Antimonium

Antimony

Antimony. Antimoine, Ft.; Antimon, Ger.

Antimonii et Potassii Tartras

Antimony and potassium tartrate. Tartar-emetic. In transparent crystals which become white and opaque on exposure to the air. It is wholly soluble in twenty parts of water. The solution yields no precipitate with chloride of barium, or, if very dilute, with nitrate of silver. Hydrosulphuric acid causes an orange-red precipitate. A solution containing one part in forty of water is not disturbed by an equal volume of a solution of eight parts of acetate of lead in thirty-two of water and fifteen of acetic acid. Dose, gr. -1/12—gr. ij.

Vinum Antimonii

Wine of antimony. (Tartrate of antimony and potassium, 4 grm.; boiling distilled water, 65 c. c.; alcohol, 150 c. c, and white wine, q. s. to make 1,000 c. c.) Nearly two grains to the ounce. Dose, τη v— 3 ij.

Mistura Glycyrrhizae Composita

Compound glycyrrhiza mixture. (Brown mixture. Contains extract of glycyrrhiza, paregoric, nitrous ether, and wine of antimony.) Dose, a tea- to a tablespoonful.

Syrupus Scillae Compositus

Compound sirup of squill. Hive-sirup. (Squill, seneka, tartar-emetic. Contains about three fourths of a grain of tartar-emetic to the ounce.) Dose, τη v— 3 j.

Antimonii Oxidum

Antimony oxide. A grayish-white powder, insoluble in water, but readily and wholly soluble in muriatic or tartaric acid. Dose, gr. j—gr. iij.

Antimonii Sulphidum Purificatum

Purified antimony sulphide. A dark-gray powder, odorless and tasteless, and insoluble in water or alcohol. Dose, gr. 1/4—gr. j.

Antimonii Sulphuratum

Sulphurated antimony is a reddish-brown powder, insoluble in water. Dose, gr. j—gr. v.

Pilulae Antimonii Compositae

Compound pills of antimony. Plummer's pills. They are composed of sulphurated antimony, calomel, and guaiac, and each pill contains a little more than a half-grain of calomel. Besides the utility of the combination, the name is convenient when prejudices exist against the use of the mercurial.

In the remarks which follow, tartar-emetie is the only antimonial preparation referred to, unless otherwise stated. None of the other preparations are employed by modern physicians.

Antagonists and Incompatibles

Tannic and gallic acids, and vegetable infusions containing them, form an insoluble tannate, and are therefore incompatible. Alkalies and the salts of lead decompose tartar-emetic. It follows that the proper antidotes to poisoning by tartar-emetic are tannic acid and substances containing it. Opium, alcohol, ether, etc., and the antispasmodics generally, are physiologically antagonistic.

Synergists

The mineral substances of this group promote the action of the antimonials; also the emetics and cathartics, and depressing remedies generally, as veratrum viride, etc.

Physiological Actions

Tartar-emetic has a sweetish, styptic, and metallic taste. In small medicinal doses, it excites a sensation of warmth in the stomach, followed by nausea, increased flow of saliva and buccal mucus, an abundant secretion of the gastric and intestinal glandular apparatus, and also of the liver and pancreas. In somewhat larger doses—a half-grain to one or two grains—it excites vomiting, first of the contents of the stomach, then of gastric mucus, and afterward of mucus and biliary matters. The alvine dejections are more fluid and increased in number, and consist at first of fluidified faeces;. afterward they are made up of a colored liquid, in which there are present biliary matters and some faeces; and, finally, there appears only a colorless or whitish liquid, having flocculi of epithelium floating in it, and bearing a striking resemblance to the "rice-water discharges" of cholera.

The gastro-intestinal symptoms are accompanied by systemic disturbance—paleness of the face, coldness of the surface (sometimes preceded by a very temporary rise of temperature), irregularity and feebleness of the pulse, and great nervous and muscular prostration. When the quantity is sufficient to cause lethal symptoms, they are as follows: epigastric pain, vomiting and purging, shrunken features, cold breath, cyanosis, arrest of the urinary secretion, aphonia, cramps —the assemblage of symptoms belonging to the collapse of cholera.

Tartar-emetic, when used in considerable medicinal doses, sets up an irritation of the fauces followed by aphthous ulcerations, which continue along the aesophagus to the stomach, and are accompanied by salivation and painful deglutition.

Applied to the skin by friction, tartar-emetic excites a follicular inflammation, succeeded by a papule, a vesico-pustule, a surrounding inflammation with indurated base, a central umbilication, and finally desiccation, terminating in a brownish scab. These antimony-pustules are very similar to those of vaccine or variola.

When applied to the skin or injected into the veins, tartar-emetic is absorbed, and manifests a selective action on the gastro-intestinal mucous membrane, causing the same irritant effects as are produced by its stomach administration. It is, therefore, a specific, and not a merely irritant emetic.

Tartar-emetic readily diffuses into the blood. In what form, unless as an albuminate, it exists in the blood, is not understood. It diminishes the number and force of the arterial pulsations, and rapidly lowers the blood-pressure. The pulse may fall from 72 to 40, but, according to Hirtz, rarely is the number reduced more than 6 to 10 per minute. In the healthy subject, the normal temperature, even when a full medicinal dose has been administered, remains unaffected as to the trunk, but it may be reduced in the extremities. In fevers and inflammations, a considerable reduction of temperature may take place, and the same result has been noted in the physiological state when the quantity of tartar-emetic has been sufficient to produce choleriform symptoms.

In man delirium, and in animals paralysis, motor and sensory, but without impairment of muscular contractility, have been observed from lethal doses of tartar-emetic.

Tartar-emetic promotes waste and hastens the elimination of the products of waste—the excretion both of carbonic acid and of urea being greatly increased by it.

The antimonial salts are found in the blood, in the liver, and other viscera, and are excreted by the bile, the milk, the perspiration, and the urine. It is, doubtless, also largely excreted by the intestinal glandular apparatus, as is the case with the metals generally.

If tartar-emetic is administered in small doses, and the quantity be gradually increased, the nauseating effects of the drug may be entirely prevented. When emetic doses even are continued in some subjects, this effect finally ceases, and the drug is borne without producing any gastric symptoms. To this state has been applied the term tolerance, by the contra-stimulant school of practitioners. It must not be lost sight of, that this tolerance, on the part of the stomach, of large doses does not mean an indifference to the action of the remedy, but very serious and profound anatomical alterations may result.

Therapy

Tartar-emetic was, formerly, much more frequently prescribed than at present as an emetic in cases of indigestion characterized by a coated tongue, loaded stomach, and anorexia (l'embarras gastrique). It is sometimes used as an emetic in cases of narcotic poisoning, but sulphate of zinc is preferable. It was formerly used as an emetic in the first stage of typhoid and other fevers, but, notwithstanding this practice is frequently followed by good results, it is now rarely pursued. If emesis is desirable in these cases, a less irritating and depressing emetic should be used.

In oroup tartar-emetic is an efficient emetic, but it must be used with caution, owing to the great depression which it produces, and the fatal result which has occurred in many instances. It is not a suitable remedy for infants and very young children. The compound sirup of squills is a domestic remedy for croup, but the incautious use of this has proved fatal. Tartar-emetic is used in laryngismus stridulus to produce emesis and consequent relaxation of the muscles of the larynx, and in true croup to cause the expulsion of the false membrane. The yellow subsulphate of mercury is safer and quite as effective.

Tartar-emetic is an excellent remedy in the first stage of acute catarrh, nasal, pharyngeal, and bronchial. It is most efficient in the first stage, when the mucous membrane is dry and swollen. It promotes secretion, diminishes fever, induces diaphoresis, and hastens the elimination of inflammatory products. In these cases, from one twentieth to one twelfth of a grain is usually a sufficient quantity, for it is not necessary that nausea be excited. When cough is violent, a little opium may be added to the prescription. Rx Antimonii et potassii tart., gr. ss; morphinae acetat., gr. ss; aquae, oz ij. M. Sig.: A teaspoonful every hour or two. In acute bronchitis, when the cough is dry and hoarse, this agent is useful, and small doses (one sixteenth of a grain), frequently repeated, are more serviceable than large doses at longer intervals.

Formerly, under the influence of the contra-stimulant school, tartar-emetic was given in large doses in pneumonia. It was sought to establish tolerance at an early period, and to administer the largest doses which could be borne. The comparative results of this method of treatment and of the expectant and restorative plans demonstrate the impropriety of the tartar-emetic treatment, and it is now abandoned. It is true that small doses of tartar-emetic, by increasing the action of the skin, kidneys, and intestinal canal, may exert a favorable influence over the temperature and diminish the plasticity of the exudation; but even small doses must be employed with care, lest a depression should be induced which may interfere seriously in the natural course of a disease which is self-limited and has its period of crisis.

Tartar-emetic gives great relief in spasmodic asthma when the bronchial secretion is deficient, and in those cases brought on by an overloaded stomach. In the former case small doses frequently repeated until very slight nausea is produced, and in the latter emetic doses, are necessary. The following is a useful form of expectorant in the acute inflammatory affections of the air-passages: Rx Antimonii et potassii tart., gr. j; ammonii muriat., Эiv; ext. glycyrrhizae, Эj; morphinae muriat., gr. j; syrup, tolutan., aquae lauro-cerasi, āā oz j. M. Sig.: A teaspoonful every two, three, or four hours.

The ointment of tartar-emetic was formerly much employed to produce pustulation of the chest in the more chronic pulmonary diseases. This painful and disfiguring form of counter-irritation has passed out of use. To produce a crop of variolas-like pustules on the skin does not cause a morbid process like caseous pneumonia or tuberculosis to cease its ravages; on the contrary, such extensive suppuration in the skin rather favors the development of these diseases.

A combination of tartar-emetic and opium is a serviceable hypnotic in some cerebral disorders. These remedies appear to be most useful when wakefulness and delirium are due to cerebral congestion, and in those subjects who become excited and wakeful from the use of opium alone. In the active delirium and wakefulness of typhoid fever, tartar-emetic and opium are prescribed: Rx Antimonii et potassii tart., gr. j—grs. ij; morphinae sulph., gr. jss; aquae lauro-cerasi, oz j. M. Sig.: A teaspoonful every two, three, or four hours. In delirium tremens, when the same conditions exist, the same combination may be prescribed. Since the introduction of chloral and bromide of potassium, however, the use of these drugs for the purposes just indicated has been much restricted.

In acute inflammatory and febrile diseases, minute doses of tartar-emetic (gr. 1/16), frequently repeated, render an incontestable service. Typhoid, typho-malarial, and remittent fevers, acute rheumatism erysipelas, etc., are maladies thus benefited. This remedy is, of course, contraindicated when there is much irritability of the stomach and intestinal canal. At the outset of fevers it was formerly the custom to prescribe an active emetic, and good results certainly followed this practice. The author believes that he has frequently seen impending attacks of malarial fever aborted by emetic doses of antimony and ipecac. Free emeto-catharsis moderates the severity of remittent fever in robust subjects when produced in the incipiency of this disease, and also puts the mucous membrane in a better state for the disposition of medicines and food.

Before the days of anaesthesia tartar-emetic was much used to relax the muscular system for the reduction of dislocations, to facilitate the taxis in strangulated hernia, to relax rigid os and perineum in labor, etc., but it is now no longer employed for these purposes.

Authorities referred to:

Gubler, Dr. A. Commentiaires Thérapeutiques du Codex Medicamentarius, p. 624, et seq.

Hermann, Dr. L. Lehrbuch der experimentellen Toxicologie, p. 218, Antimonsalze.

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, p. 218, et seq., Antimon-Priiparate.

Radziejewskt, Dr. S. Schmidts Jahrbucher der gesammten Medicin, vol. cliii, p. 10, Zur Wirkung des Antimon.

Taylor, Dr. A. S. On Poisons, American edition, p. 476.

Trousseau et Pidoux. Traité de Thérapeutique et de Matiére Médicale, edition by Paul, huitiéme édition, vol. ii, p. 951.