Substances introduced into the system are eliminated in greater or less proportion, but are never found completely unchanged in the emunctories, or in the product of secretions; ordinarily there is a certain proportion wanted. a

The class of substances that are of rapid elimination are the alkaloids. These are organic matters which take no part in the formation of tissue, and which are speedily eliminated in a few hours, or at the latest in a few days. The different salts, bromides, iodides, or the mineral salts are eliminated also with great rapidity. But the mineral substances are long delayed, as iron, manganese, mercury, antimony arsenic, etc. a

If the salivary, biliary, and in particular the urinary secretions are very active, when consequently there is great rapidity of excretion, there will be great difficulty in producing any considerable remedial effect, and in order to obtain such it will be necessary to prescribe large doses. If this condition is excellent in a certain number of cases, where it is desired to eliminate a poison, it is unfortunate in others, where it is desirable to produce remedial effects. If the secretions are in a languid state, or completely dried up. a parched mouth with anuria or oliguria, under these conditions even small doses of active substances will produce considerable effect, and you must be guarded in administering remedies. a

Substances with low osmotic equivalents, such as soluble salts, will naturally tend to follow the path of the water in the organism, and hence first tend to appear in the fluid excretions, especially in the urine, where many of the bodies, such as iodide, and ferrocyanide of potassium are readily and rapidly detected after their entrance into the circulation. b

When vegetable acids are combined with alkaline bases, as with lime, and particularly with soda and potassa, they are consumed with extreme facility, transformed into carbonic acid and instead of the citrate or tartrate of potassa and soda in the urine, are found carbonate of potassa or soda. c

Iodine is eliminated chiefly by the kidneys, and probabty to a greater or less extent by all the mucous membranes. c It may even escape through the skin. d

The elimination of iodine takes place slowly and intermittently, so that the drug when given continuously, accumulates in the system. It may be found in the saliva after it has disappeared from the urine. c Iodine may after injection into serous cavities be eliminated through the stomach. b It makes its appearance rapidly in the secretions, probably in the form a Prof. Adolph Gubler. c Prof. H. C. Wood. b Dr. L. Lewin.

b L. Hermann.

d Dr. R. W. Taylor.

of iodide of sodium. c Soda being a very common ingredient in the organism, the iodide of its base appears to be suited to the human system. d

The elimination of iodoform commences within one hour after the stomachic injection of the drug, and goes on so slowly that the haloid can be found in the urine three days later. e After application of iodoform upon wounds of the vagina or vulva, iodine can be recovered from the milk and urine of the nurse. f

When the blood is charged with the bromide of potassium, the salt probably escapes with all the secretions. a

Muriate of ammonia enters into all the excretions, and is mainly eliminated through the kidneys. a It has been found in the saliva. g

Iron is eliminated chiefly by the glands of the intestinal canal, and especially the liver; but a small portion makes its appearance in the other secretions, as in the urine, saliva, sweat, milk, and tears. c

Tartar emetic is eliminated largely by the gastric and intestinal secretions, but also by the urine, and possibly by the bronchial mucous membrane. c Under its use carbonic acid and urea are both eliminated by the urine in greatly increased quantity, but whether the antimony is to be considered a mere eliminator of the excrementitious substance, or whether it likewise increases their formation, is not determined. h

Ipecac is eliminated by the kidneys and bronchial mucous membranes, and certainly the latter method would afford the best explanation of its expectorant effects, and is an item in favor of the argument that many cures are effected through the process of some immediate or remote elimination.

Antifebrin is eliminated as paramido-phenol sulphate. This method of elimination indicates that the antifebrin breaks up in the organism into acetic acid and anilin, and the anilin is then oxidized into paramido-phenol which unites with sulphuric acid.

Balsam copaiba is eliminated through the lungs and kidneys. b In large doses it may cause paralysis with tetanoid manifestations. i Copaiba acts especially upon the mucous membrane, but after its continuous use, or in large doses, it may provoke irritation of the gastro-intestinal surface. c

Camphor is absorbed from the mucous membrane and makes its appearance again in the breath and perspiration. a

Liquor potassa will neutralize the acids in the stomach, is rapidly absorbed, and exists in the blood chiefly in the form of carbonate. The urine, if the dose be sufficient, is rendered alkaline thereby. a

Opium will not always suspend elimination. It usually will diminish the secretions; under certain circumstances it has an opposite action, augmenting them. It calms intestinal pain, but produces a certain local vascularity, and through this return of blood to the parts there is an incprof. R. T. Edes. e Rummo. g Rabuteau. i Pidoux.

d Dr. Gamberini. f Fehling. h Ringer.

cretion of intestinal mucous. b Narcotics are usually found in the excretions, and children may be narcotized by large doses given to the nurse.

Salicylate of sodium given to the nurse, and the child put to the breast an hour or less after its administration, the drug is eliminated simultaneously in nurse and child. c Nearly the same results are obtainable in the use of the iodide of potassium. In the child the elimination has seventy-two hours, in the nurse forty-four hours. The transmission of mercury from the nurse to the child is very slight and inconstant. c

When sulphur is taken internally, it is absorbed into the system, and has been detected in the chyle, the lymphatics, and the vessels of the mesentery; a large portion of it passes off by the bowels, part is oxydized and converted into sulphuric acid, which is eliminated by the kidneys, and another portion passes off by the skin in the form of sulphuretted hydrogen.

Sulphuretted hydrogen passes in part unaltered. It may be collected in the respiratory exhalations; there is, however, a certain proportion which passes into the state of sulphurous acid. b It is harmless when absorbed by the digestive membrane, because it can be immediately exhaled by the lungs while it is being absorbed. b

Digitalis is one of the substances most difficult of elimination. It would seem to be eliminated by but few organs, but is finally discharged by the kidneys and the liver. The action of digitalis on the kidneys is prolonged for some time after you cease its administration. d

Quinine may cause an eruption of the skin, and in order to arrive at a differential diagnosis of quinine eruption and scarlatina, it is necssary to note the course of the temperature, and to detect quinine in the urine. e

Santoninum in the system undergoes an oxydation having the peculiarities of a weak acid. a It is eliminated by the urine. In the event of decomposition of santonine in the urine, the carbonate of ammonium, which is generated, produces in it a red color, which, under certain circumstances, such as the existence of vesical catarrh, may cause it to be mistaken for blood urine. b

Sometimes substances are introduced into organs which may be called caducous - the nails, the hair, the epithelial surfaces - and they are thrown off with them. b