This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol2", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
Squill is the bulb of Scilla maritima, an herbaceous perennial plant, sending up numerous leaves from its bulbous root, in the midst of which an erect flower-stem rises, two or three feet high, and in consequence of its affinity for water, squill, unless kept in a dry place, is apt to attract moisture from the air, and thus to become mouldy, and undergo chemical change. From this and other causes, its strength is more or less uncertain, as it is usually found in the shops.
* I am disposed, however, to think, from the recent experience of the profession with the tincture, that the statement in the text should be somewhat qualified, in relation to this preparation. There is no doubt that the tincture has some efficiency; but, considering the very large doses of it which have of late been used with seeming impunity, I think it highly probable that the effects of the active principles of the digitalis are to some extent counteracted by the opposite influence of the alcohol; and that the tincture is less powerful than the other preparations, in relation to the quantity of digitalis they respectively represent. (Note to the third edition.) terminating in a spike of closely set, white flowers. The plant is a native of the countries of Europe and Africa bordering on the Mediterranean. The bulb is as large as the fist, or larger, pear-shaped, and composed of numerous fleshy scales, all fixed to a common base, to the lower surface of which the radicles or root fibres, which descend into the earth, are attached. The scales are compactly arranged around a common centre, one overlapping another; the innermost being very juicy, the outermost dry and membranaceous. Sometimes the recent bulb is imported, though rarely. it will keep for a long time if embedded in dry sand, or otherwise excluded from air and moisture. But the common squill of the shops is prepared from the bulb by removing the outer membranous coatings, then cutting it into several transverse slices, and carefully drying the pieces into which the slices separate. in drying, the bulb is said to lose about four-fifths of its weight. There are two varieties, one white, and the other of a deep reddish-brown colour externally; but there is no essential difference between them.
As commonly kept, squill is in small oblong pieces, thin, flexible when moist, but brittle when quite dry, somewhat translucent, usually of a yellowish-white colour, sometimes of a reddish tinge, with a feeble odour, and a bitter, acrid, nauseous taste. it yields its virtues to water, alcohol, or dilute acetic acid. Vinegar is considered an excellent solvent.
As squill is injured by boiling and by time, its virtues were formerly supposed to be connected with a volatile princi-ple. This seems to have been an error; for water distilled from squill has little or no effect on the animal system. From the most recent investigations by M. Tilloy, as well as from preceding observations, it appears that there are two distinct active principles; one an acrid substance, which is powerfully irritant, may even produce fatal effects, and deteriorates at a high temperature and by time; the other extremely bitter, but not acrid, and supposed by Landerer, who obtained it crystallized, to have alkaline properties. it is to the latter that the name of scillitin belongs. But the subject needs further investigation. Neither of these principles is obtained separate for use.
Squill is locally acrid; in the recent state very much so, inflaming, and even blistering the skin when applied to it; but the acrimony is much diminished by drying, and continues to diminish by time. it remains, in greater or less degree, so long as squill is capable of exercising its remedial influence. This acrid property it carries with it into the stomach, into the circulation when absorbed, and into the emunctories through which it escapes from the system. in small doses, without producing any sensible effect on the stomach, squill or its active matter is absorbed, and operates as an excitant to the secretory function of the kidneys and bronchial mucous membrane. it is, therefore, a diuretic and expectorant. in the latter capacity it will be treated of hereafter. it is only in reference to the diuretic effect that it is to be considered in this place. There can be little doubt that it operates on the kidneys in its efforts to escape from the system; and, when taken very largely, it has been known to bring on inflammation of the urinary passages, with strangury and bloody urine. Dr. Hammond found it not to augment, but rather to lessen the solid matters excreted by the kidneys. (Am. Journ. of Med. Sci., Jan. 1859, p. 271.) in doses somewhat larger than is necessary to produce the diuretic effect, it causes nausea, in still larger acts as an emetic, and in excessive doses may occasion inflammation of the stomach and bowels, with vomiting, hypercatharsis, abdominal pains, convulsions, and death. Twenty-four grains of it have produced fatal effects.
Squill was used by the ancients. it ranks among the most energetic diuretics, being inferior only to digitalis and bitartrate of potassa in efficiency. it is much and very advantageously used in dropsy. in consequence of its irritant property, it is not applicable to cases attended with acute inflammation or fever, and is especially contraindicated by the existence of gastro-enteritis, acute nephritis, or inflammation of the urinary passages. it is, therefore, ill adapted to the form of dropsy, attendant on acute Bright's disease. But, with these exceptions, it may be used in any form of the affection, whether anasar-cous, abdominal, thoracic, or even hydrocephalic. My own experience corresponds with that of the late Professor Chapman, who found squill peculiarly useful in hydrothorax. There is, I think, no remedy more efficacious, in either pleural or pericardial dropsy, associated with a state of chronic inflammation or irritation of the membranes, than a combination of squill and calomel. The mercurial is highly efficient in correcting the inflammation, and at the same time seems to aid the squill in its diuretic action, through which the absorption of the effused liquid is effected. The beneficial effect is sometimes very speedy, and, when no serious organic lesion exists, often complete. Even when there is incurable disease of the heart, the liquid is frequently removed, and great relief obtained. When excessive cardiac action complicates the disease, digitalis may be advantageously associated with the other medicines.
The dose of powdered squill is usually stated at from one to three grains, two or three times a day. As the squill exists in our shops, I have rarely found it, thus administered, to be of any use in dropsy. Tho individual doses are sufficiently large; but the intervals between them are too long. My uniform practice has been to prescribe squill in dropsy in the dose of two grains every two hours, to be continued until it produces its effects. When it is thus given, it will not often be necessary to augment the dose. A long established rule in the exhibition of squill is, if no effect is produced by the first dose, gradually to increase it until nausea is occasioned, and, having ascertained the point at which it produces this symptom, afterwards so to regulate the dose as to approach the point as nearly as possible, without absolutely reaching it. Some have supposed that the nausea itself is useful in promoting diuresis. Cullen was, I think, right in maintaining that it is no otherwise useful than merely as a sign of the activity of the medicine. I am quite sure that squill is capable of acting very energetically as a diuretic without it. Vomiting and purging are to be avoided, as interfering with the absorption of the medicine, and, if produced, whether by the squill, or the calomel which may be exhibited with it, should be restrained by a little opium. When squill and calomel are used simultaneously, it is, I think, best to give them separately, as each requires to be regulated according to its own effects; the squill being increased or diminished according to its influence on the stomach, the calomel to its action on the mouth. The most convenient method of exhibiting squill is in the form of pills. There are several officinal preparations, as the vinegar, syrup, and tincture, which, as they are much more used with a view to their expectorant than their diuretic effect, will be more appropriately described with the expectorants, to which the reader is referred. it is sufficient to mention here that the vinegar and tincture may be given in the dose of half a fluidrachm, and the syrup of a fluidrachm, repeated as the dose of the squill in substance. The syrup is frequently used as a diuretic for children, for whom the dose must be diminished according to the regular rule.
There is a large number of vegetable substances more or less used as diuretics, but none of primary importance, which may be conveniently introduced here, in subordination to the two very powerful medicines of the class, above considered. Most of them are used as adjuvants to more efficient remedies in the treatment of dropsy; and some are not without considerable value in this respect.