Part 135

=DOSE.= In medicine the quantity taken or prescribed at one time. The doses of medicaments vary with the sex, age, temperament, constitutional strength, habituation, and idiosyncrasies of individuals. Different circumstances, especially of climate, exercise an important influence on the activity of medicines. Thus, the inhabitants of England and the northern countries of Europe bear much larger doses in their own climates than when they remove to warmer latitudes. Warmth, indeed, appears to promote the action of most medicaments, whilst cold acts in a contrary way. Nor does the same rule apply to all medicines. Calomel, for instance, is generally borne better by children than by adults; while opium affects them more powerfully, and requires the dose to be diminished considerably below that indicated by mere calculation or analogy with other medicines.

Prescribers ought not to forget that the action of medicines is not simply proportioned to the amount, but that each remedy has a dose below which it either produces no effect or one contrary to that which we desire it to produce. Dr Paris remarks, "that powerful doses are disposed to produce local rather than general effects;" and Dr Barlow gives it as his opinion that "practitioners often err, especially in the treatment of chronic maladies, from requiring an obvious effect from each dose administered." Adult women are said to require only three fourths the full dose for men. The following rules and tables have been framed chiefly with reference to age; but, as Dr R. E. Griffith correctly observes, "no scheme can be devised, founded on age alone, to which there are not many exceptions."

I. _Formula of_ Dr YOUNG.

_For children under 12 years, the doses of most medicines must be diminished in the proportion of the age to the age increased by 12._ Thus, at 2 years, the dose will be 1-7th of that for an adult.

2 for ------------- = 1-7th. 2 + 12

II. _Posological Table of_ GAUBIUS.

For an adult, suppose the dose to be 1, or 1 drachm (60 grains).

Under 1 year will require 1/12 or 5 grains. " 2 years " 1/8 or 8 grains. " 3 " " 1/6 or 10 grains. " 4 " " 1/4 or 15 grains. " 7 " " 1/3 or 1 scruple. " 14 " " 1/2 or 1/2 drachm. " 20 " " 2/3 or 2 scruples. " 21 to 60, the full dose, or 1 or 1 drachm. Above this age an inverse gradation must be observed.

III. _Posological Table of_ PHOEBUS.

Age--_Years_ 80 65 50 25-40 20 16 12 8 5 2 _Doses_ 5/8 3/4 7/8 1 7/8 3/4 5/8 1/2 3/8 1/4

" _Months_ 12 6 2 1 _Doses_ 1/5 1/8 1/15 1/24

=DOUCHE.= [Fr.] _Syn._ DOUCHE BATH. A species of bath much employed by hydropathists, both for the relief of local affections, and to give a healthy stimulus to the whole system. The douche consists of a single jet of cold water, varying in size from the thickness of a quill to that of a man's arm; it is projected with great force, either from above, below, or on one side, upon a particular part of the body. See BATH (Shower).

=DOUGLAS' DISINFECTING POWDER.= A mixture of sulphite of calcium, chalk, and carbolic acid, or of sulphite and carbonate of lime.

=DOVER'S POWDERS.= See POWDER.

=DRAB DYE.= 1. (FOR COTTON.) For 40 lbs. Boil 6 lbs. of fustic; scald 2-1/2 lbs. of Lima wood and 2 lbs. of sumach. Decant into a wooden vessel, capable of containing 100 gallons; reduce with cold water to handling heat; enter, 6 turns; wring out; sadden with 8 ounces of copperas; 4 turns; wring out again, and give 4 ounces of bluestone.

2. (FOR SILK.) For 100 yards. Boil 4 lbs. of fustic and 6 ounces of logwood, 2-1/2 ounces of cudbear, 1-1/4 ounce of copperas. Cool to 200° Fahr.; enter, winch 20 minutes; air out; repeat; then take a little of the liquor out of the boiler, dissolve the copperas, reduce it to handling heat with water, and give one or two shots through it, as the pattern requires; one water out of the saddening; then give a warm but weak sour to clear the colour, wash in two waters, and dry.

3. (FOR WOOL.) _Dark drab._ For 50 lbs. 7 lbs. of fustic, 8 ounces of madder, 4 ounces of cudbear, 2 lbs. of alum, 8 ounces of tartar. Enter between the cold and 160° Fahr.; after heating up boil from 10 to 30 minutes; wash in two waters. All dark shades of this may be slightly prepared with chrome; wash in two waters.

4. (FOR WOOL.) _Light drab._ For 56 lbs. 4 lbs. of fustic, 1-3/4 lb. of alum, 4 ounces of madder, 4 ounces of tartar, 3-1/2 ounces of cudbear. Work as for dark drab.

=DRACONINE.= _Syn._ DRA'CINE, RED RESIN OF DRAGON'S BLOOD. A peculiar vegetable principle discovered by M. Melandre in dragon's blood.

_Prep._ Dragon's blood is dissolved in alcohol, the solution filtered, concentrated, and precipitated with cold water; the red, spongy precipitate is well washed, neutralised with dilute sulphuric acid, again liberated by means of an alkali, and well washed with water.

_Prop., &c._ Draconine has a fine red colour; is tasteless, inodorous, and flexible; it fuses at 131° Fahr. The smallest quantity of carbonate of lime in filtering paper may be detected by sulphate of draconine, the yellow colour instantly turning red.

="DRAGEES AU LACTATE DE FER."= (Gélis & Conté.) 100 grammes of lactate of iron made into 2,000 very small pills with powder and mucilage of marshmallow, and coated with eleosaccharate of anise. (Reveil.)

=DRAGEES DE COPAHU DE FORTIN.= 30 grammes balsam of copaiba made into 72 dragées, with 1·2 grammes calcined magnesia, and coated first with gum arabic and then with sugar. (Reveil.)

=DRAGEES DE CUBEBE AU COPAHU.= Cubebines (Labelonye). 2 parts balsam of copaiba, 2 parts extract of cubebs, 1 part yolk of egg, with sufficient liquorice powder to make a mass, which is divided into oblong pills, each weighing 7 decigrammes. These are dried and coated with white or raw sugar. (Hager.)

=DRAGEES DE POUGUES.= (Garnier.) Chloride of calcium, 50 parts; chloride of magnesium, 50 parts; chloride of iron, 10 parts; dissolved in water and precipitated with sodium carbonate. The precipitate is washed, pressed, and mixed with 100 parts bicarbonate of soda. Of this mixture 25 parts are made into a mass with 475 parts of a paste of sugar, peppermint, oil, and mucilage. The mass is then divided into dragées weighing 5 decigrammes, which are coated with gum and sugar. (Reveil.)

=DRAGON'S BLOOD.= _Syn._ SANGUIS DRACONIS, L. A rich red-coloured resin, obtained from various species of the genus _Calamus_. Its colour, in the lump, is a dark brownish-red; in powder, bright red. It is friable, breaks with a shining fracture, and has a sp. gr. not higher than 1·196 or 1·197. When pure, it readily dissolves in alcohol, ether, and oils, yielding rich red, transparent solutions. Adulterated and factitious dragon's blood is only partly soluble, and lacks the rich colour of the genuine article. Dragon's blood is chiefly used to tinge varnishes and lacquers.

=Dragon's Blood, Factitious.= _Prep._ 1. Shell-lac, 4 lbs.; melt, remove from the fire, and add, Canada balsam, 6 oz., and gum benzoin, 2 oz.; mix well, stir in red sanders wood, 1-1/2 lb., and Venetian red, 3/4 lb. (both in fine powder); and form the mass into sticks.

2. As the last, omitting the red Venetian.

=DRAINS.= The salubrity of a dwelling-house is largely dependent upon the sound condition, the unimpeded outlet from, and the proper construction and position of, its drains, supplemented by like conditions in the various house-pipes which run from the sinks and closets into them.

The sense in which we shall use the term "drain" is that defined by the Public Health Act of 1875:--"'Drain' means any drain of, and used for the drainage of one building only, or premises within the same curtilage, and made merely for the purpose of communicating therefrom with a cesspool or other like receptacle for drainage, or with a sewer into which the drainage of two or more buildings or premises occupied by different persons is conveyed."

There can be no doubt that the almost universal system pursued with regard to house drainage is radically irrational and dangerous. As the drains lead into the main sewer or cesspool it is most important that the house-pipes which communicate with the drains should be so connected with them and arranged, as to remove all risk of the foul air of the sewers passing into them through the drains, and thus (should the pipes be imperfect) escaping into and defiling the atmosphere of the house--a very possible contingency for two reasons, first, because the traps connecting the pipes with the drains may be defective, and, second, because the aspiratory power of the warm house is constantly tending to draw air (the sewer air) through the water in the water trap. Instead of making the connection, as is now so universally done, between the sink and closet and other pipes and the drain, by means of a water trap, _underneath the basement_, this junction should be effected _outside the house_. The drains should, therefore, always terminate outside, and not under the house; and wherever practicable all house-pipes should be carried outside, and not inside, or between the walls of any dwelling, the objections to which have been already stated. In cases, however, in which this arrangement is impossible of execution, and a pipe can only be carried through the house from the front to the rear, it is far better to take it above the basement than underneath.

The interposition of the water in the trap at the point of union between the house-pipe and the drain is not alone sufficient to effect the necessary amount of disconnection between them. There must be thorough ventilation and communication with the outer air at the point of junction, otherwise there is danger that the emanations from the sewer may find their way into the house, as in the former case.

A great number of methods have been devised for disconnecting the house-pipes and the outside drains, the simplest of which consists in placing the trap just outside the house, in opening the drain on the side of the trap the furthest from the house, and in carrying up from it a four-inch pipe to as great a height as is convenient. By this means any noxious gas that might escape from the drain is diverted from the house, and ascends into and diffuses into the superincumbent atmosphere.

In the arrangement of the house-pipes it is desirable not to carry the pipes which convey away the sink water and the waste water into the closet-soil pipes, but, wherever it can be managed, to let them discharge over a grating into the drain trap. Where we have to deal with soil or water-closet pipes, or with a pipe formed by the junction of these with the waste-water pipe (if such an arrangement is unavoidable), it is most important that there should be complete disconnection between the pipe and the drain by means of one of the many ventilating contrivances so well known to sanitary engineers.

The best material for the manufacture of drain pipes is hard, well-burnt, smooth, and glazed earthenware; bricks and porous earthenware are particularly ill adapted for the purpose; so also are iron pipes, unless they are thoroughly cemented inside.

In the laying of drain pipes care should be taken to place them on concrete, in loose soils, and on well-worked puddled clay, in the case of clay soils. When they are laid in very loose soils it is sometimes necessary, besides employing concrete, to additionally use even piling for the depth of a foot. Leakage and consequent soakage of the soil are sure to take place sooner or later if the drain pipes are not laid on a good foundation, as they are when the drains are badly and carelessly joined.

Messrs Brooke, of Huddersfield, have invented a combined drain and subsoil pipe, the latter, on which the drain pipe rests, being perforated, carries off the subsoil water. This contrivance is adapted for wet soils.

When junction pipes are required for uniting the drain pipes those known as "oblique junctions" only should be used. The junctions known as "square junctions" should be avoided, as they are always sure to become blocked up.

With respect to the fall of drain pipes Dr Parkes says, "one in forty-eight is frequently given, or three quarters of an inch in every yard; a fall of one in sixty-five in drains of six inches diameter, and one in eighty-seven in drains of eight inches diameter, will give a velocity of 220 feet per minute.

In order that drain pipes may be properly cleaned it is desirable to have them so made that they can be opened at intervals by means of lids or caps. The following cuts represent a few of the many kinds of pipes adapted for this purpose.

In addition to this method of cleansing them, drain pipes should be regularly flushed out at least once a month. House pipes are usually cleaned out by means of a flexible bamboo, or by jointed rods fitted with screws and rollers, which serve to loosen sediment. A frequent examination of all house pipes and traps should be made, and every joint and bend of the former well looked to. Unfortunately, however, they are so frequently covered in, that this is impossible.

Where it can be done all skirting boards and covers under which the pipes and traps are concealed should be removed. When, however, this cannot be managed the following plan of examination into their condition may be followed:--Pour water down the pipe, and observe if there be any smell; if there be, the pipe is full of foul air, and requires ventilation; or else the trap is defective, and the bad smell is due to sewer gas. Or, instead of pouring down water, a lighted candle or a piece of smouldering brown paper may be held over the entrance of the pipe, or the grating over a trap, when the air will be driven back. If the condition of the pipe be tested by throwing water down it, it should be noticed whether the water runs away at once or whether it is checked in its progress. This is all that, under the circumstances, can be done inside the house; but though an examination of the pipe is precluded inside, it may be possible to remove the earth on the outside, and so to get down to and open the drain with which the pipe communicates. Under these circumstances water mixed with lime should be poured down the house pipe; if the milky-looking water is long in making its appearance, and runs only in driblets, the drain requires flushing; if the milky-looking water is much coloured and mixed with dirt, then the pipes and trap are foul, or there is a sinking or depression in some part of the drain where the water is lodging.

Afterwards a pailful of lime and water should be poured down the pipe, which should be afterwards flushed by pouring water down it until the water flows off nearly clear.

Referring to the construction and position of the pipes which carry off the waste water, soil, &c., from our houses into the drains, Dr Parkes writes--"Builders are always anxious to conceal tubes, and thus carry them inside the walls, or in the case of hollow walls, between the two. The consequence is that any escape of air must be into the house. I have known a case in which the leakage of a closet pipe carried down in a hollow wall constantly contaminated the air of a house. It would be infinitely better to run the pipes at once through the wall to the outside. Few persons have any idea of the carelessness of plumbers' work--of the bad junctions, and of the rapidity with which pipes get out of order and decay. When a leaden pipe carrying water is led into a water-closet discharge pipe, it is frequently simply puttied in, and very soon the dried putty breaks away, and there is a complete leakage of gas into the house. Even if well joined the lead pipe will, it is said, contract and expand, and thus openings are at last formed. Dr Fergus, of Glasgow, has directed particular attention to this in the case of lead closet pipes, which become easily perforated, and which have only a limited duration of wear." See TRAPS, SEWERS.

=DRAUGHT.= _Syn._ HAUSTUS, L. A single dose of liquid medicine, usually dispensed in one-and-a-half-ounce or two-ounce phials. Draughts are almost exclusively extemporaneous compounds, and differ from 'mixtures' only in containing one dose; whereas mixtures contain several. The latter have now very generally superseded draughts among all but the higher classes, when the dose is to be frequently repeated. Draughts possess the advantages of extreme convenience, and, from only one phial being opened at a time, of preserving the preparation better than when it is exposed to the air by the frequent removal of the cork. They are usually taken from a wine-glass, which they about 2/3rds fill.

In the preparation of draughts the same precautions are observed as are pointed out under MIXTURE; regard being had to the increased volume of the dose. The ingredients of a six-ounce mixture, for example, containing (say) 12 doses, may be equally distributed among a dozen draught phials, after which each may be filled up with distilled water, or any other simple vehicle. In most cases a little syrup may be advantageously added. In many instances no addition will be required, the doses of each form of preparation being the same.

The following are useful formulæ, which will serve as examples for others of the class. The number might be easily multiplied, and, indeed, might be extended so as to include 3/4ths of the whole materia medica; but such a plan would lead to useless repetitions, and occupy much space. See MIXTURE, PRESCRIBING, &c.

=Draught, Abernethy's.= See ABERNETHY MEDICINES and MIXTURE.

=Draught, Ace'tate of Ammo''nia.= _Syn._ HAUSTUS AMMONIÆ ACETATIS, L. _Prep._ 1. (St. B. Hosp.) Solution of acetate of ammonia, 4 fl. dr.; water to make 1-1/2 fl. oz.

2. (Dr Paris.) Camphor mixture, 1-1/2 fl. oz.; liquor of acetate of ammonia, 4 fl. dr.; antimonial wine, 20 drops; mix. As a refrigerant and diaphoretic in febrile affections; taken late in the evening.

=Draught, Ac'etate of Potas'sa.= _Syn._ HAUSTUS POTASSÆ ACETATIS, L. _Prep._ (Mid. Hosp.) Acetate of potassa, 30 gr.; bicarbonate of potassa, 20 gr.; peppermint water, 1 fl. oz. Diuretic, antacid, and laxative.

=Draught, Ammoni'acal.= _Syn._ HAUSTUS AMMONIACALIS, H. AMMONIÆ, L. _Prep._ (Brande.) Liquor of ammonia, 20 to 30 drops; compound tincture of cardamoms and tincture of gentian, of each 1/2 fl. dr.; campho-mixture, 1-1/2 fl. oz. An aromatic absorbent and stomachic; in heartburn, acidity, low spirits, &c.

=Draught, An'odyne.= _Syn._ HAUSTUS ANODYNUS, L. _Prep._ 1. Tincture of opium, 15 drops; pimento water and syrup of poppies, of each 2 dr.; water, 1 fl. oz.

2. (Copland.) Nitre, 6 gr.; laudanum, 12 drops; compound spirit of ether, 1 fl. dr.; syrup of poppies, 2 fl. dr.; camphor mixture, 9 fl. dr.

3. (Ellis.) Tincture of opium, 15 to 25 drops; syrup of poppies, 2 fl. dr.; spirit of cinnamon, 1 fl. dr.; distilled water, 1-1/2 fl. oz.

4. As the above, but substituting a like quantity of solution of either acetate or hydrochlorate of morphia in lieu of the laudanum. All the above are given as soothing draughts to allay pain and produce sleep, especially the last thing at night. No. 4 is to be preferred if there are febrile symptoms present.

=Draught, Antac'id.= _Syn._ HAUSTUS ANTACIDUS, L. _Prep._ 1. Bicarbonate of soda, 20 gr.; tincture of calumba, 3 fl. dr.; tincture of hops, 1 fl. dr.; syrup of orange peel, 2 fl. dr.; water, 6 fl. dr. To improve the appetite in heartburn and dyspepsia; taken 1 hour before a meal.

2. Liquor of ammonia, 16 drops; syrup of saffron, 2 fl. dr.; infusion of gentian, 3 fl. dr.; water, 7 fl. dr. As the last, taken occasionally, especially in debility, low spirits, &c.

3. (Collier.) Compound tincture of cardamoms, 1 fl. dr.; solution of bicarbonate of magnesia (fluid magnesia), 9 fl. dr.; simple syrup, 2 fl. dr. Twice a day; in dyspepsia, heartburn, &c., especially in gouty patients.

4. (A. T. Thomson.) Magnesia, 1 dr.; peppermint water, 1-1/2 fl. oz.; tincture of orange peel, 1 fl. dr. In dyspepsia, &c., with acidity or diarrh[oe]a.

5. As No. 1, but using bicarbonate of potassa for bicarbonate of soda. In acidity, diarrh[oe]a, &c., accompanied by great irritability of the coats of the stomach.

6. Prepared chalk, 30 gr.; spirit of nutmeg and tincture of opium, of each 12 to 20 drops; syrup of saffron, 3 dr.; cinnamon water, 1 fl. oz. In acidity, with extreme looseness of the bowels.

=Draught, Anti-arthrit'ic.= _Syn._ HAUSTUS ANTI-ARTHRITICUS, L. _Prep._ 1. Tincture of colchicum seeds (L.), 1/2 fl. dr.; syrup of orange peel, 2-1/2 fl. dr.; water, 1 fl. oz. In gout; taken over-night, followed by another in the morning.

2. (Brande.) Wine of colchicum, 1/2 fl. dr.; carbonate of magnesia, 15 gr.; cinnamon water, 1/2 fl. oz.; water, 1 fl. oz. As the last.

3. (Sir C. Scudamore.) Magnesia, 18 gr.; Epsom salts, 1-1/2 dr.; vinegar of colchicum, 1 fl. dr.; simple syrup, 1 fl. dr.; cinnamon water, 9 fl. dr. As the last.

4. (Sir H. Halford's GOUT PREVENTIVE.) Compound infusion of gentian, 1-1/2 fl. oz.; tincture of rhubarb, 1 fl. dr.; bicarbonate of potassa, 15 gr.

=Draught, Anti-asthmat'ic.= _Syn._ HAUSTUS ANTI-ASTHMATICUS, L. _Prep._ Vinegar of squills, 1/2 fl. dr.; ipecacuanha wine, 15 drops; cinnamon water, 1-1/2 fl. oz. Expectorant. One to be taken three times daily during the attack.

=Draught, Anti-emet'ic.= _Syn._ HAUSTUS ANTI-EMETICUS, L. _Prep._ 1. Juice of 1 lemon; liquor opii sedativus, 10 drops (or laudanum, 15 drops); ether, 20 drops; simple syrup, 2 dr.; water, q. s.

2. (HAUSTUS ANTI-EMETICUS RIVERII,--P. C.) Bicarbonate of potassa, 30 gr.; lemon juice, 4 dr.; syrup of lemon, 1 oz.; water, 3 oz.; mix quickly, and tie down the cork. To check nausea and vomiting. This is best given effervescing.

=Draught, Anti-hyster'ic.= _Syn._ HAUSTUS ANTI-HYSTERICUS, L. _Prep._ Cyanide of potassium, 1 gr.; lettuce water (distilled), 2 fl. oz.; syrup of orange flowers, 1-1/2 oz.; water, 5-1/2 fl. oz.; for 6 draughts. One to be taken when the fit is expected, and a second in half an hour. Should the fit come on, the dose may be repeated at intervals of about 15 minutes until 3 or 4 have been altogether administered. The symptoms, however intense, are generally either at once arrested, or greatly alleviated by this treatment.

=Draught, Antilith'ic.= _Syn._ HAUSTUS ANTI-LITHICUS, L. _Prep._ 1. (Venables.) Borax, 8 gr.; bicarbonate of soda, 10 gr.; aerated water, 8 fl. oz. For a draught; in red gravel.

2. (Dr Paris.) Carbonate of soda, 12 gr.; tincture of calumba, 1 fl. dr.; infusion of quassia, 1 fl. oz.; water, 3 fl. dr. In dyspepsia and gravel, attended with the lithic-acid diathesis.

=Draught, Anti-neural'gic.= _Syn._ HAUSTUS ANTI-NEURALGICUS, H. NARCOTINÆ, L. _Prep._ (Jeston.) Narcotine, 2 gr.; diluted sulphuric acid, 20 drops; infusion of roses, 1-1/2 fl. oz. One every 2 hours in the intermissions of neuralgia.

=Draught, Antisep'tic.= _Syn._ HAUSTUS ANTISEPTICUS, L. _Prep._ (Dr Collier.) Decoction of yellow bark, 1 fl. oz.; tincture of opium, 5 drops; spirit of pimento and water, of each 2 fl. dr. In putrid fevers, gangrene, &c.

=Draught, Antispasmod'ic.= _Syn._ HAUSTUS ANTISPASMODICUS, L. _Prep._ 1. (Dr Collier.) Tincture of castor, 1 fl. dr.; sulphuric ether, 10 drops; peppermint water, 11 fl. dr.; mix. In hysteria, and that species of irregular muscular action dependent on debility.

2. (Dr Gregory.) Fetid spirit of ammonia, 1/2 to 1 fl. dr.; camphor mixture, 10 fl. dr.; syrup of saffron, 1 fl. dr. In cases complicated with low spirits, debility, &c.