Materia Medica: Pharmacology: Therapeutics: Prescription Writing For Students and Practitioners | by Walter A. Bastedo

Preface To The Second Edition

In addition to bringing the book into conformity with the Ninth Revision of the U. S. Pharmacopoeia, there has been a thorough revision throughout. The sections on alkalies, pituitary, salvarsan, bich...

Preface

This book is an adaptation, for the most part, of lectures delivered at Columbia University. In its preparation I have kept in mind that the physician's reason for the study of remedies is the treatm...

Part I. Introduction

Medicine sometimes cures, it often relieves, it always consoles The physician's calling has arisen from the needs of the sick, a person who is ill desiring the services of some one who can help him...

Materia Medica

Drug remedies are known collectively as the materia medica, or medical materials. The science which deals with the properties of drugs is called materia medica or, more correctly, pharmacology. It i...

The Constituents Of Organic Drugs

These may be classified into: 1. The Active Constituents. 2. The Inert Constituents. The latter are the cellulose, wood, and other structural parts of the drug, and in some instances starch, albumen,...

1. Plant Acids And Their Salts

The citric acid of lemons, the tartaric acid of grapes, benzoic, cinnamic, salicylic, tannic acid, and some of their salts are of interest pharmacologically. Glycyrrhizin, the sweet principle of glycy...

2. Alkaloids

These are a class of organic bodies of alkaline reaction, composed of carbon, hydrogen, and nitrogen, and sometimes other elements. The class includes a great many of our most powerful drugs. Their ba...

3. Neutral Principles

Besides acid and basic substances, plants furnish a large number of proximate principles which are chemically neutral. Their names end in in (Latin, inum), in accordance with the pharmacopaeial rule t...

4. Toxalbumins Or Toxins

An extensive class of poisonous compounds, probably protein, of which some occur in plants, some constitute the poisonous products of bacteria, and some are the poisonous agents in the venom of snakes...

5. The Ferments Or Enzymes

The enzymes are a class of bodies capable of instituting chemic changes without apparently entering into the reaction or forming a part of the end-products. Their activity is very persistent, but not ...

6. The Sugars, Starches, And Gums

These are carbohydrates of very slight pharmacologic action and of little importance as remedies, but of importance in dietetics and the arts. Cane-sugar or common sugar (Latin, saccharum), C12H22O11...

7. The Tannins Or Tannic Acids

These are a class of imperfectly defined astringent bodies of the aromatic group. They are all acids which form salts, and some of them are glucosidal in nature. They precipitate alkaloids, mercuric c...

8. The Fixed Oils, Fats, And Waxes

(a) The fixed oils and fats are mixtures of the three bodies, olein (liquid), palmitin (semisolid), and stearin (solid), or close relatives of these, and in addition usually small amounts of other bod...

Soaps

The soluble or detergent soaps are prepared by the action of an alkali upon a fat or oil, the potash soaps being soft, and those of soda being hard. They contain glycerin unless this is removed by was...

Lipoids Or Fat Allies

Those of interest to us are lecithin and cholesterol. Lecithin is found in certain animal tissues, especially the central nervous system and the yolk of egg. Of the fatty substances of the latter, it ...

9. The Volatile Oils

These are the substances to which many plants owe their characteristic or essential odors. On this account they are often spoken of as essential oils, or as the essences of plants. They differ fr...

Pharmaceutic Preparations

The chemicals and the various mineral, plant, or animal crude drugs may be employed in medicine as such without change, e. g., sodium bicarbonate or cod-liver oil, or powdered digitalis leaves; or the...

Definitions Of The Kinds Of Pharmaceutic Preparations In Common Use. Aqueous Liquids

I. Water (Aqua) A weak aqueous solution of one or more volatile substances (e. g., peppermint or cinnamon water, chlorine water). 2. Solution (Liquor) An aqueous solution of one or more non-volatil...

Alcoholic Liquids

I. Fluidextract (Fluidextractum) An alcoholic or hydro-alcoholic liquid preparation made by extraction, and representing the drug volume for weight; i. e., I c.c. of the fluidextract represents the s...

Miscellaneous Liquids

I. Vinegar (Aceturn) Made like a tincture, but with diluted acetic acid as the menstruum (the vinegar of squill is the only one oflicial). 2. Emulsion (Emulsum) A milk-like preparation in which an ...

Solids And Semisolids

I. Extract (Extractum) A preparation of dry or plastic consistence, made by extracting a drug with a solvent, and then removing the solvent by evaporation. An extract is of greater strength than the ...

Weights And Measures

In the metric system the liter is a unit of capacity equivalent to the volume occupied by the mass of 1 kilogram of pure water at its maximum density. It is equivalent in volume to 1.000027 cubic deci...

Active Principles And Assay Processes

As might be expected from the different conditions under which plants grow, the different methods of collecting, drying, and preserving drugs, the effects of age on the drug, etc., crude drugs vary in...

The Pharmacopoeia

The Pharmacopoeia is a book which defines and standardizes certain drugs and their preparations. Its aim is to establish definiteness for a selected number of those in extensive use by physicians. A n...

Dosage

When we say the dose of a drug, we mean the therapeutic dose for an adult, i. e., the amount ordinarily required to produce a medicinal effect. The Pharmacopoeia gives the average therapeutic dose, an...

Factors Which Modify The Dose

It must be apparent that the ordinary average adult dose is not the dose for every one under all circumstances. Some of the factors modifying the dose are: 1. Body Weight In pharmacologic experiment...

Factors Which Modify The Dose. Continued

7. The Nature Of The Disease In great pain, as in peritonitis, morphine may be borne in doses that would ordinarily be poisonous. On the other hand, in cyanosis or conditions with bad breathing, morp...

The Ways In Which Drugs May Be Administered For Systemic And Remote Local Effect

A. By mouth A. By mouth, the usual way, the drug being swallowed and absorbed into the sytem from the alimentary tract. B. Subcutaneously (hypodermatically) B. Subcutaneously (hypodermatically), th...

The Time Of Administration

This is of some importance, e. g., the saline cathartics act most rapidly after a period of fasting, so are usually administered before breakfast. Irritant drugs, as arsenic or iron or digitalis, are ...

Sites And Modes Of Action Of Drugs

Drugs may act as such: 1. Independently of the human body, as antiseptics on microorganisms in disinfection. 2. In or about the human body, but not on its structures, as in the destruction of a tape...

Synergists And Antagonists

As might be surmised, the same dose of a drug will exert its usual form of activity more easily if given with other drugs of the same class; and sometimes a combination of two similar drugs will gain ...

Scientific And Empiric Therapeutics - Animal Experimentation

Besides the constituents, the preparations, and the pharmacology of a drug, we are to learn its therapeutics, and we might ask how have our drugs come to have their present uses in medicine? From the...

The Scope Of Treatment

Treatment may be described as either specific, symptomatic, or expectant. Specific treatment is that in which a remedy directly attacks the causative factors of the disease. In the diseases for which...

How Much Shall We Learn About Drugs?

The subject of the materia medica is an extensive one, and the text-books contain many things that the physician does not need to know. He need not learn the pharmacopeial definition, where and how a ...

The Pharmacologic Action

In this extensive field almost any kind of aide-memoire will be of value. It will, therefore, be our general plan to take up in natural succession the actions of each drug as follows: first, its act...

Part II. Individual Remedies

Since any or all actions of a drug, whether desirable or undesirable, may result from its administration, the proper use of the drug requires a knowledge of all its actions. Hence it is necessary to s...

Protectives. A. Demulcents And Emollients

These are agents which are soothing and softening to epithelial tissues. Their action is essentially physical or mechanical, and is purely local. Those for application to the skin are called emollient...

B. Mechanical Applications

These are for local application, and act as protectives in a purely mechanical way. Such are: collodion, adhesive plaster, liquid glass (solution of sodium silicate), plaster-of-Paris (dried calcium s...

Sweetening Agents

These are glycerin, cane-sugar, syrup, saccharin and extract of malt. ...

Saccharin

Benzosulphinide (saccharin, gluside, C6H4So2.Conh) is an acid anhydride soluble in 290 parts of water and 31 of alcohol. Sodium-benzosulphinide (sodium-saccharin) is soluble in 1.2 of water and 50 of ...

Nutrients

From a pharmacologic point of view, the substances coming under this head are sugar, gelatin, cod liver oil, olive oil, and extract of malt. ...

Sugar - Glucose

Sugar is official in three forms, viz., cane-sugar (saccharum), milk-sugar (saccharum lactis) and dextrose or glucose (glucosum). A saturated solution of cane-sugar is syrupus. ...

Cane-Sugar

Locally, powdered cane-sugar has been used in dry form as an application to ulcers and infected wounds. It seems to promote osmosis, to dissolve fibrin and to favor local nutrition, and it does not fo...

Gelatin

Gelatin (gelatinum) is obtained by acting with boiling water upon certain animal tissues, as the skin, ligaments, and bones, and allowing the solution to dry in the air. It may be obtained in thin, tr...

Cod-Liver Oil (Oleum Morrhuae)

This is a fixed oil, obtained from the fresh livers of Gadus morrhua, and of other species of Gadus. It contains faint traces of iodine and bromine and sometimes of phosphorus. It also contains a vita...

Extract Of Malt (Extractum Malti)

This is a liquid extract of malted barley. It is of the consistence of thick honey, is sweet, and represents a large percentage of carbohydrate nutritive matter. It contains a small amount of the star...

Counterirritants

These are remedies which, by irritation of the skin, are intended to counter or check deeper-lying affections. Counter-irritation is a very old method of treatment, and it still holds a prominent plac...

Counterirritants. Continued

That counterirritation may act in other ways is also possible, for it is well known to every one that pain in a sensitive place results in a diminished sense of pain in a less sensitive region. It is ...

Caustics (Escharotics)

These are substances which act by causing the death of tissue They may destroy by consuming the tissue, as in the case of sulphuric acid, or by precipitating protoplasm, as by phenol, or by causing an...

Scarlet Red

Scarlet red is a name given to several different dye-stuffs, but that recommended for medicinal use is toluol-azotoluol-azobeta-naphthol. It is known as Scarlet R, and is marketed in powder form and...

Thiosinamine - Fibrolysin

Thiosinamine, or allyl sulphocarbamide, is soluble in 3 parts of alcohol. It is decomposed by water, though this change is retarded by glycerin. Fibrolysin is the trade name for a sterile aqueous solu...

Chrysarobin

Chrysarobin is a neutral principle extracted from Goa powder, a substance found deposited in clefts or cavities of the wood of the araroba tree of Brazil. It is an orange-yellow powder, tasteless and ...

The Digestive Ferments. Pepsin

Pepsin (pepsinum) is an enzyme usually obtained from the fresh mucous membrane of the hog's stomach. It is almost entirely soluble in 50 parts of water, and more so in water acidulated with hydrochlor...

Pancreatin

Pancreatin (pancreatinum) is usually obtained from the fresh pancreas of the hog or ox. It contains the specific ferments of the pancreas, and represents its external secretion. There is no evidence t...

Rennin (Rennet)

Rennin is not a digestant, but is the milk-coagulating ferment of the gastric juice. It is obtained from the mucous membrane of the fourth stomach of the calf. Under its influence the case-inogen of m...

Diastase

Diastase is the starch-digesting agent of barley malt, changing hydrolized or cooked starch to dextrin and maltose. It has also some power to hydrolyze raw starch. The Pharmacopoeia requires that it b...

The Inorganic Acids

The inorganic acids in common use for their acidity are hydrochloric, phosphoric, and sulphuric. Their dose is 5 minims (0.3 c.c.) well diluted. Each has an official 10 per cent. dilution; but, as sho...

The Organic Acids

Citric acid (acidum citricum, H3C6H5O7) occurs in large quantities in fruits of the citrus family, the lemon, orange, lime, and grape-fruit; and in milk to the extent of 0.1-0.25 Per cent. Tartaric a...

Fruit Acids

The acids in fruits are chiefly acetic, malic, citric, tartaric, oxalic, and in some instances salicylic and boric. Malic acid and malates occur in apples, pears, currants, blackberries, raspberries, ...

Antacids

The therapeutically employed antacids are certain salts of the alkalies, potassium, sodium, lithium, and ammonium, and certain salts of the alkaline earths, magnesium and calcium. Of the metals mentio...

Potassium, Sodium, And Lithium

The official mild alkaline salts of these ions are: Potassium bicarbonate (Khco3), soluble in 3 parts of water. Potassium carbonate (K2Co3), salts of tartar, soluble in 0.91 part of water. Sodium...

Potassium

Since potassium chloride in the blood, in amounts above 1:10,000 slows and weakens the heart and retards the activity of other muscles, the potassium ion has been considered a muscle depressant. But i...

Lithium

Since the lithium salts of uric acid are more soluble than the corresponding sodium salts, lithium has been favored as the alkali in gout and the uric-acid diathesis. But the quadriurate, which seems ...

Sodium

Even sodium chloride is poisonous under certain circumstances, and Jacques Loeb believes that the function of potassium and calcium salts in the blood and in sea-water is to prevent penetration of cel...

Alimentary Tract

Sodium bicarbonate neutralizes acids and dissolves mucus. According to Pawlow (1897), it tends to inhibit salivary, gastric, and pancreatic secretion. But in Pawlow's laboratory, Sawitch and Zeliony (...

Magnesium

The magnesium antacids are the oxide, the hydroxide, and the carbonate. Magnesium perhydrol is the magnesium peroxide. The magnesium oxide (magnesii oxidum) of the Pharmacopoeia, or burnt magnesia, is...

Calcium

Preparations The mildly alkaline salts are the carbonate and the hydroxide. The carbonate is insoluble in water. The salts for systemic action are the chloride and the lactate, both soluble in water,...

The Antacids Not Of Alkaline Reaction

These do not neutralize acids, so are not locally antacid; but in the blood and tissues they break down into alkaline carbonates, and as the Co2 is exhaled increase the alkalescence of the blood. They...

Carminatives

A carminative is a remedy which tends to overcome flatulency, that is, distention of the stomach or colon with gas. The aromatics, which depend for their action upon a volatile oil or resinous constit...

Carminatives. Continued

Therapeutics A number of carminative drugs have other striking actions for which they are of importance in therapeutics, and these we shall study in detail elsewhere. The following is an arrangement ...

Bitters

These are substances that are employed to give a bitter taste, the object of their administration being to improve the appetite. When the appetite is below normal, a strong stimulation of the taste-bu...

Anti-Bitters

There are two vegetable substances that possess the peculiar property of abolishing the appreciation of bitter taste. They are yerba santa (eriodictyon), a leaf, and gymnemic acid, a whitish powder wh...

Charcoal

Animal charcoal (carbo animalis) is prepared from bones, and 85 per cent. of it consists of mineral matter. It is called bone-black. Purified animal charcoal is bone-black boiled with hydrochloric a...

Kaolin - Fullers' Earth

These are silicates with powerful adsorptive properties. They have been employed locally as applications to wounds and infected mucous membranes, especially in diphtheria and ozena. Hektoen and Rappap...

Emetics

These are drugs employed to induce vomiting. To produce emesis requires the coordination of several mechanisms, the following actions being necessary: viz., closure of the pylorus, opening of the card...

Antemetics

These are remedies designed to check nausea and vomiting In the treatment of nausea and vomiting the recumbent position should be maintained. The antemetics are: 1. Antacids, to check hyperacidity; e...

Astringents

These are drugs which tend to shrink mucous membranes or raw tissues. Astringents produce their effects: (1) by constriction of arterioles, as epinephrine and cocaine; (2) by abstraction of water, as ...

Tannic Acid Or Tannin (Acidum Tannicum)

This substance is prepared from nutgalls. It is slowly but completely soluble in less than its own weight of water or alcohol, and, with the aid of heat, in its own weight of glycerin. It is used loca...

Anthelmintics

An anthelmintic is a remedy designed to promote the death or expulsion of intestinal worms. Most of the remedies are also toxic to man, and since the anthelmintic is to attack the worm, rather than th...

Oil Of Chenopodium

Since 1915 much has been written about the great efficacy of this remedy in hookworm disease, and it has been reported of fair value for pin-worms, roundworms, whip-worms and even tape-worms. The oil ...

Cathartics

A cathartic is a measure designed to promote defecation. Such a remedy may be employed - (1) In cases of constipation; (2) for the removal of irritating or otherwise harmful material from the intestin...

The Cecum And Colon

These form a great reservoir along which the contents are passed very slowly, and probably in a manner different from that in the small intestines. In the cecum and ascending colon so much liquid is a...

Cathartic Measures

Cathartic measures are laxative when employed to produce soft stools of about normal frequency, and purgative when em-ployed to produce copious soft or liquid movements. A hydra-gogue is any remedy th...

C. The Irritants

In Class C we have a large and valued list of cathartics, and these may be subdivided for convenience of study into several small groups. These are.: (a) Bile and bile-salts. (b) The fixed oils and ...

(A) Bile And Bile Salts

(A) Bile And Bile Salts The bile salts are sodium glycocholate and sodium taurocholate. They hold lecithin and cholesterol in solution in the bile, and serve as carriers of fats and soaps and their p...

(B) The Fixed Oils, Soaps, And Glycerin

1. Olive oil (oleum olivae) is essentially a nutritive and digestible fat. However, in amounts of one or two tablespoonfuls it may have a mildly laxative action, being changed to soap and glycerin in ...

(C) The Cathartic Mercurials

Calomel (hydrargyri chloridum mite), the mild chloride of mercury, HgCl, is a bland or unirritating heavy powder, completely insoluble in water. It has few chemic affinities, but is decomposed by alka...

(D) The Anthracene Derivatives

The drugs of this class are the chemicals, phenolphthalein and other phthaleins, and the vegetable drugs, aloes, frangula, cas-cara, rhubarb, and senna. These depend for their activity upon resinous b...

(E) The Drastics

These are so named because their action is harsh. In overdoses they tend to produce violent inflammations. Their active principles are chiefly resinous glucosides, such as colocynthin in colocynth and...

D. Saline Cathartics

The saline cathartics are certain salts of sodium, potassium, and magnesium. In the study of salts it has been found that their power of penetrating animal membranes, or, in the intestines, their abso...

D. Saline Cathartics. Continued

On the other hand, a theory propounded by Aubert (1852), that the salts had to be absorbed in order to act on the intestine, received some corroboration by the work of J. B. MacCallum (1904). He found...

Rectal Treatment

Enemata, or rectal injections, may be for cathartic, nutritive, or cleansing purposes, or they may be employed to supply liquid to the body, to cause the expulsion of gas, or to carry local remedies t...

Anti-Diarrheics

Diarrhea has so many causes that remedies of entirely different action may be required in the different types. In fermentative diarrhea castor oil may be indicated, followed by a bland protective like...

Mineral Waters

A mineral water is a natural water containing one or more ingredients different from, or in greater quantity than, those in ordinary drinking or washing water. Many bottled waters are not mineral wate...

Remedies Whose Chief Action Is Upon The Circulation

(a) General circulatory stimulants. (b) Measures to increase the volume of the blood. (c) Cardiac depressants. (d) Arterial dilators. (e) Measures to lessen the volume of the blood. ...

The Physiology Of The Circulation

The following is a brief review from a pharmacologic standpoint: The circulatory organs are for the purpose of carrying certain materials to and from the tissues by means of the blood; and since all ...

The Heart

The activities of the heart depend upon a number of things, viz., the strength of contraction (contractility), the tone of the muscle, the recuperative power, the irritability, the conductivity of the...

Coronary Circulation

Other things being equal, slowing of the heart means improved supply of coronary blood, resulting in better nutrition and better recuperative power. It has been demonstrated by Stewart and Pike (1910)...

The Vessels

The Arteries Changes in the caliber of the arterioles may be local, affecting the blood-supply of only one or two organs, or may be general, affecting general arterial pressure. The caliber is determ...

Arterial Pressure

The gross factors which go to maintain arterial pressure are four in number, viz., the arteriole or peripheral resistance, the heart's output in a given time, the volume of blood in the arteries, and ...

The Pulmonary Circulation

The pulmonary arteries have no vasoconstrictor nerves, but maintain an intrinsic muscular tone of moderate degree. They transmit just as much blood as the systemic arteries, for since the system is es...

Compensation

A term much employed in connection with disturbances of the circulation is compensation, which refers to the ability of the heart to maintain arterial pressure in spite of some condition or lesion w...

The General Circulatory Stimulants

Besides drugs, various remedial measures are adopted in the treatment of failing circulation, such as rest in bed, light, non-fermenting diet with restriction of liquids, the cold bath, the Nauheim ba...

Digitalis

Digitalis (Lat, digitalis), or foxglove, is the dried leaves of Digitalis purpurea (Fam. Scrophulariaceae). It is an ornamental flower of the gardens, grows wild in Europe, Oregon, and Australia, and ...

Digitalis Allies

There are some other drugs with effects of the digitalis kind, and the whole group is known as the digitalis group, or the digitalis series. The members of the group that are employed as circulatory s...

Digitalis Allies. Continued

Pharmacologic Action Local Action Digitalis has no effect on the unbroken skin, but to mucous membranes and subcutaneous tissues is irritant. When administered hypodermati-cally, it causes pain at t...

A. The Sinus Node

This is believed to be the normal controller or pacemaker of the rate of the heart. From it impulses are given to the auricles at more or less regular intervals of time, and normally at the rate of ab...

Arhythmia

Another effect of digitalis upon the sinus node is to change its rhythmic projection of impulses, so that the heart-rate shows regularly alternating short phases of acceleration and slowing. That is, ...

B. The Cardiac Muscle

The striking properties of the heart muscle, as viewed pharmacologically, are tonicity, contractility, irritability, and stimulus production. 1. Contractility And Tonicity Tonicity of muscle is its ...

C. The Auriculoventricular Bundle

The function of this bundle is to conduct impulses from the auricle to the ventricle, so that normally the ventricular beat follows that of the auricle in practically one-fifth of a second. The effect...

D. Digitalis Combined Effects

In cases with auricular fibrillation already established from disease the combined effects on irritability and conduction are strikingly to be observed after digitalis. The therapeutic effect of the d...

E. The Coronary Arteries

(a) Constriction of the coronary arteries is a real digitalis effect, as shown by perfusion experiments. In the coronaries of young rabbits a solution of 1: 20,000 reduced the outflow from 8 c.c. per ...

F. The Systemic Arteries

Besides its effect upon the structures of the heart, digitalis in the laboratory may produce another effect on the circulatory organs, viz., contraction of the peripheral arteries. The evidence of thi...

The Pulmonary Arteries

These tend to be contracted, though the extent or the significance of this effect is not known. The Cutaneous Arteries. - The arteries of the face and neck tend to dilate and cause flushing. This seem...

Kidneys

The cardiac effects of digitalis extend further and may be seen in the action of the kidneys. With an unobstructed ureter a normal kidney will secrete more urine if more blood flows through it. And th...

Value Of Digitalis

We might sum up the theoretically valuable effects of digitalis in a failing circulation as follows: 1. On the heart: (a) Slowing, (b) Increased contractility, (c) Increased tonicity, (d) Improved nu...

The Digitalis Allies

Strophanthus would seem to be absorbed from the alimentary tract with less rapidity and more uncertainty than digitalis (Hatcher). It is at least 50 times as poisonous to the heart muscle (Haynes, Edm...

Toxicology

1. Poisoning From An Overwhelming Dose As of 1 mg. of strophanthin per kilo intravenously in a dog, produces a regular sequence of effects in four well-defined stages, with death in a few minutes. (S...

Manifestations Of Overdosage Of Digitalis

I. Subjective Manifestations: a. Loss of appetite, nausea, vomiting, diarrhea. b. Oppression about heart, palpitation, tachycardia, consciousness of premature or skipped beats. c. Headache. II. Obj...

Manifestations Of Overdosage Of Digitalis. Part 2

Heart-Block In incipient or partial heart-block digitalis is contraindicated, for it tends to increase the degree of block. In complete block it has been recommended by Bachmann and others on the gro...

Manifestations Of Overdosage Of Digitalis. Part 3

Use As Determined By Rhythm And Rate The rhythm serves merely to determine the functional condition. The most met with rhythms, with their probable significance as judged by rate, are as follows: 1....

Manifestations Of Overdosage Of Digitalis. Part 4

In mitral stenosis the mitral orifice is narrowed by thickening of the valves or their adherence together so as to obstruct the filling of the ventricle from the auricle. The natural compensation in t...

Epinephrine

Epinephrine, more familiarly known by the proprietary name adrenaline, is an animal alkaloid or leukomain obtained from the medullary portion of the suprarenal glands, chiefly of cattle, sheep, and pi...

Epinephrine. Part 2

Fig. 25. - Adrenaline chloride solution. At a, 2 c.c. subcutaneously. No effect on blood-pressure. At b, 2 c.c. deep in thigh muscles. At c, 0.1 c.c. by vein; prompt rise in blood-pressure (lower trac...

Epinephrine. Part 3

From quickly repeated large doses the very great constriction of the arteries may result in failure of the left ventricle with dilatation and weakness, at a time when the right heart is pumping more b...

Epinephrine. Part 4

Secretion The sweat, tears, saliva, bile, and mucus are increased by stimulation of the sympathetic nerve-endings in the glands. Glands There is a distinct relation between the thyroid and adrenal ...

Pituitary Extract

Pituitary extract (hypophysis sicca, desiccated hypophysis) consists of the posterior lobe of the pituitary gland of cattle, cleaned, dried, and powdered. Dose, grain 1/2 (0.03 gm.). A solution, liquo...

Pituitary Extract. Continued

Subcutaneous injections tend to inhibit the flow of saliva and pancreatic juice. Weed and Cushing found an increase in the rate of production of cerebrospinal fluid through stimulation of the secretor...

Barium

The common soluble salts of barium {barium) are the chloride and the nitrate, dose, 1 grain (0.06 gm.). They are little employed except in pharmacologic laboratories and in veterinary practice. Barium...

Camphor

Camphor (camphora, ae) is a stearopten, C9H16CO, which is chemically a ketone. It is made synthetically or is obtained by boiling the twigs and wood of Cinnamomum camphora (Fam. Lauraceae) with water,...

Camphor. Continued

Heard and Brooks (1913) tested camphor on human beings. In 5 cases with normal circulation a hypodermatic of camphor, 20 grains (1.3 gm.) in oil, showed in four no change in the circulation, and in th...

Ammonium

The ammonium radicle (Nh4) is of dual nature, for, on the one hand, it is strongly alkaline and forms salts homologous with those of the alkali metals, K, Na, Li; and, on the other hand, it can libera...

Ammonium. Part 2

1. Nh4hco3.Nh4nh2co2 = 3CO(Nh2)2 + Co2 + 5H2O Commercial ammonium carbonate Urea 2. Nh4nh2co2 = CO(Nh2)2 + H2O ...

Ammonium. Part 3

Therapeutics And Administration 1. As a counterirritant - ammonia liniment or ammonia water. As a blistering-agent to the gums - ammonia water. 2. As a rapid reflex circulatory and respiratory stimu...

Mechanical Measures For Raising Arterial Pressure

In hemorrhage or collapse, the immediate indication is to restore the circulation of the brain centers, particularly of the vasoconstrictor and respiratory; so mechanical measures, to increase the blo...

Measures For Increasing The Volume Of The Blood In The Arteries

These are - (1) The transfusion of blood; and (2) the administration of saline solution (by intravenous infusion, by hypo-dermoclysis, or by rectal injection). Transfusion is the transmission of bloo...

How To Increase The Volume Of The Blood In The Arteries. Part 2

To understand the effects of saline solutions in the body we must know what is meant by the physiologic terms filtration, diffusion, and osmosis, and the nature of hypotonic (hypoisotonic), isotonic, ...

To Increase The Volume Of The Blood In The Arteries. Part 3

Therapeutics 1. In hemorrhage - to restore the blood volume to normal and thus permit the maintenance of arterial pressure. Probably not over 1200 c.c. should be given at one time. Bernheim cites a c...

Increasing The Volume Of The Blood In The Arteries. Part 4

Circulation After a very brief period of increased activity from accelerator stimulation, the heart becomes slowed through prolongation of the diastolic pause, and there is diminished muscular contra...

Veratrum

The dried rhizome and roots of Veratrum viride, American hellebore, (Fam. Liliaceae), a tall coarse herb of wet regions, growing in all parts of North America. Constituents There is great confusion ...

Nitrites

The pharmacologic group of nitrites includes the nitrites of amyl, ethyl, and sodium, and, in addition, certain drugs which are not nitrites, but yield nitrites by their decomposition. The alkali nitr...

Nitrites. Part 2

The veins are also somewhat relaxed, but this has not been shown to have any therapeutic importance. The Heart On the isolated heart ordinary doses have no effect, whether the ends of the vagus and ...

Nitrites. Part 3

Medulla The respiratory center is somewhat stimulated. The vagus center is depressed. Eye Besides the temporary blurring of the sight, which is due, perhaps, to dilatation of the retinal arteries, ...

Nitrites. Part 4

Action It has the effect of lessening the systemic venous congestion and the plethora which exists in a stagnant circulation. In conditions of circulatory stagnation Bolton and Starling found that in...

Nitrites. Part 5

Shock And Collapse Following severe trauma or a surgical operation, there develops at times a condition of pronounced muscular relaxation, with rapid, weak heart, low blood-pressure, and depressed re...

Remedies Whose Chief Action Is Upon The Central Nervous System

a. The stimulants. b. The depressants. Those which stimulate the central nervous system are: caffeine, strychnine, atropine, and cocaine. Central Nervous Stimulants The Caffeine Group This include...

Caffeine

Trimethylxanthine, or caffeine, is a feebly basic alkaloidal body usually prepared from damaged tea-leaves. It is found in plants growing in different parts of the world, and of no close botanic relat...

Caffeine. Part 2

Medulla Caffeine stimulates strongly the respiratory center, and slightly the vasoconstrictor and the vagus centers. Spinal Cord Caffeine stimulates the motor cells and promotes the passage of impu...

Caffeine. Part 3

Caffeine as a circulatory stimulant is, therefore, purely an emergency drug, and not one to be used repeatedly. It can in no sense do the work of digitalis. We are inclined to think that much of its a...

Caffeine. Part 4

Fig. 35. - Dog after vascular nephritis produced by arsenic: a, Before caffeine; b, eight minutes after caffeine; c, twenty-two minutes after caffeine. I, Drops of urine. II, Volume of kidney. III, Ge...

Caffeine Allies

Theobromine, occurring in chocolate to the extent of 0.3 to 2 per cent., and theophylline, which occurs in minute quantities in tea leaves, but is manufactured synthetically for the market, are isomer...

Theobromine And Caffeine Beverages

The ones that are in more or less universal use among civilized people are coffee, tea, and chocolate. Most of our coffee comes from Brazil, our tea from Japan, China, and India, and our chocolate fro...

Nux Vomica

Nux vomica is the dried ripe seed of Strychnos Nux vomica (Fam. Loganiaceae), yielding, when assayed, not less than 2.5 per cent. of alkaloids. It is native in India, Cochin-China, and Australia. Con...

Nux Vomica. Part 2

3. Claude Bernard's Experiment Cut the posterior nerve-roots to prevent afferent impulses from getting to the cord, strychnize the frog, and no convulsions result. Stimulate the central cut end and c...

Nux Vomica. Part 3

A. B. Fig. 36. - Kolliker's schema to show the reflex arc. A shows the posterior root-fiber (black) dividing and spreading up and down the cord, and connecting with many motor cells (red) thro...

Nux Vomica. Part 4

To test strychnine clinically, Cook and Briggs injected 1/60 to 1/10 grain (0.001-0.006 gm.). In persons ill enough to be in bed, they obtained a slow rise of pressure lasting from one to four hours. ...

Nux Vomica. Part 5

The convulsion is at first tonic, that is, the contraction is continuous, making the muscle rigid; it then changes to clonic, i. e., rhythmic intermittent contraction; then it ceases. Before another c...

Nux Vomica. Part 6

In nervous disease strychnine is extensively employed, but its use requires careful discrimination. Its application is as follows: (a) In the postoperative paralysis of stomach or intestine the drug ...

Remedies Which Depress The Central Nervous System. Narcotics

As the remedies which depress the central nervous system regularly depress the cerebrum, they are known generally as narcotics, a narcotic being a remedy which tends to produce a depressed state of co...

General Anesthetics

The ones in common use are: Ether, chloroform, nitrous oxide, ethyl chloride, and magnesium sulphate. As ether and chloroform have uses in therapeutics which do not involve the production of general ...

Ether

Ether, or ethyl oxide, (C2H5)2O, is obtained by distilling a mixture of sulphuric acid and alcohol. It is a very volatile, light, colorless, limpid liquid, with a burning, unpleasant taste and a chara...

Ether. Continued

After absorption it acts as a direct cerebral depressant or sedative, depressing the intellectual centers and the motor areas. Hence small amounts may be hypnotic, and large amounts will induce coma, ...

Chloroform

Chloroform (chloroformum), Chc13, is a non-inflammable, volatile liquid, which is about 1 1/2 times as heavy as water, boils at 141 F., and has a burning, strikingly sweetish taste. It mixes free...

Ether And Chloroform As General Anesthetics

When one of these drugs is administered in sufficient amount to put the patient into a state of coma, with muscular relaxation and the abolition of nearly all reflexes, the patient is in a condition o...

Ether And Chloroform As General Anesthetics. Continued

The third stage is that of stupor, i. e., unconsciousness from which one can be aroused only with difficulty. The pupils are contracted as in sleep, the heart is strong and regular and slower than bef...

Indication For Ether As General Anesthetic

Ether, especially with proper preventive precautions, is preferred to chloroform in almost all cases, including those with heart or kidney disease. It is not employed in cases with severe bronchial or...

Chloroform Anesthesia

In the production of anesthesia by chloroform there are four stages, as in ether anesthesia, and the symptoms are the same in nature. But chloroform, properly diluted with air, is not unpleasant to th...

Chloroform Anesthesia. Continued

The Third Danger In the last few years a great many cases have been reported in which the patient, after apparently recovering from chloroform, would pass in a few hours or days into a condition of m...

Rectal Or Colonic Anesthesia

Ether is sometimes given by rectum, the bowel being thoroughly cleansed beforehand. It may be given with oxygen or oil as the diluent. The opportunity for free exit of the vapor is considered a necess...

Intravenous General Anesthesia

The intravenous route was early tried with chloroform and was given up as too dangerous. Then Burkhardt in 1911 used ether, 5 per cent. in normal saline at 82.4o F. (280 C), and found it suitable. By ...

Anesthesia By Intratracheal Insufflation

In 1909 Meltzer and Auer, working with dogs, found that the ventilation of the alveolar air could be accomplished, and that an animal could be kept alive and in good condition by a stream of air blown...

Treatment Of Untoward Symptoms In General Anesthesia

(A) Cyanosis If this is due to excessive secretion or the falling back of the tongue or jaw, or falling of the paralyzed epiglottis so as to act as a valve over the glottis, or turning of the head to...

Nitrogen Monoxide (Nitrous Oxide)

Nitrous oxide, N20, or laughing-gas, is obtained by heating a mixture of salts containing ammonium nitrate. It is marketed under compression in steel cylinders, and is administered by a special inhale...

Ethyl Chloride

Ethyl chloride (aethylis chloridum), C2H5C1, is a highly volatile and inflammable gas, prepared by the action of hydrochloric acid upon absolute alcohol. It condenses to a liquid at 13 C. (55.4&d...

Magnesium Sulphate (Epsom Salt)

In 1899 Meltzer noted paralysis in a rabbit from the intracerebral injection of magnesium sulphate, and in 1905 was joined by Auer in an investigation of this action. They found that a 25 per cent. so...

Intoxicants. Alcohol

Common alcohol, grain-alcohol, ethyl alcohol, C2H5(OH), is made by fermenting a sugar solution with yeast in the presence of nitrogenous substances. The sugar may be that of a fruit-juice, or that pre...

Intoxicants. Alcohol. Part 2. Alcoholic Drinks

The alcoholic drinks in common use are of five classes: 1. The malt liquors. 2. The red and white wines. 3. The fortified wines. 4. The distilled liquors, or spirits. 5. The elixirs. 1. The malt...

Intoxicants. Alcohol. Part 3. Alcoholic Drinks

The following table of percentages, calculated to volume from Hutchinson's report, gives an idea of their alcohol and sugar contefit: Alcohol Cane-sugar Chartreuse...............

Intoxicants. Alcohol. Part 4

There are two official elixirs: Elixir aromaticum, aromatic elixir (compound spirit of orange, 1.2; syrup, 37.5; alcohol, about 25 per cent., and water to make 100). It is used solely as a flavored v...

Intoxicants. Alcohol. Part 5

2. Action On The Structures Of The Stomach-Wall As it cannot evaporate from the stomach, alcohol dilates the vessels and gives a feeling of warmth in the stomach. Below a strength of 10 per cent. it ...

Intoxicants. Alcohol. Part 6

Summary of the Effects upon the Stomach and its Functions: 1. In so far as they stimulate the appetite, alcoholic beverages induce a psychic secretion of gastric juice. 2. While in the stomach, alco...

Intoxicants. Alcohol. Part 7

Nervous System As alcohol is an ethyl compound, C2H5OH, with a close relation to ether, (C2H5)2O, it is not surprising to find that the alcohol effect upon the central nervous system is the same in k...

Intoxicants. Alcohol. Part 8

Sexuality From depression of the cerebrum the sexual desires are under much less restraint than normal, and Havelock Ellis rightly says: It is obvious that those who wish to cultivate a strict chast...

Intoxicants. Alcohol. Part 9

Food Value A food may be defined as a substance whose dominant property in the body is to build up the tissues or to yield energy. Protein is our reliance for the building or reconstruction of tissue...

Intoxicants. Alcohol. Part 10

The caloric value of alcohol is 7.1 calories per gram - i. e., one gram of alcohol is equivalent in energy-producing power to 1.75 grams of carbohydrate, or 0.77 gram of fat. The beer-drinkers' adipo...

Intoxicants. Alcohol. Part 11

Circulation Before Absorption On the ingestion of strong alcoholic liquors there is an immediate rise in arterial pressure, the rate of the beat being accelerated. But though the action lasts only a...

Intoxicants. Alcohol. Part 12

Arteries From ordinary amounts there is regularly no change in arterial pressure, but when intoxicating doses are given, there is a slow and very gradual moderate fall. The arterioles are dilated, as...

Intoxicants. Alcohol. Part 13

Elimination Von Noorden states that 1.5 to 6 per cent. is eliminated in the breath, 1 to 2 per cent. in the urine, and traces in the sweat. As we have seen above, from 6 one-ounce doses of whisky a d...

Intoxicants. Alcohol. Part 14

Toxicology In susceptible people even a teaspoonful of a strongly alcoholic tincture is enough to flush the face and make the head feel light. Acute Alcoholism is drunkenness, and we have already co...

Chronic Alcoholism

It is now quite generally considered that inebriety is a neurosis and that the alcoholic is a mental defective in some way. White says that the life history of the alcoholic shows him to be an ineffic...

Chronic Alcoholism. Continued

Late in the course of lobar pneumonia in persons accustomed to much alcohol there is sometimes seen a peculiar maniacal delirium verging on delirium tremens. In such cases the delirium may not yield u...

Intoxicants. Alcohol. Part 17

The Liver Mcjunkin (1917) gave 80 per cent. alcohol daily or on alternate days in intoxicating amounts to guinea-pigs, rabbits, cats and dogs; the greatest number of doses for any one animal was 92. ...

Intoxicants. Alcohol. Part 18

Preventives Leonard Hill reports that in alcohol poisoning fatty infiltration of the liver is prevented by feeding glycogen-builders, i. e., carbohydrates. Dogs which on pure fat diet put on 25 per c...

Methyl Alcohol

Methyl alcohol, wood naphtha, or wood alcohol, Ch3oh, is not employed as a remedy, but is of interest because of the number of cases of poisoning following its use. Its local and central actions are s...

Chloral Hydrate

Chloralum hydratum, or hydrated chloral, CCl3Coh+H2O, is prepared by passing chlorine gas through absolute alcohol and precipitating by water. It occurs in the form of hygroscopic crystals with bitter...

Chloral Hydrate. Continued

Temperature On account of diminished activity there is lessened production of heat, and on account of the dilatation of the cutaneous vessels there is increased dissipation of heat, so chloral tends ...

Ethylated Compounds

In experimental chemistry it has been found that the introduction of the radicle ethyl, C2H5, into an organic chemical will frequently confer upon it a sedative action. Hence many synthetic hypnotics ...

Hypnotics Which May Be Used To Abolish Pain. Bromides

The bromides in common use for narcotic effect are those of potassium, sodium, and ammonium, and to a small extent those of lithium, strontium, and calcium. All have a strongly salty, bitterish taste,...

Hypnotics Which May Be Used To Abolish Pain. Bromides. Continued

Skin And Mucous Membranes Scattered acne pustules very frequently appear on the face, chest, and back; more rarely the eruption may be erythematous, urticarial, furuncular, or bullous. In some cases ...

Opium

Opium is the concrete milky exudation obtained by incising the unripe capsules of Papaver somniferum (Fam. Papaveraceae), and yielding, in its normal moist condition, not less than 9 per cent, of mor...

Opium. Part 2

Stomach Through its central action it tends to lessen motor activity and to retard the secretion of gastric juice. Riegel, also Hirsch, asserts that after a temporary diminution the secretion increas...

Opium. Part 3

Fig. 45. - Record showing typical Cheyne-Stokes respiration (from a case of aortic and mitral insufficiency with arteriosclerosis). The time record gives seconds (Howell). Relation To Carbon Dioxi...

Opium. Part 4

Spinal Cord In some of the lower mammals, e. g., the cat, there is increased activity of the reflexes, and there may be convulsions of the typical strychnine type. In man, however, there is probably ...

Opium. Part 5

Untoward Effects Excitement instead of quiet, an effect seen mostly in women, and common among eastern women; it is the regular effect in cats. Occasionally there is diarrhea. The author has observed...

Opium. Part 6

Morphine Habit Chronic Poisoning Or Morphinism Opium, and its alkaloid morphine, are vicious habit-drugs, the habit being common among physicians, nurses, and druggists. The drug may be taken by hyp...

Codeine

This, the methyl ester of morphine, is a weaker narcotic, and its power to allay pain and induce sleep is very much less than that of morphine. Yet where the lesser effect is sufficient, it has the fo...

Papaverine

Papaverine, as the hydrochloride, soluble in alcohol but not readily in water, or the sulphate, soluble in both water and alcohol, is employed locally in 2 to 4 per cent. solution, and by mouth and su...

Di-Acetyl Morphine

Di-acetyl morphine, or heroine, of which the hydrochloride, soluble in alcohol and water, is in use, is somewhat like codeine, its powers to diminish pain and to promote sleep being less than those of...

Ethyl-Morphine Hydrochloride

Ethyl-morphine hydrochloride, or dionine, is soluble in water and alcohol. In dose of 1/2 to 1 grain (0.003-0.06 gm.) it is not so sedative as its composition would seem to indicate, but it is employe...

Cannabis

Cannabis is the dried flowering tops of the pistillate plants of Cannabis sativa (Fam. Moracece), grown in the East Indies, and gathered while the fruits are yet undeveloped and are carrying the whol...

The Antihysterics (Antispasmodics)

These are all aromatic carminative drugs, but they have a tendency beyond that of other carminatives to lessen states of nervous instability and hysteria. The one most in use is valerian; but asafetid...

Drugs Which Chiefly Affect The Peripheral Nervous System

I. Those which depress the peripheral nervous system - the belladonna group, cocaine, etc. II. Those which stimulate the peripheral nervous system - pilocarpus (jaborandi), physostigma, etc. We have ...

Belladonna Group

The belladonna group includes belladonna (deadly nightshade), stramonium (jimson-weed or thornapple), and hyoscya-mus (henbane), all of which belong to the potato family, the Solanaceae, and have simi...

Belladonna Group. Part 2

Alimentary Tract The chief effects of the drug are to lessen secretion and overcome colic (spasmodic contraction with pain). The taste is bitter. (A) Secretion After atropine, stimulation of the ch...

Belladonna Group. Part 3

Heart The vagus center is stimulated, but any effect from this is soon prevented by depression of the vagus nerve-endings, so that from large doses there regularly results a faster and somewhat stron...

Belladonna Group. Part 4

Eye Atropine has four important effects on the eye: It dilates the pupil, paralyzes accommodation, increases intraocular tension, and lessens pain. (A) The Dilatation Of The Pupil The iris consists...

Belladonna Group. Part 5

Temperature In poisoning it is characteristic that the temperature may rise several degrees. The author saw a case with a temperature of 106o F. (41.1 C). According to Ott, this is due to the ab...

Belladonna Group. Part 6

B. To relax over contracted smooth muscle - as in spasmodic asthma and the spasm of smooth muscle which results in colic. The latter occurs in the esophagus, cardia (cardiospasm), pylorus (pylorospas...

Belladonna Group. Part 7

Its chief uses are: 1. As narcotic in the insomnia and excitement of acute mania, uremia, and delirium tremens, in the delirium of pneumonia (especially in alcoholics), and in the insomnia of alcohol...

Cocaine

Cocaine is an alkaloid obtained from the leaves of Erythroxy-lon coca, or of Erythroxylon truxillense (Fam. Erythroxylacea). The coca shrub is extensively cultivated at an elevation of 3500 to 6000 fe...

Cocaine. Part 2

Spinal Analgesia To obtain spinal analgesia, 1/4 or 1/2 grain (0.015-0.03 gm.) of cocaine hydrochloride in aqueous solution is injected into the spinal canal, the needle being inserted between the th...

Cocaine. Part 3

Heart In perfusing the isolated heart the addition of cocaine does not change the rate or force of the beat, therefore neither the muscle nor the accelerator endings nor the vagus endings are affecte...

Cocaine. Part 4

Treatment Because of the marked anxiety it is of great importance to reassure the patient. In the excitement stage an ice-bag to the head and whisky or large doses of bromides may be supplied, or eve...

Cocaine Substitutes

The drawbacks in the use of cocaine are: 1. Its general poisonous action. 2. The frequency of undesirable idiosyncrasy to it. 3. Its decomposition at boiling temperature, which prevents effective s...

Some Other Local Anesthetics Not Used Hypodermatically

Orthoform, methyl-para-amido-meta-oxybenzoic ester, is applied as a powder to painful ulcers, or in ointment form to projecting hemorrhoids or to the vulva in pruritus; or is used in suppositories in ...

Curare

Curare, containing the alkaloid curarine, is a South American arrow-poison. It is probably obtained from a species of Strych-nos, the genus to which the strychnine-yielding plants belong. Its essentia...

Conium

Conium, or poison hemlock (not hemlock), contains the volatile liquid alkaloid, coniine. It is not official, but the fluidextract is employed, dose, 3 minims (0.13 c.c.). There is some medullary d...

Gelsemium

Gelsemium, yellow jasmine, has as its active principle the alkaloid, gelseminine. The fluidextract, dose, 1 minim (0.06 c.c.), and the 10 per cent. tincture, dose, 10 minims (0.6 c.c.), are official. ...

Sparteine Sulphate

Sparteine sulphate, dose, 1 grain (0.06 gm.), is the sulphate of an alkaloid obtained from Scoparius, or broom. It slows and weakens the heart by stimulating the ganglia on the vagus nerve and by dire...

Lobelia

Lobelia, Indian tobacco, the active principle of which is the volatile liquid alkaloid lobeline, resembles nicotine or real tobacco in its action. Its chief use is in spasmodic asthma, to depress the ...

Tobacco (Tabacum)

Tobacco is the leaves of Nicotiana tabacum (Fam. Solanaceae), subjected to a process of fermentation to remove certain proteins and fats that would make the smoke disagreeable, and then to another pro...

Tobacco (Tabacum). Part 2

Acute nicotine or pyridine poisoning is frequently seen after the first cigar, or when an unusually large quantity of tobacco is consumed in a short time. The symptoms are those of mild collapse, viz....

Tobacco (Tabacum). Part 3

As a matter of fact, the cigarette fiend does not consume any more tobacco than the cigar or pipe fiend, for 10 average cigars represent the tobacco of 50 or 60 cigarettes, and, as we have seen, the c...

Physostigma (Calabar Bean)

The ripe seed of Physostigma venenosum (Fam. Leguminosce), yielding, when assayed, not less than 0.15 per cent. of alkaloid soluble in ether. The plant is a woody twiner of western Africa, and the cal...

Pilocarpus (Jaborandi)

The leaflets of Pilocarpus jaborandi or of Pilocarpus micro-phyllus (Fam. Rutaceae), yielding, when assayed, not less than 0.6 per cent. of alkaloids. It is a Brazilian shrub. Constituents The alkal...

Muscarine And Mushroom Poisoning

Muscarine is an alkaloid contained in the mushroom known as the fly agaric, Amanita muscaria, and in some other agarics. Its actions are very similar to those of pilocarpine, but stronger, hence in po...

Diaphoretics

A diaphoretic is a remedy which tends to induce profuse sweating. Profuse sweating is diaphoresis. The measures employed to produce diaphoresis are either drugs or methods of raising and keeping rais...

Diaphoretics. Continued

When the surrounding medium is hotter than the body, as in these hot-bath methods, radiation and convection are abolished, and consequently the only cooling mechanism left is sweating. But as the heat...

Diuretics

A diuretic is a remedy which tends to promote the flow of urine. Diuresis is copious flow of urine. The kidney is a highly vascular organ, with numerous vasomotor nerves and readily influenced arteri...

Diuretics. Part 2

On account of these complex factors we must not forget, in treating patients, that the volume of the urine is made up of water, and that, therefore, the quantity of urine excretion is not necessarily ...

Diuretics. Part 3

The result in any case is diuresis, unless the molecular concentration of the plasma is decreased. For example, a hypotonic sodium chloride solution intravenously, because of its low salt content, wil...

Diuretics. Part 4

To compare the various diuretics, Raphael (1894) placed him-self on a uniform diet for a long period, the daily allowance of fluid being 1180 c.c. His twenty-four-hour urine ranged between 750 and 960...

Antipyretics

Antipyretics are remedies which tend to reduce the temperature in fever. The reduction of temperature may be brought about by cold or by drugs. Cold Some of the methods for applying cold are the col...

The Analgesic Antipyretics

The official ones are antipyrine, acetanilid, and acet-phenet-idin. Some of the quinoline derivatives, among the so-called coal-tar drugs, have been employed largely as antipyretics (kairin, thallin, ...

The Analgesic Antipyretics. Part 2

A chill is considered to be the result of surface cooling from constriction of the cutaneous arterioles, the skin being the site of the nerve-endings through which temperature changes are perceived. I...

The Analgesic Antipyretics. Part 3

That they act through the centers is shown by their failure to affect the temperature in health, by their failure to reduce temperature if the spinal cord is severed, and by the fact that there is no ...

The Analgesic Antipyretics. Part 4

Untoward Effects From idiosyncrasy, antipyrine not infrequently has produced a scarlatiniform rash with edema of the face and fever; or urticaria, or a vesicular, bullous, or eczematous eruption. The...

The Analgesic Antipyretics. Part 5

It is an interesting fact that various cells, under the influence of quinine, will undergo asymmetric cell division, e. g., the ova. In certain low vertebrates, as the salamander, dilute solutions of ...

The Analgesic Antipyretics. Part 6

Ear The deafness and ringing in the ears which are of such frequent occurrence seem to be due mostly to congestion, though arterial contraction and anemia of the middle ear and labyrinth are reported...

The Analgesic Antipyretics. Part 7

The treatment is: for cinchonism, bromides; for collapse, the regular treatment for collapse. Therapeutics Locally 1. Quinine and urea hydrochloride in solution has come into extensive use as a loc...

Ethylhydrocupreine

Ethylhydrocupreine has actions and uses similar to those of quinine, but because of a specific bactericidal effect upon all forms of the pneumococcus it has come into use in the treatment of pneumonia...

Ethylhydrocupreine. Continued

Giglio found salicylate in the synovial fluid of many joints; and Fillippi and Nesti obtained it from the synovial fluid from the hip-joint of dogs one hour after its administration by mouth. It was p...

Salicylic Allies

Acetyl-salicylic acid, or aspirin, C6H4.O.Coch3.Cooh, of slightly sour taste and acid reaction, is soluble in 125 parts of water and freely in alcohol. It gives no reaction with ferric chloride, unles...

Colchicum

Though it bears no relation to salicylic acid, colchicum, because of its use in gout, may properly be mentioned here. Both the seed and the corm of Colchicum autumnale (fam. Liliaceae), a crocus-like ...

Phenyl-Cinchoninic Acid

Phenyl-cinchoninic acid, phenyl-quinoline-carboxylic acid, marketed under the proprietary name atophan, is official; dose, 8 grains (0.5 gm.). It is insoluble in water and alcohol and has a biting bit...

Disinfectants And Antiseptics

A disinfectant is an agent that has the power to destroy microbic life, i. e., it is a germicide. An antiseptic is an agent that tends to retard the growth of microorganisms. A deodorant or deodorize...

I. Heat And Cold

The surest disinfection of all for soiled dressings is burning. In the preparation of sterile dressings there is nothing more destructive to bacteria or more penetrant to fabrics than superheated stea...

II. Oxidizers

These act by liberating oxygen, and in their action are themselves quickly destroyed. They are very inferior disinfectants, but are effective deodorizers. They readily and permanently destroy many col...

III. Deoxidizers

These are the sulphite group, viz., sulphur dioxide and sulphurous acid, sodium sulphite, sodium bisulphite, and sodium thiosulphate (hyposulphite). The sulphites absorb oxygen to form sulphates. They...

IV. Free Halogens And Their Compounds

Chlorine And' The Hypochlorites Chlorine gas is set free from chlorinated lime on contact with moisture, or it may be prepared by adding dilute sulphuric acid to a mixture of equal parts of manganese...

IV. Free Halogens And Their Compounds. Continued

3. At the same time dissolve, cold, in the five other liters of water the sodium carbonate and the bicarbonate. 4. Pour all at once the solution of the sodium salts into the jar containing the macera...

V. Metals And Their Compounds

These combine chemically with albumin to form precipitates of metallic albuminates, which make an impenetrable pellicle. Thus the metallic salts have little penetrating power, and are readily destroy...

VI. Miscellaneous Inorganic Compounds

Potassium nitrate (niter or saltpeter), sodium chloride, sodium borate (borax), and boric acid are employed as food preservatives, as in corned beef, ham, butter, etc. Wiley says that the small quanti...

VII. Phenol Compounds

This group includes phenol, the sulphocarbolates, resorcinol, pyrogallol, benzoic acid, salicylic acid, salol, cinnamic acid, cresol, creosol, guaiacol, creosote, tar, oil of cade, many volatile oils,...

Pharmacology And Therapeutics

Europhen = Cresol iodide. Losophan = Tri-iodo cresol. The Chemical Relationships of the Phenol Group of Disinfectants. Creosote, which is an empyreumatic volatile oil obtained during the disti...

Phenol, Or Carbolic Acid

Phenol is made synthetically and is also obtained from coal-tar by fractional distillation. It is a crystalline substance, of faintly acid reaction, freely soluble in alcohol, glycerin, and the oils, ...

Phenol, Or Carbolic Acid. Continued

Excretion is by the urine. The phenol passes out partly unchanged and partly oxidized to hydroquinone and pyrocat-echin in combination as ethereal sulphates and glycuronates. The urine may have a smok...

VIII. Miscellaneous Organic Compounds

Ichthyol and thiol are oily-looking sulphur compounds which are soluble in water and the oils, and not in alcohol. Ichthyol is obtained from a shale, and thiol is prepared synthetically. Their 3 to 5 ...

VIII. Miscellaneous Organic Compounds. Continued

Poisoning There are a number of reported cases of poisoning from its ingestion by mouth, with intense irritation of the esophagus and stomach, vomiting, diarrhea, coma, and collapse. The kidneys are ...

Therapeutic Classification Of Disinfectants. I. General Disinfectants And Deodorizers

(a) Used in dry form - for water-closets, sinks, and cess-pools, copperas (ferrous sulphate), naphthalin (tar balls), lime, and chlorinated lime are preferred because cheap. (b) Used in solution - fo...

II. Preservatives

1. Pharmaceutic - alcohol, glycerin, sugar, benzoin, aromatic oils, boric acid. 2. Foods - boric acid, borax, saltpeter (Kn03), salicylic acid, sodium benzoate, formaldehyd, sodium chloride (butter, ...

III. Disinfectants For Surgical Supplies

For utensils, surgical instruments, and dressings the best of all disinfectants is live, superheated steam at 220o to 225o F. The next best is dry heat. Instruments can be boiled with water, or placed...

IV. Disinfectants For Local Use About The Body

1. Skin. - (a) For the patient's skin, preliminary to operation Scrubbing with soft soap and application of tincture of iodine. (B) For The Surgeon's Hands Chlorine, generated by rubbing the hands ...

V. Disinfectants To Be Given By Mouth

For the stomach - sodium salicylate, 10 grains (0.7 gm.); resor-cinol, 10 grains (0.7 gm.); sodium sulphocarbolate, 10 grains (0.7 gm.); creosote, 5 minims (0.3 c.c.); aromatic oils, 5 minims (0.3 c.c...

The Heavy Metals

The heavy metals, though differing markedly in some of their details of action and in their therapeutic uses, have certain pharmacologic actions in common. Their salts tend to precipitate proteins, fo...

Mercury

There are many official salts and preparations of mercury (hydrargyrum), and their actions and uses are so distinct that they may well be considered separately according to their therapeutic uses. The...

Mercury. Part 2

For deep intramuscular injection the insoluble mercuric salicylate and the soluble bichloride, biniodide, and benzoate are the favorites. The former is insoluble in water or oil, and is used in 10 to ...

Mercury. Part 3

2. Severe acute poisoning is usually due to the bichloride, either from swallowing the tablets or a solution (often with suicidal intent), or from the retention of strong solutions used as uterine or ...

Lead

The lead (plumbum) salts are not much employed in medicine. Preparations (A) For External Use The acetate and sub-acetate are antiseptic and astringent and are soothing to wounds and bruises. Liquo...

Copper

Copper (cuprum) and its salts have a peculiarly deleterious action upon the lower forms of plant life, a mere trace in water, as from dragging bags of copper sulphate through the water, being found su...

Zinc

The zinc (zincum) salts fall into two distinct classes, viz., those which are irritant locally, and those which are soothing locally. The irritant salts are the sulphate and the chloride. Their actio...

Bismuth

The bismuth (bismuthum) salts commonly employed are the subcarbonate and the subnitrate, which are white, and the sub-gallate, which is yellow. Dose, 30 grains (2 gm.). The sub-nitrate is crystalline,...

Cerium

The Official Salt Of Cerium (Cerium) Is The Oxalate, Ce2(C2o4)2 10H2O, an inert powder, insoluble in water. The commercial article is very impure. Its action is practically that of the insoluble bism...

Silver (Argentum)

The official salt employed is silver nitrate, a crystalline salt which is decomposed by oxidizable organic matter and light, and is soluble in less than its own weight of water. Lunar caustic is sil...

Aluminium (Aluminum)

Alum (alumen, aluminis) of the Pharmacopoeia is potassium alum, the double sulphate of aluminium and potassium, KAl(So4)2.12H2O, or ammonium alum, Nh4al(So4)2.12H20. It is soluble in about 9 parts of ...

Iron

There are many official preparations of iron (ferrum), but a knowledge of only seven or eight will give a good equipment for iron therapy. (Those made in our laboratory were the syrup of ferrous iodid...

Manganese

Though found in the tissues in minute quantity, manganese is not essential to life, and does not form an integral part of any protein molecule. Bertrand and Megreccann claim that manganese acts as a c...

Arsenic (Arsenum)

Arsenic is widely distributed in nature and can be detected in many of our commonly used chemicals and even in certain chemic drugs. It is said to appear in the fruit of trees sprayed with Paris green...

Arsenic (Arsenum). Part 2

Alimentary Tract Nausea, vomiting, diarrhea, and colic are commonly seen from the use of arsenic. These effects seem to be produced after absorption, for they occur late, and even when the drug is ad...

Arsenic (Arsenum). Part 3

Besredka injected sublethal doses in rabbits, and found that the leukocytes usually contained arsenic, but not in the cases that proved fatal. He thought the leukocytes important in preventing the poi...

Arsenic (Arsenum). Part 4

From the arsenic treatment of chorea, G. M. Swift has seen the following: hemorrhage from stomach, hemorrhage from kidneys, conjunctivitis, neuritis, serious anemia, and tedious gastrointestinal infla...

Arsenic (Arsenum). Part 5

Untoward Effects 1. Locally, there may be a cellulitis from leakage of the drug into the tissues, or phlebitis and thrombosis of the vein. 2. From the intravenous use, the immediate effects, those th...

Antimony

The only official salt is the double tartrate of antimony and potassium, or tartar emetic, K(SbO).C4H4O6. It is soluble in 12 parts of water and insoluble in alcohol. Preparations And Doses Antimony...

Phosphorus

Phosphorus is insoluble in water, but soluble in ether, chloroform, and the oils. It is readily oxidized to phosphorous acid, which is an inert compound. It resembles arsenic in its action, but is les...

The Iodides

Preparations And Doses Iodine (iodum), 1/10 grain (0.006 gm.)- Sodium iodide, potassium iodide, 10 grains (0.7 gm.); diluted hydriodic acid, 10 per cent., 1 dram (4 c.c). Tincture of iodine, 7 per ...

The Iodides. Continued

Untoward Actions Besides the local irritation of the stomach, the most frequent undesirable effects are those upon the skin and mucous membranes. 1. Skin The skin lesion usually shows as irregularl...

Thyroid Gland

Desiccated thyroid glands (thyroideum siccum) are the dried thyroids of various domestic animals, and are required by the Pharmacopoeia to contain between 0.17 and 0.23 per cent. of iodine. They are a...

Expectorants

Expectorants are remedies which facilitate the expulsion of mucus from the respiratory organs. They do this largely by increasing the fluidity or the rate of the secretion. Most of them act reflexly f...

Ipecacuanha

Ipecac (ipecacuanha) is the root of Cephaelis Ipecacuanha from Brazil, and of the Carthagena ipecac, Cephaelis acuminata (Fam. Rubiacece), and it is required to yield on assay not less than 2 per cent...

Emmenagogues

These are remedies which tend to bring on the menstrual flow. They are: 1. Local measures, as hot or mustard foot- or sitz-baths, hot-water bottle or counterirritant drugs (turpentine, mustard) to lo...

Ergot

Ergot (ergota) is a fungus which replaces the grain of rye. It rapidly deteriorates and should not be more than one year old. Our supply comes from Europe. Constituents Though a vast amount of study...

Ergot. Continued

Respiration After the intravenous injection of 0.001 gm. per kilo of ergotoxine, the respiratory center is depressed, as shown by slow and shallow breathing or Cheyne-Stokes respiration (Wiggers). Fr...

Hydrastis

Hydrastis, or goldenseal, is the dried rhizome and roots of Hydrastis canadensis (Fam. Ranunculaceae), yielding, when assayed, not less than 2.5 per cent. of hydrastine. It is a small herb of the east...

Hydrastinine Hydrochloride

This salt (hydrastinince hydrochloridum), C11H11No2.HCl, is the hydrochloride of an artificial alkaloid formed by the oxidation of hydrastine. Dose, 1/2 grain (0.03 gm.). It is freely soluble in water...

Carbon Monoxide

This gas (CO) becomes of interest from the frequency of its poisoning. Most of the cases result from illuminating-gas, which contains 6 to 10 per cent., and is frequently inhaled with suicidal intent....

Benzine And Gasoline

The benzine of the Pharmacopoeia has a specific gravity of 0.638-0.660 at 25 C. and is known commercially as petroleum ether. Commercial benzine has a specific gravity of about 0.746 and commerci...

Benzol

Benzol (benzene, C6H6) is a colorless, inflammable liquid, insoluble in water, soluble in 4 parts of alcohol, and freely miscible with the oils. It is a solvent for phenol, a property by which it can ...

Oxygen

Oxygen gas (oxygenium) is marketed under compression in steel containers. It is regularly used by inhalation, but has also been employed subcutaneously, intravenously, and intra-abdominally. For inhal...

Part III. Prescription Writing

For three obvious reasons the writing of prescriptions is the dread of the young medical practitioner. The reasons are: (1) His fear that he may not express his desires correctly; (2) his distrust in ...

Liquid Prescriptions

Liquid medicines for internal use are administered by measure only, hence it is the custom to make the total quantity of the prescription such that its dose will be a teaspoonful, a dessertspoonful, o...

Administration Of Liquids Vehicles And Flavors

The vehicle is the diluent or solvent. It is generally employed in sufficient quantity to make the dose a readily measurable amount. A vehicle maybe - (a) non-medicinal, as plain water, or a flavored ...

Administration Of Solids

The regular diluent for powdered drugs dispensed in very small quantities is sugar of milk. Of drugs in tablet form, the tablet triturates are made with sugar of milk, hypodermatic tablets with cane-s...

Latin

The names of the ingredients are always written in Latin, for the following reasons: 1. Latin is a universal language, so is readable anywhere. 2. It is a dead language, so is not subject to change....

Latin Nouns

A general rule for case-endings in the name of ingredients is: The name of the substance or the class of remedy takes the genitive ending when the quantity is a weight or measure; and the accusative e...

Latin Adjectives

Adjectives agree in number, gender, and case with the noun which they modify. (a) Those ending in us (masculine), a (feminine), um (neuter), are of the second declension, and take the same case-ending...

Other Latin Words

Besides nouns and adjectives, there are employed in the directions for the pharmacist and for the label a few special words that should be known. They are: 1. Verbs - adde (add), bulliat, bulliant (l...

The Form Of A Prescription

Almost all prescriptions are of two classes, viz.: I. Material to be sent in bulk, as liquids, ointments, mixtures of powders, etc. II. Objects to be counted, as pills, tablets, powders, etc. Hence, i...

Figuring The Quantities

To acquire careful habits it is wise, in writing a compound prescription, to put down the names of all the ingredients desired before inserting the quantities. Then multiply the number of doses by the...

Good Usage

In prescription writing, clearness is the important thing and Latin is the medium of expression, but certain forms have become approved, and certain modes of expression are accepted as the best custom...

Abbreviations

When there can be no possible mistake in meaning, abbreviations are allowable as follows: I. Of Ingredients. - (a) In the name of the class of preparations, as elix., tinct., syr., pil., suppos., ung...

I. Practice In Bulk Prescriptions

According to the forementioned rules, write out, correctly using approved abbreviations, the following prescriptions. Ascribe each prescription to some person, e. g., For John, For Willie, For Mr. Wil...

II. Practice In Prescriptions For Objects To Be Counted

Write for - 1. Thirty five-grain capsules of quinine sulphate. Directions: Three at time of chill, then one three times a day after eating. 2. Twenty-four capsules, each containing 2 1/2 minims of ca...

Miscellaneous

Take belladonna plaster and spread it upon surgeon's adhesive plaster over a circular area 2 inches in diameter. (In this case it would be better to write the directions to the pharmacist in English.)...

Incompatibility

Incompatibility between two substances may be said to exist when their admixture brings about physical or chemical change other than simple solution. Such a change - (1) may be desired in a prescripti...

Books

Surgery And Anatomy W. B. Saunders Company West Washington Square Philadelphia 9, Henrietta Street Covent Garden, London Elsberg's Surgery of Spinal Cord Surgery of the 5pinal Cord. By Charles A....

Books. Part 2

Surgery: Its Principles and Practice. Written by 81 eminent specialists. Edited by W. W. Keen, M. D, LL.D., Hon. F.R.C.S., Eng. and Edin., Emeritus Professor of the Principles of Surgery and of Clinic...

Books. Part 3

Rudolph Mat as, M. D., Professor of Surgery, Tulane University of Louisiana. This edition is destined to rank as high as its predecessors, which have placed the learned author in the fore of text-bo...

Books. Part 4

Moynihan's Abdominal Operations Abdominal Operations. By Sir Berkeley Moynihan, M. S. (London), F. R. C. S., of Leeds, England. Two octavos, totaling nearly 1000 pages, with 385 illustrations. Per se...

Books. Part 5

Whiting's Bandaging Bandaging. By A. D. Whiting, M. D., Instructor in Surgery at the University of Pennsylvania. 12mo of 151 pages, with 117 illustrations. Cloth, $1.25 net. Published November, 1915 ...