Part 4

The _dose_ of the _Tincture of Nux Vomica_ (Tinctura Nucis Vomicæ) is from 5 to 20 minims (0.3-1.2 c.c.); of the _Extract of Nux Vomica_ (Extractum Nucis Vomicæ), ⅙ to ¼ grain (0.01-0.016 gm.); of _Strychnin Sulphate_ (Strychninæ Sulphas), ¹/₆₀ to ¹/₂₀ of a grain (0.001-0.003 gm.).

=Opium.=—This is the dried juice of a species of poppy growing in Asia. It contains several alkaloids, the chief of which are _morphin_ and _codein_. From morphin are prepared artificially two alkaloids—_apomorphin_ and _heroin_.

Opium depresses the brain, depresses the respiration, stimulates the heart slightly, lessens the peristaltic movements of the bowel, and diminishes all secretions, except the sweat. It is employed to induce sleep, to relieve pain, to allay cough, to check diarrhea, and to promote perspiration.

_Opium-poisoning_ is marked by three stages: the _first_ stage is short and characterized by mental exhilaration; in the _second_ stage the pupils are greatly contracted (pin-point), the respirations are slow, the pulse is slow and full, and there is deep stupor. In the _third_ stage the patient can no longer be aroused (coma), the respiration becomes shallow and irregular, the pulse becomes rapid and weak, the pupils finally dilate, and the patient dies from failure of the respiration.

Even after small doses of opium many patients suffer from headache and nausea. Children are much more sensitive to its action than adults. Morphin resembles opium in action, but is more powerful, less nauseating, and less constipating. Codein is less powerful as a hypnotic and less depressing than morphin.

The _dose_ of _opium_ is from ½ to 1 grain (0.03-0.65 gm.); of the _Extract of Opium_ (Extractum Opii), ⅛ to ½ grain (0.008-0.03 gm.); of the _Tincture of Opium_ or _Laudanum_ (Tinctura Opii), 10 to 20 minims (0.6-1.2 c.c.); of the _Camphorated Tincture of Opium_ or _Paregoric_ (Tinctura Opii Camphorata), ½ to 4 drams (2-15 c.c.); of _Dover’s Powder_ (Pulvis Ipecacuanhæ et opii), 5 to 10 grains (0.3-0.6 gm.); of _morphin_ and its salts (sulphate, hydrochlorate, etc.), ⅛ to ½ grain (0.008-0.03 gm.), and of _codein_, ½ to 1 grain (0.03-0.06 gm.).

_Heroin_ is chiefly used to allay cough. The _dose_ is from ¹/₁₂ to ⅛ of a grain (0.005-0.008 gm.).

_Apomorphin_ is employed as an emetic and as an expectorant in bronchitis. The _dose_ as an emetic is from ⅒ to ⅙ of a grain (0.006-0.01 gm.), always hypodermically; the _dose_ as an expectorant is from ¹/₂₀ to ¹/₁₀of a grain (0.003-0.006 gm.), always by the mouth.

=Paraldehyd.=—This is an oily liquid, having a peculiar unpleasant odor and taste. It is used chiefly as a hypnotic. While comparatively safe and reliable, its disagreeable taste and persistent odor on the breath detract from its usefulness. The _dose_ is from ½ to 1 dram (2-4 c.c.), in some pleasant vehicle.

=Phenacetin.=—This anilin derivative has properties very similar to those of acetanilid, and is used for the same purposes. _Dose_, 5 to 10 grains (0.3-0.6 gm.).

=Physostigma.=—This is the seed of a climbing plant growing in Africa. Its activities depend upon an alkaloid known as _eserin_ or _physostigmin_. It depresses the spinal cord, stimulates the peristaltic movements of the bowel, and, when applied to the eye, contracts the pupil. It is employed to check certain convulsions (tetanus and strychnin-poisoning), to overcome atonic constipation, and, locally, to contract the pupils.

The _dose_ of the _Tincture of Physostigma_ (Tinctura Physostigmatis) is from 5 to 20 minims (0.3-1.2 c.c.); of the _Extract of Physostigmatis_ (Extractum Physostigmatis), ¹/₁₂ to ⅙ of a grain (0.005-0.01 gm.); of _eserin_ or _physostigmin_ and its salts, ¹/₁₅₀ to ¹/₅₀ of a grain (0.0004-0.0013 gm.).

=Pilocarpus=, or =Jaborandi=.—This is the leaves of a South American plant. Its virtues depend entirely upon an alkaloid known as _pilocarpin_. The chief action of the drug is on the secretions—sweat, saliva, and urine—which it markedly increases. Large doses depress the circulation. Locally, in the eye, it contracts the pupil like eserin. It is mainly employed internally as a diaphoretic in Bright’s disease and dropsical conditions. The _dose_ of the _Fluid Extract_ (Extractum Pilocarpi Fluidum) is from 20 to 60 minims (1.5-4 c.c.); of _pilocarpin_ and its salts, ⅛ to ½ grain (0.008-0.03 gm.). The latter are usually administered hypodermically.

=Quinin.=—See _Cinchona_.

=Salicylates.=—These salts are employed in medicine chiefly as antirheumatic remedies. Their manner of action, however, is unknown. They are also used, both internally and externally, to some extent as antiseptics. Large doses cause ringing in the ears, headache, deafness, nausea, and a greenish discoloration of the urine.

The _dose_ of _salicylic acid_ or its salts (ammonium, sodium, strontium) is from 5 to 20 grains (0.3-1.3 gm.); of _Oil of Gaultheria_ (Methyl Salicylate), 5 to 20 minims (0.3-1.2 c.c.). These preparations should be given after meals, well diluted.

The following remedies have properties like the salicylates, but are less powerful and less irritant to the stomach: _Salol_, _dose_, 5 to 20 grains (0.3-1.3 gm.); _salophen_, 5 to 30 grains (0.3-2 gm.); _aspirin_, 5 to 20 grains (0.3-1.3 gm.).

=Senna.=—This is a purgative cholagogue and is used in the constipation of children and pregnant women. _Dose_, in substance, 5 to 20 grains; in fluidextract or tincture, 1 to 4 fluidrams.

=Silver.=—The most important salt of this metal is the _nitrate_. Locally, in concentrated form, the latter is a caustic; in dilute form it is a sedative, astringent, and antiseptic. Internally, in small doses, silver nitrate is useful as an astringent and antiseptic in inflammatory and ulcerative conditions of the stomach and bowel.

The prolonged use of the drug, even in small doses, is followed by a permanent grayish discoloration of the skin (argyria) from the precipitation of the metal in the tissues.

Toxic doses of silver nitrate cause burning pain in the abdomen, vomiting of white, curdy matter, and bloody purging.

The _dose_ of silver nitrate is from ⅙ to ½ of a grain (0.01-0.3 gm.), usually in pill form.

Several combinations of metallic silver with albumin are much used as antiseptics and astringents in inflammatory diseases of mucous membranes. They have advantage over silver nitrate in being less irritating and in not being decomposed by the juices of the tissues. The most important of these organic compounds are _protargol_ and _argyrol_. They are usually applied in solutions of from 1 to 10 per cent. A soluble form of metallic silver is also employed in the form of 15 per cent. ointment, known as _Credé’s ointment_. It is recommended as an antiseptic in various infectious diseases.

=Spartein.=—This is an alkaloid from the broom plant. It is used to some extent as a heart tonic and diuretic in _doses_ of from ¼ to ½ grain (0.015-0.03 gm.).

=Strophanthus.=—This is the seed of a climbing plant growing in Africa. Its action very closely resembles that of digitalis, for which it is sometimes substituted. The _dose_ of the _tincture_ (Tinctura Strophanthi) is from 3 to 10 minims (0.2-0.6 c.c.).

=Sulphonal.=—This artificial compound is used almost entirely as a hypnotic. In single doses it is comparatively safe and reliable, but slow in its action. Languor, headache, and drowsiness not infrequently follow its use. The repeated administration of sulphonal over several days or weeks is distinctly dangerous, being often followed by chronic poisoning. The latter is marked by a red coloration of the urine, colicky pains, profound depression, weakness, and collapse.

The _dose_ of sulphonal is from 10 to 30 grains (0.6-2 gm.). It is best given in hot tea or hot milk, one or two hours before bedtime.

=Tannic Acid, Tannin.=—This is employed externally as an astringent and styptic, and internally as an astringent in atonic diarrheas. It is used in the form of a gargle or in troches in relaxed conditions of the throat, in solution to prevent bed-sores, and in the form of ointment or suppositories for the relief of internal piles. _Dose_, 1 to 10 grains.

=Trional.=—This remedy resembles sulphonal in action, and is used for the same purpose. It may also be given in the same _dose_ and manner as sulphonal.

=Urotropin.=—This compound, prepared by the action of ammonia on formaldehyd, is employed as a powerful urinary antiseptic in _doses_ of from 3 to 5 grains (0.2-0.3 gm.). Large doses may cause pain in the bladder, frequent urination, and bloody urine.

=Veratrum Viride.=—This is the root of a North American herb. Its action resembles that of aconite in that it depresses the heart and slows the pulse. It is, however, more nauseating than aconite, and when locally applied does not cause numbness, tingling, and anesthesia. Large doses cause vomiting, muscular weakness, dizziness, sweating, failure of pulse, and collapse. It is used as a sedative in acute inflammatory diseases to subdue overaction of the heart.

The _dose_ of the _tincture of veratrum viride_ (tinctura veratri viridis) is from 1 to 5 minims (0.06-0.3 c.c.).

DOSAGE.

The following general rules will aid the student in remembering the safe dose of many important preparations:

1. Tinctures of very active drugs, such as opium, digitalis, belladonna, physostigma, nux vomica, gelsemium, arnica, and capsicum may be given in _doses_ of from 5 to 20 minims (0.3-1.2 c.c.), except the _tinctures of aconite_, _veratrum viride_, _iodin_, and _cantharides_, the _dose_ of which is from 1 to 5 minims (0.06-0.3 c.c.).

2. Tincture of less active drugs, such as gentian, calumba, krameria, quassia, valerian, cinchona, kino, may be given in _doses_ of from ½ to 1 dram (2-4 c.c.).

3. Solid extracts of active drugs may be given in _doses_ of from ⅙ to ¼ of a grain (0.01-0.016 gm.).

4. Solid extracts of less active drugs may be given in _doses_ of from ½ to 5 grains (0.03-0.3 gm.) or more.

5. Dilute acids (hydrochloric, nitric, nitrohydrochloric, sulphuric) may be given in _doses_ of from 5 to 20 minims (0.3-1.3 c.c.), except _dilute hydrocyanic acid_, the _dose_ of which is from 1 to 5 minims (0.06-0.3 c.c.).

6. All medicated syrups, except the _syrup of iodid of iron_ and the _compound syrup of squill_, may be given in _doses_ of 1 to 2 drams (4-8 c.c.) or more.

7. All infusions may be given in _doses_ of ½ to 1 ounce (15-30 c.c.) or more, except the _infusion of digitalis_, the _dose_ of which is from 1 to 4 drams (4-15 c.c.).

8. All official mixtures may be given in _doses_ of from 1 to 4 drams (4-15 c.c.).

9. All spirits may be given in _doses_ up to 1 dram (4 c.c.), except the _spirit of nitroglycerin_ (glonoin), the _dose_ of which is from 1 to 5 minims (0.06-0.3 c.c.), the _spirit of phosphorus_, the _dose_ of which is from 5 to 15 minims (0.3-1 c.c.), and the _spirit of bitter almond_, the _dose_ of which is from 5 to 10 minims (0.3-0.6 c.c.).

10. All _waters_ (aquæ) may be given in _doses_ up to 1 ounce (30 c.c.), except _aqua ammoniæ_, _aqua chlori_, and _aqua laurocerasi_ (cherry-laurel), the _dose_ of which is about ½ dram (2 c.c.).

11. Volatile or essential oils may be given in _doses_ up to 5 minims (0.3 c.c.) or more, except the _oil of bitter almond_, the _dose_ of which is from ¼ to ½ minim (0.015-0.03 c.c.).

TO ASCERTAIN DOSES OF MEDICINE FOR CHILDREN.

The following rule of Young is sufficiently accurate for most drugs: Add 12 to the age and divide by the age to get the denominator of the fraction, the numerator of which is 1. Thus, for a child of two years,

2 + 12 ——— = 7, and the dose is ⅐ of that for an adult. 2

For children up to twelve months of age, Young’s rule may be worked out as follows: Add 144 to the age in months, which sum becomes the denominator of the fraction, the numerator of which is the child’s age. Thus, for a baby of eight months,

8 8 ——— = ——, or ¹/₁₉ of an adult’s dose; 8 + 144 152

for a baby of six months,

6 6 ——— = ——, or ¹/₂₅ of an adult’s dose. 6 + 144 150

The following table, based on Young’s rule, is sufficiently accurate in ordinary cases, and its use will avoid the necessity of mathematic calculations on the part of the physician:

Child aged one month ¹/₁₄₅ of an adult’s dose. “ “ two months ¹/₇₃ “ “ “ “ “ three months ¹/₄₉ “ “ “ “ “ four months ¹/₃₇ “ “ “ “ “ five months ¹/₃₀ “ “ “ “ “ six months ¹/₂₅ “ “ “ “ “ seven months ¹/₂₂ “ “ “ “ “ eight months ¹/₁₉ “ “ “ “ “ nine months ¹/₁₇ “ “ “ “ “ ten months ¹/₁₅ “ “ “ “ “ eleven months ¹/₁₄ “ “ “ “ “ twelve months ¹/₁₃ “ “ “ “ “ two years ¹/₇ “ “ “ “ “ three years ¹/₅ “ “ “ “ “ four years ¹/₄ “ “ “ “ “ five years ⁵/₁₇ “ “ “ “ “ six years ¹/₃ “ “ “ “ “ seven years ⁷/₁₉ “ “ “ “ “ eight years ²/₃ “ “ “ “ “ nine years ³/₇ “ “ “ “ “ ten years ⁵/₁₁ “ “ “ “ “ eleven years ¹/₂ “ “ “ “ “ twelve years ¹/₂ “ “ “

Of powerful narcotics, such as opium, scarcely more than one-half of this proportion should be used. In the case of mild cathartics, however, two or even three times this proportion may be given.

THE DOSE OF DRUGS ADMINISTERED SUBCUTANEOUSLY AND BY THE RECTUM.

The dose of a drug given _hypodermically_ is usually about one-half the quantity given by the mouth, while _twice_ as large a dose is generally given by the _rectum_ as would be given by the mouth.

PROPER TIME TO TAKE MEDICINES.

Alkalis should be given before food. Iodin and iodids should be given on an empty stomach, when they rapidly diffuse into the blood. If given during digestion the acids and starch alter and weaken the digestion. Acids, as a rule, should be given between the digestive acts, because the mucous membrane of the stomach is in a favorable condition for the diffusion of the acids into the blood. Acids may be given before food when prescribed to check the excessive formation of the acids of the gastric juice. By giving it before meals you check the osmosis stomachward of the acid-forming materials. Irritating and dangerous drugs should be given directly after food, such as the salts of arsenic, copper, zinc, and iron, except where local conditions require their administration in small doses before food. Oxid and nitrate of silver should be given after process of digestion is ended; if given during food, chemic reactions destroy or impair their special attributes and defeat the object for which they were prescribed. Metallic salts, especially corrosive sublimate, also tannin and pure alcohol, impair the digestive power of the active principle of the gastric juice, so should appear in the stomach during its period of inactivity. Malt extracts, cod-liver oil, phosphates, etc., should be given with or directly after food, so that they may enter the blood with the products of digestion.

POISONS AND ANTIDOTES.

=General Treatment.=—Eliminate if possible by emetics, as zinc sulphate, 10 to 20 grains; copper sulphate, 5 grains; or hypodermic injection of apomorphin, ⅒ grain. Use stomach-pump or -tube where vomiting cannot be produced, observing great care if irritant poison has caused injury to tissues. In cardiac failure give stimulants. In narcosis keep patient awake. In threatened paralysis of respiratory movements use alternate hot and cold spray to chest, slapping, and artificial respiration. Ammonia, atropin, caffein, and strychnin are useful respiratory stimulants.

=Acetanilid.=—Emetic; rest in recumbent position; stimulants—ammonia and strychnin; artificial respiration; oxygen inhalations; external heat.

=Acid, Carbolic.=—Alcohol or Epsom salt as an antidote. Three or four ounces of diluted alcohol, followed by lavage with a solution of Epsom salt; external heat; demulcents; stimulants hypodermically.

=Acid, Hydrocyanic.=—Fresh air; artificial respiration; oxygen inhalations; ammonia by inhalation and by intravenous injection.

=Acid, Oxalic.=—Chalk or lime as an antidote; demulcents, like oil or egg-albumin.

=Acids, Mineral.=—Chalk, magnesia, soap, or white-wash from wall to neutralize poison; demulcent drinks—bland oils or egg-white; stimulants hypodermically.

=Aconite.=—Recumbent position; empty stomach with pump with patient flat on back; external heat; stimulants—alcohol, ammonia, strychnin—hypodermically.

=Ammonia.=—Vinegar with lemon-juice to neutralize the poison; white of egg or oil to allay irritation.

=Anilin Dyes.=—Give plenty of warm water to induce emesis; place patient in recumbent position; loosen clothing and permit free circulation of fresh air.

=Antimony (Tartar Emetic).=—Tannic acid as an antidote; use stomach-pump; external heat; stimulants.

=Antipyrin.=—Same as Acetanilid.

=Arsenic.=—Stomach-pump or an emetic; freshly precipitated ferric hydrate (tablespoonful every ten minutes) made by adding magnesia to any iron solution; demulcents—oil or egg-albumin.

=Atropin.=—Same as Belladonna.

=Belladonna.=—Emetic or stomach-pump; tannic acid as an antidote; cold to head; enema of warm black coffee.

=Camphor.=—Empty the stomach; apply a hot-water bag to the abdomen, and stimulate the patient if necessary.

=Cantharides.=—Emetic or stomach-pump; egg-white; mucilaginous drinks in abundance; _avoid all oily substances_.

=Chloroform.=—Withdrawal of drug; lowering of head; pulling tongue forward; artificial respiration; stimulants—strychnin, digitalis, ammonia.

=Cocain.=—Empty the stomach by means of the stomach-pump or an emetic. Stimulate patient and administer artificial respiration.

=Colchicum.=—Stomach-pump or emetic; external heat; white of egg; stimulants; opium for pain.

=Copper Sulphate.=—Yellow prussiate of potassium, soap, or magnesia; milk and albumin freely; opium for pain.

=Corrosive Sublimate.=—White of egg freely; milk; emetic or stomach-pump; opium for pain.

=Creosote.=—Same as Carbolic acid.

=Croton Oil.=—Emetic; mucilaginous drinks; opium.

=Cyanide of Potassium.=—Same as Hydrocyanic acid.

=Digitalis.=—Recumbent position; stomach-pump with patient recumbent; external heat; tannic acid.

=Elaterium.=—Emetic; external heat; demulcents; opium.

=Ergot.=—Empty stomach; copious drafts of warm water, coffee, or tea; quick purgative (croton oil); place patient in recumbent position; give hot sponge-bath and apply friction to the body.

=Gas, Illuminating.=—Fresh air; artificial respiration; oxygen inhalations; injections of ammonia and strychnin.

=Iodin.=—Starch-paste as an antidote; emetic; external heat; demulcents; opium.

=Lead Salts.=—Epsom salt as antidote; emetic; milk or egg-white.

=Lobelia.=—External heat; tannic acid; stomach-pump; stimulants.

=Matches.=—Same as Phosphorus.

=Morphin.=—Same as Opium.

=Mushroom, poisonous (Toad-stools).=—Emetics; atropin (¹/₁₀₀ gr.) hypodermically; castor oil; stimulants.

=Nux Vomica.=—Same as Strychnin.

=Opium.=—Stomach-pump or emetic; repeated lavage; black coffee enema; potassium permanganate (5 gr.) in tumblerful of water, or tannic acid as an antidote; keep patient awake with cold affusions or electric brush; artificial respiration; respiratory stimulants—atropin, ammonia, strychnin, cocain, caffein.

=Phenacetin.=—Same as Acetanilid.

=Phosphorus.=—Copper sulphate as an emetic; dilute peroxid of hydrogen or potassium permanganate as an antidote; Epsom salt as a purge; _avoid all oils and fatty substances_.

=Potassa or Soda (Lye).=—Vinegar or lemon-juice as an antidote; oils or egg-white; opium.

=Ptomain Poisoning.=—Empty the stomach by means of the stomach-pump or by an emetic. Apply a hot-water bag to the abdomen. Give opium or morphin to allay the pain and check diarrhea. Give a large dose of castor oil.

=Rat Poison.=—This usually contains arsenic or phosphorus (q. v.).

=Silver Nitrate.=—Solution of common salt as antidote; emetic; demulcent drinks. Silver nitrate stains on the skin may be whitened and their removal much expedited by the application of a solution made according to the following formula:

Mercury bichlorid, gr. v; Ammonium chlorid, gr. v; Aqua, ʒij.

=Stramonium.=—Same as Belladonna.

=Strychnin.=—Absolute quiet; if convulsions have begun, do not use stomach-pump unless the patient first be etherized; tannic acid as antidote; inhalations of chloroform or amyl nitrite for convulsions; potassium bromid (ʒj) and chloral (gr. xxx) by mouth or rectum.

=Tobacco.=—Emetic; external heat; stimulants.

ANTIDOTES.

1. =Albumen, Egg-white.=—Dissolve 4 egg-whites in 1 quart of warm water.

2. =Milk, Fatty Oils, Mucilaginous Substances.=—Substitutes for albumen.

3. =Castile Soap.=—Dissolve in plenty of water; substitute for albumen.

4. =Tannic Acid, Coffee, Tea.=—To precipitate various alkaloids.

5. =Vinegar, Diluted Mineral Acids.=—To neutralize alkalies and alkaline salts.

6. =Emetics.=—(1) Zinc sulphate, grs. v-xv, repeated twice if necessary at fifteen-minute intervals, or until emesis is produced. (2) Mustard, ʒj-iv, stirred to a cream with warm water. (3) Ipecac, gr. xv; repeat if necessary in fifteen minutes. (4) Tartar emetic, gr. ½, in sweetened water for children.

_Note._—In all poison cases loosen clothing instantly and permit free circulation of fresh air; protect body with warm blankets; do not use pump or give emetics if acid has been taken in concentrated form; secure necessary drugs so that medication may be given at once upon direction of physician in charge.

MISCELLANEOUS FORMULÆ.

SEMMOLA’S MIXTURE.