Drugs given a specified patient, a victim of acquired or inherited defect, will produce in that patient unexpected results differing from their usual action. These results, which should not be 4 classified with typically poisonous effects or with those of prolonged use, may not appear in many cases, and do not correspond, as a rule, with the admittedly poisonous symptoms. They have been termed in Germany "nebenwirkungen," in France "incon-venients therapeutiques," and among the English-speaking nations "untoward effects" and "bye-effects."

Untoward effects are of great interest from a medico-legal standpoint. Even physicians are but too apt to refer them to defects or impurities in the drug dispensed. They are seemingly multiform in character, and yet they can readily be ranged under a few general laws. The primary and secondary effects, which are often opposite in nature, the organs chiefly affected by the ordinary action of the drug, the method of drug-excretion, all play a part in what may be called general constitutional untoward effects, as contrasted with the untoward manifestations due to temporary and evanescent conditions, which last, however, also range themselves in a regulated fashion.

Prediction may be made with considerable accuracy as to the untoward effects of any drug on learning its action and all the factors cited. An antipyretic will have as untoward effects, skin-eruption because it is excreted through the skin, because the skin through its pores regulates temperature, and hence is under control of the central nervous system regulating temperature, and, finally, because the skin is in close connection from an early period with the nervous system. For the same reason profuse, debilitating perspiration often results. Since control of the temperature cannot be effected without control of the vasomotor system regulating the blood-supply, heart-failure, collapse, and palpitation may result, together with certain eye- and ear-symptoms.

The action on the heart may, by its influence on the kidney circulation, cause kidney and bladder symptoms even to the extent of albumin in the urine. If a remedy be excreted through the kidneys, albuminuria may present itself as an untoward result as is sometimes the case with ether. Alteratives and purgatives produce hemorrhages from the mucous membranes and swelling of those of the organs of special sense, beside skin-eruptions. Some hypnotics produce excessive perspiration, skin eruptions, vertigo, and heart collapse. Astringents cause diarrhea and bloody intestinal discharges. Diaphoretics cause pains at certain points from overstimulation. Pilocarpine causes at times pain in the penis; as there often occur in certain persons excessive secretion and plugged sebaceous glands around its head, the pain and other resultant symptoms simulate chancre.

It will be observed from the annexed tables (see pages 52-57) that the most potent tonics and alteratives are most fertile in untoward effects. This is naturally to be expected. A drug of potent physiological action must of necessity try more severely inherited and acquired deficiencies of constitution than an inert drug. Too excessive strain on inhibitions weakened by acquired or inherited taint gives an undue sway to inhibited centers. Untoward effects of drugs may hence be conditioned on pre-existing affections of the inhibitory apparatus of the system.

One influence which, together with hereditary or acquired defect, plays a part in determining untoward results is what the Germans call the "etiologic moment." This is excellently illustrated in the neurotics, which display such decidedly variable untoward effects. In many neuroses nerve-strain of the elimi-native and assimilative organs has produced toxins and other products; some of these naturally add to the effects of a given neurotic drug, or direct these in some special channel or inhibit certain effects, thereby giving others undue play. This may constitute, as Lewin has shown, a disposition that is but temporary, which disposition may have its foundation either in a greater abundance in the system of bio-chemical substances, which cause an unusually prompt solution or action of the medicines introduced, or which may unite with them to form injurious compounds; or it may be conditional on pre-existing pathologic changes in the inhibitory apparatus of the system.

The tables given on pages 52-57, covering all the departments of the materia medica, will give a better idea of these untoward effects than any detailed description.

Table 1.

General.

Brain and Cord.

Eye, Ear, and Throat.

Skin.

Liver, Kidneys, and Bladder.

Arsenic......................

Fever, gastralgia, nausea, bulimia, salivation, profuse sweating, diarrhea, purpura.

Vertigo, ataxic symptoms, local anesthesia.

Eyelid edema, glottis edema, catarrh, amblyopia, tinnitus.

Vesicles, pustules, papules, erythema, urticaria, purpura.

Dysuria, icterus, hematuria, glycosuria, cystitis, albuminuria.

Chelidonium ..................

Nausea.

Vertigo.

Tinnitus.

Pruritus.

Albuminuria.

Cod-liver oil...................

Nausea.

Vertigo.

Vesicles.

Colchicum .....................

Nausea, gastralgia, like guaiac.

Like guaiac.

Like guaiac.

Vesicles.

Cystitis, strangury.

Columbo.....................

Fever.

Vertigo, contractions.

Conjunctivitis, tinnitus.

Erythema.

Dysuria.

Cresole........................

Fever, nausea.

Vertigo.

Eyelid edema, tinnitus.

Erythema, papules.

Cystitis.

Gold................................

Fever, salivation, epis-taxis.

Vertigo, emotional exaltation, aphrodisia.

Tinnitus.

Erythema, papules.

Cystitis.

Guaiac.......................

Fever, profuse sweating.

Vertigo, ataxic symptoms, neuralgia.

Glottis edema, tinnitus.

Vesicles.

Cystitis, strangury.

Iodine........................

Bulimia, gastralgia, cardiac disorder, hemoptysis, dyspnea, fever, epistaxis, nausea.

Aphrodisia, ataxic symptoms, vertigo, delirium.

Amblyopia, catarrh, glottis edema, eyelid edema, diplopia, tinnitus, salivation.

Erythema, vesicles, papules, pustules, purpuric eruptions, urticaria.

Dysuria, cystitis, glycosuria, albuminuria.

Iron...........................

Hemoptysis, hemateme-sis, nausea, gastralgia, fever, diarrhea, constipation.

Vertigo, ataxic symptoms, insomnia.

Eyelid edema, glottis edema, amblyopia, tinnitus.

Vesicles, purpuric eruption, pustules.

Hematuria, albuminuria, glycosuria, icterus.

Mercury.....................

Fever, gastralgia, diarrhea, constipation, bulimia.

Insomnia, ataxic symptoms, insanity, local sensory troubles.

Eyelid edema, amblyopia, tinnitus, glottis edema.

Like iodides and quinine, tongue ulceration, salivation.

Dysuria, cystitis, hematuria, glycosuria.

Quassia......................

Nausea.

Vertigo, contractions.

Tinnitus.

Papules.

Dysuria.

Quinie........................

Fever, nausea, bulimia, hemoptysis, profuse sweating, dyspnea.

Delirium, insanity, ataxic symptoms, local sensory troubles, vertigo.

Amblyopia, photophobia, deafness, tinnitus.

Simulates scarlet fever, vesicles, papules, pustules, erythema, urticaria, purpura.

Hematuria, cystitis, albuminuria, glycosuria, icterus.

Salicylic Acid ...............

Profuse perspiration, bulimia, hemoptysis.

Vertigo, delirium, insanity, ataxic symptoms, local sensory troubles.

Dim sight, deafness, tinnitus.

Vesicles, pustules, pruritus, gangrene, purpura.

Cystitis, glycosuria, icterus.

Sarsaparilla ..................

Nausea, gastralgia, bulimia, profuse sweat.

Vertigo, ataxic symptoms.

Glottis edema, tinnitus.

Eczema.

Cystitis, strangury.

Strychnine.................

Fever, dyspnea.

Vertigo, ataxic symptoms, local sensory troubles.

Conjunctivitis, photophobia, tinnitus.

Erythema, pruritus.

Albuminuria, glycosuria, cystitis.

Turpentine..................

Fever, nausea.

Vertigo-, drowsiness, stupor.

Tinnitus.

Vesicles, erythema.

Albuminuria, cystitis, strangury, hematuria.

Table II.

General. Lungs and Heart.

Brain and Cord.

Eye, Ear, and Throat.

Skim.

Liver, Kidneys, and Bladder.

Acetanilid...................

Cardiac failure, lung edema, cyanosis, fever, pallor, hyperidro-sis, nausea, diarrhea.

Anesthesia, hyperesthesia, vertigo, delirium, stupor, ataxia.

Amblyopia, xerostoma, throat constriction, tinnitus, pupil irregularity, conjunctivitis.

Erythema, vesicles, papules.

Icterus, dysuria, cystitis, albuminuria, glycosuria.

Aconite.......................

Nausea, diarrhea, salivation, hyperidrosis, collapse, cyanosis.

Vertigo, anesthesia, paresthesia, hyperesthesia.

Amblyopia, tinnitus, xerostoma.

Erythema, urticaria.

Icterus, polyuria.

Amyl Nitrite................

Like glonoin.

Like glonoin.

Like glonoin.

Like glonoin.

Like glonoin.

Antikamnia.................

Like acetanilid.

Like acetanilid.

Like acetanilid.

Like acetanilid.

Like acetanilid.

Antipyrin....................

Cardiac weakness, pallor

Anesthesia.

Erythema.

Arnica........................

Tenesmus, bradycardia, diarrhea, collapse.

Stupor, vertigo, headache.

Xerostoma, amblyopia, throat irritability.

Erythema, urticaria, papules, pruritus.

Cystalgia, dysuria.

Atropine....................

Like belladonna.

Like belladonna.

Like belladonna.

Like belladonna.

Like belladonna.

Belladonna...............

Diarrhea, nausea, vomiting, collapse, hyperidrosis, fever, cardiac pain, dysphagia, dyspnea.

Delirium, insanity, stupor, vertigo, ataxia.

Amblyopia, lachryma-tion, xerostoma, tinnitus.

Erythema, vesicles, papules, purpura, pruritus.

Cystalgia, dysuria, polyuria.

Bromides...................

Collapse, cardiac failure, lung edema, gastral-gia, vomiting, aphro-disia, amenorrhea, pneumonia.

Delirium, insanity, stupor, ataxia, convulsions, anesthesia, hyperesthesia.

Throat anesthesia, co-ryza, laryngismus stridulus, conjunctivitis, amblyopia, myopia, diplopia, fetid breath.

Acne, papules, vesicles, urticaria, erythema, pruritus.

Dysuria, cystalgia, icterus, polyuria, glycosuria.

Caffine.....................

Bradycardia.

Delirium, insanity.

Diplopia.

Erythema, vesicles.

Dysuria.

Camphor..................

Diarrhea, collapse, aph-rodisia, hyperidrosis, vomiting.

Delirium, insanity, stupor, hyperesthesia, headache.

Xerostoma, coryza, amblyopia, tinnitus.

Erythema, vesicles.

Dysuria, polyuria, cystalgia, strangury.

Table II. (Continued).

General. Lungs and Heart.

Brain and Cord.

Eye, Ear, and Throat.

Skin.

Liver, Kidneys, and Bladder.

Cannabis Indica..........

Aphrodisia, vomiting, diarrhea, amenorrhea.

Vertigo, delirium, insanity, ataxia.

Amblyopia, tinnitus.

Erythema, vesicles.

Dysuria, cystalgia.

Chloralamid................

Like chloral.

Like chloral.

Like chloral.

Like chloral.

Like chloral.

Chloralose..................

Like chloral.

Like chloral.

Like chloral.

Like chloral.

Like chloral.

Chloral Hydrate..........

Dyspnea, lung edema, heart-failure, fever, diarrhea, hyperidro-sis, bradycardia.

Vertigo, ataxia, stupor, delirium, convulsions, analgesia, anesthesia, hyperesthesia.

Epiglottis edema, amblyopia, photophobia, conjunctivitis, choroiditis, tinnitus.

Erythema, acne, purpura, papules, urticaria, pruritus.

Icterus, dysuria, strangury, glycosuria, albuminuria.

Chloroform..................

Fever, collapse, aphrodisia, diarrhea, hy-peridrosis.

Vertigo, delirium, ataxia.

Amblyopia, like chloral.

Like chloral.

Like chloral.

Cocaine...................

Anaphrodisia, collapse, diarrhea, constipation, nausea, fever, amenorrhea, tenesmus.

Vertigo, ataxia, hyperesthesia, delirium, insanity.

Like opium.

Like opium.

Icterus, strangury, dysuria, polyuria.

Codeine....................

See Opium.

Conium....................

Nausea, vomiting, bradycardia.

Ataxia, stupor, hyperesthesia.

Amblyopia.

Erythema.

Dysuria, polyuria.

Digitalis...................

Cardiac failure, dyspnea, dysphagia, nausea.

Headache, vertigo, stupor, insanity, ataxia.

Amblyopia.

Erythema.

Dysuria, polyuria, strangury, glycosuria.

Duboisine.....................

See Belladonna.

Ergot........................

Nausea, vomiting, gas-tralgia, bradycardia, fever, cyanosis.

Convulsions, vertigo, ataxia, hyperesthesia, delirium, insanity.

Amblyopia, tinnitus, photophobia.

Erythema, papules, urticaria.

Icterus,glycosuria, strangury.

Ether........................

Pallor, cyanosis.

Vertigo, delirium.

Salivation, laryngismus stridulus, amblyopia, tinnitus:

Erythema, urticaria.

Icterus, glycosuria.

Exalgin.....................

Like acetanilid.

Like acetanilid.

Like acetanilid.

Like acetanilid.

Like acetanilid.

Gelsemium ..................

Dyspnea, coryza.

Vertigo.

Amblyopia.

Erythema.

Strangury, icterus.

Glonoin....................

Dyspnea, coryza.

Vertigo, ataxia, analgesia.

Amblyopia.

Erythema.

Strangury glycosuria.

Holocaine...............

Like phenacetin.

Like phenacetin.

Like phenacetin.

Like phenacetin.

Like phenacetin.

Homatropine............

Like belladonna.

Like belladonna.

Like belladonna.

Like belladonna.

Like belladonna.

Hydracetin ............. (like antipyrin).

Fever, nausea, cardiac irritability, dyspnea, nausea.

Vertigo, delirium, ataxia, numbness.

Pupil immobility, amblyopia, conjunctivitis, throat irritability.

Erythema, purpura.

Hematuria.

Hyoscyamus, Hyoscyamine,............ Hyoscine,

Like belladonna.

Like belladonna.

Like belladonna.

Erythema, papules, and pustules.

Icterus, bladder irritability.

Kryofine................

Dyspnea, coryza, hyper-idrosis.

Like hydracetin, except as to delirium.

Amblyopia.

Erythema.

Polyuria, dysuria.

Methylal...................

Like kryofine.

Like hydracetin, stupor.

Diplopia, amblyopia.

Erythema, urticaria.

Polyuria, bladder irritability.

Methacetin ............

(like acetanilid). Monobromacetanilid

Fever, syncope, hyper-idrosis, cyanosis.

Vertigo, stupor, headache, numbness, hyperesthesia.

Amblyopia.

Erythema.

Like methylal.

Musk..........................

Nausea, aphrodisia, fever.

Like monobromacetanilid.

Throat irritability, amblyopia.

Erythema.

Dysuria.

Opium, Morphine, ............... Codeine,

Nausea, diarrhea, gas-tralgia, dyspnea, aphrodisia, fever, hy-peridrosis.

Vertigo, stupor, convulsions, insanity, headache, paresthesia.

Throat irritability, amblyopia, yellow vision, accommodation spasm.

Erythema, vesicles, papules, purpura, pruritus, urticaria.

Dysuria, glycosuria, icterus.

Paraldehyde...........

Like alcohol.

Like alcohol.

Like alcohol.

Like alcohol.

Like alcohol.

Pental.....................

Like ether.

Like ether.

Like ether.

Like ether.

Like ether.

Phenacetin...............

Fever, collapse, dyspnea, hyperidrosis, cyanosis.

Vertigo, ataxia, stupor, hyperesthesia.

Amblyopia, tinnitus, diplopia.

Erythema, urticaria.

Dysuria, glycosuria, icterus.

Phenocol ..............

Like phenacetin.

Like phenacetin.

Like phenacetin.

Like phenacetin.

Like phenacetin.

Physostigma..........

Nausea, gastralgia, vomiting.

Vertigo, mastalgia, delirium, ataxia.

Tinnitus, amblyopia.

Pruritus, erythema, urticaria.

Dysuria, icterus.

Phytolacca..........

Like physostigma.

Like physostigma.

Like physostigmin.

Like physostigmin.

Dysuria.

Pulsatilla............

Coryza, dyspnea, cardiac irritability.

Orchialgia, mastalgia.

Amplyopia, eye-pain, tinnitus.

Erythema.

Dysuria, polyuria.

Scopolamine........

Like belladonna.

Like belladonna.

Like belladonna.

Like belladonna.

Like belladonna.

Stramonium........

Like belladonna.

Like belladonna.

Like belladonna.

Like belladonna.

Like belladonna.

Sulphonal..............

Like alcohol.

Like alcohol.

Like alcohol.

Like alcohol.

Like hematoporphynuria

Tetronal, Trional, .............

Like sulphonal.

Like sulphonal.

Like sulphonal.

Like sulphonal.

Like sulphonal.

Table II. (Continued).

General. Lungs and Heart.

Brain and Cord.

Eye, Ear, and Throat.

Skin.

Liver, Kidneys, and Bladder.

Valerian.................

Nausea, diarrhea, aphro-disia, enteralgia, gas-tralgia.

Paresthesia, vertigo, delirium.

Throat constriction, tinnitus, amblyopia.

Pruritus, erythema, papules.

Dysuria, polyuria.

Veratutm................

(like aconite).

Collapse, dyspnea, cardiac pain, enteralgia, gastralgia.

Paresthesia, hyperesthesia, vertigo, convulsions, delirium.

Xerostoma, amblyopia.

Pruritus, petechiae.

Dysuria.

Table III.

General. Lungs and Heart.

Brain and Cord.

Eye, Ear, and Throat.

Skin.

Liver, Kidneys, and Bladder.

Aloes..................

Vomiting, tenesmus.

Ataxia, vertigo.

Amblyopia.

Erythema, urticaria.

Hematuria.

Ammonium Chloride

Nausea, diarrhea.

Ataxia, vertigo.

Amblyopia.

Erythema.

Polyuria.

Buckthorn.............

Fever, diarrhea.

Ataxia, vertigo.

Amblyopia, tinnitus.

Erythema.

Icterus, polyuria.

Cascara..................

Like buckthorn.

Like buckthorn.

Like buckthorn.

Like buckthorn.

Like buckthorn.

Castor Oil.....

Vomiting, fever.

Like buckthorn.

Like buckthorn.

Like buckthorn.

Icterus.

Colocynth..............

Like castor oil.

Like buckthorn.

Like buckthorn.

Pruritus, erythema.

Icterus.

Copaiba.................

Fever, dyspnea, gastral-gia, nausea, aphro-disia.

Vertigo, ataxia, spastic palsy.

Amblyopia, photophobia, conjunctivitis, pharyngitis, tinnitus.

Roseola, urticaria, erythema, pruritus, penis ulcers.

Cystitis, nephritis, dysu-ria.

Croton Oil .............

Nausea.

Vertigo.

Amblyopia, conjunctivitis.

Erythema.

Icterus, cystitis, nephritis.

Cubebs .....

See Copaiba.

Elaterium .................

See Colocynth.

See Colocynth.

Gamboge.....

See Colocynth.

Gratiola......................

Aphrodisia, vomiting.

See Colocynth.

Ipecac....................

Diarrhea.

Vertigo.

Amblyopia, tinnitus, salivation.

Pruritus, erythema.

Dysuria.

Iris.......................

See Colocynth.

Jaborandi............

Nausea, collapse, fever, lung edema.

Vertigo, ataxia, penis-tip pain.

Amblyopia, tinnitus.

Erythema, pruritus.

Icterus, dysuria, polyuria.

Jalp.....................

See Colocynth.

Male Fern..............

Nausea, fever.

Vertigo, ataxia.

Amblyopia, tinnitus.

Erythema, roseola.

Dysuria, cystalgia.

Podophyllum............

See Colocynth.

Pomegranate............

Nausea, diarrhea.

Vertigo, ataxia.

Amblyopia, tinnitus.

Erythema.

Polyuria.

Pot. Chlorate.............

Nausea, diarrhea, fever.

Vertigo, delirium,ataxia.

Amblyopia, coryza, epis-taxis.

Roseola, erythema.

Nephritis, icterus, cystitis, dysuria.

Rhubarb...............

Nausea, vomiting, constipation, penis hemorrhage.

Vertigo, ataxia.

Amblyopia, coryza, tinnitus.

Roseola, macules, erythema, urticaria.

Hematuria, dysuria.

Rhus...................

Nausea.

Vertigo, delirium,ataxia.

Amblyopia, deafness, tinnitus.

Macules, erythema.

Dysuria, cystitis.

Santonin...............

Nausea, diarrhea, gas-tralgia, amenorrhea.

Vertigo, ataxia, insanity, delirium.

Amblyopia, photophobia, yellow vision, tinnitus.

Erythema, urticaria.

Icterus, dysuria.

Senega.................

Nausea, diarrhea, gas-tralgia.

Vertigo.

Amblyopia.

Erythema.

Dysuria.

Squills...................

Like senega.

Like senega.

Xerostoma, amblyopia, coryza, tinnitus.

Erythema.

Dysuria, hematuria.

Tartar Emetic............ (antimony).

Nausea, cyanosis, collapse.

Vertigo.

Amblyopia, conjunctivitis.

Roseola, papules.

Nephritis, cystitis, dysuria.