far more abundant than in that of the poisoned cat. From these facts 
Prof. Binz deduces the conclusion that quinia acts destructively in the system 
upon the white blood-corpuscles, in the same way as when they are out of the 
body. Dr. Geo. R. Cutter (Psychological and Medico-Legal Journal, Feb. 
1875) has experimentally confirmed the effect of quinia in preventing the 
extrusion of white blood-cells in the frog's mesentery, and A. Martin (Das 
Chinin als Antiphlogisticum, Inaug. Dissert., Giessen, 18G8)* has not only 
done this, but has also found that the action of the drug is apparent in the 
centre of parenchymatous organs, such as the liver. 
On the other hand, Schwalbef could detect no difference in the blood of a 
cat before and after poisoning by quinia; and the experiments of Geltowsky 
(loc. cit.') upon frogs and guinearpigs have yielded similar results: in all cases 
after fatal poisoning by the alkaloid the movements of the corpuscles were 
found to be very active. 
These results are in opposition not so much to the experiments as to the 
deductions of Prof. Binz,-deductions which seem to me scarcely warranted 
by his own investigations. The experiments which he performed in the 
Cohnheim method at most prove only that poisonous doses of quinia pre- 
vent or arrest inflammation. The local accumulation and the out-wandering 
of the blood-corpuscles are the result of a local inflammation or irritation, 
and if the quinia should in any way check this it would of course put an 
end to the phenomena mentioned. Again, quinia might, in the case of the 
cat, have lessened the proportion of blood-cells by checking their formation. 
The exact nature of the action of the alkaloid upon the white blood-cor- 
puscles in the body must, therefore, be considered undetermined, even when 
poisonous doses are used; when therapeutic doses are employed, the doubt is 
of course still stronger. 
It would seem that quinia acts also upon other portions of the blood than 
the white corpuscles. Manassein ( Ueber die Dimensionen der rothen Blut- 
korperchen unter verschiedenen Verhaltnissen, Berlin, 1872) has found that 
in fever occurring in the lower animals the red corpuscles are diminished in 
size. If in this condition a decided dose of an antipyretic, such as quinia 
or alcohol, be given, and the temperature falls, the globules resume their 
normal size. That the change is due to the fall of the temperature rather 
than to a direct action of the drug is, I think, demonstrated by the fact of 
its occurrence whenever the fever-heat is lowered by the application of ex- 
ternal cold. The experiments of Manassein, therefore, do not prove that quinia 
exerts any direct action on the red corpuscles. The investigations of Binz 
* Quoted by Binz, Virchow's Arohiv, Bd. xlvi. p. 137. 
f Quoted by Kerner, Pfitiger's Archiv, Bd, i, p. 203. 72 
SYSTEMIC REMEDIES. 
(Archie flir Experimentelle Pathologic und Pharmakologiey Bd. i., erstes 
Heft, 1873), however, appear to show that the alkaloid lessens the ozonizing 
power of the blood; for he found that in young cats, to which he had given 
a very large but not fatal dose of quinia, the freshly-drawn blood affected the 
tincture of guaiac much less than it normally should. 
When blood is drawn from the body and allowed to stand, acid is developed 
in it. Zunst (Beitriigezur Physiologic des Blutes, Inaug. Dissert., Bonn, 1868), 
who has studied this subject most closely, divides the investigation into-study 
of the production of acid in the time from the escape of the blood from the 
vein to its coagulation, and study of the slow changes which increase its acidity 
when coagulated until putrefaction has fairly set in. Prof. Binz believes 
that this development of acid is due to oxidation, and by an elaborate series 
of experiments has determined that quinia (also sulphate of bebeeria and 
picrate of sodium in almost as great degree) inhibits these changes very 
greatly in both their varieties. These experiments are in accord with the 
previous ones of A. Schulte ( Centralblatt fur die Medicin. Wissenschaften. 
Nov. 1871); the facts may, therefore, be considered proven. 
If ozonized oil of turpentine be dropped into an alcoholic solution of guaiac 
resin, no alteration of color occurs ; but if a drop of blood be added, the blue 
appears at once: i.e., the blood acts as a carrier of ozone from the turpentine 
to the resin. Prof. Binz has found that quinia, even in so small an amount 
as one part in twenty thousand, has a perceptible influence in preventing this. 
Similarly, when into a dilute watery solution of the sulphate of indigo car- 
bonate of sodium is thrown until the reaction is decidedly alkaline, and a little 
blood, and subsequently ten drops of ozonized turpentine, are added, a green 
color begins at once to develop, and in a little while passes into the clear 
yellow of isatin. In this case also the blood acts as a carrier of ozone, and Binz 
and his pupil Bansond ( Ueber einige Beziehungen des Chinin zum Blut, Inaug. 
Dissert., Bonn, 1871) have found that quinia also inhibits this action, one part 
of it added to a thousand of the mixture delaying the change of color for an 
hour. In these experiments Binz used a large number of different salts of 
quinia, and found that they acted identically. That the action of the alkaloid 
was on the blood, not on the indigo and guaiac solutions, was shown by the 
fact that when similar solutions without the blood were shaken in the air and 
absorbed ozone, the characteristic colorations of its action were produced just 
as readily when quinia was absent as when it was present. Binz also proved 
that the red corpuscles were the portions of the blood affected. On adding 
crystallized haemoglobin from horses' blood to the guaiac solution he found 
that it acted as an ozone-bearer between the turpentine and the guaiac, and 
further demonstrated that quinia had the power of preventing this action. 
As it is established that quinia exerts a decided antipyretic action (see 
p. 71) in ordinary fever, it is an exceedingly plausible theory that the low- 
ering of temperature is due to a checking of the ozonizing power of the 
blood. To attribute, however, the general medical virtues of quinia to an TONICS. 
73 
action on the white corpuscles seems to me unreasonable; for from the ex- 
periments of Prof. Binz himself upon the lower organisms it would appear 
that quinine acts upon all animal germinal matter ; and it is probable that the 
protoplasm of the nervous system, being more specialized than that of the 
white corpuscles, would be more susceptible of the influence of the alkaloid. 
Prof. Binz states that both conine and camphor act more forcibly upon the 
white corpuscles out of the body than does quinine, and Dr. T. Lauder 
Brunton and Theo. Cash have found that morphine, veratrine, and codeine 
check the ozonizing power of the blood ; whilst digitaline, picrotoxine, and 
caffein increase it. Each of these principles has its own peculiar physio- 
logical action, differing from that of quinine and the other alkaloids (St. 
Bartholomew's Hosp. Rep., xviii. 269). It seems, therefore, to me absurd 
to attribute such diverse physiological actions to the one common property 
of the group, and I think that we must consider the antozonizing power of 
quinine as simply one of its functions, and not as the basis of all its relations 
with the human organism. 
Antiseptic Action.-As long ago as 1765, Dr. Pringle (Observations on 
Diseases of the Army, London, 1765) called attention to the fact that cinchona 
bark, in decoction or powder, has the power of preventing for a time putre- 
faction in flesh; and more recently the subject has been studied by Mayer, by 
Pavisi, by Hallier (Das Cholera-Contagium, Leipsic, 1867), by Herbst, by 
Polli, and especially by Binz (Virchow's Archiv, Bd. xlvi., 1869, p. 68; and 
Untersuchungen uber das Wesen der Chininwirkung, p. 20), to whose elabo- 
rate articles I must refer my readers for details and references. The experi- 
ments of these authorities have demonstrated that quinia in the proportion of 
one part to three hundred will preserve for a long time flesh, meal, milk, butter, 
urine, albumen, etc., and will check very markedly the alcoholic fermentation 
in honey or in syrup. Prof. Binz has demonstrated that this antiseptic action 
is due to a poisonous influence exerted by the quinia upon the fungi which 
are the immediate cause of the changes. According to his experiments, the 
larger infusoria, such as Paramecia and Colpoda, are killed by a solution of 
quinia of the strength of one in eight hundred immediately, of one in one 
thousand after some minutes, of one in twenty thousand after some hours. 
Upon the ordinary mould Penicillium, upon Vibrios and Bacteria, as well as 
upon the higher infusoria, quinia acts with a similar fatality. In the case of 
the Vibrios and Bacteria a decidedly stronger solution than the one mentioned 
is required to quiet movement. Bochefontaine (Archives de Physiologie, 
July, 1873) found that a solution of one per cent, was needed for a vigorous 
rapid action, and that some active granules could even be found in it after 
three days. According to Binz, the singularity of the influence of quinia is 
shown by the fact that a solution of salicin, in the proportion of one part 
to forty, does not kill Paramecia and Colpoda. Indeed, these infusoria were 
not even affected by this strong solution of salicin, and they endured a solu- 
tion of morphia of one part to one hundred and twenty for an hour, and a 74 
SYSTEMIC REMEDIES. 
five per cent, solution of strychnine for some minutes. Although fungi will 
appear after a time in ordinary solution of the sulphate of quinia, I think it 
must be considered well established that this and other salts of the alkaloid 
are extremely poisonous to the fungi of putrefaction and of other ordinary 
fermentations. 
Uterus.-In 1871, Dr. Monteverdi announced (Annales et Bulletin de la 
Societe de Medecine de Gand, May, 1871) that quinia is a uterine stimulant, 
causing at times in the gravid womb contractions sufficiently violent to induce 
abortion, and, when given during labor, intensifying greatly the uterine 
pains, and after labor causing rapid expulsion of the placenta and arresting 
uterine hemorrhage; affirming, further, that in amenorrhoea or in menor- 
rhagia from uterine inertia its action is no less marked. Although this has 
been received as new the world over, so long ago as 1855 Dr. John S. Wilson 
(Southern Medical and Surgical Journal, p. 341, 1855) called attention to 
the uterine action of quinine, and in 1860 reasserted his belief (Southern 
Journal of Medicine, Sept. 1860), which in the mean while had been con- 
firmed by Dr. J. H. Rich in the Charleston Medical Journal and Review ; 
and in 1858 Dr. Jos. J. West (Savannah Journal of Medicine, vol. i. p. 19) 
wrote, " Many regard the use of quinine as dangerous and even criminal in 
any diseases in pregnant women. The belief of these persons is that this 
substance exercises a direct influence upon the uterus, causing powerful con- 
tractions and expulsion of the foetus. And to support this notion they are 
ready to bring forward innumerable instances of abortion after its use,-of 
cases of sudden suppression relieved by a prompt use of the same remedy." 
He then goes on to say that these abortions, etc., were due to the intermittent 
fever and not to the drug. Surely this is enough to show that the oxytocic 
action of quinia was believed in many years ago by numbers of our Southern 
practitioners. The question now is whether the drug has any such action. 
It is evident that the answer to this should be made out in three different ways. 
First, Is there any evidence of quinia producing abortion in healthy women or 
in females of other animals? Second, How strong is the evidence of its pro- 
ducing abortion in women suffering from ague ? Third, What is the evidence 
in regard to the action of quinia during labor ? 
In regard to the first of these sub-questions, the only affirmative evidence 
I have met with is in the experiments of M. Rancillia (L' Union Medicale, 
1873), who saw abortion in two bitches follow the administration of from six 
to nine grains of quinia: as the pups in one case were already dead before the 
administration of the drug, it would seem that this investigation was not on 
such a scale as to be at all conclusive. Moreover, I have given quinia to two 
pregnant cats, in one case in sufficient quantity to cause death, without dis- 
turbing the products of conception. On the other hand, I have met with 
no evidence that quinia is capable of inducing abortion in healthy pregnant 
women. Dr. Sayre's case (American Practitioner, 1871, p. 260) is certainly 
no proof whatever that quinia will originate labor, as labor had commenced TONICS. 
75 
under the influence of the hot and cold douche and other measures employed 
before the quinine was given. Prof. Chiara, of Milan, has furnished (Z' Union 
Medicale, Nov. 20, 1873) very strong evidence that quinia is incapable of 
originating uterine contractions in healthy pregnant women. In his public 
service, two doses of a gramme (15.34 grains) each were given without effect 
daily for two successive days to eight women all in the eighth month of preg- 
nancy. It being necessary to cause abortion, one gramme was given daily to 
one woman for seven days, to another for three days, without in either in- 
stance any effect, so that the labor had to be brought on in the usual manner. 
On the whole, I believe that the first question must at present be answered in 
the negative. 
In answer to the second sub-question, some evidence has already been 
adduced to show that abortion may be so caused. To it may be added the 
assertion of Dr. Walraven (Boston Medical and Surgical Journal, 1873) that 
he has frequently seen the exhibition of quinia followed by abortion, the 
record of two cases of such character by Dr. Burt (Medical and Surgical 
Reporter, 1870), and no doubt the affirmations of others which I have not 
seen. Opposed to this, however, is the overwhelming fact that the great body 
of the profession have for centuries been giving quinia in one form or 
other to pregnant women indiscriminately, and if abortion had been produced 
it must have been noted long ago. Further direct testimony is not wanting. 
Malaria often induces abortion, and Dr. Erwin (St. Louis Medical, and Sur- 
gical Journal, March, 1872), Dr. Jas. C. Harris (American Practitioner, 
April, 1872), and Dr. A. Russwurm (American Practitioner, 1871, No. 4, 
p. 127) testify from personal experience that quinia will arrest abortion from 
such cause. Dr. J. A. Ashford (National Medical Journal, Oct. 1871), Dr. 
Beauchamp (American Practitioner, 1870), Dr. Rooker (Ibid.), Dr. J. S. 
May (Ibid.), and Dr. A. d'Arcourd (Medical News and Library, May, 1873) 
have given the alkaloid to hundreds of pregnant women in large doses without 
result. Other testimony might be adduced; but it seems to me incredible, 
in the face of daily experience, that even the largest therapeutic doses of 
quinia are abortifacient in malarial fevers or in health. 
In regard to the third sub-question, at the time of the writing of thethira 
edition, the evidence, although greatly preponderating in one direction, was 
scarcely sufficient to be decisive.* At present, it seems established that qui- 
nine in full doses (ten to twenty grains) is a very powerful stimulant to the 
uterine contractions during labor. The pains it produces so exactly simulate 
the natural ones as to indicate that they are not so much caused by a specific 
action of the drug, as by its arousing the general nervous forces of the 
system. Be this as it may, most of the leading accoucheurs of this city and 
of New York are accustomed to rely upon quinine in cases of uterine inertia 
from exhaustion. 
* For details of the evidence the reader is referred to the third edition. Consult also 
London Practitioner, xvii., xviii., xix. 76 
SYSTEMIC REMEDIES. 
Kidneys and Elimination.-The manner in which quinine finds entrance 
into the blood has been especially studied by Dr. Kerner (loc. cit.'). As the 
gastric juice is very acid, it is evident that the alkaloid will be rapidly dissolved 
in the stomach and be put into the conditions most favorable for its absorp- 
tion : if, however, the salt of quinia escape from the stomach into the intes- 
tines, it will be liable to be precipitated by the alkaline juices, as well as by the 
bile, whose acids form very insoluble salts with it. The presumption is there- 
fore strong that, when gastric absorption fails to take place, at least a portion 
of the quinia will pass out with the faeces. That this actually does occur has 
been proven by Kerner and others, who have found the alkaloid in the excre- 
ment of persons taking it. As the blood is alkaline, it 'would appear probable 
that the quinia salt so soon as entering it would be precipitated. That this 
does not occur, according to the researches of Kerner, is due to the solvent 
power of the gases contained in normal blood. 
The authority mentioned found that one thousand parts of blood which was 
defibrinated and deprived of its gases, at a temperature of 36° C. dissolved 
in an hour only 0.398 part of pure quinia. Water saturated with carbonic 
acid gas dissolves the sulphate of quinia pretty freely ; and Kerner also experi- 
mentally determined that when a neutral solution of a salt of quinia is added 
to a very dilute solution of carbonate of sodium no precipitate occurs. It 
would appear, then, that the quinia is held in solution in the blood by reason 
of the loosely-combined carbonic acid gas in that fluid. 
It has been proven by the analyses of Landerer (Repertorium fur Phar- 
macies Bd. xxv., 1836), of Dietl ( Wiener Medizinische Wochenschrift, 1852), 
of Briquet (loc. cit.), of Binz, and of De Renzi (Bull. Thirap., xci. p. 45), 
that quinine escapes from the body through the kidneys. According to Bri- 
quet, it may generally be found in the urine half an hour after the adminis- 
tration of a large dose. Its removal, according to the researches of Binz, 
goes on slowly, for it is stated (loc. cit., p. 167) that in six experiments only 
a little more than two-thirds of the ingested quantity was excreted in the 
first forty-eight hours. Further, De Renzi, Yvon, and Dietl (Die Pflanzen- 
stoffe, 1883,1443) have found it in the urine six or seven days after the in- 
gestion of the last dose. Dr. L. Thau, however, in three experiments, out of 
the 4.4586 grammes of the alkaloid which were given, recovered from the 
urine passed during the forty-eight hours 4.3 grammes, so that only 0.1586 
gramme remained unaccounted for. A portion of this residue was perhaps 
lost in the chemical operations; but it is probable that some of the quinine 
is eliminated through other channels than the kidneys, since Prof. Binz has 
found it in the saliva of a poisoned dog, and Landerer (Buchner's Reper- 
torium, 1839 and 1842) states that he has detected it in the urine, sweat, 
tears, milk of nursing women, and in the serum of dropsical effusions, 
whilst Albertoni and Rienzi find it abundant in the bile when it has been 
taken by the mouth, but not when it has been given hypodermically. Dr. 
Thau determined that from a third to somewhat less than half of the in- TONICS. 
77 
gested quinine escapes from the body in the first six hours, and that in the 
first twelve hours about three-fourths are excreted.* Welitschkowski 
found {St. Petersb. Med. Wochenschrift, 1876) an elimination of sixty-five 
per cent, the first day and twenty-five per cent, the second day. Prior gives 
the second day as the usual final limit of elimination. I think we may 
consider that after a few doses the alkaloid is practically eliminated in forty- 
eight hours; but that when it has been given continuously, or kidney-dis- 1 
ease or great feebleness of circulation exist, the system may contain a notable \ 
amount of the quinine for a longer period. The researches of Welitschkow- 
ski are in accord with those of Jurgensen and Thau in showing that in car- 
diac and renal disease and in low fevers elimination proceeds very slowly, 
more of the alkaloid being thrown off in the second than in the first six 
hours after its ingestion. 
Ranke was, I believe, the first to notice that quinine produced a great de- 
crease in the elimination of uric acid. This was confirmed by H. V. Bosse 
{Inaug. Diss., Dorpat, 1862), and by Dr. G. Kerner {Pfl'uger's Archiv, 
1870, iii. 93). The latter observer found, when about nine grains of 
quinine were taken in divided doses during the course of the day, the urea 
was decreased not quite one-eighth, the uric acid to a little less than one- 
half, the kreatinine was slightly increased, and the nitrogenous material de- 
creased about one-ninth. When a very large dose (thirty-eight grains) was 
taken in the morning, the urea and the kreatinine were each decreased about 
one-fourth, as was also the collective nitrogenous material; the phosphoric 
acid was lessened about one-fifth, and the uric acid about four-fifths. Zuntz 
(quoted by G. Strassburg, Archiv fur Exper. Path., Bd. ii. p. 343) found that 
twenty-five grains of quinine reduced his elimination of urea nearly forty 
per cent. A. Schulte also found 1.8 gramme quinine depress the elimina- 
tion by the kidneys thirty-nine per cent. {Inaug. Diss., Bonn, 1870); 
yet in the experiments of Unruh (Virchow's Archiv, 1869, xlviii. 227) 
the alkaloid usually, but not always, acted in this way, and in the trials 
of H. Oppenheim {Pflugers Archiv, 1880, xxxiii. 446) the excretion 
of urea was actually increased. Nevertheless, the experiments, upon the 
dog, of Rabuteau {Bulletin T herapeutique, t. Ixxv. p. 475) and of Her- 
mann von Boeck (Untersuchungen uber die Zersetzung des Eiweisses im 
* Dr. G. Kerner (Pfluger's Archiv fur Physiologic, 1870) asserts that the quinia as 
excreted is in an amorphous, uncrystallizable form. He also has discovered in the urine 
of persons taking quinia a peculiar substance, sometimes amorphous, sometimes in acicular 
prismatic crystals, free from bitter taste, possessing the quinia inflorescence, which he 
believes to be a derivative formed in the body from the ingested alkaloid. He has not 
been able to get this substance in such quantity as to analyze it or further examine it, but 
has produced a principle (dihydroxyle quinia) which he believes to be identical with it by 
acting on quinia with the permanganate of potassium. An elaborate series of experiments 
have shown that the dihydroxyle quinia is physiologically inert. This dihydroxyle quinia 
must be produced in small amount, if at all, as there is abundant evidence that quinia is 
largely excreted as quinia (see Ph. Jour, and Trans., ix. 125). 78 
SYSTEMIC REMEDIES. 
Thierkorper, Munich, 1871), bear strong evidence to the fact that quinine 
does decrease the elimination of urea ; and the recent very elaborate studies 
of Dr. Prior (fPfl tiger's Archiv, Bd. xxxiv. 237) warrant us in believing it 
established that quinine powerfully depresses the elimination of the nitro- 
genous excretory principles. That such decrease is due to diminished for- 
mation and not to lessened elimination seems proven by the fact that in 
Prior's experiments there was no increase of nitrogenous excretion beyond 
the norm following the omission of the quinine. The conclusion seems 
logically inevitable that quinine has a direct or indirect influence upon the 
tissue-changes of the'human organism. Contrary to what might have been 
expected, Strassburg (loc. cit.f in an elaborate series of experiments, found 
that quinine had no very decided effect upon the elimination of carbonic acid 
either in healthy or in fevered rabbits. 
Therapeutics.-At present our estimate of the value of quinia in disease, 
and our knowledge of its therapeutic use, rest solely upon clinical observation. 
We are not as yet able to apply what information we have of its physiological 
action, nor, indeed, are we even able to explain its known clinical action by 
its observed effects on the healthy organism. 
On account of its power of arresting or preventing putrefactive fermenta- 
tion by killing the microscopic entities which produce such changes, Prof. 
Binz has recommended it in the so-called septic diseases. The chief evidence 
which he produces is in some ten experiments made upon dogs and rabbits. 
In each of these experiments two similar animals were poisoned with putres- 
cent liquids, and to one of the pair quinine was freely administered. In two 
cases the cinchonized animal recovered, whilst its fellow perished; in three 
experiments neither of the animals died; and in the other five trials the cin- 
chonized animal lived from two to twenty-four hours longer than the other. 
These experiments are certainly too few and indecisive to prove in any degree 
Prof. Binz's view. To my mind they indicate very strongly that quinia has 
no such influence over the disease as he claims for it. If living germs in 
the blood were really the cause of the septic symptoms, and quinia killed 
such germs, its action would be as manifest and as unmistakable as it is in 
intermittent fever. The results of Prof. Binz's experiments indicate no such 
specific action, but rather that the quinia in such cases does good by sustain- 
ing the nervous system, or in some other unknown manner. In pyaemia in 
man, quinia has been frequently employed, but exerts no specific action. 
It has not, that I know of, been proven that therapeutic doses of quinia 
lower, to any marked extent, animal temperature in the healthy man. Dr. G. 
Kerner and Dr. Jurgensen have each noticed that full doses of quinia appear 
in a healthy man not to affect sensibly the temperature, but to prevent the 
rise which normally occurs from exercise. Thus, in Kerner's experiment, 
certain gymnastic exercises, which when performed in his ordinary state 
elevated his bodily temperature 2° C., affected the latter to the extent only 
of 0.2° to 0.35° C. when quinia was freely exhibited. TONICS. 
79 
Even Dr. C. Liebermeister (Deutsches Archiv fur Klinische Medicin, Bd. 
iii., 1867) acknowledges that numerous experiments have shown him that 
the alkaloid has no constant action on the bodily heat in health, and de- 
tails a case in which forty grains administered within seven hours caused no 
depression of temperature. The same authority claims, however, that by a 
very large number of experiments he has demonstrated its power of lessening 
fever-heat. In one hundred and seventy-eight observations in typhoid fever. 
twenty grains of the quinine having been given during the night, the morning 
temperature was lower than that of the previous evening by, on the average, 
1.63° C. On one hundred and seventy-six different occasions a scruple of 
quinine was given during the day; sixty-nine times the temperature was 
lower in the evening than in the morning, ten times it was the same as in the 
morning, and ninety-seven times it was higher than in the morning. A com- 
mittee appointed by the London Clinical Society ( Transactions, vol. iii., 1870, 
p. 201) experimented with the drug on about fifty cases of various diseases. 
They assert that the antipyretic action of large doses was very decided, 
appearing within from one to two hours after the exhibition of the drug, 
and lasting from a few to many hours. In a very recent publication Lieber- 
meister asserts that he has given some ten thousand doses of quinine as an 
antipyretic and has almost unbounded confidence in it. He insists that from 
twenty to forty-five grains must be given within the hour, and not repeated 
oftener than once in twenty-four or forty-eight hours. 
Naunyn and Quincke (Reichert's Archiv fur Anatomie, 1869) found that 
sometimes quinia prevented the development of fever after the division of 
the spinal cord in animals, but in other cases failed to do so. Binz (London 
Practitioner, p. 4, 1870) has achieved similar results: he says that if the 
conditions of the fever are too favorably constituted the effect of the quinine 
fails thoroughly. The drift of our present clinical evidence seems to indicate 
that quinia exerts in febrile disease a decided antipyretic action, which is 
especially manifested during those stages of disease in which the natural 
tendency is towards a lowering of temperature. In typhus and typhoid fever, 
scarlatina, severe erysipelas, rheumatic hyperexia, etc., after the use of the 
cold bath (see Part II.) twenty grains of the alkaloid are often very effi- 
cacious in preventing a rapid return of the excessive fever. If the experi- 
ments spoken of above be correct, this reduction of temperature must be due 
to an action on the tissues and not on the central nervous system. It would 
seem, however, more probable that quinia acts as an antipyretic by stimulating 
the inhibitory chemical centre ; but decision of this must be reserved for future 
investigations. As an antipyretic the drug should be used whenever there is 
serious elevation of temperature, except it be in cases of simple inflammation 
of the brain or its membranes. All antipyretic remedies appear to act more 
strongly on children than on adults ; and accordingly Dr. Rapmund (Deutsches 
Klinik, 1874, p. 51) has found quinia of the utmost service in serious dis- 
eases of children with high temperature, especially lobular pneumonia. Much 80 
SYSTEMIC REMEDIES. 
of the failure which has hitherto attended its employment undoubtedly has 
been due to a faulty method of administration. 
As a simple tonic, quinia is used by every one; but I have never been 
able to see that the ordinary combination of it with iron is of much more 
value in simple cases of debility than iron with quassia or other simple 
bitter; but if, as is probable, it be true that quinia lessens to a very great 
extent the elimination of nitrogen, i.e., the consumption of tissue, the general 
practice has a good foundation. 
When given in very large doses, quinia, as has been already shown, acts 
as a powerful depressant, and as such has been used by Briquet and other 
French physicians in rheumatism. As much as sixty or seventy grains a 
day have been given, and it is beyond dispute that under the influence of 
these heroic doses the symptoms of inflammatory rheumatism have often 
rapidly abated; but the method has found little favor out of France, and is 
less efficient and more dangerous than other plans of treatment now in vogue. 
In inflammatory rheumatism, after the acute symptoms have abated, when 
the patient shows evident signs of weakness, especially if there be profuse 
sweating during sleep, fifteen grains of quinine daily are often of great service. 
Various theories have been brought forward to account for the wonderful 
power quinia has upon all forms of malarial disease; but, as we know 
nothing of the nature of malaria or of the method of its action, and as wo 
are very partially informed as to the effects of quinia upon the healthy or- 
ganism, it seems to me perfectly futile to endeavor to explain why it averts a 
paroxysm of intermittent. I shall not, therefore, occupy space with such dis- 
cussion. The present seems, however, the fitting place to notice the discovery 
of Dr. H. Bence Jones in regard to the existence of a body similar to quinia 
in the animal organism. 
Quinia and its salts have the remarkable property of converting the chem- 
ical rays of the spectrum into light, or, in other words, of rendering visible 
the ordinary invisible rays of the solar or other spectrum. Connected with 
this fact is probably the phenomenon known as the fluorescence of quinia. 
When a colorless watery solution of one of its salts is examined, a pale-blue 
line upon the surface is very noticeable; and Prof. Stokes has shown that 
solution of quinia has the power of entirely stopping certain of the rays of 
light, so that when a beam is transmitted through it to light up a second 
vessel of the solution this latter displays no fluorescence. Dr. II. Bence 
Jones (Lectures on Pathology and Therapeutics, London, 1867) has found 
that when the electric light is used this test is so delicate that one grain of 
the alkaloid may be detected in 1,450,000 grains of water. He has also dis- 
covered that man and animals are pervaded by a substance which, in its action 
on light and in many chemical reactions, very closely resembles, if it be not 
identical with, quinia. Believing this substance to be probably an alkaloid, 
he has given it the name of animal quinoidine. Drs. Edward Rhoads and 
William Pepper, Jr. (Pennsylvania Hospital Reports, vol. i., 1868), have TONICS. 
81 
made observations upon ten cases of malarial fevers in which no quinine had 
been used, and have found the fluorescence of the blood to be from 0 to 1|, 
instead of from 3 to 6, which is said to be normal. The significance of these 
results is at once apparent; but, before sufficient grounds shall have been 
obtained upon which to build a theory, far more extended researches on the 
variance of the fluorescence in health and in diseases other than malarial are 
necessary. Especially is this the case since Dr. Chalvet (Schmidt's Jahr- 
biicher, Bd. cxli. p. 152, from Gazette Hebdomadaire, 2d series, t. v., 1868) 
has found that this fluorescent body exists in various foods and even in wine, 
and is therefore probably not of animal but of vegetable origin. 
Quinia in its relations to malarial fever may be considered first as a pro- 
phylactic, secondly as a curative agent. 
The value of the daily use of quinia to persons exposed to a malarial 
atmosphere has now been thoroughly tested in all portions of the world. In 
North and South America, in Europe, in Africa, in India, the prophylactic 
powers of quinia have been tried on the largest scale in connection with the 
military and naval services, and the testimony is unanimous in favor of the 
drug. A single citation will serve to illustrate this fact.* Dr. J. B. Hamilton 
(Indian Medical Gazette, Nov. 1, 1873) reports the case of a battery of 
one hundred and thirty-five men, quartered at Jubbulpore, East Indies, in 
the same barracks with an infantry regiment. Each of the artillerists received 
three grains of quinine every other day; to the infantry none was given. 
The result was that whilst three hundred out of the five hundred men of the 
regiment were sick at one time with malarial disease, at no period was more 
than four per cent, of the battery affected. The dose of quinia as a prophy- 
lactic may be considered as three grains a day, or possibly, in very deadly 
climates, three grains in the morning and two in the evening. 
In intermittent fever, when there is sufficient time, it may be well to pre- 
cede the quinia by a mercurial or other purge. If the expected paroxysm 
be so near that there is not sufficient time for the action of the purgative, 
the antiperiodic should be administered without previous preparation of the 
patient. The value of purgatives in obstinate intermittents, as an adjuvant 
to quinia, is often overlooked, although in some cases the employment of pur- 
gatives, and of such diuretics as cream of tartar, seems to be almost essential 
for the successful use of quinia. 
When there is necessity for prompt action, the antiperiodic may be given 
in a single dose, or in any other method that the circumstances of the case 
will allow; but ordinarily the best plan is to commence the exhibition of the 
drug about eight hours before the expected paroxysm, and to continue in 
hourly doses until from three to four hours before the attack is due. 
In pernicious fever, or malignant malarial poisoning, no time should be 
lost after the first paroxysm in getting the patient cinchonized, as it may be 
* See also K. M. Downie, M.B., Indian Medical Journal, March 1, 1872. 82 
SYSTEMIC REMEDIES. 
uncertain whether the attack be of the quotidian or tertian type. At least 
thirty-five grains of the alkaloidal salt should be administered during the first 
twenty-four hours of intermission, and twenty-five grains during the second; 
in very severe types of the disease much larger doses even than these are 
necessary, less than fifty grains of the drug sometimes appearing to do but 
little good. 
In remittent or bilious fever it may often be advisable to give purgatives 
and febrifuges, but it is not proper to delay the exhibition of the antiperiodic 
on their account. As soon as the remission has appeared, the exhibition of 
quinia should be begun. Local inflammations or even severe cerebral symp- 
toms occurring during a remittent fever are no contra-indications to the use 
of the specific. When gastritis exists, other channels of entrance than the 
stomach should be employed, on account of the local irritant action of quinia. 
When the symptoms in remittent fever are severe and seemingly continu- 
ous, it may be not only proper, but necessary for the saving of life, to exhibit 
quinia freely during the period of fever. In large doses the alkaloid is prob- 
ably antipyretic as well as antiperiodic, and I do not know of any theoretic 
or clinical objection to its use during the period of fever. 
In malarial intermittent neuralgia, as in all other forms of abnormal 
manifestations of malarial disease, quinia is efficient, although it may be 
necessary to use it in large doses. 
In neuralgia which, although not dependent upon malaria, assumes the 
intermittent type, quinia will often temporarily set aside the paroxysmal 
attacks, and sometimes effect a cure. The same fact may be stated in broad 
terms as true of all non-malarial intermittent affections. In the great ma- 
jority of such cases, unfortunately, the action of the quinia is only temporary, 
and any controlling power is soon lost. 
Various idiosyncrasies exist towards quinia. Prof. Karamitsas asserts 
that in some persons it causes hmmaturia (Bull. Therap., xcvii. 53) : it not 
very rarely causes vesical irritation, and it is said that in some people (Brit. 
Med. Jour., ii., 1869 ; Berlin. Klin. Woch., 1877, 294; Phila. Med. Times, 
x. 166) a few grains given internally suffice to produce great oedema of 
the face and limbs, accompanied with a pronounced erythematous rash, in 
some cases closely resembling that of scarlatina (N. Y. Med. Record, xxi. 
627), the whole subsiding in a few days with desquamation of the cuticle, 
even purpura, although with very doubtful correctness, has been ascribed to 
the alkaloid (Boston Med. Surg. Journ., cix. p. 587). Chevallier describes 
(Gaz. des Hopitaux, 1850) a peculiar affection of the skin, etc., as occurring 
among workers in bark. 
Local Use of Quinia.-The effect of quinia upon the lower organisms has 
suggested its local use in various disorders supposed to depend upon the pres- 
ence of such entities. Thus, Dr. Henke (Deutsches Archiv fiir Klin. Med., 
Bd. xii. p. 630), finding some peculiar motile cells in the sputa of whooping- 
cough, employed inhalations of quinia with asserted good results. Dr. Henke TONICS. 
83 
was not, however, the first to suggest either this fungoid pathology of whoop- 
ing-cough or the use of quinia. Prof. Binz in 1870 {American Journal of 
Obstetrics and Diseases of Women, iii.) claimed that quinia had a specific 
action in whooping-cough, provided it was given in large doses in solution, so 
as to come in contact with the mucous membrane in its passage through the 
pharynx; and in 1871 Letzerich {Ibid., vol. iv. p. 761) announced that 
whooping-cough was due to a fungus in the lung. Prof. Dawson {Ibid., 
1873) has confirmed the value of the method of Prof. Binz; but, if the fun- 
goid theory be-as I do not believe-true, the plan of Henke must certainly 
be the better one. 
Again, Helmholtz recommended the local use of quinia in hay fever, 
believing that disease to be due to a fungus, and much testimony has been 
brought forward as to the value of the treatment. A weak, tepid solution 
(gr. j to iii-fgi), as nearly neutral as possible, should be freely applied by 
snuffing it up, or, better, by means of Thudichum's douche. If the value 
of quinia in whooping-cough and in hay fever be established, it by no means 
follows that the theory which originated the use of the remedy is true. The 
alkaloid is certainly a stimulant to the mucous membranes, and in the later 
stages of gonorrhoea the topical employment of its solution (gr. v to x-f^i) 
is often very serviceable. 
Administration.-Owing to its bitter taste, sulphate of quinia is gen- 
erally given in pill, which may be made with gum, or simply by adding a little 
sulphuric acid to the alkaloidal salt and quickly rubbing up the pasty mass 
into pills before it hardens. Whenever a rapid action is desired, the quinine 
should be given in powder, or in solution made by adding a drop of dilute 
sulphuric acid for every grain of the salt. In the use of pills of quinine, 
care should be exercised to see that they are soft and fresh, for when old 
and hard they not unfrequently pass through the bowels unchanged. The 
ready-made " sugar-coated" pills kept in the shops should be avoided, as 
uncertain in their action. The taste of the powder is best covered by 
chocolate or by liquorice. 
When sulphate of quinia is given hypodermically it acts with much greater 
promptness and apparently with greater force than when administered by the 
stomach. Albertoni and Ciotto {Bull. Therap., xc., p. 403) found that 
when they injected it into the jugular vein it failed to appear in the bile, 
but when they administered it by the mouth it was freely eliminated with 
that secretion. Biliary salts of quinia are so insoluble that their re-absorp- 
tion must be effected, if at all, very slowly; hence possibly the superior 
efficiency of the hypodermic method. The local irritant action of quinia, 
however, forbids its hypodermic employment, except in cases of great emer- 
gency. Given in this way, it very generally produces great local disturbance 
(abscesses, ulcers, etc.), and in several cases has caused fatal tetanus {Lon- 
don Lancet, 1876, i.). When it is so given, care should be taken to have 
an excess of acid (tartaric-the best) in the solution, to prevent precipitation 84 
SYSTEMIC REMEDIES. 
of the quinine by the alkaline juices of the cellular tissue. The bisulphate 
of quinine (Quininse Bisulphas, U.S.) is soluble in ten parts of water, and 
should be preferred for hypodermic use: even its solution should be slightly 
acidulated. Ten grains of quinine injected under the skin are probably 
equivalent to fifteen grains given by the mouth. • 
Contraindication.-On account of its irritant properties, quinine must be 
used with caution when there is irritability or inflammation of any part of 
the gastro-intestinal tract. It is strongly contraindicated by inflammation of 
the middle ear, and may greatly and permanently increase dulness of hear- 
ing. In connection with this is of great interest the statement of Dr. M. 
Friedmann ( Wien. Med. Presse, 1884, 927) that ergotin, given with qui- 
nine or salicylic acid, greatly lessens the auditory disturbance. 
The hydrobromate of quinine ( Quininee Hydrobromas, U. S.) is soluble 
in about 16 parts of water and in 3 parts of alcohol. It is stated that a 
ten per cent, solution in a mixture of alcohol, 25 parts, water, 75 parts, is 
not irritant when used hypodermically. 
The tannate of quiniaf although not officinal, has been used to some ex- 
tent, and is certainly not inefficient. It has the great advantage of not being 
disagreeable to the palate, but is less active and less certain than the more 
soluble salts of the alkaloid, and is also much slower in its operation. If given 
at all, it should be in doses one-third greater than those of the sulphate. 
The physiological action of cinchonine closely resembles that of quinine, 
but seems not to be quite identical with it. Laborde states that pure qui- 
nine does not cause epileptiform convulsions in the lower animals, although 
commercial quinine does so on account of its impurity; and that in poison- 
ing with cinchonine violent epileptiform convulsions are a chief symptom 
i^Compt.-Rend. Soc. Biolog., iv. 1882). M. Bochefontaine (Comp.-Rend. 
Acad. Sci., T. xcvi. p. 503) affirms, however, that quinine does convulse, 
although less actively than does cinchonine, which latter alkaloid he found 
to vomit less than quinine. According to Johnnsen, the effect of cinchonine 
upon the elimination of urinary solids is even more powerful than that of 
quinine. It is eliminated unchanged, appearing in the urine in half an 
hour, and disappearing after massive doses only in ninety-six hours : the great 
bulk being thrown off in the first twenty-four hours (Pflanzenstojfe, 1480). 
Quinidine Sulphas. U. S.-Sulphate of quinidine occurs in long, 
shining, silky, acicular crystals, soluble in 130 parts of water at 62° F., in 
16 parts at 212° ; readily soluble in alcohol, nearly insoluble in ether. It is 
a basic salt, like the sulphate of quinia, readily taking another equivalent of 
acid. It behaves like its isomer with chlorine and ammonia, but is distin- 
guished by rotating light powerfully to the right, instead of moderately to 
* For an elaborate discussion of the therapeutic value of this salt, see Bulletin de 
l'AcacKmie, Paris, 1872. TONICS 
85 
the left. It probably closely resembles quinine in its physiological and thera- 
peutic properties, and is an efficient antiperiodic; the dose is about one-third 
larger than that of quinine. 
Dextro quinia, a brown, amorphous substance, derived from chinoidine, is 
said to answer all the tests for quinia except to polarize to the right. It is 
probably an impure quinidia. 
CINCHONINE SULPHAS-SULPHATE OF CINCHONINE. U. S. 
The pure alkaloid cinchonia crystallizes in prisms and needles. The offici- 
nal sulphate of cinchonia is in short oblique prisms of a very bitter taste, sol- 
uble in fifty-four parts of water, more freely in boiling water, readily soluble 
in alcohol. From its solution in chlorine-water it is precipitated white by 
ammonia. Bill's test for it consists in adding the ferrocyanide of potassium 
in slight excess to its solution. A yellowish-white curdy precipitate is the 
result. On gently heating, this redissolves, but is again deposited, when the 
liquid cools, as abundant golden-yellow crystals. 
Physiological Action.-Conzen (quoted by Husemann) has found 
that the action of cinchonine on infusoria and on fermentation is similar to 
but weaker than that of its sister alkaloid, and that on the movements of 
the white blood-corpuscles its influence seems transient. In Bochefontaine's 
experiments the relative strength of cinchonine to quinine was about 10 to 
16 (Ibid., p. 506; in Bernatzik's (on dogs only) as 4 to 5. 
Therapeutics.-As an antiperiodic, cinchonia exerts a similar influence 
to quinia, but is probably about one-third weaker than that alkaloid, and 
must be used in correspondingly larger dose. Dr. J. B. Hamilton (loc. cit.') 
affirms as the result of experiment that cinchonia as a prophylactic against 
malaria is even superior to quinia. As a tonic I have never been able to 
perceive that cinchonia acts differently from quinia. 
ClNCHONIDINzE Sulphas. U. S.-Sulphate of cinchonidine occurs in 
white, silky, lustrous needles or prisms, odorless, of a very bitter taste, sol- 
uble in 100 parts of water, freely soluble in acidulated solutions. It polar- 
izes to the left, and is not fluorescent. G. See and M. Bochefontaine found 
that the lethal dose of cinchonidine for the frog is 0.015 gramme; for the 
dog, 2.50 gramme. The symptoms in the dog are general feebleness, titu- 
bation, increase of pulse-rate and arterial pressure, vomiting, salivation, con- 
vulsions,-less severe than those caused by quinine,-great loss of muscular 
power, stupor, fall of arterial pressure and of temperature, death from arrest 
of respiration (La France Med., 1883, 527). A boy, aged five years, took one 
hundred and twenty-eight grains in solution during six hours without vomiting. 
There were then convulsions, followed by great collapse, fall of temperature, 
pulselessness (with seventy-four cardiac beats per minute), dilated pupils, mus- 
cular relaxation, and, finally, death ; consciousness being preserved to the end 
(N. K Med. Joum., xxxix. 1884). It is evident that this alkaloid closely 86 
SYSTEMIC REMEDIES. 
resembles its congeneric alkaloids in its action upon the human organism. 
Clinical experience has proven it to be a reliable tonic and antiperiodic. 
According to Byasson, it is eliminated by the kidneys unchanged. It has 
been claimed that it produces less disagreeable symptoms, both gastric and 
cerebral, than does quinine; but Dr. Rafferty, who has administered three 
hundred ounces of the sulphate, affirms that it is more apt to cause nausea 
and vomiting. The dose is one-third greater than that of quinine. 
Chinoidinum. U.S.- Chinoidin, or Quinoidin, is a blackish substance, 
with an almost resinous fracture, which is obtained by the evaporation of 
the mother-liquor after the crystallization of the alkaloids out of it. This 
substance contains probably amorphous quinine and cinchonine, besides 
quinidine and cinchonidine. It is an excellent tonic and antiperiodic, and, 
on account of its cheapness, is largely used in some of the eleemosynary 
institutions of this city. It should be administered in about double the 
dose of quinine, and is most efficient in solution, but, on account of its taste, 
is often given in pills. Its solution should be made with acetic acid and 
water, aromatics being freely added, as it is apt to cause nausea. 
The U. S. Pharmacopoeia recognizes for use as a tonic an infusion of bark 
(Infusum Cinchonas-1 to 16.6), dose, a wineglassful; a tincture of the 
yellow bark (^Tinctura Cinchonas-1 to 5), dose, one to two teaspoonfuls; a 
compound tincture (Tinctura Cinchonas Composita-Huxham's Tincture), 
which, as a tonic, is the best preparation of the bark, and is a very elegant 
remedy in convalescence, in doses of one teaspoonful to a tablespoonful; and 
also a fluid extract and a solid extract (^Extractum Cinchonas Fluidum and 
Extractum Cinchonas), the doses of which are five to fifteen drops or grains 
respectively. 
AOIDUM PIORUM*-PICRIC ACID. 
Picric or Carbazotic Acid is not officinal, but has been used to some ex- 
tent in medicine. It occurs in pale, yellow, shining scales, but is employed by 
the therapeutist only in the form of a salt, on account of the deleterious 
influence of the pure acid on the gastric mucous membrane: the picrate 
of potassium, of sodium, or of ammonium may be used; but the last is the 
one generally chosen. 
Physiological Action.-The only detailed study of picric acid known 
to me is that of Dr. W. Erb (Die Pikrinsaure, Wurzburg, 1865). This 
observer found that the daily use of a grain (for ninety days) of a picrate pro- 
duced, in a rabbit, yellowness of the conjunctiva, of the inner surface of the ear, 
and of the urine, with an occasional slight diarrhoea and great loss of weight, 
* Picric Acid does not really belong in this chapter, but, as it has attracted most atten- 
tion as an antiperiodic, in the ignorance which exists as to its physiological action, I have 
introduced it. TONICS. 
87 
without any elevation of temperature. After a time the animal seemed to grow 
accustomed to the remedy, so as to regain in great measure its flesh. Three 
grains a day caused, in about two weeks, the death of the rabbit with symp- 
toms of inanition. All the tissues, except the nervous, were stained of an in- 
tense reddish-yellow color, as was also the urine. Eight grains produced falling 
temperature, weakness, diarrhoea, collapse, and death, sometimes preceded by 
tremblings and even convulsions, in about twenty-three hours. Most of the 
tissues were stained yellowish-red. The most remarkable physiological effect 
of the poison occurred in the blood. The blood of animals slowly killed by 
a picrate was of a dirty-brown color, with distinct nuclei both in the red 
blood-disks and floating free in the serum. M. Erb found that this alteration 
in the corpuscles occurred during life and was accompanied by a decided in- 
crease in the number of the white corpuscles. These alterations in the blood 
were apparently the cause of death, and seem to have been due, so far at 
least as concerned the red disks, to a direct action of the poison upon the blood; 
for Erb found that identical or very similar alterations occurred in these cor- 
puscles when the blood was mixed with the picrate of sodium outside of the 
body. 
Erb found picric acid to act on man as on the lower animals. Twenty-four 
hours after the ingestion of fifteen grains of it the yellow color was very plain 
in the conjunctiva, the skin, and the urine. The temperature was not ele- 
vated, and gastric disturbance was usually absent, but sometimes it was severe. 
As with animals, so in man, picric acid was found abundantly in the urine. 
A teaspoonful produced no more violent symptoms in a man than bad vom- 
iting and purging ( Wiener Med. Presse, xxiii. 1526). 
Prof. Binz ( Virchow's Archiv, Bd. xlvi. p. 130) has found that picric 
acid exerts upon the infusoria an influence similar to, but much feebler than, 
that of quinia. 
Therapeutics.-The carbazotate of ammonium has been strongly recom- 
mended by various authorities in malarial disorders; but in the experiments 
of Erb the result was so negative that the possession of any antiperiodic 
powers by the drug is doubtful.* As an anthelmintic, the picrate has also 
been commended; but Erb found it powerless in cases of teenia, and for the 
destruction of the round-worm and thread-worm there is an abundance of 
safer and even more efficient remedies. A matter of the gravest importance 
is the asserted efficiency of the remedy in trichiniasis. Erb has produced 
slow poisoning with a picrate in rabbits which had been fed upon affected 
meat, and, on examining their bodies after death, found the trichina every- 
where, even in the walls of the intestines, in very active life. On the whole, 
the testimony so far seems to indicate that picric acid has no value as a thera- 
peutic agent. Erb affirms that in robust adults from nine to fifteen grains 
* Consult Deutsches Klinik, 1855, No. 40; Medical Times and Gazette, Sept. 1862; New 
Remedies, 1873; Gazette des HGpitaux, xlv. p. 116; Ohio Medical Recorder, 1877. 88 
SYSTEMIC REMEDIES. 
a day may be given for a long time with safety; but I would fear the effects 
of more than half that quantity. 
AROMATICS. 
There are certain remedies usually spoken of in treatises on Materia Medica 
under the general head of tonics, which might more properly be considered 
local stimulants, acting, as employed in medicine, upon the alimentary canal. 
These are the so-called aromatics, substances dependent for their virtues upon 
the presence of a volatile oil. 
The volatile oils are essentially local irritants, causing when taken into the 
mouth intense burning pain; when confined upon the skin, rubefaction, blis- 
tering, and finally, if the contact be very prolonged, more destructive changes. 
Internally, taken in very large doses, they cause burning pain in the stomach, 
increased activity of the circulation, and a species of intoxication. In suffi- 
ciently large quantities they.are irritant narcotic poisons. When administered 
in therapeutic doses they act almost exclusively upon the alimentary canal. 
As compared with that of the simple bitters, their influence is more powerful 
and more transient. They do not permanently increase the digestive power, 
but simply increase action for the time being. They are employed chiefly 
-to give pungency to bitter tonics; as carminatives, to stimulate the intes- 
tines to contract upon and expel flatus ; to prevent the griping of purgatives ; 
to disguise the taste of medicines, and to render nauseating drugs acceptable 
to the stomach ; to act as condiments, and aid in the digestion of the food. 
Injected into the circulation, the volatile oils lower the blood-pressure by 
depressing the heart's action, and even in comparatively small doses may 
cause immediate diastolic arrest. In this respect oil of cloves is one of 
the most powerful. The heart-action is undoubtedly direct and upon the 
heart itself: other muscular structures would seem to be similarly affected, 
as H. Kobert has found that the oil of mace directly lowers muscular excita- 
bility (Arch. f. Exp. Path, und Therap., xv. 22). 
Some of the tonic drugs containing a volatile oil also have in them a bitter 
principle which modifies their action. Such drugs may be known as aromatic 
hitters; as bitters they are less powerful than such drugs as quassia, and are 
especially indicated where the stomach is delicate and easily nauseated. 
Inflammation of the stomach or bowels is the chief contra-indication to 
the use of aromatics. Unlike the simple bitters, they are often very useful 
in diarrhoea of nervous irritability or of relaxation, when no decided inflam- 
mation exists. 
There is one property which is probably common to all the aromatic oils, 
and which may therefore be alluded to at this place with propriety,-viz., the 
power of producing local anaesthesia. In China the oil of peppermint has 
long been used locally in neuralgia; and my own experience with our native 
oil is in accord with that of Dr. A. Wright (London Lancet, 1874, ii.; TONICS. 
89 
Bee, also, Gaz. Med., 1874) in finding it efficient in neuralgia and subacute 
rheumatism. A rag soaked with it should be laid upon the part, and when 
the burning is no longer endurable Cosmoline applied. The power of oil 
of cloves in benumbing sensitive dentine or exposed nerve-pulp is well known. 
Altogether, the subject offers an inviting field for investigation. 
AROMATIC BITTERS. 
ANTHEMIS. U. S-CHAMOMILE. 
Roman or true Chamomile is the dried flowers of Anthemis nobilis, a com- 
posite of Europe. They are sometimes single, sometimes double. The single 
are more aromatic than the double florets. Chamomile contains a bluish or 
sometimes greenish volatile oil, a bitter principle, and a small amount of 
tannin. Matricaria or German Chamomile is the flowers of Matricaria 
Chamomilla, which are decidedly smaller than those of the ordinary chamo- 
mile, and have a stronger, less agreeable odor and taste. Their volatile oil is 
very similar to that of chamomile. 
Therapeutics.-An excellent stimulant tonic; especially useful in con- 
valescence. The dose of the infusion (Infusum Anthemidis-§ss to Oj) 
is one to two wineglassfuls before meals. 
Serpentaria. U. S.- Virginia snake root is the root of Aristolochia 
serpentaria and of A. reticulata, small herbal plants of the United States. 
It occurs as fine brittle rootlets attached to a small head, of a camphoraceous 
odor and taste, and contains a volatile oil, a yellowish-green resin, and a 
bitter principle. It is an elegant stimulant tonic, especially useful as an 
adjuvant to more powerful bitters. In overdose it is said to cause vomiting, 
and even purging. The dose of the tincture (Tinctura Serpentariae-1 to 
10, U. S.) is one to two fluidrachms; of the fluid extract (Ext r actum Ser- 
pentariae Fluidum, U. S.), twenty drops. 
Cascarilla, U. S., is the bark of Croton Eleuteria, a shrub growing in 
the West Indies. This bark occurs in quills or rolled pieces, and is to be dis- 
tinguished by its outer grayish and inner deep-chocolate surface, by its spicy 
bitter taste, and the pleasant musk-like odor which it gives whilst burning. 
It contains tannin, volatile oil, and cascarillin, a neutral, bitter, crystallizable 
principle. Its therapeutic action is very similar to that of serpentaria. The 
dose of the infusion (Infusum Cascarillee-3i to Oj) is a wineglassful. 
TRUE AROMATICS. 
ClNNAMOMUM. U. S.- Cinnamon is the bark of Cinnamomum Zeylanicum, 
a native of Ceylon, and of C. aromaticum, growing in China. The finest 
variety of cinnamon, that from Ceylon, occurs in long, closely-packed quills of 90 
SYSTEMIC REMEDIES. 
a thin, very aromatic bark. Cassia bark, or Chinese cinnamon, is coarser, 
more broken, and less aromatic. Both varieties contain tannic acid and a yel- 
lowish volatile oil {Oleum Cinnamomi, U.S.), which on account of its great 
fragrance and very pleasant taste is largely used, in doses of from one to 
three drops, as an adjuvant, or to disguise the flavor of less agreeable drugs. 
Cinnamon water {Aqua Cinnamomi-fjss to Oij, U.S.) is used solely as a 
vehicle. The spirit of cinnamon {Spiritus Cinnamomi-oil 1 to 10, U. S.) 
is administered in doses of half a fluidrachm; the tincture {Tinctura Cinna- 
momi-1 to 10, U. S.) in doses of one to two fluidrachms. 
Ptdvis Aromaticus. U.S.-Aromatic Powder (cinnamon, ginger, carda- 
mom, nutmegs). An elegant carminative powder; dose, ten to twenty grains. 
Caryophyllus. U. S.- Cloves we the unexpanded flowers of Caryophyllus 
aromaticus, a tree growing in the Molucca Islands. This aromatic, largely 
used as a spice, contains an exceedingly pungent volatile oil, officinal as 
Oleum Caryophylli. This is a yellowish oil, becoming dark by age, which, 
besides being used as a carminative and aromatic, is frequently employed 
to benumb sensitive dentine, or even exposed pulp, in caries of the teeth. 
Dropped on a piece of cotton and placed in the cavity, it will very frequently 
cure toothache. Dose, one to two drops. The infusion, or clove tea {Infusum 
Caryophylli-5ii to Oj), is made with boiling water; the dose is a wine- 
glassful. 
Myristica. U. S.-Nutmeg is the kernel of the fruit of Myristica mos- 
chata, a tree inhabiting the Molucca Islands. The nutmeg contains both a 
fixed and a volatile oil. Mace {Macis, U. S. P.) is the arillus or outer imper- 
fect supernumerary coating of the seed. It contains a volatile oil identical 
with that of the nutmeg. The nutmeg is possessed of narcotic power, and 
it is said that one or two when taken will produce a dreamy, half-uncon- 
scious condition. I have found that injected into the jugular vein the vola- 
tile oil produces in the lower animals profound narcosis with abolition of all 
reflexes, and, finally, death from paralysis of the respiratory centres. The 
dose of the volatile oil {Oleum Myristicx, U. S.) is from two to five drops. 
Pimenta. U. S.-Pimento, or Allspice, is the unripe berries of the Eugenia 
Pimenta, a tree, native of the West Indies. It contains a green fixed oil and 
a volatile oil { Oleum Pimentse, U. S.), the dose of which is two to five drops. 
Cardamomum. U.S.- Cardamoms are the fruit of the Elettaria Carda- 
momum, which grows in the East Indies. They consist of tough, seemingly 
fibrous, generally more or less triangular capsules, containing a number of 
small, hard, very aromatic seeds. The capsule is itself dry and tasteless. In 
commerce cardamoms are divided into three varieties, according to their 
length. According to Trommsdorf, the seeds contain, besides 10.4 per cent, 
of fixed oil, 4.6 per cent, of a colorless, highly aromatic, volatile oil. Car- 
damom is a very grateful aromatic, much less stimulating and heating than 
most of the other substances of its class. The dose of the tincture {Tine- TONICS. 
91 
tura Cardamomi-1 to 6.6, U.S.) is half a fluidrachm. The compound 
tincture (Tinctura Cardamomi Composita, U. S.) is a very elegant addition 
to, or vehicle for, tonic medicines; dose, one to two fluidrachms. 
Zingiber. U.S.- Ginger is the dried rhizome or root-stock of the Zin- 
giber officinale, growing in the East and West Indies. Green Ginger is the 
fresh rhizome. The Black Ginger is the root-stock dried with the epidermis 
on; the White or Jamaica Ginger is the same, deprived of its epidermis. 
The fresher ginger is, the greater is its power, and by time and exposure it 
becomes completely inert. Its active principles are a soft, acrid, aromatic 
resin, and a yellow volatile oil. Ginger is much used in domestic medicine 
as a stimulant carminative in colic ; given in hot water, it is also used as a 
sudorific and stimulant in the pain due to suddenly-suppressed menstruation. 
It is often added with advantage to other remedies in dyspepsia. The syrup 
(Syrupus Zingiberis, U.S.) is used only as a cordial drink or vehicle, in 
doses of from half a fluidounce to a fluidounce. The tincture (Tinctura 
Zingiberis-1 to 5, U. S.) is the most commonly employed ; the dose is half 
a teaspoonful to a teaspoonful. The dose of the fluid extract (Extractum 
Zingiberis Fluiduni, U. S.) is ten drops. The oleoresin ( Oleoresina Zingi- 
beris, U. S.) is employed as a stimulant addition to tonic pills; the dose is 
from half a minim to two minims. 
Piper. U. S.-Black Pepper is the unripe berries of the Piper nigrum, a 
woody vine-like plant growing in the East Indies. White Pepper is the ripe 
berries, stripped of their skin and dried. It is much inferior to the ordinary 
variety. The active principles of black pepper are a soft acrid resin, a pun- 
gent, fiery, volatile oil, and piperin. 
In 1819 Oersted discovered Piperin (Piperina, U.S.), which crystallizes 
in colorless, glistening, four-sided, truncated prisms, of a neutral reaction, but 
capable of combining with acids to form salts. When pure it is tasteless; but 
very commonly it has a burning taste, due to the presence of some of the 
volatile oil of pepper. The possession of very active antiperiodic proper- 
ties * has been claimed for piperin, and it was for a time employed in inter- 
mittent fever; but it has fallen into complete disuse. The dose as an anti- 
periodic is four grains repeated once or twice during the interval between the 
paroxysms. According to the observations of Prof. H. Kronecker and of 
Herr Fliess, piperin in the frog paralyzes the peripheral ends of the sensory 
nerves (Archiv fur Physiologie, Leipzig, 1882, p. 111). In the rabbit its 
action upon the sensory nerves is much less marked; The respiratory and 
pulse rates are greatly accelerated, and death is finally caused by cardiac 
arrest (Ibid., 1884). Pepper is very largely used as a condiment; but, as its 
taste is more hot than aromatic, it is rarely used internally in medicine, ex- 
cept as an addition to simple bitters or to antiperiodics, generally in the form 
*For a discussion of the subject, see Die Pflanzenstoffe, p. 492. 92 
SYSTEMIC REMEDIES. 
of the officinal oleoresin (Oleoresina Piper is), the dose of which is a minim. 
In atonic dyspepsia the latter preparation is an excellent adjuvant to tonic 
pills. Dr. Schiffer is said (Fliess) to have used piperidin successfully in a 
case of vaginismus, by injecting 0.3 grain hypodermically near the vaginal 
entrance. 
Capsicum. U. S.-The U. S. Pharmacopoeia now recognizes only the 
small, less than an inch long, very fiery fruit of Capsicum fastigiatum, the 
African Pepper, or Chillies. The large, bright red, conical or ovate, com- 
paratively mild peppers of the market are from C. annuum; they are some- 
times known as West India peppers. Capsicum contains as its active prin- 
ciple an exceedingly acrid oleoresin. The name of Capsicin has been applied 
by different observers to the oil, to the resin, and to their combination, but 
should, I think, be dropped, as having no definite meaning. 
Capsicum is a very powerful local irritant, its oleoresin when applied to the 
skin producing in a very few minutes intense pain and redness, and finally 
destroying the cuticle. In the alimentary canal it acts in a similar manner: 
thus, moderate doses produce merely a pleasant feeling of warmth in the 
stomach, whilst overdoses may cause gastro-intestinal inflammation, with 
severe pain as well as vomiting and purging. The chief use of Cayenne 
Pepper is as a condiment; yet it is often added with advantage to tonic pills 
to increase their immediate action on the stomach. When there is habitual 
feeble digestion, with flatulence, its free use on food may do good. In ady- 
namic disease, especially as occurring among drunkards, capsicum is ofte* 
very useful by stimulating the stomach up to the point of digesting food. 
Locally, either as the diluted tincture in a gargle, or applied in powder or 
tincture by means of a swab, it is useful in severe tonsillitis, especially in 
that accompanying scarlet fever. 
Administration.-The dose of capsicum is four to five grains in pill 
form ; of the officinal Oleoresina Capsid, which is to be preferred on account 
of its lesser bulk, from half a grain to one grain. The infusion (fnfusum 
Capsici-§ss to Oj) is used as a gargle. The tincture (JTinctura Capsid 
-1 to 20, U. S.) is employed locally, and is sometimes administered in 
half-fluidrachm doses to drunkards. 
Oleum Cajuputi. U. S.-The Oil of Cajeput is obtained from the leaves 
of the Melaleuca Cajuputi, a tree growing in the Molucca Islands. This vola- 
tile oil is of a green color, peculiar fragrant odor, and burning, camphoraceous 
taste. It is not very irritating to the skin, and is exceedingly destructive to 
low forms of life, and consequently has been used as a parasiticide externally, 
and even internally against the Ascarides. I have never used it except as a 
carminative and aromatic stimulant in cases of intestinal pain and spasm, 
and in serous diarrhoea. When employed in these affections in combination 
with chloroform, camphor, and opium, it is very efficient. As a counter-irri- TONICS. 
93 
tant, it has been used in rheumatism; as a stimulant to the skin, in psoriasis, 
acne rosacea, and pityriasis. The dose internally is from ten to fifteen drops. 
Oleum Sassafras. U.S.-The Oil of Sassafras is enormously used in the 
arts on account of its cheapness and pleasant flavor. It is capable of pro- 
ducing very marked narcotic poisoning (case, Trans. Med. Chir. Faculty, 
Maryland, 1884, 288), and is said to act upon the lower animals as a con- 
vulsant and narcotic. 
Auranth Amari Cortex-Bitter Orange Peel, U. S.-The fluid 
extract (Extractum Aurantii Amari Fluidum, U. S.) and the tincture 
(Tinctura Aurantii Amari) maybe given respectively in doses of twenty 
minims and a fluidrachm. Aurantii Dulcis Cortex-Sweet Orange 
Peel, U. S.-Of the syrup (Syrupus Aurantii, U. S.) the dose is a dessert- 
spoonful, of the tincture (Tinctura Aurantii Dulcis, U. S.) a teaspoonful. 
The orange peels are themselves scarcely medicinal, but are officinal as af- 
fording preparations much used as vehicles. Limonis Cortex, U. S., or 
Lemon Peel (Spiritus Limonis, U. S.), is also used for flavoring purposes. 
Aurantii Flores.-The flowers of the orange are officinal for the 
preparation of the Orange Flower Water-Aqua Aurantii Florum, U. S.- 
which is used as an elegant vehicle, free from medicinal properties. 
The fruits of the following umbelliferous plants, Foeniculum vulgare, 
Carum Carui, Coriandrum sativum, Pimpinella Anisum, are officinal under 
the respective names of Foeniculum (Fennel), Carum (Caraway), Corian- 
drum (Coriander), Anisum (Anise). They all depend for their virtues upon 
volatile oils which are officinal. The Oil of Anise of commerce is chiefly 
the product of a Chinese tree, the Illicium Anisatum, or Star Anise, from 
whose five- to ten-rayed capsular fruit it is obtained by distillation. The 
Aqua Foeniculi and Spiritus Anisi are officinal. All of these fruits and their 
preparations may be used as carminatives and stomachics. 
The herbal portions of the following mints are officinal: Lavandula vera, 
Rosmarinus officinalis, Salvia officinalis, Mentha piperita, Mentha viridis, 
Melissa officinalis. They are respectively known as Lavender (Lavandula), 
Rosemary (Rosmarinus), Sage (Salvia), Peppermint (Mentha Piperita), 
Spearmint (Mentha Viridis), and Balm (Melissa). The most important 
preparations of them are as follows: Spiritus Lavandulse Compositus- 
Compound Spirit of Lavender, a very elegant and agreeable stomachic and 
cordial; dose, a fluidrachm to half a fluidounce. Aqua Menthse Piperitee- 
Peppermint Water, and Aqua Menthw, Viridis-Spearmint Water, both very 
frequently used as vehicles. Spiritus Menthee Viridis and Spiritus Menthee 
Piperitee-Essence of Spearmint and Essence of Peppermint, used as car- 
minatives, in doses of from ten to twenty drops. The oils of lavender* 
* MM. Masoin and Bruylant have studied to some extent the physiological action of 
the oils of lavender, rosemary (see, also, Schmidt's Jahrbiicher, clxxx. 123), marjoram, 94 
SYSTEMIC REMEDIES. 
rosemary, peppermint, and spearmint are also officinal, and may be used in 
doses of from three to ten drops as carminatives. Sage contains tannin. 
The volatile Oil of Gaultheria (Oleum Gaultherise, U.S.) is used for 
flavoring purposes. Calamus, the rhizome of the Acorus Calamus, also 
contains a volatile oil, and its infusion is sometimes used as a carminative. 
EUCALYPTUS GLOBULUS. U.S. 
The Eucalyptus globulus* is a large tree, native of Australia. The leaves, 
which are alone officinal, contain, besides tannic acid, a volatile oil, which, 
when pure, is nearly colorless, of a warm mint-like taste, with a bitter after- 
taste, and a very peculiar mint-like odor. It is freely soluble in ether, alcohol, 
and the fatty oils, and is obtained by distillation or by acting on the leaves 
and aspic (Lavendula Spica L.) (Bull. Acad. Roy. M^d. Bruxelles, 1879, 558). In frogs 
they cause generally paralysis with loss of reflex activity, the muscles being intact, and 
the sensory nervous apparatus affected before the motor. Upon the higher animals a 
similar effect was produced, except that oil of rosemary caused epileptiform convulsions. 
Oil of Peppermint (M. Piperita) has been studied by S. D. Markuson (Inaug. Diss., 
Halle, 1877; Schmidt's Jahrb., Bd. clxxx. 122), who finds that whilst very small doses 
increase, larger ones decrease the blood-pressure and lower the bodily temperature. 
Menthol, or Oil of Peppermint (Camphor), has lately obtained great notoriety as a local 
anaesthetic, and, if freely rubbed upon a part, it undoubtedly will often relieve neuralgic 
pains when they are superficial and peripheral in their origin. Its physiological action 
has been studied by Paolo Pellacani (Arch. f. Exp. Path, und Pharm., xvii. 376). In 
the frog it causes paralysis, first of the spinal centres and finally of the nerve-trunks. 
In the mammals both mobility and sensibility are depressed, the animal grows cold, the 
respiration becomes slow and shallow. Small dos s excite, larger paralyze the frog's 
heart. In the poisoned mammal there were very curious, unexplained, rhythms of rise 
and fall of the blood-pressure. 
* Attention was first called by LabillardiSre to the value of the Eucalyptus globulus in 
1792, but it was not until 1860 that M. Ramel commenced the culture of the tree in Paris 
and induced the Prefect of the Seine to order its cultivation on a large scale. Since that 
time it has been largely introduced into Europe, Algeria, South Africa, and California, 
and in some of these countries planted forests are now growing and spreading. The tree 
is remarkable for combining extreme hardness of wood with a rapidity of growth as- 
serted to be about five times that of our ordinary trees; it is even affirmed that shingles 
made of it are fire-proof. Its capability for absorbing and evaporating water is also 
extraordinary, and to it has been attributed the freedom of Australia from malarial cli- 
matic influences. Indeed, it is stated that a tree will evaporate ten times its weight of 
water in twenty-four hours, and numerous examples are given in which swamps in Europe 
and Algeria have been rapidly converted by it into dry ground. It is believed to destroy 
malaria not only by draining the soil, but also by yielding balsamic exudations to the air. 
however this may be, there is at present very strong evidence as to its power of rendering 
nfected districts healthy. As, however, the consideration of this belongs to the subject 
of hygiene rather than of therapeutics, the reader is referred for detailed information to 
the following memoirs: Regulus Carlotti, L' Eucalyptus, son Rang parmi les Agents de la 
Mature Medicale, Ajaccio, 1872 ; M. Gimbert, L'Eucalyptus Globulus, son Importance en 
Agriculture, en Hygiene et en Medecine, Paris, 1870; Waterer, Bulletin de la Soci&ti 
d'Acclimatation, 1872; London Medical Record, Dec. 1873; London Lancet, ii., 1877. 
Under the name of Eucalypsinthe, a liquor distilled from its leaves has appeared in 
European commerce. TONICS. 
95 
with ether. It does not undergo oxidation into a resinous mass on exposure 
to the air, and is remarkable for its power of resisting the influence of con- 
centrated sulphuric acid. It has been affirmed that the leaves of Eucalyptus 
contain also an alkaloid ; but Rabuteau (Bulletin, Therap., Ixxxiii. 549) has 
fairly demonstrated that this is an error. All the virtues of the remedy 
probably reside in the volatile oil, which is in greatest abundance in the 
leaves. According to the researches of Stanislas Martin (Bulletin Thirap., 
Ixxxiii. 453), the oil is entirely absent from the bark of plants grown in 
Southern France and Corsica, but exists in that from Australia and Algeria. 
Physiological Action.-Locally, the oil of Eucalyptus acts as a de- 
cided but not very intense irritant, and the first effect of large doses is 
burning in the mouth and fauces, with increased secretion of saliva, followed 
very soon by a feeling of warmth in the stomach. 
The general effect of the same dose of the oil appears to vary considerably 
in different individuals; but the following summary comprises the facts as 
nearly as may be. After the ingestion of from ten to twenty drops, a period 
of mental and physical activity is often apparent, followed by a feeling of calm 
and serenity. By somewhat larger doses, or in susceptible persons by the 
doses mentioned, increased disturbance of the digestive organs, ending often 
in loose stools having the odor of the oil, with augmentation in the frequency 
and force of the pulse, is produced, Gubler adds to these symptoms increase 
of temperature ; but in Gimbert's experience febrile manifestations, although 
occasionally occurring, were not usually present. In some cases the medicine 
acts very disagreeably, producing violent cardiac palpitations or intense head- 
ache : how far these are directly dependent upon the drug, or are sympa- 
thetic upon its local action on the stomach, is uncertain. If the dose be 
repeated, or if a larger amount be taken at once, a period of sedation mani- 
fests itself; the pulse loses its force, and the animal temperature is abated. 
After doses of seventy-five grains, Binz noted numbness of the limbs, with a 
feeling of excessive weight in them. If the use of the remedy be persisted 
in, a state of asthenia is induced ; the temperature falls as much as a degree 
and a half, and the pulse even to fifty (Gimbert, Archives Generales, 1873, 
xxi. 141); the respiration becomes less frequent; the muscular weakness is 
extreme, so that raising the arm to the mouth is painful; the sensations are 
blunted, but the intellect is absolutely unaffected. In an old man who took 
eighty drops, the power of motion almost disappeared, and he affirmed that 
he lost for the time being all sense of the presence of his limbs, so that he 
was unconscious of possessing them when he shut his eyes, although bis 
intellect was perfectly clear throughout. 
Upon the lower mammalia the oil of Eucalyptus appears to act precisely 
as it does on man. According to the experiments of Gimbert, the hypoder- 
mic injection of the oil is immediately followed by a period of excitement, 
seemingly in great measure due to the intense local irritation; after about 
half an hour, if the dose has been sufficiently large, the animal begins to 96 
SYSTEMIC REMEDIED. 
stumble and totter in walking, the breathing grows more and more slow and 
irregular, the limbs give way, the ears droop, the muscular weakness becomes 
profound, and death, preceded often by partial convulsions, occurs through 
failure of respiration. In Gimbert's experiments the heart always continued 
to beat after breathing had ceased. As the motor nerves and the muscles 
retained their functional power after death, the failure of motility and reflex 
activity must have been central, and Gimbert concludes that the drug in toxic 
doses is therefore a paralyzant to the spinal cord and the medulla. This con- 
clusion was also attained experimentally by Binz (British Medical Journal, 
i., 1874). Various observers accord in stating that, after toxic doses, there 
is, in animals, a decided fall of temperature. It would appear from the 
experiments of Hermann Schlager that, after hypodermic injections, the 
temperature sometimes rises, probably as the result of the local irritation 
(Die Physiol. Wirk. Eucal. glob., Inaug. Diss., Gottingen, 1874). The same 
observer noted that the arterial pressure was greatly lessened. As this fall 
occurred after paralysis of the parvagum, by section or by atropia, and also 
after vaso-motor paralysis by section of the cord, it must be due to a direct 
action upon the heart. This was confirmed by the direct influence of the drug 
upon the cut out heart of the frog. The oil is probably eliminated by the 
lungs, skin, and kidneys. In the experiments of Prof. Binz, the day after 
the ingestion of seventy-five drops, the breath smelt of the drug, and the 
perspiration of amylic alcohol. The urine began to have the odor of the 
oil an hour and a half after its ingestion, and continued to have it for thirty- 
six hours. Dr. Gimbert states that the odor imparted to the urine resembles 
that of violets, and is very similar to that caused by turpentine. 
Binz states that upon the lower infusoria the oil acts even more power- 
fully than does quinia, and its antiseptic properties are without doubt very 
great (Gimbert, Archives Generales, xxi. 137). Mosier (Deutsches Archiv 
fur Klin. Med., 1872, x. 160) affirms that in dogs whose spleens were ex- 
posed, injections of tincture of the leaves of the Eucalyptus produced a 
decided contraction of the viscus. According to Gimbert, the excretion of 
urea is enormously increased by the use of the drug. 
Therapeutics.-The chief use that has been made of Eucalyptus is as 
an antiperiodic. So far as I know, Dr. Joseph Keller ( Wiener Medizinische 
Wochenschrift, xxii., 1872) has employed it upon a larger scale than any one 
else. He used it in four hundred and thirty-two cases, of which two hun- 
dred and ninety-three had suffered from previous attacks. Of the tertians 
75.57 per cent., of the quartans 70 per cent., and of the quotidians 67.89 per 
cent, yielded to the remedy. He recommends it as especially valuable in obsti- 
nate cases in which quinine has been taken again and again. Lorinser ( Wiener 
Medizin. Wochenschrift, xix., xx.), Haller ( Wiener Medizin. Wochenblatt, 
xxvi.), Bohn (Berlin. Klin. Wochenschrift, 1872), Carlotti (loc. cit.f Cortan 
(Montpellier Medical, May, 1872), Gimbert (loc. cit.'), Gubler (loc. cit.f 
Tristany, of Spain (Buchner's Repertorium, xix., 1870), and others, bear TONICS. 
97 
more or less urgent testimony to the value of Eucalyptus in malarial dis- 
eases; whilst Brudell {Bulletin Th^rapeutique, May, 1875), Seitz {Bayer, 
drztl. Intell. Blatt. 1870), and Papillon {Gazette Ilebdomadaire, 1872) 
affirm it to be of comparatively little or no value. The weight of testimony 
is vastly in favor of the possession of decided antiperiodic powers by Euca- 
lyptus ; but it is exceedingly improbable that it will ever supersede the 
cinchona alkaloids: where these have failed, or for any reason cannot be 
taken, it may be used with good hope of success. 
Gimbert, Gubler, and Carlotti all claim excellent results from the use ot 
Eucalyptus in bronchitis, both acute and chronic: in the first variety it is 
not to be given until the acuteness of the symptoms has been relieved and 
free expectoration established, which, as a rule, is about the end of the 
second week. The remedy is also asserted to be of value in asthma, and 
even in catarrhal phthisis. As the oil is eliminated by the kidneys, it 
comes into contact with the urino-genital mucous tract, and has been em- 
ployed in affections of the same; it seems to be less active than copaiba, 
and the results obtained in gonorrhoea by Aron {Schmidt's Jahrbucher, 
Bd. clvii., p. 239) were not very good. The remedy appears to be safer 
than copaiba in the early stages of the disorder. The drug has also been 
employed in hemorrhages, in intestinal catarrh, in nasal catarrh, and similar 
disorders; it seems to act somewhat similarly to turpentine in these cases, 
but to be less stimulating. It appears well established that Eucalyptus pos- 
sesses decided antiseptic powers: dry dressings of gauze, lint, etc., impreg- 
nated with the oil may be used; or, as in Australia, the bruised leaves may 
be applied to the wound. (For resume of evidence and method, consult 
Australasian Med. Gazette, iii. p. 72; see, also, Berl. Klin. Wochens., xix. 
524.) 
Administration.-The oil {Oleum Eucalypti, U.S.) offers the most 
eligible preparation of Eucalyptus: in bronchitis from four to ten drops of 
it may be given in emulsion or capsules at intervals of two or three hours, 
as an antiperiodic, from half a drachm to a drachm may be exhibited two or 
three hours before the expected paroxysm. The saturated tincture made 
from Australian or Algerian leaves is efficient; dose, a drachm to half an 
ounce. The dose of the fluid extract {Extractum Eucalypti Fluidum, 
U. S.) is one to two fluidrachms. 
MINERAL TONICS 
FERRUM-IRON. 
Since iron constitutes a necessary integrant portion of the red blood-cor- 
puscles, it is a food rather than a medicine. A very large proportion of the 
various articles of ordinary diet contain a trace of it; and as, according to Que- 
venne, it is very rarely to be found in normal urine, it must accumulate in the 
system. When, however, the supply, from any cause, is insufficient, or the 98 
SYSTEMIC REMEDIES. 
power of digesting and assimilating it is impaired, or an abnormal excretion 
of it occurs, or by direct discharge it is drawn off from the blood, as in hemor- 
rhage, a less than normal amount of it exists in the body. When this is the 
case, the condition ordinarily known as anaemia existing, the circulating fluid 
contains comparatively few red disks. It is this state which constitutes the 
great indication for iron. Under its use, if the cause of the anaemia be pre- 
vented from operating continuously, the color returns to the cheeks, because 
there is an absolute increase of the haemato-globulin in the blood. Thus, 
Prof. Simon {Animal Chemistry, London, 1845, Syd. Soc, ed.) reports a 
case of chlorosis in which, under the steady use of iron for sixty-four days, 
the globulin increased from 30.86 parts to 90.80 parts per thousand, and 
the haematin from 1.431 parts to 4.598 parts per thousand; and Cutler and 
Bradford {Amer. Journ. Med. Sci., 1878, p. 78) have obtained confirmatory 
results with Malassez's tubes. This increase is certainly due in part simply 
to the supply of the peculiar food of the red corpuscles; but it seems prob- 
able that the iron acts not merely as a food, but also as a veritable stimulant 
to the organs which produce these bodies. Since, however, we have no 
definite knowledge as to the early history of the red disks, it is evident 
that any theory as to the method in which iron increases their number must 
be a mere conjecture. It has been generally believed that iron, given to the 
healthy subject, would induce a condition of excess of the red blood-cor- 
puscles. Recent exact investigations, whilst somewhat in discord, offer evi- 
dence calculated to unsettle our belief. The experiments of Nasse {Lond. 
Med. Record, 1877, p. 498) upon dogs are in favor of the older view, whilst 
those of E. C. Cutler and E. H. Bradford are in opposition to it.* The first 
observer giving iron with fat, noted not only an increase of bodily weight, 
but that the specific gravity of the blood rose from 1052 to 1060.8, and the 
amount of the metal in the blood from 0.477 to 0.755 per thousand parts, 
both the result of increase in the corpuscular element. Cutler and Brad- 
ford experimented upon man, using the tubes of M. Malassez, the result 
being slight diminution of the red blood-disks. As, however, the experi- 
ments were only two in number, and the subjects not under complete control 
as to conditions of life, their observations can hardly be considered conclusive. 
It appears to be a well-established fact that one of the functions of the red 
blood-corpuscles is to convert oxygen into ozone, which is the efficient form 
of the element in the system (see paper by A. Sasse, Vierteljaliressclirift fur 
Prakt. Heilkunde, 1866, zweiter Band). The oxide of iron outside of the 
body certainly possesses an ozonizing power similar to that of the red disk. 
* Drs. V. II. Meyers and F. Williams (Arch. Exper. Path. u. Pharm., xiii. 76) have 
studied the effects of enormous doses of the tartrate of iron and sodium upon the lower 
animals. Both frogs and mammals are killed by it: the symptoms in warm-blooded ani- 
mals being vomiting, purging, great fall of the blood-pressure, muscular weakness, finally 
coma and death. The experiments show that the heart is not much affected, but the vaso- 
motor system and the spinal-motor centres are paralyzed. TONICS. 
99 
Thus, a spot of iron mould, i.e., iron oxide, on linen will in time destroy the 
fabric. The reason of this is the corroding action of the ozone which is 
slowly generated by the oxide of iron. From a similar cause a fleck of rust on 
a bright surface of steel will steadily enlarge and deepen. It would seem a 
priori probable that in the blood iron acts as it does out of the body. If this 
be so, by increasing oxidation an increase of the iron in the blood should 
cause elevation of temperature and increased elimination of urea. The studies 
of W. Pokrowsky ( Virchow's Archiv, Bd. xxii.) have shown that, in cases of 
anaemia, after the exhibition of iron the temperature does rise, even when 
in the beginning it was not below normal, and that simultaneously there is 
an increase in the daily elimination of urea; and the experiments of Botkin, 
as quoted by Sasse (I have not seen the original), establish the same fact in 
regard to healthy men. The increased oxidation cannot be due simply to an 
increase in the number of the red corpuscles, for whilst the latter accrues 
slowly, Pokrowsky found that the temperature sometimes rose within five 
hours after the exhibition of the first dose. It would seem, therefore, that 
iron acts directly on the blood as an ozonizing agent. 
Iron in very minute quantity (Quevenne, Memoire sur V Action physiolo- 
gique et therapeutique des Ferrugineux, Arch, de Physiol., de Therapeutique 
et d' Hygiene, Oct. 1854, p. 93) is at times present in normal urine, and the 
exhibition of it as a medicine increases the percentage. According to the re- 
searches of Quevenne (p. 95), the elimination of the ordinary medicinal salts 
of iron is always very slight; but the experiments of Becquerel (Simon's 
Chemistry, vol. ii. p. 264) are not in accord with this. The amount of iron in 
the urine was found by him to vary, in those taking ferruginous preparations, 
very greatly and unaccountably from day to day, but the elimination com- 
menced as soon as the administration. According to Quevenne, the haloid 
salts escape in the urine much more freely than do the other preparations. 
Almost all of the preparations of iron are more or less astringent, and when 
in the blcod very probably exert a direct influence upon the tissues, contract- 
ing them not merely by increasing their tone, but also by acting on their 
vital contractility. 
The preparations of iron may be divided into those which are soluble and 
those which are insoluble in water. At first sight it would appear that the 
former class of preparations would be those most readily absorbed. The 
experiments of Quevenne (loc. cit.^ have, however, demonstrated that these 
soluble preparations are largely precipitated by the gastric juice even when 
it is strongly acid. This precipitate is probably an albuminate, mixed, when 
the gastric juice is alkaline, with the oxide of the metal. It has been further 
demonstrated by Quevenne that these precipitates do not yield so large a per- 
centage of material to the acid gastric juice as do some of the insoluble salts 
According to Mialhe (Chimie appliquee, Paris, 1856), after the entrance of 
an iron salt into the blood its power of acting as a ferruginous tonic depends 
upon its capability of being decomposed by the alkalies of the blood in such 100 
S YS TEMIC REMED IES. 
a way as to give origin to albuminates. From these considerations it would 
appear that the question of solubility in water is of very little importance in 
the choice of a chalybeate. Quevenne has demonstrated that the reduced iron 
yields the largest percentage, and, as it is nearly free from astringency, it is 
probably the best chalybeate. If a soluble preparation be desired, the ammo- 
nic or potassic tartrates are very unirritating. If Mitscherlich be correct in 
his deductions, the protosalts are more readily absorbed than the sesquisalts, 
and consequently should be preferred as a general rule.* 
There are some persons in whom iron produces headache; this can only 
sometimes be obviated by the use of laxatives. The observations of M. Petit, 
Dr. N. A. Bubnow, etc. (Zeitsch. f. Physiolog. Chem., vii.), that the iron 
preparations in large doses inhibit the digestive processes, throw some light 
upon these cases. 
When iron is exhibited in the usual doses, but a small proportion is absorbed, 
the remainder escaping with the faeces, to which it imparts a black color. This 
black color is due to a conversion of the iron into tannates and sulphurets; 
the tannic acid of the first compound being derived from the food, the sulphur 
of the second from the intestinal gases. 
Therapeutics.-The chief indication for the use of iron is the existence of 
anaemia; the contra-indication, a state of plethora: on these points sufficient 
has already been said, and the peculiar actions of certain salts will be consid- 
ered under their respective preparations. The preparations of iron which are 
recognized by the U. S. Pharmacopoeia are unnecessarily numerous. 
Ferrum Reductum-Reduced Iron. U.S.-This preparation is also 
known by the names of Ferri Pulvis, Iron hy Hydrogen, and Quevenne s Iron, 
and is as a chalybeate the best of all the various medicinal forms of iron. It 
is made from the subcarbonate (sesquioxide) by exposing it at a white heat 
to the action of hydrogen, which takes away the oxygen and leaves the pure 
metallic iron. It occurs as a light, iron-gray, tasteless powder, which should 
be completely dissolved by dilute sulphuric acid without yielding the odor 
of sulphuretted hydrogen, and when touched with a lighted taper should 
ignite and burn to the brown oxide of iron. If it be black, or if it fail to 
answer the tests given above, it is impure, and indeed, as offered in the shops, 
not rarely it is entirely spurious. Of all the efficient preparations of iron it 
is the freest from astringency. The dose is from two to five grains, taken in 
pill form after meals. As it is entirely tasteless, it is frequently given to chil- 
dren in chocolate-drops or lozenges, which are taken as confectionery. 
Ferri Oxidum Hydratum-Hydrated Oxide of Iron. U. S.- 
The Hydrated Sesquioxide of Iron, made by precipitating the tersulphate 
* I have left this as in earlier editions, although it seems to me that the subject of the 
absorption of iron urgently needs re-investigation; see also Berlin. Klin. Wochensch., 
1877, p. 420. TONICS. 
101 
with ammoniayjs a reddish-brown powder, which is used solely as an anti- 
dote to arsenic. For this purpose it should be freshly prepared, and should 
be so moist as to constitute a magma. Its virtues are deteriorated by age, 
even when it is kept under water, and are entirely destroyed by drying. If 
the solution of the tersulphate of iron be not at hand in an emergency, the 
perchloride will yield just as useful a product, and carbonate of sodium may 
be substituted, if circumstances necessitate it, for the ammonia. The pre- 
cipitate falls at once, and may be washed by putting it in a piece of muslin, 
squeezing out the original fluid, and then pouring on some fresh water. As 
the sesquioxide of iron is perfectly innocuous, it should be very freely admin 
istered when used as an antidote, especially since it only acts when in excess. 
A teaspoonful to a tablespoonful of it should be stirred up in water and taken 
at once, the dose being repeated several times if necessary. The Ferri 
Oxidum Hydratum cum Magnesia, U.S., differs from the hydrated oxide 
in containing magnesia, which is substituted in excess for the ammonia as a 
precipitant. As magnesia is not at all irritant, and is itself antidotal to 
arsenic, this new preparation offers decided advantages over the older anti- 
dote. It should be given promptly and freely. 
Ferri Carbonas Saccharatus. U.S.-Sacciiarated Carbonate 
OF Iron.-This greenish-gray powder is made by precipitating a syrupy 
solution of the sulphate of iron by bicarbonate of sodium. Throughout the 
subsequent washings, and during drying, sugar is kept constantly present in 
large amount, so as to prevent the absorption of oxygen, and the consequent 
conversion of the protocarbonate into the sesquioxide. This is a very gpod 
chalybeate, nearly free from astringency, and may be given in doses of from 
three to five grains, in pill form. Pilulee Ferri Composite, U.S., contain 
the protocarbonate of iron and myrrh. They are sometimes used in anmmia 
with amenorrhoea; one to three pills three times a day. The Mistura Ferri 
Composita, U. S., is a liquid preparation containing substantially the same 
ingredients as the compound pills. Dose, one to two tablespoonfuls. 
Ferri Sulphas-Sulphate of Iron. U.S. (FeO,SOs 4- 7HO - 
FeSO4 + 7H2O.). The pure protosulphate of iron is made by dissolving iron 
in dilute sulphuric acid. It occurs in transparent efflorescent rhombic prisms 
of a pale bluish-green color and a metallic styptic taste. The sulphate of iron 
is a very decided astringent, and in a concentrated form and sufficient amount 
acts as an irritant poison, producing vomiting, purging, and gastro-intestinal 
inflammation.* Externally its solution (five to twenty-five grains to the fluid- 
ounce) is used as an astringent lotion. It has been especially recommended 
in this form (gi to Oj) in erysipelas. As a simple chalybeate the sulphate 
* In a case reported in New York Med. Journ., xxxviii. 401, the early symptoms, as 
stated by the patient, were chiefly nervous; little confidence can, however, be reposed in 
the patient's report of symptoms or of the amount ingested. 102 
SYSTEMIC REMEDIES. 
of iron should never be used. In chronic diarrhoea it is sometimes employed 
as a tonic astringent. Dose, five grains; in the form of the dried sulphate 
(Ferri Sulphas Exsiccatus, U. S.), three grains. Ferri Sulphas Precipi- 
tatus, U. S., is simply a pure ferrous sulphate obtained by precipitation, and 
may be used instead of the older preparation. 
Liquor Ferri Subsulphatis-Monsel's Solution. U. S.-The solu- 
tion of the suhsulphate [of the sesquioxide] of iron (often incorrectly called 
solution of the persulphate of iron) is a most powerful astringent and styptic, 
and is used solely as such. It is but slightly irritant, and is the best of all 
the astringents for staunching hemorrhage when it can be applied directly 
to the part, as in external wounds, or in hematemesis. In hemorrhage from 
the stomach, ten drops of it may be given in a tablespoonful of water, the 
dose being repeated as necessary. Applied by means of the atomizer, it 
is often very efficient in hemoptysis. In such a case the fluid to be atomized 
should have the strength of from five to twenty drops to the ounce. The 
inhalation should last from five to fifteen minutes, and be repeated at intervals 
of an hour or longer. It is very essential that the liquid should be finely 
pulverized. In diphtheria, Monsel's solution is very valuable applied freely, of 
full strength or diluted pro re nata, to the throat every three to twelve hours. 
The Solution of the Tersulphate (Liquor Ferri Tersulphatis, U.S.), 
owing to its irritant action, is used only to make the sesquioxide preparations. 
Tinctura Ferri Chloridi-Tincture of Chloride of Iron, U.S., 
contains the sesquichloride of iron, muriatic acid, and alcohol, and, from 
the*reactions of the last two ingredients, muriatic ether. It is prepared 
by adding alcohol to the officinal Inquor Ferri Chloridi, and is a reddish- 
yellow, astringent, irritating, somewhat corrosive liquid. It is an excellent 
chalybeate, possessed of peculiar properties, probably in some measure due to 
the ether which it contains. It is a diuretic, increasing often very decidedly 
the daily urinary secretion. It appears also to exert an astringent influence 
upon the urino-genital mucous membrane, and is frequently employed with 
tincture of cantharides in gleet. In chronic Bright's disease it is often of 
very great service as a chalybeate diuretic. In erysipelas it is constantly em- 
ployed with remarkable results, controlling the disease in a manner not yet 
understood. Analogy has suggested its employment in other adynamic affec- 
tions, such as diphtheria and pyemia, but its value in these diseases is much 
more doubtful. Locally it is used as an astringent in sore throat; for this 
purpose its strength should be reduced at least one-half. As it is very de- 
structive to the teeth, care ought to be exercised in its use about the mouth, 
and also in its administration. The dose is from fifteen to thirty drops, given 
as a chalybeate three times a day; in erysipelas, every two or three hours. 
The orange-yellow crystalline deliquescent Sesquichloride of Iron (Ferri 
Chloridum) (Fe2Clt- Fe2Clg) is officinal, but is very rarely used. TONICS. 
103 
Syrupus Ferri Iodidi. U.S.-The Syrup of Iodide of Iron contains 
7.33 per cent, of the dry protiodide of iron in the fluidrachm, and is made by 
shaking iron, iodine, and water together, and adding hot syrup. It is a trans- 
parent, greenish liquid, of a sweet, ferruginous taste. It deposits no sediment on 
keeping, and should not affect the color of starch. If it strikes a blue color with 
the latter substance, it contains free iodine. The syrup of iodide of iron is 
a favorite remedy in those cases of anaemia in which there is a distinct scrofu- 
lous taint. It is believed to possess the peculiar alterative powers of iodine, 
conjoined with the tonic properties of iron. It is enormously used in scrofu- 
losis occurring in anaemic children; but it certainly possesses no advantages 
over a ferruginous tonic and iodine when given separately but simultaneously 
Indeed, it seems to me uncertain whether its use is as effective as the sepa- 
rate administration of iodine and iron. The dose of it for a child two years 
old is five to ten drops; for an adult, thirty to forty minims. As it affects 
the teeth very seriously, it should always be freely diluted when taken, and 
the mouth should be well washed after its administration. 
Ferri Iodidum Saccharatum. U. S.-Saccharated Iodide of Iron is 
a yellowish-white or grayish powder which represents the chemical and 
medical properties of the corresponding syrup, being prepared by a parallel 
process. It may be substituted for the syrup in doses of from two to five 
grains given in pill form. 
Dialyzed Iron.-Ferrum Dialysatum.-This is a clear, neutral, nearly 
tasteless, dark-red liquid, prepared by dialyzing a solution of the chloride of 
iron. Its exact chemical composition is uncertain. It contains a minute 
proportion of chloride, and it is possible that the iron exists as a basic 
oxychloride. It bears dilution with pure water, but is at once precipitated 
by alkalies, almost all soluble salts, and many organic substances. As the 
iron oxide in this condition is unable to pass through animal membranes, it 
has been asserted that it cannot be absorbed. Clinical experience shows, 
however, that it is absorbed, and it, a priori, seems certain that the dialyzed 
iron must undergo change the moment it enters the stomach. In what form 
absorption takes place we do not know. The tastelessness, harmlessness to 
the teeth, comparative freedom from astringency, have rendered it a favorite 
chalybeate, notwithstanding its feebleness; the assertion frequently made 
that it never constipates is an error. It should never be used in combina- 
tion. The dose is twenty to forty drops. Dialyzed iron seems to be the 
best antidote at command for arsenic. It is harmless, and in cases of poison- 
ing a tablespoonful should be administered at once, and repeated pro re nata 
(see Philad. Med. Times, vol. viii. pp. 104, 151, 335). 
There are four officinal Citrates of Iron, all soluble in water.* Two of these 
* Dr. Glaevecke has {Arch. Exper. Path. u. Pharm., xvii. 466) experimented upon 
rabbits by the hypodermic injection of citrate of iron. He finds that the iron appears in 104 
SYSTEMIC REMEDIES. 
(Ferri Citras and Ferri et Ammonii Citras) occur in garnety-red scales, 
and arc simply mild chalybeates. Dose, five grains. The Citrate of Iron and 
Quinia (Ferri et Quinine Citras) is in transparent scales, varying from 
reddish brown to yellowish brown in color, with a tint of green. The Citrate 
of Iron and Strychnia (Ferri et Stryciininte Citras) contains one per 
cent, of strychnia. 
There are two officinal Tartrates of Iron (Ferri et Ammonii Tartras 
and Ferri et Potassii Tartras), both occurring in garnety scales, and 
soluble in water. Dose, five grains. The Lactate of Iron (Ferri Lactas, 
U.S.) occurs in greenish-white crystalline crusts or grains, soluble in forty- 
eight parts of water. It is a good chalybeate. Dose, five grains. There 
are two officinal Phosphates of Iron, which may be used in five-grain doses. 
F erri Phosphas is a bright slate-colored insoluble powder. Ferri Pyro- 
phospiias is an excellent preparation, occurring in apple-green scales, some- 
what soluble in water, and nearly free from astringency and ferruginous taste. 
The Ammonio-ferric Alum (Ferri et Ammonii Sulphas, U. S.) occurs in 
octahedral crystals, of a pale violet color. It is freely soluble in water, is 
very astringent, and is only used hi atonic leucorrhoea, in which affection 
marked benefit is often gained by the exhibition of it in five-grain doses three 
times a day. The Bromide of Iron (not officinal) has recently been highly 
recommended by Dr. Da Costa in chorea and incontinence of urine in children 
(Medical and Surgical Reporter, 1874). He gives, to a child, five grains, 
dissolved in syrup, and rapidly increases the dose to twenty grains. In a few 
trials, I have found it useless in chorea. 
Manganese.-The Black Oxide of Manganese (Mangani Oxidum 
Nigrum, U.S.), and the Sulphate (Mangani Sulphas, U. S.), have been 
supposed by some to possess therapeutic properties similar to those of iron. 
The metal manganesium certainly exists in the blood, but its salts have 
failed to gain the confidence of the profession, although highly recom- 
mended by Harmon, of Belgium, and by Petrequin (Nouvelles Recherche# du 
Manganese, 2d ed., Paris, 1852, also Bulletin Therapevtique, March, 1852) as 
an adjuvant to the chalybeates. In Dr. Garrod's experiments upon anaemia 
(Medical Times and Gazette, 18G3) the preparations of manganese failed to be 
of service. C. C. Gmelin is said (U. S. Dispensatory') to have found the sulphate 
act as a powerful cholagogue on the lower animals; and Dr. Thomson states 
that it is a purgative to man in doses of one or two drachms. Dr. Leand 
affirms (Glasgow Medical Journal, Jan. 1865) that the oxide of manganese 
is therapeutically equivalent to the preparations of bismuth excepting in 
the urine in half an hour; that the maximum proportion is reached in two to four hours, 
and that after twenty-five hours elimination ceases. In man he states that these injections 
are well borne, and the therapeutic effects satisfactory; the dose of the citrate used for 
an adult was about 1.5 grains. TONICS. 
105 
that it does not constipate, and that it may be used with advantage in gas- 
tralgia, pyrosis, and similar stomachic derangements. 
ACIDUM SULPHURIOUM-SULPHURIC ACID. U.S. 
Oil of Vitriol (SO3,HO - H2SO4) is when pure a colorless, heavy liquid 
(sp.gr. 1.843). On exposure to the air it rapidly absorbs moisture and 
becomes less dense. When its specific gravity is 1.78, it deposits crystals of 
the bihydrated acid at 28° F., and may burst the glass in which it is kept. 
Owing to its great affinity for w'ater, it is used in chemistry as a desiccant. 
Physiological Action.-Concentrated sulphuric acid is powerfully cor- 
rosive of both animal and vegetable tissues, abstracting the elements of water 
and leaving the carbon untouched. It consequently blackens organic matter 
at the same time that it destroys its texture.* When administered in thera- 
peutic doses and absorbed into the blood, it is converted into sulphates, and 
as such, so far as is known, is eliminated. 
It escapes by the kidneys, as has been proven by Dr. II. Bence Jones 
(Lectures on Pathology and Therapeutics, London, 18G7) in regard to large 
therapeutic doses, and is attested by Maukopff as occurring after poisoning. 
As, however, the amount of elimination by the kidneys seems to be slight, 
it is very probable, as Dr. Headland (Action of Medicines, London, 1852) 
conjectures, that it is excreted both by the lower bowel and by the skin. 
Locally applied, dilute sulphuric acid is an astringent, and clinical experience 
proves that it exerts a similar action when taken into the system. Under 
such circumstances its astringent influence is most marked upon the skin and 
intestine,-parts which are believed to excrete it: it is therefore possible 
that this action is in a measure local, and dependent upon the presence of 
the excreted acid.f 
Therapeutics.-Concentrated sulphuric acid is not rarely used as an 
escharotic, for which purpose it is mixed with finely-powdered charcoal so as 
to form a paste. Appropriately diluted, it has been used as a stimulant and 
astringent lotion in venereal and other indolent xdcers. Internally, sulphuric 
acid is very useful as an astringent in colliquative sweats (night-sweats') and 
in profuse serous diarrhoeas. I have used it with great advantage in the 
sudden serous vomiting and purging of infants known as cholera infantum. 
It has been employed with advantage in cholera, and a remarkable series 
of observations by Dr. R. G. Curtin (Philadelphia Medical Times, vol. iii. 
p. G49) at least furnish good reason for further testing its powers as a pro- 
* The observation of Ore (Comptea-Rendwt, 1875), that considerable quantities of dilute 
acids can be injected into the blood without causing coagulation or serious disturbance, 
has been confirmed by Dr. Paul Guttman (Virchow'a Archie, Bd. Ixix. p. 534). The 
acid is probably at once neutralized by the alkali of the blood. 
fThe action of large but not corrosive doses of mineral acids upon animals has been 
to some extent studied by Dr. F. Hofmeister (Prager. Med. Wochensch., 1879, iv. 75). 
Death, he believes, results from asphyxia, due to the acidification in the blood of the alka* 
line salts, which serve as vehicles in carrying the carbonic acid from the tissues. 106 
SYSTEMIC REMEDIES. 
phylactic against this disease. The facts recorded by Dr. Curtin are as 
follows. A very severe epidemic of the disease ceased in the Insane Depart- 
ment of the Philadelphia Almshouse within twelve hours after the lunatics 
were all put upon the free use of sulphuric acid lemonade ; the only new case 
after this being in a man who refused to use the prophylactic. Two days 
after the use of the sulphuric acid was stopped, two new cases occurred, and the 
epidemic was again arrested by the use of the acid. In the surgical wards 
of the Hospital Department the acid was used from the beginning of the 
epidemic; and these wards, although in no way isolated, were the only parts 
of the institution unvisited by the disease. 
Sulphuric acid was formerly used in hemorrhages, but is now rarely em- 
ployed. It is, I think, much less efficacious than some other remedies. In 
acute lead-poisoning the dilute acid is an efficient antidote, and it hag been 
proposed by M. Gendrin (Dr. Bennett, London Lancet, 185G) as a remedy 
in chronic lead-poisoning. As, however, he combined its internal exhibition 
with the daily use of warm sulphur-baths, it is doubtful how much of the 
successful result was due to its action. It is difficult to perceive how it can 
do good in these cases, and I do not think the clinical proof that it does so 
has as yet been brought forward. 
Toxicology.-When swallowed in concentrated form, sulphuric acid acts 
as a corrosive poison. Death from collapse has resulted in two hours and 
a half (case in Medical Times and Gazette, vol. i., 1863), but usually the 
course of sulphuric acid poisoning is much more protracted, the fatal result 
having been delayed in some cases for several months. The usual symptoms 
are pain in the mouth, throat, and epigastrium, violent vomiting, often of 
tarry matters, with symptoms of collapse, such as cold extremities, feeble 
pulse, suppressed voice, and clammy skin. The mind is generally clear to the 
last. Profuse, and sometimes bloody, salivation is commonly present. The 
parotids sometimes swell as early as the fourth day, and Maukopff (Syd. Soc. 
Year-Book, 1863) has seen suppurative parotitis apparently induced by closure 
of the duct of Stcno, retention of secretion, and consequent irritation of the 
gland. The later symptoms are those of ulceration of the oesophagus and 
stomach, and need not be dwelt upon here. The larynx is often profoundly 
affected. There is a very marked increase in the amount of sulphates in the 
urine, which may be albuminous and contain granular casts. Desquamative 
nephritis may be developed several days after the subsidence of the first 
symptoms. Thus, in one of the cases reported by Maukopff, urine which 
had ceased to be albuminous on the third day became so again on the twen- 
tieth, with a simultaneous development of casts containing blood-corpuscles; 
after death tubular nephritis was found. Another symptom noted by Mau- 
kopff was intercostal neuralgia. 
After death, greater or less destruction of the oesophagus and stomach, 
or of the air-passages, is found. The black color of the slough is a diagnostic TONICS. 
107 
sign which an examination of the mouth will sometimes render available 
before death. 
The most important part of the treatment of sulphuric acid poisoning 
consists in the immediate and free exhibition of the antidotes, which should 
be given in milk or in water. The best antidotes are chalk, magnesia, white- 
wash, and soap. Christison condemns the use of the alkaline carbonates, 
because they are themselves irritating. As, however, in these cases time is 
a matter of vital importance, if the alkaline carbonates be the only antidotes 
at hand they should be used unhesitatingly. 
Administration.-Sulphuric acid should of course be given properly 
diluted, and with the requisite precautions to prevent its injuring the teeth. 
It is best administered in the form either of the ddute (Acidum Sulphuri- 
cum Dilutum-1 to 9, U. S.; sp. gr. 1.082 ; dose, ten to thirty drops) or of 
the aromatic sulphuric acid (Aciduni Sulphuricum Aromaticum-1 to 5, 
U. S.). The last preparation contains alcohol and aromatics. Its dose is 
from ten to twenty drops. 
AOIDUM HYDROOHLORICUM-HYDROCHLORIC ACID. U.S. 
Muriatic Acid is a colorless aqueous solution of hydrochloric acid gas, 
having the specific gravity of 1.160, and containing rather more than 33.9 per 
cent, of the gas. The muriatic acid of commerce commonly has a yellowish 
tint, produced by sesquichloride of iron, or sometimes by organic matter. 
Physiological Action.-In its concentrated form muriatic acid is highly 
corrosive, but less so than either sulphuric or nitric acid. Its astringent 
properties are not all decided, if indeed it really possess any. As it prob- 
ably is one of the natural acids of the stomach, it would seem as though it 
ought to be capable of aiding digestion. It also appears to have influence 
over the glandular system of the alimentary canal, increasing by its action 
their normal secretions. 
Therapeutics.-In stomachic dyspepsia, muriatic acid, with or without 
pepsin, is often useful by aiding in the digestion of the food. In other eases, 
where the dyspepsia is intestinal, with a tendency to diarrhoea and loss of 
appetite, muriatic acid combined with strychnia and some aromatic, such as 
compound tincture of cardamom, is often very advantageous. In low fevers 
the use of mineral acids has been highly extolled by various authorities. I 
have seen a number of cases treated upon this so-called " Swedish plan," and 
have never been able to perceive that the acids do any real good. 
Locally, diluted muriatic acid has been recommended by Bretonneau in 
diphtheria. He employed a mixture of one part of the acid to two of honey ; 
but bolder practitioners have used it of full strength, with, it is claimed, good 
effect. It should be applied by means of a little mop, scrupulous care being 
exercised to prevent any of the acid from coming in contact with parts not 
protected by false membrane. 108 
SYSTEMIC REMEDIES. 
Toxicology.-Muriatic acid, as a poison, is similar in its effects to, but 
less powerful than, sulphuric acid, recovery having occurred after the ingestion 
of an ounce of the officinal acid (^Boston Medical and Surgical Journal, vol. 
xv.). The treatment is similar to that of poisoning from other mineral acids. 
Administration.-The acid is best given in the form of the officinal 
Acidum Hydrochloricum Dilutum (§iv to Oj ; sp. gr. 1.038). Dose, ten 
to thirty drops, properly diluted. 
ACIDUM NITRICUM-NITRIC ACID. U.S. 
A liquid of the specific gravity of 1.420, which as first made is colorless, 
but by exposure to the light acquires a yellow tint. It oxidizes all of the 
common metals except gold, and is exceedingly corrosive to living tissue, 
which it stains an indelible yellow. When diluted it converts most animal 
and vegetable substances into oxalic, malic, or carbonic acid. 
Physiological Action.-When applied to any portion of the living 
organism, nitric acid acts as a most powerful chemical caustic. When very 
greatly diluted, it is a simple local stimulant, with very slight astringent 
powers. Owing to its chemical activity, its vapor was at one time used as a 
disinfectant; but it has been superseded by other substances. Taken inter- 
nally in small amount, it acts as a stimulant upon the glandular system of 
the alimentary canal, and in serous diarrhoea appears to exert an astringent 
influence. It seems to me very probable that these effects are local rather 
than constitutional, due to a direct action of the acid upon the mucous mem- 
brane of the bowel. On entering the blood, nitric acid must be converted 
into a nitrate. In regard to its elimination we have but little definite infor- 
mation, but it probably escapes through the same channels as does sulphuric 
acid. 
Therapeutics.-Nitric acid is used quite frequently as an escharotic, 
especially in cases of chancres and venereal or other warts. In its employ- 
ment care should be taken to protect the sound tissue by oil, or, still better, 
by a layer of soap. It may be applied by means of a splinter of wood, or, 
if it is to be used more freely, by a little mop. When it has penetrated as 
deeply as is desirable, washing the part with warm soapsuds will prevent 
further action. Very much diluted (five to twenty drops to the ounce), it 
forms a good stimulant lotion for indolent ulcers. It should not be employed 
as a mouth-wash, on account of its destructive action on the teeth. Of course 
this does not apply to its use as a caustic in cancrum oris, in 'which, as in other 
forms of acute gangrene, such as phagedenic chancres and hospital gangrene, 
it is very efficient. In these cases it must be applied thoroughly. 
Internally, nitric acid has been used in low fevers, but with doubtful 
advantage. In dyspepsia, in chronic hepatic congestion, in the oxalic acid 
diathesis, in the dyscrasia of constitutional syphilis, nitric acid has been 
employed with advantage, but is much inferior to the nitro-muriatic acid. 
In 1826 Dr. Hope claimed for the Acidum Nitrosum a specific action in TONICS. 
109 
serous diarrhoea, including the sudden acute diarrhoeas of hot climates, and in 
the chronic dysenteries originating under similar circumstances. The formula 
he employed is as follows : B Acidi nitrosi, f 5i; Misturae camphorae, f^viii; 
Misce, et adde Tinct. opii, gtt. xl. S.-A fourth part to be taken every 
three or four hours. Under the name of Hope's Camphor Mixture a prepa- 
ration similar to this has been much used, but has gradually lost the confidence 
of the profession, chiefly, I believe, because on theoretical grounds the original 
formula has been departed from. The Nitrous Acid of the shops (Acidum 
Nitrosum, Edinburgh Pharmacopoeia) is an orange-red liquid, which may be 
looked upon as a solution of nitric oxide in nitric acid. When it is diluted 
with water it is after a short time converted into simple nitric acid. For this 
reason it has been customary to substitute nitric acid for the Acidum Nitro- 
sum of Hope's original formula. It should be noted, however, that the latter 
only provided sufficient of the remedy to last a few hours, and, as the reaction 
which has been spoken of requires some time for its performance, I do not 
think that theory in truth warrants the change. Practically I have failed 
absolutely with the new formula, when immediate relief was afterwards ob- 
tained by the use of the medicine prepared according to the old plan. Made 
in this way and used whilst fresh, Hope's Camphor Mixture is a very efficient 
though disagreeable remedy in diarrhoeas connected with disordered secretion 
of the liver and other glands of the alimentary canal. 
Administration.-The dose of the strong acid is from five to twenty 
drops; of the diluted (Acidum Nitricum Dilutum-1 to 6, U. S.; sp. gr. 
1.068) from fifteen to sixty drops. 
Toxicology.-When taken in a concentrated form, nitric acid is a cor 
rosive poison, exceeding even sulphuric acid in violence. The symptoms so 
closely resemble those induced by the latter substance that it is unnecessary 
to detail them here, as is also true of the treatment. The distinguishing 
character is to be found in the color of the affected tissues, which in nitric 
acid poisoning are stained of a deep yellow. 
AOIDUM NITEO-HYDEOCHLOEIOUM-NITE0-HYDE00HL0BI0 
ACID. U.S. 
This preparation is made by mixing three parts of nitric with five parts of 
muriatic acid. If the acid be sufficiently strong, an orange-colored liquid is 
formed, with the evolution of intensely-irritating vapors. After standing for 
a length of time, the red color changes to a golden yellow. It is in this state 
that the United States Pharmacopoeia directs the acid to be used. By longer 
standing the golden yellow becomes Zemon-yellow, and the odor of chlorine is 
almost entirely lost. These changes are hastened by light, but will occur in 
the dark and in well-stoppered bottles. Although the golden-yellow acid is 
directed by the Pharmacopoeia, yet careful clinical studies have convinced me 
that the acid acts much more efficiently when freshly prepared and of a deep- 110 
SYSTEMIC REMEDIES. 
red color. In some cases it has seemed to me useful only when in the latter 
form. The lemon-yellow acid is nearly valueless. 
Physiological Action.-In concentrated form nitro-muriatic acid is 
exceedingly corrosive. Our knowledge of its action in small doses is purely 
clinical, and will be spoken of under the head of Therapeutics. The chemistry 
of the acid is so complex and uncertain that no reasonable conjecture can be 
made as to the form in which it is absorbed or the method of its escape from 
the body. That it is absorbed in some form is proven by its occasionally 
producing salivation, even when applied to the skin by means of baths. 
Therapeutics.-The remedial value of nitro-muriatic acid depends chiefly 
upon the power which it possesses, to a much greater degree than any other 
of the mineral acids, of influencing the action of the liver and other glandular 
organs of the alimentary canal. Originally proposed by Dr. N. Scott, of 
Bombay, in the chronic hepatitis of hot climates, it has been used with great 
success by Annesley, Martin,-and other famous India surgeons. The remedy 
would seem not to be indicated in hepatitis with high fever and a tendency 
to rapid suppuration so much as in the slower form of the affection, which 
normally ends in chronic enlargement and induration of the viscus. In the 
habitual congestion of the liver occasionally seen in this climate I have used 
it w'ith the most marked benefit. In the still milder affection known as 
" biliousness," whose pathology is probably a torpid condition of the small 
glands of the alimentary mucous membrane as well as of the liver, nitro- 
muriatic acid has yielded in my hands most excellent results. That the 
remedy does act upon the liver is proven by the fact that in these cases it 
sometimes produces violent bilious diarrhoea. When jaundice depends upon 
obstruction or upon any of the severer organic diseases of the liver, the acid 
is of little if any use ; when, however, the jaundice depends upon torpor of 
the liver, or even wdien it is catarrhal in origin, the remedy may be of great 
service. Even in the early stages of cirrhosis, whilst the liver is still enlarged, 
nitro-muriatic acid should be tried, as in some cases apparently of this char- 
acter great benefit has been derived from its use. 
In those forms of chronic diarrhoea in which the disease is really an intes- 
tinal dyspepsia, nitro-muriatic acid may be of the utmost service, benefiting 
and even curing cases which have resisted all other treatment. As the effect 
of the acid is not a sudden one, it is evident that it acts in these cases not as 
an astringent, but by restoring the normal digestive power. 
There is a morbid condition, probably dependent upon defective primary 
assimilation, in which the chief symptoms are general malaise, a feeling of 
weakness, a lack of elasticity, a very great depression of spirits, in which 
crystals of oxalate of lime are generally to be found in the urine, and in which 
nitro-muriatic acid produces in a few days a surprising revolution. 
As a " blood-purifier" the acid has been employed in constitutional syphilis, 
and in various ulcerative skin-affections. In these diseases it no doubt does TONICS. 
111 
good by improving digestion and increasing glandular action, but there is no 
reason to believe that it is a direct alterative. 
Administration.-For reasons which have already been given, when 
nitro-muriatic acid is administered internally it should be freshly prepared ; 
and, as the changes which have been spoken of take place more rapidly when 
the acid is mixed with water, the officinal dilute nitro-muriatic acid is an in- 
eligible preparation. As light hastens its deterioration, the strong acid should 
always be kept in a dark bottle with a glass stopper. Directly after mixing 
the acids the evolution of gas may be so great as to necessitate its being 
allowed to escape. After six or eight hours, however, the bottle should be 
closely stoppered. The dose of the strong acid is from five to eight drops, 
properly diluted, and taken through a tube after meals. 
In chronic hepatic diseases the external application of the acid seems to 
give even better results than its internal use. In India, according to Sir 
Ranald Martin, the bath is used as follows : 1. Take Hydrochloric acid f§iii, 
Nitric acid fgii, Water fgv. Mix. Two gallons of water and six fluid- 
ounces of the above mixture suffice for a bath, which will keep fit for use 
during three days, provided half a fluidounce of acid and a pint of water are 
added morning and evening. The bath must of course be given in wooden 
or earthenware vessels, and if it becomes necessary to warm it only a portion 
should be heated, and the rest then added. In urgent cases the whole body 
may be immersed in the bath ; but generally a foot-bath is preferable, the in- 
side of the thighs and arms and the hepatic region being at the same time 
sponged. The bath should be repeated twice daily, lasting each time for ten 
or fifteen minutes. 
I have had no experience in this method of using nitro-muriatic acid, but 
have derived great benefit from the application of the acid over the hepatic 
region. My plan has been to wring out a large piece (eight by ten inches) 
of spongio-piline, or of canton-flannel (several layers), in a lotion of a strength 
varying, according to the irritability of the patient's skin, from one to three 
fluidrachms to the pint, and to apply this over the right hypochondrium, 
covering it with a piece of oiled silk supported by a bandage. The applica- 
tion sometimes causes a prickling sensation, and after a time may produce a 
profuse local sweating. The dressing may be left on from half an hour to an 
hour, and be repeated three or four times a day; some patients can wear it 
almost continuously. 
Toxicology.-When taken in poisonous doses, nitro-muriatic acid pro- 
duces symptoms and results similar to those following the ingestion of nitrio 
acid. The color of the stain produced by it is yellow, and its antidotes are 
the same as those of other mineral acids. 
Lactic Acid (Acidum Lacticum, U. S.) appears to be the natural acid 
of the gastric juice, and may with propriety be used as an adjuvant to pepsin 
in doses of half a drachm three times a day. W. Preyer, conceiving that sleep 112 
SYSTEMIC REMEDIES. 
is due to the presence in the blood of the results of tissue change, amongst 
which is lactic acid, experimented with it and its soda salt, and announced 
that they acted as powerful soporifics upon both man and the lower animals 
(Centrail). Med. UVssens., 1875,p. 578). According to his statements, with the 
sleep came deep, slow respiration, with lessening of reflex activity and of the 
bodily temperature. Subsequent papers by Dr. E. Mendel (Deutsch. Med. 
Woollens., 1876, No. 17), Dr. Erler (Central!). Med. Wzsse/is., 1876, p. 658), 
Dr. Fischer (Lond. Med. Record, 1877, p. 193), Dr. Lothar ( Virchow's 
Archiv, Bd. Ixvi. p. 120), and Dr. Senator (Berlin. Klin. Wochens., 1877, 
p. 537), have shown that the hypnotic powers of lactic acid and its salts are 
very feeble and uncertain. The large doses used also are very prone to pro- 
duce irritation of the alimentary canal, and Senator noticed the production 
of rheumatic pains. From three to nine drachms of the lactate of sodium 
mav be given at a dose. 
Phosphorus is a translucent, when pure nearly colorless, but usually slightly 
yellowish, highly inflammable elementary body, which is tasteless, but possessed 
of a peculiar alliaceous odor. It is obtained from the phosphate of calcium of 
calcined bones, by taking away the lime with sulphuric acid and deoxidizing 
the residuum by heating with charcoal. It is insoluble in water, sparingly sol- 
uble in ether, absolute alcohol, and the oils, freely so in chloroform. It takes 
fire at 100° F., and melts at 108° F. In the shops it is in cylindrical sticks, 
covered with a whitish layer, and having when cut a waxy consistence and 
lustre. When properly treated, it is converted into several allotropic forms, 
the red phosphorus, black phosphorus, and the crystallized metallic phos- 
phorus of Hittorf. The first of these is the most important; it is brittle, 
does not take fire at ordinary temperatures, and is said not to be poisonous. 
Physiological Action.-The physiological action of phosphorus in 
therapeutic doses is probably entirely different from that which it exerts when 
in larger amounts. It is a constituent of most of the more important tissues, 
and is especially abundant in the nerve-centres. Like iron, cod-liver oil, etc., 
it appears to act when given in minute quantity as a stimulant to the nutri- 
tion of the tissues, into whose composition it enters. So far as the nervous 
system is concerned, this assertion rests chiefly upon clinical observation ; but 
Dr. Wegner ( Virchow's Archiv, June 22, 1872) has experimentally demon- 
strated such an action upon the bony tissues. He found that when adult 
animals were fed upon minute doses of phosphorus the spongy tissue in the 
long and short bones was thickened, and the compact tissue rendered more 
dense. After a time new tissue was deposited upon the inside of the shafts 
of the long bones, in some instances until the marrow-cavity was obliterated. 
The action upon the bones of growing animals was even more marked. 
Phosphorus was at one time believed to be a diffusible stimulant, and it 
PHOSPHORUS. (P.) U.S. TONICS. 
113 
possibly may exert such an influence. In the acute nervous exhaustion of 
typhoid pneumonia I have seen it apparently act very favorably in this way. 
For reasons to be hereafter adduced, it is certain that in poisonous doses 
phosphorus acts as phosphorus, and when it is administered therapeutically 
it certainly enters the blood in its elemental form, and, I believe, acts as such. 
Dr. Wegner advances the following reasons for believing that it does not act 
as phosphoric acid so far as the bony tissues arc concerned. First, no similar 
action can be obtained from phosphoric acid unless from eight hundred to one 
thousand times the proportional dose be given. Second, the newly-formed 
tissue is at first gelatinous. Third, there is no excess of phosphates in the 
bone. Fourth, when the food is deprived of lime the same new tissue arises, 
but remains in a soft, gelatinous state. 
Therapeutics.-The chief use of phosphorus in medicine is as a nutri- 
ent tonic to the nervous system. In all cases of chronic nervous exhaustion, 
whether involving the cerebral or spinal centres, it is of great value. I have 
seen marked benefit from its use when the symptoms were not severe enough 
to indicate organic lesion ; but the most remarkable results have been in the 
cases in which the structure of the centres was apparently deeply implicated. 
In threatening cerebral softening, in myelitic paraplegia from excessive 
venery, it is the only drug which appears really to affect the nerve-centres. 
In neuralgia attention has recently been drawn by several writers to its 
virtues; and, as neuralgia is often simply an expression of exhausted nerve- 
power, the use of phosphorus is commended by reason as "well as by experience. 
It is probable that it may be of value in some cases of impaired vitality, 
although the nervous system be not obviously implicated. Dr. II. Eames 
(Dublin Journal of Medical Sciences, Jan. 1872) states that he has obtained 
great benefit from its use in obstinate skin-affections, such as lupus, acne, and 
psoriasis. Attention has been recently called abroad to its use in cataract J 
On account of its marked influence on the development of bone, Dr 
Wegner suggested its use in osteomalacia and in rickets, and Dr. Friese states 
(Berlin. Klin. Woch., 1877, p. 437) that he has had brilliant success from its 
use in combination with iron in several cases in which ordinary treatment 
had failed. The recent elaborate article of M. Kassowitz (Zeitschrift. Klin. 
Med., 1884, 115) confirms this specific action of phosphorus, and I think 
it should be persistently administered to all rachitic children. Prof. Sam- 
uel R. Percy has used phosphorus successfully for repeated furuncular erup- 
tions (Prize Essay, Trans. Amer. Med. Assoc., 1872, p. 659). 
Toxicology.-The ingestion of a fatal dose of phosphorus is not followed 
by any sensible effects for some time. After, however, from three to twelve 
hours a sense of weakness and of general wretchedness manifests itself, and 
in a large proportion of the cases (according to Lewin eighty-eight per cent.) 
* Dr. Tavignot, Revue de Therapeutique Medico-Chirurgicale, August and September, 
1871; Prof. Gioppi, Qiomale d'Oftalmologia, abstract in N. Y. Medical Record, 1872. 114 
SYSTEMIC REMEDIES. 
is accompanied, or soon followed, by vomiting. With the emesis there is 
nausea, and in most cases the patient soon complains of abdominal pain, the 
severity of which, however, never equals that of corrosive poisoning. The 
matters vomited consist of food, mucus, and bile. During the first eight or 
ten hours they often smell strongly of phosphorus, and are luminous in the 
dark. The vomiting may persist during the whole attack, but generally 
ceases on the second or third day, to reappear with the subsequent jaundice, 
when coffee-colored vomit from exuded blood is ejected. The pain, which in 
most cases abates with the vomiting, often spreads from the epigastrium over 
the whole abdomen, and in rare instances is paroxysmal. If it reappear in 
the latter stages, it is apt to affect especially the right hypochondrium, and 
is associated with decided tenderness in the region named and in the epigas- 
trium. 
The tongue is whitish or abnormally red, sometimes furred. There is 
generally fever, loss of appetite, and thirst. Maukopff has noted a morning 
and evening temperature of from 37° C. to 39° C., and from 37.4° C. to 39.8° 
C. respectively. During the latter part of the case there is very often a re- 
markable fall in the temperature, which is generally, but not always, a pre- 
cursor of death. The lowest point I have seen noted was 31.2° C. (88.2° F.) 
some hours before death.* In some cases fever is altogether absent or comes 
on just before death.f 
The stools are at times normal in character and frequency, but there is 
generally diarrhoea or constipation, with flatulence. Late in the attack the 
passages are in most cases very light clay-colored, or even whitish, and ex- 
ceptionally they are bloody. In some cases they are phosphorescent. 
Jaundice comes on in from thirty-six hours (cases reported by Maukopff, 
11 tener Medizin. Wochenschrift, 1863, and by Tungel, Klinische Mittheilungen 
von der Medicin. Abtheilung des AUgemein. Krankenhauses in Hamburg, 
1861) to five days (Lebert and Wyss, Archives Generates, 6th series, xii., Sep- 
tember, 1868) after the ingestion of the poison. In most cases it appears first 
in the conjunctiva, but sometimes the urine gives previous warning of its 
approach. In some cases there is with it a decided and palpable incre:ise in 
the size of the liver, which may pass, if the patient live long enough, into 
an equally apparent lessening of the bulk of the viscus. The severe nervous 
symptoms are.rarely if ever developed until after the jaundice, although early 
in the attack there is not unfrequently anxiety, headache, giddiness, and 
dreamy unquiet sleep, or even sleeplessness. The more pronounced nervous 
symptoms consist of delirium, which may be wild and is very frequently 
erotic, with somnolence ending in coma and death, occasionally preceded by 
convulsions. According to Taylor, the latter are a certain sign of approach- 
ing dissolution. Very generally, partial spasms and fibrillar contractions of 
* See case of 'Dr. Battmann, Archiv der Heilkunde, 1871, p. 257. 
1 See case of Concato, Sydenham Soc. Year-Book, 1869-70, p. 454. TONICS. 
115 
the voluntary muscles occur, although there is always, in not too rapid cases, 
progressive paresis of the voluntary muscles. Death is usually put off be- 
yond twenty-four hours, yet it has occurred in a child in four hours, and in 
the adult in seven hours after the ingestion of the poison ( Wiener Med. 
Wochensch., May, 1884, 608). The patient may suddenly succumb to col- 
lapse and cardiac paralysis, but more commonly he dies comatose from a 
gradual failure of the respiration and circulation. 
If recovery occur, it is by a gradual amelioration of the symptoms, and 
the health of the patient is apt to be impaired for some time. Apparently 
desperate cases will sometimes convalesce unexpectedly, and Tungel states 
that a favorable issue may take place even after violent delirium. 
The urine is almost always much affected by the poison. Very commonly 
it is scanty, is albuminous, and sometimes it contains sugar. As was first 
pointed out by Munk and Leyden (Die acute Phosphorvergiftung, BerMn, 
1865), after jaundice has set in, bile-acids, as well as biliary coloring-matter, 
are always to be found in the urine. Not unfrequently a cloudy sediment 
consisting in part of epithelial cells, often tinged with bile, is deposited. 
Dr. Oswald Kohts (Pjlugers Archiv, Bd. iii. p. 1) and other observers have 
found leucin and tyrosin in the urine of dogs poisoned with phosphorus, and 
undoubtedly these substances are sometimes to be met with in the human 
excretion. The albuminuria generally follows, but may precede, the icterus. 
A very remarkable and apparently constant constituent of the urine is the 
sarco-lactic acid. Fat has been found in the urine inside of renal epithelial 
cells, and also as free globules (Schutz, Prag. Med. Wochenschrift, 1882, 
vii. 322). 
Phosphorus induces in animals symptoms parallel with those commonly seen 
m man ; although Kohts states that he has seldom seen albuminuria in ani- 
mals, even when the structure of the kidneys was profoundly altered. Orfila, 
Magendie, Munk, and Leyden found that the only effects following the injec- 
tion of phosphuretted oil into the jugular vein of an animal were the exhala- 
fion of phosphoric acid and broncho-pulmonary inflammation: on examination 
(Munk and Leyden), oil, but no phosphorus, was found in the lungs. Ludimar 
Hermann and Alfred Brunner (Deutsch. Archiv fur Klin. Med., p. 198) have 
shown that in these experiments there was embolic arrest of the oil in the 
pulmonary capillaries, and consequent inflammation with subsequent oxidation 
of the phosphorus. When the phosphuretted oil is injected in the form of 
a fine emulsion, the characteristic symptoms and post-mortem appearances of 
phosphorus-poisoning result. 
In some instances phosphorus-poisoning presents symptoms quite different 
from the typical array. Death may take place in a few hours, and in such 
cases jaundice is not generally present (case, London Lancet, 1879, ii. 311). 
Zeidler reports a death in forty-two hours, from suppression of urine, with 
collapse and erotic delirium. In a case of Bollinger's (Deutsches Archiv fur 
Klin. Medicin, Bd. vi., 1870) the chief symptoms were vomiting, pain and 116 
SYSTEMIC REMEDIES. 
tenderness over the abdomen, great weakness of pulse, gradually-developed 
paralysis of the legs, and death, without jaundice, in four and a half days. 
The autopsy revealed hemorrhagic effusion between the membranes and the 
spinal cord, and also into the sheaths of the proximal portions of the spinal 
nerves. 
In women, fatal doses of phosphorus very commonly produce a bloody 
pseudo-menstrual discharge, and when pregnancy exists almost invariably 
induce abortion or miscarriage. M. Miura has found in the foetus of 
poisoned rabbits structural changes similar to those of the mother ( Virch. 
Arch., xcvi. 54). 
The older toxicologists spoke of an erosive gastritis as a common result of 
phosphorus-poisoning, but it is now well established that such affection is 
very rarely induced by the drug.* As was first pointed out by Virchow 
(Virchow's Archiv, Bd. xxxi., 1864) there is universally a gastro-adenitis, 
which causes the gastric mucous membrane to be thickened, opaque, whitish, 
grayish, or yellowish-white. Under the microscope the epithelial cells appear 
swollen and filled with granules and oil-globules, and in very advanced 
degeneration the cells completely break down. This gastro-adenitis is not 
due to a local action of the phosphorus, because it occurs when the poison 
is introduced through other channels than the mouth. The duodenum and 
intestines suffer similar changes. The liver is generally very much enlarged, 
friable, and light-colored; sometimes it is mottled, and sometimes portions 
of it are deeply stained with bile.'f' The cells are gorged with fat-globules,J 
and in some cases there are small-celled interstitial thickenings due to hyper- 
plasia of the trabecular tissue. The gall-bladder may be full or empty. In 
protracted cases the liver undergoes atrophy, with destruction of its secreting 
cells. The kidneys, especially in their cortical portion, suffer a degeneration 
* It would appear probable that if it occurred at all it would be in rapidly fatal cases; 
yet Tiingel did not find it in a patient dead in nine hours of phosphorus-poisoning.- 
Virchow's Archiv, Bd. xxx., 1864. 
f According to researches made by Dr. Emile Rousseau in the Pathological Laboratory 
of the University of Pennsylvania, the first anatomical changes in the liver occur in the 
centre of the lobules around the hepatic vein. 
J A. Lebedeff {Arch. f. Physiolog., xxxi. 11, 1883) believes that the fat in the liver is 
not produced by degeneration of the hepatic tissue, but has simply been transported there 
from the subdermal regions. He bases this opinion upon his own observations,-first, that 
the phosphorus fat has the same chemical constitution as has the subdermal fat; second, 
in a dog which had been fed with linseed oil and then poisoned with phosphorus, the liver 
was loaded with linseed oil. This evidence is of very little value, because on the one hand 
the linseed oil probably accumulated in the dog's liver before the poisoning and simply 
remained over, and on the other hand there is no proof that fat produced by degenerative 
changes necessarily differs in composition from other fat. The fact that the liver and 
other organs are destroyed in phosphorus-poisoning may be considered proof that the fat 
is formed out of the affected tissue. TONICS. 
117 
similar to that of the liver, the epithelium becoming enlarged, granular, fatty, 
and finally undergoing destruction. The voluntary and cardiac muscles, the 
spleen, the lungs, and probably all the tissues, partake of the universal fatty 
degeneration* which Wegner has shown to involve even the minute arterioles. 
The blood is often profoundly affected, becoming very dark, losing its 
power of coagulation, and apparently suffering also in its corpuscular elements; 
for ecchymoses are almost universal, and haematin crystals are occasionally 
found in the viscera. In the case of Concato (loc. dtf) the white corpuscles 
were observed during life to be increased in number, and the red to be 
diminished in size and altered in form. The ecchymoses occur in all parts of 
the body, but are apt to be especially pronounced in the mediastinum and the 
serous membranes. Schiff has found that in dogs, after death from phos- 
phorus, the blood does not pass into the veins, but remains in the arteries 
(Archiv fur Exper. Pathol, und Therap., Bd. ii. p. 347). 
Dr. Mayer states that when very large doses of the poison have been taken, 
the blood and even the urine (?) may be phosphorescent ( Canstatt's Jahres- 
bericht, Bd. v., 1862, p. 123). 
The elimination of bile-acids in the urine shows that the jaundice of phos- 
phorus is caused not by an arrest of secretion, but by an occlusion of the 
biliary passages and consequent resorption of the bile. Dr. 0. Kohts (loc. dt.') 
has apparently demonstrated that the occlusion is most frequently due to the 
duodenitis involving the common duct, so as to obliterate its lumen by the 
swelling of the mucous membrane. In some cases, however, it is probable, 
as believed by Wyss, Alter, and Ebstein, that a catarrhal inflammation of 
the minute gall-ducts is the cause of the jaundice, and also that the result is 
in part effected through pressure upon those ducts by the swelling of the 
glandular and trabecular tissue.f It is proper to state that Demarbaix and 
Willmart (Presse Medicale, xxi., 1869, and Schmidt? s Jahrbucher, p. 152, Bd. 
cxliv.) insist that the icterus is not really heptogenous, but hacmic in origin, 
chiefly because they have found haematoidin in the urine. This fact, however, 
proves only that the blood is altered by the poison: it does not disprove the 
liver-origin of the jaundice. 
Acute phosphorus-poisoning so closely resembles yellow atrophy of the 
liver that their clinical distinction is sometimes difficult, nay, impossible. 
Distinct phosphorescence in the breath, vomit, or stools would of course be 
* The scope of the present work does not allow of a full discussion of the pathology of 
phosphorus-poisoning. The reader is referred to the following papers : Etudes cliniques 
et exp&rimentales sur V Empoiaonnement aigu par le Phosphors. Par Prof. IL Lebert et 
Dr. 0. Wyss.-Archives Giniralea, Sept. 1868. Zur pathologischen Anatomie der acuten 
Leberatrophie und der Phosphorvergiftung, von Dr. Otto Bollinger.-Deutsches Arch. f. 
Klin. Med., Bd. v., 1869. Ueber Icterus bei Phosphorvergiftung, von Dr. 0. Kohts.-Ibid. 
f For an elaborate discussion of the cause of jaundice, see Kohts's Memoir, Deutsches 
Archiv, Bd. v. p. 168; consult also that of Dr. Bollinger, Centralblatt fur die Med. Wiss., 
1869, and Deutsches Archiv. Bd. v., 1869. 118 
SYSTEMIC REMEDIES. 
direct evidence of poisoning. This phosphorescence, however, very often 
cannot be detected: according to Vetter ( Virchow's Archiv, Bd. liii. p. 186) 
it can be rendered more evident in the vomit, stools, etc., by acidifying with 
sulphuric acid and warming in a shallow dish. When death ensues during 
the first week of phosphorus-poisoning, the enlarged liver affords a distinctive 
proof of poisoning; but when the case is more protracted, the atrophied liver 
of phosphorus cannot be distinguished from that of the natural disease. The 
symptoms during life rarely, if ever, afford sufficient ground for a positive 
diagnosis. The lull in the symptoms after the first onset of the disease hap- 
pens more generally in phosphorus-poisoning than in yellow atrophy. Yet 
the clinical differences between various cases of either affection are greater 
than those which have been relied upon as separating the two affections. 
Kohler has asserted that oxymandelic acid in atrophy of the liver replaces 
the sarco-lactic acid of phosphorus-poisoning, and stress has been laid upon 
che asserted facts that in the natural disease leucin and tyrosin are present in 
abundance in the urine, whilst in the poisoning they are absent. In yellow 
atrophy, however, tyrosin is not unfrequently absent from the urine, and leucin 
present in very small amount, whilst both principles may be present in 
phosphorus-poisoning.* In regard to the acids in the urine, very careful 
chemical analysis would in any case be necessary to determine their pres- 
ence, and sufficient evidence is certainly not yet forthcoming to show that 
either of them is really characteristic. Chemical examination is therefore 
absolutely necessary in all medico-legal cases. (For discussions of the 
diagnosis between yellow atrophy and phosphorus-poisoning, see Kohler, 
Sydenham Year-Book, 1870, p. 455 ; Schultzen and Ries, Annalen des 
Berlin. Krankenhauses, Bd. xv., 1869 ; and especially Dr. I. Ossikovsky, 
Wien. Medizin. Presse, xiii., 1872, abstracted in Schmidt's Jahrbiicher, Bd. 
cliv. p. 15. For cases in which the question was legally raised, investi- 
gated, and discussed, see Schmidt's Jahrb., Bd. cxli. p. 167 ; Syd. Year-Book, 
1832, p. 430 ; Ann ales d' Hygiene, Jan. 1869.) According to M. Poulet 
(Gaz. Med. de Paris, Aug. 1872) phosphorus is eliminated as hypophosphoric 
acid, and the poisoning can be recognized by heating the urine with nitric acid 
to calcination. If hypophosphoric acid be present, as dryness is reached the 
mixture suddenly bursts into a flame like a packet of matches. 
It has of late years been demonstrated that phosphorus passes into the 
blood as phosphorus, and not in the form of phosphoric acid or other com- 
pound. In poisoning-cases in men the breath is said sometimes to be dis- 
tinctly phosphorescent; and in animals Bamberger has found phosphorus in 
the blood, and Husemann and Manne in the liver, two or three hours after 
its ingestion ; W. Dybkowsky (Hoppe-Seyler's Medicinisch-chemische Unter- 
® Cases ( Wiener Med. Presae, 1872 ; Schmidt's Jahrb., Bd. 169, p. 127: Bd. 195, p. 
123). Prof. Ossikovsky believes that the principles appear habitually about the sixth day 
of the poisoning, when the liver is still enlarged. TONICS. 
119 
michungen, Heft i. p. 54) has detected it in'the blood and liver ten hours after 
its ingestion; and other observers have demonstrated its presence in almost 
all of the tissues. It seems probable that to some extent it finds entrance 
into the circulation by being dissolved in the various fatty matters contained 
in the alimentary canal. At the temperature of the body, however, it yields 
abundant vapors, and Bamberger has demonstrated that these readily and 
rapidly pass through animal membranes. He has found that defibrinated 
blood, when separated from the fumes of phosphorus only by an animal mem- 
brane, rapidly becomes saturated with the poison. Dybkowsky (loc. dt.') has 
confirmed this, and it cannot be doubted that in a similar manner living blood 
absorbs the poison from the alimentary canal. 
W. Dybkowsky (Hoppe-Seyler's Medicinisch-chemische Untersuchungen, 
Heft i.) renders probable the theory of Schuchardt (Henle und Pfeufer's 
Archiv, N. F., Bd. viii.) that the phosphorus to some extent in the ali- 
mentary canal, but much more largely in the veins, is converted into phos- 
phuretted hydrogen, and that some of this compound and some of the phos- 
phorus itself is oxidized in the venous blood, so that phosphoric acid, besides 
phosphorus and phosphuretted hydrogen, is emptied into the arterial blood; 
further, that the last two compounds are oxidized at the expense of the 
arterial blood and the tissues it feeds, and that the poisoning is due to this 
deprivation of oxygen. For the details of the experiments upon which 
these conclusions rest I must refer the reader to the original memoir.* 
The indications for treatment in phosphorus-poisoning are very evident 
It is plain that no medication can influence the terrible organic lesions in 
duced, and that the primary object must be to prevent the absorption of the 
poison. Emetics and purgatives are, therefore, of prime importance. The 
necessity of the persistent use of evacuants is shown by the finding of phos- 
phorus by Dr. Starck in the stools three and a half days, and in the vomit 
two days, after the ingestion of the fatal dose (Deutsches Archiv Klin. Med., 
Bd. xxxv. 482). As phosphorus is soluble in oils, no fatty matters should 
be allowed either in the food or medicines. As an emetic, sulphate of cop- 
per should always he chosen. 
The minute particles of phosphorus adhere so closely to the alimentary 
canal that they cannot be dislodged by mechanical means, and an antidote is 
urgently demanded. For the purpose of oxidizing the poison, Duflos sug- 
gested magnesia usta and liquor chlorini, and Scherer the chloride of lime; 
but in practice these substances have been found of no value, on account of 
the slowness of their action. 
The oil of turpentine, originally proposed by Andant (Journal de Mede- 
* M. Lecorchd (Archives de Physiologic normale et pathologique, tome i., 1868, tome ii., 
1869) believes that phosphorus acts in the blood as phosphoric acid, but does not establish 
his opinion. For a discussion of this, see Dybkowsky's paper. 120 
SYSTEMIC REMEDIES. 
cine de Bruxelles, 1868-69) as an antidote to phosphorus,* has been largely 
used by experimenters, with apparently contradictory results, which, as is now 
known, were due to the employment of different varieties of the oil. There 
are in European commerce three varieties of turpentine,-the rectified, the 
German, and the French. Jonas (Liebig und Walder's Annalen der Chemie, 
Bd. xxxiv.) found that whilst the pure oil has no effect upon phosphorus, 
the acid French oil forms with it a crystalline, spermaceti-like mass. This is 
soluble in ether, alcohol, and alkaline solutions, and has received the name of 
turpentine-phosphoric acid. It is said to be eliminated by the kidneys un- 
changed, and to exert no deleterious influence. The elaborate experiments 
of Vetter on dogs and rabbits gave results in accord with these facts, for he 
found the rectified and German oils to be of no value in phosphorus-poison- 
ing, whilst the crude acid French oil was distinctly antidotal. Koehler, 
however, asserts that when the German oil has not been rectified for some 
time, it acts upon phosphorus. He believes that the oil acts partly by oxi- 
dizing the poison, and partly by converting it into the harmless turpentine- 
phosphorous acid. One part of the oil must be given for 0.01 part of the 
phosphorus. (Detroit Review, 1873; from Med.-Chirurg. Rundschau, June, 
1873. Case of recovery, Guy's Hosp. Reports, xxvi. 13.) Neither ordi- 
nary American oil of turpentine nor Canada balsam are of value in phos- 
phorus-poisoning 
As was pointed out by MM. Eulenberg and Guttmann (Aertz. Literatur- 
blatt, 1868, No. 12, quoted in Sydenham Year-Book, 1868, p. 450), and 
subsequently by Prof. Bamberger ( Wiener Medizinische Presse, Jan. 1872; 
Virchow's Archiv, June, 1872), phosphorus in a solution of a soluble salt 
of copper becomes immediately black, owing to the formation of a phos- 
phide of the metal. Prof. Bamberger (loc. cit.) also asserts that, whilst this 
change is very rapid, that induced by turpentine is a slow one, and, from 
an elaborate series of experiments upon animals, concludes that copper is 
much the more valuable and certain antidote. In human poisoning, then, 
sulphate of copper should be given in dilute solution, three grains every 
five minutes until vomiting is induced. After this, if the French oil be 
accessible, it may be given freely in emulsion. Otherwise, sulphate of copper, 
with opium to restrain the emesis, should be administered in such doses as 
the stomach will retain. Sulphate or citrate of magnesium should be used 
as a quickly-acting purge, and symptoms as they arise should be judiciously 
treated. 
Matchmakers and other artisans who are exposed by their occupations to 
the fumes of phosphorus suffer from chronic poisoning, which, whilst in many 
cases it profoundly affects the vitality of the sufferer, is especially distin- 
guished by the occurrence of necrosis of the upper or lower jaw. It has long 
* For cases, see Gazette Hebdomadaire, 1874; Schmidt's Jahrbueher, Bd. 169, p. 126; 
Med. Times and Gaz., 1876, ii. 461. TONICS. 
121 
been known that those artisans who have bad teeth are especially liable to be 
seriously affected, and the experiments of Wegner have demonstrated that 
the necrosis of the jaw is due to the local action of the vapor of phosphorus 
upon the part. He found that when rabbits were kept in an atmosphere full 
of the fumes of the poison do necrosis ever occurred, unless, by means of an 
unsound tooth or an artificial wound, the atmosphere had access to the bone. 
If such access were, on the other hand, allowed to any bone of the body, 
periostitis and subsequent necrosis resulted. Further, when rabbits received 
continuously small doses of the phosphorus by the mouth, no necrosis occurred 
even after wounds which laid bare the bones. As phosphorus-necrosis belongs 
to the province of the surgeon rather than of the physician, I will not dis- 
cuss it further here. 
Administration.-Phosphorus may be given in pill or in solution. The 
Oleum Phosphoratum, U. S., containing one per cent, by weight of phos- 
phorus, may be given in doses of one to three minims in aromatized emulsion 
or in capsules. The Pilulae Phosphori, U. S., or officinal pills of phosphorus, 
contain one-hundredth of a grain each. In regard to the dose of phos- 
phorus, I have found that many stomachs will not bear more than the 
fiftieth or even the hundredth of a grain, as given in the liquid form ; but 
I have often given as high as the twentieth of a grain. Dr. J. A. Thomp- 
son has used it in much larger doses {London Practitioner, July, 1873), 
prescribing one-twelfth of a grain as an average dose, and in one case having 
given as high as one fourth of a grain every four hours without injury. On 
the other hand, Dr. Anstie has seen slight poisoning from three-fourths of a 
grain taken in small divided doses during seven days {London Practitioner, 
Aug. 1873). 
Zinci Phosphidum, U. S.-Phosphide of Zinc has been largely used 
with asserted good results as a substitute for phosphorus. According to the 
researches of Vigier {Bull. Therap., xc., Jan. 1876) it would seem that the 
phosphide yields its phosphorus within the economy, probably to form a 
phosphuretted hydrogen. He found that it killed rabbits more quickly than 
did a corresponding dose of phosphorus, and that both symptoms and lesions 
were identical in the two cases. The phosphide should be given in pill or 
granule. The dose may be considered as one-twentieth to one-twelfth of a 
grain. Prof. Seguin recommends doses of from one-fourth to one-sixth of 
a grain. CLASS HI-CARDIAC STIMULANTS. 
The term cardiac stimulants is here used to designate a number of medi- 
cines which, when given internally, increase the power and force of the cir- 
culation, and are used by the physician for such purposes. There are some 
substances which are heart-stimulants in reality, but which possess other 
properties in so great a degree as to overshadow their cardiac relations, and 
are not used by the physician to affect the circulation. Such medicines are 
considered in connection with those powers which give to them their clinical 
value, and are consequently not included in the present class. Some of the 
members of this class are slow in their operation, some more rapid. Some 
produce increase in the pulse-rate, some lower it. It is evident, then, that 
no general indications can be laid down for their use, but that medicines so 
diverse must be studied individually. 
AMMONIA. 
Ammonia is a colorless, irrespirable, highly irritant gas, of a strong alka- 
line reaction, extremely soluble in water. It is obtained upon a large scale as 
a waste product in the manufacture of coal gas, and is officinal in the Materia 
Medica list of the U. S. Pharmacopoeia in the form of the stronger water of 
ammonia, and the muriate, carbonate, nitrate, and sulphate of ammonium. 
Physiological Action.-Locally applied, ammonia is a very powerful 
irritant. When inhaled, it causes intense irritation, and finally inflamma- 
tion of the mucous membrane of the air-passages, and its solution, if kept in 
contact with the skin, reddens, blisters, and at last produces even sloughing 
of the parts. When ammonia is injected into the veins of animals in con- 
siderable quantities, it causes violent convulsions, with remarkable disturbance 
of the respiration, followed, if the dose has been large enough, by death in a 
very short time. (F. Lange, Archiv fiir Experiment. Pathol, und Ther., 
Bd. ii. p. 368; V. Feltz et E. Ritter, Journal de I'Anatomic et de la Physiol., 
1874, p. 326; Funke, Pflilger's Archiv, Bd. ix. p. 426.) The respiration, 
if not interfered with by the tetanus, is enormously accelerated. Billroth 
{Archiv fiir Klin. Chirurg., Bd. vi. p. 421) states that the temperature falls 
enormously in animals poisoned with ammonia. 
Respiration.-Where a small quantity of ammonia is injected into the 
blood of an animal, the breathing is greatly accelerated ; after larger doses a 
period of arrest of respiration occurs in expiration (Funke), at once or in 
the course of a few seconds, and precedes the hurried breathing. In regard 
to the effect of section of the pneumogastrics upon the respiratory action 
of ammonia there is some disagreement: thus, in Funke's observations the 
primary arrest of respiration was always present, whilst in the experiments 
of Lange it was always absent. Both observers note, however, that section 
122 CARDIAC STIMULANTS. 
123 
of the pneumogastrics does not interfere with the increased rapidity of the 
breathing, and Funke especially remarks that the change from the slow, deep 
breathing of divided vagi to the extremely rapid respiration of ammonia- 
poisoning is colossal. Our knowledge of the physiology of respiration is 
hardly sufficient to warrant a positive deduction ; but the facts noted indicate 
very strongly that ammonia is an intense direct stimulant to the respiratory 
centres in the medulla oblongata. 
Circulation.-The chief practical interest in the physiological action of 
ammonia centres in the circulation. It is chiefly as an arterial stimulant that 
it is used in medicine, and clinical experience assigns to it a powerful but fuga- 
cious action on the heart. The only experiments on the subject besides my 
own that I have met with are those of Lange. When the drug is injected 
into the veins of animals there is a momentary fall of the arterial pressure, 
followed by a sudden, decided rise, and a corresponding increase of the pulse- 
rate. These phenomena are independent of the convulsions, because, in Lange's 
experiments, they occurred in curarized animals. According to Lange's studies 
the rise of pressure is not due to any stimulation of the vaso-motor centre, 
because it took place equally after division of the cord,-i.e., after the sepa- 
ration of the arterioles from the vaso-motor centre. The increased arterial 
tension which follows the exhibition of ammonia must therefore be due to an 
action either upon the heart itself, or upon the peripheral vaso-motor nerve- 
fibres, or upon the muscular fibres in the coats of the arteries. As in Lange's 
experiments the increase of the pulse-rate did not accompany the rise of press- 
ure after section of the spinal cord, it would seem to be caused by a stimulant 
action upon the accelerators of the heart, which are of course paralyzed by 
spinal section. The fall of arterial pressure, which immediately follows the 
injection of ammonia into the jugular vein, is probably due to a direct action 
of the concentrated poison on the heart. Previous section of the vagi does 
not prevent it, and when the dose is sufficient it is replaced by permanent 
diastolic arrest of the heart's action. That it is not produced by spasm of the 
pulmonic arteries is shown by the fact that when death occurs the left heart 
is found full of blood. When administered in toxic doses, ammonia, prob- 
ably, has some effect upon the hacmic corpuscles, for Feltz and Ritter found 
that the blood of a dog killed by the poison not only did not contain any- 
thing like the normal amount of oxygen, but even when shaken up with the 
gas refused to absorb it; further, under the microscope the red disks were 
found to resist the action of acetic acid to a markedly abnormal degree. 
Motor System.-The convulsions already spoken of as being produced by 
ammonia are not cerebral, since Lange found that they occur equally after 
division of the cord; nor are they peripheral, since, in Funke's experiments, 
tying of the artery of a limb failed to arrest them in that part, whilst section 
of the nerve was followed by immediate quiet: they must be spinal. Am- 
monia, in toxic doses, acts, therefore, as a stimulant to the motor function of 124 
SYSTEMIC REMEDIES. 
the spinal cord, heightening, as has been proven experimentally by Funke, 
its reflex activity. 
Elimination.-The volatility of ammonia and the extreme fugaciousness 
of its action would seem to indicate its elimination by the lungs; but Feltz 
and Ritter (loc. cit., p. 323) failed to find it in the breath of a poisoned 
animal, and the researches of H. Bence Jones apparently demonstrate that 
at least a portion of it is oxidized in the system (Philosophical Transactions, 
London, 1851). The last observer found, to his surprise, that even large 
doses, far from increasing the alkalinity of the urine, seem at times to heighten 
its acidity. It occurred to him that the ammonia might be oxidized ; and he 
accordingly found that the natural product of its oxidation, nitric acid, appears 
in the urine after the exhibition either of the ammonia itself or of its tartrate, 
carbonate, or muriate. It is probable that some portion of the ammouia 
is, in conjunction with carbonic acid, converted into urea.* 
Therapeutics.-Externally, ammonia is much used as a constituent of 
irritating liniments, and, on account of its efficiency and cheapness, is very 
valuable. By inverting a watch-glass full of the stronger water of ammonia 
upon the skin, a blister may be raised in a very few minutes; but, as the effects 
of the application are very apt to be severe, the use of it is justifiable only 
under rare circumstances. 
Internally the chief indication for the use of ammonia is failure of the 
heart's action. The more sudden and purely functional this is, the more effi- 
cacious is the remedy, which should in such cases be not only administered 
by the stomach, but should also be inhaled through the nostrils, as the local 
action of the irritant vapor upon the mucous membrane has a very arousing 
influence. When the failure of the circulation depends upon a slow and 
persistent cause, as in adynamic fevers, ammonia is not generally useful, but 
may be employed as an adjuvant to alcohol in the crisis of the disorder. 
In poisoning by venomous serpents, ammonia has been largely used, but 
certainly is in no sense antidotal, since, according to the experiments of Dr. 
Fayrer (Indian Annals of Medical Science, 1872), mixing it with the poison 
before injecting the latter into an animal does not in any way delay the fatal 
result. As an adjuvant to other more powerful stimulants, and especially to 
alcohol, ammonia may be useful in these cases. Dr. Gr. B. Halford, of Mel- 
bourne, Australia, has claimed (Melbourne Argus, 1872) that when injected 
into the veins its effects in poisoning from snake-bite are very extraordinary, 
and several cases of recovery after its use in this manner have been reported. 
It is far from certain, however, that these cases would have died haff no medi- 
cation been practiced; and Dr. Fayrer states that in an extended series of 
* The relation of ammonia to the formation of urea is of such purely physiological 
interest, and its discussion would require so much space, that I dismiss it with the fol- 
lowing references, which will give the reader a sufficient key to the literature: Arch. Ex- 
per. Path. u. Pharm., ii., viii., x. 125 ; xii. 77 ; Zeitechr. f. Physiolog. Chem., ii. 29, iv. 36; 
Zeitschr. f. Biol., xiv. CARDIAC STIMULANTS. 
125 
experiments upon animals he has not found its injection to be of any use. 
Ammonia cannot, therefore, be considered a specific in snake-poisoning; but, 
as the injection can do no harm, it should be practiced, yet never to the ex- 
clusion of other measures. 
In failure of the heart during anesthesia* and in poisoning other than 
from snake-bite, hypodermic injections of ammoniaj" have seemed in a 
number of reported cases to be of very great service. The same may be 
said of sudden collapse in disease, as sometimes is seen in the exanthemata, 
in cholera, and not rarely in pernicious malarial fever,\ or after surgical 
operations or injuries. From fifteen to twenty-five minims of the aqua 
ammoniac fortior, diluted with four times its bulk of water, should be thrown 
directly into a vein of the arm, and repeated in fifteen minutes if necessary. 
Prof. Stille and other authorities claim for ammonia an antidotal influence 
in alcoholic intoxication; but that it can relieve absolute drunkenness is, I 
think, very doubtful. Ammonia appears to have a tendency to act upon the 
mucous membrane of the lungs, and may be used as a stimulant expectorant 
in adynamic pectoral inflammations, as in typhoid pneumonia. As a stimu- 
lant antacid, it is frequently of service in cases of headache from gastric 
acidity. 
Toxicology.-When taken in large amounts, ammonia acts as a violent 
corrosive poison, producing generally abdominal pain, vomiting, bloody purging, 
and other symptoms of gastro-enteritis, with convulsions, collapse, and finally 
death. In some cases symptoms of impending suffocation, resulting in death 
from asphyxia, have occurred, and at the autopsy intense redness and conges- 
tion of the bronchial mucous membrane have been present, due no doubt to 
the irritant having found its way into the bronchi. The intellect may be clear 
to the very moment of death, or stupor, and finally coma, may be developed. 
In the rare instances in which death has taken place within five minutes from 
the ingestion of the poison, the fatal result has probably been brought about 
by oedema of the larynx. When the sufferer survives the first few hours, 
recovery may occur; but death sometimes happens long afterwards from the 
organic lesions which have been produced. The treatment of poisoning by 
ammonia consists in its neutralization as soon as possible by vinegar or other 
dilute acid, and the meeting of indications as they arise. If the oedema of 
the glottis be threatening, tracheotomy should at once be performed. 
Administration.-There are four officinal preparations of uncombined 
* Prof. Sidney Ringer {Practitioner, xxvii.) finds that ammonia added to the frog heart 
depressed with chloroform, iodoform, etc., has a very pronounced effect in re-establishing 
its action. 
f See Indian Medical Gazette, June 1, 1872; Medical Times and Gazette, Nov. 1872; 
Chicago Medical Journal, 1872; London Medical Record, i., 1873; L'Abeille Mtdicale, 
Aug. 1874; Berlin. Klin. Wochenschrift, No. 24, 1874; Archives Generates, ii., 1874; 
London Lancet, 1879, ii. 158; New York Med. Rec., xv. 532. 
J See Dr. Zuelzer, Revue de Thirap.-Med.-Chirur., July 1, 1872. 126 
SYSTEMIC REMEDIES. 
ammonia itself,-namely, Aqua Ammonia Fortior {Stronger Water of 
Ammonia), sp. gr. 0.900, Aqua Ammonite ( Water of Ammonia), sp. gr. 
0.959, Spiritus Ammonite {Spirit of Ammonia), and Spiritus Ammonite 
Aromaticus, or Aromatic Spirit of Hartshorn as it is usually called. 
To reduce the strength of the first of these preparations to that of the 
second requires the addition of one and a half measures of water. The spirit 
is of varying strength, but is somewhat weaker than the simple water. The 
aromatic spirit contains both ammonia and its carbonate. For hypodermic 
use the waters of ammonia are to be preferred. The spirits, especially the 
aromatic, are best suited for internal use. The dose of the simple spirit is 
from twenty-five drops to a teaspoonful, properly diluted. 
The Carbonate of Ammonium, U. S. (Ammonii Carbonas, NH4O,COg 
-2NH4,) is the best preparation for continuous use and in typhoid pneu- 
monia. It occurs in white, translucent, fibrous masses, which on exposure 
become opaque and efflorescent, parting with ammonia and passing from a 
sesqui- into a bi-carbonate. It is soluble in four and a half times its weight 
of water, and may be given in solution in doses of from five to ten grains, 
repeated pro re nata. 
The Nitrate of Ammonium (Ammonii Nitras, NH4O,NO5-NII4NOg) 
is officinal for the preparation of nitrous oxide; the Sulphate (Ammonii 
Sulphas, NH4O,SOs-2NII4,SO4), for the preparation of Ammonio-ferric 
A lum. The Muriate of Ammonia will be considered elsewhere. 
ALCOHOL. U.S 
Absolute alcohol, i.e., alcohol free from water, is a colorless, volatile liquid, 
boiling at 172° F., not congealed by a cold of -1G6° F., and having the 
specific gravity of 0.79G. It is not officinal, and is never used except for 
chemical purposes. 
The U. S. Pharmacopoeia recognizes Alcohol, containing 94 per cent, 
of absolute alcohol, and having the specific gravity of 0.820; Alcohol 
Dilutum, Dilute Alcohol, containing 53 per cent, of alcohol, and having 
the specific gravity of 0.928. 
Alcohol also exists in the officinal Spiritus Frumenti, or Whisky, and 
Spiritus Vini Gallici, or Brandy, which are obtained respectively by the 
distillation of fermented grain and of fermented grapes, and should contain 
from 48 to 56 per cent, of absolute alcohol; and in the officinal Vinum 
Rubrum, or Red Bute, and Vinum Album, or White Wine. 
For medicinal use, brandy should be at least four and whisky at least two 
years old. 
Alcohol is formed out of sugar by fermentation; but, as a discussion of the 
natural history and chemistry of this process, to be of value, would occupy 
much space, the reader is referred for it to works especially devoted to 
chemistry and to materia mcdica. 
Physiological Action.-The phenomena induced by the ingestion of 
alcohol are, unfortunately, so well known as to make any description of them CARDIAC STIMULANTS. 
127 
here unnecessary. I have not met with a close experimental study of the 
order in which the nervous centres are affected, but it is scarcely doubtful 
that alcohol acts upon them as does ether, excepting that the latter substance, 
being much more volatile than the alcohol, is consequently absorbed and 
eliminated much more rapidly, so that its influence is more evanescent. 1 
know by experiment that the vapor of alcohol is capable of producing the 
stupor known as anaesthesia, and, further, that this anaesthesia may be 
deepened into death, accompanied by all the phenomena of fatal ether- 
narcosis. The experiments of Mommsen (Arch. f. Pathdlog. Anat., Ixxxiii. 
243) would seem to show that alcohol acts slightly upon the peripheral motor 
nerves, as he found that when brought into contact with them it augmented 
their excitability. 
It is a well-known clinical fact that alcohol given to healthy men increases 
the frequency, and, to the fingers, the force of the pulse. The very careful 
and elaborate experiments of Parkes and Wollowicz upon man, with the 
sphygmograph, indicate that there is produced by brandy an increased rapidity 
of the ventricular contraction, with shortening of the period of rest or dias- 
tole. The tracings furnished, however, no distinct indications of increased 
arterial pressure. Dr. H. Zimmerberg found that enormous doses of alcohol 
reduce both the pulse-rate and force. After section of the vagi the alcohol 
lessened the arterial pressure without affecting the pulse-rate, whose slow- 
ing in the normal animal would therefore seem to be due to inhibitory stim- 
ulation. It is plain that Zimmerberg's experiments apply, not to therapeutic, 
but toxic, doses of alcohol. J. Dogiel affirms that by moderate amounts 
of alcohol the arterial pressure is at first increased and then diminished. 
During the latter state the vaso-motor centres are found incapable of re- 
sponding to stimulation. The rate of the heart-beat is stated to be at first 
increased, then diminished, then increased; the first increase being owing 
to the stimulation of the accelerators, the diminution to stimulation of the 
par vagum, and the final increase to paralysis of the same. The action of 
alcohol upon the circulation has been carefully studied in the Pharma- 
cological Laboratory of the University of Pennsylvania by Dr. J. D. Cas- 
tillo (Phila. Med. Times, xi. 45). He found that in moderate doses the 
drug caused great increase in the rate and force of the cardiac beat and 
corresponding rise of the arterial pressure, and that these phenomena were 
not affected by previous division of the pneumogastrics, of the accelera- 
tors, or of the spinal cord. These results, so far as the pulse-rate is con- 
cerned, are in direct contradiction to those of Dogiel; but in regard to the 
arterial pressure they are partially in accord. On the other hand, closely cor- 
responding with the results of Dogiel are the elaborate studies of Prof. Martin 
(Maryland Med. Joum., x. 292) upon the dog's heart, isolated according to 
the manner invented by himself. Prof. Martin found that blood containing 
one-eighth per cent, by volume of absolute alcohol has no immediate action 
upon the isolated heart; that blood containing one-fourth per cent, dimin- 128 
SYSTEMIC REMEDIES. 
Ishes within a minute the work done by the heart; blood containing one-half 
per cent, always diminishes remarkably the heart-work and sometimes nearly 
destroys it, so that not enough blood is pumped out of the left ventricle to 
supply the coronary artery. The curious observation was made that cutting 
away the pericardium stopped the action of even one-half per cent, of alcohol. 
The explanation of this offered by Prof. Martin is that the alcohol so relaxes 
the cardiac muscle that there is not room in the pericardium for a full dias- 
tole, the relaxed heart being, even in its systole, about sufficiently large to 
fill the pericardium. This explanation is hardly satisfactory. Can there be 
a local inhibitory cardiac apparatus, with peripheral filaments in the pericar- 
dium which are irritated by alcohol, and whose removal prevents the action 
of the alcohol ? Whatever the explanation of Prof. Martin's results may 
be, it is clear that at present they do not warrant positive conclusions as 
to the action of alcohol upon the circulation. The experimental evidence 
is too fragmentary and contradictory to be put against the universal belief 
of clinicians, that small doses of alcohol increase the force of the circulation 
hy directly acting upon the heart. Martin, Castillo, Dogiel, and Zimmerberg 
all agree that large doses of alcohol diminish very greatly arterial pressure. 
Castillo found that the lowering is produced after section of the cord, and 
that when it is very pronounced galvanic irritation of the sciatic causes a 
rise of pressure, showing that the vaso-motor centres are intact. This is in 
accord with the results of Martin, and it may be considered established that 
overdoses of alcohol directly depress and paralyze the heart-muscle : but it 
still seems probable that the fall of the pressure is also in part due to an in- 
fluence exerted upon the arterial system. 
Owing no doubt to the sensations of warmth induced by its local action on 
the stomach and by the increased activity of the circulation in the extremities, 
alcohol has been looked upon as a promoter of animal heat. As long ago as 
1848, however, Dum^ril and Demarquay asserted that after the administra- 
tion of large doses there is a fall of temperature. Of late years much atten- 
tion has been given to the subject, and positive results have been achieved 
As almost all experimenters are in accord, it does not seem worth while to 
occupy space with a discussion of the history of the subject. References are 
given to the principal original memoirs.* 
* For those desirous of looking up the literature of the subject, the following references 
are given: 
N. S. Davis, Transactions American Medical Association, 1855, p. 577. C. Bouvier, Pflu- 
ger's Archiv fur Physiologie, p. 370, 1869; Obernier, Ibid., p. 499, 1869. A. Godfrin, De 
l'Alcool, son Action physiologique, ses Applications therapeutiques, Paris, 1869. C. Bouvier, 
Wirkung der Alcohol auf die Korpertemperatur, Bonn, 1869. Manassein, Centralblatt filr 
die Med. Wissenschaften, 1869. P. Ruge, Virchow's Archiv, Bd. xlix. p. 265. C. Binz, Vir- 
chow's Archiv, Bd. li. p. 153; London Practitioner, vol. iii., 1869, vol. v., 1870; Journal of 
Anatomy and Physiology, vol. viii., 1874, p. 232; Sitzungsberichte der niederrheinischen 
Gesellschaft fur Natur- und Heilkunde, Mediz. Section, July 21, 1873. Brown-S6quard, 
Journal de la Physiologie, 1859, p. 467. Jacobi, Deutsches Klinik, 1857. Tscheschichin, CARDIAC STIMULANTS. 
129 
It is certainly demonstrated that lethal doses of alcohol produce in animals 
a fall of temperature which often amounts to 5° C., and that even when in- 
toxication or alcoholic narcosis is alone induced the depression of temperature 
may amount to 3° C. The proportionate dose necessary to produce distinct 
nervous symptoms is enormous in the lower animals as compared with man; 
yet, after the ingestion of amounts of alcohol which are not enough to cause 
intoxication in the animal, the fall of temperature is slight,-rarely more than 
1° C., and according to Ruge (Joe. cit., p. 265) usually from to |° C. 
The experiments of Richardson show that in some cases very minute doses 
of alcohol increase slightly the temperature (J° F. in mammals, 1° F. in 
birds). As regards animal heat, alcohol acts upon man as upon the lower 
animals. After doses only sufficient to increase the activity of the circula- 
tion, probably as a result of this increase, there is sometimes a very trifling 
exaltation of temperature (Parkes and Wollowicz). After larger doses there 
is a slight fall of temperature, and when full intoxication is induced this fall 
may amount to 3° F. (Ringer and Rickards). 
Upon animals suffering from pyaemic fever Bouvier and subsequent ob- 
servers have found that alcohol exerts a decided antipyretic action, very large 
doses of it lowering the temperature as much as 8j° C., and altogether pre- 
venting the occurrence of fever if narcosis be produced before the develop- 
ment of the latter. In fever in man alcohol exerts a similar influence, but 
in order to make its antipyretic action decidedly manifest, doses so large as to 
be toxic must be given (Ringer and Rickards). It has been noticed both 
in man and in the lower animals (Bouvier) that when the individual is accus- 
tomed to the free habitual use of alcohol the temperature is scarcely affected 
even by large doses. 
Very recently, Dr. Franz Riegel (Deutsches Archiv fur Klin. Medicin, 
1873) has made a very elaborate original investigation upon men, comprising 
as many as eighty-six experiments, and has arrived at the following conclu- 
sions, which are in exact accord with what was already in type when his 
memoir came to hand. As they embody the whole subject in a few words, 
and may be received as absolutely demonstrated, I offer no apology for inter- 
polating them here: 
" 1. Alcohol, even in moderate doses, in many cases causes a lowering of the 
temperature of the body. The amount of this diminution averages as a rule 
Reichert's Archiv filr Anatomie, 1866. Ringer and Rickards, London Lancet, 1866, p. 208. 
Richardson, Medical Tinies and Gazette, vol. ii. p. 704, 1869. Parkes and Wollowicz, 
Transactions of the Royal Society, 1870. Anstie, Stimulants and Narcotics, London. 
Mainzer, Ueber die Wirkung des Alkohols auf die Tcmperatur des Gesunden, Inaugural 
Dissertation, abstracted by Binz in Virchow's Archiv, Sept. 1871. C. Bouvier, Centralblatt 
filr die Med. Wissensehaften, Dec. 1871. I. S. Lombard, New York Medical Journal, 
June, 1865. Sulzynski, Ueber die des Alkohols, Chloroforms und Ethers Einfluss auf 
den thierischen Organismus, Inaugural Dissertation, Dorpat, 1865. S. Rabou, Berlin. 
Klinische Wochenschrift, 1871. Radziejewski, Centralblatt fur die Med. Wissensehaften, 
1871. Gustav Strassburg (use in fever), Virchow's Archiv, Bd. lx. p. 471. L. Lewin, 
Centralblatt fur die Med. Wissensehaften, No. 38, 1874. 130 
SYSTEMIC REMEDIES. 
only some tenths of one degree. 2. Only exceptionally is there noticed an 
elevation of the temperature consequent upon the administration of alcohol; 
not unfrequently, at least after minute doses, there is no noticeable change. 
3. The diminution of temperature in convalescents is, as a rule, less than in 
healthy subjects, or it may be altogether wanting. 4. In those who habitu- 
ally drink alcoholic stimulants, the depressing influence of alcohol upon the 
temperature is almost always wanting. 5. The frequent repetition of the 
doses of alcohol diminishes their lowering effect upon the temperature. 
6. The amount of diminution of temperature is directly proportional to the 
dose of alcohol given. 7. The depression of temperature caused by alcohol 
is for the most part of but short duration, and the temperature soon returns 
to its previous grade." 
The effect of alcohol upon the formation of animal heat was first properly 
studied by Dr. Bevan Lewis (Journal of Mental Sci., xxvi. 20). He 
found that after the exhibition of alcohol in the rabbit there was sometimes 
a primary lessening of heat production of very short duration, which was 
followed by a marked increase in the heat production. In some cases heat 
dissipation more than kept pace with this increase and the bodily temper- 
iture fell; in other instances the bodily temperature rose, showing that heat 
production was excited more than heat dissipation. Calorimetrical experi- 
ments made by myself and Dr. Reichert have arrived at similar results, 
but before it can be shown exactly how alcohol affects thermogenesis further 
experimentation is needed. It may be that the increased heat generation is 
simply the result of the rapid burning up of the alcohol itself. The great 
fall of bodily temperature which occurs after toxic doses of the drug seems 
to me to be clearly due to excessive heat dissipation, which in turn is the 
result of vaso-motor paralysis.* 
The effect of alcohol upon the elimination of carbonic acid by the lungs 
has been investigated by several observers, with different results. According 
to the researches of Bbcker (Beitrdge zur Heilkunde insbesondere zur Krank- 
heitsgenussmittel und Arzneiwirkungs Lehre, abstracted by Claude Bernard 
in Journal de Pharmacie, tom. xv., 3d series, 1849), of N. S. Davis (Trans 
actions of the American Medical Association, 1855), of Hammond (Physi- 
ological Memoirs, Philadelphia, 1863), and of M. Perrin (Archives Gin&rales, 
6th series, tome iv.), there is a decided lessening in the amount of carbonic 
acid gas exhaled. Dr. E. Smith, however, found that small doses of alcohol 
increased the elimination of the gas, although brandy, whisky, and gin always 
lessened the production. It is probable that the action of the small doses of 
spirits taken may vary, as it is readily conceivable that by checking or aiding 
digestion, by influencing the circulation, or in some other way, they may at 
times exert an indirect action which shall overcome any direct influence they 
* Prof. Binz's experiments and inferences upon this subject, in the light of recent 
evidence, seem of no value. CARDIAC STIMULANTS. 
131 
may possess. Be this as it may, the weight of evidence appears to be at 
present in favor of their usually diminishing the elimination of carbonic 
acid; although the matter cannot be considered as entirely settled. 
One of the most important facts to be determined about alcohol is its 
influence upon the excretion of nitrogenous material. Bocker is commonly 
believed to have experimentally determined that it lessens the excretion of 
urea. I have seen only an abstract of the original paper. In it this is not 
positively asserted, but seems to be inferred. Dr. Hammond has performed 
a very elaborate series of experiments upon himself: first, when just sufficient 
food was taken to maintain the weight of the body ; second, when more than 
enough for that purpose was ingested; third, when not enough was taken. 
Under all these circumstances, urea, chlorine, and phosphoric acid were less- 
ened in amount by the ingestion of alcohol. Darkes and Wollowicz (loc. 
cit.') affirm that their experiments gave a contrary result. In examining the 
reports of their experiments I find, however, that on one of the days the man 
taking the alcohol had a chill followed by fever. If this day be omitted, the 
average daily excretion of urea during the alcoholic period was 34.35 grammes; 
during the time when brandy was taken, 34.8 grammes; and during the water 
period, 35.02 grammes. The ingestion of alcohol seems, therefore, to have 
reduced the elimination of urea by about ten grains a day. Recently very 
careful experiments have been made by L. L. Rieso (Hoffmann und 
Schwalbe's Jahresb., 1881, 357) upon two persons under rigid conditions. 
The exhibition of alcohol was followed by great lessening of the excretion 
of urea, and to a less pronounced degree of uric acid, chlorides, phosphates, 
and sulphates, and at the same time an increase of the bodily weight. 
These results are in strict accord with those of Hammond, and it must 
be considered fairly proven that alcohol causes a great lessening in the 
excretion of the products of tissue waste. 
From the time of Liebig's celebrated classification of food until the appear- 
ance of the memoir of MM. Lallemand, Duroy, and Perrin, ingested alcohol 
was almost universally believed to be burnt up in the body. These latter 
observers asserted, however, that alcohol escapes unchanged from the body, 
not only because they were unable to detect in the blood or tissues any of the 
results of its oxidation, such as aldehyde or acetic acid, but also because they 
found it unchanged in the expired air, the sweat, and especially in the urine. 
The results obtained by the French investigators were, however, seriously 
questioned by E. Baudot (Z' Union Medicale, 1863), who demonstrated that 
the chromic acid test which Duroy and Perrin had relied on for detecting 
alcohol in the excretions is so delicate as to reveal .165 grain of alcohol in a 
quart of water; and Baudot further affirmed as the result of twenty ex- 
periments that except after immense doses the amount of alcohol eliminated 
by the kidneys is so small as practically to amount to nothing. In 1866 Dr. 
Schulinus (Archiv der Heilkunde, 1866), by a very elaborate and laborious 
investigation, confirmed the results of Baudot, showing that alcohol taken 132 
SYSTEMIC REMEDIES. 
into the blood finds its way by exosmose into all organs in similar proportion, 
and does not escape through the kidneys unless in very trifling amounts. In 
several experiments he found that one-fourth of the ingested alcohol had dis- 
appeared from the body after from two to three and one-fourth hours, and, 
as but a fractional portion of the lost amount was eliminated, he concluded 
that it must have been burnt up. Adolph Lieben (Annalen der Chemieund 
Pharmacie, 1870, vii., Supplement. Bd. p. 236) has in a number of experi- 
ments arrived at results similar to those of Schulinus. 
In 1865 a number of experiments yielded to Anstie, of London (^Stimu- 
lants and Narcotics (reprint), Philadelphia, 1868), similar results, and also 
demonstrated that the elimination from the lungs is exceedingly trifling. 
Thudichum investigated the matter on a large scale in 1864, and again with 
the assistance of Dupre in 1866 (Tenth Report of the Medical Officer of the 
Privy Council, London, 1868). In order to avoid the fallacies of the chromic 
acid test, the alcohol was obtained from the urine by repeated distillations. 
In the first instance forty-four bottles of wine, containing four thousand 
grammes of alcohol, were drunk by thirty-three men, out of whose urine, 
collected during the next six hours, ten grammes, or only 0.25 per cent., of 
the ingested alcohol were recovered. In the experiments of 1866 the process 
was substantially the same, but, greater care being taken to get absolute 
accuracy and to avoid loss during distillation, 0.82 per cent, of the amount 
administered was found in the urine. Quite recently, Subbotin (Zeitschrift 
fur Biologie, vii., 1871 ; Schmidt's Jahrbucher, 1872, Bd. cliv. p. 261) has 
made an apparently close experimental study of the subject upon six rabbits, 
and has shown that elimination continues for a longer time than had been 
generally believed, and that twice as much of the alcohol escapes by the skin 
and lungs as by the kidneys. In one experiment he found that 16 per cent, 
of the alcohol escaped unchanged in the first twenty-four hours ; elimination 
after this time, although perceptible, amounted to very little. As he, like 
Lallemand and his colleagues, experimented with poisonous doses, his results 
confirm rather than contradict those of Baudot, Schulinus, Anstie, Thudi- 
chum, and Dupr6; for it is manifestly evident that after such doses elimina- 
tion would be proportionately greater than after smaller quantities, as there 
naturally must be a limit to the powers of the system to oxidize alcohol. 
Prof. R. D. Edes, in his experiments (Boston Medical and Surgical Journal, 
1872, p. 347), found that after small doses the amount of elimination by 
the breath is greater than that by the kidneys, although the contrary holds 
where large amounts have been administered : in either case the total amount 
eliminated was but a small percentage of that ingested.* Finally, Anstie 
* Prof. Edes relied upon the chromic acid test, which Binz asserts to be fallacious. 
In the experiments made by Stenbach and Schmidt, under Prof. Binz's direction, alcohol 
could not be detected in the breath, and Prof. Binz believes that no elimination of it 
occurs from the lungs. He declares that the odor of the breath after drinking is not 
that of alcohol, but of the ethers and other volatile principles of the various liquids imbibed. CARDIAC STIMULANTS. 
133 
(London Practitioner, July, 1874) has recently repeated his experiments, 
using the method of Subbotin, and even subjecting a dog, which had been 
taking for some days very much larger amounts of alcohol than he had 
eliminated by skin, kidneys, rectum, and lungs, to distillation, with the results 
of confirming his first experiments and of finding no " residual alcohol"- 
i.e., alcohol left in the body-worthy of mention. In an elaborate research, 
Dr. Guido Bodlander found that he himself, after the use of alcohol in 
various quantities, eliminated by the kidneys about 1.2 per cent., and by 
the lungs about 1.6 per cent.; whilst in dogs he recovered from the breath 
about 2 per cent., from the urine 1.6 per cent., from the skin 0.14 per cent, 
of the ingested alcohol. He failed entirely to find alcohol in the intestinal 
excretions, and also, contrary to Lewaid's observation in 1857, in the milk 
of a goat, to which nearly a quart of brandy had been given (Archiv f. 
Physiolog., xxiii.). 
These concurrent investigations* certainly demonstrate that but a small 
proportion of ingested alcohol is either eliminated from or accumulated in 
the body, and consequently that it must be oxidized in the body, and in some 
degrees partake of the nature of a food. It has been objected to this that 
no one has as yet been able to detect^ in the blood any of the ordinary 
products of its oxidation; the probable reason of this is, however, that 
the oxidation is carried as it were at one bound to its ultimate end, the 
production of water and of carbonic acid. A strong corroborative proof that 
alcohol is largely consumed in the body is furnished even by the experiments 
of Lallemand, Duroy, and Perrin themselves, for they proved that elimina- 
lion ceased, or at least could not be detected by the most delicate tests, before 
the alcohol had all escaped from the body. 
A very strong confirmation of the theory that asserts the oxidation of 
alcohol in the body is found in the researches of our countryman Dr. H. 
Ford, whose experiments have, however, not been repeated, and therefore, 
although apparently carefully performed, lack the absolute authority of com- 
plete confirmation. Dr. Ford (AT. K Med. Journ., Jan. 1872) has worked 
upon the supposition that the hepatic sugar must be converted into alcohol 
in the body before its final destruction, and, using large quantities of blood 
of animals, has sought by repeated distillations to obtain alcohol from it.| 
Pushing his researches still further, Dr. Ford used various tissues as the 
substances to be distilled. He also made elaborate calculations, based on the 
* I believe these results have also been confirmed by Wohler, Journal den Proyriu, xi., 
but 1 have not seen the original paper or any abstract of it. 
f Duchek ( Vierteljahr. Prakt. Heilk., Bd. iii., 1853) did not, as he thought, demonstrate 
the presence of aldehyde in the blood of animals poisoned with alcohol. 
t Space is wanting to describe in detail the very elaborate methods employed by Dr. 
Ford. The tests which he relied on, to prove that the liquid obtained was alcohol, were the 
chromic acid test, the peculiar inflammability, and the optical appearance of the alcohol 
in the conducting-tubes at the time the distillate commenced to boil. In order to pre- 
vent any possible oxidation of the alcohol during the process, Dr. Ford sometimes added 134 
SYSTEMIC REMEDIES. 
carbon ingested and on the carbon exhaled, as to the amount of alcohol 
which ought to be found in the capillary blood of the lungs. The results 
are expressed in the following table: 
Alcohol in the capillary blood of the lungs: 
calculation based on "carbon ingested" . . 0.5403 
" " " " carbon exhaled" . . 0.5794 
putrescent lung-tissue (mean of exp. 8, 9, and 11). . 0.3819 
" fresh " ( " " 12, 13, and 14). . 0.3076 
putrescent thoracic blood (mean of exp. 1,2, 3,4, and 5) . 0.7625 
" fresh " " (mean of table) .... 0.0841 
" putrescent liver-tissue (exp. 6) 4.3138 
" fresh " (mean of exp. 25, 26, and 27) . 0.0190 
The important facts seemingly established in the above table are: the cor- 
respondence between the amount of alcohol in the thoracic blood as obtained 
by calculation and by experiment; that the smallest quantity of alcohol is to 
be obtained from fresh liver-tissue, the greatest from putrescent liver-tissue, 
in which the glycogen must have undergone fermentation. The fresh thoracic 
blood was blood which had not traversed the lungs; the putrescent thoracic 
blood of course represented the same blood with all its sugar fermented. 
These researches of Dr. Ford are certainly corroborated by the discovery, 
first made, I believe, by A. Lieben (Annalen der Chem. und Pharm., 1870), 
although usually attributed to Dupre (The Doctor, Feb. 1, 1873), that 
a substance exactly resembling alcohol exists in very minute quantity in the 
urine even of teetotalers.* M. Bechamp (London Lancet, 1873), apparently 
without a knowledge of the work of the other chemists, obtained, from the 
urine of persons who had not taken any alcoholic beverage for a long time, 
alcohol in sufficient quantity to burn it. As Lieben also found that this sub- 
sulphuretted hydrogen. The results of ten experiments are shown in the following 
table: 
No. 
Weight of 
Blood. 
Interval 
from 
Death to 
212°. 
Tempera- 
ture when 
distilled. 
Weight of 
First Dis- 
tillation. 
Weight of 
Final Dis- 
tillate. 
Weight of 
Alcohol 
obtained. 
Weight of 
Alcohol 
for 10,000 
parts of 
Blood. 
With or 
without 
HS. 
15 
6970 
0.0650 
0.0932 
16 
9734 
56 
101° 
1602 
0.8416 
0.0198 
0.0203 
without. 
17 
9137 
70 
100.3 
1636 
1.6218 
0.0605 
0.0662 
with. 
18 
9236 
77 
99.5 
1623 
3.6130 
0.0444 
0.0480 
with. 
19 
8988 
60 
99 
1555 
2.6092 
0.1357 
0.1509 
with. 
20 
8854 
60 
98 
1555 
1.7320 
0.0760 
0.0858 
with. 
21 
9423 
45 
96 
1560 
1.8722 
0.0708 
0.0751 
without. 
22 
9112 
61 
98 
1550 
0.9552 
0.0350 
0.0384 
without. 
23 
27330 
48 
98 
14050 
10.6883 
0.2928 
0.1071 
with. 
24 
36300 
51 
99 
17600 
14.0606 
0.5652 
0.1556 
with. 
* It is asserted that the substance " is not alcohol. It passes over among the earliest 
products of distillation, yields acetic acid on being oxidized, reduces the bichromate of 
potassium when dilute sulphuric acid is present, and its aqueous solution has a lower den 
sity than water. It furnishes iodoform, and exists in the urine in a very small quantity." 
Possessing the physical and chemical characters of alcohol, to ordinary minds it is alcohol. CARDIAC STIMULANTS. 
135 
stance exists in the urine of dogs, horses, and lions, and A. Rajewski ob- 
tained it from healthy rabbits (Archiv fur Physiologic, xi. p. 122, 1875), 
its existence in the normal organism must be considered demonstrated. 
Upon the nervous system alcohol exerts a powerful influence. Its effects 
upon the cerebrum are too well known to require elaboration; but it may be 
mentioned that I. Dogiel (loc. cit.) has found that in frogs the reflex suscep- 
tibility is at first somewhat, and afterwards decidedly, diminished by large 
doses of alcohol, and that the sensory and motor nerves are similarly affected. 
The question of the effect of alcohol upon digestion is an important one. 
There can be no doubt that very large doses hinder digestion. According 
to the experiments of W. Buchner (Deutsch. Arch. f. Klin. Med., xxix. 
537), ten per cent, of pure alcohol does not affect artificial digestion, whilst 
beer, even diluted, retards it. The use even of small doses of alcohol 
seemed to delay digestion in a few experiments made by washing out the 
stomach a fixed time after a meal taken sometimes with, sometimes without, 
alcoholic drink. The method is, however, too crude to allow much weight 
to the experiments; for it is possible that alcohol may lessen the rapidity 
with which the food leaves the stomach, and therefore aid in the thorough- 
ness of gastric digestion. Certainly every-day experience teaches us that in 
small amounts wines and liquors enable the bon vivant to digest more than 
is natural or proper. 
From what has been said, it is certainly deducible that alcohol in small 
amount is an arterial and cerebral stimulant, increasing functional activity 
in the nervous and circulatory apparatus; is a food, in the sense that it is 
destroyed in the system and yields force which is utilized by the organism ; 
is, when in sufficient quantity, a retarder of tissue changes, checking the 
excretion of nitrogen. 
If alcohol be oxidized in the body, and be a food, as it seems to me is 
clearly proven, it must of course generate force, measurable by the modern 
standard of the heat-unit. A little calculation will show the importance, or 
rather the great amount, of the generated force. According to Dupre (Lon- 
don Practitioner, vol. ix., 1872, p. 33), one gramme of alcohol oxidized in the 
body evolves 7184 units of heat, whilst the same weight of lean beef gives off 
only 1482 units of heat. It has been estimated that 9.3 ounces of lean beef 
-equal to about two ounces of alcohol-will supply the necessary force to 
maintain the circulation and respiration of an average man for one day. That 
is, four ounces of strong spirit will suffice for this purpose. Since to the 
ability of furnishing material whose consumption shall give power is added 
the ability to restrict waste and to stimulate the functions of circulation and 
of the nervous system, it is evident that in alcohol we have a most important 
means of sustaining the system during the strain of an acute exhausting 
disease. 
Therapeutics.-Our knowledge of the physiological properties of alcohol 
shows that its chief therapeutic value in acute disease is as a stimulant, a 136 
SYSTEMIC REMEDIES. 
temporary imparter of power which shall enable the system to stand some 
strain of like duration,-to bridge over some period of weakness. 
The cases to which it is especially adapted may be divided into three classes. 
First. Those in which there is a temporary loss of heart-power, as in 
fainting from exhaustion, loss of blood, or other cause. In these cases the 
alcoholic stimulant should, if possible, be given hot, and not much diluted; 
with it should also be exhibited some more rapidly-racting diffusible stimulant, 
such as ammonia. 
Second. Those acute diseases in which the powers of the system are in danger 
of being used up; to aid in the digestion of food and in the maintenance of 
power. Alcohol, as has already been stated, is to a certain extent a food, but it 
will not of itself, sustain life for a long time, and should in adynamic disease 
always, unless for special reasons, be combined with milk, or occasionally 
with eggs. One great source of its value in these diseases is the power it 
imparts of assimilating food, and in milk-punch are furnished the stimulant 
to digestion and the most perfect food known for digestion. This use of 
alcohol is apart from its office in the lowest stage of fever as a heart- and 
nerve-stimulant. Employed for this purpose it is useful in all stages of the 
adynamic fevers, such as typhus and typhoid. By the exhibition of three or 
four ounces of milk every two hours, with one or two drachms of brandy or 
whisky, from the beginning of the attack, in many cases the development of 
the severe adynamic symptoms may be prevented. 
In the advanced stages of diseases, when the typhoid state is well devel- 
oped, alcohol should be given boldly,-to quiet by stimulation the nervous 
and circulatory systems,-to afford a food which shall in a measure replace 
the natural pabulum,-to aid in the digestion of milk and other simple nour- 
ishment,-to aid in lowering temperature by checking the tissue-waste of 
fever: in a word, to enable the system to stand the drain upon its vital 
powers, and at the same time to check such drain. 
Properly administered, it always promotes, not arrests, secretion in these 
cases. The guide to the amount given should be the effects produced: so long 
as it lowers temperature and pulse-rate, moistens the dry tongue and skin, 
and quiets the nervous disturbance, it does good; if, however, the tongue 
grows drier, the pulse puts on an angry, bounding character, and the patient 
becomes restless and uneasy, stimulation is being pushed too far, and the 
amount exhibited should be lessened. The antipyretic action of alcohol has 
suggested its use in all cases of high temperature; as, however, this is only 
one of its actions, and as it is not decided unless very large doses be given, 
alcohol cannot be employed as a general febrifuge. True arterial excitement 
and sthenic inflammation certainly contra-indicate its use. The rule may be 
laid down as follows: high temperature is an indication for the use of alcohol 
only when other symptoms also demand it; in itself high temperature is 
never a contra-indication to alcohol. In acute sthenic diseases, after the pro- 
gressive stage has passed and the results of the disease simply remain to be CARDIAC STIMULANTS. 
137 
overcome, alcohol and milk will often save life. Thus, in acute pneumonia, 
when so much consolidation has occurred as to render it doubtful whether the 
exuded matter can be removed, or in abscess, when large amounts of pus have 
formed, the demand may be very great for alcohol as a food and as an aider 
of digestion, and sometimes as a stimulant. 
Third. Those in which there is a depressing agent. In many forms of 
poisoning, alcohol may be used with signal advantage simply as an arterial 
and nervous stimulant, to overcome the influence of a depressing agent. Thus, 
in snake-bite the unlimited use of it affords, with the hypodermic use of am- 
monia (see Ammonia), the best method of treatment. Recently it has been 
very strongly recommended in pyaemia by Dr. Theodor Clemens, of Frankfort 
(Deutsche Klinik, 1874, 1875), who states that he has seen eight cases of a 
severe type recover under the administration of red wine in as large amounts 
as the patient would drink. In poisoning by aconite, veratrum viride, or 
other similar substance, where death is threatened through failure of the 
heart-power, alcohol in some form is imperatively needed. In all these cases 
of acute depression threatening a fatal issue, it should be administered freely, 
not much diluted, and, if convenient, hot. From one to four ounces of 
whisky should be given, repeated every ten or fifteen minutes, until slight 
intoxication, convalescence, or death has resulted. 
What has been said up to this point in regard to the therapeutic action of 
alcohol has had reference to acute disease. The value of the drug in some 
chronic diseases cannot be doubted ; but in prescribing it the physician should 
never lose sight of the possible danger of producing a habit far worse in its 
fruits than death itself. 
In chronic neuralgia, in hypochondriasis, in melancholia, temporary relief 
may sometimes be obtained by the use of stimulants; but the very relief 
afforded doubles the temptation to the frequent use of the alcohol, and, as 
the system becomes habituated to its action and the dose has to be more and 
more increased, the habit of frequent stimulation grows almost of necessity 
into drunkenness. For this reason I do not think the physician is ever jus- 
tified in prescribing alcohol for its narcotic stimulant effect in these cases. 
The chief legitimate uses of alcohol in chronic diseases are to aid in digestion; 
to furnish a food which, without any digestive effort upon the part of the 
system, shall be absorbed and shall take the place of more ordinary food ; and 
to check excessive tissue-waste. Of course these indications exist only in 
such diseases as are either dependent upon or closely associated with a con- 
dition of system in which the general nutrition is depraved. In purely local 
affections the use of alcohol is rarely called for except in the last moments 
of life, when it may always be employed to afford relief and to protract for a 
short time the struggle. In chronic dyspepsia, alcohol administered with 
the food often aids very materially in the assimilation of the latter; but care 
has to be exercised in prescribing it, for the same reasons as were given when 
speaking of the use of stimulants in melancholia a moment since. In many 138 
SYSTEMIC REMEDIES. 
cases of chronic neuralgia, not as a narcotic stimulant, but as a food and a 
stimulant to nutrition, alcohol is often of the greatest service. The danger 
of establishing a fatal habit in this disease is, however, excessive. In almost 
all cases in which alcohol is called for in neuralgia, cod-liver oil is also indi- 
cated, and it is generally best to exhibit the two remedies together, so as to 
obtain the easy assimilation of the oil and to guard against evil moral results. 
In phthisis and its congener scrofulosis, there can be no doubt as to the 
great value of alcohol; and in the latter stages of consumption its judicious 
use as an antipyretic narcotic stimulant to lessen the sufferings of the patient 
is perfectly justifiable. During the chronic movements of the affection, 
alcohol taken with cod-liver oil, or in small amounts with the food at meal- 
times, conduces not so much to the comfort as to the well-being and recovery 
of the patient. 
The question as to the propriety of the daily use of alcohol by healthy 
men is at present a very serious one, involving so many moral and politico- 
moral issues that it cannot be fully discussed here. Suffice it to state, as 
obvious inferences from our present knowledge of the physiological action of 
alcohol, that the habitual use of moderate amounts of alcohol does no harm; 
that to a certain extent it is capable of replacing ordinary food, so that if 
the latter be scanty, or even if it be coarse and not easily digested, alcohol, in 
some form or other, is of great advantage ; that in all cases it should be taken 
well diluted, so as not to irritate the stomach; and that wine or malt liquors 
are certainly preferable to spirits. The experience of Arctic explorers has 
certainly shown that alcohol has no heat-producing power, so that at a time 
whep it was believed to have such influence by physiologists the Northern 
navigators had learned that the free use of spirits, far from enabling a man to 
withstand habitual exposure to intense cold, very materially lessened his power 
of resistance. On the other hand, the experience of almost every trout- 
fisherman or sportsman has satisfied him that spirits do have power to prevent 
"catching cold" under sudden and unaccustomed exposure to wet and cold, 
and that benumbed extremities will become warm and have their proper feel- 
ings return under the influence of a glass of whisky. There is, however, 
nothing strange or contradictory in these experiences, and they are both in 
strict accord with the present knowledge of the physiological action of the 
drug. As is often the case, the facts were practically made out, however, 
before science could solve the apparent paradox. As has been abundantly 
shown, alcohol has no heating power; but the chill of sudden exposure, the 
suffering benumbed extremities, the bronchitis that perhaps follows, all mean 
simply this: that, as the result of the cold, the blood leaves the surface and 
the extremities, the circulation fails in the outposts, and, as a consequence, 
suppressed perspiration-i.e., suspended function of the skin-and internal 
congestions result. The relief afforded by the spirits, as well as the preven- 
tion of sickness, is due simply to the power of the remedy in maintaining CARDIAC STIMULANTS. 
139 
the circulation and keeping the external surfaces warmed by the constantly- 
renewed currents of fresh blood from the interior of the body. 
Owing to its stimulant and antiseptic properties, alcohol constitutes an 
excellent dressing for wounds, whether accidental or surgical in their origin. 
It would seem also to lessen pain by a local anaesthetic effect (Horvalle, Gaz. 
des Hopitaux, Sept. 1878). Strong surgical testimony as to the local value 
of whisky has been given by Drs. Blair (Glasgow Med. Jour., Feb. 1870) 
and Suesserott (Phila. Med. Times, vol. iv. p. 774). Lint soaked and kept 
constantly wet with spirits is to be packed on or in the wound. 
Administration.-Almost enough has been already said upon this point, 
but a few further remarks seem appropriate. When stimulants are used to 
sustain the sinking powers in poisoning or in disease, the amount given 
should be almost solely regulated by the effects. Thus, in snake-bite it may 
be necessary to give a pint of whisky in the course of an hour; and in low 
fevers I have seen the greatest benefit result, and life apparently saved, by 
the exhibition of a quart of spirits a day. The rule is always to be gov- 
erned by the effects. In poisoning, one, two, three, or four ounces, as the 
case may seem to need, should be exhibited every ten minutes, until some 
effect is produced or matters become hopeless. In low fevers half an ounce 
to an ounce should be given every one, two, or three hours, pro re nata, the 
practitioner watching the results, as already spoken of. 
The question of choice, of course, comes up in every case as to which of 
the spirits shall be used. I have never been able to perceive any difference 
in their action (gin, of course, being excepted), save only that sometimes one 
agrees better with the stomach than the other. This has seemed to me to 
depend simply upon the personal likings of the patient, to which therefore 
the choice may well be left. In sudden collapse, some of the wines with a 
very high bouquet are believed to be more stimulating, on account of the 
ethers which they contain; but I have had no experience with them. In 
convalescence, and for habitual use in health, wines are preferable to spirits, 
-more agreeable, more tonic, and less apt to lead to excessive indulgence. 
When a mild stimulant is wanted in the beginning of fevers, especially if 
milk-punch seems too "heavy," wine whey may be sometimes used with 
advantage. It is made by pouring a half-pint of sherry or madeira into a 
pint of boiling milk, stirring thoroughly, and after coagulation has occurred 
straining off the whey, which may or may not be sweetened, according to the 
taste of the patient. Mulled wine is often very grateful to patients as a 
change. It is made by beating an egg up thoroughly with three fluidounces 
of sherry and adding a like quantity of water, which must be actually boiling 
when poured in. Champagne is useful in patients with delicate stomachs, 
especially if nausea or vomiting actually exists, and also may be employed 
with advantage in sudden failure of the vital powers, especially in elderly 
persons. It must always be very " dry," i.e., as free as possible from sugar. 
Milk-punch is prepared by adding from a dessertspoonful to a fluidounce 140 
SYSTEMIC REMEDIES. 
of brandy, whisky, or rum, according to the degree of stimulation required 
and the taste of the patient, to three fluidounces of milk, with sugar and 
nutmeg to taste. The addition of a tablespoonful of lime-water is not recog- 
nized by the palate, and renders the beverage more acceptable to the stomach 
when the latter is weak. 
Egg-nogg is still more nutritious than milk-punch, but is " heavier," and 
is usually rejected by the stomach if given too freely. It is made by beating 
up thoroughly the yelk of an egg with five fluidounces of milk and half a 
fluidounce to one fluidounce of spirits (and half a fluidounce of lime-water 
if required), and adding a sufficiency of sugar, with finally the white of the 
egg previously thoroughly beaten into a froth. 
Toxicology.-The acute form of alcoholic poisoning in its minor degrees 
is, unfortunately, an hourly occurrence almost in every village, but that fatal 
results are not absolutely so rare as is generally believed is shown by the 
fact mentioned by Taylor, that in four years (1863-67) thirty-five deaths 
from this source occurred in England and Wales. It is worthy of note that 
in some fatal cases convulsions have preceded death {Phila. Mad. Tinies, 
vi. p. 463). The absolute diagnosis of acute alcoholic poisoning when the 
patient is simply seen in the advanced stage of deep coma cannot be made out. 
The odor of liquor upon the breath or about the person is simply a proof that 
the subject has been drinking, not that the symptoms are caused by alcohol. 
The manifestations are merely those of profound compression or congestion of 
the brain, of apoplexy, of opium-poisoning; and a man who has been drinking 
only moderately may have been struck down with apoplexy oi' poisoned with 
opium. Dr. Hughlings Jackson has recorded a case in which the alcohol im- 
pregnated not only the breath but the urine also, and in which the patient was 
left to sleep it off; but at the post-mortem a clot was found covering nearly 
the whole of one hemisphere. After death in acute alcoholic poisoning the 
stomach is found very much congested, and sometimes ecchymosed. The treat- 
ment consists in the evacuation of the stomach, the use of the alternate hot 
and cold douche, and the usual mechanical methods of arousing a narcotized 
patient. 
White Turpentine is the concrete oleoresin obtained by incising the Pinus 
palustris and other species of pine. The supply in the American market 
comes almost exclusively from North Carolina and other of our Southern 
States. It is rarely, if ever, itself used in medicine, but by distillation is 
separated into a volatile oil and a resin (Rosin), which is officinal under the 
name of Resina. Rosin is used in medicine solely in the formation of cer- 
tain plasters, chief among which is the Emplastrum Resinee, U.S., Adhesive 
Plaster, or, in ordinary language, 11 Sticking Plaster," which is formed by 
adding rosin to lead plaster. 
TEREBINTHINA.-TURPENTINE. U.S. CARDIAC STIMULANTS. 
141 
OLEUM TEREBINTHIJUE-OIL OF TURPENTINE. U. S. 
This is a yellowish, highly-inflammable oil, of a strong peculiar odor and 
a hot biting taste, moderately soluble in alcohol, freely so in ether, very 
slightly so in water. By heating with muriatic acid it is converted into a 
red liquid and a white crystalline substance, which, from its resemblance to 
camphor, has received the name of artificial camphor. Turpentine is remark- 
able for having the property of absorbing oxygen and converting it into ozone. 
Physiological Action.-Turpentine is a powerful irritant, causing in 
a very short time inflammation in any tissue with which it comes in contact. 
When taken by a healthy person in moderate doses, it produces a sense of 
warmth in the stomach, soon followed by exhilaration, and, if the amount be 
sufficient, giddiness and even a species of intoxication. The pulse is increased 
in force and frequency. The turpentine escapes from the body through the 
lungs and kidneys, imparting its own odor to the breath, and that of violets 
to the urine. Although several recorded instances prove that turpentine is 
capable of producing death, yet cases of serious poisoning by it are rare, and 
a lethal result exceedingly so. The symptoms noted in poisoning by it are 
most of them constant, but vomiting and purging are present in some cases 
and not in others. Unconsciousness is generally complete, and in some cases 
is accompanied by dilated pupils; the urine is very much lessened in quantity, 
often bloody, not rarely suppressed; the skin is sometimes dry, sometimes 
moist; the pulse is feeble, rapid, and generally regular. The intense irrita- 
tion of the urino-genital organs in some cases has been indicated by constant 
priapism and efforts at micturition. 
The lethal dose must be very large, but is not definitely known, since recov- 
ery from four ounces in an infant fourteen months old has been reported. In 
Dr. Maund's case (Annuaire de Thirapeutique, 1846), death was supposed 
to have been produced in an intemperate woman by six ounces; and Philip 
Miall has recorded an instance of death produced in an infant fourteen 
weeks old by turpentine, of which half an ounce was thought to have been 
taken (London Lancet, March, 1869). 
Turpentine appears to be a stimulant to the circulation and to some of 
the nerve-centres, but further study of its exact influence is still needed. 
R. Kobert (Centralbl. fur Med. TFissens., 1877, p. 129) found that in 
moderate doses it exerted a powerful stimulating influence upon the inhibitory 
reflex centre, and also elevated the blood-pressure by stimulating the vaso- 
motor centre. Very large doses appeared to paralyze both of the centres 
spoken of, causing decided fall in the arterial pressure. The respiration 
was first increased in frequency, but later strongly diminished. The blood 
became very dark and the heart was finally paralyzed. The vagi and de- 
pressor nerves did not appear to be affected, nor did indeed any of the 
peripheral nerves, or the muscle. It is said that these results are in accord with 
those previously published by Azary in the Hungarian language. F. Fleisch- 142 
SYSTEMIC REMEDIES. 
mann (Schmidt's Jahrb., Bd. clxxx. 125) found that two drops produced pa- 
ralysis in the frog-first of voluntary, and afterwards of reflex activity ; in the 
cat and rabbit, toxic doses abolished reflex activity, but caused violent lethal 
convulsions. Dr. Hoppe (Journal fur Pharmacodynamik, Bd. i. p. 105) con- 
cludes that the vaso-motor nerves are the first to feel the influence of the drug. 
Upon the kidneys turpentine acts decidedly, causing, according to the size 
of the dose, increased secretion, or symptoms of renal irritation, such as pain 
in the back, and strangury, with a diminished excretion of bloody urine. 
Leon Crucis (De la Terebinthine, Paris Thesis, 1874) has made some experi- 
ments which indicate that when turpentine is given in toxic doses to rabbits 
it increases the coagulability of the blood and gives rise to numerous minute 
hepatic and pulmonic thrombi. 
Therapeutics.-Externally the oil of turpentine is very much employed 
as a powerful counter-irritant. It is useful more especially when it is desired 
to act upon a large extent of surface. When a very intense permanent local 
impression is required, a blister is to be preferred. Thus, in pleurisy a blister 
may be used, in bronchitis, turpentine stupes. In preparing the latter the 
turpentine should first be warmed by setting the vessel containing it in hot 
water, then a piece of flannel, just previously saturated with hot water and 
wrung as dry as possible, should be dipped in the turpentine and again 
wrung out. It is then ready for application, and may be left on from 
fifteen minutes to half an hour, according to the sensitiveness of the skin. 
Another local use of the oil of turpentine is as an addition to enemata. 
From a teaspoonful to an ounce of it mixed with double its amount of olive 
oil renders opening enemata much more active, especially in causing the ex- 
pulsion of flatus. Turpentine enemata containing much of the oil in a small 
bulk are also constantly used with good effect in arousing the system from 
stupor arising from narcotic poison or similar causes. 
In ulceration of the bowels, turpentine taken by the stomach is often very 
efficient, probably acting locally in the intestine, and in simple gastric ulcer 
the very best results are sometimes derived from its use. In a single large 
dose (f^ss to f^i with an equal amount of castor oil) it is a very efficient 
vermifuge, especially against the round-worm. It also may be used as a 
stimulant in low fevers, particularly when the tongue is dry and red. 
In typhoid or enteric fever it without doubt acts as a local stimulant to 
the ulcerated bowel, besides influencing the general condition of the system. 
There are two conditions or stages in the diseases named in which it is 
especially useful,-indeed, is of incalculable service. About the end of the 
second wreek the tongue sometimes becomes very dry, red, chapped, perhaps 
coated in the centre with a brownish fur, and at the same time marked 
meteorism develops. Ten drops of turpentine every two hours during the 
day and every three hours during the night will in the majority of cases 
remove the bad symptoms noted. That the action of the oil is largely a local 
one is shown not only by the arguments of the introducer of the practice, CARDIAC STIMULANTS. 
143 
Dr. George B. Wood, but also by the value of the same treatment when 
diarrhoea persists after the acute stage of the fever has passed. When con- 
valescence is protracted, when there is a constant tendency to the recurrence 
of diarrhoea, when, in other words, the ulcers of Peyer's patches are slow to 
heal, turpentine acts almost as a specific. 
In typhoid bronchitis and pneumonia, especially as intercurrent in typhus 
fever and similar diseases, turpentine applied externally and taken internally 
is often very useful. The same may be said of the low forms of puerperal 
fever. In this disease the abdomen should be kept covered with fomentations 
of the oil and of warm water alternately, the counter-irritant being used as 
constantly as a proper regard for the skin of the patient will allow. Inter- 
nally it should be given in very large doses (f5ss) every two hours. 
In hemorrhages from the stomach, bowels, or lungs, turpentine has acquired 
celebrity, but is hardly so much used as formerly. It is in the ataxic cases 
that it is useful. I have very rarely employed it, as the oil of erigeron has 
seemed even more efficacious, and is much more pleasant to the patient. In 
purpura hemorrhagica turpentine has been highly praised. 
Chian Turpentine, the product of the Pistacia terebintha, has been 
very highly commended by Mr. John Clay as a remedy in internal cancer. 
I have known of its use in one case of uterine cancer, in which most aston- 
ishing results have followed its employment, and believe it should have a 
thorough trial. It is essential that the remedy be genuine; six grains of it 
may be administered three times a day continuously for many months. 
DIGITALIS. U.S. 
The leaves of the Digitalis purpurea, or fox-glove, of the second years 
growth. These are large leaves, of a dull pale green, with whitish down 
underneath, and have a bitter nauseous taste and a faint narcotic odor. 
Digitalis yields both to water and to alcohol. M. Homolle discovered in it 
a peculiar bitter principle, which has been abundantly proven to contain the 
medical virtues of the crude drug, and, under the name Digitalin (Digita- 
linum), is now officinal in the U. S. Pharmacopoeia. As prepared according 
to the directions of the latter, it is a whitish or yellowish powder, odorless, 
but of a very bitter taste, nearly insoluble in ether and in water, readily 
soluble in alcohol and in acids. With muriatic acid it makes a yellow 
solution, which soon changes to green. The officinal preparation is made 
by a process copied after that of M. Henry and M. Homolle. It crystallizes 
with great difficulty, and imperfectly. Nativelie, in 1871, announced (Bulletin 
de I'Acad. Roy. de Mededne, 1871, vol. xxxvi.) to the Academy of France 
that he had discovered a process by which crystallized digitalin could be 
prepared, and received the grand prize of Orfila. 
Crystallizable digitalin (Journal de Chimie Medicale, 1873) occurs "in 
short and delicate needle-shaped crystals, and possesses an intense and per- 144 
SYSTEMIC REMEDIES. 
sistent bitter taste. It is but slightly soluble in water, soluble in twelve parts 
of cold and six of boiling alcohol of 90°, less soluble in absolute alcohol, and 
nearly insoluble in ether; very soluble in chloroform. It is rapidly dissolved 
by a solution of chloral hydrate, the solution becoming greenish blue in color. 
The concentrated mineral acids dissolve it, hydrochloric acid producing an 
emerald-green color, sulphuric acid a green which if subjected to the action 
of bromine fumes changes to a dark red, nitric acid a yellow, nitro-muriatic 
acid a yellow changing to an obscure green, and a mixture of equal parts of 
sulphuric and nitric acids a rose color changing to a deep violet. When heated 
on platinum, it melts, swells up, becomes brown, and disappears without leaving 
any traces. It contains no nitrogen, but is composed of 51.33 per cent, of 
carbon, 6.85 per cent, of hydrogen, and 41.82 per cent, of oxygen." 
According to Ch. Blaquart (A' Union Pharmaceutique, Nov. 1872), ten per 
cent, of crystallizable digitalin can be extracted from the crude drug, which 
probably contains twelve per cent, of it. The question whether this sub- 
stance is the pure active principle of digitalis is of course an important one. 
The French commission reported as the result of physiological experiments 
that it produces in man and animals effects similar to those of the amorphous 
digitalin, but that it is much stronger than the latter. This conclusion has, 
however, met with some opposition. M. Gubler {Bulletin de T Acad. Roy. de 
Medecine, vol. xxxvii. p. 404) denies that this crystallized digitalin is stronger 
than the amorphous preparation, and M. Vulpian in the subsequent discussion 
asserted that in experimenting he had found them of equal strength, and 
Ch. Blaquart (loc. cit.') in his experiments arrived at a similar result; yet 
one-ninth of a grain of it is said to have been given to an adult without 
causing a toxic effect.* Megerand and Daremberg {London Medical Record, 
1873, p. 278) have found the crystalline variety the stronger. Dr. Roucher 
affirms {Gazette Medicale, 1874) that the crystallized digitalin is readily 
convertible into the amorphous or granular variety; but he also asserts {Les 
Mondes, July, 1872) that it is a complex body.f This assertion is con- 
fiimcd by several chemists, especially by 0. Schmiedeberg {Archiv fur Ex- 
periment. Pathologic und Pharmakoi., Bd. iii. p. 19), who affirms that there 
are in digitalin four active principles: Digitoxin, the most active of all, 
which constitutes the greater bulk of Nativelle's crystallized digitalin; 
Digitalein; Digitalin; and Digitonin.\ For a particular account of these 
substances the reader is referred to the paper of Schmiedeberg.§ The only 
* For the process of manufacture, see Boston Medical and Surgical Journal, p. 35, 1873. 
J G. Bouchardat {Hull. Thirap., xc. p. 81) calls attention to the fact that crystallized 
digitaline does not, and amorphous digitalin does, polarize litrht. 
J Digitaliresin and toxiresin are derivatives respectively from digitalin and digitoxin 
of Schmiedeberg. A study of their physiological action may be found in Arch. Exper. 
Pathol, et Pharm., Bd. iv. p. 191. 
g Consult also Schmidt's Jahrbucher, Bd. clviii. p. 234, for abstract of thesis by Nicolai 
Gorz, of Dorpat. CARDIAC STIMULANTS. 
145 
practical conclusion at present possible is, that it is best to use only officinal 
preparations, such as the tincture, which represent the crude drug.* 
Physiological Action.-To the therapeutist the interest in the physio- 
logical action of digitalis centres chiefly upon the circulation. The drug does, 
however, exert a direct influence upon the apparatus of voluntary motion 
which is worthy of notice. In toxic doses it lowers reflex activity, and in- 
duces lassitude, prostration, muscular tremblings, and sometimes convulsions. 
That the muscles themselves are affected has been proven by the researches 
of Vulpian, of Dybkowsky and Pelikan, and of Gourvat, all of whom have 
found that the muscles of frogs poisoned with digitalis respond more feebly 
than is normal to galvanic currents. The nervous tissue has, however, been 
found by Gourvat to be more susceptible than the muscular, the nerves losing 
their functional power sooner and more completely than the muscles. 
As the result of an elaborate experimental study (Reichert's Archiv fur 
Anatomie, 1871, p. 252), Dr. A. Weil concludes that digitalis first lessens 
reflex activity by directly-i.e., independently of its action on the circulation 
-exciting the inhibitory reflex centres of Setschenow, and after a time by 
directly paralyzing the spinal cord. The experiments upon which this con- 
clusion was based are divided into two series, in the first of which it was found 
that after small toxic doses of the poison great diminution in the reflex activity 
of the frog was apparent in from ten to twenty minutes, and continued until 
the death of the batrachian ; but that this diminution for from twenty-five 
minutes to an hour was immediately suspended by section of the cord high up, 
the reflex activity returning at once to its normal state ; that after large doses 
the reflex movements were almost abolished in five minutes, and continued 
until death, but at any time during the first ten or twenty minutes could at 
once be restored by section of the upper cord; that, both after large and small 
toxic doses, a time finally came when division of the cord had no power to 
restore the lost reflex functions. These experiments have been confirmed by 
Dr. Meihuizen (Arch, fur Physiolog.,vii.,1873). The second of Dr. Weil's 
series of experiments were directed to discovering whether the action upon 
the inhibitory reflex centres and the cord was a direct one, or was simply the 
result of the altered circulation. In this part of the investigation, the hearts 
of frogs were cut out, or their motion arrested by the local application of a 
concentrated solution of the nitrate of potassium, or rendered slower by a 
dilute solution of the same salt, and the effects of these various procedures 
upon the reflex activity were studied. It was found that slowing of the 
heart's action did excite the Setschenow's centre, but not to nearly so great an 
extent as did digitalis, and that minute doses of digitalis sometimes stimulated 
* Digitonin is asserted to form the bulk of the soluble digitalin of commerce, and to 
be the same as saponin, the active principle of soap-bark. As saponin has been appar- 
ently demonstrated to be the physiological antagonist of digitalis, it is evident that the 
whole matter is exceedingly confused; and that the conclusion in the text is the only 
one that can at present be reached. 146 
SYSTEMIC REMEDIES. 
the Setschenow's ganglion and lowered reflex activity before the heart was 
sensibly affected. In regard to the spinal cord it was proven that when 
the heart was killed by the local action of potash the reflex functions of the 
spinal ganglia remained intact for a much longer period than when digitalis 
was administered. 
Circulation.-The action of digitalis upon the heart of the frog was, I 
believe, first investigated by M. Vulpian {Comptes-Rendus de la Soc. de Biol., 
1855, p. 70), who has been followed by numerous observers, among whom may 
be mentioned W. Dybkowsky and E. Pelikan {Zeitschrift fur Wissenschaft. 
Zoologie, Bd. xi., 1862), A. B. Meyer {Arbeiten aus dem Physiologischen 
Institut zu Zurich, quoted by Boehm), Legros and Legroux (quoted by 
Gourvat), Claude Bernard (quoted by Gourvat), Rudolf Boehm {Pflugers 
Archiv filr Physiologic, Bd. v., 1872), Homolle {Archives Generales de Mede- 
cine, July, 1861), Gourvat {Gazette Medicale de Paris, 1871), Fothergill 
Digitalis, London, 1871), Fagge and Stevenson {Tr. Royal Soc., London, 
vol. xiv.), J. F. Williams {Arch. Exper. Pathol, and Pharm., xiii. 1), H. 
F. Gaskell {Journ. of Physiolog., iii. 48). 
The statements of these investigators agree in all essential points. One or 
two of them have occasionally noted a primary brief acceleration of the heart's 
action; but the rarity of its occurrence shows that it has been probably 
produced by some extraneous unnoted influence. 
The first distinctive action of the drug is a marked lessening of the num- 
ber of cardiac beats per minute, due to a prolongation of the diastole, which 
may be complete, but is more generally divided by an abortive attempt at 
ventricular contraction. The systole is abnormally energetic, so that the ven- 
tricles become white as the last drop of blood is squeezed out of them. As 
the action of the drug becomes more intense, the rhythm of the heart is very 
much affected, the ventricle and auricle no longer beating in accord. At the 
same time the diastole generally becomes imperfect, one portion of the ven- 
tricle maintaining its systolic spasm, while the rest dilates. Thus, the extreme 
apex may remain hard and white during the diastole, and even hernial pro- 
trusions of the ventricle may occur. Finally, the heart is arrested in systole; 
and as the muscle so hardens, of course all its power of responding to elec- 
trical or other excitants is lost. 
In some rare instances, instead of the above series of phenomena, the 
diastolic periods throughout are prolonged and quiet, and after several periods 
of relaxation, lasting for ten or twenty seconds, final diastolic arrest may 
occur. 
As both Boehm {op. cit., p. 163) and Dybkowsky and Pelikan {loc. cit.) 
have found that the slowing of the heart's beat, the increased energy of con- 
traction, the irregularity and final systolic arrest, are produced by digitalis 
after division of the vagi and destruction of the spinal cord, and as both 
Ackermann (quoted by Boehm, op. cit., p. 158) and Boehm have found that 
the paralyzing of the peripheral ends of the vagi by atropia does not prevent CARDIAC STIMULANTS. 
147 
the phenomena just alluded to, it is evident that the drug acts directly upon 
the heart-muscle itself, a conclusion which is confirmed by Eulenburg and 
Ehrenhaus (quoted by Dr. T. Lauder Brunton, On Digitalis, London, 1868, 
p. 51), who found that digitalis, when locally applied, acts at once upon 
the heart. On the other hand, the inhibitory activity of the peripheral ends 
of the pneumogastrics is without doubt increased by the drug. There is no 
stage in which stimulation of the vagi does not cause diastolic arrest. In- 
deed, Dybkowsky and Pelikan have seen galvanization of the nerves produce 
such relaxation in the auricles after the ventricles had already become per- 
manently contracted. Further, Boehm has found that a stimulation of the 
pneumogastrics which is insufficient to make itself felt before poisoning 
will, after the exhibition of digitalis, cause diastolic arrest lasting for many 
minutes. 
It appears, therefore, that the peripheral cardiac inhibitory apparatus shares 
in the stimulant action of digitalis; and as Boehm has found that diastolic 
arrest never takes place in frogs poisoned with the drug, after section of the 
vagi, it is probable that this rare mode of death is really due to super-exci- 
tation of the inhibitory cardiac nerves. 
Rudolf Boehm (op. cit., p. 170) has investigated the influence of digitalis 
upon the working power of the heart when freed from all connection with 
the central nervous system. By using the method of Ludwig and Coats, he 
obtained as a constant result that the amount of work done was increased by 
small doses of digitalis ; that after large doses a similar increase was followed 
in a short time by very great diminution in the expenditure of power by the 
heart, a diminution apparently due to imperfect diastole and consequent non- 
admission of serum into the viscus. By direct experiment with an artificial 
circulation Dr. Williams has proven that the cut-out frog's heart actually 
puts out much more force than normal under the influence of digitalis. 
Dr. Williams believes that the increased work of the heart is largely de- 
pendent upon an altered tone of the muscle, producing a more complete 
diastolic enlargement of the ventricles. That the systolic arrest of the 
heart by digitalis is not of the nature of a paralysis but of a spasm is indi- 
cated by the fact that there are various paralyzing drugs which, applied to 
the contracted heart, will cause it to recommence its beat (Schmiedeberg, 
(Beitr. z. Anat. u. Physiol., Festgabe, A. Ludwig). The experiments of 
Francois Frank upon the isolated apex of the heart appear to show that it 
is upon the muscle rather than upon the intra-cardiac ganglia that digitalis 
acts (Journ. de Med. de Bordeaux, xi. 67).* 
The elaborate experiments of L. Traube ( Gesammelte Beitrdge zur Patho- 
logie und Physiologie, Bd. i., Berlin, 1871) upon warm-blooded animals 
* In apparent opposition to all this older evidence are the researches of Messrs. Donald- 
son and Stevens (Journ. of Physiology, iv.). For an elaborate discussion of this paper 
and for the reasons why I do not think it should change our views, see editorial in Therap. 
Gazette, February, 1884. 148 
SYSTEMIC REMEDIES. 
showed that in dogs moderate doses of digitalis produce increased arterial 
pressure, with lowering of the rate of the cardiac pulsation. When toxic 
doses were used, these phenomena were followed by increase of the pulse- 
frequency and fall of the arterial pressure, which, however, did not com- 
mence at the same time, since the maximum pressure was not reached until 
the pulse had risen above the original, normal point. 
The experiments of Boehm, Brunton (loc. cit.), Gourvat (loc. cit.), and 
of Kaufmann on soluble digitalin (Rev. de Med., iv.), are in accord with 
those of Traube; so that it may be considered proven that in mammals 
moderate doses of digitalis produce rise of arterial pressure with diminished 
pulse-rate. 
Prof. L. Traube has found that, after section of the vagi, digitalis is in 
warm-blooded animals, with rare exceptions, incapable of reducing the pulse- 
rate, and, contrariwise, that when the pulse-frequency has been reduced by 
the drug, section of the nerves causes an immediate and very marked rise in 
the rate of pulsation. I believe Boehm* has experimentally confirmed this, 
as have also Kaufmann and Gourvat. 
It has been suggested that the slowing of the pulse is due simply to the 
increased arterial pressure, but Kaufmann (loc. cit., p. 389) has noticed the 
slowing of the pulse without rise of the arterial pressure, and it appears 
to me demonstrated that digitalis stimulates the cardiac inhibitory nervous 
apparatus. The experiments of Kaufmann seem to show that in the mam- 
mals there is not at any time under the influence of digitalis an increased 
susceptibility of the peripheral vagi; and it is probable that it is the intra- 
cardiac inhibitory centres rather than the fibres of the vagi which are acted 
upon. The occasional reduction of the heart-beat in warm-blooded animals by 
digitalis after section of the vagi (Traube, Kaufmann) shows, however, either 
that the inhibitory nerves in some animals find another path than the pneu- 
mogastrics, or else that there is an additional-sometimes inoperative, some- 
times efficient-cause of the reduction of the pulse-rate. As it has been 
shown that digitalis is capable of slowing the beat of the isolated heart of 
the frog, it probably exerts a similar influence at times, in mammals, upon 
the cardiac muscle or its inhibitory ganglia. 
Although digitalis does increase the muscular energy of the heart, it seems 
scarcely possible that the enormous rise of pressure produced by it can be 
owing to this alone. This a priori reasoning has received experimental 
confirmation from Malan,f Fothergill Joe. cit.), Gourvat Joe. cit.), Acker- 
mann ( Ueber die Wirkungen der Digitalis, in Volkmann s Sammlung Klini- 
scher Vortriige, No. 48, Leipsic, 1872), and Boldt (Inaugural Dissertation, 
Schmidt's Jahrbucher, March, 1872). The first three of these investigators 
have found that the arterioles of the frog's web as seen under the micro- 
* His language is such as to leave the point somewhat doubtful. Op. cit., pp. 188, 189. 
f Quoted by Fothergill (op. cit.). CARDIAC STIMULANTS. 
149 
scope undergo very decided contraction after the systemic use of digitalis; 
and Ackermann states that if the abdomen of a rabbit be opened so as to 
expose the arteries of the mesentery, a very marked contraction, even to the 
partial obliteration of the lumen of the vessels, can be readily seen to follow 
the exhibition of digitalis. 
Boldt experimented upon curarized frogs after the manner of Cohnhcim, 
and found that the first effect of the digitalis was marked contraction of the 
arterioles. 
It is stated by Kaufmann that in the latter stages of digitalis-poisoning 
the peripheral vagi are paralyzed so that galvanic stimulation of their trunks 
is powerless to affect the heart. This appears to be in opposition to all pre- 
vious observations, and therefore must be confirmed before acceptance. 
According to Boehm, Traube found that, if the spine be divided, digitalis 
is powerless to increase the arterial pressure, although lessening, as usual, the 
pulse-rate. The same authority also states that Bezold has seen an excessive 
fall of the arterial pressure ensue immediately upon the division of the spinal 
cord in an animal under the influence of digitalis. Further, in his own ex- 
periments Boehm has attained similar results, or, in other words, has found 
that after separation of the small vessels from the vaso-motor nerte-centre, 
digitalis does not increase arterial pressure. 
These experiments would seem to prove that digitalis acts upon the vessels 
by stimulating the vaso-motor centres in the base of* the brain; but they 
have been contradicted by Ackermann {op. cit., p. 397), who states that he has 
many times cut the spinal cord and without exception found a very marked 
rise of arterial pressure follow the injection of digitalis. Unfortunately, none 
of these experiments have, that I am aware of, been published in detail, 
and it is therefore impossible to analyze or to reconcile them; but Gbrz 
{Schmidt's Jahrbucher, Bd. clviii.) expresses the opinion that Ackermann 
did'not fully divide the cord in his experiments. Gbrz himself found that 
a rise is produced by digitalin after division of the cord, but of so small an 
amount as to be readily accounted for by the increased power of the heart.* 
Br. J. F. Williams {Arch. Exper. Pathol, u. Pharm., xiii. 1) has also found, 
after reduction of blood-pressure to zero by chloral, that digitalis will cause 
rise of pressure. This does not, however, throw much light upon the vaso- 
motor action of the drug, because by enormous doses of chloral the heart 
is almost as much affected as is the vaso-motor system. Drs. Brunton and 
Meyer {Journal of Anatomy, p. 138) injected digitalin into the ear of a 
rabbit whose cervical sympathetic and pneumogastrics had been destroyed, 
but were unable to obtain any satisfactory result; there was certainly no 
constant perceptible contraction, although sometimes the vessels were seen 
to empty themselves more rapidly than before the injection. By consen- 
* A similar rise has been observed by Kaufmann, who does not, however, give the ex- 
tent of it (loc. cit., p. 406). 150 
SYSTEMIC REMEDIES. 
taneous, independent researches, Dr. Ringer and Sainsbury (Medico-Chir. 
Trans., Ixvii.), and Messrs. Donaldson and Stevens (Journ. Physiol., iv.), 
using the method of Gaskell more or less modified, have apparently proven 
that digitalis acts upon the walls of the arterioles. They destroyed the nerve- 
centres of a terrapin; excised the heart and connected bottles in such a way 
with the blood-vessels that liquids would run through the arteries and come 
out through the veins. Under such circumstances they noted a marked re- 
duction of the rate of flow when soluble digitalin was placed in the artificial 
serum. The wisest conclusion which can be drawn from our present evi- 
dence is that the drug probably acts both upon the vaso-motor centre in the 
medulla and upon the walls of the arterioles. 
It has been shown that the dichrotism in the frog's pulse is due to an 
attempted diastole before the systolic impulse has yielded ; and Kaufmann 
has determined that in the mammal a similar partial relaxation, arrested by 
a renewed very brief systole, occurs and gives origin to a double pulse. 
Kaufmann has also noticed that a tendency to cardiac tetanus is manifested 
in the horse, as in the frog, under the influence of digitalis; but that in 
the former animal a permanent, complete cardiac spasm never occurs. He 
has further experimentally determined that the diastolic, as well as the sys- 
tolic intra-ventricular pressure, is increased ; but that the diastolic intra- 
auricular pressure is slightly diminished. If it should be hereafter proven 
that these are constant phenomena, it would appear that the drug acts 
upon the ventricles rather than upon the auricles. 
The following proposition expresses our present knowledge, and probably 
is very close to the truth: 
Digitalis in moderate doses stimulates the muscidar-motor portion of the 
heart (probably its contained ganglia), increases the activity of the inhibitory 
apparatus, and causes contraction of the arterioles, probably by an action 
on the vaso-motor centres in the cord, and also upon the walls of the arte- 
rioles. As a consequence of the first action, the cardiac beats become much 
stronger; as the result of the last, there is narrowing of the blood-paths, 
and to the passage of the vital fluid an increased resistance, which, acting 
on the already excited inhibitory system, aids in the slowing of the pulse. 
According to my own experience, decided therapeutic doses of digitalis, in 
man as in other mammals, produce great reduction and sometimes dicrotism 
of the pulse, and increase the size and force of the wave; at the same time 
the arterial tension is augmented. Poisonous doses induce, after a time, 
increase of the pulse-rate, with smallness and weakness of the wave and 
lowered arterial pressure. 
Sphygmographic studies of the effect of digitalis upon persons suffering 
from various acute and chronic diseases have been made by M. Legroux, M. 
Bordier (Bulletin TUrapeutique, 1868, p. 110), Constantine Paul (Bulletin 
Therapeutique, 1868, p. 193), and Paul Lorrain (Journal de VAnatomie et 
de la Physiologie, 1870). The problems offered by these gentlemen are so CARDIAC STIMULANTS. 
151 
complex as to render a detailed study almost impossible; but, as a whole, 
their tracings seem to confirm my personal experience. Paul Lorrain calls 
attention to the fact that when the drug has reduced the pulse-rate very 
greatly a second abortive systole can, on auscultation, sometimes be heard 
occurring during the long diastole, and some of his sphygmographic tracings 
are markedly dicrotic. It is evident that in man the second systolic move- 
ment occurs precisely as in animals; and it seems very certain that the 
proposition framed for the lower mammals applies also to man. 
When the pulse has been reduced by digitalis to forty or fifty a minute, 
the change from the recumbent to the erect position will not infrequently 
suffice to alter at once its character, so that it will become feeble, small, and 
one hundred and fifty per minute. The explanation of this seems to be 
that the heart of such a patient is just in the position in which the diastolic 
impulse is being overcome by the excessive systolic stimulation of the drug. 
Whilst the patient is recumbent, the line is not passed over, but the ad- 
ditional stimulation of the erect position carries the heart beyond the limit 
of regular diastole, and the over-effects of the drug are at once manifested. 
The influence of digitalis upon the urinary secretion in health has been 
studied by numerous observers, with such diverse results as to prove that the 
action of the drug on the kidneys is so inconsistent and varying as to render 
it probable that it is in great measure indirect rather than direct. Thus, 
Jorg, Hammond (Proc. Biol. Dept. Acad. Nat. Sciences, Phila., Dec. 1858), 
and Brunton (loc. cit.} have found the secretion more or less decidedly 
increased, and Homolle (Archives Generales, July, 1861), Winogradoff 
(Virchow's Archivfur Anatomie, Bd. xxii., 1861), Stadion, and, according 
to Brunton, also Krahmer, Kluyskens, Vassal, and Shohl, have found it either 
uninfluenced or diminished. Kaufmann has found it uniformly diminished 
in the dog (loc. cit., p. 411). 
The urea in the apparently very careful experiments of Winogradoff 
(loc. cit.}, of Stadion (Prager Vierteljahrschrift fiir die Praktische Heil- 
kunde, 1862, Bd. Ixxii.), and of Hammond (loc. cit.}, was diminished, while 
in the almost equally elaborate experiments of Brunton (loc. cit.} it was 
increased. All four observers noted lessening of the chlorides. Megerand, 
using the crystallized digitalin of Nativelle, found his urine increased twenty- 
five per cent, but his urea diminished twenty per cent. Auguste Meusnier 
has sought without success for sugar in the urine both of patients taking 
large doses of digitalis and of rabbits poisoned with the drug (L' Action de la 
Digitale sur la Fonction glycogenique, Paris Thesis, 1868). M. Kaufmann 
(loc. cit., p. 413) states that digitalis leaves, or preparations which produce 
local irritation, cause in the dog an increase in the elimination of urea; 
but when digitalin is given in solution, so as to avoid all local irritation, 
the excretion of urea is diminished. 
It is very certain that toxic doses of digitalis lower the temperature a 
number of degrees in healthy men and animals. It would seem, however, 152 
SYSTEMIC REMEDIES. 
that the fall of temperature is generally, if not always, preceded by a rise, as 
has been noted by Bouley and Reynal, by Dumeril, Demarquay, and Lecointe 
(quoted by Brunton), by Hirtz, by Legros ( These, 1867, quoted by Gourvat), 
and by Gourvat ( Gazette Medicale de Paris, 1871, p. 572). Kaufmann 
believes that such rise is due to the local irritation produced by the drug, 
and asserts that if no irritation be produced there is always in the animal a 
fall of rectal temperature (0.4-0.5° C.) after even a feeble dose of digitalin. 
The effect of therapeutic doses in the normal condition has not been 
closely studied, that I am aware of. But in a number of cases, chiefly of 
pneumonia, Z. E. Coblentz (La Digitale comme Agent antipyretique, Stras- 
bourg Thesis, 1862) found that about twelve hours after the fall of the pulse 
there was also a fall of temperature. The tendency of our present knowl- 
edge is to connect the changes in temperature induced by digitalis with the 
changes of the circulation; and it seems very possible that therapeutic doses 
in health will be found to increase bodily heat, although in fever they may 
diminish it. 
Therapeutics.-The chief clinical use of digitalis is in diseases of the 
heart; and from what has been said in regard to its physiological action it 
logically follows that it should be useful in loss of cardiac power. 
When the muscle of the heart is for any reason unequal to the task set it, 
the systoles become rapid and imperfect, and by this irregular action the 
ventricles, neither completely filling nor emptying themselves, increase the 
embarrassment. Under these circumstances, digitalis, by lengthening the 
diastolic pauses and increasing the force of the systolic contractions, causes 
the ventricles to fill themselves in the one and to empty themselves completely 
in the other act. By subduing irregular action through the inhibitory nerves, 
by energizing the muscular power of the heart-walls, the remedy is of incal- 
culable service, and, increasing arterial tension all over the body, causes the 
disappearance or lessening of symptoms due to low pressure in the arteries. 
It is a logical necessity, if our reasoning as to the physiological action of 
digitalis has led to a correct result, that the drug should be of the greatest 
service when the lesion is simply loss of cardiac power; and clinical expe- 
rience tallies with this a priori argument. In simple dilatation, or in simple 
failure of the cardiac muscle without valvular lesion, the results of the use 
of digitalis are most favorable. 
On the other hand, in simple hypertrophy digitalis does harm, and should 
never be used. It must be borne in mind that although this agrees with 
what the experimentalist has proven to be the action of digitalis, yet it was 
discovered independently as a clinical fact by practitioners. Thus, Nie- 
meyer, who ridiculed experimental therapeutics because he would not take 
the trouble to study them deeply and practically and was therefore incapable 
of understanding them,-Niemeyer says, " Digitalis in pure uncomplicated 
hypertrophy is unsuitable." 
Valvular lesion of the heart, as is well known, gives rise under unfavorable CARDIAC STIMULANTS. 
153 
circumstances to dilatation, but in favorable cases to hypertrophy, or rather 
in the great majority of cases to hypertrophy with dilatation. Following out 
the principles already inculcated, it might seem at first that the use of digitalis 
in hypertrophied hearts with valvular lesion ought to be reprobated. But 
it is known clinically that digitalis often does good in valvular lesion with 
enlargement of the heart. The results of logical deductions from our physio- 
logical conclusions as premises are, however, not really at variance with this. 
It must be borne in mind that structural and functional hypertrophy are 
different things: by this is meant that although a heart be enlarged and abso- 
lutely stronger than normal, yet it may be, relatively to the work required 
of it, weak. Thus, if 1 represent the normal work of the heart and 1 its 
normal power, if the former be increased to 4 and the latter to 3 the heart 
is really in the position of a weak organ, although possessed of three times 
its original strength. Hence it is that digitalis is often useful in valvular 
disease with hypertrophy. In the vast majority of cases the heart with 
diseased valves is in the position just spoken of; but sometimes the work 
advances only to 2 and the strength to 3; then the hypertrophy becomes 
excessive, and digitalis will increase the difficulty. In almost all cases the 
increased power of hypertrophy, unless the muscle be degenerated, renders 
effectual smaller doses than can be used in dilatation, and also increases the 
danger of the over-action of large doses. 
In mitral insufficiency and in mitral stenosis digitalis is often of great 
service. It is evident that in both instances the valvular lesion leads as its 
first result to pulmonic hyperaemia. How does the digitalis lessen this ? In 
the case of stenosis, the diastole being lengthened by the remedy, the auricle 
is afforded more time to empty itself into the ventricle through the narrowed 
orifice, and at the same time is strengthened in its contracting power; evi- 
dently, then, the left ventricle when its systole occurs will have much more 
to contract on than before the digitalis was administered, and the amount of 
blood in the systemic circulation will be increased,-i.e., the amount in the 
pulmonic circulation will be diminished; further, the right ventricle will 
have greater power afforded it to force the blood through the lungs,-i.e., 
to resist the recoil from the left auricle to which the impeded valve gives 
origin. 
In mitral insufficiency the mechanism is different, but the result is the 
same. The increased power of the systole will throw proportionately more 
blood through the aortic orifice than through the partially open valve. The 
opening at the insufficient mitral valve is much smaller and more obstructed 
than the aortic orifice. As the force or rapidity of the current increases 
under the action of digitalis, the friction becomes greater at both orifices, but 
the ratio of increase is evidently far higher in the small choked mitral leak 
than in the wide aortic opening. Hence the large orifice constantly gains 
upon the smaller as the cardiac force is increased, and, more blood passing 
into the systemic circulation, the pulmonic is relieved. Again, the right ven- 154 
SYSTEMIC REMEDIES. 
tricle shares the stimulant action of the drug, and acts more strongly upon 
the pulmonic circulation, resisting the direct backward flow from the auricle. 
There are cases of mitral cardiac disease in which digitalis seems to be indi- 
cated, but when given acts unhappily. In some of these cases the augmented 
distress is probably caused by a strain upon the auricles. If the ventricle 
be already too strong for the auricle, and if by virtue of a very patulous 
mitral valve the backing of the blood upon the auricle is very easy, it is 
readily understood how increasing the power of the ventricle may augment 
the auricular strain. Especially is this consideration important in the light 
of Kaufmann's researches, which seem to show that the ventricle is more 
affected by digitalis than is the auricle. 
In aortic constriction digitalis is useful when the heart-power begins to 
fail. In these cases compensatory hypertrophy, with slowness of action, is 
very apt to occur, or even to become excessive: much more frequently does 
this happen than in mitral disease. Again, in aortic insufficiency the pro- 
longed diastole of digitalis action favors the return of blood to the heart, 
and is not advantageous. It is evident that digitalis is not so generally 
useful in aortic as in mitral disease, nevertheless when the heart-muscle 
fails, and the hypertrophy is not compensatory, the drug is useful in both 
aortic stenosis and insufficiency.* 
From the considerations which have been brought forward, it is very evident 
that a knowledge of the relation of the heart-muscle to the work required of 
it in any individual case is much more necessary to the therapeutist than to 
know what valve is diseased. 
In 11 irritable heart" of soldiers, a disease or condition of cardiac irritability 
evidently connected with muscular weakness, and very probably dependent 
upon exhaustion of the inhibitory nerves, Dr. Da Costa (American Journal 
of the Medical Sciences, Jan. 1871) found that in the early stages of the 
affection digitalis not only acted better than any other remedy, but even, 
when administered continuously for some time, often effected a permanent 
cure. When hypertrophy had taken place, the drug was of little use. 
The relief afforded by digitalis in not too inveterate cardiac disease is often 
in a measure permanent, because the drug may aid very materially in the pro- 
duction of compensatory hypertrophy. Dilatation is certainly more apt to 
occur when the muscular fibre is lax and acting feebly than when it is toned 
up and in vigorous play; secondly, the stimulus to action in a muscle is 
almost of necessity directly or indirectly a stimulus to its nutrition; lastly, 
and most important, improved systemic circulation means in a far more 
intense degree improved blood-supply to the cardiac muscle, as is shown by 
the following considerations. 
During systole the cardiac muscle contracts so as to squeeze out com- 
pletely all the venous blood from the heart-walls. The arterial blood enters 
during diastole, and the force which drives it into the relaxed walls is derived 
* Consult Fothergill, Antagonisms of Medicines, Philad., 1878, p. 85. CARDIAC STIMULANTS. 
155 
from the arterial system. The coronary arteries arise nearly at a right angle 
to the aorta: the blood squirts into the latter during systole in an unbroken 
stream, and of course does not enter the coronary artery. But when the 
reflux wave comes, the aortic valve flaps to, and the whole pressure of the 
blood-column forces the liquid into the open cardiac arteries. If the arterial 
system be empty or nearly so, the arteries are not distended sufficiently to 
give origin to a powerful reflux wave, and but little blood enters the coronary 
artery, i.c., the cardiac walls. The dilated feeble heart is unable during 
systole to free its walls thoroughly of venous blood, and during diastole the 
force is lacking for driving in the arterial blood. Digitalis enables the cardiac 
muscle to free itself thoroughly of venous blood, and at the same time, by 
restoring to a greater or less degree the normal balance of the circulation 
and removing the excess of blood from the general venous system, gives the 
aorta sufficient blood to provoke an active reflux. 
If in aneurism, or in general capillary atheroma, there be increased resist- 
ance to the circulation, and the heart have not sufficient power to meet this, 
digitalis may be useful, but must be employed with caution. It undoubtedly 
increases arterial pressure; and this increased pressure may prematurely rup- 
ture an atheromatous cerebral capillary or tear open the thinned wall of an 
aortic aneurism. The use of digitalis for the purpose of " quieting the cir- 
culation" in aneurism is of very doubtful expediency. I have seen imme- 
diately fatal hemorrhage produced thereby. 
In cardiac dropsy digitalis is of service probably not only by regulating 
through the heart the circulation, and by evacuating the surplus fluid through 
the kidneys, but also by an action upon the vessels. Clinicians do not allow 
enough for the role of the vaso-motor nerves in dropsy. Without saying 
more as to the clinical side of this question, which I have discussed elsewhere 
(American Journal of the Medical Sciences, July, 1871), it may be allowable 
to allude to the experiments of Ranvier (Comptes-Rendus, 1869, p. 1327), 
who found that when the vena cava was tied in a dog, and the sciatic nerve 
of one side cut, oedema occurred only in the leg whose nerve was divided. 
The use of digitalis in large doses as a cardiac stimulant in syncope or in 
sudden collapse from hemorrhage or other cause is in its infancy. One or 
two cases have been reported in which the happiest results have followed its 
exhibition (case, Pacific Medical and Surgical Journal, 1874, p. 273), 
and it has been given hypodermically with the most astonishing effects in a 
number of cases in my wards at the Philadelphia Hospital. From twenty 
to thirty minims of the tincture should be injected into the arm, and re- 
peated in half an hour if absolutely necessary, or one-fiftieth of a grain of 
the digitalin may be substituted. In my experience* the digitalin has several 
times given rise to severe local irritation, the tincture never. 
* Local irritation, and even the production of abscesses, has also been noted by various 
observers besides myself. See Witkowski, Deutsches Archiv Klin. Med., xviii. p. 142; also 
Pel, Centralb. Med. Wise., 1877, p. 169. 156 
SYSTEMIC REMEDIES. 
Closely allied to the last use of digitalis is its employment in poisoning 
by substances such as muscaria, delphinia, and aconitia, which arrest the 
heart in diastole. Boehm has shown {Pfluger's Archiv, Feb. 1872) that in 
digitalis-poisoning of the frog, even when systolic cardiac arrest has occurred, 
these substances will often restore the cardiac movements,-a proof that real 
antagonism exists in their action ; and Dobie reports a case {British Medical 
Journal, Dec. 1872) of recovery after the ingestion of an ounce of Fleming's 
tincture of aconite, apparently due to the hypodermic injection of twenty 
minims of tincture of digitalis and the exhibition by the mouth of three 
doses in an hour of a mixture of tincture of digitalis (one drachm each 
dose), brandy, and ammonia. 
Digitalis is often of great value in various acute diseases,* such as ady- 
namic pneumonia and adynamic fevers, by maintaining the heart's action. 
It can have no effect upon the diseases themselves, but may help most 
opportunely to sustain the heart during a crisis or a period of strain upon it. 
With the idea that digitalis is an active antipyretic, it has been prescribed 
in various acute diseases, sometimes with asserted good results. As already 
stated, toxic doses of digitalis at first elevate the temperature ; and proof is 
wanting that in healthy men therapeutic doses have any decided influence in 
depressing the temperature. There is, therefore, no good physiological basis 
for the antipyretic use of digitalis; at the same time, it is very possible that 
it may directly or indirectly lower the temperature in disease. Clinical proof 
of this is, however, still wanting. The strongest evidence in favor of such 
action is furnished by the records of Prof. Wunderlich {Manual of Medical 
Thermometry, Sydenham Soc. Translation, p. 325), according to which from 
half a drachm to a drachm of digitalis, given in divided dose during three 
or four days in the second or third week of severe typhoid fever, immediately 
produces a slight fall of temperature in a large proportion of the cases, and 
sometimes a considerable fall. This fall is said not to last more than a day, 
when the temperature rises again, but in cases favorably affected does not regain 
the original height; the pulse is very much lowered in frequency, and remains 
about uniform for four days. It is evident that at least in some of these 
cases of Wunderlich's the drug was given about the time natural deferves- 
cence would be expected to occur, and that the slight reduction of tempera- 
ture brought about at such time does not argue very strongly in favor of the 
proposition that digitalis is a powerful antipyretic in disease. Far more ex- 
tensive and complete observations must be made upon a rising, not a falling, 
temperature, before any satisfactory conclusion can be reached. At present 
the antipyretic use of digitalis should be purely tentative. In puerperal 
fever, Winkel {Philad. Med. Times, 1874, iv.) believes digitalis does good 
by its action on the circulation, by contracting the arterioles of the uterus 
and by lowering temperature. 
* Consult Hankel, British and Foreign Medico- Chirurgical Review, xxxi. 513; Grim- 
shaw, Dublin Quarterly, June, 1873; Anstie, London Practitioner, Sept. 1873. CARDIAC STIMULANTS. 
157 
The property of causing contraction of all unstriped muscular fibres has 
been attributed to digitalis, and whilst the probabilities are certainly such as 
to invite investigation, yet we have no definite knowledge upon the subject. 
Mr. Dickenson (Med.-Chir. Trans., vol. xxix.) claims that it has a powerful 
action in causing the uterus to contract and to arrest hemorrhage,-a few 
minutes after an ounce and a half of the infusion is swallowed in menorrhagia, 
severe pains resembling those of the first stage of labor coming on, with a 
momentary profuse discharge of blood and clots, if there be any present, fol- 
lowed by arrest of the flow for hours. Stadion (Sydenham Soc. Year-Book, 
1862, p. 451) claims that digitalis is capable of temporarily but completely 
annulling the activity of the sexual organs, and that it may be regarded as 
a true anaphrodisiac. M. Gaunot (Philad. Med. Times, iv. 30) makes the 
same assertion, and advises the use of the drug in spermatorrhoea. 
The use of digitalis as a diuretic will be considered under that heading. 
Toxicology.-In poisoning by digitalis, the first symptom of any severity 
is generally vomiting of mucus and bile, very violent and very often repeated. 
At the same time a feeling of heat of the head, disordered vision, and vertigo 
manifest themselves. The pulse at this time in the horizontal position may 
be full and strong and slow, but on the patient's rising becomes weak and 
rapid. The face is pale. The vomiting continuing, profound prostration 
comes on. the pulse becomes feeble, small, irregular, although the beat of the 
heart may be strong and hard. The eyes are very prominent, the pupils fixed 
and dilated: according to Tardieu, an almost diagnostic symptom is the blue 
color of the sclerotic. Abundant salivation sometimes occurs. Intense head- 
ache and pains in the back or limbs are often complained of. Diarrhoea is 
very generally present; the urine may be suppressed. The intelligence is 
often perfect in the midst of profound collapse, but delirium more or less 
violent finally comes on. Death, usually preceded by stupor or by convul- 
sions, takes place most frequently in one or two days, but has occurred as 
late as the tenth day, and as early as three-quarters of an hour.* 
In the majority of cases of digitalis-poisoning the patient recovers. When 
this happens, the symptoms gradually ameliorate. Cardiac weakness, and even 
a bruit de souffle, with more or less exophthalmos, is said to have persisted 
for weeks in some cases. In poisoning by digitalin the symptoms are those 
of rapid digitalis-poisoning,-violent vomiting, intense cephalalgia, and some- 
times rachialgia, irregular, feeble, intermittent pulse, paroxysms of suffocation. 
The minimum fatal dose of digitalis is not known. A large teaspoonful of 
the tincture is said to have caused alarming symptoms in a young puerperal 
* See case reported by M. Barth, quoted by Tardieu. In a case of poisoning by ten 
grammes of tincture of digitalis, said to contain twenty milligrammes of digitalin, the 
symptoms were vomiting, great pain in the head, prostration, a very small pulse,-forty 
per minute,-anuria, and a systolic bruit heard over the whole heart, having its maxi- 
mum intensity at the base. Recovery occurred in two days (M(m. Soc. de Med. de Bor- 
deaux, 1884, 397). 158 
SYSTEMIC REMEDIES. 
woman (Tardieu, Clinique, p. 685, Obs. VIII., Paris, 1867) ; twenty grains 
of the extract proved fatal on the tenth day (Ibid., Obs. VI.); and two and 
a half grammes of the leaves in infusion on the fifth day (Ibid., Obs. X.) ; 
fifty granules (gr. one-fiftieth each?) of digitalin have been recovered from 
(Ibid., Obs. XII., XIV.); about one-fourth of a grain of digitalin (Gazette 
Ilebdomadaire, July, 1874) produced very violent but not lethal symptoms. 
In the only fatal case of digitalin-poisoning I know of (Affaire Couty de la 
Pomerrais'), the amount ingested was unknown. 
The treatment, after the evacuation of the stomach and bowels, and the 
very free administration of tannic acid, as the best, although unreliable, chem- 
ical antidote, should consist in the exhibition of opium, of alcoholic stimulants, 
and rest in the horizontal position. I know of no recorded experiences with the 
antagonistic poisons to digitalis, such as aconite or muscarin. As it is possible 
that whilst so far as the heart is concerned they may be really antagonistic and 
yet may intensify the action of digitalis on the cord, their use requires caution. 
Two cases, one ending fatally, of what may be considered chronic digitalis 
poisoning, have been reported by Dr. Kohnhorn (Lancet, 1876, i. p. 583). 
The symptoms were loss of appetite, tinnitus aurium, vertigo, lowering of the 
rate and force of the pulse, diarrhoea, weakness, general anaemia, and syncopal 
attacks. The only lesion found at the autopsy was congestion with ecchy- 
mosis of the gastro-intestinal mucous membrane. 
Administration.-Digitalis may be given in substance in the form of 
pills; the dose being one grain three times a day, and increased until some 
effect is produced. The solid extract (Extractum Digitalis, U.S.) is less 
reliable than the leaves; its dose is one-fourth of a grain. When a rapid 
action is desired, one of the following officinal preparations, or the digitalin, 
should be used: Infusum Digitalis (1 to 66.6),-dose, one fluidrachm to 
half a fluidounce; Tinctura Digitalis (1 to 6.66),-dose, five to twenty 
drops; Extractum Digitalis Fluidum,-dose, one to two drops. Abstractum 
Digitalis. U. S.-Abstract of digitalis is a good preparation, twice as strong 
as digitalis itself, and to be given in half the dose.* 
In emergencies where single large doses are administered they may be very 
much larger than those here given. Thus, of the tincture two fluidrachms 
or even half an ounce may be exhibited; of the infusion, a wineglassful. 
When digitalis is administered persistently, its first evident influence may 
be suddenly developed after long delay (case, Philad. Med. Times, vol. ii. 
p. 24). It is said that sometimes the first marked symptom of this so called 
cumulative action is severe syncope followed by paraplegia, vomiting, diar- 
rhoea, delirium, general insensibility, and death. Such cases must be ex- 
tremely rare; usually a sudden drop of the pulse is the most serious effect, 
provided that the administration of the remedy be at once suspended. It 
* According to Fraenkel's experiments the most certain preparation of digitalis is the 
vinegar, then comes the infusion, and finally the tincture (Chariti Annallen, 1881, 225). CARDIAC STIMULANTS. 
159 
is a matter of much importance to determine when this cumulative action 
is to be expected. It is probably connected with slow absorption and elim- 
ination, and is much more prone to occur when there is no diuretic effect. 
It is also very apt to appear after tapping; the sudden removal of pressure 
from the vessels leads to the picking up from the tissues of serum,-satu- 
rated, it may be, with digitalis principles,-and also to the rapid absorption 
of any digitalis which may be in the alimentary canal. Dr. T. Lauder 
Brunton and J. Theodore Cash (Land. Practitioner, xxxiii. 272) find 
that high temperature so weakens the cardiac inhibitory apparatus in the 
cat that it will not respond to digitalis, and believe that this direct action 
of the bodily heat is in many cases of fever the reason why digitalis will 
not act. They caution against its too bold use in diseases with a sudden 
defervescence, because when the temperature suddenly falls, inordinate digi- 
talis effects may appear. It should be a general practice in the persistent 
administration of digitalis to occasionally interrupt its use so as to allow a 
clearance of the system. 
Digitalin of commerce is a complex body of various composition, power, 
and even properties. There are two distinct varieties of it, one soluble, the 
other insoluble, in water. Much of the digitalin sold is inert, and especially 
is this true of "digitalin granules." As the preparation is complex, vaiiable, 
and expensive, it has been dropped from the United States Pharmacopoeia, 
and ought not to be used, especially as it has no conceivable advantage over 
the stable preparations of the drug. Even for hypodermic use the tincture 
seems preferable, as the digitalin solution appears to undergo change in a 
few hours, and usually causes more irritation when injected than does the 
tincture. The dose of digitalin is one-fiftieth of a grain. 
Convallaria Majalis.-In 1859 G. F. Walz discovered in this plant 
two active substances, convattarin and convallamarin. Of these the first is 
crystalline, insoluble in water, and, according to the experiments of Dr. W. 
Manne (^Schmidt's Jahrb., Bd. cxxxiv. 166), when taken in doses of three 
or four grains, acts as a simple purgative. The glucoside convallamarin is 
soluble in water, and is the principle to which the plant owes its action upon 
the circulation. Marine found that it kills by a direct action upon the 
heart, and in moderate doses first slows and then quickens the pulse: pre 
vious division of the vagi did not interfere with the development of these 
phenomena. The chief studies upon the physiological and therapeutic action 
of the lily of the valley are those of Prof. Germain See (Bull. de I Acad, de 
Med., No, 27, 1882, p. 767) and of S. Isaew (Hoffmann und Schwalbe's 
Jahrb., 1883, 122, from the Russian). Prof. See finds that in the dog it 
first slows the action of the heart and increases the blood-pressure decidedly, 
the respirations at the same time becoming fuller and a little less frequent. 
If a toxic dose has been given, the heart's beats become very rapid and irreg- 
ular, the arterial pressure still being much above normal; finally, the pressure 160 
SYSTEMIC REMEDIES. 
begins to fall, the cardiac pulsations to grow more feeble, and death occurs 
through syncope. It is stated that the pneumogastric nerves are weakened, 
but never paralyzed, whilst the general nervous system is not affected. In 
man the action of the drug upon the circulation is as in the lower animals, and 
there is said to be usually produced profuse diuresis and sometimes purging. 
In Isaew's experiments upon frogs with convallamarin, the heart was arrested 
in ventricular systole by two milligrammes of the pure convallamarin, the 
frog continuing to live for a long time, the remedy seemingly having no 
effect upon its general nervous or muscular system: isolating the heart had 
no effect upon the action of the poison. In the dog the phenomena of 
convallamarin-poisoning were as described by Prof. See, it being further 
noted that the pneumogastrics were not affected, that the pulse was often 
dicrotic during the stage of rapid cardiac action, and that the final arrest 
was diastolic, the heart-muscle not being able to respond to the most powerful 
galvanic stimulation. Dr. I. Ott has found that the cardiac arrest in the dog 
is systolic {Archives of Med., Feb. 1883). In Drs. Coze and Simon's experi- 
ments the frog's heart was rendered slow and extraordinarily fifil in its beat 
and finally arrested in systole {Bull. Gen. Therap., cv. 494). G. Leubuscher 
{Zeitschr. f. Klin. Med., vii. 582) finds that convallamarin produces in the 
frog progressive palsy, with cramp-like tremblings and death from systolic 
cardiac arrest; in the mammals, violent convulsions and death from dias- 
tolic heart-arrest; that it slows the heart-beat in the mammal, and causes 
arythmical contractions, but in no dose elevates at any time the arterial press- 
ure. The evidence seems to be so contradictory as to suggest that different 
observers have used different principles under the one name. 
The lily of the valley is said to have been long used by the Russian 
peasantry for the relief of dropsy, and in 1880 Drs. Troitzky and Bojojaw- 
lewsky called attention to it as a valuable remedy in cardiac valvular disease, 
especially when associated with dropsy ( Wratsch., 1880, 47). Prof. S^e 
recommends it in palpitation of the heart, in cardiac dilatation, fatty de- 
generation, and other forms of cardiac weakness, also in valvular lesions 
with failing heart-power ; in a word, in the class of cases in which digi- 
talis is now used. When there is dropsy, its very positive diuretic action 
renders it especially valuable, and in some cases it purges freely, probably 
through the convallarin. The value of the remedy has been confirmed by 
Prof. H. Desplats {Journ. des Sciences Med. de Lille, Oct. 1882), and by 
several other practitioners. Although condemned after trial by Dr. B. Stiller 
{Wien. Med. Wochenschrift, Nov. 1882), by Pel {Centralb. f. Therapie, 
1883), by Leyden {Deutsch. Med. Wochensch., Feb. 1883), by Stiller, by 
Jacobi and Lubilinski {Sitzungsb. der Vereins flir inner. Med., 1883), 
by G. Leubuscher; it has been highly praised by Prof. Silvestrini {La 
France Med., October, 1883), and by E. Maragliana {Centralb. f. Med. 
Wwse«s., 1883, p. 43), it should be further studied both physiologically CARDIAC STIMULANTS. 
161 
and clinically. In cases in which it has failed the preparation used may 
have been a bad one. Dr. Marm£ found that the fatal dose of convallamarin 
was, for the dog, 0.015-0.03 gnn.; for the cat, 0.005 grm.; for the rabbit, 
0.006-0.008 grm. Prof. See gives, of an aqueous extract of the whole plant, 
from fifteen to twenty-three grains a day; Bojojawlewsky, each day an infu- 
sion representing from fifty to one hundred grains of the plant. CLASS EV-CARDIAC SEDATIVES. 
There are certain drugs which are used by practitioners to decrease the 
activity of the circulation; and it is these which are here considered under 
the heading of Cardiac Sedatives. Many, in fact all of them, possess other 
powers besides those which cause them to be considered under this caption, 
and none of them are in very close accord in these qualities. There is, however, 
a general resemblance in the action of such as are derived from the vegetable 
kingdom, in that they are all sedatives to the motor-nervous system and yet 
all produce convulsions. I have made an especial experimental study of these 
convulsions (^Philadelphia Medical Times, vol. iii.), and have found that they 
are cerebral and not spinal, because they do not occur in any part of the body 
separated by section of the cord from cerebral influence. Further, they are 
probably due to disturbance of the circulation at the base of the brain, for the 
following reasons, the truth of each of which has been experimentally deter- 
mined : first, lessening of the circulation at the base of the brain will cause 
convulsions; secondly, the convulsions produced by the cardiac sedatives do 
not occur until the arterial pressure is reduced about one-half; thirdly, if the 
disturbance of the cerebral circulation be artificially increased by tying the 
carotids previous to poisoning, or in any other way, the convulsions come on 
sooner and are more violent; fourthly, in some animals the convulsions caused 
by arresting circulation at the base of the brain are feeble and ill defined, whilst 
in others they are violent, and I have found that in species of the first order 
cardiac sedatives produce but slight convulsions, whilst in species of the 
second order they cause violent convulsions. 
The indications for the use of a cardiac sedative may be said to be increased 
arterial excitement, sthenic fevers, and severe local inflammations. In ordei 
that a rational selection of the various drugs may be made for any individual 
case, it is necessary to study how, in these various conditions, relief is afforded 
by an arterial sedative. When there is arterial excitement from irritation, 
or excitement of the heart, the mode of relief is too obvious to need discus- 
sion. It is plain that in such a case a drug should be selected which simply 
depresses the heart's action and does nothing more. In sthenic fever the 
case is different; here it is desirable to relax the peripheral vessels and to pro- 
mote a flow of blood to them, whilst the rapidity and force of the circulation is 
diminished. A drug which depresses the action not only of the heart but also 
of the superficial vaso-motor nerves is here indicated, and if to these powers 
162 CARDIAC SEDATIVES. 
163 
is added a special one of stimulating the perspiratory glands, the most perfect 
remedy is obtained. With inflammation the effect desired is a lessening of 
the flow of blood to the part. A simple cardiac sedative may do this, by 
lowering the force of the circulation, but a cardiac vaso-motor sedative is far 
more powerful. The blood-vessels of the inflamed part are already dilated, 
and consequently attract blood, as it were, to the part. If the remedy dilates 
all of the blood-vessels this local attraction ceases, and blood is diverted from 
the inflamed tissue. It would appear from the experiments of Ludwig, 
Schiff, and others (La Nazione, Aug. 1872), that the blood-vessels, after 
complete dilatation, are able to hold twice the normal amount of blood, and 
Golz, quoted by Fothergill {British Med. Journ., 1873), found the intestinal 
vessels were able to contain all of the blood of the body. These facts show 
how by means of an arterial sedative, which paralyzes the vaso-motor centres, 
" we can bleed a man into his own blood-vessels," or, in other words, get 
much of the effect of a venesection by drawing blood from the diseased part. 
ANTIMONY. 
ANTIMONII OXIDUM. U. S.-OXIDE OF ANTIMONY. 
A grayish-white powder, insoluble in water, wholly soluble in muriatic or 
tartaric acid. It is prepared by dissolving the sulphuret of antimony in 
muriatic acid, adding nitric acid, and precipitating with water of ammonia. 
Its solution in the stomach is dependent upon the acid there present, and 
consequently, being uncertain in its action, it should not be used internally 
-although it is capable of producing all the effects of tartar emetic, for the 
preparation of which it was introduced into the Pharmacopoeia. Antimonii 
Sulphidum, U. S., Antimonii Sidphidum Purification, U. S., and Antimonii 
Sulphuratum, U. S., are still more uncertain preparations, whose therapeutic 
use ought not to be encouraged. 
ANTIMONII ET POTASSII TARTRAS. U. S.-TARTRATE OF 
ANTIMONY AND POTASSIUM. 
Tartar Emetic is prepared by boiling the oxide of antimony in a solu- 
tion of bitartrate of potassium. It occurs in the form of a white powder, 
the result of the pulverization of transparent, colorless, slightly efflorescent 
crystals, which are most commonly rhombic octahedrons. Its taste is vari- 
ously described: to me it is at first very slight, but after a time styptic and 
acrid. In some persons it blisters the tongue and lips after a few moments 
of contact. Tartar emetic is insoluble in absolute, but soluble in dilute alco- 
hol, soluble in from two to three parts of boiling water, and in from twelve 
to fifteen parts of water at ordinary temperatures. It is incompatible with 
alkalies and with acids, including tannic acid and substances containing it. 
Physiological Action.-Locally applied, tartar emetic is an irritant, 
acting upon some very delicate and susceptible skins in a very short time. SYSTEMIC REMEDIES. 
164 
In most instances, however, its continuous application for several days is 
necessary to produce any effect. At first there is simply a redness, accom- 
panied by some burning pain and the eruption of small papules, which shortly 
become converted into vesicles and then into pustules. These are irregular 
in shape and size, varying from one-eighth of an inch to an inch and a half 
in diameter, and are very painful. Sometimes these pustules give rise to 
small sloughs, but generally, if the application be withdrawn, they simply 
give origin to superficial ulcers, which readily heal. 
The only symptoms which are induced by small therapeutic doses (one- 
twelfth of a grain) of tartar emetic when exhibited for a short time are a 
scarcely perceptible diminution of the force of the pulse and an increase of 
the perspiration. 
By somewhat larger amounts of the drug, nausea is induced, and is accom- 
panied in a more decided degree by the phenomena just mentioned. After 
large doses, prolonged nausea, violent vomiting and retching, with marked 
reduction of the force of the pulse, great muscular relaxation, and a feeling 
of faintness, occur. At the same time the saliva is generally increased in 
amount, and the skin is bedewed with sweat. 
After poisonous doses all these symptoms are intensified. The vomiting is 
violent, repeated, continuously re-excited by the slightest provocation, and is 
accompanied by burning in the oesophagus and stomach and by colicky pains 
in the abdomen. The matters vomited are first mucus, then mucus and bile, 
and finally, in some cases, blood. With the gastric disturbance occurs violent 
and frequent serous purging, the discharges resembling those of cholera, but 
becoming in some cases towards the last bloody. Cramps may occur in the 
extremity, and, in conjunction with the serous purging, have caused the anti- 
monial poisoning to be mistaken for cholera. The exhaustion is extreme, 
and finally ends in collapse, with thready or imperceptible pulse, pinched, livid 
countenance, suppressed voice, profuse cold sweats, lowered temperature, and 
at last death from asthenia, generally preceded by stupor or convulsions: 
indeed, Taylor reports cases in which wild delirium was present some hours 
before death. The urine* in mild cases is increased in quantity, as it is 
also in the beginning even in fatal cases, but in such towards the close it is 
generally scanty and bloody, and even suppressed. C. Giithgens found, in 
some incomplete experiments, an increase of the elimination of urea after 
repeated non-toxic doses of antimony {Centralbl. Med. Wiss., 1870, 321). 
It is evident that the symptoms just enumerated can be best studied 
in detail under several heads. Before entering upon this, however, it is 
well to premise that the experiments of Viborg {Stille s Therapeutics, vol. 
* What is said in the text is, I think, correct; although authorities differ on this point. 
Trousseau (Traiti thirapeutique, 4th ed., vol. i. p. 619) affirms that it is suppressed; 
Husemann, that it never is suppressed (Toxicologie, p. 854); Tardieu, that it is scanty. 
For a case in which it was suppressed, see Taylor's Medical Jurisprudence, London, 1873, 
V. 309. CARDIAC SEDATIVES. 
165 
ii.), Buchheim, Courten (Ibid.f Magendie (Ibidl), Ackermann ( Virchow's 
Archiv, Bd. xxv. p. 531), Richardson (London Lancet, May, 1856), Nbbi- 
ling (Schmidt's Jahrbiicher, Bd. cxl. p. 24), and Radziejewski (Reichert's 
Archiv fur Anatomic, 1871), and of others, have demonstrated that tartar 
emetic acts upon the lower animals precisely as on man. 
Circulation.-When a sufficient dose of tartar emetic is injected into the 
frog (Radziejewski, Ackermann, Nbbiling), the cardiac contractions in a 
very short time are lessened in frequency and force, and become irregular, 
the auricles pulsating more frequently than the ventricles, until finally arrest 
occurs in diastole. After death the irritability of the cardiac muscle to 
ordinary stimuli is almost, or more frequently entirely, destroyed; but in 
the recent experiments of I. Soloweitschyk (Arch. Exper. Path. u. Pharm., 
xii. 440), digitalis placed upon the paralyzed heart caused it to recommence 
its action; evidence that it is rather the excito-motor ganglia than the 
muscle fibre which is affected by the antimony. Upon the heart of the 
mammal the drug acts as upon that of the frog. According to the researches 
of Ackermann and of Ernst Sentz (Experimenta de Ratione Interpulsus, etc., 
Diss. Inaug., Dorp. Livon., 1853), the arterial pressure always falls steadily 
and to an extreme degree. The pulse sometimes seems accelerated at first 
but in the great majority of cases is decreased very decidedly in its rate. 
During this period of slow pulse the diastolic pauses are extremely long, but 
the individual beat will influence the mercurial column of the cardiometer 
five times as much as normal. After a while the pulse suddenly becomes 
very rapid, the force of the heart-beat is almost completely lost, the arterial 
pressure falls to a minimum, and in a very few moments diastolic arrest 
occurs. It is evident that the action of antimony upon the heart is a direct 
one. The irritability of the muscle is lost, and Ackermann has found that 
the cut-out heart of the frog is affected by the solution of tartar emetic; 
further, the experiments of Radziejewski have proven that the peripheral 
ends of the vagi in antimonial poisoning are early more or less completely 
paralyzed, so that the diastolic arrest cannot be due to excitation of the 
inhibitory apparatus.* The depression of the heart-muscle power does not 
seem, however, to be the sole cause of the lowering of the blood-pressure, 
for Soloweitschyk has found that galvanization of the vaso-motor centre 
with a powerful current is powerless to produce any elevation of the arterial 
pressure at a time when the heart still responds to stimuli. The conclusion 
is reached that antimony lowers arterial pressure by a direct action upon 
* Perhaps the present is as fitting as any other position to notice the theory of Nobiling, 
that the action of tartar emetic upon the heart is owing to the potash it contains. This 
theory in itself is so improbable that it would seem scarcely worthy of discussion, were it 
not for the fact that Nobiling asserts that the tartrate of antimony and soda is not poi- 
sonous. Dr. Radziejewski (Zoc. cit., 485) has repeated and extended the experiments of 
Nobiling and completely disproved both the asserted fact and the theory based upon it 
showing that the soda-salt is as poisonous as the potash-salt. 166 
SYSTEMIC REMEDIES. 
the heart and the vaso-motor system, and that it is probably the peripheral 
portions of the latter system which are affected. 
Nervous System.-A prominent symptom in antimonial poisoning is 
paralysis, affecting to an extraordinary degree the sensory and to a less extent 
the motor system. In man the anaesthesia which occurs in animals has been 
overlooked, but in the advanced stages of poisoning it is no doubt present. 
Radziejewski and Soloweitschyk have found that the depression of reflex 
activity occurs after section of the cord, and is therefore not due to 
stimulation of the Setschenow inhibitory centre; that it is not prevented 
by tying an artery and cutting off access of the poison to the nerve, and is 
therefore not peripheral. It consequently must be spinal, and as both ob- 
servers noted that in the frog and the rabbit voluntary movements persist 
after the total abolition of sensibility and of reflex activity, the conclusion 
is reached that antimony is a paralysant to the receptive centres or sensory 
tract of the spinal cord. 
Radziejewski states that sensibility is first lost towards thermic and 
chemical irritants, and then towards tactile stimuli. The motor nerves and 
muscles are said to retain their functional power. 
Temperature.-The influence of antimony upon the temperature appears 
not to be very marked when the drug is exhibited in ordinary therapeutic 
doses. Thus, Ackermann found that, after doses severe enough to induce 
violent vomiting, no alteration in the temperature could be discovered by 
the thermometer under the tongue. Owing no doubt to the disturbance of 
nervous and arterial action, there is in these cases, however, a very marked 
reduction of the temperature of the extremities. Thus, in the cases just 
alluded to (Ackermann) the heat of the hands was lowered from 0.2° C. to 
3.5° C. in various persons. This decrease of the temperature is certainly 
in a measure due to increase of the heat evolution. 
After poisonous doses of antimony the decrease of animal heat is very 
perceptible, provided the victim live sufficiently long. Thus, in Ackermann's 
experiments a fall of only 1.6° C. occurred in rabbits killed in the hour, but 
in those that lived five hours the depression amounted to 6.6° C. 
Abdominal Organs.-It cannot be gainsaid that tartar emetic acts as an 
irritant upon the alimentary mucous membrane. Although cases (Archives 
Geidrales, Sept. 18G5) have been reported in which no lesion has been 
found in the stomach or bowels after death from antimony, yet in the great 
majority of instances very decided indications of violent inflammation have 
been present. 
Dr. Radziejewski, on the strength of this action, and of two experiments 
in which he found the greater portion of the ingested antimony in the vomit 
of the patient, has advanced the theory that the emesis is due to a local action 
of the drug. The persistent nausea, however, certainly indicates that the 
remedy does not act like the so-called mechanical emetics. Further, the 
vomiting induced in the experiment of Magendie, of replacing the stomach CARDIAC SEDATIVES. 
167 
of an animal by a bladder and giving tartar emetic, would seem at first 
sight to settle the point completely. This experiment of Magendie has 
been confirmed by Brinton (Cyclopaedia of Anatomy, Supplement, p. 319; 
London Lancet, 1853, vol. ii. p. 599), who further proved that when tartar 
emetic was injected into the vein of an animal it was very freely and rapidly 
eliminated by the stomach. Dr. B. W. Richardson (London Lancet, vol. i., 
1856) has corroborated this, and has also found that a similar elimination 
follows the inhalation of antimonietted hydrogen. I think, therefore, it 
must be conceded-first, that the finding of even a large quantity of anti- 
mony in the vomit does not prove that its action on the stomach is chiefly 
a local one; secondly, that the emesis is certainly preceded by at least a 
partial absorption. This would seem to show that the emesis is purely 
centric. The experiments of Mooso (Schmidt's Jahrbucher, Bd. 169, p. 
236), on the other hand, indicate that the local action of the drug is a 
powerful factor in the production of the vomiting. It was found that 
when tartar emetic was administered by the mouth vomiting was caused 
by smaller quantities and more promptly than when injected into the veins; 
also that, after section of the peripheral vagi in the abdomen, a reverse 
relation existed between the two methods of administration. If these ex- 
periments be, as they appear,-correct, tartar emetic must cause vomiting partly 
by an action on the centres and partly by a local influence upon the stomach. 
The purging induced by tartar emetic is seemingly an effort at elimination. 
Respiratory Organs.-The respiration in poisoning by antimony is very 
irregular, with all sorts of variations in the rhythm of the act. In the 
advanced stages the pauses are often very long, and the inspiration and 
expiration so forced and prolonged that very generally, in animals at least, 
marginal emphysema and subpleural ecchymoses are found after death. 
The origin of the respiratory trouble is probably somewhat complex, the 
chief factor being the direct influence of the drug upon the respiratory 
nerve-centres, and minor causes the intense venous congestion due to the 
failure of the circulation, and the alteration of the blood itself. Upon 
the mucous membrane of the lungs antimony acts directly or indirectly, 
even in moderate doses, as is shown by clinical experience and by the experi- 
ments of Mayerhofer (Nothnagel's Arzneimittellehre, Berlin, 1870, p. 219). 
Therapeutics.-There are three indications to meet which tartar emetic 
is constantly employed. The first of these it fulfils by virtue of its powers 
as an emetic. The discussion of this may be found in the chapter upon 
Emetics. 
The second purpose for which antimony is used is to depress arterial 
excitement. It is chiefly in inflammation that tartar emetic is used as an 
arterial sedative. In combination with more decided diaphoretics it is con- 
stantly employed by some surgeons in fever after operations, in gonorrhoea, 
and in various sthenic inflammatory affections. In pneumonia it has been 
very largely used, forming an essential portion of the older plan of treating 
that disease. According to the method of Rasori, four or five grains a day 168 
SYSTEMIC REMEDIES. 
were at first given, but rapidly increased to twenty-four or even thirty grains 
daily. Although by the aid of opiates and careful dilution a species of tol- 
erance was often obtained for these heroic doses, yet very properly the plan 
has been abandoned by modern therapeutists. As tartar emetic if adminis- 
tered in sufficient quantity to depress markedly the circulation causes generally 
intense nausea and often purging, I think it is inferior to aconite or veratrum 
viride when it is desired to depress the circulation very decidedly in pneu- 
monia or any other disease. 
Owing to its action upon the mucous membrane of the bronchial tubes, in 
the first stages of bronchitis tartar emetic is an invaluable remedy. After 
free secretion has been established, other expectorants are, I think, of more 
service. The value of antimony as a diaphoretic depends largely upon its 
action on the circulation. Minute doses of it are constantly employed to 
increase the efficiency of fever-mixtures. It must always be borne in mind 
that it is a powerful depressant, and is therefore to be employed only in 
sthenic cases. • 
As a counter-irritant, tartar emetic is used only when it is desired to pro- 
duce a slow, persistent, and at the same time very decided impression. For 
further discussion of its application to disease, see chapter on Rubefacients. 
Toxicology.-The general symptoms produced by poisonous doses of 
antimony have been sufficiently described. There is, however, according to 
authors, a form of antimonial poisoning in which neither vomiting nor 
purging* occurs, the symptoms being simply intense prostration, cold clammy 
sweat, a sense of oppression in the chest, with the respiration at first in- 
creased, then diminished in frequency and embarrassed; a rapid feeble 
pulse, after a time becoming slow, intermittent, and irregular; delirium, un- 
consciousness, tremblings, and clonic and tonic convulsions (Husemann, 
Toxicologic, p. 853). 
Tardieu (Joe. cit., p. 608) states that in some cases of tartar emetic poison- 
ing a rash exactly resembling that produced by the external application of 
the drug has appeared all over the body on the fourth or fifth day. 
As already stated, in the vast majority of cases there are to be found, after 
death from antimonial poisoning, very decided traces of inflammation of the 
stomach and bowels; in some cases, however, these appear to be wanting. 
The venous system is generally very much engorged, and the viscera are 
intensely congested. Magendie asserted that in animals poisoned by tartar 
emetic the lungs are always full of portions apparently hepatized; but Ack- 
ermann (Joe. cit., p. 544), in twenty experiments, found only some marginal 
emphysema and subpleural ecchymoses, with, in one or two cases, spots of 
atelectasis in the lungs. The assertion of Magendie, therefore, is too sweep- 
ing; but it is true that, in a large proportion of fatal cases of antimonial 
* Husemann states this. Although vomiting is absent in these cases, purging is gener- 
ally present. I do not remember to have seen the report of a case in which it was absent. CARDIAC SEDATIVES. 
169 
poisoning, emphysema, pulmonary apoplexy, atelectasis, or other structural 
lesions of the lungs exist. The blood usually coagulates imperfectly. 
Dr. Saikowsky ( Virchows Archiv, Bd. xxxiv. p. 78, 1865), of Moscow, 
has found that when animals are fed upon antimonic acid (one-half to one 
gramme daily) or other preparations of the metal for from fourteen to nine- 
teen days, the liver, kidneys, and even the heart undergo a fatty degenera- 
tion ; also that there is a lessening of the amount of glycogen in the liver, 
and in some cases even a total disappearance of it. This has been confirmed 
by Profs. Grohe and Mosier, who state that in the duchy of Brunswick the 
peasantry give to the geese, when producing the famous fatty livers, a certain 
quantity of the white oxide of antimony every day. 
The minimum fatal dose of tartar emetic is not known. Three-quarters of 
a grain in a child, and two grains in an adult, have proved fatal; but in the 
latter case extrinsic circumstances favored the result (Taylor, Guy's Hospital 
Reportsy Oct. 1857, an analysis of thirty-seven fatal cases); two hundred 
grains have been recovered from (case, Taylor s Medical Jurisprudence, 1873, 
p. 309) ; also one hundred and seventy grains (H Y. Med. Rec., xxiv. 401). 
Chronic Poisoning.-According to Mayerhofer (Heller's Archiv, 1846, 
quoted by Taylor), the symptoms following the criminal administration of 
small doses of tartar emetic at intervals are nausea, mucous and bilious 
vomiting, watery purging, often followed by constipation, small frequent 
pulse, and asthenia, deepening into death from exhaustion. 
The treatment of antimonial poisoning consists in washing out the ali- 
mentary canal with large draughts of tannic acid,-the best known antidote, 
-and in the use of opium and of internal and external stimulants. 
Administration.-The sudorific dose of tartar emetic is one-twelfth of 
a grain, the emetic dose one-half to one grain, repeated every twenty minutes 
as necessary. The Antimonial Wine ( Vinum Antimonii, U. S.) contains two 
grains of tartar emetic in the ounce. The emetic dose is half a fluidounce. 
The Unguentum Antimonii (tartar emetic, one part in five) is employed ex- 
ternally, as a counter-irritant. A small quantity is spread upon a linen rag 
and laid upon the skin, or a little of it may be well rubbed in twice a day. 
Whenever it is persistently used, there comes on, sooner or later, a peculiar 
burning or tingling pain, which is very shortly followed by pustulation. The 
effect of the drug is very persistent as well as severe, so that the remedy is 
applicable only to a few cases in which an action of the kind spoken of is 
required. Care must be exercised not to continue the application too long, 
lest severe and obstinate ulceration be produced. 
VERATRUM VIRIDE. U.S. 
The root-stock of Veratrum viride, a coarse perennial herbal plant, indige- 
nous to the Northern United States. It is a large tapering rhizome, an inch 
or two in length, less than an inch in thickness at the base, and having a 170 
SYSTEMIC REMEDIES. 
bitter acrid taste. It contains two alkaloids, jervia and veratroidia, which 
are so closely associated with the resin as to be separated from it with great 
difficulty. The nature of these alkaloids has been the subject of much dis- 
cussion among chemists. Mr. Charles Bullock was, I believe, the first to 
separate them one from the other, and to prove the inertness of the resin. 
In accordance with the belief of Mr. Bullock that these alkaloids were dis- 
tinct from all previously discovered, Dr. George B. Wood named them viridia 
and veratroidia. Dr. Peugnet subsequently showed that viridia was identi- 
cal with jervia, previously described by Simon, from veratrum album. Mr. 
Mitchell (Proc. Amer. Pharm. Assoc., 1874) confirmed this, and concluded, 
with Peugnet and Bullock, that veratroidia is distinct from veratria. Re- 
cently (Amer. Journ. of Pharm., 1876, p. 1) Prof. Wormley has arrived at 
the conclusion that veratroidia is identical with veratria. Without intending 
to deny the conclusions of Prof. Wormley, I shall, in the present edition, 
allow the text of the old edition to stand, so far as concerns the names 
employed to represent the two alkaloids of veratrum viride. Jervia is so 
closely united with the inert resin that it is separated from it with great 
difficulty. 
Physiological Action.-In treating of the physiological action of vera- 
trum viride, I shall first speak of the effects of its alkaloids singly. When 
an animal is poisoned with jervia, the first symptom manifested is slug- 
gishness, as shown by a disposition to be quiet, accompanied by distinct signs 
of muscular weakness. In a little while peculiar rapidly-repeated thrills run 
through the muscular system, so that the animal trembles violently. After 
a greater or less length of time the animal becomes unable to stand, from 
weakness, and at or before this period violent convulsions appear,-general 
clonic spasms without rigidity. The convulsions alternate with intervals of 
relaxation, and as the animal grows more profoundly prostrated are less severe, 
but they continue in most cases up to death. Even when they are most vio- 
lent, force is evidently wanting. The animal is totally unable to raise himself 
from the ground; the pigeon drives himself forward upon his breast, the rabbit 
pushes himself along on his belly, or lies upon his side and kicks into the 
air. Sensation appears to be benumbed only very late in the poisoning, and 
consciousness is preserved almost to the last. The pupils are not affected. 
There is no purging or vomiting, but always profuse salivation. Respiration 
ceases before cardiac action, so that death probably takes place from asphyxia. 
The circulation is profoundly affected. The pulse is generally, if not 
always, lessened in frequency, provided the animal Le quiet. When there 
are convulsions, or even when the tremors are marked, it becomes very rapid. 
The arterial pressure is greatly lowered, falling progressively from the begin- 
ning to the end of the poisoning. The force of the individual beat appears 
not to be much altered at first. 
In an elaborate series of experiments (Philadelphia Medical Times, vol. 
iv.) I found that jervia had little or no effect on the pneumogastric nerves, CARDIAC SEDATIVES. 
171 
since it acts as usual after those nerves have been cut, and galvanization of 
the par vagum in animals profoundly affected by the poison produced the 
usual cardiac results. Further, when the cord was cut very high up, so as to 
paralyze the accelerators, jervia still lessened the pulse-rate. As it was also 
proven that the alkaloid lessens the arterial pressure after division of the cord, 
i.e., after vaso-motor paralysis, and also that it paralyzes the heart of the frog 
or turtle when placed directly upon it, it follows that jervia lowers the force 
and frequency of the cardiac beats independently of its nerves, by a direct 
action on the cardiac muscle or its contained ganglia. When the nerve-trunks 
were galvanized in an animal poisoned with jervia, although the pain-cries 
showed that the afferent nerves were not paralyzed, little or no rise occurred 
in the arterial pressure. It seems, therefore, that the jervia acts not only on 
the heart, but is also a powerful depressant to the vaso-motor nerve-centres. 
In frogs, as well as in the higher animals, poisoned with jervia, there is a 
very marked diminution and finally abolition of reflex activity; and, as the 
functions of neither peripheral nerves nor muscles are interfered with, it is 
evident that the alkaloid is an intensely powerful spinal depressant. The 
convulsions are cerebral in their origin, as they do not occur below the 
point of section when the spinal cord is divided.* Locally, jervia is very 
feebly if at all irritant. 
The general symptoms induced by veratroidia resemble those caused by its 
congeneric alkaloid, but it is decidedly more irritating than the latter, and 
always induces vomiting, and occasionally purging. In poisoning by it there 
are in most cases some muscular twitchings, and finally marked convulsions, 
but neither of these ?.re so severe and so repeated as in the case of viridia. 
Death takes place from asphyxia, due to paralysis of the respiratory muscles. 
Upon the spinal cord, the peripheral nerves, and the ■muscles, veratroidia 
acts very much as does jervia, being a decided spinal depressant. 
The action of veratroidia upon the circulation is a very curious one. 
After a hypodermic injection of the poison the rapidity of the pulse and the 
arterial pressure are at first decidedly lessened. After a time, the pulse still 
remaining very slow, the individual heart-beats become endowed with a force 
greatly beyond normal, and the arterial pressure becomes normal; then sud- 
denly the pulse-rate becomes very rapid, the individual cardiac beats losing 
much of their extraordinary vigor, but the arterial pressure rising nearly 
fifty per cent, beyond its original position. 
When the alkaloid is thrown directly into a vein, these phenomena are 
intensified and abbreviated. I have seen the arterial pressure fall to zero in 
thirty seconds, and in one and a quarter minutes rise to 165 (110 normal) 
centimetres. The rise is not due to a direct action of the drug, but to the 
* Some of the conclusions of my first investigation {American Journal of the Medical 
Sciences, 1870) of this drug were called in question, but I have in my last paper gone 
over the whole ground afresh. The earlier discussion may be found in the Philadelphia 
Medical Times, vols. ii. and iii. 172 
SYSTEMIC REMEDIES. 
sudden asphyxia which it induces, since it does not occur if free artificial 
respiration be maintained (^Philadelphia Medical Times, vol. iv.). 
When artificial respiration is kept up, veratroidia steadily lessens both 
arterial pressure and pulse-rate When the par vagum has been divided, 
artificial respiration being maintained, veratroidia is powerless to reduce the 
pulse-rate, and when the pulse-rate has been reduced by the drug in the un- 
injured animal, division of the par vagum is followed by an enormous rise 
in the number of cardiac beats per minute. These facts certainly prove that 
veratroidia is a powerful stimulant to the inhibitory nerves of the heart. 
Moreover, I have found that when the spinal cord is divided so as to paralyze 
the antagonists to the par vagum, a minute dose of the poison (one-thirtieth 
of a grain) will at once produce diastolic arrest of the heart's action, but if 
the pneumogastrics be now severed, and the repressive force thus taken off, 
the relaxed, seemingly dead viscus recommences its beat. The slow pulse 
of mild veratroidia-poisoning becomes rapid when a large dose of the poison 
is injected. Further, after a large dose division of the pneumogastrics has 
no effect upon pulse-rate, and the most intense galvanic current applied to 
the peripheral ends of the divided nerves is powerless to affect the viscus. 
Evidently, large doses of veratroidia paralyze the cardiac inhibitory apparatus, 
whilst small ones stimulate it intensely. The paralysis is certainly peripheral; 
whether the stimulation is centric or peripheral has not as yet been deter- 
mined. When enormous doses of veratroidia are thrown directly on the 
heart by venous injection, they at once kill the cardiac muscle. Upon the 
vaso-motor nerves veratroidia in mod?rate toxic amounts has no demonstrable 
iafluence. Dr. F. Reigel (^Pfiuger's Archiv, 1871, p. 409) has demonstrated 
that the rise of arterial pressure whi?h occurs in asphyxia is largely due to 
vaso-motor spasm. In viridia-poisoning asphyxia has very little influence 
upon the arterial pressure, because the vaso-motor centres are paralyzed; in 
veratroidia-poisoning the slightest intermission in the working of the bellows 
of the apparatus for artificial respiration is followed at once by an enormous 
rise of the mercury in the cardiometer, conclusive proof that the vaso-motor 
centres are not seriously affected. This deduction I have experimentally 
corroborated by galvanization of a sensitive nerve: always, unless an enormous 
amount of the alkaloid had been given, the rise in the arterial pressure was 
marked and immediate. In estimating the physiological action of veratroidia 
it must be borne in mind that artificial respiration was maintained during the 
study of the action of the drug on the heart and vaso-motor centres; that 
its influence on the respiratory centres is so intense as to overbalance its car- 
diac action, and, when the animal is left to itself, to cause death before any 
very decided influence has been exerted on the heart. The action of the 
alkaloid may, therefore, be summed up as follows: it is a powerful respira- 
tory poison, lessening at first the frequency of the cardiac beat by stimulating 
the pneumogastrics, but soon losing all control over the heart, owing to the 
powerful i fluences which the induced asphyxia exerts. CARDIAC SEDATIVES. 
173 
The resin of veratrum viride, when completely deprived of the alkaloids, is 
nearly inert. It seems, however, to be irritating to the digestive organs, and 
very probably aids in the production of the vomiting occasioned by full doses 
of the drug. 
As the action of the alkaloids of veratrum viride is very similar, and as 
they are the only active principles of the drug, it is very easy a priori to 
determine what the influence of the drug will be. Sufficiently numerous 
experiments* have been performed with the crude drug, or its preparations, 
to show that it acts upon the lower animals as upon man; but it is not 
necessary here to do more than allude to them. When taken in small 
doses by man, veratrum viride first reduces the force without much lessening 
the frequency of the pulse, but after a time the pulse falls very much in 
rapidity, sometimes, according to Dr. Norwood, even to thirty-five a minute. 
If any exertion be made during this stage of depression, the slow pulse will 
be suddenly converted into an exceedingly rapid one. The slow pulse is 
sometimes moderately full, but is always very soft and compressible; the 
rapid pulse is exceedingly feeble and small, often thready, and may become 
imperceptible. Severe nausea and vomiting accompany or follow the reduc- 
tion of the pulse-rate. That the latter is not due to gastric disturbance is, 
however, shown by the fact that it often precedes the stomachic symptoms, 
and may exist without them. Thus, Prof. Percy states that he has seen the 
pulse reduced to thirty per minute without nausea being induced. During 
the stage of depression there is always decided muscular weakness and 
relaxation. 
After a poisonous dose the symptoms above noted are increased in inten- 
sity and become very alarming. A running, almost imperceptible pulse,- 
a cold, clammy skin,-intense nausea, and incessant attempts at vomiting, or 
retching, or hiccough,-absolute muscular prostration,-faintness,-vertigo, 
-loss of vision, and semi-unconsciousness, make up the group of extreme 
symptoms. Various observers also speak of an excruciating praecordial pain ; 
but this I have not seen. 
From these symptoms, with what has already been said in regard to the 
alkaloids, it follows that veratrum viride is a powerful spinal and arterial 
depressant, exerting little or no direct influence upon the cerebral centres. 
In full therapeutic doses it lowers the pulse-rate both by a direct action on 
the muscle (jervia) and by stimulating the inhibitory nerves (veratroidia); it 
diminishes the force of the heart-beat by a direct influence on the cardiac 
muscle (jervia), and produces a general vaso-motor paralysis (jervia) more 
or less complete according to the size of the dose.f Under its action the 
* See especially a paper by Prof. S. R. Percy, Transactions of the American Medical 
Association. Reprinted as pamphlet, 1864. 
f Prof. S. R. Percy states that a dilatation of the blood-vessels of the frog's web and 
bat's wing can be readily seen by the microscope to follow the administration of the 
drug. 174 
SYSTEMIC REMEDIES. 
functional activity of the skin is greatly increased; but, as this is a neces- 
sary result of the profound arterial depression, there is no reason for believing 
that the drug has any specific influence upon the perspiratory glands. In a 
similar manner the excretion of bile is often indirectly increased by veratrum 
viride, through the severe vomiting which it induces. 
American hellebore undoubtedly lowers animal temperature very decidedly, 
but whether directly or indirectly has not been determined. I have fre- 
quently seen it reduce the bodily heat, and M. Linou (Gazette Medicale de 
Strasbourg, quoted in the Bulletin Therapeutique, 1869, tome Ixxvi. p. 95) 
states that it does so, but not so certainly as it lowers the pulse. Oulmont 
(Bulletin Thlrapeutique, 1868, tome Ixxiv. p. 153) asserts, as the results of 
his experiments, that in animals from half an hour to two hours after the 
administration of such doses as would produce violent symptoms without 
killing, the temperature fell 2°, 3°, or even 5° (C. ?), and remained at this 
point for twenty-four hours. 
Therapeutics.-With our present knowledge of the physiological action 
of veratrum viride, it is evident that there are only two rational indications 
for its use, namely, to reduce spinal action and to reduce arterial action. 
Owing to the very great effect veratrum viride has upon the circulation, and 
the numerous drugs which are purer spinal depressants, it is never called for 
to meet the first indication, and in practice should simply be used to lessen 
the force of the circulation. The use of the drug in typhoid fever and other 
adynamic diseases is simply an irrational and dangerous practice, founded 
upon an erroneous idea of the action of the remedy. 
Veratrum viride has been recommended in mania a potu; and in cases of 
irritation of the brain from drink, with strong bounding pulse, it may be of 
great service; but in the true delirium tremens, with universal adynamia, it 
is a thoroughly improper remedy, capable of deepening the prostration into 
fatal exhaustion : indeed, I have known of death occurring in this disease from 
its use. 
When true sthenic arterial excitement is to be combated in any disease, 
except it be gastritis, veratrum viride may be employed as a prompt, thor- 
oughly efficient, and at the same time very safe remedy,-very safe, since it 
is almost incapable of producing death in the robust adult, unless used with 
great recklessness and in repeated doses. In the early stages of sthenic pneu- 
monia it offers, I believe, the best known method of reducing the pulse-rate 
and the temperature, and of ameliorating the disease.* It is hardly neces- 
sary to mention other individual diseases in which veratrum viride may be 
employed to carry out the present indication. 
In peritonitis its tendency to cause vomiting is very much against its use, 
and, unless this action can be controlled, should interdict its employment. I 
desire, however, to call attention to its value in preventing inflammation after 
* Compare Oulmont, Bulletin Thtrapeutique, t. Ixxiv. p. 146, and MAI. Zuber and H. 
Hirtz, Ibid., t. Ixxvi. p. 468. CARDIAC SEDATIVES. 
175 
severe abdominal injuries,-indeed, after any severe injury. Thus, I am 
cognizant of the case of a woman whose belly was torn open by the horn of a 
bull; the abdominal walls were rent for about six inches, and the sigmoid 
flexure of the colon came out and was dragged in the dirt. It was washed, 
replaced, the wound sewed up, the patient restricted to low diet, and veratrum 
viride administered very carefully so as to keep the pulse as depressed as 
possible and at the same time to avoid vomiting, to aid in which opium was 
also given. Recovery without a bad symptom resulted.* 
As an emetic, veratrum viride should never be employed. 
In chronic cardiac diseases it may be used in precisely those cases in which 
digitalis is contra-indicated,-i.e., where there is excessive hypertrophy. 
The contra-indications to the use of veratrum viride are cardiac weakness 
and the existence of general adynamia. 
Toxicology.-Although veratrum viride is a remedy of great powei, 
capable of producing the most alarming symptoms, yet I believe it to be the 
safest of all the cardiac depressants; certainly it is far less dangerous than 
aconite. Overdoses of it produce vomiting so soon and so certainly that it is 
somewhat doubtful whether a robust adult could be killed by a single dose of 
any of its officinal preparations, especially if prompt and judicious treatment 
were afforded. I have several times known a teaspoonful of its fluid extract 
to be taken ; and Prof. Percy cites recoveries after the ingestion of a tumbler- 
ful of the tincture; after thirty grains of the resinoid; after two doses-a 
tumblerful each-of a syrup representing a pound of the root to the pint. 
A feeble child, eighteen months old, was killed by thirty-five drops of the 
tincture jim. Jour. Pha/rm., 1865); and a doubtful case of fatal poisoning 
in the adult is mentioned in Med. Surg. Rep., vol. xl., 372. 
I have seen the most alarming symptoms result from large medicinal doses 
repeated at short intervals, and have been astonished at the rapidity with 
which they yielded to treatment; but Dr. J. D. Blake reports (American 
Medical Weekly, No. 20,1874) a death resulting from the administration of 
between three and four drops of Norwood's tincture every two hours to a 
babe eleven months old; and a man, convalescing from typhoid fever, was 
killed by a drachm of the fluid extract (Philad. Med. Times, xiv. 863). 
In cases of poisoning, vomiting should be encouraged by large draughts of 
warm water until the stomach is well washed out. Then the patient should 
be forced to lie flat upon the back, with the head lower than the feet, and the 
efforts at vomiting should be restrained. If they cannot be checked, and 
if the prostration be severe, on no account should the patient be allowed to 
rise up, but must be made to vomit into a towel. A full dose of laudanum 
should be given by the rectum, and brandy or whisky be administered by the 
mouth. I have noticed that spirits will sometimes be retained only when 
given undiluted, and in such form will quiet the stomach at once. If the 
stomach refuse alcohol in any shape, the rectum should be made use of. Am- 
* Consult also Dr. C. S. Bishop, American Journal of the Medical Sciences, Oct. 1861. 176 
SYSTEMIC REMEDIES. 
monia may be employed as an adjuvant to alcohol, and in extreme cases 
should be injected hypodermically, or even into a vein. The use of external 
heat is important, and mild flagellations, rubbing with coarse towels, sinapisms, 
etc., may be used to keep up the external capillary circulation. 
Administration.-In administering veratrum viride, it should always be 
borne in mind that it will do no good in acute disease unless given in increasing 
doses until its physiological action is manifested. In almost all cases vomiting 
is to be avoided as far as possible. To do this, small quantities of the drug 
should be given at short intervals, and corresponding doses of laudanum (five 
to ten drops) should be exhibited fifteen minutes before each dose of the 
veratrum viride. An hour is generally the best interval between the doses. 
The drug should always be administered in the form of the fluid extract 
(Extractum Veratri Viridis Fluidum, U. S.), dose, one to three drops; or 
of the tincture (^Tinctura Veratri Viridis,-1 to 2, U.S.), dose, three to 
six drops. A saturated tincture is sometimes kept in the shops under the 
name of Norwood's tincture. 
Veratrum Album.-In cases of human poisoning with veratrum album 
the symptoms* have been-excessive vomiting, generally accompanied by 
severe abdominal, and often oesophageal, pain, and followed by a very severe 
diarrhoea; intense prostration and muscular relaxation; very pronounced 
reduction of the temperature and pulse, the latter being sometimes rapid and 
almost imperceptible in the advanced stages, and finally becoming extinct; 
sunken eyes, contracted, anxious countenance, a cold skin clammy with pro- 
fuse perspiration, and other evidences of collapse. The mind remains clear 
until the last. A fatal result is very common, and, when recovery occurs, 
the convalescence is usually protracted. 
The exact nature of the active principles of veratrum album is still in- 
volved in doubt. Pelletier and Caventou thought that they found super- 
gallate of veratria in it. So far as I can make out from the authorities at 
my command, Simonf claims that there are three alkaloids in the veratrum 
album,-veratria, barytina, and jervia ; and Dr. Mossel (Sur la Viratnne, 
Thdse, Paris, 1868) certainly indicates that sabadillia and barytina are the 
same. Very recently the subject has been elaborately investigated by Chas. 
L. Mitchell, who finds two alkaloids in the rhizome, one of which he denomi- 
nates jervia, the other veratralbia. The resin, when entirely freed from 
alkaloids, is inert. In a number of experiments made separately by Mr. 
Mitchell, Dr. J. R. Haynes, and myself, veratralbia proved itself a most 
active poison, one-tenth of a grain killing a large pigeon in four minutes, and 
one-twentieth of a grain a dog of fourteen pounds weight in one hour. The 
symptoms were nausea and vomiting, with violent purging, if the animal 
* For cases and analysis of symptoms, see Dr. Peugnet's paper in the New York Medical 
Record, p. 121, 1872. 
f I have not had access to Simon's original papers. CARDIAC SEDATIVES. 
177 
lived some time, salivation, muscular weakness passing into paralysis, con- 
vulsions, and death,-from failure of respiration after moderate toxic doses, 
from cardiac arrest after very large ones. When the fatal result had been 
slowly produced, intense hyperaemia of the intestinal mucous membrane was 
found after death. Veratralbia appears to be very closely allied in both 
chemical and physiological properties to veratria. 
ARNICA FLORES-ARNICA FLOWERS. U.S. 
ARNICA RADIX-ARNICA ROOT. U.S. 
The flowers of the Arnica montana, a perennial composite, native of 
Northern Europe and Asia, and said also to be found in the Northwestern 
United States. The yellow flowers have about fourteen striated ligulate 
tridentate florets in the ray, twice as long as the disk, which consists of 
numerous tubular florets. The taste is bitterish and acrid. The rhizome is 
also employed medicinally, but is not recognized by the U. S. Pharmacopoeia. 
Two alkaloids, Cytisin and Arnicina, are stated to have been found in the 
flowers. The first of these is believed to be identical with the alkaloid of 
the seeds of the laburnum-tree (Cytisus Laliurnum'). 
Physiological Action.-Locally, arnica is stimulating, and, if in suf- 
ficient strength, decidedly irritating. Upon some skins the tincture acts even 
violently, rapidly developing an acute eczematous inflammation of the upper 
dermal layers, as manifested by hyperaemia, papules, vesicles, excoriations, 
crusts, and scales in regular sequence (Dr. White, Boston Medical and Sur- 
gical Journal, Jan. 1875). 
That the influence which the drug exerts upon the general system when 
taken internally is very decided is certain, but the exact nature of this 
influence is at present unknown. Viborg (quoted by Still6) affirms that in 
horses and cows it causes increased action of the heart, flow of urine, and 
warmth of skin, followed by very decided general depression. According to 
Stille, the effects of moderate doses on man are similar to those noted as 
occurring in the lower animals,-namely, increase of the cardiac action, of 
the respiration, of the temperature of the skin, and of the perspiration and 
urine,-along with very decided symptoms of gastric irritation. On the 
other hand, it is claimed that ten drops of the tincture every three or four 
hours act as a decided arterial sedative (Dr. C. C. Balding, London Lancet, 
Dec. 1870). The symptoms of poisoning seem strangely to vary. Thus, 
in a woman, two cups of a strong infusion produced violent gastro-intes- 
tinal irritation, as shown by vomiting and choleraic diarrhoea, reduction 
of the pulse to 60, and finally collapse (Bulletin Therap., Ixxvi.). In 
Barbier's case (quoted by Still6), an infusion of eighty grains of the 
flowers caused giddiness, and intense muscular weakness, with spasmodic 
movements of the limbs. In another, not fatal, case (London Lancet, Nov. 
1864), according to the statement of the patient, an ounce of the tincture 
did not produce any symptoms for eight hours, when approaching collapse, 178 
SYSTEMIC REMEDIES. 
dilated, immovable pupils, with a cold, dry skin, and a feeble fluttering pulse, 
rapidly supervened upon an intense epigastric pain, which was increased by 
pressure. 
In a not fatal case reported by Dr. W. A. Thorn ( Virgin. Med. Monthly, 
Sept. 1883), four hours after ingestion of a fluidounce of a tincture by a 
young man, the pulse was 100, full and strong, the temperature normal, 
insensibility complete, conjunctiva anaesthetic, respirations 18 per minute; 
no vomiting or purging. Twelve hours later the patient became wildly de- 
lirious ; the next day he suffered from burning pain in the abdomen, diar- 
rhoea, and free diuresis. 
Therapeutics.-In the present state of our knowledge, the internal use 
of arnica is absolutely experimental. Externally it is employed to a very 
great extent as a stimulant application in bruises and sprains, generally in 
the form of tincture [Tinctura Arnicae Florum-1 to 5, U.S. ; Tinctura 
Arnicae. Radicis-1 to 10, U. S.), which may be applied pure, but sometimes 
as fomentations of the flowers. Its property of occasionally producing intense 
dermal irritation should be borne in mind. An extract (Extractum Arnicae 
Radicis, U. S.) and a fluid extract (Extractum Arnicae Radicis Fluidum, 
IT. S.) are officinal. 
VERATRINA. U. S. 
This alkaloid is procured from the seeds of Veratrum sabadilla (Asagraea 
officinalis.* As found in commerce, it is almost always more or less impure, 
and occurs as a grayish-white powder of an intensely acrid taste, and pro- 
ducing, even in the minutest quantity, when smelled, frequently-repeated 
sneezing, which may continue for hours. It has when pure been considered 
uncrystallizable, but Merck has obtained it in rhombic prisms about half 
an inch in length, through the spontaneous evaporation of its alcoholic 
solution. It is very slightly soluble in boiling water, not at all in cold water; 
soluble in alcohol, freely so in ether, and still more so in dilute acids. 
Veratria dissolves in concentrated sulphuric acid, with the production of a 
yellow color, changing in five minutes into orange, then into blood-red, and 
in half an hour into a splendid carmine. Masing states that this test is 
very faint with 0.0026 of a grain. If some bromine be dropped into the 
freshly-prepared sulphuric acid solution, a beautiful purple results. A more 
delicate test than either of those yet noted is, according to Masing, that of 
Trapp, which consists in warming the colorless solution of veratria in con- 
centrated muriatic acid, when a dark-red very persistent color is produced 
This test is said to afford very marked proof of the presence of 0.0026 of a 
grain of the alkaloid, and to be especially useful when the veratria is impure. 
Physiological Action.-Veratria is exceedingly irritating to any surface 
* The action of gabadalline, the congeneric alkaloid of veratrine, has been partially- 
studied by Dr. I. Urpav {Montpellier Med., 1883, i. 274), who finds it to have only about 
one-twelfth the toxic power of veratrine. CARDIAC SEDATIVES. 
179 
it may come in contact with, producing when given hypodermically or ender- 
mically severe pain, and when rubbed on the skin a feeling of warmth, fol- 
lowed by prickling, severe pain, numbness, and, if its use be persisted in, a 
marked redness. On the mucous membranes its action is even more decided. 
In the nostrils the minutest portion of it produces intense irritation, as shown 
by repeated sneezing and free discharge, which may be bloody. Upon the 
tongue a speck causes burning, with free salivation. 
When taken internally, in small doses, it produces slowing and weakening 
of the pulse ; more freely administered, indications of gastro-intestinal irrita- 
tion ; and in large doses it is followed by violent vomiting, serous purging, 
often with intense burning in the mouth and throat, and general muscular 
weakness. No fatal case of poisoning is on record ;* but in the experiments 
of Esche on himself a half-grain of the acetate produced collapse, with a pale, 
cold, wet skin, pinched features, a rapid, thready, irregular pulse, violent 
vomiting, and marked muscular tremblings. Other observers have noted 
more pronounced indications of convulsions; and, according to Bardsley, 
when absorbed through the skin, instead of purging it produces in some cases 
very free diuresis. On the whole, the resemblance between the symptoms 
as induced in man and in the lower animals is, so far as we know, complete. 
The phenomena of veratria-poisoning in a mammal are violent muscular 
twitchings and convulsions, which are often plainly excited by external irri- 
tants, severe vomiting, generally but not always accompanied by purging, and 
disturbance of motion, respiration, and circulation. The pulse is at first, if 
the dose be not too large, quickened and strengthened, but in a very short 
time it becomes slower and weaker, and finally very frequent, thready, and 
irregular. There is early a marked loss of muscular power, even in the midst 
of the convulsions, and the latter may give way to the quiet of paralysis, or 
may continue up to death. 
According to the researches of Claus (Journal of Anatomy, viii.) veratria 
in toxic doses causes first a slight fall of temperature, then a rise to about 
normal, and finally a fall immediately before death. Sabadillia, on the con- 
trary, produces a rise of temperature, followed only by a partial fall, so that 
the bodily heat even at the moment of death is above normal. 
M. Prevost (Robin's Journal de T Anatomie, 1868, t. v. p. 206) has, 1 
think, very well divided the action of veratria in poisonous doses into three 
stages: first, that of excitation or restlessness ; second, that of convulsions ; 
third, that of paralysis. It should, however, be understood that these may 
after large doses be fused into one. I have seen an animal suffer a convul- 
sion, or perhaps merely give a convulsive shudder, and drop dead. 
After death from a very large dose, the muscles are found to have lost 
more or less completely their irritability, so that they either do not respond, 
* In St. George's Hospital Reports, 1870, vol. v., Dr. C. Paget Blake reports a case of 
recovery after the ingestion of a liniment supposed to contain three grains of veratria! 
Intense itching of the skin was a prominent symptom. 180 
SYSTEMIC REMEDIES. 
or respond very feebly, to the strongest faradaic currents. That this is 
due to a direct influence of the alkaloid upon them is proven by the fact, 
first noted by Kblliker ( Virchow's Archiv, Bd. x. p. 257), but which I in 
common with other observers have experimentally confirmed, that if an artery 
be tied before poisoning, all the muscles supplied by that artery maintain 
their integrity. 
It is evident that veratria is a muscle-poison ; but it has other powers, and 
the subject is best studied in detail, system by system. 
Central Nervous System.-Upon the cerebrum the action of veratria is 
not very marked. That the convulsions are not cerebral is shown by the fact, 
which I have frequently noted, that they are in no wise affected by division 
of the spinal cord. The spasms must be, therefore, either peripheral or 
spinal in origin. M. Prevost (Robin's Journal de I' Anatomic, 1868, p. 
209) has found that convulsions will occur in the frog even when the spinal 
cord is destroyed, but that under these circumstances the convulsions are not 
spontaneous, but occur only when an irritation is applied to a part, and are 
limited to the part irritated. A fact analogous to this was noticed by 
Kblliker (Virchow's Ar.chiv, Bd. x. p. 262, Exp. IX.): in frogs whose 
nerves were paralyzed by woorari, the exhibition of veratria induced phe- 
nomena similar to those just noted. These facts, however, do not prove 
that the convulsions in the veratrized frog are not spinal, but only show 
that there is a state of excitation of the muscles. But M. Prevost furnishes 
the following direct proof that the cord in veratria-poisoning is not affected. 
The hind legs of a frog were separated from the rest of the body by a very 
tight ligature, so placed as not to include the lumbar nerves. Some veratria 
was then introduced into one of the fore legs, and of course found its 
way into the spinal cord and the anterior portions of the body. Under 
these circumstances it is evident that the convulsions produced, if spinal, 
would affect the whole body, but if peripheral would be confined to the 
anterior part of the frog. It was found that the posterior legs were never 
affected, that whilst irritation of them caused most violent spasms in the 
anterior part of the body, only the normal reflex actions occurred in those 
muscles not reached by the poison. If this experiment be confirmed (and 
I see no intrinsic reason to doubt its accuracy), to Prevost belongs the credit 
of having proven that veratria has no action on the motor centres of the 
spinal cord. 
There is, however, an apparent opposition between the experiments of Pre- 
vost and those of Kblliker ( Virchow's Archiv, Bd. x. p. 261). The latter 
observer noted (Exp. VI.) that when the skull of the frog was opened and 
a ten per cent, alcoholic solution of veratria dropped on the cord, violent 
general tetanic convulsions were induced; also (Exp. IV.) that when one 
crural artery and vein of a frog were tied and the veratria solution placed in 
the mouth, tetanus ensued, involving the protected limb, and continuing 
there after it had ceased in the other members. I see no way of recon- CARDIAC SEDATIVES. 
181 
ciling these experiments of Kblliker with those of Prevost except either 
by supposing that the latter are incorrectly observed, or, what seems more 
probable, that the poison in the former reached the protected parts by dif- 
fusion, although in less quantity than it did the other members: this would 
also explain the continuance of tetanus in the protected limb after it had 
ceased elsewhere. 
M. Guttmann (Reichert's Archiv fiir Anatomic, 1866) is in accord with 
Kblliker in his experiments, for he states that, notwithstanding the artery 
of a limb is tied, yet spasms occur in the leg during the convulsive stage of 
veratria-poisoning: of course the " diffusion" theory would apply to this as 
well as to the experiments of Kblliker. 
The only conclusion to be drawn from the evidence seems to me to be that 
at present it is uncertain whether veratria does or does not act upon the 
motor centres of the cord. 
In regard to the action of the drug upon the sensitive centres of the cord, 
our knowledge is by no means perfect. Anaesthesia of the posterior feet was 
noticed in the frogs experimented upon by Prevost in the manner described; 
but when the circulation is cut off from the feet of a frog, loss of sensibility 
always ensues. 
Peripheral Nervous System.-1The study of the action of veratria upon 
the peripheral motor apparatus evidently divides itself into a study of the 
influence upon the muscles and the extreme nerve-endings in them, and upon 
the nerve-trunks. 
There can be no doubt that veratria finally destroys the contractile power 
of the muscle itself, so that it fails to respond to any irritation whatever, 
and soon, becoming stiff, exhibits the acid reaction of post-mortem rigidity. 
Thus far all recent observers are in accord; and I have frequently witnessed 
the same phenomenon. Kblliker in some of his experiments (Joe. tit.') notes 
that the muscle in the early stage of veratria-poisoning responded inordi- 
nately to stimuli. The study of this phenomenon has been especially made 
by Bezold and Hirt (Untersuch. Physiolog. Laborat. Wurzburg, I.) by M. 
Prevost,* by Bossbach (Pfldgers Archiv, xiii. p. 617), by Marey, and 
Maurice Mendelssohn ( Travaux du Laborat. de M. Marey, xiv., and Compt.- 
Rend. Soc. Biolog., 1883, 147). When a muscle during the convulsive 
stage of veratria-poisoning is momentarily stimulated, instead of the usual 
momentary contraction a prolonged tetanic spasm results and lasts some 
seconds : this spasm is induced by the slightest irritation. When a nerve 
is irritated repeatedly within a short time, the tributary muscle loses its 
power of entering upon a " veratria contraction," but if left quiet for a time 
recovers itself. There is therefore in veratria-poisoning, preceding the stage 
of muscular paralysis, a stage of muscular hyper-excitability. To this are due 
no doubt in great part, if not altogether, the convulsions. It can scarcely be 
* Quoted by Husemann. 182 
SYSTEMIC REMEDIES. 
doubted that it is the result of an action not upon the nerve-endings, but 
upon the sarcoleinma of the muscle.* That the muscular paralysis is of 
similar nature would seem to be proven by the rapid changes which take 
place in the muscle after death, and by the fact, noted by Guttmann (Reichert's 
Archiv fiir Anatomic, 1866, p. 498), that whilst frogs apparently dead from 
nerve-poisons such as atropia, strychnia, and curari often recover themselves 
after a period of stupor, those poisoned with veratria never do. 
When a muscle is dead, galvanization of the nerve of course elicits no 
response; but it is possible that a substance may be at the same time a nerve- 
poison and a muscle-poison. Veratria is both a muscle-poison and a nerve- 
poison. Kolliker denies this, but the experimental evidence brought forward 
by him amounts to almost nothing. Guttmann (loc. cit J asserts that in his 
experiments, whenever irritation of a nerve failed to elicit a response, direct 
irritation of the muscle was always equally unavailing. Bezold and Hirt (loc. 
cit.') experimented, with a full knowledge of Guttmann's work, with small and 
with large doses, and evidently with great care. They found (loc. cit., p. 90) 
that when a small dose is used there is at first a very marked increase in the 
irritability both of the nerve and of the muscle, so that, whether the current 
be applied directly to the muscle or indirectly through the nerve, contractions 
take place more readily than normal. After a time, both muscle and nerve 
lose their irritability, so that no contraction follows either the direct or the 
indirect stimulation. The process does not go on pari passu in the two 
organs. The irritability increases sooner and is sooner lost in the nerve than 
in the muscle, so that there is a time when galvanic irritation of the nerve 
fails to induce contraction, although the muscle still retains its functional 
power and reacts instantly to direct stimulation. Moreover, the upper or 
spinal end of the nerve dies first, so that at a certain stage irritation of the 
nerve-trunk close to its origin fails to induce contraction of the tributary 
muscle, although when applied lower down it elicits a response. This im- 
portant observation is confirmed by Fick and Bohm (ArLeiten aus dem 
Physiolog. LaLorat. der Wurzhurger Hochschule, 1873, p. 147), and by J. 
Ott (Toxicological Studies, Philada., 1874), and would seem to prove that 
veratria acts directly on the nerve-trunks. Fick, however, affirms that under 
these circumstances he has frequently proven the existence of the norma] 
muscular galvanic currents in the seemingly dead nerve-trunks, and that 
therefore it is only the peripheral nerve-endings which are attacked by 
* Fick and Bohm, in the elaborate paper already referred to, believe that they prove 
that the prolongation of the muscular contractions in veratria-poisoning is due to a 
greater intensity of the chemical processes of the muscles, and not to a delay of the 
process of restitution. A discussion of this point would involve that of muscular physi- 
ology, and cannot be entered into here. The weak point of the argument made by Fick 
and Bohm may, however, be pointed out. Granting all their asserted facts, it is perfectly 
possible that greater intensity of the chemical processes is an effect, not a caute, of the 
prolonged contractions. CARDIAC SEDATIVES. 
183 
veratria. But it is difficult to reconcile this observation of Fick with some 
of those of Bezold and Hirt. At present, therefore, it must be considered 
undetermined whether it is the nerve-endings solely, or the whole peripheral 
nerves, which are affected by veratria. 
As already stated, the action of veratria upon the sensory centres is doubt- 
ful ; its influence upon the peripheral sensitive nerves has not, that I am 
aware of, been carefully worked out, but the effects of its local application to 
the human skin seemingly show that it first strongly excites and then para- 
lyzes them. 
Circulation.-.After death from a large dose of veratria, the heart is soft, 
dilated, full of blood, and incapable of responding to galvanism ; i.e., the heart- 
muscle is dead. According to Bezold and Hirt (loc. citf after a small dose 
there are quickening of the pulse and rise of the blood-pressure, which soon 
return to the normal condition; whilst immediate and persistent fall in the 
number of the heart-beats and in the arterial pressure follows a large dose. 
If the vagi be divided previous to the poisoning, a large dose produces a tem- 
porary increase in the pulse; and a stimulation of the distal end of the cut 
nerves by a current too slight to be felt in the unpoisoned animal retards 
very markedly the beat. From these facts it follows that in the uninjured 
animal, after poisoning by veratria, there is an inhibitory retardation of the 
pulse, and also an excitation of the peripheral ends of the vagi. That it is 
not merely the peripheral inhibitory apparatus which is affected was proved by 
injecting the alkaloid into the carotid,-i.e., into the inhibitory centre,-when 
there happened an instantaneous and remarkable retardation of the heart- 
beat, which could only have been caused by excitation of the inhibitory 
centre. In a later stage of the poisoning the strongest faradaic currents 
applied to the pneumogastrics fail to affect the heart. It is, therefore, 
evident that veratria first exalts and then destroys the functional activity of 
the par vagum, as of the spinal nerves. 
According to the researches of Prof. S. Ringer, veratria acts directly upon 
the cardiac muscle as it does upon the skeletal muscles. Each excitation 
causes in the veratrized frog's heart a prolonged series of in co-ordinated 
contractions; therefore a lessened regulation with an increased amount of 
force-generation (Archives of Med., 1882, p. 21). 
When the heart is separated from the nerve-centres by section of the par 
vagum and of the spinal cord, veratria produces, according to Bezold and Hirt, 
at first increase in the pulse and blood-pressure, secondly, lowering of both 
to the minimum; showing that it exerts upon the internal heart-ganglia, or 
upon the heart-muscle, its peculiar action of first stimulating and afterwards 
paralyzing functional activity. 
That the poison has a similar action upon the vaso-motor centres seems 
probable from the facts noted by Bezold and Hirt: first, that injection into 
the carotid after section of the pneumogastrics causes immediate rise of the 
blood-pressure; second, if the mesenteric arteries have been previously bared, 184 
SYSTEMIC REMEDIES. 
they can be seen to contract. This excitation is followed after a time by 
vaso-motor paralysis and dilatation of the vessels. 
Respiration.-Bezold and Hirt conclude, from the fact that after section 
of the pneumogastrics even the smallest doses of veratria cause retardation 
of the respiration without previous increase, that the alkaloid depresses im- 
mediately the centre of respiration in the medulla, and finally kills it. 
Therapeutic Action.-The study of the physiological action of vera- 
tria shoWs that its rational therapeutic use must be limited. As a heart- 
sedative, it is much inferior to aconite and veratrum viride, for obvious 
reasons, and, although it has been used as such, it has not achieved much 
reputation. When exhibited in full doses it is very apt to give rise to 
exceedingly disagreeable secondary symptoms, and has no advantage over 
the medicines just named. Some years ago it was employed in acute rheu- 
matism, having been recommended by Turnbull, Bardsley, Piedagnel, Trous- 
seau, and others ; but it is not so efficacious in this disease as other far less 
dangerous remedies by which it has been superseded. The same is true of 
its employment in dropsy ; and I know of no condition which would justify 
its internal use. 
Bardsley originally employed it in neuralgia, especially when arising from 
cold. He used it both internally and externally. At present it is rarely 
employed except as a local application. My own success with it has not 
been very encouraging, but others of larger experience recommend that it 
be rubbed over the affected nerves in rheumatic neuralgia. 
As an external stimulant and rubefacient it is sometimes used with good 
effect in narcotic poisoning; also in various spinal troubles as an irritant ap- 
plied to the spine, and to the skin of the paralyzed limbs, to aid in maintain- 
ing circulation ; but all these indications can, I think, be better met by other 
means. In regard to the dose of veratria for internal use, it should be borne 
in mind that one-sixteenth of a grain has produced the most alarming symp- 
toms (Taylor, Medical Jurisprudence, 2d edition, London, 1873). 
An ointment (Unguentum Veratrinse-1 to 26.5, U. S.) and an oleate 
(Oleatum Veratrinse-1 to 50, U.S.) are officinal. 
ACONITUM. U.S. 
The Aconitum Napellus,* or monkshood, is a tall perennial, indigenous 
in Europe, and cultivated in this country for the sake of its spike of blue 
* All of the species of the genus Aconitum are more or less poisonous, although A. 
Napellus is the only one officinal. For a study of the comparative strength of the various 
aconites, see Schroff, Journal fur Pharmacodynamik, 1857, p. 335. He arranges them as 
follows, commencing with the most virulent: A. ferox, A. Napellus,-with its varieties, 
neomontanum, tauricum, and variabile, A. Cammarum, A. paniculatum, A. Anthora. The 
toxic properties of the A. Anthora were very weak. Lycoctonin is the alkaloid of A. lycoc- 
tonum. For a physiological study of it by Dr. Ott, see Philad. Med. Times, vi. p. 25. CARDIAC SEDATIVES. 
185 
flowers. The leaves are three or four inches in diameter, and cut almost to 
the base into three to seven three-lobed, wedge-shaped divisions. 
The root, which is the only officinal portion, is from three to four inches 
long, very tapering, about three-quarters of an inch in diameter at the base. 
Its taste is bitterish, acrid, and after a little while benumbing, giving origin 
to intense tingling of the lips and mouth. It is to be distinguished from 
horseradish root, with which it has been fatally confounded, by its external 
brown color and its absence of odor when scraped. The whole plant is 
active and tastes like the root. 
In 1833 Geiger and Hesse discovered in aconite an alkaloid, Aconitia, 
which is undoubtedly the active principle of the drug. This alkaloid is now 
officinal. As prepared according to the directions of the U. S. Pharmacopoeia, 
it is a yellowish-white powder. In commerce there are several varieties of it, 
made by different large manufacturers: the German aconitia, which is very 
impure, and, according to Husemann, is less active than the extract; impure 
English aconitia; and the so-called English aconitia, prepared by Morson 
and said to be chemically pure. The latter is a grayish powder.* 
Duquesnel (Comptes-Rendus, vol. Ixxiii., 1864) first obtained the aconitia 
in the form of colorless, rhombic, tabular crystals, soluble in alcohol, benzine, 
ether, and extremely so in chloroform, very slightly soluble in water, insoluble 
in glycerine. 
The salts of aconite are soluble, and from their solution the alkaloid is pre- 
cipitated by alkalies in an amorphous state. That aconitia is the only active 
principle of the root would seem to follow from the experiments of Hottot 
(Journal de Physiologie, 1864). 
Physiological Action.-When applied to a raw surface, or to the skin, 
aconite, or its alkaloid aconitia, acts as a local irritant and narcotic, soon pro- 
ducing numbness, with tingling, which may persist for a long time. When 
given in sufficient dose internally, it is a violent poison, acting, so far as is 
known, similarly upon all animals. 
* In 1857, Hiibschmann announced the presence in minute quantity of a second alka- 
loid in the root of Aconitum Napellus,-Napellina. Schroff* (Journal fur Pharmacody- 
namik, i. 3) could find no essential difference between its action and that of German 
iconitia. T. and H. Smith, of Edinburgh, have found a third non-poisonous alkaloid, 
Aconella, which they think to be probably identical with narcotina; and Fliickiger asserts 
.hat there are four alkaloids contained in the genus Aconitum, namely, Aconitia, Pseud- 
aconitia,^ Napellina, and Lyctonia (Sydenham Year-Book, 1869 and 1870). Recently Dr. 
C. A. Wright has found that there are three alkaloids in Aconitum Napellus, crystallizable 
aconitia, a nearly inert base,picra aconitia, and a third alkaloid, incapable of crystallizing 
or forming crystallizable salt, which is said to frequently form the bulk of commercial 
aconitia. 
* From what Schroff says about the material he used in his experiments, it is evident that he had 
no proof that it was genuine napellina. 
t Bohm and Ewens have physiologically studied the alkaloid of Aconitum ferox under the name of 
pteudaconUia, and found the difference between its action and that of aconitia to be one of degree, not 
of kind ; it was the stronger of the two (Archiv fur Experim. Pathologie und Pharmak., Bd. i., 1873). 186 
SYSTEMIC REMEDIES. 
If the dose be large, death may be almost immediate, and, if the alkaloid 
be given hypodermically, may occur in less than a minute. In such cases 
the result is apparently due to sudden paralysis of the heart-muscle. 
After moderate toxic doses, the prominent symptoms are great disturbance 
of the respiration, muscular weakness, vascular depression, and finally death, 
with or without convulsions. As I have seen the rabbit after the injection 
of one-sixth or one-quarter grain of Morson's pure aconitia, the animal com- 
mences to jump vertically in a very peculiar manner, and often to squeal pite- 
ously. The jumping soon grows less and less powerful, and finally is replaced 
by severe convulsions, during which the animal often lies prostrate on its side. 
In the dog, however, the muscles have remained without a quiver during all 
stages of the poisoning; in the horse Harley has noticed convulsions (xSZ. 
Thos. Hosp. Reports, v.). The convulsions are an inconstant symptom, de- 
pendent upon peculiarities of the individual or species, as well as upon the 
amount injected. Dilatation of the pupil frequently occurs, if it be not, 
indeed, a constant phenomenon. There is often severe vomiting. 
The symptoms which are induced by small therapeutic doses of aconite in 
man are reduction of the force and frequency of the circulation, a sense of 
muscular inertia and weakness, and a slight tingling in the extremities or in 
the lips. If the dose administered be large, all these symptoms are intensi- 
fied; the muscular weakness is extreme; the tingling is felt all over the 
body; the pulse is feeble, and reduced to thirty or forty per minute; the 
respirations are diminished; giddiness and disordered vision may be mani- 
fested, especially when the erect posture is assumed. After three or four 
hours these symptoms gradually subside. 
When a poisonous dose has been ingested, the first thing rioticed in most 
cases is a burning or tingling in the throat or in the extremities, soon spread- 
ing over the whole body. The pulse rapidly falls in frequency, and in a very 
little time becomes exceedingly weak, intermittent, irregular, and finally im- 
perceptible ; the muscular strength is greatly reduced, and sometimes almost 
entirely gone ; the respirations are shallow, feeble, irregular, and infrequent; 
the general sensibility is very much benumbed, so that marked anaesthesia of 
the surface is present; the skin is bedewed with a cold sweat; the counte- 
nance is anxious, sunken, livid, and the eyes are often protruded, or are even 
spoken of as glaring; the pupil is generally dilated, but when there are no 
convulsions may be contracted; gastric burning is sometimes complained of, 
and severe vomiting may be present, but the stomach is not rarely retentive. 
The intellect generally remains unaffected until very near the close, sometimes 
to the very moment of death.* In the collapse of the latter stages of aconite- 
poisoning the special senses may be lost, especially the sight. The voice is 
very generally extinguished. Convulsions occur in some cases, not in others; 
and certainly in some instances, if not always, the patient is unconscious during 
* Pereira, however, states that in some recorded eases stupor has occurred. CARDIAC SEDATIVES. 
187 
their continuance. Diplopia, or other disorder of vision, has been noted 
in some cases. Death may occur suddenly, especially directly after some 
exertion on the part of the patient, from syncope. 
The symptoms which aconite produces in man and in the lower animals 
are so entirely identical that the conclusions arrived at in regard to the latter 
may be accepted without reserve as applicable to the former. 
Circulation.-The action of aconite upon the circulation is very decided. 
According to Dr. Achscharumow (Reichert's Archiv, 1866, p. 255), in the 
frog a moderate toxic dose of aconitia produces at first a reduction in the 
number of the heart's pulsations, then an increase in the rapidity of its action, 
with very evident loss of power, and finally irregular systolic movements, with 
very long intervening pauses ending in diastolic arrest. Dr. Rudolf Bohm 
and L. Wartmann (Arbeiten aus dem Physiolog. Laborat. der Wurzburger 
Hochschule, 1873) have substantially confirmed these observations. 
In the higher animals the exhibition of aconite in sufficient doses yields 
similar results. In the dog and cat (Bohm and Wartmann, and my own ex- 
periments) there is a steady sinking of the arterial pressure. In the rabbit, 
according to Bohm and Wartmann, the fall of pressure is preceded by a 
brief rise ; this rise has also been noticed in the dog by Laborde and Du- 
quesnel (Des Aconits, p. 130). The rate of the heart's pulsation also un- 
dergoes reduction, and there is finally diastolic arrest in dogs as in other 
mammals. 
The method by which the aconite influences the heart is not certainly 
settled. According to the experiments both of Bohm and of Wartmann, it 
produces a gradual paralysis of the peripheral vagi, a constant increase of 
the intensity of a galvanic stimulation of the pneumogastric nerves being 
required to influence the heart as the poisoning deepens, until finally the 
vagi entirely refuse to transmit any inhibitory impulse. 
In a single experiment, Achscharumow (p. 272) found that after section 
of the vagi in the early stage of aconite-poisoning there was an immediate 
rise both in the number of the cardiac pulsations and in the arterial pressure. 
From these data he argues that the slowing of the pulse during the early 
stage of aconite-poisoning is due to stimulation of the inhibitory centres in 
the medulla oblongata. Bohm and Wartmann (loc. cit., p. 266) repudiate this 
conclusion, because, according to their experience, the phenomena of aconite- 
poisoning occur in the usual manner after section of the vagi, or in atropized 
animals. It is evident that there is no necessary contradiction in the asserted 
facts of these observers, as it is possible that the slowing of the pulse may be 
due to two immediate causes, one having its seat in the medulla oblongata, 
the other in the heart. Although this explanation cannot be considered 
proven, it is probably correct. Prof. Plugge confirms the statement of 
Bohm and Wartmann, that aconitine finally paralyzes the peripheral vagus, 
whilst Lewin agrees with Achscharumow that there is a primary rise of the 
pulse when aconitia is given after section of the vagi, but states that this 188 
SYSTEMIC REMEDIES. 
rise is of very brief duration and is soon followed by the usual reduction 
{Prager Vierteljahrs., Bd. cxxxi.). It is very certain that aconitia also 
influences directly the heart or its contained ganglia, for Achscharumow 
(loc. cit., p. 262) has found that it acts upon the frog's heart removed from 
the body, and Liegeois and Hottot (Journal de Physiologic, p. 520, 1861) 
have observed the ordinary cardiac phenomena of aconite-poisoning pro- 
duced by the alkaloid placed directly upon the viscus. Bohm and Wart- 
mann have also noted that in aconite-poisoning the force of the individual 
beat is lessened. In the experiments of Laborde and Duquesnel, the car- 
diac beats were at first rendered very slow but very full and forcible, and 
afterwards became very rapid and very feeble (loc. cit., p. 124). After 
death.the cardiac muscle fails entirely to respond to galvanic irritation, its 
contractility being lost.* 
Our knowledge of the action of aconitia upon the vaso-motor nerves is 
not complete. Achscharumow, Dr. F. B. Nunneley (Proc. Royal Society, 
p. 46, 1870), and still more recently Dr. Mackenzie, have studied with the 
microscope the influence of injections of aconitia upon the vessels of the 
frog's web, but have been unable to detect any alteration of their calibre. 
The first observer has also found that after division of the sympathetic in 
the neck, galvanization of the peripheral end produces the usual phenomena, 
even in the most advanced stages of aconite-poisoning. These facts indicate 
very strongly that aconite does not affect the vaso-motor nerves, and this 
indication is confirmed by the experiments of Bblnn and Wartmann, who 
found that when in aconite-poisoning a galvanic current was applied to the 
vaso-motor centres in the medulla, an immediate rise of arterial pressure 
took place. As stimulation of a sensitive nerve produced at such time no 
rise of arterial pressure, the conclusion would appear to be logical that 
aconitia, whilst not affecting the efferent vaso-motor nerves or the vaso-motor 
centres, destroys the conducting power either of the afferent nerves or of the 
cord, so that in an animal under its influence no impulse can be transmitted 
from the periphery to the vaso-motor centres in the medulla. 
Nervous System.-Such diverse experimental results have been reached 
by different investigators that it is very difficult to draw any positive con- 
clusion from the evidence. Achscharumow concludes that the paralysis and 
loss of reflex activity induced depend upon the destruction of the conducting 
power of the peripheral motor nerves, because he has found that when a frog 
is poisoned after the abdominal aorta has been tied, reflex and voluntary 
activity is preserved in the hind legs long after it has been lost in the ante- 
rior portion of the body; and, at the same time, whilst the brachial nerves, 
as tested by galvanic stimulation, have lost their power of transmitting 
* Opposed to all this evidence are the extraordinary and at present inexplicable state- 
ments of Hunter Mackenzie {Practitioner, xxi. 109), that aconitia has no effect upon the 
heart, and if applied directly to it does not seriously affect its pulsations. CARDIAC SEDATIVES. 
189 
impulses, the protected ischiadic nerves have preserved their functional 
ability. The very recent experiments of Prof. P. 0. Plugge ( Virchow's 
Archiv, Bd. Ixxxvii. p. 410) confirm these experiments of Achscharumow, 
showing, however, that it is the peripheral ends of the motor nerves which 
are affected, since, when in the frog's leg the lower portion had been pro- 
tected from the poison, galvanization of the nerve-trunk a considerable dis- 
tance above the point of protection caused response in the tributary muscles. 
This concurrence of testimony would seem to prove that aconitine paralyzes 
the peripheral motor nerves. The testimony, however, to the contrary of 
this is strong. Bohm and Wartmann in many experiments with Merck's 
aconitia found that both the nerves and muscles in poisoned animals preserve 
their normal excitability until death ; they also determined that tying all 
the structures of a limb except its nerve did not prevent the usual develop- 
ment of paralysis when the poison was exhibited. In the elaborate research 
of Lidgeois and Hottot, to be spoken of in detail directly, when all volun- 
tary reflex actions were lost, the motor nerves and muscles were still found 
excitable. Mackenzie and A. Guillaud (Arch. de Physiol., 1875) also bear 
testimony to the same effect. The explanation of this conflict of testimony 
is not to be found, as has been suggested by C. Ewers (Arch. Exper. Path, 
u. Pharm., i. 1873), in the use of different species of frogs, because Plugge 
employed various species, nor is it in the employment of different com- 
mercial aconitias, because Plugge experimented with all the varieties, and 
found them to vary in power, but not in quality of action. Those observers 
who have found least influence upon the motor nerves acknowledge some 
slight effect, and that when aconitine is brought in contact with an exposed 
nerve it rapidly destroys its functional activity; also that after death in the 
aconitized frog the motor nerves lose their irritability more rapidly than 
normal (Lidgeois and Hottot, Guillaud, S. Ringer and H. Murrell, Laborde 
and Duquesnel). Further, it has been noted that when in frogs the con- 
vulsions are very severe the motor nerves seem temporarily to lose their 
functional power from exhaustion (Mackenzie). Mackenzie affirms (Prac- 
titioner, xx. 186) that aconitia has a primary stimulant effect upon the 
motor nerve, and causes at first a distinct augmentation in the irritability 
both of nerve and of muscle. 
According to Dr. Lidgeois and M. Hottot (loc. cit., p. 533), in aconite- 
poisoning loss of sensibility occurs in the frog's legs simultaneously with or 
even before the disturbances of respiration, and long before the power of 
voluntary motion is lost, and even when the reflex activity is intact. This 
sensory paralysis, according to the experiments of the French investigators 
just quoted, first appears in the hind legs of a frog poisoned with aconitia, 
and has not its primary seat either in the peripheral nerves or in the spinal 
cord, for it was found that tying the aorta close to its abdominal bifurcation, 
so as to prevent access of the blood-i.e., of the poison-to the posterior 
nerves, did not affect the development of the anaesthesia; further, that closing 190 
SYSTEMIC REMEDIES. 
the artery nearer its origin in such a way as to shut off the circulation to the 
cord and spinal nerves, but to allow the passage of the blood to the cere- 
brum, did not cause sensory paralysis to come on more slowly than is normal 
in poisoning by aconite. 
Of course it is possible for the peripheral ends of the sensory nerves to be 
paralyzed either at the same time that the perceptive centre is, or afterwards; 
and of course, the centre being paralyzed, it becomes very difficult to deter- 
mine whether the periphery is or is not affected. Liegeois and Hottot assert 
that this paralysis of the centre occurs before any serious implication of the 
peripheric nerves, because after aconitic anaesthesia had been produced 
strychnia was able to induce tetanus; afterwards, however, the extreme 
peripheric nerves became affected, so that irritation of the skin in the 
doubly-poisoned frog would not provoke convulsions, even at a time when 
irritation of the trunk of a nerve would produce general reflex motor dis- 
turbance. At last galvanization of the nerve-trunk itself failed to induce 
response. From these facts Liegeois and Hottot deduce-very logically, I 
think - the conclusion that aconite induces anaesthesia by paralyzing, first, 
the perceptive centres; secondly, the peripheral extremities of the nerves; 
thirdly, the nerve-trunks themselves. The observers alluded to also con- 
firmed this conclusion by other experiments than those already noticed. They 
found that although aconitia applied directly to a nerve-trunk paralyzes its 
sensibility, yet when the veins of a frog's leg are tied and the alkaloid in- 
jected into the artery and allowed to permeate the tissues of the leg, the skin 
loses its sensibility long before the nerve is affected. 
In regard to motion, Liegeois and Hottot found that in a certain stage of 
aconite-poisoning the frog lies with his limbs extended, relaxed, and perfectly 
paralyzed, and yet is capable of executing vigorous voluntary movements and 
evinces nearly normal reflex activity. They attribute this condition of ap- 
parent but not real motor paralysis to loss of sensibility from paralysis of the 
perceptive centre, as the unpoisoned frog evinces the same phenomena aftei 
division of all the posterior spinal roots. After a time the reflex activity is 
also lost, the power of voluntary movement remaining. Liegeois and Hottot 
believe that this loss of reflex activity is spinal; but in their experiments 
upon the conjoint action of aconite and strychnia it was found that at a cer- 
tain stage, when no amount of irritation of a nerve would induce convulsions, 
a slight direct irritation of the cord would cause violent strychnic spasms. 
This would seem to show that at least the earliest abolition of the reflex 
activity was due to paralysis of the afferent nerve-fibres. 
In some particulars the researches of Liegeois and Hottot have been 
confirmed by the later studies of Dr. George Hunter Mackenzie (London 
Practitioner, xx. p. 100). The persistence of voluntary movement after 
abolition of reflex actions, which was first noted by Bohm and Wartmann, 
and afterwards by Liegeois and Hottot, as well as by Mackenzie, proves that 
at a certain stage of the poisoning, whilst the motor pathway from the brain CARDIAC SEDATIVES. 
191 
along the anterior columns and the efferent nerves is open, either the sensory 
nerves or the receptive centres of the cord are paralyzed. The experiments 
of Liegeois and Hottot upon the joint action of aconitia and strychnia are 
also accordant with those of Mackenzie, for that observer found that when 
a nerve was protected from the poison by tying its supplying artery, irrita- 
tion of it caused reflex actions when the remainder of the frog's periphery 
was insensible; also that there is a stage of poisoning in which irritation 
of the extreme peripheral nerves fails to induce reflex movements, although 
such movements are called out by irritation of the sensory nerve-trunk; 
later irritation of the trunk was powerless, whilst irritation of the posterior 
columns of the cord still produced wide-spread movements. It must there- 
fore be considered proven that aconite paralyzes the sensory nerves, com- 
mencing at their peripheral endings, and that the loss of reflex activity is due, 
at least in great part, to such cause. 
The apparent contradiction between those investigators who have reached 
the conclusion just given and those who have found the motor nerves 
especially affected (see p. 178) can, it seems to me, be reconciled only by 
the theory that aconitine acts upon the peripheral ends both of sensory and 
of motor nerves ; which nerve is most severely affected may possibly depend 
upon the size of the dose employed, or, more probably, upon the physical 
condition of the frog. The excessive numbness and tingling of the local 
and general action of aconitine upon man indicate that in the higher 
animals it especially affects the sensory nerve endings.* 
The supposed action of aconitia upon a higher perceptive centre is at 
present very doubtful. S. Ringer and R. Murrell (Journal of Physiology, 
i., Nos. 4 and 5) deny the accuracy of the delicate experiments of Liegeois 
and Hottot. Curiously enough, Drs. Ringer and Murrell, whilst doubting 
the experiments of Liegeois and Hottot, accept the conclusions founded upon 
these asserted erroneous experiments, seemingly because they themselves 
have found that aconitia causes abolition of reflex action more rapidly in 
brainless than in normal frogs. It is evident that even if this were invariably 
the case it would in no way prove the conclusions of Liegeois and Hottot. 
Further, the experiments on brainless frogs were only three in number, and 
it is perfectly possible that the rapid reflex palsy was simply the result of 
batrachian idiosyncrasies. The only safe conclusion on the evidence is that 
the evidence does not warrant any conclusion. 
* Laborde and Duquesnel {Des Aconite, Paris, 1883, p. 103) believe that they have 
demonstrated that aconitine does not act upon the sensory nerves. Their chief experi- 
ments consisted in tying the vessels of a dog's leg in such a way that no blood could re- 
turn to the body, and injecting the alkaloid into the limb, after cutting the nerve. Under 
these circumstances they found galvanization of the centric end of the nerve continued to 
elicit response. At most such experiments prove nothing as to the action of the poison 
upon the peripheral nerve endings. Moreover, it remains uncertain whether the aconitine 
really came in contact with the divided nerve, as all circulation in the limb must have 
been arrested. 192 
SYSTEMIC REMEDIES. 
Tt is evident that we have not exact knowledge as to how aconite affects 
the nerve-centres,* but the nervous phenomena of aconite-poisoning seem 
to me explainable by the action of the drug upon the sensitive and motor 
nerves. 
Respiration.-The action of aconite upon the respiration is very decided. 
In mammals the respirations, under the influence of the drug, are slow, with 
a prolonged expiration following immediately upon the inspiration. After the 
expiration there is a long pause. The whole breathing cycle resembles very 
much that occurring after section of the vagi; and, like the alteration in 
breathing after this section, seems to be due at least in part to paralysis of 
sensory or afferent fibres. The known influence of aconite upon the periph- 
eral afferent nerves in general suggests that the poison disturbs respiration 
by paralyzing the peripheral afferent fibres of the vagi. Mackenzie states 
that in the aconitized animal section of the vagi produces no effect on the 
respiration; and Bohm and Wartmann (p. 127) affirm that aconite produces 
its usual effect after division of the nerves. It is plain that even if the 
aconite does paralyze the peripheral afferent vagi, it must also act upon the 
respiratory centres, since arrest of respiration could not be caused by afferent 
palsy. As the arrest occurs in the frog before the motor nerves are affected 
by the poison, Liegeois and Hottot believe that the disturbance is centric; 
and I think there can be no doubt that aconite is a direct depressant and 
paralysant of the respiratory centres^ 
Close studies of the action of aconite upon the temperature in health 
* Experiments by Mackenzie on frogs have yielded apparently contrary results to those 
of Bohm and Wartmann as to the effect of rerpoval of the influence of Setschenow's centre 
upon the cord in aconitized frogs. The difference probably depends upon difference in the 
doses employed. Bohm and Wartmann distinctly state that when minute doses of aconitia 
are employed there is a primary period of excitement of the spinal centres. Mackenzie 
has found that the convulsions which are so severe in frogs after small quantities of aconite 
are chiefly of spinal origin, but that the peripheral motor apparatus shares the stimulation 
with the spinal motor tract. M. Guillaud (Zoc. cit., p. 769) also affirms this primary stimu- 
lant spinal action. If it exist at all in mammals, it is in them completely masked. The 
convulsions seen in aconite-poisoning in some mammals are cerebral, not spinal, as I have 
experimentally determined that they do not occur in those portions of the body separated 
by spinal section from cerebral influence. 
As Bohm and Wartmann found that the reflex activity was lost more rapidly than the 
power of voluntary movement, and that no increase of reflex activity occurs in the aco- 
nitized frog when the cord is cut so as to release it from the influence of Setschenow's 
reflex inhibitory centres, they draw the conclusion that the aconitia first depresses the 
reflex activity of the sensitive spinal centres and afterwards that of the motor spinal 
centres, until the cord is completely paralyzed. 
f Laborde and Duquesnel affirm that after very large doses of aconitine the animal dies 
of spasm of the glottis and diaphragm, because they have noticed, especially in the young 
animal, drawing in or constriction of the lower chest during life, and sub-pleural ecchy- 
moses after death. These are, however, the marks of paralysis of the glottis from palsy 
of the recurrent laryngeal nerve. CARDIAC SEDATIVES. 
193 
are wanting. Achscharumow found in fatal poisoning a fall of about 
3° C * 
Therapeutics.-Our knowledge of the physiological action of aconite, 
although imperfect, is sufficient to show that there are only two or three 
indications to meet which the drug may be used. 
The first of these is to lower arterial action, and often, with it, excess 
of temperature. For this purpose aconite is very valuable. I have never 
used it in those cases, such as pneumonia, in which a sudden and very 
powerful effect is desired, simply because veratrum viride seemed to me safer, 
more readily controlled, and equally effective. Aconite may, however, be 
used with very good results in these cases, and especially in such diseases 
as peritonitis, in which it is very important to avoid vomiting. My own 
experience with it has been in fevers of a sthenic type not dependent upon 
so deep-seated a cause (as an example may be mentioned the febrile move- 
ments of severe, acute muscular rheumatism^, and in the ephemera or irri- 
tative fevers of childhood : in such cases its influence for good is often very 
decided. In the early stages of scarlet fever and other exanthemata, when 
not decidedly adynamic in type, it is very useful. In the reflex fever which 
sometimes follows the passage of the catheter or bougie (the so-called urethral 
fever} it is very efficient.-}' 
In some cases of hypertrophy of the heart, when the valves are perfect, or 
when, the valves being diseased, the hypertrophy is greater than is necessary, 
aconite is of use to control cardiac excitement. When, however, there is 
dilatation of the heart or any degeneration of the heart-muscle, it is an 
exceedingly dangerous remedy, and is also at all times to be avoided if the 
hypertrophy be not excessive. 
A second indication, which aconite might be used to fulfil, is to allay 
spasm. As, however, its influence upon the motor centres and nerves is 
much less than upon the sensitive centres and nerves and upon the heart, 
the indication is better met by other remedies. 
A third indication, which it would seem from its known physiological 
action that aconite should meet, is to relieve over-excitation of the sensitive 
* MM. GrShaul and Duquesnel (L'Union Pharmacentique, Aug. 1871) have commu- 
nicated to the French Academy some experiments upon frogs with crystallized aconitia, 
whose results are so strikingly different from those of other experimenters as to indicate 
the existence of some fallacy; possibly the alkaloid used by them was not the same as the 
amorphous aconitia. They found in the frog, after small doses (^y milligramme) of their 
alkaloid, that the heart continued to beat steadily and regularly after all power of sponta- 
neous or reflex movement had been lost, that sensation was preserved as long as any power 
of motion existed, and that the motor nerve-trunks were paralyzed. After large doses 
(one milligramme) they observed sudden arrest of the heart's action. These results are, 
however, entirely discordant with the later ones of Laborde and Duquesnel. 
t The following formula affords an excellent combination : R Tr. aconit. rad., gtt. i; 
Sp. ether, nitrosi, f 3ii; Mist, potass, citrat., q. s. ad f ^i. S.-Dessertspoonful every two 
hours for a child three years old. 194 
SYSTEMIC REMEDIES. 
nerves. Clinical experience has confirmed this. As long ago as 1834, Dr. 
Turnbull (On the Preparations and Medical Employment of Aconitina by 
the Endermic Method, London, 1834,- On the Medical Properties of the 
Natural Order Ranunculacese, London, 1835) called attention to the use of 
the alkaloid in neuralgia ; and his estimate of its value has been confirmed 
by Dr. A. Fleming (An Inquiry into the Physiological and Medicinal Proper- 
ties of the Aconitum Napellus, Edinburgh, 1845) and by other observers. 
In cases of rheumatic neuralgia dependent upon an acute exposure to cold 
and attended with more or less febrile disturbance, in combination with other 
suitable remedies aconite is often of great service. In chronic neuralgia, 
associated as it always is with a lowered systemic tone, the remedy is less 
efficient; yet in some cases it seems to give relief. Owing to its very marked 
local benumbing influence, applied to the painful part it is sometimes very 
useful. In my own experience, this Ipcal use of it has, however, very seldom 
been effective when, as in migraine, the pain is of centric rather than of 
peripheral origin. 
Given in full doses in the reflex vomiting of pregnancy, aconite is often 
advantageous, acting probably by benumbing the sensory reflex centres, or 
possibly the afferent peripheral nerves. I have noticed that relief lasts only 
so long as decided constitutional effects from the drug are apparent. 
Toxicology.-Aconite is an exceedingly powerful poison, one-twelfth of 
a grain of the crystallized alkaloid being, according to Duquesnel, sufficient 
to kill a rabbit in a short time. Five grains of an extract and eighty 
minims of a tincture are said to have caused death (Reichert, Philad. 
Med. Times, Nov. 1881, p. 105). The symptoms usually come on in 
a very few minutes. In the shortest case I have met with, death 
occurred in thirty minutes. The average time of death (Reichert, loc. 
cit.') is three and a third hours: the longest recorded case being five and 
a half hours. 
The aconitines of commerce vary inordinately in strength, so that whilst 
one-sixteenth of a grain (prepared by Petit,* of Paris) caused the death of 
Dr. Carl Meyer in five hours, several grains of the impure article, so largely 
sold, have been recovered from. The symptoms have been in general those 
of aconite poison, but excessively violent pains and convulsions have been 
very marked features of some of the cases. (For a very valuable general 
discussion of aconitine-poisonimr, by Dr. Thomas Stevenson, see Guy's Hos- 
pital Reports, 3d series, xxvi. 308.) 
* In the researches of Anrep, Duquesnel's crystallized aconitia was nearly twice as strong 
as a German alkaloid used by him, which in turn was much stronger than an English 
article. Plugge found Petit's aconitia eight times as strong as that of E. Merc. Lang- 
gard found an alkaloid prepared from A. japanicum exceedingly powerful. The best dis- 
cussions of the relative strength of these alkaloids I know of may be found in Schmidt's 
Jahrb., Bd. ccii. 121, and in Des Aconite, by Dr. J. V. Laborde and H. Duquesnel, Paris 
1883. CARDIAC SEDATIVES. 
195 
The peculiar tingling is the only diagnostic symptom, but it is very 
characteristic. The first indication for treatment is to evacuate the stom- 
ach and wash it out well with the stomach-pump. Alcoholic stimulants 
should be freely administered, hot and concentrated, and alcohol, ether, 
and digitalis be given hypodermically; the injection of ammonia into the 
veins may be practised. Great care should be used to keep the patient 
absolutely quiet, upon the back, with the feet a little higher thap the head. 
Laborde and Duquesnel affirm that in the lower animals death after a usually 
fatal dose of aconitine can be prevented by artificial respiration, and in a case 
of human poisoning, if the heart's action were at all sustained, and the res- 
piration failing, Sylvester's method might be resorted to. 
It was discovered by Dr. J. Milner Fothergill (Digitalis, London, 1871, 
p. 6) that in the aconitized frog, even when cardiac action has ceased, digi- 
talis has power to recall the systolic movements. More recently this antag- 
onistic action of aconite and digitalis upon the frog's heart has been abun- 
dantly proven by various experimentalists. Clinical experience, although 
still limited in extent, strongly corroborates the experimental evidence of 
the value of digitalis. Successful cases may be found in British Med. Journ., 
Dec. 11, 1872 (fgi Fleming's tincture, Tr. Digitalis n^x, hypodermically); 
Boston Med. and Surg. Journ., Oct. 1879, 544 (f$iii Tr. Aconit. Rad., 
Tr. Digitalis njjlx, hypodermically) ; Indian Med. Gazette, xvii. 323 (Acon- 
itum ferox root 48 grains, Tr. Digitalis n^xxv, hypodermically, and fji 
by mouth) ; Philad. Med. Times, xiii. 328 (a decoction of aconite, amount 
unknown, Tr. Digitalis in drachm and half-drachm doses, by mouth). In 
a successful case treated by Dr. Elliot (Lancet, 1878, ii. 917) nitrite of 
amyl freely inhaled seemed to do great good : a fluidounce of a concentrated 
aconite liniment was thought to have been taken. Ammonia injections were 
unsuccessful in a case reported in the Australian Med. Jour., 1879, i. 283. 
Administration.-Aconite is never used in substance. The dose of tho 
tincture of aconite (Tinctura Aconiti-1 to 2.5, U. S.) is one to five drops, 
repeated every one to three hours pro re nata, its effects being always 
watched. Fleming's tincture is a stronger preparation (gxss to Oj). 
The dose of the extract (Extractum Aconiti, U. S.) is one-quarter to 
three-quarters of a grain; of the abstract (Abstractum Aconiti, U. S.), one 
grain ; of the fluid extract (Extractum Aconiti Fluidum, U. S.), one to two 
minims. The tincture or the fluid extract of aconite is very frequently added 
to stimulating and anodyne liniments. 
Aconitine is not officinal, and, on account of its intense activity, should 
not be given internally; even its external use requires care. The ointment 
may be of the strength of two grains to the drachm: a two per cent. solu. 
tion of the oleate of aconitine in oil has been highly commended as a local 
application in neuralgia. 196 
SYSTEMIC REMEDIES. 
ACIDUM HYDROCYANICUM-HYDROCYANIC ACID. 
Pure hydrocyanic acid is a colorless, transparent, volatile, inflammable 
liquid, giving rise to giddiness and headache when smelled, and having, it is 
said, a burning bitter taste. So poisonous is it that when inhaled it causes 
death, and it must be handled with the greatest caution: smelling and tasting 
of it are excessively dangerous proceedings. It is indeed an imperative rule 
that no one should experiment with anhydrous prussic acid alone, or under 
any circumstances in summer, or in a warm room, or in an apartment whose 
open windows and doors do not admit of a free draft of air. The chemist 
Scheele, the discoverer of prussic acid, is believed to have been killed by the 
inhalation of the fumes of this material, whose poisonous properties were 
first pointed out by the Berlin apothecary Schrader in 1803. The anhydrous 
acid is soluble in water and alcohol, but is never kept in the shops, and is 
not officinal. 
Hydrocyanic acid of common medical parlance is the officinal Dilute Hydro- 
cyanic Acid (Acidum Hydrocyanicum Dilutum, U. S.), a colorless, watery 
solution, containing two per cent, of the anhydrous acid. Its odor and taste 
are the familiar ones of peach-kernels and bitter almonds ; its reaction is 
faintly acid. According to the directions of the U. S. Pharmacopoeia, it is 
prepared by distilling a mixture of ferrocyanide of potassium, sulphuric acid, 
and water, or by precipitating cyanide of silver from its watery solution with 
muriatic acid. With solution of nitrate of silver added in slight excess, one 
hundred grains of it produce a white precipitate, which, when washed with 
water until the washings are tasteless, and dried at a temperature not exceed- 
ing 212°, weighs ten grains, and is wholly soluble in boiling nitric acid. 
The precipitate in this case is the cyanide of silver, and the amount 
afforded shows that the liquid contains the officinal percentage of anhydrous 
prussic acid. 
As hydrocyanic acid has a great tendency to undergo spontaneous de- 
composition, especially under the influence of light, it should be kept in 
well-stopped, dark-colored bottles. 
Physiological Action.-In warm-blooded animals, poisoning by hydro- 
cyanic acid divides itself naturally into the acute and the subacute ; death oc- 
curring in the first in at furthest ten minutes, in the second not at all, or else 
only after the lapse of a longer time than that noted. After a full dose of the 
strong anhydrous acid, the animal gasps once or twice, and then instantly falls 
in a tetanic or clonic convulsion, or else drops motionless and powerless upon 
its side. In either case, at once the signs of asphyxia manifest themselves, 
and grow more and more intense, until they end in total arrest of respiration. 
The heart beats irregularly, often at first slowly and strongly, with intervals 
of suspension of movement, but always becoming weaker and more rapid in 
its action, until, after the breathing has ceased, its efforts gradually die away. 
If tue dose has been enormous, the heart and lungs may stop acting at once; CARDIAC SEDATIVES. 
197 
otherwise the cardiac pulsations may continue some minutes after the arrest 
of respiration. Ordinarily, three distinct stages are apparent: a first, very 
brief one, of difficult respiration, slow cardiac action, and disturbed cere- 
bration ; a second, convulsive stage, with dilated pupils, violent convulsions, 
unconsciousness, loud cries, vomiting, often spasmodic urination and defecation, 
erections, etc.; a third period, of asphyxia, collapse, and paralysis, sometimes 
interrupted by partial or even general spasms. 
The slow form of the poisoning follows the exhibition of the poison in an 
amount just sufficient to kill. After the ingestion of such a dose, no phe- 
nomena are offered for some seconds; then the breathing becomes labored, 
and the pulse slow and full. The animal perhaps cries out, and muscular 
tremblings invade the whole body, to give place, in a very short time, to 
clonic and tonic convulsions, which continue at intervals until the third stage, 
that of collapse, is developed. The convulsions are less violent and less fre- 
quent than those of the acute poisoning; all the symptoms noted as occurring 
during the second stage of rapid cases are present in the corresponding period 
of the subacute poisoning, although less violent and less intense in their mani- 
festations. When the third stage is developed, the anaesthesia is marked, 
affecting first the hind legs, but finally spreading to all parts of the body, and 
even being complete in the widely-dilated pupil. Death finally results from 
failure of respiration. Recovery may occur even after the conjunctiva has 
lost its sensibility; the return to life by a subsidence of the symptoms is 
usually rapid, so that generally in from one-half to three-quarters of an hour 
the animal will be eating as though nothing had happened. Coullon, how- 
ever, noted persistence of paralysis, in some cases, for days. 
In man, prussic acid produces results closely parallel with those which it 
causes in the lower animals. The symptoms come on suddenly. In a moment 
or two the individual falls to the ground insensible and convulsed, the respi- 
rations arrested or occurring at long intervals, the eyes salient, the pupil 
dilated, the mouth covered with bloody froth. If the dose be sufficiently 
large, death may occur in three or four minutes; if less have been taken, 
deep insensibility, tetanic or clonic convulsions, dilated pupils, a bloated 
countenance, cyanosed surface, set jaws, and irregular respiration, constitute 
the chief symptoms. The breathing is mostly convulsive, with deep, forcible 
expirations, but in some cases it has been stertorous. Death results from 
asphyxia. After small toxic but not lethal doses of prussic acid, giddiness, 
lightness of the head, nausea, a quick pulse, and muscular weakness, are the 
chief symptoms. 
Action on Blood.-As early as 1814, Dr. F. B. Vietz {Medicin. Jahrb. 
d. k. k. Oesterreich. Staates, Bd. ii., 1814) called attention to the change 
of color that occurs in the venous blood of animals poisoned with prussic 
acid; and his observations have been confirmed by E. L. Schubarth {Horn's 
Archiv f. Med. Erfahrung^ Berlin, 1824), by J. F. Sobernheim {Handbuch 
der Prakt. Toxicologic, Berlin, 1838), and by Dr. Coze {Gazette Medicale 198 
SYSTEMIC REMEDIES. 
de Paris, 1849). In his Legons sur les Substances toxiques, p. 193 (Paris, 
1857), Claude Bernard reaffirms the occurrence of these changes, and further 
states that if the animal die suddenly the blood in the veins and right heart 
is found of a bright arterial hue at the post-mortem. Notwithstanding all 
this testimony, J. R. Bischoff ( Ueber Ver gif tungen nebst einigen Versuchen 
an Thieren, welche mit Blausaure, Cyankalium und Arsenik angestellt 
wurden, Wien, 1844) and numerous other observers have found that after 
death from prussic acid, either in man or other mammals, nothing but dark 
venous blood exists in the body. Of the correctness of this observation 
there can be no doubt. 
Prof. W. Preyer (Die Blausaure, Bonn, 1870) has afforded by his ex- 
periments an explanation of these apparently contradictory facts. He found 
that directly after the exhibition of prussic acid to a mammal the blood 
becomes, even in the veins and in the right heart, of a bright arterial hue, 
but that after a time this color darkens into the blue of venous blood, and 
finally, even in the arteries and in the left ventricle, only blood of such char- 
acter is to be found. Dr. Carl Gaethgens (Hoppe-Seyler's Medicinisch- 
chemische Untersucliungen, Berlin, 1866, p. 324) has, in a number of experi- 
ments, confirmed this, so it must be accepted as a fact. When an animal 
dies suddenly from cardiac paralysis, during the first stage of poisoning, this 
excessive arterialization may be found after death, as mentioned by Claude 
Bernard; and, as Preyer first noticed, in cold-blooded animals the bright 
color persists for many hours. By spectroscopic examination Prof. Preyer 
(loc. cit., p. 95) found that the dark blood of prussic acid poisoning is abso- 
lutely or almost free from oxygen, showing only the absorption bands of 
deoxidized haemoglobin, whilst Gaethgens (loc. cit., p. 328) has discovered 
that the red venous blood of the first stage of the poisoning shows very 
clearly the absorption bands of oxyhaemoglobin. The first question which 
arises at this juncture is as to the causes of these changes of the blood, its 
primary excessive arterialization, its secondary excessive carbonization. Prof. 
Hoppe-Seyler affirms (Medidnisch-chemische Untersucliungen, p. 140, Berlin, 
1867) that the appearance of red blood in the veins is because the red 
blood-corpuscles have been so acted upon by the poison as to have lost their 
ability of yielding up their oxygen in the capillaries. Dr. Carl Gaethgens 
(Ibid., p. 325) has by an elaborate series of experiments shown that in the 
first stage of prussic acid poisoning much less than the normal amount both 
of carbonic acid and of exhaled oxygen is eliminated. The lessened ex- 
halation of oxygen probably depends simply upon a lessehed inhalation of 
oxygen, owing to the disordered respiration. That the lessened excretion 
of carbonic acid is not due to the same cause, however, is shown by the faot, 
determined by Gaethgens (loc. cit., p. 347), that the percentage of the acid 
in the expired air is less than normal, whilst that of oxygen is greater 'than 
normal. It is evident that if the lessened excretion of carbonic acid were 
produced by the entrance into the lungs of an amount of air insufficient for CARDIAC SEDATIVES. 
199 
the wants of the system, the expired air would contain more than its normal 
proportion of carbonic acid and less than its normal amount of oxygen. 
The observed phenomena seem to me to prove that during the first stage of 
prussic acid poisoning oxidation is arrested. They do not demonstrate, how- 
ever, that the arrest is due to a direct action of the poison upon the blood- 
corpuscles. The probabilities of such occurrence are rendered very slight by 
the investigations of Gaethgens himself, for he found that when the experi- 
ments were prolonged from seventeen to forty-four minutes, much more than 
the normal amount of carbonic acid was exhaled, a fact in accord with the 
excessive carbonization of the blood known to take place in protracted hydro- 
cyanic acid poisoning. As it seems incredible that a substance should one 
minute paralyze the ozonizing power of the blood-corpuscles and the next 
minute increase it, it is very improbable that the super-arterialization of the 
blood in the first stage of prussic acid poisoning is due to a direct action of 
the poison upon the red disk. 
Preyer has proven (loc. cit., p. 85) that when to blood at the temperature 
of the body hydrocyanic acid is added, the spectrum after a time is altered 
and new absorption bands appear. These bands are due to the formation of 
a new compound by the union of the haemoglobin and the hydrocyanic acid. 
This substance, cyanohxmoglobin, was first discovered by Hoppe-Seyler ( Vir- 
chow's Arehiv, Bd. xxxviii. p. 475), and has no ozonizing power whatever; 
to its formation, no doubt, is owing the loss of ozonizing power by blood to 
which hydrocyanic acid is added outside of the body, a phenomenon pointed 
out ny Sehonbein* {Schmidt's Jahrbiicher, Bd. cxl., 1868, p. 161), and 
indicated even earlier by the researches of Prof. Harley {London Philosoph- 
ical Transactions, 1865, p. 706).f The latter observer found that the blood 
taken out of the veins of a subject forty-eight hours after death from prussic 
acid poisoning, and thoroughly arterialized by shaking with air, and then 
allowed to stand, yielded gas containing 19.56 parts of oxygen, 80.44 parts 
of nitrogen, and 0.00 parts of carbonic acid. 
These facts at first sight seem to prove the theory of Hoppe-Seyler, to 
* In the same memoir Sehonbein calls attention to the fact that prussic acid destroys 
also the ozonizing power of living vegetables, such as roots, fungi, etc. 
j- According to Dr. E. Ray Lankester (Pfluger's Arehiv, 1869, p. 492), when blood is 
shaken with cyanogen gas, and allowed to stand for two or three hours, the spectrum- 
changes are exactly the same as after similar treatment of blood with CO. The com- 
pound of cyanogen and hasmatin (Cy,Hb) offers not only the identical spectrum of 
CO,lib, but, like the latter, is unaffected by reducing agents. After the blood stands 
awhile, according to Dr. E. Ray Lankester, the spectrum of hydrocyanic acid (H,CN) 
becomes visible in it, and the Cy,IIb undergoes conversion into the cyanohaemoglobin 
(Cy,Hb) of Hoppe-Seyler. 
Any one desirous of investigating this subject more deeply than can be done in a work 
like the present should consult especially the papers by Hoppe-Seyler, Virchow's Arehiv, 
Bd. xxxviii., and scattered through the Medicinisch-chemische Untersuchungen; by Harley, 
London Philosophical Transactions, 1865, p. 706; and by Preyer, Pfliiger's Arehiv, 1868, 
p. 395. 200 
SYSTEMIC REMEDIES. 
which indeed they no doubt gave origin. Preyer has shown (loc. cit., p. 95), 
however, that the dark blood of prussic acid poisoning has not lost its power 
of oxidization, for on being shaken with the air it assumes the red arterial 
hue; and Drs. Lecorche and Meuriot (Archives Generales, t. xi., 6e s^rie, 
p. 539) have determined that artificial respiration will produce the same 
result in the poisoned animal. Moreover, the spectroscope shows plainly 
that the haemoglobin exists in the blood either in its pure state (Preyer, loc. 
cit., p. 95), or else as oxyhaemoglobin (W. Laschkewitsch, Reichert's Archiv, 
p. 652, 1868; Hiller and Wagner, Lancet, 1877, ii. p. 933), and that no 
cyanohaemoglobin is present. The reaction between hydrocyanic and haemo- 
globin is one requiring some time, and evidently does not occur in poisoning. 
On the whole, therefore, I think that the chemical evidence clearly shows 
the falsity of the theory that prussic acid acts in the body directly upon the 
red blood-corpuscles. 
Preyer (loc. cit., zweiter Theil, p. 88) has shown that the excessive oxy- 
genation and the subsequent excessive carbonization of the blood are not 
peculiar to hydrocyanic acid poisoning, but are equally present after the 
exhibition of sulphuretted hydrogen, and even after mechanical closure of 
the mouth and nose. It is possible that an increased arterial pressure, an 
increased rapidity of circulation, may cause the blood to pass too quickly 
through the capillaries to allow time for the usual changes; but this has not 
been proven, and at present it must be acknowledged that we are ignorant as 
to the immediate cause of the blood-changes in these cases. 
It is possible, although scarcely probable, that the changes in the color of 
the blood are due to alteration in the form of the corpuscles. According to 
Ernst Geinitz (Pfluger's Archiv fur d. gesammte Physiologie, Bd. iii., 1870, 
p. 46), outside of the body prussic acid produces in the blood-corpuscles 
of the frog, first, a shortening of the long and a lengthening of the short 
diameter, and consequently a rounded form, then granulations, and, finally, a 
solution and setting free of the nucleus. In frogs poisoned with prussic acid 
a rounded form of the corpuscles was commonly exhibited, and sometimes 
granulations were present. M. Geinitz also found that the red disks of 
mammalian blood, exposed to the vapor of hydrocyanic acid in the moist 
chamber of Stricker, become first somewhat asymmetrical, then mulberry- 
shaped, and finally undergo molecular destruction. In poisoning of mammals, 
according to the same investigator, the granular blood-corpuscles are commonly 
met with. Preyer (loc. cit., zweiter Theil, p. 91) confirms the observation of 
Geinitz so far as the action of the poison upon drawn blood is concerned, but 
both he and Hiinefeld (Der Chemismus in der thierischen Organisation, 
Leipsic, 1840) assert that immediately after death from prussic acid the 
corpuscles offer their usual characters. 
Whatever may be the cause of the changes in the blood, the experiments 
of Lewisson (Reichert's Archiv, 1870, p. 352) would appear to prove that 
the action of the poison on the nervous system is a direct one, and not due CAR DIAC SEDATIVES. 
201 
to these changes in the vital fluid, for the observer mentioned found that 
prussic acid acted upon the bloodless " salt frog" as upon the normal 
batrachian. 
Action on the Heart.-The action of hydrocyanic acid upon the heart 
varies according to the dose. In sufficient amount and concentration it 
produces instantaneous diastolic arrest, which is either permanent or re-occurs 
after a few slow feeble beats (Preyer, loc. cit., p. 52, and Drs. Lecorche and 
Meuriot, Archives Generales, t. xi., 6e serie, p. 543). As early as 1826, 
Krimer found that prussic acid placed directly upon the heart of the frog 
produces arrest of its beat and loss of its muscular irritability. Preyer has 
confirmed this, and it would seem to be proven that the cardiac arrest spoken 
of above is due to a direct action upon the heart-muscle or its contained 
ganglia, yet that after cardiac death from prussic acid the heart responds to 
galvanism. 
The cardiac results of the exhibition of small non-toxic doses are, according 
to Preyer, simply slowing of the heart's action. 
Preyer and Laschkewitsch agree as to the action of large, but not enormous, 
doses. At first there is a sudden prolonged diastolic arrest of the heart, 
followed by an augmentation in the rapidity of the cardiac action, and after 
this a diminution of the rate,-to the normal number in cases of recovery, 
to cardiac stand still in cases of death. Both Preyer* and Laschkewitsch 
(Reichert's Archiv fur Anatomic, 1868, p. 653) found that after section 
of the vagi the primary diastolic arrest of the heart did not occur. The 
recent investigations of Jos. Lazarski confirm the statements of Preyer as 
to the action upon the vagus. A complete inhibitory arrest of the heart 
was rarely achieved, yet slowing of the pulse was constantly produced by 
moderate doses of the poison in the normal animal, but was prevented by 
previous section of the vagi, and was removed, when present, by division 
of the inhibitory nerves ( Wien. Med. Jahrb., 1881, 141). It would seem, 
therefore, proven that small doses of prussic acid stimulate the cardiac 
inhibitory nervous system. Bohm and Knie noted that large doses of the 
acid caused slowing of the pulse whether the vagi were cut or not (Archiv 
fur Exper. Path, und Therap., ii. 137), and in this have been confirmed 
by Lazarski. This slowing would seem to be due to a direct action upon 
the muscle, as Lazarski found that the cardiac accelerator nerves are not 
paralyzed. 
Moderate doses of prussic acid seem to produce a primary very brief but 
great rise in the arterial pressure, followed by a fall to or below the normal. 
This primary rise has been noticed by Bohm and Knie, by Wahl (De Vi 
et Ejfectu Hydrocyanato ad Curationem Attrib., Bonn, 1865), by Rossbach 
and Papitzky (Centralb. Med. Wissens., 1877, p. 640), and by Lazarski. lc 
* Preyer (toe. cit., p. 93) has also noted the same absence in curarized animals poisoned 
by hydrocyanic acid. 202 
SYSTEMIC REMEDIES. 
does not seem to be altogether the result of the asphyxia produced by the 
acid, as it is recorded by Bohm and Knie (loc. cit., p. 146) as occurring 
when artificial respiration was used, and uazarski has confirmed this. All 
observers agree that it is followed, if the dose of the poison has been large 
enough, by a profound sinking of the arterial pressure. Lazarski found 
that galvanization of a sensitive nerve has no effect at this time upon the 
blood-pressure, so that we must consider that hydrocyanic acid primarily 
stimulates very briefly the vaso-motor system directly or indirectly, and 
afterwards paralyzes it. 
Action on Respiration.-According to Preyer (loc. cit., pp. 17, 18, 19), 
during all three stages of hydrocyanic acid poisoning the respirations are 
lessened in frequency, and during the latter moments of life the efforts at 
breathing are very distant, and finally cease before the arrest of cardiac 
movements. The observer just mentioned found that, after division of the 
vagi, normally lethal doses did not kill, and that when death was brought 
about by the exhibition of larger doses it was by cardiac arrest. From this he 
deduces the conclusion that the prime respiratory action of the poison is upon 
the peripheral ends of the vagi. Dr. Preyer's experiments have been par- 
tially confirmed by Drs. Lecorche and Meuriot (loc. cit., p. 538) ; but Boehm 
and Knie (Archiv fur Exper. Path, und Therap., Bd. ii. p. 135) have in a 
series of experiments found that section of the vagus has no influence upon 
the respiratory action of the poison, and in this have been confirmed by 
Jos. Lazarski (loc. cit.'). Even if investigations had proven the correctness 
of Preyer's experiments, his conclusion could not be considered established, 
because we know so imperfectly the normal relations of the pneumogastrics 
to respiration. Moreover, Prof. Joseph Jones (New York Medical Record, 
vol. ii. p. 459) found that whilst to kill an alligator by the administration 
of prussic acid required a considerable length of time, its application to the 
medulla produced within one minute a most powerful expiration, ending in 
permanent contraction of the muscles of respiration and collapse of the 
lung. We must, it seems to me, at present consider that the respiratory 
phenomena of prussic acid poisoning are due to an influence exerted directly 
upon the respiratory centre. 
Action on Muscles and Nerves and Nerve-centres.-Dr. Kblliker ( Vir- 
chow's Archiv, Bd. x. p. 272) has found that in frogs dead of prussic acid 
poisoning both the nerve-trunks and the muscles are unexcitable, or that the 
muscles respond very feebly to direct stimulation. This is in accord with the 
experiments of Stannius (Archiv fur Anatomic, 1858, p. 95), who found 
that when strychnia and prussic acid were given together, the convulsions 
normally produced by the former poison were altogether absent, or present 
only in a slight degree. In order to determine whether the nerves are or 
are not primarily affected, Kblliker experimented by tying the vessels of the 
thigh, then dividing just below this point all the tissues except the nerve, 
and administering prussic acid by the mouth. In a number of such experi- CARDIAC SEDATIVES. 
203 
ments he found that always the nerve and muscles below the point of section 
retained their irritability, but that when the galvanic or other stimuli were 
applied to the nerve higher up, they failed to elicit any response from the 
unpoisoned tributary muscles,-positive proof that the nerve-trunks are 
paralyzed by a direct action of the drug. This is seemingly opposed to the 
experiments of Stannius (loc. dt.^ who concluded that prussic acid applied 
locally to the nerves has no effect upon them. Stannius, however, compared 
the results of soaking a nerve in water and in a weak solution (three to four 
per cent.) of prussic acid, and water thus employed is toxic to the nerve- 
trunks. Kblliker used, in repeating the experiments of Stannius, neutral 
solutions of phosphate of sodium, one containing, the other free from, hydro- 
cyanic acid, and found that the nerves in the poisoned liquid died much sooner 
than did those in the non-poisoned solution. 
The experiments of Kblliker are in agreement with those of Stannius, 
that the muscle dies very much more quickly in the solution of the acid than 
does the nerve, losing its excitability in from seven to eight minutes. This 
rapid destruction of muscular irritability by the local application of prussic 
acid was, I believe, first noted by Coullon in 1819. Yet it is most probable 
that when given internally prussic acid acts almost as rapidly upon the nerve- 
trunks as upon the muscles, since Kblliker noted that in some cases galvani- 
zation of the nerve was incapable of causing contractions in the tributary 
muscles, although the latter responded feebly to direct stimulation. This 
fact has been experimentally corroborated by Funke (Berichte uber die Ver- 
handl. d. k. sacks. Gesellschaft d. Wissensch. zu Leipzig, Bd. xi., 1859, p. 28). 
Upon the peripheral sensitive nerves prussic acid probably, if in sufficient 
concentration, acts as a paralyzant; at least Kblliker (loc. tit., p. 282) found 
that if the leg of a strychnized frog, whose heart had been cut out to prevent 
absorption, was put in a four per cent, solution of prussic acid, in a very short 
time irritation of the immersed skin ceased to produce convulsions. 
From the slowness with which, in Kblliker's experiments, the nerve-trunks 
were affected in frogs poisoned by hydrocyanic acid, it seems probable that 
he is correct in his conclusion that in these batrachians the poison first para- 
lyzes the brain, and then the reflex centres of the spinal cord, and afterwards 
the motor nerves. But I have not met with any experimental evidence in 
regard to the order in which prussic acid affects the nervous system. Ac- 
cording to Kiedrowski,* as quoted by Preyer, in frogs it first paralyzes the 
gray, then the white substance of the brain, and the early disappearance of 
reflex movements is not due to spinal palsy, but to destruction of the func- 
tional power of the peripheral afferent nerves. Preyer also states that the 
* I have, unfortunately, been unable to obtain access to the original paper of E. de 
Kiedrowski. Even Preyer appears to know it only in abstract. According to him, it was 
published in 1858, at Breslau, as a dissertation, under the following title: De quibuadam 
experiment™ quibue quantum vim habeat acidum hydrocyanicum in nervorum ayatema cerebro- 
epinale atque in mueculoa eyatematia vertebralie probatur. 204 
SYSTEMIC REMEDIES. 
conclusions of Kiedrowski rested upon the following experimentally proven 
fact, which, if accurate, seemingly renders them logically inevitable. When 
a frog is poisoned with prussic acid, and afterwards with strychnia in properly- 
proportioned doses, there is a stage at which slight irritation of the afferent 
nerve-roots causes violent general tetanic spasms, although the most intense 
peripheral irritation fails to elicit response. 
It is a question of interest to decide as to the cause of the convulsions in 
poisoning by hydrocyanic acid. I have found that they do not occur after 
section of the cord in parts below the point of section, and that they are 
therefore cerebral in origin : for reasons detailed elsewhere (see p. 143), it is 
very probable that they are due to disturbed cerebral circulation, and this 
probability is confirmed by an experiment of Laschkewitsch (Reichert's 
Archiv fur Anatomic, 1868), who opened the thorax of a rabbit so as to 
expose the heart, maintained artificial respiration, and administered prussic 
acid; directly after arrest of the heart had commenced, the convulsion came 
on. The earlier observation of Coze (Comptes-Rendus, t. xxviii., 1849, p. 
780) is also to the same effect, as he states that the convulsions did not 
occur until directly after the arrest of the circulation. In frogs poisoned 
with hydrocyanic acid, convulsions do not take place. Preyer states that 
after section of the vagi convulsions do not generally happen in mammals, 
but if artificial respiration be performed they come on (loc. cit., p. 69). 
Therapeutics.-Our knowledge of the physiological action of prussic 
acid does not lead to a belief in its wide applicability to the relief of disease, 
and I think clinical experience has demonstrated that it is of little value 
except in meeting three indications: first, to allay cough ; second, to relieve 
irritation of the gastric nerves ; third, to allay irritation of the peripheral 
sensitive nerves. 
There appears to be in the profession a very wide-spread belief in the 
power of this remedy to allay cough; at least it is very largely used for this 
purpose in cough-mixtures, either itself or in the form of cyanide of potas- 
sium. I have employed it in a great number of cases in hospital practice, 
and apparently with good effect, although, as it was always given in combina- 
tion with such remedies as morphia, it is difficult to say how much of the 
result was due to it. I do not believe it can compare with such narcotics as 
opium or hyoscyamus in its ability to fulfil the present indication. 
There can be, on the other hand, no doubt as to the value of prussic acid 
in certain stomachic affections, especially nervous vomiting and gastralgia. 
When the pain is accompanied by decided dyspeptic symptoms, the remedy will 
sometimes succeed, but more often fails. Even in the most favorable cases it 
does not always afford relief; and as the relief when it does occur is immediate, 
or at least is very soon apparent, it is useless to persist long in the exhibition 
of the remedy. In these cases its action is probably local, as it certainly is 
when the acid is employed to relieve itching in prurigo and other cutaneous 
diseases. For this purpose it is used as a wash (fjss to f5 i in f^i) ; but great CARDIAC SEDATIVES. 
205 
care must be taken to avoid constitutional effects, especially when there is 
any abrasion of the skin. Very serious results are said to have been caused 
by its absorption when carelessly used in skin-diseases. 
Prussic acid has been commended as an arterial sedative ; but it is evident 
that we possess numerous more efficient and far safer remedies of such 
character. 
Toxicology.-The symptoms of prussic acid poisoning have already been 
mentioned: those of most value from a diagnostic point of view are the 
sudden occurrence of unconsciousness; the violent convulsions ; the general 
paralysis ; the peculiar character of the breathing, expiration being prolonged 
and forced ; and the rapid results. The odor of prussic acid upon the breath 
is very often, but by no means always, present. When distinct, it is, of course, 
of very great diagnostic value. Leaving out of sight the cyanides, the only 
poison with which prussic acid could well be clinically confounded is nitro- 
benzole. The distinction is often very difficult, large doses of the latter sub- 
stance killing almost as quickly as prussic acid, and inducing analogous 
symptoms. Caspar advises that after death the body be left open, exposed 
to the air, as the odor of prussic acid disappears rapidly, whilst that of the 
nitro-benzole is persistent. The diseases with which the poisoning may be 
confounded most readily are some forms of apoplexie foudroyante, and sudden 
failure of the heart's action. The diagnosis may, during life, be almost 
impossible. It has been asserted that stertorous breathing does not occur 
in prussic acid poisoning; but it has been present in several reported cases. 
(See Taylor s Principles and Practice of Medical Jurisprudence, Philadel- 
phia, 1873, p. 363.) An autopsy, however, ought generally to enable the 
physician to determine whether the case has or has not been one of prussic 
acid poisoning, if the symptoms during life are known. 
A curious case of temporary hemiopia, apparently caused by the fumes 
of hydrocyanic acid, is reported in Brit. Med. Journ., i. 1884, 409. 
The period at which death may occur after the ingestion of the poison is 
set down by Lonsdale at from one to fifty-five minutes ; but a case is reported 
in Guy's Hospital Reports, 1868, p. 259, observed by Dr. Hilton Fagge, in 
which the fatal result was put off for at least an hour and a quarter after the 
ingestion of hydrocyanic acid. After death the body often presents a livid sur- 
face, bloated countenance, fixed glassy eyes with dilated pupils, and clenched 
fingers ; sometimes it offers nothing worthy of note except excessive rigidity, 
and the face may be very pale. When opened, the odor of prussic acid is 
generally, but not always, emitted ; the mucous membrane of the stomach is 
very commonly found much congested, and the dark or cherry-colored liquid 
blood usually everywhere fills up the veins. The heart is soft and flaccid. 
The treatment of poisoning by prussic acid is, unfortunately, as inefficient 
as it is simple. There is no known chemical or physiological antidote to it, 
the asserted antagonism of atropia having been disproven by the experiments 
of Keen (Proc. Phil. Acad. Nat. Sd., 1869) and of Boehm and Knie. 206 
SYSTEMIC REMEDIES. 
The stomach should, if possible, be emptied, and the hypodermic use of 
atropia as a respiratory stimulant might be tried; the inhalation of the 
vapors of ammonia, and the free exhibition of ammonia by the mouth and 
by injection into the veins, may be practiced. Artificial respiration has 
been found very successful by Preyer, and by Boehm and Knie, in animals 
when poisoned by small doses of prussic acid, and should always be assidu- 
ously practiced. Next to it in importance is the use of the alternate cold 
and hot douche, about a half of a small bucketful of cold water and the same 
quantity of very hot (115° F.) water being dashed upon the chest in rapid 
succession. 
Administration.-The dose of the officinal dilute prussic acid is one to 
three drops. 
The Cyanide of Potassium (Potassii Cyanidum, U. S.) is prepared, 
according to the U. S. Pharmacopoeia, by heating together the ferrocyanide 
of potassium and the carbonate of potassium. It occurs in white, amorphous, 
opaque masses, having the odor of prussic acid and a taste of similar charac- 
ter, but somewhat alkaline. It is deliquescent, and readily soluble in water. 
When the nitrate of silver is added to its solution, there falls a precipitate of 
the cyanide of silver, which is wholly soluble in ammonia. 
When the cyanide of potassium is taken into the stomach, the acids there 
present convert it into prussic acid, and the same change probably occurs, 
although more slowly, even when the salt is injected directly into the blood- 
vessels. The physiological, therapeutical, and toxicological properties of this 
salt are similar to those of prussic acid.* Death, however, does not occur so 
soon as when hydrocyanic acid has been taken, and insensibility is sometimes 
not manifested for several minutes. Five grains of the salt have caused death 
in several cases. The therapeutic dose is one-tenth to one-twelfth of a grain. 
The Cyanide of Silver (Argenti Cyanidum, U. S.) is a white insoluble 
powder, which is used solely for making prussic acid. 
Cyanogen Gas has been studied physiologically by Dr. B. Bunge (Archv. 
Exp. Path. u. Pharm., xii. 71). He finds that it kills by paralyzing the 
centres of respiration, but is less powerful and strong in its influence than 
is hydrocyanic acid, and causes only very feeble convulsions. 
VEGETABLE ACIDS. 
Although most of the officinal vegetable acids differ so much from the 
other substances considered in the present class as not to be poisonous except 
in enormous doses, and although they are never used to produce a profound 
impression upon the circulation, yet since they have, or at least are believed 
to have, the power of lowering the force of the cardiac movements to some 
extent, and since they are so commonly believed to have a tendency to de- 
* Poisoning is stated to have occurred from the inhalation of the vapors of the cyanide, 
and, in photographers, from the absorption through the hands {Brit, and Fur. Med.-Chir. 
Rm.. July, 1876, p. 231). CARDIAC SEDATIVES. 
207 
press animal temperature as to be usually spoken of as refrigerants, the 
present seems to me a fitting position for their consideration. In experi- 
ments made by W. H. Gaskell (Journ. Physiology, iii. 49), similar to those 
described in the article on digitalis (see p. 150), it was found that whilst 
alkalies contracted the arterioles of the frog, acids* caused a dilatation, 
probably by paralyzing the muscular coats. Acids also diminished the 
activity and power of the frog's heart. 
ACIDUM TARTARICUM-TARTARIC ACID. U.S. 
Tartaric acid occurs in large, hard, transparent, six-sided prisms, which 
are pyro-electric and phosphorescent when rubbed in the dark, and are nearly 
free from odor, but have a very sour taste. In the shops the acid is almost 
always kept in the form of powder. Tartaric acid is the acid of the grape, 
and occurs in grape-juice as a supertartrate of potassium. When the juice 
undergoes fermentation and alcohol is developed, the acid salt, not being sol- 
uble in the newly-formed menstruum, precipitates, collecting as a dark mass 
in the wine-casks, whence it is sent into commerce under the name of argol 
or tartar. Out of this substance the acid is manufactured by treating with 
lime, so as to form a tartrate of calcium, and precipitating this new compound 
in its watery solution by sulphuric acid, sulphate of calcium falling, tartaric 
acid remaining in solution. Tartaric acid is soluble in little more than half 
its weight of hot water and less than its weight of cold water. It is distin- 
guished from all other acids by forming a crystalline precipitate (bitartrate) 
when added to a neutral solution of potassa. 
Physiological Action.-When applied to a denuded surface, or in suffi- 
cient concentration to a mucous membrane, tartaric acid acts as a very decided 
irritant, and even upon the skin its saturated solution after a time causes 
redness and burning. 
When the drug is taken internally in sufficiently large doses, it acts as 
an irritant poison, causing violent oesophageal and gastric burning, vomiting, 
and, it may be, fatal gastro-enteritis. Upon animals it acts in large doses 
precisely as it does upon man. Thus, Mitscherlich states that three or four 
drachms suffice to kill a rabbit, the evident symptoms being great weakness 
of the heart's action, difficult and slow breathing, steadily-increasing pains, 
with slight convulsions before death. According to Devergie, it requires 
nearly half an ounce to kill a dog when given by the stomach; but Pommer 
(quoted by Husemann) asserts that one gramme (15.34 grains) injected into 
the crural vein of a dog will produce death. 
Tartaric acid is never used internally by practitioners in such doses as to 
cause any of the symptoms above detailed, and it is evident that these symp- 
toms throw little light upon its action in therapeutic doses, except to render 
* Lactic acid appears to have been the only one used, and it does not appear certain 
that the results of experiments would be the same with all acids, as is stated in Gaskell's 
generalization. 208 
SYSTEMIC REMEDIES. 
it somewhat probable that the tendencies of the medicine are to lower cardiac 
action. This probability is increased very much by the experiments of 
Bobrick (quoted by Husemann, Die Pflanzenstoffe, p. 561), who found that 
very large doses render the heart's action weaker and slower. 
A great deal of interest to the therapeutist centres in the question as to 
what becomes of the acid in the system. Unfortunately, our knowledge in 
regard to this matter is far from complete; but the drug is probably partially 
burnt up in the body and partially eliminated by the kidneys. Wohler,* in 
his experiments, found it in the urine in the form of tartrate of calcium, 
whilst Buchheim * and Piotrowski * could find only a very small percentage 
of the ingested acid in the urine, and conclude that it is mostly destroyed in 
the body. Dr. Munch (Archiv des Vereins fur Gemein. Arbeiten, 1863, p. 
370) finds that when tartaric acid or citric acid is given it soon appears in 
the urine. Dr. H. Bence Jones (Medical Times and Gazette,no\. ix.,1854, 
p. 408, and Lectures on Pathology and Therapeutics, London, 1867) has 
found that both citric acid and tartaric acid cause a very great increase in the 
acidity of the urine of persons taking them, and are apt also to give rise to 
the presence of free uric acid in the excretion. Unfortunately, Dr. Jones 
did not attempt to determine whether the increased acidity was or was not 
due to the presence of the vegetable acid in the urine. 
Therapeutics.-Tartaric acid is very rarely used in medicine, the citric 
acid almost always being preferred. It may, however, be employed whenever 
it is desired to render the urine acid, in doses of ten to twenty grains; but 
it is less valuable than the acid of the lemon. 
Toxicology.-There are, I believe, but three fatal cases of tartaric acid 
poisoning on record: one reported by Devergie (Ann. d'Hygiene, 1851, t. 
ii.) • one by Prof. Taylor (Principles and Practice of Medical Jurispru- 
dence, London, 1873, p. 230), in which death took place nine days after 
the ingestion of an ounce of the poison dissolved in half a pint of water; 
and one (Med. Press and Circular, Nov. 1880) in which a half-ounce of 
the acid was supposed to have been taken. The treatment of tartaric acid 
poisoning consists in the free exhibition of magnesia, of lime, of the carbo- 
nate of potassium or of sodium, or of any article, such as soap, containing 
an alkali in a suitable shape, which may be at hand. The after-treatment 
is that of toxic gastro-enteritis. 
ACIDUM CITRICUM-CITRIC ACID. U.S. 
Citric acid is the acid of lemon- and lime-juice, from which it is extracted 
by a process precisely similar to that employed in the manufacture of tartaric 
acid. It occurs in rhomboidal prisms, which are sometimes very large, are 
nearly free from odor, but are possessed of a very sour, almost corrosive 
taste, which, when the acid is in sufficiently weak solution, is quite pleasant. 
* All these are quoted by Huseinann, Die Pflanxeiietoffe. I have not seen the originals. CARDIAC SEDATIVES. 
209 
Citric acid is soluble in three-fourths of its weight of cold water, half of its 
weight of boiling water, soluble in alcohol, insoluble in ether. 
It is sometimes adulterated with tartaric acid, which may be readily de- 
tected by the addition of a strong neutral solution of carbonate of potassium 
to a strong solution of the suspected drug, when, if tartaric acid be present 
in any amount, a precipitate of the bitartrate is formed. 
Physiological Action.-Citric acid in concentrated solution certainly 
acts upon abraded surfaces and upon mucous membranes as an irritant, but, 
according to Mitscherlich, is less irritant than tartaric acid, since its concen- 
trated solution has no action upon the sound skin. 
No case of poisoning by citric acid has occurred in man, that I am aware 
of, and Piotrowski (quoted by Husemann, Die Pflanzenstoffe, p. 561) took, 
in six hours, thirty grammes, an hour later fifteen grammes, and an hour 
later thirty grammes, or nearly two ounces and a half in all, with the indue 
tion of no more serious symptom than vomiting. It is, therefore, somewhat 
doubtful whether citric acid is capable of causing death in man. This differ- 
ence in action between it and tartaric acid may depend upon the latter being 
so much the more irritant of the two; upon the urinary secretion their 
action is probably similar. 
Hugo Schulz states that citric acid is an active antiseptic, a five per cent, 
solution being sufficient to preserve small pieces of meat for two weeks; 
one part in a thousand was fatal to paramecia (Deutsch. Med. Wochens., 
1883, ix. 398). 
Therapeutics.-Citric acid is sometimes itself employed in medicine, 
but is almost exclusively used in the form of Lemon-juice (Succus Limonis), 
which some, it is true, have thought to be dependent upon citrate of potas- 
sium for much of its virtue, but which contains, as shown by the analysis 
of Prof. H. Bence Jones (Medical Times and Gazette, vol. ix., 1854), in 
every ounce twenty-six or twenty-seven grains of free citric acid, and not 
two grains of the citrate of potassium. 
Lemon-juice has several very distinct uses in medicine, all of them resting 
upon clinical rather than physiological data. The chief and most important 
of these is in the cure and prevention of scurvy. During the disease it 
should be drunk freely in the form of lemonade, three or four ounces of 
it being taken daily. As a prophylactic against the disease, lemon-juice is 
simply invaluable; but it is absolutely necessary that it be of good quality. 
It may be prepared for long voyages in one of two ways: first, boil the 
juice slightly, strain, allow to cool, pour into bottles up to their necks, fill 
the vacant space above with pure olive oil, cork tightly, and keep the bottle 
upright; second, add ten per cent, of brandy, and bottle as before (Medical 
Times and Gazette, 1854, p. 635). Citric acid is of some value in scurvy, 
but is incomparably less active than lemon-juice. In acute rheumatism, 
benefit may be derived from the free use of lemon-juice, as originally pro- 
posed by Dr. Rees, of London. One or two ounces of it may be given four 210 
SYSTEMIC REMEDIES. 
or five times a day ; but it is certainly less efficacious than the alkalies. In 
catarrhal jaundice, and in habitual torpor of the liver, the free internal use 
of lemon-juice often aids in effecting a cure. In fevers, lemonade often 
affords a very refreshing and useful refrigerant drink. 
Administration.-Lemon-juice, when it can be had, should always be 
preferred to citric acid ; when only the latter is available, an artificial lemon- 
juice may be made by dissolving in a pint of water an ounce of the acid 
with which four drops of the oil of lemon have been well rubbed up. 
ACETUM-VINEGAR. 
The physical properties of vinegar are too well known to need description 
here. That best suited for medicinal use is in this country prepared from 
cider, and should have a trace of the taste of cider. It is sometimes adul- 
terated with sulphuric acid, which may be at once detected by boiling with 
chloride of calcium, which precipitates any free sulphuric acid as sulphate 
of calcium, without affecting the small proportion of soluble sulphates ex- 
isting in vinegar. Vinegar may be substituted for lemon-juice as the basis 
of an acidulous drink in fever when the lemon-juice is not to be had ; but 
as an antiscorbutic it is certainly very much inferior to it, and has not, that 
I am aware of, been tried in rheumatism. 
Acetic Acid (Acidum Aceticum, U.S.) is a colorless liquid, having a 
pungent odor, free from empyreuma, and an intensely acid, corrosive taste. It 
contains thirty-six per cent, of the monohydrated acetic acid, and has a spe- 
cific gravity of 1.047. Glacial or monohydrated acetic acid is not officinal. 
It is a colorless liquid, crystallizing at 34° F., and actively escharotic,-in a 
measure, no doubt, owing to its properties of dissolving gelatine and gelati- 
nous tissue and of effecting a partial solution of albuminous matters. Dilute 
Acetic Acid (Acidum Aceticum Dilutum) is officinally prepared by the 
addition of seven parts of water to one part of acetic acid, and should have 
the sp. gr. 1.006. Acidum Aceticum Glaciale, U.S., glacial or absolute 
acetic acid, is at 59° F. a crystalline solid. 
Dilute acetic acid, or its equivalent, vinegar, is a useful topical application 
in various superficial inflammations of the skin, such as " sunburn," and in 
sprains. Applied to the skin, it acts as a powerful stimulant and astringent, 
causing contraction of the vessels and great whiteness. Diluted with two or 
three times its bulk of water, it is occasionally employed as an injection against 
seat-worms ; but the infusion of quassia is preferable. 
The use of acetic acid as a caustic will be spoken of under the heading of 
Escharotics. 
Toxicology.-Acetic acid in any of its more concentrated forms is a 
corrosive poison, and death has been produced by it in at least one case 
(Orfila, Toxicologie, t. ii.). The symptoms resemble those caused by mineral 
acids, and the treatment is exactly similar,-neutralization by an alkali or its CARDIAC SEDATIVES. 
211 
carbonate, or by some substance, such as soap, containing an alkali, and the 
meeting of indications as they arise. 
Oxalic Acid (Acidum Oxalicum), although never used in medicine, 
has so frequently caused death by its poisonous influence as to merit 
notice here. In 1874 (^Gaz. Med., p. 92) Rabuteau announced that in 
oxalic acid poisoning the nerves and muscles are not affected, and that 
therefore the acid acts upon the nerve-centres. This has been confirmed 
by the elaborate researches of Drs. R. Kobert and B. Kiissner ( Virchow's 
Archiv, Bd. Ixxviii. 109), who find that it paralyzes the respiratory, vaso 
motor, and other motor spinal centres. The acid is eliminated by the kid- 
neys. As a poison, oxalic acid figures in two forms: that of simple oxalic 
acid, and that of the acid oxalate of potassium, or salt of sorrel, or essen- 
tial salt of lemons, as it is variously termed in common parlance. The 
symptoms produced are a hot acrid taste experienced during the swallowing, 
a burning in the gullet, soon extending to the stomach, intense abdominal 
pain, vomiting of highly acid, greenish, blackish-brown or bloody mucus 
(rarely of arterial blood), collapse, livid surface, cold skin, entire prostra- 
tion of strength, small irregular pulse, stupor, unconsciousness, sometimes 
convulsions (cases, Guy's Hosp. Reports, 1838, iii.; Dublin Hosp. Reports, 
1818, ii.), and finally death. In some cases the gastric symptoms are very 
prominent; in others they are nearly wanting, and the chief manifestations 
are collapse and such nervous symptoms as almost complete general paraly- 
sis, numbness, and finally stupor; indeed, the patient may suddenly fall 
unconscious immediately after the ingestion of the poison (case, Guy's 
Hosp. Reports, 1874). According to Taylor, the smallest quantity which 
is known to have caused death is one drachm. An ounce usually proves 
fatal, but has been recovered from. After death the coats of the stomach 
are usually found softened and swollen, and sometimes perforated (case, 
Edinb. Med. Journ., vii., July, 1861). Dr. Rabuteau (Gaz. Med., 1874, 
p. 93) affirms that the blood is everywhere scarlet; but this is certainly not 
always the case (case, Taylor, Med. Jurisprudence, i. 224). According to 
Kobert and Kiissner, the urine during life contains some strongly reducing 
substance of unknown nature, oxalate crystals in abundance, and usually 
albumen and tube-casts. A pathognomonic post-mortem lesion is, accord- 
ing to the same investigators, the incrustation of the urinary tubules with 
crystals of oxalates. In poisoning by oxalic acid, the immediate adminis- 
tration of an antidote is of the utmost importance. As the oxalates of 
potassium and of sodium are poisonous, neither potash nor soda is avail- 
able ; but fortunately lime or chalk is a perfect antidote to oxalic acid, 
forming the excessively insoluble oxalate of calcium. As time is a matter 
of so much importance, very often it is best simply to scrape the whitewash 
oft' a wall, ceiling, fence, or wherever it may be at hand, rub it up hastily 
with water, and administer it freely. The after-treatment is that of toxic 
gastro-enteritis. CLASS V.-ANTISPASMODICS. 
Under the name of Antispasmodics are grouped in this treatise a number 
of medicines generally of very feeble powers, but of frequent use. In certain 
conditions of the nervous system-conditions associated with weakness rather 
than with simple depression-the nerve-centres appear to be more susceptible 
than is normal to external impressions, as well as to those impulses which 
originate in the cerebral centres themselves and are connected with the emo- 
tions. As a result of this state, various symptoms arise, of trifling import, 
but often apparently severe, and always annoying. Such symptoms, in their 
mildest form, constitute the state of unrest known as nervousness ; in their 
severer type they may rise in intensity up to the wildest convulsion of hysteria. 
It is in this class of affections that the so-called antispasmodics are useful. 
As the condition which they relieve is always associated with weakness, they 
are often spoken of as " nervous stimulants." In regard to most of them 
there is but little evidence of their increasing power or functional activity 
when given to healthy individuals. Some of them act very slightly upon the 
circulation when given in very large doses, and a few when administered as 
freely as possible induce slight cerebral symptoms, such as vertigo; but, ex- 
cepting camphor, caffein, and Hoffman's Anodyne, none are capable of pro- 
ducing serious poisoning. As any theory of the method in which the hysteri- 
cal convulsion originates-of its immediate causes and the mechanism of its 
production-would, with our present knowledge, be at best but an ingenious 
speculation, the safest plan in regard to the action of drugs belonging to 
the class now under consideration is to accept the teachings of clinical experi- 
ence as to facts, and to avoid theorizing as to the way in which the results 
are brought about. 
A highly odorous, unctuous substance, obtained from the glands situated 
just in front of the preputial orifice of the Moschus moschiferus, or musk- 
deer of Thibet. The genuine musk-sac is to be distinguished from imita- 
tions of it by the hairs being arranged concentrically around a minute orifice. 
As it occurs in commerce, musk is very greatly adulterated. 
Physiological Action.-Musk appears to act upon the nervous system 
sim^y as a mild stimulant and antispasmodic. Jorg and Sundelin have 
experimented with it upon healthy men with somewhat contradictory results 
MOSOHUS-MUSK. U.S. 
212 ANTISPASMODICS. 
213 
According to the first-named observer, twenty grains of it induce exhilaration 
without lassitude, but, according to the latter authority, may cause giddiness, 
drowsiness, and lassitude. Both observers noted a slight increase in the fre- 
quency of the pulse. It seems to me evident that the action of musk upon 
the organism is a very feeble and uncertain one. Yet there is considerable 
clinical evidence that when the nervous system is exhausted it is of service in 
calming restlessness and equalizing the disturbed balance of nervous power. 
Therapeutics.-Musk is at present very little used, but it is strongly 
recommended by some of the older writers in various spasmodic affections, 
especially in hysterical convulsions. In hiccough it has been considered a 
specific. In the delirium of low fevers it is sometimes valuable ; and it has 
been especially commended by Trousseau in the ataxic pneumonia of drunk- 
ards, when the nervous symptoms are out of proportion to the local disease. 
The dose of musk is from five to fifteen grains, which may be given sus- 
pended in mucilage. Tincture of Musk (Tinctura Moschi,-1 to 10, U. S.) 
is given in doses of one-half to two fluidrachms. 
Castoreum- Castor.-The preputial follicles of the beaver are pyriform 
sacs, occurring in pairs, and containing an unctuous material,-the castor. 
This is a substance allied to musk in its physical properties, and apparently 
also in its medicinal qualities. It is certainly less efficient, however, than 
musk, and Mr. Alexander (Pereira's Materia Medica, American edition, 
1866, p. 949) is said to have taken a quarter of an ounce of it without 
having experienced any effect. It is employed in the same affections as 
musk, in doses of fifteen to sixty grains, suspended in mucilage. There is an 
officinal tincture, which is stronger in alcohol than in castor. 
The root of the Valeriana officinalis, an herbaceous perennial of Great 
Britain. It consists of a short, yellowish-white rhizome, with numerous 
fibrous roots, of a bitter taste and peculiar odor. The active principle of 
valerian appears to be the oil of valerian, which, according to Pierlot, con- 
sists of a mixture of valerian camphene, valerian camphor, valerianic acid, 
resin, and water. 
Physiological Properties.-Upon cats valerian has a very extraor- 
dinary effect, attracting them strongly, and greatly exciting their sexual 
passions. It is possible that this action is suggestive, due rather to the re- 
semblance of the odor to that of the animals during sexual excitement, than 
to a direct action of the drug. Valerianic acid given to rabbits in large doses 
produces, at first, a slight acceleration of the pulse, which, with the respira- 
tion, afterwards becomes less frequent than normal, and at the same time 
lassitude and muscular weakness are developed. Enormous doses kill rabbits 
somewhat suddenly, or produce fatal gastro-enteritis. 
Upon man, large doses to 5iv) are said to produce a feeling of warmth 
VALERIAN A-VALERIAN. U.S. 214 
SYSTEMIC REMEDIES. 
in the stomach, and sometimes nausea, vomiting, and colicky pains. The 
pulse is generally slightly quickened, and a sense of exhilaration is induced, 
accompanied, however, by formication in the hands and feet. Very large 
amounts cause a feeling of heaviness, and even of pain, in the head. 
Therapeutics.-Clinical experience has demonstrated the value of valerian 
as a means of relief for the milder forms of functional disturbance dependent 
upon a weak and over-excitable or an exhausted nervous system. In the 
state of unrest familiarly known as " nervousness," by soothing and quieting 
the patient, it will often indirectly procure sleep. 
In hysteria it has been the most frequently used of medicines, and its action 
is ofttimes most happy. 
It has also been employed, but with more doubtful advantage, in mania a 
potu, and in the delirium of adynamic fevers. In these cases it is almost 
invariably conjoined with more powerful remedies, and it is very difficult to 
decide how far it assists in procuring the beneficial result. 
Administration.-The best preparations of valerian are the fluid extract 
(Extractum Valerianae Fluidum, U. S.), dose, one fluidrachm; and the 
ammoniated tincture (Tinctura Valerianae Ammoniata, U.S.,-^ii to Oj), 
dose, one to three fluidrachms. The dose of the infusion is a wineglassful; 
that of the simple tincture (fTinctura Valerianae, U.S.,-$ii to Oj) is one 
to three fluidrachms. 
Acidum Valerianicum.- Valerianic Acid is an oily, colorless liquid, 
of a caustic taste, and a strong odor, resembling, but differing from, that of 
valerian. It is made by the action of chromic acid upon amylic alcohol, 
by a somewhat complicated process, and is employed for the manufacture 
of Valerianate of Ammonium (Ammonii Valerianas, U.S.), a white salt 
occurring in quadrangular plates, which effloresce in a dry and deliquesce 
in a moist atmosphere, have the odor of valerianic acid and a sharp sweetish 
taste, and are very soluble in water and in alcohol. 
Therapeutics.-This salt was introduced by M. Declat, of Paris, as a 
remedy for neuralgia. It has since been used very largely for nervous head- 
ache and in hysteria. It appears to be about equivalent to valerian, but, 
unless it be in nervous headaches, is less efficient. The dose of it is ten 
grains, which is generally administered in the form of an elixir. 
ASAFCETIDA-ASSAFETIDA. U.S. 
An exudation obtained by incising the living root of the Narthex Assa- 
foetida, an umbelliferous plant of Afghanistan. It mostly occurs in irregular 
opaque masses of a dull yellowish- or pinkish-brown, white when freshly 
broken, of a bitter acrid taste and a strong garlicky odor. Even this lump 
assafetida is largely composed of tears agglutinated together; sometimes 
these tears are distinct and separate, when they constitute the variety known 
as assafetida in tears. Assafetida is composed chiefly of gum and resin, ANTISPASMODICS. 
215 
but its properties are in great part due to the volatile oil, of which it con- 
tains from 3.5 to 4.5 per cent. 
Physiological Action.-When taken into the stomach, assafetida acts as 
a local stimulant and carminative, and on this account is in some parts of the 
East used as a condiment. The oil is without doubt absorbed. The evidence 
as to its action upon healthy men is both scanty and contradictory. Thus, 
whilst M. Pidoux took half an ounce in a single dose without perceptible 
effects other .than to render his secretions horribly offensive for two days, 
Jorg and his disciples found that in twenty-grain doses it produced gastric 
uneasiness and pain with alvine dejections, increased the pulse-frequency and 
animal warmth, quickened the respiration, and caused headache, giddiness, 
and erotic excitement. 
Therapeutics.-Clinical experience has abundantly proven that assa- 
fetida is one of the most efficient of the so-called antispasmodics, and may be 
given to fulfil the same indications as valerian in functional spasm, in hys- 
teria, and in nervousness. It differs from valerian in having a much more 
decided action upon the mucous membranes. It is an excellent carminative, 
and in the form of injection is constantly used for the relief of tympanitis. 
It also in small doses increases the appetite, and affords relief in the dys- 
pepsia, with flatulent colic and costiveness, of the aged or hysterical. As a 
stimulating expectorant and antispasmodic, it is useful in whooping-cough 
and in chronic catarrh. It is especially efficient in palliating the latter 
affection as occurring in old people, when the difficulty of breathing is parox- 
ysmally increased by spasm of the bronchial tubes. In infantile convulsions 
and in severe infantile colic, assafetida enemata (f^ii to f^ss of the milk) 
are exceedingly useful and harmless. 
Administration.-The Pills of Assafetida (Pilulse Assafoetidae, U. S.) 
each contain three grains: from two to four may be given at once. 
The dose of the mixture or milk of assafetida (Mistura Assafoetidae, U. S., 
-5ii to Oj) is half to one fluidounce; for injections, one to three fluid- 
ounces; that of the tincture (Tinctura Assafatidee, U.S.,-§ii to Oj), half 
to one fluidrachm. The suppositories contain the equivalent of forty min 
ims of the tincture. Emplastrum Asafoetidee, U. S., is used externally. 
Camphor is obtained in China, Japan, Cochin China, the Sunda Islands, 
etc., by boiling the comminuted wood of the root, stem, and branches of the 
Laurus Camphora, and skimming off the camphor as it rises to the surface 
of the water when cold. This camphor is then partially purified by subli- 
mation, and comes into commerce as crude camphor, which is in grains of a 
whitish or pinkish color, and is finally purified by sublimation with lime.* 
CAMPHORA-CAMPHOR. U.S. 
* A variety of camphor, as well as of camphor oil, yielded by the Dryobalanops Cam- 
phora, is very highly valued in the East, but does not reach this country. For a physio- 
logical study of it, by Paolo Pellacani, see Arch. Exper. Pathol, und Pharm., xvii. 376. 216 
SYSTEMIC REMEDIES. 
Refined camphor (or, as it is commonly called, camphor) occurs in disks or 
hemispherical bowl-like translucent masses, of a fibrous or granular fracture, 
Its taste is hot and peculiar; its odor very strong and characteristic; it is 
volatile, inflammable, tough, but readily pulverized on the addition of a few 
drops of alcohol; melts at 347° F.; is soluble in one thousand parts of cold 
water,* in one part of strong alcohol, and still more soluble in chloroform; 
thrown upon water, a granule of camphor floats, and exhibits a rotary motion. 
By slow sublimation at ordinary temperatures, camphor can be made to 
crystallize in handsome hexagonal tables. 
Physiological Action.-Locally applied, camphor is a decided irritant, 
although when it is taken into the mouth a sense of coolness after a time is 
experienced, due no doubt to the volatility of the drug: a precisely analogous 
phenomenon occurs with some other volatile irritants, such as oil of pepper- 
mint.j' 
Great differences of opinion have prevailed in regard to the action of 
camphor upon man, and it is scarcely doubtful that it acts differently upon 
different persons, or at least that doses which in some cause only exhilaration 
in others produce general depression. When a moderate dose (five to ten 
grains) of camphor is taken, a feeling of exhilaration is usually induced, a 
sense of comfort and quietness, especially marked in those previously suffer- 
ing from " nervousnessthe pulse may be somewhat accelerated, although 
it is undoubtedly not markedly affected in the majority of cases, and Trous- 
seau saw it fall after the ingestion of ten grains of the drug. After larger 
doses (twenty to thirty grains) the pulse is usually lowered in frequency, 
and giddiness, with a feeling of lassitude, is produced, preceded, it may be, 
by a short period of exhilarative excitement. After poisonous doses (thirty 
to sixty grains) the symptoms, which are tolerably uniform, are as follows: 
faintness, headache, vertigo, confusion of ideas, burning pain in the stomach, 
delirium, violent convulsions, insensibility, apparent general paralysis; a 
pulse generally small, but sometimes accelerated and sometimes lowered in 
number; a skin cool, pale or livid, generally bedewed with sweat. Sudden 
unconsciousness, with or without convulsions, has been in some instances the 
first manifestation of the action of the poison, and, of course, in any indi- 
vidual case many of the symptoms narrated above may be wanting.^ 
No death has occurred in the adult directly from camphor. A young, 
sickly infant was killed by ten grains of it; and a woman four months gone 
* By rubbing the gum up with magnesia in water, the latter can be made to take up 
much more than one part in one thousand. 
f For physiological action of Camphor-Cymol, see Arch. Experim. Path, und Therap., 
1873, Bd. i. 
J Cases, Edinburgh Med. Journal, May, 1873; The Clinic, March, 1873; Weiner Medi- 
zinische Preaee, 1874, p. 258; Berlin. Klin. Wochena., Sept. 1873-74; Trane. Land. Clin.Soc., 
1874, p. 27; London Lancet, 1876, ii. 71; Brit. Med. Journ., Feb. 1875; also 1877, i. 607. A N T1SPA S MO D1CS. 
217 
in pregnancy, having taken three drachms of camphor, suffered the usual 
symptoms, followed by an abortion which proved fatal. 
Much contradictory evidence might be adduced as to the influence of cam- 
phor upon the genital organs. The truth evidently is that its action varies 
according to the dose and the idiosyncrasies of the patient. In the great 
majority of instances, I think, camphor in moderate doses has no decided 
influence upon the sexual system ; at least I have seen many hundred such 
doses taken and have never yet seen any aphrodisiac effect. In some per- 
sons, however, full therapeutic doses are said to cause sexual excitement. 
In regard to very large doses, the testimony is quite uniform that if they 
exert any action it is to lessen the erotic feelings. 
Camphor acts upon articulates as a violent poison ; in birds, according to 
Menghini, it causes stupor or delirium with epileptiform seizures; in mam- 
mals it produces symptoms similar to those seen in man, such as vomiting, 
violent convulsions, coma, and death, apparently from asphyxia. The con- 
vulsions must be of cerebral origin, as, according to the experiments of C. 
Weidemann (Arch. Exp. Pathol, und Therap., vi., p. 216), and of Hoffmann 
(quoted by Weidemann), they do not occur after section of the cord in por- 
tions of the body below the point of division. Whether they are the result 
of a direct action upon the cerebrum is not determined, but the other symp- 
toms produced by camphor indicate that the drug has a decided influence 
upon that organ. In frogs, Weidemann found that the convulsions are masked 
by a general paralysis, chiefly due to a depressant action upon the motor nerves; 
the spinal cord, however, also suffering in its functional activity, the muscles 
escaping. The action of toxic doses of camphor upon the circulation is de- 
cided. In the poisoned frog the cardiac beats become slow and powerful, and 
as Heubner found (Arch. Exper. Path, und Therap., v., p. 427) the camphor 
was able to excite the heart when arrested by muscarin, it is probable that its 
action is upon the heart itself. The same investigator failed to get any rise 
of arterial pressure in rabbits ; but in the more extended researches of Weide- 
mann it was found that in the convulsive stage of camphor-poisoning there 
is a very marked rise of the arterial pressure, which is largely due to the 
convulsions and disturbance of breathing, as it is in a measure prevented by 
curarization and artificial respiration. Under these circumstances, however, 
sudden periodical elevations of all of the arterial pressure occur. The cause 
of this phenomenon is not obvious, as Weidemann affirms that it is prevented 
by section either of the cord or of the vagi. As, after section of the cord, 
toxic doses of camphor lessen the arterial pressure, it would seem probable 
that it is directly depressant to the heart. 
Camphor is undoubtedly very much changed in the organism ; the most 
important of its derivations is campho-glycuric acid, discovered by Schmie- 
deberg and Meyer (Zeitschrift. f Physiol. Chem., 1881), which, by warm- 
ing with muriatic or sulphuric acid, is changed into Campherol* a crystal- 
lizable substance soluble in ether and also in water. 
* For a physiological study of cainpherol, see Archiv f. Exper. Path., xvii. 372. 218 
SYSTEMIC REMEDIES. 
Therapeutics.-Camphor is very largely used internally as an antispas- 
modic, to quiet restlessness and " nervousness." It is also employed in certain 
painful affections seen in those persons who are especially liable to the con- 
dition of the nervous system just mentioned: thus, it is often useful in 
nervous headaches and dysmenorrhoea. Indeed, in the latter disease, either 
alone or combined with opium in bad cases, it is a most valuable drug, but 
must be given freely. In diarrhoea not dependent upon inflammation, in 
cholerine, and even to some extent in cholera, camphor is a very efficient 
remedy, allaying intestinal pain and spasm, and also checking intestinal secre- 
tion. It enters into a large proportion of the popular cholera-mixtures. In 
adynamic fevers it has been very greatly employed, but is of doubtful advan- 
tage : still, a good deal of testimony could be adduced in favor of its useful- 
ness in sustaining the system in the low stages of these diseases; and in 
nervous restlessness occurring at such times it is often very soothing. In 
abnormal sexual excitement, and in chordee, large doses of camphor very 
often appear to act most happily. The drug has also been very frequently 
exhibited in various spasmodic affections, such as whooping-cough, epilepsy, 
and even puerperal and strychnic convulsions, but is, I believe, at present 
never so employed. In hysterical convulsions, as in other phenomena of the 
same origin, camphor is a useful antispasmodic. 
Externally, camphor is much used in liniments as a stimulant application 
for bruises, sprains, etc. 
Administration.-Large doses (ten to fifteen grains) of camphor are 
best administered in emulsion, because when given in this way, being very 
finely subdivided, they create as little irritation as possible, and are rapidly 
absorbed; smaller doses may be given in pill. As an antispasmodic, the 
Camphor Water (Aqua Camphorse,-1 to 125, U.S.) is usually preferred; 
its dose is half a fluidounce to two fluidounces, but, when a decided effect is 
desired, the Spirit of Camphor (Spiritus Camphorse-1 to 10, U.S.) is 
preferable: its dose is half a fluidrachm to a fluidrachm. For external use, 
the U. S. Pharmacopoeia recognizes the Linimentum Camphorse (camphor one 
part, olive oil six parts) and the Linimentum Saponis, or Soap Liniment,- 
a mild liniment, very popular by itself, or as the basis of more stimulating 
preparations. 
Oleum Camphors.- Oil of Camphor is the volatile oil of the Cam- 
phora officinarum. As it occurs in our market, it is a reddish or yellowish- 
brown liquid, having a strong odor of camphor, and a hot, camphoraceous 
taste. It contains camphor in solution, and is probably equivalent to it in 
physiological action, except that it is locally more stimulating, and therefore! 
preferable in intestinal disorders. The dose is five to ten drops. 
Campiiora Monobromata. U. S.-Monobromated Camphor, or Bro- 
mated Camphor.-With iodine and bromine camphor unites to form com- A NTISPA S MO DICS. 
219 
pounds. According to Laurent, bromcamphor occurs in red orthorhombic 
crystals. These when exposed to the air undergo rapid spontaneous decom- 
position, but by heating in a closed vessel are resolved into hydrobromic 
acid, and a compound in which one atom of hydrogen in the camphor has 
been replaced by bromine. This bromated camphor is a crystalline solid, or 
occurs in large acicular crystals several inches long. 
Our present knowledge of the physiological properties of bromated cam- 
phor rests upon the work of Bourneville (Ze Progrbs Med., 1874; also 
Compt.-Rend., Aout, 1875), of Lawson (Practitioner, 1874, 1875), of 
Pathault (Bromure de Camphor, Paris, 1875), of Richard Peters (^Schmidt's 
Jahrb., Bd. ci. 126), and of Pellicani (Ibid.}. In frogs there is progress 
in loss of reflex excitability and of voluntary movement (Peters), which, 
according to Pellicani, is due to paralysis of the motor nerves. Death is 
caused by arrest of respiration (Peters). In mammals it produces violent 
convulsions, muscular weakness passing almost into paralysis, reduction of 
temperature (after small doses preceded by a rise-Peters), great decrease 
in the rate of the respiration and of the pulse, with occasional periods of 
hurried respiration (Peters), profound sleep or stupor, and finally death. 
Bourneville states that the blood-vessels of the eyes and ears are diminished 
in calibre. Upon man the drug probably acts as upon other warm-blooded 
animals ; in a case reported by M. Rosenthal (Schmidt's Jahrb., Bd. ci. 
127), forty-five grains of it caused tremblings, marked slowing of the pulse, 
and coma of six hours' duration. 
Therapeutics.-Bromated camphor was first introduced by Prof. De- 
neffe (Presse Medicale Beige, 1871) as a nervous sedative, and as a useful 
antispasmodic, especially in delirium tremens. It has not, however, sus- 
tained its first rapidly acquired reputation, and is but little used. I have 
seen it do good in spermatorrhoea, and it may be tried in chordee, but 
especially in hysteria and allied convulsive disorders. It is taken with 
difficulty, and is apt to irritate the stomach. Bourneville proposes the 
following formula for hypodermic use, but Lawson states that it is so 
pungent that it cannot be employed : Bromated camphor, gr. xlv; Alcohol, 
f5ix; Glycerin, f$vss. The dose of the drug is five to ten grains, given 
after meals in capsule or coated pill, and repeated as necessary. In Bourne- 
ville's experiments twelve grains injected under the skin of a cat caused 
death in seventy-two hours. 
Carbolated Camphor.-When fifteen grains of carbolic acid dissolved in 
an equal quantity of alcohol are rubbed up with thirty-five and a half grains 
of camphor, an oily, pale-yellow liquid with a feeble odor of camphor results. 
This does not mix with water or glycerin, but does with almond and olive oil. 
It has been proposed by Dr. Soulez as a non-irritant, antiseptic dressing for 
wounds (see Amer. Journ. Med. Sci., July, 1877, or Lond. Med. Record, 
May, 1877). 220 
SYSTEMIC REMEDIES. 
SUCCINUM-AMBER. 
Amber is a fossil resin found on the southern coasts of the Baltic and in 
other portions of the world. It is not itself officinal or used in medicine, 
but by destructive distillation yields an empyreumatic oil which is included 
in the Materia Medica list of the U. S. Pharmacopoeia. 
OLEUM SUCCINI-OIL OF AMBER. U.S. 
Oil of amber is an amber-colored liquid, of a hot taste, and a very strong, 
disagreeable odor. As kept in the shops it is said to be usually sophisti- 
cated. It is a powerful local irritant, and has been used as a rubefacient in 
chronic rheumatism and similar disorders. It is also an efficient antispas- 
modic, and as such is used in hysteria, in whooping-cough, and in infantile 
convulsions. In the bronchitis of infants, with severe nervous symptoms, 
as well as in the two affections last named, it is very useful as a counter- 
irritant and nerve-stimulant when diluted with from one to three parts of 
olive oil and freely applied over the spine. In obstinate hiccough, given by 
the stomach, it is probably, next to musk, the most efficient remedy. Dose, 
ten to twenty drops, given in emulsion. 
SPIRITUS ^ETHERIS COMPOSITUS -COMPOUND SPIRIT OF 
ETHER. U.S. 
Hoffman's Anodyne consists of alcohol a pint, ether half a pint, and ethe- 
real oil six fluidrachnis. It is a colorless, inflammable liquid, of an aromatic, 
ethereal odor, and a burning, slightly-sweetish taste. Its specific gravity is 
0.815. Hoffman's Anodyne is sometimes offered for sale without the ethereal 
oil. Forty drops of the genuine preparation will render a pint of water dis- 
tinctly milky; but if no oil of wine be present, milkiness will not occur. 
Ethereal oil (Oleum ^Ethereum, U. S.) is a transparent, nearly colorless, 
volatile liquid, of a peculiar aromatic odor, and sharp, bitter taste. Its 
specific gravity is 0.91. It is heavy oil of wine, prepared by the action of 
an excess of sulphuric acid on alcohol, and diluted with equal parts of strong 
ether. 
Therapeutics.-We have little or no knowledge in regard to the action 
of heavy oil of wine upon the system. Clinical experience has shown that 
Hoffman's Anodyne is more persistent in its effects upon the nervous system 
than an equivalent amount of ether. It is a very efficient carminative, and 
is also a most useful antispasmodic in all the disorders for which such reme- 
dies are employed, especially when there is a tendency to failure of the cir- 
culation, as in valvular cardiac disease. The dose is one or two fluidrachnis, 
repeated in half an hour or an hour if required, and given in cold water. 
The strobiles of Humulus lupulus, or the hop-vine, cultivated in northern 
HUMULUS-HOPS. U.S. A NTISPA SMODICS. 
221 
and middle Europe and in the United States. Hops are soft, greenish cones, 
one or two inches in length, composed of thin, leaf-like, imbricated scales, 
having a bitter taste and a heavy narcotic odor. At the bases of the scales 
is a yellowish powder, officinal under the name of Lupulinum. Lupulin is in 
minute grains, and contains, according to Payen, 2 per cent, of volatile oil, 
10.30 per cent, of bitter principle, and 50 to 55 per cent, of resin. Volatile 
oil of hops is yellowish, and has a strong odor of the drug, and an acrid 
taste. The bitter principle has been obtained by Lermer in brilliant rhombic 
columns, of an acid reaction. 
Therapeutics.-Hops are a bitter tonic, and a very feeble narcotic, pro- 
ducing, when taken very freely, some heaviness, and perhaps sleep. They 
are especially useful as tonics in cases of nervous irritability requiring medi- 
cines of the class. In delirium tremens they are very largely used to quiet 
nervous irritability, to aid more powerful remedies in procuring sleep, and at 
the same time to strengthen digestion. In priapism, in irritation of the 
bladder, and in abnormal sexual excitement, hops have been exhibited with 
asserted benefit. They may be tried in large doses, but very often will fail. 
Externally, hops are employed in the form of poultice, and when fresh 
certainly seem to aid the heat and moisture in allaying pain. 
Administration.-The dose of the tincture (Tinctura Ilumuli-1 to 
5, U. S.) is half a fluidounce to three fluidounces. For a decided narcotic 
effect the practitioner may use either the oleoresin of Lupulin (f)leoresina 
Lupulinx, U. S.), dose, ten minims to a fluidrachm, in pills if desired, or 
the fluid extract {Extractum Lupulinx Fluidum, U. S.), dose, half a fluid- 
drachm to two fluidrachms. 
A hop poultice is sometimes made by simply moistening with hot water 
the hops contained in a gauze bag of the required size and shape. In some 
cases a mixture of the broken strobiles with an equal part of Indian meal 
affords a more eligible preparation. 
LACTUCARIUM. U.S. 
The concrete juice of the Lactuca sativa,* or garden lettuce, occurs in two 
forms in our markets. The English variety is in small irregular pieces about 
the size of a pea; the German, in masses of about an inch long and half an 
inch in thickness. The color varies from a dark reddish-brown to a light 
yellowish-brown. The odor is faintly narcotic, the taste bitter. It con- 
tains a bitter, crystallizable principle, Lactucin, probably first discovered by 
Aubergier, but especially investigated by Ludwig and Kromayer (Archiv 
Pharm., cxi.). 
Therapeutics.-Lactucarium is certainly a very feeble drug. Bouchar- 
dat gave half an ounce to a dog, with merely negative results; and in a 
number of trials made with it some years since I was unable to perceive that 
* For case of reputed poisoning by Lactuca virosa, see Schmidt's Jahrb., Bd. 171, p. 137. 222 
SYSTEMIC REMEDIES. 
it exerted any influence. A very large amount of testimony exists to the 
same effect; but, on the other hand, various observers have claimed that it 
exerts a peculiar soothing, hypnotic influence, like to, but much less intense 
than, that of opium, and free from its disagreeable after-effects, such as de- 
pression, nausea, constipation, etc. It may be that the drug varies greatly 
according to age, time and mode of preparation, etc. 
Lactucin has been experimented with by Fronmiiller, who found it pro- 
portionately less hypnotic than the crude drug {Deutsches Klinik, 1865). 
The usually assigned dose of lactucarium is thirty grains, of the fluid extract 
{Extractum Lactucarii Fluidum, U. S.) half a fluidrachm. Much larger 
quantities may be given with little effect. 
CIMICIFUGA-BLACK SNAKEROOT. U.S 
The root of Cimicifuga racemosa, an indigenous herbaceous plant, growing 
abundantly in rich, shady woods, attaining a height of six or seven feet, and 
readily distinguished by its very large multi-compound leaves and its long- 
branched spikes of whitish polyandrous flowers, naked when open. The root 
consists of a knotted head, with numerous fine, brittle rootlets; the odor is 
faint, the taste bitterish, somewhat astringent and acrid. It has not yet been 
determined exactly upon what the activity of cimicifuga depends. Mr. Geo. 
H. Davis has found in it a volatile oil, which Prof. Geo. B. Wood thinks is 
very probably active, since the virtues of the drug deteriorate on keeping. 
There are also two resins in the root. 
Physiological Action.-Although cimicifuga has been most extensively 
used by American practitioners since the publication of the paper of Dr. Young 
{American Journal of the Medical Sciences, vol. ix.) in 1831, yet we have 
very little accurate knowledge as to its physiological action. Dr. Chapman 
{Elements of Therapeutics, 6th ed., vol. i.) affirms that in full doses it causes 
some nausea, more or less relaxation of the surface, vertigo, tremors, and decided 
reduction of the pulse; and Dr. N. S. Davis ( Transactions of the American 
Medical Association, 1848, vol. i. p. 351) dwells very strongly upon its seda- 
tive action. In full doses it certainly influences the cerebrum, producing 
intense headache and giddiness. Although in large doses it vomits, yet its 
emetic action is never violent, and it never causes more than relaxation of the 
bowels. Various practitioners have asserted that it acts upon the respiratory 
mucous membrane. 
Therapeutics.-Cimicifuga was originally proposed by Dr. Young as a 
remedy in chorea, and since his time has been very largely used in that 
disease by American practitioners. In simple chorea, such as exists in 
children, its value is unquestionable. It must be given freely, and in most 
cases the consentaneous exhibition of iron and laxatives materially aids in 
effecting a cure. 
In acute inflammatory rheumatism, cimicifuga has been highly recom- 
mended by Dr. Davis and other practitioners. I have seen it do good, but A NTISPA S MOD ICS. 
223 
it is at present very rarely, if ever, used. In chronic bronchitis it is some- 
times employed with benefit, especially when the expectoration is free and 
hectic exists. 
Administration.-As cimicifuga deteriorates by keeping, the fresh drug 
should always be used. The powder (dose, twenty grains) is preferred by 
some practitioners; but I have found the officinal fluid extract (Extractum 
Cimicifugse Fluidum, U. S.) very active in doses of from twenty minims 
to a fluidrachm. The dose of the tincture (Tinctura Cimicifugee-1 to 5, 
U. S.) is one to two fluidrachms. 
The seeds of the Caffea Arabica are such familiar objects that space will not 
be here occupied with their description. It should be remembered that coffee 
contains, besides Caffein, an empyreumatic oil, which has decided effects upon 
the system. 
CAFFEA-COFFEE. 
CAFFEINA. U.S. 
Caffeine occurs in long, snow-white, silky, opaque, odorless crystals, some- 
times conjoined into feathery crystals, of a feeble bitter taste. It has a neutral 
reaction, but unites with acids to form salts. It is soluble in 100 parts of 
water, 160 parts of absolute alcohol, and 220 parts of ether. It was first 
discovered in coffee by Runge (Schweigg. Journ. Chern. Phys., xxxi.), in 1820. 
In 1827, Oudry discovered a principle in tea which he called thein, which in 
1838 was proven by Mulder and C. Jobst to be identical with caffein. Mar- 
tins, Stenhouse, J. Attfield, and other chemists have also shown that caffein 
is the active principle of Guarana (the fruit and leaves of the PauUinia 
sorbilis of Brazil), of Matt or Paraguay tea (the leaves of the Ilex Para- 
guaiensis)* and of the Kola nut of Africa ( Cola acuminata'). H. M. Smith 
(Journal of Applied Science, Sept. 1874) has also found it in Yaupon (the 
leaves of our native Ilex Cassine). 
Physiological Action.-The study of the physiological action of caffein 
in relation to its therapeutic use can be most conveniently made in two 
divisions, namely, the action of toxic and that of minute doses. 
Toxic Doses.-The influence of the alkaloid upon frogs has been studied 
by Albers (Deutsches Klinik, 1853, p. 370), Falck and Stuhlmann ( 1 irchow s 
Archiv, Bd. xii. p. 365), Mitscherlich (Der Cacao und die Chocolade, 
Berlin, 1859), I. Hoppe (L'Echo Med., 1858), Brill (Das Kaffein, Inaug. 
* Mate is used in South America very largely as a substitute for tea. According to the 
analyses of Dr. Peckolt, of Rio Janeiro, it contains 2.5 parts in a thousand of caffein; but 
M. Byanon found 1.85 per cent, of the alkaloid {Hull. Thtrap., xciii.). It is sold in two 
forms: matt in leaf is prepared as ordinary tea is, and taken with sugar and milk to 
taste; matt in powder is prepared by pouring upon the powdered mate boiling water, 
and sucking up through a tube, the bulbous end of which is furnished with a fine sieve, 
or the powder is thrown into the boiling water, and when the mixture recommences boiling, 
cold water is poured into it; this precipitates the powder, and the infusion is taken clear. 224 
SYSTEMIC REMEDIES. 
Diss., Marburg, 1861), Oscar Johannsen (Ueber die Wirkuny des Kaffein, 
Inaug. Diss., Dorpat, 1869), and various other observers. The minimum fatal 
dose is stated by Leven (Arch. de Physiol., 1858) to be .015 grain in a frog 
of moderate size. According to the various observers, the chief symptoms in- 
duced by poisonous doses in the batrachian are muscular quietness and weak- 
ness, with disturbance of respiration, succeeded by a stage of violent tetanic 
convulsions, ending in general paralysis and death by asphyxia, the heart 
beating after the cessation of respiration, although evidently much affected. 
Johannsen denies that there are any true convulsions produced in the frog 
by caffein, but merely a rigidity, muscular in its origin and very closely allied 
to that produced by heating a muscle, i.e., to post-mortem rigidity. Pratt, 
however, previous to the publication of the paper of Johannsen, had very 
clearly recognized the existence both of this muscular stiffness and of con- 
vulsions, and had pointed out the difference between the latter and those of 
strychnia, differences which are the result of the peculiar condition of the 
muscles in thein-poisoning. He says, " At the commencement there is the 
usual rapid action and abrupt contraction of the muscles; but as the phe- 
nomena go on, the muscles seem to act sluggishly, requiring quite an interval 
to contract and relax, . . . the spinal cord having to deal with muscles already 
much contracted by the local action of the poison on their fibres." Moreover, 
Leven (loc. cit., p. 182) destroyed entirely the lower third of the spinal cord in 
a frog, and administered caffein, when the characteristic convulsions appeared 
in the upper two-thirds of the animal, but not in the lower third. 
Pratt included all the tissues of a frog, except the spine, in a tight liga- 
ture just above the bifurcation of the aorta, and administered them, when 
the anterior legs became very stiff, and had also occasional severe convulsions, 
in which the hind legs participated, although between the paroxysms they 
were perfectly relaxed. He also noted in a number of experiments that the 
hind legs became very rigid, but not convulsed, after the lower portion of the 
spinal cord had been removed and the animal poisoned. 
Buchheim and Eisenmenger (quoted by Schmiedeberg) have recently cor- 
roborated the muscular changes noted by Johannsen, but insist, with Pratt, 
that there are also true nervous convulsions. 0. Schmiedeberg (Archiv fur 
Experim. Pathol, und Pharm., Bd. ii.) believes that he has reconciled these 
differences of observations by finding that the alkaloid acts much more power- 
fully upon the muscles of Kana temporaria than upon those of K. esculenta; 
so that a dose of caffein which causes intense general muscular stiffness in 
the former produces in the latter only true convulsions, the convulsions in 
R. temporaria being prevented or masked by the disorder of the muscles. 
The more recent researches of E. Leblond (La Caffeine, Paris, 1883) 
do not confirm this idea of Schmiedeberg, but show that the differences 
depend rather upon the size of the dose and variations in the sensitiveness 
of individual frogs. Johannsen pointed out that the rigidity spreads from 
muscle to muscle as the hypodermically injected poison diffuses itself, and is ANTISPASMODICS. 
225 
never developed in a leg to which access of the poison is denied; whilst 
Voit found that muscular rigidity came on as usual after severing the nerve 
of a leg. The rigidity and paralysis are muscular, and the elaborate studies 
of Leblond appear to prove that there are at least two stages (similar to 
the phenomena of veratria-poisoning) in the action of caffein upon the frog 
muscle, one in which the muscular excitability is exaggerated, and in which 
there is a tendency to prolonged tetanic contractions after even momentary 
stimulations of muscle, and the final stage of rigidity and lost excitability. 
The action of caffein upon the muscle is readily demonstrated by throwing 
the isolated gastrocnemius of the frog into a one per cent, or even a weaker 
solution ; in from two to three minutes the muscle becomes contracted, swollen, 
round, stiff, and unable to respond to the galvanic current. That it is the 
muscle fibre which is affected is shown by the experiments of Pratt and Voit, 
already quoted, in conjunction with one in which Pratt found that when an 
isolated muscle was soaked in a solution of curari until the nerves were 
killed, and then thrown into a solution of caffein, the usual rigidity was 
developed. Johannsen (loc. cit., p. 22) states that when a muscle under 
the microscope is touched with caffein, its fibres can be seen to contract 
half their length. 
In birds poisoned with caffein, the symptoms (Brill, loc. cit., p. 66) are 
irregular movements, apparently to some extent due to cerebral disturbance, 
increased rapidity and irregularity of respiration, spasmodic tremblings, and 
tetanic and clonic convulsions, with paralytic phenomena. In mammals the 
results of the toxaemia, as noted by various observers,* are restlessness, hur- 
ried respiration, at first a slight lowering and afterwards a decided elevation 
of temperaturef (Alex. Bennett), muscular weakness, tetanic and clonic con- 
vulsions, increasinggeneral paresis, and finally death, apparently from paralytic 
arrest of respiration. There is still a good deal of uncertainty as to the 
nature of the convulsions; but Amory in some not very conclusive experi- 
ments found that they did not occur below the point at which he had divided the 
cord. If this result be correct, the convulsions must be cerebral; but con- 
firmation is lacking. Uspensky (Reichert's Archiv, 1868, p. 526) has found 
that forced artificial respiration in great measure suspends the convulsions.^ 
Nervous System.-There is no evidence that caffein exerts a very marked 
* Leven (Archives de Physiologic, 1868; Amory (Boston Medical and Surgical Journal, 
i., 1868); Pratt (Ibid.,u., 1868); Alex. Bennett (Edinburgh Medical Journal, Oct. 1873). 
f Attention has recently been called, especially by Prof. Binz, to the effects of caffein 
upon animal temperature. He states that minute doses have no effect upon the bodily 
temperature; doses just enough to produce slight toxic symptoms cause a rise of 0.6° C.; 
excessive doses an elevation of 1° to 1.5° C., the maximum being reached in one to two 
hours; doses which rapidly kill have very little effect upon the temperature (Arch. Exper. 
Path. u. Therap., ix. 31). 
J In an elaborate series of experiments, Dr. Bennett (British Medical Journal, 1874) 
found that the minimum fatal dose of the poison for the cat and the rabbit was a little 
over a grain for the pound, five and a half grains being required for a five-pound animal. 226 
SYSTEMIC REMEDIES. 
influence upon the cerebrum of the frog, or even of some of the lower mam- 
mals, unless the convulsions induced by it are believed to be the result of 
some such action. In certain of the higher animals, such as the cat, it often 
produces a condition of almost frantic cerebral excitement. The convulsions 
produced in the frog by caffein seem, however, to be spinal. Both Pratt 
and Leblond have found that section of the cord high up does not prevent 
them, so that they are not cerebral; whilst in Pratt's experiments, as well 
as in those of Leven, destruction of the spine prevented their development. 
The conclusion seems established that in the frog caffein acts as a motor 
spinal stimulant and also as a muscle poison. 
Alex. Bennett has brought forward the theory (Joe. cit., and British 
Medical Journal, 1874) that caffein paralyzes the posterior columns of the 
cord without affecting the anterior columns; but his evidence appears to 
me insufficient to prove his conclusions. He grounds his belief chiefly on 
finding that in poisoned frogs and rabbits galvanization of the posterior 
columns of the exposed cord produced either no muscular contractions or 
only such as were very much more feeble than those provoked by galvaniza- 
tion of the posterior columns. 
The motor nerves appear not to be affected, since Alex. Bennett has found 
that after death from thein they retain their normal susceptibility, and Pratt 
surrounded one crural nerve of a frog with a paste " of thein and water," 
and irritated the spinal cord, when both legs responded with uniform alacrity. 
Bennett also tied the crural artery of a frog, poisoned it with the alkaloid, 
and found that irritation of the cord produced equally active contractions in 
the two legs. Upon the sensory nerves it is affirmed that the poison acts 
more decidedly; but careful experiments are still wanting to prove this. The 
chief evidence is furnished by Pratt, who found that when the left sciatic 
nerve of a beheaded frog was surrounded by a paste of thein and water, after 
ten minutes irritation of the right foot produced reflex movements, whilst 
irritation of the left foot failed to elicit any response. Leblond has noted 
marked hyperaesthesia in the frog, and Rumpf affirms (^Schmidt's Jahrb., 
Bd. cci. p. 123) that increased sensibility of the skin can be demonstrated 
in man. 
Circulation.-The action of caffein upon the circulation has not been 
sufficiently studied to enable us to reach definite conclusions. It can hardly 
be doubted but that it has a direct influence upon the heart, although that 
viscus continues to beat in animals poisoned by the drug after the cessation 
of respiration. According to Voit (quoted by Brill), in the frog the rapidity 
of the cardiac pulsation is at first increased, but the pulsations become 
slower and slower, and are accompanied by irregularity of rhythm, the heart 
finally ceasing to act, but still responding to stimuli at a time when the 
voluntary muscles are absolutely dead. Falk, Steehlmann, and Johannsen 
observed that caffein first increases and then lessens the frequency of the 
cardiac pulsations in the frog. According to Johannsen, the lessening of A NTISPASMODICS. 
227 
the frequency comes on the more quickly and the more powerfully as the 
size of the dose is increased. After a time the heart begins to beat irregu- 
larly, with short intermissions, which, as time goes on, grow longer and 
longer, and at last movement ceases. Johannsen found the action upon the 
cut-out frog's heart was the same upon the viscus in situ; Leblond con- 
firms this, and states that the heart is finally arrested in systole ; also Dr. 
Thos. I. Mays {Therap. Gaz., i. 1885, 84). 
Aubert and Haase {Pfliiger's Archiv, v. p. 608) find that the action 
of the alkaloid upon the pulsations of the frog's heart varies greatly, and 
indeed the individual experiments of the authors previously quoted show 
such variation. This is confirmed by the research of Dr. llioschiro Maki 
{Ueber den Einfluss des Camphers, Caffeins und Alkohols auf das Herz, 
Strassburg, 1884). This investigator experimented upon the cut-out frog's 
heart with the Williams apparatus, and found that the pulse was variously 
affected. In most of his experiments the arterial pressure-i. e., the 
heart's work-was markedly lessened, but in a few cases it was distinctly 
increased. It would seem probable that small doses of the alkaloid stim- 
ulated the frog's heart and large ones depressed it. 
Upon the'heart of the mammal, so far as can be judged from the present 
evidences, caffein acts more powerfully than upon that of the frog. Leven 
found that in the first stages of the toxaemia both the pulse-rate and the 
arterial pressure are markedly increased. In a series of experiments upon 
dogs, Aubert {Pfliiger's Archiv, v. p. 612) found as an almost constant 
effect that the drug produced an increase in the pulse-rate with a marked 
lessening in the height of the pulse-wave. There was also marked fall of 
the arterial pressure, which, with the small pulse-wave, Aubert believed to 
be the result of the direct action of the drug upon the heart-walls them- 
selves. These experiments were made with very large amounts of the 
alkaloid injected into the jugular vein ; in most cases, the animal being 
kept alive by artificial respiration. In one experiment there was a very 
distinct rise of the arterial pressure {loc. cit., p. 615). 
Prof. Binz {Arch. f. Exper. Path- u. Pharm., ix. 36) made two experi- 
ments upon dogs: in one of them, the alkaloid was given after section of 
the vagus. In each case there was a very distinct rise of the arterial 
pressure. Maki made a number of experiments, and found that large doses 
were followed by a distinct fall of the arterial pressure. In most cases he 
failed to obtain a first rise of the arterial pressure; but as his experiments 
were made upon animals that had been chloralized or atropinized, they 
were of comparatively little value. Aubert {loc. cit., p. 617-18) found 
that after section of the vagi the frequency of the pulse was still increased 
by caffein, and that galvanization of the nerve failed to arrest the heart's 
action. The most important evidence indicative of a stimulant effect upon 
the heart is furnished by Leven {loc. cit., p. 184), who asserts that after he 
\ad divided the pneumogastrics and sympathetics, and isolated the heart 228 
SYSTEMIC REMEDIES. 
from all connection with the nerve-centres, an administration of caffein 
increased both the heart-pressure and the pulse-rate. 
This summary comprises all the experimental evidence that we have in 
regard to the action of caffein upon the circulation. It is very evident that 
at present no positive conclusions can be reached, and that further researches 
are imperatively demanded. 
The only case of poisoning by caffein I have met with is reported by Dr. 
C. H. F. Routh (London Lancet, 1883, i. 680). An adult took a drachm 
of the pure citrate. The symptoms developed at once; they were burning 
in the throat, giddiness, faintness, nausea, numbness, and tremors of ex- 
tremities, pain in stomach and bowels, profuse diuresis, and finally collapse, 
with great cardiac oppression and icy extremities. Consciousness was not 
impaired, and there was no headache until the patient began to recover. 
In a case reported by Dr. Curschmann (Deutsche Klinik, 1873, 377), a 
woman, in order to produce an abortion, took a decoction made from about 
eight ounces of freshly roasted coffee. Two hours later she was found in 
a condition of great anxiety, with a sensation of intense need for air; was 
exceedingly restless, and continually attempted to get up from her chair, but 
was powerless to do so. All the extremities, but especially the hands, were 
affected with very pronounced choreic tremors. She knew persons and 
her surroundings, but her cerebration was very much affected, and the next 
day she remembered nothing that had happened at this time. The res- 
piration was quick, twenty-four and twenty-five per minute, and short. 
The pulse one hundred and twelve ; the heart-beats very strong, even violent. 
One hour after the ingestion of the dose violent diarrhoea set in and con- 
tinued until the next day. The passages were very thin and watery, with 
but little violent pain but much tenesmus. There was also marked tenesmus 
of the bladder. The urine was greatly increased in quantity, with specific 
gravity of 1014. 
Effects of Therapeutic Doses.-The peculiar wakefulness, the increased 
mental activity, and the often nervous restlessness which are induced by strong 
coffee are familiar phenomena to almost every one. They are without doubt 
largely, but are not altogether, due to the caffein contained in the beverage. 
By doses of two or three grains of the alkaloid a very similar state of body 
and mind is induced. Lehmann found that eight grains of caffein produced 
increased frequency of the pulse, very frequent urination, tremulousness, 
excited mental action, passing into a form of delirium, with confusion of 
thought, visions, and finally a deep sleep. The largest amount that I have 
met with as having been taken by man (twelve grains) was ingested by Dr. 
Pratt (loc. cit.f About two hours after the dose had been swallowed, intense 
physical restlessness and a very uneasy condition of the mind were developed; 
very marked general muscular tremulousness soon followed, and the mental 
anxiety increased. After this passed off, there was obstinate sleeplessness, 
with active and persistent thinking, and frequent urination. The increase of ANTISPASMODICS. 
229 
brain-power which has been noticed by various observers after caffein, as well 
as after coffee, tea, guarana, and all the allied crude drugs, is undoubtedly 
real, and must be due to a direct stimulant action exerted upon the cerebrum. 
The experiments made upon animals with toxic doses indicate very strongly 
that the physical restlessness and tremulousness are due to spinal stimulation 
and are the counterpart of the convulsions which toxic doses produce. 
It appears to me that the cerebral stimulation of caffein differs from that 
of opium in that it affects the reasoning faculties at least as profoundly 
as it does the imagination. Coffee prepares for active work both mental and 
physical, opium rather for the reveries and dreams of the poet. 
The enormous use made by mankind of substances containing caffein in- 
dicates that in some way it is directly of service in the wear and tear of daily 
life. It is not probable that any of the caffein is assimilated, but it is thought 
by some authorities to check very greatly the elimination of nitrogen, or, 
in other words, lessen the waste of tissue. The subject was laboriously 
investigated by Julius Lehmann in 1853, and by F. W. Bbcker in 1854, and 
earlier. Dr. Lehmann found that the exhibition of six grains of caffein daily, 
the regulated diet being uniform, diminished the elimination of urea from 
twelve to twenty per cent. Upon experimenting with the empyreumatic oil 
of coffee he found that it lessened even to a proportionately greater extent 
the elimination of urea, and also acted very powerfully in producing sleep- 
lessness, so that the favorite beverage is by no means dependent upon its 
contained caffein for all of its activity. Dr. Bbcker published his researches 
on coffee in 1849 (Beitrdge zur Heilkunde, Bd. i.), but I have never seen 
any abstract of the article, other than the statement that he found that the 
drug causes diminished elimination- of urea. His investigation of the effect 
of tea was most elaborate and laborious (Archiv der Vereins fur Gemeins. 
Arbeiten z. Forderung d. Wissen. Heilkunde, Bd. i. p. 213). He analyzed 
the faeces, the urine, and the products of respiration, and found, a similar diet 
being maintained, that the tea did not affect sensibly the elimination of car- 
bonic acid from the lungs, but did very decidedly diminish the excretion of 
urea, and also of nitrogenous matters in the faeces. He then tried abstaining 
from food for periods of thirty-six hours, with and without the use of tea, 
with results perfectly in accord with those just stated. The results obtained 
by various experimenters are singularly at discord. Henri Hoppe (Deutsches 
Klinik, 1857), in experiments upon a dog, found that coffee diminishes very 
slightly the urea elimination, but greatly increases the output of carbonic 
acid. In regard to urea, Rabuteau and his pupil Eurastratiade, working 
with coffee upon men and dogs, obtained results similar to those of Bbcker 
(Compt. Rendu, 1870, Ixxi. 426, 732), as did also Hammond in this 
country. On the other hand, C. G. Lehmann (Lehrb. d. Physiolog. Chemie, 
Bd. i., Leipsic, 1842), Voit (Untersuchungen, Munich, 1860), and Roux 
(Arch. Physiolog. Norm, et Path., 1874, i. 592) found that caffein or 230 
SYSTEMIC REMEDIES. 
coffee sensibly increase the elimination of urea, or, in those accustomed. ,o 
the daily use of coffee, have no influence. 
In a long series of experiments upon dogs by MM. Couty, Guimaraes, 
and Niobey, it is affirmed as a uniform result that the use and assimilation 
of nitrogenous food was greatly increased, that the carbonic acid and oxy 
gen in the blood were markedly decreased, and that the proportion of sugar 
and of urea in the blood was notably increased (Compt.-Rend. Soc. Biolog., 
v. 546; Compt.-Rend. de I'Acad., xcix. 86). 
In the present state of the evidence a positive conclusion can scarcely be 
reached, but I am strongly inclined to believe that the habitual use of mod- 
erate amounts of tea or coffee has practically no effect upon tissue-waste. 
Elimination.-According to the experiments of Richard Schneider 
(Ueber des Schicksal des Caffeins, etc., Dorpat, 1884), caffein, when taken 
in therapeutic doses, is entirely destroyed in the system, and when in toxic 
amount, is partially destroyed and partially eliminated by the kidneys. 
Therapeutics.-The use of caffein as a remedial agent in disease is very 
limited, whilst its employment in health as an article of diet is the daily 
practice of a great part of the race. The chief indication in disease which 
our knowledge of the physiological action of the drug establishes its fitness 
to meet, is as a cerebral stimulant; for this purpose it is often used in 
nervous headaches and in opium-poisoning. The first of these disorders it 
sometimes relieves in a marvellous manner, but more often it fails to ac- 
complish good. To predict in any case what its influence will be, in the 
present state of our clinical knowledge, is impossible; but the remedy may 
always be tried in safety in the dose of two grains, taken when the paroxysm 
is coming on, and repeated once in forty minutes if necessary. Very strong 
coffee is almost always administered in unlimited quantities in opium-poison- 
ing, but, so far as I know, Dr. J. Hughes Bennett (British Med. Journ.. 
1874, p. 697) has made the only attempt to establish by exact experiments 
the asserted antagonism of caffein and opium. That observer found that 
the exhibition of from four to four and a half grains of caffein would save 
a proportion of cats poisoned with the previously-ascertained minimum lethal 
dose (If gr.) of morphia. Several of the cats which had thus been saved 
succumbed some days afterwards to one and seven-eighths grains of morphia. 
The caffein was powerless to save animals to which larger doses of the nar- 
cotic had been given: so that it is fair to conclude that caffein is within 
narrow limits antagonistic to the narcotic alkaloid. 
There is at present much evidence to show that caffein is a cardiac stimu- 
lant. Its action upon animals has been already discussed, and both Leblond 
and Prof. F. Riegel (Berlin. Klin. Wochens., xxi. 1884) are in accord in 
affirming that given to healthy men it decreases the rate, and markedly in- 
creases the force of the pulse. It has been largely used by Prof. Riegel 
and by Dr. C. Becker (Wien. Med. Bl., vii. 21), as a substitute for digi- 
talis in cardiac disease with asserted very good results. It is even pre- ANTISPASMODICS. 
231 
ferred to digitalis, because it acts more promptly and is free from cumu- 
lative action. Dr. Becker gives from eight to thirty grains of the pure 
citrate in divided doses during the twenty-four hours, beginning with the 
smaller quantity, and rapidly increasing until the result is achieved. I 
have myself seen very good results from it in weak heart. The state- 
ments of Prof. Gubler (Bull. Thirap., xc i. 523) that the citrate of 
caffein is a powerful diuretic have received strong confirmation (see Lond. 
Practitioner, xxii., xxiv., xxv.). It may be used in cardiac dropsy, and 
in chronic Bright's disease in doses of three grains every three or five 
hours. In acute Bright's disease, it should be employed with caution, if at 
all. It is said that most of the salts of caffein are decomposed in the 
presence of water, and are, therefore, ineligible for hypodermic use; the 
double benzoate of sodium and caffein has been proposed as moderately 
stable and free from irritant properties. One equivalent of salicylate of 
sodium (160) will also cause the solution of one equivalent of caffein (244), 
and the following formula has been commended by M. Tanret for hypo- 
dermic use: Sodii salicyl., 31 gr.; Caffein, 40 gr.; Aqua destillat., 60 gr. 
The leaves of the Erythroxylon Coca, a South American shrub, which is 
very largely cultivated in Peru and neighboring countries, resemble in size 
and shape those of the tea, but are not dentate, and are distinguished from 
most medicinal leaves by a slightly curved line, running from the base to 
the apex, on each side of midrib, and produced by the peculiar folding of 
the leaf in the bud. In 1855, Gardeke discovered in coca an alkaloid to 
which he gave the name Erytliroxyline; but this principle was first thor- 
oughly studied by Dr. Albert Niemann, from whom it received the name 
cocaine, by which it is now usually known. It occurs in colorless, trans- 
parent prisms, soluble in seven hundred and four parts of cold water, and 
forms with the acids very bitter, soluble, crystallizable salts; besides it, the 
leaves contain a peculiar tannin, known as coca-tannic acid. 
Physiological Action.-From the days of the Incas the leaves of the 
coca plant have been enormously used by the natives of Western South 
America as a stimulant, and it is stated that about forty million pounds of 
them are annually harvested. Mixed with ashes or a little lime they are 
chewed, and are said to greatly increase for the time being the muscular 
strength and endurance. Although coca is thus employed habitually, our 
knowledge of its action upon the human organism is very incomplete, and 
but few scientific observers have given detailed reports of the symptoms it 
causes. There can be no doubt that moderate doses temporarily in- 
crease, to a very extraordinary degree, both physical and mental power. 
The most important account of its action upon the human being that we 
have is that of M. Montegazza, but all investigators concur in praising the 
ERYTHROXYLON-COCA. U.S. 232 
SYSTEMIC REMEDIES. 
peculiar sense of calm and happiness, the insensibility to fatigue, and the 
increase of bodily and mental activity which the drug produces. 
Montegazza states that when he took two hundred grains of the leaves, 
he was in a short time plunged into a condition of peculiar physical beati- 
tude, in which he seemed to be isolated from the rest of the world, and to 
live in a peculiar atmosphere of active calm. In a little while there came 
also a sense of plenitude of power, which was accompanied by a real in- 
crease of physical ability, so that gymnastics, which in his ordinary con- 
dition were impossible to him, became easy. This state was succeeded 
by a natural profound sleep, lasting sometimes the whole of twenty-four 
hours. After very large doses of coca, in Dr. Montegazza's case, a pecu- 
liar series of symptoms occurred to which the name of " cocaleine in- 
toxication" was given. Thus on one occasion he took thirty-five grammes, 
and an hour later nine grammes, etc., until he had taken in the course of 
two hours sixty grammes in all. The heart, which after the earliest dose 
had been slow in its actions, directly after the second dose suddenly became 
rapid and very violent in its beats; but at the end of the two hours the 
palpitations had ceased, although the pulse was still one hundred and twenty- 
eight per minute. There was now a condition of intoxication similar to 
that which is produced by hasheesh. M. Montegazza was possessed by 
a feeling of intense beatitude and inner joyousness, whilst a succession of 
visions and phantasmagoria, most brilliant in color and form, trooped rapidly 
before his eyes. He seemed to himself to look upon a world of shifting 
and incessant activity, as into a kaleidoscope. He rapidly passed into a 
delirious condition, in which he appeared to himself to be unconscious, 
although when addressed he would answer rationally. To his own con- 
sciousness he was, as it were, buried in a revery, or perhaps a more accu- 
rate description would be to say that he felt as though, by a sudden rush of 
intellectual and emotional life, he was carried out of himself, and knew not 
whether he was in or out of the body. An hour or two later he was suffi- 
ciently calm to say to his friends " that God was unjust, in that he had made 
man to live without eating coca. I prefer a life of ten years of coca to one 
of a thousand years without it." As this state was passing off he was seized 
with an irresistible desire to reproduce its delirium by taking more coca. 
Finally, however, he fell into a condition of sleep, which lasted only three 
hours. After this he was able to resume at once his ordinary occupations, 
and offered no physical evidences of his coca debauch. 
The moderate daily use of coca, according to our best information, is 
not injurious, and increases the working powers; but, according to Prof. 
Poeppig, the habit of the excessive use is readily formed, and produces 
very serious results. The first symptoms are usually those of disorder of 
the digestive organs. Little by little the power of digestion is lost; an in- 
curable insomnia is developed, emaciation becomes extreme, ascites appears, 
and the patient finally dies in a condition of general marasmus. Other ANTISPASMODICS. 
233 
authors especially dwell upon the enfeeblement of the intellectual faculties 
as very marked in those who use the stimulant to excess. Dr. Tschudy 
states that the inveterate coca-chewer can be recognized by his uncertain 
step, his general apathy, his sunken eyes surrounded by a deep purple 
aureole, his trembling lips, green encrusted teeth, and his excessively fetid 
breath, with the peculiar blackness about the corner of the mouth. 
Pronounced aphrodisiac properties have been attributed to coca, but they 
seem to rest rather upon tradition than demonstrated experience. Accord- 
ing to M. Unanue, the ancient inhabitants of Peru represented Venus by a 
female figure with a coca-leaf in her hand, and the coca still plays an im- 
portant part in the nuptials of the Indians. 
It has been affirmed by Tschudy and Unanue that coca is able to take 
the place of food, but this is clearly not the case. Dr. Weddell himself 
states that although an Indian chewing the coca could go on foot many hours 
without fatigue and without food, yet at the end he would eat more at one 
repast than he himself would take in two days. He accords with Bibra 
(Die Narkot. Genussmitell, 1855) in stating that the coca has the power of 
putting aside for some time the sense of hunger. Whilst, however, it 
may mask the appetite, it certainly does not nourish the body. Thomas 
Moreno y Maiz (Thbse, Paris, 18G8) made several crucial experiments by 
keeping animals in pairs without food, and giving to one coca freely. These 
experiments have been repeated by B. von Anrep (Pjlugers Archiv, 21, 
1880), and in every case the animal which received the coca died at least 
as early as its mate. 
In order to cause death enormous doses of the alkaloid cocaine would be 
required. According to Von Ploss (quoted by Husemann, Die Pflanzenstoffe' 
2d ed.), an apothecary for suicidal purposes took twenty-two grains of cocaine 
in a glass of beer. He shortly afterwards went to sleep, but awoke in some 
hours with great abdominal pains, dryness in mouth, excessive weakness, 
and vertigo. He suffered from suppression of urine for twenty-four hours, 
but had no further disturbance of consciousness or of the heart's action. 
Besides the studies of Dr. Ott (Toxicological Studies, Philadelphia, 1874) 
there are three physiological articles upon coca. Two of these memoirs I 
have never seen, and only know them through abstracts, especially those in 
the article of B. von Anrep (Archiv fur die Gesammte Physiologic, Bd. 
21, 1880, page 38). With this material it is possible to examine somewhat 
in detail the physiological action of the drug. 
It may in the first place be considered settled that very small doses (one 
to three one-hundredths of a grain of cocaine) produce in the frog no other 
symptoms than some evidences of excitement. After doses of from one- 
tenth to one-fiftieth of a grain the frog becomes quiet, with an apparent in- 
crease, however, in the reflex activity, sometimes amounting to tetanus, 
followed by increasing palsy and failure of the respiration j very large doses 
produce symptoms of paralysis. 234 
SYSTEMIC REMEDIES. 
In the domestic animals the symptoms vary. In the rabbit, there is first 
a peculiar state of quiet, followed in a few moments by a condition of great 
excitement, in which the animal springs and jumps about. A few minutes 
later the rabbit again becomes quiet, and now, although trembling much, is 
so weak that he moves with difficulty. The tremblings increase until they 
merge in convulsive movements of the legs, whilst at the same time there is 
partial paraplegia; pendulum movements of the head are very marked, and 
finally epileptiform convulsions appear, whilst at the same time a peculiar 
tetanic rigidity seems to indicate spinal excitement. The lethal dose for a 
rabbit is put at a grain and a half per kilo. Dogs and cats are said to be 
more susceptible to the action of cocaine than is the rabbit, and to suffer 
similar symptoms, but especially with the dog the evidences of mental 
excitement are more pronounced. 
Nervous System.-The most susceptible portion of the body to the action 
of the cocaine is the cerebrum. The peculiar sense of calm which follows 
moderate doses of the drug is evidently the result of the action on the 
brain, which eventuates, after a sufficient dose, in the peculiar ecstasy so 
graphically described by Montegazza. According to the description of Von 
Anrep, this delirium is almost equally pronounced in the dog; thus a very 
quiet animal, almost immediately after the injection of the cocaine, will 
begin to dance and leap, never standing still for a moment, and continually 
circling around the experimenter. The movements are not at all those 
of convulsions, but voluntary, and accompanied by every expression of joy 
and exhilaration. This may continue for hours, and the animal become 
gradually quiet, and pass finally into his normal condition. If instead of a 
moderate dose a toxic one has been given, there is first a period in which 
the animal is very restless, but seems full of terror and anxiety ; the least 
sound frightens him, causing him to tremble and to drop his tail between 
his legs. He does not appear at this time to know his master. Rhythmical 
movements of almost all portions of the body accompany this state. Fifteen 
or twenty minutes later the mental condition alters, and the dog becomes 
apparently full of joyous excitement. He barks loudly, runs from one per- 
son to another licking them, and giving all the characteristic signs of joy 
and pleasure. After a few moments this condition gives way to one of in- 
creasing feebleness; the dog gradually gets unable to move, rhythmical 
movements, cramps, and convulsive symptoms appear; the pendulum-like 
movements of the head become very violent, and at last narcosis develops. 
It is evident that many of these symptoms are psychical. 
B. von Anrep believes that the drug has a very distinct and peculiar in- 
fluence upon the semicircular canals, thereby causing the peculiar pendu- 
lum-like motions of the head, the lack of co-ordination, and the rolling 
convulsions especially seen in doves. 
According to the researches of Von Anrep, the convulsive movements are 
of cerebral origin, and are arrested by section of the spinal cord. Dannini A NTISPASMODICS. 
235 
appears, however, to have found that the section of the cord did not prevent 
convulsions in the hind feet. To settle this discrepancy further experi- 
ments are of course necessary. It is to be remarked that even Von Anrep 
affirms that after, as before, section of the spinal cord reflex activity is in- 
creased by cocaine, and certainly other observers have noticed an increased 
reflex activity as constant after small doses. This evidence indicates that 
the drug stimulates the spinal cord ; yet it is possible that sensory stimula- 
tion may be the sole cause of the excited reflex action. 
It is established by the concord of almost all observers that the sensory 
nerves, after sufficient doses of cocaine, are finally paralyzed. The state- 
ments and experiments of Nikolsky, of B. von Anrep, and also of Ott, 
appear to prove that the paralysis is preceded by increased functional ac- 
tivity. 
The motor nerves, according to Dannini, in the frog remain irritable until 
after death; but, according to Nikolsky, their functional activity is first in- 
creased and afterwards destroyed. Ott also asserts that cocaine depresses 
the motor nerves, and Moreno y Maiz found that when he tied the iliac 
artery of a frog on one side and administered cocaine anteriorly, there came 
a time when irritation of the poisoned limb caused no movement, whilst 
irritation of the protected extremity provoked very distinct general reflexes. 
At the same time there was diminished motility in the non-protected limb as 
compared with the protected one. These facts of course indicate that the 
drug finally depresses both motor and sensory fibres, but that its action 
upon the motor is subordinate to that upon the sensory nerves. Ott also 
noticed that there is a time in the poisoning when irritation of the central 
end of a cut sciatic nerve produces no response, whilst irritation of its 
peripheral end causes muscular action, and thereby confirms the view that 
the drug affects the sensory earlier and more powerfully than the motor 
nerves. 
An observation made at a certain stage of the poisoning by Dr. Ott-viz., 
that irritation of the posterior columns of the spinal cord produces no effect, 
whilst a prick of the anterior column is followed by the usual result-shows 
that there is the same difference in action upon the sensory and motor tracts 
of the cord as upon the corresponding nerve-trunks. Indeed, B. von Anrep 
(loc. cit., p. 56) found that after tying one of the arteries and administering 
cocaine, the protected leg soon lost the power of reflex action,-evidence 
that the sensory side of the cord is only somewhat less susceptible to the 
influence of the alkaloid than are the sensory nerves themselves. 
Circulation.-According to Von Anrep, as well as the earlier observations 
of Nikolsky, the heart of the cocainized frog is gradually weakened and 
arrested in diastole ; but observers agree that, except after enormous doses of 
cocaine, the heart remains beating long after cessation of respiration. 
In mammals, according to B. von Anrep, the pulse-rate is usually in- 
creased by full doses of the alkaloid. B. von Anrep states, however, that 236 
SYSTEMIC REMEDIES. 
this increased rapidity is not marked in rabbits, and in Ott's experiments 
upon dogs before death the pulse usually becomes slower. It certainly was 
not constant. In regard to the action of cocaine upon the vagi there is 
an absolute contradiction of evidence. Anrep affirms that these nerves are 
paralyzed by large doses, and that this condition is never preceded by ex- 
citement, whilst both Ott and Nikolsky state that cocaine does not affect 
the vagi at all. Whatever may be the action of cocaine upon the heart, it 
seems established that the rise of arterial pressure which it causes is largely 
the result of contraction of the arterials produced by stimulation of the 
vaso-motor centre in the medulla; since Dannini has found that after sec- 
tion of the cord cocaine is powerless to increase the arterial pressure, and 
Ott, that when the cord is cut in the cocainized dog the pressure falls to the 
level it usually occupies after such section in the unpoisoned animal. 
Muscles.-There is a distinct contradiction as to the effect of cocaine upon 
the striated muscles. Both Nikolsky and B. von Anrep state that the latter 
are not affected by the alkaloid, whilst Ott affirms that it acts upon them 
like veratria, and is confirmed in this by Buchheim and Eisenmenger 
(Pflanzenstoffe, 2, p. 885). The tracings given by Ott would appear to 
prove that the muscular contraction is prolonged by cocaine, and can hardly 
be accounted for by a condition which M. J. Rossbach and B. von Anrep 
(Pfluger's Archiv, Bd. xxi. 243) allege to be produced, viz.: a peculiar 
extensibility of the muscle similar to that produced by curari, and like it 
caused by a lessening of muscle tonus by paralysis of the peripheral nerve 
endings. 
Temperature.-Observers agree that there is during a certain stage of 
cocaleine intoxication a remarkable rise in the rectal temperature. Accord- 
ing to Bennett, Ott, and Von Anrep, this rise of temperature is preceded 
by a fall; in toxic cases the temperature appears again to become sub- 
normal before death. Von Anrep states that the skin temperature is 
always elevated from the beginning. The rise in the rectal temperature 
reaches the maximum (1° C.) during the convulsive stage, but is not 
produced by the convulsions, as Dannini has found that it occurs in curarized 
animals. 
Elimination.-According to Moreno y Maiz, cocaine is eliminated by the 
kidneys. Tarchanoff has noticed sugar in the urine after poisoning; but 
Anrep affirms that the sugar and the albumen, which is also frequently 
present, are caused by the asphyxia. 
Both Dr. Ott and Atherton P. Mason (Boston Med. and Surg. Journal, 
Sept. 1882) find that coca lessens the secretion of urine and very markedly 
the elimination of urea. Dr. Mason employed very large doses of coca 
during prolonged exercise. It is therefore very probable that this drug 
diminishes tissue-waste, although Dr. Mason states that Gazeau has obtained 
contrary results. In Dr. Ott's experiments the urine became filled with 
crystals of oxalate of calcium. A NTISPA S MOD ICS. 
237 
Respiration.-Fatal doses of cocaine kill by paralysis of the respiration. 
After small doses, according to Von Anrep, the respirations become some- 
what more rapid and deep, or in some cases simply more rapid. After 
large doses, the respirations become at first rapid and more shallow, then 
irregular with interruptions, after each of which the respiratory movements 
begin deep and slow, but become more rapid and shallow until the next 
standstill. 
Intestines.-According to Von Anrep, the intestinal peristalsis is markedly 
increased by moderate doses. After large doses this increase is followed 
by great sluggishness deepening into paralysis. Tarchanoff states that coca 
increases the mucous secretions, but Anrep affirms that it decreases them. 
Eye.-1The pupil is dilated in both warm- and cold-blooded animals. 
Nikolsky concludes that this dilatation is not produced by irritation of the 
sympathetic nerve, because after section of the nerve cocaine still dilates the 
pupil, and also when the pupil has already been dilated section of the sympa- 
thetic does not produce contraction. These facts, however, do not warrant 
Nikolsky's conclusions, for the action of the cocaine is evidently upon the 
peripheral nerve endings, since its local application produces a dilatation of 
the pupil lasting from one hour to two days according to the dose used. 
The dilatation appears never to be as complete as that caused by atropine, 
and the power of accommodation, while distinctly lessened in its range, is 
never entirely paralyzed (H. Knapp, Cocaine, New York, 1885.) 
Local Action.-Locally applied, cocaine acts as a very distinct and certain 
anaesthetic, as was noted by Moreno y Maiz in 1862, and by Von Anrep in 
1880, although it was not until September, 1884 ( Wien. Med. Wochensch., 
Nov. 1884), that Dr. Karl Koller demonstrated the practical value of the 
drug. According to the observations of Von Anrep, the nerves of special 
sense are as readily affected as those of common sensibility; thus cocaine 
placed upon the tongue abolishes at the place of contact, for the time being, 
the sense of taste. At the point of contact there is at first marked pallor, 
but after a short time very pronounced redness. The primary pallor is 
alleged to be due to a most powerful constriction of the small blood-vessels, 
and has led Dr. F. H. Bosworth to the conclusion that cocaine produces 
rigid contraction in unstriped muscular fibres whenever it comes in contact 
with them (N. York Med. Record, Nov. 15, 1884). This conclusion is at 
present probable but not proven. 
Therapeutics.-Cocaine appears to act with certainty as a local anaes- 
thetic whenever it can reach the nerve-filaments in sufficient concentration. 
The skin will not allow it to pass, whilst the conjunctival and nasal mucous 
membranes are very permeable, and those of the larynx, throat, and vagina 
are penetrated with more and more difficulty, in the order of their naming. 
Even in disease of the eye, when a deep operation is to be performed, such 
as enucleation, either the alkaloid should be injected subcutaneously, or 
else the solution of the anaesthetic must be reapplied at various stages of 238 
SYSTEMIC REMEDIES. 
the operation. To the nasal surgeon the alkaloid appears to be invaluable, 
whilst the gynecologist finds it less serviceable, but even he is, by its careful 
use, able to perform many operations without pain. In painful ulcers, 
fissures of the anus, etc., its application will afford temporary relief. It 
is affirmed by many observers that excessive pain is apt to be felt when the 
anaesthetic effect is going off, and that this, in many cases, overbalances the 
first relief. It is probable that this pain is the result of the congestion, as 
Dr. Carl Seiler tells me that after nasal cauterizations this after-pain can be 
at once arrested by incising the part slightly so as to cause a local bleeding. 
The congestion which follows cocaine-anaesthesia cannot at present be ex- 
plained, but, under certain circumstances, is of very great importance, and 
Prof. P. D. Keyser (Therap. Gaz., Jan. 1885) reports a number of cases 
of very severe inflammations in the eyeball, after operations in which co- 
caine had been used, and gives good reason for believing that the cocaine 
was the cause of very serious results. He condemns its use whenever the 
eyeball is to be penetrated. The injection of a four per cent, solution of 
cocaine into the nostrils will, it is affirmed, give immediate relief in acute 
coryza, and trials of the remedy should be made in inflamed hemorrhoids, 
boils, and other painful affections. It should especially be tried in hay- 
fever. 
Dr. F. H. Bosworth claims that cocaine is not only extraordinarily effi- 
cacious as a hemostatic in various surgical cases, but that topically applied 
it will so constringe the blood-vessels of an acutely inflamed mucous mem- 
brane as to arrest the disease. In bronchitis he applies by means of atomi- 
zation, using a two per cent, solution, and also putting the solution freely on 
the nose and throat. Dr. Bosworth affirms that the effects of cocaine upon 
mucous membranes last for many hours,-a statement hard to reconcile 
with the general testimony as to the brevity of the primary bleaching. He 
states that failure often comes from a lack of a proper application. 
Drs. R. J. Hall and Halsted (N. K Med. Journ., Dec. 6, 1884) have 
made the very important observation that injecting a solution into a nerve- 
trunk paralyzes sensation over the whole distribution of the nerve for about 
twenty-five minutes. In some case advantage may be taken of this. 
They used as much as thirty-two minims of a four per cent, solution ;.but 
this produced severe constitutional disturbance, such as great giddiness, 
severe nausea, staggering, cold perspiration, etc. 
For local use a four per cent, solution may be employed, and when the 
part is not readily permeable, as in the vagina, it should be thoroughly re- 
applied once or twice at intervals of five minutes. 
The use of coca in internal medicine is at present entirely tentative. It 
will probably be found advantageous in neurasthenia, melancholia, hysteria, 
and as a general nervous tonic and stimulant in acute and chronic diseases 
with exhaustion. It has been commended in Europe in serous diarrhoeas. 
It will probably come into use as a means of sustaining men under severe A NT IS PA SM ODICS. 
239 
exertion. There is considerable testimony to show that cocaine is of great 
service in giving relief to opium-eaters after the abandonment of the 
narcotic. 
The best preparation of coca for internal use is the fluid extract, the dose 
of which is half to two fluidrachms. The muriate of cocaine was used 
with great alleged success as a stimulant to soldiers making forced marches 
by Dr. Aschenbraidt (Deutsch. Med. Wochens., ix. 50, 1883). He gave 
it in doses 0.15 grain, repeated in an hour if necessary. It is probable 
that one grain will prove to be a moderate dose. Mr. E. Caudwell has 
taken five grains, with the production of symptoms severe, but lasting not 
more than two hours (Brit. Med. Journ., i. 1885, p. 17). CLASS VL-ANALGESICS. 
In the class Analgesics, in this work, are placed those drugs whose chief 
clinical use is in the relief of pain. Of course the Anaesthetics might also be 
discussed under this heading, but, as they make a very marked group of them- 
selves, they are best considered as a separate class. The only drug, besides 
opium, which seems worthy of a place in the present division, is cannabis 
indica. 
OPIUM. U.S. 
The inspissated juice of the unripe capsules of the Papaver somniferum, 
or poppy. It is obtained by incising the capsules with a small, sharp knife, 
and twenty-four hours afterwards scraping off the exuded juice with a blunt 
blade. Opium is produced in various parts of the world,-chiefly in Turkey, 
Asia Minor, Persia, and India, but also to a very slight extent in England, 
Germany, and the United States. Our market is almost exclusively supplied 
from Asia Minor, with the variety known as Smyrna or Turkey Opium. 
This occurs in masses from the size of the fist to that of a child's head, 
irregularly globular, more or less flattened, covered externally with the cap- 
sules of a species of Rumex or dock, hard externally, softer and of a reddish- 
brown color within, and of a strong narcotic odor and taste. 
Smyrna opium is at times variously adulterated with gum, licorice, and 
other substances. Such specimens are said generally to want the Rumex 
capsules. A rough but pretty fair test of the purity of opium is per- 
formed by drawing a piece of it across a sheet of white paper. If it be 
much adulterated, the mark will be continuous,-not interrupted, as it should 
be. Often the black color, the adhesive consistency, and the sweetish taste 
will also betray the nature of the sample. 
On exposure to the air, opium becomes hard and brittle, and is readily 
reduced to a powder of a yellowish-brown color. It yields to water, alcohol, 
and diluted acids, forming dark-brown solutions. Ether does not extract all 
of its medicinal principles. It is a very complex body, containing the alka- 
loids morphia, codeia, narceia, narcotina, thebaia, papaverina, porphyroxia, 
cryptopia, meconia, opiania, paramorphia, besides meconic, thebolactic, and 
sulphuric acids, extractive matter, gum, glucose, fixed oils, a volatile odorous 
principle, and other substances of no importance. In regard to the propor- 
tions of the more important principles, Messrs. Smith of Edinburgh obtained 
240 ANALGESICS. 
241 
from 100 parts of fine opium 10 parts of morphia, 6 of narcotina, 1 of 
papaverina, 0.15 of thebaia, 0.03 of codeia, 0.01 of meconia, 0.02 of narceia, 
and 4 of meconic acid (Pharm. Journ. and Trans., October, 1865, p. 183). 
Good opium should yield from nine to fourteen per cent, of morphia. 
As meconic acid strikes a blood-red color with a persalt of iron, the latter 
affords a ready, although not decisive, test for opium and the meconates. 
Physiological Action.-When opium is taken in such dose as to pro- 
duce its mildest physiological effects, it exerts a quieting influence, inducing 
a peculiar dreamy condition,-very generally a feeling of bienfaisance,- 
during which images and ideas float before the mind, and by their endless 
and effortless repetition shorten the time, which seems to lose itself in rest. 
It is commonly asserted that there is a stage of the action of opium in which 
the activity of the mental faculties is exalted. This may be so in some 
persons, and especially in those who have accustomed themselves to the use 
of the drug as a stimulant; but my experience is that in those who do not 
habitually take opium true mental power is, during all the stages of the 
action of the drug, diminished rather than increased. The state induced is 
rather the fabled calm of the lotus-eater than the energetic activity of pro- 
duction. Even in those who are accustomed to the use of opium as an aid 
to work, I think it is the imagination rather than the reasoning faculties 
which is excited by it. After a length of time, varying according to the 
idiosyncrasies of the patient and the dose of the drug, the condition which 
has been noted gradually passes into sleep,-either light and dreamful, or 
natural, or heavy and deepening into stupor, according to the amount of the 
drug ingested. On awakening, the patient may return at once to his normal 
condition, but very often he experiences a state of depression, as shown by 
languor, a little headache, nausea, or even vomiting, which may last for some 
hours. 
After very large doses, the first stage of the action of opium is very short, 
or it may be entirely wanting, sleep coming on almost at once. Thus, I have 
seen deep coma produced in three minutes by a hypodermic injection of 
morphia. The symptoms of the second stage of opium-poisoning closely 
resemble those of congestion of the brain : the pupils are strongly contracted 
the face more or less suffused, often deeply cyanosed; the pulse full, slow 
and strong ; the skin generally dry and warm ; the respiration slow and deep, 
and, it may be, stertorous; unconsciousness is apparently complete, but very 
generally the subject can be aroused by violent shaking or by shouting in hi» 
ear, but relapses at once when left to himself. When the patient is aroused, 
the respirations become more rapid, and the skin often regains almost at once 
its normal color. Death very rarely occurs during this second stage of opium- 
poisoning. When the symptoms do not gradually ameliorate, the third stage, 
that of prostration, is developed. The coma is now profound, and to arouse 
the patient may be impossible; the pupils are absolutely contracted, or, as 
death approaches, are widely dilated; the respirations are distant, slow, feeble, 242 
SYSTEMIC REMEDIES. 
and imperfect, and often interrupted by intervals of death-like quiet; the 
countenance is at once pallid and cyanosed ; the pulse grows more and more 
rapid and more and more feeble; the skin is cold and moist, finally covered 
with a clammy sweat. Even yet the patient may recover: if he do so, the 
return to life is most gradual; if he do not, death occurs generally by failure 
of the respiration, but amid an almost complete extinguishment of the vital 
functions. 
Although the symptoms which have been narrated are those usually pro- 
duced by opium, yet in certain individuals the drug provokes quite different 
phenomena. One of the most common of these departures from the ordinary 
course of symptoms is an excessive depression following the sleep produced 
by moderate doses of the medicine. This state is seen, so far as my expe- 
rience goes, most usually in females of weak, nervous organization, such as 
are peculiarly liable to attacks of neuralgia. The symptoms are a feeling of 
weakness and prostration, often accompanied by chilliness, dull headache, and 
giddiness, but especially marked by intense nausea and frequent vomiting. 
Very frequently the latter does not occur so long as absolute rest in the 
horizontal position is maintained: indeed, an almost diagnostic sign of this 
affection may be found in the fact that the stomach is quiet so long as the 
patient keeps the head upon the pillow, but the distress occurs at once upon 
rising up. In some cases this condition of depression even replaces the 
normal second stage, so that opium, instead of inducing quiet sleep, will 
provoke alarming depression and vomiting, either with or without drowsiness. 
Thus, cases have been reported in which one-fourth of a grain, or a somewhat 
greater quantity, of morphia, hypodermically injected, has been followed at 
once by syncope, with struggling for breath, and apparently imminent or even 
present death.* A rarer idiosyncrasy exists in those persons who are ren- 
dered by opium very delirious, it may be even wildly so. In certain cases 
of opium-poisoning, partial or complete convulsions have occurred amidst the 
more usual phenomena. (Cases, Brit. Med. Journ., 1876, ii., p. 496 ; Pacific 
Med. and Surg. Journ., July, 1876.) Severe itching of the skin is a 
common phenomenon when the action of opium is going off, and there are 
persons in whom such violent erythema is produced even by therapeutic 
doses as to forbid the use of the drug (case, Wien. Med. Presse, xxiv. 568). 
Opium at first sight appears to act so differently upon the lower animals 
than it does upon man, that it seems necessary to discuss this action by itself. 
In 1826, Charvet {Pereira's Materia Medica, vol. ii. p. 1035, Philadel- 
phia, 1854) found that opium acts upon all classes of animals, inducing in 
the invertebrata weakness or paralysis of the contractile tissue, with gradual 
sinking and death ; in fishes, a weakened paralytic condition of the muscular 
* See Report of the Committee on the Hypodermic Method of Injection, Medico- 
Chirurgical Transactions, vol. 1.; see also Medical Times and Gazette, 1868, cases repcted 
by Mr. Braine and by Mr. Roberts. ANALGESICS. 
243 
system, associated with convulsions; in birds and mammals, paralysis, con- 
vulsions, and stupor. These researches have been recently much extended, 
but in considering them I shall confine myself to the vertebrata. 
When one or two grains of opium are injected under the skin of a frog 
(Kblliker, Virchow's Archiv, Bd. x. p. 248; J. F. H. Albers, Virchow's 
Archiv, Bd. xxvi. p. 229), in from six to ten minutes a condition of excita- 
bility is induced, so that the least touch produces violent tetanic convulsions, 
which, a little later, also occur without obvious cause. After a time, these 
convulsions gradually give way to a deepening paralysis. The breathing, 
previously disturbed, becomes more and more shallow and imperfect, and 
finally is suspended. Morphia acts, apparently, on frogs in the same manner 
as opium: at least Drs. Richard Gfscheidlen (Untersuchungen aus dem 
Physiolog. Laboratorium in Wurzburg, Bd. iii. p. 15) and W. Baxt (Rei- 
chert's Archiv fur Anatomic, 1869, p. 128) have found that in large doses it 
induces the counterpart of the series of phenomena just described. The 
latter observer noted, however, that when a minute dose (15.25 milli- 
grammes) was employed, immediately following the injection came a brief 
period of disquietude; one minute afterwards the frog returned to its nor- 
mal state, in from six to ten minutes suffered a diminution of excitability, 
and in from twelve to fifteen minutes fell into a stupor which continued from 
four to ten hours. After awakening, the reflex excitability seemed greater 
than normal.* 
According to Kblliker, the opium-convulsions take place after the cord has 
been divided below the medulla, or even as low down as the third vertebra. 
In a single experiment, tetanus did not occur after division of the cord at 
the fifth vertebra; but the quietness was probably simply due to exhaustion, 
as the frog had already been poisoned for a length of time and had suffered 
section of the medulla and of the cord below the medulla. These facts 
seem to prove that the convulsions are reflex and of spinal origin. The 
convulsive movements which are present late in the poisoning would appear 
to be of peripheral origin: at least, in Albers's experiments (loc. cit.') they 
occurred in limbs whose nerves had been previously cut so as to sever all 
connection with the nerve-centres. Further, both Kblliker and Albers assert 
that some of the convulsions are epileptiform,-i.e., of cerebral origin. 
Further, Dr. S. Meihuizen (Arch, f Physiolog., vii., 1873) states that the 
convulsions occur at a time when mechanical irritation fails to induce any 
response. If these experimental results be correct, opium apparently induces 
in the frog three kinds of convulsions, of which those of reflex origin are 
probably the chief. 
Kblliker, from his investigations, concluded that opium does not act upon 
* Dr. S. Meihuizen affirms (loc. cit.) that this increased reflex activity is only towards 
chemical and not towards mechanical irritation. This is, however, opposed by such a 
mass of experimental evidence that I think it must be incorrect. 244 
SYSTEMIC REMEDIES. 
the peripheral nerves of frogs ; but the recent very elaborate and apparently 
accurate experiments of R. Gscheidlen ( Untersuchungen aus dem Physiolog. 
Laboratorium in Wurzburg, zweiter Theil, 1869, p. 1) have shown that 
morphia in small doses increases the excitability of the motor nerves and 
afterwards depresses them ; after large doses the period of excitation is short, 
that of depression soon coming on ; and after enormous doses diminution of 
functional activity is at once manifested. Both Gscheidlen and Kblliker 
agree that neither the contractile power of the muscles nor the excitability 
of the motor nerves is destroyed by opium or morphia, although Albers 
( Virchow's Archiv, Bd. xxvi.) asserts that both are extinguished. Gscheidlen 
calls attention to this disagreement, and states that he has verified his own 
results by frequent experimentation with enormous doses of the alkaloid. 
Experiments upon the sensory nerves are always unsatisfactory, but 
Gscheidlen (loc. cit., p. 17), employing the method of Pfliiger, found that 
morphia locally applied intensifies and protracts the excitability of an afferent 
nerve in cases of strychnic poisoning.* 
As already stated, the opium-convulsions of the frog are chiefly due to an 
excitation of the reflex centres of the cord. Gscheidlen has confirmed this 
by direct experiment, and has also proven that in the latter stages, when the 
motor functions are depressed, the paralysis is largely of spinal origin, the 
reflex activity of the cord being greatly lessened. 
Our knowledge of the action of morphia upon the nervous system of the 
frog may be summed up as follows: 
Morphia in minute, non-toxic doses causes sleep, followed by augmentation 
of reflex activity; in large, toxic doses it produces violent convulsions, fol- 
lowed by paralysis. The convulsions are chiefly spinal, and due to a height- 
ened spinal activity, but are to some extent probably, also, of cerebral 
origin, and later in the attack arise from a direct action of the alkaloid 
upon the muscle or the nerve-endings therein; the paralysis is caused by 
a depression of the cord and a diminution of the conducting power in the 
nerves. 
Dr. S. Weir Mitchell has shown (American Journal of the Medical 
Sciences, Jan. 1869, and Jan. 1870) that birds, as represented by pigeons, 
chickens, and ducks, are very insusceptible to the toxic action of opium and 
its chief derivative, morphia. It appears to be impossible to kill a pigeon 
by opium given by the mouth, and of morphia from eight to fifteen grains 
are required to produce a fatal result; but when given hypodermically from 
two to three grains of the alkaloid suffice. These results have been in great 
measure confirmed by Dr. B. W. Richardson, and are no doubt accurate. 
The symptoms induced have been very uniform: they are unsteadiness, 
* Perhaps it is appropriate here to call attention to a paper by Dietl and Vintschgau 
(PjVuger's Arch., Bd. 16), in which it is attempted to be experimentally shown that 
morphia increases, caffein lessens, and alcohol first lessens and then increases the time 
required by the nervous system for the recognition of a peripheral irritation. ANALGESICS. 
245 
labored breathing, increasing signs of apnoea, unaltered pupils, and, finally, 
general convulsions and death. No true hypnotic effect has been observed, 
but a curious and very great rise of temperature just before death was noted 
in one case. As Flourens affirms that a single grain of the aqueous extract 
of opium will throw a sparrow into a profound stupor, it can scarcely be 
allowed as proven that the drug acts upon all birds as upon those experi- 
mented with by Dr. Mitchell. 
Upon dogs morphia acts very much as upon man.* In very many cases, 
if not in the majority, eight to ten grains of the alkaloid injected into a dog 
of moderate size will cause deep sleep, amounting to coma, so that the 
animal will remain in any position in which he may be placed. The length 
and depth of this sleep are, of course, proportionate to the dose: when at 
all profound, it is accompanied by marked insensibility to pinching and other 
forms of external irritation. A repetition of irritation, and especially a 
sudden loud noise or shaking, will, however, arouse the animal, precisely as 
in man. Indeed, sometimes the dog, even when comatose, seems more than 
normally sensitive to sudden noise, trembling and starting in an almost con- 
vulsive manner. After awaking, the dog shows unmistakable signs of nervous 
and psychical depression. In walking, the hind legs are dragged, as though 
semi-paralyzed; the eyes are haggard; the naturally brave animal cowers in 
a corner or seeks to hide himself, no longer recognizing his master, and does 
not return to his natural condition for many hours. After smaller doses the 
effects are proportionately less intense. It has been shown by Harley that 
in some dogs, precisely as in some people, morphia fails to exert its usual 
hypnotic action, but produces great depression, as evinced by faintness, pro- 
longed nausea, and retching, interrupted only by intervals of dreamy delirious 
somnolency. 
In the horse (Harley, loc. dt.'), two or even three grains of morphia hypo- 
dermically injected produce sometimes a slight drowsiness, sometimes no 
perceptible effect. Doses of from four to six grains cause great restlessness 
and accelerated pulse. The mouth is moist, the temperature of the skin and 
its secretion increased; the animal paws continually, and treads about in 
his stall with an almost rhythmical movement. After twelve grains, Harley 
noticed in some cases very great excitement, as shown by marked increase 
in the rapidity of the heart's action, by muscular rigidity and tremors, by 
the animal walking rapidly to and fro, slobbering and sweating profusely. 
In another horse, after an immediate strong erection of the penis and copi- 
ous emission of semen, heavy sleep came on, interrupted after the third hour 
by the usual symptoms of excitement. Thirty-six grains of the acetate 
caused in a powerful hunter deep comatose sleep, commencing in fifteen 
* Harley, The Old Vegetable Neurotics, p. 107, London, 1869; Claude Bernard, Archives 
Generates, p. 437, vol. ii., 6th series, 1864; J. J. Reese, American Journal of the Medical 
Sciences, Jan. 1871. 246 
SYSTEMIC REMEDIES. 
minutes and lasting for three hours, when it was replaced by intense rest- 
lessness and severe delirium, continuing for seven hours. During this time 
the animal was perfectly blind. 
Barbier's previous experiments upon the horse (quoted by Prof. Stille) 
had yielded results similar to those of Harley. He used larger doses, 
and found that four drachms of the aqueous extract of opium produced 
violent tremblings, apparent insensibility to external irritants, convulsions 
without coma, and death. One hundred grains of the acetate of morphia 
killed a horse by convulsions in three hours. 
In the mouse, according to the experiments of Harley, the first effect of 
an injection of from one-twentieth to one-twelfth of a grain of morphia is a 
tonic cramp-like contraction of the muscles, especially of the trunk, of such 
character that periods of forced rest alternate with a slow, laborious creep, 
which seems to originate not in the limbs but in the trunk itself. There is 
in this state no tendency to somnolency, but, on the contrary, an abnormal 
sensitiveness to loud sounds, which cause the mouse to resume for a moment 
active running movements. The breathing is irregular, the pulse accelerated, 
and finally stupor develops itself, and coma deepens into death by apnoea; or, 
otherwise, recovery, preceded by convulsive movements of the hinder part 
of the body, is gradually brought about. 
In reviewing the action of morphia upon the lower animals, it becomes 
very evident that whilst we are not in a position to explain all of the symp- 
toms, yet two classes of phenomena are everywhere discernible,-i.e., the 
spinal and the cerebral,-and that the higher in the scale of life any given 
animal may be, the more marked are the brain-symptoms. These cerebral 
phenomena are mostly sleep and stupor; but, as is well known, in some 
human individuals morphia acts as a delirifacient; and it seems very prob- 
able that the peculiar restlessness of the horse under the influence of the 
alkaloid is due to delirium, and not to spinal excitement. 
When looked at in this manner, it seems to me that morphia does not act 
so differently as is generally believed upon the lower animals and upon man. 
The immensely higher cerebral organization of the latter, with the immensely 
greater sensitiveness which it involves, makes the man correspondingly more 
susceptible to the cerebral action of the drug: hence not only is he affected 
by much smaller doses of the alkaloid than are the lower animals, but as the 
spinal symptoms are triumphant in the frog because its spinal system is 
vastly more developed than its cerebral, so in man the cerebral symptoms 
mask the spinal because in him the brain is more developed than the cord. 
The two creatures-man and the frog-occupy the two extremes of the 
series; between them is probably to be found every gradation.* 
* A curious corroboration of the views expressed in the paragraph is found in the fol- 
'owing sentence taken from Althaus {Diseases of the Nervous System, New York, 1878, 
p. 135): "In infants, however, and also in the lower races of mankind, as in negroes and 
Malays, convulsions are observed after its [opium] ingestion." ANALGESICS. 
247 
The action of opium upon dogs and rabbits is sufficiently close to that 
upon man to enable us to reason from experiments upon the former as to the 
influence of the alkaloid upon the circulation and respiration in the latter. 
Indeed, so far as these functions are concerned, morphia appears to act 
identically in both instances. 
Action on Circulation.-In man, the circulatory phenomena are a slight 
primary evanescent acceleration of the pulse-rate (see Nothnagel, IlandLuch 
der Arzneimittellehre, Berlin, 1870, p. 8), succeeded by slowing and increased 
fulness and force of the pulse, which is followed by a return to the normal 
pulse, or a great increase of rapidity and loss of strength during the third 
stage. R. Gscheidlen has found in rabbits and dogs after the injection 
of morphia, first an increase in the pulse-rate, then a decrease, and finally 
return to the normal pulse, or else increased rapidity. Sphygmographic 
studies of the effects of small doses of morphia have been made with 
various results by several observers; undoubtedly, in some individuals, 
therapeutic amounts of the alkaloid depress sensibly the circulation, but in 
agreement with Riegel and Priesendorffer, it can scarcely be doubted that 
therapeutic doses have no sensible effect upon the circulation in the ordinary 
man (see Deutsches Archiv, Bd. xxv. p. 48). 
The slow, full pulse of the second stage of opium-poisoning is due to an 
action of the drug upon the inhibitory cardiac nerves, as may also possibly 
be in some manner the increased arterial pressure; fbr Gscheidlen (Joe. 
cit., p. 45) has experimentally demonstrated that after section of the vagi 
morphia is powerless to lower the pulse, and also that division of the nerves 
during the second stage of morphia-poisoning is followed by an extraordinary 
rise in the pulse-rate. That the peripheral ends of the vagi are stimulated 
was proven by the fact that cardiac arrest took place when the distal ends of 
the cut nerve were more feebly irritated than would suffice to affect the un- 
poisoned animal; that also the inhibitory cerebral centres are stimulated was 
demonstrated by the instantaneous very great fall of the pulse-rate, amounting 
in some cases to one-half in less than half a minute, which ensued upon the 
injection of a large dose of the alkaloid into the carotid,-i.e., into the brain 
and the inhibitory centres. The rapid, feeble pulse of the third stage of 
opium-poisoning Gscheidlen found to be due, at least in a measure, to paraly- 
sis of the peripheral vagi; for at such time stimulation of the peripheral 
end of the cut nerve was powerless to affect the heart. 
The experiments of Gscheidlen also indicate that morphia exerts first a 
stimulating, then a depressing influence upon the heart-muscle or ganglia, 
since, after isolation of the viscus by section of the cord, sympathetic, and 
pneumogastrics, life being sustained by artificial respiration, a large dose of 
morphia induced a momentary increase in the number of the cardiac contrac- 
tions, followed by a marked decrease, and finally extinguishment of the 
same. This conclusion is confirmed by the experiments of Drs. Sidney 
Ringer and H. Sainsbury (British Med., March, 1883), who found that 248 
SYSTEMIC REMEDIES. 
opium first increased the power of the cut-out heart of the frog, then de- 
pressed it, and finally caused diastolic arrest. 
The question of the action of morphia upon the vaso-motor system is of 
great interest, but cannot at present be fully answered. Gscheidlen believes 
that it first stimulates and then depresses it, and asserts that after the injec- 
tion of a large dose the arterioles in the mesentery can be seen to contract, 
and later (third stage) to dilate. The objections to this sort of evidence are 
sufficiently stated elsewhere in this book; and the rise of arterial pressure, 
which he also adduces as an argument, may be accounted for without calling 
upon the aid of the vaso-motor nerves. While, therefore, it is probable 
that morphia does exert the influence he claims for it, the question must be 
still considered as sub judice : that the vaso-motor system is not paralyzed 
even in extremis, is shown by Gscheidlen's experiment {loc. cit., p. 52), in 
which electrical stimulation of the cord at such time induced immediate rise 
of the arterial pressure. The action of morphia upon the brain is certainly 
independent of any action on the vessels.* 
Action on Respiration.-Death occurs from opium, in the great majority 
of cases, by failure of the respiration ; and that such failure is due to a direct 
action of the poison upon the respiratory centres in the medulla, is proven 
by the fact that morphia affects the breathing of dogs and rabbits whose 
pneumogastrics have been cut, as much as it does those whose nerves are 
entire (Gscheidlen, loc. cit., p. 64). 
Action on Pupil.-Since morphia locally applied does not affect the pupil, 
it follows that its constitutional action upon the latter is through the nerve- 
centres. It is probable, but has not, that I am aware of, been experimentally 
proven, that the contraction of the pupil is due to a stimulation of the oculo- 
motor nerve-centres, and that the dilatation of the pupil, as death approaches, 
is due to a paralysis of the same. Indeed, it cannot well be otherwise; for 
if the primary contraction were due to paralysis of the sympathetic, the 
secondary wide dilatation would be impossible ; the dilating force-i.e., the 
sympathetic-having been withdrawn, the pupil would not widely expand 
even if the contracting force-i.e., the oculo-motor-were paralyzed. 
In birds (Dr. S. Weir Mitchell, loc. cit.) the pupil is not affected; in horses 
it is widely dilated (Dr. Harley, loc. cit.') ; and in dogs it dilates before con- 
tracting (Dr. Reese, loc. cit., apparently confirmed by Experiment number 
eight, Harley, loc. cit., p. 109), or sometimes remains unchanged (Harley, 
loc. cit., p. 111). At present these anomalies cannot be explained. 
Elimination Action on Kidneys and Intestines.-The exact fate of 
morphia in the system is uncertain. Various chemists have failed to find 
it in the urine of persons or animals poisoned by it, but it seems to me 
established that it is at least in part eliminated with that secretion, as it 
has been detected by Dr. Hilger (Gscheidlen, loc. cit., p. 32), Bouchardat 
♦ Consult Binz, Arch. Exper. Pathol, und Pharm., vi., p. 310; Vulpian, Lemons sur 
VAppar. Vato-Moieur, ii., p. 156. ANALGESICS. 
249 
(Schmidt's Jahrbiicher, Bd. cxx.), Lefort (Journ. de Chimie, Bd. xi.), and 
Kausmann (Beitriige, etc., Inaug. Dissert., Dorpat, 1868). Although Prof. 
Wormley (Micro- Chemistry, 503) states that the tests relied upon by Bou- 
chardat are not decisive, it is probable that the conclusions reached in the elabo- 
rate research of W. Eliasson are correct (Beitrare z. Lehre des Schicksals 
Morphins, Inaug. Dissert., Kbnigsberg, 1882). They are, that when large 
amounts are ingested morphine appears freely in the urine, but that after 
small doses it cannot be found, although a substance is present giving some 
of the reactions of morphia, from which it is a derivative. The theory that 
morphia is burnt up in the blood has been advocated by those who have 
failed to find it in the urine (see E. Landsberg, Pfluger's Archiv, 1880, 
413), and there is reason for believing that it and other alkaloids are to 
some extent destroyed in the liver. The amount of the urinary secretion 
is said to be sometimes increased by morphia; but more generally it is 
diminished. Retention, which after a full dose of opium is not rare, de- 
pends upon the blunting of the sensibility of the bladder. In a series 
of examinations S. Fubini found that morphine, codeine, narceine, narcotine, 
and thebaine each increase the excretion of urea in man: upon the lower 
animals their action seemed to vary greatly (Hoffmann und Schwalbe 
Jahresber., 1883, 219). It is stated that in habitual opium-eaters morphine 
occurs in the urine not longer than seven days after the cessation of the habit 
(Lond. Med. Record, 1877, p. 92). 
Peristaltic movements, according to the experiments of Prof. Nothnagel 
(Archiv f. Path. Anat., Ixxxix. p. 2), confirmed by J. Ott (N. Y. Med. 
Journ., 1883), are diminished by small doses of morphine, but increased 
by toxic doses. The first effect is evidently due to stimulation of the in- 
hibitory nervous apparatus, and the second to paralysis of the same: it is 
probable that it is the centre which is affected. The experiment which 
Prof. Nothnagel brings forward as evincing a peripheral action is certainly 
not pertinent. 
Upon the digestive tract opium exerts a very marked influence, checking 
secretion and causing constipation, acting in these respects more efficiently 
than does morphia. 
Therapeutics.-The chief indications for the use of opium are con 
sidered below, seriatim. Nearly all of them flow evidently from the known 
physiological action of the drug; others, however, although established by 
clinical experience, and undeniable, are not so plain in their philosophy. 
1. To relieve pain. As an analgesic, opium is without a rival in the ma- 
teria medica, except it be the anaesthetics. It is used to allay pain arising 
from any cause whatever, except acute inflammation of the brain, and is 
preferred to the anaesthetics whenever the pain has any permanency. In 
painfid spasm it is especially useful, as it seems very frequently to quiet the 
motor as well as the sensory disturbance. 
2. To produce sleep. Sleeplessness occurring in acute disease, and not 250 
SYSTEMIC REMEDIES. 
dependent upon cerebral inflammation, may very frequently be relieved by 
opium. While it is often necessary to use the drug freely in such affections 
as delirium tremens, care should be exercised not to overwhelm the nerve- 
centres by enormous doses. In habitual sleeplessness great caution must be 
used in the employment of opium, not so much on account of the disturb- 
ance of digestion which it is liable to cause, as for fear of producing the 
" opium habit." Chloral is perhaps a more generally applicable hypnotic 
than opium. Be this, however, as it may, I have found the combination of 
morphia and chloral singularly efficient. In low fevers, adynamic delirium 
often coexists with sleeplessness, and is then best met by opium. 
3. To allay irritation. In various forms of nervous erethism, opium is 
most valuable; but when the affection is at all chronic, the dangers of the 
opium habit should not be lost sight of. On the other hand, in acute cases, 
as in the excitement which so frequently attends haemoptysis, the drug should 
be used freely. In many cases of disease, opium is serviceable by sustaining 
the system against an irritation for the time being irremediable, by blunting 
the sensibilities. In this way it is useful in the advanced stages of smallpox, 
and in various surgical affections, in which it also does good by allaying pain. 
In various local irritations, opium is continually employed, as in the colic 
caused by undigested food; in bronchitis, it is thus used to quiet cough. 
By allaying irritation and pain, opium affords relief in most cases of in- 
flammation ; but in certain varieties of the affection it seems to do much 
more than this, exerting, in some way at present difficult to explain, a life- 
saving influence. In peritonitis, after due depletion, or in cases not requiring 
depletion, it should always be exhibited in large doses at regular intervals, in 
such a way as to keep the patient in a state of decided narcotism. 
In severe acute vomiting, opium is one of the most reliable remedies. It 
is best used in the form of suppositories. Although, by checking secretion 
and peristalsis, opium usually causes constipation, yet when obstruction of the 
bowels is produced by spasm due to an irritation or inflammation, by relieving 
the latter the drug will sometimes act as a most efficient laxative. 
4. To check excessive secretion. For this purpose opium is very largely 
employed in diarrhoeas, and is very efficient either alone or in combination 
with various remedies. In enteritis and in dysentery, although no less fre- 
quently used than in diarrhoea, it is of service rather as an antiphlogistic and 
analgesic than by checking secretion. In diabetes insipidus, the combination 
of it and gallic acid is, I think, the most generally successful remedy. 
In true saccharine diabetes, opium is of very great value in many cases, 
often ameliorating the symptoms, and, in conjunction with restricted diet, 
sometimes even effecting a cure. Of course, however, like all other known 
remedies in this disease, it most frequently acts simply as a palliative. Ac- 
cording to Dr. Pavey (Medical Times and Gazette, June, 1869, p. 641), it 
affects the quantity of the urine before diminishing the sugar in it. ANALGESICS. 
251 
In severe mercurialptyalism, opium often seems to check the discharge, 
but certainly is not nearly so powerful in this regard as atropia. 
5. To support the system. Opium appears in low fevers, and in various 
protracted adynamic illnesses, to afford actual support to the system in some 
way not as yet made out. This is especially the case when, from any reason, 
sufficient food to keep up life cannot be taken or retained. 
6. -4s a sudorific. Dr. A. Loomis (Arew York Med. Record, 1873) praises 
very highly the use of hypodermic injections of morphia in acute ursemia. 
He states that the drug must be given in sufficient quantity to control the 
convulsions, which it does most happily, at the same time producing profuse 
diuresis. Dr. Morrison Fiset (New York Med. Record, July, 1874) and Dr. 
Dain (American Med. Journal, July, 1874) confirm this. In some instances 
the remedy has seemed to act very happily, but in one or two cases at the 
Philadelphia Hospital its exhibition was shortly followed by death in coma. 
In the form of Dover's powder, opium is very largely used when it is desired 
to produce sweating, as in the early stages of a "general cold," or other forms 
of muscular rheumatism. With its use should generally be conjoined such 
measures as "soaking the feet," covering warm in bed, and the free drinking 
of hot lemonade or hot teas. 
Toxicology.-Sufficient has already been said concerning the course and 
symptoms of poisoning by opium in ordinary cases.* Sometimes in adults 
trismus and other convulsive manifestations are added to, or in a measure 
replace, the usual phenomena, and in children the drug appears at times to 
overpower the nerve-centres at once, so that the second stage is very much 
shortened or aborted, and symptoms of collapse, with unconsciousness, are 
developed very rapidly. The positive diagnosis of opium-poisoning from the 
symptoms alone is often impossible.^ In some cases of congestion of the 
brain, or of apoplexy, or of uraemia, the phenomena are identical with those 
sometimes seen in opium-poisoning. I have thought that inequality of the 
pupils is proof that a case is not one of narcotism; but Prof. Taylor has 
recorded an instance of opium-poisoning in which it occurred (Manual of 
Medical Jurisprudence, 7th Am. ed., 1873, p. 205). 
The indications in the treatment of poisoning by opium are : first, to 
evacuate the stomach ; second, to maintain respiration ; third, to keep up the 
circulation when failing. The first indication may be met in two different 
ways: by an emetic, and by the stomach-pump or tube used as a siphon. 
There is often in narcotic poisoning great difficulty in getting an emetic to 
act, owing to the obtunding of the sensibility of the nervous system by the 
drug. For this and other reasons, so palpable as not to need mentioning, a 
prompt stimulant emetic should be used; antimony, on account of its depress- 
ing influence, should always be avoided. Mustard flour is almost always to 
* For discussion of effect on nursling and foetus when morphia is given to mother, see 
Amer. Journ. Obst., 1877. 
f See Philadelphia Med. Timet, vol. iii., 593; also Dr. Wilks, Med. Timet and Gaz., 1863. 252 
SYSTEMIC REMEDIES. 
be had at once, and is very efficient. A heaped tablespoonful stirred up in a 
tumblerful of warm water should be exhibited as soon as possible, and, if it 
fail to act in fifteen minutes, should be repeated; then a powder of thirty 
grains each of sulphate of zinc and ipecacuanha may be given, to be repeated 
once or twice, at intervals of fifteen or twenty minutes. Large draughts of 
warm water should be administered in the intervals, and also between the 
acts of vomiting, so as thoroughly to wash out the stomach. The stomach- 
pump* is of no value when the solid drug has been ingested, but, if at hand, 
is preferable to emetics when a fluid preparation has been taken, because of 
the promptness of its results. 
To maintain respiration is the ultimate object of all the measures which 
are commonly undertaken for the purpose of arousing the system in opium- 
poisoning. Unconsciousness in itself is of no moment, but as it deepens 
the sensibility of the respiratory centres grows less, and consequently the 
involuntary breathing is less rapidly or less perfectly performed. More than 
this, when at all awake, a patient suffering from opium-poisoning can be made 
to supplement the almost suspended automatic breathing by voluntary respi- 
ration ; and every effort to induce him to do this should be used. It is often 
surprising how an apparently unconscious man can be made to breathe by a 
command shouted in his ear. To keep a patient awake, walking, flagellations 
with small, fine twigs, shaking, shouting, and various other methods which 
may suggest themselves, should be practiced. Care should always be exer- 
cised not to carry these useful measures unnecessarily far, and perhaps add 
physical exhaustion to the natural prostration of the third stage. I desire 
also to call especial attention to strong faradaic currents as a means of causing 
pain, and therefore of rousing the patient, without leaving the bruises and 
soreness which often result from the severe flagellations practiced. 
The cold douche affords an excellent method of rousing the patient and 
at the same time of especially stimulating respiration. The simplest method 
of application is to support the head and shoulders of a patient stripped to 
the waist over a common wash-tub, and to dash the water over the chest and 
head. The effect is much greater if ice-cold water and water a little hotter 
than the hand will bear (115° F.) be used in quick succession. In the way 
of drugs, there are only three substances worthy of mention. Very strong 
infusions of coffee or of green tea have been long used in opium-poisoning, 
and recent scientific studies (British Med. Joum., 1874, ii. 698, 699) have 
shown that in animals doses of morphia otherwise lethal may be successfully 
combated by thein or caffein; atropia, as a respiratory stimulant, is of the 
greatest value in opium-poisoning when there is evident failure of respiration 
* The siphon stomach-pump may be extemporized by any one. It consists simply of an 
india-rubber tube three and a half to four and a half feet in length, of proper calibre, 
which is passed into the stomach. The external end being elevated, water is poured into 
it until the stomach is full; then, without the tube being allowed to empty itself, the 
external end is dropped, when, of course, the flow of water is reversed. ANALGESICS. 
253 
(for discussion of its use, see the article on Atropia) ; and alcohol is to be 
employed in the stage of depression to sustain the arterial system.* 
Whenever life is in evident danger from the insufficiency of natural res- 
piration, the use of artificial respiration should not be postponed, but should 
be practised to supplement nature, and should be maintained so long as there 
is any hope. Life has undoubtedly been saved in this way. A case is 
reported (N. K Med. Journ., June, 1880) in which a baby, who had taken 
one-third grain of morphia, was rescued by artificial respiration kept up, off 
and on, for twenty-four hours. In some cases excess of bronchial mucus 
seems to be of serious import. Under such circumstances good might be 
achieved by placing the patient in an inverted position (Brit. Med. Journ., 
1871, ii. 374). 
Opium-poisoning usually has no sequelae; but a case in which amaurosis 
was produced is reported in Schmidt's Jahrbucher, Bd. clvii. p. 74, and 
glycosuria is said to have followed the poisoning (La France Med., 1883, ii.). 
In regard to the amount of opium which will cause death, the smallest fatal 
dose on record is a sixth of a grain of morphia in the adult (Dr. Buskirk, 
Washington Post, Jan. 30, 1878).'f' According to Dr. A. Calkins (Quart. 
Journ. Psychol. Med., 1868, vol. ii., 739), four grains^ of crude opium placed 
in the ear have caused death ; also four grains by the mouth in more than one 
case. According to the authority just quoted, out of twenty-nine reported 
cases in which a fluidounce of laudanum was taken, nine died. The maximum 
doses from which recovery has occurred without emesis are fifty-five grains of 
the solid opium and six ounces of laudanum. In a babe a day old, one minim 
of laudanum (E. Smith, Lancet, 1854), and in one aged nine months, a few 
drops of paregoric (Wood, Bost. Med. Surg. Journ., 1858), have proved fatal. 
Death of an adult female has been attributed, with doubtful accuracy, to 
thirty grains of Dover's powder, given in divided doses (Chicago Med. 
Journ. and Exam., July, 1882), and still more hypothetically to a quarter 
of a grain of morphia (Boston Med. Surg. Journ., Jan. 3, 1885). Re- 
covery is asserted to have occurred after the ingestion of eighteen grains 
of morphia without vomiting (Dr. Wm. C. Chaffee, Med. Surg. Rep., 1882, 
xlvii. 697). 
Administration.-Whenever it is desired to produce very decided 
narcotism by the use of repeated doses of opium, the drug should always 
be given in liquid form, since opium pills sometimes become very hard and 
* Various drugs have been stated to be antagonistic to opium and cases of recovery 
reported. Veratrum Viride, Cincinnati Lancet and Clinic, 1879, iii. 458 ; St. Louis Med. 
and Surg. Journ., 1879, xxxvii. 601. Aconite, New York Med. Record, 1880, viii. 
| A number of cases are now on record in which death has been produced in the adult 
by the hypodermic use of from one-sixth to one-half grain of morphia. Consult Medico- 
Chir. Trans., vol. i.; Chicago Med. Examiner, May, 1878; Quar. Journ. Psycholog. Med., 
1868, vol. ii. p. 739. 
J Taken from Journal de Chimie, 1831. Assuredly there is a mistake in this case. 254 
SYSTEMIC REMEDIES. 
undergo solution so slowly that they may accumulate in the alimentary 
canal. On the other hand, in diarrhoeas, or in sickness of the stomach, old 
opium pills are thought by some to act better than more soluble forms of the 
drug. 
Many persons cannot take opium on account of the very great secondary 
nausea and depression which it produces. It has been supposed that these 
disagreeable after-effects are due to the narcotina in opium; but this can 
hardly be, seeing that they often follow the use of the pure alkaloid, morphia. 
The deodorized tincture of opium agrees with some individuals better than 
any other preparation of the drug; and, as first pointed out by Dr. Da Costa, 
by giving a drachm of the bromide of potassium with twenty-five drops of it, 
the after-effects of the narcotic are often entirely avoided. In many neuralgic 
women the knowledge of this fact is an inestimable boon ; in others the un- 
pleasant symptoms are not averted by the bromide. 
Children always bear opium very badly, and to them only the weaker 
liquid preparations should be given. Dover's powrder should especially be 
avoided. It is probable that in its manufacture on the large scale the 
ingredients are sometimes not thoroughly mixed: at least I have seen cases 
in which the symptoms caused by it were seemingly so out of proportion to 
the dose as to suggest that more than the officinal amount of opium was 
present. 
In acute vomiting from any cause, in dysentery, in strangury, and other 
irritations of the urino-genital organs, great advantage is often to be gained 
from the use of opium by the rectum. Suppositories made out of the extract 
(gr. ss to i), or enemata of laudanum (gtt. xxx to xl), may be used in these 
cases. The latter should be made by adding the narcotic to a tablespoonful 
of starch-water. 
The dose of opium for an adult is from one to two grains; for a child 
a year old, one-twenty-fourth of a grain. The U. S. Pharmacopoeia directs 
that opium in its normal moist condition should contain not less than nine 
per cent, of morphine, and that dried powdered opium (^Opii Pulvis, U. S.), 
out of which the preparations are made, should contain from twelve to sixteen 
per cent, of the alkaloid. 
The solid officinal preparations of opium are-the denarcotized opium 
( Opium Denarcotisatum, U. S.), opium deprived by the action of ether of 
its narcotina, dose, one to two grains; pills of opium (JPilulse Opii, U. S.), 
containing one grain each ; watery extract (^Extractum Opii, U. S.), twice 
the strength of opium. 
Paregoric (^Tinctura Opii Camphorata, U. S.) has in every fluidounce 
two grains of opium, besides benzoic acid, oil of anise, and camphor, and, 
in consequence of the last ingredient, is more constipating than the other 
preparations of opium, and hence is preferred in diarrhoea-mixtures. It is 
also much used in cough-mixtures. Dose, fji to f§i. The other liquid 
preparations all now represent ten per cent, of powdered opium by weight, ANALGESICS. 
255 
and may be given in doses of ten to fifteen minims. The deodorized tinc- 
ture ( Tinctura Opii Deodorata, U. S.) contains no narcotina, and none of 
the odorous principle of opium. It therefore is less apt to cause nausea 
than are the other preparations. Its drop almost equals the minim in size. 
The other preparations are-Tinctura Opii, U.S., or Laudanum (one 
hundred drops to the fluidrachm) ; Tinctura Opii Acetata, U. S., or Ace- 
tated Tincture (formerly gr. xlviii to f3i) ; Vinum Opii, U. S., or Syden- 
ham s Laudanum (formerly $i to f^i) ; Acetum Opii, U. S., or Black Drop 
(formerly gr. Ixxv to fji). 
This alkaloid occurs in minute, colorless, shining crystals, according to 
Guy melting at 330° F. and subliming at 340° F.; insoluble in cold and 
almost so in boiling water; only slightly soluble in cold alcohol and ether; 
freely soluble in boiling alcohol and in the fixed and volatile oils. 
The following are some of the most sensitive and characteristic tests. In 
a solution of the alkaloid in concentrated sulphuric acid, which has been 
allowed to stand from ten to twelve hours, or has been heated for half an 
hour to 100° C. or momentarily to 150° C. and allowed to cool, the faint- 
reddish violet changes at the point of contact to a deep-blue violet upon the 
addition of dilute nitric acid or of a crystal of saltpetre. Morphia with 
concentrated sulphuric acid makes a colorless solution, which on strong 
heating becomes red, violet, dirty green. With concentrated nitric acid it 
makes a red color, and finally a yellowish solution. With the neutral chlo- 
ride of iron morphia strikes a blue color, perceptible only when the test 
contains one part of the alkaloid in six hundred. Less characteristic, but 
much more sensitive, is the iodine test, with which, according to Husemann, 
one-ten-thousandth part of morphia can be recognized. Iodic acid, in the 
form of a mixture of iodate of potassium and sulphuric acid, is to be added to 
the suspected solution. If morphia be present, iodine will be set free, and 
can be recognized by the starch test. 
The Acetate (Morphine Acetas), Sulphate (Morphine Sulphas), 
and Ilydrochlorate or Muriate of Morphine (Morphinje Hydrochloras) 
are all officinal. The first is a white powder; the last two occur snow-white 
in feathery crystals. They are all soluble in water, and are of a bitter 
taste. 
Therapeutics.-The salts of morphia differ in their therapeutic value 
from opium chiefly in that they act with less power as sudorifics and in 
checking secretion in the bowels, and consequently constipating. The small- 
ness of their dose and their perfect solubility fit them for hypodermic use. 
Almost the only purpose for which they are used in this way is to relieve 
pain. The advantages of the method are the quickness of the results and 
MORPHINA* U.S. 
For spectrum analysis of morphia, see New York Medical Journal, 1874. 256 
SYSTEMIC REMEDIES. 
the increased power of relieving suffering which the remedy seems to acquire. 
Tn cases of severe pain, hypodermics are invaluable; but it must be borne in 
mind that sometimes they cause most unpleasant symptoms. I have seen 
very alarming results from the injection of one-sixth of a grain, and half 
a grain has produced death. In females, unless very robust, the maximum 
dose should be one-eighth of a grain ; in men, one-sixth to one-quarter. The 
dose of a salt of morphia corresponding to a grain of opium is one-quarter 
of a grain. The dose of the formerly officinal solution (Liquor Morphias 
Sulphatis, U. S. 1870,-gr. i to fgi) is one to three drachms. Magendie's 
Solution o f Morphia contains sixteen grains to the fluidounce : it is not offici- 
nal, and should not be kept in the apothecaries' shops. The Suppositories 
(Suppositoria Morphias, U. S.) contain each half a grain of morphia. 
NARCEIN. 
This alkaloid, which is not officinal, was discovered by Pelletier in 1832. 
" It crystallizes out of its watery, alcoholic, and dilute acid solutions in long, 
white, four-sided, rhombic prisms, or in bunched masses of fine acicular 
crystals, odorless, and of a taste at first bitterish, but later styptic." (Pel- 
letier, Hesse, Winckler-Husemann, Die Pflanzenstoffe.') According to 
Pelletier, it is soluble in 375 parts of water at 13° C.; according to Hesse, 
in 1285 parts at 12° C.; whilst Dr. S. Weir Mitchell found that a specimen 
prepared by Merck dissolved in 1000 parts, one prepared by Powers & 
Weightman in 4000 parts, and one of unknown European manufacture in 
2100 parts, of distilled water at 60° F. Its saturated solution in boiling 
water on cooling fills with crystals. Concentrated nitric acid dissolves nar- 
cein with a yellow color, and the solution on being heated gives off reddish 
fumes; iodine makes with it a bluish-black mass, which forms a colorless 
solution in boiling water, but on cooling separates; with concentrated sul- 
phuric acid narcein strikes a brown color, and finally makes a clear yellow 
solution (Husemann). 
Physiological Action.-According to Baxt (Reichert's Archiv, 1869, 
p. 126), three or four centigrammes (0.46 to 0.62 gr.) of narcein, when 
injected into a frog, produce, in from ten to fifteen minutes, a semi-comatose 
condition, in which the batrachian makes no resistance or effort when laid 
upon his back or in other unnatural position. The respiration and circula- 
tion are not disturbed. The frog can be aroused by strong irritation, and 
when awake seems perfectly conscious. In three to six hours he comes out 
of his lethargic condition apparently unaffected. Albers ( Virchow's Archiv. 
vol. xxvi.) found that one grain produces in the frog sleep, reflex and sponta- 
neous convulsions, and, after seventy-four hours, death. According to Ott, 
the convulsions are chiefly spinal, the muscles also being affected. Dr. S. Weir 
Mitchell (Amer. Journ. Med. Sci., Jan. 1870) found nine grains of the alka- 
loid to have very little effect upon pigeons, causing only abnormal quietness. In 
Baxt's experiments upon rabbits and guinea-pigs, fifteen centigrammes (2.3 ANALGESICS. 
257 
zr.) had no perceptible influence; and on dogs Dr. S. Kersch (Schmidt's Jahr- 
bucher, Bd. cxli. p. 15), and also Dr. Harley (The Old Vegetable Neurotics, 
p. 143), found moderate doses (26 ctgr. Kersch) equally inert. In a mouse 
(Harley) one-half grain caused tranquil sleep, with, after a time, tremors, 
from which the animal recovered, to be taken suddenly, some hours later, 
with fatal convulsions. At the post-mortem the tubules of the kidneys were 
found completely choked up with the alkaloid, which had crystallized in 
them and produced a mechanical suppression of urine, to which death was 
probably due. Schroff (quoted by Rabuteau), Fronmiiller (Schmidt's Jahr- 
bucher, Bd. cxli. p. 15), Harley, Mitchell, and Da Costa (Pennsylvania 
Hospital Reports, 1868), have found narcein to act very feebly upon man. 
Harley gave one grain hypodermically, Da Costa two and one-half grains 
by the mouth, and Mitchell took five grains himself, with the result of only 
causing some headache; and Fronmiiller has exhibited as much as twenty 
grains with equally negative results. 
These investigations are in close concord, and seemingly conclusive ; and 
the study of Dr. Da Costa upon man was very full and exhaustive. They are 
opposed by a number of seemingly equally conclusive investigations made by 
various French and German observers. Much of the interest that has been 
manifested in the alkaloid arose from the assertion of Claude Bernard in 
1864 (Archives Generates, 6e ser., t. iv. p. 459), that it is the most pleasant 
and certain hypnotic of any of the opium alkaloids. He experimented upon 
dogs, guinea-pigs, rats, pigeons, sparrows, and frogs, and in all of them there 
was produced deep sleep, closely resembling natural sleep, with benumbed but 
not destroyed sensibility. The irritability of the morphia-sleep was want- 
ing, and no secondary depression followed. Seven to eight centigrammes 
(1.65 gr.) was sufficient to throw a dog into the profoundest slumber. As 
early as 1852, Lecomte (Husemann, Die Pflanzenstoffe, p. 176) had affirmed 
that 0.1 grm. (1.53 gr.) of narcein thrown into the jugular vein of a dog would 
produce deep sleep, and very recently Rabuteau has confirmed the results of 
Bernard. Further, Behier (Bulletin Therap.J. Ixvii.), Debout (Ibidd), A. 
Eulenburg (Schmidt's Jahrbucher, Aug. and Oct. 1866), Lind (Journal de 
Pharmacie et de Chimic, 4e ser., t. iii.), also assert as the result of ex- 
perience that narcein, in doses of one-half grain to a grain, produces in man 
pleasant, persistent sleep. Rabuteau (loc. cit.') also agrees with this, except 
in placing the dose somewhat higher,-viz., at from ten to twenty centi- 
grammes (1.53 to 3.06 gr.). Oetinger (Das Narcein als Arzneimittel, Diss. 
Inaug., Tubingen, 1866) also asserts that decidedly larger doses of narcein 
than of morphia are required to obtain any action. 
As seemingly these opposing results are all true, the only possible expla- 
nation is that different substances were used by the different sets of observers 
under the one name. As the greatest care was practiced by Harley and 
Mitchell in obtaining the alkaloid pure, and as Claude Bernard states ex- 
pressly that the substance used by him was soluble in twenty parts of water, 258 
SYSTEMIC REMEDIES. 
it is most probable that the former observers really had, and that Bernard did 
not have, the narcein of Pelletier. 
It is, at any rate, a very plain deduction from the above facts that, if it 
be so difficult-nay, impossible-to obtain in commerce a uniform reliable 
narcein, it is not proper to use it as a medicine. 
CODEINA. U.S. 
Albers found that one grain of the muriate of codeine would produce in the 
frog, twenty minutes after its injection, tetanic cramps, alternating with con- 
vulsions : evidently reflex, since the slightest touch would call them forth. 
After a time the convulsive excitement grew less and less; the fore feet lost 
their sensitiveness first, but finally a paroxysm could no longer be provoked 
by touching the hind feet. The pupils at this time were widely dilated. 
Death occurred by failure of respiration, the heart continuing to beat a quarter 
of an hour after the extinguishment of all other movements. In Woldemar 
Baxt's (^Reichert's Archiv, 1869, p. 125) experiments, three centigrammes 
(0.45 gr.) produced in the frog deep sleep, lasting three or four hours. On 
awaking, the frog seemed more sensitive than natural to external irrita- 
tion. Six centigrammes produced sleep more quickly, and following the 
deep sleep a stage of excessive sensitiveness, during which external irritation 
produced repeated cramp-like contractions. M. Wachs (quoted by Huse- 
mann, Die Pflanzenstoffe, p. 163) observed phenomena similar to those de- 
tailed by Albers, but noted a peculiarity of gait in the frog preceding the 
convulsive stage, owing apparently to disturbance in the innervation of the 
adductors. Wachs also found that .010 gramme (0.15 gr.) produced in the 
pigeon only increased rate of respiration and sleepiness, whilst larger fatal 
doses caused restlessness, inability to stand, movements backward and in a 
circle, disturbance of respiration with gasping, cramps of single muscles, and 
finally convulsions, mostly clonic, frequently repeated, and followed by an 
adynamic condition, terminated by sudden death. In Dr. S. Weir Mitchell's 
experiments (Amer. Journ. Med. Sci., Jan. 1870, p. 26), seven grains pro- 
duced violent non-tetauic convulsions, ending fatally in one minute; and one 
grain caused similar symptoms, terminating fatally in eight minutes. Dr. Ott 
{Opium Alkaloids') found that the convulsions in the frog are spinal, but 
that the muscles are affected. 
According to Husemann (loc. cit., p. 133), Kunkel, in 1833, from his ex- 
periments arrived at results similar to the recent ones of Bernard. The latter 
observer found that five centigrammes (.075 gr.) produced in dogs a sleep 
similar to, but not so profound as, that of morphia, with less benumbing of 
sensation, and not followed by any symptoms of depression. 
These results have been called in question by Harley, and it seems most 
probable that Claude Bernard used something more than codeine in his ex- 
periments. Certainly Harley found that one to two grains of the alkaloid 
produced in the dog disturbance of respiration, languor, and convulsive ANALGESICS. 
259 
twitchings, but no sleep. Moreover, Husemann states that, after fatal doses, 
Wachs observed similar symptoms in the dog and in the rabbit, as follows: 
falling of the head, trembling, spasmodic movements of the eyes and lips, 
rarely trismus, movements in a circle and backwards, weakness of the legs, 
with hurried respiration and prominence of the eyeballs as prodromes; later 
in the poisoning there were severe convulsions, after one or many paroxysms 
of which great weakness developed, ending in death. Barnay, in experiments 
upon dogs, cats, and rabbits, found that the convulsions were the most promi- 
nent symptom (De la Codeine, Paris, 1877). Falck affirms (Deutsches 
Klinik, 1870) that there are two forms of poisoning produced by codeia,- 
the one tetanic and the other soporific,-corresponding apparently to the 
different results of various observers.* 
As a hypnotic in man, codeia has been used by Magendie, Berths, Aran, 
Krebel, Reissner, Robiquet, and others, some of whom assert that the sleep 
produced by it is followed by nausea or other symptoms of depression, whilst 
others deny this. It does not seem necessary to discuss in detail the researches 
of the authorities alluded to, but it may be well to give the results of one or 
two of these observers more in full. 
Robiquet in a series of experiments found that doses of 0.01 to 0.03 
gramme (.15 to .40 gr.) produced a feeling of contentment, calmed nervous- 
ness, and induced refreshing sleep, whilst 0.1 to 0.2 gramme (1.53 to 3.07 
gr.) caused deep sleep, followed by nausea and vomiting; 0.1 gramme (1.53 
gr.) caused in children very alarming symptoms. Harley has found in a 
number of experiments that, given by the mouth, codeia is a very uncertain 
and feeble hypnotic, four grains producing simply accelerated pulse, con- 
tracted pupils, and some giddiness, followed by nausea and vomiting. When 
the drug is given subcutaneously, " somnolency," he states, " is a more promi- 
nent effect, but only occurs in certain individuals." His hypodermic dose is 
one to two grains. On the other hand, Dnorzak and Heinrich found that 
codeia in doses of 0.1 gramme caused gastric uneasiness and pain, some sali- 
vation, nausea, heat, and feeling of weight in the head, some confusion of 
thought, very marked reduction of the pulse-rate, and very marked tremors 
affecting the whole body; and Mitchell took five grains of the alkaloid with- 
out inducing other effects than a rise of twenty per minute in the pulse-rate, 
nausea, slight giddiness, and a sense of heaviness about the head. Dr. A. S. 
Myrtle records (British Medical Journal, 1874, i. 478) a case of severe poi- 
soning by four grains of codeia prepared by the Messrs. Smith of Edinburgh. 
There was first vascular excitement and exhilaration, then depression with 
* From what he says on p. 226, it is probable that Falck used two preparations of 
codeia,-one made in his own laboratory, the other obtained from Merck. It is not 
possible to determine from his text whether this had anything to do with the different 
results he obtained. 260 
SYSTEMIC REMEDIES. 
great anxiety, nausea and vomiting, pale, cool, clammy skin, slight contrac- 
tion of pupil, and sleeplessness, with slight delirium. 
It is very evident that these various observers have not had the same 
principle. In my own experience codeia, prepared by Powers & Weightman, 
has failed to act in grain doses as a hypnotic. There are no reasons for 
believing that it has any advantages of morphia, whilst its uncertainty is 
very great. I have found it of some value in one-half grain doses in quiet- 
ing bronchial irritation. 
The remaining active principles of opium being objects of physiological 
rather than of clinical interest, I shall allude only to their physiological actions. 
Narcotina.-Although in Dr. Albers's experiment Joe. cit., p. 244) one 
grain of narcotina proved fatal to a frog without the production of convul- 
sions, yet the united testimony of Claude Bernard Joe. cit., p. 462), of Baxt 
Joe. cit., p. 124), of Rabuteau Joe. cit., p. 266), of Mitchell Joe. cit., p. 23), 
and of Ott Joe. cit.'), show that in the lower animals this alkaloid produces, 
when given in sufficiently large dose, active spinal convulsions. In small 
dose (one-half grain) it causes, according to Albers and to Baxt, in frogs 
a semi-comatose state. In larger dose (1.2 grains) the last observer found it 
to induce in the same batrachian very decided convulsions, similar to those 
of morphia-poisoning. Dr. Mitchell states that from two to three grains 
produce violent and fatal convulsions in the pigeon. Claude Bernard ranks 
narcotina above morphia and codeia, next to papaverina, as a convulsant in 
the lower animals. Yet Orfila found thirty grains necessary to kill a dog, 
and Baxt has given about two grains to rabbits and to guinea-pigs without 
producing any symptoms. 
Man is no more sensitive to narcotina than the lower animals, if indeed 
he be so sensitive. Twenty and thirty grains of it have frequently been 
taken without effect, and doses of one hundred and twenty grains are said to 
have been exhibited with no greater result. 
Thebaia, or Paramorphia.-Magendie, Orfila, Albers, Baxt, Claude Ber- 
nard, F. W. Muller JDas Thebaia, Diss. Inaug., Marburg, 1868), Harley, 
Fraser, Mitchell, Rabuteau, and other observers, all agree as to the very great 
similarity between the action of thebaia and that of strychnia. Falck 
(Deutsches Klinik, 1869) divided the general symptoms produced by the 
poison in mammals into three stages: the prodromal period, in which there 
was restlessness, combined with a desire to creep into corners, urination, 
increased frequency of respiration, and some stiffness of the leg; the second 
stage, in which there were violent strychnic convulsions, greatly interfering 
with respiration, and sometimes producing cyanosis; the third period, in 
which there was paralytic muscular weakness, with apparent death, ending, 
after a time, in real death. The third stage was usually momentary, and 
seems to me to have been merely the dying, which occurred when the animal 
was exhausted and cyanosed by the convulsions. A notable symptom of 
thebaia-poisoning is the increase of bodily temperature, which Falck found ANALGESICS. 
261 
to amount to from j° to 3° C. On pigeons (Falck and Ott) thebaia acts 
as upon mammals, and in frogs it produces the most violent tetanic spasms 
The convulsions are undoubtedly spinal, as they occur after section of the 
cervical cord. 
The only detailed study of the physiological action of thebaia yet made is 
that of J. Ott (Boston Medical and Surgical Journal, April, 1875), who 
found that the alkaloid does not directly affect the motor or sensory nerves or 
the striated muscles. The same observer also determined that thebaia exerts 
no influence on the inhibitory cardiac nerves, but does increase the arterial 
pressure by stimulating the vaso-motor centres, and probably also by stimu- 
lating the intra-cardiac ganglia. Thebaia is undoubtedly an exceedingly 
active poison. According to Albers, less than half a grain will cause violent 
tetanus in a frog, and in Ott's experiments .011 gr. produced very decided 
symptoms in the same animal. Harley found two grains sufficient to kill a 
bitch, and in Falck's experiments a grain and a half injected hypodermically 
killed a dog in ten minutes. The alkaloid must act upon man as upon the 
lower animals; yet Fronmiiller (KUnische Studien der Nark. Arzneimittel, 
Erlangen, 1869) affirms that he has given it in as high as six-grain doses 
without producing any symptoms, and that Prof. Leidesdorff (Wiener 
Med. Wochenschrift, No. 34, 1868) had had similar results. Rabuteau 
is said to have taken 1.5 gr. without decided symptoms. On the other 
hand, Eulenburg found one four-hundredth of a grain to cause increased 
respiration, pulse-rate, and temperature, with sometimes wide dilatation of 
the pupil (quoted by Ott). It seems impossible to avoid the conviction that 
the drug used by Fronmiiller must have been either very impure or else 
not thebain at all. Husemann (Arch. Exper. Path, und Therap., ix. 422) 
has found chloral strongly antidotal to toxic doses of thebain. 
Papaverina.-A great deal of discrepancy exists among observers as to 
the physiological action of papaverina, obviously dependent upon variations 
in the purity of the specimens which they have used. Schroff and Hoffmann 
believe it to be inert in man, since the latter observer took about seven grains 
without any effect being induced. 
Albers and Claude Bernard claim that on animals it acts as a convulsant 
resembling thebaia; whilst Baxt asserts that in frogs it produces profound 
sleep, with great slowing of the heart's beat, but without tetanus, and that it 
even acts as an antitetanic in the poisoning of codeia and of morphia. He also 
finds that rabbits and guinea-pigs bear enormous doses of it. Rabuteau says 
two to three centigrammes produce violent convulsions in the frog, but twenty- 
five centigrammes in the dog cause no symptoms ; yet in Baxt's experiments 
four to ten centigrammes served to cause profound coma in the latter animal. 
Ott affirms it is both narcotic and convulsant, and produces a condition of the 
muscles similar to that caused by veratria. These statements are irreconcil- 
able, and no opinion can be arrived at until new researches, prefaced by a 
rigid chemical study of the alkaloid used, are entered upon. 262 
SYSTEMIC REMEDIES. 
Laudania, discovered by Hesse (Annahn der Chemie und Pharmacie, 
viii., Supplement. Bd., p. 272), has been elaborately investigated by Prof. 
Falck, of Marburg* (Deutsche Klinik, 1874, p. 298). He finds that there 
are three stages of its poisoning: first, hurried respirations, pupils con- 
tracted or dilated, muscular twitchings and convulsive tremblings ; second, 
convulsions closely resembling those of strychnia-poisoning ; third, adynamia, 
apparent death, and finally death from failure of respiration, the heart being 
the last part of the body to die. 
Porphyroxia, according to Albers, acts upon the frog as the most power- 
ful of all the convulsant opium alkaloids. Baxt (he. cit., p. 123) found it in 
doses of two to three milligrammes (.030 to .045 grain) to throw the frog 
into a semi-comatose condition, followed in fifteen to twenty minutes by 
most violent convulsive excitement. In sparrows one milligramme (.015 
gr.), and in pigeons a larger dose, produced violent tremors, lasting ten 
to fifteen minutes, and followed by a state of semi-coma. In guinea-pigs 
ten to twenty milligrammes (.15 to .30 gr.), and in rabbits a one-fourth to 
one-third larger dose, caused violent tetanic cramps; larger doses produced 
speedily fatal convulsions. According to Schroff, 1.5 grains are without 
influence upon man. 
Cryptopia, according to Harley, causes in dogs wild delirium, with dilated 
pupils, followed by tetanic spasms. In the mouse, small doses produce some 
delirious excitement, followed by somnolency; while large doses cause heavy 
sleep, and death from failure of the respiration. In the more detailed inves- 
tigation of Immanuel Munk (Wirkung des Cryptopin, Inaug. Diss., Berlin, 
1873) it was found that the convulsions did not occur when artificial respi- 
ration was performed, and are, therefore, probably not spinal. The death 
was preceded by loss of reflex excitability from spinal depression, and was 
due to respiratory paralysis. Enormous doses also killed the cardiac muscle. 
A grain and a half injected beneath the skin by Harley caused in some per- 
sons intense drowsiness; in others, very slight symptoms. According to 
Dr. Ott, it is narcotic, exciting and then depressing the motor spinal centres, 
paralyzing spinal sensory centres, lessening functional activity of the motor 
nerves, and lowering heart-action by an influence on its muscle. 
Meconin, according to Albers (loc. cit., p. 248), produces in (0.045 grm.) 
the frog mild tremors, lessening of sensation, and finally death. On the 
higher animals its poisonous action is not very great. Orfila injected 0.06 
grm. (0.9 gr.) into the jugular vein of a dog, without effect. Harley gave 
two grains hypodermically to the same animal, with no further result than a 
little abnormal quietness. According to the same observers, subcutaneous 
injections of fourteen grains have no effect on the horse, but one-sixth of a 
grain produces very decided hypnotism in the mouse. On man, Dublanc 
* The following is the minimum fatal dose of alkaloids for rabbits, per kilogramme 
(2 lb. drm.) of weight, as determined by Falck: strychnia, 0.0006 gramme; thebaia, 
0.0120 grm.; laudania, .0250 grin.; hydrocotarnia, 0.1600 grm.; morphia, 0.7200 grm. ANALGESICS. 
263 
(Pharm. Centralblatt, 1832), Schroff (Medicin. Jahrb., 1870), Fronmiiller 
(Klinische Studien Narcot. Arzneien), and Harley have found meconia, when 
given by the mouth, inert in doses varying from one to eighteen grains. 
Harley, however, claims that in doses of one to two grains given hypoder- 
mically it acts upon man as a very excellent hypnotic; but Fronmiiller has 
injected nearly two grains, with entirely negative results. 
Hydrocotarnia.-The physiological action of this alkaloid has been in- 
vestigated by F. A. Falck (London Medical Record, i. 218). He finds it 
more actively poisonous to rabbits than is morphia. In some of his experi- 
ments it produced tetanic convulsions, in others coma and stupor. In frogs 
the symptoms were always tetanic. 
In regard to the action of Pseudomorphia and Opiania we have little or 
no knowledge. Sertiirner, the discoverer of Meconic Acid (quoted by Al- 
bers), found it in his experiments to be actively poisonous; but Summering 
and Albers have come to an opposite conclusion. Large doses (one to two 
grains) do, however, affect frogs, although slowly, inducing a stupor-like con- 
dition, with convulsions. 
CANNABIS INDICA-INDIAN CANNABIS-INDIAN HEMP. U.S. 
CANNABIS AMERICANA-AMERICAN CANNABIS. U.S. 
Under the respective names which head this article, the U. S. Pharmacopoeia 
recognizes the dried tops of the Cannabis gativa, or common hemp plant, as 
it grows in India and in our own country. 
EXTRACTUM CANNABIS INDICtE - EXTRACT OF INDIAN 
HEMP. U.S. 
The alcoholic extract of Indian hemp is a blackish, resinous extract, of a 
decided narcotic odor and a peculiar taste. In the East, hemp and its educts 
are used as narcotic stimulants. Gunjah is the dried plant as sold in the 
bazaars of Calcutta for smoking. Churrus is the resinous exudation with 
the epidermis, etc., scraped off the leaves. Hashish is an Arabian prepara- 
tion of the drug. The resin, which represents the activity of hemp, is 
sometimes known as Cannabin. It is best obtained by precipitating the 
saturated tincture with water containing an alkali. Hemp also contains a 
trace of volatile oil. 
Physiological Action.-When given in full doses, cannabis indica 
produces a feeling of exhilaration, with a condition of reverie, and a train 
of mental and nervous phenomena which varies very much according to the 
temperament or idiosyncrasies of the subject, and very probably also, to 
some extent, according to the nature of his surroundings. The sensations 
are generally spoken of as very pleasurable; often beautiful visions float 
before the eyes, and a sense of ecstasy fills the whole being; sometimes the 
venereal appetites are greatly excited; sometimes loud laughter, constant 
giggling, and other indications of mirth are present. Some years since, in 264 
SYSTEMIC REMEDIES. 
experimenting with an extract made from the American plant, I took a very 
large dose, and described the result as follows (Proceed. Amer. Philosopli. 
Soc., 1869, vol. xi. p. 226): 
11 About half-past four p.m., September 23, I took most of the extract. 
No immediate symptoms were produced. About seven P.M. a professional 
call was requested, and, forgetting all about the hemp, I went out and saw 
my patient. Whilst writing the prescription, I became perfectly oblivious 
to surrounding objects, but went on writing, without any check to or devia- 
tion from the ordinary series of mental acts connected with the process, at 
least that I am aware of. When the recipe was finished, I suddenly recol- 
lected where I was, and, looking up, saw my patient sitting quietly before 
me. The conviction was irresistible that I had sat thus many minutes, per- 
haps hours, and directly the idea fastened itself that the hemp had com- 
menced to act, and had thrown me into a trance-like state of considerable 
duration, during which I had been stupidly sitting before my wondering 
patient. I hastily arose and apologized for remaining so long, but was 
assured I had only been a very few minutes. About seven and a half p.m. 
I returned home. I was by this time quite excited, and the feeling of 
hilarity now rapidly increased. It was not a sensuous feeling, in the ordi- 
nary meaning of the term; it was not merely an intellectual excitation; it 
was a sort of bien-etre,-the very opposite to malaise. It did not come 
from without; it was not connected with any passion or sense. It was simply 
a feeling of inner joyousness ; the heart seemed buoyant beyond all trouble ; 
the whole system felt as though all sense of fatigue were forever banished; 
the mind gladly ran riot, free constantly to leap from one idea to another, 
apparently unbound from its ordinary laws. I was disposed to laugh; to 
make comic gestures; one very frequently recurrent fancy was to imitate 
with the arms the motions of a fiddler, and with the lips the tune he was 
supposed to be playing. There was nothing like wild delirium, nor any hallu- 
cinations that I remember. At no time had I any visions, or at least any 
that I can now call to mind; but a person who was with me at that time 
states that once I raised my head and exclaimed, ' Oh, the mountains! the 
mountains !' Whilst I was performing the various antics already alluded to, 
I knew very well I was acting exceedingly foolishly, but could not control 
myself. I think it was about eight o'clock when I began to have a feeling 
of numbness in my limbs, also a sense of general uneasiness and unrest, and 
a fear lest I had taken an overdose. I now constantly walked about the 
house; my skin to myself was warm, in fact my whole surface felt flushed; 
my mouth and throat were very dry; my legs put on a strange, foreign 
feeling, as though they were not a part of my body. I counted my pulse 
and found it one hundred and twenty, quite full and strong. A foreboding, 
an undefined, horrible fear, as of impending death, now commenced to creep 
over me; in haste I sent for medical aid. The curious sensations in my 
limbs increased. My legs felt as though they were waxen pillars beneath ANALGESICS. 
265 
me. I remember feeling them with my hand and finding them, as I thought 
at least, very firm, the muscles all in a state of tonic contraction. About 
eight o'clock I began to have marked ' spells,'-periods when all connection 
seemed to be severed between the external world and myself. I might be 
said to have been unconscious during these times, in so far that I was ob- 
livious to all external objects, but on coming out of one, it was not a blank, 
dreamless void upon which I looked back, a mere empty space, but rather a 
period of active but aimless life. I do not think there was any connected 
thought in them; they seemed simply wild reveries, without any binding 
cord,-each a mere chaos of disjointed ideas. The mind seemed freed from 
all its ordinary laws of association, so that it passed from idea to idea, as it 
were, perfectly at random. The duration of these spells to me was very 
great, although they really lasted but from a few seconds to a minute or two. 
Indeed, I now entirely lost my power of measuring time. Seconds seemed 
hours ; minutes seemed days ; hours seemed infinite. Still I was perfectly 
conscious during the intermissions between the paroxysms. I would look at 
my watch, and then after an hour or two, as I thought, would look again 
and find that scarcely five minutes had elapsed. I would gaze at its face in 
deep disgust, the minute-hand seemingly motionless, as though graven in the 
face itself; the laggard second-hand moving slowly, so slowly. It appeared 
a hopeless task to watch during its whole infinite round of a minute, and 
always would I give up in despair before the sixty seconds had elapsed. 
Occasionally, when my mind was most lucid, there was in it a sort of duplex 
action in regard to the duration of time. I would think to myself, It has 
been so long since a certain event,-an hour, for example, since the doctor 
came ; and then reason would say, No, it has been only a few minutes ; your 
thoughts or feelings are caused by the hemp. Nevertheless, I was not able 
to shake off this sense of the almost indefinite prolongation of time, even for 
a minute. The paroxysms already alluded to were not accompanied with 
muscular relaxation. About a quarter before nine o'clock, I was standing 
at the door, anxiously watching for the doctor, and when the spells would 
come on I would remain standing, leaning slightly, perhaps, against the 
doorway. After awhile I saw a man approaching, whom I took to be the 
doctor. The sounds of his steps told me he was walking very rapidly, and 
he was under a gas-lamp, not more than one-fourth of a square distant, yet 
he appeared a vast distance away, and a corresponding time approaching. 
This was the only occasion in which I noticed an exaggeration of distance; 
in the room it was not perceptible. My extremities now began to grow 
cold, and I went into the house. I do not remember further, until I was 
aroused by the doctor shaking or calling me. Then intellection seemed 
pretty good. I narrated what I had done and suffered, and told the doctor 
my opinion was that an emetic was indicated, both to remove any of the 
extract still remaining in my stomach, and also to arouse the nervous system. 
I further suggested our going into the office, as more suitable than the par- 266 
SYSTEMIC REMEDIES. 
lor, where we then were. There was at this time a very marked sense of 
numbness in my limbs, and what the doctor said was a hard pinch produced 
no pain. When I attempted to walk up-stairs, my legs seemed as though 
their lower halves were made of lead. After this there were no new symp- 
toms, only an intensifying of those already mentioned. The periods of 
unconsciousness became at once longer and more frequent, and during their 
absence intellection was more imperfect, although when thoroughly roused I 
thought I reasoned and judged clearly. The oppressive feeling of impending 
death became more intense. It was horrible. Each paroxysm would seem 
to have been the longest I had suffered; as I came out of it, a voice seemed 
constantly saying, ' You are getting worse; your paroxysms are growing 
longer and deeper; they will overmaster you; you will die.' A sense of 
personal antagonism between my will-power and myself, as affected by the 
drug, grew very strong. I felt as though my only chance was to struggle 
against these paroxysms,-that I must constantly arouse myself by an effort 
of will; and that effort was made with infinite toil and pain. I felt as if 
some evil spirit had control of the whole of me except the will-power, and 
was in determined conflict with that, the last citadel of my being. I have 
never experienced anything like the fearful sense of almost hopeless anguish 
and utter weariness which was upon me. Once or twice during a paroxysm 
I had what might be called night-mare sensations; I felt myself mounting 
upwards, expanding, dilating, dissolving into the wide confines of space, 
overwhelmed by a horrible, rending, unutterable despair. Then, with tre- 
mendous effort, I seemed to shake this off, and to start up with the shudder- 
ing thought,. Next time you will not be able to throw this oft, and what 
then? Under the influence of an emetic I vomited freely, without nausea, 
and without much relief. About midnight, at the suggestion of the doctors, 
I went up-stairs to bed. My legs and feet seemed so heavy I could scarcely 
move them, and it was as much as I could do to walk with help. I have no 
recollection whatever of being undressed, but am told I wTeut immediately to 
sleep. When I awoke, early in the morning, my mind was at first clear, but 
in a few minutes the paroxysms, similar to those of the evening, came on 
again, and recurred at more or less brief intervals until late in the afternoon. 
All of the day there was marked anaesthesia of the skin. At no time were 
there any aphrodisiac feelings produced. There was a marked increase of 
the urinary secretion. There were no after-effects, such as nausea, headache, 
or constipation of the bowels." 
The sense of prolongation of time which I experienced was to me very 
remarkable, but is not uncommon in these cases. It is evidently due to the 
immense rapidity of the succession of ideas. The mind, without doubt, 
measures time by the duration of its own processes, and when an infinitude 
of ideas arise before it in the time usually occupied by a few, time becomes 
infinitely prolonged to the mind. It is a lifetime in the minute. A very 
common mental phenomenon, not yet mentioned, is a condition of double ANALGESICS. 
267 
consciousness, a sense of having two existences, of being at the same time 
oneself and somebody else. 
In some cases Indian hemp produces, in addition to or even in the place 
of the symptom already spoken of, marked disturbances of motility. Convul- 
sions have been noticed by Dr. Lawrie (Stille s Therapeutics, vol. i. p. 772), 
and local spasms, with salaam convulsions, by Dr. F. H. Brown. According to 
Dr. O'Shaughnessy, the induction of catalepsy is not rare among the Hindoos. 
Whatever may be the symptoms of the first stage, sooner or later, if the 
dose be sufficient, drowsiness comes on. Generally, before it is marked, par- 
tial anaesthesia, often with partial loss of strength, is manifested, especially in 
the lower limbs. The pupils are dilated, the pulse is quickened, and finally 
the subject falls into a heavy sleep, out of which he generally awakes hungry, 
without any of the wretched gastric sensations or the malaise felt after an 
opiate. Confusion of thought, however, may persist for some hours. Can- 
nabis exerts no constipating influence upon the bowels, and appears to in- 
crease, rather than decrease, the excretion of the kidneys. 
Therapeutics.-Leaving out of sight the employment of the medicine 
by alienists, hemp has been used in this country chiefly for the relief of pain, 
but also to some extent as a hypnotic. As an analgesic, it is very much inferior 
to opium, but may be tried when the latter is for any reason contra-indicated. 
In full doses, in neuralgic pains, it certainly often gives relief. It has been 
very largely employed to induce euthanasia in the advanced stages of phthisis, 
and constitutes, it is said, a popular nostrum employed for that purpose. In 
tetanus, Indian hemp has been used quite largely, and until within a short 
time was, after opium, one of the few known drugs of service. Dr. Roemer 
(St. Louis Medical and Surgical Journal, p. 363, 1873) has collected 
thirty-five cases, with twenty-one recoveries and fourteen deaths. 
Administration.-The action of the preparations of Indian hemp is 
exceedingly variable, in some cases small doses producing alarming effects, in 
other instances the remedy seeming almost entirely powerless. There ap- 
pears to be a very great difference in the susceptibility of persons to its influ- 
ence ; but this cannot explain the wide variance of the clinical results obtained 
by its use. A large proportion of the extracts upon the market must be 
inert. Possibly the crude drug undergoes deterioration during its long sea- 
voyage from India; at least I have had extract carefully made from genuine 
Indian hemp and offering all the physical characters of good extract, yet en- 
tirely inert in doses of many grains. I have seen an eighth of a grain of an 
English extract produce in a susceptible woman decided intoxication. So far 
as my present knowledge goes, although the foreign extracts of hemp are 
often inefficient, they are much more reliable than the American. The only 
way of iidministering hemp with satisfaction at present is for the practitioner 
to try various samples until he gets an active one, and then, being supplied 
with this, and having learned its proper dose by clinical experiment, to depend 
solely upon it. Hemp is not a dangerous drug; even the largest doses of its 268 
SYSTEMIC REMEDIES. 
active preparations, although causing most alarming symptoms, do not com- 
promise life. No case of acute poisoning by it terminating fatally has, that 
I am aware of, been reported. There is an officinal tincture (Tinctura Can- 
nabis Indicee, U.S.), the dose of which is thirty minims. The dose of the 
fluid extract (Extractum Cannabis Indicae Fluidum, U.S.) is one minim. 
Under the name of tannate of cannabene the German chemist, Merck, 
has put upon the market a preparation of cannabis, which is affirmed by 
Fronmiiller (Memorabil., 1882, 257) and by Hiller (Berlin. Klin. Wochens., 
1883, ix. 125) to be a very valuable mild hypnotic in doses of from four 
to seven grains. Fronmiiller believes the failure of others to obtain similar 
results is largely due to the use of insufficient doses. CLASS VII-MYDRIATIOS. 
In the present group are considered three medicines,-belladonna, hyoscy- 
amus, and stramonium,-whose preparations, wdien given internally or applied 
locally to the eye, dilate the pupil, or, in other words, produce mydriasis, and 
whose action upon the system appears to be almost identical. 
belladonna; FOLIA-BELLADONNA LEAF. U.S. 
BELLADONNA] RADIX-BELLADONNA ROOT. U.S. 
The leaves and root of Atropa belladonna, an herbaceous perennial, a native 
of Europe, but cultivated in this country, and attaining a height of some 
three feet. The oval, pointed, entire, smooth, unequal leaves are in pairs, on 
a short footstalk. The bell-shaped, axillary, pendent flowers are of a dull 
reddish color. The globular berry is about three-quarters of an inch in 
diameter, deep purple, with a violet-colored juice, and adherent, green calyx. 
The dried leaves have a faint narcotic odor, and a sweetish, sub-acrid, slightly 
nauseous taste. The dried cylindrical branched root is from one to several 
inches in diameter, much longer, fibrous, externally reddish brown, internally 
whitish, almost odorless, with a very feeble sweetish taste. 
The sole active principle of belladonna, discovered by Mein in 1831 and 
independently by Geiger and Hesse in 1833, occurs in silky prismatic and 
acicular, often aggregated crystals, of a bitter, burning taste, without odor, 
soluble in three hundred parts of cold and fifty-eight of boiling water, forty 
of benzole, thirty of ether, three of chloroform, and eight of alcohol. It 
is most abundant in the root, and, according to M. Lefort (27 Union, Medicale, 
Nov. 1871), in that of young plants. Cyanogen gas passed through its alco- 
holic solution makes a deep-red (Hinterbeyer). The most reliable test is 
the physiological one,-i.e., the production of mydriasis in a rabbit or a cat 
by the local application to the eye. It has been found in all the tissues of 
poisoned individuals, but always exists in greatest abundance, and is most 
easily demonstrated, in the urine.* 
Physiological Action.-When the smallest physiological dose of atropia 
is administered to man, the only symptom induced is dryness of the throat 
and mouth, and possibly some disorder of vision. When a little larger 
ATROPINA. U. S. 
* For a chemico-physiological study of tropin and other derivatives from atropia, see 
Archiv Exper. Pathol., Bd. v., 463. 
269 270 
SYSTEMIC REMEDIES. 
amount is given, this dryness is more intense, and is associated with redness 
of the fauces, dilated pupils, disordered vision, and possibly diplopia. The 
pulse is sometimes at first rendered less frequent, but this decrease is very 
transient, and certainly in many cases cannot be demonstrated at all. Often 
from the first, certainly after a short time in all cases, the heart's beats, after 
a large dose of the alkaloid, become excessively rapid, the pulse rising to one 
hundred and twenty, or even one hundred and sixty; and in a little while a 
peculiar bright-red flush appears on the face and neck, and may spread over 
the whole body. As I have seen this, it lacks the punctations of the rash of 
scarlet fever, and is only in very severe cases followed by desquamation. 
Early in the course of the symptoms of atropia-poisoning there is very 
often forcible expulsion of urine, and erections of the penis may occur; but 
afterwards there is very generally, Harley says always (Old Vegetable Neu- 
rotics, p. 207), retention of urine. With the symptoms above enumerated, 
intellection may remain perfect; but there are generally some lightness of 
head, giddiness, and confusion of thought, as well as a staggering gait and 
restlessness. Occasionally, even with doses which may be called medicinal, 
there are spectral illusions. Drowsiness is not a general or at all character- 
istic symptom: if present, it is apparently always produced indirectly, as 
by the removal of some cause of previous wakefulness. When a decidedly 
poisonous amount of belladonna or its alkaloid has been taken, all the symp- 
toms already noted are intensified, and to them is added a peculiar talkative, 
wakeful delirium, in which the patient lives in a world of his own, engrossed 
by the spectres and visions which throng him, and completely oblivious to the 
surrounding realities. Thus, I have seen a lady remain for a long time 
stooping and holding fast to the bed-post, to which she talked in the most 
voluble manner, as though it were an intelligent living entity. Sometimes this 
delirium is wild, and the patient almost uncontrollably violent. After a 
time, sleep may come on, and on waking from this complete consciousness 
may be regained, or the symptoms may gradually subside. After a very 
large dose has been taken, severe convulsions may appear in a very short 
time, and persist, with or without furious maniacal delirium, until near death. 
Sooner or later, however, the delirium subsides into stupor, and the convul- 
sions into paralysis; and when the dose has been enormous, and especially 
when the alkaloid itself has been taken, stupor, with great muscular relaxa- 
tion, may occur very early. Lividity of the face, and evident imperfect 
aeration of the blood, are not seen in atropia-poisoning, except in the stage 
of most imminent peril. Death is preceded by marked failure both of the 
heart's action and of the respiratory forces. In most cases, I think, it is 
actually brought about by asphyxia.* Post-mortem examinations have shown 
in fatal cases congestion of the lungs, often with ecchymoses, and a similar state 
* See a case reported by S. W. Gross, American Journal of the Medical Sciences, 1869. 
p. 401, as a striking instance. MYDRIATICS. 
271 
of the membranes and even substance of the brain and cord. According to 
M. Lemattre,* congestion of the retina is an almost characteristic lesion of 
atropia-poisoning. 
Upon the lower animals belladonna to a great extent acts as upon man, 
although its influence is much less powerful in them, and very much larger 
doses are required. Seeming differences of action are in most cases simply 
apparent, not real. Thus, in the dog, as in man, the pulse-rate is very 
greatly increased by atropia, whilst in the rabbit it is not. As will be shown 
hereafter, the rise of the pulse-rate in the former is largely due to paralysis of 
the par vagum. Now, atropia paralyzes the par vagum in the rabbit as much 
as in the dog, but in the rabbit pneumogastric paralysis, by section or other- 
wise, is never followed by a rise of the pulse-rate at all comparable to that 
seen under similar circumstances in the dog. Evidently the action of the 
drug is identical in the two cases, although the symptoms are different. In 
their sensitiveness to atropia animals differ very much, and, as a general rule, 
herbivora are less susceptible than carnivora. Thus, the rabbit may be fed 
for days entirely upon belladonna-leaves without injury, and many grains of 
atropia are necessary to kill him. Birds-at least pigeons-I have found 
will often recover after the hypodermic injection of two grains of atropia, 
and three grains by the mouth did not prove fatal. A very curious and at 
present inexplicable fact, which I have repeatedly verified, is that the pupils 
in pigeons cannot be dilated by the use of belladonna. 
The close study of the physiological action of atropia can only be made 
system by system, and I shall now consider the subject under such headings. 
Action on the Circulatory System f-In the dog and in the rabbit small 
doses of atropia cause an increased frequency of the pulse, with rise of the 
arterial pressure. If, however, larger amounts of the alkaloid are used, and 
especially if the poison is thrown immediately into the venous circulation, 
there is an immediate fall of the blood-pressure, although the pulse increases 
as before. Bezold and Bloebaum ( Ueber die physiolog ischen Wirkungen des 
Schwefel- Atr op ins, in Untersuch. aus d. Physiolog. Labor at or. in Wurzburg, 
Heft i.) state that the dose of atropia can be so graduated as to produce at 
first a temporary rise of the arterial pressure, followed in a short time by 
a fall. 
In atropinized animals, as is stated both by Bezold and Bloebaum (loc. cit., 
p. 33) and by Meuriot (De la Methode physiologique en Th^rapeutique et de 
ses Applications- a I'Etude de la Belladone, Paris, 18G8, p. 73), and as I 
* Quoted by Tardieu, Sur V Empoisonnemcnt, Paris, 1867, p. 752. 
f A long paper upon Calabar bean and atropia has been published by Rossbach and 
Frohlich ( Verhandlungen d. Wiirzburger Phyu. Med. Gesellschaft, 1873), in which results 
totally at variance with those of all other observers, and many of them as totally at vari- 
ance with general physiological laws, have been reached. Space cannot be spared for a 
criticism of this paper, and the reader is referred to the memoir itself abstracted {London 
Med. Rec., i.) and to the critique of Harnack {Archie Experim. Pathol. Therap., ii. 307). 
See also Pharniakolog. Unte such., Bd. i. Heft 3 and 4. 272 
SYSTEMIC REMEDIES. 
have frequently seen, section of the vagi is not followed by any increase of 
the heart's action, and galvanization of the nerve is incapable of influencing 
the viscus. It follows that atropia in toxic doses paralyzes either the trunk 
or peripheral filaments of the nerve, and, as Bezold and Bloebaum believe, 
most probably the latter. The observers just alluded to have found that if 
atropia be injected into the carotid so as to reach the pneumogastric centres 
before the periphery, there is an instantaneous fall in the rate of the heart's 
beat,-an indication that upon the cardiac inhibitory centres atropia acts as 
a direct stimulant, precisely as it does on the spinal cord, the reason that the 
action is not more manifest under ordinary circumstances being the incapacity 
of the paralyzed vagus to transmit the central impulse. This asserted stimu- 
lation* of the inhibitory centre, if it be correct, accounts very beautifully 
for the primary brief slowing of the pulse stated to occur in some cases of 
atropia-poisoning. (See Stille's Therapeutics, vol. i. p. 725. Mitchell, Keen, 
and Morehouse found it in about one-third of the cases after large hypodermic 
injections ; Da Costa in a larger proportion, Amer. Jour. Med. Sciences, 
July, 1865 ; Miss Mary Putnam in some cases, New York Medical Record. 
1873.) 
The reports as to the action upon the frog's heart are somewhat at variance, 
Bowditch and Luciani having noted an increase, Gnauck a lessening in the 
cardiac pulsations ( Verhand. Physiolog. Gesellsch. zu Berlin, 1881). H. 
Schapiro states that this variance is accounted for by the fact which he has 
discovered, that whereas at high temperature (15° C.) the pulsations are 
diminished, at low temperature (7° C.) they are increased. The frog's 
heart appears always to suffer final diastolic arrest, and cannot be re-excited 
by galvanic or other stimuli; and Bezold and Bloebaum Joe. cit., p. 48) 
have found that the same thing occurs when an overwhelming dose of the 
alkaloid is injected into the jugular vein of a mammal. When, by the 
division of the spinal cord and vagi, the heart is isolated from the nerve* 
centres and the vaso-motor nerves are paralyzed, Bezold and Bloebaum 
have found that atropia, in minute as well as in large amount, lessens at 
once the arterial pressure. From these facts it follows that upon the heart 
itself atropia acts as a direct depressant poison, but for this influence to be 
apparent a very large amount of the alkaloid must be used. 
From what has already been said, it is evident that the increase of the 
pulse seen in atropia-poisoning is in a measure due to paralysis of the car- 
diac inhibitory nerves; but that this is not the only cause is shown by the 
fact noticed by Lemattre (Archives Generales, August, 1865) and confirmed 
* The experiments and conclusions of Rossbach and Frohlich confirm the existence of 
this stimulating action of atropia on the inhibitory centres, but cannot be received as 
correct, for reasons already given. Harnack (Archiv fur Exper. Pathol, und Therapie, 
ii. 328) finds that the minutest dose of atropia increases the rapidity of the heart after 
stimulation of its inhibitory centres by muscarin and consequent slowing of its beat. 
This does not, however, prove that atropia has no action on the inhibitory centres. 
Further investigation is necessary for a positive conclusion. MYDRIATICS. 
273 
by my own experiments, that after section of the par vagum atropia still 
causes an increase in the rapidity of the heart's action. Further, Bezold 
and Bloebaum have found (loc. cit., p. 54) that when the thoracic sym- 
pathetic is galvanized, even after large doses of atropia, the heart is very 
sensibly affected. From these facts it is obvious that atropia acts on the 
cardiac accelerator nerve-centres, or possibly nerves, as a stimulant, and, 
unless it be in lethal doses, does not destroy the excitability of these nerves. 
The relation of belladonna to the vaso-motor nervous system is of such 
practical importance that it deserves the closest study. Brown-Sequard says 
positively that the drug has the power of exciting the muscular fibres of the 
arterioles; but, as he nowhere details the reasons for this opinion, I think 
little weight is to be attached to his statement. In 1857, Wharton Jones, 
of England (Medical Times and Gazette, p. 28, 1857), announced the fact 
(confirmed by Lemattre, loc. cit., p. 52) that if atropia be dropped upon 
the web of a frog's foot, under the microscope the vessels can be seen to 
contract. Dr. Hayden (Dublin Quarterly, Aug. 1863) in repeating these 
experiments found that, if the skin were cut just above the foot, no con 
traction occurred, and concluded that the phenomenon was purely reflex. 
Meuriot (loc. cit., p. 39) has obtained in some cases, but not invariably, the 
results of the last observer. He has, however, discovered that if the nerves 
of the leg be divided, no contraction ever takes place. Atropia is an irritant, 
and it is evident that the contraction caused by its local application is simply, 
as Hayden believed, a reflex phenomenon, precisely similar to that which 
occurs on the application of any chemical or mechanical irritant. The ex- 
periments of Wharton Jones, upon which so much has been based, must, 
therefore, be eliminated from the evidence on the question. The problem 
can be solved only by studying the effects of the remedy administered so as 
to act on the part solely through the circulation. Meuriot, as the result of 
such studies on the frog's web, has concluded that there is in the first stages 
of the poisoning a very slight contraction of the vessels, amounting to nothing 
more than increase of their tonicity; never to any decided lessening of their 
lumen. Dr. Harley (The Old Vegetable Neurotics, London, 1869, p. 220) 
has witnessed a more decided contraction of the vessels. I have tried the 
experiment several times, but obtained no decided results. On the other 
hand, Bezold and Bloebaum (loc. cit., p. 50) have made similar experiments 
upon the ear and mesentery of the rabbit, and have never been able to detect 
any contraction of the vessels, and consequently deny its existence. In these 
experiments it was not possible to use the microscope,-which detracts greatly 
from their value. 
The evidence derived from direct observation of the capillaries seems to 
me to be, on the whole, decidedly in favor of their contraction by minute 
doses of belladonna. I do not think, however, that much weight is to be 
attached to evidence of this nature. The alterations in the calibre of the 
vessels are so slight as to leave great play for the imagination of the observer, 
-a source of fallacy which probably accounts for the different results ob- 274 
SYSTEMIC REMEDIES. 
tained by different investigators. Much more decisive proof is, however, 
obtainable from a study of the arterial pressure. I have found that after 
section of the vagi atropia still has the power of raising very materially the 
arterial pressure. As atropia does not augment the force of the individual 
cardiac beat, and as the increase in the number of the cardiac pulsations 
caused by it after section of the vagi is comparatively slight, it is exceed- 
ingly probable that the rise of arterial pressure just spoken of is due to a 
contraction of the small vessels. This logical conclusion becomes almost a 
certainty when it is further known that after division of the cord, and con- 
sequent separation of the vessels from their vaso-motor centres, atropia is 
powerless to produce rise of arterial pressure, a fact vouched for by Bezold 
and Bloebaum, and which I can confirm from my own experiments (Amer. 
Jour. Med. Sci., April, 1873). To this cumulative evidence must be added 
the experimental fact noted by Bezold and Bloebaum, that when a small 
dose of atropia is injected into the carotid artery-i.e., into the vaso-motor 
centres-there is an instantaneous rise of blood-pressure.* 
Viewing all these facts together, I am forced to give assent to the propo 
sition that atropia, in not too large amount, is a stimulant to the vaso-motor 
centres; a conclusion in harmony with the action of the drug on all the other 
motor centres. All observers agree that in the advanced stage of atropia- 
poisoning, after the blood-pressure has commenced to fall, there is dilatation 
of the capillaries. It seems most probable that this is due to a direct action 
of the poison'on the muscular fibres in the coats of the vessels; for when 
directly applied to the web of the frog's foot, atropia, after a time, produces 
an evidently paralytic dilatation; and Bezold and Bloebaum have found that 
the arterial muscular coats in atropia-poisoning finally lose their irritability, 
but that so long as they retain it, galvanic stimulation of a sympathetic nerve 
does not fail to induce contraction in the tributary vessels. 
Action upon the Nervous System.-The delirium which is so characteristic 
of atropia-poisoning shows that it has especial relations with the cerebral 
cortex. Prof. Albertoni has made a series of experiments to determine 
whether it inhibits or affects the motor powers of the cortex. He finds that 
neither the single large dose nor the repeated continuous dose has any power 
in preventing the epileptic seizure resulting in dogs from the stimulation of 
the motor zone of the cortex: enormous toxic doses seem only to render 
the response slower and less vivid (Arch. Exper. Path, und Therap., xv. 
p. 265). 
In 1862, Dr. S. Botkin ( Virchows Archiv, Bd. xxiv. p. 85) found that 
when the vessels of a frog's leg were tied and the animal poisoned with 
atropia, whilst paralysis developed itself in the ordinary way in the un- 
injured leg, the injured leg preserved its motility. He also discovered that 
the nerve of the leg whose artery had been tied transmitted a forcible im- 
* It is proper to state that Bezold and Bloebaum attribute this rise to psychical dis- 
turbance, without, however, as it seems to me, good reason. MYDRIA TICS. 
275 
pulse to its tributary muscles under the stimulus of a galvanic current much 
weaker than could elicit the faintest response from the nerve of the opposite 
side. He concluded, very logically, that atropia acts as a paralyzant to the 
motor nerve-trunks themselves, and also, since motion persisted in the pro- 
tected leg after it was completely lost in its fellows, that this influence of the 
drug was exerted upon the motor trunks before the spinal centres. These 
experiments have been confirmed by Lemattre Joe. cit., p. 49), by Bezold 
and BloebJum Joe. cit., p. 20), by Meuriot Joe. cit., p. 90), and by Fraser 
and others, who have proven that atropia, if in sufficient dose, has the power 
of destroying the excitability of the efferent or motor nerve fibres, but that 
it must be in very large quantity, so that in mammals death may be caused 
by the alkaloid and yet a notable amount of functional power be retained by 
the motor nerves. Bezold and Bloebaum, whose elaborate experiments are 
especially commendable, affirm that very rarely have they been able totally 
to destroy by atropia the functional power of the motor nerves, and also 
have shown that both the nerve-stem and the peripheral intra-muscular 
nerve-endings are affected. All the experimenters agree that no stage of 
super-excitability preceding that of depression can be discovered. 
Prof. Thos. R. Fraser discovered in 18G9 (Trans. Roy. Soc. Edinb., xxv. 
450) that if a frog receive an injection of about one-thousandth part of its 
weight of atropia, a condition of perfect paralysis and abolition of reflex 
action comes on after a time, and lasts from two to four days, to be suc- 
ceeded by a tetanic stage, with violent convulsions and excessive excitability 
of the reflex centres. The convulsions of this stage have been shown by 
Fraser to be spinal, occurring after section of the cord in all parts of the 
body. Dr. Fraser found (Exp. 59, p. 481) that when he protected the hind 
legs by tying the aorta at its bifurcation, tetanus appeared in them at a time 
when the anterior legs were completely paralyzed and the brachial nerves 
were unable to respond to the galvanic stimulation. Again, he was able to 
produce symptoms closely analogous to those caused by atropia by injecting 
simultaneously two poisons,-one a stimulant to the cord, the other a para- 
lyzant of the nerve-trunks. These facts would seem to prove that during 
the paralytic stage of the action of atropia a convulsant condition of the 
cord is masked by a paralyzed state of the efferent nerves. This conclusion 
is, however, invalidated by certain facts observed by Fraser, ana especially 
by the recent researches of Ringer and Murrell. Thus, in some of Fraser's 
experiments the paralysis was at no time sufficient to mask a tetanus; in 
experiments of all three observers the tetanus did not develop at once in 
parts in which the nerve-trunks were protected by cutting off their blood- 
supply ; contrary to the observation of Fraser, in a number of experiments 
performed by Ringer and Murrell, after the aorta had been tied tetanus de- 
veloped no earlier in the protected than in the unprotected leg. In some of the 
experiments of Ringer and Murrell the paralyzant effect of the poison passed 
off-voluntary and reflex action returning-before the supervention of the 
tetanus. These facts seem to show that the paralysis as well as the tetanus 276 
SYSTEMIC REMEDIES. 
are due to an action upon the centres, the drug so acting upon the spinal 
cord as first to abolish and then intensify its reflex activity. The explana- 
tion of this singular action cannot at present be considered as established. 
Drs. Ringer and Murrell believe that both the paralysis and the tetanus are 
due to a depressant action. The theory is that the normal cord has a power 
of resisting impulses received from the periphery, and especially of preventing 
their wide propagation among the spinal centres. During the first stage of 
the atropia-poisoning it is supposed that the motor portions of the cord are so 
paralyzed as to be unable to form or propagate any motor impulse, and hence 
the general paralysis. Later on, however, the motor cells have so far re- 
covered themselves as to be able to generate impulses freely, although the 
resistive power of the cord is still in abeyance. Consequently a peripheral 
impulse plays, as it were, at will, up and down the spinal cord, and instead 
of giving rise to a simple reflex action, gives origin to a series of reflex 
movements, involving all the muscles, and constituting a tetanic convulsion. 
The experiments of Lemattre (Joe. cit.') indicate that belladonna exerts 
a similar paralyzant and convulsant action in mammals, and Dr. Fraser's 
investigation confirms this. It would seem, however, that in mammals the 
convulsant action comes on more rapidly, and is less protracted, and that the 
paralyzant action is also less intense, than in the frog; so that whilst the 
batrachian poisoned by atropia is in the beginning paralyzed and afterwards 
convulsed, the mammal suffers from convulsions and reflex spasms early in 
the poisoning, and often exhibits evidences all through of the excited reflex 
activity. The difference in the action of non-fatal doses of atropia upon 
the frog and upon the mammal is graphically expressed by the diagrams on 
the following page, which are copied from the paper of Dr. Fraser. 
Fig. 1 represents an experiment made upon a dog: in it the curve of 
paralysis, opt p2, leaves the line of normality, AB, before the curve of 
spinal stimulation, the first symptoms being those of paralysis. As the curve 
of op1 pa never reaches the line of complete paralysis, CD, the paralytic 
action is not sufficiently great, in the height of the poison, to prevent the 
manifestation of the considerable spinal stimulant action. 
Fig. 1. 
Fig. 2. 
Fig. 2 expresses the results of an experiment upon a frog: in it, although M YD RI A TICS. 
277 
there was some spinal stimulant action, as evinced by the curve s4, s8, sla, s16, 
and although the paralytic curve p4, pg, p12, p16, pw never reaches the line of 
complete paralysis, CD, yet it is manifest that the paralytic action of the 
drug throughout the experiment masks and covers up the convulsive influence. 
It is very certain that in man atropia exerts this double influence; for the 
records of poisoning cases are at once the records of convulsions and of 
paralysis. It would seem that early profound paralysis occurs when a 
very large dose of the poison has been taken in its concentrated alkaloidal 
condition, and consequently has been rapidly absorbed and suddenly pre- 
cipitated upon the nervous system. 
In the experiments of Botkin, made by tying the vessels of the frog's legs, 
as described on page 236, the investigator found that although for a time 
irritation of the foot of the perfectly paralyzed leg would cause spasms in the 
opposite limb whose nerve was protected, yet later in the poisoning, although 
irritation of the foot of the protected leg caused movements in that leg, no 
irritation of the opposite poisoned foot was able to induce any response what- 
ever on either side. From this he drew the inevitable conclusion that, whilst 
atropia paralyzes first the motor nerves, yet later it acts also on the afferent 
nerves. The very beautiful experiments of Dr. Fraser, already quoted, cer- 
tainly show that the afferent nerves enjoy a comparative immunity from the 
influence of atropia in large doses. For when one leg of a frog was pro- 
tected by tying the crural artery during the period of general paralysis, any 
irritation of the poisoned leg would produce immediate reflex convulsions in 
the unpoisoned extremity,-a demonstration that whilst the functions of the 
efferent or motor nerves were suspended wherever the poison reached, the 
afferent nerves retained more or less of their activity. This of course con- 
firms a portion of the experiments and conclusions of Botkin, and does not 
disprove that atropia acts to some extent upon the afferent nerves; for a very 
feeble impulse reaching the cord in its excited condition would cause reflex 
movements. Bezold and Bloebaum Joe. cit., p. 20) have investigated this 
subject by exposing the sciatic nerves of a strychnized frog, immersing them 
for a portion of their course, the one in a solution of atropia, the other in a 
solution of the phosphate of sodium, and then testing the effect of the applica- 
tion of stimuli in causing reflex movements. The result was not very satis- 
factory, so many sources of fallacy arising-sources not necessary here to 
point out-as to vitiate greatly the experiments. They certainly found, 
however, that the nerve-trunk preserved for some time its power of trans- 
mitting impulse even when immersed in a two-and-a-half per cent, solution 
of the alkaloid. Bezold and Bloebaum (p. 25) also repeated the experiments 
of Botkin, substantially confirming them, but showing that very large doses 
arc necessary to affect seriously the conducting powers of the afferent nerves. 
The following experiments of Meuriot (Joe. cit., p. 95) prove conclusively 
that atropia does influence the afferent nerves. He found that if a frog be 
bound tightly around the body so as to interrupt the circulation, and then 278 
SYSTEMIC REMEDIES. 
be poisoned by atropia in the front part of its body, at first irritations in any 
part give rise to general spasms, but after a time in order to get any move- 
ments of the hind legs it is necessary to apply an irritant to them. Again, 
the hinder parts of a frog were so bound by ligatures as to cut off on the one 
side all communication except by the nerves, and on the other to leave free 
the nerve and the vessels. A strong injection of atropia was then given, 
and when the moment came that irritation of the periphery of the leg whose 
circulation was free would no longer cause reflex spasms, the artery of this 
leg also was tied, so that both legs, the one atropinized, the other not, were 
now connected with the body of the frog only by their nerves. Strychnia 
was given hypodermically, and it was found that, whilst irritation of the 
atropinized leg had no effect, stimulation of the non-atropinized leg gave rise 
to general convulsions. The whole present evidence shows that atropia 
depresses the afferent nerves, but much more feebly than it does the efferent 
nerves. Miss Mary Putnam (TV. K Med. Rec., 1873) asserts that if the 
general tissue of the frog's limb be tied, the vessels and nerves being left 
intact, so as to prevent diffusion of the poison through the cellular tissue, 
the sensitive nerves are alone affected by atropia. As no details of experi- 
ments are given, the matter rests simply upon the assertion of Miss Putnam. 
It is very difficult to imagine why a nerve should be affected differently by 
a poison when reaching it by different routes, and equally difficult to con- 
ceive how the poison should reach more effectively the motor than the sen- 
sitive nerves by diffusion. Further, it is also almost as unreasonable to 
believe that any perceptible diffusion through the cellular tissue should occur 
when the seat of injection is in a distant part of the body. Taking together 
the facts that Miss Putnam's assertion is unsupported by detailed experi- 
ments, is exceedingly improbable, and is seemingly opposed to an enormous 
mass of experimentation by some of the most experienced and able inves- 
tigators who have ever lived, it seems to me that it cannot be accepted. It 
is probable that atropia acts upon the peripheral filaments of the nerves more 
quickly than upon the main trunks; this is corroborated by Miss Putnam, who 
states that she has seen galvanization of a sciatic nerve cause indications of 
pain in an atropinized animal when the peripheral sensation was already lost. 
There can be no doubt that in the higher animals atropia acts upon the 
cerebrum as it does in man, producing the same peculiar delirious intoxication 
often ending in stupor. It is not necessary to discuss this matter further, 
except to remark that belladonna is not a hypnotic. The fact that the 
exhibition of a remedy is followed by sleep in disease is no proof that the 
remedy is in a proper sense a hypnotic. No one would give oyster soup such 
a cognomen, yet in certain exhausted wakeful states of the system such food 
may bring back sound sleep. If belladonna ever acts as a hypnotic, it is in 
this indirect way, by removing some cause of abnormal wakefulness. It can 
never be relied on, like opium, to induce sleep. 
Action on the Voluntary Muscles.-The voluntary muscles escape un MYDRIATICS. 
279 
scathed in atropia-poisoning. It is true that Lemattre has shown that the 
contractility of a striated muscle may be destroyed by soaking it in a very 
concentrated solution of the alkaloid; but long before any such action can 
take place in life the animal is killed; consequently after death from bella- 
donna the contractility of the voluntary muscles is found unimpaired. 
Action on the Abdominal Canal.-On the non-striated muscles the action 
of the drug is pronounced, but its exact nature is uncertain. Meuriot states 
(foe. cit., p. 112) that if the belly of an animal poisoned by atropia be opened, 
the intestines will be found undergoing violent contractions, and that bella- 
donna is a powerful excitant of the non-striated muscles. On the other hand, 
Bezold and Bloebaum affirm that they have experimented upon the intestines, 
bladder, uterus, and ureters, and that in all cases there is a state of marked 
sedation from atropia, and that, whether a small or a large dose be used (foe. 
cit., p. G5), there are produced muscular quietness and relaxation in all these 
organs,-evidences of sedation not preceded by any stage of excitement, and 
always accompanied by lessening of the electro-muscular sensibility. They 
state, further, that by the use of sufficient doses absolute muscular paralysis 
of the organs alluded to is induced, so that the strongest faradaic currents 
are unable to cause any motion. P. Keuchel (Das Atropin und der Hem- 
mungsnerven, Inaug. Diss., Dorpat, 1868) has made a most elaborate series 
of experiments to determine the effect of atropia upon the inhibitory fibres 
of the splanchnic nerve. It has been shown by Pfliiger that galvanization 
of the peripheral ends of the divided splanchnics causes immediate arrest of 
the peristaltic intestinal movements, and, although the subject has not been 
absolutely worked out, it is almost certain that some of the splanchnic fibres 
are the inhibitory nerves of the intestinal coats. Keuchel has found that 
even when doses of atropia so small as not to affect distinctly the motor 
nerves are given, galvanization of the splanchnics fails to influence the intes- 
tines, whose vermicular movements are still active, and therefore that atro- 
pia paralyzes the peripheral inhibitory intestinal apparatus precisely as it does 
that of the heart. There is, of course, a seeming disagreement between 
these researches and those of Meuriot and of Bezold and Bloebaum ; and 
the apparent confusion is increased by the assertions of Dr. I. Ott (New 
York Med. Journal, 1883, 170), that minute doses of atropia prevent 
the production of peristalsis by salt placed upon the intestine, whilst large 
doses exaggerate the action of the salt. It would appear from this that 
atropia first stimulates, then paralyzes the intestinal inhibitory nervous sys- 
tem. Before the question can be settled further researches are necessary, 
but it is possible that all these observers saw and reported correctly, the dif- 
ferences being the result of varying doses. It appears certain that, in full 
doses, atropia paralyzes the smooth muscular fibres of the intestine, bladder, 
etc., and it may be that in any dose it depresses their activity directly, but 
that, by paralyzing more quickly the inhibitory apparatus, it sometimes 
places the intestinal muscular coat in such a position that it will respond 280 
SYSTEMIC REMEDIES. 
more vigorously than normal to external stimuli, and also that very minute 
doses may cause quiet by producing inhibitory stimulation. This view is 
borne out by the fact that the smallest dose used by Keuchel was 0.075 gr.; 
by Ott, 0.015 gr., both observers experimenting on the rabbit. When Ott 
used 0.45 gr., he got the same result as did Keuchel. 
Action on the Respiratory System.-It has already been stated that in 
man small doses of atropia do not affect the respiration, whereas large doses 
accelerate it. The same is true in animals; and the acceleration takes place 
even when the vagi have been previously divided,-a proof that it is due to 
a direct stimulation of the respiratory centres in the medulla. (Bezold and 
Bloebaum, loc. cit., p. 59.) When very large fatal doses are administered, 
there is evidently also a paralysis of that portion of the peripheral pneumo- 
gastric nerve which is connected with the function of respiration; for if in 
an animal suffering only from a moderate dose the par vagum be cut, respi- 
ration is profoundly affected, but when the alkaloid has been more freely 
given, no marked influence is exerted upon the expiratory rhythm by section 
of the pneumogastrics. As death approaches in belladonna-poisoning, the 
blood, which has preserved its normal coloration, may become very dark, and 
the patient may at last die of asphyxia,-probably not entirely from failure 
of the centres themselves, but also, in part, from the loss of functional power 
in the respiratory nerves. 
Action on the Glandular System.-One of the earliest and most notable 
effects of medicinal doses of atropia is dryness of the mouth, due to sup- 
pression of the secretions of the mucous and salivary glands. The action 
of the alkaloid upon the skin is similar. It can scarcely be doubted that 
this arrest of secretion is nervous; and the experiments of Keuchel indicate 
that it is due to an action upon the peripheral nerve-filaments. As was first 
discovered by Schiff,* section of the chorda tympani is followed by arrest 
of secretion of the submaxillary gland, and galvanization of the peripheral 
end produces a greatly increased flow of saliva. In Keuchel's experiments 
these phenomena occurred in the unpoisoned animal, but when atropia had 
been exhibited, galvanization of the peripheral chorda tympani was power- 
less to excite secretion,-proof that the peripheral end of the nerve was 
paralyzed. 
Elimination.-When atropia is exhibited medicinally it probably all es- 
capes from the body through the urine; and even after poisonous doses the 
amount eliminated through other channels must be almost infinitely small. 
Action on Secretion.-After small doses of atropia the urine is increased. 
-sometimes, according to Harley, doubled. I am confident, however, that 
this increase varies very much, and is not always marked. After very large 
toxic doses the urine may be at first increased, but is usually lessened very 
* See Physiology of Man-Nervous System, by Prof. A. Flint, Jr., New York, 1373, 
p. 158. MYDRIATICS. 
281 
early, and in the later stages may be entirely suppressed.* Meuriot states 
that the secretion of urine rises and falls in atropia-poisoning with the arte- 
rial pressure. The experiments of Harley upon men (Joe. cit., p. 214) would 
appear to show that medicinal doses of atropia decidedly increase the solids 
of the urine, slightly the urea and uric acid, very markedly the phosphates 
and the sulphates. 
In regard to the secretions of the alimentary canal, the action of atropia is 
very uncertain. It has been a matter of traditional and clinical belief that 
they were increased, and Harley gives some experiments which he claims 
corroborate this; Meuriot, on the other hand, states that they are lessened. 
I cannot find, however, any experiments that seem to me at all decisive; and 
clinical evidence certainly indicates that the alimentary secretions, if affected 
at all, are increased. 
Action on Temperature.-In moderate doses atropia causes a pronounced 
rise in temperature, but in very large decidedly toxic amounts it lessens ani- 
mal heat. Thus, in the dog, Meuriot has obtained an augmentation of from 
1° to 3° C., and Dumeril, Demarquay, and Lecomtef of 4° C. In fatal 
poisoning of the same animal, these observers have noticed a fall respectively 
of 5^° and of 3°.f In man, Meuriot, in the use of medicinal doses, has 
observed the temperature to rise i° to ly^0, and Eulenburgf |° to yg-0-! 
Harley has seen in man an elevation of 1° F. As pointed out by Meuriot, 
the rise and fall of temperature probably correspond to the rise and fall of 
the blood-pressure. 
Summary.-From what has been already stated, it is evident that the 
action of atropia in therapeutic and in toxic doses is in a sense quite dif- 
ferent. 
In full medicinal doses it produces a sort of febrile state, with dryness of 
the mouth, increased rapidity and force of the circulation, quickened respi- 
ration, elevation of temperature, and secretion of febrile urine. The rapidity 
of the heart's action is due to paralysis of the peripheral inhibitory nerve 
and to stimulation of the accelerator nerves; the increased arterial pressure, 
to the increased cardiac action, together with the general contraction of the 
capillaries, the result of excitation of the vaso-motor centres. The spinal 
cord is not sensibly affected by these doses; the motor, and probably to a 
much less degree the sensory peripheral nerves, suffer lessening of functional 
activity, although the influence of therapeutic doses of atropia upon them 
must be very slight. If the dose be sufficiently large, the cerebrum is thrown 
into a condition of mild delirium, resembling also that of fever. 
After decidedly toxic doses of atropia, the blood-pressure falls, from dilata- 
tion of the capillaries, owing to the paralysis of their muscular coats, and from 
* See poison-case reported by Dr. Gross (loc. cit.), also cases of Dr. Morer (Annalee de 
la Sociiti de Midecine de Gand, 1873). 
f Quoted by Meuriot, p. 111. 
J These figures are probably all of them Centigrade, though it is not stated by Meuriot. 282 
SYSTEMIC REMEDIES. 
direct laming of the heart-muscle. The temperature also falls ; the muscular 
system is relaxed, and sensation is impaired, from the paresis of the motor 
and sensory nerves respectively; yet convulsions may now occur from the 
over-activity of the reflex centres, the predominance of paralysis or of con- 
vulsions varying with the dose, as the depressing or stimulating influence is 
the more powerful. Delirium precedes stupor, which in turn precedes death, 
from asphyxia, caused by failing trunkal nerve-functions, or very rarely from 
syncope, caused by failure of the cardiac muscle. 
Local Action.-It is evident that when belladonna is applied to a part it 
must act locally as a paralyzant, no doubt overpowering the capillary walls, 
the sensitive and motor nerves, and even muscular and glandular cell-action; 
for, except in the case of the latter, experimental evidence has already been 
brought forward to prove that, locally and freely applied, belladonna is a 
sedative poison, and clinical evidence points very strongly to its exerting 
a similar influence upon gland-cells. A. Zeller ( Virchows Arch., Ixvi.. p. 
384) has found that a one per cent, solution of atropia brought in contact 
with the blood, outside of the body, has a decided influence in arresting the 
movements of the corpuscles. 
Action on the Eye.-Atropia placed in the eye, or given internally, dilates 
the pupil of all animals except birds. Accompanying this mydriasis are 
paralysis of accommodation and a lessened intraocular pressure. In regard 
to the latter, the subject is so intricate that I must refer the reader to the 
treatises of specialists.* 
Before discussing briefly the action of atropia upon the pupil, the fact that 
a recent American female writer has reasserted the old theory that the move 
ments of the iris are due to erectile tissue, or, in other words, to its blood- 
vessels, seems to render necessary a few words as to the real motile power of 
the part. In the first place, it is an indisputable anatomical fact that the 
iris is largely composed of muscular fibres, and it is a simple common-sense 
deduction that the muscular fibres are there for the purpose of causing mo- 
tion, especially since, in many animals, it can be readily demonstrated that 
whilst some of these fibres are circular, others are radiating, so that by posi- 
tion they become antagonistic. The paper of Dr. Arlt (^Archiv fur Oph- 
thalrnologie, 1869) seems to me very decisive. In a very elaborate series of 
experiments it was found that when the upper cervical ganglion was stimulated 
the pupil dilated long before any influence upon the vessels was detected, 
and that on cessation of the stimulation the pupil became natural long before 
the spasm of the vessels yielded; to my mind a proof that the ganglion has 
fibres other than vaso-motor,-fibres which control the muscular actions of the 
iris, and are more sensitive than the vaso-motor filaments; and, secondarily, a 
proof that the movements of the iris are not due to movements of the blood- 
* See especially Der intraoculare Druck und die Innervations- Verhaltnisse der Iris. Von 
Pi of. Dr. Stelhvag von Carion. Wien, 1868. MYDRIATICS. 
283 
vessels. Space cannot be afforded in the present work for a further discus- 
sion of this subject. The reader is respectfully referred for further informa- 
tion to books on the physiology of the eye, and especially to Engelhardt's 
paper, Beitrage zur Lehre von den Bewegungen der Iris (Untersuchungen 
aus dem physiolog. Laboratorium in Wurzburg, zweiter Theil.) 
In considering the action of belladonna upon the eye, it is necessary to 
view separately its influence when applied locally and when given internally; 
and I shall consider these in the order in which they here stand. 
It may be first asserted that the dilatation induced by the local application 
of belladonna or of its principles is a nervous phenomenon, and not due to a 
direct action of the drug upon the muscular fibres of the iris ; for as all of 
these, both the radiating and the circular, are of the same nature (non- 
striated in mammals), their antagonism is simply due to position ; and it 
seems inconceivable that mere position should affect the relations between a 
muscle and a drug. Moreover, decisive proof is afforded by the experiments 
of Bernstein and Dogiel, who found that whilst galvanic irritation of the 
oculo-motor nerve was unable to cause contraction of the pupil in the atro- 
pinized eye, yet when the electrodes were applied to the eyes in such a way 
as to affect directly the iris, contraction occurred,-phenomena only explain- 
able by the theory that the nerve-endings were paralyzed, whilst the muscle 
was unaffected. Of the truth of this observation there can be no doubt, as 
it has been confirmed by Dr. G. Engelhardt ( Untersuch. aus dem physiolog. 
Laborat. in Wurzburg, Theil ii. p. 321). 
The statement first made by Wharton Jones (Medical Times and Gazette, 
1857), that the reason atropia does not dilate the pupils of birds is that their 
irides have no radiating fibres, has been disproven by the beautiful anatomical 
researches of Alex. Ivanoff and Alex. Rollett (Archiv fur Ophthalmologic, 
vol. xv. p. 1), confirmed by Johannes Diegel (Max Schultze's Archiv fur 
Microscop. Anat., Bd. vi. Heft i., 1870). Although Prof. Donders (The 
Accommodation and Refraction of the Eye, Syd. Soc. ed., p. 584) says that 
the pupillary action of atropia " is slight in birds, in whom it was formerly 
overlooked," in my own experiments the most thorough application of very 
strong solutions to the eyes of pigeons has had no distinct effect. In pre- 
vious editions of this book I ventured the surmise that the lack of action 
of atropia upon the irides of birds might be due to the muscle being of the 
striated type. According to the experiments of Szpilman and Luchsinger, 
this supposition is correct. In the oesophagus of the bird the muscle is non- 
striated, and atropia paralyzes it; in the oesophagus of the rabbit the muscle 
is striated, and atropia has no action ; in the cat a portion of the oesophagus 
has smooth muscular fibres, a part striated, and the former is paralyzed, the 
latter unaffected, by the alkaloid (Arch. f. d. Ges. Physiol., xxvi. 460). 
The dilatation of the pupil by the local application of atropia* is certainly 
* Contraction of the pupil before dilatation noticed in dogs (Reese) and rabbits (Ross- 
bach and Frohlich), is probably caused reflexly by irritant action of the atropia. 284 
SYSTEMIC REMEDIES. 
independent of any nerve-centres farther back than the ciliary ganglion. 
This is proven by the following facts : Claude Bernard (Physiologic et Patho- 
logic du Sy st erne Nerveux, Paris, vol. ii. p. 212) and Lemattre (loc. cit.') both 
have found that atropia-mydriasis occurs in animals after section of the oculo- 
motor, and I have seen it in cases of complete oculo-motor paralysis in man. 
It also takes place after section of the trigeminus or of the cervical sympa- 
thetic, or of both of these nerves, as is shown by the testimony of numerous 
observers and by my own experiments. In man, I have seen it after paral- 
ysis of the sympathetic (Philadelphia Med. Times, vol. i. p. 290). Not only 
is the dilatation of the pupil by the local application of atropia independent 
of the central nervous system, but also of the ciliary ganglion, and it is there- 
fore due to an action exerted directly upon the nerve-endings in the iris. 
The experiments of Bernstein and Dogiel, confirmed by Engelhardt, already 
quoted, are in themselves almost enough to establish the truth of this propo- 
sition. More direct evidence is not, however, wanting. Thus, Vieiordt* has 
found that atropia locally applied still causes mydriasis after the removal of 
the ciliary ganglion. Prof. I. Hoppe (Die Nervenwirkungen der Heilmittel, 
Leipsic, 1856, zweiter Heft, p. 179) has discovered, and Y. Valentin (Ver- 
such einer physiologischen Pathologie der Nerven, Leipsic, 1864, zweite Ab- 
theilung, p. 368) has confirmed, that in the eye of the frog removed from 
the body atropia will produce dilatation of the pupil. According to Borelli 
(Edinburgh Medical Journal, Nov. 1871), mydriasis is produced by the 
alkaloid when applied to the eye of a man just dead. Lastly, the presence 
of the alkaloid in the humors of the atropinized eye has been proven by 
numerous observers, among whom may be mentioned Lemattre (loc. cit., 
p. 55) and Prof. Bonders (The Accommodation and Refraction of the Eye, 
Syd. Soc. ed., p. 588), who have found that the liquids removed from such 
an eye are capable of causing dilatation of the pupil of another eye. 
It having been demonstrated that the mydriasis of the atropinized eye rs 
the result of an action upon the peripheral nerve-fibres, the question arises, 
Are the ends of the oculo-motor, the contractor of the pupil, paralyzed, or are 
the ends of the sympathetic, the dilator, stimulated, or is there a double influ- 
ence, both of these actions occurring? Both Bonders (loc. cit., p. 589)f and 
Stellwag von Carion (loc. cit., p. 92) insist that the paralysis of accommodation 
is proof of paralysis of the oculo-motor nerve, and it seems to me they do so 
with truth. However this may be, there is abundant direct proof that the 
oculo-motor fibres are paralyzed, since the experiment of Griinhagen, show- 
ing that galvanization of the exposed oculo-motor nerve does not affect the 
atropinized pupil, confirmed by Engelhardt (loc. cit., p. 321), and by Ross- 
bach and Frohlich (Pharmak. Untersuchungen, Wurzburg, i., p. 6). 
* Unfortunately, the only notice I have seen of this capital experiment is in Hermann's 
" Grundriss der Physiologic." No reference is given, and I have been unable to find the 
original paper. 
f See also Von Graefe, Deutsches Klinik, 1861. MYDRIATICS. 
285 
In artificial mydriasis there is, then, undoubtedly peripheral palsy of the 
ovulo-motor. The question arises, Is there also stimulation of the dilating 
nerve ? The evidence as to this is not so positive, but to my mind indicates 
very strongly that there is such an action. Clinical experience certainly 
shows that the dilatation produced by a mydriatic is not merely a passive 
movement of relaxation, but is active, capable of tearing up inflammatory 
adhesions even when of some firmness. Again, the dilatation that occurs 
after the paralysis of the oculo-motor nerve in man and after its destruction 
in animals is not at all equal to that produced by atropia, and, indeed, can be 
largely increased by the action of the drug; further, in the eye separated 
entirely from the nerve-centres (see above) atropia still causes a wide dilata- 
tion ; facts which necessitate the belief either that the alkaloid acts upon tha 
sympathetic fibrillae, or that the peripheral fibres of a nerve are in them- 
selves nerve-centres, acting upon the muscle of themselves even when sepa- 
rated from their centres. 
It has been urged against the view here taken that even the widest arti- 
ficial mydriasis is increased by galvanization of the sympathetic. De Ruiter 
states the contrary; but, since Griinhagen, Hirschmann, and Engelhardt 
separately affirm as the result of personal experiment the correctness of the 
asserted fact, it must be accepted. Granting its truth, I do not think it war- 
rants the deduction, since it is very conceivable that an agent may excite the 
peripheral filaments of a nerve very greatly, and yet not to that point that 
they are incapable of further excitation. 
In conclusion, the action of atropia applied to the eye may be summed 
up as follows: the mydriasis is the result of a direct influence upon the 
peripheral nerve-fibres, those of the oculo-motor being certainly paralyzed, 
those of the sympathetic and its ally the trigeminus being probably excited. 
In regard to the constitutional action of atropia, it is evident that when 
the alkaloid is administered internally there are only four possible ways in 
which it can cause mydriasis, and that these are as follows: 1. By acting 
alone on the sympathetic centres, as a stimulant. 2. By acting alone on the 
oculo-motor centres, as a paralyzant. 3. By combining these actions. 4. 
By being carried to the eye, and acting as though locally applied. 
Authors are greatly at variance in their conclusions: thus, Harley ( The 
Old Vegetable Neurotics') and Hayden (Dublin Quarterly Journal, August, 
1863) may be cited as in favor of the first view, and Budge (Ueber die Be- 
wegung der Iris, 1855), Braun (Archiv fur Ophthalmologic, Bd. v. Abth. 
ii.), and Hirschmann (Zur Lehre von d. durch Arzneimittel, etc., Reichert's 
Archiv, 1863) as favoring the second. Neither the first nor the second 
view is, however, tenable: the first, because of a fact which has been asserted 
by authorities and which I have experimentally corroborated, namely, that 
atropia given hypodermically causes dilatation of the pupil after section both 
of the trigeminus and of the sympathetic in the neck; the second, for the 
reason that after section of the oculo-motor in animals, or after complete 286 
SYSTEMIC REMEDIES. 
paralysis of the oculo-motor in man, the mydriasis is much less than that of 
atropia-poisoning. 
In regard to the third view, I have noticed that the dilatation of the pupil 
under the constitutional action of the alkaloid after section of the cervical 
sympathetic is still greater than that which is normally produced by oculo- 
motor paralysis. At my solicitation, Dr. T. G. Morton, of this city, cut 
down to the optic nerve in a rabbit and divided all the structures about it. 
The pupil contracted very much at the time; the cornea was not sensitive, 
but recovered its sensitiveness in part after some days. Atropia given hypo- 
dermically dilated the eye very markedly, but not nearly to the extent of 
the other eye. If in this experiment all the ciliary nerves were really cut, 
the proof is conclusive that the mydriasis is not of centric origin ; the reason 
that the pupil did not dilate so freely as the other being the strong contract- 
ing influence it was under, and the great reduction in the amount of blood, 
i.e., the amount of atropia, entering the eye, owing to the division of the 
blood-vessels. 
An experiment of Lcmattre, if it be accurate, is also conclusive in proving 
that the action of the mydriatics upon the pupil, even when administered 
internally, is a peripheral one. He succeeded in producing mydriasis in 
normal eyes by placing in them aqueous humors taken from dogs poisoned 
with atropia, and even from a foetus whose dam had been killed by the 
alkaloid. Bonders, however (foe. cit., p. 589), failed to get the dilatation ; 
and two or three experiments have yielded me the same negative result. It 
requires no elaborate argument to prove that in this case a negative result 
does not overpower a previous positive one: still, the experiments of Le- 
mattre need confirmation. In the Pennsylvania Hospital, under the care of 
Dr. Morton, not long since I saw a man who had been wounded by a rail- 
road accident in such a way that the whole of the temporal bone anterior to 
the petrous portion was thrust into the side of the head; there was complete 
paralysis of the facial, of the trigeminus, and of the oculo-motor, as could 
be readily demonstrated upon the man, who lived some months, finally dying 
suddenly of abscess of the brain. The carotid canal was so pressed upon 
that the sympathetic, which passed upwards through it to the eye, must have 
also been paralyzed. The eye was, as proven by the autopsy, separated from 
all connection with the nerve-centres, and yet when atropia was given hypo- 
dermically the pupil dilated. The proof seemed complete that the mydriasis 
was owing to a peripheral action. 
Our knowledge of the action of atropia upon the pupil may be summed 
up as follows: Atropia applied locally causes mydriasis by paralyzing the 
peripheral ends of the oculo-motor nerve, and probably by stimulating the 
peripheral ends of the sympathetic. Atropia given internally almost cer- 
tainly causes mydriasis, not by influencing the nerve-centres, but by being 
carried in the blood to the eye itself, and there acting precisely as when 
applied locally. MYDRIATICS. 
287 
Therapeutics.-The results of clinical experience are in strict accord 
with what is known of the physiological action of belladonna. The chief 
indication for its use is to relax spasm. In the case of voluntary muscles its 
powers are comparatively feeble, except when it is thrown directly into the 
muscle affected. In this manner Dr. S. Weir Mitchell (Injuries of Nerves, 
Philadelphia, 1872, p. 258) has obtained very marked relief in the fearful 
spasms following nerve-wounds, and Dr. J. M. Da Costa in rheumatic spasm 
(Pennsylvania Hospital Reports, 18G8). The benefit derived in this way 
is evidently due to the depressing effect of the drug upon the terminal nerve- 
filaments, with which it eomes in direct contact, and to a certain extent also 
on the muscle itself. When given by the mouth, so small an amount of the 
remedy reaches the diseased part as scarcely to affect it, and very little or no 
relief follows. As has been previously shown, the non-striated muscles are 
more affected than the striated by belladonna, and clinically the drug is found 
to be even more efficacious in spasm of the involuntary than of the voluntary 
muscles: in such cases it is often of value used internally. It must be thus 
administered in lead colic,-in simple spasmodic colic,-in spasmodic dys- 
menorrhoea,-in spasmodic constriction of the bowels with obstinate con- 
stipation,-in laryngismus stridulus,-in nervous cough,-in asthma,-in 
hiccough,-in whooping-cough,-in which, as originally advised by Breton- 
neau, it has been largely used, and is one of the best known remedies; also, 
even in the spasms accompanying passage of renal and biliary calculi, where 
of course it often fails. Wherever it is possible, however, it should be used 
locally in spasm of the involuntary as well as of the voluntary muscles. 
Thus, in spasm of the urethra, the ointment should be rubbed in along the 
canal; in rigid os uteri, the extract should be applied directly to the os; in 
asthma, belladonna should be inhaled, either by means of the cigarette or 
of the atomization of a decoction of the leaves; in spasm of the sphincter 
ani from fissure or other cause, it should be applied directly to the part by 
poultice or ointment. 
It is, no doubt, by relaxing spasm, or rather by lessening irritability, that 
belladonna acts in that form of incontinence of urine which is seen generally 
in children. It has been taught that this affection is due to a relaxation of 
the sphincter, but undoubtedly in the great majority of cases its real cause 
is an irritability of the bladder itself, so that spasmodic contraction occurs 
under the stimulus of a small portion of urine. A common result of the 
ingestion of a large dose of belladonna is a paralytic retention of urine, due 
no doubt to the local action of the atropia in the urine upon the bladder. It 
is needless to point out more in detail how the indications in incontinence 
are met. In these cases the drug must be given in as large doses as the 
system will bear, and the impression should be maintained for weeks 
Usually the dose has to be steadily increased. Under the present indication 
also probably belongs the use of the remedy in constipation. In doses of 
one-quarter to one-half grain of the extract, added to a laxative pill, belladonna 288 
SYSTEMIC REMEDIES. 
is of great service, and sometimes used alone will cure chronic constipation. 
It appears to be of most value in subjects of rigid tone; in feeble, relaxed 
people, strychnia is preferable. 
To relieve Pain.-Physiologically viewed, atropia should be of little value 
for this purpose; and I think clinical evidence bears this out. Dr. Mitchell 
has had probably the best opportunities ever afforded for testing this, and he 
says decidedly that it is of little use in severe suffering. My own experience 
is to the same effect. There is, however, considerable evidence of its value 
in neuralgia, but it is chiefly as to its efficiency when injected immediately 
in the neighborhood of a painful nerve, or applied as inunction over its 
course when superficial. In large quantity, belladonna certainly affects the 
afferent nerves, and, used as above, may readily relieve pain. It is very 
probable also that at times it cures neuralgia by modifying the circulation in 
the affected part. Though these things be so, yet belladonna is almost im- 
measurably below opium as an analgesic. In some forms of neuralgia with 
spasm it is of service by a double action. 
To impress the Heart and Blood- Vessels.-Under the idea of its contract- 
ing the blood-vessels, belladonna has been highly commended by Dr. Harley 
(loc. cit.') in pneumonia, acute nephritis, and various other acute diseases. I 
have had no experience with it in these affections, but the published accounts 
do not seem to me to indicate that it is of equal value with other remedies 
or combinations of remedies. In chronic albuminous nephritis I have tried 
it, as recommended by Dr. Harley (loc. cit.'), but have failed to derive any 
advantage from it. In ordinary sore throat, it does good by acting upon 
the blood-vessels, and by relaxing the pharyngeal muscles. It may possibly 
be of use given before the administration of chloroform, to prevent cardiac 
inhibitory arrest. (See Brit. Med., 1880, ii. 620.) 
As a stimulant to the circulation, belladonna has probably not been em- 
ployed as much as it ought. Dr. Graves, however, commends it especially 
when the pupil is contracted in typhus fever, and it has been used with 
asserted advantage in erysipelas, scarlet fever, etc. I think this use of 
belladonna offers a very inviting field for therapeutic investigation. 
To arrest Secretion.-Arresting secretion of the salivary glands by para- 
lyzing the extreme branches of the chorda tympani has already been shown 
to be a physiological action of belladonna, and it follows from this that the 
drug should be useful in ptyalism. I have tried it in several cases of mer- 
curial salivation, and found that it arrests almost at once the discharge of 
saliva, and seemingly facilitates greatly the return to health. In colliquative 
sweats it was originally recommended by Prof. Da Costa (Phila. Med. Times, 
Feb. 15,1871), and I have found it of very great service. A full dose of 
belladonna extract, or one-sixtieth to one-eightieth of a grain of atropia used 
hypodermically, at bedtime, will very frequently prevent the usual night- 
sweat. In colliquative diarrhoea it has been recommended by M. Delpage, 
and very probably will be found of service. M YD RI A TICS. 
289 
Inunctions of the breasts with belladonna ointment are habitually em- 
ployed for the purpose of arresting the secretion of milk, and in the ex- 
periments of Hammerbacher upon a goat atropia given internally lessened 
the secretion, especially of the watery portions of the milk (Arch. f. Ge- 
sammt. Physiolog., xxxiii. 228). 
Employment in Poisoning.-It is stated that as far back as 1570 it was 
asserted that opium and belladonna are, in their influence upon the system, 
antagonistic. In the early part of the present century their employment as 
counter-poisons was again brought prominently before the profession ; but, 
although a few scattered earlier records of their use as such exist in medical 
literature, it was not until the paper of Dr. Wm. F. Norris appeared (Amer- 
ican Journal of the Medical Sciences, Oct. 1862) that general attention was 
attracted to the subject. Since this publication, very many cases of the use 
of the one medicine in poisoning by the other have been published. The 
opposite actions of belladonna and of opium upon the pupils no doubt first 
suggested the idea of their antagonism; but in the light of recent experi- 
ments these apparently opposite effects upon the eye cannot be considered as 
proving any antagonism between the drugs, since it is almost certain that the 
dilatation is due to a peripheric and the contraction to a centric influence. 
In an investigation by Dr. J. Hughes Bennett (Brit. Med. Journ., 1874,547), 
twenty-one rabbits received what previous experimentation had shown to be 
a fatal dose of meconate of morphia (10 grains), and afterwards sulphate of 
atropia; six recovered; and of these six, four some weeks afterwards were killed 
by a dose of 10 grains of the morphia salt. Eleven rabbits received a dose 
of sulphate of atropia (If to 2 grains), and afterwards 10 grains of the 
meconate of morphia; seven recovered, and some weeks afterwards the 
meconate of morphia (10 grains) being given, four of them succumbed to 
it. Again, two dogs received the fatal dose of meconate of morphia (2f 
grains), and afterwards sulphate of atropia, and recovered, only to die some 
days afterwards from the effects of a second two-and-a-quarter grain dose 
of the opium salt. These experiments certainly warrant the conclusion of 
Dr. Bennett that atropia is physiologically antagonistic to morphia within a 
limited area, and that it exerts in dogs and rabbits a beneficial influence in 
opium-poisoning. Dr. Corona has experimentally reached conclusions very 
similar to those of Bennett (London Med. Record, 1877, p. 341). What I 
affirmed in the first edition of this work, namely, that our present knowledge 
of the physiological action of the two drugs renders anything like complete 
antagonism very improbable, is still as true as it is obvious. 
When the subject in hand is looked at from its clinical aspect, the con- 
clusion of Dr. Bennett is confirmed. To tabulate and discuss the reported 
cases of opium- or belladonna-poisoning in which the counter-narcotic has 
been used would require very many pages, and I therefore can only state my 
opinion that these records establish the therapeutic value of atropia in opium- 
poisoning ; but this does not indicate, much less prove, complete antagonism 290 
SYSTEMIC REMEDIES. 
between the two drugs. No one would question the value of alcohol in cer- 
tain stages or conditions of opium-poisoning, and yet no one would claim that 
opium and alcohol are in any sense antagonistic. In opium-poisoning, death 
occurs chiefly through failure of the respiration. Atropia is the only known 
drug which exerts a decidedly stimulating effect upon the respiratory centres. 
It is evident that in advanced stages of opium-poisoning this property ren- 
ders atropia an invaluable remedy. In protracted opium-narcosis the cardiac 
and vaso-motor actions of atropia are of service; but it should never be for 
gotten that the main influence for good is upon the respiratory centres.* The 
first improvement from atropia in these cases is usually increased frequency 
of respiration; and as the breathing becomes less embarrassed the other 
symptoms ameliorate, largely because of the increased aeration of the blood. 
The double nature of profound opium-narcosis must not be lost sight of: 
the blood is saturated with carbonic acid almost to the dead-line, and much 
of the unconsciousness, much of the failing circulation, much even of the 
embarrassed respiration, is due to the presence of the gas. As soon as the 
system is in a measure relieved of this load, it begins to rebound; emetics 
act, consciousness returns to some extent, the circulation frees itself, and the 
road leading towards health is entered upon. It is a matter of the gravest 
practical importance to decide when, how, and in what quantities the mydri 
atic should be employed. The exhibition of belladonna should, I think, 
commence so soon as there is decided failure of the respiration. The stomach 
is so paralyzed in the narcosis that it is uncertain how fast absorption will 
take place in the viscus; and the drug should always be given hypodermic- 
ally, in the form of the alkaloid if possible. The first injection of atropia 
should be of such size that it could not possibly do harm, and one-fortieth 
of a grain is in most instances a fair commencing dose. Very generally 
several repetitions of this are necessary, and the delicate practical point is to 
decide how often these repetitions shall be indulged in. 
I think that very frequently too much atropia is given, and believe that 
often a great deal of firmness is required in these cases not to use it too 
freely, especially since reliance is generally placed upon the pupils as a guide. 
They are, however, a very unsafe guide, as is apparent when it is remembered 
that whilst opium contracts them by influencing the nerve-centres, atropia 
probably dilates them by acting on the peripheral nerves. It must not be 
forgotten that in doses of sufficient magnitude atropia paralyzes the nerve- 
trunks, and may thus increase the danger. A cardinal principle should, 
therefore, be to give no more of the mydriatic than is absolutely necessary. 
One-fortieth or one-sixtieth of a grain may be injected every fifteen, twenty, 
or thirty minutes, as the urgency of the symptoms may demand. The 
* III the experiments of Heubaeh and Auerbach it was found that atropia produced very 
decided effects upon the circulation and respiration curves of dogs poisoned with opium. 
See Berlin. Klin. Wochensch., 1878, 767. MYDRIATICS. 
291 
judgment should be formed from a bird's-eye view of the whole case, fresh 
atropia not being given so long as the respiration and other symptoms are 
undergoing amelioration, but the dose being renewed so soon as any tendency 
to a relapse is manifested. Thus, if under the influence of atropia in a case 
the respirations had risen from four to eight per minute, I would not use the 
counter-poison again until there was manifested a tendency for the respira- 
tions to grow less frequent, or unless for a long period there had been no 
improvement. 
Atropia is useful in other poisonings than that of opium. It has been 
especially commended as an antidote to poisonous fungi.* 
As a Local Sedative.-Locally and freely applied, belladonna is a sedative ; 
and, I believe, to glandular as well as to muscular and nervous tissues. In 
this way it is often very useful in various local inflammations. In the form 
of a plaster it frequently appears to do good in palpitations of the heart. Its 
use locally in spasms and neuralgia has been sufficiently dwelt on. In mas- 
titis, or when it is desired to dry up the secretion of milk, its local applica- 
tion to the breast is often very efficacious. Whenever belladonna is used 
locally, in order to get its good effects it must be employed freely. At the 
same time, it should be remembered that a number of cases of poisoning by 
its external use have been reported (Medical Times and Gazette, Nov. 1856 ; 
also London Pharmacetitical Journal, 1871). In children it must be used 
with very great caution ; in adults, with a reasonable amount of care, its ex- 
ternal use is safe, provided directions be given to have it washed off so soon as 
any affection of the sight or dryness of the throat is induced. 
Having myself no practical knowledge of diseases of the eye, Dr. Wm. F. 
Norris, Clinical Professor of Diseases of the Eye in the University of Penn- 
sylvania, at my request, has prepared the following section: 
The Use of Atropia in Diseases of the Eye.-Pure atropia, from its slight 
solubility in water, is only applicable where we desire a moderate effect; the 
sulphate, however, can be dissolved in water in any desired proportion, and, 
therefore, is generally employed. When a four-grain solution of this salt is 
dropped into the conjunctival sac of a healthy and emmetropic eye, we find 
that in about fifteen minutes the pupil commences to dilate, and that this 
dilatation rapidly increases, till in from twenty-five to thirty-five minutes it 
has attained its maximum. The power of accommodation, and consequent 
ability to read fine print, does not show any marked decrease till twenty-five 
minutes have elapsed, when the near point commences rapidly to recede from 
the eye, until in an hour and a half to an hour and forty minutes the power 
of accommodation is completely annulled, and only objects over twenty feet 
distant from the eye, or those presenting practically parallel rays, can be 
distinctly seen. On the second day after the application the power of accom- 
* Consult The Doctor, 1874; Brit. Med. Journ., ii. 1874; Arch. Physiol. Normale, 1877, 
p. 831. 292 
SYSTEMIC REMEDIES. 
modation begins to return, and increases rapidly up to the sixth day, but is 
usually not fully regained till from ten to fourteen days; the pupil remains 
with but little change till the third day, when it rapidly contracts, but has not 
fully regained its normal state till eleven or twelve days have elapsed.* The 
mydriatic action of the drug is far more marked from a moderately strong 
solution applied to the conjunctiva than from its internal use, even when it 
has been pushed to the production of symptoms of poisoning. Thus applied, 
it acts on the intraocular nerves and ganglia; and it has been proved by 
Graefe and Bonders that when the aqueous humor of an animal is drawn off 
and collected after its application, it contains a sufficient amount of the drug to 
cause dilatation of the eye of another animal when applied to it. These experi- 
ments have been abundantly confirmed by later observers, and the rapidity 
of its action appears to depend on the thickness of the cornea and the age 
of the subject selected for the experiment. It will be apparent from the 
foregoing statements that the use of a strong solution of atropia is not to be 
undertaken without due consideration, inasmuch as it is likely to debar the 
patient from any satisfactory use of the eyes for a period of from five to ten 
days. It is, however, invaluable, from its annihilation of the accommodation, 
where we wish to determine with accuracy the refraction of the eye, and is 
daily used for this purpose in cases of hypermetropia where the patients find it 
impossible to relax their accommodation, in astigmatism where it is necessary 
to determine the exact difference between the two principal meridians of the 
cornea, and in the rare cases of myopia associated with spasm of the ciliary 
muscle. To obtain this complete paralysis of the accommodation, a few 
drops of a four-grain solution should be dropped in the eye, and this repeated 
after an interval of five minutes. The patient will be ready for examination 
one and a half hours subsequently. In the vast majority of cases it is entirely 
unnecessary to dilate the pupil to obtain a satisfactory view of the fundus 
with the ophthalmoscope ; but where this becomes necessary we can often use 
with advantage a solution of one-twentieth grain in an ounce of water; a 
drop or two of this will dilate the pupil, without, however, rendering it abso- 
lutely immovable, and with scarcely any interference with the accommodation ; 
on the next day the pupil is much smaller, and on the third day no trace of 
its action remains. In cases of suspected cataract the pupil should always be 
dilated ; otherwise we may readily fail to discover the lesion, which frequently 
first manifests itself in a few faint striae shooting out from the periphery of 
the lens. Moreover, it affords us a valuable prognostic point as to the 
probable success of any operation where the cataract is ripe; for where the 
iris fails to dilate ad maximum, we may be sure that it is more prone to take 
on inflammatory action, and more liable to be pressed on by any cortical matter 
which may remain behind in the eye. Daily experience shows that after the 
* For a more detailed discussion of this subject, see Bonders'a Anomalies of Refraction 
and Accommodation, p. 584, New Sydenham Society, 1864. MYDRIATICS. 
293 
evacuation of the aqueous humor in the operation for cataract, the iris will 
contract in spite of any previous use of atropia ; but as soon as by the closing 
of the wound the humor reaccumulates and the anterior chamber is re-estab- 
lished, the atropia resumes its sway. It is most useful in all inflammations 
of the cornea. In phylctenular keratitis, by its local anaesthetic action on the 
branches of the trigeminus, it diminishes the photophobia and blepharospasm, 
and seems to mitigate the intensity of the inflammation by its influence in 
contracting the ciliary vessels, thus diminishing the supply of nutritive ma- 
terial carried to the cornea. Where an ulcer has perforated the central region 
of the cornea, and a prolapse of the iris has ensued, the energetic use of 
atropia often enables the radiating fibres of the iris to detach it from the 
cornea as soon as the opening has been plugged by lymph, and the anterior 
chamber restored, thus preventing the formation of anterior synechiae. Mac- 
kenzie long ago called attention to the " healing and anodyne" effect of 
atropia in ulcers of the cornea occurring in the ophthalmia of new-born 
children,-a fact since universally recognized, and which holds good equally in 
the ulcers resulting from other forms of purulent conjunctivitis. It is held by 
many writers that part at least of this beneficial action is to be ascribed to its 
diminution of intraocular tension.* In cases of iritis a strong solution of 
atropia should at the outset be applied repeatedly at short intervals until we 
have obtained a full dilatation of the pupil, and subsequently sufficiently 
often to maintain the iris in this condition. We thus place the inflamed 
tissue at rest, diminish its blood-supply, and prevent the formation of poste- 
rior synechiae, which constitute so frequent a cause of the recurrence of this 
disease by their mechanically-irritating effect: putting a strain on the iris in 
its every motion, hindering that variation in the diameter of the pupil which 
normally takes place with every change of convergence and with every varia- 
tion of the intensity of light. Moreover, extensive synechiae where the iris 
is plastered down to the anterior capside by large patches of lymph tend to 
produce cataract, by interfering with the nutrition of the lens. Where the 
synechiae are narrow and tongue-shaped, they may often be torn through by 
its action, even after the lapse of years. 
* That atropia diminishes intraocular pressure has been asserted by Graefe, Coccius, and 
many good authorities ; and a reference to any manual of diseases of the eye will show 
that it is an accepted doctrine with most clinical observers of the present day. Other 
weighty authorities, such as Bonders and Stellwag, doubt its ability to produce any such 
effect. Certainly it fails to reduce intraocular pressure in cases of glaucoma. Numerous 
attempts to decide the question by physiological experiment have been made by Hensen 
and Volckers, Wegner, Adamiuk, Grlinhagen, Dor, etc. The results vary, however, con- 
siderably among themselves. Those with the manometer are open to the objection that 
the cutting open the eyeball for its introduction quite changes the conditions of intra- 
ocular pressure and circulation, and that very slight movement of the instrument or eye- 
ball invalidates the results; while those with the tenometer are also unsatisfactory, 
inasmuch as we have yet failed to obtain any reliable instrument for measuring intra- 
ocular tension. 294 
SYSTEMIC REMEDIES. 
Atropia acts more powerfully in iritis after the abstraction of blood,* and 
occasionally, where there is much exudation, fails to produce its effect till 
after the constitutional effect of mercury has been obtained. In some indi- 
viduals the instillation of a strong solution of atropia, by its rapid passage 
through the tear-passages into the nose and throat, produces symptoms of 
slight belladonna-poisoning,-viz., flushed face, rapid pulse, dryness of the 
throat, slight dysphagia; but this may usually be diminished or prevented 
by gargling the throat with water, by compressing the canaliculi, or by evert- 
ing the lower punctum lachrymarum. In some individuals it produces a 
curiously-irritant action on the conjunctiva, known as atropine conjunctivitis; 
this is sometimes quite severe, calling forth almost erysipelatous symptoms, 
at other times bringing out a crop of granulations. This is owing to idiosyn- 
crasy, and will then happen with perfectly neutral solutions. It should in 
such cases be discontinued, and the conjunctivitis which it has called forth 
combated by weak solutions of alum and sulphate of zinc or other mild 
astringent. We find, too, in some cases of iritis, especially those occurring 
in rheumatic patients with posterior synechiae due to repeated previous at- 
tacks, that we not only fail to dilate the pupil, but that atropia acts as an 
irritant to the eye. We are then obliged to give up its use, and resort to the 
application of dry warmth and appropriate constitutional remedies. Atropia 
will occasionally, in cases of chronic glaucoma, precipitate an acute attack, 
and is, therefore, to be used with due consideration in this disease.j" 
A great deal has been written about the value of belladonna as a prophy- 
lactic in scarlatina, and. authorities differ very much. For a discussion of 
the subject I must refer the reader to the treatises of Dr. Geo. B. Wood, of 
Dr. Stille, of Dr. Waring, etc. I have never had a decisive opportunity of 
testing the matter, but have no faith in the efficacy of the remedy. It ought 
to be tried further, however. The plan practiced has been to dissolve two 
grains of the extract in a fluidounce of water, and give two drops daily to a 
child a year old, adding one drop for every year in older children up to twelve 
years. 
Toxicology.-Sufficient has already been said about the general symp- 
toms of belladonna-poisoning. Those which are characteristic are the dry- 
ness of the throat, the increased frequency of breathing, the dilated pupils, 
the red efflorescence on the skin, the rapid pulse, the active talkative delirium, 
sometimes convulsions, all ending in abolition of function, as shown by stu- 
por, rapid feeble pulse, cold extremities, and paralysis. If the urine of a 
patient suffering from belladonna-poisoning be dropped into the eye of the 
cat or rabbit, it will dilate the pupil; and the diagnostician may avail him- 
* Mackenzie, Diseases of the Eye, p. 537, London, 1854. Graefe, Archiv fiir Ophthal- 
mologic, vol. ii. part 2, p. 209 (note). 
f Graefe, Archiv fiir Ophthalmologic, vol. xiv. 2, 117. II. Derby, Trans. Amer. Ophthal. 
Soc., p 35, 1868. Wells, Diseases of the Eye, p. 517 (2d Amer. ed.). MYDRIATICS. 
295 
self of this test in any doubtful case. Dr. Morel {Annates de la Society de 
Medecine de Gand, 1873) calls attention to a sort of laryngitis produced 
by poisonous doses of belladonna, and characterized by pain in the larynx, 
roughness of voice, and the expectoration of minute, pearly, tough pellets. 
It was present in the advanced stages of two cases of poisoning under his care. 
The minimum fatal doses of the preparations of belladonna are scarcely 
known. An enema representing eighty grains of the root has produced death 
in five hours {Casper s Wochenschrift, Feb. 1845) ; but, on the other hand, 
recovery has occurred after the ingestion of three drachms of the extract 
(Taylor's Principles and Practice of Medical Jurisprudence, London, 1873, 
p. 432). A tenth, or even a twentieth, of a grain of atropia will often pro- 
duce alarming symptoms ; yet Dr. Chambers reports {Lancet, 1864) recovery 
in a child four years old who had taken about two teaspoonfuls of a solution 
containing a grain of the alkaloid in half an ounce. 
After death from belladonna, no characteristic lesions are to be found. 
In the treatment of belladonna-poisoning, the first indication is to prevent 
the absorption of any more of the poison. For this purpose emetics or the 
stomach-pump should be used. The same difficulties are to be met and the 
same measures adopted as in opium-narcosis ; and, as in opium-poisoning it is 
well to exhibit tannic acid freely, because it forms with the alkaloids salts 
which are soluble with difficulty, so should vegetable astringents be given 
when an overdose of belladonna has been ingested. After the stomach has 
been evacuated, symptoms must be met as they arise. During the first feb- 
rile stage I would not hesitate to use cold bathings; and the moderate use 
of tartar emetic, or other sedative, is perhaps justifiable. The value of opium 
in belladonna-poisoning has not, I think, been determined, and its use should 
only be tentative, although good is to be expected from its judicious employ- 
ment. In poisoning by a mydriatic, in order to keep up the respiration and 
the circulation during the stage of failure of function the same measures 
should be employed as in opium-poisoning. External stimulation by heat 
and by mustard, flagellations, etc., artificial respiration, and especially the use 
of the alternate cold and hot douche, should all be practiced as necessary. 
Physostigma and jaborandi appear to be somewhat antagonistic to atropia 
within certain limits, and jaborandi has been used in atropia-poisoning 
{Lancet, 1876, i., p. 346). As this subject can best be elucidated after 
the discussion of the action of the respective drugs, the reader is referred for 
further information to the articles upon Calabar bean and jaborandi. After 
toxic doses of belladonna, there is very generally complete retention of urine ; 
and as this secretion contains the greater part of the ingested poison, and 
as reabsorption in the bladder is at least conceivable, the catheter should be 
used early. 
Administration.-Belladonna is never used internally in substance. All 
the preparations of the U. S. Pharmacopoeia except two (designated below) 
are made from the leaves. They are the tincture {Tinctura Belladonnas-1 296 
SYSTEMIC REMEDIES. 
to 6.66, U.S.), dose, ten to thirty drops; the alcoholic extract (Extract um 
Belladonnas Alcoholicum), dose, one-eighth to one-half a grain; the fluid 
extract of the root (Extractum Belladonnas Fluiduni), dose, one to two 
minims; the plaster (Empl. Belladonnas*), represents its weight of root; 
the ointment (Unguentum Belladonnas) contains one-tenth of extract. The 
abstract (Abstractum Belladonnas') represents twice its weight of root, dose, 
one grain. The sidphate of atropine (Atropines Sulphas) is most commonly 
used, on account of its solubility in water. One-sixtieth of a grain of atropia 
or its salt, given hypodermically, will generally produce slight dryness of the 
throat or other indications of its constitutional action. Where rapidity of 
action is required, this is the best method of administering belladonna. 
Hydrobromate of Homatropine.-Homatropine is an alkaloid artificially 
produced from atropia, the hydrobromate of which is preferred for practical 
use on account .of its being stable and not hygroscopic. It is said to pro- 
duce, when taken internally, symptoms similar to those caused by atropia, 
except that it slows the pulse,-an observation which needs confirmation. 
Dr. Wm. Macintosh (Unpublished Inaug. Biss., University of Pennsylvania, 
1883) has found that, like atropia, it causes in the frog first paralysis with 
abolition of reflex action, followed, if the dose has not been too large, by 
tetanus: in the first period the conducting power of the motor nerves was 
much depressed: tying an artery was found to prevent the development of 
paralysis in the protected leg: the pneumogastrics were peripherally paralyzed. 
If a solution of the alkaloid (gr. iv-f^i) be put in the eye, the pupil usually 
begins to dilate in fifteen minutes, and the effect passes off in as many hours. 
As a paralyzer of accommodation the salt is too feeble for advantageous use; 
but when it is desired merely to examine the fundus oculi, the fugaciousness 
of its action makes it a valuable mydriatic. 
STRAMONII FOLIA-STRAMONIUM LEAVES. U.S. 
STRAMONII SEMEN-STRAMONIUM SEED. U.S. 
The leaves and seeds respectively of the Datura Stramonium, or James- 
town Weed, a coarse, bushy, annual herb, three or four feet high, growing in 
waste places both in this country and in Great Britain, and readily distin- 
guished by its large, funnel-shaped, whitish, fetid flowers, and its quadrivalve 
spinescent capsules. The leaves are large, smooth, ovate, irregularly sinuate, 
with large acute teeth. The seeds are small, brownish-black, reniform, with 
a feebly-bitterish narcotic taste. The active principle is an alkaloid dis- 
covered by Geiger and Hesse, and named Daturine, but which, according 
to Ladenburg, is a mixture of atropine and hyoscyamine. 
Physiological Action.-The physiological evidence as to the identity 
* Constitutional symptoms are readily produced by the free external use of belladonna 
plaster or ointment; and patients should always be warned to remove the plaster if dry- 
ness of throat or disorder of vision come on. For cases of poisoning in this way, seo 
N. Y. Med. Record, Jan. 1884, also Journ. Amer. Med. Assoc., ii. 122. MFD RIA TICS. 
297 
of daturia and atropia is in strict accord with the chemical proof. The 
symptoms of poisoning by stramonium differ in no respect from those of 
belladonna-poisoning, although Laurent (De V Hyoscyamine et de la Daturine, 
Th^se, Paris, p. 22, 1870) asserts that irregularity of the heart's action is 
more marked under the influence of stramonium. The same accelerated 
pulse, the same elevation of temperature, the same wild delirium, the same 
increased frequency of respiration, the same widely-dilated pupils, the same- 
red efflorescence on the skin, the same restlessness or convulsions, occur in 
both cases, and, when the dose has been sufficiently large, end alike in abo- 
lition of the functions of circulation, respiration, and innervation: stupor, 
general paralysis, weak, rapid, thready pulse, threatened asphyxia, consti- 
tuting the phenomena of the closing scene in poisoning from either narcotic. 
The most careful minute investigation of the physiological action of daturia 
which I have met with is that of Charles Laurent, already quoted. In his 
experiments that observer found that under the microscope the capillaries 
of the frog's web could be seen to contract after the application of daturia, 
even when the nerves of the limb had been previously severed, and after the 
hypodermic injection of the alkaloid; that the pulse-rate and arterial tension 
were both augmented by small doses of the poison, but that by large doses 
the arterial tension was diminished, although the pulse was still increased in 
frequency ; that when the heart was completely separated from all connection 
with the central nervous system, daturia reduced the number of its beats; 
that respiration is accelerated by the alkaloid, even after section of the 
pneumogastrics; that by moderate doses of the alkaloid the conducting 
power neither of the sensory nor of the motor nerves is destroyed; that the 
muscular contractility is not affected; that small doses increase, large ones 
diminish, intestinal peristalsis. Elaborate discussion of these facts seems 
unnecessary. It is seemingly demonstrated, from both a chemical and a 
physiological point of view, that daturia and atropia are identical. 
Therapeutics.-Stramonium may be used to meet precisely the same 
indications as belladonna. It has been especially employed in spasmodic 
asthma, chiefly in the form of cigarettes made by rolling up the dried leaves. 
These are often very efficient when there is no organic disease; but their 
use requires some caution, as very alarming symptoms, if not fatal results, 
have been produced by them. In the form of cataplasms, stramonium leaves 
are often applied with advantage to painful local inflammations, inflamed 
hemorrhoids, etc. 
Administration.-The officinal preparations of stramonium are all made 
from the seeds. They are the extract (Extractum Stramonii, U. S.), dose, 
one-fourth to one-half a grain ; the tincture ^Tinctura Stramonii-1 to 10, 
U. S.), dose, ten to twenty minims; and the fluid extract (Extractum Stra- 
monii Fluidum, U. S.), dose, one to two minims. 
Toxicology.-Accidental poisoning, especially of children, by stramo- 298 
SYSTEMIC REMEDIES. 
nium, is very common. In all points, as regards both symptoms and treat- 
ment, stramonium- and belladonna-poisoning are alike. 
HYOSOYAMI FOLIA-HYOSCYAMUS LEAVES. U.S. 
Hyoscyamus niger is a coarse herbaceous biennial, indigenous in England, 
and naturalized in the Northern United States. The leaves, which alone 
are officinal, are large, oblong-ovate, deeply sinuated, and very hairy. In 
1821 Peschier announced the existence of an alkaloid in hyoscyamus, but 
it was not until 1833 that Geiger and Hesse succeeded in obtaining it pure. 
According to Geiger, when slowly crystallized, Hyoscyamia occurs in trans- 
parent needles, and in star-shaped or bushy clusters of crystals. According 
to the recent researches of Ladenburg, hyoscyamus contains two alkaloids: 
one is crystallizable, has the same chemical formula as atropine, and con- 
stitutes the crystalline hyoscyamine of commerce, and its sulphate is the 
Hyoscyamines. Sulphas of the U. S. Pharmacopoeia; the other is amorphous, 
constitutes the amorphous hyoscyamine of commerce, and, although having 
the same chemical formula as hyoscyamine, is diverse from it; to it Laden- 
burg gives the name of hyoscine. 
Physiological Action.-Hyoscyamia has a very similar, if not iden- 
tical, action with atropia. Schroff* asserts that it is decidedly more powerful 
than atropia, so far at least as concerns its local action on the pupil. On 
the other hand, Lemattre (Archives Generales, 1865) has found atropia 
much the more active of the two. It is, however, scarcely doubtful that the 
latter observer had an impure hyoscyamia, and it seems to me that it cannot 
be at present considered as determined that there is any marked difference in 
the mydriatic activity of the two drugs. Both Schroff and Diillenberg have 
noticed in man, as the result of the ingestion of hyoscyamus, dryness of the 
throat and mouth, brief sinking of the pulse-rate, followed by increased fre- 
quency, mydriasis, giddiness, muscular weakness, and insecurity of gait. The 
experiments of Schroff, of Laurent, and especially of Harley (The Old Vege- 
table Neurotics'), indicate that hyoscyamus is much more of a hypnotic than 
is belladonna. Yet Harley's recorded observations would seem to show that, 
in some individuals, hyoscyamus induces insomnia. According to Harley, 
the primary sinking of the pulse is much more marked after hyoscyamus 
than after its sister-narcotic. Laurent (De T Hyoscyamine et de la Daturine, 
p. 15) affirms that the delirium caused by hyoscyamus is calm, whilst that 
by atropia is furious ; but on page 19 of his book is recorded a case of hen- 
bane-poisoning in which the delirium was "furious." Schroff (Wochenblatt 
der Zeitschrift der Gesellsch. der Aerzte zu Wien, 1865) asserted that pneu- 
monia is a constant and even characteristic lesion of hyoscyamus-poisoning 
in the rabbit; but Lemattre (loc. cit.'') has never seen more than little scat- 
* Quoted by Ilusemann, Die Pflanzen staffe, p. 474. MYDRIATICS. 
299 
tered points of hyperaemia ; and in Laurent's experience even these have 
always been absent. 
In the elaborate research of Laurent it was found that the capillaries of 
the frog's web contracted after the local application of hyoscyamia, even 
when the nerves had been previously severed, and also after the hypodermic 
use of the poison; that small doses augmented both the pulse-rate and the 
arterial tension, whilst large doses increased the former and diminished the 
latter; that the direct application of the alkaloid to the heart produced a 
rapid diminution of the number of its beats; that moderate doses increased 
the rapidity of respiration even after section of the pneumogastrics; that upon 
the nervous system, the muscles, and the intestines, the action of hyoscyamia 
was the same as that of daturia. The more important of these conclusions 
were also experimentally arrived at by Heilman (Beitrage zur Kenntniss der 
physiol. Wirlmngen des Hyoscyamins, etc., Jena, 1873). Dr. R. Gnauck 
found ( Verhandl. d. Physiolog. Gesellsch. zu Berlin, Aug. 1881) that hyos- 
cyamine agrees with atropia in its action upon the vagus and heart-muscle, 
but is less powerful and persistent in its influence, and also acts as a power- 
ful soporific: it further appeared especially to dilate the internal abdominal 
vessels. 
Therapeutics.-Hyoscyamus may be used to fulfil any of the indica- 
tions for which belladonna is employed. Clinical experience appears in a 
measure to bear out the assertions of various authorities as to the superiority 
of hyoscyamus as a hypnotic. It has been much employed by alienists in 
various forms of delirious insanity ( West Riding Lun. Asyl. Med. Reports, 
v.; London Practitioner, xvii. p. 17 ; xx. p. 85 ; Lancet, 1879, ii.; Ar- 
chives of Med., 1880). Many of them claim that hyoscyamia has a very 
especial calmative effect. The diagnosis and treatment of the poisoning are 
identical with those of belladonna. 
The preparations are the alcoholic extract (^Extractum Hyoscyami Alco- 
holicum, U. S.,-dried leaves), dose, one to three grains, and the tincture 
(Tinctura Hyoscyami-dried leaves 1 to 6.66, U.S.), dose, half a fluid- 
drachm to two fluidrachms. 
Before we can reach positive results with hyoscyamus it is necessary that 
the isolated crystallized alkaloids be separately studied. Dr. J. C. Shaw 
(Journ. Nerv. and Ment. Dis., vii. p. 27) has recently partially studied 
crystallized and presumably pure hyoscyamia, and found that it affects the 
system of voluntary movement and the circulation, including the heart, and 
the vaso-motor system exactly as atropia does. In a single experiment the 
respiration did not seem to be affected as by atropia; but this is contradicted 
by results arrived at by previous experimenters, and needs confirmation. 
Upon man Dr. Shaw believes, as do many alienists, that hyoscyamia acts as 
a soporific. He also states that it is less powerful as a mydriatic than 
atropia, and diminishes the respiratory rate. It must be remembered that 
these studies have been made upon lunatics; before the conclusions can be 300 
SYSTEMIC REMEDIES. 
accepted as established, much more elaborate experimental researches are 
necessary, also studies upon normal individuals, and especially contrasting 
studies made with atropia and hyoscyamia upon maniacs; by the use of 
alternate doses upon the same individual any difference of action of the 
two drugs could readily be detected. It should also be remembered that 
in his studies upon normal men Dr. Richter noted no tendency to sleep 
(Neurolog ische Centralb., i. 294). 
In a careful comparative study of hyoscyamia and atropia upon a case 
of acute mania by Prof. Sydney Ringer, the two alkaloids were found to 
act practically alike (London Practitioner, March, 1877). Commercial 
hyoscyamia was formerly very impure, and a grain has been given with 
impunity; but one-fortieth of a grain of the pure alkaloid has produced 
violent poisoning (Lancet, 1879, i. 474). 
I have made recently (Therapeutic Gazette, Jan. 1885) a careful study 
of hyoscine, both upon man and upon animals. In the frog it produces a 
general motor and reflex paralysis, progressively increasing until death 
from failure of respiration. When recovery occurs, there is no stage 
of tetanus following the palsy. Neither the muscle nor motor nerves are 
sensibly affected, and the paralysis is dependent upon depression of the 
motor centres of the spinal cord. No evidence could be obtained of affec- 
tion of the sensory side of the nervous system. In mammals, the symptoms 
produced are loss of muscular power, disturbance of respiration, and marked 
tendency to stupor, and finally death by asphyxia. The alkaloid has very 
little effect upon the circulation, though after enormous doses when life is 
maintained by artificial respiration the vaso-motor system is finally paralyzed. 
On the heart itself hyoscine acts as a very feeble depressant; it does not 
paralyze the pneumogastrics. In man the symptoms which are produced by 
decided doses are dryness of the mouth, flushing of the face, great sleepi- 
ness, associated in some cases with semi-delirious mutterings, and a feeling 
of giddiness like that of intoxication. The respirations are usually lessened 
in frequency, and the pulse-rate is also somewhat diminished ; mydriasis is 
sometimes produced, but does not always follow even large doses. In the 
case of Dr. H. A. Hutchinson (Alienist and Neurologist, iii., p. 539), who 
took a quarter of a grain of very impure hyoscine, quiet coma with entire 
muscular relaxation was produced, and lasted eleven hours. It is evident 
that in man as in animals the motor tract of the spinal cord and the cere- 
bral cortex are especially affected by this alkaloid, which is also a respiratory 
paralyzant. I have used it as a therapeutic agent in a number of cases of 
delirious excitement occurring in insane persons, with, in most cases, re- 
markable effect in producing sleep, often after the failure of chloral and 
morphia. In delirium tremens it has sometimes seemed of great service, 
in other cases failed. It has been used by Prof. Edlessen (Centralb. f. Med. 
Wissensch., 1881, 416) with asserted good results in asthma, and also 
in whooping-cough. Dr. Rudolph Gnauck (Centralb. f. Med. Wssens., MYDRIATICS. 
301 
1881, 801 ; Charite Annallen, 1882, 448) also affirms that hyoscine has a 
very powerful hypnotic influence, and tends to reduce the pulse-rate. He has 
found that in some cases it causes general distress, headache, numbness, 
etc. In one or two of my own cases it seemed to disagree with the patient, 
but usually there have been no after-effects, or other unpleasant symptoms. 
In the therapeutic dose the drug is tasteless, and it may be administered 
to insane patients in their food or drink without their knowledge. In my 
own experience it has failed entirely in the relief of pain. But in sleep- 
lessness from cerebral excitement it will probably prove one of our most useful 
remedies. It is free from irritant properties and may be used hypodermically, 
either in the form of the hydriodate or hydrobromate, which salts occur in 
crystalline form in commerce, and are soluble. The only reliable prepara- 
tions at present upon the American market are those of Merck, of Darm- 
stadt; the dose is hypodermically 1-100 of a grain, by the mouth, 1-60 to 
1-90 of a grain. The influence of the single dose seems to last from six 
to eight hours. CLASS VIIL-ANAESTHETICS. 
The term Anesthetics is here employed as the name of a group of volatile 
substances, whose vapor has the power of producing loss of consciousness, 
preceded by or accompanied with loss of sensibility and diminished muscular 
action. The medicinal properties of these substances are largely due to their 
volatility, by virtue of which they are very rapidly absorbed and almost as 
rapidly eliminated by the mucous membrane of the lungs. As a consequence 
of this, their action is very easily controlled. That they are taken into the 
blood, and thereby reach all portions of the system, has been abundantly 
proven by recent investigations.* 
The action of the anaesthetics certainly is upon the nerve-centres. Thus, 
Bernard has shown (loc. cit.^ that a ligature so placed as to cut off all circula- 
tion from the posterior part of the frog does not prevent the production of 
abolition of sensation, voluntary motion, and reflex action in the hind legs 
when an anaesthetic is injected into the anterior part of the body. 
Many of the theories which have been suggested to explain the production 
of anaesthesia are so groundless that it seems unnecessary to discuss them 
here. All that are worthy of consideration may, I think, be arranged in 
four groups, as follows: 1st, those which assert that the symptoms are pro- 
duced by a partial arrest of oxidation; 2d, those which look upon anaes- 
thesia as due to precedent physical changes in the blood; 3d, those which 
assert that anaesthesia, like sleep, is due to cerebral anaemia; 4th, those 
which teach that the various agents employed act directly upon the various 
organs and tissues concerned,-including in this group the recently-pro- 
pounded theory of Bernard that anaesthesia is produced by a semi-coagulation 
of the nervous protoplasm.^ 
As the theories of the last group are the most natural, the burden of 
proof rests upon the supporters of the other theories. All the proofs of the 
first two groups as yet brought forward amount to no more than as follows: 
that in asphyxia the symptoms are similar to those of anaesthesia; that in 
profound anaesthesia there is an evident lessening of oxidation; and that 
some anaesthetics probably produce changes in the blood. 
The objections to regarding these facts as proving the truth of the theories 
alluded to are very grave. Thus, it is very well ascertained that the symp- 
* See especially 0. Schmiedeberg, Inaugural Dissertation, Dorpat, 1867, Archiv d. Heil- 
kunde, viii., 1867; Claude Bernard, Lemons sur les Anesthesiques, Paris, 1875. 
f For study of the coagulation theory, see Centralblatt Med. 1877, p. 609. 
302 ANESTHETICS. 
303 
toms of asphyxia are only analogous to those of anaesthesia, not identical,* 
and indeed that anaesthesia as caused by different agents offers different phe- 
nomena ; also, there is no proof whatever that the lessened oxidation and the 
blood-changes which are believed to occur when anaesthetics are employed are 
causes of the nervous symptoms, and not simply coincident phenomena. It 
must be insisted on, therefore, that these theories have never been proven. 
Moreover, positive proof of their incorrectness is not wanting. Thus, in 
regard to the theory of arrest of oxidation, there are substances, such as 
nitrite of amyl, which lessen oxidation very remarkably (Richardson, Medi- 
cal Times and Gazette, p. 180, 1868), but are not anaesthetics ; and an ex- 
cess of oxygen in the air does not lessen the rapidity with which anaesthesia 
is induced.j" The Anaesthetics Committee of the British Med. Association 
{Jour. Anat, and Phys., xiii. 224) also found that during chloroform nar- 
cosis there was an actual increase irtthe elimination of carbonic acid. In 
regard to the blood-theories, Ludimar Hermann {Reichert's Archiv fur 
Anatomic, 1866, p. 27) calls attention to the fact that the anaesthetics 
produce the same general symptoms in the infusoria, which have no red 
blood, as in mammals; and Lewisson^ has shown that they influence the 
so-called " salt frogs," which contain little or no blood, precisely as they do 
the normal frog, from which the conclusion is inevitable that they do not 
affect the frog by altering the nature of the blood or by inducing asphyxia, 
In regard to cerebral anaemia, it appears to be established that it occurs in 
sleep ; and recently Claude Bernard {loc. cit., p. 122) has shown that during 
the period of excitement preceding anaesthesia there is cerebral congestion, 
but during the anaesthesia cerebral anaemia. Cessation of function normally 
results in anaemia of the organ, and the anaemia of sleep and anaesthesia is, 
in all probability, an effect, not a cause, of suspended cerebration. In the 
frog it has been abundantly proven that absolute anaemia of the nerve-centres 
does not suspend their functions, and that on the bloodless cerebrum chloro- 
form exerts its usual influence. The only theory at all compatible with our 
present knowledge is that anaesthesia is in most cases due to a direct action, 
upon the cortex cerebri and other nerve-centres, of the agent inducing it. 
The action of the anaesthetic upon the nerve-structure is probably a purely 
vital one. But by no means all authorities acknowledge this. Many, if 
not all, of the anaesthetics have the power of dissolving the red corpuscles: 
and Ludimar Hermann {Reichert's Archiv fiir Anatomic, 1866) has pointed 
out a possible connection between this and anaesthesia. He states that 
protagon, which constitutes the stroma of the red blood-disks, is an important 
constituent of the nerve-centres. As death would necessarily occur before 
the protagon could be dissolved out of the nerve-centres,-i.e., before it could 
be dissolved out of the red corpuscles,-it is evident that no extensive de- 
struction of the latter bodies can occur from the action of an anaesthetic and 
* See Report of Chloroform Committee, Medico-Chirurg. Trans., vol. xlviii. p. 329. 
f Ibid., p. 335. | See Chloral for further details. 304 
SYSTEMIC REMEDIES. 
the patient survive. Bile-acids also dissolve protagon, and Hermann states 
that some experiments he has made seem to indicate that they have anaes- 
thetic properties. Before, however, the ingenious theory of Hermann can 
be considered proven, further investigations must be made. The recent 
coagulation theory of Bernard rests almost solely upon the asserted but 
doubtful fact that anaesthetics applied in sufficient concentration coagulate 
albuminous substances, and appears to me such a pure assumption that 
its discussion at length is beyond the plan of the present work. 
In 1848 (Archives Generales, 2e ser., t. xvi., 1848), Dumeril and Demar- 
quay showed that during anaesthesia there is a reduction of temperature. 
This has been confirmed by Bouisson (Traite theorique et pratique de la 
Methode anesthesique, Paris, 1850) and by Sulzynski (UeLer die des Alko- 
hols, Chloroforms und Aethers Einfluss auf den thierischen Organismus, 
Inaug. Dissertation, Dorpat, 1865); and Scheinson (Archiv des Heilkundes, 
1869) has demonstrated that there is no increase in the giving out of heat 
by the body during anaesthesia, and consequently that the anaesthetics lessen 
the production of animal heat, no doubt, like alcohol, by checking tissue- 
metamorphosis. 
The action of anaesthetics may be modified by the injection of narcotics. 
Morphia given hypodermically about half an hour before the exhibition of 
the anaesthetic is said to have a decided effect in prolonging the anaesthesia. 
Chloral administered shortly before etherization certainly causes the first stage? 
of the latter to be much quieter than usual, and also prolongs the narcosis.* 
The chief purposes for which anaesthetics are used are to relieve pain and 
to relax spasm. To meet the first indication they are employed by surgeons 
especially; but they are also exceedingly valuable in cases of suffering from 
disease. It must be borne in mind that their action is very transitory, and 
is accompanied by more or less disturbance of the general system, and that 
consequently they are to be employed only when the pain is exceedingly severe 
and transient. To relieve pain, anaesthetics are used with great propriety 
during child-birthIn natural labor it is not commonly necessary to produce 
complete anaesthesia. When the full effect of either ether or chloroform is 
induced, there is almost always a weakening, and very often an abolition, of 
the uterine contractions. The anaesthetic should be administered in such 
quantities as to relieve the pain without decidedly interfering with the mus- 
cular spasm. In some cases this can be done, in others it is impracticable. 
I have obtained very advantageous results in some cases by suspending the 
* Mr. Bonwill has proposed rapid breathing as a means of producing slight anesthesia 
in cases of minor surgery. The patient is required to breathe very rapidly for from three 
to five minutes, when a condition of partial loss of consciousness, probably dependent upon 
disturbance of the cerebral circulation, is induced. (See Phila. Med. Times, vi., p. 265.) 
f I see no reason for believing that anaesthesia of the mother seriously influences the 
child, and do not think much weight can be attached to the assertions of Dr. Hofmeier 
{Berlin. Klin. Wochensch., 1883, xx. 230), that there is produced an increased elimination 
of nitrogen in the new-born babe. ANESTHETICS. 
305 
pains for about half an hour by means of ether, and then entirely withdraw- 
ing the anaesthetic. By this treatment the weak, painful, ineffectual efforts 
of a worn-out nervous patient may often be converted into regular, success- 
ful pains. I think that the risk of post-partum hemorrhage is materially 
increased by anaesthetics, and therefore habitually give after their use two 
drachms of the fluid extract of ergot, as soon as the perineum is well distended 
by the child's head. Anaesthetics are frequently used in surgery for the pur- 
pose of relaxing spasm, as in cases of dislocation, hernia, etc. In medicine, 
they have been employed in various forms of convulsions, and are especially 
valuable in severe hysterical convulsions, in puerperal eclampsia, and in spinal 
convulsions ; in epilepsy, they are very rarely called for; in infantile convul- 
sions, they may be sparingly used when the convulsion itself threatens life. 
In various spasms of excretory ducts or canals, and especially during the 
passage of calculi, they act very favorably, both by relieving pain and by pro- 
ducing relaxation. In asthma, and in spasmodic stricture of the oesophagus, 
as in all other cases of oft-repeated spasm, they should be administered only 
to meet temporary indications, as their habitual use is deleterious. 
NITROGEN MONOXIDE-NITROUS OXIDE. (N0-N20.) 
Nitrous oxide is a colorless, almost inodorous gas, of a sweetish taste. It 
is a very active supporter of combustion. Water absorbs nearly its own bulk 
of it. It is made by the distillation of the nitrate of ammonium, which 
resolves itself into the gas and water. Thus, NO3NH4= N2O 4" 2H2O. The 
wood-cut on the opposite page represents the best apparatus,* and the rules 
appended thereto embody all the necessary instructions for the production 
of the gas. As they are very concise, they should be followed to the letter. 
The various effects of increasing heat upon nitrate of ammonia are : At 226° 
F. it fuses perfectly ; at 302° F. it emits white fumes, condensing in drops; 
at 347° F. it effervesces slightly ; at 356° F. it boils without decomposition ; 
at 437° F. it effervesces rapidly; at 460° F. it begins to evolve gas; at 
482°' F. it evolves gas in abundance ; above 500° F. nitric oxide is given off. 
To determine the temperature, thermometers have been prepared which 
may be passed through the cork and into the retort, marking the following 
degrees: 226°, 35G°, 460°, 482°, 500° F. 
To obtain the largest amount of gas, the nitrate should first be melted in 
the retort at a temperature just sufficient (226° to 250° F.). When melted, 
the heat may be at once carried up to the point of decomposition, 460° F. 
If a gradually-increasing heat is used after the salt is melted, a portion of it 
will sublime unchanged until the temperature reaches 460° F. The heat 
should never be allowed to rise above 482° F., for beyond that noxious 
products are generated. After the gas has begun to come over briskly, the 
appearance of copious white fumes in the retort is an indication that the 
heat is too great. The nearer the heat can be kept at the point necessary 
* This apparatus is furnished by Mr. S. S. White, of Philadelphia. 306 
SYSTEMIC REMEDIES. 
to generate nitrous oxide, the purer will be the gas.-Dr. Jas. W. White, 
Dental Materia Medica, Philadelphia, 1868. 
After the gas has commenced to come over freely, it is generally best to 
lessen the amount of heat applied to the sand-bath. The gas should be 
allowed to stand over water for a few hours before using. It improves 
rather than deteriorates by age, and in a properly-constructed gasometer may 
be kept for many -weeks, especially if the water between the holder and re 
ceiver of the gasometer be covered with a thin film of oil, so as to prevent 
its yielding to the air the gas which it absorbs, until saturated. In manu- 
facturing the gas, whenever the alkalinity of the potash solution in the jar 
No. 2 is lessened, all the washing-jars should be emptied and refilled. ANAESTHETICS. 
307 
Place the holder in a level position, and fill it with water to within an inch or two 
of the lower edge of the taper rim. Open all the spigots, especially the one in the top of 
the receiver, and gently sink it into the water; then close the spigot in the top of the 
receiver and that on the upper edge of the holder, and arrange the weights that are at- 
tached to the receiver. Next put pure water into the jars,-No. 1 two-thirds full; Nos. 2 
and 3 within one and a half inches of the top. Into jar No. 2 put a stick of caustic 
potash. 
Arrange the jars in line, and connect them by tubing as shown in the cut. The tube 
from the retort must connect with the long pipe of jar No. 1, and so on. Always be sure 
that the long pipe of each jar is next the retort. When properly arranged, a current of 
air blown into the tube intended to connect with the retort will cause the water to bubble 
in jars Nos. 2 and 3, and, the spigot to which No. 3 is attached being open, the receiver 
will begin to rise. 
Put into the retort the quantity of ammonia intended to be used (1 pound will make 
about 30 gallons of gas). Connect the long pipe of the first jar to the retort by rubber 
tubing, so that the condensed steam may run into it. Now apply the heat gradually, and 
watch the process, being careful not to overheat the ammonia, which will be known by its 
violent boiling, instead of the gentle bubbling which indicates the proper temperature. 
Do not make gas faster than 30 gallons per hour. 
The heat should be shut off before the ammonia is quite all decomposed, in order to 
avoid breaking the retort; and when the gas has ceased to come over, the retort should 
be disconnected from the tubing, and the receiving spigot closed. 
It will be understood that the first jar is merely to receive the drip; the use of the water 
>s simply to keep the jar cool. Some recommend placing this jar into a bucket of cold 
water. 
The inhaling-tube is attached to the spigot at the top of the holder. 
The register indicates the number of gallons of gas in the holder, as well as the quantity 
inhaled. 
The water in jars Nos. 1 and 3 should be changed every time the gas is made; that in 
No. 2 about once a month, when fresh caustic potash should be added. The water in the 
holder will keep sweet a year or longer if gas is made frequently. 
Physiological Action.-Although nitrous oxide has been used enor- 
mously as an anaesthetic, and many papers have been written upon it, yet 
our knowledge of its physiological action is due to three or four observers. 
When pure nitrous oxide gas is inhaled for from half a minute to three 
minutes, insensibility is produced, preceded in many cases by decided evi- 
dences of excitement. Some persons under its influence will sink quietly 
away into unconsciousness, but others will become hilarious, erotic, or pug- 
nacious, and be restrained only by force. During the stage of anaesthesia 
the patient presents the appearances of asphyxia. 
It is probable that the paralysis of function invades the different portions 
of the nervous system in the same order as does that caused by ether; but 
we have no positive knowledge upon the subject. A single experiment of 
Dr. Amory (New York Medical Journal, Aug. 1870) indicates that upon 
the conducting power of the motor nerves nitrous oxide exerts very little or 
no influence. No studies whatever have been made of the condition of the 
circulation before anaesthesia is produced. But if, as is almost certain, the 
anaesthesia is only an asphyxia, the well-known circulatory phenomena of 
that state Ought to be present. Confirmation of this has been afforded by 308 
SYSTEMIC REMEDIES. 
Dr. Amory, who, by means of a cerebrometer set into the skull of the dog, 
found that during the period of unconsciousness the cerebral pulsations are 
very decidedly lessened, and finally abolished, although the cerebral pressure 
is increased. This would seem to prove that the capillary cerebral circulation 
is checked and finally arrested, but that the amount of blood in the cerebrum 
is not lessened. 
It is well established that the gas is not capable of yielding its oxygen so 
as to support life. A taper will burn in it, it is true, but its decomposition 
is due to the high heat, and at the temperature of the body the compound 
is a stable one. MM. Jolyet and T. Blanche have found (Archives de Phy- 
siologic, July, 1873) that seeds will not germinate in it, and that animals 
(frogs, sparrows, guinea-pigs, rabbits) live no longer in an atmosphere of 
pure nitrous oxide than in one of nitrogen. Even Dr. Colton, who main- 
tains the absurdity that nitrous oxide produces hyperoxygenation of the 
blood, states (The Physiological Action of Nitrons Oxide Gas, Philadel- 
phia, 1871) that in an atmosphere of the gas a mouse will live only from 
thirty to sixty seconds, a pigeon one to two minutes, a kitten one to two 
minutes, a frog thirty to sixty minutes,-all dying of asphyxia. 
The French observers above named affirm that nitrous oxide has no effect 
upon the system ; that the phenomena induced are simply due to deprivation 
of oxygen. The series of facts which they have experimentally proven, and 
upon which their conclusions are based, are: 1. An animal lives no longer in 
nitrous oxide than in nitrogen ; 2. Anaesthesia occurs at the time that the 
blood of an animal becomes black ; 3. Animals breathing an air containing 
sixty to eighty per cent, of nitrous oxide, and twenty to forty per cent, of 
oxygen, are unaffected; 4. The analysis of the blood of two dogs yielded 
the following results: 
No. 1. Conscious, 
No. 2. Unconscious. 
Carbonic acid . 
. . 46 
per cent. 
Nitrous oxide . 
. . 29 
per cent. 
Oxygen . . . 
. . 19.7 
per cent. 
Carbonic acid . 
. . 36.6 per cent. 
Nitrous oxide . 
. . 34.6 per cent. 
Oxygen . . . 
. . 3.3 per cent. 
and other analyses showed that the coma was not developed until the oxygen 
in the blood was reduced to three or four per cent. It is evident that if 
the above analyses are, as from their reports they appear to be, reliable, the 
anaesthesia is not due to the presence of carbonic acid in the liquor sanguinis, 
since nearly ten per cent, more of that gas was present in the blood of the 
conscious (No. 1) than in that of the unconscious dog (No. 2), and also that 
it is more rational to believe the decrease in the oxygen, rather than the 
slight increase in the amount of the nitrous oxide, made the difference 
between consciousness and unconsciousness. 
In this connection the very careful experiments of Dr. Amory are most 
interesting. He found that during nitrous oxide narcosis the amount of car- ANAESTHETICS. 
309 
bonic acid exhaled from the lungs is only two-thirds of that eliminated before 
the inhalation, and that immediately after the recovery of consciousness less 
than one-third the normal amount of carbonic acid is given off. 
This certainly is corroborative of the conclusions of the French observers, 
which have also received confirmation from the experiments of Mr. Elihu 
Thomson (Philadelphia Medical Times, November 15, 1873), who found 
that animals in an atmosphere of hydrogen and of nitrogen, and also in 
vacuo, suffered symptoms precisely similar to those caused by the inhalation 
of pure nitrous oxide; also, that in man the inhalation of pure nitrogen 
causes the symptoms of nitrous oxide narcosis, except that the sense of 
exhilaration is absent; finally, that nitrogen, hydrogen, and nitrous oxide, 
as well as a vacuum, are rendered capable of supporting life if a proportion 
of oxygen approaching that existing in common air be introduced. Dr. C. 
A. MacMunn (The Spectroscope in Med., London, 1880, pp. 73, 75) finds 
that when an animal is killed by nitrous oxide the arterial blood gives only 
spectrum lines of reduced haemoglobin, whilst after chloroform those of 
oxyhaemoglobin are very apparent. 
The evidence so far cited would seem to prove that nitrous oxide produces 
anaesthesia by causing asphyxia; but the phenomena of mechanical asphyxia 
are asserted to be different from those caused by the gas. In the experi- 
ments of Krishaber (Lyman, Artificial Anaesthesia, New York, 1881, p. 
315) the circulation was found to be very differently affected by mechanical 
asphyxia and the inhalation of nitrous oxide. Prof. Paul Bert, of Paris, 
believing that the production or non-production of anaesthesia by nitrous 
oxide depends upon its tension in the blood, devised an apparatus by 
means of which the patient could have administered to him nitrous oxide 
gas, mixed with an equal amount of oxygen, under a pressure of at least 
two atmospheres. The result is said to be very satisfactory, and the method 
to be at present extensively used in Paris. The objections to it are the expen- 
siveness and cumbrousness of the apparatus. It is plain that the method 
in which nitrous oxide acts cannot as yet be considered as positively deter- 
mined, and that the subject offers a very good field for research. 
Therapeutics.-As an anaesthetic, nitrous oxide is chiefly valuable when 
short, minor operations are to be performed. The rapidity with which insen- 
sibility is induced, and with which it disappears, combines with the general 
absence of after-effects to enhance the popularity of the gas. When, how- 
ever, an operation requiring some little time for its performance is intended, 
ether is far preferable. Nitrous oxide has been administered to many thou- 
sands of persons, and until recently no deaths at all attributable to it have 
occurred. Four have, however, been reported within a short time. In one 
of these (Dental Cosmos, editorial, June, 1872) it is doubtful whether the 
gas had anything to do with the fatal result, or, indeed, whether it was really 
administered. In the other instance (Brit. Journ. Dent. Sci.. Feb. 1873), 
death from asphyxia, apparently induced by nitrous oxide, occurred in a 310 
SYSTEMIC REMEDIES. 
healthy man. In the third, death is asserted to have been produced by 
syncope {Brit. Med. Journ., i., 1877, p. 460). For the fourth case, see 
Ibid., 1883, ii. 729. The opinion of Dr. Cartwright {Lancet, 1876, 689) 
and of Dr. W. Ottley {Ibid., 1883, i. 95), that in case of heart disease per- 
manent increase of the cardiac weakness is caused by nitrous gas inhalation, 
is certainly not established. 
Nitrous oxide is best administered from an india-rubber bag, which should 
contain at least eight gallons. The mouth-piece should always be made with 
two valves, so that the expired gas will be thrown out into the air, and not 
back into the bag. 
Ether is a colorless, very volatile liquid, obtained by the dehydration of 
alcohol by sulphuric acid. It is very inflammable, as is also its vapor, which 
is two and a half times heavier than air. It is freely soluble in alcohol, and 
is itself a powerful solvent. Its odor is strong and peculiar; its taste hot. 
Its specific gravity, when pure, is 0.713, and its boiling-point 95° F. It is 
officinal in two forms. 
jEther-Ether. U. S.-This ether contains a large percentage of alco- 
hol, and has a specific gravity of 0.750. When shaken with an equal bulk 
of water, it loses from one-fifth to one-fourth of its volume. A test-tube full 
of it held in the closed hand should begin to boil on the addition of a piece 
of broken glass. Any specimen which does not conform to these require 
ments probably contains an overplus of alcohol or of water. 
2Ether Fortior-Stronger Ether. U. S.-This ether should have a 
specific gravity of 0.728, should not lose more than one-eighth of its volume 
when shaken with an equal bulk of water, and in a test-tube held in the 
closed hand should boil vigorously on the addition of broken glass. 
Physiological Action.-The first effects of ether when inhaled are 
burning in the fauces and a feeling of strangulation, both due to the local 
impression of the irritant vapor. The first indications of its systemic action 
are a sense of exhilaration and a lightness in the head, associated with a 
roaring or buzzing in the ears. These are soon succeeded by a feeling of 
the immediate surroundings being afar off, and this soon fades into semi- 
unconsciousness, with visions and illusions. These are of various characters, 
and are often accompanied by a species of delirium. Some patients weep, 
others laugh; some shout, some pray, some rave, and some become exceed- 
ingly pugnacious. In rare instances, the dreams become erotic; and cases 
are on record in which there were distinct evidences of the occurrence of a 
complete venereal orgasm. In this stage, the patient in most cases may be 
ETHER-ETHYL OXIDE. (C4H5O-C4H10O.) ANAESTHETICS. 
311 
more or less perfectly aroused. There is rarely sufficient anaesthesia for 
practical purposes before the period of complete unconsciousness. 
The second stage of ether-narcosis may be considered to commence with 
the complete loss of consciousness. In most cases, some degree of muscular 
rigidity is at first still present, but soon passes off, and the patient lies relaxed 
and quiet, with slow, regular, automatic respiration. The occurrence of 
stertorous respiration, due to a paresis of the muscles of the palate, shows 
that the stage of muscular paralysis is being reached. It should, except in 
very rare cases, be the signal for the immediate withdrawal of the anaesthetic 
The face during etherization is reddish; marked pallor and lividity are re- 
spectively important indications of failure of the heart's action and failure 
of respiration. The stage of excitement generally lasts only a few minutes, 
but in some cases is prolonged, and in nervous women may pass into a violent 
fit of hysterics, which soon yields, however, to a persistent use of the anaes- 
thetic. The pulse is quickened and increased in force by ether, and it will 
often maintain itself during a prolonged narcosis. If the vapor of ether 
be taken in a concentrated form, there is usually in the beginning a moment 
ary arrest of respiration accompanied by a decided sense of suffocation, evi- 
dently the result of the irritant action of the vapor upon the upper air-passages. 
So soon as this has passed off the respirations are usually accelerated as well 
as deepened ; but as the stage of anaesthesia is reached they become slower, 
and, if the inhalation of the ether be persisted in, they grow not only more 
and more distant, but also more and more shallow, until they are gradually 
extinguished. The respiratory phenomena seem to be the same in the lower 
mammalia as in man. It was noticed by Kratschmer (^Sitzungb. Wiener Akad., 
1870, Abth. ii.) that in the rabbit ether, when inhaled through the nose, 
produces at first a momentary arrest of respiration in expiration. He also 
found that section of the vagi did not prevent this arrest, but that section of 
the trigemini did; also that the arrest never occurred when the ether was given 
through a tracheal fistula. This would appear to show that the phenomenon 
was a reflex one, due to the irritation of the peripheral ends of the trigemini. 
Its importance is much increased by the consentaneous spasm of the glottis, 
noticed by Kratschmer. It is possible that some of the accidents happening 
early in human anaesthesia are the result of such spasm. As stated by Dr. P. 
Knoll (Sitzungb. Wiener Akad., Oct. 1876), the alterations of respiration are 
sometimes replaced by very irregular breathing. In either case, if the inhala- 
tion of ether be persisted in, the respirations, at first quickened, grow slower 
and slower, and less and less deep, until they are gradually extinguished. 
Dr. Knoll experimentally determined that these later respiratory changes are 
not interfered with by previous section of the vagi ; that they follow the in- 
jection of the narcotic into the blood; that they are not due to disturbances of 
circulation, or to a deprivation of the respiratory centres of their oxygen ; and 
logically concludes that they are produced by a direct action of the drug upon 
the centres, at first stimulant in its character, but subsequently depressant. 312 
SYSTEMIC REMEDIES. 
According to Prof. Eulenburg, in the beginning of anaesthesia produced 
either by ether or by chloroform, the patella reflex in man is increased; but 
whilst this increase soon disappears when chloroform is employed, with ether 
it endures even into the narcosis (Hoffmann und Schwalbe, 1883, p. 117). 
Upon the lower animals ether acts as upon man, and it has been shown by 
Claude Bernard that the most primitive infusoria are susceptible to its influ- 
ence (Ze Progres Med., 1876, p. 77). 
As the functions of the cerebrum are affected before those of the other 
portions of the nervous system, it is very apparent that the brain is especially 
sensitive to the narcotic. Flourens (Comptes-Rendus, vol. xxiv., 1847, pp. 
161, 242, 253, 340) found that, at a certain stage of etherization, pricking 
of the anterior or motor nerve-roots caused motor disturbance, although the 
posterior or sensory portions of the spinal centres were completely insensible. 
After a more prolonged inhalation, the anterior or motor centres also failed 
to respond to mechanical irritation, although the functions of the medulla 
oblongata were regularly performed, and stimulation of its anterior centres 
gave rise to motor disturbance, and pricking of its sensory portions even 
caused manifestations of pain. When the inhalation of ether was maintained 
for a sufficient time, the sensory and finally the motor functions of the 
medulla oblongata were compromised, and death from paralysis of the respira- 
tory centres ensued. 
Longet (Archives G^rales, 4e ser., tome xiii. p. 374) in part confirms 
and in part questions the results of Flourens. He states that he has found 
the sensory functions abolished very early, but has never failed in any stage 
of the narcosis to get a response from the anterior part of the cord. These 
apparently different results are simply due to the fact that, whilst Flourens 
used only mechanical stimuli, Longet employed powerful galvanic currents. 
Flourens was substantially correct, and the order of the involvement of 
the nerve-centres in man and animals is-first the cerebrum, next the sensory 
centres of the cord, next the motor centres of the cord, next the sensory 
centres of the medulla oblongata, and finally the motor centres of the 
medulla oblongata. 
That ether is capable of impressing the nerves seems established by the 
experiments of Longet (loc. cit., p. 382) and of Serres (Archives G^nirales, 
4e s6r., tome xiii. p. 433). These observers found that the direct applica- 
tion of ether to a nerve produced a paralysis of the sensory fibres of that 
nerve; so that pinching the nerve below the point of application caused no 
pain, although voluntary movement was preserved, and galvanization of the 
nerve-trunk above the point of application induced spasms in the tributary 
muscles: i.e., the power of conducting an impulse downwards was preserved, 
that of conducting it upwards was lost. By a longer application of the 
anaesthetic the function of the efferent as well as of the afferent fibres was 
abolished, temporarily at first, but, if the application were persisted in, per- 
manently. Practically, however, inhaled ether has no influence upon the ANESTHETICS. 
313 
nerve-trunks, because the nerve-centres are so much more sensitive to its 
influence that their functional power is abolished before the nerves are affected. 
Indeed, Conly (Soc. de Biologie, February 13, 1876) found that in animals 
killed by ether, chloroform, or chloral the motor nerves and muscles preserve 
their function longer than in animals killed by sudden violence. 
Upon the motor system of organic life ether certainly acts, but much less 
energetically than upon the voluntary system. Thus, after death from ether 
the vermicular movements of the intestine, although less active than normal, 
are very rarely, if ever, entirely absent. 
It has been shown by the English Chloroform Committee and other in- 
vestigators that ether increases very markedly the arterial pressure, and that 
even in a prolonged ether-narcosis there is usually no material diminution of 
this pressure until manifest failure of respiration has taken place. The rise 
of the pressure is probably due to an increase of the power of the heart 
and to a stimulation of the vaso-motor nerves.* Sansom (Chloroform: its 
Action and Administration, p. 92, Phila., 18G6) states that the vessels of 
the frog's web can be seen to contract during the inhalation of ether, and 
that this vaso-motor spasm is very permanent, and does not yield to paral- 
ysis and passive dilatation until the anaesthesia has almost deepened into 
death. Dr. Bowditch and Mr. Minot also found (Boston Med. & Surg. 
Journ., May, 1874) that the vaso-motor centres are at first stimulated and 
afterwards depressed. 
Injected even in considerable amount directly into the jugular vein of 
the mammal, or applied directly to the frog's heart, ether does not seriously 
depress the heart. When artificial respiration is maintained animals bear 
an enormous amount of this drug without cardiac failure. When death is 
produced by ether, the heart generally continues to pulsate for a long time 
after the arrest of respiration. It is evident that ether is ds little of a 
cardiac depressant as is alcohol. 
It is frequently asserted that ether when added to blood coagulates it. 
A. Schmidt, however, states that the coagulation is due to ozone which has 
been generated by the ether and is contained in it, since freshly-distihed 
ether does not coagulate albuminous substances. 
The researches of Wittich (Schmidt's Jahrbucher, Bd. cxlii. p. 212) and 
A. Schmidt ( Virchow's Archiv, vol. xxix., 1864, p. 19) have shown that 
when ether is added to the blood of horses,f cats, or rats, the red corpuscles 
disappear in a very short time; and, as their stroma cannot be demonstrated 
by the aid of reagents, this disappearance is due to its solution. The 
haematin thus set free is dissolved in the serum, but the presence of the 
ether soon causes it to crystallize. There is no proof that these changes 
* I believe there is a paper " On the Action of Ether on the Circulation" in the Deutscheg 
Zeitschrift fill- Chirurgie, 1874, Bd. iv.; but I have not had access to the volume. 
f Schmidt (loc. cit., p. 2.3) says that sometimes crystallization fails in the blood of the 
horse. 314 
SYSTEMIC REMEDIES. 
occur to any extent when ether is inhaled; and the usual rapid recovery 
from the effects of the anaesthetic indicates that there is no profound altera 
tion of the blood. 
An imperfect study by Harley of the effect of ether on the gases contained 
in drawn blood indicates that ether does not exert much influence upon their 
proportional amounts. It is, however, quite possible that a more thorough 
investigation would give a different result. 
Therapeutics.-As an anaesthetic, ether does not act with the rapidity 
and pleasantness of chloroform, but it has the advantage of safety. So dan- 
gerous is chloroform, and so safe is ether, that there is no excuse for the use 
of the former agent under ordinary circumstances.* 
The reason of the safety of ether is that, unlike chloroform, it does not 
suddenly paralyze the normal heartf It may kill by inducing asphyxia 
(cases, British Medical Journal, vol. ii., 1873 ; Chicago Med. Journ., 1877, p. 
410; Le Progris Med., 1877, p. 677 ; New York Med. Journ., xxiii.,p. 179),$ 
but it does so slowly, and in the great majority of cases after warnings which 
can be overlooked only through the most reckless carelessness.§ Many of 
the inconveniences which attend the use of ether can be obviated. Thus, in 
order to prevent the nausea which often follows the anaesthesia, the patient 
should avoid eating for at least six hours before the inhalation, and should 
take from one to two ounces of brandy just before commencing the latter 
process. 
Unlike that of chloroform, the vapor of ether should be administered in 
a concentrated form. When so inhaled, in most persons it will produce 
complete insensibility in from three to eight minutes, provided that no 
uncharged air be admitted during the time named.§ According to Dr. 
Snow, air at 80° F. saturated with ether contains seventy-one per cent, 
of the vapor. This point is probably never reached in the practical use of 
ether, but the nearer it is approached the more rapid will be the induction 
of anaesthesia. 
* Twenty-seven cases of sudden death from ether are collected by Dr. II. M. Lymau 
{Artificial Aniesthesia, New York, 1881). In most cases the respiratory centres were 
already enfeebled. Brain tumors, obstructions of the bowels, cancerous tumors, seem even 
more important contraindications than cardiac disease. In disease of the heart ether is 
probably the safest of the anaesthetics; but when there is great exhaustion of the nervous 
system its use requires great caution. Sudden pulmonic cedema, outpouring of bronchial 
mucus, and fatal cerebral hemorrhage have occurred during, or directly after, the anaes- 
thesia. 
f For case in which a fatty heart apparently suffered sudden arrest, see Brit. Med. Journ., 
1887, ii., p. 602. 
J See also Gaz. Hebdom., 1878, p. 583. 
§ Various inhalers have been invented for facilitating the use of ether, but they are very 
rarely used. For information on these points, see New York Medical Record, May 1, 1866, 
and New York Medical Journal, April, 1871. The inhaler of Dr. Allis is probably of real 
service. See Philadelphia Medical Times, vol. iv. ANESTHETICS. 
315 
The ordinary method of the administration of ether in Philadelphia is as 
follows: 
Out of stiff paper a cone is made of such size and shape that its base will 
fit closely over the nose and mouth of the patient. In this cone a napkin, 
a small towel, or a conical, hollowed-out sponge is to be placed. About an 
ounce and a half of ether having been poured on the napkin, the cone is to 
be closely applied to the face of the patient, and kept there. If anaesthesia 
be not complete in four or five minutes, a second dose of ether should be 
put on the napkin, care being taken that the removal of the apparatus is 
only momentary. When patients are fastidious, and a few moments are of 
no importance, the gradual commencement of the inhalation is much more 
pleasant, as the first choking sensation is thereby to a great extent avoided. 
In using ether at night, its inflammable nature must not be forgotten. I 
have seen fire flash from a candle through some four or five feet of diffused 
vapor to the sponge. The light should always be above the patient, as the 
high specific gravity of the vapor of ether causes it to fall towards the floor. 
Administered by the mouth, ether has been used with advantage in vari- 
ous forms of colic, but is generally inferior to chloroform. When, however, as 
in some cases of retrocedent or internal gout, there is with the painful gastric 
and intestinal spasm a condition bordering on collapse, the stimulant proper- 
ties of ether make it very valuable. 
In sudden sinking-spells, either from poison or from natural causes, ether, 
as a powerful and very quickly-acting stimulant, is often indicated. In some 
cases of this description it may even be administered by inhalation. Of 
course, under these circumstances its influence should not be carried nearly 
to the point of producing anaesthesia. 
As an anthelmintic, ether has been used by MM. Bourdier and Lortet 
with success against the tape-worm. For this purpose, an ounce and a 
half may be administered at once, followed in two hours by a full dose of 
castor oil. 
In hysteria, neuralgia, nervous headache, and spasmodic neuroses, such as 
hiccough and asthma, ether is occasionally employed with benefit. 
When ether is swallowed, it produces a sense of strangulation and choking, 
which seriously interferes with its use. For this reason, it is best given in 
capsules, or in ice-cold water. Probably large doses are best administered by 
putting them, mixed with an equal amount of brandy, on finely-cracked ice 
before drinking. The dose is from one fluidrachm to half a fluidounce. 
Etherization by the rectum has been tried and discarded because of the 
severe local irritation produced, as well as the slowness of the production of 
insensibility. 
Methenyl Chloride-Terchloride of Formyl (C2IIC18-CHC1S). 
This substance, which was discovered in 1831 by Mr. Samuel Guthrie, of 
CHLOROFORMUM-CHLOROFORM. 316 
SYSTEMIC REMEDIES. 
Sackett's Harbor, N. Y., is produced by the action of chlorine upon alcohol. 
It is a colorless, limpid, and neutral fluid, which is for practical purposes unin-- 
flammable, although it can be made to burn with a greenish flame (Fowness 
Chemistry, Am. ed., 18G9, p. 56G). Its taste is hot and sweetish; its odor 
fragrant and peculiar. It is soluble in alcohol and in ether, but when dropped 
into water it sinks, if pure, as transparent globules without milkiness. The 
alcoholic solution, when moderately diluted with water, forms an aromatic, 
sweetish liquid. It is antiseptic, but does not coagulate albumen. 
In the U. S. Pharmacopoeia it is officinal in two forms. 
ClILOROFORMUM VENALE-COMMERCIAL CHLOROFORM. U.S.-The 
crude chloroform of commerce. Sulphuric acid, when shaken with it, after 
a time separates as a stratum of a dark-brownish color. This color is due to 
a carbonization by the acid of the impurities in the chloroform. 
Chloroformum Purificatum-Purified Chloroform. U. S.-The 
U. S. Pharmacopoeia directs that the commercial chloroform shall be purified 
by the action on it of sulphuric acid and by subsequent neutralization with 
carbonate of sodium, and distillation in a retort containing quicklime. Puri- 
fied chloroform should respond to the following tests : Sulphuric acid shaken 
with it should not be colored; it should not alter litmus blue, even after it 
has been exposed in a white glass bottle to direct sunlight for ten hours. 
Physiological Action.-Although somewhat of an anaesthetic, chlo- 
roform applied locally is a powerful irritant. On the skin it produces redness 
and burning; if the evaporation be restrained, vesication is induced by it. 
Taken into the mouth, it causes a burning sensation, and, when swallowed, a 
sense of warmth in the stomach. 
The vapor of chloroform, when inhaled, produces symptoms seemingly 
similar to those induced by ether, except that the choking sensations aro 
absent, and that the stage of excitement is generally, but not always, shorter 
and less violent than that of etherization. 
Dr. Snow (On Anaesthetics, London, 1858) divides the chloroform-narcosis 
into four degrees or stages, but the division adopted by Sabarth (Das Chlo- 
roform, Wurzburg, I860) and most writers seems more useful. This classifi- 
cation recognizes three stages. In the first of these, the symptoms are similar 
to those of alcoholic intoxication. This stage is generally very short, but in 
atjiletic persons, and especially in those who have been intemperate, it may 
be very long and very violent, and may persist after loss of consciousness. 
In drunkards, this excitement at times cannot be overcome without grave 
danger to life. During this first stage, although consciousness is not lost, 
the sensibility is generally blunted, but very rarely is it altogether annulled. 
Dr. Coleman (Sansom, Chloroform, p. 55, Philadelphia, 18G6) states, how- 
ever, that he has extracted his own teeth without pain ; and Dr. Snow relates ANESTHETICS. 
317 
the anecdote of a child who played with his toys during the operation of 
lithotomy. 
During the second stage, which is that of anaesthesia, the consciousness 
and sensibility are abolished, the muscles are relaxed, and the patient lies 
perfectly quiet. This is the surgical stage, during which ordinary operations 
are performed. As already intimated, in some cases the first and second 
stages are united, so that violent excitement, muscular spasm, and rigidity 
may coexist with loss of consciousness and of sensibility. 
The third stage is one of profound narcosis, with stertorous breathing, 
intense muscular relaxation, and abolition of ordinary reflex actions. This is 
always a condirton of danger, and its. induction, except under very peculiar 
circumstances, by chloroform, is absolutely unjustifiable. 
The pulse in the first stage of chloroform-narcosis may be quickened, even 
apparently strengthened; in the second stage it is generally about normal in 
frequency, but is more or less weakened; in the third stage it may be rapid 
and weak. Dr. Noel (Load. Med. Record, 1877, p. 457) calls attention to 
a cervical venous pulse, most marked in the external jugulars, which he 
asserts frequently occurs during the waking up from chloroformization. 
He believes it to be a symptom of serious cardiac embarrassment. E. Simo- 
nin found that the temperature usually rises during the first stage (.1°-.8°C.), 
falls slightly during the second or remains above normal, and falls decidedly 
during the third stage (Centralb. Chirurgie, 1877, p. 234). 
In man the first arrest of respiration, so obvious in etherization, rarely if 
ever occurs. This is probably in great measure owing to the chloroform 
vapor, as employed, being much more dilute than the ether vapor. The 
experiments of Holmgren, Kentschmer, and others have shown that upon 
the lower animals the respiratory action of chloroform is similar to that of 
ether (see p. 281), excepting in that it is much more intense. 
Dr. Baudin (Le Progres Med., Sept. 1874) called attention to the pupil 
as a guide in chloroformization, stating that, although at first it is uniformly 
dilated, afterwards it is uniformly immovably contracted, and that this is 
the period for operating. Schliiger is in accord with Dr. Baudin ; in one 
hundred and twenty out of one hundred and twenty-two cases observed the 
pupil was dilated during the stage of excitement, during complete anaesthesia, 
narrowly contracted. He also states that if during anaesthesia the pupil re- 
turns to normal more chloroform is required, but if it suddenly dilates danger 
is imminent. At present, however, the condition of the pupil cannot be con- 
sidered a safe guide in anaesthetization. Dogiel (Reichert's Archiv fiir Anat., 
1866) affirms that in rabbits, during the stage of excitement, the pupil is con- 
tracted ; during anaesthesia, dilated. Prof. Schiff has strenuously combated 
the conclusions of Baudin; and in a very careful series of experiments on 
animals Dr. W. II. Winslow found that the state of the pupil varies very 
greatly in the same stage of anaesthesia. Thus, in complete anaesthesia, 
sometimes the pupil was widely dilated, sometimes contracted; and death 318 
SYSTEMIC REMEDIES. 
sometimes occurred with a dilated, sometimes with a contracted pupil; in 
the former case probably being syncopal, in the latter asphyxial {Philad. 
Med. Times, vi., p. 275). 
The action of chloroform on the nervous system, like that of ether, is 
chiefly upon the brain and spinal centres. Carter {British Medical Journal, 
Feb. 1867) found that very decided anaemia of the brain can be seen in 
animals subjected to its influence after the cerebrum has been laid bare; and 
accident in man {Amer. Journ. Med. Set., 1860) has furnished the corrobo- 
ration of his experiments. Bernstein {Schmidt's Jahrhucher, Bd. cxlii. p. 
227) has demonstrated that its action on the peripheral nerves is very 
slight. He found that there was no perceptible difference in the conducting 
power of the two ischiatic nerves of a frog, chloroformed after one of its iliac 
arteries had been tied. It is doubtful how far the muscular excitement of 
the second stage is due to real spinal exaltation and how far it arises from 
other causes. Bert asserts ( Comptes-Rendus, t. Ixiv., 1867) that it is purely 
psychical, and that there is during the production of anaesthesia a steady 
lowering of reflex activity. He rests this assertion upon the fact that, in 
animals chloroformed after section of the cord, there is no motor disturb- 
ance below the point of section,-a fact which certainly demonstrates at least 
that the muscular excitement and the convulsions are cerebral. 
In some animals the first effect of the inhalation of chloroform upon the 
circulation is a decrease in the frequency of the heart's action. Dogiel 
believes that this is due to a stimulation of the inhibitory centres, because he 
has found that it does not occur after section of the vagi. The after-increase 
in the rapidity of the pulse appears to be due, at least in part, to paralysis 
of the inhibitory centres, upon which chloroform seems to act as upon the 
oculo-motor centres, producing in them at first excessive functional activity, but 
afterwards functional paralysis. Both Kentschmer and Knoll (loc. cit., p. 11) 
have noticed in rabbits, when either ether or chloroform is inhaled through 
the nose, a momentary rise of arterial pressure corresponding to the arrest 
of respiration, and, like it, evidently produced by irritation of the peripheral 
trigeminal branches. 
The very careful experiments of the English Chloroform Committee {Med.- 
Chirurg. Trans., vol. xlviii. p. 326) proved that after the first half-minute of 
the inhalation of chloroform there is a progressive lowering of the arterial 
pressure. It would, a priori, appear probable that this is to some extent due 
to a vaso-motor paralysis ; but Sansom and Harley state that there is a spasm 
of the small vessels, which can be readily seen to occur in the web of the 
frog during chloroformization. Not until the third stage is reached, accord- 
in" to these authors, do the vessels relax into dilatation. If these observations 
are correct, chloroform first stimulates and afterwards depresses the vaso- 
motor centres. Elsewhere in the present work I have dwelt upon the fallacies 
of the observations of such as those just quoted, and the experiments upon 
arterial pressure of Prof. II. P. Bowditch and C. S. Minot {BostonMedi- ANESTHETICS. 
319 
cal and Surgical Journal, May, 1874) appear to prove that the fall of 
pressure is in part due to a paralysis of the vaso-motor centre. They found 
that after the exhibition of the drug in curarized animals galvanization of 
a sensitive nerve is followed by no rise of pressure, or a very slight one, 
and that compression of the carotids did not cause the customary vaso-motor 
spasm and rise of arterial pressure. 
On the heart itself chloroform undoubtedly exerts a steady, powerful 
depressing influence. Injected into the jugular vein, it instantly arrests the 
heart's action and destroys its muscular irritability.* Even the vapor of 
chloroform, when locally applied to the exposed heart, paralyzes it {Edinl. 
Aled. Journ., 1842/ When artificial respiration is maintained the effect 
of chloroform upon the heart is very apparent (Journ. Anat, and Physiol., 
xiii 226). It is, therefore, demonstrated that chloroform applied in a suf- 
ficiently concentrated form destroys the contractile power of the heart-muscle. 
The respirations may at first be rendered slower by chloroform, but after a 
time are generally quickened, and as the inhalation is persisted in they become 
more and more shallow, irregular, and distant, and finally cease. 
In animals, without doubt, chloroform, when inhaled, usually produces 
death by abolishing the functional power of the medulla oblongata and 
thereby arresting respiration. It has been denied that chloroform-vapor ever 
kills animals in any other way.f This is, however, a mistake.J If the 
chloroform vapor be administered in a very dilute form, the heart generally 
continues to beat for a long time after the cessation of respiration. If the 
vapor have been less diluted, cardiac and respiratory action may cease almost 
simultaneously. If the vapor have been administered in a concentrated form, 
arrest of the heart's beat may precede arrest of respiration § 
•When death is produced by chloroform in man, it is generally by cardiac 
arrest, sometimes by asphyxia. That syncope occurs proportionately more 
frequently in man than in animals, is simply because this form of death is 
sudden and unexpected. Asphyxia comes on gradually, so that in man the 
threatening symptoms are perceived, and death is averted by prompt meas- 
ures. In animals, however, the object being to kill, nature is allowed to 
take its course.|| 
The evidence is not at present sufficient to enable a positive determination 
as to whether the action of the anaesthetic upon the heart, when a sudden 
fatal syncope is produced, is a direct one, or whether it is a reflex one (T. D. 
* Glover (Edinb. Med. Journ., 1842), Gosselin (Arch. Gen., 1848), Anstie. II. C. Wood. 
| See, especially, report of the French Chloroform Commission. Sabarth, Idas Chloro- 
form, p. 44. 
+ Consult Snow, On Anxstheties, p. Ill; Anstie, Stimulants and Narcotics ; Richardson, 
Medical Times and Gazette, 1870 : Chloroform Committee, Medico-Chirurgical Transac- 
tions, vol. xlvii.; Vulpian, Lemons stir I' Appareil Vaso-Moteur, vol. ii. p. 157. 
$ Compare Journ. Anat. and Physiol., xiii. 226. 
|| For proof that cardiac death does occur among animals, see Jour. Anat. and Physiol., 
xiii., p. 224. 320 
SYSTEMIC REMEDIES. 
Lente, Psychol. and Med. Legal Journal, Feb. 1875), due to an irritation 
of the peripheral filaments of the pulmonic nerves. Certainly those who 
believe it to be reflex have as yet brought forward no proof of their theory. 
As chloroform does act directly upon the heart, it seems to me wiser to hold 
to its direct action until it has been demonstrated that it is impossible to 
produce syncope after division of the par vagum. The mere rapidity of the 
occurrence is of little importance, as pulmonic absorption is practically 
instantaneous and the blood goes directly from the lungs to the heart. 
What is true of the theory of reflex syncope is also true of various other 
theories which have been brought forward to account for the chloroform 
deaths. I think they are unnecessary and unproven, although some are 
ingenious, and it is possible that death Vnay take place at times in the way 
they suggest. Want of space prevents my doing more than giving refer- 
ences to the most important papers.* 
According to Harley {Physiological Transactions, London, 18G5), blood 
to which as little as five per cent, of chloroform has been added becomes 
very liquid and of a bright arterial hue. After a time crystals form in it. 
Boettcher ( Virchow's Archiv, vol. xxxii. p. 126) was, I believe, the first to 
study these changes closely. The first alteration noticeable in the red blood- 
disks is a diminution of their size, which A. Schmidt and F. Schweiger- 
Seidel {Berichte d. konig. sacks. Gesellsch. d. Wissensch., math-phys. KI., 
1867, p. 190) assert to be due to contraction, because when blood is treated 
with water until the red globules disappear, and carbonic acid gas is passed 
through the liquid until they reappear, on the addition of chloroform the 
sharply-contoured bodies will be seen to undergo marked contraction. As 
was first shown by Boettcher {loc. cit., p. 127) and confirmed by Schmidt 
and Schweiger-Seidel, chloroform alone produces no other alteration than 
contraction in the red blood-disks. If, however, air be admitted to blood 
containing chloroform, the corpuscles rapidly disappear, dissolving in the 
serum, out of which, after a time, haematin crystallizes. Both of the authori- 
ties quoted believe that the latter changes are due to oxidation. 
Boettcher states {loc. cit., p. 129) that chloroform-vapor mixed with air 
converts enough of the oxygen of the latter into ozone to react with iodinized- 
starch paper; and Schmidt and Schweiger-Seidel have found that an excess 
of carbonic acid in the blood interferes with the changes caused by chloro- 
form. From these facts it seems probable that their opinion as to the nature 
of the blood-changes is correct. Harley {loc. cit.) has studied the effect of 
chloroform on the absorption of gases in the blood. He states that when 
chloroform is added to fresh blood, and the mixture allowed to stand for 
* Richardson, Medical Timesand Gazette, 1870. Andrew II. Smith. Neio York Medical 
Journal, 1871, p. 40. Consult also J. C. Reeve, American Journal of the Medical Sciences, 
Oct. 1867 ,: Henry M. Gibbons, Jr., Pacific Medical and Surgical Journal, June, 1869 ; 
Snow, On Amesthetics ; Sansom, On Chloroform; and 0. W. Copeland, Philadelphia 
Medical Times, p. 550, 1874. ANAESTHETICS. 
321 
twenty-four hours, a marked increase takes place in the proportion of oxygen 
and a lessening in that of carbonic acid. This is in accord with the theory 
just mentioned; for, after the complete oxidation of the haemato-globulin 
brought about by the chloroform, further consumption of oxygen could not 
occur, and, as it continued to be absorbed from the air, it would accumulate 
instead of being converted into carbonic acid. 
How far, during ordinary narcosis, chloroform produces the changes just 
described in the blood, is somewhat uncertain ; but it would seem very im- 
probable that they occur to any great extent. A very sensitive test of the 
destruction of the red disks in the body is found in the production of icterus; 
and icterus never follows anaesthesia. On the other hand, Husemann 
(Schmidt's JaJtrbucher, Bd. cli. p. 84) intimates, on what authority I do not 
know, that after anaesthesia bile-acids appear in the urine ; and Bert (Journal 
of Anatomy and Physiology, May, 1870) has found that the oxygen of the 
blood undergoes during anaesthesia an increase, such as Harley has found to 
happen when chloroform is added to blood outside of the body. Nothnagel 
(Berlin. Klin. Wochensch., 1866) found in rabbits, after subcutaneous injec- 
tions of chloroform or ether, bile coloring matter in the urine ; but Kappeler 
(Die Anarrsthetica, Stuttgart, 1880), in twenty-five cases of chloroform nar- 
cosis, was not able to obtain a trace of biliary coloring matter (Zeitschrift 
f. Physiolog. Chern., viii.). 
Chloroform is undoubtedly, at least in part, eliminated as chloroform 
escaping with the breath, also with the urine. Fubini (Moleschott's Unter- 
suchungen zur Naturlehre, Bd. xiii. 1882) found it in the urine five hours 
after its inhalation. Dr. A. Zeller believes that it is in part decomposed, 
because he has found the chlorides in the urine nearly doubled by its in- 
halation (Zeitsch. f. Physiolog. Chemie, Bd. viii. p. 74). 
Albuminuria has been noticed both in animals and man after chloroform 
narcosis (Gaz. Hebdom., Fev. 1884, 104; also Brit. Med. Journ., 1883, ii. 
623). It is affirmed, also, that astigmatism has been produced by chloro- 
form inhalations (Brit. Med. Journ., 1883, ii. 476). 
Therapeutics.-As an anaesthetic, chloroform possesses the advantages 
of quickness and pleasantness of operation, smallness of dose, and cheapness. 
These advantages are, however, so outbalanced by the dangers which attend 
its use, that its employment under ordinary circumstances is unjustifiable. 
It kills without warning, so suddenly that no forethought or skill or care 
can guard against the fatal result. It kills alike the robust, the weak, the 
well, and the diseased; even the previous safe passage through one or more 
inhalations is no guarantee against its lethal action. Statistics seem to indi- 
cate a mortality of about one in three thousand inhalations ;* and hundreds 
* See Richardson, Medical Times and Gazette, 1870; Henry M. Gibbons, Jr., Pacific Med- 
tcal Journal, June, 1869 ; Squibb, On Anaesthetics, New York Medical Journal, April, 1871. 
Lyman has collected 342 cases of death from chloroform against 27 from ether, and gives 
the ratio of death in anaesthesia, chloroform, 1: 5860; ether, 1: 16,542. Nitrous oxide 322 
SYSTEMIC REMEDIES. 
of utterly unnecessary deaths have been produced by the extraordinary per- 
sistence in its use by a portion of the profession. It ought never to be 
employed except under especial circumstances, as when a speedy action is 
desired in puerperal eclampsia, or when the bulkier anaesthetics cannot be 
transported, as in the field during war-time. 
In obstetric cases, chloroform has been used even by those who give the 
preference to ether in surgery. So far as I know, no death has as yet 
occurred from chloroform during parturition, although alarming effects have 
been induced. The excitement of child-birth does seem to fortify the system 
against the deleterious influence of chloroform. But even in these cases I 
think ether is just as useful as, and much safer than, its sister-anaesthetic. 
Various mechanical inventions have been made for the administration of 
chloroform; but these inhalers do not appear to offer any advantages over 
the simple napkin, and, at least in this country, are rarely, if ever, used.* 
A handkerchief or towel may be folded into a bird's-nest shape, and twenty 
or thirty drops of the anaesthetic be put upon this and then held close to the 
mouth. Dr. Simpson advises that a towel be laid over the mouth and nose, 
and the chloroform slowly dropped upon this until anaesthesia is induced. 
Whatever plan be employed, it is of vital moment that the vapor be well 
diluted : not more than three and one-half per cent, of it should be contained 
in the inspired air. 
When administered by the mouth in sufficient quantity, chloroform pro- 
duces symptoms similar to but much more permanent than those which it 
causes when inhaled. It is, however, very rarely, if ever, used in this way 
for its constitutional effect, but is sometimes of advantage in severe neuralgia. 
Vhen quinia for any reason cannot be administered in an ague, a suffi- 
cient dose of chloroform (f3ss to f^i) to produce a mild narcosis, given just 
before the expected time for the recurrence of the chill, will usually abort it. 
When chloroform is taken into the stomach, a considerable portion of it 
is, without doubt, evaporated, so that the intestinal canal becomes filled with 
the vapor. Chloroform, therefore, when so placed exerts both a local anodyne 
and a stimulant carminative action. For this reason it is extremely valuable 
in all cases of colic, and it will often even assuage the pain of colica pictonum. 
Externally, as a rubefacient and anodyne, chloroform is very largely com- 
bined with other substances into liniments, which are especially useful in 
cases of chronic neuralgic or rheumatic pains. 
appears to be the safest of all the anaesthetics, its ratio, according to Rottenstein, being 
1:100,000. 
The mixture of' ether and chloroform used by some surgeons is open to the very serious 
objection that owing to the different volatility of the two agents the percentages of each 
in the inhaled vapor varies continually. The mixture has in several cases produced death, 
and is probably no safer than pure chloroform. For latest fatal case, see Comp.-Rend. 
Soc. Biolog., 1883, iv. 241. 
* For a description of inhalers, see works of Sansom and Snow; also Allis, Phila. Med. 
Times, iv. ANESTHETICS. 
323 
Toxicology.-Death may occur at any time during the inhalation of 
chloroform. In some cases it has seemed to be instantaneous, but generally 
it is preceded by symptoms such as a change in the expression of the face, 
which becomes very pale or livid, evident irregularity of the respiration, and 
failure of the pulse: a shudder, or a violent convulsion, or even a sudden 
access of maniacal excitement, has been noted in some cases. After death 
the heart is almost always found relaxed, distended, and its right side filled 
with blood. 
When death is threatened through asphyxia, the alternate dashing of very 
cold and very hot water upon the face and upper chest is often very effica- 
cious. Artificial respiration should be commenced at once. Faradization of 
the diaphragm, by pressing one pole firmly against the pit of the stomach 
and placing the other over the larynx and the root of the neck, has acted 
very favorably in some cases. Dr. Richardson has shown (Zoe. cit.') that 
there is a danger of the excitability of the muscle being exhausted by a 
prolonged use of the galvanic stimulus. The application should not, there- 
fore, be long continued, but should be alternated with artificial respiration. 
Whenever there is any failure of the heart's action, as is nearly always the 
case, the body should be laid at an angle of 40°, with the head downwards, 
so as to favor the passage of arterialized blood to the brain (Dr. E. L. 
Holmes, Chicago Medical Journal, Sept. 1868).* 
In artificial respiration, act with the patient, and not against him. He 
will not cease to breathe at once, and wholly. Enjoin silence; watch the 
first attempt at inspiration, and at the expiration compress the thorax, aiding 
its elastic reaction, if absolutely necessary, by Silvester's or some other quiet 
method. See that the tongue is well forward. Dry external heat must be 
vigorously used, and the inspired air should be at from 80° to 85° F., or 
even higher. Frictions and passive motion, to aid in the circulation, must 
not be forgotten. Efforts at resuscitation should be kept up for at least two 
hours. Nitrite of amyl has been used as a means of restoring' the heart's 
action, but its power must still be considered entirely sub judice (see N. F. 
Med. Journ., xxiv., p. 467). Ammonia injected into a vein and digitalis 
hypodermically given, may be used to stimulate the circulation, but alco- 
hol, if employed at all, must be given very cautiously and with the utmost 
reserve. Its action upon the heart when in excess is precisely that of chlo- 
roform, and the experiments of R. Dubois (Progrbs Med., 1883, xi. 951) 
show that when alcohol is given freely to the lower animals it intensifies the 
influence of chloroform, and lessens the minimum fatal dose. In syncope 
during ether narcosis, alcohol is of still more doubtful value. 
Poisoning has been produced by the swallowing of chloroform. The 
* I have allowed this sentence to remain as it was in the last edition. Since it was first 
published, the method has been brought forward as new, and as having originated with 
Nelaton (Philadelphia Medical Times, vols. iv. and v.) The position of the patient is of 
extreme importance. In severe cases the head should be placed vertically downwards. 324 
SYSTEMIC REMEDIES. 
symptoms induced have been stupor, with contracted, or, in later stages, 
dilated, pupils, and a stertorous respiration, which finally becomes very 
irregular, shallow, and often distant. The amount necessary to destroy 
life probably varies greatly. Recovery has occurred after the ingestion of 
two ounces (Stille, Therapeutics, vol. ii. p. 107), of one ounce (Canada 
Lancet, March, 1874), also of three ounces without vomiting (Brit. Med. 
Journ., 1882, i. 776). The treatment consists in the use of the stomach- 
pump and of the various ordinary methods of arousing a narcotized patient, 
especially the alternate cold and hot douche, artificial respiration, and the 
very cautious use of diffusible stimuli if required. Death may occur during 
the narcosis, or the patient may survive this and perish from inflammation 
of the trachea, oesophagus, and stomach, caused by the local action of the 
chloroform. 
The recognition of chloroform as the probable cause of any given death 
cannot be based upon the post-mortem appearances. Indeed, the latter are 
of no value in deciding such a question. The anaesthetic may, however, be 
recovered by distillation of the lungs and blood within a certain period 
of time after death. As to the length of this time, so far as I am aware, 
no investigations have been made. 
Experiments made at the Philadelphia Hospital and confirmed by Prof. 
Dolbeau (Annales d' Hygiene, Jan. 1874) have proven that persons sound 
asleep may be chloroformed without their being awakened. Anaesthesia 
cannot, however, be produced in any one partially awake, or even sleeping 
lightly, without his knowledge. 
Quite a number of professional men have been accused, and some con- 
victed on the charge, of committing rape on females in whom they were 
inducing anaesthesia. The women, no doubt, believed that they had been 
violated; but it is certain that in many of the cases, and probable that in all 
of them, they mistook for the real act the subjective erotic sensations induced 
by the chloroform or ether. The valuelessness of the testimony of persons 
as to occurrences during the time of their intoxication with anaesthetics 
should be recognized by law as a governing principle of evidence. 
Administration.-Internally, from fifteen drops to a fluidrachm of 
chloroform may be given in emulsion, or, as it has recently been stated, 
dissolved in glycerin (1 to 3). The deep injection of half a drachm of 
chloroform has been recommended very strenuously by Prof. Bartholow in 
obstinate neuralgia, and has found some favor in France (Bull. Th^rap., 
xciii., pp. 433, 471). In the only case in which I have tried it, one of tri- 
geminal neuralgia, the local symptoms caused by it were so severe as to 
imperil the life of the patient. The U. S. Pharmacopoeia recognizes a spirit 
(Spiritus Chloroformi-1 to 10, U. S.), dose, one to two fluidrachms, and 
a mixture (Mistura Chloroformi, U. S.). From the commercial chloroform 
a liniment (Linimentum Chloroformi, U. S.). 
Bichloride of Methylene was introduced to the notice of the profession ANESTHETICS. 
325 
by Dr. B. W. Richardson (Medical Times and Gazette, 1867, p. 478) as an 
anaesthetic similar to, but more pleasant and possibly safer than, chloroform, 
and has been rather extensively used in London. It has never been largely 
employed in this country. There is no way of knowing how many times it 
has been administered, but nine cases of death from its use are recorded 
(British Med. Journ., 1883, ii. 104). The detailed phenomena in some 
of these cases indicate that, like chloroform, the bichloride of methylene 
kills by paralyzing the heart. It is not probable that it will ever come into 
general use as an anaesthetic. 
The Bromide of Ethyl * has been used as an anaesthetic, and at one time 
bid fair to become very popular. The occurrence of two deaths during its 
use, however, early arrested its successful career. It is a very prompt 
anaesthetic, in most cases acting even more quickly than does chloroform, 
but less agreeably to the patient. Recovery is very prompt. Its action upon 
the heart is the same as that of chloroform. Injected into the jugular vein, 
it arrests the heart, and one death produced by it was distinctly by syncope. 
In some cases it has seemed very irritant. It appears to be quite as 
dangerous as chloroform, and will probably never be used to any extent in 
practical medicine. 
Bromoform.-According to the researches of Bonome and Mazza, this 
substance acts as a general anaesthetic both upon man and animals, causing, 
however, much irritation of the conjunctiva and nasal mucous membrane. 
The narcotic stage is slowly developed and passes off slowly; the blood- 
pressure sinks somewhat; the respiration is not disturbed; the irritability 
of the brain cortex is diminished. Bromoform is said also to be a powerful 
antizymotic (Central^, f. Chirurgie, 1884, 594). I see no reason for be- 
lieving that bromoform will be of any value as an anaesthetic. See also Med. 
Jahrb. Wien., 1883, 497. 
* In a valuable paper (Amer. Jour. Med. Sci., July, 1881) Dr. E. T. Reichert brings 
much evidence to show that all anaesthetics containing a halogen are cardiac depressants. 
He makes out his case sufficiently to at least warrant great caution in the use of any 
such anaesthetic. CLASS IX-EXCITO-MOTOKS. 
IN this class are included such drugs as increase the reflex activity ot 
the spinal centres and thereby give rise to disturbance of motility. The 
only representatives of the class used by the practitioner of medicine are 
those drugs which contain strychnia as their active principle. 
The seeds of Strychnos nux vomica, a middle-sized tree growing in the 
East Indies, whence the drug enters commerce. They are circular, nearly 
flat disks, a little less than an inch in diameter, covered with very short, satin- 
like, grayish hairs; internally they are tough and horny, and are possessed 
of an intensely bitter taste. They contain two alkaloids,-strychnia and 
brucia,-existing in combination with an acid, the igasuric of Pelletier and 
Caventou, which, according to Ilusemann, is probably identical with malic 
acid. Brucia, which, unlike strychnia, is not officinal, is readily recognized 
by the following test. When concentrated nitric acid is added to it, a beau- 
tiful scarlet or blood-red color is developed, which becomes yellowish-red, and. 
by warming, yellow ; if to this yellow solution, somewhat diluted, some chloride 
of tin or sulphuret of ammonium be added, it becomes a beautiful reddish- 
violet. Physiologically and therapeutically this alkaloid is similar to, but 
weaker than, strychnia. 
The dose of the extract (Extractum Nucis Vomicx, U. S.) is from one- 
fourth to one-half of a grain, given in pill; of the tincture (Tinctura Nucis 
Vomicx-1 to 5, U. S.), fifteen to twenty-five drops; of the abstract (Ab- 
stractum Nucis Vomicee, U. S.), one to two grains; of the fluid extract 
(Bxtractum Nucis Vomicx Fluidum, U. S.), two to three minims. 
NUX VOMICA-NUX VOMICA. U. S. 
STRYCHNINA. U.S. 
As kept in the shops, strychnia is a grayish-white powder, but by slow 
crystallization from its alcoholic solution it may be obtained in octahedral or 
in quadrilateral prisms. It is soluble in about seven thousand parts of cold 
water ; in two thousand parts of boiling water; very sparingly soluble in abso- 
lute alcohol, ether, and benzine; freely soluble in boiling officinal alcohol, 
which deposits it on cooling. It is so bitter that it will impart a very intense 
taste to twenty thousand times its weight of water. 
Strychnia yields a very pronounced violet color with many oxidizing re- 
agents. The one most ordinarily employed is a mixture of concentrated sul- 
phuric acid and bichromate of potassium ( Otto's test). According to Dr. Guy, 
the test is most delicate if the alkaloid be dissolved in a little concentrated 
sulphuric acid on a plate, and the bichromate added to it, when a bluish and 
326 EXCITO-MOTORS. 
327 
then violet-purplish color is developed, passing finally into a dirty green. 
Davy's test consists in the substitution of a crystal of red prussiate of potas- 
sium for the bichromate. Marchand uses the peroxide of lead; in this case 
the sulphuric acid should contain one per cent, of nitric acid. Drs. Vrij and 
Van der Burg say that these tests are about equally sensitive, and are capable 
of revealing the one sixty-thousandth of a grain of the alkaloid. Either the 
chlorate or the permanganate of potassium may be used instead of the bi- 
chromate ; indeed, Dr. Guy claims that the permanganate is preferable to 
the latter. If the strychnia be in quantity, it may be dissolved in very 
dilute sulphuric acid, and solution of bichromate of potassium be added, 
when golden-red needle-like crystals of the chromate of strychnia will sepa- 
rate. These dissolve, with the production of a beautiful blue color, in con 
centrated sulphuric acid. F. L. Sonnenschein ( Vierteljahresschrift fur Prakt. 
Pharmacie, 1871) says that if strychnia be dissolved in a strong solution of 
the sulphate of sesquioxide of cerium a beautiful color is induced, which 
generally passes into a cherry-red, and so persists for several days. Dr. 
Filchol's test (Lancet, April, 1872) consists in the addition of solution of 
chloride of gold, and the testing of the precipitate by Otto's method. The 
physiological test for strychnia is a very sensitive one. In it a fragment of 
the suspected extract, dissolved in a little acidulated water, is thrown into 
the cellular tissue of a small frog, which should afterwards be allowed to 
swim about freely, so that its unconstrained movements can be watched. 
Physiological Action.-Strychnia acts in the same way upon almost 
all animals. According to Leube (Reichert's Archiv fiir Anatomic, 1867, 
p. 630), however, it takes ten times as much to kill chickens as other birds, 
weight for weight; and among mammals the guinea-pig is very insensitive to 
it. It has also recently been asserted that on some monkeys it has very little 
influence (Boston Medical and Surgical Journal, 1872). Its local action is 
that of a slight irritant.* 
When taken in quantities just sufficient to produce sensible physiological 
effects, strychnia in man induces a feeling of restlessness, perhaps accompa- 
nied by tremblings in the limbs and some stiffness in the neck and jaws. 
When a somewhat larger amount has been given, there may be general mus- 
cular twitchings and startings, with stiffness and stricture of the throat and 
chest; formications or other abnormal sensations under the skin may or may 
not be present. After poisonous doses the symptoms come on usually in from 
fifteen to twenty minutes, rarely after the hour, with great suddenness ; some- 
times the convulsions are preceded by partial spasms of the muscles of the 
extremities, but more often the patient is suddenly thrown down by a general 
tetanic spasm. In this the body is bent backwards and rests upon the heels 
and the head, in a condition of profound opisthotonos; the legs are rigidly 
* For an elaborate memoir on the effect of age on action of strychnine, see Arch. f. 
Ges. Physiolog., 1884, xxiv. 530. It is affirmed that very young animals require very 
large doses to kill. 328 
SYSTEMIC REMEDIES. 
extended and the feet everted; the arms bent and the hands clenched; the 
eyes staring, wide open ; the corners of the mouth often drawn up so as to 
produce the risus sardouicus. The senses are often sharpened, but ringing 
in the ears and dimness of vision may be induced if the fits are severe. The 
face is at first pale, but, if the fit is sufficiently severe and be protracted, it 
becomes livid from the interference with respiration. Consciousness is not 
affected, unless when asphyxia becomes so pronounced as to threaten death ; 
in such cases sometimes a period of insensibility precedes dissolution, but 
generally the intellect is clear to the moment of death. The muscles of the 
jaw are usually the last in the body to be affected, but trismus finally comes 
on in severe cases. I have seen death occur in this first convulsion in ani- 
mals ; but Tardieu states that he knows of no such instance in man (compare 
case of Dr. Demme, Syd. Soc. Year-Book, 1865-66, p. 441). After a time 
the paroxysm is at an end, the jaw drops, the muscles relax, and a period of 
calm comes on, to be succeeded by a second convulsion like the first. These 
convulsions are excited by the slightest touch, by a draught or breath of air, 
even by a loud sound ; but a firm grasp or hard rubbing of the muscles is 
frequently grateful. A slight rigidity is sometimes manifest between the 
paroxysms, but no marked stiffness. The spasms are generally, but not 
always, very painful. There are often erections of the penis, and the faeces 
and urine may be passed involuntarily. If the case terminate favorably, 
the convulsions gradually lessen in intensity, and fade away, leaving the 
patient exhausted, with a sore, tired feeling in the muscles. After death, 
post-mortem rigidity is developed very quickly. Autopsies have revealed 
nothing but the usual congestive lesions of death from asphyxia, and, at times, 
indications of spinal hyperaemia. 
In regard to the method in which strychnia produces the above symptoms, 
it is obvious that the alkaloid is primarily absorbed; and experimental proof 
seems so superfluous that I will only mention the fact that Masing has found 
the strychnia in the blood. 
It is very plain that convulsions can be produced by a drug in only five 
ways : first, they may be epileptiform,-i.e., cerebral; second, they may con- 
ceivably be due to a stimulation of the peripheral ends of the motor nerves; 
third, they may conceivably be caused by irritation of the peripheral ends 
of the sensory nerves; fourth, they may be muscular,-i.e., due to a direct 
action on the muscles; fifth, they may be spinal. 
That the convulsions of strychnia-poisoning are not cerebral, is proven by 
the fact which has been frequently noted, and which I have confirmed, that 
they are not affected by section of the cord, or, at least, are only so far affected 
as to be more severe in those portions of the body removed from the cerebral 
influence. That they are not due to irritation of the peripheral motor nerves 
and are not muscular is proven by the experiment of Valentin (Pathologic 
der Nerven, p. 327, Leipsic, 1864), who found that the injection of a solu- 
tion of strychnia through the blood-vessels of the amputated leg of a frog EXCITO-MOTORS. 
329 
had no influence upon the muscles. A very beautiful experiment of Brown- 
S^quard {Comptes-Rendus, 1849) confirms this, and also demonstrates that 
the convulsions do not arise from hyper-excitability of the peripheral afferent 
nerves. The observer last mentioned found that when the spinal cord was 
cut just below the origin of the nerves supplying the fore legs of a frog, and 
all the blood-vessels going to the lower section of the cord were also severed 
so as to isolate the latter, on the exhibition of strychnia convulsions occurred 
in the anterior part of the body, whilst in the posterior segment quiet and a 
normal reflex activity were maintained, although the blood was carrying the 
poison to every part of it except the spinal cord. The philosophy of this is 
evident. The anterior section of the cord, receiving the poison, gave rise to 
convulsions; the posterior section, receiving no poison, maintained its usual 
status. 
This experiment of Brown-Sequard has been repeated a great number of 
times by MM. Martin-Magron and Buisson {Journal de la Physiologic, 1860, 
t. iii. p. 130) with similar results, excepting that in some very rare instances 
slight convulsions were induced in the posterior portion of the body. These 
exceptional phenomena appear to have been due simply to a minute portion 
of the poison reaching the spine by inhibition, since, when by an operative 
procedure not necessary here to detail (Joe. cit., p. 131) the posterior section 
of the cord was completely isolated and access of the poison by diffusion 
rendered impossible, spasms never occurred in the posterior part of the body. 
Strychnic convulsions must be spinal, because they do not arise in any 
of the other possible methods. This conclusion is abundantly confirmed by 
direct experiment. Thus, Van Deen {Physiologic de la Moelle epiniire) 
and Valentin {loc. cit., p. 329) have shown that when the alkaloid is 
placed upon the spinal cord, and allowed slowly to diffuse itself, the usual 
convulsions occur, but are at first confined to those muscles whose nerves 
have their origin near the point of application, and afterwards spread from 
muscle to muscle as the poison creeps through the cord. Dr. A. J. Spence 
{Edinburgh Medical Journal, July, 1866) has performed similar experi- 
ments, with similar results. He first bisected the apex of a frog's heart so 
as to allow all the blood to drain from the body, and then, cutting through 
the cranium, laid a little piece of nux vomica within it upon the brain so 
that the poison would diffuse down through the spinal cord. The result 
was that first the muscles of the throat, then those of the fore legs, and so 
on in regular order, were affected.* 
* Some of the phenomena stated by Dr. Spence to have occurred are at present very 
difficult to explain. Thus, he noted that as the poison traveled down the cord there 
was a time when irritation of the fore feet caused only spasm in them; later in the 
experiment, irritation of the front feet caused spasm of both the front and hind feet, 
although irritation of the latter did not produce other than normal reflex movements; 
later still in the poisoning came a stage when irritation of the front legs was powerless 
to cause spasm in the hind legs, although irritation of the latter would now cause spasm 
in the former. 330 
SYSTEMIC REMEDIES. 
Spinal Cord.-Claude Bernard (Lecons sur les Substances tcxiques, Paris) 
has denied that strychnia produces excitation of the spinal motor centres, be- 
cause when all the posterior nerve-roots are cut, no convulsions occur, whereas 
if a single afferent root be allowed to remain, irritation of its peripheral 
fibrillae causes general tetanic spasms. Allowing the truth of his experimental 
fact, his deduction certainly is not warrantable.* The non-occurrence of con- 
vulsions may depend upon the fact that the reflex motor ganglionic cells are 
incapable of originating an impulse, and in strychnia-poisoning are simply in 
such a condition of over-excitability as renders them exceedingly sensitive to 
slight irritations and causes them to respond most energetically to peripheral 
impulses so feeble as not to be felt in health. That the motor centres are acted 
upon by strychnia is proven not only by the experiments that have been 
already detailed, but by the following ingenious one of Van Deen (Physi- 
ologic de la Moelle epinibre). That investigator removed the viscera, vessels, 
etc., from a frog, so as to leave nothing below the second cervical vertebra 
but the bones, nerves, and muscles; then, opening the spinal cord in the 
region of the third vertebra, he cut entirely through the anterior columns 
of the cord, and finally divided all the tissues, so that the anterior portion 
of the frog was connected with the posterior solely by the posterior columns 
of the cord. When one or two drops of a solution of strychnia were placed 
in the mouth of the prepared batrachian, tetanus, confined to the anterior 
segment of the body, was developed; and it was also found that whilst 
irritation of the posterior feet caused in them only ordinary reflex move- 
ments, in the front legs tetanic spasms were simultaneously induced. It 
appears to me proven by the evidence adduced in this and the preceding 
paragraphs that strychnia is a powerful stimulant to the motor cells of the 
spinal cord; including in this term the whole spinal tract up to the pons 
varolii. As shown by Spitzka, and confirmed in my laboratory, enormous 
doses of strychnia injected into a vein kill almost instantaneously without 
the production of a spasm. Such doses probably kill the nerve-centres just 
as large doses of a cardiac stimulant overwhelm and paralyze the viscus. 
Motor Nerves.-The action of strychnia upon the motor nerves has been 
a subject of considerable controversy. That the convulsions occur inde- 
pendently of any such influence, if it exist, has been already shown. After 
death from strychnia, the functions of the motor nerves are always found to 
be more or less impaired, so that galvanization of the nerve-trunk either 
produces only very feeble contractions in the tributary muscles, or else none 
at all.f Of this fact there would seem to be no doubt; it has been 
* Dr. Spitzka (Chicago Journ. Ment. and Nerv. Dis., vi. 216) affirms that a frog with all 
the sensory nerve-roots and the nerves of special sense divided still develops tetanus when 
strychnia is administered. It would be strange if so noted a physiologist as Claude 
Bernard should make so gross an error in experimentation. 
f Dr. W. II. Klapp affirms that he has found in thirty-seven experiments the motor 
nerve unimpaired in the frog after death from strychnia (Journ. Ment. and Nerv. Dis., EXCITC-MOTORS. 
331 
attested on the evidence of personal experiment by many observers, amon» 
whom are Matteucci (Traits des Phenom, electro-physiol., Paris, 1844), 
Moreau (Comptes-Rendu* Soc. de Biol., 1855), M. Ambrosoli (Gaz. M^d., 
1857, p. 525), Wittich (Bericht Fortschritte Anat., 1857, p. 434), Kolliker 
( Virchow's Archiv, Bd. x. p. 239, 1856), and Vulpian (Arch. de Physiol., 
Nov. 1870, p. 125). Now, it is evident that this absence of response may be 
due to loss of functional power in either muscle or nerve. Sometimes the 
muscle may be at fault; but, as Matteucci (loc. cit.) insists, and as has been 
noted by many observers, not rarely-indeed, most generally-in the frog 
galvanization of the nerve fails to elicit response, although the muscle pre- 
serves its irritability. M. Ch. Bichet (Compt. Rend., xci. p. 131) deter- 
mined experimentally that if active artificial respiration be maintained, 
enormous doses of strychnine injected into the vein of a mammal paralyze 
the motor nerves. M. Vulpian (Ibid., xciv. 556) has confirmed these 
results: so that it may be considered proved that in the warm- as well as in 
the cold-blooded animal strychnine depresses directly the motor nerves. 
It having been proven that the functional power of the motor nerves is 
destroyed in strychnia-poisoning, the question arises, Is this destruction a 
direct action of the poison, or is it simply the exhaustion of over-use, due to 
the intense activity of the nerve during the stage of spasm ? 
It cannot be gainsaid that the power of the nerve is lessened by the strain 
upon it during the convulsions; and Kolliker concludes ( Virchow's Archiv, 
Bd. x., 1856) that this is the sole cause of the nerve-paralysis, because 
when he cut the sciatic nerve of a frog and exhibited strychnia the divided 
nerve would respond to galvanic stimuli after all functional power had been 
lost in the nerve whose connection with the centres was intact. Granting 
the experimental fact, it would only prove that contact of the poison was 
not the sole cause of the motor-nerve paralysis, as it is plain although both 
nerves suffered this contact, yet the uninjured suffered it plus exhaustion 
from excessive use. The conclusion is, moreover, opposed by the fact attested 
by Vulpian (Archives de Physiologie, 1870, t. iii. p. 120) and other observers, 
that an enormous dose of strychnia kills the frog without the induction of 
Oct. 1878). It is inconceivable that all previous observers should be mistaken in their 
observations. It has been suggested that the effects upon the motor nerves usually attrib- 
uted to strychnia have been due to brucia contaminating it; and Dr. Robert P. Robins 
(Phila. Med. Times, ix. 228) has found nerves insensitive in animals killed with brucia; 
a result in accord with the experiments made upon Rana esculenta by Prof. Mounier, of 
Geneva. Dr. Lautenbach has shown, however, that chemically pure strychnia impairs the 
function of the motor nerves, and that in some frogs, or under some life conditions, brucia 
has no effect upon the nerves. It would seem that both of these alkaloids impair the 
functions of the motor nerves, but that under certain conditions the nerves have greater 
resisting powers than usual. It is probably different states of health rather than different 
species of frogs, as believed by Lautenbach, that cause the diversity of results. The pos- 
sibility of a stray galvanic current being directly transmitted by a nerve to a muscle 
must also not be forgotten. 332 
SYSTEMIC REMEDIES. 
spasms by general paralysis, with total loss of power in the nerve-trunks. 
Evidently in such case the action of the poison on the nerves must be direct. 
MM. Martin-Magron and Buisson have investigated {Journal de la Phy- 
siologic, 1860, t. iii. p. 342) very elaborately this action of strychnia upon 
the nerves, and the correctness of their experiments and results seems to 
me scarcely questionable. They found (loc. cit., p. 347) that if the sciatic 
nerve of a frog were cut and a sufficiently large dose of the strychnia admin- 
istered, the divided sciatic lost its irritability, although, unless the dose was 
very large, not so soon as did its fellow. Vulpian (loc. cit., p. 126) has con- 
firmed this; and the opposite result of Kblliker no doubt depended upon his 
not using sufficiently large doses of the alkaloid or upon his testing the nerve 
too early. Martin-Magron and Buisson also tied all the tissues of a frog's 
leg except the nerve, and then, on exhibiting strychnia, found that convul- 
sions ceased in the poisoned much sooner than in the non-poisoned leg, and 
that at a certain time irritations of the poisoned foot would induce tetanic 
spasms only in the non-poisoned member,-proof that the afferent nerve-fibres 
of the poisoned leg were not affected, and that the motor nerves were para- 
lyzed wherever the poison had access to them; and that to this, not to spinal 
exhaustion, was due the general paralysis. 
M. Vulpian (loc. cit., p. 121) affirms that he has repeated this experiment 
many times, and always obtained the same result as Martin-Magron and 
Buisson. It would seem to prove that strychnia in very large doses para- 
lyzes the efferent, but not the afferent nerves; and that the collapse of 
strychnia-poisoning in the frog is largely due to the affection of the motor 
trunks, and not to exhaustion of the spinal cord. Again Vulpian (loc. cit., 
p. 122) found that the nerve protected by tying its vessels preserved its 
irritability after the non-protected nerve had lost its functional power. The 
evidence appears to be as complete as it can, and to show that in strychnia- 
poisoning, at least in the frog, the motor nerves lose their functional power 
partly through exhaustion and partly through a direct action of the poison 
upon them. As Fraser has discovered for atropia, Vulpian (loc. cit., p. 128) 
has found for strychnia : namely, that after a time,-say from some hours to 
two days,-if the dose has been of the right size, the strychnic paralysis 
passes off, the motor nerves are found to have regained their power, and the 
convulsions reappear, and continue hours or days. 
Circulation.-Strychnia has a very decided influence upon the circulation. 
Drs. Richter (Zeitschrift f. ration. Med., 1863, xviii.), Mayer (Med. Jahrb. 
d. k. k. Gesellschaft der Aerzte zu Wien, 1872, p. 112), Schlesinger (Ibid., 
1874), and Klapp (Journal of Mental Diseases, Oct. 1878) have all found 
that a decided rise of arterial pressure comes on before or about the time of 
the first convulsion. The rise is not due to the convulsion or to the inter- 
ruption of the circulation, as it occurs in curarized animals in which artificial 
respiration is maintained. Both Richter and Mayer affirm that the small 
arteries can be seen to contract under the influence of the strychnia, and EXCITO-MOTORS. 
333 
conclude that the rise of the pressure is due to vaso-motor spasm. Mayer 
also found that after paralysis of the dominant vaso-motor centres by section 
of the cord, strychnia produced no rise of the arterial pressure, or if any 
was caused, it was very slight. A different experimental result has, how- 
ever, been reached by Schlesinger (loc. cit.'). This investigator found that 
the rise after the division of the cord both absolutely and relatively exceeds 
that produced in the normal animal. It is worthy of note that in three of 
the fifty experiments made by Schlesinger upon rabbits, the strychnia failed 
to elevate the pressure after section upon the cord. Schlesinger explains 
the apparently opposite results reached by himself and by Mayer by the 
fact that the latter investigator employed dogs, and further states that in 
six experiments made by himself on dogs, he four times obtained results 
similar to those of Mayer. Klapp experimented upon the cat, dividing not 
only the spinal cord, but also all the cardiac nerves of the neck. Under 
these circumstances no rise of pressure followed the injection of the strychnia. 
A very plausible explanation of the peculiar results obtained by Schlesinger 
is that given by Klapp: namely, that he failed to make a perfect section of 
the oord, Klapp having found that a few fibres are sufficient to carry up 
the impulse. Further experimentation upon rabbits is necessary before any 
final judgment can be passed upon the work of Schlesinger, but the drift 
of the whole evidence is to show that much of the rise of the arterial 
pressure produced by strychnia upon the normal animal is due to vaso-motor 
spasm. It is well known that after division of the cord stimulation of a 
sensitive nerve fails to cause vaso-motor spasm and rise of arterial pressure. 
Schlesinger found that in the strychnized animal the contrary to this is 
true. This curious asserted fact receives some support from the experiments 
of Klapp. In the majority of instances he failed to get a decided rise, but 
in a few cases he did. The explanation of Schlesinger is that in the normal 
animal the peripheral impulse can only reach the vaso-motor nerves by first 
going to the dominant centre, but that strychnia so alters the functional 
conditions of the spinal cord as to allow the peripheral impulse to play all 
through the local vaso-motor centres, which undoubtedly are in the cord, 
and to cause a general vaso-motor spasm by producing innumerable local 
spasms. This theory may be true, but must yet be considered as sub judice. 
It has been shown by the experiments of Klapp that the primary stimu- 
lation of the vaso-motor centres by strychnia is followed by fall of arterial 
pressure and vaso-motor palsy ; also that very large doses produce an imme- 
diate depression of the vaso-motor centres and fall of the arterial pressure. 
There is some apparent conflict of testimony in regard to the influence of 
strychnia upon the inhibitory cardiac nervous system. Dr. Carl Heinemann, 
who has investigated at some length ( Virchow's Archiv, Bd. xxxiii. p. 394) 
the influence of the drug upon the heart of the frog, finds that large doses 
cause diminished frequency of the cardiac movements, with diastolic pauses. 
According to his experiments, these phenomena are not due to stimulation 334 
SYSTEMIC REMEDIES. 
of the inhibitory nerves, since they occur after section of the vagi (p. 403), 
nor are the peripheral vagi paralyzed, since galvanization of one of these 
nerves causes immediate diastolic cardiac arrest (p. 406). Mayer (Zoe. cit.) 
has also found that the peripheral vagus is not paralyzed, since he could 
suspend the action of the heart in the poisoned animal by galvanization of 
the par vagum. Klapp has also reached results confirmatory of those of 
Heinemann. On the other hand, Martin-Magron and Buisson affirm Joe. 
cit., p. 352) that in all of very many experiments, after a greater or less 
length of time, the pneumogastrics lost their power of transmitting an 
impulse. The reconciliation of these results is very difficult; possibly 
Martin-Magron and Buisson employed a strychnia containing very largely 
of brucia; possibly enormous doses of strychnia do affect the peripheral 
vagi, but not until very late in the poisoning, although when small doses are 
employed, even death may occur without very decided paralysis of these 
nerves. That the different results are not due to the use of different 
animals is evident, since, although Mayer used hounds, both Heinemann 
and Klapp employed the same animals as did Martin-Magron and Buisson, 
viz., frogs. Dr, I. Steiner has found the action of strychnia much more 
marked when it is placed upon the posterior than on the anterior face 
of the frog's heart, also that the strychnia acted much more promptly 
and severely upon the separated sinus venosus than upon the ventricles or 
auricles, and hence concludes that the strychnia acts especially upon the 
ganglia of the sinus. His experiments and conclusions have been confirmed 
by Klapp, and are probably correct. 
Upon the blood strychnia has probably some action. Harley found that 
blood shaken for twenty-four hours with air contained 11.33 parts of oxygen 
and 5.96 parts of carbonic acid; whilst blood treated in a precisely similar 
manner, except in the addition of strychnia, yielded 17.80 parts of oxygen 
and 2.73 parts of carbonic acid. He concludes from this that strychnia arrests 
oxidation in the body; but the deduction seems to me out of all proportion 
to the fact. 
Eye.-The effect of strychnia upon the normal eye has been recently 
studied by V. Hippel ( Wirkung des Strychnins auf die normale und kranke 
Augen, Berlin, 1873) and Cohn ( Wiener Mediz. Wochenschrift, Nos. 42, 47, 
1873), with rather different results. They both, however, found the sharp- 
ness of vision increased.^ 
* For the paper of Brunton and Cash showing that strychnine increases the " refractory 
period" of the isolated frog's heart, see Proc. Roy. Soc., 1883. A consideration of this 
memoir would require an elaborate discussion of the minute points of cardiac physiology, 
and, as it would throw at present no light upon the practical use of the drug, is not entered 
upon. 
f For the details of their studies the reader is referred to the ->riginal paper, or to the 
abstract in the Boston Medical and Surgical Journal, p. 473, 1874. VEXCITOrMOTORS:{ \ 
335 
Elimination.-Strychnine is'eliminated with: tljp!.,urine, according to the 
experiments of Peter von RautenfeldJ unchangedu^pdiJvery slowly (Inaug. 
Dissert., Dorpat, 1884). P. C. Plugge has found4,Jiq.wever, that at least a 
portion of the strychnine is oxidized and converted '.into a new substance, 
which he calls strychnic acid. (.For details, see Archiv d. Pharmacie, 
1883, p. G52.) ... ' 
Therapeutics.-As a vegetable bitter, strychnia is, of course, a tonic, 
stimulating to a greater or less degree the digestion, besides acting more 
universally on nerve-power. But it is more than a mere stomachic: clinical 
experience has shown that it is a most useful tonic wdien there is general 
relaxation and loss of nerve-power. A portion of its value arises, it may be, 
from its action upon the spinal motor nerve-centres ; .but in all probability it 
influences other portions of the cord, affecting the vaso-motor centres, and 
most probably also the trophic centres, if they exist. Be these things as 
they may, clinical experience has abundantly demonstrated the value of the 
drug as a tonic in general functional atony and relaxation. 
The great influence of strychnia upon the function of voluntary motion 
early led to its use in cases of paralysis, often with the result of doing harm 
rather than good. Its peculiar physiological action being known, it becomes 
very evident that it can be useful only when the paralysis is dependent upon, 
or at least accompanied by, a depressed state of the spinal or other motor 
centres. Whenever there is inflammation or irritation of these latter, strych- 
nia may do great injury by increasing such irritation, and must never be 
employed. Like galvanism, in hemiplegia it can do only a very limited 
amount of good, and should not be exhibited until irritation from the clot 
has ceased. Andral and others commend it especially in lead-paralysis. 
Since attention was so signally called to the value of strychnia in amau- 
rotic affections by Nagel, of Tubingen, in 1871, numerous observers have 
published extended series of cases in which it has been used with strangely- 
varying results. They have for the most part, however, served to verify the 
favorable results obtained by Nagel (Die Behandlung der Amaurosen und 
Amblyopeen mit Strychnin, Tubingen, 1871). His sanguine expectations 
regarding its use in nerve-atrophy have met with disappointment in the 
hands of other observers. It is now conceded that in atrophy of the essen- 
tial nerve-structure little is to be expected from strychnia or any other 
means. It is most useful in cases which have not yet reached the stage of 
atrophy, but present slight if any ophthalmoscopic changes. The chalky or 
greenish-white and cupped nerve-entrance is not always, however, sufficient 
cause for pronouncing the case hopeless, for these appearances are not always 
safe indications of the amount of injury done to the axis-cylinders. Its value 
in amaurosis from abuse of alcohol and tobacco is undisputed. Also in 
amblyopia from disuse,-e.g., in strabismus and paresis,-after the parallelism 
of the visual axes has been restored, under its use normal sharpness of vision 336 
SYSTEMIC REMEDIES. 
is much more rapidly attained. In cases where the ophthalmoscope reveals 
but slight change in the retina and nerve,-e.g., slight striation of retina 
around the disk, the margin of which is somewhat obscured, or in those 
disturbances of the anastomotic circulation at the nerve-entrance, with or 
without diminished sharpness of central vision and contraction of the field, 
-strychnia is of marked benefit. The distressing headache and giddiness 
associated with these nerve-troubles which thus manifest themselves in the 
eye are frequently relieved by the use of strychnia, even though the nerve is 
quite atrophied and the eye blind. There is much difference of opinion as 
to the method of its administration, but better results in the hands of most 
observers follow its hypodermic use. The temple would seem to be a better 
locality than the arm, as improvement in the corresponding eye has been fre- 
quently observed, while its fellow remained as before. It should be given in 
gradually-increasing doses, being governed by the tolerance of the action 01 
the drug. Commencing with one-thirtieth of a grain, it can, usually, in a few 
weeks be carried up to one-tenth or even one-fifth of a grain once or twice 
daily, these doses causing only a twitching in the calves of the legs, or a 
slight sense of constriction about the throat, coming on in from ten to fifteen 
minutes after their administration, and subsiding in the course of an hour or 
two. It is necessary to maintain the physiological impression of the drug to 
insure the best results.* 
Dr. J. Milner Fothergill has recently drawn attention to the value of strychnia 
as a respiratory stimulant in dyspnoea dependent upon pulmonic affections, such 
as chronic bronchitis, emphysema, and phthisis. In long-standing bronchitis, 
or " winter-cough," with a dilated right heart, the combination of strychnia and 
digitalis in his hands has acted exceedingly well. In other cases he is accus- 
tomed to add the strychnia to ordinary stimulant cough mixtures. 
In dyspepsia or constipation or diarrhoea, connected with atony of the 
visceral muscular coat, strychnia is a very valuable remedy. In various local 
paralyses, such as prolapse of the rectum, atonic retention of urine, atonic 
incontinence, and loss of voluntary motion in certain groups of muscles fron. 
temporary injury to the supplying nerve or even from so deep-seated a disease 
as infantile paralysis, it is useful. There is reason to believe that it sometimes 
does good in t-hese cases by influencing the nutrition of the affected muscle 
or the peripheral nerves; and it should be injected into the affected part. 
Toxicology.-Sufficient has already been said in regard to the general 
symptoms of strychnia-poisoning. It only remains to discuss the diagnosis.^ 
This is especially important, because strychnia is frequently used criminally, 
and because not rarely it is impossible for the chemist to detect it after death. 
* This paragraph was written by Dr. S. D. Risley, and is expressive of the results at the 
University Hospital, where he is chief assistant of the Ophthalmological Clinic. 
j- A lesion found in one case by Moriz Rosenthal may possibly be characteristic. It is 
numerous small cross-rents in the heart-muscle, accompanied by small extravasations 
(Nervenkrankheiten, 1870, p. 334). EXCITO-MOTORS. 
337 
The only disease with which poisoning by it may be readily confounded is 
tetanus, in its various forms of idiopathic, rheumatic, traumatic, infantile, 
and hysterical. It has been asserted that in fatal cases the duration of the 
attack will always distinguish between natural tetanus and that produced by 
poison. Dr. Louis Starr, however (^Philadelphia Medical Times, vol. iii. p. 
311), reports a case of traumatic tetanus fatal in less than twelve hours after 
the first appearance of muscular twitchings, and within one hour and a half 
after the first convulsion ; and according to Jaccoud death has occurred 
fifteen minutes after the reception of the injury {Pathologic Interne, i. 441). 
The following table shows, I think, in as clear and brief a manner as 
possible the differences* between traumatic or idiopathic tetanus (No. 1), 
hysterical tetanus (No. 2), and strychnic poisoning (No. 3). The references 
in column No. 3 are to authorities who affirm that the symptoms there given 
are peculiar to poisoning. 
No 1. 
Muscular symptoms usually 
commence with pain and stiff- 
ness of the back of the neck, 
sometimes with slight muscular 
twitchings; come on gradually. 
Jaw one of the earliest parts 
affected; rigidly and persistently 
set. 
Persistent muscular rigidity, 
very generally with a greater or 
less degree of permanent opis- 
thotonos, omprosthotonos, pleur- 
osthotonos, or orthotonos. 
Consciousness preserved until 
near death, as in strychnic poi- 
soning. 
No. 2. 
Commenced with blindness and 
weakness. 
Muscular symptoms com- 
menced with rigidity of the 
neck, which gradually "crept 
over the body," affecting the 
extremities last. 
Jaw rigidly set before a convul- 
sion, and remained so between 
the paroxysms. 
Persistent opisthotonos, and in- 
tense rigidity between the con- 
vulsions; and after the convul- 
sions had ceased the opisthotonos 
and intense rigidity lasted for 
hours. 
Consciousness lost as the second 
convulsion came on, and lost with 
every other convulsion, the dis- 
turbance of consciousness and 
motilitv being simultaneous. 
No. 3. 
Begins with exhilaration and 
restlessness, the special senses 
being usually much sharpened.! 
Dimness of vision may in some 
cases be manifested later, after 
the development of other symp- 
toms ; but even then it is rare. 
Muscular symptoms develop 
very rapidly, commencing in the 
extremities, or the convulsion, 
when the dose is large, seizes the 
whole body simultaneously.! 
Jaw the last part of the body 
to be affected: its muscles relax 
first, and, even when during a 
severe convulsion it is set, it drops 
as soon as the latter ceases.^ 
Muscular relaxation (rarely 
a slight rigidity) between the 
convulsions, the patient being 
exhausted and sweating. If re- 
covery occur, the convulsions 
gradually cease, leaving merely 
muscular soreness, and some- 
times stiffness like that felt after 
violent exercise.|| 
Consciousness always preserved 
during convulsions, except when 
the latter become so intense that 
death is imminent from suffoca- 
tion, in which case sometimes the 
* Column No. 2 is from an actual case. See Trial of Mrs. Wharton, New York Medical 
Record, 1873. 
t Taylor, On Poisons, p. 683. Wormley, Micro-Chemistry of Poisons, p. 536. 
J Wormley, p. 536. Stille, Therapeutics, vol. ii. p. 148. 
$ Taylor, On Poisons, pp. 134, 682. Wormley,-pp. 536, 540, 541. Tardieu, Sur VEm- 
poisonnement, p. 924. 
|| Taylor, On Poisons, pp. 134, 136, 682. Wormley, pp. 536, 540, 541. Tardieu, pp. 
924, 938, 939. Husemann, Handbuch der Toxicologic, p. 168. 338 
SYSTEMIC REMEDIES. 
No. 1. 
Draughts, loud noises, etc., pro- 
duce convulsions, as in strychnic 
poisoning. 
May complain bitterly of pain. 
Eyes open, rigidly fixed, during 
the convulsion. 
No. 2. 
Desired to be fanned. 
Crying-spells, in which he 
"sobbed violently," and "cried 
like a child," alternated with the 
convulsions. 
Eyes closed. 
The spasms in leg must have 
been partial, as the feet were 
crossed and toes inverted, which 
could not happen if all the mus- 
cles were involved, because the 
muscles of eversion, being very 
much the stronger, would of ne- 
cessity overcome the antagonistic 
muscles, and the feet be everted. 
No. 3. 
patient becomes insensible from 
asphyxia;* which comes on dur- 
ing the latter part of a convul- 
sion, and is almost a certain pre 
cursor of death. 
The slightest " breath of air" 
produces a convulsion.! 
Patient may scream with ;>ain, 
jr may express great apprehen- 
sions, but "crying-spells" would 
appear to be impossible. 
Eyes stretched wide open.! 
Legs stiffly extended, with feet 
everted,? as the spasms affect all 
the muscles of the leg. 
Death from strychnia in man and other mammals mostly occurs in a con- 
vulsion, and under these circumstances is undoubtedly due to asphyxia, caused 
by the unyielding spasmodically-contracted muscles. In frogs, death must 
occur from other causes, since a frog, as shown by Claude Bernard, will live 
for days after removal of its lungs, probably by breathing through its skin. 
The causes of death in the frog are not hard to find when the physiological 
action of the drug is known. The lymph and true hearts (Kblliker, loc. 
cit.; Harley, Lancet, July, 1856) are very much affected, but the chief 
factor is no doubt paralysis of the motor nerves. In man, death sometimes 
occurs not in a paroxysm, but during relaxation, and probably then is the re- 
sult not only of the exhaustion following effort, but also of the direct action 
of the poison on the nerves. 
The minimum fatal dose of strychnia is probably something under half a 
grain; the latter quantity has several times produced death, once in a man 
in twenty minutes (Guys Hosp. Rep., 1865, vol. xi. p. 208); one-third of 
a grain given at intervals in fractional doses has produced such alarming 
symptoms as to indicate that in a single dose it might readily destroy life; 
the grain is said to have killed a child three and a half months old 
(Pharm. Journ. and Trans., viii. 1010) ; but ten grains (Tschepke, Deutsches 
Klinik, 1861), twenty grains (A. E. Connor, Ohio Med. Recorder, 1879,12), 
also twenty-two grains (Dr. Geo. Gray, Brit. Med., 1880, i. 477) taken on a 
* Wormley (1st ed.), p. 536. Taylor, Medical Jurisprudence, pp. 331, 332. Wharton and 
StillS, Medical Jurisprudence, paragraph 757. Tardieu, p. 923. StillS, Therapeutics, p. 148. 
f StillS, Therapeutics, p. 148. 
J StillS, Therapeutics, p. 148. Wormley, p. 536. Tardieu, p. 924. 
Tardieu, p. 924; also other authorities, which I have neglected to note, and at present 
writing have not at hand. EXCITO-MOTORS. 
339 
full stomach and retained two hours, have failed to cause death, in each case 
probably on account of slow absorption. 
In treating poisoning by strychnia, a chemical antidote should be at once 
administered, such as tannic acid, or iodine, or one of its soluble salts. As, 
however, the compounds formed in the stomach by these substances are not 
permanent, a quick emetic must follow their administration. For the treat- 
ment of the symptoms, various substances have been recommended. Aco- 
nite, Calabar bean,* tobacco, or their alkaloids, would appear to be indicated 
as physiologically antidotal. The evidence brought forward by Dr. Haughton 
and others is not sufficient to establish clearly the especial value of tobacco, 
and in the experiments of M. Amagat (Journ. de T/drap., 1875) nicotia 
seemed to have no power in preventing the death of rabbits which had 
received a fatal dose of strychnia. Further, it is obvious that the use of 
aconite, or of tobacco, in large doses, is accompanied with grave danger, on 
account of their influence upon the heart, and we have in bromide of potas- 
sium a substance devoid of any such objection, and apparently as complete 
a physiological antidote to strychnia as are any of the substances above 
named. The chief question is as to whether the bromide has sufficient 
power and swiftness of action. In Dr. C. L. Bard's casej" (Phila. Med. 
Times, i.), recovery after the ingestion of three grains of the alkaloid, with- 
out vomiting, occurred, under the exhibition of a half-ounce dose of the 
potassium salt and " its continued use in smaller doses for an hour or so." 
The symptoms were as intense as was consistent with life, but general relaxa- 
tion was produced in thirty minutes after the ingestion of the counter-poison. 
Chloral was stated by Liebreich, its therapeutic discoverer, to be antagonis- 
tic to strychnia, and it undoubtedly is so in a measure ; but M. Orr (Gazette 
Medicale, July 6, 1872) stated to the French Academy that he had ex- 
perimentally proven that the dose of chloral which Liebreich had relied on 
as being mortal to rabbits was very often not so, that the same was true of 
strychnia, and that consequently the investigation of Leibreich was not to be 
relied on as proving the respective antidotal powers of the drugs; and, fur- 
ther, that experiments had shown him that if a certainly-fatal dose of chloral 
were given to a rabbit, the hypodermic injection of strychnia did not affect 
the result, but that his own researches had not gone far enough to establish 
the exact relations of the drugs. Prof. Bennett (British Med. Jour., vol. ii., 
1874) has made an elaborate study, which agrees with the experiments of Orr 
in showing the non-efficiency of strychnia in chloral-poisoning, but also proves 
that chloral is of great value in poisoning by the alkaloid. Out of twenty- 
one rabbits which had received much more than the minimum fatal dose of 
strychnia (gr. to the pound) fifteen were saved by the use of chloral, 
* Two cases of recovery very doubtfully attributable to Calabar bean, Ohio Med. Re- 
corder, iv. 154. 
f For other successful cases, see New Remedies, vol. ii. p. 255; also, Chicago Med. Ex- 
aminer, xxxix., 1879, 280. 340 
SYSTEMIC REMEDIES. 
and a few days later were killed in from ten to twenty minutes by a repetition 
of the original doses of strychnia. Dr. Bennett found that the chloral admin- 
istered after the supervention of convulsions had less effect in saving life in 
direct proportion to the length of time between its administration and that 
of the poison. Prof. Husemann (Arch. Exper. Path, und Therap., x.) 
found it possible to prevent death by chloral in rabbits which had received 
five or even six times the minimum fatal dose of the alkaloid. In various 
cases recovery from the effects of large doses of strychnine (four grains, 
Edinb. Med. Journ., April, 1875; six grains, Arch. Gen. de Med., 1883, 
i. 74, where also numerous cases may be found) has been brought about by 
the use of chloral, which must be at present considered a standard remedy 
in strychnine-poisoning. Alcohol has been strongly recommended by some 
authorities (Amagat, Stacchini) as antidotal; and when the great muscular 
relaxation of drunkenness is remembered, it seems very probable that the 
commendation has some basis. Prof. Husemann (loc. cit.') has, however, 
shown that alcohol can scarcely be looked upon as a real antagonist to the 
alkaloid. 
The best treatment of strychnia-poisoning is apparently to be found in 
the conjoint use of chloral and the bromide of potassium, with, when con- 
vulsions are very threatening, inhalations of nitrite of amyl, ether, or even 
chloroform. Half an ounce of the bromide with half a drachm to a drachm 
of chloral may be given at once in a severe case ; and every twenty minutes 
afterwards, if necessary, two drachms of the first and fifteen grains of the 
econd remedy. 
In some cases, artificial respiration might possibly be of service. It is 
evident that the convulsed muscles will often resist such efforts as are usually 
made to force air into the lungs of man as successfully as they do the un- 
assisted struggles of nature; and Harley states that he has found artificial 
respiration of no use whatever in animals. On the other hand, Leube 
(Archives Anat, ct Physiol., 1867), in an apparently very careful series of 
experiments, found that artificial respiration has great influence in saving or 
prolonging life, according to the amount of the poison ingested. In his ex- 
periments, the dose which ordinarily produced convulsions did not do this so 
long as artificial respiration was kept up ; and the " lethal dose" did not kill 
if artificial respiration was maintained for four hours, although opisthotonos 
was induced in some cases. Jochelsohn only succeeded in prolonging life 
(Rossbach's Untersuchungen, i., 92), but Rosenthal, according to Huse- 
mann, obtained similar results to Leube, and M. Schiff (Schmidt's Jar- 
biicher, Bd. cxli. p. 43) has, in a series of experiments, corroborated in the 
main facts the results of the German investigators, although disagreeing 
with them in minor particulars. He found that animals in which forcible 
artificial respiration was maintained survived doses much larger than those 
ordinarily fatal. The artificial respiration was performed by inserting a 
canula into the trachea, and filling the lungs by force. Klapp also found EXCITO-MOTORS. 
341 
artificial respiration of service. None of the ordinary methods of artificial 
respiration in man are, however, sufficiently powerful to be of any value. 
Administration.-As a tonic, strychnia may be given in pill; but when 
it is desired to push it until its physiological effects are manifested, as in 
some cases of paralysis, it should be always administered as the sulphate in 
solution, because death has occurred from an irregularity in the solution of 
the pills in the alimentary canal and the consequent simultaneous letting 
loose of a large amount of the alkaloid. There is no proof of a cumulative 
action of this alkaloid when given as above directed. Dose, one-twentieth 
of a grain, gradually increased pro re. nata. 
Strychnine Sulphas. U. S.-Sulphate of Strychnine occurs in minute, 
prismatic crystals. It is soluble in water, and therefore preferable to the 
alkaloid for hypodermic use. Dose, one-twentieth of a grain. 
Brucine.-L. Wintzenreid (^Dissert. Inaug., Geneva, 1882), in an elab- 
orate investigation, finds that brucine acts as a stimulant to the spinal cord 
and a paralyzant to the motor nerves, but does not influence the cerebrum 
or the sensory nerves: in the higher animals, at first it increases the arterial 
pressure, and afterwards lessens it; paralyzes in large doses the vagi; causes 
death by asphyxia, and in other ways acts like strychnine. 
Ignatia. U. S.-The seeds of Strychnos Ignatia, a tree growing in the 
Philippine Islands. The St. Ignatius Beans are pale brown, about an inch 
in length, less in breadth, often angular, with three or four faces, covered 
with a very fine, scarcely visible down. They have been compared by some 
to an olive in size and appearance. They contain largely of the igasurates 
of strychnine and of brucine, and are identical in their therapeutic value with 
nux vomica. The only officinal preparations are the abstract (Abstractum 
Ignatix, U. S.), dose, one grain, and the tincture ( Tinctura Ignatiee-1 to 
10, U. S.), dose, twenty minims; the dose of the extract ^Extractum Igna- 
tix, U. S. 1870) is one-fourth to one-half a grain. CLASS X.-DEPRESSO-MOTORS 
Under this heading are considered certain drugs which are used for the 
purpose of lessening the activity of the spinal cord. They have, except in 
this particular, but little in common in their action, and must be studied 
individually. 
PHYSOSTIGMA-CALABAR BEAN. U. S. 
An irregular, kidney-shaped bean, about an inch in length and three- 
fourths of an inch wide ; the product of the Physostigma venenosum, a per- 
ennial woody creeper of Calabar, Africa, where the bean has been used by 
the natives as an ordeal test for criminals, witches, etc., since time immemo- 
rial. It contains an alkaloid known as physostigmia, or eserina. The most 
reliable tests for the alkaloid are as follows. A watery solution of it or of its 
salts containing potassa, soda, or lime, on exposure to the air, becomes red, 
and finally yellow, green, or blue: this is said to occur when only one one- 
hundred-thousandth part of the alkaloid is in the solution. Chloride of gold 
throws down from the solution a blue precipitate, out of which the gold is 
soon reduced. According to Dr. J. B. Edwards (Medical Times and Gazette, 
1864), with strong sulphuric acid and bichromate of potassium physostigmia 
yields a violet color, passing into red. This point needs investigating, in 
relation to the well-known strychnia test. The physiological test consists in 
the placing of a drop of the suspected solution in the eye of a rabbit, when, 
if physostigmia be present, contraction of the pupil will be produced in from 
eight to twenty minutes. A second alkaloid, calabarina.* has been found 
by E. Harnack and L. Witkowski (Arch. Experim. Path, und Pharm., 
Bd. v.), in especial abundance in commercial extracts. As Prof. Harnack 
has succeeded in producing it from physostigmia (Ibid., Bd. xii.), it is a 
natural suspicion that it is formed by decomposition of the physostigmia 
during the preparation of the extract. It is much less soluble in ether 
* Calabarina, according to its discoverers, is a tetanizing agent resembling strychnia m 
its action upon frogs and other of the lower animals. Prof. Ilusemann found, however, 
that Merck's "Calabarinum purum" acts in an entirely dissimilar manner, but Harnack 
has shown that this commercial article contains little or no calabarina (see Arch. Exper. 
Path, und Therap., Bd. viii. 125 ; ix. 434; x. 301). It is possible that physostigmia has a 
strong tendency to undergo various decompositions, and to produce under different circum- 
stances diverse derivative alkaloids. 
342 DEPRESSO-MO TORS. 
343 
than is physostigmia, from which it may be separated by means of that 
menstruum. 
Physiological Action.-When an animal receives a small fatal dose 
of Calabar bean, after a time muscular tremors appear, and almost imme- 
diately the animal falls to the ground, or lies down, in a state of perfect 
muscular flaccidity. The pupils generally contract, and the respirations 
become slow, irregular, and often stertorous. All reflex actions are almost 
at once diminished, and this diminution grows greater and greater, until it 
ends in their complete abolition. So long as the condition of the motor 
system allows of it, evidences of sensibility are manifested whenever the 
animal is in any way injured. According to Clementi Papi (^Schmidt's 
Jalirbiicher, Bd. cxlii. p. 287), the voice is completely lost. The muscular 
tremors persist during the whole period of paralysis, and, indeed, even after 
cessation of the respiration. They vary greatly in intensity, and in some 
cases are so severe (Fraser) as to simulate general convulsions. As the 
minutes go by, the rhythm of the respirations becomes more and more 
affected, and at last death takes place quietly, consciousness being preserved 
until the last few gasping respirations close the scene. The pupils some- 
times, but not always, dilate immediately after death. According to the 
experiments of Dr. Fraser, the bodily temperature is slightly elevated. 
After a small lethal dose of the poison, the fatal result is always due to 
failure of the respiration, and if the body be at once opened the heart is 
found still beating; indeed, it has been seen to continue to do so for one and 
a half hours after death (Fraser). If a very large amount of the drug be 
given, the animal falls almost at once, paralyzed, with only a few muscular 
twitchings. The pupils contract, and in a very short time the gasping 
respiration ceases. The heart is now found distended and passive, but often 
will contract under the stimulation of a galvanic current. 
The symptoms induced by the drug in man are completely parallel with 
those that occur in the lower animals. They are giddiness, lessened heart- 
action, great muscular weakness, with, in most cases, contraction of the pupil, 
and sometimes with vomiting, and still more commonly with purging, which 
may be very free. A pupil of Gubler took 0.15 grain of the sulphate of 
eserina, and suffered, after a time, nausea, giddiness, and intense muscular 
weakness, so that he could not stand; three-quarters of an hour afterwards 
he vomited some of the solution mixed with bile, but his strength did not 
begin to return for two and a half hours. 
These tremors have been seen after so-called pure physostigmia by Boss- 
bach and Frohlich. Kohler, Rossbach, and others have even affirmed that 
Calabar bean produces a tetanic intoxication. A plausible explanation of 
these singular observations, and of many of the discrepancies of authorities, 
is to be found in the discovery of calabarina. Its discoverers state that it 
produces first a violent tetanus, and afterwards paralysis. It is plain how 
its presence in varying amounts in Calabar beau preparations would modify 344 
SYSTEMIC REMEDIES. 
their action. The researches of Kohler, of Vintschgau, and of Rossbach and 
Frohlich, are especially open to doubt, on account of their statements that 
Calabar bean tetanizes. It is very probable the extracts used by them con- 
tained largely of calabarina. 
The question here naturally arises, To what is the paralysis so prominent 
in poisoning by Calabar bean due ? It is evident that the suspension of 
reflex action can have only three sources : paralysis of the spinal cord, of the 
nerve-trunks, or of the muscles. I shall examine the action of the drug 
upon these organs in inverse order. 
Muscles.-The muscular twitchings which have already been spoken of 
have been mistaken for convulsions by M. Vintschgau (SitzungsLerichte der 
Math.-Nat. Classe d. k. Akad. d. Wissenschaften, Wien, 1867, Bd. lv., 
Abth. ii., p. 49), who, indeed, concluded that Calabar bean acts like strych- 
nia, because violent convulsive tremors occurred, after injection of a dose of 
the poison under the skin, in all parts of a frog whose iliacs he had tied. 
Evidence to be brought forward hereafter, however, shows conclusively that 
there was some fallacy in this experiment. The fact that the muscular 
movements continue after death indicates that they are due to a direct action 
of the drug upon the muscles themselves. This conclusion is thoroughly 
established by the experiments of Laschkewich ( Virchow's Archiv, 1866, 
Bd. xxxv. p. 294), of Fraser (loc. cit.J and of Leven and Laborde (Schmidt's 
Jahrhiicher^ Bd. cxlvi. p. 136). All of these investigators have noted that 
after death these contractions are increased by exposure to the air and by 
direct stimulation of the muscles; and Fraser has found that they occur in 
the frog during life after section of the supplying nerve, and also in a muscle 
actually cut out of the body. Laschkewich has confirmed the latter fact in 
the case of warm-blooded animals, and Leven and Laborde have proven that 
previous destruction of the lower end of the spinal cord in a guinea-pig does 
not prevent the development of the muscular twitchings in the hind legs. 
Although Calabar bean does, therefore, have some direct influence upon the 
muscles, yet the paralysis produced by it is in no sense the result of this 
influence, which appears, indeed, to be of an exciting rather than of a para- 
lyzing character, since at the time of death the contractility of the muscle 
is in no wise diminished: on the contrary, Fraser has noted that in poison- 
ing by Calabar bean the supervention of rigor mortis and of loss of func- 
tional powei' in the muscle is very greatly delayed. 
Nerves.-The paralysis caused by the physostigma is not due to an action 
on the nerve-trunks, since Dr. Laschkewich, Dr. Vintschgau (loc. cit., p. 161), 
and also Dr. Fraser, have found that when the galvanic current is applied to 
the crural nerve of either cold- or warm-blooded animals rapidly killed with 
Calabar bean, contractions are freely induced in the tributary muscles. 
Indeed, the Scotch investigator, carrying his experiments still further, and 
using delicate instruments which it is not necessary here to describe, discov- 
ered that when the artery going to a hind leg was tied in a frog before the DEPRESSO-MO TORS. 
345 
administration of the poison, after a quick death the rate of conduction of 
impulse was as rapid in the nerve to which the poison had had free access, as 
in its protected fellow. Notwithstanding these facts, the drug is not entirely 
without influence upon the nerves, since Dr. Fraser has found that when the 
blood-vessels of a frog's leg are tied, and the animal slowly poisoned by a 
small dose of the extract, whilst even many minutes after cessation of respi- 
ration both nerves seem equally intact, yet finally a time comes when the 
nerve of the poisoned leg refuses to react to the galvanic stimulus, although 
the functional power of the protected nerve, as well as of the muscles, is still 
perfect. This loss of functional power is probably rather in the termination 
of the nerve than in the trunk, for Dr. Fraser found that when all the blood- 
vessels supplying the gastrocnemius muscle were cut in a frog and the animal 
poisoned, at a certain time irritation of the crural nerve produced spasms 
of the gastrocnemius alone. It is to be noted that this perturbation of the 
peripheral nerves has only been seen in the frog when slowly poisoned, in 
which case the heart continues to beat long after the cessation of respiration, 
so that the nerves are, as it were, macerated in a solution of the poison. 
Its existence, even in this feeble degree, is denied by Harnack and Wit- 
kowski. In frogs, and still more in warm-blooded animals, nerve-paralysis, 
if it exist at all, is of such slight intensity as to be of no practical im- 
portance. 
The afferent nerve-fibres probably preserve their function after the motor 
fibres have been affected, as was seemingly proven in Dr. Fraser's experi- 
ments (Joe. cit., p. 19) by tying the vessels in the left leg of a frog which 
was afterwards poisoned with strychnia, when it was found that reflex move- 
ments were excited in the left leg by irritation of the right foot long after 
irritation of the left foot had ceased to cause movements in the right leg. 
Dr. Fraser studied to some extent the effect of a strong solution of the 
poison when applied locally to a nerve, and found that the efferent fibres were 
affected before the afferent, and that finally the function of both of them was 
abolished. 
Spinal Cord.-Since the abolition of reflex activity has its origin neither 
in the muscular system nor in the nerve-trunks, it must be spinal. The truth 
of this conclusion, arrived at by exclusion, has been abundantly demonstrated 
by direct experiment. Thus, Fraser, Harnack, Witkowski, and others have 
found that if in the frog a peripheral nerve be protected by tying its artery 
and the batrachian be poisoned with Calabar bean, the paralysis in the 
protected limb occurs pari passu with that in the remainder of the body. 
Again, Fraser divided the spinal cord of a frog, and then cut or tied all the 
blood-vessels going to the posterior section of it. After this, the animal 
was poisoned with physostigma, and, whilst the usual symptoms developed 
themselves in the anterior portion of the body, reflex actions were unaffected 
in the posterior part. Further, Dr. Fraser has found that when the poison 
is applied directly to the cord, fibrillary contractions, due probably to a local 346 
SYSTEMIC REMEDIES. 
irritant influence, are induced in the muscles supplied from below the point 
of application; but in a little while all movements cease, and even galvaniza- 
tion of the cord is itself unable to elicit response. It seems completely 
established by the evidence which has been brought forward that the most 
prominent effect of Calabar bean is a depressant action upon the spinal 
centres. 
Recently, however, it has been asserted by Papi (Schmidt's Jahrbucher, 
Bd. cxlii. p. 287) that there is in frogs, preceding the stage of depression, 
one of exaltation of reflex action ; and also, on the strength of some experi- 
ments upon animals with one-sided section of the optic thalamus, that the 
cause of loss of voluntary movement in Calabar bean poisoning is paralysis 
of the conducting fibres passing from the upper brain to the spinal centres. 
I have not been able to procure the original paper of Dr. Papi (Gazz. 
Lomb., 1868), but his conclusions seem to me highly improbable. The 
primary stage of reflex activity probably was produced by calabarina present 
in the extract used by him. 
Circulation.-Harley (loc. cit., p. 151) and Papi (loc. cit., p. 287) assert 
that Calabar bean has little or no influence upon the heart; but they are 
undoubtedly in error. According to Harnack and Witkowski, in the frog 
under the influence of the poison the heart's contractions become slower 
and stronger. When a mammal is poisoned with small doses, the cardiac 
action of the drug is subordinate to that upon the nerve-centres; but, as 
has been shown by Dr. Fraser, when very large doses of the poison are 
administered, especially if they be injected into the jugular vein, death 
results from syncope or from consentaneous failure of the cardiac and the 
respiratory function, and the heart is found arrested in diastole, flaccid, but, 
according to Dr. Fraser and to Drs. C. Arnstein and P. Sustschinsky (Un- 
tersuch. Physiolog. Labor. Wurzburg, zweiter Theil, p. 86), responding, 
though feebly and uncertainly, to direct stimulation. In the frog, Rossbach 
and Frohlich (Pharmak. Untersuch. i., p. 56) have found that the arrested 
heart is insensible to stimuli. 
When smaller doses of the poison are exhibited, there is slowing of the 
heart's action, as has been noted by Laschkewich (loc. cit., p. 298), by Fraser 
(loc. cit., p. 48), by Dr. J. Tachau (Archiv der Heilkunde, 1865, p. 70), a:id 
by other observers. Although, according to the experiments of Fraser, there 
is at first a slight fall of the blood-pressure, probably due, as he believes, to 
diminished pulse-frequency, yet, in spite of the latter, the arterial tension 
soon recovers itself, and remains for a long time much above the normal point, 
while at the same time the individual cardiac beats are greatly increased in 
strength (Fraser, Bezold and Gotz*). Finally, the arterial pressure falls far 
below normal, and the power of the heart is gradually extinguished. 
* I have not seen the original paper of these authorities in the Centralblatt fur Med. 
Wiseenechaft, 1867, but quote them from the paper of Arnstein and Sustschinsky. DEPRESSO-MO TORS. 
347 
The question as to the exact method in which these changes are wrought 
is of very difficult answer. The long diastolic pauses and the slow strong 
beat of the heart suggest at once that a chief action of the drug is upon the 
inhibitory cardiac nervous system. Tachau, however (loc. cit., p. 172), found 
that after section of the vagi the poison produces these phenomena in an even 
more intense degree than in the normal heart. As this has been confirmed 
by Laschkewich (Joe. citJ, by Fraser (loc. cit., p. 49), and by Harnack and 
Witkowski (loc. cit., p. 419), it must be accepted as a proven fact, especially 
since Vintschgau has found (loc. cit., p. 71) that if in the frog the brain and 
the medulla be destroyed, physostigmia still acts in its usual way on the 
heart.* Tachau considers that this demonstrates that the cardiac phenom- 
ena of Calabar bean poisoning are not due to an action of the drug upon 
the inhibitory nerves. Arnstein and Sustschinsky, however, admitting the 
fact, deny that it warrants the conclusion. Their idea appears to be that it 
is conceivable that a substance should so act upon the peripheral inhibitory 
nerve-endings as to cause them to influence the action of the heart without 
any external impulse, and consequently when separated from the nerve- 
centres. With our present knowledge, the possibility of this seems some- 
what doubtful. Moreover, Kohler, Harnack, and Witkowski have all found 
that in the frog Calabar bean still lessens the pulse-rate after complete paralysis 
of the peripheral vagi by atropiaj* (Archiv f. Exper. Path, und Pharm., 
Bd. i. p. 280). Kohler believes that his experiments prove that the Cala- 
bar bean paralyzes the cardiac accelerator nerves. It will be remembered, 
however, that Vintschgau found that Calabar bean exerts its normal influ- 
ence upon the heart after destruction of the accelerator centres. Whatever 
may be the action of small doses of physostigmia upon the vagi and accel- 
erators, it seems to me that it must be considered established that the general 
cardiac symptoms are due to a direct action upon the heart-muscle or its 
contained ganglia, and that any increase of the inhibitory activity must be 
of such slight amount as to be of no importance. 
In regard to the action of the drug upon the peripheral vagi, the follow- 
ing resume of the evidence is of interest. Arnstein and Sustschinsky found 
that the excitability of the peripheral cardiac vagi is increased by Calabar 
bean. They first tested the effect of graduated galvanic currents applied to 
the divided vagi in the animal to be experimented with, until the exact 
strength of the weakest current capable of causing diastolic arrest was de- 
* The fact that Calabar bean acts in its usual manner after section of the par vagum 
indicates that it has no influence upon the inhibitory centres,-a conclusion confirmed by 
Arnstein and Sustschinsky (Zoc. cit., p. 102), who found that an injection of the drug 
into a carotid-i.e., into the inhibitory centre-did not cause any marked immediate 
diminution in the number of the cardiac pulsations. 
f Rossbach and Frohlich (Zoc. cit., p. 56) assert that in frogs, although the vagi are not 
more excitable before than after the poisoning, stimulation of the venous sinuses and of 
the auricles has much more than the normal influence, which is very extraordinary if 
true. 348 
SYSTEMIC REMEDIES. 
monstrated, and then exhibited the drug and tested the nerves afterwards. 
They used in these experiments both rabbits and guinea-pigs, and found 
that, without a single exception, currents much weaker than those which 
previously were barely effective would, after the poisoning, stop the heart; 
also, the super-excitability of the peripheral inhibitory nerves was shown by 
the fact that under the influence of the drug the diastolic arrest continued 
much longer than normal after the withdrawal of the stimulus from the 
vagi. These experiments have been directly corroborated by Rossbach and 
Frohlich upon the rabbit (loc. cit., p. 57). Dr. Fraser's experiments upon 
the local cardiac application of the drug are also seemingly confirmative of 
those of Arnstein and Sustschinsky, for he found that when the poison was 
put directly on the heart, or into one of its chambers, it caused a prolonged 
diastolic pause, followed by contractions, interrupted by pauses, and finally 
resumption of regular contractions, or else by diastolic arrest, the heart still 
retaining its power of responding, in an embarrassed manner, to stimuli. 
These experiments certainly seem to prove that Calabar bean does cause 
excitation of the peripheral cardiac apparatus. Arnstein and Sustschinsky 
further confirm them by other experiments of exceeding interest. They 
injected into rabbits such amounts of atropia as completely to paralyze the 
peripheral cardiac vagi, so that the strongest currents when applied to the 
nerves failed to influence the heart's action, and then restored functional 
power to the pneumogastrics by injections of Calabar bean, so that cur- 
rents of moderate intensity caused diastolic arrest. These experiments, if 
accurate, prove that physostigma is a powerful excitant of the peripheral 
vagi. Kohler (loc. cit.}, using the frog, and Rossbach and Frohlich, using 
the rabbit, failed to resuscitate the atropinized vagi by means of Calabar 
bean, but it is evident that a negative result in such a case might be due 
to an improper proportion in the doses of the counter-poison, or in the 
atropia being employed in overwhelming amount. In warm-blooded ani- 
mals, at least, the vagi are not paralyzed during life by physostigmia, as 
is evinced by the experiments of Arnstein and Sustschinsky (loc. cit., p. 
101), confirmed by Harnack and Witkowski (loc. cit., p. 433). Some of 
the results obtained by Fraser (loc. cit., p. 36), confirmed by Rossbach 
and Frblich, apparently contradict, but in reality accord with them. In the 
frog there was, indeed, at last a loss of functional power in the vagi, but not 
until very long after the cessation of respiration, after all the nerves of 
voluntary motion had lost their functional power,-i.e., after death would 
have occurred in a mammal. Harnack and Witkowski affirm that the 
vagi never lose their power in the frog to lessen the rate of the heart-beat, 
although unable to cause diastolic arrest. 
In summing up the evidence in regard to action of the drug upon the 
vagi, it is plain that no positive conclusion can be reached, although it seems 
probable that the drug first increases and then lessens the power of the 
inhibitory nerves over the heart. DEPRESSO- MO TORS. 
349 
As already stated, a very prominent phenomenon in Calabar bean poison- 
ing is rise of the arterial pressure. This, of course, may be of cardiac 
origin, or it may be due simply to a contraction of the arterioles; or it may 
arise from a combination of these causes. Bezold and Gotz (quoted by 
Arnstein and Sustschinsky, p. 87) found that the arterial pressure still rose 
under the influence of the drug after section of the spinal cord high up,- 
i.e., after general vaso-motor paralysis. Harnack and Witkowski also found 
that when the vaso-motor centres were paralyzed with chloral, physostigmia 
causes very decided increase of the arterial pressure. It is evident the 
increased force of the circulation produced by physostigmia must, at least in 
part, be due to a direct action of the drug on the heart. 
The fact that the rise of arterial pressure produced by Calabar bean is not 
so great in animals whose cords have been divided as in those uninjured cer- 
tainly indicates, though it does not prove, that the increased arterial tension 
of physostigmia-poisoning is in part due to vaso-motor spasm. Dr. Fraser 
believes that Calabar bean does produce this spasm; but his evidence is 
insufficient to establish his conclusion. It consists simply of some experi- 
ments upon frogs in which the spinal cord was divided, and, the animal being 
put on a " frog-plate," the arteries of the web were watched whilst Calabar 
bean was exhibited. Dr. Fraser believed that under these circumstances 
the arteries contracted considerably at first, and afterwards dilated. Dr. 
Harley (^Practitioner, 1869, vol. iii. p. 163) states as the result of his studies 
that Calabar bean can be seen, when applied locally, to cause contraction of 
the veins, the arteries remaining unaffected; whilst Fraser, in contradiction 
to this, believes that he has demonstrated that the local application of phy- 
sostigma produces dilatation of the arteries. It is not necessary here to re- 
iterate my objections to such evidence as this. If, under the circumstances 
of the first-mentioned experiments of Dr. Fraser, Calabar bean contracts 
the small vessels, it must be by a peripheric, not centric, action, since the 
vessels were separated by the division of the cord from the vaso-motor 
centres. It is plain that this is in direct contradiction to Dr. Fraser's ex- 
periments on the local application of the drug. Again, it is contradictory, 
rather than confirmatory, of that furnished by the study of the blood-pressure. 
The only logical conclusion seems to me to be that at present we have not 
proof that Calabar bean acts upon the vaso-motor nervous system. As the 
increase of the arterial pressure is in great part, if not altogether, due to 
the increased energy put forth by the heart under the influence of physo- 
stigmia, and as that influence is exerted directly upon the heart-muscle or its 
ganglia, it is evident that physostigmia directly causes the heart to put forth 
more effort, or, in other words, stimulates it. The final diastolic arrest (the 
loss of the power of responding to stimuli) shows, however, that at last the 
poison paralyzes the heart. In considering the general physiological action 
of the drug, it must not be forgotten that its influence upon the heart is 350 
SYSTEMIC REMEDIES. 
entirely subservient to its influence on the nervous system,* and that death 
in the mammal occurs before the stage of cardiac palsy is reached, unless the 
drug be injected directly into the heart in overwhelming dose. 
I do not believe that physostigma has much action upon the blood. Cer- 
tainly its influence upon the nervous system is a direct one, since Lewisson 
(Reichert's Archiv, 1870) has found that it acts upon the "salt frog" as upon 
the normal animal. Fraser, however, states that after death from this poison 
the blood coagulates slowly and loosely, and the red disks in dogs and in 
rabbits present various irregularities of outline, among which may be noted a 
well-marked stellar crenation, but that the respiratory function of the blood 
is not interfered with. 
Intestines.-Intestinal peristalsis is very much increased by the action of 
Calabar bean (Westermann, Schmidt's Jahrbiicher, Bd. cxxxviii. p. 290; 
Papi, Ibid., Bd. cxlii. p. 287; Fraser, loc. cit., p. 57). After poisonous 
doses there is at first a stage of exceedingly active movements in the bowels; 
then spasmodic tetanic contraction of the intestines occurs, so that their cali- 
bre is very much diminished; and finally relaxation and dilatation take 
place. After death the vermicular movements are found very much lessened 
(Fraser), or altogether abolished (Tachau, loc. cit., p. 73). 
The action of Calabar bean upon the intestines appears to be peripheral, 
due to contact of the poison in the blood with the muscular fibres or the 
ganglionic nerve-cells in the walls of the bowels. For Westermann (loc. cit., 
p. 291) found that extirpation of the cardiac ganglion had no effect upon the 
action of the drug, but that tying of the mesenteric and of the coeliac arte- 
ries, before poisoning, prevented any increase in the peristalsis. Calabar 
bean probably influences intestinal secretion. Its action upon the salivary 
glands is often decided, and according to Heidenhain is not prevented by 
atropia. 
Eye.-Calabar bean, as is well known, strongly contracts the pupil, both 
when applied to the eye and when exhibited internally. Evidently, as in 
the case of atropia, the pupillary action of Calabar bean should be studied 
from two points of view, the local and the constitutional. 
The closeness of the analogy between the pupillary action of atropia and 
that of Calabar bean is seen in the fact that, like the former, the latter, as 
shown by the experiments of Vee and Leven on chickens (Comptes-Rcndns 
de la Society de Biologie, 18G5, p. 161), does not affect the irides of birds. 
Thus, analogy would seem to prove that the influence of Calabar bean is 
directly upon the peripheral nerves of the iris. 
Although, then, I am not able to cite any direct experimental proof, yet 
it seems to me scarcely doubtful that the contraction of the pupil produced 
* For a discussion of the peculiar cardiac relations of physostigmia and muscarin, see 
the paper by Harnack and Witkowski. Those authors believe that Calabar bear, sets 
,n motion the heart arrested in diastole, not by paralyzing the cardiac inhibitory appa- 
ratus, but by stimulating the cardiac muscle. DEPRESSO-MO TORS. 
351 
by Calabar bean is always a local, peripheral influence, whether the drug 
be placed in the eye from the outside or be carried to the general circula- 
tion. It is evident that the myosis may be caused in one of three methods: 
by paralysis of the sympathetic fibres, by stimulation of the oculo-motor 
fibres, or by a conjoint action upon both sets of nerve-endings. In which 
of these ways the drug acts, we are not yet able to decide. 
It has been held by various authorities that if galvanization of the sympa- 
thetic fibres in the neck fail to expand a contracted pupil, the myosis must be 
due to paralysis of the sympathetic. Evidently, however, this is claiming 
too much, for, as pointed out by Griinhagen ( Virchow's Archiv, Bd. xxx. p. 
521), it is conceivable that an oculo-motor spasm can exist of such intensity 
that the antagonistic nerve is unable to dilate the pupil. The question arises 
very pertinently at this point, What is the fact in regard to Calabar-myosis? 
Does or does not galvanic stimulation of the cervical sympathetic dilate the 
pupil ? The testimony is somewhat conflicting. Dr. Griinhagen (loc. cit., 
p. 521) says that dilatation always occurs, although to a slight extent (in 
beschrdnkten Masse); whilst, on the other hand, Dr. Gustav Engelhardt 
(Untersuchungen aus dem Physiologischen Laboratorium in Wurzburg, 
zweiter Theil, p. 526) has found that galvanization of the cervical sympathetic 
has no effect upon the contracted pupil. The experiments of Fraser (loc. cit., 
p. 60), of Bernstein and Dogiel, and of Rosenthal (Reichert's Archiv, 1863), 
would seem to reconcile these differences, and by their accord, to prove that 
under the maximum influence of Calabar bean the sympathetic is powerless, 
whilst when the contraction is the result of a milder influence of the drug, 
stimulation of the cervical nerve will cause a certain amount of dilatation.* 
Fraser, and also Engelhardt, have found that if the poles of a battery be 
applied directly to an iris even most profoundly contracted by physostigma, 
immediate dilatation occurs. These facts, for reasons stated above, do not 
absolutely prove, but they certainly render it highly probable, that Calabar 
bean paralyzes the peripheral sympathetic nerve-fibres in the iris. It is, 
however, almost equally probable that there is a consentaneous stimulation 
of the uculo-motor terminations; for the myosis caused, like the mydriasis 
produced by atropia, is an active, not a passive, condition, and is not only 
much more forcible, but is also much more complete, than that which follows 
section of the cervical sympathetics. If the observation of Rossbach and 
Frohlich be correct, that overwhelming doses of the physostigmia finally 
dilate the pupil, it is evident that the oculo-motor stimulation is replaced 
after such doses by oculo-motor palsy. 
Urine and Elimination.-No study, that I am aware of, has been made 
* Recently Rossbach and Frohlich affirmed that galvanization of the sympathetic still 
causes dilatation, even when the action of the physostigmia is most vigorous. As it is 
scarcely conceivable that the various other investigators should have been so much in 
error, it is probable that Rossbach and Frohlich used such strong currents that they were 
directly transmitted to the iris. 352 
SYSTEMIC REMEDIES. 
either as to the elimination of Calabar bean or its action on the urinary 
secretion in health. Dr. Merson (Journal of Mental Sci., Jan. 1875) has 
found that in general paralysis under its influence urea and the other solids 
of the urine are decidedly diminished. The physostigma probably escapes 
with the renal secretion, and in a case of poisoning its presence could prob- 
ably be detected by dropping some of the fluid in the eye of an animal. 
Therapeutics.-The physiological action of Calabar bean has suggested 
its use in spasmodic affections, in atony of the muscular coats of the bowel, 
and in various diseases of the eye. 
The action of Calabar bean upon the spinal cord very early led to its use 
in spasmodic affections, and especially in tetanus, in which disease it has been 
more freely employed during the last few years than any other remedy except 
opium. In the paper of Dr. B. Roemer (St. Louis Medical and Surgical 
Journal, 1873, p. 367) are collected forty-seven cases, of which twenty 
proved fatal. To these I am able to add the twenty whose references are 
given below,* making in all sixty-seven cases, with thirty-seven recoveries 
and thirty deaths,-not a very flattering record. 
It is, however, proper to state, as affecting the value of these statistics 
that much of the Calabar bean extract which has been offered in the market 
is practically inert, and in all probability in some of these cases the drug did 
not have a fair trial; and that when especial care was taken by certain 
observers better results were achieved, although on so small a scale as to 
leave the issue in much doubt'.j" 
In trismus neonatorum, Calabar bean has been employed with results cer- 
tainly no more encouraging than those obtained in tetanus. In chorea it 
has also been used by some practitioners with asserted advantage, but further 
experience hardly justifies its administration (see Bull. Gen. TUrap., 
Ixxxix., 85, 541). 
The physiological action of physostigma upon the unstriped intestinal 
muscle-fibres has led to its employment in atony of the muscular coat of the 
bowels and other similar organs. Dr. V. Subbotin (Archiv f. Klin. Med., 
Bd. v. p. 285, 1869) has used the extract with the happiest results in a 
case of chronic bronchial catarrh with intense dyspnoea, believed to be due 
* Fatal Cases.-Fenwick, 1 {Glasgoio Medical Journal, 1869, p. 300); Franzolin, 1 
{The Doctor, Oct. 1, 1871); Laborde, 1 {British Medical Journal, June, 1872); Valdi- 
vieso, 1 {Philadelphia Medical Times, vol. i. p. 455); Tyson, 1 {Ibid., p. 418); Johnson, 
1 {Ibid., p. 372); 1 {London Lancet, 1874); Silbermann, 1 {Charier's Thesis, 1881); Dela- 
marre, 1 {Paris Thesis, 1875); Richelot, 1 {These de Concours, 1875). Recoveries.- 
Fenwick, 1 {Glasgow Medical Journal, 1869, p. 300); Newman, 1 {Medical Examiner, 
July, 1869); W. W. Keen, 1 {Philadelphia Medical Times, vol. i. p. 195) ; J. II. Packard, 
1 {Ibid., p. 138); Cunningham, 1 {British Medical Journal, i., 1874); 1 {Cincinnati Lan- 
cet, Sept. 1878). All these cases were of the traumatic form of the disease. Charier, 1 
{Paris Thesis, 1881); Burnam, 1 {Lancet, Jan. 1881); Pooley,! {New York Med. Journ., 
Sept. 1878); Silbermann, 1 {Charier's Thesis, 1881). 
f For a favorable record, see Watson, Glasgow Medical Journal, N. S., 1869, vol. i. p. 
54; consult also London Practitioner, Sept. 1869. DEPR ESSO-MO TORS. 
353 
to weakness of the bronchial muscular fibres; and also in one of apparently 
"phantom tumor," with chronic intestinal dyspepsia and catarrh. In con- 
stipation dependent upon relaxation, it is also said to be useful. Dr. A. 
Hiller also strongly endorses the value of the extract in chronic intestinal 
atony, after or during a catarrh, in the convalescence from fever, etc., and 
in constipation with flatulence, in meteorism, etc. (Charite Annalen, 1883, 
235). 
Calabar bean has also Deen employed in strychniapoisoning, and a recovery 
obtained after the ingestion of three grains of the latter alkaloid is reported 
by Dr. J. W. Keyworth (Glasgow Medical Journal, N. S., 1869, i. 54).* 
In epilepsy, some trials have been made of the drug, but its value is very 
doubtful. Drs. Harnack and Witkowski have found that in epileptic guinea- 
pigs physostigmia causes a succession of fits lasting for hours and days. They 
have further noted a similar influence upon man. Recently attention has 
been called to the employment of Calabar bean as a galactogogue, the extract 
being applied to the breast itself (Brit. Med. Journ., ii., 1876, p. 554). 
Administration.-Calabar bean is usually administered as an extract 
(Extractum Physostigmatis, U. S.), the commencing dose of which is one- 
tenth to one-fifth of a grain. The dose of the tincture (Tinctura Physo- 
stigmatis, U. S.) is twenty to forty minims. The alkaloid is preferable on 
account of its certainty, but care is requisite not to use it too freely. 
Bouchut has found that in children one-twentieth of a grain, given hypo- 
dermically, will produce very decided symptoms, which entirely pass off in 
about three hours. It is probable that one-fifteenth of a grain, repeated 
every three hours, will be found to be a moderate dose for the adult. It 
should always be borne in mind that, in tetanus and other severe diseases, 
it is necessary to augment the dose until an effect is produced. Harnack 
gives the minimum fatal dose of eserina as for dogs four to five, rabbits three, 
cats two to three milligrammes. The frog resists these doses successfully. 
Toxicology.-So far as I know, Calabar bean has not been used, either 
in Europe or in this country, with criminal intent. In Liverpool seventy 
children were accidentally poisoned at one time (Medical Times and Gazette, 
Oct. 1864, p. 406). Many of the victims vomited spontaneously, and thus 
relieved themselves. Those brought to the hospital were in a state of ex- 
treme prostration and muscular relaxation. They appeared to suffer almost 
no pain, only some of them saying they had a little " belly-ache." Among 
some thirteen examined, only one had the pupils contracted. The only child 
who did not recover was excessively weak, and, crying out suddenly, was 
dead of sudden syncope. The heart was found relaxed and flabby, both 
sides equally full of blood. In the case of a strong man, who had eaten 
halt a bean (St. Barthol. Hosp. Rep., 1879, xv.), the symptoms were great 
* The subject of the asserted antagonism between chloral and Calabar bean wil1 be 
studied in the article on chloral. 354 
SYSTEMIC REMEDIES. 
muscular weakness, tightness across the chest, temperature of 96.6° F., very 
slow, intermittent, irregular pulse, collapse, without vomiting, purging, con- 
traction of the pupils, or abdominal pain. 
In 1864 Dr. Kleinwachter treated a case of poisoning by an unknown 
quantity of atropia with Calabar bean, apparently with great benefit. Dr. 
Bourneville detailed in 1867 some experiments which seemed to show that 
there is a real antagonism between Calabar bean and the mydriatic, and in 
1870 (Revue Photographique des Hopitaux) published five experiments 
upon guinea-pigs, which were very decisive in that a proven fatal dose of 
physostigma was given in each case and recovery obtained by the use of non- 
lethal doses of atropia. In 1869 Prof. Roberts Bartholow, of Cincinnati, 
on the strength of a few really indecisive experiments, arrived at a conclu- 
sion opposite to that of Bourneville. Recently, Dr. Fraser, of Edinburgh, 
has investigated the subject in so thorough a manner that his essay may 
serve as a model for those who are desirous of studying questions of antag- 
onisms between poisons. His experiments, three hundred and thirty-one in 
number, were made chiefly upon rabbits, a few having been upon dogs. He 
first investigated as to the minimum fatal dose, per pound of the animal, of 
the preparations used,-the extract of the bean, and the sulphate of eserina. 
It was ascertained that the minimum lethal dose for rabbits of the extract 
of physostigma which he employed was 0.4 grain per pound ; of the sulphate 
of eserina, 0.04 grain per pound. Then in sixteen experiments in which 
recovery followed the administration of a dose of atropia given in combina- 
tion with a dose of physostigma equal to or in excess of the minimum fatal 
dose, the animal used was killed long afterwards by a dose of the Calabar 
bean less than or equal to that from which recovery had occurred under the 
influence of atropia. In this way & perfect demonstration of the power of 
the counter-poison was obtained. 
It was found that the counter-poison acted most efficiently when thrown 
directly into the veins. Thus, a rabbit weighing three pounds and two 
ounces received 1.6 grains of the extract, and five minutes afterwards 0.02 
grain of atropia, in a vein, and recovery took place; eight days after this, 
1.3 grains of the extract killed the same rabbit in nineteen minutes: in 
another animal which nine days before had been saved from death after the 
exhibition of 2 grains of the extract by 0.5 grain of the sulphate of atropia, 
1 grain of the extract proved fatal in thirteen minutes. 
The next series of experiments was undertaken to ascertain the maximum 
dose of physostigma that can be successfully antagonized by atropia, and the 
dose in which the latter should be employed. In all cases the atropia was 
given five minutes before the Calabar bean. It was found that one-fiftieth 
of a grain of the mydriatic would successfully antagonize one and a half 
times, but not twice, the minimum fatal dose of the myotic. 
One-fortieth of a grain of the atropia was successful against two to two 
and a half times the minimum lethal dose of physostigma; three-fiftieths DE PR ESSO-MO TORS. 
355 
was sufficient for three times the minimum fatal dose. The small size of the 
required doses of atropia is very noticeable, and at the present point in the 
investigation a very curious result was obtained. It was found that when 
three times the minimum fatal dose of the Calabar bean was exhibited, the 
successful dose of atropia ranged from three-fiftieths of a grain to one grain 
and a fifth. When three and a half times the fatal dose of the physostigma 
was exhibited, success was achieved only with doses of atropia of from one- 
tenth to one-fifth of a grain. Unfortunately, there are only seven experi- 
ments bearing upon this point; yet its general accuracy, I think, can scarcely 
be questioned. When a rabbit received four times the lethal dose of phy 
sostigma, the mydriatic was powerless. 
In the final series of experiments, the atropia was administered five min- 
utes after the physostigma, and it was found that the largest dose of the 
latter which could be combated successfully was three times the minimum 
fatal dose, and the range of the dose of atropia was much less than when it 
was given before the poisoning. Thus, with three times the minimum lethal 
dose of the Calabar bean, death occurred when three-twentieths or one-fifth 
of a grain of the antidote was given, but recovery followed the administra- 
tion of four-twenty-fifths of a grain. 
No experiments were made to test the value of physostigma in atropia- 
poisoning. Dr. Fraser states, however, on what grounds I do not know, 
that the minimum fatal dose of atropia is twenty-one grains ; and he found 
that when one-half the minimum lethal dose of physostigma is given, 
together with nine and four-fifths grains, or more, of atropia, death 
results. 
These experiments of Fraser have been in some degree confirmed by the 
imperfect researches of Amagat (Journ. de Thirap.^ 1876). Considerations 
previously given, however, show that the cardiac antagonism of atropia and 
physostigma must be considered doubtful, and, if it exist, is of little impor- 
tance. Whatever of life-saving power the mydriatic has in Calabar bean 
poisoning is evidently dependent upon its stimulant action on the respiratory 
centres. 
The question naturally arises, How far are the results of these experiments 
applicable to the treatment of Calabar bean poisoning in man ? Without 
discussing this at length, I think the following deductions are obvious: first, 
that atropia ought by all means to be tried in poisoning by physostigma; 
second, that the doses of it should never be very large, not exceeding in all 
the tenth of a grain. The use of atropia should, of course, not cause neglect 
of such measures of relief as evacuation of the stomach, the external 
application of dry heat, etc., usual in poisoning by sedative narcotics. Arti- 
ficial respiration should, when necessary, be assiduously practiced, since death 
undoubtedly is due to failure of the breathing, and Harnack and Witkowski 
have found that animals survive very large doses of the poison, when respira- 
tion is maintained artificially. 356 
SYSTEMIC REMEDIES. 
POTASSI BROMIDUM-BROMIDE OF POTASSIUM. U.S. 
The bromide of potassium is prepared, according to the officinal method, 
by precipitating freshly-made solution of the bromide of iron by the pure 
carbonate of potassium, filtering, and evaporating the resultant solution. It 
occurs in milk-white cubic or quadrangularly prismatic crystals of an acrid 
saline taste, freely soluble in water and slightly so in alcohol. When it is 
mixed with starch, and chlorine is added, a yellow color is developed. A 
bluish tint betrays contamination with an iodide. 
Physiological Action.-Local Action.-When a solution of the bro- 
mide is applied locally to the heart, it produces instantly marked lessening 
of its action, and, if in sufficient amount and concentration, even instantane- 
ous diastolic arrest ( Virchow's Archiv, xli. 101). Upon the voluntary mus- 
cles it acts in a similar manner when similarly applied. If its solution be not 
too concentrated or abundant, however, the muscle of the frog is first thrown 
into a tetanic spasm {Dublin Journal, xlvii. 325) ; and Dr. Purser suggests 
that the tetanic symptoms seen in the frog poisoned by the bromide of 
potassium are due to this action on the muscles. On the nerve-trunks, 
and also on the nerve-centres, the bromide acts, when applied locally, as 
a paralyzing poison {Bull. Therap., Ixxiii. 253, 290 ; also Dr. Amory, 
The Physiological and Therapeutical Action of the Bromide of Potassium, 
Boston, 1872, Part IL, p. 147; also Ringer and Morshead {Journ. Anat., 
xii. 71). It is, therefore, evident that the bromide of potassium in sufficient 
quantity is a deadly poison to all the higher animal tissues. In general 
poisoning of animals by hypodermic injection of the bromide, this local 
action is often very manifest, and paralysis of the part into which the solu- 
tion has been thrown follows very rapidly upon the injection. In the form 
of powder it is affirmed to be somewhat caustic, and has been highly recom- 
mended for the destruction of excessive granulations, etc. {Brit. Med. Journ., 
ii., 1876, 496). 
General Action.-Bromide of potassium administered to frogs in minute 
doses produces as a first result a tetanoid condition, in which there may be 
very marked opisthotonos. After a short time this stage of muscular ex- 
citement gives way to one of great muscular relaxation, and total abolition 
of reflex actions. Voluntary movements, however, often occur during this 
period, and the frog which has been lying limp and apparently dead will 
startle the observer by a sudden vigorous leap. This fact has been so 
frequently witnessed that there can be no doubt of its truth. It is vouched 
for by the following observers : J. M. Purser {Dublin Journal of Med. Sci., 
xlvii. 324, 1869) ; Lewisky aus Kazan {Virchow's Archiv, Bd. xlv. p. 191, 
1869); J. V. Laborde {Archives de Physiol. Norm, et Pathol., t. i. p. 423, 
1868, and Comptes-Rendus, t. Ixv., 1867); MM. Damourette and Pelvette 
(Bull. Therap., 1867, Ixxiii. 249). Very early in the paralytic stage the 
respiratory movements are affected, and they gradually grow less until their DEPRESSO-MO TORS. 
357 
final arrest. When a very large dose of the bromide is given, death may 
be induced by paralysis of the heart (Albert Eulenberg and Paul G-uttmann, 
Virchow's Archiv, xli., 1867); but after a small toxic dose this viscus con- 
tinues to beat long after the cessation of breathing. If the drug be given 
by an injection practiced in the vicinity of the heart, sudden cardiac arrest 
always occurs. 
Upon mammals (Bulletin Thtrapeutique, Ixxiii. 256 ; Virchow's Archiv, 
xli. 97) the bromide acts very much as upon frogs, inducing progressive 
paralysis, depression of temperature, and death by asphyxia when given in 
small poisonous doses, and great disturbance of the circulation, with finally 
diastolic arrest of the heart, when very freely administered. 
No case of acute poisoning in man* with the bromide of potassium has 
been recorded. The nearest approach to a toxic effect I have knowledge 
of was in a medical student at the University, who took an ounce by mis- 
take ; he reported that the only effects were immediate severe pain in stomach 
and oesophagus, nausea, a little vomiting, great thirst, a feeling of weight in 
the head, and great sleepiness, which lasted for three days. 
The results of the continuous employment of large doses of the bromide, 
however, demonstrate that it acts upon man as upon the lower animals. When 
it is taken with sufficient freedom to accumulate in the system, a conjunction 
of phenomena known as bromism arises. The cerebral symptoms are a sense 
of mental weakness, heaviness of intellect, failure of memory, partial aphasia, 
great somnolence, and depression of spirits. With these there may be de- 
cided impairment of the sensibility of the mucous membranes and of the 
skin, so that titillation of the fauces may be without effect, and, according 
to Puche, even heat applied to the skin calls forth no complaint: Huette 
(Memoires de la Soc. Biolog., 1850) has seen in some cases absolute anaes- 
thesia of the sclerotic conjunctiva. The sexual function is abolished. There 
is also very generally fetid breath, and an eruption of acne, which may indeed 
be very severe. Of course, in any individual case of bromism many of these 
symptoms may be wanting; but when the use of the remedy is persisted in, 
they all at last become developed in an intense degree. Prof. Edward H. 
Clarke thus speaks of a case which came under his notice : " The fetid breath 
becomes nauseous; oedema supervenes on congestion of the uvula and fauces • 
the whispering voice sinks into aphonia; sexual weakness degenerates into 
impotence; muscular weakness becomes complete paralysis ; reflex, general, 
and special sensations disappear; the ears do not hear, nor the eyes see, nor 
the tongue taste ; the expression of hebetude becomes first that of imbecility, 
then that of idiocy; hallucinations of sight and sound, with or without 
mania, precede general cerebral indifference, apathy, and paralysis; the res- 
piration, without the stertor of opium or alcohol, is easy and slow; the tem- 
perature of the body is lowered ; as the bromism becomes more profound, 
the patient lies quiet in bed, unable to move or feel or swallow or speak, with 358 
SYSTEMIC REMEDIES. 
dilated and uncontractile pupils, and scarcely any change of the color of his 
skin or face." 
Action on Nervous System.-The persistence of voluntary movement in 
the frog after the abolition of reflex actions shows that the influence of the 
drug is not chiefly exerted upon the cerebral centres of motor impulse, nor 
upon those cells of the cord which originate movement, but upon either the 
afferent nerves or those portions of the cord which transmit the impulse from 
these nerves to the cells presiding immediately over motion. This is con- 
firmed by some experiments of Lewisky, in which it was found that previous 
separation of the cord from the cerebrum had no influence upon the action 
of the bromide. Both he and Purser also found that death occurred from 
small doses before the motor nerve trunks and the muscles had lost their irri- 
tability (confirmed by Saisson, Schmidt's Jahrbucher, Bd. cxliii. p. 17). This 
being so, the question arises whether the paralysis be spinal or due to paraly- 
sis of the peripheral afferent nerves. There is an apparent conflict in the 
evidence upon this point. Eulenberg and Guttmann (Joe. cit., p. 103) found 
that when access of the poison was prevented to one or more limbs by tying 
the arteries, reflex actions were abolished in these parts as rapidly as in others. 
Similar results have been obtained by Lewisky, by Roberts Bartholow {Bro- 
mides : Their Physiological Effects, Providence, 1871), by Purser* (Joe. 
cit., p. 326), and by Laborde (Joe. cit., p. 434). The latter observer has 
also found that electrical stimulation of a nerve high up will cause violent 
spasms in the muscles directly supplied by it, although it may be unable to 
excite the slightest reflex tremor. On the other hand, Damourette and PoJ- 
vette assert a contrary result. Unfortunately, they do not give the details 
of their experiments. They state, however (p. 247), that if the lumbar 
plexus of vessels be tied before the poisoning, the fore feet lose their reflex 
activity before the hinder. There are two possible methods of reconciling 
their results with those of the other observers. In some way the operation 
may have interfered with the circulation in the lower part of the cord, and 
consequently the poison have reached more freely the upper part of it and 
acted first upon it. Again, if the injection was, as is very probable, thrown 
into the anterior portion of the body, the poison may have reached the an- 
terior extremities in so concentrated a form as to have acted, as it were, locally 
upon their nerves and muscles. The same observers in another portion of 
their memoir show that the solutions of these salts travel by imbibition ; and 
this and their local action seem to me to be the cause of the differences of 
experimental results. It seems well established that cutaneous anaesthesia in 
greater or less degree accompanies the loss of reflex activity; for, as Dr. 
Purser says, a poisoned animal quite able to jump submits to pinching, prick- 
ing, burning, etc., without moving. Eulenberg and Guttmann have noticed 
* From the wording of his memoir, however, it is doubtful whether Purser performed 
the experiment himself. DEPRESSO-MO TORS. 
359 
the same thing in some rabbits. Damourette and Pelvette (l°c- cit., p. 247) 
have noticed a condition in which electrical stimulation of a nerve-trunk pro- 
duced marked reflex action, although no excitement of the skin supplied by 
the afferent fibres of the nerve was capable of doing this, showing that the 
extremities of the sensitive nerves are affected before the trunks. The evi- 
dence is, I think, sufficient to prove that bromide of potassium affects all 
parts of the nervous system of the lower animals, but that the cerebrum, the 
motor tract of the cord, and the efferent nerves are the last portions to be 
affected; that the most sensitive to its action is the receptive portion of the 
cord.-that which receives and transmits reflex impulses,-and next to this, 
and perhaps almost equally susceptible with it, are the peripheral ends of the 
afferent nerves. 
Upon the cerebrum of the higher animals the bromides undoubtedly 
exert an influence, and the researches of Prof. Albertoni (Arch. f. Exper. 
Path. u. Therap., xv. 256) have thrown much light upon the usefulness 
of the drug in epilepsy. That observer found that when administered to 
dogs the bromide depresses very markedly the power of the motor zone of 
the cerebral cortex to respond to stimuli, and to cause, on decided irritation, 
epileptic attacks; it was also discovered that this action of the bromide was 
much more decided when there had been a prolonged saturation of the 
system with the drug than after a single large or even toxic dose. The 
intellectual symptoms of bromism show that in man this action on the 
cerebral cortex is more marked than in the lower animals, on account, no 
doubt, of the higher cerebral development. The drug in other respects acts 
upon man as upon other mammals, lowering the reflex excitability of his 
spinal cord, paralyzing the ends of his peripheral nerves, and otherwise 
affecting him in the same order and degree. 
According to the researches of Dr. B. Schulze, there is under the influ- 
ence of the bromide a decided decrease in the elimination of phosphorus, 
an indication that the protoplasmic molecular changes in the nervous system 
are lessened by the drug (Zeitschrift f. Biologic, xix. 301, 1883). 
Circulation.-It is well established that large toxic doses of the bromide 
exert a direct paralyzing action on the heart, lessening both the force and 
frequency of the beat, and finally causing diastolic arrest.* Dr. J. G. Schouten 
(Archiv der Heilk.., xii. 2, p. 97, 1871 ; Schmidt's Jahrbucher, Bd. cliv. p. 
11) found that during the slow injection of a two per cent, solution into the 
vena cava of a rabbit the cardiac systole grew slower, the diastolic pauses 
longer, and finally the heart stood still, exhibiting only fibrillary contractions 
of its walls. The same observer is, so far as I know, the only one who has 
made manometrical studies of the action of small doses of the drug. He 
found that such amounts of the bromide administered hypodermically or by 
* For experiments upon the isolated heart of the frog by Prof. Sydney Ringer, sei 
Med.-Chir. Trans., 1882. 360 
SYSTEMIC REMEDIES. 
the stomach always produced increased pulse-frequency with lessened arterial 
pressure. His experiments were, however, not carried far enough to demon- 
strate either how these two changes are brought about, or the relations of 
the drug to the vaso-motor nerves. Much has been predicated upon the 
theory which asserts that bromide of potassium causes vaso-motor spasm. 
No decisive proofs have, however, yet been offered of the truth of this favorite 
dogma. The evidence so far brought forward is as follows : Lewisky found 
that if the toes of two frogs-one poisoned, the other not-were cut off, the 
unpoisoned frog bled much more freely than the other. This experiment 
has been confirmed by Dr. Amory: it, however, evidently does not prove 
the existence of vaso-motor spasm, but only that of a lessened activity of the 
circulation, which may be of cardiac origin. 
According to Damourette and Pelvette (loc. cit., p. 249), when the inter- 
digital membrane of the frog is watched during poisoning, there is seen at 
first very often an exceedingly brief period of increased circulation, but in a 
very short time the latter becomes much slower. Dr. Meuriot (Z' Etude de 
la Belladone, p. 49) asserts that by the aid of the microscope this slowing 
of the circulation can readily be seen to be due to a contraction of the capil- 
laries, and especially of the small arteries, whose lumen may even be oblit- 
erated. Dr. Saisson (Schmidt's Jahrbucher, Bd. exliii. p. 17) also asserts 
that he has witnessed a similar phenomenon in the tongue of the frog, and 
Dr. Hammond and Dr. Amory state that they have seen it in the brain of 
the dog. On the other hand, Dr. Purser Joe. cit J and Dr. F. B. Nunneley 
(London Practitioner, vol. iii. p. 351) assert that the vessels in the frog's 
web are not affected by bromide of potassium given hypodermically. 
My own studies of the action of various poisons upon the vessels of frog's 
web have yielded such varying and unsatisfactory results as to make me hesi- 
tate in accepting evidence of this nature unless otherwise corroborated. In 
the absence of manometrical studies, I think the most that can be fairly 
claimed is that our present knowledge renders it somewhat probable that the 
salt under consideration is capable of producing vaso-motor spasm. The 
further deduction that the nervous symptoms induced are secondary to and 
produced by this spasm is wholly gratuitous, unproven, and improbable. The 
action of the bromide when applied locally to the bared nerve demonstrates 
that it acts directly upon nerve-tissue. Further, the absolute anaemia of the 
bloodless " salt frog" produces no such nervous symptoms as does even a 
non-toxic dose of the bromide; and the direct experiments of Dr. A. Weil 
(Reichert's Archiv fur Anatomie, 1871, p. 271) have shown that in the frog 
the complete abolition of circulation has no effect upon the spinal marrow 
or upon reflex actions during the first half-hour. The proof is very strong 
that the drug acts directly upon the nervous tissues. 
Temperature.-In warm-blooded animals, toxic doses of the bromide of 
potassium lower very decidedly the temperature. Although the point cannot DEPRESSO-MO TORS. 
361 
be considered at all settled, it is probable that this lowering of temperature 
is due to a direct checking of tissue-changes. Dr. J. H. Bill (American 
Journ. Med. Sci., July, 1868) has found a constant decrease in the amount 
of carbonic acid eliminated after the ingestion of the salt. In his experi- 
ments, the daily excretion of urea was not perceptibly affected; but Dr 
Rabuteau found it slightly lessened (Gaz. Hebdom., 1869), as did also Dr 
Bartholow (?oc. cit., p. 11). 
Elimination.-When the blood is charged with the bromide, the salt prob 
ably escapes with all the secretions. It has been found by Voisin, Amory, 
Namias, Bill, etc., in the saliva and in the urine, and by Amory in the per- 
spiration (Bost. Med. Surg. Jour., Oct. 1868). In the body of a man who 
died whilst taking it, M. Namias ( Gomptes-Rendus, tome Ixx. p. 882) found 
it in all the liquids, as well as in the brain, liver, spinal cord, lungs, etc. 
Elimination takes place to a certain extent through the skin, and to some 
extent through the intestinal mucous membrane also. P. Guttmann ( Vir- 
chow's Archiv, Ixxiv.) has recognized bromine in the contents of the acne 
pustules of bromism. Dr. Bill (Joe. cit., p. 25) always detected the bromide 
in marked quantities in the faeces of men taking it; and H. Quincke 
(Reichert's Archiv fur Anatomic, 1868, xxxv. 158) found that when forty 
grains of the bromide of sodium were given to dogs with intestinal fistula, 
two and a half hours afterwards the intestinal juices were free from the 
bromides, which reappeared in them from three to six hours later. The 
salt escapes also through the kidneys. The rapidity of elimination seems 
to vary: thus, Amory recovered one-half of the amount ingested during 
the first and one-third during the second twenty-four hours, and Mr. Ware 
(Thesis of Dr. H. P. Bowditch, loc. cit.) obtained a little more than half 
of the amount ingested in the urine of the succeeding thirty-two hours, 
whilst Bill was not able to get more than one-eighteenth of it during the 
first day. Dr. Bill has frequently found the bromides in the urine two 
weeks after the last dose has been exhibited ; and Dr. Rabuteau has seen its 
presence persist under similar circumstances for a month. 
It has been claimed (Prof. Binz, London Practitioner, 1874) that the 
bromide of potassium owes its physiological and therapeutic powers solely 
to its base. This is plainly not the case, as the bromide is not largely de- 
composed in the system, and the symptoms caused by it are very different 
from those produced by carbonate of potash; in a later publication (Arch. 
Exper. Path, und Therap., xiii.) Prof. Binz himself has shown that bromine 
vapor produces in frogs effects in many respects similar to those caused by 
the potash salt. At the same time it is almost certain that the potash 
influences the system, and that the whole result is produced by a conjoint 
action of both ingredients of the salt. G. Krosz (Arch. Exper. Path, et 
Therap., vi. 43), in three experiments upon man, found decided difference 
in the results following proportionate doses of bromide and chloride of po- 362 
SYSTEMIC REMEDIES. 
tassium and of bromide of sodium. He attributes the lessening of reflex 
activity to the bromine.* 
Therapeutics.-The bromide of potassium is employed by the thera- 
peutist to quiet cerebral excitement when not inflammatory in its nature; to 
lessen over-susceptibility of the spinal centres of reflex action, or of the 
peripheral afferent nerves which lead to these centres; and to subdue nervous 
excitement of the genital System. The contra-indication to its use is the 
existence of a high degree of debility or exhaustion. 
There are various forms of nervous excitement or unrest, such as some- 
times follow excessive intellectual toil, anxiety, and other nervous strain, or 
occur during convalescence from acute disorder, in which the salt now under 
consideration is very valuable. The same may be said of some forms of 
hysteria. In some cases of neuralgia it undoubtedly affords great relief, but 
in the majority of cases it fails. It has seemed to me useless in neuralgia 
dependent upon anaemia or want of power; and my experience agrees with 
that of Dr. Anstie, that it is especially useful in persons of good nervous 
power, muscular force, and activity of circulation. As a hypnotic, it is em- 
ployed in wakefulness from nervous excitement and in delirium tremens. 
The chief use of the bromides is, however, to lessen reflex activity. It is 
especially in epilepsy that it has attained a most deserved reputation, doing 
far more good than all other remedies combined, sometimes effecting cures, 
more commonly ameliorating the symptoms, but occasionally failing entirely. 
There is no known method of distinguishing before trial with any certainty 
in what cases it will do good. Trousseau (Clinical Medicine, Sydenham 
Society, London) and Bartholow (loc. cit.^ both assert, however, that it is 
least efficient in the mild form of the disorder known as the petit mal. The 
most brilliant results have, as a rule, been obtained in cases of not too long 
duration in which the fits are frequent and severe. The governing principle 
in its use is to try it in every case,, increasing the dose until a mild degree 
of bromism is induced, and being guided by the results. 
The salt is also often efficacious in other reflex spasmodic neuroses; in the 
vomiting of pregnancy or of uterine disease ; in the convulsions of children; 
and, according to Dr. J. T. Rothrock, in preventing the so-called urethral 
fever induced in very susceptible males by the introduction of the catheter 
or bougie. The physiological action of the salt seemingly indicates that it is of 
all known remedies the one best suited for the treatment of tetanus. Clinical 
experience certainly accords with this conclusion; in the table below are 
collected thirty-four cases of tetanus, nearly all traumatic, in which there 
were but four deaths. Not less than a half-ounce of the salt should be 
exhibited in the day, and at night chloral should be used as a hypnotic (see 
Chloral). 
* Consult also Steinauer's paper in Virchow's Archiv, Bd. lix. DEPRESSO-MO TORS. 
363 
The following table contains all the statistical information I have on the 
subject. Cases not otherwise marked recovered : 
Reporters. 
No. 
Kin*. 
Place Reported. 
Remarks. 
Dr. Bachenal. 
1 
Traumatic. 
London Lancet, Feb. 1869. 
Dr. Derby. 
1 
M 
Boston Med. and Surgical Journal. 
Morphia also used. 
A. Fergusson. 
1 
1 
CC 
M 
Edinburgh Med. Journal, July, 1872. 
U. S. Army Med. Department Circu- 
lar No. 3, Aug. 1871. 
Chloral also used. 
Dr. Panas. 
1 
CC 
Gazette Hebdomadaire, No. 26, 1872. 
Opium also used. 
Dr. 0. L. Bard. 
1 
New Remedies, Jan. 1873. 
Dr. Bruchon. 
1 
M 
Bulletin Therapeutique, vol. Ixxvii. 
p. 8. 
Small bleeding and 
etherization also 
used. 
Robert Brown. 
1 
CC 
Edinburgh Med. and Surg. Journal, 
vol. xiv., 1869, p. 992. 
Bulletin Therapeutique, vol. Ixxvii. 
p. 428. 
Prof. May Figueira. 
1 
CC 
Ibid. 
1 
Idiopathic. 
Ibid. 
Dr. Panthel. 
1 
Traumatic. 
Deutsches Klinik, p. 21, 1874. 
Chloral also used. 
Dr. Trenholme. 
1 
Canada Med. Record, April, 1875. 
Chloral also used. 
Allen Coutts. 
1 
Idiopathic. 
London Practitioner, April, 1871. 
Calabar beau also 
used. 
II. F. Andrews. 
1 
? 
* 9 
H. K. Steel. 
1 
? 
* ? 
Died. 
G. Derby. 
1 
? 
* ? 
Took nearly 12 oz 
of the salt. 
Dr. Bakewell. 
1 
? 
• 7 
Dr. Hancock. 
1 
? 
* ? 
Died.f 30 grains of 
the bromide every 
four hours, witli 
20 minims of the 
tincture of bella- 
donna. 
R. Southey. 
1 
Idiopathic. 
Trans. Lond. Clin. Soc., x. 146. 
Died. Bromide not 
used freely enough 
to test its value. 
A. Cartaz. 
1 
Traumatic. 
Le Progres Med., 1875, 370. 
Levis. 
1 
Traumatic. 
Phila. Med. Tinies, v. 167. 
Chloral also used. 
H. Van Buren. 
1 
Traumatic. 
Chicago Med. Jourm, Feb. 1880. 
Chloral, Calabar 
bean, and opium 
also used. 
I. W. Lankard. 
2 
Traumatic. 
Virginia Med. Monthly, 1880, 698. 
Chloral and opium 
also used. 
Dr. Salter. 
1 
Traumatic. 
London Practitioner, Feb. 1882. 
Paris Thesis, 1880, No. 260 (Landon- 
Chloral also used. 
Dr. Bourgeons. 
1 
Traumatic. 
Dr. Guichard. 
1 
Traumatic. 
" " " [ard.) 
Died. 
Dr. Regnault. 
1 
? 
Dr. Brenugat. 
3 
Traumatic. 
Dr. Regnault. 
1 
Traumatic. 
Dr. Dein. 
1 
Trau matic. 
cc cc cc 
Dr. Gaudon. 
1 
1 
U CC cc 
In strychnia-poisoning, Dr. Saisson has demonstrated its value by experi- 
ments on animals, and Dr. Chas. B. Gillespie {American Journal of the 
Medical Sciences, Oct. 1870) and Dr. C. L. Bard {Philadelphia Medical 
Times, June, 1871) have each reported recovery under its use, without 
vomiting, after the ingestion of three grains of the alkaloid. 
In nervous excitement connected with the genital function, the bromides 
are often of great value. When there is actual inflammatory disease, as in 
gonorrhoea, the drug frequently fails to effect the desired end. When, how- 
* All the eases marked with an asterisk are taken from Dr. Roemer's paper (St. Louin 
Medical anti Surgical Journal, 1873). I believe they were all traumatie. 
f Since the belladonna probably did as much harm as the bromide did good, this case 
ought to be excluded. 364 
SYSTEMIC REMEDIES. 
ever, there is no organic lesion of the organs or of their nerve-centres, the 
continued dose almost always succeeds to a greater or less extent. I have 
found the remedy effective in cases of semi-impotence from over-irritability 
of the organs causing emission too soon during attempted sexual congress. 
There is abundant evidence as to the value of the remedy in nymphomania. 
As an adjuvant to other physical and moral measures of relief, the salt may 
be used with satisfaction in men suffering from masturbation. In nervous 
symptoms occurring at the time of the menopause or complicating uterine 
disease, and in the peculiar train of morbid phenomena arising from the forced 
suppression of the sexual function in vigorous individuals of either sex to 
whom circumstances have denied marriage, the bromides have almost a 
" unique power." 
Dr. Ch. Bernard (The Clinic, Sept. 1874; from Bulletin Gin. de Thirap.^ 
affirms that the bromide of potassium in doses of from twenty to forty-five 
grains a day removes with marvellous quickness malarial enlargements of the 
spleen. 
Administration.-I have known half an ounce of the bromide to be 
taken at once without inducing any serious symptoms; and in severe acute 
cases, as in tetanus and strychnia-poisoning, it is perfectly safe to administer 
two-drachm doses at short intervals, as the case may require. Almost all the 
indications for the use of the bromide are best met by the so-called continuous 
dose,-i.e., by the administration of so much in the twenty-four hours until 
an effect is induced. Thus, in epilepsy, half a drachm may be given four 
times a day, to be increased to one drachm (half an ounce a day) if neces^ 
sary; although as little of the remedy as will suffice to prevent the recur- 
rence of the fit must be used: yet any amount necessary to do this should be 
given, unless bromism be produced before the paroxysms are arrested. The 
remedy must be exhibited, in a solution freely diluted, after meals. In some 
cases it causes diarrhoea, which may generally be checked with small doses 
of opium. 
AMMONII BROMIDUM-BROMIDE OP AMMONIUM. U.S. 
According to the U. S. Pharmacopoeia, this salt should be prepared by the 
precipitation of the freshly-made solution of the bromide of iron by water 
of ammonia, the desired salt remaining in solution. It may be obtained in 
colorless crystals, but generally occurs in a granular powder, which becomes 
yellowish on exposure. It has a saline, pungent taste, is readily soluble in 
water, sparingly so in alcohol. When mixed with mucilage of starch, if 
chlorine-water be added it becomes yellowish brown; a blue tint would indi- 
cate the presence of iodine. 
Physiological Action.-The physiological action of the bromide of 
immonium has not as yet been fully investigated ; but our present knowledge 
indicates that whilst in many points it resembles that of the corresponding 
salt of potassium, in others it differs essentially from the latter. According DEPRESSO-MO TORS. 
365 
to Dr. N. Bistroff (Reichert's Archiv fur Anatomic, 1868, p. 723), when 
two decigrammes are administered to a frog, a period of quietude and less- 
ened irritability is induced, which after fifteen or twenty minutes gives place 
to violent tetanic convulsion. Later, all excitability is lost, so that even 
burning calls forth no recognition; the frog lies in whatever position it is 
placed in, the spasms become more violent, and death ensues. Similar phe- 
nomena have been witnessed by both Bistroff and Amory (The Physio- 
logical Action of the Bromide of Potassium and of the Bromide of Ammo- 
nium, Boston, 1872) in the rabbit and guinea-pig, although in one of Dr. 
Amory's experiments the guinea-pig died without convulsions having been 
noted. The curious abolition of reflex action and of sensibility consentaneously 
with the occurrence of violent convulsions was noted frequently, and death 
seems always to have resulted from asphyxia. In the experience of Dr. 
Bistroff, moderate non-fatal doses produced only weakness and uncertain 
movements in the rabbit. 
The bromide of ammonium appears to exert very little influence upon the 
peripheral motor apparatus. Amory has seen the nerves retain their power 
of conduction after having been placed in a 11 strong solution and, accord- 
ing to Dr. Bistroff, muscles retain their irritability after five minutes' soaking 
in a ten per cent, solution. According to the latter observer, the heart 
always continues beating after death from the drug, and the heart removed 
from the batrachian and laid in a ten per cent, solution did not in any degree 
lose its normal activity. Even a twenty per cent, solution dropped upon the 
bared heart produced only a momentary arrest of the ventricular systole. 
On the other hand, it is proper to state that Dr. Purser asserts that the 
heart is soon brought still in diastole in poisoning by this salt, and that the 
nerves and muscles also lose their irritability sooner than after poisoning by 
bromide of potassium. 
The subject certainly needs further investigation ; but it seems to me most 
probable that the bromide of ammonium exerts less influence upon the 
muscles than the bromide of potassium, but that in other respects their 
actions are very similar. The experiments of Amory indicate that the 
ammonium salt affects temperature and acts on the capillaries in the same 
way as that of potassium, and that it is also eliminated in a similar manner. 
The experiments of Dr. Bistroff show that in the cat, at least, the bromide 
of ammonium has no especial influence, as has been claimed, upon the 
superior larynereal nerves. 
Therapeutics.-The bromide of ammonium has been employed by prac- 
titioners for exactly the same purposes as the corresponding potassium salt, 
but certainly has not made its way into general use. Dr. Brown-Sequard 
commends highly the combination of it and its sister-salt in epilepsy as being 
much superior to either of them alone. He gives sixty grains of the potas- 
sium with thirty of the ammonium salt, and claims especially immunity from 
the disagreeable symptoms of bromism. On the other hand, Echeverria 366 
SYSTEMIC REMEDIES. 
(On Epilepsy, p. SIG') asserts that the combination is in no wise superior to 
the bromide of potassium. Prof. Clark, however (loc. cit., p. 106), from an 
experience in other than epileptic neuroses, is inclined to coincide with Dr. 
Brown-Sequard. The disease in which the bromide of ammonium has been 
most used is pertussis. Dr. J. M. Da Costa commends it highly in acute 
rheumatism (Pennsylvania Hospital Reports, vol. ii.) : a drachm to a drachm 
and a half of it was given, well diluted, in the twenty-four hours. 
Several of the bromides have been studied more or less closely by clinicians 
or physiologists.* 
Bromide of Sodium, U. S., closely resembles in appearance the bromide 
of potassium, and has been supposed by Voisin to have closely similar physio- 
logical and therapeutic properties. On the other hand, M. J. V. Laborde 
states (Robin's Journal de IAnatomie et de la Physiologic, 1868, p. 560) that 
in double the toxic dose of the bromide of potassium he has found that it 
does not produce any characteristic symptoms in the frog, the guinea-pig, or 
the dog, and leaves the animal perfectly healthy. 
By clinicians the drug has been used to a considerable extent. Dr. Mere- 
dith Clymer (New York Medical World, October, 1871) claims that it will 
arrest epilepsy without producing the unpleasant cerebral symptoms of 
bromism. He gives twenty grains three times a day. Prof. Hammond 
(New York Medical Journal, Dec. 1871) asserts that in epilepsy it is in no 
wise superior to the potassium salt, but claims that its hypnotic power is 
much greater. M. E. Decaisne, as the result of the trial of the drug in 
twenty-seven cases (epilepsy, chorea, hysteria'), asserts that its action is the 
same as that of the potassium salt, except that instead of causing diarrhoea 
it constipates (Comptes-Rendus, No. 17,1870). Notwithstanding this testi- 
mony, my own experience is in accord with the physiological teachings, that 
the bromide of sodium, although not free from therapeutic value, is not at all 
equal to the bromide of potassium in subduing excitation of the reflex functions. 
Bromide of Lithium, U. S., was, I believe, first employed in medicine 
by Dr. Gibb (Report of the British Association for the Advancement of 
Science, 1864), who recommended it as gently tonic and sometimes diuretic. 
He used it in very small doses. Attention was first called to its employment 
in nervous affections by Dr. S. Weir Mitchell, who stated (American Journal 
of the Medical Sciences, Oct. 1870), as the result of his experience, that 
when administered to the amount of half a drachm to one drachm daily, it 
acts in some cases of epilepsy after the bromide of potassium has failed, and 
is generally efficient in about one-half the dose of that salt; also that its 
hypnotic action is much more decided. Prof. Clark (loc. cit., p. Ill) con- 
firms these observations. 
* For bromide* of zinc and cadmium, see Le Progrla Med., 1877; hydrobromic ether, 
Robin's Journal, 1877, Le Progre* Med., 1877. DEPRESSO-MO TORS. 
367 
Hydrobromic Acid.-A solution of the gaseous compound of bromine 
and hydrogen in water was first employed as a therapeutic agent by Dr. 
Wade (Peninsular Journ. Med., Feb. 1875). Dr. E. T. Reichert (Post. Med. 
and Surg. Journ., civ. 505) found that its action upon the nervous system 
and circulation is almost identical with that of the bromide of potassium; 
but its influence upon the brain cortex was not studied. Moderate doses 
caused some temporary elevation of the blood-pressure, which Dr. Reichert 
attributes, without, as I think, sufficient evidence, to vaso-motor spasm of 
peripheral origin. Large doses were directly paralyzant to the heart and to 
a less extent to the voluntary muscles. Reflex action is suspended by the 
acid in the frog, and all portions of the spinal cord and nerves are depressed 
by the poison; but Dr. Reichert presents experimental facts which indicate 
that the sensory portions of the cord and the sensory nerves are affected 
before the motor system by hydrobromic acid as they are by the bromides. 
A long series of trials which I made with hydrobromic acid in the Epileptic 
Wards of the Philadelphia Hospital, determined that the officinal acid in 
equivalent doses acts very much as does the bromide of potassium, but is 
distinctly more irritant to the stomach, and less apt to produce an eruption 
of acne or muscular depression. It may be used alone in the treatment 
of epilepsy, but the combination of it with the bromide has seemed to me 
the best form of administration ; the large dose required, when it is given 
by itself, in most cases irritates the stomach too much. Under all circum- 
stances it must be well diluted. The officinal dilute hydrobromic acid 
(Acidum Hydrobromicum Dilutum, U. S.) represents in each drachm nine 
grains of the bromide of potassium, and may be given in half- to one-fluid- 
junce doses in a tumblerful of sweetened water. 
Bromal Hydrate.-This substance, which has been looked upon until 
recently merely as a chemical curiosity, is formed by the action of bromine 
upon alcohol, the alcohol being first converted into aldehyde by losing two 
atoms of hydrogen, and the bromine then replacing the remaining three 
atoms of hydrogen. The physiological effects of bromal hydrate have been 
especially investigated by Drs. John G. McKendrick (Edinburgh Medical 
Journal, July, 1874) and E. Steinauer ( Virchow's Archiv, Bd. lix. p. 65), 
Rabuteau (Gaz. Hebdom., xliii. p. 681) and Br. Chrostowski (Hoffmann 
und Schwalbe's Jahresbericht, 1881, 197). After large doses death occurs 
in a very few minutes, with contraction of the pupil, apnoea, and convusions. 
After smaller amounts (three grains in a rabbit of three or four pounds' 
weight) the symptoms are successively, restlessness, dilatation of superficial 
vessels, contraction of the pupil gradually increasing to a maximum, enor- 
mous secretion from the buccal and nasal mucous membranes, greatly 
increased rapidity of respirations, deepening paralysis, coma, lessened fre- 
quency of respirations, anaesthesia, convulsions, and death from failure of 
respiration. Chrostowski finds that the drug acts directly upon the heart 
muscle and excito-motor centres, and much more powerfully than does 368 
SYSTEMIC REMEDIES. 
chloral. The peripheral vaso-motor apparatus was apparently not affected 
by it. What knowledge we have of the physiological action of bromal does 
not indicate remedial value, and clinical experience with it is still wanting. 
CHLORAL-HYDRATE OF CHLORAL. U.S. 
Chloral, which is itself not used in medicine, is an oily liquid which at 
the ordinary temperatures gives off pungent fumes, and which is manufac- 
tured by the action of chlorine on alcohol. United with water, this oily liquid 
is converted into a hydrate. 
Chloral Hydrate,* or chloral of the U. S. Pharmacopoeia, is a volatile, 
crystalline solid, of a hot, burning taste, insoluble in cold chloroform, but 
very soluble in water, ether, and alcohol. It occurs generally as transparent, 
colorless tablets, but sometimes in acicular or even in rhomboid crystals. 
The compound of chloral and alcohol,- Chloral Alcoholate,-which resem- 
bles closely the hydrate, can be distinguished at once by its insolubility in 
water and its solubility in cold chloroform. 
If an alkali be added to a solution of chloral hydrate, it breaks up into 
formic acid and chloroform, which, when water has been the solvent, at once 
separates in the form of oily drops. 
Physiological Action.-When applied to a part, chloral acts as an 
irritant; and probably for this reason it sometimes, when given by the mouth, 
causes vomiting, or even purging. When it is given to man or other mam- 
mals in moderate doses, the most prominent result in the great majority of 
instances is a quiet sleep, as closely allied as possible to natural sleep. The 
subject can readily be aroused from the lighter degrees of this, waking to 
full consciousness, but soon dropping off again when left quiet. The pulse 
is in this degree of action not affected, or is rendered a little slower; the 
pupil is contracted, but becomes normal so soon as the subject is awakened; 
the respiration is deep, full, and regular. When larger amounts are given, 
the sleep is much deeper, and may pass into profound coma; the respirations 
fall in number; the pulse is weakened and rendered slower, but may become 
rapid and irregular if the dose has been toxic; the temperature is reduced; 
the muscular system is relaxed, and both sensibility and reflex action are 
diminished. If a fatal dose has been given, all these symptoms are inten- 
sified : with coma, intense muscular relaxation, weak, thready pulse, and a 
pupil contracted at first, but afterwards dilated, the animal gradually sinks 
into death, paralyzed and anaesthetic. The immediate cause of death is 
generally a paralytic arrest of respiration ; but in many cases there appears 
to be a simultaneous arrest of the cardiac action, and it is very possible that 
fatal syncope may at times occur. At post-mortem examination, congestion 
* There is a chloral hydrate containing a very small proportion of water, which is in- 
soluble in the latter menstruum. (Gmelin's Handbook.) For a case in which chloral was 
detected after death in stomach, and for methods of examination, see Edinb. Med. Journ., 
Oct. 1878. DEPRESSO-MO TORS. 
369 
of the meninges and substance of the brain and cord, and of the lungs, is 
commonly found. The blood is thought by Richardson (Medical Times and 
Gazette, Sept. 4, 1870) to coagulate less firmly than when normal. 
The most constant and prominent of all the symptoms produced by moder- 
ate doses of chloral is sleep: this is without doubt due to a direct action of 
the drug upon the cerebrum. In most cases, as already stated, it is quiet, 
but sometimes it is restless, and in man has even occasionally been wildly 
delirious; although it is somewhat uncertain whether the latter condition 
may not have been due to impurities in the drug. It seems to be well 
established that in the milder degrees of this sleep there is no anaesthesia. 
Demarquay (Bulletin Therap., tom. Ixxvii. p. 307) claims that hyperaesthesia 
very commonly follows the exhibition of small doses. Bouchut (New York 
Med. Gazette, Dec. 1870), Dieulafoy and Krishaber (American Journ. 
Med. Sei., Jan. 1870), Giovanni and Ranzoli (Schmidt's JahrbiLcher, Bd. 
cli.), and Rajewsky (Ibid.} confirm this, whilst Liebreich and Labb^e* 
deny it, and Hammarsten, who has noticed such hyperaesthesia, is inclined 
to think it apparent rather than real. I myself have seen this hyperaes- 
thesia, and there can be no doubt that it is an occasional, if not a constant, 
phenomenon. Rajewsky (loc. cit.} states that there is in frogs a correspond- 
ing period of over-excitability of the reflex centres, and that in rabbits he 
has noticed a glowing heat borne without much complaint, when pinching 
wrould produce violent outcries. In very large doses chloral produces anaes- 
thesia ; but, unless the amount employed be so great as to be toxic, this 
anaesthesia is in most cases very trifling. 
Motor System.-The paralysis and loss of reflex excitability induced by 
chloral are not muscular in their origin, for Labbee has found that after death 
the muscles respond perfectly to galvanism. Both Labbee (loc. cit.} and Ra- 
jewsky (loc. cit.} have found that the motor nerves are in no wise affected by 
large or even fatal doses of chloral, which must therefore act upon the spinal 
cord to produce the paralytic phenomena. The experiments of Rajewsky 
have afforded positive confirmation of the conclusion arrived at by this process 
of exclusion ; for he found that in the latter stages of chloral-poisoning direct 
irritation of the spinal cord gave rise to much less severe spasms than in the 
unpoisoned animal. Before this paralytic stage is reached, as already stated, 
Rajewsky affirms that in the frog there is a period of increased reflex activity, 
and that at this time stimulation of the spinal ganglia shows that they are 
more susceptible than normal. According to the observer last named, these 
phenomena occur just as freely after destruction of Setschenow's centre in 
the frog as before, and are therefore independent of it. 
Circulation.-According to Demarquay, when chloral has been adminis- 
tered to animals there is evident enlargement and engorgement of all their 
* He has noticed it, however, in a single case, confined to the ears. (Archives Generates, 
1870, tome xvi. p. 338.) 370 
SYSTEMIC REMEDIES. 
blood-vessels ; and Rajewsky* states that he has found sinking of the blood- 
pressure in rabbits from small as well as large doses of the drug. On the 
other side, Labb^e (loc. cit., p. 341) asserts that the rabbit's ear grows pale 
after the injection of a very feeble dose. In man, Bouchut has obtained 
sphygmographic traces, which he thinks indicate a primary increased arterial 
tension. Nanciaa, of Venice, has found the tension normal, but Anstie and 
Andrews (American Journal of Insanity, July, 1871) confirm the results 
of Bouchut when small doses are employed. Preisendorfer (Deutsches 
Archiv, xxv. 48), in a series of sphygmographic studies, thought there 
might be a brief primary rise of arterial pressure in man, as in animals, but 
under the full action of chloral the arterial pressure steadily sinks. After 
very large doses, according to both Andrews and Da Costa (Amer. Jour. 
Med. Sci., April, 1870), the tracings indicate decidedly lessened arterial 
pressure. Whatever may be the effect of small doses (and the point needs 
further investigation), it seems well made out that, both in man and ani- 
mals, by large doses the blood-pressure is very much lessened, owing prob- 
ably in part to vaso-motor paralysis, but in largest measure to an action 
of the drug on the heart. Various observers state that there is in man and 
the lower animals at this time slowing of the pulse, which, according to 
Rajewsky, is, in the frog and rabbit, altogether independent of the inhibi- 
tory nerves, occurring equally after as before their section. When toxic 
doses have been employed, the heart, after numerous pauses, is finally 
arrested in diastole. Analogy points very strongly to this arrest being due 
to a direct influence upon the heart-muscle or ganglia, but Labbee affirms 
that chloral placed freely upon the frog's heart slows, but does not arrest, 
its beat; and that after section of the cord in the choloralized frog the 
heart will continue beating for hours. These results obtained by Labbee 
are, however, contradicted by the more recent and thorough study of the 
effect of chloral upon the isolated heart of the frog by Dr. Sydney Ringer 
and H. Sainsbrury, who found that chloral lessened the frequency and power 
of the spontaneous contractions, and also the excitability of the cardiac 
muscle, and finally caused a diastolic arrest (British Med. Journ., March, 
1883). 
In poisoning in man, the pulse has towards the last been very feeble, 
generally rapid and irregular, and even in some cases in which recovery has 
occurred it has been altogether absent for a time. The experiments of 
Ringer and Sainsbrury are so concordant with this that I have no doubt 
that chloral is a direct depressant to the heart, and is capable of suddenly 
and unexpectedly destroying life, precisely as does chloroform. 
Respiration.-In full doses, chloral lessens the number of respirations per 
* The work of Rajewsky was done under Professor Rosenthal, and the results, without 
the experiments, were published as an inaugural thesis. Of course, half of its value is 
lost for want of the experimental records, and the subject needs re-investigation. I am 
acquainted with the pamphlet only through Schmidt'g Jahrbucher. DEPRESSO-MO TORS. 
371 
minute, causing them to become slow and full; and when toxic doses are 
taken this action becomes more and more marked, until finally the rhythm 
is very much affected, and the respiration grows very irregular, and some- 
times very rapid and shallow, until finally it ceases. As these phenomena 
occur equally after section of the vagi (Rajewsky), the influence of chloral 
must be exerted upon the respiratory centre at the base of the brain. 
Temperature.-A most remarkable action of chloral is upon the tempera- 
ture ; and in this point all observers are in accord with Dr. Richardson, of 
London, who has seen it fall 6° F. in a rabbit which recovered. Bouchut 
has noticed a fall of 2° (C. ?) in an infant, and Da Costa and other observers 
have noticed lesser reductions of temperature in man after therapeutic doses. 
In a case reported by Dr. Levinstein (Lancet, i. 1874), after six drachms of 
chloral the temperature rose to 39.5° C (102.1° F.), and afterwards fell to 
32.9° C. (91.22° F.). Hammarsten has found that the fall of temperature 
is very rapid, 6° C. in an hour, and that it is dependent upon diminished 
production of heat, since it occurs equally in animals well wrapped up and 
laid in a warm place. 
The physiological action of chloral may be summed up as follows. Upon 
the cerebrum it acts as a most powerful and certain hypnotic ; in full doses it 
acts as an intense depressant upon the centres at the base of the brain, and 
upon the spinal cord, causing slowing and weakness of the heart's action, 
probably vaso-motor paralysis, slowing of the respiration, and muscular weak- 
ness, with a certain amount of anaesthesia ; in fatal doses it causes death gen- 
erally by arresting, through paralysis of the nerve-centres, first respiration, 
and finally the heart in diastole. Its action in very small doses is uncertain, 
but there is considerable evidence to indicate that it irritates or stimulates the 
spinal and the cardiac, and even the vaso-motor, centres. On the vagi and 
on the motor nerve trunks it has no marked influence. 
Action as Chloral.-The conversion of chloral by alkalies in solution into 
chloroform and formic acid first suggested its use in medicine to Liebreich 
( Wiener Medizinische Wochenschrift, August, 1869) ; and the theory that its 
action is really due to chloroform generated by the alkalinity of the blood 
has been received with favor by Personne and other writers. The evidence 
by which this theory is to be disproven or established is twofold in its nature, 
-i.e., chemical and physiological. 
Personne (Journal de Pharmacie et de Chimie, 1870), by distilling the 
blood of animals poisoned by chloral at 40° C., a temperature decidedly above 
that of the body, obtained chloroform; and his results have been confirmed 
by Pellogio (Schmidt's Jahrbucher, Bd. cli. p. 89) and other chemists, so 
that I think their correctness is not to be questioned. They are, however, 
not decisive, for it is very possible that the chloroform may be formed during 
the distillation, owing to the comparatively high heat employed. This evi- 
dence is, then, to be thrown out, especially as Hammarsten (Ibid., Bd. cli.) 
has found that if chloral be mixed with fresh blood and streams of carbonic 372 
SYSTEMIC REMEDIES. 
acid be forced through it, no chloroform can be detected, but if the mixture 
be heated the latter can be obtained in abundance. Further, in dogs deeply 
poisoned with chloral the same observer examined the expired air and a por- 
tion of the blood without finding chloroform, although when a clyster of the 
anaesthetic was given to the poisoned animal chloroform could be detected in 
a few minutes, in both the blood and the breath. In non-chloralized animals 
to which similar enemata were given, the chloroform could be found in the 
breath before anaesthesia was induced. Rajewsky {Ibid., Bd. cli.), Amory 
{New York Med. Journ., 1870), and Von Mering and Musculus {Berichte 
Deutsches Chem. Gesell., 1875, i. 662) have confirmed these results: so 
that it may be considered settled that chloral mixed with blood at ordinary 
temperatures remains unaltered, and that in the most severe poisoning no 
chloroform can be detected either in the blood or in the expired air. Ham- 
marsten examined the blood and expired air unsuccessfully, for chloral, in 
dogs poisoned with the drug; but Amory {loc. cit., p. 616) has obtained 
from the blood acicular crystals, evidently of chloral. The exact fate of 
chloral in the system can scarcely be considered as established, but it is 
probable that it is eliminated with the urine, and at least partially in a 
changed condition. A. Tomascewicz recognized it in the secretion men- 
tioned by means of the delicate isocyanphenol reaction* of Hoffmann 
{Pfliiger's Archiv, ix. 35). Feltz and Ritter {Compt. Rendus, Ixix. 966) 
believed that they found sugar in the urine of chloralized animals, but both 
Von Mering and Musculus (Zoc. cit., 663), and F. Echard'f' {Archiv Exper. 
Pathol, und Therap., xii. 276) have shown that the substance which re- 
duces the copper solution will not undergo fermentation, and Von Mering 
and Musculus have separated it as urochloralic acid in colorless, shining 
needles, often arranged in star-like groups, soluble in water and alcohol, 
insoluble in ether. The existence of this acid has been confirmed and its 
chemical properties studied by A. Borntraeger {Inaug. Dissert., Marburg, 
1879), and by E. Kulz {Arch. f. Gesammte Physiolog., 1882, 506), who 
found it destitute of hypnotic or other active physiological powers. 
The physiological evidence is in strict accord with the chemical in showing 
that chloral is not converted into chloroform in the system. Whilst chloral 
produces a longer and more intense sleep than does chloroform, the latter 
agent acts much more decidedly as an anaesthetic. Again, Djurberg 
{Schmidt's Jahrbucher, Bd. cli. p. 84) has shown that, whilst after chloro- 
form-poisoning biliary coloring-matters appear in the urine, after chloral- 
poisoning none can be detected, and that when chloral is added to blood 
outside of the body no destruction of the red disks occurs. 
* Many chemists have failed to find chloral for want of a delicate test. Dr. F. Ogston 
(Edinb. Med. Surg. Jour., xxiv. 292) affirms that the sulphide of ammonium affords a 
means of recognizing minute amounts of the drug. 
j- Echard has also found that chloral will prevent the development of diabetes by the 
Bernard prick. DEPRESSO-MO TORS. 
373 
As was first shown by Cohnheim, if the abdominal vein of a frog be 
opened and salt water be 'injected until almost all the blood is washed out 
and the circulatory system is filled with the foreign fluid, the batrachian 
will live from one to three days in apparently perfect health. Both Ra- 
jewsky (loc. cit., p. 91) and Lewisson (Reichert's Archiv fur Anatomic und 
Physiologie, 1870, p. 346) have found that upon these " salt frogs," with the 
circulating fluid completely neutral, the chloral acts precisely as in the normal 
frog. 
I think the evidence which has been adduced completely disproves the 
chloroform theory, and forces assent to the proposition that chloral acts 
directly upon the organism. 
Therapeutics.-The results of the clinical use of chloral are in strict 
accord with its known physiological action. The indication which it most 
usefully meets is to induce sleep. The more purely nervous the wakefulness 
is, the more successful is this remedy. When from functional over-excite- 
ment of the brain due to excessive mental strain, or from anxiety or other 
kindred cause, the patient cannot sleep, chloral is by far our most valuable 
hypnotic. On the other hand, when severe pain causes wakefulness, chloral 
is of very little value,-at least in doses which I think safe. Sometimes 
even in these cases sleep will come, but it will very often be a restless, 
troubled sleep, with moaning or other indications of suffering; and it may 
be that the patient on awaking will complain that he has suffered more 
whilst sleeping than when awake. 
In the sleeplessness occurring at times during convalescence from acute dis- 
ease, chloral is very efficacious. In the early stages of fevers it is sometimes 
of advantage; Dr. Russell (Glasgow Medical Journal, Feb. 1860) recom- 
mends it especially in the wild delirium of typhus in its earlier stages. In 
advanced fever-cases, when the symptoms are gravely adynamic, I conceive 
that the use of chloral would be very perilous. In delirium tremens it often 
induces sleep readily, but not rarely it fails, even in large dose. In the 
sleeplessness of acute puerperal or non-puerperal mania, there is abundant 
testimony to the value of chloral. 
Dr. Lyon Playfair (Lancet, 1874, vol. i.) has introduced the use of chloral 
as a means of alleviating the sufferings of parturition, and has been followed 
to some extent by other practitioners. He affirms that it produces a drowsy 
state, from which the woman is aroused by the uterine contractions, which 
are almost robbed of their painful character. So soon as the "pains" begin 
to be active he administers fifteen grains of the drug, repeating the dose in 
twenty minutes ; thirty grains usually are sufficient, and he has never given 
more than a drachm during a labor. Towards the close, when the " pains" 
become very severe, inhalations of chloroform or of ether may be practiced in 
the usual manner. It is affirmed by other obstetricians that in rigidity of 374 
SYSTEMIC REMEDIES. 
the os chloral is often of great service, by aiding in the desired relaxation, 
and at the same time materially alleviating suffering. 
On the whole, as a pure hypnotic chloral is indeed unequalled, and may 
be used in all cases when no contra-indication exists. 
The second indication to meet which chloral may be employed is to relax 
spasm. For this purpose it has been used with advantage in puerperal and 
ursemic convulsions. It must be remembered that in many of these cases, 
although next to chloroform the best palliative, it is only a palliative, and 
must only be used to quiet the nervous disturbance until other remedies can 
have time to act. In tetanus it has been claimed that chloral is the remedy. 
Dr. Jos. R. Beck (St. Louis Medical and Surgical Journal, June, 1872) 
has collected, of the traumatic form of the disease, thirty-six cases, with 
twenty-one recoveries, in which chloral constituted the whole or the major 
part of the treatment. References* are given below to fifty-six cases in ad- 
dition ; so that the figures stand forty-eight recoveries and forty-four deaths. 
These results do not seem to warrant the high estimate which has been set 
upon the value of chloral in tetanus. Dr. Macnamara (Practitioner, No- 
vember, 1874) has employed the remedy in a different way from what is 
usual. Believing that it exerts very little control over the spasms, he has 
not used it for such purpose, but has used it simply as a hypnotic, 
giving the patient forty grains of it at bedtime, and only when the tempera- 
ture rises above 101° F. a single dose of thirty grains in the morning. No 
other medicine is given, but the patient is made to swallow four ounces of 
milk with brandy every four hours, one egg being mixed with the milk 
morning, noon, and evening. He asserts that in this way out of twenty 
consecutive cases (all traumatic ?) occurring in natives of India he has saved 
seventeen. My own opinion is that no one single remedy affords the best 
chances in tetanus, but that a combined use of bromide of potassium and 
» Recovery.-Fergusson ( Edin. Med. Journ., July, 1871); Watson {Lancet, 1870); 
Bartlett; May; Ballantyne; Cushing {Pacific Med. and Surg. Journ.) ; Lovegrove {Brit. 
Med. Journ., 1872, p. 493); Herndon {Atlanta Med. and Surg. Journ., 1873, p. 69); Mae- 
namara {Indian Med. Gaz., April, 1871); Richelot (Bulletin Therap., Ixxxvi.); Lucian 
Papillaud {Gaz. Medicale, 1875, p. 176); Bourdy {Bull. Therap., Ixxxvi.); Cane {Lancet, 
1876, i. 564); Cauvy {Bull. Therap., xciii. 186); Durand {Centralb. Chirurgie, 1876, 
778); Laurens {Le Progris Med., 1876, 180); Puglifise {Jour. de Thirap., 1875, 214): each 
1 case; Cargile {Lancet, 1877, ii. 158), 3 cases; Boon {London Pract., xx. 161), 2 cases; 
Roberts {Amer. Jour. Med. Sci., Ixxiv. 420), 3 cases; Garnett {Cincinnati Lancet and 
Clinic, 1880, 316), 2 cases. 
Fatal.-Porta {Schmidt's Jahrbucher, Bd. cli. p. 110), 2 cases; Macnamara {Indian 
Med. Gaz., April, 1871), 6 cases; Baudon {Bulletin Therap., Ixxxvi.), 3 cases; Blin 
{Ibid.), 3 cases; Petit {Centralb. Chir., 1876, 792), 3 cases; Roberts {Amer. Journ. Med. 
Sci., Ixxiv. 420), 3 cases; Cruveilhier (intravenous) {Bulletin Thirap., Ixxxvi.); Labb6e 
(Ibid.)-, Itard {Schmidt's Jahrb.,Bd. cli.); Launelongue {Bulletin Therap., Ixxxvii., 
1874); Verneul {Bulletin Thirap., Ixxxvii., 1874); Boon {London Practitioner, xx. 161); 
Boucquier (Centralb. Chir., 1876, 717); Bresson {Le Progr^s Mid., 1876, 180); Pugliese 
{Journ. de Therap., 1875, 244): each 1 case. DEPRESSO-MO TORS. 
375 
chloral should constitute the basis of treatment, the patient also being sup- 
ported with food to the utmost. In strychnine and other toxaemic convul- 
sions chloral is often of great value.* 
In trismus nascentium Dr. Widenhofer {Boston Med. and Surg. Journ., 
1874) recommends it very highly. He says that in the Children's Hospital he 
formerly lost all his cases, but that by its use he has saved six out of twelve 
He gives it to a young babe in one- and two-grain doses by the mouth, or, 
when the spasms prevent, in double the quantity by the rectum. In chorea 
chloral has been used sometimes with great advantage, more often, I think, 
with the result of simply diminishing temporarily the choreic movements, 
and sometimes without any effect. In my own experience the movements 
have generally returned with unabated violence so soon as its exhibition was 
suspended. As a nocturnal quietant and hypnotic, it would appear to offer 
very great advantages in cases of acute chorea in which speedy death is 
threatened from the incessant and violent movements; also in cases com- 
plicated with fractures, where a temporary lull is of importance. 
In puerperal convulsions its use in large doses has met with a great deal 
of favor (see Phila. Med. Times, vol. iv.). A half-drachm may be exhibited 
at once, and half the quantity every hour or two pro re nata. 
In the convulsions of children it has been employed with apparent good ; 
in cramps in pregnant women it has been commended by Dr. Morgenstern 
( Wiener Med. Presse, Nov. 1871); in singultus, by Dr. Leavitt {Amer. Journ. 
Med. Sci., April, 1871); in the spasmodic nocturnal enuresis of children, also, 
it may often be used with advantage (Dr. J. B. Bradbury, Brit. Med. Journ., 
April, 1871); in laryngismus stridulus (Dr. Behn, Jahrbuch fur Kinder- 
krankheiten, 1871) and other spasmodic affections; in spermatorrhoea at 
bedtime it is of service (Gascoyne, Brit. Med. Journ., 1872). In whooping- 
cough it would really seem to be of very great value, as has been attested 
by Drs. Adams {Lancet, i., 1870), Murchison {Ibid., ii., 1870), Bigden 
{Practitioner, xxvii., 1870), Waterhouse {Ibid., Dec. 1870), and various 
French observers. Small doses (two to eight grains), repeated at regular 
intervals during the day, are often very efficacious. Another plan, especially 
useful when the paroxysms are very severe at night, is to give a full dose at 
bedtime. When there is a tendency to bronchitis and pneumonia, chloral 
must be used with care in these cases, as in large doses it favors congestion 
of the lungs: yet Murchison saw a very threatening case, complicated with 
bronchitis and pneumonia, greatly benefited by its exhibition. In asthma it 
has sometimes been of use, but more often it has failed. In cholera, Dr. 
Hall {Lancet, May 2, 1874), believing that in the cold stage of the disease 
there is a condition of intense nervous irritation, has tried the hypodermic 
injection of chloral with asserted very good results. 
* For a paper discussing relations of chloral to various mostly unimportant alkaloids, 
see Arch. Exper. Path, und Therap., ix. 440. 376 
SYSTEMIC REMEDIES. 
The third indication for which chloral has been used is to relieve pain. 
That it will do so when given in very large doses there can be no doubt; but, 
unless the dose be so large as to be dangerous, my experience of chloral is 
that it is of little value as an anaesthetic. Its powers in this direction are in- 
comparably less than those of opium, and its habitual use is probably attended 
with very grave dangers. 
Theoretically, chloral might be of use to reduce temperature. Its other 
active properties will probably completely interfere with its use for this 
purpose in the vast majority of such cases, especially as, in order to check 
the development of animal heat, the dose must be very large. When, how- 
ever, there is a high sthenic state of the system, it might be tried with cau- 
tion ; but clinical experience is almost entirely wanting. I know of but a 
single case (^Med. Tinies and Gaz., Nov. 1869) reported: in this its use is 
said to have given satisfaction. 
Locally a solution of chloral (25 per cent, saturation) has been used with 
asserted good effects as a stimulant and antiseptic in foul ulcers, buboes, bed- 
sores, etc., especially when the discharge is free. It is also stated that it gives 
great relief from pain in uterine and other cancers. Applied to the skin, 
chloral acts as a powerful irritant, and has been proposed as a vesicant, but 
is said to cause excessive pain. See W. Y. Med. Journ., xxxvii. 445. 
Prof. Ore, of Bordeaux, has proposed intravenous injections of chloral as a 
substitute for ether and chloroform in surgery, and as a means of combating 
tetanus. His suggestion has been carried out by himself and others in a 
number of cases with asserted good results. But in other instances it has 
apparently caused death, and is, in my opinion, absolutely unjustifiable. The 
risks are twofold. Under any circumstances chloral occasionally acts with 
unexpected violence, and has caused death even when exhibited by the mouth 
in what are usually considered safe doses. It is plain that this danger is vastly 
increased by throwing the whole dose at once upon the heart and nervous 
system. Every one who has practiced intravenous injections in animals must 
be aware of the extraordinary results of throwing the poison almost undi- 
luted into the cavities of the heart. Again, chloral exerts a very great influ- 
ence on fibrin, and has even been used to coagulate the blood in varices; the 
intravenous use of the drug may, therefore, be productive of thrombi; indeed, 
M. Tillaux has reported a case in which a venous coagulum was found after 
death extending up the arm even into the axillary vein, and accompanied by 
a white heart-clot.* 
The antiseptic powers of chloral were apparently first noticed by MM. 
Dujardin Beaumetz and Hirne in 1872 (see Bulletin Thirap., Ixxxvi. 224). 
* Any one desirous of following this subject further will find the following references 
of value: 
Archives Gin.,ii., 1874; Bulletin de I'Acad., xxxviii., 1874; Gaz. Mid., xlv., 1874; Gaz. 
Mid. de Bordeaux, xiii., 1874; Gaz. dee Hopitaux, 1874; Le Progris Mid., 1874; Journal 
de Thirap., 1874; Preese Mid. Beige, Oct. 1874. DEPRESSO-MO TORS. 
377 
Recently the subject has been investigated by various observers, especially by 
Dr. Keen and M. Personne (Phila. Med. Times, vol. iv.). It has certainly 
been shown that a solution of twenty to forty grains to the ounce will pre- 
serve animal tissues for a great while, and probably indefinitely. Moreover, 
the finest microscopical structure appears not to be altered by a solution of 
this strength. Dr. Keen's first experiences led him to hope that as chloral 
does not materially affect the color of the tissues, it might be useful in the 
dissecting-room, and subsequent trials of it have confirmed Dr. Keen's first 
hopes (Amer. Journ. Med. Sciences, July, 1875). Dr. Keen has also had 
great satisfaction in the use of chloral to keep free from odor the urinals of 
paraplegics and other patients suffering from incontinence. 
Toxicology.-That chloral is a dangerous agent, capable of destroying 
life, is attested by a number of published cases; but this is true of other 
drugs; and the practical point to be determined is, Does it ever act out of 
proportion to the amount ingested ? or, in other words, does the ordinary 
therapeutic dose ever become toxic, and does it ever act in a cumulative, un- 
expected manner ? Abroad, it has very commonly been prescribed in half- 
drachm and even drachm doses, and in the vast majority of cases without 
any bad results. That thirty grains is not a safe dose is shown, however, 
by the case of Dr. Reynolds (Practitioner, March, 1870), in which forty-five 
grains caused most alarming symptoms; by that of Dr. Watson (Med. and 
Surg. Reporter, Jan. 27, 1871), in which eighty grains, given in ten-grain 
doses spread over thirty-six hours, nearly proved fatal; and especially by a 
number of cases recorded by Dr. H. W. Fuller (Lancet, March, 1871), in 
some of which very alarming symptoms followed the exhibition of thirty 
grains, and in one death in a healthy young woman of thirty. Dr. Schwaig- 
hofer, of Vienna, records (Irish Hosp. Gaz., 1873) coma and death in a 
drunkard following the ingestion of half a drachm. Dr. W. H. Lathrop ( Year- 
Book of Therapeutics and Pharmacy, 1872, p. 254) records the case of a 
man previously healthy, but suffering from delirium tremens, who took sixty 
grains between 12 and 1 P.M., at 2.30 p.M. twenty grains more, and at 3 
P.M., no effect being manifest, twenty grains more. His physicians then left 
him sleepless and complaining only of a slight paralysis of the lower ex- 
tremities ; and almost in a moment he was dead. Other cases might be 
quoted (see Berlin. Klin. Wochenschrift, 1876), but the above are sufficient 
to show that chloral may kill suddenly and unexpectedly. 
An observation of Prof. Vulpian (Comptes-Rendus, Ixxxvi. 1303) throws 
much light upon these sudden deaths. He found that galvanization of a 
divided vagus would cause in a chloralized animal not momentary, but per- 
manent, arrest of respiration, if the centric end was selected, or permanent 
diastole of the heart if the distal part of the nerve was attacked. It is very 
probable that in a man under the influence of chloroform or of chloral, 
death may be precipitated by a slight peripheral inhibitory irritation. I 
think the practical deduction from the known facts is that twenty grains is 378 
SYSTEMIC REMEDIES. 
the highest safe dose of chloral; that this amount should not be repeated 
oftener than once an hour, and, when sixty grains have been taken, not 
again for some hours, unless in very urgent cases, as acute tetanus or violent 
chorea threatening speedy dissolution. On the other hand, recovery has been 
reported by Dr. Eshleman (Philadelphia Med. Times, Oct. 1870) after the 
ingestion of four hundred and sixty grains. There are no lesions found 
after death from chloral which can be considered pathognomonic, but a 
dark, bloated countenance and other evidences of death from asphyxia have 
been noted in some cases. 
The treatment of chloral-poisoning is identical with that of opium-poison- 
ing, consisting in the free use of alcoholic and external stimulants, such as 
sinapisms, dry heat, frictions, flagellations, etc., to maintain the circulation, 
and of shaking, walking, application of galvanism, cold douches, etc., to keep 
up the respiration. Artificial respiration should always be resorted to before 
natural respiration altogether fails; and Clemens (Schmidt's Jahrbucher, Bd. 
cli. p. 99) has found that animals asphyxiated by chloral may often be at once 
aroused by the inhalation of oxygen. Hypodermic injections of strychnis 
have been recommended on theoretical ground <, and a case is reported by 
Dr. B. W. Stone (Louisville Med. News, xv. 179), in which four hundred and 
twenty-five grains of the chloral were ingested, and recovery occurred after the 
hypodermic use of one-fifth of a grain of strychnia in divided doses. Atropia 
seems to me a very rational remedy, and Dr. I. M. Booth reports a case (Lon- 
don Lancet, 1884, i. 468) of recovery after about one hundred and ten grains 
of chloral under the use of tincture of belladonna. Probably it will hereafter 
be found that it is very important in all forms of threatening narcotism to 
maintain the animal heat. Dr. Lauder Brunton has shown (Journ. Anat., 
viii., 1874) that if the bodily temperature be maintained artificially animals 
survive doses of chloral usually fatal, or recover consciousness more quickly 
than is normal after smaller doses. The inference is very obvious that in 
human chloral-poisoning, by the use of dry external heat, hot blankets, and 
other devices, the warmth of the patient should be maintained. 
Considerable attention has been given both in this country and abroad to 
the subject of chronic chloral-poisoning; and, whilst some affections have 
been erroneously attributed to the drug, there seems to be no doubt that its 
long-continued use often does produce serious symptoms. The cases are 
divisible into two or three groups, which are, however, really artificial, as is 
shown by the occurrence of cases belonging to two or even three of the 
groups. The first of these includes those patients in whom the respiration 
is chiefly affected. The dyspnoea may be slight, and may only be felt at 
times, as after exertion or after meals; but it may be constant and alarming. 
Cases of this character are reported by Jastrowitz, by Schule, and by Lud- 
wig Kirn (Allgem. Zeitschrift fur Psychiatrie, xxix., 1872 ; Practitioner). 
In one instance (Prof. N. R. Smith, Boston Med. and Surg. Journ., 1871) 
death from bronchial effusion is believed to have been caused by chloral. DEPRESSO-MO TORS. 
379 
Dr. Kirn affirms (Berlin. Klin. Wochens., xx. 721) that in some cases 
mental disturbance with hallucinations occurs. 
In the second group of cases, eruptions of the skin are the chief manifesta- 
tions of the toxaemia. In the mildest of these there is no distinct rash, only 
the occasional appearance of transient red blotches on the face or neck. But 
a very extraordinary tendency exists towards the production of a rash or dis- 
coloration at the slightest cause, so that drinking a glass of wine will produce 
an intense, even livid, erythematous redness of the face. In other instances 
there is marked erythema (Schule, Allgem. Zeitschr. fiir Psychiatric, xxviii.), 
occurring first in spots upon the face, but extending downwards to the trunk, 
becoming more and more general, and showing a marked tendency to follow 
the nerve-trunks. This erythema is seemingly due to vaso-motor weakness, 
and consequently is allied to other more urgent symptoms seen in chloral 
toxaemia. Sometimes it invades the mucous membranes, which become 
red, swollen, and oedematous; and if the glands are involved, as in a case 
reported by Dr. Chapman (Lancet, 1871), the result may be serious. A 
deeper implication of the vaso-motor and cardiac nervous system was proba- 
bly the cause of the general oedema, profound weakness, and failure of heart- 
action in the case recorded by Prof. N. R. Smith (loc. cit.'). Prof. Smith 
also calls attention to desquamation of the cuticle and ulcerations about the 
nails as being present in these cases. 
In the third group of cases, petechiae, ecchymoses, ulcerations, and even 
high fever and other pyaemic symptoms, are asserted to have been produced 
by the continuous use of chloral. It seems to me, however, very doubtful 
whether the drug really was the cause of the symptoms which have been 
recorded by Crichton Brown, by Monkton, and by Kirn. 
The habitual use of chloral as a narcotic has been indulged in, it is 
asserted, to a considerable extent, and Dr. Geo. F. Elliott reports (Lancet, 
1873, i. 754) a case in which " delirium tremens" followed the withdrawal 
of the accustomed draughts. 
Administration.-Sufficient has been said as to the dose of chloral. It 
is best given diluted with a weak syrup. 
Metachloral is prepared by acting on chloral hydrate with sulphuric 
acid. The hard white substance which forms after a few days is washed with 
water and dried by means of chloride of calcium ; then mixed with gum it is 
formed into crayons which are coated with paraffine for external use. It is 
said to be less irritating than chloral (Lancet, i., 1874). 
/ 
Chloral Camphor. Equal parts of chloral and camphor rubbed 
together produce a clear liquid. Dr. Lenox Browne claims that this " when 
painted over the painful parts and allowed to dry" gives the greatest relief 
in neuralgia, and that in toothache it is equally efficacious. It occasions 
tingling of the skin, but never blisters, and has been commended in pru- 380 
SYSTEMIC REMEDIES. 
ritus. A drachm of it swallowed by mistake produced very severe pros 
tration, feebleness of the pulse, vomiting, fifteen " coffee-ground" stools, and 
prolonged narcotism, with brief semi-delirious periods, lasting four days 
(Am. Journ. Med. Sei., Ixxix. 90). Dr. D. B. Simmons, who reports the 
case, has since found the chloral camphor, in doses of ten to twenty drops, 
to be very powerful as a sedative narcotic in mania, etc. 
Butyl-Chloral Hydrate. The substance brought forward as a remedy 
by Oscar Liebreich under the name of croton-chloral hydrate is formed by 
the action of chlorine gas upon aldehyde. It crystallizes in small glittering 
tables,* and is soluble with difficulty in water. It is now stated to be really 
butyl-chloral, and that when brought in contact with an alkali in solution 
it breaks up into chloride and formiate of sodium, and bichlorallylene. 
According to Liebreich (British Med. Journ., Dec. 20, 1873, Feb. 1876), 
a drachm of this substance, dissolved in water, and introduced into the 
stomach, produces in the course of from fifteen to twenty minutes a deep 
sleep, accompanied by anaesthesia of the head. Whilst the eyeball has lost 
its irritability, and the trigeminus nerve shows no reaction whatever on being 
irritated, the tone of the muscles remains unaltered. The effect upon the 
pulse and respiration is also stated to be much less than that produced by 
equivalent doses of chloral hydrate. Mr. Liebreich declares that the symptoms 
after large doses are deep sleep, trigeminal anaesthesia, and death by arrest 
of respiration. The circulation, he affirms, is kept up with great tenacity, 
and, even if cardiac action, as well as respiration, has ceased, artificial respi- 
ration is able to restore the action of the heart immediately, and the life of 
the animal may thus be saved. Immense doses of croton-chloral produced 
cardiac paralysis. According to the author just quoted, the value of the drug 
is in its power of lessening sensibility before producing narcosis. These as- 
sertions of Liebreich are not borne out by the seemingly much more elaborate 
researches of J. V. Mering (Arch. Experun. Pathol. Pharm., Feb. 1875). 
He found that the sensibility of the cornea was not abolished until the respi- 
ration was reduced to one-half its normal rate. In dogs, cats, and rabbits, 
the blood-pressure was reduced temporarily by small doses, permanently by 
larger ones. Intravenous injections of sufficient quantity and concentration 
were followed by immediate arrest of the heart. Altogether, the symptoms 
caused by croton-chloral seemed exactly parallel with those induced by chloral 
hydrate. H. Windel Schmidt ( Centralb. Chirurgie, 1877, p. 210) also found 
narcosis to precede the anaesthesia of the head. E. Kulz has found that 
butyl-chloral is eliminated as urobutylchloralic acid, a substance analogous 
to urochloralic acid (Arch. f. Gesammte Physiol., xxviii. 534). 
Croton-chloral has been highly praised by Liebreich for its powers of re- 
* For a detailed account of physical and chemical characters, see a paper by E. 
Schering, Neues Repertor. fur Pharm., Bd. xxi. Heft 5, 1872, which I have abstracted 
into New Remedies, vol. ii. DE PR ESSO-MOTORS. 
381 
lieving neuralgias and other painful affections of the trigeminus. He states 
that it will afford relief even in severe tic douloureux, but is, unfortunately, 
only palliative. His statements have been confirmed by Drs. J. W. Legg 
{Lancet, 1873), Benson Baker {British Med. Journ., Oct. 1873), J. B. 
Yeo {Lancet, Jan. 1874), Sidney Ringer {British Med. Journ., 1874), and 
F. B. Lee {Ibid.). In a single very severe case of centric tic under my own 
care, ten grains of the drug have given very decided temporary relief, and 
compelled sleep. It is usually administered in doses of from five to twenty 
grains, in syrup. The safest plan is to give five grains every half-hour 
until thirty grains have been taken or relief afforded. Liebreich uses it 
according to the following formula: butyl-chloral hydrate, 5 to 10 parts; 
glycerine, 20 parts; distilled water, 130 parts. Dose, half an ounce, fol 
lowed in five minutes by a second, ten minutes later by a third unless relief 
is afforded. 
AMYL NITRIS-NITRITE OF AMYL. U.S. 
The nitrite of amyl was discovered by the French chemist Balard 
(Annales de Chimie et de Phys., xii.) in 1844, and the attention of physi- 
ologists was called to it in 1859 by Guthrie; but it was not until 1865 that 
Dr. Richardson, of London, introduced it to the notice of the profession. 
Since that time it has been a good deal used, but has not been made 
officinal. It is a yellowish, oily, very volatile liquid, of a very penetrating, 
persistent, fruity odor. It is prepared by the action of nitric acid on amylic 
alcohol, or, as it is commonly called, fusel oil. 
Physiological Action.-Nitrite of amyl can be absorbed by any surface 
except the skin, but, on account of its volatility, has hitherto been used in 
man chiefly by inhalation. Owing to the physical property just alluded to, 
its action is extraordinarily quick and very transient, it being absorbed and 
eliminated with great rapidity. 
The most prominent symptoms induced when it is inhaled by a man in 
moderate quantities, are a sense of great fulness and distention of the head, 
amounting at last to severe pain, and accompanied by intense flushing of the 
face, a deep, labored respiration, and an exceedingly rapid, violent action of 
the heart. The succession of these phenomena is so rapid that often they 
seem to be simultaneous; but it is said that the cardiac disturbance is some- 
times very distinctly manifest before the other symptoms. It has been 
noticed by Peck and confirmed by Ladendorf that objects look yellow to 
a person fully under the influence of the drug. After poisonous doses the 
symptoms have been great pallor, dilatation of pupils, excessive muscular 
relaxation, slow, scarcely perceptible pulse, irregular respiration (Am. Journ, 
Pharm., 1881, 137). 
In the lower animals the first stage of the action is like that just described 
in man. After this the breathing becomes violently hurried and panting, 
progressive muscular weakness and diminution of reflex activity ensue, and 382 
SYSTEMIC REMEDIES. 
finally death from failure of respiration,-sensation and consciousness being 
preserved almost to the last. 
A very peculiar symptom is that a long time before death the arterial 
blood becomes of almost the same color as the venous blood. Convulsions 
are sometimes present; but in my experience more often the animal is ex- 
ceedingly quiet throughout the poisoning. 
Elaborate experimental studies of the action of the nitrite of amyl upon 
the circulation in animals have been made by Dr. T. Lauder-Brunton 
(Journal of Anatomy and Physiology, vol. v.,-Berichte der Math.-Phys. 
Classe d. k. sachs. Gesellschaft Wissensch., 1869), by myself (American 
Journal of the Medical Sciences, July, 1871), and by Dr. Amez-Droz 
(Archives de Physiologic Normale et Pathologiquc, Sept. 1873, p. 467). 
The results are so uniform and in such accord that they must be accepted 
as proven facts. 
Circulation.-It has been found by all three observers just mentioned 
that, although the pulse is very much increased in frequency sometimes from 
the very beginning, the arterial pressure is diminished, and finally is reduced 
almost to zero, and that the fall of pressure occurs equally after section of 
the vagi as at other times. As the number of heart-beats in the uninjured 
animal is increased rather than diminished, whilst the strength of the indi- 
vidual beat is not perceptibly lessened, it is evident that, at least in the early 
stages of the poisoning, the diminution of arterial tension is not cardiac in 
origin, but must be due to dilatation of the capillaries. This conclusion is 
confirmed by an experiment of Brunton, who found that if the descending 
aorta was tied high up, no perceptible fall of pressure was produced by 
the inhalation of the amyl salt until very late in the poisoning, when the 
heart itself was acted upon by the drug; also by the fact noted by Dr. Amez- 
Droz and by G-aspy ( Virchow's Archiv, Ixxv. 310), that the vessels of the 
rabbit's ear and of the frog's web can be seen to dilate when the salt is 
inhaled.* That dilatation of the vessels takes place in man as well as in 
the lower animals, is shown by the flushing of the face, as well as by the 
enlargement of the retinal vessels, noted by Dr. Chas. Aldridge ( West Riding 
Lunatic Reports, vol. i. p. 187). 
An interesting question which here arises is, whether the dilatation is 
centric, due to an action on the vaso-motor nerve-centres, or peripheric, due 
to a direct action upon the muscular coat of the arterioles. I believe it must 
be peripheral, and not centric, in its origin, since both in my own experiments 
* A noteworthy fact asserted by Amez-Droz is that after a long period of dilatation 
the vessels contract again, whether the inhalation be continued or not. I think the ex- 
planation of this is simply that, owing to the volatility of the nitrite, it soon all escapes 
from the dossil of lint on which it is placed for inhalation; an explanation strongly con- 
firmed by a statement of Dr. Amez-Droz, that in these cases a new inhalation was followed 
by dilatation as before. Amez-Droz says only the arterioles dilate, but Gaspy found that 
both arterioles and veins were affectid. DEPR ESSO-MO TORS. 
383 
and in those of Brunton it occurred after the arterioles had been separated 
from the vaso-motor centres by division of the cord. This fact appears to 
prove that the fall of arterial pressure is due to a direct paralyzing action of 
the drug upon the coats of the arterioles,-a conclusion confirmed by our 
knowledge of the local action of the nitrite upon muscular tissue. 
Bernheim, however, asserts that this cannot be so, and that the dilatation 
must be solely due to an action upon the vaso-motor centres, because he found 
that galvanization of the cervical sympathetic still caused contractions in the 
vessels of the ear of a rabbit to which nitrite of amyl had been given. As 
pointed out by Pick (Centralblatt Med. Wissens., No. 55,1873), Bernheim's 
experiment does not warrant his conclusion. It only shows that the muscle- 
fibres in the walls of the vessels are not so completely paralyzed as to be 
unable to respond to very powerful stimuli. Dr. W. Filehne (Pfliiger's 
Archiv, p. 478, Bd. ix.) dissents from the view here taken; but it seems to 
me that the fall of arterial pressure after paralysis by section of the vaso- 
motor nerves absolutely proves that the drug acts locally upon the arterial 
coats. It is, however, very probable from the general sedative effect of the 
drug upon the motor centres that it acts also upon the vaso-motor centres; 
and when the local flushings caused by small doses of the poison are borne 
in mind, this probability is greatly enhanced. Filehne affirms that when to 
animals, whose lungs were exposed, inhalations of the nitrite were given, 
the change of color was not nearly so great as in the ears, and that if the 
sympathetic had been destroyed in the neck in a rabbit, and the nitrite of 
amyl exhibited, the vessels on the unwounded side actually became larger 
than those of the opposite ear. The answer to these results is, that opening 
the chest must derange most profoundly the pneumonic circulation, and that 
all observations upon the comparative size of vessels are very apt to be mere 
guesswork when the change is slight. Moreover, in Schuller's experiments 
(Bertin. Klin. Wochenschr., No. 25,1874), after destruction of the cervical 
sympathetic in a rabbit, inhalations of the nitrite produced still further 
dilatation of vessels of the ear. In conclusion, it seems to me established 
that nitrite of amyl does act locally on the coats of the arterioles, although 
it may at the same time influence the vaso-motor centres. 
In man the pulse-rate is enormously increased by nitrite of amyl. In 
animals the amount of the increase varies, but in the higher groups the rule 
appears to be increase of the pulse-rate, which is especially decided in the 
dog. Filehne (Pfiuger's Archiv, Bd. ix. p. 490) has by a single very inge- 
nious experiment seemingly proved that the acceleration is due to a depressing 
influence upon the inhibitory centres. He divided the par vagum in a rabbit, 
employed an electric current to the severed nerves of sufficient strength to 
bring the pulse-rate to normal, and found that the amyl salt was powerless 
to affect the rapidity of the cardiac action. Certain experiments performed 
by Mayer and Friedrich (Arch. Exp. u. Path. Pharm., n. 63) confirm that of 
Filehne. It is known that sudden asphyxia slows the pulse by exciting the 384 
SYSTEMIC REMEDIES. 
inhibitory centre. Mayer and Friedrich found that this action is prevented 
by the inhalation of the amyl salt. Then, again, they found that when by 
compression of the arteries the blood was prevented from going to the head, 
the nitrite did not increase the rapidity of the pulse, and also determined 
that the reflex inhibitory slowing of the heart by irritation of a sensitive 
nerve is prevented by nitrite of amyl. Further, in dogs with a powerful 
cardiac inhibitory apparatus the primary influence of the nitrite is more 
marked than it is in rabbits, whose pneumogastrics are very feeble. The 
sudden, thumping action of the heart so prominent in man when the nitrite 
is inhaled is therefore probably, at least in part, due to depression of the 
inhibitory apparatus. There is, however, as pointed out by Dr. Reichert 
(W. Y. Med. Journ.., July, 1881), much reason for believing that in small 
doses the nitrite acts primarily as a stimulant to the heart. Lauder Brunton 
long ago discovered that if the aorta be compressed so as to eliminate in 
great part the influence of the vaso-motor system, the nitrite causes rise in 
the arterial pressure; and it is perfectly possible for an excessive heart-ac- 
tion to be more than neutralized, so far as the arterial pressure is concerned, 
by a vaso-motor depression, so that the immediate fall of pressure caused 
in the normal animal by the nitrite is not proof that the heart may not be 
stimulated. The question could be readily settled experimentally by study- 
ing the action of the drug in minute quantities upon the cut-out frog's 
heart; at present the physiological evidence only justifies the belief that it 
is probable that nitrite of amyl in small amount primarily stimulates the 
heart. It is very certain that finally, if the dose be large enough, the heart- 
muscle is depressed, and it may be paralyzed, by a direct action of the nitrite. 
Nervous System.-I have found (loc. cit.'), as the result of numerous 
experiments made in the ordinary methods, that the diminution of reflex 
activity and of voluntary motion which undoubtedly occurs in toxaemia from 
the agent now under consideration is chiefly spinal in its origin; since after 
death the nerves and muscles preserve, though in an impaired condition, 
their functional power. On the motor centres of the cord the nitrite acts 
as a direct and powerful depressant, at the same time that it exerts a similar 
but much less pronounced action on the nerves and muscles, decreasing, but 
not destroying, their functional life. The diminution of reflex activity is 
never preceded by a stage of functional excitement. In some animals con- 
vulsions do occur, especially when the drug is administered by inhalation; 
but they are in all probability cerebral, not spinal, and due to the asphyx- 
iating influence of the poison. Over the sensory nerves and centres nitrite 
of amyl has but little power. They are among the last portions of the body 
to be affected, sensation being intact until near death, so that the drug is in 
no sense an anaesthetic. Mayer and Friedrich assert that at first nitrite of 
amyl increases the rapidity and depth of the respiration by stimulating the 
respiratory centres. Whether this be or be not correct, it is certain that DEPR ESSO-MO TORS. 
385 
later the respiratory centres are greatly depressed, the breathing becoming 
both slow and shallow, and death finally occurring from paralytic asphyxia. 
Urine.-Elimination.-Dr. F. A. Hoffmann found {Reichert's Archiv, 
1872, p. 747) that in the rabbit a hypodermic injection of 0.111 to 0.113 
gramme of the drug is enough to cause diabetes. If twice this amount of 
the amyl salt is used, the sugar becomes very abundant in the urine, and 
continues to be present for from twelve to thirty hours. Consentaneously 
with the elimination of sugar there is a great increase in the amount of the 
urine. In a patient under my care, to whom the salt was given very freely, 
at no time could sugar be detected in the urine: so that glycosuria is prob- 
ably induced only by toxic doses. The nitrite is probably oxidized in the 
system, at least in part, as F. Rohrmann {Zeitsch. f. Physiolog. Chemie, v. 
233) has found that when nitrite of potassium is administered to the lower 
animals the nitrate appears in the urine. 
Local Action.-Nitrite of amyl causes a progressive loss of functional 
power in every highly-organized tissue with which it comes in contact. 
Nerve-centres, peripheral nerves, muscles of organic and voluntary life, all 
succumb to it alike. If the contact be not continued too long, the tissue 
may recover even after a total suppression of its function,-a proof that 
the poison exerts no destructive chemical or devitalizing influence upon the 
tissues, such as that of sulphuric acid or veratria. 
Temperature.-Nitrite of amyl, in whatever way exhibited, if given in 
sufficient amount, reduces most remarkably animal temperature. I have 
seen a pigeon perfectly conscious, although its temperature had been brought 
down by this agent some 13° F. This influence is as marked in fever as in 
the normal condition of the animal, and is independent of the nerve-centres, 
occurring after section of the cord, and even after death in those cases in 
which post-mortem rise or continuance of high temperature normally takes 
place. I have also experimentally determined that it is associated with 
diminished excretion of carbonic acid. It must therefore be due to a direct 
arrest or check of tissue-changes or oxidation within, or without, the blood. 
The mouth temperature in man is certainly sometimes elevated by the inha- 
lation of the nitrite of amyl, but the rise is a very temporary one. W. A. 
Manassein and N. Sassezki {St. Petersb. Med. Wochensch., 1879, iv. 392) 
found, in a number of studies upon normal and fevered men, that whilst the 
peripheral temperature was at first increased the rectal temperature was 
always reduced, and after a time even the surface of the body grew cooler. 
The maximum reduction was reached in one to one and a half hours, and 
in a case of fever amounted to 3° C. 
The vapors of the nitrite have a very marked influence over oxidation 
outside of the body, as is shown by many facts, of which it is only necessary 
here to cite the extinguishment of glowing phosphorus by a few drops of 
the amyl salt diffused through the jar. It cannot be doubted that within 
the economy the same thing occurs. If, however, the arrest of oxidation 386 
SYSTEMIC REMEDIES. 
was complete, instant death from suffocation would result. The true 
explanation of the symptoms evidently lies in diminution, not destruction, 
of oxidation. 
When an animal inhales the nitrite of amyl, the arterial and venous blood 
soon become of a nearly uniform hue, which resembles somewhat that of 
normal venous blood, but is quite distinct from it, having a chocolate tint. 
Moreover, this chocolate-colored blood does not assume the arterial hue when 
shaken with the air. Dr. Arthur Gaingee (Philos. Trans., 1868, p. 589) 
discovered that as the chocolate color is assumed by the blood the two spec- 
trum bands of the oxyhaemoglobin disappear and are replaced by new bands 
nearly, but not exactly, in the place of those of acid haematin. If ammonia 
be added to the chocolate blood, the color changes back to a blood-red again, 
and simultaneously the spectrum-lines regain their normal position. If a 
reducing agent, such as sulphide of ammonium, be added to the chocolate 
blood, it is able to deoxidize the oxyhaemoglobin, but, before doing so, evi- 
dently removes it from union with the nitrite, since the new bands disappear 
and those of oxyhaemoglobin reappear in the spectrum before the lines of 
the reduced haemoglobin manifest themselves. Dr. Gamgee also found that 
the nitrite of amyl blood had lost its power of absorbing oxygen, or of 
yielding oxygen to the air-pump; and that carbonic oxide gas added to the 
blood did not expel oxygen from it. Having thus determined that a new 
compound is formed in the blood by the nitrite, Dr. Gamgee finally suc- 
ceeded in obtaining it in a crystalline form. As he always upon analysis 
found the nitrite in this compound, he considered it to be a nitrite-oxyhae- 
moglobin. Recent researches have, however, shown that the spectrum of 
this new compound is identical with that of Methaemoglobin of Hoppe- 
Seyler (Zeitsch. f. Physiol. Chem., Bd. ii., Bd. iii. 54), so that the identity 
of the two substances is very probable. 
These facts do not seem to me to prove that nitrite of amyl entering into 
the blood-vessels at once paralyzes the haemoglobin of the blood-corpuscle 
and checks all oxidation. As already stated, the experiments of Dr. Gamgee 
showed conclusively that this new compound yields up its oxygen to reducing 
agents. Further, the doctor found that when the nitrite blood was brought 
into contact with prepared guaiacum-paper it still ozonized it, though not 
so actively as normal. It is evident that the blood-corpuscles retain to a 
greater or less degree their power of yielding up ozone to bodies desiring it, 
and are capable of exerting at least this portion of their respiratory func- 
tion : further, when this ozone is given up and the oxyhaemoglobin changed 
into haemoglobin, so far as our present knowledge goes, the haemoglobin must 
absorb more oxygen before it can reunite with the nitrite. Evidently, then, 
absorption of oxygen must take place; evidently the blood-corpuscles must 
perform their respiratory function; but evidently also they are greatly crippled 
and impaired in the rapidity and ease of its performance. Haemic respira- 
tion is, in other words, greatly interfered with, but not abolished. DEPRESSO-MO TORS. 
387 
The accord of the results of this chemical investigation with those arrived 
at by a purely physiological study of the drug is very striking and very beau 
tiful, both teaching the same thing,-lessened, but not absolutely arrested 
oxidation. 
Having ascertained the existence of diminished oxidation in poisoning by 
nitrite of amyl, the temptation is very strong to attribute all the symptoms 
produced by it to this arrest. I do not, however, think that this post hoc 
propter hoc argument is justifiable, for the following reasons: In the first 
place, the nitrate of potassium and other nitrates, according to Dr. Gamgee, 
act in the same manner upon the blood, yet the symptoms caused by them are 
very different from those caused by nitrite of amyl. In the second place, 
when arrest of oxidation is caused by deprivation of oxygen (see article on 
Nitrous Oxide) the symptoms are very different, the brain and consciousness 
being always affected before the centres of reflex action, whereas under the 
influence of the nitrite of amyl the contrary occurs. In the third place, 
other substances, such as toxic doses of alcohol, check oxidation, but do not 
cause the same symptoms as does the drug under consideration. The obvious 
inference seems to me to be that nitrite of amyl acts directly upon the nerve- 
centres, independent of its influence on the blood. 
Therapeutics.-The results of the clinical use of nitrite of amyl are 
in accord with what has been said of its physiological properties. Its ad- 
ministration in angina pectoris appears to have been first suggested to Dr. 
Brunton (London Clinical Society's Reports, vol. iii.; Lancet, July 27,1867) 
by the sphygmographic tracings giving evidence of arterial spasm in a case 
of that disorder. As the pathology of these cases of heart-pang is not defi- 
nitely made out, it seems useless to speculate how the nitrite acts in many 
cases ;♦ but there is now abundant evidence of its value in relieving almost 
instantly agony which has resisted all other treatment. This appears also 
true whether valvular disease or merely functional disorder exists. In cases 
of advanced fatty degeneration or of very great dilatation of the heart, I 
think its use would be attended with some danger, owing to its effect upon 
the heart-muscle. Dr. Foster (Brit. Med. Joum., 1874, i. 77) has found 
the drug of great service in a case of cardiac disease in which there was 
aortic insufficiency with excessive hypertrophy and severe frontal headache. 
Its physiological action would indicate that it should be of service in all 
cases of spasm of the capillaries, of the bronchial tubes, and of the muscular 
system generally. Accordingly, Dr. Oskar Berger (Allgem. Medicin. Central- 
Zeitung, May, 1871) and others have used it with very good effect in migraine 
with evident capillary contraction. In asthma my own experience of several 
cases coincides with that of various physicians, that it will often instantly 
arrest the paroxysm,j" especially in those instances in which there are no 
secondary lesions, such as emphysema and dilated heart. 
* For a ease of failure, see Lancet, August, 1867. 
f For remarkable cases, see British Medical Journal, Sept. 30, 1873; also Butler's Com- 
pendium, part xiii., Jan. 1874. 388 
SYSTEMIC REMEDIES. 
The convulsion of epilepsy is, according to the present theory, due to a 
vaso-motor spasm at the base of the brain, to correct which the amyl salt 
would seem to be indicated, as it also is by the mere existence of the convul- 
sion. In advanced stages of the paroxysm it must, however, be used with 
caution, on account of the obscuring of its early effects by the symptoms 
of the disease. In the status epilepticus, when there is an almost indefinite 
repetition of the fits, the remedy may be of great use in stopping them. 
When there is a notable interval in ordinary epilepsy between the aura and 
the convulsion, the latter can usually, if not always, be entirely prevented 
(Dr. S. Weir Mitchell, Phila. Med. Times, vol. v. p. 553) : the patient should 
carry a small vial containing a few drops of the drug, and inhale it at once 
whenever the aura is felt. 
Dr. Mitchell also calls attention to the value of the nitrite as an aid m 
diagnosing those occasional cases of nervous disorder in which petit-mal is 
simulated by attacks really due to passing congestion of the nerve-centres. 
In these cases nitrite of amyl instead of arresting the paroxysm increases 
its intensity. Dr. Wm. F. Jenks has found the nitrite efficient in arresting 
puerperal convulsions, but dangerous on account of producing uterine relaxa- 
tion and post-partum hemorrhage, a result to be expected from the known 
physiological action of the drug (Phila. Med. Times, 1872, vol. ii. p. 404). 
In tetanus nitrite of amyl would seem to be indicated as a spinal sedative, 
and as controlling excessive tissue-changes and consequent rise of tempera- 
ture. It has been used, so far as I know, in only three cases (Lancet, 1871 ; 
Phila. Med. Tinies, vol. v.), all of which recovered, two with the amyl salt 
alone and the other with it and chloral. In nervous dysmenorrhoea the 
remedy was first used successfully by Dr. Fuckel; it has been highly com- 
mended by Dr. Mary Putnam-Jacobi (New York Med. Rec., Jan. 1875) 
and by Dr. P. Peck (Deuts. Arch. Klin. Med., xvii. 143). Two to six drops 
should be given when the pain comes on, and repeated pro re nata. In 
cholera nitrite of amyl has been tried without, that I can perceive, even a 
good theoretical reason, and has not seemed to be of service (London Med. 
Rec., vol. i.). Dr. V. Urbantschitsch has employed it with various results 
in various irregular cases of vaso-motor disturbances, in intermittent coryza, 
migraine, etc. ( Wiener Med. Presse, 1877). I have seen it used in a number 
of cases of intermittent fever, with the invariable result of putting an end 
to the chill and of not affecting the hot stage. 
The increased cardiac action produced by inhalation of the nitrite has led 
to its employment as a cardiac stimulant, and there is now much clinical 
evidence in favor of its employment in cases of sudden heart-failure. It 
has even been given with asserted excellent results in " fatty heart" (Osgood, 
Am. Journ. Med. Sci., 1874, xx. 58) and in syncope from hemorrhage 
(Madden, London Practitioner, xii., 1874).* In cardiac failure, during 
^'Consult also Philad. Med. Times, iv.; Psychol, and Med. Surg. Journ., Feb. 1875 
Lond. Lancet, May, 1875; Med. Times and Gaz., Dec. 1874; Brit. Med. Journ., 1877. DEPRESSO-MO TORS. 
389 
anaesthesia, it has been employed in a number of cases. The peculiar ra- 
pidity of its action makes it especially valuable in emergencies, and though 
further experimentation is necessary before we can understand its use in 
anaesthesia, clinical experience is sufficient to warrant its cautious adminis- 
tration. Further, by direct experiment Dr. Reichert has found (Philad. 
Med. Tunes, May 21, 1880) that when by the ethylen bichloride the blood- 
pressure and pulse-wave in the dog have been depressed almost to zero they 
are immediately markedly increased by the amyl salt. 
The physiological action of the remedy would very strongly indicate it as 
an antidote in s^cA/na-poisoning. No case of its use for this purpose in 
man has come to my knowledge, but the experiments of Dr. St. Clair Gray 
on rabbits (Glasgow Med. Journ., 1871, p. 188) yielded very favorable 
results, although they were not sufficiently elaborate to decide the matter. 
In two rabbits to each of which ten drops of the nitrite and half a grain 
of strychnia were given together subcutaneously, no decided symptoms what- 
ever were induced ; whilst one-quarter grain of the alkaloid alone frequently 
caused death in a single convulsion. 
Administration.-As already stated, the method of administration 
usually employed hitherto is inhalation, from one to three or five drops 
being placed on a handkerchief and held near the mouth or nose, the hand- 
kerchief being removed so soon as a sense of fulness of the head is expe- 
rienced. I have given it by the mouth, dropped upon a lump of sugar and 
taken instantly in doses of two or three drops. There is not at present suf- 
ficient evidence to enable us to decide as to the maximum amount of the drug 
which it is safe to give. In a case of cholera (London Med. Record, Oct. 
1873), Dr. D. B. Smith exhibited hypodermically two drachms in the course 
of an hour and thirty-six minutes without inducing any serious symptoms, 
and a dose of a dessertspoonful has been recovered from, emetics being given 
(Am. Journ. Pharm., 1881,137). Used with care, the nitrite, although a 
very rapidly-acting and powerful agent, seems to be safe, since I have never 
seen either in man or in animals any sudden or unexpected action,-any 
influence out of proportion to the amount given. It must be borne in mind 
that the symptoms generally increase in intensity for a minute or two after 
the withdrawal of the drug.* 
Nitrite of Potassium f has been very carefully and intelligently studied 
by Dr. E. T. Reichert (Am. J. Med. Sci., Ixxx. 180). Doses of six to ten 
grains in man sufficed to raise the pulse to 110 or 120, with flushing of 
the face and intracranial throbbing; the symptoms usually began in twenty 
® For a case in which an epileptic convulsion followed a hypodermic injection of one 
minim of the nitrite, see Journ. Ment. Sci., xxx. 252. It is doubtful whether the con- 
vulsion was caused by the nitrite. 
f For a paper on the theory of the action of the nitrite of sodium by Prof. Binz, see 
Arch. Experim. Path, and Pharm., xiii. 138. 390 
SYSTEMIC REMEDIES. 
minutes and lasted several ho ir< and were in no cases disagreeably severe. 
Eructations of a phosphorus-like taste were nearly always present. Ten 
to fifteen grains have produced complete muscular relaxation, livid lips, 
headache, etc., lasting three hours (London Lancet, 1883, ii. 766). In a 
very elaborate series of experiments upon animals, Dr. Reichert found 
that the action of the nitrites of potassium and of sodium upon the blood-, 
heart-, and nerve-centres are indistinguishable from those of the amyl salt, 
except in being much less rapid and more permanent. In cases of angina 
pectoris the duration of the influence of these nitrites makes them especially 
desirable, and they will probably in practice be found superior to the amyl 
salt. Twenty grains of the commercial nitrite of sodium has been given 
without serious effect, but of a pure article, either of the sodium or potas- 
sium nitrite, the dose is three grains; five grains have often produced 
serious symptoms (see London Lancet, 1883, ii. 945). At present a pure 
article is commonly kept in good drug stores. The dose may be repeated 
every two hours cautiously. 
Nitroglycerine is the most powerful of the nitrites. The symptoms 
which it causes in man are giddiness, constriction or other abnormal sensations 
in the head often amounting to severe headache, choking in the throat, some- 
times nausea, rapid cardiac action, with lessened arterial pressure. After 
toxic doses there is great failure of the heart's action. A single drop of a 
one per cent, alcoholic solution has produced insensibility, and in the case 
of Mr. Field, who took two drops, loss of consciousness and of the pulse at 
the wrist were complete (see Brit. Med. Jom., 1880, i. 406). Dr. Lauder 
Brunton and Tait (Ni. Bartliol. Hosp. Rep., xii. 140) have found that upon 
blood coloration, arterial pressure, nerve-centres, and muscles the nitro- 
glycerine acts very much as does the nitrite of amyl. This similarity 
of action between nitroglycerine and the nitrites has been recently con- 
firmed by Dr. Murrell and Dr. Matthew Hay (Lond. Practitioner, xxx. 422); 
also by A. H. Enocque (Comp.-Rend. Soc. Biolog., 1883, v. 669), and is re- 
markable, as the nitroglycerine may be regarded as nitrate of glyceryl. It 
has been shown, however, by Hay, that during its alkaline decomposition 
it yields nascent nitrous acid, and it can scarcely be questioned that this 
acid is developed in the blood, and acts upon the system. 
The effect of nitroglycerine is certainly more prolonged than that of nitrite 
of amyl. According to Prof. Korczynski, the maximum effect of a dose in 
Iman is reached in from three to fifteen minutes, whilst all. effects disappear 
in three-quarters of an hour (Schmidt's Jahrb., cxciii. 132). Within 
the last few years nitroglycerine has been used quite largely in the Lon- 
don hospitals, with asserted excellent results, in neuralgia and in angina 
pectoris. The practice has found imitators on both continents. The reports 
are almost universally favorable in regard to the action of the drug in the DEPRESSO-MO TORS. 
391 
diseases mentioned, and in asthma, uraemia, and puerperal eclampsia, and 
other affections in which experience has shown that nitrite of amyl is of 
value. It is kept in the drug-stores in one per cent, alcoholic solution, the 
dose of which may be set down as a half-drop, increased to two or three 
drops if necessary. It is said that this solution is not explosive, but that, 
unless care be exercised in manipulating it, headache and other unpleasant 
symptoms are apt to be produced. Mr. Martindale has shown that nitro- 
glycerine is soluble in cacao butter, and it has been proposed to administer 
it in the form of chocolate lozenges. 
According to the researches of Dr. Richardson (Brit, and For. Med.- 
Chirurg., July, 1867) the nitrite of ethyl acts very similarly to the nitrite 
of amyl; and it can scarcely be doubted that all of the nitrites depend for 
their physiological activity upon the nitrous acid and have similar physio- 
logical properties. 
Valerianate of Amyl has been introduced to the medical profession 
by Dr. W. F. Wade (Brit. Med. Journ., i., 1874), who appears to consider 
its therapeutic properties about the same as those of valerianic acid. He 
makes a compound spirit by adding one part of the valerianate to nineteen of 
alcohol, and to each ounce half a minim of acetate of amyl. Of this he gives 
eight drops in an ounce of water. The preparation is no doubt an active 
one, but probably possesses other properties than those of valerianic acid. 
LOBELIA. U.S. 
The leaves and tops of the indigenous herb Lobelia inflata. The dried 
plant has a slight irritating odor and a taste at first scarcely perceptible, after- 
wards burning, acrid, and attended with a flow of saliva. The active prin- 
ciple is Lobelina, a yellowish liquid alkaloid, discovered by Prof. Procter, of 
this city. Lobelic acid, a fixed and a volatile oil, gum, chlorophyl, etc., are 
also present in the drug. 
Physiological Action.-Lobelia appears to have the same influence 
upon the lower animals as upon man. At least Prof. Procter found a grain 
of the alkaloid to produce in a cat violent emesis, with intense prostration. 
In man, the symptoms induced by it when freely administered are nausea, 
soon followed by violent vomiting, accompanied with intense prostration, as 
is shown by feeble pulse, cold sweats, pale skin, and great muscular relaxa- 
tion. Purging may or may not occur. Numerous cases of fatal poisoning 
by it have been recorded. The symptoms are those above mentioned, inten- 
sified ; in some cases vomiting does not occur, and it is especially under 
these circumstances that fatal effects have been noted. Burning in the 
fauces and oesophagus, epigastric distress, in addition to the intense prostra- 
tion, bordering upon collapse and finally merging into complete collapse, 
with coma, stupor, muscular tremblings, and in some cases convulsions, pre- 
cede the fatal termination. 392 
SYSTEMIC REMEDIES. 
Our knowledge of the physiological action of lobelia is very imperfect; 
what we have is derived from the researches of Dr. I. Ott (Bost. Med. and 
Surg. Journ., 1875, Phila. Med. Times, vi.). He found that in the frog it 
produced a gradual increasing palsy, ending in death from paralysis of in- 
spiration. After death the motor nerves were found insensitive, although the 
muscles were still irritable. He did not determine whether the spinal cord 
also suffers, or whether the paralysis is solely due to the palsy of the motor 
nerve. In the rabbit, the symptoms produced by the alkaloid were slowing 
of the respiration, progressive palsy, fall of the bodily temperature, convul- 
sive seizures, and death from asphyxia. The alteration of the blood-press- 
ure consisted in an immediate fall, succeeded in some cases by a very decided 
rise of pressure, followed in turn by a fall. The rise of pressure appears to 
me to have been produced not by the direct action of the poison, but by the 
asphyxia induced by it. In large doses lobelia seems to paralyze the vaso- 
motor centres, at least galvanization of a sensitive nerve in the poisoned 
animal failed to induce any rise of pressure. Such doses were also shown to 
have a paralytic action upon the peripheral vagi. 
Toxicology.-The symptoms of lobelia-poisoning have been sufficiently 
described. The treatment should consist in washing out the stomach with 
plenteous draughts of a warm solution of tannic acid, in the free exhibition 
of opium and of alcoholic and ammoniacal stimulants, and in the use of ex- 
ternal stimulation by dry heat, frictions, mustard, etc., precisely as in poison- 
ing from veratrum viride. 
Therapeutics.-Lobelia has been used as an emetic; but its depressing 
effects are so severe as to forbid such employment of it. It has also been 
employed to relax spasm in various affections, as in pertussis, tetanus, epi- 
lepsy, chorea, convulsions, but has been superseded by more efficient and 
less dangerous remedies. It is often useful in spasmodic asthma or in acute 
bronchitis with bronchial spasm, and appears to be expectorant as well as 
antispasmodic. An infusion (gi to Oj) has been strongly recommended as 
a local application in the eczema produced by the rhus toxicodendron, or 
11 poison-vine." The powder is very rarely used; the dose as an emetic is 
twenty to thirty grains. The dose of the vinegar (Acetum Lobel lee-1 to 
10, U. S.) is twenty to thirty minims; of the tincture (Tinctura Lobelise- 
1 to 5, U. S.), as an expectorant, ten to twenty minims,-in the paroxysm 
of asthma, f5i to f$ii every half-hour until nausea is induced. The dose 
of the fluid extract (Extractum Lobeliae Fluidum, U. S.) is, as an expec- 
torant, one to five minims; as an emetic, fifteen minims. 
GELSEMIUM. U.S. 
The root of Gelsemium sempervirens, the yellow or Carolina jessamine, 
a beautiful climbing plant of the Atlantic Southern United States, distin- 
guished by its large, axillary, very fragrant, clustered blossoms and peren- 
nial dark-green leaves. The very light, fibrous, dirty-yellowish root has a DEPRESSO-MO TORS. 
393 
bitterish taste, and contains an alkaloid, Gelsemia, in combination with 
Gelsemhuc Acid, both discovered by Prof. Wormley (Amer. Journ. Pharm., 
1870). 
The influence of gelsemium upon man is very marked. There is, how- 
ever, a wide range of susceptibility, some individuals being profoundly influ- 
enced by a dose which has no perceptible effect upon another person. After 
the smallest active dose (five to fifteen minims of the fluid extract), the only 
symptom is languor; with it may be a little lowering of the force and fre- 
quency of the pulse. When a somewhat larger amount is ingested to the lan- 
guor is added dizziness, disturbance of vision, with, in some cases, a pain over the 
brows. Kinger and Murrell state that the pupil is contracted, but this is prob- 
ably an inconstant result. After toxic doses of the poison the muscular weak- 
ness is extreme, and in several cases (Lost. Med. and'Surg. Journ., 1869, 
iii., p. 185 ; 1879, ci. 18) the flexors of the arms have been especially 
affected. The disturbance of vision is now very marked, double vision, or 
partial, or even complete blindness may exist; the pupil is widely dilated 
and immovable; the external rectus muscle is weakened, sometimes suffi- 
ciently to produce a marked internal squint; the eyelid droops, and is raised 
with difficulty or falls in paralytic ptosis. If the patient be able to walk at 
all, the gait is staggering; the jaw drops, articulation fails; the general sen- 
sibility is much impaired; the respirations slow and labored; the pulse feeble 
and thready ; the skin bathed in a cold sweat; the bodily temperature greatly 
lowered. Sometimes drowsiness is felt after moderate doses of the poison, 
but consciousness may be preserved in the midst of very severe symptoms, 
although in all the fatal cases I have met with it was lost before death. 
The drug acts very promptly, symptoms usually commencing in about twenty 
minutes after its ingestion, and commencing to subside in two or three hours. 
Gelsemium produces in the lower animals symptoms similar to those which 
it causes in man, with the exception that convulsions are very generally de- 
veloped. They are not always present, but have been observed in the frog, 
pigeon, cat, rabbit, and dog. The loss of voluntary power precedes the con- 
vulsion, and in the careful experiments of Ringer and Murrell (Lancet, 
1876, i., p. 83) upon frogs, it was found that the cord was rapidly exhausted 
by repeated irritations, so that convulsions could not at once be induced. 
Prof. Bartholow states that in the rabbit, cat, and pigeon the convulsive 
movements are backward, sometimes amounting to complete somersaults. 
The close study of the action of gelsemium is best made by taking up the 
various systems in rotation. 
Nervous and Muscular System.-The retention.of consciousness until very 
late in the poisoning, both in man and the lower animals, shows that the 
drug has very little power over the higher cerebrum, although the drowsi- 
ness and the final loss of consciousness prove that it is not entirely devoid 
of such influence. The two most prominent symptoms caused by the drug 
are the convulsion and the paralysis. The first question to be determined is 394 
SYSTEMIC REMEDIES. 
whether the convulsion is cerebral, spinal, or peripheral. That it is not cere- 
bral is proven by its occurrence in the pithed frog (Ringer and Murrell, 
Lancet, 1876, i., p. 83), and below the point of section in mammals with 
divided spinal cord (Taylor, Richm. and Louisv. Med. Journ., 1875, p. 606) ; 
that it is not peripheral is proven by its taking place in the posterior ex- 
tremities when the lower aorta is tied before the poisoning (Ringer and 
Murrell). The cause of the convulsions at present remains inexplicable. 
The theory of diminished resistance (see p. 248) can hardly be received, be- 
cause in the careful experiments of Dr. Ott {Philad. Med. Times, vii., p. 
289), a condition of exaggerated reflex activity was proved to precede the 
convulsive state. Ringer and Murrell conceive that there are present in gel- 
semium two active and antagonistic substances, one a tetanizant, the other a 
paralyzant; but in their own experiments and in those of Dr. Ott, gelsemia 
believed to be pure produced convulsions. Nevertheless, it is notable that 
Ott found the acid so much stronger in convulsive action than the alkaloid, 
as to suggest the truth of Ringer's and Murrell's supposition. 
The paralysis in poisoning by gelsemia is evidently spinal in its origin, as 
its development is not affected by tying an artery before poisoning so as 
to protect a limb (Bartholow, Lond. Pract., v., p. 203; Ringer and Murrell, 
Lancet, ii., 1875, p. 908), and as the afferent and motor nerves and muscles 
preserve their functional activity until death (Ott, Bartholow,* Ringer, and 
Murrell). It is a matter of some importance in explaining the spinal action 
of the drug to determine its influence upon the different portions of the cord. 
Dr. Bartholow says that " it acts also on the sensory portion of the cord, pro- 
ducing at last complete anaesthesia; but this effect in warm-blooded animals 
and in man is toxic only, and follows the paralysis of the motor functions." 
This may be correct, but, so far as I know, has not been experimentally proven. 
Respiration.- Gelsemium usually kills by a paralysis of respiration. 
According to the researches of Burdon-Sanderson and of Ringer and 
Murrell {London Lancet, i., 1876, pp. 490, 560), immediately after the in- 
gestion the extent of the respiration, but not its rate, is increased; very 
shortly, however, both rate and depth enter a condition of progressive palsy 
ending in death. The respiratory changes are the product of a direct action 
upon the respiratory centres, being uninfluenced by previous section of the 
vagi. 
Circulation.-The action of moderate doses of gelsemium upon the circu- 
lation is not very marked. That in toxic amounts it depresses both the 
pulse rate and pressure is abundantly shown by the symptoms of poisoning 
in man, and by Dr. Ott's experiments upon animals {Philad. Med. Times, v., 
* Dr. Bartholow affirms (London Practitioner, v.,p. 203): "This experiment indicates that 
gelsemium destroys the excitability of the sensory nerve before the motor;" but his con- 
clusion seems hardly warranted by his premises, and in his treatise in therapeutics he 
iistinctly avows the centric origin of the paralysis. DEPRESSO-MO TORS. 
395 
p. 691). As the pulse rate and pressure were reduced in these experiments 
after previous section of all the cardiac nerves and of the spinal cord, it is 
evident that the poison exerts a direct influence upon the heart. How far 
the vaso-motor centres are influenced by the drug has not been accurately 
determined. 
Eye.-The influence of gelsemium upon the organ of vision is very decided. 
Ringer and Murrell affirm that decided non-toxic doses of the drug cause 
contraction of the pupil. However this may be, marked dilatation of the 
pupil is a very constant symptom in the poisoning. It has also been discov- 
ered by Ringer and Murrell, and confirmed by Mr. John Tweedy (London 
Lancet, 1877, i., p. 833), that the local application of gelsemia to the eye 
produces violent mydriasis, with paralysis of accommodation. This indicates 
very strongly that the dilatation is produced in poisoning by the drug through 
an influence exerted upon the peripheral nerve ending in the eye. The palsy 
of the external rectus and the ptosis indicate that such action is paralytic, 
so that it is a probable conclusion that peripheral oculo-motor paralysis is the 
cause of the dilatation of the pupil. The falling of the jaw and the loss of the 
power of articulation indicate that all the motor nerves of the head are acted 
upon by the poison. 
Therapeutics.-Gelsemium was originally employed as an arterial sedative 
and febrifuge in the malarial fevers of the South, and subsequently in other 
sthenic fevers. It appears in some way to depress the bodily temperature, 
but certainly possesses no controlling influence over the arterial system at all 
comparable to that of veratrum viride and aconite. Dr. Bartholow com- 
mends it highly, as in pneumonia and pleuritis; its influence for good in these 
disorders would seem, however, to be chiefly associated with its power of les- 
sening the rapidity of respiration and increasing the tendency to perspiration. 
It does not appear probable that any advantage to be derived from it will 
counterbalance the dangers attending its employment in the large doses re- 
quired. In asthma, spasmodic laryngitis, whooping-cough, nervous cough, 
in which it is also recommended by Prof. Bartholow, its employment seems 
more plausible, as in these cases there is a distinct spasmodic element. The 
testimony to its value is most marked in cases of trigeminal, ovarian, and 
other neuralgias. How it does good in these disorders is as obscure as is the 
nature of the neuralgias. The marked effect of the drug upon the facial 
nerves would appear to indicate its employment in facial neuralgias, and espe- 
cially in facial spasmodic affections. In acute mania the drug may be em- 
ployed in full doses as a calmative. 
Mr. Tweedy has drawn attention to the local use of gelsemium (Lancet, 1., 
1877, p. 832) by the oculist as a substitute for atropia, claiming that it may 
be employed with equal surety as a paralyzant of accommodation and dilator 
of the pupil, and that it possesses the very great advantage of its influence 
going off in a few hours. To thoroughly paralyze accommodation, however, 
it must be used freely; as he states, " To insure paralysis of accommodation 396 
SYSTEMIC REMEDIES. 
within three hours, a solution of at least eight grains [Gelsemia] to the 
ounce must be used every fifteen minutes for the first hour, and every half- 
hour afterwards." Employed in this way, I should think there would be some 
danger of general poisoning by absorption. 
Toxicology.-Dr. I. Ott (Philad. Med. Tinies, n., p. 693) has collected 
six cases of fatal poisoning; a teaspoonful of the fluid extract being the 
smallest amount that has caused death in the adult. Prof. Wormley believes 
that his chemical examinations have shown that in one fatal case the fluid 
extract ingested could not have contained more than the one-sixth of a 
grain of the alkaloid. 
The treatment of gelsemium-poisoning should be conducted on general 
principles. Dr. Geo. S. Courtright asserts that morphia is antagonistic, and 
details a case in which recovery occurred after the ingestion of from one to 
two teaspoonfuls of the tincture, one and one-half grains of morphia having 
been given hypodermically and one grain by the mouth ( Cincinnati Lancet 
and Observer, 1876, p. 963). 
Administration.-The dose of the fluid extract (Extractum Gelsemii 
Fluiduni, U.S.) is five minims every two hours until constitutional effects 
are produced ; of the tincture ( Tinctura Gelsemii-1 to 6.6, U. S.), teu to 
twenty minims. 
Tobacco in its various forms is so familiar an article of every-day life that 
I shall not enter upon any description of it. It contains an indifferent cam- 
phor-like substance, Nicotianin, and a very powerful alkaloid, nicotia, upon 
which all its physiological properties have been supposed to depend. Nicotia, 
when pure, is a colorless, transparent, volatile liquid, of a strong tobacco-like 
odor and a persistent burning taste. It is freely soluble in water, which it 
absorbs readily and largely from the air. Its salts are crystallizable with 
difficulty. 
Physiological Action.-Upon those persons who are not habituated to 
its use, tobacco acts as a very powerful depressant, producing horrible nausea 
and vomiting, with giddiness and a feeling of intense wretchedness and 
weakness. If the amount taken has been large, to these symptoms are added 
burning pain in the stomach, purging, free urination, extreme giddiness pass- 
ing into delirium, a rapid, running, and finally imperceptible pulse, cramps in 
the limbs, absolute loss of muscular strength, a cold, clammy skin, and finally 
complete collapse, terminating in death. 
Nicotia produces, when taken in minute quantities, symptoms sufficiently 
similar to those just detailed. Thus, Schroff (quoted by Stills and by 
Krocker) found that in doses of from one-thirty-second to one-sixteenth of a 
grain it caused an intense burning in the fauces, oesophagus, and stomach, 
which diffused itself as a sense of heat all through the body, and was fol- 
lowed by giddiness, nausea, and some vomiting, with a rapid, feeble pulse, 
TABAOUM-TOBACCO. U.S. DEPRESSO-MO TORS. 
397 
diarrhoea, intense muscular weakness, laborious respirations, icy extremities, 
partial loss of consciousness, apd other indications of impending collapse. 
Reil (Journal, fur Pharmacodynamilc, Bd. ii. p. 203) took one-seventh of 
a grain of the alkaloid, with the production of burning in the throat and 
stomach, headache, a feeling of heat in the head, increase of pulse-rate 
sixteen beats, muscular weakness, and a feeling of oppressed respiration. 
In one or two instances, violent muscular tremblings have come on shortly 
after the ingestion of the poison, and ended in general clonic convulsions. 
In large amounts nicotia acts with lightning-like rapidity. Thus, in a case 
of suicide, in which an unknown amount was taken (Taylor's Medical 
Jurisprudence, vol. i. p. 393), the man dropped instantly to the floor insen- 
sible, gave a deep sigh, and was dead in about three minutes. 
When a minute drop (gtt. ^) of nicotia is administered to a frog, the 
first evidences of local irritation are succeeded in a few seconds by tetanic 
cramps, in which the front legs are laid forcibly along the side of the trunk, 
and the feet bent over the back. This position is said by Krocker to be 
characteristic of nicotia- or conia-poisoning, and to be due to the extensor 
muscles being more powerfully contracted than the flexors. When very 
minute doses are administered, according to Vulpian, this general tetanus is 
replaced by muscular tremblings and irregular convulsions. After a short 
time the motor excitement in either case is succeeded by complete muscular 
relaxation, which, if the dose has been toxic, soon passes into general paraly- 
sis, and finally death by failure of respiration, the heart continuing to beat 
after breathing has ceased. The symptoms which the poison produces in 
mammalia are exactly parallel with those which it causes in the batrachian. 
The evidences of the pain produced by the intense local irritation caused by 
the poison are soon succeeded, after a small dose, by muscular tremblings and 
irregular voluntary movements, during which the animal often falls through 
weakness, and which rapidly give way to violent tetanic and clonic convul- 
sions ; to these succeeds an intense calm, in which voluntary movement is 
largely but not altogether abolished. In the first part of this stage external 
irritation still produces convulsions, but later it is without influence. The 
urine and faeces are usually voided, and sometimes vomiting occurs. The 
pupils, at first narrowly contracted, now (Krocker) dilate slightly, but not 
to the normal point. The breathing, which at first was rapid and shallow, 
becomes distant and fuller, the peripheral capillaries are relaxed and full of 
blood, and finally paralysis deepens into death. After death the venous 
system is usually found engorged. The physiological action of the alkaloid 
can best be studied in detail by taking up the various systems separately. 
Nervous and Muscular Systems.-Upon the cerebrum nicotia probably 
exerts very little direct influence. The convulsions* are certainly of spinal 
* P. Uspensky has found {Reichert's Archiv, 1868, p. 525) that these convulsions are 
not influenced by artificial respiration. 398 
SYSTEMIC REMEDIES. 
or peripheral origin, since they occur, according to the experiments of 
Krocker, in frogs whose cerebrum has beon extirpated. That they are not 
peripheral is proven by the experiments of Vulpian (^Comptes-Rendus de la 
Soc. de Biol., 1859, p. 151), who found that cutting off all the arterial com- 
munication between the hind legs of the frog and its trunk did not affect the 
development of the convulsions, when the animal was poisoned with nicotia. 
This has been confirmed by Krocker, who also found that if the nerve-trunk 
of a limb be divided the convulsions cease in that limb. The convulsions 
are, therefore, spinal, and the first stage of nicotia-poisoning is one of spinal 
excitement. The question here naturally arises, Is the paralysis of the second 
stage due to spinal depression ? There is not yet sufficient evidence to war- 
rant a positive decision as to how far the cord is involved in the paresis, but 
Krocker is probably correct in believing that it is at least to some degree 
affected, since he found that tying the arteries of a limb so as to preclude 
the poison from reaching the nerves did not prevent the limb from lying limp 
and powerless during the paralytic stage. 
The action of the poison upon the peripheral nerves has been definitively 
settled by the experiments of Vulpian, of Rosenthal (Centralblatt fur die 
Med. Wissen., 1863, p. 738), and of Krocker, all of whom have found that 
the functional activity of the motor or efferent nerves is more or less com- 
pletely abolished by the poison. By tying the artery low down in one leg 
of a frog, so as to protect the peripheral endings, applying the galvanic cur- 
rents some distance above this point, and comparing the results with those 
obtained by galvanizing unprotected nerves, Krocker determined that the 
peripheral endings were paralyzed sooner than the nerve-trunks, although the 
trunks themselves were finally affected. The peripheral nerve-endings appear 
to be at first excited, as Vulpian and Krocker have found that muscular 
tremblings are not prevented by the section of the supplying nerve, and that 
they even occur in the curarized frog. These fibrillary contractions also oc- 
curred when the alkaloid was injected into a leg whose connections with the 
trunk had been cut off by a tight general ligature. According to Vulpian 
and Rosenthal, the sensory or afferent nerves retain their activity to the 
last. Upon the voluntary muscles all observers are in accord in asserting 
that nicotia exerts no influence. 
Circulation.-When nicotia is added to freshly-drawn blood, the latter 
assumes a peculiar dark hue, and the microscope shows that the red cor- 
puscles rapidly disintegrate. In nicotia-poisoning the blood is, however, not 
perceptibly affected. The amount of the alkaloid necessary to take life is 
exceedingly small, and although the death by asphyxia causes the vital fluid 
to be everywhere dark, yet the microscope reveals only normal corpuscles. 
Moreover, Krocker has found that the dark blood rapidly assumes an arterial 
hue w'hen shaken in the air, and that its spectrum is normal. 
The action of the drug upon the heart is very complicated, and has not 
yet been well determined. Upon the cardiac muscle itself the poison appears DEPRESSO-MO TORS. 
399 
to have but very little influence; after death from it the heart is found pul- 
sating, and Dr. W. T. Benham ( West Riding Lunatic Asylum Reports, vol. 
iv., 1874) found that even the pure alkaloid painted over the cut-out heart 
of a rabbit or injected into its cavities did not arrest its movements: in- 
deed, on the contrary, the heart, which had ceased action, was stimulated to 
renewed effort by the application of the drug. Traube found (Allgem. Jled. 
Central-Zeitung, 1862) that when a minute quantity of nicotia is injected 
into the jugular vein of a curarized animal, artificial respiration being main- 
tained, the pulse and arterial pressure at once sink to half their original 
position, but in about twenty seconds rise rapidly, the arterial pressure at- 
taining a maximum of about two and a half times its normal grade, the pulse 
also exceeding its original rate. This period of increased tension lasts about 
a minute, after which the arterial pressure commences to fall, as does later 
the pulse-rate also, and finally both sink much below their normal position. 
After many minutes the pulse generally increases its frequency, often to be- 
yond its original position. If during the second stage the pneumogastrics 
be cut, the pulse instantly becomes very rapid. It would appear probable 
that the first lowering of the pulse is due to an action on the inhibitory 
nerve, as is believed to be the case by Rosenthal; but it appears to me that 
other investigations are required before this can be considered established. 
Traube, indeed, states that if the pneumogastrics are cut during the second 
stage the pulse becomes at once very rapid ; but he also affirms that previous 
division of the par vagum does not prevent the slowing of the pulse. In 
the experiments of Tugenhold (reported by Rosenthal) upon frogs, the pri- 
mary slowing of the heart amounted at first to a diastolic arrest, which was 
not prevented by previous division of the par vagum, but did not occur when 
very large doses of woorara were given. Rosenthal argues from this that 
nicotia stimulates the extreme peripheral inhibitory apparatus of the heart, 
-the reason that the curare prevents the primary retardation of the pulse 
being the paralysis of the inhibitory peripheral filaments which it is believed 
to cause. It is clear, however, that the results obtained by Rosenthal are diffi- 
cult to reconcile with the effects of section of the par vagum already quoted 
from Traube. The method in which nicotia primarily lessens the pulse-rate 
must therefore be considered as still unsettled. The later increase of the 
pulse-rate appears to be due to paralysis of the peripheral inhibitory appa- 
ratus, since Rosenthal found that in this stage of the poisoning the strongest 
galvanic currents applied to the pneumogastrics failed to influence the car- 
diac pulsations. The causes of the rise and fall of the arterial pressure have 
not been determined, but they are probably connected with the at present 
undetermined vaso-motor action of the drug. Traube found that they both 
occurred after section of the vagi, and that in these circumstances minute 
successive doses would produce after each a temporary rise of pressure until 
a large amount of the poison was given, when the pressure steadily fell. 
Rosenthal believes that the dilated vessels which various observers have noted 400 
SYSTEMIC REMEDIES. 
in the ear of the poisoned rabbit prove that the alkaloid finally paralyzes the 
vaso-motor system. 
Pupil.-When exhibited in a moderate toxic dose, or when applied directly 
to the eye, nicotia produces a very marked contraction of the pupil. If, as 
is asserted by Krocker, the alkaloid contracts the pupils of cut-out eyes, it is 
evident that the action is a local one. Hirschmann {Reichert's Archiv, 1863) 
has found that galvanization of the divided cervical sympathetic fails to cause 
dilatation of the pupil. Krocker, in later experiments, has confirmed this 
in regard to large doses of the drug, but has found that myosis occurs long 
before the sympathetic is unable to dilate the pupil. This fact renders it 
probable that the alkaloid paralyzes the peripheral endings of the sympathetic; 
but it is barely possible that it induces a spasm of the fibres supplied by the 
oculo-motor so powerful that the sympathetic is unable to overcome it. Be 
this as it may, it is very probable that the sympathetic paralysis, if it exists, 
is associated with oculo-motor spasm; but at present we have not sufficient 
evidence to warrant any definite conclusion. 
Abdominal Organs.-Nasse found in his experiments {Beitriige zur Phys. 
d,er Darmbewegung, Leipsic, 1866) that injections of nicotia into the jugular 
vein produced a tetanic contraction of all the intestines, which was not 
affected by section of the vagi or by compression of the abdominal aorta; 
even the splanchnics were unable to exercise their inhibitory influence, either 
because they were paralyzed or because the spasm was too intense for them. 
In what way the poison is eliminated has not, that I am aware of, been 
determined, but it very probably escapes with the urine, since, according to 
Claude Bernard {Substances Toxiques, p. 410) the rapidity of the secretion 
of that fluid is increased. 
Therapeutics.-Tobacco has been employed in past times in a large 
number of diseases, but has almost passed out of sight as a therapeutic 
agent, and there are only two indications which it is capable of meeting. 
These are as follows: 
To relax spasm.-Imperfect as is our knowledge of the physiological 
action of tobacco, so far as it goes it indicates very clearly the great power 
of the drug in quieting violent muscular spasms. The frightful nausea and 
vomiting which it is so apt to induce, and the occasional excessive violence 
of its action, have led to its being superseded by less disagreeable and more 
controllable remedies. It is still, however, employed occasionally in tetanus, 
with asserted good results. In spasmodic asthma, if the patient be not 
accustomed to smoking, one or more strong cigars will very often at once 
end the attack, or perhaps abort one which is threatening. In strychnia- 
poisoning, tobacco has been used in several cases successfully. 
To alleviate pain.-Taken internally, tobacco has no powers of relieving 
pain at all commensurate with the danger attending its use, and it should 
never be employed for that purpose. It is different with its local use: 
thus, it is often added with great advantage to ointments in the case of DEPRESSO-MO TORS. 
401 
painful hemorrhoids; and in pruritus a strong wash of tobacco affords one 
of the surest modes of relief. It must never be forgotten that its external 
employment has led to the most serious and even fatal poisoning.* For 
this reason tobacco ought never to be employed, as it formerly was, to kill 
vermin on the person. 
Toxicology.-A large number of deaths have resulted from the medi- 
cinal use of tobacco, Husemann stating (Handbuch der Toxicologies vol. ii. 
p. 483) that no less than ten fatal cases have been reported from the use 
of tobacco enemata alone. Dr. Copland has seen a clyster containing half 
a drachm produce death (Diet. of Pract. Med., art. Colic). Even smoking 
has caused an acute fatal poisoning. Meisens affirms that the smoke of 
half an ounce of strong tobacco contains sufficient nicotia to prove fatal.'}' In 
the only case of criminal nicotia-poisoning on record, an unknown amount of 
the alkaloid was forced into the mouth of the victim, causing death in from 
three to five minutes (Ann. d' Hygiene, 1861, ii.). The treatment of tobacco- 
poisoning consists in washing out the stomach, the free administration of 
ammonia and alcohol, the hypodermic use of moderate amounts of strychnia, 
and the employment of such external measures as dry heat, rubbings, etc. 
If these fail, artificial respiration should be maintained. The excessive use 
of tobacco produces in some persons serious nervous disturbance, such as 
insomnia, irritability, general feebleness; the most characteristic symptom 
is a peculiar irregularity of the heart's action, often accompanied by distinct 
intermissions. Amaurosis is also sometimes present. Jonathan Hutchin- 
son affirms (Med. Times and Gazette, i. 1884, 40) that he has seen this 
amaurosis recovered from by the use of opium and champagne without the 
abandonment of the habit of smoking. 
Administration.-The dose of tobacco in substance is usually stated 
to be five grains, which may be given in infusion. In strychnia-poisoning 
and tetanus the remedy should be exhibited at short intervals until consti- 
tutional symptoms are induced. 
CONIUM. U.S 
The U. S. Pharmacopoeia recognizes both the leaves and the fruit of 
Conium maculatum. The fruit should be full-grown, gathered while yet 
green, and carefully dried. The plant is umbelliferous, a native of Europe, 
but naturalized in the United States. The dried leaves have a strong heavy 
odor, increased by the addition of an alkali, and resembling somewhat that 
of mice. They are bi- or tripinnate, and very much incised. The fruits are 
one to two lines long, roundish-ovate, striated, with five crenated ribs on the 
* For a number of cases, see Still6's Therapeutics, vol. ii. p. 374. 
t The activity of tobacco-smoke is connected with the presence in it of other substances 
than nicotia (see Comptes-Rendus, xc. 1538). A. P. Fokker found a large proportion of 
carbonic oxide, and asserts that animals immersed in the smoke die of poisoning by that 
gas. 402 
SYSTEMIC REMEDIES. 
outer sides of the easily-separable halves; the odor is that of the leaves. 
The active principle is Conia, a yellowish, oily, liquid alkaloid, highly volatile, 
of a strong odor similar to that of the urine of mice, and of a very acrid 
taste. It is freely soluble in alcohol and in ether, slightly so in water, with 
which it forms a hydrate, and it coagulates albumen; when exposed to the 
air it undergoes decomposition, becoming first brown, afterwards resinous; 
heat accelerates the change. 
Physiological Action.-The chief symptom produced in man by conia 
when taken in doses just large enough to impress decidedly the system is 
great muscular weakness or languor, with some disorder of vision, and giddi- 
ness. On attempting to walk, the patient suffers from a feeling as though 
his feet were made of lead, and he staggers or falls from the refusal of his 
knees to support him. There is an intense desire to lie quiet in the hori- 
zontal position, and, as the eyelids are especially affected, the eyes are kept 
shut. In some subjects these symptoms are preceded or accompanied by 
burning in the mouth or fauces, nausea, and even vomiting, besides heat of 
head, often with a sense of weight or pressure, or even severe frontal pain. 
The disorder of vision is apparently due in great part to a sluggishness and 
finally to a paralysis of accommodation. The experiments of Poehlmann 
(quoted by Husemann, Die Pflanzenstoffe, p. 269) show that very grave 
symptoms may be induced and yet the pupil remain natural; but sooner or 
later, as the drug gains power over the system, it probably always dilates. 
The pulse is first diminished, afterwards increased in frequency. In decided 
poisoning by conium. the symptoms are probably simply those already men- 
tioned, intensified. I have met with accounts of but three fatal cases of 
such character. In one, that of the mistress of Dr. Hermann Jahn, killed 
in a few minutes by from ten to fifteen drops of the alkaloid (quoted by 
Husemann, Die Pflanzenstoffe, p. 269), violent palpitation of the heart is 
said to have been a prominent symptom. The chief symptom in the second 
case ^Edinburgh Med. and Surg. Journ., 1845) was universal paralysis, with 
total failure of voluntary movement and of the voice before consciousness 
was lost. Convulsive movements were present very late in the case. Sen- 
sation appeared not to be lost until death was at hand. 
The third case was in the person of a medical electrician, suffering from 
blepharo-facial spasm, who took, beginning four hours after the last of a 
previous series of divided doses of a fluid extract amounting to one hundred 
and eighty drops, at 4.10, 4.40, and 5.15 P.M. fifty minims (one hundred and 
fifty in all) of " Squibb's fluid extract." The first dose produced dizziness 
and muscular relaxation; the second, great muscular weakness, inability to 
stand, and thickening of speech, without relief of the spasm; the third, im- 
mediately, some nausea, and tremors about the chest. At 6.10 there were 
nausea, intense muscular weakness, partial ptosis, diplopia, and great difficulty 
of speech ; the pulse was 60. Shortly after this he became unable to speak 
or to sw'allow. He made signs for electricity, and, on being asked whether DEPRESSO-MO TORS. 
403 
the chemical or the faradaic current, indicated the latter, and also the place 
of application of the electrodes, but was unable to hold one of the latter. 
Shortly after this, on being raised up, he dropped dead. {The Sanitarian, 
June, 1875.) 
In mammals conia produces symptoms parallel with those observed in 
man, and it probably acts similarly upon all vertebrates. In some animals, 
however, the convulsions are more prominent than in man ; in frogs they are 
rarely if ever present; in birds they are occasionally so ; in mammals they 
are more frequent,-thus, Ihmsen saw them in twelve out of twenty-three 
experiments ; they are chiefly clonic, but tonic spasms do occur in the 
hind legs. As the legs are usually affected before the arms in man, so in 
quadrupeds the hind extremities are usually paralyzed first. Sensibility 
is maintained to the last. The respiration is generally much affected, and 
the heart continues to beat after its cessation. 
The occasional salivation and excessive sweating of conia-poisoning indi- 
cate that the alkaloid escapes with all the secretions, but the kidneys are 
undoubtedly the chief channel of elimination. Zaleski and Dragendorff 
have found it abundant in the urine during the first twelve hours of the 
poisoning; Prevost has seen the urine of poisoned animals cause in a frog 
the characteristic general palsy, and in a doubtful case this physiological test 
might decide the diagnosis. 
Nervous and Muscular Systems.-All observers agree that the chief symp- 
tom produced by conia {i.e., the paralysis) is not due to any direct influence 
upon the muscles, which, indeed, preserve perfectly their contractility up to 
death. In 1856, Kblliker ( Virchow's Archiv, Bd. x. p. 228) announced that 
the failure of motion in conia-poisoning is due to a direct action of the alka- 
loid upon the efferent or motor nerves. He first experimentally found that 
in frogs killed by the drug the application of the galvanic current to a nerve 
fails to induce contractions in the tributary muscles. He then tied the aorta 
in such a way as to cut off the supply of blood to the hind extremities, and 
found that after voluntary motion had ceased in the fore legs, and even after 
galvanic stimulation of the anterior nerves had lost its influence upon the 
muscles directly supplied by those nerves, irritation of the same anterior 
nerves produced reflex contractions in the hind legs, showing that the anterior 
afferent nerves and the spinal cord still retained functional activity after the 
loss of it in all those efferent nerves reached by the poison. After repeating 
these experiments a number of times, he drew the conclusion already given. 
His experimental results have been confirmed by Funke {Berichte uber 
die Verhandl. der k. sachs. Gesells. der Wissensch. zu Leipzig, Bd. xi. 
p. 23, 1859), by Guttmann {Berlin. Klin. Wochenschr., 1868, quoted by 
Husemann), and by MM. Pelvette and Martin-Damourette* {Gazette Med., 
* M. Tiryakan (Compt.-Rend., Ixxxvi. 1344) has affirmed that absolutely pure conia 
does not affect the nerves, but M. Prevost (Arch. Physiol. Norm, et Path., vii., 1880) has 
shown that chemically pure bromohydrate of conia has this action. 404 
SYSTEMIC REMEDIES. 
1870, quoted in Archives Gen., 6e ser., t. xvi. p. 88). The latter observers 
extended the series by severing in a frog all the tissues at the upper part of 
the thigh except the nerve, and found that when a batrachian so prepared 
was poisoned with conia, after the paralysis was complete in all portions 
of the body to which the poison had access,-after stimulations of the 
poisoned nerves were powerless to excite contraction in the tributary mus- 
cles,-the leg which had been protected from the action of the conia upon 
it responded not only to irritations applied to its nerve, but also to stimuli 
placed upon distant portions of the body. These same observers also noted 
that when conia and strychnia were given simultaneously to a frog from one 
of whose sciatic nerves the circulation (i.e., direct access of the poison) was 
cut off in either of the manners spoken of, they produced by their conjoint 
action a commingling of paralysis in all other parts of the body with violent 
tetanic spasms in the protected leg,-a commingling explainable only on 
the supposition that the conia paralyzed all the motor nerves to which it 
had access through the circulation. Since B. F. Lautenbach (Philad. 
Med. Times, vol. v.), Verigo, A. W. Hofmann, Prof. Prevost, H. Schultz 
(Schmidt's Jahrb., Bd. exlix. p. 16; Bd. cxcv. 119), and Fliess (Arch. f. 
Physiolog., 1882, p. Ill) have confirmed these experiments, it must be 
considered as an established fact that the chief physiological action of conia 
is as a paralyzer of the motor nerves, and primarily of their peripheral 
filaments.* 
It has generally been believed that conia has little or no influence upon 
the sensory nerves; but Lautenbach affirms that by a large number of ex- 
periments he has shown that it impairs very greatly the functions of the 
peripheral afferent nerves. The nature of the experiments is not indicated in 
his preliminary report, and until published the evidence cannot be weighed. 
Before the paper of Lautenbach was published, M. Gubler (Bulletin Therap., 
Jan. 1875) called attention to the action of conium in benumbing cutaneous 
sensibility, detailing especially a case where temporary loss of sensation was 
produced in the hand by rubbing a cancerous tumor with the extract. Ac- 
cording to the observations of Prevost the glandular nerves are not affected 
in conia-poisoning. 
The exact influence of conia upon the spinal cord cannot yet be consid- 
ered absolutely determined, but it is most probable that the poison has a 
feeble depressant action. Dr. Verigo (Schmidt's Jahrb., Bd. exlix. p. 16) 
asserts that it is a powerful spinal depressant, and MM. Pelvette and Martin- 
Damourette (Archives Gen., 6e s6r., t. vi. p. 89) say that it acts as an excitant. 
Dr. Lautenbach (Proc. A. M.'S, Philad., 1875), in carefully investigating 
the subject, failed to obtain, under any circumstances, evidences of excite- 
* II. Tiryakan {Etude exp^rim. et chir. sur la Coniine, Paris These, 1878) endeavors 
to show that this action of conia is due to an impurity, and not to the a'kaloid; but this 
is, a priori, exceedingly improbable, and Prof. Prevost {Arch. de Physiol., Nov. 1880, 40), 
using the same preparation as did Tiryakan, has found that the motor nerves are affected. DEPRESSO-MO TORS. 
405 
ment of the cord ; he did succeed in producing loss of reflex activity where 
the nerve was protected by tying the artery in the limb, but as in all but two 
of fifty-two experiments the reflexes in the protected limb were not greatly 
reduced until just before death, it is plain that any action upon the spinal 
cord is unimportant and dominated by more powerful influences. The ex- 
periments of Drs. A. D. Davidson and D. Dyce Brown {Med. Times and 
Gaz., July, 1870), which have been cited as favoring the absurd theory 
of Dr. Harley that the corpora striata are especially affected by the drug, 
depended no doubt upon an artificial anomaly said to be common in the leg 
of the cat. 
According to the experiments of Lautenbach (Joe. cit., p. 451) the con- 
vulsions of hemlock-poisoning are cerebral, since, in a number of cases, after 
division of the cord they were confined to those muscles supplied by nerves 
arising from that portion of the spinal marrow above the section. 
The retention of consciousness so late in the course of poisoning by conia 
proves that the drug has but little influence upon the cerebral hemispheres. 
Pupil.-1The pupil is generally dilated by conia; but both Von Praag 
{Journ. filr Pharmacodyn., Heft i. p. 31) and Verigo assert that the phe- 
nomenon is not constant, at least in animals. The ptosis of conia-poisoning 
indicates that the dilatation of the pupil is due to oculo-motor paralysis. 
The known action of the drug upon nerve-trunks indicates that this paralysis 
is peripheral,-a conclusion corroborated by the experiments of Dr. I. Hoppe 
{Die Nervenwirkungen der Heilmittel, Heft i., Leipsic, 1855), who found 
that when conia was dropped into the eye of an animal it caused at first 
contraction, apparently due to the intense irritation, and afterwards dilata- 
tion, of the pupil. 
Temperature.-Verigo, Von Praag, and others affirm that lethal doses of 
conium cause a decided lowering of temperature; but Lautenbach asserts 
that the drug decidedly increases the temperature both when in therapeutic 
and in toxic doses. 
Circulation.-No sufficient investigation has as yet been made upon the 
action of conia upon the circulation. Lautenbach states that the arterial 
pressure falls immediately after the injection of conia, and afterwards rises 
far above the normal point, and that the pulse is at first accelerated, but 
afterwards retarded. The secondary rise of pressure was probably due to 
asphyxia. The primary pulse acceleration is explained by the observation 
of M. Pelenard, confirmed by M. Prevost, that the pneumogastrics are par- 
alyzed before the motor nerves. M. Prevost finds that the heart itself is 
scarcely affected at all by the poison. 
When locally applied in a concentrated condition, conia probably is fatal 
to all the more highly organized tissues. Certainly Christison {Edinburgh 
Philosophical Transactions, vol. xiii.) proved this to be so in regard to the 
muscles which are not influenced by it when taken internally. Upon the 
mucous membranes it acts as an intense irritant. 406 
SYSTEMIC REMEDIES. 
Therapeutics.-The paralytic action of conium naturally suggests its 
use in spasmodic affections; and accordingly it has been tried in chorea, in 
paralysis agitans, in whooping-cough, and in other diseases of similar nature. 
Although it seems not to have met with continued favor, and is but little 
used, it may be employed when life is threatened by the mere convulsive 
actions, as it will suspend these for the time being. If Dr. Harley's views 
as to its physiological action be correct, it ought to be especially useful in all 
motor disturbance connected with irritation at the base of the brain. Clinical 
proof is, however, nearly as scarce as physiological in this matter. 
In maniacal and hysterical excitement, the drug in full doses is said to 
produce a condition of calm and relaxation which is highly favorable; and 
in the treatment of the insane, conium is very much used by some alienists 
(Amer. Journ. of Insanity, April, 1873). 
Conium has also been employed to relieve pain. As a deobstruent and 
alterative it has been very largely used, both locally and internally, in neu- 
ralgia and sciatica, with asserted occasional success, in cancerous and other 
tumors, in chronic glandular enlargements, swollen joints, and in various 
chronic ulcerations. Dr. H. Kennedy (Dublin Journ. Med. Sci., Jan. 1874) 
especially commends it in chronic rheumatism, and as an aid to cod-liver oil, 
etc., in chronic phthisis. It has also been employed to arrest the secretion 
of milk and to relieve dysuria. The various uses of conium as an alterative 
certainly have no definite physiological basis, but they appear to be justified 
to some extent by clinical experience. 
Administration.-One of the great practical drawbacks to the use of 
this drug is the uncertainty of its preparations. The dose of the abstract 
(Abstractum Conii, U. S.) is one to two grains; of the extract (Extractum 
Conii Alcoholicum, U. S.), one grain ; of the tincture ( Tinctura Conii-1 
to 6.6, U. S.), f^ss to fji; of the fluid extract (Extractum Conii Fluiduni), 
^Lj to TrLii; all of which must be administered in increasing doses until 
some effect is experienced. Of these preparations, the last is certainly the 
best. The English Succus Conii, so praised by some writers, I have known 
to be used by the ounce without effect. 
The variability of all the preparations has its origin-first, in the varying 
umount of the active principle in the drug; secondly, in the great volatility 
of this principle; and thirdly, in the proneness of the alkaloid to undergo 
spontaneous decomposition, even when kept under the most favorable cir- 
cumstances, and to a much greater extent when exposed to light and air. 
The alkaloid, on the whole, would probably be the best form in which to 
use the remedy; but it is not officinal; abroad, however, it has been used to 
a considerable extent. Its unstable nature, however, is an obstacle to its use, 
and has caused M. Mourrut to propose its hydrobromate, which is said to be 
a crystalline stable salt (Bull. Therap., xc. 446, xci. 1). The dose of the 
alkaloid or its salt is one-twentieth to one-twelfth of a grain, which may be 
dissolved in alcohol. DEPRESSO-MO TORS. 
407 
Toxicology.-Sufficient has been said about the symptoms caused by 
conia. After death from it no distinctive lesions are to be found, only the 
usual indications of death from asphyxia. The treatment consists in the 
immediate evacuation of the stomach and the exhibition of tannic acid,- 
the tannate formed is, however, probably more or less poisonous,-with the 
use of external heat and of internal stimulants; artificial respiration should 
be steadily maintained so long as there is the faintest indication of cardiac 
action. No physiological antidote is known; but it is possible that atropia 
might be of service by aiding to maintain the respiration. CLASS XL-ALTERATIVES. 
There are employed by practitioners of medicine, to affect certain dis- 
eases most intimately connected with the processes of nutrition, various 
substances which do not, at least in the doses commonly used, produce any 
very obvious symptoms. These drugs may perhaps neither stimulate nor 
depress, so far as can be perceived, any function of the body; their action 
may be silent and imperceptible, their mode of influence may be unknown: 
but their therapeutic effects are among the most assured of clinical facts. It 
is to medicines of this character that the name of Alteratives has been ap- 
plied, because when administered they seem simply to alter morbid processes. 
Speculation has been rife as to the mode in which alteratives influence the 
body; and as the accepted pathology has been humoralistic or otherwise, so 
has it been strenuously argued that they act upon the vital fluid or upon the 
solids of the body. The term " purifying of the blood" has been especially 
applied to their action, and is sufficiently suggestive of their function as 
viewed from the pathological stand-point of the old humoralist. What we 
know of the action of these medicines at present amounts to this, that they 
modify the nutritive processes of the body. As the physiologist has scarcely 
learned the alphabet of that part of his science which treats of the general 
nutrition, having no knowledge as to what is the real dominant force in the 
nutritive processes,-as he is unable to tell with certainty in what organs 
the universal vital pabulum, the blood, is formed, much less to point out the 
method of its formation and the laws which govern its development,-as the 
pathologist is completely baffled in attempting to find the essence, as it were, 
of the morbid processes which are successfully met by alteratives,-as he can- 
not point out to us what perverted functions underlie these diseases as their 
basis,-why should the therapeutist be expected to explain the rationale of 
his treatment ? The empirical facts of the clinical pathologist are met by 
the empirical facts of the clinical therapeutist. It is absurd to gaze into 
mid-air for the crowning spire before the foundation-stones of the temple 
are laid. 
To deny, as has been done, the existence or value of medicines of this 
class because we cannot tell why mercury relieves syphilis or why iodide of 
potassium cures rheumatism, is as absurd as to deny the existence of the 
syphilitic and the rheumatic dyscrasia because we do not know their ultimate 
408 ALTERATIVES. 
409 
nature, net us be content, until more light comes, to hold fast to the clinical 
facts, each believing for himself, if he choose, that alteratives alter nutrition 
by affecting the functions of the blood-making organs, or, if he prefer, that 
they act by impressing the cells of the body directly; or, what is even more 
philosophical, each holding his mind free from belief, an unoccupied tablet 
on which the truth may readily be inscribed when it is discovered. 
ACIDUM ARSENIOSUM-ARSENIOUS ACID. U.S. 
White Arsenic, or Arsenic, as first prepared by sublimation from the ores, 
is in transparent masses, but on keeping becomes milk-white externally. It 
is soluble in water, has a vitreous fracture, is odorless, of a faint sweetish 
taste, and volatilizes without fusion " at a temperature not exceeding 400° 
F." When it is put upon red-hot iron it emits a garlicky odor, owing to 
its being first reduced to a metallic state and then volatilized. 
Physiological Action.-When applied to any part in a concentrated 
form, arsenic is a very active escharotic, and even when very much diluted it 
is a severe irritant. When a single dose of just sufficient size to be felt is 
ingested, colicky pains, diarrhoea, and perhaps nausea result. After a very 
large toxic dose, in from one-quarter to three-quarters of an hour an intense 
burning pain is felt in the oesophagus and stomach, soon spreading to the 
whole belly, and often accompanied by a sense of constriction at the throat, 
and an acrid, metallic taste. In a very short time violent vomiting and 
purging come on. The matters rejected are at first mucous, and variously 
colored by the contents of the primae vise ; but they soon become bilious, 
and often yellowish or greenish, and finally serous, with mucoid flakes and 
a greater or less amount of blood. As the case progresses, the symptoms 
mentioned increase in intensity, and to them are soon added others of dif- 
ferent nature. The thirst is excessive; the urine is suppressed; the ex- 
tremities are icy cold; the pulse is small, feeble, and frequent; the rapid 
and labored respiration is very much embarrassed and painful from the 
abdominal tenderness; the surface is dark and cyanosed; violent cramps 
add their torture; exhaustion deepens into collapse; convulsions or coma 
ensue, and death occurs in from five to twenty hours. 
In another set of cases, when the dose has been smaller or the subject less 
susceptible, the termination is not reached so soon. After symptoms similar 
to but less violent than those just described have lasted from a few hours 
to one or two days, a remission occurs; the purging and vomiting grow less 
frequent, or perhaps intermit; even the abdominal tenderness may in great 
measure disappear, but the persistent thirst, cold extremities, and suppressed 
urine show that the danger is not overpast, and after a time the case puts on 
a more alarming aspect. The belly becomes very tumid, the abdominal pain 
more severe, difficulty of respiration develops itself, the face is swollen and 
cyanosed, nervous symptoms, tremblings, cramps, and convulsions appear, and 
finally an icy coldness pervades the frame, and death occurs in from two to 410 
SYSTEMIC REMEDIES. 
six days. The mind is generally clear to the last. If the patient survive 
long enough, an eruption very frequently appears, sometimes as early as the 
second day, sometimes not until the fifth. Its character is various: thus, it 
may be petechial, urticaria-like, papular, vesicular, or pustular (Histoire des 
Eruptions arsenicales, par Dr. Imbert-Gourbeyre, Monit. des Hop it., 1857). 
Such are the ordinary symptoms of arsenical poisoning; but anomalous 
cases are not rare. Sometimes profound and rapid collapse, without ab- 
dominal pain, has occurred ; in other cases heavy sleep, deepening into 
coma, is said to have been the most marked symptom. Sometimes arsenical 
poisoning very closely resembles cholera, and it has been mistaken for it not 
only in life, but also after death, on the post-mortem table ( Virchow's Archiv, 
1870, Bd. 1. p. 456). 
When arsenical poisoning is not fatal, the convalescence is apt to be 
slow, and interrupted by various disorders. Prominent among these are 
affections of the alimentary canal, due to the structural changes produced by 
the poison. Nervous symptoms are common, and may affect the motor or 
sensory sphere separately or combined. In some cases they have developed 
very suddenly (W. Y. Med. Journ., 1850, 177). I have seen anaesthesia of 
the feet as the only symptom; motor paralysis may exist alone, but it is 
usually accompanied by anaesthesia, hyperaesthesia, loss of temperature 
sense, great feeling of coldness, or other disorder of sensation, and not 
rarely excessive pain, which may be aching or lancinating. Occasionally 
there are severe cramps. The normal sensibility is usually regained before 
normal motility. Of one hundred cases of arsenical paralysis collected 
by Imbert-Gourbeyre (Des Suites de T Empoisonnement Arsenicaie, Paris, 
1881), in more than half all the extremities were affected ; about one- 
fourth part were paraplegic; in the remainder there was hemiplegia or local 
palsies. Most frequently the paralysis was not pronounced above the elbow 
or knee. The lamed muscles are usually sensitive to pressure (C. Gerhard, 
Sitzunsb. Physilc. Med. Gesellsch. Wurzburg, April, 1882),* and undergo 
rapid atrophy, losing very early their electro-muscular contractility, or pre- 
senting the " reactions of degeneration." This poisoning resembles very 
closely sub-acute poliomyelitis, but differs in the frequency of pain and 
other sensory disturbances, and in the tendency towards more or less com- 
plete recovery (only three out of one hundred failing, Imbert-Gourbeyre). 
When sensory disturbance is absent the resemblance is very close. The 
lesion is probably spinal, and it is scarcely to be doubted that the motor 
cells of the cord are diseased, for Dr. N. Popow found in dogs killed in a 
few hours by a dose of arsenic, the spinal cord inflamed ; after slower poison- 
* Consult also Renner, Ueber Ein Fall von Chron. Arsenvergift. Wurzburg, 1876; W. 
P. McIntosh, N. Y. Med. Record, Feb. 1885, 145; Seguin, Journ. Nerv. and Ment. Dis- 
eases, Oct. 1882, vii. 665; C. K. Mills, Trans. College of Physicians of Philadelphia, 3d 
series, vi.; Archives de Physiolog. Norm, et Path., 1884, iv. ALTERATIVES. 
411 
ing there were masses of " exudate" in the neighborhood of the blood-vessels, 
and in very protracted cases the walls of the spinal arterioles were found 
to be thickened, and the large cells of the gray matter profoundly altered. 
The protoplasm first became opaque and granular; the nuclei grew fainter 
and fainter, and finally disappeared ; vacuoles appeared, and encroached 
more and more on the shrunken body of the cell, which finally disappeared 
( Virchow's Archiv, Bd. xciii.). 
The most obvious lesions found after death from acute poisoning by arsenic 
are in the stomach and bowels, even when the poison has found entrance 
through other channels into the system. The gastric mucous membrane is 
usually swollen, maculated with patches of a deep-crimson or, more commonly, 
brownish-red color, and is often softened and covered with a diphtheritic 
exudation, but is rarely ulcerated. Perforation is exceedingly uncommon. 
The mucous membrane of the upper part of the small intestine, and some- 
times of the whole of it, is in a condition similar to that of the stomach. 
In some cases the lesions very closely resemble those of cholera, as was first 
pointed out by Prof. Virchow ( Virchow's Archiv, Bd. xlvii.). In the micro- 
scopic examination of a cadaver whose bowels were filled with a " rice-water" 
fluid, that observer found in the intestinal contents epithelial flakes, and the 
fungus described by Klobs as peculiar to, and, indeed, the cause of, cholera. 
The epithelial cells of the mucous membrane were choked with granules, and 
many of them in an advanced stage of fatty degeneration; the interstitial 
tissue was full of large round granulated cells; the solitary glands and Peyer's 
patches were very much swollen. These facts have been confirmed by Dr. 
Hoffmann ( Virchow's Archiv, Bd. 1. p. 456). The gastro-intestinal lesions 
produced by arsenic are not due solely or largely to its immediate local 
effect, since they occur equally when the animal is killed by injection of the 
poison into a vein. The local influence of the drug is, however, probably 
not altogether lost, since Unterberger (loc. cit.') found that a larger dose was 
required to kill an animal by venous injection than by exhibition by the 
mouth. 
There is usually in arsenical poisoning a wide-spread granular or fatty 
degeneration of the tissues. M. Karajau (Tardieu, Sur I' Empoisonne- 
nient, p. 335) reports a case, which had been mistaken during life for acute 
atrophy of the liver; Fr. Grohl and Fr. Mosier ( Virchow's Archiv, Bd. 
xxxiv. p. 213) one in which they found fatty or granular metamorphosis 
of the glands and epithelium of the stomach and intestines, of the cardiac 
muscle, of the diaphragm, of the cortical portions of the kidney, and, to a 
slight extent, of some of the voluntary muscles ; Dr. I. I. Pinkham (Boston 
Med. and Surg. Journ., 1878, 358) one in which the liver, kidneys, and 
epithelial lining of the peptic glands were almost destroyed; similar lesions 
have also been reported by M. V. Cornil (Soc. Med. de Hop. de Paris, xvii. 
379) and by Dr. Fereol (Ibid., p. 321). 412 
SYSTEMIC REMEDIES. 
The absolute demonstration of the degeneration produced by arsenic was, 
however, made by Dr. Saikowsky ( Virchow's Archiv, Bd. xxxiv. p. 77), of 
Moscow, who was also the first to point it out. In his numerous experiments 
upon rabbits he found that when the animals were poisoned by a small dose 
of arsenic, so as to live from three to six days, the liver was much enlarged 
and very fatty,-indeed, contained more fat than the " phosphorus-liver." 
On microscopical examination, the cells on the exterior of each acinus were 
seen to be natural; those in the centre in the most advanced stages of de- 
generation. The kidneys were similarly affected,-their tubes choked up 
with fat-globules, their epithelium almost completely destroyed. The mus- 
cles of the heart and diaphragm were almost equally compromised. Dr. 
Saikowsky also noted that early in both arsenical and antimonial poisoning 
the glycogenic function of the liver is abolished.* In frogs poisoned with 
arsenic the epidermis peels off from the derm, as first noted by Binger and 
Murrell, and Emily A. Nunn has found that the influence of the poison is 
first manifested in the under portion of the epidermis, the degeneration pro- 
gressing from the derm outwards (Journal of Physiology, i. 247). 
As arsenic is never used in medicine for an acute effect, the chief interest 
to the therapeutist centres around its physiological action when given in 
small doses; yet it seems necessary here to take cognizance of the physio- 
logical action of large amounts of the poison.f 
Nervous and Muscular System.-The symptoms of arsenical poisoning in 
man show that the drug has a marked influence upon the nervous system. 
Dr. W. Sklarek, of Berlin (Reichert's Archiv, 1866), has found that the 
arseniates of potassium and of sodium had exactly the same effect as the 
arsenic itself upon frogs. Within five minutes after the injection of one- 
fourth to two c.c. of a two per cent, solution of arsenious acid, or of the 
arseniates of sodium or potassium, all voluntary movement ceased in the 
frog; although when the animal was laid upon his back he struggled very 
actively to recover his position. At this time, however, all sensibility to 
chemical and mechanical irritants was lost, cutting, burning, or corroding 
failing to elicit any response. That the motor system was not at fault was 
shown by the active movements when the frog was placed upon his back, as 
well as by the results of electrical stimulation of the nerves. The paralysis or 
quietness must have been due to an abolition of sensation. That this was spinal, 
and not peripheral, was proven by the circumstance that tying the iliac artery 
upon one side before the administration of the poison had no effect in pre- 
* For a spectroscopic study of the effect of arsenic upon the coloring-matter of the blood, 
see Centralblatt, 1868, p. 609. It is interesting here to note that arsenic, antimony, phos- 
phorus, and ammonia act very similarly, if not identically, upon the blood. 
f The theory of Binz and Schulz, that arsenious oxygen acts by taking from protoplasm 
oxygen, so as to be converted into arsenious acid, and afterwards yields up this oxygen to 
oxidize the protoplasm, and then repeats the process, seems to me so illy supported, that 
the reader in regard to it is simply referred to the Arch. f. Exper. Path, und Pharm., xi. 
213; xiv. 249; also British Med. Journ., 1882, ii. 1135. ALTERATIVES. 
413 
serving sensibility in the protected leg. The only explanation of the struggles 
of the frog to recover his position after poisoning is to be found in his having 
been influenced through vision, or else in the theory that the muscular sense 
is distinct from that of common sensibility and is not affected by arsenic. 
The researches of Ringer and Murrell (Journal of Physiology, i., p. 217) 
upon frogs have given very different results from those just described, they 
finding that the symptoms of poisoning came only after the lapse of somo 
hours, and that paralysis of voluntary motion preceded that of sensation 
and reflex action. Drs. Ringer and Murrell suggest that these differences 
of result depend upon the time of year at which the frog was experimented 
on. There is accord between the experimenters in regard to the cause of 
the final paralysis, all finding that it is produced by a direct action of the 
arsenic upon the nerve-centres. Ringer and Murrell have also shown, how- 
ever, that the nerves and muscles do not entirely escape the poison, which 
seems to be more or less toxic to all highly-organized tissues. 
Circulation.-Upon the heart of the frog Dr. Sklarek found that arsenic 
exerts a very powerful influence, lessening the rapidity and force of the beat, 
and finally arresting the contraction. That this cardiac action of arsenic is 
direct was shown by the exact similarity of the phenomena produced by the 
application of arsenic to the heart cut out of the body. The arrest was 
never instantaneous, but always preceded by slowing of the beat; and after 
movement had ceased, galvanic or mechanical irritation caused imperfect sys- 
tolic movements. In no case did Dr. Sklarek observe any signs of functional 
excitement preceding the development of the cardiac or motor paralysis. 
Dr. Sklarek also found that in arsenical poisoning in the cat there is 
great reduction in the force and frequency of the heart's pulsations. Re- 
cently the effect of the poison upon the circulation of mammals has been 
elaborately investigated by Dr. S. Unterberger (Archiv fur Exper. Path, 
und Pharm., Bd. ii.). Like Cunza, he found that in arsenical poisoning the 
heart persists in its movements after the cessation of respiration. Imme- 
diately after an injection of the poison in cats and dogs, both the pulse-rate 
and the arterial pressure fall enormously, and if the dose has been sufficient 
they never recover themselves. • Dr. Unterberger did not make out the 
cause of the fall of the pulse-rate, but the experiments of Sklarek, already 
mentioned, indicate that it is due to a direct action on the heart. 
The depression of the arterial pressure was shown by Unterberger to be 
largely due to vaso-motor paralysis, for in an animal under the influence of 
the poison neither galvanization of a sensory nerve nor of the vaso-motor 
centre in the upper cord had any influence upon the force of the blood- 
current. Galvanization of the splanchnics had no effect upon the arterial 
pressure,-apparently showing that the vaso-motor palsy was peripheral; but 
Dr. Unterberger found, to his astonishment, that stimulation of the cervical 
sympathetics had the usual effect upon the vessels of the rabbit's ear. Sup- 
posing that these observations be correct, there are only two seemingly pos- 414 
SYSTEMIC REMEDIES. 
sible methods of reconciling them : either the drug acts upon the peripheral 
vaso-motor nerves in the abdomen, and not upon the same nerves in the 
neck, or else there is during arsenical poisoning such depression of the power 
of the cardiac muscle that narrowing of the blood-path does not have the 
usual effect. Dr. Unterberger found that compression of the abdominal 
aorta was followed by a great rise of pressure, and therefore believes that the 
heart in arsenical poisoning has not lost its power. Some complicated trans- 
fusion experiments which he made indicated differently, so that whilst his 
proposition that arsenic paralyzes the peripheral vaso-motor nerves of the 
abdomen and not those of the head may be considered probable, it certainly 
is not proven. It would be a very easy matter to decide the question by 
dividing the spine in a poisoned animal: if the reduction of the arterial 
pressure be really due to an abdominal vaso-motor paresis, section of the 
spine should have but little effect on it. There appears to be no doubt 
that the cardiac muscle is more or less weakened by the poison. 
Action of Small Doses.-Minute quantities of arsenic may be given for a 
long time without producing any perceptible effect, unless it be a sharpening 
of the appetite, due to the local action on the stomach. When the dose is 
increased, more active manifestations of gastric irritation may appear, such as 
loss of appetite, nausea, abdominal pain or uneasiness, diarrhoea, and perhaps 
sympathetic headache. By the use of frequent small doses these symptoms 
may be generally avoided, and what may be termed the constitutional action 
of arsenic be obtained. The first sign of this is generally a puffiness about 
the eyes, at first visible only in the early mornings, but soon increasing 
into decided oedema, which after a time may lose its local character and the 
patient be involved in general anasarca. This anasarca, as was, I believe, 
first pointed outby Dr. S. Weir Mitchell (New York Medical Journal, vol. 
i.), may or may not be preceded or accompanied by the presence of albumen 
and of tube-casts in the urine. Beyond the production of the symptoms 
spoken of, arsenic should never be employed in medicine. 
Unfortunately, owing to the frequent use of the metal in the arts, chronic 
poisoning with it is by no means uncommon. 
Although the symptoms vary a good deal and are often obscure, yet in 
almost every case they are such as should at once awaken suspicion. They 
have been summed up by Prof. Taylor as follows: 11 Dryness and irritation 
of the throat, irritation of the mucous membranes of the eyes and nostrils, 
dry cough, languor, headache, loss of appetite, nausea, colicky pains, numb- 
ness, cramp, irritability of the bowels, attended with mucous discharges, 
great prostration of strength, a feverish condition, and wasting of the body." 
It is very evident that the symptoms of irritation of the respiratory mucous 
membrane are largely, if not entirely, due to the local action of the arsenic, 
since the poison finds access to the system through the respiratory organs. 
The constitutional troubles most uniformly present in these cases are weak- 
ness and emaciation, often accompanied by more decided nervous manifesta- ALTERATIVES. 
415 
tions than the picture drawn by Dr. Taylor would suggest: great depression 
of spirits and irritability of disposition, sleeplessness, giddiness, headache 
with a feeling of constriction in the forehead, numbness in the extremities, 
muscular tremors or stiffness, vertigo, and even convulsions and paralysis, 
are very common. Indeed, in some cases these nervous symptoms constitute 
the chief if not the sole features. (See Deutsches Klinik, 1874, No. 31 ; also 
Schmidt's Jahrbucher, Bd. clxv. p. 233.) 
Dr. Kirchgiisser, as the result of very large experience, asserts that the 
most characteristic phenomena of chronic arsenicism are a brown pigment- 
deposit in the skin of the face, inflammatory affection of the eyelids, and 
the disturbances of sensibility and motion, which affect most frequently the 
lower extremities, together with scalding during urination. Out of eight 
cases, he found arsenic in the urine in six (Berlin. Centralblatt, p. 574, 
1868). 
Seemingly opposed to this every-day experience is the asserted " arsenic- 
eating" of the peasants of Styria. It is stated by some that the arsenic is 
taken by the young girls to beautify their complexion and to enhance their 
charms ; by others, that the object sought to be attained is protection against 
arsenical fumes by those engaged in the manufacture of the metal, and the 
increase of the powers of endurance and of the "wind" in huntsmen and 
others who do a great deal of mountain-climbing. The habit is said not to 
be detrimental to life. Indeed, the toxiphagi are asserted to be remarkably 
long-lived people. In regard to the dose, three grains are said to be taken 
as a commencement, and to be increased to thirty! Originally affirmed by 
Vogt (Lehrbuch der Pharmacodynamik, dritte Aufl., Bd. i.), the existence 
of this practice has been especially asserted by Tschudi (quoted by Prof. 
Stills), and more recently by Chs. Heisch (Pharmaceutical Journal and 
Transactions, vol. i., 2d series, 1859 and 1860, p. 556). 
Notwithstanding the assertion of Heisch, the existence of the practice was 
not credited (see British and Foreign Med.-Chir. Review, vol. xxix. p. 114), 
but in 1864 Dr. C. Maclagan (Edin. Med. Journ., 1864, p. 203) visited 
Styria, saw several arsenic-eaters, administered to one of them five grains of 
the substance at a dose without ill effects, and found the poison in the urine. 
He also analyzed the material which the men habitually took, and found it 
to be arsenic. 
An unsigned (editorial ?) communication in the Edinburgh Medical and 
Surgical Joxirnal (1871, vol. xvi. p. 569) further asserts that a royal com- 
mission has examined into the subject, and that their report indicates that tho 
practice exists, but that it has been grossly exaggerated. They affirm that 
arsenic-eating is practiced chiefly in the northern and northwestern parts of 
Styria; that the white arsenic is preferred, the yellow commercial article 
being sometimes taken, the native red arsenic, or orpiment, very rarely; that 
the commencing dose is about 0.22 grain, which is very slowly increased 
to 0.62 grain avoirdupois. The " ratsbane-eaters" almost all belong to the 416 
SYSTEMIC REMEDIES. 
lower classes, and are said to be generally strong and healthy persons, 
courageous, pugnacious, and of strong sexual disposition. These statements 
are in accord with those of Dr. Maclagan, and must, I think, be accepted 
as true. Dr. Maclagan also says that in one case of suspected murder in 
Styria the prisoner was acquitted on the ground that the deceased was an 
arsenic-eater. 
Of especial interest in connection with arsenic-eating is the verity or non 
verity of the asserted effect of the drug upon tissue-changes. Schmidt and 
Stiirzwage believe that it has such action in a very marked degree, because 
in their experiments upon rabbits they found a decided diminution in the 
excretion of carbonic acid and of urea during the use of minute doses of 
the poison. Fokker (Schmidt's Jahrb., clviii. 13), however, was unable to 
perceive in three experiments that daily doses of from .15 to .075 grain of 
arsenic to a dog had any effect upon the elimination of urea, and Kossell 
and Gaethgens, in two experiments, have noted a very decided increase of 
the elimination of urea produced by toxic doses of arsenic in the dog (Arch. 
Exper. Pathol, et Pharm., Bd. v. 133, also Central!). Med. Wissen., 1875, 
530; 1876, 833). At present the evidence is not sufficient to warrant a 
positive opinion, but appears to indicate increased nitrogenous elimination as 
the result of repeated small toxic doses of arsenic. 
When arsenic is administered in small repeated doses, it may act as a 
tonic, by slightly irritating the stomach and thereby provoking an appetite • 
and in certain cachexias it does increase the muscular strength and the gen- 
eral vigor. The history of arsenic-eating indicates that the drug has some 
positive tonic influence over nutrition, and although the amelioration, the 
increase of strength and blood, by its use in cachexias may be due to an 
indirect action of the drug,-to a removal or overcoming of the morbific 
agent on the disease, and a consequent allowing of the recuperative powers 
of the system to assert themselves,-there is much reason for believing 
that it acts largely as a direct stimulant to nutrition. All that we know of 
the effect of arsenic upon the system throws only enough light upon its 
therapeutic action to enable us to class it as an alterative,-a modifier and 
often an improver of nutrition. 
Elimination.-There is abundant proof of the absorption, and no less of 
the elimination, of arsenic. Indeed, the latter appears to take place with 
exceptional rapidity. Thus, MM. Flandin and Danger (Husemann, Toxi- 
cologie, p. 823) failed, three days after the last dose, to detect it in the 
bodies of animals to which fifteen grains had been given daily; and in a 
child killed in two days by an arsenical pigment, none of the metal could be 
found in the body (British and Foreign Med.-Chir. Review, 1870, vol. xlv.). 
In the great majority of instances, however, there is no trouble in finding 
arsenic in the bodies of those poisoned by it, and Steinhauser reports a case 
in which it was found in the remnants of a corpse that had been buried for 
twenty-two years (Berlin. Centralblatt, 1868, p. 160). The principal chan- ALTERATIVES. 
417 
nel of escape is the kidneys; but elimination also takes place through the 
mucous membrane of the alimentary canal, through the skin, and even in 
the saliva and the tears. Unterberger has detected it in the alimentary canal 
of animals poisoned by injection into the vein. M. Chatin has found it in 
the serosity of a blister, Bergeron and Lemaitre in the sweat (British and 
Foreign Med.-Chir. Review, vol. xlviii., 1871), and Taylor (Guy's Hospital 
Reports, vol. x., 3d series, 1864, p. 227) in the contents of the stomach of 
a child poisoned by its application to the scalp.* 
Especially in connection with the therapeutic use of arsenic in malarial 
fever, some interest attaches to the effect of the drug upon the lower organ- 
isms and fermentations. The subject has been partially investigated by 
Johannsohn (Arch, fur Exper. Path.und Therap., Bd. ii. p. 106), who con- 
cludes that the poison produces a peculiar degeneration of the yeast-plant, but 
actually increases the production of bacteria in yeast. When small amounts 
of arsenic were added to yeast and syrup, the fermentative process was at 
first very much checked, but not absolutely prevented. After a time the 
process went on faster again. In urine Johannsohn found that the poison 
hindered the production of Micrococcus urea, but actually favored that of 
other fungi. In the lactic fermentation the growth of the peculiar fungi 
was checked, whilst that of Mucor mucedo was favored. The fact that 
arsenic acts slowly upon the yeast has been confirmed by Schaefer and 
Boehm (Arbeit en Physiol. Inst. Wilrzburger Ilochschule, 1873, p. 173). 
Both Johannsohn and Schaefer and Boehm have found that arsenic exerts 
no influence upon non-organized ferments, either vegetable or animal, such 
as amygdalin, pepsin, pancreatin, etc. 
Therapeutics.-Our knowledge of the value of arsenic in disease rests 
solely upon clinical observation, wdiich has abundantly established its use 
in certain very diverse affections. Chief among these is chronic malarial 
dyscrasia. No one would at present think of employing it in acute re- 
mittent fever, or even in acute intermittent, unless under very peculiar 
circumstances. It is in those cases which have resisted quinia, in which the 
paroxysms have become irregular, returning at long or irregular intervals, 
and in which the anaemia and the general nutritive disturbance are even 
more prominent than the febrile disorder, that arsenic is especially valuable. 
In these cases it should be administered with sufficient boldness, very gen- 
erally in conjunction with iron. Prof. George B. Wood recommends that 
the first doses should be as large as the system will endure, so as to make a 
decided impression at once. When the ague-paroxysms are frequent, it is 
perhaps well to employ this plan; but when it is rather the cachexia than the 
active disorder that is to be combated, it is preferable to commence with 
* Various observers have endeavored to determine which tissues contain most arsenic 
after death from the poison, with varying results. Consult Arch. d. Physiol. Norm. et 
Path., 1875, ii. 653; Chern. Centrallblatt, 1879, 602; Arch. Exper. Path. u. Pharm., xiii. 
257; The Chemist and Druggist, xxi., 1879, 381; Comptes-Eendus, 1879, Ixxxviii. 1212. 418 
SYSTEMIC REMEDIES. 
small doses and to increase them until some constitutional symptom is pro- 
duced. In ordinary intermittents, after the paroxysms have been broken up 
by quinine it is very well to place the patient upon a preparation of arsenic, 
iron, and quinine, as a prophylactic against their return. When, in ordinary 
intermittent fever, for any cause quinia cannot be administered, arsenic may 
be employed. In these cases, as already intimated, the first doses should be 
large, so as to make an immediate impression; from five to ten minims of 
Fowler's solution, properly diluted, may be given every two or three hours 
until some decided symptom is produced. When the stomach refuses the 
remedy, it has been recommended by Boudin to give it by the rectum, which 
he affirms will often bear even a grain of the acid. Not more than a third 
of this amount should, however, be used as a commencing dose. In malarial 
intermittent neuralgia, arsenic may be employed as a very useful adjuvant 
to the antiperiodic alkaloids. Dr. K. M. Downie calls attention (Indian 
Medical Journal, 1872) to the value of arsenic as a prophylactic against 
malaria. His trials were not numerous enough to be conclusive, but so far 
as they go they indicate that arsenic is even superior to quinia. Recently 
attention has been drawn to the great value of arsenic in lymphatic tumors, 
especially in the affection known as malignant lymphoma ( Wien. Med. Woch., 
1871; Arch. Klin. Chir., xviii.; Stricker's Jahr., 1877). Advantage is said 
to be sometimes derived from injections of the remedy into the growth. 
Having had very little experience myself in the use of arsenic in skin 
disease, Dr. Louis A. Duhring, Professor of Dermatology in the University 
Hospital, has kindly furnished me with the following: 
As is well known, arsenic has long been used and held in high esteem as a 
remedy in the treatment of cutaneous diseases. It is proper to state, how- 
ever, that at the present day there exists a great diversity of opinion con- 
cerning its actual value as a therapeutic agent against this class of diseases. 
Certain dermatologists claim to derive marked good from its employment in 
quite a large number of affections, while others of equal experience are in- 
clined to place but little reliance upon its curative powers. Without entering 
at all into this discussion, it may be unhesitatingly said that it is a remedy 
of real worth and service in several very important cutaneous diseases, and 
that it may be combined with other remedies and used with good result in 
certain other diseases of the skin, acting in these cases as a general tonic. 
It is the dermatologist's most valuable internal remedy in a large number 
of cases. But it must be skilfully employed, and the cases, moreover, must 
be selected if we would expect satisfactory results. To say that arsenic is 
of use in diseases of the skin viewed collectively, is an assertion so vague as 
to be of no practical value. Not only is it necessary to specify the disease, 
but it is even important to designate the particular stage if we would 
employ the remedy successfully. 
Arsenic exerts its influence chiefly upon the epidermis. Hence it is 
found that diseases affecting the more superficial strata of the skin are most ALTERA TIVES. 
419 
amenable to its influence. It possesses little or no effect upon the diseases 
which have their seat in the deeper structures. 
Its action upon the skin is slow, weeks and months being requisite to 
produce the desired result. Improvement once obtained, it is usually ex- 
pedient to allow the patient to continue the use of the remedy for some 
weeks after all symptoms of the disease have disappeared. 
Arsenic should never be employed in the acute, inflammatory stage of 
any disease of the skin. It should not be prescribed when there is great 
heat, burning, intense itching, or rapid cell-change. It not only is of no 
benefit at this stage, but is in most cases positively injurious, tending to 
augment the activity of the morbid process. It stimulates the rete into 
action when rest is most needed. Its administration should be withheld 
until the acute symptoms have subsided. 
Of many of the dissimilar diseases in which arsenic has been employed, 
both with and without reputed success, no mention need here be made. It 
will suffice for the purpose in hand to refer to those affections which it is 
generally conceded are more or less favorably influenced. It is unquestion- 
ably of great value in psoriasis. But it is not of benefit in every case, nor 
should it be prescribed for all forms, or in all stages, of this disease. When 
the process is very active, attended with intense hypersemia, arsenic, as a 
rule, only aggravates the inflammatory condition. The more active the cell- 
proliferation, the less probability is there of its being of benefit. On the other 
hand, the more indolent and sluggish the disease, the greater the chances for 
improvement. It should be withheld until the process has fairly settled in 
its career. In cases of psoriasis of long standing, which manifest little dis- 
position to undergo change, it is particularly useful. 
It is of undoubted service in certain varieties of eczema, especially in the 
chronic squamous and papular varieties; also where the elementary lesions 
are but ill defined ; and, finally, where the disease is unusually superficially 
seated, and where there is only slight infiltration of the skin. Certain forms 
of persistent localized papular and vesicular eczema, having a marked tend- 
ency to recur, as, for example, of the fingers, also often yield readily to 
arsenic. It should, of course, be avoided in acute eczema. 
Pemphigus is decidedly influenced, and often permanently relieved, by 
its use. It is our most reliable remedy for this disease. Here, as in other 
conditions, the older the process the more likely are we to obtain favorable 
results. In lichen planus and in lichen ruber it is employed with great 
advantage. Prescribed in minute doses, as a tonic, it may sometimes be 
given with benefit in chronic urticaria. 
It is likewise of value in certain varieties of acne. Before prescribing 
it, however, the digestive tract should be carefully looked into, and if dis- 
ordered in the least degree, it should first be rectified. The same remark 
holds good for its use in all diseases of the skin. Taken for a considerable 
time, several months, it often exerts a marked influence upon the small 420 
SYSTEMIC REMEDIES. 
pustular and papular forms of acne, and also in those cases where there is 
an accompanying erythematous rosacea. 
The two preparations of arsenic which it is, as a rule, advisable to employ 
are arsenious acid and liquor potassii arsenitis. The latter will be found the 
more desirable form for ordinary use. Arsenious acid is given in pill form, 
with sugar of milk, or combined with a grain each of black pepper and 
powdered liquorice, constituting the compound known as the Asiatic pill, 
which may be prescribed in various strengths, suitable to the case. The 
liquor potassii arsenitis is best given with water or combined with a bitter 
tincture or infusion; it is also well borne combined with the wine of iron. 
The mode of ordering the solution pure, and directing so many drops to be 
taken at each dose, is, in my opinion, objectionable for many reasons, to 
which it is unnecessary to refer. The average dose suitable to the majority 
of individuals is three minims. Smaller doses, one or two minims thrice 
daily, are often demanded, and in many cases are found to be much more 
beneficial than larger doses. On the other hand, four, six, or eight minims 
will not infrequently be tolerated, and occasionally even larger doses; but 
out of a number of patients it will be found that but few can take more 
than three or four minims for any length of time without derangement of 
the system. Arsenic should always be taken either with the food or directly 
afterwards. 
In certain nervous affections arsenic acts very favorably, in some unknown 
way. It is especially in chorea that it has acquired a deserved reputation. 
In this affection iron and other tonics are generally indicated, and may ba 
given consentaneously with the arsenic. It is best, however, to administer 
the latter separately, as the dose must be steadily increased until oedema or 
other manifestations betray its decided action. Arsenic has also been recom- 
mended in whooping-cough, but is at present very rarely, if ever, used. In 
ordinary non-malarial neuralgia it may be tried, and is sometimes serviceable; 
in simple gastralgia, or gastric neuralgia, it has been especially recommended. 
Arsenic is employee sometimes with advantage in asthma, and may be 
given by the stomach, but is perhaps more generally useful when inhaled. 
The following formula has been long employed in the Philadelphia Hospital. 
The prepared paper is rolled into cigarettes, one of which is smoked two or 
three times a day, until relief is afforded or some giddiness produced: 
Charta Arsenicalis Composita (Compound Arsenical Paper}. R- 
Belladonnas fol., gr. xcvi; hyoscyami fol., stramonii fol., aa gr. xlviii; extr. 
opii> gr- iv; tabaci, gr. Ixxx; aquae, Oj; M., ft. sol. et add. potas. nit., gr. 
clx; potas. arsenit., gr. cccxx. Saturate bibulous paper and dry for use. 
Arsenic is of value in those forms of chronic rheumatism in which iodide 
of potassium is commonly employed. It is often advantageous to alternate, 
administering one of these alteratives for three or four weeks, and then 
the other for the same length of time. In rheumatic gout, or rheumatoid 
arthritis, it has been highly extolled, but in my experience has furnished ALTERATIVES. 
421 
no better results than other remedies. It should, however, always be tried 
in this most obstinate disorder. 
There has been quite a number of cases reported in which an outbreak of 
Herpes Zoster has occurred during the long continued use of arsenic, and 
it does seem as though the arsenic was the cause of the eruption. (For 
paper, giving cases and bibliography, by 0. Juliusburger, see Vierteljahr. f. 
Dermatol. Wien., xi. 97.) 
Toxicology.-Sufficient has already been said concerning the symptoms 
of both acute and chronic arsenical poisoning. No mention has, however, 
been made of the peculiar local affections produced in the hands of those 
artisans who work with the preparations of arsenic. Ulcers about the roots 
of the nails are generally the first trouble in these cases, but after a time 
eczematous or papular eruptions appear, and even subdermal erysipelatous 
inflammation is developed. Very commonly to these local symptoms are 
added, after a time, the usual phenomena of chronic arsenical poisoning. 
In the arts, preparations of arsenic are largely used as pigments ;* and, 
excepting the manufacturers of arsenic, it is almost exclusively those who 
are accidentally exposed to the deleterious influence of these pigments who 
suffer from chronic arsenical poisoning. The poisonous colors are all of 
some shade of green, and, being very cheap, and remarkable for their purity 
of tone and their permanence under exposure to light, are much used by 
paper-makers. Scheele's green-the arsenite of copper, contains fifty-five 
per cent., by weight, of arsenious acid; and Schweinfurt green-the aceto- 
arsenite-fifty-eight per cent. Paper coated with them has been largely 
used not only as hangings, but even as wrappings for confectionery and 
other edibles. Sweetmeats have been colored with them ; pasteboard boxes, 
artificial flowers, tarlatan dresses, shelves in groceries, walls of dwellings, 
toys of children, and various other articles, have been made the vehicles 
of death, so that hundreds of cases of poisoning more or less severe have 
resulted from the use of these pigments, which ought to be banished by the 
strictest laws. In most cases it is probably the minute dust, which is sepa- 
rated mechanically and diffused through the room, that produces the fatal 
result; but poisoning has occurred when the arsenical paper was covered over 
with another paper. Dr. Hambers has made elaborate chemical researches 
upon the air of these apartments, and believes that he has demonstrated that 
some arsenic escapes in the form of arseniuretted hydrogen. Not rarely the 
poison has been taken directly into the stomach, especially by children. 
The time at which death occurs as well as the fatal dose of arsenic varies 
very much. Death usually results in from eighteen hours to three days; but 
Taylor reports a case in which it occurred with tetanic Symptoms in twenty 
* For an excellent report upon this subject, see Report of the State Board of Health of 
Massachusetts, Jan. 1872, where it is stated that from five hundred to seven hundred tons 
of arsenical pigment were manufactured in 1862 in England alone. Fatal chronic arseni- 
cal poisoning from working in aniline dyes is reported in Stricker's Med. Jahrb., 1877, 501 422 
SYSTEMIC REMEDIES. 
minutes, and life has been protracted until the sixteenth or even the twentieth 
day. Dr. W. C. Jackson (Amer. Journ. of the Med. Sciences, July, 1858) 
reports a case of recovery, under the early use of emetics, after an estimated 
dose of two ounces had been taken; and Dr. E. D. Mackenzie gives an 
account (Indian Medical Gazette, 1872) of a man who swallowed an unknown 
quantity of arsenic in lumps, and received no treatment for sixteen hours, 
yet recovered after passing per anum one hundred and five grains of arsenic 
in two masses. On the other hand, death has resulted from the use of very 
small amounts. Dr. Taylor asserts that the smallest fatal dose hitherto re- 
corded is two grains. Dr. Lach^se (Ann. d' Ilyg. et de Med. Legale, 1834, 
le ser., t. xvii.) affirms that six milligrammes (0.09 gr.) will produce decided 
but not serious symptoms, and that from one to three centigrammes (0.154 
to 0.462 gr.) are poisonous, and from five to ten centigrammes (0.77 to 1.54 
gr.) fatal. Tardieu places the minimum lethal dose at from ten to fifteen 
centigrammes (1.54 to 2.31 gr.). The escapes from death after the inges- 
tion of large amounts of arsenic have, without doubt, depended upon its 
being, as in the cases above narrated, in an insoluble form. The effects of 
the arsenical solutions, such as Fowler's, are more rapid and severe than those 
of the solid drug. 
As arsenic in large doses generally induces vomiting, it is very rarely neces- 
sary in poisoning to evacuate the stomach by artificial means. If free emesis, 
however, have not occurred, a prompt emetic, such as mustard or sulphate of 
zinc, should be at once exhibited, and very generally the stomach should be 
well washed out by large draughts of warm water, with salt, if necessary for 
the return of the water. With the emetic, or sooner, if possible, the anti- 
dote should be administered. The substance whose antidotal value has been 
most thoroughly tested and assured by clinical experience is the freshly pre- 
cipitated sesquioxide of iron, which forms with arsenious acid a very insolu- 
ble compound. The antidote must be freshly prepared, and must be given 
in great excess: according to the experiments of Messrs. T. and II. Smith, 
of Edinburgh, at least eight grains of the iron being required for the con- 
version of one grain of the arsenious acid. In practice, any of the sesqui 
solutions of iron-that of the chloride being generally preferred, as most 
readily procured-should be neutralized by the carbonate of sodium, and a por- 
tion of the precipitate given at once, stirred up in hot water. The remainder 
of the antidote, having been hastily washed by emptying on to a piece of 
muslin or a filter, pouring water on it and allowing it to drain, should be 
administered very freely,-indeed, indefinitely, as it is entirely harmless. 
Recently, II. Kohler, of Halle (Brit, and For. Med.-Chir. Rev., 1870, vol. 
xlv. p. 538), has made a very elaborate scries of chemical, physiological, 
and clinical experiments upon the comparative antidotal values of the sac- 
charated oxide of iron and the freshly-precipitated sesquioxide. His results 
indicate that the former preparation is the better; but, as the efficiency of the 
sesquioxide has been so frequently proven at the bedside, further testimony ALTERATIVES. 
423 
is desirable before it is superseded, especially since the other ferric prepara- 
tion is not officinal with us, and is not so readily prepared on the spur of the 
moment as its fellow. Dialyzed Iron has been used with very good results, 
but it is much better to precipitate it, just before administration, with a 
small amount of ammonia or other alkali. Magnesia, freshly calcined or 
freshly precipitated from a solution of its salts, is an antidote of some avail 
in arsenical poisoning, but is decidedly less efficient than the oxide of iron. 
After the emetic has acted in a case of arsenical poisoning, and while the 
antidote is being given, castor oil should be administered, for the purpose 
of expelling the poison from the bowels. The further treatment should 
be directed by general principles: demulcent drinks, opium, stimulants, dry 
external heat, and rubbing, being employed as called for by the symptoms. 
When there is a tendency to suppression of urine, very large draughts of 
water containing sweet spirits of nitre should be given as frequently as the 
stomach will bear them. 
The chief indications in chronic arsenical poisoning are to remove the 
patient from the exposure and to treat symptoms as they arise. Although I 
do not know of any clinical records bearing upon the subject, it might be 
well to exhibit the iodide of potassium, with the hope of hastening the 
elimination of the poison. 
Administration.-The commencing dose of arsenic is one-twentieth ot 
a grain, which should be given in pill after meals, and be slowly increased 
until a perceptible influence, or the desired therapeutic effect, is obtained. 
In many cases (chorea, lymphoma, intermittent fevers, etc.) it is necessary to 
push the remedy until decided evidences of poisoning are secured; in this 
case a liquid preparation should be selected. The following are the U. S. P. 
preparations of arsenic: 
Liquor Potassii Arsenitis-Solution of Arsenite of Potassium.-Fowler's 
Solution contains four grains of arsenious acid to the ounce, is nearly color- 
less, odorless, with a very faint taste of the compound spirit of lavender, 
which is in it. It is an excellent preparation. The average commencement 
dose is five drops in a wineglassful of water after meals, to be increased and 
used with the same precautions as arsenic. 
Sodii Arsenias-Arseniate of Sodium.-This salt occurs in transparent, 
slightly efflorescent, soluble crystals, and is solely used in making the Liquor 
Sodii Arseniatis. The Solution of Arseniate of Sodium (gr. 4.6 to f^i) 
may be used instead of Fowler's Solution, in similar doses. 
Arsenii lodidum-Iodide of Arsenic.-This is an orange-red, crystalline 
solid, wholly soluble in water and entirely volatilized by heat. It has been 
used as an alterative, and also as an external application in certain diseases 
of the skin, especially lupus and chrome tubercular affections. Iodide of 
arsenic enters into Donovan's Solution. 
Liquor Acidi Arseniosi-Solution of Arsenious Acid, is of the same 424 
SYSTEMIC REMEDIES. 
strength, and has the same therapeutic properties, as Fowler's Solution. It 
is, however, a little more irritant than that preparation. 
HYDRARGYRUM-MERCURY. U. S. 
Physiological Action.-When a mild, unirritating preparation of mer- 
cury is introduced into the system so as to produce constitutional effects, the 
first' symptoms of its action are to be looked for in the mouth. In the mildest 
degree these symptoms consist of a slight fetor of the breath, and some sore- 
ness of the teeth when knocked forcibly together or struck with a key. Mer- 
curial fetor is peculiar, and is generally the first indication that the drug is 
affecting the system, and is sooner or later accompanied by a disagreeable 
metallic taste. If the use of the mercury be persisted in, the gums become 
swollen, soft, and spongy, bleeding on very slight abrasion, and there is a 
decided increase in the secretion of saliva. Beyond this point the therapeu- 
tist is never justified in carrying the use of the drug. If it is done, the local 
symptoms in the mouth increase in severity, the gums become swollen, in- 
flamed, very vascular, and marked by a dark-red line at the junction of the 
teeth; the tongue is also swollen, sometimes enormously, protruding from the 
mouth, whose closure it may entirely prevent; the teeth are loosened in their 
sockets; the saliva is enormously increased in quantity and altered in quality, 
forming great, ropy, viscid masses, which pour over the thickened lips ; the 
parotid glands, and even the submaxillary, are very much enlarged, and 
tender. Sometimes, before salivation occurs, slight systemic erethism, marked 
by a quickened pulse and general restlessness, may be present; but when the 
mouth-symptoms are severe, very generally there is a distinct febrile reaction 
of a low type. 
In some cases of mercurialization the stomatitis has been very intense. 
loss of the teeth, extensive ulceration of the soft parts, and even necrosis 
of the jaw-bones, have occurred, and death from exhaustion resulted, or the 
patient struggled through to recovery, seamed and disfigured for life. In 
these cases passive hemorrhages often recur again and again, and, it may be, 
contribute largely to a fatal result. During severe ptyalism emaciation goes 
on rapidly, and seems to affect especially imperfectly organized tissues, so 
that exudations very generally rapidly disappear. The disturbance of nutri- 
tion is further shown in some cases by the occurrence of ulcers upon the 
extremities. The blood suffers very decidedly, becoming more fluid and 
watery than normal, and having its power of coagulation impaired. Ac- 
cording to the researches of Dr. Wright, its solid constituents are notably 
diminished, including albumen, fibrin, and the red corpuscles, and it contains 
a large quantity of a fetid, fatty material. These observations of Wright 
have been confirmed upon animals by Dr. Wilbouchewitch (Arch. de 
Physiol., Sept. 1874), and by Dr. I. Hughes Bennett. 
Although large doses of mercury lower the general nutrition and destroy 
the crasis of the blood, it is by no means certain that given in very minute ALTERATIVES. 
425 
doses it has not tonic properties. In 18G9 (Gaz. des Hop.) Lidgrois asserted 
that the subcutaneous injection of very minute doses of quicksilver produces 
in healthy men an increase of their bodily weight, and in 1876, in two ex- 
periments, Dr. E. L. Keyes (Amer. Journ. Med. Sci., Jan. 1876) found that 
not only was the bodily weight increased, but, as determined by actual count, 
the number of the red corpuscles very decidedly augmented. Very recently 
(Arch. Exp. Path. u. Pharm., Bd. xiii. 317) Dr. Hermann Schlesinger has 
laboriously experimented upon rabbits and dogs. All other conditions being 
similar, those rabbits which received the mercury increased in weight a very 
little more than did those to which mercury was not given, but the augmen- 
tation of the red blood-disks was decidedly greater in the mercurialized 
animals. With dogs the results were more decided, both bodily weight and 
blood-corpuscles increasing much faster in the animal to which mercury was 
given. Prof. I. Hughes Bennett had previously obtained similar results to 
those quoted, and Dr. Schlesinger thinks that it must be considered proven 
that very minute continuous doses of mercurials tend in the normal animal 
or man to distinctly increase the weight of the body and the richness of the 
blood, but that it is scarcely proper to call them tonic, as in his belief they 
act by hindering oxidation and restricting waste, and not by aiding in recon- 
struction. In this, however, he seems resting upon theory rather than upon 
proven fact, and there is much clinical reason for believing that in ex- 
ceedingly minute doses mercurials in some way benefit nutrition. 
Sometimes the influence of mercury falls almost exclusively upon the 
nervous system, and produces a peculiar train of paralytic phenomena. This 
occurs chiefly, if not exclusively, when it, as vapor, finds entrance to the 
blood through the lungs, and is most frequently seen in those who work in 
the metal. It is generally the result of long exposure ; but that it may be 
produced in a very short time is proven by the case, related by Dr. Christi- 
son, of two barometer-makers who slept one night in a room containing a 
pot of mercury upon a stove. One was severely salivated, the other was 
affected with a shaking palsy which lasted all his life. According to Dr. 
Sigmond (Mercury, Blue Pill, and Calomel, London, 1840), the attack of 
mercurial palsy, which is sometimes sudden, sometimes gradual, begins with 
unsteadiness and shaking of the extremities, and of the muscles of the face, 
which movements interfere with walking, speaking, or chewing; the tremors 
become frequent, nay, almost constant; " every action is performed by 
starts." If the exposure be continued, sleeplessness, loss of memory, and 
death terminate the scene. A peculiar brownish hue of the whole body, 
and dry skin, generally accompany the disease. In its first attack it may be 
mistaken for St. Vitus's dance; in its latter stages, for delirium tremens. 
According to Noel Gueneau de Mussy (Gazette des Hopitaux, 1868), these 
two forms are rather distinct varieties than different stages of mercurial 
tremors. In the latter the affection simulates paralysis agitans in its 426 
SYSTEMIC REMEDIES. 
shaking movements; in the former the motions are violent, and occur inde- 
pendently of the will of the patient, even when he is lying quietly in bed. 
In a case reported by Dr. L. Langer, the electro-contractility of the affected 
muscles was much heightened (IFten. Med. Jahrb., 1881, 478). 
In other cases, neuralgic pains are a prominent result of mercurial ex- 
posure ; and sometimes epilepsy is produced, or the intellect is especially 
affected, and insanity, most frequently of a melancholic type, results. 
According to Dr. Sigmond, the peculiar paralysis of lead-poisoning, includ- 
ing the drop-wrist, has been known to follow persistent mercurial inunctions. 
In some cases, exposure to the vapor of mercury, or even its persistent 
medicinal use, has resulted in the production of a state of the system some- 
what resembling scurvy, characterized by great anaemia, emaciation, and 
general loss of power, with loss of the hair, aching pains in the bones and 
joints, oedema, fetid breath, diarrhoea, and, generally, disordered secretions. 
This is the so-called mercurial cachexia. 
As already stated, the salivary glands are especially sensitive to the con • 
stitutional effects of mercury, and there is some reason for believing that the 
pancreas, which resembles them in structure, is also obnoxious to the drug. 
Thus, in a case related by Dr. Copland, a woman after excessive salivation 
experienced deep-seated epigastric pain and heat, with nausea, thirst, and 
fever, and voided thin stools containing liquid resembling salivary fluid. At 
the post-mortem the pancreas was found weighing four ounces, red, con- 
gested, and with its duct dilated. In regard to the action of mercury upon 
the liver, see article on Calomel as a purgative. 
It is asserted that in some peculiar persons the external, and even the 
internal use of small amounts of mercurials will produce violent eczema or 
other skin eruption (Dr. Alexander, Vierteljahrs. f. Dermatol, u. Syph., 
xi. 110). 
No attention has, that I am aware of, been paid to local mercurial poison- 
ing, but Dr. A. W. Foot has reported (Dublin Journ. of Med. Sci., 1873) 
a case in which paralysis of the muscles of the hand and fore-arm was pro- 
duced by contact with the red iodide of mercury during the rubbing of cattle 
with a salve containing it. 
That mercury is absorbed there is abundant proof.* That it is eliminated 
by the secretions is also very evident. Thus, it has been found in the blood,f 
* Dr. S. V. Clevenger {Chicago Med. Gat., Feb. 20, 1880) believes that mercurials are 
absorbed, and act in the form of excessively minute globules of the pure metal. Many of 
his statements are absurdly extravagant, but his observation that when calomel is given 
to a chicken the metallic globules can be abundantly seen in the blood should be confirmed 
or overthrown by direct experiments. See also Chicago Med. Gaz., 1880, i. 155. 
As N. Popow found that mercury is capable of producing the same changes in the spinal 
cord as is arsenic (see p. 410), it is probable that in some cases of mercurial poisoning 
the symptoms simulate those of poliomyelitis. 
j- Eld and Buchner, quoted by Prof. Stille. ALTERA TIVES. 
427 
in the urine,* in the serum of ulcers,f in the saliva,J in the faeces,§ in the pus 
from ulcers, in the seminal fluid, || in the milk of nursing women,indeed, 
in every conceivable secretion and in every tissue. Heller, of Vienna,** has 
found it in the aborted foetuses of salivated women, and Mayen§on and Ber- 
geret in the urine of a baby whose nurse was taking calomel. 
It is a matter of much interest to know how rapidly mercury is eliminated, 
and whether, when given internally, it accumulates in the system. The 
recent researches of Mayen§on and Bergeret (loc. cit.) throw some light 
upon this point as well as upon the rapidity of absorption. They found 
that if one centigramme of corrosive sublimate was given hypodermically to 
a dog, the urine for the next twenty-four hours contained mercury, after- 
wards none. When a centigramme was given daily for ten or twelve days, 
the urine contained mercury for four or five days after the cessation of 
medication. In their last series of experiments, rabbits received the drug, 
and were killed at different intervals: in half an hour the metal could be 
found in all the tissues, the liver and kidneys containing most of it; in four 
days, or even in a shorter time, mercury given in a single dose was all 
eliminated, and could not be found in the tissues. This would seem to prove 
that mercury given in a single dose does not remain in the system; but the 
experiments of Mayen^on and his colleague, confirmed by clinical experience, 
show that when the drug is administered repeatedly elimination ceases before 
it is all discharged. Thus, forty-eight hours after the cessation of a mer- 
curial course, when the urine of one of the investigators was free from the 
metal, the iodide pf potassium was exhibited; and the urine of the next 
twenty-four hours contained an abundance of mercury, which continued to 
be present in diminishing quantities for seventy-two hours. The chief chan- 
nel of escape seems to be the kidneys; but it is very certain that, at least in 
some cases, the drug is freely excreted by the salivary glands as well as bv 
the intestines. Dr. Schuster has found it in the faeces three months after 
the cessation of a mercurial course (Viertelj. f. Dermat. u. Syphilis, ix. 
307) ; indeed, he believes that it is thrown off more freely and constantly 
by the intestines than by the kidneys. He also claims that elimination is 
completed six months after the cessation of an ordinary mercurial course 
(Journal of Cutan. Med., i. No. 12, ii. No. 9).ff 
* Cantu, Jourda, Andouard, quoted by Prof. StillS. 
f Fourcroy, quoted by Prof. Still6. 
| Gmelin, Bull, de Therap., xiii.; Byanon, quoted by Mayengon and Bergeret; Sai- 
kowsky, Virchow's Archiv, xxxvii. 347; Oesterlen, quoted by Prof. Stille. 
£ Saikowsky, loc. cit., p. 347. 
|| Mayenjon and Bergeret, Robin's Journal de l'Anatomie, 1873. 
Klinik, Detroit Med. Journ., May, 1877. 
** Quoted by Prof. StillS. 
ff These papers of Schuster have given rise to some controversy, and a valuable discus- 
sion as to the best methods of finding mercury in the excreta. See papers quoted above; 
also Vierteljahrs. f. Dermatol, u. Syph., 1882, No. 702 ; Annal. de Dermat. et Syphil., iii. 
1882, 721. Sigismund has found quicksilver in the urine of patients as long as thirteen 428 
SYSTEMIC REMEDIES. 
In regard to the constitutional action of mercury we know but little, 
except that in some way it influences nutrition.* It certainly increases the 
secretions, probably by a direct action upon the cells of all the glands. It 
has been shown by Salkowsky that mercury will cause in the dog fatty de- 
generation of the renal epithelium, and in the rabbit diabetes, as well as a 
deposit of the phosphate of calcium in the kidneys, which Prof. Prevost 
has shown to be accompanied with a decalcification of the bones (Revue 
Med. de la Suisse Rom., 1882, 553, 605; also 1883, 402). These facts, 
and the emaciation, the perverted functions of nerves and glandular tissue, 
the various skin-eruptions, the altered blood of chronic hydrargyria, all 
point to a profound impression on the nutrition of every part of the 
organism. 
That mercury causes no especial waste or destruction of the nitrogenous 
compounds of the body appears to be shown by the researches of Dr. Her- 
mann von Boeck (Schmidt's Jahrbucher, Bd. cxlv. p. 142). This observer 
analyzed the faeces and urine of a man before, during, and after the exhibi- 
tion of mercury, taking proper precautions to assure uniformity as to diet 
and exercise. There was a slight but not a notable increase in the amount 
of nitrogen in the two excretions during the mercurial period. 
Therapeutics.-The use of mercury in affections of the liver and of 
the alimentary canal is fully discussed in another portion of this work; 
and, although the drug has been used for almost innumerable purposes in 
times past, it seems here only necessary to speak of its action as an anti 
phlogistic and as an antisyphilitic. 
Antiphlogistic action.-The use of mercury in inflammation originated 
towards the close of the last century with a Dr. Robert Hamilton, and soon 
became universal in England and America. It is a matter of regret that no 
sufficient analysis of the blood of ptyalized persons has been made to deter- 
mine exactly what are the changes produced in the vital fluid by mercury. 
The indications are, however, very strong that chief among them is a less- 
ening of the amount of fibrin. As is well known, increase of the haemic 
fibrin is one of the most characteristic effects of inflammation : consequently, 
theory, so far from being opposed to the antiphlogistic use of calomel, affords 
at least some grounds for the belief that there is more or less of antagonism 
between the processes of mercurialization and of inflammation. 
All important evidence as to the antiphlogistic value of mercurials at 
years after taking the medicine; but Schuster (Zeitschr. f. Klin. Med., vii. 1884) asserts 
that these patients were habituSs of a room in which inunctions were constantly being 
made, and that under these circumstances there is sufficient diffusion of the mercury to 
produce a very sensible effect in those breathing the air. 
* For an article by A. Polotebenow, of St. Petersburg, on the effect of mixing corrosive 
sublimate albuminate with blood outside of the body, see Virchow's Archiv, 1864, Bd. xxi. 
p. 35. Mercury acts upon the lower mammals as it does upon man, but experimental re- 
search has as yet thrown little light upon the method of its action. For the latest research 
Hid literature of the subject, see Archiv Exper. Path, und Pharm., xiii. 86. ALTERATIVES. 
429 
present available is clinical, and even of this it seems impossible to find 
much that is very exact and of such nature as to exclude possible fallacies. 
It is the enormous mass of testimony that overrides the chance of fallacies. 
It is the general judgment of the profession, founded upon the thousand 
daily-observed bedside facts, that indorses the use of mercury as an anti- 
phlogistic. In other words, our knowledge of the value of mercurials in 
inflammation at present is clinical rather than experimental, empirical rather 
than scientific, but it seems scarcely possible that it is not correct. There is 
one inflammatory affection, iritis, which, from its anatomical relations, is 
completely visible at all stages; and the effects of the drug upon its pro- 
cesses have been noted from day to day hundreds of times. Oculists are, 
I believe, agreed that when there is a marked tendency towards the exuda- 
tion of lymph in this disease, mercury is to be exhibited until ptyalism is 
induced. 
Of all inflammations, those of the serous membranes seem to be most 
allied to iritis; and it is exactly in the condition above spoken of, where 
there is a tendency to fibrinous exudations in pleuritis, peritonitis, and peri- 
carditis, that mercury is so constantly employed with so good an effect. In 
parenchymatous inflammations, especially in pneumonia and in hepatitis, 
mercury has been used with asserted advantage by many practitioners, but 
its value is certainly more questionable than in serous inflammations. 
Calomel is useful in severe laryngitis, and especially in the pseudo-mem- 
branous variety, when the type is sthenic; and no time should be lost in 
bringing the system under its influence. The extent of its power to arrest 
the course of endocarditis is certainly an open question; but as it is ex- 
tremely important, if possible, in this disease, to prevent exudation, and as 
mercury is the most efficient known agent for effecting this, it should be 
administered freely and at once. If the disease be of rheumatic origin, the 
alkalies may be administered conjointly with the mercurial. 
In whatever disease a mercurial is administered as an antiphlogistic, it 
should be given during the stage of exudation, and to facilitate the absorp- 
tion of the newly-organized lymph after it has ceased to be thrown out. In 
the majority of cases, mercury given for its constitutional effects should bo 
combined with opium, to prevent its acting on the bowels. 
Calomel should not be used in adynamic inflammations, or where the 
exudation is serous rather than fibrinous. In puerperal peritonitis it has 
been strongly advocated by some, and as strongly condemned by others, 
simply because there are two varieties of the disease, the sporadic or sthenic, 
and the epidemic or asthenic; and in the one both bleeding and calomel are 
strongly indicated, whilst in the other they are effective only for evil. 
Mercury as an Antisyphilitic.-It was formerly believed that syphilis 
could not be cured without the use of mercury; but latterly there has arisen 
a school of syphilographers who assert that the drug is not only not neces- 
sary, but is at all stages and in all cases of the disease most injurious ; that 430 
SYSTEMIC REMEDIES. 
the worst symptoms of the disease are due not to the constitutional affection, 
but to the remedy given for its relief. The great bulk of the profession 
occupies a middle ground between these extremes, holding the opinion that 
whilst mercury is not absolutely essential for the relief of syphilis, it is yet 
in many cases of the utmost value when judiciously used. The justice of 
this position cannot, I think, be rightly questioned ; the universal verdict in 
its favor is too fixed and definite; so that the important point now is to 
determine at what stages, and under what conditions, the remedy is advisable, 
and what is the best method of its application. 
Syphilis is ordinarily, and with sufficient accuracy for practical purposes, 
divided into three stages, the primary, the secondary, and the tertiary. Ac- 
cording to the teachings of the dualists, there are two varieties, or rather 
species, of venereal ulcer, the hard and the soft chancre, or the true chancre 
and the chancroid, the infecting and the non-infecting sore. When a vene- 
real ulcer offers the characteristic of the latter of these, mercury should 
never be exhibited. So long as there is a doubt as to the nature of the 
primary sore, the remedy should be withheld; but when there is distinct 
induration, and the inguinal glands begin to be involved, it should be given. 
It is proper to state that some high authorities deny the expediency of 
giving the mercurial until the appearance of distinct secondaries. They 
affirm that mercury is powerless to prevent the occurrence of these phe- 
nomena ; that the good which it does is found in its hastening their com- 
pletion, and consequently that it should be reserved until the second stage 
of the disorder. I myself believe this is incorrect practice, that minute 
doses of mercury should be given continuously for many months so soon as 
undoubted syphilitic symptoms are manifested. The careful experiments of 
Keys (Amer. Journ. Med. Sci., Jan. 1876) have shown that under these 
circumstances such small doses act as a tonic, increasing the number of the red 
blood-discs. Ptyalism is to be avoided unless the symptoms eagerly demand it. 
In tertiary syphilis, mercury is to be used cautiously, and only in combi- 
nation with the iodide of potassium. In the hereditary syphilis of infants, 
a decided mercurial impression offers the best chance of relief. Even in the 
primary or secondary stages of syphilis mercury should be employed with 
caution and judgment. In his researches (loc. cit.} Wilbouchewitch found 
that the mercurial when first exhibited increased the number of red blood- 
corpuscles in syphilitic patients, but after a time appeared to produce anaemia. 
Whatever preparation be employed, it should be so administered as to ex- 
hibit only signs of its constitutional action upon the mouth. It is not 
necessary to ptyalize the patient severely, or indeed at all, the proper course 
consisting in the steady maintenance of the slightest possible distinct sore- 
ness of the gums. There are various methods by which this may be done. 
That most frequently employed, because most convenient, is the administra- 
tion of small doses of calomel or blue pill by the mouth: from one-quarter 
to one-half a graiu of calomel, or twice as much of the blue mass, combined, ALTERATIVES. 
431 
if necessary, with opium, to prevent its action upon the bowels, may be given 
three times a day, and increased if required. Instead of the internal use of 
the mercurial, the system may be brought under its influence by inunctions 
with the unguentum hydrargyri. When this is done, the skin should be 
well cleansed and softened by frequent bathing, and then a drachm of the 
ointment may be rubbed into the inside of the thighs, legs, and the popliteal 
spaces, in such a way that the application be not made to any spot oftener 
than every other day. 
It is commonly advised in English works to employ the armpits; and, as 
the skin is there exceedingly thin and the absorbents very numerous, mercury 
is without doubt more rapidly taken up at that place than at any other part 
of the body. When, however, mercury is applied to any hairy surface, it 
very commonly in a short time induces a troublesome eruption, due to in- 
flammation about the hair-follicles. The eruption appears anywhere on the 
skin if the mercurial ointment be applied too freely; and, in order to avoid 
this inconvenience, in Germany the following plan is adopted (Dr. H. Zeissl, 
Lehrbuch der Syphilis, Theil ii. p. 349) : The patient, having been prepared 
by thorough warm bathing, and having received about half a drachm of the 
ointment, is directed to place it in the hollow of the hand and to rub the 
two hands together until the ointment is equally diffused; then to apply it 
forcibly and slowly to the part directed until almost all of the salve has dis- 
appeared, having been rubbed into the skin. In most cases the mercurial 
is applied daily; but in very susceptible persons only every third day. A 
regular order is maintained in the application, as follows: First day, inner 
side of both upper arms ; second day, inner side of both thighs ; third day, 
inner side of both fore-arms ; fourth day, inner side of both legs ; fifth day, 
upon both groins ; sixth day, upon the back; seventh day, recommence the 
series. 
The advantage claimed for inunction is that the digestion is less apt to be 
disturbed than when the drug is exhibited by the mouth ; the disadvantages 
are the greater or less publicity which it entails, the trouble which it in- 
volves, and its apparent dirtiness. In private practice it is rarely used except 
in the case of infants, when the mercurial ointment is rubbed into the abdomen 
and armpits, or often simply smeared upon the flannel roller or binder which 
usually envelops the body. The mercurialization of the nurse, with the 
object of affecting the child, is unjustifiable, unless the nurse and the nursling 
are alike diseased: indeed, to allow a syphilitic child to feed at the breast of 
a healthy woman is extremely reprehensible. 
Mercury is sometimes administered in secondary syphilis in the form of 
fumigations. The patient is placed upon a chair, and surrounded by a large 
blanket, or, better, india-rubber cloth, so arranged as to fit tightly around his 
neck above, and below to encompass the chair. The mercurial preparation is 
placed upon a metal plate, heated by a spirit-lamp, beneath the chair, and the 
fumes are allowed to fill the space around the patient inside of the blanket. 432 
SYSTEMIC REMEDIES. 
The heat produced generally causes the patient to sweat profusely, and in from 
fifteen minutes to half an hour the lamp should be withdrawn, and the patient 
allowed to cool off, and after a time be put to bed and wrapped up in blankets, 
with the deposit of mercury still adhering to his skin. The fumigation may 
be practiced every other night, or at longer intervals, and is believed by some 
to be especially useful in cases of secondary skin-eruptions. Calomel, black 
oxide, and cinnabar are the preparations generally used. When the last is 
employed, care must be exercised that the patient do not breathe the fumes. 
In advanced secondaries, the iodides of mercury, given by the mouth, are 
to be preferred. They should never be pushed to the point of producing 
salivation. 
In tertiary syphilis, mercury should rarely, if ever, be exhibited by itself, 
but the combination of the corrosive sublimate and the iodide is often more 
efficient than the latter drug alone. In most cases not more than one-twelfth 
of a grain of the bichloride should be given, three times a day.* 
Administration.-The following preparations contain metallic mercury: 
Unguentum Hydrargyri, U. S.-Blue, or Mercurial, Ointment is made 
by triturating mercury with suet and lard, until the metal is extinguished,- 
i.e., until a portion of the mass rubbed upon a piece of paper exhibits no 
globules under a magnifying power of four diameters. Mercurial ointment 
is soft, of a bluish color, becoming darker by age, and contains half its 
weight of mercury. When frequently rubbed upon the same part, it not 
rarely produces a disagreeable eruption. It is used to make a constitutional 
impression, and also locally as a resolvent in cases of enlarged indurated 
glands. The oleate of mercury {Hydrargyri Oleatum-1 to 10, U.S.) 
appears to be a more elegant preparation than blue ointment, and equally 
efficient. 
Emplastrum Hydrargyri, U. S.-Mercurial Plaster contains mercury, 
olive oil, resin, and lead plaster, and is used as a resolvent in indurated 
glands, enlarged chronically inflamed joints, etc. 
Massa Hydrargyri, U. S.-Pills of Mercury-Blue Mass is made by 
extinguishing mercury with honey and other inert substances. It contains 
one-third its weight of the metal, and is used for the same purpose as cal- 
omel, but is milder. Dose: purgative, grains 5 to 10 ; alterative, grains 1 
to 3. " Blue Pills" usually contain each three or five grains of the mass. 
Hydrargyrum cum Creta, U. S.-Mercury with Chalk- Gray Powder 
is made with chalk. It is a smooth, grayish powder, and is similar in its 
medical properties and strength to blue mass. 
* The hypodermic use of mercury does not seem to me justifiable. As to relations of 
sublimate to albumen and albuminous compounds for hypodermic use, consult Arch. Exp. 
Path, et Pharm., iii., 1875; Wiener Med. IFoc A., xxvi. 11, 1876. M. M. Martineau claims 
that ammoniacal mercurial peptones may be used hypodermically in syphilis with great 
advantage. The formula may be found in Lond. Med. liecord, 1882, p. 47. ALTERATIVES. 
433 
HYDRARGYRI CHLORIDUM MITE-MILD CHLORIDE OF MER- 
CURY. U. S. 
Calomel is made by boiling mercury and sulphuric acid together in such 
proportions as to form a bisulphate of the deutoxide of mercury, reducing this 
to the simple sulphate of the protoxide of mercury by triturating it with 
more of the metal and subliming with the chloride of sodium. The subli- 
mate is to be well washed with water, to remove any of the bichloride that 
shall have been formed owing to the imperfect reduction of the bisulphate to 
the sulphate. When the washings are no longer affected by the addition of 
ammonia, it may be known that the drug is free from the soluble corrosive 
sublimate. Calomel is sometimes manufactured by precipitating corrosive 
sublimate by sulphurous acid; but this method is not officinal, and is subject 
to serious disadvantages. 
Physiological Action.-Owing to the great insolubility of calomel, a 
good deal of discussion has occurred as to the way by which it finds entrance 
into the system. The theory of Mialhe (Chimie appliquee^, a modification 
of one originally advanced by Snow (Lancet., 1840), has been pretty widely 
accepted, though with some hesitation, but is, I think, untrue. According to 
the chemist named, the calomel is converted by the chlorides of the stomach 
into corrosive sublimate, and as such is absorbed. The action of calomel 
upon man is so different from that of corrosive sublimate as to render this 
theory exceedingly improbable, and, at temperatures even higher than that 
of the stomach, Mialhe was never able to obtain the formation of more than 
a sixteenth of a grain of the sublimate by the gastric juices. Further, 
Bucheim, Oetingen, and Winkler (quoted by Prof. Stille, Therapeutics, 2d 
ed., p. G55) affirm that this conversion does not occur at all at the tempera- 
ture of the body. Jeannel (Schmidt's Jahrbiicher, Bd. exliii. p. 9; from 
Journ. de Bordeaux, 4e ser., t. ii. p. 67, 1869) has confirmed this, and has 
suggested what seems to be the way in which calomel is absorbed. He finds 
that when the protochloride of mercury is placed in a solution of an alkaline 
carbonate it is decomposed and the gray oxide precipitated. A small portion, 
however, of the latter is held in solution, as much as 0.02 part in 50 parts 
of water (by weight); and if a fatty oil be mixed with the alkaline solution 
a very large part of the mercury is dissolved. From these facts it would 
seem to follow that the calomel entering the stomach escapes unchanged into 
the alimentary canal, and is there decomposed by the alkaline juices and 
dissolved by the fatty matters always present. The physiological evidence 
appears to confirm this, for calomel, being absorbed in this way, ought to 
resemble blue mass rather than corrosive sublimate in its action,-which 
it does. 
The varying constitution of the alimentary juices and the complex chem- 
ical relations of calomel would indicate that its solution in the alimentary 
canal is accomplished in more ways than one,-an indication which is con- 
firmed by the varying results following the ingestion of the drug. It is 434 
SYSTEMIC REMEDIES. 
probable that at times, when the stomach contains more than usual of chlorides 
and of hydrochloric acid, a very slight portion of the calomel is converted 
into corrosive sublimate, and that when there is an excess of sulphuretted 
hydrogen in the alimentary canal a soluble sulphide may be formed. Calomel 
has been used subcutaneously (Dr. F. Zambon, Gaz. Med. Itai. Prov. Venete; 
The Doctor, 1871), with asserted good results, in syphilis;* and, according 
to Bellini, its solution is due to the presence of alkaline chlorides in the 
system. He states that very severe constitutional and local symptoms may 
follow the hypodermic injection of calomel in persons taking the alkaline 
iodides, bromides, or sulphates. The influence of calomel upon the system 
has been sufficiently discussed. It remains only to state that its freedom from 
all irritant properties is shown when taken internally or when used externally. 
Probably no single dose of it is capable, in the average man, of acting as 
a violent poison, since it is stated that in the Western United States it is 
very frequently taken in teaspoonful doses, that sixteen grains of it will act 
as vigorously as an ounce, and that a pound of it has been given in a case of 
cholera without visible effect, f It seems to me most probable that the 
absence of serious results from these heroic amounts is due to the alimentary 
canal being unable to dissolve-i.e., to absorb-the calomel. F. D. Lente 
has claimed that given in this way the drug acts as a sedative and does not 
produce mercurialization, and Mrs. Putnam-Jacobi believes such doses to 
be valuable in diseases where there is " sudden over-distention and paralytic 
congestion of extensive regions of small blood-vessels." (See New York 
Med. Journ., xi., 1870 ; xxix., xxx., 1879.) 
Administration.-When it is desired to produce constitutional mercuri- 
alization, the dose of calomel is a half to one grain; as a purgative, from six 
to ten grains are administered, and followed in six hours by Seidlitz powder, 
or other saline, if required. Minute doses (one-sixth of a grain) of calomel 
given every hour afford a very good method of impressing the system rapidly. 
When it is desired to get its constitutional influence, it is generally necessary 
to conjoin opium with it, to prevent purging. 
HYDRARGYRI CHLORIDUM CORROSIVUM-CORROSIVE CHLO- 
RIDE OF MERCURY. U.S. 
Bichloride of Mercury, or Corrosive Sublimate, is made by subliming the 
bisulphate of mercury with common salt. It occurs in the form of colorless 
crystals, or of white, semi-transparent, crystalline masses, of an acrid, metallic, 
styptic, and very persistent taste, soluble in sixteen parts of cold and in three 
of boiling water. It is at once distinguished from the other mercurial prepa- 
* See also Prof. R. Bellini, Lo Sperimentale, June, 1873; London Medical Record, 1873 ; 
Kiilliker, Centralb. fiir Chir., 1877, 97. 
j- Prof. George B. Wood's Therapeutics, vol. ii. p. 565. ALTERATIVES. 
435 
rations by its color, taste, and solubility, and by its forming a yellow precipi- 
tate with lime-water. 
Physiological Action.-Corrosive sublimate is a violent irritant, and 
in concentrated form caustic. When given in small, repeated doses, although 
capable of inducing salivation, it is less apt to dp so than is calomel or blue 
pill. In overdoses it produces symptoms of irritant poisoning of a severity 
proportionate to the dose. If the latter be small, the manifestations may be 
only some nausea, slight burning in the stomach, colicky pains in the abdo- 
men, and diarrhoea. After large doses these symptoms are intensified. The 
subject first experiences a peculiar metallic, coppery taste at or shortly after 
swallowing the poison. If the solution be concentrated, deglutition is inter- 
fered with by a spasm of the muscles of the throat and larynx, causing a 
feeling of suffocation, and sometimes even the rejection of the draught. 
Then burning pains are experienced in the oesophagus and stomach, followed 
by violent vomiting, at first mucous, then bilious, and finally bloody, and by 
severe abdominal pain and tenderness, with profuse purging, at first serous 
in character, but afterwards affording only small, mucous, bloody stools, which 
are often voided with much straining. The breath generally becomes fetid 
and offensive in a very short time. In the course of two or three hours, very 
rarely in less than an hour, collapse occurs, with small, frequent, irregular 
pulse, pinched, anxious face, cold extremities, and finally death, preceded, it 
may be, by fainting, convulsions, and coma. The urine is very much less- 
ened in quantity, is sometimes albuminous, or even bloody, and not rarely is 
suppressed. If the patient survive several days, a petechial eruption may 
appear, and salivation sometimes, but not always, occurs. In some cases, after 
the collapse there is an attempt at a febrile reaction, which soon, however, 
gives place to a second and fatal prostration. When recovery occurs after 
severe poisoning, the convalescence is slow and protracted. 
In regard to chronic poisoning with corrosive sublimate, sufficient has been 
said under the general heading, except that colicky pains and abdominal 
disturbance are more apt to occur with it than with the less irritating prepa- 
rations. MM. Arnozan claim that chronic catarrh of the excretory ducts 
of the pancreas is a pronounced lesion in chronic poisoning of animals 
(Journ. de Bordeaux, Dec. 1883). It should be looked for in man, and 
its presence might be of medico-legal value. 
Severe purging, and even fatal poisoning, may result from a single ex- 
ternal application of this preparation of mercury ;* and in animals killed 
by hypodermic injections of it (see experiments of Dr. J. Rosenbach, 
* See case reported by Dr. Meeres, Lancet, Sept. 16, 1871, in which a solution (gr. ii 
to f^i) was applied with a camel's-hair brush to the head of a child nine years old, for 
the cure of tinea tonsurans. The symptoms were diarrhoea, profuse salivation, and great 
prostration, ending in death. Washing out vagina and uterus with a very weak solution 
of corrosive sublimate (one in two thousand) has caused severe poisoning (Centralb. f. 
Gynaekol., 1884, No. 13, No. 17). 436 
SYSTEMIC REMEDIES. 
Schmidt's Jahrbucher, Bd. cxliii. p. 9) diarrhoea and other indications of 
gastro-intestinal irritation are prominent symptoms,-facts which indicate 
that the bichloride is eliminated unchanged from the alimentary canal. 
Hydrargyri Iodidum Viride-Green Iodide of Mercury. U.S. 
-This Protiodide of Mercury is made by the direct action of iodine upon 
the metal. It is a greenish-yellow, odorless, and tasteless powder, insoluble 
in water, ether, and alcohol. Compared with the biniodide or the bichlo- 
ride, it is a mild preparation, and has been used to produce constitutional 
impression in syphilis, especially when of long standing. The iodide of 
potassium converts it into the biniodide and metallic mercury (U. S. Dis- 
pensatory), and should, therefore, never be given in combination with it. 
The alterative dose is one-fourth of a grain three times a day, increased to 
a grain if necessary. 
Hydrargyri Iodidum Rubrum-Red Iodide of Mercury.-The 
Biniodide of Mercury is made by precipitating the bichloride of the metal 
with iodide of potassium. It is a scarlet-red powder, insoluble in water 
but sparingly soluble in alcohol. It is a powerful local irritant, producing, 
when taken in overdoses, symptoms and results very similar to those caused 
by corrosive sublimate. It is used a good deal in tertiary syphilis and in 
syphilitic rheumatism; also to some extent as a local application in lupus 
(see Annuaire de Thirap., 1852). It is much more active than the protio- 
dide, and should be used as cautiously and in the same doses as corrosive 
sublimate. 
The U. S. Pharmacopoeia also recognizes the following preparations of 
mercury: 
The deutoxide occurs in two forms, the Yellow and the Red Oxide (Hy- 
drargyri Oxidum Flavum, Hydrargyri Oxidum Rubrum). Both 
are used upon ulcers, chancres, etc., solely for their local effects, and are 
stimulant and alterative when diluted, mildly escharotic when in powder. 
From Hydrargyri Oxidum Flavum is made the oleate (Oleatum Hydrargyri 
-1 to 10, U.S.). The red Precipitate Ointment (^Unguentum Hydrargyri 
Oxidi Rubri, 1 to 10, U.S.), and the ointment of the yellow oxide ^Un- 
guentum Hydrargyri Oxidi Flavi, 1 to 10, U. S.), very generally require 
dilution with lard, and are much used in chronic skin-affections, in obstinate 
conjunctivitis, in psorophthalmia, etc. 
The Red or Bi-sulphuret (Hydrargyri Sulphidum Rubrum, U. S.), 
formerly used a good deal in fumigations, is now rarely employed. Turpeth 
Mineral, or Yellow Sulphate of Mercury (Hydrargyri Subsulphas Fla- 
VUS, U. S.), a lemon yellow powder, sparingly soluble in water, is a basic 
sesquisulphate of the deutoxide of mercury, prepared by throwing the bi- 
sulphate into water, which causes it to break up into a supersulphate, which ALTERATIVES. 
437 
remains in solution, and the salt in question, which precipitates. Turpeth 
mineral has been used as a harsh emetic, and also as an alterative, but is now 
rarely employed. In croup, in emetic doses it is still very highly esteemed 
by some practitioners, and has been inordinately praised by Dr. Fordyce 
Barker. It is, however, a very dangerous remedy, since, if it fail to vomit, 
it may cause a fatal gastro-enteritis, especially in the young child. Two cases 
of such character are recorded by Dr. A. McPhedran (Med. News, xliii. 
682). The dose as an alterative is from a quarter to half a grain; as an 
emetic, for a child two years old, two grains repeated in fifteen minutes, if 
it has not operated. Forty grains of it (Guy's Hospital Reports, vol. x., 
3d series) have caused death in the adult; profuse salivation came on in six 
hours. 
White Precipitate, or Ammoniated Mercury (Hydrargyrum Ammoni- 
ATUM, U. S.), is a white complex powder, made by precipitating the bichlo- 
ride with water of ammonia. It is used in the form of ointment ( Unguentum 
Hydrargyri Ammoniati-1 to 10, U.S.) as a local application in various 
skin-affections. 
Black 11 "ash and Yellow Wash, two non-officinal but favorite preparations, 
are respectively made by the addition of a drachm of calomel to a pint of 
lime-water, and of half a drachm of corrosive sublimate to a pint of lime-water. 
They depend for their virtues upon the black and yellow oxides of mercury, 
and are used exclusively as local applications to chancres and other syphilitic 
ulcers. The yellow wash is much the more stimulating of the two. 
I0DUM-IODINE. U.S. 
Iodine is a soft, friable, opaque substance, occurring in crystalline scales 
with a semi-metallic lustre and of a bluish-black color. Its odor resembles 
that of chlorine; its taste is hot and acrid. It is somewhat volatile at ordinary 
temperatures, but when heated to 225° F. melts and emits the beautiful 
purple or violet vapor to which it owes its name. It is freely soluble in 
glycerine, alcohol, and ether, but requires seven thousand times its weight 
of water to dissolve it. With starch it strikes a deep-blue color, and this test 
is so delicate that it will indicate the presence of iodine in four hundred and 
fifty thousand times its weight of water. In testing animal liquids, such as 
urine, for iodine, a small quantity of nitric acid should be added to insure 
its being free in the liquid. 
Physiological Action.-Iodine, when applied to any part of the body, 
acts as a very powerful irritant, or, if in highly concentrated form, as a mild 
caustic. The tincture stains the skin yellow, and causes, if applied with 
sufficient freedom, smarting, some erythematous inflammation, and finally 
desquamation. Its repeated application blisters and destroys the cuticle. 
Upon mucous membranes its action is more intense than upon the skin. 438 
SYSTEMIC REMEDIES. 
When taken internally, a single moderate dose of iodine causes merely 
some gastric uneasiness and a disagreeable metallic taste in the mouth; when 
larger amounts are ingested, the gastric uneasiness may be intensified into 
violent vomiting, with increased salivary flow, abdominal pains, and even 
purging. In sufficient quantity it is a poison; although very few deaths 
have been recorded as caused by it. The usual symptoms, when toxic doses 
of it have been taken into the stomach, are vomiting, purging, severe ab- 
dominal pain, headache, giddiness, sometimes violent excitement and convul- 
sions, ending in faintness, pallor, and collapse. Dr. E. Kose (^NothnageT s 
Arzneimittellehre, Berlin, 1870, 252) has reported a case in which death 
resulted from a large injection into an ovarian cyst. Very soon after it was 
given, there ensued severe thirst, with great dryness of the throat and mouth, 
and then painless vomiting of watery matters containing iodine. The whole 
surface became very pale, the extremities cyanosed; the radial pulse very 
frequent, but so small that it could not be counted; the urine very scanty, 
dark brown, and rich in iodine. After a time, reaction occurred. For three 
days the vomiting persisted, the pulse was very frequent, full and hard, and 
the cheek put on the glow of high fever, but the temperature did not rise 
above 37.18° C. On the fourth day, exanthematous blotches, not disappear- 
ing on pressure, appeared on the skin and in the mouth ; the sputa became 
bloody; and menstruation occurred, two and a half weeks too soon. The 
urine remained-scanty, and on the eighth day, when all other symptoms save 
swelling of the parotids had disappeared, still contained iodine, and was albu- 
minous. On the tenth day, in the midst of apparent convalescence, the 
patient died suddenly. 
In the experiments of Jorg and his pupils, doses of iodine of a grain to a 
grain and a half gave rise to colicky pains, increased appetite, watery stools, 
an increased secretion of urine, malaise, and some headache. When the dose 
was augmented to two grains, a diffused sense of heat and sexual excitement 
were superadded. Other observers have noted this abnormal sexual excite- 
ment, and some have stated that at times it precedes atrophy of the mammae 
or of the testicles. Prof. Stills affirms that the menstrual flow may become 
excessive, or that during pregnancy abortion may be caused. Very large 
quantities of iodine are asserted to have been taken without serious results. 
Julia de Fontenelle (quoted by Stille, Therapeutics, ii. 731) tells of a man 
who took two and a half drachms of iodine without experiencing any re- 
markable effects; and Magendie relates the case of a child four years old 
who swallowed ten grains without serious consequences.* 
In the experiments of A. Hbyges and Prof. Binz (^Arch. Exp. Path, und 
T/terap., x. 229; xiii. 114), preparations of iodine, iodide of potassium, 
* For an elaborate, careful study of the action of large toxic doses of iodine upon the 
lower animals, see Hoffmann und Sehicalbe'8 Jahrsbericht, 1879, 199. ALTERATIVES. 
439 
and iodoform in fatal doses produced in the lower animals wide-spread fatty 
degenerations. 
If full doses of iodine be exhibited continuously for a length of time, a 
train of phenomena result, known as lodism. In regard to these there has 
been a good deal of difference of opinion and statement, a difference which 
seems explainable only upon the supposition that different individuals are 
differently affected by the drug. Rilliet (Trousseau's report on his memoir, 
Bull, de I'Acad. Roy., xxv.), who has had wide opportunities and has ap- 
parently studied the subject very closely, makes three forms of iodic intoxi- 
cation : first, that in which the symptoms are those of gastric irritation; 
second, that characterized by nervous troubles, neuralgia, ringing in the ears, 
convulsive movements, disturbed intellection, with coryza, ophthalmia, sali- 
vation, vomiting, diarrhoea, polyuria, and cutaneous eruptions, and in some 
cases atrophy of the mammae in the female and of the testicles in the male;* 
third, iodic cachexia, caused either by iodine or iodide of potassium contin- 
uously used for many months. It is said to be most easily induced in goitrous 
persons, and is characterized by rapid emaciation, commencing mostly in the 
face, and severe nervous palpitations of the heart, with excessive appetite, 
which sometimes precedes and sometimes follows the loss of flesh. So long 
as the drug continues to be taken, these symptoms continue to progress, and 
after a time hysteria or hypochondriasis, with insomnia, manifests itself. The 
goitre, the mammae, and the testicles waste away together; but if the medi- 
cine be suspended and health gradually return, whilst the abnormal growth 
reappears, the sexual glands remain wasted. 
The second form of iodism of Rilliet, in which the nervous symptoms are 
prominent, has been spoken of by other authorities; and Brodie has especially 
noted disturbances of vision, and paralysis. 
Most authorities affirm that iodine and iodide of potassium produce sim- 
ilar symptoms. Prof. See (London Med. Record, i. 777) indeed asserts 
that iodine exists in the blood only in the form of an alkaline iodide, whilst 
Dr. H. Kammerer (Virchow's Archiv, lix. 467 ; lx. 527) and Prof. Binz 
believe that the iodides are decomposed in the tissues and act by the libera- 
tion of the iodine.j" I do not think, however, that these views can be ac- 
cepted as completely established, and the general professional belief is that 
the therapeutic value, and consequently the physiological action, of iodine 
* For a case of wasting of testicles, see Phila. Med. Times, iv. p. 661. 
j- Consult also Prof. Bucheim (Arch. Exper. Pathol, und Therap., Bd. iii.). Dr. Dubu- 
jadoux (Gaz. Hebd., 1883, xx. 24) found that iodine injected into guinea-pigs suffer- 
ing from malignant pustule, had no influence upon the disease, even if the injections 
be repeated until they killed the animal, and that the blood also is as poisonous as ever 
to other guinea-pigs. This led him to believe that the iodine exists in the blood in a new 
compound which is not antiseptic. He believes this compound to be albuminous, because 
he has found iodine mixed with milk or albuminous solutions soon disappears, so that 
it cannot be recognized by the starch test, and that shortly after this disappearance putre- 
faction sets in. 440 
SYSTEMIC REMEDIES. 
and iodide of potassium are different. Iodine is universally preferred in 
scrofulosis, the iodide in rheumatism. I have given the salt in enormous 
doses, and have seen nervous symptoms in only a single case,-a man who 
received for a long time two hundred and seventy grains a day, and who was 
intensely sleepy and -stupid, presenting symptoms exactly similar to those of 
bromism, including an eruption of acne. 
Of the physiological action of iodine we know little more than that it 
modifies nutrition. Locally the drug is an irritant, and sometimes gastric 
symptoms are produced by it from this cause. The general erethism which 
it induces is believed by Prof. See to be produced by a direct excite- 
ment of the circulation, and even the nervous symptoms are attributed to 
the same cause,-all of which is very improbable. Iodine is certainly 
absorbed and is eliminated chiefly by the kidneys, but probably to a greater 
or less extent by all Che mucous membranes; and Dr. R. W. Taylor 
{American Journal of Syphilography and Dermatology, April, 1873) be- 
lieves that he obtained in a case evidences of the free escape of the iodine 
through the skin. Prof. See asserts {London Med. Record, i. 757) that 
the elimination takes place slowly and intermittently, so that the drug when 
given continuously accumulates in the system. He further states that it 
can be found in the saliva after it has disappeared from the urine. The 
iodine seems to be eliminated partly as an alkaline iodide and partly in 
organic combination (E. Harnack, Berlin. Klin. Wochensch., 1882, No. 20). 
During its passage through the kidneys iodine undoubtedly exerts an 
influence upon those organs, as is shown by its producing albuminuria at 
times. It is indeed asserted that it occasionally causes a true tubular 
nephritis. The evidence as to its effect upon the solids of the urine is both 
contradictory and insufficient. M. Rabuteau* dieted himself for five days, 
measured the quantity of urea daily eliminated, took iodine on the fifth day, 
and found a decided decrease in the excretion of urea. It is plain that this 
experimentation was too slight to be of much value, and Dr. Hermann von 
Boeck {Zeitschrift filr Biologie, iii. 393, 1869 ; Schmidt's Jahrbucher, Bd. 
cxlv. p. 142) found that the ingestion of iodine does not increase notably 
the elimination by the kidneys or bowels. On the other hand, M. Bouchard 
(quoted by S£e) declares on his personal experience that iodine does increase 
the daily elimination of urea, especially in diabetic patients. Dr. C. Hand- 
field Jones {Beale's Archives, i.) analyzed the urine of six patients taking 
large doses of iodide of potassium, with the following results: first, water 
increased in three cases very much, in one slightly so, in two diminished; 
second, acidity increased in three and diminished in two; third, urea in- 
creased in three and diminished in three; fourth, phosphoric acid and sul- 
phuric acid increased in four and diminished in two; fifth, chlorine increased 
very greatly in two .cases, moderately in one, and decreased in two; sixth, 
uric acid increased very greatly in two cases and diminished in four. 
* Quoted by S6e. ALTERATIVES. 
441 
Therapeutics.-As an alterative, iodine is of especial value in chronic 
scrofula. In those cases in which there is indolent enlargement of the 
lymphatics, which exhibit no tendency, or but little tendency, to suppurate, 
it is of especial value. Except in very acute cases, however, it should 
always be tried, even when the glands do tend towards suppuration, espe- 
cially as it exerts a very beneficial influence upon the ulcers left after 
suppuration. In other forms of scrofulous disease, in chronic enlargements 
of the joints, and bone-affections of such nature, iodine is often of great 
service. As scrofulosis is generally, if not always, associated writh lowered 
nutrition and with anaemia, cod-liver oil and iron in some form should usually 
be administered as adjuvants. At the same time that the drug is exhibited 
internally in these cases, its ointment should be freely applied to the enlarged 
and indurated glands. Experience has demonstrated the value of iodine in 
goitre, whether of the ordinary variety or of that known as exophthalmic 
goitre or Graves's disease. All tumors of the thyroid body are not goitre, 
however; cystic degeneration of it is very common, and is in no wise bene- 
fited by iodine. It is in simple hypertrophy of the gland that iodine used 
internally and applied externally over the tumor is so beneficial. During 
the acute stage of enlargement the use of leeches is often of great benefit, 
and whenever much tenderness exists should precede the exhibition of the 
drug. In phthisis, iodine sometimes does good, but only in the most chronic 
cases; and inhalations of its vapors, as have been recommended by Piorry, 
can only be of service by stimulating the bronchial mucous membrane and 
the surfaces of cavities. When softening is progressing and the lung break- 
ing down, iodine sometimes appears to hasten the process. 
Local Application.-As a simple counter-irritant, iodine is very frequently 
employed when it is desired to maintain a mild, persistent influence, as in 
chronic rheumatic affections and sometimes in phthisis. For this purpose 
the tincture is generally preferred, and it should be applied freely once or 
twice a day, or every other day, according to the susceptibility of the patient's 
skin. In various affections of the skin, iodine has been employed with 
asserted advantage. In erysipelas of the skin, very beneficial results have 
been ascribed to its local use, and, I think, with justice; but great care is 
necessary lest it be applied too strong. I have seen very serious results from 
the destruction by it of the skin in this affection. If the full strength of 
the tincture be used, it should be applied at first very lightly, and not more 
than once in the twenty-four hours. In psoriasis, in acne, in parasitic 
skin-diseases, it has been used, but holds only a secend rank among remedies. 
In a similar manner it is employed in various chronic diseases of the mucous 
membranes, such as ozeena, leucorrhoea, chronic cystitis, chronic dysentery, 
and scrofulous ophthalmia,-whenever, in a word, an alterative, stimulant 
action is desired. In cases of retraction of the gums, with consequent 
loosening of the teeth, Prof. Stille recommends the application, with a 442 
SYSTEMIC REMEDIES. 
camel's-hair brush, after each meal, of a watery solution (gr. i to fji) of 
iodine, the mouth being immediately afterwards washed. The most impor- 
tant external use of iodine is as a resolvent in cases of indolent glandular 
hypertrophic enlargement, and where there are large watery exudations, as 
in some forms of chronic pleurisy and of diseased joints. 
Iodine has been very largely employed by injection into serous cysts, as in 
hydrocele, for the purpose of exciting inflammation and causing obliteration 
of their cavity ; but this use of it is purely surgical, and the reader is referred 
to treatises upon such subjects. In chronic empyema, the injection of iodine 
after free exit has been given to the pus is often of the greatest service 
The solution in the beginning should be very weak, containing not more 
than six grains each of iodine and of iodide of potassium in a pint of water; 
with this the pleura should be daily washed out, the strength of the solution 
being gradually increased. 
Administration.-Iodine is never administered in solid form; nor 
should the tincture be given internally, because the iodine is precipitated 
by the watery juices of the stomach. Taking advantage of the solubility 
of iodine in a watery solution of iodide of potassium, the framers of the 
Pharmacopoeia have directed the following preparations, which may be used 
internally; they should always be given well diluted, after meals; any of 
them may be used hypodermically, as suggested by Prof. Da Costa (Amer. 
Journ. Med. Sci., Jan. 1875), in glandular enlargements: 
Liquor lodi Compositus-Compound Solution of Iodine-Lugol's Solu- 
tion (Iodine, 1 part; Iodide of Potassium, 2 parts; Water, 17 parts),- 
dose, gtt. v to xv. 
For external use, a tincture (Tinctura lodi, 1 to 12.5), and an ointment 
(Unguentum lodi: Iodine, 4 parts; Iodide of Potassium, 1 part; to 100). 
POTASSII IODIDUM-IODIDE OF POTASSIUM. U.S. 
This salt occurs in white or colorless, generally cubic, crystals, soluble in 
two-thirds of their weight of water and in from six to eight parts of rectified 
spirits. If to its solution starch be added, no blue color should arise, but on 
the passage of chlorine the characteristic iodine reaction should take place, 
owing to the liberation of the metalloid by the gas; or if sulphuric acid be 
added, a purple tint gradually appears, and deepens into blue: a spontaneous 
blue color betrays the presence of the iodate of potassium, a harmful adul- 
teration. At a dull red heat iodide of potassium fuses into a crystalline 
mass ; by a bright heat it is decomposed. 
Physiological Action.-Iodide of potassium influences nutrition in a 
manner similar to iodine: indeed, most authorities teach that their action is 
identical; yet in therapeutics they find a different range of employment, and, 
I believe, act differently. Dr. I. Wallace (Liverpool Med. and Surg. Rep., 
1871) has found that the iodide lessens the elimination of lime saits through ALTERATIVES. 
443 
the kidneys, but his analyses were not sufficiently repeated to prove that this 
is a constant effect.* 
Therapeutics.-In certain forms of rheumatism, iodide of potassium is 
of the utmost value. In the early, active stages of inflammatory rheu- 
matism, it is much less efficient than the alkalies; but when all the good 
that can be has been obtained from these, and when the joint symptoms 
persist in a subacute form, the iodide comes very well into play. In subacute 
or muscular rheumatism, the iodide is the most efficient remedy. Often 
when the symptoms are very acute it may be advantageously combined with 
the alkalies, and in lingering cases., especially where there is reason to suspect 
a gouty taint, with colchicum. In sciatica, in lumbago, in rheumatic neu- 
ralgia following exposure to cold or wet, as in all other forms of subacute 
rheumatism, very much is to be hoped for from its use. In gout, it is of 
less service than in rheumatism, but in the chronic form of the disease, and 
in the irregular, inherited gout which so frequently appears as neuralgia or 
other anomalous affection, it adds to the efficiency of small continuous doses 
of colchicum. In rheumatic gout, or rheumatoid arthritis, it should be 
tried; although little is to be hoped for from its use. There is a good deal 
of clinical testimony as to the value of iodide of potassium given continu- 
ously between the paroxysms of asthma. This disorder appears at times to 
bear a close relation to irregular gout or rheumatism, and it is probably under 
these circumstances that the remedy is efficient. In tertiary syphilis, in- 
cluding in the term all cases of syphilitic bone, visceral, or nervous disease, 
the remedy is really of inestimable value. It must be given freely, and, 
when there is no cachexia, may be advantageously combined with the bi- 
chloride of mercury. It is scarcely in place here to enumerate all the forms 
which tertiary syphilis may assume; but the iodide is useful wherever the 
dyscrasia has existed for a length of time. 
The iodide of potassium appears to have the power of promoting absorp- 
tion of serous fluids, and certainly is of value in chronic pleuritis with 
effusion, in chronic pericarditis, and even in chronic hydrocephalus. 
In aortic aneurism large doses of iodide of potassium with continuous rest 
in the horizontal position have been used by Dr. Balfour (Edinburgh Med. 
Journ., xiii., xiv., xv.,xvi.; British Med. Journ., 1874, i. 112) with results 
that warrant a further trial. Dr. T. S. Sharpe claimed success from its 
employment in chronic Bright's disease (Amer. Journ. Med. Sci., Jan. 1876). 
In various chronic metallic poisonings, the iodide of potassium is of great 
service. With both lead and mercury it forms double salts, which are soluble, 
and there is very good reason for believing that the formation of these salts 
takes place in the economy, and that the metal which has been lying in an 
* For a research upon the physiological action of large amounts of iodide of potas- 
sium injected into the blood, see Arbeiten aua dem Pharmak. Laborator, zu Moskau, i. 
125. As it does not seem to throw much light upon the therapeutic use of the drug, it is not 
here analyzed. 444 
SYSTEMIC REMEDIES. 
insoluble condition in the various tissues is taken up and excreted. Severe 
salivation and ulcerative stomatitis have sometimes resulted from the use of 
the potassium salt in those who had previously taken large quantities of mer- 
cury ;* and in Meisen's experiments, dogs to which insoluble preparations of 
mercury had previously been given without the induction of severe symptoms 
afterwards died under the action of the iodide, the mercury also having ap- 
peared in their urine. The experiments of Mayen^on and Bergeret, quoted 
in the article on Mercury, afford striking confirmation of these facts, and 
seem to render the evidence irresistible that the iodide does cause the elimi- 
nation of mercury. In regard to lead, the researches of Drs. Parkes, Gool- 
den, Swift, Melherbe, and Sieveking f have shown that very frequently, in 
cases of chronic lead-poisoning, the exhibition of iodide of potassium causes 
the appearance of lead in the urine. This chemical evidence is abundantly 
corroborated by clinical experience, so that in all cases of chronic metallic 
poisoning, especially by lead and mercury, the persistent use of the iodide 
of potassium should be tried. 
Administration.-The ordinary dose is ten grains three times a day; 
but much larger quantities may often be given with impunity, and, in 
internal syphilitic affections, may be necessary. In the latter class of dis- 
eases, the best plan is to begin with twenty grains three times a day, and 
rapidly to increase the amount until drachm Joses are reached, or frontal 
pain or other symptom of iodism produced. The best substance for dis- 
guising the very disagreeable taste of the drug is the compound syrup of 
sarsaparilla. Unguentum Potassii lodidi, U. S., contains about one-eighth 
its weight of the iodide. 
Liquor Arsenii et Hydrargyri Iodidi, U. S.-Solution of the 
Iodides of Arsenic and Mercury contains one per cent, each of the iodide 
of arsenic and the red iodide of mercury. It was originally suggested by 
a surgeon of Dublin, by whose name it is very generally known. Donovan s 
Solution is a powerful alterative, used chiefly in very obstinate chronic scaly 
skin-diseases when the local action is of a very low grade, and in chronic 
rheumatism. It is an exceedingly active preparation, very capable of acting 
as a corrosive poison, and when administered a little too freely is said some- 
times to cause salivation. When applied locally, it acts as a violent irritant. 
The dose of it is from three to ten drops, well diluted. 
IODOFORMUM-IODOFORM. U. S. 
This substance was discovered by Serullas in 1822, and was introduced as 
a remedy by Dr. Glover in 1837, but did not become officinal until the last 
revision of the U. S. Pharmacopoeia. It occurs as small, pearly-yellow 
* See Dr. Budd, British and For. Medico-Chir. Rev., xi. 202, for a striking case, 
f See Stille's Therapeutics, vol. ii. p. 735, Blanchard and Lea, 1864. ALTERATIVES. 
445 
crystals, having a strong, persistent, saffron-like odor, insoluble in water, but 
readily soluble in alcohol and ether. 
Physiological Action.-According to M. Maitre, when taken by man 
in doses of five or six grains iodoform causes no notable symptoms, but two 
hours after the drug has been ingested, iodine can be found in the urine. 
The extensive surgical use of iodoform has led to a number of poisonings 
by it. The symptoms are variously described, and it is almost certain that 
in some cases they have been due to the wound and not to the dressing. 
They may be preceded by general malaise for a day, and then suddenly 
burst forth (Case, Deutsch. Med. Wochensch., ix. 443). In the most 
characteristic and severe class of cases the phenomena resemble some- 
what those of meningitis, and may be somnolence, deepening into stupor, 
with contracted motionless pupils, or restlessness, ending in active delirium, 
in either case the temperature being normal and the pulse exceedingly rapid. 
A peculiarity of these cases seems to be that death usually follows, although 
the symptoms have developed abruptly and the dressings have been removed 
at once. Dr. Schede, of Hamburg, describes six classes of cases, his sixth 
form being that just spoken of. 1. High fever, without other phenomena. 
2. Fever, with mild gastro-intestinal irritation, depression of spirits, and 
rapid pulse; recovery almost invariable. 3. Very rapid, soft pulse, 150- 
180, no fever; great danger. 4. Very rapid pulse, with high fever; death 
almost invariable. 5. After severe operations, rapid collapse and death. A 
form of poisoning with melancholia, dilated pupils, and hallucinations is also 
described. A roseola-like dark-red eruption has been noted in some cases 
of poisoning. 
The action of iodoform upon the lower animals has been investigated by a 
number of observers, but to complete'our knowledge further researches are 
necessary. The symptoms in the frog are said to be muscular relaxation with 
sometimes, at a later stage, convulsive movements. In the higher animals 
large but non-toxic doses produce symptoms of intoxication, tottering, weak- 
ness, and loss of appetite, but no vomiting; fatal doses cause anaesthesia, 
narcosis, convulsions, with violent opisthotonos, hurried or irregular breath- 
ing, slow, feeble pulse, and finally death. A. Hoyges found that in dogs 
and cats toxic doses caused deep sleep without loss of reflex activity ; but 
that in rabbits no sleep resulted (Arch. Exp. Path, und Therap., Bd. x. 
405). Very frequently after these large doses, especially when they are 
repeated, there is great gastro-intestinal disturbance, as is shown by vomiting, 
diarrhoea, and dysentery, with bloody discharges. The action of the drug 
upon the circulation has been especially studied by M. Rummo (Arch. de 
Physiolog. Norm, et Pathol., 1883, 144). He finds in the frog the rate 
of the cardiac pulsations is lessened, and for a time the energy of the ven- 
tricular systole is increased, but afterwards the pulsations become feeble, and 
finally the heart is arrested in diastole; the contractions cannot be re-estab- 
lished by the use of atropia. In the mammal, the rate of the pulse is 446 
SYSTEMIC REMEDIES. 
decreased, and after small doses, the arterial pressure at first increased. By 
large doses the pressure is much diminished. Section of the pneumogas- 
trics does not affect the cardiac action of the drug. M. Rummo finds that 
iodoform acts first upon the nerve-centres, and finally upon the trunks of 
the nerves and upon the muscles. After very large doses there is albumi- 
nuria and even haematuria. 
After death from iodoform, a very wide-spread, fatty degeneration is to 
be found. This change appears to commence in the liver, and to rapidly 
involve all tissues of the body. M. Floucaud (These de Montpellier, 1872) 
states that there is a very distinct alteration of the blood-corpuscles. 
By the alimentary canal iodoform is absorbed very slowly, from wounds 
it is taken up with comparative freedom. Zeller believes (Zeitschrift fur 
Physiolog. Chemie, Bd. viii. 70) that there is always an albuminous com- 
pound of iodine formed at the seat of absorption. The iodine escapes from 
the body by all the secretions as well as by the breath, partially as an iodide, 
partially as an iodate, and partially in the form of a new organic compound 
of iodine.* According to the researches of M. Rummo, the elimination 
of iodine commences within one hour after the stomachic ingestion of the 
iodoform, and goes on so slowly that the haloid can be found in the urine 
three days later. 
It is probable, as Prof. Binz teaches, that iodoform acts by liberating 
iodine in contact with the tissues, since Moeller has found that the iodates 
and iodic acid cause similar symptoms (Inaug. Diss., Bonn, 1877), and Dr. 
Schwerin has shown that methyliodide is also anaesthetic and hypnotic 
(Centralb. f. Med. Wissensch., 1884, 146). 
When iodoform is applied in strong solution, or in substance, it acts as a 
very powerful local anaesthetic. Thus, a suppository containing it, if intro- 
duced into the rectum, will so benumb the parts that defecation may take 
place without the person or animal being aware of it. 
Therapeutics.-Iodoform has been used internally as an alterative and 
analgesic in syphilitic rheumatism and night-pains, and in other forms of 
neuralgia. Dr. Stiles Kennedy highly commends it (Med. and Surg. Rep., 
Jan. 1870, p. 50), and Lazansky finds it very useful in some cases (Cen- 
tralb. Chirurgie, 1876, 219), but that it fails in others; he gives ninety grains 
a day. Dr. J. Moleschott (Loud. Med. Record, Nov. 1878) praises it most 
highly as an absorbefacient, affirming that by its use he has obtained absorption 
of various lymphatic tumors, pleuritic, pericardiac, and other effusions, and 
has even cured acute hydrocephalus and leukxmia. He relies especially upon 
* For an important bibliography, see the paper of M. Rummo. For details as to 
elimination and discussion of methods of finding the iodine in the urine, consult 
Johannes Grundler, Schmidt's Jahrb., Bd. ccii. 232; Prof. Harnack, Berlin. Klin. 
Wochens., 1883, No. 47, also Zeits. f. Physiol. Chern., viii. 158, 1884; A. Zeller, Arch. f. 
Klin. Chir., xxviii. 590; Dr. E. Baumann, Schmidt's Jahrb., Bd. ccii. 233; Verhandl. 
Deutsch. Gcsell.f. Chemie, Berlin, 1882, xi. 219. ALTERATIVES. 
447 
its external employment in the form of a collodion (1 part of iodoform, 15 
of elastic collodion). So soon as the collodion has dried, he covers it with 
a film of solution of gutta-percha. Dr. Von Hoffer has used it hypoder- 
mically (three to five grains a day) in syphilis, and claims that so employed 
it greatly increases the number of the red corpuscles. Dr. E. Thomann also 
bears testimony to the value of these hypodermic injections in secondary 
syphilis (Centralb. f. Med. Wissen., Oct. 1881). Iodoform, however, has not 
come into general use, and, in the extensive trials made with it at the 
Philadelphia Hospital, has failed to sustain its first reputation in syphilitic 
disorders. 
Whatever position iodoform may finally acquire as an internal remedy, 
there can be no question as to its value when employed locally. It is useful 
in cases of painful ulcers, even when they are cancerous* serving to alleviate 
pain and to promote cicatrization. At first employed especially in syphilitic 
affections, it is now found to act equally well in indolent leg-ulcers and other 
non-specific abrasions, and is thought to act not only as a local anaesthetic, 
but also as a decided stimulant to nutrition. Within the last few years 
it has been very freely employed in Germany as an antiseptic dressing to 
wounds, and the testimony is so strong that it is difficult to avoid believing 
that it is the most certain remedy of this class. It is, however, affirmed to 
have no power in preventing erysipelas, and used freely is very dangerous 
to the patients. It is employed either in the form of powder dusted in the 
wound, or as dressings saturated with it, the first method being at once the 
more effective and the more dangerous. The quantity required to take life 
is uncertain. Dr. Langenstein attributes a death to four grammes ( Wien: 
Med. Wochensch., 1882, xxxii. 1051). The cause of death seems, however, 
doubtful. Dr. Czerny reports death from six grammes, not doubtful (Ibid., 
p. 180). 
Administration.-Iodoform may be applied to ulcers in powder, in 
solution, or in ointment (Unguentum lodoformi-1 to 10, U.S.). When 
there is a great deal of pain, especially if there be much discharge, the 
powder may be preferred. In uterine cancer, in painful hemorrhoids, cacao 
butter suppositories, containing from five to ten grains of the drug, should 
be employed. Owing to the bad odor of the drug, its application about the 
mouth and throat is often objected to. According to Dr. Lewis Elsberg 
(Phila. Med. Times, Oct. 4, 1873, vol. iv. p. 4), if to four parts of absolute 
ether (Squibb's) one part of crystallized iodoform be added, and the whole 
shaken in a red glass flask, a solution is obtained of sufficient strength for 
* Consult papers by Dr. G. Volker {Bulletin de Therapentique, t. Ixxiii., Dec. 1867) and 
Dr. FSreol {Ibid., t. Ixxiv., May, 1868). The surgical reader may consult with advantage 
the following additional references: Correep.-Blatt f. Schweiz. Aertz., 1882, xii. 609; 
Deutsch. Med. Wochensch., Berlin, 1882, viii. 146; Centralb. f. Chirwrgie, viii. 755, ix., 
various papers; Journ. Med. de Bordeaux, xi. 205; Allgem. Wien. Med. Zeitung, 1881, 
xxvi. 455; Wien. Med. Presse, 1882, xxiii. 201. 448 
SYSTEMIC REMEDIES. 
effectual use in diseases of the mouth, and free from udor other than that 
of ether. 
OLEUM MORRHUU-OOD-LIVER OIL. U.S. 
Cod-liver oil is obtained from the liver of Gadus morrhua and other 
species of Gadus. In the manufacture of the so-called shore oil, the only 
variety usually employed in medicine, the fish caught near land are brought 
at once to the shore, and the oil is obtained from the fresh livers by one or 
other of several processes. The original custom was to put the livers into 
large kettles, add water, boil to a pultaceous mass, drain off the liquid, allow 
it to stand, and finally to skim the oil as it rose to the top. A more modern 
method is to heat the livers by steam applied to the outside of the vessel 
containing them, to allow drainage, and to proceed as in the process just de- 
scribed. I am informed that at present some of the finest brands of oil are 
prepared by forcing currents of steam at high pressure through the mass of 
livers, tearing them in this way to pieces and melting out their oil. Shore, 
oil should be a perfectly limpid, yellow, thick oil, free from rancidity, 
and having the peculiar taste and smell of the oil well developed. Straits 
oil or Banks oil is prepared from those fish caught at the " Banks," far 
from land. 
The livers are thrown into casks and allowed to stand for a greater or less 
length of time and to undergo more or less complete putrefaction, until, on 
the return of the fishing-smack to port, they are thrown into water-boilers 
and treated in a manner similar to that previously described. Of straits oil 
there are two varieties : the brown oil, which is much darker than shore oil, 
and much more nauseous to the taste and smell; and the black oil, which is 
very dark, and still more disgusting in its evidences of rancidity. Both of 
these varieties are largely used in the preparation of leather. 
When a mineral acid (especially the sulphuric) is added to cod-liver oil, 
the well-known biliary play of colors occurs; but this does not prove the 
genuineness of the drug, or demonstrate that it is derived from the codfish : it 
only shows that it is a liver oil. It is scarcely to be doubted that not rarely 
the livers of other fish are largely mixed with those of the Gadus morrhua, 
but it is not probable that this often happens to such an extent as to inter- 
fere with the therapeutic value of the product: indeed, it is far from certain 
that cod oil is really superior to that produced by the same organ of other 
fishes. Be this as it may, the physical properties afford the only known test 
as to the genuineness of the drug. Cod-liver oil is a very complex substance, 
containing, according to the analysis of De Jongh, glycerine, oleic, margaric, 
butyric, and acetic acids, gaduin, various biliary principles, such as fellinic, 
cholic, and billifellinic acids, iodine, chlorine, traces of bromine, phosphorus, 
phosphoric acids, and various other substances. According to the U. S. Dis 
pensatory, the proportion of iodine never exceeds one part in two thousand. 
In De Jongh's analysis the greatest amount was found in the light-colored ALTERATIVES. 
449 
oils, and was only four-hundredths of a grain in one hundred grains of the 
oil. Gaduin is a peculiar, dark-brown substance, which is probably medici 
nally inert. When to cod-liver oil ammonia is added, there can be obtained, 
by distillation, a peculiar ammoniacal base, trimethylamin (commercial pro- 
pylamin), which exists in no other officinal oil, but occurs in the ergot. 
Physiological Action.-As is well known, all fatty substances when 
taken into the system have a tendency to cause deposition or formation of 
fat in the body. Cod-liver oil certainly shares this property in an eminent 
degree. Dr. Pollock, as quoted by Prof. Stille, has found that if there be 
given of it to pigs from one to two ounces per diem, to sheep one ounce, and 
to bullocks from three to nine ounces, it is digested, and aids in fattening 
the animal; larger amounts than those noted, in Dr. Pollock's experiments, 
always deranged very seriously the digestive function. No close studies of 
the effect of cod-liver oil upon healthy men have, that I am aware of, been 
made. Undoubtedly it tends to produce obesity ; but, as no other oil is able 
to supply its place in various chronic diseases, it must have some influence 
upon nutrition not shared by ordinary fatty matters, and therefore is an 
alterative. 
The history of the clinical use of oleum morrhuae certainly indicates that 
it influences the constitution of the blood. It is an every-day occurrence 
to see pale, anaemic patients become, whilst taking it, rosy and plethoric. 
According to the analysis of the blood of a patient made by Simon, there is, 
during its use in phthisis, a great increase in the amount of solids in the 
blood, a diminution of the fibrin, and an increase in the albumen. The ex- 
aminations of Dugald Campbell (British and Foreign Med.-Chir. Review, 
1856, vol. xvii. p. 21) have confirmed the results of Simon. It is very 
probable that cod-liver oil has some peculiar influence upon the blood-making 
organs. Upon the various single functions of the body, except the digestive, 
cod-liver oil has no apparent immediate effect, disturbing directly neither the 
nervous, motor, respiratory, circulatory, nor secretory movements. When by 
its use the general nutrition is improved, all the functions seem to share 
equally in the improvement. Cod-liver oil has undoubtedly, when given with 
sufficient freedom, a tendency to cause indigestion and looseness of the bowels. 
All oils are of difficult digestion, and when too much of the oleum morrhuae 
is exhibited in man, as in animals, it exerts a deleterious local effect upon the 
alimentary apparatus. 
Much speculation has been indulged in as to which of its ingredients cod- 
liver oil owes its peculiar medicinal properties. Certainly, however, no real 
light has been shed upon this matter, and the present probabilities are that 
it acts as a whole,-i.e., that its virtues depend upon the peculiar combi- 
nation. 
If the experiments of Dr. Oswald Naumann (Archiv der Hetlkunde, 1865, 
p. 536) be as accurate as they appear, he has certainly proven that cod-liver 
oil has physical properties which must aid in its usefulness, although it is not 450 
SYSTEMIC REMEDIES. 
probable that its value depends solely, or even in great part, upon them. He 
first tested the rate at which various oils pass through fresh moist animal 
membranes when pressed upon by a column of mercury or by the weight of 
the atmosphere over an exhausted receiver, and found that cod-liver oil passed 
much more rapidly than any of a number of oils tried. Apparently this 
power depended in some measure upon the presence of the biliary principles, 
since if it was deprived of them the rate of its passage was greatly lessened, 
but was again increased by the addition of a little bile. The investigator 
then, opening the abdomen of cats, separated in each animal by ligatures 
two knuckles, of equal length and entirely similar, from the remainder of 
the intestines. Into each of them he injected a certain amount of bile, and 
then into one ordinary oil, into the other cod-liver oil; and when the ani- 
mals died, some hours afterwards, it was always found that much more of 
the oleum morrhuae was absorbed than of the other oil. These experiments 
were, unfortunately, too few and incomplete to be decisive, but certainly they 
indicate that the oleum morrhuae is more easily and rapidly absorbed than 
other animal oils. The superior fitness of the oil for absorption is in accord 
with the clinical observation of M. Berthe (L' Union Med., x. 1856), that 
cod-liver oil could be taken longer than other fats without appearing in the 
faeces, and is confirmed by Prof. Bucheim (ArcA. Exper. Path. u. Therap., 
Bd. iii.) as well as by J. Gad (His and Braunes Archiv fur Anatom., 
1878). Both Bucheim and Gad believe that this absorbability depends 
largely upon the presence of free fatty acids in the oil. 
Dr. Naumann's last series of experiments were directed to discovering 
the comparative ease with which animal oils and the cod-liver oil were 
oxidized. For this purpose he used a test solution of the permanganate 
of potassium, and on adding to given bulks of this, in test-tubes, equal 
amounts of the various oils, noted the changes of color induced by the 
reduction of the permanganate. He found that cod-liver oil was the first 
to be affected. It is evident that the power of being easily absorbed and 
easily oxidized fits a fat for use in the animal economy; but the peculiar 
value of oleum morrhuae does not depend solely upon these properties. 
Therapeutics.-Cod-liver oil is especially useful in that condition of 
system in which, with general lowered tone, there is a tendency to cellular 
hyperplasia, to the formation of 11 exudations" composed of imperfectly- 
developed cells, which, in the great majority of cases, from the very begin- 
ning are incapable of development into perfect entities, having only one 
potential quality, that of dying. There are various types of this diathesis, 
or condition of system. In one of them there is a tendency to increase in 
the lymphatic glands; to multiplication, at the expense of development, of 
their cellular elements,-i.e., to the formation of numerous imperfectly-devel- 
oped cells, and, finally, to the destruction of them. The death of these cells 
is partly due to their inherent qualities, and is partly the result of the pressure 
which they exert upon one another and upon their sources of food-supply ALTERATIVES. 
451 
If they undergo a slow, fatty degeneration, with desiccation, cheesy deposits 
are formed; if a rapid, fatty change, with abundance of moisture, pus and 
abscesses are produced: in either case, ulceration is the final result. This is 
the so-called scrofulous diathesis,-scrofulosis. In another of this group of 
diatheses, the tendency to cellular hyperplasia affects the mucous membranes 
of the air-passages, and the patient, on the slightest provocation, suffers from 
catarrh, until finally a multiplication of cells occurs so rapidly as to fill up 
a greater or less number of the air-vesicles of the lungs, generally those of 
the apex, and " consumption" results ; or else, an attack of pneumonia being 
produced by some exposure, the exudation is cellular rather than fibrinous, 
and catarrhal pneumonia, ending in the majority of cases in a more or less 
rapid phthisis, occurs. 
As already stated, it is especially in these conditions of system that cod- 
liver oil is so extremely useful. Preceding the development of active disease 
in these cases there is very generally a recognizable stage, marked by weak- 
ness, a tendency to emaciation, more or less anaemia, and other symptoms, 
which the present is scarcely the place to consider in detail. In this stage, 
cod-liver oil is exceedingly efficacious, and its use, combined with proper 
hygienic measures and the exhibition of other suitable drugs, may often suc- 
ceed in warding off fatal disease. In scrofulosis, it is useful in all stages, but 
should never be relied on to the exclusion of other drugs. Its effects are 
more marked during the ulcerative and suppurative stages, but in most cases 
it aids iodine very materially to reduce the enlarged glands in the earlier 
periods of the disease. 
There are various diseases of the bones, dependent upon or resulting from 
a scrofulous taint, which are most favorably affected by cod-liver oil. Some- 
times the disease attacks the articulating surfaces, giving origin to chronic 
inflammations of the joints,-white swellings ; sometimes it is the body of 
the bones, especially of such as are composed chiefly of spongy tissue, that is 
affected, and caries, with subsequent abscesses, results. In these, as in all 
other forms of scrofulosis, cod-liver oil is almost a specific. An affection 
probably not identical with, but closely allied to, scrofula, is rickets ; cod- 
liver oil is of great value in this complaint. In certain pale cachectic 
children there may be found a swollen, tumid belly, perhaps with evident 
enlargement of the liver, and very generally, if not always, with enlarge- 
ment of the mesenteric glands. This is the so-called tabes mesenterica, 
which is sometimes relieved, or even cured, by the exhibition of cod-liver 
oil. 
The value of cod-liver oil in what is often very incorrectly called the "pre- 
tubercular" stage of phthisis has already been alluded to, but is so important 
that it will bear reiteration. There can be no doubt that consumption often 
commences with catarrh, and is often developed slowly as the result of fre- 
quently "catching cold." Whenever a patient is feeble, pale, somewhat 
anaemic, complains of his liability to catch cold on the slightest exposure, 452 
SYSTEMIC REMEDIES. 
even though no local disease exists anywhere, or rather because no local dis- 
ease exists anywhere, there is cause for alarm; and it is of the most vital 
importance that the patient be put upon a tonic treatment whose basis is 
cod-liver oil, be fed upon nutritious diet, and have the hygiene of his daily 
life regulated, especial care being taken to avoid any exposure to cold. In 
the advanced stage of chronic phthisis the remedy is less efficacious, in that 
it much more rarely effects a cure than in the pre-tubercular stage; yet it 
does more good than all the other remedies of the Pharmacopoeia combined, 
-alleviating the cough, increasing the strength, weight, and general health 
of the sufferer, often retarding or even arresting the pulmonic disorganiza- 
tion, almost always greatly prolonging life, and sometimes, in conjunction 
with other measures, effecting a cure. It is a question of some importance 
to decide how the remedy does good in these cases. Its value, before the 
occurrence of any lesion, as a preventive of consumption, indicates that its 
influence during phthisis is not directly upon the local lesion, but upon the 
general condition of the system. This inference is borne out by clinical 
experience. The general symptoms commence to improve before the local 
lesions, and sometimes, although the patient fattens and gets stronger for a 
time, the pulmonic affection steadily increases ; again, in some instances the 
oil fails to increase the weight of the patient or sensibly to affect the general 
nutrition, and in these cases it never does any good. In true tuberculosis^ 
cod-liver oil, like all other remedies, is of very little, if any, value. 
In cases of defective nutrition, when pallor, anaemia, loss of strength, and, 
perhaps, emaciation, occur without any obvious cause, cod-liver oil is often 
of great service, especially when the subject is a child. Indeed, in children 
these symptoms are simply the result of a very mild action of the same 
depressing causes whose more intense malign influence produces scrofula. 
In persons broken down with any of those chronic diseases which take 
the form of a dyscrasia, the remedy is often of great service. Thus, in 
the cachexia of tertiary syphilis it is invaluable. The disease by whose 
relief and cure cod-liver oil first achieved its reputation is chronic rheuma- 
tism. I think, however, that it is much more efficacious in those cases in 
which the rheumatic disease has been grafted upon a scrofulously-tainted 
constitution, or in those cases in which the patient has been broken down 
by the disease, or by other agencies, so that there is what may be styled a 
general nutritive dyscrasia, than in simple chronic rheumatism ; yet in obsti- 
nate sciatica and lumbago trial of it should always be made. In gout, oleum 
morrhuae is of little service, and should be used only in the very chronic 
form of the disease, and when there is a generally disordered nutrition. 
In nervous affections, especially in neuralgia, in skin-diseases, in fact, in 
any chronic disorder in which the patient is feeble and presents a condition 
of general depraved nutrition somewhat similar to that seen in consumption, 
cod-liver oil may be exhibited with advantage. 
Administration.-The dark oil has been esteemed most highly by some ALTERATIVES. 
453 
authorities, especially by De Jongh, who asserts that it contains more of the 
biliary principles than does the pale oil, and even believes that the products 
of decomposition in it increase its beneficial action. It is, however, never 
employed at present, because of its exceedingly repulsive taste, and because 
it is very prone to disagree with the stomach. One of the difficulties in the 
use of even the pale oil is the very common real or imagined inability of 
the patient to take it. Without doubt, this very often arises from its nau- 
seous taste, to lessen or disguise which various expedients are resorted to, 
with more or less doubtful success. Sometimes a piece of salt taken into the 
mouth just before the oil, which is also immediately followed by another 
lump of salt, suffices. It is said that some prefer the oil in emulsion made 
with some strong aromatic water. The addition of an equal part of glyce- 
rine and a half to one drop of the oil of bitter almonds to the dose certainly 
lessens the taste of the medicine. Some patients take it best in the froth of 
ale or porter, the glass being first half filled with the malt liquor, then the 
oil being carefully floated on the top of it without touching the sides of the 
glass, and the remainder of the vehicle put upon the top of it. Most of 
the patients requiring oil are also benefited by the use of alcohol; and my 
experience with the remedy is that the most generally successful plan of ex- 
hibition is to place, according to the exigencies of the case, from one to three 
tablespoonfuls of whisky or brandy in a tumbler, add not so much water, 
put the oil in the centre, and toss the whole down the throat, the head being 
held well back, the mouth wide open, and the lips not touched by the medi- 
cine. The stimulus of the alcohol often enables the stomach to digest the 
oil when otherwise it could not do it. Sometimes it is necessary to com- 
mence with a single small daily dose, even a single teaspoonful, which is best 
taken at bedtime, and gradually to increase the amount as the patient be- 
comes habituated to it. Children almost always learn to tolerate the taste 
of the oil, or even become in a short time fond of it. The usual dose is for 
an adult a tablespoonful three or four times a day; for a child one year old, 
a teaspoonful. When infants cannot tolerate cod-liver oil by the mouth, in- 
unctions may sometimes be practised with advantage. Drs. N. A. Randolph 
and A. E. Roussel state that they have seen in such cases the oil appear 
tn the faeces (JPhilad. Med. Times, xiv. 239). 
Phosphoric acid, which results from the burning of phosphorus iu the air, 
is prepared by the action of sulphuric acid upon bone-ash, which consists 
chiefly of the phosphate of calcium. The officinal acid is the tribasic acid 
of chemists. Acidum Phosphoricum Dilutum, U. S., contains twenty per 
cent, by weight of the stronger acid. It is a colorless, inodorous, sour 
liquid, of a syrupy consistence, which has a very acid reaction, but is not 
corrosive to animal tissues. The bibasic pyrophosphoric acid is said to be a 
cardiac sedative (Journ. Anat, and Physiol., xi.). 
AOIDUM PHOSPHORICUM-PHOSPHORIC ACID. U.S. 454 
SYSTEMIC REMEDIES. 
Therapeutics.-Phosphoric acid has been used to a considerable extent 
abroad as a tonic and alterative in scrofulous affections. Upon the digestive 
organs, in my experience, it has little or no effect, and I have never been 
able to perceive that it is at all astringent or exerts any alterative influence 
upon the glands of the alimentary canal. In scrofulosis and rickets it is, I 
think, inferior to the phosphates. 
Phosphate of Calcium.-The phosphate of calcium is, as is well known, 
an essential ingredient of bones, of which, indeed, according to the analysis 
of Berzelius, it forms more than fifty per cent. (Traits de Chimie, Paris, 
1833). It should not be forgotten, however, that it exists in notable quan- 
tities in all the tissues, and is probably as essential an ingredient of their 
structure as of that of bone. Whenever it is taken out of the food of ani- 
mals, although they be otherwise well fed, sooner or later they waste, sicken, 
and die. Chossat fed pigeons exclusively on corn containing very little of 
the phosphate of calcium, and found that after some months they wasted, 
were affected with diarrhoea, and died (Comptes-Rendus, t. xiv.). Accord- 
ing to Roloff ( Virchow's Archiv, Bd. xlvi. p. 302), a herd of cows which 
had been fed upon hay from a certain meadow were very much out of health, 
and suffered from fragilitas ossium. On examination, the hay was found to 
be nearly free from earthy salts, and upon bone-meal being given to the cows 
they recovered their health in four weeks. The same authority further states 
that, in some meadows with which he is acquainted, the disease is endemic 
among the cows because the grass is so poor in phosphates. Haubner also 
affirms (Schmidt's Jahrb., Bd. cli. p. 138) that cattle fed exclusively upon 
potatoes, or upon roots very poor in phosphates, fail to fatten, become weak, 
and are apt to suffer from caries, but that if the phosphate of calcium is given 
they rapidly improve; and E. Voit (Zeitsch. f. Biologic, xvi. 198) states that 
rachitis without emaciation can be produced in three or four weeks in young 
dogs by taking the phosphate of lime out of the food. Hegar (Schmidt's 
Jahrb., Bd. cli. p. 138) has considered the absorption of the phosphate of 
calcium, when given as a medicine, very doubtful, because when he exhibited 
it freely there was no increase in the amount of the phosphoric acid or of 
the earthy bases in the urine. B'dker (Ibid.'), on the other hand, has found 
that if the drug be given to those wet-nurses whose milk contains an abnor- 
mally small amount of phosphates, the milk soon becomes rich in the earthy 
salts, and L. Perl ( Virchow's Archiv, Ixxiv. 54) has found that administra- 
tion of the phosphates is followed by an increase in their amount in the urine. 
Further, Albert Riesell (Hoppe-Seyler's Medidn.-chem. Untersuch., p. 318) 
has shown that the phosphates are eliminated by the intestines, and there- 
fore that even if it were a constant fact that their renal excretion is not 
augmented by their administration, it would not prove that they are not 
absorbed. M. Teissier has found that in the early stages of phthisis there 
is a very great increase in the excretion of the earthy phosphates by the ALTERATIVES. 
455 
kidney (Ze Mouvement Med., Sept. 1875), and the researches of Prof. 
Beneke* (Schmidt's Jahrb., Bd. cli. p. 138) are said to have shown that this 
increased renal elimination, which plainly occurs in several allied diseases, 
is not accompanied by any increase in the amount ingested in the food, or 
decrease of the amount eliminated by the intestines, and that, consequently, 
there is a very decided wasting of the normal phosphates of the body. 
This being so, the use of phosphates in these diseases is as rational as that 
of iron in anaemia. 
Therapeutics.-According to Dusart (Archives Gin,., 6e s^r., t. xv.), to 
Beneke (loc. citj, and to Teissier (Joe. citj, the diseases in which the phos- 
phate of calcium is especially indicated are rachitis, osteomalacia, phthisis, and 
scrofulosis. It is evident that the indications for the earthy salts are very 
strong in the first two of these affections; and clinical experience has cer- 
tainly borne out the results of a priori reasoning. In scrofulosis, the call for 
the drug is not so plain; but Prof. Beneke states that in many cases, if the 
urine be examined, it will be found to be abnormally rich in earthy phosphates, 
and that under these circumstances the remedy is of the greatest value. Cases 
are not rare of children of slow development, often seemingly well nourished 
and robust, and yet really pale and with flabby flesh, but without any distinct 
symptoms or marks of scrofulosis or of rachitis. Under these circumstances, 
the child is in a condition allied to that of the diathesis spoken of, and of the 
value of the phosphate of calcium I have no doubt. In cases of delayed 
union after fracture, the present remedy is seemingly indicated, especially since 
Dusart (loc. citj has experimentally proven that when given to animals whose 
bones have been broken it hastens union and makes the callus abnormally 
heavy and firm. The phosphate of calcium has been recommended in various 
diseases other than those mentioned, but its value is much more doubt- 
ful. Bennett commends it in chronic phthisis; Piorry (Journ. de Chim. 
Med., t. ix., 1863), in syphilitic periostitis; Beneke, in syphilitic gummata; 
Schbnian, and also Kugelmann, in the menorrhagia of anaemic women. 
Prof. Beneke calls attention to the use of it during pregnancy, and believes 
that it exerts an influence on the foetus, so that women who have borne, it 
may be, only rachitic or scrofulous children will bring forth healthy off- 
spring. 
Administration.-The U. S. Pharmacopoeia recognizes the Precipitated 
Phosphate of Calcium (Calcii Phosphas Prsecipitatusf a white, inodorous, 
tasteless powder, which is prepared by dissolving bone-ash in muriatic acid 
and precipitating with ammonia. This may be employed in doses of ten 
grains three or four times a day, but, owing to its insolubility, is not so use- 
ful as the so-called lacto-phosphate of lime. This preparation, originally sug- 
gested by Dusart and Blache (Archives Generales, t. xv. p. 67), is made by 
* I have not had access to the original memoir of Beneke, Zur Wurdigung des Phos- 
phors Kalkes in physiolog. und therapeut. Beziehung, Marburg, 1870. 456 
SYSTEMIC REMEDIES, 
the action of lactic acid upon the phosphate of calcium, and was found by 
those experimenters to be soluble in all proportions, not only in water but 
also in the gastric juice. There is prepared by the druggists in this city an 
emulsion containing fifty per cent, of cod-liver oil and two grains of the lacto- 
phosphate of lime to the drachm, which has appeared to me to be the best 
of all the alterative preparations in cases of the character spoken of in the 
section on therapeutics. It certainly is very often more easily digested than 
the pure oil. The dose is a teaspoonful to a tablespoonful, or even more, 
according to the age. 
Under the name of chemical food, or compound syrup of the phosphates, a 
very complex preparation has been much used in disorders attended with im- 
paired nutrition, such as the lacto-phosphate of lime has been recommended 
in. I have had no experience with it, but very much doubt its being superior, 
or even equal, to the latter drug. 
OOLCHICI SEMEN-COLCHICUM SEED. U. S. 
OOLCHICI RADIX-COLCHICUM ROOT. U. S. 
Colchicum autumnale, or meadow saffron, whose products the above drugs 
are, is a little plant growing in Europe and England. It is not really the 
root which is officinal under the name of colchicum root, but the thick- 
ened Sweden end of the stem, with the little bulblet whose office it is to 
develop a new plant. This corm is solid and fleshy, an inch and a half to 
two and a half inches in length, with a longitudinal groove, having a nail- 
like process (the bulblet) at its base. In the shops it is very commonly kept, 
in transverse slices, which are notched and cordate; the taste is bitter, hot, 
and acrid. Colchicum seeds are nearly round, about an eighth of an inch in 
diameter, and of a bitter, acrid taste. The active principle of both seed and 
corm is an alkaloid, Colchicia, whose individuality was first made out by 
Geiger and Hesse. According to Hiibler, it is slowly soluble in water, readily 
so in alcohol, and not at all so in ether: with concentrated nitric acid it makes 
a violet solution, which when diluted with water becomes yellow; with 
concentrated sulphuric acid it strikes an intense yellow. By the action of 
mineral acids and by other agencies it is resolved into a brownish-green 
insoluble resin and a crystallizable neutral substance, soluble in water, Col- 
chiceina. 
Physiological Action.-When taken in dose of sufficient size, colchi- 
cum acts upon man as a poison, producing repeated, uncontrollable vomiting, 
with nausea and retching, and also violent purging of at first serous charac- 
ter ; afterwards the passages become smaller, more mucous, with flakes in 
them, and finally in some cases bloody. Abdominal pain may be absent or 
present, but if present is generally griping; sometimes there is gastric burn- 
ing. Nervous symptoms have been prominent in some of the severe cases. 
In one instance, it is said, a feeling of numbness or prickling was complained ALTERATIVES. 
457 
of by the patient; but this seems not to be common. Spasms are very fre- 
quent, and sometimes convulsions, which may be fatal, are present. Muscular 
pains are not rarely experienced, in some cases replacing the spasms, and 
probably in all other cases coincident with them is great muscular weakness, 
amounting, as death approaches, to paralysis. Finally, a condition of cob 
lapse develops itself, the circulation fail's more and more, the pulse, which has 
been frequent and feeble, becomes rapid and thready, the skin cold, pale, or 
livid, bedewed with sweat, and death from exhaustion results. Consciousness 
is preserved until the last. The effect of lethal doses of colchicum on the 
urina'y secretion varies; sometimes the kidneys seem to be nearly unaffected 
almost to the last; sometimes their functional activity is decidedly increased, 
but in other cases it is diminished, and even suppression of urine has been 
noted. The symptoms produced by the largest therapeutic doses of col- 
chicum are slowing of the pulse, nausea, vomiting, abdominal uneasiness, 
borborygmi, and free purging, together with a sense of prostration and of 
weakness. The occurrence of the inflammatory changes after the hypoder- 
mic injection of colchicia proves that the irritant principle of colchicum acts 
by absorption, and that the intestinal symptoms are not simply due to a local 
action,-deductions confirmed by the chemical experiments of Aschoff, who 
found colchicia . in the liver, kidneys, heart, lungs, and blood of a rabbit 
poisoned with one and a half grains of it. 
Upon most animals colchicum acts very much as it does upon man, in 
poisonous doses producing, as prominent symptoms, severe and often bloody 
purging, vomiting, great prostration, embarrassed respiration, finally more or 
less pronounced paralysis, and death, not rarely preceded by convulsions. 
Reflex actions are lessened, and finally abolished (Albers, Rossbach), in the 
frog; but Rossbach affirms there is a precedent stage of convulsions with 
excessive reflex activity; in warm-blooded animals this first stage of excite- 
ment is rarely, if ever, seen. According to the elaborate experiments of 
Rossbach, the motor nerves and the striated muscles are not affected by the 
poison, but the higher nerve-centres, the spinal cord, and the peripheral 
sensory nerves suffer palsy. The same observer found that the circulation 
was very little influenced, that the pneumogastrics were not affected until 
near death, that the splanchnic and intestinal vagi escaped altogether. In 
no case do reflex spinal convulsions occur at any time. 
A curious fact noticed by Schroff, which shows that colchicia really has little 
direct influence upon the nervous system, is that the rapidity of death is not 
at all in proportion to the size of the dose. Thus, in his experiments, the 
fatal result occurred in rabbits after one and a half grains of the alkaloid, in 
fourteen hours; after fifteen grains, in eleven hours. This fact, which has 
been confirmed by Rossbach (^Pharmalc. Untersuch., Bd. ii. p. 24), seems to be 
explicable only by the supposition that colchicia kills chiefly by its irritant 
action on the alimentary canal, and, not being in any dose corrosive, requires 
time to work out the fatal result, through the instrumentality of a gastro- 458 
SYSTEMIC REMEDIES. 
enteritis. This deduction is confirmed by the long-protracted course of the 
poisoning after small doses. Thus, Aschoff noted death on the ninth day 
in a pigeon which had received one-fourth of a grain of the alkaloid. 
After death from colchicum, the blood is generally found very dark and 
imperfectly coagulable; but whether this is due to a direct action of the 
poison, or is the result of the slow death by asphyxia and exhaustion, is 
uncertain. The chief changes are, however, in the alimentary canal, the 
mucous membrane of which is much swollen, intensely congested, sometimes 
ecchymotic, or with blood free in the intestine. 
Geiger (Annah Chem. Pharm., vii. 274), Hoppe, Aschoff ( Vierteljahres- 
schrift fur Prakt. Pharm., vi.), Schroff (Oester. Ze it schrift f. Prakt. IIeilk.t 
1856), and Albers (Deutsches Klinik, 1856, xxxvi.), have experimented with 
colchicia^ and have shown that it causes symptoms similar to those produced 
by colchicum,* of which it is without doubt the active principle. The 
closer studies of Schaitanoff, Rossbach, and Paschkis (Schmidt1 s Jahrb., 
Bd. cci. 2'32) appear to have yielded contradictory results. Schaitanoff and 
Paschkis found that the alkaloid notably increases the arterial pressure; 
Rossbach, that the circulation is but little affected; whilst in Rossbach's 
experiments there was a narcosis which seems to have been replaced in the 
experiments of Paschkis by a peculiar loss of sensibility. The last ob- 
server noted also that neither the vagi nor splanchnics were affected. All 
observers appear to agree in stating f that the chief force of the poison is 
expended upon the alimentary canal, at least in mammals, and that after 
death, even when the alkaloid has been given hypodermically, the intestinal 
mucous membrane is found much inflamed, as is also very frequently the 
inner coat of the stomach. Paschkis has found the normal excitability of 
intestinal peristalsis by galvanization of the pneumogastric nerve is destroyed 
by colchicine. 
The action of poisonous doses (one to two grains) of colchiceina has been 
studied upon dogs by Dr. Sami. R. Percy. The symptoms are very similar 
to those produced by colchicia; they are-increase in the frequency of the 
pulse, severe purging with tenesmus, vomiting, finally great slowing of the 
pulse and failure of the heart's action, and death without convulsions. The 
urine, at first increased, was afterwards suppressed. On post-mortem exami- 
nation, the mucous membrane of the intestines was found highly inflamed, 
that of the stomach slightly so, and the heart and arteries were filled with 
black tarry blood, similar to that of colchicine-poisoning. On the other hand, 
Paschkis asserts that 1.5 grains of colchiceine injected into the jugular vein 
of a dog-produced no results whatever. It is evident the two experimenters 
had different substances. 
* Dr. R. Lewins's experiments (Edinburgh Med. and Surg. Journ., vol. Ivi., 1841) may 
be used for comparison. He used colchicum. 
j- Unfortunately, the works of nearly all these investigators are known to me only at 
second hand. Not having had access to the original papers, I have been forced to depend 
upon abstracts in various journals. ALTERA T1VES. 
459 
The main interest to the therapeutist in the physiological study of col- 
chicum, of course, is in regard to its action in small therapeutic doses. The 
most prominent result of the ingestion of such amounts is gastro-intestinal 
disturbance, as shown by abdominal uneasiness, colicky pains, borborygmi, 
loss of appetite, moderate purging, and sometimes nausea,-symptoms differ- 
ing in degree only from those of poisoning by the drug. Before they come 
on, however, there is a lowering of the pulse-rate, sometimes as much as 
twelve beats per minute. Upon the skin the medicine occasionally acts, 
producing in some cases diaphoresis, and it is said that the amount of this 
action is in inverse ratio to the effect on the bowels. According to Schroff, 
the one-hundredth of a grain of colchida is rather more than the therapeutic 
dose, and produces purging, lasting for several days, with griping pains, 
cerebral distress, a pulse at first lowered but afterwards accelerated, and a 
secretion of thick lateritious urine. Any nervous symptoms, such as vertigo, 
headache, muscular weakness, which may be present as the result of the 
administration of colchicum, are probably sympathetic upon the gastro-intes- 
tinal irritation. It is evident that colchicum influences the bowels power- 
fully, and probably in this way acts as an eliminative. But in the minute 
doses often used with great advantage in disease, purging does not occur, 
and consequently increased elimination, if it takes place, must be through 
the kidneys: great interest therefore attaches to the influence of the remedy 
upon the urinary secretion. In considering this, the effects of poisonous 
and of therapeutic doses must not be confounded, for it is very evident that 
an irritation which causes suppression of urine may, when present in a much 
milder degree, produce an increased flow. 
It seems very certain that in moderate doses, repeated at regular intervals, 
colchicum very often increases the flow of urine. In 1828, Chelius an- 
nounced that during its administration in gout the amount of uric acid 
eliminated is nearly doubled. Dr. R. Lewins (Edinburgh Medical and 
Surgical Journal, 1841, vol. Ivi. p. 200) submitted the urine of several 
persons suffering from gout, taken before and after the administration of 
colchicum, to Prof. Christison, who found in the colchicum-urine the pro- 
portion of urea nearly double, and that of uric acid greater* than, that of 
the other specimens. 
In 1852 Dr. Maclagan (Edinburgh Monthly Journal of Med. Sci., 3d series, 
vol. xiv. p. 24) analyzed the urine of three cases of rheumatism before and 
after the exhibition of colchicum: in two instances the proportion of urea 
was very greatly increased, that of uric acid slightly so. In the third case 
the effect just noted happened at first, but not afterwards. 
* Dr. Harley {The Urine and its Derangements, Phila., 1872, p. 81) makes the assertion 
that colchicum diminishes the excretion of uric acid and even the urea: as, however, he 
does not deem it necessary to give any authority for the assertion, and as he does not 
appear to have made any elaborate chemical examination himself, not much weight is to 
be attached to his testimony. 460 
SYSTEMIC REMEDIES. 
On the other hand, Prof. Stille states that Graves and Gardner affirm that 
the urates diminish under the use of the medicine. It is evident that these 
different results are not so contradictory as they seem, for it is possible that 
in one case the colchicum may so act as to increase the elimination of urea, 
in another that of uric acid; and that when one of these is increased the 
other may be unaffected, or even diminished. 
Further, when the medicine purges freely it is very probable that elimina- 
tion by the kidneys is lessened; and no account of this is taken by any of 
the observers whose original papers I have seen. Moreover, these observers 
also all contented themselves with noting the proportion of urea and uric 
acid in the urine, when it is evident that the mere proportion, unchecked by 
the absolute amount of urine secreted during the twenty-four hours, is no 
criterion as to the absolute amount eliminated. Dr. A. B Garrod (Med.^ 
Chir. Trans., 1858, xli. 348) has made a study of the subject in such a 
way as to avoid this fallacy, and found that in some cases the amount of 
urea and uric acid eliminated was seemingly lessened, whilst in others it was 
seemingly increased; on the whole no marked effect was produced. More 
precise and extended investigations are still needed to settle the question, 
but there is certainly at present no proof that colchicum in gout materially 
influences elimination. 
The action of the drug upon the urine during health is evidently very 
closely connected with the question just discussed. Here again we find con- 
flicting and insufficient testimony. Dr. Bird (^Urinary Deposits, Phila., 
1859, p. 354) quotes Prof. Kramer's* experiments as showing that colchicum 
does not increase the amount of solids eliminated, and intimates that his 
own investigations had given similar results. Dr. Hammond (Proc. Phil. 
Acad. Nat. Sci., Dec. 1858), on the other hand, in a series of experiments 
in which every care to avoid fallacies, by maintaining equality as to diet and 
exercise, was observed, found that while squill and digitalis only increased 
the watery part of the urine, both the organic and the inorganic solids were 
remarkably increased by colchicum. 
In regard to cokhiceina, the experiments of Prof. S. R. Percy (Amer. 
Med. Times, April, 1862, p. 167) indicate, but are much too few to prove, 
that in gout it increases the elimination of urea and uric acid. 
Therapeutics.-Our knowledge of the use of colchicum in disease is 
purely empirical, based upon clinical experience; and our acquaintance with 
its physiological action is not sufficient to enable us even to explain fully 
what experience has taught, much less to guide us in our use of the drug. 
Gout is the one disease in which colchicum is almost universally recognized 
as a specific. It may be advantageously employed both as a preventive of 
the paroxysm and to lessen its severity when developed. During an attack 
* Kramer's paper was published in Keller's Archives, Dec. 1847, and is entirely in- 
accessible to me. ALTERATIVES. 
461 
of gout, from ten to twenty drops of the wine of colehicum root may be 
exhibited every four hours until some decided evidence of its action, such as 
nausea or slight purging, is induced. It should always be borne in mind 
that although looseness of the bowels may be useful, yet when colchicum 
purges the gouty patient actively it mostly fails in achieving the desired 
therapeutic result. Its action is most favorable when its influence is felt 
chiefly upon the skin and the kidneys. To effect this desired result, it is 
often well to restrain the tendency of the drug to act upon the bowels, by 
combining it with opium. This is especially the case in debilitated subjects, 
in whom anything like over-purgation must be avoided with the most scru- 
pulous care. By large purgative doses of colchicum the paroxysm of gout 
may often be suppressed; but experience has shown that this use of col- 
chicum is dangerous, the suppression being sometimes followed by serious 
internal disease, apparently due to a transfer of the gouty irritation. Be- 
tween the paroxysms, colchicum may be steadily exhibited to the gouty 
subject in small doses (ten drops of the wine of the root three times a day); 
and often great advantage is derived from its combination with the iodide 
of potassium. This combination is especially useful in irregular atonic gout, 
such as is most frequently seen in women of feeble nervous organization 
who have inherited the diathesis, but is sometimes present even in robust 
men. Ten grains of the iodide and ten drops of the colchicum wine may 
be given three times a day. Speculations as to how colchicum cures gout 
seem to me useless in the present state of our knowledge: until we know 
more of the physiological action of the drug and of the nature of the dis- 
ease, one theory seems as good as another. 
In rheumatism, colchicum has been highly recommended by some, but has 
never come into such general use as in gout. In the inflammatory variety 
of the disease it is of but little value, except in purgative doses, and is 
mostly administered in the form of Scudamore's Mixture, which is composed 
of magnesia and its sulphate with wine of colchicum root. In subacute 
rheumatism, the combination of colchicum and iodide of potassium, already 
spoken of, is very useful. 
Colchicum has been administered in various diseases, but when there is no 
rheumatic or gouty taint is at present very rarely used. 
Toxicology.-The symptoms of poisoning by colchicum have been 
already enumerated. The fatal dose varies, but is small. Prof. Geo. B. 
Wood Dispensatory, 13th ed., p. 1504) states that death has been 
produced by two drachms and a half of the wine of colchicum root; and 
Taylor (Medical Jurisprudence, 2d ed., vol. i.) records a case in which three 
drachms and a half proved fatal. On the other hand, recovery has taken 
place after the ingestion of an ounce.* According to the experiments of 
Schroff, colchicia is eighty to one hundred times stronger than the fresh 
* See case in L'Union Medicale, Aug. 1848. 462 
SYSTEMIC REMEDIES. 
corm. According to Heinrich,* 0.15 grain of colchicia will produce poi- 
sonous symptoms in man, and iu Krahmer's experiments (Journal fur 
Pharmacodynamik, ii. 561) 0.3 grain caused in an adult violent serous 
purging, lasting for four days, and accompanied with severe tenesmus. 
Casper has seen death result from a quantity of the wine containing 0.025 
to 0.03 gramme (0.37 to 0.45 grain) of colchicia; but, according to Huse- 
mann, recovery has taken place after the ingestion of 0.045 gramme of 
the alkaloid. Very recently (Dr. Geo. W. Major, Canada Med. and 
Sury. Journ., Dec. 1873) seventeen cases of poisoning from one bottle of 
wine of colchicum seeds occurred in Montreal, seven proving fatal. The 
patients had been vomiting and purging almost continuously for many hours 
when first seen, and the symptoms were exactly those of the stage of col- 
lapse of severe cholera morbus. In no case was the purging bloody. Con- 
sciousness was preserved to the last, and in only one case was there anything 
like convulsions. There was decided numbness of the extremities; and a 
peculiar hoarseness of the voice was especially noted. 
The treatment of colchicum-poisoning is as follows. If the stomach and 
bowels have not been freely evacuated, administer at once an emetic and a 
cathartic, so as to empty the alimentary canal; allow the patient to drink 
freely of warm water, to aid in these operations and to act on the kidneys. 
Give freely of tannic acid, as the only known chemical antidote ; although 
experiments upon animals have shown that it is not to be relied upon. To 
check the vomiting and purging, administer opium freely; and to allay the 
irritation, cause the patient to drink freely of albuminous matter, such as 
white of egg dissolved in water; the tannic acid having been given as soon 
as possible after the taking of the poison, the demulcents are useful in the 
more advanced stages. Symptoms of gastro-enteritis or of collapse are to be 
met as they arise. 
Administration.-Colchicum is never used in substance; the wine of 
the root is deservedly the most popular preparation. Recently it is claimed 
that colchicia hypodermically administered is especially efficacious in rheu- 
matism; the dose is one-fiftieth of a grain (Berl. Klin. SVochen., 1877, 197). 
The officinal preparations from the seeds are: the tincture (Tinctura Col- 
chici Seminis, 1 to 6.6),-dose, half a teaspoonful to one and a half tea- 
spoonfuls ; the wine ( Vinum Colchici Seminis, 1 to 6.6),-dose, half a tea- 
spoonful to one and a half teaspoonfuls; and the fluid extract (Extractum 
Colchici Seminis Fluiduni),-dose, two to six minims. 
The officinal preparations of the root are: the wine ( Vinum Colchici 
Radicis, 1 to 2.5),-dose, ten to fifteen drops; as a purgative, half a fluid- 
drachm ; the extract (Extractum Colchici Radicis),-dose, one to twc 
grains; and the fluid extract (Extractum Colchici Radicis Fluiduni),- 
dose, two to four minims. 
* Quoted by Husemann. ALTERATIVES. 
463 
SARSAPARILLA-SARSAPARILLA. U.S. 
The root of Smilax officinalis and other species of Smilax, woody vines 
inhabiting Mexico and the northern portions of South America. There are 
in commerce a number of varieties of sarsaparilla, the two most important of 
which are the Honduras and the Brazilian. The former of these is almost 
the only sarsaparilla used in this country. It occurs in bundles two or three 
feet long, composed of several very long, thin roots, folded upon themselves, 
the whole being bound round by a number of turns of the root. The Bra- 
zilian sarsaparilla also comes in cylindrical bundles, each of which is closely 
wrapped about by a very flexible stem: it mostly has fewer rootlets than the 
Honduras variety. The crude sarsaparilla has little or no smell, but its taste, 
which is at first simply mucilaginous, soon becomes, if the root be chewed, 
persistently acrid. According to Prof. Geo. B. Wood, the degree of this 
acridity is the best measure there is of the activity of any specimen of the 
drug. Sarsaparilla contains a crystallizable principle, first discovered by Pa- 
lotta in 1824. From its discoverer this substance received the name of 
Paraglin. By subsequent authorities it has been variously called Smilacin, 
Salseparin, Sarsaparillin, and Parallinic Acid. Paraglin, according to 
Poggiale, crystallizes in fine needles; according to Thubeuf, in star-like clus- 
ters of plates. It has a neutral reaction, and in solution a bitter, acrid taste, 
but when solid it is nearly tasteless. It is very slightly soluble in cold water, 
more so in boiling water; moderately soluble in dilute alcohol when cold, 
freely so when hot. Palotta asserts that thirteen grains of it cause vomit- 
ing, constriction in the throat, weakness, diaphoresis, and depression of the 
circulation. On the other hand, Bbcker, of Bonn, has exhibited it in doses 
of a like amount without producing any symptoms whatever (Journ. fur 
Pharmacodynamik. Bd. ii. p. 23). 
Physiological Action.-It has already been shown that there is very 
little reason for believing that paraglin has much immediate action on the 
system; and the question naturally arises, Has sarsaparilla any more influ- 
ence ? The answer to this question must, I believe, be a negative one, since 
the only sensible effects that follow even the largest draughts of the decoction 
are simply the results of slight gastric disturbance. It has been claimed that 
sarsaparilla acts as a diuretic and diaphoretic; but the only record I have met 
with of any careful experimentation is that of Bbcker (loc. cit.'). That inves- 
tigation seems to show conclusively that the drug has no marked influence 
upon these secretions. If, therefore, sarsaparilla have any value whatever 
in disease, it must be simply as an alterative,-as a remedy which in some 
unknown way modifies nutrition. 
Therapeutics.-Sarsaparilla has been used, and still is used, to such an 
enormous extent in medicine that it seems impossible to believe that it is 
destitute of therapeutic virtue. It is not in accordance with the plan of the 
present work to enter into an elaborate discussion of the recorded clinical 
experience with it: suffice it to say that, although the evidence is contradic- 464 
SYSTEMIC REMEDIES. 
tory, on the whole there is a decided preponderance in favor of the value of 
the drug in chronic syphilis and in chronic scrofulous diseases. I have used 
it largely, but always in combination with more powerful alteratives, so that 
it is impossible to decide how much of the good achieved has been due to 
its influence. There are two distinct methods or objects of use of sarsa- 
parilla in syphilis: one as an adjuvant to mercury in the secondary stage; 
one as an adjuvant to the iodide of potassium, or as a sole reliance, in the 
advanced tertiary cases, especially where the constitution is very much broken 
down by the disease. It is stated that, in the latter condition, very often 
during its use the appetite will gradually increase, the spirits rise, the secre- 
tions become more and more normal, and the strength grow day by day. 
Administration.-Sarsaparilla is never given in substance, but in one 
of the following officinal preparations : 
Decoctum Sarsaparillee Compositum- Compound Decoction of Sarsa- 
parilia.-This contains sarsaparilla, bark of sassafras root, guaiac wood, 
liquorice root, and mezereon, and is an imitation of the famous "Lisbon 
Diet-Drink." The dose is three or four fluidounces three or four times 
a day. 
Syrupus Sarsaparillae Compositus-Compound Syrup of Sarsaparilla.- 
This contains sarsaparilla, guaiac wood, pale rose, senna, liquorice root, oil of 
sassafras, oil of anise, and oil of gaultheria, and is a very popular preparation, 
on account of its pleasant taste : it affords the only vehicle I know of capa- 
ble of disguising the taste of the iodide of potassium. The dose of it is one 
to two tablespoonfuls three or four times a day. 
Extractum Sarsaparillae Fluidum-Fluid Extract of Sarsaparilla.- 
Dose, half a teaspoonful three times a day. 
Extractum Sarsaparillae Compositum Fluidum-Compound Fluid Ex- 
tract of Sarsaparilla.-This contains sarsaparilla, liquorice root, sassafras, 
and mezereon. The dose is a teaspoonful. 
GUAIAOI LIGNUM-GUAIAO WOOD. U.S. 
GUAIAOI EESINA-GUAIAO EESIN. U.S. 
The wood and the resin of the Guaiacum officinale, a large tree growing 
in the West Indies. Guaiac wood, or lignum-vitx, is imported in billets, but 
very generally is kept in the shops in the form of raspings or shavings. It 
is a very dense wood, the central heart-wood having a dark-olive or brownish- 
green, and the outer sap-wood a light-yellowish, color. It is inodorous, but 
becomes somewhat fragrant when rubbed or heated. Besides the resin, it 
contains an extract which is believed to have medicinal properties. 
Guaiac resin is obtained to a slight extent by spontaneous exudation from 
the living trees; much more largely by boring a hole into the centre of one 
end of a billet, placing the other end in the fire, and catching the melted 
resin as it runs out; and still more frequently by boiling the chipped wood in 
salt and water and skimming off the resin as it rises to the surface. Guaiac AL TER A TIVES. 
465 
occurs in irregular lumps or masses, of a dark reddish-brown greenish color 
externally, offering a conchoidal fracture with somewhat translucent edges. 
The odor is feeble, peculiar, agreeable, increased by heat. The taste is at 
first very slight, but, as the resin melts in the mouth, becomes very acrid and 
persistent. It is a very complex body, containing three acids, the guiaconic 
acid of Hadelich, the guaiac acid of Righini, and the guaiacresinic acid 
of Hlasiwetz, besides guaiac yellow, a peculiar resin, and other substances. 
Landerer asserts that he has found in it a peculiar crystallizable substance, 
which he calls guaiacin (Husemann, Die Pflanzenstoffe, p. 1106.) 
When a lump of guaiac is freshly broken, it offers a dark, blackish surface, 
which on scraping or bruising becomes yellowish; on exposure, the well- 
known greenish tint is acquired, owing to a spontaneous oxidation. The 
ease with which the resin undergoes oxidation is its most distinctive charac- 
teristic. As already stated, the change occurs on simple exposure to the 
light. According to Wollaston, it is most rapid and perfect in the focus 
of the violet rays of the spectrum, whilst in the focus of the red rays the 
original color is regained. Oxidizing or ozonizing agents, such as nitric 
acid, chromic acid, iodine, bromine, and chlorine, produce this oxidation 
very rapidly and very thoroughly, the resin acquiring an intense blue color. 
Physiological Action.-Guaiac is believed by some to act as a dia- 
phoretic, to do good by increasing the elimination of the skin; but, as I have 
not been able to obtain either from medical literature or from the exhibition 
of the medicine any distinctive proof of its having such action to any marked 
extent, I have preferred to consider the drug as an alterative. When taken 
internally, very little sensible effect results, unless the dose be so large as to 
irritate the stomach. 
Therapeutics.-Guaiac has been very largely employed in chronic 
syphilis, in connection with sarsaparilla, and is an ingredient of its most 
favorite preparations. Guaiac has also had a good deal of repute in rheu- 
matism, and in the subacute and chronic forms of the affection is often of 
service. For an account of its employment as an emmenagogue, see the 
chapter upon that class of remedies. Guaiac is best administered in cinc- 
ture, either the simple (Tinctura Guaiaci, U. S.) or the ammoniated 
(Tinctura Guaiaci Ammoniata, U. S.). The dose of either of these is 
from one to two teaspoonfuls, administered, preferably in milk, three or four 
times a day. 
Mezereum.-Mezereon is the bark of two species of Daphne, native 
shrubs of Europe. It is a thin, grayish, tough, flexible bark, occurring 
in long strips folded upon themselves, nearly odorless, but having a very 
acrid taste. It contains a neutral, crystallizable, bitter glucoside, Daphnin, 
besides a volatile acrid principle. Mezereon is intensely irritant, and its 
ointment ( Unguentum Mezerei, U. S.) is used as a stimulant dressing to very 
indolent ulcers, and to keep blisters sore or to maintain issues. Internally, 466 
SYSTEMIC REMEDIES. 
in small doses it is believed to be an alterative, but is never used except in 
combination with sarsaparilla. In overdoses it is an active poison, pro 
ducing severe vomiting, purging, and gastro-intestinal inflammation. Some- 
times the symptoms of the poisoning are simply those of collapse, with 
unconsciousness and other nervous disturbances, such as are seen in children 
from intense gastro-intestinal irritation (case, Brit. Med. Journ., 1882, 
vol. ii. p. 521). 
Sassafras.-The bark of the root of the Sassafras officinale is believed 
by some to be an alterative, on, as I think, very slight foundation. It con- 
tains some tannic acid, and very largely of a volatile oil (Oleum Sassafras), 
which, on account of its cheapness and agreeable odor and taste, is much 
used both in medicine and in the arts as a flavor and perfume. 
Taraxacum. U. S.-The root of the common dandelion, Taraxacum 
officinale, is believed to have the property of altering the action of the liver; 
although no effect is to be witnessed from a single dose of the drug, how- 
ever large, other, at least, than some nausea. Diuretic properties have also 
been ascribed to taraxacum; but the only evidence brought forward to estab- 
lish this is the vulgar name which the plant bears both in English and in 
French. If useful at all, it is in those cases of dyspepsia in which there is 
habitual torpor of the liver, with costiveness. It must be given very freely 
and continuously for weeks before any good effect is to be looked for. The 
U. S. Pharmacopoeia recognizes a fresh juice extract (Extractum Taraxaci) 
and a fluid extract (Extractum Taraxaci Fluidum), either of which may 
be used in doses of one or two drachms, administered after meals. Subdivision II.-Local Remedies. 
CLASS L-EMETICS. 
Emetics are those drugs which are employed in the practice of medicine 
for the purpose of producing emesis, or vomiting. The mechanism of vomit- 
ing has been so frequently written upon, and has so little connection with 
the application of emetics, that it is not necessary here to enter upon an 
elaborate discussion ♦ of it. Suffice it to state that emesis is the result of a 
very complicated series of actions, in which the chief expulsive force is sup- 
plied by the abdominal muscles and the diaphragm,-the stomach, however, 
participating in the general contraction, and not being, as some have thought, 
entirely passive. The exact relations and functions of the various nerves 
concerned are not, I think, fully made out. It has been generally believed 
that the pneumogastrics were the afferent nerves, and that, although emetics 
introduced into the circulation after their section acted, yet irritation of the 
gastric mucous membrane was not capable of so doing. But Schiff found in 
his experiments that, even when the nerves were cut in the neck, the intro- 
duction of semi-solid food into the stomach gave rise to efforts at vomiting, 
which were in some cases successful; and Maclagan f has obtained similar 
results with the sulphates of zinc and copper. Moreover, I have invariably 
failed to induce vomiting with veratria, even when given immediately after 
section of the par vagum. Evidently, further investigations are needed. 
Vomiting occurs under two provocations, or in two manners. Thus, a 
mental impression, or a disordered state of the blood, may influence the 
nerve-centres directly, and emesis, spoken of as centric, results; or a periph- 
eral irritation in the stomach itself, or in some other organ, as in the kidneys, 
may induce vomiting precisely similar in the method of its production to the 
more ordinary reflex movements; such vomiting is called reflex or excentric. 
Emetics produce their results in both of these methods. Thus, tartar 
emetic has been believed to affect the centres directly, so as to cause centric 
* For a very elaborate general discussion on emetics, see Prof. Joseph Carson, Phila. 
Med. Times, June, 1872; also, Dr. D'Ornellas, Bull. Thlrap., Ixxxiv. 193. 
f The Action of Medicines in the System, by F. W. Headland, M.D., Amer, ed., 1839, 
p. 110. 
467 468 
LOCAL REMEDIES. 
vomiting, whilst sulphate of copper has been believed to irritate the mucous 
membranes of the stomach as to produce reflex vomiting. Recently much 
doubt, however, has been thrown upon the old views, and it is probable that 
most emetics have a double influence. Thus, the purging of veratria or of 
tartar emetic is almost certainly connected with its elimination, and is proba- 
bly due to a direct action of the circulating poison upon the intestinal mucous 
epithelium, gland-cells, and peripheral nerves. It seems a priori almost a 
necessity that the vomiting caused by these poisons is produced in the same 
way as the purging. Dr. D'Ornellas has found that when emetia is injected 
into the veins of animals the vomiting occurs simultaneously with the elim- 
ination of the alkaloid from the gastric mucous membrane, and asserts that 
Kleimann and Simonowitsch have determined the same thing with anti- 
mony.* Further (see page 159), antimony seems to cause vomiting partly 
by acting upon the centres, partly by irritating the peripheral nerve. Irri- 
tant emetics are more prompt than those which chiefly affect the nerve- 
centres, and act more certainly when the nerve-centres are obtunded, as in 
narcotic poisoning; they always cause less nausea and general systemic 
disturbance than do the centric emetics. 
Another evident practical fact is, that whilst centric emetics will act in 
whatever way they are introduced into the system, the mechanical must be 
exhibited by the stomach. Thus, apomorphia may be given by hypodermic 
injection, but mustard must be taken by the mouth. 
A very curious property of emetics has been pointed out by Dr. E. Har- 
nack (Archiv Exper. Path. u. Tiler., Bd. iii. p. 44), who, as the result of an 
elaborate investigation, affirms as a law that all specific emetic substances 
destroy, even when in relatively small dose, the excitability of striated mus- 
cular fibre. Dr. Harnack seems to establish the general truth of this; but 
that it is a universal law seems scarcely probable, and the connection between 
the two properties is very obscure. According to H. Kobert (Arch. Exper. 
Path, und Therap., xv. 36), antimony has an effect only when the contact 
is prolonged. 
In regard to the phenomena of vomiting, there are a few points to which 
it is necessary here to call attention. First of these is the fact that nausea 
always produces, or is accompanied by, muscular relaxation. Vomiting may 
exist, as from mustard, without much relaxation ; but when it is accompanied 
by much nausea the whole system is as it were unbent, the skin soft and 
bedewed with perspiration, the pulse soft and feeble, the muscular system 
limp and incapable of exertion, the mental acts almost suspended. During 
violent vomiting the blood is driven to the head, so that the whole exterior 
of the cranium, and probably the interior also, becomes very much congested. 
* Copper has been thought to be a purely mechanical emetic, but the experiments of 
Brunton and West (St. Bartholomew Hosp. Rep., 1876) show that a peptone of copper 
injected into a vein causes violent vomiting. Those remedies whose irritant powers are 
great may still well be considered as "mechanical emetics." EMETICS. 
469 
The abdominal circulation is very much affected, and the blood is as it 
were squeezed out of the portal vein and its tributaries. The matters re- 
jected consist of the contents of the stomach, and, in repeated vomiting, 
also those of the duodenum. The secretion from the gastric mucous mem 
brane is very much enhanced, and without doubt is more or less modified. 
Bile in ejecta is to be recognized by the green color and the bitter taste, or 
more infallibly by testing with the proper reagents. 
The indications for the use of emetics are as follows: 
1. To unload the stomach.-For this purpose they are employed in poi- 
soning ; in the existence of crude articles of food or indigestible substances 
in the stomach; or in the presence of acrid, perverted secretion. The symp- 
toms induced by irritating materials in the stomach are various, and some- 
times it requires a good deal of tact or experience to recognize their cause. 
Among them may be mentioned a feeling of weight or load in the stomach, 
gastric distress, or severe cramp or spasmodic pains, with or without some 
nausea and retching. In other cases no local manifestations of trouble may 
be present. Thus, convulsions in children are very frequently the result of 
gastric irritation, and are at once relieved by emptying the stomach. In 
adults, apoplectiform coma may offer a similar history. Occasionally urti- 
caria, or hives, and not rarely severe headache, have a similar origin, and 
require a similar treatment. 
2. To affect the abdominal viscera and circulation.-Emetics have been 
recommended by some in congestions of the spleen; but evidence is wanting 
as to their power to affect materially other viscera than the liver. 
In congestion of the hepatic and portal circulation, not dependent upon 
organic cause, and in the condition of digestive derangement known as 
biliousness, they are often of service. In catarrhal jaundice they may 
effect much good by causing dislodgment of the mucus plugging the ducts. 
They have been employed in cases of biliary calculi; but the chances of 
forcing out the calculus by external violence are probably no greater than 
those of lethal rupture of the gall-bladder. 
3. To dislodge substances f rom the respiratory passages.-For this purpose 
emetics are sometimes used when foreign bodies have found entrance into 
the larynx; but it is chiefly in membranous croup that the present indica- 
tion is met with. The emetics chosen for this purpose should be such as act 
with violence without producing much nausea or systemic disturbance; the 
mechanical emetics are therefore the best. 
4. To produce muscular relaxation.-The introduction of anaesthesia has 
rendered the use of emetics to meet this application almost obsolete. Occa- 
sionally, however, in asthmatic or other spasmodic affections of the respira- 
tory organs, emetics are still employed. For this purpose the drugs causing 
much nausea are preferred. In adults, lobelia is the best; in children, 
ipecacuanha. Nauseating rather than emetic doses should be employed. 
5. To lessen arterial action and reduce inflammation.-Almost the sole 
disease in which advantage can be derived from this use of emetics is acute 470 
LOCAL REMEDIES. 
bronchitis in its early stages. In very many cases a " cold on the chest" in 
its outset may at once be subdued by ipecacuanha, or, better still, tartar 
emetic: small doses should be given at short intervals, to produce continuous 
nausea, terminating after a time in vomiting. This method of cure is so 
disagreeable, although very efficacious, that patients will rarely submit to it, 
unless, as sometimes in the case of public speakers, relief within a short 
period of time be a matter of great importance. It should be added that 
the cure is wrought in these cases not merely by the lessening of arterial 
action, but also by the induction of free bronchial secretion. 
6. To create a shock to the system.-Under this head may be included 
several empirical uses of emetics, in which advantage is gained, but in a 
method which is not very clear. Thus, in epileptic attacks, when the fits 
have a tendency to recur every few minutes, the unconsciousness persisting, 
it may be, for hours, emetics will sometimes break up the succession of dis- 
ordered nervous action. Again, not unfrequently an ague-fit can be set 
aside by an emetic given just before its expected recurrence. 
Contra-indications.-The chief contra-indications to the use of emetics 
are the existence of congestion of the brain, and of gastric inflammation. 
Advanced pregnancy, and hernia, whilst they do not positively contra-indicato 
the use of emetics, should cause great caution to be practiced in their em 
ployment. 
Administration.-Emetics should, as the general rule, be given in a 
full dose, so as to avoid unnecessary repetition, and should be administered 
dissolved in water or in syrup. Their action should be assisted by frequent 
and copious draughts of tepid water, which also have the advantage of ren- 
dering the vomiting less painful. When for any reason protracted nausea is 
desired, the doses should be small and repeated at short intervals. 
Hyperemesis may advantageously be divided into two varieties : first, such 
as is due to overdoses of depressing centric emetics; second, such as arises 
from irritation of the stomach, as by mechanical emetics. The treatment 
of the first of these consists in the enforcement of absolute quiet in the 
horizontal position, the free use of opium enemata, the application of counter- 
irritants to the epigastrium, and the use of alcoholic stimulants. The latter 
should be given in hot water, and should not be too much diluted. I have 
seen raw brandy arrest at once the most alarming centric emesis, after the 
failure of other methods. Creasote, chloroform, or chloroform and volatile 
oils, are sometimes of value in this form of hyperemesis. When excessive 
vomiting is due to some irritant emetic, the stomach should be thoroughly 
washed out by large draughts of warm mucilage, opium given by the 
rectum, a mustard plaster or blister, or, often better still, leeches applied to 
the epigastrium, and no medicine at all be taken into the inflamed viscus. 
The swallowing of small pieces of ice is sometimes of service. If these 
remedies fail, the treatment of this form of hyperemesis soon resolves itself 
into that of gastritis. EMETICS. 
471 
VEGETABLE EMETICS. 
IPECACUANHA. U.S. 
The root of the Cephaelis Ipecacuanha, a small, shrubby plant, growing 
in Brazil, where the drug is gathered by the Indians to be exported in large 
bales or bags. Ipecacuanha occurs in pieces of two or three lines in thick- 
ness, variously bent and contorted, marked on their surface with numerous 
prominent rings, and composed of an outer, thick, active, hard, and horny 
cortex, and an inner, light, inert, woody centre. Varieties of ipecacuanha- 
the red, the gray, and the brown-have been formed from the color of the 
bark, but the distinction is trivial. The root has very little odor, but the 
brown powder has a decided and peculiar smell, and in some persons excites 
sneezing, or even violent asthmatic dyspnoea. The taste is bitter, acrid, and 
nauseous. The active principle is Emetia, an alkaloid first discovered by 
Pelletier in 1817. The cortex also contains small quantities of ipecacuanhic 
acid, which is related to tannic acid. Pure emetia is a white, uncrystalliza- 
ble, odorless powder, of a bitter, burning taste, soluble in one thousand parts 
of water at 50° C. (Lefort), freely soluble in dilute and absolute alcohol, in 
chloroform and benzole, scarcely so in ether. Its solution in acidulated 
water, according to Draggendorff, has a decided blue fluorescence. Its salts 
are, according to Pelletier, uncrystallizable. Concentrated sulphuric acid 
turns it a dirty brown, nitric acid a yellowish brown. Pure emetia is very 
difficult to prepare, and, according to Mr. Williams (St. Bartholomew's 
Hospital Reports, vol. v.), only two grains of it can be obtained from an 
ounce of the root. The ordinary impure alkaloid of the shops occurs in 
brownish-red, transparent, very deliquescent scales, which are very soluble 
in water. 
Physiological Action.-Locally applied, ipecacuanha is a decided irri- 
tant, manifesting its action not only upon mucous membranes and upon 
denuded surfaces, but even, when used by inunction, producing an eruption 
upon the sound skin. According to Dr. Dyce Duckworth, this eruption con- 
sists at first of small, discrete pustules, with a rather large areola; after- 
wards, if the application be persisted in, of large pustules, followed by severe 
ulceration. When exhibited in small repeated doses to man, it produces 
malaise, with nausea, and perhaps an increase of the secretions of the salivary 
glands and of the mucous membrane of the bronchial tubes and of the 
stomach. In large amounts it causes vomiting, accompanied by only a mod- 
erate amount of nausea but by a decided increase of the secretions mentioned 
above. The vomiting, even when very large amounts are taken into the 
stomach, is not apt to be severe, nor the prostration marked,-no doubt be- 
cause the excess of the drug is rejected before absorption. In large doses 
of emetia, this mildness of action, in all probability, would not occur: cer- 
tainly animals are readily killed by the alkaloid. Although ipecacuanha was 472 
LOCAL REMEDIES. 
made known in 1649 by Piso, and, although it has been enormously used 
since its introduction into Europe in 1672, its physiological action is not as 
yet well made out. That the active principle is absorbed, and that the vomit- 
ing is so produced, is shown by the experiments of Orfila (^Toxicologic, i. 
651), and of Drs. Dyce Duckworth, D'Ornellas, and Pecholier, who found 
that vomiting followed the hypodermic use of emetia in dogs and cats. If 
it be true, as is affirmed by D'Ornellas, that the emetia produces vomiting 
much more slowly when thrown into the veins than when given by the 
stomach, it would seem that the local irritant action of the drug efficiently 
favors emesis. 
According to Dr. D'Ornellas (Gaz. Med., 1873, p. 537), Merck's com- 
mercial emetia in toxic doses (0.03 milligramme) produces in frogs dryness 
of the skin, swelling of the abdomen, diminution of the circulation and res- 
piration, increased rather than diminished sensibility, muscular feebleness 
deepening into abolition of voluntary movement, with at first increased and 
afterwards diminished reflex activity, and finally death from failure of respi- 
ration ; the heart continuing to beat often for many hours. In mammals 
the symptoms induced by the poison in large doses are very similar to those 
just detailed, excepting that emesis is usually violent, but in some cases it is 
wanting. 
Circulation.-The action of the drug upon the circulation has not as yet 
been clearly made out. Any action upon the heart-muscle must be a very 
feeble one, since D'Ornellas states that although the frog's heart is finally 
arrested in diastole, yet it retains often for many hours its irritability. It 
has been supposed by some that the drug acts especially upon the vaso- 
motor system, but evidence of this has not as yet been brought forward. 
Polichronie, it is true, asserts {L' Ipecacuanha, Paris, 1874) that dryness 
and paleness of the intestinal mucous membrane are very apparent in mam- 
mals poisoned with emetia, and Chouppe (Ze Progrls Med., 1874, p. 425) 
has observed the same thing; but this is an absurdly slight ground for be- 
lieving that emetia causes vaso-motor spasm. Pecholier found in a single 
experiment that the drug abated very decidedly the arterial pressure, but Dr. 
D'Ornellas found that emetia neither depresses nor increases the blood-force ; 
and in a series of elaborate experiments by Dr. Dyce Duckworth the alkaloid 
failed to influence materially the circulation, at least until very late in the 
poisoning. The pulse-rate was not constantly affected; sometimes it was 
apparently lowered, sometimes it remained about the same, and sometimes it 
was seemingly increased. The effect of a toxic dose was, however, marked. 
In one case immediate suspension of cardiac action followed injection into 
the jugular vein; in another dog, in a minute and a half after half a grain 
of emetia, the arterial pressure descended from 135 to 20, and in a moment 
the animal was dead of cardiac paralysis. Dr. Foulkrod (Phila. Med. Times, 
viii., p. 554) has noticed a steady fall of arterial pressure produced both EMETICS. 
473 
before and after section of the cord of all the cardiac nerves. There is no 
proof that emetia ever causes vaso-motor spasm, whilst it is certain toxic 
doses directly paralyze the heart; therapeutic doses probably have no decided 
direct effect upon the circulation. 
Respiration.-According to D'Ornellas, Pecholier, and Foulkrod, emetia 
in toxic doses usually kills by arresting the respiration ; but in many of Dyce 
Duckworth's experiments (St. Bartholomew s Hosp. Rep., v., vii.) the death 
was certainly the result of cardiac paralysis, possibly because the poison was 
thrown directly into the circulation,-i.e., into the heart. 
Nervous and Muscular Systems.-Upon the cerebrum ipecacuanha exerts 
no perceptible influence; but, as both D'Ornellas (loc. cit., p. 538) and Pecho- 
lier (loc. cit., p. 57) have found that after death from emetia in the frog 
both nerves and muscles retain their susceptibility to feeble galvanic cur- 
rents, the paralysis which the poison produces is probably spinal. D'Ornellas 
and Pecholier are in opposition in regard to the action of the alkaloid upon 
sensibility, the one affirming that it is not, the other that it is, affected. 
Temperature.-Pecholier, Dyce Duckworth, and D'Ornellas all state that 
in emetia-poisoning there is a distinct fall of temperature in the mouth and 
on the surface of the body, but that in the intestines the temperature either 
remains stationary or, more commonly, rises; D'Ornellas affirms that it always 
rises decidedly. This rise is probably, as D'Ornellas believes, local, and due 
to the action of the poison upon the intestinal tract. 
Pulmonic and Digestive Organs.-The post-mortem results obtained in 
animals poisoned with ipecacuanha are diverse, but affect chiefly either the 
lungs or the digestive tract. Pecholier, in his earlier experiments, found great 
paleness of the lungs, with intense hyperaemia of the stomach and the upper 
half of the intestines, but in some of his later experiments the lungs were 
profoundly influenced. Dyce Duckworth especially noted intense hyperaemia 
of the lungs, which were in some places emphysematous, but in other por- 
tions collapsed and even affected with true consolidation. The lesions were 
much less marked in the intestines than in the lungs, which resembled very 
closely those taken from the bodies of animals killed by section of the vagi. 
The pulmonic lesions were found to be most intense in the rabbit; the intes- 
tinal, in the dog, cat, and guinea-pig. Magendie forty years ago noted the 
pulmonic lesions of emetia-poisoning, and D'Ornellas has also recorded them, 
but has also seen cases in which ischaemia of the pulmonary tissue was found 
after death. It is evident that the poison has an especial action upon both 
lungs and intestines; but why the pulmonic lesions should so vary is not at 
present known. The occurrence of changes in the pulmonary tissues is in 
accord with the results of clinical experience, which teaches most decidedly 
that ipecacuanha has an action upon the pulmonary mucous membranes. 
After section of the cervical vagi, Dr. Dyce Duckworth found that emetia 
failed to cause vomiting. 474 
LOCAL REMEDIES. 
Clinical experience also shows that ipecac acts upon the digestive tract. 
Whether given in large or in small doses, it is very apt in man to increase 
and modify the intestinal secretions. It probably influences the liver, since 
Pecholier (Gazette Medicale, 1862) affirms that in animals killed by it no 
hepatic glucose can be found. Moreover, great advantage from its use may 
often be obtained in the condition known as " biliousness." In " bilious 
dysentery" it will often produce large tarry discharges; and I have seen a 
change in the color of the stools follow its use in catarrhal jaundice. The 
mechanical effect of the vomiting induced by it in these cases, however, must 
not be lost sight of; yet it does not seem to me at all sufficient to account 
for the results, especially as some observers state that the effects noted aro 
produced even when little or no vomiting occurs. It has been proven by 
D'Ornellas and Pecholier that when emetia is introduced into the circulation 
or into the cellular tissue it escapes with the secretions of the stomach and 
bowels; so that the changes which are provoked in these organs are evidently 
connected with the elimination of the drug. 
Therapeutics.-The most ordinary use of ipecacuanha is as an emetic. 
Whenever it is desired to unload the stomach or to act by emesis upon 
disease, without inducing much prostration, this drug commends itself by 
its safety and efficiency. In narcotic poisoning it is less certain than the 
" mineral emetics," but, as it produces no irritation of the stomach, can be 
given more freely than they can, and is constantly used as an adjuvant to 
them. It is especially useful in the diseases of children, never causing the 
serious depression which tartar emetic is so apt to produce. When, how- 
ever, very violent emesis is desired, as in membranous croup, other emetics, 
such as zinc or alum, are to be preferred, on account of the greater force of 
their action. 
In sick stomach of nervous origin, such as occurs in pregnancy, minute 
doses of ipecacuanha have so often met with success that there can be no 
doubt of their value. One drop of the wine in a teaspoonful of water 
should be given every hour. The use of ipecacuanha as an expectorant 
will be spoken of under that heading. 
One of the most important uses of ipecacuanha is in acute dysentery,-all 
forms of which have been treated with it with asserted advantage. I think, 
however, its beneficial action is best seen in " bilious dysentery" and in 
" malignant dysentery," as is indicated by the fact that its use is most com- 
mon in tropical climates. In " sthenic inflammatory dysentery" it seems to 
be less available; although even in this it has been strongly advocated by 
some. Dr. Chouppe (Bull, de Ther., June, 1874) commends injections of 
ipecacuanha highly in choleriform diarrhoea of children, and in tuberculous 
diarrhoea, and Polichronie not only corroborates him, but also affirms that the 
same treatment is of great value in colliquative sweats. In a very valuable 
clinical paper (Atlanta Med. and Surg. Journ., 1875) Dr. A. A. Woodhull 
brings forward very strong evidence of the value of the remedy not only in EMETICS. 
475 
dysentery but also in choleriform diarrhoeas. The drug appears to exert a 
direct influence upon the hepatic and intestinal glands, and may be tried with 
great hope of success wherever there is decided glandular derangement. 
In catarrhal jaundice, and in intermittents or remittents accompanied by 
congestion of the portal circulation, ipecacuanha is often very serviceable. 
As a haemostatic, ipecacuanha has been recommended by Trousseau, and 
Pecholier asserts that in haemoptysis it is a specific (Bull. Therap., xcvii. 49).* 
It has been given, with asserted advantage, in flooding after child-birth, and 
Dr. Carrigen claims for it oxytocic powers (N. K Med. Journ., 491,1878). 
Administration.-As an emetic, ipecacuanha is generally administered 
in powder, thirty grains being given every fifteen or twenty minutes until 
the desired effect is produced. For a child a year old the emetic dose is five 
grains. Its action should be aided and hastened by large draughts of luke- 
warm water. As a nauseant the dose is from two to five grains. In dysen- 
tery it is generally best to begin with a full emetic dose, or with ten grains 
repeated every half-hour until emesis is produced. Two or three hours after 
vomiting, fifteen drops of laudanum should be exhibited, followed in twenty 
minutes by five to ten grains of ipecacuanha in pill-form; this should be 
repeated every two or three hours, the amount of the opium being lessened 
and that of the ipecacuanha increased, according to circumstances. The 
object is to have as much of the ipecacuanha retained as possible. Anothei 
plan is to give larger doses (twenty grains), repeated every two, four, or sis 
hours, mustard being applied to the epigastrium and opium exhibited as 
before; and it is said that after two or three doses tolerance is established 
and the drug retained. In India, enemata of ipecacuanha are often em- 
ployed, either as a substitute for or an adjuvant to its use by the mouth. 
This treatment has recently been imitated by Chouppe and others, and has 
been practiced quite extensively in my ward in the Philadelphia Hospital. 
It is undoubtedly frequently efficient in abdominal complaints, and the gas- 
tric symptoms are almost always avoided. In chronic cases the repetition 
of the enemata sometimes produces so much local irritation as to forbid their 
continuance. I have been accustomed to give a scruple of the powder with 
starch and laudanum, repeated every four hours. A decoction of the drug 
is to be preferred, as probably causing less local irritation and being more 
thoroughly absorbed. To an adult, Chouppe gives two injections of a decoc- 
tion daily, each lavement representing two and a half drachms of the drug. 
As a counter-irritant, ipecacuanha is rarely used in this country; but in 
England a liniment is employed composed of four parts of the powder te 
fourteen parts of olive oil. 
The preparations for internal use are: a syrup (Syrupus Ipecacuanhae, 
U.S.,-Fid. ext. 5 to 100),-dose, as an emetic for an infant, one to two 
teaspoonfuls; a wine ( Vinum Ipecacuanhae, U. S.,-Fid. ext. 1 to White 
* Consult Pacific Surgical and Med. Journ., 1876. 476 
LOCAL REMEDIES. 
Wine 7),-dose, the same as the syrup; and a fluid extract (Extractum 
Ipecacuanha Fluidum, U. S.), dose, as an emetic, for an adult thirty 
drops. Trochisci Ipecacuanha, U. S., Trochisd Morphine?, Ipecacuanh.ee 
U. S., are used in catarrh-of the throat as a local application. 
Emetia is not officinal, but has been used by Dr. Dyce Duckworth (London 
Pharmaceutical Journal, March, 1872) and his colleagues in doses of from 
one-twelfth to one-sixth of a grain. 
SANGUINARIA-BLOODROOT. U.S. 
This is the rhizome of an indigenous perennial herb, Sanguinaria Cana, 
densis. It occurs in pieces two or three inches long, reddish brown exter- 
nally, a bright somewhat orange red internally, and, when fresh, full of a 
similarly-colored juice. It contains two asserted alkaloids, Puccin and Por- 
phyroxin, besides an alkaloid, first discovered in it by Dr. Dana in 1829, and 
named by him Sanguinarina, but which is identical with the alkaloid of 
Chelidonium majus-Chelerytlirin. As the latter was not discovered by 
Probst until 1839, it is obvious that the name sanguinarina has the priority 
and should be adopted. Sanguinarina occurs in colorless stars or groups of 
fine needle-like crystals, tasteless when dry, of a sharp burning taste when 
moistened with alcohol, very irritating to the nasal mucous membrane, and 
uniting with acids to form brilliant red, mostly soluble, salts. 
Physiological Action.-In full doses sanguinaria acts upon man as 
a harsh emetic, and in overdoses, according to Dr. Tully, it produces, with 
the vomiting, burning at the stomach, faintness, vertigo, diminished vision, 
general insensibility, coldness, extreme reduction of the force and frequency 
of the pulse, together with great irregularity of action and often palpitation 
of the heart, great prostration of muscular strength, and sometimes a con- 
vulsive rigidity of the limbs. Fatal poisoning of several persons occurred 
by it at Bellevue Hospital; but the only symptoms recorded are " racking, 
burning pains, and tormenting thirst." 
The only physiological study of the drug as yet made is that of Dr. 
Robert Meade Smith (Amer. Journ. Med. Sci., Oct. 1876). He finds that it 
causes in mammals vomiting, purging, profuse salivation, followed by collapse, 
dilated pupils, with sometimes clonic convulsions, and death from asphyxia. 
As the result of numerous experiments, he concludes that the convulsions arc 
spinal, but associated with decrease reflex excitability, which is at first due to 
an excitation of Setschenow's centre, but afterwards to a depression of the 
spinal centres; and that there is a progressive lowering of the pulse and arterial 
pressure after large doses, caused partly by a direct action upon the heart, 
partly by paresis of the vaso-motor centres. Moderate doses of sanguina- 
rina Dr. Smith finds to at first irritate the vaso-motor centres, and so produce 
a primary rise of the arterial centre. Muscular contractility is reduced by 
it, salivation greatly increased, and the respiration progressively rendered 
slower and shallower by a direct action upon the centre. EMETICS. 
477 
Therapeutics.-As an emetic, sanguinaria has fallen into well-deserved 
disuse. Indeed, I have never known of its employment except as a stimulant 
expectorant in obstinate bronchitis, and even then with doubtful advantage. 
Administration.-The crude drug is very rarely used; the emetic dose 
of the powder is from ten to sixty grains. Prof. R. P. Thomas, in experi- 
ments upon himself and others with the alkaloid, found that in a dose of 
from one-eighth to one-twelfth of a grain it acted as an expectorant, without 
disturbing the stomach ; one-sixth or one-fourth of a grain, given every two 
or three hours, generally nauseated, the emetic dose being half a grain re- 
peated every ten minutes. One-sixth of a grain every three hours, in the 
course of two or three days, reduced the pulse from five to twenty-five beats 
per minute. The expectorant dose of the tincture ( Tinctura Sanguinarix, 
-1 to 6.6, U. S.) is gtt. xx to xl; of the vinegar (Acetum Sanguinarix, 
U. S.), fifteen to thirty minims; of the fluid extract (Extractum Sangui- 
narix Fluidum, U. S.), three to five minims. 
AP0M0EPHINE HYDR00HL0RAS-HYDROOHLOEATE OF AP0- 
MOEPHINE. U.S. 
Apomorphine was discovered by Dr. Matthieson and C. B. A. Wright 
(Proceedings Roy. Soc., xvii. 455), who made it by the action of a strong 
solution of hydrochloric acid upon morphine. A probably better method of 
preparation is that of E. L. Mayer (Berichte Deutsch. Chem. Gesell., Berlin 
1871, iv. 121), in which the morphia is treated with a solution of the chloride 
of zinc at 120° C. Apomorphia occurs as a snow-white powder, which is 
permanent when dry, but when moist soon becomes green. Its solution 
suffers this change, which is probably an oxidation, in a few minutes by heat 
(Matthieson and Wright), and in a few hours at ordinary temperature; and 
in the course of some weeks the green tint deepens into a black. Bichro- 
mate of potassium turns it a dense yellow orange; bichromate of potassium 
and concentrated sulphuric acid make a dark red with it; and with neutral 
chloride of iron it strikes an amethyst color. It differs from morphia in 
being soluble in cold water. The officinal salt is soluble in six parts of 
water. 
Physiological Action-In doses of from one to five milligrammes in 
frogs apomorphia causes at first a stage of restlessness, which, after a time, 
yields to an increasing sluggishness and muscular weakness that may end 
in real or apparent death. In some instances there are violent convulsions, 
both clonic and tonic in character.* Sometimes after both respiration and 
cardiac action have apparently ceased, recovery occurs. 
When small doses (1 to 2 milligrms.) of the alkaloid are given to dogs, 
* Consult E. Harnack, Arch. Exper. Pathol, und Pharm., ii. 291; Max Quehl, Ueher der 
Physiol. Wirk. des Apomorphins, Inaug. Diss., Halle, 1872; I. B. V. Bourgeois, Del Apo- 
morphine, Paris, 1872; E. Reichert, Phila. Med. Times, x. 110; G. Valentin, Arch. Exper. 
Path. u. Pharm., xi. 399. 478 
LOCAL REMEDIES. 
vomiting, without any other decided symptoms, is induced; after slightly 
larger amounts, the vomiting is severe, and accompanied by free salivation 
and muscular tremblings. After very large doses, vomiting does not occur, 
but a condition of intense restlessness is soon developed, the animal often 
jumping in the air, running about the room, howling and champing con 
stantly. The slightest noise or alarm throws him into violent excitement and 
terror; with pupils dilated, ears drawn stiffly back, he endeavors to get out of 
the apartment, and even to climb the wall. After still larger amounts (4 or 
5 gr.), to this excitement is soon added failing muscular strength, and the 
hind legs are dragged behind the animal in his movements. The respiration 
is exceedingly hurried, and convulsions are suddenly developed. The paresis 
and convulsions increase, so that the animal lies upon his back, kicking 
wildly into the air, and finally he dies asphyxiated. Rabbits cannot vomit, 
but the general symptoms produced by the alkaloid in them and in cats are 
exactly parallel with those just described as occurring in the dog. Very 
small doses (10 milligrms., Harnack) suffice to kill the rabbit. On chickens 
and pigeons, according to C. David (Gaz. Med., 1874, p. 465), it acts very 
much as it does upon dogs; the stage of excitement is very marked. After 
death no distinctive lesions are to be found, unless, as Quehl (loc. cit., p. 19) 
believes, there is habitually an excessive hyperaemia of the pons varolii. 
To the therapeutist the chief interest in apomorphia is in connection with 
its power of producing vomiting; but before taking this up I shall endeavor 
to portray what is known in regard to the physiological actions of the drug. 
Nervous System.-The action of apomorphia upon the cerebrum seems 
to be that of a primary stimulant delirifacient, and final paralyzant. The 
cause of the convulsions at present cannot be considered as made out.* Ac- 
cording to Reichert's experiments both the sensory and motor nerves are 
first stimulated and afterwards paralyzed. In opposition to the experiments 
of Quehl, Harnack found that the muscles in the frog around the place of 
injection soon lost their irritability, evidently from the poison reaching them 
in a concentrated form by imbibition. He also separated one hind leg of a 
frog from the rest of the body, leaving only the nerve intact, and then poi- 
soned with apomorphia. After voluntary motion had ceased, the muscles of 
the intact leg were far less excitable than were those of the leg to which 
access of the poison had been prevented. These experiments have been 
confirmed by Reichert, and there can be no doubt that apomorphia is a 
muscle-poison. 
Circulation.-The reports upon the action of this drug upon the circula- 
tion are somewhat discordant. Seibert (London Med. Record, i. 44), Max 
Quehl, and Bourgeois affirm that the blood-pressure is not affected even by 
* The only one who has carefully studied them is Reichert, and his published account 
is self-contradictory. He reasons that the convulsions are chiefly spinal, and yet says 
(p. Ill) that in mammals, after section of the spinal cord, except "in very exceptional 
cases," they are confined to the anterior part of the body. EMETICS. 
479 
toxic doses. Harnack, however, found, after large doses in dogs, a distinct 
fall of arterial pressure, and also that apomorphia is a direct paralyzant of 
the cut-out frog's heart. The latter fact has been confirmed by Reichert, 
who has also shown that the mammalian heart is similarly affected by the 
drug; and that finally this cardiac action causes a fall of the arterial pressure. 
Preceding the fall there was in Dr. Reichert's experiments a distinct rise of 
arterial pressure, which was prevented by previous section of the cord, and 
was therefore probably due to stimulation of the vaso-motor centres. Thera- 
peutic doses of the drug have no distinct action upon the force of the circu- 
lation. The pulse-rate is markedly increased by small and large doses of 
apomorphia, the maximum usually being reached about the time vomiting 
is fairly established; subsequently, in poisoning, the pulse falls below normal. 
Reichert believes the rise to be due to stimulation of the accelerators, and 
the fall to the influence upon the heart-muscle. 
Respiration.-Usually the respiration-rate is increased by decided or toxic 
doses ; although the amount of increase varies greatly, it is often very large. 
Harnack says that after toxic doses the rate rises very much before the 
occurrence of convulsions, but Reichert has not been able to observe this. 
During the convulsive period the respirations become irregular and unequal, 
and they finally grow more and more shallow and infrequent, until death 
results from a paralysis of the respiratory centres. Both Harnack and 
Reichert have noted that in the rabbit previous section of the par vagum 
does not prevent, but rather increases this acceleration, so that it would seem 
that apomorphia stimulates the respiratory centres ; but Reichert affirms that 
in the cat and dog no increase of the respiration-rate occurs under the action 
of the drug if the pneumogastrics have been cut. 
Temperature.-1The action of apomorphia upon the temperature appears 
to be very trifling and inconstant. According to Ziolkowski (Apomorphin, 
Inaug. Diss., Griefswald, 1872), the bodily heat usually falls after large doses 
from 0.1° to 0.5° C. Moerz noticed in one man that the temperature rose 
during the vomiting two-tenths of a degree; whilst Bourgeois affirms that 
in man the drug has no influence over the temperature, and Reichert has 
seen in animals a rise follow the hypodermic, but not the intravenous injec- 
tion of the alkaloid. 
Emesis.-Dr. Gee (St. Bartholomew's Hosp. Rep., vol. v. p. 215) was 
the first to announce that apomorphia is a certain and prompt emetic, pro- 
ducing but little nausea, and having the great advantage of acting in very 
small dose, a tenth of a grain being sufficient, when injected under the skin, 
to cause vomiting in ten minutes. His statements have been confirmed by 
very many observers, excepting that the dose employed by Gee is usually 
considered too large. Thus, Dr. Pierce (British Medical Journal, 1870, p. 
274) employs one-fifteenth of a grain, and M. Bertrand (Gaz. Med., 1874) 
has vomited with .06 grain. The time required for action depends largely 
upon the amount of the drug exhibited. After very small doses twenty 480 
LOCAL REMEDIES. 
minutes may elapse, and in Bourgeois's experiments 0.45 grain produced 
violent vomiting in less than two minutes. After these large doses the 
emesis usually recurs once or twice at intervals of a quarter to half an 
hour.* The vomiting seems to be of centric origin, as Reichert has suc- 
ceeded in producing it when the thoracic aorta was tied so as to prevent 
any of the poison reaching the stomach. 
A knowledge of the effects of narcotics upon the action of apomorphia is, 
of course, of great practical importance. There is as yet very little clinical 
evidence. A case of poisoning with bitter almonds has indeed been reported 
(Schmidt's Jahrbucher, Bd. civ. p. 272), in which the injection of 0.013 
grain of the alkaloid was followed by prompt emesis; but it is evident that 
no inference in regard to narcotic poisoning could be drawn from this. It is 
inconceivable that there should be any differences in the relation between 
apomorphia and narcotism in man and in animals, and the subject has been 
investigated, with mostly similar but insufficient results, upon animals by 
several observers, j" In dogs chloral retards, or, if in sufficient dose, prevents, 
the emesis of apomorphia; during chloroform-sleep the alkaloid is affirmed 
by David and Dujardin-Beaumetz to be powerless; but MM. Coyne and 
Budin state that it will produce emesis even during profound anaesthesia if 
the dose be large enough; David found that in a dog three centigrammes 
of morphia prevented the occurrence of the vomiting. It is plain that these 
experiments prove no more than that narcotics influence the action of apo- 
morphia as they do that of every other emetic; and the probabilities seem 
to be that the alkaloid produces vomiting more surely than do our ordinarily 
used drugs. The emesis is probably the result of a stimulant action exerted 
upon the nerve-centres; and the fact that after toxic doses vomiting does 
not occur indicates that in such amounts the drug paralyzes these centres. 
Local Action.-Apomorphia is not an irritant, so that the hypodermic 
use of even concentrated solutions of it elicits in the lower animals no 
evidences of pain. In man the injections have sometimes caused intense 
pain, probably because they had been originally improperly prepared or had 
undergone chemical change. 
Therapeutics.-There is now sufficient evidence to show that apomor- 
phia is a safe and reliable emetic, possessed of advantages which have already 
been sufficiently dwelt upon. It may be used whenever it is desired simply 
to empty the stomach. In narcotic poisoning there is no reason why it 
should not be given hypodermically whilst sulphate of zinc or some mechan- 
ical emetic is exhibited by the mouth. As an expectorant^ apomorphia is 
employed with asserted great advantage in the suffocative catarrh of infants, 
* For the doses required to vomit various animals, see Gaz. Mid., 1874, p. 466. 
f E. Harnack (loc. cit.); 0. C. David (Gaz. Med., 1874, p. 465); Dujardin-Beaumetz 
(Bull. Thirap., Oct. 1874). 
| Dr. Jurasz (Centralb. f. d. Med. Wies., 1874, 499); Dr. M. Wertner ( Wien. Med. 
Presee, 1876, 269); Dr. Carl Beck (Beuts. Med. Wochen., 1881, 156). EMETICS. 
481 
when an emetic is required to get rid of the bronchial exudation. Under 
these circumstances it is said not only to act efficiently as an emetic, but 
also in rendering the mucus more copious and fluid. It is claimed that in 
the early stage of acute bronchitis it rapidly causes copious, loose secretion, 
and that in chronic bronchitis it is very useful when expectoration is scanty. 
Administration.-As an emetic, apomorphia has usually been adminis- 
tered hypodermically, in doses of one-tenth of a grain, repeated every ten 
minutes until some effect is induced ; but it may be exhibited by the stomach 
in double the amount. In cases of severe poisoning, where time is of great 
moment, it may be well to give as much as one-fourth of a grain at a single 
injection. In feeble persons, however, caution must always be exercised in 
using it, as one-fifteenth of a grain has caused death in seven minutes in an 
adult, fifty-four years old, suffering from chronic bronchitis with marked 
emphysema (Med. Rec., 1877, 664). Wertner gives the expectorant dose 
as 0.07 to 0.15 for children, or double the amount for the adult, repeated 
every two hours by the mouth. Care must be exercised in its use in children. 
In Vulpian's clinic the dose is from 0.07 to 0.09 grain. Dr. Loeb (Schmidt's 
Jahrb., Bd. civ. p. 272) gave hypodermically 0.03 grain to an infant thirteen 
months old suffering from capillary bronchitis; the free vomiting which was 
induced left the infant much exhausted. In a very few cases apomorphia has 
failed to vomit, and even caused startling symptoms: so that care should be 
exercised not to push the remedy too far. M. Carville affirms that three- 
tenths of a grain has caused a syncopal condition in an adult, and M. Prevost 
details a case (London Medical Record, 1875, p. 183) in which syncope and 
threatening collapse were apparently induced by a very small dose. In chil- 
dren especially must care be exercised, since, according to Harnack, the drug 
is very liable to produce collapse. The ordinary solutions of apomorphia 
undergo a rapid change, becoming green; and Dr. Loeb has reported a case 
in which very alarming symptoms followed the use of such a solution. 
M. Constantine Paul states that if glycerine be used as the sole menstruum 
the solution will keep three or four days. M. Carville (Gaz. Hebdom., 1874, 
p. 408) affirms that glucose acts well as a preservative, and it is claimed that 
a few drops of muriatic acid will suffice for the same purpose. 
A very useful stimulating emetic is mustard flour, very prompt and even 
violent in its action. It acts as a mechanical emetic, and is to be used when 
it is desired simply to evacuate the stomach rapidly, and especially when 
there is torpor of the viscus. As it is generally to be had at once, it is 
especially useful in such emergencies as narcotic poisoning. It has also 
been commended in nervous collapse, such as is seen in malarial pernicious 
chill. The dose is a heaped dessertspoonful in half a pint of water, repeated, 
if necessary, in ten minutes. As mustard is irritant to the stomach, if it 
fail to act it should not be repeated more than three or four times, even in 
narcotic poisoning. 482 
LOCAL REMEDIES. 
Squill (^Scilla^ is sometimes used as a harsh, stimulating mechanical 
emetic. 
MINERAL EMETICS 
The mineral emetics in ordinary use are tartar emetic, sulphate of zinc, 
and sulphate of copper. As they are all considered elsewhere, it is only 
necessary here to say a few words in regard to their use as emetics. 
Tartar emetic is the most depressing of all the substances here spoken of 
as emetics. It is rather slow in its action, but the vomiting which it causes 
is preceded and accompanied by intense nausea, and is exceedingly violent 
and persistent. For these reasons, tartar emetic is rarely used simply to 
unload the stomach, except in the absence of more eligible substances. Its 
use in inflammatory diseases is discussed elsewhere. It is usually believed 
to be a centric emetic acting by absorption. 
Sulphate of zinc is an excellent and prompt mechanical emetic, producing 
little or no irritation, and is to be preferred above all others when an emetic 
of such nature is needed. In narcotic poisoning it should be given in com- 
bination with ipecacuanha, and perhaps be preceded by mustard whilst it 
is being obtained from the apothecary. Thirty grains of it with fifty of 
ipecacuanha may be given as the first dose, and a mixture of fifteen grains 
of the former to thirty grains of the latter be administered every fifteen 
minutes until the desired effect is produced or one hundred grains of the 
zinc are taken. Beyond the latter amount it would be hardly safe to go, 
for fear of causing gastro-enteritis. 
Sulphate of copper resembles the corresponding zinc salt as an emetic, but 
is more severe and irritating, and more capable of causing gastro-enteritis. 
The full dose in narcotic poisoning is from five to ten grains, which should 
not be repeated more than once. 
Powdered alum is a mechanical emetic, which has been especially recom- 
mended in membranous croup, on account of its being believed to act bene- 
ficially upon the diseased surfaces in its passage up and down the throat. A 
heaped teaspoonful of it may be given in molasses or syrup. In my experi- 
ence alum has proved an unreliable emetic. CLASS H-CATEAHTICS. 
Purgatives, or cathartics, are those drugs which are employed in medi- 
cine to act upon the intestinal tract so as to produce purgation, or catharsis. 
The question has recently been a good deal discussed as to whether purgation 
is produced by an increase of the watery secretions or of the peristaltic 
movements of the intestines. 
M. Thiry (Sitzungsberichte der k. k. Acad. d. Wissensch., Bd. 1.) experi- 
mented upon this subject by drawing out a knuckle of intestine through a 
wound in the linea alba, cutting it free from the remainder of the gut with- 
out injuring its nerves or blood-vessels, sewing together the distal and proxi- 
mal ends of the main portions of the intestines so as to re-form a continuous 
tube, and then, after closing up one end of the knuckle, forcing the other 
into the wound so as to make an intestinal cul de sac which could be studied 
through a fistulous opening. In dogs which had recovered after this opera 
tion, Thiry found that large doses of the sulphate of magnesium, of senna, or 
of croton oil failed alike to increase the secretion of the separated piece of 
intestine, although they induced violent purging; further, neither concen- 
trated solutions of Epsom salt, nor infusion of senna, even though kept in 
the cul de sac for some time, were able to increase its secretion by exosmose. 
More recently, Dr. S. Radziejewski has made an elaborate investigation of 
the subject (Reichert's Archiv fur Anat., 1870, p. 37). As the result of a 
number of very careful analyses, he asserts that there is nothing to be found 
in the stools produced by the sulphate of magnesium, by calomel, castor oil, 
croton oil, senna, or gamboge, to indicate that they are anything besides the 
ordinary contents of the upper and lower bowels. Dr. Radziejewski confirms 
the fact observed by C. Schmidt, that the stools of purgatives contain a great 
deal of soda, but denies that this proves at all that they are transudations, 
asserting that the alkaline salts are derived simply from the pancreatic 
fluid. Dr. Radziejewski also corroborates the confirmation by Asp (Ludwig s 
Arbeiten, 1868) of the discovery of Moreau,* that division of the intestinal 
nerves is followed by free serous exudation into the gut, but denies that pur- 
gatives act by paralyzing the vaso-motor nerves, because croton oil injected 
into a loop of intestine which had been separated by two ligatures from the 
remainder of the gut caused both vomiting and purging. As no emulsifying 
* Comptes-Rendus, t. Ixvi., 1868; also Asp, Ludwig's Arbeiten, 1868. 
483 484 
LOCAL REMEDIES. 
substance was contained in the intestine, he declares that no absorption 
could have occurred, and that consequently the general intestinal disturbance 
was simply due to increased peristaltic action, caused by the internal local 
irritation of the oil propagated along the intestines. The experiments of 
Thiry have also been repeated by Radziejewski with croton oil and with sul- 
phate of magnesium, as well as by Schiff (Naove. Richerche sid Potere dige- 
rente, H. Morgagni, 1867) with aloes, jalap, and sulphate of sodium. In all 
cases the results were the same as those already noted as obtained by Thiry. 
Carrying his investigations still further, Radziejewski, by forming intestinal 
fistulae at such positions as would enable him to study the rate of passage of 
the intestinal contents, found that after a dog is fed upon flesh the small 
intestine empties the partially-digested food into the colon so rapidly and in 
such quantity as to constitute, so to speak, a normal diarrhoea, and that the 
long delay in the exit and the hardening of the faeces occur in the large in- 
testine. The liquid which passed into the ascending colon agreed in all its 
characteristics with the stools of purgation. Dr. Radziejewski plso claims 
to have established by direct experimentation that the peristaltic movements 
of the small intestine were affected very decidedly by drastics, and to some 
degree by Epsom salt, and that in all cases the large intestine was still more 
intensely acted upon. Although these experiments are very interesting, it 
cannot be allowed that they prove what is claimed for them, namely, that 
purgatives cause no increase of intestinal secretion, but only of peristaltic 
action. So much violence to natural conditions is done in the experiments 
after the method of Thiry that they seem worthy of very little weight. The 
assumption of Radziejewski, that croton oil confined in a loop of intestine is 
not absorbed, is a pure assumption, and his experiment does not warrant the 
conclusions drawn from it. 
The other facts brought forward seem to prove only that increased peri- 
stalsis, especially of the large bowel, plays a more important role in the 
induction of diarrhaea than has been assigned to it. 
Leaving out of sight for the moment all clinical evidence, the fact that 
previous section of the par vagum prevents the action of purgatives* is 
opposed to the German theory, since it is almost certain that the division 
of the nerves of the neck does not arrest peristaltic movements. Further, 
Armand Moreau (Archives Gin., 6e s£r., t. xvi. p. 234) has found that a 
solution of Epsom salt placed in a knuckle of intestine isolated by means 
of two ligatures does cause a serous exudation into it, and in repeating M. 
Thiry's experiments (Gaz. Mid., 1871) he has obtained opposite results. 
His experiments indicate three possible sources of fallacy in the work of the 
previous investigators: first, if the Epsom salt be not kept in the intestine 
for a sufficient length of time (some hours), no transudation occurs; second, 
in some cases the inner end of the isolated piece of intestine fails to adhere, 
• See paper by the author, American Journal of the Medical Sciences, vol. lx., 1870. CATHARTICS. 
485 
ho that the opening is not obliterated, and the matters injected into the ar- 
rested cul de sac really pass into the peritoneal cavity; third, atrophy of the 
mucous membrane and glandular apparatus of the cul de sac often follows 
almost at once upon the operation, and of course necessitates a negative result 
in the subsequent experiments. Recently, Dr. Lauder Brunton, in a com- 
munication to the Medical Society of London, has stated that he had repeated 
Moreau's experiments, and found that sulphate of magnesium injected into the 
intestine of a cat caused about two-thirds of a drachm of fluid to be secreted 
in four hours by each inch of the bowel operated on, although the proportion 
of sulphate was only one grain to an inch (Med. Press and Circular, Dec. 
31, 1873). In further experiments by Dr. Brunton, gamboge, elaterium, and 
croton oil gave results similar to those of the Epsom salt (Practitioner, May, 
1875). M. Vulpian has repeated the experiments of Moreau, and found that 
both sulphate of magnesium and jalap provoke a 11 true intestinal catarrh 
the vegetable cathartic at the same time increasing the peristaltic action, but 
the saline having no such effect (Gaz. Med., 1873, p. 300). M. Legros 
(Ibid.), and also M. Van Braam Houckgeest (Pfliiger's Archiv, 1872, 266), 
have experimentally determined that salines do not increase the activity of 
the peristaltic movements.* 
* Dr. Matthew Hay (Jowrn. Anat. Physiolog., xvi., xvii.) has most exhaustively in- 
vestigated the action of saline cathartics. Space is wanting in which to discuss his article 
in detail, but the following are his results as formulated by himself: 
1. A saline purgative always excites more or less secretion from the alimentary canal, 
depending on the amount of the salt and the strength of its solution, and varying with 
the nature of the salt. 
2. The excito-secretory action of the salt is probably due to the bitterness as well as to 
the irritant and specific properties of the salt, and not to osmosis. 
3. The low diffusibility of the salt impedes the absorption of the secreted fluid. 
4. Between stimulated secretion on the one hand, and impeded absorption on the other, 
there is an accumulation of fluid in the canal. 
5. The accumulated fluid, partly from ordinary dynamical laws, partly from a gentle 
stimulation of the peristaltic movements excited by distention, reaches the rectum and 
produces purgation. 
6. Purgation will not ensue if water be withheld from the diet for one or two days pre- 
vious to the administration of the salt in a concentrated form. 
7. The absence of purgation is not due to the want of water in the alimentary canal, 
but to its deficiency in the blood. 
8. Under ordinary conditions, with an unrestricted supply of water, the maximal 
amount of fluid accumulated within the canal corresponds very nearly to the quantity of 
water required to form a 5 or 6 per cent, solution of the amount of salt administered. 
9. If, therefore, a solution of this strength be given, it does not increase in bulk. 
10. If a solution of greater strength be administered, it rapidly increases in volume 
until the maximum is attained. This it accomplishes in the case of a 20 per cent, solution 
in from one to one and a half hours. 
11. After the maximum has been reached, the fluid begins gradually and slowly to 
diminish in quantity. 
12. Cteteris paribus, the weaker, or in other words, the more voluminous the solution of 486 
LOCAL REMEDIES. 
The experimental evidence bearing upon the question under discussion is, 
so far as I know, all included in the above summary : it is very far from dem- 
the salt administered is, the more quickly is the maximum within the canal reached; and 
accordingly purgation follows with greater rapidity. 
13. Unless the solution of the salt is more concentrated than 10 per cent, it excites 
little or no secretion in the stomach. 
14. The salt is absorbed with extreme slowness by the stomach of the cat. 
15. The salt excites an active secretion in the intestines, and probably for the most part 
in the small intestine, all portions of this viscus being capable of yielding the secretion 
in almost equal quantities. 
16. The bile and pancreatic juice participate but very little in the secretion. 
17. The secretion is probably a true s„ccw« entericus, resembling the secretion obtained 
by Moreau after division of the mesenteric nerves. 
18. The secretion is promoted by local irritation of the intestine, as by ligatures, but 
only in the immediate vicinity of the irritation. 
19. Absorption by the intestine generally is reflexly stimulated by such irritation (the 
effect of numerous ligatures applied at points remote from the seat of the injected salt 
being to diminish the amount of purgative fluid by accelerated absorption). 
20. If the salt solution be injected directly into the small intestine, the stronger within 
certain limits the solution is, the greater will be the accumulation of fluid within the 
intestine. 
21. This difference is not observed when the salt is administered per os, as tho strong 
solution becomes diluted in the stomach and duodenum before passing into the intestine 
generally. 
22. The difference is due to the local action of the salt on the mucous membrane, and 
probably more to an impeded absorption than to a stimulated secretion. 
23. When the salt is administered in the usual manner, it appears, in the case of the 
sulphate of magnesia and sulphate of soda, to become split up in the small intestine, the 
acid being more rapidly absorbed than the base. 
24. A portion of the absorbed acid shortly afterwards returns to the intestines. 
25. After the maximum of excretion of the acid has been reached, the salt begins very 
slowly and gradually to disappear by absorption, which is checked only by the occurrence 
of purgation. 
26. During the alternations of absorption and secretion of the acid, it is the salt left 
within the intestine which excites secretion, the absorbed and excreted acid exerting no such 
action whilst in the blood, or during the process of its excretion, as Headland believed. 
27. The salt does not purge when injected into the blood, and excites no intestinal 
secretion. 
28. Nor does it purge, when injected subcutaneously, unless in virtue of its causing 
local irritation of the abdominal subcutaneous tissue, which acts reflexly on the intestines, 
dilating their blood-vessels, and perhaps stimulating their muscular movements. 
29. The sulphate of soda exhibits no poisonous action when injected into the circulation. 
30. The sulphate of magnesia is, on the other hand, powerfully toxic when so injected, 
paralyzing first the respiration and afterwards the heart, and abolishing sensation or 
paralyzing the sensory-motor reflex centres. 
31. Both salts, when administered in the usual manner, produce a gradual but well- 
marked increase in the tension of the pulse. 
32. According as the salt-solution within the intestine increases in amount, there occurs 
a corresponding diminution of the fluids of the blood. 
33. The blood recoups itself in a short time by absorbing from the tissues a nearly equal 
quantity of their fluids. 
34. The salt, after some hours, causes diuresis, and with it a second concentration of 
the blood, which continues so long as the diuresis is active. 
35. As the intestinal secretion excited by the salt contains a very small proportion of CA TH ART ICS. 
487 
onstrating that increased peristalsis, and not increased secretion, is the cause 
of the watery stools produced by purgatives. The evidence, both experi- 
mental and clinical, is indeed overwhelmingly in favor of increased secretion. 
The facts proven by clinical observations and by experiment-that purga- 
tives increase greatly the secretion in an isolated knuckle of intestine, that 
various purgatives act when taken into the blood, and that in these cases 
elimination by the bowels occurs ; that at least some purgatives (Headland, 
Action of Medicines, London, 1867, p. 443), when given by the mouth, are 
absorbed, disappearing from the alimentary canal and reappearing when pur- 
gation occurs; that the stools induced by overdoses of various drastics, as 
elaterium, are so enormous as to cause the profoundest depression, and even 
choleraic collapse, in a very few hours ; that the discharge of hydragogues 
contains a very large percentage of soda, the alkali of the serum; that 
the relief obtained in portal congestion by the depletion of salines is very 
marked-are, when viewed together, to my mind, incompatible with any 
other belief than that purgatives cause increased secretion, as well as, in 
many cases, increased peristalsis, in the alimentary canal. 
The question of the action of drugs upon the flow of bile is a very im- 
portant one, the evidence concerning which is best considered under two 
headings: first, the experimental; second, the clinical. 
The experiments upon this subject which have attracted most attention 
are those of Dr. Scott, and of the Edinburgh committee, of which Prof. 
Bennett was chairman and Drs. Rutherford and Gramgee the workers. The 
method employed both by Dr. Scott and by the Edinburgh committee was 
to make biliary fistulae in dogs in the usual physiological method, and, after 
recovery from the operation had taken place and the bile regularly escaped 
by the external orifice, to administer the drugs, especially calomel and podo- 
phyIlin, and study the effects upon the excretion of bile. Of the accuracy ot 
their experiments I do not think there can be any reasonable doubt. I be- 
lieve they prove that in dogs with biliary fistulae mercury has no effect upon 
the flow of bile unless given in such quantities as to deteriorate the general 
health, when it diminishes the biliary secretion. The result does not, how- 
ever, warrant the further conclusion that mercury does not increase the flow 
of bile in healthy dogs. The animals were in such an unnatural condition 
that, in spite of the daily ingestion of much more than the normal amount of 
food, they progressively emaciated, and finally died apparently of inanition: 
organic matter as compared with the inorganic matter, the purgative removes more of the 
latter than the former from the blood. In certain cases a large quantity of the salts of 
the blood is thus evacuated. 
36. The amount of the normal constituents of the urine is not affected by the salt. 
37. After the administration of sulphate of magnesia much more of the acid than of 
the base is excreted in the urine. 
38. The salt has no specific action in lowering the internal temperature of the body, or 
has it only to a very small extent. 
39. It reduces, however, the absolute amount of heat in the body. 488 
LOCAL REMEDIES. 
moreover, the innervation, and very possibly the blood-supply, also, of the 
liver was very much interfered with. Under these circumstances it is clearly 
conceivable that the mercurial or other purgative might in the uninjured dog 
affect the biliary secretion, and yet fail to do so in the experiment, hindered 
by some obscure yet efficient cause. Very recently, Dr. A. Rbhrig has ex- 
perimented (^Stricker's Medicin. Jahrbiicher, 1873) in a method which simu- 
lates more closely the natural conditions; although even the results thus 
obtained do not seem to me conclusive. In curarized dogs in which life 
was maintained by artificial respiration, he placed a glass tube in the gall- 
duct so that the bile could escape only through it. Under these circum- 
stances, of course, after a time secretion ceased ; and Dr. Rbhrig experimented 
not only on the effect of remedies upon the secretion whilst naturally going 
on, but also upon their power of re-establishing it. He found that large dosea 
of croton oil (eighteen drops) thrown into the duodenum caused an immediate 
very great increase, or a re-establishment, of the secretion. After the oil, the 
vegetable cathartics were most active, decreasing in power in the following 
order: colocynth, jalap and aloes, rhubarb and senna. Castor oil had very 
little influence, as had also the bitter salts. Calomel, even in large doses (twenty 
grains), very rarely re-established the secretion, but its power of increasing 
and maintaining it beyond the natural time for cessation was very marked. 
Prof. W. Rutherford, in a most extended and laborious research, used 
the method of Rbhrig with some improvements (Trans. Roy. Soc. Edinb., 
xxix.). The drug, mixed with bile to facilitate absorption, was injected 
directly into the duodenum by means of a hypodermic syringe. The results 
obtained may be briefly summarized as follows • 
Croton Oil in enormous doses neither purged nor affected the biliary 
secretion. 
Podophyllin very greatly increased biliary secretion, especially when in 
such small doses that it did not purge severely. 
Aloes very greatly increased biliary secretion, the doses used not purging 
greatly. 
Rhubarb, Colchicum, Iridin, Colocynth, Jalap, Sulphate of Sodium, 
Phosphate of Sodium, Rochelle Salt, very greatly increased biliary secretion, 
at the same time purging. 
Senna, Taraxacum, Scammony, Gamboge, Castor Oil, Sulphate of Mag- 
nesium, Chloride of Ammonium, acted very feebly, if at all, upon the liver. 
Leptandrin, Chloride of Sodium, Bicarbonate of Potassium, had some, 
but not a powerful, effect on the liver. 
Euonymin, Sanguinarina, Ipecacuanha, had very powerful influence on 
the secreting of bile, and did not purge. 
Calomel had no effect on the biliary secretion, but when to it a minute 
proportion of corrosive sublimate was added the effect was very marked; 
Corrosive Sublimate acted as a very powerful biliary stimulant. 
There is one objection to the experiments of Rutherford and Vignal, en- CATHARTICS. 
489 
tirely independent of the method employed,-there were rarely more than 
two experiments with any one substance, and in several instances two experi- 
ments gave antagonistic results. It is very possible, indeed probable, that if 
a number of experiments had been made with each drug, the variation in 
results would have been much greater. 
What is to be drawn from these various facts ? Evidently, I think, but 
one conclusion,-that the experimental evidence at present does not warrant 
positive deductions as to the effect of purgatives upon the biliary secretion 
of healthy dogs. The canine diet and digestion are so different from the 
human that it is to be expected that medicines acting upon the digestive 
apparatus will influence dogs differently from man: thus, I have given doses 
of elaterium that would have killed a man to some of the carnivora without 
causing the slightest purging. In view of these facts, the only fairly de- 
ducible conclusion in regard to the experimental evidence that has been 
brought forward is, that it must be received with the greatest reserve or be 
entirely laid aside when we desire to study the question as to the cholagogue 
action of remedies upon man, and that our conclusions are most safely based 
upon clinical evidence. 
In regard to the drastics, there can be little doubt that almost any irritant 
purgative will to a greater or less extent increase the escape of bile, probably 
both by increasing its flow into the duodenum and by sweeping it out of the 
small intestine before absorption can take place. There are, however, two 
actively purgative substances for which it is especially claimed that they are 
cholagogues: namely, calomel and podophyllin. The discussion of the action 
of these will be found under their respective headings. 
Dr. Hugo Heinrichsen has found (Schmidt's Jahrb., Bd. ccii. p. 214) 
that the excretion of urine is diminished by purgatives; very much so by 
Glauber and Epsom salts; slightly by castor oil and compound liquorice 
powder. The solids of the urine are not sensibly affected by the vegetable 
cathartics. Under the influence of the salines the solids of the urine are 
increased. Glauber salts is said to be partially converted into an alkaline 
carbonate, and to thereby give an alkaline reaction to the urine. 
Various divisions of purgative medicines have been proposed by different 
authors ; but probably the most convenient arrangement is as follows : 
1. Laxatives.-Medicines which simply unload the bowels, and are not 
able to cause active purgation, even when given in very large doses. 
2. Purges.-Medicines which purge actively, but are not capable of acting 
as poisons, even in very large amount. 
3. Hydragogues, which produce very large watery stools without much 
irritation. In overdoses, medicines of this class assume some of the char- 
acters of those of the next. 
4. Drastics, which cause great irritation of the alimentary mucous mem- 
brane, and in overdoses are violent poisons. 
It must be borne in mind that this classification is somewhat artificial; 490 
LOCAL REMEDIES. 
that the effects of the remedies depend much upon the doses in which they 
are administered, so that in sufficiently minute quantity a drastic may act as 
a laxative; and that the dividing-lines between the groups are not very 
distinct. 
Enemata.-When it is desired simply to unload the lower bowels, the 
object can often be advantageously attained by injecting various materials 
into the rectum, so as by mechanical distention, or by irritating the mucous 
membrane, to stimulate the peristaltic action. The simplest, least irritant, 
and least active enema is one of cold water. In cases of habitual constipation, 
especially when complicated with piles, the injection of a pint of cold water 
at a fixed hour daily often acts most kindly. The ordinary opening injection 
consists of a pint of water, and a tablespoonful, each, of salt, molasses, and 
soft soap; castor oil is often added to it, and, if it be desired to make it very 
active, a teaspoonful of oil of turpentine. 
Forced enemata.-The forced injection of large quantities of water for the 
lulief of certain diseased conditions has long been employed in an irregular 
way; but the practice has become more common since Gustav Simon has 
proven the possibility of readily filling the large and even the small intes- 
tine, by forcing water into the rectums and through two patients suffering 
from intestinal fistula, the opening leading in the one case into the large 
intestine about the junction of the caecum and ascending colon, in the other 
probably into the small intestine (Archiv d. Klin. Chir., xv.). Recently 
Mosier has experimented on a patient in whom a finger introduced through the 
fistulous opening could feel the ileo-caecal valve. Using a method to be shortly 
described, he found that in two minutes from the time water first entered 
the rectum it commenced to stream from the orifice, having traversed the 
whole length of the large intestines (Berlin. Klin. Wochensch., No. 45,1873). 
Forced enemata are of especial value in intussusception, in which disease 
they have not rarely relieved the symptoms at once by mechanically dis- 
tending and unfolding the invaginated gut. Dr. Mosier also commends 
them in hernia, and has employed them as anthelmintics. As such they 
are, of course, especially useful against the oxyuris vermicularis, which often 
inhabits the whole of the large intestines; but Dr. Mosier succeeded with 
them in removing a large tape-worm, probably from the colon. Especially in 
the case of the seat-worm the vermifugal enemata should be medicated; and 
probably the safest and most efficient substance for this purpose is quassia. 
Dr. Mosier used a tablespoonful of chlorine-water to every pint and a halt 
of injection. In various catarrhal and other diseases of the large intestines, 
Dr. Mosier commends these large enemata as a means of cleansing the gut, 
removing acrid secretions or foreign matters, and applying local treatment. 
A. Rbhrig (Experim. Untersuch. u. d. Physiol, der Gallenabsonderung, 
Wien, 1873) having found that intestinal injections of water have a very 
great influence over the secretion of bile, Dr. Mosier has been led to try 
forced enemata in catarrhal and other jaundices, with asserted good results. CATHARTICS. 
491 
In administering these large injections a syringe should never be used. 
The apparatus to be provided consists of a rectal tube of hard rubber, with a 
conical point, below which are several good-sized openings; an india-rubber 
tube two feet and a half long fitted to the rectal tube, and a funnel. The 
patient should lie upon his back, with the hips elevated. The tube being 
introduced into the rectum, the free end with the funnel is raised verti- 
cally, and water poured into it. When it is desired to force fluid into the 
small intestine, much depends upon the introduction being performed slowly, 
and the patient should be placed upon his knees and shoulders, so that the 
pelvis may be much higher than the shoulder. It is essential that the tube 
be fitted with a cock, or be pinched, so as to regulate the passage of the 
liquid. In this way from five to nine pints are readily injected. 
The indications to fulfil which cathartics are used are as follows: 
1. To unload the bowels.-It is not necessary, in a work like the present, 
to say anything about the evil results of retained fecal matter, but only to 
point out the methods of relief. Before this can be done to advantage, how- 
ever, a summary of the causes of constipation is required. Constipation 
may be well divided into acute and chronic. Acute or temporary constipa- 
tion is that which occurs under special, transient circumstances, as in conva- 
lescence from acute disease, and in pregnancy. It is to be relieved by the 
use of laxative articles of diet, and, this not sufficing, by laxatives or pur- 
gative medicines. It should never be forgotten that acute constipation is 
sometimes due to organic affections of the alimentary canal, such as enteritis 
or intussusception, or is caused by mechanical obstacles, such as a hard 
foreign body or an enormous gall-stone. It is evident that such cases are 
not simple constipation; that the treatment required is essentially different 
from that of the latter affection, and is various according to the lesion. For 
the diagnosis and treatment of these diseases the reader is referred to works 
on the practice of medicine. Chronic constipation may be due to sedentary 
habits of life; to habitual overwork, especially of the nervous system ; to a 
deficiency of intestinal secretion and of peristalsis, apparently natural to the 
individual and without obvious cause; to long-continued voluntary habit of 
restraining the desire to go to stool; tc lead or other forms of poisoning ; 
and to diseases of the nervous system producing a paralytic state of the 
intestinal muscular fibres. It is evident that in the treatment of these 
various forms of constipation due regard must be paid to the cause, which 
should always, if possible, be removed. There are also certain cardinal 
principles which apply to the treatment of all forms of chronic constipation. 
They are as follows : 
1. A voluntary effort at defecation is to be daily made at a fixed hour, 
whether the desire exist or not. 
2. Medicines are to be avoided as far as possible, a sustained effort being 
made to regulate the bowels by means of diet. 492 
LOCAL REMEDIES. 
3. In very many cases the daily use of enemata of cold water, with atten- 
tion to diet, suffices to attain the desired result. 
4. If medicines become necessary, as small an amount as will suffice, and 
the mildest drugs, are to be used. Purgatives or laxatives are at best merely 
temporary devices, and if abused in costivencss increase the trouble. So far 
as can be, the attempt should be to produce a permanent impression, an alter- 
ation of the intestinal glandular action or peristalsis. Thus, when atony of 
the muscular coat exists, strychnia, or, according to recent experiments and 
clinical observations, Calabar bean (see page 304), may be employed: if the 
hepatic or other glands are habitually torpid, nitro-muriatic acid may be 
administered. 
When constipation is attended with low spirits and a coated tongue, it is 
almost always due to a deficiency of secretion, and may be looked upon as a 
form of dyspepsia: in such cases nitro-muriatic acid is especially valuable, 
but sometimes a mild mercurial course seems almost imperative. 
A second use of cathartics under the present indication is to remove 
offending materials, as indigestible or irritant food, foreign bodies, acrid 
discharges, etc. For these purposes a brisk, quickly-acting purgative is 
generally best. 
2. To deplete.-On account of the large serous flow which they produce, 
the hydragogue cathartics when freely exhibited cause a very decided general 
depletion. 
Local depletion by means of cathartics is called for in congestion of the 
portal circulation, as well as in dysentery and other acute intestinal inflam- 
mations. Under the first of these conditions may, we think, be included 
without violence cases of the so-called 11 torpidity of the liver," which will 
be discussed in the article upon calomel. In acute intestinal inflammations 
the salines are to be preferred when depletion is desired, as they produce 
very large serous discharges and are not at all irritant. 
3. To promote absorption.-By emptying the blood-vessels the cathartics 
favor the absorption of the exuded fluid in general dropsy. For this purpose 
the hydragogues, and especially elaterium, are the best purgatives. The 
production of catharsis is the surest method of relief in general dropsy, also 
in ascites ; in other forms of local effusion its effects are less marked. As, 
however, purgation is the most exhausting of all the plans employed for the 
cure of dropsy, due regard must always be had to the strength of the patient. 
It is frequently necessary actively to support or even to stimulate while it is 
being carried out. 
4. To remdse.-The long tract of the alimentary canal affords a great 
extent of surface upon which to practice revulsion in certain brain-diseases, 
as in mania and rheumatic or gouty irritation of the cerebrum. In hyper- 
semia of the brain, purgatives do good by depleting as well as by acting as 
revulsives. The drastics should be preferred. 
5. To eliminate.-It cannot be doubted that the use of purgatives in such CATHARTICS. 
493 
discases as fevers and cholera, with the idea of eliminating some materies 
morbi, rests simply upon a crude, unproven, and probably false pathology. In 
rheumatic disease and in gout it is more probable that they do good in this 
way, although it is by no means certain that the advantage derived from their 
use is not simply due to depletion. In cases of retained renal secretion, the 
evidence is very decided that they do aid in separating the products of retro- 
grade metamorphosis from the blood. 
6. To influence the pelvic circulation.-The only purgative used for this 
purpose is aloes, in the article upon which all that is necessary will be said 
upon the subject. 
LAXATIVES. 
As has been already stated, constipation should always, when possible, be 
overcome by laxative food. There are two qualities by virtue of which food 
is laxative. Chief of these is bulk. All aliment which contains a large 
amount of innutritious material affords a large residuum, which, by distend- 
ing the intestine, stimulates peristalsis. Contrariwise, articles of diet which are 
highly nutritious and afford but little residuum are constipating. This holds 
good, more or less strictly, among the lower animals. Thus, the flesh-eating 
carnivora are habitually constipated; the grass-eating herbivora very gener- 
ally lax. Owing to its containing so little of the innutritious portion of the 
grain, the finest white flour favors a costive habit, whilst the " cracked wheat," 
in which the whole grain is eaten, is laxative; as to a still greater degree is 
bran, which is composed almost wholly of the husk of the wheat, the least 
nutritious portion of it, and therefore leaves a large residuum after digestion. 
Cracked wheat is boiled into a sort of jelly-like mass, and eaten with cream 
and sugar, whilst bran is taken in the form of bran bread, bran crackers, or 
bran mush. Unbolted flour, containing the whole of the grain, is about equal 
to cracked wheat, and is often made into bread. Indian meal, in the form of 
cakes or of mush, is highly nutritious, and somewhat laxative; oatmeal is 
decidedly laxative, scarcely so much so as bran, but much more nutritious. 
When it agrees with the stomach, and is easily digested, it is probably the best 
of all these laxative articles of food. As the oats produced in warmish cli 
mates are very inferior, care should be taken to procure oatmeal manufactured 
from Northern grain. It should be thoroughly cooked, and is best eaten in 
the form of a thick porridge. In dyspepsia all of these articles sometimes 
disagree with the stomach and cannot be used. 
Some dietary articles seemingly possess dynamic laxative powers,-i.e., they 
exert a direct action which is not mechanical, but is similar to, although far 
less active than, that of the true purgatives. They intensify the intestinal 
action. Chief among substances of this class are molasses (Syrupus Fuscus, 
U.S.), and its congener, brown sugar; white sugar (Saccharum, U.S.) prob- 
ably does not share these laxative powers ; sugar of milk (^Saccharum Lactis, 
U.S.) is probably also nearly inert. Of course, great care is usually neces- 494 
LOCAL REMEDIES. 
sary in taking advantage of the laxative virtue of molasses, on account of 
the danger of producing fermentation and acidity in the primm vise. An 
obvious deduction, however, is to encourage the use of brown instead of 
white sugar in those of constipated habit. 
There are certain foods which combine the two methods of action spoken 
of. Chief among these are the fresh acidulous fruits-such as apples, pears, 
etc.-and the dried fruits. Of the latter, the fig (Ficus, U. S.) is one of the 
most palatable, and, owing probably to the great number of small seeds which 
it contains, is the most efficient. Prunes are nearly as agreeable as figs. To 
a limited extent the finest varieties of them may be eaten raw ; but they are 
especially to be recommended stewed. When it is necessary, a pinch of 
senna-leaves may be oooked with them, and, if it be not made too large, in- 
creases the activity of the dessert without affecting its flavor. 
Among constipating articles of diet, it is only necessary to call attention to 
milk as one of the most decided of the class. 
The laxative remedies of the U. S. Pharmacopoeia are as follows: 
TAMARINDUS-TAMARINDS. U. S. 
The preserved fruit of the Tamarindus Indica, a large tree, native of the 
East and West Indies. The fruit is a broad, compressed pod, usually from 
four to six inches long, somewhat curved, with an exterior brown hard rind. 
It contains seeds inclosed in cells formed of a tough membrane, between which 
and the rind is an acid pulp, the medicinal part of the fruit. Tamarinds are 
preserved for market by stripping off the outer rind, packing the inner por- 
tion in layers, and pouring on boiling syrup. In the market they are offered 
as adhesive masses composed of pulp, membranes, strings, and seeds, and 
having a sweet, acidulous taste. They contain a good deal of citric acid, much 
less of the tartaric, and a little of the malic acid. They are used chiefly in 
making refrigerant acidulous drinks for fever, and in convalescence as a laxa- 
tive article of diet, half an ounce to an ounce or more being eaten like pre- 
serves. They enter into the officinal confection of senna. 
MANNA-MANNA. U.S. 
An exudation of the European ash, Fraxinus Ornus, chiefly produced in 
Sicily and Calabria. There are three varieties of it. The best, flake manna, 
occurs in unequal, rough, stalactite-like pieces with a crystalline or granular 
fracture, and is obtained in the hottest and dryest weather in July and Au- 
gust. The next quality, manna in sorts, consists of pieces of flake manna, 
mixed with a soft brownish matter; it is obtained in September. Fat manna, 
a soft viscous mass, which exudes during the wet weather in the latter part 
of October and in November, is the least valuable variety. Manna has a 
slight odor, a sweet, mawkish taste, and should contain from forty to eighty 
per cent, of the saccharine, active, crystalline principle Mannite, which differs CATHARTICS. 
495 
from ordinary sugar in not containing equal parts of hydrogen and oxygen, and 
is therefore not readily convertible into grape sugar or its derivative, alcohol. 
Therapeutics.-Manna is a gentle laxative in large doses, sometimes 
causing flatulence and pain. It is rarely used by itself, but is added to infu- 
sions of more powerful purgatives, to cover their taste and aid in their effects. 
The laxative dose for an adult is half an ounce to two ounces; for a child, 
one to four drachms in an aromatic infusion. 
Cassia Fistula. U. S.-Purging Cassia is the pulp of a hard, blackish, 
cylindrical pod from one to two feet in length and about an inch in diameter, 
having on one side a single and on the other a double dark band, running 
the whole length of the pod. and marking the positions where its valves are 
united. The pods are produced by a large tree, Cassia fistula, a native of 
Egypt and India. The dark, sweetish, acidulous, officinal pulp may be used 
as a laxative in doses of half an ounce, but is apt to cause griping. It enters 
into the confection of senna. 
Frangula. U. S.-The bark of the Rhamnus Frangula, one of the 
buckthorns of Europe; is considerably used abroad as a laxative, and con- 
tains a crystalline principle, franguline, besides glucosides, of which emodine 
is also found in rhubarb. In this country it is employed very rarely, but 
the bark of the Rhamnus Purshiana, or California buckthorn, is very 
largely used under the name of Cascara Sagrada. It probably contains 
principles either identical with or allied to those found in the European 
bark. In many cases its fluid extract acts most happily as a laxative 
in habitual constipation, although sometimes it causes griping pains and 
irritation of the mucous membrane. The best results are usually to be 
obtained by giving from ten to fifteen drops of the fluid extract one or two 
hours after meals; rarely half a fluidrachm given at bedtime seems to 
suit better an individual case. 
MAGNESIA-LIGHT MAGNESIA. U.S. 
MAGNESIA PONDEROSA-HEAVY MAGNESIA. U.S. 
The heavy and the light magnesia differ only in their physical characters, 
the particles being differently aggregated. The carbonate of magnesium 
(Magnesii Carbonas, U. S.) is manufactured by precipitating a solution of 
the sulphate of magnesium by one of the carbonate of sodium. If the two 
solutions be concentrated, the dense or heavy carbonate falls; on the other 
hand, if the solutions be dilute, the precipitate is a light carbonate. Heavy 
magnesia is obtained by calcining a heavy carbonate; light magnesia, by 
using a light carbonate. All of these substances are of a milk-white color, 
and occur in powder; the carbonate sometimes in very light cubical blocks. 
They are all practically insoluble in water, freely so in dilute acid, and in 
the presence of acids they both act as alkalies. 
Therapeutics.-Magnesia and its carbonate act in the same manner upon 496 
LOCAL REMEDIES. 
the human economy, being both antacid and laxative. For their purgative 
powers they are probably dependent upon the presence of acids in the primae 
viae, and hence their effects vary. They are sometimes taken as habitual 
laxatives by persons suffering from acid dyspepsia; but, as they are said at 
times to accumulate in the intestines and to do harm mechanically, this use 
of them should be discountenanced. They are very frequently employed in 
conjunction with Epsom salt, senna, or other of the more powerful purga- 
tives, on account of their antacid properties. Their chief use is in acute 
acid dyspepsia, in sick headache, in some forms of diarrhoea with excessive 
acidity in children, in gout, rheumatism, and in various cutaneous affections; 
wherever, in a word, a laxative antacid is indicated. 
Administration.-The dose of the carbonate is, for a child a year old, 
from five to twenty-five grains, according to the effect desired; for an adult, 
half a drachm to half an ounce ; that of the magnesia is about one-fifth less. 
SULPHUR. 
Sulphur is officinal in three forms: Sulphur Sublimatum, or Flowers 
of Sulphur; Sulphur Lotum, or Washed Sulphur; and Sulphur Pr^e- 
CIPITATUM, or Precipitated Sulphur. The first of these is made by sub- 
liming sulphur into cool chambers, and always contains some sulphuric acid, 
generated during the process. ■ When freed from the acid by washing with 
warm water and ammonia, it constitutes the washed sulphur. The U. S. 
Pharmacopoeia directs the precipitated sulphur to be prepared by boiling 
lime and sulphur together, so as to form a sulphide of calcium, and precipi- 
tating this with muriatic acid. 
The sublimed and the washed sulphur occur as sulphur-yellow, crystalline 
powders; the precipitated as a whitish powder, whose particles are often co- 
herent into friable lumps. For an account of the various allotropic forms 
of sulphur, and its chemical properties, the reader is referred to works on 
chemistry. It is insoluble in water, but soluble in alkaline solutions, in 
alcohol, the fixed and volatile oils, chloroform, ether, etc. 
Physiological Action.-When applied locally, sulphur is almost with- 
out influence. Taken internally, it is dissolved to some extent in the alkaline 
intestinal juices and absorbed. It has been detected in the milk, sweat, urine, 
and even in the breath. It would appear to suffer oxidation in the system, 
at least its ingestion is followed by increase of the urinary sulphuric acid 
(Regensburger, Centralb. Med. Wissen., 1877, 328). When in sufficient quan- 
tity, sulphur acts as a mild laxative, producing soft, semi-liquid, feculent 
stools, accompanied generally with much offensive flatus of sulphuretted 
hydrogen. It is affirmed that in some instances the latter gas has been 
so freely generated and absorbed as to cause systemic poisoning. Cases 
have also been reported in which the flowers of sulphur acted as an irritant 
poison; but this, without doubt, has been owing to their containing a large 
quantity of sulphuric acid. Its continued use has probably some effect upon CATHARTICS. 
497 
nutrition; the secretions generally are slightly increased, and some have 
affirmed that the temperature is somewhat elevated; but the truth of this is 
certainly very doubtful. The results of clinical experience indicate that it 
has an especial tendency to act upon the skin and mucous membranes. 
Therapeutics.-As an habitual laxative, sulphur has been used with 
asserted advantage in cases of hemorrhoids and of chronic rheumatism. In 
subjects of the latter disease it is claimed that it exerts a beneficial alterative 
influence, especially in sciatica and in lumbago and other varieties of mus- 
cular rheumatism. It has also been employed as an alterative in various 
cutaneous affections; and in the form of natural sulphur-waters, used exter- 
nally and internally, there is much testimony as to its value in both rheu- 
matic and skin diseases. Sulphur is very largely used as a parasiticide in 
cases of itch. Dr. Tilbury Fox recommends its application in the following 
manner. He says, "I have applied to all papules and vesicles the following 
ointment: sulphur, half a drachm ; ammonio-chloride of mercury, four 
grains; creasote, four drops; oil of chamomile, ten drops ; and an ounce of 
lard. This is rubbed in night and morning for three days, especially to the 
interdigits and wrists ; the same shirt is kept on till the third day, when it is 
changed and a warm bath given. The use of the parasiticide for two or 
three days should be followed by a good washing and the discontinuance of the 
remedy for a night. If the patient be not troubled with itching during the 
night, we may conclude that the acari are killed, and all we need to do is to 
guard against the hatching-out of fresh acari by the light application of our 
parasiticide once a day to any ' pimply' or itchy place for a few days longer, 
taking care that the foul clothes are well heated or scalded. ' Not too strong 
and not too long,' is my rule in the use of remedies for scabies. The occur- 
rence of red, rough, erythematous patches is a sign that the remedy itself is 
creating a disease." 
Administration.-Sulphur is generally given in powder, mixed with 
syrup or molasses. Dose, as an alterative, ten to twenty grains three times 
a day; as a laxative, one to three drachms at bedtime. 
Potass A Sulphurata.-Sulphurated Potassa is prepared by heating 
together sulphur and carbonate of potassium. It occurs in liver-brown 
fragments, which form an orange-yellow solution in water. Its taste is 
acrid, alkaline, and very disagreeable. When moistened, it feebly emits the 
odor of sulphuretted hydrogen. 
Locally applied, the sulphuret of potassium is a very decided irritant. 
Taken in large quantities, it is a violent corrosive poison, and is said to 
have produced fatal gastro-intestinal inflammation. In medicine it has until 
within a very short time been employed only externally. It has been used 
as a stimulating ointment (3ss to §j) in various skin-affections, and is also 
used for the formation of sulphur-baths, the strength of which should vary, 
according to the requirements of special cases, from two to six ounces of the 
drug in thirty gallons of water. They should be taken warm, the patient 498 
LOCAL REMEDIES. 
remaining in from twenty minutes to two hours, and are said to cause a 
general excitement, amounting in some susceptible persons to high fever. 
When employed strong, they sometimes occasion a papular eruption. They 
have been used in chronic rheumatism and in various scaly skin-diseases. 
Calx Sulphurata. U. S. Sulphurated Lime.-In the Lancet for 
February, 1874, Dr. Sidney Ringer recommended in the most laudatory 
manner sulphide of calcium in frequently-repeated doses of a tenth of a 
grain in boils when they appear in successive crops, and in various scrofu- 
lous and other unhealthy sores, such as occur especially in children, also 
in scrofulous glandular enlargements. The value of the remedy has been 
confirmed by Duhring and others; it is often given in half-grain doses. The 
Calx Sulphurata of the Pharmacopoeia contains not more than 36 per cent, 
of pure sulphide of calcium, but is the commercial article known by that 
name. 
PURGES. 
OLEUM EIOINI-CASTOR OIL. U. S 
A fixed, nearly odorless oil, of a nauseous taste, obtained from the seeds 
of the Ricinus communis by expression. The seeds are slightly warmed 
before being put under pressure, so as to liquefy their contained oil; and 
the crude oil obtained from them is boiled with a small amount of water, 
so as to coagulate its albuminous impurities. The oil was formerly manu- 
factured by means of alcohol, also by heating the seeds or by boiling them 
in water, and several varieties of it existed; but these are no longer in the 
market. Castor oil is remarkable for being soluble not only in ether but 
also in alcohol. The castor-oil seeds, or beans, as they are commonly called, 
contain an acrid fixed principle, which makes them exceedingly poisonous. 
Physiological Effects.-Castor oil acts upon the human organism as 
a mild but decided purgative, producing copious fluid fecal discharges, and 
in overdoses sometimes vomiting, and always purging freely. It is a matter 
of some doubt whether the properties of the officinal oil are or are not due 
to the presence of a minute quantity of the acrid principle of the seeds; 
although the probabilities are in favor of the affirmative proposition. That 
the oil or its active principle is absorbed is proven by analogy, and by the 
facts that in children it sometimes purges when rubbed upon the skin of the 
abdomen (Canvane, quoted by Still6), and that when taken into the stomach 
it has been known to exude from the skin (Ward's case, London Med. Gaz., 
vol. x. p. 377). In regard to its existence in the stools, the testimony is 
conflicting. Thus, Bucheim ( Virchow's Archiv, Bd. xii.), although he sub- 
mitted the passages produced by it to careful chemical manipulation, failed 
to detect it or any of its derivatives in them; but Bird (quoted by Stills) 
and other observers affirm that it can be seen by the eye in the dejecta, CATHARTICS. 
499 
either as oil or in the form of caseous flakes. According to the experiment 
(quoted by Still6) of Hale upon himself, half an ounce of castor oil injected 
into a vein produces malaise, nausea, faintness, anxiety, and general dulness 
and depression, without purging. 
Therapeutics.-On account of the mildness of its action and an especial 
property which it appears to have of soothing an irritated bowel, castor oil 
is constantly employed whenever it is desired simply to evacuate the in 
testinal canal; not so much, however, in chronic constipation as when a 
temporary action is alone required. In various inflammatory or irritative 
affections of the alimentary canal, castor oil is of the greatest service, partly, 
no doubt, by removing acrid irritating secretions or foreign materials, such 
as undigested food, and partly by causing a depletion of the congested vessels, 
but also apparently by virtue of an almost specific power, which renders it 
the most satisfactory cathartic in these cases. This is especially seen in the 
acute diarrhoeas and even in the chronic enteritis of children, but also holds 
good in the diarrhoeas and dysenteries of adults. 
Within the last few years a good deal has been written in regard to the 
use of the leaves of the castor-oil plant as a galactagogue, and sufficient evi- 
dence has been brought forward to render them worthy of some confidence. 
A poultice made of the fresh leaves should be applied to the breasts, and a 
teaspoonful of a fluid extract, prepared from the same, should be exhibited 
three or four times a day. 
Administration.-Castor oil is very repulsive to the palate, so much so 
as to nauseate, or even vomit, by its taste, some susceptible individuals. It 
has been the habit to administer it in emulsion with a strong mint-water, or 
to give it in the froth of porter or in a cup of hot coffee; but by far the 
best plan is to mix it with an equal part of glycerine and to add two or three 
drops of the oil of cinnamon or of gaultheria to each dose. The substances 
do not stay mixed, but separate on standing: when used, they may be made 
temporarily to recombine by shaking the bottle. As glycerine has feeble 
laxative power, an ounce of this mixture represents a little more than half 
an ounce of the oil. It should be taken directly out of the spoon. The 
full purgative dose of the oil is half an ounce to an ounce for an adult; for 
an infant a year old, one to two teaspoonfuls. In dysentery it is sometimes 
advantageous to give the drug in small dose every three hours until a decided 
purgative operation is induced. 
Toxicology.-Although castor oil is harmless, yet the beans contain an 
acrid principle, which renders them exceedingly poisonous, three of the beans 
having sufficed to destroy the life of a man (Med. Times and Gaz., May, 
1861). The symptoms do not usually come on until from two to five 
hours after the ingestion of the poison, when severe abdominal pain is felt, 
accompanied by violent vomiting and by purging, which after a time may 
become bloody, and soon ushers in a stage of collapse, with or without severe 
muscular cramps, with cold sweating skin, contracted features, thirst, rest- 500 
LOCAL REMEDIES. 
lessness, small rapid pulse, and sometimes the general appearance of Asiatic 
cholera. After death, intense redness and even abrasion of the stomach and 
of the small intestines are found. The treatment should consist in the 
evacuation of the stomach and bowels by mild emetics, such as ipecacuanha 
and warm water, and by mild cathartics, such as castor oil, provided nature 
has not already sufficiently fulfilled the indications, and in the free use of 
opium and demulcent drinks, the early external application of leeches and 
of emollient poultices, and the swallowing of small pieces of ice: in other 
words, the treatment, after evacuation, should be that of acute gastro-enteritis. 
HYDRARGYRUM. U.S. 
The only preparations of mercury which are used as purgatives are 
calomel and blue mass. Of these the first is by far the more active, and 
indeed is the only one which can be relied upon to purge, since the pilulae 
hydrargyri very frequently will, if given by themselves, fail to induce liquid 
stools. 
The chief interest in the purgative action of mercurials centres in the 
question as to their influence upon the liver. The evidence at present de- 
rivable from experiments upon the lower animals has already been discussed, 
and the decision arrived at that it must be rejected.* 
When calomel is given to a healthy man in moderate purgative doses, 
green liquid stools are produced, which, after larger doses, are replaced by 
brown passages. The color of these passages has always been supposed by 
clinicians to be due to the presence of bile; but recently it has been affirmed 
that the green tint is owing to a compound of the mercury itself. Although 
no chemical proof of the presence of the metal or its salt has, that I am 
aware of, been furnished, yet it can scarcely be doubted that mercury is 
present in the first passages produced by calomel. The question, evidently, 
is not, Is mercury ever present in the " spinach-stools" ? but, Is it always 
present? or, in other words, Is it an integrant portion of them? The 
evidence is not so abundant upon this point as is desirable, yet seems suf- 
ficient to furnish a negative answer to the last question. Simon (Animal 
Chemistry, Sydenham Soc. TransL, vol. ii. p. 386) and Golding Bird (Lon- 
don Med. Gaz., 1845, p. 801), in careful analyses, both failed to detect the 
metal; and, as the recognition of mercury is an exceedingly simple chemical 
problem, it seems impossible that these chemists could have overlooked the 
metal if it had been present. Simon's analysis was performed upon the fifth 
stool after the administration of a large dose of calomel. The passage was 
fluid, perfectly green, had no fecal odor, exhibited a mild acid reaction, and 
showed, under the microscope, a great number of mucous corpuscles and 
* For a very elaborate and careful review of the clinical evidence as to the action of 
calomel on the liver, see Dr. Thos. R. Fraser's paper in the Edinburgh Medical Journal, 
April, 1871. CATHARTICS. 
501 
epithelium-cells. Ether extracted from the solid residue (obtained by 
evaporation) a considerable amount of fat, which had an acid reaction, con- 
tained cholesterin, and was colored by biliverdin. All the other substances, 
which were separated from the stool by water and alcohol, were more or less 
colored by bile-pigment. Bilin, bilifellinic acid, and biliverdin were found 
in large quantity. 
The most satisfactory evidence is, however, that furnished by Michea 
(Lancet, 1849, vol. i. p. 15), who examined chemically the faeces under 
four different conditions. First, the spontaneous dejections of six healthy 
individuals: no bile was detected. Second, green stools of three persons 
suffering from gastro-intestinal derangement: bile-pigment was found in one 
case only, and in that could not be detected after persistent vomiting had 
ceased. Third, calomel having been given to eight healthy persons, five 
men and three women, bile was readily demonstrated in the green passages 
produced in all of the subjects. Fourth, saline and resinous purgatives were 
given to five persons, but no bile could be detected in the liquid stools. 
To the evidence brought forward in favor of the proposition that calomel 
given to healthy men causes an increased escape of bile from the aliment- 
ary canal, may be added the conclusive fact that in some persons, whose 
idiosyncrasies render them very susceptible to the action of calomel, it pro- 
duces not merely purging, but also vomiting of bile, which is scarcely at all 
altered. 
From the facts which have just been passed in review, the conclusion 
seems inevitable that mercurial purgatives given to healthy persons cause the 
escape of large quantities of bile from the alimentary canal. 
As is well known, when from any cause bile does not pass into the duo- 
denum, the stools become very pale, of a peculiar potter's-clay, or even white, 
color. Very frequently under these circumstances, which may co-exist either 
with diarrhoea or with constipation, mercurials will modify the color of the 
passages and alleviate or cure any symptoms present. In many cases the 
mercurials are, of course, powerless to effect the desired result; but this 
depends upon the cause being organic, or of some other nature not to be 
overcome by a mere stimulant to secretion. 
As mercurials in health increase the flow of bile from the intestine, and as 
they will sometimes re-establish it in disease when the secretion has altogether 
ceased or has been very materially diminished, the conclusion seems to me 
inevitable that mercurials have the power of directly or indirectly increasing 
the secretion of bile. The only objection of any force to be urged against 
this deduction is founded upon the idea that the drug simply increases peri- 
stalsis in such a way as to cause the bile naturally in the duodenum to be 
swept out instead of being absorbed. The answer to this is embraced in the 
following facts: mercurials restore the color of the passages when pale from 
arrested secretion, often without producing diarrhoea ; other even more active 
purgatives fail to induce the same bilious passages; when diarrhoea exists 502 
LOCAL REMEDIES. 
with clayey stools, the change in the color of the passages caused by a mer- 
curial may coincide with a not increased, or even a lessened, amount of 
liquidity; diarrhoea ordinarily does not cause bile to appear in the passages. 
Therapeutics.-A mercurial purge is especially indicated by the con- 
geries of symptoms known as " biliousnessa heavily-coated tongue, bitter, 
disagreeable taste, heavy headache, depression of spirits, loss of appetite, 
slight nausea, and light-colored passages. It should be borne in mind that 
one or several of these symptoms may be absent in any individual case. Of 
all single indications for the use of calomel, the occurrence of potter's-clay- 
colored passages is the most important; and if such stools exist, and do not 
depend upon an organic cause, a mercurial should be given, whether there 
be constipation or diarrhoea. 
In bilious fever,-i.e., malarial fever with congestion of the liver,-a mercu« 
rial purge, or several mild mercurial purges, will often, by exciting the action 
of the hepatic gland, be of great service in preparing the way for or aiding in 
the action of quinine. In catarrhal jaundice, mercurials, on the whole, offer, 
I think, the most frequently successful mode of treatment. It is evident that 
in such cases calomel does good not merely by its cholagogue influence, but 
even to a greater extent by its antiphlogistic power, no doubt lessening the 
viscidity of the secretions and abating the inflammatory action in the hepatic 
ducts. In many instances it is well to exhibit a mercurial purge to start 
with; but the main reliance is to be placed in the continuous exhibition of 
small doses of the drug until the gums are rendered slightly sore. Anything 
like profuse salivation is, of course, to be avoided. In dysentery of an acute 
sthenic type, calomel has yielded, in my hands, better results than any other 
remedy. It probably acts as an antiphlogistic and as an alterative, not only 
to the liver, but to all the intestinal glands. In one or two cases of obstructive 
enteritis, with severe constipation, which I have seen treated with this drug 
after the failure of other remedies, improvement in the local and constitu- 
tional symptoms commenced simultaneously with slight ptyalism, and con- 
tinued on to recovery. 
The root of Rheum officinale, Bailion, and other species of Rheum 
growing in China, Chinese Tartary, and Tartary. 
Rhubarb occurs in hard, irregularly cylindrical or roundish pieces, of a 
brownish-yellow color, peculiar bitter taste, and imparting to the teeth a 
sense of grittiness, due to the presence of great numbers of minute crystals of 
the oxalate of calcium. There were formerly two chief varieties in market, 
the Russian and the Chinese. The first of these was the best, and was dis- 
tinguished by the exterior of the pieces being cut or pared with a knife, and 
by a conical hole, evidently made for inspection with the point of a sharp 
instrument, and never reaching beyond the centre of the mass. The cause 
of the superiority of this brand of rhubarb was the close governmental in- 
RHEUM-RHUBARB. U.S. CATHARTICS. 
503 
spection which it received on the Russian frontier. Such pieces as failed 
to pass the officials found their way into commerce through Turkey, and 
constituted the so-called Turkey Rhubarb, which resembled the Russian in 
external characters, but was of somewhat inferior quality. The Chinese 
Rhubarb was distinguished by the outside of the pieces having been scraped, 
and by the existence of a large hole running clear through and often retain- 
ing a portion of the cord upon which the roots had been strung to dry. 
Owing to the expiration and non-renewal of the treaty between the govern- 
ments of Russia and of Tartary, the only officinal variety of rhubarb now 
in the market is the Chinese. Besides the true officinal varieties from Asia, 
there is a drug in commerce which from its source is known as European 
Rhubarb. It occurs in long, cylindrical pieces, or very often is cut to imi- 
tate one of the varieties of the genuine drug, from which it is to be distin- 
guished by its more spongy texture and by the complete or almost complete 
absence of grittiness when chewed.* 
The active principles of rhubarb have not all been made out; it certainly 
contains chrysophanic acid, and a peculiar tannic acid, to which it owes its 
astringency. Chrysophanic Acid^ crystallizes out of alcohol in orange-yellow, 
golden, shining needles; out of benzole in orange-yellow or pale six-sided 
rhombic plates ; with nitric acid it produces a fine yellow color; with the 
alkalies, a beautiful purple-red. According to Schlossberger, Bucheim, Mey- 
kow, and Auer, it is not purgative ; but Schroff has found it to be so.^ It 
certainly is not the chief purgative principle of the drug. The substances 
known as Rhein and Rhabarbarin are complex bodies. 
Physiological Action.-Rhubarb is somewhat stomachic, tonic, actively 
* In the past, the European rhubarb has been considered of little value; but recently 
it has been claimed that it is as good as the Asiatic. See U. S. Dispensatory, 13th ed., p. 
735; also Prof. Radius (Apotheker Zeitung, Bd. vi., 1871). 
f Under the names of Goa Potoder and of Araroba or Ghrysaroba have long been 
used in Brazil and the East Indies certain powders, varying from fine to coarse and from 
a light yellow to a dark chocolate, which are now known to be identical, and the product 
of a Brazilian tree. They depend for their activity upon chrysophanic acid, of which 
Squier states they frequently contain as much as sixty-five per cent. Dr. I. Ashburton 
Thompson has found that from six to eight grains of this acid taken internally, after 
about four hours produce vomiting, sometimes repeated at intervals and sometimes 
followed by purging (British Med. Journ., May, 1877). The slowness of the results he 
believes to be due to the difficulty of absorption. The only practical application of the 
Goa powder or its active principle is in certain skin diseases, especially in psoriasis. 
According to the researches of Dr. Balmano Squier, its power in this disorder is ex- 
traordinary. He uses an ointment made by dissolving the acid in hot lard (gr. v to 5ij 
in ^i), cooling, and mixing thoroughly with a pestle. The ointment sometimes produces 
excessive irritation, hence it is advised to commence with a strength of not more than 
twenty grains to the ounce, well rubbed in twice daily. The acid stains of a dark 
purple; this can be removed from hair, underclothes, etc., by hot benzole, if no soap or 
alkali has been used. The skin and nails are said to contain enough of potash to set 
the dye. 
t See Die Pflansenstoffe, p. 985. 504 
LOCAL REMEDIES. 
purgative, and, owing to its tannic acid, secondarily astringent, leaving a 
decided tendency to constipation after the primary purgation. Owing prob- 
ably to its chrysophanic acid, it gives a yellowish color to the milk of nursing 
women and to the urine. Rhubarb urine is to be distinguished from that of 
jaundice by its becoming purplish-red on the addition of an alkali. Rhubarb 
is asserted to affect chiefly the muscular coat of the bowels, and to purge by 
increasing peristalsis; but I have never met with any proof of this common 
belief. 
Therapeutics.-Notwithstanding its astringent property, rhubarb is 
largely used as a habitual laxative, because it does not impair, but, on the 
contrary, seems to strengthen, the appetite and the digestion. It should not 
be used in a high sthenic state of the system, or when depletion is necessary, 
but is, on the other hand, the best purgative when it is desired simply to 
unload the bowels in a debilitated subject. In diarrhoea, with intestinal 
weakness or relaxation, it is the best purgative with which to unload the 
bowels of acrid secretions retained in them ; and in the form of the aromatic 
syrup combined with an alkali it is especially valuable in the summer bowel- 
complaints of children when the stools are greenish and mucous. 
Administration.-Rhubarb is seldom employed in powder, but, when 
used, may be given in the dose of twenty grains. In chronic constipation, 
small pieces of the root are very often carried in the pocket and chewed by 
the person affected pro re nata. The U. S. Pharmacopoeia recognizes the 
following preparations: Extractum Rhei, dose, five to ten grains; Pihdae 
Rhei, each containing three grains of rhubarb; Pilulae Rhei Compositae 
(two grains rhubarb, one and one-half grains aloes), dose, two to four pills; 
Pulvis Rhei Compositus (rhubarb and magnesia), dose, half a drachm to a 
drachm; Extractum Rhei Fluidum, dose, twenty to thirty minims; Syrupus 
Rhei, dose, for an infant, a fluidrachm ; Syrupus Rhei Aromatica, dose, for 
an infant, a fluidrachm; Tinctura Rhei, dose, one to two fluidrachms; Vinum 
Rhei, dose, one to four fluidrachms; Tinctura Rhei Aromatica, dose, half 
to one fluidrachm ; Tinctura Rhei Dulcis, dose, two to three fluidrachms. 
The aromatic preparations are of pleasant taste and efficient. 
Juglans. U. S.-The inner bark of the Juglans cinerea, or common 
butternut, or white walnut. Juglans is said to be a mild cathartic, resem- 
bling rhubarb in its action, as a substitute for which it was introduced 
during the Revolution by the famous Dr. Rush. The dose of the extract 
(Extractum Juglandis, U. S.) is twenty grains. 
ALOE-ALOES. U.S 
There are three commercial varieties of aloes, which are all obtained in a 
similar manner,-i.e., by cutting off the thick succulent leaves of the various 
plants, standing them up, allowing the juice to drain into suitable vessels, 
and afterwards inspissating, either by exposure to the sun or by slowly CATHARTICS. 
505 
evaporating. The leaves contain a very large amount of a thick muci- 
laginous juice, which escapes on pressure: hence aloes prepared by express- 
ing the leaves or by boiling them-both of which processes are sometimes 
practiced-is very inferior. Socotrine Aloes is the product of Aloe Soco- 
trina, which grows in the island of Socotra in the Indian Ocean, and on the 
southern coast of Arabia. It alone is recognized by the U. S. Pharma- 
copoeia. Barbadoes Aloes is prepared in Barbadoes and other West Indian 
islands, from the Aloe vulgaris. Cape Aloes is obtained at the Cape of Good 
Hope, from the Aloe spicata. 
Aloes are darkish extracts, of a bitter nauseous taste, yielding their virtues 
to alcohol, imperfectly to water, and very perfectly to alkaline solutions. The 
Cape aloes is said to be " characterized by its dark-olive or greenish-black 
color, its smooth and very glossy surface when broken, its translucency at the 
edges, and the fine bright-yellow color of its powder, which is slightly tinged 
with green." The Socotrine aloes is distinguished by its yellowish-brown or 
reddish-brown color, its translucent edges, agreeable aromatic odor, and beau- 
tiful golden-yellow powder. The Barbadoes aloes is characterized by its dark- 
brown or reddish-brown color, its dull fracture, opaque edges, disagreeable 
nauseous odor, and dull olive-yellow powder. Of these varieties the Socotrine 
is most esteemed in human medicine. The Barbadoes is said to be the 
strongest, but is employed almost exclusively in veterinary surgery. 
Messrs. T. and H. Smith (Chemical Gaz., 1851) in 1850 discovered in 
Barbadoes aloes a crystalline principle,-aloin,-which was shortly afterwards 
found by Pereira to exist already crystallized in the sap of various species or 
aloe plants, and was subsequently obtained by Groves (Pharm. Journ., xvi.) 
from Socotrine aloes. Aloin crystallizes from its watery solution in sulphur- 
yellow granules, from a hot alcoholic solution in star-like groups of needles. 
It is neutral, odorless, of a taste at first sweetish, afterwards intensely bitter; 
soluble with difficulty in cold, freely in boiling, water and alcohol. The 
statements regarding the purgative properties of aloin are exceedingly con- 
tradictory, some physicians finding it a drastic purge in doses of one or two 
grains, others declaring that fifteen grains of it have no effect, whilst others 
affirm that it is a mild purge. It is evident either that there are several 
substances described and used under the same name, or else aloin owes its 
purgative properties to some impurity that adheres to it closely.* 
* Consult Chern. Gaz., 1851; Die Pjlanzenstoffe, p. 1047 ; Trans. Brit. Pharm. Soc., 1872 ; 
Brit. Med., i., 1887, p. 747; Bull. Thirap., xci., p. 259; Land. Med. Record, 1877, p. 459 ; 
Edinb. Med. Journ., xx., p. 1002; xxii., p. 1087. Dr. Fronmiiller {Med. Chir. Centralb., 
Wien, 1879, xiv.) says that one to three grains of Merck's aloin dissolved in hot water 
administered hypodermically acts as an efficient purge; whilst Dr. R. Kohn affirms that 
he has used both aloes and aloin of three different commercial varieties hypodermically 
without effect, giving ten times the dose employed by Fronmiiller. In the lower animals 
Dr. Kohn found the hypodermic injections to cause gastro-enteritis with albuminous urine, 
and a peculiar inflammation of the kidneys : 0.1 grm. of Merck's aloin for every kilo 
gramme of bodily weight was found to be a fatal dose for the dog. Aloin could be detected 
in the urine. (Method of analysis given.) Schmidt's Jahrb., cxciv. 246. 506 
LOCAL REMEDIES. 
Physiological Action.-Aloes is a stomachic, stimulant cathartic, re- 
markable for the slowness of its action. It has been supposed to influence 
chiefly, if not solely, the large intestine, and the clinical evidence is very 
strong that in overdoses it produces irritation of the rectum. The belief, 
formerly so universal, that it is capable of producing haemorrhoids, has been 
very much weakened by the researches of a number of modern observers, 
among whom may be mentioned Trousseau and Pidoux (Stille, Therapeutic 
vol. ii. p. 444). Its habitual use in large doses is said to cause tenesmus, a 
feeling of weight, heat, and uneasiness in the pelvis, and occasionally excita- 
tion of the sexual organs. Although I have used it a good deal, however, I 
have never seen these results. It undoubtedly has a tendency to increase the 
menstrual flow. Aloes is certainly absorbed, as is shown by the fact attested 
by Dr. Gerhard (North American Med. and Surg. Journ.') and other ob- 
servers, that it will purge when its powder is sprinkled upon a blistered sur- 
face. In regard to its action in combination, Prof. Stille states that when 
other and quickly-operating cathartics are taken along with aloes it does not 
appear to modify their action; but if it is administered seven or eight hours 
before a saline or other active purgative, a combined and very powerful 
operation is the result. 
Therapeutics.-Aloes in small doses is one of the best remedies for con- 
stipation of atonic subjects, especially when a stomachic stimulant is indicated. 
In these cases it may often with great advantage be combined with a simple 
bitter, one or two grains of it taken directly after meals being generally suf- 
ficient. In the constipation of plethora it should not be employed; neither 
should it be administered when active abdominal or rectal inflammation 
exists. During pregnancy it may be used as a laxative, but, unless some 
especial indication calls for its use, it is best avoided. Large purgative doses 
of it should never be given to pregnant women, as it certainly irritates the 
pelvic organs, and is even said to have the power of causing abortion. For- 
merly it was taught that aloes should not be used in hemorrhoids ; but most, 
if not all, of the cases of this affection depend upon a condition of relaxation 
of the rectal veins, and Dr. Fordyce Barker (American Practitioner, 1872) 
insists upon the great value of aloes in piles, and states that Oppolzer was 
especially famous for his treatment of this affection, and that his prescriptions 
were, when piles are associated with constipation, aloes and quinine; with- 
out constipation, aloes and sulphate of iron. For bleeding piles he used 
R.-Ferri sulphat., Qi; ext. aloes aq., 5i; ext. taraxaci, q. s. Ft. pil. no. 
60. S.-One morning and evening, and increase to three a day if neces- 
sary. When costiveness accompanies atonic amenorrhoea, aloes alone of 
all the laxatives should be exhibited; and it is also of service in atonic 
menorrhagia. 
Administration.-Aloes is very rarely or never used by itself to pro- 
duce free purgation, but may be given in the dose of from ten to twenty 
grains; in the dose of from three to five grains it is a decided laxative. As CATHARTICS. 
507 
aloes often contains sticks and other extraneous matters, the U. S. Pharma- 
copoeia directs that an Aloe Purifcata, or Purified Aloes, should be made by 
dissolving the crude drug in alcohol, straining, and evaporating. The prep- 
arations are: the tincture (Tinctura Aloes,-1 to 10, U.S.),-dose, as a 
laxative, one to three teaspoonfuls; the tincture of aloes and myrrh, Elixir 
Proprietatis (Tinctura Aloes et Myrrhee,-aloes and myrrh, aa 1 to 10, 
U. S.), dose, as a laxative, one to two teaspoonfuls ; the wine ( Vinum Aloes, 
-6 to 100, U.S.), which contains also cardamom and ginger,-dose, as a 
laxative, one-half to one teaspoonful; the pills (Pilules Aloes, U. S.), which 
contain each two grains of aloes and two grains of soap; the Pills of Aloes 
and Asafetida (Pilules Aloes et Asafoetides, U. S.), useful in costiveness 
of hysterical or old subjects, each pill containing four grains of a mass com- 
posed of equal proportions of aloes, asafetida, and soap; the Pills of Aloes 
and Mastich (Pilules Aloes et Mastiches, U. S.), the famous " Lady Webster 
Dinner-Pill," each containing two grains of aloos; the Pills of Aloes and 
Myrrh (Pilules Aloes et Myrrhee, U. S.), used in amenorrhoea, and contain- 
ing two grains of each ingredient in every pill; the Pills of Aloes and Iron 
(Pilules Aloes et Ferri, U. S.), containing each one grain of aloes and one 
of dried sulphate of iron. 
SENNA-SENNA. U.S. 
The leaflets of the shrubs Cassia acutifolia and C. obovata, of Nubia and 
Upper Egypt, and of C. elongata, of Southern Arabia. The senna leaves 
vary from three-fourths of an inch to an inch and a half in length, and are 
to be distinguished by the inequality of their bases, the two sides of the 
lamina or leaf-blade joining the midrib at unequal heights and angles. There 
are three commercial varieties of senna, which are named from the places of 
their export. Alexandria Senna, the most common variety, is distinguished 
by the presence of the shorter argel-leaves, with equal bases, by the ovate- 
pointed leaflets of Cassia acutifolia, and by the scattered mucronate-obovate 
leaflets of C. obovata. India Senna is characterized by the oblong leaflets, 
from one to two inches in length, entire and perfect. Tripoli Senna may 
be recognized by the great extent to which the leaflets are broken up. The 
active principles of senna have not been completely isolated, but appear to 
be several. Cathartic Acid, discovered by Draggendorff and Kubly ( Viertel- 
jahresschrift fur Pralct. Pharm., Bd. xvi.) is undoubtedly actively cathartic, 
as Kubly found that fifteen grains of it dissolved in an alkaline solution 
produced in six hours frequent watery discharges, with griping; but the 
researches of Bourgeois and Bouchut (A' Union Pharmaceutique, Nov. 
1871) indicate that, besides cathartic acid, there are in senna chrysophanic 
acid, and a purgative principle which has not as yet been isolated. The 
cathartine of the older writers is undoubtedly a complex body. 
Physiological Action.-Senna is a very powerful cathartic, producing 
watery fecal discharges, and acting, it is said, as readily upon swine, dogs, 508 
LOCAL REMEDIES. 
cats, and horses as upon man. According to Prof. Stille, both Courten and 
Regnaudot found that its infusion injected into the veins caused vomiting 
and purging. It is undoubtedly absorbed ; and Bergius affirms that it will 
impart its purgative property to the milk of nursing women. 
Therapeutics.-Whenever a brisk, somewhat irritating cathartic is 
desired, senna may be selected. When given alone, it is very apt to gripe 
severely, and is consequently more often used in combination,-especially its 
infusion with Epsom salt (Black Draught). In obstinate fecal accumula- 
tion the Black Draught constitutes a most efficient and safe remedy. It is 
claimed that senna does not leave a tendency to constipation after its action; 
and hence, in small doses, it is preferred by some as an habitual laxative. 
Administration.-Whenever senna is exhibited, an aromatic should be 
united with it, to lessen its tendency to gripe. The leaves are not given in 
substance. The dose of the fluid extract (Extractum Sennse Fluidum, 
U.S.) is two fluidrachms to half a fluidounce; the confection (Confectio 
Sennse, U. S.) is a very complex but elegant preparation, used only, as a 
laxative, in doses of one to two drachms, especially in pregnancy, and not 
suited to dyspeptic cases, on account of its tendency to derange the 
digestion. Infusum Sennse Compositum, U. S. (Black Draught'), contains 
manna and sulphate of magnesium,-a very active hydragogue purge, dose, 
four fluidounces; the dose of the syrup (Syrupus Sennse, U. S.) is one to 
four fluidrachms; the Pulvis Glycyrrhizse Compositus, U. S., or compound 
liquorice powder, is an excellent pleasant laxative in doses of thirty to sixty 
grains. 
Euonymus, U. S., or Wahoo, the bark of the Euonymus Atropurpureus, 
is, according to the experiments of Prof. Rutherford, an active cholagogue 
in dogs, and given in the form of the fluid extract, or of the solid resinoid 
extract, euonymin, its effects are often most happy in cases of habitual con- 
stipation and hepatic torpor. It acts very slowly and purges only moder- 
ately. The dose of the fluid extract is a dessert- to a tablespoonful; of 
euonymin, two to four grains: in cases of dyspepsia it may be repeated 
with good results two or three times a week. The dose of the extract 
(Extractum Euonymi, U. S.) is three to six grains. 
SALINE PURGATIVES. 
Magnesii Sulphas, U. S.-Sulphate of Magnesium, or Epsom Salt, is 
now manufactured on a large scale from dolomite, the double carbonate of 
calcium and magnesium, and from native siliceous hydrite of magnesium. 
Sulphate of magnesium ordinarily occurs in small, acicular, slowly-efflores- 
cent crystals, containing about fifty-one per cent, of water of crystallization, 
soluble in their own weight of water at ordinary temperatures. By proper 
precautions, it may be obtained in large quadrangular prisms, terminating 
in a four-sided pyramid or a dihedral summit. The taste is bitter, saline, 
nauseous. CATHARTICS. 
509 
Physiological Action.-Epsom salt is a most active hydragogue 
cathartic, producing very large watery discharges without causing any irrita- 
tion of the intestines. In very large doses it is, however, capable of pro- 
ducing fatal hypercatharsis; and Christison reports the case of a boy ten 
years old, said to have been killed by two ounces of the salt, without the 
induction of purgation. Injected into the veins of the dog or rabbit it is 
a deadly poison, causing death by failure of respiration, and also depress- 
ing the heart (Dr. J. II. Recke, Inaug. Diss., Gottingen, 1881 ; also Dr. 
M. Hay). 
Therapeutics.-Whenever, in inflammation, it is desired to deplete 
through the bowels, the sulphate of magnesium offers the most advantageous 
method of doing it. Especially is this the case when the intestines are 
affected, as in enteritis or in colitis. There is probably no other purgative in 
common use which produces at the same time such free serous evacuations 
and so little intestinal irritation. On account of the efficiency of its action 
and the watery character of its discharges, it is especially applicable to cases 
of fecal accumulation and of obstinate colica pictonum. The dose is half 
an ounce to an ounce, properly diluted. Recently the hypodermic use of 
the sulphate has attracted some attention. M. Luton has found that ten 
centigrammes (1.53 gr.) administered in this way usually provoke several 
watery stools (Gaz. Hebdom., 1874, p. 455). 
LlQUOR Magnesh ClTRATIS, U. S.-Solution of Citrate of Magnesium 
is prepared by putting into a strong bottle a syrupy solution of the citrate 
of magnesium containing an excess of citric acid, adding the bicarbonate 
of potassium, and corking tightly. On account of its agreeable taste and 
effervescence, this preparation is much used as a purgative. It is similar 
to Epsom salt in its action, but is less efficient, more apt to gripe, and 
more irritating. It ought not to be used in inflammatory affections of the 
bowels. 
Magnesii Citras Granulatus, U.S.- Granulated Citrate of Mag- 
nesium contains less free acid than the solution, and is therefore somewhat 
less pleasant to the taste. The dose is one to three teaspoonfuls taken in 
solution whilst effervescing. 
Sodii Sulphas, U. S.-Sulphate of Sodium, or Glauber s Salt, is at 
present manufactured from common salt by means of sulphuric acid. It 
occurs in six-sided, very efflorescent, striated prisms, which finally crumble 
into a white powder. Its taste resembles that of Epsom salt, but is more 
nauseous. On this account, and because its action upon the economy is 
similar to but harsher than that of the sulphate of magnesium, in human 
medical practice it has been completely superseded by the latter salt. The 
dose is a quarter of an ounce to half an ounce, properly diluted. 510 
LOCAL REMEDIES. 
Sodii Phosphas, U. S.-Phosphate of Sodium occurs in colorless, trans- 
parent crystals, which effloresce and become opaque on exposure. It is a 
tribasic phosphate, one part of water acting as a base. It is soluble in 
four parts of cold water, and has a saline taste, closely resembling that of 
common salt. In large doses it is said to be a mild saline purgative, but 
as such is at present very rarely used. Within a few years the use of the 
phosphate of sodium in chronic infantile diarrhoea has attracted a good 
deal of notice. Originally recommended, so far as I know, by Dr. Routh, 
in his work on Infant-Feeding, as being a valuable nutrient or alterative in 
children, attention has been especially drawn to the phosphate of sodium by 
Dr. William Stephenson (Edinburgh Med. Journ., 1867, vol. xiii. p. 336). 
He believes that it acts upon the liver, and adduces much clinical evidence 
in favor of his views. The cases in which he especially recommends it are 
" infants who are being artificially reared, and who are liable to frequent de 
rangement of the bowels; also when the phosphatic elements in the food 
seem deficient; where, from the character of the motions, there is a deficient 
or defective secretion of bile. It is thus of service in cases of chalky stools 
or white fluid motions, and in many cases of green stools; also in duodenal 
dyspepsia, and in diarrhoea and weaning." Dr. S. G. Webber (Boston Med. 
and Surg. Journ., 1868, vol. i. p. 5) confirms these statements of Dr. Ste- 
phenson, and in a few cases I have seen .very notable effects from this use 
of the drug. 
Potassii et Sodii Tartras, U. S.- Tartrate of Potassium and Sodium, 
or Rochelle Salt, is made by the addition of the carbonate of sodium to a 
solution of the bitartrate of potassium. It occurs in large, colorless, trans- 
parent, slightly efflorescent, prismatic or half-prismatic crystals, which are 
soluble in two and a half parts of cold water, and have a slightly saline 
taste. It is a mild saline purgative, decidedly less efficient, but much less 
offensive to the palate, than Epsom salt. The dose is from half an ounce 
to two ounces, properly diluted. 
Pulvis Effervescens Compositus, U. S.-Seidlitz powder is in two 
packets, the white paper containing thirty-five grains of tartaric acid, the 
blue paper forty grains of the bicarbonate of sodium and two drachms of 
Rochelle salt. When they are taken, the powders are dissolved separately, 
the solutions added, and the whole drunk whilst effervescing. They are 
very acceptable to the stomach, refrigerant and laxative rather than purga- 
tive. Seidlitz powders are used almost exclusively to evacuate the bowels, 
and exhibited after blue mass to " carry off" mercurials, etc. They should 
be taken on an empty stomach, as before breakfast. One powder is the usual 
dose; but not rarely even two powders will fail to purge. 
Potassi Sulphas, U. S.-Sulphate of Potash, or Vitriolated Tartar, CATHARTICS. 
511 
was formerly used as a purgative, but is no longer employed in medicine, 
except in the preparation of Dover's powders. 
The Sulphovinate of Sodium has recently been brought forward as a sub- 
stitute for Epsom salt. A very great advantage is claimed for it, in that it 
has a refreshing flavor with very slight bitterness, and when given in flavored 
syrups makes a very pleasant drink. Its action is said to be rapid and 
thorough. The dose is two to four drachms for children; four to six 
drachms for an adult. 
DRASTICS. 
As already stated, the drastics are those vegetable cathartics which are 
actively irritant. With perhaps one or two exceptions, in sufficient amount 
they are capable of causing fatal gastro-intestinal irritation. The line between 
the drastics and the stronger purgatives is, of course, placed more or less 
arbitrarily, since the various cathartics differ in action almost by insensible 
degrees. Thus, jalap, although included among the drastics in this work, 
might with perhaps even greater propriety be classed among the purgatives, 
since it is very little more active or irritant than is senna. Further, these 
remedies in combination seem to lose, in a measure, their power of causing 
irritation, and to become useful purgatives. A fact, however, which makes 
the classification here employed clinically useful, although it be not scien- 
tifically accurate, is that none of these remedies should be used when a pur- 
gative is desired to relieve gastro-intestinal inflammation or irritation ; and, 
on the other hand, when a revulsive action is wished for, as in some cases 
of brain-disease, one of the drastics should always be selected. 
JALAPA-JALAP. U.S. 
The tuber of Exogonium purga, a convolvulaceous vine growing in 
Mexico. Jalap conies into the market in two forms: one, that of the 
younger roots, which are sold undivided; the other, that of the old roots, 
which are brought into the market in transverse or longitudinal slices, and 
in pieces. The first variety consists of very hard, irregularly globular, 
brittle roots, about the size of a shut fist, or smaller, and often slashed with 
vertical incisions, made for the purpose of facilitating drying. The section 
of jalap is always distinctly resinous, if not to the naked eye, at least to the 
vision aided by a lens. The active principle is a duplex resin, one portion 
of which is soft, and soluble in ether, the other (Rhodeoretin) hard, and 
insoluble in the latter menstruum. Rhodeoretin is asserted by both Kayser 
and Mayer (Id S. Dispensatory} to be the purgative principle ; but Mr. J. C. 
Long (Amer. Jour, of Pharm., 1861) has shown that the soft resin is 
equally active. The percentage of resin varies very much in different speci- 
mens, but is much greater in those that are worm-eaten. 
Physiological Action.-Upon dogs and horses jalap (Stille, Therapeu- 512 
LOCAL REMEDIES. 
fics, vol. ii.) is said to act as a powerful hydragogue cathartic, and in over- 
doses as a gastro-intestinal irritant. If the experiments of Cadet de Gassi- 
court be correct, it probably acts by absorption, as, according to that observer, 
diarrhoea may be produced in dogs by its free application to the shaven skin. 
Prof. Stills, however, asserts that it does not impart its purgative properties 
to the milk of nursing women, and that in man it is not absorbed by the 
skin. In man jalap produces free hydragogue catharsis, often with nausea; 
or, if in overdoses, violent vomiting and purging. 
Therapeutics.-Jalap is especially indicated when it is desirable to pro- 
duce large watery stools. It is, however, very rarely used alone. A favorite 
combination with many practitioners is of it and calomel. In the form of 
the compound powder (Pulvis Jalapx Compositus, U. S.,-jalap, thirty-five 
parts, cream of tartar, sixty-five parts), jalap is very frequently used with 
great advantage in ascites and also in other forms of general dropsy. It is 
believed when given in this way to exert some influence upon the renal 
functions: for very many cases the proportion of cream of tartar in the 
officinal compound powder is too small, and should be increased. 
Administration.-The dose of powdered jalap is ten to twenty-five 
grains, of the abstract (Abstractum Jalapse, U. S.), five to thirteen grains. 
The resin (Resina Jalapse, U. S.), like the other purgative resins, is pre- 
pared by precipitating a saturated tincture with water. According to Huse- 
mann, the ordinary adulterations of jalap resin may be detected by the solu- 
bility of the substances employed in the oil of turpentine, which does not 
affect the genuine article. On account of its tastelessness, this preparation, 
as well as the similar one of scammony, is sometimes employed as a purga- 
tive for children. The dose for an adult is from two to four grains. 
The fruit, deprived of its rind, of the Citrullus Colocynthis, or bitter 
cucumber, a vine growing in the Cape of Good Hope, Japan, Syria, Egypt, 
Turkey, the islands of the Grecian Archipelago, etc. The fruit is a round 
gourd, from two to four inches in diameter, of a whitish or pale-yellow color. 
It occurs in the market with or without its rind. The pulp is dry and 
membranous, whitish, and contains the active purgative glucoside Colocynthin, 
first discovered by Herberger. 
Physiological Action.-The experiments of Orfila and Schroff have 
shown that upon dogs and rabbits colocynth acts very much as it does in 
man, producing copious watery evacuations, and, although not so irritant as 
gamboge, in overdoses causing death by gastro-intestinal irritation. If the 
statement of Richter that violent purgation may be induced by rubbing the 
abdomen with tincture of colocynth be true, the active principle is without 
doubt absorbed. 
Therapeutics.-Colocynth is rarely, if ever, used alone, but is given in 
combination with the other drastics, or with milder purgatives, to increase 
COLOCYNTHIS-COLOCYNTH. CATHARTICS. 
513 
tneir activity. It is frequently added in small quantity, with advantage, to 
laxatives, especially when the constipation is somewhat obstinate. Its minute 
bulk is often of great advantage in these cases. Neither colocynth nor any 
of its combinations should be used in dropsy. Its chief use is, as a laxative, 
to unload the bowels, and to deplete directly from the portal circulation : 
even in cases offering these indications it is almost never used alone. 
Toxicology.-Colocynth has not rarely produced death, preceded by 
hypercatharsis and the usual symptoms of gastro-intestinal irritation. The 
fatal dose probably varies very much. Christison records the death of a 
woman twenty-four hours after taking a teaspoonful and a half of the powder. 
Roques chronicles a fatal result produced by less than a drachm of the pow- 
der in decoction, but, on the other hand, narrates a case in which three 
drachms failed to kill (Husemann, Handbuch der Toxicologie, p. 625). 
Administration.-Colocynth is used only in the form of the extract 
(Extraction Colocynthidis, U. S.) ; useful as an addition to laxatives,-dose, 
as a purgative, three to five grains ; and of the compound extract (E^tractum 
Colocynthidis Compositum, U. S.), which contains extract of colocynth, six- 
teen parts, purified aloes, fifty parts, resin of scammony, fourteen parts, 
cardamom, six parts, soap, fourteen parts, and is a very useful purgative 
preparation, either as a laxative in minute dose (one to three grains), or in 
large dose (five to twenty grains) as an active purgative. 
SCAMMONIUM-SCAMMONY. U. S. 
A resinous exudation from the root of the Convolvulus Scammonii, a vine 
growing in Syria. It is said to be obtained by cutting off the root obliquely 
about two inches from the origin of the stems, and catching in shells the 
few drachms of milky juice which exude from each root. From these shells 
it is emptied into a vessel and allowed to concrete. Before exportation 
it is usually adulterated with the expressed juice of the leaves and stalks, 
and with chalk, flour, ashes, sand, etc. This adulteration was formerly 
carried to a very great extent, but is at present indulged in to a much less 
degree. The pure or Virgin Scammony is in irregular, rough, fissured 
masses, of various sizes, commonly solid, with a dull resinous fracture, and 
of a dark greenish color, inclining to black. The smell is peculiar, resem- 
bling that of old cheese. The taste after a time is acrid. Factitious or 
adulterated scammony occurs in cakes of various sizes and shapes, and is 
sometimes spoken of as amylaceous or cretaceous scammony, according to 
the material used for its adulteration. The active principle of scammony is 
a resin, very similar to that of jalap. The proportion of this resin in the 
drug varies, according to the purity of the article, from eight to ninety per 
cent. The U. S. Pharmacopoeia directs that scammony shall contain seventy- 
five per cent, of the resin. 
Therapeutics.-Scammony acts upon the system like jalap, but is some- 
what more irritating, and therefore more apt to gripe severely, and is still 514 
LOCAL REMEDIES. 
more strongly contra-indicated in inflammatory diseases of the intestinal 
canal. It is decidedly less drastic than gamboge. It is never used alone, 
but in combination with other less active cathartics. The dose of the resin 
{Resina Scammonii, U.S.) is two to five grains. 
As all of the ingredients have been noticed, the present seems the proper 
place for the consideration of Pilule Cathartics Composits, U. S.- 
Compound Cathartic Pills. These popular pills contain each: compound 
extract of colocynth, one and a third grains; abstract of jalap and calomel, 
each one grain; gamboge, one-fourth of a grain. As there is soap in the 
first ingredient, the calomel is sooner or later reduced to the black oxide of 
mercury. 
The compound cathartic pills are a very efficient purgative, generally not 
producing much griping. They cause large watery stools, and are used when 
it is desired to empty the bowels and deplete from the portal circulation. 
PODOPHYLLUM-PODOPHYLLUM. U. S. 
The rhizome of the Podophyllum peltatum, or May-apple, a perennial 
herb, growing in the Northern and Middle United States. Podophyllum 
occurs in simple or branched, cylindrical, brownish pieces, about the thick- 
ness of a goose-quill, smooth or wrinkled longitudinally, often obscurely 
marked with the scars of leaf-scales, and furnished with numerous rootlets or 
their remnants attached to the lower surface. The taste is bitterish, acrid, 
nauseous. The rhizome contains the alkaloid Berberina, but the purgative 
power resides in two resins, one soluble, the other insoluble, in ether.* 
Physiological Action.-The experiments of Dr. Snow, of Dr. S. R. 
Percy {American Med. Times, vol. iv.), of Dr. F. E. Anstie {Med. Times 
and Gaz., March, 1863), and of others, have shown that, whether adminis- 
tered by the mouth or hypodermically, podophyllum produces in the lower 
animals purging, with colicky pains and sometimes vomiting. If the dose be 
sufficient, the stools are bloody, and after large amounts death occurs, pre- 
ceded by hypercatharsis, prostration, and slight convulsions. On post-mor- 
tem examination, Dr. Anstie found intense inflammation, with ulceration of 
the mucous membrane of the small intestines. Upon man podophyllum acts 
as upon these animals, producing in large doses violent catharsis, accompa- 
* Podowyssotzki states {Arch. Exper. Path. u. Pharm., xiii. 40) that he has isolated a 
crystalline substance (Podophyllotoxin) which he believes to be the active part of podo- 
phyllin. One-tenth of a grain of it in a cat produced fatal vomiting and purging. By 
the action of an alkali it is resolved into two substances, pikropodophyllin and podophyl- 
Unic acid, which also exist in the rhizome. Pikropodophyllin resembles podophyllotoxin 
in its action upon the organism, but is less powerful. Dr. D. 0. Brau has used podophyllo- 
toxin as a purgative for children, and finds it to completely represent podophyllin. To 
a child thirteen years old he gives from six- to nine-hundredths of a grain (Arch. f. Kin 
derheillc., ii. 1880). CATHARTICS. 
515 
nied by much pain, and is probably capable of acting as a fatal gastro-intes- 
tinal irritant. Ten grains produced in a strong woman violent bilious but 
not bloody vomiting and purging, with collapse, but final recovery (Philad. 
Med. Times, xii. 520). The experiments already alluded to show that it 
acts by being absorbed, which is confirmed by the experience of Dr. Percy, 
who found that its application to an ulcer was followed by its specific effects. 
It has been claimed that it acts especially upon the liver; and much clinical 
testimony has been adduced to support this view, which is also confirmed 
by the experiments of Rutherford (see p. 488). 
Very large doses are distinctly poisonous. A child four years old was 
killed in this city by an unknown amount. The symptoms were repeated 
vomiting, slight purging, collapse, and finally coma, ending in epileptiform 
convulsions (Dr. T. G. Morton). An infant twenty-two months old re- 
covered from four grains (Australasian Med. Gaz., ii. 237). 
Therapeutics.-Podophyllum acts as a purgative like jalap, but more 
slowly and more continuously, and is more apt to produce " bilious dis- 
charges" and griping pains. In this country it is very largely used in cases 
of acute constipation, and with very good effect; and it has also been com- 
mended very highly by numerous practitioners in the so-called " bilious 
attacks." Owing to the extreme slowness of its action, it is not well 
adapted for combination with brisker cathartics. The same quality fits it, 
however, for use with calomel, it requiring nearly the same length of time 
as that drug to produce purgation. L. Lewis (Brit. Med. Journ., 1876, ii., 
p. 546) affirms that in small repeated doses (gr. t. d.) it is a powerful 
stimulant of the gustatory nerves. 
Administration.-Although an extract (Extractum Podophylli} is 
officinal, podophyllum is scarcely ever given in other form than that of the 
resin, commonly known as Podophyllin. Resina Podopliylli (U. S.) is pre- 
pared by precipitating a concentrated tincture with water: as berberina is 
soluble in the latter menstruum, the resin as thus obtained is free from 
the alkaloid. The portion of this duplex resin which is soluble in ether is 
certainly more actively purgative than the other part, to which, indeed, any 
purgative property is denied by some. Dose, as a purgative, from one-sixth 
to one-fourth of a grain ; as a laxative, one-twelfth of a grain. 
A substance deposited by the juice of the fruit of the Momordica Elate- 
riurn, or squirting cucumber, a native of Greece, but cultivated in England. 
In the interior of the ovate fruit is an elastic sac, which contains the seeds 
and at ripening becomes so distended with juice that when the fruit falls off 
the vine, and the support is removed from the stem end, a rupture occurs at 
the latter position, and the liquid with the seeds is forcibly projected. The 
elaterium is said to be contained only in this inner juice. In order to avoid 
loss, the fruit is picked with a piece of the stalk adherent to it before ripeu- 
ELATEEIUM. 516 
LOCAL REMEDIES. 
ing, and is opened by slicing. Elaterium occurs in light, friable, slightly 
incurved, greenish-gray cakes about a line thick. The taste is acrid and 
bitter; the fracture finely granular. Owing to the variability of commercial 
elaterium, the U. S. Pharmacopoeia now recognizes only the active principle, 
Elaterin (Elaterinum, U. S.), which was first separated in a pure state by 
Morries {Repertor. fur Pharm., xxxix. 134). It crystallizes in colorless, 
shining, rhombic, six-sided, odorless tables, of a very bitter sharp taste and 
neutral reaction. According to Dr. H. Kohler ( Virchow's Archiv, Bd. 1. 
p. 287), it is insoluble in water and glycerine, readily soluble in cold alcohol, 
and soluble with difficulty in ether and turpentine.* 
Physiological Action.-Locally applied, elaterium is a very decided 
irritant, producing, according to Pereira, ulcerations in the fingers of those 
who handle the fruit and prepare the drug for market. When taken inter- 
nally, it acts on man as a most powerful hydragogue cathartic, producing, 
when the dose and administration are properly regulated, enormous watery 
stools, without much irritation. On the lower animals its action is much less 
certain. Viborg asserts that a horse was unaffected by a pound of elaterium 
fruit; and I have given one and even two grains of a presumably active 
elaterium to a dog without producing very obvious results. If the dose be 
sufficiently large, all animals probably are, however, fatally affected by elate- 
rium, perishing by progressive depression. Prof. Stille asserts ( Therapeutics 
vol. ii. p. 459) that the death is not rarely preceded by violent vomiting and 
purging ; and even when these are absent during life, post-mortem examina- 
tion reveals congestion and inflammation of the gastric and intestinal mucous 
membranes. In none of my own experiments, which have not been very 
numerous, has any purging been present; further, in Dr. Kohler's elaborate 
investigation foe. citf elaterium dissolved in alcohol was injected under the 
skin, the powdered elaterium was put into the rectum, and was given by the 
mouth after the galj-duct had been tied so as to prevent the flow of bile into 
the intestine, and in neither case was there any purging, but prostration, 
apathy, disturbed respiration, salivation, and violent convulsions, ending in 
death. From these experiments Dr. Kohler draws the conclusion that 
elaterium exerts a general action upon the system, for which its introduction 
into the blood is all that is requisite, and also a purgative influence, for 
which it is necessary that there be bile in the duodenum to dissolve the 
elaterium and cause it to act locally on the intestine. The objection to 
this conclusion is that our present light seems to indicate that elaterium 
does not purge dogs and rabbits, even when given under ordinary circum- 
stances. Further, there is considerable evidence to show that elaterium 
applied externally will cause purging in man (see Stilld, Therapeutics, vol. 
ii. p. 459). If this be true, the application of the conclusions arrived at by 
* For the behavior of it with various reagents, and for the methods of searching for it 
in medico-legal investigations, the reader is referred to Dr. Kohler's memoir. CATHARTICS. 
517 
Kohler to man certainly would be incorrect. Kohler's experiment proved 
that in animals elaterium is absorbed, even when given by the mouth, since 
he found it in the urine of the poisoned dogs and rabbits. 
Therapeutics.-Elaterium is certainly the most efficient of all the hydra- 
gogue cathartics, producing in properly-regulated doses the freest evacuations 
with comparatively little pain and irritation. It is therefore indicated when- 
ever a powerful cathartic of such nature is indicated. It is the most efficient 
of all the medicines of the class in general dropsy or in ascites. As, how 
ever, its action is very exhausting, great care should be exercised not to give 
it in too large doses, and also to support the strength of the patient during 
the period of purgation, and afterwards by alcoholic stimulants, easily- 
digested nutritious food, and appropriate hygienic measures. In the latter 
stages of dropsy the injudicious use of elaterium may favor, and no doubt 
has accelerated, the fatal result, by intensifying the exhaustion. An idea 
has prevailed that elaterium is especially valuable in uraemia, because it pro- 
duces an elimination of the urea in the stools; but I have been unable to 
find authority for the asserted elimination. Be this as it may, however, 
clinical experience has demonstrated the utility of elaterium in chronic renal 
disease. In order to deplete, elaterium has been employed in various diseases; 
but this use is not to be encouraged, and especially when there is any gastro- 
intestinal irritation or inflammation are the salines much preferable to elate- 
rium. In cases- of plethora, however, when there is a sudden determination 
of blood to the head and a very powerful impression is needed, the vegetable 
cathartic may be advantageously employed. 
Toxicology.-Elaterium is without doubt capable of destroying life, and 
that, too, when not in large quantity. I know of but one recorded death.- 
that of a woman who took, by the advice of a quack, two and two-fifths 
grains of the extract of elaterium and sixteen grains of rhubarb. Violent 
and uncontrollable vomiting and purging came on, and proved fatal in thirty- 
six hours. After death, the gastro-intestinal mucous membrane showed 
marked evidences of inflammation. (See Beck's Medical Jurisprudence, 
12th ed., vol. ii. p. 719.) 
Administration.-It is not safe to commence with more than one-sixth 
of a grain of elaterium, to which should be united a grain of the extract 
of hyoscyamus and a drop of some aromatic oil. The dose of the officinal 
elaterinum is one-twentieth of a grain; of the trituration ( Trituratio Ela- 
terini-1 to 10, U.S.), one-half a grain. 
OAMBOGIA-GAMBOGE. U.S. 
A gum resin, obtained in Siam by breaking off the leaves and young 
shoots of the tree known by botanists as the Garcinia Morelia, and catching 
in suitable vessels the juice as it drops. When the receptacles consist of 
hollow bamboos, the juice hardens into cylindrical casts, striated externally, 
and with a central cavity due to the loss of substance in drying. This is the 518 
LOCAL REMEDIES. 
so-called pipe gamboge. Gamboge in sorts occurs in irregular masses. Gam- 
boge is a hard, resinoid substance, of a brittle, often conchoidal fracture, of a 
deep reddish-orange color on exposed surfaces, more yellowish when freshly 
broken, affording a bright-yellow powder, insoluble in water, with which it 
forms, however, an intensely yellow emulsion. It has little or no taste, but 
when chewed produces, after a time, an acrid sensation in the fauces. It 
contains, according to Christison, as much as seventy-two per cent, of gam- 
bogie acid, a resinous acid of a cherry-red color, forming red salts with 
alkalies. This would appear, however, to be only one of the purgative prin 
ciples of the drug, since it is less drastic than an equal weight of gamboge 
(Christison, Ann. Chern. Pharm., xxiii. 185; Pabo, Additam. qused. ad Vir- 
futes chem. et physiol. Resinarum quarundam comparatas, Dorpat, 1851 ; 
Daraszkiewicz, Meletemata de Resinarum, prxsertim Resinse Gutti, in 
Tractu Intestinali Rationibus, Dorpat, 1858); five grains producing in some 
persons only watery evacuations, in others not even these, and as much as 
seventeen grains having been taken without more serious effect than severe 
purgation. 
Physiological Action.-Administered by the mouth to dogs, cats, 
horses, and probably other of the lower animals, gamboge acts very generally 
as a violent drastic cathartic; but from the experiments of Schaur and of 
Orfila it would appear to cause sometimes simply vomiting, and, when in very 
large amounts, death, without any marked symptoms other than those of 
progressive depression. In such cases the gastro-intestinal mucous membrane 
was found highly inflamed, and the intensity of the irritation probably p.ira- 
lyzed the intestinal functions. According to Daraszkiewicz and to Schaur, 
in order for gambogic acid to act as a purgative the presence of bile in the 
intestine is necessary. As it has been determined by Schaur (quoted by 
Husemann, p. 754) that the hypodermic administration of gamboge to dogs 
results simply in the production of local abscesses, and as A. L. Richter 
asserts that when applied to raw surfaces in man it acts simply as a local irri- 
tant, it would appear at first sight that gamboge does not act by absorption. 
This is, however, probably not true, the alkaline juices of the alimentary 
canal probably dissolving it so that it can readily be taken up by the villi. 
Further, both Gmelin and Tiedemann assert that they have found its prin- 
ciples in the urine. Schaur has, however, been unable to detect it in the 
urine of persons or of animals taking it. Even when he injected large 
quantities of it into the blood of dogs, he failed to find it in the urine, 
although he did obtain a resinoid substance which he believes to be a de- 
rivative of gambogic acid. Lewis, Abeille, and Ferriar assert that, when 
given in certain ways, gamboge acts as a decided diuretic. If this be true, 
absorption of it must occur. 
Therapeutics.-On account of the intense irritation which large doses 
of it produce, gamboge is very rarely, if ever, used alone as a purgative, but 
is employed to give sharpness to purgative combinations. In very obstinate CATHARTICS. 
519 
habitual constipation it has been used in doses of one or two grains as a 
decided laxative. Its use as a hydragogue in dropsy is to be absolutely con- 
demned, it being much less effective for this purpose, and more irritating, 
than various other substances. The dose of gamboge is from two to five 
grains, made into pill with soap, or given in alkaline solution. 
OLEUM TIGLII-OROTON OIL. U.S. 
The fixed oil obtained from the seeds of the Croton Tiglium, a euphor- 
biaccous shrub of Hindostan and other portions of Southern Asia. This oil 
is quite viscid, and varies in color from a pale yellow to a dark reddish brown, 
and has an acid reaction. Its taste is hot, acrid, and extremely persistent; 
its odor faint, but peculiar. The composition of croton oil is very complex, 
and the active purgative principle has not as yet been separated. The most 
important of the substances so far discovered in the drug is that found by 
T. Schlippe and named by him Crotonol. According to this investigator, 
it is not the purgative principle, although to it the drug owes its power of 
causing a peculiar dermal inflammation. 
Physiological Action.-Locally applied, croton oil is an intense irri- 
tant, producing upon the skin an eruption which is at first papular, but in a 
very short time becomes pustular. This effect of the drug will be consid- 
ered more in detail under the heading of Counter-Irritants. When given 
by the mouth, croton oil acts upon the horse, dog, and probably other mam- 
mals, as upon man, producing violent purging, with severe griping, and, 
when in sufficient amount, fatal gastro-intestinal inflammation. The ques- 
tion as to whether it acts by producing a simple local impression or by ab- 
sorption is unsettled. In the experiments of Hertwig (Stille, Therapeutics, 
2d ed., vol. ii. p. 449) and of Bucheim ( Virchow's Archiv, xii. 1), purgation 
did not follow the injection of the oil into the veins of animals ; but Con- 
well obtained a result contrary to this, and there is considerable testimony 
that its external use in man is sometimes followed by its specific effects upon 
the alimentary canal (Stille, Therap., 2d ed., vol. ii. p. 451). The probabili- 
ties seem to me to be in favor of the purgation being due to the absorption 
of the oil. 
Therapeutics.-Croton oil is a very rapidly-acting, violent drastic and 
hydragogue cathartic. It is chiefly used in cases of obstinate constipation 
from disease of the nervous system or from lead-poisoning. The fact that a 
drop of it placed upon the tongue will purge actively, peculiarly fits it for use 
in mania, delirium tremens, and other diseases when the patient refuses to 
take medicine. When it is desired, as in some brain-diseases, to revulse 
through the bowels, croton oil is probably the most available of the cathar- 
tics. The dose is one drop, which may be administered in pill, emulsion, or 
by simply placing upon the tongue. In overdoses, croton oil is a violent 
poison. 
Toxicology.-Although in small amounts croton oil causes such severe 520 
LOCAL REMEDIES. 
symptoms, yet in larger quantities it has failed to produce as serious results 
as would be naturally expected. It is, however, very possible that in at least 
some of these recorded cases the oil was adulterated. Cowan has reported a 
case (Husemann, Toxicologic, Bd. ii. p. 443) of a child, four years old, who 
recovered in two days from a teaspoonful of croton oil taken on a full stoni 
ach ; Adams (Ibid.') saw recovery in an adult after the ingestion of a drachm, 
and in the Boston Med. and Surg. Journ., 1868, i. 294, is recorded the 
case of a woman who took about an ounce, was vomited forty-five minutes 
afterwards with mustard, and finally recovered. The minimum fatal dose is 
not known, and probably varies very much. A child aged thirteen months 
was killed by a quantity believed not to exceed three minims (Med. Times 
and Gaz., 1870, i.). Giacomini (Stille, Therapeutics, vol. ii. p. 451) reports 
a case in which twenty-four grains of the drug proved fatal in as many 
hours: although there were but four stools, the patient presented the symp- 
toms of general collapse, preserving consciousness to the last: a little less 
than two drachms have caused vomiting and death without purging (Amer. 
Journ. Med. Sci., April, 1874).* 
Helleborus Niger.-Black hellebore is the root-stock of the Helleborus 
niger, a native of Southern and Middle Europe. It contains two active 
medicinal principles, Ilelleborein and Helleborin. Both of these substances 
are glucosides. According to Marme (quoted by Husemann), helleborein 
is an active cardiac poison and a drastic purgative, whilst helleborin, although 
having to some extent the latter property, acts chiefly as a narcotic, pro- 
ducing in animals at first inquietude, soon followed by paresis both of motion 
and of sensation constantly deepening after large doses into death. 
Black hellebore when taken by man is said to cause, if in sufficient 
quantity, violent catharsis, with vomiting, abdominal pains, cramps, and con- 
vulsions, which have ended fatally. Locally applied, the fresh root is a vio- 
lent irritant. It has been used in times past as a hydragogue cathartic, but 
appeals to be both uncertain and very harsh in its action, and, in this country 
at least, is never used at present. The extract and the tincture are purga- 
tive in doses of ten grains and two fluidrachms respectively. 
* For other cases, see Med. Gaz., vol. xliii.; Edinburgh Med. Journ., 1861; Lancet, 1S70 
i.; Brit. Med. Journ., 1874, i.; Aan. d'Hyg., 1871, i. CLASS III-DIURETICS. 
Diuretics are medicines used for the purpose of increasing the flow of 
urine. Some of them, without doubt, act directly upon the secreting struc- 
ture of the glands, but others of them induce the increased secretion indi- 
rectly, by, in some way, removing the obstacle to secretion. It is notorious 
that diuretics often fail in practice when their action is most urgently needed. 
This results, in many cases, from the nature of the disease, and is not because 
diuretics are powerless or uncertain. Thus, in cardiac disease the congestion 
of the kidneys may be so great as to render secretion impossible ; and it is 
equally evident that when the tubules are destroyed by Bright's disease 
medicine must be powerless to provoke excretion. 
There are certain agencies whose influence upon the kidneys should never 
be lost sight of in exhibiting diuretics. Thus, cold, by checking the secretion 
of the skin, often acts as a most efficient remedy of the class, and, whenever 
a diuretic action is urgently needed, it should be employed as an adjuvant to 
the medicinal substances. 
Again, mere vascular fulness tends to provoke excretion of water by the 
kidneys. This assertion does not rest simply upon theory. In an elaborate 
series of experiments, E. Koux (Archives Physiol., 1874, p. 578) found that 
the ingestion of large quantities of water greatly increased the flow of urine, 
but did not sensibly affect the elimination of urea or uric acid, although the 
elimination of the chlorides seemed to be augmented; in Bbcker's (British 
and For. Med.-Chir. Rev., xiv., 1854) experiments, however, large draughts 
of water increased not only the amount but also the solids of the urine. The 
recent investigations of J. Meyer (Hoffmann und Schwalbe's Jahresb. 
1881, 345) explain these discrepancies and show how water may be of 
service in various diseases. He found that at times, when the tissues were 
full of the products of disintegration, the effect of water in increasing elim. 
ination was very marked, but that upon the wasting processes of the body 
the water exerted no influence. It would seem, therefore, that whilst we 
cannot by water produce tissue disintegration, we can wash out by it the 
retained products of tissue change, and I cannot help suspecting that the 
great rarity of uninherited gout in America has some connection with the 
universal habit of drinking water very freely. The taking of large draughts 
of simple water at regular intervals has been found to act very favorably in 
acute Bright's disease, greatly increasing the urinary flow, and at the same 
521 522 
LOCAL REMEDIES. 
time lessening the irritation of the kidneys. In various inflammations 
or irritations of the genito-urinary organs, as in gravel, whenever it is desired 
to make the secretion less irritating or less concentrated, the value of water 
as an adjuvant to medicinal diuretics should always be taken advantage of. 
There certainly is a very marked antagonism between the bowels and the 
kidneys, so that free catharsis reduces very decidedly the secretion of urine. 
There is also an antagonistic relation between the skin and the kidneys, so 
that an increase in the excretion from one of these generally results in a 
diminution of that of the other emunctory. This should also be taken ad- 
vantage of when a diuretic action is desired. Sweating and purging at such 
times are therefore to be avoided. When a diuretic is exhibited, the patient 
should be kept cool, walking about if able, or if it is necessary for him to 
remain in bed he should be covered lightly. Not rarely, a remedy which 
when administered cold and the patient kept cool afterwards will act as a 
diuretic, when given hot and the patient kept warm will act as a diaphoretic. 
There are various substances which are of such nature that when elimi- 
nated by the kidneys they act upon the mucous membrane of the bladder 
and other surfaces over which they pass. It seems hardly correct to speak 
of these drugs as diuretics; yet they are best considered in the present class. 
The chief indications for the use of diuretics are as follows: 
1. To maintain the action of the kidneys. It is hardly necessary here to 
discuss the necessity of excretion to the system. In various kidney diseases 
this indication is very urgent; but as the lessened excretion too often de- 
pends upon a profound organic alteration of the renal secreting structure, it 
is evident that very frequently diuretics must fail when most needed. In 
the great majority of cases in which diuretics are used to fulfil the present 
indication, only the mildest of the class should be employed. Whenever 
there is inflammation of the kidneys, even if it be chronic, the stimulating 
diuretics should be avoided. When lessened urinary excretion is purely 
functional in its origin, diuretics are often most serviceable. In fevers 
especially is it necessary to maintain the action of the kidneys; for this 
purpose water should always be freely given during fever. The alkaline 
diuretics sometimes may be exhibited; but the most generally serviceable of 
all remedies of the class in these diseases is the sweet spirit of nitre. 
2. To evacuate fluid. For this purpose diuretics are employed in all forms 
of dropsy, and are successful in direct proportion to the universality of the 
effusion and the structural perfection of the kidneys. 
3. To soothe and diminish irritation of the genito-urinary organs. The 
value of water in fulfilling this and the next indication has already been 
pointed out. By lessening the acidity of the urine and rendering soluble 
the uric acid which is present, the alkalies are equally important in carrying 
out the present and the following indication. 
4. To alter the urinary secretion so as to prevent the deposition of calcu- 
lous material. Notwithstanding it has been claimed otherwise, I think it DIURETICS. 
523 
indubitable that as yet no practical measure has been devised of dissolving 
a calculus when once formed. Even to alter the urine so as to prevent 
further deposition is probably impracticable, except in cases of uric acid 
diathesis. A discussion of the use of diuretics for this purpose will be found 
in the article on Potash, which is the only diuretic used to meet the present 
indication. 
Diuretics are very naturally divisible into three sets,-the hydragogue 
diuretics, the refrigerant diuretics, and the stimulating diuretics. These 
classes, of course, run more or less into one another, but are sufficiently 
distinct for practical purposes. The drugs belonging to the first set simply 
increase the flow of water from the kidneys, and are therefore used chiefly 
for the relief of dropsy ; those of the second division exert a marked sedative 
action upon the system,-very generally do not increase to a great extent the 
water of the urine, but mostly modify the secretion in one way or the other. 
They are used in dropsy to alter the urinary secretion, and for their sedative 
and eliminative action in acute disease. Diuretics belonging to the third 
division are of such nature that their active principles are eliminated by the 
kidneys, and act upon the mucous surfaces over which they pass; for which 
purpose they are chiefly employed. 
HYDRAGOGUE DIURETICS. 
SOILLA-SQUILL. U.S. 
The bulb of Scilla maritima, a liliaceous plant growing in the south of 
Europe, especially on the shores of the Mediterranean. The bulb varies in 
size from that of a child's head to that of the fist. It is composed of nu- 
merous layers or scales, which separate when it is sliced for drying. As kept 
in the shops, squill is in horny flakes, of a white or red color, becoming 
leathery when wet, and having an acrid bitter taste. It yields to water and 
alcohol, and also to vinegar. Sdllitin has been asserted to be the active prin- 
ciple of squill; but the sdllitin of different authors is diverse. According to 
Reil, there are two active principles in squill, one of which he names sdllitin, 
representing the diuretic and expectorant properties of the drug, whilst the 
toxic and irritant properties reside in a substance which he calls sculdn; 
very recently (Arch. Exp. Path, und Ther., xi. 22) C. V. Jarmersted* 
has described a new principle from squill (Scillain), and Merck has sold 
three substances as derived from squill,-sdllin, sdllipicrin, and sdllitoxin.^ 
* Jarmersted states that his scillain increases, and afterwards diminishes, blood-press 
ure, causes vomiting and purging, and finally paralyzes the heart-muscle. 
f Dr. Fronmiiller has reported (Memorabilien, 1879, xxiv. 250) a series of experiments 
made, upon persons suffering from various ailments, with the scillin, scillipicrin, and scilli- 
toxin of Merck. He found that the scillitoxin in doses of 0.45 grain acted as a rather 
uncertain diuretic, and frequently caused giddiness, headache, and loss of appetite; scillin 
seemed to be devoid of diuretic properties, whilst a gramme of a solution of scillipicrin 
in water (one part in fifty) administered hypodermically usually invoked a great flow of 
urine, without other evil symptoms than some smarting at the place of injection. 524 
LOCAL REMEDIES. 
Physiological Action.-According to the experiments of Chateau 
(quoted by Stille) and of Marais, squill in poisonous dose produces in dogs 
and other of the lower animals vomiting, then purging, dulness, stupor, 
intermittent paralysis, convulsions, and finally death in the course of twelve 
or fifteen hours. The temperature always falls. Recently, Prof. Schroff 
( Wochenblatt der Zeitsch. der k. k. Gesellsch. zu Wien, 1864, p. 424) has re- 
investigated this subject, using alcoholic extracts of the red and white squill, 
and also the scillitin of Merck. Fifteen grains of the latter caused in a 
vigorous rabbit great weakness, mydriasis, and, after an hour or so, tremors 
gradually becoming violent, partial stupor, labored breathing, and finally 
death; twenty-three grains caused in another rabbit sinking of the pulse 
and respiration-rate, mydriasis, diuresis, and death, preceded by the other 
symptoms noted in the previous case. The alcoholic extract (fifteen grains) 
caused (loc. cit., 424) in a large rabbit decrease of the number of respira- 
tions per minute, with rise of the pulse-rate, narrowing of the pupil, semi- 
stupor, and finally death. On post-mortem examination of rabbits killed 
with the scillitin, erosion of the gastric mucous membrane, pericardial and 
sub-pleural hemorrhages, pulmonary apoplexy, bloody urine, and hyperaeinia 
of the kidney and brain were found. In rabbits destroyed by the extract, 
gastric erosion and the various hemorrhages were wanting. It seems evi- 
dent that the scillitin of Merck does not represent squill. In a recent 
memoir, which I have only seen in abstract, Dr. Husemann states that the 
extract of squill has no expectorant properties, that it acts on the heart like 
digitalin, that its diuretic powers are dependent upon its action on the circu- 
lation, and that both in large and small doses it uniformly produces a rise of 
temperature (Deutsche Med. Wochens., No. 13, 1875 ; abstracted Lond. Me I. 
Rec., 1876, p. 120). Husemann also finds commercial scillitin very uncertain. 
These statements receive confirmation, at least in part, from the researches 
of C. Lupinski, who has found that scillitoxin is a powerful stimulant to 
the peripheral vagi in the frog, causing slowing of the pulse, and in certain 
doses diastolic cardiac arrest, and in the dog slowing of the heart. Large 
doses cause in the frog tetanic contractions of the heart. He also found 
that in the dog large doses finally paralyze the peripheral vagi and produce 
a rapid pulse. The arterial pressure is increased, partly, it is affirmed, by 
the increased cardiac energy, and partly by a peripherally produced vaso- 
motor contraction (Hoffmann und Schwalbe's Jahrb., 1883, 123; from the 
Russian). 
Clinical experience has established the fact that in small repeated doses 
squill is diuretic as well as expectorant. The remedy is evidently a stimu- 
lant to the kidneys, and in overdoses causes an irritation whose result is less- 
ening of the secretion, scanty bloody urine, or absolute suppression of urine, 
according to the ingested dose of the poison. Its diuretic action has been 
noted in animals by Schroff and by Chiarenti (quoted by Stills), and there DIURETICS. 
525 
can be no doubt as to the power that squill has of increasing the watery por 
tion of the urine. I know of no studies upon its action on the urinary solids. 
That the active principles of squill are absorbed is proven not only by its 
action on the kidneys, but also by the fact that its characteristic effects on 
the system have been seen to follow its external application. (See Stills. 
Therapeutics, 2d ed., vol. ii. p. 534.) 
In man, overdoses of squill produce violent vomiting, colicky pains, 
purging, and diminution or suppression of the urine, which may contain 
blood. 
Therapeutics.-As a diuretic, squill is in great repute, and is especially 
employed in cases of dropsy where the condition of the system is atonic and 
where there is no disease of the kidney. Profs. Wood and Chapman recom 
mend it very strongly in cases of serous effusion into the pleura or the peri- 
cardium dependent upon chronic inflammation of the membrane. In these 
cases it may often be advantageously combined with calomel. The combina- 
tion of squill and digitalis is very efficient in cardiac dropsy. The one 
contra-indication to the use of squill is the existence of any form of Bright's 
disease or of acute irritation of the kidney. 
Toxicology.-Overdoses of squill produce violent purging and vomiting, 
with abdominal pain, lessened or almost suppressed secretion of bloody, albu- 
minous urine, very marked reduction of the pulse-rate, ending, it may be, in 
collapse, convulsions, and death. According to Husemann ( Toxicologie, Bd. 
i. p. 413), twenty-four grains of it have brought about a fatal result. The 
treatment consists in the evacuation of the stomach and bowels by ipecacu- 
anha and castor oil, if nature has not already fulfilled the indication ; the 
free use of opium; the exhibition of large quantities of water, for its action 
on the kidneys; and the usual measures for the relief of gastro-enteritis, if 
much tenderness be present. Early in the poisoning care should be exer- 
cised in the exhibition of alcoholic stimulants, for fear of increasing the 
gastric irritation; during the stage of collapse they may be imperatively 
demanded, and with their use should be combined that of dry heat applied 
externally, and of the othe" usual measures of relief during collapse. 
Administration.-As a diuretic, squill should be given in solid form, 
two grains every two hours, the dose being gradually increased until some 
nausea is felt. The preparations of squill are the tincture ( Tinctura Scillse, 
-1 to 6.6, U. S.),-dose, Hx to Hxx ; the vinegar (Acetum Scillse-1 to 
10, U. S.),-dose, Hx to Hxx; the syrup (Syrupus Scillse, U. S.),-dose, 
f5ss to f$i; the fluid extract {Extractuni Scillse Fluidum, U.S.),-dose, 
Hi to Hiii. 
Digitalis, in its general relations, has already been sufficiently discussed, 
and it remains only to speak of its employment as a diuretic. In the first 
place, it should be distinctly understood that it has no alterative effect what- 
ever, either upon the nature of the secretion or upon the mucous membrane 526 
LOCAL REMEDIES. 
over which that secretion flows. In other words, when it has any effect it 
is purely a hydragogue diuretic, simply increasing the watery portion of 
the urine. That digitalis has direct diuretic properties cannot, I think, be 
doubted. Nor does it seem less certain that it varies greatly in their exer- 
cise, so that when given to persons in health it will sometimes produce free 
diuresis and will at other times fail to do so. Another point to be constantly 
borne in mind during its administration is the fact that, like all the other 
actions of digitalis, diuresis is very slowly induced, and is very persistent 
when produced by the ordinary cautious method of administration. The 
diuresis of digitalis is not simply a result of its action on the circulation, 
since it will sometimes appear before the circulation is sensibly affected. At 
the same time, it is very evident that in disease the good effect of digitalis 
upon the renal organs is often in large measure due to its action upon the 
heart. Thus, in dropsy from a dilated heart the renal gland-cells cannot act 
because they are not supplied with the proper kind and quantity of blood, 
because their circulation, like that of the remainder of the body, is nearly 
stagnant. If under these circumstances digitalis be exhibited, and the cir- 
culation becomes comparatively free and active, the result is diuresis wrought 
out through a double mechanism, partly indirectly and partly directly pro- 
duced by the drug. As a consequence of these facts, the clinicians have long 
since practically determined that digitalis is especially valuable as a diuretic 
in cardiac dropsy. Digitalis is, however, also very useful in renal dropsy, 
both in the subacute and the chronic form. Of course, like everything else, 
it frequently fails in these varieties of Bright's disease, but certainly it 
should always be tried. Prof. George B. Wood asserts that he has seen 
cases of " what appeared to be decided and obstinate attacks of Bright's dis- 
ease, with universal dropsy, and unconnected with scarlatina, which yielded 
completely and permanently to the use of digitalis." In acute suppression 
of urine, digitalis is often a very valuable remedy when applied externally, 
especially when the stomach refuses to retain medicines. At the same 
time, it should be remembered that large doses of the drug used in this way 
sometimes induce very alarming symptoms. Flannels saturated with the 
tincture may be applied to the abdomen, or poultices of the leaves may be 
similarly used. Dr. Lente (Psychol. and Med. Leg. Journ., 1875) says that 
he has been accustomed to use, even in children, four ounces of the best Eng- 
lish leaves, and with a quart of water " make a poultice which extends all 
round the body, and from the thorax to the pelvis." Only in desperate cases 
is such heroic use of the remedy warrantable. Dr. E. F. Fannell has seen 
(British Med. Journ., March 11, 1871) almost fatal collapse produced by 
the external use of an ounce of the tincture in a case of renal dropsy. 
Administration.-The dose of the powder of digitalis, as a diuretic, is 
three grains a day (in divided doses), increased by a grain every second or 
third day, until some sensible effects are manifested. The infusion or the 
tincture may be substituted for the powder, in corresponding dose. Digitalis, DIURETICS. 
527 
in the majority of cases, is best given in combination: in cardiac dropsy it 
is much more efficient if given with squill; in renal diseases the bitartrate 
of potassium may be exhibited simultaneously. Whilst our present knowledge 
of the physiological action of digitalis is in accord with the ascertained 
clinical fact that it is safe to give the drug cautiously in the last stages 
of cardiac exhaustion, yet it should never be forgotten that, as a diuretic, 
digitalis sometimes refuses to act, and that it is possible to produce the most 
profound depression with it without inducing the desired result. It is, 
therefore, worse than useless to persist with the medicine to the danger of 
the patient after its constitutional effects have been distinctly produced and 
no diuresis has occurred. The diuretic external use of digitalis is made by 
putting a poultice of an ounce of the fresh leaves upon the abdomen of the 
patient, or, preferably, flannel cloths wrung out of the infusion may be 
applied to the same part and covered with oiled silk, or half an ounce to an 
ounce of the tincture may be sprinkled upon previously-moistened spongio- 
piline. In either case the application should not be allowed to stay on for 
more than eight hours, at the expiration of which period it should be re- 
moved, to be replaced at the end of six hours if no effect has been produced. 
Scoparius, U. S.-Broom is the dried tops of Cytisus Scoparius, or the 
common broom-plant of Europe, cultivated in, and in some places escaped 
from, the gardens in this country. The drug occurs as greenish pentangular 
twigs with minute downy leaves, having a bitter nauseous taste, and, when 
bruised, a peculiar odor. Two principles have been discovered by Dr. Sten- 
house in scoparius, Scoparin, a neutral crystallizable body, to which, he 
believes, the drug owes its diuretic properties, and a liquid alkaloid, Spartein. 
This alkaloid appears to influence the nervous system; although the testi- 
mony concerning it is discordant. According to Husemann (Die Pflanzen- 
stoffe, p. 64), Mitchell found that about four grains of it administered to a 
rabbit caused death in three hours, preceded by a very short stage of excita- 
tion and then deep sleep without convulsions, whilst in Schroff's experiment 
a single drop caused in the rabbit violent convulsions, followed by a stage of 
muscular weakness, depression of the heart's action, renewed convulsions, 
and finally death. In an elaborate examination of the action of large doses 
of spartein (Archiv fiir Exper. Path. u. Therap., 1873), Dr. Fick arrives at 
the following conclusions as to the influence of poisonous doses of spartein • 
1. So far as can be ascertained, spartein affects the intellectual functions 
both of frogs and of the mammalia, and can therefore to a certain extent 
be regarded as a narcotic. But this effect upon the brain is not a very 
marked one in degree, since, even in cases where the most decidedly poison- 
ous results have been produced, entire suspension of consciousness has not 
been observed. 2. Spartein exhibits powerful toxic effects upon the spinal 
cord, the reflex action of which in particular is lessened to a great degree. 
3. Spartein paralyzes the motor nerves, which after a larger dose of the 528 
LOCAL REMEDIES. 
poison lose their electrical excitability entirely. 4. A small dose of spartein 
causes the suspension of the electrical excitability of the vagus, so that its ex- 
citation produces no interfering influence on the motions of the heart. In 
larger doses the governing centres themselves are paralyzed, so that neither 
by the use of muscarin nor by other means can a diastolic cessation of the 
heart be produced. 5. In the poisoning of mammalia by spartein, death is 
dependent upon paralysis of the respiratory centres. By employing artificial 
respiration, life may be prolonged in the poisoned animals for some time. 
In very large doses, scoparius produces in man free purging, and even 
vomiting; but as ordinarily used it is simply a most efficient hydragogue 
diuretic. It is very largely used in general dropsy, and is one of the most 
reliable remedies of the class, seldom failing unless the structural lesions are 
such as to prevent any diuretic from acting. It is best given in decoction : 
half an ounce of the tops in a pint of water boiled down to half a pint. Of 
this an ounce may be given every three hours until some effect is produced; 
or a fluid extract, which is not officinal, may be given in half-drachm doses. 
Spiritus JEtheris Nitrosi, U.S.-Sweet Spirit of Nitre will be consid- 
ered in the class Diaphoretics, in detail. Suffice it for the present to state 
that when given in a single large dose (a teaspoonful to a tablespoonful) and 
the patient afterwards kept cool, sweet spirit of nitre acts as a pretty efficient 
diuretic, increasing the watery portion of the urine, but not to such an extent 
as to render the drug available for use by itself in dropsy. It acts upon the 
kidneys as a mild, soothing stimulant, and is mostly employed as an adjuvant 
to more powerful diuretics, or by itself when there is simply diminished 
renal excretion of functional origin, or when the kidneys suffer from slight 
congestion, as shown by aching in the loins without other more serious 
symptoms. 
REFRIGERANT DIURETICS. 
POTASSIUM. (K.) 
The salts of potassium, like the substance itself, are very poisonous to the 
lower animals. According to Dr. Paul Guttmann, they are all exactly alike 
in the character and the intensity of their action; but further experimenta- 
tion is wanting before this point can be considered as decided, and I have 
preferred to study the bromide entirely separate from its congeners. 
In the experiments of Podocaepow ( Virchows Archiv, 1866, Bd. xxxv. 
p. 460) it was found that one cubic centimetre of a solution of the chloride 
(one to five), given to a frog by the stomach, would in eight minutes cause 
abolition both of voluntary and of reflex movements. After from fifteen to 
twenty minutes, cardiac arrest occurred. Upon mammals similar results 
were obtained, but the abolition of motility was apparently not so profound 
as in the frog. Thus, four or five drachms of the chloride of potassium DIURETICS. 
529 
injected into the stomach of the dog caused bloody stools, reduction of tem- 
perature, muscular weakness, and death without convulsions. Although in 
most, if not all, of the reported cases of poisoning by potash salts, the most 
prominent symptoms are those due to the local action upon the alimentary 
canal, yet it would seem that poisonous doses act upon man as upon other 
mammals, as great feebleness of pulse and lowering of temperature have 
been noted as constant phenomena. 
Circulation.-The most marked action of the potash salts is upon the 
heart. When a frog is killed by a salt of potash, the heart* is arrested in 
diastole, according to both Podocaepowf and Guttmann. The blood-current 
before death is greatly lessened in force, as was determined by Podocaepow 
by watching the circulation in the web, and by comparative experiments in 
regard to the rate at which blood flowed from wounded vessels in poisoned 
and in unpoisoned frogs. In mammals, potash influences the heart even 
more markedly than in cold-blooded animals. Ten or fifteen grains of the 
chloride quickly injected into the jugular vein suffice to produce instant 
cardiac death. According to Aubert and Dehn {Pfliigers Archiv, 1874, p. 
122) for a few secopds before complete suspension of movement there are 
irregular, "stormy" convulsions, which run through the heart in a sort of 
peristaltic manner with great rapidity, but have no effect in expelling the 
blood. A curious fact discovered by Aubert and Dehn is, that the effect of 
the potash is not permanent unless it has continued a certain length of time. 
Thus, a hound received into its jugular a fatal dose of the chloride of potas- 
sium, and ten seconds after all pulsations had ceased the crural artery of a 
second dog was connected with the jugular of the poisoned animal, when the 
heart recommenced its movements, only to cease again after a time. The 
action of a poisonous dose of potash upon the heart appears to be a local 
one. Traube found that when death in the dog was produced by injection 
into the jugular the heart-muscle failed entirely to respond to electricity. 
In this case, however, the heart received at once the full dose of the poison, 
and the careful experiments of Podocaepow and of Guttmann have shown 
that when the potash is introduced gradually and in the more ordinary 
methods into the circulation, the contractility of the cardiac muscle, although 
very much impaired, is not at the time of death entirely destroyed; in frogs 
it is less affected than in warm-blooded animals. Guttmann has found that 
previous section of the vagi has no influence upon the action of large doses 
* The poisonous influence of potash upon the heart was, I believe, first discovered bj 
Black (Comptes-Rendue, 1839), and has been confirmed by Bouchardat (Annuaire de 
Therapeutique, 1844), by Grandeau (Robin's Journal de l'Anatomie, 1864), by Rabuteau, 
(L'Union Medicale, 1871), and by others. 
f Virchow's Archiv, Bd. xxiii. It is proper to mention that Podocaepow states, on 
p. 506, that the arrest is sometimes systolic, sometimes diastolic, although on p. 511 
he asserts that the arrest never occurs in systole. 530 
LOCAL REMEDIES. 
of potash. The diastolic arrest is therefore independent of the inhibitory 
system, and is due to a direct impression upon the cardiac muscle. 
Although the effects of large doses of compounds of potassium on the 
heart appear to be made out, definite knowledge is still wanting in regard to 
small doses. Traube (^Gesammelte Beitrdge, Bd. i. p. 386) asserts as the 
result of his experiments that, injected into the blood in doses of two or 
three grains, the nitrate of potassium produces a fall in the pulse and a rise 
in the arterial pressure. Aubert and Dehn ^PJlilgers Archiv, 1874, p. 126) 
have experimented with a number of the salts of potash, and found that, 
with the exception of the permanganate, they all act upon the circulation in 
the manner just described. If larger doses of the potash preparations were 
employed, the rise was preceded by a temporary fall of pressure, and if the 
dose were still larger, the fall was permanent. The first fall of pressure, as 
well as the permanent impression produced by large doses, was probably 
caused by the direct action of the drug upon the heart-muscle. The cause 
of the rise is still enveloped in obscurity, as is also the manner in which 
potash affects the pulse-rate. Traube affirms that if the vagi be cut after 
exhibition of the potash salt, the lessened pulse-rate instantly becomes rapid, 
and the already increased arterial pressure rises still further. The same 
observer also found that after section of the pneumogastrics small doses of 
the nitrate produced a fall in the pulse, with increased arterial pressure; but 
on a repetition of the dose in the same animal no lessening of the pulse- 
frequency was perceptible, while each time the pressure rose. This seems to 
indicate that the cardiac action of the drug is independent of the inhibitory 
apparatus, which is confirmed by the experiments of Aubert and Dehn (foe. 
cit., p. 145) upon atropinized dogs. It is very probable, but not in any way 
proven, that the rise of pressure is brought about through the vaso-motoi 
nerves. Both Podocaepow (foe. cit., p. 515) and Aubert and Dehn (loc. cit.. 
p. 150) have called attention to the very temporary effect of the potash 
injections: thus, after small doses the arterial pressure returns to its normal 
position in three minutes; after large doses the maximum effect is reached 
in ten minutes. Aubert and Dehn also assert that there is no cumulative 
action, many small doses given at brief intervals leaving no residual effect; 
but this is in direct opposition to the statements of Guttmann. Kohler 
affirms that after section of the spinal cord potash salts have less influence 
upon the heart, and that larger doses are required to kill (Centrail). Med. 
Wiss., 1877, p. 675). The only fixed conclusion warranted by the evidence 
is the absolute necessity of further investigation. 
Muscular and Nervous Systems.-The action of the drug upon the motor 
system is more marked in cold- than in warm-blooded animals. Podocaepow 
believes, but does not definitively prove, the paralysis of both voluntary and 
reflex movement to be of muscular origin. The much more elaborate ex- 
periments of Guttmann show that the muscles of poisoned frogs are not only 
excitable at the time of death, but are nearly as sensitive as normal muscles, DIURETICS. 
531 
and maintain their excitability nearly as long after death. As both nerve- 
trunks and muscles are capable of performing their functions in the dying 
frog, Guttmann concludes that the paralysis is of spinal origin, a conclusion 
which he confirmed by tying the aorta directly above its bifurcation and 
then administering the potash, when the paralysis appeared as early in the 
protected hind legs as in the non-protected front ones. 
By an elaborate series of experiments, Drs. Ringer and Murrell have 
shown that the potash salts, in sufficient concentration, act powerfully upon 
the cerebrum, the motor and sensory nerves, and the muscles; in a word, 
that they are poisonous to all the higher forms of tissue. In poisoning, how- 
ever, the brain and spinal cord suffer in their functional activity far more 
quickly and deeply than do the peripheral, nervous, and muscular tissues; 
consequently, in general poisoning the symptoms are produced through the 
higher nerve-centres (Journal of Physiology, i. 88). All of the potash salts 
probably act in a similar manner* upon the spinal cord, their power, accord- 
ing to the experiments of Ringer and Morshead (Journ. Anat., xii. 82), 
being in direct proportion to the amount of potash they contain. 
General Influence.-Outside of the body, potash favors very greatly the 
oxidation of organic substances. Thus, when olein is exposed to ozone no 
change occurs, but if potash be added rapid oxidation follows. Again, when 
albumen or haematin is dissolved in water no change, or a very slow one, occurs, 
but if potash be added the organic principle is oxidized with extraordinary 
rapidity. Whether a similar influence is or is not exerted within the body is 
not as yet completely determined, but the present evidence strongly indicates 
that it is.j* The fall of temperature produced by poisonous doses of potassium 
salts would seem to point to lessened oxidation, but is probably simply the result 
of the profound depression of the circulation. The chief arguments in favor 
of the theory of increased oxidation in the system as yet brought forward have 
been drawn from studies of the action of the drug upon the urinary excre- 
tion in health and in disease. Potash or its salts administered in sufficient 
quantity certainly, under ordinary circumstances, increase the watery portion 
of the urine ; but, as Prof. E. A. Parkes and others have demonstrated, they 
do more. In an elaborate series of'experiments upon himself, Prof. Parkes 
found (Brit, and For. Med.-Chir. Rev., 1853, xi. 258) that liquor potassee 
(f 5ii) when taken fasting produced in from thirty to ninety minutes an 
increased flow of slightly acid urine containing the whole of the alkali and 
organic matter, which differed in quality from that ordinarily found in urine, 
and was also larger in amount than normal. An organic acid, certainly 
neither uric nor hippuric, was believed to form a part of the solid matter by 
* Ringer and Murrell, applying the chlorides, iodides, and bromides of potassium and 
ammonium directly to the ends of the afferent nerves, found that they paralyzed, the 
effect of the potash salt being much the most powerful and permanent, that of ammonium 
the next, and that of sodium the least (Journ. Anat., xii. 71). 
f Lehman was, I believe, the first to originate the oxidation theory. LOCAL REMEDIES. 
532 
Parkes, who attributes the alteration of the urinary solids to the oxidizing 
influence of the potash. Taken after meals, the liquor potassae acted simply 
as an antacid, and had no perceptible effect upon the urine. Both the 
acetate and the nitrate of potash in Parkes's experiments failed to act on the 
urine, probably because taken in too small doses, for it is a fair presump- 
tion that their oxidizing influence is less than that of potash itself. Cer- 
tainly other experimenters have found that they do influence the urinary 
excretion. Golding Bird found (On Urinary Deposits, 2d Amer, ed., 1859, 
p. 356) that in a case carefully tested, under favorable circumstances, three 
drachms of the acetate of potassium increased the solids of a dog's urine 
from four hundred and sixteen to seven hundred and eighty-two grains, or, 
deducting all the eliminated potash, to over six hundred grains. The in- 
crease of the uric acid was about thirty-two per cent.; of the urea, about 
sixty per cent.; of extractives, including creatine, creatinine, etc., about 
twenty per cent.; or, speaking absolutely, the uric acid was increased eighty- 
five grains, the urea seventy-two grains, and the extractive, thirty-six grains. 
Rabuteau (D Union Medicale, 1871, p. 389) found that the daily ingestion 
of seventy-five grains of the chloride of potassium caused an increase of 
twenty per cent, in the amount of urea discharged. Aug. Dehn has also 
experimentally found that the potash salts greatly increase the elimination 
of urea (Pfluger's Arch., Bd. xiii. p. 368). 
The various studies which have been made as to the action of the potash 
salts in disease seem to bear out the oxidation theory. In six observations 
upon subjects affected with what may be termed indifferent diseases, such as 
lead-palsy, Parkes (Brit, and For. Med.-Chir. Rev., xiv., 1854) found that 
the urea was increased, and also the sulphuric acid, by the use of drachm 
doses of liquor potassae. Dr. Austin Flint (American Med. Monthly, Oct. 
1860) has studied the effect of the nitrate of potassium upon a number of 
persons suffering from various diseases, and found that it very greatly increases 
the amount of solids in the urine. In rheumatism Prof. Parkes found that 
the liquor potassae increased the elimination of sulphuric acid, but had no 
decided influence on the uric acid. lie, however, used such small doses of 
the drug as not to get the effect obtained in the alkaline treatment of the 
disease, since he expressly states that the urine remained acid (Brit, and 
For. Med.-Chir. Rev., 1854). Rheumatism, gout, and the uric acid dia- 
thesis certainly bear some relation with one another. It has long been cus- 
tomary to use potash salts in excess of uric acid in the urine, and the relief 
obtained has been believed to be due to the conversion of the acid into a 
urate. Dr. Basham affirms (Practitioner, vol. v., 1870), however, that as 
the result of a series of analyses he has found that in uric acid diathesis not 
only is there a great increase of the urea during the use of potash, but that 
tire uric acid, either free or combined, in the urine is greatly diminished. 
Dr. Basham, remembering that Mr. Schunck had proved that, under the 
oxidizing power of potash, uric acid outside of the body is converted into DIURETICS. 
533 
oxaluric acid, which in its turn is readily metamorphosed into oxalic acid 
and urea, carefully examined the urine of gouty patients taking the potash, 
and found that not only was the urea increased, but that oxalic acid also 
appeared as the uric acid decreased, and that the urine, on standing, deposited 
crystals of oxalate of calcium, although none of those could be found in it 
when first voided. This research of Dr. Basham certainly seems to demon- 
strate that in uric acid diathesis the potash salt increases the oxidation and 
the ultimate metamorphosis of tissue. Where this occurs, whether in the 
blood, in the kidney, or in the urine itself, is not at present determined. 
Rabuteau, in his experiments with the chloride, found that the urine 
maintained its acidity. It is notorious, however, that large doses of the 
acetate, carbonate, or citrate of potassium produce alkalinity of the urine. 
The explanation of the apparent contradiction is that the vegetable salts are 
destroyed in the system and eliminated as alkaline carbonates, whilst the 
nitrate, and probably chloride, sulphate, and similar compounds, pass en- 
tirely, or in great part, unchanged through the body. A proof of the latter 
fact is furnished by Prof. Alfred S. Taylor (^Guy's Hospital Reports, 1863, 
p. 177), who from the urine of a patient taking two hundred and seventy 
grains of the nitrate daily, obtained 158.7 grains of the ingested salt per 
diem. A portion of the potash salts escapes through the intestines, as Dr. 
Kramer [Annates d' Hygiene Publique et de Medecine Legale, vol. i., 1843) 
has found the nitrate in the faeces of animals taking it; and it is much more 
probable that the nitrate not accounted for in Dr. Taylor's investigation was 
eliminated by the intestines than that it was decomposed in the system. If, 
as there is much reason to believe, a vegetable acid when given alone passes 
through the system in great measure unchanged, whilst, as asserted by Dr. 
Munch (Archiv des Vereins fur gemein. Arbeiten, 1863, p. 370), and as 
seems to follow from the facts already brought forward, the same acid is 
found when combined with an alkali to be destroyed by oxidation, there is in 
this strong corroboration of the belief that the alkalies aid oxidation in the 
system. Putting all the evidence together, it seems to me that the oxidation 
theory must be accepted as exceedingly plausible and probable, although not, 
perhaps, absolutely proven. 
When a potassium salt is given in large doses for a long time, it produces 
a condition of dyscrasia, with impoverishment and excessive fluidity of the 
blood. How or why it has this action is unknown, as indeed is the exact 
nature of the changes. Very probably there is some connection between 
these changes and the oxidizing power of the drug; but any theory in the 
present imperfect state of our knowledge could at best be only an ingenious 
speculation. 
Our knowledge of the physiological action of the potassium salts seems to 
show that the vegetable salts and the carbonates are equivalents, but that the 
mineral salts are more or less peculiar and individual; and clinical experience 
confirms this. There is, however, one exception: the bitartrate of potassium 534 
LOCAL REMEDIES. 
appears to act differently from the other vegetable acid salts, and, although 
direct proof is wanting, probably is not decomposed in the system. Potash 
itself is never used to affect the system, on account of its irritant properties; 
and its local action will be discussed under the headings of Escharotics 
and Antacids. I shall here group all the potassium vegetable salts, except 
the bitartrate, together. 
The potash of commerce, obtained from wood-ashes and other sources, 
occurs in the form of fused, stony masses, variegated in color, and of a 
caustic, burning taste ; when purified so as to form pearlash, it becomes of a 
bluish-white color. When further purified so as to conform with the officinal 
tests, it occurs as a coarse, granular, whitish powder, very deliquescent, 
soluble in its weight of water, insoluble in alcohol. It should contain only 
traces of the sulphate, chloride, and silicate of potassium. 
Potassii Bicarbonas, U. 8.-Bicarbonate of Potassium is manufac- 
tured by passing carbonic acid gas through a solution of the carbonate in 
distilled water. It occurs in transparent, colorless crystals, not deliquescent, 
slightly alkaline to the taste and to test-paper. It dissolves in four times 
its weight of boiling water, but is insoluble in alcohol. 
Therapeutically the carbonate and bicarbonate are of equal value, except 
that the carbonate is more irritant, and is therefore not so well borne by the 
stomach as is the bicarbonate. On account of its nauseous taste, even the 
latter salt is not so available as the acetate or the citrate. The full dose of 
the bicarbonate is half an ounce daily, given in diluted solution. 
Potassii Citras, U.S.- Citrate of Potassium is a whitish, granular, 
deliquescent salt, of neutral or very slightly acid reaction, freely soluble in 
water. It is the least offensive to the palate of all the potash salts, except 
the tartrates. The Solution of Citrate of Potassium {Liquor Potassii 
Citratis, U. S.,-Bicarbonate of Potassium, 9G0 grs.; Citric Acid, 720 grs.; 
Water, 24 fa), and the Neutral Mixture (Mistura Potassii Citratis, U. S., 
-Lemon-juice, Oj ; Bicarbonate of Potassium, enough to neutralize), have 
been long used as diaphoretics in sthenic fevers. The dose is half a fluid- 
ounce to one fluidounce every one or two hours. A very elegant method 
of exhibiting neutral mixture is in the form of Effervescing Draught. It 
is especially useful when there is any tendency to sick stomach. It should 
be prepared in two solutions : one consisting of lemon-juice and water, equal 
parts, or of citric acid 5ii, water f£iv; the other of bicarbonate of potas- 
sium Ji, water faiii. An ounce of each of the solutions to be put together, 
and the whole to be drunk during effervescence. 
POTASSII CARBONAS. 
Potassii Acetas, U. S.-Acetate of Potassium is a perfectly neutral DIURETICS. 
535 
white salt, of a decidedly saline taste, extremely deliquescent, and soluble 
in half its weight of water. It is made by dissolving the bicarbonate in 
acetic acid, and evaporating. It occurs sometimes as soft, fibrous masses, 
at other times it has a foliated structure. 
Therapeutics.-An important use of the vegetable salts of potassium 
is in acute inflammatory rheumatism. Before the introduction of the sali- 
cylates the alkaline treatment was the best that was known for cases of 
thoroughly acute rheumatism: the medicine must be given freely, an ounce 
to an ounce and a half in the day, and be persisted in, opium, of course, 
being at the same time employed in as large doses as is necessary to relieve 
the pain ; after a few days, when the violence of the symptoms has abated 
and decided anaemia appears, the exhibition of the drug should be dis- 
continued and iodide of potassium, with tonics, be substituted. In cases 
subacute from the beginning I have found a combination of the iodide and 
acetate of potassium very efficient, ten grains of the former and thirty of the 
latter being administered three or four times a day. The potash probably 
does good in rheumatism by lowering arterial action, by favoring oxidation 
and elimination of partially effete materials, and by neutralizing excessive 
acidity. Be the method what it may, I have no doubt of the great clinical 
value of the remedy, its applicability being in direct proportion to the acute- 
ness and violence of the symptoms. 
As depuratives, the potash salts are very useful in various diseases. 
Attention has been especially called by Dr. Golding Bird to their value 
in that class of cases spoken of as 11 chronic biliousness in chronic malarial 
poisoning, in catarrhal jaundice, and in the jaundice of simple hepatic torpor, 
they are often of use. In uric acid gravel and in uric acid calculus there 
can be no doubt of the value of potash as a prophylactic, as a preventive of 
the formation or deposition of the uric acid. The remedy has also been 
used to dissolve uric acid calculi; but the results offer such slight encour- 
agement that it is only necessary here to give a reference to the work of Dr. 
Wm. Roberts (On Urinary and Renal Diseases, Am. ed., 1866). 
Administration.-As usually exhibited, the potash salts are exceedingly 
distasteful. There is no need of this whatever. The citrate may be given 
dissolved in lemon-juice, or, what is a still more pleasant method, a syrupy 
solution of the bicarbonate and the citrate may be made, of such a strength 
that every tablespoonful of it shall contain half a drachm of each salt. At 
the time of exhibition one or two tablespoonfuls of this may be put in a little 
water, and to it be added a large tablespoonful of lemon-juice, the whole to 
be drunk whilst effervescing. If the patient takes in the course of the day 
six of the largest doses mentioned, the whole amounts to an ounce and a 
half of the citrate of potassium. When the remedy is used simply as a 
depurative, as in jaundice, such large doses are, of course, not proper; a tea- 
spoonful of the alkaline solution, with a corresponding amount of lemon-juice, 
taken three times a day, will generally be sufficient. 536 
LOCAL REMEDIES. 
Potassii Bitartras, U. S.-Bit artrate of Potassium, made from argol 
(see Tartaric Acid), occurs in white crystalline crusts or masses, which are 
commonly pulverized before being sold as Cream of Tartar. It usually 
contains tartrate of calcium, and is only sparingly soluble in cold water. It 
appears to differ therapeutically from its congeners in being more actively 
diuretic, and in acting more powerfully as a hydragogue cathartic. Half an 
ounce to an ounce of it given at once will very generally cause watery purging. 
In this city it is probably employed more frequently in dropsy than any other 
diuretic: the usual plan is to dissolve an ounce of it in a pint of infusion 
of juniper-berries, and have this all taken, in divided doses, during the 
twenty-four hours. In acute desquamative nephritis, cream of tartar is a 
very useful diuretic: as, however, the avoidance of irritation of the kidneys 
is imperative in this disease, the alkaline diuretic should not be administered 
in infusion of juniper. 
The Tartrate of Potassium (Potassii Tartras, U. S.) is rarely used 
in medicine. It is said to be actively purgative in doses of half an ounce. 
Potassii Sulphas, U.S.-Sulphate of Potassium occurs in small, ag- 
gregated, transparent, very hard crystals, permanent in the air, usually 
short six-sided prisms, possessing a nauseous somewhat bitter taste. It is 
insoluble in alcohol, slowly soluble in nine and a half times its weight of 
cold and in less than four times its weight of boiling water. Sulphate of 
potassium is said to be " a mild purgative, operating usually without heat or 
pain or other symptoms of irritation," in doses of four or five drachms ; and 
in doses of one or two drachms acting as a laxative. It is, however, very 
rarely employed in this country as a purgative. Sulphate of potassium, in 
doses not a great deal in excess of those which have been recommended by 
practitioners, acts as an irritant. Dr. Mowbray states that the salt is used 
in France as a popular abortifacient, and that he has seen very alarming 
symptoms produced by four drachms of it. Dr. Taylor records a case in 
which less than two ounces caused in a woman severe vomiting, purging, 
abdominal pain, and finally death. At the post-mortem the stomach and 
intestines showed very decided evidences of inflammation. 
Nitrate of Potassium, or Nitre, is either obtained from certain saline earths, 
occurring chiefly in India, but to a certain extent in other portions of the 
world, or else is artificially manufactured in nitre-beds formed out of animal 
and vegetable matter, wood-ashes, and calcareous earth, or, finally, is obtained 
from old plaster rubbish. In the " nitre-beds," as well as in the natural 
saline earths, which have undoubtedly in the beginning contained animal 
and vegetable matters in a state of decomposition, nitric acid is formed by the 
oxidation of ammonia, and unites with the bases in the soil. Most of the 
nitre used in this country comes from Calcutta, through Boston, packed in 
POTASSII NITRAS-NITRATE OF POTASSIUM. U.S. DIURETICS. 
537 
grass-cloth bags. Chili saltpetre is the nitrate of sodium, which impreg- 
nates certain soils in the country whose name it bears. It is undoubtedly 
formed in these soils by a process precisely analogous to that in which the 
nitre of India is produced, excepting that, little or no vegetable matter being 
present to afford the potassium during the decomposition of the animal matter 
and the generation of nitric acid, the latter unites with the calcium of the 
soil. Chili saltpetre is employed as a substitute for true saltpetre in the 
manufacture of nitric acid, and may be made into the nitrate of potassium 
by means of crude potash. 
Saltpetre occurs in more or less perfect, long, striated, semi-transparent, 
six-sided prisms, with dihedral summits; of a sharp, saline, somewhat cooling 
taste; containing no water of crystallization, but decrepitating when thrown on 
the fire, from the evaporation of water mechanically retained in the crevices 
of the crystals ; soluble in four or five times their weight of cold and in two- 
fifths of their weight of boiling water, sparingly soluble in proof spirit, in- 
soluble in absolute alcohol. At a high heat they decompose, liberating a 
large quantity of nascent oxygen, and thereby greatly intensifying the com- 
bustion of surrounding objects. The Sal prunelie of the shops is a salt- 
petre which has been fused and run into circular moulds. 
Physiological Action.-Nitrate of potassium applied to any raw surface, 
or to a mucous membrane, acts as a violent irritant. As death has not in- 
frequently resulted from its ingestion, whilst it has occurred very rarely from 
that of any of the other ordinary salts of the alkali, it has generally been 
thought that nitre possesses peculiar properties. It is not to be gainsaid, 
however, that the cause of death in nitre-poisoning is very generally the 
local inflammation of the stomach and intestines produced by it,-effects 
dependent simply upon its irritant properties, and not upon any constitu- 
tional action ; a conclusion becoming doubly evident when it is remembered 
that, if the drug be given in weak solution, much larger amounts can be ex- 
hibited with only therapeutic effects than would cause death if administered 
in solid form or in very concentrated solution. Thus, in a case under the 
care of Dr. Wilks ( Guys Hosp. Rep., vol. ii., 3d series, 1863, p. 173), a man 
suffering from renal dropsy took, between October 28 and December 26, 
1862, one pound twelve ounces and six drachms of the nitrate of potassium, 
with benefit. As one ounce has caused death in three hours (Taylor, Prin- 
ciples and Pract. of Med. Jurisp., 2d ed., vol. i. p. 237), this patient received 
in fifty-nine days the equivalent of twenty-eight fatal doses. Again, accord 
ing to Prof. Stille (Therapeutics, vol. ii.), Dr. Brocklesby habitually pre- 
scribed one ounce of the salt a day, and Dr. Martin-Solon even two ounces 
per diem. 
The symptoms of poisoning by the nitrate of potassium are pretty constant, 
and yet, as in other irritant poisoning, vary within certain limits. Very gen- 
erally there is first an intense burning pain in the stomach, coming on in a 538 
LOCAL REMEDIES. 
few minutes after the ingestion of the poison, and soon followed by violent 
vomiting, and, it may be, free purging. In a little while collapse develops, 
with great muscular weakness, not rarely with local convulsive tremblings. 
The matters vomited, and even the stools, may be bloody (case, Th. Huse- 
mann, Journal fur Pharmacodynamik, 1859, ii. 178). Sometimes the 
nervous symptoms predominate, and the purging may be absent; collapse, 
with slight vomiting and with or without paralysis of the lower limbs, may 
alone exist. Suppression of urine has been noted in some cases (case, 
Pharmaceut. Journ., Feb. 1846, p. 356). After death, very grave lesions 
are found in the stomach and the intestines, such as intense redness and 
congestion, effusion of blood into the submucous coat, and sometimes into 
the stomach itself. Even ulceration and corrosion of the mucous membrane 
nave been observed. It is evident that the symptoms previously detailed as 
existing during life are in accord with the post-mortem results, and all point 
to the irritant action of the drug as the source of trouble. The predomi- 
nance of the nervous symptoms in some cases is no more than is exceptionally 
seen in other forms of irritant poisoning (see Antimony), and is no proof of 
a special action of the drug upon the nervous system. Sometimes, however, 
death has occurred, in poisoning by saltpetre, with great suddenness. In 
the only cases of this character the record of which I have met with, the 
dose has been very large, and it is possible that the death was the result of 
the action of the drug upon the heart, for, like the other salts of potash, it 
has a direct paralyzing influence upon the cardiac muscle. 
Nitre has been supposed by practitioners to be especially sedative to the 
circulation; but there is no reason to believe that it is any more powerful 
as a cardiac sedative than the vegetable salts of the base. It certainly shares 
the diuretic properties of the latter, but appears to be more irritant to the 
kidneys, since it seems difficult otherwise to account for the suppression 
of urine already noted as occurring occasionally in poisoning by it. It is 
possible that nitre may differ to some extent in its actions from the other 
salts of potash, on account of its acting upon the blood as a nitrate. (See 
page 334.) 
Therapeutics.-Nitrate of potassium has been especially used in acute 
rheumatism, and when given in large doses has some favorable influence 
upon the course of the affection. It is certainly, however, a more dangerous 
remedy than the vegetable salts of the base, and, according to my experience, 
much less efficacious. I can therefore see no good reason for continuing the 
practice. If given, not less than an ounce should be dissolved in a full quart 
of barley-water or other demulcent, and be administered in divided doses 
during the twenty-four hours. 
In the treatment of poisoning by saltpetre, after the stomach and bowels 
have been emptied, the usual means for the relief of toxic gastro-enteritis 
should be resorted to. DIURETICS. 
539 
This salt is said to be chiefly prepared by heating the solutions of the 
hypochlorite of lime and chloride of potassium; on cooling, the chlorate 
of potassium crystallizing out and the chl&ride of calcium remaining in 
solution. Chlorate of potassium occurs in white rhomboidal plates of a 
pearly lustre, of an acerb taste, dissolving in sixteen parts of water at 60° 
F., and in two and a half parts of boiling water. 
Physiological Action.-Upon mucous membranes and ulcerated sur- 
faces this salt acts as a powerful irritant, being, I think, even more active 
in this respect than the nitrate of potassium. Taken internally in sufficient 
quantities it is a powerful poison, and has frequently caused death. There 
are on record a large number of fatal cases, most of which are collected in 
the brochure of Dr. J. von Mering (Chlorsaure Kali, Berlin, 1885). To 
Dr. Jacobi, of New York, belongs the credit of having first called atten- 
tion to the dangerous action of this much-used remedy (American Med. 
Times, April, 1861, p. 245). The smallest amount which will produce 
death is not known, but in a case recorded by Dr. Matthisson, a little over 
half an ounce taken in the course of several days proved fatal. A drachm 
in the course of a night has killed an infant of a year old, and three drachms, 
a child three to four years old. In most cases of fatal poisoning in the adult 
the dose has been much over half an ounce. The symptoms may be acute 
or subacute. In the rapid cases there have been violent vomiting, profuse 
diarrhoea, excessive dyspnoea, great failure of the heart's action, and marked 
cyanosis. In most of these cases the blood has been found of a chocolate 
color. In the subacute cases the gastro-intestinal symptoms have been 
severe with generally vomiting of blackish-green matters, and distinct swell- 
ing of the liver and the spleen. The urine is markedly lessened in quantity, 
albuminous, often of an opaque reddish-brown or blackish color, showing 
under the microscope brownish or yellowish-brown tube-casts, often contain- 
ing the detritus of blood-corpuscles. Haemiglobinuria has been noticed 
(Trans. Internat. Congress, 1881, vol. 1. p. 463), and methaemoglobin is a 
common constituent. The nervous symptoms have been severe delirium, 
coma, tonic and chronic cramps, and a peculiar stiffness of the extremities. 
Headache, loss of appetite, violent pains in the abdomen and other por- 
tions of the body, and marked abdominal tenderness have usually preceded the 
loss of consciousness. Not rarely upon the surface of the body are there minute 
small ecchymoses, and even more frequently there is a general jaundice. In 
some cases the patient has rallied and seemed to be on the road to recovery 
when the fatal relapse has occurred. 
After death the blood is usually chocolate-colored, the gastro-intestinal 
tract inflamed, the liver and spleen are enlarged and filled with the brown- 
ish debris of red blood-corpuscles ; the bone-marrow and the brain are often 
similarly colored, whilst the mucous membranes are usually swollen and 
POTASSII CHLORAS. U. S.-CHLORATE OF POTASSIUM. 540 
LOCAL REMEDIES. 
ecchymosed. The kidneys tire profoundly affected, their tubules full of 
brownish casts and their epithelial structure evincing a nephritis. The 
most characteristic and probably the most important of the lesions is the 
change in the blood, which was first noticed after death by Felix Marchand 
( Virchow's Archiv, Bd. 77, 1879). Dr. L. Riess (Berlin, Klinisch. Wochen- 
schrift, 1882) noted in a case during life that many of the red blood-cor- 
puscles were decolorized, and others contained little granules of an elliptic 
shape. The researches of Marchand, abundantly confirmed by subsequent 
investigators, show that the changes in the blood are the result of the for- 
mation of a substance apparently identical with the methaemoglobin of 
Hoppe-Seiler and characterized by the appearance in its spectrum of a 
blackish line in the red. The same substance is readily produced by mixing 
either the chlorate of sodium or the chlorate of potassium with human or 
animal blood outside of the body. 
It was asserted years ago by Dr. Stevens that when the chlorate of potas- 
sium is taken internally the venous blood acquires an arterial hue, and the 
confirmatory statements of Dr. O'Shaughnessy led many of the profession to 
give credence to the idea that the chlorate yields its oxygen to the blood; 
so that it has been used to an enormous extent in various low forms of dis- 
ease with the idea of increasing oxidation in the blood. It is beyond cavil 
that the observers just quoted mistook the altered coloration of the blood 
for the arterial hue. It is very improbable from a chemical stand-point that 
chlorate of potassium should part with its oxygen in the blood at the 
temperature of the body, and there is no proof that it does so. It has 
been shown by Rabuteau and other observers that the chlorate of potassium 
escapes unchanged with the saliva, urine, and probably all the secretions of 
the body. Isambert found it in the tears, the bile, the nasal mucus, and 
even in the milk of nursing women. Rabuteau took five grammes of the salt, 
and recovered from the urine 4.873 grammes (Gazette de Med. de Paris, 
p. 30). Isambert, in two experiments, recovered respectively ninety-five and 
ninety-nine per cent, of the ingested chlorate pf potassium from the urine. 
J. von Mering, out of fifteen grammes given to a dog, obtained 14.7 grammes; 
out of five grammes which he took himself, 4.62 grammes, and when he 
took but a single gramme he recovered in the urine of the next ten hours 
0.91 gramme. From the saliva and urine of a case of mercurial stomatitis 
in which five grammes had been exhibited he recovered 4.54 grammes. 
When the escape of the salt through other channels than the kidneys 
is remembered, these experiments appear to prove it is possible to recover 
practically all of the ingested chlorate, and that it all escapes unchanged 
from the body. F. von Mering, however, believes that some of the chlorate 
of potassium is reduced in the system, chiefly because he thinks that met- 
hemaeglobin is formed by a process of oxygenation. The exact nature of 
methaemaglobin is, however, not made out: according to C. A. Macmunn 
(Spectroscope in Medicine, n. 100, 1881), methaemaglobin is probably a DIURETICS. 
541 
mixture of haematin with soluble albumen, as it has been shown by 
Hoppe-Seiler that it is not formed by oxidation. M. von Mering in one or 
two instances in the dog found a slight increase in the chlorides of the urine 
during the administration of the chlorate, and it is possible that a minute 
quantity of the chlorate does undergo deoxidation, but it must be considered 
established that any such change affects so small a portion of the drug as 
not to be worthy of consideration. 
The effect of therapeutic doses of chlorate of potassium upon the system 
is certainly not marked, and is probably the same as that of the nitrate. 
The potash seems to exert some influence, as Isambert states that the drug 
directly injected into the jugular vein paralyzes the heart, and produces a 
general depression similar to that caused by the nitrate. In his experi- 
ments upon himself, Isambert found that when taken in large doses, two to 
five drachms a day, the chlorate caused salivation, free diuresis, increase of 
the appetite, and when not well diluted, gastric irritation; the urine con- 
tinued strongly acid, and contained an excess of rosacic acid, uric acid, and 
the urates. 
Therapeutics.-The chlorate of potassium has been very freely used, 
and with great asserted advantage, in all forms of disease believed to be due 
to blood-poisoning: such as scarlet and other adynamic fevers, diphtheria, 
scorbutus, syphilis, and even hydrophobia. As already stated, the theory 
upon which this practice rests has no foundation in reason or science, and 
my own empirical experience with the remedy has been in exact accord with 
the teachings of physiology. I have seen the chlorate repeatedly employed 
in various diseases of the class just spoken of, and have never seen it do a 
particle of good. On the other hand, in various forms of stomatitis the 
remedy is undoubtedly of great value. Thus, there is a great deal of evi- 
dence of its usefulness in mercurial sore mouth ; and when given in the 
form of a powder, with sugar, it almost always acts like a charm in the fol- 
licular or aphthous stomatitis of children.* I do not believe, however, that 
its influence in these cases is other than local; yet, as the remedy is elimi- 
nated with the saliva, and, therefore, when given internally is constantly 
present in the mouth, the ordinary method of using it is probably the best. 
The salt now under consideration has been used in ascites and other drop- 
sical affections, but is, undoubtedly, inferior to the other salts of the alkali. 
When used locally, the chlorate of potassium acts as a stimulant to the 
various mucous membranes, and is often of excellent service in cases of 
angina, and is even said to have been used advantageously by enemata in 
dysentery and in cholera infantum. The most generally efficient gargle that 
* M. Laborde {Bull. Gen. Therap., Ixxxvii. 1874) and M. Tacke {Inaug. Diss., Bonn, 
1878) have shown that the chlorate of sodium acts physiologically like the potassium salt; 
and Dr. S. Ringer and H. Sainsbury {London Lancet, ii., 1882, 736) have found it equally 
efficient in stomatitis. 542 
LOCAL REMEDIES. 
I know of in ordinary sore throat may be made by pouring a pint of boiling 
water over a powder composed of an ounce of sumach berries and half an 
ounce of the chlorate of potassium, allowing to simmer in an earthen vessel, 
with occasional stirring, to three-fourths of a pint, straining, and using in 
the ordinary manner, or the fluid extract may be used (see Rhus Glabra, 
p. 32). A half-ounce to an ounce of the saturated solution of the chlorate 
combined with a few drops of laudanum injected into the rectum once or 
twice a day and retained, is often of the utmost service in hemorrhoids. 
Administration.-For manifest reasons, when taken in large doses the 
chlorate of potassium must be exhibited in dilute solution. The usual dose 
is from ten to thirty grains; as a lotion, from ten grains to half a drachm 
may be dissolved in the ounce of water. 
Lithii Carbonas, U.S.- Carbonate of Lithium is a white powder, 
sparingly soluble in water, and readily distinguishable by the carmine-red 
color which it imparts to the flame of alcohol. From it the U. S. Pharma- 
copoeia directs that the citrate (a white, deliquescent, freely soluble powder) 
shall be prepared by solution with citric acid in water. The combining 
number of lithia is so low that all the salts contain a very remarkable pro- 
portion of the base. We have but little accurate knowledge of the physio- 
logical action of lithia, but it probably closely resembles potash in its effects 
upon the system. In twenty-grain doses I have seen it apparently produce 
severe general prostration, amounting almost to general paralysis, in a feeble 
adult female, but have given it very largely to other patients without inducing 
any constitutional symptoms. It is eliminated by the kidneys, rendering 
the urine alkaline. 
Therapeutics.-According to the experiments of Dr. Ure and of Dr. 
Garrod, solutions of the lithia salts have the power of dissolving uric acid 
and the urates; and the drug was strongly recommended by Dr. Garrod in 
uric acid diathesis and in chrome gout, given in doses of three or four grains 
three times a day. The drug was extensively employed, but fell into dis- 
repute until recently, when its claims have been revived, especially by Prof. 
Ditterich {Schmidt's Jahrbiicher, Bd. cli. p. 270). As stated by the latter 
observer, it is very generally given in too large dose. In my own experience, 
given as prescribed by Dr. Garrod for a length of time, it has appeared to 
do great good in some cases of chronic gout. Either salt may be exhibited 
dissolved in water, in doses of five grains, three times a day; preferably 
taken a half-hour before eating. 
Blatta.-The dried bodies of the Blatta orientalis, or cock-roaches, 
have long been popularly used in Russia as a remedy for dropsy. Bogo- 
molow found in them a crystalline principle which he called Antihy- 
dropin.* Under their influence the sweat and urine are said to be greatly 
* J. Tschernischew (Schmidt'B Jahrb., Bd. cxcvii. 205) states that he has found in the 
cock-roach a very powerful poison, Blattic acid, which produces in frogs paralysis of the DIURETICS. 
543 
increased and the dropsy rapidly to disappear. When the urine contains 
albumen, this is greatly lessened or disappears entirely. The proper dose 
is uncertain. Bogomolow (^Lond. Record, 1877, p. 502) gives four and a 
half grains three times a day to children. Probably fifteen to twenty grains 
daily is about the proper commencing dose for the adult. 
STIMULATING DIURETICS. 
The leaves of the Barosma crenata, and of other species of the genus, 
natives of Southern Africa. These leaves, which are gathered by the Hot- 
tentots of the Cape of Good Hope, are an inch or less in length, from three 
to five lines broad, of various forms, but always notched on the edges, and 
having a strong, rather rank, yet somewhat aromatic odor, and a warm, bitter- 
ish taste. They owe their virtues, which they yield to water and to alcohol, 
to a volatile oil and to a bitter extractive. 
Therapeutics.-Owing to its bitter principle, buchu is perhaps slightly 
tonic; but its chief medicinal virtue is as a diuretic stimulant and alterative 
to the mucous membrane of the genito-urinary organs. It does not very 
largely increase the flow of urine, and hence is never administered in dropsy, 
but in all cases of subacute or chronic inflammation of the genito-urinary 
organs it may be employed with hope of success. Its oil is undoubtedly 
absorbed, and is eliminated by the kidneys, to whose secretion it imparts its 
odor. In chronic pyelitis, chronic cystitis, and irritation of the bladder, it 
is one of our best remedies, especially when, as is frequently the case, these 
diseases are associated with a generally-lowered systemic tone. As compared 
with turpentine, buchu is much less stimulating, and has a far more soothing 
effect upon the mucous membranes of the genito-urinary tract. In irritated 
bladder, when the urine is highly acid, and when there is a constant desire 
to urinate, with but little relief from micturition, buchu, in combination with 
a vegetable salt of potash and the sweet spirit of nitre, often gives great 
relief. The dose of the fluid extract (Extractum Buchu Fluidum, U. S.) 
is a teaspoonful, well diluted, given three or four times a day. 
Pareira, U. S.-Pareira Brava is the root of Chondodendron tomen- 
tosum, a climbing plant of South America. There appear to be in the 
root one or more alkaloids (see U. S. Dispensatory, 15th ed., p. 1085). 
Pareira Brava has been used with asserted advantage in chronic cystitis, in 
" irritable bladder," and in chronic gonorrhoea, and appears to exert a stim- 
BUCHU-BUCHU. U.S. 
heart and motor nervous system. In the mammal small doses slow the pulse without 
affecting the vagi, whilst large doses paralyze the vagi and increase the pulse-rate. The 
blood-pressure is reduced by a direct action upon the vaso-motor centre. The secretion 
of urine is increased from five- to ninefold by even moderate doses. 544 
LOCAL REMEDIES. 
ulant action upon the mucous membrane of the whole genito-urinary appa- 
ratus. It is said to be also tonic, and slightly aperient, so that it is especially 
valuable in urinary diseases when there is feebleness of digestion and a ten- 
dency to costiveness. The remedy should always be given in the form of 
the infusion (§i-Oj), or fluid extract (Extractum Pareirse Fluidum, U. S.), 
of which the doses are respectively a wineglassful and a teaspoonful three 
or four times a day. 
Uva Ursi, U. S.-Bearberry is the leaves of the Arctostaphylos Uva 
Ursi, a low evergreen shrub, indigenous to northern maritime Europe, and 
also to our northern coasts as far south as New Jersey. They are from half 
an inch to an inch in length, wedge-shaped, thick, coriaceous, with a smooth, 
rounded margin. The odor is hay-like, the taste bitterish, astringent, and 
somewhat sweetish. Uva ursi contains gallic acid besides a crystalline prin- 
ciple discovered by Mr. J. C. C. Hughes (Amer. Journ. Phar., 1847), and by 
him named Ursin, but now generally known as Arbutin. It occurs in long 
acicular colorless crystals, freely soluble in water, less so in alcohol and ether, 
and is resolved by the action of sulphuric acid into glucose and hydrochinone. 
Therapeutics.-Uva ursi is capable of acting as a weak astringent, but 
has been long used in medicine for its influence upon the genito-urinary 
mucous membrane, and at present is employed only in chronic pyelitis, cys- 
titis, and other affections of the genito-urinary mucous membrane, when a 
slightly stimulant and an astringent action is desired. Mr. Hughes found 
that in doses of one grain arbutin is a powerful diuretic. It seems to be 
free from poisonous properties, as Jablonowski (Thesis, Dorpat, 1858) took 
in forty-eight hours eighteen grammes of it without discomfort. It pro- 
duces a discoloration of the urine varying from pale greenish to dark green- 
ish brown, the color deepening upon standing. It has been proven by the 
researches of Von Mering (Pjliigers Archiv, Bd. 14, 1877, p. 276), of L. 
Lewin (Virchows Archiv., 1883, Bd. 92), and of Steffen ( Untersuchungen, 
Wurzburg, 1883) that the discoloration of the urine is due to the breaking 
up of the arbutin in the body into glucose and hydrochinone. The change 
probably occurs in the kidneys, as arbutin is free from toxic properties, 
whilst Brieger has shown that hydrochinone is poisonous, producing in man 
giddiness, ringing in the ears, lessening in the force and frequency of the 
pulse, etc. The experiments of Lewin indicate that the arbutin is the 
active principle of uva ursi, and Forster (Aerztl. Intelligenzblatt, 1881) 
has shown that hydrochinone is a powerful disinfectant and anti-ferment. 
It is stated that a one per cent, solution will arrest putrefaction and alcoholic 
fermentations, whilst one-half per cent, is sufficient to check butyric fermen- 
tation. On the other hand, H. Paschkis ( Wien. Med. Presse, Bd. 25, p. 
13, 1884) states as the result of the practical use of arbutin in gonorrhoea 
and cystitis, that it does not effect much good, and that only a portion of it 
is changed into hydrochinone, most of it being eliminated as arbutin. He 
believes that uva ursi is of value in genito-urinary diseases, chiefly on ac- DIURETICS. 
545 
count of its tannic acid and of the volatile oil which it contains. He 
affirms that the dried extract of the leaf, the best preparation, contains 
about three and one-half per cent, of arbutin to sixteen per cent, of 
tannic acid. In the hands, however, of Dr. Menche (Centralblatt Klin. 
Med., 1883, p. 433), arbutin in doses of twelve grains a day has proven a 
very decided diuretic and very useful in cystitis. Whatever may be the 
value of arbutin, it is evident that the solid extract fully represents the drug, 
of which it is about four times the strength. It may be given in drachm 
doses three or four times a day. The dose of the fluid extract {Extractum 
Uvx Ursi Fluidum, U. S.) is two to four fluidrachms three or four times a 
day. 
Chimaphila, U. S.-Pipsissewa is the dried leaves of the Chimaphila 
umbcllata, a little indigenous perennial, distinguished from its inert congener 
C. maculata by the uniform glossy green of its leaves. The latter are about 
an inch and a half long, wedge-shaped, notched, pointed, and coriaceous. 
They contain tannic acid, bitter extractive, and, according to Mr. Samuel 
Fairbank, a crystalline principle, Chimaphilin (see U. S. Dispensatory}. 
Pipsissewa is probably about equivalent to uva ursi in its therapeutic 
value, though perhaps not quite so actively diuretic. Prof. Geo. B. Wood 
( Therapeutics, vol. i. p. 133) commends it very highly in external scrofula, 
asserting that he has had a large experience with the remedy, and that in power 
over the disease it stands next to cod-liver oil and the preparations of iodine 
and iron. He believes that it acts not only as a mild astringent and tonic 
but also as an alterative, and states that its exhibition should be long con- 
tinued, the administration being temporarily suspended whenever there is 
much fever. The remedy should be administered in the form of decoction, or 
of fluid extra ctfExtr actum Chimaphilse Fluidum, U. S.), the doses of which 
are respectively a wineglassful and a teaspoonful three or four times a day. 
Juniperus.-Juniper is the fruit of the common juniper of Europe and 
this country. These berries are round, bluish bodies, about the size of a 
large pea, of a sweetish, terebinthinate, aromatic taste. They owe their prop- 
erties to a volatile oil {Oleum, Juniperi}, which is officinal. They yield to 
boiling water and to alcohol. Juniper is gently stimulant and cordial to the 
stomach. Upon the kidneys it exerts a decided stimulant action, and the 
oil freely given is capable of irritating the renal organs above the secreting- 
point, and of producing lessened secretion, strangury, and even suppression 
of urine. The volatile oil is undoubtedly absorbed, and chiefly escapes from 
the system through the kidneys. As a diuretic, juniper has two distinct- 
uses. The most usual employment of it is as an adjuvant to cream of tarta* 
or the alkaline diuretics. On account of its stimulant local influence upon 
the alimentary canal, it renders the cream of tartar far more acceptable to 
the stomach, and at the same time aids its diuretic action. Sometimes juni- 
per is employed for its stimulant action on the mucous membrane of the 546 
LOCAL REMEDIES. 
genito urinary organs in chronic pyelitis and in chronic catarrh of the blad- 
der. In the form of the compound spirit (Spiritus Juniperi Compositus, 
U. S.), or its equivalent, gin, juniper is often useful in the subacute congestion 
of the kidneys frequently seen in old persons, and characterized by aching 
in the loins without other more serious symptoms. The infusion is made by 
macerating an ounce of the berries in a pint of boiling water for an hour, 
the whole to be taken in divided doses during twenty-four hours. The dose 
of the oil is from five to fifteen drops; of the spirit, one tablespoonful. 
Oleum Erigerontis, U. S.-Erigeron Canadense, or Canada Fleabane, 
contains a large proportion of a yellowish volatile oil of a rather pleasant odor 
and taste, which has properties resembling those of turpentine, but is much 
less stimulating. It may be employed in affections of the genito-urinary 
organs, and in passive hemorrhages. It is especially valuable in menor- 
rhagia. According to Dr. Starke, it is very efficacious in gonorrhoea (Lond. 
Med. Rec., 1876, p. 267). The dose is five to twenty drops every two or 
three hours, and is best administered on sugar. 
The stigmata of Zea Mays, or Indian Corn, has been strongly recom- 
mended as a mild stimulant diuretic in both acute and chronic inflammations 
of the bladder, and in uric acid and phosphatic gravel, and, we are informed, 
is much used by several surgeons of this city. It is claimed that it has a 
distinct anaesthetic effect in allaying the pain of these affections, unless there 
be so much mucus as to prevent contact with the mucous membranes. M. 
Landricux, of Paris, asserts that the urinary secretion is much increased, 
and the arterial tension distinctly augmented, even in cases of cardiac dis- 
ease (Med. and Surg. Reporter, 1882, 103). Dr. Vauthier (Arch. Med. 
Beiges, Aug. 1880*) states that its activity depends upon Maizenic acid. 
It may be given ad libitum in infusion (two ounces to pint of boiling 
water) ; the dose of the fluid extract is one to two tcaspoonfuls every two or 
three hours ; of the maizenic acid, one-eighth of a grain. Dr. Ducasse 
gives half a drachm of the extract a day (La France Med.. 1882, 811). 
TEREBINTHINA-TURPENTINE. 
Sufficient has already been said concerning the natural history of white 
turpentine (see page 126) ; but Canada Turpentine (Terebinthina Cana- 
densis, U. S.), or Canada Balsam, as it is more commonly called, was not 
spoken of, because it is never used as a stimulant. It is the product of the 
Abies balsamea, or Balm of Gilead, or American Silver Fir, as it is variously 
named, a beautiful evergreen indigenous to the extreme northern United 
States and to the British Colonies. The juice is said to collect in little 
receptacles under the bark, and to be gathered by cutting these open and 
* Consult also La France Mid., 1880, xxvii. 99 ; La Union Mid., April, 1880 ; Medical 
News, vol. xliii. 372. DIURETICS. 
547 
allowing them to drain into vessels. Canada Balsam is a thick and viscid 
but clear, yellowish liquid, containing, it is said, about twenty per cent, of 
volatile oil. The amount of the latter ingredient must vary greatly, since 
by age and exposure to the air the liquid balsam, losing its oil by evaporation 
and oxidation, becomes converted into a hard, brittle, translucent, resinous 
mass. Canada Balsam is very rarely, if ever, used in medicine. 
Oil of Turpentine, the volatile oil of ordinary turpentine, has already 
been considered; but it seems necessary to add here a few sentences in regard 
to its diuretic action and use. When moderate doses (ten drops every three 
hours) of turpentine are taken, there are usually no renal symptoms pro- 
duced, except a slight increase of the urine. Somewhat larger amounts, 
when exhibited, are apt to give rise to aching in the loins and to frequent 
micturition, with perhaps urethral pain accompanying the act. If still 
larger quantities are ingested, these symptoms are intensified, and at the 
same time the secretion of urine is diminished. After very large repeated 
doses of the drug, the aching in the loins is very great, often with spasmodic 
pain in the ureters; a constant desire to pass water struggles with the 
inability to micturate, caused by the urethral spasm ; the urine is very scanty, 
albuminous, and even bloody; priapism may be present, and an intolerable 
irritation may affect all the pelvic organs. These symptoms produced by 
overdoses of the drug show that its action upon the urino-genital organs is 
essentially and powerfully irritant, and that under all circumstances the ex- 
istence of active irritation or inflammation of these organs absolutely contra- 
indicates the use of oil of turpentine. 
Oil of turpentine is never employed to increase the flow of urine for the 
purpose of affecting serous effusions. As a diuretic, it is used solely for its 
local influence upon the organs. Excessive diuresis sometimes is apparently 
dependent upon a relaxed condition of the kidneys, and under these circum- 
stances oil of turpentine may be of great service. Chronic pyelitis, chronic 
cystitis, and gleet are all often very much benefited by the use of the drug. 
In using the remedy in these cases, it should always be borne in mind 
that, with the exception of cantharides, it is the most actively stimulating 
of all the diuretics, and must be employed only when such a remedy is 
called for. In those comparatively rare cases of urinary incontinence which 
are dependent upon debility of the bladder, turpentine is sometimes of great 
service. When the same symptom is spasmodic, the remedy, of course, is 
harmful. In absolutely passive hematuria, in impotence, in certain condi- 
tions of spermatorrhoea, in amenorrhoea when great local debility exists, 
turpentine may be tried with fair hopes of its being useful. The dose of 
turpentine as a diuretic is ten to fifteen drops in emulsion, given from four 
to six times a day. If glycerine and oil of gaultheria be added to the emul- 
sion in such proportion that half a teaspoonful of the one and one or two 
drops of the other be taken with each dose, they will almost completely dis- 
guise the taste of the remedy. 548 
LOCAL REMEDIES. 
COPAIBA-COPAIBA. U.S. 
The oleoresin of Copaifera multijuga and of other species of Copaifera, 
large trees growing in Brazil. Copaiba is a yellowish liquid of varying vis 
cidity according to age, of a strong, terebinthinate, peculiar odor, and a bitter, 
burning, disagreeable taste. It mixes uniformly with absolute alcohol and 
volatile and fatty oils, and is readily dissolved by ether. It contains a vola- 
tile oil, a small quantity of a soft, viscid resin, and about fifty per cent, of a 
hard, acid resin. In 1829, Schweitzer (Poggend. Annal., Bd. xvii. pp. 487 
and 1095) announced that he had found in copaiba a peculiar crystallizable 
acid, Copaivic Add. It is not in the plan of the present work to discuss 
elaborately the chemistry of drugs, and consequently I must remain content 
with the statement that the researches of Prof. Bernatzik (Prager Viertel- 
jahrschrift, Bd. c., 1868, p. 239) have shown that very frequently this 
crystalline acid does not exist in copaiba, and consequently that it is an 
unimportant constituent. Indeed, these researches seem to me to prove 
conclusively that copaiba is simply an oleoresin. 
Physiological Action.-When given in therapeutic doses, copaiba has 
very little if any action upon the general system, and the influence even of 
very large amounts is often scarcely perceptible. In the researches of Ber- 
natzik (Joe. dt., p. 251), eighteen grammes of the volatile oil were taken in 
three doses during twelve hours, and caused only an acceleration of a few 
beats per minute in the pulse-rate, and a rise of a fraction of a degree in the 
temperature, with, after a time, violent gastric and intestinal disturbance, 
evidently due to the local action of the drug, and characterized by vomiting 
and purging. Complete strangury was not produced, but there was some 
difficulty in passing the urine, which caused decided burning in the urethra. 
On the other hand, the action of the drug is much more decided upon some 
very susceptible persons, so that full doses of it produce decided fever, with 
increased frequency of pulse, and hot skin, accompanied almost always by 
decided symptoms of gastro-intestinal irritation. Sometimes, also, the urinary 
organs are more sensitive than usual to the action of the drug, so that 
strangury, and, as is stated by some authorities, even almost complete urinary 
suppression, may occur. 
In 1841, Dr. Gr. 0. Rey (quoted by Bernatzik) called attention to the 
fact that if nitric acid be added to the urine of persons taking copaiba, a 
precipitate is formed resembling that of albumen. This fact has been noted 
and commented on since its discovery by Dr. H. Weikart (Archiv der Heil- 
kunde, 1860), by Dr. Rees (Guy's Hosp. Rep., vol. xvii.), by Valentine 
(Grundriss der Physiologic''), and by other observers. In order to produce 
the phenomenon with distinctness and certainty, it is seemingly necessary to 
use large doses of the drug, since Weikart failed to detect it after the ex- 
hibition of small amounts of copaiba oil. Various surmises as to the nature 
of this precipitate have been indulged in ; but the experiments of Bernatzik DIURETICS. 
549 
loc. cit., p. 252) appear to show that it consists of the oxidized oil united 
to some urinary principles. Dr. Bernatzik found that the elimination of the 
oil goes on slowly, continuing for as much as four days after its ingestion 
when large doses are employed. In his experiments with the resin of 
copaiba, the authority just noted exhibited fifteen grammes of it inside of 
five hours. It acted as an emeto-cathartic, causing a great deal of pain and 
irritation. The urine deposited very copiously on the addition of nitric acid, 
the resin seemingly being eliminated more abundantly than was the oil. 
Copaiba does not increase to any great extent the amount of the renal secre- 
tion, and no evidence has, that I am aware of, been offered to show that it 
affects materially the solids of the urine. Professor Quincke has recently 
found (Archiv f. Experiment. Pathol, u. Pharmakoi., xvii. p. 273, 1883) 
a new substance, copaiba-red, in the urine of persons taking the oil of 
copaiba. This substance is a colorless acid, forming easily soluble salts, 
and has the property of reducing the oxide of copper and polarizing to the 
left. It is colored red by sulphuric acid, gives a characteristic spectrum, 
and is soluble in water, chloroform, and amylic alcohol, but not in ether 
Its presence can be detected by warming the urine with concentrated sul- 
phuric acid, when a rosy red color is produced, deepening into purple-red. 
The color may usually be developed by allowing the urine to stand with 
about five per cent, of sulphuric acid ; a precipitate forms after a time, at 
first colorless, but finally becoming of a dirty violet. After the use of 
copaiba resin, the copaiba-red cannot be detected in the urine, but the 
urine still responds to Trommer's test for sugar. These facts are important 
as showing how a false diagnosis of diabetes might be made. 
The clinical employment of copaiba has shown that the drug exerts its 
peculiar stimulant alterative action on other mucous membranes than those 
of the genito-urinary apparatus, and it is very possible that a slight elimina- 
tion of the volatile oil takes place through the lungs. 
Therapeutics.-The chief use of copaiba in medicine is in subacute and 
chronic inflammations of the genito-urinary mucous membrane. In its 
action upon this structure it is a decided stimulant, but is less irritating and 
less stimulating than the oil of turpentine. Gonorrhoea is the disease in 
which it is mainly exhibited. It is especially useful in the advanced stages of 
this affection. If it be given in the beginning, before the inflammation has 
fully developed, it may sometimes succeed in aborting the attack, but, if it fail 
to accomplish this, may greatly aggravate the symptoms. During the height 
of the inflammatory stage, copaiba should not be employed. In other inflam- 
matory affections of the genito-urinary mucous membrane, such as pyelitis, 
and chronic cystitis, when the disease is of a subacute or chronic character, the 
remedy may be employed, it being borne in mind that in its action it is much 
more stimulant than buchu or pareira brava, but much less so than turpentine. 
In chronic diarrhoea and dysentery, copaiba is sometimes of use, through 
its local action on the diseased surfaces. The remedy has been highly 550 
LOCAL REMEDIES. 
recommended in the advanced stages of bronchitis; and in the chronic form 
of the disorder when attended by very free muco-purulent expectoration, I 
have occasionally employed it, with excellent results. Copaiba is sometimes 
used internally in skin-affections, but more frequently is employed externally 
as a stimulant dressing. The resinous mass which is left behind after the 
distillation of the oil of copaiba is stated to be an active hydragogue diuretic, 
increasing greatly the flow and lessening the specific gravity of the urine. 
In dropsies not dependent upon renal disease it is stated to be very effica- 
cious given in doses of fifteen grains three times a day {Guy's Hosp. Rep., 
1876). 
Administration.-The dose of copaiba is ten to twenty minims, repeated 
from three to six times a day, according to circumstances; the best effects 
are probably to be attained by the frequent use of small quantities. The 
medicine may be given dropped upon sugar, or, what is much better, ex- 
hibited in an aromatic emulsion, made with syrup and mucilage of gum- 
arabic in such a manner that a tablespoonful shall contain the required dose. 
When patients object to the taste, the drug may be given in gelatine cap- 
sules, each containing ten drops. It is said that these capsules do not, 
however, agree so well with delicate stomachs as the emulsion. When 
copaiba is rubbed up with magnesia, the resin unites with the earth to form 
a solid mass, in which the oil is mechanically held {Massa Copaibse, U. S.). 
Pills made in this way are ineligible, being disintegrated and absorbed with 
difficulty. The oil {Oleum Copaibse, U.S.), which is prepared by distil- 
lation, is isomeric with oil of turpentine. It may be exhibited in emulsion 
or in capsules, in doses of eight to fifteen minims. 
OUBEBA-CUBEBS. U.S. 
The unripe berries of the Piper Cubeba, a climbing plant of Java and 
other portions of the East Indies. These berries are blackish-veined, about 
the size of a small pea, and have attached to them a short stalk three or four 
lines long. Their odor is aromatic and peculiar; their taste warm, cam- 
phoraceous, and peculiar. Cubebs is a somewhat complex body, but there 
can be no doubt that the ethereal extract, or oleoresin, as it is commonly 
called, represents its medicinal virtues. The extract appears to consist 
chiefly of three substances: a volatile oil and the brown resinous substance 
formed by its oxidation, a peculiar acid, and a neutral crystallizable principle, 
Cubebin. Cubebic Acid was first discovered by Monheim, but has been 
especially examined by Prof. Bernatzik {Prager Vierteljahrschrift, 1864, 
Bd. Ixxxi., p. 9). It is nearly tasteless, forms salts with the bases, has a 
very faintly acid reaction, and dissolves in concentrated sulphuric acid with 
the production of (according to Bernatzik) a purple-violet color, changing 
on the addition of a little water to a cherry-red, and altogether disappearing 
when further dilution is practiced. 
Physiological Action.-In some respects, cubebs, when taken inter- DIURETICS. 
551 
nally, resembles black pepper in its effects. It is, however, much less 
stimulating than its congener. After the ingestion of the ordinary thera- 
peutic dose of cubebs, nothing unusual is experienced; but when very large 
amounts are taken there are evidences of gastric excitement, such as sen- 
sation of warmth in the stomach, slightly-increased frequency of pulse and 
heat of skin, with perhaps some giddiness or headache. The urine is slightly 
increased in amount, and acquires a peculiar odor. When very large doses are 
ingested, the symptoms of gastric irritation are more severe, and the subject 
suffers from gastric burning, nausea, vomiting, and colicky pains, with in 
some cases, purging. 
An eruption resembling urticaria has been occasionally noticed after the 
exhibition of cubebs: it is exactly similar to the eruption sometimes caused 
by copaiba, and, like it, is probably due simply to gastric irritation. 
That the active principles of cubebs are eliminated by the urine is well 
established, as, after the exhibition of the drug, when nitric acid is added to 
the urine, a precipitate, resembling somewhat that of albumen, occurs. 
The most elaborate physiological study of cubebs that I have met with 
was made by Prof. Bernatzik (Zoe. cit.}. This experimenter took himself, and 
save to a student, ten grammes of the cubebate of magnesium. No decided 
symptoms were induced by this, further than some pulse-acceleration and 
gastric uneasiness; but the elimination of uric acid was greatly increased, 
and the cubebic acid was found in the urine. Half an ounce of the oil of 
cubebs was taken in thirty-six hours, the last three doses, aggregating ten 
grammes, being ingested in six hours. This was followed by very decided 
gastric irritation ; by the appearance in the urine of the oil, not as it was 
ingested, but oxidized and in the form of a resin; the eliminated uric acid 
was about one-third in amount of that excreted after the exhibition of cubebic 
acid. Of the powdered cubebs, fifty grammes were taken in eight hours; 
the gastro-intestinal irritation was very marked; the nitric-acid precipitate 
was abundant in the urine; the elimination of uric acid was about midway 
between the extremes of the previous experiments. According to the re- 
searches of Prof. Bernatzik, cubebin is inert. 
Therapeutics.-Cubebs has been used to some extent for its local stim- 
ulant action upon the alimentary canal, but for this purpose is very inferior 
to black pepper and other spices. It is at present almost exclusively employed 
to influence the genito-urinary mucous membrane, in precisely those cases in 
which copaiba is exhibited. The two drugs have very nearly the same range 
of action, but the cubebs is less apt than is the copaiba to derange digestion. 
Very often the best effect in gonorrhoea and other genito-urinary disorders is 
obtained by giving the two remedies in combination. Cubebs is sometimes 
employed with asserted advantage in chronic h&morrhoids, and also in those 
varieties of bronchitis in which copaiba is useful. It forms the basis of certain 
proprietary lozenges, much used by public speakers and others to relieve the 
relaxation of the larynx which follows slight colds or over-use. For this 552 
LOCAL REMEDIES. 
purpose the berries themselves may be chewed, and are very effectual. In 
coryza, the powdered drug used as a snuff has sometimes a beneficial effect. 
It should not be employed in the early stages before secretion has been 
established, but is indicated later in the affection, when the discharge is 
profuse. 
Administration.-The dose of powdered cubebs is from half a drachm 
to three drachms, which may be exhibited in syrup or molasses three times 
a day. The volatile oil of cubebs {Oleum Cubeba?) is officinal, and.may 
be given in emulsion three or four times a day, in the dose of fifteen 
drops, gradually increased to half a drachm, unless some effect is previously 
produced upon the urinary organs. This oil does not so thoroughly repre- 
sent the crude drug as does the officinal oleoresin {Oleoresina Cubeba,), 
which may be given in doses of from ten to fifteen minims, increased as 
necessary. It is best administered in emulsion, but may be exhibited in 
the form of a bolus, enough sugar having been added to make a plastic 
mass. The tincture {Tinctura Cubeba-1 to 10, U.S.) is an ineligible 
preparation ; dose, f jii to f3vi. The dose of the fluid extract {Extractum 
Cubeba Fluidum, U. S.) is ten to forty minims. 
Matico^ U. S.-Matico, the dried tops of the Piper angustifolium of 
Peru, contains a volatile oil, resin, and, it is said, a bitter principle, Maticin 
It is largely employed as a styptic, and as such probably acts chiefly mechan- 
ically, coagulating the blood in its interstices, adhering to the wound, and 
thus arresting the hemorrhage. It has also been employed in internal hem- 
orrhages, and in gonorrhoea. In these affections it probably acts similarly 
to oil of turpentine, although much less of a stimulant, and much more 
feeble. The fluid extract {Extractum Matico Fluidum, U. S.) and the 
tincture {Tinctura Matico-1 to 10, U.S.) maybe respectively given in 
doses of forty-five minims and two fluidrachms. 
CANTHARIS.- Cantharides is considered elsewhere in detail (see Epispas- 
tics), and it is only necessary here to say a few words in regard to its use in 
diseases of the genito-urinary tract. The active principle of Spanish flies is 
certainly eliminated by the kidneys, and acts therefore locally upon these 
organs, as well as upon those over which their secretion flows. The influence 
exerted by this means is simply one of intense irritation, cantharides being 
an irritant to these organs in any dose sufficiently large to have an effect. 
Indeed, of all the officinal drugs cantharides is the most actively irritant to 
the kidneys and subordinate organs. Consequently it is employed only when 
an intensely stimulant action is desired, as in obstinate gleet, in which affec- 
tion it is often combined very advantageously with the tincture of chloride 
of iron. In pyelitis and cystitis it is very rarely indicated, but may be 
cautiously employed in very chronic cases. The tincture of cantharides is 
the only preparation used internally. For the dose and method of adminis- 
tration, see Epispastics. CLASS IV.-DIAPHORETICS. 
Diaphoretics are those medicines which are employed to increase the 
action of the skin. It is scarcely in place here to discuss the results of sup- 
pression of the functional activity of the skin or the importance of the surface- 
elimination to the system. It does seem well, however, to call attention to 
the fact that the perspiratory glands have a double function to perform,-that 
of elimination, already alluded to, and that of keeping down the temperature 
of the body during exposure to heat. When a man enters a Turkish bath 
the temperature of which is perhaps 160° F., or when he works in the sun on 
a very hot day, there is, if he be used to such exposure, little or no rise in the 
temperature of the body, because the surface-glands secrete sweat so actively 
as to expose a great amount for evaporation, and by the conversion of so 
much water into vapor such an amount of heat is absorbed-i.e., converted 
from heat into repulsive force-that the body is cooler. The reason that 
even a moderate degree of heat in a moist atmosphere is intolerable is because 
evaporation cannot take place. 
From what has already been stated, it is obvious that the use of dry ex- 
ternal heat, or rather exposure to a hot atmosphere, is a powerful means of 
producing perspiration: it is, indeed, in healthy men the most powerful 
method at our command. It may be applied either in the form of the Turkish 
bath, in which the air of the hot chamber is very dry, or in the Russian or 
vapor bath, in which the atmosphere is surcharged with hot vapor. Very 
wonderful therapeutic properties have been ascribed to the direct action of 
heat (Urquhart, Manual of the Turkish Bath, London, 1865)* when ap- 
plied by the Turkish bath; but the remedy appears to me to act only as a 
powerful sudorific, perhaps also doing good in some cases of acute internal 
congestion by attracting the blood to the surface and thereby depleting the 
interior. In private practice, or whenever a properly-provided bath cannot 
be commanded, a very' efficient and readily-applied substitute consists of a 
* The term Turkish Bath is here applied to the bath used in this country under that 
name. This bath appears not to be a copy of the Oriental bath, but merely a derivative 
from it. According to a writer in the British and Foreign Medico-Chirurgical Review 
(vol. xxxvii. p. 87), in the East the sudarium, or sweating-chamber, rarely has a tem- 
perature of more than 98° F. Consult also Bathing ; How to Do It, When to Do It, and 
Where to Do It, by E. Sheppard, London, 1865; The Anglo-Turkish Bath, by Y. J. Moore, 
London,1865. 
553 554 
LOCAL REMEDIES. 
large tin funnel furnished with a long bent beak, a stool with a hole in the 
centre of its seat, or else a few bricks, and a large spirit-lamp. The patient 
being closely wrapped up in bed, and the clothes being especially " tucked 
in" about the neck and shoulders, the funnel is placed upon the stool or the 
bricks in such a manner that the beak of it enters well under the bedclothes, 
coming close to but not in contact with the person of the sick man. The 
spirit-lamp, being then placed immediately under and close to the funnel, 
must, when lighted, send a column of hot air and vaporized water through 
the beak into the space around the body of the patient. When the lamp 
is sufficiently large, and a little care is taken to see that the nozzle of the 
funnel is not obstructed by the bedclothes, the process just detailed affords 
a very efficient method of giving a vapor-bath. 
Hot-water baths offer another very successful method of inducing profuse 
perspiration. The patient should be placed in a bath of about 98° or 100° 
F., and remain there fifteen or twenty minutes, during which time, by the 
repeated addition of very hot water, the temperature should be raised to 110° 
F., or to such point as the patient can endure. Warmed blankets having 
been plentifully provided, the sick man should be lifted from the bath into 
them, be closely wrapped up, and so left for three or four hours before being 
transferred to the usual bed. According to Dr. A. Steffen (Jahrb. fur Kin- 
derheilk., Hft. iii., 1871), after this use of the bath the body has been proven 
to undergo loss of weight continuously for one or two days. 
Profuse sweating is always more or less exhausting, but is not nearly so 
much so as purging, and therefore may be practiced in dropsical patients too 
feeble to allow of the use of purgatives. The hot baths are not, however, 
altogether free from danger or objection. Sometimes in the Turkish and 
Russian baths the patient fails to sweat freely, and a feeling of distress, a 
bounding, rapid pulse, and perhaps severe headache, develop themselves: 
under these circumstances the bodily temperature rises, and a fever develops, 
which may go on to the production of a true " thermic fever," and perhaps 
terminate in sudden death. This is an exceedingly rare result, and one that 
never can occur if the patient is removed from the hot chamber so soon as 
any unpleasant symptoms are manifested. Sudden death has, I believe, 
taken place once from "sun-stroke" in a patient whilst taking the "Turkish 
bath," also once from " congestion of the lungs" {Brit. Med. Jour., Oct. 1878). 
The use of hot baths of any kind is, of course, contra-indicated by the 
existence of fever; but, according to Dr. Steffen, the hot-water baths are 
pre-eminently contra-indicated by the existence of congestion or oedema of 
the lungs, or of a tendency towards these disorders, since under such circum- 
stances the bath greatly increases the disease, or precipitates a perhaps fatal 
attack. My own limited experience, so far as it has gone, has corroborated 
these statements of Steffen. I have seen, under the conditions mentioned, 
the most frightful dyspnoea result from the use of the hot-water bath, a 
dyspnoea which was apparently prevented from terminating fatally only by the DIAPHORETICS. 
555 
removal of the patient from the bath-tub. If disturbance of the respiration 
come on during the bath, the patient should be immediately taken out, and, 
if the symptoms be urgent, cold water should be freely dashed over the head, 
neck, and chest. 
Diaphoretics produce the desired result in various methods, which may 
be briefly considered under four headings, representing as many modes of 
action. 
First. By relaxing the skin. As has already been sufficiently shown (see 
Cathartics, p. 420), there is a form of secretion, or perhaps it would be more 
correct to term it of leakage, from mucous membranes, which is distinctly 
paralytic in its mechanism. The same assertion may be made in regard 
to the skin: the colliquative so-called " night-sweats" of phthisis afford a 
familiar example of this, occurring as they do in profoundly debilitated sub- 
jects, and at such times as there is the greatest relaxation of the system,-i.e., 
during sleep. The profuse sweats of collapse also may be instanced as ex- 
amples of the general truth just enunciated. Normal processes which pro- 
duce great relaxation cause great sweating: thus, during vomiting, especially 
if it be accompanied by much nausea, the skin pours out its secretion. By 
virtue of this general law certain remedies act as diaphoretics. All of the 
diaphoretics which cause sweating by producing relaxation, and which are 
employed in medicine, are nauseants, constituting a distinct group,-the 
Nauseating Diaphoretics. 
Second. By reducing the force of the circulation. There is undoubtedly 
a condition of over-action or over-rapidity of the circulation in which the 
affected glands are unable to perform readily their normal functions. Thus, 
it is well known that the first stage of inflammation is one of arrested secre- 
tion, and that in high fever there is a general drying-up of the secretions. 
The skin does not differ from other organs in this respect: consequently its 
functional activity may fail because of excessive arterial action. Hence there 
is a class of remedies which, although perhaps not actively sudorific in health, 
are in disease very efficient in reducing the circulation and restoring the func- 
tional activity of the skin. It is evident that there is a close connection be- 
tween the present mode of influence and that noted in the previous section; 
and it is no less apparent that the nauseant diaphoretics act most powerfully 
in reducing the circulation. There are, however, certain diaphoretics which 
aot in the present method but are not nauseants: these sudorifics form a 
separate class by themselves,-the Refrigerant Diaphoretics. 
Third. By entering the circulation and directly stimulating the glands of 
the skin. It appears to be a general law that when any medicinal principle 
is eliminated by any excretory organ, the general activity of that organ 
is increased by the effort at elimination. Thus, the vomiting and purging 
of arsenical or antimonial poisoning, the increased urinary secretion following 
the ingestion of a potassium salt, are apparently the results of attempted 
elimination. The skin undoubtedly eliminates medicinal substances, and is 556 
LOCAL REMEDIES. 
undoubtedly subject to the general law: consequently there is a class of 
remedies which increase its action by a direct influence. 
It is manifest that a drug may relax the general system, may diminish 
the force of the circulation, and also may stimulate directly the skin : indeed, 
it is most probable that antimony does all of these; and at least some of 
the refrigerant diaphoretics probably act in the last two ways. There are, 
however, certain substances which seem to cause sweating purely by stimu- 
lating the function of the skin. These are in this work grouped as Simple 
Diaphoretics. 
Fourth. By filling up the blood-vessels. There is much reason for be- 
lieving that precisely as under certain circumstances water, by increasing the 
amount of the blood, will provoke increased renal secretion, so, under other 
circumstances, will it cause increased dermal excretion. The antagonism 
which exists between the skin and the kidneys in regard to the amount of 
their respective secretions has already been sufficiently dwelt upon (see p. 
455). It seems well to reiterate, however, that warmth favors the action 
of the skin, whilst cold stimulates the renal activity. Thus, large draughts 
of water, if taken cold, the patient being kept cool, increase the urine, but, 
if they be taken hot, and the patient covered up warmly in bed, increase the 
perspiration. 
Diaphoretics are employed in the practice of medicine to fulfil the following 
indications: 
First. To arrest forming diseases of not very severe type, probably by 
causing a flow of blood to the surface, and thereby relieving slight internal 
congestions, and possibly by eliminating principles which have been retained 
in the blood instead of being excreted as they ought to have been. In 
general cold, in muscular rheumatism, suppressed menstruation, and other 
results of exposure to cold and of checked perspiration, the diaphoretics 
afford the most efficient means at our command for restoring the normal 
functions. 
Second. To favor absorption. In dropsy the diaphoretics are of very 
great value, often aiding diuretics and purgatives in effecting a cure, and 
sometimes, when these fail, or when circumstances forbid their use, rescuing 
the patient from impending death. None of the medicinal diaphoretics 
except jaborandi are of sufficient power to be relied upon in dropsy. The 
Turkish, the Russian, and the hot-water bath are capable of producing 
sufficient sweating to cause absorption of dropsical fluid, but must be 
vigorously employed. 
Third. To aid in the subsidence of diseases which naturally pass off with 
a sweat. The chief use of diaphoretics for this purpose is in miasmatic 
fevers, especially in the remittent form of the affection, when the sweating 
stage fails to develop itself thoroughly and the paroxysms run into one 
another. Even in the single paroxysm of intermittent fever, by hastening 
the closing stage, diaphoretics will often shorten the paroxysm. DIAPHORETICS. 
557 
Fourth. To eliminate noxious materials from the blood. The old humoral 
idea of the ground-work of such diseases as fevers, the belief in a distinct 
materies morbi which could be eliminated from the blood, has no sufficient 
demonstration to be accepted, and, although diaphoretics do good in fevers, 
yet it cannot be granted that it is in this manner. The very great power 
of increased diaphoresis in cooling the body through surface-evaporation has 
already been dwelt upon ; and much of the good effected by diaphoretics in 
diseases of high temperature probably has its origin in this power. Modern 
science seems, however, clearly to point out that this class of remedies may 
aid in separating from the blood retained secretions, and may to some extent 
replace the action of the kidneys when these organs are disabled by disease. 
In 1851, Dr. Schottin {Archiv fur Physiolog. Heilkunde, Jahrg. xi.) dis- 
covered urea in the sweat of patients suffering from the collapse of cholera. 
Not only has the discovery of Schottin been confirmed by the researches of 
G. 0. Rees {Encyclopaedia of Anatomy, vol. iv. p. 841), of Fiedler {Diss. 
Inaug., Leipsic, 1854), of Hirschsprung {Gaz. des Hopit., 18G5), of Kaup 
and Jurgensen {Deutsches Archiv fur Klin. Med., Bd. vi., 1869, p. 54), of 
Leube {Ibid., Bd. vii., 1869, p. 3), and of G. Deininger {Ibid., p. 587), but 
it has also been abundantly proven that the skin excretes urea freely during 
the advanced stages of Bright's disease, and also during the partial urinary 
suppression of scarlatinal desquamative nephritis. The urea in renal dis- 
ease may even form a distinct crystalline powder on the skin; but it is most 
abundant about the mouths of the sweat-glands. I believe Landerer was 
the first to announce that urea was present in the sweat of healthy persons; 
and, although chemists of excellence have been unable to detect it, yet its 
presence at times can no longer be denied, since it has been found not only 
by Landerer, but also by Funke in 1858 {Moleschott's Untersuchungen, Bd. 
vi.), by Meissner {De Sudoris Secretione, Diss. Inaug., Leipsic, 1859), and 
by Leube {loc. citi) ; Fourcroy (quoted by Rees) has also found it in the 
sweat of horses. By a series of elaborate experiments, Leube {loc. cit.') has 
rendered it probable, if he has not actually proven, that in health there is 
such a relation between the skin and the kidneys that when the former is 
very active the latter excrete less than the normal amount of urea. 
When to the facts already narrated are added the observation of Grie- 
singer, that in diabetes the perspiration contains sugar, and the well-known 
circumstances that in rheumatism the sweat contains lactic acid, and in 
jaundice biliary products, the value of diaphoretics as a means of getting rid 
of retained excretions becomes manifest. For this reason, in Bright's dis- 
ease, especially of the acute form, they are of the greatest value, acting bene- 
ficially in three different ways: by drawing the blood to the surface, and 
thereby relieving any internal congestions of the kidneys or other organs 
that may exist; by promoting the absorption of dropsical effusions; and by 
eliminating retained secretions. 558 
LOCAL REMEDIES. 
NAUSEATING DIAPHORETICS. 
The most frequently employed medicine of this class is tartar emetic. 
This substance is so fully discussed in the earlier portion of this book that 
very little need be said about it here. It seems well to point out, however, 
that the antimonials act as diuretics, even when not given in doses sufficient 
to cause nausea, and that they do so apparently in two ways,-by reducing 
the force of the arterial circulation, and by a direct action. They are proba- 
bly eliminated to a very slight extent by the skin; although this has not, to 
my knowledge, been proven. Tartar emetic is to be employed as a diapho- 
retic in sthenic cases only, and is especially used in inflammatory fevers. 
The dose of it as a diaphoretic is from the sixth to the twelfth of a grain. 
If a diaphoresis is urgently demanded, the dose should be gradually increased 
until decided nausea is induced. An excellent combination in many cases is 
tartar emetic, neutral mixture, and a minute amount of morphia. 
Ipecacuanha is another nauseating substance, which, like tartar emetic, 
seems to exert an influence upon the skin, even independently of its action on 
the stomach. Moreover, like the antimonials, it never in small doses by itself 
causes profuse sweating, but simply seems to aid in maintaining the insensible 
perspiration and in keeping the skin soft and pliable in inflammatory fevers. 
Partly for this reason it is frequently combined with mercury in such diseases 
as acute peritonitis. The diaphoretic dose of ipecacuanha is a grain every 
two hours. Some persons with delicate stomachs are decidedly nauseated by 
this amount; and to these only half a grain should be given at a time. 
A very famous and efficient diaphoretic preparation of ipecacuanha is 
Dover s Powder (Pulvis Ipecacuanha et Opii, U. S.), which con- 
tains one grain of opium, one grain of ipecacuanha, and eight grains of 
sugar of milk. Dover's powder is employed in two distinct methods. 
In some diseases, as in acute rheumatism, an opiate is indicated to allay 
pain or for some other purpose, and at the same time a diaphoretic is needed 
to keep up the action of the skin. Under these circumstances, from three 
to five grains of the compound powder of ipecacuanha may be given every 
two, three, or four hours, pro re nata. The medicine is more apt to nau- 
seate when taken in powder than when exhibited in pills; for which reason 
the latter form of administration is preferable in the class of cases now under 
consideration, especially as the powder is to most persons a disagreeable 
medicine. In the second method of using Dover's powder, a single large 
dose is given for the purpose of producing profuse sweating. In the intense 
suffering which sometimes results from suddenly suppressed mens ruation, 
the remedy is most efficient, alleviating the pain and aiding in the pro- 
duction of the desired diaphoresis. In breaking up a cold, or in muscular 
rheumatism, Dover's powder is often used to cause sweating (see Alcohol 
as a Diaphoretic). DIAPHORETICS. 
559 
REFRIGERANT DIAPHORETICS. 
Aconite, veratrum viride, and all the various remedies used to depress the 
cardiac action when excited, are, in the strictest sense of the term, refrigerant 
diaphoretics. Sufficient has, however, already been said in regard to their 
use. The citrate of potassium, whether in the form of effervescing draught 
or of neutral mixture, is constantly employed in sthenic fevers, and affords, 
I think, the best basis there is for fever-mixtures in such cases, the more 
powerful depressants being added to it as circumstances demand. 
SIMPLE DIAPHORETICS. 
PILOCARPUS, U. S-JABORANDI. 
This drug, which has long been employed by the natives of South America, 
received its first notice, under the various names of Jaborandi, Jaguarandy, 
and Jamguarandi, from Dr. T. J. H. Langgard in his " Diccionario de Mede- 
cina domestica," Rio Janeiro, 1865. It attracted no attention, however, 
until 1874, when it was brought to Paris by M. Coutinho. Its botanical 
source is Pilocarpus pinnatus, a member of the rue family. The leaves are 
oval, elongated, entire, 1.2 to 1.5 inches long, and one-third to one-fourth as 
broad; their taste is bitter, and their odor hay-like, and depend upon the 
alkaloid, pilocarpia, discovered by Byarson.* The nitrate of pilocarpia is 
readily obtained in white lamellated crystals, and is soluble in eight parts of 
distilled water. The virtues appear to reside exclusively in the leaves and 
bark, Dr. Frerichs (Berlin. Klin. Wochenschr., 1875) having found the wood 
inert, f 
Physiological Action.-When an infusion of from sixty to ninety 
grains of jaborandi is given to an adult, in about ten minutes the face and 
neck become deeply flushed, and free perspiration and salivation commence. 
After a hypodermic injection of the alkaloid, the symptoms may set in in 
six minutes. The sweating begins on the face; both it and the salivation are 
excessively profuse, and last from three to five hours. There is not rarely 
* A second alkaloid has been discovered by E. Harnack and II. Meyer and named 
jaborin (Arch. Exper. Path, und Pharm., xii). It is a derivative of pilocarpin, and is said 
frequently to contaminate the commercial alkaloid. Its discoverers assert that they have 
studied its action upon the heart, pupil, intestines, and salivary glands, and found it 
identical with that of atropia. Its presence has no doubt been the cause of some contra- 
dictory results obtained by experimenters. 
f Under the name of Jaborandi various drugs other than the product of Pilocarpus 
pinnatus are sold in Brazil. As the Pilocarpus pinnatus has been found to be active when 
grown in France, it is probable that it might be successfully cultivated in our Southern 
States 560 
LOCAL REMEDIES. 
nausea, and sometimes even vomiting. The pulse is usually more or less 
quickened, as is also frequently the respiration. After the sweating has 
ceased, the patient is left more or less exhausted. The nasal and lachrymal 
secretions are also very generally increased under the action of the drug, and 
M. Gubler has noted diarrhoea, which in the experiments of Ringer and 
others has not been present. There is sometimes contraction of the pupils, 
and even disturbance of vision. These effects of the drug are in the adult 
fairly constant; but subjects have been occasionally found who were not sus- 
ceptible to the action of the remedy, and, very curiously, in Dr. Ringer's 
experiments children were found to be very unsusceptible, although doses of 
sixty grains were employed. SchWann, M. Morat (Lyon Med., Juillet, 
1882), and other observers have noticed in the lower animals that very 
violent gastric and intestinal movements are produced by the drug. 
Secretion.-The sweat produced by jaborandi is often enormous in quan- 
tity (nine to fifteen ounces by estimation). It is stated to be at first acid, 
then neutral, and finally clearly alkaline. Vulpian (Lemons s. Subst. toxiq., 
Paris, 1881, 87) denies that even the first sweat has other than alkaline 
reaction, and believes, with MM. Luchsinger and Trumpy, that there has 
been a mistaken observation, due to the fact that the secretion of the se- 
biferous glands is acid. In the analyses of M. Robin the chlorides were 
found in excess, the carbonates and phosphates in very minute amount, 
and the urea in more than five times its normal proportion, the amount 
eliminated in the sweating being estimated at from ten to fifteen grains. 
MM. Hardy and Ball believed that in their experiments the average amount 
of urea eliminated by the skin was seventeen grains (Journ. de Therap., 
1874). Pilicier noted in a dog with a gastric fistula great increase of the 
gastric juices (Med. Centndb., 1876,430); the biliary secretion appeared 
to be lessened. On the other hand, M. Morat (Lyons Med., July, 1882) 
has noted a temporary increase of the sugar in the blood, an evidence that 
the glycogenic function Qf the liver is stimulated. Dr. Hammerbacher has 
found the secretion of milk lessened (Arch. Gesam. Physiolog., xxx. 
236). Whether or not the urine is increased in healthy persons when 
pilocarpin is given in a single large dose may be considered uncertain, 
but the assertion of M. Gubler that the alkaloid administered in very small 
repeated doses has a marked diuretic influence has received clinical confir- 
mation. Much interest attaches to the effect of jaborandi upon urea elimi- 
nation, but it cannot be considered as determined, except that in various 
diseases the combined urinal and dermal elimination is greatly increased by 
the drug. Hardy and Ball state that in health urea elimination from the 
kidneys is diminished by the drug, whilst Prof. Tyson and Dr. Bruen have 
found it increased both in health and in disease. The experiments have, 
however, been too few, and especially the conditions of their performance 
too lax, for much importance to be attached to them. 
There appears to be some relation between the flow of saliva and that DIAPHORETICS. 
561 
of perspiration produced by jaborandi: if the one is very profuse the other 
is often, but not always, correspondingly scanty. Sometimes the salivation 
almost replaces the sweating (Fereol, Journ. de Therap., Jan. 1875) ; very 
frequently it commences before the sweating, and often it is more persistent. 
During it the mouth is warm, and there is often a feeling of tenseness about 
the maxillary glands. The saliva contains an abundance of salts and of 
ptyaline, as well as a small excess of urea (Boston Med. and Surg. Journ., 
p. 347). Pilicier, it is true, states that the proportion of albuminous com- 
pounds, and especially of sulphocyanide of potassium, is much diminished, 
but in M. Kobin's analyses the proportion was even beyond the normal, and 
Ch. Bougarel has by careful experimentation shown that the power of jabo- 
randi-saliva in converting starch into sugar is equal to that of the normal 
secretion. According to I. N. Langley (Brit. Med. Journ., p. 247), in the 
frog the mouth and skin, after the exhibition of jaborandi, become covered 
with a viscid secretion; in the dog and the rabbit and cat there is profuse 
salivation. The effect upon the salivary secretion must be due to a direct 
influence upon the gland, as it is produced equally well after section of all 
of the salivary nerves (Langley, Journ. of Physiology, 1878, 339; Carville, 
Journ. de Therap., 1875 ; confirmed by Schwann, Med. Centralb., 1875, p. 
440) ; also when the drug is injected directly into the gland and prevented 
from entering the general circulation (Langley). According to the elaborate 
experiments of Langley, very small doses cause in the cat great increase of 
the secretion. Stimulation either of the chorda or of the sympathetic nerve 
causes respectively some increase or lessening of the secretion, but this in- 
crease or lessening is not nearly equal to that which occurs in the normal 
animal, and is due to the action of the nerves upon the circulation, and not 
to any influence of their secretory fibres. Very large doses of the drug 
injected into the gland immediately arrest the secretion, and doses of less 
size given in the same way, whilst increasing secretion, paralyze both chorda 
tympani and sympathetic nerves, so that stimulation of them has no effect. 
It is probable from the last fact that jaborandi has an action upon the secre- 
tory gland-cells. 
Although the evidence just deduced indicates that an influence is exerted by 
jaborandi upon the gland-cells, the fact that atropia arrests the jaborandi sali- 
vary secretion prevents us from considering it settled that the drug does so act 
upon the salivary gland-cells rather than upon the peripheral nerve-endings, 
since there is reason for believing that the sweating which the drug causes 
is due to an action on the nerve-endings. Dr. Fuchsinger (confirmed by 
Nawrocki) has found that section of the nerves of the cat's leg did not prevent 
the paws from sweating when jaborandi was exhibited. This demonstrates 
that the action of the drug is peripheral, not centric. Five or six days after 
the section, when the peripheral nerve-endings had undergone degeneration, 
Fuchsinger found that jaborandi was unable to excite sweating. This, how- 
ever, can hardly be considered to absolutely prove, as Fuchsinger claims, that 562 
LOCAL REMEDIES. 
the drug acts upon the peripheral nerve-endings, and not directly upon the 
glandular cells themselves, since it is probable that these glandular cells shared 
the anatomical changes of the nerve-endings (Pfluger's Archiv, xv. 482). 
Jaborandi appears to stimulate the nutrition of the hair, and Prof. Pren- 
tiss, of Washington, has reported several cases in which the continued in- 
ternal use of pilocarpin caused the hair to become exceedingly coarse and 
to change its color from light to dark (Philad. Med. Times, xi. 610). Dr. 
H. Rasori has noticed a tuberculated eruption apparently produced by jabo- 
randi (Trans. Intern. Med. Congress, 1881, iii. 146). M. Grocco has found 
that pilocarpin, hypodermically injected or locally applied, sensibly affects 
hysterical anaesthesia (Lond. Med. Record, 1882, 137). 
Temperature.-The action on the bodily heat varies somewhat. M. Robin 
affirms that before and during the early stages of the sweating from jaborandi 
the temperature rises 1° to 2° F., but afterwards falls as much below the 
normal point, and remains depressed for one or two days. This primary rise 
of temperature has been noted by other observers (Ringer, Lancet, i., 1873, 
157 ; Greene, Phila. Med. Times, vi. 56 ; Scotti, Berlin. Klin. Woch., 1877, 
141; Pilieier,* Med. Centralb., 1876, 429; Weber, Ibid., 770), but is 
certainly frequently absent altogether or very trifling.j" The subsequent 
fall of temperature seems to be a very constant phenomenon when the action 
of the drug is sufficiently severe; it probably depends in great part, or alto- 
gether, upon the loss of heat during the sweating. 
Circulation.-The action of jaborandi upon the circulation has been 
studied by Mr. Langley (Journ. of Anatomy, x. 188), E. Leyden (Berlin. 
Klin. Wochenschr., 1877, 406), Kahler and Sayka (Med. Centralb., 1876, 
541), and Harnack and Meyer (loc. cit., p. 374). The phenomena noted by 
these observers are in most respects in accord, but Kahler and Sayka using 
the extract of jaborandi, and E. Leyden commercial pilocarpin, have found 
the pulse either as a constant or occasional phenomena at first increased in 
its rate, whilst Harnack has never seen this with chemically pure pilocarpin. 
Immediately after the injection of the alkaloid into the jugular vein the 
arterial pressure falls, but in a few moments the characteristic phenomena 
of a slow pulse with increased arterial pressure come on. This slowing of 
the pulse is not prevented by previous section of the pneumogastric, but is 
at once set aside by an injection of atropia (Langley, Leyden, Harnack, 
and Meyer): as is also the diastolic arrest of heart which pilocarpin produces 
in the frog. Harnack and Meyer therefore believe that both in the frog 
and the mammal the chief cardiac influence of the alkaloid is exerted upon 
the intracardiac inhibitory ganglia: but Prof. Ringer (Practitioner, xxvi. 
* Pilieier noted that the rise occurred in the axilla, but not in the rectum; this would 
indicate that it is a local phenomenon, the result of a heating of the surface, not of tthe 
interior, of the body. 
■{■Consult Riegel, Berlin. Klin. Wochent., 1875, 86; Bardenhewer, Ibid,., 1877, 8; 
Auschmaun, Ibid., 353. DIAPHORETICS. 
563 
12) finds that jaborandi and atropia act antagonistically upon the ventricles 
separated from the auricles, and as the ventricles contain no inhibitory 
ganglia, some other explanation of the antagonism must be found.* The 
rise of the arterial pressure is stated by Harnack and Meyer to be prevented 
by the use of curari and artificial respiration, and to be, therefore, a second- 
ary, not direct, result of the drug's action ; it is probably due to the con- 
vulsive muscular contractions produced by the drug. In the latter stage 
of the poisoning the arterial pressure falls. As in the experiments of Har- 
nack and Meyer asphyxia in this stage did not cause rise of pressure, 
although the heart appeared still to retain its force, the vaso-motor system 
is probably paralyzed. The pulse still continues slow, although, according 
to Harnack, the vagi are completely paralyzed. 
Sexual Organs.-Jaborandi does not appear to have any power over the 
sexual organs, except the pregnant womb. Cases of abortion during its use 
have been reported by M. Masmann (quoted by Larvand, La Pilocarpine, 
1883) and by Schanta (Wiener Med. Wochens., No. 18, 1878), but in the 
hands of other observers the drug has appeared to have little, if any, 
abortifacient influence, and M. Hyernaux and M. Chanteril have found it 
powerless in the lower animals (quoted by Larvand). When, however, the 
pregnant female is at her full term, the drug may affect the uterine contrac- 
tions, as Larvand and others have noted an increase of the pains, or even a 
precipitation of labor, both in women and lower animals. Nevertheless, 
the oxytocic powers of jaborandi are very feeble. (See British Med- 
ical Journal, 1879, ii. 509; also, Wien. Med. Blatt., 1879, vol. ii., 1178, 
1207.) 
Motor System.-In man, muscular tremblings have been observed during 
the action of jaborandi, but it is doubtful whether they are due to a direct 
action of the remedy. In the frog, as first noticed by Murrell (Pharm. 
Journ. and Trans., vi. 228), small doses (3 mgrm. of pilocarpin) produce 
violent convulsions with heightened reflex activity, whilst larger amounts 
cause complete palsy. According to Harnack and Meyer the convulsions 
are due to spinal stimulation, and the paralysis partly to overwhelming of 
the spinal centres, and partly to paralysis of the muscles, the motor nerves 
themselves not being affected. In man and the higher animals convulsive 
movements have been noted, but the action of the drug upon the musculo- 
nervous system is entirely subservient to its other effects. 
Eye.-When applied to the eye pilocarpin produces great contraction of the 
pupil, tension of the accommodative apparatus, and an approximation of the 
nearest and farthest points of distinct vision (Jno. Tweedy, Lancet, 1875, i. 
* Prof. Ringer's explanation seems at present the most probable. It is-that pilocarpin 
paralyzes the heart by combining with the molecules of the excito-motor apparatus and 
of the muscular tissue, and that atropia displaces the pilocarpin and thereby substitutes 
its own action. 564 
LOCAL REMEDIES. 
159 ; C. Scotti, Berl. Klin. Woch., 1877,143 ; Galezowski {Med. Times and 
Gaz., 1877, ii. 358). Mr. Tweedy also states that there is impairment of 
vision, due to benumbing of the retina. According to P. Albertoni the myosis 
is followed by a moderate but persistent mydriasis, and is not prevented by 
previous section of the oculo-motor nerve or of the upper cervical sympa- 
thetic ganglion. It is certainly the result of a peripheral influence. Gale- 
zowski, who uses a solution of one part of a pilocarpin salt in fifty parts of 
water, affirms that it answers as well as a solution of eserina in diseases of 
the eye, and has the great advantage of not producing irritation. 
Therapeutics.-Jaborandi is so powerful and certain in its diaphoretic 
action that it has already taken rank as the most reliable and influential of 
the remedies of its class; indeed, so great is its power that it has widely 
extended the use of diaphoretics. It is doubtful how far it is applicable to 
the treatment of fevers, although the decided lowering of the temperature 
by it would indicate a power over such bodily conditions. In bilious and 
other malarial fevers it is probably of value, but sufficient use has not as 
yet been made of it to determine its exact powers in hastening the desired 
remission. In typhoid and other asthenic fevers it would probably do much 
injury. In dropsits it has been widely employed, and certainly is a most 
efficient remedy. It appears to be as safe in asthenic dropsies as in any other 
remedy comparable with it in power, although in my own observation a free 
jaborandi sweat is almost as exhausting as a purging. Great value has been 
ascribed to it in facilitating the removal of local watery effusions, such as occur 
in pleurisy, etc. Cases of pulmonic oedema have been reported in which lives 
seem to have been saved by its employment. In ursemia it is the most efficient 
remedy at our command. In acute or chronic Bright's disease it is of great 
value, sufficing often in the one case to bring about convalescence, and in the 
other greatly to prolong life and make it comfortable. The sweats may be 
repeated daily, bi-weekly, or weekly, according to the circumstances of the 
case. There is one point in connection with this use of the drug which needs 
further study,-i.e., the action of the remedy on the kidney itself. Purjezs 
{Deutsch. Arch. Klin. Med., xvii., p. 533) has noted one case in which the 
drug seemed to produce albuminuria, but the occurrence may have been 
accidental, and there is some clinical experience in favor of the plan of giving 
the pilocarpin in doses of one-tenth of a grain three times a day, so as to 
avoid any violent action upon the skin and get a decided increase of the 
urine. Still, the case of Purjesz, and the occasional occurrence of stran- 
gury after the drug (my own experience, also Stumpf, Deutsch. Archiv, 
xvi.) would indicate that it stimulates the urinary organs, and that some 
caution must be exercised in its employment in the earliest stages of acute 
tubular nephritis. In subacute and muscular rheumatism it is very efficient. 
Prof. Ringer has reported several cases of unilateral sweating cured by the 
use of full doses of pilocarpin given hypodermically {London Pract., xvii., 
p. 401), and it has been used with asserted success in alopecia. It has DIAPHORETICS. 
565 
been extensively used in diphtheria and croup, but has no direct influence 
over the disease, and may do great harm in adynamic conditions : by in- 
creasing the glandular secretion of the bronchial tubes it may aid in loosen- 
ing the membranes. 
Locally applied (half-ounce of the leaves) in the form of a poultice, 
jaborandi may sometimes produce local sweating only, but I have seen very 
marked and extraordinarily prolonged general sweating so caused. 
Administration.-The dose of jaborandi is forty grains to a fluidrachm. 
The fluid extract (Extractum Pilocarpi Fluidum, U. S.) may be used in 
doses of half a drachm to a drachm. Pilocarpin is superior to jaborandi in 
the certainty of its action, and in being less disagreeable, and probably less 
apt to nauseate. Weber, Bardenhewer, and Auschmanu agree that 0.3 of a 
grain of it is equal to seventy-five grains of the best leaves; but this is 
probably an over-estimate of its powers. In the form of the hydrochlorate 
(Pilocarpinae, Hydrochloras, U. S.) it may be used hypodermically in watery 
solution, the dose being from one-eighth to one-third of a grain. Dr. Demme, 
of Berne, gives to children between one and two years old 0.075 grain ; be- 
tween two and six, 0.1 to 0.15 grain; between six and twelve, 0.15 to 
0.35 grain, and finds it to work very well (Med. Times and Gaz., 1877, ii. 
636). No fatal results have as yet been reported, although Auschmanu has 
twice seen alarming collapse follow moderate doses, apparently produced by 
excessive vomiting (Berl. Klin. Wochenschr., 1877, p. 356).* 
Antagonism with Atropia.-In February, 1875 (British Med. JournaT), 
Mr. Langley called attention to the antagonism existing between jaborandi 
and belladonna. When the heart has been slowed or arrested by jaborandi, 
atropia will bring the rate of pulsation almost to normal; the reverse of this also 
occurs, provided the amount of atropia previously applied has not been too 
great (Langley, Journ. Anat., x. 194). Upon the sweat-glands the two drugs 
have also antagonistic powers, one being able to annul the action of the 
other (Luchsinger, loc. cit.}. The same is true in regard to the salivary 
secretion (Langley). This antagonism between atropia and jaborandi is 
affirmed by H. Larvand to extend to the intestines and pupil. In bella- 
donna-poisoning the alkaloid has been used, with no advantage, in very 
small dose (Lancet, i. 1876, 346), but in a case in which nine-tenths of a 
grain of atropia had been taken, nine grains of pilocarpin are said to have 
been injected hypodermically in between one and two hours with success 
(Prof. Purjesz, Pest. Med.-Chir. Presse, 1880). Dr. L. Juhasz reports 
(Klin. Monatsbl. f. Augenheilk., xx. 86) a case in which it was estimated 
that about one and a half grains of atropia were taken, followed in half an 
hour by vomiting; four and a half grains of pilocarpin were injected in 
about seven hours, with a favorable result. Dr. Hofferts reports ( Wien. Med. 
* A case of poisoning to which I have not had access, in Bull, and Mem. Soc. de Therap., 
s6r. 2, v. 88. 566 
LOCAL REMEDIES. 
Presse, 1883, xxiv. 1412) a case in which 7.5 grains of extract of belladonna 
were ingested, and nearly two grains of pilocarpin given, with recovery. 
LIQUOR AMMONII A0ETATIS-S0LUTI0N OF THE ACETATE OF 
AMMONIUM. U.S. 
Spirit of Mindererus is prepared by saturating dilute acetic acid with the 
carbonate of ammonium, and consequently consists of a solution of the ace 
tate of ammonium, containing as much of free carbonic acid as the water 
will absorb. It is a colorless liquid, and should have no odor, or a very faint 
odor of acetic acid. Any specimen having an ammoniacal odor should be re- 
jected, as containing an objectionable excess of the carbonate of ammonium. 
The taste is disagreeable and saline. As the solution upon standing under- 
goes decomposition after a time, it should be freshly prepared when needed. 
Therapeutics.-Spirit of Mindererus appears to be a feeble stimulant 
diaphoretic. Cullen has known eight ounces of it to be taken in a very 
short time without inducing any effect; yet the testimony is very strong aS 
to its having some value in disease, and in adynamic fevers it may be em- 
ployed as a diaphoretic. It is, however, much less efficient than the sweet 
spirit of nitre, and is probably to most persons more disagreeable than that 
favorite drug. Special value has been claimed for it in dysmenorrhoea, and 
even in menorrhagia ; but I do not believe that it has any superiority over 
other diaphoretics in the former affection, and its being of any use in the 
latter disease seems apocryphal. The dose is one to two tablespoonfuls. 
SPIRITUS UTHERIS NITROSI-SPIRIT OP NITROUS ETHER. U. S. 
Sweet spirit of nitre is prepared by adding sulphuric acid to alcohol, then 
adding copper wire, and after this nitric acid, distilling at a temperature 
not exceeding 180° F., and adding alcohol to the distillate. The first re- 
action which takes place between the sulphuric acid and the alcohol results 
in the liberation of ether, the hydrated oxide of ethyl; the nitric acid, giving 
to the copper two of its equivalents of oxygen, is converted into nitrous 
acid, which combines with the oxide of ethyl to form a nitrite. Spirit of 
nitrous ether is a volatile, inflammable liquid, of a pale-yellow color inclining 
slightly to green, having a fragrant, ethereal odor, free from pungency, and 
a sharp, burning taste. It slightly reddens litmus, but does not cause effer- 
vescence when a crystal of bicarbonate of potassium is dropped into it. When 
mixed with half its volume of officinal solution of potassa previously diluted 
with an equal measure of distilled water, it assumes a yellow color, which 
slightly deepens, without becoming brown, in twelve hours. A portion of 
the spirit in a test-tube half filled with it, plunged into water heated to 145° 
and held there until it has acquired that temperature, will boil distinctly on 
the addition of a few small pieces of glass. Spirit of nitrous ether has the 
specific gravity 0.837, and contains five per cent, of its peculiar ether. It 
should not be long kept, as it becomes strongly acid by age. DIAPHORETICS. 
567 
Physiological Action.-Undoubtedly, the sweet spirit of nitre, if taken 
in sufficient amount, acts very decidedly upon the organism. Mr. D. R. 
Brown reports {Pharm. Jour. Trans., March, 1857) the effects of the inha- 
lation of sweet spirit of nitre. The first symptoms are a bluish-purple, 
livid discoloration of the lips and fingers, and a peculiar pallor of the face. 
These increase, the face assumes a ghastly look, the extremities grow cold, 
and the pulse becomes very weak and frequent, but the breathing remains 
slow and regular; muscular weakness is extreme, and the least exertion causes 
hurried respiration, with painful oppression in the chest, and cardiac distress. 
Confusion of mind and giddiness may or may not occur, but headache always 
comes on sooner or later. In sufficient amount sweet spirit of nitre is un- 
doubtedly an active poison. Dr. Christison reports the case of a woman 
whose death was attributed to it, and between three and four ounces killed 
a child three years old in twelve hours, the symptoms closely resembling 
those of alcoholic poisoning with the addition of vomiting and purging 
{London. Lancet, 1878, ii.). In therapeutic doses it has no marked action, 
except in increasing the secretion of the skin and kidneys, and in a slight 
degree stimulating the nervous system. In children it is often of value as 
an antispasmodic. 
Therapeutics.-Sweet spirit of nitre is one of the most popular of the 
diaphoretics. As it exerts a stimulant action, it is useful in adynamic rather 
than in sthenic fevers. In children with fever offering nervous symptoms, 
such as starting, jerkings, etc., it is especially useful. If the patient be kept 
about and cool, instead of being warmly covered in bed, spirit of nitrous 
ether acts as a decided diuretic ; but it is not sufficiently powerful to make it 
worthy of reliance in dropsy. The dose of sweet spirit of nitre is: for an 
adult, a teaspoonful to a tablespoonful; for a child three years old, half a 
teaspoonful. If a diaphoretic action is required, very minute doses should 
be exhibited at short intervals. Thus, for a child a year old, a teaspoonful 
should be put in five ounces of water, and a tablespoonful given every hour. 
Alcohol.-As is known to every hard drinker, alcohol when taken in 
excess, and especially if drunk with hot water, is eliminated by the skin, and 
often causes profuse sweating. As a diaphoretic it is, however, used in medi- 
cine for only one purpose,-i.e., in those cases, such as a forming " cold," 
subacute rheumatism, and suppressed menstruation, when a single profuse 
sweating is desired. In these cases I have found the following plan most 
efficacious, provided the patient have not decided fever: a Dover's powder 
is administered, and directly after this the patient goes into a hot-water or 
vapor bath, or else does what is known in common parlance as " soaking his 
feet,"-i.e., takes a pediluvium. The proper method of doing the former 
of these acts has been sufficiently described. In taking a foot-bath the 
patient should use a tub of sufficient size to enable him to place in it his 
feet and legs up to the knees; the water should be as hot as can be borne, 568 
LOCAL REMEDIES. 
and, as the feet become a little accustomed to the temperature, hotter water 
should be added; the immersion should continue fifteen or twenty minutes ; 
during it, the patient, being in his night-clothes, should be well wrapped 
up in blankets, and at the close should be so transferred to the bed as not 
to get in any way chilled. After he has got to bed, and has been heavily 
covered with blankets, the patient should drink one or two tumblerfuls of a 
very hot and strong lemonade, containing one, two, or three tablespoonfuls 
of whisky or brandy. 
I think the popular belief that after a sweat there is a greater liability 
than usual to take cold is well founded: care must, therefore, be exercised 
to avoid any exposure for a day or two. Anointing the skin with oil of 
sweet almonds, or with other equally bland fat, appears to have some effect 
in preventing the deleterious effects of cold after sweating. 
Warburg's Tincture.-This is a dark-brown liquid, prepared in accord- 
ance with a very complicated formula,* which has obtained an extraordinary 
reputation in India and other tropical countries in the treatment of severe 
remittent and malignant malarial fevers. The testimony is so strong as to 
its remarkable and almost certain efficiency that it cannot be questioned, and 
entitles the tincture to rank above all other remedies. The method of adminis- 
tration is as follows: the bowels having been freely opened, a half-ounce of the 
tincture is given undiluted, all drink being withheld, and at the end of three 
hours a second half-ounce is in similar manner exhibited. Soon after the last 
dose a profuse and very aromatic perspiration sets in, and convalescence is 
usually secured. The remedy is also highly commended iu acute nervous 
exhaustion and sudden collapse without organic disease. 
* For formula, see Med. Times and Gaz., 1875, ii. 511; or Phila. Med. Times, vi. 136; 
or London Practitioner, xviii. 82. CLASS V.-EXPECTORANTS. 
These are medicines possessed of the power of modifying the secretions 
and thereby influencing the inflammatory conditions of the respiratory mucous 
membranes. There are various, and even opposing, methods, in accordance 
with which drugs act upon the pulmonary surfaces. In certain states of the 
latter, as in the first stages of acute bronchitis, the irritation of the part is 
too great for secretion, the first stage of inflammation being, as is well known, 
connected with suspension of function : in this condition the so-called sedative 
expectorants are indicated. These are remedies which lower arterial action: 
they are all nauseants, and the increase of bronchial secretion by them is 
analogous to that which they produce in the skin. In order to get their 
full effect, they must be given in nauseating doses; and if these are gradu- 
ally increased until emesis is induced, the fullest therapeutic influence will 
be obtained. There are other drugs which may be termed stimulating ex- 
pectorants, and which act directly upon the bronchial mucous membrane, 
some of them perhaps increasing secretion, but most of them rather modify- 
ing it, and some of them even diminishing it, by toning up a relaxed, over- 
secreting mucous membrane. Some substances which can hardly be called 
expectorants are nevertheless useful in bronchial diseases: thus, gallic acid 
will sometimes lessen the large quantities of mucus secreted in bronchorrhoea ; 
or, when the mucus is tenacious in chronic bronchitis, alkalies will frequently 
be of great service by rendering it less viscid and thereby facilitating 
expectoration. 
In many cases of disease occurring in the very young and in the very 
old, mucus may so accumulate in the lungs, owing to the inability of the 
enfeebled powers to force it up, as seriously to embarrass, or even fatally 
compromit, respiration. Very frequently, in acute cases of this character, 
such as the suffocative catarrh of infants, mechanical emetics are of the 
greatest service; but in chronic cases they induce so much disturbance of 
digestion as to render their use dangerous, and alcohol, carbonate of ammo- 
nium, oil of garlic or of turpentine, and other drugs capable of increasing 
the bronchial muscular power or activity, have to be relied upon. 
Again, in certain conditions of the lungs, especially in chronic catarrhal 
pneumonia, iodine and other alteratives are of great value in facilitating the 
absorption of exuded materials; yet these remedies can hardly be called 
569 570 
LOCAL REMEDIES. 
expectorants. It may be affirmed that the value of true expectorants in 
pneumonia of any variety is exceedingly problematic, and, except it be the 
muriate of ammonia, they far more often do harm in the chronic varieties 
by deranging digestion than they do good by influencing the lung-tissue. 
There are several substances, chief among them being morphia, hyos- 
cyamus, and hydrocyanic acid, which have the power of allaying cough and 
lessening irritation by an anodyne action. In regard to morphia, its property 
of checking secretion should not be forgotten, but should not prevent its use. 
These narcotics are especially useful when the cough is disproportionate to 
the amount of inflammation. When large quantities of mucus are being 
secreted in debilitated subjects, their use requires great caution, for fear of 
benumbing the nerves or nerve-centres and thereby increasing the danger of 
an accumulation of phlegm in the lungs. 
Expectorants may be arranged under two heads: the nauseant or sedative 
expectorants, and the stimulating expectorants; and the general proposition 
may be laid down that expectorants of the first class are to be used in the 
first stages of acute bronchitis, whilst expectorants of the second class are to 
be employed in the advanced stages or in the chronic varieties of the disease. 
As these diseased conditions gradually merge into one another, so must the 
practitioner balance the ingredients of his expectorant mixtures, adapting 
their relations to the individual case. 
The present seems a fitting place to say what is necessary in regard to the 
use of drugs by atomization. In this method of administration, a solution 
of the medicine employed is broken up by a mechanical contrivance into a 
fine spray and projected into the back of the mouth. There can be no doubt 
that when the operation is properly performed the spray reaches even the 
finest ramifications of the pulmonary bronchi. A discussion of this is at 
present scarcely necessary. Any reader having doubt upon the subject will 
find the evidence in the work of Dr. J. Solis Cohen (Inhalation: its Thera- 
peutics and Practice, Phila., 1867). 
The following rules should be attended to, to secure successful results: 
1. Use the steam atomizers: all other forms of apparatus give irregular 
or too feeble currents, and should be discarded. 
2. See that the points of the atomizing tubes are sharp and clean,-not 
foul, cracked, or with their edges worn. 
3. See that the steam is generated equably and with sufficient force, and 
that the solution used is free from all solid particles, and, unless otherwise 
ordered, about the temperature of the body. 
4. Never allow inhalations when the patient is excited, directly after eating, 
or immediately after exercise, unless especial circumstances, as in haemoptysis, 
demand haste. 
5. Have the glass mouth-speculum inserted well into the mouth, and the 
line of its axis and of the propulsion of the spray coincident with that of 
the mouth. EXPECTORANTS. 
571 
6. When the pharynx, or even the larynx only, is to be reached, the 
operation is very simple, and respiration should be natural; but when it is 
desired to make applications to the ultimate bronchi, the respirations should 
be regular, slow, and as deep and full as possible, the lungs being well emptied 
at expiration. 
7. Do not protract the sitting until the patient is fatigued. Five minutes 
is generally long enough to commence with. In haemoptysis, this rule may 
sometimes be departed from with advantage. 
8. Let the patient give his whole attention to the matter in hand. 
9. In chronic disease, one, two, or three inhalations a day are usually 
sufficient. In acute disease, they may be required much more often, as every 
hour in diphtheria. 
10. Never use atomization for the purpose of general medication: it is 
simply a method of applying substances locally to the respiratory organs. 
The substances used by atomization may be conveniently arranged as 
follows :* 
Diluents.-The only diluent of any value is warm water. In acutely 
inflamed conditions of the mucous membrane, the very frequent application 
of water at about the temperature of 90° F. will often afford marked relief, 
especially in laryngitis. 
Astringents.-These are employed to arrest excessive secretion or hem- 
orrhage. In their use, it must always be remembered that they are more or 
less irritant, and that whilst some persons bear them very well, in others they 
produce very harmful irritation ; also, that the idiosyncrasies of patients vary, 
so that whilst one person will best bear a certain one of the astringents, a 
second may be less irritated by another drug. The rule is to try carefully 
until the pulmonary idiosyncrasies are known. In cases of excessive bron- 
chial secretion, any irritation sufficiently severe to give origin to tightness 
in the chest, or to much coughing, calls for the withdrawal of the medicine. 
In haemoptysis, a greater risk can be judiciously assumed. The astringent 
substances employed in this way are: First, tannic add, one to twenty grains 
to the fluidounce of water. I have not used this; but it is said to be well 
adapted to cases of free secretion. Second, alum, varying in strength from 
a solution of five grains to the ounce to a saturated solution. This I have 
used with great satisfaction. In haemoptysis, only the strongest preparation 
is of avail; in bronchorrhoea, a weak solution should be employed at first, 
* Recently attention has been called to the inhalation of fresh, almost nascent vapors 
of muriate of ammonia. By means of a very simple apparatus, air loaded with muriatic 
acid vapor is drawn at each inspiration through a weak water of ammonia, and of course 
reaches the lung saturated with the vapors of the muriate. Dr. Leberman {Brit. For. 
Med.-Chir. Rev., 1874, i. 518) affirms that he has employed this with the happiest 
results in one hundred and two cases of granular sore throat, chronic bronchitis, asthma, 
whooping-cough, and even angina pectoris ! Most druggists, I believe, keep the inhalers. 572 
LOCAL REMEDIES. 
and the strength increased pro re nata. One advantage this drug has over 
tannic acid is its compatibility with the sulphate of morphia, which should 
always be added to its solution when any tendency to irritation exists. In 
chronic bronchitis with excessive expectoration, I have seen alum produce 
most gratifying results. Third, preparations of iron: of these the solution 
of the perchloride has been used in Great Britain and on the Continent; 
but Monse!s solution (Liquor Ferri Subsulphatis) is much preferable, as 
even more powerfully styptic and less irritating. Ten drops of the solu- 
tion may be added to the fluidounce of water and be used for the trial dose. 
If the lungs will bear it and necessity exists for a stronger solution, the 
strength may be carefully increased up to half a fluidrachm to the ounce. 
Acetate of lead is at once astringent and sedative. It has been recommended 
by Beigel and by Fieber in the advanced stages of acute catarrhs, in the 
proportion of three to ten grains to the fiuidounce. 
Narcotics.-When there is great laryngeal or even bronchial irritation, 
especially in the laryngitis of advanced phthisis, half a grain of morphia, or 
a drachm of tincture of hyoscyamus, will often afford very great relief. It 
must not be forgotten that the constitutional effect of the narcotic may be 
produced in this way. 
Solvents.-As is well known, in certain respiratory affections it is very 
important to get rid of a false membrane, or exudation, which appears upon 
the mucous surfaces. Some substances seem to exert at least a degree of 
solvent power upon this material. Of these, lime-water appears to be the 
most effective and the least irritant. It should be used pure. (See article 
on Lime (post) ; also consult Meigs and Pepper, Diseases of Children, 
Phila., 1874, p. 680.) 
Alteratives.-In chronic bronchitis, and even in chronic catarrhal pneu- 
monia, or phthisis, balsamic vapors have long been used, but atomization is 
not necessary in their application. Muriate of ammonia may, however, be 
so applied : in chronic bronchial catarrh it is sometimes advantageous, and 
in acute laryngitis inhalations of a warm saturated solution of it are often 
very useful. In chronic laryngitis, nitrate of silver may be exhibited by 
atomization, but it is, I think, much better to apply it directly by means of 
the laryngoscope and the brush or probang. In cases of fetid expectoration, 
carbolic acid in weak solution (gtt. i-ii to f§i) may be used as an antiseptic 
and alterant. 
NAUSEATING EXPECTORANTS. 
The three nauseating expectorants are ipecacuanha, tartar emetic, and 
lobelia. As these substances are sufficiently discussed elsewhere in this 
work, it remains only to say a few words in regard to their comparative use 
as expectorants. EXPECTORANTS. 
573 
Lobelia is used only when the inflammatory action is complicated with a 
tendency to spasm of the bronchial muscles. It is too powerfully depressant 
to be given to children with safety. The best expectorant preparation is the 
tincture ( Tinctura Lobelix, U. S.). The ordinary expectorant dose of this 
is twenty to thirty drops, usually given in combination every three hours. 
When a very decided impression is desired, as in some cases of asthma, one 
fluidrachm may be exhibited every two hours, until vomiting is produced or 
relief obtained. Under these circumstances, the patient should be closely 
watched, as lobelia in these large doses sometimes causes very alarming 
symptoms. 
Ipecacuanha is the safest and most used, although perhaps the least 
powerful, of all the nauseating expectorants. It is the only one that should 
be given freely to children. In the early stages of all acute inflammatory 
conditions of the respiratory mucous membranes it is of great service. The 
preparation most generally used in acute bronchitis is the syrup, the dose of 
which is from twenty drops to a tcaspoonful, every two, three, or four hours, 
according to the exigencies of the case. Any of the other liquid prepara- 
tions of ipecacuanha may be employed in a corresponding dose. The Ipe- 
cacuanha Lozenges (Trochisci Ipecacuanhx, U. S.) each contain about 
one-quarter of a grain of ipecac, and may be employed in catarrhal com- 
plaints. The troches of ipecacuanha and of morphine (Trochisci Morphinx 
et Ipecacuanhx, U. S.) contain each the fortieth of a grain of sulphate of 
morphine and the twelfth of a grain of ipecacuanha, and may be used when 
an anodyne effect is desirable. 
Tartar Emetic is much more powerful than ipecacuanha as a sedative 
and nauseant, and must be used with more care. It is the most efficient of 
all the sedative expectorants, and affords in cases of urgency a very effica- 
cious, although a very disagreeable, method of putting an end to an attack 
of acute bronchitis. I have known of a public speaker, who had risen in 
the morning completely overwhelmed with bronchitis, enabled to deliver his 
evening speech by the judicious use of tartar emetic. To effect this rapid 
relief, one-twelfth of a grain of tartar emetic should be taken every ten or 
fifteen minutes until it induces profuse vomiting. After the nausea is passed, 
the system may be toned up for exertion by a lunch of ale and oysters. 
Tartar emetic is a powerful remedy, and is especially injurious to young 
children, in whom it is very apt to induce collapse. It is therefore contra- 
indicated by infancy, as it also is by the existence of gastro-intestinal inflam- 
mation. The dose as an expectorant is from one-twelfth to one-quarter of a 
grain, repeated according to circumstances. 574 
LOCAL REMEDIES. 
STIMULATING EXPECTORANTS. 
AMMONII CHLORIDUM-CHLORIDE OF AMMONIUM. U.S. 
(NH3HC1-NH4C1.) 
Muriate of Ammonia, or Sal Ammoniac, is prepared by heating with 
chloride of sodium the sulphate of ammonium, which is obtained from gas- 
liquor by the addition of sulphuric acid. Gas-liquor is a water which has 
been used to wash ordinary burning-gas, and contains largely of the car- 
bonate, hydrocyanate, hydrosulphate, and sulphate of ammonium. The 
sulphate of ammonium is not itself employed as a medicine, but is officinal, 
because the other preparations of ammonia are made from it. 
The muriate of ammonia is a white, translucent, fibrous, and tough salt, 
free from odor, but having a sharp, saline taste. It occurs iu large concavo- 
convex plates, dissolves in three parts of cold and in one of boiling water, and 
at a red heat sublimes without decomposition. 
Physiological Action.-When applied in a solid form, or in a concen- 
trated solution, the chloride of ammonium acts as an irritant upon raw sur- 
faces and upon mucous membranes. This influence seems, however, not to 
be sufficiently powerful to enable the drug in any dose to produce lethal 
poisoning: at least, Oesterleu (fleilmittellehre, Tubingen, 1851) states that 
one of his patients took two ounces of the salt without suffering any more 
severe results than colicky pains and some diarrhcea. 
If some of the older experimenters are to be credited, its influence upon 
the lower animals is more powerful. In the experiments of Dr. Smith 
(quoted by Stille), two drachms of the salt applied to the wounded thigh of 
a dog caused death in from twelve to thirty-six hours, and, according to Orfila, 
the same quantity dissolved in two ounces of water and introduced into the 
stomach of a dog caused violent convulsions, with great tetanic rigidity, and 
finally death. Arnold (Wibmer, Die Wirkungen der Arzneien und Gifte, 
Munich, 1831, Bd. i. p. 143) found that thirty grains will kill a rabbit in 
ten minutes. On the other hand, in the recent studies of Dr. Rabuteau 
(L'Union Medicale, 1871, p. 330), half a drachm injected into .the veins 
of a moderate-sized dog had no apparent effect, whilst one drachm only 
produced muscular weakness, deepening into temporary paralysis of the hind 
legs, vomiting without diarrhoea, and general prostration for four or five 
hours. 
The chief interest of the clinician in the physiological action of the 
muriate of ammonia centres in its effects when given continuously for some 
time. The older writers upon the subject assert that its influence on the 
heart is a sedative one, but that it increases the capillary circulation (Sun- 
delin, Heilmittellehre, Band i. p. 150, Berlin, 1853). This opinion appeals 
to me to be founded chiefly upon speculation and inference, and not to have EXPECTORANTS. 
575 
any sufficient basis. Whatever may be the action of very large amounts, I 
have never been able to perceive that the muriate of ammonia, given in 
ordinary doses, has any decided influence upon the circulation. According 
to Sundelin and other authorities, the drug, when given freely and contin- 
uously, produces a profound impression upon the blood itself, lessening its 
plasticity and impairing its constitution. One case of profound and other- 
wise inexplicable prostration and typhoid condition, which occurred in a 
patient who was taking nearly a half-ounce of muriate of ammonia per diem, 
has come under my own notice; and Dr. Isham reports (Med. News, xl. 
455) a case in which an eruption of bloody blebs, with haematuria, hemor- 
rhages from mucous membranes, and great prostration, was apparently pro- 
duced by the prolonged use of the salt. The elaborate analyses of F. W. 
Bocker (Beitrage zur Heilkunde, Bd. ii. p. 170, Crefeld, 1849), although 
somewhat discordant, indicate that sal ammoniac does impoverish the blood, 
since in some instances there was a decided decrease in its solids. Arnold 
(loc. cit.) also noticed that in dogs poisoned with the muriate of ammonia 
the blood contained less than the normal percentage of solids. In accord 
with this reputed action on the blood is the effect of the drug upon the 
urinary secretion. In a very elaborate series of experiments, Bocker (loc. 
dt., p. 158) found that, given to a healthy man, sal ammoniac increased 
very notably all the solids of the urine, except the uric acid, which was 
very slightly diminished; and Rabuteau, in an investigation in which, by 
identity of diet, etc., all sources of fallacy were as far as possible excluded, 
found that the excretion of urea was very decidedly increased. 
The opinion has long prevailed that the muriate of ammonia especially 
affects the mucous membranes, and Bocker believes that in them it hastens 
very greatly the nutritive changes and the exfoliation of epithelium. Clinical 
experience has, I think, demonstrated that the drug does act especially upon 
the mucous membranes ; although it is very difficult to bring forward any 
definite tangible proof of this. 
The muriate of ammonia, when ingested, probably enters into all the ex- 
cretions, since Rabuteau (L' Union Medicale, t. xii. p. 329,1871) has found 
it in the saliva. The same observer has shown that the chief elimination 
takes place through the kidneys, since he found in the urine almost all of 
the salt that had been taken. 
Therapeutics.-In the last century the chloride of ammonium was very 
extensively used in intermittent fever ; but at present the salt is rarely or 
never employed, although Aran (Bulletin Therapeutique, t. xii. p. 344) has 
attempted to revive the practice, and asserts that he has had very good effects 
resulting from it,-in thirteen cases of intermittent fever curing, by the ex- 
hibition of two drachms a day, seven at once, four after the second paroxysm, 
one after the third, and one after the fourth. The chief present use of the 
muriate of ammonia is as a remedy- in acute and in chronic bronchitis: in 
the first variety of the disease the drug should not be exhibited in the first 576 
LOCAL REMEDIES. 
stages; but after active inflammatory action has been subdued by the seda- 
tive expectorants, it is very useful. It is very largely employed in the 
catarrhs of young children, and is often of great service. In Germany the 
remedy has been extensively exhibited in gastric and intestinal catarrhs ; 
Dr. W. Stewart,* as the result of a large experience, highly commends its 
use in chronic torpor of the liver, chronic hepatitis, and hepatic abscess. In 
the first of these affections I have employed it to a limited extent, with very 
good effects. Dr. Stewart gives twenty grains of it three times a day, and 
continues its use for weeks or even months. 
In various neuralgias, especially in the ovarian variety, but to a less 
extent in migraine and other forms, sal ammoniac has been largely em- 
ployed for the purpose of relieving pain. Thirty grains of it are given in 
combination with from two to five drops of tincture of aconite root, and 
the dose is repeated in half an hour, if necessary. 
Administration.-The usual dose of the muriate of ammonia in catarrh 
is from five to ten grains three or four times a day. This dose is given in a 
tablespoonful of water, to which, for the purpose of concealing the taste, from 
five to ten grains of liquorice may be added. The troches (Trochisci Am- 
monii Chloridi, U. S.) contain two grains each, and are used as a local 
stimulant to the fauces and the epiglottis. 
The root of Polygala Senega, a small, herbaceous perennial, indigenous to 
the Middle and Southern United States. This root is several inches long, 
very much contorted, of a peculiar feeble odor, and a taste at first sweetish 
but afterwards acrid. It is distinguished by a keel-like line, shorter than 
the root, and presenting the appearance as if a string were drawn tightly 
under the bark from end to end. Quevenne discovered in seneka a peculiar 
principle which he named Polygalic Acid, although he thought that it was 
closely allied to saponin. According to Husemann (Die Pjlanzenstoffe, p. 
751), the more recent researches of Bolley (Ann. Chern. Pharm., xc., xci.) 
have shown that it is identical with saponin, a glucoside first found in the 
root of Saponaria officinalis, but now known to exist in a great many 
plants. It is a white, amorphous powder, of a neutral reaction, odorless, but 
very irritating to the nostrils, and having an acrid, burning taste. It is very 
soluble in water, to which, even when in no greater quantity than one part in 
a thousand, it imparts the property of foaming like soap-suds, when shaken. 
Therapeutics.-Seneka is chiefly used as a stimulant to the mucous 
membrane of the lungs in chronic bronchitis and in the very advanced stages 
of the acute disorder. It is believed to be one of the most stimulant sub- 
stances of its class, and is therefore contra-indicated by acute pulmonary 
SENEGA-SENEKA. U.S. 
* Chloride of Ammonium, Rangoon, 1870; Madras Monthly Journ. Med. Sei., Febr., 
March, 1872; Indian Med. Gaz., Dec. 1872; Phila. Med. Times, viii. 316. EXPECTORANTS. 
577 
inflammation and is indicated by a relaxed state of the bronchial mucous 
membranes. If its stimulant effect be modified by combination with tartar 
emetic, it may be given in acute bronchitis at an earlier stage than it could 
be used by itself. Seneka is locally irritant, and, when administered in large 
doses, produces vomiting, which is probably reflex in its origin. In over- 
doses it not only vomits, but also purges: it is, however, never used for 
these purposes. Seneka has been employed as an emmenagogue in amenor- 
rhoea and as a diuretic in dropsy, but has achieved no permanent reputation 
in these disorders. The abstract (Abstractum Senegee, U. S., dose, five to 
ten grains) and the fluid extract (Extractum Senegee Fluidum, U. S., dose, 
ten to fifteen drops) are officinal, but the syrup {Syrupus Senegee, U. S., 
dose, a fluidrachm) is usually employed. 
AMMONIACUM-AMMONIAC. U. S. 
The concrete juice of an umbelliferous plant, Dorema Ammoniacum, a 
native of Persia. It is said to exude from punctures made in the plants, and 
also to be obtained by a process similar to that employed in the case of assa- 
foetida. It is a gum resin, containing a little volatile oil, and occurs in com- 
merce as irregularly globular yellowish tears, from the size of a pin to that 
of a large chestnut, hard and brittle when cold, and breaking with a smooth, 
resinous fracture; and in irregular mottled masses, composed in part of tears, 
and containing many impurities. The odor is faint and disagreeable, the 
taste bitterish, sweetish, and somewhat acrid. 
Therapeutics.-The influence of ammoniac upon the general system is 
very slight. It is a local irritant, and therefore in large doses is capable of 
producing vomiting and purging. It was formerly employed as a nervous 
stimulant, but its internal use is now restricted almost exclusively to chronic 
bronchitis with either deficient or excessive secretion. The dose of it is 
twenty to thirty grains ; of the officinal mixture (Mistwra Ammoniaci, U. S.), 
a tablespoonful. There are two officinal plasters of ammoniac : the Emplas- 
trum Ammoniaci, which is used as a mild counter-irritant and as a local 
stimulant to promote the resolution of scrofulous tumors or enlarged joints ; 
and the Emplastrum Ammoniaci cum Hydrargyro, which contains mercury 
and sulphur, and is employed as a local stimulant, alterative, and discutient 
in the same affections as the first-named plaster, and in syphilitic nodes and 
tumors; its external use is said to have caused salivation. 
BENZOINUM-BENZOIN. U.S. 
The concrete juice of Styrax Benzoin, a large tree, native of Peru. The 
drug is said to be obtained by incising the tree and allowing the juice to 
harden as it exudes. The finest specimens of benzoin consist of tears agglu- 
tinated together; the poorest, of brown or blackish masses without tears. 
The fracture is resinous, the surface of the tears smooth and whitish, the 578 
LOCAL REMEDIES. 
odor fragrant, the taste at first very slight, afterwards somewhat acrid. The 
chief constituents of benzoin are resin and benzoic acid; cinnamic acid is 
also frequently present, and is said to be especially found in the white tears. 
Benzoic Acid (Acidum Benzoicum, U. S.) is obtained by sublimation of 
gum benzoin. As thus prepared, it is in white feathery crystals, of a silky 
lustre and a fragrant vanilla-like odor, due to the presence of a volatile oil, 
the pure acid being inodorous. The taste is warm, acrid, peculiar. Benzoic 
acid melts at 250°, and volatilizes without change ; is soluble in two hundred 
parts of cold and in twenty-four parts of boiling water; is soluble in alcohol, 
fixed oil, and alkaline solutions. It is a feeble acid, but forms neutral salts 
with the alkalies. Benzoic acid is widely distributed through the vegetable 
kingdom, constituting the peculiar principle of all true balsams, and is occa- 
sionally present in the urine of grass-eating animals. It is a normal constit- 
uent of castor, and has been detected by Seligsohn (^Chemische Centralblatt, 
1861) in the suprarenal capsules of an ox. It is used considerably in the 
arts, and for this purpose is prepared from the allied hippuric acid of horse- 
urine, and also, it is said, from naphthalen. 
Physiological Action.-Locally applied, benzoic acid is a decided irri- 
tant, and its vapors, when inhaled, produce bronchial catarrh. 
Our knowledge of the action of benzoic acid upon man and the higher 
animals is very limited. In ordinary therapeutic doses it exerts no percep- 
tible influence upon man, except it may in the production of gastric irrita- 
tion, with consequent nausea and vomiting. Thus, Schreiber took in two 
days about half an ounce of the acid, and suffered only a feeling of abdominal 
warmth, spreading over the whole body, and accompanied by an increase of 
the pulse-rate amounting to thirty beats per minute, by increased secretion 
and excretion of phlegm, with slight disturbance of digestion. 
Very few experiments with benzoic acid upon the lower mammals have 
been reported. W. Grube (Centralb. f Chirurg., 1876, p. 777) states that 
in massive doses (1 to 5766 of animal's weight) it produces intoxication, with 
disturbance of circulation and respiration, and paralysis of the hind feet, and 
that the antipyretic influence of benzoic acid is greater than that of salicylic 
acid. 
Especial interest attaches to the elimination of benzoic acid, because, as 
was first discovered in dogs by Wohler, and afterwards in man by Ure, it 
appears in the urine, united with nitrogenous atoms, as hippuric acid.* It 
becomes a matter of great interest to know where this change occurs ; but this 
has only recently been certainly determined. Kuhne and Hallwachs thought 
that the conversion occurred in the liver ; but the more recent researches of 
Meissner and Shepard ( Untersuchungen uber das Entstehen der Hippursdure 
in thierischen Organismus, Hanover, 1866) appear to show that it really • 
* Gusseron found hippuric acid in urine of a new-born child when benzoic acid had been 
given to the mother just before the birth {Hoffmann und Schwalbe's Jahresb., 1879, 283). EXPECTORANTS. 
579 
takes place in the kidneys. Certainly it does not happen in the intestines or 
in the blood, since after the exhibition of large doses of benzoic acid it alone 
can be detected in the blood; and after the administration to rabbits by the 
mouth of large amounts of hippuric acid, only traces of the latter, with large 
quantities of benzoic acid, can be found in the blood, although the hippuric 
acid reappears in the urine ;* further, moderate amounts of hippuric acid in- 
jected into the blood cause severe symptoms of poisoning, which is not true 
of benzoic acid. When very large amounts of benzoic acid are introduced 
into the blood, a portion escapes through the kidneys unchanged.^ These 
experiments are confirmed by G. Bunge and C. Schmiedeberg, who also 
found that in the dog with renal arteries tied no conversion of benzoic acid 
into hippuric occurred, but that tying of the ureters did not interfere with 
the change. They have also succeeded in converting benzoic into hippuric 
acid by passing blood containing benzoic acid, with or without glycocoll, 
slowly through the kidneys, removed from the body directly after death. 
From some of their experiments it would seem that the blood-corpuscles 
play an important role in the process, as when serum freed from blood- 
corpuscles was used, at most only a trace of hippuric was formed. Accord- 
ing to Meissner and Shepard, sometimes the benzoic acid is converted into 
succinic acid instead of hippuric acid in man, and in chickens it is habitually 
changed into two new products, one of which is nitrogenous. The point as 
to whence the nitrogen necessary for the formation of the hippuric acid is 
obtained has not yet been clearly made out. In the elaborate experiments 
of Carl Virchow {Zeitsch. f. Physiol. Chern., vi.) there was a decided increase 
produced by benzoate of sodium of the nitrogenous elimination from the 
kidneys; but the testimony as to the effect of the ingestion of benzoic acid 
upon the urea and uric acid of the urine is singularly contradictory. Thus, 
Ure {Medico-Chirurg. Trans., xxiv. 30, 1841), Leroy d'Etiolles (quoted by 
Stille), and Debouy (quoted by Stille) all affirm that the uric acid is very 
much diminished or altogether absent, whilst Garrod {Memoirs of the Chem. 
Soc., i., 1842, and London Lancet, Nov. 1844) and Keller (Ann. der Chem. 
und Pharm., xliii., 1842) assert that its quantity remains normal. Again, 
Garrod affirms that the urea is very much diminished in quantity, whilst 
Keller and Meissner and Shepard {loc. cit.) declare that it is not affected. 
The only logical conclusion would seem to be that the effect of benzoic acid 
upon the urine is variable. All authorities appear to agree, however, in 
asserting that the acidity is increased. 
* This alleged conversion of hippuric acid is not thoroughly established, and has given 
rise to much discussion. For a general summary and latest information, see paper by 
Van de Velde and Stockvis, Arch. Exper. Patholog. u. Pharm., xvii. 189. 
f According to the experiments of Th. Weyl and B. von Anrep, if benzoic acid be given 
to man or animals in a febrile state a much larger proportion of it than usual is eliminated 
unchanged (Hoffmann und Schwalbe's Jahresb., 1881, 447). 580 
LOCAL REMEDIES. 
In April, 1872, Dougall (Med. Times and Gaz., i. 1872) announced that 
benzoic acid is one of the most active of antiseptic drugs. Since this publi- 
cation, numerous experiments have been made by E. Salkowski (Berlin. Klin. 
Wochens., 1875, 297), Grube (Centralb. f. Chirurg., 1876, 778), by Buch- 
oltz (Archiv Experim. Pathol, und Pharm., Bd. iv.), Fleck (Benzoesaure, 
etc., Miinchen, 1875), with the unanimous result of ascribing to benzoic 
acid a first rank in destroying bacteria and preventing putrefaction. In 
most of these investigations benzoic acid was found to be much more active 
than salicylic acid. Bucholtz found that 0.02 per cent, of benzoic acid had 
a very perceptible effect upon the development of bacteria, and 0.1 per cent, 
inhibited entirely their growth; also that the benzoate of sodium was no less 
active than the pure acid. 
Therapeutics.-Benzoic acid, or gum benzoin, was formerly very freely 
exhibited in chronic bronchial catarrh as a stimulant expectorant; at present 
it is not much employed. The chief use of it is in urinary affections. Dr. 
Ure first suggested and commended its employment in uric acid gravel and 
calculus, because, as he thought, it diminishes the excretion of uric acid : as 
its possession of this power has been strenuously denied, the theory of its 
use in uric acid gravel is exceedingly doubtful. No less an authority, how- 
ever, than Dr. Golding Bird* asserts that clinical experience has shown its 
value in uric add diathesis. In the phosphatic urine of vesical catarrh, 
benzoic acid may be employed with much advantage. By rendering the urine 
more acid it increases its power of dissolving the phosphates, and at the same 
time it exerts a stimulant action upon the mucous membrane of the bladder. 
Dr. Lamaire affirms that benzoic acid (fifteen grains in twenty-four hours) 
given along with cannabis indica acts most happily in acute gonorrhoea (Phil. 
Med. Times, iv. 638). 
Since the discovery of the antizymotic power of benzoic acid, it has been 
used to some extent in Germany as a remedy in diphtheria, erysipelas, 
and allied diseases with asserted good results. Two or three drachms of the 
benzoate of soda are given during the twenty-four hours. Prof. Senator, of 
Berlin, states that, given in sufficient dose, benzoic acid is as much of a spe- 
cific in acute rheumatism as is salicylic acid. He gives it in daily doses of 
from two to three drachms, and states that larger amounts may be employed 
with impunity; the benzoate of sodium is preferred to the pure acid as of 
easier solubility (AUegem. IVien. Med,. Zeitung, 1878, xxiii.). 
Benzoic acid has the property of preventing animal fats from becoming 
rancid, and is therefore much used as an addition to ointments. Moreover, 
it exerts a peculiar, often very beneficial, stimulant action upon the skin, and 
* Urinary Deposits, Philadelphia, 1859, p. 160. Dr. Bird states that he has found 
the following formula of great service in chronic uric acid gravel: ]{ Sodii carbonatis, 
oiss; acidi benzoici,gr. xl; sodii phosphatis, 5*"; aquae ferventis, f^iv; solve et adde 
aquae cinnamomi, f^viiss; tincturae hyoscyami, f^iv. S.-Two tablespoonfuls three 
times a day. EXPECTORANTS. 
581 
is very useful in such conditions as chapped hands, lips,* or nipples, and 
even in fissure of the anus. 
There would seem to be no doubt but that benzoic acid may be substituted 
for carbolic or salicylic acid in antiseptic surgery. Under the name of bal- 
samum traumaticum a preparation practically the same as the compound 
tincture of balsam was formerly much used as a vulnerary. The practice 
has gone out of vogue; but the discoveries concerning antisepsis and the 
excellent results obtained by Mr. Bryant (Lancet, ii., 1876, 747) show that 
it was well founded. Mr. Bryant simply covers the wound in compound 
fractures and other severe injuries with lint thoroughly saturated with the 
compound tincture of benzoin, and maintains absolute quiet with non-removal 
of the dressing for some days. His results appear to challenge those obtained 
by the most complicated antiseptic surgery (see also Lancet, 1877, i. 671). 
Administration.-The dose of benzoic acid is from ten to thirty grains. 
Gum benzoin is never used itself, but in the form of the tincture ( Tinctura 
Benzoini-1 to 5, U.S.),-dose, f$ss to f3i; of the compound tincture 
(Tinctura Benzoini Composita, U. S.), used in chronic bronchial catarrh,- 
dose, f3i to f5ii. Adeps Benzoinatus, U.S., contains only enough of the 
benzoin to preserve the lard, and is employed as the basis of ointments. 
Balsamum Peruvianum, or Balsam of Peru, is obtained from the Myro- 
spermum Peruiferum, a tree of Central America, by making incisions in such 
places as have been previously beaten with clubs, slightly burning them, catch- 
ing the juice in old rags, and finally boiling these in water and skimming off the 
balsam as it rises to the surface. This balsam is a viscid, honey-like, fragrant, 
brownish fluid, of a warm, bitterish taste. According to Fremy, it contains 
not benzoic, but cinnamic acid. It has been used in chronic catarrhs of the 
respiratory and the genito-urinary system, in doses of half a fluidrachm. 
Balsamum Tolutanum, or Balsam of Tolu, is obtained from a tree 
very closely allied to that which yields the balsam of Peru, if indeed it be 
not identical with it. The incisions, however, are not burnt, and the juice 
is simply caught in vessels. Balsam of Tolu is at first a thick, viscid fluid, 
but by time it is converted into a hard, translucent, resinous solid. Its odoi 
is highly fragrant, and its taste vanilla-like. It contains cinnamic acid and 
a volatile oil, and its medical properties are the same as those of the balsam 
of Peru. On account, however, of its grateful taste, it is preferred to the 
latter, and is very much used to flavor medicines, especially cough-mixtures. 
In large doses (gr. xx to xxx every three hours) it may be of some value 
in chronic catarrh, but as generally used its preparations are simply agree- 
able vehicles. The dose of the tincture ( Tinctura Tolutana-1 to 10, U. S.) 
is one-half to one fluidrachm ; of the much more frequently used syrup 
(Syrupus Tolutanus, U.S.), half a fluidounce. 
* Prof. StillS commends a mixture of one part of the compound tincture of benzoin and 
four parts of glycerine. 582 
LOCAL REMEDIES. 
Allium, U. S., or English Garlic, the clove of the Allium sativum, con- 
tains a volatile oil, which is a stimulant in small doses to digestion, and is 
also a stimulating expectorant often of very great service in certain stages 
of bronchitis. It is in lingering, deep-seated " colds" that I have derived 
especial benefit from its use. It is also very valuable in the acute bronchitis 
of infants, when the powers of the system begin to give out. The oil of 
garlic is further believed to have the ability to stimulate the expulsive func- 
tion of the small bronchial tubes, and is certainly a powerful rubefacient and 
a decided nervous stimulant. For these reasons, garlic poultices are a favor- 
ite application in the acute suffocative catarrh of infants, and are not rarely 
applied to the spine, legs, and feet in general infantile convulsions. They are 
made by simply reducing the garlic to a pulp by pounding. When a con- 
tinuous application is desirable to the delicate skin of an infant, as in catarrh, 
it is generally necessary to reduce their strength with flaxseed meal. 
Scilla, or Squill, is one of the most used and most efficient of the stim- 
ulating expectorants, coming especially into play in the advanced stages of 
ordinary bronchitis. The syrup (Syr up us Scillee, U. S.) is the favorite ex- 
pectorant preparation. As it contains acetic acid, it is incompatible with the 
carbonate of ammonium. The Compound Syrup of Squill (Syrupus Sc dine 
Compositus, U. S.: squill, seneka, aa one hundred and twenty parts; tartar 
emetic, three parts to two thousand parts) contains one grain of tartar emetic 
to the ounce, and is therefore sedative to the circulation, although stimulant 
to the bronchial mucous membrane. It is, of course, in large doses a power- 
ful emetic; and, under the name of Coxe's Hive Syrup, it is very frequently 
used in the domestic treatment of croup. The dose of the simple syrup is 
one-half to one fluidrachm; of the compound, twenty to forty drops; as an 
emetic to children, ten drops to a fluidrachm, according to age, repeated 
every twenty minutes until it operates. 
Fix Liquida.- Tar is a black semi-liquid substance, of peculiar odor 
and taste, obtained by the destructive distillation of various species of pine. 
The tar used in this country is almost exclusively the product of the Pinus 
palustris of North Carolina and other of the Southern States. In composi- 
tion it is very complex, containing pyroligneous acid, creasote, empyreumatic 
oil, and a number of more or less peculiar principles. When distilled, it 
yields an oily liquid, known as oil of tar, and a solid, black residue, pitch. 
It is freely soluble in alcohol, ether, and the fixed and volatile oils, and also 
to a slight extent in water. 
Physiological Action.-As tar contains a notable proportion of 
creasote, if taken in sufficient quantity it is capable of exerting the peculiar 
influence of that agent upon the system. But creasote is not the only 
active principle in it: hence tar differs from that drug in acting more than 
it does upon the mucous membranes. That tar is capable of acting as a 
poison is shown by the case reported by Taylor (Principles and Practice of EXPECTORANTS. 
583 
Medical Jurisprudence, 2d ed., vol. i. p. 334), in which death resulted in a 
man from taking by mistake the oil of tar. To cause death, tar itself would 
have to be ingested in enormous quantity, since a sailor (according to Stilly 
is said to have recovered after taking between a pint and a quart of it. 
Applied to any part, tar acts as a very decided stimulant. 
Therapeutics.-Tar is used internally almost solely as a stimulant ex 
pectorant in the advanced stages of obstinate acute bronchitis, or in chronic 
bronchitis. Its chief use in medicine is in chronic diseases of the skin, as 
a stimulant application in the form of the officinal ointment (Unguentum 
Pids Liquid#, U. S.,-equal parts). In many cases this is too severe, and 
the strength must be reduced. Prof. Hebra states, in his work on diseases 
of the skin, that if it be applied too freely enough of the tar may be 
absorbed to darken the color of the faeces and the urine, and even to cause 
gastric irritation and black vomit. Tar Water may be used internally, in 
doses of half a fluidounce to one fluidounce; a better preparation is the 
Syrup of Tar (^Syrupus Picis Liquid#-6 to 100, U. 8.),-dose, half a fluid- 
ounce. CLASS VL-EMMENAGOGUES. 
Emmenagogues are medicines which are employed to promote the men- 
strual flux. As the stoppage, scantiness, or non-appearance of this secretion 
arises from very different causes, and as these causes are of diverse or even 
opposite natures, and may often be removed by drugs, it is obvious that very 
many remedies of very different character are indirect emmenagogues. Thus, 
amenorrhoea may depend upon plethora, or it may be the result of anaemia; 
and whilst in the one case depletory medicines are indicated, in the other 
case tonics are no less essential. Besides these indirect emmenagogues, there 
are other substances which appear to act directly as stimulants to the uterine 
mucous membrane; and indeed it is probable that many of the indirect em- 
menagogues possess more or less of this power. The emmenagogues may 
be conveniently arranged in three groups: the tonic emmenagogues, the 
nurgative emmenagogues, and the stimulant emmenagogues. 
TONIC EMMENAGOGUES. 
Iron is the most prominent member of this section of the emmenagogues. 
By far the larger number of cases of amenorrhoea are associated with, if not 
dependent upon, anaemia, and are benefited by the use of iron. It should be 
given in full tonic doses until the anaemia is relieved or the powerlessness of 
the remedy to effect such change is demonstrated. It is very rarely proper 
to rely solely upon the iron, which in the great majority of instances should 
be combined with more decidedly active emmenagogues. 
Myrrh has some reputation as a tonic emmenagogue, but, as it is always 
employed in combination with other more active medicines of its class, the 
role it plays is somewhat uncertain. It should be employed in atonic uterine 
conditions, and is said to be especially valuable when chronic pulmonary 
complications exist. The preparations of it most used in amenorrhoea are 
the compound pills of iron, the compound mixture of iron, and the pills of 
aloes and myrrh. 
584 EM MEN A GOG UES. 
585 
PURGATIVE EMMENAGOGUES. 
Aloes is believed by some to act as an emmenagogue solely by virtue of 
its stimulant action upon the rectum, but it very probably directly affects the 
uterine mucous membrane. Be this as it may, it is a stimulant emmena- 
gogue, especially useful when atonic amenorrhoea exists with constipation. 
Ordinarily it should be given in repeated doses (three times a day) of 
such size as will produce daily one or two soft, semi-liquid stools. At the 
menstrual period advantage may be sometimes derived from the administra- 
tion of a full purgative dose. It is almost always given in combination, 
especially with iron, whose tendency to constipation it obviates. In plethoric 
amenorrhoea, when torpidity of the bowels is present, salines, and not aloetic 
purgatives, should be employed. 
Black Hellebore has been used by some as a purgative emmenagogue, 
but is now very rarely if ever employed. From twenty drops to a fluidrachm 
of the tincture may be given three times a day. 
STIMULATING EMMENAGOGUES. 
With the exception of guaiac, of parsley, and of one drug of animal origin, 
the medicines of this class depend upon a volatile oil for their virtue, and 
are very closely allied in their physiological and therapeutic action. 
SABINA-SAVINE. U.S. 
The dried tops of Juniperus Sabina, a juniper, native of the south of 
Europe and the Levant, but very similar to our native species, the Juniperus 
Virginiana, or red cedar. The active principle is a pale or dark yellow, when 
highly rectified colorless, volatile oil, which has a strong terebinthinate odor 
and burning taste, and is officinal (Oleum Sabinx). 
The oil of savine is a powerful local stimulant, causing burning and red- 
ness when applied to the skin, and is capable of producing fatal gastro- 
intestinal inflammation. Taken internally in minute doses, its effects are 
confined to a sense of warmth, with perhaps some ill feeling in the stomach, 
and slight acceleration of the pulse. After larger amounts, the arterial ex- 
citement is more pronounced, and is accompanied by an increased frequency 
of urination, and sometimes, also, by an actually increased flow of urine. 
The symptoms induced by poisonous doses are: severe abdominal pain; 
incessant vomiting and bloody purging; diminution or even suppression of 
the urine, which is often albuminous and bloody; disordered respiration; 
symptoms of disturbed innervation, such as unconsciousness, stertorous 
breathing, convulsions or convulsive tremblings; the scene closing by death 
in collapse. In pregnant females, abortion, accompanied by violent flooding, 586 
LOCAL REMEDIES. 
almost always occurs before the fatal issue. After death, signs of gastro- 
intestinal inflammation are generally present, but in some instances these are 
wanting, and in one case reported by Dr. Letheby (London Lancet, 1845) 
pulmonary apoplexy and congestion of the brain were the chief lesions. 
Taken in small, repeated doses, savine is a powerful stimulant to the uterine 
system, and may be used as such in atonic amenorrlwea. Its powers in 
menorrhagia dependent upon a relaxed state of the uterine tissues are even 
more pronounced. Its use as an abortifacient is accompanied by the gravest 
dangers to life. In uterine disease of a sthenic type savine is strongly 
contra-indicated. The dose of the oil (Oleum Sabin ee, U. S.), the only 
preparation which should be used, is from five to ten drops, repeated every 
three or four hours. 
RUTA-RUE. 
The leaves of Ruta graveolens, or common garden rue, an undershrub oi 
the south of Europe. Rue has a strong peculiar odor, a warm, bitter, acrid 
taste, and is dependent for its medical properties upon a peculiar volatile oil, 
although it also contains a crystalline neutral body, Rutin. 
The influence of rue upon the system is similar to, but less decided than, 
that of savine. Locally it is an irritant, producing, when applied to the skin 
persistently or in a concentrated form, such as the oil, burning, redness, and 
vesication. According to M. Helie, taken internally, in large doses, it causes 
violent gastric pains, excessive and sometimes bloody vomiting, profuse sali- 
vation and swelling of the tongue, great prostration, confusion of mind, and 
convulsive twitchings, with, in pregnant women, abortion. Rue has been, and 
probably still is, employed in Europe for the production of criminal abortion, 
and, although its use for this purpose certainly endangers life, I have met 
with no record of a fatal case. Indeed, the only death from rue that I am 
cognizant of occurred in a man weakened by dysentery (case, Dr. G-. F. 
Cooper, Med. Examiner, N. 8., ix. 720). Like savine, it is employed both 
in amenorrlwea and in menorrhagia when dependent upon uterine atony ; and 
especial advantage has been claimed for the combination of it with savine. 
Owing to the aromatic properties of its oil, it has been used somewhat as 
a carminative. The oil, the only proper preparation, may be used in doses 
of from three to six drops every three or four hours. 
PETROSELINUM-PARSLEY, 
The root of the Petroselinum sativum, or common parsley. It contains 
a peculiar, non-nitrogenous, liquid, neutral principle, Apiol, which resembles 
somewhat the fixed oils, but is not saponifiable; a glucoside, apiin, and a 
volatile oil. 
Physiological Action.-The volatile oil of parsley has probably the 
same physiological and therapeutic value as the more ordinary essential oils, 
and according to Mitscherlich very large quantities of it (half an ounce) will 
produce death in the rabbit, largely, no doubt, owing to its local irritant EMMEN A GOG UES. 
587 
action. The chief interest of parsley to the physician centres in apiol. Ac- 
cording to the discoverers of this principle, MM. Joret and Homolle (Jour- 
nal de Pharmacie, 3e s6rie, xxviii. 219), one gramme of it will produce 
in man a cerebral excitation very similar to that induced by coffee, without 
other symptoms. In doses of from two to four grammes it causes a species 
of intoxication, with vertigo, ringing in the ears, and severe frontal headache. 
-a group of symptoms very similar to those seen in cinchonization. 
Therapeutics.-Apiol was introduced by its discoverers as a remedy in 
intermittent fever, over which, they asserted, it exercised a control secondary 
only to that of quinia. A commission of the Paris Society of Pharmacy 
reported that it would cure about half the cases of quotidian and tertian, 
but was powerless against the quartan ; also, that a return of the paroxysm 
was more common after apiol than after quinia. Clinical experience subse- 
quent to these experiments has, I think, demonstrated that the drug has some 
power over malarial disease, but is very inferior to quinia. In one or two 
cases in which the latter could not be employed on account of the idio- 
syncrasies of the patient, I have used apiol very successfully. Joret and 
Homolle also employed the drug in intermittent neuralgia, and in amenor- 
rhoea as well as in dysmenorrhoea. Joret (Bulletin Therap., Feb. 1860) has 
recommended apiol very highly in the last two affections, and his results 
have been confirmed by Marotte (Ibid., t. Ivi., 1863) and other writers. 
When there was very decided plethora, the apiol was thought by Marotte 
not to be so efficacious as at other times. In any case of amenorrhoea de- 
pendent upon or associated with anaemia or other systemic vice, the continu- 
ous administration of iron, tonics, or other suitable medicines must not be 
neglected. The apiol is given not between the menstrual periods, but just 
before the latter. Joret and Homolle believe that small doses (three grains 
twice a day) of it should be exhibited for the week preceding the expected 
return of menstruation. If any symptoms of the menstrual molimen appear, 
fifteen grains of it may be administered in the course of a few hours ; or they 
may be given daily for two or three days at the expected time. In intermit- 
tent fever, the same quantity may be exhibited four or five hours before the 
expected paroxysm. On account of its exceedingly disagreeable taste, apiol 
is always administered in capsules, one of which, as imported from France, 
usually contains the fourth of a gramme (gr. 3.9). 
Cantharides is a very decided uterine stimulant, and is much used as 
an ingredient of emmenagogue mixtures. From three to five drops of the 
tincture may be given three times a day ; if no unpleasant symptoms arise, 
the dose may be cautiously increased to eight drops, the production of 
strangury being of course sedulously avoided. 
Guaiac, as an emmenagogue, is much less stimulating than cantharides, 
and is believed by some to be especially useful in rheumatic dysmenorrhoea. 
In this affection, full doses of the ammoniated tincture should be given. The 588 
LOCAL REMEDIES. 
following formula, adapted from one of Prof. Dewees, and known as Dewees's 
Emmenagogue Mixture, I rely upon almost exclusively in the treatment of 
simple atonic amenorrhoea. The proportion of the various ingredients should 
be varied to suit the exigencies of individual cases. Thus, the amount of 
iron should be altered according to the extent of the anaemia; of the aloes, 
according to the state of the bowels; of the cantharides. according to the 
susceptibility of the urinary organs : 
R Tincturae ferri chloridi, f3iii; tincturae cantharidis, f3 i; tincturae aloes, 
f^ss; tincturae guaiaci ammoniatae, f^iss; syrupi, q. s. ad f^vi. S.-Table- 
spoonful three times a day. 
Tanacetum, U. S.-The common tansy of the gardens in the form of 
decoction, or of its volatile oil, is sometimes used as a stimulant emmena- 
gogue or for the purpose of producing abortion, but is a very unsafe remedy. 
When taken in sufficient amount it causes abdominal pain, vomiting, loss of 
consciousness, and violent epileptiform convulsions.* The minimum fatal 
dose of the oil of tansy which will cause death is not known, but in two 
cases (Cincinnati Lancet and Clinic, 1881) a teaspoonful of the oil pro- 
duced violent epileptiform convulsions, and the same amount is said to have 
caused death (U. S. Disp.^. Recovery has occurred after one and a half 
fluidrachms (Loud. Med. Rec., 1882, p. 48). The action of the oil upon 
the lower animals has been studied by Prof. Guillery (Bull. Acad. Roy. 
Med. Bruxelles, 1878, xii.). In frogs the most important effects which he 
found it to produce were paralysis of the peripheral endings of the motor 
nerves, with early appearance of post-mortem rigidity ; paralysis of the vaso- 
motor centre of the medulla, and of the inhibitory cardiac apparatus, with 
at last paralysis of the heart itself. In warm-blooded animals the oil pro- 
duced symptoms precisely similar to those it causes in man. After section 
of the spinal cord the convulsions did not occur in the hind legs, and are 
therefore of cerebral origin. The arterial pressure was not affected until 
death was at hand, so that it is evident the drug has little action upon the 
heart. 
Oil of Pennyroyal.-The oil of Mentha pulegium is sometimes used as 
a stimulating emmenagogue in domestic practice, but has very little power. 
Two fluidrachms taken by a young lady produced vertigo, faintness, muscular 
weakness, frequent feeble pulse, cold skin and extremities (Dr. C. A. Bryce, 
South. Clinic, vi. 323). 
* For references to fatal cases, most of which have occurred in the United States, see 
U. S. Dispensatory, also Prof. Guillery (loc. cit.). Prof. Guillery believes that the symp- 
toms caused by the oil and by tansy tea are different. In a case of poisoning by the 
leaves, however, reported in the Nashville Med. and Surg. Journ., 1879, xxiii., the symp- 
toms were those alleged to be characteristic of oil-poisoning, and the oil probably is the 
only active principle of the drug. CLASS VII.-OXYTOCICS. 
Oxytocics are those remedies which are employed during or directly after 
parturition, to increase the uterine action. It has been asserted that the 
sulphate of quinia is a member of this class ; but, as this subject has been 
already fully discussed, no more will be here said about it. The power of 
stimulating the uterine pains has been claimed for various drugs, but at 
present there is only one substance really used for this purpose; and instead 
of discussing under the general heading the indications for and the dangers 
attending the employment of oxytocics, I shall do it in the article upon 
Ergot. 
ERGOTA-ERGOT. U.S. 
Ergot is a blackish body, one to two inches in length, irregularly cylin- 
drical, grooved along one side, and very generally curved. When examined 
under the microscope, it is seen to be composed of very thick-walled cells, 
which contain oil-drops but no starch. Various opinions have been ad- 
vanced in regard to the nature of this body; but as by the researches of 
Tulasne (Annates Scien. Natur., Bolan., 3e s6rie, t. xx., 1853) it has been 
determined exactly what it is, I shall not occupy space with a discussion of 
the older views. Among the lowest of vegetable organisms, and distinguished 
from all other plants by the absence of chlorophyl, are the fungi. There are 
in most cases two distinct states or stages in the life of a fungus: in the first 
of these, the vegetative period, it exists as a mycelium, a usually filamentous 
mass or flocculus, whose sole function is to grow and increase; in the second 
stage the thallus, or ordinary fungus or mushroom, is formed, and to it is 
assigned the function of developing reproductive bodies, after whose forma- 
tion it perishes. Between these stages there is in some fungi an intermediate 
one, in which the plant exists as a sclerotium. The genus Claviceps com- 
prises a number of parasitic fungi, which develop in the pistils of the various 
species of Gramineae. The officinal ergot is the sclerotium of the Claviceps 
(C. purpurea, Tulasne) which infests the grain of the Secale cereale, or rye. 
The first appearance of the fungus is during the earliest life of the pistil, at 
the base of which there arises a minute flocculent mass of mycelial filaments. 
These filaments, continually growing and invading all parts of the tissue of 
the pistil, at last form of it an irregular whitish body, at the base of which 
after a time appears a dark-colored body, the sclerotium, which continues to 
589 590 
LOCAL REMEDIES. 
grow, lifting up the diseased and withering mass formed out of the original 
pistil, and finally developing into a perfect ergot. If a fresh, living ergot be 
placed in a damp, warm place, after a time little cracks will appear in its 
surface, and through these cracks little round bodies will project, and finally 
be raised up on stalks and constitute perfect thalli,-minute fungi, which 
finally produce spores. 
Ergot is an exceedingly complex substance, containing nearly thirty-five 
per cent. (Legrip) of an inert fixed oil, and, in minute amount, a peculiar 
ammoniacal base, which was stated by Winckler to be propylamia, but ap- 
pears really to be trimethylamin. What its activity depends upon is unsettled, 
every chemist who has studied it arriving at a diverse result. Three alka- 
loids have been described from it; two non-crystallizable, Ecbolina and Er- 
gotiua, by Winckler (Amer. Journ. Pharm., May, 1864), and one crystal- 
lizable, Ergotinine, by Tauret (Ball. Therap., xciii., p. 231) ; three acids, 
Ergotic, Phosphoric (Levi, Lo Sperimentale, Aug. 1875), and Sclerotinic 
(Dragendorff and Podwissotzky, Arch. Exper. Path, und Pharmak., Bd. 
vi., 192) ; also various other substances of even still more doubtful nature.* 
As pretty much all are agreed that the watery extract contains all the active 
ingredients, it may be used as the nearest approach to the active principle 
at our command. 
Physiological Action.-In ordinary therapeutic doses, ergot causes no 
immediate perceptible symptoms ; but when a sufficient amount is exhibited, 
it acts as a poison both upon man and animals. Before considering its 
action when given in small quantity, I shall discuss the toxic effects of the 
drug. 
According to Diez (quoted by Stills), the principal effects of poisonous 
doses of ergot are in the lower animals profuse salivation, vomiting, dilata- 
tion of the pupils, hurried breathing, frequent pulse, cries, trembling, stag- 
gering, paraplegia, sometimes diarrhoea, sometimes constipation, prostration, 
urgent thirst, convulsions, f and death. Mr. Sami. A. Wright, in a series of 
* Besides papers quoted, the reader desirous of following up the subject should look at 
llaudelin {Schmidt's Jahrbdcher, Bd. civ.; T. C. Hermann {B'dchner's Repertorium fur 
I'hG-m., 1871J Bucheim {Arch. Exper. Pathol, u. Pharmak., Bd. iii.; also Berlin. Klin. 
Wbchens., 1876, p. 309; Salkowski {Berl. Klin. Wochensch., 1876, p. 22); Zweifel {Arch, 
f. Exper. Path. w. Pharm.., Bd. iv.). 
f Pereira {Materia Medica, 3d American edition, vol. ii. p. 137), on the authority of 
Phoebus, states that in the experiments of Diez convulsions were not present. 
Sclerotinic Acid.-Dr. Max Stumpf {Deutsch.. Arch. Klin. Med., xxiv. 417) asserts that 
in various hemorrhages he has obtained from the hypodermic use of sclerotinic acid most 
happy results, but Dr. Rennerb {Centralb.fur Gynecologie, 1879) has met with nothing but 
failure. Dr.W. Nikitin ( Wiirzburger Phys. Med. Verhand, xiii.) has studied the physiological 
action of the acid upon frogs, cats, and rabbits. I have seen the report only in abstract, 
but it is stated that the fatal dose for rabbits was fifteen grains; that directly after the 
injection the bodily temperature fell from 1° to 3°, and that there was a progressive low- 
ering of muscular power and arterial pressure, and, finally, death from failure of respira- 
tion. The paralysis was found to be spinal, and when pregnancy existed contractions oi OXYTOCICS. 
591 
experiments {Edinburgh Med. and Surg. Journ., Oct. 1839, vol. lii.), noted, 
when the medicine was given by the mouth, symptoms similar to those just 
spoken of: the paralysis was much more marked than the spasms. Late in 
the poisoning, the heart's action became irregular and intermittent, and the 
pulsations, which had been rapid, grew slow and feeble. In some cases the 
special senses seemed to be destroyed, and coldness of the surface was a very 
prominent symptom. Mr. Wright also injected a strong infusion of the drug 
directly into the torrent of the circulation. Death was in some cases pro- 
duced in nine minutes, the symptoms being immediate dilatation of the pupils, 
great increase in the rate of the cardiac pulsations, paralysis, and convulsions. 
When the fatal result was not brought about in so short a space, great anaes- 
thesia of the surface was noted a considerable time before death ; coldness 
of the surface and paralysis of the special senses were also present in some 
cases. In Dr. Kersch's experiments {Betz's Memorabilien, vol. xviii.*) the 
concentrated infusion was injected into the jugular vein ; the coldness of the 
surface was especially noted, and also great muscular rigidity. Upon rabbits, 
according to the researches of Wright, ergot acts very feebly. In birds, 
as represented by chickens, turkeys, and pigeons, it causes symptoms analo- 
gous to those produced in mammals, as is testified to by Tessier and by Gross, 
both quoted by Stille, and by Bonjean {TraiU de I'Ergot de Seigle, Paris, 
1845). Enormous doses of ergot are required to produce toxic symptoms 
in animals, since in one of Wright's experiments an amount equivalent to 
two drachms for every pound weight of the dog failed to kill. 
Upon man the toxic influence of ergot is also very slight, and, although I 
have given the fluid extract in ounce doses, I have never seen it cause any 
distinct symptoms.f Fatal abortion has several times been produced by ergot; 
but I know of but two instances of decided poisoning in a non-pregnant 
person. In the first case ( U. S. Dispensatory} gastric irritation, thirst, diar- 
rhoea, burning pain in the feet, and convulsions are said to have preceded 
death. In the second case (Dr. G. S. Oldright, Canada Med. Journ., 1870, 
p. 404), two hours after taking the drug (amount not stated) there were 
developed tingling in the fingers and feet, cramps in the legs, arms, and 
chest, with dizziness and weakness; the pupils were dilated, the pulse was 
very small, and a feeling of coldness was complained of. These symptoms 
the gravid womb were produced. On the other hand, a series of experiments at the lab- 
oratory of the University of Pennsylvania made by Dr. Chas. M. Seltzer with imported 
sclerotinic acid, showed that this acid at least did not at all represent ergot, and at present 
it does not seem probable that sclerotinic acid will prove of practical value. 
* Unfortunately, I have not had access to Kersch's paper, and know it only by abstracts 
in The Medical Times of Canada, vol. i., and Schmidt's Jahrbucher, Bd. clx. p. 120. 
j- For cases, see Neubert, Journ.fur Pharmacodynamik, Bd. ii. p. 483, 1860, also, same 
case, Richter, Caspar's Vierteljahrschrift, Bd. xx. p. 177; Tardieu, Ann. d'Hyg., 1855, vol. 
i.; Toledo Med. and Surg. Journ., July, 1878. 592 
LOCAL REMEDIES. 
were relieved by the administration of stimulants and the use of external 
heat; after a time they recurred with greater violence; finally, under the 
reinstitution of the measures previously employed, the face became intensely 
congested and purplish red, pain in the head was felt, the patient seemed 
much excited,* and convulsions were feared, but did not occur; there was 
some diarrhoea, with dark-gray stools. In the case recorded by Neubert 
(loc. cit.}, the great coldness of the surface was especially noted; and as 
this symptom was very prominent in the case recorded in the Toledo Medical 
and Surgical Journal, and has been so commonly remarked in ergotized 
animals, it probably is characteristic of poisoning by the drug. Dr. Davidson 
reports a case with fluid blood, jaundice, and universal hemorrhages, attrib- 
uted with doubtful correctness to poisoning by ergot (London Lancet, ii. 
1882, p. 526). 
The above summary of the general symptoms caused by poisonous doses 
of ergot shows that the phenomena are mainly paralytic in their nature; but, 
although an enormous amount has been written about the drug, we have very 
little knowledge as to the immediate causes of the paralysis. Since both 
Wright (loc. cit., pp. 320, 321) and Kohler have found that the voluntary 
muscles are not affected by ergot, it would seem that the nervous system 
must bear the brunt of the poison. Eugene Haudelin is said to have shown 
that the peripheral nerves are not affected,f and the experiments of Kohler 
have confirmed this so far as concerns the motor nerves and the watery ex- 
tract of ergot. He found, however, that those portions of the drug not soluble 
in water appeared to increase the excitability of the peripheral efferent nerves, 
and that upon the peripheral sensory nerves both portions of the ergot acted 
as a feeble depressant. On the whole, it is probable that the chief action of 
the drug is upon the nerve-centres. 
The chief interest to the therapeutist in regard to the physiological action 
of ergot centres upon its influence on the circulation, especially on the blood ■ 
vessels, and upon its action on the impregnated uterus. I shall discuss these 
points seriatim. Before doing so, it would be, perhaps, best to speak of the 
chronic poisoning by ergot; but, as any deductions from the symptoms of 
ergotism as to the physiological action of the drug would be at best only 
inferences, I shall defer the consideration of the subject to the section on 
toxicology. 
Action on the circulation.-Although the heart is profoundly affected in 
acute poisoning by ergot, yet death is probably not due to this cause, since 
Wright (loc. cit., p. 320) found that after death, even though the heart was 
quiet, it commenced to beat so soon as the congestion was relieved by an 
incision, and continued to pulsate for fifteen minutes. 
* These symptoms were very probably caused by the large quantities of alcohol taken. 
f Inaug. Dissert., Dorpat, 1871. I have seen only an abstract, contained in Schmidt's 
Jahrhucher, Bd. civ. p. 142. OXYTOC1CS. 
593 
One of the earliest careful cardiac studies of ergot is that of P. Eberty 
(abstracted, Schmidt's Jahrbucher, Bd. clviii. p. 127). He found that 
in the frog the injection of a gramme of ergotin caused a diastolic arrest 
of the heart, and that the viscus was unable to respond at all to stimuli. It 
is inconceivable that this can be due to other than a direct action of the 
drug upon the cardiac muscle; yet Eberty seems to believe it is caused 
by an influence exerted through the pneumogastrics, and it is said that after 
division of these nerves even very great quantities of ergotin are powerless 
to produce cardiac arrest. 
In man, full doses of ergot unquestionably diminish the frequency of the 
pulse, since the phenomenon has been independently noted by Parola, Gib- 
bon, Arnal, Hardy, Beatty (all quoted by Prof. Stills), and by Profs. Bailly 
and See (Bulletin Th^rap., t. Ixxviii. p. 435); but the method in which 
this reduction is brought about is uncertain. The amount of the reduction 
varies from ten to thirty-five beats per minute; but very rarely is the pulse 
reduced below sixty even by the largest doses. According to Eberty's ex- 
periments, therapeutic doses of the drug produce in mammals, as in man, 
slowing of the heart's beat. It was found that in frogs the pulsations of 
the heart were still affected after destruction of the medulla, but that in 
mammals, after paralysis of the peripheral vagi by atropia, ergot was power- 
less to alter the cardiac rhythm. These experiments, if correct, appear to 
prove that ergot acts as a stimulant to the peripheral cardiac nerves, and 
that the reduction of the number of beats is due to this, and is independent 
of the nerve-centres. Boreischa has noticed that toxic doses quicken the 
heart's action, and that under these circumstances galvanization of the par 
vagum has little or no effect upon the heart. It would seem, therefore, as if 
the drug first stimulated and then paralyzed the peripheral pneumogastrics. 
As early as 1827, M. Courhant advanced the opinion that ergot produces 
a spasm of the blood-vessels; but, although his theory was very generally 
adopted, only within a very few years has any earnest attempt been made to 
prove or disprove its correctness. In 1870, Dr. Ch. L. Holmes (Archives 
de Physiol., t. iii., 1870) found that when the blood-vessels of the frog's 
web were watched under the microscope and the animal poisoned either with 
the aqueous extract of ergot or with the powdered drug, the vessels, both 
venous and arterial, could be seen to undergo a very great contraction. Dr. 
A. Wernich ( Virchows Archiv, 1872, Bd. Ivi. p. 510) observed that when 
rabbits in which the arteries of the thigh, back, pia mater, etc., were ex- 
posed, received full doses of ergot, these arteries could be seen to undergo 
a very remarkable diminution in their calibre. These observations have 
been confirmed by other observers, among whom may be mentioned Vogt, 
Dr. S. Kersch (loc. cit.'), Max. Schuller (Berliner Klin. Wochensch., 1874, 
p. 305), and Boldt (Schmidt's Jahrbucher, March, 1872). The latter 
observer also affirms that there ran through the ergotized capillaries wave- 
like, peristaltic spasms. Patrick Nicol and J. Mossop (Brit, and For 594 
LOCAL REMEDIES. 
Medico-Chir. Rev., vol. 1., 1872) have noted with the ophthalmoscope the 
contraction of the retinal vessels after the exhibition of ergot in man. 
If general vaso-motor spasm be produced by ergot, unless the heart's 
action be greatly weakened by the drug there must be a very decided rise in 
the arterial pressure. The question as to the existence of this rise was first 
investigated by Dr. Ch. L. Holmes (loc. citj. This experimenter injected 
the aqueous extract directly into the jugular vein of the dog, whilst the 
manometer or the kymographion was connected with one of the main arteries. 
The phenomena induced were immediate, rapid, and very decided depression 
of the arterial pressure, with violent cries and efforts on the part of the dog, 
followed by a period of quiet and a rise of the arterial pressure above the 
normal point. Twenty-three experiments were performed: in two of them 
the first depression of the arterial pressure was wanting; in six of them the 
arterial pressure did not rise above normal. As the experiments are not 
reported in detail, it is not possible to point out in all the cases the causes 
of these exceptional phenomena; but Dr. Holmes mentions sickness of the 
animal, death during the stage of depression, or some other obvious reason 
for the departure from the usual results, as being present in nearly all the 
cases, so that the exceptions are, I think, at present best disregarded in the 
interpretation of the phenomena. As Kohler and Eberty ( Virchow's Archiv, 
Bd. lx. p. 384) and myself have all found that ergotin (Bonjean's) raises the 
arterial pressure enormously in frogs and mammals, the fact must be accepted 
as proven. 
Dr. Holmes tried the effect of the injection of the ergot after section of 
the cardiac nerves, but obtained results so varying and contradictory that he 
could come to no other conclusion than that the alterations of the arterial 
pressure produced by ergot are not dependent upon its cardiac action. In 
the absence of details of these experiments, we can but accept this conclusion. 
The unexpected result in the investigation of Dr. Holmes was the primary 
depression of the arterial pressure, a depression which at first sight seems 
incompatible with the idea that ergot contracts the vessels. It is, of course, 
possible that the fall of pressure may be due to an intense action of the drug 
upon the heart; but Dr. Holmes, in order to explain it, propounds a theory 
which is very plausible, but which he certainly does not prove to be true. 
Uis idea is that the first fall of the arterial pressure is due to a spasm of 
the pulmonic capillaries, hindering the blood in its passage to the left heart, 
and thereby causing venous repletion and arterial depletion. It is to be 
remembered that he injected the ergot directly into the jugular vein, so that 
the whole force of the remedy fell directly upon the pulmonic circulation. 
It is evident that this matters very little if ergot produces vaso-motor spasm 
only through an influence upon the nerve-centres, but that it does make a 
material difference if the contraction of the vessels be the result of a local 
action. Holmes asserts that after section of a sympathetic nerve and injec- 
tion of the ergot the vessels supplied by the divided nerve can be seen to OXYTOCICS. 
595 
contract; and Wernich confirms this observation. If ergot does thus cause 
vaso-motor spasm, it is plain that in Dr. Holmes's experiments this spasm 
must have been very intense in the lungs before the systemic capillaries 
were affected. Our investigator proved by experiment what a priori seems 
necessarily true, that if blood be prevented from passing freely to the lungs 
the arterial pressure falls very greatly. In this connection it is worthy of 
notice that the period of arterial depression following the injection of the 
drug into the jugular vein was very brief. In the only experiment detailed 
in full by Dr. Holmes, the pressure began to rise in three minutes after the 
completion of the injection; in five minutes it was nearly normal, and in 
eleven minutes it was above the normal point. If the asserted facts are all 
true, the theory of Dr. Holmes is plausible. It is, however, very doubtful 
whether the ergotic spasm is local in its origin. Evidence derived from 
judging by the eye as to whether a vessel does or does not contract must be 
taken cum grano salts, and the observations of Holmes, of Wernich, and of 
J. H. Peton (De I'Action Physiol, et Therap. de I'Ergot, Paris, 1878) are 
directly contradicted by the apparently careful and elaborate experiments of 
Dr. Paul Vogt (Berliner Klin. Wochenschr., 1869, No. xii.), in which the 
dilated vessels of the ear of a rabbit whose cervical ganglion had been ex- 
tirpated could not be made to contract by ergot.* 
The results obtained by P. Eberty (Inaug. Dissert., Halle, 1873) are in 
accord with those of Vogt, and disagree with those of Dr. Holmes, especially 
in their bearing upon the question whether the contraction of the arteries 
is centric or peripheric in its origin. He finds that the arterial pressure 
rises directly and enormously after the injection of ergotin. This rise, 
which he acknowledges to be chiefly due to the contraction of the vessels, 
occurs in the veins as well as in the arteries, and in the frog as well as in 
the dog and the rabbit. According to his experiments, it must be, at 
least in the batrachian, centric, since in the frog it does not take place 
after destruction of the medulla. He also found that after the inhalation 
of nitrite of amyl the ergot caused rise of the arterial pressure. It is a 
fair inference that if the vaso-motor spasm be centric in the frog it is also 
so in the mammal. 
* In a series of experiments made by Prof. S. Ringer and Dr. H. Sainsbury {Brit. Med., 
Jan. 1884) upon tortoises according to the method of Gaskell (see Digitalis, p. 150), the 
addition of ergotin greatly slowed the rate of flow through the arterioles. 
These results certainly appear to be contrary to the previous drift of our evidence in 
showing that ergot acts locally upon the vessels. It was found, however, that the addition 
of ergotin to the saline solution used had no distinct effect until there was ten per cent, 
of the extract in solution. Ten per cent, of ergotin is enough very seriously to influence 
the viscidity of the saline solution, and it is probable that the slowing effect of the ergotin 
was the result of altered physical conditions; a conclusion which is corroborated by the 
fact that the records clearly show complete loss of vitality in all parts of the tortoise ex- 
perimented with, a loss of vitality which in all probability was shared by the arteries. 
Certainly these experiments cannot be accepted as valid in contradiction of the older 
results. 596 
LOCAL REMEDIES. 
In an especial investigation (Phila. Med. Times, vol. iv.) of the subject,/ 
I found that ergotin injected into a vein does, as Holmes states, produce in 
the mammal an immediate fall of the arterial pressure, which is shortly fol- 
lowed by an enormous rise. I also found that division of the cord, i.e., vaso- 
motor paralysis, does in dogs prevent the rise of the pressure, and hence that 
the latter is centric, due to a vaso-motor spasm. As the vaso-motor action 
of the drug must now be acknowledged as centric, the theory of Holmes 
falls. If this be true, the only conceivable cause of the first fall of pressure 
must be a direct action on the cardiac muscle, upon which the ergotin is at 
once precipitated when thrown into the jugular vein. That this is the real 
cause I think is demonstrated by the facts that the fall does not occur when 
the drug is introduced gradually into the circulation by hypodermic injec- 
tion, and that the drug is a poison to the cardiac muscle, as was shown in 
my experiments as well as in those of Eberty. 
Haudelin is stated to have found that the arterial pressure falls after the 
exhibition of the poison. Brown-Sequard has insisted (^Archives de Physi- 
ologic, 1870, t. iii. p. 434) that in ergotic poisoning there are two periods: 
first, vaso-motor spasm ; second, vaso-motor paralysis, and Haudelin noted 
a fall of arterial pressure after toxic doses. Dr. Boreischa (Arbeiten. 
Pharm. Laborat., Moskau, i. 55) also, in a number of experiments, using 
Bonjean's ergotin, found a very decided fall of pressure produced by the 
drug. In none of these experiments was there any rise of pressure at 
all; either the ergotin used was not equivalent to that employed by Holmes 
and myself, or else the result obtained was dependent upon the use of very 
large doses. In a series of experiments, Boreischa found that the fall of 
pressure after section of the spinal cord high up was proportionately not 
nearly so great as in the normal animal. This indicates that the fall of 
pressure was due to vaso-motor palsy. It would seem, therefore, that the 
conclusions of Brown-S^quard are correct, and that decidedly toxic doses of 
ergot lower the arterial pressure, by depressing both the heart and vaso-motor 
centres. 
Action on the intestines.-The fibres in the coats of the blood-vessels are 
certainly not the only non-striated muscles upon which ergot acts: indeed, 
the probabilities are strong that the drug influences muscular fibre of this 
character wherever it exists in the body. There is considerable evidence to 
show that it causes increased intestinal peristalsis. In Dr. Wright's experi- 
ments (Joe. cit., p. 320) the intestines were found in very active peristalsis 
at the post-mortem examination of the poisoned animal. Dr. Wernich 
( Virchow's Archiv, 1872, Bd. Ivi. p. 515) noticed that very violent peri- 
staltic movements followed the injection of ergot, as was seen not only in 
rabbits whose abdomens were opened, but in some cases even through the 
uninjured walls; and Haudelin has confirmed his observations. 
Uterus.-Upon the uterus of parturient women ergot exerts a very pro- 
nounced and fixed influence, increasing the length and force of the pains, OXY TOC ICS. 
597 
and, if it be given in sufficient dose, causing after a time violent tetanic 
cramp of the whole organ. The drug certainly acts in this respect upon 
the lower animals as it does upon man, since Youatt states that in a large 
experience, both with monogastric animals and ruminants, he has never 
known the drug to fail in its action on the uterus of the parturient female. 
The action of ergot in producing contraction in the impregnated but not 
parturient womb is by no means so constant. Upon animals, Dr. Wright 
found it to fail in all of a number of trials, as did also Bonjean in a single 
experiment. On the other hand, Diez (Stille, Therapeutics, 2d ed., vol. ii. 
p. 585), Oslere (Ibid.), and Percy and Laurent (Ibid.'') found it to cause 
abortion in guinea-pigs, sows, rabbits, cows, and cats; and M. Bodin has 
reported an epidemic of abortion occurring among cows near Trois Croix, 
which he attributes to feeding upon ergotized grasses (Journal des Connais- 
sances Medicales, 1842). The evidence of those who have used ergot for 
the induction of premature labor in woman tallies very closely with that 
which is brought forward in regard to the lower animals. As the matter is 
so fixed, I will not enter into an elaborate discussion of the effects of ergot 
upon pregnant women. To show that the fungus very often will act as an 
abortifacient, it is only necessary to quote Prof. Ramsbotham, who states 
(The Principles and Practice of Obstetric Medicine and Surgery, Phila., 
1860, p. 318) that he has made a "great number of trials," and found that 
"expulsive action soon followed its exhibition, with very few exceptions." 
It cannot be gainsaid, however, that very often the drug has failed: some- 
times, no doubt, because of poor quality or because given in insufficient dose, 
yet sufficiently often to show that its abortifacient action is uncertain.* 
Whether the uterine disturbance is of centric origin, or is due to a direct 
action of the drug upon the uterus and its nerve-fibres, is uncertain, although 
the drift of the present evidence is towards a peripheral action. Dr. Wernich, 
in two experiments, found that no vermicular movements were produced in 
the unimpregnated womb by ergot after section of the spinal cord; but in 
one of these experiments the animal was so feeble as to destroy any possible 
force the result might have, and I do not think much weight is to be 
attached to the evidence. On the other hand, Boreischa, in several experi- 
ments, succeeded in producing violent uterine movements after dividing all 
of the nervous connections of the organ. 
Therapeutics.-As a therapeutic agent, ergot is employed both by the 
obstetrician and by the physician; and I shall consider these uses of it 
separately. 
Owing to the power that ergot possesses of intensifying labor-pains, it has 
been long used in uterine inertia during parturition. Indeed, it was for this 
purpose that the drug was first employed in medicine, and thereby acquired 
* For a more elaborate setting-forth of the matter, the reader may consult Prof. Tay- 
lor's Principles and Practice of Medical Jurisprudence, 2d ed., 1873, vol. ii. p. 193. 598 
LOCAL REMEDIES. 
the name of puhis parturiens. The literature of the subject is immense, 
and all imaginable opinions as to the effects of the drug when given in labor, 
and as to the advisability of its employment, have been advanced ; but, with- 
out discussing these, I shall here simply point out the clearly-established 
rules for its use and the clinically-determined dangers and advantages of its 
employment. If ergot be given in very small doses during labor, the natural 
pains are simply intensified; but if the dose be large enough to have a de- 
cided effect, their character is altered: they become not only more severe, 
but much more prolonged than normal, and finally the intervals of relaxation 
appear to be completely abolished and the intermittent expulsive efforts are 
changed into one violent, continuous strain. It is evident that, if the resist- 
ance be sufficiently great, this may endanger the safety both of the mother 
and of the child. The dangers to the mother are twofold: there is a possi- 
bility of the uterus rupturing itself by its efforts ; and, when the head comes 
down upon the perineum, if the soft parts be rigid there is a very strong 
probability that they will be lacerated. The danger of uterine rupture is, I 
think, a remote one ; for although several alleged cases have been recorded, 
yet in very few is the accident clearly traceable to the asserted cause (see 
Still6, Therapeutics, 2d ed., vol. ii. p. 591). The fatal character of the acci- 
dent is such, however, that the possibility of its occurrence should always 
prevent the reckless use of the drug. 
The improper use of ergot is far more serious in its effects upon the child 
than upon the mother. During a violent uterine contraction, the passage of 
the blood from the placenta to the child must be interfered with, or, in other 
words, the respiration of the foetus is temporarily stopped, so that its life 
depends upon the aeration of the blood during the intervals. If the latter 
be very much shortened, the life of the child is greatly imperilled; and if 
they be abolished, it must be destroyed, unless delivery occurs in a very few 
moments. These considerations are, I think, sufficient, without further dis- 
cussion, to show the imperativeness of the rule never to give ergot in uterine 
inertia when there is much resistance, either in the bony or in the soft parts 
of the mother. In priiniparae such resistance is always to be looked for, and 
its degree often difficult to judge of beforehand; and in such women ergot 
should not be used at all for the purposes of expulsion. Even under the 
most favorable circumstances for its employment-when the woman has pre- 
viously borne children, when the bony pelvis is capacious, and the soft parts 
are relaxed and dilatable-its use should be entered upon with caution; and 
if the accoucheur be skilful in the application of instruments, cases must be 
rare in which the latter are not preferable to the ecbolic. 
In women of lax fibre, with roomy pelves, ergot may be used in uterine 
inertia if instruments are not at hand, or if they are objected to, or if the 
obstetrician is timid in their application. 
At the close of parturition, ergot is very commonly employed to prevent 
post-partum hemorrhage ; and in this case there is no objection to its use, OXYTOCICS. 
599 
and the remedy is invaluable. But, as it requires from fifteen to twenty 
minutes for its action when given by the mouth, ergot exhibited in this way 
cannot be relied upon to arrest flooding when it has already set in. To 
prevent the occurrence of the latter, it is an excellent rule to give a full dose 
of the ecbolic when the child's head is well down upon the perineum and 
beginning to emerge at the vulva. After labor, if a tendency to bleeding 
is manifested, the exhibition of ergot may be added to the other measures 
employed. Its hypodermic use under these circumstances would be emi- 
nently proper. 
For the induction of premature labor, ergot has been and still is to some 
extent used ; but it is uncertain in its action, and offers no advantages over 
instrumental methods. 
The success of ergot in arresting hemorrhage after labor soon led to its 
use in uterine hemorrhages in other than parturient or pregnant women ; and 
the next step beyond this was its employment in other hemorrhages. In all 
forms of hemorrhage in which no direct local application can be made, ergot 
is to-day probably the most generally used remedy; and even when local ap- 
plications can be made, if the bleeding be obstinate, ergot is very generally 
exhibited. It is thus employed in menorrhagia, in hemoptysis, hemorrhage 
from the gums, epistaxis, etc., etc. Ergot acts with especial rapidity and 
efficiency in these cases, if given hypodermically: used in this way, the sud- 
denness of the result in haemoptysis is sometimes surprising. Even when the 
hemorrhage is apparently dependent upon a dyscrasia, as in purpura hemor- 
rhagica, the hypodermic injections of ergotin sometimes produce the happiest 
results (cases, Brit. Med. Journ., ii., 1874; Philad. Med. Times, vol. v.). 
The value of the drug in hemorrhage is no doubt dependent upon its power 
of contracting the small vessels. In colliquative night-sweats due to relaxa' 
tion of the blood-vessels, ergot is a most efficient remedy. 
Allied to its use in hemorrhage is the employment of ergot in enlargement 
of the spleen from various causes. Dr. Da Costa was the first to suggest 
hypodermic injections of the drug for this purpose, and he claims to have 
even cured leukemia (Amer. Journ. Med. Sei.., Jan. 1875). 
It was the physiological action of ergot upon the muscular fibres in the 
walls of the vessels that led Prof. Langenbeck to try the effect of the hypo- 
dermic injection of the remedy in aneurism. The result obtained, as re- 
ported in the Berliner Klin. Wochensch. (vi., 1869), was surprising. How 
far surgeons have followed up this matter I do not know; but, according to 
Dr. Paul Vogt (Berliner Klin. Wochensch., March, 1872), Schneider has 
cured a case of femoral aneurism, and Dutoit one of the subclavian. Vogt 
has himself employed the remedy successfully in a very severe case of vari- 
cose veins of the legs, of many years' standing. The remedy is injected into 
the immediate neighborhood of the aneurism or varix, one or two grains of 
ergotin, or the aqueous extract of ergot dissolved in water and a little alco- 
hol, being employed every day. A good deal of local swelling and hardness 600 
LOCAL REMEDIES. 
is induced, and it is certainly a question whether the good achieved has not 
been simply the result of the local inflammation set up. 
Very many years ago, Dr. F. E. Barlan-Fontayral proposed (Journ. des 
Sci. med. pratiques de Montpellier, tomes vi., vii.) the use of ergot in chronic 
dysentery and diarrhoea, on account of its power of causing contraction 
of the capillaries; and Massolaz, in an epidemic of chronic diarrhoea among 
the French troops serving in the Orient, found that the suggestion was well 
timed. Although Barlan-Fontayral afterwards published a book (Le Seigle 
ergote et de I'Application de C Ergotine a la Cure de la Dysenteric et de la 
Diarrhee chroniques, Montpellier, 1858) upon the subject, yet it attracted little 
or no attention. In 1871, Prof. A. Luton, of Rheims (Gaz. Hebdomad., 
Oct.), stated, as something new, that he had used ergot with remarkable 
success in a violent and protracted epidemic of dysentery. Successful cases 
of chronic diarrhoea are also reported by other observers (see Schmidt's 
Jahrbilcher, Dec. 1871 ; Lancet, 1876, ii., p. 409), so that trials of the 
remedy should be made in all obstinate cases. 
Another employment of ergot for the purpose of restraining excessive 
secretion is in galactorrhoea, in which affection it has been used with success 
by Dr. Le Gendre (Bull. Therap., t. Ixxvii. p. 282) who was led to employ 
it by an observation of Drs. Poyet and Commarmond (Annal. de la Soc. de 
Med. de Saint-Etienne et de la Loire, 1863) that wet-nurses fed upon ergot- 
ized bread lost their milk. 
The use of ergot in diseases of the nervous system has recently attracted 
a good deal of attention. It would appear to be especially indicated in con- 
gestion of the nerve-centres, and in congestion of the cord has been especially 
commended by Brown-Sequard, Hammond, Beard, and others. I have em- 
ployed it with most excellent results in numerous cases, and there can be no 
doubt as to its great value when given in sufficiently large doses. In other 
diseases of the nervous system its use is not so clearly established. Dr. 
Hampel (Practitioner, vol. i. p. 263) recommends it in whooping-cough. 
Mr. Woakes believes the pain of neuralgia (Ibid., p. 257) to be due to 
congestion and serous effusion into the nerve-sheaths, and has used ergot with 
very good results. Dr. Daniel H. Kitchen (Amer. Journ. of Insan., July, 
1873) has employed it with great success in headaches of the most diverse 
and even opposite origins, and has cured (?) epilepsy with it. In the latter 
disease he continues its use for months. 
In 1872 (Berliner Klin. Wochensch., June 17), Prof. Hildebrandt an- 
nounced that in nine cases of fibroid tumors of the uterus he had used with 
the utmost advantage hypodermic injections of ergotin ; and this practice has 
been followed very widely on this continent. It is scarcely to be doubted 
that cures are sometimes effected, but probably in the majority of cases* the 
* See Amer. Journ. Med. Sei., July, 1873 ; Amer. Practitioner, May, 1873, May, 1874, 
August, 1874; the Clinic, April, 1873 ; the Lancet, May, 1873 ; Chicago Med. Journ., 1874; 
and especially Dr. Byford's Address, Trane, of Amer. Med. Aseoc., 1875. OXYTOCICS. 
601 
drug simply lessens the uterine congestion, and does good precisely as it does 
in chronic subacute metritis and in subinvolution and hypertrophy of the 
uterus (Meadows, Practitioner, vol. i. p. 166) ; it may be that sometimes 
it strangles the growth by causing uterine contractions. If the latter be 
the case, a cure, as is suggested by Prof. Goodell (Proceed. Med. Soc. of 
Pennsylvania, 1873), is to be expected from the remedy only in mural and 
submucoid tumors. 
An objection to the method of Hildebrandt is the great pain and local 
inflammation which often result; and Goodell proposes, as a substitute, the 
use of enemata or suppositories containing the drug. 
Very recently, led by a fancied resemblance between the physiological action 
of ergot and that of quinine, Dr. Duboue has proposed the fungus as a suc- 
cedaneum to the alkaloid in malarial fevers, and in support of his views has 
published a book entitled Rccherches sur les Proprietes therapeutiques du 
Seigle ergote, Paris, 1873. He brings forward some evidence of the value 
of the remedy; but probably the latter will share the fate of the older sub- 
stitutes for the South American specific. Dr. Th. Clemens (Deutsches K Unite, 
1865, p. 267) affirms that ergot affords the most potent relief in the ammo- 
niacal cystorrhoea of paraplegics. He gives it internally, but especially uses 
injections into the bladder of a solution of ergotin (gr. ii to f §v). Ergotin 
suppositories are asserted to be of great value in hemorrhoids (N. Y. Med. 
Record, xvi. 563). I have used them in one or two cases without benefit. 
Toxicology.-Enough has already been said in regard to the acute poi- 
soning by ergot, except it be to state that, when abortion is threatened from 
its ingestion, in the maintenance of perfect quiet and in the free exhibition 
of opium are to be found all the measures of relief at our command. 
Since the days of Galen, there have swept over larger or smaller districts 
of Europe epidemics of diseases which have been attributed to ergot. In 
many parts of Europe, rye bread forms the great staple article of food of the 
lower classes. It always contains a small quantity of ergot, but not enough 
to have any deleterious effect upon the health. When the summer is wet 
and cold, the rye becomes very extensively ergotized, so that the fungus con- 
stitutes a large proportion of the materials entering into the bread. It is 
under these circumstances that there occur those epidemics of ergotism or 
chronic ergotic poisoning which have been recorded from time to time since 
the days of Galen and of Caesar. It is not always the rye which causes these 
frightful losses of life, as Heusinger (Journ. fur Pharmacodyn., Bd. i. p. 
405) has traced one epidemic to diseased oats. Before going farther, it seems 
proper to state that no less an authority than Trousseau and Pidoux asserts 
that these epidemics are not dependent upon any specific action of ergot, but 
are either epidemics of blood-diseases or simply the results of improper and 
insufficient food,-merely the outcomes of poverty, wretchedness, and famine. 
It seems to me indisputable that some of the various epidemics which have 
been recorded were of this character, but certainly it is no less indisputable 602 
LOCAL REMEDIES. 
that others were not. Moreover, quite numerous scattered cases are on 
record in which a few persons or a family have been affected with ergotism 
unmistakably traceable to the use of bread largely composed of the fungus.* 
The scope of the present work is such as to forbid my entering into an 
elaborate discussion of the epidemics of ergotism, especially as the subject 
has no practical bearing so far as the American profession is concerned, since 
the absence of deep poverty is so complete in our country that no one would 
feed on largely ergotized bread, and, in fact, no case of ergotism has as yet 
been recorded as occurring in the United States.f 
There are two varieties of ergotism, the spasmodic and the gangrenous. 
Gangrenous ergotism has been especially observed in France, and is be- 
lieved to be the same as the Ignis Sacer or the Ignis Sancti Antonii of the 
Middle Ages,-an affection which in 922 killed forty thousand persons in 
Southwestern France, and in 1128-29 fourteen thousand in Paris alone. It 
generally commences with itching and formications in the feet, severe pain 
in the back, contractions in the muscles, nausea, giddiness, apathy, with 
abortion in pregnant women, in suckling women drying of the milk, and in 
maidens amenorrhoea. After some time, deep, heavy, aching pains in the 
limbs, an intense feeling of coldness with real coldness of the surface, deep 
apathy, and a sense of utter weariness, develop themselves. Then a dark- 
red spot appears on the nose or on one of the extremities; all sensation is 
lost in the affected part; the skin, perhaps over a large surface, assumes a 
livid red hue, and in the foci of local changes bullae filled with serum appear. 
The adynamic symptoms, in severe cases, deepen as the gangrene spreads, 
until finally death puts an end to the scene. Very generally the appetite 
and digestion are preserved to the last, and not rarely there is an almost 
ferocious hunger. The gangrene is generally dry, the parts withering and 
mummifying; but sometimes it is moist, and pyaemia symptoms may even 
be developed. Of course a very large number of cases do not terminate in 
death ; but the part immediately affected is generally lost. In these cases 
the toes most generally are the portion destroyed, but it may be any one or 
all of the extremities; and thu nose, lips, ears, and even the buttocks, some- 
times bear the brunt of the disorder. 
Spasmodic ergotism may in the lightest cases be manifested only by itch- 
ings, formications, numbness, or complete anaesthesia of the fingers and toes 
or of the buttocks, and by gastro-intestinal irritation, as shown by colic, 
vomiting, diarrhoea, or constipation, and withal a ravenous hunger. In more 
severe cases these manifestations are intensified, and spasmodic symptoms 
appear, violent and painful tonic contractions affecting especially the flexors 
* For a modern epidemic, see Deutsch. Arch. f. Klin. Med., xxxiii. 216. 
f Any one especially interested in the subject will find the literature very well repre- 
sented in the references of Prof. Stille's work on Therapeutics, to which may be added 
Duboue's book, quoted on the previous page. For the reader of German, a very excellent 
r6sum6 exists in Husemann's Handhuch der Toxicologie. OXYTOCICS. 
603 
of the extremities, interrupted at times by intervals of quiet, but gradually 
growing into severe general tetanic paroxysms, with opisthotonos and empros- 
thotonos. In the intervals there are very generally muscular tremblings, 
and as the case progresses there are developed cerebral manifestations, such 
as disturbances of vision, photophobia, chromopsis, hemiopia, and periodic 
amblyopia and amaurosis, giddiness, cataleptic and epileptic paroxysms with 
or without loss of consciousness, delirium, and idiocy. Gastro-intestinal 
symptoms are always very marked, but with them is a characteristic raven- 
ous hunger and a longing for sour food and drink. The skin is earthy or 
yellowish in its tint, often spotted with boils or pustules or semi-gangrenous 
vesicles. Death is apparently caused by exhaustion ; and in those that re- 
cover, various local paralyses, habitual spasms, amaurosis, mental aberrations, 
or even idiocy, often remain through life. In a few cases the symptoms 
are still more violent, and the spinal and cerebral disturbances soon lead to 
death. 
In some epidemics of ergotism the cases have been a mixture of the spas- 
modic and gangrenous forms of the disease. 
Administration.-Ergot may be given in powder, but at present thi» 
method is very rarely used : the dose is half a drachm to two drachms. The 
TJ. S. Pharmacopoeia recognizes a wine ( Vinum Ergotse,-1 to 6.6) and a 
fluid extract (Extractum Ergotee Fluidum). The first of these is a good 
preparation for internal use, and may be administered, as an ecbolic, in doses 
of half an ounce to two ounces. The fluid extract is, however, preferable. 
The usual ecbolic dose is one to two drachms. In nervous diseases much 
larger doses are required: thus, in congestion of the spinal cord I usually 
commence with half an ounce, and increase it to an ounce three times a day.* 
Of the so-called Ergotin two varieties have been proposed, that of Bonjean 
and that of Wiggers. Bonjean's ergotin is made by exhausting the ergot 
with water, evaporating to the consistency of a syrup, precipitating the albu- 
men, gum, etc., with an excess of alcohol, decanting the clear liquid, and 
evaporating to the consistency of a soft extract. This ergotin is believed to 
be about ten or eleven times as strong as ergot, five or six grains of it repre- 
senting about a drachm of the drug. 
The ergotin of Wiggers simply contains everything in the ergot which is 
insoluble in water. Kohler ( Virchow's Archiv, Bd. lx.) has proved that 
Wiggers's preparation has no influence upon the circulation, but in toxic 
doses produces violent convulsions. It ought not to be employed therapeu- 
tically. Bonjean's ergotin is that usually kept in our pharmacies, and repre- 
sents all the virtues of the remedy. The officinal extract of ergot (Ex- 
tractum Ergotee, U.S.) is probably as good for hypodermic use as Bonjean's 
* It would appear that sometimes, owing to idiosyncrasies, even small amounts of ergot 
cause much disturbance. Thus, Dr. R. B. Faulkner reports {New York Med. Journ., 
June 14, 1884) a case in which a fluidrachm of the fluid extract caused great sleepiness, 
swelling and redness of the feet, and violent prickling of the extremities. 604 
LOCAL REMEDIES. 
ergotin, and in all respects represents the drug therapeutically. Its strength 
is five times that of the fluid extract; when used hypodermically it should 
be dissolved in water and filtered. It is stated that the danger of severe 
local trouble is much lessened by plunging the nozzle of the syringe 
deeply into the muscular tissues. In an elaborate research (Du Bois Rey- 
mond's Archiv., 1884, 434) upon the activities of the various derivatives 
from ergot, M. Marckwald found that the ergotinin preparations (Ergoti- 
num Citricum of Gehe, Ergotinum Solutum of Bombelon) raise the arterial 
pressure, whilst sclerotinic acid depresses it; and the ergotin (aqueous ex- 
tract') first raised, then depressed, then raised the arterial pressure ; also that 
the ergotin and sclerotinic acid act violently upon the uterus, whilst the 
ergotinin preparations do not influence the organ. 
Gossypii Radicis Cortex, U. S.-The root of the ordinary cotton-plant 
is asserted to be used by the negroes in various portions of the South as an 
abortifacient, and Dr. Bouchelle, as long ago as 1841, claimed for it medical 
properties similar to those of ergot. It has not, however, come into general 
use, and our knowledge of its properties is at present very scanty and un- 
certain. In the experiments of Dr. I. C. Martin enormous doses produced 
heaviness and stupor both in'frogs and mammals, but did not cause abortion 
in pregnant guinea-pigs and rabbits : neither the spinal cord, the muscles, 
nor the nerves were affected (Amer. Journ. Med. Sci., Jan. 1882). The 
oxytocic dose of a decoction ($iv in a quart of water boiled to a pint) is 
stated to be a wineglassful, to be repeated every thirty minutes as necessary. 
The remedy has also been employed in amenorrhoea and in dysmenorrhoea, 
in which diseases from three to five grains of a solid aqueous extract have 
been given three times a day. The fluid extract (Extractum Gossypii 
Radicis Fluidum, U. S.) may be used in doses of a fluidrachm. 
The Smut of Indian Corn ( Ustilago, U. S.) appears to have active me- 
dicinal properties, and should be investigated. It has been used successfully 
in uterine inertia during labor by Dujardin-Beaumetz (Bull. Therap., xciii. 
85). Consult also N. K Med. Journ., xxiv. 654; Schmidt's Jahrbiicher, 
Bd. 172, p. 19; Centralb. fur Med. IFiss., 1876, p. 228; Chicago Med. 
Times, 1879-80, xi. 434. Dr. James Mitchell has found that in the frog 
the ustilago maidis abolishes sensation and reflex action before voluntary 
motion; he states that reflex action is destroyed at a time when motor 
nerves and muscles are still active, and that consequently the first influence 
of the poison is upon the sensory side of the lower nervous system; late in 
the poisoning the whole motor tract became involved (Unpublished Inaug. 
Dissert., 1883, University of Pennsylvania). CLASS VIII.-SIALAGOGUES. 
Sialagogues are medicines which increase the flow of saliva and of the 
buccal mucus. Various substances, such as mercury, when taken internally, 
affect the mouth and its tributary glands in such a way as to produce saliva- 
tion : these substances are, however, never employed in medicine for this 
purpose, so that practically sialagogues are local remedies acting by the in- 
duction of a local impression on the mouth. The influence which they exert 
is a stimulant one, and most of them are more or less irritant. They are 
used to effect two distinct purposes. Some of them dissolved in the saliva 
pass over the mucous membranes not only of the mouth but also of the 
fauces and of the epiglottis, and exert upon them a direct stimulant influ- 
ence. Other sialagogues, by exciting a very great flow of saliva, seem to 
lessen the congestion of the part. 
In reference to the first of these modes of action, sialagogues are employed 
in relaxed conditions of the mucous membrane of the fauces, and even of the 
larynx. Chief among the substances so used is cubebs, which when slowly 
chewed in the mouth exerts a very decided local influence, and is useful in 
relaxation of the fauces, of the uvula, and even of the upper portions of the 
larynx. Either in form of the berries or made into lozenges, cubebs is much 
used by public speakers; and in the hoarseness from relaxation following 
over-use or slight inflammation, it is often very efficient. 
Through their depletory influence, sialagogues are sometimes useful in 
allaying rheumatic toothache, or other rheumatic irritations about the jaws. 
The only remedy of the class employed for the purpose and requiring a sepa- 
rate notice here is pellitory. 
Pyrethrum, or Pellitory, is the product of the Anacyclus Pyrethrum, a 
small herbaceous perennial, growing in the neighborhood of the Mediterra- 
nean. It is a small root, about the size of the little finger, wrinkled longi- 
tudinally, light brown externally, with bright, shining spots on the surface, 
hard, brittle, with a resinoid radiated fracture. It is inodorous, and when 
chewed is at first almost tasteless, but soon becomes acidulous, saline, and 
acrid, and produces a very persistent burning, tingling sensation, which is 
accompanied by a profuse flow of saliva. Half a drachm to one drachm of 
it may be chewed at a time in painful rheumatic affections of the face, in 
toothache, in relaxation of the uvula, and in similar disorders. Taken 
internally in excess, it acts as a narcotic irritant, fifty minims of its tincture 
having caused gastro-intestinal irritation, with violent convulsions, which 
nearly proved fatal in a child three and a half years old (London Prac- 
titioner, xvii., p. 86.) 
605 CLASS IX EREHINES. 
These are substances employed to act upon the mucous membrane of the 
nose. Strictly speaking, the term should be applied only to those drugs 
which are used to excite secretion in the nasal mucous membrane. Such 
remedies are, however, so rarely used as to be by themselves scarcely worthy 
of notice. The employment of irritating vapors to arouse the nerve-centres 
by stimulating the nerves distributed in the nasal mucous membrane, is a 
very old and a very popular custom. Smelling-salts, or preparations of 
hartshorn, so much used by ladies as a slight stimulant, and by others in 
reviving those who are suffering from or threatened with fainting, act in this 
manner. The ammonia held close to the nostrils brings about the reaction, 
not by any direct stimulating action on the circulation, but by irritating the 
nasal mucous membrane, as is proven by the rapidity of its influence and by 
the exceedingly minute quantity which will sometimes act efficiently. In 
the use of hartshorn, especially with young children, it is necessary to exer- 
cise care, lest injury should be done to the delicate mucous membrane. The 
only errhine used for the purpose of influencing affections of the nasal 
passages themselves which is worthy of mention here is cubebs. This freely 
snuffed up in powder is very useful in acute coryza, after the first stage of 
congestion and dryness has passed away. 
606 CLASS X-EPISPASTICS. 
Counter-irritation.-Almost from time immemorial, physicians have be- 
lieved that morbid processes in deep-seated or superficial organs could be 
modified by irritations artificially induced in distant parts. To the drugs 
used for producing these remedial irritations the name of revulsives or 
counter-irritants has been given, the process being called revulsion, or coun- 
ter-irritation. Latterly, the value of these remedies in disease has been 
questioned, chiefly because not only were the accepted theories of their 
action deemed untrue, but any explanation of how they do what is claimed 
for them was asserted to be, in the present state of our knowledge, incon- 
ceivable. 
Evidently, in studying the matter, the inquiry should be divided into two 
parts, and fact should be separated from theory; the effort being made to 
ascertain, first, whether experience does or does not demonstrate that it is 
possible by an irritation to affect a distant part which has no apparent con- 
nection with the seat of the new irritation; second, whether the facts taught 
by experience are in truth irreconcilable with reason. In regard to the first 
part of this inquiry, it seems to me indisputable that experience does teacn, 
in the most unequivocal manner, that an organ may be affected through a 
distant part. There are physiological proofs of this, which it is only neces- 
sary to allude to : such is the relation of the uterus and the mammary glands. 
The proofs which may be drawn from disease are, however, much more 
numerous and striking. Thus, it is well known that in mumps there may 
be relief of an existing irritation of the salivary gland by a new irritation 
of the testes; in gout, the swelling of the toe will relieve the disordered 
digestion, etc. If it be affirmed that these phenomena, happening during 
the existence of a blood-disease, are sui generis, the objection cannot be made 
to the paraplegia produced by the irritation of a calculus in the kidney, or to 
the headache due to the irritation of the gastric mucous membrane by acid, 
or to the shoulder-pain of diseased liver, or to the amaurosis caused by the 
irritation of a decayed tooth. A well-known experiment of Brown-Sequard's 
illustrates the point so well that it may be quoted. In it he found that if 
one sciatic nerve of a guinea-pig be cut, epileptic attacks may be produced 
by gently rubbing the back of the ear upon the same side. A very curious 
instance of an external irritation affecting a deep-seated part is the duodenal 
607 608 
LOCAL REMEDIES. 
ulcer produced by burns, especially of the abdomen. The pathological evi- 
dence of the truth of the present proposition is simply overwhelming, and 
facts might be brought forward almost indefinitely to show that irritations 
are capable of affecting the functions and nutrition of distant parts. This 
being true, surely it is in the highest degree reasonable to suppose that arti- 
ficial irritations can in a greater or less measure be controlled so as to affect 
the distant organ for good and not for evil. 
Clinical experience has certainly demonstrated that this can be done. The 
va'ue of any individual counter-irritant in this or that disease is not the 
present question ; but certainly no physician who has had any practice can 
have failed to see instances of relief from the use of counter-irritants. A 
case of obscure brain-trouble recalls itself at present writing, in which stupor 
and a clear intellect alternated at will, according as the drastic cathartic was 
given or withheld. The relief of abdominal pain, or " stomach-ache," by a 
mustard plaster, is a daily nursery experience. 
From what has been already stated, it may be laid down as proven beyond 
cavil-first, that we have power to influence internal morbid processes by 
creating external irritations ; second, that the fact of counter-irritation exists, 
whether we can or cannot explain its rationale. 
Physiological knowledge is not yet sufficiently extensive to enable us to 
perfect a theory of counter-irritation. The action of these remedies is com- 
plex, but I think can be explained at least in part. There is only a certain 
amount of blood in the body. If it be accumulated in one place, it cannot 
be in another. Thus, the difficulty of studying after a hearty dinner prob- 
ably depends, as do the cold feet so common in feeble persons under such 
circumstances, upon the accumulation of blood, and probably also of nervous 
energy, in the digestive organs. Now, by artificial interference, by deter- 
mined study, by violent exercise, we can often draw the blood away from the 
alimentary apparatus into the cerebrum, or into the motor system, and pro- 
duce indigestion. Clinical experience proves that we can also reverse this 
process. The brain is excited, the blood is concentrated in it, congestion 
exists, inflammation is threatened; a drastic cathartic is given, the blood is 
drawn into the intestinal canal, and by revulsion the brain is relieved. Cer- 
tainly this is not mysterious, not inexplicable. All forms of counter-irrita- 
tion cannot, however, be explained on the above principle. It is a probable, 
but not a positive, teaching of modern physiology that there are nerves which 
preside over nutrition,-the so-called trophic nerves. If this be so, it is to 
be expected, a priori, that peripheral irritations will cause reflex alterations 
of nutrition, precisely as they cause reflex disturbances of the motor func- 
tions. Further, whether these trophic nerves do or do not exist, there are 
vaso-motor nerves, and the duodenal ulcer of burns is a positive proof that, 
either through the trophic or through the vaso-motor nerves, external irrita- 
tions do produce internal reflex alterations of nutrition. The sympathetic 
ophthalmia caused by a morbid eye in its healthy fellow, or induced by a EPISPASTICS. 
609 
diseased tooth, is another instance of this reflex alteration of nutrition. As 
this is true, it seems to me absurd to state that it is impossible to conceive 
how an external counter-irritant can affect the nutrition of a deep-seated 
organ. 
It is evident that in all the cases which have been mentioned of external 
irritation causing disease in a distant organ, there is no direct communication 
between the part irritated and the organ which is secondarily affected. And 
clinical experience confirms the evident deduction from this,-i.e., that it 
is impossible to determine, except by experiment, where the counter-irritant 
should be placed to affect most powerfully any given organ. It has, how- 
ever, been clinically demonstrated that the general law for deep-seated parts 
is that the revulsant should be put directly over the part. When a super- 
ficial action is desired, other directions are needed. We are indebted to Dr. 
Anstie for pointing out what appears to be another law,-namely, that when 
a superficial part supplied by the anterior branches of a spinal nerve is to 
be affected, the counter-irritant should be placed over the posterior roots of 
the nerve. Not only can obstinate neuralgia often be relieved by this reflex 
action, but also the inflammatory changes so often coincident with intercostal 
neuralgia. The law seems also to apply to cervical nerves, since the proper 
position for the blister in facial trigeminal neuralgia is back of the ear or on 
the nape of the neck. Dr. A. Dumontpallier affirms that the best results 
of counter-irritation are obtained by applying the counter-irritant upon the 
opposite side of the body, so as to be exactly symmetrical with the pain, 
and especially commends hypodermic injection of water as a counter- 
irritant (Gaz. Hebdomadaire, Nov. 14, 1879). 
Counter-irritants may be conveniently arranged under two heads: 1st, 
those which produce a decided structural alteration of the skin, including 
epispastics; 2d, those which do not provoke decided alterations of dermal 
etructure, the rubefacients. The indications for the use of these substances 
can best be considered under their respective headings. 
As is well known, any sthenic inflammation, if of sufficient extent and 
intensity, may excite the general system even to the point of high fever. In 
this respect inflammation of the skin does not differ from that of other 
organs. Hence dermal irritants have a direct tendency to arouse or excite 
the system, and may be used as general stimulants. It will be seen at once 
that it is the nervous and arterial systems which alone feel their influence. 
Hence the irritants should not be relied upon in cases of exhaustion, for the 
only possible source of absolute increase of power to the system is in food; 
and in exhaustion those stimulants should be employed which increase the 
power of assimilating food. For this reason, external irritants are useful as 
stimulants in conditions of depression rather than of exhaustion. Such 
conditions of depression exist in acute collapse from any cause, in 11 shock" 
following injuries, in the first stage of pernicious malarial fever, in snake- 
bite, and in other cases when the powers of the system are seemingly over1' 610 
LOCAL REMEDIES. 
whelmed by some depressing agency. The rubefacients are preferable to 
blisters for this purpose, because their local after-effects are comparatively so 
trifling that they can without injury be applied to a very large extent of the 
surface. 
Epispastics, vesicatories, or, more colloquially, blisters, are substances 
which are used by the physician to produce that peculiar inflammation of the 
cuticle and outpouring of serum known as a blister. The immediate effect 
of a blister is more severe and more permanent than that of a rubefacient. 
Blisters are especially useful in inflammations of serous membranes, such as 
pleuritis and peritonitis ; are very strongly recommended by some prac- 
titioners in parenchymatous inflammations, such as pneumonia; and are 
often of service in neuralgia, and in other forms of nervous irritation, such 
as the maniacal delirium of fevers, when dependent upon the irritant action 
of a blood-poison, and not upon exhaustion. The amount of serum which 
is poured out from a blister is sometimes quite large, and vesicants have even 
been used to relieve dropsy. In general dropsy, their use is simply unjusti- 
fiable ; but in local dropsies, as, for example, serous effusion into the pleural 
sac or into the pericardium, dependent upon local disease, they often do good, 
not only by affecting favorably the disease-process, but also by hastening the 
removal of the effusion. 
In some chronic affections, long-continued severe counter-irritation is re- 
quired : in such cases a blister may be " kept open" by the use of stimulating 
ointments, such as the unguentum mezerei. In chronic inflammation of the 
joints, repeated blistering is very often of service. When the inflammatory 
action is rheumatic, in my experience better results are obtained by repeated 
blistering than by keeping a blister sore by means of irritants. In neuritis, 
whether rheumatic or otherwise, blisters are often of service: they should 
be applied as a long narrow strip along the course of the nerve. In obsti- 
nate local neuralgia, very mild blistering over the seat of pain, or in accord- 
ance with Anstie's law, is sometimes advantageous. 
The contra-indications to the use of blisters are high arterial and febrile 
excitement and a decided want of vital power. In the former case, the irri- 
tating influence which they exert upon the general system may increase the 
constitutional disturbance to such an extent as to do far more injury than 
any local benefit derived from them can do good. When the vitality is 
very weak, blisters may give rise to sloughing ulcers, which, refusing to 
heal, may waste very seriously the already exhausted system. Hence, in all 
acute diseases of such type that the nutritive forces are exceedingly de- 
pressed, blisters must be avoided, or must only be used with great caution. 
For the same reason, great care must be exercised in their employment in 
the very young.or the very aged. Very rarely indeed is a blister called for 
in the case of a young infant, and, when employed, it should be allowed to 
remain in contact with the skin only just long enough to produce slight EPISPASTICS. 
611 
redness, and the complete vesication should be obtained by the use of the 
poultice. 
There are various substances which are capable of producing vesication, 
but the only one in ordinary use is cantharides. In cases of emergency, a 
blister, it is said, may be raised in a very few minutes by the use of the 
stronger water of ammonia, a little of which is to be kept in contact with 
the skin by means of an inverted watch-glass. It is necessary to watch the 
process closely, and to remove the irritant so soon as vesication has occurred, 
as the ammonia is very capable of causing sloughing. 
CANTHARIS-CANTHARIDES. U.S. 
The dried bodies of the Cantharis vesicatoria, a beetle inhabiting South- 
ern Europe, and coming into commerce in Spain, Italy, Sicily, and the 
southern provinces of Russia. Spanish flies are from half an inch to nearly 
an inch in length, and two to three lines in breadth, and have a large heart- 
shaped head, and brilliant metallic-green elytra or wing-cases. Their odor 
during life is very strong and fetid, but is almost entirely lost in drying; 
their taste is urinous, very burning, and acrid. They are taken in May and 
June, when they swarm on the trees which they affect, by beating the 
branches early in the morning, when the insects are torpid from the cold, 
catching them upon linen sheets, and plunging them into hot vinegar and 
water, or exposing them to the fumes of boiling vinegar. In some places 
they are gathered by smoking the trees with the fumes of burning brim- 
stone. When ground, Spanish flies afford a grayish-brown powder, full of 
minute greenish spangles, the remains of the feet, head, and wing-cases. 
The active principle of cantharides is Cantharidin, which occurs in white 
crystalline scales, is inodorous, tasteless, insoluble in water, nearly so in cold 
alcohol; 'soluble in ether, benzole, the oils, and very freely so in chloroform. 
Notwithstanding the insolubility of their active principle, Spanish flies yield 
their virtues to alcohol and to water, because, as is generally believed, a 
yellow coloring-matter is so united with the cantharidin as to render it 
soluble. 
Physiological Action.-When a minute therapeutic dose of cantharides 
is taken, no perceptible immediate result is produced, and after a somewhat 
larger quantity the only symptom is usually some burning and pain in urina- 
tion. Doses more than just sufficient to induce this should not be employed 
in medicine, as the symptoms produced by large amounts of the drug are 
exceedingly severe and distressing. Cantharides is very irritating, and, when 
applied to the skin, causes at first redness, with burning, then free vesication 
and severe pain, and, if the contact be longer maintained, deep inflammation 
and sloughing. Upon the mucous membranes it produces a no less intense 
effect; and consequently gastro-intestinal inflammation forms a prominent 
symptom of poisoning by it. Further, the active principle or principles are 
undoubtedly absorbed and are eliminated by the kidneys, coming in contact 612 
LOCAL REMEDIES. 
with almost the whole genito-urinary mucous membrane: hence intense irri- 
tation and inflammation of these organs always result from the ingestion of 
an overdose of Spanish flies. 
Very soon after a toxic dose of cantharides has been taken, the sufferer is 
seized with burning in the pharynx and oesophagus, and a sense of stricture 
in the throat. The pain soon spreads to the stomach, and vomiting comes 
on. The symptoms rapidly increase in severity; the abdominal pain becomes 
very severe, and, in the majority of cases, purging takes place. The matters 
rejected by the stomach are first mucous (with, if the drug have been taken 
in powder, little greenish specks through them), then bilious, and finally 
bloody. The stools are mucous, then fibrinous, bloody, becoming often very 
scanty, but excessively numerous, and in their passage accompanied by great 
tenesmus. Probably in most cases very early in the attack, severe salivation 
is developed, and is very frequently accompanied by great swelling of the 
salivary glands. Sometimes death occurs in a very short time, from collapse 
produced by the intense gastro-intestinal inflammation ; but more generally 
it is postponed for some hours, and a new train of symptoms arises. Aching 
pains in the back, and very frequent micturition, indicate the commencing 
urino-genital irritation. These symptoms increase in intensity until there is 
a constant irresistible desire to urinate, with violent tenesmus of the bladder, 
and yet an inability to pass more than a few drops of urine, which is albu- 
minous, and not rarely bloody. In some cases there is a violent erotic ex- 
citement, an unquenchable lust, accompanied in man by numerous seminal 
emissions ; violent priapism, swelling and heat of the organs, and even severe 
inflammation of the parts, indicate the intensity of the local action of the 
poison ; sometimes gangrene ultimately occurs. 
Neither amatory desire nor true priapism is, however, a constant symptom 
in cantharidal poisoning (cases, Journ. de Pharm. et de Chimie, June, 1871): 
indeed, the former is probably absent in the majority of cases. Conscious- 
ness and general power are often long preserved amid intensely severe local 
symptoms and agony, but, if the dose have been large enough, sooner or later 
collapse comes on with its usual symptoms, and the prostration deepens into 
complete powerlessness, stupor, coma, and finally death. In some cases vio- 
lent hydrophobic delirium and severe tetanic convulsions are said to have 
occurred (Tardieu). Paraplegia has been noticed in several cases by Dr. 
Palle (Journ. de Pharm. et de Chimie, June, 1871) : it was probably reflex 
in its origin, and due to the intense irritation of the urino-genital organs. 
In animals, cantharides produces very much the same symptoms as in man. 
In dogs, according to the experiments of Orfila and of Beaupoil, the symp- 
toms of gastro-intestinal inflammation are more prominent than those of irri- 
tation of the genito-urinary tract. It has been asserted that the lack of 
erotic excitement in these cases shows that the medicine acts differently upon 
man and animals. As already stated, however, erotic delirium is very gen- 
erally absent in fatal poisoning by man, whilst Schroff states that ten drops EPISPASTICS. 
613 
of the tincture of cantharides will frequently produce great sexual excitement 
in man, and the whole drift of the evidence is that libidinous desires are 
much more apt to be caused by amounts of Spanish flies but slightly toxic, 
than by fatal doses. Indeed, the irritation caused by the latter would seem 
to be too intense, the general perturbation too great, for erotism to be induced. 
There appears to be the same difference in the effects of different doses of the 
drug upon animals. Fatal doses very generally do not excite sexual desire', 
but Schubarth (quoted by Stille) found that small doses do cause evident 
salaciousness and irritation of the genital organs, whilst, according to Huse- 
mann (^Handbuch der Toxicologic, 1862, p. 264), the peasants of Northern 
Germany habitually give cantharides to cows when backward in coming into 
heat at the proper season. According to Dr. Gautieri ^Schmidt's Jahrb., Bd. 
clxv. p. 237), toxic doses of cantharides rapidly lessen blood-pressure and the 
force of the cardiac pulsations, but markedly increase the pulse-rate. He 
found in animals killed with cantharides marked hyperaemia of the brain and 
spinal cord and very decided nephritis. M. Galippe (Gaz. Hebdom., 1874, 
p. 439) noted inflammation of the alimentary canal, kidneys, and bladder. 
Therapeutics.-Cantharides is employed internally only for the purpose 
of influencing the genito-urinary organs ; and sufficient has already been said 
in regard to this use under the headings of Diuretics and Emmenagogues. 
The external use of cantharides is simply as a vesicant; and the employ- 
ment of blisters has been sufficiently considered in the general discussion 
of the class. Two points, however, seem worthy of notice here: first, that 
this drug affords the only practical means of blistering at our command; 
secondly, that when it is freely employed there is always some danger of 
the absorption of a sufficient amount of the active principle for strangury 
to be induced. In susceptible persons, therefore, care has to be exercised in 
the use of epispastics; and whenever active irritation of the kidneys exists, 
cantharidal blisters should not on any account be applied. 
Toxicology.-Sufficient has already been said about the symptoms pro- 
duced by cantharides. The minimum fatal dose is not certainly determined, 
and probably varies very much. According to Stille, twenty-four grains of 
the powder, taken in two doses, have caused fatal abortion, and an ounce of 
the tincture has destroyed life after the lapse of a fortnight. After death, 
intense injection, swelling, patches of exudation, loss of epithelium, and other 
results of inflammation are found along the whole tract of the alimentary 
canal; intense hyperaemia of the kidneys, with contraction and injection of 
the bladder, also usually exists. According to the experiments of Aufrecht 
(Centralb. f. Med. Wissensch., xx. 1882, 850), all the forms of nephritis 
may be produced by cantharidin in various doses, but it is probable that 
in most cases of poisoning the first change is exudation of the white blood- 
corpuscles, rapidly followed by a desquamative nephritis, with profound 
alteration in the glomerules (see Dr. Ida Eliaschoff, Virchow's Archiv, 
xciv. 323). 614 
LOCAL REMEDIES. 
There is no known antidote to cantharides, and the treatment of the poi- 
soning must be conducted upon general principles. The stomach, if not 
already thoroughly emptied, should be evacuated at once by a stimulating 
emetic if the stomach-pump be not at hand. Large quantities of mucilagi- 
nous or albuminous drinks should be taken ; and all oily substances should 
be avoided, as favoring the solution, and consequently the absorption, of the 
poison. Opium should be freely exhibited, especially by the rectum, to allay 
pain and relieve the strangury. For the latter purpose warm sitz-baths or 
general baths should be given. In some cases leeches to the epigastrium 
are advisable. When the suffering is very intense, the cautious use of an- 
aesthetics seems to me not only justifiable, but imperative. In the stage of 
prostration, the measures to be adopted are those commonly practiced in 
collapse from poison. 
Administration.-The preparation of cantharides most commonly used 
for the production of a blister is the Cantharides Cerate (Ceratum Can- 
tharidis, U. S.), which is best spread upon sticking-plaster in such a way as 
to leave a margin about an inch in width, which shall adhere to the skin and 
hold the plaster in its place. The Cantharides Paper (Charta Cantharidis, 
U. S.) is thought to be more elegant than the plasters made of the cerate, 
and is said to be efficient. In order for a blister to " draw" thoroughly, it 
usually has to be left on some eight hours; but in most cases the same 
result can be achieved with less suffering by allowing the blister to remain 
only six hours, or until decided redness and slight vesication have been in- 
duced, and then applying a flaxseed poultice. In certain localities vesication 
requires a much longer application than that just spoken of: thus, upon the 
shaved scalp a blister will rarely act efficiently in less than twelve hours, 
and often not in that time. In maniacs, in the delirious sick, in children, 
and in other unruly patients, it is often necessary to put on a blister in such 
a way that the sick person has no control over it. For this purpose the Can- 
tharidal Collodion (Coilodium cum Cantharide, U. S.)* may be used. It 
is ordinary collodion impregnated with cantharides, and on evaporation leaves 
an adhesive blistering film: two or three coats of it should be applied, by 
means of a camel's-hair brush. When there is any especial danger to be 
feared from absorption of the active principle, the use of the poultice, after a 
brief application of the blister as described above, should always be practiced. 
The liniment of cantharides (Linimentum Cantharidis, U. S.) contains tur- 
pentine, and is used as a violent rubefacient liniment. The Ceratum Extracti 
Cantharidis, U. S., is probably an efficient blistering preparation, but has 
not been much tested. The tincture ( Tinctura Cantharidis, U.S.) is used 
internally in doses of three to five drops. 
• For case of poisoning by cantharidal collodion, see Phila. Med. Times, iv. 312. CLASS XI.-RUBEFACIENTS. 
Rubefacients are those remedies which are employed for the purpose of 
producing, not any permanent inflammation of the skin, but a general intense 
irritation, redness, and congestion, which shall exert a temporary influence, 
whose power is the result of the large surface affected, and not of any per- 
manent impression upon the nutritive acts of that surface. Most, if not all. 
rubefacients are capable of causing disorganizing inflammation if allowed to 
remain for too long a time in contact with the skin. 
The superiority of rubefacients over blisters when it is desired to arouse 01 
stimulate the system has already been pointed out (see p. 532). It remains 
to speak of the use of rubefacients in local diseases. They are especially 
useful in sudden cases of severe pain due, it may be, to acute congestion of a 
part, or to some internal irritation like that of gout. Thus, in the ordinary 
intestinal pain caused by irritant articles of food, or more commonly by a 
rheumatic, gouty, or other irritation following exposure to cold or wet, 
rubefacients are most useful. In this as in all other cases of what may be 
termed temporary functional derangement, when a counter-irritant is desired, 
rubefacients are superior to blisters, because their effects are not nearly so 
lasting, and also because, for the time being, they seem to impress more 
powerfully the nervous system, breaking up, as it were, the concentration of 
nervous energy, or calling off the irritation, or impressing the nervous system 
in some way which in our present ignorance it is difficult to find terms 
to express. A correct idea of the difference in the use of the two classes of 
counter-irritants can perhaps be conveyed by saying that when profound 
local alterations of nutrition are to be dealt with, blisters are to be used; 
when functional disturbance is to be met, rubefacients are to be employed. 
Yet this rule cannot be applied with strictness. 
SINAPIS ALBA-WHITE MUSTARD. U.S. 
SINAPIS NIGRA-BLACE MUSTARD. U. S. 
The seeds of the Sinapis alba and Sinapis nigra respectively,-European 
crucifers, cultivated in the temperate regions of the world. These seeds are 
minute, globular bodies, yellowish within: they are to be distinguished one 
from the other by the smaller size, external brown color, and more fiery taste 
of the black mustard, and the light yellowish exterior of the white mustard 
615 616 
LOCAL REMEDIES. 
Black Mustard contains Myronic Acid in combination with potash, and 
also a peculiar albuminous principle, Emidsin. When to these substances 
water is added, a reaction occurs, resulting in the production of a volatile oil 
out of the myronic acid. Volatile oil of mustard is a colorless or yel- 
lowish fluid, of an intensely pungent, or even corrosive, odor and taste. A 
momentary contact with it suffices to redden and blister the skin, and 
mucous membranes are said to be rapidly destroyed by its vapors. 
White Mustard does not yield on distillation with water a volatile oil, but 
contains an acrid fixed principle. The chemistry of white mustard seeds 
appears not to have been certainly determined. In 1825, Henry and Garot 
discovered a substance in them,-Sidpho-sinapisin,-which, according to 
Husemann, has been variously designated as Sinapin, Sinapisin, Sinapinic 
Acid, etc., but has been demonstrated by Babo and Hirschbrunn to be an 
alkaloid, which also exists in the seeds of the black mustard. Robiquet and 
Boutron believe that the acrid fixed principle of white mustard is formed by 
a reaction between this and water in the presence of the emulsin. 
Physiological Action.-The oil of mustard is a most intense irritant, 
and if taken internally would act as a very powerful irritant poison. The 
ground mustard, of course, shares its properties. 
Therapeutics.-Mustard affords a most excellent material for the prac- 
tice of mild revulsion. One great advantage it possesses is the ease with 
which it can be controlled,-all grades, from the mildest impression up to 
severe blistering, being at the will of the practitioner. It should be remem- 
bered, however, that the blister produced by it discharges but little, and is 
exceedingly sore and painful as well as very slow and difficult of healing: so 
that, as an epispastic, mustard is in every way inferior to cantharides, and 
should not be employed. The black mustard is much stronger than the 
white, and must usually be diluted at least one-half (by the addition of flour 
or of flaxseed meal). The white variety may sometimes be employed pure, 
but generally it also may be reduced in strength. 
In many cases it is desirable to maintain for hours a mild, equable counter 
irritant impression ; and this may be done by adding from one to three tea- 
spoonfuls of mustard, more or less, to a poultice of flaxseed. A mustard 
poultice half-and-half black mustard, three parts to one white mustard, and 
flour, may generally be left on from twenty minutes to half an hour without 
danger of blistering. Weaker preparations may be used longer. A mustard 
plaster may be prepared like an ordinary poultice; but a very convenient 
method is to take a newspaper folded to a little larger than the desired size, 
and tear open the front piece so that it can be folded back like a flap, leaving 
one edge attached ; next, to spread upon the thick portion the mustard, leaving 
the edges free, and then to close the flap upon it and fold the edges back to 
the desired shape: when done with, this plaster can be thrown away, and no 
rags are lost. The mustard draws well through the single layer of newspaper 
covering it, but is, I think, less apt to leave troublesome after-soreness tbsm RUBEFACIENTS. 
617 
when employed in the usual manner. In the 1870 edition of the U. S. Phar- 
macopoeia a new preparation of mustard was introduced, under the name of 
Charta Sinapis, or Mustard Paper. It consists of black mustard mixed 
with solution of gutta-percha and spread upon stiff paper four inches square. 
These mustard papers may be useful for travelers, but in my experience do 
not act so well as the home-made mustard plaster. Their size is not so easily 
regulated, and their action is often too violent. 
Capsicum and the stronger spices afford excellent materials for rubefaction. 
The Cayenne pepper is probably as strong as mustard, but is much less 
pleasant to handle, on account of the readiness with which it is diffused, and 
is much less frequently employed. Spice-plasters are useful when it is de- 
sired to make a steady, continuous mild impression, as in certain abdominal 
complaints. They may be made by the apothecary by means of the follow- 
ing recipe : Take of powdered ginger, gii; powdered cloves and cinnamon, 
each, gi ; Cayenne pepper, j tincture of ginger, f^ss ; honey, q. s.; mix 
the powders, add the tincture, and sufficient honey to make of proper con- 
sistence for a stiff cataplasm. The domestic spice-plasters are much more 
elegant and cleanly than those made on the above plan. They are to be pre- 
pared as follows. Take equal parts of ground ginger, cloves, cinnamon, and 
allspice, and one-fourth part of Cayenne pepper, and thoroughly mix them ; 
then put the resulting dry powder into a previously-prepared flannel bag 
of the desired size, distribute the powder equably through the latter, and 
quilt it in,-i.e., run lines of stitching across the bag, so as to confine the 
powder in little compartments. When used with common whisky or with 
alcohol, a plan which has seemed to me still more pleasant is to put two 
ounces of unground ginger, an ounce of unground cloves, cinnamon, and 
chillies, or African peppers, in a pint bottle, and pour the whisky upon 
them. After this has stood awhile, the liquor is to be put upon a piece of 
flannel of the proper size, and the latter is to be laid upon the part and 
covered with a larger piece of oiled silk, or else a piece of spongio-piline may 
be employed. If the strength of the preparation is too great, it can readily be 
reduced by dilution; if it is too little, it can as readily be increased by adding 
more of the spices, especially of the peppers. In many cases, when the 
tenderness is very great, the weight of the spice-plaster is objected to. Under 
these circumstances the substitute here proposed is especially valuable. 
Oil of Turpentine is a very powerful rubefacient, capable, if applied to 
the skin for too long a time, of destroying the epidermis. It produces, when 
properly used, simply an intense diffused redness. The most frequent mode 
of application is in the form of stupes, which should be made by dipping a 
piece of flannel, previously wrung out with warm water, into a cup of the 
turpentine which has been warmed by setting it in hot water, and then 
wringing out all excess of the turpentine, and applying. These stupes may 
be left on from ten to thirty minutes, according to the severity of the im- 
pression desired and the susceptibility of the patient's skin. On some per- 618 
LOCAL REMEDIES. 
eons the least contact of turpentine, or even of its vapors, produces a most 
painful furuncular eruption. Where this idiosyncrasy exists, of course the 
remedy should never be used. The officinal liniment (Linimentum Terebin- 
thinae, U. S., Kentish Ointment^ is used as a stimulant application to burns. 
According to the U. S. Dispensatory, it should be applied as soon as possible 
after the reception of the burn, by covering the injured surface with pledgets 
of patent lint saturated with it, and should be allowed to remain on until the 
peculiar inflammation excited by the fire has subsided. 
Ammonia is a most efficient rubefacient, which in its general relations 
has been sufficiently discussed elsewhere. When great haste is required, it 
may be employed as an epispastic by applying a piece of common lint, satu- 
rated with the strongest water of ammonia, and covering it with some im- 
pervious coating. Great care must be practiced lest the ammonia act as an 
escharotic, since a too prolonged application may produce a deep slough. To 
raise a blister requires from five to ten minutes. On account of its cheapness 
and efficiency, ammonia is very largely used in extemporaneous liniments. 
In prescribing, it must always be borne in mind that there are two waters of 
ammonia : Aqua Ammonias Fortior, U.S., with a specific gravity of 0.900, 
containing twenty-six per cent, of the gas; and Aqxia Ammonias, U.S., with a 
specific gravity of 0.960, containing about ten per cent, of the gas. The rube- 
facient action of ammonia is less permanent than that of turpentine. There is 
an officinal liniment (Linimentum Ammonias, U. S.), containing one part of 
the simple water to two parts of olive oil. It is, of course, an ammoniacal soap. 
Pix Burgundica, U.S., or Burgundy Pitch, is a concrete juice obtained 
by wounding the Abies excelsa, or Norway spruce, and Abies picea, or Eu- 
ropean silver fir,-lofty forest-trees of Middle and Northern Europe,-melt- 
ing the product of the exudation with hot water, and straining. It is hard, 
opaque, brittle, of a feeble terebinthinate odor and taste, and contains resin 
and a minute amount of volatile oil. It is a mild rubefacient, which, in tho 
form of plaster, may be kept applied for a long time in chronic bronchitis 
and in rheumatic affections of the trunkal muscles. The officinal plaster 
(Emplastrum Picis Burgundicas, U. S.) contains one-twelfth of its weight 
of wax. The Warming Plaster (Emplastrum Picis cum Cantharide, U. S.) 
contains one part of cantharides cerate to twelve parts of Burgundy pitch, 
and is a very decided counter-irritant, whose prolonged use will sometimes 
blister susceptible skins. 
Pix Canadensis, U.S., or Canada Pitch, is the concrete juice of the 
Abies Canadensis, or the indigenous hemlock spruce of this country, purified 
by melting with water and straining. It is hard and brittle in winter, soft 
in summer, of a yellowish-brown color, deepening to black on exposure. It 
contains resin and a minute quantity of volatile oil, and is used for the same 
purpose as the Burgundy pitch. The plaster (Emplastrum Picis Canaden- 
sis, U. S.) contains one-twelfth of its weight of wax. CLASS XIE-ESCHAROTICS. 
Escharotics are drugs which are used to destroy diseased or sound 
tissue. Many of them exert a purely chemical influence, whilst others seem 
to destroy life by directly affecting the vitality of the part, and are said to 
act dynamically. Those which act chemically do so in several ways ; some, 
like bromine, probably produce an intense corrosive oxidation, whilst others, 
like sulphuric acid, abstract the water. 
Escharotics are used for various purposes. Formerly they were employed 
to open abscesses; but in the very few cases in which the knife is not allow- 
able, as in abscess of the liver, aspiration affords, without doubt, a much 
superior and, in hepatic abscess, much safer method. They are constantly 
employed to destroy unsound, harmful tissues and growths. Thus, they are 
used to remove the specific tissue of a chancre, or to kill a malignant or 
semi-malignant tumor. Another purpose which they fulfil is the destruction 
of poisoned wounds. In these cases they may in some instances destroy the 
poison itself, but in other cases they simply prevent the absorption of the 
toxic agent by putting an end to the life-actions of the tissue containing it. 
It is hardly necessary to mention all the various cases in which caustics are 
employed to overcome the effects of poisoned wounds. Hydrophobia is a 
perfectly uncontrollable disease ; but the thorough destruction of the wounded 
tissue at any time before the manifestation of the symptoms will probably 
prevent its occurrence, as it will certainly do if performed early. In malig- 
nant pustule, life depends upon the free early use of escharotics. Escharotics 
are employed to produce ulcerations which shall be the bases of issues; also, 
by destroying the exuberant granulations or the indolent surfaces of ulcers, 
to remove at the same time diseased tissue, afford protection to the parts 
below by forming an impermeable surface, and exert such alterative action 
upon the part as shall modify for good the life-processes. 
It is evident that the choice of the caustic should depend upon the object 
to be attained. When large tumors are to be killed, or when it is all-impor- 
tant completely to destroy a poisoned wound, a powerful deep-reaching escha- 
rotic must be employed; but when the surface of an ulcer is to be filmed 
over, a caustic which acts superficially and forms a dense albuminous coating, 
as does nitrate of silver, is to be chosen. 
An observation of Drs. N. A. Randolph and S. Gr. Dixon (Med. News, 
Jan. 4, 1885) indicates that the pain produced by a caustic may be almost 
nullified by the use of cocaine. They find that the saturated solution of 
cocaine in nitric acid acts as powerfully although much more slowly than 
nitric acid, and that the only sensation that is produced during the pro- 
duction of even a deep eschar is a slight prickling. 
619 620 
LOCAL REMEDIES. 
All of the more powerful of the escharotics, when taken internally in suf- 
ficient amount, act as violent corrosive poisons, producing agonizing pain in 
the oesophagus and hypogastrium, violent bloody vomiting, often purging of 
similar character, and finally collapse, deepening into death, which is some- 
times preceded by convulsions. When the dose is not so large, the system 
may rally from the immediate effects of the poison to succumb finally to the 
local lesions produced, or to struggle through a protracted convalescence to 
health, perhaps only to die years afterwards from organic stricture, caused by 
the ulcerations of the oesophagus or other of the digestive tubes. The first 
indication in poisoning by one of these substances is to neutralize or chem- 
ically antidote the poison. Many, if not quite all, of the escharotics have 
some chemical antidote : with the alkalies, dilute acid, generally convenient in 
the form of vinegar; with the acids, alkalies, generally at hand in the shape 
of whitewash or of soap ; with others, specific substances, which, as antidotes, 
should be at once exhibited. Opium should always be freely given, and the 
symptoms during and after the first poisoning be treated as they arise, upon 
general principles. 
Potassa, U.S.- Caustic Potash is officinally prepared by boiling liquor 
potassa? until ebullition ceases and the potassa melts, when it is run into 
cylindrical moulds. It occurs in grayish semi-translucent sticks, about three 
inches long and as thick as a large goose-quill, very deliquescent when ex- 
posed to the air, and extremely soluble, except impurities (lime, oxide of iron, 
and carbonate of potassium), in both water and alcohol. When it is placed 
upon the skin it soon melts, and, as it does so, gives rise to a pain which 
increases until it becomes very intense, and continues until the power of the 
alkali is so lost that it can no longer reach through the tissue it has killed to 
the sound flesh below. Under the action of the escharotic the skin becomes 
a dirty ashen-gray, and finally a slough is formed, with inflammation of the 
surrounding parts, and ulceration and detachment of the dead tissue in from 
six to ten days. The potash appears to act chiefly by abstracting the water, 
and, to some extent, by combining with the fatty and other portions of the 
tissues. Its slough being perfectly permeable, and its power being but slowly 
expended by its own action, potash is one of the most thorough of the 
escharotics: it is, therefore, to be preferred when a very deep and decided 
influence is required, as after the bite of a rabid dog. It is somewhat un- 
controllable in its action, and requires care in its use. The best method of 
application is as follows. Take a piece of heavy adhesive plaster, and cut a 
hole in it of such size that, when the piece is warmed and properly placed 
upon the skin, the part to be acted upon will be exposed whilst all around 
it will be protected. Then apply the plaster, and grease the outer surface 
of it, without allowing any of the oil to come in contact with the exposed 
central skin. Then lay the caustic potash upon the latter, and when the action 
is believed to have extended deep enough, wash the part with dilute vinegar. ESCHAROTICS. 
621 
Potassa CUM Calce, U. S.- Vienna Paste is a grayish-white powaer 
composed of equal amounts of caustic potash and of caustic-i.e., unslaked 
-lime. It is less active than the simple caustic potash, but is preferred by 
some on account of its being less apt to spread and diffuse itself. When 
applied, it is mixed with sufficient alcohol to form a paste, and then used in 
the manner described when speaking of the simple alkali. M. Piedagnel 
affirms {Journal de Pharmacie et de Chimie, 3e ser., t. xxxiii.) that this 
caustic may be rendered nearly or entirely painless in its action by mixing 
one part of the muriate of morphia with three parts of the powder, and 
then by the addition of chloroform forming a paste that may be spread upon 
lead-plaster and so applied. In five minutes the skin under the application 
becomes of a dead white color, and at the end of fifteen minutes is brown 
and carbonized. If the application be persisted in, the thickness of the eschar 
becomes finally about equal to that of the layer of the paste employed. 
Acidum Arseniosum.-As a caustic, arsenic is energetic and powerful, 
but somewhat slow, in its action, and causes intense pain, with violent inflam- 
mation of the neighboring parts. It is stated to affect more rapidly morbid 
than normal structures, and hence is especially used for the destruction of 
malignant growths. It appears to act chiefly upon the vitality of the part, 
acting, when sufficiently diluted, as a powerful irritant, and when in a con- 
centrated form producing an irritation so intense that life cannot endure it. 
Hence, probably, the reason of its affecting more rapidly morbid growths, 
which, as is well known, have a lower vitality than sound tissues. 
The great objection to the employment of arsenic is the possibility of its 
absorption in sufficient amount to cause constitutional symptoms : even death 
has resulted from its external use. Absorption takes place, of course, much 
more rapidly in a healthy than in an intensely inflamed or dead tissue. For 
this reason, whenever arsenic is employed it should be used freely, and under 
no circumstances should it be applied to a large healthy surface, such as that 
of a fresh wound. The rationale of these precepts is very evident. Arsenic, 
if employed at all as an escharotic, must be applied in quantities which 
would, if absorbed, endanger life; but when a very large amount is used it 
causes death so rapidly as to prevent absorption. In the case of a fresh 
wound, the poison may be taken up before it has an opportunity to produce 
local death. 
Used in any way, arsenic is a hazardous caustic, and it ought to be em- 
ployed only with the knowledge and distinct remembrance of this fact. 
Cancer, and perhaps some forms of semi-malignant ulceration, such as lupus, 
appear to be the only diseases which justify its use. Sir Astley Coopers 
Arsenious Ointment consists of one drachm of arsenious acid, one drachm of 
sulphur, and an ounce of spermaceti cerate, which is to be allowed to remain 
in contact with the morbid growth for twenty-four hours. 
The Arsenical Paste of Frire Cosme and Rousselot, which is officinal in 622 
LOCAL REMEDIES. 
France, is composed of one part of arsenious acid, two of dragon's blood, 
and two of porphyrized cinnabar, made into paste with mucilage when 
applied. There is no reason for believing that any of the almost innumerable 
substances which have been proposed as a basis for arsenious pastes possess 
any marked advantages: the only needful direction is to mix the caustic 
with from eight to ten times its bulk of inert material of such a nature as to 
make either an ointment or a paste, as the whim of the surgeon or the cir- 
cumstances of the case may dictate, and to allow this to remain on for from 
eighteen to twenty-four hours. 
Zinci Chloridum, U. S.- Chloride of Zinc is made by the action of 
muriatic acid upon zinc. It occurs in broken fragments of a grayish-white 
color, translucent and waxy in appearance, of an acrid corrosive, or, when 
diluted, acrid astringent, metallic taste. It is extremely deliquescent, fusible, 
volatilizable at a high temperature, and very soluble in both water and alco- 
hol. Chloride of zinc is a very powerful caustic, producing, when applied 
in a concentrated form, intense pain lasting for six to eight hours, and a 
whitish eschar, which usually separates in from six to twelve days. Its 
penetrating powers are said to be a little less than those of caustic potash, 
and its action is certainly much less rapid and diffusive. It is a superior 
caustic, because its action is more readily controlled than that of potash, 
because its absorption does not endanger life, as is the case with arsenious 
acid, and because it leaves a slough which is free from odor. 
Canquoins Paste is made by mixing the chloride of zinc with flour and 
water. The strength varies according to the purpose, the weakest paste con- 
taining only one part of the caustic in six parts; the strongest, one part in 
three. When used, ten or fifteen drops of water are added to the paste, 
which is applied in layers, successive applications being required when a 
large tumor is to be destroyed. Anhydrous sulphate of calcium has been 
especially commended by Dr. A. Ure, as forming a drier paste with the 
escharotic and limiting its action more definitely to the site of application 
than any other substance. Concentrated alcoholic or watery solutions of the 
chloride of zinc are often used as caustics in cases of chancres and other 
small specific ulcers, and are reputed to be efficient. They should be applied 
by means of little pledgets of lint. As the action of the chloride upon the 
skin is slow and very painful, whenever the cuticle over the part to be 
destroyed is sound it should be removed by means of blisters. By some 
surgeons the escharotic is introduced directly into the tumor to be destroyed. 
Thus, Maisonneuve makes a paste of one part of the chloride with three of 
flour and a little water, then cuts these into pointed strips or "arrows" and 
dries them. Ue then thrusts these hardened bodies into the tumor,-if 
necessary, first making incisions with the bistoury,-in such a way that they 
lie close together and form a ring around the base of the tumor. A con- 
tinuous slough is thus created, which cuts off the remainder of the mass ESCHAROTICS. 
623 
from the sound tissue and causes its death. Sometimes Maisonneuve simply 
thrusts these arrows into the body of the tumor, and destroys it directly. 
The officinal solution {Liquor Zinci Chloridi, U. S.) is used as a dis- 
infectant. 
Hydrargyrum Chloridum Corrosivum.- Corrosive Sublimate is an 
escharotic of moderate power, which shares the dangers of arsenic, since 
death has followed its external use. In saturated solution it is much used 
as a caustic in chancres, but is scarcely equal to the acid nitrate of mercury. 
In these cases it should be applied by means of a camel's-hair brush. Prof. 
George B. Wood recommends very highly in onychia maligna the use of a 
powder composed of equal parts of corrosive sublimate and sulphate of zinc 
intimately mixed. This powder is to be sprinkled thickly over the diseased 
surface, and a pledget of lint thoroughly wet with laudanum is to be laid 
thereon. There is severe pain for half an hour to an hour ; but the dress- 
ings are not to be removed until eight or ten hours have elapsed. When 
the slough which is thus formed separates, a healthy granulating surface is 
left behind. 
Liquor Hydrargyri Nitratis, U. S.-Solution of the acid nitrate of 
mercury is a nearly colorless, highly corrosive, acid liquid, having a specific 
gravity of 2.165, and made by dissolving mercury, or its red oxide, in a 
large excess of nitric acid. It contains free nitric acid and the binitrate of 
the deutoxide of mercury. I do not know of its external use ever having 
produced death; but it has caused salivation, and it is perfectly conceivable 
that its careless employment should lead to much more serious results: 
indeed, in the Lancet for Jan. 3, 1874, is reported a very serious case of 
poisoning by the application of the pernitrate to a space not bigger than a 
half-crown. It is rarely used, except for the purpose of destroying specific 
or cancerous ulcers. It is especially useful in chancres, to which it should 
be applied with a glass rod. In obstinate acne, a minute drop applied by 
means of a glass brush to the top of an indolent tubercle is said to destroy 
it without producing a scar. It has been largely employed by gynaecologists 
in ulcerations of the cervix uteri. Its action in all these cases is very prompt 
and is moderately deep; the pain is severe, but transient. 
Acidum Sulpiiuricum.-Sulphuric Add is a powerful escharotic, and 
has been used extensively for the purpose of destroying even large growths. 
For this purpose the strongest acid is mixed with charcoal, so as to make a 
thick, manageable paste. Before the application of this, the skin should be 
removed by a blister. At present this escharotic is not much employed. 
Acidum Nitricum.-Nitric Acid is a powerful caustic, which is never 
employed to destroy large growths, but is a favorite application to chancres, 
to syphilitic, phagedsenic, and other unhealthy ulcers, as well as to condylo- 
mata and other small dermal growths. It is applied by means of a glass 624 
LOCAL REMEDIES. 
rod or a splinter of wood A drop or two is usually amply sufficient; and 
when the action has gone far enough, the part should be washed with soap- 
suds, which at once arrests action and causes the severe pain to cease. 
Acidum Muriaticum.-Muriatic Acid is capable of acting as a caustic, 
but is less powerful than either sulphuric or nitric acid, and is rarely used. 
Acidum Chromicum.- Chromic Acid occurs in anhydrous acicular crys- 
tals, of a deep-red color, and an acid, metallic, corrosive taste. They are 
very deliquescent, melting down, when exposed to the air, into a deep-red 
solution. Chromic acid is a very active oxidizer, and when mixed with 
organic matter rapidly alters it, and if in slight excess will dissolve almost 
any form of tissue. It is no doubt in this way that it acts as an escharotic. 
It is very much used to destroy condylomata and other dermal growths, and 
no doubt would be efficient in cases of larger tumors. In superficial affec- 
tions it is best applied by means of a glass rod, the liquid formed by the 
spontaneous deliquescence of the crystals being used. Chromic acid is some- 
times prescribed dissolved in, or made into a paste with, glycerine, but it is 
stated that in mixing the two great care must be taken to add the liquid 
slowly drop by drop, as otherwise there is danger of an explosion (Phila. 
Med. Times, iv.). Care must be exercised in the free use of chromic acid,* as 
it is a violent poison, and has produced death when employed locally (Strick- 
er s Jahr bucher, 1877, p. 139; also Schmidt's Jahrb., Bd. cci. 1884, 129). 
Bromum, U. S.-Bromine is a dark-red liquid which has a very powerful, 
disagreeable, chlorine-like odor, and at ordinary temperatures emits exceed- 
ingly acrid, pungent fumes. It is sparingly soluble in water, more soluble 
in alcohol, and still more so in ether. Alcoholic and ethereal solutions lose 
their color and become acid in a few days, from the generation of hydro- 
bromic acid. When bromine is brought into contact with organic matter, it 
oxidizes and completely destroys it with great rapidity. On account of its 
liquid form and of this property, bromine is one of the most severe, thorough, 
and rapid of all the caustics. It has not been much employed to destroy 
morbid growths, but during our late war was found to be the most efficient 
of all the applications tried in hospital gangrene. After most of the slough 
had been cut away, the caustic was applied pretty freely to the living tissue 
by means of a glass rod. The pain tvas very severe; but it ceased after a 
few moments when the caustic was washed off. 
Sulphate of Zinc and Sulphate of Copper are feeble escharotics, never 
used to destroy sound tissue. Burnt Alum belongs in the same category, 
but is probably a little more feeble. All three of these drugs are used to 
destroy exuberant granulations in ulcers 
• For experiments on its effect on animals, see Arch. f. Exper. Path. u. Pharm., vi.; 
also Stricker's Jahrb., 1877, p. 139. CLASS XIIL-DEMULCENTS. 
These are bland substances, which form more or less gummy or mucilagi- 
nous solutions in water, capable of exerting a calming or soothing influence 
upon inflamed surfaces. Without doubt water itself is the demulcent par 
excellence; but the remedies here discussed do seem to enhance its power. 
It has been claimed for these medicines not only that they soothe surfaces 
to which they are immediately applied, but also that taken internally they 
relieve irritation in distant organs. As, however, all of them are complex 
vegetable products, as many of them are staple articles in the world's food 
and as none of them have been detected in the blood or the secretions, it 
cannot be allowed that they reach distant parts through absorption into the 
blood. What is certainly true of some of them is probably true of all,-i.e., 
digestion of them occurs in the primae viae. The relief which undoubtedly 
follows their use in certain affections of parts which they can reach only 
through the circulation is probably in great part, if not altogether, due to the 
large quantities of water with which they are administered, which, passing 
through the body, lessen the concentration, and hence the acridity, of the 
urine and other secretions. 
Clinically, demulcents are useful as local applications in all forms of 
acutely-inflamed surfaces, and they are taken internally in acute inflamma- 
tory conditions of the alimentary canal. In slight bronchial irritation they 
are often of service, especially when allowed to dissolve slowly in the mouth: 
used in this manner, they not only exert an influence upon the mucous 
membrane of the mouth, but very probably find their way also into the res- 
piratory passages. 
ACACIA-GUM ARABIC. U. S. 
A gummy exudation from Acacia vera and other species of Acacia, small 
trees growing in Northern Africa, Senegambia, Guinea, etc., the Cape of 
Good Hope, and Australia. Gum arabic occurs in roundish or irregular 
pieces, more or less transparent, hard, brittle, varying in color from white or 
yellowish white to red, or even deep orange brown. It consists of a peculiar 
principle, Arabin, united with about three per cent, of lime, potash, and mag- 
nesia. According to Husemann, pure arabin is an amorphous substance, 
glassy and transparent when dry, but milk-white when moist, and having a 
feeble acid reaction, with the power of uniting with bases. In the plant, 
625 626 
LOCAL REMEDIES. 
arabin, like other gums, appears to be formed by a retrograde metamorphosis 
of cellulose. Indeed, Wigand declares that the flesh and even the hard en- 
docarp of the plum can undergo this metamorphosis. The same investigator 
affirms that bassorin is a first product of the change, and is, by a continuation 
of the process, converted into arabin.* On account of its solubility and 
pleasant taste, gum arabic is often used as a demulcent in irritation of the 
fauces and in angina. It is also sometimes used as an addition to drinking- 
water in fevers, and is believed to have some slight nutritious properties. Its 
chief use, however, is in Pharmacy, in the making of emulsions, pills, etc. 
The mucilage (Mucilago Acaciee) is officinal. 
Tragacantha, U.S.- Tragacanth is the concrete juice of Astragalus 
verus, a small shrub of Asia Minor. Tragacanth occurs in large, whitish, 
horny, waved flakes, or sometimes in filamentous pieces. It is odorless and 
nearly tasteless. Introduced into water it does not dissolve, but swells up into 
a soft paste. One hundred parts of it contain, according to Guerin, 53.3 parts 
of arabin, 33.1 parts of bassorin, and 2.5 parts of inorganic ash. Bassorin 
is a gummy principle, at once distinguished from arabin by its not dissolving 
in water, but simply swelling up into a pasty mass. Tragacanth is used in 
medicine only in the manufacture of troches and in suspending heavy pow- 
ders, for which purpose the difficulty of its solution and the extreme viscidity 
of its mucilage especially fit it. Its mucilage (^Mucilago Tragacanthse.^ is 
officinal. ' 
Ulmus, U. S.-Slippery Elm is the inner bark of* Ulmus fulva, a large 
indigenous tree. The bark is of a yellowish-white or tan color, fibrous, 
yet when dry somewhat brittle, and occurs in long, flat strips or pieces one or 
two lines thick. It is pleasantly mucilaginous when chewed. It contains a 
large quantity of a peculiar mucilage, which it yields freely to water. Its 
infusion is sometimes taken in large quantities in inflammations of the intes- 
tines as a demulcent laxative; but its chief use is as an external application. 
When ground into powder, slippery elm makes a very excellent soothing 
poultice. The mucilage (Mucilago Ulmi^ is officinal. 
Cetraria, U. S.-Iceland Moss is the fronds of a lichen, Cetraria Islandica, 
growing on rocks in Iceland, and in most of the northern portions of the world. 
It is said to be abundant in the mountains of New England. The foliaceous, 
dry, shining, lobed, and laciniated fronds are about four inches long, of vari- 
ous intermixed colors, gray, brown, and red, of a mucilaginous, bitter taste. 
Iceland moss contains a peculiar starch-like principle, lichen starch, and a 
bitter principle. It is inodorous, and has a mucilaginous, bitter taste. It 
* The reader interested in the method of formation of the gums is referred to the fol- 
lowing papers : Kiitzing, Archie d. Pharmacie, 1851, Heft i.,-translated in the American 
Journal of Pharmacy, vol. xxv. p. 37; Mohl, Botanische Zeituny, 18 57j p. 33; A.Wigand, 
Jahrbucher fur Wies. Botanik, 1861, iii. 117; and for a general discussion by Dr. J, 
Sachs, to Hofmeister'e Handbuch der physioloyischen Botanik, Bd. iv. p. 367. DEMULCENTS. 
627 
yields to cold water its bitterness; to boiling water all of its virtues. Ce- 
trarin, or Cetraric Acid, is the bitter principle, which may be obtained as a 
snow-white mass of interlaced acicular crystals. It unites with alkalies to 
form salts. With it in the lichen is associated in small quantities lichstearic 
acid. Lichenin, or Lichen Starch, the mucilaginous, nutritive principle of 
Iceland moss, differs from ordinary starch in not being deposited in granules 
within the cells, but in layers or irregular masses between the cells, or in- 
deed forming the walls themselves of the cells (De Bary, Hofmeister's Ilandb. 
der physiolog. Botan., Bd. ii. p. 255). In cold water it swells up without 
dissolving; in hot water it dissolves, and on cooling condenses into a jelly. 
With iodine it strikes a yellow, green, or sometimes rather faint blue, color. 
It is found in very many lichens; also in many species of sea-weed, notably 
in the so-called Corsican moss. Iceland moss has enjoyed some reputation 
as a demulcent in pectoral complaints. From its bitter principle it is prob- 
ably somewhat tonic, and its lichenin is probably about equal to ordinary 
starch as a nutrient. When prepared as an article of diet, in the form of 
jelly, the bitter taste should be removed by soaking for some hours in a very 
weak cold alkaline solution, and afterwards for a little while in cold water. 
Chondrus, U. S.-Irish Moss, or Carrageen.-The fronds of Chondrus 
crispus, a sea-weed growing on the coast of Ireland, and also on the northern 
coast of the United States, where it is now gathered in large quantities. The 
fronds are purplish red,-but, as kept in the shops, bleached by washing in 
fresh water, whitish, and translucent,-cartilaginous, slender, much branched, 
swelling up but not dissolving in water, and having a slightly saline taste 
Their virtue depends chiefly upon a starch- or gum-like principle, Carra 
geenin, which is distinguished from starch by not turning blue with iodine, 
from gum by not precipitating from its watery solution on the addition of 
alcohol. Chondrus also contains a notable proportion of a vegetable albu- 
men, very rich in nitrogen. 
Carrageen, being demulcent and nutritious, is employed as an article of 
diet in those cases requiring food of such character, and may be used instead 
of arrow-root. It is to be prepared by first soaking for ten minutes in cold 
water, and then boiling from half an ounce to an ounce of it (according to 
the desired consistency) in a pint and a half of water down to a pint, sweet- 
ening and flavoring to taste. Milk may be substituted for water, and the 
preparation thus rendered more nutritious. 
Glycyrrhiza, U. S.-Liquorice Root is the root of Glycyrrhiza glabra, 
a native herb of Southern Europe. It occurs in long cylindrical pieces, from 
a few lines to more than an inch in diameter, brownish externally, and yel- 
lowish within. . Its fracture is fibrous, its taste sweet and mucilaginous, its 
odor none. Its active principle is Glycyrrhizin. This is a sweet, neutral 
substance, differing from the sugars in not being converted by nitric acid into 628 
LOCAL REMEDIES. 
oxalic acid, and by its inability to undergo the vinous fermentation. Liquor- 
ice root is very largely used as a demulcent in pectoral complaints, and, on 
account of its pleasant taste, as a means of disguising or of flavoring medi- 
cines. In the form of glycyrrhizin it is said to conceal almost entirely the 
bitter taste of quinine and similar substances. It is used almost exclusively 
in the form of the extract (Extraction Glycyrrhizae, U.S.), known a? 
Liquorice. The Mistura Glycyrrhizae Composita, U.S., or Brown Mixture, 
contains paregoric, antimonial wine, and sweet spirit of nitre, and is much 
used as a domestic remedy in " colds" and the early stages of mild bronchitis. 
The dose for an adult is half a fluidounce to a fluidounce every three hours; 
for a child three years old, a teaspoonful. The pure extract (Extractum 
Glycyrrhizae Purum, U. S.) and the fluid extract (Extraction Glycyrrhizae 
Fluidum, U. S.) are excellent preparations. Glycyrrhizinum Ammoniation, 
U. S., is a very elegant preparation, which, however, is incompatible with 
acid or alkaline solutions; its dose is from five to ten grains. 
Medulla Sassafras, U.S., is the pith of the indigenous sassafras, which 
yields a delicate mucilage with water. This mucilage, which is much used 
in diseases of the eye, is officinal (Mucilago Sassafras'). 
Althea, U. S.-The roots of the Althaea officinalis yield a bland muci- 
lage, and are occasionally employed to make a decoction, which is given in 
irritated states of the stomach and bowels, or in the form of a syrup as a 
vehicle (Syrupus Althaeas, U. S.). 
Linum, U. S., or Flaxseed, is the seed of Linum usitatissimum, or com- 
mon flax, and contains large quantities of mucilage and of oil: its Compound 
Infusion is much used internally. It is often made with boiling water; 
but the application of too much heat causes the extraction of more or less 
of the oil, and thereby renders the preparation less palatable. The infusion 
should never, therefore, be boiled during its making. The addition of lemon 
and sugar renders it more palatable. It may be drunk ad libitum in pectoral 
catarrhs, in enteritis and dysentery, and in irritation of the kidneys or the 
urinary passages. Ground flaxseed (Lini Farina) is especially adapted, 
by the oil and mucilage it contains, for making poultices. 
The seeds of the quince (Cydonium, U.S.) contain a large quantity 
of mucilage, which they readily yield to water, forming a thick tenacious 
solution (Mucilago Cydonii, U. S.). 
Tapioca is the fecula of the root of Janipha Manihot, a native of South 
America. There are two varieties of the tapioca plant, the sweet and the 
bitter cassava. The latter is in its fresh state poisonous, from the prus- 
sic acid which it contains, but yields most, if not all, of the tapioca of com- 
merce. The tapioca is obtained by allowing the expressed juice to stand, DEMULCENTS. 
629 
separating the powder which deposits, washing, and drying by heat, owing 
to the action of which the starch is rendered partially soluble in cold water, 
ft is in irregular, hard and rough, nearly tasteless grains, which the micro- 
scope shows to be composed of broken, ruptured starch-granules. It con- 
stitutes an elegant farinaceous article of diet, and may be prepared in the 
following manner: Soak two tablespoonfuls of very clean tapioca in two tea- 
cupfuls of cold water over-night; in the morning add a little salt and one 
pint of milk, or water if milk is not allowed; simmer it until quite soft; 
stir well while cooling ; when done, pour into a bowl, and add sugar, wine, 
and nutmeg, according to taste or the exigencies of the case. 
Maranta (Arrowroof) is a fecula or starch, obtained from the rhizome 
of the Maranta arundinacea, a native of the West Indies. Arrowroot is 
produced in the West Indies, in Africa, and in the Southern United States, 
especially Florida. The most esteemed variety is that which comes from 
the island of Bermuda. It is obtained in the usual method by beating 
the root-stocks into a pulp, and the use of flowing cold water. It occurs as a 
very light, tasteless, and odorless white powder, which the microscope shows 
to be composed of ovate, oblong, or irregularly-convex granules, from the 
seven-hundred-and-fiftieth to the two-thousandth of an inch long, marked 
with very fine rings and a circular hilum, which cracks in a linear or stellate 
manner. It is often adulterated with other starches, which are best detected 
by the microscope. 
Arrowroot affords the most readily prepared and, in the sick-room, the 
most popular of all the farinaceous articles of diet. It may be prepared in 
the following manner: Stir two teaspoonfuls of arrowroot in half a teacupful 
of cold milk until a perfectly smooth mixture is made; have on the fire a pint 
of milk, and, while this is boiling, add the arrowroot little by little, stirring 
constantly until cooked,-i.e., from one to two minutes after the last is poured 
m; add sugar, nutmeg, and wine, according to taste or the exigencies of the 
case. When milk is not to be had, or a very low diet is required, water 
may be substituted. 
Sago is a fecula obtained from the pith of Sagus Rumphii and other 
sago palms of Sumatra and the neighboring regions. It is first prepared 
in the usual manner, and then formed into a paste with water, rubbed into 
grains, and dried. Pearl Sago occurs in hard, roundish, somewhat trans- 
lucent or sometimes opaque grains, about the size of a pin's head. Common 
Sago is in larger and browner grains, often mixed with some powder. It is 
composed of oval or ovate, often truncate and muller-shaped, often much 
broken, starch-granules. It is used exclusively as an article of diet, forming 
a jelly, which is best prepared as follows: Wash the sago well in cold water ; 
put a small teacupful of it to soak in half a pint of water over-night, and in 
the morning put this mixture iuto one pint of hot water; squeeze into it the 630 
LOCAL REMEDIES. 
juice out of a thinly-pared lemon, and allow to simmer slowly for twenty 
minutes; then sweeten, add wine according to taste or the exigencies of 
the case, then pour into moulds to cool. 
Canna, or Tons les Mois, is a starch which is prepared in the West 
Indies, and resembles potato starch, but has a remarkable satin-like lustre, 
due to the extraordinary size of its granules. It forms with water a tena- 
cious jelly, which is not so clear as that produced by arrowroot. It is very 
rarely, if ever, used in this country. 
Hordeum.-Under the name of Hordeum, or Barley, the United States 
Pharmacopoeia recognizes the decorticated seeds of the common barley, the 
pearl barley of commerce. They contain starch and mucilage, and the 
decoction (Decoctum Hordei) was formerly officinal. Barley-water is used 
as a nutritious, demulcent drink in fevers and inflammatory conditions, 
especially when the gastric mucous membrane is involved. The U. S. 
Pharmacopoeia 1870 directed that it should be prepared as follows: " Take 
of barley two troyounces ; water a sufficient quantity. Having washed away 
the extraneous matters which adhere to the barley, boil it with half a pint 
of water for a short time, and throw away the resulting liquid. Then, 
having poured on it four pints of boiling water, boil down to two pints, and 
strain." CLASS XIV.-EMOLLIENTS. 
True emollients are perfectly bland, fatty substances which, when applied 
to the skin, soften it and render it more pliable. The action of these reme- 
dies is largely mechanical, and they probably soften the derm in precisely the 
same way as they affect a rawr hide or a piece of leather. They are therefore 
especially useful when the skin has a tendency to crack or to chap. When- 
ever surfaces become sore by attrition, or, in other words, chafe, emollients 
are also useful in a mechanical method. Emollients often afford relief in 
simple inflammations of the skin under such circumstances that their action 
cannot be explained in any of the ways alluded to: indeed, they seem to 
exert a dynamic influence upon the nutrition of the parts concerned. To 
the best of our present knowledge, the oxygen or other constituent of the 
air acts as a stimulant to exposed surfaces and increases inflammations there 
present; and it is believed that fatty matters do good by keeping out the air. 
If this be so, the apparently dynamic influence of fatty niatters is, after all, 
mechanical. Be these things as they may, clinical experience has demon- 
strated that fatty matters are of very great value in the treatment of super- 
ficial inflammations. It must be borne in mind that the blandest fat, when 
it becomes rancid, is very irritating, and will do far more harm than good. 
In the use of fatty emollients, the strictest attention must therefore be paid 
to the condition of the material employed. Any perfectly bland oily sub- 
stance may be used as an emollient. Mutton suet and goose-grease are 
famous in domestic medicine, but are simply valuable because, if well pre- 
pared, they are less apt than some other fats to become rancid. It cannot 
be allowed that there is any difference in fats, unless it be in penetrating 
power : a very hard fat is of course not so readily applied as a softer one, and 
therefore only such fats as freely melt, or at least become very soft, at the 
temperature of the body, are to be used. Common Lard (Adeps, U. S.), when 
freed by washing from the salt which it commonly contains, is a mild fat, 
melting at the temperature of the body. It is enormously used in pharmacy. 
Cacao Butter (Oleum Theobromse^ U. S.) is an absolutely bland vegetable fat, 
which is a firm solid at ordinary temperatures, but melts with the heat of 
the body, and is consequently very largely used in the preparation of supposi- 
tories, both officinal and magistral. Spermaceti ( Cetaceum, U. S.) is also em- 
ployed to give consistence to ointments, as is also wax ( Cera alba, or white 
631 632 
LOCAL REMEDIES. 
wax, and Cera flava, or yellow wax, U. S.). Cold Cream, (Unyuentum 
Aqvse Rosse, U. S.), containing oil of sweet almonds, spermaceti, white wax, 
and rose-water, is the most elegant of all the officinal fatty emollients, unless 
it be glycerine, which is so much used that it merits a distinct notice. 
GLYOERINUM-GLYCERINE. U. S. 
This is a thick syrupy liquid, colorless, and free from odor, but of a sweet 
taste. It was originally prepared by heating together a metallic oxide and 
ordinary fats, as in the manufacture of lead-plaster. Chemically speaking, it 
belongs to the alcohols, and is known, according to the recent nomenclature, 
as propenyl alcohol. It is always set free during the process of saponifica- 
tion, when the stearic or other acids of the fat unite with some base to form 
salts, known as soap. Consequently, glycerine always forms a considerable 
part of the soap-maker's waste; but in this it is so mixed with impurities 
that until recently it was valueless. Now, by means of certain patent pro- 
cesses, the glycerine is said to be obtained pure from the waste products of 
soap-factories. It is also manufactured on a very large scale by the direct 
decomposition of fats by heated steam, in accordance with a plan patented 
by Mr. Tilghman. The great bulk of the glycerine in commerce is at 
present prepared in this way. 
Under certain circumstances, not well understood, glycerine forms hard, 
brilliant crystals. In its usual liquid form it mixes in all proportions with 
water and alcohol, and possesses itself very great solvent powers, dissolving 
iodine, bromine, the alkalies, tannic and other vegetable acids, a large num- 
ber of neutral salts, salicin, and very many other organic principles, so that 
it is largely used in pharmacy. 
Glycerine does not evaporate upon exposure, but is very hygroscopic, and 
absorbs water from the air. When pure, it is incapable of becoming rancid 
or of fermenting spontaneously. The acrid glycerine, formerly so abundant 
in commerce, and still met with, owes its irritant properties to contaminating 
substances, especially, it is said, to oxalic and formic acids. The former of 
these substances is apt to be created by the action of the sulphuric acid used 
during the purification of the glycerine, the latter by the reaction between 
the oxalic acid and the glycerine. 
Physiological Action.-When large doses of glycerine (in the dog 
eight or more parts per thousand by weight) are injected subcutaneously, 
death is produced in a period varying, according to the dose, from one hour to 
several days. The symptoms are loss of muscular strength, lethargy, bloody 
urine, vomiting, dryness of the mucous membrane with marked thirst, fall 
of temperature, gradual extinction of both respiration and circulation, and 
finally convulsions and coma (Dujardin-Beaumetz and Audijd, Bull. Thirap., 
xci., p. 62). The convulsions occur more early and severely when large 
doses are employed, and are then said to be tetanic, and to be accompanied 
with a decided rise of temperature. The fall of temperature is, even in the EMOLLIENTS. 
633 
milder cases, only present late in the poisoning, and is sometimes, if not 
always, preceded by a rise. After death intense congestion, with more or 
less softening of the tissue, is found in the lungs, kidneys, and intestines. 
In man no symptoms of poisoning have ever been produced by glycerine; 
the largest single amounts ingested-an ounce or so-having no perceptible 
effect other than that of a laxative. 
Catillon claims that glycerine administered in small continuous doses exerts 
a decided effect upon nutrition {Bull. Therap., xcii., p. 130; Archiv. Physiol. 
Norm. Path., 1877). In his experiments he found that eight grains given 
daily to guinea-pigs produces a very marked gain in weight, with a lessened 
excretion of urea. In man an ounce daily also produced, in the elimination 
of urea, a decided diminution, which was not increased by increasing the 
doses of glycerine. The appetite in many cases was, after a little time, much 
improved, and then the increased ingestion of food produced an increased 
elimination of urea. The fact that an increase of food was permitted in 
these experiments shows, however, that the conditions of experimentation 
were not sufficiently rigid to allow much weight to be attached to the result; 
and the relation of glycerine to the elimination of urea has been recently 
investigated by L Lewin (Zeitschr. f. Biologle, xv.), by N. Tschirwinsky 
(Ibid.'), and by Dr. I. Munk ( Virchow's Archiv, Ixxvi. 130), with somewhat 
contradictory results. Of these experiments the most extensive are those 
of Munk, who seems to have used all proper precautions, and found that 
glycerine has no effect upon the elimination of urea or the general bodily 
nutrition. The results reached by Lewin correspond with those of Munk. 
Tschirwinsky omitted fatty materials from the food, and found that whilst 
at first the elimination of urea was diminished, it afterwards, under the use 
of very large doses of glycerine, was increased. 
With our present evidence it must be considered most probable that 
glycerine has no controlling power over the waste of nitrogenous tissues, but 
there is reason to believe that it is in some manner burnt up in the system, 
and has, therefore, some slight food value. It is undoubtedly absorbed, and 
when given very largely can be recognized in the urine, which, in some ex- 
periments, Tschirwinsky found to contain as much as 8.7 per cent, of it. 
Even when given freely it seems to be, at least in part, changed, since both 
Dstimowitsch (Arch. f. d. Ges. Physiolog., xiii. 453) and Pldsz (Ibid., xvi. 
153) have found a new substance in the urine which they believe to be a 
derivative product from glycerine. M. Catillon found that it was not elim- 
inated by the skin or intestines even when it purged, and was only partiallv 
eliminated with the urine, whilst, in a series of very careful experiments, 
Munk found that when given in small quantities it cannot be detected in the 
urine. According to Fuchsinger, the bloody urine produced by poisonous 
doses contains an abundance of the coloring matter of the blood, but no 
free corpuscles (Pfluger's Arch., Bd. xi. p. 502). Very interesting in con- 
nection with the use of glycerine in diabetes is the assertion of Fuchsinger 634 
LOCAL REMEDIES. 
(Pfliigers Archiv, xii., p. 501 ; Centralb. Med. H7ss., 1877), that in rabbits 
slightly poisoned with glycerine no sugar appears in the urine after the 
" diabetic puncture." The experiments of Eckhard gave, however, a con- 
trary result {Centralb. Med. Wissen., 1876, p. 273), and Catillon affirms 
that given in very large continuous doses glycerine increases the amount of 
sugar in the blood. 
Therapeutics.-Locally applied, glycerine is perfectly unirritating, and 
is much employed as an emollient. The chief disadvantage that attends its 
use is its stickiness; on the other hand, its non-volatility and its hygroscopic 
properties give a persistency to its action which is often very advantageous. 
It enters largely into the composition of popular emollient ointments, or 
" creams," as they are called, and is often used itself for chapped hands, ex- 
coriations, and similar troubles. It is also employed by dermatologists to 
some extent in chronic eczema; in seborrhoea, whether affecting the hairy 
scalp or other parts, it is asserted to be especially useful, softening the masses 
of secretion, and, used in conjunction with such remedies as borax, zinc, and 
acetate of lead, diminishing the amount of secretion. When there is a want 
of sebaceous secretion, it is said also to act efficiently ; in scabies, pruritus, 
and even psoriasis, glycerine is used, diluted with water, as a vehicle for 
more active remedies. Upon the mucous membranes glycerine acts very 
much as it does upon the skin, and diluted with water is very useful in 
coryza, and even, by enemata, in dysentery ; in croup or laryngitis it may 
with advantage be applied freely by means of a large camel's-hair brush to 
the orifice of the larynx, so as to run into the latter. In laxative doses it 
is asserted to be very effective in hemorrhoids. It also forms an excellent 
basis for mouth-washes; or a paste may be made with it and borax, or 
similar substance, for use in ulcerations of the same cavity. The list of 
diseases in which this remedy is employed might be very much lengthened ; 
but the examples already given are sufficient to indicate the range of its 
application as an emollient and a vehicle. There are certain persons upon 
whose skin and mucous membranes even the purest glycerine seems to act 
as an irritant. This influence is most intense when the glycerine is nearly 
or entirely free from water. It is, however, discernible even when the 
remedy is much diluted, and often prohibits its use. The existence of this 
idiosyncrasy to glycerine can be determined only by trial. 
When administered internally in doses of one or two ounces, glycerine 
acts as a gentle but very uncertain laxative. I do not think that a single 
dose has any other perceptible effect. It was long ago proposed as a sub 
stitute for cod-liver oil in cachectic diseases, but failed to acquire reputation. 
Nevertheless, the results of Catillon would seem to demand for it more 
extensive trial. That observer states the proper amount of it to be half an 
ounce to an ounce in the course of the day in three doses. It has also been 
proposed and highly commended in diabetes.* It appears to be harmless in 
* For literature and discussion of point, see Ziemasen'a Encyclopaedia, vol. xvi. EMOLLIENTS. 
635 
this affection, and therefore may be used as a sweetening-material for coffee, 
tea, and other beverages ; but there is no reason to believe that it exerts any 
control over the disease. The most important internal use of glycerine is as 
a harmless substance which has the power of disguising nauseous medicines. 
In this way it may be employed with castor oil, in emulsions of turpentine, 
in solutions of iron, and in various mixtures. It seems, as it were, to envelop 
the medicinal substances and prevent their acting on the palate. Plasma, 
or Glycerite of Starch {Glycerituni Amyli, U.S.), is often used as a pro- 
tective: Glycerite of Yolk of Egg (fGlyceritum Vitelli, U.S.) is chiefly 
employed in making emulsions. 
Poultices.-Under the head of Emollients I shall also speak of poultices, 
which are moist, soft, scarcely adhesive, perfectly bland plasters, used to a 
very great extent to combat superficial inflammation. Poultices are much 
more powerful agents than the true fatty emollients, and are much more 
capable of being abused: the results of such abuse will be spoken of directly 
A poultice may, of course, be stimulating and irritant if made of such a 
substance as mustard ; but the emollient or true poultice is prepared out of 
some bland material, which is totally free from action upon the skin. I do 
not think that there is any difference whatever in the action of the various 
substances usually employed in the preparation of poultices, the latter de- 
pending for their remedial powers solely upon the warmth and water which 
they contain. Water, when pure and of a temperature approximating that 
of the body, is a sedative, checking all action, possibly by a direct influence, 
but probably by the merely mechanical acts of dilution of the pabulum and 
of separation of the germinal granules. It is also a relaxant, rendering all 
tissues soaked in it soft and yielding. 
Poultices are sometimes applied in the early stages of phlegmonous and 
other superficial inflammations, for the purpose of checking the morbid 
action. Their influence is in such case simply one of sedation, and they are 
certainly not so efficient as the cold-water dressing. They are, however, 
especially useful in the advanced stages of inflammation, when suppuration 
has already commenced or is about to set in. Clinical experience has demon- 
strated that they now favor the formation of pus. It is hardly worth while 
to discuss how they do this, so long as the natural method in which pus is 
produced is a matter of dispute. If, as Cohnheim believes, pus is composed 
solely or largely of out-wandering white blood-corpuscles, it is evident that 
the relaxing influence of a warm poultice will greatly facilitate the escape of 
these bodies. Further, the poultice in the latter stages of a superficial 
phlegmon not only hastens the formation of pus in the inflammatory focus, 
but lessens irritation in the outlying parts by its sedative action, and so 
softens the tissues as to aid in the passage outwards and the discharge of the 
inflammatory products. When poulticing is too long persisted in, the part 
becomes pale or white, swollen, relaxed, and has a sodden look; the granu- 636 
LOCAL REMEDIES. 
(ations of the ulcer or abscess are large, pale, and very flabby, and all the vital 
actions are below the normal point. It is possible that even death of a part 
might be brought about by continuous poulticing. Be this as it may, after 
the discharge of pus, whenever the parts put on the aspect just spoken of. 
the poultice should be removed and stimulating applications be substituted. 
So far, the use of poultices to combat external inflammations has alone 
been spoken of; but clinical experience has demonstrated their value in in- 
ternal inflammations, even when such deep-seated tissues as the lungs are 
affected. Their action in these cases is somewhat different from that which 
they exercise over superficial inflammations. According to the dictates of 
experience, they should be applied very hot, and be frequently renewed; 
very often, too, a small amount of mustard or of some similar stimulating 
material is added to them with advantage. As a result, these poultices act 
as gentle but deep-reaching counter-irritants, which in all likelihood affect 
not merely the blood-vessels of the skin, but also those of the subdermal 
tissue. When it is borne in mind that in all these cases the poultice is 
applied to a very large surface, it will be readily perceived that this counter- 
irritation is a powerful one. Thus, in pleurisy, or in pneumonia, the whole 
anterior or posterior surface of the chest is covered, or perhaps the whole 
chest is enveloped, by the jacket-poultice. In peritonitis, the poultice should 
be as large as the abdomen of the patient. Now, in either of the cases 
mentioned, it is plain that the amount of blood drawn to the surface must 
be considerable. I cannot help surmising that the water of the poultice in 
some cases actually soaks through and reaches the affected tissue so as to 
exert its direct sedative influence upon it. In lung-diseases of children, 
whose chest-walls are very thin, the value of poultices has seemed to me 
much greater than in corresponding affections in adults; and it is not 
illogical to believe that the difference may be dependent upon the inequality 
of the chest-walls. 
Flaxseed meal is the most frequently-used substance for making poultices, 
for which purpose the large amounts of oil and mucilage which it contains 
especially fit it. Ground slippery elm makes a very elegant demulcent, muci- 
laginous poultice. Ordinary mush from Indian meal affords a cheap and 
very serviceable material, and bread and milk makes a popular, very mild 
and unirritating, but expensive poultice. When a poultice is to be applied 
to affect internal organs, and consequently has to be large and capable of 
holding the heat for a long time, the choice of material lies exclusively be- 
tween flaxseed and Indian meal. The former of these is the more adhesive, 
and makes the more manageable poultice: but popular belief, and I think 
with reason, attributes to mush a superior power of retaining heat. In 
either case the poultice should be put on as hot as it can be borne, and 
should be covered by a large piece of silk oil-cloth, which aids in retaining 
not only the moisture, but also the heat. The interval of renewal should 
be short, and should be governed solely by the rapidity with which the 
applied poultice grows cold. CLASS XV.-DILUENTS. 
A diluent is an indifferent substance which is absorbed and in its 
passage through the body simply dilutes the various fluids of the organism 
as well as the excretions. The only diluent is water, which is given in 
various forms. Thus, the natural medicinal waters owe much of their value 
to the large quantity of water they contain. It is evident that when a quart 
of water more than usual is taken into the system, it must whilst it stays 
there lessen the concentration of the bodily liquids, and must finally in some 
way find an exit from the body. The increased excretion even of water 
means increased action in the eliminating glands; and the water passing out 
of the blood must always carry with it more or less of the soluble matters 
contained in the same, so that whilst the percentage of solid matter in the 
urine or in the sweat may be lessened by large potations of water, the actual 
amount eliminated is no doubt increased. Hence water acts not only as a 
diluent, but also as a depurant. 
It is especially in regard to the urinary organs that water is employed 
medicinally, with three distinct possible objects. Thus, it may be used 
simply to aid the re-establishment of completely or partially suppressed 
renal secretion. During a recent visit to Bellevue Hospital, New York, I 
was informed that in acute Brigid's disease water had been found to be a 
most efficient diuretic, increasing very remarkably the urinary excretion, 
relieving the irritation of the kidneys, and aiding the return to health. In 
these cases at least half a pint of water should be taken every two hours. 
I have tried it in chronic Bright's disease, and found it to work well in some 
cases; but in others, no increase of the urine taking place, the water accu- 
mulated in the system and added to the distress. Again, the dilution of the 
urine is often important, as in gonorrhoea, or when there is a tendency to the 
formation of either gravel or calculi. Water is also used as a depurant in 
chronic disorders in which there is no organic disease, but an habitual torpor 
of the emunctories,-cases in which the liver is said to be torpid, and in 
which there is a foul tongue, habitual costiveness, and a scanty urine with a 
tendency to the formation of a lateritious deposit.* In these cases a couple 
of tumblerfuls of water upon rising will often produce a stool after break- 
fast, as well as increase the flow of urine. Very generally a mild saline may 
be advantageously added in small quantity to the water; and such natural 
mineral waters as those of Saratoga are especially beneficial. 
• For experimental evidence that water in rabbits does increase flow of bile, see Zawik 
ski, Centrulb. fur Chir., 1877, p. 327. 
637 CLASS XVL-PROTECTIVES. 
In the present class are included those materials used by the physician as 
external applications to exclude the air and to protect inflamed dermal or 
other tissues. Sufficient has already been said in regard to the importance 
of the exclusion of the air, under the heading of Emollients. It is evident 
that the latter class of remedies, as well as demulcents, act as protectives; 
but the class of Protectives proper seems necessary for the consideration of 
certain remedies which act more plainly in a mechanical method and which 
will defend the skin against external agencies. 
First to be considered under the present class are certain plasters, used to 
protect the skin and raw surfaces from external influences. The adhesive 
plaster {Emplastrum Resinee, U. S.) is used enormously for mechanical pur- 
poses. It does, however, irritate the skin somewhat, and consequently is 
rarely employed where protection is the only object. Under the latter cir- 
cumstances, the lead plaster (^Emplastrum Plumbi, U. S.) or the soap plastei 
(Emplastrum Saponis, U. S.) is preferable. These substances are free from 
irritant properties, but are very slightly adhesive, and are scarcely used except 
to protect the skin from pressure or friction, as when bed-sores are threatened. 
They should be spread upon very soft kid. It is also very important that they 
be not so thick or hard as to lose their pliability. If they are stiff, by their 
movements during the motions of the body they often do more harm than 
good. 
COLLODIUM-COLLODION, U.S. 
When any finely-divided ligneous body, like raw cotton, is steeped for a 
few minutes in a mixture of nitric acid of the specific gravity of 1.5 and con- 
centrated sulphuric acid, and then squeezed, thoroughly washed, and dried, 
it gains about seventy per cent, in weight, and is converted into a substance 
known as pyroxylin, or gun-cotton. The change consists in the substitu- 
tion of nitryl (NO2) for a portion of the hydrogen. There are a number of 
varieties of gun-cotton. The true explosive gun-cotton, that which is alone 
adapted for gunnery, is trinitrocellulose. It is not so soluble as the less highly 
nitrated variety, and is not fit for use in medicine. The officinal pyroxylin 
(Pyroxylinum, U. S.) is one of the more soluble varieties of gun-cotton 
but is not soluble to any extent in ether. 
Gun-cotton is a perfectly inert substance, so far as the external surface 
of the skin is concerned, and probably has no effect upon the system when 
638 PROTECTIVES. 
639 
taken internally. It is not at all soluble in water, and its only use in medi- 
cine is in the manufacture of collodion. This substance is officinally pre- 
pared by dissolving two hundred grains of pyroxylin in a mixture of twelve 
and a half fluidounces of stronger ether and three and a half fluidounces 
of stronger alcohol. It is a colorless, slightly opalescent liquid, of a syrupy 
consistence, and smelling strongly of ether. By long standing it deposits a 
layer of fibrous matter, and becomes more transparent. This layer should be 
reincorporated, by agitation, before the collodion is used. When it is ap- 
plied to the skin, and the menstrua are allowed to evaporate, collodion forms 
a colorless, transparent, flexible, and strongly contractile film, which adheres 
very closely, and cannot be readily removed by washing, motion of the part, 
or external mechanical force. As this coating is perfectly impervious to air 
and water, collodion is much used in surgery for various purposes. It is 
evident that care should be used in its application to abscesses and discharging 
wounds, lest it should prevent the discharge of pus. Small fresh wounds 
are often very advantageously dressed in the following manner, especially 
cuts on the fingers and about the head. If necessary, the hair should first be 
shaved off the part, and then a piece of coarse gauze or mosquito-netting, of 
suitable size and shape, should be laid so as to cover the wound and extend 
across each side from half an inch to an inch and a half, according to circum- 
stances. One end should then be tightly fastened to the skin by repeated 
applications of the collodion with a camel's-hair brush. When the adhesion 
has become sufficiently firm, the gauze should be drawn so as to close the 
wound tightly, and whilst it is held in position the collodion should be 
applied all over it. As the collodion contracts during drying, the wound is 
more and more tightly closed, until at last a firm, perfectly tight dressing 
binds it close together. Of course in deep wounds this method of closure is 
not to be used. 
The contraction of the collodion film is a great drawback to its use for 
certain purposes. This can be in great measure obviated and the film made 
more pliable by the addition of from eight to ten drops of castor oil to the 
ounce of the liquid. Under the name of Flexible Collodion (Coilodium 
Flexile), the U. S. Pharmacopoeia directs a preparation very similar to that 
just spoken of. It contains twenty grains of Canada turpentine, besides 
ten grains of castor oil, to the ounce; and probably the stimulant effect 
of the terebinthinate will make itself apparent upon some susceptible skins. 
Whenever collodion is used simply as a protective, one of these modified 
preparations is much preferable to the pure article. 
Any principle which is soluble in a mixture of ether and alcohol may be 
added to collodion, and in this way medicinal substances may be applied to 
the external surfaces. The films formed are often less firm and adhesive 
than those of the simple collodion. 
Gutta-Percha, U.S., is a whitish or pinkish solid, the concrete juice of 640 
LOCAL REMEDIES. 
the Isonandra gutta, a large tree growing in the Malayan Archipelago. 
When pure it is a carbo-hydrogen, but as it occurs in the shops it contains a 
minute proportion of resin, vegetable, and casein. Under the influence of a 
mild heat it softens, and on cooling hardens again. Hence, rolled into sheets, 
it is much used in surgery for making splints, the piece being plunged into 
hot water, fitted to the limb, and allowed to stiffen. 
Solution of Gutta-Percha (Liquor Gutta-Perchse, U. S.) is made by dis- 
solving small pieces of gutta-percha in purified chloroform. When it is 
applied to the skin, a thin elastic adhesive film is left, which protects the 
parts from the air. This is said to be a very elegant preparation for use in 
small cuts, abrasions, chapped lips, and the little injuries which come within 
the province of domestic medicine rather than that of the professional ait. DIVISION II.-NON-SYSTEMIC REMEDIES. 
These are drugs which act not directly upon the human system or upon 
any of its tissues, but upon some extraneous material or entity, either in the 
cavities of the body or upon its exterior. Thus, an antacid neutralizes acid 
in the stomach, or an anthelmintic kills the tapeworm in the intestines, or a 
disinfectant destroys poisonous emanations in the exterior world and thereby 
wards off disease. 
CLASS I-ANTACIDS. 
Antacids are, strictly speaking, substances which are capable of neutral- 
izing acid. The class, as here defined, contains those remedies which in 
medicine are used for the purpose of neutralizing an excess of acidity in the 
primae viae. They are almost solely employed in forms of dyspepsia. With- 
out doubt, cardialgia, gastric uneasiness, "heartburn," and the rising of 
sour water in the mouth, are often the result of too much acid in the stom- 
ach, perhaps secreted by a perverted glandular action, but more probably in 
the great majority of cases formed by fermentative changes in the partially- 
digested food. As excessive acidity of the stomach causes gastric uneasiness 
and derangement, so will a similar condition of the intestinal canal cause 
pain and spasm and functional disturbance in the bowels. This is seen most 
frequently in infants, and is very often associated with a diarrhoea in which 
the passages have a green color, similar to that of spinach, and hence are 
sometimes spoken of as " spinach-stools." In diarrhoea of this character, 
as well as in colic, antacids are often of service by neutralizing the acid in 
the intestinal canal. 
Clinical experience has demonstrated that dyspepsia is often permanently 
relieved by the use of alkalies when they are given steadily day after day, 
about twenty minutes after eating, for a long time. According to Dr. Thomas 
K. Chambers {The Indigestions, Am. ed., 1870, p. 67), this is dependent 
upon an effect pointed out by Claude Bernard, the augmentation of the acid 
gastric juice, and so of the normal peptic powers of the stomach. The same 
641 642 
NON-SYSTEMIC REMEDIES. 
authority further says, " The test of benefit being derived from an alkali is 
the dose not requiring to be increased as the patient goes on taking it, but, 
on the contrary, being diminished gradually, while relief from the recurrence 
of heartburn continues still to be experienced." 
Sick headache is sometimes dependent upon gastric irritation produced by 
an excess of acid in the stomach. This true sick headache is generally to be 
distinguished from migraine by the early occurrence of the stomach-symp- 
toms, either as heartburn, nausea, vomiting, or simple gastric distress, and by 
the fact that the pain comes on with an attack of blindness or of dizziness, 
and is not limited to any one spot, as the supraorbital or other neuralgic foci, 
but is felt all across the brows. In this form of cephalalgia, antacids often 
afford very great relief. 
Various substances which have already been discussed in this work are 
excellent antacids, most of them uniting this to other medicinal properties. 
Thus, when a stimulating antacid is desired, as is very often the case in sick 
headache, half a drachm of the aromatic spirit of hartshorn may be taken, 
well diluted with water. Again, when a laxative antacid is desired, a tea- 
spoonful to a tablespoonful of magnesia may be exhibited. Potassa and its 
carbonates have already been dwelt upon with sufficient detail. They may be 
used as antacids; but, as they exert other powerful influences upon the system, 
they are, I think, not so generally useful as the soda preparations. Never- 
theless, the Solution of Potassa {Liquor Potasses, U. S.) is largely employed 
as an antacid. It is a colorless water-like liquid, of a strong, acrid, alkaline 
taste, and is made by boiling a solution of the bicarbonate of potassium with 
lime. It contains only five and eight-tenths per cent, of the alkali, but acts 
upon animal and vegetable substances, and imparts a distinct soapy feel to 
the fingers when they are moistened with it and rubbed upon one another. 
It is capable, in overdose, of acting as an irritant poison. The dose is ten 
to twenty minims, well diluted. 
SODIUM. 
Unlike potassium, sodium and its salts have very little influence upon the 
higher animals. Frogs are much more affected, it causing spinal convulsions, 
and slowing, or even diastolic arrest, of the heart (Podocaepow, Virch. 
Arch., Bd. xxxiii. 507 ; Schonlein, Arch. f. d. Ges. Physiol., xviii. 26). 
M. Laffout affirms that soda primarily stimulates the frog's heart {Compt.- 
Rend. Soc. Biolog., 1880, 282). Prof. S. Ringer and Dr. H. Sainsbury 
find that the sodium salts are capable of arresting the cut-out frog's heart 
in diastole, the arrest being preceded by very little disturbance of rhythm ; 
the amounts required were, however, so large that sodium salts can hardly 
be made to kill {London Lancet, 1882, ii., p. 736). 
On the other hand, Grandeau (Robin's Journal de TAnatomic, 1864) 
found that one hundred and seven grains of the carbonate of sodium injected 
■into the vein of a dog produced only very slight symptoms, and that thirty- ANTACIDS. 
643 
Sve grains of the nitrate similarly administered to a rabbit caused only some 
convulsive movements. According to Guttmann (Virchow's Archiv, Bd. 
xxxv.), however, the soda salts thrown directly into the blood in very large 
amounts will slowly cause death, the agony being very prolonged, and, when 
the chloride is used, convulsions being developed. 
Both Podocaepow and Guttmann assert that even the largest doses do not 
sensibly affect the heart or the temperature; and the latter observer further 
declares that they are without influence upon the nerve-centres, the periph- 
eral nerves, or the muscles. 
If this be the case, however, it is difficult to perceive how they can cause 
death; and the earlier experiments of Podocaepow indicate that they do 
exert a very feeble action upon the peripheral nerves or the muscles. 
Upon the blood the immediate influence of the soda salts is very slight, 
for Podocaepow asserts that one part dissolved in twelve parts of blood does 
not affect either the physical characters of the red corpuscles or the intensity 
of the ozone reaction. 
The effect of the continuous exhibition for a few days of large amounts 
of salt upon the human organism has been elaborately investigated by Dr. 
Munch (Archiv Vereins Gemeinschaft. Arbeiten, Bd. vi. p. 369, 1863), and 
found to be very feeble. At first there was a slight diminution of excretion, 
and a corresponding gain of the body in weight; but after a time the ex- 
cretions increased, and the weight of the body decreased. The variations 
in excretion affected chiefly the urine, but sometimes the perspiration and 
faeces were also influenced. The urine was rendered alkaline, but its solid 
ingredients were scarcely at all affected. 
Although a certain amount of the soda salts is a necessary food for the 
higher animals, yet it is very doubtful whether an habitual excess of them 
has any decided effect upon nutrition. MM. Damourette and Hyades claim 
that the elimination of urea and uric acid (Journ. de Th^rap., 1880, 440) 
is markedly increased ; but an examination of their experiments will show 
that this conclusion is not warranted by them, and in a series of experi- 
ments with the phosphate, acetate, and sulphate of sodium, Dr. I. Mayer 
{Zeitsch. f. Klin. Med., 1881, 82-95) found no increase, and the experi- 
ments of A. Ott on the dog gave the same results (Hoffmann u. Schwalbe's 
Jahresbericht, 1883, 220). Plouriez (Compt.-Rend., t. xxv.) believes that 
the chloride has a tonic influence: he analyzed his blood after he had used 
daily one hundred and fifty grains of salt beyond the ordinary amount for 
three months, and again after he had taken only the usual quantity. The 
red corpuscles were very decidedly more numerous,.the fibrin slightly more 
abundant, and the albumen decidedly less abundant, at the first analysis than 
at the second. 
As Bidder and Schmidt (Canstatt's Jahresbericht, 1852) assert that the 
hydrochloric acid of the gastric juice is derived from the chloride of sodium, 
and as Rabuteau (L'Union Med., t. xii. p. 186, 1871) found that, in dogs 644 
NON-SYSTEMIC REMEDIES. 
with gastric fistula, both the quantity and the acidity of the gastric juice are 
decidedly increased by the use of salt meat, it would appear probable that 
common salt acts as a tonic by increasing the digestive power. On the other 
hand, it is well known that physiologists are still disputing as to whether free 
hydrochloric acid exists at all in the gastric juice.* Further, it is certain 
that pepper or any similar condiment will, by its local action, increase the 
flow of gastric juice; and in Rabuteau's experiments the mere local irrita- 
tion of the salt, or the difficult digestion of the preserved meat, may have 
given rise to the increased secretion by the stomach. 
The experiments of Dr. S. W. Lewaschen prove that the carbonate, the sul- 
phate, or the phosphate, given to dogs with biliary fistula, increase very mark- 
edly the liquidity of the bile by diminishing the percentage of solids. The 
salicylate of sodium acted similarly but much more powerfully than these salts. 
These experiments are in accord with clinical experience, which shows that 
the alkaline salts of soda given one to two hours after meals in full doses 
are of decided value in the treatment of gall-stones and various affections 
associated with excessive viscidity of the biliary secretion. 
Soda, U. S.- Caustic Soda is prepared by the evaporation of the liquor, 
and occurs in grayish-white fragments, which deliquesce when exposed to 
the air; but, as the fluid absorbs carbonic acid and the soda in it is con- 
verted into an efflorescent carbonate, the liquid is after a time converted into 
a white powder. Caustic soda is powerfully corrosive. Liquor Sodse, U. S. 
-Solution of Soda.-A colorless, exceedingly acrid liquid, containing about 
five per cent, of hydrate of soda, and having the specific gravity 1.059. It 
is made by the action of milk of lime upon a solution of the carbonate of 
sodium. 
Sodii Carbonas, U.S.- Carbonate of Sodium occurs in colorless 
crystals, which rapidly effloresce on exposure to the air, and fall into a white 
powder. The taste and reaction are strongly alkaline. It is very soluble 
in water, insoluble in the air. The chief native materials from which it is 
manufactured are common salt and the sulphate of sodium. As it occurs 
in commerce, the carbonate of sodium is sufficiently pure for ordinary use. 
When the carbonate of sodium is heated, its water of crystallization is 
driven off, and the officinal Dried Carbonate (Sodii Carbonas Exsiccatus, 
U. S.) is left. This may be given in pill-form. Commercial Bicarbonate 
of Sodium (Sodii Bicarbonas Venalis, U. S.) is a white, opaque powder, 
containing variable amounts of soda not fully saturated with carbonic acid. 
Pure Bicarbonate of Sodium (Sodii Bicarbonas, U. S.) should always be 
selected for internal use. The antacid dose of these preparations is ten to 
twenty grains. 
* See Bernard's Physiologic Expirimentale, t. ii. p. 393, also Phila. Med. Times, vol. v., 
and for a discussion of the subject, Prof. F. G. Smith's note to the American edition of 
Marshall's Physiology, p. 530 ; also Longet's Physiologic, Paris, 1861, t. i. p. 196. ANTACIDS. 
645 
Therapeutics.-The fact that soda, in moderate amount, has no depress- 
ing action, and indeed very little, if any, influence upon the general system, 
renders it preferable to potash in cases of acidity of the primae viae. It is 
par excellence the alkali for acid dyspepsia. On the other hand, the circum- 
stance clearly established by Dr. Roberts ( Urinary and Renal Diseases, Am. 
ed., 18G6, p. 240), that it is less powerful as a solvent of uric acid than its 
sister alkali, together with the property, believed to belong in a much greater 
degree to potash, of preventing the formation of uric acid, makes soda of 
very inferior value in uric acid gravel or uric acid diathesis. When in 
any case it is desirable simply to render the urine alkaline, and at the same 
time to avoid depressing the system generally, soda would, on theoretical 
grounds at least, seem preferable. 
Sodii Acetos, U. S.-Acetate of Sodium is a white, slowly efflorescent 
salt, which occurs in long prisms of a sharp, bitterish taste. It has been 
supposed to have the same remedial powers as the acetate of potassium; but 
this is certainly a mistake. It is rarely if ever used in medicine. Nitrate 
of Sodium, although officinal, is not used as a therapeutic agent. 
OALX-LIME. 
The therapeutic properties of slaked lime are dependent chiefly upon its 
alkalinity and its astringency. It does not possess the latter property in an 
eminent degree, yet its preparations, when properly diluted, whiten and 
lessen the secretion of mucous membranes to which they are applied. It 
also appears to have, as it were, a sedative influence upon mucous mem- 
branes, lessening their irritability. Caustic or unslaked lime is a powerful 
caustic, but, except in the form of Vienna paste, is rarely if ever used as 
such. It is more soluble in cold than in hot water. At 60° F. it re- 
quires about seven hundred times its weight of the liquid to dissolve. It 
is much more soluble in syrup than in pure water. 
Liquor Calcis, U. S.-Solution of Lime.-Lime-water is a colorless 
liquid, having the sp. gr. 1.0015, and containing about 0.15 per cent, of 
lime. It has an alkaline taste, and is nearly destitute of irritant properties. 
On exposure to the air it becomes turbid, or forms a crust upon the surface, 
or deposits a precipitate, owing to the absorption of carbonic acid from the 
air and the conversion of the lime into a carbonate. Twenty minims of 
syrup of lime (Syrupus Calcis, U.S.) equal a fluidounce of lime-water. 
Therapeutics.-Lime-water is used internally exclusively for its effects 
upon the primae vise. In vomiting, from almost any cause except acute 
gastritis, equal parts of it and milk afford an elegant, simple, and much-used 
remedy. If the vomiting be severe, all other food should be inhibited, and 
one or two tablespoonfuls of the mixture be given every half-hour; the 
quantity, as well as the proportion of milk, being increased as the stomach 646 
NON-SYSTEMIC REMEDIES. 
is able to bear it. As lime-water when put in milk prevents the formation 
of dense coagula, it is often added with advantage to that fluid when used 
as food for infants, or for adults with weak digestion. As an alkaline 
astringent, the syrup is often useful in diarrhoea in doses of one to two 
fluidrachms well diluted. 
Externally, lime-water has been used as a wash in various skin diseases, 
especially in tinea capitis: it is also applied to ulcers, and is said to have a 
very marked influence in lessening the amount of discharge. When mixed 
with an equal bulk of linseed or olive oil (Linimentum Calcis, U. S.), lime- 
water is a favorite application for recent burns: the thick, soapy liquid which 
is formed is sometimes spoken of as Carron Oil, from the name of the 
iron-works at which its reputation was first made. 
Lime-water has the power of dissolving mucus, and also false membrane, 
and has therefore been introduced as a local remedy in pseudo-membranous 
croup and in diphtheria. It is sometimes used by causing the patient to 
inhale the vapors of slaking lime; but a better method is to pulverize lime- 
water by means of an atomizer, and direct the spray upon the back of the 
fauces while the patient is respiring deeply. The application should be 
made every two or three hours, and, in patients of sufficient age to allow of 
its being thorough, is often very serviceable. 
CARBONATE OE CALCIUM. 
Chalk is the native, friable carbonate of calcium, a milk-white, soft solid, 
of an insipid, earthy taste ; insoluble in water; wholly soluble, with effer- 
vescence, in dilute muriatic acid. Creta Preeparata, U. S.-Prepared 
Chalk is chalk freed from impurities by pulverization, levigation, and elu- 
triation ; a white, perfectly smooth powder. Calcii Carbonas Prxcipitatus, 
U. S.-The Precipitated Carbonate of Calcium is a white powder, free from 
grittiness, which is made by precipitating chloride of calcium with carbonate 
of sodium. 
Therapeutics.-Carbonate of calcium in its different forms is used 
internally as an antacid and very mild astringent. As none of the salts 
which it forms are purgative, it, with the other preparations of lime, is the 
best antacid when diarrhoea is present. The crude chalk should never be 
used, but the other preparations are probably of equal value. Some prac- 
titioners claim, however, that the oyster-shell is more acceptable to delicate 
stomachs, on account of the animal matter which it contains ; and, under the 
name of Castillon's Powder, a mixture of salep, tragacanth, sago, aa three 
parts, prepared oyster-shell one part, and cochineal q. s. to color it, has 
been much used in obstinate summer diarrhoeas. A drachm of this is boiled 
in a pint of milk, and the decoction taken as food ad libitum. The dose 
of carbonate of calcium is twenty grains to a drachm. Chalk Mixture 
(Mistura Cretx, U. S.) is generally preferred to the powder. It contains ANTACIDS. 
647 
thirty grains of the chalk to the ounce, and is given in doses of one to two 
tablespoonfuls. It is often combined with laudanum or paregoric and tinc- 
ture of kino or catechu. 
Externally, prepared chalk and the precipitated carbonate of calcium are 
used as desiccants and protective applications to ulcers and chronic burns; 
also in excessive sweating of the feet, and in intertrigo and other affections 
of the skin. CLASS ANTHELMINTICS. 
These are medicines which kill or cause the expulsion of intestinal worms. 
They are sometimes divided into vermicides, those which kill, and vermifuges, 
those which expel; but there is little or no practical use in the division. It 
is of much greater importance to establish the relations between these drugs 
and the different species of entozoa, since clinical experience has demon- 
strated that an anthelmintic very efficient against one form of intestinal 
worm may be not injurious to another species. Therapeutically considered, 
the entozoa may be divided into the Tapeworms (T&nix), Round-worms 
{Lumbrid'), and Seat-worms (Ascarides'). The last of these differ from 
the others in that they are to be attacked solely by enemata. 
It is obvious that the value of an anthelmintic depends not only upon its 
power of poisoning the articulate, but also upon its harmlessness as regards 
the patient. Thus, it is the eminent combination of these qualities which 
renders the infusion of quassia so valuable in cases of seat-worms, whilst 
carbolic acid, though very efficient, should never be used against the same 
parasite, since it has greatly imperilled, if it has not destroyed, the life of 
the patient when so employed. 
There are certain general rules which govern the administration of anthel- 
mintics, and which should not be lost sight of. They may be summed up 
as follows: Let the alimentary canal be as empty as possible, so that the 
drug may act with the greatest force upon the enemy. For this reason, 
anthelmintics are best administered early in the morning; and in obstinate 
cases the patient should be required to fast until dinner-time. 
If the drug be not itself a purgative, from four to eight hours after its 
administration a brisk cathartic should be administered; or a purgative dose 
of -calomel may be combined with it, as the bilious purging induced by the 
latter drug seems to be especially obnoxious to the entozoa. 
SPIGELIA-PINKROOT. U. S. 
The root of Spigelia Marilandica, a herbaceous perennial, growing in the 
Southern and Southwestern United States. It consists of a knotty head, 
with numerous fine, crooked, branching rootlets. The odor is faint and 
peculiar; the taste sweetish and slightly bitter. It contains, according to 
the analyses of M. Feneulle and of R. H. Stablen, tannic acid, fixed and 
648 A NTHELMINTICS. 
649 
volatile oils, resin, and a bitter uncrystallizable body; but exactly upon what 
its virtues depend has not been determined. 
Physiological Action.-Although there is sufficient testimony to show 
that pinkroot possesses decided narcotic powers, yet its action has been 
scarcely at all investigated The observations of Drs. Hodge Thompson 
(Inaug. Dissert., quoted by Eberle), Eberle (Materia Medica and Thera- 
peutics, vol. i.), and Spalsburg (Boston Med. and Surg. Journ., 1855) have 
shown that in overdose it causes symptoms similar to those produced by one 
of the mydriatics. They are acceleration of the pulse, dilatation of the 
pupils, heat and dryness of the skin, flushing and a swollen appearance of 
the face, with, in Eberle's cases, talkative delirium. Two fatal cases* of 
poisoning by it are said to have been recorded by a Dr. Chalmers. 
Therapeutics.-Spigelia is a most efficient remedy in cases of the round- 
worm, and is, when given within the bounds of moderation, entirely safe. 
It appears to narcotize the worm, and requires the use of a brisk cathartic. 
The fluid extract (Extractum Spigelix Fluidum, U. S.) is efficient in doses 
of two fluidrachms. A better preparation is the Fluid Extract of Spigelia 
and Senna (Extractum Spigelix et Sennx Fluidum, U. S. 1870), which 
is much liked by children on account of its agreeable taste. The dose, for 
an adult, is f $ss; for a child two years old, f 3ss to f $i, repeated every four 
hours until it purges. 
Azedaracii, U. S., the bark of the root of Melia Azedarach, or Pride of 
China, is used in the South as a remedy for the round-worm. It is said to 
possess poisonous properties similar to those of spigelia, yet it is affirmed 
that animals and children eat its fruit with impunity. It is usually given 
in decoction (gii to Ojss, boiled to a pint), the dose being for a child a 
tablespoonful every two or three hours, until the bowels are affected. 
Chenopodium, U. 8., or Wormseed, is the fruit of Chenopodium anthel- 
minticum, or Jerusalem Oak, a rank, odorous plant, growing about waste 
places in the suburbs of towns in the United States. It consists of minute, 
globular, light-brown seeds, about the size of a pin's head, of a nauseous 
odor and pungent taste, due to the volatile oil which they contain in large 
quantity. Wormseed Oil (Oleum Chenopodii, U.S.) is of a light-yellow 
color, becoming darker and less fluid by age, of a peculiar powerful odor 
and a hot burning taste.f It has been used in hysteria, but is now employed 
* These cases appear to have been indefinitely copied, and are of doubtful authenticity. 
j- In the Maryland Med. Journal, vol. iv. page 20, Prof. T. R. Brown reports a case in 
which death was attributed to the taking of an ounce or more of wormseed oil in divided 
doses. The patient was found in bed, unconscious, with vomited matters over his sur- 
roundings, after some hours became sensible, relapsed an hour or two later into heavy 
sleep, was again roused, and whilst playing cards became aphasic, deaf to conversation, 
acutely sensitive to other sounds, and finally died with hemiplegic apoplexy. It is plain 
that the wormseed was not the direct immediate cause of all these symptoms or of the 
fatal result. 650 
NON-SYSTEMIC REMEDIES. 
umy as an anthelmintic against the lumbricus, and more rarely the tapeworm. 
It is very efficient, and ten drops of it on sugar may be given to a child 
three years old, before breakfast, dinner, and supper, for two days, followed 
by a brisk purge. 
Brayera, U. S., or Koosso, is the dried flowers and unripe fruit of Brayera 
anthelmintica, a tree, native of Abyssinia. They occur in compressed 
greenish-yellow clusters, of a fragrant balsamic odor and a taste which in a 
little while is acrid and disagreeable. Koosso contains a volatile oil, tannic 
acid, and a resin, Koossiu or Taeniin, discovered by Pavesi. This is crystal- 
line, white or yellowish, slightly soluble in water, freely so in alcohol, and 
was shown by Dr. Bedall (^Sydenham Year-Book, 1868, p. 476) to be the 
active principle of the drug, which yields about three per cent, of it. 
Brayera is a most efficient remedy against the tapeworm, and even in large 
doses causes no greater inconvenience to the patient than some nausea, ab- 
dominal pain, and looseness of the bowels. It is generally not necessary to 
administer any purgative with it, and the worm is discharged dead with the 
last watery passages. A half-ounce of the powdered flowers is given sus- 
pended in water ^Iiifusum Bray er ee, U. S., §ss to Oss) in the morning, with 
the usual precautions as to diet, or from twenty to forty grains of koossin, 
wrapped up in a wafer, may be substituted for the crude drug. The fluid 
extract (JExtractum Brayerx, Fluidum, U. S.) is also efficient in doses of 
half a fluidounce. Care should be exercised in administering brayera to 
pregnant women, as it is stated that it has produced abortion. 
SANTONIOA-SANTONIOA. U. S, 
Levant Wormseed consists of the unexpanded flowers and peduncles of 
Artemisia Contra, a composite of Asia Minor and other parts of the East. 
It consists of pale, greenish-brown, smooth heads of four or five tubular 
flowers, of very strong aromatic odor when rubbed, and a bitter disagreeable 
taste. It contains volatile oil, resinous matter, and a crystalline principle, 
Santonin {Santoninum, U. S.), or Santoninic Acid, which occurs in color- 
less, pearly, four-sided, orthorhombic tables, soluble in from four thousand 
to five thousand parts of cold and two hundred and fifty parts of boiling 
water, freely soluble in alcohol and chloroform, moderately so in cold ether; 
insoluble, or nearly so, in glycerine. It has a neutral reaction, but unites 
with alkalies to form salts, and hence is freely soluble in alkaline solutions. 
When slowly heated, it sublimes, unchanged, at from 165° to 175° C. 
When rapidly heated, it is converted into a brownish-red oil, which becomes 
carmine-red upon the addition of caustic potash. On exposure to sunlight, 
or, more slowly, even in the ordinary daylight, the colorless crystals of san- 
tonin acquire a golden-yellow tint. If this change be a chemical and not a 
mechanical one, the alteration must be very slight, since, according to Krauss, 
the yellow crystals conduct themselves in their chemical relations precisely ANTHELMINTICS. 
651 
as do the colorless crystals, and are precipitated, by the addition of acid to 
their alkaline solutions, as colorless crystals. 
Physiological Action.-Santonin is said to have been first introduced 
into medical practice in 1830, by Dr. Alms, by whom and Dr. Kahler it was 
simultaneously discovered. It is at present used almost solely on account of 
its poisonous action upon entozoa, but certainly has a very great influence 
upon man and the higher animals. When it is given to dogs and rabbits in 
large doses it causes accelerated breathing, slowing of the pulse, universal 
trembling, cramps, free salivation, unconsciousness, convulsions, dilated pupils, 
and death. (See experiments of-Manns, Das Santonin, Marburg, 1851 ; 
Rose, Virchow's Archiv, Bd. xvi., 1859 ; T. Krauss, Ueber die Wirkungen 
des Santonins und Santonin-Natrons, Inaug. Diss., Tubingen, 1869.) After 
death the lesions are not absolutely constant, but hyperaemia of the nerve- 
centres and congestion of the lungs and heart are nearly always present. Ac- 
cording to Rose, dogs will recover after doses of from thirty to sixty grains, 
although five to six grains will produce very decided symptoms; and accord- 
ing to Krauss, thirty grains are required to kill a rabbit, even when they are 
dissolved in chloroform and given subcutaneously. 
The symptoms caused by large doses of santonin in man are closely similar 
to those which it produces in the lower animals. There are several fatal cases 
of poisoning by it on record. A child five years old was killed in half an 
hour by an unknown quantity {Pharm. Journ. and Trans., viii. 996), and 
one six or seven years old is said to have been destroyed by six grains 
of the acid, after suffering from haematuria* {Bull. Therap., Ixxiv. 362) : 
four grains produced very serious symptoms in a child four years old 
{Pharm. Journ. and Trans., ix. 696). In Dr. Grimm's case {Schweizer 
Zeitschrift fur Med., Chir., und Geburtshilfe, 1852, p. 493), a rather 
feeble child, five years old, took two one-grain doses of santonin, and was 
seized with convulsive tremblings, which increased in severity until they 
became severe convulsions, which were accompanied by unconsciousness, 
trismus, pallor of the face, cold sweats, dilated pupils, and rapid pulse and 
respiration. Thirteen or fourteen hours after the ingestion of the poison, 
whilst the patient lay on her back, quiet, unconscious, with moderately- 
dilated pupils and a slow, feeble pulse, death occurred suddenly. No 
post-mortem was allowed. The santonin is said to have been chemically 
pure and to have been used in other cases with its usual results. Nine- 
tenths of a grain of santonin are said to have caused complete unconscious- 
ness in a child five years old {Schmidt's Jahrb., Bd. cci. 128). In quite a 
number of very serious but not fatal instances of poisoning the symptoms 
have been similar to those in the case just detailed; great pallor of surface, 
with a blue color around the eyes or involving the whole countenance, has 
♦ This is probably a mistaken observation, the urine being only blood-colored, and not 
containing blood (see p. 603). 652 
NON-SYSTEMIC REMEDIES. 
been generally an early symptom ; vomiting has not rarely been present, and 
sometimes has been accompanied by colicky pains. Besides these manifesta- 
tions, giddiness, mental apathy or stupor, great coldness of the surface, pro- 
fuse sweating, trembling, mydriasis, and finally loss of consciousness, with 
convulsions, often violent and accompanied by opisthotonos and emprosthoto- 
nos, and failure of respiration, are the usual phenomena of santoniu-poisoning. 
The circulation seems to be very little affected (case, Arch. Exper. Pathol, 
u. Pharm., vi., p. 302). 
2k very curious symptom caused by santonin, even when in doses which 
can scarcely be called toxic, is xanthopsia, or " yellow-seeing," as the Ger- 
mans term it. It was, I believe, first noticed by Calloud, and has since been 
spoken of by almost every writer upon the drug. Usually it consists of a 
very deep yellow tint imparted to the landscape and to every object looked at, 
an effect perhaps most comparable to that of looking through yellow glass; 
sometimes this yellow is replaced by green; and Heydloff states that he has 
seen patients in whom the tint was red, and others in whom it was blue. Dr. 
Edm. Rose has published exceedingly elaborate papers upon this chroma- 
topsia; but, as the matter is of interest rather to the physicist and student of 
optics than to the clinician, I content myself with a reference to his memoirs, 
which may be found in Virchow's Archiv (xvi. 233; xviii. 15; xix. 522 ; 
xx. 245; xxviii. 30). Santonin is eliminated probably in a more or less 
altered condition by the kidneys, and thus gives rise to a very characteristic 
symptom or sign of poisoning by the drug which has not as yet been 
spoken of,-namely, discoloration of the urine. The new color is a very 
marked yellow, which has at first an orange tint, but after very large doses 
becomes saffron-like, or sometimes even a purplish red, which has given origin 
to the idea that blood was present. According to Manns, the addition of an 
alkali to the yellow urine causes it to become red. The exact nature of the 
eliminated principle has not been determined: it is, however, probably the 
result of an oxidation of the santonin, as is believed by Kletzinsky, who 
Asserts that the drug receives in the system six atoms of oxygen. 
The results of the ingestion of large doses of santonin show that it has a 
very powerful action on the organism; but as to what portions of the latter 
are especially affected we have no information. Rose believes that the chro- 
matopsia is due to a peculiar action of the drug upon the nerve-centres; but 
it seems to me more probable that it is simply the result of a very faint stain- 
ing of the humors and other parts of the eye by the drug, and is analogous 
to the similar phenomenon sometimes seen in jaundice. Like very many 
other substances which escape through the kidneys, santonin increases the 
flow of urine, and, according to Dr. Farquharson (British Medical Journal, 
1872), increases slightly the elimination of urea. 
Therapeutics.-Dr. D. Dyce Brown (Brit, and For. Med.-Chir. Rev., 
April, 1871), having noticed that a blind man to whom he was giving san- 
tonin for worms recovered to an extraordinary degree his vision, has recom- A NTHELMINTICS. 
653 
mended it in cases of loss of optic nerve power, and Dr. Ogston has used it 
with more or less complete success in a number of cases. Although Dr. 
Brown had apparently no knowledge of it, yet many years before his experi- 
ence M. Guepin and M. Martin recommended the drug in amaurosis (Ann. 
de Th Arap., 18G2). M. Guepin believes it to be especially useful in amau- 
rosis following choroiditis and iritis. Whether the use of santonin in dis- 
eases of the eye will or will not ever amount to anything, cannot at present 
be told; but in the past the drug has been employed almost solely as an 
anthelmintic in persons troubled with the lumbricoid or round worms. It is 
a parasiticide, killing and not expelling the worm, and consequently should, 
when used, be combined with or followed by a brisk cathartic. Especial 
advantage is said to be derived from the joint use of it and calomel. It 
has been employed in epilepsy (Brit. Med. Journ., 1876, ii., p. 787). 
Toxicology.-It has been denied that santonin is poisonous, and asserted 
that the evil results which have followed its use have been due to the mixture 
of strychnia with the drug. The only ground for this opinion is that in one 
or more cases death has resulted from strychnia being mixed with san- 
tonin, or else sold instead of santonin (Lancet, 1877, ii., p. 857), through 
the carelessness of an apothecary. Dr. Walz, in an extended examination 
(Jahresbericht fur Pract. Pharmacie, Bd. xv.), found that the santonin of 
the shops is pure; and it is inconceivable how strychnia could be mixed 
with it except purposely or by the grossest carelessness. Moreover, the 
symptoms which have been produced in alleged poisoning by santonin are 
very different from those caused by strychnia, and are in close accord with 
those which santonin induces in the lower animals. Finally, in some of the 
reported cases, seven of which are collected by Krauss, the santonin was 
examined and found to be pure. Under these circumstances, it would be 
absurd longer to deny the poisonous properties of santonin. The reason 
large doses have been so often given without serious results is probably 
the great hardness and insolubility of the crystals of the drug. The treat- 
ment of poisoning by santonin, after evacuation of the stomach and bowels, 
must at present be entirely tentative. One case appears to have been saved 
by artificial respiration (Arch. Exp. Path. u. Pharm., vi., p. 300) ; but Prof. 
Binz (Ibid.} has found in animals nitrite of amyl, morphia, and artificial 
respiration alike useless; chloral given before the poison he found of service. 
Administration.-Santonin is best administered in the form of lozenges, 
which, if the unbroken crystals are used, can be rendered very pleasant to the 
taste, so that children will eat them as candy. The dose of santonin for an 
adult is two to four grains; for a child two years old, one-fourth to one-half 
grain. Very alarming symptoms have been caused by two one-grain doses 
exhibited within three hours in a child eight years old (Grimm); in a child 
two and a half years old, four grains apparently came very near causing death 
(Dr. Berg, Wurttcmbery. Medic. Correspondenzblatt, 1862); and in the fatal 
case noted on page 573, only two grains were taken by a child five years old. 654 
NON-SYSTEMIC REMEDIES. 
For young infants, santonin is hardly a safe remedy in any efficient dose. 
When a dose of any size is given, it should not be repeated in less than 
eight hours, and the last dose should be accompanied by a purgative amount 
of calomel. 
The santoninate of sodium (Sodii Santoninas, U. S.) has been proposed 
instead of santonin, but as an anthelmintic it is much more dangerous and 
less efficient: the object is to get as much of the remedy as possible in 
contact with the worm, and as to do this a slow, not rapid, absorption is 
necessary, the insolubility of santonin is an advantage. 
Aspidium, U. S.-Filix Mas, or Male Fern, is the rhizome of Aspidium 
filix mas, or male fern of Europe. Under the name of Aspidium the present 
U. S. Pharmacopoeia recognizes it and the rhizome of the indigenous A. 
marginale. The rhizome, when perfect, is six to twelve inches long, and 
covered with large, brown, imbricated scales. Its taste is bitter and astrin- 
gent. Its therapeutic properties appear to reside in an oleoresin ( Oleoresina 
Aspidii, U. S.), which, as extracted by means of ether, is a dark, thick 
liquid, of a bitterish, nauseous, slightly acrid taste. Male fern is employed 
almost exclusively against the tapeworm. In its administration it is neces- 
sary to regard strictly the general rules applying with greater or less force 
to all the remedies of the class, which are especially imperative when a drug 
is employed against the tapeworm. The patient should live upon milk and 
a little bread for one day, and the following morning take a full dose (f5ss 
to f 5i) of the oleoresin, fasting, and repeating it in two or three hours. At 
noon the patient may resume the use of food, and in the evening a brisk 
cathartic should be given. In overdoses male fern acts as a violent intestinal 
irritant, and six drachms of the oleoresin have caused death in the adult 
(Lancet, Oct. 14, 1882). 
Pepo, U. S.-Pumpkin Seeds.-The seeds of the ordinary pumpkin are 
a most valuable remedy in cases of tapeworm, perhaps even more efficient than 
the male fern, and perfectly harmless. Two ounces of the seeds may be 
beaten up with sugar into an electuary, or with water into an emulsion, and 
be taken fasting in the morning, the patient having dieted the previous day. 
Some hours after their administration, a brisk purge should be given. Mr. 
I. G. Wolff asserts that the active principle is a resin, which he has found 
efficient in doses of fifteen grains. 
Turpentine, in doses of half a fluidounce, has been used in cases both 
of tapeworm and of round-worm. It is efficient, but is liable to produce 
unpleasant effects, and should be employed only when other remedies have 
been used without success or are not to be had. It should be given in com- 
bination with twice its bulk of castor oil. 
Granatum, U. S.-Pomegranate Rind.-The bark of the pomegranate 
root is efficient, though very unpalatable, against the tapeworm. The de- ANTHELMINTICS. 
655 
coction of the fresh root (§ii to Oj) is to be preferred; a pint of it to be 
taken in three doses, an hour apart, before breakfast. The French chemist 
C. Tanret has isolated from the bark four alkaloids (Bull. de Therap., xcviii. 
316), of which two, pelletierina and isopelletierina, have been found by 
Dujardin-Beaumetz to be active taeniacides. In sufficient amount it is stated 
that they act in the same manner upon the higher animals as does curare, 
causing paralysis of the motor nerves, without affecting sensation or mus- 
cular contractibility (Ibid.}. The dose of the salts of the alkaloids is said 
to be 4.6 grains. The efficiency of pelletierine as an anthelmintic has been 
confirmed by various clinicians. It has by some been used in doses of 
twenty grains. Dujardin-Beaumetz also has employed it successfully in 
Meniere's disease, and states that hypodermic injections of six grains 
produce in man severe vertigo and muscular weakness with great retinal 
congestion. 
Mucuna.- Cowhage.-1The sharp, rigid hairs of the pods of Mucuna 
pruriens, an East India plant, were formerly used in cases of the round- 
worm. They are believed to kill the worm by piercing it. The pods are 
dipped into molasses, the hairs scraped off, and a tablespoonful of the thick 
mass given to an adult-a teaspoonful to a child-morning and evening, for 
three days, after which a brisk purge is administered. 
Kamala, U. S.-Kamala.-The hairs of the fruit of Rottlera tmc- 
toria, a plant cultivated in India as a dye-stuff. It is said to be an efficient 
parasiticide in cases of tapeworm. It is an orange-red, very inflammable, 
granular powder, mixing with water with some difficulty, and containing 
traces of a volatile oil and coloring resinoids, to one of which Dr. Anderson 
has given the name of Rottierin. Kameela, in full doses, is actively purga- 
tive, indeed drastic, and sometimes causes also nausea and vomiting. It 
imparts its virtues to alcohol, and hence may be exhibited in the form of 
tincture. The dose of the powder is from one to two drachms suspended 
in syrup, given in the morning, and repeated in eight or ten hours if it do 
not purge. CLASS III-DIGESTANTS. 
In this class are put a few remedies which are used to aid the stomach in 
dissolving the various articles of food. There are, I think, really but three 
articles worthy of a position in the class: namely, pepsin, hydrochloric acid, 
and lactic acid. Prof. Geo. B. Wood claims, however, a position in it for 
yeast. The theory upon which the latter drug is employed is that in diabetes 
there is an excessive formation of sugar in the stomach, and that the yeast, 
by causing a fermentative alteration of this into acetic acid, will do good. 
With our present knowledge of the pathology of the disorder, it is certain 
that the sugar is not formed in the prinue vise, but in the liver, or at least 
in some internal viscus; and, this being so, it is evident that the theory 
above spoken of falls to the ground. Further clinical experience has, I 
think, demonstrated the uselessness of yeast in diabetes, and at present the 
remedy is very rarely, if ever, exhibited in that disorder. 
PEPSINUM SACCHARATUM. U.S-PEPSIN. 
As every one knows, there is secreted by the gastric glands a peculiar 
albuminous body, which has the power not only of coagulating albumen, but 
also, with the aid of acidulated water, of redissolving it. To this principle 
the name of pepsin has long been given. A discussion of its nature and 
properties would be more in place in a work upon physiology than in one 
on therapeutics, and I shall therefore say nothing further about them. 
The dried stomach of calves has been used since time immemorial for the 
purpose of coagulating milk, by housewives, with whom it is customary to 
place the dried viscus in wine, and to call the liquid thus formed, as well as 
the prepared stomach, rennet. It is stated by Dr. Jas. Gray (Edinburgh 
Med. Journ., Jan. 1853) that rennet-wine should be of such strength that 
one teaspoonful of it will coagulate a pint of milk. Rennet is said to have 
been long used in England as a domestic remedy in dyspepsia (Med. Times 
and Gaz., April, 1857). In South America, the inner coat of the gizzard 
of the ostrich is stated to be put to a similar use (E. S. Wayne, American 
Journal of Pharmacy, 1868) ; and in our own country the dried gizzards 
of chickens and turkeys are no less famous among medically-inclined house- 
wives. 
Dr. Corvisart, of Paris, is asserted to have been the first to propose the 
656 DIGESTANTS. 
657 
use of the active principle of the stomach in feeble digestion; and of latter 
years the manufacture and consumption of pepsin have become very great. 
Various processes have been suggested for the preparation of the drug, but 
none of them yield a pure proximate principle, if indeed pepsin have really 
such nature, and be not an albuminous body of varying constitution. By 
most of the methods of manufacture the pepsin is obtained in the form of 
a viscid fluid ; and to change this into a powder requires the addition of a 
large quantity of starch or sugar, so that the powdeied pepsin, as sold, 
contains a considerable percentage of foreign material. 
Whatever form of pepsin be used, if good effects are to be obtained from 
it it must be given with acid, unless indeed there be reason to believe that 
this constituent of the gastric juice is not wanting. Alcohol destroys the 
digesting power of pepsin, and therefore wines are inferior preparations of 
it. The reactions of pepsin with organic and inorganic matters are very 
complex, and not well understood : consequently I think the physician should 
eschew all elixirs or compound preparations of the drug, using only the 
powdered pepsin or a glycerole of pepsin, or a freshly-prepared digestive 
solution. If other remedies are to be given, it is no great hardship to write 
a second prescription and exhibit them by themselves. In making the 
digesting fluid, water and muriatic acid, or glycerine, water, and muriatic 
acid, should alone be employed with the pepsin. 
Therapeutics.-It is a question of some importance to decide how far 
pepsin is valuable and reliable as a medicine. It is evident that any influ- 
ence for good which it possesses is dependent upon its solvent power, and 
that this, therefore, is a measure of its value. According to the experiments 
of Dr. C. L. Dana, which seem to be very reliable, good pepsin ought to 
dissolve in the stomach twenty times its weight of albumen and the U. S. 
Pharmacopoeia requires that the pepsin, aided by hydrochloric acid, should 
dissolve fifty times its weight of coagulated egg albumen in five or six hours; 
but it is very doubtful whether twenty per cent, of commercial pepsin will do 
this. One of two conclusions seems to be inevitable: either the doses of 
pepsin habitually used are preposterously small, or else pepsin acts upon the 
stomach itself in some way as a stimulant. Clinically, pepsin has been used 
with asserted advantage in the loss of digestive power in adults, whether 
primary, or occurring in the course of other affections. Probably four-fifths 
of the drug which has been given has been inert, either originally or from 
the method of its administration; and in the great majority of cases the 
good that has been achieved has been probably due, not to the pepsin, but 
to the regulation of the diet and habits of the patient and to the drugs 
which have been exhibited along with the animal ferment. The value has 
been over-estimated, and it has been given to adults in ridiculously small 
doses: at least half a drachm of the commercial article should be given at a 
dose. The testimony as to the value of pepsin in diseases of young children 
is very strong. To such it is generally given in doses nearly as large as 658 
NON-SYSTEMIC REMEDIES. 
those usually exhibited in the cases of adults. If we represent the absolute 
digesting power of ten grains of pepsin as x, it is evident that x represents 
a proportionately much greater power in the primae vice of a child than in 
those of an adult. The use of pepsin in children is therefore much more 
rational than in adults ; and my own experience is in close accord with what 
seem to me the dictates of common sense: in the chronic indigestion and 
consequent diarrhoea of young children it may be tried with great hope of 
benefit. To a baby six months old five grains may be given in a little 
acidulated water after each feeding. 
Pancreatin.-Modern physiology has shown that the pancreatic secretion 
has varied and extensive digestive powers, and pancreatin, pancreatic ex- 
tracts, and other similar products are now found in commerce. They have 
been especially commended by Dr. Wm. Roberts (On the Digestive Fer- 
ments, London, 1881). There are two ferments in the pancreatic fluid, pan- 
creatic diastase, which dissolves starch, and trypsin, which is closely allied 
to pepsin in its activities. When milk is subjected to pancreatic digestion 
in the presence of an alkali, it becomes first softly curdled, then the curds 
dissolve wholly or in great part, and the fluid assumes a peculiar, character- 
istic yellowish-gray color, and acquires a peculiar, bitterish, to most persons 
unpleasant taste. It is now peptonized, and is not coagulated by nitric acid 
or by boiling. 
If pancreatin be added to fresh milk without an alkali, in the course of 
a few minutes the liquid acquires the property of curdling abundantly upon 
boiling; and Dr. Roberts takes advantage of this fact as a means of testing 
the activity of a pancreatic preparation. The value of a sample is estimated 
as the number of cubic centimetres of milk which are transformed to the 
curdling point in five minutes by one cubic centimetre of the sample at a 
temperature of 40° C. The liquor pancreaticus used by Dr. Roberts has 
a power oscillating between fifty and seventy. In applying his processes for 
peptonizing milk this must be remembered, and the amount of pancreatin 
used made to correspond. Peptonized milk is made by diluting a pint of 
milk with a quarter of a pint of water, heating to about 140° F., adding 
two teaspoonfuls of the liquor pancreaticus with twenty grains of bicarbo- 
nate of sodium, digesting in a warm place for an hour to an hour and a 
half, and raising momentarily to the boiling point; at the temperature of 
the sick-room, 65° F., the digestion will usually require about three hours. 
Peptonized milk gruel is especially commended. It is made by first pre- 
paring a thick gruel with arrowroot, oatmeal, sago, or other similar fari- 
naceous articles; whilst still hot, an equal quantity of milk is added, the 
mixture to have a temperature of 125° F.: to each pint are added twenty 
grains of the bicarbonate and two teaspoonfuls of the liquor, digestion 
allowed in a warm place for two hours, and the mixture momentarily boiled, 
and then strained. Peptonized beef-tea is prepared by simmering half a 
pound of minced beef for two hours in a pint of water containing twenty DIGESTANTS. 
659 
grains of bicarbonate of sodium, allowing to cool to about 100° F., digesting 
at this temperature with a tablespoonful of liquor pancreaticus for three 
hours, decanting, and momentarily boiling. This beef-tea is said to be about 
equivalent to milk in nutritive value, containing 4.5 per cent, of organic 
solids, three-fourths of which is peptone. 
The following recipes, which were devised by Dr. N. A. Randolph, are 
said to yield very good results: 
1. Pancreatized Oysters.-The oysters of an ordinary stew (containing 
milk) are removed and finely minced, then returned to the liquid portion 
of the stew. The whole is brought to a temperature of 100° F., the ap- 
propriate proportions of pancreatic extract and sodium bicarbonate are 
added, and the mixture maintained at the temperature mentioned for thirty 
minutes, with occasional stirring. It is then strained and served, and forms 
not only a highly nutritious and palatable soup, but one which is retained 
by very irritable stomachs, and utilized with a minimum of digestive power. 
After boiling, to prevent the further action of the digestive ferment, gelatine 
may be added, and the mixture served cold, as a jelly. Cooked tomato, 
onion, celery, or other flavoring suited to the individual taste of the patient, 
may be added at the beginning of the artificial digestion, and the solid 
residue removed in the final process of straining, at which time it will be 
noticed that the minced oysters originally added have been in great part 
dissolved. 
2. Pancreatized Milk- Toast.-Ordinary milk-toast, in which there is an 
abundance of milk, when digested in the manner just described, becomes an 
almost homogeneous, pulpy mass, which, when the crusts have been removed, is 
usually acceptably retained by the irritable stomach. In extreme cases, how- 
ever, it may advantageously be strained and the fluid portion alone used, in 
which the partially peptonized solution of casein of the milk is reinforced 
by actually digested gluten and starch of the bread, together with a very 
little dextrin. Plain, light sponge-cake may be similarly digested, and occa- 
sionally forms a desirable change. 
Pancreatin has also been used extensively as a therapeutic agent in dys- 
pepsia. Its value is, however, problematical. For action it requires the 
presence of an alkali, and in the acid gastric juice would not only not act, 
but would itself in all probability be digested and destroyed as a ferment 
(New York Medical Record, xl. p. 398). Dr. J. Milner Fothergill proposes 
to prevent this destruction of pancreatin by administering ten to fifteen grains 
of bicarbonate of soda with the dose; but there is no valid reason for be- 
lieving that this amount of alkali would be capable of sufficiently altering 
the gastric juice to allow of the escape of the pancreatin. 
Feeding by the Rectum.-It is sometimes of the greatest consequence to 
feed a patient in other ways than by the stomach ; and therefore the question 
of nourishing by the rectum is one of the gravest importance. The solvent 
influence of the rectal juices is practically nothing, and formerly the attempt 660 
NON-SYSTEMIC REMEDIES. 
was made to supplement this complete lack of power by the use of soups. 
It is evident that very little nutriment can be introduced into the system by 
such a plan; and consequently feeding by the rectum has hitherto been only 
a " forlorn hope," and has accomplished little good. Dr. W. 0. Lcube 
(Deutsches Archiv filr Klin. Med., 1872) has proposed a new plan, which 
bears upon its face the marks of efficiency, and which, as he h; s proven by 
experiments made upon dogs, is capable of yielding to the blood largely of 
nutritive materials. Moreover, he has by it maintained life for four weeks 
in a patient who had been poisoned with iodine and whose stomach rejected 
all food. The plan consists simply in digesting the food before injecting it 
into the rectum. The method is carried out as follows. The pancreas of 
swine or cattle is carefully cleaned of fat, and 50 to 100 grammes thereof 
cut into very small pieces. In like manner 150 to 300 grammes of beef are 
prepared. Both substances are then put into a dish with about 50 to 150 
cc. of lukewarm water, and stirred into a thick paste, and drawn in a clyster- 
pipe with wide opening. In many cases from 25 to 50 grammes of fat may 
be added to the mixture, also at times some starch. An hour before using 
this clyster, one of pure water should be administered, to clean out the 
intestines. In very warm weather there is some trouble in obtaining and 
keeping sweet the pancreas. This difficulty may be avoided by making 
a glycerine extract, which is said to be quite equal in digestive power to the 
fresh pancreas, and will remain good for several weeks. The following is 
the manner of its preparation. The pancreas of a bullock (which is suffi- 
cient for three enemata) is finely chopped and rubbed with 250 grammes of 
glycerine; and to each third of this, when about to be used, are added from 
120 to 150 grammes of finely-divided meat. It is important that this 
mass should be injected into the intestine as soon as it is made; for if it 
is allowed to stand, the meat swells and the operation is thereby rendered 
difficult. For these preparations of Dr. Leube the pancreatic beef-tea, 
etc., of Dr. Roberts might perhaps be substituted with advantage. 
The experiments of Dr. L. S. Joynes (Richmond and Louisville Med. 
Journ., 1869) have shown that the stomach of the pig, placed in water 
acidulated with hydrochloric acid, will not only rapidly dissolve itself but 
also small pieces of beef. When life is to be maintained by rectal feeding, 
probably a preparation made in this way could with advantage be alternated 
with the solutions of Leube. CLASS IV-ABSORBENTS. 
This class contains remedies which are used for the purpose of absorbing 
acrid and deleterious materials, such as offensive discharges on the exterior 
of the body, and acrid secretions, or the irritant products of the partial de- 
composition of food, in the alimentary canal. For the first purpose very fine 
dry earth and plaster of Paris are used to some extent in practice ; but, as 
their employment is purely in the province of the surgeon, I shall say no 
more about them here. 
CHARCOAL. 
Charcoal is officinal in the U. S. Pharmacopoeia in two forms : 
Carbo Ligni.- Charcoal prepared from wood. 
Carbo Animalis.-Animal Charcoal, prepared from bone. 
Charcoal for medical purposes should be made out of a light porous wood, 
and that prepared from the young shoots of the willow or of the poplar is 
almost exclusively employed. It is a black, brittle substance, and should 
have more or less lustre. It has a very remarkable power of absorbing 
many times its own bulk of gases, and, when exposed to the air, increases 
rapidly in weight. It should therefore, when intended for medicinal pur- 
poses, be powdered so soon as it is burnt, and put in small, completely-filled, 
closely-sealed bottles. 
Animal charcoal, or bone-black, formed as it is by the partial burning 
of bones, contains a large percentage of the phosphate and the carbonate 
of calcium. Although this does not interfere with its strictly medical em- 
ployment, it does with many of its uses in pharmacy; and consequently 
the U. S. Pharmacopoeia directs that a Purified Animal Charcoal ( Carbo 
Animalis Purificatus') be prepared by digesting ordinary animal charcoal 
in dilute muriatic acid, by which all the lime salts are dissolved out, 
washing thoroughly with water, and heating to redness. 
Bone-black possesses absorbing powers far greater than those of ordinary 
or wood charcoal, and takes up coloring-matters, alkaloids, and other sub- 
stances from these solutions: it is therefore very extensively used in phar- 
macy, as well as in the refining of sugar, and in other processes of the arts. 
Therapeutics.-Charcoal is used externally as an absorbent and disin- 
fectant dressing to foul wounds and ulcers. A charcoal poultice may be 
661 662 
NON-SYSTEMIC REMEDIES. 
made by adding one to three drachms (according to size) of powdered char- 
coal to a flaxseed poultice; or, as the British Pharmacopoeia directs, two 
ounces of bread may be well mixed with ten ounces of warm water, an ounce 
and a half of flaxseed meal be thoroughly stirred in, and to the cataplasm 
thus formed two drachms of powdered charcoal be added, and one drachm 
be sprinkled on the surface. 
Internally, charcoal is employed as an absorbent in those cases of acute or 
chronic indigestion in which there are offensive liquids and gases in the ali- 
mentary canal, giving rise to local symptoms and foul discharges: in this 
way it is sometimes employed in dyspepsia, cardidlgia, and similar disorders. 
It is at least conceivable that charcoal, given very freely, should accumulate 
in the alimentary canal, and mechanically cause serious trouble : for this 
reason, its habitual employment is very generally combined with that of 
laxatives. 
On account of its power of absorbing alkaloids, purified animal charcoal 
has been recommended in poisoning by substances of that class. Its action 
is, however, too slow for much good to be expected from its use. If given 
at all, it should be exhibited very freely, since at least half an ounce of it is 
said to bo required for the absorption of one grain of the poison. 
Administration.-The ordinary dose of charcoal is from half an ounce 
to one ounce. Except in a mechanical way, it is perfectly innocuous in any 
dose. CLASS V-DISINFECTANTS. 
Disinfectants are substances employed for the prevention or destruction 
of noxious miasmata or effluvia. It is evident that the consideration of these 
materials belongs rather to the province of hygiene than to that of thera- 
peutics, since their employment is hygienic rather than medicinal, preventive 
rather than curative. The importance of disinfection is, however, so great 
that I shall treat of it, although very briefly, and giving especial attention 
to the action of disinfecting drugs upon the human system. For further 
details the reader is referred to the classical work of Vallin and the able 
report of the Committee of the American Public Health Association, 1885. 
All disease-poisons may be divided into those which are generated or 
multiplied within the human body, and those which arise solely without the 
body. To the former I shall apply the term " contagions," to the latter the 
term " miasms." Of the nature of miasms we have no definite knowl- 
edge, but it is probable that in many, if not all, cases they are organic 
entities. It is certainly established in regard to very many contagions that 
they are living forms, and for practical purposes all contagions must be con- 
sidered of such nature. In the experimental study of the power of poison- 
ous agents over the contagions, we are forced to take, as the measure of the 
power of such agents, the influence which they exert over the lower forms 
of life. We have no better criterion forjudging of the effectiveness of dis- 
infectant agents upon miasms. It must be remembered that these poisons 
are not necessarily connected with bad odors, but may in a most deadly form 
saturate the air in an apparently clean chamber, whilst the emanations from 
the most stinking cesspool may be free from them. It is probable, however, 
that foul gases are of themselves able to produce systemic depression, although 
not definite disease. It is, therefore, always important to prevent the giving 
off of foul gases from masses of decomposing matter. 
An antiseptic is not always a germicide, though a germicide is always an 
antiseptic. The antiseptic is a substance which has the power of preventing 
putrefaction, that is, the growth of the organisms which produce putrefac- 
tion. Whereas the germicide is a substance which is capable of killing 
disease-germs and their spores, which entities are much more resistant than 
are the bacteria of putrefaction; thus alcohol, common salt, borax, sulphate 
of iron, and many other agents commonly used as antiseptics do not even in 
concentrated solution destroy the spores of bacilli, and consequently are 
not germicides. 
A question of very grave importance naturally arises here, as to the exact 
663 664 
NON-SYSTEMIC REMEDIES. 
province of disinfection when applied to contagions ; or, in other words, Is 
it possible to destroy them in the air ? It is a law which holds everywhere, 
that the more imperfectly developed animal organisms are, the more tenacious 
are they of life ; also experience has shown that all substances actively 
poisonous to contagions are still more poisonous to the germinal matter of 
human beings, and that it may be laid down as a general proposition that it 
is impossible to destroy the contagion-germs in the confined air of a room 
while men or women remain in the apartment. When it comes to the gen- 
eral atmosphere, to attempt to disinfect it, to essay the destruction of a wide- 
spread poison, such as, for example, exists in a smallpox epidemic, is simply 
so childish as to need no discussion to reveal its utter futility.* It is well 
known that contagions diluted beyond a certain point are powerless, and the 
admission of large quantities of fresh or pure air, or, in other words, free 
ventilation, is the only means at our command of disinfecting rooms in which 
there are human beings. In ventilating an apartment, it must always be 
remembered that it is not merely air, but pure air, that is required. To 
ventilate one room into another, as is sometimes done, is foolishness ; to open 
a window with the wind blowing over a miasmatic swamp or an open sewer, 
may be but to invite disease. The opportunity to destroy disease-germs is 
to be found not after they have been dispersed into the air, but whilst they 
are still in connection with the various solids and fluids passed from the 
body or brought in contact with it. In most, if not all, contagious diseases 
the poison-germs are eliminated in large quantities with the urinary and 
fecal discharges; it is of the most vital importance to act on the excretions 
so soon as they leave the body ; and the disinfectant should be placed in the 
receptacle before, not after, it is used. To allow any excretion, sputum, or 
other infected discharge to exist for a moment undestroyed, or at least 
undevitalized, is most culpable neglect. 
The nature of miasms is not known at all. Over many of them, malaria 
for example, we have no control. Those which we are able to influence are 
almost all the results of animal or of vegetable decomposition, either alone or 
conjoined. After these poisons have been produced and diffused through 
the air, they are probably in great part beyond our reach. The only thing 
that can be done is to dilute them precisely as in regard to contagions; and 
hence free ventilation is the only reliable disinfectant under these circum- 
stances. The stinking gases are probably of use as indicators of the pres- 
ence of more subtle poisons. The gases which arise from cesspools and 
similar depositories no doubt act as carriers of the peculiar poisons produced 
in these places, and it may be that destruction of the gas causes a depo- 
sition of the organic poison. This is, however, merely speculation: it is 
not proven. Moreover, the deposition of a poison in an apartment is no 
advantage. Even then if it were possible to make an apartment appear to 
* For failure of such attempt, see New Orleans Med. and Surg. Journ., Nov. 1875. DISINFECTANTS. 
665 
the smell pure by destruction of its stinking gases no good would be accom- 
plished by so doing. Wide-open windows, great draughts of fresh air, are 
the only proper disinfectants for a close room or a noisome hospital-ward. 
The attempt so often indulged in to purify such apartments by little saucers 
of chlorinated lime or of carbolic acid would be exceedingly ludicrous if it 
were not for the frightful results of the false security engendered. 
It is otherwise when the gases are destroyed at their places of emanation. 
Thus, if a sewer be belching forth deleterious gases and poison, chlorinated 
lime or other materials generating disinfecting gases at the mouth, or in the 
sewer, may really be of service by destroying the noxious vapors before they 
find their way out and carry with them into the air the poisonous effluvia. 
Although miasms cannot be readily destroyed when once generated, yet 
in very many instances we have power to prevent their formation. In doing 
this the chief factor is cleanliness, and the best disinfectant is water. Water 
acts chiefly in two ways: first, by dilution ; secondly, by destroying organic 
substances. In order for decomposition to produce serious poisoning, the 
mass of material must be considerable. If the matter be diffused through a 
large bulk of water, and this spread over a considerable surface, it is evident 
that the effect of dispersion is obtained. Further, when water containing 
organic matter is allowed to run away in its natural channels, oxidation and 
destruction of the impurities result. Without entering further into the 
subject, it is sufficiently evident that, so far as miasms, and also disease- 
germs in the air, are concerned, air and water are the great disinfectants, 
and that the most skilful use of chemical substances cannot take the place 
of ventilation and cleanliness. Moreover, antiseptics may do harm by de- 
laying the destruction of filth by putrefaction, which latter process is simply 
nature's method of getting rid of filth. Destructive, that is, oxidizing dis- 
infectants, rather than antiseptics, should be used in cesspools. On the 
other hand, when the contents of a privy or other organic mass has been in- 
fected by disease-germs, it is essential to kill such germs by a germicidal agent. 
The most complete and thorough, but the most destructive of all disin- 
fecting agents is fire. Heat of less intensity may be used either moist or 
dry. The germicidal powers of moist heat have been especially investigated 
by Dr. George M. Sternberg, who finds that, in the absence of spores, boiling 
water will quickly destroy the vitality of all micro-organisms of the class 
to which known disease-germs belong; that boiling for two hours does 
not kill the spores of Bacillus subtilis, but a more prolonged boiling is 
fatal; that steam at a temperature of 110° C. (230° F.) maintained for 
one or two minutes, or of 105° C. (220° F.) maintained for ten minutes, 
will infallibly destroy the spores of bacilli, the most difficult test of disin- 
fecting power known. 
In regard to dry heat, the results reached by Koch and Wolffhiigel (^Mitt. 
Kais. Gesundtheitsamte, Bd. i.) are in accord with our other evidence, and 
may be considered correct. They are as follows: 666 
NON-SYSTEMIC REMEDIES. 
1. A temperature of 100° C. (212° F., dry heat), maintained for one 
hour and a half, will destroy bacteria which do not contain spores. 
2. Spores of mould-fungi require for their destruction in hot air a tem- 
perature of from 110°-115° C. (230°-239° F.) maintained for one hour 
and a half. 
3. Bacillus spores require for their destruction in hot air a temperature 
of 140° C. (284° F.) maintained for three hours. 
4. In dry air the heat penetrates objects so slowly that small packages, 
such as pillows or small bundles of clothing, are not disinfected after an 
exposure of from three to four hours to a temperature of 140° C. (284° F.). 
5. Exposure to a temperature of 140° C. (284° F.) in dry air for a period 
of three hours injures most objects requiring disinfection (clothing, bedding, 
etc.) to a greater or less degree. 
Dr. George II. Rohe (Med. News, 1885, i., p. 283) found that rolls of 
blankets exposed in a chamber heated to 280° F. for three hours were very 
slightly affected in their interior, and it is evident that whenever clothing 
is to be disinfected, prolonged boiling is the surest method ; and that when 
pillows, bedding, or articles of furniture are seriously infected, taking them 
apart before disinfection is essential. 
LEAD AND IKON. 
There are various metallic salts which are believed to act as disinfectants 
by uniting with the sulphur of sulphuretted gases and precipitating as sul- 
phurets. As examples of such may be mentioned sulphate of zinc and 
nitrate of lead. Under the name of Ledoyens Disinfectant Solution, a 
solution of the latter salt has been and still is used to a considerable extent 
as a disinfectant. Although it certainly destroys sulphuretted hydrogen with 
great rapidity, it does not seem to me a good material for the purposes to 
which it is applied. The reasons of this are, first, it has no action besides 
that of a desulphurating body ; second, it is a comparatively dear salt; third, 
it forms an intensely black precipitate, discoloring everything with which it 
comes in contact. 
The power which the oxides of iron have of converting ordinary oxygen 
into ozone has already been spoken of (p. 99). This action is a slow, per- 
sistent one, and the oxidation which results is equally slow and persistent. 
As already stated, organic matter, if diffused through water and exposed to 
the air, is gradually destroyed by oxidation. It has been found that when 
water which is loaded with the products of decomposition is exposed to the 
action of iron plates, or even of iron pipes, this destruction of organic im- 
purities is greatly hastened. According to Mr. G. Michaelis (^Philadelphia 
Medical Times, vol. iii. p. 621), even the most filthy water, under the influ- 
ence simply of iron plates and the air, will become perfectly pure in forty- 
eight hours. The action is evidently one of oxidation, but is in its details 
complicated. According to the researches of Dr. Mankiwich, iron possesses DISINFECTANTS. 
667 
the property of converting ammonia into nitric acid, and also facilitates, or 
even provokes, such decompositi m in the organic matter as shall cause am- 
monia to be formed. The nitric acid thus generated is one of the most 
powerful oxidizing substances known, and as fast as formed attacks the 
organic matter. It is evident that in this process the iron acts as an inter- 
mediate agent between the air and decomposing matter; that, unlike 
the permanganate of potassium, it does not itself undergo a conversion 
equivalent in chemical relation to the oxidation, and consequently that 
its power is not so limited as that of those compounds. The iron, however, 
undoubtedly suffers to some extent, and is largely oxidized; but the oxide 
formed has certainly the power of generating ozone, and very probably to 
as great an extent as the original metal. How soon the power of oxidation 
is finally lost, and what eventually becomes of the iron, in the presence of 
an overwhelming mass of organic matter, has not, that I am aware of, been 
determined. 
Copperas, or impure sulphate of iron, is an important destroying disinfec- 
tant, although, according to recent experiments, it has no germicidal power.* 
The changes wrought by sulphate of iron thrown into a mass of decompos- 
ing matter are very complex and not absolutely known. In the first place, 
if sulphuretted hydrogen and ammonia be present, a sulphuret of iron is at 
once precipitated ; again, a part of the salt is decomposed by the ammonia, 
and probably also by the stinking alkaloids which exist in the decomposing 
mass of a cesspool; further, by oxidation, in all probability, some of the 
protoxide of iron is changed into the sesquioxide, by which the ozonizing 
power of an iron compound is doubtless exerted long after the destruction 
of the original salt. The sulphuric acid set free from the iron very pro- 
bably contributes to a feeble extent in the destructive reactions which are 
set up. From what has been already stated, it is evident that the sole 
use of the copperas is in altering the course of putrefaction and in destroy- 
ing its products. 
If a rapid effect be desired, or a mass of solid material is to be acted on, 
* That this substance is of great practical value for use in cesspools, etc., is strongly 
indicated by the experiments of Albert Eckstein, who published (Zeitschrift de» Oester. 
Apotheker-Vereines, Feb. 10, 1873) an account of his attempts to disinfect a privy which 
was used daily by one hundred persons: 1. Two pounds of the sulphate of iron in solu- 
tion were used. After from two to three hours all bad smell had disappeared, but in 
twelve hours all the influence of the disinfectant was lost. 2. The sulphate of copper was 
employed in solution; result the same. 3. Two pounds of the sulphate of iron in crystals 
were thrown in ; their effects lasted two days. 4. The sulphate of copper, the same. 5. 
Sulphurous acid in solution rapidly lost its effect, and was exceedingly irritating to the 
respiratory organs. 6. Two pounds of impure carbolic acid filled the house for two days 
with such a disagreeable smell that it was impossible to tell whether the original odor 
was destroyed or covered up. 7. Two pounds of sulphate of iron in a parchment sack 
exerted a disinfecting influence for three full days, and when the parchment sack was 
drawn up it contained only some dirty, odorless fluid. 8. Two pounds of the best chlori- 
nated lime in the parchment sack disinfected the privy for at least nine days. 668 
NON-SYSTEMIC REMEDIES. 
the copperas should be in solution ; if a more persistent action is wanted, 
or if the mass is liquid, the method employed by Eckstein, of using a parch- 
ment sack, may be resorted to, or the salt in powder may be scattered over 
the surface of the material to be disinfected. 
Lime is probably the oldest of all the disinfectants, but is only of value 
as a destructive agent,-i.e., as causing a slow oxidation of organic matter. 
It is notorious that a compost-heap to which lime has been added rots-i.e., 
oxidizes-much more rapidly than one which has none of the alkaline earth 
in it. This action of lime is, however, too slow for ordinary purposes : more- 
over, there are very serious objections to the use of lime as a disinfectant. 
The poisonous principles contained in sewage, etc., whatever their nature 
may be, are probably volatile, and lime, acting as a strong base, sets free 
large quantities of ammonia in animal matter undergoing decomposition. It 
may be that volatile poisons, alkaloids, are liberated with the ammonia; but, 
whether they are or not, it is a well-known physical fact that a volatile 
substance in escaping carries off with it even non-volatile materials, and 
facilitates to a still greater degree the escape of principles only less volatile 
than itself. 
Lime is, for the above reasons, not available for use as a disinfectant in 
cesspools and sewers unless it is added in large quantities day by day from 
the beginning, so as to keep the collection under its influence, and unless 
some absorbent is added with it to take up volatile principles. In the or- 
dinary open privies of the country, a shovelful of a mixture of lime and 
plaster of Paris, or of lime and dry earth, thrown in day by day, will at 
once tend to prevent odor, and at the same time prepare the contents for use 
as manure. 
When spread upon walls in the form of whitewash, lime may act to some 
extent as an oxidizer; but probably its chief influence is as an absorbent, 
which takes up the deleterious emanations. A very striking example or 
illustration of this action of whitewash occurred some years since in the New 
York city hospital. Award which stood isolated from the remainder of the 
institution had been used for the reception of cases of typhus fever from the 
shipping of the port. It was finally abandoned and allowed to stand unoc- 
cupied, with its windows wide open, for several months. At the end of this 
time, a gang of men were set to scraping the whitewash off the walls. Of 
these workmen a majority were seized with the ship-fever, and several died. 
In 1870, Dr. John Dougall announced that corrosive sublimate, one part 
in sixty-five hundred would kill spermatozoa, and one part in six thousand, 
infusoria; the later researches of Koch, Jalan de la Croix, and of Stern- 
berg have more than confirmed this result, and shown that corrosive 
sublimate is one of the most powerful of known germicides. Micrococci and 
CORROSIVE SUBLIMATE. DISINFECTA NTS. 
669 
bacilli in active growth without spores are killed by solutions of one in 
twenty thousand, while solutions of one in one thousand will rapidly destroy 
the spores of B. anthracis and B. subtilis. Results contrary to these have, 
it is true, been obtained by Klein of London, who asserts that a one per 
cent, solution of the mercuric chloride is no more a germicide than is 
vinegar; but the strength of the evidence to the contrary is so strong that 
it seems almost a certainty that there is some error in Klein's experi- 
ment. According to the detailed experiment of Koch, the spores of B. an- 
thracis are absolutely incapable of germinating in a proteid solution if as 
little as one part of corrosive sublimate in three hundred thousand be 
present. Dr. Sternberg confirms the experiments of Koch, and it would 
theoretically appear that one part of corrosive sublimate in one hundred 
thousand is sufficient to destroy germs in a mass of filth, provided that the 
filth is so situated that the corrosive sublimate will remain in contact with 
it for some time. It must be remembered, however, that the corrosive 
sublimate is readily decomposed by the ammonia and other chemical sub- 
stances in a mass of filth, and it is very doubtful whether in practice it will 
be found that the mercuric chloride is available for disinfectant purposes 
on a large scale. Even, however, if its powers be considerably less than 
they appear to be, it would still remain for many purposes the best of 
all germicides. A standard solution of one part in a thousand may be used 
for bedding, which can be soaked in it; for washing the floors and walls of 
infected apartments; and for disinfecting the hands of surgeons and gynae- 
cologists ; after the corrosive sublimate has done its work it should be re- 
moved by free washing with pure water. For the destruction of germs in 
fecal discharges, the solution should have at least the strength of one part 
in five hundred. 
In regard to the use of corrosive sublimate in the treatment of wounds, 
etc., the reader is referred to treatises on surgery. It is, however, proper 
here to state that a number of cases of death from the local use of cor- 
rosive sublimate, especially in obstetrical and gynaecological use, have been 
reported. In most of these cases the solution has been at least one part 
in fifteen hundred, but I have known the use of a vaginal wash, one 
in ten thousand, to be followed by severe poisoning. It is probably very 
rarely proper to use continual irrigation of a mucous surface or of a wound 
with a solution stronger than one in ten thousand; and for a single wash- 
ing, the solution should not be more than one in two thousand. 
POTASSII PERMANGANAS-PERMANGANATE OF POTASSIUM. 
U.S. (KO,Mn2O7-Mn2O8K2.) 
This salt is prepared by heating together ten parts of binoxide of man- 
ganese and twelve of potassa. It occurs in slender, prismatic crystals of a 
dark-purple color, inodorous, of a sweetish, disagreeable taste, and very 
soluble in water, with which they form a solution varying from a purplish 670 
NON-SYSTEMIC REMEDIES. 
black to a beautiful reddish lilac, according to the strength. When kept 
dry and not exposed to the atmosphere, the permanganate of potassium is 
a permanent salt, but whenever in solution it is brought into contact with 
an organic body it at once gives up its oxygen to the latter, and is converted 
into potassa and the black oxide of manganese. 
The disinfectant power of this salt is beyond question ; but at the same 
time this power is very limited, as the remedy yields up its own oxygen and 
becomes inert. According to the experiments of Dr. George M. Sternberg 
(Med. News, Jan. 10, 1885), as a germicide the permanganate is very 
potent, 0.12 per cent, (one part in eight hundred and thirty-three parts) 
killing the micrococci of pus in two hours. For practical purposes, however, 
this agent is of very little value as a germicide, because it is at once decom- 
posed by organic matters, and whilst in the laboratory disease-germs may 
exist almost isolated, in the sick-room they are mixed with a large excess 
of organic material. Nevertheless the permanganate affords a very elegant 
disinfectant and germicidal wash for wounds, ulcers, abscesses, etc.; fetid 
ozeena, otorrhoea, leucorrhoea, etc. In dilute solution its local influence is 
stimulant and beneficial. When employed in the form of powder it even 
affects living tissues, acting as a mild caustic, and, as such, may often be 
applied with advantage to sloughing ulcers. As a wash, the strength may 
vary according to circumstances, from one to twenty grains to the ounce. 
Internally this salt has been commended in various diseases, in doses of one 
or two grains. Since it is evident that, even if many grains were taken into 
the stomach, immediate complete decomposition of them would there occur, 
the absurdity of this use of the drug needs only to be pointed out. The 
officinal Liquor (Liquor Potassii Permanganates, gr. Ixiv to Oj) has no 
advantages over extemporaneous preparations. 
OHLORUM-CHLORINE. 
Chlorine gas is officinal only in the form of the Aqua Chlori, which is 
prepared by heating together the black oxide of manganese and muriatic 
acid, and allowing the chlorine which is generated to pass through water until 
the latter is saturated. Chlorine Water is a greenish-yellow liquid, of a very 
sharp taste, and having a strong odor of chlorine. When it is desired to 
liberate chlorine in the air of a room, eighteen parts of finely-ground com- 
mon salt with fifteen parts of finely-powdered black oxide of manganese 
should be introduced into a flask; then there should be added forty-five 
parts of concentrated sulphuric acid and twenty-one of water, previously 
mixed and completely cooled ; and, lastly, the flask is to be well shaken. 
When the evolution of gas ceases, it may be renewed by placing the flask 
in warm water.* When chlorine is brought into contact with organic sub- 
* Inspired in sufficient amount chlorine gas produces, both in man and the lower animals, 
narcotism and finally death from paralysis of the respiratory centres (consult Arch. Exper. 
Path, und Pharm., xiii.). DISINFECTA NTS. 
671 
stances and moisture, it unites with the hydrogen of the water and liberates 
nascent oxygen, which rapidly oxidizes and destroys the organic compound. 
When chlorine comes in contact with sulphuretted hydrogen, it removes 
its hydrogen and thereby destroys it. 
The germicidal influence of chlorine is very great. Fischer and Proskauer 
found that dried anthrax spores maintained their integrity for one hour 
when exposed to the action of a dry chlorine atmosphere containing 44.7 
parts of chlorine in 100. When the air and the spores were moist, one 
hour's exposure to an atmosphere containing four per cent, of chlorine pro- 
duced complete disinfection. If the exposure was continued for three hours, 
one per cent, of chlorine was an efficient germicide ; and if the spores were 
exposed for twenty-four hours, the effective proportion of chlorine could be 
still further reduced. In Dr. Sternberg's experiments (Rep. Nat. Bd. of 
Health, 1880), six hours' exposure of vaccine lymph dried upon ivory 
points to an atmosphere containing one part of chlorine in two hundred, 
was sufficient to destroy the infective property of the lymph, whilst the 
bacteria of putrid urine were destroyed after, six hours' exposure to an at- 
mosphere containing one part of chlorine in four hundred. 
The result of all our knowledge upon the subject of the disinfectant prop- 
erties of chlorine, iodine, and bromine is summed up by Dr. Geo. H. Rohe 
(Med. Neivs, xlvi. 89) as follows : 
1. Chlorine is an efficient disinfectant when present in the proportion of 
one part in one hundred ; provided the air and the objects to be disinfected 
are in a moist state, and the exposure continues for upwards of one hour. 
2. Chlorine, when used in sufficient concentration to act as a trustworthy 
disinfectant, injures colored fabrics and wearing apparel. 
3. Bromine is an efficient disinfectant in the proportion of one part in 
five hundred; provided the air be in a moist state, and the exposure con- 
tinues for upwards of three hours. 
4. Iodine, in solution, is an efficient disinfectant in the proportion of one 
part in five hundred; the exposure continuing for two hours. 
5. The use of chlorine, and in a greater degree of bromine, requires 
considerable experience in management; when carelessly handled they may 
cause inconvenient or even dangerous symptoms in persons using them; for 
these reasons they are not suitable as disinfectants for popular use. 
Internally, chlorine water has been used in various diseases, especially in 
malignant typhus, but at present is very rarely if ever employed. It is stated 
to be stimulant and tonic to the stomach, and is thought by some to have 
an especial influence upon the liver. It has been employed in chronic hepatic 
affections ; the dose is half a fluidrachm to two fluidrachms in three or four 
fluidounces of water. Chlorine water is a powerful irritant, capable of pro- 
ducing severe inflammation of the skin or toxic gastro enteritis. Properly 
diluted, it forms an excellent stimulant, disinfectant, detergent wash for foul 
ulcers, and may also be used as a gargle in malignant sore throat. 672 
NOR-SYSTEMIC REMEDIES. 
This is a grayish-white substance, occurring in powder or friable lumps, 
having a hot, acrid, astringent taste, and an odor resembling that of chlorine. 
It is made by the action of chlorine upon hydrate of calcium or slaked lime, 
and should contain at least twenty-five per cent, of chlorine. It probably 
varies in its chemical constitution, but, according to the most recent views, 
is chiefly composed of the hypochlorite and the chloride of calcium. When 
exposed to the air it slowly evolves hypochlorous acid, which, being an 
unstable compound, undergoes spontaneous decomposition, and finally sets 
free fourteen-fifteenths of its chlorine. When an acid is added to chlori- 
nated lime, the chlorine gas is rapidly evolved. If a specimen of bleaching- 
powder be very moist, it generally contains an over-proportion of the deli- 
quescent chloride of calcium, and is correspondingly unable to liberate 
chlorine. 
The experiments of Dr. J. R. Duggan {Medical News, xlvi. p. 147) 
indicate that the hypochlorites are among the very best of our practical 
disinfectants. He found that 0.25 of one per cent, (one part to four hundred) 
of chlorine as hypochlorites is an effective germicide even when allowed to 
act for only two minutes ; while 0.06 (six parts to ten thousand) will kill the 
spores of B. anthracis and B. subtilis in two hours. 
Bleaching-powder usually contains from twenty-five to forty per cent, of 
available chlorine. Formost purposes, a solution containing one part of this 
preparation to one hundred of water is strong enough, for this will contain 
from 0.25 to 0.40 of one per cent, of chlorine as hypochlorite. As is stated 
above, the smaller of these quantities is sufficient to destroy spores almost 
instantly. There are very few purposes to which disinfectants are applied 
that are not fulfilled by this solution of one to one hundred of bleaching- 
powder. It is not dangerously poisonous, is said not to injure clothing, bed- 
ding,* etc., and is very cheap, since bleaching-powder is worth only about 
five cents per pound, j- For the destruction of disease-germs in urine, fecal 
CALX CHLORATA-CHLORINATED LIME. U. S. 
* This statement seems to me doubtful. 
f To fix the value of solutions of the hypochlorites, the following method is, according 
to Duggan, sufficiently accurate for ordinary purposes. A standard solution of potassium 
arsenite may be made by diluting seven parts of Fowler's solution with one and a half 
parts of water. This corresponds to a one-half per cent, solution of available chlorine. 
To apply the method, a given volume of the hypochlorite solution is measured out, and 
the arsenite solution added in small quantities. Between each addition the mixture is 
well stirred, and a drop taken out on a glass rod and tested on a strip of paper saturated 
with iodide of potassium and starch-paste and dried. As long as any hypochlorite is 
present, the blue iodide of starch is formed; but when it has all been used up in convert- 
ing the arsenite into an arseniate, the paper will remain colorless. As each volume of the 
potassium arsenite solution required for this corresponds to one-half per cent, of available 
chlorine, the calculation is very simple,-e.g., if one volume of the hypochlorite solution 
= 4.6 volumes of the arsenite solution, the amount of available chlorine present woald 
correspond to 2.3 per cent. Since the preparations now on the market vary so much in the DISINFECTANTS. 
673 
discharges, sputum, etc., a saturated solution of bleaching-powder appears 
to be in all respects the best disinfectant known. 
Liquor Soda: Chlorate, U. S.-Solution of Chlorinated Soda, or 
Labarraque's Solution, is an officinal preparation, made by triturating chlo- 
rinated lime with a solution of the carbonate of sodium. It is a greenish- 
yellow liquid, having a slight odor of chlorine and a sharp saline taste. It 
contains, among other substances, hypochlorite of sodium, and possesses the 
therapeutic and disinfectant properties of the chlorinated compound. Owing 
to its liquid form, its comparative freedom from odor, and its depositing 
chloride of sodium on evaporation, it is the most elegant of all the chlorine 
preparations for use in the sick-room. Properly diluted, Labarraque's 
solution may be employed for all the therapeutic purposes that chlorine 
water is used for. The dose is half a fluidrachm to two fluidrachms, in 
half a tumblerful to a tumblerful of water. 
AOIDUM BOBICUM-BORIC ACID. U. S. 
Sodii Boras, U. S.-Borax.-Boric or Boracic acid crystallizes in white 
translucent scales, soluble in about thirty parts of cold water, much more 
soluble in boiling water, which on cooling precipitates all but about twenty- 
three grains to the fluidounce. Hot glycerine dissolves and holds upon 
cooling as much as three drachms to the fluidounce. Borax occurs in 
white, flattened, prismatic crystals, soluble in twelve times their weight of 
cold water. 
The action of boracic acid and its salts upon the animal system is a very 
feeble one. In experiments made by Dr. E. T. Stewart and myself, enor- 
mous doses were required to affect the frog; they depressed the spinal 
centres and produced progressive loss of voluntary and reflex activity with- 
out affecting nerve or muscle. A saturated solution of the quadroborate 
of sodium brought in direct contact with the heart exercised a very feeble, 
depressant influence; and when injected in sufficient amount into the 
jugular vein of the mammal lowered the arterial pressure. Cyon (^Hoff- 
mann und Schwalbe's Jahresb., 1879, 301) has found that daily doses of 
three drachms of borax increase the appetite and digestion in dogs without 
causing other effect, unless it be gain in weight. Max Gruber* (Ibid., p. 
351), in a series of experiments, found that the elimination of urea and of 
amount of chlorine they contain, this test should always he used to determine their value, 
and the amount of dilution required. 
* A very curious effect is said, by Prof. Schiff (Rev. Med. de Suisse Rom., 1881, 244) 
to be produced by the local application of boracic acid to nerves; the part affected is 
affirmed to lose its power of originating but not of transmitting impulses, so that if the 
galvanic current be applied to the part of the nerve which has been exposed to the drug no 
muscular contractions result, but if the poles be placed above this part, the distal muscles 
respond at once. 674 
NON-SYSTEMIC REMEDIES. 
water by the kidneys is increased by large doses of borax. Mododewkow is 
said (St. Louis Clin. Rec., Sept. 1881) to have had two cases of fatal 
poisoning with boracic acid ; in the one case a lumbar abscess, in the 
other a pleuritic cavity, was washed out with a five per cent, solution of the 
acid, much of which remained. The symptoms were nausea, incessant 
vomiting, hiccough, erythematous eruption, fall of temperature, and collapse, 
the mind remaining clear. In a not fatal case (Med. News, xl. 704) the 
symptoms were erythema, with rapid, feeble pulse. Dr. R. Hogner reports 
(Schmidt's Jahrb., Bd. ccii. 238) two cases in which washing out of a 
dilated stomach with a two and a half per cent, solution of boracic acid was 
followed by erythematous eruption, headache, great general distress and weak- 
ness, disturbance of respiration, coma, involuntary discharges, ecchymoses on 
the skin, and death.* 
In the experiments of Dr. Walb (Centralb. Klin. Medicin, 1882, iii. 529), 
two per cent, solution of borax distinctly checked the putrefaction of solution 
of fibrin ; a five per cent, solution kept the solution fresh for nineteen days. 
Fresh muscle-fibres from oxen were kept fresh many days by a one percent, 
solution. In the elaborate experiments of Dr. Sternberg it was found that 
boracic acid and the biborate of sodium are inefficient as germ-destroyers, 
but have considerable antiseptic power (Amer. Journ. Med. Sei., Ixxxiv. 
321). 
Recently boracic acid has attracted attention as a disinfectant, or rather 
antiseptic, and its power seems to be undisputable, although further ex- 
periments are necessary to settle its exact value. In 1874, Dumas and 
Schnatzles announced that borax is poisonous to the lower forms of life 
(Pharm. Journ., April, 1874); in Bucholz's experiments, 0.75 per cent, of 
boracic acid was found sufficient to prevent the development of bacteria 
(Arch. Exper. Path. u. Pharm., Bd. iv.). The acid has been used to a 
considerable extent in antiseptic surgery, and it is affirmed to be free from 
irritating properties, and of great practical value in the treatment of fresh 
wounds, foul ulcers, abscesses, old burns, etc. (see especially Dr. M. Greene, 
Boston Med. and Surg. Journ., ciii. 209). A lint may be made by satu- 
rating ordinary patent lint with a saturated boiling solution of boracic acid; 
wounds dressed in a dry manner with this are stated to heal as rapidly as 
when a complicated antisepsis is employed. Dr. Greene prepares an oint- 
ment by melting one part each of spermaceti and white wax with six parts 
of vaseline, and adding, whilst hot, two to four parts of a saturated glycerite 
of boracic acid. In the form of lotion, the remedy has been used with great 
advantage in phlegmonous erysipelas (see Ijondon Lancet, May, 1873 ; May, 
1876; also, Prof. F. L. Lebovicz, Gaz. Hebdom. de Med., xxi, 1884, p. 
624). There can be doubt of the value of boracic acid and borax as a local 
* There is no reason for believing that boric acid had anything to do with the symp- 
toms in the alleged case of poisoning reported in Med. News, xliii. p, 199. DISINFECTANTS. 
675 
application in aphthous ulceration, diphtheria, and other inflammations of 
the mouth, in which crystals of the sodium salt may be allowed slowly to 
dissolve in the mouth ; whether, as affirmed by Dr. William Greene and by 
Dr. F. P. Atkinson (Lond. Practitioner, xxiv. 254), boracic acid is useful 
in septicaemia, puerperal fever, erysipelas, etc., is more problematical.* The 
statements of Prof. Rosenthal (Allegm. Wien. Med. Wochens., Jan. 1884), 
that boracic acid is efficient in ammoniacal urine and cystitis, acidifying the 
urine and checking the fermentation, have been confirmed (see Lond. 
Lancet, ii., 1884, 133). The acid may be given in doses of ten grains 
three to six times a day; the salt, twenty grains to a drachm; in each case 
administered in diluted watery solution. As a disinfectant and soothing 
eye-wash its solution is much used by oculists in conjunctival inflamma- 
tion and irritation. The strength may vary from five grains to the ounce 
up to saturation. In the cystitis of spinal diseases I have secured great re- 
lief by washing out the bladder with a few ounces of a saturated solution 
of boracic acid after the use of the catheter. 
A0IDUM SULPHUR0SUM-SULPHUROUS A0ID, 
Sulphurous acid and its salts are most efficient in destroying the low forms 
of life which are connected with putrefaction and fermentation, and for this 
reason are excellent preservatives of organic matters. 
Sulphurous acid and its salts are among the oldest of disinfectants, hav- 
ing been used as long ago as 1771; but recent experimental evidence seems 
to indicate that they have not the great superiority which has been attrib- 
uted to them. According to the experiments of Sternberg one volume of 
sulphurous acid gas in one hundred volumes of air is sufficient to disinfect 
dry vaccine matter. As these experiments are in accord with older observa- 
tions they may be considered as correct. 
According to Wernitz, the action of pepsine, of ptyaline, of invertine, and 
of diastase is prevented by the presence of an aqueous solution of SO2 of 1: 
1317 to 1 : 8600 (by weight) ; while the action of myrosine and of emul- 
sine is neutralized by 1 : 21,000. 
According to Wernick, strips of woollen or cotton goods saturated with 
putrefactive matter are disinfected by exposure of from four or six hours to 
an atmosphere containing four per cent, of sulphurous acid gas. The very 
elaborate experiments of Koch, of Wolffhiigel, and of Sternberg have 
shown, however, that when the infectious material contains spores sulphur 
dioxide is of very little value. Wolffhiigel concludes that it should be 
* M. Cyon commends most highly the use of borax in daily doses of eighty to ninety 
grains as a prophylactic against cholera, and affirms that during the epidemic in Italy 
during 1864-65, none of the villagers employed in the borax works were affected, whilst 
in a village in close proximity one-third of the inhabitants died. He believes that the 
drug kills the germs in the alimentary canal ( Comp.-Rend. Acad. Sci., xcix. 149). 676 
NON-SYSTEMIC REMEDIES. 
abandoned as a disinfectant; nevertheless, as probably but few of the con- 
tagions are in the condition of spores, sulphurous acid is probably, when 
sufficiently concentrated, an effective disinfectant, if applied for a sufficient 
length of time. It has been proven by the experiments of Sternberg that 
the gas acts much more freely and powerfully when the air is loaded with 
moisture. Fumigation of an apartment with sulphurous acid gas should 
never be allowed to take the place of cleanliness and thorough disinfection 
of the walls and of all articles of furniture. Whether after all this is done 
the fumigation does any good-whether in practice it is of any real value, 
remains doubtful. It is perfectly sure that it is of no service unless the air 
of the room be made to contain at least five volumes per thousand of the gas, 
and this for a period of from four to six hours. The following method is 
the one generally employed. 
Take a large iron pot or caldron, put in a little stand, such as the cheap 
tripod used by chemists, place on this an iron plate containing flowers of 
sulphur thoroughly wet with alcohol or (probably better still) with turpen- 
tine ; underneath the plate set a tin alcohol lamp; then put the whole on 
bricks in the middle of the room. Light the lamp underneath the dish, and 
if the sulphur does not take fire previously, when it begins actively to melt, 
ignite it. Leave the room at once, closing the door. The room should be 
as tight as possible, the chimney-places, ventilators, windows, and doors 
of exit being closed, whilst all the drawers of furniture and the doors of 
closets are widely opened. 
Sulphurous acid may be used in a saturated solution for the purpose of 
destroying disease-germs in the excretions of the sick ;* its action upon 
vegetable colors of course completely unfits it for many uses. The sulphites 
and the bisulphites are largely employed to arrest or control fermentation in 
various processes in the arts. 
AOIDUM CABBOLICUM-CARBOLIC ACID. U. S. 
Phenic Acid, or Phenylic Alcohol, is a substance obtained from coal-tar 
by distilling at a temperature of between 300° and 400° F., adding to the 
distillate a hot concentrated solution of potassa, and after this water, sepa- 
rating the light oily matters which rise to the top, and adding muriatic acid 
to the heavy alkaline bottom layer, when impure carbolic acid separates. This 
impure carbolic acid (Acidum Carbolicwn Crudum, U. S.) is of a dark color, 
and contains several congeneric bodies, especially xylic and cresylic acids. 
For disinfectant purposes these appear to be at least of equal value with the 
carbolic acid, and therefore the crude product of the above-detailed process 
is very largely used. Carbolic acid is separated from its allies and obtained 
* For a very interesting account, by Dr. J. Hjaltelin, of the strangling of a smallpox 
epidemic in Iceland, see British Medical Journal, 1871, vol. ii. p. 519. I cannot help be- 
lieving that the strict isolation and quarantining of the sick had far more to do with 
arresting the spread of the disease than had the sulphurous acid employed. DISINFECTANTS. 
677 
in a pure state with some difficulty, by a process too complex to be discussed 
here. When finally procured, it occurs at ordinary temperatures in minute, 
colorless, transparent plates, or long rhomboidal needles, often fused into a 
mass, having a hot, corrosive, peculiar taste and a peculiar odor, resembling 
but entirely different from that of creasote. If, on exposure to the air, 
phenic acid becomes brown, it contains impurities. When opportunity is 
afforded, solid carbolic acid absorbs water from the atmosphere and melts into 
an oily-looking colorless liquid. It is inflammable, neutral to test-paper, but 
combines with bases; soluble in about twenty parts of water, very soluble 
in alcohol, acetic acid, ether, glycerine, and the volatile and fixed oils. Nitric 
acid converts it into picric acid. 
Cbeasotum, U. S.- Creasote is a substance closely allied to carbolic acid, 
and is prepared from wood-tar, by a process similar to that by which the latter 
is obtained from coal-tar. It resembles closely carbolic acid solutions, but may 
at once be distinguished by its odor, which is much more smoky. More- 
over, if a splinter of pine be dipped into carbolic acid, and then into muri- 
atic acid, the wood, after the lapse of half an hour, assumes a distinct blue 
color. This does not occur with creasote. Again, carbolic acid does, and 
creasote does not, coagulate collodion; and by the action of nitric acid crea- 
sote is converted into oxalic acid, resinous matter, and but a small proportion 
of picric acid. Creasote is at present a rare drug, the material which is 
usually sold under its name in the drug-stores being really a solution of car- 
bolic acid. In their therapeutic value the two substances are probably about 
equal.* Five cases of poisoning are on record: Muller ( Wiirtemb. Cor- 
respondenz Blatt, 1869), T. Stevenson (Guy's Hosp. Rep., xx., 1875, 144), 
Piirckhauer (Friedreich's Blatter fur Gericht. Med., 1883, 430), F. Grinell 
(Med. News, xl. 345), Manouvriez (Soc. Med. Legale de France, vii. 108). 
The symptoms are like those of carbolic acid poisoning,-i.e., unconscious- 
ness, collapse, stertorous breathing, and great cardiac depression. 
Physiological Action.-Carbolic acid is exceedingly poisonous to all 
forms of life, from the lowest to the highest. Much of its employment in 
medicine depends upon its action on infusoria and fungi; and yet its direct 
internal and external use in human medicine is quite large. Its physio- 
logical action is therefore to be viewed from two distinct stand-points: first, 
its influence upon the higher animals and man; second, its action on the 
lowest animal and vegetable forms. 
Upon mammals, if not upon all vertebrates, carbolic acid acts as it does 
upon man. According to Dr. Isidor Neumann (Archiv fur Dermatol, und 
Syphilog., Jahrgang i., 1869, p. 425), to Dr. Ernest Labee (Archives Gen., 
6e ser., t. xviii. p. 451, 1871), and to Salkowski (Pflugers Archiv, Bd. v., 
* Creotol appears to be the basis of pure creasote; from it is easily prepared creogotinic 
acid. This substance has been found by E. Buss {Berlin. Klin. Wocheng., 1876, p. 445) 
to have active antipyretic and other therapeutic properties. 678 
NON-SYSTEMIC REMEDIES. 
1872), when a poisonous dose is given to a frog there is produced a paralytic 
condition which usually affects first the hind legs,* but eventually spreads to 
the front ones and involves all parts of the body. After a time there are 
developed tetanic convulsions, which are apparently reflex in their nature, 
and are said to be excited by external stimuli or irritations. 
Carbolic acid acts upon mammals in very much the same way as upon the 
batrachian. According to W. K«mpster (Amer. Jour. Med. Sci., July, 1868), 
in the mouse and rat it causes intense muscular weakness, followed by violent 
convulsions and stupor. In the rabbit (Neumann, Salkowski), phenylic 
alcohol produces muscular weakness, often accompanied by tremblings and 
restlessness, at last giving place to violent convulsions. Before these have 
fairly set in, the animal is generally unable to stand ; and during them he 
lies on his side, kicking into mid-air. Early in the poisoning the respiration 
is very much affected; and the death, which usually occurs in the midst of 
convulsions, appears to be owing to a disturbance of the respiration, since in 
acute cases the heart is found beating continuously immediately after death. 
According to the researches of Dr. Jules Lemaire (De I' Acide Phtnique, 2e 
ed., Paris, 1865), in the dog symptoms very similar to those detailed above 
are caused by lethal doses of the drug; and Husemann (Schmidt's Jahrh., 
Bd. civ. p. 274) states that in mammals and in birds the characteristic phe- 
nomena of carbolic acid poisoning are clonic convulsions, sinking of the tem- 
perature, diminution of sensibility, dyspnoea, free salivation and secretion of 
tears, keratitis and conjunctivitis. According to the latter authority, albu- 
minuria and haematuria are occasional phenomena. Upon man carbolic acid 
acts as upon other mammals. Reserving the details for the section on Toxi- 
cology, it is sufficient for our present purpose to state that the prominent 
symptoms induced by lethal doses are disturbance of respiration, coma, mus- 
cular weakness, and, in some cases, convulsions. A closer investigation of 
the action of large doses of carbolic acid is best made by studying the effects 
upon the different systems seriatim. 
Nervous System.-Upon the cerebrum phenylic alcohol appears to exert 
a direct influence, which, although not very intense in the lower animals, in 
the higher species, and especially in man, results in the early production of 
super. 
These convulsions are not peripheral, since they do not occur in a limb 
whose connection with the spine has been severed by division of the nerve, 
and do take place in a leg which has been protected against the local 
action of the poison by tying the artery (Salkowski, Labee). They are, 
therefore, either cerebral or spinal. Although there is a distinct conflict of 
evidence, it seems to me established that they are of spinal origin. Labde 
and Jno. R. Haynes failed to get them after section of the cord, but in 
* According to Lemaire, when a frog is allowed to swim in water impregnated with 
carbolic acid, the front legs are the first affected. DISINFECTANTS. 
679 
the far more numerous experiments, upon frogs and mammals, of Salkowski, 
of Berb and Jogel (Gaz. Med., 1872), of J. S. Stone (Philad. Med. Times, 
ix.), and of T. Gies {Arch. f. Exper. Path, und Therap., xii. 401), con- 
vulsions occurred after destruction of the medulla, section of the cord, and 
other operative procedures separating the brain from the lower nervous 
system. The failures of the first-named experiments are explainable by the 
facts that the paralyzing influences of carbolic acid are usually first mani- 
fested upon the hind legs, and that very large doses of the acid were em- 
ployed. The spinal convulsions are accompanied by increased reflex activity, 
which is lost as the paralytic state is reached, so that carbolic acid appears 
first to stimulate and then depress the spinal centres. Stone asserts that 
the stimulation is preceded by a primary depression, due to stimulation of 
Setschenow's inhibitory centre in the medulla. 
In carbolic acid poisoning the nerves and muscles are not distinctly para- 
lyzed, galvanic stimulation of a nerve after death eliciting vigorous response 
in the tributary muscle (Salkowski, loc. cit., 338; Hoppe-Seyler, loc. cit., 476); 
but the very careful experiments of Gies (loc. cit., p. 413) have proven that 
such muscles are less sensitive and more easily exhausted than in the un- 
poisoned animal. 
Circulation.-The action of carbolic acid upon the heart is not a very 
marked one, but there can be little doubt that in sufficient amount the drug 
depresses the viscus. After death from acute poisoning the heart is usually 
found to be beating regularly (Salkowski), but in some cases of slow poisoning 
the death has seemed to be ultimately caused by cardiac diastolic arrest. In 
Hoppe-Seyler's manometrical studies (Pfliiger's Archiv, 1872, Bd. v. 475) 
the arterial pressure was not affected until convulsions came on, when it 
rose largely, as a result of the general muscular contraction. It afterwards 
fell very decidedly and permanently. Reduction of the arterial pressure 
has been shown by Gies to be the characteristic effect of the carbolic acid: 
in his experiments moderate doses of the acid failed to affect the pressure 
after section of the cord, whilst neither asphyxia nor stimulation of a sen- 
sitive nerve elevated the lowered pressure, although the heart was beating 
forcibly,- facts that demonstrate that carbolic acid paralyzes the vaso-motor 
centre in the medulla before it markedly affects the heart. 
Respiration.-According to Salkowski (loc. cit., p. 344), Labee, and other 
authorities, in the first stages of carbolic acid poisoning the respiration is 
remarkably increased in frequency. This acceleration Salkowski believes to 
be due partly to a stimulant action upon the peripheral vagi, and partly to a 
similar influence upon the respiratory centres. He states that the respira- 
tions are very shallow, and that the diaphragm scarcely participates at all in 
them, but that if the cervical vagi be cut they become much slower, deep, 
and regular. On the other hand, if carbolic acid be given to an animal 
suffering from section of the pneumogastrics, the slow breathing is very 
much accelerated. From the former of these facts the German investigator 680 
EON-SYSTEMIC REMEDIES. 
draws the conclusion that the accelerated breathing produced by phenylic 
alcohol is in part due to a stimulation of the peripheral vagi, and from the 
latter fact that it partly arises from a similar action upon the respiratory 
centres. 
Temperature.-1The effects of carbolic acid upon the temperature in the 
normal animal have not, that I am aware of, been studied, but Emil Erls 
{Schmidt's Jahrbiicher, Bd. clxiv. p. 148) has found that in mild putrid 
poisoning in animals it diminishes greatly the fever-heat; when the poison- 
ing was more severe the acid had no influence. 
In sufficient concentration carbolic acid seems to be poisonous to all forms 
of protoplasm. Dr. T. M. Prudden {Am. Journ. Med. Sci., Ixxxi. 82) finds 
that in strong solution it paralyzes, in weak solution depresses, the move- 
ments of the batrachian white blood-corpuscles and ciliated cells, and Labee 
has determined that outside of the body it materially affects the blood of 
mammals. Both Labee and Hoppe-Seyler {Pfluger's Archiv, v. 476), how- 
ever, affirm that the blood of higher animals poisoned by carbolic acid pre- 
sents nothing abnormal, so that the symptoms it produces must be the resub 
of a direct influence upon the various tissues. 
Post-mortem examinations of animals killed by carbolic acid have yielded 
varying results. In Lemaire's investigation, nothing abnormal was found 
except intense injection of the alimentary mucous membrane, a pseudo- 
membranous and purulent inflammation of the bronchial tubes, with a dis- 
seminated lobular pneumonia or else congestion of the lungs and of the 
nerve-centres. Prof. Bruckmiiller, in Neumann's investigation (Zoc. cit., p. 
429), found the cells of the liver and kidneys in a state of fatty degenera- 
tion. This process, which seemingly was the counterpart of the changes in 
phosplwrus-poisoning, was always more advanced in the kidneys than in the 
liver. Dr. Neumann states that it was found in a number of autopsies, and 
that it is a constant phenomenon; but Salkowski {he. cit., p. 273) was 
unable to find it in a number of examinations. In man, the post-mortem 
appearances are very much the same as in animals. If the acid has been 
ingested in a concentrated form, white, hardened spots are found upon the 
mucous membrane of the mouth, oesophagus, stomach, and even intestines. 
They are, of course, due to the local action of the poison, and are sometimes 
blackish in the centre, or even blackish throughout, and very generally are 
surrounded by a red inflammatory zone. The liver, spleen, kidneys, and 
indeed all the organs, are found filled with dark, imperfectly-coagulated 
blood, such as is habitually found after death from asphyxia. According to 
Husemann, the fatty degeneration of the liver and kidneys is not either in 
man or in animals a constant or characteristic phenomenon of carbolic acid 
poisoning. Render found the renal epithelium degenerated in a man who 
had been fatally poisoned by the drug {Journal de Pharm. et de Chimie, 
p. 456, Dec. 1871). 
As the internal use of carbolic acid in such diseases as gangrene of the DISINFECTANTS. 
681 
lungs is so closely connected with the question of its chemical history in the 
system and its elimination from the body, the latter is of very great interest. 
Since carbolic acid coagulates albumen, its absorption unchanged into the 
blood would seem a matter of doubt: yet in some form or other it certainly 
is absorbed, as is proven by the history of its elimination and by its having 
been found in the blood (Hoppe-Seyler, Pflugers Archiv, Bd. v. p. 479). 
In exactly what form it circulates in the blood is not known; but most 
probably it is as an alkaline carbolate. Lemaire {loc. cit., p. 77) states that 
it may be found in the breath of poisoned animals; but Hoffmann asserts 
that it is burnt up in the system, because he failed to detect it in any of the 
secretions. In this conclusion he is, however, certainly in error; for it has 
been distinctly proven that carbolic acid is rapidly eliminated from the system. 
It has been detected in the urine by Almen {Zeitschrift f. Analyt. Chimie, 
Bd. x. Heft vii.), by Patrouillard {Journal de Pharmacie et de Chimie, Dec. 
1871, p. 459), by Salkowski {Pflugers Archiv, Bd. v.), by Hoppe-Seyler 
{loc. cit.Y by Waldenstrom {Zeitschrift des Allgemein. Apothek.-Vereines, 
Jan. 10, 1872), and by Hauxmann {Ibid.'); and Hoppe-Seyler {loc. cit., 
p. 480) has detected it in the saliva. It is probably eliminated in all the 
secretions. The researches of Baumann {Zeitschr. f. Physiol. Chern., 1878, 
350), which have been substantially confirmed, show that the carbolic acid 
is changed into a peculiar sulphocarbolic acid, a sort of ether-sulph-acid, 
having the formula C6H5O.SO2.OH, which finally unites with potash and 
is eliminated as a sulphocarbolate; when large quantities of the acid are 
administered, some of it escapes unchanged, for in a fatal case of poisoning, 
Patrouillard {Zeitschr. des Allgemein. Apothek.- Vereines, p. 4G0) obtained 
an oily fluid, believed to be pure carbolic acid, by shaking the urine with 
ether, allowing the mixed fluids to separate, and removing the ethereal layer 
and evaporating. 
Although, as stated, carbolic acid is to some extent eliminated from the 
system, a portion of it is burnt up in the body. The black coloring-matter 
of the characteristic urine of carbolic acid poisoning is in all probability an 
cduct from carbolic acid, formed by its partial oxidation. Hauxmann has 
proved that it is not altered haematin or any fixed coloring principle, by 
finding that the urine is cleared up by heating after the addition of an acid ; 
and his conclusion is corroborated by the observation of Dr. Stevenson, 
of Guy's Hospital {Brit. Med Journ., April, 1870), who found that the 
black urine does not contain more than a normal proportion of iron. When 
carbolic acid is oxidized outside of the body, as by the action of the per- 
manganate of potassium, oxalic acid is formed; and Salkowski has found 
that when phenic acid is given to animals oxalic acid appears in the urine. 
Other observers have, however, failed to find these oxalates. Fr. Schaffer 
{Journ. f. Prakt. Chern., xviii. p. 282), A. Uerbach ( Virchow's Archiv, 
Ixxvii. 226), and E. Baumann and C. Preusse {Zeitschr. f. Physiol. Chern., 
iii. 156) found that the phenol was at least in part oxidized into hydro- 682 
NON-SYSTEMIC REMEDIES. 
chinion, and partly into a greenish-black substance upon which the coloring 
of the urine seems to depend. The recent researches of L. Brieger (Zeit- 
schr. f. Klin. Med., 1881, ii. 25) seem to prove that when carbolic acid is 
taken in not too large quantities a portion of it unites with sulphuric acid, 
and a portion of it is converted into various colored oxidation products, 
some of which are very poisonous. According to the experiments of W. 
Kochs, this change occurs in the large abdominal glandular viscera (Arch, 
f. Physiol., xx. 64, xxiii.). Schmiedeberg has recently come to the con- 
clusion that no phenol is oxidized in the body, but that it is all eliminated 
in combination with sulphuric acid, or to a less extent with glyco-uronic 
acid (Arch. Exper. Path. u. Therap., xiv. 288). The evidence is, how- 
ever, too strong against this view, and the true conclusion seems to be that 
when carbolic acid is taken in great excess it is in part eliminated as car- 
bolic acid, and that the remainder of it (the whole of it when taken in 
moderate amount) in part escapes in combination with an alkali as sulpho- 
carbolic and glyco-uronic acids and is in part oxidized in the system. 
Stildeler (Ann. d. Chern, und Pharm., Bd. Ixxvii. p. 17) discovered that 
when sulphuric acid was freely added to cow's urine the latter yielded upon 
distillation carbolic acid, and concluded therefrom that normal urine contains 
carbolic acid. He has been corroborated by Buliginsky (Hoppe-Styler s 
Med.-Chern. Untersuch., p. 234) and by Hoppe-Seyler (Pfliigers Archiv, 
1872, Bd. v. p. 470), and phenol is certainly a constituent not only of the 
urine of cattle, but also of that of men, dogs, horses, and probably other 
animals. Baumann has succeeded in producing carbolic acid out of fibrin 
by a protracted digestion with the pancreatic glandular substance, and Neucki 
and Brieger have found that it is constantly present in normal human faeces. 
It is probable, as asserted by Salkowski, that the acid is formed in the or- 
ganism as a late product of the pancreatic digestion. Its elimination by 
the urine is enormously increased in ileus (one-hundredfold, Salkowski), and 
diminished in anaemia, phthisis, scorbutus, scrofula, and cancer (Brieger, 
Med. Centralb., 1878, p. 515). Hoppe-Seyler's theory that the acid does 
not pre-exist in the urine, but is formed out of indican during the processes 
employed for procuring it, is not tenable. It appears to be formed from the 
albuminous substances, tyrosin being an intermediate product, since Brieger 
has found that the taking of large doses of tyrosin is followed, not by elimi- 
nation of tyrosin, but by a great increase of the urinary phenol. In this 
connection it is interesting to note that Christiani has found in the urine 
of chickens fed upon vegetable diet no phenol, but a notable amount when 
a flesh diet was allowed (Zeitschr. f. Physiol. Chern., ii.). In a series of 
experiments Dr. I. Munk obtained three grammes as the average excretion 
of twenty-four hours from a horse (Arch. f. Thierheilkunde, viii. 104). 
The local action of carbolic acid is a very decided one. When applied 
to the skin, it produces at once a burning pain, and in a few minutes a 
peculiar white spot. If the acid be removed, the pain continues for some DISINFECTANTS. 
683 
minutes, and the white color changes to a dark or red stain, which gradually 
fades away as the skin desquamates. On a prolonged application, carbolic 
acid does not blister, but causes the formation of an eschar. A curious local 
action of carbolic acid, to which attention was drawn almost simultaneously 
by Dr. Erasmus Wilson (Journal of Cutaneous Medicine, June, 1870) and 
by Dr. J. H. Bill, U.S.A. (American Journal of the Medical Sciences, Oct. 
1870), is due to the property which it has when applied in concentrated 
form of causing very great local anaesthesia. The complete loss of feeling is 
not confined to the tissue killed by the drug, but extends some little distance 
inwards. 
Therapeutics.-In the doses in which it is usually given, carbolic acid 
exerts no perceptible effect upon the system. It has been used to a con- 
siderable extent in zymotic diseases for the purpose of destroying the poison 
in the blood. Even, however, if such poison be micrococci or bacteria there 
is no reason for believing that these are more sensitive to the action of the 
drug than is the human organism, and clinical experience with the acid in 
these diseases has certainly demonstrated its uselessness. The study of its 
physiological action has failed to show the possession of any property which 
should render the medicine valuable in constitutional diseases. Our physio- 
logical knowledge conforms with clinical experience in showing that carbolic 
acid is of no value in constitutional diseases, and it is employed directly in 
medicine only for its local effects. 
Internally it is of value in nervous vomiting, especially when there is an 
irritability of the gastric nerves. One or two drops of it, or of creasote, may 
be given in emulsion every three or four hours in such cases. The good 
which it achieves is probably dependent upon its local anaesthetic properties. 
In gangrene of the lung, the internal administration of carbolic acid, com- 
bined with the use of a weak solution (ten drops to the ounce) by atomiza- 
tion, is sometimes of service. 
Prof. M. H. Desplats has used carbolic acid as an antipyretic with asserted 
good results, but the practice seems to me a very doubtful one. He gives 
from fifteen to thirty grains of the acid by the rectum, and states that he 
has administered as much as three drachms a day without injury (Gaz. 
Hebd., 1880, xvii. 628). 
Jts external use is much more important than its internal employment; 
but it belongs to the domain of the surgeon rather than of the physician, and 
I shall only discuss it briefly.* As a caustic, carbolic acid is not available 
when large masses of tissue are to be destroyed, but it may often be employed 
with advantage against condylomata and similar growths. Even in such 
cases, to be efficient, it must be in the most concentrated form. In diph- 
theria, ulcerated sore throat, and aphthous stomatitis, its concentrated solu- 
* Perhaps it is proper here to call attention to the experiments of Dr. L. A. Stimson 
(Am. J. Med. Set., Ixxix. 83), which seem to show that the carbolic acid spray, as used by 
Lister, has no effect upon floating germs. 684 
NON-SYSTEMIC REMEDIES. 
tion in glycerine may be carefully applied, by means of a camel's-hair brush 
or a mop, as a mild caustic scarcely capable of destroying sound tissue. In 
various forms of indolent ulcer, in ill-conditioned wounds, carbolic acid 
affords a very useful stimulant application; in " burns," properly diluted with 
oil (gtt. x to f^i), it is one of the very best remedies that can be used, 
relieving pain by its anaesthetic properties and at the same time lessening 
suppuration and facilitating cicatrization. 
As a local anaesthetic, carbolic acid has not been used so widely as it seems 
to deserve. Dr. Bill (loc. cit.} has employed it in a number of cases of minor 
operations, always with the result of preventing or greatly mitigating pain. 
His plan in opening a felon is to soak the fingers for fifteen minutes in warm 
water containing three per cent, of the acid, and then to draw a brush dipped 
in the concentrated acid along the line of the incision. Sometimes, when a 
deep incision is necessary, a sensitive part is reached. Under these circum- 
stances he is accustomed to brush out the wound anew with the anaesthetic. 
In operations requiring much cutting, this method is not available; but 
whenever only the skin is to be divided, as in opening abscesses, it appears 
to be very successful. 
So far as I know, the first to suggest and employ deep injections of car- 
bolic acid as a means of combating deep-seated injlammations was Dr. J. A. 
Eames { British Med. Journ., May, 1873); but the method has been especially 
studied by Prof. C. Hueter {Deutsch. Zeitsch. f. Chir., iv. 1874; Schmidt's 
Jahrbucher, Bd. clxiv. p. 144). He employs a two per cent, solution, a weaker 
one not being efficient, and a stronger one endangering the coagulation of the 
blood and of the exudation in the inflamed tissue. Of this solution he uses at 
one time never more than half a drachm, and generally less than this. After 
anaesthetizing the skin by the local application of carbolic acid, he introduces 
the hollow needle into the centre of the inflammation obliquely, so as to 
diminish as far as possible the chances of the introduction of air. To avoid 
the danger of throwing the acid directly into the circulation, the needle is 
not connected with the syringe until it is seen that no blood comes out 
through it. If the extent of inflamed tissue be large, several injections are 
practiced at one time; in acute cases they are usually repeated twice a day, 
in chronic cases every day, or every other day. Dr. Hueter has made about 
a thousand of these " parenchymatous injections," and only ten times has 
any inflammation been excited by them. The pain is usually very slight, 
and the relief apparent in one or two days at most. In chronic synovitis, 
the drug is thrown into the joint once in two or three days, and the method 
has been practiced by Dr. Hueter with asserted extraordinary success in 
glandular swellings and injlammations, phlegmons, of all grades and char- 
acters, erysipelas, poisoned wounds, inflamed bursee, hydrocele, and even in 
bone-disease. 
The practice has been followed with satisfaction by Dr. Aufrecht in ery- 
sipelas (Centralbl. Med. IKtssew., 1874, p. 129), by Senator (Berlin. Klin. DISINFECTANTS. 
685 
Wochens., 1876, p. 69), Mader (CentraTbl. fiir Chir., 1877, p. 376), and 
Kunze in acute and subacute rheumatism (Centralbl. Med. Wissen., 1874, p. 
479), by Hagen in several diverse inflammations (Schmidt's Jahrb., Bd. 
clxiv. p. 146), and by I. Schmidt in chronic synovitis (Centralbl. Chir., 1876, 
p. 552). Dr. Hagen has even used these injections with very excellent re- 
sults in three cases of severe angina which he believed threatened diphtheria, 
throwing the remedy into the neighborhood of the second tracheal cartilage 
(Ringknorpel). Dr. Moses K. Taylor (Amer. Jour. Med. Sei., April, 1882) 
has used injections in one hundred and fifty cases of buboes and other- 
wise enlarged glands with uniform success. He throws into the inflamed 
part about twenty minims of an eight-grain solution of the acid, previously 
chilling the surface with an ether spray. The total evidence seems to show 
that this method of treatment is both safe and effective. 
Toxicology.-The number of fatal cases of carbolic acid poisoning now 
on record is quite large, and the list is constantly growing.* The symptoms 
although varying within certain limits, are, on the whole, quite uniform. 
They almost always appear in a very short time after the ingestion of the 
poison. Sometimes the rapidity of the fatal result almost equals that of 
prussic acid poisoning. Thus, Dr. Taylor, U.S.N. (Philadelphia Medical 
Times, vol. ii. p. 284) records a case in which about an ounce is supposed 
to have been ingested, and in which the man fell unconscious within ten 
seconds after taking the fatal draught, two minutes afterwards was totally 
unconscious, pulseless, with irregular distant gasping respirations, and in less 
than a minute later was dead, apparently from cardiac paralysis, since the 
impulse of the heart was entirely lost before the cessation of respiration. 
Generally some minutes elapse before the symptoms develop themselves: 
nausea, cold sweats,f stupor deepening rapidly into insensibility and collapse, 
are the most frequent phenomena. During the period of insensibility, com- 
plete abolition of reflex movements and anaesthesia of the mucous membranes 
have sometimes been noted (case, Journ. de Pharm. et de Chim., Dec. 
1871): indeed, it is scarcely doubtful that in all cases both sensibility and 
reflex movements are profoundly affected. Convulsions are only exception- 
ally present. The symptoms of collapse are usually well developed, and the 
pulse is generally feeble and very frequent, but has been noted as being re- 
duced to from forty to fifty per minute (case, Med. Times and Gaz., April, 
1871). Haemoglobinuria has been noted. Dyspnoea is often extreme ; the 
respirations may be stertorous, are usually very rapid, and, in the advanced 
stages, shallow. In very rapid cases they are irregular and suspended at 
intervals. Total temporary amaurosis, with contraction of the pupil, has 
* References to one hundred and sixty-nine cases of carbolic acid poisoning have been 
collected by H. Robert {Schmidt's Jahrb., cxciv. 229). 
j-The excessive sweating sometimes seen in carbolic acid poisoning Th. Gies believes to 
be of central origin, since in a poisoned cat with one sciatic nerve cut, no sweat came 
from the injured part. 686 
NON-SYSTEMIC REMEDIES. 
been noted (case, Berlin. Klin. Wochensch., xix. 748). Death may occur 
in a very few minutes; but usually the patient lives from one to ten hours, 
and life has been protracted for sixty hours (case, Sydenham Year-Book, 
p. 446, 1871-72; amount taken, one and a half ounces of the commercial 
acid). In some cases a great amendment has occurred and consciousness 
been restored, but after some hours rather sudden fatal collapse has come 
on (case, Brit. Med. Journ., Feb. 1861). The minimum fatal dose of car- 
bolic acid is not known ; but half an ounce has several times caused death 
(Med. Times and Gazette, 1870, ii., p. 474; Philad. Med. and Surg. Rep., 
•Jan. 1870 ; Lancet, 1878, ii., p. 510), and a little over a drachm is reported 
to have killed a man sixty-four years old (London Lancet, 1869, i.') ; in a 
case of puerperal metro-peritonitis fifty drops contributed towards the fatal 
result (Dr. A. D. L. Napier, Trans. Med.-Chir. Soc. Edinb., ii. 75). 
The free external use of carbolic acid is by no means devoid of danger: 
Dr. Falckson, after two hours' exposure to carbolic acid spray, recovered 
from his urine thirty grains of carbolic acid (Arch. Klin. Chirurg., xxvi. 
204), and he describes a marasmus or chronic poisoning resulting from the 
surgical use of the remedy. The symptoms are said to be headache, loss 
of appetite, bronchial irritation, which finally may become very severe, 
severe pains in the region of the kidney, recurring vomiting, pruritus, or 
various paraesthesiae, and loss of power in the legs. (See also paper by Dr. 
Wallace (Brit. Med. Journ., April, 1870). 
There have been numerous cases of acute poisoning from the external use 
of carbolic acid. A single vaginal injection has produced very severe con- 
stitutional results (Schmidt's Jahrb., Bd. cci. 129). Prof. R. Kohler 
reports (Schmidt's Jahrb., Bd. civ. p. 276) the cases of two journeymen 
joiners, suffering from scabies, who applied externally each about a half- 
ounce of carbolic acid, in watery solution. One of them was found dead. 
His fellow, who suffered from unconsciousness and drunken delirium ending 
in unquiet sleep, after his recovery, stated that directly after rubbing him- 
self with the solution he had giddiness, that seven or eight minutes later his 
companion complained of burning, but that of what took place after this he 
knew nothing.* It is scarcely necessary to refer in detail to cases in which 
serious results have followed the surgical use of carbolic acid.f In vol. ii., 
1870, of the Medical Times and Gazette is narrated a curious case of fatal 
poisoning from inflammation of the external parts and of the rectum, pro- 
duced in a child by its sitting upon a block on which some of the acid had 
been thrown. A serious result which has been known to follow the appli- 
cation of phenol to a slight wound of the finger is gangrene of the whole 
* For other fatal cases, consult Bulletin Thirap., t. Ixxv. p. 285. 
f Consult British Medical Journal, March 1, 1873,-death from absorption by a wound 
four inches long; New York Medical Gazette, April, 1871 ; British Medical Journal, 1868, 
p. 220,-two fatal cases; Med. Times and Gaz., 1878, ii. p. 461; M7en. Med. Wochenschrip, 
1879, xxix. 1233. DISINFECTANTS. 
687 
member (L' Abeille Med., Dec. 11, 1871). It is affirmed with somewhat 
doubtful truth that the absorption in these cases is through the surrounding 
skin, rather than from the wound, and that if contact of the carbolic acid 
dressing with the skin be prevented by a coating of gutta-percha upon the 
latter, all danger of poisoning is averted (Med. Times and Gaz., ii., 1878. 
p. 461). 
The diagnosis of carbolic acid poisoning during life ought in most cases to 
be practicable ; for, although the symptoms simulate some forms of apoplexy 
too closely for the diagnosis to be made from them, very generally the odor 
of the drug can be perceived about the person of the victim, and close 
examination of the mouth will nearly always reveal traces of the local action 
of the acid, in the form of white, hardened, or corrugated patches of mucous 
membrane. Either these, or a blackish ■Urine in conjunction with the 
symptoms, are diagnostic. After death a strong odor of carbolic acid can 
almost always be perceived when the body is opened, and the mucous mem- 
brane of the stomach affords very reliable evidence as to the cause of death. 
According to Dr. A. Hiller, the urine of carbolic acid poisoning as first 
passed varies from a clear yellow to a golden yellow, and upon standing in 
the air becomes dark olive and finally often blackish green. Sometimes it is 
grass-green, but it may appear to be normal (case, Schmidt's Jahrb , Bd. 
ccii., p. 238). This carbolic acid urine, if treated with nitric acid and after- 
wards with potassa, becomes, after a certain degree of concentration, blood- 
red or brown-red, changing through pea-green to violet. Carbolic acid mixed 
with urine does not answer this test (Schmidt's Jahrbilcher, Bd. clxiv. p. 
144).* The absence of carbolic acid urine proves that the case is not one 
of poisoning. Baumann and Hueter declare that the earliest symptom of 
the poisoning is disappearance of the sulphates from the urine (Zeitschr. 
f. Physiol. Chern., i.).j" 
In a case of carbolic acid poisoning emetics are generally useless, owing 
to the paralysis of the stomach which exists, and the stomach-pump must 
be employed to empty the viscus. Alkalies in excess are of some value, 
according to Husemann, who employs a saccharate of lime,J and the free 
ingestion of oils was formerly recommended, but to Baumann and Hueter 
(Med. Times and Gaz., ii., 1878) belong the credit of discovering the proper 
antidote to carbolic acid. They found that during carbolic acid poisoning 
the sulphates disappear from the urine, and that if a soluble sulphate be 
given freely to an animal poisoned with carbolic acid, the latter was con- 
* For method of detecting carbolic acid in urine, see Lond. Med. Rec., 1877, p. 455. 
f To detect the diminution of sulphates in the urine, remove any albumen present by 
boiling, acidify with acetic acid, and add chloride of barium in excess. This reagent 
gives a milky cloud of sulphate of barium in the presence of sulphates, but a mere haze 
or no alteration in carbolic acid poisoning. 
| Dissolve sixteen parts of sugar in forty parts of distilled water, and add five parts of 
caustic lime; digest for three days, stirring from time to time, filter, and evaporate to dry- 
ness. The product thus obtained dissolves easily in water. 688 
NON-SYSTEMIC REMEDIES. 
verted into a harmless sulpho-carbolic acid.* Sonnenburg found that in 
patients presenting the dark-colored urine and other symptoms of poisoning 
resulting from the too free external use of the acid all trouble disappears 
upon the administration of the sulphate of sodium. Dr. D. Cerna (Philad. 
Med. Times, ix. 593) has, in an elaborate series of experiments upon animals, 
employed the sulphate of magnesium with entire success, so that it may be 
considered established that a soluble sulphate is the proper antidote to car- 
bolic acid, and that it should be employed very freely and in all stages of 
the toxaemia, as being capable of neutralizing the poison in the blood. 
The chemical history of phenol inside of the body (^ee p. 678) explains 
why the sulphates are so efficient. Dr. De La Bate (Bull. Gen. Therap., 
cv. 418) affirms that he obtained very happy results in one case of carbolic 
acid poisoning from inhalations of oxygen. Dr. Jos. Szydlowsky saved a 
pulseless and apparently dying child ten hours after the ingestion of the 
carbolic acid, by hypodermic injections of ether and the administration 
of dilute sulphuric acid and sulphate of sodium (St. Petersburg Wochen- 
schrift, 1883, x. 87). So long, therefore, as a patient can swallow, the anti- 
dote of carbolic acid should be given. 
Carbolic Acid as an Antiseptic and Germicide.-In 1870, Grace Calvert 
proved that albumen was preserved for eleven days when mixed with car- 
bolic acid, and Dr. John Dougall that one twenty-five-hundredths part 
would destroy spermatozoa and the higher infusoria. Schroeter, in 1878, 
found that 0.0501 per cent, (one in two thousand) would keep flesh for 
four weeks and 0.2 per cent, permanently. It was soon found that the 
acid acted even more powerfully upon moulds than upon putrefactive or- 
ganisms. 
The first to study the action of carbolic acid upon vaccine lymph were 
Braidwood and Vacher, and their experiments have been repeated and ex- 
tended by Dougall, by J. W. Miller, by Hoppe-Seiler, and by Baxter. Each 
of the last two observers found that two per cent, of the carbolic acid de- 
stroyed with certainty the infective power of vaccine, a conclusion on the 
whole not discordant with that of the other observers. 
The germicidal power of the drug has also been studied by Hugge, Rosen- 
bach, Baxter, Sternberg, Davaine, Koch and Blyth, Arloing, Cornevin, 
Thomas, and various other observers upon almost all of the known forms of 
infective organisms. 
Their concordant testimony shows that one per cent, in an aqueous solu- 
tion will destroy with certainty the virulence of ordinary septic and purulent 
matters, of the tubercle bacillus, and of the micrococci of fowl cholera; 
some of the organisms related to putrefaction have also been destroyed by 
* For a study of sulpho-carbolic acid, see L'Tribune Mid., Juillet, 1884, 328. M. F. 
Vigier affirms that whilst not poisonous to the higher animals it is an active antiferment. 
M. Rabuteau {Conipt.-Rend. Soc. Biol., iii., 1882,42) finds that the acid is simply a feeble 
purgative. DISINFECTANTS. 
689 
solutions of this strength. But to produce these results in some instances 
the contact with the disinfectant had to be continued for many hours. Two 
per cent, of the acid in an aqueous solution was required to destroy the 
infection of vaccine or of glanders. 
There are, it is true, some experiments which seem to be discordant with 
these results, especially those of Notter and of Jalan de la Croix, who found 
that as much as ten to thirty per cent, of the acid was necessary to prevent 
the movements of bacteria in putrid infusions of beef; but there was prob- 
ably some error in their experimental methods. 
As a vapor carbolic acid seems to act very feebly as a disinfectant or 
germicide, and it is very evident that the popular estimate of the value of 
carbolic acid is too high. 
AOIDUM SALIOYLIOUM-SALICYLIC ACID. U.S. 
Salicylic acid has long been known to chemistry, but has only very re- 
cently been rendered available by Prof. H. Kolbe, who discovered that it 
could be prepared by treating a solution of carbolic acid in caustic soda 
with carbonic acid at a moderate heat. It occurs in long acicular crystals 
or in the form of a white, dull powder, of a peculiar pungent odor, and a 
mild, peculiar taste, accompanied by a transient sense of numbness. 
It is soluble in three hundred parts of water, and in four parts of alcohol. 
By warming, glycerine can readily be made to dissolve four grains to the 
drachm ; no precipitation occurs on cooling. 
Physiological Action.-When salicylic acid is given to man in doses 
just sufficient to manifest its presence, symptoms closely resembling cin- 
chonism result. These are fulness of the head, with roaring and buzzing 
in the ears. After larger doses, to these symptoms are added distress in 
the head, or positive headache, disturbances of hearing and vision (deafness, 
amblyopia, partial blindness), with excessive sweating. According to Reiss 
(Berliner Klin. Wochenschrift, 1875, p. 674), decided fall of temperature 
without alteration of the pulse also occurs; but this is denied by other 
observers. The action upon the system of the acid and of its sodium salts 
(also ammonium salt, Martenson, Petersb. Med. Zeitschrift, 1875, p. 343) 
appears to be identical, and, as several cases of poisoning with one or other 
of these agents have occurred, we are able to trace the toxic manifestations. 
Along with an intensification of the symptoms already mentioned, there are 
ptosis, deafness, strabismus, mydriasis, disturbance of respiration, excessive 
restlessness passing into delirium, slow laboring pulse, olive-green urine, and 
involuntary evacuations. In some cases the temperature has remained about 
normal, but in others has approached that of collapse. The respiration 
appears to be almost characteristic; it is both quickened and deepened. In 
some cases the dyspnoea has been extreme, and given rise to the most violent 
respiratory efforts. The suggestion of Dr. Hastreiter (Med.-Chir. Corresp. 
Blatt, Buffalo, Mai, 1884) that this dyspnoea is due to pulmonary conges- 690 
NON-SYSTEMIC REMEDIES. 
tion produced by cardiac weakness is plausible. Sweating usually is very 
free, and the urine early becomes albuminous. Various local evidences of 
vaso-motor weakness may supervene, such as rapidly appearing bed-sores at 
points subjected to pressure, and transitory dark-colored maculae on various 
parts of the body.* In several cases death was probably produced by the 
acid. The most conclusive case is that of H. Quincke (Berlin. Klin. 
Wochenschr., xix. 710). The chief post-mortem change was a breaking 
down of the blood, congestion of most of the viscera, and ecchymoses on 
the serous membranes.j" In certain cases the mental disturbance has been 
strangely prolonged, lasting for eight days. In some instances it is cheer- 
ful, in others melancholic in type. It is stated that upon drunkards the 
acid acts very unfavorably, violent delirium being an early symptom of its 
influence. When given to dogs by the mouth in large doses, salicylic acid 
is said to be usually vomited. According to Laborde (Bull. de Th^rap., 
xciii. 27 6), when from four to five grammes of the salicylate of sodium are 
injected into the veins of the dog, the first result is a slight acceleration of 
the heart's action and of breathing, some efforts at vomiting, quietude, loss 
of muscular strength, with a decidedly ataxic gait, hebetude, stupor, and 
finally sleep. When death occurs, it is preceded by dyspnoea and general 
convulsions. Kohler is probably correct in attributing it to asphyxia. 
After these general considerations, we can probably best get an idea of the 
physiological action of the drug by studying its influence upon the various 
systems in detail. 
Circulation.-In regard to the action of salicylic acid upon the arterial 
pressure, observers are so much at variance as to leave the subject enveloped 
in mystery. Kohler (Centralb. f. Med. Wissensch., 1876, pp. 163, 195) 
affirms that when salicylic acid or salicylate of sodium in solution is injected 
into the jugular vein, there is an immediate fall of blood-pressure, which 
after a large dose is very pronounced; in a short time the pressure rises to 
some extent, but not to the normal point, whilst the pulse-waves become 
excessively high and two or three peaked. As he found that the fall of 
pressure occurred after section of the depressors, vagi, and the cervical cord, 
♦For cases, consult Deutsches Archiv fur Klin. Med., xix., p. 319; Centralblatt fiir 
Chirurgie, 1877, p. 278,-401 grains salicylate of sodium taken in twelve hours; London 
Lancet, 1876, 2, 681 ; Berlin. Klin. Wochenschrift, No. 4, 8, 1876; and Bull. Thirap., 
1877, xciii., p. 25. 
f In the case recorded in the Virginia Medical Monthly, June, 1877, forty-eight grains 
of the acid were taken in four hours. The symptoms were violent vomiting, headache, 
total unconsciousness, with stertorous breathing. Death occurred forty hours after the 
first dose. See also Medical and Surgical Reporter, 1878. There is no probability that 
in the alleged case of poisoning reported by Dr. Frank Ogston (Brit. Med., 1883, i. 869) the 
salicylate had anything to do with the untoward symptoms or result. The case reported 
by Dixneuf (These, Paris, 1878) I have not had opportunity of examining; also that of 
Empis and Gubler (Bull, de I'Acad. Mid., 1877). DISINFECTANTS. 
691 
he very naturally concluded that it was due to an action upon the heart 
itself.* 
In 1879 {Th^se de Paris'), Hugues Oltremare found that moderate doses 
of the salicylate of sodium increase the arterial pressure and the frequency 
of the pulse, whilst poisonous doses strongly depress the heart-force and the 
blood-pressure. In accord with this are the elaborate experiments of 
Danewsky {Arbeiten Pharm. Laborat., Moskau, i. p. 190). He found that 
at first the arterial pressure was increased, partly on account of an increase 
in the force and energy of the cardiac beat, but chiefly as the result of ex- 
citation of the vaso-motor centre. Vaso-motor spasm was shown to be the 
main factor in the rise of the blood-pressure, by the inability of the drug 
to increase the arterial pressure after section of the spinal cord. The action 
on the heart was seemingly direct. The arterial pressure slowly fell during the 
later stages of poisoning, the heart-stroke becoming weaker and weaker, and 
finally being extinguished. 
With our present evidence it appears probable that the fall of arterial 
pressure observed by Kohler was due to the use of very large doses, and 
that moderate doses have no depressing effect upon the circulation. Clin- 
icians have, I think, generally come to the conclusion that the drug is de- 
pressant to the heart in man, and not to be used when cardiac weakness 
exists. This is, however, earnestly combated by E. Maragliano (Zeitschrift 
f. Klin. Med., 1884, viii. 248), who has made a very large number of 
sphygmographic studies, and also a series of experiments with the sphygmo- 
manometer of Basch, and finds the arterial pressure usually elevated, and 
never depressed, by therapeutic doses of the drug. It is possible that the 
general nervous depression which the drug-given very largely-produces 
has been mistaken by clinicians for a cardiac depression, but it must be re- 
membered that when given continuously the salicylates probably accumulate 
in the system, and may reach the amount necessary to depress the heart. 
Nervous System.-Our knowledge of the action of the drug upon the 
nervous system is very imperfect. According to See, the violent convulsions 
that precede death are in the lower animals almost the sole evidences of dis- 
turbance of the nervous system, neither the reflex power of the spinal cord, 
the general sensibility, nor the conducting power of the nerve-trunks being 
affected. M. Bochefontaine affirms, however (Ze Progres Med., 1877, p. 
630), that in the frog the drug acts as a paralyzant, destroying the func- 
tional power of the spinal centres, whilst according to M. Laborde four 
* Prof. S6e (Bulletin de l'Acadtmie de Midecine, 1877, p. 697) states that in his experi- 
ments there has been no action whatever upon the arterial pressure or on the pulse-rate ; 
but there is reason for believing that these negative results were reached, because Prof. S€e 
gave the acid by the mouth and cited the blood-pressure before the drug was absorbed, since 
Kohler found (loc. cit.) that injections of solutions of the acid into the stomach of dogs 
and rabbits failed to affect the blood-pressure, although the sodium salt administered in a 
similar manner did depress the force of the circulation. 692 
NON-S PS TEMIC REMEDIES. 
grammes of a salicylate will produce in the dog profound cutaneous anaes- 
thesia {Ibid., 609). 
Respiration.-In Kohler's experiments upon rabbits and Danewsky's ex- 
periments upon dogs, the respiration during the injection of the acid or its 
sodium salt into a jugular vein was decidedly quickened, but after a time the 
rate fell to much below the normal. When, in Kohler's experiments, the pneu- 
mogastrics were divided during the period of retardation, the frequency of the 
respiration was still further lessened. Danewsky practised section of the vagi 
before exhibiting the drug and during the first stage of accelerated breathing. 
In the first instance he found that the breathing was only slightly accelerated 
by the drug; in the second that the quickened respiration fell to the same 
slowness that is seen in the unpoisoned animal with cut pneumogastrics. 
His experiments were too few to be conclusive, but indicate the correctness 
of his deduction, that the quickening of respiration is largely due to an irri- 
tation of the pulmonary vagi, and not solely to an influence upon the respira- 
tory centres. There is, however, probably some stimulation of the respiratory 
centres after small doses, but after very large doses fatal failure of respiration 
occurs through a gradual or sometimes sudden depression of the centres. 
Temperature.-Especial interest attaches to the action of salicylic acid 
upon the temperature. In Prof. S6e's experiments upon normal men and 
upon animals, very large doses (ten grammes for men) had no effect upon 
the temperature {loc. cit., p. 697). The experiments of Dr. Paul Fiir- 
bringer upon rabbits, dogs, and men are in accord with this {Zur Wirkung 
des Salicylsaiire, Jena, 1875). M. Gedl, in twelve seemingly very care- 
fully conducted experiments upon man, in which the doses varied from 
forty-six to seventy-eight grains, found that the effect in three cases was 
various, in two cases negative, in three a lessening of the daily alterations 
of temperature, in three a slight lowering of temperature, and in one a fall 
of 0.8° C. {Centralblatt f. Med. Wissensch., 1876, p. 403). Danewsky 
states that in normal animals and man the influence of the acid upon tem- 
perature is slight and inconstant. The evidence seems to show that salicylic 
acid, like quinine, has, in non-toxic doses, little or no decided action upon 
the temperature in health. In one or two experiments upon himself, Mr. 
North {Practitioner, xxiii. 184) found that the acid exerted a decided in- 
fluence in preventing the rise of bodily temperature normally caused by 
exercise. 
The original article of Dr. E. Butt upon the action of salicylic acid upon 
temperature in fever has been followed by a number of papers (see London 
Med. Record, 1876, p. 193*), which show that the drug fails in some cases, 
* Consult also Deutsches Archin fur Klin. Med., 1876, xv. 457, 518, 612, xvi. 162, xvii. 
294, 314, 607, 692, xviii. 401, 452, 504; Centralblattfur Med. Wissensch., 1876, xci. 198; 
London Lancet, 1877, ii. 812; London Practitioner, xvi. 200; Land. Medical Record, 
1877; Berlin. Klinische Wochenschrift, 1875, 693; Le Progres Med., 1877; Bulletin de 
V Acadimie de MMecine, 1877. For information in regard to its action on pyaemia 
rabbits, see Fiirbringer, loc. cit. DISINFECTANTS. 
693 
and should never be used to the exclusion of the cold bath and other similar 
remedies, but seems to be more certain and decided in its effects than is 
quinine; although the latter is denied by some practitioners who have used 
both drugs. 
The first effect of a single antipyretic dose in fever is usually a profuse 
sweat, which may appear fifteen minutes after the ingestion of the remedy 
(Ewald, London Practitioner, vol. xvi. p. 200). Very shortly after this 
the temperature begins to fall, and, according to Justi (Centralblatt fur 
Chirurgie, 1876, p. 629), the depression reaches its maximum in about six 
hours. The sweating is profuse and exhausting, amounting, according to 
Ewald, not rarely to seven hundred and fifty grammes. The perspiration 
can scarcely be the only factor in the reduction of temperature, as there 
appears to be no relation between its amount and the degree of the fall, and 
it usually ceases before the latter reaches its maximum. 
The statements in regard to the action on the pulse in fever vary so much 
as to suggest that when any decided lessening of the cardiac beat does occur, 
it is dependent upon the fall of temperature. Thus, Garcin (Journ. de 
Therap., 1876, p. 25), Oulmont (Ze Progres Med., 1877, p. 587), Moeli 
(Deutsches Archiv., xvii. p. 592), have all observed the pulse-rate to fall 
with the fever-heat, whilst L. Schroeder affirms that after moderate doses 
the pulse is slackened, after large ones quickened, and Ewald and other 
observers state that it is usually not affected. The antipyretic dose em- 
ployed varies somewhat. Ewald gives as a minimum to the adult seventy- 
five grains, repeated in five hours if necessary; Justi, from ninety to one 
hundred and twenty-five grains. 
Absorption and Elimination.-Salicylic acid appears to be absorbed very 
rapidly. Drasche [Centralbl. Chir., 1876, p. 777) affirms that it is only 
necessary to apply its alcoholic solution to the sound skin for a short period, 
in order to find the drug in the urine. Owing to the insolubility of salicylic 
acid, the problem of the method of its absorption and of the state in which 
it circulates in the blood early attracted attention. Salkowski (Berlin. Klin. 
Wochens., 1875, p. 297) pointed out that the acid in the blood probably 
exists in the form of a salicylate of sodium. Prof. Binz supposes (Lond. 
Prac., xxvi. p. 443) that the acid is liberated in the blood by the carbonic 
acid formed in the tissues. The only basis for this theory consists in the 
fact that, by passing carbonic acid gas through a solution of phosphate, car- 
bonate, and salicylate of sodium, agitating with ether, and separating and 
evaporating the latter, crystals of salicylic acid are obtained. It is evident 
that if in the blood changes take place similar to those which occur in this 
solution, salicylic acid should be yielded to ether shaken with the blood 
of an animal poisoned with the drug. Feser and Friedeberger found 
that unless enormous doses of the drug were injected into the blood so as to 
produce immediate violent convulsions and death, the vital fluid of the poi- 694 
NON-SYSTEMIC REMEDIES. 
soned animal yielded nothing to ether. In Kohler's experiment (Centralbl. 
fur Med. HVssews., 1876, p. 553), when salicylic acid was dissolved in normal 
blood no acid was yielded to ether, but when the blood of asphyxia, i.e., blood 
supersaturated with COa, was employed, a very notable amount of the acid was 
extracted by the ether. The theory of Prof. Binz is certainly not proven, 
and is probably incorrect. 
Feser and Friedeberger (loc. cit.) have advanced the theory that the sali- 
cylic acid circulates in the form of an albuminate. This has received some 
support from the experiments of Farsky (Sitzb. d. k. Akad. d. lUsse/is., 
Ixxiv., Bd. ii.), which seem to show that the acid is capable of forming such 
a compound.* On the other hand, the theory is contradicted by the results 
of Fleischer (Med. Centralbl., 1876, p. 628), who digested albuminous solu- 
tions with the acid, and after coagulation by heat found all the acid in the 
filtrate ; and who also treated the blood of poisoned animals in a similar way, 
and found the salicylic acid only in the serum, the coagulum being free. 
Viewing all this evidence together, it seems a probable conclusion that 
salicylates, when administered internally, enter the vital fluid and circulate 
there as salicylates, and that salicylic acid itself is probably converted by the 
alkaline juices of the alimentary canal into a salt, and as such enters the 
system and exerts its influence on the organism. 
Salicylic acid escapes from the body chiefly through the kidneys.f Fih- 
bringer and Drasche (Centralbl. Chir., 1876,777) failed to detect it in the faeces, 
the saliva, bronchial secretion, or the sweat, but M. Mussy found it in the saliva 
(Bull. Tldrap., xiii., p. 318), as did also M. Balz; and M. Oulmont detected 
it in the serosity of a blister. It appears in the urine very soon after its 
ingestion, but its elimination proceeds slowly. Thus, in a case of exstrophy 
of the bladder it was detected in the urine dripping from the ureters eight 
and a half minutes after its ingestion (Balz, Arch. d. Heilk., xviii., S. 60), 
and it has been found in the urine eight days after the exhibition of the last 
dose (Byanow, Centralbl. fur Chir., 1877, p. 809). The latter observer also 
found it in the urine of a normal man as a salicylate twenty-five minutes 
after its swallowing. The same authority states that it is excreted partly as 
salicyluric acid,£ partly as a form of salicin, and he believes to some extent 
as oxalic acid. Urine which had been passed some hours after the ingestion 
of a dose polarized to the left. Dr. A. E. Stuart (Lond. Practitioner, xviii., p. 
* He digested various albuminous substances with salicylic acid, washed them with 
ether until it would take no more acid, dried, washed with water, and found on analysis 
salicylic acid largely present in the residue. 
f To detect salicylic acid in the urine add the solution of chloride of iron carefully. 
At first white phosphate of iron precipitates, then, if the acid be present, a violet color 
is produced (Kolbe). 
J Salicyluric acid is a parallel compound to hippuric acid, made by the union of the 
elements of a glycocol with salicylic acid. DISINFECTANTS. 
695 
4-25), after so small a dose as nine grains of the acid, saw free, distinct crys- 
tals of salicyluric acid in the urine. It is possible that such of the salicylic 
acid as escapes unchanged from the kidney may, as first excreted, be in the 
lorm of a salicylate, but be set free by the phosphoric acid of the urine; at 
least such would be indicated by the fact that in Balz's case of exstrophy 
salicylate of sodium appeared in the urine twelve minutes before the free 
acid. The green color of the urine characteristic of the free use of salicylic 
acid appears to be due to an increase in the formation of indican (S. Wolf- 
berg, Deutsch. Archiv f. Klin. Med., xv., p. 403; M. Robin, Lond. Med. 
Record, 1877, p. 151), or else to pyrocatechine (see Bull. Acad. Med., 1877, 
p. 705), and it is not improbable that the pyrocatechin is formed out of the 
salicylic acid. The urine itself is often augmented in quantity, but some- 
times it is diminished. It not rarely contains albumen, evidently the product 
of a local irritation of the kidneys. See reports (loc. cit., p. 705) a case in 
which the renal irritation was so severe as to give rise to haematuria. In 
regard to the solids of the urine, the testimony varies somewhat. See (loc. 
cit.) affirms that in gout the uric acid is greatly increased, and that both in 
health and disease the urea is unaffected. S. Wolfsohn (Inaug. Diss., quoted 
in Centralbl. f. Med. Wissens., 1877, p. 30), on the other hand, determined 
an increase in the nitrogenous renal elimination, whilst Lecorche and Sala- 
mon have found that when the acid is exhibited in rheumatism there is at 
first an enormous increase in the excretion of both urea and uric acid, fol- 
lowed by diminution, which may carry the elimination below the normal. 
In acute rheumatism the first increase lasts three or four days, in subacute 
rheumatism one or two days; excretion of phosphoric acid is also at first 
increased and subsequently lessened. In experiments upon dogs Carl Vir- 
chow found that the nitrogenous elimination was increased by the salicylate 
of sodium (Zeitschr. f. Physiol. Chem., vi. 78). 
Therapeutics.-The known physiological action of salicylic acid would 
only lead to one use of it in internal medicine, namely, as an antipyretic. 
The question as to whether good is achieved in fevers by its administration is, 
of course, entirely separate from that as to its power of reducing temperature. 
It is certainly possible for a drug to lower the fever-heat, and yet to do far 
more harm than good, and the evidence at hand does not yet seem sufficient to 
answer the present inquiry. In the Semenoffschen Military Hospital, from 
January, 1875, to the middle of September, 1875, two hundred and eleven 
cases of typhoid (?) fever were treated without salicylic acid, and from the 
last date to March, 1876, one hundred and sixty cases with the acid. The 
mortality in the first period was 14.7 per cent., in the last 19.4 per cent. 
(Schroeder, Deutsches Archiv filr Klin. Med., xviii., p. 516). In the garri- 
son of Stargard, in 1872, thirty-nine cases received mild cold-water treat- 
ment; in 1874, sixty-three cases, cold-water treatment energetically; in 
1875, thirty-five cases, the salicylic acid treatment; the mortality being, re- 
spectively, 30.7, 9.5, 8.5 per cent., and the average length of treatment 696 
NON-SYSTEMIC REMEDIES. 
66.6, 53.3, and 37 days (Jahn, Ibid., p. 451). Riess treated 260 cases 
of typhoid fever, and lost 24.2 per cent. (Berlin. Klin. Wochens., xii., p. 
675). He asserts that the duration of the disease was very much shortened. 
These statistics are all that are at command, and certainly leave the question 
at issue sub judice. My own feeling is that salicylic acid will be found to do 
more harm than good in such diseases as typhoid fever. 
The antiperiodic action of the drug does not appear to be such as to entitle 
it to confidence. It is true that Senator in nine cases of intermittent fever 
had but one failure (Berlin. Klin. Wochens., 1875) ; but the general drift of 
experience coincides, we think, with that of Helley, who found salicylic acid 
to fail in obstinate malarial cases, and in mild cases to require longer time 
to cure than does quinine. 
The antipyretic properties of salicylic acid early led to its being* used in 
rheumatism, and iu 1876 (Berlin. Klin. Wochens., xiii.) Stricker first an- 
nounced that it was an exceedingly valuable remedy in this disease, usually, 
when given in hourly doses of from seven to fifteen grains, causing a disap- 
pearance of the symptoms in a period not exceeding forty-eight hours. The 
conclusions of Stricker have been substantially confirmed by numerous ob- 
servers in Germany, France, England, and this country. Although some 
cases of rheumatism do not seem to yield to the drug, in the great majority 
of instances improvement sets in within twenty-four hours, and is rapidly 
followed by disappearance of the pain and fever. The dangers of cardiac 
and cerebral complications are certainly lessened, but not altogether done 
away with.f In excessive rheumatic hyperpyrexia it cannot be depended 
upon to the exclusion of the cold bath. Jaccoud states (Progres Med., 
1877, pp. 528, 745) that he has found it of great service iu chronic rheuma- 
tism; but the general testimony appears to show that it is much less certain 
in the chronic than in the acute disorder. Jaccoud also states that in acute 
gout it acts with extraordinary effect. As in cases of habitual gout the 
kidneys are often seriously affected, the urine should always be examined, 
and if it be found albuminous the remedy be withheld. Various mishaps 
(gangrene, Bull, de Therap., xciii., p. 324; necrosis, British Medical Journal, 
1876, pp. 2, 776, 820, 843) have been ascribed to the use of the acid in 
rheumatism, but these were in all probability accidental complications of the 
disorder. Delirium and temporary insanity, sometimes erotic, have been 
in various cases, perhaps correctly, attributed to the acid (New York Med. 
Record, xxi. 456; London Med. Record, 1882, 452). Dr. H. Weber has 
seen the salicylates act most happily in gonorrhoeal rheumatism (Bull, de 
Therap., xciii. p. 328). 
In diphtheria locally applied and exhibited internally the remedy has 
* E. Busa was probably the first one to make trial of this remedy. 
| Consult for this point Jaccoud {Le Progrit Mid., 1877, p. 588), Green {London Lancet, 
Nov. 11, 1877), Roe {London Lancet, 1877, 2, p. 905), Jacobs {Ibid., 655), Brown {Botton 
Med. and Sury. Journ., Feb. 8, 1877). DISINFECTANTS. 
697 
been highly commended. In chronic cystitis with ammoniacal urine, and 
in chronic pyelitis, it is often of service. 
Administration.-The maximum dose of salicylic acid in acute rheuma- 
tism may be set down as a drachm in the twenty-four hours, although it is 
employed by some practitioners in much larger doses. The salicylate of 
sodium (Sodii Salicylas, U. S.) contains forty-eight grains of the acid to 
the drachm: since it is freely soluble in water, and is less unpleasant to the 
taste and less irritant to the stomach, it is much preferable to the uncom- 
bined acid. From sixty to eighty grains of it may be administered in the 
course of the day in a strongly aromatized syrup. If ringing of the ears 
or other evidences of intoxication appear, the remedy should at once be 
partly or entirely withdrawn. 
Use as an Antiseptic.-Salicylic acid was originally brought to the notice 
of the profession on account of its inhibitory influence on putrefaction. Kolbo 
found that .04 per cent, had great influence in preventing souring of milk. 
Bucholz found that 0.15 per cent, of the acid is sufficient to prevent the 
development of bacteria in ordinary organic mixtures, and that the influence 
of 0.005 per cent, is plainly visible; 0.3 to 0.4 per cent, of the acid killed 
bacteria in vigorous growth (Arch. Exper. Path. u. Pharm., Bd. iv.). The 
salicylate of sodium was about equal to the pure acid, 0.4 per cent, destroy- 
ing the bacteria.* In the preservation of urine, Meyer and Kolbe found 
that one part of salicylic acid to two thousand of urine was sufficient to 
prevent putrefaction (Journ. fur Prakt. Chern., Bd. xii.). According to 
Prof. Kolbe and others, salicylic acid arrests or prevents the action of the 
non-organized organic ferments. Thus, it will forbid the action of emulsin 
upon amygdalin or upon myronic acid, and prevent the development of 
hydrocyanic acid or of the volatile oil of mustard. Dr. Miller found 
that one per cent, of salicylic acid was sufficient to check the action of 
ptyaline upon starch; for the same effect ten per cent, of carbolic acid was 
required. The digestive action of pepsin, outside of the body, was very 
seriously affected by 0.2 per cent, of salicylic acid in Dr. Miller's experi- 
ments, but in Kolbe's experiments the ingestion of twenty grains a day of 
the drug had no effect. 
There can be no doubt that salicylic acid is capable of accomplishing much 
in antiseptic surgery, but it does not seem to be replacing carbolic acid, as it 
at one time bid fair to do. Its freedom from odor and comparative freedom 
from poisonous and irritant properties are certainly strong recommendations 
in its favor; nevertheless, carbolic acid is more generally employed, and Mr. 
Callender, after twelve months' trial in the wards of St. Bartholomew's Hos- 
pital, has formally condemned salicylic acid as much inferior to carbolic acid 
(Trans. London Clin. Soc., ix.). Thiersch's salicylic acid wadding for 
hermetically sealing wounds is made by dissolving two ounces of the acid 
* The power of the acid has been denied by Fleck (Benzoesliure & C., Munich, 1875), who 
has been abundantly answered by Prof. Kolbe (Journ. fur Prakt. Chem., Bd. xii.). 698 
NON-SYSTEMIC REMEDIES. 
in two pints of alcohol (sp. gr. 0.83), diluting with twenty pints of water 
at 158° to 178° F., saturating with this six pounds and eight ounces of 
cotton batting deprived of oily matter, and afterwards drying. This wadding 
contains three per cent, of the acid; for some purposes a stronger batting, 
containing ten per cent., is prepared. When the wound or abscess is dis- 
charging profusely, jute is substituted for the cotton batting, because it is 
much more permeable to pus. An efficient ointment may be prepared by 
dissolving one and a half parts of the acid in two parts of alcohol and add- 
ing lard, or the solubility of the drug in glycerine may be taken advantage of. 
The following solutions are used in St. Bartholomew's Hospital: Phos- 
phate of sodium, three parts; salicylic acid, one part; water, fifty parts.- 
Salicylic acid, one part; olive oil forty-nine parts.-Salicylic acid, one part; 
bicarbonate of sodium, half part; water, one hundred parts.-Salicylic acid, 
ten parts; borax, eighteen parts; water, one hundred parts. A twenty-five 
per cent, solution, which will bear dilution with water or alcohol, may be 
prepared according to the following formula: R. Acid, salicyl., Jii; Sodii 
biborat., 5i 5 Glycerinae, q. s. 
Mix the acid and borax with four fluidounces of glycerine; heat gently 
until dissolved; then add enough glycerine to make one fluidounce. Prof. 
Thiersch has found that the drug cannot be employed for cleaning surgical 
instruments, because it corrodes the steel. 
SALICINUM-SALICIN. U. S. 
Salicin is obtained from the bark of the willow and other trees. It occurs 
sometimes in tabular crystals, more frequently in white, shining needles of 
neutral reaction, soluble in about thirty parts of cold water, very soluble in 
hot water and in alkaline solutions. Concentrated sulphuric acid dissolves 
it, with the production of a beautiful red color. By carefully warming it 
with dilute sulphuric acid it is converted into glucose and saligenin, and it 
is therefore a glucoside. 
The action of salicin upon the animal organism is not known, but would 
seem to be very feeble, as Ranke (Pftanzenstoffe, p. 903) is said to have 
taken nearly three ounces of it without any notable effect. It is certainly 
rapidly absorbed, probably as salicin; but once in the blood it seems to be 
quickly decomposed, the products of its change appearing in the urine fifteen 
to thirty minutes after the ingestion of a single dose. This change does 
not appear to be complete, as, according to Husemann (PJlanzenstoffe, 
963), in the urine of man and rabbits after the ingestion of salicin not only 
saligenin and salicylic acid but also unchanged salicin occur. Further, Falck, 
injecting salicin into the blood of the dog, found that it chiefly escaped from 
the kidneys unaltered. The elimination seems to go on slowly, as Senator 
has detected salicylic acid in the urine sixty hours after the ingestion of a 
single dose of salicin (Berlin. Klin. Wochens., 1877, 181). 
In 1874, Dr. Maclagan, led by some fancied dependence of rheumatism DISINFECTANTS. 
699 
upon malaria, began the use of salicin in acute rheumatism, and in 1876 
(Lancet, 1876, i. 342) announced that it was a specific remedy, rapidly abating 
both the fever and the local symptoms. In the same year (Centralb. Med. 
Wissens., 1876, 241 ; also Berlin. Klin. Wochens., 1877, 181) H. Senator 
confirmed these statements, and further affirmed that in various affections he 
had found salicin to have an antipyretic power entirely comparable to that 
of salicylic acid. If these views are correct, the freedom from irritant prop- 
erties and disagreeable taste made salicin superior to the acid. The only 
person, other than those mentioned, who has tested the matter on a con- 
siderable scale, is Dr. Buss, who does not find that the drug is nearly so 
powerful as salicylic acid (Berlin. Klin. Wochens., xiii. 504). If, as is 
believed by Senator, the activity of salicin depends upon its conversion in 
the blood into salicylic acid, it is plain that its action should be slower and 
more uncertain than that of the acid.* Further investigations are necessary 
before any conclusion can be reached; but the later evidence does not seem 
to be so favorable to salicin as do the reports of Maclagan and Senator. In 
regard to the dose employed, it is worthy of remark that no serious symptoms 
have been reported as produced by salicin. Senator recommends two to two 
and a half drachms as a moderate dose for the adult. Maclagan used much 
smaller doses,-twenty grains every three hours.f 
THYMOL. U.S. 
Thymol is found in the oil of thyme and of some other plants. It occurs 
either as an uncrystallizable liquid or in white rhombic or acicular crystals. 
It has been used with satisfaction as a substitute for carbolic acid by Volk- 
mann and Kanke, of Halle, and other practitioners, but, although it is 
undoubtedly powerfully antiseptic, does not seem to have rapidly gained 
favor. Its fragrant odor has proved a decided disadvantage, in summer at 
least, by attracting swarms of flies. It is not free from poisonous properties. 
On the other hand, it is claimed that it does not irritate the skin, and has 
a decided influence in preventing discharges. Spencer Wells employs its 
watery solution (1 to 1000 of warm water) ; Volkmann, thymol 1 part, 
glycerine 20 parts, alcohol 10 parts, water 1000 parts. It has been used 
internally by Biilz (London Med. Record, 1878) in doses of thirty grains 
a day, or less. In a few instances nausea and vomiting were caused. There 
was abundant sweating, singing in the ears, deafness, constriction in the 
forehead, reduction of temperature, and frequently diarrhoea. The urine 
was dark greenish, yellowish brown by transmitted light, free from albumen, 
* Dr. Maclagan asserts (London Lancet, 1872, ii. 179) as proof that salicin does not act 
as salicylic acid, but as salicin, that he has given salicin to rheumatic patients suffering 
from cerebral symptoms due to large doses of salicylic acid, and seen both the rheumatism 
and cerebral disturbance abated; is it possible the delirium in these cases was due to rheu- 
matic irritation and not to the salicylates ? 
f Consult also Brit. Med. Journ., ii. 1876, and Boston Med. Surg. Journ., Feb. 1877. 700 
NON-SYSTEMIC REMEDIES. 
becoming cloudy and grayish white on the addition of the tincture of the 
chloride of iron. Violent delirium occurred several times, also marked col- 
lapse, and, in one case of typhoid fever, unconsciousness, with most alarming 
collapse. Dr. Balz concludes that the remedy is much less certain and more 
dangerous as an antipyretic than is salicylic acid. The possession of poison- 
ous properties by thymol has been confirmed by the recent experiments of 
Dr. B. Kuessner (Med. Times and Gaz., Dec. 1878, p. 716). This ob- 
server found that when given to dogs and rabbits by the stomach the poison 
acts very slowly and feebly, on account of its slow absorption, but that when 
injected into the circulation it produces death by failure of respiration. 
Coma is developed some time before death, and the blood-pressure, which at 
first maintains itself, now falls steadily. Post-mortem examination failed to 
detect fatty degeneration or other lesion in either the solid tissues or the 
blood. The continuous repeated exhibition of small doses of thymol had 
no perceptible effect, except to in some way interfere with nutrition, so that 
the animals lost flesh. 
The evidence already forthcoming indicates that the therapeutic use of 
thymol will be very limited. Its costliness and the absence of marked ad- 
vantages in its favor militate against its being largely used externally. There 
is, however, one local employment of it which is important,-namely, as 
a detergent antiseptic in various ulcerated and diseased conditions of the 
mouth. For such use its agreeable taste and odor pre-eminently fit it. That 
anything whatever is to be gained by its internal administration is not at all 
certain. Enough has been said to condemn it as antipyretic. Kuessner 
found the sugar in the urine of a patient with diabetes reduced by from one 
to two grammes thymol per diem; but Fiirbringer (Deutsches Archiv fur 
Klin. Med., xxi.) reports a case in which one gramme daily increased the 
sugar. Kuessner thinks thymol (three to five minims of a 1 per cent, solu- 
tion three times a day) of value in vesical catarrh and in infantile diarrhoea, 
and found that inhalations (one part to 1000) diminish the fever and 
expectoration of phthisical patients. 
* According to a statement in Hoffmann und Schwalbe's Jahresb., 1879, 208, Kiissner 
has found that thymol has the power of dissolving the red blood-corpuscles. DISINFECTANTS. 
701 
This is a substance discovered by Dr. Ludwig Knorr, of Munich, and first 
experimented with by Professor Filehne, of Erlangen {Zeitschrift. f. Klin. 
Med., 1884, Bd. vii., 641). It is a grayish or reddish-white crystalline 
powder of a slightly bitter taste, soluble in fifty parts of ether, much more 
so in water, ten parts of it bein^ dissolved in six parts of cold water, and 
also very soluble in alcohol and chloroform. Its solution strikes with a 
solution of perchloride of iron a reddish-brown color, with nitric acid a 
beautiful greenish color. Chemically, it is dimethyloxyquinizine. It is 
prepared by a very complicated (patented) process. 
Physiological Action.-Our knowledge of the physiological action 
of antipyrin is very incomplete. According to the observations of Dr. 
Leon Arduin (Paris Thesis, 132, 1885), of Prof. Demme (^Fortschritte der 
Medicin, Bd. ii., 1884, p. 65*7), and Dr. Coppola (Kobert's Jahresbericht, 
1885, p. 314), it produces in frogs, when given in very large doses, com- 
plete relaxation, with loss of reflex action and death. In moderate toxic 
doses (half to one centigramme) it causes opisthotonos with very marked 
increase of the reflexes. In the earlier stages of this condition the animal 
is cataleptic. According to Coppola, the convulsions are, at least in part, due 
to the action upon the brain, and are arrested by section of the spinal cord. 
Both Arduin and Demme state that death is produced by arrest of the 
heart in diastole; but Coppola affirms that the antipyrin has no influ- 
ence upon the circulation in the frog, and that in many cases after the 
largest dose the heart is arrested in systole, and that in the Williams appa- 
ratus no influence was exerted by antipyrin upon the isolated heart except 
after the most enormous doses. 
There have been but few experiments made upon the higher animals with 
this drug. Demme asserts that the symptoms which it produces in rabbits 
are similar to those that occur in frogs. One gramme in his experiments 
produced in a rabbit very marked elevation of the blood-pressure, fol- 
lowed by violent tetanic cramps, progressive falling of the blood-pressure, 
and lessening of reflex excitability. In his experiments the heart con- 
tinued to beat vigorously after the blood-pressure was reduced almost to 
zero, and death appears to have been produced by failure of the respiration. 
In the experiments reported by Arduin, three grammes of antipyrin pro- 
duced in a rabbit cataleptic stiffness, diminished reflexes, complete paraplegia, 
followed by violent convulsions, epileptiform in type and occurring at a 
time when the reflexes were completely destroyed in the hind legs. There 
was also very marked fall of the bodily temperature. M. Bouchard (quoted 
by Arduin) has found that the stiffness of the muscles is prevented en- 
tirely by section of the sciatic nerve, and is therefore of nerve origin. In 
Demme's experiments upon the isolated frog's heart, antipyrin rapidly 
slowed and enfeebled the systole. Coppola affirms that antipyrin has a very 
ANTIPYEIN. 702 
NON-SYSTEMIC REMEDIES. 
flight and temporary influence upon the sensitive nerves, and at the place 
of injection sensibility is lessened for some minutes. The pupils are also 
constantly dilated by it. 
Antipyrin is freely eliminated by the kidneys. Marigliano {Kobert's 
Jahresbericht, 1885, p. 313) states that it appears in the urine three hours 
after its ingestion, and that the elimination is at its height in four hours, 
and continues for a day to a day and a half. He states that it can readily be 
recognized by rendering the urine acid and adding an iodized solution of 
iodide of potassium, when a reddish-brown color develops. The urine itself 
is normal in appearance, and never contains albumen. I. I. Hage (Ibid., 
p. 316) failed to detect antipyrin in the sweat or saliva. 
M. Arduin has called attention to the haemostatic action of antipyrin, 
and affirms as the result of experiments that given internally its effect is 
similar to but more powerful than that of ergotine. The same observer 
has found that it has very great preservative powers, and indeed is superior 
in preventing putrefaction to salicylic acid. It is asserted that given in 
cases of phthisis it will diminish remarkably the fetidness of the expecto- 
rations. 
Therapeutic Action.-When antipyrin is given to a healthy man in 
a dose of half a drachm, it usually produces no marked symptoms except 
some singing in the ears, slight nausea, and an uncertain fall of bodily tem- 
perature, which very rarely, if ever, amounts to more than one-tenth of a 
degree. After doses of a drachm or upwards vomiting is very apt to occur, 
accompanied or preceded by giddiness and distress in the head. In fever 
cases, about half an hour to an hour after a dose, profuse sweat occurs, and 
it is at this time that the fall of temperature occurs. It does not appear, 
however, that the fall of temperature is produced by the diaphoresis. At 
least, according to Carl von Noorden {Berlin. Klin. Wochen., 1884, p. 523), 
the sweating can be arrested by the use of hypodermic injections of atropia or 
agaricin without affecting the fall of temperature. According to most 
authorities the depression of temperature lasts longer than that caused by 
other antipyretics, continuing from two to twenty hours. It is accompanied 
by a reduction of the rate but not of the force of the pulse. In some cases 
the sweating is not profuse, and it is probably under such circumstances that 
observers have noticed a markedly increased diuresis. Most observers affirm 
that the patient is usually more comfprtable under the action of the drug 
than at other times; sometimes, however, the vomiting is distressing, and 
the occurrence of a peculiar eruption upon the surface of the body is 
frequent, and is often accompanied by considerable distress. This erup- 
tion is of the character of roseola, or sometimes resembles very closely 
measles. In the severest cases its coming on is marked by a chill followed 
by fever, and it may last for four or five days. 
Antipyrin has been employed as an antipyretic, with asserted very good 
results, in almost all of the diseases accompanied by high temperature, such DISINFECTANTS. 
703 
as pneumonia, erysipelas, and typhus, scarlet, yellow, and typhoid fevers, rheu- 
matism, etc.: it has also been freely given in the hectic fever of phthisis, but 
various observers state that in such cases it produces so much feebleness 
and general depression as to forbid its use. In typhus fever it reduces the 
temperature, but in a number of recorded cases has caused very serious 
collapse. Whether it has any specific action in rheumatism is at present 
uncertain ; the testimony which we have indicates, however, that it does not 
in this respect at all equal salicylic acid. According to A. Pribram (^Prager 
Med. Wochen., 1884), in pneumonia the frequency of the respiration is 
distinctly lessened by it. In children it has been used with asserted good 
results by a number of clinicians. M. Hucard found it especially useful in 
the pneumonia and bronchitis of children. 
Antipyrin may be administered hypodermically by the mouth or the 
rectum. The hypodermic injections at times produce local irritation, but 
are usually well borne. The dose for a child of one or two years of age 
may be set down as three grains; for a child five years old seven grains; 
for the adult the dose should not exceed thirty grains, repeated every one 
or two hours until from sixty to eighty grains are given, or sweating comes 
on. In children it would not be safe to repeat the dose more than once 
Some authorities prefer a single large dose of from sixty to seventy-five 
grains in the adult. 
Hydrochlorate of Kairin, occurring in white crystals freely soluble 
in water, and of a bitter, saline, and somewhat aromatic taste, has been used to 
a considerable extent abroad as an antipyretic. It produces, when given to 
a fever patient, distinct fall of temperature with excessive sweating, and 
greenish-colored urine. Its influence upon the temperature is rapidly pro- 
duced, but rarely lasts more than three hours. In a number of cases, espe- 
cially of typhus fever, its use has been followed by cyanosis and collapse, 
and it is also very apt to produce vomiting: the general testimony is that 
it is less powerful in its antipyretic action, and more dangerous and disagree- 
able in its secondary effects than is antipyrin. The dose is from five to ten 
grains every hour until the fall of temperature sets in. It is stated that 
after the fall the effect may be maintained by giving smaller doses every 
hour. 
Thallin, or parachinanisols, appears to be an exceedingly powerful anti- 
pyretic, producing a rapid fall of temperature, but also very disagreeable 
symptoms with a decided tendency to collapse. PART II. 
FORCES 
CALORIC. 
There are two conditions of the force caloric, spoken of as distinct entities, 
but which are merely relative terms, expressive of the presence of an excess 
or of the absence of the normal amount, or, more strictly speaking, normal 
intensity, of the force. Cold and heat, in connection with the human body, 
mean simply an intensity of caloric below or above 98 F. 
USE OF HEAT. 
The phenomena of death from cold show that a lack of caloric in the 
body is no less paralyzant of animal functions than is an excess of the 
same force. Evidently the organism was constructed to run upon a certain 
plane of heat, and cannot vary from this without serious results. By 
numerous experiments upon animals I have proven that in a cool apartment 
death rapidly results after section of the spinal cord, from falling of the 
bodily temperature, the animal which, in a warm room, will live indefinitely, 
dying very shortly in a temperature of forty degrees. The cause of the 
inability of the animal to resist external cold after section of the cord is 
undoubtedly vaso-motor paralysis. Normally, the temperature of the interior 
of the body is maintained by keeping an outer layer of partially-cooled tissue 
between the internal organs and tissues and the outer air. When the power 
of contracting the superficial vessels has been lost, the organism can no longer 
maintain this protecting layer, the surface temperature rises to that of the 
interior, heat is rapidly lost, and the whole body uniformly cooled. 
Vaso-motor paralysis is produced by toxic doses of various remedies, and 
under these circumstances artificial maintenance of the bodily temperature 
is imperative, forming a most important portion of the treatment of all 
such poisoning. Collapse from any cause is largely dependent upon, or, 
more correctly speaking, largely is, vaso-motor palsy; hence, in almost all 
forms of collapse, the use of external heat is of great importance. 
Dr. Chas. Hunter, of this city, has very successfully applied this treat- 
ment to that form of collapse which follows injuries and surgical operations, 
and is known by surgeons as shock. The lack of power of alcoholic and other 
ordinary stimulants in this condition is proverbial. The pathological state 
is undoubtedly vaso-motor palsy, the bodily temperature is much below 
normal, and the rational treatment consists in the hypodermic use of atropia 
704 CALORIC. 
705 
and digitalis, and the external employment of the hot bath. I believe that 
this plan of treatment will be found to be a most important addition to 
surgical therapeutics. In the first days of post-foetal life the power of re- 
sisting external cold is very slight, and in many cases of still-born children, 
or of children whose vital powers are almost extinguished at birth, life may 
be saved by a high external temperature, the little waif being kept in an air 
of 98° F., and from the influence of cold walls and articles which shall draw 
off, as it were, the little store of heat provided by nature, radiation being 
greatly affected by the temperature of surrounding objects. 
It is hardly necessary to dwell in more detail upon the various forms of 
collapse. Enough has been said to illustrate the principle that whenever the 
bodily temperature falls below normal pyretic treatment is demanded. The 
vigor of the treatment should always be in direct proportion to the sudden- 
ness and extent of the fall of temperature. 
In regard to the methods of applying heat, it must, in the first place, be 
understood that wrapping in blankets, etc., is only able to prevent cooling of 
the body; that when the animal temperature has already fallen it will not 
suffice at all. The same may be said of air heated to temperatures which can 
be readily obtained or can be continuously borne by the attendants. Radiated 
heat is somewhat better, and often the use of a brisk open fire is of service. 
The hot bath is, however, the only pyretic remedy which can be relied on. 
It should always be a full bath, in as warm a room as can be {trocured, and 
should be at a temperature of about 104° when the patient is put into it. 
The duration of the bath must vary with the circumstances of the case. It 
should not be less than half an hour, unless the mouth temperature should 
sooner become normal. During the bath the heat of the water should steadily 
be increased as fast as it can be borne if the patient be conscious, or if he 
be unconscious, until a temperature of 108° is reached. 
USE OF COLD. 
The practical study of the use of cold as a therapeutic measure naturally 
arranges itself under three divisions: first, its local use; secondly, its very 
brief general application as a tonic; thirdly, its employment in pyrexia. 
LOCAL EMPLOYMENT OF COLD. 
When cold is applied persistently to any part, it acts as a direct and very 
powerful depressant, of varying power according to its intensity. It is, there- 
fore, used locally to reduce inflammation, especially when the latter is of an 
active type. In this employment of cold, care must be exercised not to carry 
its use too far, lest it suspend all nutritive actions and interfere with those 
processes of repair which almost always form a part of inflammation. In- 
deed, it is possible to convert an inflammation into gangrene by the too ener- 
getic employment of this agency. Locally, cold is generally applied by means 706 
FORCES. 
of cold-water compresses, irrigation with cold water and the application of 
pounded ice, either inclosed in india-rubber bags or in bladders, or in form of 
the ice-poultice.* It is very doubtful whether the use of " freezing mixtures" 
is ever justifiable in inflammation. The effects of the cold in individual cases 
are to be judged of by the alterations in the heat and redness of the part. 
The local employment of cold belongs, for the most part, within the province 
of the surgeon, but the remedy is of great value in certain diseases. In diph- 
theria and in anginose scarlatina, as originally insisted upon by Dr. Hiram 
Corson, very great benefit may be obtained by enveloping the throat over the 
tonsils with powdered ice inclosed in bladders, pieces of pigs' intestines, such 
as are used by the sausage-makers, or thin india-rubber bags. 
lu using cold for the purpose of combating inflammation, the application 
must be kept up until the desired effect is produced. When employed 
intermittently, cold even becomes a stimulant, the reaction which follows its 
first impression being greater than its direct effects. Hence the cold douche 
has been used with asserted advantage as a stimulus to sluggish ulcers. 
In internal trunkal inflammations, such as pneumonia and pleurisy, the 
application of cold wet compresses over the diseased organ has been employed 
extensively in Germany. In the hospital at Prague every patient suffering 
from acute pulmonic inflammation is said to be treated with cold compresses, 
and Smoler affirms that it is very rare that immediate relief is not afforded. 
Niemeyer states that he has employed the method in a large number of cases 
of pneumonia with surprisingly good effect, the pain, the dyspnoea, and even 
the frequency of the pulse being usually reduced in a few hours. On the 
whole, the evidence in favor of the local use of cold in pneumonia, as well as 
in the croupous catarrhal pneumonia of children (Bartol, Ziemssen), is so 
strong, that the repugnance felt to such measures by the profession in the 
United States would seem to be the offspring of unfounded prejudices. 
In meningitis the great value of the application of ice to the shaven scalp 
is undeniable, and in peritonitis I have seen very great relief afforded by the 
use of cold, as recommended by Abercrombie, Niemeyer, and others. As is 
the case in pneumonia, warm poultices are more generally viewed with favor 
in peritonitis by the profession in this country. I have frequently used them 
with excellent effect, and in at least one instance after ice-poultices had been 
previously employed. In this case the cold applications at first were very 
agreeable to the patient, as were the warm poultices afterwards, and the good 
achieved seemed to be in accord with the sensations of the patient. It seems 
to me a good clinical rule to select the ice or the warm poultice according to 
the feelings of the patient. Early in the attack, when the fever is high, the 
ice will generally be the most useful. 
Under the head of the local action of cold, it is perhaps proper to allude 
briefly to the use of the cold douche as a means of reducing splenic enlarge- 
ments. I have had no expe e ce with the measure, but an elaborate experi- 
* Made by mixing finely-broken ice with dry Indian meal or fine sawdust. CALORIC. 
707 
mental and clinical study has led Dr. Fr. Mosier to the following conclusions. 
In the spleen immediate contact with cold water produces a very perceptible 
contraction, which is in direct proportion to the coldness of the water; the 
application of cold water to the abdomen influences similarly but less effi- 
ciently the normal spleen ; the cold douche applied for two or three minutes, 
and repeated at longer or shorter intervals, very perceptibly affects the 
enlarged spleen of intermittent and typhoid fevers, and even of leukaemia. 
In chronic cases the application should usually be made twice a day ( Virchow's 
Archiv, Bd. Ivii. p. 1). 
Almost every one has experienced the exhilaration of the reaction which, 
in a healthy person, follows the sudden dash of a cold shower-bath or the 
plunge into a mass of cold water. The researches of Liebermeister, which 
will be detailed hereafter, prove that a cold bath, when of not too long dura- 
tion, actually increases the oxidation of tissue to such a degree as to elevate 
the temperature of the body. When cold bathing is employed as a tonic, 
the first principle to be borne in mind is that the bath should not be too 
severe or too long continued, else it becomes a direct depressant, debilitating 
and lowering the temperature of the bather. When the subject has suffi- 
cient vital power to react after the bath, sea-bathing is often of very great 
service, but in debilitated subjects it may produce a serious exhaustion, partly 
by the fatigue induced, and partly by the excessive abstraction of heat from 
the body. The cold bath, when not followed by a healthy reaction, is any- 
thing but a tonic. 
COLD AS A TONIO AND STIMULANT. 
COLD IN PYREXIA. 
The use of cold in fever is no new thing: employed by Galen, used not 
infrequently during the last century, first systematized and insisted upon by 
Currie, cold bathing in fever was brought before the world as a really new- 
born measure by Brandt of Stettin, and received the seal of permanent use- 
fulness from the scientific clinical labors of Jurgensen at Kiel. 
The consideration of the method naturally divides itself into-first, a study 
of its physiological action ; second, an investigation as to its clinical value; 
and third, a more particular account of its effect, the cases to which it is best 
adapted, and the method of its application. Moreover, there are two distinct 
forms of pyrexia, which may be termed the acute and the chronic, and which 
are best considered separately. 
Acute Pyrexia.-If the following propositions be true, caloric in an excess 
acts as a direct poison to the body, and the phenomena of severe acute fever 
are largely due to the heat itself. The proofs of the propositions are given 
very briefly after them.* 
First. External heat applied to the body of the normal animal, so as tc 
elevate the temperature, produces derangement of the nerve-functions, of 
* Want of space prevents the elaboration of this. The unconvinced reader is respect- 
fully referred to the author's treatise on Thermic Fever, and his Toner Lecture on Fever. 708 
FORCES. 
circulation, etc., precisely similar to those seen in natural fever; the intensity 
of the disturbance being directly proportionate to the rise in temperature. 
Second. Heat applied locally to the brain or to the heart produces in the 
functions of the organ those disturbances which are familiar phenomena of 
fever, the intensity of the disturbance being directly proportionate to the 
excess of heat in the organ. 
Third. The withdrawal of the excess of heat in fever is followed by a 
-elief of the nervous and circulatory disturbances. 
When a dog, cat, or rabbit is shut up in a box heated either by the sun's 
rays or by artificial means, the temperature of the animal rises, and at the 
same time the pulse-rate becomes pari passu more rapid, the breathing 
grows more and more hurried, and the restless, uneasy movements of the 
victim show the general distress it is suffering. As the temperature in- 
creases, the nervous disturbance becomes more and more apparent; and stupor, 
coma, partial paralysis, convulsions, and finally death by arrest of the respira- 
tion, occur. These phenomena sometimes come on gradually, but sometimes 
are developed suddenly. The temperature at which death occurred in my 
experiments varied in the rabbit from 1110 to 114J° F.; in the dog it was 
about 111° F. In man a similar series of phenomena are developed by 
exposure to excessive heat, although, owing to his extraordinary power of 
cooling his body and of protecting it against cold, he is able to bear extremes 
of temperature far beyond the points which would prove fatal to any given 
species of animal. Yet when his body is heated the results are the same, as 
is proven by the terrible mortality of sunstroke. 
To prove the second proposition, I caused hot water to flow through pigs' 
bladders fitted as a sort of bonnet to the heads of cats and rabbits. It is 
evident that with small animals we can in this way heat the brain without 
heating materially the remainder of the body. It was found that coma, 
with or without convulsions, was produced. Sometimes the stupor came 
on gradually, hebetude slowly deepening into coma, but in other instances 
unconsciousness was developed very suddenly. It was found that severe 
nervous symptoms and death were produced when the brain reached the 
temperature which was fatal to the animal in the hot box. Without occu- 
pying more space, the conjoint labors of Dr. T. Lauder Brunton and of Dr. 
C. Liebermeister have proven that the accelerated pulse in fever is largely 
due to the action of the heat upon the heart and its nerves: so that the 
second proposition may be considered demonstrated. 
In regard to the third proposition, I have frequently taken animals out of 
the hot box perfectly unconscious and plunged them into a bucket of cold 
water, watched the temperature of the water rise whilst that of the animal 
fell, and as the bodily heat came towards normal the coma disappeared, so 
that within ten minutes the at first absolutely comatose and dying rabbit 
would be skipping about on the grass. I have placed a man whose tempera- 
ture was nearly 110° F., who was absolutely comatose, with a feeble-running 
pulse of 160 or 170, irregular, jerking, slow respirations, and every indica- CALORIC. 
709 
tion of immediate death, in a bath of 60° F., and within a minute and a half 
have seen consciousness partially restored, and in another minute and a half the 
man trying to get out of the bath. What could the bath do to affect the man 
so much but withdraw the heat? That the heat was present and that it was 
withdrawn the thermometer proved. If the drowsiness had been due to 
simple congestion of the brain, very certainly would the bath, by driving 
the blood from the surface, have increased the trouble. It must be borne 
in mind that this case is by no means unparalleled: similar instances of the 
good effects of the sudden withdrawal of heat in rheumatic hyperpyrexia 
have been recorded by both English and German observers, and recent Conti- 
nental literature is full of reports of the relief of nervous symptoms in 
various pyrexias by the abstraction of heat. 
In conclusion, as excessive heat is present in fever, as excessive heat, 
when present, not only is able, but is forced, so to speak, by its own at- 
tributes, to produce disturbance of the functions of innervation and circu- 
lation, and as the withdrawal of the excessive heat in fever is followed by 
instantaneous relief of the symptoms of disturbed innervation and circula- 
tion, surely the conclusion is logically inevitable that excessive temperature 
is the chief cause of the other symptoms of fever, and that in acute pyrexia 
threatening life the heat should be withdrawn as rapidly as possible by means 
of the cold bath. 
Chronic Pyrexia.-1The effects of a long-continued pyrexia, not sufficiently 
intense to induce immediate serious symptoms, upon the structure of the va- 
rious tissues, have been elaborately investigated by Liebermeister {Deutsches 
Arch, fur Klin. Med., Bd. i.), who found that the liver, spleen, kidneys, 
voluntary and involuntary muscles, blood-vessels, and even the nerve-centres, 
undergo a granular degeneration during a continued pyrexia. The lesion 
was constantly present in the bodies of those who had suffered in this way 
during life, entirely independent of the nature of the primary disease. In 
cases of infectious fever in which the temperature had never been high, this 
granular degeneration did not exist. Previous to the investigation of Lie- 
bermeister, Zenker had demonstrated that the muscles undergo a peculiar 
granular degeneration in typhoid and other fevers; and the fact has been 
abundantly attested by later observers. I do not know that the observations 
of Liebermeister as to the occurrence of this lesion in non-infectious pyrexia 
have been confirmed, but I have no doubt of their correctness. 
It is evident that in all fever a primary therapeutic indication is to reduce 
the temperature. Of course, if possible, this should be done by checking 
the excessive production of heat; but, unfortunately, this often lies out of 
our power, and we are forced to abstract the heat by mechanical means. 
It is a priori impossible to determine what effect upon the production of 
heat the rapid abstraction of it would have, but, from the well-known powers 
of the organism to resist external cold, it seems probable that the heat- 
production would be increased rather than diminished by the abstraction of 
caloric. An experimental study of this problem has been made by several 710 
FORCES. 
observers, but with, unfortunately, different results. Weisflog {Deutsches 
Archiv fur Klin. Med., Bd. ii. p. 570) has found that the local abstraction 
of heat by a cold sitz-bath causes a rise in the temperature of the axilla, and 
that in fever-patients, unless the sitz-bath is prolonged over twenty minutes, 
no fall of the bodily temperature results. In 1860, Kernig {Reichert's 
Archiv, 1860) found that a healthy man in a bath of the temperature of 
28° to 30° C. produces about twice as much heat as normal; in baths of 24°, 
about three times as much; and in baths of 20° C., about four times as 
much. Liebermeister {Beobachtungen und Versuche uber die Anwendung 
des kalten Wassers bei fieberhaften Krankheiten, Leipsic, 1868) found that 
in a healthy man exposure to cold for a brief period of time causes a rise 
in the bodily temperature, and on extending his researches into fever proved 
that where the external cooling was not too powerful or too long continued 
the same was true of fever-patients. From this it follows that the use of 
external cold stimulates heat-production. This, to my mind, has been con- 
firmed by the chemical researches upon men of J. Gildemeister ( Virchow's 
Archiv, Bd. lii. p. 131), of Dr. L. Lehmann {Ibid., Bd. Iviii., 1873), and of 
Prof. Liebermeister himself {Deutsches Archiv fur Klin. Med., Bd. x. p. 89), 
and by those of A. Roehrig and N. Zuntz {Pfluger's Archiv, Bd. iv. p. 66) 
upon animals, all of which show that both in health and in fever very much 
more carbonic acid than normal is eliminated under exposure to cold. This 
would appear to prove that cold baths increase the production of animal heat. 
It seems most probable that this is the case; but A. Murri believes that he has 
proven that the cold baths have no such influence.* At any rate, investi- 
gations of Liebermeister {loc cit., p. 134) and others have shown that the 
first rise of temperature produced alike in healthy and in fever subjects by 
exposure to a moderate and not too long continued cold is followed after 
removal of the cold by a fall of bodily temperature of greater or less degree. 
Whilst, therefore, external cold probably first stimulates, it afterwards de- 
presses the production of animal heat. The further experiments of Lieber- 
meister {Deutsches Archiv, Bd. x. p. 425) upon the elimination of carbonic 
acid are also in accord with his temperature-study, for he found that after 
the bath the elimination sank below normal, and continued so for some 
considerable time. This conclusion has been strongly corroborated by Dr. 
N. A. Sassetzky {Virchow's Archiv, xciv. 517), who finds as the outcome 
of an elaborate research that the continuous use of the cold bath lessens in- 
variably the urinary elimination of nitrogenous materials and of the phos- 
phates, although increasing the total flow of urine. 
The results of the physiological study of the effects of cold in fever may 
be summed up as follows. During a prolonged and severe application of cold 
the bodily temperature falls, although an increased production of heat-i.e., 
* I have never seen the brochure of A. Murri {Del Potere regulatore della Temperatura 
animate, Firenze, 1873). It is abstracted in the London Medical Record, vol. i. CALORIC. 
711 
consumption of tissue-probably occurs at first; afterwards the bodily heat con- 
tinues to fall, or but slowly regains its former position, because there is a dimin- 
ished production of animal heat with decrease of tissue waste. The increased 
consumption of tissue which occurs during the cold bath is of no moment, 
being more than counterbalanced by the lessened production after the bath. 
The clinical evidence in regard to the use of cold in fever may be looked 
at in two different ways. Thus, we may consider the assertions and results 
of individual observers who have seen large numbers of cases of fever and 
used the method faithfully, or we may weigh the sum total of the experience 
of all who have written upon the subject. At first sight it may appear that 
the latter is by far the best course to pursue; but it must be borne in mind 
that the treatment is one opposed to the ordinary medical prejudices, that its 
efficient carrying out involves so much labor and attention as to be almost 
impossible to those who disbelieve in its usefulness, and that those physicians 
who claim most for the method affirm most strongly that to do much good it 
must be practiced very vigorously and steadily. These things being so, it 
seems wisest to look at the evidence from both points of view. 
M. Franz Glenard affirms (Glasgow Med. Journ., 1874) that there have 
been from six thousand to eight thousand cases of typhoid fever treated by 
the use of cold in Austria, Prussia, and Russia, with an average mortality 
of from four and five-tenths to seven and six-tenths per cent.; the previous 
mortality under the old expectant method having varied from eighteen to 
twenty-five per cent. If these figures be correct, they are decisive. Where 
M. Glenard gets them from, however, I do not know. All the evidence that 
I have met with is summarized in the following table. Unfortunately, it is 
not always easy to decide whether a German is writing about typhus or typhoid 
fever; but where it is not mentioned the probabilities are that the cases are 
in great part, if not wholly, enteric fever: 
TABLE SHOWING THE RESULTS OF THE COLD-WATER TREATMENT IN 
TYPHUS AND TYPHOID FEVER. 
Name of 
Reporter. 
Place. 
Number of 
Cases. 
Mortalitt, 
Per Cent. 
Remarks. 
Jtirgensen. 
Kiel. 
160 
3.1 
Previously 15.4 per cent. Typhoid fever. 
Petri. 
Laubbach. 
31 
3.2 
Liebermeister. 
Basel. 
1121 
8.2 
Previously 26 to 30 per cent. Treatment very 
rigorous. Typhoid fever. 
Mosier. 
Greifswald. 
71 
7 
92 
9 
Typhus exanthematicus, previously 50 (?) per 
cent. 
Becher. 
Ostpreussen. 
17 
24 
Typhus exanthematicus, previously, on an 
average, 10 per cent. 
Private practice. 
Brandt. 
Stettin. 
187 
2.1 
84 
10 
Military Hospital. Previously 30 per cent. 
Goden. 
U 
24 
20.8 
Stohr. 
WUrzburg. 
120 
6.6 
Previously over 20 per cent. 
Drasche. 
Vienna. 
40 
10 
Year before 16.5 per cent. 
Ziemssen. 
Erlangen. 
32 
9.4 
Formerly, with bad cases, 30.2 per cent. 
Stieler. 
Munich. 
226 
5.6 
Formerly 12.15 per cent. 712 
FORCES. 
TABLE.-continued. 
Name of 
Reporter. 
Place. 
Number of 
Cases. 
Mortality, 
Per Cent. 
Remarks. 
Pas tau. 
Breslau. 
246 
11.8 
Typhus exanthematicus. Without baths, mor- 
tality 16.5 per cent. 
Popper. 
Prague. 
20 
5 
Riegel. 
WUrzburg. 
156 
4.4 
Only serious cases included. Almost every 
fatal case came in too late for baths to do 
good. 
Gotz. 
Prague. 
54 
5.5 
Typhoid fever. Other cases treated at the same 
time, expectantly, 15.4 per cent. 
c« 
50 
18.8 
Typhus exanthematicus. 
Scholz. 
Bremen. 
125 
4 
Typhoid fever. 
Wunderlich. 
Leipsic. 
155 
7 
Typhoid fever. Previously 18.1 per cent, out 
of 1178 cases. 
Zaubzer. 
Munich. 
356 
5.6 
Typhoid fever. Previously 17.6 per cent, out 
of 701 cases. 
Bauer. 
u 
87 
7 
Typhoid fever. Previously 11}^ to 16 percent. 
Duchek. 
Vienna. 
60 
28.3 
According to Brandt, this high mortality de- 
pended upon the treatment having been im- 
perfectly performed. 
Krofft-Ebing. 
Rastatt. 
105 
25.7 
Only bad cases. Previous mortality 34 per 
cent. 
Wille. 
Rheinau. 
59 
19 
Stecher. 
Claye. 
146 
8.2 
Schonheiden. 
Dam martin. 
82 
3.6 
Mild epidemic. 
Pfeifer. 
Weimar. 
58 
5.2 
Leube. 
Ulm. 
47 
19 
Typhoid fever, among French prisoners of war 
Baths of moderate temperature used. 
Bohm. 
Niederbronn. 
131 
11.5 
Typhoid fever. Military hospital. 
Gersauer. 
Vigy. 
97 
6.18 
Typhoid fever. Mortality on expectant treat- 
ment 23.91 per cent. 
Drasche. 
Vienna. 
55 
19 
Typhus fever. 
Merkel. 
Nuremberg. 
41 
2.2 
Typhus fever. 
Loebel. 
Vienna. 
87 
18.4 
Typhoid fever. 
li 
105 
28.6 
Typhus fever. The treatment in this and in 
the preceding case was not thoroughly car- 
ried out; the patients mostly receiving only 
three baths a day. 
G16nard. 
Lyons. 
52 
0 
Typhoid fever. 
Schmidt. 
Erlangen. 
56 
0.18 
Several fatal cases not counted, because not 
received until the fifteenth day, and, there- 
fore, too late to test the treatment; they 
bring the total mortality to 4.14 per cent. 
Heubner. 
Leipsic. 
72 
0.14 
Binz. 
Versailles. 
190 
2.1 
Soldiers. Mostly, if not all, typhoid fever. 
Zeroni. 
Mannheim. 
72 
18 
Soldiers. 
Valette. 
Lyons. 
21 
0 
Typhoid fever. 
This table is of such a character that any lengthy discussion of it seems 
unnecessary. It is, however, allowable to call attention to the facts that 
the failure of the method at Vienna is, by the upholders of it, very justly 
attributed to the inefficient carrying out of it, and that in some other 
instances the apparent high mortality is due to none but the most serious 
cases being included, or to the patients having been soldiers, worn out by 
the hardships and toils of a severe campaign. 
When the evidence furnished by single observers is noted, the results are 
even more astonishing than those of the above table. Jurgensen states that 
from the year 1850 to 1861 there had been treated in the hospital at Kiel, 
according to the expectant method, three hundred and thirty typhoid-fever 
patients, with a mortality of fifteen and four-tenths per cent.; while from 
1863 to 1866, during which period the anti-pyretic method was employed in CAL ORIC. 
713 
one hundred and sixty cases, the mortality was three and one-tenth per cent. 
Prof. Liebermeister has eniployed the cold-water treatment on a larger scale 
than has any other individual. At the hospital at Basel, up to the year 
1865, one thousand seven hundred and eighteen cases of typhoid fever were 
treated upon the expectant plan, with a mortality of twenty-seven and three- 
tenths per cent. In 1865, Dr. Liebermeister introduced the use of cold 
bathing in a timid, inefficient manner, and reduced the mortality, in nine 
hundred and eighty-two patients treated, to sixteen and two-tenths per cent. 
In 1866 he commenced the vigorous regular employment of the method, 
and reduced the death-rate, in one thousand one hundred and twenty-one 
patients treated, to eight and two-tenths per cent. Prof. Liebermeister him- 
self criticises very closely, in the recent " Encyclopaedia of Medicine," these 
statistics, and raises the mortality, by excluding trifling cases, to from ten to 
eleven per cent.; but, after the anti-pyretic treatment has been even unjustly 
dealt with, the statistics still show that the mortality under the cold-water 
treatment is not half what it formerly was. Further, a certain proportion 
of cases are always admitted to the hospital moribund, too late for any 
human agency to be of avail: these cases, of course, maintain the same pro- 
portion under any treatment; they really constitute a large part of the deaths 
seen in the cold-water treatment, so that if they were eliminated from both 
sides the death-rate " under the anti-pyretic plan would be but a small frac- 
tion of what it would be under the other." 
In hospital practice the patients are very rarely received upon the first 
day of the attack, and very frequently do not enter the wards until the third 
week, so that the statistics, as already intimated, favorable as they are to the 
new treatment, express only a portion of the truth. If the good effected be 
so great when the remedy is often not applied until the second or third week, 
much more is to be expected when it is employed faithfully from the moment 
the temperature becomes elevated. Accordingly, Brandt is said to claim that 
if the case be properly treated, from the onset of typhoid fever, death will 
never occur ; and it is stated (Lancet, January 23,1875) that out of two hun- 
dred and fifty-nine cases he has had two hundred and fifty-nine recoveries. 
I have not had access to the original papers of Dr. Brandt, and cannot, there- 
fore, analyze his statistics ; but Glenard (loc. cit.) is quite as enthusiastic ; he 
states, " You will not find in the five or six thousand cases of typhoid fever 
treated by this method one single unsuccess among those which have been 
submitted to it since the beginning of the disease." Prof. Edes, also, states that 
of thirty-two patients received in the Boston City Hospital during the first 
week and treated with cold bathing, only one died (Med. and Surg. Hep., 
Boston City Hospital, 1877). Mayet states that in typhus fever in Lyons, 
of six hundred and forty-nine treated without cold water, 14.48 per cent, 
died; of three hundred and thirty-five treated with cold baths, 10.74 per 
cent, died (Gaz. Hebdom., Mars, 1883). 
All those physicians who advocate the use of cold baths in typhoid 714 
FORCES. 
and typhus fevers appear to be agreed that, although the mortality is very 
much reduced, the duration of the disease is only shortened in so far as com- 
plications are avoided. As, however, the patient is left by the disease much 
stronger than he is when the expectant method of treatment is pursued, 
convalescence is much more rapid than under the old plans. By the anti- 
pyretic treatment the intense prostration, delirium, stupor, carphologia, in- 
voluntary passages, and other manifestations of the typhoid state are greatly 
lessened. The relief afforded is so evident to both patient and attendants 
that they usually, after one trial, acquiesce in the regular employment of 
the cold baths, although to the one the sensations are at first very disagree- 
able, and for the other the labor and attention required are very much in- 
creased. The antipyretic use of cold in typhoid fever has not, however, 
been free from determined opposition (see discussions in Le Progrts Med., 
1877 ; also Bull. Therap., xci.), and the assertions in its favor are some of 
them evident exaggerations. I am, however, very sure from my own per- 
sonal experience, as well as from the great mass of evidence now existent, 
that the method is of the utmost value, and I believe that the cold bath is 
safer and more efficient than are antipyretic drugs. 
A very practical question, but one which we are as yet scarcely in a position 
to answer fully, is, What are the contra-indications to the use of cold in fever ? 
According to our old ways of thinking, bronchitis and pneumonia would 
especially seem to be in the way. The serious lung-affections of low fevers 
are, however, largely dependent upon the general adynamia, and this adynamia 
is, in turn, largely the result of the excessive temperature. Accordingly, the 
German investigators have not found the baths to do harm in the pneumonias 
of exanthemata. Liebermeister, who has had more experience than any other 
man, says that " pneumonia, hypostatic congestion, and the like, offer no 
reason for suspending the baths ; the hypostatic troubles sometimes disappear 
under their use." I have carried one or two cases, in which the lung 
symptoms were very severe throughout, to a successful issue, employing 
cold freely, and was unable to perceive any evil effect upon the lungs. Prof. 
Raynaud, as the result of his experience, affirms most emphatically that 
neither pulmonic nor intestinal complications should interfere with the use of 
the cold bath (Bull. Therap., xci.). On the other hand, Proust reports (Ibid., 
xcii.) two cases in which fatal pneumonia of the ordinary type, not the hypo- 
static pneumonia of advanced fever, was apparently produced by cold baths. 
Doctor Alix also reports two deaths from pneumonia in three cases in which 
he tried the baths. My own feeling is that severe bronchitic or pneumonic 
symptoms occurring in the beginning of typhoid fever should make us very 
cautious in using the antipyretic method, but that when they occur late 
in the fever, and are due rather to hypostasis than to inflammation, they are 
not contra-indications to the use of the bath. Prof. Liebermeister affirms that 
perforation of or hemorrhage from the bowels is a contra-indication to the 
use of cold in fever, because cold has a tendency to produce determine CALORIC. 
715 
tion of blood to the internal organs. The experience of Wunderlich 
(Schmidt's Jahrbucher, Bd. clvi. p. 101) is, however, very much op- 
posed to this idea of Liebermeister's. He treated sixteen cases of severe 
intestinal hemorrhage with cold baths, with but two deaths; neither of 
which resulted directly from the hemorrhage, one being from intestinal 
perforation and one from severe pneumonia. This mortality is certainly 
a very small one, for when cold water was not employed, out of thirty-two 
cases Griesinger had ten deaths; out of twenty-one Jenner lost seven: 
out of fourteen Gietl lost six; and Jaccoud had six deaths in six cases 
(Pathologic Interne, t. ii. p. 758). Bauer, however (Schmidt's Jahr- 
biicher, Bd. clvi. p. 101), is in agreement with Liebermeister in believing 
that the baths should be discontinued during intestinal hemorrhage. Yet 
their views seem to be based upon preconceived theory rather than upon 
actual trial. Thus Liebermeister says, " I have thus far ordered the baths 
entirely discontinued as soon as even slight hemorrhage from the bowels 
occurred." The proportion of cases in which intestinal hemorrhage occurs 
does not seem to be increased by the cold-water treatment, at least Gols- 
dammer (Berlin. Klin. 'Woch., 1877, p. 98) affirms that under the older 
methods thirteen thousand five hundred and sixty-three cases gave five 
hundred and thirty of intestinal hemorrhage, whilst five thousand six hun- 
dred and thirty-six cases of cold-water treatment yielded two hundred and 
forty of intestinal hemorrhage, the percentage being in the two cases 
respectively 3.9 and 4.2. Menstruation appears not to be looked upon as a 
contra-indication. On the whole, the testimony seems to me to show that 
no local internal disease ought in the present state of our knowledge to be 
looked upon as absolutely contra-indicating the use of cold baths when the 
temperature is high in typhus or typhoid fevers. 
It is otherwise when there is a general tendency to collapse,-when the 
heart is so weak that local stases of blood occur in almost all the internal 
organs. Under these circumstances the circulation has not sufficient powei 
thoroughly to equalize animal heat, so that it is said to be entirely possible 
to cool the exterior of the body several degrees without materially affecting 
the temperature of the interior. One of the severe accidents which it is 
affirmed has very rarely followed the use of the cold bath in pyrexia is a 
sudden collapse; and clinical experience seems to indicate very strongly that 
when collapse is already existent the cold baths should not be administered. 
In no disease attended with a long-continued pyrexia has the cold-watei 
treatment been employed upon so grand a scale as in typhus and typhoid 
fevers ; but the results there obtained are sufficient to indicate its usefulness 
in allied diseases. Of all the exanthemata, none is more constantly attended 
with excessive temperature than is scarlet fever. In this disorder the testi- 
mony to the value of cold is very strong. Going back to Currie, who really 
first systematized the abstraction of heat in fever, we find that he habitually 
practiced in the most heroic manner cold affusions in the treatment of scarlet 716 
FORCES. 
fever, and claimed the greatest success for the measure. Since his day . the 
remedy has been employed with asserted good results by various observers, 
among whom may be mentioned Gerard, Bru^re, Giannini, Armstrong, Lay- 
cock, Rilliet and Barthey, Trousseau, and Hiram Corson, of this State. The 
evidence is, unfortunately, too much generalized to allow of its being put in a 
statistical form, but for an extended resume of it the reader is referred to 
the excellent article in Meigs and Pepper's work on the diseases of children. 
In almost all of these cases the cold was applied in the form of affusions, a 
method which is certainly far more terrifying to the child, and probably less 
efficient, than the cold bath. Recently, Dr. G. Mayer (JahrLuch fur Kin- 
derkrankheiten, vii. 4) has been placing the child in a bath of from 93° F. 
to 73° F. (according to the intensity of the fever) for ten minutes, whenever 
the temperature rises above 102° F. He affirms that the effect wTas most 
beneficial, and that the reduction of temperature usually lasted for several 
hours. In diphtheria, cold bathing has been used to some extent, with 
seemingly good results. In both this affection and in anginose scarlatina it 
is of the utmost importance to combine the cold bathing with the local 
application of the ice-bag or ice-poultice to the throat. During the summer 
months serous diarrhoea (cholera infantum), in some of its forms, annually 
destroys large numbers of children in this country. In most of these cases 
the bodily temperature is much elevated, and the diarrhoea is produced 
and maintained by the heat, as originally pointed out by Dr. Comegys 
(Philada. Med. Times, v., p. 665; Amer. Journ. Med. Sci., Oct. 1876). 
All the ordinary methods of drug administration fail, or, at most, succeed 
in keeping the child alive until the heat of the weather subsides. Under 
these circumstances antipyretic treatment acts in a most magical manner. I 
have always found simple bathing in water at about 75°, at intervals of from 
three to six hours, sufficient, but in some cases the plan recommended by 
Dr. Comegys may be required,-namely, by cold affusions whilst the child is 
sitting in a cold bath. The effect is usually immediate, quiet and sleep at 
once replacing the wakeful restlessness so distressing to mother and child. 
There may be a few instances of sudden collapse with low temperature from 
exhaustion by the serous discharges, but usually cases in which the disease 
is said to " go to the head," are those in which the temperature rises so high 
as to produce brain symptoms; under these circumstances the vigorous use 
of external cold is imperatively demanded. 
It is in the highest degree probable that systematic cold bathing will be 
found serviceable in all blood-poisonings with high temperature, such as 
smallpox, erysipelas, pyaemia, etc.; but as yet we have no clinical evidence 
of moment upon the matter. The high temperature that prevails in sthenic 
pneumonia and certain other inflammatory diseases would appear to indicate 
the abstraction of heat; but how far the local disease will be advantageously 
or disadvantageously affected in these cases is as yet an open question. Dr. 
G. Mayer (Schmidt's Jahrbiicher, Bd. exlix. p. 347) is stated to have CALORIC. 
717 
found that defervescence is materially hastened both in men and in children 
by cold bathing. Dr. Kissler ( Virchow's Archiv, Bd. xciv. p. 490) had 
in one epidemic a mortality of 17.4 per cent, in twenty-three cases treated 
with the cold bath, and of 57.1 per cent, in twenty-one cases treated 
otherwise. In dysentery, Dr. B. Wenzell (^The Doctor, 1874) strongly 
advises the use of large enemata of ice-water, which by their local action 
relieve very greatly the pain and tenesmus, and at the same time have a 
decided effect upon the pyrexia. 
In carrying out the antipyretic treatment of fever certain general con- 
siderations should never be forgotten. It should always be remembered 
that the treatment is directed against a symptom only, and hence is to be 
used only when that symptom threatens injury. The danger-point may be 
considered to be a mouth temperature of 103°. As it is possible to cool 
the axilla without cooling the interior of the body, all temperatures should 
be taken in the mouth or rectum. Again, no bath or other application 
does good unless it removes the heat, but the cold should never be applied 
more severely than necessary. I have used cold spongings, cold packings, 
and the various baths, and have found that when a portable bath-tub can be 
brought to the bedside of the patient and readily filled and emptied, its use 
is accompanied with less fatigue and disturbance than any other efficient 
means of employing cold. The patient, wrapped in a sheet, is to be lifted 
by two attendants into the bath, and then made comfortable with pillows, 
etc. Unless the pyrexia is very severe, the bath should be at a temperature 
of 90° F., and cooled down pro re nata. When no portable bath-tub is at 
hand, efficient antipyresis may be had by lifting the patient, wrapped in a 
sheet, upon a cot covered with a rubber blanket, and sousing rather than 
sponging him with cold water from a large carriage sponge. If the sacking 
bottom or the canvas of the cot be so loose as to sag down several inches, and 
the rubber blanket be turned up at the bottom and top over a wide board nailed 
across the top and bottom, the patient during the sponging lies in a big pool of 
water, and all the effect of the cold bath is obtained by removing with a car- 
riage sponge this water as fast as heated, and sousing fresh cold water (ice 
water if necessary) freely over the upper part of the patient. Under no circum- 
stances should the patient be allowed to help himself at all during the vari- 
ous movements. When the extremities seem especially affected by the bath, 
they should be rubbed so as to maintain their circulation. I have frequently 
applied hot-water bottles to the feet whilst the body was being bathed, with 
good effect. 718 
FORCES. 
ELECTRICITY. 
General Considerations.-Electricity is a force which is developed in 
various ways, but which is essentially the same entity under all circumstances. 
When it is obtained by rubbing two surfaces together, 
it is known as frictional electricity ; when by the union 
of two dissimilar metals, it is called galvanism. Fric- 
tional electricity is almost never used in medical prac- 
tice, and I shall say nothing more about it in this book. 
There are a large number of different patterns or 
arrangements of the elements which generate galvan- 
ism, but the ideal or typical cell may be said to be 
formed of two dissimilar metals immersed in some cor- 
rosive liquid and connected with each other by a piece 
of wire externally. Under these circumstances the 
current starts from the metal most easily corroded, 
passing through the liquid to that less easily acted 
upon, and from this over the external wire to the start- 
ing-point. The external end of the least-easily corroded plate is therefore 
always giving off electricity, and is known as the -|- or positive pole, whilst 
the corresponding end of the other plate is constantly receiving electricity, 
and is spoken of as the - or negative pole. When wires are attached to 
these plates they become, as it were, prolongations of the plates, and their 
ends constitute the poles. Thus, in the diagram, C = copper, Z = zinc, 
P and N- poles, and the arrows show the direction of the current. The 
positive pole is called the Anode (aw, upwards, a way) ; the negative, 
the Cathode (zara), downwards, 88oz). 
As the electric current does not primarily exist, it is evident that in the 
typical or ideal galvanic cell there must be something which sets it in motion. 
This force is the so-called electro-motor force, and has been determined by 
physicists to be a definite quantity for the same combination of metals at 
the one temperature. This force is generated at the point of contact of the 
metals, and is in consequence of the law discovered by Volta, that when two 
metals are in contact with each other a disturbance of the electrical condi- 
tions of those metals occurs. The amount and energy of this disturbance 
vary according to the nature of the metals, and experiments have shown 
that all metals have definite electro-motor powers or properties, and that 
they can readily be arranged in a regular series. A study of this series is 
not necessary to an understanding of electro-therapeutics, and the reader de- 
sirous of knowledge upon this especial point is referred to works on physic.® 
Fig. 1. ELECTRICITY. 
719 
It must be borne in mind that the electro-motor force is constant, so that 
in any given combination of metals in a galvanic cell the electro-motor 
force is always the same, whether the plates of the metal be large or small, 
whether the solution be an acid, a saline, or pure water. The strength of 
the current is not, however, decided entirely by the electro-motor force of 
the cell. Every known substance refuses more or less imperiously to allow 
the passage of electricity. The best conductors oppose a really very great 
resistance. Now, it is evident that this resistance is opposed to the electro- 
motor force, and that if it be greater than the latter it will altogether prevent 
the passage of any current. The strength of the current, then, depends 
upon the relation between the resistance and the electro-motor force; and 
we have the celebrated law of Ohm, which may be expressed by the formula 
, e (electro-motor force) m, . , . _ 
c (current-strength) = -- ; -. Ihis law experiment has 
r (resistance) 
shown to be imperative: no increase or diminution of the size of the plates, 
no change in the character of the solution, affecting it. 
The resistance to the current in a galvanic combination is a double one: 
inside of the cell the fluid between the plates opposes the passage of the 
electricity, and outside of the cell the conductor which completes the circuit 
also offers a resistance. The reason a battery almost ceases to yield a current 
when water is substituted for the acid usually employed is not a purely 
chemical one, but simply because water is an almost complete non-conductor, 
and offers triumphant resistance to the current, whilst the acid conducts and 
readily allows the current to pass. The entire resistance (r) is then made up 
of two factors: the internal resistance (ir), and the external resistance (er). 
e 
The formula of Ohm may therefore be read c = • 
ir er 
As already stated, when the plates of a cell are increased in size the 
electro-motor force is not increased, but as the surfaces of the plates are in- 
creased the diameter of the conductor-i.e., the mass of fluids between the 
plates-is increased ; and consequently, as the resistance in a conductor is 
inversely as the size of its cross-section, the strength of the current is in- 
creased. To make this a little clearer, suppose ir in a certain cell equal 10, 
then c = e : if now the plates of the cell be doubled in size, 
10 + er 
c = = . A similar result-i.e., lessening of the internal re- 
4" 5 er 
sistance-can be achieved by shortening the distance between the plates of 
the cell,-i.e., the length of the conductor,-or by in any way making the 
intervening liquid a better conductor. 
The change in strength of a current by the increase of the size of 
the plates of the cells can readily be expressed by the formula of Ohm. 
If the letters signify as before, and the internal resistance be diminished y 720 
FORCES. 
e 
times by increasing the size of the plate y times, instead of c = 
e ir 4- er 
c will = - If, instead of a single cell, a number of cells are 
_ 4~ er arranged in such a way that the copper of one is con- 
nected with the zinc of the next, the electro-motor 
force of the combination is equal to the sum of the electro-motor forces 
of the cell: thus, if e = the electro-motor force of the single cell, and y = 
the number of cells, the electro-motor force of the battery will be ye. It 
is also plain that the internal resistance of the battery is also increased y 
VC 
times, so that the formula of Ohm will stand c = - 
yir er 
Of course, the strength of a current is greatly affected by the external 
resistance. In very many instances the external resistance is enormous. 
Suppose, then, this external resistance in a given case be 1000 times the 
internal resistance, the formula of Ohm will read, c = . It is 
ir 4~ 1000 ir 
evident that under these circumstances ir, the internal resistance, becomes 
very insignificant, and that very little is gained by increasing the size of the 
plates,-i.e., by diminishing the internal resistance; for if the plates were 
increased fivefold, the increase of the strength of the current would only 
c c 
be the difference between - and - ---, a difference 
tr , ir 4- 1000 ir 
v- 4" 1000 ir 
which is very slight. On the other hand, when the external resistance is 
very great, everything is gained by increasing the number of cells,-i.e., 
5e 
increasing the electro-motor power; for -: - gives a very differ- 
5 ir 4- 1000 ir 
ent result from . When, therefore, the external resistance is 
ir 4- 1000 ir 
many times greater than the internal, practically nothing is gained by 
increasing the size of the plates ; everything by increasing the number of 
the elements. 
The converse of the above reasoning also holds. If the external resistance 
be very slight, the internal rises in importance. Thus, suppose er = 
Then the formula would be c = 7. In this case a great deal is 
. ir 
. ir 4 
1000 
gained by increasing the size of the plates, for gives a very dif- 
ir ir 
5+1000 
£ 
ferent result from :-. In such a case, by quintupling the size of the 
ir 4 - 
1000 
plates the strength of the current is practically increased fivefold. On the ELECTRICITY. 
721 
other hand, it is plain that when the external resistance is slight the gain 
by increasing the number of cells is a slight one, for the internal resistance 
is increased as many times as the electro-motor force. Thus, if five cells 
5 e 
are used, the formula will be c = --, which will, of course, give 
ir 
5 ir +1000 
. ,, , _ e 
practically the same result as :. 
ir 
ir + 
1000 
The law, then, may be stated to be that when the external resistance is 
very slight, increasing the number of the elements has no practical effect upon 
the strength of the current, whilst an increase of the size of the elements has 
the greatest effect. 
When there is no very great disproportion between the internal and the 
external resistance, it is evident that the strength of the current may be 
increased either by increasing the size or the number of the elements. Thus, 
if er = ir, c = ---- = --- ; and increasing the size of the plates four- 
ir + er ir + ir 
€ 
fold will give the formula c = - ; or increasing the number of the ele- 
ir 
1- ir 
4 
4 c 
ments to four will yield the formula c = -: -• Perhaps the result will be 
4ir + ir 
clearer if figures be used. Suppose e = 100, ir= 10, and er = 10. Then 
. , i -UK 100 n 100 o 
the first formula will be c = = 5 ; the second, c = - 8 ; 
10 + 10 L° > io 
4 
the third, c = -- = 8. When, therefore, the external and the in- 
40 + 10 ' 
ternal resistance are equally balanced, the strength of the current is equally 
increased by increasing the number or the size of the plates. 
The application of the foregoing principles to electro-therapeutics is a 
very simple one. In the ordinary applications of electricity to the body, the 
resistance of the tissues is very many times greater than the internal re- 
sistance of any battery, and consequently the latter may be totally dis- 
regarded. Hence for ordinary purposes the formula stands c = -, and 
er 
power can be gained only by increasing e,-that is, by augmenting the 
number of cells. 
When, however, it is desired to act upon the blood in an aneurismal sac, 
the needles are brought close to each other; and, moreover, the blood is 
a comparatively good conductor of electricity. Hence in such cases the 
external resistance is so much reduced that the internal becomes of such 
importance that it should not be overlooked. It follows, therefore, that 722 
FORCES. 
when an aneurism is to be acted upon the plates should be increased in size, 
whilst at the same time a number of cells should be used. 
In the so-called " galvano-cautery" the current is not passed through the 
body at all, but through a wire, which is thus kept at a white heat. In this 
case the external resistance is vastly less than when human tissues form a 
part of the circuit. Hence it becomes a matter of importance to reduce to 
as great a degree as possible the internal resistance, and the elements or 
plates should be very large and should be placed very close to one another 
in the cells. The external resistance is not, however, so slight that it can 
be entirely overlooked, and hence a number of cells are combined with one 
another, so as to give sufficient electro-motor force. 
In writing or speaking about the use of electricity in medicine, it is a 
matter of great importance to avoid the use of the old terms quantity and 
intensity, which, to use the language of one of the most eminent of living 
writers on galvanism, " are remnants of an erroneous theory." The amount 
of mystification which has been produced by talk concerning the therapeutic 
effects of currents of large quantity with low intensity as contrasted with 
those of currents of high intensity and low quantity is equalled only by the 
amount of nonsense which has been written. Currents of galvanism have 
really only one attribute,-i.e., current-strength,-and that is in strict 
obedience with the law of Ohm. 
Again, a dense fog has been thrown around the subject of electro-thera 
peutics by the idea that there are various essentially different forms of gal- 
vanism. The current which flows from a cell or a combination of cells is 
spoken of as a continuous current, or sometimes as & primary current; be- 
sides this, modern therapeutists use another series of currents, which are 
known as the induced currents. 
The term primary current is often applied to one of these induced cur- 
rents. If we employ the name continuous current for that current derived 
from the galvanic cell, we must continually be speaking of the interrupted 
continuous current, which certainly is inelegant. I shall, therefore, employ 
the name chemical current or galvanic current to designate that form of 
galvanism which is generated in the galvanic cell. 
If a coil of insulated wire have a bar of soft iron placed in its centre and 
be surrounded by an external coil of wire, when a chemical current is passed 
through the first coil, owing to physical laws which it is not necessary here to 
consider, every time the galvanic circuit is completed or interrupted a brief 
current of electricity is induced in the inner or first coil, and also a similar 
current in the outer or second coil. The only physical facts which it is 
necessary for us to know are that these induced currents are very brief and 
of great strength, also that they are to-and-fro currents,-that is, run in 
opposite directions in each individual coil. Thus, in the inner or first coil, 
when the galvanic circuit is closed, the induced current in the inner coil runs 
parallel to the generator chemical current, but when this current is broken, ELECTRICITY. 
723 
the induced runs in a contrary direction. In the outer coil, the induced cur- 
rent, which is instantaneously developed when the galvanic current is sent 
through the inner coil, pursues a direction opposite to that of the chemical 
current; but when the latter is broken, the return induced current in the 
outer coil runs parallel to the generator current. 
As these induced currents run backwards and forwards, to and fro, in this 
way, it would appear that there could not be any negative or positive pole to 
the battery which generates them, for if one end or pole of the wire consti- 
tuting the coil be negative in regard to the first induced current, it must be 
positive in regard to the second or return current. This is assuredly true 
so far as concerns the outer or second coil, but is not true for the inner or 
first coil, as is readily understood by means of this diagram of an induction 
battery. 
Fio. 2. 
G Galvanic element, with the -|- and - metals in it. 
c Coil in which the primary induced current or currents of the first coil are generated. 
h Spring-hammer or vibrator. 
m A piece of soft iron becoming a magnet when the current is passing. 
2c Outer coil in which the secondary induced current, or current of the second coil, is gen stated- 
P Handles of inner coil. 
P' Handles of outer coil. 
It is plain that when the current is passing, the hammer h being in the 
position represented in the diagram, m will become magnetic and attract h. 
This at once breaks the current, and an induced current runs through the 
first coil and is received by the patient grasping the handles P P. The 
instant the current is interrupted, m loses its magnetism and the spring- 
hammer flies back. Now the circuit is closed, and for the second time an 724 
FORCES. 
induced current runs through the first coil c. It is evident, however, that 
this induced current of closure will not pass through the body of the person 
grasping the handles P P, but will pass along h through the cell to the 
other end of the coil, as a shorter route and one of vastly less resistance. 
It is plain that from the inner or first coil the induced current of broken 
circuit alone passes through the body of the patient. 
In regard to the outer coil, it is evident that when the circuit is closed 
the momentary induced current must run through the body of him who 
grasps the handles P' and P, and that the return current which passes when 
the circuit is broken must take the same route. 
It follows from the above considerations that the current of the first coil 
runs through the patient only in one direction, and electricians may correctly 
mark poles -|- and - 5 but that the current of the second coil runs in both 
directions, so that any designation of its handles as positive and negative is 
incorrect. The only justification for the marking of the secondary or outer 
current poles, as is often done, is found in the fact that the induced current 
of the broken circuit is stronger than that of the closed circuit. Hence it 
is that with very strong currents the two poles can sometimes be distinguished 
when grasped in the hand. The difference is, however, a slight one, and 
for all practical purposes the induced current of the outer coil is a to-and- 
fro one, without any negative or positive poles. 
If a strong continuous galvanic current be passed through a person, a 
shock is felt at the moment of making and breaking the circuit, but whilst 
the current is passing no sensation is perceived except at the points of 
entrance and exit. Or if the current be passed through the nerve of a 
muscle, that muscle violently contracts at the moment the circuit is made 
or broken, but whilst the current is flowing is quiescent. If a rapidly in- 
terrupted faradic current be passed through a nerve, the muscle supplied 
by that nerve is thrown into a continuous spasm. The reason of this is 
obvious. The so-called faradic or induced current is, as has already be^n 
stated, a succession of instantaneous broken currents for the first coil, and 
as brief to-and-fro currents for the outer coil; so that the circuit is con- 
tinually being closed and broken, and the muscle is continually excited to 
action. There is, therefore, a different result achieved in the application of 
the continuous and induced currents, not because there is any real difference 
in their nature, but because the mode of application is diverse. 
Most medical electricians teach that the true galvanic current is very dif- 
ferent from the faradic current, and many, like Duchenne, persist in assert- 
ing that the currents of the first coil are essentially different from those of 
the second. Galvanism is, however, galvanism; and its nature and attributes 
are probably always the same; the faradic currents are lacking in the chem- 
ical power of the continuous current because they pass so quickly that they 
have not time to exert a chemical influence. Gunpowder can be passed so 
quickly through the hottest flame as not to ignite it. The secondary in- ELECTRICITY. 
725 
duced current differs somewhat in its action from the primary simply because 
the latter is not a to-and-fro current, and we cannot readily convert an induced 
into a galvanic or chemical current, because we cannot readily tie together, 
as it were, the ends of the brief currents into one. I have no doubt 
that if we could get the interruptions at the rate of many thousand times 
a minute, we should find that the primary induced current would act as a 
continuous current.* 
We can readily, by mechanical means and contrivances, interrupt the con- 
tinuous current, or even rapidly reverse the poles so as to give a to-and-fro 
current like that of the outer coil. When this is done, it is impossible to 
distinguish between the action of the galvanic and that of the faradic cur- 
rent in producing muscular contractions. It is true that in certain diseased 
states of the muscle it has been asserted, and with apparent reason, that the 
action of the induced current is essentially different from that of the true 
galvanic current. But I believe further investigation will show that the 
seeming differences are really due to the difference in the lengths of time 
during which the currents are passing, and not to any inherent peculiarities 
of the various currents themselves. 
It is of the utmost importance to determine by what route or routes gal- 
vanic currents pass through the body when the poles are applied to it, and, 
since the body as a galvanic conductor is governed by ordinary physical 
laws, some knowledge of these laws is a necessity to the electro-therapeutist. 
If a current be passing along a homogeneous conductor, such as a wire 
of iron, of copper, or of other metal, and that conductor splits up into 
a number of branches, the current also divides, as is illustrated in the 
diagram (Fig. 3). If these branches, being of equal size and length, offer 
an equal resistance, the current 
divides equally ; but if the size or 
length, and consequently the re- 
sistance, of the branches be un- 
equal, the division of the current 
is unequal; the law being that the 
strength of the current in each 
branch of the conductor is in- 
versely proportional to the resist- 
ance of that branch. This law is as applicable to conductors composed of 
Fig. 3. 
* It has been found that when a faradic machine, or its equivalent, the so-called 
magneto-galvanic machine, is so constructed that the interruptions are excessively rapid 
and the to-and-fro currents separate from one another, the infinitely rapid succession 
of instantaneous induced currents in one direction has all the chemical effects of a 
steady current; in other words, the interruptions are so brief that they are without influ- 
ence. I am not aware of any trials with these machines upon living tissues, but do 
not doubt that their currents will be found to produce the same results as chemical 
eurrents. 726 
FORCES. 
many substances as to those composed of a single substance; but then the 
resistance in a branch depends upon the specific resistance of the substance 
of which it is composed, as well as upon its size and length. 
In applying these laws to the passage of galvanism through the body, it 
must be borne in mind that the dry skin offers an enormous resistance to the 
passage of the current, so that practically none of the latter will pass along 
it. On the other hand, when the skin is thoroughly wet with salt water it 
allows the current to pass through it readily. 
Let us suppose, then, that in the diagram (Fig. 4) -}-p and -p = wetted 
Fig. 4. 
poles ; ss = skin, with the tissues below it. It is evident that, if the tissues 
were a uniform mass, the current, passing through the skin as a solid bolt, 
would break up into an infinite number of curved currents, which would 
meet and pass through the skin again as a solid mass at -p. It is equally 
plain that, of these sub-currents, those whose course was nearest the straight 
line from -\-p to -p would be the shortest, and would, therefore, meeting 
with the least resistance, be the strongest, whilst as the curve and conse- 
quently the length and the resistance increased, the strength of the current 
would diminish until it became practically null. In this imaginary case, the 
tissue beneath the skin has been supposed to be homogeneous: in actual life 
the tissue never is homogeneous, and the resistance of the different con- 
stituents varies somewhat. Consequently, the strength of the subdivisions 
of the current is modified: those branch streams being increased which run 
along or through tissues that conduct readily, and vice versa. 
By remembering these facts, we are enabled to apply electricity as closely 
as may be to any desired portions of the body. Thus, if it be intended to 
affect as exclusively as possible a certain spot or minute portion of a nerve, 
a well-wetted small electrode is placed directly over this portion, and, espe- 
cially if the nerve be somewhat deeply situated, pressed down firmly, so as 
to condense the tissues as far as possible into a homogeneous mass, whilst a 
large wet electrode is placed at a small distance from it in a situation which 
the anatomy of the part will readily suggest. The diagram (Fig. 5) will 
perhaps illustrate this point more clearly than would many words. 
It is evident that the spot immediately under the small electrode will 
receive the full strength of the current, which is directly afterwards so 
broken up as to affect very slightly any other part. ELECTRICITY. 
727 
Again, suppose it is desired to pass a current through some length of a 
nerve; it is evident, in the first place, that two small electrodes should be 
Fig. 5. 
chosen, and that they should be well wetted and pressed firmly upon the 
trunk of the nerve at the two ends of that portion which is to be affected. 
Again, in applying electric currents to muscles it is found that if the cur- 
rents be sent through the body of the muscles, only very imperfect and partial 
contractions occur, unless indeed the currents be excessively strong. Du- 
chenne was the first to discover that when one pole is placed over certain 
spots or points in the muscle, violent general spasms of the muscle are pro- 
duced by currents usually too feeble to elicit a distinct response. To these 
places the name of motor points has been given. These motor points corre- 
spond to the position at which the supplying nerve enters the muscle. When 
it is desirable to affect chiefly or solely a given motor point, it is evident 
that one small well-wetted electrode should be pressed firmly over the motor 
point, and another large sponge electrode placed at some little distance 
from it, in the manner which has already been explained. 
For certain purposes, to be hereafter explained, it is often desirable to 
affect chiefly the skin by the electric current. Under these circumstances 
the skin should be well dried. It then offers so great a resistance that only 
currents of considerable strength are able to force their way through, and 
even these currents, taking advantage of the natural apertures formed by the 
sweat- and other glands, are broken up into a number of branch currents. 
The galvanic current reaches the internal structures in a great number of 
small streams very much reduced in power by the resistance they have over- 
come. If the second pole of the battery be a large well-wetted disk or 
sponge at a distant part of the body, it is evident that these branch currents 
will separate and subdivide in such a way that their effect upon the deeper 
structures will be almost entirely lost. 
It is a principle in physics that electricity upon points does not strictly 
obey Ohm's law, but the force accumulates on the extreme end of the point 
until its density is excessive, and until its self-repulse power becomes so great 
as to break down all resistance, and to break off highly electrified particles of 
the conductor, which fly off through the air. It is this which renders the 728 
FORCES. 
so-called 11 electric brush" so energetic in its action on the skin. This instru- 
ment consists of a number of wires united in the form of a cylindrical brush 
and connected with one pole of the battery; when this is brought in contact 
with the skin of a person, on whom at some distance is placed the other 
large well-wetted electrode, each wire point offers a dense accumulation of 
electricity, which forces its way at all hazards through a minute portion of 
the skin. The whole current of course enters the deeper tissue in an infinite 
number of subdivisions, and consequently its effect in these tissues is reduced 
to a minimum. 
Physiological Action.-When a moderately strong current of gal- 
vanism is passed along a certain length or portion of a nerve, there appear 
between the two poles two zones of disturbed nerve-function, separated by 
a neutral point at which the nerve retains its normal condition. In the 
neighborhood of the positive pole the irritability of the nerve, and also its 
power of transmitting impulses, are diminished, whilst in the proximity of 
the negative pole these nerve-attributes are increased: to the condition of 
diminished activity the name of analectronous has been applied, whilst that 
of increased activity has been called katalectronous. Thus, in Fig. 6, cn 
equals the nerve ; -\-p and -p, the positive and negative poles respectively; 
np, the point at which the function of the nerve remains normal, with the 
zone of analectronous (a) on the one side, and that of katalectronous (k) on 
the other. The longer the current continues, and the more intense it is, the 
more does the zone of analectronous gain upon that of katalectronous, or, in 
other words, the more closely does the neutral point (np) approach the nega- 
tive pole (-p). Consequently, when a strong current has passed for a 
length of time through a nerve, the zone of katalectronous is a very short 
one, confined to the immediate vicinity of the negative pole. 
When the particles of a motor nerve pass from a state of inertia to one 
of motility,-i.e., from one of diminished to one of increased excitability,- 
the nerve is momentarily excited, and gives origin to an impulse. There- 
fore, when analectronous disappears in a nerve,-i.e., when a condition of 
diminished activity becomes one of normal activity,-an impulse is generated 
just as certainly as when katalectronous-i.e., increased functional activity 
-appears in a nerve previously normal. 
Suppose (Fig. 6) cn represents a nerve, and m the muscle to which it is 
distributed. If, then, a downward current be applied to this nerve, it is 
Fig. 6. 
plain, -\-p being the positive pole and -p the negative, that a will be the 
zone of analectronous, np the neutral point, and k the zone of katalectronous. 
When the circuit is closed in obedience to the law already enunciated, an ELECTRICITY. 
729 
impulse starts from k, and, in order to reach m, has to pass only through 
the stretch of normal nerve between -p and m. Therefore this impulse 
of circuit-closure reaches the muscle unimpaired. 
Again, when the circuit is broken, the impulse which is generated in a, 
in order to reach the muscle travels only through the zone k, whose con- 
ducting-power is increased, and a portion of normal nerve; consequently it 
also reaches the muscle unimpaired. It is plain, then, that with descending 
currents strong movements must be induced, both at the making and at the 
breaking of the circuit. 
With ascending currents the results are different. Thus, in Fig. 7, cn = 
nerve ; m = muscle ; -{-p = positive pole ; -p = negative pole ; np = 
Fig. 7. 
neutral point; a = zone of analectronous; k = zone of katalectronous. 
Now, it is plain that the impulse generated in k at the closing of the circuit 
must pass through a, the zone of diminished conducting-power, in order to 
reach m. Consequently, with the ascending current the contractions of 
circuit-closure are very feeble, or are altogether wanting. When, however, 
the circuit is broken, the impulse generated in a reaches the muscle m un- 
impaired. 
Without occupying more space with a discussion of the subject of elec- 
trotonous, but contenting myself with the statement that these facts and 
reasonings apply especially to such currents of moderate strength as are with 
propriety employed in therapeutics, it is plain that descending currents ought 
to be more efficient in inducing contractions than are ascending currents. 
What science thus has discovered, clinical medicine has also found out: de- 
scending currents are in practice found to be more powerful than ascending 
currents. 
From what has been already said, it is so evident as scarcely to need 
further demonstration that the breaking of a current running in one direc- 
tion must render the nerve more sensitive to the closure of a current run- 
ning in the opposite direction, but less sensitive to the closure of a current 
running in the same direction ; for when the currents pass in opposite direc- 
tions analectronous suddenly becomes katalectronous,-i.e., that which was 
below normal suddenly becomes above normal,-whilst with parallel currents 
analectronous remains analectronous. 
To make this more clear, however, Fig. 8 may be employed. In it the 
letters have the same significance as in those previously used, whilst the 
arrows on the side of the lettering represent the direction of the current to 
which the lettering applies. The downward current is supposed to be broken, 
and to be followed instantly by the upward: of course the upper, a, changes 730 
FORCES. 
into k, and a doubly powerful impulse is sent down to m. Now the upward 
current is broken, and the downward sent through the nerve; at once the 
lower a becomes k, and m receives again a doubly powerful impulse. 
Fig. 8. 
The practical application of this reasoning is a very apt one. It becomes, 
in the first place, very plain why the secondary to-and-fro current of the 
induction coil has so much more power over muscles than has the primary 
induced current or the chemical current, as ordinarily applied. 
If, however, instead of the chemical current being simply interrupted, its 
polarity be suddenly reversed at brief intervals, all the effects of the to-and- 
fro induction current upon healthy muscle are obtained. More than this, 
for reasons to be hereafter adduced, in certain muscular paralyses I have 
found that muscles which fail to respond to all other currents respond readily 
to a very slow to-and-fro chemical current. 
Having obtained an idea of the manner in which galvanic currents pro- 
duce muscular contraction, it is next in order to study their influence upon 
diseased muscles. 
If a muscle by destruction of its supplying nerve be cut off from all spinal 
influence, it or its nerve rapidly undergoes a degeneration * In the course 
of a very few days it will be found upon testing that the muscle no longer 
responds to a rapidly-interrupted faradic current, but does respond to such 
current when slowly interrupted ; a couple of days later, and the muscle fails 
to contract to the most powerful and most slowly-interrupted induced currents. 
When, however, the continued current is applied, and is very slowly inter- 
rupted, or, better still, reversed at intervals of one or two seconds, contrac- 
tions are produced. It is this fact which has led to the belief that there 
is some intrinsic and inscrutable difference between the induced and the 
chemical currents. But time is an element required for the propagation of 
any force. If the hand be passed rapidly through a flame, the latter is not felt; 
if the hand move more slowly, a sensation of warmth is perceived; if the 
motion be still slower, this sensation becomes pain. Now, if the hand be 
partially anaesthetic from disease, in order for the sensation of warmth to be 
perceived motion must be much slower than in the first instance. In other 
words, more time is required for the partially paralyzed sensory nerve to 
perceive heat than for the normal nerve to do so. What is true of the sen- 
sory nerve is true also of the motor nerve. It does not respond so quickly to 
stimuli when partially paralyzed as when normal The muscle first loses its 
power of responding to those galvanic currents which are excessively rapid, 
* The peculiar electrical reactions of a degenerating muscle are given in detail on p. 695. ELECTRICITY. 
731 
then to those which are less so, and finally to all induced currents, because 
from their very nature these currents, even when slowest, last but a fraction 
of a second. The chemical current may be continued for any length of time 
at the will of the operator, who is thus enabled to act upon a muscle whose 
nerve has become so insensitive that it fails to perceive the flash of faradic 
galvanism. 
The proof of this somewhat dogmatic reasoning is to be found in the fact 
that the rapidly-interrupted chemical current is no more able to affect the 
diseased muscle than is the rapidly-interrupted faradic current, as I have 
proven over and over again in various forms of paralysis. That there is no 
difference between the chemical and the induced currents in their chemical 
action, excepting in so far as their influence is affected by the duration of 
their passage and the to-and-fro character of many induced currents, is 
abundantly proven by the " Gramme magneto-electric machines," in which an 
induced current is obtained with almost infinitely rapid interruptions and 
running only in one direction. With this current all the phenomena of 
chemical decomposition, etc., are obtained, and no doubt the effects of the 
continued chemical current upon the human frame would be producible. 
Therapeutic Application.-Motor System.-Galvanic currents are 
employed in paralytic affections for three distinct purposes,-namely, diag- 
nosis, prognosis, and therapeusis. These I shall consider in the order in 
which they have been enunciated. 
There are certain palsies, such as pseudo-muscular hypertrophy, in which 
the muscular structure is so destroyed independently of any involvement of 
the nervous system that no response to the galvanic current is possible. All 
of these palsies are, however, essentially exceedingly chronic, and their diag- 
nosis is to be made out chiefly by a microscopical examination of the muscles 
themselves. As electricity does not come into play in the diagnosis of these 
cases, I shall not say more about them. It is otherwise with suddenly-devel- 
oped paralysis in which the history does not point to any immediate cause, 
such as diphtheria. Often, in such cases, galvanism is of great diagnostic 
value. As stated previously, when a muscle is entirely deprived of the influ- 
ence of the spinal centres it rapidly loses its electro-contractility, whereas, if 
a muscle be paralyzed from a lesion of such character or position as not to 
interfere between it and the trophic cells of the cord, it maintains its integrity 
for many weeks. When a muscle is degenerating for want of spinal influence, 
it first loses its power of responding to rapidly-interrupted faradic or chemical 
currents, then to slowly-interrupted faradic currents, then to slowly-inter- 
rupted chemical currents, and lastly to slowly-reversed chemical currents. 
At this time occurs with the galvanic current the so-called " reaction 
of degeneration," first discovered by Brenner, and since elaborated by Erb 
(Ziemssens Encyc., xi. 273) and G. B. Massey {Med. News, Feb. 1883, p. 
124). To comprehend this, it must be remembered that it is obtainable 
only by applying the electrode to the muscle: if the electrode be applied to 732 
FORCES. 
a nerve-trunk of a degenerating muscle it will be found that reaction is 
diminished in quantity but not altered in quality. When a galvanic current 
of only moderate strength is used, and the negative pole (kathode) placed 
over the normal muscle but not over its motor point, a strong contraction 
occurs at the closure of the circuit; when, however, the positive pole 
(anode) is placed over the normal muscle the contraction is much less; in 
neither case is there any contraction when the circuit is broken : in other 
words, with the normal muscle and a feeble current we obtain good 
kathodal closing contraction, slight anodal closing contraction, and no 
motion whatever at either kathodal opening or anodal opening. When 
a current of sufficient power is used, opening contractions are produced, 
and the anodal contraction is greater than the kathodal. The " reaction of 
degeneration" consists merely in a more or less perfect reversal of the above 
formula. The anodal (positive pole) closure then causes a stronger con- 
traction than the kathodal (negative pole) closure. When there is only 
a slight degree of degeneration present, there is a correspondingly slight 
increase of anodal closing over kathodal closing contraction. A minimum 
degeneration would be indicated by an equality of the two closing contractions. 
These alterations in the electrical relations of a degenerating muscle are 
readily formulated, and in this way are perhaps more readily grasped by the 
student. The symbols are as follows: An Cl C represents anodal closing 
contraction ; An 0 C represents anodal opening contraction ; K Cl C rep- 
resents cathodal closing contraction; K 0 C represents cathodal opening 
contraction; < represents is less than; )> represents is more than (the 
point of the <( being towards the lesser quantity). Then the formulas are: 
An Cl C < Ca Cl C ) 
* va n n ( muscle normal. 
An O C > Ca O C J 
An Cl C=Ca Cl C) , . „ 
* i muscle in first stage of degeneration. 
An O C = Ca Cl C) ° ° 
An Cl C > Ca Cl C ) 
An 0 C < Ca 0 C j muscle in more advanced stage of degeneration. 
After the latter Reactions of Degeneration (De R of some authors) have 
been established, if the muscle continue to undergo change, the galvanic 
irritability slowly diminishes, stronger and stronger currents being required 
to produce an effect. When a certain stage is reached all reactions cease, 
save a feeble An Cl C, and at last this is lost, and the muscle responds not 
at all. When recovery occurs, the electrical reactions of the muscle pass 
upwards along the pathway they have descended. 
The practical importance of the Reactions of Degeneration is greatly les- 
sened by the circumstance that their demonstration usually requires much skill 
and patience,* and that it probably is never present when a muscle still retains 
* Dr. Massey gives the following directions as to the method of making the test: 
Having placed one well-moistened electrode over the muscle to be tested, and the other ELECTRICITY. 
733 
its integrity as regards the faradic current. For the purposes of the prac- 
titioner, the failure of response to the latter current is the best test as to 
the condition of a muscle. When a muscle loses its power of responding 
to the rapidly-interrupted faradic current in a week or ten days after the 
occurrence of paralysis, whether the reaction of degeneration can or cannot 
be satisfactorily demonstrated, the inference is very positive that the lesion 
either is one of the nerve-trunk, or, if of a nerve-centre, is of such a 
character as seriously to involve the trophic cells of the spinal cord. If a 
few days later such muscle is unable to respond to any faradic current, this 
inference becomes a certainty. Under these circumstances, the possible 
lesion is narrowed down to infantile paralysis, a conceivable destructive 
myelitis, and an affection of a nerve-trunk. 
A myelitis so rapid and severe as to destroy in a few days a portion of the 
spinal cord, and consequently the electro-contractility of its tributary mus- 
cles, is exceedingly rare, and, if it occurred, could only be confounded with 
spinal congestion complicated with hemorrhage. In infantile palsy the 
nature of the case is usually but too apparent, although the muscles often 
lose their electro-contractility as quickly as when a nerve-trunk is severed. 
Practically, therefore, very rarely is there any difficulty in recognizing the 
seat of the lesion in acute organic palsies by means of the galvanic test. It 
may be laid down as a practical rule that when in the adult a muscle loses 
to a sensible degree in a few days its electro-contractility, the lesion is in a 
nerve-trunk. In recognizing, however, these peripheral palsies, it must not 
be forgotten that the injury to the nerve may be very deeply situated,-even 
within the membranes or substance of the nerve-centres. This is especially 
to be borne in mind when it is a cerebral nerve that is affected. Thus, 
a tumor situated in a superficial portion of the brain may press upon the 
fibres of a nerve just as they are collecting together previous to leaving 
the brain, and the result will be a palsy which is really a peripheral one, 
although the tumor is in the nerve-centre. A similar thing may happen 
to the spinal cord: thus, I have seen, in spinal congestion giving origin to 
meningeal apoplexy, rapid and total destruction of the electro-muscular 
contractility in the lower extremities, from the pressure of the clots upon 
the cauda equina. 
The persistence of the muscular contractility intact for some weeks after 
in some carefully-selected point of departure, it next becomes necessary to properly close 
and open the circuit. For this purpose nothing is in any way comparable to a pedal 
rheotome, a simple mechanism worked by the foot; it is, in fact, a necessity whenever the 
services of an assistant cannot be obtained, as a steady application of the electrodes is 
essential in many delicate cases,-even the slightest movement produced by the working 
of the hand-current-breaker being confusing. If the pedal rheotome also contains a 
commutator, worked by the foot, for changing the poles while still in situ, its handiness 
will be greatly increased. The clock-work current-breakers usually furnished by instru- 
ment-makers are totally unfit for diagnostic purposes." 734 
FORCES. 
the occurrence of a palsy depending upon an organic lesion, proves that 
the disease is of cerebral origin, or, being spinal, is of such nature as not 
to compromise seriously the trophic nerves of the cord. 
In applying these rules, it must not be forgotten that whenever a muscle 
is not used it loses its contractile power, so that even in paralysis from cere- 
bral hemorrhages the muscles finally degenerate, although this degeneration 
is rarely so complete as in peripheral palsies. It is not the fact of degener- 
ation, but its degree, and especially the period of time which elapses between 
its occurrence and the commencement of the paralysis, which is the im- 
portant factor in the diagnosis. In cerebral palsies no distinct loss of func- 
tional activity in the muscles is usually perceived sooner than six weeks after 
the onset of the attack, and even after years have elapsed some response 
may often be elicited by strong slowly-interrupted or reversed currents. 
There are certain palsies in which the electro-muscular contractility is 
really or apparently above normal. Very frequently the excessive contrac- 
tions produced are not so markedly in the muscles to which the currents are 
applied as in other muscles, whose movements are in reality reflex in their 
nature. In all these cases the probabilities are that there is a condition of 
acute hyperaemia or of excessive functional irritability of the spinal cord. 
In regard to certain so-called functional palsies; in diphtheritic paralysis 
the irritability of the muscles is often diminished and sometimes destroyed ; 
in lead palsy it is generally lost, and, curiously enough, according to my 
own observation the muscles may recover to a marked degree the power 
of voluntary motion, without a corresponding restoration or their normal 
electrical relations. 
In hysterical paralysis any aid to diagnosis is often of very great value; 
and it has been asserted that in this class of palsies the preservation of 
electro-contractility with loss of electro-sensibility is always present, and is 
of diagnostic import. My experience, however, is very positive that in 
hysterical palsy both electro-contractility and electro-sensibility are frequently 
normal. When, however, the paralyzed muscle responds to galvanic cur- 
rents, and the patient is to a great extent, or altogether, insensible to their 
passage, a very positive diagnosis of hysteria may be given. The electro- 
contractility is never seriously compromised in hysterical palsy. 
In using galvanism as an aid in prognosis, the condition of the muscular 
contractility is always to be considered in conjunction with the nature of the 
lesion and the length of time it has existed. 
Taking first ordinary hemiplegia as the type of cerebral palsies, it must 
be borne in mind that the actual existent amount of paralysis is really the 
product of two essentially different factors. The nerve-centre is primarily 
damaged, and after a time the muscle also suffers loss of structural integrity 
from want of use. The restoration of the nerve-centre does not necessarily 
involve the restoration of the muscle, so that in a case of hemiplegia of some 
standing the cerebrum may have recovered itself partially or entirely, and ELECTRICITY. 
735 
yet the muscle be in such a state of degeneration as to be unable to respond 
to the impulse transmitted to it from the nerve-centre. 
Under these circumstances, galvanic treatment, although unable to affect 
to any extent the nerve-centres, does great good by restoring the muscular 
tone. It is manifestly impossible in such a case to determine before treatment 
how far the nerve-centre has recovered itself, or, in other words, to what 
extent the existing paralysis is of centric and to what extent it is of muscu- 
lar origin. When, in a case of apoplectic hemiplegia, there is no recovery at 
all of the power of voluntary movement after the lapse of six weeks, the 
prospect of decided improvement from electrical treatment is very gloomy, 
because the probabilities are altogether in favor of the existence of a serious, 
persistent centric lesion. If, however, there is some motion, the probabili- 
ties of improvement are inversely proportionate to the structural health of 
the muscles. If the tone and the electro-contractility of these are normal, 
the centric factor is the chief one in the production of the paralysis, and 
little good is to be achieved by the use of the galvanic current. On the 
other hand, if the muscles have undergone a very decided degeneration, much 
good is to be expected. No hopes of absolute cure should, however, be held 
out, because, in the great majority of cases, after the muscles have been fully 
restored the nerve-centre is found to be more or less damaged. The improve- 
ment under the use of electricity is usually at first rapid, but after a time 
ceases altogether, because, the muscles having recovered their tone, it is not 
possible to affect, to any great extent, the sole remaining cause of the 
paralysis,-t.e., the centric lesion. Under these circumstances it is useless 
to continue treatment. 
In infantile paralysis, early in the attack the galvanic current is of little 
value in determining the prognosis, excepting that the general law is, that 
the more rapidly electro-contractility is lost, the more serious is the case. In 
advanced cases, the duration of the attack and the condition of the electro- 
contractility in the muscles are both to be considered. If no response at all 
to an electric current can be obtained, the prognosis is always very grave; 
although even under such circumstances a decided improvement has occurred 
in a small percentage of the cases I have treated. If the case be an old one, 
the preservation of some degree of electro-contractility indicates that the 
structural lesion in the cord is not a fatal one; and as, under these circum- 
stances, the muscles can always be more or less perfectly restored, the pros- 
pect of improvement is very good. The preservation of electro-contractility 
late in the disorder, when the centric lesion is no longer progressing, is of 
much more import than it is in the first few weeks or months of the case, 
when the central trouble may be increasing. 
Tn peripheral palsies the prognosis depends rather upon the nature of the 
nerve-lesion than upon the condition of the muscle; but it must be remem- 
bered that when a muscle has absolutely lost its power of responding to 736 
FORCES. 
any electrical current its restoration is always a matter of difficulty and of 
some doubt. 
In regard to therapeusis, the first point to be determined in acute cases is, 
very often, when to commence electrical treatment. When the lesion is of 
such nature as not to provoke any irritation of the nerve-centre, no time 
should be lost. Thus, if a man is unable to use his arm because he has 
slept with it under his head and thereby paralyzed the nerve by pressure, 
galvanism should be at once employed. 
When, however, the lesion is of such character as of necessity to irritate 
the noi-ve-centres, the case is different. The local stimulation of the periph- 
eral nerve-fibres by the electrical current does, in some way not yet defi- 
nitely understood, affect the nutrition of the nerve-centres; and when these 
nerve-centres are in a state of active excitement or inflammation, a peripheral 
galvanic irritation may do serious injury. Hence the rule that when an 
acute palsy is connected with active irritation of the nerve-centres, galvanism 
should not be used upon the muscles until the centric disturbance has sub- 
sided. Thus, in hemiplegia from cerebral hemorrhage the muscles must 
be allowed to rest not only until all symptoms of centric irritation have 
passed away, but also until the brain has become so accustomed to the clot 
that the latter no longer acts as a foreign body. It is usually from three 
to six weeks before electricity can be used with advantage in these cases. 
Again, in acute cerebritis, cerebral or spinal meningitis, and myelitis, the 
employment of galvanic currents should be strictly forbidden until a stage 
is reached when the effects of the inflammation, and not the inflammation 
itself, are to be dealt with. 
When it has been decided to commence the use of galvanism, it is next to 
be determined what current shall be employed. It has already been shown 
that there are no inherent mysterious differences in the various currents; 
yet there is a practical difference, and the clinical rule of choice is, Always 
select that current which produces the greatest number of muscular contrac- 
tions with the least amount of pain; trying the rapidly-interrupted faradic or 
the rapidly-interrupted chemical current, and the slowly-interrupted faradic 
or the slowly-interrupted chemical current, and always, when these fail to 
elicit response, the slowly-reversed chemical current, which, if necessary, 
may be increased in strength until the patient can no longer bear the pain. 
The current having been selected, the individual muscles must be gal- 
vanized at each seance. 
After what has been said previously, it is not necessary to speak at this 
point as to the best methods of applying the currents to the muscles, but 
only to insist upon the fact that it is not so much the electricity as the con- 
tractions induced by it which benefit the palsied parts, and that consequently 
the electro-motor points of the muscles should always be separately reached. 
The diagrams given in the Appendix will point out more clearly than would 
pages of description the approximate positions of the motor points, which ELECTRICITY. 
737 
vary somewhat in their location in various individuals. Some deep-seated 
muscles we are not able to reach directly, but we can reach them indirectly 
by galvanizing the nerves which supply them. 
There are certain precautionary rules which must never be lost sight of 
in the galvanic treatment of palsies. Pain is an evil, and its infliction is 
always to be avoided as far as possible. Hence the rule never to use stronger 
currents than is necessary. It is very possible to fatigue a healthy muscle, 
much more a diseased one. A weak muscle may be greatly injured by being 
over-fatigued. Hence the rule that currents are not to be applied to muscles 
sufficiently long at a time to induce fatigue. In general, an electrical seance 
should last from ten to twenty minutes, no one muscle being subjected to the 
currents for more than five minutes, and it may be repeated daily, or three 
times a week. 
Sensory System.-Affections of the sensory nerves are of three kinds,- 
pain, hyperaesthesia, and anaesthesia. There are, of course, distinct states or 
disorders, which may exist separately or conjointly: as an instance of the co- 
existence of pain and anaesthesia may be mentioned the anaesthesia dolorosa 
of Romberg. The use of electricity for the relief of these disorders is almost 
entirely empirical,-indeed, is often purely experimental in an individual case, 
as no clinical laws regulating the use or enabling us to decide as to the 
applicability of the agency have as yet been worked out. 
It may be laid down, however, as an axiom, that the galvanic current is 
powerless to relieve the pain of phlegmonous inflammations, and that its 
use should be restricted chiefly to nervous pain or neuralgia. It is also true 
that the currents are possessed of no therapeutic power over neuralgia de- 
pendent upon central organic lesions; this is also probably true of such 
neuralgias as migraine, malarial hemicrania, and toxic neuralgias, in which, 
although there is no perceptible organic lesion, there is some deep-seated, 
inherent deficiency either in the central nervous system or in the constitution 
or condition of the patient. 
In rheumatic neuralgias, such as sciatica, electricity sometimes does 
great good, but perhaps more often fails. I have seen it effect the greatest 
good, and I have seen it aggravate the disorder. My experience has not 
been sufficient to allow me to speak authoritatively, but it appears to indicate 
that the currents are most successful when the stage of acute inflammation is 
past and when the pain is maintained by some persistent condition or habit 
of the nerve-trunk. In regard to the selection of the current, my expe- 
rience is that it must be purely empirical. The most usually successful is a 
very mild (four to eight cells) chemical current, which should be passed 
steadily for ten minutes down the nerves. It should not be so strong as 
to give actual pain, and must not be interrupted. As in the great majority 
of cases this method of application yields the best results, it should always 
be tried first. When it does good, it nearly always affords relief after, at 
the most, two or three sittings. Some cases receive most benefit from a 738 
FORCES. 
rapidly-interrupted faradic current, which should therefore be tried if the 
continuous current fail. To the employment of electricity should of course 
always be added the proper constitutional treatment of the case. 
In hysteria, in some cases whose nature is very obscure, and rarely as a 
sequela or result of a serious cerebral or spinal lesion, which may have been 
more or less completely recovered from, there exist local anaesthesias of the 
skin. When these are not dependent upon a too serious organic lesion, they 
are often very much benefited, or even cured, by the use of the electric brush. 
This should be large and composed of fine wires, whilst the other electrode 
should consist of a large, well-wetted sponge, placed upon a distant part of 
the body. Either the faradic or the chemical current may be employed; in 
either case it should be a very strong one. 
Application to the Nerve-Centres, and Use as a Tonic.-Gal- 
vanism in various forms has been applied locally to the nerve-centres in 
various diseases. In regard to the brain, I have never yet met with any 
clear clinical evidence of good having been accomplished; and, with our 
present physiological knowledge, it is difficult to imagine in what way or 
under what circumstances cerebral galvanization can produce good results 
On the other hand, harm certainly has been wrought by the application of 
strong currents to the head. Galvanic currents passed through the brain can 
act only as irritants, and I agree entirely with the dictum of Cyon {Principes 
d' Electroti dr apie, Paris, 1873), that galvanization of the head ought to be 
abandoned. 
An enormous amount of influence in all sorts of diseases has been claimed 
for the so-called galvanization of the sympathetic. In this application an 
olive-shaped electrode is pressed firmly into the auriculo-maxillary fossa, 
whilst a large sponge electrode is placed over or by the side of the sixth and 
seventh cervical vertebrae. For anatomical reasons, I do not believe it possible 
in this method to affect the upper cervical sympathetic ganglion; and the 
physiological and clinical evidence seems to me to point to the same con- 
clusion. The ganglion is placed deeply beneath the carotid artery, and so 
situated that any current traversing it en route to the other pole, as usually 
applied, would have to pass through the vertebrae. The laws of electrical 
conduction, however, show that the currents would seek the routes of least 
resistance, so that it is a priori improbable that any appreciable portion of 
the galvanism would pass through the ganglion. 
Leaving all this aside, the physiological proof that the currents of appre- 
ciable power do not reach the ganglion are, to my mind, very absolute. When 
the slightest galvanic stimulus is applied to the bared ganglion, the results 
which follow are uniform, constant, and so apparent that a child can see 
them: they are dilatation of the pupil, and contraction of the vessels of the 
eye, ear, etc., and nothing more. These results do not follow the application 
of the currents in man, as above described. It has been asserted that the 
vessels of the retina have been seen to contract; but Prof. William F, ELECTRICITY. 
739 
Norris, one of the best ophthalmologists in the country, has very closely 
observed the retinal vessels under these circumstances, and has never been 
able to detect the slightest change. Moreover, some of the observers who 
have seen the vessels alter state that they dilate, while others affirm that 
they contract, or that they sometimes contract and sometimes dilate. If the 
vessels change under the influence of the current, why does not the pupil ? 
Any unprejudiced observer can be convinced at once that it does not alter, 
and any prejudiced and not very skilful ophthalmologist may find in the 
retinal vessels what he expects. Drs. Beard and Rockwell strongly insist 
upon the possibility of galvanizing the cervical sympathetic, yet they ac- 
knowledge (Joe. cit., p. 129) "that the ordinary therapeutical measures for 
electrizing the sympathetics do not produce the same effects as electrizing 
the ganglia." This being so, it would seem unnecessary to discuss the sub- 
ject further: yet I shall analyze somewhat the evidence upon which the 
gentlemen mentioned, along with other electro-therapeutists, rest an opinion 
so seemingly opposed to all scientific induction. This evidence, as founded 
on the large series of experiments of Drs. Beard and Rockwell, is embraced 
in the following paragraphs : 
First. The alleged action on the retinal vessels. 
Second. A hypnotic effect was sometimes perceptible, but only in the very 
nervous and impressionable. 
Third. A sensible perspiration was caused when very strong currents were 
used. 
Fourth. The pulse was sometimes accelerated, sometimes slackened. 
In regard to the evidence contained in the first paragraph; as already 
stated, the results of observations are altogether contradictory, even Beard and 
Rockwell stating that " much seemed to depend on the temperament and con- 
dition of the individual; what would cause contraction in one would cause 
dilatation in another." The changes in the retinal vessels could not, under 
these circumstances, have been due to an action of the galvanism upon a gan- 
glion, stimulation of which always produces contraction of the vessels: 
evidently, if alterations of the vessels really occurred, they were the results 
of psychical or other influences, and not directly due to the galvanic current. 
As none of the phenomena mentioned in the second, third, and fourth 
propositions are produced when the bared ganglia is galvanized, and as all of 
them are producible by pain or nervous excitement, it seems very plain that, 
like the asserted retinal changes, they must have had their origin in the 
psychical disturbance of observer or patient. 
Very great therapeutic value has been attached by various writers to the 
effect of galvanization of the spinal cord. As in the case of the sympathetic, 
most opposite opinions are held by equally high authorities: one asserting 
that a downward spinal current dilates and an upward one contracts the 
vessels of the cord, whilst another most strenuously insists that upward cur- 
rents contract the vessels and downward currents dilate them. The same 740 
FORCES. 
line of reasoning that has here been given in regard to the sympathetic 
nerve applies to the spinal cord. The infinitely weak current formed be- 
tween a silver grooved director and a pair of iron forceps, moistened with 
the fluid of the body, will induce when applied to the bared cord very 
distinct evidences of functional excitement, in the form of spasms; and yet 
no current I have ever been able to apply to the spine in patients has ever 
caused a tremor in the muscles other than those of the back. If spinal cur- 
rents do good directly, I conceive it must be by an action upon the nerve- 
peripheries ; for it is entirely possible that such an action may affect the 
nutrition of the cord. Moreover, in some of the diseases in which the 
measure has been practiced with most success, the very great power of the 
emotions is notorious ; and I conceive electricity often cures by acting on the 
mental or moral nature. Of course the cure may be no less real and im- 
portant on this account. In that peculiar affection allied to hysteria, variously 
known as spinal irritation, spinal anaemia, etc., I have seen the application 
of electricity to the back of the greatest service. Sometimes a rapidly-inter- 
rupted, strong faradic current has appeared to be most effectual; some- 
times a moderate, continuous chemical current has best suited the case. In 
spinal congestion, and in chronic spinal inflammations of all forms, I have 
used downward chemical currents in a large number of cases, but in every 
instance other measures were at the same time employed, and only in a very 
few cases has there been any definite evidence of the galvanism being of any 
service. From ten to twenty-five cells may be employed, the positive pole 
being applied for fifteen to twenty minutes upon the nape of the neck, the 
negative over the coccyx or on the centre of the lumbar vertebrae. 
It has recently been shown that galvanism has some tonic powers, and 
may be used as such in cases of simple debility or nervous exhaustion 
without any definite lesions. From what we know of its physiological 
action, it is reasonable to suppose that the force must be able to modify the 
circulation of every part that has muscular fibres in itself or in its blood- 
vessels ; and such parts constitute the great bulk of the body. It has also 
been shown by Dr. S. Weir Mitchell that it is capable of temporarily 
elevating the general bodily temperature. Whether its action is solely by 
modifying the circulation and causing muscular contractions, or whether it 
has also a more direct influence upon the nutritive cell actions, is uncertain. 
Beard and Rockwell* employ two methods of application, which they de- 
nominate general faradization and central galvanization, as follows : 
General Faradization.-In practicing this, the patient should put the 
feet upon a copper plate, which serves as one electrode, or should have a 
large, moistened sponge placed over the coccyx, whilst a large sponge elec- 
trode is passed over the surface of the body. The movable electrode should 
* A Practical Treatise on the Medical and Surgical Uses of Electricity. New York.- 
Wm. Wood A Co. 1875. ELECTRICITY. 
741 
be first placed upon the forehead, then back of the ears, a mild current being 
used. It may then be pressed firmly over the sixth and seventh cervical ver- 
tebrae, and a powerful current employed; then it should be passed to the 
posterior cervical triangle just by the posterior border of the sterno-cleido- 
mastoid muscle; then to the middle of the spine, where very strong cur- 
rents are usually well borne; then down the chest to the pit of the stomach, 
and finally to the extremities. Beard and Rockwell give the following 
as the usual length and proportion of the stance: head, one minute; neck 
and cervical spine, four minutes; back, three minutes; abdomen, three 
minutes; upper and lower extremities, four minutes. 
In employing this method, at first the currents should not be too power- 
ful, afterwards they should be made as strong as can be borne without pain. 
The stances should be held two or three times a week. 
Central Galvanization.-" The object in central galvanization is to bring 
the whole central nervous system-the brain, sympathetic and spinal cord, as 
well as the pneumogastric and depressor nerves-under the influence of the 
galvanic current. One pole (usually the negative) is placed at the epigas- 
trium, while the other is passed over the forehead and top of the head, by 
the inner borders of the sterno-cleido-mastoid muscles, from the mastoid 
fossa to the sternum, at the nape of the neck, and down the entire length of 
the spine." In applying the pole to the head, the hair should be wetted, or, 
if this be objected to, the application should be made to the top of the head, 
locally dampened, and over the prominences back of the ears. Care should 
be taken not to interrupt the current, and in increasing it to use the rheostat 
no oftener than is absolutely necessary. The seance should be repeated twice 
or three times a week, and should be arranged as follows: head, one to two 
minutes (six to eight cells); neck, both sides, one to five minutes (ten to 
fifteen cells) ; back, three to six minutes (ten to thirty cells). 
In regard to the choice of these plans, Beard and Rockwell affirm that 
general faradization is to be preferred where great muscular debility exists; 
central galvanization where there is rather a nervous exhaustion, as in hys- 
teria and chorea, hypochondriasis, etc. In many cases the best effects are 
to be obtained by alternating the modes of application, either from day to 
day or from week to week. 
My own experience leads me to prefer decidedly the induced current as a 
tonic. The plan which I have adopted is to affix a large stationary electrode 
to the feet, or during part of the seance to the coccygeal region, and then 
to apply slowly and successively a smaller electrode to the motor points of the 
various muscles of the upper extremities, neck, trunk, and lower extremities; 
also to place for longer periods one electrode over the larger abdominal 
viscera. The most marked results have been met with in large, relaxed 
multipara, with a tendency to uterine displacement. In these cases one pole 
has been introduced high up into the vagina, and care taken especially to act 
upon the broad ligaments. APPENDIX. 
ON THE ART OF PRESCRIBING MEDICINES. 
In the practical use of remedies, very much depends upon the methods 
of their combination, and, so far as concerns the reputation of the physician, 
no little importance is to be attached to the mere prescription-writing. The 
recipes of the master are very widely seen, and he who is incorrect in the 
grammar or spelling of his English or Latin, or departs without reason from 
the traditional forms, lays himself open to ridicule, than which nothing is 
more damaging. A crooked, bad chirography is the traditional mark of 
learning; but absolute plainness should be a sine qua non in the writer of 
prescriptions. This should also apply to abbreviations: these should be of 
such a character as not only to be readily made out, but also to be so evident 
as to afford no shelter to the apothecary whose carelessness has led to serious 
error. In the case of alkaloids and other powerful remedies, the chief name 
at least should be written in full. In writing the prescription, all the in- 
gredients should first be put down, then the number of doses should be 
decided upon, and the individual amounts of each substance marked seriatim. 
It is a very good custom always to place first upon the list the strongest of 
the drugs employed. Without further comment, the following recipes are 
appended, simply as examples of the method of writing prescriptions: the 
first two only are given in full, with date, signature, etc.: 
John Smith, Esq. 
R Tr. cantharidis, f^ss; 
Tr. ferri chlor., f^ss. 
M. 
S.-Fifteen drops three times a day. 
July 1, 1875. S. W. W. 
R 01. morrhuae, f^ii; 
01. amygdalae amarae, gtt. vi; 
Mucil. acaciae, f^iv. 
M. et ft. emuls. 
S.-Tablespoonful three times a day. 
R Cerat. cantharidis, q. s. 
Ft. emplastrum iii X iv unc. 
S.-Use as directed. 
Jno. Jones, Esq. 
U Syr. scillas, 
Syr. senegas, Sa f^i; 
Liq. morphiae sulph., f^ss; 
Syr. tolutan., q. s. ad f^iii. 
M. 
S.-Dessertspoonful four times a day. 
July 1, 1875. R. S. T. 
R Extr. chirettas, gr. xx; 
Strychnias, gr. i; 
Ferri pulv., Si J 
Oleores. piperis, gr. viii. 
M. et ft. mas. in pil. xx div. 
S.-One before meals. 
743 744 
APPENDIX. 
R Quinim sulph., gr. xxxvi; 
Tr. ferri chloridi, f3iii; 
Glycerina, 
Syrupi, aa f^iss. 
M. 
8.-Dessertspoonful after meals. 
R Hydrarg. chi. mitis, gr. vi; 
Sacchari, q. s. 
M. et ft. pulv. vi. 
S.-Use as directed. 
R Acidi tannici, £i. 
Ft. pulv. in chart, vi div. 
8.-Use as directed. 
R Extr. colocynth. comp., gr. xii; 
Extr. belladonna, gr. ii; 
Aloes, gr. xviii; 
01. caryophyl., gtt. xii. 
M. et ft. pil. xii. 
S.-One at bedtime. 
R Senna, $iii; 
Magnesii sulphatis, 
Manna, aa. ^ss; 
Faniculi, 3* > 
Aqua bullientis, Oss. 
Macera per horam in vase leviter clause 
et cola. 
S.-Black Draught. Dose.-A teacupful 
every six hours, until it operates.* 
The art of combining remedies is not a difficult one; but in practice cer- 
tain principles should not be lost sight of. Chief of these are, to prescribe as 
few remedies as possible, and to use no powerful drug without a very distinct 
idea of what it is intended to do. Whenever it is desired to give a power- 
ful remedy in increasing doses until its physiological effect is produced, it 
should always be given by itself. Thus, it may be necessary to give arsenic 
so as to impress the system, at the same time that iron is indicated; but the 
two remedies should be given separately, so that the dose of either can be 
increased or diminished independently of the other. 
The principles of combination, formulated below, were long ago enunciated 
by Dr. Paris, but are to-day as imperative as ever. Medicines are combined : 
First. To augment, correct, or modify the action of a medicine. Thus, 
purgatives act much more kindly when a number of them are united to- 
gether. The chief reason of this probably is, that as different remedies 
affect different portions of the gut, the whole intestine is best reached by a 
union of the diverse substances. It may take an intense irritation of the 
mucous membrane to purge as actively as does a mild irritation of both the 
mucous membrane and the muscular coat. In the case of neurotics, the 
principle has a very limited action, because so many of this class of reme- 
dies are physiologically more or less antagonistic; yet sometimes the prin- 
ciple can be advantageously applied: thus, the anaesthesia of chloroform or 
ether may be prolonged by a hypodermic injection of morphia; and chloral 
and morphia certainly make a mixture which is much more powerfully 
hypnotic than is either of the substances separately. 
Second. To obtain the joint action of two or more diverse remedies. 
Thus, in a cough mixture, morphia may be included to quiet the cough, 
♦ These prescriptions are printed as usually written, with abbreviations. The full 
sentences of directions to the apothecary are:-Misce et fiat emulsio-Fiat emplastrum 
iii X xiv unciarum-Misce-Misce et fiat massa in pilulas viginti dividendus-Misce et 
fiat pulveres sex-Fiat pulvis in chartulas duodecim dividendus-Misce et fiat pilula 
duodecim. APPENDIX. 
745 
whilst ipecacuanha and squill (in accordance with the first principle) are 
added to affect the mucous membrane. The application of this principle 
requires caution, or the practitioner will be led into that chief abomination, 
polypharmacy. It is worse than futile to attempt to prescribe for every 
symptom. It is the underlying cause of the disorder or the under-stratum 
of bodily condition which must be sought out and prescribed for simply. 
Third. To obtain a special combination, which is really a new remedy, or 
which experience has shown acts almost as a new remedy. Thus, when to 
iodide of potassium in solution corrosive sublimate is added, a new chemical 
compound is formed, which experience has shown to be of great value in 
syphilitic diseases. Griffith's antihectic mixture is another instance of the 
use of chemical changes, the proto-carbonate of iron being formed out of 
the sulphate of the metal and the carbonate of potassium. In the famous 
Dover's powder no chemical change occurs, but the ordinary action of opium 
upon the skin is so enhanced that the combination may be looked upon 
almost as a new remedy. 
Fourth. To afford a suitable form. Thus, acacia is added to make an 
emulsion, or confection of rose to make a pill. In the choice of excipients, 
care should be exercised to select a substance free from medical properties, 
having no chemical incompatibility with the medicinal agent, and of suitable 
physical character. Bread-crumbs often make a good basis for pills; but 
with nitrate of silver they are chemically incompatible, on account of the 
chlorides in them. When writing a prescription, the utmost care should be 
taken to use such excipients that the combination should not only be attract- 
ive to the eye, but also as little repulsive to the palate as may be. When- 
ever possible, the pill form should be employed with bitter or disagreeable 
medicines. The pill may be readily coated with silver-foil; tonic pills may 
be coated with iron by shaking or rolling them in ferri pulvis whilst soft 
and sticky. Sugar-coated pills and " compressed pills" are apt to get so hard 
and insoluble that their use requires caution. In regard to mixtures, 
flavoring oils should be freely used, and the power of glycerine to conceal 
the disagreeable taste of many substances should be remembered. 
Incompatibilities.-In combining remedies, the subject of incompatibilities 
must never be lost sight of. The kinds of incompatibility are two in number,- 
physiological and chemical. The first of these it would require large space 
to discuss fully, and any one familiar with the text of the book, if possessed 
of the slightest reasoning powers, can readily make all necessary deductions. 
In many works on materia medica long lists of chemical incompatibilities 
are given in the accounts of individual drugs. These lists have seemed to 
me useless, as I have never met with a student who could commit and retain 
them. Moreover, they contain so much matter of no practical use that the 
valuable portion is hidden out of sight. A certain amount of chemical 
knowledge is essential to the student, and is not to be taught in a book like 
the present. He who would ignorantly combine sulphuric acid and a car- 746 
APPENDIX. 
bonate needs to re-study his chemical text-book. All that I shall do here is 
to point out certain principles and a few especial reactions. The following 
rules may serve for a guide : 
Soluble salts which can, by mutual decomposition, form an insoluble 
compound, will undergo such decomposition when they meet in solution, 
and will precipitate, unless in some very rare instances, in which a double 
salt is formed. 
Soluble salts which are not capable of forming an insoluble salt never 
precipitate, and rarely undergo decomposition when they meet in solution. 
Mineral acids decompose salts of the weaker (carbonic, acetic, etc.) acids, 
and form ethers with alcohol and alcoholic preparations. 
Alkalies precipitate the alkaloids and the soluble non-alkaline metallic 
salts. 
Glucosides, such as santonin and colocynthin, should not be prescribed 
with free acids or emulsin. 
Tannic acid and all substances containing it are incompatible with alka- 
loids and drugs containing them, with albumen and gelatine, and with most 
soluble metallic salts used in medicine. 
Iodine and soluble iodides are incompatible with the alkaloids and the 
substances containing them, as well as with most soluble metallic salts. The 
iodide of potassium* should always be prescribed alone, or only in combina- 
tion with corrosive sublimate (with which it forms a double salt), or with 
iodine itself. 
Tinctures and other alcoholic preparations containing resin precipitate 
the latter when water is added. 
Nitrate of silver should always be prescribed alone, or in combination 
with opium only. Most vegetable extracts decompose it, and with creasote 
it is said to make an explosive compound. 
Corrosive sublimate is incompatible with almost everything, and should 
be given in simple syrup; even the compound syrup of sarsaparilla is said 
to decompose it. 
Syrup of squill containing acetic acid is incompatible with carbonate of 
ammonium, but not with the chloride. 
Acetate and subacetate of lead are incompatible with almost everything, 
but are nevertheless frequently used in lotion with opium, the insoluble 
compound formed being therapeutically active. 
Vegetable infusions are generally incompatible with metallic salts. 
♦ Death has resulted from a prescription containing strychnia and iodide ,f potassium, 
all the alkaloid being taken at the last dose. APPENDIX. 
747 
WEIGHTS AND MEASURES OF THE UNITED STATES PHARMACOPEIA. 
Pound, tt> = 12 Ounces. Gallon, C = 8 Pints. 
Ounce, 5 = 8 Drachms. Pint, O =16 Fluidounces. 
Drachm, 3 = 3 Scruples. Fluidounce, f^ = 8 Fluidrachms. 
Scruple, g = 20 Grains. Fluidrachm, f^ = 60 Minims. 
Grain, gr. = 1 Grain. Minim, TIP = 1 Minim. 
WEIGHTS AND MEASURES OF THE METRICAL OR FRENCH SYSTEM. 
MEASURES OF LENGTH. 
One Myriametre = 10,000 Metres. 
One Kilometre = 1,000 Metres. 
One Hectometre = 100 Metres. 
One Decametre = 10 Metres. 
One METRE = the ten-millionth part of a quarter of the meridian of the eartn. 
One Decimetre = the tenth part of one Metre, or 0.1 Metre. 
One Centimetre = the hundredth part of one Metre, or 0.01 Metre. 
One Millimetre = the thousandth part of one Metre, or 0.001 Metre. 
WEIGHTS. 
One Myriagramme = 10,000 Grammes. 
One Kilogramme = 1,000 Grammes. 
One Hectogramme = 100 Grammes. 
One Decagramme = 10 Grammes. 
One GRAMME = the weight of a cubic Centimetre of water at 4° C. 
One Decigramme = the tenth part of one Gramme, or 0.1 Gramme. 
One Centigramme = the hundredth part of one Gramme, or 0.01 Gramme. 
One Milligramme = the thousandth part of one Gramme, or 0.001 Gramme. 
One Myrialitre = 10 cubic Metres, or the measurO of 10 Milliers of Water. 
One Kilolitre = 1 cubic Metre, or the measure of 1 Millier of Water. 
One Hectolitre = 100 cubic Decimetres, or the measure of 1 Quintal of Water. 
One Decalitre = 10 cubic Decimetres, or the measure of 1 Myriagramme of Water. 
One LITRE .= 1 cubic Decimetre, or the measure of 1 Kilogramme of Water. 
One Decilitre = 100 cubic Centimetres, or the measure of 1 Hectogramme of Water. 
One Centilitre = 10 cubic Centimetres, or the measure of 1 Decagramme of Water 
One Millitre = 1 cubic Centimetre, or the measure of 1 Gramme of Water. 
MEASURES OF CAPACITY. 748 
APPENDIX. 
RELATION OF WEIGHTS AND MEASURES OF THE U. S PHARMACOPEIA 
TO EACH OTHER. 
One Pound = 0.7900031 Pint = 6067.2238 Minims. 
One Ounce = 1.0533376 Fluidounces = 505.6019 Minims. 
One Drachm = 1.0533376 Fluidrachms = 63.2002 Minims. 
One Scruple = = 21.0667 Minims. 
One Grain = * = 1.0533 Minims. 
One Gallon = 10.1265427 Pounds = 58328.8862 Grains. 
One Pint = 1.2658178 Pounds = 7291.1107 Grains. 
One Fluidounce = 0.9493633 Ounce = 455.6944 Grains. 
One Fluidrachm = 0.9493633 Drachm = 56.9618 Grains. 
One Minim = 0.9493 Grain. 
In distilled water at the temperature of 60°. 
RELATION OF MEASURES OF THE U. S. PHARMACOPEIA TO CUBIC 
MEASURE. 
One Gallon =231. Cubic Inches. I 
One Pint = 28.875 Cubic Inches. 
One Fluidounce = 1.80468 Cubic Inches. I 
Ono Fluidrachm = 0.22558 Cubic Inch. 
One Minim = 0.00375 Cubic Inch. 
RELATION OF WEIGHTS OF THE U. S. PHARMACOPEIA TO METRICAL 
WEIGHTS. 
Fractions of a grain in 
Milligrammes. 
Grain. Milligrammes. 
A = 1-012 
& = 1.079 
& = 1.295 
A = 1.349 
A = 1.619 
A = 1.799 
& = 2.159 
= 2.591 
A - 2.699 
* = 3.239 
A = 4.049 
* = 4.319 
A = 5.399 
A = 6.479 
I = 8.098 
J = 10.798 
1 = 12.958 
J = 16.197 
J = 21.597 
J = 32.395 
Grains in equivalent 
metrical weights. 
Grains. Centigrammes. 
1 = 6.479 
Decigrammes. 
2 = 1.295 
3 = 1.943 
4 = 2.591 
5 = 3.239 
6 = 3.887 
7 = 4.535 
8 = 5.183 
9 = 5.831 
10 = 6.479 
12 = 7.775 
15 = 9.718 
Grammes. 
16 = 1.036 
20 = 1.295 
24 = 1.555 
25 = 1.619 
30 = 1.943 
40 = 2.591 
50 = 3.239 
60 = 3.887 
Drachms, Ounces, and Pounds in 
equivalent metrical weights. 
Drachma. Grammes. 
1 = 3.887 
2 = 7.775 
Decagrammes. 
3 = 1.166 
4 = 1.555 
5 = 1.943 
6 = 2.332 
7 = 2.721 
Ounces. 
1 = 3.1103 
2 = 6.2206 
3 = 9.3309 
Hectogrammes. 
4 = 1.2441 
5 = 1.5551 
6 = 1.8661 
7 = 2.1772 
8 = 2.4882 
9 = 2.7992 
10 = 3.1103 
11 = 3.4213 
Pounds. 
1 = 3.7324 
2 = 7.4648 
Kilogrammes. 
3 = 1.1197 APPENDIX. 
749 
RELATION OF METRICAL WEIGHTS TO WEIGHTS OF THE U. S. 
PHARMACOPEIA. 
Metrical Exact Approximate 
'nite equivalents equivalents in 
weig as. grains. 
Milligrammes. 
1 = .0154 & 
2 = .0308 & 
3 = .0463 & 
4 = .0617 
5 = .0771 & 
6 = .0926 
7 = .1080 A 
8 = .1234 I 
9 = .1389 | 
Centigrammes. 
1 = .1543 J 
2 = .3086 4 
3 = .4630 
4 = .6173 £ 
5 = .7717 3 
6 = .9260 
7 = 1.0803 1 
8 = 1.2347 H 
9 = 1.3890 li 
Decigrammes. 
1 = 1.543 1$ 
2 «= 3.086 3 
3 = 4.630 4J 
4 = 6.173 6 
5 = 7.717 74 
6 = 9.260 9 
7 = 10.803 11 
8 = 12.347 124 
9 » 13.890 14 
Metrical E?a? , Approximate 
wmi, equivalents equivalents tn 
weighs. <n grains Troy WeighL 
Grammes. 
1 = 15.434 gr. xv. 
2 = 30.868 3ss. 
3 = 46.302 9ij. 
4 = 61.736 3i. 
5 = 77.170 ^iv. 
6 = 92.604 §iss. 
7 = 108.038 9vs8. 
8 = 123.472 3ij. 
9 = 138.906 Qvij. 
Decagrammes. 
1 = 154.340 3iiss. 
2 = 308.680 5v. 
3 = 463.020 ^viias. 
4 = 617.360 $x. 
5 = 771.701 3xiij. 
6 = 926.041 $xv. 
7 = 1,080.381 Sxviij. 
8 = 1,234.721 $xx. 
9 = 1,389.062 Sxxiij. 
Hectogrammes. 
1 = 1,543.402 Siii ^v. 
2 = 3,086.804 gvj 5iij. 
3 = 4,630.206 gix 5v. 
4 = 6,173.609 ibi £vij. 
5 = 7,717.011 ibi ^iv. 
6 = 9,260.413 ibi ^vij. 
7 = 10,803.816 ibi gx ^iv. 
8 = 12,347.218 Ibij gi 3v. 
9 = 13,890.620 ibij §v. 
Kilogramme. 
1 = 15,434.023 ibij £viij. 
Myriagramme. 
I - 154,340.023 {1^. 750 
APPENDIX. 
FABLE OF THE PROPORTION BY MEASURE OF ALCOHOL (SP. 
GR. 0.825) CONTAINED IN ONE HUNDRED PARTS 
OF DIFFERENT WINES, ETC* 
Lisa (mean) 25.41 
Raisin wine (mean)... 25.12 
Marsala [Sicily ma- 
deira] (mean)... 25.09 
strongest (J.) 21.10 
weakest (J.) 19.90 
Port, strongest 25.83 
mean 22.96 
weakest 19.00 
strongest (C.) 20.49 
mean (C.) 18.68 
weakest (C.) 16.80 
strongest (J.) 23.20 
weakest (J.) 20.70 
White port (C.) 17.22 
Madeira, strongest 24.42 
mean 22.27 
weakest 19.24 
strongest (C.) 20.35 
strongest (J.) 19.70 
weakest (J.) 19.00 
Sercial madeira 21.40 
Ditto (C.) 18.50 
Sherry, strongest 19.81 
mean 19.17 
weakest 18.25 
strongest (C.) 19.31 
mean (C.) 18.47 
weakest (C.) 16.96 
Amontillado (C.). 15.18 
strongest (J.) 24.70 
weakest (J.) 15.40 
Teneriffe 19.79 
Cider, highest average 9.87 
lowest average.... 5.21 
Perry, average of four 
samples 7.26 
Mead 7.32 
ale (Burton) 8.88 
Teneriffe (C.) 16.61 
Colares 19.75 
Lachryma Christi 19.70 
White Constantia 19.75 
Red Constantia 18.92 
Lisbon 18.94 
Ditto (C.) 19.09 
Bucellas 18.49 
Red madeira (mean).. 20.35 
Cape muscat 18.25 
Cape madeira (mean). 20.51 
Grape wine 18.11 
Calcavella (mean) 18.65 
Vidonia 19.25 
Alba flora 17.26 
Zante 17.05 
Malaga 17.26 
White hermitage 17.43 
Roussillon (mean) 18.13 
Claret (strongest) 17.11 
mean 15.10 
weakest 12.91 
ditto (F.) 14.73 
vin-ordinaire (C.) 10.42 
Chateau-Latour, 
1825 (C.) 9.38 
first growth, 1811 
(C.) 9.32 
strongest (J.) 11.10 
weakest (J.) 9.10 
Malmsey madeira 16.40 
Ditto (C.) 15.60 
Ale (Edinburgh) 6.20 
Ale (Dorchester) 5.56 
Brown stout 6.80 
London porter 4.20 
London small beer 1.28 
Lunel 15.52 
Ditto tF.) 18.10 
Shiraz 15.52 
Ditto (C.) 15.56 
Syracuse 15.28 
Sauterne 14.22 
Burgundy (mean) 14.57 
strongest (J.) 13.20 
weakest (J.) 10.10 
Hock (mean) 12.08 
strongest (J.) 13.00 
weakest (J.) 9.50 
Nice 14.63 
Barsac 13.86 
Tent 13.30 
Champagne (mean)... 12.61 
Ditto (F.) 12.20 
Ditto, strongest (J.)... 14.80 
weakest (J.) 14.10 
Red hermitage 12.32 
Vin de Grave (mean). 13.37 
Frontignac (Rives 
Aites) 12.79 
Ditto (C.) 12.29 
C6te rOtie 12.32 
Tokay 9.88 
Rudesheimer, first 
quality (C.) 10.14 
inferior (C.) 8.35 
Hambacher, first qual. 
(C.) 8.88 
Catawba (Stearns).... 8 to 11 
Brandy 53.39 
Rum 53.68 
Gin 51.60 
Scotch whisky 54.32 
Irish whisky 53.90 
* The analyses whose results are given in this table were mostly made by Mr. Brande. 
When no mark is attached, the quotation is upon his authority. When the mark (F.) is 
added, the analysis was made by Julia-Fontenelle ; (C.) by Professor Christison; (J.) by 
Dr. H. Bence Jones. APPENDIX. 
751 
1, M. corrugator supercil.; 2, M. 
compressor nasi et pyramidal, nasi; 
3, M. orbicular, palpebr.; 4, M. leva- 
tor lab. sup. alteque nasi; 5, M. 
levator lab. sup. propr.; 6, M. zygo- 
matic. minor; 7, M. dilatat. narium 
ant. et post.; 8, M. zygomatic, major; 
9, M. orbicularis oris; 10, Ram. comm, 
pro Mm. triangular, et levator menti; 
11, M. levator menti; 12, M. quad- 
ratus menti; 13, M. triangularis 
menti; 14, Rami subcutan. colli N. 
facial.; 15, Rami cervical, pro Platys- 
mat. ; 16, M. sterno-hyoideus; 17, M. 
omo-hyoideus; 18, M. sterno-thyroi- 
deus; 19, M. sterno-hyoideus; 20, M. 
frontalis; 21, Mm. attrahens et at- 
tollens auriculas; 22, Mm. retrahens 
et attoll. auriculae; 23, Muse, occipi- 
talis; 24, Nerv. facialis; 25, Ram. 
auricular, post. prof. N. facialis; 26, 
M. stylo-hyoideus; 27, M. digastricus; 
28, Rami buccales, N. facialis; 29, M. 
splenins capitis; 30, Rami subcutan. 
maxill. infer.; 31, Ram. ext. N.acces- 
sorii Willisii; 32, M. sterno-cleido- 
mastoideus; 33, M. cucullaris; 34, M. 
sterno-cleido-mastoideus; 35, M. leva- 
tor. anguli scapulae; 36, N. thoracic, 
post. (Mm. rhomboidei); 37, N. 
phrenicus; 38, M. omo-hyoid; 39, N. 
thoracic, lateral. (M. serrat. magn.); 
40, N. axillaris; 41, Ram. plex. 
brachialis (N. musculocutan.,pars N. 
mediant); 42, N. thoracic, ant. (M. 
pectorales). 
M. serrat. magn. 
M. latissimus 
dorsi. 
M. rectus ab- 
dominis. 
(Nervi inter-1 
costales abdo- 
minal es.) 
M obliquus 
abdominis ex- 
tern us. 
(Nervi inter- 
cos tales ab- 
dominal es.) 
M. transversus 
abdominis. 752 
APPENDIX. 
N. cruralis.., 
M. tensor fasciae lat. (Ram. N 
glutaei sup.) 
N. obturatorius.... 
M. sartorius 
M. tensdr fasciae lat. (Ram. N 
cruralis.) 
M. adductor longus 
Ram. N. cruralis pro M. quadri-, 
cipitus. 
M. rectus femoris 
M. cruralis... 
Ram. N. cruralis pro M. vasto Int. 
M. vastus exterzus. 
M. vastus externus. 
M. peroneus l-'ngng... 
Nerv. peroneus 
M. tibialis anticua- 
M. gastrocnem. externua 
M. soleus. 
M. extensor digitor. com 
munis longus. 
M. peroneus brevis. 
M. soleus. 
M extens. halluc. longus. 
M. flexor hallucis longus. 
Ram. N. peron. prof pro 
M. extens. digitor. 
brev. 
M. extensor digitor. com- 
munis brevis. 
Mm. interossei pedis dor- 
sales. 
M. abductor digiti minimi 
pedis. APPENDIX. 
753 
Bam. Inf. N. glut. inf. pro M. glut, 
maximus - 
N. Ischiadicus 
M. biceps (Caput longum) 
M. adductor magnus 
M. semitendinosus. 
M. semimembranosus. 
M. biceps (Caput breve)... 
N. tibialis 
N. peroneus.. 
M. gastrocnemius externus 
M. soleus ... 
M. gastrocnemius intern us. 
M. gastrocnemius internus.. 
M. soleus.... 
M. flexor digitor. communis longus... 
N. tibialis.. 
M. abductor hallucis... 754 
APPENDIX. 
N. musculocutaneus. 
M. biceps. 
N. musculo- Cap. intern. N. media- N. ulnaris. Ram. N. median! 
cutaneus. M. tricipit. nus. M. brachialis pro M. pronator. 
interims. 
Ram. Nervi median! pro M. 
p»'<nat. teret 
SI. palmaris longus.. 
M. radialfe internua. 
M. ulnaris internus... 
flexor digitor. profund 
M. flexor digitor. sublim. (di- 
gitt. II et III.) 
M. flexor digitor. sublim 
N. ulnaris.. 
SI. flexordigitor. sublini. (digitt. 
indicia et minimi) 
M. flexor pollicis longus. 
N. medianus. 
Bam. volar, prof. Nervi ulnar. 
SI. palmaris brevis 
M. abductor digitor. min 
M. flexor digitor. min 
M. opponens digitor. min 
M. abductor pollicis brevis, 
M. opponens pollicis. 
M. flexor pollicis brevis. 
M. adductor pollicis. 
SI. lumbricalis I. 
Mm. lumbricales II, III et IV-^ APPENDIX. 
755 
Caput extern. M. tricipit. 
N. radialis .......... 
M. brachialis internus........ 
M. supinatorlongus.. 
M. radialis externua long. 
M. radialis externus brevis 
M. radialis externus longus.. 
M. supinator longus... 
M. radialis externus brevis.... 
M. extensor digitor. connnunia - 
M. extensor indicia propr. 
M. extensor indicia propr. et M. 
abductor pollicis longus. 
M. abductor pollicis longus 
. M. ulnaris externns. 
M. extensor digit, min. propr. 
M. extensor pollicis brevis... 
- M. extensor indicia propr. 
M. flexor nollicis longus 
M. extensor pollicis longus. 
M. interosseus dorsalis L..... 
M. interoseeus dorsalis II 
M. abductor digiti minimi. 
M. interosseua dorsalis IIIMa< 
. M. interosaeus dorsalis IV. GENERAL INDEX. 
A. 
Absorbents, 661. 
Abstract of aconite, 195. 
of belladonna, 296. 
of conium, 406. 
of digitalis, 158. 
of ignatia, 341. 
of jalapa, 512. 
of nux vomica, 326. 
of seneka, 577. 
Acacia, 625. 
Aceta, 18. 
Acetate of ammonium, 566. 
of copper, 49. 
of lead, 42. 
of morphine, 255. 
of potassium, 534. 
of sodium, 645. 
of zinc, 46. 
Acetated tincture of opium, 
255. 
Acetic acid, 210. 
Acetum, 210. 
lobelias, 392. 
opii, 255. 
sanguinariae, 477. 
scillae, 525. 
Acid, benzoic, 578. 
carbazotic, 86. 
copaivic, 548. 
cubebic, 550. 
gentisic, 59. 
hydrobromic, 367. 
meconic, 263. 
nitrate of mercury, 623. 
oxalate of potassium, 
211. 
picric, 86. 
salicylic, 689. 
Acidum aceticum, 210. 
aceticum dilutum, 210. 
aceticum glaciale, 210. 
arseniosum, 409. 
benzoicum, 578. 
boricum, 673. 
carbolicum, 676. 
carbolicum crudum, 
676. 
chromicum, 624. 
citricum, 208. 
gallicum, 29. 
glaciale, 210. 
Acidum hydrobromicum 
dilutum, 367. 
hydrochloricum, 107. 
hydrochloricum dilu- 
tum, 108. 
hydrocyanicum, 196. 
hydrocyanicum dilu- 
tum, 196. 
lacticum, 111. 
muriaticum, 107, 623. 
muriaticum dilutum, 
108. 
nitricum, 108, 623. 
nitricum dilutum, 109. 
nitro-hydrochloricum, 
109. 
nitromuriaticum, 109. 
nitromuriaticum dilu- 
tum, 111. 
nitrosum, 109. 
oxalicum, 211. 
phosphoricum dilutum, 
453. 
picrum, 86. 
salicylicum, 689. 
sulphuricum, 105, 623. 
sulphuricum aromati- 
cum, 107. 
sulphuricum dilutum, 
107. 
sulphurosum, 675. 
tannicum, 26. 
tartaricum, 207. 
valerianicum, 214. 
Aconella, 185. 
Aconite leaves, 185. 
as a diaphoretic, 559. 
root, 185. 
Aconitine, 194, 195. 
crystallized, 193. 
Aconitum, 184. 
antidote for, 195. 
Adeps, 31. 
benzoinatus, 581. 
Adhesive plaster, 40, 140. 
Administration, methods of, 
20. 
JEther, 310. 
fortior, 310. 
African pepper, 92. 
Age, in relation to dose, 22. 
Alcohol, 126. 
as a sudorific, 567. 
Alcohol dilutum, 128. 
fortius, 126. 
Alexandria senna, 507. 
Alkalies, 641. 
Allium, 582. 
Allspice, 90. 
Aloe, 504. 
Barbadensis, 505. 
Capensis, 505. 
purificata, 507. 
Socotrina, 505. 
Aloin, 505. 
Alteratives, 408. 
Althaea, 628. 
Alum, 32. 
as an emetic, 482. 
curd, 34. 
Alumen, 32. 
exsiccatum, 32. 
sulphas, 34. 
Amber, 220. 
American hellebore, 169. 
hemp, 263. 
Ammonia, 122, 641. 
Ammonia-aluin, 32. 
Ammoniac, 577. 
mixture, 577. 
plaster, 577. 
Ammoniacum, 577. 
Ammoniated copper, 48. 
mercury, 437. 
tincture of guaiac, 467 
tincture of valerian 
214. 
Ammonii acetas, 566. 
bromidum, 364. 
carbonas, 126. 
chloridum, 573. 
nitras, 126. 
sulphas, 126. 
valerianas, 214. 
Ammonio-citrate of bis- 
muth, 45. 
Ammonio-ferric alum, 104 
126. 
Amorphous hyoscyamine, 
298. 
Amygdalin, 62. 
Amyl, nitrite of, 381. 
valerianate of, 391. 
Amyli nitritum, 381. 
Amylic alcohol, 381. 
Anaesthetics, 302. 
757 758 
GENERAL INDEX. 
Analectronous, 690. 
Analgesics, 240. 
Animal charcoal, 661. 
quinoidin, 80. 
Anise, 93. 
water, 93. 
Anisum, 93. 
Anodes, 718. 
Antacids, 641. 
Anthelmintics, 648. 
Anthemis, 89. 
Antihydropin, 542. 
Antimonial ointment, 169. 
plaster, 169. 
wine, 169. 
Antimonii et potassii tar- 
tras, 163. 
oxidum, 163. 
sulphidum, 163. 
purificatum, 163. 
sulphuretum, 163. 
Antimony, 163. 
Antipyrin, 701. 
Antiseptics, 663. 
Antispasmodics, 212. 
Apiin, 586. 
Apiol, 586. 
Apomorphine, 477. 
Aquae ammonia, 126, 618. 
ammonia fort., 126,618. 
chlori, 670. 
camphora, 218. 
cinnamomi, 90. 
Aqua, 18. 
Arabin, 626. 
Araroba, 503. 
Arbuten, 544. 
Argel, 507. 
Argenti cyanidum, 57, 206. 
iodidum, 57. 
nitras, 49. 
nitras dilutus, 57. 
nitras fucus, 49. 
oxidum, 57. 
Argentum, 49. 
Argol, 207. 
Argyria, 51, 56. 
Arnica flowers, 177. 
root, 177. 
Arnicina, 177. 
Aromatic bitters, 88. 
powder, 90. 
spirit of ammonia, 126. 
sulphuric acid, 107. 
syrup of rhubatb, 504. 
tincture of rhubarb, 
504. 
Aromatics, 88. 
true, 89. 
Arrow-root, 629. 
Arseniate of sodium, 423. 
Arsenic, 409. 
antidotes for, 422. 
as a caustic, 621. 
eating, 414. 
Arsenical paper, compound, 
420. 
paste, 621. 
Arsenici iodidum, 423. 
Arsenious acid, 409. 
Arsenious ointment, 621. 
Arsenite of potassium, 423. 
Artificial camphor, 141. 
Asafetida, 214. 
Asiatic pill, 394. 
Aspic, 94. 
Aspidium, 654. 
Assafoetida, 214. 
mixture, 215. 
Astley Cooper's arsenious 
paste, 621. 
Astringents, 25. 
mineral, 32. 
vegetable, 26. 
Atomization, 21, 569. 
Atropine, 296. 
antagonism to Calabar 
bean, 354. 
antagonism to jabo- 
randi, 565. 
Atropinae sulphas, 296. 
Aurantii amari cortex, 93. 
dulcis cortex, 93. 
flores, 93. 
Azedarach, 649. 
B. 
Balm, 89. 
Balsam of Peru, 581. 
of tolu, 581. 
Balsamum Peruvianum, 
581. 
Tolutanum, 581. 
traumaticum, 581. 
Banks oil, 448. 
Barbadoes aloes, 505. 
Barberry, 61. 
Bark of pomegranate root, 
654. 
Barley, 630. 
water, 630. 
Barytina, 178. 
Bassorin, 626. 
Baths, cold, 707. 
hot, 553, 667. 
Turkish, 553. 
vapor, 553. 
Bean of St. Ignatius, 341. 
Bearberry, 544. 
Bebeerine, 60. 
sulphate, 60. 
Bebeeru bark, 60. 
Belladonna in opium-poi- 
soning, 289. 
leaves, 269. 
plaster, 270. 
root, 269. 
Belladonna folium, 269. 
radix, 269. 
Benzoic acid, 578. 
Benzoin, 577. 
Benzoinum, 577. 
Berberine, 61, 514. 
Berberis, 61. 
Bicarbonate of potassium, 
534. 
of sodium, 644. 
Bichloride of mercury, 434. 
Bichloride of methylene, 
324. 
Biniodide of mercury, 436. 
Bismuth, 44. 
Bismuthi citras, 45. 
et ammonii citras, 45. 
subcarbonas, 44. 
subnitras, 44. 
Bismuthum, 44. 
Bisulphate of quinine, 84. 
Bitartrate of potassium, 534. 
Bitter orange peel, 93. 
Bitters, peculiar, 62. 
simple, 56. 
Black draught, 507. 
drop, 255. 
ginger, 91. 
hellebore, 585. 
mustard, 616. 
oak, 31. 
oil, 448. 
oxide of manganese, 
104. 
pepper, 91. 
snakeroot, 222. 
wash, 437. 
Blackberry, 32. 
Blatta orientalis, 542. 
Blattic acid, 542. 
Bleaching powder, 672. 
Blistering cerate, 614. 
Blisters, 610, 614. 
Bloodroot, 476. 
Blue galls, 30. 
mass, 432, 500. 
ointment, 432, 500. 
pills, 432, 500. 
Bluestone, 47. 
Boneblack, 661. 
Boneset, 61. 
Bonwill's method of anaes- 
thesia, 304. 
Boracic acid, 673. 
Borax, 673. 
Boric acid, 673. 
Bougies, 21. 
Bran, 493. 
Brandy,126. 
Brayera, 650. 
Brazilian sarsaparilla, 463. 
Bromal hydrate, 367. 
Bromated camphor, 218. 
Bromcamphor, 219. 
Bromide of ammonium, 364. 
of camphor, 218. 
of ethyl, 325. 
of iron, 104. 
of lithium, 366. 
of potassium, 356. 
of quinine, 84. 
of sodium, 366. 
Brominated camphor, 219. 
Bromine, 624, 671. 
Bromoform, 325. 
Bromum, 624, 671. 
Broom, 528. 
Brown mixture, 628. 
oil, 448. 
sugar, 493. 
Brucine, 341. GENERAL INDEX. 
759 
Chalk mixture, 647. 
Chamomile, 89. 
Champagne, 139. 
Charcoal, 661. 
poultices, 661. 
Charta arsenicalis compos- 
ita, 420. 
cantharidis, 614. 
sinapis, 617. 
Chartae, 19. 
Chelerythrin, 476. 
Chemical current, 685. 
food, 456. 
Chenopodium, 649. 
Chian turpentine, 143. 
Chili saltpetre, 537. 
Chimaphila, 545. 
Chimaphilin, 545. 
Chinoidin, 86. 
Chinoidinum, 86. 
Chiretta, 62. 
Chloral, 368. 
alcoholate, 368. 
camphor, 379. 
hydrate, 368. 
poisoning, 378. 
Chlorate of potassium, 539. 
of sodium, 541. 
Chloride of ammonium, 574. 
of iron, 102. 
of mercury, corrosive, 
433. 
of mercury, mild, 433. 
of potassium, 433. 
of zinc, 622. 
Chlorinated lime, 672. 
Chlorine, 670. 
water, 670. 
Chlorum, 670. 
Chloroform, 315. 
Chloroformum purificatum, 
316. 
venale, 316. 
Cholagogues, 488. 
Chondrus, 627. 
Chromic acid, 624. 
Chrysaroba, 503. 
Chrysophanic acid, 503. 
Churrus, 263. 
Cigarettes, arsenical, 420. 
Cimicifuga, 222. 
Cinchona, 63. 
flava, 64. 
pale, 63. 
pallida, 63. 
red, 64. 
rubra, 64. 
yellow, 64. 
Cinchonidine, 85. 
Cinchoninae sulphas, 85. 
Cinchonine, 85. 
sulphate of, 85. 
Cinchonism, 66. 
Cinnamic acid, 581. 
Cinnamon, 89. 
water, 90. 
Citrate of bismuth, 45. 
of bismuth and ammo- 
nium, 45. 
of iron, 103. 
Buchu, 543. 
Buckthorn, 495. 
Burgundy pitch, 618. 
pitch plaster, 618. 
Burnt alum, 34, 624. 
Butternut, 504. 
Butyl chloral hydrate, 380. 
Buxia, 60. 
C. 
Cacao butter, 631. 
Cadmii sulphas, 47. 
Cadmium, 47. 
Caffea, 223. 
Caffeine, 223. 
Calabar bean, 342. 
Calabarina, 342. 
Calabarinum purum (foot- 
note), 342. 
Calamine, 46. 
Calamus, 94. 
Calcii carbonas praecipitata, 
646. 
Calcii phosphas praecipita- 
tus, 453. 
California buckthorn, 495. 
Calisaya bark, 64. 
Calomel, 433. 
as a purge, 500. 
Caloric, 704. 
Calumba, 61. 
Calx, 645. 
chlorata, 672. 
sulphurata, 498. 
Gamboge, 517. 
Camphor, 215. 
Camphor, artificial, 141. 
bromated, 218. 
carbolated, 219. 
cymol, 216. 
mixture, Hope's, 219. 
monobromate of, 218. 
oil, 215, 218. 
water, 218. 
Camphora, 215. 
Camphorated tincture of 
opium, 254. 
Canada balsam, 546. 
erigeron, 546. 
fleabane, 546. 
pitch, 618. 
pitch plaster, 618. 
turpentine, 546. 
Canna, 630. 
Cannabin, 263. 
Cannabis Americana, 263. 
Indica, 263. 
Canquoin's paste, 622. 
Cantharidal collodion, 614. 
Cantharides, 587, 611. 
cerate, 614. 
paper, 614. 
Cantharidin, 611. 
Cantharis, 552. 
Cape aloes, 505. 
Capsicin, 92. 
Capsicum, 92. 
Caraway, 93. 
Carbazotate of ammonium, 
87. 
Carbazotic acid, 86. 
Carbo, 661. 
animalis, 661. 
animalis purificatus, 
661. 
ligni, 661. 
Carbolated camphor, 219. 
Carbolic acid, 676. 
antidote to, 687. 
as an antiseptic, 688. 
parenchymatous injec- 
tions of, 684. 
poisoning, 685. 
Carbonate of ammonium, 
126. 
of calcium, 646. 
of lead, 43. 
of lithium, 542. 
of magnesium, 495. 
of potassium, 534. 
of sodium, 644. 
of zinc, 46. 
Cardamom, 90. 
Cardamomum, 90. 
Cardiac sedatives, 162. 
stimulants, 122. 
Carminatives, 88. 
Carolina jessamine, 392. 
Carrageen, 627. 
Carrageenin, 627. 
Carron oil, 646. 
Carthagena bark, 64. 
Carum, 93. 
Caryophyllus, 90. 
Cascara Sagrada, 495. 
Cascarilla, 89. 
Cassava, 628. 
Cassia bark, 90. 
fistula, 495. 
Castillon's powder, 646. 
Castor, 213. 
oil, 498. 
oil beans, 498. 
Castoreum, 213. 
Catechu, 30. 
Cathartic acid, 507. 
Cathartics, 483. 
Cathartine, 507. 
Cathode, 718. 
Caustic potash, 620. 
soda, 644. 
Cayenne pepper, 92. 
Central galvanization, 741. 
Cera alba, 632. 
flava, 632. 
Cerata, 19. 
Cerates, 19. 
Ceratum cantharidis, 614. 
extract! cantharidis, 
614. 
Cerebrum, galvanization of, 
735. 
Cerii oxalas, 45. 
Cetaceum, 631. 
Cetraria, 626. 
Cetraric acid, 627. 
Cetrarin, 627. 
Chalk, 646. 760 
GENERAL INDEX. 
Citrate of iron and ammo- 
nium, 104. 
of iron and quinine, 104. 
of iron and strychnine, 
104. 
of lithium, 542. 
of potassium, 534, 559. 
Citric acid, 205. 
Classification, 24. 
Climate, 21. 
Cloves, 90. 
Clove-tea, 90. 
Coca, 231. 
Cocaine, 231. 
Coca-tannic acid, 231. 
Cockroach, 512. 
Codeine, 258. 
Cod-liver oil, 448. 
Coffee, 223. 
Cohnheim's salt frog, 373. 
Cola nut, 223. 
Colchiceine, 456. 
Colchici radix, 456. 
semen, 456. 
Colchicine, 456. 
Colchicum root, 456. 
seed, 456. 
Cold as a tonic, 707. 
in pyrexia, 705. 
local use of, 705. 
Cold cream, 632. 
Collodion, 638. 
with cantharides, 614. 
Collodium, 638. 
Collodium cum cantharide, 
614. 
flexile, 639. 
Colocynth, 512. 
Colocynthin, 512. 
Colocynthis, 512. 
Columbin, 61. 
Columbo, 61. 
Commercial bicarbonate of 
sodium, 644. 
chloroform, 316. 
oxide of zinc, 46. 
Compound arsenical paper, 
420. 
cathartic pills, 514. 
decoction of sarsapa- 
rilla, 464. 
extract of colocynth, 
513. 
fluid extract of sarsapa- 
rilla, 464. 
infusion of flaxseed, 
628. 
infusion of gentian, 60. 
infusion of rose, 32. 
iodine ointment, 444. 
jalap powder, 512. 
liquorice powder, 508. 
mixture of iron, 101. 
mixture of liquorice, 
628. 
pills of iron, 101. 
pills of rhubarb, 504. 
powder of ipecacuanha, 
558. 
powder of jalap, 512. 
Compound powder of rhu- 
barb, 504. 
solution of iodine, 442. 
spirit of ether, 220. 
spirit of juniper, 546. 
spirit of lavender, 89. 
syrup of sarsaparilla, 
464. 
syrup of squill, 582. 
syrup of the phosphates, 
456. 
tincture of benzoin, 581. 
tincture of cardamom, 
91. 
tincture of catechu, 30. 
tincture of cinchona, 86. 
tincture of gentian, 60. 
tincture of iodine, 442. 
Confection of rose, 32, 
of senna, 508. 
Confectiones, 18. 
Confections, 18. 
Conia, 402. 
Conii folia, 401. 
fructus, 401. 
Continuous current, 722. 
Convallamarin, 159. 
Convallaria majalis, 159. 
Convallarin, 159. 
Cooper's arsenious ointment, 
621. 
Copaiba, 548. 
Copaivic acid, 548. 
Copper, 47. 
Copperas, 667. 
Coptis, 62. 
Coriander, 93. 
Coriandrum, 93. 
Cornus Florida, 60. 
Corrosive chloride of mer- 
cury, 433. 
sublimate, 434, 668. 
as a caustic, 623. 
Corsican moss, 627. 
Cotton root, 604. 
Counter-irritation, 607. 
Cowhage, 655. 
Coxe's hive syrup, 582. 
Cranesbill, 32. 
Cream of tartar, 536. 
Creasote, 677. 
Creasotum, 677. 
Creta, 646. 
prseparata, 646. 
Croton choral hydrate, 380. 
Croton oil, 488, 519. 
Crotonol, 519. 
Cryptopia, 262. 
Cubeb, 550. 
Cubeba, 550. 
Cubebic acid, 550. 
Cubebin, 550. 
Cupri acetas, 50. 
sulphas, 47. 
Cuprum, 47. 
ammoniatum, 50. 
Cyanide of potassium, 6. 
of silver, 57, 206. 
Cynno-hmmoglobin, 199. 
Cyanogen gas, 206. 
Cydonium, 628. 
Cytisin, 177. 
D. 
Dandelion, 466. 
Daphnin, 465. 
Daturine, 296. 
Decoeta, 17. 
Decoction of barley, 630. 
Decoctum chimaphilae, 545. 
sarsaparillae composi- 
tum, 464. 
Degeneration, reaction of, 
729. 
Demulcents, 625. 
Denarcotized opium, 255. 
Deodorized tincture of 
opium, 255. 
Depresso-motors, 342. 
Dewee's emmenagogue mix- 
ture, 586. 
Dextro-quinia, 85. 
Diagnosis, use of electricity 
in, 731. 
Dialyzed iron, 103. 
Diaphoretics, 553. 
Digestants, 656. 
Digitalein, 144. 
Digitalin, 143, 159. 
Digitalinum, 143, 159. 
Digitaliresin, 144. 
Digitalis, 143. 
as an antipyretic, 156. 
as a diuretic, 525. 
Digitonin, 144. 
Digitoxin, 144. 
Dihydroxyle quinine, 77. 
Diluents, 637. 
Diluted acetic acid, 210. 
alcohol, 126. 
hydrobromic acid, 367. 
hydrocyanic acid, 196. 
muriatic acid, 108. 
nitric acid, 109. 
nitromuriatic acid, 108. 
phosphoric acid, 453. 
solution of subacetate of 
lead, 41. 
sulphuric acid, 107. 
Diospyros, 32. 
Disinfectants, 663. 
Diuretics, 521. 
Dogwood, 62. 
Donovan's solution, 423, 
444. 
Doses, rules for, 22. 
Dover's powder, 558. 
Drastics, 511. 
Dried alum, 32. 
carbonate of sodium, 
644. 
sulphate of iron, 97. 
E. 
Ecbolina, 590. 
Effects of medicines, pri- 
mary, 19. GENERAL INDEX. 
761 
Effects of medicines, remote, 
19. 
Effervescing draught, 534, 
559. 
Egg-nogg, 40. 
Elaterin, 516. 
Elaterium, 515. 
Electric brush, 728. 
Electricity, 718. 
use of, as a tonic, 738. 
Elixir Proprietatis, 507. 
of valerianate of ammo- 
nium, 214. 
of vitriol, 107. 
Emetics, 467. 
mineral, 482. 
vegetable, 471. 
Emetine, 471. 
Emmenagogues, 584. 
Emodin, 495. 
Emollients, 631. 
Emplastra, 19. 
Emplastrum ammoniaci, 
577. 
ammoniaci cumhydrar- 
gyro, 577. 
antimonii, 161. 
asafoetidae, 215. 
belladonnas, 270. 
hydrargyri, 432. 
picis Burgundicae, 618. 
picis Canadensis, 618. 
picis cum cantharide, 
618. 
plumbi, 42, 638. 
resinae, 42, 140, 638. 
saponis, 42, 638. 
Emulsin, 62, 616. 
Emulsions, 18. 
Endermic administration, 
21. 
Enemata, 490. 
English aconitia, 185. 
garlic, 582. 
Epispastics, 607, 610. 
Epsom salt, 508. 
Ergot, 589. 
Ergota, 589. 
Ergotic acid, 590. 
Ergotin, 603. 
Ergotine, 590. 
Ergotinine, 590. 
Ergotism, 601. 
Erigeron, 546. 
Canadense, 546. 
Errhines, 606. 
Erythroxyline, 231. 
Erythroxylon, 231. 
Escharotics, 619. 
Eserine, 342. 
Essence of peppermint, 94. 
of spearmint, 94. 
Essential salt of lemons, 211. 
Ether, 310. 
Ethereal oil, 220. 
Ethyl, lead, 40. 
nitrite of. 391. 
oxide, 310. 
Eucalypsinthe (foot-note), 
94. 
Eucalyptus, 94. 
Euonymin, 508. 
Euonymus, 508. 
Eupatorium, 61. 
Excito-motors, 326. 
Expectorants, 569. 
Extract of aconite, 195. 
of American hemp, 248. 
of arnica, 178. 
of belladonna, 296. 
of black hellebore, 490. 
of butternut, 504. 
of Calabar bean, 353. 
of chiretta, 62. 
of cinchona, 86. 
of colchicum root, 462. 
of colocynth, 513. 
of conium, 406. 
of dandelion, 466. 
of digitalis, 158. 
of ergot, 604. 
of euonymus, 478. 
of gentian, 60. 
of haematoxylon, 31. 
of hellebore, 520. 
of hyoscyamus, 299. 
of ignatia, 341. 
of Indian hemp, 263. 
of krameria, 31. 
of liquorice, 628. 
of logwood, 31. 
of May-apple, 515. 
of nux vomica, 326. 
of opium, 254. 
of podophyllum, 515. 
of quassia, 59. 
of rhatany, 31. 
of rhubarb, 504. 
of stramonium, 297. 
of taraxacum, 466. 
of uva ursi, 545. 
of wahoo, 508. 
Extracta, 18. 
fluida, 18. 
Extractum cannabis Indicae, 
263. 
hasmatoxyli, 31. 
juglandis, 504. 
F. 
Faradic current, 722. 
Faradization, general, 740. 
Feeding by the rectum, 
659. 
Fennel, 93. 
water, 93. 
Ferri carbonas saccharatus, 
101. 
chloridum, 102. 
citras, 103. 
et ammonii citras, 104. 
et ammonii sulphas, 
104. 
et ammonii tartras, 104. 
et potassii tartras, 104. 
et quininas citras, 104. 
Ferri et strychninae citras, 
104. 
lactas, 104. 
oxidum hydratum, 100. 
oxidum hydratum cum 
magnesia, 101. 
phosphas, 104. 
pulvis, 100. 
pyrophosphas, 104. 
subcarbonas, 100. 
sulphas, 101. 
sulphas exsiccata, 102. 
sulphas praecipitatus, 
102. 
Ferrum, 97. 
dialysatum, 103. 
reductum, 100. 
Figs, 494. 
Filix mas, 654. 
Flaxseed, 628. 
meal, 628. 
oil, 628. 
Fleabane, 546. 
Fleming's tincture of aco- 
nite, 195. 
Flexible collodion, 639. 
Flowers of sulphur, 496. 
Fluid extract of aconite 
root, 195. 
of American hellebore, 
176. 
of arnica, 178. 
of belladonna, 296. 
of bitter orange peel, 
93. 
of boneset, 62. 
of brayera, 650. 
of buchu, 543. 
of ehimaphila, 544. 
of chiretta, 62. 
of cimicifuga, 223. 
of cinchonas, 86. 
of colchicum root, 462. 
of colchicum seeds, 462. 
of coluinbo, 61. 
of conium seed, 406. 
of cotton root, 604. 
of cubebs, 552. 
of dandelion, 466. 
of digitalis, 158. 
of ergot, 603. 
of eucalyptus, 97. 
of eupatorium, 62. 
of gelsemium, 396. 
of gentian, 60. 
of ginger, 91. 
of hemp, 268. 
of hops, 221. 
of ipecacuanha, 476. 
of jaborandi, 565. 
of krameria, 31. 
of lactucarium, 222. 
of lemon peel, 93. 
of liquorice, 628. 
of lobelia, 392. 
of lupulin, 221. 
of matico, 552. 
of nux vomica, 326. 
of pareira brava, 544. 
of quassia, 59. 762 
GENERAL INDEX. 
Fluid extract of rhatany, 31. 
of rhubarb, 504. 
of sanguinaria, 477. 
of sarsaparilla, 464. 
of seneka, 577. 
of senna, 508. 
of serpentaria, 89. 
of spigelia, 649. 
of spigelia and senna, 
649. 
of squill, 525. 
of stramonium, 297. 
of sumach, 32. 
of sweet orange peel, 93. 
of taraxacum, 466. 
of uva ursi, 545. 
of valerian, 214. 
of veratrum viride, 176. 
of wild cherry, 63. 
Fceniculura, 93. 
Foot-bath, method for, 567. 
Forced injections, 490. 
Forces, 701. 
Fowler's solution, 423. 
Frangula, 495. 
Franguline, 495. 
Frere Cosme, arsenical paste 
of, 621. 
Fumigations, mercurial, 
431. 
Fusel oil, 381. 
G. 
Gaduin, 449. 
Galactagogue, 499. 
Galla, 30. 
Gallic acid, 29. 
Gallo-tannic acid, 26. 
Galls, 30. 
Galvanic current, 719. 
Gambir, 30. 
Gamboge, 517. 
Gambogia, 517. 
Gambogic acid, 518. 
Garlic, 582. 
Gas liquor, 574. 
Gaultheria, 94. 
Gelsemine, 393. 
Gelseminic acid, 393. 
Gelsemium, 392. 
General faradization, 740. 
Gentian, 59. 
Gentiana, 59. 
Gentiopikrin, 60. 
Gentisic acid, 59. 
Geranium, 32. 
German aconitine, 185. 
chamomile, 89. 
Germicide, 663. 
Gin, 546. 
Ginger, 91. 
Gizzard, 656. 
Glacial acetic acid, 210. 
Glauber salt, 509. 
Glycerine, 632. 
Glycerinum, 632. 
Glycerita, 18. 
Glycerite of egg, 635. 
Glycerite of gallic acid, 29. 
of starch, 635. 
of tannic acid, 29. 
Glycyrrhiza, 627. 
Glycyrrhizin, 627. 
ammoniatum, 628. 
Goa powder, 503. 
Goldthread, 62. 
Goose-grease, 631. 
Gossypii radicis cortex, 604. 
Goulard's extract, 43. 
Granati fructus cortex, 32, 
654. 
radicis cortex, 32, 654. 
Granatum, 654. 
Granulated citrate of mag- 
nesium, 509. 
Gray powder, 432. 
Green galls, 30. 
ginger, 91. 
iodide of mercury, 436. 
Guaiac, 464. 
acid, 465. 
as an emmenagogue, 
587. 
Guaiac-yellow, 465. 
Guaiaci lignum, 464. 
resina, 464. 
Guaiacic acid, 465. 
Guaiacin, 465. 
Guaiaconic acid, 465. 
Guaiacresinic acid, 465. 
Guaiacum wood, 464. 
Guarana, 223. 
Gum arabic, 625. 
Gun cotton, 638. 
Gunjah, 263. 
Gutta-percha, 640. 
H. 
Habit, 22. 
Hsematin, 31. 
Haematoxylin, 31. 
Haematoxylon, 31. 
Hartshorn, spirit of, 126. 
Hashish, 263. 
Heat, 665, 704. 
Heavy magnesia, 495. 
oil of wine, 220. 
Helleboreine, 520. 
Helleborine, 520. 
Helleborus, 520. 
Hemlock pitch, 618. 
plaster, 618. 
Hemp, 263. 
Herapathite, 65. 
Hippuric acid, 579. 
Hive syrup, 582. 
Hoffmann's anodyne, 220. 
Honduras sarsaparilla, 463. 
Honey, 18. 
Hop poultice, 221. 
Hope's camphor mixture, 
108. 
Hops, 220. 
Hordeum, 630. 
Hot baths, 554. 
Humulus, 220. 
Huxham's tincture, 86. 
Hydragogue diuretics, 523. 
Hydragogues, 489. 
Hydrargyrum, 424. 
ammoniatum, 437. 
chloridum corrosivum, 
434. 
chloridum mite, 433. 
cum creta, 432. 
iodiduin rubrum, 436. 
iodidum viride, 436. 
oleatum, 432. 
oxidum flavum, 436. 
oxidutn rubrum, 436. 
sulphas flavus, 436. 
sulphidum rubrum, 436. 
Hydrate of chloral, 368. 
Hydrated oxide of iron, 100. 
sesquioxide of iron, 100. 
Hydriodateof hyoscine, 301. 
Hydrobromate of conine, 
406. 
of homatropine, 296. 
of hyoscine, 301. 
of quinine, 84. 
Hydrobromic acid, 367. 
Hydrochinone, 544. 
Hydrochlorate apomor- 
phine, 477. 
of morphine, 255. . 
Hydrochloric acid, 107. 
Hydrocotarnine, 263. 
Hydrocyanic acid, 196. 
Hyoscine, 263. 
Hyoscyami folia, 298. 
semen, 298, 300. 
Hyoscyamine, 298. 
Hyoscyaminse sulphas, 298. 
Hyoscyamus leaves, 298. 
seed, 298, 300. 
Hyperemesis, 470. 
Hypochlorites, 672. 
Hypodermic injections, 20. 
injections of calomel, 
434. 
I. 
Iceland moss, 626. 
Idiosyncrasies, 22. 
Igasuric acid, 326. 
Ignatine, 341. 
Ilex, 223. 
Incompatibilities, 745. 
Indian corn, 546. 
Indian hemp, 263. 
Indian meal, 493. 
smut of, 604. 
stigmata of, 546. 
Indian senna, 507. 
Indications for the use of 
medicines, 19. 
Induced current, 722. 
Infusa, 18. 
Infusion of brayera, 650. 
of buchu, 543. 
of capsicum, 92. 
of cascarilla, 89. 
of chamomile, 89. GENERAL INDEX. 
763 
Infusion of cinchona, 86. 
of cloves, 90. 
of digitalis, 158. 
of gentian compound, 
60. 
of ginger, 91. 
of hops, 321. 
of juniper, 546. 
of krameria, 31. 
of pareira brava, 544. 
of quassia, 59. 
of rhatany, 31. 
of senna, 508. 
of valerian, 213. 
of wild cherry, 63. 
Infusum picis liquid®, 583. 
Inunctions, mercurial, 431. 
Iodide of arsenic, 423. 
of potassium, 442. 
of silver, 57. 
Iodine, 437. 
ointment, 442. 
lodism, 439. 
Iodoform, 444. 
ointment, 447. 
lodoformum, 444. 
lodum, 437. 
Ipecacuanha, 471. 
as a diaphoretic, 558, 
573. 
as an expectorant, 573. 
Irish moss, 627. 
Iron, 97. 
by hydrogen, 100. 
Quevenne's, 100. 
Iron rust, 100. 
Isopelletierine, 655. 
J. 
Jaborandi, 559. 
antagonism to atropia, 
565. 
Jaborine, 559. 
Jaguarandy, 559. 
Jalap, 511. 
Jalapa, 511. 
Jamaica ginger, 91. 
Jamestown weed, 296. 
Jamguarandi, 559. 
Jamgurandy, 559. 
Jervine, 170, 176. 
Juglans, 504. 
Juice of conium, 406. 
Juices, 18. 
Juniper, 545. 
Juniperus, 545. 
K. 
Kairin, 703. 
Kamala, 655. 
Kameela, 655. 
Kataleetronous, 729. 
Kentish ointment, 618. 
Kinic acid, 64. 
Kino, 30. 
Kino-tannic acid, 26. 
Kinovic acid, 64. 
Kola nut, 223. 
Koossin, 650. 
Koosso, 650. 
Krameria, 31. 
L. 
Labarraque's solution, 673. 
Lactate of iron, 104. 
Lactic acid, 111. 
Lacto-phosphate of lime, 
455. 
Lactucarium, 211. 
Lactucin, 211. 
Lady Webster pills, 507. 
Lard, 631. 
Laudanine, 262. 
Laudanum, 255. 
deodorized, 255. 
Lavandula, 93. 
Lavender, 93. 
Laxatives, 493. 
Lead, 34, 666. 
acetate of, 42. 
carbonate of, 43. 
ethyl, 40. 
nitrate of, 43. 
oxide of, 42. 
plaster, 42, 638. 
poisoning, 35. 
water, 43. 
Ledoyen's disinfectant solu- 
tion, 43, 666. 
Lemon-juice, 209. 
Lemon peel, 93. 
Lemons, essential salt of, 
211. 
Levant wormseed, 650. 
Lichen starch, 627. 
Lichenin, 627. 
Lichstearic acid, 627. 
Light magnesia, 495. 
Lignum-vit®, 464. 
Lily of the valley, 159. 
Lime, 645. 
as a disinfectant, 668. 
juice, 209. 
lacto-phosphate of, 456. 
liniment, 645. 
water, 645. 
Limonis cortex. 93. 
Lini farina, 628. 
Liniment of ammonia, 618. 
of camphor, 218. 
of cantharides, 614. 
of chloroform, 324. 
of lime, 645. 
of soap, 218. 
of turpentine, 618. 
Linimenta, 19. 
Linimentum calcis, 645. 
camphor®, 218. 
cantharidis, 614. 
chloroformi, 324. 
saponis, 218. 
terebinthinae, 618. 
Linum, 628. 
Liquor acidi arseniosi, 423. 
ammonii acetatis, 566. 
Liquor arsenici et hydrar- 
gyri, iodidi, 444. 
bismuthi et ammonii, 
citratis, 43. 
caleis, 645. 
ferri chloridi, 102. 
ferri subsulphatis, 102. 
ferri tersulphatis, 102. 
gutta-perchae, 640. 
hyd rargyri nitratis, 623. 
iodi compositus, 442. 
magnesii citratis, 509. 
morphiae sulphatis, 255. 
pancreaticus, 658. 
plumbi subacetatis, 41. 
plumbi subacetatis di- 
lutus, 42. 
potass®, 642. 
potassii arsenitis, 423. 
potassii citratis, 534. 
potassii permanganatis, 
670. 
sod®, 644. 
sod® chlorinatae, 673. 
sodii arseniatis, 423. 
zinci chloridi, 623. 
Liquores, 18. 
Liquorice, 628. 
root, 627. 
Lisbon diet-drink, 464. 
Litharge, 42. 
Lithii carbonas, 542. 
Lithium, bromide of, 366. 
Liver, action of cathartics 
on, 488. 
Lobelia, 391, 573. 
Lobelic acid, 391, 573. 
Lobeline, 391. 
Logwood, 31. 
Lozenges of cubebs, 573. 
of ipecacuanha, 573. 
of ipecacuanha and 
morphia, 573. 
of santonin, 573. 
Lugol's solution, 442. 
Lunar caustic, 48. 
Lupulin, 211. 
Lupulina, 211. 
Lyctonine, 184. 
M. 
Mace, 90. 
Macis, 90. 
Magendie's solution, 256. 
Magnesia, 495. 
Magnesia ponderosa, 495. 
Magnesii carbonas. 495. 
citras granulatus, 509. 
sulphas, 508. 
Maizenic acid, 546. 
Male fern, 654. 
Malic acid, 32. 
Manganese, 104. 
black oxide of, 104. 
sulphate of, 104. 
Mangani oxidum nigrum, 
104. 
sulphas, 104. 764 
GENERAL INDEX. 
Manna, 494. 
Mannite, 494. 
Maranta, 629. 
Massa copaibae, 550. 
hydrargyri, 432. 
Mate, 223. 
Materia medica, 2. 
Maticin, 552. 
Matico, 552. 
Matricaria, 89. 
May-apple, 514. 
Meadow saffron, 456. 
Measures, 740. 
Meconio acid, 263. 
Meeonine, 262. 
Medulla sassafras, 628. 
Melissa, 93. 
Mellita, 18. 
Mentha piperita, 93. 
viridis, 93. 
Menthol, 94. 
Mercurial ointment, 432. 
oleate, 432. 
plaster, 432. 
purgatives, 500. 
Mercury, 424, 500. 
ammoniated, 432. 
hypodermic use of, 437. 
with chalk, 332. 
Metachloral, 379. 
Methyl chloride, 315. 
Methylene bichloride, 324. 
Mezereon, 465. 
ointment, 465. 
Mezereum, 465. 
Mild chloride of mercury, 
433. 
Milk of assafetida, 215. 
Milk-punch, 139. 
Mineral emetics, 482. 
tonics, 97. 
Mistura ammoniaei, 577. 
cretse, 647. 
ferri composita, 101. 
glycyrrhizae composita, 
628. 
potassii citratis, 534. 
Mistura), 18. 
Mixture of assafetida, 215. 
of chloroform, 324. 
of citrate of potassium, 
534. 
Molasses, 493. 
Monobromate of camphor, 
218. 
Monsel's solution, 102. 
Morphine, 244, 255. 
and chloral, 250. 
Morphinae acetas, 255. 
hydrochloras, 255. 
murias, 255. 
sulphas, 255. 
Moschus, 212. 
Motor points, 727. 
Mucilage of gum arabic, 
626. 
of quince-seed, 627. 
of sassafras pith, 628. 
of slippery-elm bark, 
626. 
Mucilage of tragacanth, 626. 
Mucilagines, 18. 
Mucuna, 655. 
Mulled wine, 139. 
Muriate of ammonia, 574. 
of morphine, 255. . 
Muriatic acid, 107. 
as a caustic, 624. 
Muscaria, antidote for, 158. 
Musk, 212. 
Mustard, 615. 
as an emetic, 481. 
paper, 617. 
plaster, 616. 
Mutton suet, 631. 
Mydriasis, 269. 
Mydriatics, 269. 
Myristica, 90. 
Myronic acid, 616. 
Myrrh, 584. 
Myrrh a, 584. 
N. 
Napelline, 185. 
Narceine, 256. 
Narcotine, 260. 
Nauseating diaphoretics, 
558. 
Nectandra, 60. 
Neutral mixture, 534. 
Nicotia, 396. 
Nicotianine, 396. 
Nitrate of ammonium, 126. 
of lead, 42. 
of mercury, solution of, 
623. 
of potassium, 536. 
of silver, 47. 
of sodium, 537. 
Nitre, 536. 
Nitric acid, 108. 
as a caustic, 623. 
Nitrite of amyl, 381. 
of ethyl, 391. 
of potassium, 389. 
of sodium, 389. 
Nitrites, action of, on the 
blood, 385. 
Nitrogen monoxide, 305. 
Nitroglycerine, 390. 
Nitrohydrochloric acid, 109. 
Nitromuriatic acid, 109. 
Nitrous acid, 108. 
oxide, 305. 
Norwood's tincture of vera- 
trum viride, 176. 
Nutgall, 30. 
Nutmeg, 90. 
Nux vomica, 326. 
O. 
Ohm's law, 719. 
Oil of amber, 220. 
of anise, 93. 
of cajeput, 92. 
of camphor, 215, 218. 
Oil of caraway, 93. 
of chenopodium, 649. 
of cinnamon, 90. 
of cloves, 90. 
of copaiba, 550. 
of coriander, 93. 
of cubeb, 552. 
of erigeron, 143, 546. 
of eucalyptus, 94, 97. 
of fennel, 93. 
of gaultheria, 94. 
of juniper, 545. 
of lavender, 93. 
of marjoram, 93. 
of mustard, 616. 
of nutmeg, 90. 
of pennyroyal, 588. 
of pepper, 91. 
of peppermint, 94. 
of phosphorus, 121. 
of pimento, 90. 
of rosemary, 93. 
of rue, 586. 
of sassafras, 93, 468. 
of savine, 586. 
of spearmint, 93. 
of succinum, 220. 
of tansy, 586. 
of tar, 582. 
of turpentine, 140, 547. 
of valerian, 213. 
of vitriol, 105. 
of wormseed, 649. 
Ointment, 19. 
of ammoniated mer- 
cury, 436. 
of antimony, 169. 
of belladonna, 296. 
of carbonate of lead, 43. 
of gallic acid, 29. 
of galls, 30. 
of iodine, 442. 
of mezereon, 465. 
of nutgall, 30. 
of oxide of zinc, 46. 
of red iodide of mer- 
cury, 436. 
of rose water, 632. 
of stramonium, 297. 
of tannic acid, 29. 
of veratria, 184. 
of white precipitate, 
437. 
of yellow oxide of mer- 
cury, 436. 
Olea destillata, 18. 
Oleate of mercury, 432. 
Oleatum veratrinae, 184. 
Oleoresin of black pepper, 
92. 
of capsicum, 92. 
of cubeb, 552. 
of fern, 654. 
of ginger, 91. 
of lupulin, 221. 
Oleoresinse, 18. 
Oleum aethereum, 220. 
cajupute, 92. 
chenopodii, 649. 
erigerontis, 546. GENERAL INDEX. 
765 
Oleum morrhu®, 448. 
phosphoratum, 121. 
ricini, 498. 
succini, 220. 
terSbinthin®, 140. 
theobrom®, 631. 
tiglii, 519. 
Opianine, 263. 
Opium, 240. 
alkaloids, 255. 
denarcotization, 254. 
poisoning by, 251. 
Turkey, 240. 
Orange flowers, 93. 
flower water, 93. 
peel, 93. 
Oxalate of cerium, 45. 
of potassium, 211. 
Oxalic acid, 211. 
Oxide of antimony, 163. 
of ethyl, 310. 
of iron, hydrated, 100, 
666. 
of lead, 42. 
of silver, 57. 
of zinc, 46. 
Oxytocics, 589. 
Oyster-shell, 646. 
P. 
Pale catechu, 30. 
cinchona, 63. 
rose, 32. 
Pancreatic diastase, 658. 
extracts, 658. 
Pancreatin, 658. 
Papaverine, 261. 
Paraglin, 463. 
Paraglinic acid, 463. 
Paraguay tea, 221. 
Paramorphine, 260. 
Paregoric, 254. 
Pareira, 543. 
brava, 543. 
Parsley, 586. 
Pearl ash, 534. 
sago, 629. 
Peculiar bitters, 62. 
Pelletierine, 655. 
Pellitory, 605. 
Pelosine, 60. 
Pepo, 654. 
Peppermint, 93. 
water, 93. 
Pepsin, 656. 
Pepsina, 656. 
Peptonized beef tea, 659. 
gruel, 659. 
milk, 659. 
Permanganate of potassium, 
669. 
Persimmon, 32. 
Petroselinum, 586. 
Pharmacology, 17. 
Pharmacopoeia, 17. 
Pharmacy, 17. 
Phenic acid, 676. 
Phenylic alcohol, 676. 
Phosphate of calcium, 454. 
of iron, 104. 
of sodium, 510. 
Phosphide of zinc, 121. 
Phosphoric acid, 453. 
Phosphorus, 112. 
- antidote to, 119. 
Physostigma, 342. 
Physostigmine, 342. 
Picra-aconitine, 186. 
Picric acid, 86. 
Pikropodophyllin, 514. 
Pill of aloes, 507. 
of aloes and assafetida, 
507. 
of aloes and mastic, 507. 
of aloes and myrrh, 507. 
of assafetida, 215. 
of carbonate of iron, 
101. 
of iron, 101. 
of mercury, 432. 
of opium, 254. 
of rhubarb, 504. 
Pilocarpine, 559, 565. 
antagonism with atro- 
pia, 565. 
Pilula ferri carbonatis, 101. 
Pilul®, 19. 
asafoetid®, 215. 
cathartic® composit®, 
514. 
ferri composit®, 101. 
phosphori, 121. 
rhei, 504. 
rhei composit®, 504. 
Pimenta, 90. 
Pimento, 90. 
Pinkroot, 648. 
Piper, 91. 
Piperin, 91. 
Pipsissewa, 545. 
Pitch, 582. 
Pix Burgundica, 618. 
Canadensis, 618. 
liquida, 582. 
Plasma, 635. 
Plaster of ammoniac, with 
mercury, 577. 
of Burgundy pitch, 618. 
of Canada pitch, 618. 
of pitch with canthari- 
des, 618. 
Plumbi acetas, 42. 
carbonas, 43. 
nitras, 43. 
oxidum, 42. 
Plumbum, 34. 
Podophyllin, 514. 
Podophyllinic acid, 514. 
Podophyllotoxin, 514. 
Podophyllum, 514. 
Polygalic acid, 576. 
Pomegranate rind, 654, 
Poppy, 240. 
Porphyroxia, 262. 
Potassa, 620. 
cum calce, 621. 
sulphurata, 497. 
Potassii acetas, 534. 
Potassii bicarbonas, 534. 
bitartras, 536. 
bromiduin, 356. 
carbonas, 534. 
chloras, 539. 
citras, 534. 
cyanidum, 206. 
et sodii tartras, 510. 
iodidum, 442. 
nitras, 536. 
nitris, 389. 
permanganas, 669. 
sulphas, 510, 536. 
tartras, 536. 
Potassium, 528. 
Potentilla tormentilia, 32. 
Poultices, 635. 
Precipitated carbonate of 
calcium, 455, 646. 
carbonate of iron, 100. 
carbonate of zinc, 45. 
phosphate of calcium, 
454. 
sulphur, 496. 
Prepared chalk, 346. 
oyster-shell, 346. 
Prescribing, art of, 743. 
Pride of China, 649. 
Primary current, 743. 
Propenyl alcohol, 632. 
Propylamin, 590. 
Protectives, 638. 
Protiodide of mercury, 436. 
Prunes, 494. 
Prunus Virginiana, 62. 
Prussic acid, 196. 
Pseudaconitia, 185. 
Pseudomorphia, 263. 
Puccin, 476. 
Pulveres, 19. 
aromaticus, 89. 
effervescentes composi- 
tus, 510. 
glycyrrhiz® composi- 
tus, 508. 
ipecacuanhas et opii, 
558. 
jalapae compositus, 512. 
rhei compositus, 504. 
Pulvis parturiens, 598. 
Pumpkin seed, 654. 
Purgative enemas, 490. 
Purgatives, 483. 
Purges, 498. 
Purging cassia, 495. 
Purified aloes, 507. 
animal charcoal, 661. 
chloroform, 316. 
Pyrethrum, 605. 
Pyrogallic acid, 27. 
Pyrophosphate of iron, 104. 
Pyroxylin, 638. 
Pyroxylum, 638. 
Q. 
Quassia, 59. 
Quassin, 59. 
Quercitron, 31. 766 
GENERAL INDEX. 
Quercus alba, 31. 
tinctoria, 31. 
Quevenne's iron, 100. 
Quince seed, 628. 
Quinidine, 84. 
Quinidinae sulphas, 84. 
Quinina, 64. 
as an abortifacient, 74. 
as an antipyretic, 78. 
bromide of, 84. 
dihydroxyle, 77. 
tannate of, 84. 
Quininse sulphas, 64. 
Quinoidin, 86. 
Quinoidine (animal), 80. 
R. 
Reactions of degeneration, 
732. 
Red cinchona, 64. 
ipecacuanha, 471. 
iodide of mercury, 436. 
oxide of mercury, 436. 
precipitate, 436. 
rose, 31. 
sulphuret of mercury, 
436. 
wine, 126. 
Reduced iron, 100. 
Refrigerant diaphoretics, 
559. 
Refrigerants, 207. 
Rennet, 656. 
Resin of jalap, 512. 
of May-apple, 575. 
of podophyllum, 575. 
of scammony, 514. 
of veratrum viride, 514. 
of plaster, 42, 140. 
Resina, 140. 
Resinae, 18. 
Rhabarbin, 503. 
Rhamnus, 495. 
Rhatany, 31. 
Rhein, 503. 
Rheum, 502. 
Rhodeoretin, 511. 
Rhubarb, 502. 
Rhus glabra, 32. 
Rochelle salt, 510. 
Roman chamomile, 89. 
Rosa centifolia, 32. 
Gallica, 31. 
Rosemary, 93. 
Rose-water, 32. 
Rosin, 140. 
Rosmarinus, 93. 
Rottlera, 655. 
Rottierin, 655. 
Royal yellow bark, 64. 
Rubefacients, 609, 615. 
Rubus, 32. 
Rue, 586. 
Russian bath, 553. 
Ruta, 586. 
Rutin, 586. 
S. 
Sabadilla, 178. 
Sabadilline, 178. 
Sabina, 585. 
Saccharate of lime, 687. 
Saccharated carbonate of 
iron, 101. 
iodide of iron, 103. 
Saccharum, 493. 
Saccharum lactis, 493. 
Sage, 93. 
Sago, 629. 
Sal ammoniac, 574. 
prunelle, 537. 
Salicin, 699. 
Salicylic acid, 689. 
as an antipyretic, 696. 
wadding, 697. 
Salicyluric acid, 694. 
Saline cathartics, 485. 
purgatives, 485, 508. 
Salseparin, 463. 
Salt of lemons, 211. 
Salt of sorrel, 211. 
Saltpetre, 536. 
Salvia, 93. 
Sanguinaria, 476. 
Sanguinarine, 476. 
Santoninate of sodium, 654. 
Santonica, 650. 
Santonin, 650. 
Santoninic acid, 650. 
Santonicum, 650. 
Saponin, 576. 
Sarsaparilla, 463. 
Sarsaparillin, 463. 
Sassafras, 468. 
pith, 628. 
Savine, 585. 
Scammonium, 513. 
Scammony, 513. 
Scilla, 521. 
Scillaine, 521. 
Scilline, 521. 
Scillipicrine, 521. 
Scillitine, 521. 
Scillitoxine, 521. 
Sclerotinic acid, 590. 
Sclerotium, 589. 
Scoparine, 527. 
Scoparius, 527. 
Scudamore's mixture, 461. 
Sculein, 521. 
Seidlitz powders, 510. 
Senega, 576. 
Seneka, 576. 
Senna, 507. 
Septfoil, 32. 
Serpentaria, 89. 
Sesquichloride of iron, 102. 
Shore oil, 448. 
Sialagogues, 605. 
Silver, 49. 
Simaruba, 59. 
Simple bitters, 58. 
Sinapin, 616. 
Sinapinic acid, 616. 
Sinapis alba, 615. 
nigra, 615. 
Sinapisin, 616. 
Sipeeria, 60. 
Slippery elm bark, 626. 
Smelling-salts, 606. 
Smilacin, 463. 
Smut of Indian corn, 604. 
Soap liniment, 218. 
plaster, 42, 638. 
Socotrine aloes, 505. 
Soda, 644. 
powders, 644. 
Sodii acetas, 645. 
arsenias, 423. 
biboras, 673. 
bicarbonas, 644. 
bicarbonas venalis, 644. 
bromidum, 366. 
Carbonas, 644. 
carbonas exsiccata, 644. 
nitras, 645. 
phosphas, 510. 
sulphas, 509. 
Sodium, 642. 
Solution of acetate of am- 
monium, 566. 
of arseniate of sodium, 
423. 
of arsenious acid, 423. 
of arsenite of potassium, 
423. 
of chloride of zinc, 623. 
of chlorinated soda, 673. 
of citrate of magne- 
sium, 509. 
of citrate of potassium, 
534. 
of gutta-percha, 640. 
of iodide of arsenic and 
mercury, 444. 
of lime, 645. 
of nitrate of mercury, 
623. 
of permanganate of po- 
tassium, 671. 
of persulphate of iron, 
102. 
of potassa, 642. 
of soda, 644. 
of subacetate of lead, 43. 
of subsulphate of iron, 
102. 
of sulphate of morphia, 
255. 
of tersulphate of iron, 
102. 
Spanish flies, 611. 
Spartein, 527. 
Spasmodic ergotism, 603. 
Spearmint, 93. 
water, 93. 
Spermaceti, 631. 
Spice plasters, 617. 
Spigelia, 648. 
Spinal cord, galvanization 
of, 736. 
Spirit of ammonia, 126. 
of anise, 93. 
of camphor, 218. 
of chloroform, 324. 
of cinnamon, 91. GENERAL INDEX. 
767 
Spirit of juniper, 546. 
of lavender, 93. 
of lemons, 93. 
of Mindererus, 566. 
of nitrous ether, 528, 
566. 
of peppermint, 93. 
of spearmint, 93. 
Spiritus, 18. 
aetheris compositus, 220. 
aetheris nitrosi, 566. 
ammoniae, 126. 
ammonias aromaticus, 
126. 
chloroformi, 324. 
frumenti, 126. 
vini Gallici, 126. 
Squill, 521. 
as an emetic, 482. 
as an expectorant, 582. 
St. Ignatius' bean, 341. 
Star anise, 93. 
Sticking plaster, 42, 140. 
Stigmata of Zea mays, 546. 
Stimulating diuretics, 546. 
Stomach pump siphon, 252. 
Straits oil, 448. 
Stramonii folia, 296. 
semen, 296. 
Stramonium leaves, 296. 
seed, 296. 
Stronger alcohol, 126. 
ether, 387. 
water of ammonia, 126. 
Strychninae sulphas, 341. 
Strychnine, 326. 
poisoning by, 336. 
Subacetate of copper, 49. 
of lead, 43. 
Subcarbonate of bismuth, 44. 
of iron, 100. 
Sublimed sulphur, 496. 
Subnitrate of bismuth, 44. 
Succi, 18. 
Succinum, 220. 
Succus conii, 406. 
limonis, 209. 
Sugar, 494. 
of lead, 42. 
of milk, 493. 
Sulphate of aluminium, 34. 
of ammonium, 126, 574. 
of atropine, 290. 
of bebeerine, 60. 
of cadmium, 47. 
of cinchonidine, 84. 
of cinchonine, 84. 
of copper, 482, 624. 
of hyoscyamine, 277. 
of iron, 101. 
of iron and ammonium, 
104. 
of manganese, 104. 
of magnesium, 508. 
of morphia, 255. 
of potash, 510, 536. 
of quinidine, 84. 
of quinine, 64. 
of sodium, 510. 
of strychnine, 341. 
Sulphate of zinc, 46, 482, 
624. 
Sulphide of calcium, 498. 
Sulphites, 675. 
Sulpho-sinapisin, 616. 
Sulphovinate of sodium, 
511. 
Sulphur, 496. 
lotum, 496. 
ointment, 497. 
praecipitatum, 496. 
sublimatum, 496. 
Sulphurated antimony, 163. 
lime, 498. 
potassa, 497. 
Sulphuret of antimony, 163. 
of potassa, 497. 
Sulphuric acid, 105. 
as a caustic, 623. 
Sulphurous acid, 675. 
Sumach, 542. 
Suppositoria, 19. 
Suppositories of assafetida, 
215. 
of lead, 43. 
of morphia, 256. 
of tannic acid, 29. 
Sweet orange peel, 93. 
Sweet spirit of nitre, 528, 
566. 
Sydenham's laudanum, 255. 
Sympathetic, galvanization 
of, 738. 
Syrup, 18. 
of acacia, 625. 
of althaea, 628. 
of ginger, 91. 
of iodide of iron, 103. 
of ipecacuanha, 475. 
of krameria, 31. 
of lime, 646. 
of red rose, 32. 
of rhatany, 31. 
of rhubarb, 504. 
of sarsaparilla, com- 
pound, 464. 
of seneka, 577. 
of senna, 508. 
of squill, 525, 582. 
of sweet orange peel, 93. 
of the phosphates, com- 
pound, 456. 
of tar, 583. 
of Tolu, 581. 
of wild cherry, 63. 
Syrupi, 18. 
Syrupus ealcis, 646. 
fuscus, 493. 
T. 
Tabacum, 396. 
Table of proportion by mea- 
sure of alcohol contained 
in one hundred parts of 
different wines, etc., 749. 
Table of relation of weights 
and measures of the U. S. 
Pharmacopoeia to each 
other, 747. 
Tables of relation of weights 
of the U.S.Pharmacopoeia 
to metrical weights, 749. 
Table of weights and meas- 
ures of the metrical sys- 
tem, 747. 
Table of weights and meas- 
ures of the U. S. Pharma- 
copoeia, 748. 
Table showing results of 
cold-water treatment of 
typhus and typhoid fever, 
711. 
Taeniin, 650. 
Tamarind, 494. 
Tamarindus, 494. 
Tanacetum, 586. 
Tannate of quinine, 84. 
of cannabene, 268. 
Tannic acid, 26. 
Tansy, 586. 
Tapioca, 628. 
Tar, 582. 
ointment, 583. 
water, 583. 
Taraxacum, 468. 
Tartar, 207. 
Tartar emetic, 163, 482, 573. 
antidote to, 28. 
Tartaric aoid, 207. 
Tartrate of antimony and 
potassium, 163. 
of iron and ammonium, 
104. 
of iron and potassium, 
104. 
of potassium, 536. 
of potassium and so- 
dium, 510. 
Temperament, 22. 
Terchloride of formyl, 315. 
Terebinthina, 140, 546. 
Canadensis, 546. 
Tersulphuret of antimony, 
163. 
Thebaia, 260. 
Theine, 223. 
Therapeutics, 17. 
Thymol, 699. 
Tinctura ferri chloridi, 102. 
opii, 255. 
opii acetata, 255. 
opii camphorata, 254. 
opii deodorata, 255. 
Tincturae, 18. 
Tincture of aconite, 195. 
of aloes, 150. 
of aloes and myrrh, 150. 
of arnica, 578. 
of assafetida, 215. 
of belladonna, 270. 
of benzoin, 581. 
of bitter orange peel, 
93. 
of black hellebore, 520. 
of bloodroot, 477. 
of Calabar bean, 353. 
of cantharides, 552, 614. 
of capsicum, 91. 
of cardamom, 90. 768 
GENERAL INDEX. 
Tincture of castor, 213. 
of catechu, 30. 
of chiretta, 62. 
of chloride of iron, 102. 
of cimicifuga, 223. 
of cinchona, 86. 
of cinnamon, 89. 
of colchicum, 462. 
of columbo, 61. 
of conium, 406. 
of cubeb, 552. 
of digitalis, 158. 
of eucalyptus, 97. 
of galls, 30. 
of gelsemium, 396. 
of gentian, 60. 
of ginger, 91. 
of guaiac, 467. 
of guaiac, ammoniated, 
467. 
of hellebore, 520. 
of hemp, 268. 
of hops, 221. 
of hyoscyamus, 299. 
of ignatia, 341. 
of iodine, 442. 
of kino, 30. 
of lobelia, 392. 
of lupulin, 221. 
of matico, 552. 
of musk, 213. 
of nutgall, 30. 
of nux vomica, 326. 
of opium, 255. 
of opium, acetated, 255. 
of opium, camphorated, 
254. 
of opium, deodorized, 
255. 
of quassia, 59. 
of rhubarb, 504. 
of rhubarb and senna, 
504. 
of sanguinaria, 477. 
of serpentaria, 89. 
of squill, 525. 
of stramonium, 297. 
of sweet orange peel, 93. 
of Tolu, 581. 
of valerian, 214. 
of valerian, ammoni- 
ated, 214. 
of veratrum viride, 176. 
Tobacco, 396. 
Tonics, 58. 
Tormentil, 32. 
Tormentilia, 32. 
Tous des mois, 630. 
Toxiresin, 144. 
Tragacanth, 626. 
Tragacantha, 626. 
Trimethylamin, 449, 590. 
Trinitro-cellulose, 638. 
Tripoli senna, 507. 
Trituration ofelaterium,517. 
Troches, 19. 
Trochisci ipecacuanhas, 476. 
morphinas et ipecacu- 
anhas, 476. 
ammonii chloridi, 576. 
Trypsin, 658. 
Turkish bath, 553. 
Turpentine, 140, 546, 654. 
stupes, 142, 617. 
Turpeth mineral, 436. 
U. 
Ulmus, 626. 
fulva, 626. 
Unguenta, 19. 
Unguentum antimonii, 169. 
aquae rosse, 32, 632. 
hydrargyri, 432. 
hydrargyrum ammoni- 
atum, 437. 
mezereon, 465. 
picis liquid®, 583. 
plumbi carbonati, 43. 
potassii iodidi, 444. 
veratrinae, 184. 
zinci oxidi, 46. 
Urea, elimination of, by the 
skin, 557. 
Urochloralic acid, 372. 
Urobutylchloralic acid, 380. ' 
Ursin, 544. 
Urson, 544. 
Ustilago maidis, 604. 
Uva ursi, 544. 
V. 
Valerian, 213. 
Valeriana, 213. 
Valerianate of ammonium, 
214. 
of amyl, 391. 
Valerianic acid, 214. 
Vapor bath, 553. 
Vegetable acids, 206. 
Veratralbia, 176. 
Veratrine, 176, 178. 
ointment, 184. 
Veratroidia, 170. 
Veratrum album, 176. 
viride, 169, 559. 
viride as a diaphoretic, 
559. 
viride, resin of, 170. 
viride, tincture of, 170. 
Verdigris, 49. 
Vermicides, 648. 
Vermifuges, 648. 
Vienna paste, 622. 
Vina, 18. 
Vinegar, 210. 
of bloodroot, 477. 
of lobelia, 392. 
of opium, 255. 
of sanguinaria, 477. 
of squill, 525. 
Vinum album, 126. 
rubrum, 126. 
Virginia snakeroot, 89. 
Viridia, 170. 
Vitriolated tartar, 510. 
Vomiting, 468, 470. 
Vomiting, treatment of ex- 
cessive, 470. 
w. 
Wahoo, 508. 
Warburg's tincture, 568. 
Warming plaster, 618. 
Washed sulphur, 496. 
Water of ammonia, 126,611. 
Wax water, 632. 
as a diuretic, 521. 
Weights and measures of the 
metrical system, 7. 
Weights and measures of the 
United States Pharmaco- 
poeia, 7. 
West India pepper, 92. 
Wheat, cracked, 493. 
Whisky, 126. 
White arsenic, 409. 
galls, 30. 
ginger, 91. 
hellebore, 176. 
lead, 43. 
mustard, 616. 
oak, 31. 
pepper, 91. 
precipitate, 437. 
precipitate ointment, 
437. 
sugar, 464. 
turpentine, 140. 
vitriol, 45. 
wax, 632. 
wine, 126. 
Wild cherry, 62. 
Wine of aloes, 507. 
of antimony, 169. 
of colchicum root, 462. 
of colchicum seed, 462. 
of ergot, 603. 
of ipecacuanha, 475. 
of lobelia, 392. 
of opium, 255. 
of rhubarb, 504. 
whey, 139. 
Wormseed, 649. 
oil, 649. 
Y. 
Yaupon, 223. 
Yeast, 656. 
Yellow cinchona, 64. 
jessamine, 392. 
oxide of mercury, 436. 
sulphate of mercury, 
436. 
wash, 436. 
wax, 632. 
Young's rule for doses, 22. 
Z. 
Zea mays, stigmata of, 546. 
Zinc, 45. 
phosphide of, 121. 
Zinci acetas, 46. 
carbonas prascipitata, 
46. 
chloriduin, 622. 
oxidum, 46. 
oxidum venale, 46. 
sulphas, 45. 
Zincum, 45. 
Zingiber, 91. INDEX OF DISEASES. 
A. 
Abscess : 
tannic acid, 28. 
alcohol, 137. 
carbolic acid, 680. 
permanganate of potas- 
sium, 670. 
Acidity of stomach : 
ammonia, 125. 
Acne : 
arsenic, 419. 
iodine, 441. 
phosphorus, 113. 
solution of nitrate of 
mercury, 623. 
Acne rosacea : 
cajeput, 92. 
solution of nitrate of 
mercury, 623. 
Aconite-poisoning : 
alcohol, 137. 
treatment, 194. 
Adynamic fevers .• 
ammonia, 124. 
alcohol, 136. 
camphor, 218. 
digitalis, 156. 
mineral acids, 107. 
opium, 251. 
chlorate of potassium, 
541. 
acetate of ammonium, 
566. 
spirit of nitrous ether, 
567. 
turpentine, 142. 
valerian, 214. 
Alcoholic intoxication : 
ammonia, 125. 
Alimentary inflammation : 
demulcents, 625. 
Alopecia : 
jaborandi, 564. 
Amaurosis ; 
strychnine, 335. 
santonin, 653. 
Amenorrhoea : 
carbonate of iron, 101. 
cantharides, 587. 
aloes, 506. 
turpentine, 547. 
alcohol, 567. 
seneka, 577. 
Amenorrhoea: 
emmenagogues, 584. 
myrrh, 584. 
hellebore, 585. 
iron, 585. 
savine, 586. 
rue, 586. 
apiol, 587. 
guaiac, 588. 
cotton root, 604. 
•- Ansemia : 
iron, 97, 100. 
Anaesthesia of skin : 
electricity, 735. 
Aneurism : 
digitalis, 155. 
iodide of potassium, 
443. 
ergot, 600. 
Angina : 
gum arabic, 625. 
j4 ngina pectoris : 
nitrite of amyl, 387. 
nitrite of potassium, 
389. 
nitrite of sodium, 390. 
nitroglycerine, 390. 
chlorate of potassium, 
541. 
Animal poisoning : 
ammonia, 125. 
alcohol, 137. 
J Aortic disease : 
digitalis, 154. 
Aphthous sore mouth : 
chlorate of potassium, 
V 541. 
borax, 675. 
carbolic acid, 683. 
Arsenical poisoning : 
treatment, 422. 
" Arterial excitement: 
aconite, 193. 
antimony, 167. 
gelsemium, 395. 
veratrum viride, 174. 
Ascites : 
elaterium, 517. 
chlorate of potassium, 
541. 
jalap, 512. 
» Asthma : 
eucalyptus, 97. 
belladonna, 287. 
Asthma : 
emetics, 469. 
gelsemium, 395. 
hyoscine, 300. 
stramonium, 297. 
anaesthetics, 305. 
ether, 315. 
chloral, 375. 
nitrite of amyl, 387. 
lobelia, 392. 
nitroglycerine, 391. 
tobacco, 400. 
arsenic, 420. 
iodide of potassium, 
443. 
Atheroma ; 
digitalis, 155. 
B. 
Bed-sores : 
chloral, 376. 
protectives, 638. 
Belladonna-poisoning : 
treatment, 294. 
Biliary calculi : 
belladonna, 287. 
emetics, 469. 
Bilious fever : 
quinia, 82. 
calomel, 502. 
jaborandi, 564. 
Warburg's tincture, 
568. 
Biliousness : 
muriate of ammonia, 
576. 
nitro-muriatic acid, 
110. 
calomel, 502. 
podophyllum, 515. 
potassium salts, 535. 
Bites : 
caustic potash, 620. 
Bladder, irritable: 
buchu, 543. 
hops, 221. 
pareira, 544. 
Indian corn silk, 546. 
Boils: 
cocaine, 238. 
phosphorus, 113. 
sulphide of calcium, 
498. 
769 770 
INDEX OF DISEASES. 
Boils : 
sulphurated lime, 498. 
Brain softening : 
phosphorus, 113. 
Bright's disease : 
caffein, 231. 
cream of tartar, 536. 
jaborandi, 564. 
gallic acid, 29. 
iodide of potassium, 443. 
tincture of the chloride 
of iron, 102. 
diuretics, 521. 
diaphoretics, 556. 
water, 521, 635. 
Bronchitis : 
antimony, 168. 
apomorphia, 481. 
assafetida, 215.' 
Calabar bean, 352. 
benzoic acid, 581. 
oil of amber, 220. 
lobelia, 392. 
oil of eucalyptus, 97. 
oil of turpentine, 142, 
143. 
tartar emetic, 572. 
cimicifuga, 223. 
opium, 250. 
lobelia, 392. 
sanguinaria, 477. 
copaiba, 550. 
cubebs, 551. 
expectorants, 569. 
inhalations, 572. 
ipecacuanha, 572. 
chloral, 375. 
chloride of ammonium, 
575. 
seneka, 576. 
alkalies, 569. 
ammoniac, 577. 
garlic, 582. 
- squill, 582. 
strychnine, 335. 
tar, 583. 
Burgundy pitch, 618. 
demulcents, 625. 
liquorice, 628. 
Bronchorrhoea : 
gallic acid, 29, 569. 
alum, 33. 
astringents, 571. 
Buboes : 
iodoform, 447. 
chloral, 376. 
4 Burns : 
Carron oil, 646. 
carbonate of lead, 43. 
carbolic acid, 685. 
Kentish ointment, 618. 
chalk, 647. 
Bursee, inflamed : 
carbolic acid injections, 
684. 
C. 
Cachexia : 
glycerine, 634. 
Calculi : 
anaesthetics, 305. 
benzoic acid, 580. 
Cancer : 
arsenic, 621. 
Chian turpentine, 143. 
chloral, 376. 
conium, 406. 
acid nitrate of mercury, 
623. 
iodoform, 447. 
Cancrum oris : 
nitric acid, 108. 
Carcinoma of stomach : 
bismuth, 45. 
Cardiac disease, chronic : 
aconite, 193. 
digitalis, 152. 
Hoffmann's anodyne, 
220. 
nitrite of amyl, 387. 
veratrum viride, 175. 
Cardiac dropsy : 
caflfein, 231. 
squill, 525. 
digitalis, 159. 
Cardiac failure : 
ammonia, 125. 
nitrite of amyl, 387. 
Cardialgia : 
antacids, 641. 
charcoal, 662. 
Caries : 
cod-liver oil, 451. 
cloves, 90. 
Cataract : 
phosphorus, 113. 
atropia, 292. 
Catarrh : 
balsam of Peru, 581. 
chloride of ammonium, 
576. 
Catarrh, chronic : 
assafetida, 215. 
benzoic acid, 580. 
expectorants, 569. 
Catarrh of bladder : 
benzoic acid, 581. 
juniper, 545. 
thymol, 700. 
Catarrh, suffocative : 
allium, 582. 
apomorphia, 480. 
expectorants, 569. 
► Catarrhal pneumonia : 
cod-liver oil, 451. 
alteratives, 569. 
Cerebral excitement: 
bromide of potassium, 
362. 
Cerebritis : 
electricity, 736. 
- Chancres : 
iodoform, 447. 
escharotics, 619. 
Canquoin's paste, 622. 
solution of nitrate of 
mercury, 623. 
corrosive sublimate, 
623. 
Chancres : 
black and yellow 
washes, 437. 
chloride of zinc, 622. 
nitric acid, 108. 
Chapped hands, lips, nip- 
ples : 
benzoic acid, 581. 
solution of gutta-per- 
cha, 640. 
Chloral poisoning : 
treatment of, 377. 
Cholera : 
ammonia, 125. 
camphor, 216. 
chloral, 375. 
sulphuric acid, 105. 
nitrite of amyl, 388. 
Cholera infantum : 
sulphuric acid, 105. 
chlorate of potassium, 
541. 
cold, 716. 
Chordee : 
brominated camphor, 
219. 
hops, 221. 
camphor, 218. 
Chorea : 
arsenic, 420. 
Calabar bean, 342. 
cimicifuga, 221. 
chloral, 375. 
conium, 406. 
bromide of iron, 104. 
bromide of sodium, 
366. 
lobelia, 392. 
oxide of zinc, 46. 
Cirrhosis : 
nitro-muriatic acid, 
110. 
Cold, a general : 
Dover's powder, 558. 
hot baths, 556. 
Colic : 
assafetida, 215. 
atropia, 287. 
belladonna, 287. 
cajeput, 92. 
chloroform, 322. 
ether, 315. 
antacids, 641. 
ginger, 91. 
opium, 250. 
Colica pictonum : 
alum, 33. 
sulphuric acid, 107. 
belladonna, 287. 
chloroform, 322. 
Epsom salt, 509. 
Colitis : 
nitrate of silver, 55. 
sulphate of magnesium, 
509. 
Collapse : 
ammonia, 125. 
digitalis, 155. 
heat, 704. 
mustard, 609. INDEX OF DISEASES. 
771 
Collapse : 
Warburg's tincture, 
568. 
Colliquative sweats : 
gallic acid, 29. 
alum, 33. 
sulphuric acid, 105. 
belladonna, 288. 
ergot, 599. 
ipecacuanha, 474. 
Condylomata : 
nitric acid, 623. 
chromic acid, 624. 
carbolic acid, 683. 
Congestion of brain : 
elaterium, 517. 
Congestion of cord : 
ergot, 600. 
Congestion, hepatic : 
nitro-muriatic acid, 
110. 
Congestion, renal .* 
juniper, 545. 
Conjunctivitis : 
alum, 33. 
sulphate of copper, 47. 
nitrate of silver, 53. 
yellow oxide of mer- 
cury, 436. 
Constipation : 
alum, 34. 
aloes, 506. 
belladonna, 287. 
Epsom salts, 509. 
strychnine, 336. 
general treatment, 491. 
Calabar bean, 353. 
cascara sagrada, 495. 
castor oil, 499. 
podophyllum, 515. 
cracked wheat, 494. 
bran, 494. 
unbolted flour, 494. 
Indian meal, 494. 
forced enemata, 490. 
rhubarb, 504. 
gamboge, 519. 
croton oil, 520. 
wahoo, 508. 
Consumption : 
cod-liver oil, 451. 
Convulsions : 
anaesthetics, 305. 
bromide of potassium, 
362. 
brominated camphor, 
219. 
chloral, 375. 
emetics, 469. 
garlic, 582. 
lobelia, 392. 
nitrite of amyl, 388. 
Coryza : 
cocaine, 238. 
cubebs, 606. 
errhines, 606. 
glycerine, 737. 
nitrite of amyl, 388. 
lough, to quiet: 
belladonna, 287. 
Cough, to quiet : 
prussic acid, 204. 
Cramps of pregnancy: 
chloral, 375. 
Croup, membranous : 
alum, 33, 482. 
glycerine, 737. 
ipecacuanha, 474. 
jaborandi, 565. 
lime-water, 646. 
mercury, 429. 
Cystitis, chronic : 
arbutin, 544. 
boracic acid, 675. 
budhu, 543. 
iodine, 441. 
pareira, 543. 
uva ursi, 544. 
turpentine, 547. 
copaiba, 549. 
cantharides, 552. 
salicylic acid, 697. 
zea mays, 546. 
Cystorrhoea : 
ergot, 601. 
D. 
Debility: 
prunus Virginiana, 63. 
Delirium, of low fevers : 
musk, 213. 
valerian, 214. 
opium, 250. 
chloral, 375. 
blisters, 610. 
Delirium tremens: 
brominated camphor, 
219. 
veratrum viride, 174. 
hops, 221. 
opium, 250. 
bromide of potassium, 
362. 
chloral, 373. 
croton oil, 519. 
gamboge, 520. 
Dermal growths : 
chromic acid, 623. 
nitric acid, 624. 
Diabetes : 
opium, 250. 
glycerine, 737. 
thymol, 700. 
yeast, 650. 
Diabetes insipidus : 
opium, 250. 
Diarrhoea : 
aromatics, 88. 
tannic acid, 28. 
eatechu, 30. 
coca, 238. 
antacids, 641. 
haematoxylon, 31. 
alum, 33. 
acetate of lead, 42. 
bismuth, 45. 
eucalyptus, 97. 
oil of cajeput, 92. 
Diarrhoea : 
ipecacuanha, 474. 
sulphuric acid, 106. 
magnesia, 496. 
nitrous acid, 109. 
camphor, 216. 
opium, 250. 
pepsin, 658. 
belladonna, 288. 
strychnine, 330. 
castor oil, 499. 
rhubarb, 504. 
ergot, 600. 
lime-water, 646. 
charcoal, 662. 
Diarrhoea, chronic : 
bismuth, 45. 
sulphate of copper, 47. 
sulphate of iron, 102. 
sulphate of zinc, 46. 
nitro-muriatic acid, 
110. 
magnesia, 496. 
oxide of zinc, 46. 
copaiba, 549. 
ergot, 600. 
phosphate of sodium, 
510. 
Dilatation of heart: 
digitalis, 152. 
convallaria, 160. 
Diphtheria : 
benzoic acid, 580. 
carbolic acid, 685. 
cold, 706. 
borax, 675. 
jaborandi, 564. 
tincture of the chloride 
of iron, 162. 
muriatic acid, 107. 
chlorate of potassium, 
541. 
lime-water, 656. 
salicylic acid, 696. 
Diphtheritic paralysis : 
electricity, 734. 
Dislocation : 
anaesthetics, 305. 
Diuresis, excessive : 
turpentine, 547. 
Dropsy : 
antihydropin, 542. 
bitartrate of potassium, 
536. 
caffein, 231. 
colocynth, 513. 
convallarin, 160. 
copaiba, 550. 
digitalis, 160, 525. 
elaterium, 517. 
gamboge, 518. 
hot baths, 556. 
jaborandi, 564. 
jalap, 512. 
scoparius, 528. 
seneka, 577. 
squill, 525. 
veratria, 184. 
Dysentery : 
acetate of lead, 42. 772 
INDEX OF DISEASES. 
Dysentery : 
cathartics, 492. 
cold, 717. 
nitrous acid, 109. 
opium, 250, 254. 
iodine, 441. 
ipecacuanha, 474. 
calomel, 502. 
castor oil, 499. 
chlorate of potassium, 
541. 
copaiba, 549. 
ergot, 600. 
flaxseed, 628. 
glycerine, 737. 
Dysmenorrhoea : 
acetate of ammonium, 
566. 
aloes, 506. 
apiol, 587. 
ginger, 91. 
belladonna, 218. 
camphor, 218. 
guaiac, 587. 
nitrite of amyl, 388. 
cotton root, 604. 
Dyspepsia: 
alcohol, 138. 
charcoal, 662. 
ginger, 91. 
piperin, 92. 
magnesia, 496. 
pepsin, 657. 
muriatic acid, 107. 
nitrate of silver, 54. 
pepper, 92. 
nitric acid, 108. 
assafetida, 215. 
strychnine, 336. 
Calabar bean, 353. 
antacids, 641. 
taraxacum, 466. 
wahoo, 508. 
Dysuria: 
conium, 406. 
E. 
Eczema : 
arsenic, 419. 
glycerine, 737. 
oxide of zinc ointment, 
46. 
Effusion, pericardial: 
squill, 525. 
Effusion, pleural: 
squill, 525. 
Emphysema : 
strychnine, 336. 
Empyema: 
iodine, 442. 
Endocarditis : 
mercury, 429. 
Enteritis : 
nitrate of silver, 55. 
opium, 250. 
sul phate of magnesium, 
509. 
Enteritis : 
chlorine, 671. 
castor oil, 499. 
flaxseed, 628. 
slippery elm, 626. 
Enteritis, obstructive : 
calomel, 502. 
ulmus fulva, 626. 
flaxseed, 628. 
Epididymitis : 
nitrate of silver, 54. 
Epilepsy : 
oxide of zinc, 46. 
ammoniated copper, 48. 
nitrate of silver, 55. 
camphor, 218. 
bromide of camphor, 
219. 
ergot, 600. 
anaesthetics, 305. 
Calabar bean, 353. 
bromide of potassium, 
362. 
bromide of sodium, 366. 
bromide of lithium, 366. 
bromide of ammonium, 
365. 
lobelia, 392. 
nitrite of amyl, 388. 
santonin, 653. 
Epistaxis : 
tannic acid, 28. 
ergot, 599. 
Erysipelas : 
nitrate of silver, 54. 
benzoic acid, 580. 
borax, 674. 
sulphate of iron, 101. 
tincture of the chloride 
of iron, 102. 
belladonna, 288. 
quinia, 79. 
iodine, 441. 
carbolic acid injections, 
685. 
Exophthalmic goitre : 
iodine, 441. 
F. 
Failure of heart: 
ammonia, 125. 
digitalis, 155. 
Fatty heart: 
nitrite of amyl, 388. 
Faucitis : 
nitrate of silver, 53. 
Fecal accumulation : 
black draught, 508. 
Epsom salt, 509. 
Feet, tender : 
tannic acid, 28. 
Felon : 
nitrate of silver, 54. 
carbolic acid, 684. 
Fetid expectoration : 
carbolic acid, 572. 
Fever : 
antipyrin, 701. 
kairin, 703. 
digitalis, 156. 
aconite, 193. 
cold, 707. 
chloral, 373. 
gelsetnium, 395. 
muriatic acid, 107. 
nitric acid, 108. 
ammonia, 125. 
tartar emetic, 168. 
lemon-juice, 209. 
Fibroid tumors of uterus : 
ergotin, 600. 
Fissure of anus : 
belladonna, 287. 
benzoic acid, 581. 
Fragilitas ossium : 
phosphates, 454. 
Furuncles : 
See Boils. 
G. 
Galactorrhoea : 
ergot, 600. 
Gangrene : 
nitric acid, 108. 
carbolic acid, 683. 
Gangrene, hospital: 
bromine, 624. 
nitric acid, 108. 
Gastralgia : 
alum, 34. 
bismuth, 45. 
manganese, 105. 
prussic acid, 204. 
arsenic, 420. 
Gastric catarrh : 
chloride of ammonium, 
576. 
bismuth, 45. 
Gastric ulcer : 
nitrate of silver, 55. 
oil of turpentine, 142. 
Gastritis : 
nitrate of silver, 55. 
veratrum viride, 174. 
Glands, enlarged: 
ammoniac, 577. 
carbolic acid injections, 
684. 
conium, 406. 
iodine, 442. 
mercury, 432. 
sulphurated lime, 498. 
cod-liver oil, 145. 
Glaucoma : 
atropia, 293. 
Gleet: 
tincture of the chloride 
of iron, 102. 
turpentine, 547. 
cantharides, 552. 
Goitre .• 
iodine, 441. 
Gonorrhoea : 
acetate of zine, 47. 
antimony, 167. INDEX OF DISEASES. 
773 
Gonorrhoea : 
arbutin, 544. 
benzoic acid, 580. 
bismuth, 45. 
bromide of potassium, 
363. 
eucalyptus, 97. 
nitrate of silver, 53, 54. 
oil of erigeron, 546. 
tartar emetic, 167. 
pareira, 543. 
copaiba, 549. 
cubebs, 551. 
matico, 552. 
quinia, 83. 
water, 637. 
Gonorrhoeal rheumatism : 
salicylic acid, 696. 
Gout: 
arsenic, 420. 
carbonate of lithium, 
542. 
ether, 315. 
iodide of potassium, 
452. 
lithium, 542. 
magnesia, 496. 
cod-liver oil, 452. 
colchicum, 460. 
potassium, 532. 
rubefacients, 615. 
Gout, retrocedent: 
ether, 315. 
Granulations, exuberant : 
burnt alum, 624. 
sulphate of copper, 624. 
sulphate of zinc, 624. 
Gravel : 
stigmata of Indian corn, 
546. 
water, 637. 
benzoic acid, 580. 
Graves's disease : 
iodine, 441. 
Gums, retraction of : 
iodine, 441. 
H. 
Heematemesis: 
tannic acid, 28. 
gallic acid, 29. 
subsulphate of iron, 102. 
oil of turpentine, 143. 
Hematuria: 
gallic acid, 29. 
turpentine, 547. 
Hemoptysis : 
alum, 33. 
acetate of lead, 42. 
gallic acid, 29. 
ipecacuanha, 475. 
subsulphate of iron, 102. 
opium, 250. 
oil of turpentine, 143. 
astringent inhalations, 
571. 
ergot, 599. 
Hay fever: 
cocaine, 238. 
quinine, 83. 
Headache: 
ammonia, 125. 
antacids, 642. 
caffeine, 230. 
magnesia, 496. 
ergot, 600. 
Heartburn : 
antacids, 641. 
Heart-disease : 
aconite, 193. 
convallaria, 160. 
digitalis, 152. 
Hoffmann's anodyne, 
220. 
veratrum viride, 175. 
nitrite of amyl, 387. 
Hectic fever : 
prunus Virginiana, 63. 
cold, 716. 
Hemiplegia : 
strychnine, 335. 
electricity, 736. 
Hemorrhage from bowels : 
tannic acid, 28. 
oil of turpentine, 143. 
Hemorrhages : 
astringents, 28. 
oil of erigeron, 546. 
oil of eucalyptus, 97. 
sulphuric acid, 106. 
matico, 552. 
subsulphate of iron, 
102. 
ergot, 599. 
acetate of lead, 42. 
chlorate of potassium, 
542. 
Hemorrhoids: 
cocaine, 238. 
tannic acid, 28. 
stramonium, 297. 
glycerine, 737. 
iodoform, 447. 
sulphur, 497. 
aloes, 506. 
cubebs, 551. 
tobacco, 401. 
ergotin, 601. 
Hepatic abscess: 
chloride of ammonium, 
576. 
escharotics, 619. 
Hepatic congestion : 
nitric acid, 109. 
nitro-muriatic acid, 
110. » 
dandelion, 466. 
lemon-juice, 209. 
chlorine, 671. 
hydragogues, 492. 
Hepatic torpor: 
potash salts, 535. 
wahoo, 508. 
Hepatitis: 
nitro-muriatic acid, 
110. 
mercury, 429. 
Hepatitis ; 
chloride of ammonium, 
576. 
Hernia : 
forced enemata, 490. 
Hiccough: 
chioral, 375. 
musk, 213. 
oil of amber, 220. 
belladonna, 287. 
ether, 315. 
Hospital gangrene: 
bromine, 624. 
Hydrocele ; 
iodine, 442. 
carbolic acid, 684. 
Hydrocephalus : 
iodide of potassium, 
443. 
iodoform, 446. 
Hydrophobia: 
escharotics, 619. 
chlorate of potassium, 
541. 
Hyperemesis : 
treatment, 470. 
Hyperpyrexia : 
quinia, 79. 
salicylic acid, 695. 
Hypertrophy of heart : 
digitalis, 152. 
aconite, 193. 
Hypertrophy of uterus: 
ergot, 601. 
Hypochondriasis : 
alcohol, 137. 
electricity, 741. 
Hysteria : 
antispasmodics, 212. 
bromide of potassium, 
362. 
bromide of sodium, 366. 
brominated camphor, 
219. 
cocaine, 238. 
musk, 213. 
valerian, 214. 
valerianic acid, 214. 
assafetida, 215. 
camphor, 218. 
conium, 406. 
electricity, 740, 741. 
anaesthetics, 305. 
ether, 315. 
oil of wormseed, 649. 
oil of amber, 220. 
valerianate of ammo- 
nium, 214. 
Hysterical paralysis: 
electricity, 73. 
I. 
Impotence : 
turpentine, 547. 
Incontinence of urine : 
belladonna, 287. 
bromide of iron, 104. 
chloral, 375. 774 
INDEX OF DISEASES. 
Incontinence of urine : 
strychnine, 336. 
turpentine, 547. 
Indigestion : 
charcoal, 662. 
pepsin, 657. 
Infantile convulsions : 
anaesthetics, 305. 
assafetida, 215. 
bromide of potassium, 
362. 
brominated camphor, 
219. 
chloral, 375. 
oil of amber, 220. 
garlic, 582. 
Infantile diarrhoea : 
phosphate of sodium, 
510. 
thymol, 703. 
Infantile paralysis : 
electricity, 735. 
strychnine, 336. 
Inflammations : 
borax, 674. 
lead, 41. 
blisters, 610. 
tartar emetic, 167. 
mercury, 429. 
cold, 703. 
stramonium, 297. 
copaiba, 549. 
Intermittent fever : 
arsenic, 41. 
apiol, 586. 
chloroform, 322. 
chloride of ammonium, 
575. 
eucalyptus, 96. 
gelsemium, 395. 
ipecacuanha, 475. 
hot bath, 553. 
nitrite of amyl, 388. 
piperin, 91. 
quinine, 81. 
salicylic acid, 696. 
Intertrigo : 
chalk, 647. 
Intestinal catarrh : 
chloride of ammonium, 
575. 
cathartics, 492. 
eucalyptus, 96. 
forced enema, 490. 
Intestinal dyspepsia : 
muriatic acid, 107. 
Calabar bean, 353. 
Intussusception : 
forced enema, 490. 
Iritis : 
atropia, 293. 
mercury, 429. 
Irritable heart: 
digitalis, 154. 
Irritative fevers : 
aconite, 193. 
Itch : 
sulphur, 497. 
J. 
Jaundice : 
emetics, 469. 
lemon-juice, 210. 
nitro-muriatic acid, 
110. 
potassium salts, 535. 
calomel, 502. 
forced enema, 490. 
ipecacuanha, 474. 
Joints, chronic inflammation 
of: 
blisters, 610. 
cod-liver oil, 451. 
mercurial plaster, 432. 
Joints, enlarged: 
oonium, 406. 
iodine, 441. 
cod-liver oil, 451. 
emplastrum ammoni- 
aci, 577. 
K. 
Keratitis: 
atropia, 293. 
Kidneys, congestion of: 
gin, 546. 
flaxseed, 628. 
L. 
Labor: 
anaesthesia, 304. 
chloroform, 322. 
ergot, 597. 
Laryngismus stridulus : 
belladonna, 287. 
chloral, 375. 
Laryngitis : 
gelsemium, 395. 
glycerine, 737. 
nitrate of silver, 53. 
mercury, 429. 
inhalations, 571. 
Lead paralysis : 
strychnine, 335. 
electricity, 735. 
Lead-poisoning ; 
atropine, 287. 
alum, 39. 
sulphuric acid, 105. 
treatment of, 39. 
Leucorrhoea : 
bismuth, 45. 
tanpic acid, 28. 
ainmonio-ferric alum, 
104. 
iodine, 441. 
permanganate of potas- 
sium, 670. 
Leukeemia : 
ergot, 599. 
cold, 707. 
iodoform, 446. 
Lichen: 
arsenic, 419. 
Locomotor ataxia : ' 
nitrate of silver, 55. 
Lumbago ; 
iodide of potassium, 
443. 
cod-liver oil, 452. 
sulphur, 497. 
Lupus : 
arsenic, 423, 621. 
phosphorus, 113. 
mercury, 436. 
Lymphoma : 
arsenic, 41S. 
M. 
Malarial neuralgia : 
quinine, 82. 
Malarial poisoning : 
chloroform, 322. 
calomel, 502. 
gelsemium, 371. 
quinine, 79, 80. 
arsenic, 417. 
epispastics, 609. 
bebeerine, 60. 
potassium salts, 535. 
apiol, 587. 
ergot, 599. 
eucalyptus, 96. 
jaborandi, 564. 
muriate of ammonia, 
575. 
picric acid, 87. 
Warburg's tincture, 
568. 
Malignant pustule : 
escharotics, 619. 
Mania : 
bromide of potassium, 
362. 
chloral, 373. 
chloral camphor, 379. 
croton oil, 519. 
gelsemium, 395. 
gamboge, 520. 
conium, 406. 
blisters, 610. 
Mania a potu : 
veratrum viride, 174. 
valerian, 214. 
Mastitis : 
belladonna, 291. 
Melancholia : 
alcohol, 137. 
cocaine, 238. 
Meningitis : 
cold, 706. 
Menorrhagia ; 
aloes, 506. 
oil of erigeron, 546. 
acetate of ammonium, 
566. 
rue, 586. 
savine, 586. 
ergot, 600. 
phosphates, 455. INDEX OF DISEASES. 
775 
Menstruation, acute suppres- 
sion of : 
Dover's powder, 558. 
ginger, 91. 
alcohol, 567. 
hot baths, 554. 
Mercurial sore mouth : 
tannic acid, 28. 
opium, 251. 
belladonna, 288. 
Metallic poisoning : 
iodide of potassium, 
443. 
Metritis: 
ergot, 600. 
Migraine : 
aconite, 195. 
nitrite of amyl, 387. 
muriate of ammonia, 
576. 
Mitral disease : 
digitalis, 153. 
Muscular rheumatism : 
eupatorium, 61. 
ipecacuanha, 475. 
aconite, 193. 
alcohol, 567. 
Dover's powder, 251, 
558. 
hot baths, 554. 
iodide of potassium, 
443. 
sulphur, 497. 
Myelitis: 
electricity, 733. 
nitrate of silver, 55. 
phosphorus, 113. 
N. 
Narcotic poisoning: 
apomorphine, 480. 
ipecacuanha, 474. 
mustard, 481. 
sulphate of copper, 482. 
sulphate of zinc, 482. 
Nasal catarrh : 
eucalyptus, 97. 
Nephritis : 
belladonna, 287. 
bitartrate of potassium, 
536. 
jaborandi, 564. 
Nervous cough : 
belladonna, 287. 
flaxseed, 628. 
gelsemium, 395. 
Nervous exhaustion : 
phosphorus, 113. 
Warburg's tincture, 
568. 
Nervous headache : 
caffeine, 230. 
camphor, 218. 
ether, 315. 
valerianate of ammo- 
nium, 214. 
Nervous irritability : 
assafetida, 215. 
bromide of potassium, 
362. 
prussic acid, 204. 
valerian, 214. 
Nervous vomiting : 
hydrocyanic acid, 204. 
carbolic acid, 683. 
Neuralgia : 
arsenic, 420. 
bromide of potassium, 
362. 
blisters, 610. 
electricity, 737. 
phosphorus, 113. 
veratria, 184. 
aconite, 194. 
alcohol, 137, 138. 
valerianic acid, 214. 
gelsemium, 395. 
cannabis Indica, 267. 
belladonna, 287. 
ether, 315. 
chloral camphor, 379. 
chloroform, 322, 324. 
croton chloral, 380. 
nitroglycerine, 390. 
iodide of potassium, 
443. 
iodoform, 446. 
cod-liver oil, 452. 
oonium, 406. 
chloride of ammonium, 
576. 
valerianate of ammo- 
nium, 214. 
quinine, 82. 
ergot, 600. 
epispastics, 610. 
Neuralgia, intermittent: 
apiol, 587. 
aromatics, 88. 
arsenic, 418. 
ergot, 601. 
oil of peppermint, 88. 
quinine, 82. 
Neuralgia, intestinal: 
alum, 34. 
Neuralgia, rheumatic .* 
veratrine, 184. 
aconite, 194. 
iodide of potassium, 
443. 
Neurasthenia : 
cocaine, 238. 
Neuritis : 
blister, 610. 
Night-pains, syphilitic : 
iodoform, 446. 
Night-sweats: 
alum, 33. 
belladonna, 288. 
ergot, 599. 
gallic acid, 29. 
sulphuric acid, 105. 
ipecacuanha, 474. 
Nipples, sore : 
tannic acid, 28. 
Nymphomania : 
bromide of potassium, 
364. 
O. 
Obstruction of bowels : 
belladonna, 287. 
opium, 250. 
(Edema of the lungs .• 
jaborandi, 564. 
(Esophagus, stricture of : 
anaesthetics, 305. 
Onychia maligna : 
nitrate of lead, 43. 
corrosive sublimate, 
623. 
Ophthalmia : 
iodine, 441. 
Opium-poisoning : 
caffeine, 230. 
atropine, 289. 
treatment, 251. 
Osmidrosis: 
tannic acid, 28. 
Osteomalacia : 
phosphorus, 113. 
phosphates, 455. 
Otorrhoea: 
permanganate of potas- 
sium, 670. 
Ovarian neuralgia : 
gelsemium, 395. 
muriate of ammonia, 
576. 
Over-secretion : 
astringents, 28. 
Oxalic acid diathesis : 
nitric acid, 108. 
nitro-muriatic acid, 
110. 
Oxyuris vermicularis : 
forced enemata, 490. 
Ozxna : 
iodine, 441. 
permanganate of potas- 
sium, 670. 
P. 
• Palpitation of heart : 
belladonna, 291. 
Paralysis : 
strychnine, 335. 
Paralysis agitans : 
conium, 406. 
Paraplegia, myelitic .• 
nitrate of silver, 55. 
phosphorus, 113. 
Parasitic skin-diseases : 
iodine, 441. 
oil of cajeput, 92. 
Pemphigus : 
arsenic, 418. 
Pericardial effusions : 
iodoform, 446. 
blisters, 611. 
squill, 525. 776 
INDEX OF DISEASES. 
Pericarditis : 
mercury, 429. 
iodide of potassium, 
443. 
iodoform, 446. 
Periostitis, syphilitic : 
phosphates, 455. 
Peritonitis : 
cold, 706. 
veratrum viride, 170. 
aconite, 193. 
opium, 250. 
mercury, 429. 
blisters, 610. 
ipecacuanha, 558. 
poultices, 636. 
Pernicious fever : 
ammonia, 124. 
epispastics, 609. 
mustard, 609. 
quinine, 81. 
Phagedeenic ulcers : 
nitric acid, 108. 
Phantom tumor : 
Calabar bean, 353. 
Phlegmons : 
carbolic acid injections, 
684. 
Phosphatic gravel: 
zea mays, 546. 
benzoic acid, 580. 
Phosphorus-poisoning: 
treatment of, 119. 
Phthisis: 
prunus Virginiana, 63. 
alcohol, 138. 
cannabis Indica, 267. 
conium, 406. 
eucalyptus, 97. 
gallic acid, 29. 
iodine, 441. 
cod-liver oil, 451. 
phosphates, 455. 
strychnine, 336. 
thymol, 700. 
Pityriasis : 
oil of cajeput, 93. 
Pleuritic effusion : 
iodoform, 446. 
blisters, 610. 
squill, 525. 
Pleuritis: 
gelsemium, 395. 
mercury, 429. 
jaborandi, 564. 
iodide of potassium, 
443. 
iodine, 442. 
blisters, 610. 
poultices, 636. 
Pneumonia : 
aconite, 193. 
alcohol, 137. 
ammonia, 125. 
belladonna, 288. 
cold, 703, 713. 
expectorants, 570. 
gelsemium, 395. 
digitalis, 156. 
oil of turpentine, 143. 
Pneumonia : 
tartar emetic, 167. 
veratrum viride, 174. 
musk, 213. 
chloral, 375. 
mercury, 429. 
phosphorus, 113. 
quinia, 79. 
blisters, 610. 
poultices, 636. 
veratrum viride, 174. 
Post-partum hemorrhage : 
ergot, 598. 
ipecacuanha, 475. 
quinia, 75. 
Pregnancy : 
phosphates, 455. 
confection of senna, 
508. 
ipecacuanha, 474. 
Priapism ; 
hops, 221. 
Prolapsus of the rectum : 
emetics, 469. 
strychnine, 336. 
Prurigo : 
hydrocyanic acid, 204. 
Pruritus : 
chloral camphor, 379. 
glycerine, 634. 
tobacco, 401. 
Psoriasis : 
oil of cajeput, 93. 
phosphorus, 113. 
chrysophanic acid, 503. 
arsenic, 419. 
iodine, 441. 
glycerine, 634. 
Psorophthalmia : 
yellow oxide of mer- 
cury, 436. 
Pseudo-membranous croup : 
alum, 482. 
ipecacuanha, 474. 
mercury, 429. 
Ptyalism : 
belladonna, 288. 
opium, 251. 
Puerperal convulsions : 
nitrite of amyl, 388. 
anaesthetics, 305. 
camphor, 218. 
chloroform, 322. 
chloral, 374, 375. 
nitroglycerine, 391. 
Puerperal fever : 
oil of turpentine, 143. 
digitalis, 156. 
borax, 675. 
Puerperal peritonitis : 
mercury, 429. 
Purpura heemorrhagica : 
oil of turpentine, 143. 
ergot, 599. 
Pyeemia : 
alcohol, 136. 
tincture of the chloride 
of iron, 102. 
quinine, 78. 
Pyelitis, chronic : 
buchu, 543. 
uva ursi, 544. 
juniper, 545. 
turpentine, 547. 
copaiba, 549. 
cantharides, 552. 
salicylic acid, 697. 
Pyrosis : 
bismuth, 45. 
manganese, 105. 
nitrate of silver, 54. 
oxide of silver, 57. 
R. 
Rachitis : 
phosphates, 455. 
Rectum : 
feeding by, 659. 
Relaxation : 
astringents, 28. 
Relaxation of uvula : 
pellitory, 605. 
Remittent fever : 
quinia, 82. 
arsenic, 417. 
ipecacuanha, 475. 
Warburg's tincture, 
568. 
Renal calculi : 
belladonna, 287. 
Retention of urine : 
strychnine, 336. 
Retrocedent gout : 
ether, 315. 
Rheumatism : 
aconite, 193. 
arsenic, 420. 
bromide of ammonium, 
366. 
quinine, 80. 
jaborandi, 564. 
conium, 406. 
cimicifuga, 222. 
carbolic acid injections, 
685. 
chloroform, 322. 
oil of amber, 220. 
oil of cajeput, 93. 
veratrine, 184. 
arsenic, 420. 
iodine, 441. 
iodide of potassium, 
443. 
iodoform, 446. 
cod-liver oil, 452. 
Donovan's solution, 
444. 
Dover's powder, 251, 
558. 
colchicum, 461. 
guaiac, 465. 
hot baths, 556. 
opium, 251. 
magnesia, 496. 
mercury, 436. 
nitrate of potassium, 
538. INDEX OF DISEASES. 
777 
Rheumatism : 
sulphur, 497. 
Scudamore's mixture, 
461. 
alcohol, 567. 
Burgundy pitch, 618. 
pellitory, 605. 
sulphurated potassa, 
497. 
Rheumatism, inflammatory : 
quinia, 79, 80. 
lemon-juice, 209. 
cimicifuga, 222. 
benzoic acid, 580. 
bromide of ammonium, 
366. 
iodide of potassium, 
443. 
potassium salts, 535. 
nitrate of potassium, 
538. 
salicin, 698. 
salicylic acid, 696. 
Dover's powder, 558. 
vinegar, 210. 
Rheumatoid arthritis: 
arsenic, 420. 
iodide of potassium, 
443. 
Rhus toxicodendron poison- 
ing : 
lobelia, 391. 
Rickets: 
phosphorus, 113. 
cod-liver oil, 451. 
Rigidity of os uteri: 
belladonna, 287. 
Round worms : 
oil of turpentine, 142, 
654. 
spigelia, 649. 
azedarach, 649. 
chenopodium, 649. 
santonin, 653. 
mucuna, 655. 
S. 
Scabies : 
glycerine, 634. 
Scarlet fever : 
aconite, 193. 
belladonna, 288, 294. 
cold, 706, 715. 
chlorate of potassium, 
541. 
quinine, 79. 
Sciatica : 
conium, 406. 
iodide of potassium, 
443. 
cod-liver oil, 452. 
sulphur, 497. 
electricity, 737. 
Scrofulosis : 
alcohol, 138. 
sarsaparilla, 464. 
pipsissewa, 545. 
iodine, 441. 
Scrofulosis : 
cod-liver oil, 451. 
'phosphoric acid, 455. 
phosphates, 455. 
syrup of iodide of iron, 
103. 
Scrofulous tumors: 
emplastrum ammoniaci, 
577. 
Scrofulous ulcers : 
sulphurated lime, 498. 
Scurvy : 
lemon-juice, 209. 
chlorate of potassium, 
541. 
vinegar, 210. 
Seat-worms : 
forced enemata, 490. 
quassia, 59. 
oil of cajeput, 92. 
vinegar, 210. 
Seborrhoea : 
glycerine, 634. 
Septicsemia : 
quinia, 79. 
borax, 675. 
Sexual excitement : 
bromide of potassium, 
362. 
camphor, 218. 
hops, 221. 
Shock : 
epispastics, 609. 
hot baths, 705. 
Sick headache : 
antacids, 642. 
magnesia, 496. 
Sick stomach : 
ipecacuanha, 474. 
Singultus: 
chloral, 375. 
Sinking spells: 
ether, 315. 
Skin, affections of: 
arsenic, 418. 
chalk, 647. 
cod-liver oil, 452. 
Donovan's solution, 
444. 
magnesia, 496. 
nitro-muriatic acid, 
110. 
tar, 583. 
oxide of mercury, 436. 
copaiba, 550. 
oxide of zinc, 46. 
sulphur, 497. 
sulphurated potassa, 
498. 
Sleeplessness: 
opium, 249. 
chloral, 373. 
bromide of potassium, 
362. 
hyoscine, 301. 
Smallpox : 
opium, 250. 
Snake-poisoning : 
ammonia, 124. 
alcohol, 136. 
Softening of brain .• 
phosphorus, 113. 
Sore throat: 
tannic acid, 28. 
alum, 33. 
chlorine water, 671. 
nitrate of silver, 53. 
belladonna, 287. 
chlorate of potassium, 
542. 
sumach berries, 542. 
gum arabic, 625. 
carbolic acid, 683. 
Spasms: 
atropia, 287. 
opium, 249. 
assafetida, 215. 
oil of cajeput, 92. 
aconite, 193. 
belladonna, 287. 
anaesthetics, 304. 
Spermatorrhoea : 
brominated camphor, 
219. 
chloral, 375. 
turpentine, 547. 
Spinal aneemia or irrita- 
tion : 
electricity, 740. 
Spinal congestion : 
electricity, 740. 
ergot, 690. 
Spinal depression : 
strychnine, 335. 
Spleen, enlargement of : 
bromide of potassium, 
364. 
cold, 706. 
ergot, 599. 
Spongy gums : 
tannic acid, 28. 
Sprains : 
camphor, 218. 
Goulard's extract, 41. 
vinegar, 210. 
Status epilepticus: 
nitrite of amyl, 388. 
Stomatitis : 
chlorate of potassium, 
541. 
carbolic acid, 683. 
thymol, 703. 
Strangury : 
opium, 254. 
Stricture, spasmodic : 
belladonna, 287. 
anaesthetics, 305. 
Strychnia-poisoning : 
treatment, 340. 
Calabar bean, 352. 
bromide of potassium. 
363, 374. 
chloral, 375. 
nitrite of amyl, 340,389. 
tobacco, 400. 
Subinvolution of uterus : 
ergot, 601. 
Sunburn : 
vinegar, 210. 778 
INDEX OF DISEASES. 
Suppressed menstruation ; 
ginger, 91. 
Dover's powder, 558. 
alcohol, 567. 
Suppression of urine : 
digitalis, 526. 
Sweating, excessive : 
gallic acid, 29. 
chalk, 647. 
jaborandi, 564. 
Syncope : 
ammonia, 124. 
alcohol, 136. 
digitalis, 155. 
ether, 315. 
nitrite of amyl, 388. 
Synovitis, chronic : 
carbolic acid injections, 
685. 
Syphilis : 
nitric acid, 108. 
nitro-muriatic acid, 
110. 
mercury, 429, 436. 
iodide of potassium, 
443. 
iodoform, 446. 
cod-liver oil, 451. 
sarsaparilla, 464. 
guaiac, 465. 
chlorate of potassium, 
541. 
phosphates, 455. 
Syphilitic nodes ; 
emplastrum ammoniaci 
cum hydrargyro, 577. 
T. 
Tabes mesenterica : 
cod-liver oil, 451. 
Tape-worm : 
ether, 315. 
forced enemata, 490. 
chenopodium, 650. 
brayera, 650. 
pepo, 654. 
picric acid, 87. 
rottlera, 655. 
male fern, 654. 
mucuna, 655. 
pomegranate, 655. 
turpentine, 654. 
Teething: 
broininated camphor, 
219. 
Tetanus : 
cannabis Indica, 267. 
Calabar bean, 352. 
bromide of potassium, 
362. 
chloral, 374. 
lobelia, 392. 
nitrite of amyl, 388. 
tobacco, 400.' 
Tic douloureux: 
croton chloral, 381. 
gelsemium, 395. 
Tinea capitis: 
lime-water, 646. 
Tonsillitis: 
tincture of capsicum, 92. 
Toothache : 
chloral camphor, 379. 
oil of cloves, 90. 
pellitory, 605. 
Trichiniasis: , 
picric acid, 87. 
Trismus nascentium : 
Calabar bean, 352. 
chloral, 375. 
Tuberculosis .• 
cod-liver oil, 452. 
Tympanitis : 
assafetida, 215. 
Typhoid fever : 
quinia, 79. 
alcohol, 136. 
cold, 707. 
jaborandi, 564. 
oil of turpentine, 142. 
digitalis, 156. 
veratrum viride, 174. 
salicylic acid, 695. 
mineral acids, 107. 
thymol, 700. 
antipyrin, 703. 
Typhus fever: 
alcohol, 136. 
belladonna, 288. 
chloral, 373. 
chlorine water, 671. 
cold, 710. 
salicylic acid, 695. 
digitalis, 156. 
quinia. 79. 
U. 
Ulcer of cervix uteri : 
solution of nitrate of 
mercury, 623. 
Ulcer of cornea : 
atropia, 293. 
Ulceration, chronic : 
conium, 406. 
iodoform, 446. 
Ulceration of bowels: 
oil of turpentine, 142. 
Ulcers : 
alum, 33. 
bismuth, 45. 
borax, 674. 
carbolic acid, 685. 
chloride of zinc, 622. 
conium, 406. 
chloral, 376. 
chalk, 647. 
charcoal, 662. 
escharotics, 623. 
iodoform, 446. 
nitrate of silver, 53. 
nitric acid, 108. 
sulphuric acid, 105. 
sulphate of copper, 47. 
tannic acid, 28. 
lime-water, 646. 
chlorine water, 671. 
Ulcers : 
cold, 706. 
permanganate of potas- 
sium, 670. 
Unilateral sweating : 
jaborandi, 564. 
Ununited fracture : 
phosphates, 455. 
Ur semi a: 
chloral, 376. 
opium, 251. 
elaterium, 517. 
jaborandi, 564. 
nitroglycerine, 390. 
Ursemic convulsions : 
chloral, 374. 
Urethral fever : 
aconite, 193. 
bromide of potassium, 
362. 
Urethral spasm : 
belladonna, 287. 
Urethritis: 
nitrate of silver, 54. 
Uric acid calculus and 
gravel: 
benzoic acid, 580. 
potassium salts, 535. 
soda salts, 645. 
zea mays, 546. 
Uric acid diathesis : 
benzoic acid, 580. 
carbonate of lithium, 
542. 
potassium salts, 532. 
sodium salts, 645. 
Urticaria : 
arsenic, 419. 
emetics, 469. 
Uterine inertia : 
ergot, 597. 
smut of Indian corn, 
604. 
Uterus, cancer of: 
Chian turpentine, 143. 
chloral, 376. 
iodoform, 447. 
Uterus, subinvolution of : 
ergot, 601. 
Uvula, relaxation oft 
pellitory, 605. 
V. 
Valvular disease of heart : 
digitalis, 152. 
aconite, 193. 
veratrum viride, 175. 
compound spirit of 
ether, 220. 
Venereal ulcers: 
Canquoin's paste in, 
622. 
Venereal warts: 
nitric acid, 108. 
Veratrum viride poisoning : 
treatment, 175. 
Vesical catarrh : 
benzoic acid, 580. INDEX OF DISEASES. 
779 
Vomiting : 
bismuth, 45. 
ipecacuanha, 474. 
prussic acid, 204. 
opium, 250, 254. 
oxalate of cerium, 45. 
lime-water, 645. 
carbolic acid, 683. 
Vomiting, excessive: 
treatment of, 470. 
Vomiting of pregnancy : 
aconite, 194. 
bromide of potassium, 
362. 
ipecacuanha, 474. 
oxalate of cerium, 45. 
W. 
White swelling : 
cod-liver oil, 451. 
Whooping-cough: 
assafetida, 215. 
camphor, 218. 
belladonna, 287. 
hyoscine, 300. 
gelsemium, 395. 
bromide of ammonium, 
366. 
chloral, 375. 
conium, 406. 
arsenic, 420. 
Whooping-cough : 
lobelia, 392. 
quinine, 83. 
ergot, 600. 
oil of amber, 220. 
Winter cough : 
strychnine, 336. 
Wounds: 
alcohol dressing, 139. 
carbolic acid, 684. 
salicylic acid, 697. 
carbolated camphor, 
219. 
charcoal, 662. 
THE END. ugg