=Acetanilid.=—This substance, a derivative of anilin,
is used to lower temperature; to relieve headaches and
neuralgic pains; and to allay spasm, as in chorea and
whooping-cough.
Toxic doses cause lividity, cold sweats, ringing in
the ears, and heart failure.
The _dose_ is from 5 to 10 grains (0.3-0.6 gm.).
=Arsenic.=—Arsenic is used internally as a tonic
in anemia, an alterative in chronic constitutional
diseases, as a special remedy in chorea, and as an
anti-malarial. Externally, it is occasionally used
as a caustic.
The indications of its too free use are puffiness under
the eyes, or griping pains in the abdomen, with diarrhea.
Toxic doses cause abdominal pain, vomiting, purging,
swelling of the face, and collapse.
Preparations of arsenic should be given after meals. The
_dose_ of _arsenous acid_ is from ¹/₄₀ to ¹/₂₀
grain (0.0016-0.0032 gm.); of _Fowler’s Solution_
(Liquor Potassii Arsenitis), 1 minim (0.06 c.c.), very
gradually increased to 10 minims (0.6 c.c.).
=Aconite.=—This drug depresses the heart, slows the
pulse, and lowers temperature. Externally, it causes
numbness and anesthesia. Internally, it is employed
chiefly as a heart sedative in hypertrophy of the heart,
and as a febrifuge in acute febrile disease when the
pulse is strong and rapid. Locally, it is sometimes
employed in liniments in neuralgia and muscular
rheumatism.
Aconite is a powerful poison, causing in overdoses
tingling of the lips, tongue, and extremities, cold
sweat, pallor, a feeble pulse, and collapse.
The _dose_ of the _tincture_ (Tinctura Aconiti)
is from 1 to 5 minims (0.06-0.3 c.c.).
=Alcohol.=—In moderate cases alcohol stimulates the
heart, favors digestion, and lessens tissue-waste. For
these reasons it is a useful remedy in low fevers, like
typhoid fever, diphtheria, and pneumonia. On account
of its prompt action, it is a valuable circulatory
stimulant in sudden heart failure. It has
been recently recommended also as an antidote in
carbolic-acid poisoning. Externally, it is used as a
cleanser for the skin and as a stimulant application in
the prevention of bed-sores.
_Preparations._—_Wines_ are produced by the
spontaneous fermentation of fruits. The strongest are
port, Madeira, and sherry, each of which contains about
20 per cent. of alcohol. The _dose_ is from 4 to 8
drams (15-30 c.c.). The weakest wines are the clarets
and Rhine wines, which contain about 8 per cent. of
alcohol. The _dose_ of these is from 1 to 2 ounces
(30-60 c.c.).
_Champagne_ is prepared by adding sugar to an
ordinary wine, and allowing the mixture to ferment in
corked bottles, the carbon dioxid thus being retained.
It contains from 10 to 12 per cent. of alcohol. The
_dose_ is from 1 to 2 ounces (30-60 c.c.).
_Whisky_ is made by subjecting fermented grains
to distillation. _Rum_ is made by distilling
fermented molasses. _Gin_ is prepared by distilling
fermented grain and adding oil of juniper berries to the
distillate.
_Brandy_ is a spirit produced by the distillation
of a wine.
Whisky, rum, gin, and brandy contain from 40 to 50 per
cent. of alcohol. The _dose_ of each is from 1 to 4
drams (4-15 c.c.).
_Beer_, _ale_, and _porter_ are made from
an infusion of malt—that is, fermented barley, flavored
with hops. They each contain from 4 to 6 per cent. of
alcohol.
In large doses alcohol in any form causes mental
excitement, delirium, loss of co-ordination, and finally
stupor and coma. Death may result from paralysis of the
heart or respiration.
=Aloes.=—This is cathartic and stimulant, and is
given in chronic constipation, amenorrhea, and atonic
dyspepsia. The laxative _dose_ is from ½ to 2
grains; the purgative and emmenagogue _dose_ is
2 to 5 grains.
=Ammonia.=—This is a gas employed medicinally in the
form of a watery solution (water of ammonia) or an
alcoholic solution (spirit of ammonia).
These preparations are used internally as heart stimulants,
respiratory stimulants, gastric antacids, and externally
as counterirritants. The _dose_ of the _Aromatic
Spirit_ (Spiritus Ammoniæ Aromaticus) is from ½ to 1
dram (2-4 c.c.), well diluted. Large doses of ammonia
preparations cause burning pain in the throat and
abdomen, vomiting, purging, and collapse.
=Antipyrin.=—This drug has about the same action
and uses as acetanilid, and may be given in the same
_dose_.
=Antitoxin of Diphtheria.=—This is obtained from
healthy horses which have been rendered artificially
immune to diphtheria from having received a prolonged
course of treatment with diphtheria toxin in doses
gradually increased. The immunity is due to the
formation in the blood of a substance which in some way
counteracts the poison or toxin of the disease. This
substance is known as the antitoxin. It exists in the
serum of the blood, and so far has not been separated
from it. The dose of the serum is measured in units, a
unit being ten times the amount of antitoxin required to
save the life of a guinea-pig which has been injected
with 100 fatal doses of diphtheria toxin.
Antitoxin acts both as a curative and a preventive remedy.
Since its introduction the mortality of diphtheria
has been reduced more than one-half. The _curative
dose_ is from 2000 to 5000 units, to be repeated
in from six to twelve hours, if necessary. The
_prophylactic dose_ is 500 units. The protection
afforded is only temporary, lasting from two to three
weeks.
The injections are sometimes followed by a rise of
temperature, pain in the joints, or a cutaneous rash,
but these symptoms are without serious significance.
=Aspirin.=—This is acetyl-salicylic acid and is used
like sodium salicylate in rheumatism and pleurisy, and
as an antipyretic and analgesic. _Dose_, 5 to 15
grains.
=Atropin.=—See _Belladonna_.
=Belladonna.=—This drug owes its activity to the
alkaloid _atropin_. It is employed internally to
stimulate the respiration; to stimulate the circulation;
to allay local spasm, as in asthma and whooping-cough;
to check excessive secretion, as in the night-sweats
of phthisis; and to stimulate peristalsis in atonic
constipation. Locally, it is employed in the form of
solutions of atropin to dilate the pupil of the eye,
and in the form of a liniment or plaster of belladonna
as a sedative application in various inflammatory
conditions. Toxic doses of belladonna cause dilatation
of the pupils, dryness of the throat, quickening of the
pulse and respiration, delirium, and a diffuse red rash
resembling that of scarlatina.
The _dose_ of _atropin_ is from ¹/₁₅₀ to ¹/₅₀
grain (0.00043-0.0013 gm.); of the _Tincture of
Belladonna_ (Tinctura Belladonnæ), 5 to 20 minims
(0.3-1.2 c.c.); of the _Extract of Belladonna_
(Extractum Belladonnæ), ⅛ to ¼ grain (0.008-0.016 gm.).
=Bismuth.=—The insoluble preparations of the
metal—_subnitrate_, _subcarbonate_, and
_subgallate_—are used internally as mild
antiseptics, sedatives, astringents, and antacids in
various inflammatory diseases of the stomach and bowel.
They are scarcely poisonous when taken internally in
any amount. The usual _dose_ of any one of the
preparations named is from 5 to 30 grains (0.3-2 gm.)
in dry powder or stirred in milk or water.
=Bromids.=—The salts of bromin in common use are
the bromids of potassium, sodium, ammonium, and
strontium. The action of these is very similar. They
are especially useful as depressants to the central
nervous system. They are employed to produce sleep, to
check convulsions, and to relieve headache and neuralgic
pain. Large doses depress the heart and respiration. The
continued use of the bromids causes a condition known as
_bromism_. This is characterized by fetor of the
breath, a rash on the skin, languor, and somnolence. The
_dose_ of the _bromin salts_ is from 10 to 60
grains (0.6-4 gm.).
=Caffein.=—This is an alkaloid obtained from coffee.
It is a heart stimulant, respiratory stimulant, brain
stimulant, and kidney stimulant (diuretic). The
_dose_ is from 1 to 5 grains (0.06-0.3 gm.).
=Calomel.=—See _Mercury_.
=Carbolic Acid.=—Externally, this acid is used in
weak solutions (1 : 40 to 1 : 20) as an antiseptic,
and in concentrated form as a caustic. Weak solutions
are also employed to allay itching in skin diseases.
Internally, carbolic acid is used as an antiseptic in
dyspepsia and diarrhea. Applications of carbolic acid,
even when dilute, should never be prolonged, as they are
liable to cause gangrene. Poisoning by carbolic acid is
characterized by white patches on the lips, the odor of
the drug on the breath, burning pain in the abdomen,
vomiting, purging, unconsciousness, and collapse. The
_dose_ is from ½ to 3 minims (0.03-0.2 c.c.).
=Castor Oil.=—This is an oil expressed from the seed
of an East Indian plant. The seeds themselves are acrid
poisons. It is a mild purgative, unloading the bowels
very thoroughly in from four to six hours. It may be
given in flexible capsules, in emulsion, or with equal
parts of lemon-juice and glycerin. The _dose_ is
from ½ to 1 ounce (15-30 c.c.).
There are two simple methods of taking castor oil without
producing nauseating effects. Have the patient wash
out the mouth with water as hot as can be borne, then
swallow the oil, and follow this by rinsing out the
mouth well with hot water. The other method is to hold
a piece of ice in the mouth long enough to chill the
lining membrane, swallow the oil, and rinse the mouth
with ice-water.
=Chloral.=—This substance is an active depressant
of the brain and spinal cord. In large doses it also
depresses the heart and respiration. It is employed to
produce sleep and to check convulsions. The _dose_
is from 10 to 30 grains (0.6-2 gm.) in some agreeable
syrup.
Poisonous doses cause unconsciousness, embarrassed
breathing, and collapse.
=Chloralamid.=—This is a comparatively safe and reliable
hypnotic, producing sleep without causing much depression of
the heart or disagreeable after-effects. The _dose_ is
from 10 to 30 grains (0.6-2 gm.), well diluted. Hot liquids
decompose it.
=Chloroform.=—This substance is employed by inhalation
as a general anesthetic, by the mouth as a sedative
in colic, neuralgia of the stomach, and obstinate
cough, and externally in the form of liniment as a
counterirritant in muscular rheumatism, sprains, etc.
As a general anesthetic it is more powerful than ether,
more readily inhaled, but not so safe. Death from
chloroform is usually the result of heart failure. The
_dose_ of _Spirit of Chloroform_ (Spiritus
Chloroformi) is from 5 to 30 minims (0.3-2 c.c.); of
_Chloroform-water_ (Aqua Chloroformi), 1 to 8
drams (4-30 c.c.).
=Cinchona (Peruvian Bark).=—This is the bark
of an evergreen tree growing in the tropics. It
owes its medicinal properties to _quinin_ and
_cinchonin_, especially the former. It is used as
a general tonic, as a stomachic, as a febrifuge, and as
an anti-malarial. Large doses cause ringing in the ears,
headache, deafness, dimness of vision, convulsions, and
coma. The _dose_ of _quinin_ and its salts is
from 1 to 30 grains (0.06-2 gm.); of _cinchonin_,
1 to 30 grains (0.06-2 gm.); of the _Compound Tincture
of Cinchona_ (Huxham’s Tincture), 1 to 4 drams (4-15 c.c.).
=Cocain.=—This is the alkaloid of a shrub
(_coca_) growing in South America. Applied to
mucous membranes or raw surfaces, or injected under the
skin, it blanches the part and produces anesthesia.
Applied directly to the skin, however, it is without
effect, as it is not absorbed from the unbroken skin.
Internally, it is sometimes employed to stimulate the
heart, to stimulate the respiration, and to allay
vomiting. Its repeated use, even as a local remedy, is
dangerous, in that it is prone to cause a habit, the
symptoms of which are mental failure, loss of flesh and
strength, anemia, and intense craving for the drug.
The symptoms of acute cocain-poisoning are excitement,
delirium, a rapid pulse, hurried breathing, convulsions,
and coma. The _dose_ of _cocain_ is from ⅛ to
½ grain (0.008-0.03 gm.). As an anesthetic it is usually
employed in from 2 to 4 per cent. solutions.
A 2½-grain tablet of cocain, dissolved in a teaspoonful
of water, makes a 2 per cent. solution; a 4½-grain
tablet, in the same amount of water makes a 4 per cent.
solution; a 10½-grain tablet in a like amount furnishes
a 10 per cent. solution. These percentages are not
mathematically correct, but are sufficiently exact for
any surgical purposes.
=Cod-liver Oil.=—This is more of a food than a
medicine. It is preferable to other oils in being more
readily digested. When well borne by the stomach, it
is a valuable remedy in wasting diseases, especially
phthisis. The _dose_ is from 1 to 4 drams (4-15
c.c.). It may be given in emulsion, in flexible
capsules, or pure, dropped in the froth of porter. It
is best taken two hours after meals.
=Creasote.=—This is an oily substance obtained from
the slow burning of beechwood. It is chiefly used
internally as an antiseptic in dyspepsia and diarrhea,
and as an expectorant in purulent bronchitis and
phthisis. Large doses produce the same toxic effects as
are observed in carbolic-acid poisoning. The _dose_
is from 2 to 20 minims (0.1-1.2 c.c.) in capsules,
in milk, or in some bitter tincture, like that of
gentian. The _dose_ of _creasote carbonate_
(creosotal), which is free from the unpleasant odor and
taste of pure creasote, is from 5 to 20 minims (0.3-1.2
c.c.).
=Croton Oil (Oleum Tiglii).=—This is an oil expressed
from the seed of a small tree growing in Asia. Locally
it is an active vesicant; internally it is a powerful
purgative. Large doses cause severe inflammation of
the stomach and bowels. The _dose_ is from 1 to
2 drops (0.06-0.12 c.c.) in glycerin, olive oil, or
bread-crumbs. A bland vehicle is necessary to prevent
the vesicating effect of the drug on the throat. Diluted
with from 2 to 4 parts of olive oil, and applied with
friction, it is sometimes used as a counterirritant in
inflammatory diseases of the chest.
=Digitalis.=—This is a powerful circulatory
stimulant, strengthening the contractions of the
heart, constricting the peripheral blood-vessels, and
slowing the pulse. By increasing the blood-pressure in
the kidneys it also increases the flow of urine. It
is chiefly used as a stimulant in heart disease when
there is failure of circulation, and as a diuretic in
various forms of dropsy. The effects of the drug should
be carefully watched; too large doses cause marked
slowing and irregularity of the pulse, and a decrease
rather than an increase in the urine. The _dose_
of _powdered digitalis leaves_ is from ½ to 2
grains (0.03-0.13 gm.); of the _Tincture_ (Tinctura
Digitalis), 5 to 20 minims (0.3-1.2 c.c.); of the
_infusion_ (infusum digitalis), 1 to 4 drams (4-15
c.c.); of _digitalin_, an important principle of
the leaves, ¹/₁₀₀ to ¹/₆₀ grain (0.00065-0.001 gm.).
=Ergot.=—This is a fungus growing on rye. It is
employed to contract the blood-vessels in internal
hemorrhage and to stimulate the uterine contractions in
the second stage of labor when post-partum hemorrhage is
feared. Its use in the early stage of labor to hasten
delivery is dangerous, since it may cause tetanic spasm
of the uterus and asphyxiation of the child or even
rupture of the uterus.
The _dose_ of the _Extract of Ergot_ (Extractum
Ergotæ) is from 1 to 15 grains (0.065-1 gm.); of the
_Fluid Extract_ (Extractum Ergotæ Fluidum), ½ to 1
dram (2-4 c.c.); of the _Wine_ (Vinum Ergotæ), 1 to
4 drams (4-15 c.c.); of _ergotin_, a concentrated
extract, 2 to 5 grains (0.13-0.3 gm.). When given
hypodermically abscess is likely to form, even under the
most strict antiseptic precautions.
=Ether.=—Next to nitrous oxid, this is the safest of
the general anesthetics, although it is not so readily
inhaled as chloroform, and is more apt to produce
unpleasant after-effects, such as nausea and vomiting.
The latter may sometimes be relieved by the inhalation
of hot vinegar fumes.
Death from ether is usually the result of asphyxia, and
not, as in the case of chloroform, from heart failure.
Internally, by the mouth or hypodermically, ether is
sometimes used as a circulatory stimulant in sudden
heart failure. Great care should be exercised in
handling ether in the neighborhood of lighted gas-jets,
as the vapor of the drug is highly inflammable. Ether
should be stored in well-stoppered containers, in a cool
place, remote from lights and fire.
The _dose_ of ether as a circulatory stimulant
is from 5 to 30 minims (0.3-2 c.c.) in ice-water or
hypodermically.
=Formaldehyd.=—This gas is employed in the form of
a 40 per cent. solution (_formalin_). It is used
as an antiseptic, disinfectant, and deodorant. It is
the best disinfectant for sick-rooms that we possess,
although on account of its lack of penetrating power
it can not be used for disinfecting bedding, stuffed
furniture, carpets, books, etc. To be effective the gas
must be generated from formalin in a special apparatus,
or from paraform tablets heated over a suitable lamp.
Attempts to vaporize solution of formaldehyd from an
open vessel placed on a stove are unsuccessful, since
this treatment converts most of the formaldehyd gas into
crystals of paraform. Solutions of formalin—1 : 2000 to
1 : 500—are sometimes used for irrigating suppurating
cavities and disinfecting instruments. A solution of
1 part of formalin to 20 parts of water makes a good
disinfectant for stools, urine, and sputa.
=Iodids.=—The salts of iodin—potassium, sodium,
ammonium iodid—resemble each other in their action and
uses. They are used as alteratives in constitutional
diseases, like chronic rheumatism and gout, as
absorbents of exudates in chronic inflammatory diseases,
and as eliminants in chronic mineral poisoning. Their
continued use occasions a group of symptoms—frontal
headache, nasal discharge, sore throat, and a cutaneous
eruption—termed _iodism_. The _dose_ is from
5 to 30 grains (0.3-2 gm.), well diluted, after meals.
=Iodoform.=—This drug owes its virtues to iodin, of
which it contains about 50 per cent. When brought into
contact with raw surfaces it exerts a mild anesthetic effect,
liberates its iodin, and thereby acts as an antiseptic. When
applied too freely it may be absorbed and cause toxic
effects—headache, elevation of temperature, restlessness,
a diffuse red rash on the face and limbs, delirium, stupor,
and collapse. The unpleasant odor of the drug can be removed
from the hands and from instruments by oil of turpentine.
=Ipecac.=—This drug is used as an emetic and
expectorant. As an emetic it is safe, but somewhat slow
in action. It is especially useful in the young and
feeble, as it causes but little depression.
The _dose_ of powdered ipecac, as an emetic, is from
20 to 30 grains (1.2-2 gm.); of the _Syrup_ (Syrupus
Ipecacuanhæ), as an expectorant, from 10-60 minims
(0.6-4 c.c.); as an emetic, from 2 to 4 drams (8-15
c.c.); of the wine, as an expectorant, from 10 to 30
minims (0.6-1.8 c.c.); as an emetic, 1 dram (4 c.c.).
=Iron. (Ferrum).=—The various preparations of iron are
employed as tonics and astringents. As tonics, they are
especially indicated in simple anemia; as astringents
they are employed locally in bleeding, and, internally,
in diarrhea.
The _dose_ of _Reduced Iron_ (Ferrum Reductum)
is from 1 to 5 grains (0.06-0.3 gm.); of the _Pills
of Iron Carbonate_ or _Blaud’s Pills_ (Pilulæ
Ferri Carbonatis), 1 to 3 pills; of the _Tincture
of Ferric Chlorid_ (Tinctura Ferri Chloridi), 5 to
10 minims (0.3-0.6 c.c.); of the _Solution of Iron
and Ammonium Acetate_ or _Basham’s Mixture_
(Liquor Ferri et Ammonii Acetatis), 1 to 4 drams (4-15
c.c.); of the _Sulphate of Iron_ (Ferri Sulphas),
1-3 grains (0.06-0.2 gm.); of the Syrup of _Iodid of
Iron_ (Syrupus Ferri Iodidi), 5 to 60 minims
(0.3-4 c.c.). The _Solution of Iron Subsulphate_
(Monsel’s solution) is used only as a hemostatic, and
_Iron Hydrate with Magnesia_ as an antidote in
arsenic-poisoning. The _dose_ of the latter is a
tablespoonful every ten to fifteen minutes.
=Lead.=—The preparations of lead are used internally
and externally as sedatives and astringents. _Lead
Acetate_ (Plumbi Acetas) is employed internally in
diarrhea. The _dose_ is from 1 to 3 grains
(0.06-0.2 gm.), in pill form.
The _Solution_ of _Lead Subacetate_ (Liquor Plumbi
Subacetatis) is employed externally. Diluted with from 5
to 6 parts of water it is used as a sedative application
in ivy-poisoning and erysipelas.
The _Dilute Solution_ of _Lead Subacetate_
(Liquor Plumbi Subacetatis Dilutus) is known as
_lead-water_, and is chiefly employed in making the
sedative preparation known as lead-water and laudanum.
As usually dispensed it contains 1 dram (4 c.c.) of
laudanum and 4 drams (15 c.c.) of lead-water to 2 ounces
(60 c.c.) of water.
_Acute lead-poisoning_ is characterized by a burning
pain in the abdomen, a metallic taste in the mouth,
vomiting, purging, coma, and collapse.
_Chronic lead-poisoning_ is characterized by anemia,
intestinal colic, constipation, a blue line on the
gums (deposit of lead sulphide), and paralysis of the
forearms (wrist-drop).
=Magnesium Sulphate (Epsom Salt).=—This salt is
an excellent hydragogue cathartic, producing in the
course of a few hours copious watery stools. It is also
employed as an antidote in acute lead-poisoning and
carbolic-acid poisoning.
To secure the most prompt and powerful cathartic effect
the drug is best given before breakfast, in a single dose,
and with but a small quantity of water. _Dose_,
from 1 to 8 drams (4-31 gm.).
=Magnesium Oxid (Magnesia).=—This is a white,
tasteless, and insoluble powder. It is a cathartic, but
much milder in action than Epsom salt. _Dose_, from
10 to 60 grains (0.6-4 gm.).
=Magnesium Citrate.=—An effervescing solution of
this drug is much used as an agreeable laxative. The
_dose_ is from 6 to 12 ounces (180-360 c.c.).
=Mercury.=—The most important preparations of this
metal are calomel, blue mass, corrosive sublimate, oxid
of mercury, iodid of mercury, nitrate of mercury, and
ointment of mercury.
_Calomel_ (Hydrargyri Chloridi Mite).—This
preparation is employed internally as a cathartic and
gastric sedative, and externally as a stimulating and
antiseptic dusting-powder. As a cathartic its best
effect is secured by giving it in _doses_ of from
⅒ to ⅙ grain (0.006-0.01 gm.) every half-hour or hour,
until a grain has been taken. In this way the whole
amount ingested is absorbed. When large doses are
employed much of the drug escapes absorption.
_Blue Mass_ or _Blue Pill_ (Massa
Hydrargyri).—This is a mixture of mercury, glycerin,
honey, and licorice. Its action is much like that of
calomel.
_Corrosive Sublimate_ or _Bichlorid of
Mercury_ (Hydrargyri Chloridum Corrosivum).—Although
irritant, toxic, and destructive to instruments, no
other drug has supplanted this salt as an antiseptic
for use in general surgery. The following are the
strengths of the solutions usually employed for various
purposes: for the skin, 1 : 1000 to 1 : 500; for wounds,
1 : 10,000 to 1 : 2000; for cavities of the body, 1
: 20,000 to 1 : 5000. Corrosive sublimate is not a
good disinfectant for stools, sputa, etc., as it forms
an impenetrable coagulum on the outside of the mass.
Internally, corrosive sublimate is used as an alterative
in constitutional diseases in _doses_ of ¹/₆₀ to
¹/₁₂ of a grain (0.001-0.005 gm.).
_Oxid of Mercury._—This appears in two
forms—yellow oxid and red oxid. Both preparations are
employed externally in the form of ointments for their
alterative properties.
_Iodid of Mercury._—This salt occurs in two forms:
Red Iodid or Biniodid (Hydrargyri Iodidum Rubrum) and
Yellow or Green Iodid (Hydrargyri Iodidum Flavum). The
first is an irritating preparation, somewhat resembling
corrosive sublimate in its action; the latter is
comparatively unirritating, and is much used internally
as an alterative. The _dose_ of the _red
iodid_ is from ¹/₆₀ to ¹/₁₂ grain (0.001-0.005 gm.);
of the _yellow_ or _green iodid_, ¹/₁₀ to ½ grain
(0.006-0.03 gm.).
_Nitrate of Mercury._—This preparation is used in
the form of a solution (Liquor Hydrargyri Nitratis) as a
powerful caustic.
_Ointment of Mercury_, or _Blue Ointment_
(Unguentum Hydrargyri).—This is an ointment of metallic
mercury. It is used as a stimulant and absorbent
application in chronic inflammatory swellings, as a
parasiticide in certain skin diseases, and by inunction
in syphilis. When used for the latter purpose about a
dram (4 gm.) should be rubbed in the axilla, groin, or
inner surface of the arm or thigh daily, a different
region being selected each time, so as to avoid
irritation of the skin.
_Mercurial Poisoning._—Patients taking mercury
continuously, even in small doses, should be
carefully watched, as symptoms of _ptyalism_ or
_salivation_ sometimes arise very speedily. This
condition is manifested by fetor of the breath, soreness
of the teeth when the jaws are brought together,
increased flow of saliva, redness and swelling of the
gums, and finally by ulceration of the tissues, loss
of the teeth, and necrosis of the jaw bones. On the
slightest evidence of these symptoms the drug should
be suspended, and the mouth washed out frequently with
a solution of hydrogen peroxid (1 : 4) or of potassium
chlorate (1 dram to 8 ounces of water).
The ingestion of a single large _dose_ of an
irritant salt of mercury, such as the bichlorid or
biniodid, gives rise to severe burning pain in the
abdomen, vomiting, bloody purging, and collapse.
=Nitroglycerin.=—This drug is a depressant to the
central nervous system, a heart stimulant, and a
dilator of the peripheral blood-vessels. It is useful in
certain local spasms (asthma), in heart failure, and in
neuralgia of the heart. Owing to its action in dilating
the vessels, it sometimes causes, even in small doses,
headache, dizziness, and flushing of the face.
The _dose_ of nitroglycerin is from ¹/₂₀₀ to ¹/₅₀
of a grain (0.0003-0.0013 gm.). The _dose_ of the 1
per cent. alcoholic solution (Spiritus Glonoini) is from
1 to 5 minims (0.06-0.3 c.c.). The latter should be kept
in well-stoppered bottles, in a cool place, remote from
lights or fire.
=Nux Vomica.=—This is the seed of an East Indian tree.
Its activity depends upon an alkaloid _strychnin_.
It is a general stimulant, acting especially upon
the spinal cord, respiratory center, heart, stomach,
and intestine. It is employed in a great variety of
affections in which there is deficient functional
activity.
The limit of tolerance is indicated by restlessness,
stiffness of the neck muscles, and jerking of the limbs.
Toxic doses cause violent spasms closely resembling
those of lock-jaw or tetanus. The convulsions of
strychnin-poisoning, however, come and go, the muscles
being completely relaxed in the intervals, and,
moreover, they rarely involve the muscles of the jaw.
The _dose_ of the _Tincture of Nux Vomica_
(Tinctura Nucis Vomicæ) is from 5 to 20 minims (0.3-1.2
c.c.); of the _Extract of Nux Vomica_ (Extractum
Nucis Vomicæ), ⅙ to ¼ grain (0.01-0.016 gm.); of
_Strychnin Sulphate_ (Strychninæ Sulphas), ¹/₆₀ to
¹/₂₀ of a grain (0.001-0.003 gm.).
=Opium.=—This is the dried juice of a species
of poppy growing in Asia. It contains several
alkaloids, the chief of which are _morphin_ and
_codein_. From morphin are prepared artificially
two alkaloids—_apomorphin_ and _heroin_.
Opium depresses the brain, depresses the respiration,
stimulates the heart slightly, lessens the peristaltic
movements of the bowel, and diminishes all secretions,
except the sweat. It is employed to induce sleep, to
relieve pain, to allay cough, to check diarrhea, and to
promote perspiration.
_Opium-poisoning_ is marked by three stages: the
_first_ stage is short and characterized by mental
exhilaration; in the _second_ stage the pupils
are greatly contracted (pin-point), the respirations
are slow, the pulse is slow and full, and there is
deep stupor. In the _third_ stage the patient can
no longer be aroused (coma), the respiration becomes
shallow and irregular, the pulse becomes rapid and weak,
the pupils finally dilate, and the patient dies from
failure of the respiration.
Even after small doses of opium many patients suffer from
headache and nausea. Children are much more sensitive
to its action than adults. Morphin resembles opium in
action, but is more powerful, less nauseating, and less
constipating. Codein is less powerful as a hypnotic and
less depressing than morphin.
The _dose_ of _opium_ is from ½ to 1 grain
(0.03-0.65 gm.); of the _Extract of Opium_
(Extractum Opii), ⅛ to ½ grain (0.008-0.03 gm.);
of the _Tincture of Opium_ or _Laudanum_
(Tinctura Opii), 10 to 20 minims (0.6-1.2 c.c.); of the
_Camphorated Tincture of Opium_ or _Paregoric_
(Tinctura Opii Camphorata), ½ to 4 drams (2-15 c.c.);
of _Dover’s Powder_ (Pulvis Ipecacuanhæ et opii),
5 to 10 grains (0.3-0.6 gm.); of _morphin_ and its
salts (sulphate, hydrochlorate, etc.), ⅛ to ½ grain
(0.008-0.03 gm.), and of _codein_, ½ to 1 grain
(0.03-0.06 gm.).
_Heroin_ is chiefly used to allay cough. The _dose_
is from ¹/₁₂ to ⅛ of a grain (0.005-0.008 gm.).
_Apomorphin_ is employed as an emetic and as an
expectorant in bronchitis. The _dose_ as an emetic
is from ⅒ to ⅙ of a grain (0.006-0.01 gm.), always
hypodermically; the _dose_ as an expectorant is
from ¹/₂₀ to ¹/₁₀of a grain (0.003-0.006 gm.), always by
the mouth.
=Paraldehyd.=—This is an oily liquid, having a
peculiar unpleasant odor and taste. It is used chiefly
as a hypnotic. While comparatively safe and reliable,
its disagreeable taste and persistent odor on the breath
detract from its usefulness. The _dose_ is from ½
to 1 dram (2-4 c.c.), in some pleasant vehicle.
=Phenacetin.=—This anilin derivative has properties
very similar to those of acetanilid, and is used for the
same purposes. _Dose_, 5 to 10 grains (0.3-0.6 gm.).
=Physostigma.=—This is the seed of a climbing plant
growing in Africa. Its activities depend upon an
alkaloid known as _eserin_ or _physostigmin_.
It depresses the spinal cord, stimulates the peristaltic
movements of the bowel, and, when applied to the eye,
contracts the pupil. It is employed to check certain
convulsions (tetanus and strychnin-poisoning), to overcome
atonic constipation, and, locally, to contract the pupils.
The _dose_ of the _Tincture of Physostigma_
(Tinctura Physostigmatis) is from 5 to 20 minims
(0.3-1.2 c.c.); of the _Extract of Physostigmatis_
(Extractum Physostigmatis), ¹/₁₂ to ⅙ of a grain
(0.005-0.01 gm.); of _eserin_ or _physostigmin_
and its salts, ¹/₁₅₀ to ¹/₅₀ of a grain (0.0004-0.0013 gm.).
=Pilocarpus=, or =Jaborandi=.—This is the leaves
of a South American plant. Its virtues depend entirely
upon an alkaloid known as _pilocarpin_. The
chief action of the drug is on the secretions—sweat,
saliva, and urine—which it markedly increases. Large
doses depress the circulation. Locally, in the eye, it
contracts the pupil like eserin. It is mainly employed
internally as a diaphoretic in Bright’s disease and
dropsical conditions. The _dose_ of the _Fluid
Extract_ (Extractum Pilocarpi Fluidum) is from 20 to
60 minims (1.5-4 c.c.); of _pilocarpin_ and its
salts, ⅛ to ½ grain (0.008-0.03 gm.). The latter are
usually administered hypodermically.
=Quinin.=—See _Cinchona_.
=Salicylates.=—These salts are employed in medicine
chiefly as antirheumatic remedies. Their manner of
action, however, is unknown. They are also used,
both internally and externally, to some extent as
antiseptics. Large doses cause ringing in the ears,
headache, deafness, nausea, and a greenish discoloration
of the urine.
The _dose_ of _salicylic acid_ or its salts
(ammonium, sodium, strontium) is from 5 to 20 grains
(0.3-1.3 gm.); of _Oil of Gaultheria_ (Methyl
Salicylate), 5 to 20 minims (0.3-1.2 c.c.). These
preparations should be given after meals, well diluted.
The following remedies have properties like the salicylates,
but are less powerful and less irritant to the stomach:
_Salol_, _dose_, 5 to 20 grains (0.3-1.3 gm.);
_salophen_, 5 to 30 grains (0.3-2 gm.); _aspirin_,
5 to 20 grains (0.3-1.3 gm.).
=Senna.=—This is a purgative cholagogue and is
used in the constipation of children and pregnant
women. _Dose_, in substance, 5 to 20 grains; in
fluidextract or tincture, 1 to 4 fluidrams.
=Silver.=—The most important salt of this metal is
the _nitrate_. Locally, in concentrated form, the
latter is a caustic; in dilute form it is a sedative,
astringent, and antiseptic. Internally, in small doses,
silver nitrate is useful as an astringent and antiseptic
in inflammatory and ulcerative conditions of the stomach
and bowel.
The prolonged use of the drug, even in small doses,
is followed by a permanent grayish discoloration of the
skin (argyria) from the precipitation of the metal in
the tissues.
Toxic doses of silver nitrate cause burning pain in
the abdomen, vomiting of white, curdy matter, and bloody
purging.
The _dose_ of silver nitrate is from ⅙ to ½ of a
grain (0.01-0.3 gm.), usually in pill form.
Several combinations of metallic silver with albumin are
much used as antiseptics and astringents in inflammatory
diseases of mucous membranes. They have advantage
over silver nitrate in being less irritating and in
not being decomposed by the juices of the tissues.
The most important of these organic compounds are
_protargol_ and _argyrol_. They are usually
applied in solutions of from 1 to 10 per cent. A soluble
form of metallic silver is also employed in the form of
15 per cent. ointment, known as _Credé’s ointment_.
It is recommended as an antiseptic in various infectious
diseases.
=Spartein.=—This is an alkaloid from the broom plant.
It is used to some extent as a heart tonic and diuretic
in _doses_ of from ¼ to ½ grain (0.015-0.03 gm.).
=Strophanthus.=—This is the seed of a climbing
plant growing in Africa. Its action very closely
resembles that of digitalis, for which it is sometimes
substituted. The _dose_ of the _tincture_
(Tinctura Strophanthi) is from 3 to 10 minims
(0.2-0.6 c.c.).
=Sulphonal.=—This artificial compound is used
almost entirely as a hypnotic. In single doses it is
comparatively safe and reliable, but slow in its action.
Languor, headache, and drowsiness not infrequently
follow its use. The repeated administration of sulphonal
over several days or weeks is distinctly dangerous,
being often followed by chronic poisoning. The latter is
marked by a red coloration of the urine, colicky pains,
profound depression, weakness, and collapse.
The _dose_ of sulphonal is from 10 to 30 grains
(0.6-2 gm.). It is best given in hot tea or hot milk,
one or two hours before bedtime.
=Tannic Acid, Tannin.=—This is employed externally
as an astringent and styptic, and internally as an
astringent in atonic diarrheas. It is used in the form
of a gargle or in troches in relaxed conditions of the
throat, in solution to prevent bed-sores, and in the form
of ointment or suppositories for the relief of internal
piles. _Dose_, 1 to 10 grains.
=Trional.=—This remedy resembles sulphonal in action,
and is used for the same purpose. It may also be given
in the same _dose_ and manner as sulphonal.
=Urotropin.=—This compound, prepared by the action
of ammonia on formaldehyd, is employed as a powerful
urinary antiseptic in _doses_ of from 3 to 5
grains (0.2-0.3 gm.). Large doses may cause pain in the
bladder, frequent urination, and bloody urine.
=Veratrum Viride.=—This is the root of a North
American herb. Its action resembles that of aconite in
that it depresses the heart and slows the pulse. It
is, however, more nauseating than aconite, and when
locally applied does not cause numbness, tingling,
and anesthesia. Large doses cause vomiting, muscular
weakness, dizziness, sweating, failure of pulse, and
collapse. It is used as a sedative in acute inflammatory
diseases to subdue overaction of the heart.
The _dose_ of the _tincture of veratrum viride_
(tinctura veratri viridis) is from 1 to 5 minims
(0.06-0.3 c.c.).