jS'/vT WELLCOME INSTITUTE LIBRARY Acc. 339030 Cal! C?v/?4-0 . No. Ml i i932- l%b ^ 96 THE Extra Ph ARMACOPCEIA OF Martindale and Westcott REVISED BY W. H arrison Martindale, Ph.D., Ph.Ch., F.C.S. TWENTIETH EDITION. IN TWO VOLUMES VOL. I. LONDON: H. K. LEWIS & Co., Ltd. 1932. [All pigrhts reserved.] The use in this volume of certain portions of the text of the United States Pharmacopoeia is by virtue of permission received from the Board of Trustees of the United States Pharmacopoeia! Convention. The said Board of Trustees is not responsible for any inaccuracy of quotation nor for any errors in the statement of quantities or percentage strengths. Permission to use for comment parts of the text of the National Formulary Fifth Edition, in this work has been granted by the Committee on Publications by Authority of the Council of the American Pharmaceutical Association. “ The Commissioners of Customs and Excise will be prepared to regard articles made in accordance with formulae in the Extra Pharmacopoeia as ‘ known admitted and approved of ’ remedies for the purposes of the Medicine Stamp Duty, provided that a sufficient reference to the book appears in the labels under which the articles are sold.” Definite and complete statement of the actual ingredients is required and a t atement that no proprietary rights are claimed on all labels, sartons, etc. Came into force March, 1930.—P.J. i./3o,238,261. PREVIOUS EDITIONS OF THE EXTRA PHARMACOPOEIA. No. of Pages 1st Edition published ... (exclud ing Introductory 1883 313 2nd y y yy • • • ••• • p • 1884 330 3rd y ) yy •• • • • • • • • 1884 330 4 th y y yy •• • • • • • • • 1885 446 5 th yy yy •• • • • • • • • 1888 462 6 th y y yy •• • • • • • • • 1890 485 7th y y yy •• • • • • • • • 1892 524 8th yy yy •• • • • • • • • 1895 580 9 th y )) •• • • • • 1898 626 10th yy >) • • • • • • 1901 688 llth y y >) •• • • • • • • • 1904 809 12 th y y yy • • • • • • • • • 1906 1075 13 th y y )> • • • • • • • • • 1908 1203 14 th 9 9 15 • • • • * • • • • 1910 1054 \ Supplement: Organic Analysis Chart... 1910 80/ 15th Edition, Vol. I published ... • • • 1912 1112 \ 15th yy ,, 11 ,, ... • • • 1912 370/ 16 th y y » f )) • • • ... 1915 1113\ 1 6th y y ,, II ,, ... 1915 469/ 16th yy Reprint (both Vols.) • • • 1918 16th yy yy yy yy • • • 1920 17 th yy Vol. I published ... • • • 1920 11151 17 th y y ,, II ,, ... • • • 1921 688/ 17 th yy Reprint (Vol. I) ... • • • 1922 1122 18th , y y Vol. I published ... • • • 1924 11631 18 th y y )j if ,, ... • • • 1925 728/ 19 th y y Vol. I published ... • • • 1928 12071 yy VOLUME I. TABLE OF CONTENTS. - PAGE Preface to the Twentieth Edition . . .. . . iv-xxv Synopsis of Principal Additions and Changes in B.P. ’32 xxvi-xxxiv Abbreviations . . . . . . . . . . .. xxxv-xxxix Weights and Measures, xl; Metric Equivalents . . .. xlii Percentage and Grains per Fluid Ounce Equivalents .. xlii Approximate Equivalent Weights and Measures . . . . xliii Neutralisation Table, xliv ; Arithmetical Memoranda . . xliv Calculation of Dose for Man from known Dose for an Animal xlv Transposition Table of Doses stated for Man in mgr. per Kilo to Man’s Weight . . . . . . . . . . . . xlv Thermometric Equivalents .. . . . . . . .. xlvi International Atomic Weights .. . . . . . . .. xlvii Materia Medica, alphabetically arranged .. . . .. 1-826 Supplementary List of Drugs .. . . . . . . 827-893 Vaccines and Antitoxins . . . . . . . . . . 893-947 Animal Organotherapy . . . . . . .. . . 947-986 Blood Transfusion. . . . .. . . . . . . . . 987 Table of Infectious Diseases . . .. . . . . . . 988 Poisons and Schedule of Poisons . . .. . . 989-991 Orders in Council re Mineral Acids, Disinfectants, etc. . . 992 Wholesale Trading, Sales to Medical Men and Poisons by post 993 Sale of Arsenic .. . . . . .. .. . . .. 993 Regulations for Keeping, Dispensing and Selling Poisons .. 993 Labelling of Poisons Order, 1924 .. . . . . . . 994 994-995 995 996 997 Poisons in Northern Ireland and Irish Free State Pharmacy and Poisons Bill Dangerous Drugs Acts Summary Dangerous Drugs Act, 1920 Dangerous Drugs and Poisons (Amendment) Act, 1923 (Amendment as to Dealings in {jp j] Poisons) Dangerous Drugs Act, 1925 Dangerous Drugs (Consolidation) Regulations, 1928 Hospital Exemption Order, 1924, 1004; Special Authorisations Statutory Rules and Orders ... Dangerous Drugs Act, 1932 Morphine Addicts References to Dangerous Drugs Regulations ... ... Points of Assistance, Calculation Tables, Examples of gg] Prescriptions and ‘ Signed Orders ’ under the Acts . . — Venereal Diseases Act, 1917, 1014 ; Dentists Act, 1921 Therapeutic Substances Act, 1925, and Regulations, 1931 Merchandise Marks Act, 1926 Import Duties Act, 1932 Trade Marks and Patents Legislation Therapeutic Index of Diseases and Symptoms Antidotes to Poisons Intravenous Doses, Table of Proportional Dose Table (according to age) Index and Posological Table Corrigenda. 998 999 1000 1005 1005 1006 1006 1007 1008-1014 .. 1015 1015-1018 .. 1019 .. 1019 1020-1021 1022-1094 1095-1101 1102-1104 .. 1104 .. 1105 .. 1216 PREFACE. The nineteenth edition of the First Volume of The Extra Pharmacopoeia was issued in June, 1928, followed by the Second Volume in October, 1929. Since then several National Pharmacopoeias have been published and to these reference has been made in revising our pages. We would mention in this connection—Farmacopea Ufficiale del Regno D’Italia, quinta edizione, 1929; Pharmacopee Belge, quatrieme edition, 1930; and Farmacopea Oficial Espanola, octava edicion, 1930. With regard to the British Pharmacopceia, 1932, we have followed with interest the various Pharmacopoeia Commission Reports of Sub-Committees printed from time to time during the last two years by the General Medical Council. We have prepared abstracts from these and have conducted independent research work in our laboratories on chemical and pharmaceutical points arising from their study, and, we may add, on several occasions have made suggestions to members of one of these Committees which occurred to us as helpful. We prefer, for example, the metric cubic centimetre, and its well-known contraction the Cc., in contradistinction to the millilitre and its abbreviation ‘ mil.* The United States Pharmacopoeia, it will be recalled, tried ‘ mils 5 for an edition but reverted to the more universally accepted cubic centimetre. In addition to this, Gm. is considered the best contraction for Gramme. So far as weights and measures in general for medicinal purposes are concerned, it is doubtful whether perpetuation of the dual system (Imperial and Metric) has any special advantages—vide Weights and Measures posted. It is perhaps not in order to give a detailed criticism of the changes in the British Pharmacopoeia, but one cannot help remarking (pharmacists would agree) that the requirements in the Official work, both as to the making and assaying of preparations, should be as simple and convenient as possible. The pharmacist’s work should be reduced, rather than increased by complicated processes. Criticism will no doubt be forthcoming for some time so we must restrain the pen—much as we should like to digress on the subject. One small instance of labour-saving we must however mention, namely, we proved a few years ago that in many cases maceration of drugs was as effectual as percolation. The result in the case of an investigation of Tincture of Digitalis—confirmed by Bio-Assay—was remarkable—v. p. 390. With these considerations before us it was thought best to arrange the Principal Additions and Changes to be effected in the B.P. ’32 in the form of a Synopsis, as was done on similar occasions in connection with the B.P. ’85, ’98 and ’14. We trust the arrangement will be found convenient. It enables those using the British Pharmacopceia in their work to note quickly the alterations that have been made and to compare information that has been brought into our own pages during the last five decades and especially in recent years. Whilst in the body of the work we retain references to a number of B.P. ’14 preparations, we have included with the contraction ‘ P. Off.' (i.e., Proposed Officially by the Pharmacopceia Commission Reports) on occasion, the proposed recommendations, and the Synopsis gives in precis remarks upon strengths, doses, etc., as laid down in the new Official work. Further, it is certain that many of the B.P. ’14 drugs, preparations, etc., now omitted from the B.P. will continue to be in favour and are therefore referred to in our pages. International Unification of Potent Remedies has been secured in some degree. The position regarding this Unification is as follows : An International Conference met at Brussels in 1902 and a Second Conference in 1925. The salient points arising from the Agreements decided upon we recorded, by means of the abbreviations ‘ F.I.’ and 4 F.I. Second,’ in past editions of the book. International agreement regarding medicinal preparations, many of them handed down for centuries in separate countries, is naturally difficult and will be a slow development. Twenty-six States were represented at the 1925 meeting and a S draft International document, embodying the decisions reached was submitted to the various governments for ratification. (The Conference also appointed two Commissions—one to deal with [ Chemical and Physico-chemical Assay Methods and the other to study methods of making potent galenical preparations. The decisions reached by these Commissions may be introduced in Supplements to Pharmacopoeias now in operation.) The Belgian Pharmacopoeia Commission has taken important steps in the general question of unification of National Pharmacopoeias and one wishes it success in reaching the useful desideratum. The Governments of the following countries signed the Second International Agreement on August 20, 1929 :—Belgium, Greece, Latvia, Roumania and the Kingdom of the Serbs, Croats and | Slovenes. The following countries signed with certain reservations:— Bulgaria, Denmark, Egypt, France, Italy, the Netherlands, Norway, Sweden and Switzerland. The British Government has not yet signed the Agreement, but will do so at a later date (with reservations). In notifying adhesion to the Agreement Great Britain reserved the right to introduce modifications in detail rendered expedient by established usage and progress in medical and pharmaceutical science. The letters I.A. therefore appear in B.P. ’32, after the following subsidiary headings :— Aconiti Tuber, Cocaini Hydrochloridum, Extractum Opii Aquosum, Lobelise Herba, Pulvis Opii et Ipecacuanhse Compositus, Scillse Bulbus, Secale Cornutum, Solutio Arsenicalis seu Fowleri, Solutio Nitroglycerini Spirituosa, Strychni Semen, Sirupus Ferrosi Iodidi Concentratus, Tinctura Opii Benzoica. So far as liaison between the B.P. and the U.S.P. authorities is concerned, obviously good should accrue, but in actual practice a complete understanding as to interchangeable potent preparations in the countries of Europe would be useful to the Profession on both sides of the Channel if it could be attained. Certainly the pharmacist at home sees relatively few U.S. prescriptions, while those of France, Germany, Switzerland and the rest of Europe are frequent arrivals and they are often puzzling owing to absence of conformity. It is in fact only with the aid of National Pharmacopoeias at hand or information embodied in our own pages that the exact wishes of the preseriber can be arrived at in some instances when dispensing foreign prescriptions, or indeed can safety be assured. Nomenclature (even Latinised) is bound to offer difficulties in unification owing to local usage, thus to point to but a single instance —Liquor Arsenicalis, Fowler’s Solution, of universal reputation during the last two centuries, has the following divers Latin designations in the recently completed Pharmacopoeias : Kalium Arsenicosum solutum in P. Ital. V. Arsenicalis Solutio Fowleei in P. Belg. IV. Solutio Aesenitis Potassii in P. Espan. VIII. followed in the last two by the International designation Solutio Arsenicalis seu Fowleri. Add to these the fact that the U.S.P. designates the solution Liquor Potassii Arsenitis. Numerous examples of other kinds of unfortunate International lack of uniformity were given in the preface of the last edition. We would draw attention to some of the New Remedies, and new methods of using old ones, incorporated in the Extra Pharma- copceia, in sequence, according to the pages on which they are to be found. Acidum Carbolicum.—Carbolised Almond Oil (5% strength) for the injection treatment of haemorrhoids is new, and its use has resulted in discussion by surgeons—v. p. 16. Acidum Cresylicum.—Research has been actively conducted in regard to Cresylic Disinfectants. The opinion has been expressed that in respect of antiseptics in midwifery no Lysol can be other than a delusion, as it is only active on Gram-negative organisms. This is a sweeping condemnation. Lysol was under consideration by the Central Midwives Board and the L.C.C. The Board continues its use providing it contains 50% Cresols—v. p. 28. Amyl-meta-cresol is a powerful antiseptic of low toxicity offering hope of utility as a urinary antiseptic. Acidum Salicylicum.—This Chapter contains an extended review of the use of Sodium Salicylate as a sclerosing agent for dealing with varicose veins. A number of surgeons have written favourably concerning it, especially in conjunction with Sodium Chloride. According to an authority on the matter (B.M.J. i./32,1054), the Sodium Salicylate method with addition of 1% Novocain is deemed 4 the technique of choice which will solve all problems.’ ‘ Twin ’ injections, combining Lithium Salicylate with. Quinine • • and Urethane have been well spoken of, resulting in a deposition of Quinine Salicylate. We would refer to pp. 63-66 for a chronological account of the matter covering the work of the last three or four years. By a slip the three lines embodying the recent reference B.M.J. i./32,1054 on p. 66 are out of order ; they should precede the words varicose veins in italics. (Other sclerosing agents are referred to subsequently.) Halogenised Aspirin Derivatives.—Both the Bromine and Iodine substitution compounds continue to attract attention. It is of marked interest that the strongly held halogen in the respective molecules (over 30% in the case of Sedasprin and over 40% in the case of Aspriodine), requiring in laboratory practice; fusion with alkali to effect removal, is proved to be liberated and absorbed in the human digestive tract. Methyl-Aspriodine, which may be viewed as a derivative of Methyl Salicylate, having the Salicylic radical converted into Aspirin, with the inclusion of nearly 40% Iodine, has been subjected recently to animal experiments, in the hope that the compound would be tolerated by injection. In oily solution it is shown that the substance is tolerated even to the extent of 1 Cc. doses of 10% solution subcutaneously in mice. The method applied to the human being may be a useful adjuvant to local treatment by inunction in rheumatic affections—v. p. 81. Acidum Sulphurosum.—New to this Chapter is the inclusion of Magnesium Hyposulphite employed both per os and intramuscularly as a remedy in resistant cases of asthma—v. p. 86. Acidum Tannicum.—Concise directions are given for the Tannic Acid treatment of burns. As is common with all new procedures, some contra opinions have appeared. We include, however, a definitely favourable account from a hospital in an iron-smelting district, where the procedure is adopted as a routine with satisfaction —v. pp. 88, 89. JEther.—This Chapter has been revised in numerous particulars. Attention is called to the data on p. 101 on Rectal Oil-Ether Anesthesia. The opinion is given in the U.S.A., that it has 4 wider limits ' of safety than any inhalation method.’ Alcohol.—-It may be recalled that in our last edition we welcomed 'Regulation 10,’ which was a part of the Methylated Spirit Regulations, 1925, as providing increased facilities for the supply on a written order or prescription of Industrial Methylated Spirits. Still further concessions by the Excise Authorities have been granted, and the Regulations governing the use of Methylated Spirits and Industrial Methylated Spirits have been consolidated in the form of the Methylated Spirits Regulations, 1930. These Regulations are clearly arranged, showing application to 4 all users ’—medical men, wholesale chemists, dispensing chemists, etc., on pp. 115 to 11?! Properly appreciated, they render 4 Surgical Spirit’ (p. 117), unnecessary, as plain Industrial Methylated Spirit without any approved denaturants (Castor Oil* Boric Acid—somewhat curiously conceived) takes its place. The last-mentioned had some vogue as a temporary expedient in overcoming difficulties caused by the addition in 1924 of Pyridine to the formula for Mineralised Methylated Spirits. Aldehyda.—Paraldehyde, given per rectum. as one of several Basal Hypnotics (to which further reference is made posted), is described as valuable and easy to work with—v. p. 122. Amyl Nitrite .—A recent statement is to the effect that this standard remedy (and Nitroglycerin) may be used indefinitely in heart affections. Antimony.—Several new Organic Antimonials are described, notably for treatment of schistosomiasis and for kala-azar. By far the most important work, however, of recent times in this sphere is the research that has been conducted at the Chemical Research Laboratory, Teddington. The composition of the Antimony analogue of Tryparsamide, made by others, could not be substantiated. We give a resume of a number of new Aromatic Stibinic Acids made at the Chemical Research Laboratory, with their M.L.D.’s, determined by the Chemotherapy Committee of the Medical Research Council. They possess, however, only slight activity against T. equiperdum. Antimony Carbazole compounds are also referred to in the work from the Teddington Laboratory— v. p. 164. Arsenic.—The Organic Arsenicals needed marked revision, especially the Aromatic and the Diphenyl Nucleus Series, which we differentiate with some semblance of logical chemical sequence, following the Aliphatics. An amazing amount of ‘ literature * surrounds these compounds in general (sometimes perhaps of a purely propagandist type), and in each succeeding issue of the book it is found necessary to omit old information, and to digest and present the new with what we consider to be an accurate view of dosage and therapeutic utility, and-—the most important factor from the human aspect—to provide cautions in regard to possible toxic effects arising from their administration. The probability of toxic effects resulting from these relatively slowly absorbed bodies given in massive doses is one to be seriously reckoned with. Additions on this occasion are Parosan, Halarsol and Carbarsone. The duplication in nomenclature of Organic Avsenicals imported from abroad presents added difficulties, and in this connection our method of conveying synonyms is, we think, convenient. Concluding the Aromatic Series, certain new Succinyl derivatives of Quinquevalent Arsenic, which have been made at the Chemical Research Laboratory, Teddington, call for attention. They embody low toxicity accompanied by therapeutic activity. There are, further, from the same Laboratory, Malonyl and Glutaranilic Derivatives—v. pp. 190, 191. With regard to the Diphenyl bodies, we were informed quite recently that Arsenobenzol has been ‘ discontinued ’ in favour of Novarsenobenzol. The preparation of the injection of the original compound gives, it is true, more trouble, but it is difficult to correlate its discontinuance with the recent statement (B.M.J. iL/31,157) that 4 the first place must be given to 606—it hits the spirochsete harder and longer than 914—but reactions deterred many patients from continuing * (see our p. 196). Combined Arsenobenzol and Mercury (or Bismuth) Treatment. On pp. 194, 195, we provide the result of an elaborate investigation under the Medical Research Council. On the question of differentiating between the inclusion of Mercury or Bismuth in the course, the opinion is that there is no superiority in Bismuth, though it is better tolerated than Mercury. * Alternating ’ Treatment is thought economical and successful, whilst ‘ Concurrent ’ Treatment is wasteful and not productive of success, and yet, as an authority remarks, ‘ after 20 years’ trial of Salvarsan there is an absence of unanimity as to the best method of treating syphilis’—v. p. 202. Novarseuobenzol appears to be most used. Our remarks relative to duplication in names apply strongly to the bodies allied to Novarsenobenzol. Bismuth Arsphenamine Sulphonate (Bismarsen) is the outcome of research in the U.S.A. It is relevant here to refer to Bismuth Arsanilate, which is more conveniently dealt with in the Bismuth Chapter (p. 238). This compound is an important one in the treatment of yaws and it has, to our mind, the advantage of relative simplicity. Aurum.—On the subject of simplicity, just hinted at, is it not still a question why the elaborate and complex Gold Cyanides and Double Thiosulphates, etc., etc., should supersede a plain, definite, simple compound like 4 Commercial Chloride of Gold,’ an old though useful name, conveying Gold and Sodium Chloride ? This compound, at our suggestion, has been tried in leprosy and the associated eye affections. Actually there is independent support for our suggestion (in the treatment of lupus erythematosus) that the simple body may be preferable to complex compounds—v. p. 212. We provide data on the complex competitors of which there is now an extensive series—v. pp. 213 to 215. Barium Sulphate.—The provision of a bulky Barium Sulphate meal for X-Ray purposes developed into quite a small thesis of its own. Our experiments are detailed on p. 216, the object being to produce a really minute precipitate. Bismuth. A somewhat similar investigation concerned the preparation of metallic Bismuth in the finest possible suspension for injection in syphilis and yaws. We provide a working formula to effect the requisite reduction, starting from Bismuth Oxychloride. The particles were measured microscopically and the method has now been in operation some time in the author’s laboratory for the provision of 4 Injectio Bismuthi ’ in a dilute Glucose vehicle—v. p. 221. Pulvis Bismuthi Compositus for the intensive alkaline treatment of gastric and duodenal ulcers is described at length on p. 224. Bromum.—Tribromethyl-alcohol. Syn. Avertin, as a basal hypnotic, is the subject of over a page of discussion. We bring out many of the salient features in bold type for convenience—v. pp. 241,'242. Chiorbutol (Chloretone).—The solubility of this compound has been attacked. A reasonable solubility is 1 in 200, as given in our pages for some years, and recently confirmed—v. p. 243. Calcium Chloride.—May we draw brief attention in passing to the revision of the abstracts on pp. 252, 253. They are for the most part not new, but they have been re-arranged in alphabetical order for ready reference. Calcium Gluconate.—This is stated to be the only Calcium salt available at present which can be injected into the muscles, in adequate doses. It is advocated in a variety of conditions attributable to Calcium deficiency. As is common with a large number of these procedures Pharmacology steps in and gives some warnings. The margin between effective and toxic dose is said to be not great —v. p. 257. Calcium Lasvulinate has been introduced as an alternative. Carbon Tetrachloride.—The general conclusion as to a safe dose of this chemical for use as an anthelmintic, especially in ankylostomiasis, receives support from authoritative opinion in India. Cerevisige Fennentum.—Sodium Nucleinate injections in septicaemia are dealt with on pp. 278, 279. Coal Tar Derivatives.—Noteworthy in this Chapter are the comments on Acriflavine for prophylaxis in midwifery in respect of puerperal sepsis (the subject is further dealt with under Glycerin pp. 301, 432 and 433). An improved formula for Acriflavine Emulsion has been published. By some, Acriflavine is regarded as near the Ideal Antiseptic. New uses of it, both local and by intravenous injection, are recorded. Tetrophan is a further recently introduced Acridine compound —v. p. 304. Phenyihydrazin and its Acetyl compound, given for their powers of destroying erythrocytes in polycythemia, are now included here with numerous references, pp. 307, 308, several of the statements emphasising caution. Pyiidium is a new vesical antiseptic. We cite its contraindications, which appear to be extensive—v. p. 308 Cinchophen is now described as ‘ often invaluable in chronic gout,’ but it is requisite to test the patient with small doses at first. Attention is again drawn to toxic jaundice following its administration—v. p. 317. Perhaps patients are not sufficiently careful in following their medical advisers’ directions concerning this and other medicaments. They do not realise the potency of these chemicals and in consequence may take them in excess. Neotropin is a new urinary antiseptic—v. p. 319, Percain.—This is a new local anaesthetic, effective in high dilution, and hence of interest for that reason—v. p. 319. It has a slow rate of elimination and prolonged action. Details are given of various surgical procedures employing the anaesthetic. Quinanil, a new Quinoline derivative, is used as a prophylactic antiseptic dressing for wounds and has various other local uses, e.g. as an irrigant—v. p. 320. Amidopyrin.—It is held that this useful antipyretic has specific powers in measles. The pros and cons are provided on pp. 329, 330. Gocse Folia.—An interesting historical note on the first use of Cocaine by a practitioner in London—house physician at the time to Sidney Ringer at University College Hospital—is on p. 333. The first dose wTas 1/6 grain, which was gradually increased to \ grain, given to him by a fellow resident, simply as a pharmacological experiment to test cutaneous sensibility to tactile, thermal, and painful sensations, and their distribution around the site of injection. The next logical step, the injection of Cocaine Hydrochloride subcutaneously for surgical purposes, was the first occasion, so far as is known, of its actual use in a minor surgical operation, and the induction of a sufficiency of anaesthesia—v. p, 333. Latterly, during the last decade or two, for reasons which we consider quite inadequate, Cocaine has been under a ban. To maintain that there is any marked misuse of the alkaloid in this country is of course absurd. The ‘ Yellow Press ’ must, however, continue to provide 4 Yellow’ stunts for consumers. A few weeks ago the smuggling of Cocaine in the ends of long cigars packed in petrol tins and thrown overboard in quiet harbours on the East Coast of England, from Dutch exporting localities, was dwelt upon to the extent of several columns by a newspaper famous for its enterprise. Apart from journalistic 4 stunts ’, we agree with the writer in the R.M.J. i./3i,495, that 4 misuse of Cocaine in England is nilOn the subject of drug addiction in general, England is a model among nations in this, and kindred, spheres. Our Home Office knows of oniy 250 addicts. See our p. 561. Novocain.—On p. 346 et seq. we provide a digest of new information on the induction of spinal and other types of anaesthesia with the aid of Novocain. The inclusion of Ephedrine in the technique is new. The proprietary Spinocain, hailing from U.S.A., is briefly touched upon. A certain amount of doubt centres round the chemistry of Gliadin or Amyloprolamin, which is a constituent. The controllable spinal anaesthetic introduced by the late A. E. Barker, comprising Stovaine with the addition of Glucose, has, so far as we recall, never been adversely criticised, and only quite recently an authority speaks of its having been used many hundreds of times—v. p. 352. Anaesthesin has the advantage of being an innocuous anaesthetic soluble in oils. This property has been made use of in a solution termed 4 A.B.A.’, for injection in pruritus ani and anal fissure —v. p. 350. Codeine.— are included. Notes on Eucodal and Dicodid, two new narcotics, These are both |p 1] and [gj], and their use is subject to licence from the Home Office. They are not made in this country. Acetyl-dihydrocodeinone (Acedicone) came under the same regime within the last few weeks and similar remarks apply. It is added to Part III of the [§]. All these are referred to on p. 357, and are also in the Acts, p. 996 et seq. Colloidal Metal chapter.—Lead Selenide has half a page devoted to it, but the conclusion of a M.R.C. Report is that it is not curative of cancer—v. p. 368. Digitalis.—Digitalis Leaf Tablets prepared with powdered leaf of the same strength as International Standard present a simple method of overcoming what may be termed ‘ Digitalis Difficulties.’ The writer has been interested in Digitalis for a good many years. So far as assay is concerned, he has from time to time had numerous comparisons made between, on the one hand, his colorimetric method (devised in 1912), and described in Vol. II, nineteenth edition, p. 72 et seq., and results from Bio-Assay (M.L.D. for frogs) and he has no hesitation in remarking that the results are comparable ; this relatively simple test if carefully carried out will show whether a Tincture is below Standard or above Standard. We have had occasion to compare (a) 1932, (b) 1931, (c) 1930 homegrown leaf, (d) leaf of British Standard (for which acknowledgment is due to the Department of Biological Standards of the National Institute for Medical Research), and (e) leaf supplied by a pharmacist friend in Spain, also an enthusiast on the subject. This Spanish leaf had been collected 1200 metres up in the mountains at Salamanca (Sierra de Francia), and stabilised immediately after collection. Prior to sending tinctures of these leaves to our Pharmacologist, we found (a), (b) and (c) above standard, and the Spanish leaf (e) decidedly above by the colour assay method. (The marked potency of this Spanish preparation we attributed to sunlight rather than stabilisation.) The potency of our own (1931) growing of leaf was confirmed by the Bio-Assay result. Ephedrina.—In our previous edition Ephedrine had merely some brief notes in the Supplementary List. These have been re-written and extended, and, together with numerous preparations suitable for prescribing, now occupy over four pages (397-401). The chief utility of Ephedrine is for asthma and hay fever, hence Nebuke, plain and compound, and both oily and aqueous, are required. There has been some misconception as to the solubility of Ephedrine Base in Liquid Paraffin. Experiments were needed to determine the amount of vegetable oil to be incorporated to make a stable Spray Solution. In similar manner, experiments were needed to produce a satisfactory Elixir for internal use in asthma, and whooping cough in children. We regard the alkaloid as a [jpjj Poison, and its sale is therefore protected. One case of overdose is recorded. We provide recommendations as to antidotes, on p. 397. We would draw attention to the pages relative to treatment, as they are, for the most part, entirely new. Ergot.—Defatted Ergot preparations in capsule form are useful for giving by the mouth. A large amount of investigation has been carried out to improve the B.P. ’14 Ext. Ergot. Liq., which has been condemned as of no therapeutic value. Extraction with Dilute acidified Alcohol gives a preparation containing what are thought to be the specific alkaloid or alkaloids. P. Belg. IV. uses Tartaric, P. Ital. V. uses Acetic, and F.E. VIII. Hydrochloric Acid in their respective methods. When the work of the Pharmacopoeia Sub-Committee had been brought to a conclusion there appeared, curiously enough at the last moment—just prior to the new B.P. being available for inspection—a communication from the Registrar of the Obstetric Unit, University College Hospital, London, detailing a Clinical Investigation on the Action of Ergot Preparations on the puerperal uterus (R.M.J. i./32,1119). We refer to this on p. 402 : the essence of the article is that the clinician sp>eaks highly of the B.P. ’14 Liquid Extract. The suggestion is made that perhaps the Liquid Extract contains an active constituent hitherto unidentified. The position has led to discussion from the clinical aspect, on the one hand, and the pharmacological on the other, which hardly calls for analysis in these prefatory notes. We come now to the question of the colorimetric assay of Ergot preparations. The Pharmacopoeia Commission issued in one of their Reports the suggestion that the colour intensity produced by mixing Paradimethyl-amidobenzaldehyde when added to a Tartaric Acid Extractive should be utilised as a method of assay. The intensity of colour is to be gauged in a colorimeter when it reaches a maximum. In sunlight only some ten to fifteen minutes are needed, but in diffuse light some two hours may be required. The credit of employing this chemical as a reagent is due to a Dutchman who has made some elaborate trials with it in respect of a number of substances with which it responds by providing divers tints. A w'orker in the U.S.A. extended the matter in regard to the Ergot alkaloids. The potentialities of the test are, we think, adequately stated, on p. 403. We felt that even these International efforts might perhaps be improved upon. There are other reagents giving colours with the Ergot alkaloids, and the suggestion is made on p. 404 that Ammonium Sulpho-Molybdate might be effective. Investigation showed that this reagent gives an immediate slate-blue colour of considerable intensity with Ergotoxine (and with Ergotamine), and it should be possible to compare the tint with that produced by Ergotoxine Ethanosulphonate. The exact conditions remain to be worked out. We may be able to attack the problem, which is surrounded with difficulties, again at a later date. Pressure of othei matters prevented a completion of the experiments. We hold that the immediate colour produced is of value—there is no need to work in sunlight, or to make adjustments for its absence, and certainly we feel strongly that the pharmacist should not be compelled to acquire an expensive colorimeter for this assay for a drug actually in very slight general demand, if a simpler method o f evaluating Ergot can be devised. It is of interest to remark that apparently on the Continent generally, Ergotamine is more ‘ in evidence ’ than Ergotoxine. Ergotamine Tartrate is Official in P. Belg. IV. Reference should be made to p. 406 for some recent discussion on the two constituents. Ferrum.—An outstanding feature of Iron Therapy for ansemia is that Ferrous Salts (e.g. Ferrous Chloride) are shown to be more effective than Ferric. There are notes giving this information on pp. 412, 413 and 420. A small proportion of Copper as an adjuvant to Iron is also referred to on the same pages. Gelatin Injections.—Under the designation gelatino-thorax, intrapleural injections of Gelatin containing Euflavine have been advised in the treatment of empyema thoracis—v. p. 425. Glucose.—The Chapter is arranged under the headings Glucose Feeding (per os), Glucose Injections and Rectal Feeding, and a large amount of fresh information is incorporated in pp. 427-430. Glycerin.—The theory has been advanced that in some cases of cancer there is incomplete combustion of fats and carbohydrates, causing superabundance of fatty acids, with possible formation of saponins, which, owing to their solvent effect on the Lecithin and Cholesterin of the cell, are extremely irritating, the alteration of surface tension produced having a profound influence on cell division. Glycerin intravenously (using a catatyst) may combine with fatty acids to form innocuous fat—v. p. 431." The headings on p. 432—Germicidal Action of Glycerin, Glycerin as Surgical Dressing, and Hygroscopic Action—lead to the discussion of Glycerin in labour. A viscous hygroscopic fluid of this kind containing an antiseptic, if used during labour, should diminish the chance of infection from without, or from the vagina. Recommendations by numerous authorities are given on pp. 432, 433. Hamamelis.—Cosmetics can hardly be ignored to-day. Some are good, but more (or is it less ?) common sense should be brought to bear on these preparations. Some trenchant criticism is on p. 448. Hexamine.—Long experience in general practice has prompted communications on the utility of Hexamine in divers affections—in epilepsy, in phlebitis, and in rheumatoid arthritis, see p. 452. Our correspondent is a great believer in giving regular doses in a variety of ills. Hexamine Salicylate receives commendation from a medical man who has suffered from chronic cystitis—v. p. 453. Hydrargyrum. The younger generation may be impressed with the intimation that there was no chapter on Mercury in the Extra Pharmacopoeia until the 3rd Edition. It now occupies nearly 32 pages (454-486). On p. 462 we deal with various Links with Lister. Lister was born in 1827 at Upton House, East Ham. We claim him, therefore, as a London man. We have recollections of the work done in our laboratories to assist Lord Lister, and we print on the page men- Vol. I. A ° b tioned, relative to the pulling down of the Lister Ward at the Glasgow Royal Infirmary, the strong comments of Dr. A. Freeland Fergus on this subject. Mercurochrome.—Some misunderstanding has existed as to the status of this chemical, both in regard to Patents and Trade Marks. The few lines on p. 477 make the position clear. The compound should be deemed at least a CE> Poison—legally, it is not a Poison at all. As a rule one deprecates questions of priority—but we would record the fact of our priority as makers of this Organic Mercurial, so far as Great Britain is concerned. It follows that some intimate knowledge of the chemistry, pharmacology, and methods of assay of the compound, has been gained in our works through an experience of nearly ten years. Although containing more than 21% metallic Mercury, it is relatively non-toxic per os. Note the massive doses referred to on p. 478. Intravenously, 10 Cc. of a 0-5% solution is the maximum dose. We have no great experience of the addition of Glucose, which has been suggested by others. Some hold that this addition may create a cumulative effect and for that reason is to be deprecated. In the LLS.A. the Mercurial is, we understand, freely sold as a First-Aid dressing for wounds, abrasions, etc. A conservative view of the matter is perhaps desirable for the present. A recent criticism of its antiseptic powers is provided in the Jl. A.M.A., July 9, 1932, where it is maintained that the dye does not penetrate living tissue and hence could not destroy bacteria in same. Biological assay of Mercurochrome is dealt with at some length on pp. 478, 479. Animal experiments with it do not give entirely concordant data, and no exact figure per kilo weight of mouse can be taken as a hard and fast standard. One reads, indeed, that toxicities of samples for mice may vary in different laboratories of the same town. The references to the literature on Mercurochrome occupy nearly four pages. Meroxyl, Metaphen, and Neptal are new to the book. Kyoscine.—Twilight Sleep induced by Hyoscine in 50% Magnesium Sulphate Solution, and other formulae, is regarded as a routine by some—v. p. 492-494. Iodine.—There are numerous recent remarks on the use of Iodine as an antiseptic. The midwife needs an antiseptic to kill streptococci on the hands quickly—within two or three minutes at most—and without previous washing. Iodine does this. Coal Mines Regulations (First Aid) 1930 require it to be carried in the First-Aid outfit underground. It is preferable that the Iodine should be dissolved in a solvent other than Spirit. Hydriodic Acid and other decomposition products which cause dermatitis when employed surgically may be formed in storage. Various alternative solutions have been adopted from time to time—Benzene, Carbon Tetrachloride, Isopropyl Alcohol, and so on. The writer prepared a solution in oily combination to which the name Viodar is given. The solution, which is violet in colour, is stable in stoppered bottles. The preparation is neutral in reaction ; its composition is such that it cannot turn acid. Applied to the skin the Iodine is rapidly liberated. The solution is adapted to both internal and local use. It represents Iodine in the free condition—v. p. 512. A number of papers have been written on the French preparation Lipioaol, which is employed both therapeutically and in a variety of diagnostic procedures (in conjunction with c X ’ Rays) relative to the lung and other parts of the body. The selection of an oil with which to combine the Iodine for combinations of this description has been investigated by pharmacologists—v. p. 515. We revert to the controversy relative to Iodine in drinking water, and point out (p. 709) that Chlorination, so largely and successfully employed, does not deprive the consumer of the Iodine he needs, which is normally contained in drinking water. Ipecacuanha.—The data on Emetine have been revised in many ways. There is no great influx of commendations concerning Emetine Bismuth Iodide—a compound introduced under erroneous premises, as the Emetine contained is liberated b}^ physiological acid. We were asked the other day by a medical man from the tropics if we had ever taken it. He described the effects as drastic, even with the conjoint use of opiates. The writer’s preparation, Auremetine, in the form of a combined treatment, initiated by a specialist for whom he devised the chemical, is said to have stood the hardest tests and stands first in usefulness among the remedies at hand in a dysentery-infected locality in the East—v. p. 529. Ligatures.—It will be noted from a M.R.C. Report that the sterilisation of catgut ligatures is well effected by Iodine. We give comparative data with other bactericides. Peppermint Oil is new for the purpose. Raw catgut may be treated by immersing first in a Bichromate solution, then in a solution of the oil—v. p. 533. Magnesium Phosphate, Tribasic (as also the corresponding Calcium salt) is given as an antacid without producing systemic alkalisation. Morphine.—H Esters of Morphine, their salts and preparations, etc., are embodied in an Order in Council. Further, preparations containing any proportion of Heroin are brought in, excepting five approved formulae exempted by arrangement with the Pharmaceutical Society—v. p. 560. The traffic in Dangerous Drugs in the Near East is described on p. 561, as also is Dilaudid, a narcotic analogous with Dicodid, to which reference has been made. Clinical experience of it is available —v. p. 562 Nutrimenta.—The Chapter contains a number of additions. Much continues to be written on Pasteurisation. Some relevant points are brought out on p. 581. It is nearly always considered rank heresy to criticise Pasteurisation, but it would seem that thermophilic and thermoduric bacteria may cause trouble. The consumption of milk in this country is described as 4 lamentably small.’ It is not clear who laments, but from the consumer’s aspect it may be asked whether this small consumption is not brought about by an innate instinct in the direction of self-protection. Accessory Food Factors.—The Permanent Standards Committee of the Health Organisation of the League of Nations makes recommendations regarding standards for Vitamins ‘ A ’ to ‘ D ’—the standards to be kept at the National Institute for Medical Research. Crystalline products of high activity have been obtained. Calciferol is stated to be pure crystalline 4 D ’—v. p. 587 et seq. The pages devoted to Vitamin preparations of commerce {pp. 593, 594) will we hope be of service to the practitioner, and incidentally, we trust, to the manufacturers. They are, with one or two exceptions, all British products. Oleum Chaulmoograe and Oleum Hydnocarpae.—A great deal may be said for the curative powers in leprosy of Chaulmoogra Oil, given preferably in the form of Sodium salts of the constituent fatty acids. We have from time to time supplied preparations of this type for treatment to clinics and leprosy centres in various parts of the world, frequently with gratifying results—note, for example, those referred to on pp. 604, 605. . Ramifications and modifications are regarded with some degree o^ incredulity. To our mind, the position needs a 4 clearing house to sort the good from the bad. Why should Ethyl Chaulmoogra u or Ethyl Hydnocarpate have greater efficacy than the original oil . If modifications are better why do they not oust the parent compounds m toto ? Whatever preparation is used m trea mg eprosy we think its use need not be painful. . 7 ^ The name for B. lepra has been changed to Mycobacterium lepra. Oleum Morrhuae.—Scottish oils rank first, then Newfoundland, then Norwegian in Vitamin richness. This is as i s ou e . Sodium Morrhuate.—Chemical criteria aie provi e, experiments in 1931, for a pure Morrhuate. 1 ie aci sis i . yellow and of stated Iodine value. There s ou e matter insoluble in Ether. 1 ^ Qnrl nttpr It will be remembered that the ^saturated aci 3 , • j anq ^ fats were originally employed in treatment o vaT , removed, seems reasonable that Palmitic and Stearic ci 3 3 ag -n ^e The author employs a PryMS ^jf'^XcesVsotation of Sodium case ol the Chaulmoogrates. tins proau ^^anontionllv more Morrhuate as a sclerosing agent whic is Pj^ ^ evidenCe on elegant, as it will not deposit m cold ration for the the whole is that Sodium Morrhuate is a goo p treatment of varicose veins—v. pp• 613- • . - • • Insulin.—The system of dosage, detads of^diet^ec^ mque tion, treatment of coma, and so on, have preservation of are made from ox, others from pig’s Insulin, i.e. whether with or without C ^ > —v. p. 640. b The extent of general use of Insulin does not appear to be adequate, according to a M.R.C. Report—v. p. 638. Glowing testimonies of the extension of life that its injection causes are to be found. A medical man writes ‘ previously forced to give up work and live on starvation diet. Now able to do 14 hours’ work a day.’ Castor Oil as suspending agent is dealt with on p. 642. Since the war diabetes has apparently become more common. Peptone Therapy.—Desensitisation by immunisation with nonspecific protein continues to be an effective procedure, especially by means of graded doses of Peptone. This agent would seem more rational than the injection of a remote type of protein, e.g., of bacterial origin. Recent results are available on p. 670. Phenolphthalein. Sodium Fluorescein.—As the outcome of some interesting and valuable work in London a treatment of malignant disease has been evolved employing Sodium Fluorescein, followed by X-irradiation. No pain is caused. Results are given on p. 673. Other dyes have been used in similar manner—v. p. 674. Sodium Tetraiodophenolphthalein, etc.—The single-dose method of employing this chemical in cholecystography has advantages for oral administration. Limitations of the diagnostic capabilities of the test are brought out in a communication by an authority—v. p. 678. Intravenous use should be avoided. Two or three pages on the intravenous method have been omitted. Plumbum.—A matter of interest here is industrial and other types of poisoning by minute doses of Lead. An improved method of making Goulard’s Extract is given, with notes on assay from friends in Australia. Quinidine, Cinchonidine, Cinchonine and Cinchona Febrifuge.— The apparent ty diametrically opposed interests regarding the production of an adequate Cinchona Febrifuge for employing in malarious districts seem to need what is sometimes called the Mussolini touch.’ It is indeed a ‘ variable product.’ The latest requirement (from the Malaria Commission) is that Totaquina should contain 70% crystalline alkaloids of which not less than 15% should be Quinine. A friend, travelling in S. America, who has been much exposed to the possibility of malarial infection says ‘ Cinchona Febrifuge is useful but might be better borne and more effective if Quinine, and the useless and toxic alkaloids, were left out. The Quinine could be added if desired ’—v. p. 713. Our friend makes a useful suggestion as to Quinine Base and Sodium Bicarbonate Tablets for prompt effect—v. p. 718. Quinine-MannitoJ is a form of basic Quinine designed by the writer to replace acid solutions employed in the past, as being more likely to be absorbed by the blood, and less likely to produce bad effects at the site of injection. Although possessing obviously a scientific raison d'etre, clinical data upon the preparation are as yet not extensive. Quinisan is a new Quinine salt—v. p. 729. Quinine and Urethane Injection for varicose veins is discussed at length on pp. 734-736. The method was originally popularised in France. It is well spoken of by a surgeon at one of our leading hospitals. Quinine Prophylaxis in malaria. No general rule can be laid down. So far as an individual returning from the tropics is concerned, the evidence is that he, or she, should continue to take Quinine. With regard to prevention of malaria, there is new information on pp. 744-745 relative to the German synthetic, Plasmoquin. Atebrin (Syn. Erion) is also referred to. Its action is the reverse of Plasmoquin and it appears to be of little use in prophylaxis. Sodium lodoMethane Sulphonate.—This compound contains 52% Iodine ; it is given intravenously in pyelography, enabling a skiagram to be taken within a few minutes, the opacity persisting for a considerable time—v. p. 769. Stramonium.—Preparations of the leaf, especially in the form of Extract given in bold dose over lengthy periods have useful palliative effect in chronic encephalitic parkinsonism. Per os medication has marked advantages over irksome routine hypodermic injections —v. p. 780. Sulphur._To induce a febrile condition of short duration as a succedaneum to infecting with malaria in the treatment of geneial paralysis and other types oi nerve disease, graded doses oi a solution of Sulphur in Oil for injection intramuscularly have been tiied. The opinions expressed on the procedure diverge to some extent—v. p. 789. Sulphur found better than malaria where the patient is too ill to stand the latter treatment.—L.ii./32,387 for the two 1 of Veronal, xuo -p but the complexity of the resulting many types pounds which though Barbituric Acid. concluding yyp- "V , • of allied, cannot be considered derivatives o Reverting to Nembutal rectum, and by intravem consciousness and unconsciousness before inducing general anaesthesia. The subject of Basal Hypnotics is new and certainly in this country there is no extensive knowledge to enable anyone to dogmatise about it. We commend p. 811 et seq to those contemplating their employment. The current information from the makers of Nembutal lays stress on oral administration in preference. Perhaps a very pointed assessment of the entire subject is the finding by the Committee of Reference working in conjunction with the American Medical Association that Pernocton is not acceptable by them on the grounds, inter alia, that ‘ there is lack of critical evidence that routine intravenous injection of potent narcotics is desirable or safe *—v. p. 815. On p. 1062 there is a note by an authority to the effect ‘ the most valuable basal hypnotics are Paraldehyde or Avertin per rectum, or these Barbituric Derivatives.’ The position at the moment, so far as our knowledge goes, is that Paraldehyde, Nembutal and Avertin are most in demand for the purpose. In the Supplementary List one may point to the treatment of chronic ulcers from Chromium plating, Bulbocapnine in paralysis agitans and other types of tremor, Harmine and Harmaline, Kurchi Bismuth Iodide, Uroselectan (a Pyridine derivative). Soy Bean preparations, Xysmalobinum—a glucoside from the root of a S. African plant, and the relegation into this Supplement from the main body of the work of a number of medicaments not now in extensive demand. VACCINES.—As to Bacteriophages it is said that ‘ many disagree with the French authority profoundly.’ On the subject of Vaccine Therapy in general there are recent opinions on p. 900. Every Vaccine in the Chapter has been gone through ‘ on its merits ’ with regard to questions of dose, standards, etc., and these have been brought up to date as far as possible. Tuberculins.—B.C.G. for the prophylactic vaccination of infants receives criticism, for the most part destructive, we fear, on p. 934. vaccine Lymph.—The Ministry of Health Committee’s Report on Vaccination and the League of Nations’ Commission Report on post-vaccinal encephalitis are given in brief on pp. 944, 945, with reports on fatal cases. ANIMAL ORGANOTHERAPY.—The preparation of Powdered Liver Extract for administration in pernicious anaemia is referred to, with descriptions of several extracts of commerce, one of them for intravenous use. Its specific power in the affection is confirmed —v. p. 951. It may be added that recently (B.M.J. ii./32,349) Extracts of Fish livers were found potent in pernicious anaemia. The daily dose was 50 Gm. (= 1000 Gm. of raw fresh liver). This preparation is far cheaper than mammalian liver and its employment would be of help to the fishing industry around our coast. Muscle Extract (Extract of Heart Muscle) has been advised for use in heart affections. Numerous Ovarian Hormone preparations which claim to have effect in ovarian disorders, and to be of service at the climacteric, are dealt with on pp. 954-955. Pituitary Gland Extracts.—The Chapter has been revised, attention being paid, for example, to the separation of the Oxytocic and the Pressor principles, as distinct substances—v. pp. 955-963. Placental Hormones.—Emmenin has been used in dysmenorrhcea with encouraging results. It also corrects amenorrhoca of recent origin and has been found of use in other affections of women—v. p. 963. . . Stomach, Desiccated.—The Liver treatment of pernicious anaemia was followed by giving the whole desiccated hog stomachy It was shown that the stomach normally secretes a substance which can extract a blood-maturing principle from meat. It was concluded therefore that ‘ stomach feeding ’ would have the same effect as liver. Reports are very promising. Several British-made stomach extracts are described on pp. 965, 966. Suprarenal and its active constituent are now well known. Ike cortical hormone has been used in Addison s disease. Thyroid —The Pharmacopoeia Commission proposes to determine the Iodine* in dry Thyroid in terms of Thyroxin Iodme. Intravenous Dose Table—The remark from a practitioner added on v 1102 to the Intravenous Dose Table which was compiled o theJ last edition, that ‘ every kind of intravenous matroni except Normal Saline has at some time or other proved iatai is a sweep g one, though it may well be taken to heart as a geneiJ var g ^Two Interesting additions to the table are Glycerin and Morphine In the pages devoted to Legal Requirements (989-10.1) the following are noteworthy : , _ qo^* DANGEROUS DRUGS ACTS.—Our Summary , ; ' Ats°ni. ssjss 1925 Act (p. 999) dealt in Regulations arc of The 1928 Dangerous ^ers having dealings great importance to the Eroiession • m a somewhat in dangerous drugs. The RegUa ion^ » d jettering on pp. abbreviated form and with the main issues 1000-1004. This enactment to restrict The 1932 Dangerous Druf H Pi including Codeine and Dionme the manufacture of dangerous drugs melumi in the Far was ‘ initiated ’ on the basis of illicit r ^ “ East (p. 1006). Its raison d etre is expla l THERAPEUTIC SUBSTANCES REGULATIONS, 1931, supersede those of 1927, and hence our summary needed re-writing—v. w* 1016-1018. The THERAPEUTIC INDEX, pp. 1022-1094 has been subjected to the blue pencil and at the same time extended by many additions. International Atomic Weights.—The necessary corrections in atomic and molecular weights have been made in accordance with alterations that have been agreed upon since our last edition. Calculations are in the 1932 International Atomic Weights. The 1925 Weights, e.g. of Arsenic, Barium, Calcium (this year), Cerium, Hydrogen, Lead, Phosphorus, Potassium, Sulphur, inter alia were altered. The time entailed in working through the compounds containing Hydrogen, to make the molecular quotient up-to-date by the needed change from 1*008 of 1925 to the current 1*0078 is begrudged. Solubilities.—The Solubilities we print are intended to be reasonable solubilities such as would be needed at the dispensing counter under mean temperature conditions. Naturally, the generally used 15° C. approx, for room temperature has formed the basis for our determinations. The common-sense of the position is that a chemical is often far more soluble at summer temperature than in the winter, and annoyance, if not danger, may arise when a chemical deposits from solution. PATENTS AND DESIGNS ACT, 1932. This Act, which comes into operation November 1, this year, has important bearings for the medical worker and the manufacturer of chemicals for use in medicine. It amends the Patents and Designs Acts 1907 to 1928. A Patent may now be revoked on any of the following grounds : That the invention was the subject of a valid prior grant, that the first inventor was not the applicant, that the Patent was obtained in fraud, that it is not a manner of new manufacture, that the invention is obvious, or not useful, that the complete specification does not sufficiently describe the nature of the invention and the manner of its performance, that the invention claimed in the complete specification is not the same as that contained in the provisional specification or the same as that for which protection has been applied for outside the U.K., that the patent was obtained on false representation, that the invention was secretly worked on a commercial scale prior to the date of the Patent. . H Ike Comptroller is satisfied that the monopoly rights have been abused m such a way as unfairly to prejudice in the TJ.K. the manufacture, use, or sale of materials involved in the process of the invention he may order the grant of licences to the applicant or his customers. Clause 38a of the Principal Act (1907) is now amended to read, * Provided that in i elation to a substance intended for food or medicine a mere admixture resulting only in the aggregation of the known properties of the ingredients of that substance shall not he deemed to be a method or process of manufacture.' (See also p. 1021 for the Act of 1919.) A Conference on Medical Patents called by the B.M.A. in April 1932 passed resolutions to the effect that they considered the granting of further patents in the medical field undesirable, that the granting of patents for biological remedies (serums, toxins, vitamins, etc.) was detrimental to research, that the granting of patents for synthetic remedies is not so detrimental and that a system should be established by which such patents could be dedicated to the use of the public in this country white affording priority of action in other countries, and that they considered it undesirable that medical men should apply for patents in the medical field until some such system is established.—B.M.J. Supp., May 28, 1932, p. 256. These recommendations came too late for consideration in connection with the Patents and Designs Acts, 1932 (antea), but “ there is reason to believe that the Government will be willing to hear evidence as to the effect of patents on research and practice.”-—Sir H. H. Dale, B.M.J. Supp., July 2, 1932, p. 10. For further references see our p. 1021. TRADE MARKS .—As in past editions, we provide the numbers of British Registered Trade Marks in respect of remedies, etc., wherever applicable, with sjc preceding such Trade Marks. Our search for this purpose at the Patent Office covers Classes 1, 2, 3, 42 and 48, in the Public Register, as available up to the time of going to press. Further data on these Classes are on p. 1020. It may be of interest to remark that the earliest Mark in the book is 464, applying to 4* Nepenthe, while the current number at the Patent Office is over 535,000. Synonyms.—The application of Registered Trade Marks to 4 Brand ’ manufacturers’ Proprietaries opens up a big question. The author holds that a producer is justified in adopting the procedure. He sees no reason, for example, why a maker should not apply, if he wishes, the Trade Mark “ Empirin ” to Aspirin, or “ Sedasprin ” to Acetyl-Bromo-Salicylic Acid. These cases refer to relatively simple substances. It is, however, when we get further into chemical fields, e.g. amongst the complex Organic Arsenicals, that confusion is almost bound to occur owing to the absence of uniformity in chemical nomenclature, and the fact that the correct complete chemical composition is not always disclosed. To bring the matter to an issue, some useful official work might be done to clear up what promises to be a menace. This work would be appreciated by the Medical Profession, but it should be clearly understood that the British producer is justified in applying a Brand T.M. designation to his goods, and any type of substitution or ‘ passing off ’ should be prevented. We need not go deeply lrito l but some curtailment will be needed in the future, and it wou e to the good of all concerned. . Absence of Clearness in Prescribes’ Wishes.—-A small point arises which we 'would impress on the Profession regar mg some prescriptions, viz., that they are written in a way to ma e i mi possible for the dispenser to determine whether . e amoun b prescribed refer to the total amount to be divided m o a num e of doses, or whether the amounts apply to the smg e c ose, Q multiplied in consequence by the number of doses to he suppiie . In the case of definite chemical substances confusion is not sc» 1 ike y to occur, but we have known instances m respcc o re . _ indefinite medicaments, e.g. organotherapeutic prepara Thyroid-—-which are given bo^i in massive doses or m mtention- ally small ones, where it was impossible to say what wanted, owing to the vague wording of the prescrip ion. We would specially mention that the book has been almost entirely re-set- by our printers on their own initiative, and the result, we submit, calls for commendation of their efforts. They realised that the face of some of the standing type had become worn. This work, apart from involving heavy expense, entailed the most assiduous attention on the part of their readers (duplicated, of course, by the writer and bis staff). Slips, the result of high pressure effort, may have crept in ; a few that have been found are in a short list of Corrigenda, at the end of the Index. Users of the book will please be on their guard against mistakes, if any, that have escaped notice ; the pages now contain a considerable amount of detail. As this is the fiftieth year of publication it may be of interest to mention that the Extra Pharmacopceia was first published in 1883 as a collaboration between the late W. Martindale and the late W. Wynn Westcott. The book was continued under this conjoint authorship until the 10th Edition, in 1901. On the death of W. Martindale in 1902, his son, the present author, carried on the work through eight editions with Dr. Westcott, until the death of the latter in 1925. Since then the writer has issued the book with the aid of occasional assistance from medical friends on points of difficulty. Apart from the help of medica 1 men, he desires on this occasion to record his acknowledgment and appreciation of the services of his assistants—A. J. V. Field, Pharmacist; F. G. Dewdney, Chemist; and his Secretary, S. L. Ward, whose skill and perseverance have been of value in many particulars. The times of stress in the commerce of the world, and consequent International considerations to-day, create an inclination to dilate upon them in a few words. We wrote at length on the post-war position in our 17th Edition (1920), pointing out, broadly, that Science was not and had not been, International. There is no reason to regret one word that was penned on that occasion. (Reverting to our opening remarks, States with divergent commercial views can at least agree on important medicinal issues.) Since then the trade pendulum at home has swung first to the detriment, and then, we trust, to the advantage of the British manufacturer, but even this last mighty effort (for which foreigners cannot blame us) seems likely to be smirched by degrees of bitter internal competition, sometimes of an objectionable description. We plead heart and soul for more sportsmanship in our avocation. As a distinct and separate issue, the Medical Profession at home is again appealed to to support the British producer. It is a curious fact that with all his excellence the medical practitioner sometimes seems blind to the interests of the labour market. He has it in his power—wdtness the immense gathering of the Profession at the Centenary Exhibition of the British Medical Association in London a few weeks ago—to create employment within the Empire literally for thousands of men and women, where to-day the figure is of the order of tens or at most hundreds. We referred earlier in this preface to a M.R.C. statement of regrets that the general use of Insulin has been ungratifying ; on an allied train of thought, one might remark that there are many formulae (devised or suggested by medical men) for useful non-proprietary preparations in this book which could, we believe, enjoy greater popularity; their recommendation would certainly tend to create employment. Writing on behalf of manufacturing interests, makers of medicinal chemicals ask for a helping hand for their employees whenever it is possible to give it and they would urge the Profession to foster trade within the Empire. In closing these prefatory remarks, the writer hopes that some of the information embodied in this edition may prove helpful to suffering humanity in regaining and retaining—to borrow the phrase of an old friend—that priceless blessing, good health. W. HARRISON MARTINDALE. 12, New Cavendish Street, London, W.l. 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X) Mi be bn bn > s a a a a Jgaaaa o • 5s be (4 oJ 5s •2 ^ 2 t» 3ffl X™ O. _'>s_ So >> be u c8 5s T3 >» a a CO a a 2 •P4i 2 333 <X> <D 2 a a 2 %%< CD s.O CM £3 © •<s> £3 © © so £ £ © &s O M >» be to c3 5s T3 >5 a aa-aa a| nu a ® a *2 a a so © Ci r© 2 © ?££3 ti. £ ©>« v_ S> *s £ © £ Cl ©£3 , 5s •5^ ©' K) rs £ £ so £ © £ ©0 £ b o a 52 a Co a 2 a o-» a a> a be a a Xfl • r-4 o a <u XI Ph a a> a be a a 00 oo o CO co o 05 05 co S£ b oo o x o. ABBREVIATIONS. When the reference is to a periodical, the number put first is the number of the volume ; then follow the last two figures of the year, and the last number refers to the page, thus, B.M.J. i./32,250. A. R.—List of Reagents for Analytical Purposes prepared by a Special Committee appointed by the Councils of the Institute of Chemistry of Great Britain and Ireland and the Society of Public Analysts and other Analytical Chemists.—London, 1915. Allen.—Allen’s Commercial Organic Analysis.—Edited by S. S. Sadtler, E. C. Lathrop, and C. A. Mitchell, 5th Edn., 1924-1930, 8 vols. ; Vol. IX., 4th Edn., 1917, edited by W. A. Davis. Am. Jl. Ph.—American Journal of Pharmacy. Anal.—Analyst, W. Heffer and Sons, Ltd., 4, Petty Cury, Cambridge. Arch. Radiol.—Archives of Radiology and Electrotherapy of the British Assoc, for Advancement of Radiol, and Physiother. See also ‘ J.R.S.’ B. C.A.—British Chemical Abstracts. Branch A—pure Chemistry—is issued monthly with the Journal of the Chemical Society, London. B. & C.P.—British and Colonial Pharmacist, London, previously B. & C.D. B.J.R.—The British Journal of Radiology, W. Heinemann, London. See J.R.S. B.M.J.—British Medical Journal, London. B.M.J.E.—British Medical Journal Epitome. B.P.’14.—British Pharmacopoeia 1914 (previously indicated, Off.). B.P.’32.—British Pharmacopoeia 1932. B.Pt.—Boiling Point. B.P.C.—British Pharmaceutical Codex, 1923. B. P.C. 1894 or 1901.—Formulary of the British Pharm. Conference. Barnett.—Preparation of Organic Compounds.—E. De Barry Barnett (Churchill), 2nd Edn., 1920. Batty Shaw.—Organotherapy, or Treatment by means of preparations of Various Organs, H. Batty Shaw. 1905. Berl. Klin. Woch.—Berliner Klinische Wochenschrift, Berlin. ^ Brompton H.—Pharmacopoeia of the Hospital for Consumption anu Diseases of the Chest.—Brompton, Eleventh Edn., 1928. Brooke.—Tropical Medicine, Hygiene and Parasitology, by Gilbert R. Brooke, 1920. C. D.—Chemist and Druggist, London. C.H.W.—Eormulse of Chelsea Hospital for W omen, 1927. C.L.T.E.—Central London Throat and Ear Hosp. Pharm., 1924 and eaiher. C.R.—Changes proposed in the British Pharmacopoeia by Agreement for the Unification of Pharmacopceial 1 ^ • Drugs, Brussels, Nov. 29, 1906, from a report to the Ui^ruiacopceia Committee of the General Medical Council. Adopted Marc , This Committee issued further reports in 1908, 1910, 1911. cj. r .i. C.X.—Charing Cross Hospital Pharm., 1922. ,• Can. Form.—The Canadian Formulary of Unofficial Preparations Chemical Abstracts.—Published by the American Chininum.—Chininum Scriptiones Collectse, Bureau foi incr g of Quinine, Amsterdam, 1925. Clin. JJ.—Clinical Journal, London. qi , Colyer’s Dental Surgery and Pathology. Sixth Ed ., _ issues (previously Smale and Colyer s Diseases and 1 j , . D’Aca- Comptes Rend.—Comptes Rendus Hebdomadanes dts demie des Sciences. Cushny. Text Book of Pharmacology and Therapeutics, by the late Arthur R. Cushny, F.R.S., 9th Edn., 1928. jD.M.W.—Deutsche Medizinische Wochenschrift. Leipzig. ®*~Drugs or preparations coining within the scope of the Dangerous Drugs Acts, 1920 and 1923, and Consolidated Regulations, 1928. Digitalis Assay.—W. H. Martindale. A communication to the Pharmaceutical Society of Great Britain, 1913. (H. K. Lewis & Co., Ltd.). Disp. Art of Dispensing, published by The Chemist and Druggist, London. 10th Edition, 1926. Dixon.—Manual of Pharmacology, 7th Edn., 1929, by the late W. E. Dixon, F.R .S. E.—Pharm. of Evelina Hospital, Southwark, 1906. E.G.A.—Elizabeth Garrett-Anderson. Hosp. Pharmacopoeia, 1926 and earlier Edns., Euston Road, London (formerly Hew Hospital for Women). E. L.—Pharm. of East London Hospital for Children, 1929. Ec.Prod.I.—Economic Products of India, 1889-96. Ed.M. J.—Edinburgh Medical Journal. Edition XIX.—Nineteenth Edition of this work (1928). For References and comments unavoidably deleted. Emery.—Clinical Bacteriology and Haematologv, W. D’Este Emery, 6th Edition, 1921. Evans.—Evans’ Analytical Notes.—Evans Sons, Lescher and Webb, Ltd., London and Liverpool. F. E.—Farmacopea Espanola Octava Edicion, 1930. Madrid. T.L—Formula International^, International Agreement for Unification of Formulas signed 1906—cf. C.R. antea. Also Agreement made at Second International Conference at Brussels 1925 as stated in Final Report and Preliminary Draft. (P.J. ii./25,517 ; i./26,56 ; see also P.J. i./26, 41,42*294 ; ii./26,734 ; ii./27,372.) This Agreement was signed by a number of States With and without reservations at Brussels, Aug. 20,’29. See Preface. F.N.—Formulaire des Medicaments Nouveaux. Bocquillon-Limousin. F. Norsk.—Den. Norske Farmakop^, 1913. Norwegian Pharmacopoeia. Fit. Cx.—Codex Medicamentarius Gallicus, Pharmacopee Francaise. Paris, 1908, Matson et-Cie, 120, Boulevard Saint Germain. Fr. Cx. Supp. I. to V.—Supplement I (1920) to V. (Official from Apl. 5, ’26); also ‘ Nouveau Supplement,’ 1926, issued in book form. Finnemore.—Essential Oils, their Chemistry and Technology.—H. Finne- more, 1926. C.—The Essentials of Materia Medica and Therapeutics.—Sir A .E. Garrod, and Sir R. J. C. Tirard, 13th Edition, 1890. C.H.—Pharmacopoeia of Guy’s Hospital, 1916. G. N.C.—Pharm. Gt. Northern Central Hospital, 1908. (See also R.N.H.) Garrod.—Sir A. E. Garrod, Inborn Errors of Metabolism, 1923, and other communications. Gehe.—Gche’s Codex der Bezeiclinungen von Arzneimitteln, 5th Edn. 1929, und Nachtrag I., 1930 and II., 1931 (Dresden) and earlier issues. Ghosh.—Treatise on Materia Medica and Therapeutics, by the late R. Ghosh, L.M.S. Edited by B. H. Deare, Lieut.-Col. L.M.S. 12th Edn., 1930 (and Abstracts from earlier Editions). Glyn-Jones.—The Law of Poisons and Pharmacy. Sir W. S. Glyn-Jones. Gould.—Gould’s Medical Dictionary, by G. M. Gould, 9th Edn., 1930, and earlier issues. Gradwohl and Blaivas.—“ The Newer Methods of Blood and Urine Chemistry,’’ by R. B. H. Gradwohl, Chicago and St. Louis, and A. J. Blaivas, St. Luke’s Hospital, New York. Sec. Ed., 1920. Gt. Orm. H.—Gt. Ormond St. Hosp. Children Pharm., 1927. Green.—Green’s Encyclopedia of Medicine and Surgery. 11 vols., 1906-11, H. —Text Book of Practical Therapeutics, Hobart Amory Hare. 21st Edn., 1930 (and abstracts from earlier Editions). H.W.—W. Hale White, Materia Medica, Pharmacy, Pharmacology and Therapeutics, 20th Edn., 1931, and previous issues. Hager.—Handbuch der Pharmaceutischen Praxis, 1907 and 1925. Hewlett.—Serum and Vaccine Therapy, T. R. Hewlett, 2nd Edition, 1910, also Bacteriology, 8th Edition, 1926. Hutchison—R. Hutchison. Food and Principles of Dietetics Edward Arnold, London, 6th Edn., 1926. I.C. Add.—Indian and Colonial Addendum (1900) to the B.P., 1898 I.D.C.—Indigenous Drugs Committee, 2nd Report, Simla, 1909 ' Third Report, Calcutta, 1916. I.M.G.—Indian Medical Gazette. l. V.—Iodine Value. Int. Conf. Trop. Am.—Proceedings of the International Conference on Health Problems in Trop. America, 1924, United Fruit Co., Boston Int. Cong.—VHth International Congress of Applied Chemistry, London May, 1909 (papers read at) ; also VUIth Congress, Washington, 1912 ’ J.C.S.A.—Jl. of the Chem. Soc. Abstracts. London. See also B.C.A. J.C.S.T.—Journal of the Chemical Society. Transactions. London. J. R.S.—Journal of the Roentgen Society, London, and as from Jan 1924 “ The British Jl. of Radiology, Rontgen Society Section, incorporating the Jl. of the Rontgen Society.” See also Arch. Radiol. Jl. A.M.A.—Journal American Medical Association, Chicago. Jl. Am, Ph.A.—Journal of the American Pharmaceutical Association. JL Ph. and Exp. Ther.—The Journal of Pharmacology and Experimenta Therapeutics. Edited by J. J. Abel (The Johns Hopkins University, and Walter E. Dixon (University of Cambridge), Baltimore and London). Jl. R.A.M.C.—Journal of the Royal Army Medical Corps (Mthly.). Jl. R.N.M.S.—Journal of the Royal Naval Medical Service (Qtrly.). Jl. Trop. Med.—Journal of Tropical Medicine and Hygiene, London. K. C.H.—King’s College Hospital Pharmacopoeia, 1927. Knox.—Radiography & Radio-Therapeutics, by Robert Knox. 4th Edition in 2 vols. (Vol. II, completed and edited by W. M. Levitt, 1923-32), L. —The Lancet, London. L.H.—Pharmacopoeia of the London Hospital, 1925 and earlier Edns. L. L.—London Lock Hospitals Pharmacopoeia, 1919. M. —Annual Report of E. Merck. M. & R.—R. Muir and J. Ritchie, Manual of Bacteriology, 9th Edition, 1932 and earlier issues. M.A.—Medical Annual. M.Pt.—Melting Point. M.R.C. or Med. Res. Counc.—Medical Research Council (formerly Med. Res. Committee, National Health Insurance, now incorporated by Royal Charter, York Buildings, Adelphi, W.C. 2, and Nat. Inst. Med. Research, Hampstead, N.W. 3, London. m. a.—Milliampere. . 4 M.P.C.—The Medical Press and Circular, London. M. Index.—Merck’s Index, 5th Edn., 1927, Darmstadt. Mann.—J. Dixon Mann, Physiology and Pathology of the Urine, 2nd Edition, 1908. Manson.—Tropical Diseases. A manual of the Diseases of warm climates. Sir Patrick Manson, G.C.M.G., 9th Edition, 1929. May.—Chemistry of Synthetic Drugs. Percy May, 3rd Edn., 1921. Mid. H.—Pharm. Middlesex Hospital, 1927, also prev. Edns. Mitchell Bruce.—Materia Medica and Therapeutics, 13th Edition, by the late J. Mitchell Bruce and Walter J. Dilling, 1926. Mod. Tech, in Treatment.—Modern Technique in Treatment, Vols. 1-4, 1925-1928, The Lancet, London. Morgan.—G. T. Morgan, F.R.S., Organic Compounds of Arsenic and Antimony, 1918. Murrell.—“ What to do in cases of Poisoning,” by the late Williaip Murrell, 13th Edition, 1925, revised by P. Hamill. Myers.—Practical Chemical Analysis of Blood, by V. C. Myers, 2nd Edn., 1924 Na.—“ Nature,” London. N. E.H.—Pharm. of the North-Eastern Hosp. (now called Queen’s Hosp. for Children), 1927, and earlier issues. N.F.—National Formulary of Unofficial Preparations issued by the Am. Pharm. Ass., 4th Edn., 1916 (pubd. 1919), and 5th Edn., 1926. N.H.I.—National Formulary for National Health Insurance Purposes, with 1930 alterations. Issued by the B.M.A. for the National Insurance. Defence Trust. N.H.W.—Phannacopoeia of the New Hospital for Women, London, 1904. ^ Tor some formulae not contained in E.G.A. q.v. N.N.R.—New and Non-official Remedies, Amer. Med. Assn. 1931 and earlier issues. N. S.D.—National Standard Dispensatory in accordance with U.S. VIII. Newth.—G. S. Newth, Test Book of Inorganic Chemistry, Revised Edition, 1923. O. R.—Optical Rotation of Essential Oils (100 m.m. tube) at 20° C. P. G.V.—Pharmacopcea Germanica, 5th Edition, 1910. P.G. VI.—Deutsches Arzneibuch, 6th Edn., 1926. P.I.—Pharmacopoeia of India, 1868. P.J.—Pharmaceutical Journal and Pharmacist, London. P.J.F.—Pharmaceutical Journal Pormulary. P.L.-—Pharmacopoeia Londinensis, 1851. P.M.C.E.—Select Parliamentary Committee on Proprietary Medicines Enquiry, 1912-1913. P.N.E.—Proposed National Formulary (U.S.). P. Off.—Proposed Official recommendations as embodied in Pharmacopoeia Commission Reports of Sub-Committees issued by General Medical Council 1930 onwards. P.R.—Perfumery and Essential Oil Record. London. P.R.S.M.—Proceedings of the Royal Society of Medicine, London. IS!'— Part I. Poisons Schedule, 1908. See Vol. I. E.P. Edn. XIX., p. 998. CB).—Part II. Poisons Schedule, 1908. See Vol. I. E.P. Edn. XIX., p. 999. P. Argent II.—Pharmacopoeia of the Argentine Republic, 2nd Edition, 1919. P• Austr.—Pharmacopoeia Austriaca, viii.; 1906. P. Aus. Add. Additamenta. P. Belg. IV.—Pharmacopee Beige, Quatrieme Edition, 1930. P. Bor.—Pharmacopoea Borussica. (Russian.) Ed. VI.. 1910, and Edn. VII (1926), (State Pharmacopoeia). P. Dan.—Pharmacopcea Danica, Edn. vii., 1907. P. Helv.—Pharmacopoea Helvetica, Ed. IV., 1907. P. Hung,—Pharmacopoea Hungarica, Editio Tertia, 1909. P. Ital. V.—FarmacopeaUfficiale del Regno D’Italia Quinta Edizione, 1929. P. Jap.—Pharmacopoeia Japonica , III., 1907, and 1912 and 1913 revisions. P. Jap. IV.—Pharmacopoeia Japonica IV. Official as from April 1, 1921. I • Svec.—Pharmacopoea Svecica (Swedish), Ed. ix., 1908 and Ed. x., 1925. Ph—Pharmacopedia by E. White and J. Humphrey, 1909. Ph. Form.—Pharmaceutical Formulas, 9th Edition, Second Reprint, Oct. 1921, by Peter MacEwan, and 10th Edition, Vol. 1, 1929, revised by S. W. Woolley and G. P. Forrester. I’ll. Mex.—Farmacopea Mexicana, 5th Edn., 1926. Ph. Ned.—Pharmacopoea Nederlandica, Fourth Edn., 1906, and Supplement, 1914 and 5th Edn., 1926. Ph. Notes.—Pharmacy Notes from various parts of the world. W. H. Mart indale, 1907. Pharmacol.—Chemical Basis of Pharmacology, Francis Francis and J. M. I ortescue-Brickdale, 1908. Plaistow.—Pharm. St. Mary’s Hosp. Women and Children, Plaistow, 1913. Pr.—The Practitioner, London. Pres. The Prescriber, monthly, Thos. Stephenson, Edinburgh. Broc. Chem. Soc.—Proceedings of the Chemical Society, London. Prov Hosp. Provincial Hospital Pliarmacopceias, issued by the Chemist and Druggist, London, 1913. Q. J P.—Quarterly Jl. of Pharmacy, Pharm. Soc. of Gt. Britain, London. Queen s Hosp. for Children, Bethnal Green, 1927, see N.E.H. ^—Handbook of Therapeutics, by Sydney Ringer and Harrington Sains- bury, 13th Edition, 1897 and earlier issues. RR-Rf* -Pharm. of Royal Dental Hospital, London, 1926. -H^—Pharmacopoeia of the Royal Free Hospital, London, 1922. R. I.—Refractive Index. - Pharm. Royal Northern group of Hospitals, 1930 (previously Great Northern Central Hospital), London. R.O.H.—Pharmacopoeia, Royal London Ophthalmic Hospital, 1929. R-V.I.—Pharmacopoeia, Roy. Victoria Infirmary, Newcastle-on-Tyne, 1922 Rem—Remington’s Practice of Pharmacy, 7th Edn., 1926. Rutherford.—Radioactive Substances and their Radiations, 1912. E. Rutherford, F.R.S. Nobel Laureate, 1913. S.H.—Pharm. Samaritan Free Hospital, 1926 and earlier Edns. S.H.D.—Steevens’ Hospital (Dublin) Formulary, 3rd Edn., 1930. S. V.—Saponification Value. St. Bart’s. H.—Pharm. St. Bartholomew’s Hospital, 1921. St. G. H.—Pharm. St. George’s Hospital, 1927. St. J. H.—Pharm. St. John’s Hosp. Skin Diseases, 1926 and earlier Edns. St. M.’s H.—Pharm. of St. Mary’s Hospital, 1925 and earlier Edns. St! Th. H.—Pharm. St. Thomas’ Hosp., 1931. Salvarsan.—Salvarsan : Its Chemistry, Pharmacy and Therapeutics.— Martindale and Westcott, 1911. . Schmidt.—Ausftihrliches Lehrbuch der Pharmaceutischen ^hemie, Vol. I. (Inorganic), New Edition in preparation, and Vol. II. (Organic), Part 1, 1922 and Part II. 1923 ; by the late Dr. Ernst Schmidt, Marburg,Germany. Secret Remedies.—Secret Remedies, What they Cost and What they Contain.—Brit. Med. Association, Lond., 1909 ; also * More Secret SeidelL—Atherton Seidell, Solubilities of Organic Acids and Salts. Washington, 1910 ; also Solubilities of Inorganic and Organic Substances, 2nd tjyIti 1Q20 Soddy.—Interpretation of Radium.—F. Soddy, M.A., London, 4th Edition, 1920. (First Edition, 1909.) Also Chemistry of Radio-Elements, Part 1 2nd Edition, Part 2, 1914. . . , , Q.r—Specific Gravity at 15-5° C., unless otherwise stated. Stitt —Practical Bacteriology, Blood Work and Animal Parasitology, E R Stitt, 8th Edition, 1927, and earlier issues. . , . nr.Q Svstem of Dietetics.—Edited by G. A. Sutherland, by various authors, 190b. T^g —Tropical Diseases Bulletin issued by the Trop. Dis. Bureau, Ldn. TH—Pharmacopoeia of the Hospital for Diseases of the Throat, 1914. T. m!—Trade Mark (British) with Registered No. m brackets Trxifcrpn Ada B_Profitable Herb Growing and Collecting, 1916. , Thorpe.—The late Sir Edward Thorpe, Dictionary ?f Apphed Chemistry 1921-1927, 7 vols. Vols. VI. and VII. with assistance of H. lorster Morlev and numerous contributors. nf Taiaco in Tibbies.—William Tibbies, Theory of Ions a consideration of its ph Biologv and Therapeutics.—Chicago, 190b. m.,, v 4+^ T.da 1991 l:R!IVM"nlctfons°rf <* »al M*icta°; u OH-Pharm. of the University College Hospital 1926 and earlier Edns. uL.C. •«^-Fourteenth Annual Beport U. S.D.—Dispensatory of the United States, 19th Edition, xy. , Edition, 1918. 21st Edition 1926. Tenth Decennial Revision, Uffi2?(Offic^JanuSy 1, 1926) ; also U.S. 1^,1915’ eta. ^ Vi? Pa^Snn? city of’Sndon H S for Diseases of’the Heart and Lungs, Victoria Park, E. 2, 1926. w goho gquare, 1907. W —Pharmacopoeia of the Hospital for Women &ono oqu , W.H.—Westminster Hospital ph^r^®p(^1r0,ne? fjr N.E. London. w w>w _w. Wynn Westcott, sometime Coroner ioi borator in this work 1883-1925. Pattison Muir, and H. Watts.—Dictionary ofChemistry. M. M.■ mu , .SIiliSSSSE*««• 511 w‘s' Colla- Forster [n connection with a text heading signifies ^ g^giSe^The * is only WEIGHTS AND^ MEASURES. Within the Empire a dual system of Weights and Measures is commonly employed, viz., the Metric and the Imperial. In making pharmaceutical preparations and in analytical work the former is chiefly used, but in matters relative to prescribing it is to some extent unfortunate that we do not come into line with other countries. The continued use of the Imperial System, when speaking of small doses, e.g., -g-J-n- grain, grain, etc., has, it is true, a little in its favour in place of the more cumbersome 0-0003 Gm. and 0-0006 Gm., but this is only a matter of usage and on broad lines the existence of a dual system cannot be commended for pharmacopoeial requirements. The incessant rapid calculations needed by the pharmacist in trans- posing from one type of figures to the other are irritating and they should be prevented whenever possible as they constitute a possible source of error. Certainly it is gratifying that during the last ten years or so Metric Measures have markedly superseded the Imperial System for all purposes relative to medicinal treatment. Metric Measures in the B.P. ’32 are to be graduated at 15° while by the Weights and Measures Act (1878) Imperial Measures are graduated at 16-7° C. (62° F.). For determining Specific Gravities the temperature 15-5° C. (60° F.), is used in the British Pharmacopoeia. The recently issued P. Ital. V., P. Belg. IV. and F.E. VIII. specify 15° unless otherwise stated. U.S.X. employs mostly 25° C. The Beard of Trade, May 1, 1908, recognised the word ‘ mil ’ as a short official designation for the millilitre, ‘ decimil * for -fa of a millilitre, and ‘ centimil ’ for of a millilitre. These terms have been used in the British Pharmacopoeia. In our pages formulae are given in ‘ proportional parts,’ solids by weight, and liquids by measure, as the dispensing of liquids in Great Britain is always conducted by measuring. Exceptions to this rule are always made clear in the text. In those, therefore, in which proportional parts ’ are used, the quantities of solids and liquids may be taken respectively in grammes and cubic centimetres, ounces and fluid ounces, grains and (to be strictly accurate) grain measures, but minims in place of the latter will often be used, and only cause one-eleventh minus error. In the body of the work (but not always in the Supplementary List of Drugs or in the Index) the approximate doses of each drug and preparation in terms of the metric system follow those of the Imperial System. For all practical purposes, a fluid drachm may be considered as 4 cubic centimetres ; 60 grains as 4 grammes ; the avoirdupois ounce (about 28g grammes) may be taken, as 30 grammes; the fluid ounce as 30 cubic centimetres ; and the pound avoirdupois as half a kilogramme (approximately it is nine-twentieths). In using the metric system, prescribers may consider the British grain as 60 milligrammes (nearer 0-065 Gm.), 1J grains as 0-1 Gm,, and 15 minims (nearer 17 minims) as approximately 1 cubic centimetre. (See table, pp. xlii and xliii.) Note.—U.S.X. also makes 15 minims equivalent to the Cc. The following approximations will also be useful:— 80 minims = 5 Cc.* = 1 teaspoon. 240 minims = 15 Cc.* =/ 3 teaspoons. I 1 tablespoon, f 12 teaspoons. 960 minims = 60 Cc. = ■< 4 tablespoons. L 1 wineglass, f 16 tablespoons (about). 250 Cc. = 50 teaspoons = ■< 4 wineglasses. I 1 tumbler. The word gramme (preferably shortened to Gram), is contracted ito Gm., and the words cubic centimetre to Ce. The contraction Gm. in heavy type and with a capital initial letter distinguishes it from gr., the usual (though dangerous) contraction for grain. The latter is only used in our pages in the index for sake of brevity. By Article 9 of the International Agreement respecting the Unification of Pharmacopoeial Formulas for Potent Drugs signed at Brussels on Aug. 20, 1929, the contracting parties adopt a Standard Drop- bottle which gives (at the temperature of 15° C.) 20 drops of distilled water per Gm. Farmacopea Oficial Espanola VIII. and the French Codex give very complete Drop Measure Tables. The sizes of bottles in most frequent use in France are :— 1,000, 500, 250, 200, 125, 100, 50, and 25 cubic centimetres. Mixtures may be prescribed in 125, 200, 250, or 500 Cc. and drops should be ordered in quantities of 15, 30, and 60 Cc.' Solubilities are taken at 15*5° C. Refe fences. The Metric System.—A treatise on its adaptability and utility in science and commerce.—W.H.M., 1905. _ ^ ,r T Cumbersome British Weights and Measures.—Johnston-La vis, B.M.J. ii./12,527. . . _ a Max. Single and Daily Doses of Numerous Remedies, Acetanilide, Arsemous Acid, Cocaine, Morphine, etc.—L. i./i3,1491. Advocacy of Metric Doses in the B.P.—C. O. Hawthorn, L. 1/14,23. _ Metric System in prescribing. Useful general summary. B.M.J. i./22,4UU. See also W. C. Sillar, L. 0/22,469,492. . . Gm. and Cc. (for gramme and millilitre) would save unnecessary printing in the B.P.—D. B. Dott, P.J. 0/30,214. i A Suggested reforms by modifying Metric System and introducing Mmpar, a new equivalent unit of weight—480 to the ounce avoir. 4. J. Smith, i .J. [.13O.238. 1 • t n n ‘ Anomalous Weights and Measures. Major R. I. Lasker, Chairman L.C.• in his Presidential Address to the Incorporated Society of Inspectors, point bo the large expenditure of public money spent on yerihcation 0:1qtmio 9, y The ‘ reputed quart ’ contains two-thirds of the Imperial Quart.- P.J. n•/ 3 , * These quantities are respectively those recognised by the l R. Cx. coffee spoonful (teaspoonful) and a tablespoonful (Cuilleree a boupe;. According to the P. Beig.— La cuilleree a cafe holds 4 Gm. of water. La cuilleree a dessert holds 10 Gm. of water La cuilleree a bouche ou a Soupe holds 15 Gm. of water. Generally speaking :— r One teaspoon = J yc- One dessertspoon = ° One tablespoon = 15 to 16 Cc. V as also in J PR. CX. METRIC WEIGHTS AND MEASURES AND THEIR EQUIVALENTS. 1 Gramme (or Gram.) (Gm.) .=15*4323564 grains. 1 Centigramme (Cgm.) ... ... ... = 0*154323 grain. 1 Milligramme (Mgm.) .= 0-015432 grain. 1 Litre .=35*196 fluid ounces. 1 Cubic Centimetre (Cc.).=16-9 minims (nearly). 1 Metre .=39*370113 inches. The Gramme has its decimal multiples—Dekagramme, Hectogramme, and Kilogramme ; and divisions—Decigramme, Centigramme, and Milligramme. The Litre and Metre have their corresponding decimal divisions—Decilitre, Centilitre, and Millilitre,—and Decimetre, Centimetre, and Millimetre. In Continental States, where this system is now generally adopted for the dispensing and preparing of medicines, all liquids are weighed, and the terms Gramme, Centigramme, and Kilogramme only are used. This avoids the possibility of errors, which the similarity of the names Decagramme and Decigramme might lead to, but if the Greek prefix deka were always spelt with a K this possibility of error would not exist. Furthermore, the quantities of the ingredients in prescriptions are sometimes written in decimal proportions, the gramme being understood to be the unit; the name of the integer is generally not mentioned thus : Rhubarb 35* means 35 grammes of Rhubarb „ *035 ,, 35 milligrammes The following abbreviations are oificially used in all French educational establishments :— Myriametre, mam Kilometre, km Hectometre, hm Dekametre, dam Metre, m Decimetre, dm Centimetre, cm Millimetre, mm Dekastthe, das Stere, s or m3 De cist ere,ds tonne, t Quintal metrique, q Kilogramme, kg Hectogramme, hg Dekagramme, dag Gramme, g Decigramme, dg Centigramme, eg Milligramme, mg Kilolitre, kl Hectolitre, hi Dekalitre, dal Litre, 1 Decilitre, dl Centilitre, cl Millilitre, ml Hectare, ha Are, a Centiare, ca or m2 PERCENTAGE AND GRAINS PER FLUID OUNCE EQUIVALENTS. Where Percentage Solutions are mentioned, it is intended that 100 Cc. shall contain n Gm. or that 100 grain-measures of the finished solution shall contain n grains of the substance, a 50 per cent, solution of Cocaine Hydrochloride will contain 50 Gm. in 100 Cc. or 50 grains in 100 grain-measures. Grains per Grains per Grains per % fluid ounce 0/ /o fluid ounce o/ /o fluid ounce 10*0 43*75 4*5 19*7 1*4 6*1 9*5 41*56 4*0 17*5 1*3 5*7 9*0 39*4 3*5 15*3 1*2 5*25 8*5 37*2 3*0 13*1 1*1 4*8 8*0 35*0 2*5 10*95 1*0 4*4 7*5 32*S 2*0 8*75 0*9 3*95 7*0 30*6 1*9 8*3 0*8 3*5 6*5 28*45 1*8 7*9 0*7 3*05 6*0 26*25 1*7 7*45 0*6 2*6 5*5 24*05 1*6 7*0 0*5 2*2 5*0 21*9 1*5 6*55 0*4 1*75 APPROXIMATE EQUIVALENTS. WEI3HTS. IMPERIAL TO METRIC. grain. Gm. 1 10 ou = 0*000065 FO = 0*0003 T<X0 = 0*0008 1 ¥¥ — 0*001 l = 0*0013 1 io — 0*0015 1 3? -: 0*002 1 ¥¥ = 0*0025 l 2<y = 0*003 i Tff 0*004 1 T¥ 0*005 1 ID —- 0*008 1 8 = 0*008 1 6 — 0*01 i a = 0*012 grain. Gm. i = 0*016 I = 0*02 i = 0*03 1 = 0*05 1 = 0*08 grains n = o*i 2 = 0*12 3 -= 0*2 4 = 0*25 5 = 0*3 6 = 0*4 8 = 0*5 10 = 0*6 12 = 0*8 grains. Gm. 15 = 1*0 20 = 1*2 30 = 2*0 45 = 3*0 60 = 4*0 90 - 6*0 120 = 8*0 150 =10*0 180 -12*0 i ounce (av*.)=15‘0 1„ =30*0 (or nearer 28*35. 1 pound = 453*59 WEIGHTS. METRIC TO IMPERIAL. 1 kilogramme ... = 2 1b. 3| oz. 500 Gm. ... = 1 „ X 8 9? 100 ,, . 25 ,, . 10 ■L V y y ••• ••• ••• 1 p y • • • ••• ••• ... = 3-J oz. = ¥ >> _ 1 ... 8 >» ... = 15*43 grains. J „ or 500 milligrammes ... = 7*7 9 9 MEASURES. IMPERIAL TO METRIC. Cc. fluid oz. Cc. minims. minim. Cc. 1 = 0*03 1 = 0*06 minims. 2 = 0*12 3 = 0*2 4 = 0*25 5 = 0*30 6 = 0*4 8 = 0*5 10 = 0*6 12 = 0*8 15 = 1*0 20 = 1*2 25 = 1*5 30 = 2*0 40 = 2*5 45 = 3*0 60 = 4*0 90 = 6*0 120 = 8*0 240 =15*0 1 = 30*0 fluid ozs. 2 = 60*0 4 = 115*0 5 = 140*0 6 = 170*0 8 = 230*0 10 = 280*0 20 = 568*0 gallon litres. 1 = 4*538 ME AS - RES. METRIC TO IMPERIAL. 1 Cc.= 15 (nearer 17) minims. 1 litre ... ... ... ••• = 1 pint 15 A. oz. appiox. 1 micromillimetre = 1 micron =* 1 millimetre = 1 centimetre = 1 decimetre = 1 metre = MEASURES OF LENGTH. T.(J_iTj7Jcr millimetre, usually represented by millimetre, or 1 micrometre, ,, ,, /*• 0.03937 inch. 0*3937 inch. 3 037 inches 39*370113 inches or 1 yard 3*37 inches nearly. NEUTRALISATION TABLE. Ammonium Carbonate Magnesium Carbonate Potassium Bicarbonate Sodium Bicarbonate Sodium Carbonate ( + 10 H20) 10 grains neutralise f Citric Acid grains. 13 J 14 1 7 84 5 l Tartaric Acid grains. 14 16 7f 9 +1 Lemon Juice (freshly expressed from Citrus Medico, var. B. Limonum) contains from 30 to 40 grains Citric Acid per ounce. A good lemon yields on average an ounce of juice. Arithmetical Memoranda. Ratio of circumference of a circle to its diameter = jz = 3-14159. Circumference of a circle - 2 7U r. Area of a circle = tt r2. Area of a Triangle with base a and height h = i a h. Volume of a Cube with length l~P. Volume of a Cylinder = 7U r- h. If r and h be in inches, this divided be 277-278 the result is in gallons (water). A olume of a Cone = —-— Volume of a Sphere = —rz A gallon of Water weighs 10 pounds ; 1 gallon contains 277-278 cubic inches. A ‘ Corbyn ’ = 40 ounces fluid (1 quart). A ‘ Winchester ’ quart = 80 ounces fluid (4 gallon). Lead and Arsenic Calculations. 50 parts in 1,000+00 = 1 in 20,000=0-005% too grain per lb. =approx. 1*4 parts per million. 1% =1 in 100 0-1% =1 in 1,000 0-01% =1 in 10,000 0-001% =1 in 100,000 0-0001% =1 in 1,000,000 0-0050% =50 in 1,000,000 WATER ANALYSIS TRANSPOSITIONS. To transpose grains per gallon into parts per million multiply by To transpose grains per gallon into parts per 100,000 multiply by ^ To transpose parts per million into grains per gallon, multiply by To transpose parts per 100,000 into grains per gallon, multiply by RELATION OE VOLUME TO MASS. 1 minim = the volume at 16-7° C. of 0-9114583 grains of water. 1 fluid drachm = the volume at 16-7° C. of 54-6875 grains of water. 1 fluid ounce = the volume at 16-7° C. of 437-5 grains of water. 109-7143 minims (taken as 110 minims) = the volume at 16-7° C. of 100 grains of water. CALCULATION OF A DOSE FOB MAN FROM KNOWN DOSE FOB AN ANIMAL. The Rate of Catabolism of an animal is not proportional to size or weight but approximately to the body surface. Surfaces of solids of the same shape are proportional to the two-thirds power of their volumes (i.e., the cube root of the square of the volumes). [ Since the specific gravity of animals varies only slightly, their body surface is a function of the two-thirds power of their weight. This relation is expressed by Meeh’s Formula, S = &(W)^, where S is the surface in square centimetres, W is the weight in grammes, i and k is a factor which is nearly constant for all animals of the same shape. (See Armsby’s “ Nutrition of Animals ”—Macmillan). (Rubner gives the following values for k : Man, 12*3 ; Dog, 10-3—11-2; Rabbit, 12-0—12-9; Cat, 9-9 ; Guinea Pig, 10-5.) A formula for calculating the dose for man. This assumes that k, the factor, is the same for man and animals, and is approximate only, as the values actually differ somewhat. If the dose for man and the animal should be proportional to their i rates of catabolism, i.e., to their body surface, then : Dm _ Sm _ k(M)s Da Sa k(A):1 Dm = Dose for man in Gm. Da = Dose for adult test animal in Gm. Sm = Body surface of man. Sa = Body surface of animal. M = Wt. of man in Gm. A = Wt. of test animal in Gm. Hence Dm — M) X Da = 1590 X Da (A)* (A)3 for a 10-stone (63*5 kilo) man. Thus, a dose of 1 Gm. per kilo for an animal is equivalent to 15-9 Gm., not 63-5 Gm., for a 10-stone man. No exact method of calculating the corresponding dose for man from that of an animal is known. The figure obtained by the above formula is useful as a guide, but allowance must still be made for the fact that man mav be more sensitive to the drug than the animal. TRANSPOSITION TABLE OF DOSES STATED FOR MAN IN MGR. PER KILO. TO MAN’S WEIGHT. Mgr. per Kilo. 1 = 1 grain (0*065 Gm.) for a 10-stone (03 5 kilo) man 5 = 5 ,, (0-32 Gm.) ,, ,, >> >> 10 = 10 ,, (064 Gm.) ,, *> ? j 50 = 50 ,, (3*20 Gm.) ,, «, As 5 mgr. per kilo more nearly — 4‘9 grains (0*318 Gm.) per 10-stone man, the above figures contain a 2% error in excess. THERMOMETRIC EQUIVALENTS. °c. °F. °C. °F. °C. °F. °C. °F. °C. °F. °C. °F. _ _ 9 48-2 62 143-6 117 242-6 172 341-6 227 440-6 40 40-0 10 50-0 63 145-4 118 244-4 173 343-4 228 442-4 39 38-2 11 51-8 64 147-2 119 246-2 174 345-2 229 444-2 38 36-4 12 53-6 65 149-0 120 248-0 175 347-0 230 446-0 37 34-6 13 55-4 66 150-8 121 249-8 176 348-8 231 447-8 36 32-8 14 57-2 67 152-6 122 251-6 177 350-6 232 449-6 35 31-0 15 59-0 68 154-4 123 253-4 178 352-4 233 451-4 34 29-2 16 60-8 69 156-2 124 255-2 179 354-2 234 453-2 33 27-4 17 62-6 70 158-0 125 257-0 180 356-0 235 455-0 32 25-6 18 64-4 71 159-8 126 258-8 181 357-8 236 456-8 31 23-8 19 66-2 72 161-6 127 260-6 182 359-6 237 458-6 30 22-0 20 68-0 73 163-4 128 262-4 183 361-4 238 460-4 29 20-2 21 69-8 74 165-2 129 264-2 184 363-2 239 462-2 28 18-4 22 71-6 75 167-0 130 266-0 185 365-0 240 464-0 27 16-6 23 73-4 76 168-8 131 267-8 186 366-8 241 645-8 26 14-8 24 75-2 77 170-6 132 269-6 1S7 368-6 242 467-6 25 13-0 25 77-0 78 172-4 133 271-4 188 370-4 243 469-4 24 11-2 26 78-8 79 174-2 134 273-2 189 372-2 244 471-2 23 9-4 27 80-6 80 176-0 135 275-0 190 374-0 245 473-0 22 7-6 28 82-4 81 177-8 136 276-8 191 375-8 246 474-8 21 5-8 29 84-2 82 179-6 137 278-6 192 377-6 247 476-6 20 4-0 30 86-0 83 181-4 138 280-4 193 379-4 248 478-4 19 2-2 31 87-8 84 183-2 139 282-2 194 381-2 249 480-2 18 0-4 32 89-6 85 185-0 140 284-0 195 383-0 250 482-0 17-778 o-o 33 91-4 86 186-8 141 285-8 196 384-8 251 483-8 34 93-2 87 188-6 142 287-6 197 386-6 252 485-6 — + 35 *95-0 88 190-4 143 289-4 198 388-4 253 487-4 17 1-4 36 96-8 89 192-2 144 291-2 199 390-2 254 489-2 16 3-2 37 98-6 90 194-0 145 293-0 200 392-0 255 491-0 15 5-0 37- 5 99-5 91 195-8 146 294-8 201 393-8 256 492-8 14 6-8 38 100-4 92 197-6 147 296-6 202 395-6 257 494-6 13 8'6 39 102-2 93 199-4 148 29S-4 203 397-4 258 496-4 12 10-4 39.5 103-1 94 201-2 149 300-2 204 399-2 259 498-2 11 12-2 40 104-0 95 203-0 150 302-0 205 401-0 260 500-0 10 14-0 41 105-8 96 204-8 151 303-8 206 402-8 261 501-8 9 15-8 42 107-6 97 206-6 152 305-6 207 404-6 262 503-6 8 17-6 43 109-4 98 208-4 153 307-4 208 406-4 263 505-4 7 19-4 44 mi-2 99 210-2 154 309-2 209 408-2 264 507-2 6 21-2 45 113-0 100 212-0 155 3110 210 410-0 265 509-0 5 23-0 46 114-8 101 213-8 156 312-8 211 411-8 266 510-8 4 24-8 47 116-6 102 215-6 157 314-6 212 413-6 267 512-6 3 26-6 48 118-4 103 217-4 158 316-4 213 415-4 268 514-4 2 28-4 49 120-2 104 219-2 159 318-2 214 417-2 269 516-2 1 30-2 50 122-0 105 221-0 160 320-0 215 419-0 270 518-0 0 32-0 51 123-8 106 222-8 161 321-8 216 420-8 271 519-8 52 125-6 107 224-6 162 323-6 217 422-6 272 521-6 4" + 53 127-4 108 226-4 163 325-4 218 424-4 273 523-4 i 33-8 54 129-2 109 228-2 164 327-2 219 426-2 274 525-2 2 35-6 55 131-0 110 230-0 165 329-0 220 428-0 275 527-0 3 37-4 56 132-8 111 231-8 166 330-8 221 429-8 4 39-2 57 134-6 112 233-6 167 332-6 222 431-6 * Clinical 5 41-0 58 136-4 113 235-4 168 334-4 223 433-4 Limits, 6 42-8 59 138-2 114 237-2 169 336-2 224 435-2 7 44-6 60 140-0 115 239-0 170 338-0 225 437-0 8 46-4 61 141-8 116 240-8 171 339-8 226 438-8 The Reaumur scale (with zero at freezing point of water and the boiling point of water being 80°) is now little used. To convert C. into F. multiply by - and add 32. To transpose F. into C. subtract 32 and multiply by To convert C. into R. multiply by To convert R. into C. multiplv by To convert F. into R. subtract 32 and multiply by To convert R. into F. multiply by f and add 32. INTERNATIONAL (1932) ATOMIC WEIGHTS. The Molecular Weights of Compounds in the book are now given in terms of the following Atomic Weights as issued by the Committee on Atomic Weights of the International Union of Chemistry in their Second Report.—Ref. P.J., Apl. 30, 1932. — Sym bol. Atomic Weight. 1 Symbol. Atomic Weight. Aluminium • • A1 26*97 Molybdenum a a Mo 96-0 Antimony • • Sb 121*76 Neodymium a a Nd 144*27 Argon .. • • A 39*944 Neon . . a a Ne 20*183 Arsenic . . • • As 74*93 Nickel * # Ni 58*69 Barium . . * . Ba 137*36 Nitrogen a a N 14*008 Beryllium • • Be 9*02 Osmium a a Os 190*8 Bismuth • • Bi 209-C0 Oxygen a a O 16*0000 Boron .. •» • B 10*82 Palladium a a Pd 106*7 Bromine • • Br 79*916 Phosphorus a a P 31*02 Cadmium • • Cd 112*41 Platinum a a Pt 195*23 Calcium.. • • Ca 40*08 Potassium a a K 39*10 Carbon • • C 12*00 Praseodymium. Pr 140*92 Cerium .. • • Ce 140*13 Radium a a Ra 225*97 Cesium .. Cs 132*81 Radon a a Rn 222 Chlorine a a Cl 35*457 Rhenium • a Re 186*31 Chromium • • Cr 52*01 Rhodium a a Rh 102*91 Cobalt .. • • Co 58*94 Rubidium • a Rb 85*44 Columbium • • Cb 93*3 Ruthenium • a Ru 101*7 Copper • • Cu 63*57 Samarium • a Sm 150*43 Dysprosium • • Dy 162*46 Scandium a a Sc 45*10 Erbium • • Er 167-64 Selenium • a Se 79*2 Europium • a Eu 152*0 Silicon a a Si 28*06 Eluorine • • Si1 19-00 Silver . . a a Ag 107-880 Gadolinium • « Gd 157*3 Sodium a a Na 22*997 Gallium • • Ga 69*72 Strontium a a Sr 87*65 Germanium » • Ge 72*60 Sulfur .. a a S 32*06 Gold • • Au 197*2 Tantalum a a Ta 181-4 Hafnium • • Hf 178*6 Tellurium a a Te 127*5 Helium .. • • He 4*002 Terbium a a Tb 159*2 Holmium • • Ho 163*5 Thallium a a T1 204*39 Hydrogen • • H 1*0078 Thorium a a Th 232-12 Indium .. • • In 114*8 Thulium a a Tm 169*4 Iodine • a I 126*932 Tin a a Sn 118-70 Iridium • • Ir 193*1 Titanium a a Ti 47-90 Iron • • Fe 55*84 Tungsten a a W 184*0 Krypton • a Kr 83*7 Uranium a a u 238*14 Lanthanum • • La 138*90 Vanadiim a a V 50*95 Lead • • Pb 207-22 Xenon a a Xe 131*3 Lithium • a Li 6*940 Ytterbium a a Yb 173*5 Lutecium • a Lu 175*0 Yttrium a a Y 88*92 Magnesium • a Mg 24*32 Zinc a Zn 65*38 Manganese a a Mn 54*93 Zirconium a a Zr. 91*22 Mercury • • Hgl 200-61 _-. Isotopes.—For a consideration of these see Vol. II. The author would welcome any suggestions regarding the subject matter or arrangement of the work, from Medical Men, Pharmacists, or Analysts ACACIA GUMMI. Syn. Acacia U.S. X., Gomme Arabique, Gomme du Senegal, Fr. Cx., P. Belg. IV., P. Ital. V., F. E. VIII. A gummy exudate from A. Senegal, Willdenow (N.O. Leguminosce), | and other species, either colourless or with yellowish tint.—B.P. ’14. The gum consists, in the main, of a mixture of Alkali Arabinates. Soluble almost completely in water : insoluble in Alcohol. As emulsifying agent for oils, Powdered Gum Acacia is used, e.g., in Mistura Olei Ricini {B.P. ’14), the usual proportion being about 1 of Gum to 4 of oil. Less suffices in some cases. For suspending resinous ingredients of Tinctures vide Tincturse. For its use as a pill excipient, vide Pilulae. Mucilago Acacise (B.P. T4).—Gum Acacia 4, washed to remove any adherent dust, dissolved in water 6. This quantity measures about 8|. Benzoic Acid 0 • 1 % added will keep it. Incompatibles.—Alcohol, Mineral Acids, Borax, Ferric Salts, Oxalic Acid and most Lead Salts. Bismuth Carbonate should not be suspended with Acacia Mucilage. Tragacanth answers better. Mucilago, U.S. Contains Gum Acacia 35, Sodium Benzoate 0-1, Water to 100. Potion Gommeuse. Fr. Cx. Gum Acacia Powder 1, Syrup 3, Orange Flower Water 1, Water 10, parts by weight. Gum Acacia Solution for Intravenous Injection. Syn. Solutio j Salina cum Acacia, U.C.H. and St. Th. H. (6% Gum); Injectio ] Salinje et Gummi Acacia:, R.N.H. (7% Gum). Gum Acacia 70 Gm., Sodium Chloride 9 Gra„ Water to 1 litre. : The solution to be sterilised after straining through fine linen. The addition of any antiseptic is not desirable. Gum Acacia Sterules are prepared. The contents of one Sterule, diluted to 250 Cc. with boiled water, produces a 7% injection in Normal Saline. jjseSt-j£o raise blood pressure after loss of blood, e.g., from a wound of the femoral artery. Many such cases could be saved if the blood pressure could be kept up for 24 hours or so. I he solution has the same viscosity as the blood and a content of colloids with osmotic pressure equal to that of the blood, hence aftei its injection there is little tendency for water to pass into the tissues. Large quantities may be used. In surgical shock the method has been found of great value. Solutions of 5% or over will restore permanently the due to loss of blood.—Sir W. M. Bayliss, B.M.J. 1./17,564 , n./i7,808 , i./i8,553f i./io,262. Jl. Ph. & Exp. Ther., Mar. 1920, p. 29. r*9°/ has also be<m suggested.—-Med. lies. Counc., B.M.J. i.[iy,1*06. The balance of Colloid and Crystalloid in chobra, shock and allied conditions. ThMncrease in blood voh?me caused, enables the heart to send on a large von,me Whin the total volume of blood is deficient the tissues suffer from want of' Oxygen though the blood, may be of normal constitution. Normal Saline was first proposed, but it disappears from th0 c:iu m aion m - - - minutes. A colloid with an osmotic pressure equal to that ol the bloou ooiioiob must be added. Good gum answers the purpose well.—Sir W. M. Bayliss, L"considerable nutritive value, suitable for toirtartn. «“ li(?" of Ringer’s Solution or Dextrose.—Nakaschima, Jl.A.M.A. 1.129,1b -. Obstetric Shock treated with definite benefit. Many lives saved by early me. Should be employed more extensively.—L. M. Randall, Ji.A.M.A. ii./29,847. Need for blood transfusion often obviated at the Mayo Clinic. No injurious effects on kidneys, no harmful chemical changes in blood, no harmful alterations in physiologic process, no pathologic changes demonstrated at necropsy. Six days usually required to rid blood of Acacia.—L. D. Huffmann, JI.A.M.A. ii./29,1698. Diabetic Coma. Desperate cases recovered with large quantities of intravenous fluid—hypertonic Saline and Gum Acacia solution (7%).—R. D. Lawrence, B.M.J., i./3o,G90. A means of restoring volume far more available than Blood Transfusion (q.v.).—Lionel J. Picton, B.M.J. ii./3o,G64. 3% Gum Acacia and 1% Glucose used.—C. F. M. Saint, B.M.J. i./i8,473. Serum Colloidale Completum. Syn. Sueko Coloidal Completo, F.E. VIII. Gum Arabic 70 Gm., Sodium Chloride 8 Gm., Potassium Chloride 0*2 Gm., Calcium Chloride 2 Gm., Magnesium Chloride 0-1 Gm., Sodium Carbonate 1-2 Gm.. Distilled Water sufficient quantity to 1,000 Cc. Sterilise for 30 minutes at 115° C. Gliatti Gum is from Anogcissus latifolia (N.O. Combretacece)—used technically chiefly. Mucilago of this is B.P. '14. 1 to 3 of water. Leaves of the Indian Gum, are used for tanning light leathers.-—Imp. Inst. Rept. 1930. Impurities, Acidity and other Pharmaceutical Data relative to Gum Acacia.— See Vol. II. ACETANILIDUM. In most Pharmacopoeias. Syn. Antifebrin, Phenylacetamide. CH3CO. NH.C6H5= 135-0782. Dose.—2 to 5 grains (0*12 to 0*3 Gm.) Maximum single dose 8 grains (0-5 Gm.) ; Max. daily dose 23 grains (1-5 Gm.). "May be given in cachets or suspended by compound tragacanth powder. Prepared by the action of glacial acetic acid on aniline. In small white odourless glittering crystals with M. pt. 113° C., which produce a burning sensation on the tongue. Antidotes.—Emetics, Inhalation of Ether and Oxygen, Stimulants—e.g., Strychnine hypodermically, warmth to feet and body. Soluble 1 in 210 of water, slightlyin glycerin, 1 in 4-2 of alcohol 90%, easily in chloroform, benzol and ether. PhcurmcLCOiocfy and adverse ejects.—The anilides, e.g., Acetanilide and Phenacetin, owe their activity in part to the fact that they are only slowly hydrolysed in the organism with liberation of the parent base.—O. C. M. Davis, B.M.J. iL/22,11. The action on the heart, blood and respiration is similar to that of Aniline. In Aniline poisoning, there is a relative increase in erythrocytes, haemoglobin and oxygen capacity; witii a very low blood pressure. Chronic poisoning causes anaemia. The brown colour of the blood and urine is due to the presence of )t>-amino-phenol.—Jl. Pb. & Exp. Ther., ’26,125. Prolonged administration of sublethal doses produces anaemia and emaciation.—JI.A.M.A., iL/26,103. ‘ Head and Nerve Powder ’ containing 8 grains Acetanilide and 2 grains of Tartaric Acid caused swelling of the face and a feeling as if patient was going to burst.—B.M.J. i./si,524. For deaths from and risks with Acetanilide ; Tests for Acetanilide, also use of Acetanilide in the form of * Tubes Temoins ’ to determine efficient sterilisation of Dressings, see Vol. II. Uses*—As a febrifuge and antipyretic, hypnotic sedative, antiepileptic, anti-arthritic, and nervine tonic. Checks the chills and fever of phthisis, quiets the nervous system, and is useful in typhoid. Relieves sciatica and the darting pains of locomotor ataxy. Tablets, 3 grains (0*2 Gm.). Dose.—1 or 2. Also made with Caffeine, 1 .grain ; useful in migraine. Slipule No. 1 holds 5 grains (0*3 Gm.). Pulvis Acetanilidi Composite, U.S. VIII. (not now in U.S.). Dose.—3 to 5 grains (C*2 to 0*3 Gm.). Acetanilide 7, Caffeine 1, Sodium Bicarbonate 2. Elixir Acetanilidi Compositum. Dose.—h to 1 drachm (2 to 4 Cc.}. Acetanilide 328 grains, Caffeine 32 grains, Nux Vomica Tincture 256 minims, Aromatic Spirit of Ammonia 8 ounces, Aromatic Elixir to 18 ounces. Eilter with aid of Talc 120 grains, Ior headache. jjg Pfaenalgin (T.M. 221616). Dose.—5 to 20 grains (0-3 to 1*2 Gm.). A mixture with Antifebrin as the active base, as an antipyretic and hypnotic. Tablets and Gelatin (Hard) Capsules, 5 grains. Caution.—Analysis of Phenalgin gave Acetanilide 60%, Sodium Bicarbonate 25%, Ammonium Carbonate 15%. Incompatible with Calomel and Aspirin. Dangerous interaction may occur.—J. Noble, P.J. 1./22, lol. Methyl acetanilide. Syn. ^cExalgine. (T M. 90^08). Fn. Cx. C6H5N (CH3) CH3CO=149.0938. Dose.—J to 2 grains (0*03 to 0-12 Gm.) in pill. In colourless crystals, with a slight saline taste. An analgesic, anti-neuralgic, antipyretic (only in unsafe doses). Toxic doses cause paralysis of respiratory organs. Soluble 1 in 60 of water, freely in alcohol. Incompatible with salicylic acid. MisturaExalgine. Dose.—2 to 4drachms (8 to 15 Cc.). Exalgine 1, Tincture of Orange 4, Syrup of Orange-Flov er 12, Water to 100. TabelEe Exalgine.—J grain (0-03 Gm.) each, with chocolate. ACIDUM ACETICUM. Acidum Aceticum Glaclale (B.P. T4). U.S. X. Contains 98-9% Hydrogen Acetate. CH3.COOH= 60 0292. Sp. Gr. 1*058. P. Belg. I\ P. Ital. V. and F.E. VIII. not less than 98%. ^ A colourless liquid or crystals melting at about 14* / C. Uses.—Is not given internally. It is applied to corns and warts. Has caustic action, but gives much pain. m . , Psoriasis of a chronic type has been cured in a week or tv, o y A pptir* A IdpaIIv Antidotes.—Chalk and water, alkalis, magnesia, washing soda, and then demulcents such as olive cr almond oil, milk, or w i 0 W-o* Acidum Aceticum {B.P. T4). 33%. U.S X. is 38-37%. Pose,—5 to 15 minims (o*3 to i Cc% ^ This has Sp. Gr. 1-044. P. Austr., P.G. VI. and P. Belg. IV. (30%) and F.E. VIII. (30%) designate this acid ‘ Dilutum.’ A product of the destructive distillation of wood and of the oxidation of ethylic alcohol. Incompatibles.—Alkalis. (Hydrates, Carbonates, etc.). Use.—Externally for ringworm. Acidum Aceticum Dilutum (B.P. ’14). 5%. Dose.—| to 1 drachm (2 to 4 Cc.). Sp. Gr. 1-007. (Fr. Cx. is 10% U.S. X. 5-7-6-3%.) Uses.—May be given as an antidote to poisoning by alkalis, and largely diluted is applied as a lotion for inflamed joints., &c.,and to bathe the skin as a refrigerant in cases of fever. Lotio Acidi Acetici R.O.H. Dilute Acetic Acid 30 minims. Water to 1 ounce. Believes itching and irritation, e.g., in spring catarrh. Acetnm. Syn. Vinegar. Contains about 4% of acetic acid. Made from fermented Malt Liquor and from wine and artificially by diluting Acetic Acid and colouring with burnt sugar. Chronic vinegar poisoning in which nearly a quart of vinegar had been taken every day for 30 years—D. A. Urquhart, B.M.J. ii./27,1226. Acidum Pyrolignosum Crudum. A brown acid liquid, the product of destructive distillation of wood. Contains Acetic Acid 5 to 13% (P G VI has minimum 8-4%) according to the kind of wood used, also other acids— Propionic, Butyric, etc., also small quantities of Methyl Alcohol, Furfural, Pyridine, Creosote and Resins. Has been employed locally to gangrene ana has veterinary uses. It has antiseptic and preservative properties. ° Acidum Pyrolignosum Rectificatum. Contains about 5% Acetic Acid of yellowish color becoming darker on keeping. Occasionally ordered diluted f> to 10% m mouth-washes and gargles. Acetic Anhydride. (CH3C0)20 = 102 0468. A colourless liquid with pungent odour, Sp. Gr. 1-080. B. Pt. 138° 0. Manufacture.—British Patent 137701. By interaction of Anhydrous Sodium Acetate and Carbonyl Chloride, thus:— 2CH3.C00Na+C0Cla = (CH3.C0)30 + C02+NaCl.—J.C.S.A. i./2o,287. Tests 95 to 98% pure, the rest being acetic acid. Not employed medicinally to any extent, but chemically, e.g., in the process of acetylation. Should be free from Hydrochloric Acid. Acetyl Chloride. CII3COC1=78-4S04. manufacture.—By combining carefully Glacial Acetic Acid 130, with Phosphorus Pentachloride 137. Finally, distil and redistil the fraction passing over below 00° C.—this separates from phosphorus oxychloride. A volatile liquid with intensely penetrating odour, boiling at 51° C. Acidum Amido-Aceticum.—Syn. Glycocoll, Glycine. CH2.NH2.c6OH=75-047. Dose.—10 to 30 grains (0‘6 to 2 Gm.) suggested. White crystals with sweet taste, soluble in water 1 in 4J, slightly in alcohol, not in ether. M. pt. 234° C. It is both acidic, by reason of its acid group, and basic by reason of its amino grouping. It forms double salts with soluble metallic chlorides axd nitrates. The Amino Acids are diuretic—they are decomposed by the liver with formation of urea. Glycocoll used as such is ncn-toxic and is not unpleasant to take. Experiments on healthy individuals showed decided increase in the output of urine under daily doses of 5 Gm.; Sp. Gr. remaining the same, also increase in Chlorides excreted. In some cases good results by the use of Glycocoll with Digitalis — P.JT ii./iM99. The name “ Glycin ” (not now a T.M.), though applied in Chemistry to this body, was given (P.J. i./o;,208) to p-oxy-phenvl-amido-acetic Acid C6H}OH.NHCF2-COOH. = 167*07S2. Used in photography as a developer. Tor further consideration of Amino-Acids see Vol. II. Choline. HO.N (CH3)3C2H4.OH=12M25. A non-poisonous syrupy fluid (v. also Vol. II). A decomposition product- of Lecithin. Choline has been isolated from washed portions of rabbits’, dogs’ and cats’ intestine. It has the power of stimulating intestinal movements. Acetylcholine is even more active in stimulating peristalsis.—Le Heux, Pfluger’s Archiv. 1919, p. 8, per Pres., Oct-., ’20,861. Choline Chloride. Syn. CHOLINE HYDROCHLORIDE. Cl.N(CH3)3C2H4.OH== 139-5642. Dose.—0-6 Gm. intravenously. Deliquescent needles soluble in water and Alcohol. Ileus treated by Choline Hydrochloride. It acts on the hormone of intestinal movement. That it is specific in its action on the intestine is shown by the fact that it does not affect the rhythmicity of the heart or of the uterus. In practice it is well to make ampoules containing 0*6 Gm. of the Hydrochloride in 6 Cc. This solution is diluted with 180 Cc. of Normal Saline and given intravenously. At least 17 minutes should be employed to administer the whole of the solution. The treatment re-established normal function in some cases.—C. G. L. Wolf and J. It. C. Canney, L. L/26.707. Sterules of Choline Chloride contain 0-6 Gm. in 6 Cc. for dilution as indicated. Pacyl Tablets* Dose :—1 or 2 tablets twice or thrice daily commencing with the smaller dosage—to be swallowed whole and followed with water. A Choline preparation, each tablet containing 1/12 grain (0 005 Gm.), employed to reduce blood pressure in arteriosclerosis, chronic nephritis and the climacteric. Dose :—1 or 2 tablets three times daily—subsequently 2 tablets a day. A Choline derivative used at the climacteric.—L. i./3i,170. pi cetylcholme. The Acetyl derivative of Choline, (CH3)sN(OH).C2H4.COO.CH3== 163T406, usually employed as Acetylcholine Chloride or Hydrochloride. Syn. Acecoline, (CHs)3N.C1.C2H4.COO.CH3==181*G076. A white hygroscopic powder forming a stable solution in water. Dose.—|grain (o’05 Gm.) subcutaneously or intramuscularly, and 14 grains (QT Gm.) the following day. If inadequate after 10 daj-s, increase to 0*2 Gm. twice daify. Average course 15 days treatment per month for 2 or 3 months. Dangerous intravenously and inefjech t e orally. Ampoules contain 0*02, 6*05, 0*1 and 0 2 Gm. Uses,—Possesses the properties of Choline in a greater degree. Has powerful vasodilator effect, which is confined to tne artenes aiu arterioles, and is of value in. Raynaud’s syndrome, gangrene arising from arteritis, and in the complications of arterial hypertension. Tuberculous sweats yield to doses of 0*01 to (M 2 Gm. Contraindications.—Old people with atheromatous arteries •—danger of giving too large a dose. M. Vi liar et an j- Justin-Besangon, L. i./2g,493, Pres. Apl. ’29,146. , Acetylcholine resembles Histamine in features. It- was oy q “ ? v in 1894. It was found in Ergot extracts by Hale end Twins, < v t/Hale Hale and Dudley as a normal constituent in ox and horse spleen. ’ L‘m.E9c!" Annual Reroit, 1828:2P. Identification of Acr-t-ylcholme m the spleen of large animals.—13.M.J. i./3o,559. . Hypkrpiesis without marked arterial change treated. Semi-permanem fall m blood pressure produced—A. H. Douthwaite, B.M.J. i./3o,742. Twenty years ajter physiological activity was known the drug came into clinical use. Clinicians might pay more attention to physiology. It produces dramatic relief m various forms of arterial spasm. Of benefit in earlv arthritis deformans, hemiplegia, trophic ulcers, hyperidrosis and other conditions, e.q. lead colic. Unstable in aqueous solution and oxidation produces toxic substances—should be kept in powder form iD sealed ampoules. Dose.—1 to 6 grains. Has no cumulative action and may be given for months without ili effects. A valuable and interesting remedy for which other clinical uses will probably be discovered in time.—Editorial B.M.J. ii./3o,1011. Neurine. Trimethyl-Vinyl-Ammonium Hydroxide. N.(CH3)3(CoH3)OH = 103-1094. A ptomaine resulting as a decomposition product of meat. Highly poisonous. Hygroscopic. Commercially a 25% solution is prepared 3 to 6% aqueous solution has been used to paint diphtheritic membrane. Betaina. Syn. Trimethyl-Glycocoll. 117.0788. Betaine occurs in beets and mangolds (especially wnripe roots) and has been found in a number of vegetable and animal substances. It is formed on oxidation of Choline and is chemically related to Muscarine and Neurine. Beiainss Hydrcchioridum — Syn. ^Acidol. (T.M. 2G3431 ) C5H11N02.HC1-153-5586. Dose.—1 to 8 grains (0*06 to 0*5 Gin.). Manufacture.— Patented method from Molasses. See Edn. XIX., p. 5. White crystalline substance soluble in water 1 in 2; in alcohol about 1 in 20. Uses.—Liberates hydrochloric acid (almost 25% of its weight), and is given with pepsin or diluted with water in gastric affections! I1 favoring.—Glyl Rosse, Glyl Menthae Piperitae, Syl Caryo- phylli, Syrupus Aurantii. Acidol-Pepsin. Dose.-—I or 2 tablets (7.1 grains in each) in water after meals. Contain Betaine Hydrochloride and Pepsin. Issued in two strengths, Ho 1 strongly acid, JSo. 2 slightly acid, equivalent to 10 and Ik minims respectively of Dilute Hydrochloric Acid. “ J In anorexia, hypocblorhydria, gastritis, etc. Acetamide. CH3.CO.NH2—59-047. Deliquescent crystals M.pt. 82° C., made by interaction of Ammonia and Acetyl Chloride. As a denaturant (£%) of Alcohol has been used, e.q., in Phenacetin manufacture. Acetamide or Formamide, cither molten or in solution, used in extracts drugs.—F. Bayer & Co.’s Patent.—P.J. ii./22,295. ACIDUM BENZOICUM. In numerous National Pharmacopoeias Syn. Benzoyl Hydrate. C6H5.CQOH= 122*0468. Dose.—5 to 15 grains (0*3 to 1 Gm.j. Manufactured either from Gum Benzoin or from Toluol, the former being the more expensive. Soluble, if pure, 1 in 400 of water ; 1 in 3 of alcohol 90% ; 1 in 7 of chloroform; and very soluble in fats, oils, and in glycerin about 1 in 30. Incompatible with Ferric Salts and Mercuric Chloride. Uses.—Benzoic acid is an antiseptic, a stimulating expectorant, antipyretic and diuretic. It is given in cases of chronic cystitis, urinary calculi and incontinence, also for rheumatism. It acidifies the urine but is mostly employed in form of one of its salts—v. posted* It prevents fats becoming rancid, as in Adeps Benzoatus, q.v. Four grains of Benzoic Acid with 1 grain of Canada Balsam, or 1 minim of glycerin, make a good pill. A one in 20 solution in alcohol relieves urticaria, and, as an Antiseptic Lotion or Gargle, 1 dissolved in 500 of water is employed. 15 to 20 grains every hour or 2 hours has specific remedial action in acute rheumatism, but is much weaker than Scdium Salicylate. —B. Stockman, B.M.J. i./13,597. For use as preservative in Foods, etc., see Vol. II. Cp) Tablets, Benzoic Acid Compound. Dose— One or two occasionally. , ^ Benzoic Acid i grain, Codeine 1/10 grain, Ipecacuanha Boot 1/10 grain. Menthol 1/10 grain, Bed Gum i grain. Stimulating and soothing for throat i rr o n Benzoin.—There are two'varieties known as Siam and Sumatra, the former being the better. U.S. X. allows^both. Sumatra Benzoin is B.P. 14 if at ■ ~ For source oj Siam Benzoin, see Vol. II. least 85 % soluble in alcohol SO % Tinctura Benzoini Composite (B.P. ’14). Syn. Friars’ Balsam, Traumatic Balsam. Dose.—| to 1 drachm (2 to 4 Cc.), with yolk of egg. U.S. X. has approximately the same composition as B.P. ’14. A drachm to a pint of hot water is valuable as an inhalation in acute larvngitis. Undiluted it is used as a wound dressing. Tincture Benzoin! Simplex. Dose.—4 to 1 drachm (2 to 4 Cc.). One in 10 of Alcohol (90%) (U.S. X. is 1 in 5). P. Ital. V. 1 in o of Alcohol (80%). One of the Tincture in Pose Water 40, is useful as a face lotion in urticaria and in irritable conditions of the skin. Mistura Balsam! Composita—Vic. Park. D^e. 1 ounce ‘rinr.+-m'£» Compound Tincture of Benzoin, Tincture of Tolu and Compound imciuio of Camphor, of each 20 minims, Ammoniacum Mixture to 1 ounce. Spbygsr©graphic Varnish. Contains Benzoin, Baisam or loiu and Alcohol. This is used for pulse tracings. Oollutcrium Acidi Benzoici, B.IXH. Dose.—One tahlespoonful in a tumblerful of water. Benzoic Acid 10 grains, Krameria Tincture 15 minims, G grains, Peppermint Oil 2 minims, Cinnamon Oil 2 minims, 90% to 1 ounce. Miller’s Mcrath Wash is similar. GJuside Alcohol Trochisci Acid! Benzoioi. . i ... . p Contain \ grain with either simple sugar or fruio basis (h.I. i ;. those of T.H. have a red currant basis. Useful as a voice lozenge. Ammonii Bsnzo&s (B.P. ’14). C6H5.COONH4= 139*0782. . Dose.—5 to 15 grains (0*3 to 1 Gm.'t p In colourless laminar crystals: soluble 1 in 6 oi cold Mater, in 30 of alcohol, and 1 in 8 of glycerin. Flavoring.—Glyl Sassafras, Glyl Aurantii Amari: Syrupus Aurantii, Syrupus Tolutanus. Useful expectorant in chronic bronchitis. Where pyelitis is associated with cystitis the urine is frequently alkaline, ammoniacal and offensive, Ammonium Benzoate or Salicylic Acid, may be of value on account of their action within the bladder—Tirard. Mistura Boro-Benzcatis, k.c.h. Dose.—1 ounce (30 Cc.}. ^Ammonium Benzoate 20 grains, Boric Acid 10 grains, Tincture of Hyoscyamus 30 minims, Infusion of Buchu to 1 ounce. A useful urinary antiseptic mixture. Traumatic paraplegia. Bladder and rectal functions show a departure from normal and often complete paralysis of micturition. Ammonium Benzoate over long periods does not cause digestive upsets like Sodium Acid Phosphate._ A routine mixture :—Ammonium Benzoate 15 grains, Urotro- pine 10 grains, Hyoscyamus Tincture 30 minims, Syrup of Orange 1 drachm, water to 1 ounce. The urine can generally be kept at a constant level of acidity by this and drainage. Irrigation with 1 in 8,000 Potassium Permanganate, in some cases.—O. H. Gotch, B.M.J. i./23,849. Magnesii Benzoas. (C6H5.COO)2Mg=266-398. Dose.—5 to 15 grains (0*3 to 1 Gm.). White crystalline powder. Antipyretic. Soluble in water 1 in 30, hardly soluble in alcohol 90%. Incompatible with Acids, also with Sodium Bicarbonate. Used as an anti-arthritic for rheumatism and cathartic in cirrhosis of the liver. Sodii Benzoas (B.P. ’14); Fr. Cx. Sup. 1020, P. Ital. V. C6H5.COONa= 144*039. Ph. Ned. V. has J mol. H20. Dose.—5 to 30 grains (0*3 to 2 Gm.). In white granular crystals : soluble 1 in 2 of cold water. Two varieties are made, one from the acid obtained from Gum Benzoin, the other from the artificial acid—the cheaper of the two. Flavoring„—Syl Vanillse, Glyl Carui, Syrupus Aromaticus. Incompatible with mineral acids and with Ferric Chloride. It is apt to cause gastric irritation if taken on an empty stomach. Uses.—Urinary antiseptic. Acute lacunar tonsillitis is stated to be curable with it in 12 to 36 hours if given in 5 to 15 grain doses every 2 hours. In pyelitis clue to B. Coli infection, Sodium Benzoate combined with Hexamine has given good results. Tablets 2 grains each. #Cryogenin (T.M. 248320). — Syn. Meta-benzamine-semi- CARBAZ1DE. PhEXYL-SEMIC ARB AZIDE. F.E. VIII. C6H4.CONH2.NH.NH.CONH2= 194-058. Done.—3 to 24 grains (0*2 to 1*5 Gm.). A crystalline body only slightly soluble in water and 1 in 25 of alcohol 90%. A useful antipyretic in acute fevers. A case of erysipelas migrans successfully treated. Bose 10 to 15 grains per diem during 7 days, also in treatment of phthisis and lingering pyrexia following acute stages of an infection.—- H. Sainsbury, L. ii./i5,336. I11 chest affections 5 to 7 grain doses at 3 p.m. to anticipate the evening rise in temperature. If single dose not sufficient give 5 grains thrice daily in the 12 hours.—A. T. Davies, ibid. 835. Acid urn Hippurieum. Syn. Benzamido-acetic Acid, Benzoas glycocoll. COOH.CH2.NH.CO.C6H5==179 0782. Dose.—5 to 20 grains (0-3 to 1*2 Gm.). This acid, occurring as white crystals, soluble in hot water (very slightly in cold—about 1 in 000), melting at 187° C., may be prepared "from the urine of herbivora, also synthetically by treating Glycocoll (Amino-acetic Acid, CH2NH2.CQQH, q.v.) with Benzoyl Chloride or Benzoic Anhydride. Hip sou sic Acid Synthesis Test as regards functional condition of the kidney. The normal amount of Hippurie Acid having been estimated, the patient is given 0-5 Gm. each of Glycocoll and Benzoic Acid. Analysis of 24 hours' urine should then show an excess over normal of about 074 Gm., the normal being 0-4 Gm. When the figure is lower the hippurie function is abnormal and probably there is some renal parenchymatous disorder.-—P. L. Violle, L. i./2i,1239. So&ii Eippuras. C9H8NaNO3=201-0674. Dose.—5 to 30 grains (0-3 to 2 Gm.). A soluble white powder used in gout, gravel, and calculus, as solvent for urates. A powerful depressant in arteriosclerosis. Ammonium Hippurate and Calcium Hippurate are salts with properties allied to the Sodium compound. Acidum Phthalicum. C6H4.(COOH)2= 166*0468. Dose.—20 grains 4 hourly. Has slight anti-rheumatic effect. Benzoyl Peroxide, C6H5.CQ.O2.CO.CGH5=242-078. A crystalline compound, M. Pt. 103-5°, prepared by the interaction cf ICO of sodium peroxide and 180 of benzoyl chloride, at a low temperature. Soluble slightly in water, more so in alcohol. Uses.—For burns and ulcers 2 to 3% solution in oil. ACIDUM BORICUM. Syn. Boracic Acid {B.P. ’14), Hydrogen Borate. Sal Sedativa de Homberg, F.E. VIII., P. Belg. IV., P Ital. V. H3B03= 61-8434. Dose.—5 to 15 grains (0-3 to 1 Gm.). In white laminar crystals, or as powder (that known as Pulv. Acid. Boric. Subtilis has been passed through a No. 170 sieve); with bitterish taste, made by the action of sulphuric acid on borax and other borates. Soluble 1 in about 25 of water, 1 in 3 of boiling water, 1 in 30 of 90% alcohol, 1 in 5 of glycerin at 0° C., 7 in 10 at 100° C., slightly soluble in volatile oils. Insoluble in ether. Preset* i hi neg Mote.—May be given in slipule form. Incompatible wTith sodium salicylate in powder a boro- salicylate is apparently formed. Uses,—Antiseptic and antiputrefactive. In powder and crystals as dressing to wounds, sores, and skin generally. Boric Gauze contains 10 to 15%, Boric Lint 35 to 45% and Boric Wool 15 to 25%. When mixed writh starch it forms a useful “ dusting powder for infants, &c. A little in the socks or stockings pre \ ents the odour of perspiring feet. As Eupad and Eusol q.v. it was much used as a wound dressing. Vomiting in gastric dilatation or gastric catarrh of infants has been treated by washing out the stomach with weak Boric Acid Lotion. Cachets of Boric Acid containing 10 grains (G'6 Gm.), as antiseptic before and after bladder operations, have been given in typhoid, also for cystitis. Tablets contain 5 grains. In otorrhcea an alcoholic solution of boric acid may be used. Fifty per cent, of the acid administered, it has been found, is excreted in the urine within 12 hours, the rest remains in the body for 3 or 4 days and hence may accumulate under repeated dosage. B. Coli grew with difficulty in sterilised urine after taking Boric Acid per os. It is efficient as a urinary antiseptic, its action being apparently unaffected by alkalinity.—A. Jordan, B.M.J. ii./i3,653. Rodent Ulcer. A Boric Lotion and Adrenalin Solution applied had remarkable effect. In three weeks the ulcer healed. Boric Acid Poisoning, A teaspoonful taken in error has caused death. Used for lavage, by idiosyncrasy it may prove poisonous.—Rash produced. Empty the stomach or give an emetic of mustard or Magnesium Sulphate. Fatal poisoning of six babies weighing about 7 lbs. with from 0-8 to 3 Gm. of Boric Acid given in solution in error for water.—P, J. i./27,361. In December, 1928, the writer took about 1 drachm of Boric Acid in solution from a measure on the laboratory table in error, thinking it to be water (about 2 to 3 ounces of 1 in 30 solution). The taste was poor in consequence of ‘ liverishness,’ hence the difference between the solution and plain water would not be noticed. As emetic ^ ounce of Vin. Ipecac, with an ounce or so of water was taken with no effect. About 5 ounces of saturated salt solution were then taken, also without effect. Finally, by means of the fingers a small amount of acid mucus was got away. There was great thirst at night. For its use as a milk, cream, etc., preservative—vide Vol. II. Glycorinuin Aci&i Eorici (B.P. ’14). Glyceritum Boroglycerini. Heat Glycerin 9 (by weight) to not above 150° C., and add Boric Acid 6. Continue heafr with stirring until weight is reduced to 10, and add Glycerin (by weight) 10, U.S.X. has 31 in 100. It is readily miscible with water and alcohol. Of value in otorrhoea. Guttse Pro Auribus Acidi Borici. N.H.I. Boric Acid Powder 35 grains, Industrial Spirit 76 minims , Glycerin to 1 ounce. Pessus Glycerini Acidi Borici for vaginal use weigh 90 grains each, and contain 70 grains of Glycerin of Boric Acid with gelatin 10 grains and water 10 minims. Acidum Boro-Salicylicum. Boric Acid 3, Salicylic Acid 1. A white powder, soluble about 1 in 120 of water. Is mostly employed as— Sodium Boro-Salicylate. Dose.—5 to 45 grains (0*3 to 3’0 Gm.). Has been given in rheumatic affections. Liquor Antisepticus, U.S. VIII. Average dose.—1 drachm (4 Cc.). Boric Acid 20, Benzoic Acid 1, Thymol 1, Eucalyptol 0-25, Oil of Peppermint 0-5, Oil of Gaultheria 0*25, Oil of Thyme 0T, Alcohol 250 and Water to 1,000. Filtered through talc. Kesembles jfcListcrine Antiseptic. (Listerine is T.M. 463,839 Class 2 27665, and 469574 Class 3, 259141 and 294469 Class 48.) Listerine Antiseptic examined by method of G. F. Reddish on S. aureus, S. hcemolyticus and viridans, pneumococcus and B. acidophilus odontolycus. Killing time for majority of organisms was 20 seconds. Approximately 600 to 800 millions of the various organisms killed in 15 seconds at 37 C. L. ii./29,616. Lotio Acidi Borici, R.O.H. 16 grains to 1 ounce (4% approx,). _ A useful soothing antiseptic lotion for the eyes, bladder, vagina and mouth. Isotonic Boric Acid Lotion is 2% strength—isotonic with the tears. Lotio Acidi Borici cum Zinci Sulphate, R.O.H. Boric Acid 8 grains, Zinc Sulphate J, 1 or 2 grains, Water to 1 ounce. A.B.C. Powder. A . Boric Acid, Bismuth Subnitrate, Calomel, equal parts. A stimulant antiseptic dusting powder. Pastillus Acidi Borici, T.H., v. Glyco-gelatin Pastils. Useful in aphthous affections of the mouth and throat. No. 3. • o . 15 . 4 Pessus Acidi Borici. Ten grains (0*6 Gm„) in each, with Theobroma Oil. Convenient to replace douches after delivery. Suppositorium Acidi Borici. Three grains (0*2 Gxn.) in each. Useful in pruritus. Unguentum Acidi Borici—Marl indo le. No. 1. NO. 2. Paraffin (M.Pt. 57° C.) .. .. 5 .. 5 White Soft Paraffin .. .. 5 .. 10 Boric Acid, in fine powder.. .. 2 .. 3 Melt the paraffins, sift the Boric Acid into the liquid, and stir constantly till cold. These three ointments contain the same quantity of Boric Acid, i.e., 1 to 5 of basis. . c No. 1 ’ is used where cavities exist or where a stiff base is neeo.cd<.. { No. 2 5 is for use to surface wounds, burns, eczema, chaps,^pruritus ani et pudendi, and sores, as an antiseptic dressing and healing ointment.’ ‘ No. 3 ’ is for toilet use. ‘ Boric Cream 5 is similar. The B.P. T4 Ointment is far too stiff for general use. A small proportion of Beeswax, e.g., 3%, improves it, as pointed out by J. H. Franklin. . } , , ‘Collapsubes,’ i.e., collapsible tubes containing ointments, creams an lubricants, with catheter attachment for applying to th®r^^1Lraiv^s > suitable tubes for the uterus and rectum. 4 or general purposes Gollapsu oe alone are provided. See Index for list. . . . . p ' Collapsubes * are also suitable for introducing omtments into tue nose. The patient should put the head well back and press the omtment into ti n°imali size Collapsubes marked * in Index are convenient in ophthalmic surgery. Unguentum Acidi Pheno-Borici. ,T Q Contains 2J% of Phenol added to either No. 1, No. 2 or No. d Boric Acid Ointment. In some cases this may prove more healing. Ubguentum Lana-Borieuni Camphoratmn. Boric Acid Ointment (No. 2) \ ounce, Hydrous Lanolin, -2 ounce, Essential Oil of Camphor 20 minims. For earache in children. Applied with a brush to the meatus. Petrolatum Acidi Borici.—Syn. Boric Petroleum Jelly. Boric Acid in fine powder 1, White Soft Paraffin 9. In Collapsubes with catheter attachment for urethral use or with tube suitable for uterine or rectal use. Unguentum Bemulcens R.N.H. Boric Acid 5 grains, Glycerin of Starch, Hydrous Wool Fat, and Soft Paraffin of each equal parts, to 1 ounce. Magnesii Boro-Citras. Dose.—15 to 30 grains (i to 2 Gm.). Wianuf&cturte.—Dissolve Light Magnesium Carbonate 70 in a solution of Citric Acid 100 in Water 400, add Boric Acid 30, evaporate to dryness on a water bath and powder or scale. A white powder or colourless scales, readily soluble in water; used as a urinary antiseptic internally for stone, gout, and rheumatism : and 1 with 2 of sugar is prescribed as Boracite, or Pulvis Magnesii-Boro“Citratis Composita. Dose.—60 grains ter die, to sterilise the urine 48 hours before operations. Undergoes some dissociation in the body, with haemostatic effect, but inferior to the lactate q.v. Sodii Biboras. Borax. B.P. ’14, Sodii Boras (U.S. X.). Syn. Sodium Pyroborate, Sodium Tetraborate. Na2B4Or.10H2O=^381‘43. Dose.—5 to 20 grains (0*3 to 1*2 Gm.). Soluble 1 in 25 water, in glycerin 1 in 1, insoluble in alcohol (90%). Incompatible with gums, mineral acids, also with cocaine hydrochloride. Flavoring.—Glyl Pini, Syl Lavandulae, Syl Rosie ; Syrupus Aromaticus. Uses.—As gargle in diphtheria, for aphthae, eancrum oris, and gangrenous stomatitis ; pruritus ani and vulvae, in brcmidrosis and foetid sweating of the feet. Gouty affections are treated with compresses of saturated solution. Epilepsy.—In chronic cases, as an adjuvant to or substitute for Bromide. It lessens excitability—J. McCartney, B.M.J. ii./2o,548 ; ii./21,527,617,673, and with Fowler’s Solution.—B.M.J. i./23,1c. See also Potassium Borotartrate. Considered better than Luminal. Treatment consists essentially of Borax 10 grains and Sodium Bromide 10—15 grains thrice daily. If the fits do not cease in a fortnight, the Borax is increased to 15 grains. After 6 weeks 15 minims of Belladonna Tincture daily are given in addition if necessary, and after 2 months it is reduced and then omitted. The salt mixture is given for a year at least, when the Bromide is gradually reduced. The patient then remains on Biborate for another year. This almost invariably achieves a cessation of fits in adults, but children do not as a rule respond so well.—• P. Figdor, L. iL/25,840. See also ibid. 892,943. Fa tal Poisoninct in 2-weeks’ old child following ingestion of 1| drachms Borax and Boric Acid in the form of Honey and Borax and Glycerin of Borax : a dummy teat dipped in the latter may convey 11 to 2 grains of Borax to the child’s mouth.—J. Birch, B.M.J. i./28,177 ; L. i./28,287. Hyperthyroidism.—A daily dose of 2 to 4 Cc. of a 5% solution of Sodium Borate taken with meals gave good results.—Jl. A.M.A. ii./25,30s. Potassii Biboras. Syn. Potassium Pyroborate. K2B407.5H20=323-558. Prismatic crystals, readily soluble in water. Varicose and traumatic ulcers treated with tri-weekly application consisting of Boric Acid 63 Gm., Potassium Hydroxide 28 Gm., Water 200 Cc., starting with half-strength solution..—Per Jl. Trop. Med., June 1, ’26,165. The quantities employed are the calculated amounts to produce Potassium Biborate. The solution contains approx. 58 Gm. Sodii Boro-Tartras. Syn. TARTARUS BORAXATUS. Dose.—20 to 40 grains (1*2 to 2*5 Gm.). Sodium Biborate 2, Potassium Acid Tartrate 5, Water 15, evaporate until a little of the residue cooled is brittle. Powder and dry at 50° C. Antiseptic and diuretic. May be tried for gcut. See also Potassium Borotartrate, re Epilepsy. Sodii Perboras. Fr. Cx. Supp. II., F.E. VIII. ENaB03,4H20— 153-8794 ; derived from the hypothetical Perboric Acid, HB03— 59-8278. A white permanent powder. Soluble in water, about 1 in 50, with decomposition. Manufacture.—Sodium Perborate may be prepared pure by treating Crystalline Borax 380 Gm. with Normal Sodium Hydrate Solution 2,000 Cc. to convert it into Sodium Metaborate—NaBOs, and then adding to the solution 4.500 Cc. of 10 Volume Hydrogen Peroxide Solution. Cool immediately by refrigeration and collect and dry the crystalline precipitate on filter paper. For details of Assay, see Vol. II. Uses.—Antiseptic and deodorising. To produce Oxygenated Water, 1 kilo yields 104 Gm. or about <2 litres of active oxygen. This quantity will produce 7 to 7-5 litres of ‘ 10 volume oxygenated water. The solution is not acid. It contains Hydrogen Peroxide and Borax. In practice 170 Gm. with 60 Gm. Citric Acid makes a litre of about ‘ 10 volume ’ strength. . . . These solutions may be used to prepare antiseptic lotions, vaginal injections (about ‘ 5 volume ’ strength), e.g., in leucorrhcea and metritis, and are useful in minor surgery. The dry salt may be used as a disinfectant, deodorant dusting powder. It has been, used for soil-contaminated wounds. Tonsillitis occurring as complication in typhoid has been treated with Sodium Perborate gargle, 2 drachms to the pint. Vincent’s Angina. Rapid cure in 95% of cases with 2% Sodium Pei- borate solution as a mouth wash. Best used as a thick paste and-retainer in the mouth for 4 or 5 minutes while oxidising froth develops. Jl.A.M.A. Unguentum Sodii Perboratis. 1% m Paraffin Ointment basis. Antiseptic and healing. . _ , . on/ . ^ „ Sodium Perborate Tooth Powder. Sodium Terborate 2 A, in Precipitated Calcium Carbonate. , ,, .' , 2kZoe! (T.M. 373442) Antiseptic contains Sodium Monoborate (Metaborate, NaBOo). Antiseptic and deodorant. A white granular substance soluble in water 1 in 18. It is alkaline in reaction and on this account permits_a tree flow of lymph without coagulating.—L. ii./16,832. ,. _ ± Persil. (TSM. 302781, Class 2, 294552 & 513485, Class 40- A preparation extensively used in laundry work. Contains Sodium Perborate. It liberates Oxygen in contact with water. ACIDUM CARBOLICUM. Ce^Carbolic Acid and liquid 'preparations of Carbolic Acid and its homologues, containing more than 3% of these substances, except preparations for use as sheep wash or for any other purpose m connection with agriculture or horticulture, contained m a closed vessel distinctly labelled with the word ‘ Poisonousf the name and address of the seller a nd a notice of the purpose for which the preparations are intended. For further details regarding the sale by retail by registered and unregistered persons of liquid preparations sold as Carbolic, Carbolic Acid, Carbolic Substitutes or Carbolic Disinfectant containing not more than 3% of Phenols, see 4 Poisonous Substances.* Cp)Phenol (B.P. T4). Syn.—Phenyl Hydrate, Benzophenol, P. Belg. IV. C6Ii5OH=94*0468. Dose.—1 to 3 grains (0*06 to 0*2 Gm.), Pr. Cx. ; Max. single dose, 1J grains ; max. during 24 licurs, 4J grains approximately. Fenol, F.E. VIII., the same. In colourless crystals or agglomerated masses liable to become pink—a little Sulphurous Acid will prevent this for a long time. Neutral to test paper ; made by distillation of coal tar. M. Pt. 39 to 40c C. (Pr. Cx. Supp. 1920, 41° C.). ‘Synthetic ’ Phenol made from Benzene. In Germany and U.S.A. there is not enough natural Phenol to supply demand, large quantities being needed for making synthetic resins and for dye intermediates and Salicylic Acid. Method described.—W. G. Adam, P.J. i./3i,460. Antidotes (See also Acid. Cresylic).—Give Sodium Sulphate or Magnesium Sulphate 1 or 2 ounces in b pint of water. (They do not act chemically but hinder absorption,) Wash out the stomach with water several times. Ape morphine as emetic (not always effectual). White of egg, and large doses of any innocuous oil. Calcium saccharate and Caffeine are also antidotes. The former may be freely administered. Amyl Nitrite Sterules, hot water bottles. Camphorated Oil (2 drachms) has been used'with recovery. Iodine is a true antidote. Use within obvious limits the seme quantity of Tincture of Iodine as of Liquid Carbolic Acid. _ liquid Paraffin has been suggested—also for burns—washing in it and dressings. Subsequently alkalis. Caffeine the best respiratory stimulant — O. 8. Gibbs, B.M.J. i./3i,5Sl. Internally. It is thought however to be a waste of precious time. Externally. Mop persistently with warm Castor Oil. If not available use Plenty of soap and a little warm water, applying Castor Oil dressings later. If poison is swallowed wash-cut tube with 'plain water, unless strongly contraindicated. # Give Magnesium Sulphate and Sodium Sulphate together, whether the pox. on v; external or internal.—W. A. BowcUer, B.M.J. 0/31,686 ^ CAs^U0ll.hils hiSl?er Petition coefficient than Paraffin for the Acid.— 0. S. Gibbs, B.M.J. i./3i,770. Alcohol lavage is no good ; it promotes absorption. The same applies to plain water and glycerin. 1 Intravenous Saline with addition of Sodium Bicarbonate saved life in a case of inhalation of fumes. For bad effects of compresses, local use, and inhalation, see Vol. II. Solubility.—100 parts are liquefied by 10 of water, should form a clear liquid with 30 to 40 of water, and should be completed dissolved by 1,200 of water. Also soluble 3-J in 1 glycerin, 3 in I chloroform (nearly), I in 2 olive oil, 5 in 1 ether, 6 in 1 alcohol (90%), 2J in I benzol and 1 in about 20 soft paraffin. Solubility in Liquid Paraffin. 1% is a saturated solution. More will dissolve warm but throws out again on cooling. It has been thought that the addition of Menthol might form a non-escharotio compound and hence alleviate effect of the Phenol but this is erro- neons. A case turned on the subject some years ago in which a large proportion of Phenol (plus Menthol) had been prescribed as ear drops. . Incompatibility-—A solution of Lead Subacetate gives a precipitate with Phenol, but no change with the Acetate. °ther Phenols, Cregols, etc., do likewise, except Pyrogallol The precipitate may be prevented by ^toB a trace of Acetic Acid to the Subacetate solution.—G. A. Medley, 1 J. n.(2bA4J. The nrecipitate formed is apparently of the formula 1 WO.CcHd^r l ( ) (O-.C.CH3).—E. A. Lum, P.J. 1./29,149,251 ; J. E. Enver, ibid. -51 , see also E. Matthews, 297, and E. H. Lane, 321. _ jFlavoring.—Glyl Coriandri, Syl Vanillse; Tinctura Lavandulae Composita, Tinctura Cinnamomi. Uses._A powerful antiseptic, anti-putrefactive, caustic, and applied locally, anaesthetic. Internally for dyspepsia and flatulence, eq. with rhubarb and nux vomica extract m capsule. Also Aor erysipelas, in typhoid fever and diarrhoea in pills coated t° render them soluble in the intestines, and in puerperal fever, phthisis, bronchitis, pertussis, and for the gangrenous stage of pneumonia. As a vaginal injection one in 80 or more of water for leucorrhcea, uterine ulceration, erysipelas, and cancer ; cleanses, heals, disinfects and allays pain, and is suitable as a gargle. ,., Mosquitoes are kept away by 1% solution. It also relieves bites of same. 2% is effective for disinfecting instruments, the skin, and for artificial dentures left in soak all night. m ^ A J. added, relieved. . , i jii, lL-micl arid with good results Small-Pox pustules have been touched with muici acia \ - toxin in Tetanus treated by intrathecal injections. 1 ^ 1 1Q t of 14 cases vitro 1 in 400 solution employed—30 to 40 Cc. lor aauus. ±u uut ux recovered.—S. Suvansa, L. iV3Id075. ^c«7soTetanus. portion of the Laryngeal Tuberculosis.—Amputation o* ™ four times at epiglottis, and under cocame, pure carbolic c a . infiltration or intervals of a fortnight) to theunrated area, ulceration in the larynx. I. L; S. M- . > »• * with’a mixture of equal Sapr^mia treated by swabbing out the utmu^witn a parts of Carbolic Acid and Camphor. - pur8 Liquefied Appendical Abscess treated by scabbingnablv poJsible). Subsequently Phenol (after removing appendix if reaso bly po s ga;me after drying spreading Iodoform (any amount up to * teaspoomui; m out. B.M.J. i./n,676. /mni-orDf't! the surface and is only feebly War Wounds.—When used pure, backaU discharges. Soln- antiseptic as its combination with aibumiii^l , . „ painless but a weak tions 1 in GO on double cyanide gauze good * out with the destroyer of putrefactive organisms. Gauze! must not oe> - bare hand.—Casualty Station experience.—A. Eon, B.ai.j . a/ ’ . Add in Haemorrhoids treated by iMers tit iai 1 ^hc ^ ' als^ ln Liquid Almond Oil, see Gar housed Almond J , Extract of Hamamelis.—See Hamamelis. CH)Phenol Solubes, 5 and -d lotions. Potassium Carbolate, in proportion of assists solubility of Tablets of this kind. grains, produce 1 molecule added to antiseptic 3 of Phenol SDAcidum Carbolicum Licpief&ctuni [h.i. j- )• Dose,—1 to 3 minims (0-06 to 02 Cc.). Fifteen parts of water by weight added to 100 of above i e 870/ nearly. Sp. Gr. 1-067 to 1-069. This is used as a caustic. „ vrr0l!!)Ie frequently arises with liquefied phenol crystallising in the winter '. !(T \ie1re1ls a sudden drop in the temperature. Experiments which we’ conducted showed that the proportions 8-1, 9-1, 10-1, are all apt to separate. P. Belt*. IV. has Phenol 10, Water 1. CR)Carboiic Acid, Camphorated. Phenol 12, Camphor 4, Water 1. Melt oi rub together till liquefied. Is not miscible with water or glyceiin. Antiseptic, and local anaesthetic, serviceable in toothache. Ulcers produced by ‘ X ’ ray burns have been treated locally by a mixture of equal parts of Carbolic Acid Crystals and Camphor. Caution.—Neither of these is intended for extensive use. They cue not suited for applying all over the face ! Accidents have occurred. Acne—In bad cases press out the comedones, puncture pustules, evacuute contents, and apply to each the smallest quantity of a mixture of carbolic acid crystals and camphor m equal parts or in proportion of 3 to 2. Subsequent usual sulphur applications. 1 War Wounds of all kinds, many of them ‘large/ treated bv application °Af equal parts Phenol and Camphor—highly spoken of.—I. Feldman and A. J. Walton. L. n./i6,1043. ‘ Phenolisation * of gas gangrene wounds with Phenol 9 and Alcohol 1 was employed m the war, with MencUre’s Solution after. ’ Hypopyon Ulcers treated by a mixture of Phenol and Camphor applied with a match.—Bishop Harman, B.M.J. ii./2i,737. ®Carbolic Acid Lotion. Syn. Phenol Lotion. Liquefied Phenol 1, Water 19 or more as required. Carboluric ochronosis due to use of 5% Carbolic Acid lotion as dressing to les ulcers over 35 years.—J. L. Berry, L. ii./3i,124. ° Liquor Flaxns.L.n.—Xaphthol Yellow ‘ S/ 124 grains, water 10 ounces. Used for tinting Carbolic Acid Lotion, using 96 minims to the gallon. Lotio Acidi Carbolici, R.O.H. Liquefied Phenol 24 or 48 minims, Water at 50° C. 1 ounce. Solutio Phenolis, F.I., or Aqua Phenolata, to contain 2% of Phenol. Aqua Carbolisata P. Jap. is this strength. US il? llLotio Acidi Carbolici et Cocainae. Carbolic Acid J drachm, Cocaine Hydrochloride l drachm, Cherry Laurel Water 1 ounce, Rose Water 3 ounces. For pruritus. In the later stage of treatment of chronic eczema a Lotion containing Phenol, Liquor Picis Carbonis, Glycerin and Spirit may be used as a stimulant to growth of healthier epidermis. ®CarboIised Almond Oil. Carbolic Acid 1, Sterile Almond Oil to 20. HcemormhoicSs. Well treated by injection of 1 to 2 Cc. for each pile, under the mucous membrane, and injections continued at 5 to 7-day intervals until piles are of parchment-like hardness. Requires special instruments, skill, and experience.—A. S. Morley, L. i./28,545; see also W. B. Gabriel, L. i./3o,162. CE)Sterules of Carbolised Almond Oil, 1 Cc. 5%, are made. V. Meisen now adopts 5% Phenol in Almond Oil.—L. i./3i,877. W. S. Perrin uses Carbolic Acid 1, Glycerin 2, and Water 2—’usually a 5 minim dose.—L. i./29,569. W. B. Gabriel uses 5% Phenol in Almond Oil—with usually 3 Cc. dose—as also E. T. C. Milligan ; Sir Charles Gordon Watson uses 15% Carbolic Acid in Glycerin, and A. S. Morley 5% in Oil.—B.M.J i /31 897* 10°4 Phenol in Glycerin and Water is too weak. 20% better. 5% in oil, by submucous injection eliminates secondary haemorrhage, sloughing, and pam. —A. S. Morley, L. i./29,265. MfUtpd Crystalline Phenol 1 ounce, warm Almond Oil 1 ounce, and Menthol 40 grains. Thit is therS solution. The working solution (5% PrO.) is 1 part of the 50% P-O. with 9 parts warm Almond Oil. 3 to 5 Cc. of this injected high up above the piles produces sclerosis lasting many weeks. W. B. Gabriel, Pr5%aCarboiiciA Oleum Aracliis gives good results but exact technique im- P°l>taKtennedy jjurphyfB.M.J^./jUOSO, issues a strong warning against the method. Cg)Garbolised Olive Oil. Phenol 1 Olive Oil to 20 (more or less, if ordered). For burns and Scarlet Peyer has been treated by rubbmg with 10% Carbolic Oil or Eucalyptus Oil. Tonsils also painted with 10% Carbolic Oil during the first 24 hours.—B.M.J. ii./i8,359—but not found effective. See Therapeutic Index. dDLund’s Oil, L.L. Syn. Oleum Lubricans. Catheter Oil. For oiling catheters, Phenol 1, Castor Oil 4, Almond Oil 20. Carbolised Catheter Oil has no value.—O. S. Gibbs, B.M.J. i./3i,581. Surgical Lubricant for catheters, &c. Starch 4, Glycerin 35, add Water 8|; heat to boiling remove from flame and add Boric Acid in powder 2J, warm to dissolve, and when nearly cold add Phenol 1. The Lubricant is non-greasy and does not attack rubber goods. It can be removed by water. It will not attack metal instruments if left in contact for a short time, but is not intended as a coating to store them m—for this vaseline or liquia paraffin is best. BTC“ •£££& s"“-“a;dd Water 100. and .term*, then add Mercury Oxycyanide 0-25. Gargarisma Acidi Carbolici. _ . .. , Aqueous Solution 1 in 100 or more. For foul breath and sore throat. E.L. has 1 of Glycerol of Carbolic Acid m 40. Gauze, Carbolic, 5%, is in 6-yard pieces. Carbolic Gauze Ranges (Lister’s) are also made. Gossypium Carbolisatum. Syn. Carbolic Wool. To prepare this, impregnate Absorbent Cotton 1, under pressure with 1 of an ethereal solution (5%) of Phenol. Spread out and dry rapidly. Linteum Acidi Carbolici is also 5%. Formethods of preparing Catgut and other Ligatures, see Vol. 1 . ®Glycerimim Acidi Carbolici (B.P. ’14). Syn. Giyceritum Phenoiis. Dose.—(not B.P. T4) 5 to 15 minims (0*3 to 1 Cc.) Phenol 1, Glycerin q.s. to 5. (U.S. X. has Liquefied Phenol 20, Sodium Citrate 1, Boiling Distilled Water 1, Glycerin 79.) ^ paration is unnecessarily strong for general local use. It is emp oj eel as a throat pigment and is applied to wounds and to nngwoi . has been used in acute middle ear catarrh with gooc lesn . A solution of Phenol in Glycerin is almost non-caustic and on y slightly toxic. See Iontophoresis, Vol. II. Itching of Eczema, Carbolic Acid 4 grains, Glycerin 40 minims, Alcohol 90% to 1 ounce is often useful, but may irritate. Carbuncles are well treated by applying pledgets soaked in the glycerol. As soon as pus shows, the epithelium is turned back and the part may be later syringed out. Hygroscopic action of the Glycerin prevents fear of absorption. dDGutlae Pro Auribus Acidi Carbolici N.H.I. Glycerin of Phenol 3, Glycerin 5* i.e., 36 grains of Phenol in 1 ounce. For EARACHE, a few drops of Solution of Phenol, 6 grains to the ounce of Glycerin (Guttse Acidi Carbolici) slightly warmed, are invaluable.—This strength is ample. Smith’s Sterilising Solution. Phenol 20, Sodium Biborate 5, Glycerin 200, Peppermint Water 30, Water to 1,500 parts. ®Ravogli’s Liniment. Carbolic Acid 1, Glycerin 2, Alcohol 90% 16, Rose Water to 32. In skin affections. CE>Pigmentum Antisepticum. For hay fever. Glycerin of Carbolic Acid 1 ounce. Quinine Hydrochloride 30 grains, forms a useful pigment for the nasal passages. Solution of Phenol 2% in Spirit is used for diphtheritic membrane. CED Iodized Phenol. Pigmentum Iodi Carbolicum,’ Acidum Carbolicum Liquefactum et lodum.—C.II.W. Iodine 1, Liquefied Phenol 4. Digest till dissolved. For intrauterine medication on cotton wool. Chronic discharging sinuses have been treated by 5 minutes’ application of Iodized Phenol, also inoperable uterine careincma after curetting. Useful also for ringworm of the scalp. Carefully distinguish from :— Dilute Iodized Phenol Injection. As pigment in diphtheria, or as a gargle or inhalation, a much weaker preparation is made containing Solution of Iodine (Lugol’s) 2-5, Phenol 1, Boiling Water to 200. Is useful also as a nasal douche in ozcena, and for intra-uterine injection Physicians shcmld caref ully specify which is required. Injectio Acidi Carbolici Hypodermiea. Dose.—5 to 20 minims (0*3 to 1 *2 Cc.). Two percent strength. This has been used for tetanus, erysipelas, and phlegmonous inflammations of the skin.-—Whitla. CJEDLiqiior Sodii Carholatis. Dissolve Phenol 8, Caustic Soda 3J, in Distilled Water 100. To be diluted with 10 to 20 times its volume of water. These proportions of Phenol and Sodium Hydroxide are nearly the theoretical, the mouth-wash is sharp and pleasant. CE>Phenol Sodique is similar. Fr. Cx. has Carbolic Acid 100 Gm., Sodium Hydroxide Solution 20 Gm. (30% by weight). Water to 1,000 Cc. The Sodium Hydroxide in this is insufficient to combine with the Phenol. The Fr. Cx. preparation, in fact contains about 8-6 Gm. per 100 Cc .free Phenol, only 1-4 of the total 10 Gm! being in the combined condition, whilst the Fr. Cx. 1884 had the correct proportions to make Sodium Phenate.—W. H. M. Antiseptic Dental ^ Solubes. For preparing an antiseptic mouth wash. Contain Boric Acid, Sodium Phenate, Thymol, Scdii m Benzoate, tnd Aromatic Essential Oils. For prevention of dental caries ar d in suppurating conditions. One to be used in a wineglassful of waim water. Pastiiius Acidi Carboliei. (Glyco-Gelatin Basis.) Contains \ grain (0’03 Gm.) phenol. Antiseptic and stimulant. For ulcers in the mouth or throat, and for purifying the breath. jPerles and Capsules of Carbolic Acid. Dose.—1 or 2. Contain one grain (0’06 Gm.) and two grains (O'12 Cm.) of Phenol m oil. Paula Acidi Carbolic!. I Phenol 2, Powdered Liquorice 1, Powdered Althsea 1. In grains c:or one pill, in grammes for 15 pills. Smelling Salts, Carbolised. ! Phenol 24, Ammonium Carbonate 16, Strong Solution of Ammonia M, Oil of Lavender 1J, Camphor 3, Pine Sawdust (sifted), q.s. For pcryza, hay fever, influenza,etc . Anti-Catarrhal Salts. Phenol 1, Eucalyptus Oil 1, Pumilio Pine Oil J, Strong iodine Solution i Camphor"!, Ammoniated Alcohol 2, Pine Sawdust 2 or q.s. riDEesina Acidi Carboliei, B.D.H. Resin 4, Carbolic Acid 4, Chloroform 3. Dissolve and filter. . [ This is used as an obtundent and a temporary antiseptic filling. .Method.—Syringe out all food from the cavity and remove as much decay as possible. Apply on a wool pledget to relieve toothache. Suppositorium Acidi Carboliei (B.P. ’14). Phenol 0*8 Gm., White Beeswax 0-5 Gm., Oil of Theobroma, q.a. lor 12. XToeiiisci Acidi Carboliei {B.P. ’14). > Contain J grain (0*03 Gm.) with Sugar basis, lemon flavored. For sores in mouth and throat. jUnguentum Acidi Carboliei {B.P. 514). Phenol 3% in White Paraffin Ointment. For ulcers and parasitic An ointment made with Almond Oil or Adeps Lanse instead of the Glycerin La the *93 B.P. formula is satisfactory. SOUnguentum Acidi Carboliei cum Coeaina. Liquefied Carbolic Acid 20 minims, Cocaine Hydrochloride 10 grains, Soft White Paraffin 1 ounce. dFOnguentum Acidi Carboliei cum Eydrargyri Perchlondo. Liquefied Carbolic Acid drachm, Mercuric Chloride 2 grains, Oil a e Oil 2 drachms, Zinc Ointment to 1 ounce. Both the above are used for pruritus. Unguentum Acidi Carboliei cum Menthol. Carbolic Acid 2, Menthol 1, Cold Cream 100. For eczema with much itching. Vapor Acidi Carboiici. 20 drops of Liquefied Phenol in a pint of water at 60° C. Inhale c or as a spray, in pertussis and for throat ulcers. It lessens and dis infects the expectoration in bronchitis and gangrenous lung. (©Preservative Solution for anatomical specimens. Phenol 1, Glycerin 4, Methylated Spirit 5. Acidum Sulphocarbolicum. C6H4. OH. SO3H==174-1068. Syn. Phenol-sulphonic or Sozolic Acid. Prepared by the action of strong sulphuric acid on phenol. The para-acid is produced in the warm (the ortho- when working in ther cold), crystallises with difficulty, dissolves readily in wrater, alcohol, and glycerin, and is a strong antiseptic and disinfectant. In gingivitis and pyorrhoea a 3% solution is useful, reduces swelling and arrests flow of pus. A 33% solution has been sold as Aseptol. Principally 'para-acid with only about 6% ortho-. To separate ortho- and vara- acids utilise different solubilities of Mono-barium Salts—(SOHI Salts)—that of the ortho- body crystallises out first. The ortho- magnesium compound is more soluble than Vara-. See also Water Analysis, Yol. II. for US'use as a reagent for Nitrates. Cupri Sulphocarbolas.—Syn. Cupri aseptol. (C6H40H.S03)2 Cu + 6H20=517-7816. In light green crystals, soluble in water, a useful haemostatic or antiseptic lotion or astringent injection, J to 1 J%. Cholera has been treated with small doses (1/24 grain per hour). Sodii Sulphocarbolas (B.P. ’98). Sodium Phenol-parasulphonate C6H40H.S020Na,2H20=232-0872. Dose.-—5 to 15grains (0*3 to 1 Cm.) In white rhombic crystals, somewhat like magnesium sulphate. Soluble 1 in 5 of water, in alcohol 90% 1 in 130, by experiment. Flavoring.—Diluted, it has little taste. TJses.—Tn dilatation of the stomach due to flatulence and fermentation. For flatulence, the dyspepsia of phthisis, and in tonsillitis 5 to 10 grains every 2 hours have been given. Carbolic saturation to prevent the growth of streptococci in the circulating fluids. 20 to 25 grains of Sodium Sulphocarbolate needed for an adult every two hours. Treatment is stopped immediately there are any signs of Carbolic poisoning.—T. S. Wilson, B.M.J. ii./27,57. Mistura Sodii Sulphocarbolatis N.H.I. Sodium Sulphocarbolate 5 grains, Potassium Bicarbonate 10 grains. Water to Jounce. Zinci Sulphocarbolas (B.P. ’98). Zinc Phenol-para-sulphonate ; Zinci Piienolsulphonas, (C6H.0H.S03)2Zn,H20=429-5948. The commercial salt contains 8H2G (was in U.S. lX.). Crystals in rectangular colourless plates. Soluble 1 in 2 of water In Alcohol 90% 1 in 3, by experiment.—W.H.M. In gonorrhoea and leucorrhcea : 2 or 3 grains per ounce for injection, Solubes, 2 and 10 grains (0-12 and 0-6 Gra.), produce 2 and 10 ounces or more respectively of lotions for external use or injection. Tribromophenoi.—Syn. Bromol. C6H2Br3.OH=330-7114. Dose.—\ to 2 grains (0*03 to 0*12 Gm.) in pill. Manufacture.—By adding Bromine 120, in small portions, to Phenol 53, dissolved in water, q.s., with continuous stirring and recrystallising the product from spirit. la long silky needles, nearly insoluble in water, soluble 1 m o of alcohol 90%, 1 in 1 of ether, 1 in 3 of chloroform and glycerin ; also soluble in fats and oils. M.pt. 85° C. Used alone is strong y ana- septic : ointment (10%), oily solution (1 in 30). Is not dissolved by gastric juice, and is used as an intestinal disinfectant and m yp 101 , also in minute doses for cholera infantum. Bromnhenol Bismuth.-,S>. Bromphenobis. *Xekofokm. S;IXSSBl,0,(r,. F. W FG. VI. PF Krf V. (also P.Jap. IV. but without formula), P.Helv. has Bi2C6H3Br304. Dose.—5 to 20 grains (0*3 to 1*2 Gm.). iyS re ry e e fVs S' it LS r G CtdCS TOStS » SM Edll. XIA-, P- —0. A yellowish insoluble powder, with faint odour and taste, containing bismuth oxide and tribromphenol in nearly equal proportions. An intestinal antiseptic, e.g., for cholera. Bromphenoi Bismuth Gauze. 10%, 6-yard pieces. ^ The CfD following is similar.—Phenol 90, Salicylic Acid 20, Lactic Acid and Menthol of each 1, mix by heat. 0*2—04% m conjunctivitis and in eczema 1%. Trichlorphenol.—S yn. Trichlorphenic Acid. , White crystals, with pungent taste ; soluble 1 m a co , , ether l in 9 glycerin, also in fixed and volatile oils. Ointment and solution 10% strength are used as antiseptics. Para-Monoclilorplieiioi. C6H4C1.0H=128 496. sir Monochlor-phenol is practically identical and is used similarly. The ortho- body boils at 176° C. and the meta- melts at 28 o O. allA powerful antiseptic used in treatment of lupus, phthisis, keratitis, iritis and is also employed in dental work as an analgesic. A Pa£% for filling is made with Cobalt and Tropacocaine Hydrochloride equal parts, with enough Monochlorphenol and Zinc °XldP,°tE, paste. The unpleasant taste may be moderated by Ment • 5 to 10% in glycerin has also been used for laryngeal catar . inhalations \ to £% ygiiflH.’itu'wiM't’iiV. »**»*• fat 50. Chilblains are well treated with this and sol > f- j leutic Index To cover the odor we found Lavender Oi /o TrModopheno! C6H2I3OH has been used for making lotions and ;argies. Bismuth Tri-iodophenol. Syn. ^OFORM. • water. Has antiseptic CGH2T3.OBiO. Yellowish powder insoluble m watux. •■TSU (T.M. 408 144 dimethyl-me thoxyphcnol, C6H2(CH3)2(ULxj-3/- Lose. In 1 grain Tablets (Pulverettes)—2 to 4 with water after each meal: also m Syrup, strength 0-3 grain per drachm. It is described as Dimethyl-methoxypheno! in combination with tri- and tetramethylphenols. The preparation is voided in the faBces unchanged. It has been well spoken of in dysentery, coiitis and intestinal toxaemias generally. Rheumatoid arthritis — G out of 10 unselected cases showed definite i mprovement following treatment.—J. 0. Oliver, Hat. Fedn. of T. Unions Kept., May 31,28. . Chronic dysentery, sprue, mucous colitis, intestinal worms, auto-intoxica- tion, etc., treated by coloniclavage, using a solution of 1 to 4 ozs. Dirnol x owder in 8 gallons of Hypertonic Saline (4 ozs. of Powder = 1*4 grains per oz.) with good result. An investigation by Cuthbert Dukes showed marked effect on the effluent. At 15 minutes there were 10 organisms and no B. coli per Cc. against a control showing more than 200 bacteria and 800 B. coli.—W. Herr Russell, Brit. Jl. Phys. Med., May, *31. Stated to have a C.A. Coefficient (Rideal-Walker method) of 35. The Action of Certain Alleged Intestinal Antiseptics.—Neither Dimol, Enrol, Izal, or Yatren were found to exert any appreciable effect on the total numbers of living serobic organisms in the faeces, when administered by mouth in adequate doses. The first three were found to exert on faeces in vitro an antiseptic action much greater for coliform bacilli than for streptococci, the concentration of the drugs being considerably higher than in the intestinal tract, which presumably follows their administration by the mouth. Yatren had no evident action whatever in any dilution employed. “ Specific and detailed evidence as to the alleged action of these drugs should be published in support of the claims constantly made for them.”—L. P. Garrod B.M.J. L/26.369. Garrod’s conclusions, as far as Dimol concerned, according to the makers of Dimol, are contra to clinical evidence. Method of enumerating bacteria in faeces not accurate to within 100%. Whereas B. coli normally present are not affected, the causal infective organisms are destroyed by the drug. B. coli count alone thought of no value.—B.M.J. i./26,505. Dimol Ointment useful for cuts and abrasions, and for insect bites in the tropics. Dimol Dentifrice, Pastilles and Dusting Powder arc also made. ACIDUM CARBONICUM. Carbon Dioxide, Carbonic Anhydride. C02—44. Carbon Dioxide in the gaseous condition in small ""percentages has been advocated for use therapeutically, i.c., when used in dilutions of 4 to 6% with air it stimulates expiration, acts as a cardiac stimulant, exerts an indirect effect as a sedative and possesses the property of toning up a weak pulse. It has been used after an anaesthetic and operation. It has also been inhaled in czsena and nasal catarrh. It is believed to act as an antiseptic in such cases. To accelerate pulmonary elimination of poisons cr drugs, e.g. Carbon Monoxide, Ether and Alcohol. Valuable in treatment of empyema.—L. i./26,1052. In general anesthesia as an aid.—J. S. Lundy, Jl.A.M.A. H./25,1953. Carbon Dioxide 5% with Oxygen 95% (some employ even 25%) as a control of respiration in anesthesia; also in asphyxia of the new-born, alcoholic intoxication and Carbon Monoxide asphyxia. The mixture is not used “straight” but is added to air or Oxygen from another cylinder.— Yandell Henderson, B.M.J. ik/25,1170 ; see also ibid. 1181 el se/. and 1186. Also to prevent collapse of lungs following drowning. 7% is usually sufficient. —Y. Henderson, B.M.J. ii./3i,G89. See also Poisons and Antidotes—Asphyxia. Carbon Dioxide and Oxygen to'-prevent atelectasis. Important prophylactic in operations.—La Fleche, B.M.J. ii./3o,526. Angina Pectoris benefited by inhalation daily for 15 minutes from an open mask.—B.M.J. E.ih/31,26. mpneumonia.andasphyxiafromotherthought ta°the as, has been advised mlJ.S.A. ^“t£?f"jcarbon Dioxide from the lungs. Cmo/cOor oxygen (Ca™ Method) _former in preference as it is rapidly absorbed. Ihe proeed... is of utility for taking X-ray photos. F. Hernaman-Johnson, ‘ Carbonic Snow ’ i.t.. Carbon Dioxide in the ^mi-sond oondition formed as the eas evaporates from a storage cylinder, mi. . e7Koted^ee11Ctyown as Refrigeration or Chrymotherapy f«rpeuds=frost). The cylinders contain C02 at a pressure of ab 950 lbs to the square inch (65 atmospheres), yield the snow on open- ing with a temperature—79° C. (-110° R), which by collecting m a suitable receptacle can be formed into a stick or crayon b ordinary candle or mav be compressed into a mornd and cut any shape with a knife. The cylinders should be mounted on a stand with the stopcock on a lower level than the opposite end so that the liouid sras covers the inner orifice of the valve. Crayons, Method of Making.-The enow evaporates slowly—a crayon 5 by 1 inch will last about 1 to 2 hours As many as thirty applications with this size can be made, ihe temperature of tiwfcrayon is constant. A towel is folded into three and wrapped roundUi ordinary ruler-the ruler is ^en removed and the tube thus produced is bound on to the valve of the CO Cylinder the gas is turned on and the towel tube fills with the snow. The frozen gas may then be pressed into a piece of \ ulcamte or Celluloid Tubing about 1 inch in diameter with a ruler. A can - beard postal tube or roll of blotting paper several thicknesses) w. 1 also serve. Cover end of crayon with lint for handling. Can be pointed with a pen-knife or shaped .by rubbing against the sic e of a vessel e a copper steriliser—containing hot water. _ theAl4^ tii^SSngTi^pondtoAen^h of the crayon which can be used to meta, syf gedike apparatus convenient in use. Ref. C.I). n./ >•1 > Bully described E.P. Edn. XiX, p. -3. Uses,—For removal of nsevi, moles and blemishes, lupus evy matosus, lupus vulgaris, rodent ulcer, and warts (for last “““Doned long application necessary). Also employed for trachoma and chronic localised eczema. A single application usually suffices. The thawing out is usually more painful than the freezing. ALOPECIA AREATA of 3 to 7 years’ duration well treated. Hau „re ft three or four applications within 3 weeks.-Per Jl.A.M.A. ii.M5.o5- bee also 1 ^Chronic Localised Eczema—The method in trachoma without risk The lid is,ever ted and0B t® the parto?the“onhmSivEo be\reatedPfor l^to 30 seconi.y touched. CoCaine is not necessaryf”'lt pltienTcomplains of discomfort the eye can be bathed with cold boraoic lotion. The surface of the ulcer becomes white and raised Within twenty-four or thirty-six hours this ‘ slough ’sepSates ' leavlim a clear 1 WrS}^er* InfiBratlons disappear from the surrounding’ healthy cornet and hypopyon vanishes. After treatment, pads and bandages are user ThfmethU^fnSt^dv1}^^ atrop-ine, sulphate 1% is instilled once daily me metnoci is not advised for marginal or ring ulcers J HlNMO?RHomsRIA;r!tches removed by 30 seconds’ application. •tUEMORRHOIDS. Carbon Dioxide satisfactory.—B.M J i 112 190 accompanying ‘ X ' ray dermatitis. Brief applications answer ueP- t he treated area becomes firmer and in two or three minutes swollen A wheal forms with acute hyperaania within half an hour and a vesicle usualW followed1Dlw°Xsc’arrIi?Iym?thl.rtty scconds or longer, this will almost certainly be iolloued by scarring. An intense superficial destruction is obtained bv a SCrwr aPAPl-5atA0n2mm.ed.iately afterthe tissues have thawed out. Done Acid Ointment is used for after-treatment. If blister forms the fn re™oved W1*dm a few days, the crust forming should be allowed to fad oft. The scar ultimately is pale, soft and pliable. cimmeu to cihaTwVtn 0f an ordinar7 capillary ncevus the crayon is roughly shaped to that of the nsevus—or slightly larger* it is aoulied and firmiv pressed down for, on an average, 40 leconds. If’there is Ceimmediatelv beneath, a shorter time will do. For a cavernous nnevus the end of the cravon ji1Ze or sIi?htly smaller than the area of the growth. A Ion" POR??NT?TWqnp^eepPreSST^e Sh0^ld effectually freeze the whole mass. ° to recurTAL SoEE~Perseverance necessary as there is strong tendency to KS f?oTTmIAemt?inSwnd m?les vVhere many applications would have x j te made diquid Air (q.v.) is said to be more satisfactory. As a preservative of eggs the gas is useful.—H. E. Jones, B.M.J. i./26,848. F or details of the presence of excess of C02 in the air and its effect on the human organism on inhalation, see Oxygen. ACIDA CBLORACETICA. Acidum Monochloraceticum. CH2Cl.COOH=94*4804. JPi cpcii'ci tioH, By Chlorination of Acetic Acid in presence of Iodine at water-bath temperature, subsequently fractionating and reserving the 180°—188° C. fraction. ‘ * Deliquescent white crystals, M. Pt. 63c C., or liquefied. It blisters the skin, and is a caustic for warts and corns. Soluble with ease in water, alcohol, and ether. In the electrolysis of Sodium Chloride, as used in treatment of gonorrhoea, this acid is less decomposed than the salt, and it is able to neutralise the alkalinity which would deposit against the urethral membrane, cf. Gonorrhoea, Therapeutic Index. Acidum Dichloraceticum. CHCl2.COOH= 128*9296. A colourless caustic for venereal sores. Acidum Trichloraceticum. u.s. x., p. Heiv., Ph. Ned.v., p. jap. F.E. VIII. CCl3.COOH= 163*3788. Prepared by chlorination of acetic acid, or by the action of fuming nitric acid on chloral hydrate. 6 In deliquescent crystals, M. pt. 55° C. (lower if moist), and boiling at 195° C., very soluble in water, alcohol and ether. Uses, A quick escharotic for venereal and other warts. As lotion or gargle, 1 to 5% aqueous solution may be used, and as strong as 1 in 1 or 2 of glycerin with a little iodine and potassium iodide has been employed for temporary application. In gonorrhoea, solution 1% or less is used. Tobacco stains on he teeth can be removed by its cautious use (25% solution). Rigg’s Disease—incipient stages—this acid applied to the gum alter leaning with H ydrogen Peroxide Solution 10 or 20 Volume, is a good remedy. I'he action is probably dual—killing the infective organisms and dissolvm, he Calcium Carbonate of the tartar. With the disappearance of the tartar he presence of bacteria is excluded. Should be tried bJore sound teeth ^onsi'ts. Diseases of.—Where operative treatment is not permitted, the iso of Trichloracetic Acid applied on a right angled wool-earner and passed ieeply into the crypts, has been found of value m reducing the size of the t.onsil and adding to the comfort of the patient. eTVS.,fi. _T T Vincent’s ANGINA.—Trichloracetic Acid stated m be sp-cihc. 1. • lallaher Pres., Aug., 1920. Chromic Acid applications (saturated solution) ,Iso advised. Afterwards gargle with water, later with Hydrogen leroxide Liluted 1:10. Further bibliography ibid. Feb., 1921,63. Leprotic Lesions treated with applications of a solution 1 ^ r >f large thick nodules, 1 in 5 for painting on fane, and 1 generally dust not be too strong or brush too wet. When dry, skm .s.^°puld^wbe ivhite powdery appearance, otherwise repeat 2nd or 3rd time. May be ‘PDPBitscl ciffccr 10 duvs.—E. IVIiiir, T.lVI.Gr.) 26,^10. # . . Rodent Ulcer.—A solution of Trichloracetic Acid, 3 drachms in 201 minims )f watQr, applied.—The acid should be washed off after about 3 minutes, and ;hen for 24 hours no soap or water is allowed on the ulcer.. The eschar usually eeels off in about 22 days.—H. Leslie-Roberts, Laryngeal tuberculosis treated by Trichloracetic Acid thought specific. The infection is secondary to pulmonary tuberculosis. B.M.J.L. • j ^ ^ y Far its use as a delicate test for albumin, v. Vol IL ACIDUM CITRICUM. C3H4OH.(COOH)3, H20=210*078. Dose.—5 to 20 grains (0*3 to V2 Gm.). Colourless crystals or white powder, 99-5% pure.—B.P.’14 and U.b. Lemon juice contains as much as 7 to 9% (30 to 40 grains per ounce). Soluble.— 2 in 1 of water. 1 in 2 of glycerin, 1 in of aicohol (90%), 1 in 8 of ether, Sp. Gr. 0-735, but much less soluble m 0-720 For quantities of alkalis to be prescribed with this acid in the foim of effervescing mixtures, vide Neutralisation Table. JJses,—Relieves thirst in fever. Lemon juice is better than citric acid for scurvy. . __ In rheumatism and given internally in jaundice. H. Diminishes coagulability of the blood (Sir A. E. Wrigh ). \ i e also Calcium Chapter and Vol. II. , . To replace Hydrochloric Acid, Citric Acid recommended where it is desired to administer acid to bring acidity of the urine to normal. 0UIt required would be roughly 7 Gm., in the case of a neutral gastric juice, it can be given in pill form.—B.M.J.E. ii./22,78. . - Organic acids, e.g., Citric, Acetic and Tartaric m form o nq "tAmano- for all types of protozoal infections : malaria, Le:kltabolic somiasis, spirochetoses. These acids are thought to act as P 1 flourish poisons to malarial parasites. Kala-azar parasites expurime < £ and multiply in citrated blood at 20° C. but die cases of malaria treated without Qnmine on these lines, - s P without Emetine.—8. L. Rodrigues, Bombay, May, 1922. Incompatible with potassium tartrate and alkaline carbonates. Impurity.—Lead should not exceed 20 parts per million (B.P214). Lotio Acidi Citrici et Phenolis. Citric Acid 3 drachms, Phenol J ounce, Water to 1 pint. For cleansing sockets after removing septic teethe Acid fruit tooth paste better than soap and chalk.—B.M.J. ii./26,864. ®*ACIDUM CRESYLICUM, Cresol (B.P.T4). iSyn. Cresolum Crudum, Cresyl, PARACRESYLOL. Cresyl Hydrate, Methyl Phenol, Methyl Hydroxy- benzene, “ Commercial Carbolic Acid,” &c., C6H4.OH.CH3 = 108-0024. Kresolum Crudum P. Hung, is “ Acidum Carbolicum Flavum 100%. ” Dose.—1 to 3 minims (0*06 to 0-2 Cc.). A yellowish brown liquid with tar-like odour. A mixture of ortho-, meta-, and paracresols, forming the principal constituent in crude carbolic acids. Crtho-cresol (1 : 2) melts at 31° C. and boils at 188° C. Meta- (1 : 3) is a colourless liquid, boiling at 201° C. Para- (1:4) melts at 36° C. and boils at 198° C. Sp. Gr. 1-04 to 1-05. When distilled 90% should boil at 195 to 205° C. A definition of Mecf/ci/sa/ Creso/ is needed.—C. E. Sage, P.J. iL/30,2. Er. Cx. requires, in the following proportions : Ortho 35, Meta 40, Para 25. P.Gl. VI. and P. Belg. IY. (Cresol Brut) require at least 50% m-cresol C JT4.OH (CH3).(1 : 3), also that at least 92% must distil between 199 to 204° C. Method of estimating by converting into Trinitro-w-cresol is given in the former. Cresolo Grezzo, Ph. Itai. V. The bulk must distil between ISO and 204° C. Separation of m-and p-Crcsol.—Process depends on the fact that only Calcium m-Cresoxide is decomposed when the Calcium Salts of m-and p-Cresol are treated by superheated steam at 105—110° C. m-Cresol alone distils over.—Terrisse and Dcssoulavy (D.B.P. 267210), ex .T.C.S.A. i./i4,38. Manufacture of Phenols and Cresols from Gas Wash Liquors. At present there is more Crcsylic Acid available than can be sold. Separation of Cresols—methods kept trade secrets.—W. G. Adam, P.J. i./31,461. For Tests to distinguish Carbolic Acid, Cresols and ether Phenols, and further Analytical Data, see Vol. II. Soluble 1 in 50 water (H.2V14), we find mostly 1 in 70. Miscible with alcohol 90%, chloroform, ether, castor oil, and glycerin in all strengths. Also miscible wdth almcnd and olive oil in all proportions, but to make a clear solution we found about 1 in 24 necessary. Uses.—The mixed Cresols are less potent in action than Phenol (considered one-eighth as poisonous) and are used in many respects on analogous lines to the latter. Their odour is a disadvantage. “ Cresol ” is valuable for vaporising into the air in the treatment of whooping cough. Cresol is largely employed in the manufacture of Liquor Cresol Saponatus (B.P. ’14) and other disinfectants as described later. A small proportion (0-5%), preferably freshly distilled, is much used as an antiseptic to add to vaccines. Post-influenzal cough cured by inhalation of Lysol—about 1 drachm to 4 ozs. of boiling water.—C. Higgens, L. i./i5,1204. * But see first par. Acidum Carbolicum. The nomenclature used by manufacturers in describing their preparations includes the following :— “ Tar Acids .”—These are Oxygenated Hydrocarbons including Phenols, Cresols, and higher Hydroxy compounds. . 7 . . , , . “ Phenoloids.”—A vague term. The bodies so called simply consist of phenol and its higher homologues, i.e., Xylenols and Dimethylhydroxybenzenes. They are more bactericidal and less poisonous, and they make good emulsions with soap and water. . . .. , . “ Tar Oils.”-—The neutral bodies present, i.e., insoluble in soda. “ Coke Oven Oils.”—Contain varying percentages of “ Phenoloids with Tar Oils/' Disinfectants containing less than 3% Phenol and homologues sold at grocery shops and stores are relatively useless. The puohc should he protected. More disinfectants are sold by grocers than by chemists.— U. Kenwood, L. i./2i,1327. Cp) Liquor Cresolis Sapcnatus (B.P. T4). Mix Cresol 50 by weight with Castor Oil 35 by weight. Heat to 80° C. Dissolve Potassium Hydrate 8 in Water 7, mix and heat until 1 vol. mixes clear with 10 of Water. Cool ana add Water to 100 by volume. . Many formulae have been published—some employing Linseed Oil, as in the original Lysob Others proceed without heating, making the Potash Soap first by shaking, adding a proportion of Alcohol and finally the Cresol little by little. Others suggest an equivalent smaller proportion of Sofia instead of potash. As the result of many experiments we find the B.P. method good. The P.G. AL method, which can be completed at room temperature,is also satin- factory, vide infra. To make a clearly soluble article one must use the best potash ana Cresol. Soda and Castor Oil will produce a clearly soluble Liquor if the Soda is good, but we do not favour the suggestion to use soda. Preparations making a milky emulsion with water were favoured in the past. P. Off.—Linseed Oil to be used. 7 ™ , x Points of value in Cresols for making Lysol.—X. Glass and A. J. Jones, P. J. ii./3i,76. . . „no _ Liquor Cresolis Compositus, U.S. X., is prepared by warming to /0 C. Cresol 500, Linseed Oil 350, with 10 X^NormalTDekanormal> Caustic Potash 22 and 10 X Normal Caustic Soda 88, finally adjusting to 1,000 with waur. Liquor Cresolis Saponatus, P.G. VI., contains 3% by weight of A.coho fof strength 90% bv vol.), and is made as follows :— , . . _. . Add a solution of Caustic Potash 27 in Water 41, with shamng, to Linsee Oil 120, and then Alcohol 12. Shake frequently at room tempemture until saponified. Finally, add Cresol 200 and shake. (All parts by weight.) it may be necessary to allow to stand a day or so. . . _ W. Knight also advises saponifying with the use of spirit, o\erni*ht. P.J.i./26,409. ... These solutions are incom&ate&Ic with aciqs. . The Lysol Patent specification, 1017/1390 (expired) gives the following methods of preparation: , 0. (i) Tar Oil 100 Gm., Linseed Oil 100 Gm. Caustic Potash Solution (1 m -) 75 Gm., Alcohol 65 Gm. Boil with reflux con^nser ratil sapomfied. (ii) . Tar Oil 40 Gm., Common Kesm 10 Gin., Caustic iotasn bouu. 70 Gm., Alcohol 70 Gm. , , A “ Lysof ” mast contain ateoat 50% Cresofs* Products con- tabling 3% or less of Cresols, to be sold by grocers, etc., must not be labelled “ Lysol.” ltesultof Lysol, Ltd. v. Freesol Co., July 15,1925.—P.J.ii./25,85,91. ^Marshall’s Lysol (T. M. 428G70, 441893, 98947) found to contain 44% Carbolic Acid, but that is not inconsistent with its containing 50% Cresylic Acid.—H. X. Linstead, P.J. i./3o5205. Has quick and effective action on S. aureus, S. pyogenes, and S. hcemolyticus, using 2 : 100 dilution for the hands and 1 : 100 for the patient’s body.—L. L/31, 590. The dilution recommended by the makers for vaginal douches is 1 in 400, and no figures are given for the disinfectant action of Lysol in this dilution.™ L. P. Garrod, ibid. 729. Antiseptics in Midwifery. The Central Midwives Board and the L.C C. drew attention to the variation in bactericidal power of Lysol preparations and the strengths for use variously stated, but the Board, while giving the view that its use should be discontinued, gave no advice as to what should take its place. (Biniodide well spoken of by J. Gutch, B.M. J.L/30,359.) The germicidal action of Lysol, e.g., in midwifery on streptococci e.g., S. pyogenes is wholly inadequate in the dilutions which its caustic properties demand for clinical use. The best agent is that which destroys the organism in the highest dilution relative to the minimum tolerated by the tissues in the shortest time under simulating conditions. No Lysol can be other than a delusion. Lysol is only active on Gram-negative bacteria.—L. P. Garrod, B.M. J. i./3o,413. An investigation employing Streptococcus pyogenes. If prophylaxis can be served by merely teacieriosiatic action, Acriflavine is the most powerful agent. Adequate proportion would have to be maintained in the birth canal for several days. Few germicides possess adequate bactericidal action. Brilliant Green is the surest safeguard against streptococcal infection (kills in 1 in 10,000 dilution). Next in order are Monsol, Izal, and Cyllin. Acriflavine, Rivanol, and one brand of Lysol are bn the borderline. Lysols when diluted to 1 in 400 have little 'margin 0f safe use. Other Lysols, Mercurochrome, and Mercury salts found ineffective.—L. P. Garrod, B.M.J. i./31,572. The Central Midwives Board recommend (reissued from the L.C.C.) continued use of Lysol provided it contains 50% C.-eso/.—L. P. Garrod, B.M.J. L/31,572. The disinfecting power of the higher phenols increases in proportion to their position in the homologous series, but their solubility decreases proportionately. Bodies, therefore, with the hypothetical diphenyl nucleus which have become so popular can only be used as emulsions made with vegetable or with Tar Oils, Glue, etc. The use of Alcohol to dissolve reduces a ctivi tv.—Hewlett. Cresol Soap solutions are effective in proportion to their content of Phenols as shown by chemical analysis, and presence of organic matter calls for increase of strength, the ratios of increase being for pure Carbolic Acid 1-4, for Cresol Soap solutions 2-4, and for emulsions 8-2.—B.M.J. ii./26,1133. Poisonings Many cases are recorded, e.g., the following:— Apparently about 4 ounce taken. Recovery after vomiting and a dose of Magnesium Sulphate.” The copious vomiting and 3 glasses of milk which had been taken were probably the saving factor. Lavage not conducted.-— B.M.J. i./i3,19. In 1927 the deaths from Lysol poisoning were : by accident, 13 : by suicide, 361.—L. ii./2S,203. In 1928 the number of deaths was 287.—P.J. iL/29,274. Frequency of Lysol poisoning remarkable. If antidotes were given on the bottle it might lead to saving of life.—Coroner (Clitberoe), P.J. iL/30,214. Sulphates, best given as Magnesium Sulphate, render Carbolic Acid inert and prevent its action on tissues.—E. B.Leech, L. i./27,452. Antidotes,—Give Saccharated Lime-Water freely, then wash out the stomach or induce vomiting by mustard and water; Olive Oil; Parley Water may be given after. Strychnine hypodermically and dxygen inhalation.—Barts. See also Acid Carbolic. On no recount give water except by lavage. Comparative poisonousness with Phenof. Lysol usually considered one-eighth as poisonous as Phenol. Brandy given as enema, with recovery, in a case when 2 ounces had been taken. B M J ii /25 774. Acute pancreatitis following Lysol poisoning (taken per os).—V. Belial, L. i./3i,407. _ The following are some Proprietary and Cresylic disinfectants :— With regard to CE> see also first par. in Acid Carbolic chapter. (15) Acrosyl (T.M. 437105, Class 3). fp~)Clearsol (Canadian T.M. 212, folio 46308). . , Q , A Cresylic disinfectant forming solution in water. Has K.W . Coefficient 6 to 4, and by the Hygienic Laboratory Method 2 to 3. The preparation is on the I® *c“faecktant (T.M. 349583 Class 3.). 307885, 310359, 349582, Class 2. 349585, Class 48. Cg) sfcCreolin [T.M. 87839 and 92050 (Class 3), also 81450, 87838 I (Class 2) and 1G1927 (Class 48) and 161924 (Class 1)]. ( *Creoline is T.M. 214446, Class 2, *Pacolin 305633). Cg) Creophen (Ferris). CP) *Cyllin [T.M. 256051, 258990 and 299502 (Class 2), and 259683, 264589 (Class 3)] Medical. Dose.— 1 to 5 minims (0*06 to 0*3 Cc;). Ungucntum (Creolin) Cyllin Compositum.—Cyllin Soft Soap 1, Ammoniated Mercury Ointment 4, Soft Paraffin 8. In chronic eczema 1 in 200 with Lotio Calamime Oleosa.—B.M.J. n/09,ld4i. The Bideal-Walker Co-efficient for Cyllin in respect of Staphylococcus ^Cyllin Syrup.—Dose for adults 10 to 60 minims, for infants 5 to 10 minims. keratin-coatee, have keen need in summer diarrhoea, dysentery, colitis and sprue. ‘ Stomachic are also supplied. Cjg)DiiTusol, Lysol-Martindale.—A soapy solution . containing o0,o specially purified ortho-, meta- and para-cresols soluble m water m all proportions. For general surgical use dilute to 1/0. lor instruments -/o- ^°The^iffusible and penetrating properties of this preparation w*ere referred to in the 1915 Hunterian Oration by Sir Watson Cheyne. ~ The penetration diffusibility is determined by means of Edmunds CeU an ingenious apparatus employing a slab of Agar culture medium with to Test organism brushed on one side and the antiseptic to be tested on the other. °The area of no growth corresponds with diffusibility and penetration of the antiseptic. Diffusol was found superior to foreign maae .Lysol For mucous membranes 0-1% or 10 minims to the pmt approx, is efficient. For coughs and throat irritation 20 minims added to H Pints of water at 149° F. and inhaled, e.g., in a Portable Inhaler. -nrpnaration ^Hycol (T.M. 305595, Class 2, also 414679;> Class 3). The preparation is said by the makers to be “ non-poisonous. Hycol has R.W. Coefficient 18-20. L.11./29,895. . . • Hycol Medical is also made Dose internally . 1 to J^o^^VS-efficient A tar product containing 38% “ Phenol01 ds (200Vm 16 000 in ble- on B. Typhosus is indicated as 24-26. Used in dilution 1 m 10,000111 b pharitis to as strong as 1 in 5, e,g.,inlwus and lupus. In spray 1 in 1,000, in gonorrhoea 1 in 1,000 to 1 m 200 . to wounds - to 5 /0. In gynaecology 1 in 400. CDHypro (Canadian T.M. 212, folio . 46o07). WHker A white emulsified disinfectant similar to Hycol. Has ^Themeparv Coefficient 18-22, and by the Hygienic Laboratoiy Method lo-l 9. The pi 1 . tion is marketed in Canada. Izal (T.Ms. 171127, 300079, 443284. Class 2; 171043, Class 1; 171812, Class 3, and 443285, Class 3) (Medical); 516485, Class 3 ; 245827, Class 42; 171813, 443286, Class 47 ; 171814, 443287, Class 48. Dose.—15 to 60 minims in £ to 1 ounce milk or water. For use, 1 in 200 of water, is employed. An emulsion of Polymethylhydroxy Benzenes, with Phenol Coefficient of 18. A 1 in 3,000 dilution in warm water kills S. hcemolyticus and B. typhosus in 30 seconds. Active in presence of body fluids, non-toxic compared with Lysol, does not oxidise, is not impaired by tap water, is non-staining, and does not harm the skin. Puerperal Sepsis.—Mortality reduced from 46% in treatment of 79 eases by general means alone to 23% in 86 cases treated by currettage and active disinfection of the uterus with Izal.—D. S. Sutherland (Monsall Fever Hosp.), Jl. Obstet. & Gynec. Capsules of Izal (plain), 2 minims and Izal 2 minims with Cod Liver Oil 5 minims are supplied for use in phthisis. Izal, with Bismuth Subnitrate and Cliloromorphine Solution, is useful in dysentery. Izal Fluid containing the same amount of impure Izal Oil is also supplied. Strength of 1 in 400 disinfected Staphylococcus pyogenes aureus in pus in 15 minutes—in a simple broth culture 1 in 600 will do the work in 5 minutes. Pharmaceutical Socy. r. J. Brown (a grocer). Appeal dismissed concerning sale for ‘ excepted ’ purposes.—P.J. i./32,3S9,402 ; C.D. L/32,527. (g)#Jeves Fluid Disinfectant (T.M. 66985), Class 3; 42495, 51937, 524391, Class 2, 521784, 81826, 81977, 154330, 186844. 204987, 206486, 465216, Class 2 ; 66987,521784, Class 48. Contains Cresols with B,esin Soap. Cg^^Jeyes Soluble Fluid (# Jeysol. T.M. 385267, Class 2) differs from the Fluid Disinfectant in mixing clear with water. It contains 50% Cresylic Acid. (g)#Kerol (T.M. 275140, Class 2, and 469285, Class 3).—Claimed to be a non-irritant germicide. It. T. Hewlett reported this preparation slightly less toxic than Lysol. 1 in 180 is germicidal to Tubercle Bacilli in three hours even -when dried.—- W. G. Savage. Cg)Kerol Capsules are used as intestinal antiseptics. Cg)Kresapol (Ferris). Lycrvl (T.M. 363297, Class 2). 50% Cresols. 3^ Lysol (cf. antea). Trade Mark 98947 and 9S948, removed from Register (avoided) under Patents, Designs and Trade Marks (Temporary Rules) Act, 1914; cf. Patents, etc. (Temp. Rules) Act, 1914. Lysol was the name of an article made according to an expired patent. When a patent expires the name of the patented article becomes public property. The name, however, remained on the Trade Mark register until, removed under the Temporary Rules Act, 1914.—C. D. Feb. 20/15. See also result of Lysol, Ltd. v. Freesol Co. under Lysol antea. The following are now (1931) on the Register.—98947, B433040, 509951, 428670, B415189 (2); B400947 (3); 313061 (47). (‘ B * means Limited Pro- tection.) T.M. 406947, Class 3, applies to Marshall’s Lysol Hair Wash, and was obtained on the device of a label, not on the. name Lysol. rg)#Microbcne (T.M. 299709, also 321586, Class 2). 50% Cresols. Cg)#Monsol (T.M. 455799, 501707, Class 3; 485798, 501706, Class 2). Stated to be prepared from new oils obtained in the gasification of coal by the Mond Power Gas Process. They resemble the Phenols and have germicidal powers, but are less toxic and less irritant. Uses-—As an antiseptic for wounds, Monsol stimulates phagocytosis and promotes granulation. For a dressing a 1 in 200 solution. For douchings, irrigation, etc., use 1 in 500, gradually increasing to 1 in 250; for packings and tampons, and for instruments, use 1 in 20. In midivifery is stated to reduce incidence of puerperal sepsis and to have selective action on Gram4-organisms, and to be 10 times as powerful as.Lysol. Has special action on S. hcemolyticus—1 in 1,500 is stated to kill. It is nonirritant to mucous membranes and tissues. Monsol Germicidal Ointment for streptococcal and other forms of dermatitis, and for septic sores, impetigo, eczemas, ringworm, etc. Monsol Capsules are prepared for alimentary antisepsis, and the pastilles are stated to be expectorant, demulcent, and stimulating, as well as germicidal according to the makers, contain Rectified Oil of Aniseed | minim, Oil of Orange Vo minim, in a Monsol Throat Pastilles, Oil of Tar A minim, sugar basis. , . Cp)sfcPacolol (T.M. 328008, Class 2, and 328009, Class 3.) C02^Trikresol (T.M. 216094, Class 3), a specialty of the three cresols. It is a colourless liquid, slightly soluble in water, said to have three times the germicidal power of Phenol. For surgical use, | to 1% solution. As an eye wash 1 in 1,000 or 2,000. . , . . „ ®Trikresol-Formalin. These substances, m proportion 01 4 m 1, form a useful application as a dental dressing. , , nn 1% Trikresol is an effective solution for rendering the tooth-brush nee from the common pathogenic organisms. . , . For the Lancet and Rideal-Walicer methods of standardising Disinfectants B P Conf. Discussion and modifications of the methods, see Vol. II. Airtyl-Meta-Cresol.—Brit. Pat. 330,333 (1929). A new powerful antiseptic of low toxicity, the outcome of research on the effect of Alkyl groups on Phenols. A colourless solid substance, JM.pt. 24“ C., with pleasant odour and taste, sparingly soluble in water, insoluble in Alcohol, Ether and oils. . I Has marked lethal and inhibitive effect on bacteria and moulds. 1 m 20,000 and 1 in 25,000 inhibit growth of B. coli and Peniciilia_ moulds respec- tively. As a urinarv antiseptic it offers great promise. F. L. Pyman, C. E. i Coulthard, J. Marshall and Co-workers, Boots lies. Lab., Apl., 1931. Phenol Coefficient of from 200-300 against B. typhosus, streptococcus and staphylococcus, low toxicity and pleasant taste. Suitable as mouth-wash, and possibly as urinary antiseptic.—F. L. Pyman, L. i./3°,7o9. It is of interest to remark that Thymol, one of the most potent antiseptics, is Iso-propyl-meta-Cresol. . , ^ , Compound Glycerin of Thymol Pastilles with Amyl Cresol added, aic made. ACIDUM FORMICUM (P.G. VI.). Syn, Aminic Acid. H.COOH=46*0156. Dose.—2 to 10 minims (0-12 to 0-6 Cc.) per os freely diluted, e.g., with mineral wrater. Hypodermically 2 to 15 minims of 1 in 1,000 dilution of actual acid, but it is intensely irritating. It is better given as Sodium Salt. A colourless liquid Sp. Gr. 1-061—1-064 (24 to 25% H.COOH). Miscible with water. In concentrated form has a caustic action. Note Formic Acid is obtainable also of Sp. Gr. 1-12 = 50%, 1*15 = 65%; 1*2=85%; 1-22=100% H.COOH. As a rule the 25% Acid is referred to. . Jjses.—It is alleged that this acid (acting in a manner similar to cantharides) gives tone to the muscles and restrains muscular tremor, as in cases of paralysis agitans, and in chorea. It increases muscular energy and abolishes the sense of fatigue. It is employed usually as one of the salts, e.g., in influenza, gout, rheumatism, tremors, etc. The acid was originally made from the Red Ant, Formica ruja. The stinging nettle, Urtica dioica, contains formic acid, and has long been employed as a tonic and diuretic. Succus Urticae is prepared in strength 1 = 1. Dose.—1 to 4 drachms increased if desired. The juice expressed from the fresh plant, preserved with 25% of 90% Alcohol. Formic Acid is stated to be produced by the growth of B. rheu- maticus and is a considerable constituent in sweat, c/. 1 ol. II. Rheumatism, it is said, has been cured by applying bees to joints. Bee keepers it is said are remarkably free from rheumatism. Sodii Formas, II.COONa=68 0048. Dose.—5 to 10 grains (0*3 to 0*6 Gm.) in solution, increased if desired to as much as 60 grains (4 Gm.) per diem. A white alkaline powder soluble in water. A strong reducing agent and powerful antiseptic. Incompatible with Acids. T. Tyrcrand F. 0. Gosling found 2 H2 O in the crystalline salt.—P.J.ii./'i2,157. Uses.—In cases of heart and kidney diseases it is stated to lessen the loss of albumin by the urine, although it has diuretic powers. Does not disagree with the stomach. Said to be non-toxic. Has been employed in phthisis and in pneumonia. Improves appetite, mental and physical activity. Ocular fatigue has been treated with sodium formate instillation 1 in 50 to 1 in 30. Rheumatism has improved by 15 grain doses. Diphtheria has been treated with 5 to 10 minim doses of 25% solution in water every 4 hours. Sterules of Sodium Formate contain | and J grain. As much as 5 grains (0*3 Gm.) in 2 Cc. has been given. Elixir Sodii Formatis. Dose.—2 drachms (8 Cc.). Sodium Formate 4, Vanilla Essence, q.s., Simple Syrup to 100. Calcii Formas, (H.COO)2Ca= 130-0956. Dose.—3 to 5 grains (0*2 to 0*3 Gm.). White crystals soluble 1 in 10 of water. More permanent than the Sodium Salt. For haemorrhages has been found useful. Sterules of Calcium Formate contain J grain (0*05 Gm.). Ferri Formas. (Ferric Formate.) Fe3(0H)2.(IIC00)7.4H20 = 588-6526. Dose.—1J to 3 grains (0*1 to 0*2 Gm.). Red crystals soluble in water about 1 in 19 at 17° C., but solutions are unstable. Lithii Formas, H.COOLi, H20=69-9634. White crystalline powder freely soluble in water. Dose.—1 to 5 grains (0*06 to 0'3 Gm.). As much as 1| Gm. of this salt have been given daily. Uses,—Similar to the Sodium Salt and has been given in gout. Magnesii Formas, Mg.(PICO2)22H20=150-3668. Dose.—3 to 10 grains (0*2 to 0-6 Gm.). Colourless crystals soluble in water. Potassii Formas, H.COOK=84-1078. Dose and use similar to the Sodium Salt. Crystalline powder very soluble in water forming neutral solution. Owing to hygroscopic tendency the commercial salt is about 95% pure. [ICO Sfrychninse Formas, C21II22N202. HCOOH=380-2032. Dose.—grain (0-001 Gm.). White crystalline powder, soluble in water about 1 in 3J. A nerve stimulant and muscular tonic. Itis best prepared anhydrous. CE)Kypodermic Sterules of Strychnine Formate contain 1/64 grain (9-001 Gm.) in 15 minims (1 Cc.). ®Syrupus Form-atom Composite (Syn. Elixir Formatum Gompositum). Dose.—1 to 2 drachms (4 to 8 Cc.). One drachm contains Formates of Sodium and Potassium each 2 grains, Calcium 1 grain, Quinine \ grain, Strychnine T^-0 grain, Formic Acid 2 minims, Cochineal Vanillin, Lemon Oil, Alcohol. Water and Syrup. ACIDUM GLYCEROPHOSPHORICUM. C3H 5( OH) 2O.PO.( OH) 2== 172-0902. Dose.—5 to 10 minims (0-3 to 0-6 Cc.) of 25% acid. This dibasic acid forms a colourless liquid, miscible with water and alcohol. It is usually made 25% strength and has Sp. Gr. 1-125. It may be prepared by heating Glycerin with two-thirds of its weight of Phosphoric Acid 60%, at not exceeding 105° C. Uses of the Glycerophosphates*—Thought to aid metabolism, hence given in emaciation and generally for tonic action. : The Compound Syrup and Glycerol of Glycerophosphates, the Syrup 1 of Glycerophosphates with Formates, and many of the Milk and Glycerophosphate preparations have tonic properties in devitalised 1 conditions, e.g., during convalescence from illness. The Glycerophosphates were originally introduced into medicine by Robin, on the grounds that Lecithin (q.v.), an omnipresent, complex fatty body, ; contains its phosphorus in the form of the Glycerophosphoric radical. For a further consideration of the subject, see Edn. XVIII. Oaicii Glyeerophosphas (Neutral). C3H7O3.PO3Ca=210-1546 or -j-H20=228-1702, Fr. Cx., P. Belg. IV., P. Helv. and P.G. VI. have +2 H20. U.S. X. requires 98% anhydrous salt when dried at 130° C. P. Ital. V.—On calcining should leave not less than 59-5% Calcium Pyrophosphate. F.E. VIII. has Syn. Nettrosina. Dose.—3 to 10 grains (0-2 to 0-6 Gm.) or more per os in water, vide infra. Slipule No. 1 holds 5 grains. Hypodermically 1 grain i (0-08 Gm.) in 40 minims (2-5 Cc.). Intravenously 1 grain (0-06 Gm.) in 100 minims (6 Cc.) is suggested by analogy with the Lactophos- phate. This salt is a white crystalline powder. It is formed, together with i choline, on the breaking up of lecithin in the process of digestion. Solutafs in cold (about 1 in 40, but different maker’s products. vary | according to whether the compound is mainly the p modification, which is less soluble than a. The a position is the terminal hydroxyl in Glycerin and ! the p the central in combination with Phosphoric Acid); It is only slightly soluble in hot water, soluble also in glycerin, insoluble in alcohol.. The pure a salt is soluble 1 in 22.—G. J. W. Ferrey, P.J. ii./26,159. Uses.—Stated to improve nutrition of the nervous system in all cases where nerve activity is enfeebled. It is useful per os, for incontinence of urine. It may also be given hypodermically, 2 to 4 grains daily in water. Calcium Glycerophosphate Sterules contain one grain, also 2. 3 and 4 grains. For deficiency of Calcium in the blood bold doses are required. The soluble Phosphates have power in increasing coagulability of the blood. Se vere urticaria has been cured by its use. Incompatible with soluble Carbonates and Phosphates. Pulyis Caicii Glycerophosphafcis cum Lacta Exsiccate. Milk and Glycerophosphate.—Martindale. Dose.—One heaped tablespoonful (J ounce), mixed with 4 to 5 ounces of hot (nearly boiling) water, two or three times daily. This preparation is intended as a restorative and nutritive. Phosphorus and Nitrogen retention are likely to improve with its use. Has proved of value in the feeble for inducing sleep. It contains 5 grains of Calcium Glycerophosphate in the above dose combined with all the solids of fresh milk. Dried Casein alone is sometimes used for preparations of this kind, but in this case the Milk Fat, Salts and Sugar are eliminated, and Dried Caseins of commerce are not always readily soluble even with added alkali. *Vitafer (T.M. 347470, also 324675 and 333647, Class 3 ; also 329754 and 334627 (assoc.) and sfcCibrola (T.M. 319735, Class 42) are preparations of this description—the former containing the Glycerophosphates of Lime and Sodium. Caicii Glycerophosphas Solubilis consists of the Neutral Glycerophosphate with Citric Acid added to render it soluble 1 in 25. Ferri Glycerophosphas (FeRRic Glycerophosphate). Dose.—1 to 5 grains (0*06 to 0*3 Gm.). In yellowish powder containing approx. 15% of Iron—slightly soluble in water, or in the more soluble brownish-yellow scales. Flavoring.—Syl Lavandulae, Syl Vanillae, Syl Limonis. Vinum Ferri Glycercphosphatis contains 1%, with Glycerin 5% in Sherry. Sterules contain J grain (0*03 Gm.). (©Compound Iron Glycerophosphate Capsules. Dose.—One thrice daily after meals. Iron Glycerophosphate, Beta Naphthol of each 3 grains, Extract of Nux Vomica and Indian Hemp of each J grain, Compound Gal- banum Pill 1J grains. For anaemic patients in dyspepsia.—G. Rankin, B.M. J. i./i5,1036. Magnesii Glycerophosphas. C3H703.P03Mg= 194-3946. Dose.—3 to 10 grains (0*2 to 0-6 Gm.). A white amorphous powder, soluble in water (1 in 41). May be rendered soluble by addition of Citric Acid.—Umney. We found 1% of Citric Acid increases the solubility to about 1 in 35, 5% to 1 in 25, 10% to 1 in 20. Glycerophosphoric acid added gives the figures 1 in 33, 1 in 24 and 1 in 18 respectively. Manganesii Glycerophosphas. C3H703.P03Mn=2250046. Dose.—1 to 5 grains (0*06 to 0*3 Gm,). Is reddish white in colour, only slightly soluble in water. The relative anaemia which is often associated with cardiac over-strain may well be treated by administering Manganese Glycerophosphate with Haemoglobin. Potassii Glycerophosplias, C3H703.P03K2+3H20=302*3214. Bo-se.—3 to 8 grains (0*2 to 0*5 Gm.) ; hypodermically 3 to 5 grains (0'2 to 0*3 Gm.)* A yellowish liquid in 50 and 75% solutions and 100% (solid). Quininse Glycerophosplias. Syn. Kineurixe. Dose.—3 to 8 grains (0*2 to 0*5 Gm.). C3H703.H2P03.(C2(1H24N202)2.4H20 = 892*559. Fr. Cx. has the :compound with 5H20, termed ‘ basic ’ quinine glycerophosphate in France. A white powder, soluble in alcohol, but only very slightly in water. Sterules contain 4 grain (0*03 Gm.). Sodii Glycerophosplias. Bose.—5 to 10 grains (0*3 to 0*6 Gm.), per os; also given hypodermically vo 3 to 5 grain doses. It is supplied commercially in the following forms :— Dry Pieces or Powder 100% C3H7O3.PO3Na2.3H2O=270*1154. Very soluble in water. Hygroscopic. Solution 75%, a translucent straw-coloured mass which cannot be poured without warming, j Solution 50%, syrupy fluid convenient for dispensing. Glyeero-phosphate de Sodium Cristallize. PR- Cx. Supp. Nouv., T926. Is the hydrated diFodium Salt of /s-glycerophosphoric Acid with 5 mols. ILO. It contains 70-6% anhydrous salt and 29-4% water. P. Ital. V., P. Belg. IV. and P.E. VIII. similar. Ph. Ned. V. has 5iH20. Sterules of vSodium Glycerophosphate contain 3 grains (0*2 Gm.). Also [jp!] Sodium Glycerophosphate 1J grains with Strychnine Cacodylate Ft grain and IgjQ with Fo grain. Uses,—In nervous affections, facial neuralgia, Addison’s disease, lumbago, phcsphaturia, anaemia and general debility. Glycolactophos (T.M. 344300, Class 42), ^Sanaphos (T.M. 363457, Class 3), 2kSanatogen, (335408, Class 3), and ^JcVisem (T.M. 334359, Class 3, and 336808, Class 42), are Casein and Glycerophosphate combinations used in neurasthenia, and enfeebled nervous conditions ’generally. Further details are available, Edn. XVIII., p. 45. #The Sanatogen Co. 335407, Class 3, and Sanatogen Wulflng 316530, ClassrS are also on the Register. ijPT]Strychninse Glycerophosplias. Bose.—Ft to Fd gr. (0*001 to 0*003 Gm.) _ White crystalline powder, soluble in water. A ‘ tonic.’ Gonfectio Glyeerophosphafcum Composifca. Martindale. Bose.—1 to 2 drachms (4 to 8 Cc.). Calcium glycerophosphate 24, Iron glycerophosphate 2, Sodium glycerophosphate 2J, Lecithin J, Citric Acid 1|, Glyl Anisi 12, Pepsin lb, Full Cream Dried Milk to 120. This preparation has restorative, nutritive and digestive properties. Gonfectio Glyeerophosphafcum cum Malto. Martindale. Dose.—1 to 2 drachms (4 to 8 Cc.). Contains the glycerophosphates as in the last mentioned in a basis of Malt Extract. It does not contain Pepsin. Elixir Glyeerophosphafcum. Calcium and Sodium Glycerophosphates of each 2, Iron Gjycero- phosphate 1, Aromatic Syrup 250. Bose.-—1 to 4 drachms. GDGlycerimun Glyeerophosphafcum Compositum . rb. jtLV cerole of Glycerophosphates. Dose.—1 to 2 drachms (4 to 8 Cc.). b2 Cudbear J ounce, Water 10 ounces. Boil 10 minutes, strain, and dissolve in the warm liquor—Calcium Glycerophosphate 160 grains, Potassium, Sodium, and Mhgnesium Glycerophosphates of each 80 grains, Iron Glycerophosphate 40 grains, Citric Acid 30 grains ; add Tincture of Kola 10 drachms, Tincture of Ignatia Amara 1 ounce, and Glycerin q.s. to 1 pint. This is more palatable than if made with Strychnine and Caffeine. It keeps well, is suitable for export, and fcr patients who may not take sugar. Glycerimmi Glycerophospliatum cum Medulla Rubra. GLYCEROLS of Glycerophosphates with Bed Bore Marrow. Pose.—1 to 2 drachms (4 to 8 Cc.). Dissolve Calcium Glycerophosphate 80 grains, Iron Glycerophosphate 20 grains, Magnesium Glycerophosphate 40 grains, Manganese Glycerophosphate 20 grains, Potassium Glycerophosphate 40 grains, Sodium Glycerophosphate 40 grains, and Citric Acid 15 grains in Distilled Water 10 ounces ; then filter and add Chloroform 5 minims, Alcohol (90%) 40 minims, Orange: flower Water 1 drachm, Cherry Laurel Water drachmsGlycerin Extract of Red Bone Marrow 10 ounces. Given in rickets and debility. The writer prepares this Glycerol with four times the amount of Chloroform, i.e., 1 in 480. Granular Effervescent Glycerophosphates. Dose.—60 grains (4 Cm.). Contains in 1 drachm. Glycerophosphate of Calcium 3 grains, of Iron 1 grain, of Magnesium 3 grains, of Potassium 3 grains, with Caffeine Citrate 1 grain. A palatable mode of administration. Malted Glycerophosphates. Dose.—1 to 4 drachms (4 to 15 Cc.). Sodium Glycerophosphate 1, Potassium Glycerophosphate 1, dissolved in Water 30, with Liquid Extract of Malt to 120. CEDSyrapus Glycerophosphatum Composite, B.P.C. Dose,—1 to 2 fluid drachms (4 to 8 Cc.). 1 drachm contains 1/80 grain Strychnine with Calcium Glycerophosphate 1J grains, Potassium, Sodium and Magnesium Glycerophosphates of each a grain, Iron Glycerophosphate and Caffeine each TV grain—with Glycerophosphoric Acid and Cudbear (q.v., Vol. II.), to colour. This has been described as a good tonic. (©Capsules arc prepared equivalent to \ and 1 drachm. (©Pulvis Glycerophosphatum Compositus. Dose.—1 to 2 drachms (4 to 8 Gm.). Glycerophosphates of Calcium 2-0 Potassium (100%) 1-0, Sodium 1*0. Magnesium DO, Iron 0*5, Caffeine 0'5, Strychnine Hydrochloride 0-024 (use Trituration 0-24), Powdered Sugar to 100. This keeps satisfactorily in corked bottles. Compound Glycerophosphate Tablets are prepared containing in each the same quantities as the Syrup per drachm but without strychnine. To be crushed and taken in a little waim water. <©)Svrupus (Syn. Elixir) Glycerophosphatum cum Formstibus (Martindale). Contains Sodium and Potassium Formates of each 5 grains added to each drachm of a compound Glycerophosphate Syrup (made with Acetic Acid). Cp) Syrupus Glycerophospliatum {Robin) is a special preparation. Dose.—1 to 4 drachms (4 to 15 Gc.). The published formula (vide Edn. XVIII, p. 47) is impracticable. Emulsio Clei Morrhuee et Glyeerophcsphatwn. Dose.—2 to 8 drachms (8 to 30 Cc.). Contains the Glycerophosphates of Calcium, Iron, Magnesium, Potassium and Sodium, combined "with Ccd Liver Oil Emulsion, containing 50% Ccd Liver Oil. A useful nutrient combination. skJecovol (T.M. 315237 and 318395, Class 3) is a proprietary Emulsion of Cod Liver Oil with Sodium, Calcium and Iron Glycerophosphates. !FXS&rum N^vrosthUnique Ampoules (Fraisse) contain 0-1 Gm. ^odium Glycerophosphate and 0-0005 Gm. Strychnine Cacodylate, for hypodermic injection. In neurasthenia and other nervous affections. . ggj]Drops are also prepared for use by the mouth, containing the above quantities in 25 minims. Bose.—25 drops daily. # . . . _ ~ i i + n m p™ iJFlFerruginous Ampoules (Fraisse) contain Iron Cacodylate 0-01 Gm. (fgrain), Sodium Glycerophosphate 0-1 Gm. (1| grains) and Strychnine Cacodylate 0-0005 Gm. (rH grain) in 1 Cc. _ Drops containing the above quantities m 2o minims are prepared. nose.—8 to 10 drops in water after food twice a day (for adults). Maximum daily dose 25 drops. . . Similar Combinations, British made, are available in ampoules. ACIDUM EYDRIQDICUM. Syn. Acidum. Hydriodicum Dilutum, U.S. Dose.—5 to i0 minims (0*3 to 0-6 Cc.) in syrup. This Acid is readily prepared by heating red phosphorus and iodine in presence of water. A colourless, sour liquid, which becomes dark in colour on exposure to light. If this happens on keeping shake with a little dilute Hypophosphorous Acid (B.P.514 contains 1% added). Sp. Gr. 1-085=about 12% of Hydrogen Iodide HI=127-9398. {B.P. 514 and U.S. contain 10%). Commercially it is also prepared 20% with Sp. Gr. L17, and 46 to 47% strength with Sp. Gr. 1*5. Flavoring.—Syl Bosm, Syl Origani ; Syrupus Tolutanus. Syrupus Aeidi Hydriodiei (B.P. T4). Dose.—30 to 60 minims (well diluted). Diluted Hydriodic Acid 1 by wt., Water 0-5, Syrup to 10. Contains 1% HI. U.S. is similar, containing 1*4%. Glycerinum Acid Hydriodiei. Dose.—20 to 60 minims in Water, increased to three drachms. Experiments which we have conducted show that dilute Hydriodic Acid 1, Glycerin 4J, and Water 4J, produce a glycerole with good keeping qualities. Contains 1% hydriodic acid. ACIDUM HYDROBROMICUM. HBr=80-9238. Acidum Hydrobromieum Hydrobromic Acid of coloured, when diluted ; Concentratum. Sp. Gr. 1-308=35%, colourless or straw- one volume with three of distilled water produces an acid of 10% strength. Should be kept from sunlight. If of Sp. Gr. 1-260 = 30% ; 1-375=40% ; 1-450=45%. Ph. Ned. V. is 4 X N. (about 32%). Incompatible as Acid Hydrochloricum, q.v. Acidum Hydrobromicum Dilufcum (B.P. ’14); U.S. IX., Fr. Cx, Dose.—15 to 60 minims (1 to 4 Cc.) ; 60 minims = 10 grains of potassium bromide approximately. Contains 10% of hydrogen bromide. Sp. Gr. 1-077. May be prepared by the action of Phosphoric Acid on Potassium Bromide. A colourless, very sour liquid, without odour. Uses.—To allay nervous excitability and exhaustion, as a solvent for quinine and preventing quinism 8 minims will dissolve 5 grains of quinine sulphate in water, and as an alternative for potassium bromide ; given with morphine to allay after effects. Obviates the sense of fulness of the head felt when taking iron. It is useful for tinnitus aurium and tickling hackingcough in doses of 10 minims, and in headache, writh flushing in the face and ringing in the ears. In vertigo it is successful and it relieves toothache. In epilepsy, up to J ounce well diluted may be given ; even to 3 ounces daily. ‘ Bon Voyage * a specialty for sea sickness, of some service, contains, inter alia, this acid and sodium bromide. Dose.—Half an ounce in a wineglassful of wrater at 6 and 3 hours before embarking, and once a day in half doses for the first two days of the voyage if required. Not to be taken on an empty stomach. Bon Voyage Tablets are also prepared, 2 being equivalent to J ounce dose. ACIDUM HYDROCHLORICUM. HCl=36-4648. “ Poisonous—Not to he taken.” For retail in Great Britain, Northern Ireland and Irish Free State, the box, bottle, vessel, wrapper, or cover in which the acid is contained must be distinctly labelled with (1) the name of the substance ; (2) the words “ Poisonous—not to be taken ” ; (3) the name and address of the seller. Any liquid substance to which Section 5 of the Poisons and Pharmacy Act, 1908,—Restrictions on sale of certain Poisonous Substances—applies (to wit, Hydrochloric, Nitric and Sulphuric Acids, Soluble Salts of Oxalic Acid, Liquid preparations containing more than 5% by weight of free Ammonia, and all liquid preparations sold as Carbolic, etc., containing not more than 3% Phenols,—see Poisons Schedule), shall not be delivered exceqd in bottles or other containers, rendered distinguishable by touch from ordinary bottles or containers. B.P. ’14 has Sp. Gr. 1-160. Contains 31-79% by weight HC1. Ph. Ned. V. and P. Helv. 25%. Fr. Cx. and F.E. VIII. 33-65%. P.G. VI. 24-8 to 25-2%. P. Ital. V. 35-39%. P. Belg. IV. 36-47%. U.S. X. 31—33%. Antidotes.—Alkalis, sal volatile, saccharated lime, calcium carbonate, alkaline bicarbonates, carron oil, white of egg, morphine, lime water, magnesia, milk, soap and water. Give beef tea enema and stimulants. Suggestions to add mineral acids and Salts of Lemon to Poisons Schedule. —H. R. Oswald, West London Coroner, B.M.J. ii./25,1020,1033. Incompatible with alkalis, alkaline carbonates, metallic oxides, silver and lead salts. Use.—Escharotic. Alimentary Toxemia.—Bouchard’s Remedy ; fuming hydrochloric acid 5 to 10 m. freshly mixed at the time of administration with 6 to 8 ounces of water and taken with every meal. Of 'great value—reinforces the antiseptic power of the gastric juice.—W. Armstrong, L. i./i3,1384. Neuritis treated by applying strong Hydrochloric Acid to the skin along the line of the inflamed and painful nerve on a wad of cotton wool. Results striking and appreciated (H. Wingfield’s treatment).—H. Sainsbury, L. i./i7, 911. The treatment was described 20 years ago. It was discovered accidentally. R. A. Bayliss reported cases successfully treated.—L. ii./17,57. Hydrochloric Acid, arsenic-free, may be made by warming with pure fine copper gauze, and then distilling, Acidum Hydroehloricum Dilutum (B.P. ’14). jDose.—5 to 20 minims (0-3 to 1*2 Cc.). Is prepared by diluting 28-44 by vol. of the strong acid with water to 100. Sp. Gr. 1-048. Contains, B.P. ’14 U.S., P. Helv., F.E. VIII and F. Norsk, 10% HC1 by weight. P. Ital. V. 8-07%, Pn. Ned. V. is 4 X N (14-5%), P.G. VI. 12-4 to 12-6%, P. Belg. IV. 7-29%. Sp. Gr. and % Tables.—See Vol. 11. Use.—Tonic biliary stimulant. In dyspepsia, where insufficiency of acid. In pernicious ansemia strong Hydrochloric Acid 10 to 15 drops given in mucilage has been found useful. Gargle 1 in 50 to 1 in 100 for sore throat. When diluted forms a useful refrigerant drink and lotion. In dilatation of the stomach 10 to 15 minims after each meal may be given with or without 6 to 8 grains of Pepsin. Rheumatoid Arthritis.—It is often associated with some focus of pyogenic infection,—e.g., oral sepsis. The following is of use : An acid mixture containing Dilute Hydrochloric Acid 5 minims, Glycerol of Pepsin 20 minims, Clove Oil 1 minim, Tincture of Quillaia 20 minims, Aniseed Water to 4 oz. Dose—thrice daily. Cases benefited.—A. S. Woodwark and R. L. MacKenzie Wallis.—L. ii./i2,943. The regulation of the alkaline balance of the blood, and through it of the tissue fluids, is one of the most important functions of the kidneys. Treatment with Hydrochloric Acid largely regulates the amount and character of the urine excreted by its action on the renal tissue. Where acid is being administered in doubtful cases the blood pressure should.always be observed to avoid overdose.-—J, Campbell McClure and H. A. Ellis, L. ii./21,271. Rickets treated with Hydrochloric Acid.—B.M.J.E. i./24,69. Spasmophilia (Infantile Tetany).—Hydrochloric Acid {e.g., 260 Cc. of 3ST/10 Acid with 750 Cc. Milk) efficacious, but effect only transient.—Dan T. Davies, L. L/30,202. The role of Hydrochloric Acid in the causation of gastric pain. Concentrations of 0'5% or even less will reproduce typical gastric pain in susceptible individuals suffering from painful disturbances of gastric function. Hydrochloric Acid plays no essential part in ordinary pain production.- T. L. Hardy, L. L/29,711. ^Oxyntin (T.M. 274899). Dose.—5 to 15 grains (0*3 to 1 Gm.). An Albumin-Hydrochloric Acid compound. Contains 5% by weight of Hydrochloric Acid (HC1). Ten grains are equivalent to 5 minims of Dilute Hydrochloric Acid, instead of which it may be prescribed. Given in gastric disorders to increase HOI content.—B.M.J. 1./15.0O7. Acidin —Bose— 5 to 15 grains (-O'3 to 1 Gm.), equivalent to 2| to 7| minims of Dilute Hydrochloric Acid (B.P. T4), in cachet or powder, followed by a draught of water. A protein compound containing 5% Hydrochloric Acid, soluble in water, useful for liberation of acid in a nascent condition as digestive. Acidin Pepsin Tablets, made each=5 minims Dilute Hydrochloric Acid and 3 grains Pepsin. Dose.—1 or 2 as required after meals. An investigation into the value of Pepsin and Hydrochloric Acid in a chlor- hydria showed that a proper concentration of free Hydrochloric Acid seemed to be the primary consideration in gqstrie secretion.—II. V. Dobson, Jl. Ph. and Exp. Ther., Apl. ’27,447. ACIDUM HYDROCYANICUM. Prussic Acid (Schbele’s Strength). P l!Prussic Acid and all ‘preparations or admixtures 0*1 or more O/ /o of Prussic Acid (i.e., Hydrogen Cyanide), Laurocerasi, q.v. containing e.g., Aqua Applicable to Northern Ireland as above and in respect of Irish Free State “ Prussic Acid ” only. OF)All preparations or admixtures containing less them QT% Prussic Acid (Hydrogen Cyanide intended). Manufactured by distillation of Potassium Ferrocyanide with dilute Sulphuric Acid. Dose.—1 to 3 minims (0*06 to 0*2 Cc.). A colourless liquid with powerful odour. Sp. Gr. 0-994. Contains 4% IICN=27-0158. Antidotes.—Emetics immediately, stomach tube, brandy, or ether, fresh air, inhaling ammonia, artificial respiration (20 per minute). grain atropine hypodermically. Hydrogen Peroxide and Chlorine Water have been given. Dissolve about 15 grains of Ferrous Sulphate and about 20 minims of Tincture (or Solution) of Ferric Chloride in a. wineglassful of water, then add 1 to 2 drachms of Magnesium Carbonate, previously made into a thin cream with water. Mix and give and repeat s.o.s. These quantities are equivalent to about 100 minims of Dilute Hydrocyanic Acid, B.P.—St. Bart.’s H. 50 to 70 Cc. of a 20% Sodium Thiosulphate solution intravenously should be tried. A case where life was saved.— B.M.J. i./25,1158. Two intravenous infections of Sodium Thiosulphate, using 10 Cc. of a 30% solution, of use in a case of Potassium Cyanide poisoning.—Pres., July, ’27,250. Poisoning of a laboratory assistant who inhahd fumes from HCX lying in a concentrated sludge in a sink which escaped on stirring.—B.M.J. 0/30,132. Hydrocyanic Acid poisoning. Effects of being gassed.—J. R. Graham. B.M.J. i./30,262. Thiocyanate formation the primary factor in Cyanide poisoning.—R. G. Smith and It. L. Malcolm, JL Pharm. <fe Exp. Therap., Dec., ’30,471. Hydrocyanic Acid for killing rats in ships no serious risks to foodstuffs.— G. W. Monier Williams, B.M.J. I./31,65. UJAcidum Hydrocyanicum Dilutum (B.P. ’14), U.S. IX., Pn. Ned., P. Belg. IV., Fr. Cx. (previously 1% only). Syn. Dilute Prussic Acid. Dose.—2 to 5 minims (0*12 to 0*3 Cc.). Fr. Cx.—Max. single dose 1|- minims (0s 1 Gm.) ; Max. during 24 hours 8 minims (0-5 Gm.). Contains 2% HCN, Sp. Gr. 0-997. F.I. 1925 no longer recognises this acid. Keep in inverted stoppered bottles in the dark. For the estimation of Hydrocyanic Acid and detection of minute amounts in Toxicological luork, see Vol. II. Flavoring,—Glyl Lavandulae, Glyl Menthae Piperitae ; Spiritus Mcnthae Piperitae; Syrupus Zingiberis. Incompatible with soluble silver, mercury and iron salts. Uses.—In dyspepsia with pain, combined with Bismuth or Sodium Bicarbonate. To allay vomiting and cough. It is very useful as a sedative in an effervescing mixture. To promote healing of acute gastric ulcer bismuth, according to some, is of no particular value, but dilute hydrocyanic acid 5 minims in two drachms of water is useful for vomiting. CPjLotio Acidi Hydrocyanici cum Sodio, L.K. Diluted Hydrocyanic Acid 4 minims, Borax 4 grains, Sodium Bicarbonate 4 grains, Water to 1 ounce. As a soothing eye lotion.— R.Q.H. has 1% approx, of each. ACIDUM HYPOCHLOROSUM. HC10 = 52-4648. Hypoclilorous Acid, as such, has not been isolated. In solution and especially in the form of its salts—the Hypochlorites, e.g. those of Calcium and Sodium, it has played an important part in many chemical processes. The method of treating Chloride of Lime with Boric Acid in excess, as advocated during the wTar, was recognised in the past as a method of making solutions of Hypochlorous Acid. The acid in dilute solution is practically colourless ; in a concentrated form it is yellowish. It readily undergoes decomposition with formation of chlorine, chloric acid, oxygen and wrater. It is hence a strong oxidising agent and for this reason a bleaching agent. Medicinally the Chlorinated Soda Solution was a popular detergent during the last hah century, but has latterly fallen into desuetude. The Hypochlorites were, however, resuscitated and were extensively employed for wound treatment in the wrar as described in the following pages. Gals Chlorinata {B.P. ’14). Sel de Javelle. A dull white powder having about 30% available Chlorine. Solutions of 0-25 to 6-5% applied to burns and ulcers heal them rapidly. 25,000 gallons of water can be sterilised for less than Id. by aid of Calx Chlorinata.—Thresh. ‘ Tropical ’ Bleaching Powder is available, which is remarkably stable even in hot climates.—L. 1-/29,666. . „ AAn Chlorination of Potable Water. 1 ounce of Chloride of mme to -,000 gallons. Remove taste by a few crystals of Sodium Hyposulphite, ministry of Health Circular, L. ii./2i,671. cf. also Vo!. IX. Pools.—From 1 to 'll lbs. per 100,000 gallons of water used in Liquor Ca'.cis Chlorinata (B.P. ’14). . 10%. Contains not less than 2% available Chlorine, 3% when freshly made. Swimmin America. Unguentum Calcis Chlorinate. Chilblains can be cured with 10% strength in Paraffin Ointment. Gonococcal arthritis in wcmen has been treated by vaginal douching twice daily with solution of calx chlorinata 1 in 100. Afterwards a solution of Hydrogen Peroxide is freely used. Phthisical sufferers advised to work at bleaching powHer factories. Interesting data concerning Chlorine and Nitric Peroxide fumes.— T. Aitchison, B.M.J. ii./i5,489. Liquor Sodse Chlorinatse (B.P. ’14). 2-5% Cl. Dose.—10 to 20 minims. Dissolve Sodium Carbonate 600 in Water 1,060. Triturate Chlorinated Lime 400, wfith Water 3,000. Mix, and filter. Should be freshly made. Other Pharmacopoeias use more Sodium Carbonate to obtain a preparation which wall keep better. The reaction may be represented as follows :— CaOCl2 + Xa2C03 = NaCIO + XaCl + CaC03. The quantity of Sodium Carbonate in B.P. ’14 method is not enough to precipitate all the dissolved Calcium Hydroxide, and if sufficiency is used the preparation is excessively alkaline. It. C. Cowley modifies the formula.—- C.D. 1919,91, 49, abst. Y.B.P. 1919, 280. Carefully distinguish from Liquor Sodoe Chlorinates Chirurgicalis, U. S. X. our p. 45. Uses,—As a wound lotion and for general antiseptic purposes; for infected wounds or ulcers. It is usually employed diluted with 15 to 60 times its volume of water or normal saline. Thus diluted it has been used as a vaginal douche and as an irrigantof the bladder, and mouth wash. Locally in skin affections, howrever, a 10 to 30% dilution is suitable. It is strongly alkaline and may well be treated with .Boric Acid. (cf. Dakin’s Solution.) Eau de Labarraque or Liqueur de Labarraque.—Fu. Cx., is about I the strength of Liquor Sods® Chlorinata) (B.P. T4). U.S. X., gives Eau de Labarraque as a synonym for Liquor Soda) Chlorinata?—the strong preparation containing 2-5% available Chlorine. Initially Labarraque made his bleaching solution by passing Chlorine into Sodium Carbonate Solution. In tills case free Hypochlorous Acid is present: Na2C03 + 4C1 + HoO = 2HC10 + 2XaCl + CO,. Eau de Javelle (first made in 1789) was originally a solution of Chlorinated Potash made with Potassium Carbonate on the same lines as Chlorinated Soda Solution, but it is now replaced in great measure by the Soda Compound. Dor carbuncles Liquor Soda) Chlorinata), diluted 1 in 20 or 1 in 30, is a non-irritant and powerful dressing.—S. Phillips, L. i./21,63. Liquor Acidi Hypochlorosi Composite. Syn. EusoL—(Lorrain Smith, Drerman, Rettie & Campbell.—B.M.J. U./15,129). This solution contains approximately 0*27% Hypochlorous Acid, with small amounts of Calcium Biborate and Calcium Chloride. The solution is slightly alkaline to test paper. Manufacture.—Take Bleaching Powder 12*5 (of recent preparation and which has not been allowed to get wet), and Tap Water 1,000. Triturate thoroughly with enough of the water to make a paste and dilute with the remainder. Add Powdered Boric Acid 12-5 and shake well. Allow to stand for two or three hours and filter through cloth or paper. Eupad 25 may be used instead of the two ingredients. The interaction according to the originators may be represented by the following:— 2CaOCls + 2H3BOs = 2HC10 + CaB204 + CaCl2 + 2H20. It is to be noted that only half the ‘ available ’ chlorine (as determined in an assay) is liberated as Hypochlorous Acid, the available Chlorine from 2CaOCla being 4CJ. The two powders may conveniently be packed separately ready weighed for nse sufficient to make 1 or 2 or 5 litres, for purposes of transit—the 1 chlorinated lime in waxed paper (cf. L. i./io,32). For Details of Preservation, Assay and Bactericidal Power, see Vol. II. Uses,—Eusol may be employed as a lotion or on gauze wrung out and applied without waterproof; or as a bath full strength or diluted. The object is to secure the maximum effect with minimum irritation. As a lotion it should be used warm. In presence of blood or any considerable amount of organic matter Eusol is worthless.—L. P. Garrod, B.M.J.i./3i,574. We cannot reconcile this statement with undoubted clinical data of value.—W.H.M. Although solutions of Alkaline Hypochlorites have been used for many years, solutions of the acid have not been generally employed. Chlorine water probably owes its antiseptic power to the presence of this acid. Lister found the Lipaor Chlori of the old B.P. effective when a 1 in 5 solution of Phenol had failed (1870). . Eusol was the result of an investigation at the Royal Infirmary, Edinburgh, to prepare an antiseptic which could be applied as a first dressing in the field to prevent sepsis. It has no harmful effect upon the tissues, the effect being purely local. Plow of lvmph is induced by it from the tissues. It removes ) offensive odour in a wound. For field use the antiseptic may also be em- : ployed in the form of dry powder (Eupad) if water is not available—vide Eupad. I The authors of the original communication used the solution in out-patient , cases—injuries to the head or hands, lacerated, contused or incised, many being septic. Septic cases were clean in 1 to 3 days, while Boric Acid soaks conducted as control required 4 to 6 days. In clean injuries it had about the same effect as Iodine, but produced less smarting. In mastoid operations and in cases of cerebellar abscesses the use of the solution was encouraging, also as a douche in maternity cases and in cystitis, for treatment of ulcers of the leg, gangrene of the feet, pyorrhoea alveolaris and follicular tonsillitis. In a wound superficial bleaching may occur and with some irritation. If pain is produced, the application is to be diluted with saline. The above notes refer to the undiluted preparation. The solution combines a hypertonising effect with its antiseptic action. It must not be applied for long periods to wounds oj the bade of the hand, dorsum of foot and of the neck, forearm and wrist. In general it should be applied once or exceptionally twice daily and should not be covered by protective. It should be freshly made. The drip method is useful in compound fractures, and m lacerated wounds of the limbs where there is gas gangrene and foul smelling sores. It need not be continued after the wound is fairly clean and free from smell. A sterile dressing is then sufficient.—A. Lon, B.M.J. i./i6,648. Varicose ulcer, carcinoma of rectum (operation), lacerated wounds (results of accidents), severe burns, cystitis (1 in 8 irrigation), tuberculous periostitis with abscess and ulceration, tuberculous arthritis of knee (sinus), hydatid cyst (douche with 2 pints half strength), septic cellulitis, tuberculous osteomyelitis, necrosis of lower jawr for 6 months, tuberculous hip joint (amputation through joint), acute suppurative appendicitis (syringe and soak half strength), acute streptococcic infection of thumb, epithelioma of neck, tuberculous empyema, gonorrhoeal discharge (burning pain at first on injection—1 in a but decreased as discharge lessened and finally stopped in a days), tuberculous otitis media, tonsillectomy (sprayed)—were amongst 99 civil cases reported by the Medical Research Committee in which Eusol and Eupad were success- i in t rave no u a injection was tried in septicaemia and in malignant endocarditis with pneumonia, also in acute toxaemia secondary to gas gangrene. Eusol Sterules 50 Cc. are prepared. References, bee Edn. A.1A., p. - 8. Eupad. Pulvis Calcis Chlorinatae et Acidi Borici. (Lorrain Smith and co-workers, B.M.J. ii./i5,129.) Mix intimately equal weights of finely ground Bleaching Powder (dry) and powdered Boric Acid. Should be kept in stoppered bottles and not exposed to the light; in preference mix fres y. Caution. The evolution of Chlorinated vapour in mixing the ingredients is sufficient to “ gas ” the unwary Strength.—Using Bleaching Powder B.P. ’14 strength, this powder contains 15% available Chlorine or 11% approx, of Hypo- chlorous Acid. Uses.—Was employed as a dry dressing to wounds during the war. It evolves Hypochlorous Acid rapidly when moistened between layers of gauze or lint (as in the pad of a first field dressing), and covered with wool and a bandage. When applied covered with waterproof it should be used for a short time only—10 to 15 minutes as a rule. If it causes pain a weaker application is indicated. 1 to 2 Gm. is suitable in the first field dressing. Pulvis Caicis Chiorinatae et Acidi Borici Mills. Syn. “ Kepad.” —Martindale. Chlorinated Lime 1, Boric Acid in fine powder 94, Kieselguhr (sterilised) 9J (i.e., 5% Chlorinated Lime). Eupad was found to be irritating. This preparation (% its strength) is suggested as a dusting powder on septic sores. PresesrvatlcM.—Should be kept in stoppered bottles. The sterile Kieselguhr and Boric Acid may be kept mixed and the Chlorinated Lime added. Kepad containing stronger proportions of Chlorinated Lime may be prescribed, c.g., 10, 20, 30%, etc. Smaller proportions—1, 2%, etc.— of Chlorinated Lime may also be used—the ratio of Boric Acid and Kieselguhr being kept the same, viz., equal amounts. Kieselguhr commends itself as diluent on account of its light physical character and absorbent properties.— B.M.J. ii./i6,147. Bakin’s (Stronger) Hypochlorite Solution. The following method wo find best in making large quantities:— Rub Chlorinated Lime 150 into a smooth paste with 100 of water and add gradually, with stirring, Sodium Carbonate (Cryst. + 10H2O) 285, previously dissolved in water 900. Allow to deposit, filter and titrate 20 Cc. of the filtrate with Boric Acid solution (31 Gm. per litre) using phenolphthalein suspended in water as indicator to ascertain the amount of boric acid to be added to the bulk. An excess is to be avoided ; it is best to add slightly less than the calculated amount. Alcoholic solution of phenolphthalein cannot be U3ed as the alcohol is at once attacked. The titration must be done fairly rapidly. The amount of Boric Acid to be added is generally about 2% of the volume. Strength.—This concentrated solution contains about 4% of sodium hypochlorite and is to be diluted with 6 parts of water for use. It can be kept for a month without serious decomposition. Contains small amounts of free hypochlorous and boric acids and a balanced mixture of the hypochlorites and polyborates of Scdium. Owing to the presence of these buffer salts the solution maintains approximate neutrality under most conditions, so that the irritating action of free alkali is avoided. Bakin's (Weaker) Hypochlorite Solution. Syn. Solutio Darin K.C.H. Rub Chlorinated Lime (of good quality) 200 Gm. to a smooth paste with a little water and dilute with water q.s. to 5 litres. Dissolve Sodium Carbonate (Cryst. + lOIIoO) 400 Gm. in a further quantity of 5 litres of water and add to the Chlorinated Lime suspension with thorough stirring or shaking. After b hour the clear liquid is syphoned off and filtered through cotton wool. Boric Acid 40 Gm. is added to the clear filtrate (not before filtering). The solution should not be kept longer than 1 week. It contains approx. 0-5% available Chlorine. Soiutio Hypocliloritis Sodii ex Dakin. Sun. Solucion de hipo- clorito de sodio, de Dakin, P.E. VIII. is prepared by the interaction of Bleaching Powder and Exsiccated Sodium Phosphate. The quantities to be employed are stated according to the available Chlorine in the Bleach. The Solution contains 0-45 to 0-5% available Chlorine. . . P offm—Quantities of Chlorinated Lime, Sodium Carbonate, and Boric Acid required for varying percentages of Chlorine in the bleaching powder. Work done for the B.P. Commission.—H. Davis, P.J. ii./3i,82. For a comparison of strengths of Dakin's Solutions with Liquor Sodas Chlorinates (B.P. ’14), as also Bactericidal Power, see Vol. 11. Uses.—A non-irritating antiseptic for wounds. Fresh quantities should be brought in contact frequently. The solution assists in the dissolution of necrosed tissue, this being doubtless due to the ability of hypochlorites to attack the Nil groups present in proteins, forming soluble chloramines—cf. ChloramineV TV Vol. II. Liquor Sodse Chlorinate (B.P. ’14), owing to hydrolysis, gives rise to alkalinity, which increases with dilution : NaCiO + HoO = NaOH + HCIO hence the Boric Acid was added with a view to neutralising the caustic alkali £is formed * The solution was first used by Carrel's Method (B.M.J. ii./i5,318b rubber tubes with holes throughout their length about 1 Cm. apart. Pieces ot gauze are nlaced round and between the tubes and the solution rims into the wound and irrigcitos it. Soft PsxciiRn is smeared on tlic surrounciing skin. Cicatrisation is not delayed even by continuous use. X.B.—Not to be injected intravenously. Sloughing and dead and decomposed material quickly disappear. There must be no impermeable material outside the gauze. Refs, to results in the war. See Edn. XIX., p. 50. , ...... ., r< w Clockwork-controlled Douche irrigates the wound satisfactorily. C. \\. Cathcart, B.M.J. ii./25,933. . .. , Empyema.—Irrigation with Dakin's Solution.— L. n./307«3<. Bacillary dysentery.—Colon lavage of value.—H. Jocelyn Smyly, ir. Roy. Soe. Trop. Med., June, 30,48. . Electrolytic manufacture of Dakin’s Solution. British hospital snips were equipped with electrolysers.—P.J. L/29,15,29. Baufresne’s Modified Dakin’s Solution. . , , Chlorinated Lime 200 Gm. is shaken vigorously with 5 litres of water and left ill contact for 6 to 12 hours. Sodium Carbonate (Dry) 100 Gm. am Sodium Bicarbonate 80 Gm. are dissolved in a further 5 litres, i his solution is poured into the Chlorinated Lime Solution, the mixture well shaken ancl The solution should contain between 0-45 % and 0-5 % Sodium Hypochlorite. Its use is particularly satisfactory if employed in the first -4 hours after the infliction of the wound. 75% of the deaths from woundsm war, wasi stated, after the first 24 hours, were due to sepsis.—Sherman on Carrel s uteimsation method. L.ii ./i6,SQ0. ... tt c v q, m oTiTFirB Liquor So die Chlorinates Chmirgicalis, L .S. X., _ Syn. ^ _.l < urn v> Dakin’s Solution, contains 0-45 to 0-5% NaOGl equivalent to 0 40 to 0 48/o available Chlorine. Preferably to be kept not longer ^n.n7 days. Made with varying quantities of Bleaching Powder and Sodium Phosphate accoidmg to the strength of the former. i , ,, ,. „rte( Taaa pallcf;P Magnesium Hypochlorite is well tolerated by tbe,tissues. Less‘ caustic than the sodium compound. It has less antiseptic power, but twice as - CaTo^prepare, mix Magnesium Sulphate 190 Gm. in 2 litres of water and interact with Chlorinated Lime 100 Gm. dissolved into* amount of water and filter out the Calcium Sulphate. B.M.J.1./ > • 5k“ Milton ” Disinfectant (T.M. 375959, B. 409o3o, o81,ol3. Class 2, and 382491, Class 3, and 382490, Class 1, ain^3ff;249^C1^ss147)* This antiseptic contains Sodium Hyp°clllor1^ 1’0/ S°dlum Chloride 16*8% and small quantities of Chlorate, Sulphate and Cai Donate, and Calcium Chloride. It is made by electrolysing Sodium Chloride resulting in the production of a stable form of Hypochlorite with only Sodium as a base. (Chas. Watt discovered an electrolytic process of making Hypochlorous Acid in 1859, since u len there have been scores ’ of electrolytic processes advanced.— B.M.J.ii./i5,809.) A deodoriser, preservative, insecticide and general antiseptic, it is stated to be harmless to the human system either internally or externally. It is used for wounds and skin affections, either full strength or diluted down to 1 in 50 or more. For abscesses, fistulas, etc., it can be used undiluted. Eor the vagina and cervix 1 in 4. lor packing the vagina, gauze soaked in a 1 in 10 to 1 in 30 dilution. The ISu changed every 12 hours for several days prior to operation.—W. Blair i>eu, ±j. i./2o,yy/. In gonorrhoea of the female, prior to childbirth, a tablespoonful to the pint, as a vaginal douche, and half-tablespoonful to the pint for bladder and urethral irrigations m cases of urethritis.—C. W. Bundle, L. i./2o,1268. + *iuGraise-psls* Af^vised, in cases where it is known at the time of labour ^he utenne cavuy has probably been infected by intrauterine manipu- latmg—Victor Bonney, B.M.J. i./2o,266. Employ a 1 in 10 dilution for the first irrigation and later 1 in 30.—W. Blair Bell, B.M.J. i./2i,695. Has been found useful for syringing out antrum suppuration and for pyorrhoea and other suppuration in the mouth. . Dentures may be cleaned with it by the use of 10 to 20 drops—not more— m a tumbler of cold water overnight. Antiseptic action of Sodium Hypochlorite solution, it is suggested, is not chemical, but due to rays similar to ultra-violet emitted by solution.—Comptes Rend., ’25,180,1615, per Pres., Jan., ’26/6. £ "iJa/liiiyv, 1 r1 M. 384803, Class 3, and 384802, Class 2). A solution of Sodium Hypochlorite m salt, containing 1% available Chlorine. A household antiseptic. Chloramine^ T.’ Syn. Chlorazene, or ^-Toluene Sodium Sulpho-Chloramide. Ciiloramina U.S.X., with 11-5 to 13°/ active chlorine, Mianin P.G. VI., P. Belg. IV., F.E. VIII. CH3.C6.H4S02.N.Cl.Na+3H20=281*6226. Dose.—I to 3 grains (0-C3 to <P2 Gm.) has been given with charcoal. Manufacture.—p-Tolume Sulphonamide is made by acting on p- Loluene Sulphone Chloride (a by-product in making Saccharin) with Ammonium Carbonate. The sulphonamide (1 mol.) is dissolved in 5°/ cold alkaline solution of Sodium Hypochlorite (1*2 mol.), warming gently if necessary, filtering and adding 14 volumes of saturated brine. Chloramine-4 T ’ crystallises out, is filtered off, washed with brine and dried in the air It was originally made by Chattaway.—J.C.S.T.,87, p. 153 (1905) * For the theory appertaining to use of Chloramine-‘ T ’ and its Bactericidal Toicer, see Vol. II. 6 Solubility.—In water about 1 in 7, 1 in 7 of glycerin and 1 in 12 of alcohol by our experiments, but organic solvents are undesirable. The aqueous solution is faintly alkaline and has a bitter taste It is insoluble in Liquid Paraffin. Incompatible.—Alcohol and Hydrogen Peroxide and many other substances. Should not be mixed with other antiseptics. Uses*—For treatment of infected wounds and as a general surgical antiseptic, mouthwash, vaginal douche and for urethral irrigation. It is non-irritant and practically non-toxic; does not coagulate blood serum. Not suitable for intravenous use_has, marked haemolytic action. 2% is used for infected wounds increased to 4%. Mouth-wash, nasal or vaginal douche or for urethral irrigation, 0*25 to 2°/0. . Vaginal douche of 0-05 to 1% Chloramine, either as preliminary to operation or for disinfection of discharges during pregnancy.—B.M.J.h. 11./25,8. To sterilise water 1 in 250,000 of Chloramine-1 T is effective if a little Citric Acid (0-8 Gm. per litre) be added—the resulting water “ J1in ^oukwlutionk 1’ln8f minutes to the B. Typhosus, 1: 20,000 ; Staphylococci, 1. xb,J00. Chloramine-* TV Tablets 8-75 grains. Two in 2 ounces of water __ . ~ ^ _ * 4- -tiro t OT* ( . LilllUrdliiniC" A • x O , _ 1 Q __20/ • Tablets 43-75 grains. One m ten ounces water — 1/ o* TChlommineTV^Cause. Sand 35% strength is made.-The former for General u=e • the latter as preliminary dressing of a wound. Use dry and subsequently moisten if necessary when m Position. VVUi effect growth 86. Watsr°4amAs a dressing to a wound after it has become suTOiflcaal and is healthily granulating. .The content may be increased to Wo 01 reduces Mouth and favv Cunds treated with 2% solution Non-irritant. Results 3il 5S £?& £f$ sstsfe Wgo°»^ Di-Cliloramme - ‘ T. ’ Syn. Toluene - Sulphodiohloramide, Diciiloramina U.S. X., F.E. VIII. CH,C,H,S0,NC11- TMs substance (insoluble in water) enables an oily solution to be prepared, the corresponding monochloride being inso u e m -Shake thoroughly Chlorinated Lime 350 to 400 Gm Manufacture.—Shake tnorougm, Syphon olf the clear in water 2 litres tor one hour and allow to C|®I - * suiphonamide 75 Gm. liquor and filter off the pr if necessary* Acidify in a separator to the liquor and shake to dissolve. Fil ami act the Dichloramine with with Acetic Acid 100 Cc addedm la^rSfter removal, with Chloroform about 100 Cc. pry the Chloroform ^yar>^Wallise if neces- Calcium Chloride and allow to evaporate m the air Kecrystamse sary.—Chattaway (J.C.S.T. i'J°5, '«!• lx-Vv u-> ‘ Bichloramine-* T ’ Solution in Chlorinated Eucalypto.-Paraffin. Dissolve Dichloramine - ‘ T ’ 2, in Chlorinated Euca.lyptol .0, without heating, and add Chlorinated Paraffin 80. _ The solution is not to be used when a Pr<Vff j • , 265 865. E. K. Dunham and H. D. Dakin, Med. Res. tom., • Chlorinated Eucaiyptol. . nhlorate 3 Gm. and Hydrochloric Treat Eucaiyptol 100 Cc- with Then wash with water and with Acid (cone.) 10 Cc. for 12 hours or FA add Sodium Carbonate 3 Gm., Sodium Carbonate solution E|?]^Ad dryVitha little Calcium Chloride. and allow to stand 24 hours. Tliter ana ary Chlorinated Paraffin. Potassium Chlorate and Hydrochloric Employ Liquid Paraffin 100 Cc .with Pocassiu sunlight, several Acid as above, exposing the mixtuie to the u=nt. vrei hours. \\ ash with water, then Sodium Carbonate, then water again. Remov the oil, add a little Calcium Chloride and about 1 Gin. of Animal Charcoal Shake and hlter. Russian Oiis, containing much Naphthenes, are not so suitable as Americas (.Pennsylvanian) Oils, which contain considerable quantities of Olehnes as well cf. Paraffinum Liquidum. Uses.—For disinfecting the naso-pharynx in treatment 03 meningococcus carriers. Wounds treated by spray and covered with gauze. Dress again ever: % hours; saves pain, as it is easily removed. Eliminates the Carrel tube.— t .. : £weet> B.M.J. ii./i7,249. See also J. T. Morrison and co-workers L. n./i8,230. Iliis Eucalyptol and Liquid Paraffin method is now superseded' by the use of Paraffin Wax :— Cffilorcosane. Syn. Ghlorcosane Solvent, Paraffinum Chlorinatum, U.S.X. A chlorinated paraffin wax in the form of a light yellow oil slightly heavier than water, without odour and bland in use as a nasal spray or when placed on wounds. Employed chiefly as solvent of Dichloramine- ‘ T.’ Manufacture.—Hard Paraffin of melting point 50° C. or higher is heated to about 120° C. and chlorinated. The temperature while the gas is being quickly passed into it should be kept within 125—140° C. Continue until the paraffin has increased in weight 45 or 55%. Hydrochloric Acid is evolved. The oil while still warm is then shaken vigorously with 5% of its weight of dry sodium carbonate and filtered. To prepare a solution of Dichloramine - ‘ T ’ (of which it will dissolve 8-5 to 10%, 7-5 to 8% is strong enough), a portion of the oil, e.g., a quarter, is heated to 75 or 80° C. and the Dichloramine -4 T * added, when dissolved add remainder of the Chlorcosane. This solution is employed for nasal irrigation and for wounds. Carbon Tetrachloride 10% may be added to make the solutien more fluid for spraying—H. D. Dakin and E. K. Dunham, B.M.J. i,/i8,51. p-Sulpliondichloramino-benzoie Acid. C12N02SC6H4.C00H= 270-021. Halazone. Manufacture, Notes on. See Edn. XVIII, p. 63. When used to sterilise ordinarily contaminated water in 30 minutes 1 in 300,000 is sufficient. Soluble sparingly in water, insoluble in chloroform and petroleum Soluble also in excess of cold Sodium Hydroxide solution, but with lews quantity or with feebly alkaline salts, e.g., phosphates or borates, hydrolysis occurs. Tablets.—To prepare, powder the Sulphondichloramino-acid 4, with dry Sodium Chloride 92 and add dried Sodium Carbonate 4 (or dried Borax 8%) Pass through a No. 40 sieve (no lubricant required or indeed is to be used)', and compress into tablets weighing 100 mgr. Each tablet so made contains 4 mgr. of the Disinfectant—sufficient for a litre or a quart of heavily contaminated water.—H. D. Dakin and E E Dunham, B.M.J. i./i7,682. ACIDUM LACTICUM. (B.F. ’14) and numerous Pharmacoixeias. CH3.CHOH.COOH=90-0478. Dose.—15 to 30 minims (l to 2 Cc.), well diluted. U.S. average dose 30 minims. A colourless, odourless, syrupy, sour liquid, obtained by the fermentation of milk sugar by the action of Bacillus acidi lactici. Lime or Zinc Oxide is used to neutralise the acid as formed. The respective lactates are then decomposed. It has Sp. Gr. T21 and contains not less than 75% by weight of hydrogen lactate mid not less than 10% by weight cf lactide C8H804. Fr. Gx. has Sp. Gr. 1*24 at 15° C. Solubility,—Is miscible with water, alcohol, and ether; it coagulates milk and albumin. Uses.'—It has been used locally in tuberculous ulceration of the pharynx and lar3'nx, in diphtheria, &c., and internally for infantile and tropical diarrhoea, dyspepsia, and to allay cough in phthisis, and as a stomachic tonic in combination with iron and lime, and in vesical catarrh. As a paint, or paste with kaolin, or as a 50% injection, has been used in lupus, but is painful. Chronic Enteritis treated with Lactic Acid 71 minim doses t.d.s.p.c., the rationale being that B. Coli, which is, as a rule, universally active in those r cases where the motions are unduly offensive, cannot grow in a concentration of Lactic Acid of more than 1%.—I. II. Lloyd-Williams, B.M.J. i./23,lG53. Infants over 3 months in which attempts to give an adequate quantity of food have been attended by signs of intolerance frequently thrive on milk to which has been added Lactic Acid B.P. 1 drachm to the pint. The milk i should be boiled for two minutes, allowed to cool, and must be beaten or i shaken up while the acid is added slowly drop by drop. The culturing of the : Lactic Acid Bacillus in the milk has also been of great value in certain types of cases.—B.M.J. ii./27,1173. Lactic Acid Milk Gt. Orm. H. is similar. Test for in vomit, &c., vide i Examination of Stomach Contents, I Vol IL Butyric Acid—C3H7.COOH=88*0624.—(with the characteristic evolution of hydrogen) may also be produced if the fermentation of milk sugar proceed too long, or if the lactic acid is not neutralised by lime or zinc oxide. Acidum Lacticum Bilutum (B.P. 1885) Sp. Gr. 1*040. Lactic Acid 3 ounces, Distilled Water q.s. to 1 pint. Dose.—\ to 2 drachms (2 to 8 Cc.). Injectio Acidi Lactici. Lactic Acid 4 to 6 drachms, Water to 1 ounce. In tuberculous 1 ulceration has been injected into the tissues of the larynx. Nebula Acidi Lactici. . ., Lactic Acid I, Distilled Water 15. Of some use m dipntheria ; appears to have the effect of dissolving the membranous exudation. Spirit us Acidi Lactici. Lactic Acid 3, Castor Oil 2, Lavender Water 4, Alcohol 90% to 24. Suitable for treatment of alopecia areata. To be rubbed in gently at first, later with some friction. ---- Caleii Lactas (.B.P.’14), etc. %H4j^%”j2Ca+5H2O=308-23G. Dose.—10 to 30 grains (0-6 to 2 Cm.). Intravenously, 5 to 10 grains (0-3 to 0-6 G.m,) well diluted has been suggested. Subcutaneously too irritating. Causes abscess formation.—per Ji.A.M.A. i./29,1697. Maximum tolerate! dose in dogs intravenously 85/°T4^ffS^l^11Sa™K^lr kilo, or 1*5 Gm. in 30 Cc. water for an 8 kilo dog.—A. L. Lieberma.ii, 3 i. I haim. and Exp. Therap. Sept. *30,69. See also Calcium GLiiconw.e. An opaque, white, crystalline powder, antiseptic and stomachic, and given for rickets ; soluble in water, jl in. 15 if freshly prepared. Manufacture.—Pure Calcium Lactate can be made by precipitating the cold saturated solution with Acetone and then washing first with Aceton* and then with Ether. B.P. T4 requires 93% pure. Flavoring*—It is practically tasteless ; if desired to flavor an^ Glyl or Syl may be prescribed. Uses*—Urticaria and chilblains have been treated with it. Chil blains are stated by Sir. A. E. Wright to be caused by thinness o the blood, which permits of effusion into the tissues and consequen swelling and inflammation. Is useful to give prior to operation to in crease coagulability of the blood, but in a case it was found not suit able per os. (According to Dixon must be injected to produce the effect—cf. Calcium Chapter.) Further, hypodermically, it has produced painful coagulation locally and collapse. Chilblains in the adult treated with 15 grain doses dissolved in 1 ounce1 of Chloroform Water with £ to 1 minim of Capsicum Tincture, thrice daily one hour before meals, to be continued over six weeks. Constipation, which may be expected, is to be corrected by Senna Pod Infusion. Three 5 grain tablets daily for prophylaxis on an empty stomach before breakfast for a week. For treatment, 9 tablets daily, three before meals. Not to be given in excess.—D. C. Nasmyth, L. i./26,416. Hsemoglobinuria, oedema of the feet, boils, eczema, scurvy, urticaria, erythema, lichen planus, gouty pruritus, pruritus ani, have also been treated with success. It has also been advocated in epilepsy. Colour blindness has been treated by Calcium Lactate—the theory being: that it stimulates metabolism, hence ought to stimulate retinal cells to respond more to colour sensations. Post-partum Haemorrhage treated. Six multiparae, who had suffered more or less from haemorrhage in previous confinements, treated with 3 Gm. doses pro die for some time before delivery. In all the haemorrhage appeared to be less than normal, but the treatment wras not entirely satisfactory. In a girl of 13, however, suffering from metrorrhagia which had refused to yield to Hydrastis or Ergotin, Calcium Lactate arrested the discharge in three days. Erythema with periodical return. Drachm doses were most effectual, to our knowledge. Spasmodic IIhinorrhcea.—An annual sufferer from hay fever relieved by tapping antrum and washing out, giving Vaccine from the B. Goli isolated from the pus and full doses of Calcium Lactate.—L. ii./i2,1012. See also W. Mollison, L. ii./29,G12. Migraine aborted by 30 grains Calcium Lactate at first warning of onset. —B.M.J.E. i./26,61. Serum Calcium level of normal fasting subjects definitely elevated for extended periods of time by 5 Gm. in 250 Cc. water. No longer necessary to incur dangers of intravenous technique.—J. H. Roe and B. S. Kahn, Jl. A.M.A. i./2 7,984. Further on the administration and removal of lime salts, vide Calcii Chloridum. Calcium Lactate Tablets contain 5 grains eacli. Liquor Calcii Lactatis. Syn. Mistura Calcii Lactatis. Martindale. Dose.-—J to 2 ounces ( = 15 to 60 grains Calcium Lactate). Calcium Carbonate 4, Lactic Acid (75% strength) 8, Water to ISO, This, is stored in well corked bottles, keeps satisfactorily. Calcii Lactas Recens.—P.J. ii./3o,515. The Lactide does not interact.— Ibid 587. The amoimts used in the waiter’s Liquor are correct. At the end of pregnancy the amount of ionised Calcium in the blood tends to rise owing to lessened demands of the foetus and these salts greatly influence the tone of involuntary muscle fibres. Pregnant women should take 2 ounces of a mixture of this kind every night with Infundibulin 0-5 Cc. intramuscularly night and morning for a fortnight before parturition is due.—W. Blaii Bell, B.M.J. ii./21,545. jjcKalzana Tablets (T.M. 408762, Class 3,410843, Class 42) are stated ;o contain 7 J grains of Calcium-Sodium Lactate. To supply calcium leficiency and advised for expectant and nursing mothers and growing children. Ferri Lsctas (Ferrous), Fr. Cx. p. Beig. IV., P. ital. v., P. Jap., Ph. Ned. V., F. E. VIII. (C 2H4OH.COO)2 Fe+3H20=287-9548. Dose.—I to 5 grains (0‘06 to 0*3 Gm.). In greenish white crystals, soluble 1 in GO of water; when taken internally is easily assimilated by the system. Calcii Lactophosplias. Dose.—3 to 10 grains (0-2 to 0*6 Gm.). Crystalline or amorphous powder. Is often a mixture of equal parts of calcium lactate and (dibasic) calcium phosphate. Soluble in water. Stomachic tonic. In cardiac disease useful (Brunton). This salt has properties similar to Calcium Lactate v. anted. Syrupus Calcii Lactophosphatis (B.P. T4). Dose.—J to 1 drachm (2 to 4 Cc.). Mix Calcium Lactate 7*5 with Water 40 and add Concentrated Phosphoric Acid 4*5 (volume), dissolve and add Orange Flower Water 2*5. Filter and [dissolve Befined Sugar 70 in the solution without heat and add Water q.s. to [make 100. Dusart’s Syrup. Dose.-—2 drachms to \ ounce (8 to 15 Cc.). Calcium Carbonate 9, Lactic Acid 75% 22, Phosphoric Acid 10% 88, Water q.s. Dissolve the Calcium Carbonate in the Lactic Acid diluted to 108 with Water with the aid of heat. Cool and add the Phosphoric Acid, and make up to 370. Dissolve in this Sugar 623, and add Spirit of Limes 7. Mix and adjust to 1,000. All parts by weight. Liquor Calcis Lactophosphatis. LACTOPHOSPHATE DE CALCIUM Dissous Fr. Cx. Rub Dibasic Calcium Phosphate 17, smoothly with Water 964, add Lactic Acid 19 (Fr, Cx., Sp. Gr. 1*24, practically pure acid) -—all by weight. Shake to dissolve ; filter. Syrupus Calcii et Ferri Lactophosphatum. Dose.—J to 1 drachm (2 to 4 Cc.). Dissolve by aid of slight heat Ferrous Lactate 150 grains with Potassium Citrate 150 grains in Water 1 ounce, and add to Syrup of Calcium Lactophosphate 20 ounces. Plumti Lactas. (CaH4OH.COO)2Pb=385-298. A white crystalline powrder, soluble in water. Sodii Lactas. C2H4.OH.COONa=112*021. Dose.—5 to 10 grains (0*3 to 0*6 Gm.). Usually in form of yellowish syrupy liquid miscible with water, containing 75% of the salt. Large doses are said to be hypnotic. In scorbutic symptoms this is better than sodium citrate. Diabetes Melijtus, when there is tendency to acidosis, give Sc drum Lactate or Citrate in 40 grain doses, thrice daily. Sir William Willcox. Three cases treated.—B.M.J.E. ii./-2i,14. . . „ a ,. Prior to the use of Chloroform, the administration of fecdium Lactate has been suggested to prevent possible acidsemia. Elixir Sodii Lactatis. Dose.—1 drachm=10 grains. Prepared with Simple Elixir (B.P.C. 1894), this is a palatab e and convenient method of administration. ACID! LACTIC! BACILLI* The salient points of Prof. Metchnikoffs well-known Lactic Acid Bacillus Therapy are given. The subject is further dealt with in Vol. II. ^Lacteol (T.M. 317182), ^Lactobacilline (T.M. 290294, 321883, Class 42), sfc Sauer in (T.M. 297939), and ^Trilactine (T.M. 302646} are commercial preparations of Lactic Acid Bacilli. Liquid Cultures are also on the market. These latter onfy remain active a month or less. Moulded tablets are said show a higher initial count of the bacillus than compressed tablets. ^.Trilactine Tablets contain B. Caucasicum as their principal active constituent. They are intended for therapeutic use to be taken per os or for curdling milk (vide infra). For the former they are best taken in conjunction with a little milk sugar (the bacillus does not ferment cane sugar or maltose), e.g., dissolved in a iittle boiled (and cooled) water. Bose.—-Three to six per diem after meals. Trilaciine Tablets, Intestinal, i.e., coated to render them less likely to dissolve in the stomach than in the intestinal tract, are also prepared. These are not for curdling milk. The treatment, according to severity and nature of the case, extends over one to three months. Patient must avoid foods such as gravy, meat jelly, meat extracts, white of egg, fat meat, high game, etc., which would act as culture-media for proteolytic bacilli. Lactic Acid Bacilli—Curdled Milk. Dose— 1 pint or more (less if not tolerated) per diem, divided into 2 or 3 portions. After the bacilli have appeared in the stools, one daily dose, first thing in the morning or evening, is given. It is usually preferred during or after meals, but if taken on an empty stomach the organisms will pass through to the duodenum with less contamination with the stomach juices. Conduct the treatment for 3 weeks then stop for a period before proceeding again. It should not be given up the second week if flatulence is produced or constipation increased. Preparation of Curdled Milk.—An agreeable mode of treatment. Sterilization of the milk before introducing the lactic bacilli is essential. An organism dividing three times an hour (as mentioned in a contribution on “ Surgical Methods ” by Sir W. Watson Cheyne), which is a fair average, will give rise to something like thirty-three million bacteria in twelve hours. To kill all organisms in milk would necessitate exposure to a temperature of 108° to 120° C. (226° to 248° F.), which would give the milk an unpleasant- flavour. Pasteurising at 140° F. is not sufficient to kill B. tuberculosis or the spores of the butyric bacilli. Metchnikofx hence advised boiling for several minutes. For safety ari hour would be preferable, but commercially pasteurised milk may be used after 4 bringing to the boil.’ We find the organism grows best at about 4-4° C. (110° F.) N.B. —Acid production ceases at a slightly higher temperature. The required quantity of milk (a pint or a quart being a customary day’s supply), cooled to about 40° C. (104° F.) (this can be done expeditiously by standing the saucepan with lid on, in a basin of cold water), is placed in a suitable jar or basin so arranged with a small light beneath that a temperature of 40° to 45° C. (104° to 113° F.) —not higher—can be maintained for eight to ten hours,—a ventilated dry heat (hot air) will work satisfactorily. For a pint of milk two or more active Lactic Acid Bacilli Tablets—the quantity varies with the different brands—are crushed, e.g., with a spoon, in a little of the previously heated and then cooled milk (reserved for the purpose), to make a paste and stirred into the remainder cf the milk in the jar. For a quart four or more tablets should be employed. The milk will then (or a little later v. infra), have formed a junket ready for consumption. If the Curdled Milk be 4 over made 5 {i.e., much whey formed on the top), the heat must be reduced till the correct adjustment is ascertained. Curdled Milk may be taken, according to taste, either with milk, sugar, or with cream and sugar, or with sugar and a little powdered cinnamon, or ginger as flavoring. It is usually taken 12 to 24 hours after souring has been started. We finci in our experiments Tmt, after 8 to 10 hours, B. Gaucasicum is in great preponderance in the cream—the bacilli appear to be carrie d up with the milk fat. The milk must he free from, preservatives, pure and fresh. Pharm. Form, says acid-production in milk begins immediately the mil v is drawn from tlia cow, and in 48 hours sufficient acid (1%) is produced to coagulate the milk at normal temperature. For this reason dairy tarmeis have been known to add sodium bicarbonate, to counteract acidity and act as preservative. Some medical men think sodium lactate to be provocative of diarrhoea, and object to the addition. JJses,—Both the Tablets and the Curdled Milk are used for summer diarrhoea in children, diarrhoea and constipation in adults,, skin affections, such as eczema and psoriasis, acne and furunculosis, infective disorders of the intestinal tract, such as typhoid, dysentery, for intestinal tuberculosis and tuberculous diarrhoea, and for cancer of the stomach or intestines, and in enteritis and colitis generally. Also as a cliolagogue in hepatic congestion and gallstones, and m threatened appendicitis. May be of use in migraine, neurasthenia, and loss of appetite. The Milk acts as a lubricant to the digestive tract, forming a pleasant article of diet, and may be taken m comparative health, as a nutrient and antiputrefactive. Contra*Indications.—In some cases, notably in dironio acul gastritis, the stomach will not tolerate the Curdled ^Llk Many case enteritis are aggravated by milk in any form. Personal ,0 | osyncrasy; a.so enters into consideration. Suitable cases, those m w.nch abnoima v faction of proteid. Unsuitable, where symptoms due to carbohydrate in health and chronic disease.-!. Cruick- Sh'cmiONio Enteritis in infants. Lactic Acid Milk, scute 4Jkfl!01 Jyere high curative value, and possibly.of value m infantde < urticaria, but use of soured milk in trie average horm f , .. ' c °' from pathogenic contaminations.—-E. Cassis and U. Co ., -»• w~ > p* S. Acidophilus.—Cheplin and Uettger say Metchrdtoff this and not U. Bulgzricus.—Pres.,/Dec. It is a first cousm oi B. Bulgaricus and not easy to distinguish. Doubt as to any real a aide m the p. Acidophilus is a normal inhabitant of the human taken- 1 utre * ** nc 99NSTIP-^10^ relieved almost without exception by daily doses LfbSorTTr^6CAreS 0f * ***>**“■ “ be preW in the In sprue of benefit.—jl. Trop. Med., Jan. 15/27, 23. Bacillus Acidophilus Blocks. JJose.—-3 to 4 daily for 6 to 12 weeks. Acidophilus in Agar J elly covered by a chocolate coating. They drugs.t ie 1 ltage 0f sma]l volume- are palatable and contain no laxative &,I-lLa/tic ^ilk emP]oying either B. Bulgaricus or B. Acidophilus ThP .nl J card containers sufficient for a week’s use, two cupfuls pro die. Ine ariangement is hence convenient. ^Sphornhn^mCtlAC -Shee/e is.stated to contain 1-55% Phosphate calculated rv}anrt)i}fUQ Acul> 01 which about 68% is in organic combination. B. fn nTnmL l ti and the number of organisms which have been tound. approach the number existing in soured milk. Register ^n*C 1 ass^4*9^33956j Class 3- A number of T.M.’s are also on the ?f, Indian dietary made by inoculating freshly-boiled J, 1,v^sbuffalo) with soured milk, and after curdling, skimming off the rlKlIrS Tn earthen pots. Practically devoid of Vitamin A.—A. L. rsacnarach, 13.M.J. n./3o,141. ^Yarom (T.M. 499892). A Yoghourt type of sour milk, flavoured with fruit juices. of Lactic-Ferment Preparations.—A fresh culture of lactic rr^v °rSariisms lias been used to free the urethra from bacteria, e.g., in r infections. _ An ounce injected night and morning for a week resulted m lactic organisms only being found. Vaginal Suppositories of Lactic Acid Bacillus.—A hard gelatin capsule (Ao. 11) is filled with Syru]iy Glucose—one daily for gonorrhoea. Upon decomposition of the glucose, acid is formed in which the large Bacillus Kri?n"? 1i?ri?!al in1hat)itaiitr—can grow. The acid lulls off the pathogenic bacteria.—P. H. Marsden, P.J. i./2o,365. Cystitis has been treated by irrigation of the bladder with B. Bulgaricus. Vulvitis treated by smearing a paste of Bulgarian soured milk all over the vulva introducing if necessary a tampon soaked in it into the vagina. Combine this with gonococcic vaccine.—T. J. Abraham, Clin. Jl., Feb. 14/23,73. Buttermilk contains Protein 3, Pat 0'5, Sugar 4*8, Water 01 per cent. Contains less fat than soured milk. The ordinary Lactic Acid Bacilli found in this are not so active nor resistant as those contained in Bulgarian hour Milk. Milk in any form, however, in sufficiently large quantity tends to lessen internal putrefaction. Erysipelas has been cured by Buttermilk internally and locally. Malnutrition in Infancy.—Some cases of atrophy appear to do well on s um buttermilk or unskimmed diluted Lactic Acid Milk. Indeed most children over three months tolerate large quantities of milk if previously soured.—C. Chisholm, L. ii./22,497. ACIDUM NITRICUM. HNU3=63-0158. Poisonous—Not to be taken.” For Conditions of Sale v. p. 38, Dose.—1 to 4 minims (0-06 to 0-25 Cc.). (B.P. ’14.) Sp. Gr. 1-42, contains 70% by weight hydrogen nitrate. U.S. 68% ; Ph. Ned., 50% ; P. Helv. and P.G. VI., 25% ; Pr. Cx., and P.E. VIII. 63-64% ; P. Belg. IV. 63-02% ; P. Ital. V.,G5.3%. Uses.—A caustic to warts and condylomata. Quantitative Estimation.—By reduction with nascent Hydrogen f into Ammonia, which is precipitated as Ammonio-Platinic Chloride or titrated with Standard Hydrochloric Acid. .. c TVifmn frliubprivlene- A direct method of estimatmn is with the aid of Nitron (diphenyiem, lanilodihydro-triazole), which gives an insoluble nitrate—th- Preen lUt being quantitative. It also precipitates Picric Acid. 0. . •/ 7> Acidum Nitricum Dilutum. Dose.—5 to 20 minims (0-3 to 1*2 Cc.). Contains (B.P.-14), U.S. IX, Fa. Cx„ F.E VIII. and P. Helv. 10% by weight* P. Belg. IV. 12-6%. Pu. Ned. quadn-normal. Tonic and biliary stimulant. Sp. Gr. and % Tables.—See Vol. II. Incompatible with alkalis, sulphides, hyposulphites, ferrous sulphate, and alcohol. Antidotes as for Hydrochloric Acid, q.v. Chloroform in 5 drop doses every ten minutes will prevent the convulsions following the inhalation of nitrous fumes, as in the accidental breaking of a bottle of nitric acid. Poisoning by small quantity taken in mistake.—H.M. J.ii./o , • Acidum Nitricum Fumans. ‘ Poisonous—not to betaken Sp. Or. 1 a. / -p Tor, i.dSfi +n i • ? G VI. has 8o%, Sp. Gr. at lea^t 1 4io.) _ A reddish-brown liquid, giving off yellowish-red fumes. Contains ahou 91% by weight of hydrogen nitrate. Used as a caustic. Acidum Nitro-hydrochioncum, U.S. IX. (Strong. (Not no# . ■) Nitric Acid 9, Hydrochloric Acid 41, to Produce 50. , , Aqua Regia is Nitric Acid 3, Hydrochloric Acid 4. 1 oisonous. ACIDUM PHOSPHORICUM CONCENTRATUM. II 3P04= 98-0434. Pose.—1 to 4 minims (0-06 to 0-25 Cc.). Antidotes.—As for Hydrochloric Acid, q.v Hydrated Phosphoric Acid, containing 66-3% of hydrogen orthophosphate, corresponding to 47-4% of phosphoric anhydride; Sp. Gr. 1-5. Commercially, it is also prepared, havmgSp.Gr. 1 75, and containing 64-3% of the anhydride = 88-8/> H3I 04 (IJ.S. is So to 88% H3PO4). This strength may be reduced to L.l. 14 strength by adding to each 3 parts by weight 1 part of distilled water. Fr. Cx. and P. Ital. 50% by weight of H3P04. Sp. Gr. 1-349. * Acidum Phosphoricum ’ P.G. VI. and Ph. Ned. V., is UP /0. See Vol. II. lor Analysis and further details. Acidum Phosphoricum Dilutum {B.P. ’14). Dose.—5 to 20 minims (0-3 to i-2 Cc.). Contains (B.P.’14), U.S., P. Helv. and P. Belg. I v. 10% H3PO4. bp. Dilute Concentrated Phosphoric Acid (66-3%) 106-3 Cc. with Distilled Water q.s. to 1000 Cc. Incompatible with alkalis, ferric chloride, lime salts. Uses.—A nerve tonic and hsematime. Said to increase the proportion of phosphates in the red blood corpuscles, and to increase the coagulability of the blood. Well diluted, is a pleasant cooling drink in fevers; and relieves thirst in diabetes. It renders iron preparations compatible with astringent vegetable infusions. r 56 ACIDUM PIGRICUM. 7?.P.’14, P. Jap. ; Fa. Cx., P. Ital. V., F.E. VIII., U.S. Syn. Carbazotic Acid ; Trenitrophenol. CgH2.0H.N02.N02.N02 [1:2:4: 6] = 229-G474. Dose.—| to 2 grains (0-016 to 0-12 Gm ). Is formed by cautiously adding phenol to fuming nitric acid, heating the mixture, and purifying by re-crystallizing. It is in yellow, shining, bitter tasting crystals, which melt at 125-5° 0.—the yellow liquid may be distilled without decomposition. Heated rapidly to 300° C. in the open it burns. For details of this and other compounds as explosives, see Vol. II. Solubility.—1 in 90 of water with yellow colour, and 1 in 10 of alcohol 90%, and in ether about 1 in 20. Use.—Solutions or ointment are applied in the treatment of burns, erysipelas, pruritus, eczema, chilblains and gonorrhoea. Local use in skin affections may cause dermatitis. Stomatitis Mercurialis. A watery paste of the acid has been applied every 2 days—relieves pain and removes ulceration. Picric Acid 6 grains in 2 grain doses at intervals of some hours taken without harm. Turns urine orange coloured.—Walter Smith, B.M.J. i./i7,61S. l-otio Aeidi Picrici, 1% aqueous (St. Th. H.). May be diluted with one or more parts of water, as required. For burns cotton wool impregnated with this lotion is used. Recommended by H.M. Inspectors of Explosives to keep handy as First Aid for burns. After 48 hours remove and wash with Potassium Permanganate 5 grains in Water 16 ounces. Washing with weak ammonia and then with hydrogen peroxide removes the stains. In naval warfare Picric Acid found efficacious as a first dressing, but subsequently moist, and mild antiseptics found more suitable.—Surgeon-General II. 1). Rolleston, B.M.J. i./i7,224; L. i./i7,258. Burns due to Cordite were treated on H.M.S. ‘ Lion' and ‘ Tiger ’ in the Jutland battle with Picric Acid solution. Pound a suitable dressing but if left on too long it dried and was difficult to remove. As a second dressing 5% mixture of Eucalyptus in Olive Oil, sterilised by boiling, and if acid made alkaline by Lime Water.—B.M.J. ii./i6,598. For burns not advised. Permanently scarred faces in the Jutland Battle.— C. P. G. Wakely, M.P.C., July 10, 29,32. Gonorrhoea treated by l in 400 to 1 in 200 solution. An extremely potent germicide, and good when tolerated.—D. Lees, B.M.J. ii./2i,480. nnrmrrTimn. in wnmpii front,pH with Gonorrhoea in women treated with a douche of two teaspoonfuls of Pipri Acid in 64 ounces of hot water followed by Protargol Tampon and Ointment —B. W. Turner, Abst. Pres., Oct., 2o/363. Gauze and Wool, impregnated with Picric Acid are prepared. Pigmentmn Aeidi Picrici et Campkorse.—Picric Acid 2, Cam phor 50, and Alcohol 90% to 100. Ringworm has been treated wit] this. Sig.—“ Inflammable. To be painted all over the scalp twice daily.” The hai is to be clipped quite close, and the scalp washed once or twice a week an covered by a calico cap. Generally the ringworm hairs are loosened, an come away with tneir bulbous portions m from ten to thirty days. A sib ,1 J ♦ • j. , x , , v’ * yv/ *“,*7 XA. 01 list 11 yellow staining Qi tne nair may be noticeable some weeks after treatment — A. W. Williams, Brit. Jl. Dermat., June, 1912. Unguentum Aeidi Picric!, I to 3%, for pruritus of scrotum an gonorrhoea. ACIDUM PYROGALLICUM. For burns : Relieves pain and may be left 48 hours without changing. For bums of the eye, Ointment 2% preferred by some to solution, using a little cocaine solution beforehand. Collapsible Tubes of Picric Acid Ointment, 4% ^ soft paraffin basis, are supplied with catheter attachment for urethral medication. Papillary erosions of the cervix uteri have been treated with saturated alcoholic solution swabbed for three minutes twice or thrice weekly. Vaccinated surfaces treated by painting with a 4% alcoholic solution 48 hours after insertion of the lymph, lessens the degree of reaction. Makes a kind of natural dressing. Picric Acid is stated to be about four times as efficient as phenol as a local antiseptic. Ammonii Picras.—C6H2(N02)o0.NH4=245-0788. Dose.—J to i grain (0*01 to 0-02 Gm.) in solution. Yellow crystals exploding if rapidly heated in a test tube, but without loud detonation. To our knowledge 4 ozs. in a bottle were dropped and the bottle broken on the stone footway without exploding. Soluble 1 in 100 of Water, 1 in 85 Alcohol. Uses.—This and the Potash Salt have been thought to act like Quinine ; they are also used for hardening tissues prior to microscopic examination and as a urine test for albumin, q.v. Malaria has been treated by Ammonium Picrate in India. Misiura Ammonii Picratis. Dose.—4 ounce (15 Cc.) thrice daily. Saturated Ammonium Picrate Solution 30 minims, Syl Aurantii 1 drachm. Water to J ounce. Indicated after febrile diseases with loss of appetite and asthenic condition. Generally given with a clean tongue, but even when dirty the salt does not. seem to disagree. It takes the place of strychnine to a great extent, am is a really valuable drug. In explosive factories it is stated workmen take it as'a bitter tonic.—F. Fowler Ward, Ipswich. ACIDUM PYROGALLICUM. Syn. Pyrogallol, U.S. X., Pit. Ned. V. C(iH3 (OH)3 1:2: 3= 126-0408. Dose._4 to 14 grains (0-93 to 0*1 Gm.) in aqueous solution, or m pills with syrup—freshly prepared, and kept from the light. Manufacture.—By heating gallic acid. ^ _ In light small white odourless crystals, with M.Pt. 13i to 13b G., producing a sensation of coolness on the tongue. It has great affinity fcr oxygen. Solubility.—One in 2 parts of water, about 1 in 1 of alcohol 90%, and in 10 parts of melted lard. Uses*—Antiseptic in skin affections and in ringworm. Ointment 2 to 10% sometimes combined with Salicylic Acia 2 to 5% and Ich- thyol about 5%. It darkens the skin, used with Silver X it rate blackens the hair. Large’doses poisonous. Seldom used internally. Lupus vulgaris, if the area is not too large, 40% plaster as caustic, JL afterwards 10% Ointment is a good treatment, or apply the Ointment for a long time (until blister rises), then proceed with 2% Ointment, finally with a weak (0-1%) ointment. Syphilitic Ulcerations, resistant to usual treatment, well treated with Pyrogallol Ointment—2% for two days, 10% for two days, 20% for two days, and 30% for 8 days. The urine has to be controlled (black coloration with overdoses), undermined edges removed, and surrounding tissues protected with Zinc Paste.—Jl.A.M.A. ii./25,314. Fatal pointing following treatment of a universal psoriasis with ointment containing Pyrogallic Acid. Patient collapsed five minutes after covering about 2/3 of body with ointment. Estimated absorption of about 10 Gm. of Pyrogallic Acid.—per Jl.A.M.A. ii./25,555. Acidum Fyrogailieum Oxidatum (Syn. Pyraloxin). A brownish insoluble powder prepared by the action of air and ammonia on Pyrogallic Acid. 3 to 10% ointment for skin affections. Eugallol, C6H3(OH)a(CH3COO) = 168-0624 Pyrogallol-Monacetate. Manufacture.—Add Acetyl Chloride 78 to Pyrogallol 126 with stirring. When thoroughly mixed heat to 60° C. £ hour. Neutralise the syrup with Sodium Carbonate and extract with ether. This product is mixed with 50% Acetone (i.e., 2 of product and 1 of Acetone). A yellowish syrupy liquid, applied in skin affections mixed with an equal quantity of acetone with a brush. Lenigallol. Pyrogailol-Triacetate, C6H3.(CH3.COO)3 = 252-0936 in white powder, is much weaker, may be used with zinc paste in acute and chronic eczema. Manufacture,—Lenigaliol is made by combining Pyrogallol 1, with Acetic Anhydride 3, in presence of fused Sodium Acetate 3 at boiling temperature. The oily compound solidifies on cooling, and is recrystallised. M. Pt. 157° C. ACIDUM SALICYLICUM. In numerous National Pharmacopoeias. CgH4.OH. COOH 1:2 = 138-0468. Syn. Ortho-oxy'-benzoic Acid. Meta and vara Oxybenzoic Acids have very feeble action of any kind— either anti-rheumatic or anti-fermentative. Much larger doses—135 and ISO grains respectively—are required to kill rabbits than with Salicylic Acid (60 to 90 grains).—R. Stockman, B.M.J. i./i3,59S. Dose.—5 to 20 grains (0*3 to V2 Gm.) in cachets. Pr. Cx. Max. single dose I Gm. ; max. during 24 hours 4 Gm. Manufacture.—Salicylic Acid (artificial acid) of commerce is made by H. Kolbe’s method devised in 1874, by heating Sodium Phenate in a current of Carbonic Acid, or by a modification of it. The Basic Sodium Salicylate so formed is decomposed with Hydrochloric Acid. A modification (R. Schmitt’s) consists in heating the Phenate and Gas under pressure ; this is more economical. Potassium Phenate is also employed as starting point. It may also be prepared from Salicin and from Oil of Wintergreen (Gaultheria procumhens,—Ericacece) and sweet birch (Betula lenta,—- Belulacece). For internal use this natural acid is preferred. An artificial acid, Physiologically Pure, is also in commerce. In colourless prismatic crystals, odourless, but its dust irritates the nostrils, taste sweetish. M. Pt. 156° to 159° C. Soluble 1 in 500 of cold water, 1 in 3*5 of 90% alcohol, 1 in 40 of 45%, 1 in 2 of ether, about 1 in 80 of olive or almond oil, 1 in 100 of castor oil, 1 in 200 of glycerin, and 1 in 55 chloroform ; soluble also in melted fats and soft paraffin. Borax, ammonium citrate and sodium phosphate increase its solubility in water. Incompatibility.—Spirit of nitrous ether, quinine salts, sal volatile. An aqueous solution of the acid gives a deep violet colour with a trace of a persalt of iron. TJscs*—Anti-fermentative and anti-putrefactive. For various :?ebrile conditions generally as one of its salts, particularly for acute Rheumatism, v. Sodium Salicylate. In stomatitis a saturated aqueous solution is used. Large doses alone act as a direct poison on the heart and affect respiration. For sweating feet Pul vis Salicyli- cus cum Talco is used. It is applied to corns, warts and lupus. A saturated aqueous solution as Rectal Injection has been used fcr dysentery of children. Tc eradicate stumps left after removal of xoapillomatous growths 1 to 6% solutions in spirit. It may also be used dissolved with [sodium sulphoricinate.—q.v. For scarlatinal sore throats and tonsillitis, compresses of 2% Alcoholic Solution found of value. In gonorrhoea, may prove irritant, necessitating periodical dropping and renewal. Typhoid should be treated by 3 to 5 grain dcses given with milk so as to be carried more quickly into the bowel.—A. Wilson, B.M.J. i./i5,331. To remove tattoo marks, mass Salicylic Acid with glycerin to a dough— apply over the marks with a compress and strips of adhesive plaster and allow to remain in contact for a week. After the first dressing the epidermis oyer the marks is removed and a fresh application of the Salicylic paste applied. Usually the second application removes. Dermatitis may in some instances be caused by the external use of Salicylic Acid and its derivatives.—Y.B.P., ’24,341. _ Septic wounds treated by hypertonic saline to which 2 to 3 drachms of saturated solution of Salicylic Acid in Alcohol is added to the pint the crystals thrown out are deposited on the wound. Salicylic Gelatin 2 to 4 /0 'also used.—L. G. Anderson and co-workers.—L. i./i6,1119. Adsorption through the Skin. Salicylic Acid can be transported through the epidermis into the connective tissues and thence into the blood stream. The colloids of the connective tissues retain the drug by adsorption and from these surfaces it is liberated gradually, passes into the blood and is mainly excreted by the kidney. The excreted portion may be estimated colorimetrically in mg. per 100 Cc. urine, and if the quantity of urine voided in the 24 hours is known the total urinary excretion of Salicylic Acid may be calculated. Adsorption may take place from Soft Paraffin, Alcohol and Water, but the first is probably best.—-H. I Leslie-lloberts, Brit. Jl. Dermal. & Syph., Aug., ’28,325 ; per Jl.A.M.A. 11./2S, * 1409. ! Elixir Acidi Salicylic! Composifcum. Dose.—1 to 2 drachms (4 to 8 Cc.) well diluted with water. Each ounce represents Salicylic Acid 40 grains (as Sodium Salicylate), Gelsemium 8 grains, Cimicifuga 15 grains and Potassium Iodide 4 grains. In chronic gout and rheumatism, lumbago, and sciatica. It is antirheumatic, analgesic and the eliminative action of small doses of Potassium Iodide is useful. Cp~) E m p 1 a s t r u m Acidi Salicylici Saponatum. Salicylic Acid 2J, 5 and 10% in Emplastrum Saponis. Liquor Acidi Salicylici. Boiling Distilled Water 1,000 parts, Salicylic Acid 1J parts, a good antiseptic gargle*- A useful solvent for alkaloidal and ether salts ; it is irritating to the eyes. t Lotio Acidi Salicylici cum Borace. Mid. H. Salicylic Acid 4, Borax. _, Glycerin 15, Alcohol 90% 15, Water to 140. For use in urticaiia, prurigo and itching affections Pulvis S&Iicylicus cum Talco. Salicylic Acid 3, Wheat Starch 10, Talc 87. Mix to form a fine powder. For perspiration of the feet. CeD Salicylic Cream or Pasta. Salicylic Acid, in powder, 2, Carbolic Acid 1, Glycerin 10 ; mix, G.H. had Salicylic Acid 1, Glycerin 9. Used as pigment when the skin is irritated by the discharge from wounds, &c., under antiseptic dressings. Oleum Aeidi Salicylic!. Scabs in eczema are well treated by Salicylic Acid dissolved in Castor Oil.—We suggest 1 in 50. This dissolves on warming. Unguenium Aeidi Salicylic! (B.P. ’14). Salicylic Acid, in powder 1, White Paraffin Ointment 49. Useful in eczema, acne, ringworm and cancer. In seborrhcca, the following is useful; Salicylic Acid 1, Precipitated Sulphur 2-5, Cold Cream 25. Lupus vulgaris, scabies, acute eczematous dermatitis and ringworm treated by 50% Salicylic Acid Ointment.—Sir Archibald Reid, L. i,/23,1325. Unguentum Aeidi Salieyliei Compositum. Syn. Whitfield’s Ointment. Salicylic Acid 1, Benzoic Acid 1, Cocoa Nut Oil 12, Soft Paraffin 16. For ringworm.—L. i./i7,222. Salicylic Gauze, Lint and Wool, each 4%. Dissolve the Salicylic Acid in alcohol, q.s. (about 1 = 1 of dressing) and impregnate under pressure : dry. Salicylosol.—A solution of Salicylic Acid in a partly oxygenated mineral oil. Used by massage into the skin. When 10 Cc. of the solution was rubbed into tlie skin, 0T37 Gm. of Siiicylic Acid appeared in the urine in 24 hours. Hanzlik found that a normal person excreted 40% of a dose of a Salicylate given per os in 24 hours. The absorption of Salicylic Acid from inunction is therefore only about one-third of the absorption of Salicylic Acid given per os. —13.M.J.i./22,233. ^clodinosol (T.M. 33G541). A preparation containing 0 and 10% of Iodine in a base similar to Salicylosol for inunction.—B.M.J. i./22,233. Capsules containing lodinosoi 6% 10 minims are made. Mycozol.—An ointment containing Salicylic Acid 4%, Mercury Salicylate 4%, and Chloretone 5%, with aromatics for treatment of epidermomycos; s (athlete’s foot) a fungous infection, also for jockey strap itch and ringworm of feet and hands. Ammonii Salicylas U.S> C6IT4.OH.COO.NH4= 155-0782. Ph. Ned. V. with \ II20. Dose.—5 to 30 grains (0-3 to 2 Gm.), U.S.—Average, 15 grains. In crystalline powder, very soluble in water. * Merely another Salicylate/ possessing no special advantages over Sodium Salicylate, or over ether Ammonium salts. Can be dispensed with from the materia medica.—C. C. Johnson and P. J. Hanzlik, Jl. Ph. & Exp. Ther., July, ’29,332. Ferri Salicylas. Syn. Ferric Salicylate. Composition varies. Dose.—3 to 10 grains (0*2 to 0*6 Gm.). Brownish powder, sparingly soluble in water, but readily in solution of Potassium Bicarbonate. In tonsillitis as an antiarthritic tonic and as a dusting powder for foul wounds. Useful in erysipelas and acute tonsillitis in solution formed by interaction of 7J grains each of Sodium Salicylate and Potassium Bicarbonate and 74 minims of Ferric Chloride Solution B.P. with diluent q.s.—M.C.S. Lawrence. jMistura Ferri Salicylafa. Cohen’s Salicylated Iron Mixture. Dose.—1 to 2 drachms (4 to 8 Gc.) increased. . , c - Dissolve citric acid 14 in distilled water 200, add ammonium carbonate b-5, then dissolve sodium salicylate 125 in this solution; add tincture of ferric chloride, 125, glycerin 175, and oil of betula 4, and tnen add sufficient distilled water to make 1,000. and filter. ilea water to max« diui muwi. , The question hns been ciskecl *, i)o trie bilicy^a/tc^ <xnd kindred drugo sl late or exhaust thyroid activity or do they actually neutralise it : Maynesii Salicylas. (C6H4.0H.C00)2Mg,4H20=3/0*4o04. Dose.—10 to 30 grains (0-6 to 2-0 Gm.j. Colourless crystals. Soluble 1 in G of water. Incompatible with acids and Sodium Bicarbonate. It has been given in typhoid. In flatulence 15 to 45 grains thrice daily has been found useful. Potassii Salicylas. C6H4.Oil.COOK=176-139. Dose._5 to 30 grains (0-3 to 2 Gm.). A white crystalline powder, very soluble in water. Has given relief in rheumatic affections of the eyes. Sodii Salicylas (B.P. ’14). U.S. X. C6H4.OH.COONa = lCO-036. Dose._10 to 30 grains (0-6 to 2 Gm.) in a mixture or in cachets. Fr. Cx.—Max. single dose, 30 grains. Max. during 24 hours, 180 grains approximately; F.E. VIII. 140 grains. Intravenously, doses as large as 15 grains (i Gm.) have been given, also in combination with the same amount of Sodium Iodide (see Injectio Sodii Salicylatis.) In white scales or shining tabular crystals (of sweetish taste). For varieties in commerce, compare Salicylic Acid. Soluble in water 1 in 1. Concentrated solutions should be made with hot water and filtered. In alcohol 90% 1 in G by experiment. W. II. M. Storage.— P. Belg. IV. directs to be kept in the dark. Incompatible with free ammonia, ammonium carbonate, and aromatic spirit of ammonia (turns brown). Mineral and many organic acids cause separation of salicylic acid, e.g., to dispense Sodium Salicylate with Tincture of Perchloride of Iron, dissolve 1 drachm ot the salt in 2 ounces of Water, add 30 to 40 minims of t!m Tincture and 1| ounces of a solution of Potassium Bicarbonate 1 arachm in 1 ounce, then Chloroform Water to 8 ounces. The result is a clear palatable claret-colored mixture useful in rheumatic sore throats combined with ansemia miuiueu vviiu aucciuio. . , . , , „ ... In the case of a Sodium Salicylate, Tincture of Ferric Chlorideand Bicarbonate mixture, a Sodium Ferryl-Salicylate 13 formeu.—J. ltuthe.iord Hill, P..T. 1./26.358. Flavoring.—Syl Lavandulae, Olyl Pini, Syrupus Aromaricus, Sxtractum Glycyrrhizse Liquidum, Syrupus Zingiberis. Germicidal Action. Almost nil. For our experiments see Vo1. II. For antirheumatic effect vide R. Stockman s work, postea. Uses.—Rheumatism, neuralgia, diarrhoea (of young children said ,0 be almost specific), vertigo, Meniere's disease, malarial fevers and liabetes may all be well treated by salicylates. In influenza and mute tonsillitis, 10 grains every three hours relieve the distressing symptoms. Puerperal fever, biliousness, acute pains of fibrositis, nephritis, cystitis, urticaria and Graves’disease have been well treated with it. It is considered the most powerful of hepatic stimulants. As a urinary antiseptic ('per os) it has less action than Hexamine— about 50% of that given is excreted as Salicyluric Acid. In sciatica the electro-negative saiicyl ions have been used by Iontophoresis. In acute rheumatism some advise very large dcses, e.g., 150 grains daily, with twice the amount of Sodium Bicarbonate or even double these amounts. Sodium Bicarbonate should always accompany it to prevent constipation. It is thought to counteract the acid toxins. Rectal injections of 8 Gm. in 150 Cc. with. 1*5 Cc. Opium Tincture have been employed. Stockman has shown that the fall of temperature under treatment with Salicylate and return of joints to the normal, varies within limits with the dose administered. The COO El grouping in the Benzene ring in conjunction with the OH in the ortho- position seems to place Salicylic Acid at the highest point of efficacy of all anti-rheumatics: with 2COOH introduced, as in Phthalic Acid, efficacy vanishes. The Cresotinic Acies are the only bodies at all approaching Salicylic Acid in utility. It is not known definitely whether the Salicylates act as antitoxins or as antimicrobics. In acute rheumatism 90 to 160 grains or more in 24 hours act when infection i3 recent and when the inflammation is confined to joints, but when fibrous tissues of the heart valves or of the muscles or body generally are deeply implicated a more potent remedy is wanted.—R. Stockman, B.M.J. i./i3,598. Rheumatic Infection.—For immediate treatment the Salicylates are the most efficacious of remedies at present known.—G. A. Allen, PresHo v.,’2 6,400. Salicylates appeared best in preventing subsequent carditis developing, next in order being Arsenic, sedatives giving rest onlv.—Mary Bertram, B.M.J. i./25,496. Rheumatic Polyarthritis well treated by larcse doses, giving 10 times daily at 2-hourly intervals 50 Cc. of a solution containing 30 Gm. Sodium Salicylate, 60 Gin. Sodium Bicarbonate, 300 Gm. Syrup of Orange, and Distilled Water to 1000 Cc. When fever and pains have disappeared, reduce to 4-hourly intervals. Quick cure in acute cases, and the accompanying endocarditis is improved or cured.—J. T. Peters, Jl.A.M.A. ii./2g,958. Pruritus Ani.—The itching may be instantly relieved by the application of a very minute quantity of Sodium Salicylate. In Typhoid suggested to give 3 to 5 grains in intestinal capsules. Chorea believed to be always rheumatic, at least in part, therefore give Sodium Salicylate lest fresh rheumatic manifestations develop, which might thus be avoided. Smaller doses advocated than those of Lees (with Sodium Bicarbonate). Before starting treatment bowels should be freely opened, and before increasing dose evacuation should have taken place during preceding 12 hours. Chloretone as sedative sometimes useful in 3 to 5 grain doses.—F. Langmead. R. Stockman does not believe in the Salicylic treatment of chorea, but prefers Arsenic and nerve sedatives. Anti-piarrhceic Action.—It was used in the war. Men going within the hearing of big guns for the first time received 15 grain doses, preventing the otherwise involuntary motion. Sympathetic Ophthalmia treated with Sodium Salicylate : large doses— one grain for each pound of body wreight in the course of from 10 to 14 hours, i.e., for patient of 140 pounds, seven doses of 20 grains are given at intervals of an hour and a half.—Jl. A.M.A., Sept. 11/20,725, per Pres., Feb./2i,74. Encephalitis Lethargica treated by Sodium Salicylate, 15 to 30 grains every 4 hours. When there is insomnia give 5 to 10 grains of Bromide and Iodide of Potassium.—A. G. Gullan, B.M.J. L/25,1120. Toxicity of Salicylates. Mean toxic dose for males of the synthetic Sodium Salicylate was 180 grains, for females 140 grains ; of the natural Salt gOO andl35 grains respectively; of Methyl Salicylate 120 minims alike for males and females ; of Aspirin 165 and 120 grains respectively. The doses m arriving at these figures were given untilsymptoms of intoxication appeared. —P. J. Hanzlik, L.i./i3,1811; Jl. A.M.A., March 29, 1913. Excretion of Sc&Sscylic AcidL About 20 Cc. of a 10% Sodium Salicylate solution given hourly until toxic symptoms appeared—i.e., after an average of 13-8 Gm. of Salicylic Acid had been taken. Fluid wars then taken •egularly until salicylic acid disappeared from the urine. The total excretion (60 %) in acute rheumatism was about 15 % less than in normal persons (75 %). —B.M.J. ii./17,296. (A statement by Devrient, Arch. Exp. Path. Pharm., 1921,90, p. 242 (J.C.S.A. i. 2i,909) is to the effect that not more than 15% of the acid administered is excreted in the urine.) Salicyl reaction obtained from urine 27 hours after taking 2 Gm. of Sodium Salicylate. An investigation into the metabolism of Salicylic Acid resulted in the isolation of Salicyluric Acid from the urine and gave no evidence for the destruction of Salicylic Acid in the body.—E. G. Holmes, Jl. Ph. & Exp. Their., Nov., *25-,297—313. Sodium Salicylate Tablets, 3 and 5 grains (C’2 and 0'3 Gm.). Effervescent Sodium Salicylate. This is made in two strengths— |5 and 10 grains in a drachm. Dose.—1 drachm (4 Gm.) or more. Injeetio Sodii Salieylatis. Dose.—15 to 30 minims (1 to 2 Cc.). 1 in 20 of sterile water or weaker. Rheumatic Pain.—Injected into an acutely inflamed rheumatic joint, the pain disappears and the patient is able to move his joint. This points to a specific action, since analgesia is central.—Dixon, p. 255. # Intravenously, 1 Gm. doses have been given in rheumatic affections. The stimulation is more rapid than in doses per os. Acute Rheumatism.—Refractory cases treated by large doses intravenously— B.M.J.i./3B70. . , - ‘ Opsonised Salicylate ’ in rheumatic fever. Into a 20 Cc. syringe first 5 to 8 Cc. of 20% Sodium Salicylate solution, then 8 to 10 Cc. of blood from patient’s median basilic vein. After 4 minutes it is injected. Temperature dropped and patient better.—L.L/29,245. . . n , Psoriasis.—In selected difficult cases, intravenous injections (10 Cc. 01 a 20% solution, three times weekly for 4 or 5 weeks) appear to be of definite value.—B.M.J.E.i./25,26. a . , , Typhus Fever treated with encouraging results by Sodium, sane ware intravenously, injections, frequently up to 5 and 6 Gm., being given daily. Myocarditis a contraindication.—Jl. Intrav. Therap., Jan. ’26,20. EncephalitisLethargica well treated by Sodium Salicylate intravenously. M.) per L.i./24,1011. , , Wr TT Pneumonia.—Injections of a 1 in 30 solution (dose not stated.—W . n intravenously efficacious in all pneumococcic pulmonary infections. Jl. A.M.A. ii./29,1078. Sterules of Sodium Salicylate for hcemorrholds contain 1 Cc. (15 minim's) of 30% solution. . . Haemorrhoids treated by interstitial injection of this solution Results as good as those obtained with Carbolic Acid {vide Hamamelis) but the pain immediately after the injection is more severe and lasts longer.—J. Dunbar, B.M.J. ii./23,809. Sterules of Sodium Salicylate for varicose veins (Sicard and Paraf) contain 3 Cc, of 20%, 30% or 40% solution. Varicose veins have been cured by injecting into them a /0 solution of Sodium Salicylate, followed by 30% solution a wee later, and by 40% later on if necessary. Produces obliteration 01 vein and is not caustic or toxic : TOO cases cured. Sir S. Alexander, L. ii./26,176. Of value, but complications frequent. Should be used with caution.—V. Meisen, L.ii./26,662. \. Meisen used later Sodium Salicylate 25% and Sodium Chloride 16%, which is practically painless. Max. dose 10 Cc. Cannula (not too sharp) is inserted with patient standing : rotate once or twice wdien blood flows from it to see that it has not caught in the opposite wall. The patient then lies down with leg on a special stand. When varices are empty commence injection very slowly, stopping if flow is resisted or if patient feels pain. For injections m the neighbourhood of the malleoli inject -|% Novocaine direct into the varix. Massage lightly after injection. Repeat the treatment every other day and if both legs are affected treat one every day. Reference is also made to Sicard and L. Humbert.— L. i./27,1355. Sodium Salicylate injections (strictly intravenous) are safer in pregnancy and during menstrual period than Quinine-Urethane, commencing with 20 to 30% solutions, and passing on to 40%, 8 to 10 Cc. of the 20%, 5 Cc. of the 30%, or 3 to 4 Cc. of the 40%, is the customary dose at each sitting. It is important to work up to the maximum strength as soon as possible as the veins quickly accustom themselves to the injections. There are several disadvantages, including possible loss of time in testing sensitivity of the patient, acquirement of tolerance by veins if they are not quickly obliterated, cramp during administration, ulceration if leakage occurs, uncontrollable effect.—A. H. Douthwaite, “The Injection Treatment of Varicose Veins,” H. K. Lewns, 1927. It is unwise to give more than 5 Cc. of 40% solution at a time, though 10 Cc. of weaker dilution may be used initially.—W. S. C. Copeman, B.M.J. ii./26,G14. The 40% injection was found painful but the results -were good. 1 Cc. of 20% Sodium Chloride should be injected into an inch length of a vein previously emptied and kept so for a minute after the injection. No local anesthetic is needed, but if advised a 1% Novocain Solution.—B.M.J. ii./27,4b. The following are more recent expressions of opinion—arranged approx, chronologically. Operation seems no longer justifiable except in certain very isolated cases.—G. H. Colt, B.M.J. ii./28,527. The standard injection now for a medium-sized, vein is 5 Cc. 30% solution (10% saline), and for a large vein 7 Cc. 40% solution. Inject writh limb emptied of blood and from below upwards. The effect can be judged after a fortnight. Local analgesics added to allay the pain found entirely negative.—G. H. Colt, B.M.J. ii./29,850. 25% Saline -with 5% Salicylate is a good average * guidable ’ solution for those who prefer Saline to Salicylate.— G. H. Colt, B.M.J. i./3o,760. This authority has tried a large number of variations in strength of both ingredients. He wwites us 6 Aro«e seem so certain as Salicylate 30 to 40% in Sodium Chloride 10% (If* Messen's formula)’. It causes hovrever much pain.—Feb. 1931, and again, Oct. ’31. 4 Solutions can be divided into painful and guidable and painless and not guidable. With myself the Salicylate-Saline results continue to be excellent and more reliable and permanent than others.’ Injection treatment regarded, as unscientific. The same applies to haemorrhoids.—Archibald Young, L. i./29,467 Reply to Prof. Young’s criticisms by R, T. Payne and H. M. Han- schell, L. i./29,578. A. Young replies—a good rejoinder. Inter aha, is thrombosis, or is it not, a thing the surgeon is justified in deliberately inducing ? L. i./29,634. Sclerosing agents used with safety for 6 years in Chile.—S. M. Weds, L. i./29,951. k Salicylates, 30 and 40%,intensely painful.-Alan Perry, L.ii./29,901. 20% Sodium Salicylate causes no ‘ Salicylate cramp.’—L. P. H. Crivelli, B.M.J. i./3o,618. . . . Relative value of sclerosing solutions. Sodium Salicylate painful and accompanied by cramps in the calves. Even a small quantity getting into the tissues is irritant. A large percentage do notc take,’ D. Levi, L. ii./30,16. Injections should be given with patient recumbent.—R. Thornhill, B.M.J. iL/30,161. . ^ , Poisoning following 4 intravenous injections of 5 Cc. 20% Sodium Salicylate solution for varicose veins,—oedema, urticaria, nausea, and vomiting.—B.M.J.E. i./2S,31. T#ie following are general statements, Twin ’ injections, ££ "to C* m Valvular defect and varicosis. Details of exciting factors.-—W. Turner Warwick, L. ii./30,1278. Lithium Salicylate 30%, with Tutocaine 0*75%, scleroses well and produces no symptoms. Sodium Chloride 20% with Tutocaine 0-75% good for small veins, especially if thin-walled and the 6kin over them atrophic. It should however not be used in large healthy veins. Quinine-Urethane best from point of view of thrombosis but many do not tolerate it even in smallest doses. ‘Twin injections ’ good, viz., 4 Cc. Lithium Salicylate solution and 2 Cc. of Quinine-Urethane simultaneously, injections being 3 to 5 inches apart. Only to be used if veins are very large. The Lithium solution to be given first.—N. Scott, B.M.J. ii./30,58. Discussion of N- Scott’s technique.—A. R. Rooke, B.M.J. ih/30,121. Sodium Morrhuate is less painful than Quinine Urethane, but thrombosis followed.—A. H. Winchester, B.M.J. ii./3°,!20. Injection of undiluted Liquid Carbolic Acid, 2 to 4 minims, preferable to Quinine-Urethane, Sodium Salicylate, etc. which gh e rise to considerable pain and are dangerous in cases of idiosyncrasy. The Carbolic Acid is at once locked up in the clot which forms immediately. 4 minims is sufficient to obliterate a large varicose saphenous vein. The injection is practically painless and the vein almost immediately hardens. Four to eight veins may be injected at a sitting. Veins do not become immunised to the acid.- P. P. Dalton, B.M.J. iL/28, 1037. Vol. I, c Lithium Salicylate 30% with 1% Tutocain, 5 Cc. injections into the larger veins and a similar amount of Sodium Chloride solution 20% with Tutocain added, for smaller veins at weekly intervals until sclerosis is complete.—P. M. Deviile, B.M.J. ii./3o,1000. Lithium Salicylate 30% with Tutocain 1%, 4 Cc. and Quinine Urethane 2 Cc. Quinine Salicylate deposited.—R. H. Maingot, B.M.J. l/32,1054. I/aricoss Ufcers. As the result of a questionnaire of 550 medical men, A. P. Luff concludes that the treatment is best limited to two procedures; (1) Injection of veins (preferably with Sodium Salicylate) in combination with Unna’s Zinc Gelatin for local treatment; (2) Unna’s Zinc Gelatin alone if injection is refused or cannot be done. Ultra-violet light treatment appears very reliable in the hands of experts. The rational method of prevention of varicose ulcere is the obliteration of varicose veins.—B.M.J. ih/28,1146. Scq a iso G/wcose, Q u / n in e-U re thane? Sodium fyiorrhucztOf Sodium Ciiioridc* cs.nd T h ora joe «tic index. Sterules, Intravenous, of Sodium Salicylate, 15 grains (1 Gm.) in 320 minims (20 Cc.), and combined with Sodium Iodide, 1 Gm. In chronic arthritic affections this combination is good. According to Connor (Med. Rec. vol. 85, 323, 1914), Hall (Med. Times, May, 1920), and others, the relief of pain in rheumatic affections is more prompt by giving Sodium Salicylate intravenously than by giving it per os. Salicylates are of great benelit in acute arthritis and this affection has been thought to be a symptom of streptococcal infection. Salicylates are of less curative effect in so-called chronic arthritis. The latter is no doubt a mixed infection. Where the infection is of a chronic nature, only a transient analgesic effect is produced by Sodium Salicylate, but the best (more permanent) results are to be obtained by using Sodium Iodide in addition. Acute Sciatica. Elfect sometimes dramatic—better than per os, —F. J. W. Porter, L. H./25,130G. Mistura Sodii Salicylatis. Dose.—1 ounce (30 Cc.). Sodium Salicjdate 10 grains, Aromatic Spirit of Ammonia ^ drachm, Belladonna Tincture 5 minims, Chloroform Water to 1 ounce. For a common cold, every four hours.—Pr. Mar. 1911. Sodium Salicylate not so certain in its effects as Quinine and invariably caused cramps.—Reginald Payne (St. Bart’s.), B.M.J.i./32,238. Oleum Gaultherise (B.P. ’ 14). Syn. Wintergreen Oil. Dose.—5 to 15 minims (0*3 to 1 Cc.). The Distillate from Gaultheria Procumbens, N.O. Ericaceae, and from the bark of Betula Lenta (Betulacece) are practically identical, cf. Methyl Salicylate. Characters and Tests.—Colourless liquid with strong characteristic odour and pungent taste. Sp. Gr. PISOto 1*187 ; O.R., 0° to—1° ; R.I., 1-537 to 1-539 ; Soluble 1 volume in 6 of 70% Alcohol at 25° C. Should contain at least 99% Methyl Salicylate determined by the saponification process. Stimulant and diuretic. Maceration of the leaves for 12 to 24 hours prior to distillation is necessary for the best yield, the oil being a “ ferment ” oil not pre-existing in the plant, but occurs as a non-odorous glucoside, which must be hydrolised by the ferment before distilling. Capsules of Gaultheria Oil—10 minims in each. Dose.—One three times a day or oftener. The oil has similar properties to salicylic acid. 10 to 20 minims are given every 3 or 4 hours in rheumatism and sciatica. With olive oil externally for rheumatism. Metliy! Salieylas (B.P. ’14). (98% pure.) C6H4.OH.COQ.CH8 = 152-0624. Artificial (or Synthetic) Oil of Wintergreen. Dose.—5 to 15 minims (0-3 to 1 Cc.). XJ.S. X. gives Oleum Gaultheriae and Oleum Betulse from the bark of B. lenta (Sweet Birch) as synonymous with Methyl Salicylate. P. Belg. IV. directs Methyl Salicylate to be given when Essence de Winter- green is prescribed. F.E. VIII.—May be either synthetic or natural. P. Ital. V. —Synthetic only. A colourless liquid, with Wintergreen odour, manufacture. —May be prepared by carefully distilling a mixture of Salicylic x\cid 2, Methyl Alcohol 2 and Sulphuric Acid 1. Sp. Gr. 1-185 to 1-192. Soluble in 90% alcohol, ether, chloroform or glacial acetic acid. Applied covered with impermeable tissue is quickly absorbed. In local rheumatic pain an efficient application.—B. Stock- man, B.M.J. h/13,597. See also Methyl-Aspriodine. Also used for furunculous ulcers, orchitis, and mumps. Bile secretion is increased by Methyl Salicylate per cs without causing loss of body weight. Animal experiments.—P.J. ii./i6,615. Poisoning due to swallowing one ounce of Methyl Salicylate. Recovery after forcing liquids by the mouth, 2% solution Sodium Bicarbonate by oroctoclysis, and wrapring patient with blankets.-—>71. A.M.A. ii./25,306. Less than 15 Cc. per os has caused more than one fatality in infants.^ 13 cases of poisoning have been recorded, with 6 deaths.—B.M.J.E. i./28,57. * Methysal Balm (T.M. 303967).—Martindale. Syn. Bnguentum Methyl Salicylatis Compositum. Contains Methyl Salicylate 7, in combination with Menthol 5%. Also prepared containing 25% and 33% Methyl Salicylate (with Menthol 5%). For analgesic effect in rheumatism. It relieves pruritus and is suitable as an antiseptic Ointment. For muscular rheumatism of the limbs, which it cures (W.W.W.), it is best applied after fomenting the part with hot water. Chloral Hydrate 1 to 5% has been suggested as an addition to creams of this kind. Oil of Cajuput is also used. Linimentum Methyl Salicylatis, Martindale. Methyl Salicylate 20, Menthol 10, Chloroform 10, Camphor 10, Eucalyptus Oil 10, Turpentine Oil 10, Lavender Oil 5, Liquid Paraffin to 100. For use similar to the above. Opium Tincture or Belladonna Liniment 10 to 20% may be addt a if required, but they do not mix with the Salicylate Liniment. Preparations designated 44 Betulol,” “ Linimentum Betulee Compositum,” and Baume Analgesique, are supplied. s^Menthofax (T.M. 405840). _ . . A combination of analgesic, local-ansesthetic, and counter-irntan substances. Balmosa.—A non-greasy, analgesic cream, containing Methyl Salicylate and rubefacients. _ Unguentum Acidi Salicylic! Terebinthinatum— Salicylic Acid 1, Oil of Turpentine 3, Lanolin 1. . The above are of value in rheumatic affections, appliec to 301 gn lint covered with guttapercha tissue and flannel bandage. 0 2 Ethyl Salicylate. Syn. Ethyl Ortho-hydroxy-Benzoate CaH4.OH.COOC2H5== 166-083* A colourless liquid of aromatic odour, with Sp. Gr. 1-13 and B.Pt. 225—234°, and properties similar to the Methyl compound. Soluble in alcohol. Amyl Salicylate. CeH4.OH.COO.C5H11=208-1248. Substitute for Methyl Salicylate, w ith much less odour. For painting on to rheumatic joints. Capsules of Amyl Salicylate contain 3 minims (0*2 Cc.) for internal medication. Burns e specially from Acids—are well treated with a pad soaked in it-—the part being first dried and then flooded with water and neutralised with dilute Quinidina.—Spencer, Chapman & Messel, Ltd. Unguentum Amyl Salicylatis Compositum. Syn. ‘ Amysal.’ Similar to Methysal Balm q.v. but made with Amyl Salicylat®. Odour more pleasant. Borneol Salicylate. Syn. s^Salit (T.M. 258851). In muscular rheumatism and acute neuralgia, by inunction or by painting over affected part. Apply 4 to 1 drachm, with equal quantity of olive oil. Salicv! Salicylate. Syn. if Biplosal (T.M. 303704). OH.CflH4.COO.C*H4.COOH = 258-078. Bose.—15 grains (1 Gm.) in cachet or tablets. Salol in which the phenyl group is replaced by Salicylic Acid. White odourless needles melting at 147° C. Insoluble in water'and dilute acids, soluble in alcohol. Used for rheumatism, neuralgia, and cystitis. Pharmacological experiments showed that the compound remained unchanged for 6 hours in the gastric juice, but uTas decomposed in 2 or 3 minutes in the duodenal secretion. Hence it does not cause gastric disturbances. ‘ Triclilorophenyl-Iodomethyl-Salicyl,* described as ‘T.C.P.’ A non- poisonous liquid preparation for local use to wrounds and burns, in nasal catarrh, pyorrhoea and shin affections, for relief from the pain of bites and stings, and as a preventive against influenza and malaria. It is also used as a remedy for chilblains, piles and as a general antiseptic application. Acidum AcetyBSalicylicimi (B.P. ’14). Syn. Aspirin. Fr. Cx., P.G. VI., P. Heiv., P. Dan., P. Ital. V., U.S. X., P. Svec. X., F.E. VIII., P. Belg. IV. CHsGO.O.C6H4COOH=180-0824. The Name Aspirin is public property. For details of removal (‘ avoidance ’) of the Trade Mark from the British Register, and from the U.S. Patent Office, see Edn. XV111. 3$cAspirinoids, 284821 assoetd, is however, still on the British Register. Acetosal, Acetysal, if Aspirgran (T.M. 457720), J$cAspro (T.M. 405787), *Empirin (T.M. 364114), *Genasprin (T.M. 380162), are further names for the substance. Patents.—Nos. 27088 of 1898 and 9123 of 1899. Riedel’s Patent is No. 11596/97. All these are now void. For judgment in Patent case in this country see P.J. ii./o5,76; ii./o7,724. Dose.—5 to 3.5 grains (0-3 to 1 Gm.), in cachets or suspended in a good draught of water thrice daily after meals—not on an empty stomach. Children J to 5 grains (0-03 to 0-3 Gm.). P. Ital. V. has 3 Gm. as max. dose in 24 hours. F.E. VIII. 5 Gm. Manufacture.—By action of acetic anhydride on Salicylic Acid. Salicylic Acid 50 and Acetic Anhydride 75 are heated to 150° C. for two hours under a reflux condenser. On cooling, the crystals are pressed out and recrystallised from dry Chloroform. Alternatively Salicylic Acid 25 and Acetyl Chloride 20 are heated under a reflux condenser to 80° C. for some hours. Excess of Acetyl Chloride is removed on the water bath and the product recrystallised from dry Chloroform, Benzene or Carbon Tetrachloride. Consult also Patents above referred to. N. Evers, ‘ Chemistry of Drugs,’ 1926, has data of large-scale production. Characters.—A white powder, M. Pt. 133 to 135° G. (the latter in preference). It is not an absolutely stable body—all samples have more or less odour of Acetic Acid. Soluble about 1 in 4C0 of water, 1 in 5 alcohol 90%, 1 in 17 of Chloroform, 1 in 15 of ether—by our experiments. Incomplete solubility is caused sometimes by the use of benzene as recrystallising medium.—Prof. EL Llewellyn Smith.—P.J. i./i 5,200. Aspirin passes (in great measure) unchanged through the stomach, decomposing to a great extent on reaching the alkaline i intestinal juices. Incompatible with free acids, iron salts and alkalis. It forms a clear mixture with Sodium Bicarbonate, owing to formation of , Acetate and Salicylate of Sodium, and is not intended to be thus prescribed. Heating the acid in presence of moisture also causes dissociation. For Potassium Citrate in conjunction v. posted. Acetic Acid is liberated on dissolving Aspirin in Liquor Ammonise Acetatis. The Acetic Acid thenforms Ammonium Acetate and Salicylate.—P.J.l./3o,184. Ferric Chloride added to Solution produces no violet colour; distinction from and absence of Salicylic Acid. For further details see Vol. II. Uses.—Has anti-rheumatic properties, and is used as a substitute for Salicylic Acid and its salts. Does not irrita-te the mucous membrane of the stomach, and is to be preferred in heart and ear i complaints. Is useful in influenza (especially with Quinine), acute and chronic affections of the joints, headaches, and in gout, neuralgia, chorea, and pleurisy. Has been used in hay fever, diabetes and dysmenorrheea. The gradual hydrolysis of the substance in the body is said to prevent the cumulative toxic action of the Salicylic Acid. It relieves the pain of cancer and of cystitis. In influenzal complaints a dose taken at bed-time will often induce perspiration, quiet sleep follows, fever is reduced and pulse improves. In some cases, it is useful with Caffeine, e.g., Aspirin 1\ grains with Caffeine 3 grains. .Physiological Action.—Our experiments have shewn that in passing through the stomach Aspirin splits up to an extent not exceeding 5% of the amount taken, the bulk of the acid being absorbed as salicylate in the intestines after hydrolysis^. Prof. H. Llewellyn Smith went over similar ground with numerous samples and confirmed our results.—P.J. i./i5,2G0. Elimination of Salicylic AoicS and of unchanged Aspirin. A paper by P. J. Hanzlik and E. Presho in the Journal of Pharmacology and ( Experimental Therapeutics, May, 1923, embodying some results obtained m vitro and an investigation of the urine of 6 patients, 4 of them being convalescents and the remaining 2 suffering with rheumatic fever, was apparently written to upset existing beliefs as to the fate of Aspirin in passing through the system. So far as the in vitro experiments go, the results confirm our own investigations which have been published for some years, i.e. ;the amount of decomposition depends on the time in solution at body temperature. With regard to the clinical results, the total of Salicylic Acid and unchanged Aspirin, which was found to have been passed, varied considerab.y in the various cases, for example, in one case, 68-5% of the total Salicylic Acid and Aspirin was excreted, while in another case only 27% was excreted. It should also be made clear that the dosage was heroic and, intentionally, bordering on the toxic. The paper says that with ordinary doses, i to 1 Gm. of Aspirin, no data are at hand, but that with doses of this magnitude the mean excretion of total Salicylic Acid in 3 normal individuals was about 60%. The main point of the paper appears to be that in the 6 persons referred to, receiving toxic doses of Aspirin, there was a total excretion of unchanged Aspirin ranging from 8-8% to 36-6% of the Aspirin taken, and, broadly speaking, that a considerable amount of unchanged Aspirin would circulate through the body in such cases. The investigation is of interest, but the conditions do not seem to be in agreement with ordinary therapeutic developments. For further details, also for Bactericidal Action, vide Vol. II. Mistiira Aspirin. Syn. Mistcjra Acidi Acetyl-Salicyltci. Dose.—J ounce=10 grains. Aspirin in fine powder 10 grains, Tragacanth Mucilage 90 minims, Chloroform Water to J ounce. Mistura Aspirin et Potassii Citratis. Dose.—Half an ounce (15 Cc.) with a little water. Aspirin 2 drachms, Potassium Citrate 4 drachms, water to 6 ounces. This forms a clear solution. To be prepared without heat. Not to be kept more than a few days—actually, the Aspirin is hydrolised in proportion to time. In influenza the alkaline effect of the Potassium Citrate is beneficial. Potassium Citrate with Aspirin.—Aspirin in presence of Potassium Citrate has its solubility in water markedly increased. We made some experiments on the subject in 1927. The practical upshot was that to make Aspirin soluble approx. 1 in 20 it is necessary to prescribe nearly twice the amount of Potassium Citrate with it. The above mixture is the result of our investigations. There may be a notable difference in physiological effect, as apart from the independent action of the Potassium Citrate the speed and even the locus of absorption in the system may give enhanced effect. A larger proportion may perhaps be absorbed in the stomach, and in consequence less would be carried forward to the duodenum, where Aspirin alone is thoughtto be assimilated—cf. B.M.J.i./27,908. The velocities of decomposition of Aspirin in the presence of Sodium Bicarbonate or Potassium Citrate are practically identical. 81% Aspirin was recovered in 18 hours and 69% after 3 days.—D. B. Dott, P.J. i./29,302,311, 355; i./3Q,214. Aspirin Chewing Gum is made for producing local effect on the throat and tongue. Aspirin Tablets are prepared weighing 5 grains (0-3 Gm.), and 8 grains (0*5 Gm.). These should not be swalloived whole. Also Tablets of Acetyl-Salicylic Acid 5 grains with Phenacetin 2J grains each and [jjj] ||0] with Dover’s Powder 2J grains. If made with Lactose 5 grains in addition these are CE> but outside jf§]. Prescribes should specify “ Form 2.” Acute febrile diseases—measles, pneumonia, diphtheria and sepsis generally—treated by the following combined ; Aspirin 10 grains, Phenacetin 5 grains, Compound Ipecacuanha Powder 15 grains, with striking effects. Inflammation reduced at site of origin, with sweating and fall of temperature.*—R. J. G. Parnell and co-workere, B.M.J. ii./22,1000. The combination is highly spoken of by others ; valuable during the paroxysms of malaria, ibid., p. 1097. See also L. ih/23,1422. Lover’s Powder, it is stated, should not be compounded with Aspirin, as in cases susceptible to Opium it retards the action of Aspirin and causes serious danger.—T. M. Allison, L.i./26,1280. Pulvis Aspirin Compositus, vel 44 PuLV. A.P.O.”—VlC. PARK. Aspirin 5 grains, Phenacetin 4 grains, Caffeine Citrate 3 grains. Aspirin and Phenoquin—combined powders 7J grains each, followed in the morning by a brisk Saline aperient, useful. Better than Aspirin alone in producing a profuse perspiration.—N.Y.M.Jk, Mar./2o, 459, per Pres., Feb./2i,85. Pulvis Aspirin Quininse et Amidopyrin. Dose.—10 grains (O’6 Gm.). Aspirin 5 grains, Quinine Salicylate 2 grains, Amidopyrin 3 grains. Used extensively at TJ.C.H. for relief of post-operative pain, neuralgia, etc.—Communicated by Mr. Herbert Tilley. Aspirin Tablets made with l£ molecules of Sodium Bicarbonate to 1 molecule of Acid subject of a Patent.—P.J. i./13,768. Magnesium Oxide has been added to Aspirin tablets to disguise taste.— P. J.ii./29,199. Elixir Sodii Brom-Acetosalicylatis. Dose.—J ounce repeated each hour if necessary until 4 doses ha ve been taken. Contains the equivalent of 10 grains of Aspirin and 10 grains of Sodium Bromide in 1 ounce. Antipyretic. Relieves chronic articular rheumatism, and may be , tried for vague neuralgic pain.—W. W. W. Pl’Piiula Aspirin et Acidi Arseniosi (Hoedemaker’s Pill).— Vic. Park. Aspirin 2J drachms, Arsenious Anhydride 1/6 grain, Starch and Distilled Water sufficient to make into 100 pills. Dose.—2 pills thrice daily, increasing carefully by one pill every second day to a maximum, continued for a period, of never more than 25 pills daily, and then reducing at the same rate. References to Aspirin. Asthma. Some cases relieved by Aspirin. In others it is quite unsuited. —B.M. J.E.ii./22,33. . After Tonsillectomy an Aspirin 4 Throat Bath,’ 10 grains floating on a half tumbler of water, held in the throat, first one side and then the other, ! issoothing.—It. S. Stevenson, L.iL/25,1332. . Soporific Effect.—Aspirin often has this, probably by causing a dilatation of peripheral vessels.—‘Insomnia,’ E. M. Callender, L. ii./27,1282,1294. Hirudicidal power of Aspirin. A child in Palestine with fever and blood spitting was treated with Aspirin. An hour after two leeches were emitted. Found good in dogs.—B. Salah, L. ii./29,750. , 10 to 15 Aspirin tablets (5 grain) are frequently prescribed for one dose in some hospitals in the U.S.A.—P.J. i./3o,354. Safety first m Gt. Britain. —ibid. 391. May occasionally cause gastric pain, vomiting and giddiness; oedema of face and skin rash. . _ ... Rheumatic Pains in the Arm. 15 grains in, three o grain doses during 4 to 5 hours. Within 20 minutes of the third dose marked oedema of tne eyelids, forehead and cheeks suddenly developed. The oedema did n disappear until the third day, and rlnumatic pain ceased. Another patient Tto”romWeS1BlMjef/iiT3lfrainS CaUsed puffiness of the eyelids.—P. H. Cyanosis and rash af ter’lO grains of Aspirin—special idiosyncrasy.—W. A. E. Karunaratne.—B.M.J. ii./i9,42. * Patients with low blood pressure and nasal polypi cannot take Aspirin. Phenacetm is usually safe.—A. Francis, ibid. 204, 560 and 694. As a drug crave Aspirin may developin thef uture.—Prof. Wild, L. ii./2o,35. 4oa grains of Aspirin taken in tablet form in one dose. Vomited copiously. Oiuck recovery—no active treatment adopted.—J. H. Robinson, L.ii./26,256. i caa h after taking 2 dessertspoonsful of a solution containing 1,500 grains (300 5-grain tablets) of Aspirin in a pint of water, deliberately administered by the mother with intent to kill.—B.M.J. ii./29,12S. For further references see previous Edns. Caleii Aceto-salicylas, Syn. * Tylcalsin (T.M. 337714). Martxndale. (CH,CO.O.C6H4.COO)aCa (+2H20) =434-2204. Kalmopyrin (T.M. 348371) lias the same composition. White amorphous, non-hygroscopic powder. Dose. 5 to 15 grains (0*3 to 1*0 Gm.) to be taken in a little water. Solubility.—In water 1 in 6, but it dissociates in proportion to time and temperature in this form. It is preferably given in tablet, crushed at the time of taking in water, or as a cachet, followed by a draught of water. Exposure to excessive tGmaeratures.—Tylcalsin should heated, especially with moisture. Decomposition commences between 50° and 60° C.—W.H.M., Oc-t., 1921. Incompatible with mineral acids and as other Lime Salts. Prescription in mixture form is not advised. Tablets and Cachets 8 grains (0-5 Gm.) each are prepared. Uses.—In view of its greater solubility, Tylcalsin forms a useful substitute for Aspirin. (Soluble medicaments pass rapidly into the intestine and are absorbed there.) Attention may be drawn to the intravenous use of Tylcalsin postea. A prompt rheumatic and influenza specific, in catarrhs and neuralgia, and for relief of pain. It combines the good qualities of Sodium Salicylate and Aspirin. It is well tolerated and has never been known to produce vomiting. May be tried in obstinate diarrhoea. Antipyretic action occurs in about an hour, with drop of temperature of 0*4 to 0-8° C.—the fall being maintained for 2 to 2J hours, then give further dose—for rheumatic gout pain. As analgesic one tablet suffices, two may be given if heart action is normal. I11 lumbago 2 tablets at night in hot tea (as diaphoretic) valuable. In gonorrhoeal rheumatism, Tylcalsin has given excellent results. It does not cause pharyngeal or gastric pain like tliefree acid and it occasions less renal irritation.—P.J.i./i 7,419. Asthma well treated by Tylcalsin, ten grains three or four times a day. Calcium Lactate used for children.—A. M. Bremner, B.M.J. ii./22,66b. Dengue has been welltreatedby Tylcalsin. In some cases relief commenced in half an hour.—R. B. Biilimoria. Septic Throat (Staphylo. and Streptococcal) treated with Tylcalsin internally and Tinctura Ananassa1 locally. In less than 24 hours the symptoms had completely disappeared. Tylcalsin acted well in checking the incubation of the Cocci and reducing temperature rapidly.—Craik Taylor. Neuritis and Neuralgia.—Tylcalsin 5 grains. Quinine Salicylate 1 grain, Salol 5 grains and Phenalgin 10 grains, as a combined powder, has been found most efficient. TYLCALSIN INTRAVENOUSLY, For rheumatic and other types of pain, Tylcalsin intravenously was suggested,—A. Cambell, B.M.J. ii./2i,37,774. Dose.—The usual dose is 0-5 Gm. in 10 to 20 Cc. of water, but larger doses, even 2 Gm., have been administered. The concentration is of importance ; it should not exceed 6%. Technique.—The contents of one Sterule are dissolved in 10 Cc. of previously boiled and cooled water, and injected very slowly. Solutions of Tylcalsin must not be heated. Tylcalsin Steruies contain 0-5 Gm. dry powder. Tylcalsin is a delicate compound liable to hydrolysis on keeping. If there is evidence of marked acetous cdour, or a * puff ’ on snapping off the Sterule, the chemical is unsuited for use. Uses,—Successful in sciatica, acute rheumatism, tabes dorsalis, interstitialkeratitis, acute iritis, gonorrhoeal synovitis, dysmenorrhoea j and severe headaches of doubtful causation. Psoriasis of 15 years7 standing was treated by the method, with “ marvellous ” result. The affection cleared up completely. In obstinate influenza the procedure is worthy of trial. In rheumatic endocarditis, we have been told, there is nothing equal to it. £-Gm. doses have been given to children of 14. In acute and subacute rheumatism, and in septicaemia useful intravenously.—H. Pritchard, B.M.J. i./27,794. Rapid results in rheumatic infections from Tylcalsin intravenously. ; —J. Burnford, L. i./3i,351. (Not Calcium Salicylate, as stated). Aiasil (T.M. 494545) Tablets. Dose.—1 or 2 thrice daily in an ample supply of water. Tablets contain Calcium Acetyl-Salicylate 7£ grains and Alocol (Colloidal < Aluminium Hydroxide) 6 grains. Antipyretic, analgesic and sedative. In rheumatic affections, influenza, chills, neuralgia and cough. Well tolerated. If free perspiration is desired 2 tablets should be stirred into a wineglassful j of water and taken as a draught at bed-time, followed at once by a tumblerful 1 of hot lemon-water, hot milk, or other hot beverage. Lithii Aceto - Salicylas CH3CO.O.C6H4COOLi = 185-9946. Syn. ^Tyllithin (T.M. 337715). Litmopyutn is a similar compound. Dose.—5 to 15 grains (0-3 to 1 Gm.). Maximum daily dose 75 . grains (5 Gm.). White powder with bitter taste. Soluble 1 in 1 in Water, 1 in i 4 Alcohol, insoluble in Ether. The salt, is to be kept in a well closed i bottle as it undergoes decomposition in moist air. Uses.—Analogous to those of the Calcium Salt (antea). By reason of greater solubility, possesses advantage over Aspirin. Incompatible with Iron Salts, Mineral Acids and Alkalis. It is preferably given as Cachets or Tyllithin Tablets, 8 grains (0-5 Gm.) in each, the latter to be crushed and taken in a little water. It is not desirable to give it in mixture form. Enema Sedativum St.G.H. Lithium Aceto-Salicylate 10 grains. Sodium Bromide 1 drachm, Distilled Water to 5 ounces. To be mixed with equal quantity of warm water and given immediately after operation. Magnesii Aceto-Salicylas. Syn. *Magisal (T.M. 413697). (CH3CO.O.C6H4.COO)2Mg. =382-292. Dose.—5 to 15 grains (0-3 to i-0 Gm.). Microcrystalline powder, non-hygroscopic, almost tasteless and odourless, soluble 1 in 12 of water, less readily in spirit. Incompatible with Iron Salts, Mineral Acids and Alkalis and otherwise as Aspirin Compounds. Uses.—This is a relatively stable, Acetosalicylate which may be used as an alternative to the other salts and the acid. Panniculitis.—If pain is severe or interferes with treatment, a cachet containing Magisal, Pyramidon and Caffeine Citrate may be given occasionally, otherwise drug treatment, apart from a digestive aid, is of doubtful value.—W. Bain, B.M.J. i./25,450. 3$c Magisal Tablets 5 grains (0*3 Gm.). Dose.—One to three tablets as required, to be crushed and taken in a little water. Sodii Aceto-Salicylas, CH3CO.O.C6H4COO.Na = 202-0516. Syn. *Tylnatrin (T M. 337716). Dose.—5 to 15 grains (0-3 to 1 Gm,). White amorphous hygroscopic powder, very soluble in water. Uses.—Similar to Tylcalsin. Has also been given intravenously, but Tylcalsin is preferable. Saligenin.—C6H4CH 2OH. OH=124-0624. Dose.—10 grains (0-6 Gm.). This is the Alcohol of which Salicylic Acid is the corresponding- acid. It is converted into the acid in the body. It is formed with Glucose on the hydrolysis of Salicin. In acute rheumatism it has been well spoken of by It. Stockman. Further details, Edn. XIX, p. 79. Acetyl-methyl-Salicylate. Syn. SALACETOL. C6H4(OH).COO.CH2CO.CH3= 194-078. Dose.—10 to 30 grains (0-6 to 2 Gm.) in cachets or suspended. Manufacture.—By heating Sodium Salicylate with Monochlor-Acetone in equimolecular proportions, in shining crystals very slightly soluble in water, in alcohol 90% lin 14easily. Caustic alkalis decompose it, forming salicylates. Used in rheumatism. Tor diarrhoea best given in Castor Oil (if required) ■—before breakfast. Salicinum (B.P. T4). U.S. C6II11O5.O.C6H4.CH2OH=286T404. jDose.—5 to 20 grains (0-3 to 1-2 Gm.) in aqueous solution, taste may be covered with liquid extract of liquorice, or small dose in a pill with glycerin of tragacanth. A glucoside in colourless shining trimetric tabular crystals, without odour, taste moderately bitter. Soluble 1 in 28 parts of cold water, less in alcohol, but not soluble in ether. Obtained from Salix frcigilis or S. 'purpurea and other species of willow. M. Pt. 200° C. Uses.—Cures influenza and as a prophylactic. In acute rheumatism, large doses are specific. It is given to reduce fevers, e.g., of malaria or phthisis. Is of value in psoriasis and in syphilis where Mercury is not tolerated. It is not adapted for use as an external antiseptic. Effervescent Salicin. Dose.—1 drachm. Contains 5 grains in 1 drachm. Tablets, 5 grains of Salicin (0-3 Gm,). Dose.—1 to 4. Its action depends on production of Salicylic Acid in the blood. In rheumatic fever it is highly satisfactory. 20 grain doses hourly or 30 grains every 2 or 3 hours. 60 grains have been given, repeated in 2 hours without ill effect.—R. Stockman. In Lupus Erythematosus with good results, 15 grains 3 times a day with saline aperient.—J. M. H. MacLeod, B.M.J. ii./i3,313. Influenza.—Salicin, large doses effectual; 20 grams every hour for 1- hours followed by 20 grains every 2 hours for the next 12; also remo\es infectivity of patient.—E. B. Turner, B.M.J. ii./ik,ll~, i./I9»2<o. . Its value in Influenza—from 1889-1927.—E. B. Turner, B.M.J. ii./27,93; SepsoRiAsis.—Salicin, 10—i.5 grains three times a day a valuable drug in acute and spreading cases.—B.M.A. Ann. Meeting, 26, L. n./~6,550. Se also G. Pernet, Arch. Berm. Syph., Jan. 26,111. lodo-Salicin, C13Hl7I07+2H20. This compound, the author suggests, may prove a valuable antirheumatic and anti-influenza remedy. No data as tc dosage are as vet available. Balol (B.p: 14), P. Belg. IV., P. Ital. V., F.E. VIII, U.S.X., P.G. VI. Sun. Phenyl Salicylate C6H4.OH.COO.C6H6=214*078. Dose.—5 to 15 grains (0-3 to 1 Gm.) in cachets or suspended in milk. Fr. Cx. and P. Belg. : Max. single dost, 15 grains. Max. during 24 hours, 90 grains. _ ,0 0 n Small crystals, with a slight wintergreen odour. M. Pt, 4^ to 43 U Tablets, 5 grains (0'3 Gm.). Dose.—1 to 3. Pills contain 2£ grains. Capsules contain 5 and 10 grains (0-3 and 0-6 Gm.). Soluble 1 in 10 or more of alcohol, 1 in 12 of liquid paraffin, in fixed oils, and a trace in glycerin. Almost insoluble in water. oil in a warmed mortar (salol melts about 42 to 43 C.), emulsify withtrag canth, using hot water to complete. 11ft , r^tor Oil5minims. In the case of the following prescription, Saiol lO grains pastor Oil o mi coutinuoussttetog'hailanOTnJ:?o£ mucilagl °J Tragacantti^aad^flnany, the requisite quantity of water. This method produces a fine, white non separating emulsion.—A correspondent, C.D., Sept. 9, i922- . . Flavoring.—Glyl Lavandulse, Glyl Pmi; Elixir Aromat Svrupus Aurantii Floris. Uses.—Antiseptic and antipyretic. In the small intestine 1 splits up into its component parts, both being Success which is rendered aseptic and becomes very • , j for rheumatism, acute and chronic, for sciatica. d^entay. and typhoid fever, gonorrhoea and vesical catarrh and diabetes. 1 dose is limited by its phenol content.—R. Stockman. T a.l forms ofysore throat; relieves earache and ocular neuralgia, and of value for summer diarrhoea, especia y o be given in renal disease. In acute infection of the urinary tract and efficacious in inactions due to colon bacillus. Total dose : 40 to 45 grains in 24 hours, given in 7£ grain cachets with a warm drink, or at meal times.—B.M.J.E. L/27,12. in diagnoses ©? fermentative indigestion 5— The time taken for the food to leave the stomach may be found by giving 15 grains of Salol. This does not undergo decomposition in acid, but in an alkaline medium is split up into constituents, phenol and salicylic acid. The presence of the latter is readily found in the urine by adding a little neutral Ferric Chloride solution. One may expect to find it normally in from 45 to 75 minutes after Salol is taken.—B.M.J. i./n,C65. Cachets of Salol, Bismuth Carbonate and Sodium Bicarbonate, 5 grains each are useful as intestinal antiseptic. Salol Mouth Wash. Salol 2*5, Saccharin 0*004, Peppermint Oil 0*5, Clove and Caraway Oil of each 0*1, in Alcohol 80%, to 100. For use dilute in proportion l to 1 teaspoonful to the | pint of warm water. Emuisio Salol. Dose.—J to 1 ounce. Salol 20 grains, Compound Tragacanth Powder 20 grains. Distilled Water q.s. to 1 ounce. Cholera.—During the algide stage the following mixtures have been usedSalol 10 grains, Mucilage 1 drachm, Spirit of Chloroform 15 minims, Water 1 ounce—every 2 hours until reaction sets in—then Sodium Bicarbonate 10 grains, Spirit of Chloroform 20 minims, Sweet Spirits of Nitre 20 minims, Water to 2 drachms, every four hours till urinary secretion is established and normal. May be combined with 2 or 3 quart intravenous injections of warm Sodium Chloride Solution (100 grains to the quart). This injection is made by gravity (2 or 3 feet head of water), and may be repeated.—Brooke. Saiol Coating of Pd/s is conducted by employing Salol melted. This renders the pill insoluble in the acid gastric juice, but soluble in the alkaline fluid of the intestine; hence suitable for purgatives to act on the bowels, and for administering antiseptics in eczema and urticaria—cf. Piiulje. Collodium Salol. Salol 4, Ether 4, Collodion 30. Gives relief in pain of acute rheumatism. Figmentum Salol, Mid. H., I927. Salol 1, Glycerin 4, Alcohol (00%) 15. Salol Catheter Oil. Salol 1, Castor Oil and Almond Oil, of each 15. Does not dissolve the varnish of catheters. Saiol cum Camphora, Salol Camphor. Salol 3, Camphor 2, heated together, combine to form a viscid liquid, which has been used as an antiseptic in place of iodoform. Prepared with 10% only of camphor, quickly crystallizes, and when powdered is suitable for application, where liquid not practicable. Useful in suppuration of the middle ear ; non-irritating. lSJ P1 Unguentum Salol cum Cocaina. Salol 2, Cocaine Hydrochloride 1, Ceratum Petrolei 16, for burns. Unguentum Salol cum Menthol. Salol 4, Menthol 2, Olive Oil 4, Anhydrous Lanolin to 100. For fissures of the skin, e.g., in chapped hands. #Asprio&ine (T.M. No. 435198). Syn. Acetyl-Iodq-Salicylio Acid. CcH3I.O.CH3CO.COOH-:305*9866. Dose.—5 grains (0*3 Gra,) per diem after food, increased if required. To be given alone in tablet (crushed) or in cachet or slipule (No. 1), followed by a little water. Chemical Composition.—Aspriodine is a definite compound containing 41'47% Iodine, the balance (5b*53%) being tbe Aspirin radical. It is stable at ordinary atmospheric temperatures. It has M.pt. 154°. Soluble in Alcohol 90% 1 in 16-5, Ether 1 in 22, Chloroform 1 in 57, very slightly in Water (1 in 5,500). Incompatible with Alkalis ; preferably administered alone. JPharmacology•—Aspriodine embodies the properties of Iodides on the one hand and Aspirin on the other. It is not affected by physiological acid, but it is readily split up by the alkalinity of the intestinal digestive tract. Evidence of liberation of iodine in tbe body. Examinations of the urine after taking, for example, 10 grain doses of. Aspriodine by the mouth have shown that the Iodine is promptly liberated m.the system—within an hour The Iodine in these instances is associated with inorganic bases, bouium or Potassium. The result is of peculiar interest, because Iodine m the Sen- xeae ring of an aromatic compound is generally “strongly held and difficult to remove chemically as, for example, by simply treating it with an aqueous solution of an alxali. <Ve repeat there therefore distinct evidence that the compound is dissociated, possibly in pa*-t by enzyme action, in the alkaline portion of the duodenum. Method Employed in Testing the Urine. Possible confusion with Iodine in the organic condition was excluded by treating the specimens with Ether after acidifying to remove any compound of the nature of lodo-Salicylic Acid, which ft is Lssumfffiwould be formed in the first stage of cedure employed was to acidify a small amount, e.g., 30 Cc., of the urine irom the total output and extract it with Ether, as stated, by repeated-^^^the to render alkaline with Caustic Soda, evaporate to dryness and mc.nerape. The residue was dissolved in 10 Cc. of water and, after filtering, a small quanti y of Sodium Nitrite and Sulphuric Acid were added m the presence of a little Chlorolom fto Iodiue passed into the Chloroform with the customary colour. (This method is preferable to the use of chlorine \\ ater.) It is of interest to remark that a rheumatic sufferer had to take 10 grains 3 times a day after meals for 3 days before the Iodine was found in his urine, whilst a normal individual gave evidence oi Iodine, as stated, in an hour after taking the dose. It is noticed also that the urine of some individuals becomes promptly cloudy owing to an increased elimination of Urlc ^clf* The point is of value from the clinical aspect to those who still ho ^ to the Uric Acid theory of rheumatic affections. Uses,,—Small continued doses have been used for rheumatic affections and in arteriosclerosis with benefit. ^ Aspriodine may also be of value in asthma and in many other affections, where Iodides have proved beneficial, e.g., m scrofula and for enlarged glands and wherever small continued do.es oi the.two constituents are desired. The substance has pronounced antiseptic powers and is well tolerated. Aspriodine Tablets, Cachets and Slipules 5 grams (0*3 Gm*) au ^Sodium-Aspriodine, Lithlum-Aspriodine, Calcium-Aspriodine and Ma "m^spriodine have been prepared. These are also definite stable bodies which are new to medicine. # Sedasprin (T.M. No. 435197). Syn. Acetyl-Bromo-Salicylic Acid. C6H8Br.O.CH3CO.COOH=258-9706. Dose.—5 to 10 grains (0-3 to 0-6 Gm.) afford a mild sedative effect. The dose should be given preferably alone in tablet (crushed), slipule (No. 1 for 5 grains), or cachet form, with water. Chemical Composition,—Sedasprin is a definite compound* containing 30-86% Bromine, the balance (69-14%) being the Aspirin radical. It was apparently first made by Robertson (J.C.S.T. 8i, [1902], p. 1482), but it has not been used medicinally until introduced by the author (1923). In common with Aspriodine, this Bromine analogue is stable at ordinary temperatures. It has M.Pt. 136° C. Soluble in Chloroform 1 in 11-5, Ether 1 in 4, slightly in Benzol, in Absolute Alcohol 1 in 10 ; in Alcohol 90% 1 in 4; slightly in water (1 in 1500). Incompatible with alkalis. It is best given uncombined with other medicaments. Pharmacology and Uses,—The process of absorption of Sedasprin is analogous with that of Aspriodine. Clinically the effect of Sedasprin is distinct from that of Aspirin. It combines the antirheumatic, anti-neuralgic and febrifuge properties of Aspirin with the sedative and hypnotic powers of a Bromide. It has been suggested for use in all forms of nerve trouble, many types of headache, dysmenorrhcoa, asthma, chorea, epilepsy, fevers, influenza, insomnia, laryngitis, neuralgia, sea-sickness and tonsillitis ; in general, in cases where the combined qualities of Aspirin and Bromide are indicated. In chronic bronchitis, given at night as required, it has given relief. Neuralgic pains not affected by Aspirin were instantly relieved by Sedasprin.—Major G. W. Vincent, 24/9/26. Sedasprin Tablets, Cachets and Siipules, 5 grains (0-3 Gm.), are prepared. Sodium-Sedasprin, Lithium-Sedasprin, Calcium-Sedasprin and Magnesium-Sedasprin have in addition been made. They are definite compounds, new to medicine. Liberation of Bromine from Sedasprin in the System. Although in the case of Aspriodine. inorganically combined Iodine can readily be shown in the urine shortly after taking a small dose of the com - pound, the demonstration of Bromine after taking a dose of the Bromine analogue is not easy because the Bromine is absorbed. Examination of the urine and fseces, even subsequent to taking a dose of Potassium or Sodium Bromide, shows that elimination is very slow.—Details, Edn. XIX, p. 85. Urine Examinations after taking various Bromine Compounds (,Sedasprin, Adalin and Potassium Bromide), see Vol. II. Methyl-Aspriodine. Syn. Methyl-Iodo-Aspirinate, Methyl- Acetyl-Iodo-Salicylate. (# Aspriodine is a Reg. T.M.). CcH3I.O.CH3CO.COOCH3=320-0022. Chemical Characters•—Methyl-Aspriodine forms white crystals in small agglomerated granules with the interesting characteristic of melting at body temperature, 40° C. (104° F.), to a light yellow liquid with Sp. Gr. 1*6. In temperate climates it is therefore solid or waxy, while in tropical climates it will be liquid. In either form it is practically odourless ; its taste is aromatic and pungent. It contains the equivalent of 56*3% Aspirin and 39-7% /odme. Solubility.—It is readily soluble in all the usual organic solvents, e.g., Ether, Chloroform, Alcohol, and it is miscible with Olive and Almond Oils in all proportions. It is also soluble 1 m 50 in a mixture of 40% Alcohol in Glycerin. It is insoluble m water or plain Glycerin and is not miscible with Liquid Paraffin. Uses.—-In painful rheumatic joint anections, neuritis, sciatica, lumbago, sprains, headache, and broadly speaking as a prompt general local analgesic, Methyl-Aspriodine, as such, or as Balm or Liniment, is advised. (For inflamed areas, e.g., enlarged glanos, very light application of the Liniment or Balm may be tried.) borne cases in which the compound has been successfully used are mentioned The parent substance, Aspriodine (C6H3LO.CHs.CO.COOH), introduced by the writer in 1923, has been proved of value per os in combating rheumatic affections and in a large variety o con ditions where the combined effects of Aspirin and Iodine are requisite . Following up the chemistry and pharmacology of the liaiogenieed Aspirin derivatives, on which the author has been at work lor 3»eaas, an attempt was made to modify .Aspriodine in such a way as to produce a compound suitable for inunction. Methyl-Aspriodine resulted in 1926. .. ,, iAmiD Methyl-Aspriodine permits of the local use oi considerable d of Aspirin and Iodine conjointly. Alternatively, one may vi*w its use as the combined employment of Acetylated Methyl-Saucy and Iodine. Logically, one may suggest that as Aspirin is a more effective anti-rheumatio than the parent Salicylic Acid, Met y Acetyl-Salicylate may be more reactive than ordinary Metnyl- Salicylate (Oleum Oaultherice). The high percentage of Iodine is an additional argument in favour of the compound. Directions.—5 to 20 grains (0-3 to 12 Gm.), or, if liquid, 7 to 30 drops may be lightly rubbed into the affected part. Upwards of 5 grains of Methyl-Aspriodine will he on a sixpence a 8 ‘ on a shilling.’ A small quantity almost completely ^aPpear when rubbed into a few square inches of body surface, ihe B or Liniment infra are preferably prescribed. , .„.,nnjv A potent preparation of this kind is not intended to be vigorously rubbed into an extensive tender or inflamed area. T . information of dermatitis caused by a patient m.^mg too yigorous use of the substance (in the pure condition) *>»*•>* the shoulder for eight successive days. The er nainalso cleared after treatment with Calamine Lotion . e diSl^arUrom two cases of dermatitis no ^ “f^aS mly been brought to the notice of the author. rather than daily even be salutary in obstinate cases. Inter use may be recommended. There is initially a slight warming or tingling sensation, or in some cases a mild local anaesthetic effect. . Mucous Membranes.—Originally, it was thought desirable to direct that Methyl-Aspriodine should not be used to the mucous membrane. It has, however, since been employed in neuralgic affections of the gums. See Methyl-Aspriodine Pigment, posted. In addition to the pure substance, the following are prepared : Methyl-Aspriodine Balm, containing 50% in a Lanolin basis. This may be preferred by some patients. Directions.—5 to 30 grains (0*3 to 2 Gm.) to be lightly applied. Methyl-Aspriodino Liniment—This contains 20% of Methyl- Aspriodine, in conjunction with Camphor, Chloroform, and Menthol. Directions.—-A small quantity to be lightly rubbed into the part. Methyl-Aspriodine Pigment.—A 2% solution in an Alcohol ana Glycerin solvent. Suitable for inflamed gums. The taste is somewhat comparable with that of Glycerole cf Tannin. lection of suggested therapeutic doses into the body, neither the Iodme nor the Salicylic radical could be readily traced in l3’Ut thlLnegative result is of interest. The urine was tested for bne me too d described under Aspriodine. Similar negative data are obtained with a large number of drugs used locally. mWe recalledL the interesting work of Prof. It. B. Wild and Miss Ivy Roberts (B.M.J. i./26,10/6) with Mercurial preparations (see Ung. Hydrarg.). Thev found, infer aha, that 4 Gm. of Mercury Ointment (B.P. ’14) gave an absorption into the body of 0*12 Gm. Mercury when used for 2 minutes and 0*17 Gm. lu minutes. Prof. Wild, however, was not able to investigate the urine of normal persons who received the rubbings; we do not recall any systematic examination of the urine of persons so treated. It seemed of interest- to. carry Prof. Mild’s work a stage further, weighing the non-absorbed quantities and examining the urine for Mercury and other well-known medicaments (as tried) that are used locally and are known to be efficacious. A resume of our findings is in Edn. XIX fn 710 instance could the active constituent of these ointments he traced in the urine during the same day. The specimens were evaporated and examined by delicate analytical methods. It was shown that a number of chemicals, e.g., the potent Mercurials, of known efficacy in divers complaints, when rubbed into the skin, cannot be traced promptly as having passed through the system. We note further that Prof. A. J. Clark in “ Applied Pharmacology ” gives a graph relative to work by Lomholt, showing that a few mgr. of Mercury could be found in the urine after daily rubbings for six weeks with large amounts (3 Gm.) of 50% Ung. Hydrarg., i.e., the bulk of the Mercury is absorbed into the body, probably as a fatty acid compound. In order that a drug may be absorbed, as explained by Prof. W. E. Dixon (‘ Manual of Pharmacology ’), it must pass through either a sebaceous or sweat gland, since absorption through the horny epithelium is impossible. The cutaneous glands are filled with fatty material to which water is impervious, so that a drug p be absorbed, must be dissolved either in fatty substances or icohol, all of which find their way through the fat. Me thvl-Aspriodine being soluble in fats, fulfils these requirements. internal admin/straiten.-—Doses of 5 to 10 grains of [ethyl-Aspriodine are suitable for use per os, and Iodine has been etected in the urine within 2 hours of taking a 5-grain dose. Obstinate cases which fail to respond adequately to the compound nployed locally may be treated with the substance by the mouth, r indeed by a combined medication. Methyl-Aspriodine Capsules containing 5 and 10 grains (0-3 and ;6 Gm.) are prepared. Methyl-Aspriodine Injection.—Methyl-Aspriodine (in suitable lute form) may, we believe, be used intramuscularly. iecent Pharmacological Investigation (193i). Two solutions were employed: [A) 10% Methyl-Aspnodme in live Oil; (B) the same with the addition of 3% Ansesthesin. These w^ere injected subcutaneously over the flanks into mice and do a rabbit and the animals were closely observed for signs of in- nmmation during two days. Injection A.—No ill effect was observed in three mice receiving Cc. (| Cc. into each flank). After 6 hours one of the mice was killed id examined. The injection had not been completely absorbed but Lere was no inflammation. After 24 hours a second mouse was lied and examined. Absorption was nearly complete and no flammation. After 48 hours the third mouse was killed and cammed. The oil was completely absorbed without inflammation. Injection B.—Effects were exactly similar to those from A on a rther three mice. # Tests on Rabbit.—A rabbit weighing 400 Gm. received 1 Cc. of A. one flank and 1 Cc. of B. in the other. No tenderness or induration as observed during 24 hoars. Erom these data the opinion is expressed that even without the Idition of the local anaesthetic Ansesthesin, 1 Cc. doses of 10% [ethyl Aspriodine could safely be given subcutaneously. The writer has received numerous expressions of opinion on Methyl- sDnodine *— Rheumatism.—Methyl-Aspriodine, also the liniment, and balm, have been sed in about 100 cases and have given better results than any yund for local use. A suitable preparation for the type of disability treated i this country .--Vincent Coates, 1927. j , . ,rT3 In chronic rheumatism (29 years) of great value. A.M.R. . , , Fibrositis.—Methyl-Aspriodine as a routine treatment was found t oe mch more successful in rheumatic affections than Methyl Salicylate. l» J* Lennane, ^9^7* » ±. i_.rAO Ite relieves pain and in the limited number of cases treated it was con- dered to be the best local application.—J. A. Venning, J927- Sciatica, Lumbago, Rheumatism, Sprains, etc.—In th. relief of pan xcellent results were obtained with the ointment and linime <. Found of benefit in a case of sciatica.—G. E. W. dins* and had Strained Tendons.—In two cases which were <of M'ethyl- ot yielded to ionisation or massage, improvement followed the use of M y spriodine. Methyl-Sedasprin the analogous derivative of Sedasprin, has alec been prepared. A yellow oily product, which does not solidify abov« 0° C. Has been rubbed on the skin experimentally. Phenyl-Aspriodine. Syn. Acetyl-Iodo-Salol. (The name Aspriodine is a Registered Trade Mark.) /O.OC.CH3 C6H3I< -382 0170. \coo.c6h5 Dose.—5 grains (0-3 Gm,) in tablet (crushed), cachet or slipule. with a little water. The dose may be cautiously increased. Il should be given as such, not admixed with other chemicals. This body, which is new to medicine, is also the outcome of the author’s work on compounds of the nature of halogenised Aspirin. The compound is obtained as a white, crystalline powder of neutral reaction containing 33*22% of Iodine. The phenyl radical in it is equivalent to 24*6% approximately of Phenol. It is a stable body giving practically no colour with Ferric Chloride. It has M.Pt. 123° C. Soluble in Chloroform 1 in 3, in Alcohol 90% 1 in 250. Insoluble in water. Pharmacology and Uses*—Phenyl-Aspriodine embodied the therapeutic effects of Iodine, Aspirin and Phenol. The Salol principle is involved. The ester passes unaltered through the stomach, to be split up by the alkalinity and saponifying enzymes of the intestines. The constituents are then slowly absorbed. Urine contains Iodine and Salicylate after a dose. A (lose of 5 grains was taken and the urine examined after 3, 10 and 17 hours. Both Iodine and Salicylate were found in all the samples, even using 10 Cc. For the Iodine the E.P. Sodium Xitrite Process was used, and for the Salicylato Self’s Vanadate Reaction. Bactericidal Power in Vivo.—The urine of a normal individual added to broth grew. 1 hour after taking 5 grains the urine was sterile, but not so 2 hours after. The dose of the substance is, in great measure, dependent on the Phenol content. This should be borne in mind, to prevent too potent effect. It should supersede Salol in some instances as the antiseptic power of the compound is enhanced by its high Iodine content. The special claim of this drug is as an intestinal and urinary antiseptic. In 5 grain doses it causes slight darkening of th@ urine. Phenyl-Aspriodine may prove effective in typhoid and dysentery and in gonorrhoea. It should further be tried in rheumatic affections, neuralgia and in arteriosclerosis. Contraindication.—It should not be given in kidney disease. Phenyl-Aspriodine Tablets, Cachets and Slipules, 5 grains (0*3 Gm.) each are prepared. No. 1 slipule holds 5 grains. IS henyl-Se&asprin, Syn. Acetyl-Bromo-Salol. fskThe name Sedasprin is a Registered Trade Mark.) /O.OC.CH3 C6H3Br< =335-0018. \coo.c6h5 Dose.—5 grains (0*3 Gm.) carefully increased if desired. It referably given as such in tablet (previously crushed) or m cache r slipule (No. 1 holds 5 grains), with a little water. This compound is the Bromine analogue of Phenyl-Aspnodine. t introduces the Salol principle to the halogenised Aspirins, which ave already been considerably employed in medicine. ; Phenyl-Sedasprin is in white crystalline masses of neutral reaction bn taming 23-85% Bromine. The phenyl radical present is equivalent to 28% approximately of Phenol. It is stable at ordinary vmperatures and gives practically no colour witi ^®r£1<c hloride (absence of Salicylic Acid and Bromo-Salol). It has JM.Pt. 18° C. Soluble in Chloroform 1 in 3, in Alcohol 90% I in 380. Insoluble 1 water. \ Pharmacology and Uses.— Phenyl-Sedasprin embodies be activities of Bromine, Asprin and Phenol. It resists physiological acid but readily splits up in presence of physiological alkali |t body temperature. Care should be taken to avoid over-dosage, rhe dose is limited to the equivalent content of Phenol. The ompound should possess advantages over ordinary Salol a3 an ntiseptic and antipyretic. It has especially antiseptic action on he urine, which is slightly darkened in colour after a dose of 5 grains, t is advanced for treatment of rheumatic affections, neuralgia, 3vers, tonsillitis, laryngitis and particularly as a bactericide with bdative effect in urinary affections. Contraindication— It should not be given in renal disease. Cachets and Slipules, 5 grains Phenyl-Sedasprin Tablets, D-3 Gm.) each, are prepared. ammonium Ortho-iodoxybenzoate. Syn. AMIODOXYL BENZOATE, ^Arthrytin (T.M. 486810) C6H4(IO2).COONIl4=297-C024. A white crystalline powder, containing 42-7% of Iodine, readily soluble i water. To avoid decomposition, it should be kept dry and away iroin 11 to 15 grains (0*75 to I Gm.) intravenously, or twice this dose 't/ses.—Chiefly in arthritis, especially active infection jsgiven l 100 Cc. of Normal Saline intravenously within 7 to 12 minutesh cut rally and in 2 Gm. doses by high enema it has been found effective. I olio v\mg Ltravenous use, reactions resembling non-specific protein reactions may ccur The salt is quickly reduced in the blood stream, and it is stated to imuiate phagocytosis of streptococci and staphylococci by human leuco- ytes.—Jl. A.M.A.ii./27,1061. 1/r oookaa\ t> ’RiT'rn .cetyl-para- amido - Salol. ^Salophen. (T.M. 322560) P. Belg., Ielv., Svec., Ph. Ned. V., F.E. VIII., P. Ital. V. C.H, OH.COO.C,H.NH.COCHj= 271*1094. Patent 11,833/1891 and 3435/1892,' both now lapsed. . tq Dose.—10 to 15 grains (0-6 to 1 Gm.) 3 or 4 times a day m cachets. S4 Tablets, 5 grains, are prepared. White crystalline scales, tasteless; soluble in alcohol, ether, and alkalis, almost insoluble in water. It contains about 50% salicylic acid, /ncom- pczfihle with Alkalis and their carbonates. It is unaffected by gastric juice, but decomposed by pancreatic ferment. Anti-febrile and anti-rheumatic. Used in chorea, neuralgia, sciatica, headache, and throat affections. Ointment 10% in Lanolin for psoriasis and other skin affections. ACIDUM STEARICUM, U.S., P.Jap. Stearinum, P. Austr. Commercial Syn. “ Stearine ” wrongly so called. C17Ha5COOH=284-2308. This monobasic acid occurs as a hard white solid substance and is not entirely pure. It is prepared by decomposition with superheated steam of Stearin (the triglyceride of stearic acid contained with those of palmitic and oleic acids in tallow). Soluble about 1 in 18 of alcohol 90%. Readily soluble in ether. Melts at about 56° C. (132-8° F.) (U.S.). This melting point corresponds to a mixture of 40% stearic acid and 60% palmitic. A melting point of 58° C. (136-4° F.) would be better for some suppositories. Fide Glycerin. It is obtainable commercially withM. Pts. 50° C. (122° F.), 52-5° C. (126° F.), and 56° C. (132-8° F.). The pure acid melts at 69-2° C. Commercially it contains 20 to 30% oleic acid. Iodine No. 21-7 would indicate about 24%. Pure stearic acid would of course have Iodine No. nil, which condition of purity may be approached by successive re-crystallisations from alcohol. Cocoa-nut Stearine.—A white firm fat melting at 84° F. (29° C.J suggested for use as suppository basis, as having a melting point somewhat lower than cacao butter. It is obtained by chilling and pressing Oil of Coconut (Cocoa-nut Oil or Cocoa-nut Butter, Oleum Cocos, P.G. II.), i.e., the oil or butter from the Cocoanut Palm, Cocos Nucifera Linne, hence to be distinguished from the product called Cocoa Butter (Oleum Theobromatis, q.v.). Oil of cocoanut is solid between 40° and 50° F., and liquid at about 80° F., and has characteristic odour. It is used as a substitute for lard and largely in soap manufacture. The dried pulp of the Cocoanut is known as Copra. The endocarp or meat of the nut is said to be a powerful taenicide. The patient should drink the milk and then eat the flesh of the nut.— U.S.D. Cocoa-nut Oil has usually very low Iodine number—about 8. The oil from the rind, however, gives as high as 25 or 40. Cocoa-nut Oil Soap. This, according to Lewkowitsch (quoted in Thorpe’s Dictionary), can be prepared by a simple cold process, not requiring anything in the nature of boiling. To the fat, previously warmed to about 35° C., an accurately measured quantity of Caustic Soda Sp. Gr. 1-35 (i.e., 32%) is added with stirring. (Use approx. 21 of this lye to 5 of Oil. This will saponify with slight heating.) The mass is allowed to stand and becomes warm, and saponification is effected in 24 hours. The soap is not ‘salted out,’ that is, it contains the Glycerin formed. For making a Cocoa-nut Shampoo the following is suggested :— Dissolve Sodium Hydroxide and Potassium Hydroxide, of each 1 part, in 5 parts of Distilled Water and when cold add spirit 5 parts; melt Cocoa- nut Oil 10 parts, and when this is nearly cooled to the congealing point add gradually to the alkaline solution with shaking. Continue shaking occa- naily for 10 to 20 minutes; finally add water enough to make 50. ihe eparation is alkaline, and can be neutralised with a little Oleic Acia. rpineol and Coumarin are suitable perfumes.—C. & D., Oct.11920, p. 1420. ■irthsr Suggestions, see Edn. XIX, Vol. I, p. 92. ACIDUM SULPHURICUM. Syn. Oil of Vitriol. H2S04=98-0756. ‘ Poisonous.—Not to be taken ’—For f urther conditions of sale v. p. ;. Dose.—1 to 2 minims (0*06 to 0-12 Gc.). With Sp. Gr. 1-843 contains 98% by weight of hydrogen sulphate. Po ’14.-—Sp. Gr. 1-841, i.e. 95%. e£ Contact Process ” o? manufacture.—A mixture of Snipnur oxide and Oxygen is passed over finely divided Platinum or Oxide of Iron rich acts as catalytic agent, causing union of the gases. By dissolving e Sulphur Trioxide thus formed in water, Sulphuric Acid is obtained. Use.—Very occasionally as caustic. Pruritus has been treated by internal use of, even when alkalinuria is absent. ose, 1 tablespocnful every 2 hours of II to 21% solution. The itching 13 id to disappear rapidly. Antidotes.—Magnesia and cf. Acidum Hydrochloricum. dphuric Acid ‘'Arsenic-free” is specially prepared to stand the Marsh-Berzelius Test 1 hour. cidum Suiphuricum Aromaticum (B.P. ’14). Syn. Elixir of Vitriol. Dose.—5 to 20 minims (0-3 to 1-2 Cc.). This contains a small amount of (aromatic) ethylsulphuric acid. , would be improved by carefully heating the mixture of acid and cohol to encourage the formation of the vinous acid. Contains >•9% w]v. of hydrogen sulphate, and has Sp. Gr. 0-917 to 0-923. cidmn Suiphuricum Dilutum. (B.P. ’ 14). Sp. Gr. 1-069. Dose.—5 to 20 minims (0-3 to 1-2 Cc.). Contains )0% as also U.S., Fr. Cx., F. Norsk., F.E. VIII. and Helv., Ph. Ned. V. is 4 x N., i.e., 19-6%, P.G. VI. 15-6 to 16-3%, . Xtal. V. approx. 19% ; P. Belg. approx. 9.8%. Sp. Gr. and % Tables.—See Vol. II. Carbuncles, boils, staphylococcic infections and certain strepto- >ccic infections have been treated by internal use cf Dilute Sul- luric Acid—20 to 30 minim doses with 2 or 3 ounces of water every 4 ours (small doses in carbuncle are no use).—J. and R. J. Reynolds, ,, March 15,T3. Externally, 1 in 20 Carbolised Vaseline. Cases of ronchiectasis and pulmonary tuberculosis where there is often a ;aphylocoecic infection have also benefited. It has been given for prophylaxis and treatment in puerperal fever. Incompatible with alkalis and carbonates. It precipitates arium and calcium from solutions of their salts, also soluble lead ad silver salts. Acidum Suiphuricum Fumans. Syn.^ NORDHAUSEN _ SULPHURIC CID or 4 Oleum,’ Sp. Gr. about 1-9. Contains some sulphuric anhydride ssolvedin sulphuric acid. When made by distillation 01 Ierrous Sulphate, erric Oxide or Colcothar or Polishing Rouge reniains behind, .dye rmula H2S2Q7, i.e., TI2SO4 + SO3, contains about 45 /0 S03. Commercially le range of S03 content is from 10% to 40%. ACIDUM SULPHUROSUM. H2SO3=82*08; SO2=64-0636. Dose.—\ to 1 drachm (2 to 4 Cc.). A colourless liquid, with strong sulphurous odour, and containin B.P. ’14, 5% of S02. Sp. Gr. 1-025. P. Belg. IV. 6%. Preparation.—By roasting sulphur or by heating copper and sul phuric acid, or carbon and sulphuric acid, and dissolving the gas in watei Sulphur Dioxide is also available compressed in cylinders. Sulphurous £ume3 arising from coal combustion, as in the much discussec Battersea Electric Bower Station, can be oxidised to Sulphuric form, instea< of being discharged into the air. Carbon Dioxide, Carbon Monoxide, an< flue dust are other grave factors affecting human vitality. Uses.—This solution of Sulphurous acid is applied external!; as a lotion—one part to two or more of water and sometimes a littk glycerin added—for affections such as chloasma, ringworm pruritus, thrush, and chapped hands, with very good results. It ii sprayed into the throat for tonsillitis, diphtheria (better diluted) anc asthma, or used as an inhalation, a teaspoonful to a pint of cold water It is strongly antiseptic, and has been used in whooping cough by fumigating the room. Also diluted, for feetor of the teeth, e.g. ira syphilis. Internally it has been used in cholera (freely diluted). As a rectal injection, a 1 or 2% solution of the gas. Also for gastric fermentation accompanied by sarcinm, and in typhoid (20 to 30 minim doses, diluted) every 2 or 3 hours. Magnesii Sulphis, MgS03+6H20=212-4736. Dose.—10 to 30 grains (0*6 to 2 Gm.). White crystalline powder. Soluble 1 in 90 in water. Given in diphtheria and other infectious diseases. Large doses may be given with impunity. Tablets 5 grains. Magnesii Hyposulphis. Syn. Magnesium Thiosulphate. Mg.S203, 0H2O=244-5336. Dose.—8 grains (0*5 Gm.) in water. Colorless crystals, very soluble in water. Spasmodic coryza and asthma, resistant cases successfully treated by Magnesium Hyposulphite tablets 0-5 Gm., 4 to G daily, or the intramuscular injection every fourth day for two weeks of 10 Cc. of a 10% solution. Injections stated to be painless and amelioration of symptoms to follow almost immediately.—G. Boissel, Presse Med., May 17, 1930. Asthma of 2 to 25 years’ standing treated per os. Results satisfactory, no contraindications.—M. J. Fenton, B.M. J. ii./3O,940. Intramuscularly begin with 5 Cc. and increase to 10 Cc. of 10% solution.—M. J. Fenton, B.M.J. ih/30,986. Magnesium Hyposulphite Sterules contain 10 Cc. of 10% solution. Sodii Hyposulphis.—Syn. Sodium Thiosulphate (B.P. ’14). U.S., P. Ital. V. and F.E. VIII. (without dose). Na2S203+5H20= 248-192. Dose.—10 to 60 grains (0*6 to 4 Gm.). Crystals soluble in water 1 in 1. Insoluble in alcohol. JJses.—As a lotion, 1 in 10 for chloasma, ringworm, etc. It may >e made to evolve sulphurous acid as, e.g., in the following : Sodium hyposulphite 6, Diluted Sulphuric Acid 1, Water 32. Useful in clearing out the intestinal tract (in arteriosclerosis). Purgative Action.—In Italy medical men and the general public demand odium hyposulphite (specially re-crystallised). For internal use the dose 3 Horn 1 to 6 grammes; its antiputrescent action is said to be superior to that >f the sulphite. While passing through the blood stream it is transformed irst into sulphite and then into sulphate.—Ph. Notes. Blood Pressure Reduced by Sodium Thiosulphate per os, but made >atient feel poorly.—H. H. Sanguinetti, L. ii./3o,1291. Eczema.—0-45 to 0*75 Gm. intravenously repeated daily without danger for veeks at a time.—L. i./31,649. . . . ,. Pellagra.—Even advanced cases cured by intravenous injections 0110 Uc. 0% solution 20 to 60 injections necessary. No complications. I. Sabry, ii. ih/31,1022 ; Jl. Trop. Med., Sept. 15,'31,303. _T . 1 Burns, and Dermatitis caused by Arsenic and Mercury.. Moist Lpplications of a 1 or 2% solution of Sodium Hyposulphite beneficial m treatment.—per Jl. A.M.A. U./25,636. Intravenous Use in IVlercurial and Bisrnuth Stoniatitis fond Arsenical Poisoning.—In dose of 3 to 4 injections of 0-45 to )-6 Gm. in 5 Cc. of water intravenously alternate dajs.it is potent- possibly •or all acute metal poisoning.—H. C.Semon, B.M.J. i./24,C64; stated to be aon-toxic up to 2 Gm. doses. . .... , , Large doses (2 Gm. or over) will not cure Arsenical dermatitis, but will ma,ke it worse. The best dosage is that advocated by Denme and McBride rJl.A.M.A., Dec. 27, ’24), i.e., 0-3, 0-45, 0-6, 0*75, 0-9 Gm., etc ,with intervals of a day or two.—H. Schussler, Jl. Intrav. Therap., Jan. 26,11. See also our pp. 174, 197. , . , . , -»■»■ Mercurial stomatitis and a case of tissue reaction due to leaking of Neo- arsphenamin from a vein treated by 0-45 Gm. Hyposulphite in 10 Cc., 0-6 Gm. given prior to Arsphenamin was followed by slight rigor.—China Med. Jl., Sept. ’25, per C.D. ii./25,899. . . . Antidotal action in Mercuric Chloride or Mercurochrome poisoning not 'substantiated.—K. I. Melville & M. Bruger, Jl.Pharm. & Exp. Flier. Sept., *29,7; Mendelson, Med. Jl. & Rec., 1927, per Pres.^Oct., 28 349. For inorganic Arsenicals per os valueless.—Jl. A.M.A. 1./27,12^,0. Potassium Cyanide poisoning. Two injections of 10 Cc. 30/0 ot value.-— per Jl. A.M.A.L/27,1525. 1 Gm. intravenously.—Klin. Woch., July, 28,1351, per Pr., Oct.,’28,268. . , , . , In the later treatment of Arsenic and Mercury poisoning not of much value. Liver Extract of value in Salvarsan dermatitis. Intramuscular injections of 5 to 10 Cc. of a 1 = 1 preparation.—L.L/29,1102. Sterules of Sodium Hyposulphite are prepared, 0-2, 0-45 and 0*6 Gm. in 5 Cc. Ametox (T.M. 451286) and ^Thiostab (T.M. 458531) are preparations of Sodium Hyposulphite. Lotio Sodii Thiosulphatis, Mid. H; Sodium Hyposulphite 20, Sulphurous Acid 45, Glycerin 30, Distilled Water to 568. In tinea versicolor. Distemper in dogs is well treated by Sodium Hyposulphite. First give a purgative of 4$ to 7£ grains of each Calomel and Scammony, then the hyposulphite, 9 to 15 grains in milk or sugar and water next day for 1U days. Respirator Solution.—Sodium Carbonate Cryst. 60, Sodium sulphite 52, Water 100. A proportion of Glycerin should be added to keep the wool or material moist. P. A. W. Self came to the conclusion that l e above is the most satisfactory to neutralise both Chlorine and the Acids formed.—P.J.ii./i5,133. Sodii Hydrosulphis. Na.2S204=174*114. White powder soluble in water with evolution ot bOg- agent used in manufacturing processes. An active reducing Po^ONiisG. 100 mgr. per kilo weight per os enabled animals tc survive faoal doses of Arsenic. Low toxicity but may cause vomiting. Bes oiven in a fresh solution followed by 25 Cc. Normal Hydrochloric Acid.—W It Bond and E. W. Gray, Jl. A.M.A. i./ 29,1919. Sodii Hydrosulphidum. Syn. Sodium Sulph-hydrate. NaHS^56-177 vvhen fresh this is m hygroscopic crystals, very soluble in water. Used ir analytical work. ACIDUM TANNICUM. Syn. Tannin. C14H10O9=322-078. F. E. VIII., p. Belg. IV., P. Ital. V. Dose,—5 to 10 grains (0-3 to 0-6 Gm.). Extracted from galls with ether containing a little alcohol and water. Estimation of Tannin and Identification of Drugs containing—see Edn. XIX, pp. 94, 95. Soluble in water 1 in 1 slowly, and in glycerin, less so in alcohol 90%. Almost insoluble in ether and chloroform. Incompatible with ferric salts, acids, alkalis, silver and other metals and with gelatin—c/. Tannalbin infra. Furthermore, Tannin solution precipitates the majority of alkaloids from solution, hence is occasionally employed as an antidote to these. I ses. Throat and mouth wash 1 to 2 %. Astringent and styptic in powder form for epistaxis (by coagulating the albumin). Sometimes given in dysentery. Rectal injection of 30 grains in a quart of hot water, with or without opium, has been given in cholera-. Burns have been treated with a 2 to 3% solution in ether painted over the part 2 or 3 times daily. It is a useful astringent applied to the gums and as an ingredient in tooth powders. Tannic Acid Treatment of Burns under First-Aid Conditions. Dissolve 440 grains Tannic Acid in 2 pints (2J%) of water and add 8-75 grains Corrosive Sublimate. Soak lint in warm solution and wring out gently ; apply smooth side to burn, cover with layer of wool and fix with gauze bandage. Wash hands thoroughly before touching lint. In face burns keep eyes closed and smear vaseline over eyelids, eyebrows, and round eyes and cover with wool. Apply face- mask leaving regions round eyes, nose and mouth exposed through slits.—W. C. Wilson, M.R.C. Report No. 141, B.M.J. ii./2c>,824. Tannic Acid Packets containing 110 grains are’ available to produce l pint of the solution and may be kept ready for use. The Corrosive Sublimate in the solution is poisonous, and limits use as First-Aid and Nursery medicament.—D. A. Coles, L. ii./2o,l011. Description of First-Aid outfit.—ibid., 1022. (We agree—better omit it —W.H.M.) First advocated by E. C. Davidson (Surg. Gyn. & Obstet., 1925, XII, 202) Results confirmed by W. C. Wilson. 2*% solution sprayed on and dried," electric lamp bulbs, in bed case, or by hot air from an electric drier at intervals of one hour till the parts are covered with a thin brown layer of coagulated tissue.—L.ii./29,955. 2% solution applied for 24-48 hours with good results.—B. M. Gordon, L. i./28,336. 2P/0 solution sprayed on hourly for 8 hours and allowed’ to dry without dressing. No part of burnt area should touch bedclothes or bed.—G. Herzfeld, ibid. 520. 50 cases treated. Promotes rapid analgesia, invariably lessens severity id of ten prevents acute toxaemia, sepsis usually avoided, scarring less marked, lid death rate reduced. Prognosis, even in children with 40 /0 of body sur- ,ce affected, not necessarily grave. Extended use recommended.—W. b. Filson, B.M.J.H./28,91-94. . A ^ rWi Burns in children. Deduction in mortality in Belgrave Hospital for Chil- ren attributed to use of Tannic Acid and nursing. Prevents absorption of xins. There is no changing of dressings, hence no trauma. , Spray every (hour until a crust forms.— C.P. G. Wakely, M.P.C., July 10, 29,32. No better than other local remedies. Shock best treated by introduction fluids into the circulation.—C. Donald, L. iL/30,949. . Tannic Acid well spoken of. Picric Acid, Aluminium Acetate, and Acn- kvine condemned.—Pack and Davis, B.M.J. i./3i,028. I fpus forms under scab, drain by cutting channels in tlie coagu.um do not se fomentations or moist dressings.—E. I. Lloyd, B.M.J. ii./3i,l<o. Not to be applied to the finger-tips—coagulum forms tight tourniquet.and nger-tips may slough off. Bums of buttock close to rectum difficult to treat -infection may spread from rectum under the coagulum. Apply Tannic Acid or 3 inches from anus and treat skin round the anus with Flavine or Picr^ cid solutions. Also fails when bum is near the mouth. Ulcerating conditions id excoriations of skin from fsecal fistulas of smau intestine well treated, ir W. I. de C. Wheeler, M.A. *31,85. Sheffield experience—Bums and scalds treated with 2|% solution as spray, ormation of protective coagulum lessens primary shock by relieving pain, and •events toxaemia. Severe sepsis is avoided and scarring reauced. The ana cleaned with Ether, under light Gas and Oxygen It is sprayed hourly with le warm solution until the coagulum forms. No dressings are required, atient is beneath electric light bulbs (as above). The coagulum loosens 1 eek or so and is then removed. The use of Picric Add or oily fluid in first-aid Lterferes with the action of the Tannin and should oe avoided—Wilfred rvncs ^ovGribcr jqq Diarrhoea.—Tannic Acid in mild cases of, is unnecessary and in severe rses is useless.—B.M.J.E. i./26,48. . ,. , Disinfection of the Hands.—A 5% watery solution of Tannin of value, re Tannin acting as a fine coating (similar to a glove) which prevents bacteria itering the skin.—B.M.J.E. iL/24,78. lyeerimnn Acidi Tannici, atcLiie cum Alumine, v. Glycerin, argaristna Acidi Tannici contains 10% of Glycerin of Tannin. otio Acidi Tannici Sulphurosa St. BaRT.’s H. Glycerin of Tannic Acid 1, Sulphurous Acid 1, Water to 8. Ovules with Theobroma basis for vaginal discharges, v. Ovules. Pessus Acidi Tannici 10 grains each in theobroma oil basis, 120 ;rains weight. uppositoria Acidi Tannici (B.P. ’14). 3 grains with theobroma oil q.s. to 15 grains. [Jg IpJ Suppositories of Tannic Acid with Opium, 1 grain in ddition, or U|] jjp l] Morphine | gr.—The latter are W.H. Alumioii Tannas.—TANNAL INSOLUBILE. . . , +inn Am. .^^M.a^£w®toitfcS^rhrf^re»jtotoryor8Hffl. -Y.B.P. 1913,122. Jbuminum Tannicum. P. Jap. U.S. X., P. l>iC|S- l^*> , patents cTannalbin. (Trade Mark 216134/1899, renewed 1926, patents Ifo^-Sto 15 grains (0‘5 to I Gm.), P. AGS®., PH. Neb. V. with method ' “compound of tannin with albumen, in pale brown insoluble, tasteless owder. qp tWanufactu re.—See details of our work, Edn. N1N, p. j. Uses. A disinfectant soluble in the intestines, but unaffected by the stomach, given for diarrhoea. Zinci Tannas. Syn. “ SEL de Baknit.” , rS °,b™ine5 bytreating Zinc Oxide 10 in Water 15 with Tannin 50 in Alcohol 4a /o 100. Dry at gentle heat. We have found this method, satisfactory. Used as ophthalmic application and for decubitus and other skin lesions. Further Tannates. Details of making.—Y.B.P. 1913,125. Di-acetyl-tannin. Syn. Acetannin, Acidum Acetyltannicum, Tannyl Acetate, J.S. X. ^Tannigen. (T.M. 322568; PATENT 1228/1894, void.) Ch4H8(C0CH3)*08 =406*1392. Dose— 5 to 15 grains (03 to 1 Gm.) in cachet. Manufacture.—Tannin Acid 10 Gm., Acetic Anhydride 15 Cc.; heat on water bath 1 hour. Add 25 Cc. Alcohol and pour the solution into 500 Cc. of water, collect, wash and dry at not exceeding 60° C.—C. E. Corfield and G. R. A. Short, P.J. ii./24,11s. A tasteless, insoluble powder, but rendered soluble by alkali. In diarrhoea. Dissolves in the intestine appearing in the urine as gallic acid. Should not be prescribed with alkali. P.G. VI. defines as mainly a mixture of Diacetyl and Triacetyl-Tannin. Methyl Ditannin. Syn. TANNOFOEM (T.M. 216873). C29H2QOis = 656T56. A compound of tannin with formaldehyde in reddish-white powder insoluble in water, soluble in alcohol and alkalis. Used as an antiseptic in ointment (1 in 10) or dusting powder alone or with 1 to 4 parts of starch, for bedsores, hyperhidrosis, pruritus, eczema (particularly in interdigital eczema), and piles. In diarrhoea. (Dose—from 1 to 20 grains according to age) and enteritis and for tender feet. Is official in P.G. VI. ACIDUM TARTARICUM. (CH.OH. COOH)2=150-0468. Dose.—5 to 20 grains (0-3 to 1-2 Gm.). Manufactured from acid potassium tartrate by heating with water and sufficient calcium carbonate to almost neutralise, converting thus into insoluble calcium tartrate and soluble neutral potassium tartrate. The latter is also converted by aid of calcium chloride into calcium tartrate. The two portions of calcium tartrate are washed and then decomposed with the necessary quantity of sulphuric acid. Sol able, 10 in 8 water, 1 in 2| alcohol 90%, 1 in 4^ glycerin, 1 in 120 ether 0-720, 1 in 5 absolute alcohol. Nearly insoluble in benzol and chloroform. Incompatible^with alkaline carbonates, and with potassium calcium, and mercury salts. Uses. For making Effervescent Preparations, Effervescing Tablets (see Neutralisation Table for equivalents), and cooling drinks. Specificity in Antiseptics.—'This acid (as also Malic Acid) has boon found to bo active against B. aerogenes capsulatus. Vide Vol. II. For details as to presence of Lead in Tartaric Acid and Method of Estimation, also for Acidum Glutaricum, Syn. Pyrotartaric Acid, see Vol. II. Gollutorium Acidi Tartarici. Syn. Tartaric Acid Mouth Wash, R.D.H. Tartaric Acid 1 grain, Potassium Acid Tartrate 2 grains, Lemon Syrup 3 minims, Saccharin Soluble i grain, Water to 1 ounce. Use 4 ounce in 1 tumbler of water. HACONITI RADIX. IIP JjAconite, Aconitine, and their preparations. Hoot collected from Aconitum Napellus (Eanunculaceoe) and dried. B.P. ’14 gives no dose but requires not less than 0-4% ether-soluble alkaloids. Eft. Cx. gives Dose (max. single), 0-1 Gm.; max. during hours 0-3 Gm That of P. Belg. IV. in powder dried at 60° C., ntaihs 0-5% alkaloids. P.G. Y. and Fr. Cx.—Selected heavy roots from the wild paint fleeted before the end of the flowering season. (Not in P.G. VI-) U.S. X. assays biologically with average dose 1 grain (0-06 Gm.), F.E. VIII. assays biologically with dose 0-01 Gm. and 0-05 Gm. in 24 hours. = Use.—Anodyne, diaphoretic, diuretic. Externally the liniment, as such, or mixed with chloroform or bella- nna liniment in neuralgia and rheumatism (causes tingling and umbness). . Internally the tincture diminishes the force and rate ol the pnlse, pecialiy in the early stages of fevers and mild local inflammations ch as feverish cold, laryngitis, and first stages of pneumonia anc ysipelas. It also relieves the pain of neuralgia, pleurisy and eurism. Large doses cause tingling of mouth and skin generally. Acute tonsillitis. Children generally well treated by Aconite. For diild 5 to 10 years old, 1 to 2 minims of Tincture—Yeo. Experiments on small animals show that Aconite is oi no aval reducing the frequency of the pulse, but clinically good results e obtained in some manner from its use.—Sir Dyce Duckworth. MlAconiti Folia may contain as much as 0-6% total alkaloid. Fr. Cx. and Supp. Nouv. 1926 employ fresh leaves for -Alcooiature A.conit. 1 = 1 using 95% alcohol for macerating 8 days, lo contain 0 1/o raloids. Max. single dose 1 Gm., max. daily dose 5 Gm. Antidotes.—Apomorphine A grain hypodermically or an aetic of mustard or Ipecacuanha Wine ; stimulants , Am\ I trite. Atropine Sulphate ^ grain hypodermically has been commended, also Digitalis Tincture 20 minims hypodermically course of 4 hours was successful. Aconite poisoning from taking Liniment in error. Jk 1tm^Tas cardiac depressant—had been given as first antidotal treatm , < _ - ought well to give only one mustard emetic toi save the ead was kept low—feet raised, a sinapism was placed on vno- mnels to the extremities and abdomen. Strychnine and digitalis h p rmically and brandy per rectum. Artifi rial respiration kept up uljceasmg j , covery after six hours. Quantity of Aconite was sufficient to kiL s . p Poisoning^ by a tablespoonful of Liniment containing lO minims ea^ Em. coniti, Lin. Belladonnse, Lin. Chlorofqrmi and. Tmct. Capsici v ith bO minims aultheria Oil. There was no dilatation of the pupils as would have been :pected, nor odour of Wintergreen, but vomiting oc^edraadtag strongly [ it. Recovery under Liquor Strychnin*, 10 minims bypodermically and ounces of hot strong coffee into the rectum. A remarkable recovery takm le aconite into account, which amounted to 3a times the maximum dose or ie official tincture.—L. ii./io,1270. ~ . nyi(1 A^tidnfp^ ’ For Aconite and Belladonna combined, see also Poisons and Antidote . Chloro- jp ijGhloroformum Aconiti, B.P.G. i — 1. rmum Belladonnas.—B.P.C. 1907. Prepared as TlExtractum Aconiti Radicis Alcoholicum. Fr. Cx. and I. Belg. IV. Dxtrait d’Aconit) prepared from the root with t0 /Q alco Q an andardised to 1% alkaloids. Max. single dose, \ gram. Max jring 24 hours H grains approx. F.E, VIII, is assayed biologically, . Ital. V., 0-5% alkaloids. jjp jjFluidextractum Aconiti, U.S. IX. (Not now in U.S.) Average dose.—0-03 Cc. (J minim). Standardised to 0-5 Gn ether-soluble alkaloids of Aconite in 100 Cc. iPTLinimentum Aconiti (B.P. ’14). Prepared by macerating and percolating the root with Alcohol 90% Useful in neuralgia. It is not suitable for painting on the gums. Should contain 0*2% w/v ether-soluble alkaloid. 9 minims of Aconitine liniment=about grain aconitine hav proved fatal. HLinixnsntum Aconiti Composition. G.H. Syn. a.b.c, Liniment Aconite Liniment, Belladonna Liniment, Chloroform Linimen equal parts. To be well shaken before use, as the olive oil in th chloroform liniment is not soluble in the other ingredients. B.P.C uses Liniment of Aconite 2, of Belladonna 2, Chloroform 1. Mis cible. jjpfLinimentum Aconiti cum Ghloroformo, B.P.C. Chlorc form 1, Aconite Liniment 7. The Oil in the original ‘ A.B.C/ formula seems to be essential—otherwise proves too irritant to sensitive skins. Poisoning by i ounce of A.B.C. liniment. Liquor Strychninoe and salin enema 2 pints, containing 2 ounces brandy, saved life. Afterwards i grai morphine. The lethal effect of the aconite was abolished by stimulatin action of the atropine. See also Poisons and Antidotes. [jCflFilula Aconiti.=2 minims of tincture, i.e. grain approx, o Root in each. Dose.—1 hourly. •P iTinctura Aconiti (B.P. ’14). Dose.—2 to 5 minims (0-12 to 0-3 Cc.). As a febrifuge 2 minim every 10 minutes or quarter of an hour for an hour, then repea dose every hour till skin acts well and temperature is reduced. Strength 1 in 10 approx, by percolating dried root in No. 40 powde with 70% alcohol and standardising to 0*04% ether-soluble alkaloid Fr. Cx. has the B.P. ’14 strength made with 70% alcohol. It is termed Teinture d'Aconit au dixieme and has max. single dos 9 minims approx. P.G. V. (1 in 10). Maximum single dose, 0*5 Gm. Max. daib dose, 1*5 Gm. U.S. N. has 1 in 10, assayed biologically. Averag dose 10 minims. P. Ital. IV., P. Belg. and Ph. Ned. V. confab 0*05% alkaloids. By the U.S. X. Assay, the tincture, administered subcutaneously to guinea pigs, has a minimum lethal dose not exceeding 0-0004 Ce. per Gm. body weight P.E. VIII. is assayed biologically. [jj> IjTablets are prepared each equivalent to 2\ minims. To b< directed to be dissolved in a little water. IFHPastilli Aconiti, and [PljTrochisei contain each 1 and \ minim of Tincture respectively. Given in fevers and mild in flammatory conditions. jp3)Rlemin6’s Rnd Turnbull’s Tinctures of Aconite are aboir six times the (B.P. ’14) strength made with 70% Alcohol. They art used externally, and were given internally in doses of 1 to 5 minims Combined with equal volume of Weak Tincture of Iodine (B.P. ’14 it is sometimes ordered to be painted on the gums for pain. EACONITINA. Syn. Acetylbenzoylaconine. C34H45N011= 643-359. jpTCrystallissd Aconitine. Dose.— ,y(j-(7 grain to grain (0-0001 to 0 0003 Gm.), and may increased if desired with extreme caution, the maximum single se being 0-00 1 Gm. Fr. Cx. gives 0-0005 Gm. as maximum during 24 hours; E. VIII., 0-C01 Gm. B.P. ’14 gives no dose, U.S. X. average dose An grain. An alkaloid obtained from Aconitum napellus root and dried leaves [content about 0-03%. In colourless crystals. Soluble in dilute ids, alcohol and chloroform (1 in less than 1), less readily soluble ’ether, and almost insoluble in water and petroleum ether ; melts at !S° C. In weak acetic solution yields a red crystalline precipitate jth potassium permanganate. .U.S. assays biologically and tests for pseudaconitine and atropine Vitali’s test—q.v. By the U.S. test subcutaneously in guinea-pigs should have a minimum lethal dose of 0-000000055 Gm. and not ire than 0-000000065 Gm. per Gm. body weight. A drop of dilute solution placed on the tongue produces a charac- fistic tingling sensation. Antidotes, vide Aconite, Uses,—Employed externally (vide Unguentum Aconitine and eatum Aconitine) in neuralgia, avoiding mucous membranes, and w skin. Internally in the form of a pill is a depressant, calmative, d diaphoretic. ljAeonitinse Nitras. 934H45NO11HNO3==706-3748. A crystalline stable salt, soluble in water and alcohol, cf. Vol. II. Dose.—An grain (0-0001 Gm.), hypodermically. jJtlypQdermic Tablets (An grain), to be dissolved in warm water. JjGranules of Aconitine Fr. Cx. and of Aconitine Nitrate Fr. Cx. contain TV mgr. in each, and are coloured pink. JjAconitinse Hydrobromidum. C34H45N011.HBr.2!II2Or=769'3218, and j£>l] Aconitines Hydrochloridum are crystalline Salts with dose as for the Nitrate. JOIeatum Aconitinse. Aconitine 2, Oleic Acid by weight 98. Dissolve ; may be perfumed is painted on the skin (avoid broken) for neuralgia. ljUnguentiim Aconitinse (B.P. 14). Aconitine 1, Oleic Acid (by weight) 8, (1 grain=2 drops) ; heat ntly to dissolve, and add Lard 41. Mix thoroughly. Best freshly spared. Apiece of the size of a bean is gently rubbed in for facial uralgia, avoiding broken skin and mucous membranes. ADEPS LANAS. Wool Fat (B.P. ’14). U.S.X., Ph. Ned. V., P. Itai. V., F.E. VIII. nhydrous Lanolin. The purified yellowish cholesterin fat of sheep s wool, M.Pt. lout 40° C. Sheep’s wool yields from 10 to 30%, Trade Marks : ‘ Lanoline * 50214 (Class 48) and 50215 (Class 3' 1886. Patent 4992/1882 expired. The specification states tha 4 the invention relates to a new or improved manufacture of fatt matter from Wool Fat termed “ Lanolin.” * The process describe is of centrifugalising waste liquors of wool, washing and purifyin by a suitable solvent.—cf. C.D., March 20/15. Soluble 1 in 25 ether, 1 in 18 oil of turpentine (both with som residual matter), almost insoluble in alcohol 90%. Adeps Lanse can only be saponified by alcoholic solutions of Potas' underpressure—paraffin can be easily detected by this means. Adeps Lanse Hydrosus. Hydrous Wool Fat (jB.P. ’14). Common!; known as ‘ Lanolin,’ Wool Fat 7, Distilled WTater 3. Melt an! mix. Fr. Cx., P. Belg. IV. and Ph. Ned. V. have 25% watei P. Ital. V. has Wool Fat 30, Liquid Paraffin 6, Water 10. Yellowish white ointment basis. More water, up to about equa weights of fat and water, may be incorporated with it without affect ing its consistence. Soluble partly in alcohol, while ether an chloroform dissolve only the fats it contains. Wool Fat is readily absorbed by the skin (especially if washed wit' ether). It helps absorption of narcotic extracts, quinine, iodine potassium iodide and chaulmoogra oil. When an ointment containing Mercuric Chloride or Carbolic Aci< is ordered, it is usually intended for antiseptic purposes, therefor the anhydrous should be used, otherwise caustic action ma}? result Sapolanoline. Lanolin 5, Soft Soap 4. For acne and eczema. Unguentum Lanolini. Lanolin (hydrated) 2, Soft Paraffin or Vaseline 1. Mix. May bo perfumed to form Lanolin Cream. Less sticky than Lanolin. Lanolin, lard and soft paraffin, p.ceq. melted, give a useful basis, a also Wool Fat 9, with Almond Oil 1. Unguentum Lanse Ccmposi turn {B.P. ’14) is Wool Fat 2, Prepared Lard 2, Paraffin Ointment 1 Crembas. A proprietary basis for making Vanishing Creams, Cold Cream and Toilet Creams generally. In the presence of a trace of alkali it will com bine with from 1 to 5 times its weight of water, forming a white cream which i free from a greasy or sticky feeling. It may be mixed with Lanolin and watei For other Ointment bases see Unguevta and for M.pts. of Fats, Table, Vol. IT Cholesterol. Syn. Cholesterin. C27H45OH-f H20=404-3784 is prepared from wool fat by saponifying the same with potash, anc extracting the cholesterol with ether. It is also a constituent o gallstones, often to the extent of 90% or more, and can be obtainec from these by extraction with spirit. Tuberculosis and malignant disease have been treated by giving cholesterir v. Edn. XIX., p. 101. Pernicious Anaemia.—Cholesterin in form cf cream and butter ad lib has been given with success. (Cholesterin is antagonistic to hsemolysis.) 50 injections of 0-2 Cm. in 5 Cc. Olive Oil, in 10 weeks, gave rapid improve ment in grave anaemia and tuberculosis.—per JI. A.M.A. i./26,1103. Blackwater Fever has been treated by Cholesterin internally. In epileptics the average blood Cholesterol is subnormal and is more variable at the time of fits than in periods cf freedom from attacks, a fall usually preceding an attack.—M, Gosdcn, J. T. Fox and W. R. Brain, L. ih/29,14, :<o/estero/ Meiafoofo'sm. During pregnancy there is a disturbance of Cholesterol metabolism resulting large changes in the ratio of free to ester Cholesterol in the plasma, but to s definite changes in the total Cholesterol. There is a great increase in 9 percentage of plasma Cholesterol (free and ester) in subacute parenchy- 'tous nephritis, associated with an increase in the Cholesterol ester content the kidney. Some eliminate from diet in cholelithiasis all substances ;h in sterols, e.g., eggs, milk, butter, and suggest that diet should be restricted this way during pregnancy.—J. Addyman Gardner and H. Gainsborough, i. /29,603,619. the significance of Cholesterol in physiology and pathology.—E. N. amberlain, B.M.J. ii./29,896. Cental Disorders.—Cholesterol is an important controlling factor in .dation processes, its power being best exercised in relation to Lecithin when tli substances are present in normal amounts in the blood. Brains of general :aiytics are remarkably deficient in Cholesterol and a case of dementia ;ecox was completely cured by parenteral injections of 0-25 Gm. Cholesterol Olive Oil every 3rd day for a month and then £ Gm. daily in emulsion by j mouth for two months, with a special Cholesterol-promoting diet.—B. H. iw & J. S. Sharpe, B.M.J. ii./31,252. Che photo-active function of Cholesterol in skin cancer.—Prof. A. H. Bolfo, ii. /31,1187. Ergqsterol q.v. extracted from ergot resembles Cholesterol. jETHER. C2H6.O.C2H6=74-078. |jp l\Applicable to Northern Ireland and CED Irish Free State. Syn. /Ether Sulphuricus ; Ethyl Oxide. Dose.—45 to 60 minims (3 to 4 Cc.), or 15 to 30 minims to 2 Cc.) repeated. Wctnufactur'&dl by the distillation of Alcohol and Sulphuric Acid Lyl Hydrogen Sulphate being first formed which reacts with a further -ntity of Alcohol, liberating /Ether and Sulphuric Acid again ; in this mer the Acid will react with a very considerable quantity of Alcohol. Gr. 0-720. Soluble lin 10 of water, and the ether similarly dissolves about ) same amount of water. Is miscible in all proportions with ohol. Ether is a solvent for a number of alkaloids, fats, resins, I of mercury perchloride and biniodide, also of bromine and iodine. Commercial Varieties in General Use. her PurihcatilS (-S.P.’ld). For inhalation as anaesthetic. ‘/Ether.’ Ph. Ned. V., P. Helv., P. Jap., P. Belg. IV., P. Ital. V., and F.E. VIII. Sp. Gr. 0-720. Syn. /Ether Purissimus, Ether officinalis, /Ether pro Narcosi. n our own and several Continental Pharmacopoeias this is directed to be efully tested and preserved. ’he B.P. T4 allows /Ether and Hither Purificatus to be manufactured m either Ethyl Alcohol or Industrial Methylated Spirit. Ether Purificatus. Pure Ethyl Ether for production or aesthesia may now be made from ^Duty-Free Rectified Ethyl johol (cf. L. i./29,295). It attains a standard much higher than it required by the B.P. ’14 for /Ether Purificatus. It contains trace of Peroxide, Aldehyde, or decomposition products, ich may cause unpleasant post-operative effects. Its admini- ation ensures comfortable anaesthesia. /Ether T’uriiicatus should be stored in amber bottles wrapped in black paper. The ‘ toxicity ’ which develops in Ether, develops proportionately to the aegree of oxidation by exposure to light and air ; oxidised Ether, in additior to producing local and necrosing effects, has distinct action on heart and central nervous system. Toxic phenomena due to presence of peroxides The Anaesthetic Committee of the Roy. Soc. Med. reported (Oct., 1926), ‘the purer the Ether, the better the anaesthetic.’ Suggested that analyst’s certificate of purity should accompany all anaesthetic Ether.—H. E. Laws, L.i./2 7,789 B. M.J. i./27,932. FartherdatavideVol.il. Effects of Acetaldehyde, Peroxide, Mercaptan and Sulphide.—Jl. Pharm. and Exp. Therap. ’26,409. The rate of formation of peroxide increases greatly as the amount presenl increases—F H. Carr, B.M.J. ii./27,664. See also L. ii./27,1305. Ether Convulsions—A complication of Ether anaesthesia: some fatal anc non-fatal cases reported. Due to presence of impurities, Acetaldehyde and ‘peroxide,’ in the Ether. Impurities present on deliverv and increased in amount by existing methods of Ether administration. Question of Ethei purity requires further investigation. Exposure to light and air should be eliminated, and stale Ether should be discarded. Use of amber glass in Ether vapour bottles to protect Ether from theatre lights, and metal tube projecting below level of Ether replaced by bone or ivory. Convulsions treated by prompt ventilation of patient with Oxygen containing 5% Carbon Dioxide.—S. R. Wilson, L. i./27,1119. See also L. ii./27,765. Ether convulsions during anaesthesia are rare, but dramatic and dangerous. —W. Stanley Sykes, B.M.J. i./3p,112S. Acetaldehyde and Peroxide in Ether highly improbahie to cause convulsions. £% said to be toxic (Wilson). Carbon Dioxide per se apparently not responsible.—J. Ross Mackenzie, B.M.J. i./31,441. Steniles, Anaesthetic, contain 1 and 2 ounces (30 and 60 Cc.) of this Ether for the operating bag and (being sealed) for hot climates Ether,4 Methylated.’ Sp. Gr. 0-720. Made from Industrial Methylated Spirit. Contains a little methylic ether, and may be used for spraying to produce local anaesthesia, as it begins to boil below 27° C. (80° F.), and is free from water. It is not adapted for producing general anaesthesia. Ether, * Methylated.’ Sp. Gr. 0-730 and 0-735. Adapted for pharmaceutical and technical extraction purposes. For photography a purer preparation, Sp. Gr. 0-725, is available. CO2 as stabilising agent for Ether and storing in Copper containers.— C. Langton Hewer, L. i./2g,770. ^Ethanesal (T.M. 410750). Described as Ether free from mercaptans and aldehydes. It contains certain ketones, some C02 and some Ethylene, pure Ether being the vehicle. The COa appears to act as a stabiliser. Stated to be less irritating than ordinary Ether and to stimulate the respiratory system less.—R. L. Mackenzie Wallis and C. Langton Hewer, B.M.J. i.'/2i,565 ; L. i./2i,L173 ; Pr. Mar.,/22,168. See also Sir C. English.—L. ii./23,302, and other refs., Edn. XVIII., p. 113. The preparation was found to consist of 95*5% Ether with about 4% of normal Butyl Alcohol and a small quantity of an aldehyde. Anaesthetic properties to be attributed to Ether.—H. H. Dale and co-workers. —L. i./23,424. See also B.C.A. ’26, A863. Uses.—Internally Ether is a rapid stimulant in syncope. Is carminative. May relieve dyspepsia and asthma. Hypodermically it may save many cases of syncope, collapse, and shock from haemorrhage and injury. It depresses nerve tissue, in very large doses it tends to depress muscle tissue, including cardiac muscle but it never excites. Recoveries from shock by intracardiac injection of Ether. 1 Cc. lirect into the left ventricle successful in two cases. Response iramatic and gratifying.—N. Hay Bolton, B.M.J. ii./26,482. Whooping Cough treated by ether injected intramuscularly in ihe buttock. Supposed to act by combating the spasmodic element of the disease. 1 Cc. up to age of 7 or 8 months, and in older children jj Cc. repeated daily or on alternate days—not invariably successful.— L. 1./21,1311. Most dramatically successful; also useful in bronchopneumonia.—B.M.J.E. ii./22,49. Rectal injection with equal amount of Olive Oil, 1 drachm of the mixture for every year of age, gave good results when combined with drugs, e.g., Belladonna.—C. Elgood, B.M.J. i./25,963. For general anaesthesia ether produces less depression on the heart ;han chloroform, but its use is unpleasant both to the patient and }o the operators. Its suffocating action on the patient, if suffering ’rom any lung or bronchial affection, is very irritating, and has proved fatal. Care must be taken not to employ it near a light; its vapour is 2J times heavier than air and very inflammable, and is an anaesthetic it has to be used freely. Dangers from Ether are usually respiratory and due to excess of saliva; Atropine hvpod.before the ether prevents this. Inversion, pulling the tongue and slapping the back usually expels mucus.—R.D.H. Grile’s Nasal Tube method of giving Ether. Less Ether is required than by employing the ordinary way using the open drop method. An injection of Morphine £ grain with Atropine yV grain is given an hour before the operation. Oxygen in addition not found necessary.—L. ii./o9,364. I With flannel or with lint in the open method (Skinner’s mask), so adjusted that all inspirations and expirations pass through the fabric, a more or less equable atmosphere containing approximately 8 or 9% of ether vapour may be depended upon.— L. i./12,217. Anaesthesia in throat and nose operations. Ether is thought to be the proper anaesthetic—safer than chloroform.—Felix Pmod, L. i./2o,433. [ Rectal use of Ether as an anesthetic is favoured by some, e.g., where presence of the Ether cone over the face would hinder the operation ; or in diseased condition of the lungs. Contraindicated in diseased state of the intestines and generally in abdominal cases. It is thought that a little under six volumes per cent, in the circulation is required to produce complete anaesthesia. Deaths during ether anaesthesia. See Edn. XVII., p. 107. Ether an ideal anaesthetic for squint operations on children. Chloroform so dangerous, its use forbidden.—T. Harrison Butler, B.M.J. ii./25,1150. Sterules of Ether contain half a drachm in each for hypodermic injection as a dose in heart failure. 20 to 60 minims have proved a successful restorative in typhoid fever and for dyspnoea, but cf. antea. These are made with 0-735 ether. Sciatica has been treated by injection of ether with either cocaine or morphine subcutaneously into the sciatic nerve. _ 5 minim doses of ether with 2 minims of 1 in 12 cocaine, or morphine injection 3 minims, using a 2|-inch needle. Vol. L D Oxygen and Alcohol administered during aneesthesia by Ether or other Anaesthetics. Apparatus is described by means of which Oxygen is bubbled through Absolute Alcohol, and thence the combined vapour mixes with the anaesthetic in a mask.—I,. i./n,331. cf. Oxygen and Alcohol Administration. The apparatus consists of a cylinder of Oxygen, wash-bottle containing Alcohol with exit tube above leading to a Sckimmelbu3ch mask or Hewitt’s modification, which is specially adapted for giving Oxygen with anaesthetics. These are joined together in series in this order. Prolonged Anaesthesia under Ether alternately with Gas and Oxygen. Temperature sometimes remains subnormal for many hours. Nitrous Oxide in connection with Oxygen may be more generally used, but it causes inconvenient rigidity, also faintness, dilated heart, persistent vomiting, etc., but by using Ether alternately with ‘ Gas ’ and Oxygen these objections in great measure disappear. Rigidity can be entirely avoided. The method consists in anaesthetising the patient with Ether, and when a certain degree of Ether saturation is reached changing to Nitrous Oxide and Oxygen—the latter being again dropped in favour of Ether on certain indications, and so on. The details are—when Ether anaesthesia is thoroughly established Nitrous Oxide and Oxygen in proportion of 96 or 95 to 4 or 5 is given. The corneal reflex, if still present, but dulled before the change, will now be abolished after a few breaths of gas, but the pupil will remain small and colour good. After two minutes or so the Oxygen must be increased to 12, 15 or 20%. Frequent breaths of fresh air are admitted, and generally at the end of five minutes it is advisable to return to Ether. This second Ether will probably extend over five minutes, after which Gas can be given for 10 minutes. As the operation proceeds the Ether applications become shorter and the intervals between them longer. The anaesthesia is even, and shock during and after operation seems to be very slight. The method is applicable to a large variety of patients and cases. There is a wide margin between light and deep narcosis. Post-operative conditions good. Nausea less than after open Ether. Rebreathing was allowed on a few occasions without apparent detriment. In the discussion it was thought that the amount of Nitrous Oxide necessary must be very great, and hence the method seemed as if it would be cumbersome. The question of post-operative vomiting was fully gone into.—A. L. Fleming, R.S.M., Sec., Anaesthetics, "Dec., 1910, p. 1, et seq. Gas and Oxygen (1 of Oxygen to 4 of Gas) in nose and throat work preceded by at most Atropine 1/200 gr. in children, or Morphine gr. c. Atropine 1/150 gr. in adolescents, or Combined Hyoscine, Morphine and Atropine for adults. Only a small amount of anaesthetic or a mixture of Chloroform and Ether (Ethanesal) is needed. —H. E. G. Boyle, B.M.J. ii./2i,591. Gas, Oxygen, Carbon Dioxide, Ether Anaesthesia, with local or regional analgesia and de-etherisation, the nearest approach to the ideal anaesthetic, but requires expensive and complicated apparatus and considerable experience. —J. Ross Mackenzie, L. i./27,164. .... The effects of Ether, Chloroform, Ethylene and Nitrous Oxide anesthetics on the gastro-intestinal tract.—G. H. Miller, Jl. Ph. & Exp. Tiicr., Eeb. ^.6, . Oil of Orange, Effect of, on Anaesthesia. 1 Essence of Orange,’ 1 ounce (v. infra) and 3 ounces of Ether placed m the hot water bottle of Gwathmey’s three bottle vapour anaesthesia apparatus, and Ether in the other two bottles, cause not only the odour of the anaesthetic to be completely disguised, so that the patient is unable to tell when its administration begins, but anaesthesia is improved. The result may he due to the pleasant sedative effect. Gwathmey states that Essence of Orange employed by him is composed of Oil of Bitter Orange Peel 1, Absolute Alconol 3. —B.M.J. i./i7,126. Atropine and * open Ether ’ administration. An Atropine injection is given 1 hour before the ether to prevent the secretion of mucus in the air passages which may otherwise be caused by ether. H. Bellamy Gardner, B.M.J. i./i2,422. Enucleation of tonsils by dissection is best done under open ether preceded by 1/100 grain atropine. Suitable for all patients from six months up^rds. —H Tilley, B.M.J. i./i9,781; ii./i9,27. (A death under C2E3 and C3Ei. H. S. Gabbett, ibid. i./i9,739.) , . . . , Morphine and Atropine in the usual hypodermic dose do not affect kidney functions unfavourably, and given prior to Ether anaesthesia they prevent inhibition of kidney function and should therefore be of value m urologic surgery.—W. H. Haines and L. F. Miliiken, Jl. A.M.A. n./25,1855. Anaesthesia. A modification of the open ether method, T. vv. Suu, B’Crile’s method of shockless surgery.—It consists of (1) a preliminary injection of Scopolamine to allay the patient’s fear of the impending ordeal, (2) genera anaesthesia with Ether, followed by (3) local anaesthesia with 200 combined with Adrenalin at the site of incision, and Quimne-urea-hydro chloride 0-75% solution into the peritoneum m cases of gas^ro:cnfrt^t^; The object being to keep the brain free from shock before, during ana after the operation.—W. I. He C. Wheeler, M.P.C. i./i4,332. Ether Infusion Anaesthesia by means of Saline Solution. Burghardt, the originator of the method of Infusion Anaesthesia, used an ordinary infusion apparatus containing a 5% solution of ether ra n^ial saline. The method was modified later. An hour before the induction Sconolamine ^rain. Morphine 1 grain, and Atropine too grain (as a\ crag ,) is given hypodermically, the selected arm is bandaged to a splint, vcm exposed (a few drops of eucaine may be used)—cannula tied in and tke solution run in rapidly. Induction usually lasts about ten minutes. The apparatus used consists of a reservoir containing a 5% solutionofeth^innormalsaline fixed about 8 feet above the floor level, the solution oy means of a pipebe drips into an indicator (capacity 8 ounces) fixed below this and from tl ence into a warming chamber to which the cannula is attached. The advantages claimed are :— ...... . .. Surgical anaesthesia may be attained with 8 ounces of ^e solution, while for maintenance of the anaesthesia one pint an hour (1 ounce of ether) s■ most cases enough. Great flexibility, patient can adjusted with g* eat nicety. Patient comes round within a few minutes. Posi_-anaesthetic vomiting and pulmonary irritation are noth rare. r. Rood, B.M.J. n./ »»' . Solubility of Ether in Normal Saline—At 15°-wo/strencth 0*91°/ Anaesthetic Ether dissolve in 100 Cc. of Normal Saline (of strength 0 9 /0 NaCI by weight).—R. R. Bennett, P.J. ii./i2,1t6. no/ Ether Saline infusion compares favourably with other^JSfomnbimiria ° It (s can be safely used. A 10% solution, may Produce J best to begin with 5%. The metnod is suitable e\en tor the old and teeme. Recovery is rapid and post-anaesthetic vomitinga rare- F. B°o^ B3 -J* ii./i2,608 ; L. ii./i2,1801. H. W. Buxton s Anaesthetics, 6th Edn. p2 Strength 74% and amount raised from 2G0 to CGO Cc. given in 3 to 7 minutes. In one case over 2 litres of the Solution were given.-—G. A. H. Barton, B.M.J. ii./i2,610. An apparatus described for giving.—E. G. Schlesingcr, L. ii./i2,1220. Satisfactory results in 170 cases from intravenous use.-—Pres., Jan. ’23,5. Scopolamine-Morphine Atropine with Ether Saline.— Scopolamine (1/100 grain) with Morphine (1/6 to 1/4 grain) and Atropine (1/100 grain), given about f hour before operation—under 5% Ether Saline. The combination is very useful, as the amount of Ether is reduced to a minimum. It is especially suitable for head, throat, etc., operations, as the anaesthetist is not in the way. The patient is spared the disagreeable sensations of inhalation method. No irritation of the respiratory organs ; no after effects.—E. L. Napier, Glas. Med. Jl., July, 1912. For a further method of Intravenous Anaesthesia see Paraldehyde. Intramuscular Etherisation.— Ether injection into the buttocks, 0-45, 0-S and 0-8 Cc. respectively administered to three patients. In the first Ethyl Chloride was necessary, and in the second and third Chloroform to hasten anesthesia. Another operator found that he failed to induce anaesthesia, though 60 to 70 Cc. in 10 Cc. doses were injected. The patient was drunk in consequence 24 hours, and became very excited.—L. ii./i2,lS02. Successive injections of 2 to 5 Cc. into gluteal region—into each side alternatively. Amount used roughly 1 Cc. per kilo body weight. Advantage in head and neck operations.—B.M.J. ii./i3,394. Intramuscular slow injection of Ether as ansesthetic; 5 Cc. every few minutes.—20 to 30 Cc. usually sufficient. Used in oto-rhino-larvngologv.— B.M.J.E. ii./21,79. Intratracheal Insufflation of Ether.— Almost incredible operations have been done with this method on dogs, e.g., complete removal of one or more lobes of the lung, complete division and suture of the thoracic oesophagus and complete division and suture of the transverse arch of the aorta. Employed in 25 cases with success.—B.M.J. ii./i2,112; ii./13,393,1621. The method will maintain ansesthcsia after it has been established by the usual manner. A tube ft of the diameter of the trachea is introduced into it nearly to its bifurcation. A fairly rigid silk woven catheter 30 Cm. long is used—the average size for an adult being No. 21 or 22 French. The warm ansesthetic—Ether, or a mixture of Oxygen and Ether—is introduced by means of a pump or mechanical blower—Elsburg’s Apparatus is probably best. By this means respiration with full aeration persists, but with lessened respiratory movements.—I). W. Buxton’s “ Anaesthetics,” 6tli Edm The method of choice for all operations on head, nose; mouth, and throat, where satisfactory ansesthesia cannot be maintained with a free airway by the ordinary methods without inconvenience to the surgeon. When there is blood in the upper air passages it is a necessity.—S. Rowbotham, L. ii./26,584. Tracheal insufflation of Gas and Oxygen.—W. Howard Jones, L. i./29,330. Pharyngeal Insufflation Ansesthesia is a method of prolonging Ether ansesthesia after it is established by ordinary methods. The vapour is given through the nose by means of Crile’s tubes, the mouth and nasopharyngeal space having been previously carefully cleansed.—D. W. Buxton’s “ Anaesthetics,” 6th Edn. Rectal Oil-Ether Ansesthesia. Syn. Colonic Absorption— a mixture of Olive Oil and Ether in definite proportion and amount slowly introduced ;per rectum. An evolution of Intravenous Ansesthesia. For children under 6 a 50% solution is used, allowing 1 ounce for every 20 lbs. of body weight. This is non-irritating and no preliminary medication is wanted. Between 6 and 12 years use 55 to 65% solution without preliminary medication. Keep the patient quiet and allow 20—30 minutes for the full effect. Use 1 oz. for every 20 lbs. body weight as before. Between 12 and 15 years use the same percentage and amounts, with possibly the addition of 1/12 grain Morphine and 1/200 grain Atropine hypodermically as a preliminary. From 15 years upwards a 75% mixture is used with same amount as before—1 oz. to every 20 lbs. It will be seen, therefore, that for an adult weighing about 160 lbs., 8 ozs. of the mixture would be wanted (i.e., Ether 6 ozs. and Olive Oil 2 ozs.). The 8 ozs. should be passed in slowly, i.e., it should take 5 minutes. A maximum strength of 65% is now advised by Gwathmey.—D. W. Buxton’s “ Anaesthetics.” See also R. B. Coleman, B.M.J., i./26,94:3. The method is claimed to be perfectly safe. The anaesthesia is automataiclly safeguarded by the gradual and equal absorption of the Ether from the colon, and at the same time its rapid evaporation from the lungs. A further reason for the safety is the affinity of the Oil and Ether for each other.—J. J. Gwathmey, L. ii./i3,1756. Ether (4 ounces) and oil (2 ounces) as anaesthetic per rectum in diverse operations with success.—H. M. Page and G. B. Mower White, L. ii./i7,643. Rectal Ether and Olive Oil. Has many advantages over inhalation, e.g., | ease of administration, absence of apprehension in patient, and of coughing, retching, and straining, reduction of shock, and absence of post-operative vomiting.—R. D. Laurie, B.M.J. ik/2 5,1123. Chloretone 0-3 to 1-5 Gm. is given per rectum and after 4 hour Morphine and Atropine hypodermically. Twenty minutes later, Oil-Ether in proportion of 3 of Ether to 1 of oil (but this may be varied) is run into the colon slowly by catheter and funnel, one minute being allowed for each 30 Cc. The amount used is approximately 3 Cc. per kilo body weight. Should never exceed 250 Cc. Eor head and neck operations.—A. E. Boyd, Dublin J. Med. Sci., May ’20, p. 121, per Pres., Eeb. ’21,37. Safest and most effective method for relief of pains of childbirth, over a period, of hours, so far devised. Greater applicability than Scopolamine amnesia, and does not require trained anaesthetist. Quinine an essential ingredient. Uterine inertia the only contraindication. The woman must be in active labour.—J. R. Harrar, Am. Jl. Med. Sci., per Jl. A.M.A. ii./25,1160. Mixtures of.equal volumes of Ether and Oil are the most suitable. Wash bowel immediately after operation and remove residual mixture. Smear Vaseline on buttocks and thighs to avoid irritation from escaping Ether. Chief among.the disadvantages is that depth of ansesthesia is not under such control as with inhalation : this may mean death to the patient. It causes irritation of the intestines, leading sometimes to severe and even fatal haemorrhage. Must not be used in room with open flame. Evidence is not convincing that the use of 2 to 6 Cc. Gwathmey’s 50% [Magnesium Sulphate v. jpostea materially lessened the amount of Ether required, but the action of Morphine on the respiratory centre is synergistic with the Ether and Magnesium Sulphate and numerous deaths have resulted from their combined use. Synergistic analgesia in childbirth is by no means safe in the hands of the unskilled. No method is suitable for universal use. The Gwathmey method mitigates the pains of labour, but no woman should be promised a painless labour. Should be used only in selected cases and by skilled anaesthetists.— R. A. Hatcher, Am. Med. Assn., Jl. A.M.A. ik/27,2114-2117 ; 2189-2193; 2258-2263. In a series of 5,000 anaesthesias slight diarrhoea occurred in only 6 cases, and no deaths. (The retention enema now appears to consist of a 2 to 1 Ether- OH mixture, with the addition of 2 drachms Paraldehyde.) A full description of technique is given. Has wider limits of safety than any nhalation method. Any pathologic condition of the bowel a contraindication.—J. T. Gwathmey, Jl. A.M.A. ik/29,447-452. Safe and easily controlled, to use in all bad surgical risks. Leaves minimum 3f bad effects after onerations lasting many hours.—W. Wood, B.M.J. ih/29, 1156. The following formula is good. Magnesium Sulphate 2 oz., Glucose 1£ oz., Dlive Oil 1 oz., Acacia 54 dr., Ether 4 oz., Paraldehyde 4 dr., Morphine Sulphate i gr., Water to 12| oz. Rub the Acacia with Olive Oil in a dry mortar, lissolve the Magnesium Sulphate and Glucose in Water 7 oz., and add 1 oz. ff this solution to the Acacia and Olive Oil, gradually adding the remainder, transfer to a bottle and add the Morphine Sulphate dissolved in water. Dissolve the Paraldehyde in the Ether and add gradually to the rest. Make up to 1.24 oz„ It is not safe to use after 36 hours. Cork securely and keep in cool fface. Introduce solution high up into bowel, preferably in a dark room : ntroduction takes 20 minutes. Ansesthesia usually occurs in 10 to 20 minutes, deal for operations on head and neck, No toxic after-effects or vomiting; absolutely safe and lias no after-effects on bowel. Wash out bowel when patient returns to ward.—B. Hughes, B.M.J. i./29,897. Synergistic Method of Painless Childbirth (Rectal Ether Analgesia)—Gwathmey and others. This method depends on the supposed synergistic action of Magnesium Sulphate and Ether, much smaller doses of both being necessary then when either is used alone. In obstetrics, when the os will admit three fingers, 0-006 Gm. (1/10 grain) Morphine in 2 Cc. of a 50% solution of Magnesium Sulphate is injected intramuscularly. The inj ection is repeated in two or three hours if the pain is not relieved. At the same time, an Enema composed of Ether 70 parts, Alcohol 8, Quinine Hydrobromide 0-6, and Olive Oil to 120 parts, is administered. Sometimes a mixture of Ether 90 and Chloroform 10 is used instead of Ether alone. Forty-seven patients had painless labours ; 13 were fairly free from pain; while 7 failures were due to giving the drug too early in labour. The failures emphasised the short duration of anaesthesia—4 to 5 hours. No bad effects were noted on either mother or child.—Adler, ‘ Anaesthesia in Obstetrics and Gynaecology,’ Wien. Med. W^och., ’26, May 8. The following are modifications :— Preliminary high soap-suds enema followed by rectal irrigation of tepid water until return is absolutely clear. Patient placed in quiet room, eyes covered and ears closed with cotton. When os will admit 24 or 3 fingers, with contractions at C to 7 minutes interval, of duration of 10—12 seconds, inject 2 Cc. 50% solution Magnesium Sulphate, combined with £ grain Morphine Sulphate intramuscularly, injection being given during one of the uterine contractions. If no effect within 20 minutes, repeat Magnesium Sulphate injection without Morphine. After the slight drowsiness, patient receives retention Enema of 20 grains Quinine Alkaloid, Alcohol 45 minims, Ether 2} ounces, and Olive Oil to 4 ounces. Lubricate rectum and anal region, and warm mixture, which should take 10—15 minutes to empty. Rectal tube must not be inserted during uterine contraction. Patient becomes drowsy, and must not be disturbed for 2 or 3 hours, but should be carefully watched, as precipitate delivery often occurs. If no analgesia follows enema, a third injection of Magnesium Sulphate may be given an hour after. Effect of procedure lasts about 4 hours, and if patient is not then ready for delivery the whole treatment may be repeated, leaving out the Morphine.—D. Deutschman, M.J. & R., Oct. 6, ’26,421—425. From a further account, with approximately identical formula as the last-mentioned for the enema, we take the following : A second or even third instillation (enema) may he given at intervals of 3 hours or more, but only 10 grains Quinine Alkaloid is used in these instillations, which are accompanied each time by a further intramuscular injection of 2 Cc. 50% Magnesium Sulphate solution. Great relief is given in 85% of cases and more or less relief in 10%. It is not claimed to give painless childbirth, but gives relief in the agonising part of the ordeal. No ill-results to mother or child. 5,800 cases treated with satisfactory results.—J. A. Harrar, Am. Jl. Obstet. & Gvnec., April. ’27,486—491. A paper to prove that Gwathmey’s contention that synergism takes place between Magnesium Sulphate and Morphine is erroneous, and that no satisfactory evidence has been brought forward to show that this synergism does occur in man. The results of dog experiments are produced in support of the argument.—H. Beckman, Jl. A.M.A. ii./25.332 —336. Gwathmey replies and produces extensive clinical evidence to prove that this synergism does occur in man—ibid, ii./25,1482. 0‘25 Gm, per kilo the minima.! effective dose causing depressant action. Addition of Magnesium Sulphate to colonic anaesthesia mixtures and its use in obstetric analgesia in the dosage now advised would therefore seem of no value.—I. Neuwirth and G. B. Wallace, Jl. Ph. & Exp. Ther., Eeb., ’29,170. On the one hand Gwathmey says Quinine is an essential stimulant to the uterus in his system of analgesia. The Quinine is given into the colon. But Bourne says it has no effect- on results of 2 cases. Balance in favour of Gwathmey's experience— 20,000 cases.—A. H. Skinner, B.M.J. ii./3o,621. Analgesia and anaesthesia in childbirth.—Discussion of Chloral Hydrate per os and per rectum, Opium, Twilight Sleep, and Adalin. Morphine, 1/6 to i grain, in 50% Magnesium Sulphate Solution injected into the buttock has prolonged effect. The plain Magnesium Sulphate can be repeated without the Morphine, and the sedative effect is prolonged. With such an ideal sedative, why try others ? The effect of the Morphine on the foetus is said to be fatal in some cases (Browne). Similar remarks apply to Twilight Sleep. As to anaesthetics, Chloroform, Ether, Nitrous Oxide, Ethylene, local and spinal, are reviewed.—A. Louise Mcllroy, B.M.J. ii./3o,549. Morphine Sulphate Sterules £ and 1/6 grain, in 1 Cc. 50% Magnesium Sulphate Solution, also of the plain Magnesium Sulphate Solution I Cc. are prepared. Benefit derived from Gwathmey’s method in 97% of cases. Bectal Ether 30% more efficient than ‘ Twilight Sleep * and without danger to the infant.— O’Donel Browne, L. i./31,643. Discussion.—ibid. Ether Vapour per rectum has been employed and found to answer admirably for operations about the mouth, nose and post-buccal cavities. D. W. Buxton’s apparatus consists of an Ether receiver holding 2 or 3 ounces and surrounded by a vessel containing wrater kept at 120° E. The vapour is conveyed to the rectum by a tube which has a glass intercepting drip chamber to prevent the passage of any liquid Ether which would be liable to cause dangerous results.—D. W. Buxton’s “ Anaesthetics,” 6th Edition. See also B.M.J.E. i./i5,46. Oral Administration for Anaesthesia.—Ether 50% in Liquid Paraffin 1 to 2 ounces effectual in 90 seconds—probably the safest general anaesthetic and not followed by nausea. A little anaesthetic by inhalation may be wanted in addition. The dose may be sandwiched between mouthfuls of Port Wine. Useful for dressing wounds.—J. T. Gwathmey and H. T. Karsner.—B.M.J. i. /i 8,254. Application of Ether to Wounds employed in such inflammatory affections as peritonitis, periostitis, etc. Ether compresses considerably relieve the congestion.—M.P.C. ii./ii,377. Wounds have been swabbed out thoroughly with Ether (without watery solution beforehand).—B.M.J. i./i5,393, also irrigated with 2% of Ether in lukewarm water with benefit.—A. Distaso and T. It. Bowen, B.M.J. i./i7,259. Infected wounds treated with Ether as antiseptic dressing. There vas no sign of infection throughout the process nor rise of temperature.-—B.M.J.E. ii. /15,41. Also by the Carrel-Dakin method of irrigation but it is costly and causes intense cold.—B.M.J. ii./i7,598. Bronchitis (post-operative). Intramuscular injection of 0-5 Cc. Ether, in 05 Cc. Olive Oil, with the addition of a local anaesthetic gave good results One such injection daily, recommended in every, case of acute or chronic bronchitis without emphysema.-—per Jl. A.M.A. iL/25,157. , Otitis Media, suppurative, treated by Ether which is run into the affected ear and allowed to evaporate. In the cases not relieved chronic mastoiditis was revealed by X-rays.—Med. Jl. & Bee., Apl., ’26,503, per Pres., Feb., 27,64 . Ether is used as a menstruum and vehicle for skin medication, on account of solvent action on sebaceous secretion. Ethereal Tinctures and Solutions of Belladonna, Capsicum, and Menthol are prepared. Preparations. Paries of Ether, 3 minims in each. Dose.—1 to 4. Spiritus Etheris (B.P. ’14). Ether 1, Alcohol (90%) 2. Dose.—60 to 90 minims (4 to 6 Cc.), or 20 to 40 minims (1*2 to 2-5 Cc.), repeated. The older formula is occasionally prescribed, viz. :— Spiritus etheris Ccmpcsitus (B.P. ’98). Syn. Hoffmann’s Anodyne, Liquor Hoffmanni, but the simple Spirit of Ether is now called Hoffmann’s Anodyne abroad. PjBeig- IV hasi Ether 468, Alcohol (94%) 532. P. Ital. V. Ether 1, Alcohol (95%) 1. F.E. VIII. Ether 4, Alcohol (90%) 1. Mistura Etheris cum Ammonia (Martindale). Dose.—1 to 2 ounces. bpmt of Ether 3, Aromatic Spirit of Ammonia 3, Water to 48. St. Th. H. terms this Patent ; with 1 grain of Camphor to the ounce ‘ Camphorated I atent A rapid stimulant. Gt. Orm. H. has Spirit of Ether 3* minims, Aromatic Spirit of Ammonia 3£ minims, Tincture of Orange 2 minims, Chloroform \V ater to 1 drachm. Suitable for a child one year old. ®Lotto iEtheris Composita. Caution : Inflammable. Hoffmann’s Anodyne 250, Ammonia Solution 4, Distilled Water 25, Pilocarpine Hydrochloride J ; Spirit of Lavender 25. For hair falling off, applied with friction, after washing with soap. Spiritus etheris Nitrosi {B.P. ’14). Dose.’—15 to 60 minims (l to 4 Cc.). An alcoholic solution containing ethyl nitrite (1-52 to 2-66% by weight), aldehyde and other substances. For the Decomposition and Volatilisation of this preparation on storage, see r CJ V • / i 4 Uses,—Antipyretic, diaphoretic, diuretic, and stimulant. Believes the spasm and pain of asthma, dysmenorrhoea, angina pectoris ; also the pain of the passage of renal calculi and gall stones. Spiritus AEthylis Nitritis. U.S. requires 3*5 to 4-5% ethyl nitrite. Incompatible with Potassium Iodide (c/. Vol. II.), also with Phenazone unless previously neutralised with Sodium Bicarbonate; also incompatible with Salicylates and Ferrous Sulphate. Ethyl Nitrite is the active ingredient; the other ingredients (Aldehyde, Ethyl Nitrate, Alcohol) play a subordinate part and of little practical importance. As there is a rapid loss of Ethyl Nitrite on mixing with water, it is best prescribed as such to be diluted just before use.—C. R. Marshall and E. Gilchrist, B.M.J. ii./i5,125. Any loss of strength in this is generally due to volatilisation of the Ethyl A itrite alone. Only direct sunlight has any effect in inducing decomposition, and this can be prevented by storing in amber bottles with greased stoppers. —R. Wright, P.J. i./26,256. It i3 stated that it does not affect the kidneys nor the sweat glands ; it is neither diuretic nor diaphoretic.—P.J, ii./io,298. Liquor Ethyl Nitritis. Solution of Ethyl Nitrite. {B.P. ’14). Dose.—15 to 60 minims (1 to 4 Cc,). Should be directed to be added to a small quantity of water at the time of taking. A mixture of Absolute Alcohol 95 and Glycerin 5, containing in 100 parts by volume, 3 parts, or not less than 24 parts by weight of Ethyl Nitrite (obtained by the interaction of alcohol, sodium nitrite, and diluted sulphuric acid, at a low temperature). Store in small bottles. Sp. Gr. 0*823 to 0*826. It keeps better than the Spirit. The circulation is distinctly affected by a fraction of a minim, yet large quantities do not cause death.—Leech. iEther Aceticus. Acetic Ether. (B.P. ’14)—Consists principally of Ethyl Acetate. CH3.COO.C2H5=88 0624. Fr. Cx. Dose.—45 to 60 minims (3 to 4 Cc.) or 15 to 30 minims (1 to 2 Cc.) repeated, Sp. Gr. 0*900 to 0*907. Not less than 90% pure. Boils between 165° and 172° F. (73*9° and 77*8° C.). Was used in preparing Liquor Epispasticus, and is inhaled for laryngeal catarrh, ! drachm to the pint of warm water. Soluble in all strengths in Alcohol and Ether, and about 1 in 11 of water. Dimethyl Ether. CH3.O.CH3 = 46-0478. A gas at n.t.p. Boils at 24° C. and at 100° C. exerts a pressure of 97 lbs. to the square inch. It can be safely compressed into cylinders. The gas condenses into a thin mobile liquid, with slightly ethereal, pleasant odour. Used as an anaesthetic.—L. ii,/23,1302. /ETHYL CHLORIDUM. Ethyl Chloridum (B.P. ’14), P.G. VI., U.S. X. C2H5C1=64*496. Syn. Chloryl Anesthetic, ^Ethanoli Chloridum, P. Belg. IV ^Kelene (T.M. 414307), Dose.—A good average for an adult by inhaler is 5 Cc. Using a Rendle’s mask—by the ‘ open ’ method which is thought preferable to one involving the breathing and rebreathing from a closed bag of vitiated air, 7 to 8 Cc. are advised as adult dose, 5 Cc. for children of 7 to 12 years. Cyanosis and subsequent discomfort is certainly less. The anesthesia may be prolonged by removing the mask and spraying more on the sponge. jySaruffactured by the action of hydrochloric acid on absolute ethyl alcohol. If made {B.P. T4) from Industrial Methylated Spirit will contain a small amount of Methyl Chloride. Tested {B.P. '14) to contain 99-5% Esters calculated as C2H6C1. At ordinary temperatures this is gaseous, but condenses into a colourless mobile liquid with a sweetish burning taste. Slightly soluble in water, readily in alcohol. Sp. Gr. 0*920 to 0*960 (U.S. about 0*921) at 0° C. (B.P. ’14). On account of its low boiling point (about 50° F.) and the intense cold produced by evaporation, it is useful as a local anaesthetic in minor surgery, also for neuralgia. The part should be washed with soap and then with alcohol or ether before applying. In dental cases the patient is instructed to breathe through the nose during operation, the part is well dried, and other parts protected. Its vapour is inflammable. For inducing general anaesthesia, it is described as pleasant; is taken readily by children and adults, with few or no after effects. Probably within the limits for which it is intended it is safer than any other anaesthetic excepting nitrous oxide. It has the advantage of requiring no complicated apparatus. A closed mask must not be used. It is quicker in action than ether. To prolong the anaesthesia induced by ethyl chloride, chloroform has been advised as best. Ethyl Chloride (and Ethyl Bromide) are said to stimulate the heart, not to depress it as chloroform does. Open Ethyl Chloride a very convenient method of induction—portable, easy to patient, rapid in action, and safer than Chloroform. Useful for enucleation of tonsils, circumcision, and other minor operations, as also for major operations—J. Ross Mackenzie, L. i./2?,165. Bulbs for general anaesthesia (large spray) contain 3, 5, 7, and 50 Cc. Tubes for local use 10, 15, 30 and 50 Cc. with screw or auto- stopper. Bottles for local or general anaesthesia 60 and 100 Cc. These 60 Cc. b >ttles are the most convenient for use. Metal Cylinders contain 55 Gm., 110 Gm., 1000 Gm. Instructions for treatment if dangerous symptoms arise in administration— Ethyl Chloride or Somnoform.—See that the airway is clear and the clothing loose, and begin artificial respiration at once. Weak ammonia vapour may be held to the nostrils. Hot flannels should be placed over the heart, and chest smacked with a towel wetted in cold water. Artificial respiration must be kept up for at least an hour. The patient must be kept warm. For R.D.H. method "proceed as under Chloroform. For tonsils and adenoids Ethyl Chloride is as safe as Ether. No death from it recorded.—C. B. Dale, B.M.J. ii./19,616; G. A. H. Barton and others, ibid, 690 ; L.B.C. Trotter entirely disagrees, ibid ; ‘ not very safe.’—D. W. Buxton, ibid. 725. Skin frozen around area of operation—little pain.—Pres., Jan., ’23,6. Dental Extractions under Ethyl Chloride at Gt. Ormond St. Hospital for Sick Children found satisfactory. Closed method with a bag invented by Dr. Loosely is used. 60 to 180 seconds’ surgical anaesthesia.—H. Sington, B.M.J. i./3o,217. Ringworm well treated by Ethyl Chloride after washing with Sodium Bicarbonate and Spirit of Ether.—L. i./i4,242. Patients to attend six mornings a week for at least two weeks. Useful and reliable.—M. W. Geffem B.M.J. i./22,267. Warts have been treated with Ethyl Chloride—one application is sufficient if small, and for large warts at intervals of a week. Ethyl Chloride with Eau de Cologne is available. The addition is thought to minimise post-narcosis effects. 3^Dridustsol (T.M. 384131) solutions in Ethyl Chloride of various medicaments, e.g., Amyl Salicylate, Ethyl Salicylate, Methyl Salicylate aa. 2%, [SMlUocaine 1%, Menthol 5%, Benzoic Acid 2%, Salicylic Acid 2%, Cresol 2%, Formaldehyde 1%, Guaiacol 2%, Iodine 3%, Iodoform 2%, Naphthol 2%, Phenol 2%, Resorcin 2%, Picric Acid 2%, Mercuric Oleate 1%, for spraying for antirheumatic, anaesthetic, and antineuralgic effect, for use in skin affections, and Pyridine 2% for inhalation. The spray is used at not less than 65° F. (18° C.) at a distance of 2 feet and deposits the medicament in a fine dry adherent powder or coating on the skin. Somnoform is said to be a mixture of Ethyl Chloride 60%, Methyl Chloride 35%. and Ethyl Bromide 5%. 60 Gm. glass tubes with “ valve stopper ” for i nhaiation as an anaesthetic in dentistry. Glass Capsules contain 3"and 5 Cc. If dangerous symptoms arise in administering proceed as directed under ethyl chloride. Respiration must be watched carefully. METHYL IODIDUM. Ethyl Iodide—Syn. Hydriodic Ether. C2H6I=155*971. May be obtained by distilling a mixture of alcohol, iodine, and phosphorus. A colourless liquid (but liable to become coloured by setting free iodine). Of a penetrating odour ; boils at 148° F., has Sp. Gr. 1-94 ; is not inflammable. Soluble 1 in 400 of water, and miscible with alcohol and ether in all proportions. jjses.—It is useful inhaled as an anaesthetic to relieve the dyspnoea of bronchitis. As it contains four-fifths of its weight of iodine, it forms a rapid means of saturating the system with this element; iodine can be detected in the urine 10 minutes after inhalation, and as long as 30 hours after ; it neither impairs appetite nor weakens In bronchial catarrh it induces sleep and promotes expectoration when inhaled. It is useful for inhalation in cedema of the glottis from catarrhal laryngitis. It acts as an antispasmodic in angina pectoris, spasmodic asthma and certain forms of nervous dyspnoea. Internally Ethyl Iodide is found useful in bronchitis, asthma, rheumatism, and for secondary syphilis. , Externally 10 to 20% ointment with paraffin basis may be used (stronger may blister). . . . .... , u General iodization may be produced by painting the iodide on the calf of the leg or between the shoulders, and covering with lmper- meabb dressing. The system may be saturated ™th Iodine m this way.—'Whitla. In angina pectoris, inhalation of Ethyl Iodide useful, action thought to be due to liberation of free iodine which is rapidly absorbed by the blood. Yeo. !V1ec3.c2iigmesnent of Heart Efficiency* Tp when only minute amounts of Ethyl Iodide are contained m the air th?amount of°vaocm?can be determined by the use of Iodine Pentoxide to liberate Iodine. Ethyl Iodide is decomposed in the tissues, presumably into n u;11rn Tnrlulp nnd 41cohol The volume of circulation is determined oy tne quince? inhalin?a mixture of a few drops of Ethyl Iodide in 100 litres of air, thf?expiredair>paS?gtSough a mixing ch^bOT. .^samgl6 of ^^eolar air miiprtprl This and equal volumes of the inspired ana expueu an ru - assayed The circulation is found by the formula : Volume of air breathcd nor rninnte is multiplied by the difference m the amount of Ethyl Iodide in the S”pheVa“pked ah, and is divided by twice the —t ‘ound ,n thMYCVo\1crAT™s 0, the*SEtfN treated by’Ethyi l^dM&on* ' A lar“e Sunt of Iodine enters the blood stream and only a small amount is returned'in the venous blood, hence the tissues are exposed to larg® • Inhale 1 0c. in about 20 minutes. An apparatus is mentioned for•cornioiling ouantity. Fungus cured. Should be tried in asthma, hjputem , * - tertiary syphilis.—B.M.J.E. h/30,62. ^Encase cTfn^cotton*wool and rayon, containing 5 minims m each. The sterule is snapped, the fluid is absorbed by t¥ cove^f ’^ inhaled for four or five minutes for spasmodic affections. This may be repeated three or four times a day. The patient requires no assistance, and can take one of the sterules from the bedside, m the dain wh“g-rcyough they have been found useful-the coughing fits are rapidly reduced. . . _ * (©Ethyl Iodide and Chloroform Sterules contain o minims oi Ethyl Iodide and 10 minims of Chloroform, and are of the greatest service in the relief of asthma and whooping-cough. Ywttwl Indide Chloroform and Menthol Sterules as the last J5SZS. SM.n.h” 8..in 1» .« .1~ m«i, I<* » in bronchial affections. Compound Ethyl Iodide Capsules L.H. contain these ingredients but £ grain only of Menthol. Methyl Iodide. CH3I= 141*9554. A colourless liquid (when first made) boiling at 44° C. Sp. Gr. 2*285. As a vesicant is even more powerful than Cantharides. Blisters may be produced in a few hours by rubbing in 15 to 20 drops. ALCOHOL iETHYLICUM. C2H5OH=46*0468. Together with notes on Allyl, Amyl and Methyl Alcohols. Alcohol Absolution (B.P. ’14). u.s., Eh. Cx., P.G. VI. Syn. Ethylic Alcohol, B.P. 1885. Ethyl hydroxide, with not more than 1% by weight of water. Sp. Gr. 0*794 to 0*7969 representing 99*95% by volume and by weight to 99*4% by volume or 99% by weight. Fr. Cx.—Sp. Gr. must not exceed 0*79683 at 15° C. Ph. Ned. V. allows 2% Water. Dehydration with Glycerin, one part to three of Alcohol, with subsequent distillation, is a rapid method of dehydrating, better than Calcium Oxide, Alcohol 89-5% being easily recovered. Alcohol (90% fey VO 1.)—{B.P. ’14). Syn. Spiritus Rectificalus. SriRITUS VlNI. P. Austr. ‘ SPIRITUS,’ Ph. Ned. V. Contains 90% by volume, or 85*6S% by weight, of Ethyl Hydroxide Sp. Gr. 0*8337. Strength 57*S0° O.P. (he., 100 volumes contain the same quantity approximately of Ethyl Hydroxide as 157*8 volumes of proof spirit). It is generally manufactured commercially of higher alcoholic strength, he., about 70° O.P., Sp. Gr. 0*809, containing nearly 95% by weight of Ethyl Hydroxide, and is diluted as required. 4 Alcohol,’ U.S. X. has Sp. Gr. 0*816 at 15*56° C. (0*809 at 25° C.). and contains 94*9% by volume (92*3% by weight) of Ethyl Hydroxide. Alcool Ordinaire (officinal) Fr. Cx. has Sp. Gr. 0*81602 at 15° C., and contains approx. 95% by volume (92*43 by weight). P. Belg. IV. is 94*09% by vol., F.E. VIII. 95% by vol. as P. Off. Spiritus Rectificatissimus, P. Ital. V. is 94—96% by vol. For various pharmaceutical purposes dilutions containing 70, 60, 45, and 20% by volume of Ethyl Hydroxide are convenient. For Alcohol Dilution Tables see Vol. IT. Alcohol Dilutum, U.S. 41*5% Absolute Alcohol by weight (48*9% by volume). Note.—U.S. X. orders on occasion a mixture of ‘ Alcohol ’ (94*9% by vol.) 3 parts and water 1 part as menstruum in making Tinctures and Fluid-extracts. This is approximately equivalent to 70% by volume. Spiritus Tenuior, Proof Spirit. B.P. 1885, contained 57% Ethyl Hydroxide by volume=49% by weight. Sp. Gr. 0*920. Prepared by mixing 5 volumes rectified spirit, Sp. Gr. 0*838, with 3 volumes of distilled water, the contraction being about 2*5%. The greatest contraction occurs when quantities are in the proportion of 3 molecules of water and 1 of alcohol. ,, . The addition of 100 to the number of degrees k overprooi gives the number of proof gallons, thus 100 gallons of 56 o.p. spirit - 156 proof gallons. immature Spirits (Restriction) Act, IBIS, 1. (a) No British or foreign Spirits shall be delivered for home consumption unless they have been warehoused for at least 3 yeais . Provided that—(6) This restriction shall not apply (i.) to spirits delivered to a licensed rectifier, to a manufacturing chemist, or to a manufacturer of perfumes or to other persons licensed by Customs & Excise (ii.) to spirits delivered for scientific purposes. 2. Nothing in this section of the Act shall interfere with the : supply of Rectified Spirits of Wine for the purpose of making medi- i cines to registered medical practitioners, to hospitals and to person^ I and firms and bodies Corporate entitled to carry on the business of Chemist and Druggist. Duty and Rehate to Chemists. The following table shows the alterations in Excise duty on spirit since 1908. , . In April, 1909 the duty was increased to 14/9 per Pf. gallon (from^ll^h In May, 1915 ,, ,, >> In April, 1918 In May, 1919 In April, 1920 16/3 31/6 51/6 74/— an increase of 1/6 over 14/9. an increase of 16/9 over 14/9. an increase of 36/9 over 14/9. an increase of 59/3 over 14/9. At the time of going to press (i932) with this edition there has been no further change. A Re hate of the various increases shown above as charged by the Excise authorities over the old 1909 duty of 14/9 is allow e to duly qualified Medical Practitioners, duly registered Pharmaceutical Chemists and Chemists and Druggists on all Duty-paid spirit used by them in preparations recognised as medicines by the Customs and Excise authorities. Rebate is also allowed on Rectified bpirits used for scientific research purposes approved by the Commissioners. The Rebate is not allowed on Tincture of Orange, Spirit oi Peppermint, Mouth washes and the like. A complete record of spin us^ must be kept, and claims for rebate must be made to the local Customs and Excise authorities within 3 months of use. A minimum period to claim for is one month. The present increase of 59/3 per proof gallon over the old 1909 duty of. 14/9 is equivalent o o3. per bulk gallon of S.V.R. 90%> 58 °/p. A Stock Book has to he kept for obtaining rebate (a 0^ issued by Messrs. Fletcher, Fletcher & bo., Holloway), showing 11 quantity, strength and proof quality of each consignor P and the details of use. A Spirit Re'oate Book, containing Records of ^mts received a.nd used and notes for making claims is issued by the Retail Pharmacists union, , Queen Square, London, W .C. 1. E. C. J. Bird issued a set of Tables (C.D. Dec. 27, ’19) for making the claims for repayment in question. Claims must be expressed in “ proof ” gallons to the second place of decimals. The following taken from the paper are useful:— Proof Spirit Conversion Factors. Metric Measure. To express Litres to Gallons—multiply by 0-2199. Litres of 90% Alcohol B.P. in Proof Gallons 70% 60% 46% ,, ,, >> 20% Imperial Measure. Gallons 90 % Alcohol B.P. in Proof Gallons 70% 99 9 9 9 9 9 9 99 9 j Pints 99 9 9 99 99 Ounces 9 9 9 9 99 Drachms 3 9 99 9 9 99 60% 45% 20% 90% 70% 60% 45% 20% 90% 70% 60% 45% 20% 90% 70% 60% 45% 20% 9 9 9 9 99 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 99 99 9 9 9 9 9 9 9 9 99 9 9 9 9 99 99 9 9 9 9 9 9 9 9 9 9 9 9 99 9 9 9 9 99 99 9 9 9 9 9 9 9 9 *9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 99 9 9 9 9 Multiply by 99 9 9 99 99 Multiply by 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 7 9 9 9 9 9 9 9 7 0-3471 0-2697 0-2312 0-1733 0-0767 1-5779 1-2263 1-051 0-7877 0-3487 0-1972 0-1533 0-1314 0-0984 0-0436 0-00986 0-00766 0-00656 0-00492 0-00218 0-001233 0-000958 0-000S2 0-000615 0-000272 Quantity of Spirits which may be sold by a Chemist without Licence. In view of the Immature Spirits (Restrictions) Act, 1915, the Commissioners of Customs and Excise reduced the quantity of duty-paid Spirits of Wine (including Absolute Alcohol), which may be sold without a licence, to 5 ounces fluid. Strict inquiries should be made by the pharmacist as to requirements.— P.J.i./22,505. EXPORT OF TINCTURES ON DRAWBACK. (IMPERIAL AND FOREIGN.) Tinctures (includes medicinal spirits, flavouring essences, perfumed spirits, toilet vinegars and waters, dentifrices, hair washes and brilliantines) may be exported on drawback as merchandise, shipped or deposited in warehouse for use as ship’s stores, and by Foreign and Imperial Parcels Post, direct from the premises of a person licensed to rectify or compound spirits (Licence, £15 15s. per annum). Spirits of Wine (includes ‘ Absolute Alcohol,’ Ethyl Hydrate and Ethyl Hydroxide) may also be exported as above. Quantities which may be removed :— (a) Rot less than 2 bulk gallons of medicinal spirits and flavouring essences: Rot less than 4 bulk gallon of perfumed spirits (includes toilet water, hair washes, etc.): Rot less than 2 bulk gallons of Spirits of Wine. (b) If by Parcel Post.—Each parcel not less than 0-125 bu k gallon, but not less than a total of 2 gallons packed for export in one day. Smaller quantities than the above may, on special application, be allowed by the local Surveyor, or by the Board, in special circumstances. Shipping Bills to be filled up by exporter and presented to the local Customs and Excise Offlcer, who will examine and check all goods for export and seal the parcels or cases containing same. General References toTreatment, etc., with Alcohol Physiologically t is narcotic and antipyretic, not stimulant.. H ounces of pure alcohol is all that can be utilised as a food m the h'ainan body per diem = 3 ounces of brandy and whisky 7 ounces sherry o champagne, claret and white wines. . . . . -n Even in smal quantities is injurious to the proper working of the brain (VI?°£a™urS of Alcohol in moderation. The ‘ power of unlocking energy exerted by Alcohol ’ is one of tne themes.—Charles Merf^»Jd*“'(^llTord 90% of the crime of this country depends upon irrtemperance Loru Alverstone, L. i./is,197. See also ibid. j.3£>1,150o , B.M.J. l , Sweden’s Gothenburg System, ii./i3,1107- . vaTimN +rn(rpc. Fatigue and alcohol. Be view of labour conditions m various trader. Effects of alcohol worse than useless.—A. F. S^Kent, .L. «•/* Champagne injections in Surgical Shock, iransfer contents of a small bottle (about 400 Gm.) into an ordinary 500 Gm. serum bottle andmdd formal Saline 100 Cc. Inject subcutaneously m the normal manner and“ six hours if necessary. If a prompt evacuation oi: the bowels “ give an injection of Pituitary Extract and if necessary repeat m three hours. Valuable in certain cases of pneumonia, influenza, etc. h. i./13,1410. Alcohol Injection in Neuralgia. v.PPT1 treated bv Intractable trigeminal neuralgia or ^9, dojjlonrenx has.been.Vgp £ ^ Alcohol injections (80% usually employed) around the s^Faorbitai notcrp 112 cases. Give Hyoscine 1/150 gram and Morphine> * gram_20 ^mute3 m advance. Prior to the Alcohol a few drops of 3, 4 Encam^to assist m locating the nerve trunks.—Wilfred Harris, L. 1./ 3,8 > •/ » " foramen »—s_> anSinwm not returnfJthe majority of cases « “^flnM^inmcattd Si- distribution of the fifth nerve persists for a month. Definitely indicat patients who have Radium treatmentfor cancer-ofthe indication being carcinoma of the maxillae or of t 8 •■ . d_y ^ j £ usually gives permanent relief, if enough Alcohol is injected, c.ivt.o a. ‘ 'Trigeminal neuralgia. Hartel Injection route, using Alcohol into the region of the Gasserian ganglion.—L. Moms, h. iections into of p Bucaine Hydrochloride per ounce and gencraI inflammatory ss2|SsastK:::r;::: by means of a layer of absorbent cotton compress of cold water with The^aterts^eTCwed°hourl>a the alcohol is left 8TnraS"™oTioN|, especially and angio-neurotic oedema, alcohol has been appiiea ro i is often useful. inicctins 1*5 Cc. of absolute alcohol on PROLAPSE OE Rectum treated by u«e<A^t0 24. inChes.-L. Findlay each side or into the pen-rectal tissue at a deptn oi&w „ and J. B. Douglas Galbraith, L. 1./23, • , , . f]ie qjfrestive process Alcohol as a Food. movements and promoting absorption by increasing the activity oj the gas o increases the rapidity of (r/. our Pepsin experiments, i 0.. absorption of potassium iodide. Neither the intake of oxvgen nor the output of carbonic acid gas is altered by alcohol, therefore as it has been oxidised in the body it saves tissue and is a food.—Hale White. Wines may actually render digestion quicker and easier than it otherwise would be. This, indeed, is one of their most useful actions both in health and disease.—Hutchison. So long as the amount of Alcohol in the body can be oxidised and destroyed by the tissues (about 0T85 Cc. per kilo body weight per hour) it acts as a food. When this amount is exceeded, it exerts a specific effect on the central nervous system, inducing toxic effects. An excess, however, of any food substance in the blood may induce toxic effects, e.g., sugar, in time, may cause fatty degeneration of the tissues. The value of Alcohol as a food in disease is determined by its very rapid absorption under circumstances when ordinary foods are only absorbed with difficulty.—Dixon, p. 49. Alcoholic neuritis, formerly common in this country, is now comparatively rare. Alcohol is rapidly absorbed from the stomach and small intestines in from | to 2 hours and undergoes no change in the process. It passes direct into the blood stream, and therefore the amount circulating in the blood varies according to quantity taken. Only a small proportion is excreted as such by the kidneys and lungs—about 2% and never more than 10%. The rest is eliminated as water and Carbon Dioxide. 10 Cc. of Alcohol is oxidised in an hour.—T. Grainger Stewart, B.M.J. ii./25,461. Action of Alcohol on the human economy. Given therapeutically it must be well diluted. In diabetes it ought to be diluted down to 5 or 6% strength and in small doses.—E. Mellanby, B.M.J. ii./22,195. Alcohol as a Drug of Addiction. Prohibition in other countries has led to other and worse addictions and industrial unrest.—W. E. Dixon, B.M.J. ii./2i,822. The murderers and cut-throats in Ireland, Russia and elsewhere are largely teetotallers. Present day unrest attributed to expensiveness of Alcohol. Would be sorry to see the moderate use of Alcohol abolished in this country. —Sir J. Barr, B.M.J. ii./22,199. Table showing proportion of accidents in Germany and Austria, as also convictions for assaults, drunkenness, etc., greater on the Monday than other- days. Prohibition in U.S.A. is increasing industrial efficiency.—E. L. Collis, B.M.J. ii./22,244. A recrudescence of Alcoholism in France, due to the substitution of Aniseed liquors for Absinthe, which was prohibited in 1922.—B.M.J. i./26,157. Venereal disease in relation to Alcohol. A predisposing factor.—-L. W. Harrison, L. ii./22,942. Prof. Starling holds, in moderation, it does not shorten life as compared with total abstinence.—L. ii./23,983. Alcohol and life duration.—R. Pearl, B.M.J. i./24,948. Alcohol for Burns.—Cleanse the burns with Alcohol (70%) under Chloroform anaesthesia. The whole surface of the burn and surrounding skin is rubbed vigorously with the dressing. Blisters are rubbed off with all dead tissue (better than using scissors and forceps). After cleansing, a dressing of sterile gauze wrung out of the Alcohol is applied, over this dry gauze and wool: repeat.—L. i./13,705. Spirit-Glycerin.—For wounds, Spirit and Glycerin alone or with antiseptics, e.g., Biniodide Spirit, Glycerin and Ichthyol, act like hypertonic saline in producing free discharge, and require frequent changing. Not so painful as Iodine.—A. Don, B.M.J. i./i6,648. General ancestkesia by Alcohol in Glucose solution. Two solutions are used : (a) Isotonic Glucose solution, (b) 30 Cc. of 96% Ethyl Alcohol in 70 Cc. of 25% Glucose solution. Intravenous dose is estimated according to patient’s weight at 2 to 3 Cc. of the 96% pure Alcohol per kilo but the maximum allowance is seldom exceeded. A few Cc. of the (a) is allowed to run in first.—J. D. Constantin, L. h/29,1247,1263: L. 1/30,1393. Intravenous injection of Ethyl Alcohol 33-3% in Ringer’s or Normal Saline. Animal experiments showed it to be without danger.—D. Thursz, L. i./3o,8Sl. References to Inebriety. Normal content of Alcohol in the human body.-—See Vol. II. “ Drunkenness often chooses for its victims not the men and women originally the worst, but persons of strong social susceptibility and open in special respects to temptation.”—Gladstone at Liverpool, 1893.—B.M.J. i./n,515. Habitual inebriety is an evidence of an unsound mind rather than a cause of it.—C.D. ii./13,1259. The majority of insane inebriates have become alcoholics because of congenital defects or tendency to insanity, not insane as a result of alcoholism. Alcohol, more of a coefficient than an actual cause of insanity—this is, however, disputed by others who say that Alcohol is the direct cause in a large proportion of cases.—B.M.J. i./n,1383. ! Pharmacology of Alcohol—best looked upon as a drug.—It. B. Wild, L. ii./i8,623. Ammonium Chloride in doses of 30—60 grains with copious draughts of water is a suitable antidote to alcohol. The administration of smaller doses may be continued. It prevents the effects of alcohol, sobers the patient quickly and is a valuable preventive against delirium tremens. See also Poisons and Antidotes. Test for Drunkenness.—The patient is made to inflate a bladder, e.g., a football rubber. The exhaled air obtained is passed through potassium bichromate solution, which changes from yellow to green according to the amount of alcohol. Has been used in U.S.A. The test is not infallible. Excretion of Alcohol in the urine as a guide to Alcoholic intoxication.— H. W. Southgate and G. Carter, B.M.J. i./26,463. Alcohol and the motorist. Alcohol concentration in the urine as test.— G. Carter, B.M.J. ii./27,333. Atropine-Strychnine, see Atropine. “Normyl Treatment,” Vol. II. Cocktail habit.—L. L/29.1207. Paralysis from drinking adulterated Ginger Wine m_ U.S.A. Apparently due to a Cresol-phosphoric Acid Ester.—B.M.J. ii./so,971. Spiritus Vini Gallici. Brandy. Contains 40 to 50% (or 60% in case of good Cognac) by volume of alcohol. Contains 0-6 to 1*2% Extractive, 0-3 to 0*8% sugar, 0*08% compound ethers and yields 0-01 to 0-02% ash. Spiritus Vini Vitis, U.S. X. 48 to 54% by vol. An ounce of brandy yields 100 calories of energy.—Hale White.— cf. Nutriment a. Spiritus Frumenti. Whisky prepared by distillation of fermented grain—barley, wheat, rye, Indian corn. Sp. Gr. is usually about 0-925, contains 37 to 47% by weight (44 to 45% by volume) of alcohol. U.S. X. ‘ From wholly or partly malted cereal grains and not less than four years old, 47—53% by vol.’ Whisky According to the findings of the Royal Commission on Whisky (1909), ts Whisky is a spirit obtained from distillation from a mash of cereal grain saccharified by the Diastase of IVialt.” This decision allowed the name Whisky to be applied to the patent-still spirit in addition to the old pot-still spirit. The strongest objection to patent-still spirit was its ‘ tameness ’ and lack of response to ageing, as a result of which many foreigners regard Whisky as plain Alcohol, and are astonished at the superior taste and aroma of matured Whisky. ‘ v eteran, Harper’s Wine and Spirit Gazette, Oct. 31, 1931. ... , , , Malt Whisky is made entirely from barley, a fine hard gram being selected. In patent distillation, Indian corn or maize, rye and bar lev, are ail employed, A Pure Malt Whisky is a mixture of heavy Highland Malts of 10 to 14 years* maturing and of lighter Malts of from 6 to 10 years* maturing. Spirits do not improve in bottle.. . For Amounts of Alcohol in various Wines and Spirits, see Vol. II. Eau de Paris. Syn. Spiritus Coloniensis. Oil of Bergamot 20, Oil of Lemon 20, Tincture of Musk (1 in 50 Ale. 45%) 5, Oil of Neroli 2, Oil of Cinnamon 1, Oil of Cloves 1, Oil of Bose 1, Alcohol (90%) .1,800, Distilled Water 150 (all by weight). Macerate for 8 days, and filter. Spiritus Myrciae, Bay Rum, U.S., 1890. Oil of Myrcia acris (Myrtacetr) 16, Oil of Orange Peel 1, Oil of Pimento 1, Alcohol (94%) 1,220. Mix, and add gradually Water to 2,000. After 8 days filter. Of considerable renown as a Hair Lotion. Another formula is:—Oil of Bay 5, Oil of Pimento 1, Oil of Orange 1, dissolved in Alcohol 400 then add West India Bum 200 and Water 400. Aqua Mellis, Honey Water. Yellow Sandal Wood, in shavings, 16, Alcohol (90%) 640. Macerate 7 days, and pour off the alcohol. Add to the marc, Concentrated Bose and Orange Flower Waters, of each 160, shake well, decant, and add to the alcohol set aside. To this mixture add English Oil of Lavender, Oil of Cloves, of each 2, Oil of Bergamot 1, Oil of Nutmeg, Oil of Sandal, of each &. Alcohol Allylicmn, CH2: CH.CH2.OH=58-0468. A colourless liquid miscible with water, with a pungent odour and burning taste. It inhibits bacterial growth. Investigation of Allyl Compounds, cf. Sinapis Chapter and Oleum Allii. Open chain derivatives containing unsaturated carbon atoms are more toxic than isomeric saturated bodies. Thus Allyl Alcohol is fifty times more toxic than normal propyl Alcohol. In such bodies the combining energy of every atom in the double linking is not completely absorbed. The atoms possess a partial valency—hence the reactivity (Thiele).—O. C. M. Davis, B.M.J. ii./22,12. Alcohol Amylicmn. C5Hn.OH=88-0736. Consists principally of primary iso-amylic alcohol. (CH3)2CH— CH2—CH2.OH. Made by purifying and fractionating fusel oil, collecting that distilling between 257° and 289° F. (125° to 143° C.). Closer range of boiling points has been recommended. If B. pt. 128° —130° C., Sp. Gr. is commercially about 0-833 at 15° C. Alcohol Mcthylicum, CH3.OH = 32-0312. Pyroxylic Spirit. Dose.—30 to 60 minims (2 to 4 Cc.). Synthetic Manufacture. Methyl Alcohol is synthesised on a commercial scale from Water Gas (a mixture of Carbon Monoxide and Hydrogen) under pressure at about 400° C.. in presence of a catalyst, usually Metallic Copper containing 10% Zinc Oxide, CO + 2HS CH3OH. The Badische Anilin and Sodafabrik produced 10—20 tons daily in 1923 at a cost of about 1/- per gallon—one quarter of the market value.—C.D. i./25,884. Over a million gallons of Wood Spirit are used annually in this country for varnishes. By altering the physical conditions in the process above mentioned, it is possible to produce Ethyl Alcohol and Iso-propyl Alcohol. Synthesis of carbohydrates for food purposes is on the horizon. Iso-propyl Alcohol is hypnotic rather than ‘ stimulant/ It finds no favour in TJ.S.A.-— B.M.J. ii./26,795. Synthetic Methyl Alcohol made as above has been used as an anti-freeze mixture for radiators. Toxic effects in TJ.S.A.-—B.M.J. ii./3o,745. If absolute and “ acetone-free,” Methyl Alcohol has Sp. Gr. 0-796, but it is not allowed by the Excise to be retailed pure unless duty-paid. Has been used internally for vomiting of pregnancy, sometimes combined with menthol. The commercial substance known as Wood Naphtha, or Wood Spirit, is 60 to 90% pure and contains acetone and other empyreumatic impurities. A purer preparation used in the arts has Sp. Gr. 0-81. It is a solvent of pyroxylin. The Methylated Spirit license is not necessary for the, ale of Wood Spirit, but that licence does not, of course, cover the ale of pure Methyl Alcohol. Wood Alcohol Poisoning is generally accompanied by blindness The end >roduct excreted by tlie kidneys is Formic Acid. This reduces I^hlingi Solution, so its presence may interfere with diagnosis.—S. L. /.legier, ii./2i,618. It is said that blindness may follow even 7 or 8 Gm. of it, but the oxic dose is less. Numerous references to the subject m Edn. XV11., p. Fumes of Methyl Alcohol killed rats exposed to them in one or two days.— 'in 1926 2,000 people died in U.S.A. as a result of drinking so-called whisky prepared from denatured Alcohol.—L. i./27,89. Methylated Spirit Drinking—Memorandum dealing with resolutions under consideration bv the Convention of Royal Burghs, anent the prevalent evil if Methylated Spirit intoxication. Complicated regulations proposed by he Convention, under police control.—P.J. i./22,38< . M.O.H. for Edinburg 1 tated large quantities were supplied.—C-D. ,April2/21,448,449. ^ Toxic effects of Methylated Spirit—Sir Mm. W filcox ,L.ii. / 29,124 Red Biddy.—No evidence of manufacture or sale m Scotland of admixtures if Red Wine and Methylated Spirits, though reason to believe such mixtures ire made by purchasers of cheap red wine. Considerable quantity of latter Ulfed1Lizz^.—Known ^as Lisbon Wine in South and East London. Caused icute cirrhosis of the liver.—Sir Wm. Willcox, B.M.J. J-/3L596. ‘ ited Liz * made with the current S.\ .M. and Lisbon Wme. F.J. n./30,dU6. For Red Biddy of Glasgow, see Vol.II. For Detection of Methyl Alcohol m Ethyl Alcohol, etc., see Vol. ll. Ipiritus Methylatus, Mineralised or Denaturalised. Sin^e May, 1924, this consists of a mixture of Spirit 90/,, Mood Naphtha (Methyl Alcohol) 9-5% and crude Pyridine 0-5 /0, with m addi- iion |% (0-375%) of mineral Naphtha (‘ Petroleum ) and a small proportion )f Methyl Violet to colour. It forms an opaque mixture with water. Caution.—It is not well adapted for local use—e.g., for bed-sores. It caused Dermatitis amongst surgeons of Manchester Loyal Infirmary , ind amongst barbers of that town. Pyridine was probably the cause 01 the trouble. (The Pyridine was added to render the spirit undrinkable.) Industrial Methylated Spirit was introduced by the provision of the R«vpnnp Act 1906 This is simply a mixture of plain Spirits witn one- Nineteenth of its bulk (5% of its volume) of Wood Naphtha. (Methyl Alcohol) md is^considerably pLr and of greater utility for manufacturing purposes. FZfystc$ f*or correct use by IVSanuFacturer* , .1 The Commissioners do not as a rule require a Bond where the quantity does not exceed 100 gallons per annum, but they reserve the right to iequii a Bond in anv case where considered necessary. . _ .,. „ The Act provided for the use of Industrial Alcohol m the compogtw:n of Soaps, Compound Camphor, Aconite and Belladonna Liniments of! the 4V The regulations governing the use of both Methylated and Industrial Spirit have recently been revised and consolidated by the following:— Methylated Spirits Regulations, 1930. In operation since January 1, 1931. S. R. AND O. 1930. NO. 832. (Abstract of Salient Points.) Notice No. 50 (Buff Colour).—Applicable to ail Users. 34. Methylated Spirits may not be purified. . d excet)fc bv 39. Methylated Spirits may not be recovered or ie-dist _ , sanction. Must be kept under lock, or to satisfaction of C be taken,’ be labelled *' For externa! use only,’ or Not to be xanen, chemists under Regn. 50. . Mpfhvlated Snirits Retailer’s (1.) Any wholesale or dispensing chemist with a Metnyiaxca ©pints Licence may, on application, receive Industrial Methylated Spirits in quantities not exceeding 4 gallons for sale to authorised users on receipt of requisition in the official form. This applies to all sales of Industrial M.S. to dispensing chemists, and the limit of 1 gallon is now withdrawn. May be sold in quantities not exceeding % gallon at a time to a medical practitioner, dentist, veterinary surgeon, hospital, or nursing home, on a signed order—purchaser need not hold official authority or submit a requisition, but order must be signed by a doctor, chemist, or veterinary surgeon. This does not cover supplies to dispensing chemists. (2.) Industrial M.S. may be exported in quantities not exceeding 4 gallons. Requisitions unnecessary, and the spirits may be supplied merely on customer’s order. (3.) Every wholesale or dispensing chemist wishing to sell Industrial M.S. must apply for special authority, whatever authority he may already hold. (4.) Regn. 50 requires Industrial M.S. for sale in accordance with para. (1) and (2) to be kept apart from I.M.S. used for other purposes, a separate stock being kept under proper control, and an account kept of this separate stock. Accounts must be balanced monthly, orders and documents must be kept for two years and the contents of bottles or other containers must be labelled ‘ Industrial Methylated Spirits.’ Notice No. 54 (Green Colour).—Applicable to dispensing chemists. 1. Where already authorised to receive Industrial M.S. for dispensing, he is automatically and without further application entitled to use and dispense I.M.S. as at (i) and (ii) para. 2, while being liable to conditions in para. 3 and 4. If existing authority covers use of I.M.S. in making articles not in Second Schedule he will continue to be entitled to use I.M.S., but as from Jan. 1, 1931 no authority held prior to that date to sell I.M.S. to other chemists is valid and special authority must be obtained. 2. All future applications must be made on special form (Ex. No. 225A), and grant of authority will convey (i) right to make and sell articles in Second Schedule; (ii) right to make and dispense on prescription only articles not scheduled or authorised, or I.M.S. subject to Regulations and Conditions in para. 4. Application may also include request for authority to use I.M.S. in making other articles or for other specified purposes. 3. Permits received from metliylators must be kept and delivered to Officer. M.S. must not be purified, except with special sanction. M.S. must be kept under proper control. All containers to be labelled ‘ For external use only,’ or ‘Not to be taken,’ or otherwise to the same effect. Return to be made once a year. 4. Articles not in the Second Schedule or authorised may be supplied only on the following conditions :— (i.) Dispensed only on signed order or prescription by medical practitioner, dentist, or veterinary surgeon. (ii.) A prescription or order for I.M.S. diluted or undiluted must specify the Quantity required, must not be acted on more than once, or more than 7 days after date borne, and, unless issued under N.II.l. to be kept for two years. (iii.) Articles made with I.M.S. on prescription not issued under N.H.I. must be entered in Prescription Book with name of person for whom prescription is written and person by whom signed. Prescriptions according to formulae given in any recognised book of reference may be quoted by the recognised short title (e.g., ‘ E.P. ’). (iv.) Not more than 1 pint of I.M.S. alone, or diluted, or as an ingredient may be supplied at one time to any one person. (v.) Containers to be labelled. SECOND SCHEDULE TO REGULATIONS includes Collodions Liniments, Tinctures, B.P. and B.P.C., etc., for external use only, Extracts and N.H.I. and R.P.U. Formulary, and Varnishes, etc. Notice No. 55 (White Colour).—Applicable to doctors, dentists, veterinary surgeons, hospitals, and nursing homes. 1. Medical men, etc., may obtain authority to receive I.M.S. 2. I.M.S. (95% Ethyl Alcohol denatured with 5% Wood Naphtha) may pe had in various strengths, including a strength corresponding to absolute Alcohol. 3. From a methylator not less than 5 gallons, or from an iuthorised wholesale or dispensing chemist not more than 4 gallons may be obtained at one time, and official requisition must be sent. 4. Without authority he may obtain k gallon from a chemist. 5. I.M.S. may be used for dispensing or be used without admixture for any medical, etc., purposes only. 6. Must be labelled ‘ For external use,’ or ‘ Not to be taken, or words to effect Only 1 pint may be dispensed by a medical man, etc., either alone er as an ingredient, at one time for any one person. Reference.—P.J. ii./3o,512. The conditions as to quantities and 4 For external use,’ or ‘ Not to be taken,’ night have been inserted in the Regulations themselves.—L. ii./30,1134 ; B.M.J. ii./3o,966. . , , , . ^ ^ , . Industrial Methylated Spirit is permitted for making Dry or Solid Extracts in new B.P. , Perfume Manufacture.—I.M.S. may be used with permission. ‘Regulation 10.’—No. 10, S.R. & 0., 1925, No. 1240, t.e-, of ihe Methylated Spirits Regulations 1925 is thus superseded by the 1930 Regulations. For details of the 1925 Regulations, see Edn. XIX., p. 121. A further short-lived permission by the Commissioners of Customs and Excise was:— . T , , . _ ,, . , , 0 . ., ‘Surgical ’ Spirit.—This type of Spirit was Industrial Methylated Spirit mpyridinised, suitably denatured, employing an approved formula. The following has been used: Castor Oil £ ounce, Boric Acid lg drachms, Industrial Methylated Spirit to 1 pint. . No prescription is necessary, and if supplies are obtained from a wholesale louse it is unnecessary for the retailer to keep records of the sale of Surgical Spirit. Any desired quantity may be sold. Surgical Spirit may not be used as a base m the manufacture of other Dreparations. It must be sold exactly as received from a wholesaler.— P.J. i./26,323,536. Further ref.—B.M.J. i-/25,316. . , The new Methylated Spirits Regulations properly appreciated, render Surgical Spirit unnecessary. . , Alcoholic poisoning due to application of Surgical Spirit as a dressing prior to operation.—Vincent C. James, B.M.J. i./31,539. French Polish or Finish (Spirit Varnish). . Industrial M.S. may be used in making for sale : (a) Mixtures containing not less than 8 ounces of resin (or 6 ounces of Commercial Shellac) to the gallon, (b) hot lacquers, irrespective of the proportion of resin (it not less than 3 ounces). „ . . , . . » Mineralised M.S- may be used in making Finish for which the minimum of 3 ounces of gum resin is required. . . nT1 Mixtures (except hot lacquers) containing 3 ounces or more but less than 3 ounces (or 6 ounces if the resin is Commercial Shellac) to the gallon, must, if tor sale, be made with I.M.S. (Pyridinised). . -p-, 1Q90 “ Power-Methylated Spirits ” was introduced m the Finance Bill, 1J2U. N. Ireland Methylated Spirits and Ether Regulations, 1928—see Vol II. Hii'ty Alcoltol9 other than Mineralised, and Industrail Methylated Spirit, is obtainable by permission of the Commissioners for use in any art or manufacture in which the spirit is require and where it is proved to their satisfaction that Methylated Spin .s unsuitable or detrimental, such as manufacture of esters, a so or ise by hospitals, schools, chemists, or other scientific workers for use n research or teaching. A bond must be given and the attendance of a Revenue officer to witness the denaturing of such supplies is requisite.—Commissioners of Customs and Excise, per P.J. i./i5,34. See also P.J. ii./i4,316,339. Alcohol 75% (about 5 volumes of 90%, or of Methylated Spirit, to 1 of Water) is used for sterilising the skin and instruments. Denaturalised spirit in Germany contains 2\% of a mixture of wood spirit 80 parts, pyridine bases 20 parts. (This amounts to 0-5% ‘ Pyridine 5 as in our new (1924) Methylated Spirit.) U.S. gives a method of detecting Methyl Alcohol. Lotio Evaporans, St. M.’s. H. Methylated Spirit 1 drachm, Solution of Ammonium Acetate 1 drachm, Water to 1 ounce. Antidotes.—In America, poisoning by so-called deodorised spirit is common. In acute poisoning treat by rectal injections and stomach pump. Give brandy, strychnine or coffee. Further, for the subsequent amaurosis give pilocarpine and potassium iodide, and later strychnine hypodermically or per os. Treatment: Pilocarpine sweats with Potassium Iodide or Sodium Salicylate in the early stages and full doses of Strychnine hypodermically when optic atrophy sets in.—B.M.J. ii./o6,1855. ALCOHOL ISOPROPYLICUM. Syn. Secondary Propyl Alcohol, Dimethyl Carbinol, Avantine, CH3.CH(OH).CH3=60*0624. Iso-propyl Alcohol Regulations, 1927. Manufacturers, sellers and users of Iso-propyl Alcohol in Great Britain and Northern Ireland must render a six-monthly return to the Customs and Excise authorities, showing the quantity manufactured, ■used, and/or sold, together with the names of purchasers, and the purposes for which the Alcohol has been used. A colourless liquid with spirituous odour and somewhat burning taste. In the anhydrous condition it has Sp. Gr. 0*789 at 15*6° C. and B.pt. 82*4° C. Commercially, it is available admixed with water. A mixture containing 95% to 96% of the Alcohol has Sp. Gr. 0*810. [Our examination of the 95% article (British made) of commerce showed Sp. Gr. 0*8135. It distilled chiefly at 61 C.]. It is miscible with water or Ethyl Alcohol in all proportions. Preparation.—It may be made on synthetic lines, e.g., by reducing Acetone, using Sodium Amalgam or by passing Acetone and Hydrogen over a metallic catalyst, or by treating Propylene, in the Petroleum Industry. The latter is less pure and considerably more pungent, vide Vol. 11. Production as a by-product of the Petroleum Industry in the U.S.A. I he method is to absorb the olefine gases, containing Propylene, m Sulphuric Acid and hydrolise the resulting Alkyl-sulphuric Acids: aciu anew >CH:CHi + HiS04aCH8.CH(0S0iH) CHI . Pronvlene Isopropyl Sulphuric Acid. CH3.CH(0S08H)BH8 + H20 = CH, CH(OH) CH3 + H2S04. The rectified product contains 91% of the Alcohol and Sp. Gr. 0*819. It cannot be concentrated by simple distillation beyond a certain point, but with dry Caustic Soda it can be made anhydrous.—H. D. Grant and U. O. Johns.—Am. Jl. Ph., June, i922» P*J* ii./22»272. Chemical Eocamination.~Iso-pTopjl Alcohol, unless supplied as a commercial one, should be free from Acetone, Petrol [hydrocarbons, leave no residue on evaporation and contain no ;added perfume. The Petrol product of commerce certainly has a Petrol odour and taste. To test for Acetone employ Rothera's Test, vide Vol. II, q. v. also for letection of Isopropyl Alcohol. Pharmacology.—Isopropyl Alcohol is twice as toxic as Ethyl Alcohol ntravenously in cats. Vapour of Isopropyl Alcohol did not kill rats exposed /0 fumes (c/. Methyl Alcohol). 50 Cc. given per os to a dog weighing 6-5 kilo, •aused serious incoordination, but the animal completely recovered. Applied <o wounds in concentration up to 50% allowed same to heal normally. P.J. i 122 272. It is stated to be less toxic than n.-Propyl Alcohol. Administration by mouth produces narcosis, in larger doses anaesthesia, finally coma and death. 7ery little is absorbed by inhalation or through the skin.—J.C.S.A., 1922,1093. Uses.—It is safe internally in small doses in dilute form, and should be useful to make tinctures of drugs. It has been suggested is a surgical antiseptic and could, no doubt, replace Ethyl Alcohol n many surgical and medical procedures. In commerce, it is also suited as a solvent for crystallising and extract manufacture. (Note: —Its boiling point is only 2° to 3° higher than Ethyl Alcohol), and it has the advantage in perfumery in which it is now largely used, md in the culinary arts (flavouring essences) in avoiding excise regulations. A return has to be made annually. Externally, it has been found harmless to the skin and hair, and vithin reason it can be inhaled mixed with air. Acne of the face, complicated with severe seborrhcea, treated by 15% solution two or three times a day. Non-irritating also good n prurigo, pityriasis and seborrhoea of the head.—B.M.J.E. ii./2i,85. $ The above remarks apply, it should be noted, to isopropyl Alcohol. The isomeric normal propyl alcohol (Syn. Primary) CE2.CE2.CEt.OE obtained Yrom fusel oil is more toxic and unsuited for making tinctures and the like. j 4Isopropyl’ Tinctures and spirits*—We made and examined 1923-24) samples of the following, keeping the content of active ingredients the same as those in the B.P. ’ 14 Tinctures, and assaying vhere necessary. In each case the brand known as * Avantine vas used. The object was to determine whether Isopropyl Alcohol has a power jqual to Ethyl Alcohol to extract the drugs. The percentages of extractive 4 Residue’ obtained in our laboratories are arranged reside similar data recently obtained in respect of B.P.. ’14 Tine cures. To those conversant with this type of work, these figures are evi- lence of the suitability of Isopropyl Alcohol—the slight differences in figures as compared with the B.P. ’14 Tincture figures are justifi- ible. It is of interest to remark that few figures for Extractives lave been published in respect of the i9I4 B.P. Tinctures, ^hile m last years, as applying to the ’98 and ’85 Tinctures, the subject vas nuch discussed by Pharmaceutical chemical houses, and in passing, ve may add that B.P. ’14 Tinctures made with authentic samples if drugs yield very considerable differences in extractive content. Tinctura. ISOPROPYL TINCTURES. % Extractive Strength % Extractive Residue from used %. Residue. B.P. ’14 Tincture. Asafetidae 70 8-5 9-8 Aurantii 90 3-6 2-7 Benzoini Composita. 90 18-2 17-1 Calumbae 60 10 1-5 Camphorae Comp. .. 60 Satisfactory solution Cantharidini. 90 Satisfactory solution Capsici 60 1-6 0-6 Cinchonae Comp. . . 70 3-9 4-4 Colchici 70 2-7 2-3 Ergotae Ammoniata 60 4-4 4-0 Guaiaci Ammon. .. 90 15-1 17-0 Hyoscyami .. 70 2-4 2-5 lodi Fortis. . . 90 Satisfactory solution ,, Mitis. .. 90 Satisfactory solution Limonis 90 2*1 2-3 Nucis Vomicae 90 Satisfactory solution Pruni Virg. . . 90 15-0 13-0 Quininae Ammon. .. 60 Satisfactory solution Tolutana. 90 8*1 9-0 Valerianae Ammon. 60 2-8 3-4 Belladonnae Cinchonae Opii 70 1 70 90 The alkaloidal content of the strong ^ tinctures made by B.P. '14 directions, but " using isopropyl Alcohol is amply sufficient to allow of dilution to B.P. 14 strength. All these tinctures resemble the B.P. T4 preparations with the exception of a slight distinctive taste ; this is not noticeable when the preparations are diluted. The characteristic smell of the freshly prepared tinctures due to the isopropyl alcohol, entirely disappears after about 4 to 6 weeks. ISOPROPYL SPIRITS. Spiritus. Strength. TEtheris... ... 1 in 3 Anisi ... 1 „ 10 Cajuputi. ... 1 „ 10 Camphorae. ... 1 „ 10 Chloroformi. .. ... 1 ,, 20 Cinnamomi ... 1 „ 10 Juniperi. ... 1 „ 10 Lavandulae. ... 1 „ 10 Menthae Piperitae. ... 1 „ 10 Myrislicae. ... 1 „ 10 Rosmarini. ... 1 „ 10 Sp. Gr. within B.P. T4 limits. See Notes below. All the above dissolved easily and gave good, clear solutions except Spiritus Junipcri. All appear to be miscible with Isopropyl alcohol in all proportions except Spiritus Juniperi and Spiritus Myristicse. Iso-propyl Alcohol is therefore a suitable menstruum and solvent and can be used to replace Ethyl Alcohol for drug extraction and for dissolving volatile °*The procedures are at present illegal for B.P. T4 preparations. ALDEHYDA. Aldehydum Absolutum. Syn. Acetaldehyde CH^.COH = 44*0312. A colourless mobile liquid, irritating when inhaled. Sp. Gr. 0-7876 at >L6° C. B.pt. 21° C. Becomes acid on keeping exposed to air—oxidation to acetic acid. Polymerises with rapidity in presence of sulphuric acid at atmospheric temperature into paraldehyde (vide infra), but if temperature sbe below 0° C. crystalline metaldehyde is formed. Aldehydum Dilutum. , , , _ . ,, , Contains 15% in Alcohol, is neutral to test paper, and has an ethereal suffocating odour, producing spasm of the glottis when respired. Diluted 1 in 1,000 with water at 140° E. has been used as inhalation in catarrh and ozcena. iParaldehydum (CH3.COH)3= 132-0936. (B.P. * 14.), U.S., P. Ital. V., RE. VIII. Dose.—30 to 120 minims (2 to 8 Cc.), or more, in diluted syrup or almond mixture, repeated if needed in \ an hour. (In the knowledge of the writers J ounce has been given—this is probably a maximum single dose.) A colourless liquid, crystallizing below 50° F. ; Sp. Gr. 0-998, may be obtained by treating Aldehyde with dilute sulphuric acid. Soluble 1 in 10 of Water and in all proportions in alcohol 90%. Caution.—Paraldehyde is liable to be converted into Glciciai Acetic Acid. Even a trace may act as a catalyst for more forming. Keep in stoppered bottle.—B. Hutchison, B.M.J. i./3o,718. Uses.—As a sedative and hypnotic, but without action on the heart. In spasmodic asthma it relieves spasm and induces sleep. Per rectum and intravenously it is an ansesthetic and hypnotic, v. posted. It is diuretic. It sometimes produces rash and digestive disturbances, and slight excitement. A case is recorded of three and a half ounces taken in error ; 9 hours afterwards strychnine hypodermically and ammonia applied and injected ; recovered consciousness in 34 hours. Two ounces have proved fatal.—W. W. W. In delirium tremens 100 minims is a safe hypnotic.—Whitla. Flavoring.— Prescribed as Elixir or Mistura Paraldehydi, q.v. Extractum Glycyrrhizse Li quid um covers the taste. Elixir Paraldehydi. Dose.—1 to 3 drachms (4 to 12 Gc.). Paraldehyde 240, Glycerin 240, Alcohol (90%) 480, Oil of Cinnamon 4, Oil of Bitter Orange 8, Saccharin 1. Strictly speaking, however, alcohol is physiologically incompatible with paralde lyde. Mistura Paraldehydi. T l , . ... Paraldehyde 2 drachms, Essential Oil of Almonds (sine Acid. Hydrocyanic) 3 minims, Syrup 1 ounce, Liquid Extract of Liquorice 2 drachms, Water to 4 ounces. This covers the nauseous taste to some extent and forms four doses of J-drachm or two doses of 1 drachm. The following are preferable :— Paraldehyde Capsules, 10, 20 and 30 minims. Dose.—I or more. Mistura Paraldehydi et Potassii Iodidi. Dose.—1 drachm (4 Cc.). Paraldehyde 1*25, Potassium Iodide 0*92, Liquid Extract of Liquorice 6-25, Water to 100. In broncho-pneumonia and capillary bronchitis of infants valuable. The constituents of the mixture are incompatible, free Iodine being formed but not sufficient to harm. In severe cases the secretions dry up remarkably. Rectal Anaesthesia. Paraldehyde 9 drachms—the customary drachm per stone weight—in 5 ounces Olive Oil, for dental operation. Error in copying by a third party, stating 9 ounces, caused death.—L. i./29,247. Before operations Paraldehyde (per rectum) not very successful.—H. R. Phillips, B.M.J. i./30,279. Paraldehyde before and after anaesthesia.—R. Francis Matters, B.M.J. i./30, 1112. Rectal Paraldehyde as preliminary to tonsillectomy in children. Removal of tonsils and adenoids without anaesthesia is practised in Continental Clinics. In this country we are thankful for anaesthetics. Paraldehyde in advance, of value, 1 drachm in 1£ ounces of Saline, neither warm nor cooled, per stone weight, an hour before operation.—M. Sourasky, B.M.J. ii./3o,993. Valuable as a basal hypnotic, per rectum, 1 drachm per stone, given slowly 1£ hours before operation in 10 times its quantity of Normal Saline. Atropine as usual, and Morphine to adults. Specially useful for children.—I. W. Magill, L. i./3i,353. Easy to work with on the upper air passages.—C. H. Thoma3, ibid., 354. Intravenously as Ancesthetic.—Deep anaesthesia can be produced. 5 to 15 Cc. mixed with equal quantity of Ether and this mixture dissolved in 150 Cc. of cold solution of Sodium Chloride (1%) in sterile water. Inject the solution cold or at not exceeding 25° C. Minor operations may be performed when 10 Cc. of the chemical have been given, but as it is rapidly excreted by the lungs usually the whole 15 Cc. will be required.—H. L. C. Noel and H. S. Souttar, L. ii./i2,818,1221 ; Oliver Atkey, L. i./i3,168. Paraldehyde 1 drachm, Ether 3 drachms, and Liquid Paraffin 4 drachms, given per os produced sufficient analgesia to permit of dressing of painful wounds.—J. T. Gwathmey and H. T. Karsner, Jl. A.M.A., April 6th, 1918 ; L. i./i8,711. Metaldehyde.—Usually thought to be a combination of 3 molecules of Acetic Aldehyde, as in the case of Paraldehyde. Made by treating Acetic Aldehyde with a small amount of Sulphuric Acid at a low temperature (below 0° C.). 4 Meta ’ is a trade name for compressed Metaldehyde. It is a solid fuel burning with a non-luminous carbon-free flame, used in place of Alcohol, etc. It emits characteristic odour on burning owing to presence of traces of unpolymerised Acetaldehyde.—P.J. ii./26,292. Poisoning in a boy of 16 through taking 5 Gm. of Metaldehyde. Treatment consisted in giving large doses of alkalis and by controlling the convulsions with Chloral Hydrate and Potassium Bromide.—L. ii./27,670. Two cases of poisoning in children after eating the tablets in mistake for sweets—acute poisoning of the central nervous system. Treatment: gastric bxvage and purge.-—B.M.J. 4/29,120. Aldehydum Formicum. H.COH.—30-015G. Formic Aldehyde in vapour is an active antiseptic, preventing decomposition and fermentation, while it is comparatively non- poisonous. Liquor Formaldehydi (B.P. 14), U.S., P. Belg. IV., Fr. Cx., P. jAp., F.E. VIII., P. Ital. V. Syn. Formalin, Formol, Methanal, Methyl Aldehyde Solution. Patent : A patent was granted 7038/1893 for the 40% solution described as a New Antiseptic material. Expired 1900. Trade Mark : An application to register the word “ formalin ” was refused in 1900 on the ground that it was the name of the patented article.—G.l). Dose.—1 minim, internally, well diluted. Wiley gave 0T to 0-2 Gm. daily in an investigation.—Cf. Vol. II., Milk Preservatives. An aqueous solution of Formic Aldehyde, containing 36 to 38% w/v. Sp. Gr. 1-079 to 1-081. (35% by weight=38% by volume.) Assay method by means of sodium hydroxide and hydrogen peroxide is given (B.P: ’14). P. Jap. has also Aqua Formalinata 1 in 35 of the 35% preparation. Manufacture by oxidation of methyl alcohol by air in conjunction with the catalytic action of Copper Gauze or a Copper couple coated with a film of Silver or Platinum. It is the custom (C.D. Commercial Compendium), to prevent polymerisation, to leave some Methyl Alcohol m the commercial article, which may correspond to Formaldehyde 36, Methyl Alcohol 12, Water’52i Caution.—A 1% Solution of Formalin means 1% of the Commercial 1 40% * Formaldehyde Solution. 1% Solution of Formaldehyde means 1% of actual Formaldehyde H.COH. Antidotes.—Stomach tube and emetics followed by alkaline drinks, sal volatile (or ammonia in other suitable form), alcohol. Uses.—For wound treatment, and for sterilising surgical instruments, and the hands of operators, e.g., as Formosyl, q.v.. Has been ; suggested, 1 or 2%, as a pigment and spray for diphtheria. Also as Glycerin Pigment 2% to the throat in angina follicular is, and as a i lotion in pertussis 2% or less—with caution. See also Paraform. j As compresses to malignant tumours 2% or stronger either as pallia- jtive, or prior to removal. For alopecia 10% or stronger. For eye washes 2?o% has been employed. It shrivels up soft corns, causing them to drop off if applied daily, : Under the name of Durine a preparation is made for this purpose. For a common cold inhalation of 1% will cure. Ophthalmia, trachoma (1 in 2,000 up to 1% used) and sweating feel are well treated by a lotion. Ringworm, lupus, laryngeal growths by pigment of 1 to 3 glycerin. A spray or douche is useful fox \ozcena (1 in 2,000 up to 1 'in 500 with coarse spray). For puerperal ]fever uterine injection of 1 ounce of glycerin with 3% of Formalin. ; Also 1 minim doses per os have been practised. . . Recurrent pleural effusion has been treated by intrapleural injection of Glycerin 1 ounce, containing 10 drops of Formalin. Eczema in dry form should be treated with moist formalin application, e.g., I of formalin (40%) in a starch and water jelly 99. To eczema that is weeping, apply Lysoform or other fox-malm dusting powder. Staphylococci of eczema are killed by 1 /0 k orma- lin.’—E. Blake. ... , . Vegetable Infusions.—From 0-05 to 0-1% Formaldehyde is generally adequate to preserve. . ... .a For preserving and embalming animal tissues and museuin specimens _ rtTout 10 tirae^to harden about 25 times, but tor preservative purposes a far weaker solution is sufficient. For Room Disinfection and Utensils (in addition to sunlight, fresh air and soap and water) 1 or 2% Formalin as spray (coloured fabrics are not injured), or burn Formalin Disinfecting Tablets, q.v., As a wash, up to 10% solution may be used. For furniture 1% would be suitable. Or simply evaporate a pint of Formalin per 1,000 cub. ft. in an open vessel over a Bunsen or spirit lamp. Fumigators are made for room disinfection. They are arranged to be lit at the bottom of the container whilst the fumigator stands on a tray with a little water. Formaldehyde is volatilised into the room and continues to be evolved for i hour. Windows, etc., to be pasted down in the usual way where complete disinfection is required, and clothing, etc., left exposed to the vapour for 3 or 4 hours. Formaldehyde fumigation.—O. L. Crooke, P.J. ii./31,411. Terminal disinfection during common epidemics “ a procedure erroneously founded, almost always useless, and whose practical results bear no adequate relation to the labour and cost involved.” Fumigation described by Dr. Andrew Balfour as “ undoubtedly a process of camouflage.” ‘ Current ’ disinfection, i.e., sterilisation of articles soiled by patient’s excreta, and prompt disposal of excreta themselves, of more value.—Prof. Chagas, L. i./28,922. See also Paraform. For the use of Formalin with Potassium Permanganate for Room Disinfection and for purifying utensils, also as Preservative of Foods, also for the Detection in Milk, Urine, etc., and for Method of Determination and its General Antiseptic Power, see Vol. II. References to Medicinal Use of Formalin Acute Endometritis has been treated by injecting 50% solution of Formalin into the uterus and washing out again quickly. Not so dangerous as Zinc Chloride. Epithelioma on the face has been treated with Formalin after using Cocaine. The treatment is repeated after four days—the scab comes off and the surface below cicatrises rapidly. There is no local reaction, but the method is only suitable for epithelioma not larger than a florin. A solution of 2% Formaldehyde is valuable in extensive and inoperable cases. It causes necrosis and elimination of neoplastic bodies without irritating healthy adjacent tissue or causing pain. Aphthous Ulcerations of the buccal mucous membrane may be washed with a tampon soaked in Formalin. Use Cocaine first. Ringworm can be cured by painting with it, keeping the patch of skin in such a position that the solution will not run off it. One painting usually suffices. If skin greasy wash with Spirit first. May smart a little but otherwise rapid, clean and effective. Second application may be repeated in five days’ time. Tuberculous Empyema treated by injecting Formaldehyde-Glycerin (2% Formaldehyde in glycerin). After removal of purulent material 1 to 12 ounces of this solution employed.—L. ii./2i,770. Bacillary Dysentery treated by rectal injections of Formalin, 300 Cc. of 1% twice daily. Painful.—Schiff, Abst. Pres., Oct., 20,355. Sensitisation with Formalin in a medical student. Desensitisation by injections of 1 Cc. of 1 of Formalin in 1,000,000, then 2 Cc., and later 4 Cc. Rash disappeared.—H. MacCormac, B.M.J. iL/25,731. Formaldehyde Poisoning by drinking 3 ounces of 4% Formaldehyde. Unconsciousness occurred in three minutes. Treatment consisted in washing out the stomach with strong Saline Solution and later with a Solution of Ammonium Acetate. At the post mortem examination it was found that the interior of the oesophagus and stomach was extremely corroded.—B.M.J. ii./12,350,1470. x l , , ,, , , , ,, Poisoning of a boy, aged 7, treated by washing out the stomach and then giving a quantity of very dilute Ammonia, as an attempt to produce Hexa- mine with the Formaldehyde. An uneventful recovery was made.—B.M.J, ii./2 7,687. Preparations of Formaldehyde lollutorium Formalini, R.D.H. Formaldehyde Solution 18 minims, Peppermint Oil 5 minims. Alcohol (90%) drachms, Peppermint Water to 1 ounce. Half a ;;easpoonful to a tumbler of water for use. jjargarisma Formaldehydi. Formalin Solution 1 minim to Water 1 ounce. tfebuia Formaldehydi.—c. Mutim’s inhalants. \ Inhalant ‘A.’—Chloroform 1 drachm, Menthol 10 grains, pumilio Pine Oil 10 minims, Alcohol (90%) to 1 ounce, with 2|% formaldehyde (in the form of gas). ‘ B.’—Guaiacol 1 drachm, Chloroform 1 drachm, Menthol 15 grains, Pumilio Pine Oil 15 ninims, Alcohol (90%) to 1 ounce with 5% Formaldehyde. ‘ C.’ —Guaiacol 2 drachms, Chloroform 2 drachms, Menthol 15 grains, himilio Pine Oil 15 minims, Terebene 1 drachm, Alcohol (90%) ,o 1 ounce. ‘ D.’—Guaiacol 2 drachms, Iodine 1 drachm, Tere- oene 1 drachm, Pumilio Pine Oil 15 minims, Chloroform 2 drachms, Alcohol to 1 ounce. Dose.—About 10 drops of one of the above sprinkled on the inhaler wery half to one hour, and used by continuous inhalation. These inhalations are used progressively. After reaching ‘ C,’ D.’ is used as an alternate Solution or for night use. About 50% of phthisical patients treated are stated to have ecovered under the treatment. Urengths of Formalin admissible for Inhalation. A plain 1% mixture of Commercial Formalin in 90% Alcohol (i.e., without hloroform, etc.) is, we find, tolerated without being too irritating to the hroafc and nostrils. A 5% mixture is too irritating for prolonged use by ihalation. A 10% mixture is out of the question. All the above were tried in an ordinary Burney Aeo Inhaler. Formalin and Chloroform Solutions :— ) No. 1. Formalin 5, Chloroform 15, Alcohol (90%) 80. : No. 2. Formalin 10, Chloroform 20, Alcohol (90%) 70. : No. 2 is only ventured upon where Formalin is well and easily i ndured. In the absence of the anaesthetic effect of the Chloroform patients were not able to bear even the mild preparation for any length of time. Results in phthisis encouraging.—H. Collier. Formanllid. C6H6NH.COH = 121-0626. Dose.—2 to 4 grains (0 12 to 0;25 Jm.). Hypodermically 15 minims (1 Cc.) of 3% solution. # Yellowish crystals oluble in water and alcohol, melting at 46° C. Employed m haemorrhage and 3vers. 20% solution said to produce local anesthesia in 1 hour. 2 to 3 /0 dt urethral discharge.—M. Am., 1907. To be distinguished from Formamid, rco.NH2. ^Formosyl (T.M. 293326).—A liquid formaldehyde potash soap, t is highly antiseptic, relatively non-poisonous, inodorous, deodorant nd cheap ; does not coagulate albumin, and is miscible with water nd alcohol in all proportions. It combines the penetrating lathering ,ction of soap with the antiseptic power of Formalin. A 2% solu- ion is sufficient for general purposes and is better freshly prepared. ?or hand disinfection 1 to 2% is suitable. The stock bottles should e kept well corked. A 5% solution is rapidly fatal to B. typhi abdominalis, B. coli communis, and Staphylococcus pyogenes aureus, and a 3% solution destroys B.anthracis spores in 24 hours. Uses.—In using warm solutions a temperature of 45° C. should not be exceeded ; h to 1% is suitable for irrigation of the vagina, uterus, abscess cavities, etc. Diluted it is useful for psoriasis, lupus, eczema, and as a wash for perspiring feet. Impetigo may be treated with 5% ointment combined with carbolic acid and ammoniated mercury, or same strength with zinc ointment (paraffin basis) for eczema. 25 to 50% ointments with lanolin basis are applied to ringworm and alopecia areata. A 10% ointment is used in psoriasis. 20 to 30% may be used to arrest sweating of the feet where of limited area. For seborrhoea a 10% ointment with 5% resorcin is useful. 10 to 15% in gall ointment is suitable for piles. In the sick room and operating theatre its deodorant properties will be evident. It cleanses suppurating wounds and has styptic action on bleeding surfaces. Two to 5% is also suitable for bites, stings and burns. It is valuable also for general household disinfection, for deodorisation and cleaning. Good results have been obtained with it in veterinary use. Formosyl Mouth Wash. An efficient antiseptic, agreeably flavoured. A small teaspoonful is added to a tumbler of water for use. Dermatologists who treat the skin with lotions and ointments and leave the state of the mouth unattended to, are proceeding on unscientific lines. Eruptions on the head and face are frequently found in conjunction with an unhealthy condition ot the teeth and gums. Thymaglycin is an alkaline mouth wash which may be mentioned. * Formosyl Gargle. Contains Formalin, Phenol, Boric Acid, Essential Oils, etc. An antiseptic preparation for use as a gargle or mouth wash.—1 tablespoonful with an equal quantity of water (preferably warm). As Nasal Douche.—Dilute four to eight times. The commonest avenue of rheumatic infection is the tonsil and next to it the nose. Irrigation and thorough cleansing of the nose and pharynx with an antiseptic lotion is essential routine in anti-rheumatic treatment. The paper entitled ‘ The Avenues of Rheumatic Infection ’ is the outcome of examination of 75 cases of Sydenham’s chorea. Of these 88% showed nasal and pharyngeal inflammations.—W. P. S. Branson, B.M.J. ii./i2,1432. * Formosyl Tooth Paste, Tooth Soap, Tooth Powder, Dusting Powder (for moist surfaces, bed sores and ulcers) are prepared, also Pessaries of Cacao Butter, containing 2 grains each. IP 1 Formosyl Dental Dressing in paste form is prepared containing 6% Cocaine. % Formosyl Pastils are useful to allay irritation and are antiseptic. Liquor Formaldehydi Saponatus (B.P. ’14), contains 20% oi Formaldehyde Solution. Formalinsapa, Terpinoform P. Svec. X. Terpineol 5, Alcohol 90% 20, Soft Soap 40, Formaldehyde Solution 35. A pleasant, fragrant antiseptic preparation. »fc Cromessol (T.M. 397289). An antiseptic containing Formalin and essential Dils. Has germicidal powers equalling Carbolic Acid. Lice do not live more dian 6 hours after being sprayed with it.—L. ii./26,1118. jVlorestin’s Fluid. | Bose.—1 to 4 Cc. injected drop by drop into the not completely bvacuated sac. A mixture of Formalin, Glycerin, and Alcohol equal parts. | In the treatment of hydrocele it is generally not painful. After k few hours the scrotum swells, becomes heavy and oedematous and ,3ome liquid reforms, but this is reabsorbed. Iodine has been used in bhildren (congenital hydrocele), but is dangerous.—St. George B. Delisle Gray, B.M.J. i./3o,649, 726 (correction). ^Yadil (T.M. 371511, Class 3, and 37152, Class 48). > Syn. ‘ Tri-Methanal-Allyl Carbide.’ | a water-white liquid having a slight allyl odour and a sweetish and pungent caste like Formalin. Sp. gr. 1-015. Neutral or very faintly acid. Uses.—An antiseptic solution employed as a deodoriser and bactericide Locally. For external use employ 1 in 300 as nasal spray, gargle or wash for offensive perspiration. ‘Has been used for impetigo, acne, erysipelas, eczema nnd chilblains. For enemas and vaginal douches 1 in 150. For instruments 1 Sir W*. J. Pope found about 1% Formaldehyde, 4% Glycerin, with a minute quantity of either garlic or mustard oil. Prof. Dixon made indictments egarding its advertisement for cure of phthisis.—Daily Mail, July 22 and -3, :924, It is very weak relatively to Carbolic Acid.—J. Eyre, ibid. July 26, 24. sjcParaform (T.M. 216093) Paraformic Aldehyde, Tri-oxy-methylene» Fr. Cx. Formaldehydum Polymerisatum, P. Belg. IV., U.S.X., F.E. VIII. (H.COH)3. Manufacture.—On evaporating aqueous Formaldehyde solution, the polymer Paraform (H.COH)?i throws out, which, on frying, changes to (H.COH)^. White amorphous masses, slightly soluble in water, with an irritating vapour especially on heating, when formaldehyde is formed. Doom Disinfection : Tablets of Paraform 1 gramme, Formalin-Disinfecting Tablets, are used in a vaporiser or with i night light,—20 to 25 tablets per 1,000 cubic feet, the latter number insuring thorough disinfection. Walls and furniture should first )e sprayed with water. They are also prepared of strength 0-1,0*25 and 0-5 Gm. The use of 20 Gm. of Paraform or an equivalent of Formalin Solution, .e.y If ounces of the 40% article, killed B. typhosus by two hours exposure, dixed vapours of Sulphur Dioxide and Formaldehyde may have advantages 0 destroy, in addition to bacteria, vermin such as moths, fleas and bugs. Che efficacy of Sulphur Dioxide, particularly when in association with aqueous rapour, was also clearly re-established.—C. T. Kingzett, H. F. Bottomley tnd J. E. Brimley, M.P.C. i./i7,157. . . . . m, ! Sick-room disinfection. Spring-cleaning alone is not adequate, lne i poisonous ’ 3% Phenol preparations sold by grocers, etc., are criticised, our p. 27.—H. B. Kenwood, L. h/26,1055. . . .. ooa • Termsna! disinfection of premises after infectious disease is >eing regarded with increasing scepticism. It was dropped in Xuo de Jane ro n 1920 without untoward results.—L. ii./26,61Q. See also Andrew Balfour, )ur p 124. Catheters may be maintained aseptic by wrapping in lint im- )regnated with 20% of paraform. Dental Use.—Paraform, for the induction of painless dentine drilling is mixed with Harvard Cement in the proportion of 1 to 20 and then made into a fairly firm mass with the fluid. If left in the cavity from 1—3 months the cavity may be shaped without any pain to the patient. In addition, the slow emanation of formaldehyde gas over a lengthy period most probably arrests the process of decay. The cement should not be placed closer than half way to the nearest point of the pulp.—E. Clayton, Trans. Brit. Soc. Dental Surgeons, 1925, No. 1, p. 33. Paraform Collodion, 25% strength, applied three times a day to warts is efficacious. Whooping-cough has been treated by inhalation of Formalin vapour—i.e., from Paraform. Insufflatio Paraform!. Syn. Paraform Snuff.—Paraform 40, Ammonium Chloride 20, Lavender Oil 0-2, Menthol 0'5, Lycopodium to 100. This preparation should prove a useful nasal antiseptic. We found that Paraform as such, undiluted, can be tolerated by the nostrils without causing irritation or sneezing. If sneezing is undesirable the Ammonium Chloride must be omitted, also the Paraform may be reduced if preferred. Mixtures of Paraform with Sodium, Barium or Strontium Peroxide, when brought into contact with water, yield formaldehyde vapour. Pasta Formalin!, R.D.H. Powder Thymol 1 drachm, and add Paraform 3 grains, Glycerin 10 minims. Zinc Oxide 2 drachms. Formaldehyde Tablets for internal administration contain Paraform i grain, Milk Sugar 2 grains, Citric Acid, Peppermint and Sugar, q.s. to 10 grains. Useful antiseptic to the mouth. *Formarnint (T.M. 335409 Class 3 Assoctd., Formamint Wulfing 301G95 Assoctd.) Tablets are said to contain 0-01 Gm. ‘ Formaldehyde.* Furfural C5H402 = 96-0312. Syn. FURFUROL, PYROMUCIC ALDEHYDE, Artificial Oil of Ants. A liquid of aromatic odour, colourless but turning red on exposure to light. Manufactured by distilling various Cellulose fibres, wood, straw, etc., with dilute Hydrochloric or JSulphuric Acid. In U.S.A. corncobs or oat hulls are used. It is used in making synthetic Resins or Rubber substitutes.—C. D. Comm. Compendium. ALKALOIDAL NOTES. ‘ACTIVATED’ ALKALOIDAL SOLUTIONS. Alkaloidal salts in presence of alkali have increased activity and toxicity. An example is the clinical use of 0-5% Cocaine Hydrochloride solution with the addition of 0-5% Sodium Bicarbonate (c/. Injectio Cocainae et Sodii Bicarbonatis), which is stated to be more efficacious and anaesthetic than even a 4 or 5% plain Cocaine Hydrochloride solution. Other alkaloids, e.g., Morphine and Quinine, behave similarly (for further details v. 18th Edition, p. 141). This effect we ascribe to the presence in solution of some of the alkaloidal base. It can be shown that many alkaloidal salt solutions, on making neutral or slightly alkaline, give no precipitate and yet contain alkaloidal base which can be extracted. From considerations of solubility, all the alkaloid can not be present as base, and we believe these solutions to contain an equilibrium mixture of base and salt. Removal of the base, e.g., with a solvent (or by absorption, in vivo) favours the further and complete decomposition of the salt. If this explanation of the ‘ activation’ is correct, it implies ! that the alkaloid itself is more readily absorbed by the tissues than is a corresponding salt. We have shown in the cases of Cocaine, Quinine, and Strychnine Hydrochlorides that a solution in contact with blood contains free base. This is in agreement with the suggestion of Overton (Ztschr. f. Physikal Chernie, 1897, p. 207), that, in the organism, the salts of the alkaloids are split up by the alkali of the blood and lymph, their action being due only to the free alkaloids. In support of this view, there are also the observations of Gros (Arch. f. exp. Path, u. Pharm., 1910, p. 80), who compared the anaesthetic effect of some bases and their salts, and in nearly every instance the base was •shown to be considerably more active. Some suggest a loose state of combination between the alkaloids and blood serum constituents, f The following are our' conclusions : (a) On injection, all alkaloidal salt solutions, before having physiological effect, must be decomposed by the alkalinity of the blood, with the production of free base. (b) Alkaloidal salt solutions containing alkali are more active (than those of the salt alone, since they already contain free alkaloidal base in solution. Basic Alkaloidal Preparations. The following preparations are the result of attempts to apply in oractice the idea that the alkaloidal base is more active than its salts. 2$cBorocaine (T.M. 459625).—This is Novocain (Ethocaine) jBorate, first examined in 1912 by Gros (Arch f. exp. Path. u. Pharm., b9T2, p. 132), who found it to have the greatest anaesthetic effect bf the five Novocain salts tested. The borates, being the salts of h very weak acid, are readily hydrolised, so that their aqueous holutions contain alkaloidal base. The compound was reintroduced by Copeland and Notion (B.M.J :i./25,547), wTko found it superior to Cocaine and other Cocaine substitutes. (See Novocain for further on this compound.) Addition of Sodium or Potassium Bicarbonate to Novocain solution renders 11 almost equal to Cocaine in mucous membrane anaesthesia.—W. It. Meeker dl. Lab. & Clin. Med., Nov. ’25,139, per Pres., Apl. ’26,146. j Quinine-Mannitol.—A concentrated solution containing Quinine baSe, Boric Acid, and Mannitol, suggested for intracutaneous or intravenous injection in place of the acid salts of Quinine at present in use. (For further details of composition, dose and toxicity, lee Quinine Chapter, post.) On dilution with water or blood, the Solution becomes slightly alkaline, owing to the liberation of Quinine ►ase by hydrolysis.—W. H. Martindale, L. i./26,455. ! *Steri!oids ‘(T.M. 260647) of Alkaloidal Bases.—These are Iolutions of alkaloidal bases in suitable solvents. Owing to limita- Vol. I. E tions of solubility, they contain only small amounts of alkaloid, and yet in some instances, e.g., with Atropine and Morphine, they have been found as effective as much larger doses of the corresponding salts (v. infra). * ‘ Steriloids.’ Prepared with 2 Cc. (except where stated) of No. 1 solvent (1% Sodium Chloride) of Atropine 1/400, 1/200 and 1/100 grain in 1 Cc. ; Cocaine 1/60 gram; Codeine 1/16 grain and i grain; Diamorphine 1/50 grain, 1/30 grain (in 2-5 Cc.) ; Emetine 1/18 grain; Morphine 1/160 grain; Quinidine 1/60 grain; Strychnine 1/360 grain in J Cc., 1/180 grain in 1 Cc., and 1/90 grain. 4c ‘ Steriloids,’containing 2 Cc. of solution in No. 2 solvent (5% Glucose) have been made of Cocaine 1/50 grain; Emetine 1/14 grain ; Quinidine 1/50 grain ; Quinine 1/60 grain. In like manner ‘ Steriloids,’ using No. 3 solvent (1% Sodium Bicarbonate), containing 2 Cc. of the solution, have been made of Cocaine 1/30 grain ; Codeine 2/7 grain ; Emetine 1/9 grain ; Morphine 1/160 grain ; but in general we should not favour this solvent. For the data as to solubilities of alkaloidal bases in these solvents and in water, see Edn. XVIII., Vol. I, p. 143. Uses.—Prompt effect is produced without calling upon the tissues to break down the medicament injected. The amounts are in some cases small, but the injection can be repeated if desired. There is economy in the chemical and the possibility of overdose is reduced to a minimum. The injection of a minute amount of the alkaloidal base, producing a prompt effect of the calibre of a much larger amount of the corresponding alkaloidal salt, may be of value in ‘ withdrawal ’ treatment. They are outside the provisions of the Dangerous Drug Acts. Intravenously, these preparations offer considerable possibilities. Clinical Trials in a small number of surgical cases were made with some of the solutions (in 1924). In particular, the Atropine Base in No. 1 Solution was used to check secretion before gas and prior to ether anaesthesia. Doses of 1/400 grain were, as a rule, satisfactory except for very robust patients. It was found necessary to operate within J hour. Atropine 1/400 grain in this basic form was roughly equivalent to 1/100 grain of Atropine Sulphate, given at about the same interval before operation. The effect with Atropine base passes off more rapidly. Morphine Base 1/160 grain in No. 1 Solution has been tried after operations where pain follows, both of slight and medium severity. It is remarkable that this small quantity of morphine had some effect : as a rule, sufficient to ensure satisfactory sleep and comfort in women. When used for big men, the patients were restless in coming round from the anaesthetic, but did not, as a rule, complain of pain. Morphine Base 1/160 grain in half-strength Chloroform Water was also tried with somewhat similar effect. (The usual routine had been Morphine Tartrate £ grain after operation.) Base or salt for injection. An editorial note on the above. —L. i./26,451. ALKALOIDAL PERIODIDES. Numerous Alkaloidal Periodides, in addition to Emetine Periodide been made. A paper dealing with the last mentioned was read by the author in conjunction with J. Graham Willmore at the Royal Society of Tropical Medicine and Hygiene, London, in [May, 1923. There would seem to be a field of usefulness for these in the light of results obtained with the Emetine compound. The liteiature on the chemistry of the Periodides is exceedingly meagre. i(Ref. : Jl. Pharm, et Chim. ’09, 193.) The following are described in the body of the work :— Cinchonidine Periodide Cocaine Codeine ,, Emetine ,, Morphine ,, Papaverine ,, Quinidine ,, Quinine ,, Sparteine ,, Strychnine ,, iConstitution of the Alkaloidal Periodides. There are two distinct classes of Alkaloidal periodides—those containing hydriodic acid of the type B.HI.Li—and those prepared by (3ombination of alkaloid and Iodine only, of the type E.Iw where B is the alkaloidal base. The latter true periodides with which we are concerned, vary in their capability of withstanding Physiological Acid and per contra of )iberating the alkaloidal base in presence of Physiological Alkali. Those of Codeine, Morphine, Quinidine and Strychnine liberate a considerable percentage to both acid and alkali, while those of Cincho- lidine, Emetine and Papaverine eliminate small amounts. On the >ther hand Cocaine and Quinine Periodides respond markedly to the Hkali. For further consideration and experimental data, see Edn. mil, p. 146, and XIX, p. 136. In making the determinations, 1 Gm. of the periodide was repeatedly shaken nth 200 Cc. of 0-2% of Hydrochloric Acid during 4 hours at 40° C. The nsoluble residue was then again shaken during 4 hours at 40° C. with 200 Cc. >f Physiological Alkali. The Physiological Alkali was a solution containing 1-34% of Sodium hcarbonate and 1-14% of Sodium Carbonate ( + 10H2O), as this has a Hydro- en Ion concentration similar to that of the intestinal fluid (pH = 9-5). Pharmacology and Uses.—For further details see each ndividual Periodide. Dose. 1J to 3 grains. 1/40,, 1/20 „ 4 1 4 > > 2 > > 1 9 ° ,, & ,, i/16 to i „ 4 >> 14 to 3 ,, 1£ >) 3 ,, ^ >> 3 ,, 1/100 ALOE. Aloe (B.P. ’14) is from A. chinensis {Liliacece), and A. Perryi and other species, known commercially as Curacao, Socotrine or Zanzibar Aloes. ‘Aloe’ Fr. Cx., P. Ital. V. and F.E. YII1. (Acibar) and P. Jap. is from various species. P. Helv. and P. Belg. IV. specify A. ferox. For analytical data on Aloes see Vol. II. Dose.—2 to 5 grains (0*12 to 0-3 Gm.). Uses.—Aloes and Aloin act chiefly on the lower bowel. They are employed with soap and with iron and with strychnine in the treatment of habitual constipation. Aloes, in dose of 10 grains a day, is very unsafe for pregnant women—very likely to produce abortion.—P.J. ii./24,343. The Natal or Cape varieties of Aloes (from A. ferox) are of vitreous fracture, and characteristic odour, and mostly used for veterinary purposes. They contain as much as 6% Barbaloin. Extraction Aloes {B.P. ’14). Dose.—1 to 4 grains (0*06 to 0*25 Gm.). Barbados Aloes yield 60 to 70% of Extract, cf. Vol. II. Deeoctum Aloes Compositum {B.P. ’14). Dose.—J to 2 ounces (15 to 60 Cc.). A 1% solution of the Extract, with Myrrh and Potassium Carbonate, Licorice and Compound Tincture of Cardamoms. A purgative and used in amenorrhcea. Pilula Aloes et Ferri {B.P. ’14). Dose.—4 to 8 grains (0-25 to 0-5 Gm.). Exsiccated Ferrous Sulphate 1, Aloes 2, Compound Cinnamon Powder 3-5, Glucose Syrup 3-5 or q.s. Tablets are also prepared 4 grains each. An excellent remedy for habitual constipation.—W. W. W. Pilula Triplex. Dose.—1 to 3 pills. Aloes Extract 2 grains, Podophyllin £ grain, Mercurial Pill 1 grain, Cathartic with particular action on the liver. ®Pilula Aloes, Cascara et Hyoscyami. Dose.—4 to 8 grains (0-25 to 0-5 Gm.). Extract of Aloes, Extract of Cascara, Extract of Hyoscyamus, equal parts. pTfPilula Aloes, Nucis Vomicae et Belladonna. ^Extract of Aloes 1, Extract of Nux Vomica £, Extract of Bella- r donna J. In grains for one pill. Tinctura Aloes {B.P. ’98). Dost%—ii to 2 drachms (6 to 8 Cc.), or | to 1 drachm (1-2 to 4 Cc.) repeated. Extract of Barbados Aloes 1 in 40. Pruritus vulvffi,—tampons saturated with this give relief. Glycerinum Aloes. Evaporate Aloes Tincture 6 to 3; gradually adding Glycerin 30, Pigment for bed sores and anal fissures. Dewees ’ Emmenagogue Mixture (H.). Dose.—J ounce thrice daily. Tincture of Aloes 8, Tincture of Ferric Chloride 6, Tincture of Cantharides 2, Ammoniated Tincture of Guaiacum 3, Syrup to 90. Largely employed in the U.S. in functional and organic amenorrhoea. Aperitive Elixir. Dose.—\ to 1 drachm (2 to 4 Cc.) Tincture of Aloes 2, Tincture of Myrrh 2, Tincture of Saffron 1. Tinctura Aloes Composita, P. Austr. Average dose.—1 to 2 drachms (4 to 8 Cc.). Cape Aloes 15, Gentian Root 2J, Rhubarb 24, Zedoary Root 2 b, Saffron 2 J, Alcohol (70%) 500. For threadworms, Aloes with carminative in the morning early. After evacuation an enema of 3 tablespoonfuls of salt—repeated during 10 days nr so. Avoid salads and watercress. Pulvis Aloes cum Caneila, P. Dan, 1836. Syn. Hiera Picra Dose.—3 to 10 grains (0-3 to 0-6 Gm.). Hepatic Aloes 16, White Caneila Bark 3. Much used as a domestic emmenagogue. For insect bites a saturated solution of Aloes in Tincture of Tolu. —F. W. Cock, B.M.J. ii./i8,256. Atom, CieH1<;07,3H20=374-176. Dose.—\ to 2 grains (0-03 to 0-12 Gm.). \ grain may be considered an aperient, and 1 grain a full purgative dose. The former is U.S. Average dose. In a pill with hard soap. Assuming Extract of Aloes to contain 25% of Aioin, it follows that £ grain of the latter is equivalent in activity to 1 grain of Extract. Has been tried as hypodermic purgative,—4 grain in warm water 30 minims, but it is not always satisfactory. A principle obtained officially from Barbados or Socotrine Aloes in odourless yellow crystals, having the characteristic taste of aloes; soluble in cold water, 1 in 140 (Barbaloin), in alcohol 90%, 1 in 20, almost insoluble in Ether, xiloes contains as much as 30% of Aioin. Oxidation of Aioin and of other constituents of aloes with alkali persulphate also by Caro’s Acid and Sodium Peroxide.—E. Seel, J.C.S.A. i./2o,67 et seq. p lPiiula Aioin Composita.—For constipation, Sir A. Clark recommended aioin, extract of mix vomica, sulphate of iron, myrrh and soap, of each 4 grain in a pill taken 4 hour before last meal of the day. If faeces be hard and there be no special heart weakness add 4 grain of ipecacuanha, and should griping be caused add also J grain of extract of belladonna. ggljTablets, Anti-Constipation.—The above without Ipecac. F lPilula Aioin, Strychninse et Belladonnas. Dose.—1 or 2. Aioin A, Strychnine , Alcoholic Extract of Belladonna J, in each : in fractions of a grain, make one pill ; of a gramme, fifteen pills. jp ijTablets of Aioin Compound represent the latter with Ipecacuanha ^ gr. Tablets of Aioin (Plain), and J grain. IP XjPilulaeLaxativas Composite, U.S. VIII. 100 pills contain Aioin 1-3* Strychnine 0-05, Extract ofJBelladonna Leaves 0-8, Ipecacuanha 0-4, Glycyrrhiza 4-6 Gm., Syrup, q.s. Suppositoria.—Fr. Cx. Aloes 0*5 Gm., Cacao Butter 2*5 Gm. C£)Pil. Alophen. Dose.—1 to 3. A proprietary. Each contains Aloin £ grain, Phenolphthalein | grain, Ipecacuanha 1/15 grain, Strychnine 1/80 grain, Extract of Belladonna 1/12 grain. For constipation due to torpidity of the lower bowel. Evacuation usually occurs in from 8 to 10 hours. CE) Pilula Phenaloin, N.H.I. Aloin £ grain, Phenolphthalein \ grain, Strychnine 1/80 grain, Extract of Belladonna 1/12 grain, Ipecacuanha Root Powder 1/15 grain. CEDMarienbad Tablets. Published formula :—Aloes Extract 1-25, Rhubarb 1-25, Podophyllin 0-25, Cascara Extract 0-50, Belladonna Extract 0T2. Divided into 50 tablets, keratined and silvered.—Pres., Mar., 1907. ALUMINIUM. Al=26*97. Aluminium Soldering.—A large number of solders and appropriate fluxes are given.—C.D. ii./o7,631. Thermit is a mixture of powdered Aluminium and magnetic Iron Oxide used in welding Iron and Steel and repairing steel castings. Duralumin.—An alloy of Aluminium slightly heavier than the pure element. Its strength is about the same as mild steel. Practically non-corrodible. For surgical appliances.—B.M.J. i./i2,236. Aluminium Vessels.—Aluminium is not appreciably acted on in cooking and laboratory work. It is a good conductor of heat. When not in use should be kept perfectly dry.—L. ii. 13,54. Not toxic or detrimental to any biological function when present in diets in concentrations up to 609 parts per million.—L. i./31,596. Alumen Purificatum (B.P. ’14) is Aluminium and Potassium Sulphate (Potash Alum) A12(S04)3 K2S04, 24H20 —948*7544, or the Ammonium Salt A12(S04)3(NH4)2S04> 24H2O=906*5768. Dose.— 5 to 10 grains (0*3 to 0*6 Gm.). Soluble 1 in 10 of water. Uses,—As an astringent for local application. Ulcers on the lips are cured by its use. As a mouth-wash its solution is possibly not desirable unless it be quickly removed by rinsing. Destruction of the teeth may occur. Injectio Aluminis L.H. for vaginal use. 60 grains in 1 pint. Injectio Aluminis et Zinci, St. Th. H. Burifled Alum powder 2 parts, Zinc Sulphate powder 1 part. Mix. One or two teaspoonsful dissolved in 1 pint of warm water for vaginal injection. Whooping-cough has been treated with 1 to 2 drachm doses of 2% Alum Solution alternate hours—also combined with adequate doses of Chloral Hydrate.—B.M.J.E. i./20,13 ; Pres. Feb./2i, p. 110. Poisoning Iby Aluminium produces a rather slow intoxication. In a case contracted by a metal worker there was loss of memory, tremor, jerking movements and impaired co-ordination, also chronic constipation and incontinence of urine.—J. Spofforth, L. i./2i,1301. . A solution of Alum useful to destroy slugs, snails, and their eggs without harming the plants.—P.J. i./25,638. Alumen Exsiccatum (B.P. ’14). Syn. Alum Ustum, Burnt Alum, is made by heating Potash Alum until it has lost 45 to 46% of its weight. Also made (U.S.) from Ammonium Alum. Glycerinum Aluminis (B.P. ’14). 1 in 6. Astringent throat- paint. Points of Alum, also of Copper Sulphate, mounted in wooden cases, are prepared for ophthalmic and other uses. \qua Hsemostatica, P. Ital. V., P. Belg. IV. AcQUA DEL PAGLIARI. Alum (Potash) 80, Benzoin Tincture 10, Benzoic Acid 2, Water to 1,000. Filtered after allowing to deposit. If with 10% Sodium Chloride it is Pollacci’s modification. fUuminii Sulphas, Syn. Aluminium Trisulphate. A12(S04)3 + 16H20 = 630 3696. White crystalline powder or lumps made by dissolving freshly precipitated Aluminium Hydroxide in Sulphuric Acid. Soluble 1 in 1 of water nearly. Loses about 45*7% water at 200" C. Incompatible ; alkalis and alkaline carbonates. Liquor Aluminii Acetici, P.G. VI., P. Austr., P. Jap. IV. Syn. Burow’s Solution (Burow’s Solution, P. Belg. IV. is Liquor Alumii Aceto-Tartratis similar to P. Helv.). Dissolve Aluminium Sulphate 100 in Water 270 without heat. Filter md add Water to Sp. Gr. 1-15, and while constantly stirring pour in by degrees Precipitated Calcium Carbonate 46, mixed with Water 60, and inally Dilute Acetic Acid (30%) 120 in portions. Set aside in an open dish until gas evolution ceases (P.G.VI. says at least 3 days), stirring frequently, -hen decant, press the sediment (without washing), filter the solution and dilute to Sp. Gr. 1-044 to 1-048. Contains 7-3 to 8-3% of Basic Aluminium Wetate A1(C2H302)20H. Uses.—Diluted with twice as much water, thus making a 24% olution as an antiseptic astringent lotion, and gauze impregnated vith a 5% solution is used as a dressing. 1 to 3 of orange flower water forms a pleasant mouth lotion. Acute otitis externa and media has been treated with the liquor diluted ' times The P.G. Liquor diluted 1 drachm to the ounce forms an approximate 1% olution. It is much used on the Continent in place of Boric Lotion. For uoist fomentations and as the medicament for a bath in which to place hand r foot for continuous irrigation. In dermatitis whatever be its cause, in sup- •urating open wounds, and in cutaneous erysipelas there is nothing to equal omentation with it. An objection is, however, that after three weeks’ con- inuous irrigation tissues become very hard. Twenty-four hours’ immersion a warm normal saline (one drachm to the pint) largely removes the indurated tate.—H. F. Waterhouse, B.M.J. ii./io,62. A 1% solution an effective substitute for Calamine Lotion and in some cases nay produce better and quicker therapeutic result.—B. M. B. MacKenna, 3.M.J. i./32,7S. . . , Note.—Burow’s Solution, Ph. Ned. V., is made by interacting between ’otash Alum and Basic Lead Acetate Solution and in consequence contains ome Lead Sulphate (0-6%) in solution and some undissolved. It contains -nly 1% approx. Basic Aluminium Acetate. , Solution de Burow avec Precipit^, P. Belg. IV., Potash Alum 10, Lead Lcetate 50, Water 940. The salts are dissolved in half the water and mixed. Uuminii Acetas. A12(0H)2(C„H302)4 (?) = 324 0492. White powder slightly soluble in water. Is used as a desiccant and deodorant in powder or with glycerin. Note.—Neutral Aluminium Acetate A12(CH3COO)6 = 408-2804 3 only known in Solution. If such a Solution be evaporated >elow 38° C. the basic salt probably of formula Al2(OH)2(CH3COO)4, oluble in water, is obtainable as in the Liquor above. If on the other .and the Solution be boiled the basic salt, probably of formula l!2(OH) 4(CHsCOO)2, is thrown out, t»e., it is insoluble in water. For ophthalmia neonatorum 10% Ointment has been used applied between the lids every hour in place of Silver Nitrate drops. (Edematous Swelling : antiphlogistic treatment with cooling applications, boric acid and acetate of aluminium.—B.M.J.E. i./io,36. As an anthelmintic Aluminium Subacetate has been used in treatment of oxyuriasis. Dose for an adult 1 Gm. 3 times daily for three days ; for children 0-5 Gm. twice daily—preceded in each case by a dose of Calomel.— W. T. Schmidt, per Jl. Trop. Med., May 1/23,146. Aluminii Aceto-Tartras.—Syn. Alsol. Made by dissolving Aluminium Hydroxide freshly precipitated in Acetic and Tartaric Acids. We use 312,360 and 450 parts respectively. In shining masses, Soluble in water. An astringent and antiseptic employed in 1 or 2% solution as mouth wmsh and gargle. Also for wound treatment the same strength. Solubility,—We find that a solution as strong as 50% in water can be made. Powder finely, and allow to macerate a few hours with shaking. The salt is more rapidly soluble in Ammonium Chloride and in Ammonium Acetate Solutions. Liquor Aluminii - Aceto - Tartratis, Syn. Aluminium Aceto- Tartaricum Solutum, P. Helv. Dissolve Aluminium Sulphate 30 in warm water 100, cool and add Acetic Acid (30%) 36, then, with stirring, Calcium Carbonate 13 in water 35, allow to stand 24 hours with occasional shaking, filter off the solution and add to every 100 of filtrate Tartaric Acid 3J. Specific Gravity 1-055 to 1-059. Contains about 10% Aluminium Aceto-Tartrate. Acoording to P. Helv. this is to be supplied when Liquor Aluminii Acetatis is ordered. This formula contains Aluminium Sulphate and an excess of Acid. P.G. VI. contains 45% Aluminium Aceto-tartrate, and is prepared by dissolving Tartaric Acid 15, in Aluminium Acetate Solution 500, and evaporating on the water bath to 114 and Acetic Acid 6 is added. Filter after standing in stoppered bottle, protected from light. Sp. Gr. 1-26 approx. Stomatitis may be treated by frequent rinsing of the mouth with this solution and by using Salol as a paste to the parts. Liquor Aluminii Formatis.—We find this may be prepared by precipitating the Hydroxide from 630 of Aluminium Sulphate crystals, and dissolving in 1152 of 25% Formic Acid. Thus made, it contains the equivalent approximately of % of its weight Aluminium Formate taken as AU (H.COO)6. Other formula have been given for Aluminium Formate. Employed like the foregoing as a gargle, diluted 1 to 3% with water. Aluminii Chloridum, Al2Clc,12H20=4S2-8692. Dose.—2 to 4 grains (0-12 to 0-25 Gm.). A white, amorphous deliquescent powder. Has been found of distinct service in locomotor ataxy ; relieves the lightning pains. Liquor Aluminii Chloridi. Dissolve Aluminium Chloride (+ 12H20) 20, in water to produce 34 by volume=42-5% by wt. Sp. Gr. 1-35. Pilula Aluminii Chloridi.—Martindale.—2 grains in each. Dose.—1 to 2 thrice daily. These are convenient for treatment. Aluminii Chloras, A1(C103)3 = 277-341. Deliquescent crystals containing either 6 or 9 H20. A 25% solution may be prescribed. This further diluted 1 to 25 forms a 1% mouth wash or spray in throat affections, and is a prophylactic against infection. A 20% solution in Water or Glycerin has been used on tampons for leucorrhoea or cervical catarrh. Aluminii Hydroxidum. Prepared by pouring Lot potash alum solution into a hot solution jof Sodium Carbonate. aftAlocol (T.M. 406220) Tablets. Colloidal Aluminium Hydroxide Tablets. Dose.—Two to be dissolved in the mouth half an hour before and after each meal. For treatment of flatulence, hyperacidity, pyrosis and allied gastric disturbances. ^Alumnole (T.M. 215948) is aluminium naphthol-sulphonate. Manufacture.—by interaction between Barium Betanaphthol Sul- phonate and Aluminium Sulphate Solutions. The Barium compound is nade by warming Betanaphthol 10 in Sulphuric Acid 8 on a water bath mtil a sample dissolves clear in water, then diluting and saturating with Barium Carbonate, filtering and evaporating to dryness (Patent 10,668 expired L902). Lotion, gargle and ointment 1 to 2% in pharyngitis, rhinitis, ozoena, and gonorrhoea. Pulvis pro Pedibus, p. Heiv. Potash Alum 15, Talc 85, in fine powder. For tender feet. Another useful form of Foot Powder is : Talc 2, Boric Acid 2, Orris 1, Zinc Oleate Powder 1. ECaolin (B.p. ’14). Bolus Alba, P.G.V., P. Jap., Bol Blanc, P. Belg. IV. Native white aluminium silicate, H2Al2Si208-f-H20== 258-6912, burified by elutriation from sandy matter; it is a smooth white lowder and is a useful absorbent for irritation of the skin. It is macted upon by most chemicals, hence used for making pills of Silver titrate, Gold Chloride, and Potassium Permanganate (see Unguentum £aolini). It is useful for sprinkling on to the filter paper in clarifying iquids. It should leave not less than 85% non-volatile residue on gnition, nor should it contain marked impurity of iron. Absorptive value of Medicinal Kaolin, estimated by a Methylene 31ue solution. Kaolin 2 Gm. dried to constant weight and shaken occasionally luring \ hour with 70 Cc. 0-04% aqueous solution of Methylene Blue, should ?ive a colourless filtrate.—J. Rae, P.J. ii./28,150. Various proportions of NaOH cause different amounts of Kaolin to diffuse :n water. 1% causes it to settle in small bulk and renders diffusion difficult. Higher concentrations increase the volume of the deposit and diffusion hence easier.—J. Rae, P.J. ii./3o,223. Internal Use: Dose.—J to 1 ounce (8 to 30 Gm.). 4 Spoonfuls’ are mentioned, vith water, milk or emulsified with gum. Best on empty stomach. Both Talc and Kaolin have been given as substitute for Bismuth n gastric and intestinal affections. Talc is insoluble and not affected iy acids.. In diarrhoea of phthisis upwards of 200 Gm. p.d. Does rot constipate like bismuth. Asiatic Cholera well treated by Kaolin 100 Gm., water to 250 Cc. i pint loses were given £ hourly for the first 12 hours, the second 12 hours several glasses were taken. Vomiting ceased and patients improved. Rectal injec- ions of the same suspension also given. Also good in diphtheria, ptomaine )oisoning, bacillary diarrhoea.—R. R. Walker, Proc. R. Soc. Med., Oct. 21 ; Li. ii./2i,273,300. Hypertonic Saline in conjunction might be tried in typhoid. -B.M.J. i./2i,640. A suspension of 800 Gm. Kaolin in a litre of water employed, 3 ounces being flven every half-hour until vomiting and diarrhoea abate, then continued every lour and then every two hours up to 12 or 15 hours. Renders bacteria and oxins harmless by a process of adsorption.—B.M.J. i./26,440. More efficacious than injections of antiserum, Iodine, or Hypertonic Saline. Mortality in cholera camps dropped from 44 to 3%. Tumblerful of emulsion containing 100 Gm. Kaolin in 250 Cc. cold boiled water given every half- hour or hour for 6 doses or more and continued for next few days with smaller dosage.—I.M.G., Feb. ’26,93. Gastric Ulcer.—75 grains of a preparation containing Aluminium Silicate three times a day in milk satisfactory.—L. ii./2g,621. 4cOsmo Kaolin. (T.M. Osmo 496981, Class 4, Associated and 385762, Class 16, Associated.) Syn. Colloidal Kaolin. Dose.—A teaspoonful or more in water, two or three times a day, gradually increased, if required. If necessary, a little aperient is given at the same time. The preparation is a very efficient absorbent of bacteria and toxins. Has also been tried in cases of rheumatism and gout. For chronic intestinal conditions, and healing ulcerated mucous membrane. A prescription is Collasan 3i ounces (a variety in commerce), Tragacanth Mucilage 1 ounce, Peppermint Oil 10 minims, Water 8£ ounces—a wineglassful every 6 hours.—A. C. Jordan, L. i./23,432. Colloidal Kaolin should contain no organic or inorganic toxic matters and should yield no bacterial growth either aerobically or anaerobically.—A. White-Robertson, P.J. ii./22,396. Charkaolin Granules.—A combination of Charcoal and Osmo-Kaolin. An absorbent preparation for use in intestinal infections. Sil-Al.—Dose, 1 drachm (4 Gm.) increased, in water half an hour before meals, is for the same purposes as the above. Vaginal insufflation of the powder with subsequent douching to check discharge has been tried. The dry method is claimed to have a prophylactic value—by absorbing irritant discharge the production of fresh erosion is prevented, and those existing have an opportunity of healing. For protection of skin round gastric or intestinal fistulae opening through the abdominal wall Kaolin is better than ointments.—M.A., 1931,10. 4cKaylene (T.M. 449072 and 449073).—Dose.—A dessertspoonful or more in J tumbler of hot water night and morning. For children, 1 teaspoonful. Described as an activated Colloidal Aluminium Silicate absorbing toxins and in early stages of colitis, thus by its mechanical action replacing intestinal Antiseptics, also available as Laxative, Mint and Sweet Kaylene. A severe case of food poisoning treated with Kaylene] 4 dr. in half tumbler of water hourly. Recovery. 4c Kaylene-Ol. (T.M. 4S66S5.) Dose.—^ ounce before meals. Contains Hydrocarbon Oil. An evacuant and adsorbent. Operative Skin T reparation and Treat merit. All clean wounds heal better if kept dry. Moisture favours inflammation. Clean the skin with Ether Soap, then go over with Turpentine, then Biniodide in Spirit, finally cover with Sterile Kaolin and bandage with a dry sterile compress, but no waterproof protective.—L. i./i3,10o2. Gimolite is a special preparation, agreeably perfumed. Fullers’ Earth (China Clay) is a similar silicate, containing traces of Iron and Magnesia. For oil-refining purposes samples from Hew Zealand as good as Fullers’ Earth from Surrey.—Imp. Inst. Rept., 1929. Terra Alba in commerce is variously Kaolin, Gypsum, Burnt Alum or Magnesia,’in preference the first.—W. H. M. Westcott drew attention to deaths of infants by tetanus when unsterilised Fullers’ Earth has been applied to sores on navel and nates. Warning should be given to the poor not to use it. Boric Acid with Zinc Oxide and Starch is safe. Fulmar Oil.—The oily contents of the stomach of the fulmar petrel, used is dressing to the umbilical cord by the islanders of St. Kilda, might possibly ause tetanus.—B.M.J. ih/26,80,137. Jnguexitum Kaolini. Soft Paraffin 1, Hard Paraffin 1 ; melt, add Kaolin 1, and stir till old. Spread on rag to apply on abraded skin, it allays irritation, yso as pill excipient, v. ante. Asbestos in intimate contact, e.g., with Solutions, has an action m various substances. Diastase, e.g., is removed from liquids confining this ferment in 24 hours.—the Asbestos itself becoming ictive. Starch Paste (0-5% in water) in presence of Asbestos, after I months, show's no trace of Starch in Solution- —it is converted into >ugar. The Asbestos also gives no Starch reaction. It reduces the adio-activitv of radio-active waters and of Thorium Nitrate Solution. %/ delatin loses its power of setting again. It also removes Alkaloids, h’oteins and Hormones (e.g., Adrenalin) from Solutions.—B.M.J. i./i3,1362,1376. Asbestos is chemically a Magnesium Silicate. Extraction of Morphine and other alkaloids by means of an insoluble Silicate »f Metal of the Aluminium group, e.g., Fullers’ Earth. Subject of patent.— bJ. i./14,32. Pulmonary asbestosis in Asbestos workers.—B.M.J. i./3o,789 ; i./31,1112. lee also ii./31.80,306,367,1162. Once Asbestos bodies appear in the sputum the course is progressively downwards and cessation of exposure to dust does not check advance.—Wood and jxloyne, per M.A., ’31,56. Talc. A native foliaceous magnesium silicate ; that from the Tyrol— Venetian Talc—is soft and unctuous. H'alcum Purificatum, U.S., is the above purified (by hydrochloric acid), and it is intended only as a Altering medium. french Chalk is a harder silicate of magnesium. Soapstone..—A hard massive variety of French Chalk, consisting chieAy of Tagnesium Hydrogen Silicafte, MgjJKSijCba.—C.D. b/30,682. Steatite.— A hydrated Magnesium Silicate with some Aluminium, Iron, and dme, used as a furnace lining.—C.D. ii./3o,382. Lieselguhr, a diatomaceous or infusorial earth, known as white peat, burnt produces a light absorbent powder. It is used in making tooth pastes. Ceyssatite is a calcined siliceous earth from Ceyssa (Auvergne). ! Terra Silicea Purificata, U.S. PuriAed Kieselguhr is prepared by neans of dilute hydrochloric acid. Portland Cement is prepared by incinerating a mixture of Limestone nd Clay. Consists mainly of Calcium and Aluminium Silicates. Possesses he property of solidifying to a stone on moistening with water—presumably iwing to formation of Hydrous Calcium—Aluminium Silicates and Calcium duminates. A large proportion of the lime is, however, present in the cement dien ‘ set ’ as Calcium Hydroxide. Might be used for its scouring effect on rounds.—L. ii./17,368. AMMONIUM. NH4= 18-0392. Anmionii Bromidum (B.P. ’14). NH4Br=97*9552. Dose.—5 to 30 grains (0.3 to 2 Gm.). Small colourless crystals Soluble in water 2 in 3, less in alcohol 1 in 15). Incompatible with mineral acids and silver nitrate. Limit of Lead content as impurity—10 parts per million. Jt letvo/' if iff.—Glyl Vanillae, Glyl Rosse (excellent) ; Syrupus Zingiberis, Extractum Glycyrrhizse Liquidum. Uses.—Possesses similar sedative properties to those of the other bromides, and is thought to cause less depression. In sea sickness Ammonium Bromide beginning a day or so before the voyage, in doses of 20 grains in Chloroform Water with 15 grains of Sodium Bicarbonate thrice a day found useful.—Yeo. In tinnitus a course of ammonium bromide with Syrup of Glycerophosphates does well. The Bromide at bedtime.—Sir James Barr. Tablets, 5 grains (0*3 Gm.) and 10 grains (0*6 Gm.) are made. Effervescent Ammonium Bromide. Dose.—1 drachm. Contains 5 grains. Linctus Ammonii Bromidi. Syn. Elixir Ammonii Bromidi. Dose.—1 to 2 drachms (4 to 8 Cc.). Contains 10%. A palatable method of administering for throat affections. Mistura Ammonii Bromidi, Phenazoni et Caffeinae. Dose.—One ounce (30 Cc.). Ammonium Bromide 10 grains, Phenazone 10 grains, Caffeine Citrate 5 grains, Chloroform Water to 1 ounce. Ordinary headache is rapidly relieved by this, repeated in two hours if necessary.—A. P. Luff, B.M. J. i./i4,635. Pastilli Ammonii Bromidi. 1 grain in each vTith Glyco-gelatin basis. For whooping-cough and throat affections. Trochisci Ammonii Bromidi with Gum basis, containing 1 grain each, are very useful in asthma and for tickling cough. Ammonii Carbonas {B.P. ’14). NH4HC03 :NH4NH2.CO2=157'1098. Dose.—3 to 10 grains (O’2 to 0*6 Gm.). White masses with ammoniacal odour and alkaline taste, consisting of Ammonium Bicarbonate and Carbamate. A stimulant, carminative and expectorant. Soluble 1 in 4 water, 1 in 5 glycerin. /nco tupatible with acids, iron salts and salts of alkaline earths. For equivalents to acids v. Neutralisation Table. In broncho-pneumonia 4 to 1 grain doses useful, combined with a little potassium iodide or ammonium chloride, tincture of nux vomica and syrup of tolu. Even grain doses for infants of six months.— Cautley. In Buoxchitis 30 grain doses were advised by the late Sir L. Brunton as emetic. Has advantage of being a stimulant:— ‘ In smaller doses it stimulates the secretion of gastric juice, may be used in atonic dyspepsia, flatulence, etc., as a substitute for alcohol. From its power of stimulating the respiratory centre, it is employed as a stimulating expectorant in chronic bronchitis, in the broncho-pneumonia of children, and in asthma depending on cardiac disease.’ For dispensing powdered Ammonium Carbonate is unsuitable, especially if bottle is frequently opened, Ammonium Bicarbonate being formed. A 1 in 8 solution is found to be stable.—P. A. W. Self and C. E. Corfield, P.J. i./26,132. The solution should be prepared by dissolving the salt in translucent lumps without powdering, in a closed vessel.—R. A. Cripps and F. W. Hoyland, P.J. ii./28,236. Ammonii Chloridum (B.P. ’ 14). NH4Cl=54-4962. Dose.—5 to 20 grains (O'3 to T2 Gm.). White crystals soluble 1 in 3 of water. Liquid extract of liquorice disguises its nauseous taste. Incompatible with carbonates of alkalis and alkaline earths. Flavoring.—Glyl Rosae, Glyl Coriandri, Syl Lavandulae, Syl Aurantii Amari; Extractum Glycyrrhizse, Syrupus Tolutanus. Nephritis.—Where ingestion of Calcium Chloride causes nausea and vomiting, Ammonium Chloride in doses of 5 to 16 Gm. for 3 to 18 days may be substituted with practically identical results. Watch for acidosis.—P. S. Hench, Jl. A.M.A. ii./26,13. " „ , Spasmophilia (Infantile Tetany).—Ammonium Chloride, 5 Gm. a day, efficacious, but effect only transient. Must be followed up by specific measures against tetany.—Dan T. Davies, L. i./3o,202. For use as an anti-alcohol remedy, see Alcohol. Lotio Evaporans. Syn. Lotio Ammonii Chloridi, Gt. Orm. H. Ammonium Chloride 15 grains, Alcohol 90% 1 drachm. Water to 1 ounce. Tablets, 3 and 5 grains ; also 3 grains with Borax 2 grains. Trochisci Ammonii Chloridi, T.H. 4 F.’ 2 grains, marked M.A. One every 3 hours useful in congestion of the pharynx and larynx, loss of voice arising from cold and bronchial cough. Trochisci Ammonii Chloridi cum Glycyrrhiza. Contain 3 grains of each. Tablets are also made same strength. Trochisci Ammonii Chloridi Compositi, T.H. Contain Ammonium Chloride 1 grain, Potassium Chlorate 2 grains, and £ grain approximately of Cubebs. Marked 4 C.M. A.’ Vapor Ammonii Chloridi is used in affections of the throat and Eustachian tube. Inhalers, Ammonium Chloride.—The principle of these consists in combining the vapour of ammonia and hydrochloric acid. Ammonii lodidum. NH4I=144*9712. Average dose.—5 grains (0*3 Gm.). A white granular salt containing not less than 99% pure ammonium iodide in minute crystalline cubes, very deliquescent and soon becoming yellow or yellowish brown on exposure to air ; odourless when white, with a sharp saline taste and a neutral reaction. Soluble 1 in less than 1 of Water, 1 in 3 of 90% Alcohol (by experiment). Should be kept from light and air, or free iodine is quickly liberated. It causes less depression than potassium iodide, and is preferred by some for syphilis and rheumatism. . Asthma (Humid).—Ammonium Iodide, Tincture of Sangumaria, Tincture of Lobelia, of each 1 drachm. Syrup of Tolu to 6 drachms. One drachm in a little water every two to four hours -Bartholow. Ammonii Nitras. NH4NO3=80 0472. B.P. The fused salt is used for making Nitrous Oxide. Syn. Nitrogen Monoxide U.S., Laughing Gas. N20=44-046 ; on heating to 350° F. it splits up into this gas and water vapour. The gas is passed through a strong solution of ferrous sulphate to remove nitric oxide—the traces of acid being removed by passing through alkali. The gas is considered one of the safest anaesthetics. The heart is not directly affected by its action. There is no anaesthetic, if carefully given, comparable with nitrous oxide for quietly and pleasantly inducing anaesthesia. Treatment if dangerous symptoms arise during administration of nitrous oxide. Dangers arising under gas are almost invariably due to failure of the respiration caused either by obstruction or over dose. Obstruction may result from “ falling back of the tongue,” from pressure due to engorgement of the thyroid or thymus, or other glands in the neck, or from foreign bodies entering the respiratory passages—teeth, bloodclot, vomit, etc. Over-dose is more likely to occur if the patient’s clothing be not loose. If the breathing stop, give no more anaesthetic, clear the mouth and pharynx with a swab or towel round the finger, pull forward the tongue and compress the lower ribs ; if no air enter or leave the chest, place the patient upon his side upon the floor, with a pillow or something equivalent under his shoulders. Loosen his clothing, pull the tongue forward and give the tongue forceps to an assistant to keep up the traction. Try to expel any possible obstruction by compressing the lower ribs and abdomen, and then turn the patient upon his back and begin artificial respiration, giving oxygen gas and applying c&tnyi nitrite or weak ammonia vapour to the nostrils meanwhile. If there be another assistant tell him to give an injection of strychnine (:110- grain) or 1 drachm of ether or both, but do not stop the artificial respiration or waste time over the injection yourself. If no air enter or leave the chest during the artificial respiration, do tracheotomy forthwith, and immediately the trachea is entered resume the artificial respiration and continue it for at least an hour, keeping the patient warm during this time. It may be preferable, Nitrous Oxide being half as heavy again as air, to place the patient face downwards—in the ‘ prone ' position with a pad below the chest with the forehead upon the right forearm. Then press with the hands over the lower ribs and maintain this for 3 seconds. Then turn the patient on the right side, maintain that position also for 3 seconds—repeating these movements alternately. It may suffice to simply hold patient upside down. Self administration of Nitrous Oxide, accidental death from.—L. ii./2o,1167. Pr. Mar. ’22,164. Nitrous Oxide and Oxygen for major surgery has been extensively used in the U.S. Anaesthesia varies from 11 to 75 minutes. II. M. Page said the special indications for the method are : (1) desperate cases from toxaemia, traumatism or haemorrhage, if spinal anaesthesia were not used ; (2) operations on diabetics; (3) in certain genito-urinary operations. A previous injection of a narcotic with atropine is advised, and failing this atropine alone. Induction recommended to be always done with addition of Ether. H. Bellamy Gardner agreed as to use in diabetics, but not in favour of for abdominal sections.—L. i./13,459. In major operations Teter gives as an average 100 gallons Nitrous Oxide and 20 gallons of Oxygen for one hour’s anaesthesia. The temperature of the gases should be 85 to 90° F. His apparatus consists of a stand carrying two cylinders each of Nitrous Oxide and Oxygen and an Ether attachment. The cylinders are in pairs, so that an empty one can be replaced without interfering with the administration. For operations on regions other than the mouth or nose, injections of Atropine 1/150 to 1/100 grain, Morphine 1/8 to 1/6 grain are given hypodermically H or even 2 hours before the inhalation. Crile and others add Scopolamine 1/200 to 1/100 grain. At first Nitrous Oxide with 2% Oxygen is given with a pressure of 4 to 40 m.m. of Mercury. More or less Oxygen is given according to circumstances—more if patient is cyanosed, less if he struggles. Unconquerable rigidity is controlled by giving Ether—this may occur in about 10% of cases.—T). W. Buxton’s “ Anaesthetics ” 6th Edition. As anaesthetic in dental work, the average quantity of gas used is 2 to 3 gallons and Oxygen 6—12 ounces. Portable apparatus for the gases. Results in dentistry better than with gas alone.—L. ii./12,1372,1464. In military surgery Nitrous Oxide and oxygen with rebreathing—stated to be infinitely better than Ether or Chloroform.—H. E. G. Boyle, L. ii./i7,667. Nitrous Oxide has been repeated on the same patient every day for more than a month without harmful effects. Ethylene almost as innocuous. Satisfactory anaesthesia cannot be secured with Nitrous Oxide and Oxygen except with adequate preparation ; necessary for the patient to be receptive of the gas type of anaesthesia, i.e., with blood stream capable of receiving and using the gas supplied. Anaesthetist must know metabolism of patient. F. H. McMechan, B.M.J. ii./26,1118. Surgical anaesthesia with Nitrous Oxide depends partly on the presence of a certain degree of anoxaemia, and this must impose a limitation on its uses and increase its dangers.—W. E. Brown and Co-workers, Jl. Ph. & Exp. Ther., Aug. ’2 7,269. _ , , . Obstetrics. Use of Nitrous Oxide and Oxygen. Only a certain proportion of patients are able to be managed with analgesia m labour. It seems to demand great co-operation on part of patient. J. Blomfield, Pr. iviar. 122,165. See also Pr. Dec. 1920,402. _ar „ ; Anaesthesia with Nitrous Oxide and Oxygen under pressure. An operating room could be built as a pressure chamber. The pressure would be about an extra half atmosphere and the gas 4, 5 or 6 to 1 of oxygen. H. ±1. Dale and Leonard Hill, L. ii./2i,326. nrvrifrQ Gas-Oxygen an effective substitute for Ether or Chloroform. Contraindications—face and mouth operations : changes in colour render it unsuitable for endoscopic examination of mucosae and congestive bleeding may make ssome operations difficult. Apparatus rather expensive—A. H. Macklin, Nitrous Oxide and Oxygen better than Ether alone in any case where it is important to prevent or minimise shock.—F. P. de Caux, B.M.J. 11-/3°^oE Hydrogen, Ethylene and Propylene (and presumably other gases) mixed with Nitrous Oxide form explosive mixtures more readily i^ita by heat than similar mixtures with Oxygen—H. B. Dixon, L. i./2 7,^». Ammonii Sulphas (NH4)2S04=132 1424. . Colourless crystals soluble 1 in less than 1 of water. Its chief use is as fertiliser and for fire proofing. It is made by distilling ?as liquor with hm , into Sulphuric Acid and is a source of Ammonia for refrigeration and similar purposes. Ammonii Valerianas. Ammonii Valeras. Fr. Cx. Another formula,—NH4.C5H9O2+2C5H10O2—323-2G74# Bose.—1 to 8 grains (0 06 to 0*5 Gm.). In masses of flat colourless deliquescent crystals, with a strong valerian odour, very soluble in water and alcohol. A 25% aqueous solution is prepared for dispensing. Solute de Valerianate d? Ammoniaque Compose a b rench • Nerve Tonic ’ (Fr. Cx. and P. Helv.), is Valerianic Acid 3, Ammonium Carbonate q.s. (about 4) to neutralise, Extract of Valerian 2, Water to 100 all by weight. Dose.—2 to 4 drachms (7 to 15 Cc.). Linimentum Ammonise (B.P. ’14). Solution of Ammonia 1, Almond Oil 1, Olive Oil 2. Shake together. Arachis or Sesame Oil may be used in parts of the Empire. To make more fluid, mix the Almond Oil and the Ammonia Solution and tb^Hartshorn anfonds usually Solution of Ammonia 1 and Almond Oil 3, Liquor Ammoni®. In Great Britain. Northern Ireland and Irish Frefsuufto be labelled “ Poisonous-Nat to be taken, aud io be supplied in bottle distinguishable by touch. For further conditions of Sale v. p. 38. Solution of Ammonia (B.P. ’14) has Sp. Gr. 0*959. This and Aqua Ammonias, U.S., and Ammonia Liquida, Ph. Ned. V.. contain 10% by weight of NH3. Fr. Cx.—Ammoniaque Dilute is about the same strength. Dose.—10 to 20 minims (0-6 to 1-2 Cc.). Hypodermically 2 to 6 minims for collapse ; or up to 36 minims for snake poisoning. Internally it is stimulant, diuretic and diaphoretic. In embolism large doses of ammonia, well diluted, tend to reduce the coagulability of the blood.—Whitla. Liquor Ammonise Fortis. “ Poisonous—Not to be taken," cf. antea. Dose.—3 to 6 minims (0-2 to 0-4 Cc.). Contains 32*5% by weight NH3. Sp. Gr. 0-888. (Aqua Ammonise Fortior, U.S. X. contains 27 to 29%. Ammoniaque officinale. Fr. Cx. 20*18%). Ammoniaca Liquida : P. Ital. V. and F. E. VIII. is 20% (Sp. Gr. 0*925.) Haber, of Karlsruhe, succeeded in combining atmospheric Nitrogen with Hydrogen, producing Synthetic Ammonia.—Na. Feb., 1911,560. Germicidal action, see Vol. II. Ammonia Sterules, 3 minims in each of strong Ammonia Solution. Encased in cotton wool and Rayon. Intended as a restorative—to be crushed and contents inhaled—a portable form of smelling bottle. Ocular injury caused by inhalation of 10% Ammonia.—I. Abramovicz, Brit. Jl. Ophth., May, ’25,241 ; per Pres., Feb., ’26,63. Enema Ammonise.—Strong Ammonia Solution 1, Water 160 (1 drachm to the pint). In the treatment of post-operative ileus and intestinal paresis— a sequel of abdominal operations most distressing to the patient. Its effect is enhanced by a dose of Pituitary Extract hypodermically given | hour previously. Effects a good motion and discharge of excessive flatus. Not to be used too frequently or in excess of above strength.—T. A. Black, L. ii./i6,374. Liquor Ammonias Domesticus (vel Detergens), Household Ammonia. Signa—“ Poisonous—Not to be taken." Oleic Acid 1, Alcohol 1, mix and add strong Solution of Ammonia 7, Distilled Water 7 ; shake well. For use diluted as a detergent of the skin. In the bath 1 in 1,000 to 2,000 softens the water ; also for general domestic purposes. Cloudy Ammonia is made with tap water—for this the gravity of the preparation must not be too light, otherwise the lime salts constituting the ‘ Cloud’ will settle down. We can recommend the following Dissolve Castile Soap 1*3 in Water 60, and add Strong Solution of Ammonia 27, Lime Water 0*6, and Water to 100. Hair Lotion, Erasmus Wilson’s. Strong Solution of Ammonia 1, Almond Oil 1, Spirit of Rosemary (B.P. 1885) 4, Honey Water 2. For alopecia areata Strong Ammonia Solution 1, Chloroform 1, Olive Oil 1, Spirit of Rosemary to 8, is useful. hquor Ammonii Aeetatis {B.P. ’14). Dose.-—2 to 6 drachms (8 to 24 Cc.). Keep in green glass stoppered bottles. The neutral point may be found by trying effect on a little ammonium car- )onate on a watch glass. . U.S X. is similar and contains 6-5 to 7-5% Ammonium Acetate. lIUMistura Anti-Catarrhalis. Burney Yeo. Solution of Ammonium Acetate 3 drachms, Spirit of Nitrous Ether [ drachm, Opium Tincture 10 minims, Ipecacuanha Wine 5 minims, ^ iphor Water to 1J ounces. To be taken at night. Assists action >f skin and kidneys. liquor Ammonii Aeetatis Fortior. B.P. 1885. Dose.—25 to 75 minims (1-5 to 5 Cc.). Ammonium Carbonate 1, Acetic Acid q.s., Water to 4, i.e., approx. 5 times as strong as :he B.P. ’14 Liquor. p. Off—The concentrated liquor to be a 1 to 7 preparation and to contain 57*5% w/v Ammonium Acetate. Acetate d’Ammonium Dissous (Solution Officinale). 1r. Cx. Contains 18-5% by weight of Ammonium Acetate. Ammonii Acetas.—CH3.COONH4=77*0626. Dose.—10 to 30 grains (0-6 to 2 Gm.). | This salt is obtainable in white crystals, very soluble in water. Incompatible with mineral acids, alkaline carbonates, potassium chlorate and clichromate, and with mercurous nitrate. Serviceable in all fevers and in dilirium tremens, one drachm every hour at first, reduced gradually. Choice of a diuretic.—Ammonium, Sodium and Potassium Acetates, Citrates md Tartrates, increase osmosis and are diuretics by stimulating the convo- uted tubes of the kidney. They draw water from the tissues into the blood stream : they do not irritate the kidneys and may be used even when the organs are acutely inflamed,—they should be well diluted 1 bine Spirit of Nitrous Ether with them, which, owing to the Ethyl Nitrite contained in it, is a useful agent in causing dilatation of the different vessels of the kidney. The action of these drugs, e.g., m^ renal dropsy, should be encouraged by sufficient doses of a watery aperient every day or other day, t.g.% Compound Jalap Powder.—B.M.J. i./ii,289. . «. Mistura Febrifuga, N. H. W. (not in E. G. A.). .Solution of Ammonium Acetate 2 drachms, Spirit ot Nitre 20 minims, Sodium Bicarbonate 5 grains, Chloroform Water to \ ounce. Liquor Ammonii Citratis {B.P. T4). Dose.—2 to 6 drachms (8 to 24 Cc.). Prepared by neutralising Citric Acid 10, with Ammonium Carbon ate 7 or q.s. in Distilled Water q.s. to 80. Keep in green bottles. Liquor Ammonii Citratis Fortior. B.P. 1885. Dose.—-30 to 90 minims (2 to 6 Cc.). as four times as strong as the above. Ammonii Citras.—C8H4.OH(COONH4)3=243:1566. This salt is a deliquescent white powder, diuretic, and acts similaily the acetate. Dose.—30 to 60 grains (2 to 4 GmJ* Citrate [n PNEUMONIA a mixture of the following : Solution*ofA»mm Citrate minims with Potassium Iodide 4 grams and poUie made up a tablespoonful of water every four hours—an 8 ounce Dortie maae up above proved an efficient treatment for the seventh time m a oad cast . Ammonii Tartras (CHOH)2(COO)2(NH4)2=184-1096. White crystals soluble in water. Liquor Arrmonii Tartratis R.O.H.—20 or 40 grains to Distilled Water 1 ounce. Irrigation (under Cocaine initially) with 5 to 10, and ultimately 20% solution, in a case of erosion of the cornea—complete clarification.—M. /o8,128. Lime burns of the eye. Daily irrigation for a period of 15 minutes with a 10% solution of Neutral Ammonium Tartrate recommended. Stated to dissolve the Calcium Carbonate formed in the tissue.—L. i./26,1212. Spiritus Ammonise Fetidus (B.P. ’14). Macerate Asafetida 75 in small pieces in a closed vessel in Alcohol 90%, 750 for 24 hours. Distil until Alcohol ceases to be condensed. Mix distillate with Strong Ammonia 100 and add Alcohol 90% q.s. to 1,000. Flavoring,—Syl Menthse Piperitse, Svl Limonis, Syl Coriandri all double dose) ; Syrupus Zingiberis (not so good). Spiritus Ammonias Aromaticus (B. P. ’14). Dose.—20 to 40 minims, for repeated administration ; single, 60 to 90 minims. Contains approximately 2*4% by weight of NHS. That of U.S. contains Ammonium Carbonate 3*4, Ammonia Water 9, Lemon Oil 1, Lavender Oil 0*1, Nutmeg Oil 0*1, Alcohol 70, Water to 100 and is not distilled. Liquor Ammoniae Aromaticus (Simplex) Ammonium Carbonate 4 ounces, Strong Solution of Ammonia 8 ounces, Terpeneless Oil of Lemon 13 minims, Terpeneless Oil of Nutmeg 54 minims, Alcohol (90%) 6 ounces, Distilled Water 149 ounces. The Oils to be dissolved in the Spirit before adding to the rest of the mixture. The liquor has been suggested as being useful in ‘ Stock Mixtures ’—i.e., for Hospital work, etc., where the saving of Spirit is a consideration. This preparation mixes perfectly clear with water as distinct from the B.P. ’14 Spirit. It is not so'pungent to the taste as Sal Volatile. Liquor pro Spiritu Ammoniae Aromatico. For dilution 1 with 3 of a mixture of Alcohol (90%) 12 and Water 1. Dissolve Ammonium Carbonate 4 ounces in Water 20 ounces. Add Strong Solution of Ammonia 8 ounces then Terpeneless Nutmeg Oil 54 minims and Terpeneless Lemon Oil 13 minims in Alcohol (90%) 10 ounces. May also be prepared for dilution 1 with 2 with the same Alcohol mixture as for the ‘ 1 with 3 ’ preparation above. In this case proceed as for the latter, but'dissolve the Ammonium Carbonate in Water 2H ounces and the Oils in Alcohol 90% 2H ounces. This is clearer than the above. Note.—It is not practicable to make a Concentrated Liquor for dilution with Water only. Our experiments show it is not possible to make the Concentrated Liquor much stronger in Alcohol than is contained in the above, as the Ammonium Salts are thrown out. AMYGDALA AMARA. (Rosacea.) Bitter Almond. (B.P. ’14). Oleum Amygdalae (B.P. ’14) is expressed from the seeds of this Ld the sweet almond. The content of oil in bitter almonds is ji-5%, to 62*5%, average 51-3% ; in sweet almonds 45-3-67-1%, rerage 58-9%.—P.J. i./23,324. The residue from bitter almonds is : ilised for the production of Essential Oil of Bitter Almonds (Ben- idehyde, C3H5COH=106-0468, or Oleum Amygdalae Essentiale \ne Acido Hydrocyanico). Benzaldehyde is official in P.G. VI., LS., F.E. VIII. and P. Jap. IV. Dose.—J minim (0*03 Cc.). In tter case produced artificially or as above, containing not less than >%, Sp. Or. 1-045 at 25° 0. B. pt., 179° to 180° C. Tests for hydro- Unic acid and chlorinated products and assay process are given in .S. Is a flavouring agent and non-poisonous. DOleum Amygdalae Amarae Essentiale. (E)Almonds, Essential Oil of (unless deprived of Prussic Acid), also eparations or admixtures containing. . The Essential Oil containing the Hydrocyanic Acid to the extent ' about 5% is also prepared and must be carefully distinguished om the foregoing. (That ordered by U.S. contains not less than 2 • more than 4%.) The glucoside Amygdalin C20H27NO11,3H2O=511-2654 (P. Svec. £)—crystals soluble in 12 parts of water with slightly bitter taste -in the presence of the enzyme Emulsin, a constituent in the seeds, ,kes up water on coming in contact with it, forming grape sugar id UJ Benzaldehyde-hydrocyanic Acid, C6H5COH-f HCN= 13-06M. Syn. Benzaldehyde Cyanhydrin CbH5CH(OH).CN, P.G. I. This latter compound is decomposed and the Hydrocyanic cid is removed to produce the above Essential Oil suitable for rvouring purposes. A similar body to Amygdalin, or one identical ith it, is contained in Prunus Laurocerasus (Cherry Laurel eaves.) AjAqua Laurocerasi is standardised (B.P. ’14), Fr. Cx., P.G.V. id FJ.) to 0T% Hydrocyanic Acid. It also contains some Ben- ildehyde. For analytical data, vide Vol. II. It is liable to variation and is unsuited to make eye lotions. 0. M. Caines, J. ii./22,91. . [IjAqua Pruni Macrophyllae (from fresh Bakuchi Leaves). P. ap. IV. contains also 0-1% Hydrogen Cyanide. >4]Aqua Amygdalae Amarae should contain the same amount of [ydrocyanic Acid.—F.I. and P. Jap. III. (now omitted). (U.S. I a. as 1 of oil of bitter almonds shaken in 1,000 of water and filtered.) .verage dose.—1 drachm. F. Norsk gives a “synthetic” Bitter Almond Water, viz:-— Oil of Bitter Almond 4, Hydrocyanic Acid (2%) 50, Alcohol iyu /„) mo, fistilled Water 800. Contains 0-1% HCN. /ViV Amygdalin is also contained in the bark of Prunus serotma (Vir- inian Prune or Wild Cherry bark), and the same action occurs when his drug is bruised with water. Solubility.—Almond oil dissolves in all proportions in chloroform, about 1 in 2 J of ether and slightly in alcohol 90%. Spiritus Amygdalae Amarae, U.S. IX. Average, dose.—8 minims. Oil of Bitter Almond 1, Alcohol 80, Distilled Water to 100. Amygdala Bulcis also yields about the same amount of Oleum Amygdalae as Bitter Almond (v. antea) and contains Emulsin, but is free from Amygdalin. Fuivis Amygdalae Compositus (B.P. ’14).—Sweet Almonds powdered (s.a.) 6, Refined Sugar 3, Powdered Gum Acacia 1. Mistura Amygdalae (B.P.’14) contains of this Powder 1, Mater to 8, rubbed smooth and strained. Emulsum Amygdalae,U.S. IX. (not now in U.S.).—Average dose 4 ounces. Sweet Aimonds 60, Acacia Powder 10, Sugar 30, Water g.s. to 1,000. Sterilised Almond or Olive Oil or Liquid Paraffin intended for hypodermic injection, or lubricating catheters, is prepared by sterilising the oil in small flasks or bottles tightly plugged with cotton wool at 115° C. for 10 minutes. Physicians and Surgeons should specify which oil is to be employed for ‘ Sterilised Oil.’ Oleum Amygdalae Persicae. Syn. PEACH OK APRICOT KERNEL Oil (or Mixtures). Is available in commerce and used instead of Almond Oil in culinary arts and for face creams, etc. Bieber’s modified Nitric Acid Test indicates presence of small quantities of Peach Oil in Almond Oil. cf. B.P. ’14. There is no pharmacological difference between this oil and the expressed oil of almonds. Kernel oil has the higher Iodine No., vide Vol. II. AMYL NITRIS. B.P. T4, U.S. X., Ph. Ned. V., P. Austr., P. Belg. IV., P. Jap., p. Hung., P. Ital. V., P.G. VI., P.Svec. X., F.E. VIII. Syn. Amylium Nitrosum. C3H11NO2=117T038. Bose.—By inhalation, the vapour of 2 to 5 minims (012 to 0-3 Cc.) up to 10 minims—Martindale. By the mouth | to 1 minim (0-03 to 0-06 Cc.). Hypodermically, 1 to 5 minims (0-06 to 0-3 Cc.). A yellowish ethereal liquid with a peculiar not disagreeable odour ; produced by the action of nitrous acid on amylic alcohol boiling between 128 and 132° C. and consisting chiefly of iso-amyl nitrite. —Sp. Gr. 0-870 to 0-880 ; not less than 90% distils below 212° F Amyl Nitrite is sol able in alcohol but insoluble in water. Should be kept cool; by exposure to the air it becomes comparatively inert. For Assay see Vcl. II. Incompatible.— Alkaline Carbonates, Potassium Iodide, Bromides and Ferrous Salts. Pharmacology.—Amyl nitrite dilates the vessels and lowers blood-pressure. In 30 to 40 seconds after inhaling or swallowing a dose it flushes the face, and increases the heat and perspiration of the head and neck. The effect on the pulse can be shown within ten seconds of inhalation. This is due to the large area of the lungs absorbing the drug— :oughly 100 sq. meters—and to the thinness of the membranes (about —i— m.m.) separating the air of the pulmonary vesicles from the blood. __ . . The action of Amyl Nitrite and the Nitrites generally m relaxing arterial tension, was discovered experimentally by Rutherford and Gamgee, This led Sir Lauder Brunt on to the discovery of its value and that of Nitroglycerin for relief of anginal spasm. He first used Amyl Nitrite in angina pectoris in the winter of 1866-67. During an attack in this case the pulse became very quick and the pulse tension considerably raised. This rise of pressure he attributed to.enaction of the arterioles. The success of the remedy proved the tiuth of the theory which led him to administer it.—L. ii./i5,163. With the inhalation of Amy 1 Nitrite the vessels dilated and the pain passed off. It is now used for all varieties of cardiac pain, especially when it comes on m paroxysms. H.YW. Amyl nitrite cannot be deemed dangerous in use m any way. Murrel 1 writes ‘A patient took a teaspoonful, vomited in a few minutes and seemed non the wor«e_another took 4 drachms and recovered—I know of no fatal case. Lowering of venous tension in each of 5 persons, preceded m one case by brief hypertension. Action of Trinitrin analogous m 7 cases, preceded. by liypertension in three.—Comptes Rend., July 10, 25, per Jl. A.M.A. m/25,1-0.). JJses._It has been successful in relieving angina pectoris, seasickness, ague, spasmodic asthma, migraine, neuralgic dysmenorrhcea, post-partum haemorrhage, tetanus, as an antidote to chloroform, o ward oh epileptic attacks, and for the spasm of false croup and whooping-cough, and in cocaine and strychnine poisoning. It is largely employed in threatened fainting and collapse, and as a restorative after gas in dental extractions. It is valuable to restore animation in cases of apparent death, as from drowning. Amyl Nitrite Sterules, Mariindaie. . . Encased in cotton wrocl and Rayon ; 1, 2, 3, 4, o, 0, or 10 minims (0-06,0*12, 0*2, 0-25, 0-3, 0-4 and 0-6 Cc.). In use the sterule is broken, the liquid soaks the cotton wool and cover, and can be inhaled most conveniently. The 3-mmim size The contents of these sterules do not deteriorate on keeping. On the contrary, the contents of some 17 years old were found to be fully active. Er. Cx. has Azotite d’Amyle.—- ? ‘ Preferably preserved in Sealed Capsules, tj S. F.E. VIII., and P. Jap. direct to be kept m the same manner In Angina Pectoris the best form for administration of Amyl Nitrite. Several may be used as there is practically no danger rom its administration.—-Whitla. In some cases more than average doses are needed to bring about fall of blood pressure. . Pseudo-angina occurring, as a rule m the young not serious with regard to patient’s life, and is not relieved by the Nitrites it requires tonic treatment and exercise ; true angina requires the NitrTs and Iodides. Brunton observed that rise ir.tension occurred along with angina and probably caused it, B.M.J. 11./09, “causation of Angina Pectoris.-TIic exciting causes to angina pectoris are increased muscular effort and conditions which produce increased pressure in the peripheral arterial circulation—that is, conditions which throw an increased strain (either actual or relative) on the left ventricle.—Byrom Bramwell. Clifford Allbutt lays down the rule that everyone of forty and over should at intervals of five years or so have his blood pressure measured in order that he may know in time if he be tending towards arteriosclerosis. A man of, say 45, in whom a systolic pressure of some 160 m.m. of Mercury is found may seem well but has probably a slight increase in amount of urine, which will be too watery and may show a trace of albumin occasionally and probably now and then a few hyaline casts. Cut down animal proteids, give lacto-vegetarian diet, cut off excessive smoking and Alcohol, give a saline purge every morning with an occasional mercurial purge and the pressure will come down to normal or nearly so. If this is not sufficient Potassium Iodide will help. It probably helps in elimination. Not by any means a general rule, but occasionally high blood pressure may need use of vasodilators. Vasodilators usually act even in profound cases of arteriosclerosis, and Wallace and Ringer showed that their action is more prolonged here than in normal vessels. They may be placed in the following order as to speed of action and associated evanescence of effect:— Amyl Nitrite, Nitroglycerin, Spirit of Nitrous Ether, Sodium Nitrite, Erythrol Nitrate, and lastly and more lasting, Mannitol Nitrate. In tobacco angina, useful.—Osier. In chloroform syncope, Amyl Nitrite affords the quickest means of restoring the heart’s action. The sterules are the most convenient form of using it. Longevity.—An early recognition of excessive tension is one of the important steps towards this (Hill and Barnard’s and Oliver’s Sphygmomanometers indicate the oscillations readily and are recommended). The systolic pressure is taken to be that which suffices to stop the pulse altogether, and the diastolic that at which the index gives the maximum oscillation. The normal systolic pressure is 100-120 m.m. for young adults, 115-135 or 140 for men in middle life and above 150 is abnormal. To lower pressure potassium iodide and cholagogues, etc., are used, but Amyl Nitrite and isobutyl nitrite have more rapid action than any other drug and are useful in cutting short paroxysms of pain. Nitroglycerin can be given in divided doses during the day and keeps the tension low. Erythrol Nitrate has a still slower and more prolonged action.—Sir Lauder Brunton, L. ii./o6,1335. The nitrites have been used in many cases of aortic disease for a great length of time with marked relief of urgent symptoms and with no indication of prejudicial effects. Angina is a symptom relieved by certain drugs which dilate the coronary arteries and improve blood supply to the heart: on this supposed effect of Amyl Nitrite, etc., is based the more widely accepted view of the pathology of the condition that it is caused by disease of the coronary vessels. The condition is however a symptom-complex and that ill-defined!— Harlow Brooks, B.M.J. i./31,18. Observations upon angina pectoris. Nature and distribution of the pam, duration of attack, etiology—the current theory (Allan Burns) is that it results from muscular anoxaemia—diagnosis, prognosis, treatment. If the blood pressure is raised during attacks the Nitrites are useful, but useless if it is not raised. Sedatives—Morphine.—John Cowan, B.M.J. i./3i,879. Sense of Dying.—Amyl Nitrite effective in a case when consciousness lost and pulse-rate fell to 19 to the minute. Pulse rose to 52 and some colour returned. There was no evidence of heart disease.—J. A. Ryle, L. i./3i,740. In an attack of angina pectoris its efficacy is well known.—R. O. Moon, Pr., April, ’28,225. See also M. Newman, Pr., Sept. ’30, p. 400. No reason why Amyl Nitrite and Nitroglycerin should not be used indefinitely. 'They enable patient to lead a more normal life. Maurice Campbell, ft., j ^ 3 ^ 35 Aortic incompetence of syphilitic origin. A man while lying Quietly in bed. suddenly developed acute pain, described as ‘ knife-like and stabbing, in right shoulder, spreading over the precordium and down left side. During the attack he had an expression of intense agony on his face. The whole affair was relieved in about 2 minutes by Amyl Nitrite. About 20 minutes later the pain returned, but Amyl Nitrite again afforded relief with no return of pain 12 days later there was another attack, accompanied with dyspnoea and a oulse-rate of 124, Amyl Nitrite again 'gave almost instant relief — C. F. Coombs, B.M.J. i./28,1012. . . ... Haemoptysis arrested in every case in which Amyl Nitrite was tried, whether of mitral obstruction or from phthisis. Normally the effusion of blood irritates the lung tissue, causing coughing* The strain raises the blood pressure, inducing fresh bleeding. A vicious circle is in this way maintained till eventually the loss of blood becomes so great that the exertion of coughing no longer causes a marked rise of pressure, then the bleeding ceases. Amyl Nitrite accomplishes the same effect without further loss of blood. Ed in. Med. J. July, 1904 ; L. iL/04,522,942,1446 ; M.A. 1906,240 ;B.M.J.E. i./o6,79. In severe haemoptysis—rupture of an atheromatous pulmonary vessel—free use satisfactory.—B.M.J. i./o6,917. The general vasodilation produced is preferableHo the vaso-con- striction effected by Adrenalin internally.—L. iL/04,1446. Amyl Nitrite has the support of many clinicians.—E. (4. Chandler, L. i./3Q,589. See also further abstract of this paper in Therapeutic Index under Haemoptysis. Haemorrhage from bullet wounds in the chest, e.g., in battle, can be controlled by inhalation of 5 minims.—L. ii./o7,941. One’of the most useful drugs in’dealing with the immediate emergency of haemorrhage.—H. H. Carleton, Bristol Med. Clin. JL, Spring, ’28,39 ; per Pr., Aug. ’28,133. In haemoptysis amyl nitrite acts better the quicker it is used. In most cases it can be completely arrested if inhaled as soon as the first signs of blood show themselves in the sputum. If excitement afterwards of any kind, } grain Morphine given. . Amyl Nitrite, the drug par excellence, to be used first. Especially usefu in sanatorium work where the patient is seen at the beginning o 3/tt)8/Ck« Tn pulmonary haemorrhage resort at onee to Amyl Nitrite after } grain Morphine Tartrate hypodermically. The cough slackens and haemoptysis tlecrea^es —J W Allan, (Has. Mbd. Jl., Nov., 1913- In cerebral haemorrhage Amyl Nitrite —'X'i1^Mmultt" over venesection It was found that m animals the drug stimulated tne respiratory centre in addition to decreasing the blood pressure. It may be possible with this drug in man to cause a temporary fall of blood pressure without prejudicially affecting the respiratory centre as may occur with venesection.—Philip Hamill, Clin. Jl., July, ’i4,430. Post-pabtum Haemorrhage arrested.—B.M.J. ii./o6,1125. Invaluable, but must be used with caution. During parturition Chloroform* as is well known, is safe owing to the tension within the abdominal cavity, but it is dangerous given shortly after delivery, on account of the sudden withdrawal of this tension, which is liable to cause paralysis of the vasomotor mechanism, thus permitting the blood to accumulate in the splanchnic area. L. Hill has pointed out that Amyl Nitrite, if incautiously given, may produce the same effect.—A. T. Brand and J. R. Keith, “ Clinical Memoranda for General Practitioners,” 1923. Can be used to control flooding at periods. By dilating the arterioles generally it diminishes the peripheral resistance ; thus reduces general blood pressure, and thereby the vascular distension of the uterine mucosa. May prove of value in tiding over fibroid disease until the menopause, without necessity for major operation. Obviously patients should be prevented from using to arrest normal flow. In cases of ‘ contraction ring ’ Amyl Nitrite inhalation is the one method of treatment which alone seems to meet with universal success. Description of 5 cases, inhalation followed by delivery.—C. R. Croft, L. ii./28,167. In tetanus, inhale at every spasm to gain time.—L. i./o9,103. Infantile convulsions are well treated by inhalation of 1 minim doses ; a whiff sometimes cuts the attack short.—Whitla. A powerful agent to relax uterine spasms and hour-glass contraction, whether natural or caused by ergot. Epilepsy well treated, controlling the fits and preventing insensibility.—B.M.J. ii./89,599,688. Asthma is relieved by Amyl Nitrite relaxing the peripheral vasoconstriction which is an essential factor in the bronchial vascular distension responsible for the obstruction in respiration.—L. i/07, 189. Pr., Oct 1910, p. 529. Clin. Jl., Aug. 1909. After the relief the patient usually no longer suffers from cold hands and feet. Brilliant results follow the removal of polypi from the nose—this has a marked effect on blood pressure.—B.M.J. ii./i 1,1327. In croup prompt in action.—Whitla, Pract. Med. In hiccough sometimes gives good results.—ibid. In cardiac displacement. A case of severe attacks of dyspnoea which occurred every two days, a history of pleurisy. As a result of the adhesions, the heart was anchored much outside the usual position. Amyl Nitrite advised, which patient used (5 minims) during next attack, this so allowed the heart to act ‘ as it were being pulled right out ’ that it broke away from its false moorings. Patient able to bend with ease which was previously impossible. No further angina attacks which previously occurred every two days or so. Further treatment Strophanthus Tincture, which brought the heart back to normal position.—J. C. McNaughton, B.M.J. ii./i2,181. Intrathoracic aneurysm. For the acute anginal attacks—Amyl Nitrite inhalation followed by internal use of Nitroglycerin or Erythrol Nitrate J to J grain is generally efficacious.—F De Havil- land Hall, L. ii./13,948. Fear of death entirely disappeared as patient knew he would get relief from Amyl Nitrite or Nitroglycerin. Angina much more common amongst the rich than the poor, associated as a rule with gout.—-L. ii./o9,572. Hysterical aphonia. Vasodilators (Amyl Nitrite and Nitroglycerin) used with success. A woman lost her voice fcr several days. After a few doses of Nitroglycerin 1/100 grain, aphonia I disappeared and did not return. A girl of 18 had been aphonic tor a year with varied treatment unsuccessfully. On inhaling a Little Amyl Nitrite her voice instantly returned. Also used per os [with Sodium Nitrite.—J. R. Keith, B.M.J. i./i5,847. i Purulent pericarditis simulating angina pectoris. Patient when first seen was in an almost moribund condition. Pulse could not ibe felt; heart apparently beating feebly and irregularly at about 50. 'Strychnine and Camphor were injected with little improvement, but there was prompt response to Amyl Nitrite. At autopsy the pericardium was found to contain about 2 ounces of haemorrhagic sero-purulent fluid. The man was probably killed by angina pectoris, but this condition was excited by the unrecognised pericarditis.— M. A. Cassidy, R. 0. Moon and F. Le Q. Pelly, L. ii./2i,559. Acute Suffocative Pulmonary (Edema. Patient, well-built, felt perfectly fit all day, but awoke suddenly at night with intense dyspnoea and feeling of impending death. Became cyanosed, orthopnceic and speechless. 1/100 grain Digitalin subcutaneously with improvement in pulse, but he complained of pressure in the head and giddiness. Amyl Nitrite inhaled with wonderful effect. Venesection employed, with instant relief. Blood pressure reduced.—F. Stuart Coleman, B.M.J. i./26,696. Of value for relief of pleuritic pain.—H. Cardin, B.M.J. ii./29,482. Skin affections : Eczema and other skin affections improved remarkably by inhalation, the arterial hypersemia being the curative factor. Local treatment is also promising and brilliant results are stated to be obtained in urticaria and in senile pruritus.—Jl.A.M.A. i./25,1241, per P.J. i./25,546. As a diagnostic test of mitral stenosis. Its action like that of exercise is to increase the flow of blood through the A V ring which favours the production of the murmurs in question. Inhalation of 3 minims will often bring to light a clear presystolic or full diastolic murmur in a patient lying on his back, rendering early mitral stenosis diagnosable.—R. A. Morison, B.M.J. i./i8,452. See also T. Fisher, ibid. 577. Sterules, Hypodermic, contain 15 minims (1 Cc.). (Note the hypodermic dose is 1 to 5 minims.) Useful when inhalation is impracticable. Amyl Nitrite in conjunction with Pilocarpine Hair Lotion (q.v.) has been used to increase the growth of the hair. Employ Amyl Nitrite 10% in Alcohol 90%. To be rubbed in the scalp on alternate nights. ANTIMONIUM. Sb=121-76. Antimony Alloys, Antimony Poisoninq and Fur Dermatitis, see Vol II. Antidotes to Antimony Compounds•—Stomach tube (for Tartar Emetic, but not for Butter of Antimony), emetics, tannin or tea followed by stimulants. Accidental poisoning. A case is recorded with recovery. Child was fed with milk and white of egg for the first 24 hours, afterwards barley water. A mixture containing Cinchona and Calumba was given subsequently. stibuite (Antimony ore) shipped from Alaska.—P.J. i./i6,623. [PUpAntimonii Arsenas. Dose.—to Ay grain (0’0006 to 0-002 Gm.) twice or thrice daily. Max. single dose.—^ grain (0-002 Gm.) ; | grain (0-02 Gm.) in 24 hours.—M.A. A mixture of Antimonic Oxide and 20% Arsenic Acid ; a heavy white powder. Used in syphilis and skin eruptions. Nervine and muscular tonic. Is a constituent in Gelineau’s Dragees. Dose of these is one twice a day, increased to three, after meals. For further details of their composition see Vol. II. Antimonium Sulphuratum (B.P. ’14). A mixture of the sulphides and oxides in orange red powder. Uses.—Diaphoretic. In syphilis and skin affections. Kermes Minerale is made by boiling black Antimony Sulphide (Tri- sulphidc) with Sodium Carbonate Solution, and allowing the liquor to cool. Tabellae, P. Belg., contain 0-01 Gm. Dose.—1 to 2 grains. Incompatible with sodium bicarbonate and potassium acid tartrate. Antimonii Pentasulphidum. Pentasulfure d’Antimoine. Fr. Cx., Ph. Ned. V., P. Belg. IV., P. Ital. Y. Sb2S6 = 403-82. An orange powder made by decomposing fSchlippe’s Salt (Sodium Sulph- Antimonate NaaSbS^OH^O) with dilute Sulphuric Acid. Antimonium Nigrum Puriflcatum. B.P. ’98, P. Belg. IV. Sb2S3 = 339-7. Greyish crystalline powder, decomposed by boiling hydrochloric acid. Used in veterinary practice as parasiticide. Stibium Sulfuratum (Trisolfuro) Crudum. Sun. Stibina or Anti- monio Crudo, P. Ital. V. is converted into Stibium Sulfuratum depuratum. Syn. Stibina depurata by treatment with Ammonia. F. E. VIII. is similar. Linctus Expectorans. Dose.—4 to 1 drachm (2 to 4 Cc.). Sulfidi Stibici (Antimonii Sulphurati) 2, Syrupi 450, Aqua) Amygdala) Amaru1 50. To be shaken before administering. Said to be of value for cough. Ph. Notes.—Denmark. Antimony Crocus.—For veterinary use, is a mixture of Tri-oxide (about f) and Tri-sulphide (l). Formed by heating equal weights of Antimony Tri- sulphide and Potassium Nitrate to which r\ of Hydrochloric Acid has been added.—U.S.D. Antimonii Oxidum (Antimonious Oxide) Sb203=291-52. Dose.—1 to 2 grains (0-06 to 0-12 Gm.). A white powder, soluble in Hydrochloric Acid and in Alkaline Tartrate Solution, Caustic Potash, etc. Expectorant and emetic. Injectio Antimonii Oxidi.—Martindale. Dose.—15 to 30 minims (1 to 2 Cc.). Subcutaneously, intramuscularly, or intravenously, increased as required.— Vide Refs, postea. These doses contain TAo and grain respectively in a solvent of Glycerin and Water, equal parts. Note.—20 Cc. contain l grain Antimony Oxide=J grain nearly of Antimony Potassium Tartrate. The Antimony Oxide in fine powder, is heated with the Glycerin, saking care to prevent the decomposition of the solvent, the water being added to the glycerin solution (warm). This produces a per- nanent preparation. It is not possible to increase the strength of the Injection when a glycerin and water solvent is used : it is practically a saturated solution. For a stronger preparation a solution in 75% Glycerin, diluted it time of use, is suggested, v. Injectio Antimonii Fortior. The preparation is no doubt Glyceryl Antimonite (cf. G. T. Morgan, “ Organic Compounds of Arsenic and Antimony,” 1918, p. 295). Uses,—Even with the small doses indicated the injection has [been effective in Leishmaniasis and trypanosomiasis, stronger doses could, no doubt, be used in bilharziasis. The preparation in dose equal to even l/20th grain Tartar Emetic is active, hence it is useful when treatment has to be extended over long periods. The Antimony is in a reactive and labile state. Glyceryl Antimonite is more easily broken up than Antimony Potassium Tartrate where the component radicals are strongly linked. The preparations should be tried in syphilis and in malaria. See Prevention of Malaria, postea. Trypanosomiasis.—C. W. Daniels and H. B. Newham pointed out that successful treatment of these tropical protozoal infections (trypanosomiasis, 3tc.) entails keeping the disease under control possibly for two years. A case of Rhodesian trypanosomiasis wras first treated with atoxyl subcutaneously ind antiluetin per os. Trypanosomes wrere easily found in peripheral blood and varied from 1 or 2 to 20 per 200 leucocytes. Antimony Potassium lar- brate intravenously was given and for two or three days afterwards no trypanosomes were seen, but they recurred to the extent of 6 to 24 per 200 leucocyte, ‘on the third or fourth day. . Injectio Antimonii Oxidi in 2 Cc. doses wTas given ( = 1/20 gram Tartar Emetic) daily subcutaneously and no trypanosomes were found f°J y days (2 per 200 leucocytes) and next day 3 per 200 leucocytes. On the following day 2 Cc. of the injection were given, and then twice a day for a fortnight, and no trypanosomes were found. See also G. C. Low and H. B. Newham, B.M.J. i./22,96. Subcutaneously it is painless and can be repeated extended use of the preparation is thought well worth while.-—L. i./i6,102. . . Burg. Rear-Admiral Sir P. Bassett-Smith employed the injection m a case of trypanosomiasis. The dose employed to begin with was 4 Cc. (containing 1/25 grain of Oxide) increasing to 12 drachms (42-6 Cc.) (containing 2/0 gram), this was given as an intravenous injection once a week. As this involved the injection of a considerable quantity of solution, a more concentrated preparation was employed, viz., 1 grain (0.06 Gm.) m LVA; L pure glycerin. This was diluted by him four times, viz., to the proportion 1 grain (0.06 Gm.) in 16 Cc. Of this 2-5 Cc. ( = 1/6 gram Antimony Oxide approx.) were given intramuscularly without ill effect. rnQf.]v The object was to give the concentrated intramuscular^ with the intravenous one—the latter has the highest sterilising eft blood, but it is not so lasting/or killing off ‘ hidden away A case with T. gambiense infection. At one time he had 4,00 y p< per c.mrn. of blood. Under the intravenous injection ^Antimony f-b-fw the blood rapidly cleared. In May, 1917, he was again admitted for further course of Antimony as there was relapse, which rapidly cleared up. Lad spring of 1918, 1919 and 1920, he had a course of 10 injections of Antimony Tartrate £ to 2 grains. Patient working in 1922. It was a severe T. gambiense infection cured by Antimony.—B.M.J. i./22,311. In ‘ Medical Services of the War/ the Injectio Antimonii Oxidi received favourable mention for use in trypanosomiasis. Kala-azar and oriental sore well treated.—A. Castellani, B.M.J. ii./i6,552. American leishmaniasis in S. America. Injectio Antimonii Oxidi promising ; it may be subcutaneous, intramuscular or intravenous, the last mentioned being the most rapid. From 1 to 2 Cc. on alternate days or from 5 to 6 Cc. of the solution weekly. Alternate days appears to have more lasting effect. (1) Leishmaniasis lesion on nasal septum and forearm cured by 1 to 2 Cc« injections until 30 Cc. reached and by local treatment with Tartar Emetic (saturated solution) ; (2) lesions of leg and entire mucous membrane of nose and mouth—apparent cure after 58 Cc. intravenously ; (3) Ulcer on foot and much ulceration of mucous membrane of nose and mouth ; apparent cure after 35 Cc. injected, but relapse later cured by further injections ; total of 80 Cc. injected ; (4) leishmaniasis of ear—15 Cc. intravenously (1 or 2 Cc. per injection) and 2 applications saturated solution Tartar Emetic effected cure. Unsuccessful in blastomycosis.—E. Escomel, L. ii./17,355 ; L. i./i8,592. Injectio Antimonii Oxidi Fortior—Martin dale. Suggested dose, to be used with extreme caution, S to 15 minims (0-5 to I Cc.) diluted with 2 or 3 vols. of wrater and injected immediately, subcutaneously or intramuscularly.—See Animal Experiments, postea. A solution in 75% Glycerin of strength 0*5% w/v, i.e. 0-005 Gm in 1 Cc. or 1 /12th grain in 15 minims. 1 Cc. is equivalent to 0-012 Gm. (3/16 grain approximately) Antimony Potassium Tartrate. In making the solution, slight heat is employed as mentioned in the previous preparation, neutralising any acidity by the addition of N/l Sodium Hydroxide. Chemical and Physiological Note.—The antimony is in a relatively loosely combined condition and hence reactive. On dilution with blood serum nascent Antimonious Oxide is precipitated in a fine state of subdivision—ready for reaction with the infective parasites, the tissues and the body fluids. It is probable that all antimonials suffer a breakdown to Antimonious Oxide before they are assimilated. Uses.—This preparation may permit of the use of bolder doses of Antimony Oxide than with the previously described. Animal Experiments (1024-) indicated that the injection given undiluted under the skin of the back of a cat caused swelling and suppuration later. The preparation must be diluted at the time of use in man. The ordinary Inj ectio Antimonii Oxidi is safe, and it i s probable that an intermediate strength, e.g. 0-25% in glycerin and water will be tolerated. Bassett-Smith gave a 0-36% solution without ill effect. Prevention of Malaria. It is known that Quinine given to a patient just previously to his being bitten by infected mosquitoes is of no avail in preventing or delaying onset of the attack. It is possible that an Antimony injection of this type might be effective where Quinine fails. [jPlAntiinonium Tartaratum. (B.P. ’14»), E.E. VIII., P. Belg. IV. and P. Ital. V. Syn. Tartar Emetic. Antimony Potassium Tartrate. Er. Cx. ‘ Emetique.’ |rjj ‘And all preparations or admixtures containing 1 or more per ent. of emetic tartar.' [K(Sb0)C4H406]2,H20=667-798. . Dose.—Diaphoretic ^ to J grain, emetic J to 1 gmm. Intravenously i to 2 grains (0-03 to 0-12 Gm.), usually m 1 or 2 /0 dilution. lyvodermically it is painful, irritating and not advised. Fr. Cx. has max. single dose 3 grains; max. in 24 hours 9 grains. \ single dose over limit of safety, i.e., between 0-01 and 002 Gm. perbdo iveightfis sufficient to cause death.-Fernand Micbiels, per Jl. Trop. Med. ^Colourless crystals made by combining Antimomous Oxide with 4.cid Potassium Tartrate. Soluble 1 in 17 of cold water. Almost insoluble in alcohol )0%. Incompatible with acids and alkalis, soap, and tannin. Uses*—Diaphoretic and emetic. In chorea in children it is less dangerous as emetic than apo- morphine. It is an active remedy in acute bronchitis often given m combination with opium. In Sleeping Sickness, Tartar Emetic and Antimony! Sodium Tartrate (vide posted) are given intravenously, as hypodermically STey are too painful. The method alone (without Mercury or some other powerful adjuvant) is not effective, it drives the trypanosomes from the blood, but they still remain in the cerebro-spinal fluid. Intravenously 1% solution in Normal Saline used in 2 to 10 c. doses daily for 5 to 10 days, then every other day or twice a week. In espundia, granuloma inguinale, kala-azar and oriental sore tartar emetic has powerful action. Efficacious also in yaws (wi other drugs) and beneficial in relapsing fever Chancroid well treated. 5 Cc. of a 1% solution h)trav< aToUd second day or at longer intervals :; 4 to 6 injections mcreapd by 1C • to tot of 12 Cc.—H. Goodman, Jl. Urology, Apl., 25,489, per Ires., ieD., . Casteliani’s Injection of Antimony Potassium Tartrate (Infra- muscular). OTTfb JV0 1 3 foA IT contains* §°graiii Sodium ™**^**ffi^ Both these produce some pam a few hours after admmistrc t “ilr" diluted with 3dS? 4ttaestte'quantity of water thrice U The^mi'xture may deposit Antimonies Oxide, brt wetoltt"camtie iS^mclSepo^) aXeachobhesalts mustbe dissolved separately Cantlie, Jl. Trop. Med.? Feb. 1/23,37. References to use of Tartar Emetic. Alarming results may follow Antimony Potassium Tartrate intravenously, due apparently to individual susceptibility or anaphylaxis. —J. B. Christopher son and 8. R. Gloyne. L. i./ 26, 227, 242. The regulation dosage is safe for bilharziasis and nearly a certain cure, but skill in technique and judgment of suitability of cases are needed. Asphyxia in a woman following 1 grain in 6% solution intravenously. Recovery after intracardiac injection of 0-2 Cc. 1 in 1.000 Adrenalin.—L. ih/31 1325. Bilharxiasis, seventy cases, treated by Antimony Potassium Tartrate at Khartoum Civil Hospital. The solution used is 4 grain in 10 Cc. of water (a recent revision). It is thought to be the only drug with any direct effect on the disease. The dose, always dissolved in IO Cc. of water (given every other day) is increased by \ grain every injection until 2 or 21 grains have been reached and this is maintained. (In the case of boys of 16 or under, 1| grains is the maximum.) The total quantity injected would be 20 or 25 grains according to circumstances. If more than 25 grains is required, the surplus needed should be reserved for a second course. When the dose is 14 or 2 grains (sometimes before), a cough immediately on injecting indicates that the Antimony is already in the pulmonary circulation and shows that the drug is both rapid and far reaching in its action. Two notable changes occur during the course of injections : disappearance of red blood from the urine but microscopic blood (smokiness) remains till later. The second change (after about 20 grains have been given) is that the urine apparently becomes clear and normal. These changes may coincide with the closing activities of the worm. Daily estimations of the Antimony eliminated during a course show that a third of the total amount of the Antimony given is eliminated. The cumulative action of Antimony may have been over-estimated by the older writers. Bilharzia infection in Egypt on physique and character is disastrous, the backward condition of the peasant (who constitutes 90% of the population) is attributable to this scourge.—J. B. Christopherson and J. B. Newlove —Journal of Tropical Medicine and Hygiene, July 15th, 1919, pp. 129—144. Hot only is the parasite Schistosoma Hcematobium killed in situ by the method but later the embryos in the ova deposited in the terminal vessels are killed and the patient therefore ceases to be a carrier. The Egyptian Fellaheen do not know they are infected. The parent worms, often many hundreds, are situated in the portal vein and its tributaries. The ova working their way from the venule to the surface of tl e bladder and rectum in order to escape with the urine or f races may take months to do so. An ordinary uncomplicated case lasts 10 years or more. S. Hcematobium lives for that length of time or longer. Hitherto it has been thought that “ no direct or other means is known by which the parasite can be destroyed.” (Manson, Trop. Dis., 1918). After about 12 grains have been given in as many days some of the ova are shrunken, shrivelled, blackish, etc., and they do not later hatch out in water. When this point is reached the parent worm is held to be killed in the portal circulation and the ova sterilised in situ. The patient ceases to be a carrier after about 20 grains. The Antimony Injections should only be given with greatest caution when any important organs—kidneys, liver, heart, lungs, etc.—are not sound.—J. B. Christopherson, L. i./i9,1021. Value in bilharzia, syphilis and leprosy.—F. Gordon-Cawston, M.P.C., Sept. 27/22,261. See also Pomm6, Jl. Trop. Med., Jan. 15/23,33. Contraindications, when the disease is too far advanced, are serious cardiac and renal disease. Initial dose is 4 grain (children under 10, J grain) increased by I grain on alternate days, or thrice weekly until 2 or 2£ grains is reached, always using 10 Cc. of water. ‘ Rheumatic Pains ’ liable to occur during the night following the 4th or 5th injection. There is increased hramaturia as treatment proceeds ; later, the blood and the ova vanish. Where there is intolerance, give brandy, 4 Cc. Adrenalin solution, and 4 Cc. 20% Post Pituitary Extract intramuscularly. 10,000,000 infected Chinese on the Yangtse, and 6,000,000 people in Egypt.—J. B. Christopherson, L. i./24,1071. See also I.M.G., Mar. ’25,108, | Other drugs also kill the ova, but no drug deals with bilharziasis so com- uetely because none has so great a parasitotropic action and so little organo- i opic in comparison. It kills the ova first and then the adult worm.—J. B. ffiristopherson, B.M.J., March 5, ’27,418. Antimony acts directiy on the schistosome, possibly in organic combination. -J. B. Christopherson, B.M.A. Ann. Meeting, B.M.J. ii./28,207. See also paper read at Boy. Sod. Med., Nov. 13, ’28. The treatment is now so popular that often Hindoos, both male and female, ith their children, come long distances solely to be injected. Results intra- mously absolutely favourable. The bilharzia (and filaria) carrier can always 3 cured ; the bilharzia (and filaria) patient often not. The necessary dose iries widely for different individuals and question arises whether it is right ) inject all patients with the dogmatic dose of 200 Cc. (30 grains). Experience om 3,000 injections.—P. H. J. Lampe, Jl. Trop. Med., Jan. 26,4—9. - About 11 million people affected with bilharziasis in India. Tartar Emetic irtravenously for 12 days, starting with 0-03 Gm., then 0-06 Gm., then 0T Gm. Lily to a total of 1-09 Gm., gives complete cure.—Jl. Intrav. Therap., Jan. ’26, 12. ... ( In bilharzia its use is generally accompanied by cough, vomiting, and famt- jig.—M. Khalil and M. H. Betache, L. i./3o,234. Tartar Emetic found effective but difficult to give intravenously in some ises. Sodium Antimony Tartrate and Emetine no advantage. A 6% fiution of Antimony Potassium Tartrate in distilled water most convenient, le maximum dose being 2 grains in 2 Cc., and the injections being given on ternate days for 12 injections, commencing with 1 grain and increasing by grain until 2 grains is reached at the 4th injection, when this dose is con- nued.—M. Khalil, Archiv fur Schiffs-und Tropen-Hygiene, 1926, Band 30, 451—467. Exceeding the maximum dose causes sudden displacement of the bilharzia irasites, which lose their hold on the vein-walls and are precipitated as irombi into the liver, possibly resulting in hepatitis, congestion of the bile’ lets, or even septic foci in the pulmonary circulation, if not completely estroyed. The method of choice is gradual destruction over a period of one onth.—F. G. Cawston, Jl. Trop. Med. & Hyg., Feb. 16, ’31- Chronic append 1- tis due to bilharzia is common in Natal, and operation must not be attempted ithout the previous destruction of the parasites.—Ibid. Japanese Bilharziasis treated.—J. B. Christopherson, B.M.J. ii./2i,551. Schistosomiasis Japonica treated in incipient cases and those in secondary age but not in cases with advanced cirrhosis and ascites. Initial dose, Cc. 1% solution intravenously, with total of about 2 Gm. over period of ) days.—H. E. Meleney, et al. Jl. Trop. Med., Apl. 15, ’25,165. Rectal use for bilharziasis. First dose 1 grain, then 2 grains every :cond day, increasing to 3, 4 and 5 grains during 3 weeks in 100 Cc. of water, ess nausea and results equal to intravenous injections. H. F. Wilson, I.M.J. i./22,137. A large single dose per rectum is the only rational treatment. As much 1 19 grains have been given (not for bilharzia). After 6 grains, m 4 ounces : warm water, ova disappeared in a case. Half an hour m the recumbent Dsition afterwards is enough.—J. B. Anderson, B.M.J. ii./25,700. Wilson showed that the rectum is tolerant of large doses of Antimony irtrate (16 grains). Day, in Cairo, showed that 100% of the ova are killed r intravenous injection of 6 grains.—J. B. Christopherson, B.M.J. n./25,8b/. The internal administration of the Liquid Extract of Male -Fern 1 Gm. 1., “ often acts like a charm ” in controlling haemorrhage,—Brooke. In e Zambesi district, the Wortabel Treatment with spirit of turpentine th thymol added.—L. ii./o7,923. Avoid bathing too long m infected /ers and ponds. This is frequently a direct cause the Parasite rough the urethra or anus. Bilharziasis is responsible m Egypt for most ses of moderate anaemia in children.—L. ii./ii,H-.8. # _ Good results from Thymo-benzene (2 grains of Thymo in colour ne). Ova passed in shoals on the third day. khe ur " .f w blood. Mild cases in robust subjects lose all trace of infection in a le leks.—W. Robertson, L. i./i6,698. The intermediate host of the worm is a fresh-water mollusc. The two main species in Egypt have distinct intermediate hosts. Effective means found for rendering infected water safe in military camps.—B.M.J. i./i7,832. A pamphlet (No. 339 Health), issued by J. Alexander Mitchell, the Secretary for Public Health and Chief Health Officer, Pretoria, Eeb. ’26, deals with varieties and distribution of types of bilharzial disease. Slow-flowing streams, pools and lagoons, in Cape Province, Natal, Transvaal, Portuguese E. Africa, Swaziland, and portions of S. Rhodesia, are looked upon with suspicion, as harbouring snails which may be infested with human red-water parasites. Useful precautions are given and a diagram poster showing the snail carrier of urinary and rectal bilharzia. Natural enemies of the snails are trout and 1 duck. The life cycle of the parasite is shown on the diagram. The presence or absence of bilharzia disease may be diagnosed by examining the blood serum on the lines of a Wasserman Test, the antigen used j being made from the liver of snails infected with the cercariae of schistosoma haematobium—Murray, S.A.Med. Rec., May, 1920, p. 168. See also Fairley, L. i./i9,1016. Cerebro-Spinal Fever benefited by 4 grain dose intravenously. A daily remitting temperature fell to normal in 60 hours and remained so.—S. Neave, L. i./i6,1101. Kala-azar well treated by Tartar Emetic injections intravenously. Dose. —Commence with 4 Cc. of 2% solution and gradually increase up to 10 Cc. Excellent results.—L. Rogers, L. ii./16,782. Except for melancholia and depression, no toxic effects.—H. I. Winifred Kerr, L. ii./i8,45. Kala-azar treated in like manner starting with 4 grain and rising with two or three days’ interval to 24 grains. Total given 64f grains. The case died of influenzal pneumonia and examination of all the organs determined that complete sterilisation of the system had occurred so far as L. Donovani was concerned. Given in large doses over long period Antimony produces fatty changes in the liver and kidneys. The solution should not be too concentrated. Antimony Potassium Tartrate is evidently a specific against L. Donovani.—G. C. Low, B.M.J. i./i9,702. Compulsory treatment of kala-azar in Assam with Tartar Emetic intra- I venously ‘ has converted a disease with a 90% mortality into one with a 90% rate of cure.’—B.M.J. i./25,269. Yaws. No amelioration after Antimony Potassium Tartrate intravenously in 1 grain doses for 8 to 10 days.—F. T. Auden, B.M.J. ii./22,83. Malaria is not combated by Tartar Emetic.—J. Pratt-Johnson and co- workers.—B.M.J. i./2i,80. It was originally suggested by Sir L. Rogers. Numerous refs, in 17th Edn. pp. 157,158. American Leishmaniasis of the skin treated by Antimony Potassium Tartrate beginning with 4 gram, increased to 1 grain—six injections during 14 days. Then a second course starting with 1 grain and gradually increased to 24 grains.—22 injections in this second course spread over ten weeks—total, 47 grains of Antimony. Each dose was dissolved in^2 ounces of normal saline and sterilised. Cure.—G. C. Low, B.M.J. i./19,479. Leishmaniasis of the skin is curable by a few grains (5 to 8) of Antimony Sodium Tartrate intravenously. 60 grains or more are needed for Leishmaniasis or kala-azar and possibly more still for trypanosomiasis.—J. B. Christopherson, L. i./2i,522. Sec also H. B. Bay, ibid. 525,545, and Christo- pherson, B.M.J.E. ii./23,21. Cutaneous leishmaniasis in Brazil. Two rare cases described. One cured by Tartar Emetic and the other well treated by Bi-Sodo-Luargol.—Be Aguiar Pupo, per Jl. Trop. Med., June 1/23,201. Bermal leishmaniasis is a very widespread disease among the gum gatherers in Mexico, thought to be transmitted by a flying insect, which frequents the forests.—A. Inchaustegui, per Jl. Trop. Med., June 1/2 3,198. Tartar Emetic is only slightly germicidal for leishmanias in vitro, a 1 in 100 solution being required to kill. Exact mode of action on parasites in Keratitis well treated by Tartar Emetic intravenously. j Granuloma inouinale—a disease endemic in Louisiana. Tartar Emetic Ltravenously specific.—I. M. Gage, per Jl. Trop. Med., June 15/2 3,222. i F. M. Johns is unable to substantiate claim that the organism of granuloma nguinale is probably identical with Donovan bodies, and concludes that is a protozoan parasite. Tartar Emetic ‘ strikingly specific,’ but as damage 1 the liver is possible interrupt dosage. Usual treatment 5—12 Cc. of a 1% fiution intravenously at 2 or 3 day intervals.—Int. Conf. Trop. Am., ’24,440— 51. ,'HANCRES. Chancroidal ulcers well treated by application of 0-5% solution.—E. Bupel, L A.M.A. i./26,545. Also by intravenous injection of a 1% solution. 'niticildose 3 Cc., increased by 1 Cc., up to 10 Cc. : injections at 4-day intervals. A. E. Jones, Jl. A.M.A. i./27,1699. Trichinosis (one case) well treated with Tartar Emetic, 3 to 4 Cc. of a •esh 2% solution strictly intravenously for every 10 lbs. weight. Injections iven every second or third day, and dose gradually increased but not beyond 0 Cc. for every 10 lbs. weight.—J. S. Grove, Jl. A.M.A. iu/25,350. Tuberculous Hemoptysis arrested with Tartar Emetic by the mouth— total daily dose of 0-05 to 0T5 Gm., usually for 5 days, in pills containing *02 to 0-05 Gm. with 0-01 Gm. of Opium, with water an hour before or after leals.—Presse Med., Oct. 14/25, per Jl. A.M.A. ii./25,1762. See also B.M.J.E. ./25,76. Cancer.—Injections of a combined solution of Tartar Emetic and Emetine tated to have given good results.—L. i./28,1311. In cattle harbouring T.conqolense or T. vivax of value—1 Gm. intravenously very 5 days for 6 doses. Of no value in horses infected with T. brucei.-— Kenyon, 462. Successful in saving the lives of thousands of animals. A orm of Antimony which can be injected subcutaneously is urgently required. -Li. E. W. Bevan, Trans. Boy. Soc. Trop. Med., Aug., ’28,154. Criticism of statement that ‘ no treatment has been found to give satis- actory results in the case of T. vivax infection ’ (in cattle). After a single ourse of Tartar Emetic injections relapses to T. vivax infection are the xception, whereas relapses to T. congolense infection are the rule.-—H. E. lornby, Trans. Boy. Soc. Trop. Med., Jan. 30/29,403 ; also J. N. Hall, ibid. FUSterules of Antimony Potassium Tartrate, l grain (0 03 Gm.), grain (0-06 Gm.), and 2 grains (0-12 Gm.) in 1-5 Cc. (25 minims), , Cc. (45 minims) and 6 Cc. (90 minims), i.e. 2% solutions, are nade. For intravenous use. grams FJSolubes of Antimony Potassium Tartrate contain 10 0-6 Gm.) with Sodium Chloride 6 grains (0-4 Gm.), on the same fines as those of Antimony Sodium Tartrate, q.v. ’ulvis Antimonialis. (B.P. ’14.) James’s POWDER. Dose.—3 to 6 grains (0*2 to 0*4 Gm.). Contains 33 1 % Antimonious Oxide. jp)Pilu!a Antimonii Conii et Quininse. Dose.—As required in fever. James’s Powder 1 grain, Conium Extract 2 grains, Quinine Sulphate 2 grains. A pill on the lines of this formula had a reputation n Italy for treatment of malarial fevers. A most successful pill ised in a variety of febrile conditions. laustus Emeticus Purgans, Mid. H., 1927. Antimony Tartrate 1/6 grain, Magnesium Sulphate 60 grains, Vater to 1 ounce for a dose. Unguentum Tartari Stibiati. P. ITAL. V. Antimony Potassium Tartrate 20 Gm., Lanolin or Vaseline 80 Gm. VOL. I. * CE>¥inum Antimoniaie (B.P. 514.). Note,—CeD Preparations or admixtures containing Antimonial W ine. Dose.—10 to 30 minims (0-6 to 2 Cc.) ; as emetic 2 to 4 drachms (8 to 15 Cc.) ; contains 1 in 250 by volume. F.L (Second Int. Conf. 1925) is similar. Ph. Ned. V. has this. Flavoring,—It has little taste when diluted. Pneumonia is well treated by repeated 24 minim doses of Antimonial Wine. Crisis comes at the end of the fourth day. Headache due to high blood pressure.—Especially of value where chronic interstitial nephritis is a contraindication to Blue Pill.-—A. Eeiling, B.M.J. ii./30,907. For further uses see Antimonium Tartar alum. Antimonii et Sodii Tartras. Antimony! Sodium Tartrate. [Na(SbO)C4H406]2H20 = 635*592. (It is not a Poison within the meaning of the Act.) Dose.—Per os, presumably on the lines of Tartar Emetic. Intravenously, J to 2 grains (0-03 to 0-12 Gm.) usually in 1 or 2% dilution. Hypodermically it is not advised. Manufacture,—Boil Antimonious Oxide 10 in a solution of Sodium Acid Tartrate 13 until almost clear (the quantity of Antimonious Oxide is purposely in slight excess). Filter and evaporate to dryness. "W hen dried at 105° C. the substance retains l H20. Plimmer has shown that by adding alcohol to the concentrated solution the compound crystallises out with 2\ II30. There is no great advantage in this method. Furthermore, we have found that much of it remains in the mother liquor. The body is a white crystalline powder. Solubility, 1 in 14 of water. Uses,—This compound has properties similar to Tartar Emetic, Its greater solubility may be of some advantage. It is stated to have the lowest degree of toxicity of the Antimonials for intravenous injection—Chopra and Napier, I. M. G. Jan. 1923. It has been largely employed in bilharzia infection, in which it is effectual. Kala-azar has been treated with it. It has also been used in syphilis and in trypanosomiasis. Sfcerules 01 Antimony Sodium Tartrate.—J grain (0 03 Gm.) 1 grain (0-06 Gm.), and 2 grains (0T2 Gm.) in 1*5 cc. (25 minims), 3 cc. (45 minims) and 6 Cc. (90 minims) respectively, i.e. 2% solutions, are made. Antimony Sodium Tartrate Solubes 10 grains (o-6 Gm.), combined with Sodium Chloride (0-4 Gm.). These, on dissolving m 40 Cc. of distilled water and boiling produce a solution for injection. 2 Cc. contain I grain (0-03 Gm.). Convenient in the Tropics— J. B. Christopherson, L. i./24,lQ91. Caution.—One-third of the amount of Antimony injected is excreted by the kidneys in 24 hours. Great caution required where heart, kidney or lung disease crisis ' In weak emaciated and anaemic subjects begin with small dose gradually increased.—R. N, Chopra, per Jl. Prop Med., April 16/23,133. Bilharztasis.—For abstract of literature, see lartar Emetic. KaLA-azar well treated intravenously. Begin with small dose, 0-5 Cc. of 00/ increasing bv 0-5 Cc. up to a maximum of 5 Cc., and continue xor 2 to t months as required. Heart, kidneys and lungs must function well.—R. X. Ihopra and L. E. Napier, Ind. Med. Gaz., Jan. 1923, per B.M.J.E. i./23,4o. H. Trop. Med., Mar. 1/22,64. Oriental Sore.—5 to 10 Cc. of 1% solution intravenously daily, or less often, until healed.—A. W. Sheen, Pr. Feb. 21, p. 85. See also J. 15. Christo- pherson, Jl. Trop. Med., June 1/23,205. Oriental sore in Russian Turkestan —well treated with 2% solution.—Maj. J. A. Sinton, per Jl. Trop. Med., June 1/23,200. Filariasis is not cured by Antimony Tartrate intravenously.-—G. C. Low, L. i./21,221. (Sir L. Itogers tried Antimony Sodium Tartrate.) Granuloma Pudendi well treated. Salvarsan useless.—D. J. Maxwell, JL Trop. Med., July 2/23,235. Leishmaniasis oe the Skin is treated with this and Tartar Emetic q.v. Syphilis treated intravenously. Initial dose A grain, increased to 1£ or 2 grains—in 3 Cc. of water. In one case 23 grains total. Results not inferior to those with Arsenic.—F. G. Cawston, B.M.J. i./22,266. Tuberculous Disease of the lungs and of the eye treated. Tartar Emetic (intravenously) deserves further trial.—F. G. Cawston, B.M.J. i./24,82c. Trypanosomiasis.—In the experimental treatment in rats 0-5 Cc. of 1 % solution per Gin. weight considered maximum dose. Its quickness of action is remarkable. A few persistent forms can still be found in the liver. They need to be tired out by successive doses.—Plimmer and Thomson. Some cases tend towards a natural recovery and appear to respond well to treatment, others get progressively worse in spite of remedies.—Wenyon. Earlier Refs, in trypanosomiasis.—Edn. XIX., p. 1G7. Unguentum Antimonii. We have made this ointment containing 5% and upwards of finely powdered Metallic Antimony in a basis of Lanolin Ointment for use in skin affections. Urea Stibamine is composed of Urea and 'p-amino-phenylstibinic acid NH3C6H43bO.(OI[)2, but apparently not a definite compound. Kala-azar. Safer than Tartar Emetic. An effective intravenous dose stated to be 0-25 dm.—U. X. Brahmachari.—Ind. Jl. Med. Res., 1922, Y.B.P., ’23,64. See also Jl. Trop. Med., July 15/24,203. I.M.G. ’24,391 and 464. Intravenous injections on alternate days, starting with 0-1 Gm. in cold sterile water, increasing by 0-05 Gm. to a maximum of 0-25 Gm. and continued for subsequent doses. Rapidity of disappearance of symptoms compared with Sodium Antimony Tartrate, 2 to 3 weeks as against 3 months.— H. E. Shortt and Ram Taran Sen, I.M.G. 1923,289 ; C.D., Feb. 23/24,259. Reactions following administration.-—-L. E. Napier, I.M.G., Nov. ’26,559. See also N. Chatterjee, I.M.G., June ’26,284 ; I.M.G., June, ’26,291. Leishmania well treated.—U. Brahmachari and R. Banerjea. JL Roy. Soc. Trop. Med., Nov. 25/29,301. Further notes on kala-azar treated with organic Antimony compounds.— U. Brahmachari and Go-workers, Tr. Rov. Soc. Trop. Med., Apl. 17/30,617; Nov. 25, ’30,351. 4 Aminostiburea ’ is said to be a compound of ^-amino-phenylstibmic Acid with Urea and Glucose. In Kala-azar.—L. E. Napier, I.M.G., Dec., ’25,571. Stibamine Glucoside.—A compound containing 30% Antimony and allied to 39-amino-phenylstibinic acid. It has a 111.l.d. of about 500 mgm. per kilo. Average duration of treatment about a month. Initial dose 0-1 Gm. of 4% solution intravenously, 0*2 Gm. the maximum for patients weighing over 50 lbs. Injections on alternate days.—L. Napier,T.M.G., Jan., ’25,24. ^UNeostam’ (T.M. 464,641). A brand of Stibamine Glucoside (the Nitro- gen-glucosidc of Sodium ^-Aminophenylstibinate), available in phials of 0-05, 0T, 0-2, 0-5 and 1 Gm. for use in Kala-azar, etc. *Necstibc.san (T.M. 491346). Syn. ‘ 693 B.’ piethylamine-^-Amino- phenyl Stibinate now supersedes both Stibenyl and Stibosan. > In kala-azar. Initial dose 0-05 to 0-2 Gm. according to age intravenously ; 8 injections on 8 consecutive days for intensive treatment. See also B.M.J .E. L/31,65. ^Fcuadin (T.M. 503040). Sodium Antimony Pyrocatechiri-disulphonate, Schistosomiasis cured by intramuscular injections of 1 to 5 Cc. of 7% solution. Local reaction slight, and no deaths or serious symptoms occurred m 20 cases. 2 weeks treatment gives cure.—B.M.J.E. iL/29,92. Schistosomiasis in W. African children. Given intramuscularly, the total lourse of treatment being equivalent in Ccs. to the weight of the cmld m kilos ; given in 10 doses, the third to the tenth being equal and given on alternate lays ; the first injections given on consecutive days and being about 30% F 2 and 70% respectively of succeeding full doses. Of 6 cases treated all were clear of ova by the twenty-fourth day, but there was loss of weight and considerable local pain.—R. M. Gordon and E. P. Hicks, Ann. Trop. Med., Oct. 22/1930. Nine intramuscular injections for an adult, cure in the majority of cases. First day, 1-5 Cc. ; second, 3-5 Cc. ; third, 5 Cc. ; fifth, 5 Cc. ; seventh, 5 Cc. ; ninth, 5 Cc.; eleventh, 5 Cc. ; thirteenth, 5 Cc. ; fifteenth, 5 Cc. If ova found give further two doses.—M. Khalil and M. H. Betache, L. i./3o,234. Advantages over Tartar Emetic—duration of treatment 10 days less, and absence of local complications. Disadvantages—greater expense ; sometimes causes brachycardia ; preparation a monopoly.—B.M.J. ii./31,1191. Leishmaniasis cured. No pain intramuscularly.—L. ii./3i,1145. Aromatic Stibinic Acids containing Phenyl and Quinolyi radicals. It was not found possible to prepare the Stibinic analogue of Tryparsamide (Sodium Y-phenyl-glycineamide-p-stibinate), which Brahmachari claims to have isolated, m-amino-phenyl-stibinic Acid is however much more stable than the p acid. The material supplied by Brahmachari did not agree with theory, but it has been efficacious in the East clinically.—Prof. G. T. Morgan, Brit. Assn. Meeting, Bristol, 1930. The following inter alia have been prepared and their trypanocidal action has been determined by Professor Warrington Yorke under the Chemotherapy Comm, of the M.R.C. They were given intraperi- toneally and were found to possess only slight activity against T. equiperdum. The M.L.D.s are given in mgr. per 20 Gm. mouse, Sodium m-aminophenylstibinate being included for comparison. Substance. M.L.D. Sodium w-aminophenylstibinate. ... ... ... 25 Sodium m-carbamidophenylstibinate.25 Sodium iV-phenylglycineamide-m-stibinate ... ... 20 Sodium M-phenylglycinemethylamide-m-stibinate ... 30 Acetylated 3-amino-4-hydroxyphenylstibinic acid ... 10 Sodium Quinolyi-5-stibinate ... ... ... ... TS Sodium Quinolyl-6-stibinate . ... ... 3-6 Quinolyl-8-stibinic acid... ... ... ... ... 0-9 —G. T. Morgan and J. W. Cook (Cliem. lies. Lab., Teddington), J.C.S., April, 1930. Antimonial Analogues of the Carbazole Series. A description of certain organic derivatives in which Antimony replaces Nitrogen in the Carbazole nucleus, the starting material in the research being o-aminodiphenyl prepared from commercial Diphenyl. Xenyl-o-stibinic Acid C6H5.CBH4SbO(OH)2, Nenyl-o-stibine Tetrachloride CflH5.C6H4.SbCl4, Xenyl-o-stibine Dichloride C6H5.CcH4.SbCl2, Xenyl-o-stibine Di-iodide CfiHs.CflH4.SbI2, Xenylcnestibine Iodide (CeH4)2: Sbl, Xenylenemethylstibine (CfiH4h : Sb.CHj, and a number of other derivatives are described—G. T. Morgan and G. It. Davies (Cliem. Res. Lab., Teddington), Proc. Roy. Soc. A., Vol. 127, 1930. . ^ ^ The pharmacological action of organic Antimony derivatives.—R. N. Chopra, I.M.G., Apl. ’26,162. For further Organic Antimony Compounds, see Vol. II. APIOL (LIQUID). JDose.—3 to 6 minims (0-2 to 0-4 Cc.), in Perles, 3 minims in each, or Capsules 3, 5, and 10 minims. Liquid Apiol is obtained from, and contains the active properties of, the fruit of Carum Petroselinum, Syn. Apium Petroselinum, Petroselinum sativum, common parsley. It is a green oil, with a peculiar odour and a pungent taste like parsley. Soluble readily in alcohol and ether. The only substance to which the name Apiol can be correctly applied is the crystalline Stearoptene, previously in the Fr. Cx. The essential oil of Parsley appears to be the only body worthy of the name liquid Apiol and that only from an Apiol-bearing variety of parsley.—J. F. Walmsley, P.J. ! ii./28,89. P. Belg. IV. has the Liquid preparation. Liquid Apiol has decided efficacy in primary amenorrhoea or de- fficiency of secretion, as well as in accidental suppression and in dys- menorrhcea. Should be given night and morning for 4 or 5 days during the time. Parsley contains no alkaloid ; cf. JEthusa Cynapium. ;£l]Gapsules of Liquid Apiol and Ergotin. Contain Liquid Apiol 5 minims (0-3 Cc.) and Ergotin 2 grains [(012 Gm.). jPjjErgoapioI. Under this name capsules are supplied for amenorrhoea, dysmenorrhoea and allied disorders. Gall Stones treated by infusion of parsley—a double handful of fresh parsley ^ eaves soaked in cold water, which was afterwards brought to the boil, strained und allowed to cool. Dose : 14 pints daily. Obviated operation for years.— EL C. Kidd, B.M.J. ii./2o,244. Apiol, Crystallised. ‘ White Apiol ’ Ether Methylenique et DIMETHYLIQUE DE U ALLYL-APIONOL. CaMPHRE DE PERSIL. E.E. VIII. (Was inFR. Cx.) CH2: 02: C6H(OCH3)2CH2.CH. : CH2= 222-1092. In acicular crystals. For amenorrhoea a solution in olive oil containing p grains (0-2 Gm.) in 15 minims (1 Cc.) has been given—injected once daily for tome days before the period. Also given as a quinine substitute in malaria. Apium graveclens. (Umbelliferce) Ache des Marais.—Fr. Cx. Celery. The entire herb is used in ‘ Sirop des Cinq racines.’ Oil of Celery. Dose.—£ to 3 minims or more. Capsules are made 3£ md 5 minims. Contains a small proportion of Apiol. Antispasmodic and lerve stimulant. In rheumatoid arthritis 5 to 15 minim doses have been used successfully, t acts probably as an intestinal antiseptic. HAPOMORPHINiE HYDROCHLORIDUM. (Fj]Apomorphine and its Salts. Q Apomorphine Hydrochloride (B.P. ’14). U.S. X., P. Helv., P. Jap., P.G. VI., Ph. Ned. V. Chloretum Apomorphicum, P. Dan., P. Ital. V., E.E. VIII., P. Belg. IV. For details of the Chemical Formula of this body, see Volll. Dose.—to W grain (0-002 to 0-004 Gm.), increased, as an expectorant (not official) ; f-() to | grain (0-006 to 0-016 Gm.) as m emetic per os ; to y^- grain (0-003 to 0-006 Gm.) as emetic hypo- lermically. A derivative of morphine or codeine obtained by heating them vith an excess of hydrochloric acid in sealed tubes. In commerce he hydrochloride occurs in greyish white, acicular crystals. Misleading to describe the reaction in making Apomorphine as due to loss of i molecule of II20.—D. B. Dott, P.J. i./3i,516. Soluble,—1 in GO of water, 1 in 5 of alcohol 90%. Insoluble in ither and chloroform. A trace of acid prevents solutions turning jreen, vide Injectio postea. Incompatible with sodium carbonate and bicarbonate, tannin and iron salts. Uses,—In all cases of poisoning it is of g?’eai value as an emetic. It is an anti-stimulant ; in bronchial asthma doses of | grain are very useful. Small doses are expectorant and relieve bronchitis and pertussis. In puerperal convulsions it soon causes vomiting and f ree perspiration ; patient sleeps and awakes quiet. In a case of obstruction of the oesophagus by a plumstone, the injection of Apomorphine hypodermically caused its removal. (©Tabelke Apoinorpliinse, too grain (°'°006 Cm.) and -6V grain (0-0013 Gm.) in each, with chocolate. (©Injectio Apomorphinae Hypodermica. (B.P. ’14). Apomorphine Hydrochloride 1, Diluted Hydrochloric Acid 1, Distilled Water to 100. TV grain in 11 minims. Dose.—5 to 10 minims (or more) as an emetic. The addition of the trace of acid keeps it stable and colourless. The following will also remain colourless:—Shake Apomorphine Hydrochloride 1, with Alcohol 90% 50 ; add Water 140 and finally Diluted Hydrochloric Acid 10.—Pharm. Zeitung 6i,640. We found the formula satisfactory. The effect produced by a small injection on a mad-drunk patient is remarkable. As hypnotic Ao to Wo grain. The patient, however wild, sleeps 12 hours and awakes refreshed.—B.M.J. ii./i 3,663. (©Hypodermic Tablets are prepared containing yV and grain in each. (© Sterules, Hypodermic contain % grain. (©Syrupus Apomorphinae (Hydrocliloridi), b.p.c. Apomorphine Hydrochloride 0-05, Diluted Hydrochloric Acid 0*25, Alcohol (90%) 4-5, Distilled Water 4-5, Syrup to 100. Dose.—| to 1 drachm (2 to 4 Cc.), contains grain Apomorphine Hydrochloride in 1 drachm. (©Linctus Apomorphinae cum Codeina. (Adopted by St. G. H.) Dose.—1 drachm (4 Cc.). Apomorphine At grain, Codeine Phosphate TV grain, Dilute Hydrocyanic Acid 2 minims, Syrup of Virginian Prune to 1 drachm. A useful expectorant. (©Mistura Apomorphinse Composita (Syn. Misiura Tussis* Luff.) Dose.—Half ounce every four hours. Apomorphine Hydrochloride 1/48 grain, Morphine Hydrochloride' 1/24 grain, Heroin Hydrochloride 1/24 grain, Dilute Hydrochloric- Acid 5 minims, Syrup of Virginian Prune b drachm, Chloroform Water to 1, ounce. A palatable mixture useful for irritable cough, expecially postinfluenzal cough. The hydrochloric acid effectually prevents the precipitation of any of the alkaloids. AQXJiE CONCENTRATES. These are made 40 times as strong as the distilled Aromatic Waters by dissolving the requisite amount of Essential Oils in 70% Alcohol. They keep good any length of time in any climate The following amounts of Essential Oil (or ingredient) make 100 ; parts of concentrated water Aqua Anetlii Cone.s-0 Aurantii Floris Cone. ... 8-0 Camphorse Cone. ... 4-0 (Camphor) Carui Cone. .8-0 Chloroform! Cone. ...10-0 ? 5 5 5 Aqua Cinnamoni Cone. ,, Foeniculi Cone. ... ,, Menthse Piperita Cone. >> Pimentse Cone. Sambuci Cone. 8-0 S-0 8-0 5-0 1-0 ” . ~ ^ w. ... O.V7 , , UtliUUUOl UUI1C. . . . ... JL I he more soluble Terpeneless and Sesquiterpeneless Oi s may be used ARGENTUM. Ag= 107-88. Leaf Silver as wound dressing.—L. ii./2Q,1166. Argent! Acetal CH3COO Ag=166-9034. In white crystals, soluble in water. A 1% solution for purulent ophthalmia in infants. Dilute Salt Solution may be used after it. Ophthalmia Neonatorum is prevented by Silver Acetate as well as by phe. Nitrate ; causes less catarrh.—B.M.J.E. i./26,39. H! Argent! Cyanidum. AgON =133-89. Bose.—to Ay grain (o-ooi to 0-0G3 Gm.) White powder containing 80*48% Ag. Antipyretic occasionally ised in epilepsy and chorea. 'Hi Pilula Argenti Cyanidi contains grain. Recovery of Silver in the electrolytic refining of Cupper. Electro-plating, ising Silver Cyanide and Potassium Cyanide. Silver.ag of mirrors.—G. vlalcolm Dyson, P.J. ii./29,117. Vrgenti Ghloridum. AgOl. =143*337. Varicose Ulcers.—-Silver Chloride suspension made in the presence of ^ protective found to be useful, emploving 1 to 10% dilutions. 4% usually mployed.—B.M.J.E. ii./26,44. Argent! Iodidum Eecens. Ag 1=234*812. In the freshly precipitated form this salt has been used in cases )f ophthalmia. It has astringent properties stated to be almost as pod as Adrenalin. Urethritis.—Nascent silver iodide in 3% suspension may be produced L’om silver nitrate 2-2 Gm., potassium iodide 2*2 Gm., distilled water 50 Cc., aucilage of Irish moss N.E. to 100 Cc. For a light flocculent precipitate dis- olve each in 50 Cc. of water. To produce a coarse precipitate the salts are eparately dissolved in 5 Cc. of water, shaken and diluted with the mucilage, felatin 0-3% has also been used to dissolve the Potassium Iodide. Corneal opacities, conjunctivitis and pannus have been treated, commencing dth 1% strength. In ulcer of the cornea it should be used cautiously. For onorrhoeal ophthalmia most efficacious. One drop of weak solution instilled hree times a day or oftener in cases of extensive chemosis and danger of orneal sloughing, alters the condition in a few days.—P. Moloney. Neoprotosil.—A colloidal protein-Silver Iodide compound, containing bout 20% Silver Iodide in scales, readily soluble in water, but when making solution the container should be briskly shaken for a minute. The solution i bland and bactericidal in urethritis^inflamed conditions of the eye, ear, ose and bladder, etc.—L. ii./22,298. : Neoprotosil Capsules.—One dissolved in 2 clraclims of water forms a % solution. Argentine.—A concentrated Solution of Silver Iodide, containing 100 rains in each ounce. A small quantity added to water causes a precipitate [ silver iodide for cystitis, gonorrhoea and conjunctivitis. Cystography.—A 5% Silver Iodide emulsion makes a good opaque medium and lias soothing antiseptic action on the bladder. Also of value for urethrograms—distend urethra by means of syringe and inject solution during entire time of exposure.—W. P. Braaseli, “ Urography,” reviewed B.M.J. l/28,849. ArgentietPotassiiIodidum. Silver Potassium Iodide. KAgI2.—400*844. The double Iodide of Potassium and Silver (Mellor’s Inorg. and Theor. Chem.). A crystalline substance readily soluble in water. Silver Iodide is precipitated on dilution but precipitation is not complete until a fairly high dilution is reached. Preparation of an Injection.—One part of crystallised Silver Potassium Iodide and 4 parts Potassium Iodide are dissolved in water, as required, in strengths of 0*5 Gm., 1 Gm., and 1*5 Gin., in 20 Cc. in each case. Each of the dilutions contains a fine suspension of Silver Iodide and a solution of the double salt. Uses.—In gonorrhoea the injection of 20 Cc. into the meatus (apply tight bandage over glands for 15—30 minutes after injection), causes a rapid decrease of discharge after 6 injections and a complete disappearance of gonococci after 12 to 15 injections. Injections need only be given twice or thrice weekly, as Silver Iodide persists in the urethra.—S. R. Naidu, B.M.J. i./27,139. Argenti Nitras. AgN03=169*88. Syn. Lunar Caustic. Dose.—J to grain (0-016 to 0-03 Gm.) in a pill, best with kaolin ointment as an excipient. Incompatible with organic material, e.g., rose water, if used instead of distilled water for preparing a lotion of pigment; also with Tartaric Acid, Hydrocyanic Acid, Iodine, Iodides and Bromides. Soluble 1 in 0*53 of water and 1 in 20 of alcohol 90%. TJses.—As a caustic and stimulant to promote healing. Small doses internally check diarrhoea of children. In typhoid, where there is haemorrhage £ grain every 3, 4 or 6 hours, or even as often as every 2 hours. Rectal injections are also useful for the bleeding of dysentery (GO grains in 3 pints). In laryngeal phthisis a spray £ to 2 grains to the ounce. In vomiting of pregnancy }. grain in a wine-glass of water every 6 hours has been found effective. In gastric ulcer i grain in a pill 3 or 4 times daily half an hour before food useful. Solutions have also been used. In eczema of the flexures and particularly of mucous surfaces, Solution 2 to 3%, alternating with Lotio Oalaminae Oleosa is valuable. Pigments, 2 to 5% are used for the throat, and applied to ulcers as a stimulant. Lotions and eye-drops vary from 1 in 1,000 to 1 in 100. Purulent ophthalmia is treated with 1 to 2% drops. Ulcerative stomatitis is well treated by 0*5 to 2% Solution. Glycerin 15% added to £ to 2% silver nitrate solution renders it less painful, and possibly more effective. Silver Nitrate is on the alert to react (e.g., precipitate with soluble chloride in such manner that its electrical state and stability of its ions are altered— herein lies its nature.—Burdon Cooper. War wounds have been treated by spraying with very dilute Solutions— see Wounds, Therap. Index. . Silver Nitrate stains on the skin may be removed with Mercuric Chloride solution. Urethral and Vaginal Injections. 0*02 toO’2% (1 in 5,000 to 1 in 500 usually employed. In lavage of the entire urethra 2 grains to the pint (1 in 5,000 approx.) is jmfficiently strong. Hydrostatic pressure may be used, i.e., the container being about 5 feet above the couch, instead of a syringe. Silver Nitrate has more penetrating effect than any organic Silver compound jmd should be adhered to as a standard remedy for injection treatment o gonorrhoea.—Brit. Jl. Yen. Dis., Oct. ’25,245, per Pres., Feb. ’26,78. Cystitis : Diagnosis and treatment. Against IJrotropine there are innumerable failures. Ideal urinary antiseptic not found. With regard to avage, Silver Nitrate best. A weak solution, 1 in 20,000 first, gradually ncreased. Eusol as accessory to supra-pubic drainage ; rarely with catheter —too painful. Vaccines useless.—J. F. Dobson, B.M.J. ii./21,305. Epithelial Tumours of the Urinary Bladder. The old-fashioned Silver Nitrate washes still hold the field. A patient had the bladder washed Dut over 2,000 times. Diathermy more rapid.—F. Kidd, L. i./23,582. Whooping Cough treated by painting the throat every two days with 11% Silver Nitrate Solution—success attributed to suggestion rather than Dactericidal action.—L. i./2i.l312. Creeping Disease (Pseudo-myiasis), a suspected case of, successfully created with Nitrate of Silver.—A. Gambier, per Jl. Trop. Med., April 16/23,133. Antidote to Silver Nitrate.—Common salt, given in some demulcent irink (excess should be avoided as it is very irritant to the stomach). Salt is also used to arrest its action locally as a caustic. The pain caused by ipplication of solutions of silver nitrate may be alleviated by previous application of a solution of cocaine nitrate. Argyria produced. Inside of nose repeatedly painted for 18 months, and ifter an interval of a year nose and throat painted practically daily. Pro- onged use dangerous.—per Clin. Jl. Jan. 3/23,6. A mixture of 0-25% Potassium Ferricvanide and 6% Sodium Thiosulphate njected infradermally quickly removed discoloration.—per Pres., Oct. '2 8,324. Ferricyanide 1% with Thiosulphate 6% removes a large part of the Silver rom the skin in old cases with deep pigmentation. As many as 200 injections nay be made in 2 hours. A small dose of Morphine and Atropine cuts short iting of the injection.—A. W. Stillians and T. K. Lawless, Jl. A.M.A. i./2q,21. Strains on hands caused by Silver Nitrate are best removed by Potassium Oyanide. Or by first wetting with tap water, rubbing Potassium Iodide Crystals over the area and allowing to remain on the skin for several hours.— W. W. Wilkerson. Jl.A.M.A. L/32,72. Liquor® Argent! Nitratis, R.O.H.—4 to 8 grains to 1 ounce (1 to 2% ipprox.). In ulcerative blepharitis 1 or 2% solution a sovereign remedy ; Protargol L0% or Argyrol 20% may be employed.—It. A. Greeves, L. ii./23,997. As prophylactic, drops should not be used in stronger solution than 1%, md caution needed if used more than once or twice. Case of conjunctival laemorrhage following 5 instillations of 1-5% solution.—L. i./28,716. [Jrethral Bougies of Silver Nitrate contain £ grain with Theobroma Dasis. Give good results in obstinate cases of gonorrhoea. Vrgenti Nltras Fusus. U.S. Contains 94*5% of Silver Nitrate. Silver Nitrate 100 Gm., Hydrochloric Acid 4 Gm. Melt at low ! temperature and pour into suitable moulds. Argent! Nitras Mitlgatus (B.P. ’14). Syn. MITIGATED CAUSTIC. Silver Nitrate 1, Potassium Nitrate 2, fused together and moulded nto sticks for use as caustic.—P. Jap. uses equal parts. Vrgenti Nitras Induratus, Toughened Caustic (B.P. ’14). Contains 5% of potassium nitrate moulded into caustic points. For the use of Silver Nitrate in preparation of Hair Byes, see Yol. II. Pigmentum Argenti Nitratis ZEthereum, L.H. Silver Nitrate 10 grains, Distilled Water 1 drachm, Spirit of Nitrous Ether to 1 ounce. Caustic even when painted on a greasy skin. 3 to 10 grains to the ounce relieves pruritus ani and pruritus vulv®. [§ji ||P l] Piluia Argenti Nitratis et Morphinte Acetalis, Crocq’s Pill, contains } grain of each salt made with Kaolin Ointment. Unguentum Argenti Nitratis Composition. Syn. Unguentum Billrothi, Ph. Ned. V. Silver Nitrate 1, Peru Balsam 5, Yellow Soft Paraffin 94. Pigmentum Delineans K.G.H. No. 1, Silver Nitrate 5 grains, Water 1 ounce. No. 2, Pyrogallol 10 grains. Water 1 ounce. The solutions are used in conjunction. Argenti Oxidmn. B.P. ’98. Ag20—231-76. Dose.— J to 2 grains in a pill with kaolin ointment. Is not so caustic in action as silver nitrate. Continued administration may discolour the skin. It readily yields its oxygen, and will explode (if mixed) with such bodies as phenol and creosote. ZTses.—Has been given in epilepsy, chorea, and dysentery. It stains the skin less than the nitrate. Argenti Fluoridum (soluble 1 iu 2), Argenti Citras (hardly soluble), and Argenti Lactas, are occasionally used by urethral injection, strength 1 in 5,000 upwards, in gonorrhoea. £ Argyrol (T.M. 255098).—Syn. VlTELLIN. ARGENTUM VlTELLINATUM, P. Belg. IV., Plata Vitelina, F.E. VIII. A vegetable protein compound containing about 30% of silver. Soluble in water in all proportions—solutions keep well. Inpom- patib/e with Cocaine Hydrochloride (confirmed, P.J. h/32,282. 10% found compatible with 1% Atropine Sulphate—ibid.) In purulent conjunctivitis (gonorrhoeal, neonatorum, etc.), free instillation of 25% solution every 3 or 4 hours ; catarrhal conjunctivitis, 5 to 20% one or more times daily ; trachoma, 25% solution rubbed with force on wool into lids once daily ; dacryocystitis, comeal ulcers, etc., 25% solution. Numerous critical views as to its efficacy have been published. Ulcerative colitis has been treated by washing out with IT pints of 1% Argyrol solution at 80° F. Unguentum Argyrol 2% with paraffin basis in eczematous conjunctivitis and keratitis. R.O.H. has 20%. Suppositories containing 1 to 4 grains have been used. Argento-Proteinum Mite. Syn. MlLD SILVER PROTEIN, MlLP Protargin, U.S. X. Contains not less than 19% or more than 25% Silver. It is in dark brown or almost black shining scales or granules. It is therefore of the Argyrol type (cf. N.N.1U, 1925). * Collargolum (T.M. 219555), Colloid Silver.—Syn. Argentum Colloid ale, P. Jap. IV., Argentum Cr£de. Plata Coloidal F.E. VIII. Dose.—£ to 2 grains (0-03 to 0-12 Gtn.) in pills or solution. Argent Colloidal (Collargol). Fr. Cx. Nouv. Supp. ’26 (and P.G. VI.). Contains at least 70% Silver in combination with albuminoid substances. Soluble slowly 1 in 25 in cold water. The precipitate obtained on adding saturated solution of Sodium Chloride re-dissolves on further addition of water. P.G. VI. says, on adding dilute mineral acids to aqueous solution, a precipitate forms which re-dissolves on neutralising with alkalis. Ph. Ned. V. requires 74-5 to 80% Silver. P. Svec. X. 72 to 80%. Collargol Tablets contain £ grain (0-05 Gm.). Black scales, miscible in all proportions with water, but does not form a clear solution even when dilute. Internally has been used for gastric and intestinal catarrh ; also inirqvenws injections of a i to 1% solution for septic affections such as endocarditis, also in difficult labours where septic complications feared. 0T to 0T5 Gm. in 1% solution as a dose. For ophthalmic use 1 to 10% solutions are employed. Diphtheritic membrane is said to disappear under swabbing with 5 % solution. B. CoH and other infections of the urinary tract satisfactorily treated with various strengths (0-5 to 4%).—H. H. Sanguinetti, B.M.J. h/25,1168. Suppositories of Collargol 2£ grains, also (©Compound Collargol Suppository, Collargol 2% Ethyl-Morphine Hydrochloride f, Extract of Indian Hemp 2 grains, Glycerin and Cacao Butter q.s. In pelvic suppurations with pain, tenderness and general septic symntoms. Unguentum Cr6d6. Collargol 15, Adeps Benzoatus 75, Cera Alba 10. For eczema, syphilis and gonorrhoea, and as a prophvlactic to gonorrhoeal ophthalmia. Argentum Proteinicum, P.G. VI., Ph. Ital V., P. Jap. IV., Ph. Ned. V., F.E. VIII. and P. Helv. (8% Ag.). P. Belg. IV. Syn. ^cArgein (T.M. 364945) ; s^Protargen (T.M. 368227); ^Protargol (T.M. 322555). P. Austr, Argento-Proteintjm Forte, c Strong Silver-Protein,’ U.S. X. P. Svec. X. 7*8 to „ 10% Ag. Dose (internally ).—1 to 3 grains (0-06 to 0-2 Gm.). Patent 18478/1897 now exp/red. Three methods of making are given in the specification. (1) deals with the precipitation of Protalbumose 4-4 with Silver Nitrate 1, in 14 of water and the subsequent heating on a water bath of the washed moist precipitate with a warm solution of Deuteroalbuminose 5, in water 4}. The precipitate dissolves and the soluble Silver Proteinate is obtained by evaporating under reduced pressure. (2) Peptone and Silver Oxide are used, and in (3) Peptone and Silver Nitrate. Characters.—A protein compoun , containing 8% of silver, very soluble in water. Decomposes with heat. Solutions i to 1% (or stronger up to 10 and 40%) for ophthalmic use, and from 4 to 20% for wounds and ulcers, are prepared by rubbing the powder into a paste with water and diluting as required with cold or lukewarm (not hot) water. Stains the conjunctiva to some extent. Ointments 5 to 10%. It is alkaline to litmus and precipitates Cocaine Hydrochloride, but 10% found compatible with the Nitrate (2%). P.J. i./32,282 ; also with 1% Atropine Sulphate.—ibid. Gonorrhoea well treated with 4 to 10% solutions, injections to be made every half-hour and retained five to ten minutes.—M.P.C. ii./11,559. Bactericidal Power of the Various Silver Preparations. — The organic silver preparations are far less penetrating and active than silver nitrate. See Vol. II. Ophthalmic Use.—A coilyrium containing half a grain of sulphate of zinc and 10 grains of boric acid is more cleanly, certain and promptly ellicacious ‘than the silver compounds.—S. Theobald, L. ii./n,1570. Liquor Protargol R.O.H. Protargol 40, 60, 120, or 160 grains, Sterile Water to 1 ounce. Steruies Gphthalmic of 10 and 25% solutions are prepared. Collapsible Tubes of Silver Proteinate Ointment in paraffin basis, 2% and stronger as required, with catheter attachment are prepared for urethral medication in gonorrhea. 4 Capsungs ’ of Protargol Ointment contain 2 Gm. ol 2% Ointment 111 Soft Paraffin. Protargol Jelly. Syn. Schindler’s Jelly, Solve with slight heat Agar 1 in Distilled Water 200, when cold incorporate Protargol 1. In treatment of gonorrhoea the Agar has the effect of holding the Protargol in contact with the urethral wall. It must not be used too eariy before the acute stage has well subsided as it may prove irritating—nor should it remain in the urethra too long.—L. W. Harrison and C. H. H. Harold, B.A.M.C. Jl., Oct., 1912. Vide also Manual of Venereal Diseases by Sir Alfred Keogh, Brevet-Col. C. H. Melville, Brevet-Col. Sir William Leishman, and Major C. E. Pollock. Second Edition, 1916. Leistikow’s Bougies have a basis of starch, sugar, dextrin and a little glycerin. A silver salt (e.g., Silver Proteinate £ grain for each), is added and the mass is rolled into bougies. Before being used they are dipped in hot water, which makes the outside smooth and slippery. When left in the urethra they slowly dissolve.—ex ibid. Neisser’s Bougies. Silver Proteinate 1%, Antipyrin 2% in Cacao Butter or Glycogelatin basis. 4 inches long. Por the treatment of gonorrhoea. Silver Gelatose. P.G. VI. (15% Ag.), P. Svec. X. (16%). Syn. *Albargine (T.M. 258119) ; Patent 23,507/1900, expired 1914. According to the patent specification, Gelatose (produced by hydrolysis of glutin, etc., by acid or alkali) 10 Gm., is dissolved in water 10 Cc. and mixed after neutralising with Silver Nitrate 1-5 Gm. in water 5 Cc. The mixture is evaporated to dryness in vacuo. The salt thus obtained is a yellow white powder soluble to the extent of 50% in water. Preparation.—Por some details of procedure, vide Edn. XVIII., p. 189. Characters and Uses.—A non-irritant compound containing 15% silver, of sand-like appearance. Soluble in water (about 1 in 2), and in alcohol 90% about 1 in 130. For gonorrhoea a 0*2% solution injected four or five times daily. 0-5 to 3% for ophthalmic use. incompatible with Chlorides and Tannin. Stains on fabric may be removed with hot Sodium Thiosulphate solution 1 in 10. Silver Gelatose Enema. Dose.—1 pint increased to 1J pints of strength 1 grain in I ounce on successive days. Chronic Bacillary Dysentery Treatment.—Medicines per os cannot well reach the parts affected,—except, perhaps, large doses of Bismuth which might help to coat and protect ulcers. Medicated Enemata advised.— Silver Nitrate killed the Dysentery Bacillus in 5 minutes up to a dilution of 1 in 10,000, yet in the presence of a little broth (i.e., albuminous substances) it failed to kill in a dilution of 1 in 100 and 1 in 500—being at once precipitated by the broth. Albargin gave best results in broth, killing the Shiga Bacillus in 5 minutes up to dilutions of 1 in 500 and 1 in 1,000. Collargol, Ichthargan and Argyrol were inert in presence of broth, as also Copper Sulphate and Cuprol (Copper Nucleinate). Cyllin was active up to 1 in 2,500 and Iodine 1 in 1,000, as also lzal. In bacillary cases the Silver Gelatose Injection is of great value—not m amoebic cases (for these vide Emetine).—L. Rogers, B.M.J. ii./i3,U99. Gonorrhoea treated by irrigation with 1 in 4,000 Albargin solution.—D. Lees, B.M.J. ii./2i,4S0. 3$cTargesin (T.M. 469190). ..... . . A l)i-ucetyltannin Silver Albumen combination m scale form. Dose.— 1 to 5% aqueous solutions for irrigation in gonorrhoeal infections in the male and 6 to 10% in the female. 5% ointment issued for inflammatory eye affections, and for ulcers, and skin affections. Silver and other Hair Dyes.—See Vol. II. HARSENIUM. As=74-93. |5T)4 Arsenic and its Preparations.’ (Except for Agricultural, etc., purposes, see Schedule of Poisons.) Applicable to Irish Free State : [jjj ‘ Arsenic and its preparations.’ [jpUApplicable to Northern Ireland : as Great Britain, except the 1925 and 1926 alterations to the British Schedule. Agricultural According stances, i.e., and Horticultural Poisons. . to the Poisons <b Pharmacy Act, 1908, Poisonous Sub- those containing Arsenic, Tobacco, or the Alkaloids of i Tobacco (i.e., Nicotine in 'particular), used exclusively for the above purposes for destroying insects, fungi, or bacteria, or as sheep dip or weed killers, may be sold in Great Britain and 1 reland by Pharmaceutical Chemists, Chemists and Druggists, and Registered Drug- , gists and by persons licensed by local authorities who conform to the Regulations of the Privy Council as to storage, transport, etc., pro- \ viding the provisions of the Pharmacy Acts and those appertaining to the Arsenic Act in the case of Arsenical Preparations are complied with. See also Agricultural and Horticultural Poisons at end of the book. PlAcidum Arseniosum. As203= 197-86. Syn. Arsenic; White Arsenic, Arsenious Anhydride, Arsenious Acid, Arseni Trioxidum U.S. Dose.—-fa to yu grain (0-001 to 0-004 Gm.). Maximum single dose fa grain f 0-005 Gm.) ; maximum daily j dose i grain (0-016 Gm.). Possible fatal dose—2 grains. Made by roasting arsenical ores, occurs in white lumps or powder. Soluble about 1 in 60 of water. This solution is practically neutral, at any rate is compatible with both acids and alkalis. The ; solubility in w'eak Hydrochloric Acid solution is about the same. I More soluble in Alkaline hydroxide and carbonate solutions. Ac- > cording to our experiments it is ver}7- soluble in Glycerin, at least 1 in 7—cf. Antimony Oxide. Physical characters of specimens, however, vary considerably. Incompatible with Iron Salts, Lime Water, and Magnesia. Uses.—It is given internally immediately after meals as a general tonic and nerve tonic, as for chorea, in diabetes and anaemia, as antiperiodic for malaria, for chronic skin diseases, and in association with iron, which it appears to render more easily assimilated. : Latterly its efficacy in all forms of skin affections has been doubted. Small doses of Antimony it is stated may succeed when arsenic fails—especially in lichen planus. It is said to increase respiratory i power (Styrian mountaineers add it to their diet) and to improve the i complexion. All preparations of arsenic should be given after food. Externally it has a caustic action, and is put into the cavities of carious teeth to kill the nerves. Rheumatoid arthritis is treated by Arsenic, but its action is slow and it must be given for w'eeks or even months. In certain types of nervous vomiting in childhood, in obstinate cases, small doses of Arsenic and Opium, just before meals, are often immediately efficacious. In tuberculosis may be of use. Arsenic interferes with carbohydrate metabolism, so that after the exhibition of small medicinal doses fat is laid on, especially in the subcutaneous regions. Arsenic also has a favourable influence on growth.—Dixon, Pr. 1913, 1. For f urthev uses see Liquor Arsenicalis and Liquor Arsenici H ydrochloricus. L 74 o > i 1 O 0 > 1 6 0 > 0 > 1 "SO [jp I] Pills and Tablets of Arsenious Acid contain and A0- grain. P. Jap. IV. Pills contain o-ooi Gm. (Hj grain). Toxicpiogy. An interesting resume in a paper on “ The Relationship of Medicine and Toxicology ” of numerous causes celebres in which Arsenic and Antimony have been found. In one instance Arsenic, given apparently for poisoning, was found in the hair to the extent of 1/22 mgr. in 3 Gm. of hair.—Sir William Willcox, L. i.As,167. !n criminal cases of Arsenical poisoning the symptoms may be those of acute Arsenical poisoning, such as one would expect from a single dose, masked by those of prolonged action of Arsenic. Thus, symptoms of Arsenical neuritis or renal or liver disease may be superimposed upon those of the acute gastro- intestinal symptoms.—Sir William Willcox, B.M.J. ii./22,118 and L. ii./22,129, 139. See Vol. II. for a further abstract of this paper. Arsenic can be found months or years after taking, in the nails and hair.— Sir W. Willcox, M.P.C., Nov. 12,’30. Stoke-on-Trent Arsenic in sweets trouble. No deaths, probably because of the large amount, 77 to 150 grains of Arsenic in the lb. of sweets. It was used as dusting powder and got into treacle and was originally bought by colour manufacturers, who left it on the premises where the sweets were made.—- B.M.J. ii./3o,492. M.O.H. on the ease of obtaining large quantities of Arsenic by colour merchants, and leaving it about after vacating works.—P. J. ii./3o,305. Arsenic Eating, Arsenical Fly Papers, Weed Killers, Arsenical Wood Preservatives, Detection of Arsenic in Drugs, Organs of the Body, etc., and Various Arsenic Tests, see Vol. II. Arsenic in Pha.rsTta.cy and Chemistry. Occurrence, Metal, Oompounds (weed-killers, etc.), Veterinary, etc., preparations.—G. Malcolm Dyson, P.J. b/29,72. Arsenic in the Middle Ages, Detection.—Ibid., 147. Organic compounds.—Ibid., 225. Antidotes, Stomach tube and emetics, olive oil, calcined magnesia in large quantity, mucilaginous drinks, stimulants and especially— Antidotum Arseilici, Antidote to Arsenic. P. Dan. U.S. X. (Ferri Hydroxidum cum Magnesii Oxido.) P. Helv., F.E. VIII. and P. Jap. use Feme Sulphate, and in other pharmacopoeias. Ferric Chloride 3 (or Strong Solution of Ferric Chloride B.P. '98,3), Water 17. When required for use add this solution to Calcined Magnesia 1, previously mixed with Water 19, and shake well. Should be freshly prepared, and given in doses of a tablcspoonful every 5 or 10 minutes, until the symptoms are relieved. Ferric Hydrate should be administered in at least 12 times the quantity of the Arsenic supposed to have been swallowed. The Antidote contains about 2£% of the hydrate. The diluted Ferric Solution and the mixture of Magnesium Oxide should be kept ready in separate bottles for immediate use. 7 he following is more expeditions in emergency. Dilute Tincture of Ferric (Idoride 4 ounce with half tumbler of water ; add l ounce of strong solution of Sodium Carbonate. This antidote is stated to only delay the average time of death.—II. MeGuigan, II. V. Atkinson and G. A. Brough, Jj. Am. Ph. A., per P.J. i.A3,483. Or give Liquor Ferri Dialysatus. Sodium Hyposulphite.—Arsenical poisoning due to drinking cider from a barrel which had previously contained Arsenic. Sodium Hyposulphite was given by the mouth in 2 Gm. doses, being repeated every time the patients vomited, and from the eighth to the fourteenth day all the patients (28) were given 20 grains daily. 'The most severe cases (13 died) were given daily intravenous injections of 7% grains. No immediate improvement was observed following the use of the drug. To be of possible value in acute poisoning it should be given at once and in maximum doses.—G. B. Lawson and co-workers, JJ. A.M.A. ii.,/25,26. See also Sodii Hyposulphis. So€lium Hydrosu/phite (q,v.) has been advised on basis of animal experiments (dogs). 0T Gm. per kilo followed by 25 Cc. N. Hydrochloric Acid, in a half-tumbler of water, and subsequently lavage. Solution (B.P. ’14). IV., E.E. VIII. Byn. Fr. Cx., Liquor iF lLiquor Arsenicalis, Fowler’s P.G. VI., P. Jap., P. Belg. Potassii Arsenitis, U.S. X. Dose.—2 to S minims (0-12 to 0-5 Co.). Contains i% CJ arsen- ious anhydride.—F.I. Fr. C %,—Max. dose during 24 hours, 25 minims approx. , p op.—The Arsenic is dissolved in excess of Caustic Potash and neutralised with Dilute Hydrochloric Acid. Strength to remain 1%. According to the proposed form it would appear that approx. 10% of the Arsenic is present as Metarsenite (KAs02) and the rest free. Omit Compound Tincture of Lavender. The preparation is colourless. Liquor Arsenicalis Neutralis Ausrr. and N.Z. Ph. Form (1%). Heat Arsenious Anhydride 87*5 grains with Glycerin 2 ounces, to loO < C. to dissolve. Cool and add Water 17 ozs., then Tinct, Lavand. Co. 288 minims, and finally Water q.s. to 1 pint. P.J. ii./3o,620.—Suggested previous^ by H. Finnemore, see ibid. i./3i,535. (The idea is interesting cf. the author s Glycerinum Antimonii Oxidi.) Incompatible with Liquor Strychninse Hydrochloridi. Employ Liquor Arsenici Hydrochloricus. Poisoning has occurred. Exophthalmic Goitre.—Arsenic is a routine treatment, 5 minim doses of Liquor Arsenicalis thrice daily, except during one week in each month, oi during the menstrual period, for 6, 8 or even 12 months. May be combined with Bromide, e.g., 3 minims with 10 grains t.d. tincture of Convaiiaria is recommended if pulse rate be over 110. Pernicious Anjemia.—Arsenic is often given, but it has probably no real value. There is no specific remedy.—P. N. Panton and co-workers, n. i./23,277. cf. the Liver Diet. , , , _ . ,, , .. ., . . In Hodgkin’s Disease, arsenic should be pushed to the farthest limn slioit of toxic effects.—Whitla, Pract. Med. _ . . Asthma treated by 5 minim doses with breakfast and dinner m conjunction with an alkaline Stramonium mixture.—P.J. ii./yo,694. Anemic Vomiting.—2 minims of Fowler’s Solution thrice daily iound of great value—to this may be added at once or in the course of a few days 10 grains of Citrate of Iron and Ammonia. Bismuth and Alkalis of little value. —A. P. Beddard, Pr., March, 1912,359. ' . , . ,. Herpes Zoster relieved by Arsenic—15 drops of howler s solution uaitv being taken for some time.—H. Carlill, B.M.J . ii./i7,9. Arsenical Keratosis followed by Cancer—Patient had a moie or less general psoriasis, which was controlled by arsenic for 7 years, w aity gmv ■ appeared on palms and soles, and the arsenic was stopped. 14 >eais ai cessation of the drug the hyperkeratosis on palms and soles was as obvious ab ever, and a tumour, necessitating amputation, developed. L. C. 1 m Skin Papilloma well treated by swabbing thrice dam with the f>. . solution.—Per Jl. A.M.A. i./26,654. We recommend great caution. PH Liquor Arsenici Hydrochloricus (B.P. '14). u.s. x. Dose.—2 to 8 minims (0-i2 to 0-5 Cc.)._ Contains 1% of arsenious anhydride. Is compatible with acid mixtures. In making this by the B.P. ’14 directions use the entire litre oi water with the Hydrochloric Acid instead of half that quantity. Solution is more easily effected. Chloride 1/04 Acid and Mercuric gram JjVJ] Tablets of Arsenious (0-001 Gin.) of each. . .. In exophthalmic goitre have been given thrice dai y* UJ Mistura Arsenii Quininae et Ferri—Syn. BaccELLI S MIXTURE (slightly modified). Dose.—b to 1 ounce (15 to 30 Cc.). i;hd Dissolve Quinine Sulphate 3 in Water 150 with aid of a little Dilute Sulphuric Acid. Then dissolve Green Ammonio-Citrate of Iron 5 in Water 150, mix and add Fowler’s Solution 3. Employed in malaria. Mistura Antimalarica (Baccelli). P. Ital. V. Dose.—I\ to 1 ounce (15 to 30 Cc.). Quinine Sulphate 3 Gm., Iron and Potassium Tartrate 7*5 Gm., Distilled Water 300 Gm., Fowler’s Solution 25 drops. HI Sodii Arsenis. Syn. Sodium Metarsenite. NaAs02 = 129e927. Dose.—to TV grain (o-ooi to 0-004 Gm.). A whitish powder soluble in water, slightly in alcohol. Has properties equivalent to Arsenious Acid. EOArsenii Bromidum. AsBr3=314-678. Dose.—An to (0-001 to 0-005 Gm.). In yellowish white deliquescent crystals, soluble in water. Is recommended for diabetes and epilepsy. HI Liquor Arsenici Bromatus. Syn. LlQUOR POTASSII ARSEN ATI'S et Bromidi. Clemens’ Solution. Dose.—1 to 5 minims (0-06 to 0-3 Cc.), once or twice a dav. Potassium Carbonate 1, Arsenious Anhydride in powder 1, Distilled Water 80. Boil until dissolved. Wlien cooled, add Bromine (by weight) 2, and Distilled Water, q.s. to 100. Heat until decolourised. The solution is useful in epilepsy and diabetes with careful diet. Contains approximately 1-5% Arsenic Acid, 0-5 to 0-0% Hvdrobromic Acid, and 1-6 to 1-7% Potassium Bromide. !HI Granula Dioscoridis. (P. Dan. and Fr. Cx.). Contains 1 milligramme Arsenious Anhydride. Dose.—1 to 5. (D ll Pilula Arsenicalis et Strychninae contains Ay grain (0-0013 Gm.) of each. [HI Pilula Asiatica. Dose.—1 or 2 daily. Arsenious Anhydride, Ay grain (0-005 Gm.), Black Pepper f grain (0 05 Gm.), Cum Acacia q.s. In chronic skin affections. In psoriasis this is a convenient method of giving arsenic. P.G. VT. contains 1/64 grain (0 001 Gm.) Arsenious Acid, and 4 grain (0 03 Gm.) of Pepper. (IP H Pilula Ferri Arsenicalis. Dose.—1 thrice daily. Arsenious Anhydride, in fine powder A<> > Exsiccated Ferrous Sulphate 3, Syrup J ; in grains, for one pill ; in grammes, for fifteen. In chlorosis and ansemia most efficacious. (HI pl,ula Ferri Arsenicalis cum Strychnina is the same with Strychnine Hydrochloride Ay grain. (D l) Pilula Acidi Arseniosi et Ferri Redacti.—MONCKTON. Dose.—1 to 3 grains. Arsenious Anhydride, 12 grains. Reduced Iron 1 ounce. Excipient q.s. Mix. El Tablets, of Arsenious Acid A+ grain and Blaud’s Pill 4 grains. Dose.—1 to 4. El Tablets of Arsenic, Iron and Quinine contain Arsenious Acid rrV grain, Ferric Hypophosphite 2 grains, Quinine Acid Sulphate 1 grain. [P] HI Pasta Arsenicalis.—Martindale. For dental caries to destroy the nerve. Arsenious Anhydride, levigated, 24, Plaster of Paris 32, Morphine Sulphate 16, Cocaine 4. Mix and add Clove Oil 4, Phenol 20. R.D.H. has Arsenious Acid 2, Morphine Acetate 1, Creosote q.s. to :orm a paste. These two preparations are very poisonous. The equivalent of about Ar grain of Arsenious Acid is sufficient. Apply as follows :—Remove as much carious tissue as possible, exclude moisture and disinfect. Apply the paste as near pulp as possible and protect py concave cap. Seal cavity carefully with Masticho in Chloroform. :gj] jFJ] Dental Arsenieal Fibre. Syn. Arsenious Wool. Gossypium Arseniosum, R D.H. Arsenious Acid 5, Tannin 2, Morphine Acetate 10, Carbolic Acid liquefied q.s. to make a thin paste. Mix with a sufficiency of finely cut cotton wool. Contains in the finished condition, Arsenious Acid 24-17%, Morphine Acetate 48-3%, Carbolic Acid 16*7%. Used in the same way as Pasta Arsenicalis. Some formulae contain creosote vice carbolic acid. jPjD Arsenii lodidum. (B.P. T4). u.s. As I3=455-726. Dose.—to i grain (0-003 to 0-012 Gm.), in a pill. Soluble, forming a slightly cloudy acid solution in water 1 in 11, in alcohol 90% 1 in 40. The two elements combine forming orange-coloured crystals. It ffiould be recrystallised so as to exclude a melted mixture of Arsenium md Iodine, or Arsenium powdered 10, may be mixed with Iodine 51 n presence of water, digested at gentle heat and evaporated to dryness. i Solution 1% in 1 to 10 drop doses in milk, useful for lymphatic and icrofulous children, has marked iodine effect. Also used externally. In diseases of the alimentary canal, especially gastritis, in phthisis, md in all cases of neuritis it is of great use. In epilepsy by gradually idding arsenic to the bromide mixture, the dose of the bromide may le lessened and will finally keep the fits under alone. Useful also n helping to clear up a pneumonic lung and in promoting absorption of pleuritic’effusion.—L. i./n, 1210. The content of Asl3 may be estimated by titrating a weighed quantity in in aqueous Sodium Bicarbonate Solution with decinormal Iodine Solution. gjl Injectio Arsenii Iodidi Hypodermica. , Dose.—TJ0 grain (0-0006 Gm.) in 6 minims (0-4 Cc.) of sterile water. The strength may be increased if desired. Sterules, Hypodermic, contain 1/100 grain. jp~l]Liquor Arsenii et Hydrargyri Iodidi (B.P. 14). P. Jap. III? (now omitted). Syn. Donovan’s Solution. Contains Arsenious Iodide and Mercuric Iodide, of each 1%, or 87£ grains of each in Distilled Water q.s. to 20 ounces. Dose. 5 to 20 minims (0-3 to 1-2 Cc«). (U.S. X. has smaller average, minims.) Given for syphilitic skin diseases. Incompatible with potassium iodide and Sal Volatile (cf. essler’s reagent) : also with alkaloids and acids. Should be freshly prepared or stored in small bottles completely filled. A mple after 14 months was found to contain no Arsenious Arsenic. isting Cocking, Qtrly. Jl. Ph., ’29,409. See also (gj Pilula Arsenii et Hydrargyri Iodidi. LO lnjectio Sodii Arsenitis et Ferri. Ihis Arsenic and Iron Injection ’ is largely employed in two strengths in anaemic conditions :—• “ No. 1 grade (weak).” Hypodermic dose 1 Cc.=0*025 Gm. ‘ Soluble Iron Arsenite,’ equivalent to 4 milligram of Arsenious Acid, anc the other. No. 2 grade ” (double strength) 1 Cc.= I mgr. of Arsenious Acid Injections may be made (as deeply as possible) with advantage ai 1 to 2 days interval, and commencing for the first few doses with j to 4 Cc. only of the No. 1 when the stomach is empty. Intramuscu lar (gluteal) injections may be better tolerated, but the injections art as a rule not painf ul. The course of the treatment extends over 1 to 2. months. the- IP 1| Sterules of Arsenic and Iron are prepared of each of above. Dose.—15 minims (l Cc.) hypodermically. Physicians should specify which strength is required. Pernicious Anjbmia,—The injection intramuscularly appears to be oi value : 1/3 grain in 1 Cc. on alternate days for 12 doses would be a suitable course.—Sir W. H. Willcox, L. ii./27,778. Alopecia.—A five weeks’course of iron and Arsenic injections gave benefit. (FjGuttae Sodii Arsenitis etFerri.—“Iron and Arsenic Drops.” Dose.—5 drops (or minims) containing f grain (0*05 Gm.) of! ‘ Soluble Iron Arsenite ’ equivalent to % grain (0-001 Gm.) of Arsenious Acid—(cf. anted) per os. A gradual increased dose up to 20 drops is recommended. [533 Potassii Arsenis.—Dose.—..f to 111J grain (0*002 to 0004 Gm.). The dry salt KAs02+HAs02-fH20 = 271*9834, containing about 73% As203 made from arsenious acid and potassium bicarbonate. Used occasionally in place of arsenious anhydride. [FUCupri Arsenis. Cu3As206 = 436*57. Scheele’s Green. Dose.—1/100 to 1/25 grain (0*0006 to 0*0025 Gm.). Amorphous green powder, used in various intestinal affections, cholera morbus, cholera infantum, diarrhoea, dysentery and typhoid. Hose for adults ,oV.o to soon grain every 10 minutes for an hour, then hourly; for children, half this quantity. Small repeated doses essential. For chlorosis and functional anaemia, A to A grain thrice daily are given. iPlIAcidnm Arsenicum.—Syn. Ortho-Arsenic Acid. H3As04.iH20= 150-9618. Dose.—% to iV grain (0-001 to 0*005 Gm.). A crystalline powder soluble about 2 in 1 of water, and very in Alcohol 90%. Arsenites are said to be twice as active as arsenates. The following salts are in use :— |P 1 Ferri Arsenas (B. P. ’98). Dose.—fa to £ grain (0-004 to o-oi6 Gm.). This is an amorphous greenish powder and consists of Ferrous Arsenate, Fe3(As04)2,6H20 = 553*4736 (not less than 10%) with Ferric Arsenate Fe2(As02)2=389*54, andiron Oxide. The Ferrous Arsenate rapidly oxidises in the air. In chronic skin affections of all kinds. Tablets contain J grain (0*008 Gm.). The Fr. Cx. preparation (method given) has formula (As04)2Fe3 -j-3H20—Ferrous Arsenate—with a little Ferric salt. To be kept i bottles sealed down with fat. Maximum single dose £ grain ; raximum during 24 hours 2-J grains approximately. RE. VIII. Max. single dose, 1/12 grain, during a da,y J grair. [ISodii Arsenas Anhydrosus (B.P. ’14). Dose.—-£q to Pq grain (0 0015 to 0-006 Gm.). Sodium Arsenate, crystallises with either 7 [Na2HAs04,7H20 = 12-047], Fr. Cx., Ph. Ned. V., P. Belg. IV., or 12 molecules Ah W.=402-1392] of water. The anhydrous salt, in white powder, ried at 150° C., contains 61-8% of As20?;, and is soluble 1 i n 3 of water t 25° C. 1 of the anhydrous salt equals 1-68 of the salt with 7H20. F.I. and P. I tab V., require the salt crystallised with 7ELO and ontaining 36-85% of arsenic acid as in many Pharmacopoeias. Soluble 1 in 5 of water. Slightly soluble in alcohol. Fr. Cx. (vide above) has max. single dose -}■ grain. Max. during 24 ours, J grain approximately. Ulcerative endocarditis. Influence of Arsenic (as Sodium Salt) dvised.—J. Lvcett, B.M.J. ii./22,402. Deafness. Sodium Arsenate has been found beneficial, p2 grain n pill followed by * grain the next day—altogether 40 to 60 pills n as many days.—per P.J. ii./26,287. JjFilula Sodii Arsenatis, V2 and Wf grain- FJ] Injectio Sodii Arsenatis et Strychnine. Dose.—5 to 10 minims (0-3 to 0-6 Cc.) hypodermically. Sodium Arsenate 2 (-fo grain in 10 minims), Strychnine Hydrochloride 1 (p0 j;rain in 10 minims), Water to 600. 2 i Ster-dles, Hypodermic, contain 10 minims of above. M] Injectio Sodii Arsenatis et Strychninse et Quininee contains j. grain Quinine Acid Hydrochloride added to 10 minims of the above. Vf| Stemles, Hypodermic, contain 10 minims. Pi] Liquor Sodii Arsenatis (B.P. T4). 1% of Exsiccated Salt. i Dose.—2 to 8 minims (0-12 to 0-5 Cc.). M] Pearson’s Solution of Arsenic used on the Continent, e.g.y A Ital. V. is 1 of crystallised Sodium Arsenate (7H20) in Water 600, P. Belg. IV. is 1 in 1,000. Ml Arsenical Cigarettes are made of paper impregnated with odium arsenate, so that each contains | grain (0-05 Gm.) of the salt. The patient ought to inspire the fumes deeply three or four times. Ml Tablettse Sodii Arsenatis Composite. Anhydrous Sodium Arsenate Vq grain, Lupulin 3 grains. A digestive tonic combination. IO ORGANIC ARSENIC COMPOUNDS. For the pioneer work on Chemotherapy readers are referred to the earlier editions of the book. An organic Arsenic compound, as distinct from the inorganic orm, has the Arsenic in combination with a Carbon atom. This ppears to lessen its toxic properties. Furthermore, Arsenium acts either as a tri- or penta-valent element and, broadly, the former compounds are more potent upon protozoa. Examples of the first class are Arsenobenzol and of the second, Sodium Cacodylate, Sodium Arsanilate, Tryparsamide, etc. We prefer to classify the compounds under the headings (i) Aliphatic, (ii) Aromatic, (iii) Diphenyl nucleus bodies, as far as practicable. The dose of Organic Arsenic compounds should not be i pushed,9 Signs of disturbance of vision should be looked for. The following terms are used :— Arsinic Acid constitutes a dialkyl or diary] derivative of arsenic acid— i.e., cacodylic acid—and homologues, e.g., phenyl-arsinic acid, (CGII5)2AsO.OH. Arsenic Acid indicates arsenic acid, AsO.(OH)3, in which one of the hydroxyls is replaced by an organic radicle. An arsonate is a salt of this acid. Trench and German chemists do not as a rule make these distinctions. Arylarsonate.—This term indicates an aromatic arsonate. Aryl indicates, e.g-, phenyl, tolyl, xylyl, or naphthyl, as applied to substituted hydroxyl in arsenic acid. Arsenoic.—In Trench literature refers to aromatic arsenic bodies containing two atoms of arsenic believed to be coupled together by a double linkage—e.g., C6H5 —As = As—C6H5, arsenobenzene, comparable with C6H5—N = N —CSH5. azobenzene. (I). Aliphatic (or Fatty) Series. |j? Ij Acidum Cacodylicum. Dimethylarsinic Acid (CH3)2AsO.OH=137*9846. Dose.—-l to 2 grains (0*03 to 0*12 Gm.). The ultimate product of oxidation of Arsenium-dimethyl (Caco- dyle). Syn.—Tetramethyl Diarsine (CH3)2As—As(CH3)2, discovered by Bunsen in 1842, and of Cacodyle Oxide, Syn. Alkarsin, (CH3)4As20=225*9536. Colourless crystals neutral to Methyl Orange. Soluble about 2 in 1 of water, 1 in 4 of alcohol 90%, readily in chloroform, and although containing 54*3% arsenium, equivalent to 7T6% arsenious acid, it is relatively non-toxic—similarly with the Salts. It will be noted that this acid has only 1 OH group, hence it is not so toxic as its parent arsenic acid, with 3 OH. Sodium Cacodylate and Arrhenal are probably broken down in the body to such slight extent that large doses may be given without producing any therapeutic, much less toxic, effect. They appear, principally in the urine, unaltered. A small proportion is, however, oxidised and from this arsenic Ions are set free, exerting a mild action during a prolonged treatment. Pj] Calcii Cacodylas [(CH3)2AsO2]2Ca=314*0236. Dose.—£ to 2 grains (0 03 to 0 12 Gm.) per os or intramuscularly. A white amorphous powder. Soluble 2 in 1 of water, 1 in 2 of alcohol. In tuberculosis daily injections of | grain with a glycerin Solution of Calcium Iodide 10 grains and Ferrous Iodide 1J grains per drachm internally have been found satisfactory. Fli Ferri Cacodylas. [(CH3)2AsO2]3Fe=466*7704. Dose.—J to 5 grains (0 05 to 0*3 Gm.) per os per diem, or 4 to \\ grains (0*03 to 0*1 Gm.) hypodermically per diem. Intravenously 1 grain (0*06 Gm.) in 5 Cc. Manufacture.—Precipitate the Ferric Hydroxide from a suificiency »f Ferric Chloride solution containing 1 molecular proportion of Ferric Chloride Fe2Ci9 + Aq.). Wash the precipitate and combine with Cacodylic Acid. 6 mole- ular proportions, or precipitate Barium Cacodylate with Ferric Sulphate Solution in molecular proportions. Yellowish powder soluble 1 in 15 of water, used for anaemia and ;hlorosis, also in glandular swellings, e.g., in syphilis, hypodermically. Iron Cacodylate grain intravenously every other day used for raising he haemoglobin content.—H. Pritchard, B.M.J. i./2 7,794. ?11 Guaiacol Cacodylas. (CH3)2.As0.0.C6H4(0CH3).H20 = 262-047. Syn. Cacodyliacol. Dose.—J to 2 grains (0-03 to 0-12 Gm.) per os or hypodermically n sterile oil in affected regions for tuberculosis. Soluble 1 in 25 vater, 1 in 1*5 alcohol 90%. M] Magnesii Cacodylas. [(CH3)2As02]2Mg,?H20. Dose.—f grain (0*05 Gm.) hypodermically, gradually increased (5% olution suitable). White amorphous powder soluble 1 in 3 of water. Uses9 etc., as the Sodium Salt, q,v. FllSodii Cacodylas. p. Heiv. Fr. Cx. and Supp. 1920, P.G. VI., U.S. x., P. Ital. V., F.E. VIII., P. Belg. IV. Sodium Dime- thylarsinate. (CH3)2As02Na-b3H20 = 214*0206. Dose.—Average per rectum and hypodermically J to 1 grain 0 03 to 0 06 Gm.). | Fr. Cx. has max. single dose 3 grains and during 24 hours 3 grains approximately. I "The salt of the above formula contains 35% Arsenium whilst the anhydrous salt contains 46-8%, equivalent to Gl-8% arsenious acid. Fr. Cx. Supp. 1920 gave a formula+2 JH20 (previously anhydrous) ina states the official salt must contain 75 to 78% Anhydrous Sodium jlacodylate. (Not confirmed in Supp. Nouv. 1920). P. Ital. IV. •equires it to contain 70%. In commerce it usually contains 18 to 15% of water. It should be carefully examined for inorganic arsenic, tnd, being a deliquescent salt, solutions should be standardised. P.G. VI. requires a content of 32-8 to 35% Arsenium. Soluble 2 in 1 water, in alcohol 1 in 1. Uses•—In tuberculosis generally (curative results come very dowly), in diabetes mellitus, exophthalmic goitre, pernicious anaemia, cancer (particularly of the stomach),malaria,chorea, leprosy, psoriasis, ind other chronic skin affections, and in all cases in which arsenic has :>een used, but when given by the mouth or per rectum may cause r enal congestion with albuminuria and fall in the quantity of urine excreted. As far back as 1862 Cacodylic acid was found to give excellent results in treatment of chronic skin diseases and in pulmonary tuberculosis. It was stated in 1865 (before Koch’s discovery of .the bac- llus) to * impart to the blood of the patient a condition rnrmical o the tuberculosis.’ „ _ . ,, Much later it was employed in syphilis and for the various other purposes for which Arsenic is indicated. Syphilis.—The usual dose has been 1 to 2 grains intramuscularly for a week or 10 days. Some proceed to a course of 3 grains for 7 days, with finally 1 grain doses daily subcutaneously. Intermitting the courses for a few days may be well. It seems to destroy the spirochetes. It possesses advantages over Arsenobenzol, and it is still considerably used in spite of this competitor. Intravenously in sufficient quantity Sodium Cacodylate is better than Arsenobenzol. Dose never less than 10 grains and often as much as 30 grains repeating the dose in 4 days’ time. No toxic symptoms.—W. H. Forster, Jl. Amer. Pharm. Assn., 1917, 6, 142 (P. J. i./ 17, 275.) Chronic Broncho-spirochetosis rapidly recovered under sodium cacodylate per os.—E. C. Paust, Jl. Prop. Med. Jan. 1/23,14. Endocarditis treated by Capps’s Sodium Cacodylate Method—daily intravenous injections beginning with 1 grain and increasing gradually to 5 grains. Free from ill effects.—Sir Thos. Horder, B.M.J. i./26,737. Paralysis Agitans has been treated by Sodium Cacodylate intravenously. The usual dosage for syphilis was employed, 1-5 Gm. increasing to 6-5 Gm. in 16 days, altogether 32 Gm.—Jl. Intrav. Therap., May ’26. Sclerosis, Disseminated.—Good results with f grain doses injected daily or every other day for 12—14 days. The patient was kept fit for 18 months with injections at 3-monthly intervals. Pernicious Anaemia.—Sodium Cacodylate 4 grain may be given hypodermically daily for 20 days.—Sir IV. H. Willcox, L. ii./27,77S. Malaria well treated by intravenous injections of 30 grains, divided into 4 doses of 74 grains at 6 hour intervals, until parasites have disappeared from peripheral blood, when dose is halved and continued for a fortnight.— Jl. A.M.A. ii./26,124. Pemphigus of acute type responded dramatically to 2 grain doses. Total injected 50 grains during 5 weeks.—L. J. A. Loewenthal, B.M.J. i./3o,153. I^XlElixir Sodii Cacodylatis (Standardised). Dose.—30 minima (equivalent to 4 grain of the salt). This forms a palatable method of administering the salt. IDJPills contain 4 grain (0-03 Gm.). The following formula in grains is useful:— Sodium Cacodylate 50, Benzoin 50, Liquorice Powder 50, Acacia Powder 25, Alcohol 90% q.s. Divide into 100 pills. Dose.—4 three or four times a day. UjHypodermic and Intravenous Injection. A sterile preparation is made and standardised to contain 0*05 Gm. (J grain) of Cacodylic Acid in 1 Cc. (15 minims approx.), a dose once in 24 hours. The same dose diluted with 4 drachms of water is used for Rectal Injection. !D l]Stcrulcs Hypodermic of Sodium Cacodylate contain 4, §, 1, 14 and 2 grains in 15 minims (l Cc.). [jpTSterules of Sodium Cacodylate, 1 grain (0*06 Gm.), with Nucleinic Acid Solution 1 Cc. (see also Acidum Nucleinicum). Septicaemia.—Arsenic, e.g., Sodium Cacodylate, intramuscularly may be placed first—given in conjunction with Nucleinic Acid, usually 1 grain of Sodium Cacodylate in a saturated solution of Nucleinic Acid, 1 Cc. intramuscularly being given twice in 24 hours for the first two or three weeks of an acute case. A good leucocyte stimulant. A convenient method of knowing that the patient is receiving an effective close is the smell of his breath. Opium and specific vaccines.—-Sir Thomas Horder, B.M.J. i./25,G57 :ii./3i,593. FJInjectio Cacodylatum Compositum. Dose.—(average) 15 minims 1 Cc.), containing Sodium Cacodylate f grain, Iron Cacodylate ? grain, Strychnine Cacodydate dr grain. It should, we find, be •endered slightly acid with Cacodylic Acid at the finish. 1 Cc. iontains approx. 0-03 Gm. (J grain) Arsenium. Gautier recommends : CB) Cacodylic Acid 5 Gm., Sodium Carbon- ite q.s., Cocaine Hydrochloride 0-08 Gm., Creosote 6 drops, dissolved n Alcohol 8 Gm. with Sterile Water q.s. to 100 Cc., i.e., 15 minims 1 Cc.) contain J- grain (0-05 Gm.) of Cacodylic Acid for a dose— lypodermieally —which is not to exceed 0*1 Gm. (14 grains) pro die, lie average being 0-02 to 0-05 Gm. every 24 hours. P 1| Solucion de Cacodylato de Sodio Iodo-mercurico Esterilisado Sodium Cacodylate 4, Mercuric Iodide 0-5, Sodium Iodide 0-5, Vater to 100. Hose.—-Each Cc. contains 0-04 Gm. of sodium cacodylate and s-005 Gm. of mercuric iodide. FT] Strychnines Cacodylas. C222NT20,(CH3)2AsO.OH=472-1722. 8 0 ,T to 1 1 0 grain (0-002 to 0-006 Gm.). Dose.- White crystalline powder hardly soluble in water, readily soluble n chloroform. Has proved a useful salt. £33 Di-sodium Methylarsenate. Syn. Sodium Methyl Arsonate, Arrhe nat.New Cacodyle’,CH3.As=0(ONa)o.5H90=274-0254. Fr. Cx,, F.E. VIII., P.Belg. IV., P. Hal. V. (6HaO). Dose.—-I to 3 grains (0-025 to 0-2 Gm.) per os or hypodermically. Ir. Cx.—Max. single and during 24 hours dose 3 grains. Prepared by the interaction of Methyl Iodide and Sodium Arsenate n presence of excess of Alkali. Soluble about 1 in 1 of water, only slightly in alcohol 90%. Arsenic content. (With 5 mols. H,0)=27-35%. Uses.—Similar to Sodium Cacodylate q.v. It is stated not to produce Cacodyle Oxide when given by the mouth. FT Sterules, Hypodermic of Arrhenal, i grain (0-02 Gm.), and f grain (0-05 Gm.). F ijMercury Salicyl- Arsonate. Syn. EnesOL. "~Dose.~l to 1 grain (0-015 to 0-06 Gm.) intramuscularly. Syphilis and parasyphilis are treated by 2 Cc. of 3% solution 1 grain approx.) intramuscularly once daily, or for intensive reatment of syphilis 4 to 8 Cc. every 2 or 3 days, intravenously, 1 to 10 Cc. every 2 or 3 days according to urgency. When a total amount of P5 Gm. is reached, suspend treatment :or 10 days. A combination of Arrhenal and Mercury Salicylate. A white )owder containing 36% mercury. It is best supplied in solution. this is said to be painless on injection. General paralysis, malaria, and psoriasis, are also treated with it. FT Sterules, Hypcdermic, of Mercury Salicyl-Arsouale are prepared, grain in 30 minims (3% approx.), for intramuscular injection. A course of twenty 1 grain Enesol Injections would result in giving Font 8 grains of mercury in 10 weeks. O’ (II.) Aromatic Series. LO p-Aminopiienylarsonic Acid, Syn. Arsanilic acid. Aniline- arsenic acid. NH2C6H4.AsO(OH2)=217*0024. Arsanilic Acid is weakly basic. Its Hydrochloride is immediately hydrolised by water. It is soluble, however, in methyl and ethyl alcohol. It has been employed as. ED Sodii p-Aminophenylarsonas. Syn. * Arsamin, (T.M. 302016) *Atoxyl (T.M. 244636), *Soamin (T.M. 302133), Sodium Arsanilate. NH2C6H4AsO(OH)O.Na=238*9896. Usually in commerce + 4H20 = 311*052, and containing about 24% As, P. Belg. IV., 3H20. Dose.— f to 3 grains (0*05 to 0*2 Gm.). This dosage per os for syphilis has been advised daily for a week, then to be intermitted, but caution is recommended. Max. single dose 3 grains (0*2 Gm.). Intramuscular injections (into the buttock) have been given of much larger doses, even up to 10 grains at a time, in a total course of 100 grains, at several days’interval in treatment of syphilis, as a substitute for Mercurials. The upper third of the buttock is the usual site of injection.—N.B. Not without danger.—Avoid heroic doses. Intravenously 1 to 5 minims (0*06 to 0*3 Cc.) of a 15% solution have been given, i.e. approx. \ to f grain, but larger doses have been used, and we should advise 1 Cc. at least of diluent.—Cf. Intrav. Dose Table. Solutions should be freshly prepared with cold boiled water and may be slightly warmed at time of injection. Manufacture.—-It was originally prepared by Bechamp, vide Comptes Bend., 1863, Vol. 56,1., p. 1172, though the substance he obtained he thought to be Arsenic Anilide. By heating Arsenic Acid with an excess of Aniline the Arsenate is formed, this however, is transformed bv prolonged heating at 190° C. into p-Aminophenylarsonic Acid. This attained, one neutralises with Sodium Carbonate, decomposes with Nitric Acid, collects the Acid neutralises with Sodium Hydroxide, and evaporates to crystallise. Becrystallise from 90% Alcohol. History of Organic Arsenic Compounds in treatment of protozoan diseases.—Benjamin Moore, B.M.J. i./i6,617. See our Edn. XVIIT., p 202 A white crystalline powder with slightly saline taste. Soluble about 1 in 6 of water (some samples may dissoVe in a little less). Also soluble about 1 in 125 of alcohol 90% and more so in Methyl Alcohol. The Anhydrous substance is readily soluble in Methyl Alcohol but practically insoluble in Ether, Acetone, Benzol, or Chloroform. Incompatible with Mercurials (e.gPerchloride), and other heavy metals in solution, also with Acids. Uses.—Large quantities of arsenic can be given by it in skin diseases (psoriasis, lichen), in anaemia, syphilis, sarcoma, eiephantiasis, malaria, tuberculosis and trypanosomiasis. Syphilis has been treated with 50% Ointment used on chancre of the skin. It is stated to have less than 1/40 the toxicity of Arsenious Acid. SO Pills of Arsamin contain ^ grain and upwards. [JppElixir Arsamin contains i grain in each drachm and may be prepared stronger if required. ffjl Sferules (Hypodermic) of Arsamin J also J grain in 15 minims (l Cc.). Purves Stewart has prescribed the Elixir considerably in cases of isseminated sclerosis and tabes without having witnessed bad effects rom the drug, but cases must be watched carefully. ijp I’Arsamin Paste. 10% may, from our experiments, be prepared nth Pigmentum Caseinse, q.v. In syphilis this has been used to primary sores, with large in- ections of Atoxyl simultaneously into the buttock. }]p jj Tablets Arsamin contain one grain. ||PjJ Capsules Arsamin and 2 grains, also [gyjCapsules Arsamin 1 grain with Blaud Pill f grains and with Quinine 3 grains are prepared and are useful or treatment in cases where the added drugs suggest themselves. For Methods of Testing Sodium Arsanitate for inorganic A rsenic, see Vol. II. Sodium Arsanilate plus Mercury.—Combined have been used without luch favour.—Sodium Arsanilate plus Orpiment (Arsenic Tri- nlphide As2S3 = 246-04) were also largely given. The trypanosomes probably .ever become resistant to inorganic Arsenic. Sodium Arsanilate plus Tartar Emetic was also tried. Syphiiis.—Though Atoxyl is a cure, it is no longer used, as it dissolves a the tissues of the eye and causes optic neuritis and atrophy.—W. E. Dixon, 3.M.J. i./25,813. Sodium Arsanilate plus Bismuth v. Bismuth Arsanilate. Relapsing Fewer. Large doses have been given, e.g., doses of from 9 o 23 Cc. of 20% solution. Kala-azar. Success has followed 3 grains every third day. Trypanosomiasis.—Thomas of Liverpool first applied Atoxyl in rypanosomiasis. 2 Cc. of 20% solution repeated after 18 days. Immediate ffect was magical, but it only helped the sufferers in dying. Koch thought t to be a specific. The para-Acid acts promptly on trypanosomes, the meta- has less effect ,nd the ortho-Acid no effect at all.—L. ii./i2,1822. See also Fortescue 3rickdale, B.M.J. ii./i2,1489. Ehrlich pointed out that a drug can only be of value in infectious diseases, l taken up more readily by the parasite—bacterio-tropous (syn. aetiotropous) —than by the organism—organotropous. Many protozoa take up dyes, rrypan Red is active against trypanosomes. He advised the use of Atoxyl, Parafuchsin, Trypan Red and Trypan Blue. Combine a potent substance which will kill the bulk of the trypanosomes with i, weaker one, which will account for the remainder, which would cause relapse, dercuric Chloride is a useful adjuvant to Atoxyl. Trypanblue C8iH24N6014S4Na4-960-4632 successful in piroplasmosis nliary fever or malignant jaundice of the dog (canine piroplasmosis) and red vater or Texas fever of cattle (bovine piroplasmosis). It is stated to be a certain md immediate cure for distemper. Bose.—Dogs 2 months old, of 3 to a lbs. veight 3 Cc. to 4 Cc. of i% Solution. From 10 lbs. to 60 lbs. "weight, dose anges from 3 to 20 Cc. of Saturated Solution (1% approx.). . Subcutaneously, >r in preference intravenously, into the vena saphena in the hind leg of a dog. Cattle.—Dose.—100 to 200 Cc. of Saturated Solution. _ . Trypan Blue is a remedy for piroplasmosis in domestic animals, but no >ther success is recorded.—Dixon, p. 22. See also B.M.J. ii./22,410. Ghlorazol Blue 3 B is a color closely related and has been used instead ! Trypan blue. . .. Elimination of Sodium Arsanilate is by the skin and the kidney s. May .use transient albuminuria, the bulk is in the urine. The excretion us nounts to 50—90% within nine hours. The amount remaining is to some Lent decomposed, so that sometimes toxic symptoms of ^fanic ^Arsenic e produced. Fortescue Brickdale thought there was n0 *dv£inta^rJ0gw f8 syphilis and anaemia a rapidly eliminated form of Arsenic in large dose ther than one which being slowly excreted can be given m smal doses. In ypanosomiasis it is thought that a small amount of organic Arsei rough the Amido group, with the proteins of th? WoodASn^omes ie Arsenic is set free, and in a nascent condition iMls the trypanosomes. For poisonous effects and their treatment, see Vol. II. I or further details of action of Arsanilate and allied bodies on Trypanosomes vide Salvarsan,’ by M. & W., p. 168 et seg. SO Sodii Aeetylarsanilas, Syn. Sodium Acetyl-p-aminophenylarsonate, ^Arsacetin (T.M. 305705), P.G. VI. Acetyl-atoxyl. C6H4NH.CO.CH3.AsO3HNa=2Sl-0052. (P.G. and P. Belg. IV. + 4H20.) ° Dose.-—Per os h grain (0*03 Gm.) three or four times a day. Colourless Crystals. Soluble in water 1 in 10, insoluble in alcohol. In syphilis, malaria, trypanosomiasis. A course of 20 injections of 0-6 Gm. spread over 10 weeks. In the case of diseases of metabolism smaller amounts ■—0T to 0-3 Gm. Caution.—This dosage is quoted in Gehe, but the preparation came under senous consideration years ago. Bagsliawe, L. ii./o9,1193, reported blindness after its use in trypanosomiasis. In syphilis, 0-5 Gm. was toxic.—L. ii./o8,1315. P.G. VI. states maximum single dose 0-2 Gm. Tor further data see E.P. XVI., p. 167. Arsacetin specially recommended in pernicious ansemia, leukaemia, and 1 ymphadenoma.—B.M.J.E. ii./24,63. [gi]Sodium p-Hydroxy-»i-Aminophenylarsenate or ‘ 189.’ 1 irst results of treatment show that this salt has favourable action on human syphilis although not so powerful or constant in its results as Salvarsan. It is relatively slightly toxic and is supported by patients who do not tolerate other arsenical preparations.—J. C. S., 1922, Ai 300. * EfStovarsol. (T.M. 432473). Syn. Acetylamino-oxy-phenyl- arsonic AciD.Acetarsone, ^Kharophen (T.M. 493420), j^Orar- san (T.M. 481226), *Spirocid (T.M. 341748), *Troposan (T.M- 472029). HO <r >AsO.(OH).r NH.CO.CH,. Dose.—4 grains (o-25 Gm.) in Tablets per os. Stated to be readily absorbed from the gastro-intestinal tract. Colourless crystals, practically insoluble in Water and Alcohol 90%. The compound has high As. content (27% approx.) and low toxicity. It was introduced by Fourneau and Levaditi in 1922. Manufacture.—See Edn. XIX. p. 192. Uses,—In amoebiasis, frambeesia (yaws), lambliasis, malaria (Plasmodium Vivax) and the early treatment of syphilis. Amcebiasis in acute cases destruction of cysts entails dosage of two tablets per day for 10 days. Stated to cure when Emetine has failed. In chronic cases, 1 tablet the first day, later one tablet every other day for a week, then one tablet twice a week for several weeks. (For the combined treatment with Auremetine, v. p. 528.) There is no evidence that it is a direct amcebicide, but it has definite value in the chronic stage.—P. H. Manson-Balir and It. M. Morris, L. ii./2 5,546. The combined treatment of amoebic dysentery (in France) with Stovarsol and Emetine lasts 4 weeks and consists of administration of 0 5 Gm. of Stovarsol a day during 1st and 3rd weeks, and Emetine during 2nd and 4th wrecks. The ‘ opening ’ treatment with Stovarsol alone consists of administration of 0-75 Gm. a day for 1 week, discontinued following week and resumed On 3rd week, followed for one or two months by daily dose of 0*25 Gm. Amoebse disappear in 4 days and cysts in 8 days. Affects Lamblice but Trichomonas resist it. Superior to Novarsenobenzol. A failure in practically all acute cases of amcebic dysentery, but has tonic properties and worthy of further trial in arise rnia or owered vitality from whatever cause.-—Drennan, U.F.C., ’25,123. Ref. to Kharophen.—L. i./2g,1126. Frambcesia (Yaws.)—The following has been advised : Two tablets the first lay, three the second day, four the third day. Omit for one day, then four, hree, and two tablets respectively on alternate days. Used with success in spirillary diseases. e.g., intestinal spirochsetosis, ulcer- rembranous-stomatitis, spirillary bronchitis, phagedenic ulcer, and Vincent’s ngina ; also lesions resistant to Arsenobenzenes. See also P. S. Selwyn Clark, Trans. Roy. Soc. Trop. Med., Jan. '27,373. Lambliasis.—One tablet a day for six days. The dose may be doubled nd treatment extended, in cases with cysts. The dosage for children should n pro rata. Improvement with disappearance of cysts. Blastocysts, the ause of diarrhoea, destroyed. Malaria.—Marchoux considers it is effective against Plasmodium vivax, iut not against P. malarice or falciparum.—per L. ii./25,595. Little, if any, effect, either as a nrophylactic or in acute fever.—H. C. Clark, J.F.C., ’25,192. Said to be a useful adjuvant to Quinine. Has specific action in destruction of Balantidium Coli.—R. Aguilar, U.F.C. 25,247. Syphilis well treated, by 1 Gm. daily, with a total of 20 Gm. in the month. Bismuth in addition may be required. Has a general tonic action on the whole ystem.—C. Levaditi, L. ih/25,594. Congenital syphilis in infants of 2 months treated with a daily dose of '•12 Gm. for 4 days a week up to a total of 6-6 Gm.—B.M.J.E. i-/26,52. Spirillum or Tick Fever.—Stovarsol gave good results.—A. T. Sehoi.eld, 3.M.J. ii./27,H40. Chronic Respiratory Diseases treated with doses of 0-5 Gm., given or 10—15 days, interrupted by intervals of equal duration. Hepatic or renal Insufficiency contraindicated.—B.M.J.E. i./2 6,48. Vincent’s Angina and ulcerating stomatitis treated.—B.M.J.E. i./26,S5. Toxic symptoms sometimes occur, e.g., diarrhoea, vomiting, headache, md cutaneous eruptions.—per Pres., Aug. ’29,282. # Exfoliative dermatitis due to continued use.—J. C. Michael, Jl.A.M.A. ./20,645. , „ , , One tablet of Stovarsol (0-25 Gm.) taken immediately after breakfast made |t man violently ill. Copious draughts of warm water, also a Ferric Hydrate nixture, produced recovery. Symptoms were suggestive of Arsenic poisoning. —J. R. O’Brien, L. i./26,313. Stovarsol-Sodium, Syn. Sodium Acetylamino-oxyphenyl- lE lESONATE. For injection iu frambeesia (yaws), general paralysis, and malaria. Ampoules contain 0*5, 1 and 1*5 Gm. See also page 527, et seq. PlBismuth Acetyi-amino-oxy-Phenylarsonate. Syn. J^BlSTOVOL (T.M. For adults a series of 12 injections of i '5 to 3 Cc. at intervals of 4 to 5 da^ s Stovarsol and Sodium Potassium Bismuth Tartrate interact, producing 1 white precipitate of this body. Ampoules contain 3 Cc. of 10 /0 suspension n oil. Has a curative effect both on animal and human syphilis, it is njected intramuscularly in suspension in either saline or on. yitn niice, bund of value for Trypanosomiasis naqana. In^ general, the ih-cnects 1 Bismuth or Arsenic are not observed.—C. Levaaiti, E. i./2o,zi£>, js.in.a. ^ Primary and. secondary syplri is well treated by Bistoyol per os either in solution or tablets. Well tolerated in doses of 2 Gm daily d'r 8—11 da^ s. Liapid disappearance of spirochsetes and prompt cicatrisation oi lesion,, oevaditi and L. Fournier, E. i./28,697. c„CTw^cirm tljBimitai is an allied compound. Bose, 2 Cc. of m hm intramuscularly in syphilis. It occurs as a yellow insoluble powder contamn g 11% Bismuth and 15% Arsenic.—C.D. ii./25,4o4. ^ [)p IjAcetylarsan (T.M. 444635). Available in solution containing 23-6% of Oxy-acetylamino- phenylarsonate of diethylamine. Solution contains 0-05 Gm. Arsenic per Cc. Elimination complete in 36 hours. Trial injec tions of 1—2 Cc. subcutaneously or intramuscularly and then 8—10 weekly injections of 5 Cc.—L. i./27,26. See also B.M.J, i./27,lll. The compound itself is a white, crystalline substance, soluble in water. Subcutaneous or intramuscular injections are painless and the drug is only slightly toxic. Used in hepatitis with success—dose, 0-75 Gm. once a week for 4 weeks. Treatment of amcebiasis (in France) with Acetylarsan and Emetine combined lasts 4 weeks, Emetine being administered the 1st, 2nd and 3rd day of each week and Acetylarsan on the 4th day in dose of 0-75 Gm. ^_The openmg treatment with Acetylarsan consists of primary injection of 0-75 Gm., with 3 days later a second dose of 0-75 Gm. and a succession of injections of same dose at intervals of 8 days until 6 or 7 doses have been given. Amoebae disappear shortly after 8th day ; cysts disappear at same time and in same way. Lamblioedisappear the morning following the first injection, asalso Trichomonas. Less toxic and more effective than Novarsenobenzol.—Ch. Garin and P. R. Lepine, Int. Conf. Trop. Am. ’24, p. 315. . Effect on S. pallida equal to that of the Arsenobenzenes, and serological effect compares favourably. More frequently followed by minor toxic effects than the Arsenobenzenes.—V. E. Lloyd, L. i./28.1323. iPlIParosan. Dose.—3 tablets daily (0-75 Gm.) for 14 days, with similar interval before repeating. . . An organic Arsenical compound, “ S-acetylamino-3-hydroxy 1 : 4-benzi- soxazine 6-arsinic acid.” Has some analogy with “ Stovarsol ” and ” Try- parsamide.” . . ^ . . Uses.—In disseminated sclerosis and neurosyphilis. Of little use in early syphilis. ;gjQ Treparsol. Syn. Formyplienarsine, P. Belg. IV. OXYEORMYL-AMINO. Phenylarsonic Acid. Tablets contain 025 Gm. fgj yfc Halarsol. (T.M. 4G5410). 3-AMINO-4-HYDROXYPHENYL-DICHLORARSINE Hydrochloride. _ e n/ Dose.—Intravenously at intervals of 4 to 5 days from 3 to 6 Cc. of a 2-5 /0 solution (less for children). A single injection frequently suffices. Intramuscularly in very small children 1-5 to 2*5 Cc. Immediate sharp pain lasting for an hour, with dull ache for 2 days. Subcutaneously too painful. Uses.—May be the drug of election for rapid sterilisation of yaws.—K. VV . Todd, T.lt.S.T.M., J 11110/31,65. jFTCarbarsone. Syn. 4-C ARB AMINO-PHENYL ARSONIC Acid H203As.C„H4 NHCONHo. Dose.—0-25 Gm. twice daily for 10 days in gelatin capsules. A white crystalline solid first prepared by Ehrlich, without odour or taste, containing 28-85% Arsenic. It is practically insoluble in water, but dissolves in alkaline aqueous solutions and melts at 174° C. Uses.—In the treatment of amcebiasis. Of 40 unselected cases 36 were ‘ cured.’ It is stated to be less toxic than Stovarsol, but more amcebicidal, but caution is advised until it is decided whether or not it may injure the eye. The Arsenic is only slowly liberated and care must be taken to avoid Arsenic toxicity. It is non-toxic in clinically effective doses.—A. C. Reed and Coworkers, Jl.A.M.A. i./32,189—198. Apparently effective—ibid. 231. [FTi *Tryparsamide. (T.M. 446503). Syn. * Moranyl (T.M. 458062), SODIUM-tt-PIiENYL-GLYCINAMIDE-p-ARSON ATE, P. Itah V., Gly- phenarsinum, P. Belg. IV. HoN.CO.CH2.NH(CtH JAs.ONa: O.OH=296*021. Dose,—1 to 2 Gm. by injection, weekly. A derivative of Atoxyl, having pentavalent Arsenic in its molecule ith low toxicity the minimal lethal dose for mice on intravenous ijeetion was over 2 Gm. per kilo, which is about 1/20 the toxicity f salvarsan. Sleeping Sickness has been treated with it—about 2 Gm. was found to e efficient and safe intravenous dose, although as high as 7 Gm. were given.— icobs and Ileidelberger; Brown and Pearce, B.M. J. ii./22,1183. See also iss Pearce, Jl. Trop. Med., Feb., 15/23,70, and further abstracts postea. 40 cases in the Belgian Congo treated. A course of eight weekly intravenous jeetions was given, each injection in a solution made with boiled rain water ■' a concentration equal to 3 Gm. in 10 Cc. The dose should not exceed 4 Gm. week. Removes trypanosomes from the cell content of even the most Lvanced cases.—C. C. Chesterman, B.M.J. i./23,149. ; African sleeping sickness can be cured. The dose of 4 Gm. should never be ::eeeded and the maximum tolerated dose should be arrived at gradually and ust be maintained for at least 10 injections, which can be weekly or fort- ;ghtly. Adults receiving less than 0-05 Gm. per kilo will relapse, and children Ln stand double this amount, i.e., 0T Gm. per kilo. If toxic amblyopia bvelops, substitute Tartar Emetic for three weeks—Sodium Thiosulphate jected is apparently ineffective in preventing amblyopia.—C. C. Chesterman, , ii./25,965. Gives considerably better results than Bayer ‘ 205 ’ and neither shows any periority over intrathecal injection of Salvarsanised serum.—C. H. Marshall id S. M. Vassallo, Jl. Trop. Med., Mar. 15/’26,8S. Cleared the blood in infections with T. gambiense in from 6 to 12 hours in ises of 1 to 5 Gm. intravenously. Dimness of vision the only untoward mptom.—P. Manson-Bahr, L.i./27,132. In patients of the first stage, a total dosage of 20 to 40 Gm. usually cures, it in chronic cases 50 to 100 Gm. is necessary (Van den Branden). The best )sage for adults in good condition is 3 Gm. weekly, and in poor condition to 3 Gm. ; for children 0-5 to 2 Gm. Action is rapid, durable, constant, id superior to any other drug, relapses or incomplete cures being due to Traneous causes; toxic reactions are negligible, cases of total blindness corded being due to previous Arsenical treatment (Marugo). Treatment ith Soamin and Tartar Emetic more prolonged and more uncertain than ith Tryparsamide ; in 25 out of 61 cases treated with the latter the spinal lid became normal (Van den Branden). Of 100 eases treated all were cured, • in advanced cases the disease was completely arrested. Can be given fcher intravenously, intramuscularly, or subcutaneously. Quicker, easier, id less painful than Atoxyl, and the most efficient cSruct so far vastakiie, (Kellersberger.) The single course of 50 Gm. for an adult ipears to cure 52% and to ameliorate greatly 48% in the second stage, ccidents insignificant and ocular troubles rare and not severe (Infante), he drug is of great moral value to the natives, who are beginning to have as uch confidence in the treatment of sleeping sickness as they have in the eatment of yaws and syphilis (Trolli).—Abstracts of eight papers on the use Tryparsamide, Ann. Soc. Beige de Med. Trop., per T.D.B., Oct., ’28,790-794. Results of use in 1,000 eases. Exerts unique action on advanced cases, it equally satisfactory in early cases. A drug capable of oral use would be benefit—a German preparation called ‘ 4002 ’ has given promising results :perimentally per os.—Louise Pearce, Rockefeller Inst. Monograph 193° ; .M.J. ii./3o,i094. Though first employed in trypanosomiasis, it is now used almost sclusively in the treatment of :— Neurosyphi/is* General condition of patients improved sense of ell-being.—D. Lees, B.M.J. ih/25,14. Marked serologic improvement in majority of cases of all types. 50 or more jeetions are usually required over a period of a year or longer. Very itoward symptoms.-—H. C. Solomon and B. R. Viets, Jl. A.M.A. n./25,o31. Does not possess an unusual power of penetration into the central nervous 3tem.—Am. Jl. Syph., per Jl. A.M.A. ii./25,1088. Neurosyphilis treated intravenously, and in some cases subcutaneously, in 3ekly doses of 3 Gm. in 10 Cc. water over a period of 8 or 10 weeks. At the ine time Mercury Salicylate intramuscularly in 1 gram doses. Reactions both early and late appear to have been considerable, including visual disturbance in 20% of cases. There was a good effect on nutrition.—J. I). Silverston, L. ii./26,693. A hrst course of 8 weekly injections of 2 to 5 Gm., combined with spinal drainage, followed by a second course, six months later, exactly as the first, except that after the spinal drainage 30 Cc. of a 30% sterile Sodium Chloride solution is given intravenously. Improvement mostly symptomatic. Ocular effects occasionally caused, but not more often than with other Arsenicals. Has little or no effect on the serologic reactions in general paralysis, and is of use in tabes.—,T. M. Wolfsohn and C. Leiva, Ji. A.M.A. ii./25,495-496. General Paralysis and Tabes.—In 20 cases treated at Maudsley Hospital no remarkable results were obtained. Similar improvements might have been obtained with other Arsenicals.—W. S. Dawson, L. i./25,1072. In general paralysis, particularly megalomanic forms, the prolonged use is worthy of trial. 1 to 2 Gm. doses given at weekly intervals intravenously.— M. Brown and A. R. Martin, L. ii./26,699. See also Jl. A.M.A. i./27,475. Tryparsamide as adjuvant to malaria treatment caused improvement.—- J. H. Ewen, L. ii./3o,690. Tonic and ameliorative. Begin with 1-5 Gm. and increase by 0-5 Gm. to a max. weekly dose of 3 Gm. intrav.—J, P. Steel, Pr., Oct. ’31,484. ‘ Tryponarsyi Meuriee ’ is a Belgian product of the same chemical formula as '1 ryparsamide and having the same action on human trypanosomiasis. Amphoteric Arsenical Compounds, i.e., those containing both basic and acidic groups, are more frequently trypanocidal than the non-amplioteric.— King and co-workers, mentioned by Francis N. Carr, Pres. Address, Soc. Chem. Industry, 1927. ||5j[]Sodiurn 7-acetamidofluorenone-2-arsonate n rv AcHN A/ y^j AsO(OH)-ONa,H20 V V lias been prepared by G. T. Morgan and Jessie Stewart in an investigation of the Arsonic Acids of the Fluorene Series. It forms bright yellow needles, and has M.L.D. 15 mgr. per 20 Gm. mouse, with Therapeutic activity of 10 mgr. curative (5 mgr. some action). Glycine and Glycinamide compounds have also been made with higher M.L.D.—respectively 50 and 30 mgr.—with some therapeutic activity in maximum doses.—(Chem. Res. Lab., Teddington) J.C.S., March, 1931. C H Fluorene. Syn. 0RTI10-DlPHENYrLENE METHANE CH2<£6g4= 166-078 is present in tar. Colourless leaflets with violet fluorescence. M.pt. 113° C. [P JSuccinyl Derivatives of ^-Arsanilic Acid. (New Derivatives of /rArsanilic Acid, Part I. A new series of quinquevalent Arsenic compounds made by E. Walton from Atoxyl. They are distinguished by presence of the group NH.CO.(CIi2)x.CONRR/. In this series x=2. The starting point is Succinyl-p-arsanilic Acid, made by condensing Atoxyl with. Succinic Anhydride. Treatment of this acid with Methylamine or Aniline yields the Methylamide or Anilide respectively. Heating Succinyl-£>-arsanilic Acid produces the Imide. This is converted! into the Amide. By a similar treatment with Dimethylamine or Piperidine the Imide yields the Dimethylamide or Piperidide. Reports on the Sodium salts of the Amide, Dimethylamide and Anilide indicate low toxicity accompanied by therapeutic activity, and ir iese respects the new Succinyi derivatives compare favourably [ ith Tryparsamide when tested on mice infected with T. rhodesiense. -J, Stewart, Brit. Assn. Meeting, Bristol, 1930. See also full hcount by Prof. G. T. Morgan and E. Walton, J.C.S., March, 1931. dalonyi Derivatives of £>-Arsanilic Acid (New Derivatives of u-Arsanilic [ Acid, Part II.). p Treated with Ethyl Malonate, ^-Arsanilic Acid failed to yield i?-Arsono- I alonalic Acid (D.It.P. 191548), but the corresponding Ethyl p-Arsonomalon- lilate readily gave Malonanilomethylamide-p-Arsonic Acid with cold aqueous ethylamine, and under pressure with aqueous Ammonia, Diethylamine and thylamine, yielded respectively the Amide, Diethylamide and Ethyl amide ; xe Piperide and Anilide were also prepared, and the Diarsonic Acid by con- uising Malonyl Dichloride with ;p-Arsanilic Acid. Reports on the Sodium dts of these acids shows the therapeutic activity of the Malonyl series to be ightly lower than the Succinyi series.—G. T. Morgan and E. Walton, J.C.S., dy, ’31,1743. p-Arsonoglutaranilic Acid and related Compounds. (NEW DERIVATIVES ? 2?-Arsa:nilic Acid. Part III.) The Sodium Salts of many of these uivatives show considerable curative trypanocidal activity on mice.—Prof. . T. Morgan and E. Walton, Jl. Chem. Soc., Jan.,’32,276-280. (iii.) Diphenyl Nucleus Series. [Fll Bioxy - diamino - arseno - benzol Bi - hydrochloride,—Arseno- snzene, Arsenobenzol, Arsphenamine (U.S. X.), Arsen- tENOL-amine, Ameno-arseno-phenol, if Arsen obillon (T.M. 3809), Dioxydiamido-Arsenobenzol Di-Hydrochloride, Kharsivan (T.M. 363586), ^Salvarsan, P. Argent II., P.G. [., Ehrlich-Hata, or ‘ 606, C12H12O2M2As2(HG1)22H2Q==474-9304. The compound is believed to have a di-benzol nucleus coupled together two trivalent Arsenic atoms. >r Dose and Methods of Injection see p. 194, el seq. Patents.—The Patents concerned with the manufacture of this compound have pired Details of procedure are given in “ Salvarsan,” by M. & W. See also In. XIX., p. 194. Trade Marks: “Salvarsan” and “ Neosalvarsan.” No. 310235 for the former and Nos. 340386 and 340387 for the last-men- >ned were “ suspended ” in favour of British houses during the war, but is order was revoked in 1923. In 1929 both Marks were reassigned to German uses. The compound is available in ampoules, each containing 0-6, 0-5, 0-4, 0-3, - or 0-1 Grn. tilled with inert gas to prevent oxidation. If discoloured— -her grey or brownish—it must not be used. ThG£*czp<Qut£G Sutbstanaes Aat, 1925- — Under this Act and the atutory Rules and Orders 1927, No. 486, in force since August, 1927, Arseno- azol, commonly known as Salvarsan, and analogous substances used for the zcific treatment of infective disease, are controlled by Licence, under the nister of Health in England and Wales, the Scottish Board of Health in otland, and the Minister for Home Affairs in Northern Ireland, both with mid to manufacture and standards of strength, quality and purity. The Standard Preparations of Arsenobenzene, etc., are kept in the National stitute of Medical Research, Hampstead. Biological Tests and tests for bility are applied. The label must state that the contents have been ted in accordance with Regulations under the Act. Tests for Toxicity and Therapeutic Tests (M.R.C.) are provided in Vol. II. Introduction.—-Ehrlich and his assistants (notably S. Hata of kyo) conducted research (vide “ Die Experimentelie Chemotherapie r Spirillosen ”), which led finally to the introduction of Arseno- nzol for treatment of syphilis and other affections. It was hoped compound would effect a “ sterilisation of the system. ’ For further notes on its introduction, Parasitotropic and Organotropic Com- : pounds, see Vol. II. Arsenobenzol solutions kill protozoa in vitro, and the 2 ratio, i.e.r Curative dose or sufficient to destroy oil parasites T for the sub- Toxic dose or Max. dose which patient can tolerate stance is satisfactory.—Ehrlich maintained that this ratio must be l or less for a drug to be of value in this type of disease. Note.—The Chemotherapeutic index (R) — = .-^ax* l°lerated dose _ M.C.D. Min. curative dose If it is fairly large (5 to 10), the minimum curative dose is sufficiently far removed in quantity from the maximum dose tolerated for the drug to be useful. In the case of the Veronal group introduction of one unsaturated (Allyl) group increased the therapeutic action more than the toxicity, so the R is raised. The most efficient and safe members are the Diallyl body (Dial) and the Isopropyl compound.—G. Malcolm Dyson, P.J. i./26,3. Specific Nature of the Treatment. Ehrlich made numerous statements regarding specific action of Salvarsan. The subject is fully dealt with in “ Salvarsan ” by M. & W., pp. 19, 20. Bactericidal Power. Arsenobenzol kills haemolytic streptococci, but only after 3 hours. May injure blood corpuscles. In practice, results doubtful.—Colebrook quoted bv Sir A. Wright, B.M.J. ii./3o,735. No ordinary antiseptic is bactericidal intravenously, Salvarsan in high dilutions, not themselves bactericidal, increased bactericidal power of the blood for S. pyogenes, but protozoal infections (e.g., bilharzia) are eradicated by Antimony.—Prof. Fleming and others, L. i./3 r ,350. Manufacture. — 39-Oxyphenylarsonic acid—C.H4.OHAsO(OH)._, on nitration and subsequent reduction under certain conditions produces a condensation of two molecules forming ultimately the Dioxy-diamino compound. This base is then converted into the Di-Hydrochloride. Vide Patents for further details. The varying toxicity of commercial samples is apparently due chiefly to presence of sulphonic derivatives formed during reduction process with sodium hyposulphite. If hypophosphorous acid is used the product is relatively non-toxic.—J.C.S.A., 1920, 42, p. 2402. T., 1921, 1109 and 1415. The compound forms a bright yellow powder containing 3T6% approximately of Arsenium. According to the Therap. Substances: Act not less than 30% or more than 34%. Soluble in water 1 in 5 forming a thick syrupy liquid with acid reaction, but not acid to Congo-red paper, 1 in 3 Methyl Alcohol and in Glycerin ; 1 in 12 in Ethyl Alcohol. Insoluble in Ether. The Di-Hydrochloride may be converted into the basic substance Dioxy-diamino-arsenobenzol (No. 592 in Hata’s series) of the formula C12H1202N2As2 —365*9196. by treatment with alkali. This base is an unstable, easily oxidisable, insoluble substance containing:. 40*98% of Arsenium-—readily soluble however in Alkalis. Uses.—The acidity of Arsenobenzol must be neutralised at the time of use; it has been largely replaced by Novarsenobenzol, but the compounds are similar in effect; the description of uses, etc^behyw applies also in a large measure to the latter. A syphilitic chancre, a secondary syphilide or ulceration, on a tertiary gumma or ulceration, yields remarkably to the arsenical ; every stage of syphilis treated, however, requires Mercury subsequently - They are also of value in acquired or congenital syphilis, but in parasyphilitic affections they have not yet been proved of great benefit, though they may prevent their progress. Visceral syphilis. Discussion on—especially of the central nervous By stem and cardi)-vascular system. Sir Clifford Allbutt states diat the syphilitic process wherever it is found consists in a lymph- arteritis with consequential irritative and atrophic effects. The division of syphilis into time periods—primary, secondary, tertiary md visceral—is misleading. The pvrexial phase, slight as it may oe, indicates a general syphilitic sepsis in which the cerebro-spinal (system is soon involved. Early necropsies have shown that in i,he pyrexial phase the aorta, brain, liver and other viscera become infected and the cerebro-spinal system does not long escape.— B.M.J. ii./2i,177. ‘ Although Salvarsan may kill all spirochaetes in the skin and mucous nemhranes, it may not go deeper—hence, both exospinal and intra- pinal treatment may be needed from an early stage. Within limits he more parasites that are killed the better time it may be for the est. Small repeated doses preferable to two or three big doses.— fir T. Clifford Allbutt, B.M.J. ii./2i,177. Organic Arsenicals have no marked effect on spirochaetes in the est-tubes, but they destroy them in the body.—Prof. W. E. Dixon, J.M.J. ii./22,410. The body of the patient co-operates.—H. H. Dale, 3.M.J. i./22,807. Note.—Writers designate the causative organism of syphilis, tpirochceta, Spironema, Treponema, etc. U&& in Malaria, Yaws, Fret mb cost a, Levrosy, Pernicious incem/a and other diseases—It is thought that not only ie the ibstance specific for syphilis, but that it probably acts against Spirillosa 1 general. Malaria.—Benign tertian infection. Arsenobenzol intravenously has a efinite parasiticidal effect, but not on any stage of the malignant subtertian arasite ; it intensifies Quinine.—J. Pratt-Johnson and co-workers, B.M.J. /2I,81. Yaws has been treated by intramuscular injection. 0-8 Gm. injected into le buttock gives astonishing result. 12 intramuscular injections of Hectine, iven daily, only equal in result one dose (0-6 Gm.) of Novarsenobillon.— . Cantlie, Jl. Trop. Med., Feb. 1/23,37. Frambcesia.—Among 900 cases in Surinam there were only three unsuccess- illy treated.—L. ii./n,1303. Vincent’s Angina.—A throat swab dipped in Glycerin and this in the owder and rubbed on to the affected parts in the throat. Not painful, elief afforded after a few hours.—L. ii./i3,1120. Leprosy.—Some reports have been favourable. In Small-pox, no influence ; Typhus favourable; in Relapsing Fever tore active than in syphilis.—B.M.J.E. ii./i 1,4. Rat-bite Fever successfully treated by Novarsenobillon 0-4, 0*6 and 9 Gm. at intervals.—G. C. Low and R. P. Cockin, B.M.J. i./i8,203. Experimental determination of minimum lethal, minimum effective and aximum tolerated doses of Arsenic and Antimony compounds in trypano- >me infection.—C. Voegtlin,H. W, Smith and co-workers, perT.D.B. 17/21,330. Cancrum Oris in Formosa. Salvarsan has reduced mortality rate from mrly 100% to 25%.—I). J. Maxwell, Jl. Trop. Med., July 2/23,235 . On micro filarioe bancrofti, intramuscularly, has toxic action.. Periodical jections suggested for persons suffering from lymphangitis, fumculitis, etc., king into consideration age and general condition of patient. 1. Noe, ’r Jl. Trop. Med., July 2/23,238. r VOL. I. G Administration.—Protect the liver by giving an ounce of glucose two or three hours before Arsenobenzol, the drug is then tolerated better Arsenobenzol is usually given intravenously by the gravity methoc Intramuscular injections into the gluteal muscles, are now little- used on account of the pain produced. Novarsenobenzol and Metarsenobillon have superseded for that route. Preparation of the Injection.—Dissolve the dose in about 10 Cc. of Sterile Water and make it alkaline by adding Normal Caustic Soda solution (40 Gm. per litre), using the amount on the label required to dissolve the dose. A precipitate is formed which redissolves on shaking. Dilute with Normal Saline so that each 0*1 Gm. is contained in approx. 20 Cc. of solution. Injection ie usually through one of the veins of the fold of the elbow, e.g.t the median cephalic, but any prominent vein may be used. Dose.—0*1 to 0*6 Gm. Early syphilis is generally treated with from 0-2 to 0-3 Gm., and a number of injections, at intervals of a few days, gradually increasing up to 0-6 Gm., are given, with a total of 4 to 5 Gm. This course usually is repeated after an interval varying from 4 to 6 weeks, and three or four such courses are generally required. The injection should not be given immediately before or after a meal. A mild purgative before the injection lessens the liability to untoward reactions. Children may receive from 0-02 to 0-2 Gm., according to age, but Metarsenobillon subcutaneously, or; Novarsenobenzol intravenously, are preferable in such cases. ‘ Combined Treatment ’ with Mercury vide postea. Patients should be treated in bed and observed for at least three days. If ; patient shows during administration any signs of collapse, the injection should be stopped at once. [g]jFi] Arsenobenzol Suppositories. Arsenobenzol 0*1 Gm., Cocaine 0*1 Gm., Almond Oil q.s., Theo- broma Oil to 1-0 Gm. Not to be kept more than 48 hours. May be coated with beeswax as protective. [MlSupsalvs.—A proprietary brand containing 0T (adult) and 0 03 Gm. (infants). Combined Arsenobenzol and Mercurial (or Bismuth) Treatment. An analysis of records of 3598 cases treated at St. Thomas’s Hospital V.D. Centre between January, 1920 and March, 1926. A course consisted of not less than 5 Gm. of an Arsenobenzol compound (except with Silver-Salvarsan, q.v.) with a minimum of 5 grains of Mercury or 2 Gm. Bismuth, intramuscularly or subcutaneously, over a period of not more than 4 months. With Silver Salvarsan a total of not more than 2-5 Gm. was given, with or without Mercury or Bismuth. A second course was given 3 months after the first and completed in 4 months. The results of treatment with Arsenobenzol compounds and Mercury, compared with those with Arsenobenzol compounds and Bismuth, shewed no superiority of Bismuth over Mercury, though Bismuth was better tolerated. (The preparation of Bismuth used was mainly the Oxychloride suspended in Glucose solution.) In sero-negative primary cases not less than two courses were necessary, and in sero-positive primary and early secondary cases rsven three courses did not give a satisfactory percentage of cures. Most relapses in early cases occurred in the first year, and a very small proportion after the second. iUnit Course on which treatment of cases analysed in Report was BASED. Day. Arsenobenzol Comp. Gm. and Hg. grains or Bi Gm. Day. Arsenobenzol Comp. Gm. and Hg. grains or Bi Gm. f 1 0-45 — — 50 0*75 1 0-4 8 0-45 1 0-4 57 0-75 1 0-4 15 0-45 1 0-4 78 0-75 1 0-4 29 0-60 1 0-4 85 0-75 1 0-4 36 0-60 1 0-4 92 0-75 1 0*4 (Potassium Iodide from 57th to 78th day.) Course instituted 22/2/28. In this course, the principle is to follow three short * bursts ' of ‘ 914 ’ (which jmght effectually to destroy accessible Sp.p.) with three rests of a month each o allow liver cells and skin to recover, and to finish with two full courses of . 914.’ The Bismuth is crowded into the first 10 weeks to build up a depot. Day. Arsenobenzol Comp. Gm. Bi Gm. Day. Arseno- benzol Comp. Gm. Bi Gm. 1 0-45 0-4 43 0-75 0-4 8 0-45 0-4 50 0-90 0-4 15 0-60 0-4 571 — 0-4 22 — 0-4 64 } K.I. — 0-4 29 — 0-4 71J 36 — 0-4 78 0-90 -Col. L, W. Harrison, “The Treatment of ipecial Report Series, 132, 1929. Arseno- benzol Bi Day. Comp. Gm. Gm. 113 120 Syphilis,” 85 921 99 - Ell. 106 J Med. 0-90 0’90 0-90 Res. Council, ■ The necessity of associating intravenous Arsenic with Mercurial treatment was confirmed by the French Military Medical Service during the war. Bismuth or Mercury compounds in con junction, e.g., 01 Gm. jf a Bismuth compound, with 0*45 Gm. Neoarsphenamine, maybe given once a reck. This obviates complications and gives as good results as obtained ormerly with larger doses of Arsenobenzol.—Jl. A.M.A. iu/29,1310. I Extra courses of Salvarsan, rather than Mercury, for prevention of Wasser- nann reactions and destruction of residual spirochnetes. Grey Oil courses aid to increase tendency to relapses.—Prof. E. E. Glynn, L. ii. /26,1075. Modern aspects. of syphilis. Every early primary case with negative Vassermann Reaction should receive 20—25 Salvarsan injections intravenously nd some 16—18 of Mercury and Bismuth, or Mercury given ver os.—W. H. Srown, B.M.J. ii./26,890. War Office Method. Letter, May 8/16, No. 24/General/4912, A.M.D. 2.) lee Edn. XIX., pp. 199,200. Congenital Syphilis in Children.—Vary dose according to ye of child: e.g., for child 1 month old, initial dose of N.A.B. 0*05 Gm., —3 years 0-1 Gm., and for older children 0-15 Gm., increasing during the ourse of 6 injections to respectively 0-1 Gm., 0-25 Gm., and 0-3 or 0-45 Gm., ubsequent courses starting with larger doses and reaching higher maxima, ut not exceeding 0-45 Gm. for a child of 12. For older children commence dth 0-04—0-06 Gm. and increase up to 0-36. Injections are given intra- enously or intramuscularly in from 1 to 3 Cc. Distilled Water. Mercury is iven either as Hyd.c.Cret., £ to 1 grain thrice daily, or better still the oint- Q 2 V-7 ment rubbed in once a day, or Green Iodide of Mercury, 1/8 to 1 grain, two or three times daily during injections. In older children 30 or even 40 Arsenic injections may be necessary.—D. Nabarro, Modern Technique in Treatment, Vol.III., p. 111. Syphilis in Women, Weekly intravenous injections of 0-3 to 0-6 Gm.( with a drink of lemon-flavoured Glucose Solution (3 oz. each of Glucose and Water) half an hour before, and a Hutchinson’s Pill thrice daily. After a course of N. A.B. the pills are stopped for two weeks, and if the W.R. is negative and the case first seen in the primary stage, allow to carry on with pills alone for two months ; but if case when first seen had well-established secondary lesions the patient is given pills to last a month and is then given a further set of injections, which may be slightly different from the first, e.g., Sulfarsenol instead of N.A.B. During remainder of treatment W.R,. is taken every three months and a further course of injections given if required. If all tests are negative and condition satisfactory, pills only are given during remainder of time. Standard of cure negative W.R. over two years.—Margaret Rorke, Modern Technique in Treatment, Yol. I., p. 146. ‘Alternating’ treatment economical and successful, whilst ‘ Concurrent ’ is wasteful and productive of greater number of uncured syphilitics.—E. Tytler Burke, L. i./3i,1127. Adequate treatment of syphilis. Further discussion.—L. W. Harrison, Howard Allen and D. Lees in reply to Col. Burke, L. i./3i,1265. First place given to ‘606 *—hits the spirochsete harder and longer than 914 * in dosage equivalent in terms of Arsenic, but reactions deterred many patients from continuing. The Sulpharsenobenzene class subcutaneously better than ‘ 914 ’ intravenously, but painful and more likely to cause aplastic anaemia. More ‘ 914 * used in the Clinic, but more Sulpharsenobenzene in private cases. Mercury reserved for cases in which Bismuth is impracticable— Calomel best, followed by Mercurial Cream (not greater than 10% strength). —Col. L. W. Harrison, B.M.J. ii./31,157. Warnings, Contraindications, After-effects, and Treatment of Toxic Effects following Arsenobenzol Compounds. It should not be given to aged and infirm patients, or where there is a general exhaustion of vitality following the severity of the syphilitic poisoning, especially in persons already suffering from chronic organic diseases of the kidneys and from chronic degenerations of the cardiac muscle, patients with definite atheroma of the arterial coats, such as have already suffered from anginal attacks or from signs of cerebral haemorrhage, add to these, patients with diabetes, tabes dorsalis and general paretics, and lastly any case in which there is or has been recent endocarditis. Extreme caution is necessary in cases with signs of active pulmonary phthisis, owing to the congestive action of the drug. Idiosyncrasy to Arsenic in general may exist in the patient. If necessary, try the effects of Fowler’s Solution ver os. Patients giving a positive reaction should not receive the injection. After-effects. A drink containing Glucose 2 ounces? given £ hour before injection, ippears to reduce jaundice. Among after effects have been observed:—Headache, numbness of the imbs, sickness, skin eruptions—urticaria, acute dermatitis, erythema, and jaundice. Effects on the eye: iritis. (A person with unsound eyes must not receive the injection.) Pyrexia; sensory nerve complications; defects in hearing have been reported. Two fatal cases of icterus gravis following Hovarsenobillon.—B.M.J.i./i 8,448. Jaundice. 115 cases in 7,000 patients.—Col. Bolam, B.M.J. i./i9,489. Evidence is that the arsenical is conducive. It is more common with ‘ Neo ’ than with the original.—R. Hallam, L. i./2o,1356. See also A. T. Todd, L. i./2i,632. . Atropine, Quinine, Lead, Copper, Zinc, and Bismuth pass over m the mammary secretion. From clinical observations the following are added:— Iodine, Salicylic Acid, Ether, Mercury, Phenazone, Aspirin, Arsenic, Morphine, Hexamine Acetanilide, Scopolamine and Luminal, Arsenic is found in the milk Faliowincg Arsenobenzol treatment, so that caution is advised.—M. M. W., ’26,322, per Pres., Feb., ’27,65. Risks of Arsenobenzol injections—Medical Research Council Report. Some degree of hepatic insufficiency demonstrable 3 months after a course—but the treatment thought justifiable.—L. ii./22,193. Toxic efFects, and their treatment. If doses of 0*0 Gm. Arsenobenzol are repea ted too frequently toxic effects are frequent, epileptiform convulsions coming on within 5 days, and often ending fatally. According to a German edict a few years ago a single dose must not exceed 0*4 Gm. Even 8 doses of 0*3 Gm. in 28 days with Mercury is unsatisfactory—dermatitis and jaundice follow. Both these are apt to be fatal. It is certain the drug can cause death. It is very unwise to inject a total of 1*2 Gm. (2 doses of 0-6 Gm.) within three days—a wider interval is important. Delayed Arsenical poisoning from Arsenobenzol preparations. A report of a number of cases, some fatal.—G. S. Strathey, L. i./2o,802. Daily intravenous injections of Sodium Hyposulphite recommended when Salvarsan poisoning threatens. Has never failed and no ill effects have been observed from it.—B.M.J.E. i./27,93. Sodium Hyposulphite Sterules, 0*2, 0-45, and 0-6 Gm., are prepared. Three or four injections of 0-2 or 0-45 Gm. intravenously on alternate days in Arsenical Poisoning. See Sodium Hyposulphite see p. 87. Calcium Chloride 10% solution in Salvarsan Poisoning given separately or with the injection prevents toxic symptoms.—B.M.J.E. i./22,94. Severe vasomotor disturbance : Adrenalin Chloride 1 : 1,000, 10—15 m. subcutaneously. Cerebral symptoms with severe epileptiform convulsions : lumbar puncture, 20—30 Cc. fluid being withdrawn. Erythema : Alkaline Glucose Solution (25%), 25 Cc. intravenously, daily or every other day as required. Sodium Thiosulphate 0-6—0-9 Gm. intravenously, every day or every other day, also effective. Exfoliative dermatitis : same treatment as erythema so long as bend of elbow not involved : diet as for typhoid fever. Injections not repeated for at least a year after recovery. Jaundice : Glucose intravenously, and diet as for dermatitis. Bowels kept open and mixture containing Bismuth and Sodium Bicarbonate given.— L. W. Harrison, Pres., Sept., *26,323. Atropine 1/50 grain hypodermically is also advised for immediate vasomotor reactions. The cardiac reactions are best treated with hypodermic injections of Strychnine 1/32 grain, Ether 30 minims, or Camphor 1| grains. Later reactions, e.g., stomatitis, affections of the central nervous system, liver complications and skin reactions, may be treated with Sodium Thiosulphate or Thiosinamin.—P. Power, Jl. R.A.M.C., Jan., ’27,46. Toxic effects not due to Arsenic content but to the amino-benzene derivatives. The 1922 Report of the M.R.C. Salvarsan Committee needs revision. —Semon, L. ii./31,914. Disadvantages oe Salvarsan Treatment. Dr. Dreuw, a Berlin specialist, gives the following statistics : (1) 84% of 8,000 soldiers so treated were not cured, (2) 13 practitioners report 101 fatal cases of Salvarsan poisoning in 1 year, (3) for every 100,000 persons treated with Salvarsan there were 620 with consequent skin complications, 1-3 cases blindness, 2-6 cases complete, and 4 partial, deafness, 62-2 cases of cerebral involvement, 224 of paralysis, and 16-2 deaths undoubtedly and 14-2 deaths probably due to Salvarsan.—B.M.J. i./24,441. Local Anaesthetics. Novocain injection—2 Cc. of 1% Solution has been advised before, and is said to render the injections painless. Ethyl chloride has also been used. Also Morphine in dose of 0 01 Gm. where pain is excessive with subcutaneous injections. Injectio Salvarsan cum Novocain (Intramuscular). Dose.—Salvarsan 0-3, Novocain 0-03, Normal Saline to 10 Oc. This has been employed, but the pain caused may persist after the anaesthetic effect has passed off.—W. H. M. Local Use. For condylomata a powder containing Arsenobenzol as also a 50% Ointment strongly caustic when used in this manner and hence curative. For milder effect a 10% Ointment in a mixture of equal parts Soft Paraffin and Lanolin is used. Salvarsan in glossitis.—Swabbing with solution of 0T Gm. in water 30 minims and Glycerin £ ounce was curative. At the end of a week ulcers ■diminished to quarter of original size.—A. Allport, B.M.J. ii./i2,349. Ordinary ulcers heal rapidly by local use of Salvarsan and Neosalvarsan as dusting powder.—H. Alston, B.M.J. ii./i2,1748. Intrathecal Injection of Patient’s Serum after Salvarsan Treatment. —The transmission of Sp. Pallidum from the brains of general paralytics to the rabbit and the experimental production of syphilitic encephalitis in this animal (Noguchi’s experiments), led up to this method. The entire subject is dealt with in Edn. XVIII., p. 214. Neuro-syphilis. Defined as comprising only such nervous or mental symptoms as are actually due to the syphilitic organism or its toxin. It does not mean the mere presence of nervous or mental symptoms in a syphilitic patient. The treatment is Salvarsan combined with Mercury, but 0-6 Gm. of the former intravenously is now considered risky. It is safer to give not more than 0*3 Gm. in repeated doses. Salvarsanised serum, (patient’s own blood), or human, or horse serum, mercurialised in vitro, is suited for tabes and cerebro-spinal syphilis. Arsenobenzol given direct intraspinally into the cerebro-spinal fluid is dangerous.— Sir. J. Purves-Stewart, B.M.J. ii./22,621. See also S. A. Kinnier Wilson, ibid. 628. See also D. K. Adams’ ‘ Treatment of Neuro- syphilis with special reference to changes in the cerebro-spinal fluid.’ (Cell counts and Colloidal Gold reaction), ibid. 630. Parasyphilitic affections of the nervous system treated by Salvarsanised Serum by means of double puncture. Smali dose of Neosalvarsan added to patient’s serum, and part re-injected.—T. Brunner, L. ii./29,117. “ Salvarsan,” by M. and W., provides abstracts of the literature of the subject ranging from March 15 to December 17, iqio. These constitute everything of importance that was written on the subject up to that date. Further references are contained in the I5th-I9th Editions. Wassermann's Reaction, Effect on and other details. See Vol. II. (jPH^Eparseno ”132” (T.M. 422G53) is stated to be a stabilised solution of Arsenobenzol for painless injection (it is only to be used this way) in the treatment of syphilis, yaws, recurrent fever, etc. It is supplied in ampoules each containing 1 Cc. of solution, corresponding to 0-12 Gm. of Arsenobenzol or 0-25 Gm. of Novarsenobillon. [Pi])$cStabilarsan (Brit. Pat. 177283 of 1922, T.M. 411118). A preparation of Arsenobenzol base with Glucose for injection, supplied in liquid form ready for use, either intravenously or intramuscularly, in ampoules. Stabilarsan is based on the theory that a molecule of Arsenobenzol combines with two molecules of Glucose to form a definite chemical compound. This compound is stated to be relatively stable when exposed to the air. It is supplied in 50% Glucose solution. Ampoules contain 0T, 0-15, 0-20, 0-30, 0-45, 0-6, 0-75 and 0-9 Gm. In congenital syphilis the preparation is stated to be safe. For an infant 15 lbs. weight dose 0-075 Gm. (0-75 Cc. of the solution in the ampoule). For routine treatment of syphilis a course is given combined with Potassium Iodide on the lines of Arsenobenzol methods. Sanogyl (T.M. 421128). A tooth-paste to combat pyorrhoea ; claimed o have a specific action on spirilla of the mouth, and to contain arsenobenzol. —P.J. ii./22,392. EjPyorrhease. . ^ tooth-paste containing Novarsenobenzol, for use in pyorrhoea, stomatitis, gingivitis, etc. ’ ED Silver Salvarsan, P.G. VI. Dose, Intravenously in 1% solution, one or two injections of 0*1 Gm. each, then 0*2 Gni, for women and 0*25 Gm. for men at intervals of not less than 4 dajrs. Repeated at intervals until clinical symptoms and blood test satisfactory. In weakly patients begin with 0*05 Gm. It is a brownish black powder, containing 22-5% Arsenic and 14% Silver, S01u61e in water, with alkaline reaction. Ampoules contain 0-05, 0-1, 0-15, 0-2, 0-25 and 0-3 Gm. 1 Oiinicniiy 0*1 Gm. corresponds to about 0-3 Gm. Novarsenobenzol. It is l thought to have the combined effect of Arsenobenzol and Silver against S syphilitic parasites. Mercury to be suspended during treatment. Contraindications. Cardiac diseases, diseases of the liver and kidneys, and constitutional tendency to skin diseases. Syphilis. Efficient with pronounced effect on visible syphilis lesions. Absence of characteristic and often nauseating garlic-like odour noticed by patients receiving Salvarsan intravenously—no authentic case of argyria reported.—H. E. Michelson and D. M. Siperstein, L. ii./2i,571. See also B.M.J.E. ii./2i,l,54. Probably about twice as effective as ‘ 914 ’ in similar doses.—Col. L. W. Harrison, B.M.J. ii./2i,944. Late syphilis. Importance of thorough treatment in the first instance—to prevent late sequelae. Sulfarsenol praised for use in myocarditis and aneurism. Tabes: Intravenous injections with deep subcutaneous injections. For intravenous use Silver Salvarsan and for subcutaneous Sulfarsenol. G.P.I.: • Silver Salvarsan in large quantities.—Col. L. W. Harrison, L. h/23,4. Multiple sclerosis. Silver Salvarsan the most effective remedy—0-05 Gm. twice weekly, increased to 015 or 0-2 Gm., the average total dose being 2-5 Gm. —B.M.J.E. ii-/24,55 ; Jl. Trop. Med., April 15, ’25,168. The Silver is not combined with the Salvarsan in [jMjSodium Silver Sal- varsan (another preparation), but is present merely in colloidal form.— W. H. Gray, P.J. h/23,216. (JPJjNeo-Silver Salvarsan, P.G. VI. A molecular compound of Neosalvarsan and Silver Salvarsan in brown powder. jjFljNovarsenohenzene. Syn. Novarsenobenzol, Neo-arsen- phenolamine, ^Neo-Kharsivan (T.M. 364607), * Neosal- varsail (No. 914 of Ehrlich’s Series T.M. 340386, 340387 Assoctd., see Salvarsan), ^Novarsenobillqn (T.M. 413810), Arsenobenzol Acid Sodium Eormaldehyde-Sulphoxylate, Sodium Dioxy- DIAMIDO - ARSENOBENZENE - METHANE SULPHONATE. P. Argent. II., P.G. VI., Neoarsphenamina, U.S. X., E.E. VIII., P. Beig. IV., Neoarsaminol, P. Svec. CAs — AsC A A PIC CH HC CH =466 0344. H2N.C CH HC C.NH.CH2O.SO.Na V V C.OH C.OH (Theoretical formula.) Brit. Patent No. 7865/12. Aqueous Solutions of Salvarsan and Formal- ehyde Sulphoxylate give a precipitate which is soluble in a minute quantity f alkali to form an almost Neutral Solution. The product differs according to temperature employed. At ordinary temperature the precipitate contains one “Sulphur-Acid” group, at 60—70° it contains two “ Sulphur Acid ” groups. See also Patent No. 8219/i2. These Patents have now lapsed. The soluble compound may be made directly from Sodium Formaldehyde Sulphinite, Syn. Fongalite.—G. Malcolm Dyson, P.J. i./26,32. Novarsenobenzene under the Therapeutic Substances Act, 1925, and the S.R. & 0., 1927, No. 486, is made under license (cf. Arsenobenzene) and assayed biologically. It is a yellow powder, readily soluble in water. The compound changes in the air ; it is hence issued in sealed ampoules. The dry powder as taken from the sealed ampoules must contain not less than 18% or more than 21% of Arsenic. U.S. X. says not less than 19%. Injections must be made immediately after preparation. Strength in comparison with A rsenobenzoh— It is 2/3 the strength. Intravenous dose.—Many authorities recommend an initial intravenous injection of a small dose, e.g., 0-45 Gnu, followed by 8 to 10 doses at intervals of 3 to 8 days, gradually increasing the dose up to 0-9 Gm. as a maximum, repeating after an interval of 4 to 6 weeks. Three or four series may be required for complete treatment. Mercury or Bismuth is frequently given during the intervals. 0T5 to 0-45 Gm. is given in from 5 to 10 Cc. of wTater, or 0-6 to 0-9 Gm. in 15 to 20 Cc. water, by slow injection into the median cephalic vein. More concentrated solutions have been employed, e.g., 0*9 Gm. in 2 to 3 Cc. water ; concentrated solutions however require great caution. Intramuscular Dose.—0T5 Gm. to 0-45 Gm. This should be dissolved in a mixture of Guaiacol-Glucose and water 10 to 20 minims, for injection into the buttock. The part should be massaged after injection. The absorption is slower, so it is probable that smaller doses suffice than by the intravenous method. Guaiacol-Glucose Sterules 2 Cc. for preparing the intramuscular injectirn are made of the strength, Guaiacol 1, in 50% Glucose. This method of procedure was advocated by T. Anwyl-Davies, L. ii./i8,757. It was found painless. Even 0-75 Gm. will dissolve in 10 to 20 minims. Lises,—As for Arsenobenzol. It is said to be better tolerated. For contraindications and treatment of after-effects see Arsenobenzol. References. Syphilis.—Subcutaneously Novarsenobillon influences syphilitic lesions more rapidly than intravenous doses of Salvarsan or Arsenobillon. Experience of 1,500 subcutaneous or intramuscular injections of Neo-Salvarsan. Numerous methods were tried and are described, the best being to dissolve the Neo- (0-6 Gm.) in 1 Cc. of a 4% Stovaine solution and make up to 2 Cc., with a Creo-Camph Cream melting at 15° C., which is stated to be a ‘ special ’ formula. Campho-Phenique, instead of Creo-Camph., also used with encouraging result. Morphine § grain is required to overcome pain. The injection is made about a point three finger breadths below the crest of the ileum on a line joining the tuber ischii with a point on the crest of the ileum which is perpendicularly above the great trochanter when the patient is upright.— L. W. Harrison, C. F. White and C. H. Mills.-—B.M.J. i./i7,569. In syphilis of the central nervous system Novarsenobillon safe and most efficient.—H. Carlill, L. i /18,243. Severe dermatitis from Novarsenobillon.—L. G. Leonard, B.M.J. ii./i9,773. Gastric syphilis treated by Mercury and Arsenobenzol.—D. J. Galloway, B.M.J. i./22,217. Soft chancres treated by swabbing with 3% solution.—B.M.J.E. ib/22,18. Ante-natal treatment of congenital syphilis. The focus of infecting spirochsetes is probably the placental tissue. Arsenical compounds and Mercury at Glasgow given with 100% successes—J. R. C. Greenlees, B.M.J. ii./2i,654. Four or five intravenous injections of Neosalvarsan with Mercurial inunctions during pregnancy. Results good.—B.M.J. ii./^ 1,654,887. Intraperitoneal Injection in infants suffering from congenital syphilis with safety. A child of 10 lbs. should receive 50 mgm., or 5 Cc. of a solution consisting of 150 mgm. of Neo-arsphenarnin dissolved in 15 Cc. warm sterile water. The usual treatment consists of four injections at three-day intervals, followed by 4 injections at seven-day intervals, the ideal site for entrance of the needle being in the middle of the left rectus sheath, slightly below the level of the umbilicus. The method is not as rapid as intravenous injections, but Neo-arsphenamin is absorbed with sufficient rapidity to act in any condition. It is ideal for children with small veins needing urgent treatment.— H. S. Sanford, Jl. A.M.A. ii./25,242—245. fewer injections required in the treatment of syphilis when combined with milk injections.—B.M.J.E. i./26,30. Cardio-aortic syphilis treated by, each year, a series of 6 to 8 intravenous injections of Novarsenobillon 0-6 Gm. at weekly intervals.—T. F. Cotton, B.M.J. i./26,855. Spirochetal pulmonary gangrene well treated with Neoarsphenamin intravenously.— B. S. Kline and S. S. Berger, Jl. A.M.A. ii./25,1452. Disseminated Sclerosis, early cases treated with Novarsenobillon. Six weekly intravenous injections (0-15, 0-3, 045, 045, 0-6, 0-6 Gm.) repeated at end of six months, with Arsenic per os in the interval.—W. Johnson, L. i./23,1209. Sodium Thiosulphate simultaneously with “ 914 ” found to have no deleterious effect on therapeutic action.—L. W. Harrison, H. H. Dale and P. A. Clements, L. i./25,1161. Trypanosomiasis.—Intravenous injection of Arsenical compounds, and an immediate subsequent attempt to sterilise the central nervous system by intrathecal injection of Salvarsanised Serum. The patient’s treatment is complete in 2 days. Comparative tables of a variety of procedures. A dose of Neo- Kharsivan with 1 injection intrathecal serum gave a large percentage ‘ alive and well.’—C. H. Marshall and S. M. Vassallo (Uganda), B.M.J. i./21,773 ; i./23,231. Marshall and Vassallo produced no satisfactory evidence that intratheca injections of Salvarsanised Serum sterilise infected cerebro-spinal fluids (in trypanosomiasis).—Prof. Warrington Yorke, L. ii /21,973,1077. Cysts of Giardia intestinalis, Chilomastix mesnili, E. Coli, E. histolytica;, and E. nana rapidly disappeared from stools of a man, following intravenous injections.—Carr and Chandler, T.D.B., Vol. 17, 1921,99. Malaria treated with conflicting results. Sodium Cacodylate recommended as an adjuvant to Quinine.—W. A. Murray, T.D.B., Vol. 17, 1921,142. In early cases of simple tertian malaria an injection is a therapia magna sterilisans.—Jl. Trop. Med., Aug. ’15,308; Jl. A.M.A. ik/25,151. Broncho-spirochetosis in China. Immediate relief; recovery after second or third administration.—E. C. Faust, Jl. Trop. M., Jan. 1/23,14. Intrathoracic injections valuable in suppurative lung conditions, e.g., gangrene, abscess, empyema and bronchiectasis. First aspirate pus and inject 045 Gm. Neosalvarsan, and repeat injection every 4 or 5 days, increasing to 0-6 Gm.—per Pr., Aug., ’29,155. , , , , , AT Guinea-w'ORM.—Novarsenobillon, 0-6 Gm., is the best treatment.- N. Cantlie, Jl. Trop. Med., Feb. 1/23,39. .... Massive doses given intrarectally in cases where intravenous injections are dangerous or undesirable. As much as 4 Grn., it is stated, may be given with safety.—H. G. Mehrtens, per Jl. Trop. Med., Nov. 1/22,348. Hemiplegia cured in 3 weeks by intravenous injections of 0o to 0-9 Gm. —L. Le Dentu. per Jl. Trop. Med., Oct. 1/23,312. ... AmcebiasiS has been treated with it per os m l ranee. L. n./26,824. Typhus Fever treated intravenously. In two cases the course of the disease was aborted.—Glas. Med. Jl., Nov., 1913,0 <0. nJjUJE1^CUL0SI1S-—Organic compounds of Arsenic, e.g., ‘ 914 ’ (intravenously) kuuarsenol (intramuscularly) in pulmonary tuberculosis where Arsenic oems indicated—intramuscular route preferable. Improvement due to stimulation of the metabolic functions ; there is no specific effect upon the bacilli.—J. Guy and G. B. Page, L. i./24,847. Chronic lung affections treated with intrapleural injection of Neosai- varsan. The pleura tolerates high dosage, 0-45 to 0-6 Gm. in 10 Cc. water, it is a powerful antiseptic, especially against streptococci. It has been used m the bronchial tree in bronchiectasis.-—L. ih/29,32. . ^l°ocf pressure is generally lowered by Neosalvarsan intravenouslv * it is certainly not increased.—H. D. Rolleston, B.M.J. ii./i5,281. . Heucocytosis is induced powerfully by Novarsenobenzol (0-3 to 0-6 Gm. intravenously) ; useful 111 trachoma and staphylococcal infections.—G. R. S Thomas, L. 1./25,1292. Yaws, acuta, generally cured within 3 days by one injection of Novar- senobillon or Galyl.—F. T. Auden, B.M.J. ii./22,83. In W estern Samoa, the standard treatment for yaws is three doses intravenously at one-week intervals.—Per Jl. iTop. Med., Apl. 1/26,27 (Col-Med. Eep. No. 191). Treatment with ‘ 914,’ especially insufficient treatment, may actually activate latent syphilis. After 20 years’ trial of Salvarsan, etc;, c nere is absence of unanimity as to the best method of treating syphilis, -t is pointed out that some advise alternate course of ‘ 914- ' anc# tsismuth, others simultaneous, others3 again, wan t Arsenic t° Follow Mercury, and so on.—J. H. Sequeira, -Li. 1./30,1348. (pjNovarsenobenzol Suppositories (0-10 Gm. in cocoa butter) given to three months’ old baby with hereditary syphilis, with good results.—E. G. Melon, per Jl. Trop. Med., Oct. 16/22,334. FTSulpharsenobenzene. Syn. Sulpharsphen amine, ^Sulfar- senol (T.M. 434138 Limited use), *Khaksulphan (T.M. 445499), *Metarsenobillon (T.M. 459,333), ^Myosalvarsan (T.M. 501,517), Di-sodium Dioxy-diamino-arsenobenzene-dimethy- lene Sulpiionate. P. Ital. V., F.E. VIII., P. Belg. IV. I he Disodium salt of 4 : 4 dioxy-3 : 3-diamino-arsenobenzene- diformaldehyde bisulphite. Na0S02.CH2.NH.0H.C6H3.As : As.C6H30H.NH.CH2.02S0Na. This compound, of which the 1 proper name ’ under the Therapeutic Substances Act, 1925, and S.R. & 0. No. 486, 1927, is Sulpharsenobenzene, is a yellow dry powder soluble in water without gelatinous particles visible in the solution. It must comply with tests for toxicity, therapeutic potency and stability detailedin the S.R. & O. ” It contains approx. 20% of Arsenic, is soluble, and gives a faintly acid solution. Dose.—The preparation can be given hypodermically or intramuscularly in fairly concentrated condition. The following is suggested as a course in primary syphilis for an average adult :— Water. 1st day 0T2 to 0T8 Gm. in 2 to 3 Cc. 3rd ,, 0T8 ,, 0-3 Gm. ,, 3 ,, 5 ,, 5th „ 0-30 ,, 0-42 Gm. ,, 5 ,, 7 ,, 8th „ 0-42 „ 0-6 Gm. „ 7 „ 10 „ 13th „ 0-48 „ 0-6 Gm. „ 8 „ 10 „ Water. 19th day 0-54 to 0-6 Gm. in 8 to 10 Cc. 25th „ 0-6 Gm. „ 10 „ 40th,, and later, Wasserman 40th to 60th day, Arrhenal. 61st day, New Series of injections of Sulfarsenol. It is supplied commercially in a range of doses. The preparation is also given intravenously, starting with 0*06 Gm., proceeding with caution (see also Col L. W. Harrison, infra). The patient should fast for at least 3 hours before the injection and be kept in bed for several hours after. No solid food should be given for 12 hours following, but a little soup may be given after 4 or 5 hours. It is stated that this is the oniy Arsenobenzol compound on the market, which can be given into the muscles or subcutaneous tissue without causing great pain. Intramuscular or subcutaneous treatment of syphilis with Arsenobenzol preparations in general said to be better than intravenous.— I'. C. Doble, L. ii./2o,243. Also used in complications of gonorrhoea, arthritis, rheumatism, hyperkeratosis and epididimytis (especially good in the last- mentioned).—L. i./23,70. See also W. M. Browdy, ibid. 158. (Doble uses only 8 to 10 minims of water for 0-2 to 0-6 Gm. injected into the forearm.) Intramuscularly or subcutaneously in doses as high as 0-6 Gm. in 3*3% solution, without significant local reaction. End results favourable. Intramuscular injection the method of choice. Relatively high incidence of dermatitis, especially with intravenous injections. In congenital syphilis, as effective as Neoarsphenamin.—Am. Jl. Syph., per Jl. A.M.A. ii./25,108s. Congenital syphilis treated. Its intramuscular injection not so efficacious as Kharsivan intravenously.—E. Crawford and G. B. Fleming, L. ii./21,700. Can not be recommended for intravenous use. Given subcutaneously, it offers a hope of treating syphilis over long periods without toxic effects’.— Col. L. W. Harrison, B.M.J. ii./2i,944. After 3 injections of the drug in the treatment of yaws in a child of 6 an eruption of herpes zoster appeared—possibly due to the Arsenic.—H. Coppin per Ji. Trop. Med., May 1/23,140. Gqnorrhceal ARTHRITIS. It is said to ‘ act like a charm.’—Dose, 0T2 Gm. followed in 2 days by 0-18 Gm. intravenously; three injections usually sufficient.—F. C. Doble, L. i./23,1315. Puerperal Septicaemia well treated subcutaneously, in doses of 0-12 Gm. In some cases 5 or 6 injections (at one-day intervals) of 0-18 Gm. were needed*. Intravenously may be preferred in grave cases of septicsemia.—Paris Med * per Jl. A.M.A. ii./2 5,393. Good results with Sulpharsenol, 0-06 Gm. to 0-12 Gm., given similarly to Novarsenobenzol in puerperal fever.—L. it/25,28. Based on trypanocidal tests, Sulpharsplienamine is considerably inferior to Arsphenamine, and only half as efficient as Neoarsphenamine.—per Jl. Trop. Med., May 15/’25,200. Dangers of Suipharsenobenzol injections.—B.M.J.E. ii./26,92. Death following intravenous administration of Sulpharsplienamine.—J. R. Williams, Jl, A.M.A. ii./29,1096. gjBismuth Arsphenamine Sulphonate, Syn. Bismar3en. A precipitation compound made by adding Bismuth Potassium Tartrate to Sulpharsenobenzene and pouring the solution, made by means of Soda, into Methyl Alcohol. A yellowish soluble compound with Arsenic content 13% approx, and Bismuth content 24%. Dose.—Intramuscularly, 0*2 Gm, in 1 Cc. Distilled Water, to which is added 2 minims Butyn 0-2% as local ansesthetic. Initial dose OT Gm. 2 injections weekly for 20 injections. Children over 5 tolerate adult dosage well. Of value in early syphilis. Toxicity low and reactions benign and controllable.—J. H. Stokes and S. O. Chambers, Jl. A.M.A. ik/27, 1500—1503 For a lengthy account of the substance see N.N.R. 1930. Criticism of the compound.—E. Tytler Burke, L. i./31,1127. Early syphilis treated with Bismarsen 0T to 0-2 Gm. intramuscularly.— Stokes, Miller and Beerman, per B.M.J.E. i./31,116. [jfp l|Sulphoxyi-Salvarsan. P.G. VI. SODIUM 2?-Arsenophenyl-dimethylaminopyrazqlon-methylenesul- PHOXYLATE, C33H2504NAs2S.Na- 774-16. Dose.—8 to 12 Cc. intravenously at 2 to 3-weekly intervals. It occurs in commerce only in isotonic solution containing 5% of the Arsenic compound and 12 % Lactose. Decomposition occurs on exposure of the solution to light and air. Used, in paralysis framboesia, syphilis and tertiary malaria. P J '0i^g%^iatOTY 0f Arsen°benzol, ‘ 418/ and others.—G. Malcolm Hyson, W. H. Mart indale’s paper on Organic Arsenic to the Int. Cong., iqoq and other data on preceding compounds, see Vol. II. 9 9 MATROPINA (B.P. ’14). Fr. Cx., U.S. X., F.E. VIII. Ci7H23N03 = 289-1874. EE Atropine and its Salts and their preparations—See Note to Guttse Atropinse Sulphatis. Dose. s"od tt>o grain (0-0003 to 0-0006 Gm.), increased to T®' or in acute mania to g grain or more. Fr. Cx.—Maximum dose m ^4 hours 0-001 Gm. grain) approx.—is generally given internally as sulphate. An alkaloid obtained from Atropa Belladonna, and other solana- ceous plants. Generally in acicular crystals, alkaline in reaction. Soluble.—1 in 560 of water, 1 in 3 of 90% alcohol, 1 in 36 of ethei (Fr. Cx. 1 in 25), 1 in 1 of chloroform, 1 in 40 of olive oil, freely soluble in glycerin and oleic acid. Melts (B.P. ’14) at 114-5° to 115-5° C. Presence of hyoscyamine lowers M.pt. Incompatible with caustic alkalis and mercurial salts. Solutions of Atropine Salts left for several hours with Ammonia or Alkali Carbonate and to some extent Bicarbonate, are liable to saponification forming tropine and tropate.—B. B. Dott, P.J. ii./2i,286. * 5 Tne mydriatic alkaloids, Atropine and Hyoscyamine may be manufactured from Atropa Belladonna, Datura Stramonium, Duboisia myo- poroides and Hyoscyamus niger, and Hyoscine may be obtained from the last two plants. Atropine does not exist as such to any great extent in these plants, but is produced from the Hyoscyamine (its isomer) by the action of Alkali which is used in the manufacture. Egyptian Henbane, which is available in large quantities, is a fruitful source of the alkaloid. 13y the action of baryta water both Atropine and Hyoscyamine split up into Tropic Acid and Tropine ; it is, in fact, Tropyl Tropate. Atropine is to all intents an intimate mechanical mixture of d.~ and /.- hyoscyaminos which differ in physiological effect. The purest Atropine contains these two constituents in almost precisely equal quantities. This is not the case in the solanaceous alkaloids. Cushny showed that 0-045 mgr /.-Hyoscyamine had the same optic effect as 0-55 mgr. of d -Hyoscyamine’ hence the variety /. has 12 times the strength of the latter A sample of Egyptian Henbane (H. muticus) yielded at least 83% of its alkaloids as / - Hyoscyamine. 0-5% solutions of this are equal to 2% solutions of Atropine for ophthalmic purposes.—H. II. Jensen, L. ii./i6,797. I ropine may also be combined with other acids, such as salicylic or mandelic acid, to form salts. These salts when treated with diluted hydrochloric acid form a class of artificial alkaloids, to which the generic name of tropeines is given. One of these made from the man- delate of tropine is Homatropine or oxytoluyltropeine (q.v.) Amt/dot&s.—Stomach pump and emetics followed by stimulants, hot coffee, morphine hypodermically J grain every two hours or pilocarpine nitrate £ grain, hypodermically. Electricity, heat, and artificial respiration. Pharmacological antagonism between Atropine and Pilocarpine appears to depend on mass action rather than upon actual amounts injected into the animals.—A. It. Cushny, Jl. Ph. Exp. Therap., 1915, 6, p. 439. Atropine Sulphate 0-02 Gm. in 1% solution (2 Cc.) given in error intravenously instead of Tartar Emetic to a bilharzia patient. No antidote was given yet the patient was not seriously affected.—W. B. Haddad, L. i./22,155. Uses.—Atropine and its salts are used for ophthalmic purposes to dilate the pupil and paralyse accommodation. Given internally or hypodermically, they are antagonistic to opium and morphine, Calabar bean and physostigmine, jaborandi and pilocarpine, aconite and aconitine, and hydrocyanic acid. Physiologically, whilst Atropine acts as a ” stimulant ” to a large part of the central nervous system, it paralyses many of the nerves. It lessens the perspiration, especially the night sweats of phthisis, and has been thought to stop the flow of milk and saliva, most of the secretions, but not the amount of the urine. It is also injected to relieve pain in sciatica and is given to check bed wetting, and to relieve spasm of pain of urinary calculus, cystitis, and prostatitis. Relieves bronchial spasm, whooping cough and asthma. Hypodermically prior to chloroform it is of value as an antidote to the cardio-inhibitory effects of the anaesthetic. Morphine better than Atropine as a pre-medicant. Atropine has actually a stimulant effect and may facilitate onset of shock instead of delaying it.— ft. J. Clausen, B.M.J. ii./3i,377. To diminish gastric secretion give Atropine in small dose in a large volume of water, on an empty stomach. Experimental proof.—T. Izod Bennett, B.M.J. h/23,366. Typhoid Diagnostic, vide Vol. II. Gas Poisoning.—Animal experiments (rabbits) showed that doses by injection of 2*5 mgr. to 4 mgr. were most satisfactory. Its administration tends to cure inebriety.—Owen Lankester, B.M.J. iL/05,106. '3? 1 Atropine and Strychnine injection treatment for inebriety First week, Atropine TGo grain, with Strychnine gram i.i.d. Second ,, ,, -gG >> >> >> in> >> ** Third ,, ,, -gV ,, >> >> to ** >» Fourth ,, ,, riR) >> sme Strychnina. . . together with a mixture of Cinchona Extract, Sal Volatile, and Spirit of Chloroform thrice daily. A little Capsicum may also be added. (g)Mistura Antidipsomania Form No. 2. Dose.—J ounce (15 Cc.) Concentrated Liquors of Commerce of Cinchona and Gentian 10 minims, of Capsicum \ minim, Solution of Strychnine Nitrate (4 grains to the ounce) 1 minim, of Atropine Sulphate (1 grain to the ounce) 1 minim, Glycerin 1 drachm, Water to ounce, has been found of great value with the Strychnine and Atropine injections, gradually diminished in strength. In the knowledge of the writers Liquor Strychninse anc Liquor Atropinse Sulphatis up to 8 minims respectively internally and then gradually reducing, together with a cinchonine tonic, worked w onders, but recently doubt as to the efficacy of Atropine has been expressed. It is of little use in the acute stage—when help ie most wanted. On commencing treatment give a general tonic and stomachic to reduce physical craving for Alcohol, e.g., the following mixture 6 times daily : Atropine Sulphate Solution i m., Strychnine Hydrochloride Solution 1 m., Compound Tincture of Cinchona I drachm, Glycerin I drachm, Compound Infusion of Gentian Root to £ ounce. After 4 days this is replaced by the following every 2 hours: Liquid Extract of Cascara 10 m., Compound Tincture of Cinchona I drachm, Aloin grain, Strychnine Hydrochloride Solution 3 m., and Compound Infusion of Gentian Root to 1 drachm. The Strychnine is omitted after 1 week. Colloidal Gold (2 Cc. daily) is also given in equal doses thrice daily, after meals, continued for 3 weeks.—P. Bonsfield, L. ii./25,1150. For further Inebriety Treatment see Alcohol—Inebriety. References to use of Atropine and its Salts. Cholera successfully treated by hypodermic injection of Atropine. Originally advised by Sir L. Brunton to lessen vomiting. TtU grain doses tried morning and evening. Results of value.—Sir L. Rogers, L. ii./i5,222. Colds can be aborted by dose of T^o to grain (Sulphate), to be dissolved in a tumbler of water and the whole sipped in the course of an hour, to be repeated next day if necessary. Diphtheria, Cardiac Depression in, treated by Atropine Sulphate iin grain, Strychnine Hydrochloride grain, Adrenalin Solution (1 in 1,000) 5 minims, Water to 10 minims, hypodermically ivery four hours.—B.M.J. i./i2,535. Epididymitis prevented by hypodermic or Suppository use (1/75 grain in each) of Atropine. Useful in treatment of gonorrhoea.—W. Harrison and C. H. Heald, from a Military Hospital Report. Haemostatic action is obtainable from full doses of Atropine with development of toxic symptoms—dry mouth, flushed face, and dilated pupil. Successful in active and passive arterial and capillary, traumatic and lisemophilic forms of bleeding.—Waugh. In Pulmonary Haemorrhage in tuberculosis Atropine Sulphate T£c grain hypodermically at intervals of 4 or 2 hours according to circumstances—acts no doubt by lowering pressure in pulmonary vessels.—J. W. Allen. Heart Block.—In cases of high degree not due to organic causes, Atropine is often effective in reducing the block. Not successful in cases of complete organic block, nor does it appear to lessen either frequency or severity of the syncopal attack. Antisyphilitic treatment (Mercury, Potassium Iodide, Salvarsan) has been extensively tried in view of the fact that many cases of block are due to gumma of the bundle—results on the whole disappointing.— Pr., Nov., *12/655. Small doses of Atropine slow the heart, whereas large doses cause acceleration. Small doses increase heart block, but large doses tend to remove it. Individuals vary considerably in reaction, but 1/100 gr., as a rule, slows the heart.—B.M.J.E. L/25,11. Infants may receive Atropine in Alcoholic solution, e.q., 0-1 mgr. (max. initial dose). Most infants bear it well, one 8 months old being given mgr. of Atropine Sulphate daily without harm. It often has a tranquillising effect in excessively nervous children and may arrest habitual vomiting and pyloro- spasm ; eczema and exudative diathesis is sometimes influenced favourably. Best given before meals.—Per Jl. A.M.A. ii./25,938. But may cause severe reaction with hyperpyrexia and abdominal distension. Fever reduced by hydrotherapy. No harmful after-effects. Dose should be increased slowly. —G. F. Munns, Jl. A.M.A. ii./29,171. Iritis is to be treated locally by dilating the pupil and keeping it dilated. Henderson uses Atropine 1% with Cocaine 0-5% Ointment for the first three days every four hours. Then the Cocaine is eliminated, Atropine being used alone three or four times a day. Hot fomentations and leeches to temple beneficial.—B.M.J. i./og,1221. Labour. Atropine appears to stimulate contractions. It certainly has no inhibitory action.—A. W. Bourne and J. H. Burn, B.M.J. ih/30,87. Mania, Acute. Very large doses cause sleep.—R. Migraine well treated by Liquor Atropinse Sulphatis 1 to 3 minims three imes daily after meals.—H. D. O’Sullivan, B.M.J. i./23,1s. Pyloric Stenosis.—Begin with small dose of 3 or 4 drops of 1 in 1,000 eatery solution of Atropine Sulphate half an hour before feed, increased till ■hild is receiving 35—45 drops in 7 or 9 drop doses five times daily. Results >est perceived when given over a period of weeks.—J. L. Meagher, B.M.J. './26,89. . Seasickness.—Atropine hypodermically 1/50 to 1/30 grain. As preventive /60 grain on embarking is efficacious.—Pres., May, 1920. Tuberculosis.—Atropine in doses of to At gr. at bedtime makes weating impossible.—Dixon, Pr. xc., 1. •jfMP Afcropinee Salicylas C17H23N03.C7H60, = 427-2342. Dose.—Ao grain (0 001 Gm.). A deliquescent powder, stated to be superior to the sulphate as nore rapid in effect. gj] Liquor Atropinze Salicylatis.—Atropine \ grain, Salicylic Acid | grain, Water 1 ounce. iplj Atropine Sulphas (B.P. ’14). P.G. VI., P. Helv., P. Jap., U.S. X. (Ct7Ho3NO3)2H2SO676-4804. P.G. VI. and Fr. Cx.+H20. Ph.Ned. V. 2H20. F.E. VIII., P. Belg. IV. and P. Ital. V., 1H20. Dose.—20"o to Too grain (° 0003 to 0-0006 Gm.) increased to jV, or in cases of acute mania J grain. Fr. Cx. has maximum dose n 24 hours grain approx.; P.G. VI. Ay grain i P* Pelg. Ao grain. Opaque white minute crystals or granules, soluble 1 in less than 1 of water.—W. H. M. Commercial samples melt mostly at 186° to 87° C., P. Jap. 180° C. . . . „ J .. Incompatibles.—Bromides, Iodides. Quinine Hydrochloride 3 incompatible, but the acid Hydrochloride does not precipitate n reasonable dilutions. See also under Atropine. On heating, aqueous solutions of the Sulphate are liable to be hydrolysed 0 Tropine and Tropic Acids. The Chloride, Nitrate and Phosphate are table.—B.C.A., 1926, A184. Uses,—See Atropine (base). IJPTJ Tablets grain (0*0096 Gm.). . . Ptyalism is relieved by taking Atropine Sulphate gram m water very 4 hours.-—Beddoes. Granules de Sulphate d* Atropine.—Fr. Cx. contain 1 mgr. FjO Compound Asthma Fluid (Martindaie). ' This preparation is only supplied on a prescription by a qualified nedical practitioner. , It contains, amongst other ingredients, a small proportion o a ro- line, and is found of considerable value in preventing attacks of ,sthma. A few “ blows” from a fine spray will be found sufficient o ward off an attack. A special Spray is made for the flui . ^ It is prepared in 3 strengths, designated' A, B an > reaper vely. We find by experience that the' A' strength u well t0}*fattd y all sufferers, the ‘ B’ being double strength of A w ro^ , , ften more effectual. The 4 Cf double strength of , is J on firmed asthmatics and affords relief. , The use of atropine in asthma was first advocated by Trousseau, ts employment may effect permanent relief. £1) Lamellae Atropinae, Discs of Atropine (B.P. ’14). —— — ' -—M. w i t _a_ r • Contain grain of the sulphate in each, for dilating the pupil * others containing [PJl^rr (R.Q.H.) paralyse the accommodation. Also prepared containing [f§ (FH Atropine Sulphate T¥Vtt grain conn bined with Cocaine Hydrochloride ^ grain and p [fl] Cocaine with Atropine grain. (R.Q.H. has [f§ ff 1 Atropine 7Cocaine Ton gram.) Jpj] Hypodermic Tablets contain tstt* r4r, bV> and tt> grain in each, also g] r-|-o grain combined with Morphine Sulphate 4 grain, and Atropine Sulphate ^ grain combined with Morphine Sulphate { grain, vide also Morphine Sulphate. ED Steniles, Hypodermic, contain ^ grain in 15 minims (1 Cc.). The strength of |P jj Injectio Atropinae Hypodermica, B.P.C. is rinr grain in 8 minims. Dose.—2 to 8 minims. P Jj Liquor Atropinae Sulphatis (B.P. ’14). Dose. 4 to 1 minim (0’03 to 0.06 Cc),, or more. Strength 1%. Should be directed to be freshly prepared. [fjjGuttae Atropinae Sulphatis, R.O.H., J, J, 1, or 2%. St. Th. H. has 0-5 or 1% ; U.C.H. 0-5 or 1%. St. M.’s H. 0-5%. A simple solution of Atropine is a preparation of Atropine, but a compound of several substances to which a small percentage of Atro- pine has been added, may more properly be regarded as a “ preparation or admixture containing Atropine”—Glyn-Jones. [IOG«ttae Atropinae cum Zinco, R.O.H.—Atropine Sulphate 0*5 or 1, Zinc Sulphate 0-25 Sterilised Distilled Water to 100. Chalk s Bottles with rubber cap on hollow stopper are convenient for eye ai ops and mostly employed. They are supplied in colourless and amber glass Metal cases, sterilisable for same, are durable, and suitable for travelling" ’ oimmeMs oSr sohftions1!01" ’ (U) llattened or (iii) bulbous ends (Lang’s) for ffl P 1 Guttae Atropinae cum Cocaina, St. Th. H. Atropine Sulphate 1, Cocaine Hydrochloride 2. Sterilised Distilled Water to 100. (ED Sterules,’ Ophthalmic, of Atropine Sulphate Solution 1 % are made ; also of g (p lj Atropine Sulphate Solution 4% with Cocaine Hydrochloride 24%. fp H Guttae Atropinae et Quininae (Liverpool Eye and Ear Infirmary). Atropine Sulphate 4 grains, Quinine Sulphate (bi-sulphate) 4 grains, Distilled Water 1 ounce. [PJ] Glycerinum Atropinae. St. Th. H. has Atropine Sulphate 254 grains dissolved in W ater 5 ounces, add Compound Tincture of Lavender 100 minims, and made up to 1 pint with Glycerin. This is more cleanly than Glycerinum Belladonnas and does not stain. It replaces Glycerinum Belladonnas. U.C.H. is similar. che resinous matter in the Compound Tincture of Lavender deposits. We found the following to keep better : Atropine Sulphate I27| grains, Water 25 ounces, Spirit of Lavender 2 minims, Spirit of Rosemary 2 minims, Cinnamon Oil 1 minim. Magenta Solution q.s., Alcohol 90% 1 ounce, Glycerin to 100 ounces. >1: Linimentum Atropinae. Atropine 1 (more or less, if ordered), Oleic Acid 15, Castor Oil 15, )il of Lavender 1, Alcohol (90%) q.s. to 100. In lumbago and other rheumatic affections is very serviceable used nth gentle friction ; it is readily absorbed. St. Th. H. has Atropine Sulphate 38J grains, Compound Tincture f Lavender 100 minims. Methylated Spirit to 1 pint. Does not bain. Is the same strength (0-375% w/v) in Atropine as Bella- onna Liniment B.P. T4. inimentum Atropinae et Chloroformi, St. Th. H. 5 parts of the latter with 1 of Chloroform. [I] Oleum Atropinae. Atropine 1, Castor Oil q.s. to 100. Heat to dissolve (R.O.H. 4 rains in 1 ounce). Forms a stable solution, vide Alkaloidal Ohs, nder Oleum Ricini. Q! Pessaries Of Atropine are prepared (weight 120 grains) with gelatin mass or at times wdth oil of theobroma, containing gener- ally -dt grain of the alkaloid in each. 51 Fiiola Atropinae, sihr* Tihr> At* ere gr&’in in each. Taken at night, to check sweating. May cause dryness of the hroat. > 1 Piled a Atropinae -2-] n grain, Arsenic! grain, et Quininae l£ rams. Quinine Sulphate 150 grains, Arsenious Acid Trituration 10 grains, dropine Sulphate Trituration 5 grains with Milk Sugar and Acacia .5. to make 100 pills. For catarrhal cold, if taken in early stage, one very 3, 4, or 6 hours, “ nips it in the bud.” Q] Unguentum Atropines, R.O.H., Atropine 2, 4 or 8 grains, Soft Paraffin to 1 ounce. Dissolve Atropine in Chloroform and add to melted Paraffin at not exceeding 61°C. jp 1 Unguentum Atropines cum Acido Borico, R O.H., was Atropine 1, Powdered Boric Acid 15, Soft Paraffin to 100 ; [j§] [P Ij Unguentum Atropines cum Cocaine, R.O.H., has Atropine 4 grains, Cocaine 8 grains to ounce. Proceed as under Unguentum Atropines, jpn Unguentum Ky&rargyri Oxidi Flavi cum Atropina, r.g.h., has Yellow Mercuric Oxide 4 grains, Atropine (dissolved in Chloroform) 2 or 4 grains, Soft Paraffin to I ounce. |P_l] Unguentum lodoformi cum Atropina, r.g.h., Atropine 2 grains (in Chloroform). Add to melted Soft Paraffin 1 ounce at 61° C. Stir until cold and add Iodoform 60 grains. Atropines Methyl-Bromidum. Syn. MydrIASINK. C j 7H 2 30 3NCH 3Br = 384-1318. Bose.—A grain to A grain (0 001 to 0 002 Gm,). An addition product of Methyl-bromide to the alkaloidal base. White crystals soluble in water 1 in 1 easily. —Internally similar to those of atropine. Subcutaneously in roupous pneumonia, pleuritis sicca and appendicitis ; dyspepsia with pyrosis vith sodium bicarbonate), and epilepsy (with bromide). As eltect passes otf ipidly it is useful in I to 2% solution with cocaine hydrodnonde 1 A for dating the pupil in suspected iritis to ascertain whether adhesions exist. iFl!Homatropine. C16H21NOs=275-1718. Manufacture. -Heat Atropine Mandelate seven days on the water bath with dilute Hydrochloric Acid. Precipitate the clear liquid with Potassium Carbonate and shake out the oily base with Chloroform. Remove the latter and convert the base for further purification into the Picrate. Dissolve the pi crate in water q.s. to retain it in solution in the cold. Add excess of Potassium Carbonate and shake out with Chloroform. The base is difficult to obtain crystalline. fjpJjHomatropine Hydrobromide, [JJjHydrochloride, C16H21N03.HC1 = 311-6366 and ill] Salicylate C16H21N03.C7H603 = 413-2186 are readily obtainable in minute granular white crystals. Their solutions act as quick and decided local mydriatics, the pupil rapidly returning to its normal condition. The mydriatic action commences in J to J hour, and disappears in from 6 to 24 hours. The salts are freely soluble in water ; Homatropine (the base) is nearly insoluble in water, but soluble in oils, or 1 in 100 of soft paraffin. Dose, of each.—-fo to Ar grain (0-0008 to 0-003 Gm.). Action in checking night-sweating is said to be inferior to atropine and picrotoxin. Large doses may cause, like atropine, staggering gait, and delirium in children. Homatropine slows"the heart beats i and renders them irregular in force and rhythm. CE) Oleum Homatropinae. A 2% solution in Castor Oil, dissolved by heat (using the smallest amount possible). Powder the Homatropine first. jPjj Oleum Homatropinae cum Cocaina addition 2% of Cocaine. R.O.H., contains in Homatropine Oil is used in preference to Atropine in estimating lesions of refraction ; inconvenience of mydriasis may be partially overcome by Eserine. These oily solutions are not washed out by the tears. EIHomatropinse Hydrobromidum, (B.P. ’14). u.s. x., p.g. vi. P. Helv., P. Svec. and P. Jap., P. Belg. IV., P. Ital. V., F.E. VIII. C16H21N03HBr= 356-0956. Dose. yV to t40 grain (0-0008 to 0-003 Gm.). (U.S. av. yUj grain). In minute trimetric crystals, soluble 1 in 6 of Water. GD Guttae Homatropinae R.O.H., 1 or 2%. IH 3FJ Guttae Homatropinae cum Cocaina, R.O.H. Homatropine Hydrobromide 1 or 2, and Cocaine Hydrochloride 2 in Water 100. Menthol 2 grains, Methyl Salicylate 2 minims, and Tincture of Iodine 2 minims, to the pint of distilled water as an antiseptic solvent of Homatropine and other alkaloidal salts for eye work.—N. Bishop Harman, B.M J. ii./i6,178. See also ibid. i./2o,599. CE> Sterules (Ophthalmic) of Homatropine Hydrobromide Solution, 1 % are prepared, also 13 E] Sterules (Ophthalmic) of Homatropine Solution 1% with Cocaine Hydrochloride 2J %. Hydrobromide GD Injectio Homatropinae Hypodermica, 1 in 120, is used. Dose.—1 to 6 minims (0-06 to 0-4 Cc.)» \) Tablets, Hypodermic, contain -2- *-0 grain. (Sterules of Distilled Water, containing 5 Cc. are useful for ssolving hypodermic tablets in the syringe.) 0 Lamellae Homatropinae (B.P. ’14) contain grain (0 0006 Gm.) of Homatropine Hydrobromide. j] Lamellae Homatropinae et Cocainae (Gelatin Ophthalmic Discs) contain of each grain (R.O.H.) for paralysing the accommodation, also made grain of each. JJ Methyl-Atropine Nitrate. C16H19N03.CH3.CH3HN03=366-2188. Dose.—to Yt grain (0-001 to 0-0025 Gm.). Manufacture.—Although the patent specification mentions the use Methyl Nitrate, to be employed by direct addition in presence of Methyl :cohol at a temperature of 110° C. in a closed vessel for 2 hours, we believe fat the more rational procedure would be to heat the alkaloidal base with 3thyl Iodide in Methyl Alcohol Solution to 100° C., forming Atropine-Methyl- dide, and then to convert this into Hydroxy-M.ethyl-Ati opine by means of ishly precipitated Silver Oxide. Finally prepare the nitrate in the usual anner. • A white odourless powder, M.Pt. 163° C., soluble in water, a iwerful mydriatic, and less poisonous than Atropine. 1% or 2% lution dilates the pupil after 25 minutes, the maximum is reached 50 minutes. Dilatation persists for 12 hours. AURUM. Au=197-2. For dental fillings the metal is empioyed in * cohesive ’ and ‘ non-cohesive ’ rm. uri Broraidum. AuBr3—436-948. Dose.—^ to T\T grain (0-001 to 0-006 Gm.), increased to $ grain, ell diluted. A brown powder, soluble in water 1 in 75. Uses.—In epilepsy, hysteria and migraine, also in nervous fspepsia, amenorrhoea, and chronic Bright’s disease. Epileptics eated with it may remain for years free from attacks. Useful in coholic neurasthenia; the ‘ Gold Cure ’ combined with Hyoscya- ine (or Atropine) and Strychnine treatment has proved of value. ?e Colloidal Gold. I] Liquor Auri et Arsenii Bromidi. , Auric Bromide 1J grains, Oxybromide of Arsenium 3 grains [or emens’ Solution (q.v.) 192 minims], Distilled Water to 1 ounce. Dose. -5 to 10 minims (0-3 to 0-6 Cc.). quor Auri et Hydrargyri Bromidi. . Auric Bromide, Mercuric Bromide, of each 1£ grains, Distilled ater to 1 ounce. Dose.—5 to 10 minims (0-3 to 0-6 Cc.) has been led in neurasthenia, epilepsy, syphilis, and acne. uri Tri-Cilloridum (Purum), AuC13=303-571. Contains about 65% Au. and is official in Fr. Cx. and the Portuguese Pharm. A brown variety is also made. It contains #H20. Auri Tri-Chloridum Aciduin. Syn. Aurochloric Acid. AuC13. HC1. a-H 20. Dose. Ar to Tc grain (0-001 to 0-004 Gm.), increased to J graii In brown crystals ; contains about 50% of gold. Is deliquescent an easily soluble in water. Has been given as an alterative in phthisi Auri 6t Sodii Chloridum. Gold and Sodium Chloritii AuCi3.NaCl,2H20 = 398-0562. (Fr. Cx.). Dose.—At to T\ grain (0-002 to 0-005 Gm.), increased to \ grai in a pill with kaolin ointment. Hypodermically, grain (0-00 Gm.) doses have been given. Sterules of this Gold and Sodium Chloride contain 1/20 grail (0-003 Gm.) and upwards. This is the ordinary Commercial “ Chloride of Gold,” e.g., th Scales ” Brand, as largely used in the past for toning in photo graphy. An orange-yellow crystalline, deliquescent powder, soluble 1 in 2 of water, only partially soluble in alcohol. The Fr. Cx. pre paration contains a molecule of each salt combined, yielding approxi mately 50% of metallic gold. It is sometimes used as a caustic, anc given internally for syphilis. Combined with strychnine it is useful in neurosis. Leprosy and the eye affections associated, have been treated with this Chloride of Gold in 1/20 grain doses.—T. F. G. Mayer,Lagos. According to Heimburg and Yii, China Med. Jl. (Sept.1 30), Gold has its place in treatment, but is of doubtful curative value. With a.d combination of Chaulmoogra Oil subcutaneously and Gold intravenously the effect might be comparable to the use of Arsenic and Mercury, or Bismuth, in syphilis. In these eye affections of leprosy, not only in conjunctivitis but. in the deeper laj^ers, even to iridocyclitis, the compound acts like a specific. Two to four doses of the 1/20 grain intravenously at 10-day intervals completely healed 5 cases. Larger doses seem unnecessary. Many lepers’ eyes might be saved.—Russell L. Robertson, Garkida, Nigeria,—1931. Lupus Erythematosus treated by Gold salts intravenously. Of the Chloride, 1 Cc. of 0-1% once a month, increased to 5 Cc. and if necessary to 10 Cc. Results fully equal to those from complex compounds. The latter had annoying sequels not seen with Gold Chloride. The Chloride seems at least equal in therapeutic effect to the complex bodies. The 0-1% is strongly bactericidal and does not need boiling.—B.M.J.E. ih/30,46. Locomotor Ataxia.—grain in pill form seems to have some power of retarding the degenerative process; arsenic A grain in solution thrice daily is also believed to act in the same way. Alternate monthly courses of each advocated.—Whitla, Tract. Med. Cirrhosis of the kidney has been well treated by Chloride of Gold ; said to improve character of the urine, to diminish the frequency of nocturnal micturition and to increase general well-being.—Tirard, Med. Treatment. Commercial “Chloride of Gold and Sodium” consists of Auri et Sodii Chloridum (50% Au) mixed with an equal weight of sodium chloride. It contains, therefore, 25% Au approximately. iFIjAuri et Potassii Cyanidum. KAu(CN)2-f-2H20== 324-3472- Dose.—At t° ^ grain (0-001 to 0-02 Gm.).—with caution. White crystalline soluble powder. [n lupus and in syphilis has been used. Intravenously the dose was found be 0-02 to 0-05 Gm. for adults, and 0-0005 to 0-03 Gin. for children. To the se in 1% solution 50 Cc. of Normal Saline Solution are added, and given ery second or third day to the extent of 12 injections. The injection is d to be quite painless. After 48 hours a local reaction occurs. Caution :— ie doses seem large. We have no personal knowledge of them. *Sanocrysin(T.M. 448683). Syn. *Crisalbine. (T.M. 461294). dium Aurothiosulphate, Au(S2O3)2Na3=490*431. A double Thiosulphate of Gold and Sodium. pose.—Intravenously initially 0-01 Gm., gradually increasing tolerated and no violent reaction, to 0*015 Gm. per kilo weight, , a maximum of 1 Gm. per average adult’s weight of 10 stone, iutions must not exceed 5% strength. May also be given intramus- arly (3% solution) if intravenous method is inconvenient, e.g., children. This treatment of tuberculosis is due to Prof. H. Moellgaard.— M.J. i./25,643. It is stated to be indicated in cutaneous, glandular; d early pulmonary cases. As with Krysolgan, a few years previously, there has been the same wnward graduation of dosage in response to poisoning cases, stead of 1 and 1*5 Gm., initial doses of 0*125 and even 0*05 Gm. ve been given intravenously. No doubt many of the effects are e to Gold poisoning.—L. i./25,934. Che M.R.C. made two Reports on its use. Early cases of open infection of [ lungs showed some improvement. More advanced cases did not stand the .atment well—some were made worse. ,* 3ne death recorded in 140 cases (2 deaths in 30 m the first Report). Risk aains. Need for extreme care. Patients must be in bed under close itrol. There is definite hope of a drug along these lines.—B.M.J. 1./25, < 35 ; 26,158; L. ii./26,181. , _ ,. ,, ... The 30 cases in the M.R.C. Report might have shown better results with berculin. To discover the pyschic effect of a new remedy, a Normal balme 1 Phenol solution was labelled “ New Tuberculin, O.K.,” deceiving staff and bient. After a series of injections with 8 patients, 4 claimed (and showed) Unite improvement, 2 were uncertain and 2 definitely negative! VV. L. Th^treatment shortens the duration of lesser degrees of tuberculosis, and lere sufficient tissue with vital energy remains, gives good results m more ronic cases. It is extremely dangerous in the more severe forms 10 proles a last chance, which, failing, might accelerate death. Early cases of mduiar and pulmonary tuberculosis in children well treated, but laUi iges less amenable. Local application in surgical tuberculosis benefic al. Prof.’ 0.' Bang states'that 1 in 3,200 solution does not interfere with growth tubercle bacilli.—B.M.J. b/25,1096. cfonaino but Effective in tuberculosis of the lungs of less than one year s standing, but older cases treatment is uncertain.—Knud Taber of Copenhagen, L. 11./2 5,02. Favourable report on 8 cases.—Prof. S. L. Cummins, L.11./25, _ . Small doses as good as large ones. Lse of serum abandoned. Discussio The^salt punetrates^the lipoid substance of the bacillus and ^old :o its body, killing and dissolving it with immunizing effect. Mary T. ^Alrwroth' Wrigid tags there is no evidence that the fompoumd as a chem0‘ rapeutic agent is able to destroy the bacillus. -B.M.J. •/-}) Tf arows With Sanocrysin in the dilution of 1 in 2,500 in human bipod tubule grows 4 as well as when none is present.—Prof .Fleming, B.i. • */3 ’ • Eleven cases. More rapid improvement than could be obby any aer method. Unlikely to prove useful m lupus and renal tutercuJ . of. T. R. Elliott, B.M.J. i./26,486 ; L. i./26,126 , see also ibid., R • Sanocrysin Research Committee of Japan conclude it is not specific aa does not directly destroy the bacillus, but may on occasion be a stimulant the stationary proliferative type of pulmonary tuberculosis. May can serious damage to tissues. Laryngeal and intestinal tuberculosis unsuit' for treatment.—B.M.J. ii./28,349. No patient who has had the treatment should be exposed to bright sunligh as it may result in lilac-coloured pigmentation of the parts exposed.—G. Beaumont, B.M.J. ii./28,819. Intravenously once or twice weekly 0-1 Gm. in 2 to 5 Cc. water an efficacioT and apparently safe remedy for intractable tuberculous dermatosis.—Whit house and Bechet, Arch. Derm, and Syph., 1927 ; per Pres., Oct., *28,341. Beneficial for cases of fairly good physique and no abdominal tuberculosis.- F. Heaf, L. i./29,1138. Improvement under.—B. R. Clarke and H. G. K. Haddick, L. i./29,714,87 Favourable results.—L. iL/29,76. Lu&us erythematosus. Almost specific. Initial dose 0-05 Gm. in 2 Cc. water, and second injectic 5 to 7 days later—injections continued at weekly intervals.—Per Jl. A.M.^ 1./27,1m. Larger doses not advised. In 30 cases there were 27 clinical cures and improvement in the remainde Dose.—0-025 Gm. in 2 Cc. water once weekly intravenously, increased t 0-005 Gm. weekly, provided there are no toxic symptoms, up to a maximum «r 0-1 Gm.—A. J. Markley and O. S. Pliilpott, Jl. A.M.A. ii./29,235. Toxic Reactions and Deaths. The three principal reactions—fever, rash, and albuminuria—act as guide! to conduct of case. In obviously difficult cases preliminary serum treatmei 1 is necessary to avoid albuminuria. Nine patients died as direct residt c treatment. All slight cases which became symptom-free under treatmei reacted violently. It is only suitable for hospital practice.—B.M.J. i./25,27«; The toxic effects are the same in tuberculous and non-tuberculous subject: They are due to metal poisoning and not cleavage products from the bacill No demonstrable specific action in tuberculosis.—E. Le Blanc, M.m.W., Mar 12/26,444 ; per Pres., Aug., *26,297. Re metallic intoxication.—American criticism, see L. h/2 5,501 : see alsn ibid., 239,556. May even make difference between life and death, but physician should b conversant with its use.—C. A. Sprawson, I.M.G., Dec., *26,588. Retards growth of tubercle bacillus in cultures in 1 part in a million- (Moellgaard said 1 in 100,000.) Animal experiments suggestive but no» conclusive.—W. E. Dixon, B.M.J. h/25,815. These statements are not supporter by other workers.—v. antea. Drugs in tuberculosis reviewed.—Cerium, Copper compounds, etc Krysolgan and Sanocrysin.—W. E. Dixon, B.M.J. i./25,813. Dangers greatly exaggerated. With care rarely causes harm. Has an apparent specific effect on the tuberculous process. Best results in early ane pneumonic type.—A. Morland and E. Zimmerli, L. i./27,652. Poor results due to low dosage—K. Seclier, L. ii./3i,1344. See also ibidT 1348,1362. Krysolgan (T.M. 439288). The Sodium salt of 4-amino-2-auromercapto-benzene Carboxylic Acid. Contains 50% Gold. Dose.—Initially 0-0001 to 0-001 Gm. to establish tolerance, in- creased to 0-01 Gm. at intervals of 2—4 weeks. Prevents the growth of the tubercle bacillus in 1 part in a million. Anima: results not promising, but clinical results hopeful and inspiring.—W. E Dixon, B.M.J. i./2 5,815. Severe reactions from.—B.M.J.E. i./22,77. Pulmonary tuberculosis.—Review of methods of treatment including golc and other heavy metals and colloidal calcium. Reactions very similar tc those with tuberculin.—C. Riviere, B.M.J. i./25,77E A. Cowan Guthrie claims to be the originator of the Colloidal Gold treatmeni of tuberculosis, having introduced ‘ Auro-cyanase,’ a double colloidal cyanid< of Gold and Potassium, which was found effective in all stages of the disease 3 preparation is given subcutaneously over the deltoid, the administration eucocytic extract before, during and after the injections preventing the era! reaction which otherwise occurs.-—B.M.J. i./26,284. .sji3MS Erythematosus treated by Krysolgan.—H. C. G. Semon, l.J. ii.[27,258. dmost specific, and, with ordinary care, not dangerous. Reports of nine 3S—six cured.—J. II. T. Davies, B.M.J. h/29,12. )eathhas followed an injection of 0-001 Gm. in a case of lupus erythematosus, therapeutic value of Gold compounds. Lupus cases improved. — B.M.J. 0,592, s§£ Solgaual (T.M. 486956). Described as the di-Sodium deriva- e of 4-amino-methyl-sulphinic Acid-2-auro-mercaptobenzene-l- phonic-Acici. Contains 36*5% Gold. ^eprosy treated with Carbon Dioxide pencils and this gold preparation.— 6/29,874. ^Lopion (T.M. 461073.) (‘ G. 2949’.) The Sodium salt of the Gold ivative u-allyl-U4-carboxy-phenyl-thiourea. A water-soluble npound containing 40% Gold. )ose.—Initially intravenously 0-1 Gm., increased to 0-7 to 1-0 Gm. ’he Gold is concentrated in the liver instead of in the kidneys, laid to be 10 times less toxic than Krysolgan. Indications as for Sanocrysin. fresh or extensive disease smaller doses must be employed.—Per Pres., y, ’29,250. die Gold compounds have not yet proved themselves of value in practice.— vlalcolin Dyson, Pres., April, ’29,124—128. iistribution of Gold after intravenous injection. Tests made on rabbits !w that about two-thirds of the metal is eliminated in the urine and the Lainder in the faeces. After a week, the intestines, especially the large istine, show considerable though variable amounts.—Analyst, ’26,97. fold exerts a selective action on tuberculous lesions and is therefore of ae in tuberculosis and lupus erythematosus. Discussion on the various iplex Organic Gold compounds.—L. i./3o,691 ; B.M.J.E. ii./30,80. ledicinal Gold compounds.—Solganai, etc.—P.J. ii./29,266. BARIUM. Ba=137'36. All Salts of Barium except the Sulphate. LEDBarii Sulpliidum—BaS= 169-42. Dose.—J to 1 grain in pills coated so as to be more likely to dissolve :he intestines than in the stomach. ^ greyish yellow powder, soluble in water, given as an alterative syphilitic affections. Barium Sulphide Depilatory. Syn. (Causticum Baku). Barium Sulphide, in fine powder from 1 to 3 ,Wheat Starch 3. When required for use, make into a cream with water, spread on s part and let it remain five or ten minutes, then remove with a nt knife.—N.B.—It temporarily reddens the skin. p) Another formula is Barium Sulphide 5, Powdered Soap 1, French ilk 7, Starch 7. One part of this mixed with 3 of water, is applied 1 to avoid possible dermatitis, is washed off after 5 minutes. May used from time to time. rentium Sulphide—SrS = 119-69, is also used. A patented German aration contains Strontium Sulphide 12, Corn Starch 40, Talc 35, Dextrin erolin 1, and Essential Oil 5 parts. It is claimed that the Dextrin protects ikin and hair papilli and prevents the bad odour during use. 1 .J. J,/25,13. Barii Sulphas. P.G. VI., U.S. X., F.E. VIII., P. Ital. V. P. Belg. IV. BaS04= 233-42. Dose.—For X-ray work only, 2 to 5 ounces (60 to 150 Gra. approx, in a cornflour or other ‘ meal ’ of about 6 to 15 ounces. A heavy white powder insoluble in water and acids. For outlining portions of the alimentary tract, instead of Bismut] Carbonate and Subnitrate (q.v.). Poisoning lias resulted from Bismuth Salts. The latter, however, have th advantage of higher molecular weight, and hence form darker shadows. Barium Sulphate Suspensions in Olive Oil 10, 20%, etc., have been usee for bladder examination. Atropine is a valuable adjuvant in visualisation of the appendix. 1 mggj Atropine in an enema an hour before the Barium increased visualisation.— Jl. A.M.A. ii./25,1762. Enema Barii Sulphatis C.X. For X-ray Examinations. Barium Sulphate 192, Methylated Spirit 45, Mucilage of Gun' Acacia 20, Distilled Water to 900 (6 ounces, 1J ounces, j ounce* to 30 ounces respectively). U.C.H. directs Barium Sulphate 40 ounces, Tragacanth Powder 60 grains Water to 80 ounces. Dilute with equal amount of water at time of used This is a satisfactory formula for Emulsio Barii with addition of flavourings1 e.g., Lemon Oil if required. Emulsio Barii et Bismuth! C.X. For X-ray Examinations. Barium Sulphate 16, Bismuth Carbonate 16, V* ater 45. (J ounce, J ounce and If ounces respectively.) I—X Barium Meal. Barium Sulphate 85, Aluminium Silicate 10, Malted Milk 5, Saccharin a trace. Mix 3 to 4 ounces with 8 ounces of Water.—N.N.R.- Jl. A.M.A. iL/29,769. W. Barolac (T-M. 515146) Brand Barium Sulphate Suspension. Contains 30%. White, tasteless, odourless and neutral. Contains no suspending agent, hence yields a clear-cut shadow. Used as an opaque meal for X-Ray examinations. Bulky Barium Sulphate, 33% in water, according to our experiments is best prepared by dissolving Barium Chloride 244 in water 700„ and Sodium Sulphate 322 in water 700, mixing, washing by decantation until Chlorine-free and finally making the volume 700. The investigation included the use of five times and ten times the quantities stated of water, in each case decanting, washing, and diluting to the required final volume, and finally measuring the size of the particles under the microscope There ivas no material difference in size, namely, between 1/500 and 1/250’ millimetre. It was expected that the degree of dilution would affect the magnitude of the particles.—W.H.M., JNov., 1931. , Sulfate de Barium Gelatineux Fr. Cx. Nouv. bupp. 26, is in paste form, containing 55 to 58% of water. Bariumiscd Wool for X-ray work in oesophagoscopy.—W. Frank Wilson, B.M.J. i./25,656. (pbRarium Thiosulphate inadvertently admimsteied in place of Barium Sulphate caused death.—P.J. ii./2i,315 ; C. and D., Oct 1921, p. 47. Caution —Barium Carbonate is also soluble and hence poisonous. Confusion with Bismuth Carbonate occurred— P.J. ih/21,344. . CE)Barium Chloride cind. other S&lcs cire in the Supplemen List of Drugs.—q.v. BELLADONNA. Deadly Nightshade. |TJ| “ Belladonna and all preparations or admixtures (except Bella- vna Plasters—which are cjel>) containing 0*1 or more per cent. of lladonna Alkaloids.” All parts of the plant Atropa Belladonna (Solanacece) yield the alka- ds Hyoscyamine and Atropine. The root contains from 0-3 to ,% (Maben states rarely as much as 0-5%) of total alkaloids— .efly Hyoscyamine. OM roots may contain a little Atropine.— nry. The leaves contain 0*2 to 0-7%, principally Hyoscyamine. lie total alkaloids of Belladonna are twice as active as Atropine, without ng more toxic. Recommended in treatment, especially in spasm and iotomy.—L. ii./25,241. 'for details as to cultivation of Belladonna, varying Alkaloidal content he Drug, and Assay Methods see Vol. II. international PREPARATIONS of Belladonna compared, with special lirences to their standardisation.—A. J. Jones, P,J. ii./23,106. Ittahi/ised Be Had! on met Lec&ises (Fresh) by vapour of 96% ohol heated in an electric oven, i to i atmospheric pressure needed to ; enzymes. Stabilisation, however, thought of no great advantage. Appear- le inferior. Modified Assay method needed.—J. P. Todd, P.J. i./3o,94. Antidotes.—See Atropine. Poisoning by Belladonna is. well ated by Pilocarpine. belladonna berries caused poisoning. Pilocarpine 1/10 grain hypodermically, water bottles, subsequently more pilocarpine (1/6 grain) and again rejieated h soap enema. Recovery.—Mary E. Joli, L. ii./i6,647. Gating rabbit which had fed on the plant caused poisoning. Pupils became Lted, mouth dry ; giddiness and rapid pulse.-—D. Firth and J. R. Bentley, ii,/2i,901. . . ,, , ’oisoning by topical application of a liniment containing Bcllauonna. ed, per Clin. Jl., May 30/23,264. . . . .... i. fatal case of (most probably) chronic Belladonna poisoning, m which 1 £ drachms of the Tincture had been taken every day for 6 years. J. Spears. 4.J. i./27,1105. ^ , ]Belladonnse Folia (fi.P. ’14), U.S., F.E. VIII., P. Belg. IV. len as Belladonnse Pulvis), and P. Helv. contain not less than % total or mydriatic alkaloids. Dose.—1 grain. Chose of Fr. Cx. have no standard. Maximum single dose 2 grains, -ximum during 24 hours 7J grains approximately. P» Ital. V not ndardised, 0T and 0*4 Gm. respectively. ] Belladonnse Radix (B.P. ’14) without standard. U.S. requires 5% total alkaloids of Belladonna. Dose.—f grain (0-05 Gm.). Uses.—Externally relieves the pain of rheumatism, neuralgia, irdee, and local inflammations, as of the breast. In leucorrhoea, pnal injection of Tincture 3, Sodium Bicarbonate 1, and Water ) is useful.—R. "nternally relieves spasm, palpitation, menstrual pain, headache, ooping-cough, petit mal, checks profuse perspiration, and m- ltinence of urine. In acute sore throat. Acts on the e)e as mydriatic. Relieves the dyspnoea of asthma. A rash on tie n, said to be like that of scarlet fever, may be produced by m- nal and local use of Belladonna. lay produce congestion of the throat. B.M.J. ii./op,..4-. Heart failure in diphtheria treated with.—L. i./o6,282. Obesity associated with voracious appetite well treated. By its inhibitoi action on the secretion of the gastric glands Belladonna reduces hyperacidit of the gastric juice and thus takes the edge off the appetite. Especial! indicated where there is cardiac weakness which prohibits physical exercises.- B.M.J.E. ii./13,39, cf. also Atropine. Urinary incontinence.—Belladonna should only be used to * break tl habit ’ and never pushed for more than two months at a time. It is useles and even harmful when there is definite lack of tone in the sphincters ; her Nux Vomica is indicated. Thyroid (advocated by Leonard Williams) is usefi in some cases, especially when there are adenoids. Alkalis may be useful wlier the urine can be shown to be hyperacid.—E. Hernaman-Johnson, L. i./2i,129U Asthma is due to over-excitability of the pneumogastric system ; Belladonn is the best remedy.—Per Pres., Jan., ’23,10. Though used ‘ to allay the sense of griping ’ in the intestines, when give with purgatives, there is no evidence that it does so. tHjCoilodmm Belladonnse.—Martindale. Snake liquid Extract of Belladonna (B.P. ’14) 50, Magnesium Oxide Light j with Canada Turpentine 4, Castor Oil 2 and Ether 40, allow to stand 12 hours Decant, filter, dissolve Camphor 14, and Proxylin 2| in the mixture and ad Ether q.s. to 100. ®EmpIastrum Belladonnse. (B.P. ’14). (CfDcf. Emp. Plumbi) The B.P. ’98 plaster produced toxic symptoms (skin irritation) It was only half the strength of that of the B.P. 1885, but it wa still too strong to be used with safety. The B.P. ’14 plaster wa again reduced to \ strength, viz., it contains 0-25% alkaloids. An explanation of its supposed effect in stopping milk secretion is tha after the plaster is applied no milk is removed, and so less and less is secreted— the action is merely mechanical.—D. Grieve, C. & D., Dec., 1921, p. 856. See also K. Mackenzie under Pituitary Extract. Must not be applied by the midwife to mothers too ill to feed their babies where there is heart, disease, on account of paralysing effect of Atropine or the vagus, with consequent quickening of heart’s action.—W. H. E. Oxley" B.M.J. h/31,7. Bee and wasp stings are well treated by belladonna plaster—if slight, lef on short time ; if severe (? entered vein), several days may be necessary— gives considerable relief. Probably good for mosquito stings also. CEmplastrum Belladonnse Extensum. Belladonna plaster in rubber combination spread on calico in porour sheets 7 in. by 5 in. and in yard rolls 7 in. wide, porous and non-porous also prepared with Belladonna and Aconite combined.—(American) Cg) Emplastrum Belladonnse, U.S. X. An adhesive plaster con taining Extract of Belladonna leaves corresponding to not less than 0-25% or more than 0-3% of the alkaloids of the leaves. Cp>Fr. Cx. has Belladonna Extract (Fr. Cx. q.v.) 1, Elemi 1, Diachylon Plaster (Fr. Cx.) 2. [l?j|Extractum Belladonnse Liquidum (B.P. ’14). Dose.—^ to 1 minim (0-02 to 0-06 Cc.). Prepared from Belladonna root in fine powder, by repercolation process, adjusting so that the extract contains 0*75% alkaloids. P. Jtal. V. contains 0-25% (w/w). [FJExtractum Belladonnse Siccum (Syn. Alcohclicum) (B.P. 514). Dose.—J to 1 grain (0*016 to 0*06 Gm.). This is prepared from the leaf—it is a mixture of alcoholic extract and powdered leaf, containing 1% of alkaloids. E.I. (Second) recommended 1-3% alkaloids. P. Ital. V. is 1% total alkaloids made by means of 95% alcohol. 'he 1*3% alkaloids is roughly a mean figure of the standards in the chief vmacopoeias.—P.J. i./26,294. Inuresis in children is best treated by increasing doses of Belladonna extract bed time, tonic measures, such as Cod Liver Oil, Iron and Nux Vomica uld be employed during the day time.—Tirard, Med. Treatment. Extractum Belladonnae F.I. to be a “ solid ” extract (containing about /0 of water) prepared by means of alcohol 70% from the leaf.—Fr. Cx., I P. Dan. agree with F.I. The Fr. Cx. follows the F.I. method of making L gives a method of estimating, but does not set up a standard. It states x. single dose £ grain. Max. in 24 hours 14 grains approx. P. Ital. V. is ilar, containing 1-25% alkaloids. Extractum Belladonnae (Foliorum) U.S. X., made with 3 parts alcohol L 1 water as solvent and contains added glucose for pilular consistence, ydered Extract is made differently. Both contain a mean of 1*25% ladonna alkaloids. Extractum Belladonnae, P. Austr., is alcoholic from the leaves and tains 2% alkaloids; @93Ph. Ned. V. is the same but contains not less n 1-15 to 1-3% alkaloids. gjP. Belg. contains 1*5% alkaloids, r average yield of alkaloid, see Vol. II. |pExtractum Belladonnse Viride (B.P. ’98). Dose.—J to 1 grain (0-016 to 0-06 Gm.), increased to 2 grains more. fA green extract prepared from the expressed juice of leaves and ung branches (3 to 3| ounces are procurable from a pound of leaves); contains from 0-5 to 2-0% (average 1) of alkaloids, and standard- d to contain 1%. [j Fluidextractum Belladonnae Radicis, U.S. X. Average dose.—f minim (0-05 Cc.). Hydroalcoholic percolate ; conns 0-45 Gm. Belladonna alkaloids in 100 Cc. For assay vide Vol. II. 0 Glycerinum Belladonnse, b.p.c., r.o.h. Green Extract of Belladonna, 1 ounce ; Boiling Distilled Water, 1 achm. Bub in a warm mortar to a smooth paste, and add Glycerin, to 2 ounces (fluid). Fo check pain and inflammation, is often painted on boils, abscesses d carbuncles, and covered with a poultice, also applied on lint to b breasts to disperse milk. Cragacanth added in proportion of 0 grains to the ounceAvould thicken the paration. l]Linimentum Belladonnas {B.P. ’14). Camphor 1, Alcohol (90%) 6. Dissolve and add Liquid Extract of lladonna 10, Distilled Water 2, Alcohol (90%) q.s. to 20. A useful lative for neuralgia and rheumatism. Contains 0-375% alkaloids. Sprinkled on impermeable piline relieves lumbago. Poisoning by the Liniment. Strychnine hypodermically, strong t, and making the patient vomit, brought a patient round. jOLinimenhim Belladonnae cum Chloroformo. Chloroform Liniment 1, Soap Liniment 1, Belladonna Liniment 2. DjO B.P.C. Chloroform 1, Belladonna Liniment 7. (The previous 'm may be better for sensitive skins.) ) Pilula Quininae cum Belladonna, r.o.h. Green Extract of Belladonna { grain, Quinine Sulphate 1 grain, nfection of Roses q.s, [jFH Pilula Belladonna, Nucis Vomicae et Cannabis. Extract of Belladonna, Nux Vomica Extract and Cannabis Ex tract, of each J grain. For the constipation in gastric ulcer. Tin cannabis has a good effect on the mental side, belladonna regulate peristalsis and the Nux Vomica has a good effect as an aperient anc for improving tone of the gut. FXi Snppositoria Belladonna (B.P. ’14). Each contains 014 Cc. of freshly evaporated Liquid Extract o Belladonna in 1 Gm. of Theobroma Oil, i.e., 0-001 Gm. of roo alkaloids. Cp) Pessaries (60 grains weight) may also be made containing tin same or double the quantity of extract. Vide also Ovules. Unilateral convulsions have been produced by their use, togethe with dryness of throat, dilated pupils (special idiosyncrasy). giFU Snppositoria Belladonna | grain, etMorphinaeKydrochlorid £ grain. These possess a useful sedative effect, and are valuable in irritatec and painful conditions of the rectum and prostate and for chordee I Cel)Tinctura Belladonnae {B.P. ’14). Dose.—5 to 15 minims (0-3 to 1 Cc). This is prepared 10% with dried leaf and standardised to 0-035%, alkaloids=F.I. approx., Fr. Cx., Ph Ned. V. and U.S. are similar P. Ital. V. 0-03%,B.P. ’98 was Liquid Extract of Belladonna (root) 1 Alcohol (60 per cent.) q.s. to 15. Hence the B.P. ’14 tincture differs in colour. It is T7¥ strength of B.P. ’98. Uses.—Relieves the spasm of asthma and bronchitic cough ; alsc bladder spasm set up by calculi and prostatic irritation. Full doses are useful for incontinence of urine. Of value in dyspepsia (vide ref. post.) Ufaeorhif/.—Syl Myristicse, Syl Rosse ; Syrupus Aurantii. Cp) Tablets are prepared, equivalent to 2 and 5 minims, weighing 1 and 2 grains respectively. Broncho-Pneumonia is sometimes well treated in early stages with 4 to 5> minim doses or 1 grain of extract every 3 or 4 hours according to age of child and severity of case—combine with diuretics and diaphoretics. In DYSPEPSIA 5 minim doses of Tincture before food results in reduction of acid values, both absolute and relative, of the stomach contents. Thought to* inhibit and relieve spasmodic contractions. Tor PTYALISM 10 drops of Tincture thrice daily or Pilocarpine Nitrate grain of benefit. ... Exophthalmic goitre has been treated with Belladonna, and with Arsenic Bromide, and Digitalis added. . In enuresis valuable, give potassium citrate first, when the urine is hyperacid, or Sodium Acid Phosphate if markedly alkaline. Post-encephalitic Parkinsonism well treated with Tincture of Belladonna, 45 minims daily.—A. J. Hall, B.M.J. i./26,129. Cp) Mistura Belladonnae Xanthoxyli et Hyoscyami. Syn. Towns’ Specific. Dose.—6 to 8 minims (0-4 to 0-5 Cc.). Belladonna Leaf Tincture (U.S. 1890) 2, Fluidextract of Xantho xylum 1, Fluidextract of Hyoscyamus 1. The above dose is equivalent- to a little less than 3 to 4 minims B.P.’gS Tincture. Said to be specific in morphinism, cocainism, and alcoholism. Increase from 6 drops, by 2 drops every 6 hours, until 16 drops have been reached. Discontinue for a few doses if symptoms of Belladonna poisoning are observed.—E. Huntington Williams, “ Opiate Addiction.” li Linimentum Belladonnae ZEtkereum. Prepared with Ether, 1 in 1J, with Camphor Recommended in ace of Alcoholic Liniments for quicker absorption. TjUnguentum Belladonnae (B.P. ’14). Contains a basis of Benzoated Lard and Wool Fat. Made by raporating Liquid Extract of Belladonna q.s. to provide 0*6% kaloids. Said to be too strong for general use and may cause unpleasant symptoms. To lessen excessive secretion in nasal catarrh, this ointment has been em- oyed diluted 5 to 10 times with Soft Petroleum and a small proportion of annin or Gallic Acid added. Cg) XJnguentum Populi, P. Belg. IV. Macerate Dry Belladonna eaves 125, Dry Henbane Leaves 125 and Dry Poplar Buds 200 (all uiised) in Alcohol 90% 150 for 2 hours ; warm on a water-bath with ard 1000 for 3 hours with stirring until the Alcohol has evaporated- train, press and stir until the ointment sets. The formula in Fr. Cx. differs from this. BISMUTHUM. Bi=209-0. Metallic Bismuth Preparations for Injection. Bismuth Metal has been largely used in conjunction with, and in >me quarters instead of, Mercury in treatment of syphilis and yaws, he preparations used are summarised. reparation of Metallic Bismuth in fine powder. The Pharmacopoeia Com. Rept. (Second Report of Pharmacy Sub-Committee, ay, 1931) states this may be obtained by reducing a solution of Bismuth richloride in Hydrochloric Acid with Hypophosphorus Acid. It is in the >rm of a dull grey powder, and none of the particles when examined under re microscope should exceed 15 microns (15/1,000 millimetre = 1/66 milli- etre approx.) in diameter. The use of Bismuth Trichloride we found in an investigation to be unneces- iry. It is best to start with Bismuth Oxychloride, e.g. Bismuth Oxychloride kilo is dissolved in Water 10 litres by means of Hydrochloric Acid, and armed on the water-bath with the reducing agent, adding it in small qualities at a time. Wash and collect secundum artem, Hypophosphorus Acid in icess of theory (4 times theory) : 2BiCl, + 3H,P0a + 3H20=2Bi + 3H3P03 + 6HCl needed. We also included in our experiments numerous trials using a dilute Gum cacia solution as protective, hence tending to reduce the size of the particles /. Gutbier and Hofmeyer, Zeit Anorg. Chem. 44,225), but no great advantage mid be seen by its use. The agglomeration of the particles of the metal may be overcome by atten- on to details of temperature and technique in general. The particles in the preparation made as above, were, on an average 1/60 iin. in diameter. Those in preparations of commerce were larger. W.H.M., ov., 1931. The absorption rate of Metallic Bismuth is uniform, and action -eady. In syphilitic affections of the heart and respiratory system ismuth is the only drug to fall back on. Only danger to avoid is jt to inject into the blood stream, as it causes paralysis and death ithin two hours.—C. F. Chenoy, I.M.G., Nov. 26,536. Soluble compounds are more toxic and painful than insoluble Bismuth eparations. Metallic Bismuth is # the /east toxic—should : given by deep subcutaneous route. Poisoning may occur in spite Oj. absence of blue line. Tertiary lesions of mouth and tongue and symptoms of tabes respond particularly well. Valuable in nephritis, jaundice and organic disease where Mercury and Arsenic are not suitable. Not an efficient substitute for Arsenobenzol. May have an inhibitory rather than a curative effect. It is not established that Bismuth is more effective than Mercury in the permanent cure of syphilis.—T. Anwyl-Davies, L. i./27,200 ; ibid, 148—152. E. T. Burke obtained best results with metallic Bismuth.—Brit. Ji. Vener. Dis., per L. i./2 5,497. Bismuth is more rapid in action on S. pallidum in vivo than Mercury but not so rapid as Salvarsan. It influences lesions as rapidly as Salvarsan and more rapidly than Mercury. It is free from danger in therapeutic doses—best given as metallic Bismuth in Isotonic Glucose.—David Lees, B.M.J. ii./27,298. The tartrates and oleate are toxic to rabbits, causing necrosis of the tubules of the kidney. The maximum tolerated dose is about 0-2 Gm. per kilo intravenously. Precipitated Bismuth Metal has a tolerated dose of 0-4 to 0-5 Gm. per kilo.—B.C.A. '26.A975. Sunerior to Mercury in syphilis. Intramuscular the best route, preferably of compounds not quite insoluble in water—Bismuth Salicylate one of the best. Oxychloride specially good. Daily dose of Bismuth Metal fixed at 0-5 mgr. per kilo weight. Routine treatment a series of 5 or 6 intravenous injections of Neosalvarsan, in doses of 0-6 to 0-7 Gm. and a series of 8 to 10 intramuscular injections of Bismuth Oxychloride in watery suspension in dose of 0T5 to 0-2 Gm., with a total of 18 Neosalvarsan and 60 Bismuth injections in 2 years. Definitely effective.—Svend Lomholt, B.M.J. ii./29,890. Yaws. Cannot be cured by Potassium Iodide and Mercury, but Bismuth Metal is effective. Three or more injections are needed and the treatment is used in Kenya and Tanganyika Territory on the lines of syphilitic treatment.— P. H. Manson-Bahr, Brit. Jl. V.D., Jan., ’28, and others. Metallic Bismuth caused necrosis ; suspended in oil is slowly absorbed.— Svend Lomholt, L. ii./2g,983. Local nickel poisoning (2 cases) due to use of nickel-plated piston for Bismuth injections. An all-glass syringe should be used.—F. C. Eve, B.M.J. ii./29,1030. Metallic Bismuth Sterules contain 0-2 Gm. in 1 Cc. of 5% Glucose solution. Dose.—0-5 to 1 Cc. intramuscularly into the buttocks. ^Blcreol (T.M. 439276). Syn. Bismuth Cream. Dose.—1 to 5 Cc. intramuscularly, alternating with organic Arsenic injections. Contains Bismuth Metal 0*15 Gm. per Cc. in a Creo-Camph base. ^cBismostab (T.M. 447724). Dose.—0*5 to 1 Cc. intramuscularly using right and left buttocks alternately. A preparation of 20% Bismuth in 5% Glucose solution. Painless and non-irritant. Neo-tr6pol is a 10% suspension in isotonic solution. Given intramuscularly in doses of 1*5 to 2 Cc. every 3 or 4 days.—C. Levaditi, L. i./23,639. Late syphilitic treatment. During 3 months a number of patients received 2 08 Gm. of Bismuth with 1,260 grains Potassium Iodide and 210 grains of Grey Powder. Three courses a year, or five in two years. 46 cases treated. Wassermann reaction negative in 65%.—T. Ferguson, B.M.J. ii./3o,513. Bismuthyl is a similar preparation in 10% suspension in a glucose medium. Dose.—2 Cc. intramuscularly every 5 days until 12 to 15 doses have been given. 3$cBisglucol. (T.M. 460418).—Bismuth in Glucose Solution. Lupus erythematosus treated.—R. Hallam, L. i./31,216. Syphilitic ocular conditions. Routine treatment 12 weekly intramuscular injections of Metallic Bismuth and Sulfarsenol followed by a course of Potassium Iodide.—E. O. Kirwan, B.M.J. ii./31,534. A new Bismuth mineral, not previously described, containing 50% Bismuth Trioxide, 40% Tantalum Pentoxide, and 6-5% Niobium Pentoxide, from Uganda.—Imp. Inst. Rept., 1929. Bismuth Salts and Compounds. The absorbent action of the preparations of bismuth taken internally is increased by combination with antiseptic compounds. ?hese combinations have been much recommended in those disorders >f the digestive tract in which several infectious diseases make their arly manifestation. Thus the Salicylate, and Naphthol, Phenol, Jyrogallol and Bromophenol compounds have been brought into use. ?hese check the fermentative processes forming ptomaines, yet, it is aid do not interfere with intestinal digestion. Bismuth compounds are in general incompatible with Potas- ium Iodide, the insoluble brown Bismuth Tri-iodide being formed. Bismuth hotsoning.—The most striking features are stomatitis, black line and white diphtheritic membrane on the gums and Bismuth in the rine. Beck’s Paste has caused poisonous symptoms.—L. i./13,1039. See also Sodium Potassium Bismuthyl Tartrate. iismuthi Benzoas, Bismuth Oxybenzcate. CcH5~CO.Q (BiO) (?) = 346-039. Dose.—-5 to 20 grains (0.3 to 1.2 Gm.) thrice daily. A white powder insoluble in water, containing about 65% Bismuth Oxide. Antiseptic, internally in gastro-intestinal diseases, xternally to chancroid, indolent and sloughing ulcers. ismilthi Carbonas. Syn. Bismuth Oxycarbonate or Subcarbonate. (Bi202C03)2.H20 = 1038-1056. Dose.—5 to 20 grains (0-3 to 1-2 cm.). Slipule No. 00 holds 10 grains. 1 May be suspended in an ounce of water by means of a drachm of mucilage of agacanth or about 6 grains of compound powder of tragacanth. Prescribers rould indicate if a suspending agent is required. A light variety of the rbstance needs no suspending agent. The following forms an agreeable dose :— [istura Bismuthi. Dose.—1 ounce. Bismuth Oxycarbonate 10 grains, Sodium Bicarbonate 10 grains, Lucilage of Tragacanth 1 drachm, Compound Tincture of Carda- 10ms 30 minims,. Spirit of Chloroform 10 minims, Cinnamon Water > 1 ounce. Tablets of Bismuth Carbonate contain 5 grains, to be rushed and swallowed with a little water. jLMistura Bismuthi Astringens N.E.H. Bismuth Carbonate 2 grains, Tannin 14 grains, Aromatic Powder of Chalk th Opium 2 grains, Water 1 drachm. Dose for a child. For X*ray of conditions of the oesophagus and omach large doses are frequently ordered. Standard’ Opaque Meal. Bismuth Carbonate 4 ounces, Lactose 14 ounces, Water, q.s., to make a lin emulsion—less than a tumblerful.—A. C. Jordan, B.M.J. ii./13,1348. ‘Homogeneous Bismuth Mixture.’—For use in radiography. 34 ounces 00 Cc.) contain § ounce (20 Gm.) approximately. Bismuth Carbonate 120, Gum Arabic 20, Tragacanth 5, Syrup 150, Water >0. Does not separate into two layers and hence give deceptive effect in diography.—B.M.J.E. i./13,42. ismuth Meal.—Vic. Park. Bismuth Carbonate 3 ounces, Bread, pounded up, 3—4 ounces, Milk 15 mces. Bismuth Oxychloride is preferable. Barium Sulphate q.v. has placed the use of Bismuth Compounds. Bronchoscopic Insufflation with Bismuth Carbonate of value in radio- aphy of the lungs. One ounce can be safely used in adults. B.M.J.E., 2 0 35 Gastbitis is usually well treated by a dose of Bismuth Carbonate with a lall dose of Morphine and 2 or 3 minims of Dilute Hydrocyanic Acid.' hitla, Bract. Med. In ulcerative colitis, Bismuth Carbonate 15 grains to the pint, als Potassium Permanganate 1 in 30,000, useful and soothing. In the late stages irrigation with Per chloride 1 in 20,000, Zinc Sulphate 4 drachms n 3 pints, and Silver Nitrate 5 to 10 grains to the pint, effectual when use< alternately. Chlorodyne was beneficial as anodyne.—B.M.J. i./n,864. Intimately mixed with Liquid Paraffin it is stated to be better tolerated In this way it is not attacked by the hydrochloric acid of the stomach.—A Vicario, Jour. Pharm. Chirm, 1914, 9, p. 458. Hyperacidity is well treated by powders containing Bismuth Carbonat 30 grains, Magnesium Carbonate 20 grains, and Sodium Bicarbonate 30 grains —G. Rankin, B.M.J. i./i5,1036. Renal insufficiency well treated with Bismuth Carbonate 50 Gm. daily.— per Pr., May, ’26,385. Ascaris and Strongylis. Large doses, e.g., 30 Gm. in 24 hours, effective —Y.B.P., '26,193. Pulvis Bismuthi Compositus. Syn. Ptjlvis Alkalinus Com positus.—Hugh MacLean. Dose.—First Week. A teaspoonful in a little water or milk 6 or 7 times daily (preceded by a glass of milk with 10 grains Sodium Citrate added to prevent coagulation), with double dose last thingj at night and extra powder during night if patient wakes. If bowels disturbed excessively, adjust powder or add Magnesia Cream. Second: Week. If discomfort and symptoms still persist continue as first week for a few days, otherwise reduce powder to 4 or 5 doses daily and reduce milk, adding beaten up eggs and gradually increasing diet so that by end of week patient is receiving toast, butter, eggs, custard and cream. Dose immediately before retiring and during night ae before. Third Week. Reduce to 3 or 4 doses daily and one at bedtime and increase food to include fish and potatoes and cereal puddings. 4th to bth Weeks. Powder 3 times daily with dose at bedtime and reduce or give up milk. A small amount of meat may be taken the 5th week. After-treatment. Continue powder two or three times daily for further 6 weeks, with a dose at bedtime for a long time afterwards, and return to milk or light diet with powder 4 or 5 times daily if symptoms return at any time. Form I.—Bismuth Carbonate 2, Sodium Bicarbonate 1, Magnesium Carbonate (Heavy) 2. Form II.—(Hospital Formula). Bismuth Carbonate 1, Sodium Bicarbonate 3, Magnesium Carbonate (Heavy) 3, and Creta Preparata 3. For the intensive alkaline treatment of gastric and duodenal ulcers. Smoking and Alcohol should be avoided. Practically all uncomplicated ulcers can be cured in a comparatively short time by this treatment.—Hugh MacLean and Co-workers, L. L/28,14-19 ; B.M.J. i./28,619. Criticism of the word ‘ cure ’ and of omission of any reference to the ‘ Sippy ’ Treatment (see p. 536), wiiich is on similar lines. Renal disease and pyloric stenosis contraindications.—J. A. Ryle, ibid. 104 ; also T. Izod Bennett and A. Moncrieff, ibid. 104. Reply to criticisms—no claim to originality ; pyloric stenosis not found a contraindication. Main purpose to help the genera] practitioner.—Hugh MacLean and Co-workers, ibid. 157. Creta prseparata used in preference.—J. Rutherford Hill, P.J. i./30,99; see also H. P. Arthur, ibid., 157 ; also ii./29,463. ulvis Bismuthi Compositus N. H. I. Dose (average).—£ teaspoonful in a little water. Bismuth Carbonate 1, Sodium Bicarbonate 1, Heavy Magnesium Car- onate 3, Prepared Chalk 3. ulvis Bismuthi Compositus, L.H. Dose.—1 drachm. Bismuth Carbonate 1, Heavy Magnesium Carbonate 2£, Sodium icarbonate 2J. An antidyspeptic powder. Caution: Ferrier’s Snuff was previously called Pulvis Bismuthi Co., but lis name is now dropped for the Snuff. For Alkaline Treatment with Tribasic Calcium or Magnesium 'hosphate (Hurst), see pp. 256, 538. astralka. Dose.—One teaspoonful in half a glass of milk or water before meals and at idtirne. A Canadian preparation used as an antacid and anti-fermentative, con- ining Bismuth Carbonate, Bismuth Subgallate, Calcium Carbonate, Mag- isium Carbonate, Sodium Bicarbonate, Sodium Bromide, Papain, and Oil Peppermint. In gastritis, hyperacidity, flatulence, etc. t> * Sedeff. (T’.M. No. 204175). Dose.—1 to 2 drachms in water. Contains Morphine (1/30 grain in 1 drachm), Bismuth and digestive rments. A palatable granular effervescent preparation, for use in ckness and derangement of digestive functions. D Pastillus Bismuthi Carbonatis (3 grains) cum Morphlnae Acetate (T\, grain), v. Glyco-gelatin. |H Collapsubes (with rectal tube attachment) of Bismuth 20%, orphine J%, and Cocaine 3% Ointment,—Unguentum Bismuthi or phi nee et Cocainae, Allingham (Bismuth Carbonate 20, Morphine ydrochloride Cocaine Hydrochloride 3, Soft Paraffin to 100) are iieful as astringents in haemorrhoids and for allaying irritation. quor Bismuthi et Ammonii Citratis. Syn. Liquor Bismuthi, (B.P. ’14.) Dose.—| to 1 drachm (2 to 4 Cc.). Prepared by interaction of Bismuth Subnitrate with Citric Acid id Water until the product is soluble in Ammonia and then after ishing dissolving in Ammonia. Contains 5 grains of citrate=3 ains of Oxide of Bismuth in 1 drachm. For some data as to manu- cture, see Vol. II. Flavoring.—Syl Lavandulae ; Syrupus Aromaticus. In following the B.P.’ 14 directions the mixture of Bismuth Subnitrate, brie Acid and water sets hard and is not completely soluble in Ammonia.—F. nfold suggests alteration of directions.—P.J. ii./i6,567. The amount of -ter should be 60 instead of 20. Place the Bismuth Oxynitrate, Citric :id and water in a vessel and allow the reaction to proceed.—J. H. Franklin, J. i./27,53. Bismuth and Ammonium Citrate (when strongly alkaline) is incompatible th Sodium Bicarbonate. Besides Ammonium Hydroxide, the alkaline Mroxides yield precipitates of a basic Bismuth Carbonate.—A. E. Lum, I. i./29,597. Evaporated to a syrup, spread on glass and dried, it produces :— smuthi et Ammonii Citras, U.S. IX. Dose.—2 to 5 grains (0-12 to 0*3 Gm.). En soluble shining pearly or translucent scales. 1 Gm. yields not s than 0-46 or more than 0-52 Gm. Bi208. Vol. I. H B Liquor Bismuthi Concentratus, B.P.G. (Double strength Oa Liquor B.P. ’14). Dose.—15 to 30 minims (l to 2 Cc.). Dissolve Bismuth Subnitrate 14, with gentle heat in Nitric Acid (B.P.’M). 10 previously diluted with an equal volume of water and add Citric Acid li dissolved in distilled water 14. Add gradually with stirring Sodium Bicarbonate 17-5 previously mixed with distilled water 14 ; wash the precipitate by decanting until free from nitrates and dissolve it by adding Solution of Ammonia 12 or q.8. Finally add Ammonium Citrate Solution 24 and make up to 100 with water. (£) Liquor Bismuthi Sedativus. Syn. ^Bisedia. (T.M. 252630, Schacht. Dose.—1 drachm (4 Cc.) containing Bismuth and Pepsin .with grain Morphine Hydrochloride, 2 minims of Hydrocyanic Acid, and 5 minims of Tincture of Nux Vomica. For acute dyspepsia, vomiting of pregnancy and gastric hyperasthenia. *Bismosal (T.M. 317911 and 433830). Dose.—\ to 1 drachm (2 to 4 Cc.). Children, 5 to 20 minims (0-3 to 1*2 Cc.). Contains! Bismuth as hydroxide in suspension with Salol. In diarrhoea. Bismuthi Citras, BiC6H6O7 = 398 039. Dose.—2 to 5 grains (012 tc 0 3 Gm.). A white crystalline powder, yielding not less than 56 nor more thar 58% pure Bismuth Oxide. Insoluble in Water and Alcohol 90% but soluble in Ammonia. It is astringent and stomachic. Bismuth Citrate prepared by usual methods is not BiC6H50,, but impure Monobismuthylcitric Acid H2C9HR0 (BiO). Alkalis, apparently, do no* form salts of this acid but more complex substances.—E. W. Adams, B.J ii./24,87. Bismuth Citrate Gauze.—May replace Iodoform Gauze, being non-toxic and without odour. May be left in uterine cavity a * least five days and still be free from offensiveness. For use afteE curettings, in nasal and aural surgery and for burns. Strips, 1, 2 anc 3 inches wide, are made, also 36 inches. Elixir Bismuthi.—Dose.—1 drachm (4 Cc.). Bismuth Citrate 1, Distilled Water 6, Solution of Ammonia f 02 q.s. Dissolve, filter and add Simple Elixir q.s. to 30. Cg) Mistura Bismuthi cum Pepsina.—Martindale. Dose.—1 to 2 drachms (4 to 8 Cc.) diluted. Contains Bismuth Citrate 2 ounces, Pepsin (soluble) 320 grains Morphine 5 grains, Strychnine 1J grains, Dilute Hydrocyanic Acic 320 minims, Chloroform 30 minims, Saccharin Elixir 480 minims Rosein Acetate q.s., Water to one pint. This mixture will not deposit This preparation is retained as mixtures of the kind are ordered but the action of the Pepsin is seriously interfered with by the othei ingredients. (Cf. our experiments with Pepsin, Vol. II., and, Bismutl and Pancreatin, postea.) Tabellse Bismuthi et Pepsinte. Bismuth Carbonate 3 grains, Pepsin 3 grains, in chocolate basis. Useful digestive. Compressed Tablets are also prepared. ablets Bismuth, Pepsin and Cascara.—Martindale. Dose.—One or two as required after meals. Bismuth Carbonate 3 grains, Pepsin 3 grains, Cascara Extract grain. A useful digestive. lismuth and Pancreatin.—Martindale. Dose.—1 to 2 drachms (4 to 8 Cc.). An alkaline stimulant digestive combining the sedative properties f Bismuth with the pancreatic ferment in a compatible form, and eing an alkaline solution the mixture will promote gastric secretion, 'he peptonising power of the preparation is practically speaking ermanent. Our investigations show that Pepsin and Bismuth nixtures are mutually incompatible—the activity of the ferment l such mixtures is interfered with by the necessary alkalinity of oe Solution of Bismuth unless an acid Bismuth Salt is employed ;. Bismuth Tartrate Acid). Pepsin can only operate in a slightly cid solution (equivalent to the Hydrochloric Acid of the normal astric juice). The alkalinity of Bismuth and the Hydrochloric Acid jquired with Pepsin are incompatible in a mixture, resulting in the jrecipitation of Bismuth Oxychloride, hence the more compatible lismuth and Pancreatin. | The preparation has been found of particular service as a digestive in the ritated condition of the stomach during convalescence from illness. p)Mistura Bismuthi Phenolis et Morphinae. Dose.—1 ounce from 2 to 3 hours after every meal. Bismuth Carbonate 40 grains, Phenol 2 grains, Solution of Mor- :hine Hydrochloride 1*5 minims, Mucilage q.s., Compound Gentian pfusian to 1 ounce. Duodenal ulcer is relieved by this. For the constipation produced ly large doses of Bismuth give Pilulae Hydrargy»-i Subchloridi, hel, Cascara et Capsicin.—Guthrie Rankin, • ismuthi et Cinchonidinse lodidum (short name ‘ BiscinSod ’— —Martindale). C 19H22N2O.HI + Bil 3= 1011-9234. Dose.—J to 1 grain (0*01 to 0*06 Gm-)> Yellowish red powder, insoluble in ordinary solvents, containing bout 20% Bismuth, 40% each Iodine and Cinchonidine. This substance, containing digestive, febrifuge and antiseptic con- oituents, should certainly find utility in therapeutics, isciniod Suppositories. Contain \ grain (0-03 Gm.) in Cacao Butter basis. Ismuthi Nitras Crystallisatus, Fr, Cx., P.G. VI. Syn. Bismuthi Titras ‘ Neutrus 5 F.E. VIII., P. Ital. V. Bi(N03)3,5H20=485-108. Dose.—5 to 10 grains (0-3 to 0-6 Gm.). In colourless deliquescent crystals, which, if dissolved in a small uantity of water, give a solution with an acid reaction, this on fur- ier dilution throws out Basic Bismuth Subnitrate. It is practically Lsoluble in Alcohol 90%, but soluble in cold Glycerin, cf. Glycerinum ismuthi Nitratis infra. Tt is astringent and antiseptic, and useful )r the diarrhoea of phthisis, Glycerinum Bismuthi Nitratis. Bismuth Nitrate in crystals 1, Glycerin to 4. Diluted 4 or 5 times with Glycerin is a stimulant application in eczema. Bismuthum Hydroxydatum, Hydrated Bismuth Oxide. Bi (OH)3=260-0218, but the compound is not always uniform. Dose.—5 to 20 grains (0*3 to 1*2 Gm.). . An amorphous white insoluble powder, but soluble in Sulphuric Acid and Hydrochloric Acid in presence of water and in fixed alkalis in presence of: Glycerin. Permanent in the air. The following are Fr. Cx. directions. Shake Glycerin 150 Gm. with Bismuth Nitrate (cryst.) 100 Gm., add Water 100 Cc. in portions, shaking constantly to prevent formation of the Subnitrate. When dissolved filter if not clear, and pour the liquid, a little at a time, into a mixture of water 150 and 10% Potash Solution 850 Gm. When reaction complete add drop by drop Dilute Sulphuric Acid 100 Gm. (10% approx—Fr. Cx.) mixed with its weight of water to neutralise, then render the mixture slightly alkaline. Wash the precipitate by decanting until a sample of the wash liquor leaves nothing on evaporation. Collect and dry at 100° C. Employed in making Basic Bismuth Salicylate. In an experimental quantity we obtained 45 Gm. of product from above quantities. The theoretical amount is 50% approximately._ Uses.—A substitute for bismuth carbonate : also injected. Lupus Erythematosus treated by 12 Bismuth Hydroxide injections of 3-75 grains, two injections a week : cured. Better than Arsenic.—B.M.J.E. ii./ 2 7,29. Syphilis.—Suspended in Water and Glycerin stated to be preferable to the oily preparations.-—Svend Lomholt. Bismuthi Oxidum, Bi2Os=466. Dose.-—5 to 20 grains (0*3 to 1*2 Gm.). Is prepared by boiling Bismuth Subnitrate in solution of Soda, washing and drying the deposited yellowish Bismuth Oxide. May be precipitated with acid from an alkaline solution containing glycerin. Anderson’s Ointment. Bismuth Oxide 1, Oleic Acid 8, White Wax 3, White Soft Paraffin 9. In pruritus. Bismuthi Oxychloridum, BiOCl=260-457. Dose.—5 to 20 grains (0*3 to 1*2 Gm.). A non-irritant cosmetic powder, pearl white or ‘ blanc de perle.' Given internally it produces a coating on the irritated parts of the stomach or bowels. As insufflation to the larynx J to J gr. *Bisoxyl (T.M. 491273). A suspension of Bismuth Oxychloride in Chloretone solution. Initial dose 0*1 Gm., increased to 0-2 Gm., corresponding to 0-01 and 0-02 Gm. of the Bismuth salt for congenital syphilis.—T. M. Ling, L. ii./29,1034. Bismuth Oxychloride preferred in syphilitic treatment. It is probably reduced to metal. Course of 4 Gm. in 10 injections. Give concurrently with Arsenobenzol, rather than Bismuth or Mercury to follow. Quinine Iodo* Bismuthate has disadvantage of low Bismuth content.—L. W. Harrison, ’lupus Erythematosus treated with Bismuth metal, Bismuth Oxychloride, and Sodium Bismuth Thioglycollate injections, deep subcutaneous or intra muscular, when possible once weekly or fortnightly, allowing 6 weeks, lapse after every 10 or 12 injections. Average dose, 0-3 to 0-4 Gm. per injection (latter considered max. dose). The Thioglycollate gave no better results Acid Nitrate of Mercury used locally seems to improve treatment. R. M. B, Mackenna, L, i./3o,178. sfcBismurung (T.M. 512988).*—A Bismuth Oxychloride Ointment, 5 and 0%, for chronic lupus erythematosus, rubbed in for at least 2 minutes twice aily. Pustular folliculitis cleared up; tinea unguium and chancroids also •eated. May be of value in yaws.—R. M. B. Mackenna, L. i./3i,126. [ascent Bismuth Oxychloride. Pain and vomiting due to catarrh or organic disease of the stomach treated y Bismuth Oxychloride in fine suspension made in nascent state by using iquor Bismuthi and Dilute Nitro-Hydrochloric Acid q.s. The mixture aggested is : Liq. Bismuthi 6 drachms, Dilute Nitro-Hydrochloric Acid 1$ rachms or q.s., Peppermint Water to 6 ounces. One half ounce in water d. shortly before or after meals. (In dispensing, the acid is to be diluted ad added last so as to throw out the Bismuth as a dense white cloud.)— O. Nicholson, Pres., June, ’20. An Oxybromide is also made, with similar internal use. lucilago Bismuthi. For “ X ” Ray Diagnosis. | Bismuth Oxychloride 1J to 2 or 3 ounces or more made into a thick saste with Acacia Mucilage for a dose, for determining condition f the oesophagus and for examining shape, position and motor func- :ion of the stomach. A special Bismuth Oxychlorid e free from Nitrate a made for X-ray work. It is inert in the stomach. Bismuth in Bread and Milk in proportion of 1£ ounces of Bismuth Oxychloride to l pint of bread and milk to form a thick paste— ot a liquid—is also employed and is in some respects more suitable. In tuberculous joints Bismuth injections are useful for diagnosis and eatment. See also Bismuth Carbonate antea and Radiology, Vol. II. essaries or Suppositories may be made with Oil of Theobroma, mtaining 10 grains (0*6 Gm.). nguentum Bismuthi Oxychloridi. Bismuth Oxychloride 1, White Soft Paraffin 15. Is useful for anointing the speculum for vaginal examinations. nguentum Bismuthi Compositum, Plaistow. Bismuth Oxychloride 2 drachms, Dilute Hydrocyanic Acid 20 dnims, White Paraffin Ointment 1 ounce. The Oxyiodide has been applied to ulcerating sores and injected l suspension, 1 in 100 of water for gonorrhoea ; also as an ointment [>r rectal affections. Internally for ulcer of the stomach. ismuthi Salicylas, Bismuth Oxysalicylate, or Subsalicylate, C6H4.OH.COO.BiO=362-039 (B.P. *14). U.S., Jap., p. itai. v., P.G. VI., P. Belg. IV., Ph. Ned. V, and P. Helv. (last two with method of making). Dose.—5 to 20 grains (0-3 to 1-2 Gm.). A white powder, insoluble in Water, Alcohol, and Glycerin, yields 1 incineration about 64% of Bismuth Oxide. Useful in some forms diarrhoea, typhoid fever and gastric catarrh, and as a substitute for >doform. A good intestinal antiseptic. [smuth Salicylate Sterules, 2 grains (0?12 Gm.) in 1 Cc. of Sterile Olive Oil are prepared. Syphilis well treated. Better tolerated than Mercury. Can be used in ses with marked renal involvement.—Per Jl. A.M.A. ii./25,223. _ Criticism is, however, that this insoluble compound is dangerous oy mjectiop. Ref, under Sodium Potassium Bisjnuthyl Tartrate, 3^Bismogenol (T.M. 444974) in syphilis. A suspension of a Bismuth compound of a ‘ highly valent Oxybenzoic Acid ’—‘ possibly Bismuth Salicylate ’—in Olive Oil.—H. Ritter and C. L. Karrenberg, L. ii./29,971. For Notes on Chemical Examination, see Vol. II. Tablets, 5 grains (0*3 Gm.). Dose.—1 to 4. Suppositories of Bismuth Salicylate. 10 grains in each. A useful astringent in dysentery. Bismuthum Subsalicylicum, Basic (Fr. Cx.). CfiH4.OH.COO.Bi(OH)2 = 380-0546. Dose.—5 to 20 grains (0-3 to 1-2 Gm.). An amorphous anhydrous insoluble white powder neutral to Litmus incompatible with Acids. To prepare, warm without boiling Hydratec Bismuth Oxide (q.v.) 158 or as much as corresponds to 150 Gm. Bi2Os with Salicylic Acid 100 previously mixed with water 1,000. The mixture should be finally slightly acid. After cooling collect and wash rapidly, and dry at not exceeding 80° C. In an experimental quantity which we prepared we found a distinct proportion of free Salicylic Acid. Bismuthi et Cerii Salicylas. Dose.—5 to 20 grains (0-3 to 1-2 Gm.), For sickness, diarrhoea, dysentery, and ulceration of the bowels. Bismuthi Sulphocarbolas vel Sulphophenas. Dose.—4 to 8 grains (0*25 to 0*5 Gm.) in cachets. A red-tinted slightly soluble powder used in intestinal affections. Bismuthi Subnitras9 Bismuth Oxynitrate, Magisterium Bismuti (B.P. ’14), Ph. Ned. V., P. Helv., P. Ital. V., P.G. VI. Bi0N03H20 —305*0236. Dose.—5 to 20 grains (0-3 to 1-2 Gm.). P. Jap. gives method of making—i.e., Bismuth 1, Nitric Acid (1 *2 Sp. Gr.) 5 solve and allow to crystallise, then take the crystals 1, water 4, and add boiling water 21. Pour off, wash with water 25, and dry at 30° C. Yields (B.P. ’14, P. Jap. and P. Ital.) 79 to 82% Bi203. For pharmaceutical purposes it is usually 6Bi203.5N205.9H20 (79-8^ Bi203).—C. E. Corfield and G. Short, P.J. ih/24,80. /n comt><rfible with alkaline carbonates, also decompose Potassium Iodide, and incompatible with Tannin and Sulphur. Best suspended in aqueous vehicle by Compound Tragacanth Pow der, 1 drachm to 8 ounces, or by powdered Gum Acacia or wit] half its weight of Starch Powder.—P.J. i./26,96. Uses.—In gastric ulcer and dysentery as an intestinal antisepth and occasionally as a dusting powder in eye work. During the ws it was much used to wounds in the form of ‘ B.I.P.P.’ Gastric ulcer well treated by Bismuth Subnitrate rubbed into paste with Liquid Paraffin,—a good vehicle for Bismuth, undoing it constipating effect. Decomposition into nitrite in the stomach avoided, cf. Bismuth Carbonate.—L. J. Picton, B.M.J. ii./i7,6F As a dusting powder for wounds it has caused poisoning. Syphilis.—Bismuth Subnitrate as effective as any other Bismuth conrpouni Good results with following injection : Bismuth Subnitrate 10 Gm., Novocair Nitaate 1 Gm., Sterile Almond Oil 100 Gm., the dose being 1 Cc. (0-07 Gn Bismuth) every third day.—E. Sonnenberg, D.M.W. ; per Pres.? Sept. *26,32! Hypertension.—Bismuth Subnitrate assists materially in obtaining reduction of arterial tension, owing to breaking the vicious circle of vasculi fatigue, hyperirritability, with more spasticity and fatigue, and there! permitting of physiologic rest.—E. J. Stieglitz, Jl. Pharm. and Exp. Therai Dec., *28,422. jectio Bismuth! Subnitratis.—Beck’s Bismuth Paste. For X-ray Examination of fistulae (c/. also Bismuth Oxychloride). (a) For Diagnosis and Early Treatment.—Place Bismuth ibnitrate 1 in a mortar sterilised by burning a little spirit in it ad add in portions hot melted Soft White Paraffin 2. (b) For Late Treatment.—Bismuth Subnitrate 6, White Wax 1, ard Paraffin 1 (M.pt. 120° F.), Soft White Paraffin 12. Prepare on nilar lines to the last. The (a) form was originally injected to diagnose the extent of ,ronic tuberculous sinuses. It was found also to have curative feet. It is melted before use. The (glass) syringe must be sterilised y and the plunger dipped in sterile oil before charging.—Beck, fistulous Tracts, Tuberculous Sinuses and Absce ss Cavities/ The following is a modification :—Bismuth Oxychloride 1, Soft hite Paraffin 1J, Liquid Paraffin 1J, for injection into sinuses. By X-ray examination, sinuses can be localised. Large quantities should t be left in situ. Three ounces of (a) injected at the knee, and later 4 ounces further caused isonous effects. Caution is necessary when using for diagnostic purposes. The Bismuth is bactericidal, chemotactic and astringent. Mechanical bion is also good. tsta Bismuthi et lodoformi. Syn. “BXPP” Mix Bismuth Subnitrate 1, and Iodoform 2, stir in Liquid Paraffin 1 q.s. to a soft cream, and rub down on a slab with a spatula. A Paraffin Base of composition : Paraffin melting point 45° C. parts, and Liquid Paraffin (Sp. Gr. 0*880) 40 parts suggested when Irking a soft “ B.I.P.P.”—S. Dunstan, B.M.J. ii./17,505. Large infected wounds have been treated without special drainage, ey can be closed by sutures at any period and the dressings can be t on one to six weeks with a knowledge that they are making progress. Smear the surface of ivounds and rub in “ B.I.P.P.,” removing any cess. In cfg'&ssJnci a wound— (i.) Clean with Carbolic Lotion and cleanse, if possible, with dry sterile gauze mops. (ii.) Mop out with cotton-wool mops soaked in Spirit and dry. (iii.) Apply ‘ B.I.P.P.’, in thin covering over the wounded surface. Dress in the usual way. This requires no change for days or weeks if patient is free from pain. If discharge comes through, the stained part must be soaked in spirit and a gauze dressing applied as a further covering, iv.) In redressing, the wound is cleaned with spirit. Tor fresh wounds, when infective gangrene is still a possibility, free drainage ist be employed. The method makes possible the healing by first intention der infrequent dressings. Acute abscesses opened, cleaned, filled with .I.P.P.’, and closed by interrupted sutures can heal without further pus niation.—Rutherford Morison, L. ii./i6,268. The fresher the wound is the better it reacts to the treatment. Thick sterile k sutures rubbed all over with ‘B.I.P.P.’ are better than silkworm-gut. mpound fractures of all the bones can be treated with as great ease as iple fractures. Cases of compound fracture of ankle, gun-shot and other unds well reported on.—Rutherford Morison, B.M.J. ii./17,503. It combines a maximum amount of rest to the wound, a, persistent storage inhibitory antiseptic and a minimum amount of attention, but is not free m risks.—Sir G. H. Makins, B.M.J. i./17,216 ; L. i./i7,252. Jsteomyelitis.—The more frequent use of ‘ B.I.P.P.’ urged in treatment. B.M.J.E. i./2 6,20. „ . . _ Tropical Ulcer well treated.—T. R. E. Rerby, L. 1-/32,237. B.I.P.P. modified.—Bismuth Subnitrate 1, Iodoform 2, and Soft Paraffin 13 (Tood in appendicitis operations, but some say would never introduce it intc the abdomen.—It. A. Stoney, B.M.J. ii./3o,737. See also ‘ Wounds.’—Therapeutic Index. Enema Bismuthi et Sodii Salicylatis. Bismuth Subnitrate 3 drachms, Sodium Salicylate 2J drachms Psyllium Seed Mucilage to I pint. Colitis the treatment of, by Revellicd’s method (modified). Empty the bowels by enemata of warm water twice daily for three days— on the fourth day inject the above. Action of the bowels must be discouraged after the injection, as the medicament should be retained for two days, ii possible, to permit of absorption. During the injection the patient should lie upon the left side with the pelvi&{ raised 2 or 3 inches. This treatment has, of course, no effect upon enteritis] alone or complicating (? originating) colitis ; consequently a modification i&fl necessary. Pilula Bismuthi-Sodii Salicylatis cum Salol. Syn. Compound Bismuth Pill. Dose.—Two immediately after each of 6 consecutive meals, therc discontinue for two days and repeat in the same manner. This pill contains in the centre Bismuth Carbonate 2J grains,, coated thinly with Gelatin, and around this is a layer of Sodiumi Salicylate 2 grains, covered finally with Salol 1J, 2J or 3 grains, or as desired {the Salol to he applied pure by rneaiiS of heat only). It was devised to ensure its reaching the part of the intestine affected by the catarrh. It is coated with acid-resisting material and it dissociates on. meeting the alkaline intestinal juice. The well-known coating effect of the Bismuth Carbonate on the inflamed mucous surfaces is enhanced by the:: Sodium Salicylate. The Bismuth remains in situ for from 8—10 days. Bismuth Subnitrate Tablets are made 5 to 10 grains. CE>Lotio Bismuthi Mid.H. Bismuth Subnitrate 5, Zinc Oxide 20, Mercuric Choride 0-161 Glycerin 10, Hydrogen Peroxide Solution 120, Water to 300 As a stimulant in rosacea and pigmentary disorders. iSEJPulvis Bismuthi cum Morphina. Syn. Insufflatio Bismuthi et Morphina:. Furrier’s Snuff. Bismuth Subnitrate 180, Morphine Hydrochloride 1, Powdered Gum Acacia 60. From 1 to 2 drachms may be used as snuff in 24 hours for catarrh. For acute coryza add powrdered cubebs. It may cause drowsiness for some hours in susceptible patients |p| [jpj] Unguentum Bismuthi cum Cocaina, St. Mark’s H. Bismuth Subnitrate 120 grains, Cocaine Hydrochloride 8 grains, Soft White Paraffin to 1 ounce. Bismuthi Oxy-Iodogallas. p. jap. IV., P. Helv., Ph. Ned. VM P.G. VI. C6H2(OH)3COOBi. OH.1=521-7788. ^Airol (T.M. 181257 of 1894). Renewed 1922. Syns. Airoform, Airogen. Manufacture (from specification of expired Patent). Bismuth oxyiodide derived from 9-5 kilos of Cryst. Bismuth Nitrate is washed and stirred with water. 3-4 kilos Gallic Acid are added until red colour changes to greyish-green. Collect, wash and dry at moderate heat. Or, Bismuth Gallate (Dermatol), 10 kilos are treated under heating with 3-1 kilos of Hydriodic Acid until of green colour. Wash and dry. A light greyish-green powder, odourless, non-irritant. Used as itment for ulcers, boils, whitlows, chancres, and intertrigo. Also ■ dusting powder, e.g.> for gonorrhoeal ophthalmia. ppositoria Haemorrhoidalia. Bismuth oxyiodogallate 6, Resorcin 1*5, Zinc Oxide 6, Balsam of Peru 1*5, ilow Beeswax 0-0075, Sesame Oil 1-5, Oil of Tlieobroma 19 Gm. Divide |o twelve suppositories. i^nusol Suppositories (T.M. 226005 and 455228). Contain Bismuth Oxyiodide, Bismuth Resorcin Sulphonate, Zinc Oxide, Isam of Peru, in a fatty base. For haemorrhoids. iSanusinufc Sempules (T.M. 329438) contain Resorcin, Boric Acid, Balsam pi, Zinc and Bismuth Carbonate—useful in treatment of haemorrhoids. smuthi Subgailas, C6H2.(0H)3C0.0.(Bi0),H20 or Bi(0H)2C7H506 — 412-0546. Syn. ^Dermatol; U.S.X. 52-57% Bi2Os. P. Jap. Ph. Ned. V., P. Ital. V., and P. Helv. Gallate de Bismuth. Fr. Cx. 56-45% Bi203 (with directions for making). P.G.- VJ and P. Belg. IV. (46*6% Bismuth), F.E. VIII. (52—57%). Patent 6234 of 1891 became void in the 11th year. Now publio bperty. ^Dermatol (T.M. 215949). Manufacture.—Bismuth Carbonate 258 and Gallic Acid 188 are ited in presence of Water 2,000, until interaction has occurred, the colour is lemon yellow and the Bi208 content we find approximates ory—56-4%.—W. H. M., 1917. Che Fr. Cx. method is also satisfactory : Dissolve Bismuth Nitrate Cryst. ) Gm. in Glacial Acetic Acid 200 Gm. Dilute with water 500 Cc. and add i}h stirring Gallic Acid 37 dissolved in water 1,500 Cc. Wash the p.p. until ; liquor is no longer acid to litmus. Dry at not exceeding 60° C. P. Ital. thod is similar. Average dose (U.S.)-—15 grains (1 Gm.). An odourless, yellow, insoluble, non-irritant antiseptic dusting wder, employed alone or with starch. Incompatible with alkaline Sulphur compounds. Given internally for diarrhoea in doses of 30 to 90 grains daily, nulsion of Bismuth Subgallate 2, Gum Acacia 2, Water 25, has r.en used in gonorrhoea, with good results. In ulcerative colitis an emulsion may be used to adhere to the acosa; also of value after pile operations. Promotes healing.— S. Handley. fAWS.—Dermatol intramuscularly gave as good results as the Arsenics.— Jl. Trop. Med., Jan. 15/25,35. lapsible Tubes, with catheter attachment, of Bismuth Subgallate Ointment, 10%, with paraffin basis, are useful in ! gonorrhoea ; this ointment is also good for burns and eczema, rbassus Bismutlii Subgallatis. Bismuth SUBGALLATE Gauze. Po prepare, use an emulsion of Bismuth Subgallate, \ to 1 of Glyce- 1 to 2 of Alcohol (90%) and proceed in the customary manner (cf. rilised Dressings)—the final strength being 10 to 20% of the smuth in the gauze as required. For packing cavities. smuthi Tannas. Dose.—10 to 30 grains (0-6 to 2 Gm.). A yellow powder insoluble in water, is astringent, and useful in irrhoea and dysentery. smutose (cf. German patent 117269). Dose.—15 to 30 grains for children, adults by the teaspoonful. A compound containing about 20% of Bismuth with 60% of Albumen ; useful in gastric ailments. Naphthol-Bismuth. BASIC BISMUTH BetA-NaPHTHOLATE. Bi2O2(OH)C10H7O = 610-0624. Syn. jJcOrphol (Trade Mark 190732.) Dose.—10 to 30 grains (0-6 to 2 Gm.). Manufacture s We have made a compound of this kind by interaction of a Sodium Naph- tholate solution made with Beta Naphthol 144 (one molecule) and Sodium: Hydrate 120 (three molecules) with Bismuth Citrate 397 (one molecule) in tin- form of a paste with water. This method produces a light buff coloured pow’der, which gave on ignition approx. 80% Bismuth.Oxide. Theory demands 76.3%. A useful antiseptic to the stomach and intestines, astringent. Phenol-Bismuth. Dose.—10 to 30 grains (0-6 to 2 Gm.). Preparation :— The method advised is to dissolve Bismuth Oxynitrate 60, in 70% Nitric- Acid 45, diluted with water 150, and to add this very slowly to Sodium Hydroxide 42 and Phenol 20 in water 750 with stirring and wash with cold water. The body obtained yielded on analysis 14-76% Phenol and 81-93% Bismuth Oxide. The exact formula of the compound is therefore uncertain. Products with the highest Phenol content are obtained by precipitation from neutral solution in the cold. The figures do not agree with Bi(OH),C«H,0 — C. E. Corfield and G.R.Boyes, P.J. i./2i,483. 5 A white powder, insoluble, containing about 20% of Phenol, combined with bismuth oxide. Acts slowly on the digestive tract and does not cause carboluria. Has a similar action to last preparation. Pyrogaliol-Bismutli. C6H3 <!q^q or C6H3(OH)O2BiOH = 35Q-039 has internal action similar to Salol. • Dose.—2 to 8 grains (0-12 to 0-5 Gm.). ALKALI BISMUTHYL TARTRATES. The Alkali Bismuthyl Tartrates may be divided according to method of making and use. (cf. Corfield and Adams, P.J. ih/23,82.) (1) ‘Neutral’ compounds, termed ‘Bismuthyl Tartrates,’ or ‘ Tartrobismuthates,’ which are either soluble or insoluble in water, tor injection in wf-mczoal diseases* They are made by dissolving Bismuth Oxy-Tartrate in alkali, the Alkali Bismuthyl Tartrate resulting by evaporation or by precipitation with Alcohol. (2) ‘ Acid ’ preparations, described as ‘ Bismuth Tartrate Soluble,’ in scales giving an acid solution. These are used with Pepsin for digestive complaints, they are made by treating Bismuth Hydroxide with a solution of the alkali acid tartrate, and evaporating. Sodium Bismuthyl Tartrate, Neutral. Syn. Sodium Tartro- bismuthate. Sobita ’ (T.M. 461385). For Injection. Dose.—As for Sodium Potassium Bismuthyl Tartrate posted. Manufacture.--B\fmi\tb. Oxytartrate is first prepared by the method °f.JR; c- Co wley (C.D. i. /13,312). D is3olve Bismuth Subnitrate 70 Gm. in Nitnc Acid (Sp. Gr. 1-42) 5/ Cc. diluted with an equal volume of water, add Sodio-Potassium Tartrate 64-5 Gm. dissolved in a little water, then Sodium Bicarbonate 57 Gm., also in solution. Heat to drive off C02. Filter and thoroughly wash the precipitate of Bismuth Oxytartrate. This gives a product which, when dried, contains only about i% of Bismuth Subnitrate and has a Bismuth content of about 57%, corresponding > the formula BiaO (C4H406)2. The washed precipitate of Bismuth Oxytar- •ate is dissolved in 115 Cc. of 2 N/l NaOH and the solution, after filtration, e find is best run into fifteen times its volume of 95% Alcohol to precipitate le compound. The precipitate is collected and dried at 50° C. We find that the substance so prepared corresponds approximately to the >rmula C4H4Ofi (BiO) Na, but this agreement seems to be only accidental, nee the composition of the product can be altered by varying the strength i Alcohol used for precipitation. Thus it seems probable that the substance [i in reality either more complex, or else a mixture of several compounds, dher workers have arrived at a similar conclusion. R. C. Cowley (loc. cit.) dissolves the Bismuth Oxytartrate in normal Caustic oda, evaporates and scales. On experimenting, we find the Alcohol precipi- ition preferable, since evaporation gives an insoluble product, which only ives a clear solution on the addition of a little more alkali. The compound occurs as a white powder, soluble 1 in 6 parts f water, giving a nearly neutral solution, and containing about 3% of Bismuth. Uses,—As under Sodium Potassium Bismuthyl Tartrate. odium Bismuth Tartrate, Acid. Syn, Bismuth Tartrate Soluble. Dose.—-2 to 5 grains (0T2 to 0-3 Gm.) per os. iVIanufacture,—By either hot or cold digestion of freshly precipi- ited Bismuth Hydroxide with Sodium Acid Tartrate, the solution being then ;aled. In no case could a neutral compound analogous with Tartar Emetic e isolated, the resulting preparation always contains Sodium Acid Tartrate. 'ee also S. Webster Jones and A. J. Jones, P.J. ii./31,76. Colourless scales with acid reaction. Commercial samples xamined contained from 30—45% of Bismuth, and from 15—25% f Sodium Acid Tartrate, calculated from the acidity. Uses,—For digestive complaints, in conjunction with Pepsin, tie acid solution favouring the action of the enzyme with which, we nd, it is compatible in moderate amount, iquor Bismuth! Tartratis. Dose.—\ to 1 drachm (2 to 4 Cc;). Dissolve Bismuth Tartrate Soluble 1040 grains, in water 10 ounces, nd Chloroform 20 minims, in Alcohol 40 minims, mix and make up p 20 ounces.—T. D. Morson and J. Harpham, C.D. ii./i2,947. otassium Bismuthyl Tartrates. These are similar to the corresponding Sodium salts and are pre- ared by similar methods. * Neutral ’ Potassium Bismuthyl Tartrate is a white soluble owder containing about 50% of Bismuth. ‘ Acid ’ Potassium Bismuthyl Tartrate is obtainable in scales ontaining about 38% Bismuth, and acidity equivalent to 10 to 15% f Potassium Acid Tartrate. lodium Potassium Bismuthyl Tartrate. Syn. Sodium Potassium Tartrobismutiiate. This substance occurs almost exclusively in the form of the water oluble, neutral preparation used for injection purposes. Dose.—3 grains (0-2 Gm.) intramuscularly every 3 or 4 days, epeated until a total of 2 to 3 Gm. has been given. (The compound is given in 10% suspension in sterile Oil.) Subsequently a ingle weekly injection of 0-2 to 0-3 Gm. may be given, or the treat- aent may be suspended for a month and started again, if necessary. „„^tfnul^ac*u.r‘®.‘ Commercial samples which we have examined show e ^onsiderable variation m the Bismuth content, ranging from 30 to 60% n/^ss?WlgSBlsm^thOxytartrate in a 2 N/l solution of equimolecular parti of Caustic Soda and Potash with subsequent precipitation with Alcohol a*6 tahdne6 about6 ^O80^/1 SS^^thyJhTar^te> a Preparation is obtained con taming about 50 52% of Bismuth. The above method appears to give substances which are nearly uniform as regards Bismuth content, but as it of th.e corresponding Sodium Bismuthyl Tartrate the products are probably a mixture of complex compounds. A white powder, soluble about 1 in 2 parts of water, giving at neutral solution. Uses.—This is the compound used in syphilis, but the difference, in effect between it and a body without the Potassium is no doubt negligible. Pharmacology.—Sazerac and Levaditi found a dose of 0*01 Gm» per kilo of this body intramuscularly caused disappearance of the treponema from rabbits with experimental syphilis Of the various compounds tried (Bismuth Citrate, Lactate, Subgallate, etc.} it gave the speediest results. Therapeutically, the treponema dis* appeared from a chancre after the second injection, with subsequent healing. In the secondary stage, eruptions or mucous patches clear up quickly. Very favourable results have been obtained in the tertiary stage.—Jl. des Praticiens, Feb. ’22, per Pr. It has been much used both at home and abroad. An extensive investigation into the toleration of animals towards injections of Bismuth m various forms. The soluble Sodium Bismuth Citrate com taming 65-8% Bismuth appeared to be less toxic in rabbits than Tartrate compounds.—C. S. Leonard, Jl. Ph. Exp. Ther., July ’26,89—13C)™™ Note on manufacture of Bismuth Sodium Citrate. Its solution* can be boiled without decomposition.—Jl. Ph. & Exp. Ther., Sept., ’27,353 DC Bismuth intramuscularly, as the metal in Dextrose solution, or Potassium lartrate or Salicylate m oil, Bismuth causes definite and prompt diuresis in human subjects—Jl. A.M.A. ii./28,225. prompt Studies in the pharmacology of Bismuth salts.—C. S. Leonard T1 PW™ and Exp. Therap., Dec. '28,333—364. uam> J1- Bharm. intramuscularly 0-03 Gm. of Bismuth Sodium Tartrate causes diuresis. More effective than insoluble products.-P. J Hanzlfk and cm workers, Jl. A.M.A. i./29,1416. -tianziik and co- Caution. Bismuth preparations, in general, are apt to cause gingivitis and stomatitis. Gingivitis is said to be less frequent with aqueous than with oily solutions. Care must be taken with the mouth. Bismuth medication causes local pain ; avoided by use of suitable nre™™ * t ons and careful technique. Effects on the skin /a1to“£tay occur' depression! ncpllr,t,s have occasionally been reported; also headache and Bismuth should not replace Arsenic in all cases, being specially indicated in cases resistant to, or intolerant of, Arsenic. Emory and Morin Paris Me^ ment22’B m’/p ^ Sb- V Tlf Urine “ b« watcheTjlurtag St" ment. B.M.J.E. 11/22,58. Bismuth compounds contraindicated in heart disease, being liable to induce weakness and irregularity of action.—per Pres Bismuth compounds in general are much less toxic intramuscularlv than intravenously—Raiziss & Severac, Arch. Derm. & Syph Nov"’2s 6m ™ Peripheral polyneuritis following injection of metallic Bismuth preparation Risk of injections of Bismuth preparations when kidneys are M. Critchley, Brit Jl. Ven. Dis., Jan. '26,83, per Pres , Sept '26 330 8 „ ?laTn& c?s,es Zl a'buminuria recorded following Bismuth administration.— t>.M.J .Pi. 1./25,77. ► ALKALI BISMUTHYL TARTRATES. Injections of metallic Bismuth are dangerous—probably true, though to ;ss extent, of Bismuth Oleate. Bismuth Salicylate is also dangerous, and lould be replaced by a more soluble salt, e.g., Potassium Bismuth Tartrate itragluteally once a week. Injection of insoluble Bismuth Salts twice weekly i open to question, as only a small amount is absorbed at most and too fre- uent deposits may lead to cumulative action.—Per Jl. Trop. Med., June 1, {6,161. See also G. A. Masson, Jl. Ph. & Exp. Ther., Dec., ’26,121. Cowley’s compound in 10% suspension in Olive Oil employed. Dose itramuscularly 2 to 3 Cc. Soluble salts are at least 10 times as toxic when Lven intravenously as when given intramuscularly. Liquor Bismuthi et mmon. Cit. B.P. 0*5 or 1 Cc. subcutaneously had no general effect, but on spetition a black line formed on the gums with sometimes a stomatitis. ubcutaneous injections are in general less safe than intramuscular. Intravenous ljection, especially with 2 Cc., gave signs of poisoning, nausea and copious iuresis.—H. B. Day, L. ii./22,328. Bismuth Sodium Tartrate and Bismuth Potassium Tartrate given in oil. ntramuscular injections to be given, not hypodermic or intravenous. Dose ■2 Gm. every other day or 0-3 Gm. every three days. Total dose 1 to 1£ Gm. tomatitis seen, but milder than Mercurial.—Sazerac and Levaditi, B.M.J.E. 122,9. See also B.M.J. i./22,443. The Bismuth is widely distributed and rapidly eliminated. The Wassermann Reaction is changed.—L. i./23,39. Y vws in Kenya Colony well treated.—R. Howard, T. Roy. S. Trop. Med., tar. ’23,437 —C. R. Steel, Jl. Trop. Med., Nov. 1/27,274. There is a difti- jjty in determining whether a case should be diagnosed as syphilis or yaws, le administration of Mercury will often clear up the doubt, as Mercury has lo influence on yaws.—A. Castellani. Bismuth Oxides must be used with caution. May produce abscesses. A [iismuth course may consist of (a) a soluble compound in small repeated loses, (b) precipitated Bismuth metal in aqueous suspension, for rapid results, k) inorganic insoluble compounds, chiefly Iodoquinates for prolonged and onic treatment.—R. Barthelemy, Urol. & Cut. Rev., May, *26,310. Tartro-bismuthate of Sodium and Potassium too painful for general use. Iismuth slow in healing active signs of disease in comparison with Arsenic, iismuth therapy superior to Mercury for primary, secondary and tertiary bsions of syphilis, when either is combined with Arsenobenzol.—Maj. A. 1. frost, Med. Soc. for Study of Yen. Dis., L. i./24,901. ‘Bismutol’ Sterules contain 3 grains (0-2 Gm.) of Sodium ^otassium Bismuthyl Tartrate in 2 Cc. (30^minims) of sterile )il. For use intramuscularly. A Sodium Potassium Tartrobismuthate containing approximately >0% Bismuth and giving a neutral aqueous solution. Alternatively 1 Cc. doses of 10% aqueous solution may be employed every ; or 3 days—the course being 10 to 20 injections. Cataract has been treated by injections of Bismutol. Epileptic maniacs and allied sufferers in the Tanganyika Territory were ound to benefit from Sodium Potassium Bismuth Tartrate. J. G. McJN aughton, une 16, ’29. .elapsing Fever. . . , . . Sodium Potassium Bismuth Tartrate brings f.eyer down. Given mtra* mscularly—for an adult, 2 injections of 0-2 Gm. m 2 Cc. Mater, for a child f 2 to 10 years 2 injections each of 0T Gm. For a baby under 2 years, 1 ljection of 0T Gm.—J. Todd, B.M.J. i./3o,312. [Yepol is stated to be a preparation of similar composition. Trepol is essentially basic Bismuth Carbonate and not Sodium_Potassmm Iismuth Tartrate, as stated. Neotrepol—the dose of metallic B s h ifferent ampoules was inexact. Neither compounds admitted to A.JS.Jx. BP *26 223 Said to cause rapid disappearance of the spirochsetes in syphilitic chancres nd healing of lesions in 6 to 20 days.—L. i./22,1001. Good effects from intragluteal injections twice weekly of x to 2 Cc. of the 0% emulsion.—B.M.J.E. ii./22,73. Psoriasis successfully treated by intramuscular injections. Complete retrogression of lesions in 12 and partial retrogression in 9, out of 21 cases. No local treatment.—L. ii./26,559. £lsm"th Tartrate, Bi2(C4H406)36H20 = 970-1872. Mix; 70 Gm. Bismuth Oxynitrate and 55 Gm. of Tartaric Acid with 60 Cc. of Water, allow to stand until small portion soluble in Ammonia. Wash three tunes by decantation with 400 Cc. 0-375% Tartaric Acid solution. Filter and dry.—S. G. Stevenson, Qtrly. Jl. Ph., 2, ’31,178 HJBismuthi Arsanilas, BiO.O.AsO(OH).C6H4.NH2==440-9926. A white powder containing 53% approx. Bismuth, calculated as Bi203 and 17% Arsenic. The writer has prepared this compound for use in yaws and syphilis, by interaction between Bismuth Sodium Tartrate and Arsamin. It is best given in the following fresh precipitated and washed form : IP U Bismuth Arsanilate Suspension 1 grain (o*06 Gm.) in 15 to 3 Cc., for grown-up minims (l Cc.). Dose.—Intramuscularly for adults 2 children 1 Cc., for young infants 0*5 Cc. An injection consisting of 3 grains Bismuth Sodium Tartrate and 2 grains boamm, m 1 Cc. water, given every 2nd day, almost invariably cleared up yaws m 6 days, and 75% of 538 cases of tertiary or congenital syphilis wer* completely healed in 12 days.—J. O. Shircore, L. ii./2 6,43. 300,000 cases of yaws treated with Bismuth since 1922. The Soamin and Bismuth Sodium Tartrate preparation costs less than a penny per dose.— J. O. Shircore, L. ii./a6,43. Routine treatment for yaws in Kenya Colony— m two districts alone over 36,000 cases treated during 1923. Dose 3 grains intramuscularly in 2 Cc. Distilled Water: smaller dose for children Enormous saving compared with Novarsenobenzol.—A. B. Paterson, Int. Conf Trop. Am., ’24,584. Stovarsol com/pound of Bismuth, see Stovarsol. Quinine Xodo-Bismuthate, Fr. Cx. Nouv. Supp. (1926), P. Bek. IV. F.E. VIII. & » (BiI3)2C20H24N2O2-2HI= 1759-6748. Method of preparation is given in all the above works. Suspension DTodobismutiiate de Quinine, Fr. Cx. Supp. (1926). Sterilise the pestle and mortar by burning a little spirit in the latter, and incorporate Quinine Iodobismuthate, 17 Cm., with Anhydrous Wool Fat 5 Gm., and Neutral Olive Oil 87 Gm., making up to 100 Cc. Quinine Iodobismuthate Sterules are prepared containing 1 Cc., t.e., 0-17 Gm., corresponding to 0-04 Gm., Bismuth. The dose has also been prepared in 2 and in 4 Cc. Jodo-bismuthate of Quinine gave good results in some cases apparently drug-fast to Arsenic and Mercury.—Col. E. T. Burke, L. i./24,902. Good results confirmed.—Margaret Rorke, ibid. * Bi-Quinyl (T.M. 440714). Is also a double Iodide of Quinine and Bismuth. Dose.—Each ampoule contains 0-3 Gm. of the compound in 3 Cc. of oil. Adult dose, one ampoule every 3 days up to 15 or 20 injections. This constitutes a course of treatment, to be repeated after intervals of 10 days. The combination of Quinine and Iodine with the Bismuth is thought to enhance the spirillocide action, especially in all stages of syphilitic infection. Spirobismol (T.M. 490555). Syn. Tartro-Quiniobine is a similar combination. Oil-soluble Bismuth Salts from, e.g. DlPROPYL-CARBlNYL Malonic ESTER and Bismuth-Nitrate subject of Patent 356,550.—P.J. ii./3i,509. BROMUM. Br=79-916. A dark brown liquid, Sp. Gr. 2*99, with penetrating odour. Soluble in 30 of water. Is not used as such medicinally. Since the war romine has been made in large quantities in France from sea water. Imperial Bromine made from the Dead Sea has recently come on the market. AlcohoMnhalathm is good, see also Chlorine and Irritant Gases under ntidotes. . romine Sterules for urea estimation, 1, 2-2 and 4 Cc. and Liquor Bromi, vide Vol. II. alcii Bromidum. U.S. CaBr2=199-912. Dose.—10 to 20 grains (0-6 to 1-2 Gm.). A white crystalline powder soluble 1 in 0-3 of water and about J 10-6 of alcohol 90%. , Fr Cx Nouv. Supp. (1926), allows 20 to 25% of water. This salt is ob- lined by solidification of the molten mass in its water of crystallization. Flavoring.-Syl or Glyl Menthse Pipentse, Syl Limoms (bold lose), Syrupus Aromaticus. . Epilepsy treated with good results. Frequency and int iminished—effective in half the dose of Potassium Bromide. Mental activity iicreases6 and general health improves. Effect marked i patient previous j n Potassium Bromide.—A. Humphrey Davy, B.M.J. u-/j5,692. A. G. Auia joints out the relative content of Bromine m the two salts. Tbe effect ib levertheless, in his opinion, due to the Calcium .—ibid. p. 7G5 , see also 101a. ^A^thma hay fever, and anaphylactic shock treated with Calcium ^rornide intravenously; also infections such as typhus. Prevents post- Operative bleeding in obstructive jaundice, j^u >*6 5. (rally in tetany following excision of goitre.—Jl. Intrav. lhcrap., Jan., 20,„. VEagnesii Bromidum, MgBr2+6H20=292-2456. Dose.—10 to 20 grains (0-6 to 1-2 Gm.). Contains 54-9% of Bromine. Given in hysteria and epilepsy as a nervine sedative. Soluble 1 in 0-6 of water and 1 m 2 of alcohol 90 /0. MEanganesii Bromidum, MnBr2+4H20==286*8244. Dose.—1 to 3 grains (0 06 to 0-2 Gm.). . T . Contains 55-7% of Bromine, and is given as a nervine tonic. It is soluble 1 in less than 1 of water and alcohol. Botn of these m y contain less water of crystallisation. Bromal Hydras, CBr3.C0H.H20=298-/714. ^Dose.—2 to 5 grains^O-12 to 0-3 Gm.) at bedtime. ' In large colourless crystals, which melt on the hand solluhie m water 1 in 2h Applied externally it irritates the skin. It has been tried in epilepsy, chorea and insomnia. Brominoleum, Brominol (33%).—Martindale. . -ii Dose.—10 to 60 grains (0-6 to 4-0 Gm.) approximately equivalent in content of Bromine to 5 to 30 grains Potassium Br0I“,dc; i i An additive compound of Bromine and Sesame Oil, containing 331% of the halogen in form of a thick brown odourle-. , c p 1-31. Gradually liberates Bromine to the system. rrse^_In epilepsy and all forms of nerve troubles also m headache an! sea sickness! May also be rubbed into the skm ,f diluted with an equal weight of Lanolin Ointment. It may be taken internally shaken up with an equal volume of syrup, in beer, wine or milk, or dispensed as follows : Brominol 33°/ 2 ounees Gum Acacia 1 ounce, Chloroform 18 drops, rub together and add quickly with vigorous agitation Water q.s. to 6 ounces. Dose.— 2 drachms equal 20 grains Potassium Bromide. Brominol containing 10% of Bromine is also prepared. A dose of J ounce of this equals approximately 20 grains of Potassium Bromide. Sp. Gr. 1-045. Capsules contain 2 Gm. of 33% Brominol in each, equivalent to 15 grains (1 Gm.) Potassium Bromide. C1D Mistura Brominol cum Nuce Vomica. Brominol 30 grains, iiim Acacia 30 grains, Tincture of Nux Vomica 6 minims, Spirit of ^ L°r0f0rm ^ minims, Water to 4 an ounce. For one average dose. HfioolfUune f-r0IP PatieA1.t3 under Brominol treatment contains small quantities of Bromine m combination, and the faeces contain traces_W H M Brominol Tablets are prepared, each equivalent to 9 grains of Potassium Bromide. Brom-Albumen. Syn. Bromo-Protetn. Dose—10 grains (0-6 Gm.) = | grain Bromine approx.—increased as desired. Contains 7% Bromine, combined with albumen, made by interaction of Bromine with Egg Albumen, in form of a light brown powder. s a substitute for Alkaline Bromides in epilepsv, where larger doses than the above may be required. It is hardly soluble in 0-2% Hydrochloric Acid even in presence of Pepsin,‘but is readily dissolved m 0-5 /o Sodium Bicarbonate in the presence of Pancreatin hence absorption takes place in the intestines. Bromoform, P. Helv., Fr. Cx., P. xtal. V., ph. Ned. V., P Belg IV F.E. VIII. CHBr3=252-7558. g* ’ Dose. J to 2 minims (0 03 to 0-12 Cc.) or more. P.G.VI. and Fr, Cx. maximum single dose 0-5 Gm. ; max. during 24 hours U Gm. ( = 8 minims approx.). Children as many drops as years old—up to 6. A limpid, colourless, sweet liquid, with an agreeable odour : So. Gr. ^829 to 2-833, B.pt. 148° C. Soluble in alcohol 90% in all propor- t ions, slightly in water, decomposed by light. It should be preserved by addition of 0-5 to 1% alcohol. Is a powerful sedative, useful in insane cases. Capsules contain J minim (0 03 Cc.) dissolved in oil. Aqua Bromoformi. A Veil shaken, 1 minim is dissolved in 2 ounces of water. Dose.—1 to 4 ounces (30 to 120 Cc.k For sea-sickness half doses occasionally. Syrupus Bromoformi. Dose.—J to 1 ounce (8 to 30 Cc.) = i to 2,minims of Bromoform. To be diluted with an equal quantity of water or more, at time of taking. J 2 minims, Alcohol 90%, 80 minims, Syrup 160 minims f^yce^n^ ounce..; ano/ o ^ri°P °f ^ Cx’ _^ouv* Supp. 26, is Bromoform 1, Alcohol svruP 16o. boftdfrrlt cough diminishes number, duration, and ge verity of attacks, and mupQtMJ secretion is more easily got. rid of. * > BROMUM. 241 jp 1; sJcRami (T.M. 245697) Syrup. Dose..—Adult, 1 tablespoonful to 5 times a day : Children over 5, 1 teaspoonful 3 to 5 times daily, hildren under 5, 15 minims diluted, every hour or 4 hour according ) age. Contains ‘ per (tablespoon) dose,’ Aleoolature d’Aconit 3 rops, Codeine 0*01 Gm., Rromoform 2 drops, Tolu 0-05 Gm. yrupus Bromoformi Compositus. P.Ital.V. 20 Gm. contain 0-02 Gm. Bromoform, 0-01 Gm. Codeine, and 0-04 Gm. conite Tincture. Is similar to the last mentioned. (Tincture of Aconite . Ital. is 0-05% Alkaloids and hence approx. B.P.) rometone. Tri-brom-tertiary Butyl Alcohol. C4H7OBr3=310-8026. Dose.—5 grains (0-3 Gm.), repeated 2 or 3 mes during 24 hours. White crystals melting at 167° C. containing about 77% Bromine. oluble in alcohol, slightly in cold water. Uses.—Hypnotic, analgesic, antiseptic. Useful in sea-sickness Capsules of Brometone, 5 grains in each. In epilepsy, in some cases, of value and has some hypnotic power. Large doses may produce dizziness, loss of appetite, and mental paviness.—Hs Averiin. Syn. Tribromethylalcohol or E.107. CBr3CH2OH — 32-7714. A new anaesthetic, stated to have been first made by reduction l Bromal (1926). It is the subject of German Patent 437,160. /hite crystals containing 85% Bromine. Soluble 3 in 100 of water at 37° C., also 1 Gm. in 1 Cc. of mylene Hydrate, in which form it is issued (‘ Averatin Fluid ’) : lis is miscible with water. Solutions must be made without heat. Dose.—0-1 Gm. per kilo is safest, but for exhausted patients hose Glycogen reserves are diminished and powers of detoxicating Ivertin are impaired, 0-08 Gm. Maximum dose, apart from weight, ) Gm. The solution is administered in 2-5 to 3% aqueous solution jr rectum (by gravity). It is non-irritant to the mucosa. Surgical isesthesia can be superimposed. Reaction of the solution must be determined by adding 2 drops of in 1,000 solution of Congo Bed to 5 Cc. of Avertin solution. The -ange colour should be unchanged. No great change occurs in the patient for 10 to 15 minutes after le dose. Respiration then becomes slow and shallow, and slight muosis may be noticed. Another anaesthetic may be required in Idition.—F. B.Parsons, B.M.J. ii./30,554. The use of this preparation, especially as a Basal Hypnotic, is been much discussed. The following remarks are in approxi- ately chronological order. Deferences. Early Refs.—L. h/27,1037,1267. . „ ... Now made synthetically. In only 40 to 50% of cases is full anaesthesia isured by its use alone. Liquid diet only to be given the night before opera- on. Narcosis lasts 2 to 4 hours. Of value in operations on .horax and oper respiratory tract and in cranial surgery. B.M.J.E. i./2o,d. As rectal anaesthetic used 100,000 times in Germany, but its advantages ■e not yet finally determined on a basis of security. —L. 11./2»,1141, Used safely. ,T. Blomfield and F. E, Shipway, L. i./29,o4(). Non-recovery from Avertin.—L. i./2gs1365. Induction of anaesthesia gradual. Only a small quantity of inhalation anaesthesia wanted to complete.—G. Edwards, L. ii./29,826. For reduction of fractures, in combination with local anaesthesia it is ideal. —B. Hughes, B.M.J. i./29,898.—L. ii./29,1220. Used 2b years in combination with other drugs, themselves not anaesthetics but rather amnesics, with big fall in mortality rate.—B. Hughes, B.M.J. ii./3o,887. A review of literature.—Pres., Apl., ’29,139. Discussion.—L. ii./29,978. Decomposition products formed by the action of heat (over 50° C.), light, and air are irritant to the rectal mucosa. In anaesthetic doses it has no effect on the cardio-vascular system, but in larger doses it slows the rate and weakens the force of the heart-beat—coronary vessels dilate and blood pressure falls. Toxic doses cause death by respiratory paralysis. It is excreted in the urine over a period of several days—more than 50% in the first 24 hours.—F. B. Parsons, B.M.J. ii./29,712. See also G. Edwards, ibid. 713. In Childbirth advocated for safety, ease of administration, and mitigation of pain. It is given at second stage pains after Morphine £ grain at first (sometimes a further 1/6 grain). There must be 2 hours' interval between Morphine and Avertin. Should be given when the cervix is fully half dilated, if the contractions are strong and regular. Some excitement may follow for 5 minutes. Dose.—0-075 Cc. Avertin Fluid per kilo weight, e.g., 4-5 Cc. for a person of 9 stone (60 kilos), given per rectum in 1,000 Cc. warm water—milk has been used in preference.—Prof. Martin. The method eases pains of labour.—J. S. M. Connell, L. ii./3o,184. intravenous Use.—B.M.J. ii./3o,527. See also L. i./27,1037. Given under the guise of an f enema ’—4-5 Cc. in 188 Cc. of water. In 10 minutes patient was snoring and an abdominal operation conducted— short circuit of intestine. During operation 2b drachms of Chloroform-Ether given, to facilitate closing of the peritoneum.—J. Blomfield, L. ii./3o,689. Where there is serious pulmonary disease, Avertin advised : in combination with local anaesthetic or gas and Oxygen it is said to be ideal.—Sir F. E. Shipway, B.M.J. ii. 30,663. Being superseded by Sodium Amytal.—F. B. Parsons, B.M.J. ii./3o,756. See also Sir F. E. Shipway, ibid. 799. Breathing with difficulty and some cyanosis.—E. J. Chambers, B.M.J. i./31, 35. As a basal hypnotic, per rectum, 0-1 Gm. per kilo in 2-5% solution.—I. W. Magill, L. i./3i,353. Preferable to Paraldehyde, especially for children.— Sir F. E. Shipway, ibid. 354. Valuable in ear, nose, and throat operations. —Sir J. Dundas-Grant, ibid. Gynaecology—1,000 operations without deleterious effects. Safe in doses not exceeding 0-1 Gm. per kilo.—J. Young, L. i./3o,1177 ; B.M.J. ii./31,1028. Contraindicated in renal disease—no adequate margin of safety between surgical anaesthesia and death.—J. R. Veal and Co-workers, Jl. Phaim. & Exp. Therap., Dec. ’31,643. For a r&sumb on Organic Bromine Compounds with comparison of the quantity of Bromine in daily doses vide Vol. II. BUTYL-CHLORAL HYDRAS. Syn. Trichlorbutylidene Glycol. (B.P. ’14.) Croton- Chloral Hydrate (formerly so-called), CH3.CHC1.CC12,CH(0H)2== 193*4256. Dose.—5 to 20 grains (0-3 to 1*2 Gm.), in pills or cachets. This body is produced by the addition of water to liquid Butyl Chloral which is the final product of the action of Chlorine on Aldehyde. In pearly-white crystalline scales with pungent odour resembling that of Chloral Hydrate, and an acrid, nauseous taste. Soluble 1 in 43 of cold water; freely in alcohol, 1 in 1 of Glycerin, and Olive Oil 1 in 20. Incompatible with alcohol. Butyl-Chloral Alcoholate will be urmed, and in case of some mixtures will be precipitated. Menthol 2, with Butyl Chloral Hydrate 1 part, liquefy. Combines also with Phenazone, q.v. Flavoring.—Syl Menthse Piperitse ; Extractum Glycyrrhizse Biquidum, Syrupus Zingiberis. Uses.—In combination with Phenazone, Cannabis, or Gelsemium, Butyl-Chloral is useful in migraine ; neuralgia of nerves other than :he cranial are rarely benefited. Antidotes.—Stomach tube, emetic, Coffee, Caffeine, Atropine. Uistura Butyl-Chloral. Butyl-Chloral Hydrate 4 grains, Glycerin 15 minims, Water to 1 !)unce. Vilula Butyl-Chloral. 3 grains (0-2 Gm.) or more* : Dose.—1 every 2 hours, or hourly. Ip)PiiulaButyl-Chloral cum Gelseminina.—Neuralgic Ptlls. Gelseminine Hydrochloride grain (0-0003 Gm.) is added to :acli of the above. Cp) Tablets are also prepared. For facial neuralgia two at the outset followed by one hourly until nix have been taken. Ip) Piiula Butyl-CM oral cum Camphora et Gelsemio. Butyl Chloral Hydrate 2 grains, Camphor 1 grain, Alcoholic Extract of Gelsemium £ grain, Powdered Acacia Gum £ grain, Powdered [Tagacanth J grain, Powdered Liquorice Root I grain, Syrup q.s. Varnish. Use similar to the last mentioned. /hlorbutoi. Syn. Chloretone; Acetone-Chloroform, P. Ital. V., F. E. VIII., P. Belg. IV. Trichlor-Tertiary-Butyl-Alcohol. CC13.(CH3)2C.0H= 177-4256. Dose.—5 to 24 grains (0-3 to 1*5 Gm.) in cachet, capsule, or tablet ollowed by a draught of water or milk, or suspended in a mixture. Manufacture.—This compound was discovered by Willgerodt in 1886, lee Bev. 20 (1887), 2455. It is prepared by adding Potash to a mixture of Chloroform and Acetone, and fractionally distilling. White crystals, with camphoraceous taste, melting at 80° C. It volatilises with heat. Soluble 1 in 200 of water (solutions should >6 made as required. This solubility was confirmed by Gordon Trrins.—-P.J. i./32,265). It is correct.—W. H.M., July, ’32. 1 in 10 Ilycerin, 3 in 2 Alcohol 90%, 1 in 50 Liquid Paraffin, 1 in 12 Olive Oil. Uses.-—Local anaesthetic and antiseptic and slightly hypnotic, ^cts particularly on the stomach. Solutions in Liquid Paraffin 1 o 2% have been used for inflammation of the middle ear. Vaginal pruritus has been treated with a warm douche 0-4%. For piles, 5 grains in a 30 grain suppository ; for a dusting powder or wounds and scalds use Chloretone 23, with Zinc Oxide 120, and Tench Chalk 90 parts. 10% may be added to Linimentum Calc is or burns. Chloretone Inhalant.—Contains Chloretone 1%, Camphor, Men- hol and Oil of Cinnamon in Liquid Paraffin for use in rhinitis, •ronchifis, nasal catarrh and ‘ sore throats.’ Solutio Chloretonae Composita Inhalans. Syn. S0LUCI0N DE Clore- TONA COMPUESTA INHALANTE, F.E. VIII. Chloretone 1 tGm., Camphor 2-5 Gm., Menthol 2-5 Gm., Cinnamon Oil 0-5 Gm., Liquid Paraffin 93-5 Gm. Capsules, 5 grains, check sea-sickness and other vomiting and are useful in chorea. Post-operative vomiting and shock prevented. Value proved by 15 grains in a cachet where time permitted, to every adult operated on 1£ hours beforehand. Tetanus successfully treated by Chloretone in dose varying between 30 and 120 grains per rectum in Olive Oil, and Antitetanic Serum. The Chloretone injections reduced rigidity of the jaw.—B.M.J. ii./io,1402. Sea-sickness. Should be given either in solution or limited to 10 grains daily with intermissions when extended over several days. Satisfactory when given in Oil or Paraffin or in Cachet when taken with moderation.—L. i./13,1375. Semi-coma in a woman who took 30 grains for toothache has been observed. A useful drug, but its action requires careful supervision. The explanation of toxic effect is, that there is accumulation of the insoluble drug in the alimentary canal followed by sudden absorption of large quantities when any substance capable of absorbing it is taken by the mouth.—L. i./i3,1557. Dysmenorrhgea well treated with Chloretone 5 grains two or three times daily for week before period.—B.M.J.E. i./26,13. Nervous vomiting and vomiting due to pertussis. Effective dose 0-05 Gm. Drowsiness which may develop after 8 or 10 days’ medication counteracted by adding 0 015 Gm. Caffeine.—P. Freud, Jl. A.M.A. ii./29,1181. Sea-sickness, whooping-cough, conjunctivitis, and hay fever. In the latter, inhaled as a spray from an atomiser, the solution immediately allays symptoms, the effect lasting many hours. Occasional repetition will carry the patient through distress in early summer. As an anti-spasmodic in acute gastric flatulence, dysmenorrhcea, hiccough, or the pain of shingles.—W. E. Wynter, L. ii./29,1245. Mothers ill’s Remedy (T.M. 368055) and J^Zotos (T.M. 304157) contain it—c/. Proprietary Remedies, Vol. II. Poisoning by Mothersill’s Remedy : also stated to contain Scopolamine !— B.M.J. i./3o,739. (We doubt it.) CAFFEINA. Caffeine {B.P.'U). P.G. VI., Ph. Ned. V., Fr. Cx., P. Jap., P. Ital, F.E. VIII., P. Belg. IV. Syn. Theine. Guaranine. C.H l0N*O H 20 = 212 • 1256. Dose.—-1 to 5 grains (0 06 to 0-3 Gm.) or more—as much as 18 grains being recommended—given in solution, or in pills. A crystalline alkaloid (M. pt. about 235 to 237° C.), usually obtained from the dried leaves of Camellia Thea, or dried coffee-seeds— Coffea arabica ; also contained in Guarana {q.v.) and in Mate— the leaves of Ilex paraguayensis—also kola nuts—the seeds of Cola acuminata, growing in Western Africa ; it is identical with Theine and Guaranine. Caffeine and Theobromine {q.v.) can be prepared from Xanthine j5 GO (Theobromine being di- and Caffeine tri-methyl- xanthine). These are Purin derivatives {q.v. Vol. II.). Soluble, 1 in 80 of water, about 1 in 40 in alcohol, less in Ether ; acids render it more soluble in water, but it is a feeble base, and on concentrating the solution of the salts they are apt to split up, and the caffeine crystallises out by itself. Is rendered soluble in less water by the addition of an equal quantity of Phena- zone. See also Caffeine-Sodio-Salicylate, etc. Regarding th caffein in coffee and tea taken as a beverage, see Vol. II. An tic$Qi<os.—-Stomach-pump and emetics, e.g. Apomorphine W (rain. Nitroglycerin is also of value. Poisoning by 60 grains of iitrate caused burning in throat, giddiness, violent vomiting, purging ind diuresis, tremors of extremities, pain in stomach and bowels, tnd great thirst. Uses, In heart affections {e.g., cardiac failure in pneumonia), )ut its power as a cardiac stimulant is doubted, nervous headache, Iropsy (of value in renal dropsy), stomachic (lessens metabolism), t wards off fatigue. Also given in diarrhoea. Subcutaneously in heumatic affections with Sodium Salicylate, q.v. Locally, to the eve, t dilates the pupil. Bronchial asthma of adults is relieved by 2 to o grain doses of he Citrate before bedtime and again during the night.—Yeo. Neuralgic Powders. Caffeine 1 grain, Quinine Hydrochloride 5 ;rains. Phenazone 10 grains (or Phenacetin 5 grains). Chlorosis.—Caffeine in conjunction with Digitalis should be used. Mag- lesium Sulphate is useful for the bowels, and Zinc Sulphate has been tried by mesis. Intake of liquids must be limited, and as little salt must be taken s possible—B.M.J. ii./o9,1668. For Estimation of Caffeine in presence of Acetanilide, see Vol. II. \ Elixir Caffeinse—Martindale. Dose — 1 to 2 drachms ( = 1 to 2 grains of Caffeine). Caffeine 17-5, Minted Hydrobromic Acid 4, Simple Elixir (B.P.C. 1894) to 1,000. p) Elixir Antineuralgicum. {Not within D.D.A.). Dose.—1 to 2 drachms (4 to 8 Cc.). Phenazone 50, Caffeine 30, Cocaine Hydrochloride 1, Cochineal hneture 6, Elixir of Orange 25, Alcohol (75%) to 1,100. Has been sed on the Continent for headache.—Ph. Notes. aifeinae Citras. C8H10N4O2.C3H4(OH)(COOH)3=376-1724. Caffeina Citrata {B.P. ’14), U.S. (No formula; 48—52% Anhydrous Caffeine.) F.E. VIII. (50% approx.). Dose.—2 to 10 grains (0'12 to 0*6 Gm.). Combine Caffeine 1 and Citric Acid 1 in a small quantity of dis- illed water and evaporate to dryness on a water bath. Soluble—1 in 32 Water, 1 in 25 Alcohol (90%). Incompatible with Potassium Iodide and SpiritusLEtheris [itrosi, Iodine being liberated. But the following according to our xperiments does not darken —Potassium Iodide 5 grains, Caffeine ase 2\ grains, Spiritus MEtheris Nitrosi (neutralised with Ammonium arbonate) 30 minims, Water to 1 ounce. Also incompatible with Sodium Salicylate. A little Sal Volatile or odium Hydroxide will prevent the Salicylic Acid being thrown out -or use half the Citrate as Caffeine Base. Flavoring—Glyl or Syl Vanillae, Glyl or Syl Lavandulae; yrupus Aurantii Eloris. Uses,—See Caffeine. affeinae Citras Effervescens. (B.P.’14). Contains 4% of the Citrate* or about 2\ grains in a drachm, as in B.P.’98. Dose.—1 to 2 drachms* Effervescent Caffeine Citrate with Potassium Bromide, has in addition 5 grains of the latter salt to the drachm. For headache. Tabellae Caffeinae Citratis, containing 1 grain in chocolate basis, are agreeable to the taste. Tablets, contain 2 grains (0*12 Gm.). Tablets of Caffeine 1 grain (0*06 Gm.), with Phenazone 3 grains also prepared with Phenacetin 4 grains. Dose.—1 to 5. Caffeine Hydrobromide, C8H10N4O2, HBr, 2H20 = 311-065. Soluble 1 in 50 approx., the Hydrochloride C8H10N4O2, HC1 2H20=266-614 and the Hydriodide (unstable) are in use. Dose of each.—\ to 5 grains (0*03 to 0*3 Gm.) or more. In transparent crystals. Tablets contain 2 grains each of the Hydrobromide. Effervescent Caffeine Hydrobromide is prepared containing 4%, or about 2\ grains in a drachm. Dose.—-1 to 2 drachms (4 to 8 Gm.). Caffeinae Salicylas. C8H10N4O2.C6H4OH.COOH = 332T568. Dose.—1 to 5 grains (0 06 to 0-3 Gm.). White crystalline powder soluble in water. Caffeine is very soluble in aqueous solutions of Benzoate, Cinna- mate, and Salicylate of Sodium. These dissolve it in chemically equivalent quantities, Caffeinae Sodio-Salicylas. Dose.—1 to 4 grains (0-06 to 0*25 Gm.) hypodermically, or per os. Max. single dose per os, 1 Gm. or in 24 hours, 3 Gm. Evaporate to dryness Caffeine 50, Sodium Salicylate 60, Water 200. A white amorphous powder, containing 43-8% of Caffeine, and soluble 1 in 2 of water. This salt and the corresponding cinnamate and benzoate act like Digitalis, but more rapidly. Caffeinae Sodio-Benzoas. P. Jap. IV., P.G. VI., U.S. X., P. Belg. IV., P. I tab V. Dose.—As for the Sodio-Salicylate. Contains approx. 40% CaB feine. Ph. Ned. V. require 50%. P. Ital. V. must yield 43 to 46% Anhydrous Caffeine. Soluble 1 in 2 of water, 1 in 40 of Alcohol 90%. As stimulant for desperately ill patients 2 grain doses, intravenously. It improves breathing, circulation and other fundamental functions, and, following its use, the mind and depressed vital reflexes become active and normal. Coma, shock, collapse under anaesthesia, and poisoning from Morphine and other depressant drugs treated. W. W. Duke, J.A.M.A., April 7th, 1923,998 ; see also P.J. i./23,403. Sterules, Intravenous, of Caffeine Sodio-Benzoate. 2 grains (0-12 Gm.) in 15 minims (1 Cc.) and in 75 minims (5 Cc.) are prepared. HnMOGLOFiNURiC fever well treated with Caffeine Sodio-benzoate intramuscularly, 3 grains twice daily for 7 days and once daily for further 5 days.— A. A. Facio and M. D. Rojas, Jl. Trop. Med., Feb. 16, ’25,88. Shock.—For use in the event of severe Novocain reaction. Caffeine 3 grains Sodium Benzoate 7 grains, Strychnine grain.—C. Hope Carlton, B.M.J. i*/25,651. Xnjectio Caffe inae Hypodermica. K. C. H. Caffeine 20 grains, Sodium Salicylate 17J grains, Distilled Water to 1 drachm. Dose.—1 to 6 minims, contains 1 grain in 3 minims. Unirritating—recommended for alcoholic and morphine intoxication, also for hemicrania and in rheumatism. The addition of Camphor as preservative for this injection is suggested. Thus to 3 Cc. of pure sterile glycerin add a solution of Caffeine and Sodium Salicylate of each 0-25 Gm. in water 1 Cc.; then add Spirit of Camphor (10%) 1 Cc.; 5 Cc. contain Caffeine 0-25 Gm. and Camphor 0-1 Gm. Hypodermic Tablets contain Caffeine Sodio-Salicylate \ grain (0*03 Gm.). Sterules Hypodermic 1 grain (0*06 Gm.) and 2 grains (0*12 Gm.). Iritis of rheumatic origin has been treated by injection into the median cephalic vein of Caffeine 0-05 Gm. with Sodium Salicylate 0-5 Gm. Caffeine Tri-iodidum, Caffeine Di-iodo-hydriodide. {Sometimes called Caffeine Periodide—but it is not a * true ’ periodide.) C8Hi0N4O2HI, I2-flJH20 = 602*9352. Dose.—2 to 4 grains (0*12 to 0*25 Gm.). In prismatic black iridescent crystals, rich in iodine. Has been used with success in rheumatism and gout. —The two loosely combined Iodine atoms can be estimated by titration with standard thiosulphate solution and should equal about 43%. The total Iodine is 63% approx. FH Pilula Caffeinse Tri-Iodidi Composita (Billimoria). Dose.—One early in the morning, one about 3 or 4 p.m., and one at bedtime with water, to be lessened to two or one a day as required. Caffeine Tri-iodide 2 grains, Arsamin J to 1/3 grain, Valerianic Acid 2 minims, Green Extract of Belladonna 1/6 to 1/3 grain, Jalap Extract, q.s. (if constipated). Reduced Iron 1 grain (in asthma only). For one pill or preferably Gelatin Capsule. Asthma in India has been well treated with this compound. R. B. Billimoria (Bombay) states the majority of the cases there have not the usual book type ‘ attacks,5 but dyspncea every night for days and days, while during the day the patient may be fairly comfortable or again the dyspnoea may be slight or worse. Whooping cough even in infants, with proportionately smaller doses, has likewise been well treated by this preparation. jfcEupnine Vernade (T.M. 452489). Dose.—1 drachm before meals up to 4 drachms daily. Contains Caffeine and Iodine. In asthma, emphysema, and arteriosclerosis. In asthma it is useful, also Morphine I grain, especially if it induces sickness.—J. Pirie, B.M.J. ii./25,1039. Caffeinae Valerianas, C8H10N4O2.C5H10O2==296-188, Dose.—\ to 3 grains (0*03 to 0*2 Gm.). In irregular crystals or powder, of somewhat variable constitution. It controls hysterical symptoms, and is useful in pertussis. <£> Caffeine-Chloral. Small white granular crystals, freely soluble in water, with the taste of Chloral. Is analgesic and laxative, and in hypodermic injections of 3 to 8 grains useful in constipation, painful gastric distension, sciatica, and rheumatism. Iodo-Caffeine.—Syn. Sodium-Caffeine Iodide. Dose.—2 to 10 grains (012 to 0*6 Gm.). , A white pP^d«r’- 8li8htiy soluble in cold, freely in water at 100° F. Con- tams o5 /0 of Caffeine. Is a good diuretic, especially to prolong the diastole a cases of enfeebled heart. Is useful in cardiac dropsy, and pleurisy with effusion. Said not to disorder digestion. Antipyrin Caffeino-citricum.—Syn. *Migrainine (T.M. 73257), P. Austr., P. Jap. IV., p. Helv., and Ph. Ned. V. Dose.—8 to 15 grains (0*5 to 1 Gm.). Slipule No. 00 holds 8 grains. Contains 9% of Caffeine, 1% Citric Acid, and 90% of Phenazone, is of crystalline appearance, easily soluble in water. Incompatibles as Phenazone q.v. Is serviceable in headache, but apt to cause sleeplessness. Migralgin. Jblavtindale. Dose.—8 to 15 grains (0'5 to 1 Gm.). Phenazone 88, Caffeine 9, Salicylic Acid 3: the ingredients are fused together. Tablets 8 and 15 grains each. Slipule No. 00 holds 8 grains. Headache is well treated with this combination. Oxyquinotheine Cachets—Dr. Faivre’s. According to analysis by C. Mannich and L. Schewedes in a German Journal these are said each to contain Caffeine 0*3 Gm., Pyramidon 0-15 Gm., Quinine Sulphate 0-135 Gm., Magnesia 0-04 Gm.—Copied from P.J. i./i3,891. Kola. Dose. 10 to 20 grains (0-6 to 1-2 Gm.). Seeds of Cola vera contain about 2£% Caffeine, also in C. acuminata (not so much) (Ster- culiacece). Fr. Cx. Supp. 1920 allows seeds of other varieties of Cola providing they contain at least 1-25% Caffeine. (Not mentioned in Fr. Cx. Nouv. Supp. 1926.) Extractum Kolae Liquidum. B.P.C. Dose.—10 to 20 minims. Kola nuts in 40 powder exhausted with 60% Alcohol; 1 = 1. Fr. Cx. standardises to 1-25% Caffeine, but the method of manufacture is stated to be impracticable. The administration of Kola, Coca and Arsenic flavoured with a little Elixir of Orange forms a useful tonic and pick-me-up. Flavoring.—Syl Lavandulae ; Syrupus Aurantii. Tinctura Kolae. Dose.—20 to 60 minims (1-2 to 4 Cc.). Kola nuts in powder 1, macerate one week in 60% Alcohol q.s. to 6. Vinum Kolae. Kola in coarse powder 1, in Sherry 25, macerate for 7 days, filter and flavour with Essence of Vanilla. Celerina is said to contain Kola, Coca, Celery and Viburnum. ® Syrupus Kolae Compositus. Dose.—1 to 2 drachms (4 to 8 Cc.) twice daily. Iron, Quinine and Strychnine Citrate 3, Citric Acid 0-3, Sodium Glycerophosphate 5, Liquid Extract of Kola 50, Alcohol 90% 5, Syrup of Orange to 100. Finished product to be slightly acid. In anorexia, and as a general * tonic,’—Ph, Notes. Mate, Ilex paraguay ensis (Ilicacece) Syn. Yerba, Paraguay tea, Hervea, or Jesuit tea, contains less caffeine than tea, and is less astringent. Removes fatigue and induces sleep. About the ‘ herva matte * drinking, there is a complete system of etiquette. Narcotic in influence, it has none of the after effects of tea. It is tonic, laxative, ebrifuge, and stimulant to the digestive organs— P.J. ii./22,387. For further notes on Mate—Analytical, Dietetic and Commercial, see Vol. II. CALCIUM. Ca=40-08. Clalcii Carbonas. (R.P.’14.) CaC03=100,08. Syn. Craie Prepares. Gefalltes Calcium Carbonat. Dose.—Per os 15 to 60 grains (1 to 4 Gm.). White insoluble powder. Much employed in diarrhoea and dysentery and as an ingredient in tooth powders. Sys Specific. An Indian cure for sprue, dysentery, and diarrhoea, -t consists of ‘ powders ’ containing principally Calcium Carbonate —one to be mixed with 12 ounces of water and laudanum to be idded, if necessary. Diarrhoea of gastric origin is well treated by Calcium Carbonate and Calcium )hosphate equal parts, a teaspoonful thrice daily. The best antacid without any other inorganic salt in the gastric hyperacidity yndrome and in gastric and duodenal ulcer.—Jl. A.M.A. i./27,1558. Vistula Cretae, Chalk Mixture (P.P.’14). Dose.—J to 1 ounce (15 to 30 Cc.). Contains 3%with Sugar 6% and a little Tragacanth, in Cinnamon Yater. The powders are generally kept mixed in a dry condition, tnd added to the Cinnamon Water as required. Blair’s Tooth Powder. Dissolve 3 of soap in about 4 of water and mix atimately with about 25 of precipitated chalk and dry at moderate heat, lissolve Catechu 1 in Alcohol 5 and mix intimately with precipitated chalk 25. lix equal parts of Oil of Wintergreen and Oil of Sassafras with a further 25 of >recipitated chalk, using 6 drops of mixed oils for each 100 Gm. of powder, lix the three portions and sift.—P.J. i./22,263. Jalcii Chloridum. (B.P. T4). F.E. VIII. CaCl2= 110-994. (Calcium Chloride Crystal ( + 6H20), as in P. Jap. IV., P. Belg IV. and 3. Ital. V., is occasionally ordered. It contains only 50% Calcium Chloride. J.3. X. requires not less than 75% Calcium Chloride. P. Ital. V. also mentions the fused of commerce, containing 20 to 25% H20 (CaCl2.2H20).) Dose of the Anhydrous Salt.—Per os 5 to 15 grains (0-3 to 1 Gm.) in aqueous solution, or pills made with syrup ; these must be kept in >ottles. Intramuscularly (deeply) 1 grain (0-06 Gm.) in 15 minims (1 Cc.) >r 75 minims (5 Cc.) Hjqiodermically it may produce sloughing. ntravenously 4 grains (0-25 Gm.) in 75 minims (5 Cc.) have been given. Intravenous injection of 4 Cc. of a 10% solution dangerous—believed to ause heart-block.—W. D. M. Lloyd, B.M.J. i./28,664. In fused white agglutinated, very deliquescent masses. Soluble (the fused salt) in water 1 in 1 in alcohol 90% 1 in 3. Incompatible with carbonates, phosphates, sulphates and artrates. Flavoring,—Prescribe as Elixir q.v. or with Elixir Saccharin!. Calcium Chloride Sterules are prepared 5%, 5 Cc., and 10%, 5 Cc. Uses.—Calcium Chloride increases the coagulability of the blood. and so acts as a hsemostatic (Sir the blood is— Increased by— Carbonic Acid, Calcium Chloride or Lactate, Milk, Magnesium Carbonate or Lactate, Phosphoric Acid and Soluble Phosphates, Strontium Carbonate or Lactate, Thymus Gland. A. E. Wright). Coagulability of Diminished by— Oxygen, Alcohol, Restriction of food, Diminution of Lime Salts, Large quantities of fluid, Citric Acid, Rhubarb, Acid Fruit Juices, Acid Wines, Tobacco smoking, Bile, Leech Extract, Hirudin (q.v.). It is employed in itching skin affections, e.g., pruritus, prurigo, urticaria. It is useful in chilblains, full dose frequently, and certain forms of headache, v. infra. In tubercular disease, chorea, glandular affections, to stop the growth of uterine fibroids, and to check the vomiting due to sarcinm. Administration and Removal of Lime Salts. According to Sir James Barr fixed lime (in the albumin molecule) increases viscosity and coagulability, while the free Calcium ions in association with the suprarenal and pituitary secretions increase the tone and contraction of the arteries and arterioles, heighten blood pressure and maintain force and efficiency of the cardiac contractions. Some persons absorb lime more quickly than others—a glass of milk may increase lime in the urine in an hour or two. The blood is the agent for carrying the lime to the tissues and from them to the excretory organs. Lime Salts have been found useful in treating exophthalmic goitre. The following are some special lines of ment. Angina Pectoris.-- Phosphoric Acid l drachm (of the dilute acid) every four hours and all lime to be excluded from diet and the drinking water. On the other hand, there may be deficiency of lime, in which case Calcium Iodide and Iodine Tincture is beneficial. Arteriosclerosis.—Chronic high tension leads to degenerative changes with subsequent atheroma and calcification of the deep layers of the intima of the aorta—lime salts are deposited as Calcium Soaps. Women are not so liable to arteriosclerosis as men—they get rid of a good deal of Calcium with each menstrual period. Asthma.— There is an excess of free Calcium ions in the blood. Decalcifying agents to be given and lime-free diet. Milk, etc., rigidly excluded. Bronchitis and Emphysema.—There is not, as a rule, too much free lime, but in the later stages too much fixed lime—rigid costal cartilages and fixed chest wall. Never let these become rigid—use decalcifying agents and lessen intake of lime. Cirrhosis.—Lime index generally low, owing to the catarrh of the stomach and the intestines set up by the alcohol. First stop the alcohol. Colitis.—In some cases of obstinate constipation there is too much lime in the blood and intestinal wall. In mucous colitis all forms of lime should be forbidden. Fats of the unsaturated type, cf. note under Oleum Morrhuse, e.g., a wineglassful of Olive Oil at bed-time, should be ordered. Digestive Tract.—So-called ‘ congenital * hypertrophic stenosis may be due to excess of lime in the milk. If people kept their bowels open, thus preventing 3. Coli from assuming a malignant type, appendicitis would be rare. Some >eople absorb Calcium badly—this is "due to the form in which it reaches the aucous membrane. The insoluble fats, Stearin and Palmitin, which constitute he greater part of beef and mutton fat, can be extracted from the faeces to the xtent of 80% or more. The acids of these fats when split off readily combine rith Calcium forming insoluble soaps which irritate the mucous membrane, lod Liver and Olive Oil, butter and bacon fat contain a large amount of nsaturated fatty acids, which, even with lime, form relatively soluble soaps. Ahen, therefore, a person is for any reason on a 4- lime diet the fat should onsist largely of Olein. This may partly account for beneficial action of Jod Liver Oil in rickets. The popular view that milk is a suitable diet in adults in any form f illness is erroneous. In the production of intestinal stasis the lime alts play an important part. Insoluble Calcium Soaps have an injurious, rritating effect on the intestinal mucosa. On the other hand in atony of the bomach and intestines there is deficiency. Where lime is necessary it may be iven internally as Iodide or Glycerophosphate or subcutaneously largely Liluted with Normal Saline with addition of 5% Glucose.—B.M.J. ii./i2,695. The commonest cause of gastric catarrh and of cirrhosis of the liver is Icohol; while the teetotaller, from eating too much and from immoderate onsumption of lime salts, more frequently suffers from arteriosclerosis and hronic diseases of the kidneys.—B.M.J. ii./i2,162. Disseminated Sclerosis.—Calcium Salts useful: the Sodium Salts ajurious. Acids should be avoided. Epilepsy.—All the soluble Calcium Salts do good. Calcium Iodide is the nost efficient. Milk foods good. See also Calcium Lactate. Locomotor Ataxia.—The Calcium Salts are in excess. Give Acid and strychnine. Migraine.—Lime Salts as a rule are in excess. Eliminate same from the liet and give Magnesium Sulphate in the mornings. Muscular System.—In myalgia, or the so-called muscular rheumatism, here is Calcium deficiency. Correct also any dilatation or acid fermentation. Neurasthenia and Hysteria.—Lime Salts variable. As a rule they are eficient—give Calcium Glycerophosphate. Pneumonia.—‘ In the acute stage of pneumonia the more scanty and the nore sticky the expectoration, the more viscous the blood, the more Lime >alts and leucocytes it contains, caeteris 'paribus, the more favourable the prognosis, and on the other hand the more fluid and haemorrhagic the :xpectoration, the more liquid the blood, and the less the Lime Salts and eucocytes, the worse the prognosis.’ Kheumatism, Acute.—There is an excess of free Calcium ions and a tendency o fibrin formation. Milk diet does harm—plenty of red meat which increases he Ammonia in the tissues and thus neutralises the sarcolactic acid, is beneficial. n gout there is more frequently an excess of lime in the tissues and urine than n the free state in the blood—decalcify, e.g., with Phosphoric Acid. Skin—Eczema, etc.—In many cases there may be deficiency of lime and a Lilated stomach. In urticaria, eczema and serum rashes there is deficiency of ime in the blood. Tetany and Cramp.—Usually there is dilatation, acid fermentation and leficiency of Calcium Salts. . Urinary Tract.—Healthy kidneys always excrete a certain proportion of Jalcium, though not so much as the bowel. When diseased, Calcium may be etained. It is useful to precipitate the lime when examining urine as a outine. If there be no excess in the blood there will be none in the urine, >ut the condition of the kidneys and the Sp. Gr. of the urine must be taken nto account. In dropsy, Sodium Chloride should be excluded while lime alts are beneficial. . In Dupuytren’s contraction surgeons’ operations have all failed. -^ere 1S ,n excess of Calcium in these cases.—Sir James Barr, B.M.J. n./io,82J. General References to ‘Lime' Therapy. Acne.—A 10% solution of Calcium Chloride intravenously, a Cc. every lird day, increased to 10 Cc. every second day, of value. Inject slowly, iking care not to infiltrate the skin or the hypoderm. When 5PaUent implains of heat in the face, stop till this disappears. Per Pres., Oct., 29,882. . Aneurism op the Aorta (abdominal) apparently cured by Calcium Chloride m doses of 15—30 grains.—Whitla, Pract. Med. Angioneurotic (Edema treated with 10 grain doses thrice daily, increasing ^ A? grams. The swellings which appeared continuously in different parts of the body disappeared completely. Arterial Atheroma, Decalcified Dietary.—The amount of * lime ’ necessary to man decreases with age. An adult should not take more than 1 Cm. a day he eliminates about 0-9 Gm. pro die—elimination ought to be proportional to intake. Cows’ milk, cheese, eggs, onions, contain 0-2%, being rich in lime. Moderately rich (0T to 0-2%) are peas, beans, cauliflower ; poor m lime (less than 0T%) are bread, meat, flsh (most kinds), potatoes, apples, pears, plums, etc. Large amounts of milk, bread, beef tea, and green vegetables must not be taken by atheromatous subjects. Blood Calcium.—See Metabolism posted. Bronchitis.—The popular belief that hot lemonade ‘ cuts the phlegm ’ may be due to the fact that citric acid in lowering the coagulability of the blood would thus give it greater ease of gaining access to the infected focus. Chilblains.—Calcium consumption helps to an extent.—B.M.J. i./3i,516. Coagulation-time of blood not delayed in chilblains.—R. Hallam, B.M.J. i./31,215. Chorea.—There is a rather low total serum Calcium content. The Calcium content of the cerebro-spinal fluid is consistently low.—E. C. Warner, L. i./3o,339. Eclampsia.—Calcium Therapy is the prophylactic. Continuous administration during pregnancy of 15 grains Calcium Phosphate in £ ounce water thrice daily as prophylactic in midwifery, combined with a 1 in 1,000 solution of Acriflavine in Glycerin (q.v.) for vaginal injection.—J. L. Moir, B.M.J. i./3i,118. Eclampsia treated by washing out the stomach and transfusion of a pint of Calcium Chloride Solution (30 grains to the pint) into a vein of the arm—also 20 grain doses four times daily per os. Rapid improvement. Possibly the Calcium Chloride acts as sedative to nerve cells.—B.M.J. ii./i2,1124. Calcium Therapy in eclampsia disappointing. The fits are not influenced by the Calcium content of the serum.—W. C. W. Nixon, L. ii./3i,292. Eczema treated with a 6% Calcium Chloride ointment: found to be effective. —G. Lampronti, per P.J. i./23,573. Epididymitis well treated by intravenous injection of 0-5 to 1 Gm. in dilute solution—4 or 5 injections once daily.—Per Jl. A.M.A. ii./28,1136. Epistaxis has been treated by 10 grains, t.d. Glycosuria.—The greater the amount of sugar the larger the excretion of Calcium. It can be reduced by giving Sodium Bicarbonate.—F. Ransom. Haematemesis of Gastric Ulcer.—In severe cases the only reliable drug is Calcium Chloride, 1 drachm dissolved in 5 or 6 ounces of water given by the rectum, alone or in conjunction with saline transfusion or subcutaneous injections.—Whitla, Pract. Med. Haemophilia treated intravenously, 10—12 injections of 20 Cc. of 5% solution.—Paris Med., Dec. 6/24,467, per Pres., Jan., ’26,23. Coacgulation of the blood is thought to be little affected by Calcium Chloride per os, but injected the time of coagulation was reduced in 15 minutes from 3£ minutes before injection to If minutes after.—Dixon, B.M.J. ii./o9,540. As hcemostatic. Calcium Chloride should be given intramuscularly. Hypodermically it may produce sloughing even in 1 grain doses.— W. R. Grove, B.M.J. i./2o,47. Haemorrhage controlled by intramuscular injection of Calcium Chloride. 1 grain in 100 minims injected deeply into the gluteal muscles is generally painless. The Calcium value of the blood is found to rise slowly to a maximum in 6 hours and then to remain constant for 24 hours. The effect is probably a direct one on the blood vessels. The increased Calcium content of the plasma may cause combination between the Calcium and the blood lipoids with consequent acceleration of clotting. A second injection at end of 24 hours and a third, 24 hours later, may be given. Per os, Calcium salts have no effect on blood Calcium. Helpful in uterine haemorrhages and results in aneurisms hopeful.—W, R. Grove and H, W, C, Vines, B,M,J, ii./2i,4Q, Haemorrhages, Intestinal, to check, 30 to 60 grains daily have been ?iven internally, accompanied by rectal injections containing 60 grains to ;wo pints of water; opium may be given in addition. Hay Fever.—Consumption of large quantities of flesh increases the excretion }f Calcium. A low body content of Calcium is favourable to hay fever, the idministration of Calcium Chloride acting beneficially. A retention of Potassium and a greater output of Sodium results from increased Calcium in he diet.—J.C.S.A. i./22,1210. 10 grain doses t.d. have been advised. Heart failure accompanying post-influenzal pneumonia. Sir Lauder Brunton pointed out, may be averted by extended use of Calcium Chloride. Usual dosage is 5 to 10 grains every four hours. Increases secretion and ones up the vessels. May be prescribed as Elixir q.v. For inter-dental fissure 15% solution on pledget of wool. Jaundice. 5 Cc. of 10% solution intravenously helped to hasten coagu- ation of the blood, prevent post-operative bleeding, and neutralise toxic )ile products.—Jl. A.M.A. ii./25,885. Menstruation, Profuse, to check. Doses of 10 to 15 grains daily for a veek before the period, have been given ; but not if there be kidney disease, )ut see ref. under Nephritis, etc., infra. An excess of Calcium Salts in the blood thought to be associated with the nenstrual period. Metabolism.—Daily Calcium requirement of growing boys found to >e 0-43 Gm. When an individual is living on a low Calcium diet the amount ff Calcium in the blood may not necessarily reflect the deficiency.—J. M. lenderson, L. ii./3o,755. Importance of Calcium metabolism.—G. Arbour Stephens, B.M.J. i./3i,605. Studies in Calcium and Phosphorus metabolism.—Donald Hunter, L. h/30, 197.947,999,1022. The free or floating Calcium added by means of milk to a nursing mother’s Liet is of intense value, both to mother and child. In addition, as Calcium ’hosphate has to be formed, the Phosphorus-Calcium ratio must be correct, 'he Calcium of the diet should be 0*63 (minimum total Calcium per diem 0-9 o 1 Gm., and of Phosphorus 0*88). In treatment of tuberculosis Calcium to •e given to promote calcification.—F. E. Tylecote, M.P., Mar. 27, ’29,261. Significance of blood Calcium. About 60% of the Calcium in the blood is a a diffusible form, the rest is probably combined with protein. When food lgested is free of Calcium, tetany occurs. Hypocalcaemia occurs in spasmo- hilia, rickets, renal dwarfism, coeliac disease, osteomalacia, parathyroidectomy, nd renal disease.—Dan T. Davies, L. i./3o,149. Nephritis and (Edema successfully treated with Calcium Chloride, 21 to If drachms daily, free diuresis occurring.—B.M.J.E. ii./24,62. In chronic parenchymatous nephritis the Calcium is at a low level.—Dan ’. Davies, L. i./3o,203. On the nervous system Calcium has a sedative effect and diminishes per- leability of the walls of the blood vessels.—B.M.J. ii./io,1594. Piles, Bleeding, have been treated by injection every morning of 4 to 6 rachms of a 10% solution. Pleuritic Effusion. Calcium Chloride per os found to have remarkable ffect in treatment. 30 Gm. of the dry granulated salt (Caution : an extra- rdinary dose!) in 100 Cc. of water taken in a little coffee and milk the best lethod of administration.—Per Pr., Sept., ’23,233. Pneumonia, acute lobar, has been treated with 5 to 15 grain dose every hours. Scurvy.—In the siege of Kut-el-Mara, Calcium Chloride was urgently eeded by the Mesopotamia forces for treatment of scurvy. It was “ home- lade ” by acting on lime with Hydrochloric Acid, of which latter there was mndance (used with Potassium Chlorate for chlorinating water). Nearly lbs. of this home-made Calcium Chloride was issued daily for 2f months. .D. i./i7,576. , . In Skin Disorders, clinically, the effect though good, is not due to increased )agulability of the blood. The soluble salts have no particular value. Mistura retse as useful as Calcium Lactate.—Prof. It. B. Wild. Spasmophilia (Infantile Tetany) well treated by 30 grains per os every hours ; rapid cessation of convulsions. Cod Liver Oil as well and after,— Graham and G, H, Anderson, B.M.J. i./24,903, In acute cases the Calcium content of the serum ranges between 4 and 8 mgr. per 100 Cc. Give Calcium Chloride 2 Gm. every 2 hours. As much as 6 Gm. can be given in 24 hours to an infant without any apparent intolerance in milk. Improvement in \ hour. Hydrochloric Acid (e.g., 260 Cc. of N/10 Acid with 750 Cc. Milk) and Ammonium Chloride, 5 Gm. a day, also efficacious, but they are only transient in effect.—Dan T. Davies, L. i./3o,202. Thrombosis or Embolism, tendency to, should be stopped by decalcifying agents such as Phosphoric and Citric Acids and their soluble salts.—Sir James Barr. Tuberculosis (Intestinal—producing tuberculous diarrhoea) has been treated by Calcium Chloride intravenously, e.g., 5 Cc. doses of 5% solution with benefit. Ascribed to the action on the sympathetic system, checking peristalsis.—Pres., Nov., *19, p. 202. The tolerance of the 'patient should invariably be ascertained before administering the full dose. Tuberculous intestinal ulcers healed by weekly intravenous injections of 5 Cc. of 5% solution for 102 w~eeks.—Am. Rev. Tub., Sept., ’25, per Jl. A.M.A., ii./25,1583. It has been adopted with heliotherapy and dietetic treatment as a standard treatment for cases showing gastro-intestinai involvement.—Am. Rev. Tub., April, ’24. Intravenously ‘ surpassed all expectations ’ in the treatment of 200 cases of pulmonary, surgical, or inflammatory tuberculosis. 1, 1*2, 1-4, or 1-5% solution injected in two series of 15 injections with 10-day interval between series. Controls hsemoptysis and reduces clotting time of blood.—Per Jl. A. M.A. ii./25,1169. Calcium chloride intravenously is excreted in the urine to the extent of about 50% in 3 hours and is completely excreted in the urine and faeces in 3 days. It is impossible to bring about retention of Calcium in tuberculous patients even bv a series of injections at short intervals.—Biochem. Z., *26,/146, per B. C.A., ’26,A753. Intravenous injections should not exceed 1% strength. 50 Cc. doses given slowly.—Jl. Trop. Med., Nov. 2, ’25,386. Workers in lime and Plaster of Paris, found in general to be immune. In the treatment of tuberculosis it is needed not only for healing properties but also to overcome hypo-alkalinity or acidosis, which is almost always present. Patients should have plenty of vegetables and fruits, milk and eggs, and if possible shells of fresh raw eggs ground to powder—boiled or stale will not do. -F. Tweddell, Med. Rec. per Medical World, April, 1922. Weekly intravenous injections of 5 Cc. of a 5% solution of Calcium Chloride, over a period of 102 weeks, healed tuberculous intestinal ulcers.—Jl. Intrav. Therap., ’26,15. Urinary Infections, particularly colon bacillus pyuria, cured by rendering the urine acid by a daily fractionated dose of Calcium Chloride in 2 litres of water, the treatment being based on the assumption that the pH controls the growth of bacteria. Contraindicated if kidneys are pathologic or if there are signs of diabetes.—Per Jl. A.M.A. ii./25,1768. Viper Bites well treated with 3% solution intravenously.—C. Kobayashi* per Jl. Trop. Med., May 1/22,121. Vomiting of Pregnancy, uncontrollable, successfully treated by intravenous injection of concentrated solution, 35% of Calcium Chloride, in 2 Cc. doses.—L. i./24,663. Calcium in the human economy.—W. R. Grove, Clin. Jl., Oct. 31/23,521. A seasonal variation, especially in children, of Phosphorus and Calcium content of the blood—percentage being highest from March to July, the months of maximum sunshine, with a fall from August to February. —C. W. Saleeby, P.J. i./23,247. An interesting discussion on the therapeutic uses of Calcium Salts at the meetings of the B.M.A. 1927.—B.M.J. ii./27,777 et seq. In the Nauheim Baths the increased specific gravity has a primary effect of raising the peripheral resistance of the body which is afterwards followed by reaction, and the effervescence stimulates, but the Calcium Chloride in the water has no effect—it is not absorbed—otherwise it might work great mischief. 1 J CALCIUM. 255 cTranskutan (T.M. 485353). A proprietary containing Calcium Chloride, Iodine, Bromium, Strontium ad Lithium Salts, and Badium, with aromatic oils, for adding to baths at 8°, increased to 106—108°. Patient lies in the bath for 10 minutes and is ren put to bed with hot packs for 2 hours. Sweating results and pain is ilieved. In rheumatoid arthritis, fibrositis, etc. iquor Caicii Chloridi B.P. 1885.. was 1 to 5 of distilled water. Dose.—15 to 45 minims (l to 3 Cc.). llixir Caicii Chloridi. Dose.—I to 2 drachms, best given 1 hour after a meal. Calcium Chloride 60 grains, Orange Syrup and Syrup of Tolu of ach J ounce. listura Caicii Chloridi, N.H.I. Calcium Chloride 10 grains. Syrup of Ginger J drachm, Water to J ounce. ielatinum Caicii Chloridi. (cf. Gelatinum for further Gelatin Injections). Dose.—5 to 7 Cc., warmed in a water bath and cooled to a suitable tempera- [ure. To arrest hemorrhage inject into the gluteal region. 1 This contains Calcium Chloride 5%, with Gelatin 5 to 10%. The addition f Gelatin stated to avoid the necrotic effect of the Salt.—Pr. May, '13,902. 1 Shock treated with an injection of Calcium Chloride 0-5 Gm., Glucose 1*5 Gm., 1 elatin 0-3 Gm. in 10 Cc. Water. Ampoules kept ready, melt when required, live as such or dilute with tap water.—J. E. R. McDonagh, P •., Aug., 1920. lalcii lodidum. CaI2=293-944. Syn. Caicidin. Dose.—2 to 4 grains (0-12 to 0-25 Gm.). Given in dilute aqueous olution. Deliquescent crystalline powder. On exposure to light or ir will give off Iodine ; best preserved in amber bottles. It is bated to have been introduced into medicine by G. Arbour Stephens. See B.M.J., July, 1906). Excellent results in foul ulcers and chil- lains. Eczematous patch on tibia measuring 7x3 inches cured by 4 grain oses thrice daily. Diabetic ulcer on foot, also seat of recurrent lammary carcinoma, were treated with it. Elixir Caicii lodidi. —Dose.—1 drachm (4 Cc.). Calcium Iodide grains, Aromatic Elixir I drachm. Employed in tuberculosis. Caicii Peroxidum. Syn. Calcii Superoxydum Gorit. Ca02—72-08. It may be made -j- 8H20. Dose.—3 to 10 grains (0-2 to 6 Gm.) daily. A wdiite crystalline powder slightly soluble in water, evolving xygen. It explodes if mixed with Glycerin or Formalin. A useful intestinal antiseptic, given in milk, for infants, e.g., in ummer diarrhoea. Recommended in hyperacidity ; also in soil ontaminated wounds. Under the name “ Calox ” it is contained in a dentifrice. Mag- esium Peroxide 5 to 10% added to a prepared or precipitated halk has also been used. alcii Phosphas {B.P. ’14). Ca3(P04)2=310-28. (The Salt according to N.N.R. in U.S.A. contains 85%.) ‘Neutral’ or ‘ Tribasic ’ Calcium Phosphate, Calcium Ortho-Phosphate. Dose.—5 to 15 grains (0-3 to 1-0 Gm.), but larger amounts (1 to Gm.) are given as antacid. White powder made by interaction of calcium chloride with sodium phosphate and excess of ammonia at a boiling temperature. Insoluble in water ; soluble in dilute hydrochloric and nitric acids. Uses.—To supply lime to growing bones and to assist in general nutrition. It is also given to pregnant women for the same purpose, ‘Antacid ’ Use.—Being insoluble, it neutralises excess acid in the stomach but does not produce systemic alkalisation.—N.N.R. May be somewhat constipating. Gastric Ulcer.—Bismuth Carbonate is not an alkali: Sodium Bicarbonate gives off Carbon Dioxide and causes distension and in excess stimulates gastric secretion. Best method of avoidance of free acid and mechanical irritation is by giving hourly feeds of 5 ounces of milk, or its equivalent, through a tube, and neutralising acid by giving doses of Atropine 1/200 grain increased to tolerance: Sodium Citrate prevents milk clotting : Manganese Oxide, dose regulated to keep bowels open : and Tribasic Calcium or Magnesium Phosphate (chiefly the former) effectually prevents acidosis. Stomach emptied last thing at night.—A. F. Hurst, L. i./3°,242. Calcii Phosphas Mono-acidus. Er. Cx., Ph. Ned. V., F.E. VIII., P. Belg. IV., P. Ital. V. Syn. Dibasic Calcium Phosphate, Calcium Mono-hydrogen Phosphate Ca2H2(P04)2, 4H20 or CaHP04, 2HaO = 172-139. j)ose.—10 to 30 grains (0-6 to 2 Gm.). Prepared by decomposing Calcium Chloride with Dibasic Sodium Phosphate. Colourless crystals with slight acid reaction. Used in making Liquor Calcis Lactophosphatis, q.v. *Pepsodent. (T.M. 518628, 522821, 396079.) A dentrifice with an acid reaction due to Acid Calcium Phosphate.—L. ii./2i,395. Calcii Phosphas Di-acidus. Er. Cx., F.E. VIII., P. Belg. IV. Syn. Monobasic Calcium Phosphate, or Acid Calcium Phosphate. CaH4(P04)2, 2H20 = 270-1784. Dose.—5 to 20 grains. Deliquescent crystals, insoluble in alcohol. Mix Calcium Mono-acid Phosphate 154 Gm. with Phosphoric Acid (50%) 200 Gm. to a paste, and leave to stand 1 hour at about 50° C., add water sufficient to make clear and boil ^ hour. Evaporate to Sp. Gr. 1-40 (taken on the warm liquor) and leave to crystallise.— Er. Cx. We have employed this Salt for some time past in making Syrupus Tann-Iodo-phosphoratus and Vinum Tann-Iodo- phosphoratum, q.v. Calcii SaCCharaS- Calcium Monosaccharate C12H 22011CaO = 398-2446, Dose.—8 to 30 grains (0-5 to 2 Gm.). In colourless tufts, soluble in water. An antacid for dyspepsia, specially for children ; also as an antidote to carbolic acid poisoning in 10 times above doses. Liquor Calcis Saccharatus. (B.P. ’14). Dose.—15 to 60 minims (1 to 4 Cc.). Prepared by interaction of slaked lime and sugar. Contains nearly 2% Calcium Oxide. Jalcii Gluconas. Syn. Calcium Sandoz. (CeH11O7)2Ca=430-2516. Dose.—Per os. A heaped teaspoonful increased to a tablespoonful hrice daily between meals in water. Children, a teaspoonful thrice Laily. Intramuscularly or intravenously 5 to 10 Cc. of 10% solution every f or 3 days. Children, 2 to 5 Cc. •Tablets, 25 grains are available. Dose, 1 to 2 according to age. Gluconic Acid CgHg^OH^COOH is formed by oxidation of Glucose, Cane Sugar, Dextrin and Starch. A syrupy compound oluble in water, insoluble in Alcohol. Dextro-rotatory. The Calcium salt forms a white crystalline tasteless powder readily oluble in warm liquids. Contains (Anhydrous) 9-3% Calcium. Uses,—Taken by the mouth, it is well absorbed. Intravenously p is better tolerated than Calcium Chloride. The acid-base factor p eliminated. Intramuscularly it is painless and non-irritant. It is t present the only Calcium salt which can be given into the muscles i adequate dose. It is said to be almost specific in hay fever, and as influence on many respiratory diseases, relaxing bronchial spasm nd decreasing the secretion of mucosa of the respiratory tract. Also sed in debility, malnutrition, neurasthenia, rheumatic cardiac lanifestations, and urticaria. Pharmacology.—Maximum tolerated dose in dogs intravenously of alcium Gluconate and Calcium Lactate 35 to 40 mgr. Calcium ion per kilo, r 1-5 Grn. in 30 Cc. water for an 8 kilo dog. Caused rise of blood pressure nd fall in pulse rate (both more persistent with the Gluconate), and Digitalis- ke effects. Over-dosage caused Chevne-Stoke’s respiration. Margin between ITective and toxic doses not great. Intravascular clotting the greatest danger -gives no warning and may cause sudden fatality.—A. L. Lieberman, Jl. Pharm. !nd Exp. Therap., Sept., ’30,69. Eclampsia.—Hyperguanidinsemia is associated with hypocalcemia. 7 Gm. -otal) of Calcium Gluconate intravenously, intramuscularly and sub- utaneously, cured in 24 hours. Eclamptic syndrome yields to Calcium icdication.—B.M.J.E. ih/30,42. (Edema of children suffering from nephrosis treated.—B.M.J.E. i./3i,102. Milk fever cured by injecting Calcium Gluconate: also prophylactic.— . ii./3o,411. cTetanol (T.M. 521153). Syn. Calcium L.evulustate (Crookes). Contains 13% Calcium. Dose.—Intravenously, 5, 10, or 20 Cc. 10% solu- ion ; Intramuscularly, 2 Cc. 25% solution. In treatment of tetany and Galium deficiency diseases. Chronic tetany cured by 21 daily intramuscular injections of 5 Cc. 3% olution.—T. Izod Bennett, L. ii./31,403. See also G. Slot, ibid. 556. CalCii Hydras. Ca(OH)2 = 74-0956. Should be recently made by ction of water on calcium oxide. Has slight caustic action. Is lore soluble in cold water than in hot. Liquor Calcis is given to infants with milk. Warts (verruca plana) on the back of the hand are stated to have •een cured in a week by \ pint a day. linimenfum Calcis. (B.P. ’ 14). Solution of Lime 1, Olive Oil I ; or with Linseed Oil 1, is known as Jarron Oil.—Syn. Linimentum Carrot. Mid. H. and U.S. X. Eucalyptus Oil 1 to 2% is sometimes added as antiseptic. In the tropics Arachis and Sesame Oil are permitted. Burns are treated with it, but it is thought to be out of date, 'annic Acid is now advised, q.v. Vol. I. 1 Calcii Sulphas. CaS04,2H2Q=172*1712. Dose.—20 to 30 grains daily (1*2 to 0-2 Gm.). A heavy white powder soluble in water 1 in 390. For phosphaturia is considered a specific ; it may be given with an equal weight of Heavy Magnesium Carbonate. Dried Calcium Sulphate, 2CaS04,H20 = 290*2956, so long as it remains dry, is used to make Plaster of Paris splints. Two pounds require about one pint of water ; this sets rapidly and firmly. Moistening with 5% Dextrin Solution makes a strong dressing but sets slowly. Sodium Chloride 1% added hastens setting but 2% retards. Plaster of Paris Bandages, 2, and 3 inches wide (6 yards). In sealed tins. Crinoline Bandages are used for these and for silicating (cf. Sodii Silicas). Calx Sulphurata (B.P. ’14). Syn. Calcii Sulphidum Crttdttm ; Canton’s Phosphorus. Contains not much less than 50% CaS = 72*14. Dose.—J to 1 grain (0-016 to 0-06 Gm.) in pill. Some forms of it shine in the dark and are used in luminous paint. See P.J. ii./i5,80G ; (CaS.)i./i6,105, also Radium Luminous Paints. Is prepared by reducing Calcium Sulphate by charcoal. A greyish powder with sulphuretted odour sparingly soluble in water with decomposition. It thus represents the properties of Harrogate, Bareges, Gilsland, and similar springs. Largely used for boils, carbuncles, acne, scrofulous sores, especially in glands of the neck. It rarely purges even in 2 grain doses thrice daily. Some give small doses every hour. In bronchitis and phthisis where sputum is tenacious and ropy, cough hard and prolonged—Calcium Sulphide liquefies sputum and makes cough easier. In abscess of the middle ear, urinary tract, acne, and, wherever there is pus formation, Calcium Sulphide should be given. In follicular tonsillitis £ grain may be given every hour until alleviation, then every two hours, said to act as specific. In zymotic diseases, Calcium Sulphide probably finds its most useful place. In the treatment of contagious diseases of childhood Calcium Sulphide seems to act similarly to Antitoxin—that is, it increases the inherent power of the blood to destroy bacteria and their poisons. Should be given throughout the course of measles, scarlet fever, diphtheria and whooping-cough.—Clin. Med., Jan., iqii. Reading that Calcium Sulphide is specific for Follicular Tonsillitis, and having had this trouble for nine years, with only temporary disappearance of the lesions from medical treatment, a patient tried Calx Sulphurata, 1 grain pills, 3 per day. Supply of pills ran out in twenty days, but during this time tonsils had healed perfectly and there was no sign of relapse 60 days after last taking the pills. Extent of treatment not thought sufficient. Control of the disease also by Lactic Acid 25% solution as swab.—S. M. Klages. Pilula Calcis Sulphuratae, TV, T% L i i> b b anci 1 grain. Tablets contain £, and 1 grain. Keep in bottles. In strumous ophthalmia, as well as in periostitis and alveolar abscesses has been found of service. For boils give 1 grain t.d., increased to 8 grains p.cl. Stearettes of Calcium Sulphide, freshly made, should prove useful in suppurative conditions in fairly large doses, e.g., I grain in each. They would avoid decomposition in the stomach. otio Calcis Sulphuratse. Syn. Liquor Calcis Sulphurate. Slaked Lime 4, Sublimed Sulphur 4, Distilled Water 35. Boil to- 3ther, evaporate, and filter, to produce 20 of solution. Diluted with ti equal quantity of warm water is a remedy for itch, which it will ire in half an hour. It resembles in composition Vlemingkx’ Olution. (Calcium Sulfuratum Solution.—P. Helv.). For eczematous itching, baths of the Solution, 1 tablespoonful to very 7 gallons of water, have been used. In scabies found too irritating for use. Not equal to a weak julphur Ointment in curative effect.—B.M.J. ii./17,468. Freshly recipitated Sulphur has been used by washing the patient first ith a dilute Sodium Hyposulphite Solution and then with dilute ’yarochloric Acid. Subsequently to allay irritation, Sulphur intment. ulphurated Lime Depilatory. Milk of lime charged with sulphuretted hydrogen. y rap us Sulphatum (H. P. Symonds). Dose.—J an ounce (15 Cc.) contains appropriate doses of the sulphates of erberine, Quinine, Iron, Potassium and Sodium. Is useful for boils, &c. aken twice or thrice daily. ilula Sulphatum. The salts of \ an ounce of this syrup in two pills. Calcium Metal, Calcium Carbide, Cyanamide, and further matter on leach, also Estimation of Lime in Blood, Urine, etc., see Vol. II. alcium Lactate and Lactophosphate are under Acid Lactic, Vol. I. CAMPHORA. C10H,,0=152-1248. Dose.—2 to 5 grains (0*12 to 0-3 Gm.), Camphor is a white crystalline substance obtained from China- homum camphora (Lauracecc) in Formosa and Japan. (Essential fiL of Camphor is of a pale straw-colour or darker, with fragrant lour, Sp. Gr. 0*898 to 0*920 ; consists principally of a terpene, ith about 1 in 4 or less of camphor in solution, the heavy variety preferred for massage in rheumatism. The heavy Oils range from 975 to 1*025, 50 to 75% Safrole. Light fractions practically avoid of same.—P.J. ii./o8,62). Camphor is sold in bells, and in > b b 1 and 4 ounce cubes, also as Flowers 0! Camphor. The utter is a convenient form for dissolving. Melting Point 175° C., Boiling Point 204° C.—P. Jap. Soluble in water, 1 in 700, in alcohol 90% 1 in IJ (more soluble l absolute alcohol), in ether 12 in 7 barely, chloroform 4 in 1 scarcely, fiatile and fixed oils (olive 1 in 3), in glacial acetic acid 2 in 1. It is rendered more soluble in water by the presence of carbonic acid, acid rbonate and carbonate of magnesium, sugar, and myrrh, and less soluble 7 bromide of potassium, liquor potasses, sulphate of magnesium, alkaline rbonat.es and many other salts, l2 Camphor, when mixed in certain proportions with many crystalline substances, causes mutual liquefaction of the two—e.g., camphor 4, phenol 12, and water 1 (see Acidum Carbolicum); camphor 1, and chloral hydrate 1 (see Chloral Hydras) ; camphor 2 and menthol 3 (see Menthol), camphor 1 and thymol 1 (see Thymol) ; camphor 2 and /3-naphthol 1 (see Naphthol); camphor 2 and salol 3 {see Salol); camphor and butyl-chloral hydrate liquefy when heated, but solidify on cooling ; so will camphor 84 and salicylic acid 65 (see Camphora Salicylata). Camphor is powdered by rubbing with a few drops of alcohol. (Camphora Synthetica. P.G. VI. may be used in place of Natural Camphor in Germany, also in Spain as stated in F.E. VIII. Further details see Vol. II.) Synthetic Camphor made on large scale at Adlershof.—P.,T. 3./3x,379. Flavoring.—Extractum Glycyrrhizje Liquidum. Lises.—Sedative, anti-spasmodic, carminative, expectorant, diaphoretic, anaphrodisiac, antiseptic, given internally to abort colds in the head, to relieve hiccough, for whooping cough, diarrhoea, chordee and lumbago. Is injected as a stimulant for patients in extremis. For arteriosclerosis and for old patients with heart trouble continued use of camphor internally is of value.—L. i./i 8,143. Meningitis caused by camphor liniment has been treated by caffeine injection. Cases of Camphor habit have been reported. Caution*—It is dangerous to place camphor or menthol, e.g., a 20% ointment, into the nostrils of an infant. A small quantity of this camphor ointment applied in this way for coma in an infant of 9 months caused immediate collapse with signs of a severe syncopal attack.—Pres., July, 1913. Poisoning from 75 grains of Camphor as Camphorated Oil. Recovery. Stomach washed out and several ounces Concentrated Magnesium Sulphate Solution left in.—J. Cottrell, B.M.J. i./31,96. Camphor Water. (Syn. Camphor Julep or Mixture) 1 in 1,000. The Ammoniated Liniment (—Poisonous, not to be taheyi) 12|%, with Lavender Oil 0*5%, and Strong Solution of Ammonia 25%, Alcohol 90%, q.s.. Spirit 10% (and U.S., Syn. Teinture de Camphre Concentr^e, Alccol Camplir6 Fr. Cx.), and Compound Tincture 0-3%, of the B.P. ’14, are in general use. Aqua Sedativa. Eau Sedative. LOTION AMMONIAC ALE CAMPHREE (Fr. Cx.). Spirit of Camphor (10%) 10, Sodium Chloride GO, Solution of Ammonia 60, Distilled Water 1,000, all by weight. As a compress for migraine and rheumatism, and to contusions. Teinture de Camphre Faibie, Fr. Cx. is 1 ill 40 Alcohol 60%. Camphor Ball. Spermaceti 4, White Wax 12, Oil of Almonds 5 ; melt in a wTater bath and add Flowers of Camphor 4. Dissolve, and when nearly cold pour into moulds. Useful for chapped skin. Camphorated Chalk. Flowers of Camphor 1, Precipitated Calcium Carbonate 7. Mix, and sift for use as a dentifrice. Camphorated Carbolic Acid, vide Acidum Carbolicum. Elixir Camphora?. Dose.—to 1 drachm (2 to 4 Cc.). Spirit of Camphor 10, Syrup 5, Distilled Water 1. Contains 1 in 16. It mixes and diffuses well in water. Linimentum Camphorae (B.P. ’14). Camphor 1, Olive Oil 4, by veight. U.S. is the same strength in Camphor to be prepared with Cotton Seed Oil—Oleum Gossypii Seminis expressed from Gossypium lerbaceum and other species—Malvacece. . In preparing this, ‘ English-refined ’ flowers should he rubbed through a ieve, and dropped into the oil at 70° to 80° F. Foreign flowers give muddy olution. Oleum Camphorae Forte, P.G.V. is the same strength. Examination of camphorated oil for camphor substitutes.—P.J. i./og,S. Wesson Oil, is a high grade of Cotton Seed Oil, largely used in America as ialad Oil, said to be superior to Olive Oil for making Mayonnaise. Cotton Seed Oil unsatisfactory for Camphor Liniment. Likely to congeal ;o consistence of cheese.—J. J. Blackie, P.J. L/31,17. )leum Camphoratum, Huile Camphree Fr. Cx. 1 to 9 of Olive Oil. Injeetio Camphorse Hypodermica. Dose.—10 to 30 minims (0*6 to 2 Cc.). Camphor 1, Sterile Olive Oil to 5. In pneumonia 25 minims has been given as a general rule to tart with, but much larger doses have been employed—even 12 Cc. >f a 20% solution. Huile Camphree Sterilis^e pour Injection, Hypodermique. Fr. Cx. rouv. Supp., 1926. Bose.—Max. during 24 hours, 100 Cc. Caution.—A 10% >/v solution in Olive Oil. Injeetio Camphorae Hypodermica (Aetherea) L.H. Camphor 2 grains, Ether 3 minims, Olive Oil to 10 minims. Steruies, Hypodermic, contain Camphor 14 and 3 grains in sterile Olive Oil ; Steruies of Camphor 4 grain, with Ether 15 uinims ; also Steruies of Camphor 3 grains with Guaiacol 2 grains, mployed in phthisis. N.F. uses Cottonseed Oil as a solvent for the Camphor. ursehmann’s Solution. Dose.—15 minims (l Cc.) increased if necessary. Camphor 2, Ether 3, Olive Oil 7. Steruies of Curschmann’s Solution 1 Cc.=0*2 Gm. (3 grains) of !amphor are prepared. Cardiovascular Diseases treated by Camphor. During the course of ironic myocarditis with simple cardiac insufficiency, changes in rhythm nd auricular fibrillation, no drug can compete with Camphor in sustaining stivity of the heart and steadying the pulse. Bose.—0-1 Gm. (1£ grains) in il hypodermically once or twice daily—or per os. Not merely a remedy in le hour of death, but used intelligently can be given with benefit throughout le entire course of various cardiac and vascular diseases.—L. ii./i7,460. Heart Failure in typhoid and pneumonia (and other causes, e.g., gassing y chlorine and where the patient is in ecctremis). It is one of the most valuable mitants we possess.—U.S.D. Gastric Haemorrhage is stated to have been arrested by the injection, ot suited when there is insufficient active carbohydrate metabolism. Sciatica and Neuritis well treated.—Jensen, B.M.J.E. i./2o,17. Engorgement of Breasts.—Intramuscular injections of. H grains of ilue. Has inhibiting action on milk secretion. Give two injections, the :st day and one for each of next three days.—W. Philphot, Jl. A.M.A. ii./29,65. Caution.—Various amounts (30 to 300 Cc.) of 1 to 10% solution have ien injected. A case recorded of acute poisoning from 170 Cc. of 10% lution after an operation. 1% may be safe and not more than 300 Cc. of us solution. Urticaria following the use of injections.—Per Jl. A.M.A. ii./25,476. Cg) Pigmentum Camphorae Chloral et Menthol. Acute Fibrositis.—In early stage hot fomentation useful. Afterwards apply Camphor, Chloral Hydrate, and Menthol, p. aeq., painted on and rubbed in gently with the fingers—or paint with Iodine Tincture, and apply hot poultices or very hot fomentation.—A. P. Luff, B.M.J. i./i6,858. Pilula Camphorae. To form camphor into pills use ^ its weight of powdered curd soap and a few drops of alcohol, or a little lard in a warm mortar. Tablets, Camphor and Quinine. Camphor ^ grain, with Quinine Acid Sulphate 1 grain. To check catarrh, and as a tonic. Spiritus Camphorse Fortier. Syn. Rubini’s Solution. Flowers of Camphor 1, Absolute Alcohol (by weight) 1. Dose for diarrhoea.—2 to 5 drops on sugar every 5, 10 or 15 minutes, according to the severity of the symptoms. Trochisci Camphorae contain 2 grains in each. Wool, Absorbent, Camphorated (33%). Acidum Camphorieum. Ph. Ned. V., P. Helv., P. Jap. I\., F.E. VIII. C8H14(COOH)2=200* 1248. Dose.—10 to 20 grains (0*6 to 1*2 Gm.) in cachets. Formed on oxidation of camphor with nitric acid (test for free nitric acid with ferrous sulphate). Odourless crystals, M. pt. 187° C. Soluble in water about 1 in 200, in alcohol 90% about 1 in 14, and in fatty oils about 1 in 10. It is dextrorotatory. Uses.—With success in night sweats of phthisis, also in cystitis by intravesical injections of 2% aqueous solution "with 11% alcohol and as an intestinal disinfectant. Further in solution as a local astringent for nose and throat, also for diarrhoea. In skin affections saturated solution in dilute alcohol locally useful. Camphora Monobromata, C10H15BrO=231*033. P. Helv. directs—gradually combine Camphor 15, Bromine 18 in a mortar. Also official in P. Ital. V., P. Jap., F.E. VIII., P. Belg. IV., and Ph. Ned. V. Dose.—2 to 10 grains (0*12 to 0*6 Gm.) in pills, with J- of its weight of curd soap and proof spirit q.s. In colourless prisms, soluble in ether, alcohol, and fixed oils, insoluble in water. Should be soluble in sulphuric acid with nearly colourless solution. M. Pt. 76° C.—P. Jap. It is used as a hypnotic, and of value in epileptic vertigo, cases of petit mal, chorea, hysteria, delirium tremens, whooping-cough and asthma, and for erections in gonorrhoea. - i Tablets contain 1 grain (0*06 Gm.). Perles 2 grains (0*12 Gm.). Elixir Camphorae Monobromatse. Monobromated Camphor 1, Spirit of Cinnamon (1 in 10) 10 ; dissolve and add Red Elixir 60, Syrup q.s. to 100. Dose.—| an ounce. Enuresis is treated with this combined with belladonna, where potassium bromide is unsuitable. Camphora Salicylata. Dose.—1 to 5 grains (0*06 to 0-3 Gm.), in pill, with suet or lard. Camphor 56, Salicylic Acid 44, combined. Soluble about 1 in 20 in oils and alcohol. As ointment in skin affection. Trochisei Oamphorae Salicylatse Compositi. Camphor Sali- ylate 2 grains, Sodium Sulphate 4 grains. One thrice daily an hour >efore food. To ward off a cold. <Coramine(T.M. 437910). Syn. Pyridine-/3-Carbonic Acid Diethylamide Dose.—1 to 2 Cc. of the liquid, with a little water orally. 1 to 2 ampoules, ach 1*1 Cc., hypodermically, intramuscularly, or intravenously. Uses.—In shock, heart asthenia following infectious diseases (pneumonia, ■be.) arteriosclerosis, renal affections, bronchial asthma, emphysema, poisoning irough narcotics, and asphyxia of the new-born. A substitute for Camphor, Strychnine and Caffeine, since in cases of collapse l> has a stimulating action on central nervous system and on the circulatory nd respiratory apparatus. It has the advantage of being water-soluble and on-cumulative. Pharmacological and clinical results are given.—E. S. Faust, p. i./2 5,1336 j C.D. i./25,880 ; B.M.J. ii./25,910. t Cardiazol (T.M. 475209). Syn. Meteazol Pentamethylenetetrazol (CH2)5=N-N=N-N. Dose.—14 grains (0-1 Gm.) per os. Ampoules containing 1*1 Cc. are supplied >r subcutaneous use. A colourless crystalline powder, M.pt. 56—58° C., readily soluble in water nd other solvents. Solutions can be sterilised. . Has many of the properties f Camphor. Tablets contain 0-1 Gm. For use in collapse and heart affections. Cardiazol-Ephedrine.—1 Cc. = 0T Gm. Cardiazol with 0-015 Gm. Ephe- ,rine. In pneumonia and heart affections : acute asthmatic attacks. May re given per os or hypodermically, but not intravenously. 13 CANNABIS INDICA (B.P. T4). u.S., F.E. VIII., P. Belg.IV. jl ljCannabis and Resins f rom it—vide Poisons Schedule. |P]Extract and Tincture of Indian Hemp. The dried dowering or fruiting tops of the pistillate plant of pannabis sativa (Urticacece). It is grown in India (not deprived of esin). j The masses obtained in European commerce are called Guaza. Ganja lifers slightly and is more active. Bhang or Hashish consist of the leaves, mall stalks and fruits. The therapeutic value of the drug is contained in the resin. It ap~ jears to contain no peculiar alkaloid. The constituent Cannabinol ecomes oxidised on exposure to the air. For use in medicine if hould be as fresh as possible. It is a powerful drug. A high export duty is imposed on it. N.B.—The. B.P. ’14 dose of Extract has proved toxic. History of Cannabis.—Sir David Brain, B.M.J. ii./25,963. For details of Assay and Physiological Examination, see Vol. ll. * Mariahuana ’—the official name for Cannabis Indica in Mexico. Large uantities seized by Customs. Forbidden import and growing.—L. i./26,426. Antidotes.—Stomach pump, emetics, stimulant draughts, arti- cial respiration, coffee. No death from cannabis is on record.—H. Effects of largudoscs of Cannabis Indica depicted by the author’s experiment n himself. There is a distinct unmistakable sex tinge to its action, exhilaration ad emotion.—A. Schneider, per B.J. i./23,389. Flavoring.— Vide Tinctura. 13ses.—For chordee and asthma, also as an aphrodisiac, and is accessful in migraine. Is a narcotic and anodyne, but may give eculiar dreams and even delirium. It is useful in dysmenorrhcea, especially with Gelsemium; with Nux omica in incipient delirium tremens, nausea, and paroxysmal colic, supraorbital neuralgia, cough of phthisis and for whooping cough. It is of great use combined with strychnine, with chloral in chorea in mental worry and restlessness. Should be given in small and frequent doses. It is the remedy for menorrhagia. In gonorrhoea (urethritis acuta anterior) Cannabis internally with Hyoscyamus is useful before patient is in condition for injections. Headache due to high blood pressure well treated, especially where chronic interstitial nephritis is a contraindication to Blue Pill.—A. Felling, B.M. J. ii./30,907. See also Vinum Antimoniale. OSEl Extraction Cannabis Indicse {B.P. ’14). Syn. Extract de Chanvre Indian. Fr. Cx, Nouv. Supp. ’26. In U.S. is assayed biologically. Dose.—J to 1 grain (0-016 to 0-06 Gm.), in pill with lycopodium. An alcoholic extract,of which 1 dissolved in alcohol 90% q.s., to 20 forms— [P] Cg) Tinctura Cannabis Indicze {B.P. ’14). (A 1 in 10 of Alcohol Tincture was in U.S. IX. ; assayed biologically.) Dose.—5 to 15 minims (0*3 to 1 Cc.), in some mucilaginous fluid. Flavoring.—Glvl Lavanduhe, Glyl Amygdalae Amarae, Glyl Pini, Syl Vanillie ; Syrupus Aurantii, Syrupus Zingiberis. [PI CEP Fiuidextractum Cannabis, U.S. 1 = 1. An alcoholic percolate assayed biologically. Dose.—14 minims (0-1 Cc.). [P| CE> Piiula Extract! Cannabis Indlcae, contain J, 4 and 1 grain. In sciatica a pill of Cannabis Extract and Hyoscyamus Leaf in powder of each 1 grain may help. Local treatment. Dose.—2 to 5 during the day. ® Cannabin Tannas. Cannabin Tannate not a ‘ D.D.’—P.J. ii./2g,462. Dose.—2 to 10 grains (0-12 to 0-6 Gm.) taken an hour before bedtime in a pill or in sal volatile and water. A brownish powder, soluble in alkaline water and alcohol, said to be a useful hypnotic and is specially valuable in nervous sleeplessness and in acute mania ; also for dysmenorrhoea and menorrhagia. dDPilula Cannabin Tannatis, 2, 3 and 4 grains. ED CANTHARIS. UJCanlharides and its poisonous derivatives. CE) Cantharides, Tincture and all vesicating liquid preparations and admixtures of {and N.B. last clause of Part II. of Schedule). Syn. Lytta; Spanish or Blistering Fly.—P. Jap. IV. has Epicauta Gorhami with 1% Cantharidin. Dose.—TV to 4 grain (0*004 to 0*03 Gm.) in pill. Better given as tincture. Fr. Cx~ Max. single dose f grain. Max. in 24 hours, 2 grains. Antidotos. —Emetics, stomach pump, white of egg (no fats); sedatives. Cantharidin poisoning. l/50th grain taken.—L. ii./2i, 654. See also Liquor Epispasticus. For note on Estimation of Galenicals, see Vol. II. A study of Cantharides in practical pharmacognosy—T. E. Wallis, P.J. ii./2 7,167. ZTs.es—Externally vesicant, irritant and powerful counter- rritant. Used in pleurisy, pericarditis, meningitis, neuritis, applied bove the stomach to stop vomiting and in rheumatoid arthritis, v. Emplastrum). Internally is said to have aphrodisiac properties. Has been given a lupus and in chronic gout. Caution, avoid irritation of the kidneys, liematuria is checked by five-minim doses of tincture. It is of ervice in incontinence. In cardiac dropsy Cantharides is one of the most useful means of promoting diuresis. It acts on the secreting ceils of the tubules, and he effects manifest themselves quickly. Dose of Tincture may be 2, or 10 minims according to age, given several times daily. Can isefully be added to a mixture containing Caffeine, Tincture of itrophanthus and Spirit of Nitre. UfiMyiabris phalerata and sp. are not now official but were in I.C* idd. for making external applications in India. These contain bout 1 to 2%, or more than double the amount in Cantharides, £ the neutral principle— FH Cantharidinum (B.P. ’14), P. Ital. V., P. Helv., F.E. VIII., P. Belg. IV. C8H120 (CO)20 = 196-0936. Cantharidin is the Lactone of Cantharidic Acid, in flat glistening octangular prisms, which melt at 210° C. approx., and volatilise in rery irritating white fumes. Soluble 1 in 56 of chloroform, 1 in ;8 of acetone, and about 1 in 150 of acetic ether. Soluble also in ther, benzene, glacial acetic acid, 1 in 1,000 of absolute alcohol, and Lout 1 in 400 of water (Greenish). Poisoning Effects and Antidotes, see Cantharis. Uses.—Solutions of Cantharidin, as well as other preparations of antharides, are employed for stimulating the growth of the hair, in lopecia, and preventing its falling off. g)Acetum Cantharidmi {B.P. ’14) contains Cantharidin 1 in an Lcetic Acid solution q.s. to 2,000. g)Linimentum Crinale (Squire). Cantharidin. 1 grain, Acetic Ether 6 drachms ; dissolve with gentle Leat, and add Alcohol 90% 6 ounces, Castor Oil 2 ounces, Lavender )il 15 minims. It is better to dilute this with an equal quantity of pirit, and the head should be washed after applying it a few times, o prevent the cantharidin accumulating. pj Emplastrum Cantharidini {B.P. ’14), contains Cantharidin 1, in basis of Beeswax 225 and Wool Eat q.s. to 500 previously melted. £> Emplastrum Calefaciens B.P. ’98.—Was l\ strength of this. CE)Emplatre Mouches de Milan used in France is similar to Implastrum Cantharidis B.P. ’98. In rheumatoid arthritis counter-irritation is of value. Cantharides plasters in. or 5 in. by 24 in. painted immediately before application with Cantharides iniment or Liquor Epispasticus to increase effect, are applied at bed time, ae on each side of the seventh cervical vertebra or the twelfth dorsal, according 3 the joints of the upper or lower extremities are most affected—leave on *r 24 hours. If the kidneys are unhealthy electric cautery should be used instead. After blistering and cutting away the loose cuticle a bread poultice made with Boric Lotion is applied over night. Next morning dress with fresh Savin ointment and repeat every eight or ten days—soak well with Boric Lotion in removing. Twenty drops of Laudanum at night useful. Pain and swelling of joints generally much relieved after three or four days.— Latham, It.S.M. Bain. Sectn., May, 1910, p. 110, or L. i./io,929. The theory is that the changes in the joints and muscular wasting are due to active and destructive lesions in the spinal cord, and especially the cervical and lumbar enlargements.—B.M.J. i./13,864. CEL) Emplastrum Vesicans. Cantharidin 1, Chloroform q.s. ; heat to dissolve and add to Yellow Wax and Wool Fat, in equal portions, previously melted together, 499. CE) Liquor Epispasticus (B.P. ’14) is now made about same strength as B.P. ’98, using Cantharidin. Effects of painting the side with the Liquor to the size of a surface measuring 7 by 2f inches—in error. Blood, albumin, kidney cells passed in the urine.—L. ii./o8,800. CE) Collodium Vesicans (B.P. ’14) is approximately the same strength. Lotio Ammoniae et Cantharidini Mid. H. Strong Ammonia Solution 1, Spirit of Rosemary 2, Alcohol 90% 4, Tincture of Cantharidin 2, Almond Oil 6. CE) Linimentum Cantharidis Compositum, W.H. Liquor Epispasticus 30, Glacial Acetic Acid 20, Rosemary Oil 3, Castor Oil 90, Alcohol 90% to 480. CE) Emplastrum Cantharidis Liquidum, a special preparation, is painted on with a brush. It dries rapidly, forming a pellicle on the skin. Effect more certain than with a plaster. The size of a blistering plaster is usually 1 inch square—rarely more than 2 inches square. For applying behind the ear the shape should resemble that of the space formed when the tip of the forefinger comfortably touches the tip of the thumb. CE) Oleum Cantharidatum. P. Jap. IV. Macerate Cantharides in pow'der 3, in Olive Oil 10, on the water bath for 10 hours with occasional shaking. Strain. CE) Tinctura Cantharidini (B.P. ’14) 1 in 10,000; is approx. } strength of F.I. Bose.—2 to 5 minims (0-12 to 0*3 Cc.). IJ.S. 1 of Cantharides in 10 of Alcohol (94*9% vol.) containing Glacial Acetic Acid L Average dose 1J minims. Fr. Cx. and P. I tab V. 1 of Cantharides in 10, Alcohol 70%. (F.I.) Max. single dose 9 minims and max. during 24 hours 25 minims approx. F.I. (Second) recommended 0-06% Cantharidin. CE) Unguentum Cantharidini (B.P. ’14). Contains Cantharidin 1, dissolved by means of Chloroform in Benzoated Lard, 30CO. One part diluted further with two of soft paraffin forms a useful pomade for stimulating growth of the hair. Erasmus Wilson’s CE) Unguentum Stimulans is described as consisting of 1 of Cantharides in 5 of plain lard. CE) Unguentum Cantharidin cum Hydrargyro Compositum is sold as ‘ Pomade Max.’ CE) Unguentum Hydrargyrl Oxidi Rubrl et Cantharidis, W. H, Blistering Liquid 15 minims, Red Mercuric Oxide Ointment 1 ounce. B CAOUTCHOUC. FJPotassii Cantharidas. Er. Cx. (+1H20). C8H120(C00K)2,2H20=326-3248. Dose,.—4^ to grain (0-0001.5 to 0-0003 Gm.) hypodermically in very dilute solution. In minute white needles, soluble 1 in 25 of >vater." Has properties representative of Cantharidin, q.v. CAOUTCHOUC. India-Rubber. Syn. Elastica. (B.P. ’98.) The prepared milk-juice of Hevea brasiliensis (Euphorbiacem) and yther species ; known in commerce as Pure Para Rubber. JPreservation,—The best, means of preserving rubber goods is to immerse completely in distilled water. Liquor Caoutchouc (B.P. ’98)- Caoutchouc 1, Benzol 10, Carbon Bisulphide 10. Treat the rubber with the carbon bisulphide for an hour or two to form a jelly, and add the benzol. It may be medicated, but Traumaticin is preferable. Bandages of rubber are (i.) webbed with strands of rubber ; (ii.) Statham’s porous; (iii.) Martin’s (solid) perforated and non-perforatcd; (iv.) Elastic Circular Stocking and India-rubber Webbing. Bougies of solid elastic gum :— With bulbous end = k Boule, in sizes 1 to 16. ,, „ silk web „ ,, ,, 1 to 16. Conical pointed in shape ,, ,, ,, 1 to i2. Cylindrical, not tapered, various textures and materials—Sizes 1 to 16. JEsophageal Bougies are bulbous, conical and cylindrical, of elastic gum.— Sizes 10 to 24. Catheters.—Elastic gum, black and webbed, or silk web :— Bulbous (a Boule).—Sizes 1 to 16. Coude (bent at end) also Bi-Coud6 with two bends.—Sizes 5 to 12. Cylindrical.—Sizes 1 to 15, with or without wire Stilettes, and sizes 5 to 12 “with solid or hollow ends. . u Conical (simply pointed, i.e., tapered), with wire Stilette.—Sizes 1 to 12. Catheters, Soft Rubber.—13 and 16 inches long, with and without funnels, and the sizes vary between 4 and 12. Belfast linen Catheters are also prepared. Web Catheters may be sterilised by boiling in nearly saturated solutions of Ammonium Sulphate or Sodium Chloride, washing afterwards m sterile water. , . . ,, .. Catheters, Female, are of glass, straight or curved, metal, or soft rubber. Dental Rubber, manufactured of pure para rubber and coloured, ihis is supplied in various shades of colour, e.g., white, pmk, red, orange, black. The varieties in commerce are designated ‘ Samson, Doherty, ‘ Gold Dust,’ Ash’s ‘ Whalebone,’ and Jamieson’s Horn. The rubber is hardened by vulcanisation and used to form a frame to carry artificial teeth. In vulcanising most rubber, especially Ash’s, raise the temperature gradually until 315° F. or 100 lbs. pressure is obtained.# Maintain this temperature or pressure 75 minutes to complete vulcanising process. Drainage Tubing is of various dimensions, and is supplied m Carboiised solution in glass tubes. ^Elastoplast (T.M. 493126) Bandages. ox , Self-adhesive, resilient elastic plaster bandages, available m widths 2 a ancl 3 These bandages have recently been much used as a tight binder for varicose veins and ulcers, both for support and for fixing Zinc ^]a^1Jp^rtersps^^s' , f Thev also provide compression and support for the aite*-treatment 01 fractures and dislocations, injuries to joints, tendons, muscles, etc., xracture of ribs, clavicle, femur, Colies’ fracture, etc. .n„i00<. X-Ray photographs can be taken through several lay crs of Elastoplast. i/aricose Ulcers.—Put the hydraulics right, and the ulcer will take care of itself. The varicose circulation should be squeezed out of existence. The ulcers should be hermetically sealed with sticking plaster, as found by Payton 150 years, ago. In Technique 5% Sodium Morrhuate injection and a 3-inch EJasiopiast bandage. Discharge occurs and is beneficial. Enormous cost of patients of this kind to the State. Some probably £5,000 each. 324 patients cured.—A. Dickson Wright, B.M.J. ii-/30,996. See also ‘Chronic ulcer of the leg treated by Dickson Wright Method.’ There is no danger of putting the bandage on too tight and no danger of imprisoning septic secretions of the foulest.—J. H. Twiston Davies, and A. E. Drynan, B.M.J. ii./3o,998. Reflux pressure in the veins may upset the hydraulics on removing bandage. Single long veins easiest to treat.—E. A. E. Silcock, B.M.J. i./31,34. Varicose ulceration. Compression, or squeezing of excess fluids out of the limb. Very tight bandaging required.—J. H. Twiston Davies, B.M.J. h/31,201. Support is given which skin and tissues have lost and the blood is made to circulate properly. Patients should walk about.—Sir L. Hill, B.M.J. i./31,240. Method beneficial.—H. Haldin-Davis and others.—B.M.J. i./3i,329,330. Painting the leg with 5% (chthyoi in Glycerin prevents irritation.—R. W. Cockshut, B.M.J. i./31,652. Varicose Vein Clip to apply over site of injection, to take the place of an assistant.—R. Davies-Colley, B.M.J. L/30,156. Gloves, Surgical, are prepared smooth and rough surface. We had occasion to submit a brand known as the ‘ Vcedip ’ to sterilisation tests (1927) and found same to withstand repeated heatings with highly satisfactory results comparative with ordinary rubber gloves. A" brand termed Tensile is made under Patent 208235. Gutta Percha Tissue is prepared from Gutta Percha, the dried milky juice of Palaquium oblongifolium and other trees belonging to the N.O. Sapotacece. Contains about 80% gutta similar to that of caoutchouc. The tissue has been used after sterilising in spirit as a wound-dressing. It is not flexible like indiarubber. It cannot be vulcanised by heating with sulphur unless it is first melted with a proportion of indiarubber. The principal districts of supply are Pahang, Kclentan, Siak, Bolungen and Sarawak. Small quantities are also exported from Siam and Manila, and a lower grade from Nigeria. Prom Borneo is obtained the well-known ‘ leaf gutta ’; this is extracted from the leaves and small twigs of the tree, and is boiled, cleaned, and pressed into slabs and cakes, considered by some to be the best. Unfortunately on keeping it oxidises and becomes brittle. Gutta percha is the balata of the old world, as balata is the gutta percha of the new wrorld.—C. 1). Commercial Compendium. Mackintosh or Waterproof Sheeting, 44 inches wide is supplied :— 1. Double texture arid double width. 2. Having rubber on both sides. ^cVulpro (T.M. 4(10806, Cl. 11 and 460807, Cl. 40) Sheeting is made by a new process, it is rot-proof and cannot crack. Made 36 and 40—42 inches wide. Oiled Calico. Calico treated with boiled oil, and thus rendered waterproof. Oiled Silk is supplied (a) green, (b) in the 11011-adhesive form of yellow colour, and (c) a further variety is brown in colour. Oiled Silk, Dextrinized, is prepared from the best English Oiled Silk by treating the latter with a solution of Carbolized Dextrin. Oiled Silk Protective. This consists of oiled silk coated on both sides with copal varnish, and when dry, brushed over with Dextrin 1, Starch 2, Carbolic Lotion (1 in 20) 16. Pessaries arc ball shape, butterfly, circular, oval, cradle, and ring form. India Rubber Plasters are made 7 inches wide and in Tape form. Stomach Tubes.—That known as Van Valsh’s, with bevelled ‘ Velvet Eyes,’ is considered one of the best, but the bevelling may have the disadvantage of weakening the tube on one side and causing it to turn round when an obstruction is met. For passing the tube a special Lubricant Glycerin Jelly is supplied in Collapsubes, or a Glyco-Gelatin Pastil of Menthol A, and Cocaine A, is useful. (Vide Examination of Stomach Contents.) Sutures (vide Ligatures). CAPSICI FRUCTUS. Syn. Cayenne, African Pepper, Chillies. Dose.—b to 1 grain (0-03 to 0-06 Gm.), in a pill. The dried ripe fruit of Capsicum minimum (Solanaceoe). Contains as chief constituent Capsaicin—formula variously stated. apsicin. Dose.—S-6 to Vo grain (0-003 to 0-006 Gm.). Made by extraction with 90% Spirit. It is a dull reddish brown ily mass becoming crystalline. Gerrard found that Alcohol 90% is a good menstruum for extraction. He repared a 2 in 1 liquid extract, and from this an ointment 1 in 10 with t e Ihcial basis or hydrous lanolin, also a plaster 10%. Heo-Resina, Capsici, U.S. A bright red oil obtained by extraction with ether. 11 of acetone will exhaust (if percolated slowly) 1 of capsicum. Yield of leo-resin 5 to 16%.—Caspari. The name Capsicin is not synonymous with the Oleo-Resin. The word ‘ Oleorosin ’ properly applies to the ether or acetone extractive. „ weighed quantity is dissolved by solution of soda filtered through calico, the olution is then acidified and extracted by ether. The dried ether extract is hen treated with 60 per cent spirit. To prevent any oily acid from passing hrough the filter, stir with calcium sulphate or the like before filtering. The pirit solution is evaporated and the dried extract weighed. A sample of a reparation made with 60% Alcohol gave 10-66 per cent, while one of the true leoresin gave 18-82 per cent.—I). B. Dott, P.J. i./22,6b, C.D., 1922,117. »ilula Capsici Composite. Capsicum Oieo-resin J minim, Clove Oil \ minim. Calomel 1 grain, Goes 2 grains. For the atonic stomach of drunkards.—H. g) Empfastrum Capsici. (CfD cf. Emp. Plumbi). Evaporate the Alcohol from Liquid Extract of Capsicum 10, and tir into Resin Plaster 95. Contains 5% of Solid Extract (Gerrard). J.S. has Oleo-Resin of Capsicum 0-25 Gm. brushed over 15 square )m. of adhesive plaster. Capsicum plasters in rubber combination are also made in sheets r in. by 5 in., and yard rolls 7 in. wide. Smplastram Capsici Mite (Mild for dental use). R.D.IR Caoutchouc 10, Yellow Paraffin 1. Heat carefully so as to just liquefy, nd add Resin 10, Powdered Orris Root 4, Finely Powdered Capsicum 4. Mix nd spread on linen and cut into pieces half the size of linger nail. Dry the um thoroughly before application. Smplastrum Capsici Forte, R.D.PI. Prepare as above, omitting the powdered Capsicum. Spread and brush the surface thinly with 01eo-R,esin of Capsicum q.s. Neither of these plasters contains lead.) Tui&extractum Capsici. Dose.—1 minim (0*06 Cc.) Alcoholic Percolate 1 = 1. Gerrard ,dvised the following formula :— Exhaust Capsicum 100 with 90% Alcohol, distil off alcohol until he residual extract weighs 50,1 of extract = 2 of drug, i.e., double the trength of the U.S. VIII. preparation. Unguentum Oleo-Resinse Capsici. Oleo-resin of Capsicum 1, Hard Paraffin Wax 1, White Soft Paraffin 8. Melt the paraffins, add the oleo-resin, and stir until cold. For use as the -mirnent. P.J. ii./16,630. May be too strong for tender skins—will bear dilution 2 or 3 times. Tinctura Capsici {B.P. 514). 1 in 20 of 60% alcohol. U.S. X. 1 in a mixture of Alcohol (94*9% vol.) 95 and Water 5, q.s. to 10. Dose.—5 to 15 minims (0-3 to 1 Cc.). Given internally it increases the flow of saliva and gastric juice, Increases peristalsis, relieves atonic dyspepsia, and is useful in dipsomania—it allays the craving for alcohol. cf. Mistura Capsici Sedativa, infra. The B.P. ’ 14 tincture is too weak for external use as a rubefacient. FILARIASIS is treated prophylactically by Pepper and Capsicum. Tincture of Capsicum found useful in acute filarial fever and lymphangitis.—J. A. Robertson, L. ii./i5,673. Tinctura Capsici TEtherea. Prepared as B.P. ’14 tincture, with pure ether vice alcohol. Tinctura Capsici Fortier, B.P.C. Dose.—1 to 3 minims (0 06 to 0-2 Cc.). Principally used externally. Is •practically identical ivith Concentrated Tincture of Capsicum (Turnbull). Capsicum 1, Alcohol (90%) q.s. to 3. Is useful for chilblains, but only when the skin is not broken. This is too irritating generally. The writer’s formula is :—• Linimentiim Capsici.—Martindale, Capsicum Fruit in No. 80 powder 10, percolate with Alcohol (90%) to 70, and add Oleic Acid 10, Oil of Lavender I. Painted on the skin, or applied sprinkled on piline or flannel, in an hour it produces a red glow ; its action may be arrested by smearing the part with vaseline. Useful in chest affections, rheumatism, sciatica, etc. Does not redden the skin for any length of time, hence may be used on exposed parts. Linimentum Capsici Duplex is the latter, double strength. Mistura Capsici Sedativa (anti-alcoholic).—L.FI, Dose.—I ounce (15 Cc.) containing Capsicum Tincture 5 minims, Tincture of Ginger 20 minims, Potassium Bromide and Sodium Bicarbonate each 10 grains, Infusion of Quassia to £ ounce. XJnguentum Capsici (B.P. ’14). Capsicum Fruit bruised 25% in a basis of soft and hard paraffin and prepared lard, strained after digesting an hour on the water bath. Resembles Smedley’s Chillie Paste. The following formula (Gerrard’s) is not wasteful of the fats Liquid Extract of Capsicum (1^2 of drug, Gerrard) 60 grains, Olive Oil 1 ounce, Spermaceti 60 grains, melt the fats and stir in the liquid extract. A more absorbent ointment would be liquid Extract of Capsicum 60 grains, Hydrous Lanolin 1 ounce 60 grains. Capsicum Wool, Calorific Wool.—Oleo-resin of Capsicum 1, Ether 30, Absorbent Cotton 19. Dissolve the oleo-resin in the ether, saturate the wool evenly with the solution and dry. Alternative formula (Gerrard) Dissolve liquid extract of capsicum (Gerrard) 2 ounces in alcohol 90% 7 ounces. Pour the solution on to the cotton wool 9 ounces under pressure to saturate evenly. Dry and preserve in well closed cartons. Contains 10% extract. Colour with eosin, as otherwise the colour fades. Cover with oiled silk when applying to increase activity. CARBONIS TETRAGHLORIDUM. L. H. directs to make a tincture by percolating Capsicum 2 ounces with lcohol 70% 10 ounces, and to then impregnate Cotton Wool 16 ounces with ^Gapsogen^JVL 327250) is a trade variety of the above encased in gauze. Capsicum Gamgee Tissue is also made. , i • i All the above are very useful in rheumatic affections, bronciiiai nd similar painful complaints where warmth relieves, IARBONIS TETRAGHLORIDUM. Ned. V., E.E. VIII. Syn. ^Tetraform (T.M. 445574). C.C14 == 153*828. Dose—The general conclusion is that 3 Cc. (45 minims) (in several apsides) is adequate, but 6 Cc. doses have been taken by an adult. 0 to 20 minims is safe for children of 3 to 4 years. Children of 1 ear can have 10 minims ; a child of 10 should receive 30 minims ; youth of 16, 40 minims (2\ Cc.), and so on even when seriously 1 from various causes. Milk is the best vehicle even if given in apsule. Must not be given in spirit or turpentine. It would be desirable to qualify the above with the following Not the ideal anthelmintic. In addition to the many deaths reported m he literature (some wuth doses as low as It Cc.) there are many unrepoiue ^ italities. No justification in morality, science, or expediency ml the> nerd reatment of backward races.—Clayton Lane, B.M.J. n./28,19o. bee alto i./3o,1317.—1'5 Cc. is the fatal dose. Very strong remarks Teffurthlr abstract of this authority’s criticisms and those of others Postea A heavy, volatile, and mobile chloroform-like liquid, ha& a pleasant mngent, quince-like odour if pure. Sp. Gr. 1*56. B.pt, 77 to 78 C. JJses._It has been extensively used in Ankylostomiases, byn. Uncinariasis, Dochmiasis, HookvTorm infection. , ,, The vapour inhaled relieves hay fever. Employed locally, prinkled on piline or lint covered with American oiled cloth, it l'DeatLrtav7beeneS^S°by7teSuse as a dry shampoo hy hairdressers.- ;^For\%®cttafGinger, etc., not well spoken of.-G. Trease, AnAmstomiasis and other Worm Infection. ft Ss expulsion of ascaris lumbricoides.iffollowed hy boturnot , t i loo °Q1 1057 10 Cc. doses considered a maxi- Effective m animals. L. j q /22 295. 10 Cc. doses, in 264 h00kW°rmS "fent as fkthymT Tt°may bebomhined with Oil of Chenopodium for variations m individual reaction to drug^ -0^ . symptoms in an acute especially susceptible, 1*5 Cc. having■ ji Trop. Med., April I6/23,127. ilcoholic.—W. G. Smillie and S. B.Pess ’,1* . . • ^ has soporific action on Doubtful whether it is an actual anthelmintic, rookworm patients.—T. A. Hemy,i . .-/ 8, • ^ adults found to he Hookworm in Filipinos. Approxralately i^ ™ ‘^Tubangui, per .11. Trop. nfested with hookworm.—B. Schwartz ana m. a. Med., May 1/2 3,143. Report from Tort Benning Hospital, Ga. Vastly superior to Oil of Cheno- ?2?lul?™r Thymol•—A. T. Cooper and A. J. Vadala, Jl. Trop. Med., April 16/23,130. In i iji 27,000 people treated without a casualty.—S. M. Lambert, per Jl. Trop. Med., Mar. 15/23,92 ; Col. Hep., Aug. 15/23,61. Action on the liver.—Inadvisable to prescribe 5 Cc. doses, as an anthelmintic with purgation, let alone without it. 3 Cc., however, appears safe. It is specific for ankylostomes, and is fairly efficient for ascaris lumbricoides and oxyuris vermicularis, but of little value in the elimination of trichuris trichiura. —J. I. Docherty and E. Burgess, B.M.J. ii./22,907. Surface infection of the soil is only one phase in the free life of the hookworm. I he hookworm larvae spend a considerable part of their life in the soil at various leveiS. Eggs may hatch out in a few days and the larvae start then to migrate. —L.i./23,604. Moderate alcoholism is not a contraindication, providing liquor is withheld two or three days before and after treatment. Saline pu rgatives should not he given immediately before treatment. 1 he drug should never be given during the course of an infectious disease. In surgical cases where it is desired to rid patient of hookworm the drug should be given several days before the use of an anaesthetic.—C. N. Leach and co- workers, per Jl. Trop. Med., Ecb. 15/23,47. Given in Travancore, to several thousand coolies every month—the dose being 2 minims for each year of.age, with a maximum of 45 minims, floated on 2 ounces of water; no complaints.—J. H. Moore, Travancore, Feb., 1925. Pregnancy not a contraindication where Necator americanus is the offending agent—Jl. A.M.A. i./26,736. Follow with a saline purge. Unsuited for weak individuals and those with liver derangement. Fats and Alcohol should be avoided and a diet rich in carbohydrates and poor in fats is indicated. Can be given in kala-azar and malaria during remissions of fever, and is safe for pregnant women. Superior to Chenopodium for Necators and on a par in removing Ankylostomes. M ith Clienopodium has a distinct ascaricidal action and orally has more action on Oxyuris than any other anthelmintic. Promising also by rectal injection, in warm milk. Little action against Trichuris, Strongyloides, or tapeworms— A. C. Chandler and A. K. Mukerji, I.M.G., Feb., ’25,68. Good results in Egypt—Per Jl. Trop. Med., July 15/25,268. The addition of Chenopodium of no value in pure Necator infections, but the combination is more powerful on Ankylostomes than either drug alone. A dosage of 60 m. of Carbon Tetrachloride m milk and 15 m. Oil of Clienopodium in a capsule is safe for controlled patients. —A. C. Chandler and A. K. Mukerji, I.M.G., April, ’25,147. Combined almost ideal.—L. i./3o,27. More than 225,000 persons treated in Siam since May, 1923, with a mixture of Clienopodium (40%) and Carbon Tetrachloride (60%). Maximum dose 2 Cc. Three deaths reported—Jl. Am. Pub. Health, per Jl. A.M.A. ii./2 5,1001. A dose of 3 to 4 Cc. for an adult of Carbon Tetrachloride is as safe or safer than any other anthelminticr provided it is accompanied or followed by a saline purge, patient is well nourished and has normal liver, has adequate amount of Calcium in his diet, refrains from use of Alcohol before and after treatment, is given diet rich in carbohydrates and poor in fats, and is not starved preliminary to treatment, the drug being given about 3 hours after a moderately light carbohydrate and protein meal. Heavy ascaris infection a contraindication unless the drug is given in combination with Oil of Clienopodium. A single dose of 3 to 4 Cc. is safer than a smaller amount given in divided doses.—It. N. Chopra and A. C. Chandler, ‘ Anthelmintics and Their Uses ' (Balliere, Tindall and Cox, 1928). 60,000 hookworm patients received treatment at the Old Cairo Hospital (C.M.S.) during 8 years. Writing October, 1928, the treatment most favoured was Carbon Tetrachloride and Chenopodium Oil, or Thymol with Magnesium Sulphate intervening—course spread over 12 days.—Miss C. 0. Byrde, B.C.P.. Oct., 1928. A mixture of Carbon Tetrachloride 2 and Chenopodium Oil 1, given to children, 0-1 Cc, for every year of age up to a maximum of 1-5 Cc.—Col. Med. Report, No. 207, p, 33, per Jl. Trop. Med., May 2/27. t t CARBONIS TETRACHLORIDUM. 273 Criticisms.- Carbon Tetrachloride does not occupy the osition claimed. Thymol and Chenopodium Oil, 4 Gin. ™ Cc. respectively, are safe, the latter being more effective against . auodenale. After expulsion of the worms Arsenic may aid the bone marrow formation of haemoglobin. A drug specific in its toxicitv to hookworms ns yet to be found.—Lt.-Col. C. Lane, L. ii./26,346. Deaths after Carbon Tetrachloride have occurred in Jamaica, and Thymol now the drug of choice against hookworms.—B. M. Wilson, B.M.A. Ann. eeting, B.M.J. ii./28,207. Carbon Tetrachloride a proved potent liver nson and should not be given to a purged and fasting patient unless sufficient Lucose is given at the same time.—H. M. Hanschell, ibid. Of value by the out.h and intravenously in human schistosomiasis and in distoma infestation cattle.—F. G. Cawston, ibid. D sual simile dose 2-5 to 3 Cc.—F. G. Cawston :ans. Boy. Soc. Med., Nov. 25/28, p. 245. Tetrachlorethylene and Carvacrol (q.v.) have been tried in hookworm id the former in liver fluke.—P.J. L/31,29. Distomiasis of sheep.—Carbon Tetrachloride 1 Cc. in capsule, without evious starvation is generally sufficient to clear adult flukes from the bile Lets. Some flocks tolerate the drug badly and it is best to try it on a m sheep first.—L. ih/27,128. From personal knowledge this dose harmful and not efficacious : on the other hand a much smaller dose—e g 1 Cc. combined with 0-3 Gm. crude Filicin in 0-4 Cc. Vegetable Oil is certainly ective.—W. H. M., March, 1928. Carbon Tetrachloride poisoning.—Much has been written on is subject, see Edn. XIX., p. 275. Carbon Bisulphide has been suspected as isonous impurity. Antidote for Carbon Tetrachloride. Magnesium Sulphate the best — G. Cawston, Pr., Apl. *31. Fractionation and rejection of the first 1 % desirable—M. Khalil, L. h/2 6,547. Should not contain more than 5 parts per million of Carbon ’sulphide, should be free from acidity, chlorides, free chlorine, organic itter and aldehydes—M. Perkins, P.J. ii./24,101. See also H. H Dale — es., Sept., *24,323. !>sorption and Excretion of Carbon Tetrachloride. The livers of dogs receiving 3 Cc. by the mouth were badly damaged. Since } danger is greatest during the first few minutes after reaching the duodenum i/e a saline purge immediately.—H. S. Wells, Jl. Pharm. and p. Ther., ’25,235. Poisoning due to production of hypoglycaemia. Believed by intravenous Tcium Therapy—A. S. Minot, JL Pharm. & Exp. Therap., Oct. ’31,312. Schistosomiasis.—Carbon Tetrachloride is not contraindicated even ring a course of treatment with Antimony, though both drugs are liable produce hepatitis or to aggravate this condition where it already exists in tistosomiasis. May be given alone, or, with intravenous Antimony, adds the effectiveness of Antimony therapy. The parasites may show very >id signs of destruction after one or more doses, but those not completely ed are still confined to the blood-stream and soon recover.—F. G. Cawston, ms. Boy. Soc. Trop. Med., Vol. XXII., No. 3, Nov., ’28,247 ; Jl, Trop. d., Feb. I6/31. Dry Cleaning.—Being non-inflammable, the solvent is useful. When added Benzine for safety it should constitute at least 70% of the mixture. For ve cleaning it leaves the leather less likely to crack. Pertain oleo-resins may be made by Carbon Tetrachloride extraction, but las no great advantage except non-inflammability. It is not suited for aioidal drugs. It gives colour reactions with the 0- and m- but not the p- •stituted phenols.—G. E. Trease and H. Tingey, P.J. ii./26,150. odised Carton Tetrachloride.—Two cases of lupus erythematosus and one uberculous lupus treated by local use of Carbon Tetrachloride and the same ised (3% is mentioned). Applied on cotton wool alternately, and in Lition Iodine internally. Fistulas were washed out with 1 to 5 Cc. of the parations. In a case with great oedema 1 to 2 Cc. of the Iodised preparation 1 injected under the skin.—Goubeau, Cong. Derm, and Syph. Strasbourg, 3. CASCARA SAGRADA. (.B.P. ’14). U.S., P.G. V., P. Ital. V., F.E. VIII., P. Belg. IV. Syn.—Sacred Bark. The dried bark of Rhamnus purshiana {Rhamnacece). Dose.—3 to 15 grains (0*2 to 1 Gm.) in cachets. The active constituents of Cascara cannot be defined. In Vol. II. we provide some data. B.P. ’14 and U.S. X. require the bark to be kept one year. The tree grows extensively in British Columbia. For notes on cultivation and substitution, see Vol. II. P. Ital. V. requires the bark to yield not less than 24% extractive and not more than 6% ash. Flavoring.—See Extractum Cascara Liquidum. Uses.—Increases peristalsis, empties rectum ; it is useful for internal piles, and is a good laxative. For dosage see Liquid Extract. Cascara Capsules (‘ mild ’) represent 30 minims of Liquid, or about G grains of Solid Extract. Capsules (‘ strong *) are double strength. Dose.—1, 2, or more. The mild are also prepared with Euonymin 1 grain. Dose.—1 or 2 at bedtime. Cascara Jelly. Dose.—1 to 4 drachms, equivalent to Cascara Extract J to 2 grains. For habitual constipation. The agar-agar basis renders the faeces more voluminous and In/drous, It is agreeably flavoured. Cascagar.—Marlindale. Bose.—1 teaspoonful up to 2 tablespoonsful to be taken with stewed apple or other moist food. A preparation of flaked Agar with Cascara Extract flavored with Lemon, also with Baspberry, acting similarly to the preceding. Syrupus Cascara Aromatieus {B.P. ’14). Syn. Elixir of Cascara B.P.C., 1894. Contains 40% of Liquid Extract of Cascara flavoured with Orange and Cinnamon. Dose.—4 to 2 drachms (2 to 8 Cc.) as laxative. Extractum Cascara Sagrada Siccum {B.P. ’14). Dose.—2 to 8 grains (0*12 to 0-5 Gm.) in pill.—An aqueous extract {Cascara Sagrada is indeclinable, being Spanish and not Latin). U.S. X. 1 = 3 by extraction with boiling water, and adjusting with starch. Fr. Cx. and P. Ital. V. extract with 60% alcohol. Extractum Cascara Sagrada Liquidum {B.P. ’14). Dose.—30 to 60 minims (2 to 4 Cc.). An aqueous extract containing 25% of alcohol (90%). It may be made miscible with water by adding half its volume of sal volatile. 110 minims on evaporation on a water bath for 4 hours should yield not less than 20 grains of residue. p. ital. V. is similar. P. Belg. IV. uses 60% Alcohol. P. Jap. makes with Alcohol 90% and Water equal parts. Fr. Cx. Nouv. Supp. 1926, with Alcohol 50% 1 = 1 by weight using 8% of Light Calcined Magnesia in the extraction. Fluidextract U.S. X. 1 = 1 by percolation with hot water, evaporating and adding 25% of alcohol (95% vol.). cf. Giycetracts. Tse in Constipation.— ; It is best to take advantage of its tonic properties and avoid its purgative j;tion. The initial dose depends on the individual, but it must be correctly und—To to 20 drops t.d., suffices for the adult. The object is to procure one j otion only a day. The dose that is sufficient must be taken in a wineglassful I water thrice daily after meals for a week or ten days, or until the action jcomes somewhat too pronounced. Then reduce dose by one drop only id take with same regularity as before. In time it will be found that 1 drop water thrice daily after meals will be sufficient. Finally the medicine may i omitted altogether. Constipation in a child will often be relieved by one to three drops in a •achm of syrup one to three times a day.—Gordon Sharp. After laparotomy, suitable aperients are Confection of Senna or the following : xt. Cascara Sagrada Liq. 1 ounce, Sodium Sulphate 1 ounce, Solution of cmmonia 40 minims, Chloroform Water to 8 ounces. Dose.—2—4 drachms |ght. and morning.—C. W. Gordon Bryan, L. ii./3o.ll41. I Flavoring.—Syl Lavandulae, Syl Vanillae, Extractum Glycyrr- zse Liquidum, v. also Syrupus Cascara Aromaticus. Orange, Coriander, Anise, Cassia and Liquorice all mask the un- i easant taste of Cascara. 3itter-free Cascara ’—Martindale. Dose.—J to J drachm increased. A preparation to supply the tonic laxative properties of the bark hile omitting the griping substances. It is not made by means of magnesia. Fluidextractum Gascarai Sagradse Aromaticum, U.S. X.—Average dose. 130 minims (2 Cc.) 1- = 1. Made by percolating the drug mixed with magnesia Id slaked lime with boiling water, evaporating and adding several flavouring lents. Sometimes called ‘ Aromatic Cascara’ in the States. P. Ital. V. has also an Aromatic Liquid Extract employing Magnesia, th Licorice, Glycerin, Saccharin and Anise. ; ctractum Cascara Aromaticum Liquidum.—Coicley. , Dose.—30 to 60 minims (2 to 4 Cc.). (Cascara Sagrada (No. 20 powder), 20 ounces, Diluted Sulphuric Acid, Jounce, Alcohol (90%), 4 ounces, Oil of Coriander and Oil of Orange, of each minims, Spirit of Chloroform, 80 minims, Gluside (soluble), 13 grains, quid Extract of Liquorice, 4 ounces, Solution of Ammonia and Distilled ater, aa. o.s. to 20. For details of procedure, see Edn. XIX., p. 278. Kasak (T.M. 67927, 67928, 90413).—Dose for children, 1 or 2 drachms ; adults, J ounce. A laxative free from bitterness. isena.—-Dose as last, is the same with Senna. Kasena Capsules are also made. istura Cascara. Gt. Orm, H. iLiquid Extract of Cascara, Liquid Extract of Liquorice, Syrup of range Peel, Chloroform Water, of each 15 minims for one dose. CEDMistura Cascara Sagrada Compositus, Vic. Park. \Dose.—| to 1 ounce. (Liquid Extract of Cascara 1 drachm, Hyoscyamus Tincture \ drachm, fficture of Nux Vomica 10 minims, Aromatic Spirit of Ammonia 1 drachm, agnesium Sulphate 1 drachm, Syrup of Ginger 1 drachm, Water to 1 ounce. 'R.O.H. Liquid Extract of Cascara 20 minims, Liquid Extract of Licorice minims, Tincture of Belladonna 5 minims, Tincture of Nux Vomica 5 minims, 1 Volatile 20 minims, Chloroform Water to 1 ounce. istura Hepatica. Dose.—1 to 2 drachms in water. Liquid Extract of Cascara 20, Tincture of Jalap 20, Tincture of Podophyllum 10, Compound Tincture of Gentian 10, Chloroform Water 50, Sal Volatile 10. Pastils of Cascara each contain 2£ grains of Extract, and are coated with Tolu. Dose.—1 or 2 taken whole with a little water. CE> Pilula Cascara Composita. Extract of Cascara 1Extract of Nux Vomica, Dry Extract of Belladonna, of each -J, Milk Sugar 1. In grains for one pill, or in grammes for fifteen, each pill weighing 3J grains. Dose.—One before dinner or at bed-time. An agreeable and efficient aperient, with gentle action continuing beyond the first day ; good for liver inaction. Cascara Extract Tablets, plain or sugar coated, 1, 2, 3, 4, and 5 grains. Dose.—1 or more according to strength. Tmctura Cascara Sagrada. Laxative dose.—10 to 60 minims (0-6 to 4 Cc.). Percolate 1 to 5 with Alcohol 60%. (TDTineiura Laxativa. Dose.—20 to 60 minims (1-2 to 4 Cc.). Liquid Extract of Cascara Sagrada 2, Aromatic Spirit of Ammonia 2, Spirit of Chloroform 2, Tincture of Belladonna 1, Tincture of Nux Vomica 1. This is an agreeable and elegant form of administering Cascara, being miscible with water. Trociiisci Cascara Sagrada et Olei Menthse Fiperitae. These are made with fruit basis, contain 2b grains of Extract flavoured with Peppermint, and are useful correctives. Dose.—I or 2. Vinixm Cascara.—Martindale. Dose.—| to 1 ounce (15 to 30 Cc.). Liquid Extract of Cascara 1, Sugar 1, Aromatic Elixir 1, Sherry to 20. Mix and decant from any sediment which may form on standing. Dioxyanthraquinone. Syn. s^ISTIZIN (T.M. 318008). HO.C6H3CO.CO.C6H3.OH=242*0624. P.G. VI. Dose.—2 to 6 grains (O’12 to 0*4 Gm.). Orange crystalline powder, slightly soluble in water. M.pt. 190 to 192° C. A synthetic purgative. Tablets contain 0T5 Gm. if. Isacen (T.M. 451886). Syn. Diacetyl-dihydroxyphenyl-isatine. Dose.—2 to 4 granules, each 1/12 grain (0 005 Gm.). A synthetic purgative, which in small doses stimulates peristalsis by action upon the mucous lining of the colon and large intestine. It passes through the stomach unchanged and has no action upon the kidneys. CEREVISUE FERMENTUM. Syn. ILex Medicinalis. Dose.—b to 1 ounce (15 to 30 Gm.). The cells and spores of Saccharomyces Cerevisice. P.G. VI. requires Fsex Medicinalis to be dried at a temperature not exceeding 40° C.j and to retain its fermenting properties. "All fermentations produced by living organisms (as in the case of yeast fermentation of sugar) are caused by definite chemical substances_ferments—produced in the cells of the organism. The ferment from the yeast cell was extracted in 1897 by precipitating yeast juice with Acetone, centrifugalising and washing the sediment with Ether and Acetone, and drying over Sulphuric Acid. Molasses used for growing Yeast.—P.J. i./3o,577. Feexin. A dry powdered yeast. Pills and tablets are made v. infra. Dose.—A teaspoonful in water, beer, or milk with meals. Manufacture. The Acetone method of drying consists in treating the yeast with repeated quantities of Acetone, pressing off and then treating with Ether and Anally drying at not exceeding 45° C. Another method is to work in a partial vacuum over Sulphuric Acid at 42° C. (108° E.). Spread the Yeast in very thin layers. Uses*—Fresh yeast may be useful in indigestion and flatulence. The Vitamin content may assist in developing muscular tissues and the nerves and consequently improve general health. Both fresh yeast and the dried form are given to check boils and for acne. It is said that fresh yeast given per os grows actively in the stomach and slightly reduces sugar in diabetes. Yeast has been used for constipation, as also in tuberculous affections and in dysentery. In dyspepsia due to swallowing nasopharyngeal pus, it acts gastrically, and probably by direct contact. It not only checks vomiting, but after 14 to 21 days’ use it will be noted that the patient loses the icteric complexion, and gets a healthy colour. Some hold the action of Yeast is virtually that of Nuclein, as it is still effective after the yeast has been heated to 130° for an hour. Glycogen 5% (equivalent to 25% of the dried material) is a constituent of yeast.—Pavy and Bywaters. For the peripheral neuritis of mediterranean fever, yeast has been recommended in doses of two drachms, twice daily, (c/. Vitamins.) Fsexin Extract. Syn. Extractum Cerevisiaa Fermenti. Made by extracting fresh Yeast. This has been used for the various affections for which fresh and dried Yeast is employed, e.g., in acne, erysipelas, furunculosis, folliculitis, leucorrhoea, diabetes, conjunctivitis, phlyctcnulosa, typhoid and acute articular rheumatism. Faexin Extract Pills, Stearettes and Tablets contain 3 grains (0-2 Gm.). Extractum Faecis, P.G. VI. Prepared by Arst removing the bitter of fresh ‘ lower ’ beer Yeast with 1% Sodium Carbonate, and then submitting to a process of auto-digestion in the presence of Hydrochloric Acid, Anally extracting the mass with water, evaporating and incorporating 25% of ‘ Medicinal Yeast ’ (entire Yeast with bitter removed) to produce the powder. The extract is used as pill excipient. 5|cBarmsule (T.M. 521176). A proprietary (Patent 18426/31 applied for) containing live Yeast cells in Capsule form. Dose.—2 to 4 twice or thrice daily. . Advocated in amemia, boils, constipation, eczema, headaches, indigestion, insomnia, nervous disorders, rheumatism, sciatica, etc. Live Yeast, by regulating the process of digestion may improve assimilation. The Vitamins present are also brought into effect, as also the stimulation of the white blood corpuscles. ^Marmite (T.M. 249997, 321670, 404589, 430172, 510094, Cl. 2), a palatable yeast extract, is rich in Vitamin B. It is stated to promote growth in w^eakly children, assimilation of fat, produces leucocytosis in chronic septic conditions and increases general metabolism. Vitamins are absent from meat extract. Apart from this fact, there is no available information to show that meat extract is better or vice versa.— A. Chapman, P.J. i./i9,115. The preparation of Yeast Extract.—P.J. n./27,4S-. PERNICIOUS anemia of pregnancy treated with Marmite and with Liver Extract. Both preparations are active even when complicated by malaria or hookworm. Marmite thought equal to Liver. Suggests that macrocytic anemia is a deficiency disease.—Lucy Wills, B.M.J. i./3i,1059. Irving’s Hefe-Vitamin Tabletten, according to investigation of C. A. Rojalm, contain Yeast 31%, Water 6.65%, Sodium Bicarbonate 25-2%, Ammonium Bromide 8-9%, Phenolphthalein 4-4%, Pyramidon 15-5%, Excipients 8-2%. The lreast was non-fermenting.—Gehe. Yeast Vite is T.M. 461971. Nuclein. Dose.—15 grains (l Gm.) several times daily. Tablets, 1 grain (0 06 Gm.). Is considered to be a compound of Nucleinic Acid with Albuminates and Carbohydrates. It tends to stimulate formation of white blood corpuscles, and hence to act as a bactericide. Septicaemia has been treated with it. The following is generally used :— Acidum Nucleinieum. Syn. Nucleic Acid, White powder somewhat soluble in water in the presence of a sufficiency of Sodium Hydroxide or Potassium Acetate. Its solution is acid to litmus paper. Insoluble in Alcohol. J. J. Blackie, in a note on Pharmaceutical nomenclature, supports our divisions of these compounds.—P.J. ii/2i,543. Commercial Nucleic Acid should contain not much less than 15% Nitrogen and 9% organic Phosphorus on the dry material.—A. C. Chapman, Analyst, 1918, 43, 259 ; see also Y.B.P., 1919, 148. E.E. VIII. gives 10-11% Phosphorus in organic combination. Dose.—15 minims (1 Cc.) of a solution made with Alkali q.s., v. infra, hypodermically. Sterules, Hypodermic, contain £ grain in 15 minims (0-05 Gm. in I Cc.). Much larger amounts have however been given, vide infra. Per os \ to 2 grains. When NUCLEINIC ACID is ordered for injection, give the equivalent in the form of Sodium Nucleinate, the Sodium Nucleinate being prepared from Nucleinic Acid and a sufficiency of Sodium Carbonate to make it neutral to litmus. The wr iter is in the habit of employing a 5 % Sodium Nucleinate solution when a saturated solution of Nucleinic Acid is ordered for injection. Sodium Nucleinate solutions should be prepared with Normal Saline and a sufficiency of Phenol for preservative purposes. Uses,—In treatment of anaemia, scarlet fever and puerperal fever, also in tuberculosis. To increase leucocytosis, and also the resistance of the patient in typhoid. Sodium Nucleinate Solution 2 Cc. containing 0-05 Gm. per Cc- intramuscularly increases leucocyte count; found of value in influenza.—J. "Graham Willmore & F. M. Gardner-Medwin, L. i./22,116. See also Gardner-Medwin, B.M.J., July 12, 1924, and P. S. Hichens and R. E. Gibson. Apparently saved life in a case of imminent pneumonia. 2 Cc. given every 4 hours. Should be tried in puerperal fever and other bacterial infections.—B.M.J. i./28,52. Lobar Pneumonia.—Sodium Nucleinate, 0T Gm. intramuscularly, of value It brings down the temperature within 48 hours—otherwise the dose is repeated. Sodium Bicarbonate also given by mouth in \ drachm doses every 4 hours in severe cases when the urine contains Acetone.—B.M.J.E. i./27,64. In lobar pneumonia of an asthenic type in which leucocytes do not rise in number as the disease advances.—J. D. Comrie, Pres., Nov., ’27,390. Pneumonia treated—H. J. Clutterbuck, B.M.J. 4/31,830. Septicemia, where operation is requisite, treated by B. toll 50 millions and Streptococcus 10 million 10 days, and again 3 days before operation and on the night preceding operation, 5 Cc. of 5% Sodium Nucleinate intramuscularly.—D. P. D. Wilkie, B.M.J. ii./3i,595. Sodium Cacocfyfate with Nuciesnec Acid in Septicaemia, see p. 182, Progressive paralysis treated by Sodium Nucleinate on the basis that leucocytosis should be the aim.—O. Fischer, L. ii./22,537. Bismuth! Nucleinas. Dose.—20 (1*2 Gm.) to 40 grains (2-5 Gm.), Yellowish powder containing 50% Bi. Insoluble in water and in dilute acids, splits up in the intestines, hence used as astringent for chronic intestinal catarrh. Was used on children under 2 years of age, also in cases of tuberculous diarrhoea, with benefit. s^Nargol (T.M. 228097), Mercurol and Cuprol are compounds of Nucieinic Acid with respectively Silver, Mercury and Copper. Cuprol and Nargol are of use in granular ophthalmia in the form of 5% instillations. Nargol is soluble in water 1 in 4. Contains about 10% Ag. Nargentol is stated to be a silver nucleinate. Glutathione. A tripeptide containing Glutamic Acid, Cystine, and Glycine, corresponding to C,0Hi7N3SO6, M.pt. 190° (with decomposition). The tissues of rat sarcoma, carcinoma and human mammary carcinoma contain abnormally small amounts of reduced Glutathione. Glutathione promotes the oxidation of certain unsaturated fatty acids and Lecithin. \ Glutathione was first isolated by Sir Gowland Hopkins in 1921. (The author prepared a small quantity for experimental purposes from yeast (1930), using the method of Sir Gowland Hopkins.)—Jl. Biol. Chem., Oct., *29,269. Relation of Glutathione to Arsenicals.—Ho relationship established between reduced Glutathione and susceptibility of animals to Arsenical intoxication. The therapeutic effect of Thiosulphates in Arsphenamine dermatitis must depend on*some property other than effect on the Sulphydril content of the skin.—H. Brown and J. A. Holmer, Jl. Ph. & Exp. Therap., *2 9,417. ®CHLORAL HYDRAS (B.P.’li). U.S. X, P.G. VI.. Ph. Ned V., P. Jap., P. Helv., P. Ital. V., P. Belo. IV., i'.E. VIII., C.C13.CH.(0K)2== 165-3944. Trichloretiiylidene Glycol. Dose.—5 to 20 grains (0-3 to 1-2 Gm.) in aqueous solution, or in chloroform water well diluted. Fr. Cx. has maximum single dose 60 grains, during 24 hours, 180 grains approximately. Manufacture.—By the action of dry Chlorine upon Alcohol. It has M. pt. 49—53° C. Soluble 4 in 1 of water, 5 in 1 of alcohol, 2 in 1 glycerin, 2 in 1 of ether, and 1 in 3 of chloroform, likewise soluble in oils and fats. Flavoring.—Glyl Rosse, Glyl or Syl Amygdalae Amarae; Syrupus Aurantii Floris. Antidotes to Chloral.—Keep patient awake, apply strong ammonia to nostrils. Stomach pump or emetics (zinc sulphate 20 grains), followed by amyl nitrite, coffee, electricity, oxygen, picro- toxin, or strychnine. For Antidotes to Ohiorai when in oon* Junction with Morphine, see Antidotes to Poisons. It is useful as an antidote to poisoning by strychnine. incompatible with alkalis, ammonium salts, potassium iodide or permanganate, and with bromides in presence of alcohol—chloral- alcoholate may separate ; also, with Magnesia, Chloroform and Magnesium formate may be produced; and with Sodium Barbiturate. ■—P.J. i./3i,503. Liquefies with camphor, q.v. Uses,—As a hypnotic, it is often combined with opiates, morphine or bromides, but it is incompatible with quinine. Its use is contra-indicated in heart affections, Bright’s disease, and when the vital force is very weak. Its sedative action resembles that of chloroform. In asthma Chloral Hydrate 30—40 grains is often useful.—Yeo. Chorea has been treated by inducing prolonged sleep with its aid. It is given in tetanus. In epilepsy small doses may be efficacious. In puerperal eclampsia—control of fits by Chloral and Morphine regarded in France as almost specific.—For details see Edn. XIX., p. 282 or B.M.J. i:./i2,1128. , . , . 8ea-sickness has been treated with drachm doses of a mixture of 2 drachms of Syrup of Chloral with 30 grains ammonium bromide, in water I t ounces. Influenza has been treated with 2% solution as gargle. ®Chloral Camphoratum, B.P.C. (Pigmentum Chloral et Camphors?, T.H.). Chloral Hydrate 1, Flowers of Camphor 1. Sp. Gr. 1-223. Combine in a warm mortar. It remains liquid at ordinary temperatures, and forms a valuable application painted on painful parts in neuralgia and rheumatism. It mixes freely in alcohol, ether, oils and fats, but the camphor is precipitated on adding to water or glycerin. Cocaine 10% or less may be incorporated. The compound (chloral and camphor) dissolves the alkaloids atropine, morphine, and veratrine to the extent of 1 in 30 or more, but their salts are less soluble in it. Liquefactions of a similar kind take place on mixing and gently heating respectively chloral hydrate 1 with menthol 1, or phenol 3, or thymol 1. Quinine salts and chloral hydrate also form liquid combinations. . In fibrositis the mixture of chloral hydrate, camphor and menthol is found to be satisfactory. Painted over the part, then gently rubbed in with the fingers.—A. P. Luff. Cej Pigmentum Chloral Compositum.— Yv . H. lias Chloral Tiyuiate ], Menthol 1, Thymol 1, Camphor 3. L.H. consists of equal parts of Chloral Hydrate, Mentho land Camphor. Cautiously used it is good for minor cases of flexural prurigo—one or two drops rubbed into the spots at bed-time.—W. J. O’Donovan, B.M.J. ii./30,957. Cg) Linimentum Chloral Compositum.—R.D.H. is the same, eg) Chloral Tannin Solution.—Syn. CAPTOL. Chloral Hydrate 1, Tannin 1, melt together on water-bath and dis solve in water, q.s. to produce 8. For strengthening the hair. eP) Lotio Crinalis R.N.H. Chloral Hydrate 10 grains, Salicylic Acid 10 grains, Mercuric Chloride i grain, Glycerin 20 minims, Acetone 1 ounce, Isopropyl Alcohol to 1 ounce. eE> Liquor Bromo-Chloral Compositus. B.P.C., 1901. j)osc.—.1 to 2 drachms (2 to 8 Cc.). 1 drachm contains nearly 1( trains each of Chloral Hydrate and Potassium Bromide. Choral Hydrate 1,600 grains, Tincture of Indian Hemp 40C minims, Tincture of Fresh Orange Peel 400 minims, Henbane Juice 1,600 minims, Svrup 3^ ounces, Liquid Extract of Liquorice % ounce? Dissolve, add Potassium Bromide 1,600 grains dissolved in Distillec Water 7 ounces. Filter and add Distilled Water to 20 ounces. Resembles (E> Eromidia (T.M. 45813), which is stated to contain in each drachm Chloral Hydrate 15 grains, Potassium Bromide 15 grains, Extracts of Cannabis and of Hvoscyamus 4 grain each. Dose.—J to 1 drachm in syrup or water. CE> Enema Chloral, L.H. Chloral hydrate 10 to 40 grains, starch enema to 4 ounces. <E> Suppository of Chloral. Chloral Hydrate 5, Oil of Theobroma 10. In grains, for one suppository, in grammes, for fifteen. Press into moulds. Heat must not be applied. It is useful in infantile convulsions. It is locally irritating. CE) Syrupus Chloral (B.P. ’14). Dose.—J to 2 drachms (2 to 8 Cc.). Chloral Hydrate and Water a.a. 20% in Syrup. CE) Tablets of Chloral, 5 and 10 grains (O’3 and 0*6 Gm.) to be dissolved—not swallowed whole, might blister. Dose.—1 or more. Chloral amide. Syn. Chloral Formamidum (B.P. 14). CClaCH(OH)NH.COH=192-4102. Dose.—15 to 45 grains (1 to 3 Gm.) in weak spirituous or acidulated solution. Max. single dose 4 Gm. Max. in 24 hours 8 Gm. Patent : 7391/1899 Expired. Trade Mark : A device with name and address, T.M. 95188, is still on the Register. In colourless, inodorous, shining crystals with a faintly bitter taste. Soluble about 1 in 20 of water, 1 in 2 of alcohol. Must not be heated over 55° C. M. Pt. 114-115° C. Incompatible with alkalis. Manufacture.—By combining anhydrous Chloral 147 with Pormamide 45 and recrystallising from Alcohol about 70%—care being taken, as above mentioned, not to heat above 55° C. The toxicity of a brand of Choralamide made by the author, August, 1916, was found to be less than that of Chloral Hydrate and not greater than that of the Chloral which it would yield on hydrolysis. The details showed that up to 70 mgr. per 100 Gm. of frog were tolerated in the case of Chloral Hydrate, while up to 100 mgr. were tolerated in the case of Chloralamide. Wses.—Hypnotic in insomnia of alcoholism, neuralgia, hysteria, cardiac diseases and sea-sickness, Chloralamide and Potassium Bromide of each 15 grains, with Orange Tincture and Chloroform Water recommended. It acts if given as an enema.—Hale White. Elixir Chloralamidi. Dose.—1 ounce (30 Cc.) = 30 grains (2 Gm.) Chloralamide 2 Gm., Alcohol 5 Cc., Aromatic Syrup 5-4 Cc., Glycerin 15 Cc., Water q.s. to 30 Cc. Haustus ChloraJamidi, G.H. Chloralamide 30 grains, Mucilage of Tragacanth 1 drachm, Chloroform water to 1 ounce. Tablets, 5 grains (0*3 Gm.). Dose.—3 or more. Chlorobrom. Dose.—| to 1 ounce. A specialty said to contain 30 grains each of chloralamide and potassium bromide in an ounce, flavoured with liquorice, for insomnia and sea-sickness. Haustus Chlcralamidi Compositus, N.H.I. Chloralamide, Potassium Bromide, of each 15 grains, Spirit of Chloroform 20 minims and Water to 1 ounce. ® CHLOROF0RMUM (B.P. ’14). P.G. VI., U.S. X, P. Jap., P. Helv., Fr. Cx„ Ph. Ned. V., P. Ital. V. CHC13= 119-3788. Ce)Chloroform and all preparations or admixtures containing mort than 20% of Chloroform. Sign. Trichloro-methane ; Formyl Terchloride. Dose.—1 to 5 minims (0-06 to 0-3 Cc.), in mucilage and water or in a perle ; 3 drops =1 minim. Small doses may be given ai chloroform water or spirit of chloroform. Verv large amounts (uj to 2 ounces) have been taken internally without causing death. For History and Testing of, and further information on Chloroform see Vol. II. A little caustic lime added to a bottleful will neutralise any acid products that may form in it. Pink Chloroform and Green Ether suggested to prevent accidents — B.M.J. ii./i4,241. CE)Acetone Chloroform specially prepared for anesthesia. Shouk be kept in amber-coloured, stoppered bottles or in the dark. Chloroform has Sp. Gr. 1*490 to 1*495 at 15*5° C. Boils at 60 °— 62° C. Miscible in all proportions with Alcohol, Ether and Oils It may (B.P. ’14) be made from Alcohol, Industrial Methylatec Spirit or Acetone Sp. Gr. 1*483 to 1*487, and contains 2% Alcohol Uses»—Inhaled, it is anesthetic and analgesic. Internally i antispasmodic and sedative for asthma, colic, cough, and neuralgia In sea-sickness, one or two drops of Chloroform on a lump of suga or in a wineglass of iced soda water, repeated every fifteen minutes often give relief. Externally in liniments to promote absorption and allay pain, a in neuralgia and sciatica. See General Preparations of Chloroform 1 in 500 is a preservative of Infusions and Animal Extracts. It i a useful deodorant, e.g., for the hands after post-mortem work. Infection by intestinal parasites, e.g., Anhylostoma, Ascaride< and Oxiurides are well treated by doses per os of 3 to 4 Gm. mixec with Castor Oil or Olive Oil. It is a panacea also against all form of external parasitic infection—e.g., a 20 to 30% Chloroform in i fatty ointment base.—G. Alessandrini, L. ii./i5,346. Ancesthetic Uses and Preparations of Chloroform. Chloroform is a liver poison. If Glucose is given a few hour before it is well tolerated. The Vernon Harcourt Regulator permits of accurate dosi metry by the anaesthetist. The temperature of the Chloroform i adjusted to 16-18° C. and an admixture of Chloroform vapour 0*2^ with air is used to begin with, afterwards increasing the Chlorofom every half minute by 0*2% to a maximum of 2%. Narcosis is main tained by 0*5 to 1%. See also “Anaesthetics” by Dudley Buxton (H. K\ Lewis). Shipway’s Apparatus (L. i./i6,70). The most satisfactory wa; of giving Chloroform or Ether. Warmed mixture of air and anses thetic vapour in operations for abdominal wounds in war. Patien recovers consciousness quickly and vomiting is rare.—C. Wallace and G. Marshall, L. i./i 7,640. Administration of Chloroform either alone or with A.C.E. or Ether on the open Mask. The following is “ a rough sketch ” of the usual procedure :— “ The patient who has been breathing steadily and counting aloud, begins to waver and make errors, and then passes into complete anaesthesia. The pulse slows down, and becomes regular, the respirations become regular and blowing, the flaccid cheeks being puffed out with each respiratory effort; the whole muscular system becomes limp, and the pupils become moderately contracted and fixed. The chin must be maintained pulled up ; respirations must always be audible, even loud ; pulse must be frequently taken and pupils watched.” These are the three indicators. Pulse.—Pulse greatly accelerated generally means that the patient is coming out and is liable to be sick shortly. If pupils or conjunctival reflex corn- firm this, push the anaesthetic. Pulse becoming weak, irregular or slower, indicates a state of faintness,—remove mask, /f collapse supervenes commence stimulatory measures,—the head to be lowered and body tilted up. Ether and Strychnine hypodermically ; gag to be inserted. See that the pharynx is free from mucus by pulling tongue forward. Rectal in- jection of Brandy, cold water to face and ears ; hot cloths over pericardium and (to the adult) artificial respiration. In the case of an infant or child the operator doubles a fist into the child’s epigastrium to prevent distension of the stomach, covers child’s mouth with a layer or two of gauze, and placing his mouth over the child’s, blows the lungs up. The air is then expressed from the lungs and the procedure repeated several times. Pupils.—“ Pin point ” pupils may either mean profound anaesthesia, m which case remove mask, or patient is coming out. When the pupil becomes dilated remove mask, draw both upper eyelius back rapidly and simultaneously. If patient is coming round, response will be obtained,—push the anaesthetic. If no response, patient is in a state of collapse and requires stimulation. Respiration.—Should the respiration tend to become too quiet, correct by- closing one of the nostrils with the finger. Keep lower jaw pushed forward and pharynx clear of mucus, also see that the tongue is well forward. The loop handle of a sponge holder is useful to bring tongue forward in the case of children. Vaseline should be smeared over the parts most likely to come in contact with the mask, thus preventing burning the patient’s skin with the overflowing anaesthetic. . . , , _ , Combined Use of Chloroform and Oxygen.—This is conducted by passing the Oxygen through a wash-bottle containing the anaesthetic. The quantity of the Chloroform or Ether is, however, relatively small in comparison with the Oxygen passed through. Alternatively a funnel-shaped leather inhaler containing a piece of spongiopiiine or felt is used. In the upper surface of the leather inhaler is a small metal tube for connecting with the Oxygen supply, thus a definite quantity of anaesthetic is given and the amount of Oxygen can be varied as desired. . . Crile’s Kasai Tube method of giving Chloroform (with a little Oxygen), preceded by Morphine and Atropine.—L. ii./o9,364. Antidotes for treatment if dangerous symj.i- tams arise cfurinQ inhalation of chloroform- (For Antidotes to c^Boroform swallowed see Antidotes to Poisons.) See that the airway is clear and the clothing loose. Place patient upon the floor with legs held up so that the abdomen is higher than the brain. Artificial respiration by tongue traction (Pull out the tongue) and Sylvester’s or Schafer’s method. Amyl Nitrite to the nostrils and inject hypodermically 1 drachm of ether or brandy or grain of strychnine or 1 Cc. of Cursch- mann’s Solution. Hot flannels should be placed over the heart. Caffeine hypodermically or Brandy per rectum. Inversion of the body has frequently saved patient. Fibrillation of the heart can be remedied by Atropine sub* cutaneously. Sodium Lactate Solution. Copious rectal injection has been recommended to restore alkalinity of the blood—assuming Acetone and Diacetic xAcid are products of the effects. Heart massage in Chloroform Syncope by the subdiaphragmatic route often induces recovery. Glucose per os if no vomiting, otherwise subcutaneously or intravenously. If i grain of morphine be first injected hypodermically, less Chloro~ | form is needed, the insensibility is more profound, and the danger attending its use is lessened. Tne previous administration of Quinidine protects against Adrenalin Chloroform syncope and against the danger of heart failure under anaesthesia.— J. Pharm. China., *27,190, per P.J. ii./2 7,591. The Dangerous Effects of Chloroform fall into four groups (1) depression of the respiratory centre (2) fall in blood pressure (3) late toxic effects (4) Chloroform syncope. The use of Chloroform is not justifiable (1) in cases of grave debility with low blood pressure, especially in cases of patients suffering from shock (2) in cases likely to develop acidosis, e.g., the diabetic, the sufferer from septic abdomen, and children (3) in a great many cases during the induction period. To continue to administer Chloroform to an excited and struggling patient cannot be made a safe proceeding and is unnecessary and unjustifiable.—A. Mills, L. i./26,1134-30. Sodium Bicarbonate dissolved in hot water is given to neutralise acid, and dissolve mucus and dilute the irritant in the stomach. Hot fomentations or poultices are efficient counter-irritants for JL the epigastrium. A dilute Hydrocyanic acid, Bismuth and Soda Mixture acts well, and in some cases with a foul tongue, powders of Rhubarb, Bismuth and Soda are useful. Morphine increases the sickness, but gives rest. Scopolamine and Morphine is better. After most abdominal operations flatulence is relieved by Saline per rectum—1 pint to 1 quart every four hours—leaving in a rectal tube for an hour or so between times. Rubbing the abdomen adds: to the comfort of the patient, but more vigorous treatment may be required, such as Turpentine enemata. If the violent sickness still persists give Castor Oil or Magnesium Sulphate by the mouth. If the bowels do not act in six hours an enema of soap and water is effectual. Enemata of brandy and water and sips of brandy may be needed. In abdominal operations when the vomit is haemorrhagic and resembles beef-tea dregs or coffee grounds, carry out the above treatment for flatulence, stimulate the patient, give copious draughts of hot soda solution. A leak of blood into the stomach tends to increase sickness. Wash out the stomach and follow with 5 to 10 minims of Adrenalin Solution in a little water.—J. W. Keay. Adrenalin must not however be injected into a patient under chloroform. Small doses of chloroform on a lump of sugar sucked, when desire to vomit comes on, give brilliant results. Confirmed ‘ Spreeers * get best result for alcoholic vomiting with small doses of alcohol. Bibliography of untoward results with chloroform, vide Vol. II. Eye troubles following anaesthesia. Acute conjunctivitis may be caused by vapour of Chloroform or Ether, and keratitis with subsequent corneal scarring may occur. Instillation of Castor Oil prior to anaesthesia, or irrigation with Boric Acid lotion afterwards, recommended as preventive measures Reep ; lids carefully closed and avoid frequent examination —J. Blomfield, Brit J1 ; Ansesth., Oct., ’25,66, per Pres., April, ’26,142. ! Alkalosis well treated by Ammonium Chloride per rectum, 3 drachms in s 5 or 6 ounces water just before operation, and 10 ounces, 15% Sodium Chloride I intravenously as soon as patient is put under anaesthetic.—R. Chalmers, L. ; ii./26,1267. Anaesthesia in relation to cardio-vascular affections.—R. W Price B M J ; ii./26,879 ; J. Blomfield, ibid., 883. ’ The immediate risk is probably 10 times greater with Chloroform than with : Ether.—J. Ross Mackenzie, L. i./27,165. Infants and children take Chloroform well, but it should not be used in ■I those with anaemia, sepsis or shock.—J. Ross Mackenzie, L. i./27,164. The effect of Chloroform anaesthesia on blood, kidneys and liver of young i children is very slight—with proper supervision, a good anaesthetic for children'. —B.M.J.E. i./24,43. As an anaesthetic in women at the menopause Chloroform should not be used.—J. H. Hannan, B.M.J. iL/27,15. Carbon Di-oxide as an aid in general anaesthesia.—J. S. Lundy, Ji. A.M.A. ii./25,1953. See Acid Carbonic. CfDA.G.E. (Alcohol, Chloroform and Ether). Absolute Alcohol 1, Chloroform 2, Purified Ether 3. Sp. Gr. about I 1-002. The three ingredients are intended to evaporate uniformly. A.C.E. is as effective as pure Chloroform, and is safer for deep and prolonged anaesthesia, while it is sufficiently rapid in operation to be convenient for general use, although it takes longer than Chloroform (10 to 15 minutes) to procure anaesthesia. It is of service in midwifery. ®C.E.# i-e., a mixture of chloroform 2 parts with ether 3 parts, is an even better anaesthetic mixture in some cases, where the airway is encroached upon. This mixture in same proportions, using a Skinner’s mask, employed in a 1 variety of grave operations—panhysterectomies, removal of double pyosalpinx, difficult appendicectomies, excisions of rectum, etc. Time of induction of . anaesthesia averaged about 8 minutes. Modifications of the proportions have been suggested from time to time. Chloroform and Ether anaesthesia produces immediate and marked lowering f of the blood j>H, leading to a condition of uncompensated alkali deficit which j may go on to profound acidosis (coma). Ether and Chloroform produce a i decided hyperglycaemia during anaesthesia, and deep and prolonged anaesthesia by these agents readily leads to oliguria or anuria. Gas anaesthetics not subject to these disadvantages, but they increase haemorrhage, especially oozing from raw surfaces. Ether and Chloroform have inhibiting effect on uterine contractions, while gas anaesthetics increase contractions and afford ( more definite and controllable pain-relief and oxygenation. Absence of general circulatory depression with gas anaesthetics.—E. H. McMechan, B.M.J. iE/26,1110. Deaths under anaesthetics. Contra to the common opinion, the Registrar-General’s report serves to dispel the idea that Chloroform is safe when diluted with Ether.—A. Goodman Levy, L. i./26,I74. Rcs&ira tory complications following operations.— 55 cases recorded in 33,000 operations. Anaesthesia induced with Ether in 50%. A mixture of 2 parts Chloroform and 3 parts Ether used in any operation where required—i.e., if Ether not adequate for relaxing.—D. C. Aikenhead (Manitoba), B.M.J. ii./3o,515. . Anaesthol. A mixture of Ether and Chloroform with 17% of Ethyl Chloride. Used by Gwathmey in adenoid and tonsil operations. Gas and oxygen are passed over the preparation for inducing anaesthesia, and gas- oxygen—ether for maintaining.—J.A.M.A., N.Y.M.J., June 19/20, p. IO60, per Pres., Feb.,’21,36. Tissues exposed to various concentrations of Ether and Chloroforrn. 1 here was greater reversibility on low organisms, Yeasts and seeds and Chlamydomonas, with Ether than with Chloroform.—A. L. Flemming, B.M.J. ii./22,921. General Preparations of Chloroform. Aqua Chloroformi (B.P. ’14) and P. Jap.—-I in 400 of water. F.E. VIII. and P. Ital. V., 1 by wt. in 200. Bose.—J to 2 ounces (15 to 60 Cc.). Salts, like sodium sulphate, are apt to cause deposition of chloroform from aqueous solution. CEDChloroforai Sterules for Inhalation. Encased in cotton wool and silk ; contain 10 minims in each. Are convenient for use in asthma, etc. ; may be fractured and used by the patient while in bed. In angina pectoris Chloroform inhalations —‘ so far from being unsafe in cardiac disease, are often of the greatest use and perfectly safe.’ In croup, brief inhalation of Chloroform acts promptly.—Whitla. Yeo. Sterules are also made containing 20, 30, and 60 minims—the last for obstetric purposes avoiding risk of overdose. dD Gelatin Capsules of Chloroform. Dose.—One or two. Contain each 5 minims ; are for similar uses, but the chloroform is apt to volatilise ; Perles 3 minims. Very useful in sea-sickness. GD Chloroform and Ethyl Iodide Sterules, v. Ethyl Iodide. CJD Chloroformum Camphoratum, B.P.C. Camphor 2, Chloroform 1. Useful for toothache, applied on cotton wool. ® Chloroformum Mastiche. Mastiche 1, Chloroform q.s. to 2. GDGuttse Chloroform! cum Menthol Composite.—SelF-INFLATOR Drops. Menthol 15 grains, Chloroform 4 ounce, Acetic Ether and Alcohol 90% of each 2 drachms.—Dundas Grant. Directions.—2 or 3 drops to be placed upon the wool in the in- flator on each occasion of use. Chronic Tympanic and Eustachian Catarrh.—Value depends to an extent on the ease with which air containing a little chloroform passes up the Eustachian tubes. Inflation with an Eustachian Self-Inflator is conducted as follows:—Prop the amount prescribed on the wool in the mouth-piece with a dropper. With the mouth-piece held firmly between or against the lips (according to the form of the instrument) and the nose-piece tightly in the freer of the two nostrils, compress the other nostril to close it completely. Draw a breath (not through the instrument) and then blow through the mouthpiece so as to puff out the cheeks and * crack the ears.’ If vapour is too irritating blow through the instrument a few times before use. To concentrate the effect on the right ear close firmly with the. finger the left ear and bend head sideways over the left shoulder—vice versa for the left ear. The duration of treatment should be controlled by the prescriber. Eorthe Medicated Politzer Apparatus in which these drops may be used, see Pundas Grant, Pr., June, ’25. CeD Linimentum Chloroformi (H.P.’14). Chloroform 1, Liniment of Camphor 1. Vaseline might with advantage replace the oil of the camphor liniment for this preparation. U.S. orders Chloroform 3, Soap Liniment 7. [gj li? 1| Liquor Chloromorplli^e, Chloromorphia Solution. (Miscible.) Dose.—5 to 15 minims (0-3 to 1 Cc.). Chloroform 150, Glycerin 400, Liquid Extract of Liquorice 100, Morphine Hydrochloride 10, Solution of Atropine Sulphate Oil of Peppermint 2, Alcohol (90%) q.s. to 1000? 10 minim dose contains:—Chloroform 1J minims, Morphine Hydrochloride -A- grain, Solution of Atropine Sulphate, 4 minim. Dissolve the Morphine Hydrochloride in the Liquid Extract of Liquorice, Glycerin and Atropine Solution, previously mixed : in part of the Alcohol dissolve the Chloroform and Oil of Peppermint; mix with the morphine solution, and add Alcohol q.s. to 1,000. A useful sedative. HIE] Capsules (Gelatin) contain 5 minims for use of travellers. H HQJ Tinctura Chloroformi et Morphines Composita (B.P. ’14). Dose.—5 to 15 minims (0-3 to 1 Cc.). Chloroform 75, Morphine Hydrochloride 10, Diluted Hydrocyanic Acid 50, Tincture of Capsicum 25, Tincture of Indian Hemp 100, Oil of Peppermint 2, Glycerin 250, Alcohol (90%) q.s. to 1000. 10 minim dose contains :—Chloroform § minim, Morphine Hydrochloride A grain, Dilute Hydrocyanic Acid 4 minim, Tincture of Capsicum J minim, Tincture of Indian Hemp 1 minim. Contains approximately four times the proportion of morphine present in the preparation of B.P. 1885. N.B.—Contains Hydrocyanic Acid which the Chloromorphia Sola- j tion does not. [FTiTincfcura Chloroformi et Morphinae B.P. ’85 (Not within D.D.A.). Syn. Ciilorodynum, N.H.I. Dose.—5 to 10 minims. 10 minim dose contains Chloroform J minim, Ether 4 minim, I Alcohol 90% J minim, Morphine Hydrochloride ¥V grain, Dilute Hydrocyanic Acid $ minim, Peppermint Oil A> minim, Liquid ! Extract of Licorice 1J- minim with Treacle and Syrup q.s. Poisoning by 4 ounces of Chlorodyne, with recovery by use of : Atropine, Strychnine, and stimulants is recorded. iFlChlorodyrmm. N.H.I. When Chlorodyne is prescribed under N.H.I., Tinctura Chloroformi et Morphinse B.P. ’85 must be given. The name Chlorodyne should not be applied to any preparation containing more than 0-1% Morphine cf., p. 561. A preparation falsely described as “ Chlorodyne B.P. ’85,” contrary to the Merchandise Marks Act, 1887, resulted in penalties totalling £25 13s.—P.J. | ii./29,130. CeD Collis Browne’s Chlorodyne is not within the D.D.A. and contains no Hydrocyanic Acid. It contains 1-4% Liquid Extract of Opium (10% Morphine) and 0-21% of Codeine Phosphate, amongst other ingredients. Smritus Chloroformi {B.P. ’14).—Syn. Chloric Ether. 1 in 20 of alcohol (90%). U.S. has 3 in 50. Dose.—30 to 40 minims (2 to 2-5 Cc.), or 5 to 20 minims (0-3 to 1-2 Cc.) repeated. Tinctura Chloroformi Composita. B.P. 1885. Chloroform 2, Alcohol 90% 8, Compound Tincture of Cardamoms 10. Dose.—5 to 60 minims. Emulsio Chloroformi U.C.H. _ rr ,,, , , G Chloroform 5, Quillaia Tincture 2, Water to 100.—St. Th. H. chloroform 8, Senega Tincture 1, Water to 160. Employed to preserve vegetable preparations. Ethylene. CH2: CH2=28-0312. Syn. Olefiant Gas. The first known member of the Alkylene or Olefine series of hydrocarbons—i.e., the series in which a double linkage occurs. Ethylene is a colourless gas with slight ethereal odour. It has Sp. Gr. 0-9784; (Air=l). It burns in air with a bright flame. A mixture with 3 vols. of Oxygen burns with violent explosion. At 0C C. and under! a pressure of 42-5 atmospheres it is converted into a colourless liquid which boils at—102° C. The gas is very soluble in Alcohol and Ether. It is a constituent of illuminating gas. Anaesthetic Use.—Ethylene has been experimentally shown to possess many advantages when deep surgical anaesthesia Is required. A proportion of 80 to 90% of the gas is used. Analgesia comes on easily, respirations remain regular, no cyanosis or suggestion of asphyxia observed, and recovery from the anaesthesia is always rapid. Is usually administered with Oxygen.— A. B. Luckhardt and J. B. Carter, Jl. A.M.A., Mar., 17/1923, p. 765 ; B.M.J.E. i./23,62 ; P.J. i./23,456. For a review of its anaesthetic uses vide L. ii./23,240. There were 14 instances of vomiting in a series of 92 inhalations. The relative toxicity and potency of gas anaesthetics might be expressed as follows. Ethylene being taken as unity : Nitrous Oxide 0-85, Acetylene 1-5, Propylene 2-25, Butylene 4-5, Amylene 15.—F. H. McMechan, B.M.A. Ann> Meeting, 1926, L. ii./26,331. Urological Operations. Ethylene said to be the best anaesthetic, but its use requires a certain amount of experience. The average time for complete anaesthesia is five minutes, and as a rule awakening is without agitation or vomiting. Pantopon subcutaneously before administration suppresses period of excitation.—Jl. A.M.A. ii./25,1742. Ethylene resembles Ether and Nitrous Oxide in speed, is less irritating than Ether, but more so than Nitrous Oxide. Induction by Nitrous Oxide-Oxygen, followed by Ethylene-Oxygen, returning to Nitrous Oxide-Oxygen towards close of operation. More depressing and powerful generally than Nitrous Oxide.—E. I. McKesson, B.M.J. ih/26,1111—1113. Noticeable lack of after-effects the chief advantage. Methods of preparation and administration described.—C. Langton Hewer, L. 1./25,173. At Presbyterian Hospital, Chicago, 1,100 cases anaesthetised with Ethylene* without serious condition.—L. i./25,1129. Majority of patients make excellent recovery and are soon ready to take’ food. Avoid, risk of explosion.—F. E. Shipway, L. i./25,1128. Signs of anaesthesia with Ethylene and Oxygen.—J. S. Lundy, B.M.J- li./26,1112. Specially suitable in diabetic cases.—E. J. Chambers, B.M.J. u./28,/7. A survey of 425,000 Ethylene anaesthesias shows it is probably as safe a? Ether, if not safer. The quantity of Ethylene capable of explosion is too small to produce considerable damage.—M. Salzer, Jl. A.M.A. i./29,2097. Ethylene anaesthesia discussed at ltoy. Soc. Med.—B.M.J. L/30,862. Much more satisfactory than Nitrous Oxide—could be used with as much as 20% to 30% of Oxygen. Dangerous with cautery or diathermy.—I. W Magill, L. i./3i,353. , . , . For dental work its smell and risk of lire is a disadvantage.—R. R. Macintosh- Brit. Dental Jl., Feb. 15/32. By continued application of Ethylene or Propylene green fruit can be ripened, the same changes taking place as occur in the plant.—P.J. ii./27,562.: Propylene and higher liomologues as gas anaesthetics. _ These new anaesthetics show by-effects that, for the present,'challenge their safety and utility in clinical anaesthesia. Experiments with Methane, Propane, Pentane and Heptane do not offer any hope of a satisfactory clinical anaesthetic.— F. H. McMechan, B.M.J. ih/26,1106. Propylene as an anaesthetic.—Jl. Ph. and Exp. Ther., Feb., 26,1. See also F. E. Shipway, L. i./25,1130 and our p. 118. Acetylene. CH=CH = 26-0156. The initial member of the Acetylene series of hydrocarbons {i.e.., with triple linkage), gas with unpleasant odour. It has Sp. Gr. 0-92 : i (Air—1). It is compressible into a liquid. This liquid form has explosive properties. It is more soluble in Alcohol than Ethylene. It is formed by the interaction of water with Calcium Carbide. Acetylene 40% and Oxygen 60%, with the addition of Oil of Pine to mask the smell, used as genera/ anaesthetic. Rapid, simple and safe, but for child-birth, like ail other general anaesthetics, its defect is to diminish uterine contractions.—C. H. S. Horwitz, L. i./23,619. Give 60% to start with, increase to 70% for full anaesthesia and reduce to 20 or 30% in a long operation.—Precede with Morphine and Scopolamine.— L. ii./23,240. Acetylene thought to be an inefficient anaesthetic except in exceptional cases.—E. E. Shipway, L. i./25,1128. Acetylene-Oxygen may supersede Chloroform and Ethyl Chloride-Ether in many operations. Has greater safety, vomiting rare, sense of comfort afterwards, serious sequelae not observed, but danger of explosion. A 10% concentration will eliminate labour pains without loss of consciousness or diminution of uterine contractions.—H. Wieland, Brit. Jl. Anaesth., Jan., '25,142, per Pres., Apri], ’26,142. Acetylene 80% with Oxygen 20% as a general anaesthetic induced insensibility and muscle relaxation in three minutes. Toxic effect very slight and initial phase of excitation did not occur.—Comptes Rend., Oct. 30/25, per Jl. A.M.A. ii./25,1998. In dental surgery Acetylene of value.—A. Goldman and J. D. Goldman, Anaesth. and Analges., Aug., ’25,211, per Pres., April, ’26,142.. 2,000 anaesthesias made with Acetylene at gynecologic clinic. No deaths ; post-operative pneumonia in only 0*3%, and bronchitis in 0*3%. Surpassed in obstetrics all classical types of anaesthesia.—D.M.W., Sept. I8/25, per Jl. A.M.A. ii./25,1437. Dichlorethylene. Syn. Acetylene-Dichloride C2H2C12==96*9296. The commercial product is a mixture of two stereoisomers boiling at 48° d 60°, and having Sp. Gr. of about 1*28. It is not readily inflammable and ! and It is the best known solvent is suggested to replace Ether for laboratory use. for rubber. # . . Is employed as a solvent of Iodine for sterillising the skin.. 2*5% w/v is used, i.e., practically a saturated solution. This solution is said to cause the operating surgeon or assistants no lachrymation or catarrh of the nasal mucous membrane which the Iodine Tincture produces. N.B.—The name Dichloride of Ethylene has. been applied to this substance, v. B.M.J. i./io,1288. It has the composition C2H4C12 — 98*9612. B. pt. 85° 0. and Sp. Gr. 1*255 at 15° C., but it should be particularly noted that Dichlorethylene is required for the purpose.;—P.J. ii./n,623. Iodine in skin asepsis—comparative results with Dichlorethylene. J. W . Peek P.J# i./i2 4:50# Trichlorethylene. Syn. #Westrosol (T.M. 310199 Class I). CHIC :C.C12= 131*3788 Sp. Gr. 1*47, B.pt. 88° G—difficult to volatilise, though a good solvent, especially for fats. Trichlorethylene Sterules, 10 minims (0*6 Cc.) encased in cotton wool for inhalation through the nose, are made. Uses.—Inhaled for trigeminal neuralgia several times a day. B.M.J.E. L/22,86. Facial neuralgia. Inhalation of Trichlorethylene 20 drops through the nose. Patient lying down.—B. R. Johnston, B.M.J. i./3o,180; B.M.J.E. i./3i,115. In commerce for the solution of tarry bituminous products, India- rubber, Sulphur, and Phosphorus. s?cWestropol (T.M. 350667 and 352362, Class 2, 350668 and 352363, Class 47). A soap solution containing 25% Trichlorethyene and *Westoran (T.M. 433061, Class 2, and 433062, Class 47)-- a soap solution containing 95% Tetrachlorethane CgH^Gli —167-84 VOL. I. K were found efficient as vermicides. For cleaning the body, bathing, or sponging with soap solutions containing 2% Trichlorethylene or 10% Tetrachlorethane give good results. Further, a 25% solution, of Trichlorethylene in Vaseline would be an efficient insect pomade. Dichlorethylene also useful—J. P. Kinloch, B.M.J. i./15,1038.— P.J. ii./16, 384; i./20,243. The parasiticidal action of the Chlorhydrocarbons, especially of Tetrachlorethane.—J. W. Dougal, C. and D. i./25,199. Tetrachlorethylene, C2C14 = 165-828. Syn. perchior-Ethyiene. Carbon Bichloride (CC12). Heavy liquid (Sp. Gr. 1-619), B. pt. 110° to 120°, solvent of fats, resins, rubber and alkaloids. Used for dry-cleaning and for solvent soaps. Originally investigated by Faraday. Difficult to volatilise. Gives a heavy vapour which caused death in aircraft works when used in a cellulose varnish, (c/. Carbon Tetrachloride which is similar and has also produced death). All these bodies are non-inflammable and non-combustible. A mixture of 10% Petroleum Ether in it readily burns and a mixture of10% Benzol with it will not burn, but any higher percentage burns readily.— \y. h. m. Ankylostomiasis. Trials with Tetrachlorethylene for hookworm showed no reason why this compound should replace Carbon Tetrachloride. The doses given were 2 to 4 Cc. in 2 ounces of saturated Magnesium Sulphate solution.—Col. Med. Report, p. 11, per Jl. Trop. Med., Feb. I/27. In hookworm not effective. There is no sure and safe anthelmintic against hookworm.—L. i./3o,418. Liver Fluke in sheep treated.—P.J. i./3t,29. Tetrachlorethane. ^Westron (T.M. 310198 Class I.). C2PI2C14 = 167-8436. A liquid with penetrating odour B.pt. about 140° C. It dissolves oils, fats, waxes, and resins, and Sulphur (1% at ordinary temperature), Phosphorus and Chlorine. Used as a solvent for varnishes, especially Cellulose Acetate, and as a paint-remover and degreaser. Extensively employed as an insecticide, especially for white fly on tomato plants, and for weevils. See also Westoran. Pentachlorethane, C2HC15 = 202-2958, is similar to Tetrachlorethane, and has B.pt. 159°. Hexaclilorethane, C2Cl6=236-742. A solid subliming at 185° without melting : almost insoluble in water, more soluble in Alcohol and hither, or a mixture of the two. It has a smell similar to Camphor, for which it is used as a substitute in the Celluloid industry. Also employed to render substanceB non-inflammable in explosives industry, and is incorporated in anti-fouling plants. Physiological experiments :—The saturated solution has no effect on muscle hence its toxic effect is considerably less than that of Chloroform (compared per molecule or per weight), with which of course it is chemically allied. Rats; were fed with butter mixed with the crystals—no effect produced after 24 hours. Cyclohexanol and Allied Compounds. . , , Cyclohexanol (CsHnOH) is prepared by the catalytic hydrogenation of Phenol, using Nickel at about 180° C. It is a solvent for fats, waxes, resins, rubber, celluloid, etc., but is principally used in conjunction with soaps— with which it forms clear aqueous solutions—as a detergent in laundry and textile work. The commercial product is known as Sextol in this country, and as ^Hexalin (T.M. 409135) in Germany. Its derivatives, Cyclohexano- l Acetate (Sextate) and Cyclohexanone (Sextone), and also the Methylcyclol hexanols (Metiiylhexalm), produced by hydrogenation of the mixed Cresols, are similarly employed. Trichlorisopropyl Alcohol. Syn. :*IS0PRAL (T.M. 322543). CC13.CH(0H).CH3= 163-41. Used for intravenous narcosis. Has been given up to 8 Gm. (in toto) as an anaesthetic. A mixture of this and Hedonai (vide. Edn. XVI., p. 783) may be useful.—R. K. Lambert, L. i./26,121, see also E. R. Flint, ibid 257. Employed in eclampsia in children. CHRYSAROBINUM (B.P. ’14),U.S., p. Jap., Ph. Ned. V., P. Ital. V., F.E. VIII., C30H26O7=498.2028. Syn. Commonly but erroneously called Chrysophaxic Acid. Dose.—} to 4 grain (Q*0i to 0-03 Gm.) or more. This substance was erroneously stated to contain 80 to 84% of Chrysophanic Acid, but it was subsequently shown that the Acid was developed from the Goa Powder (q.v.) by the Alcoholic Solution of ; Potash used in extraction. It consists chiefly of Chrvsarobin, with varying amounts of Chrysophanic Acid. Further details, see Vol. II. It is obtained from Araroba by means of hot chloroform. It might be renamed 4 Ararcba Purificata.’ A tasteless inodorous crystalline yellow powder. It is contained in rhubarb (mainly as Chrysophanic acid) and dock root. Ash limit 1%. Soluhil ity.—In alcohol and slightly in petrol and water; in Ether 16, Chloroform 12, 1 in 18 Benzol. Uses.—Externally as ointment or pigment. Chrysarobin is a powerful stimulant and parasiticide in acne rosacea, alopecia, psoriasis, lupus, ringworm of the scalp, pityriasis and tinea circinata. Psoriasis in the army treated by Chrysarobin and Salicylic ointments or n Lassar’s Paste.—H. W. Barber, B.M.J. i./18,369. The only reliable local remedy to remove the eruption with promptitude, but recurrence after its use just as frequent as with other remedies. B.M.A. i Ann. Meeting, ’26, L. ii./26,550. Unguentum Chrysarobini (B.P. T4). 4% in Soft Paraffin. U.S. has 3 in 50 of Bcnzoated Lard. It stains the skin and hair, and a strong ointment after three days’ continued use sometimes produces feverishness and irritation. 5 to 10 grains to an ounce may be better. Its stains can be removed by Benzol, weak solution of Potash or Chlorinated Lime. Unguentum Chrysarobini Composition (Unna) and St. J. H. Chrysarobin 5, Salicylic Acid 2, Ichthycl 5, Soft Paraffin 88. Psoriasis is treated by an ointment of Chrysarobin 5, Salicylic Acid 24, Birch Tar (Oleum Rusci) 5, Soft Soap 6J, Vaseline 64. Baculum Chrysarobini. Chrysarobin 30 grains, Wax 20 grains, Lanolin 50 grains. CEoPigmentum Chrysarobini.—Adopted by G. II. ^ Chrysarobin 1 ; Gutta Percha Solution (B.P. 1085), 9. In psoriasis, painted on twice a day witn a brush foi ten days without washing—finally washing off. Tv 2 ®Traumaticin (Martindale), adopted by P. Belg., P. Ital. V., F.E. VIII. and Pit. Ned. V., composed of Gutta Percha (purified) 1, Chloroform (by weight) 9, is also used for making the above pigment. More cleanly than liniments or ointments. Pigmentum Chrysarobini et Pyrogallol. Chrysarobin 1, Pyrogallol 1, Ether and Alcohol, of each 10, Collodion 120. Appiy after bathing every third day for psoriasis and ringworm. Chrysarobin may also be applied with Camphoid, q.v. CE> Suppositorium Chrysarobini. Chrysarobin 1J grains, Iodoform yo grain, Belladonna Extract 4 grain, Glycerin q.s. to make a suitable paste and Cacao Butter q.s. to 30 grains. Gives good results in haemorrhoids. Araroba* Syn., Goa Powder (B.P. ’ 14). Crude Chrysarobin. Araroba Depurata, P. Austr.==Chrysarobinum. A brownish concretion from the cavities in the trunk of Andira araroba (Leguminosce), dried and powdered. h- Crude Araroba is imported from Brazil; not less than 50% of its weight is chrysarobin, or chrysophanic acid so-called. The Indian mode of using the drug was to cut a lime fruit, dip it in the powder and dab it on the affected skin. The Brazilians mix it with vinegar. Chrysarobin Tri-Acetate. A brownish powder recommended as a substitute for Chrysarobin. Solutions of 2 to 3% are said to be effective and free from toxic effects, non-irritant, and do not stain. It is soluble in Ether, Chloroform and in Acetone. Lenirobin is Chrysarobin-tetra-acetate. * Cignolin (T.M. 354703). A synthetic Chrysarobin substitute, free from toxic action on the kidneys, in psoriasis and other skin diseases. Deodorised Oil of Cade 40 minims, Cignolin 4 grain, Benzol 1 oz. used. Paint twice daily and cover with dry white gauze. Reduce Cignolin by half if irritation caused.—L. ii./31,754. CINCHONiE CORTEX. (Rubiacece). Tercentenary Cinchona Celebration. (The 300th Anniversary of the first recognised use of Cinchona by Europeans.) Addresses on the History of Cinchona by Sir Humphrey Rolleston and Sir David Prain. There are 3,000—4,000 acres under Cinchona in India, yielding 40,000 lbs. of Quinine per annum. The medical man must determine whether the alkaloids other than Quinine are equally efficacious in malaria.—B.M.J. ih/30,969,1090. L. ii./3°J 1355, 1422. P. J. ib/30,621. The principal dried barks used for the production of the salts of the Cinchona alkaloids arc :—Bed Cinchona bark, from Cinchona' succirubra ; Yellow Cinchona bark, obtained from Cinchona Galisaya containing upwards of 6% of alkaloids (half of which is quinine) ; pale Cinchona bark (crown or Loxa bark), from Cinchona officinalis (containing 5% alkaloids of which half may be quinine);. the bark of Cinchona lancifolia, Mutis; Columbian bark (containing about 2% alkaloids, of which only a small proportion is quinine); and other species of Cinchona ; that of certain species of Remijia may also be used. The variety most used for making galenical preparations is the cultivated Red Cinchona. Cinchona, U.S., is from various species. 5% total alkaloids. C. Calisaya, Quinquina Jaune, is official in Fr. Cx. for making Extract. 1000 Gm. of good Calisaya Bark should yield 30 Gm. of Quinine Sulphate ( + 8H20)=25 Gm. approx, of anhydrous Quinine Sulphate=22 Gm. approx, of anhydrous Quinine. C. Succirubra, Fr. Cx. Quinquina Rouge is to contain at least 50 Gm. total alkaloid=15 Gm. Quinine Sulphate ( + 8H20) = 12J Gm. approx, anhydrous salt dried at 100° C. = 10*9 Gm. approx, of Quinine base anhydrous —per 1000 Gm. of bark. P. Ital. V. prescribes Calisaya or Succirubra bark containing at least 5% alkaloids. F.E. VIII. officialises Calisaya, Loja andC. Succirubra. P. Belg. IV. has C. Succirubra and * other species ’ containing at least 6-5% alkaloids. The Quinine barks, as they are called, now imported from South America, are chiefly the Calisaya in quills ; those known as Cuprea barks, the produce of species of Remijia, are more expensive. A larger quantity of cultivated bark, the produce of C. succirubra, G. officinalis, and hybrids, arrives from Madras and other parts of India. Most of the rich Java bark, produced by G. Calisaya, vcir. Ledgeriana, Gias hitherto been shipped to Amsterdam. The old natural “ flat ” Calisaya bark is not now met with, but a kind of i yellow bark, pressed into flat pieces, is imported from Bolivia to replace it. The flatness is produced by tight packing in serons bound with green hide s thongs which, contracting, keep it flat. There is a large demand for ‘ Factory ’ Cinchona Bark, i.e., barks of Cinchona Ledgeriana and certain Cinchona hybrids, rich in Quinine and containing I comparatively small amounts of other Cinchona alkaloids, for making Quinine. Effort should be made to produce in India sufficient of the commodity to meet a much larger proportion of the requirements of the Empire. There is | at present only one Quinine factory making Quinine from bark in Great Britain.—Imp. Inst. Com. for India.—L. ii./22,526. The Amani Institute (in what was German E. Africa) having passed into British hands, we are now in possession of some C. Ledqeriana-C. Succirubra hybrids which are amongst the most profitable species of Cinchona in the world from the standpoint of Quinine. Some were shown to yield up to [ 11*83% Total Alkaloid and 6-97% Quinine.—Prof. Greenish and C. E. Corfield, B.P. Conf., 1923, P.J. ii./23,95. The only Cinchona it is possible to produce without financial loss is Yellow Bark, and this has put it beyond the power of our Empire to supply its own requirements as regards Quinine. History of the use and cultivation of the Bark.—B.M.J. i-/24,1023. Nine-tenths of the world's supply of bark conies from Java, Cinchona requires fastidious conditions—a mean temperature of about 75° F. Some shade. Rainfall of 75 to ISO inches. Altitude of 1,000 to 5,000 ft. Rich porous soil.—L. ii./29,834. . . 1 TT For further details on History, Cultivation, etc., see Quinine and VoL. 11. Cinchonas Ruorae Cortex, Red Cinchona Bark (B.P. H4). Dose. 5 to 60 grains (0-3 to 4 Gm.). P. Helv. has minimum 6*5% alkaloids. Fr. Cx. has 5%, vide antea. The dried bark of the stem and branches of cultivated plants of Cinchona succirubra. Tested by B.P. H4 process, it should yield between 5 and 6% of total alkaloids, of which not less tnan one-haix should consist of Quinine and Cinchonidine. Total alka’oids of Cinchona.—Self and Corfieid’s modification.—P.J. 11./30,98. Flavorings.—as for Quinine q.v. Uses,—The bark in the form of the Liquid Extract, Tincture and its alkaloids has extended use as a bitter tonic. Taken, as such., in powder form it is astringent, giving a feeling of warmth in the* epigastrium and occasionally causing vomiting. For further data see the Alkaloids Quinine, Quinidine, etc. Decocturu Cinchonae. B.P. 1885.—1 produced 16. Dose.—1 to 2; ounces (30 to 60 Cc.). Elixir Cinchonae. Dose.—\ to 1 drachm (2 to 4 Cc.). Liquid Extract of Cinchona 1, Simple Elixir 7. Mix. Extractum Chinae. Dose.—1 to 4 grains (0-06 to 0-25 Gm.). Fr. Cx.—Aqueous extract containing not less than 6% alkaloids: Ph. Ned. V., 14 to 18% alkaloids, P. Ital. V. 10%. Extractum Cinchonae Liquidum (B.P. ’14). Dose.—5 to 15 minims (0*3 to 1 Cc.). This contains 5% of total alkaloids, and is an acid preparation 1 = about 1 of bark. If prescribed with Acidj as in the following:—-Spirit of Chlorofori 1J drachms, Nitro-hvdrochloric Acid 14 drachms, Liquid Extract of Cinchon I t drachms, Water to 6 ounces, mix the first three in order written, and pou into the water to produce best result. Liquid extract of red bark has been much lauded in America for givin drunkards a distaste for alcohol. Only about 20% of the total alkaloids in Cinchona can be extracted b Dilute Hydrochloric Acid, as in making this liquid extract Glycerin does nc exert a solvent action on the alkaloids : best to add it at end of the process? The B.P. 1898 Assay process is best.—O. Chick, P.J. ii./17,144 ; C.D. ii./i7,612 For further Notes on Assay, see Vol. II. Fluidextractum Cinchonae, U.S. Averacje dose.—15 minim?1 Standardised to 4-5% alkaloids, w/v. Extrait de Quinquina Rouge (Fluide) Fr. Cx. Supp. ig20, is made b percolation with dilute Hydrochloric Acid and contains 3*5% total alkaloids- P. Ital. V, contains 5% total alkaloids. Tinctura Cinchona (B.P. ’14). Dose.—J to 1 drachm (2 to 4 Cc.). About 1 in 5 of 70% alcohol; standardised to about 1% of alkaloid: U.S. not less than 0-8 or more than 1% of alkaloids. P. ital. * not less than 1%. Maceration for 24 hours with | ounce hide powder to the pint is said 1 detannate the tincture. Mistura Antidipsomania. N.H.W. (Not in E.G.A.) Tincture of Cinchona 1 drachm, Glycerin \ drachm, Tincture <r Capsicum 3 minims, Decoction of Cinchona to ounce. Tinctura Cinchonae Composita (B.P. ’14). Syn. Huxiiam’s Tincture of Bark. About 1 in 10 of 70c alcohol. Dose—l to 1 drachm (2 to 4 Cc.). U.S. is similar. *Vibrona. (T.M. 187745 Class 3 and 245073 Class 42.) A wir containing the alkaloids of Cinchona. A wineglassful contains tt combined alkaloids of 5 grains of Cinchona Bark in the form - Hydrobromides. Total alkaloidal content 0*025%. ' Vin de Quinquina Officinal (Fr. Cx.) Macerate Cinchona 25 with Dilute Hydrochloric Acid 2, Alcohol 60% 75, for 24 hours, shaking occasionally. Add Red Wine 920, macerate 24 hours and filter. Dose.—i to 5 ounces (15 to 150 Cc.). Less for children. IVinum Chinae. P. Jap. IV. Dose 1 to 4 drachms. Dissolve Gelatin 1, by warming in Distilled Water 10, and add Sherry 1,000, Cinchona Bark in coarse powder 40. Macerate for eight days ; press and in the expressed liquid dissolve Sugar 100, Tincture of Bitter Orange Peel 2 : set aside in a cool place for 14 day3 and filter. i - CINNAMOMI CORTEX. The dried bark from C. zeylanicum (Lauracece). Dose.—10 to 30 grains (0-6 to 2‘0 Gm.). Aromatic, carminative and antiseptic, employed as flavouring agent. Contains volatile oil and tannin. B.P. T4 are Compound Powder (1 in 3), Water (1 in 10), Spirit (1 of oil in 10), and Tincture. P. Jap. IY. and U.S. X. have Cortex Cinnamomi Loureirii, Syn. Nikkei Bark, Japanese Cinnamon Bark. Tinctura Cinnamomi (B.P. ’ 14). Dose.—4 to 1 drachm. 1 in 5 alcohol 70%. Alcohol 60% would do equally well. Tinctura Cinnamomi Composita F.L. Dose.—20 to 40 minims (1*2 to 2*4 Cc.). Cinnamon Bark 16, Cardamom Seeds 8, Long Pepper 5, Ginger 5, Alcohol 60% 640. Macerate seven days. Oleum Cinnamomi (B.P. ’14). U.S. Dose.—J to 3 minims (0-03 to 0*2 Cc.). Contains 55 to 65% Cinnamic Aldehyde by volume. U.S. requires I I 80%. For Analytical Data, see Vol. II. The light yellow oil distilled from the bark. The Chinese oil, as distinguished from that made in Ceylon, is known as Cassia Oil. Leaf Oil is practically free from Cinnamic Aldehyde. Soluble in alcohol 90% about 10 in 3. Cinnamon oil is used in influenza and catarrhs. Is occasionally prescribed as an inhalation (30 to 40 minims) with boiling water 1 pint. I Stimulates the heart reflexly and directly dilates blood vessels, thus exerting valuable action on vaso-motor system. Action on bronchial tubes anti-spasmodic. Should be given in 20 minim doses in milk (or on sugar) for first three hours, every other hour 15 minims for two doses, then three or four hourly 10 minim doses. If patient can take to bed cure will be rapid. (See also Oleum Eucalypti). Cinnamon oil relieves toothache. In chronic deep-seated sepsis, such as internal venous thrombosis with :j pyrexia and other constitutional symptoms, more general use of Essential Oils advocated. It is a good plan to vary the Oil, e.y., 10 minims four times daily in capsules of Cinnamon one day, Cloves the next, Peppermint, and so^ on. The antiseptics in this way saturate the system. Not on empty stomach.— H. French, Woolwich Medical Association. Children exposed to infection by German Measles have been prevented from taking the disease by powdered Cinnamon—as much as will lie on a sixpence or shilling with their food night and morning. Should be tried in measles also as a prophylactic. Acute Coryza.—Spirit of Cinnamon in 25 drop dose one of the most effective remedies.—W. B. Drummond, B.M.J. i./17,765 ; ii./17,32. Capsule of Cinnamon Oil, 2J minims increased to 5 minimsa with Quinine Sulphate 1 grain, are used in influenza. Cinnamon Dental Paste. Iodoform made into a paste with Cinnamon Oil. COAL TAR DERIVATIVES. Pix Carbonis, Coal Tar, Syn. Steinkohlenteer, Pix Lithan- thracis, Oleum Lithanthracis, Goudron de Houille. The Aromatic series of derivatives from coal tar, so freely used ae antipyretics and analgesics, produce changes in the blood, diminishing; its respiratory capacity and destroying red corpuscles if used in excess. ^Liquor Carbonis Detergens. (Wright's). (T.M. 7418 & 7419). (A formula for a solution is given in P.G. VI.) This alcoholic preparation owes its properties in part to Phenol Used as a Lotion, from 1 drachm to 1 ounce to a pint of distilled' water it forms a yellowish milky emulsion; or, as an Ointment,Liquou Carbonis Detergens 1, Unguentum Hydrargyri Nitratis 3, Unguentun: Simplex 4. In prurigo and chronic scaly skin diseases. The following is also useful in eczema : Liquor Carbonis Detergens 2, Liquor Plumbi Subacetatis 2, Zinci Oxidum 4, Glycerinum 4 Aqua 36. Vide also Wright’s Coal Tar Soap. A ^tCoal Tar Inhaler and Vaporiser is made for treatment o whooping-cough, croup, bronchitis, influenza and like affections. Balneum Picis Carbonis. Syn. Balneum Bituminis, L. H. Solution of Coal Tar 8 ounces, Water at 95° F. 30 gallons. Lotio Plumbi Detergens, V.H.C. One drachm to a pint of water Liquor Carbonis Detergens 24, Liquor Plumbi Subacetatis Fort. 1 Unguentum Picis et Acidi Salicylic!. V.H.C. Liquor Carbonis Detergens 30 minims, Salicylic Acid 15 grains Ammoniated Mercury 5 grains, Soft Paraffin to 1 ounce. In psoriasis 1 in 8 and in pruritus ani. Liquor Picis Carbonis (B.P T4). A solution made by dissolving Prepared Coal Tar 2, in a 10% Tincture o> Quillaia Bark 10 parts made with 90% Alcohol at 50° C. and filtering. Lotio Picis Carbonis Alkalina. St. Th. H.—Liquor Picis Carbonis 1 drachm, Sodium Bicarbonate 120 grains, Water to 1 pintH Lotio Picis Carbonis Aromatica. Coal Tar 3 ounces, Ether 2 ounces, Spirit 1 ounce. Dissolve, filter and add Peruvian Balsam 6 drachms, Salicylic Acid \\ drachms. Liquor Picis Ligni may be prepared by dissolving Wood Tar 1 in 20 of a Tincture of Quillaia 1 in 10 of Alcohol 90%. One part to 7 or more is useful for skin affections. The Tincture of Quillaia enables tar solutions to form emulsions with water. Aqua Picis, Ph. Ned. V., 5%, by mixing with Pumice. Alopecia areata has been treated by this preparation. Hair grew completely -—P. S. Abraham. Bitumen. A name given to various inflammable hydrocarbon mixtures, even colorless naphtha or rockoil of Sp. Gr. 0- 7 to 0-8, but in this country we should associate it with Asphalt or of similar consistence. The name is also given to the residue after distilling petroleum products. Liquor Bituminis, Syn. Bitumarine is an anticorrosive paint. Acriflavine. Syn. Trypaflavine. Diamino-Methyl-Acridine Chloride Hydrochloride. C14H 14N3C1.HC1.=296*055. Dose.—5 grains have been given, but Euflavine is more used per os. Chemical Composition. ) Confused statements appear in the literature as to the composition of this body. It is the Hydrochloride as indicated in our formula, and our analyses confirm the |statement. In comparison with Euflavine, which is a monochloride, Acriflavine \may be viewed as a dichloride. afcTrypaflavine. Trade Mark (No. 327437, Class 1). There are no proprietary rights in the word Acriflavine. Lor details of Patent expired, see Edn. XIX., p. 300. Manufacture.—Details of the process are given by Benda (Ber. 45, . p. 1787, et seq.) and in the patent specification. See also Edn. XVIII., p. 313. In the patent specification it is stated that, compared with its higher homo- logues, such as Acridine Yellow (which is 3 : 6—diamino—2: 7 dimethyl- i acridine Hydrochloride) this body has the advantage of being very soluble, . and these hitherto ‘ unknown salts of 3 : 6 Diamino—10 alkyl or aralkyl Acridine have proved specifics against trypanosomes.’ It might be made by a method other than that of the patent.—See C.D., ; July 14/i7, p. 609. Acridine Compounds—3 : 6 Diamino-Acridine preparation.-—Poulenc Preres 1 & B. Meyer, Pat. 137,214 Abst. J.C.S.A. i./2o,252. Properties.—The compound is in the form of a reddish brown crystalline powder. The trypanocidal property depends greatly, Browning says, on :: the presence of the methyl group attached to the Nitrogen atom—- this is implied, though not expressly stated, in Benda’s work. It may be added that the Acridine series of dyes have as initial cn ■ member Acridine C6H4< • >C6H4. They are formed by heating Diphenylamine with fatty acids in presence of Zinc Chloride, e.g. ] (C6H5)2NH+H.COOH=(CeH4)?N-CH+2HaO.> Solubility.—In water 1 in 5. Commercial samples we find 1 vary considerably. In alcohol 1 in 40. In glycerin 1 in 4 or less. | Insoluble in liquid paraffin, oleic acid, vaseline and eucalyptol—by 1 experiment—W, H. M., 1917. Concentrated aqueous solutions are ; brown, dilute ones lemon yellow with green fluorescence. Compatible with Normal Saline if required for immediate use, but we observe a deposit after about 24 hours. Concentrations of l Saline higher than 5% throw out a precipitate almost at once. Compatible with 0*5% Sodium Citrate. Incompatible with Dakin’s Solution, Eusol and other Chlorine Antiseptics. Also with Mercuric Chloride Solution {e.g. 1 in 1,000 as used), also with Phenol (e.g., 1 in 20 solution) by our experiments. Solutions may be boiled or heated in an autoclave to 130° C. To remove Acriflavine stains from the hands, etc. Rub with a little dilute Hydrochloric Acid or with a little dilute Sulphurous Acid, or with Sulphurous Acid followed by Hydrochloric Acid, and then wash with water. Antiseptic Powers.—It is markedly antiseptic especially in serum, and it has trypanocidal powers, lienee the name Trypaftavine. The ideal antiseptic, it is held, should have potency in the presence of serun —Acriflavine has : it must stimulate granulating processes: it should not interfere with phagocytosis, nor irritate the tissues. The potency of Acri-i flavine is enhanced by blood proteins. Diamino-Acridine derivatives to serum are the most potent bactericides known. Diamino-Acridine Sulphate (Profaiine) has similar properties, though h is not so curative in trypanosome infections. This salt intravenously in rabbits renders the serum antiseptic or augments its bactericidal power, even severa hours after injection.—C. H. Browning and R. Gulbransen, Proc. Roy. Soc., B. Yol. 90, 1917, p. 140. I Phenol, Iodine, Hypochlorites, Malachite Green, Mercuric Chloride, Crysta Violet, and other dves, were examined. Acriflavine is 20 times more powerfu against S. aureus than Perchloride and 800 times more so than Phenol oi Chloramine-T in these conditions. . ... Most antiseptics are very inimical to phagocytosis, hence their action is a mixed blessing. The higher the germicidal power in serum and the lowei the hindering of phagocytosis the more useful the antiseptic. FharmctcolGGy.—M.B.D. intravenously for dog and rabbit 30 mgr per kilo. Dogs injected intravenously at short intervals with doses from 5 tc 25 mgr. per kilo develop pathogenic liver and kidney changes with extensive destruction of erythrocytes and derangement of metabolism.—R. S. A. Heath- cote and A. L. Urquhart, Jl. Pharm. & Exp. Therap., Feb., ’30,160. The Therapeutic Ccefficient (“T.C.”) of Browning is the ratio between the highest concentration of the substance, which does not reduce the phagocytic count below half that of the control, to the weakest concentration of the- body, which is sufficient to kill Staphylococci in the presence of serum. Acriflavine and Brilliant Green gave the highest ratios. Acriflavine is less irritating, to conjunctival epithelium than Brilliant Green. Both stimulate granulation! in wounds. The “ T.C.” of Acriflavine is 200, i.e., centration of 1:100,000, whereas to greater than 1 : 500 is requisite. . 10000 T.C. of Mercuric Chloride is^7rno = l-4 it kills both cocci and B. Coli in con- affect phagocytosis a concentration 250 ; of Phenol = 0*5, and so on. The germicidal value of Acriflavine on staphylococcus in Broth and in human serum and in pus was found lower than that given by Browning. Its action too is very slow, not less them 24 hours’ contctct being adoptee by Browning for the experiments. Staphylococcus in pus is not killed by 1 in 1000 Solution.—R. T. Hewlett, L. ii./i7,493,727. . Browning turned the table by replying that the view that a substance to possess therapeutic value as an antiseptic must rapidly kill organisms is a time-hallowed test—witness phenol and mercuric chloride which do not put an end to suppuration in an infected wound, ibid -p. 622. « A. Fleming criticised Acriflavine as “therapeutically unsound and that there is nothing to specially recommend it for use to septic wounds. A concentration of 1 in 2000 he finds inhibits leucocytic emigration, that even 1 in 8200 strongly agglutinates human red corpuscles, that 1 in 500 solution is usually unable to sterilise an equal volume of pus from a wound in 24 hours* that 1 in 500 injected into the pleura or peritoneal cavities loses its antiseptic power in 2 hours.—L. ii./i7,341. An equally powerful reply by C. H. Brown- ing.—ibid. 437. A. Fleming’s rejoinder.—ibid. 508. Chemotherapy of Pyogenic infections with special reference to the antiseptic properties of the Acridine compounds.—ihe flavines are the most efficient antiseptics therapeutically so far investigated, b. aureus and B Coli used. ‘ Fragments ’ of the Acridine Molecule were examined— these showed a low grade of antiseptic power—as also Phenazine Compounds.-—C. H. Browning and J. B. Cohen, B.M.J. ii./2i,695. Acriflavine and Rivanol. ... ,. , , Action on streptococci.—Experiments m vitro gave unsatisfactory results—individual behaviour of animals the predominating factor In some; cases 1 in 4000 did not prevent inflammatory condition, and m others 1 m 40,000 was effective. In vitro, using serum, Acriflavine varied between lm 1 000 000 and 1 in 100,000 and Rivanol 1 in 400,000 to 1 in 20,000.—G. H. Browning and B. Gulbransen, Jl. Ph. & Exp. Therap., 28,18/. Flavine inflicts a certain amount of damage on white blood corpuscles. It loses its power by being absorbed by muscle, dressings, etc.—Sir A. Wright, B.M.J. ii./3o,735. Acriflavine has selective injurious action on liver and kidneys when injected intravenously in rabbits.—Jl. A.M.A., Jan. 17, ’25,166, per Pres., Jan., ’26,6. Neither staphylococcal nor streptococcal infections are touched by Acriflavine, when distributed to them through the blood stream.—E. L. Walker, Jl. Pharrn. & Exp. Therap., XXVI., No. 6, p. 461. Strengths of Acriflavine Solutions for Use.—Solutions of 1 in 1,000 in normal saline are recommended. This strength (= on the basis of bactericidal concentration to an 80% Phenol i solution in the case of Staphylococci) is used to the surface of wounds f without causing pain or irritation. The dye is advised for prompt use to wounds, soon after inf.iction, to prevent sepsis, by destruction of virulent organisms before they have time to gain a foothold and to multiply—e.g. for casualty r work, this solution may effect healing bj^ first intention. The muscles round the site of an infected wound may be injected with several ounces of 1 : 1,000 solution wdthout ill effect. Acriflavine Tablets are made 0-87 grain to produce 2 ounces of 1 in 1,000 solution, also 1*75 grains to make 4 ounces. Use in conjunction with Hypertonic Saline.— I The 1 in 1,000 solution is not precipitated by adding Sodium Chloride up to 5% strength or by 0-5% Sodium Citrate. Suppurating Wounds.—Acri- or Proflavine solution 1 in 1,000 is used to swab out the open wound once or twice a day after free drainage has been secured. All the crevices of the wound are to be reached and sloughs, etc., removed. Then lightly pack with gauze steeped in the solution and cover with a “ protective ” Several ounces of the solution may be safely left in the tissues or peritoneal cavity. In cases showing spreading inflammatory conditions, it is well to inject the antiseptic into the part and especially around the edges with a hypodermic serum syringe. When the infection has been practically overcome, weaker solutions, e.g., 1: 5,000. may be used or the treatment may be intermitted for a day every few days, dry dressing being substituted in the intervals, or stimulating applications, e.g., Brilliant Green solution 1 in 1,000, may be employed. Inlet tubes may be used, but frequent periodic flushing, e.g., every two hours, with an aqueous solution (Carrel’s method) is to be avoided. Suitable concentration of serum is required to produce the full activity of these antiseptics. Brilliant Green in 1 in 2,000 solution is, however, niore powerful than these bodies in aqueous solution, but rapidly inactivated by serum ; the latter has given good results by Carrel s method. Gauze steeped in the solution is specially favoured as the dressing need only be changed once or twice in 24 hours. Pronh i/iacfsc Usg jbefore onset of Suppuration .——K. contaminated wound, within the first few hours of infliction, if thoroug y cleaned with 1 in 1,000 solution—as much as possible being ^ —may be sewn up and will heal by first intention, ihe same result 1 y expected in war wounds if similar facilities are permitted but on the whole this is not favoured. It is better to pack the wound with the soaked gauze for three or four days after requisite surgical procedureSuppin^bion may thus be aborted in many cases. Inject the solution into sum>u g tissues and muscle planes with a syringe and fine needle as previously men tioned, if there is extensive damage to the tissues. Acriflavine is also advocated at the time of prevent the recrudescence of sepsis when operating m an area already attected. Intravenous Injection—The preparation has been tried eve:; to the amount of 300 Cc. of 1 in 1,000 solution. The injection i given slowly—at the rate of 50 Cc. per minute. The method ha not been largely practised. Eufiavine is preferable. Subcutaneous and Intramuscular injections of 5 to 10 Cc. of 1 ii 1,000 solution have been given. General Local Use.—Strengths ranging from 0T%, to 1% ar used for the ear, skin (eczema, sycosis, folliculitis, etc.) v. postea. Internal Urinary Antiseptics, . The relatively non-toxic internal urinary antiseptic, active in high dilutioi m the urine and eliminated in high percentage by the kidney, without injur' to the body, does not exist. Some 200 dyes were examined (details in Edn XIX., p. 304). there is no dye suitable for use either by the mouth or intravenously, to act as a urinary antiseptic, with the exceptions of Proflavine and Acriflavine, and these were given in a dose of 10 mgm per kilo to rabbits.—E. G. Davis, Am. Jl. Med. Sci., Feb., *21, No. 2, p. 251. Acriflavine Emulsion, l to i,ooo. Thoroughly clean and sterilise with spirit a pestle and mortar of amole size Place 0-1 Gm. Acriflavine in the mortar, thoroughly powder and dissolve in 1 Cc. of Alcohol 90 %. The substance may not dissolve entirelv. The particles should be made into as fine a condition as possible. Place 1 Gm. of White Wax B.P. in an enamelled saucepan, melt it carefully, and add 99 Cc. ot Liquid Paraffin, and heat together to 110 or 120° C., then gradually add this mixture to the Acriflavine in the mortar with continual stirring. This produces an emulsion or suspension of 0-1% strength. Stronger or weaker dilutions may be prepared.—W. H. M. Another formula— Acriflavine 0-1, Thymol 0-005, White Wax 4, Liquid Paraffin 7(3, Water 20. Wounds and tuberculous glands well treated.— T. E. A. Stowell, B.M.J. i./ig,244. The following is also advised : Dissolve Acriflavine 0-5 Gm. in warm boiled Distilled Water 25 Cc. : sterilise Wool Fat 30 Gm. and put in a sterile mortar - add the solution in small portions with stirring, and finally add Liquid Paraffin to 500 Cc.—W. J. Clarke, P.J. ii./32,435. Oil Solution made by means of Oleic Acid.—S. Le Prescott, P.J. 1/32,66. Applicatio Acriflavine Gt. Orm. H. is similar strength without Thymol. Impetigo contagiosa.—The 1 in 1,000 Emulsion in Paraffin the most- suitable treatment.—A. It. Balmain, L. ii./26,487. Perineal Dressings.—Emulsion in Liquid Paraffin 1 in 1,000 used as a routine dressing in perineorrhaphies. The dressing renewed after each micturition. When operating for the cure of prolapse, with reasonable nursing, the wound will heal by first intention.—M. A. Dobbin Crawford L. ii./29,980 ; B.M.J. i./30,822. As protective perineal dressing. Acriflavine 14 grains, Liquid Paraffin 2£ ounces, White Wax 40 grains, Distilled Water 5 drachms.—E. M. It. Fraser B.M.J. ih/30,10(36. Aquaflavine Soap Paste prepared by neutralising Stearic Acid 1 with Sodium Carbonate If and incorporating 0-1% Acriflavine, also a Starch Paste or Mucilage with 0-1%.—C. J. Bond, B.M.J. ih/17,6. Flavine-Starch poultices in the treatment of eczema. 4 tablespoonfuls 1 of Rice Starch and 10 grains (0-6 Gm.) of Acriflavine mixed with cold water ; 1 pint of boiling water added, and the mixture boiled till it thickens. When nearly cold pour on to dressing cloth, to form a layer \ inch thick. When cold and set, cover with a layer of gauze and apply to part. Change 3 or 4 times a. day and bathe part at each change with Acriflavine 1 in 1,000 in 0-85% NaCl. Resistant cases of seborrhoeic eczema successfully treated by this method.—Jl. Trop. Med., June 1/23,196. Literature on Acriflavine. F For the original paper advising the therapeutic use of this dye, see C. II. Browning, R. Gulbransen, E. L. Kennaway and L. H. D. Thornton, B.M.J. i./i7,73. See also D. Ligat, B.M.J. i./i7,78. Bo&o.—A free-living flagellate protozoon. Has been submitted to Acri- flavine, in which it grows—normal strains just survive 1 in 5,000. By sub- cultivation a strain has been obtained which will grow in 1 in 1,500, though not surviving 1 in 1,000. A heritable modification has been impressed on it.—M. Robertson, L. i./3o,364. (Bodo caudatus very resistant to gamma rays from Radium.—L. ii./3o,418.) Burns and pyogenic conditions well treated. No interference with granulation.—C. Bennett, J. W. S. Blacklock and C. H. Browning, B.M.J. ii./22,306. Conjunctivitis and gonorrhoeal ophthalmia well treated by ‘ Flavine * 1 in 4,000.—P. Ganguli, Pres., Feb., ’21,70. Epidemic encephalitis well treated with intravenous injections of Neutral Acriflavine, 8 consecutive injections of 10 Cc. of a 0-5% solution being given. Injections given slowly at rate of 10 Cc. in 5 minutes.—B.M.J.E. i./26,34. Gangrene, Moist, of arm and leg, and hernia of spleen, well treated with Flavine.—W. J. Sheehan, B.M.J. i./3o,822. Gonorrhoea treated by lavage with 1 in 4,000 Acriflavine—one pint used I twice daily.—D. Watson, B.M.J. i./ig,571. See also H. E. Gibson, L. i./i9,741. \ Also by 1 in 1,000 Acriflavine with 2% Alkali.—J. Armstrong, B.M.J. ii./i9,170. See also W. M. Browdy, Pr., Oct., 1921, and B.M.J. i./23,1080. Acriflavine intravenously sufficient without any other treatment to cure old-standing cases of gonorrhoea. Usual course 15 injections 5 Cc. 2%.—- Per Jl. A.M.A. i./27,211. See also R. D. Herrold and H. Culver, ibid., 460. In gonorrhoea Acriflavine said to be ideal. It is highly toxic to the gonococcus. 1 in 1,000 used. Solutions to be made with 0-91% Sodium Chloride. May be sterilised without decomposition. Keep in amber bottles. Injections twice a day. Pessaries with Glycogelatin basis 1 in 500 are made. Gonococcal Infections of the Urethra.—Intravenous injections of Acriflavine 0*3 Gm. in 100 Cc. Normal Saline, followed at weekly intervals by second and third injections and a week later by O'4 Gm; in 130 Cc., were of varying activity. A special apparatus for injection is described.—Jl. R.N.M.S., Oct. ’25,250. . . . ^ A J , In gonorrhoea less injury to urethra if Gelatin solution used instead of water or normal saline. Neutral Acriflavine dissolved in water to strength 1 in 4,000, heat to 60° C. and add Gelatin 10% : keep in vacuum flask. One injection daily retained for 8 minutes.—R. D. Herrold and H. Culver, Jl. A.M.A. i./27,459. Influenza Epidemic.—Acriflavine spray 1 in 1,000 seemed to have some preventive effect.—B.M.J. ii./i8,111. Lymphangitis.—1 in 1,000 hypodermically in Normal Saline of value. Meningitis refractory to serum treatment successfully treated with doses of 5 Cc, 2% solution intravenously.—Per M.A. ,3I>88. Ophthalmic surgery.—Flavine 1 in 4,000 can be safety dropped into the eye twice daily to prevent septic sutures.—Sir A. Lawson, B.M.J. n./2 7,ll~J. Corneal wounds wTell treated.—C. Killick, per Pres., Feb., 23,^0. Otorrhgea.—A few drops of \% solution in distilled water, Oi value. S. JN. Consul, I.M.G., Aug., *25,374. . _ ^ , , ,, . ,Tr ,, _,o11 Psoriasis.—Intravenously 0.1 Gm. m 20 Cc. of water, thrice weekly, veil tolerated and of benefit.—Pres., Oct. ’31,357. Puerperal Sepsis.—Prophylaxes < in midwifery. One tablet (1-75 grains) in 4 ounces Glycerin, previously heated to 11J C. ana cooled, makes a 1 in 1,000 solution for vaginal injection. Non-irr _ highly toxic to pathological bacteria, including the gonococcus.—J. h. Moir, B.M.J. L/31,118. See also under Glycerin . Intravenously Acriflavine would be worth trying in early cases of puerperal sepsis. Dog experiments, using 1 Cc. of 1% solution ptr 1 e J. L. Meyer, Am. Jl. Obs. Gyn., 1930 ; L. i./3x,143. . ,. . Cc Rheumatism.—23 out of 33 cases cured by intravenous injection of ll. 2% solution of Acriflavine Hydrochloride. Two S relief from pain. Phagocytic action. No untoward effects. JNonoka, J1Skin Affections—Paint parts with 0-5 to 1% Alcoholic solution. Of value in crusty eczema pyodermia and impetigo. Four-hourly compresses of I in 1,000 solutfoTta pemphigus neonatorum and .mpet.go contagiosa. Tonsillitis.—Paint tonsils daily with 1 in 1,750 solution, previously clearing throat with Hydrogen Peroxide. Tuberculosis, Pulmonary.—Advanced cases greatly improved following hypodermic injection of a 1 in 1,000 solution of Acriflavine in normal saline, the first dose being 5 minims, increased to 10 minims every 48 hours, and further to 25 minims every fourth day. As much as 40 minims twice a week given.—G. H. Johnson, B.M.J. i./26,567. See also R. Aidin, B.M.J. ii./27,217. Threatened sepsis of knee joint aborted by injection of 30 Cc. of 1 in 1,000 Flavine.—W. H. Hiilyer, L. i./i8,103. Tuberculosis.—Neither Acriflavine in doses up to 0-2 6m., nor Mercuro- chrome up to 0 005 Gm., had any recognisable effects in the treatment of tuberculous patients. A case of septicaemia, complicating ischio-rectal abscess, which had as a maximum dose 0-01 Gm. of Acriflavine seemed to show definite improvement. 1 Cc. of Acriflavine 1 in 5 has been injected intravenously.— G. It. Gittins, B.M.J. i./27,857. Undulant Fever.—Curedbyintravenousinjections,commencing withO'l Gm. increased by 0.1 Gm. to 0'5 Gm. at increasing intervals of one, two and three days.—B.M.J.E. ih/29,1. Wounds.—Gauze soaked in 1 in 1,000 solution in Normal Saline, but 1 in 5,000 for subsequent applications is enough. For Carrel’s irrigation method 1 in 10,000. The primary dressing need' not be changed for two or three days.—H. Drummond and J. W. McNee, L. ii./i 7,640. See also Sir A. Bowlby, L. ii./17,640. The Carrel-Dakin process is not of universal application on account of inherent difficulties in technique, but for ease of application, early cleaning of wounds, and abatement of reaction to absorption, the dye is admirable.— E. M. Pilcher and A. J. Hull, B.M.J. i./18,172. Acriflavine is more potent than Proflavine. 1 in 4,000 thought efficient for a wound infected with strepto. or staphylococci.—W. Parry Morgan, L. i. /18,256. A film or coagulum liable to form on the surface of wounds—not easy to remove.—M. Pearson, B.M.J. i./18,271. Sepsis can be prevented by the primary use of Flavine-soaked gauze. Formation of a yellowish pellicle in three or four days is a sign for change to Eusol or Brilliant Green or Magnesium Sulphate.—H. M. Savery, B.M.J. ii. /18,283. Dressings should be applied dripping wet—not wrung out, or the content or strength may be considerably reduced owing to affinity of cotton for the dye.—J. G. Graham, B.M.J. 1.J2 8,174. Untoward results. Acute toxic hepatitis after Acriflavine pier o-s, \ grain four-hourly per diem for 2 months (10 Gm. in all). Delayed symptoms, with death. Other cases reported of serious effects from intravenous injections in gonorrhoea, —E. R. Cullman, L. i./31,218. Average onset of jaundice 112 days after last injection of Acriflavine intravenously.—C. Allan Birch, L. i./31,269. 100,000 tablets issued to 2,500 male patients—danger negligible.—H. M. Hanschell, L. i./31,269. Regarded as near the ideal antiseptic.—T. Young Simpson, L. i./31,323. In animal treatment, e.g., throat canker and one eyed cold in pigeons, 1 in 200 solution used as swabbing, efficacious.—Pigeon World, July I6/1920. ^Peracrina (T.M. 443098). A combination of Trypaflavine and an albuminous substance, found to have beneficial action in malaria.—L. i./25,195, Panflavin Tablets. Dose.—1 or 2 sucked hourly as influenza prophylactic. Trypaflavine the active constituent. It is known to be powerful against disease organisms in the mouth. 30 to 50 are said to cure a sore throat. Harmless to children. E alia vine. Syn. Neutral Acriflavine, Dtamino - Methyl- Acridine Chloride. C^H^NgCl + HaO = 277-6058. Dose._Internally J to 1 grain (0-03 to 0*06 Gm.) in tablets ‘ Enteric coated.’ . . . This substance, being more basic than Acriflavine, is even less irritant to mucous tissues and more suited for use intravenously. Uses and Dosage_As for Acriflavine. Stronger solutions can be employed. For local use to wounds 1 in 1,000 to 1 in 500. For bladder irrigation and urethral injection 1 in 4,000 to 1 in 1,000. For skin infections 1% in Alcohol. _ Intravenously 1 in 1,000 to 1 in 200 in lymphangitis, enlarged tuberculous glands and threatened, sepsis. 50 to 100 Cc. of this has been given. '50 to 100 Cc. of 1 in 200 solution, in rheumatic fever, influenza, pneumonia, endocarditis, puerperal fever, septic abortion, erysipelas, etc. : 1 in 500 to 1 in 100 in gonorrhoea. Euflavine Tablets 0-87 grain, with Sodium Chloride make 2 ounces of 1 in 1,000 solution; also 1-75 grams to make 4 ounces of solution. . . CnvmumfFA_-Euflavine 4 grain per os thrice daily with Oxycyanide of Me"SationsUl inllooo to 1'in 8 000 renders the none clear m the inflinritv nf rases within a week.—A. O. Ross, L. ii.mOjI^V, •, , , Containing about 1-5% Sodium Chloride as stabiliser, it does not smart like Acriflavine. P.J. i./23,So,504. , , . • non Qaiinr infra- a°routine.a 2& was 50 times more effectual than Phenol B.I.P.I . not tounu euecnve. r tt Prnwnincr and R Gulbransen, B.M.J. i./2 5,b»». °* Further references to this compound are given under Acriflavine. Proflavine.—Syn. 3:6.- Diamino acridine sulphate. HoN CH AAA i ! nii2 N HaS04=516*2952. 2 This aniline dye precedes Acriflavine in manufacture by several steps—hence it is the cheaper of the two. . .. . Pa+pritq Patent—The method of making ^230412 (“Manufacture It was, however, also the subject of Caseila r2 ^59/1 qi0—the latter has now of 3 : 6 Diamino-Acridine ) British Patent Ziboz/igio expned. «mnrui o q the two German 1 atents This Brit. Patent covers the same ground as in 230412 and 243085 (Acriflavine). YVIII V 318, dealing with For a description of the process see our Edn. XV u V 3 Benda's paper (Ber., 1912 P. 1787). & n the formula, Chemical Note.-Though a diamine, ^J^^Fane molecule of B,SOt to unctionates as a mono-acidic base. 2 itrati ico of base. ...t*,;, orp j,ave examined have been the (Samples of Proflavine of commerce ivh h QT m sulphate.) Hydrochloride of the formula C13Bi^xa• concentrated It is in the form of a coarse brown povder.^ ^ aqueous solution is biown. . - yellow with fluorescence. Acriflavine. Dilute solution is also 1 & y Solubility.—In water 1 in 140, in Alcohol 90% 1 in 48, in glycerin 1 in 10 or less, insoluble in liquid paraffin, oleic acid_ vaseline and eucalyptol—(by our experiments, 1917). Compatible with Normal Saline Solution as distinct from Acriflavine (q.v.). ^ Antiseptic Powers.—This compound resembles Acriflavine in being: strongly bactericidal for all the common pathogenic bacteria. As weak a solution of Proflavine as 1: 200,000, it is stated, will kill staphylococcus aureus m the presence of serum. . The general toxicity of Proflavine for mice as tested by subcutaneous injection, and the irritating effect of concentrated solutions on the conjunctiva, are markedly less than those of Acriflavine. They may be supplied to the* peritoneum with safety.—C. H. Browning and co-workers. Uses.—Similar to those of Acriflavine, but it is stated to differ in that it exerts a degree of haemostatic action. Proflavine Tablets.—-0-87 grain (with Sodium Chloride) make 2 ounces of 1 in 1,000 solution ; also 1*75 grains with Sodium Chloride to produce 4 ounces of solution. Proflavine Bougies. Contain 4 grain (0-03 Gm.) in Theobroma Oil basis ; 4 inches long. Lotio Proflavine (Pro Oculis). Proflavine 1 grain in 10 ounces. In ophthalmic surgery useful. 1 in 1,000 non-irritating, but 1 in 4,000 is strong enough. ^Rivanol (T.M. 451097). Syn. Ethoxy-diamino-acridine Lactate. NH2 AAA. OC2H;. CH3.CHOH.COOH. TT N ■ I I I “ vvv N . A yellow dyestuff soluble about 1 in 15 of water. Used in 1% or 2% solution as a local antispetic for abscesses, furunculosis, and the like. Injections need the addition of Novocain (1 to 4%). The dye has powerful antiseptic action. Recommended in acute and chronic conjunctivitis.—W. liumbaur, M.m.W., June 19, ’25,1031, per Pres. Eeb., ’24,62. Ajkebic dysentery—Given rectaliy 1 in 2,000 irritating : 1 in 10,000 has no lethal effect on entamoeba. No marked lethal action given per os, but may relieve colic and tenesmus.—Prof. Biggam and M. A. Arafa, L. i./3o,1335. Puerteral SEPSIS treated by 0-1 G111. in 100 Cc. water, with 0-3 Gm. of Sugar added, intravenously. 60 to 80 Cc. given. A second injection may be needed. Drop in temperature caused and general condition improved.— G. II. Morrison, L. i./3i,217. The sterilising concentration of Acriflavine in vitro is lower than that required by Rivanol.—C. H. Browning and R. Gulbransen, Jl. Pharm. & Exp. Therap., Oct., *28,194. Tetrophan. Syn. Di-hydronaphtho-acridine Carbonic Acid. Dose.—J grain (005 Gm.) twice daily, increasing to 14 grains (0 1 Gm.) twice daily if well tolerated. In tabes dorsalis, pseudo-tabes, and various other nerve affections. Nomenclature and formulae of medicinal dyestuffs.—G. M. Dyson, P.J. i./26,101. Aniline. Syn. Mono-Phenylamine, Aniline Oil. C6H5NH2=- 93*0626. A colorless (when freshly distilled) oily liquid, with Sp. Gr. 1-027. Of burning taste, soluble in alcohol and oils, slightly in water. An ti dotes.—Eresli air, emetics, alkaline salt (NaCl) solution, sodium sulphate, artificial respiration, oxygen, transfusion. Has a direct effect on the heart muscle, producing arrhythmia and heart- block. The following solvents are permitted:—Alcohol, Acetone, Furfural, Orthodichlorbenzene.—Jl. A.M.A. i./2g,1471. Poisoning by a boy drinking less than 2 Cc. of a water and aniline mixture. Final recovery under Oxygen given through a Nitrous Oxide bag for 5 minutes at a time with intervals of 15 minutes, instead of constantly through a funnel —far better this way.—J. Inkster, L. ii./26,752. Poisoning by Aniline and Nitrobenzene. A particular shoe dye containing Aniline caused five cases of poisoning in America, and even the Aniline laundry- mark on diapers has produced effects in infants. L. ii./25,262. Aniline intoxication may be produced either by absorption per os or through the skin, and in its acute stage cardiac and not respiratory treatment is indicated. Methods of detection in blood and urine. Jl. Pli. & jixp. J.her., Mar., ’26,101, et seq. . , , . . The term * Aniline poisoning ’ is intended, wdien considering industrial poisoning, to include the haemolytic action of red blood cells, to which the term ‘ Anilism ’ has been given.—L. ii./2 7,289. The use of shoe-polishes containing poisonous substances, e.^., Nitrobenzene or Nitro-aniline, prohibited by the Chicago Dept, of Health, Marcn 3, ] 927 Tetrvl Sun Tetra-Nitro-Methyl-Aniline. An explosive; causes demSis aXgst workers. Use fomentation and.Calamine and Castor Oil Ointment. Lead lotion to be avoided , Lead has a dangeious affljyollL°ClaTeS(]fr. Pat. 355695, 1905) proposed this body and the Ethyl analogue as detonating explosives. Wi l (US Pad. Mtm. l90b) ui*s uie same compound mixed with Mercury Fulminate, lliorpt, . •> P- Aniline Sulphate. (C6H5NH2)2H2SO4=284-2008. Don.-* to 3 grains (0-03 to 0*2 Gm.). , Has been used for emphysema and asthma; must be used cautiously, as it may cause cyanosis. Faraphenylenediamine. c6h4(nh2)2=k)8'0824. an^^^rochloH JAcidf^Ii?v^ite or?^d£h^crySSs soSible in water, Alcohol ^For use as hair dye! apply first 3^01 then an^oxidising agent e.g^ M a ^ eczema, etc.., pause* ision. B.M.J. ii./09,812 ; r.J. „. —— ^ust be removed. 1% Hair Dyes.—before gafe put 10% injurious. Lead approx, of Ammonia issai thiosulphate) are dangerous, as Dyes (e.g.. Lead Acetate and ^od spver Nitrate. Pure Henna dye is also are Silver, e.g., Pyro, Amidol :and ralso Henna-reng (Henna and hiarmless, though peTietratnig the cmtex, ^ ais^ effects are both local Indigo). As to the Paraph enyienediammegoup, gensitisation test. The and general. Sabouraud-Rousseaui si Test is used as ^ then the dye and skin over the mastoid Process ^ cleaned ] Collodion. After 24 hours its oxidant applied. When dry. cover with tient is sensitive a remove Collodion and wash with soap andl w a .g cauged in use as hair dye, mild reaction will have formed. L dc 'nT1faining 2% Ichthyol should be or from furs, a simple Calamine used. Bo not attempt to remove the dye by UVMOQ abstract under Cosmetics, Mackenna, B.M.J. i./3o,899. See also^J^rale criticised by A. Mahony- our p. 448. Some of these trenchant reman Tones, ibid., 979. T ; /~Q 1072. Hair dyes and their application. L. •/- > i he only cure, when ladies are affected by skin eruptions from use of haa containing Paraphenylenediamine, is by shaving the head. It is cheape-' than Silver Nitrate, hence probable reason of its use by hairdressers.—B.M.J ii./o9,918. A patent specification says the addition of Sodium Sulphite 1 to 1 render the compound harmless.—P.J. i./n,804,823. IVirs. Fetter’s Walnut Juice Hair Dye is well known to contain Para phenylenediamine as active ingredient. A case of acute catarrhal eczema o theface and scalp caused by it yielded to the use of Iodine Ointment. . j-hough toxicity has been reduced by converting Paraphenylenediamin into Sulphate, idiosyncrasies still occur. Tolylenediamine with Sodium Sulphite occur in ‘ Primal’—usually non-irritant.—Apl. 24/1914. Inecto Ltd., issue a warning on the use of Inecto, which contains Para phenylenediamine and Itesorcin, but this was not sufficient to protect them— later warnings were more complete. Damages £200.—B.M.J. i./22,373. P further case. In spite of proved negligence of user, she was awarded £500' plus a further sum as special damages.—L. i./2 6,1058. The oedema of head, neck, tongue, eyelids and face is the first stage, probablv due to a change in the composition of the blood—O. S. Gibbs, per P.J. i./23,233 CEdema in animals prevented by large repeated doses of Strvchnine ana other substances increasing Adrenalin output— Jl. Ph. & Exp/Ther., Apl. ’26,228. Hair dyes wuth a base of Paraphenylenediamine are so noxious that nearly every European country, in addition to New York, forbids them.—L. ii./27,824 The Victoria Pharmacy Board (Australia) has added Paraphenylenediamine and similar irritant bases, preparations and admixtures to Part II. of the Second Schedule of the Poisons Act.—P.J. i./27,373. Dyed Furs..—Eur workers and wearers of dyed fur are liable to be affected with dermatitis from this substance. Investigations show that Paraphenylenediamine is almost the only dye used, since it has the advantage of being used cold. The fur is dipped in a 0-5% solution and then into Hydrogen Peroxide, when “ Bandrowski’s Base ” is formed. The fur is then washed in revolving drums. Complete removal of all unoxidised amine should be made compulsory.—Y.B.P., ’24,524. See also Metaphenylenediamine. Labyrinthine deafness caused by dyed fur—E. Watson-Williams, L. L/28, 1123. Fox fur hai s with their springy surface may be more irritant to a sensitive skin than the smoother rabbit hairs. Naphthaline, or perhaps Camphor,, etc., used in storage to keep moth away may also be a factor—there are others,, if the matter is a Court case (consult original paper). Paraphenylenediamine is thought to te the worst. Pyrogallic Acid thought to be relatively harmless to handle (as in photography). In using Paraphenylenediamine the un- oxidised bases, and the partly oxidised are the dangerous bodies. They are generally present only in traces. A well-dyed fur yields a colourless extractive with Petrol Spirit and acid. In doing colour tests use various dilutions of reagents, avoiding using them too strong. Indamine reaction shows Para-diamines. Oxidise with cold dilute K2Cr207 in presence of Aniline Hydrochloride : blue, turning pink on boiling. Dilute Sodium Nitrite, added to a cold acidified dye extract, gives yellowish brown with Metaphenylenediamine, fugitive brown with Para-, orange with Metatoluylenediamine, faint yellow with Para-aminophenol, red with 2 : 4 diaminophenol and Paramino- diphenylamine, and faint yellow with Metol and Hydroquinone.—Further colorations see.—P. Bean, P.J. ii./3o,640. Paraphenylenediamine thought to be the sole cause of dermatitis from furs, but strictly speaking not an irritant: the dermatitis depends on an allergic state of the skin and is idiosyncratic.—G. H. Percival, L. ii./31,423. Metaphenylene-diamine Hydrochloride. Syn. Meta-DIAMIDO- Benzol Hydrochloride. Lentine. CfiH4 (NH2)2.HC1. Dose.—| grain once or several times daily. In acute diarrhoea. Adult dose 14 grain to 3 grains thrice daily. The urine becomes dark coloured.—Gehe, see also Brickdale. This compound, traced in fur, considered more poisonous than the para. The fur cut away from the leather yields nil to distilled water, but dilute saline, alkalis, acids and wool fat (if digested some hours), extracted a coloured principle which agreed with metaphenylene-diamine.—H. Skinner quoted by H. C. Semon, B.M.J. i./23,6'13. Materials used in dyeing furs are Amino-derivatives of Benzene, Raphtha- sne, etc. Others are Benzene-derivatives containing Amino- and Oxy- ;roups. Paraphenylene-diamine is known as ‘ Uusol.’ In its oxidation )hinondichlordi-imine, which is very irritating, is formed. Pyrogallol, and a lumber of other dyes are used to produce different shades.—B.M.J. i./s3,535. Dermatitis from dyed fur. “ Dyed coney ” is probably rabbit—probably oaraphenylenediamine employed.—H. C. Semon, B.M.J. i./23,4(57. Metol poisoning due to the presence of the Methyl derivative of Para- >henylenediamine. Victims of poisoning by phenylenediamines are warned igainst the use of soap which aggravates the dermatitis. Acetic Acid 50% 's advocated as a detergent, and for the relief of the itching bathing the parts n cold water is recommended.—Brit. Jl. Photog., April 13/23,218, per P.J. ./23,386 ; P.J. i./25,126. See also L. i./26,417, and our Therapeutic Index. Orthctoluidine.—C6H4CH3RH2 =107-0782. A colourless liquid turning brown on exposure to air and light and otherwise Idosely resembling Aniline. Sp. Gr. 1*0037, B.pt. 199° C. Soluble 1 in about f0 of water. Does not appear to have been used therapeutically. Acidum Sulphanilicum. C6H4NH2S03H, 2H20 (1:4) = 209*1558. Dose.—5 to 10 grains (0*3 to 0-6 Gm.). In small white crystals, slight ty soluble in water. Used in Ehrlich’s :Diazo Test, now deleted from this work. Iodism has been treated !by 15 grain doses daily of the Acid in 7 ounces of water. It is analgesic, and is best given as— Sodii Sulphanilas. C6H4NH2S03Na, 2H20 = 231T43. Dose.—5 to 15 grains (0*3 to 1*0 Gm.). In white shining scales, easily soluble in water. Useful in acute .atarrh, laryngitis, and otitis. Said to convert the harmful nitrites in saliva and nasal mucus into innocuous diazo bodies. Ferri Sulphanilas. (C6H4.NH2.S03)3Fe=572T844. Iron Sulphanilate is not now used medicinally to any extent. Zinci Sulphanilas. Syn. ^Nizir. (T.M. 287103). (C6H4NH2.S03)2Zn. =409*6096. White crystals soluble 1 in 7 water, 1 in 250 Alcohol 90% (by our experiments). Solutions 1 in 500 to 1 in 250 are injected in tne acute stage of gonorrhoea. In atrophic rhinitis the nasal fossa) may be packed with gauze dipped in 1 to 2% solution. Phenyl Hydrazine Hydrochloride. C6H5.NH.NH2*HC1 = 144*5432. Dose.—1J grains (0*1 Gm.) given three times daily. Each Um. o Phenylhydrazine destroys on an average 6 Gm. of lisemoglo m. Colorless shining scales, readily soluble in water. Randle carefully, mail produce eczema. . , Phenylhydrazine has a specific effect in destroying erythrocy es. There is a marked reduction in blood volume directly propor lona to destruction of the erythrocytes and when anaemia has been produced a relative increase in plasma volume is noted. non Discontinue the drug when the erythrocyte count di ops o , per c.mm.—B.M.J.E. ii./26,66. . „ial_ POLYCYTHEMIA Vera. It was originally given the destruction of erythrocytes, but 7 thrice daily to 3 grains twice t&Tk eg HsVTUUef11 '»** dangcioiB, hut not known whether equally effective. L. i./29,io o. The erythrocyte count may be kept near normal by 0-1 Gm. daily to a total Cm., wnen the drug may be safely discontinued for months. I tins dosage there is no deleterious effect on the liver.—C. L. Stealy, Jl. A.M.A l./20,1289. In advanced polycethemia vera, should not be given, and only witl extreme caution to those over 60, patients with marked arteriosclerosis, o* ad\ anced visceral injury. Such patients should be given only small doses O'l or 0-2 Gm., and subsequent dosage determined by symptoms. Les advanced cases do. well on 0-1 to 0*3 Gm* weekly and the effect observed ove several days. Patients who have had thrombosis should be treated cautiously Ambulatory treatment best, every effort being made to keep circulation a free as possible. Frequent c<punts of red and white cells and estimations o> serum bilirubin needed. As its action continues after withdrawal, it should be stopped before red cell count is normal. Marked rise in bilirubin mean excessive blood destruction, and rising leucocyte count indicates great destruc tlQn 3f \l7eb ceils- Results transitory and merely palliative.—H. Z. Giffii and H. M. Connor, Jl. A.M.A. i./29,1507 ; Hurwitz and Levitus, Jl. A.M.A i./29,1629. Acetyl-Phenylhydrazin. Syn. Pyrodin, Hydracetin, CcH5.HN.NH(CoH30 = 150-094. Colourless crystals slightly soluble in vnter, has also been used'. Slipules of Phenylhydrazine and Acetyl-Phenylhydrazine 14 grain (0-1 Gm.) are made. Phenylhydrazine for the Osazone Reaction for Glucose, see Vol II. *Pyridium. (T.M. 487395.) Syn. Mallophene. PHENYL-AZO-ALPHA-ALPHA DIAMINO-PYRIDINE HYDROCHLORIDE. Dose. 14 grains (0-1 Gm.) in tablet. In hyperacidity dose should be regu lated and given immediately after meals. A red, microcrystalline powder, slightly soluble in vrater, readily soluble m hot water. It possesses anti-bacterial action against cocci and B. Coli and is eliminated through the genito-urinary tract. Uses.—Gonorrhoeal infections in the male and female, B. Coli and mixeo infections, pyelitis and cystitis. Also used locally as antiseptic. Contraindications.—Some may display an idiosyncrasy toward? the compound when given internally, causing colic, nausea, headache and vertigo : reduced dosage may however establish tolerance, but if not discontinue. Kidney disease is a contra-indication, and it should not be given in severe hepatitis, where excretion is slow% nor in uraemia. Use with caution in severe chronic gastro-intestinal disorders. I he compound should not be used simultaneously with Mercurial irrigations Anthrarobin. C6H4C(OH)CH.CcH2(OH)2 = 226-078. A light brownish powder, darkening with age, obtained from alizarin by reduction. A powerful deoxidising agent, soluble in weak alkaline solutions. 10% ointment in psoriasis, etc. Benzol. Fr. Cx.—‘ Benzine.’ (Avoid this way of spelling.—W.H.M." Syn. Benzene (B.P. ’14). C6HG==78-0468. Dose.—5 to 10 minims (0-3 to 0-6 Cc.), in capsule or oily solution. A mixture of homologous hydrocarbons obtained from light coal tar oil. Sp. Gr. 0-880 to 0-887. Antidotes,—See Poisons and Antidotes. When swallowed it usually produces a sensation of burning in the stomach. It is a narcotic which, when swallowed or inhaled, produces vertigo, delirium and tonic convulsions, followed by deep sleep ; 30 Cc. has proved fatal. Uses.—For cough, and whooping-cough, and in influenza. It quickly destroys pediculi capitis or pubis, applied freely ; one application sufficient.—For seborrhcea, should be brushed on the skin. It has also been extensively tried per os in leukaemia. It has preservative action on organic matter. Distinguish from Petroleum Benzine or Benzoline, obtained in the fractionation of the hydrocarbons in Shale. Petroleum Ether and Petroleum Benzine are used for boating cauteries for nsevi, etc. Benzol is not suitable for this purpose—it burns with a smoky flame. It is, however, better for removing grease stains. A test for it is to drop into a sample a few grains of Dragon’s Blood. If the genuine article it is at once coloured; if it be the Petroleum article, scarcely any effect. Michael Faraday discovered the body in the liquid of coal gas cylinders (as then used) calling it Bicarburet of Hydrogen C, 2HG. It was renamed Benzole by him and Benzine by the French (who still adhere to the term—vide Fr. Cx.). Benzole would be the best name for this body (‘ ol ’ being retained for Alcohols) Benzine, or better Benzin, being kept for the petroleum distillate. Benzol Capsules contain 5, 10 and 15 minims diluted with J volume of Olive Oil. also Benzol ‘ Formagules ’ same strength. Leukaemia has been treated by large doses, e.g., 3 to 4 Gm. (45 to 60 minims approx.). Give small doses at first and note effects. 4 case of spleno-medullary leukaemia treated with doses ranging from 30 to 90 minims daily markedly improved. White cells dropped from 133,000 to 7,100 with corresponding increase in red from 2,400,000 to 4,175,000 also increase in Haemoglobin from 40% to 75%. Nodular lympathic leukaemia treated with similar results but terminated fatally, likewise a case of lymphosarcoma. The question arises as to whether the improvement is permanent.—T. G. Moorhead, B.M.J. i./i5,410. _ , , We know of a case improved by 15 m. Capsules. As much as - drachms per diem of Benzol were taken. .. , rro . „ , Benzol poisoning as an industrial hazard.—L. n./26,558. Chronic Benzol poisoning takes the form of aplastic anaemia when small quantities of Benzol are inhaled over a prolonged period.—L. ii./27,289. National Association’s Specification for Motors. &p. Gr. 0*885. Sulphur not I exceeding 0*4%. Distillation tests.—B.M.J. i./19,251. Benzoyl Chloride. CaHs.COCl = 140-496. Prepared from Phosphorus Pentachloride and Benzoic Acid. Distils between 190° C., and 200° C., Sp. Gr. 1*218. Distinguish from Monochlorbenzene (Syn. Benzol Chloride), C6H5C1 = 112*490, Sp. Gr, 1*106, B.pt. 132° C., and Benzyl Chloride C6H5CH,Cl = 120*51 lb. Sp. Gr. 1*106, B.pt. 178° C. ; also Benzal Chloride, Syn. Bfnzyh- dene Chloride or Benzyl Dichloride, C6II5CHC]2 — 160*9o08, Sp. Gr. 1*288, B.pt. 206°C. , _ ... ,. Benzyl and Benzylidene Chloride and liomologues and substi u i pounds", Patent 134,250, see J.C.S.A. L/20 21. Paraffin Wax Han. sold as Globol or Chloryl, when vaporised, is effective for killing lice in clothing. P-J- ii./26,71,. Moles can be banished effectively by a teaspoonful P 1 6 to 8 feet intervals. , , i „wnoa,.rQ+Dp Ortho-dichlor-benzol has also been usee, as wo p ^ . .... * 0^. Anocide.—A preparation containing the ortho compound for killing wood ,XNifcrobenzol C6H5NOa=123-047, ‘ Oil of Mirbane.’ has an odour similar to Benzaldehyde, and is used m cheap pe y > is ■‘sasti. ? & bsKSH"- Fatal case—D. R. Thomas, I.M.G., May, 26,2-9 Antidote.—Strychnine hypodermically and stimulants. Nitrobenzol can be reduced electrolvtically to Azoxybenzol CgH5N : 0 : NCgH5 = 218-094; Azobeizol CGH5N : N.C6H5 = 192-094; Hydrazobenzol, C6H5NH.NHC6H5 = 194-1096 ; and Aniline CGH5NH2. Preferable to chemical means.—P.J. i./i6,3. Dinitrobenzol, C6H4(N02)2= 168-0472. The meta compound is formed by treating Benzol with a mixture of equal vols. fuming Nitric Acid and Concentrated Sulphuric Acid, and has melting point 90° C. The ortho- body has melting point 117° C. Para-, i72° C. Trinitrobenzol, CcH3(N02)8(l : 3 : 5) = 213-0474. Crystalline leaflets melting at 121° C. Manufacture.—Heat Meta-dinitrobenzol 60 with fuming sulphuric acid 1,000 and Nitric Acid (Sp. Gr. 1-52) 500, for a day at 100° C. and for 4 days at 110° C. The yield depends a good deal on the length of heating and other conditions. We found this method (Beilstein Erg. 3 Aufl. ii. p. 49) to work better than that given in Watts. The Trinitro body is separated by pouring the reaction mixture into water (5 or 6 vols.). Benzyl Alcohol. Syn. Phenmethylol. CgIT5.CH2.OH= 168-0874. Dose.—5 to 40 minims (0-3 to 2-5 Cc.) in water three or four times a day. A liquid with a slight aromatic odour. Is a satisfactory local anaesthetic,preferably mixed with Chloroform. A few drops on an exposed nerve or cavity is an efficient anodyne for toothache. It is 40 times less toxic than Cocaine. In common with the other Benzyl derivatives this parent Alcohol was found by Macht to be useful in excessive intestinal peristalsis, pylorospasm, and conditions of the nature of persistent hiccough, as also in whooping-cough. It is stated that the addition of 1% to 5% of Benzaldehyde improves efficacy.—C. & D. Nov. 1920, 1629. Jacobson’s Solution. Syn. “ Benzyl-Cinnamic Ester ” so called. A solution of Ethyl Cinnamate, C9H702.C£H5, in Benzyl Alcohol and Olive Oil. Dose.—0-25 to 1 Cc. intramuscularly in the gluteal muscles. In tuberculosis, both glandular and pulmonary. Bose from 0-25 Cc. of the solution. Improvement in all cases. 0-25 Cc. intramuscularly daily for 12 days, followed by rest of 15 days, and after three series a rest of 1 month.—H. Gainsborough, L. i./28,906, and with P.J. Joy, L. b/29, 1142. In ‘ external’ and general tuberculosis.—L. i./29,320. Contraindication.— Nephritis. Benzyl Benzoate. Syn. ^Spasmodin (T.M. 398016). (sfcSpas- modine is T.M. 397417). Ester Bencil-b enzoico, Peruscabina, F.E. VIII. C6H5CO.O.C7H7=212-0836. Dose.—10 to 30 minims (0-6 to 2 Cc.) of 1 in 5 Alcoholic Solution in water or as emulsion, vide below. A liquid with aromatic odour, Sp. Gr. 1-1 as occurring in commerce. White crystals melting at 20° C. (Fluid at 19° C.). The preparation of commerce is physiologically pure, but cannot be guaranteed 100%, —the difference would be Benzyl Alcohol. Manufacture.—Erom Benzyl Alcohol and Benzoyl Chloride (Krant, Ann. 152,130). Also by heating Benzaldehyde at 100° several days with a small quantity of Sodium Benzylate. The following has been stated to give a yield of 70 to 75% of theory :— _ A mixture of finely powdered, desiccated sodium benzoate and a slight excess of benzyl chloride is heated on an oil bath at 170° to 175° for about 24 hours, the mass being frequently stirred. The mixture is allowed to cool, whereupon it is first shaken up with water and then sufficient sodium carbonate added to produce an alkaline reaction. The benzyl benzoate, which separates as an oily liquid, is removed by decantation and distilled in vacuo to remove the excess of benzyl chloride. After rectification the pure product boils at 196°, at a pressure of 25 mm.—C. D., Mar. 31/23, p. 438. Uses.—It is practically non-toxic and lias been used in excessive intestinal peristalis, diarrhoeas and dysentery, intestinal biliary and renal colic, spastic constipation, vesical spasm, uterine colic, arterial spasm and bronchial spasm of true asthma. It has antipyretic action. Might be of service in dysmenorrhoea. Capsules of Benzyl Benzoate contain 3 and 5 minims. Emulsion cf Benzyl Benzoate. Dose.—£ to 2 drachms (2 to 8 Cc.) every two hours as required. Benzyl Benzoate 1, Mucilage of Acacia 15, Aromatic Elixir to 40. "Whooping Cough is well treated by Benzyl Benzoate. D. Maeht, L. ih/20, 615, but its action is uncertain.—L. i./2i,394. Spastic Constipation. Should be given intramuscularly, e.g., diluted with Olive Oil. Adult dose 20 minims. Tor children jpro rata by 1 oung s table.— L. i./2i,394. Persistent Hiccough. Highly spoken of. Twenty to 30 drops of the 20% Alcohol Solution, in milk or water.—L. ih/20,51«. Lymphatic Leukaemia has been treated with it.^ It is harmless in comparison with Benzol. Dose.—5 drops t.d. Pres-, Aov., 19. . RQ Vasodilator action of Benzyl Benzoate and Acetate.—B.M• J • E .11./ 2 &, 89. It was found that Papaverine, which is pr obab 1 y an.^(1 Isoquinoline, had the effect of inhibitmg contractions ft "gud lowering the tonus of plain muscle, whilst the Dyr 1 ^ 1 ne X lienan111 icne represented by Morphine was found to stimulate contraction and increase tonicity. Benzyl esters were therefore examined and found to act onsmooth muscle of the viscera in a similar way to the first mentioned alka benzoate being finally selected for use.. TTirrmirie Acid Has low toxicity due to conversion into, and excretion as, Hippuric Aj h Ho serious case of poisoning in many thousands treated. In* £ antispasmodic properties it has antipyretic effect, and is , 295 large doses.—D. I. Maeht and H. P. Leach, Jl. Ph. & Exp. Tlier., Mai., *9iMo. Benzyl Esters tested. They all produced relaxation of themtestinai muscles, lowered blood pressure and depressed respira . . to Benzyl Benzoate.-Nielsen and Higgins, Jl. Lab. and Clin. Med. St. Louis, Nov. 1921. Benzyl Succinate. Syn. *Spasmine (T.M. 421401) C18H1804 =298-1404. Hose.—5 to 15 grams (0-3 to lGm.). This is a tasteless crystalline substance, ^ot nauBeating to the stomach. It is employed for conditions. similar to'those for which the Benzoate has been given. EsteroS-^ earn . 4 I Capsules of Benzyl Succinate 5 grains with Papaverine Sulphate 2 gram aie prepared for the combined effect of these bodies. .SS1 Capsules are stated to contain Benzyl Cinnamate C2Hv03.C7H, ~38 114^ a constituent of Balsam of Peru—and Cliolesterin. or^Crang^Oil.’ &VU' /3‘phenyl'ethyloL C6H5.CH2.CH2OH. ‘Rose Oil3 A local anaesthetic thought to be superior to Benzyl Alcohol Toxicitv use — AheTVraHinrt t ^ lattCTi ^is sufficiently soluble for therapeutic- use. A. M. Hjort & J. I. Eagan, Jl. Pharm. & Exp. Therap., Nov., 1919. Toluol (Methyl-Benzol) C6H5CH3 = 92*0624 and Xylol (Dimethyl- Benzol) C<;H4CH3CH3= 106*078 have chemical and physical pro perties allied to Benzol. The 1 : 2 Xylol boils at 141° 1 • 3 Xvlo“ boils at 139°, 1 : 4 Xylol boils at 138°. y Xylol. Syn. Xylene, unless otherwise specified, is a mixture of the three modifications. In dose of 5 to 15 minims in capsule lendered less likely to dissolve in the stomach juice than in the intestines ; has been employed in respiratory affections and in dyspepsia, and has also been suggested for use in certain skin diseases.. toluol has a pieservative action as Benzol above. Solvent naphtha a mixture of toluol and xylol obtained in distilling coal-tar—is used as a sol- vent for mdiarubber. (Solvent Naphtha commercially may now be of much higher B.pt. cf. Mineral Naphtha.). Scarlet Colors. Biebrich Scarlet * R ’ Medicinal. Syn. o-Toluene-azo-o-toluene- azo_/}.naphthol C7H7N2.C7H6N2.C10H6OH. A red dye with IVjL* _r t. 1 —loO Soluble in oils and fats, insoluble in water. . Uses.—To regenerate skin and to hasten epitheliation. As ointment, 2 to 8% Scarlet has been much employed. Aurinarla of Scarlet 5% strength are for aural treatment. Unguentum Scarlet 2 to 8%, in Soft Paraffin, also in Unguentum Lanolini. Prescribes should specify which is desired. Cp}Oleum Scarlet et Atropinae.—Corneal ulcers have been treated by a 5% suspension in castor oil containing 1% atropine.—P. J. Hay. There has been some confusion regarding the nomenclature and constitution of the Scarlet R dyes, and the above Medicinal Biebrich should always be specified. The following Scarlet colours have been similarly employed. Cerasine Red. Syn. Benzene-azo-benzene-azo-/3-naphthol. - ill1 f 1S also insoluble in water, moderately in Alcohol, and very soluble satisfactory1111 ^ Ether ^by our exPeriments), and has been found quite Non-Staining Scarlet. Syn. 0-AMINO-AZO-TOLUENE. Soluble in oils and fats, insoluble in water. Considered by some to be more efficacious than Scarlet 11. Ordinary ’ Biebrich Scarlet is the Sodium salt of 35-sulpho-benzene- solution^phobenzene‘azo'/3'naPhth0l, soluble in water making an orange-red Indolent ulcers.—The following dressing applied at least twice daily recommended. Immerse lint for two days in a solution of 20 grains of Biebrich Bed in a pint of water with 2% powdered Allantoin. Allow to dry without wringing or artificial heat and then iron out at low temperature. Cut to size and shape of ulcer.—J. M. Barbour, B.M.J. i./28,382. Further references to Treatment with Scarlet 4 Rsee Edn XIX p. 313. ' Amaranth.—Sodium Salt of p-Sulpho-alpha-naphthalene-azo-beta-naph- thol-disulphonic acid. Useful for tinting Cold Cream and for foodstuffs.— P.J. i./3o,427. jfcFeilidol. (T.M. 342061). Syn. Djacetyl-amino-azo-toltjol. P.G. VI., P. Svec. X. CH3.C6H4.N : N.C6H3CH3.N(CO.CH3)2 = 309-1722. Red powder with slight acetous odour. Insoluble in water, soluble in Alcohol, Ether or Chloroform, also in oils, fats, and soft Paraffin (‘ Vaseline p Q- VI.). Used in 2% Vaseline salve—does not stain. Azodermin, the monacetyl derivative and the Aminoazotoluol have also been used for promoting the growth of skin on wounds. Un£uent*im Granulin. . , A Canadian preparation containing 2% of this dye, does not stain (except on linen) makes a homogeneous ointment, is more effective than 8 to lu /0 Scarlet Red, and is non-irritating. Promotes epithelial growth, spread thinly on gauze, oil silk or wax paper. Bordeaux Bx is the Sodium salt of Xylol-azo-Xylol-azo-Beta-naphthol- Beta-monosulphonic Acid: soluble in water. Bayer ‘ 205,’ Syn. ^Germauin (T.M. 446358). This compound is probably a derivative of the type : [(SO,H)2. oh. c10h4xh. CO. c«h4 XH. CO. CfH4. xh]2 CO Dose.—The injection is made intravenously in dose of 1 Gm. in 10 Cc. of water at a time, but may also be given subcutaneously. A white powder soluble in water. The solution can oe sterilised. A series of dyes containing Amino-naph^ to have active trypanocidal properties. A single dose of ^ mgr. js stated produce immunity in a mouse to trypanosomiasisf 01’or months. 1 n r peutically it has been successful where Antimony, Arsenic and Emetine i lalThe compound exerts a strong action on T. Irucei, T.eQuinum T rhodesiense, T. qambiense, hut has not the same effect on T. lewisi oi:T. Prom experiments, the ratio of the minimal therapeutic dose to the minimal tolerated dose was found to he 1 : 60. It was possible to give ^ much as 0-5 Gm. per kilo body weight without causing death of ™}ce (i^ected mu T. equiperdum). It would, hence, be safe to assisS treated As tolerated hv man. Details of nine cases of trypanosomiasis treated a much as 12 Gm. within 14 days have been given intravenously. Seven of 11 . cases apparently cured.-G C. Low and P. The dye becomes attached to tne proteins the llood sci > It is .free 4 ultra-filtrate ’ from the serum was found devoid of the ren y. excreted unchanged in the urine.—Leader, L. u./22,12 . . , , The best effect seemed to be obtained by giving 3 infections at c^se ^ervals, and spacing out the remainder into 1 Gm. doses once, a■ veek. 1 ^.Bahr> the kidneys need not be regarded as contraindicatingfitsate^^th Bayer Records of nine cases of trypanosomiasis m Europeans treated wnu ^ * ‘ 205.’—G. C. Low, B.M.J. i./23,149. . , „ native As much as 5 Gm. have been given intravenously m50 hours to a nat . —X. H. Dyce Sharp (West African Med. Service,, L. 1.123,- U >• If given in smaller closes than 1 to T5 Gm. the ^[sg0aIj^y .Stephens and susceptibility to the cirug. B.M.J-1 • /23 >^ y • T • , 6 427 Warrington Yorke, Jl. Trop. Med., Feb>. 3L\•/ , taWy a It has a chemotherapeutic index 1 • 60 (Atoxyl 1 • Je Apl., ’23,155. derivative of Xaphthylamme-Sulphonic Acid.—Barger, per i ’ See also L. ii./26,28. . ™.v,on it 'hn'i reached Bayer * 205 ’ and Atoxyl do not grave accidents and the second stage. 0-05 Gm. mtrarachidi«n y Y , ^ | renal irritation 0-?, Gm. mortal accidents.. Cutaneous eruption noticed anai sometimes ending in nephritis, per Jl. drop. ’’ THE EXTRA PHARMACOPOEIA. c Treatliontfn q !f -may l <|?at1h Horn uraemia — L. i./25,892. Cannntwt S S* A.f[lca prophylactically encouraging.—L. ii./25,1246. andSj/fSwnrrW a cure for late cases.—Tryparsamide almost equal, ana easier to work.—A. T. Schofield, B.M.J. i./26,92. antigen^amhlpnnfc?e wfy.witk the trypanosome cell producing a heterogenic Med8, SeptP 15 ’26 3™U atmg formatlon of specific antibodies.—Per Jl. Prop. Mwl?,l°May ietie6 113treatment of animal trypanosomiasis.—Per Jl. Prop. ^^desiense than for T. Gambiense. Of value where 132P nosomes become fast to Arsenic or Antimony.—P. Manson-Bahr, L. k/27, with d°s.e gradually increased up to 1 Gm.— to -Warrt2 vWJ ease (1922) m which 0-2 Gm. was disastrous is referred aM P F rrB-MJ,.L/2¥70*. Two fatal cases.—J. T. Duncan —T p H-Manson-Bahr, Trans. Roy. Soc. Trop. Med., Vol. 17, 400. A failure —L. E. Rapier, per Jl. Trop. Med., Rov. 15/23,348. viMent^rpsfctinnPa^Jlful local reaction m one case. In another, 2 Gm. gave circ.datina in fUo i? a sfa*P mitlal rlse m the number of embryos rlonri nf^? the I?1?0*1’ fol]owed by a pronounced temporary fall. Ro evi- ^257-270 ane magG t0 thG kidney*-F- G* Rose, Int. Conf. Trop Am., #»e«!hl5«2ayor 120-5 ’ caused raPid disappearance of the trypanosomes, the ainariV^D S0-me ?fses Progressing to complete • - d against its general employment.—Work of Sleeping Sickness Commission m Portuguese W. Africa in 1923, per T. D. B., Oct., ’28, smanydeoSes2--p7rGTyeD. ^Oct?^VosT*”® Sympt0mS may folIow eve“ In sleeping sickness a recent reference. 1 Gm. doses.—L. i./29,1104. Relationship to Bayer 205.—G. M. Dyson, P.J. i./26,103. . No 309• Syn- Moranyl (T.M. 458062) produced in France, has similar properties and trypanocidal action, and is probably identical chemically. According to description the product should be 1? 1,)Ht :S.?i,I)?)''iNH'CO CoH3' (CH,)NH.CO.CiH,NH] 2CO.-C. D. Mar., 29/24,451. Trypanosomiasis.—“ No. 309 ” like ” 205” proved inferior to Arsenics. nnri?*mraI sterilisation easily obtained but of short duration. Causes albumi- fria ln mosfc1 cases- Preventive action good : prophylactic action in man not yet proved.—Per Jl. Trop. Med., Sept, 15,’26,344. nv' 36, Dose. 1/12 to 1/3 grain (0-005 to 0 02 Gm.) intravenously ^ c - airnyr Ampoules contain 0-01 Gm. in 1 Cc. Also issued in Dll IK O-l Prill. Ill 10 Cc. The symmetrical urea of 2?-benzoyl-z>-amino-benzoyl-i-aminc-S- N AP HTH OL- 3- 6- S 0 DIUM SULPH0NATE. Ill acute staphylococcic infections, in non-metallic intoxications, in pulmonary Thrombosis and oedema, venous thrombosis and the pernicious vomiting of pregnancy. Its action is thought to depend on ” liberation of + charged and conductor-functioning Sodium atoms” from the 6-positions. In the 11 eat men t of colds m the head, hay fever, influenza, acute asthma, and other inflammatory conditions of the lungs. BRONCHOPNEUMONIA and PNEUMONIA (pneumococcar). 0-01 Gm. should be given on two successive days, and a third dose a few days later if necessary. Urethritis. Fever reduced by injections.—F. Kidd, L. i./29,1094. Asthma. Patients with occasional attacks should be treated bv SUP 86 or B.R.368.—J. E. It. McDonagh, L. ii./29,271. U,r*oD Influenza of value. Influenza dose 0-5 Cc. ( = 0-005 Gm.) into the gluteus ™dius muscle, followed by 0-75 Cc. 4 days later if necessary.—R. M Pearce B.M.J. ii./29,603. ’ Influenza. Ro benefit noted in 50 consecutive cases.—A. H. Douthwaite B.M.J. ii./29,739. ’ Septic Conditions, e.g., boils, quinsy, etc. Not superior to other remedies, but invaluable in catarrhal fever.—W. T. Brown, R.M.J. ii./29,785. SUP. 468.—Dose.—1/60 to 1/20 grain (0-001 to 0-003 Gm.) intramuscularly. A similar compound used in septicaemia. SUM. 36.—Dose.—1/30 to 1/6 grain (0 002 to 0-01 Gm.) intramuscularly everv 5th day on two or three occasions. Also allied to SUP. 36, used in infections caused by gram-negative °rinnthe5treatment of gonococcal infections, such as urethritis, vulvitis and ophthalmia : also in very acute cases of gonococcal arthritis. SUM. 468 is the symmetrical UREA OF META-BENZOYL-META-AMINO-BENZOY L- 1-UAPHTHYLAMINE-4-6-8-SODIUM SULPHONATE. . . „ In malaria, piroplasmosis of horses, and trypanosomiasis of dogs, rour- neau’3 “ No. 309 ” is allied.—J. E. R. McDonagli, B.M.J. i./25,6o4 , i./26,693. “T N.T.” Tri-nitro-Toluene. Syn. Ti-otyi, C6H2CH3(N02);,= 22Trinitro-ButJ’l-Toluene C,HCH>C.H»(NOt). «s synthetic Musk or Ton- quinol. Chiaolinum. Syn. Quinoline. C9HtN=129-002G. Dose.—3 to 10 minims (0-2 to 0-6 Cc.). A colourless liquid,with peculiar odour, soluble m alcohol, but insoluble in water. Prepared by oxidising a mixture ol Aniline and Glycerin with Nitrobenzol (Skraup’s Synthesis). CaiinoUni Tartrag ,(COOH),]4=987'335. -51 15 sSls (.-3 .. 1 Gm.) in chloroform -rotor, noth about 1 in 80 of water. Antiseptic and antipyretic, e.g., m enteric and intermittent fevers, useful in neuralgia. 4i-->0S31 Qxyquinoline Sulphate. Syn. *Superoi. <t.M. 39 , (CaH,N.OH)..H!SO1 = 388-2008. 221898 (Class 48), 48S001 (Class 3), and 1896, “ An proved Disinfectant,” granted to the owners of the trade inarm x i lnxre^rpat?ni defis with the • heating of Oxyquinoiine with Potassium PyTrSlttt;e was originally stated doefnot but the content of Potassium in the h on incineration, agree with theory. The substance lea\es no> asn onm For notes on Manufacture see l Uh M. pt. 175 to 177° Characters and Uses. . ^y-ohol A 2% solution checks surface C., readily soluble in water sparingly m ha£ds. In chronic eczema haemorrhage and for scalds. 1 in . . 1 in 200 combined with Lotio CaUmin® Oleosa. of water is said Tablets 5, 8 and 15 grains. One ttw lai$0/o 6 yd. pieces, to he equal to Phenol 1 in 40, as an an - P tricophytic conditions ol Beneficial effects m many mycoses ‘ repeated applica- face, arms, and wrists, cured within a week by repea . tions of 1 in 2,000 solution.—B.M.J.",2/> ;wice daily with powder Diphtheria carriers treat ed by msufflatioiiJ3* ’31,155. containing 1 to 2% in Bismuth Carbonate, le ^ nsed as Cyanine Dyes, Sensito! Red> .^ordinarily active against staphy- photographio sensitizers, are extradorcima. uy THE EXTRA PHARMACOPOEIA. c G7T’ a",is0Cyanin°- is made hy condensing quinoline methyl iodide with p-tolu-quinaldine methiodide.—0. H. Browning and co-workers. B.M.J. i./22, 514,612. Cyanine. Syn. Quinoline Blue, Iodocya'nine, is usually given the composition C29II35N2I or C28HS5N,L ' h gaa^JpBagL^.y « -^■siitaSiirs^SSjSi" Acidum Phenylcinchoninicum, P.G. VI., TJ.R X Ph Ned V ninivuPp-Sveo-x -p-Ita]-p- Bdg: iv.; p.£ vm.^V;: Acidum Phenylchinolincarbonicum P.G.), Cinchophenum. ^ Phenoquin (T.M. B. 403738.) ^cAtopiian (T M 331*4731 ’ *Agotan (T.M. 401393), Cinchophen, XylofInol, S Quinoline Carboxylic Acid. C6H5.C9H5N.COOH=249-093S. * ’ Patent 15,684/12, “ Improved process for Manufacture.” There are others to which reference should be made, e.tj., 12,052/12. .. . 8 grains (0-5 Cm.) four times daily to ’l5 grains’ll Gm.l thrice daily after meals Simultaneously on the first day, 4 ounce * 5 Gm/),ai;d 011Tie ? owlr,g days 75 grains to 150 grains (5 to 10 Gm.) of Sodium Bicarbonate, but this is not the invariable practice Tabiets 4 grains (0-25 Gm.) -eight to twelve daily, also *8 grains (0-5 Gm.)—lour to six daily. A yoliewish cream-coloured amorphous powder of the composi- tion^ 2-Phenylquinohne-4-Carboxylic Acid. 1 Jj scs,- Is said to facilitate the elimination of uric acid from tiie organism in gout and rheumatic affections, also used in neuralgia and sciatica. It may cause cloudiness and red colour in the urine. \vw!u with s°dhun Bicarbonate and other alkalies in vitro Vv e did not find it incompatible with Potassium Iodide. ^n< loaycti excretion of Uric Acid confirmed.—Folin and Lvman J1 Ph & Exp Ther., 1913, 4,539—546) ex J.C.S.A. i./i4,115. ^ ’ Ji. Ph. & said bPettc^-|neiVspWnnZa th° C°mbined eflcct in “cg Jaundice of the new-born disappeared in 12 days in 80% of 67 eases [-“h 0-1 Gm. daily (with or without 2 Gm. of sugar).—Per Jl. A.M.A. rr£HE0?C 4G0-YtT* 0f*e? invaluable, and can cure or alleviate symptoms Test patient with small close at first. It is generally given on three days fn succession each week When nutrition is poor and there is suspicion of poor Gl) cogen reserves in the liver, carbohydrate diet should be given Where symptoms of liver poisoning arise, e.g., loss of appetite, stop the drug at once —Geoffrey Evans and A. W. Spence, L. i./2Q,704 Excretion of Uric Acid. Large doses of alkalies, Hexamine and Piperazine, which dissolve Uric Acid in vitro, do not appreciably alter the excretion. Salicylates increase both formation and elimination. The derivatives of Quinoiihe Carboxylic Acid Uixonypfai00tate excre 10r1’ shown a reduction in blood Uric Acid.— 1 Tic Acid the true stimulant for Uric Acid secretion. Atophan diminishes secretion.—O. S. Gibbs, Jl. Ph. & Exp. Ther., Jan.’29,62. from Atop hern, _ General malaise, headaches, gastro- mtestmal disturbance, urticaria, aibummuria and jaundice, the latter did 110^ .for several weeks.-—C. Worster-Drought, B.M.J. i./2s 148 ontn^* !5-./26’93f and Geofirey Evans, ii./26,93. (Severe poisoning going bonate ) dlC° and rcpeated vomitmg whether with or without Sodium Bicai? Three cases of toxic Jaundice following the administration of Atophan in ordinary doses per os. One of these was fatal. Toxic action is probably jiue to the quinoline nucleus. Atoquinol can hardly be regarded as a deriva- Ibive of Atophan, but both are derivatives of quinoline. Probably toxic 3ffect only where there is defective hepatic function, but possibly there i3 actual toxic action on the liver.—Sir W. H. Willcox, B.M.J. ii./26,273. Lumleian Lectures.—The type of toxic jaundice from Quinoline derivatives s dangerous. Van den Bergh Test and the Icterus Index indicate merely the ile regulating mechanism. The Lcewulose Test is best. Both Atophan and Arsenobenzol effects may be very long delayed.—Sir W. Willcox, B.M.J. i./31,553. Gorun Cachets. (T.M. 496893). A combination of Cinchophen, Hex- amine, and Glycocoll. Intramuscularly or per os, in sciatica, lumbago, etc. I Jaundice has followed taking.—Sir Wm. Willcox, B.M.J. h/31,395. t Eorty-seven cases of Cinchophen toxicosis published, with 10 deaths. Evidence of serious injury to liver in all cases. On the appearance of gastric intestinal symptoms, rashes, or icterus, it should be immediately stopped. Its therapeutic use may well be re-evaluated in view of its harmful properties. —H. S. Rcichle, Jl. A.M.A. ii./29,951. Ratal case of poisoning. 45 grains a day for 4 days, with intermission for 2\ months. Death due to acute hepatitis.—W. Morris, B.M.J. i./3i,221. Two cases terminating fatally following continued use (three 7\ grain tablets 'daily). Intolerance may be indicated by nausea, loss of appetite and albuminuria. Even if used in the correct intermittent manner it may be dangerous. —L. J. A. Lowenthal, W. A. MacKay and E. Cronin Lowe, B.M.J. i./28,5Q2. ‘Ung. Agotan Co.’ „ . , ,. , Agotan with a rubefacient in ointment form, for use m general, articuiar and muscular rheumatism, gout, lumbago, sciatica, erythema nodosum, i torticollis, pleurodynia, neuritis, urticaria and chilblains. The simultaneous use of Agotan tablets per os increases results. Atophan applied externally as ointment gave good results in c^I?.n*c j rheumatism and lumbago.—H. Horsters & H. Itothmann, Med. Klin., Apl. 9/26,582, per Pres., Sept.,’26,315. See also L. n./29,41o. Magnesium-Phenylcinchoninate is less toxic and a more efficient anti- j pyretic than the Sodium salt, and the addition of Magnesium Chloride m the ratio of 3 to 2 causes marked antipyretic synergism. H. G. Barbour ana J. B. ) Winter, Jl. Ph. & Exp. Ther., April/29,434. *Atophanyl (T.M. 434667). Contains equal parts of Sodium Atophan and Sodium Salicylate in solution. For intravenous injection.—10 Cc., containing 7*5 grains or each. After injection, the arm should be held above the head for 1 to 2 minutes. Warm the ampoules first. The patient should not undertake undue exertion too soon after the pain has been re lcvtc. For intramuscular injection.—5 Cc., containing 7 o grains of Sodium Atophan, 7*5 grains Sodium Salicylate, and 0 o gj.am ± °vo cain in distilled water. To be given deeply m the upper external quadrant of the gluteal muscle. Uses.—Rheumatism, csteo-arthritis, and metastatic joint- diseases of various kinds : and otherwise as Atophan. In chronic cases, 10—15 injections are given, usually one in jection per day for 4 days, followed by an mterva o * } • Various rheumatic conditions benefited by intravenous use. Atophan intramuscularly or intravenously in ca diathesis is said to give .good results in sclentis, mtis, and maocj jeetions daily or twice daily.—B.M.J.E. i./27,i^- %Keo-Phenoquin. (T.M. B. 403739). Lithium Phenyl-cinch ninate. C6H5C9H5N.COOLi=255-026. Dose. From 5 to 15 tablets daily, each tablet containing 0-25 Gn titter meals, followed by a glass of water. Simultaneous use of Sodium Bicarbonate is sometimes desirabl IjSCs. For elimination of Uric Acid in acute and chronic gout. ancFr^hvf tt*IT’M' 5A0239)- A. combination of Phenyl-cinchoninic ac± liver —B in T/3f757No reaS0n to bellcve causes yellow atrophy of tb ‘ Iodo-Cinehopheii.’ Syn. EARASTAN. Stated to be a ‘ new chemical complex ’ containing 33 % Iodine. In arthrit and neuntic conditions.—Jl.A.M.A. i./3o,484,11737 Methyl Phenylcinchoninaie, Methyl Phenylchinolincarbonat* '• ‘V- *Noyatophan (T.M. 344161) (Schering). UbT5. C9H5N.COOOHs=263,1094. (?'5Am,),four times daily to 15 grains (1 Gm.) thrice daiK irn i?e0/iS? Siirs I ounce (15 Gm.), and on the following day 75 t ISO grains (5 to 10 Gm.), of Sodium Bicarbonate. » comPound is the Methyl ester of Atophan and is used similarly. I occurs as yellowish tasteless crystals insoluble in water. Afcoquinol. (T.M. 440681). Allyl Phenylcinchoninate. rpiRZseir~\ f ? 8 fcablets in 24 hours [each tablet contains 4 grains (0-25 Gm.) They should be administered with a large quantity of liquid. aohySE?herUaXfK10WiSh °ryStalS’ 3°°> “soluble in water- !il Uses.—This Atophan derivative has analgesic and antipyretic propertie and is used similarly in arthritis, gout, neuralgia, sciatica, etc. P It may be applied externally in an ointment (20%). Atoqumol has been shown to stimulate elimination and inhibit productioi ot uric Acid.—M.P.C., April 16,’24. urine shows a sediment of Uric Acid or urates, it is advisable to« prescribe Sodium Bicarbonate as well. Renal lithiasis is the only known contraindication. Toxic iJaundice. 1 wo fatal cases following use of Atoquinol inrheui wldTTrw^u1S'_•X->Lo?ogd01^Bir0wn’ h-/26,37, see also ibid. 93, and Su W. H. Willcox, ibid. 273, and Atophan—Toxic Effects. *Tolysin. (T.M. 496959.) Syn. Ethyl Methyl-Phenyl-Cin CHONINATE. Dose.—10 to 15 grains (0-6 to 1 Gm.) three or four times daily lor four or five days. It may be necessary to give 100 grains daily in rheumatic fever. A yellowish-white crystalline pow der, M.Pt. 74° C. Uses.—An analgesic, antipyretic, and Uric Acid eliminant,. Indicated in gout, rheumatism, rheumatic fever, arthritis, neuralgia, neuritis, and sciatica. It does not depress the heart, or injuriously affect the kidneys. 50 Gm. have been given in 8 days without, causing untoward symptoms. Efficient in acute rheumatic fever, complete relief of symptoms being usually obtained alter 10 to 16 Gm. 2 Gm. given every 2 hours for 3 doses, followed by 2 Gm. every 4 hours.—H. G. Barbour, E. Lozinsky & C. Clements, Am. JL Med. Sci., May,’23,708. See also P. J. Hanzlik, R. W. Scott and others Jl. A.M.A., ’21,1728. 5 Efficacy in arthritis—Chace, Myers and Killian, Jl. A.M.A., Oct.’2i,1236. Advocated for headaches of nephritis.—A. I. Ringer, Am. Jl. Med Sci June,’21,814. In acute rheumatic fever.—C. W. Chapman, Pr., Jan. ’24,41. In. rheumatic heart disease Toly sin has definite action, is less toxic than Salicylates, and enables the worst cases of carditis to be treated without fear of drug complications.—F. J. Poynton, L. ii./28,638. Cinchophen compounds classified.—B.M.J. i./31,387. Neotropin. Syn. 2-Butyloxy-2'-6'-diamino-5-5/-azopyridine. (C14H18ON6). A dye giving yellow coloured solution used as a urinary antiseptic. Functions whether urine is acid or alkaline. More pronounced effect by reducing fluid intake. Bose.—2 dragees (each OT Gm.) daily for a week, but in prolonged treatment interpose interval of day or so each week. Dose may be increased.—B.M.J. ./31,589. Percain (T.M. 379675). The Hydrochloride of a-butyloxycin- choninic acid diethylethyleii diamide, AA —OONH—CH2—CH2-~N(C2H5)2, HC1 vv -oc4h9 N Max. dose advised to be injected, 0-1 Gm. in 0-2% Solution and 0-2 Gm. in 0-05% Solution.—B.M.J. ii./29,1114; i./3o,156. Colourless crystals, M.Pt. 97°. Readily soluble in water and Alcohol with neutral reaction. A new local anaesthetic effective in a dilution as high as 1 in 1500. Solutions are made in Normal Saline. Effect greater than of Cocaine, but five times more toxic. Deaths recorded from 0-13 and 0-2 Gm. Has slow rate of elimination and prolonged action. Maximum dose not yet determined, but should not be used in concentrations of more than 0*5 to 1 per 1,000.—B.M.J.E. ii./2Q,84. feee also Use m anal fissure, our p. 350. , , It is potent in such high dilution that the content adds next to nothing to the Sp. Gr. of the vehicle. For thoracic nerve root blocks solutions 1 m 2,000 to 1 in 1,000 according to duration of analgesia needed. 71 to 10 mgr. sard to be more effective than 150 mgr. Novocain.—W. Howard Jones, L. i./30>57o. Mucous membranes, especially of the nose, anaesthetised with 1 and 2/0 solutions, with addition to each 50 Cc. of } Cc. Adrenalin solution, for partial resections of turbinals, removal of polypi, ethmoidal curettages, and intranasal drainage of maxillary antrum. The mucous membrane is not permeated, though profoundly affected. It is admitted to be twice as toxic as Cocaine. O. Popper, B.M.J. i./3o,669. . n„PT„. Fatal syncope following Percain. The prone position is an error. Oper tion for a large ovarian cyst occupying the abdomen up to the ■ * It should be remembered that the gravid uterus is a similar contraindicauio . —W. Howard Jones, L. ii./3o,550. ihnn Clinical experience with Percain (made by Ciba of Basle). Chcape 1 Novocain. 7\ mgr. have longer effect than 150 mgr. of the laRer- N- C- L v and C. J. Marshall. Often it is not the ansesthetic, but the anaesthetist is re sponsible for good results in spinal anaesthesia. C. Donald, B.M.J. i./3 ? ^Toxicity negligible. Gives complete relaxation in high abdominal operations.—I. W. Magill, L. i./31,353. -vw^nai-n Arirpnnlin Has far greater toxicity and no great advantage over N ovocam-A for infiltration anaesthesia but promising for mucous membranes. M. C. Israels and A. D. Macdonald, B.M.J. ii./31,986. Sodium lodohydroxy-quinoline Sulphonate. Syn. 417770), Geiseein, Loretin, #Quinoxyl (i.M.4 ClIINIOFON. Bose.—15 grains (1 Gm.) thrice daily. Manufacture.—From 8-Hydroxyquinolme or t5?,,nW?no'in Sulphuric S-Hydroxyquinoline-5-Sulphonic Acid is prepared by d*ss © P J Acid, pouring into water, and allowing to crystallise. On iodising this pro- wHi’oAw0d?'?"hJdr0X^'5’qiUm0line*sulpll0nic"acicl is formed, which, mixed with ^0 /o °f Sodium Bicarbonate, constitutes the preparation. It contains about 28% Iodine and on adding to water the fairly soluble (about 1 in 25) Sodium Sulphonate is obtained. Uses. In acute and chronic aw.oebic dysentery 15 grains three or foiii times daily for a week, repeated on two or three days durino* two following weeks; or a daily enema of 200 Cc. of 2% solution has been advised. A dose three times daily for a week, then an interval of 8 or 10 days, and repeat—m resistant cases supplement with nightly lavage for 6 or 8 nights repeated after 3 to 6 days’ interval (during days when lavage suspended, continue treatment per os giving 0-75 to 1 Gm. daily). Lavage should be retained ah night it possible. Of value in acute and good in chronic cases; where complicated with liver abscess the intestinal lesion is ameliorated but not tne abscess. In amoebic dysentery with lesions high up in the intestines lavage is useless, but oral method of value.—Louis Schwartz, Paris 1927. Yatren, by enema, acts rapidly in the acute stage, amoebse being apparently destroyed m 4 days.—P. H. Manson-Bahr and R. M. Morris, L. ii /2 s 544 Advances in treatment with Yatren.—P. Manson-Bahr, B.M.J. ii I2 7 486-490 Some favourable reports are tabulated in the Pres., Jam’27 15 The action of certain alleged intestinal antiseptics (Yatren, Kerol, Dimol Izal). ^Experiments showed ‘no evident action whatever in any dilution employed. —L. P. Garrod, B.M.J. i./26,367, see also our abst. under Dimol. . vh mixed amoebic and bacillary types Quite contraindicated per os—too irritant.—J. Graham Willmore, T.R.S.M., Nov. ’28; G. C. Low, ibid . Yatyen-Casein Ampoules for intramuscular and in rare cases intravenous injection are made. / Weak’ 2\% Yatren plus 2£% Casein, ‘strong’ 24% Yatren plus 5% Casein.. Doses ranging from 1 to 7 Cc. are used in bronchitis acute articular rheumatism, and eye affections. ’ Quinanil. Syn. * 48 S/ A SULPHONATF.D 2 (p-DlMETHYLAMINO Anil) 6 Methyl Quinoline Methociiloride. Antiseptic power I in 500,000. Effected sterilisation of S. aureus on addition to 1 % Peptone Water. More potent than Acriflavine. Uses.—(a) As a prophylactic antiseptic dressing or pack for accidental wounds, laceration of soft tissue, circumcisions, amputations, skin grafts and the post-rectal space after operation for prolapse, or excision of rectum’ Also (b) as a local application for boils, suppurative hsematomata, fungathw growths, etc And (c) and (d) as an irrigant; (e) as a general urinary diseases irrigant. (/) Intravenously m septicaemia with positive blood culture Results favourable ; worthy of extended trial.—G. Armitage and others L.’ii.Ao Fuchsine.—Rosaniline Mono-Hydrochloride (principally) H-N. CHa. Cp. H2N CflH.4 Syn. Magenta ; Aniline Red, Rubine. Dose.—\ to 4 grains (0*03 to 0*25 Gm.), in a pill. Iridescent crystals, forming a deep-red solution for staining B. tuberculosis.— Vide Clinical and Bacteriological Notes, Vol. II. Soluble in alcohol 1 in 8. Given in renal albuminuria. Must be arsenic-free. Unguentum Fuchsin 5% in Soft Paraffin. Carbuncle and soft chancre well treated.—L. i./14,1502. Fuchsin Paint.—Cctstellani. Epidermophytosis of the toes (Mango toe) and other forms of epidermophytosis well treated with a paint consisting of saturated Alcoholic Solution of Basic Fuchsin 10 Cc., 5% Phenol Solution 100 Cc. Filter and add Boric Acid I Gm., after 2 hours add Acetone 5 Cc., 2 hours later add Resorcin 10 Gm. Keep in dark colored stoppered bottles. Should be employed initially with care and in small amount. —Sir A. Castellani, L. ii./28,596. Rosaniline (Syn. Roseine) Acetate. C20H1SiN3. C2H402+5H20=45T2814. Dark red crystals soluble in water and in alcohol Both these bodies are sometimes called ‘ Roseine.’ Methyl Violet. Syn. Pyoktanin. In green crystalline powder, soluble 1 in 20 of water, 1 in 20 of alcohol 90%, also in Glycerin 1 in 15, and in Oleic Acid. Insoluble in Liquid Paraffin and Vaseline—by our experiments. Commercial Methyl Violet, the colour used in the manufacture of inks, is a mixture of the tetra-, penta- and hexa-Metliyl derivatives of Pararosaniline Hydrochloride. It may be added that there are numerous Methyl Violets, the particular shade depending on the degree of methylation. Dilute solutions have been injected locally and applied for malignant growths, but Gentian Violet, a purified Methyl Violet, is now generally used. Tor details of antiseptic action see under Brilliant Green. Gentian Violet, Medicinal. Dose.—0-003 to 0-007 Gm. per kilo [=3 to 7 grains (0*2 to 0*45 Gm.) for a 10-stone man] intravenously in a £ to 1 % aqueous solution. Chemical Composition.—The product used therapeutically is a purified Methyl Violet, and consists of a mixture of the hydrochlorides of hexa- and penta-methyl-pararosaniline with some tetramethyl-pararosaniline hydrochloride. Soluble in water, but solutions cannot be made in Normal Saline, as the presence of the electrolyte results in precipitation of the dye. A ci u iteration.—For intravenous injection the dye should be free from metals and Dextrin. Gentian Violet of commerce contains, according to the ‘ Color Index,’ and other authorities, 50% of Dextrin. Examination.—The dye must be examined for Lead, Copper, Zinc, Iron and Arsenic : we suggest as limit for the last mentioned 1 in 100,000. Dextrin content should not exceed 1%. Ash we advise should not exceed 0-5 to 1%. _ , . Griibler’s Gentian Violet found to consist of about equal parts of Dextrin and dye. Dye was a mixture of chiefly hexa- and penta-methyl-p-rosamlme hydrochlorides.—Chern. Absts., 1920,190. ~ . Bactericidal Action.—The dye is stated to be specific for the Gram4 group of organisms only.—Jl. A.M.A., Dec. 29/23. Staphylococcic infections only are attacked by Gentian Violet, not streptococcal.—E. L. Walker, Jl. Pharm. & Exp. Therap., XXVI., No. 6, 461. Uses. —It is employed intravenously in septicaemia ana endocarditis. Has been tried in encejikalitis. For direct application a solution 1—500 to 1—1000 has been recommended : for instillation 1-10,000, and for intravenous injection 5 mgr. per kilo-weight, injected in 0*5% solution. _ Gentian Violet proves selective not only between Gram-positive and Grain- negative organisms, but also as between bacteria and tissue cells. jA ing results have been obtained in acute infections of joints by lavag In the dyes showing the greatest inhibitory action, theEA •' TVi]^' a 1RW the amino groups are all substituted with alkyl radicals , r & , ^ ' inert radical is the methyl group. Acid dyes or salts of acid or be is- 3 1 mump The substitution of a hydroxyl radical for a methyl ^ the mixture tory power. If two dyes of opposite selective power‘s.^® resoStivelv combines the power of both, e.g., Gentian V lolet and Ao . » of ^ie tw0 on Gram-positive and Gram-negative organisms, while - bacteriostatic for both.—Pres. June, ’34/240. VOL. I. L Empyema, Post-Influenzal.—Aspiration and intrapleural instillation of Gentian Violet in concentrations of 1 in 10,000 to 1 in 1,000 were used ii treatment. Of 27 cases, 14 recovered without operation.—A.J.Med.Sci. 162/21,397. Chem. Absts.,’22,591. Encephalitis. Three cases recovery : also one of Chorea.—Per Jl. A.M.A ii./2 5,1670. Endocarditis.—Review of literature (entirely American) on the subject of intravenous injections of the dye. Details of 7 cases of rheumatic carditis so treated, all children, varying from 5 to 13 years. Dose, 25 to 50 Cc. of a 0-25% aqueous solution (i.e., 0-005 Gin. per kilo). Injections given at weekly- intervals. Definitely toxic effects occurred in the case of a 5-year old child. Of 10 cases, 8 were definitely improved. With caution as to dose and type of case, the method is safe and worth further trial in the treatment of'blood! infections.—William Gunn, L. i./27,127. Subacute infective endocarditis. Good result with 1 in 500 aqueous solution.—It. H. Major, B.M.J.E. i./25,38. Malignant endocarditis treated: disappointing. 1% aqueous solution used. Except for intense cyanosis of short duration, no untoward symptom! produced.—Jl. A.M.A., Nov. 13/26,1677. Pernicious Anaemia.—Gentian Violet per os, 5 to 50 Cc. of a 1 in 1,000 solution after meals, or in 1 to 2£ grain capsules or tablets, gave a rise in hemoglobin content and in erythrocyte count, and in some cases amelioration of symptoms. Vomiting, nausea, or diarrhoea may be caused.—Med. J1.& Rec.. ’27,9, per Pres., June, *27,225. Skin. Infectious eczematoid dermatitis, impetigo, folliculitis and furunculosis. A 5% solution in water containing 20% Alcohol, applied with a swab. —A. R. McFarland, Arch. Derm, Syph., Jan.,’28, per Pres., Oct.,’28,319. Staphylococcal Septicemia has been treated. A dilution of 1 in a million will inhibit the growth of Staphylococci. In a case of staphylococcal septicaemia in an infant 15 months old, 3 injections of a 0-25% aqueous solution were given at 24 hour intervals. First dose 5 mgr. per kilo of body weight. As the white cell count was reduced, the second and third doses* were 3 mgr. per kilo. Blood cultures were sterile as result. The child finally- recovered and was discharged from hospital.—D. T. Smith and H. Casparis,, Jl.A.M.A., Dec. 29,’23. Startling results may be obtained, but failures arc equally numerous. The? cases reported total about 40% definitely improved, 20% possibly improved and 40% unimproved. Used in 1 in 200 solution in water each Cc. containing; 0-005 6m. of dye, a full dose being 45 Cc. for a 7-stone patient. More concentrated solutions may cause thrombosis. Initial injection of 0-002 Gm.. per kilo. Sharp temperature reaction, sometimes a chill, following injection., In favourable cases, following fall in temperature, improvement is marked- Value due to its bacteriostatic action in the blood stream.-—W. D. Gatch,. H. M. Trusler and J. E. Owen, Jl. A.M.A., Sept. 19/25,894. In sepsis, when Gram + staphylococci are the sole or predominant etiologicr organisms and when bacteria are accessible to blood stream, Gentian Violet intravenously is justifiable, indicated, and most beneficial. May be given, in safety in doses varying from 0-003 to 0-007 Gm. per kilo in a 0-25 to 1% solution.—Per Jl. A.M.A., July 25/25,306. Doses of less than 0-003 Gm. per kilo of little, if any, value. Several injections at intervals of one or several days often necessary.—Per Jl. A.M.A.,, Aug. 7/26,442. Thrush treated with local use of 1% aqueous solution. Apparent cure in one day or less in 50% of cases. Relapses on stopping treatment occasionally to be expected.—Jl. A.M.A. ii./2 5,901. Auramine. Syn. Tetramethyldiamino - diphenyl - ketonimine; Hydrochloride. C17H22N3Cl.H2O=303-6522. jDose.—1/3 grain (0 02 Gm.) has been given per os. A yellow powder soluble in water. The solution is decomposed! on boiling or on long standing in the cold, the imino group of the compound being converted into a Ketone group by hydrolysis,, giving the insoluble Michler’s Ketone and Ammonium Chloride.. L 2 ? A concentrated stable solution, 5fc Glauramine (T.M. 440880) in Glycerin and Alcohol is, however, obtainable, which is diluted f with water immediately before use. In ear and nose surgery, and for skin operations might be tried j intravenously (1 in 20,000)—T. H. Fairbrother and A. Renshaw, I Jl* R.S.A., March, 16,1923, 313. It is not caustic or irritant to the 1 tissues.—B.M.J. ii. /24,504. In bone suppuration Auramine is a good antiseptic.—Harry Platt. Anthrax.—1 in 5,000 prevented growth and rendered sterile even spore cultures of B. anthracis. Auramine might be injected round the pustule, or to swab the cut surface of the wound after excision of pustule.—A. Renshaw, B.M.J. ii./24,504. Intravenous Use.-—0-01 Gm. per kilo is tolerated intravenously in rabbits.—F. G. Davis, Am. Jl. Sci., Feb. ’21, p. 251. Septicaemia.—Auramine 0T Gm. intravenously on the first two davs and 30 Cc. of antistreptococcic serum subcutaneously on the first three days.— I J. E. It. McDonagh, B.M.J. 1./26,693. Se/ecf;Ve Act'on of Coo?/ Tar Dyes.—As a general rule dyes with any marked action contain one or more amido groups. If it has a colloidal state in solution it is no+ likely to be a strong antiseptic. Auramine and Nile Blue, 1 in 20,000 killed trypanosomes in 15 minutes. Auramine also killed paramoecia in 15 minutes at 1 in 20,000, and it was only surpassed in this property by the Meldola blues, but the most powerful of these, Meldola blue D (1 in 80,000, 1 in 160,000), contains Zinc Chloride. Auramine killed twelve organisms (including anthrax) at 1 in 5,000, the culture media containing the bacteria were incubated for 48 hours with varying amounts of the dye and were then sub-cultured to detect sterility. Small gold-fishes, however, lived in a solution of 1 in 20,000 for 18 hours, whereas in Brilliant j Green they died in 90 minutes. 1 in 500 of Phenol is necessary to kill 3 paramoecium in 15 minutes, as against the 1 in 20,000 of Auramine.—F. B. 1 Fairbrother and A. Renshaw, B.M.J. i./23,314,265 ; L. i./23,314. Journ. . Soc. Chem. Industry, May, 1922 ; Journ. Roy.Soc. Arts, Vol. LXXI., Nos. ■ 3668 and 3669, March, 1923. . O ur experiments, using recognised methods, indicated a more moderate germicidal power, but 1 in 500 killed B. Coli in seven and a half minutes. (For further details, see Vol. II.) Feed of attacking the malaria and sleeping sickness problems on chemotherapeutic research lines.—A. Renshaw, B.M.J. ii./26,857. ptY9s€iwsfery.—A Glycerin dilution of Glauramine is suggested. See Glycerin. Auramine is a constituent of Auromotine, the compound used in amoebic dysentery, v. f). 528. Malachite Green, Syn. Benzaldehyde Green. Characters.—This is chemically either the Zinc double chloride or oxalate of Tetra-methyl-di-para-amino-Triphenyl- carbinol: (C23H25N2C1)3 -f-2ZnCl2 + 2H2Oor (C2oH24N2)2 The former is in green prismatic crystals while the oxalate is in green metallic glistening plates. Solubility.— The Zinc Double Salt by our experiments is soluble in water 1 in 20, very soluble in Alcohol, in Oleic Acid 1 in 14 (?) in Glycerin 1 in 7 (?), totally insoluble in Liquid Paraffin, vaseline and Eucalyptol. The Oxalate is also soluble in water and Alcohol. |7s£S,_Durmg the war was much employed as an antiseptic wound dressing—especially as spray. Stains on the hands with Malachite Green are easily reumvR)^ by rubbing with a little cotton wool soaked in either A. 3 chloric Acid or dilute Acetic Acid. Ce) Cheatle’s “Green Spray.” Syn. ® Sublimate Malachite Green Solution. Syn. SOLUTIO MALACHITI VlRIDIS ET Hy- DRARGYRI PeRCHLORIDI K.C.H. Equal parts of 2% Malachite Green in 80% Alcohol and 2% Mercuric Chloride in 80% Alcohol. The two solutions are best kept separate and mixed as required. The spraying must be thorough and the spirit allowed to evaporate before applying the dressing. Must not be used to mucous membranes. Proved satisfactory at Haslar.—W. G. Axford and G. L. Cheatle, B.M.J. i./i7,535. Malachite Green kills Staphylococcus Aureus in serum in a dilution of 1 in 2,000, while it kills B. subtilis spores in a dilution of 1 in 5,000. Its effect is more marked in the case of Gram + bacteria, the commonest flora of war wounds. When mixed with Mercuric Chloride it does not diminish the effect of the latter.—L. ii./i 5,165. Valuable routine results from Malachite Green in naval hospitals.—Med. lies. Committee, B.M.J. i./i7,769. Brilliant Green, Syn Tetra - Ethyl - Diamido - Treprenyl - Carbinol in form of either Sulphate or Zinc Double Chloride (discovered 1879). In medicine the Sulphate C27H34N204S is to be used. Yellow crystals, solublem water and in Normal Saline and in Alcohol, forming a green solution. Chemical Examination.—Samples which we have examined were mostly the Zinc double salt and probably much of the dye that is sold as Brilliant Green is in reality Malachite Green, the latter being in the form of Oxalate. Fuse with fusion mixture to liberate Zinc if present, before employing usual tests. Antiseptic Power.—C. H. Browning and his co-workers found this substance to compare favourably with Acriflavin'e (q.v.), though the latter is more rapid. Uses.—The dye was much used initially on their recommendation as a substitute for the yellow dye, and is still used, solutions of strength 1 in 1,000 being employed. As a dressing it is painless. These two had the highest “ T.C.” (v. Acriflavine). Brilliant Green differs, however, in that it is not advised to be introduced by injection into closed spaces. Brilliant Green is almost as strongly bactericidal as Hexamethyl-Violet for Staphylococcus aureus, B. diphtherioe or B. anthracis (a concentration of 1 in 5 million completely inhibited growth of these organisms on agar, whereas 1 in 250,000 of Mercuric Chloride was required for similar result). Hexamethyl- Violet, however, is so weak in its action on the coli-typlioid group as to render it of little value as an antiseptic against these organisms '; whereas Brilliant Green is extremely potent in its action on the coli-typhoid group. Purtlier, even in the presence of serum, Brilliant Green is very actively antiseptic. It is also highly inhibitory towards anaerobes, such as B. malignant oedema.^— Browning and Gilmour, Jl. Path, and Ract. (Cambridge), Vol. XVIII., p.144. The most powerful antiseptic investigated by a standard method using Streptococcus fcecalis.—Emery for Med. lies. Com., L. i./i6,S17 ; i./i7,159. Internal antisepsis by means of “ Sulphate ” dyes which contain Sulphuric Acid combined with the Alkyl Amino group.—M. Coplans and A. G. Green, Jl. Ph. and Exp. Ther., Oct., '27,433. Septic Conditions of the ears have been treated with Brilliant Green 4%, Mercuric Chloride \% in 90% Alcohol. Bonney and Browning’s Violet and Green Solution. Syn. 4 Blue Paint. Brilliant Green and Crystal Violet (Hexa or Penta-Methyl Violet or a mixture of these), 1% each in a mixture of rectified spirit and water equal parts used to sterilise the skin.—V. Bonney and C. H. Browning, B.M.J. i./i 8,562* Stains on the skin can be removed with spirit, those on clothes by ; spirit or washing witn soap. J Brilliant Green Ointment. Brilliant Green 1 or 2% in twice the amount of Alcohol 90% and incorporated with Soft Paraffin. 1 Epithelial stimulant in various minor injuries and affections, e.g., impetigo, indolent ulcers of various kinds, superficial shell wounds involving onlv the |skin, blisters, etc,—It. W. Hodgson-Jones, B.M.J. i./i7,455. Sycosis. Remove crusts with 5% Salicylic Ointment, followed by epilation of loose pustule-encircled nairs and daily painting with 1% Alcoholic solution . of. Brilliant Green in 70% Alcohol. 53 cases cured after 12 to 25 applications i with no relapses.—L. i./32,202. Brilliant Green Paste (Key’s). Brilliant Green 1, Boric Acid 275, French j 1 Chalk 25, Liquid Paraffin 200. The Green is incorporated, dissolved in a little i ispirit. For filling wound cavities.—Wilson H. Hey, B.M.J. ii./i7,445. Cholera Vibrio is particularly susceptible to Brilliant Green.’ Suggested :use m man. Dogs tolerate l/5th grain per os— L. Nicholls, L. ii./i7,563. Methyl Green is Ghlor -Methyl - hex ameth yl -p - r osanil in e Hydrochloride. Syn. Light Green. Methylene Blue, Medicinal.—Sun. Methy^lthioninte Hydro- chloridum. U.S. X. Methyeenum Coeruleum, P. Helv., Fr. Cx. (+3H20) P. Jap. IV., Tetramethylthionini Chloridum, P. Belg. IV. C16H18N3CJ.S=319-6814. Dose.—1 to 4 grains (0-06 to 0-25 Gm.) in pill, cachet or capsule ; or hypodermically, 1 grain. Slipule No. 4 holds 1 grain. Methylene Blue Sterules contain 1 Cc. of 5% solution for hypodermic use. Dull dark green crystals, forming an intense blue solution in water. Soluble 1 in 50.—Fr. Cx. 1 in 20. Incompatible with caustic alkalis. Distinguish from the commercial compound with Zinc. Vide Vol. II. ! (Night Blue (cf. McCrorie’s stains Vol. II.) and Patent Blue A are more suitable for colouring Perchloride Solution.) Uses.—Analgesic, of service in rheumatism and painful nervous affections ; also in malaria, ague, nephritis and retinitis. Colours urine blue, mid faces become blue on exposure to air. Chlorinated Soda Solution will remove stains caused by it. Actinomycosis.—Two grain doses thrice daily, increased to 5 grains has been used. Nausea, dizziness and weakness wTere evidenced at first but soon disappeared. A 3% solution was injected locally but abandoned on account of pain. X rays alone or in combination with drugs should be sufficient.— Jl. A.M.A., Nov. 27/1920, p. 1470, per Pres. Feb., ’21, p. 34. Blackwater fever.—(Edema appeared lessened by its use. Colitis Ulcerative—Irrigation with 1 in 1,000 solution has been tried. Cystitis.—Two grains should be given per os and the bladder washed 3ut with 2% solution. In dysentery a rectal injection 1 in 5,000. In chronic suppurative otitis media and conjunctivitis—1 in 500 solution warm is instilled. In intertriginous eczemas, 3 to 5% solution. It has been used in bilh^rziRsis Gonorrhcea.—Hare suggests capsules of 2 grains, oil of sandal wood 1 minims, oleo-resin of copaiba 3 grains, oil of cinnamon 1 minim. Purulent discharge (due to S. aureus) from the eye socket well treated uy 0-1% solution.—H. M. Mcllroy, B.M.J. i./i9,465. Malaria treated by Methylene Blue—experience, of 5,000 three grain doses* Though inferior to Quinine in cutting short attacks it is valuable m preventing •elapses. No fear of ‘toxic’ symptoms.—D. G. Marshall, L. l/2o,1334. Methylene Blue used as a substitute for Quinine m mild but refractory ;ases. It is given in 0*1 or 0-2 Gm., to a total of 1-a Gm.—1 res., Jam, 27,20. Specially useful in cases refractory to Quinine. Dose 0-05 Gm. in 5 Cc. water, from two to five doses during day intravenously—well tolerated : or by the mouth up to a total of 1*5 Gm. taken during meals. Subcutaneously may cause abscess.—Ver Jl. A.M.A. ii./26,712. Intrapleural injection of 200 Cc. of 5% solution caused death in a case of empyema. Animal experiments showed that 0-0005 Gm. of Methylene Blue is toxic, and 0-005 Gm. lethal, for mice.—D. M. W., per Jl. A.M.A. ii./25,395. For Methylene Blue, Indigo Carmine, Phenol Bed and other Tests of the Kidneys, see Vol. II. Soudan Red III. AmLNDAZOBENZENE-AZO-BETANAPHTHOL. C22H16N40. = 352-1568. A brown dye for colouring fats, and in histology. Chrysoidine.—DlAMII'OAZOBENZENE HYDROCHLORIDE. C6H6N2C6H3(NH2)2HC1. = 248-5904. An orange dye, slightly soluble. Phenacetinum. Syn. Acetphenetidinum, Acet - para - pbenalide (B.P. ’14), U.S., Fr. Cx., P. Austr., Ph. Ned. V., P. Ital. V., Fenedina, Fenina, F.E. VIII. C2H5O.C6H4.NH.COCH3 1 : 4 = 179-1094. Dose.—5 to 15 grains (0-3 to 1 Gm.), in cachets, tablets (Slipule No. 1 holds 5 grains), or suspended in mucilaginous fluids. P.G.V. max. single dose 15 grains. Max. during 24 hours 45 grains, approx. An acetyl compound of Phenetidin, C6H4(NH2) OC2H5= 137-0938 (the ethylic ether of paraminophenol). It is analogous to acetanilide (antifebrin). White, shining, laminar crystals, M. Pt. 135° C., tasteless, soluble sparingly in water, 1 in 21 of alcohol (90%), and in sulphuric acid without colour. Manufacture, Notes on —See Vol. II. Does not liquefy with sodium salicylate, but phenazone does, e.gn Phenacetin 10 grains, Caffeine Citrate, 2 grains, Sodium Salicjdate 5 grains, are not incompatible. Uses.—Reduces temperature and soothes pain, very rarely causes rash or cyanosis. Successful in rheumatism, neuralgia, migraine, and hysteria. In first stage of influenza relieves headache and mitigates aching of limbs. The safest of the antipyretics.—Dixon, p. 245. This and other anilides, e.g., Acetanilide, are only slowly hydrolised in the organism with liberation of the parent basis—hence their activity.—O. C. M. Davis, B.M.J. ii./22,ll. Antipyretic effect of Phenacetin is enhanced by Magnesium Oxide in proportions of Phenacetin 2 : Magnesium Oxide 1. Probable synergistic action.— J. E. Winter and co-workers, Jl. Pharm. and Exp. Therap., Mar., ’3°,347. Tabes dorsalis.—Useful to control pains.—L. i./io,355. Toxic EfTects from large amounts (60 to 70 grains) taken in error or] intentionally. Treatment is: Whisky, Strychnine hypodermically, strong, coffee, large quantities of hot water (not stomach tube). Effervescent Phenacetin. Dose.—1 drachm (4-0 Gm.) or more. In two strengths, 5 and 10 grains in 1 drachm respectively. Tablets 4, 5 and 10 grains. Also 4 grains with Caffeine 1 grain,, also GeD2| grains with Sulphonal 2| grains. Dose.—1 or more. Phenacetinum cum Caffeina Effervescens. Dose.—1 to 2 drachms. Contains 5% Phenacetin and 24% Caffeine Citrate. PhenOCOll Hydrochloridum, Hydrochloride of Amido-acet-para- phenetidin, a derivative of Phenacetin. Trade Mark : The word Phenocoll alone is not registered. T.M. 157131 f (l89i) is a device embodying the word. Patent 5269/i89i expired 1903. I C«H'i I NH(^H20)NH2 } HC1.=230-59. Dose.—8 to 15 grains (0-5 to 1 Gm.). A white crystalline powder with sharp saline taste, made by the action of Ammonia on Bromophenacetin. Soluble about 1 in 16 of water. Rheumatoid arthritis is treated with Phenocoll combined with Piperazin (q.v.) Also beneficial in neuralgia arising from sudden cold and for headaches and pertussis (J grain hourly). In malaria a prophylactic. Phenazonum (B.P. ’14). U.S. X., Fr. Cx., P.G. VI., Ph. Ned. V., etc. Syns. Analgesine, Antipyrinum, Dimethyl oxy- QUINIZINE, PhENYLDIMETHYL-ISO-PYRAZOLONE. Trade Marks : if “ Dr. Knorr’s Antipyrine ” No. 42855, was Registered in 1885, and lias since been periodically renewed. A label bearing the word Phenazon and device of three stars is also a T.M.—No. 208865. Patent : 3097/i884 to the same firm remained in force 14 years, but now ; expired. (CH3)N.C(CH3) : CH.CO.N(C6H5) = 188-1096. Dose.—5 to 15 grains (0-3 to 1 Gm.) in cachets, tablets, or solution. Slipule No. 1 holds 5 grains ; No. 0 holds 10 grains. U.S. Average dose.—5 grains. Hypodermically 4 grains (0-25 Gm.)—painful. Was given with Cocaine Hydrochloride 1/5 grain. Mctnufczciure,—Condensation of Phenylhydrazine and Aceto-Acetic- Ethyi Ester followed by methylation.—C.D. ii./i4> P* 273. In white crystalline bitterish scales or powder. Gives a deep red colour with ferric chloride, nearly discharged by diluted sulphuric acid. Soluble 1 in 1J of water, about 1 in 1 of alcohol and chlorofornn and 1 in 40 of ether. Flavoring.—Glyl Menthse Piperitse, Glyl Rosse, Syl Vanillse; Aqua Menthse Piperitse, Syrupus Limonis, Syrupus Aurantii. Given as an enema if contra-indicated by the mouth. TJses.—It is an analgesic, reduces the temperature of fevers, and the pyrexia of pneumonia, pleurisy, phthisis, and erysipelas. In doses of 4 to 15 grains it relieves locomotor ataxy, chorea, migraine, facial neuralgia, rheumatism, sciatica, and sea-sickness. Hypodermically for lumbago, sciatica, angina pectoris, biliary and renal colic, and dysmenorrhcea. A skin rash has at times been observed after its use, and in the past some poisonous effects were reported. Solution applied locally is haemostatic. Antidotes.—Administer brandy or ether, atropine, strychnine or ftyvcfftn. Warmth to the feet and body. Incompatible with spirit of nitrous ether, or other nitrites in the presence of free acid, an apparently inert bluish-green iso- nitroso-antipyrine being formed ; also with the cinchona alkaloids* forming a precipitate which is soluble in wreak acids. Further, with phenol, tannic acid, iodine, or mercuric chloride (precipitates); amyl nitrite, ammonia alum, hydrochloric acid, ferric chloride, ferrous and ferric sulphates, cupric sulphate, nitrous acid, sodium bicarbonate or orthoform. In general it is best to administer antipyrin alone. Calomel and Antipyrin are incompatible. Reaction in presence of alkali with marked toxicity— J.C.S.A. i./2o,94. Liquefies with butyl-chloral hydrate, /3-naphthol and sodium salicylate, but solutions with the latter keep if dilute. Sciatica.—The _ following relieves the painful symptoms :—Phenazone 6 grains, Phenacetin 3 grains, Exalgin 1^ grains, Potassium Sulphate grains, Dover's Powder (sine Ipecacuanha) 3 grains. To be given in a cachet three of four times in the 24 hours. Good effects are also obtained from the following:— Phenazone 5 grains, Phenacetin 5 grains, Opium Powder § grain, in a cachet; 3 to 6 of which can be taken each day. . Antipyrin (4 Gm. in 10 Cc. of water with a little Novocain) by perineural injection also alleviates pain.—Pr., May, ’25,882. In middle-ear diseases, otitis media and inflammation of the tympanum, and tympanic membrane a 5% solution of Phenyl- dimethyl-pyrazolone (>^Otalgan, T.M. 4IG863) in Glycerin is used* by instillation. 4j Glossopharyngeal neuralgia well treated by Phenazone and Gelsemium I —J. P. Martin, B.M.J. i./31,533. Effervescent Antipyrin contains 5 or 10 grains in a draclim. Dose.—One teaspoonful or more. Tablets of Antipyrin contain 2| and 5 grains each. Dose.—1 to 4 or more. Also 3 grains and Caffeine 1 grain. Mistura Phenazoni Expectorans, St. Th. H. Dose.-—1 to 2 drachms (4 to 8 Cc.). Phenazone 1 grain, Potassium Iodide 1 grain, Ammonium Carbonate \ grain Ipecacuanha Wine 3 minims, Syrup £ drachm, Dill Water to 1 drachm. Local haemorrhage of haemophilia has been treated by applicatioi of a strong solution of Antipyrin in Ferric Chloride. CEDPommade Reclus. Phenazone 5, Salol 3, Boric Acid 3, Iodoform 1 Phenol 1, Mercuric Chloride 0-1, Vaseline to 200. The formula is often modified e.g., that of Fr. Cx. Nouv. Supp., ’26—it may be diluted or made much stronger For burns 1 or 2% Orthoform may be added. Anfipyrinum Salicylicmn, p. Austr., p. Beig., Fr. Cx., p. Heiv., P. Jap., P.G. VI., Ph. Ned. V. Syn.—SalIPYRIN, PYRA- zolonum Phenyl-dimetbylicum-Salkwlicum. C11H12N2O.C6H4(OH)(COOH) —326*1564. Dose.—15 to 30 grains l to 2 Gm.). Max. single dose 2 Gm., pro die 6 Gm. Manufacture.—Warm on a water bath Antipyrin 188 with Salicylic Acid 138. They liquefy and on resolidifying may be recrystallised. The process in the Patent Specification IO432/1890 which was in force for 12 years states that Phenylhydrazin, Aceto-acetic Ether, Methyl Salicylic Ether, Hydriodic Acid and Methyl Alcohol have to be heated together under pressure at 160—180° C. (!) A white crystalline powder, with sweetish taste, sparingly soluble in water; incompatible with acids, alkalis, and nitrites. Useful in acute rheumatic fever and in chronic rheumatism, anc sciatica; also for influenza and any acute catarrh and for menorrhagia ; as antipyretic in dose double that of Antipyrine. Tablets contain 5 grains (0*3 Gm.). Acetopyrin(T.M. Expired).—Syn. Aktipyein Aceto-salicylas. c6h4 HjCOp pr <-- ^-rnrirr .'-r.rl5-iN \ CO.... CH 308-172. i COOH ^N(CH3).C.CHs Dose.—8 to 15 grains (0-5 to l Gm.). A white crystalline powder, soluble 1 in 160 water, but about 1 in 3J of Alcohol 90%. Analgesic, antipyretic, and anti-arthritic, used in sciatica, hemicrania, influenza, etc. Ferropyrin. Fe2Cl63(C11H12N20) = 888*7508. Dose.—3 to 8 grains (0*2 to 0*5 Gm.). A soluble orange-coloured powder. Given for chlorosis and anaemia. It is haemostatic and locally astringent, applied pure or 20% aqueous solution; and in gonorrhoea, injections 1%. Incompatible with Salicylic Acid. Quadronal (T.M. 514585). A preparation containing Phenazone, Lactophenin, Phenacetin, Magnesium Peroxide, Caffeine and Hexamine. Analgesic, antineuralgic and sedative. Quadrc-Nox (T.M. 514585). Bose.—4 to H S-grain tablets, softened in hot water, 2 hours before bedtime. A proprietary ,stated to contain Phenazone 4 grain, Lactophenin 1/50 grain, Veronal 74 grains, Phenacetin 4 grain, Hexamine 1/10 grain, Magnesium Peroxide 1/12 grain. It contains 80% Veronal. Uses.—Hypnotic in nervous insomnia and pain. Felsol (T.M. 472588). Dose.—First week : 1 powder thrice weekly an hour after meals. Second week : 1 powder night and morning. Third week : 1 powder every morning. For children from 2 to 10 reduce to 4 or 4 dose. Place powder on tongue and swallow with drink of water. Composition stated to be Phenazone 0*47, Todopyrin 0*03, Anilipyrine /3 0*4, Caffeine 0*1, Ext. Visci Alb. 0*01 and Ext. Brachycladii 0*01. As a prophylactic and remedy for asthma. Makers state it can be used in cases of cardiac affections and is not cumulative. Anilipyrin a and p. Dose.—7% grains (0.5 Gm.). According to Gehe, these are condensation products 1 : 1 and 2 : 1 of Phenazone and Acetanilide. Amidopyrin. U.S. X. ^Pyramidon (T.M. 215952 and 360918.) Dimethyl-Amido-Antipyrintjm. Syn. Dimethyl-amino- Antipyrine. Amidofebrin. P. Ital. V., Fr. Cx., P. Jap., P.G. VI., Pit. Ned. V., P. Belg. IV., F.E. VIII. CijHj! (N[CH3]2)N20=231*1566. Dose.—5 to 8 grains (0*3 to 0*5 Gm.). Slipule No. 0 holds 5 grains. Fr. Cx. has max. single 15 grains ; max. during 24 hours 45 grains approx. Patents : 7709/1896 and 9268/1897 (ex&'rcd) U.S. Patent 579,412 (1897). . Manufacture,—Nitrosoantipyrin is reduced to which is then methylated. (See also Edn. X\II, P- 316, Ldn. XVlIi, p. 336, and Edn. XIX, p. 330.) _ , , , , • 0 r A white powder with M.Pt. 108 C. Soluble about 1 in 9 water and 1 in 2 of alcohol 90%. Incompatible with ^myl X* n e, Apomorphine and Gum Acacia. . „ Uses.—Antipyretic ; similar to Phenazone, but effective m sma er doses ; of special effect in sciatica. . . , Measles well treated. Dose.—2 to 5 grains in teaspoon with little water. 12 powders at 4-hourly intervals day and night. rrmW,idt7 n.Enrfs if given early.—J. I. Collier, B.M.J. 1./3 , a Completely aborts if 1093. Gladstone no?'* Urquhart and A- H- Winchester, B.M.J. i./3o,1153 ; H. B. loO cases. 1 grain for each year of age, with a maximum of 5 grains. /7^1Pi?iC-ra^lir(l(droi)S,^ n°rmal within 24 hours, with improvements in general condition. Given 4-hourly day and night until temperature settled.—G. W ldson and J I. Collier, B.M. J. ii./3o,995. On the other hand, W. H. w! Attlee treated GO cases on * ordinary ’ lines against 9 with Amidopyrin and was not favourably impressed.—Ibid., 996. Definitely good from 1 to 9 years but oyer 12 it is not indicated.-H. 6. Gladstone, B.M.J. ii./io,1103. The noys in an epidemic with it were more comfortable and seemed less ill.—G. E Fnend^B.M.J. h 3I’33, Effective. Apparently specific—T. Tires, B.M.J. vr^ri^yrin^Campl?orate (^ose—S to 12 grains), Bicamphorate and » ^amphorate (Dose—12 to 15 grains), and Salicylate (P. Ital. V.) (Dos<8 to 12 grams) are also prepared. (Patents lapsed.) lhe Camphorates are antipyretic, and have been advocated to suppress a - ®weads }n phthisis, but why combine the antipyretic with Camphoric Acid— an active antisudorific ? The Salicylate is given in rheumatic affections. Gardan Tablets, 5 grains. A combination of Pyramidon and Novalgin (v. posted). Dose.—5 to 10 e™* % or 2 tablets) two or three times daily as an antipyretic and analgesic. 1 ibbositis.-6 grain doses of Amidopyrin enhance the utility of Aspirin (10 grams) m relieving pain.—A. P. Luff. F Novalgin. Syn Nynalgin, Sodium Phenyl-dimethyl-pyrazolon-methyl- ammo-methane-sulphonate. * Dose. One tablet (7A grains) thrice daily, after meals, with water. An Amidopyrin derivative introduced as an anti-rheumatic, stated to be better tolerated and more effective than Salicylates, for use in articular and muscular rheumatism, sciatica, polyarthritis, and lumbago. An injection of 1 to 2 Cc. 50% Novalgin solution available in ampoules is also given as analgesic. Amidopyrin diethyl-barbiturate, Dimethylaminophenyldi- .. Syn. * ED Veramon (T.M. methylpyrazolon Di-ethylbarbiturate. 418411). C84H46N805=646-4228. Dose. Adult 1 to 2 tablets; children i to 1 tablet, followed by half glass of water. s A combination of Amidopyrin and Veronal (see P.J. i./29,193) for use as analgesic in headache, migraine and neuralgia. Useful in dysmenorrhcea and for the pains of bilious and renal calculus. J*Cibalgin (T.M. 455201). A compound of Amidopyrin with Dial. Tablets 4 grains (0-25 Gm.) : Dose 1 to 4. Liquid for oral use, 1 Cc. =0-25 Gin. (4 grains) Cibalgin : Dose 1 to 4 Cc. Ampoules each containing *2-3 Cc. Cibalgin (1 Cc. —0-25 Gm.): Dose A or 1 ampoule daily. The tablets and liquid should be taken with a little warm water or tea, but not in coffee In neuralgia, migraine, and other types of pain, e.g., dysmenorrhoea , articular and muscular pain. Annotation on.—B.M.J. ii./25,910. *Dismenol (T.M. 432802) is a mixture of Amidopvrin and Parasulphamido- benzoic Acid, C„H4.S02.NH2.C00H, used in dysmenorrhcea. P Dose.—1 tablet two or three times daily. 5$c Gompral (T.M. 466699). A new analgesic—Pyramidon combined with Trichloretliyl-urethane for use in dysmenorrhoea and pain generally —L i./3o,930. Tablets contain 7£ grains. ‘ COCiE FOLIA. pXju Coca, any 'preparation or admixture of, containing 0*1 or more per cent, of Coca alkaloids.” m Cocaine and Ecgonine and their respective salts, preparations and substances containing not less than one-tenth per cent, {one part in 1000) of cocaine or ecgonine. See also Dangerous Drugs Acts. Coca Leaves and Indian Hemp Regulations.—P.J. ii./28,262. History of Coca. The plant originally named “ Ivlioka,” meaning “ the tree of trees ” first became known in Europe through the writings of Garcilaso Inca de la Vega, a student of Peruvian history, who died in x6i6. Joseph de Jussieu in 1750 was the first to send specimens of the plant to Europe — P'ThVl°a9te W. Martindale had much to do with the introduction of Coca and Cocaine about the year 1884. He wrote a book Coca and Cocaine, which went through several editions and which is a classic on the suoject. Many new preparations oi the drug were devised by him and made m his laboratory. See also Historical Note by J. H. E. Brock under Cocaine. iPlJP 1| Cocss Folia {B.P. ’98), P. Ital. V. Syn. Cbca. ~ Dose.—h to 2 drachms (2 to 8 Cm.). . . r . N The dried leaves of Erythroxylum Coca and its varieties (Lmaccce) Eit Cx Two varieties occur in commerce, the leaves of E. Coca var. Bolivianum, known as Bolivian or Huanuco leaves, and those of E. Truxillense (Busby), the Peruvian or Truxillo variety, Vvhich is sufficiently distinct to be now considered as a separate species, although formerly regarded as a form only of E. Coca. . The Bolivian leaves are browner, larger, broader and thicker , the veins are prominent; and there are clearly defined lines on each side of the midrib, which shows a distinct ridge m its centre. Those of E. Truxillense are pale green ; less oval and more elliptical in outline ; and are much more fragile, being frequently broken The Bolivian leaves, imported from thatidsis^ocaSe for medicinal use, since a ^“at one time 0,l7.vC7Ltr.”SoM during tonuporl customary in Coca.nc near the plantations, purification be g From C. & D. Commercial Compendium, 1./25.1 • & )arge numbc;r of Morphological and histological characti ^ size of lcaves.__c. W. Cocas, with elaborate data as t° .2 6 per C.D., Oct. 30/26,657. Ballard, Jl. Am. Ph. A., May, June, July, « P > A con. The leaves contain the crystalline a“”dh°faT4ndard. For tent of 0-5% of this base has been su|ge td ^ ^ within Hpurposes 0-1% of Cocaine or jEj^ t0 be mosSt active when freshly the meaning of the Act. T1 y in Bolivia and Peru, miners, 7?*— •/ & «*' M”‘ vide Vol. ID thFo^EAF chewing IN Bolivia. To the Indian there are two things for Tn?i° vS,8h dse is only the means—coca and alcohol. The !5m °-tllC * una chews coca incessantly, in addition to a small , / %ia a 819^ substance like a bit of tailor’s chalk, composed of boiled potatoes ground into a paste with wood ash, dried and made into little flat cakes. I his enhances the flavour and effect (it liberates the alkaloids! borne peons use as much as two pounds of dried leaf per week.—From ‘ Six Tears in Bolivia, by A. T . L. Guise (T. Fisher Unwin), quoted, P.J. i./23,55# Time is gh en specially to workmen for coca chewing in the mornmv and afternoon. A man uses 2 to 4 ounces a day. Staves off hunger and weari- ™?es st“.on journeys. Indians use it in native religious rites.— H. It. McLean, P.J. u./3o,27 ; C. E. Green, ibid. 51. ® Coca-Chewing Gum is prepared containing in each piece (weighing 45 grains) 2 grains of extract ( = about grain of Coca Alkaloids). ® Elixir Cocee.—6 parts are equivalent to 1 of the leaves. Dose.—1 to 4 drachms (4 to 15 Cc.) in water is a palatable preparation. Standardised to 0-075% Coca Alkaloids. IIH Extractum Cocse. Dose. 2 to 15 grains (0-12 to 1 Gm.), in pills or pastils. A ‘ solid ’ or powdered extract. Made with alcohol 60% standardised to 2% Coca Alkaloids (1— about 4 of leaves). H] m Extractum Cocse Liquidum {B.P. ’98). Dose. -J to 1 drachm (2 to 4 Cc.). 1 = 1 of leaves exhausted with 60% alcohol. It therefore contains approx. 0-5% Coca alkaloids. (45 or even 30% alcohol 'would make it more miscible.) A single emergency dose of Extractum Cocse Liquidum (1 in 1), said to act like a charm ’ in cases of haemorrhage due to 'piles, when patient has to stand for any length of time.—C. E. Shelley, Pr., Sept., ’23/2II. If freed from wax, it is miscible with water and more palatable. b f(ivoriiiff• Syl Vanillse, Glyl Coriandri; Elixir Saccharin. [FljFluidextractum Cocse, U.S. Dose,—30 minims. Standard 0-5 Gm. ether-soluble alkaloids in 100 Cc. CS> Infusum Cocse.—1 in 50 of boiling water. Is a refreshing beverage with a slice of lemon. HEOPastillus Cocse Extracti — 2J grains (0-15 Gm.) of the extract in each. Each contains 1/20 grain Coca Alkaloids (0-25% ). Dose — One every two or three hours. For loss of voice due to weakness or relaxation of the vocal cords. HIFJViniim Cocse. Dose.—J to | ounce (8 to 15 Cc.) diluted with wine or water. Checks vomiting of irritable stomach. To be sold without a licence it must contain half a grain of alkaloid in the ounce (0*1,14%). Uses of Coca.—Coca has been praised as a nervine and muscular tonic, preventing waste of tissue, appeasing hunger and thirst, relieving fatigue, aiding free respiration, and as being useful in various diseases of the digestive and respiratory organs; it is recommended for indigestion, gastraigia feastrodynia, nausea, sickness, distaste for food, is given to relieve pain, nausea,’ v omiting or discomfort caused by excess in either eating or drinking, or by regnancy, and as a cure for morphine and alcohol craving. In using it for the latter in America it is said in some cases to have produced * Coca Craving.’ The leaves are sometimes smoked to relieve asthma ; and used generally for the stimulant and narcotic effect of tobacco and alcohol.—From ‘ Coca and Cocaine,’ W. Martindale (1886). PUSH Cocaina (2?.P.’14). F.E. VIII. Syn. Methyl-benzoyl- ecgoisIne. C9H13(CH3) (CcH5CO)NO3=303-1718. Dose.—2Lo to i grain (0-003 to 0 03 Gm.), in a pill or tablet. This important alkaloid crystallises in shining monoclinic prisms. It was obtained from Coca, and was first isolated by Niemann hi 1860. First use of Cocaine.—J. K. E. Brock, so far as we are aware, was the first to use Cocaine subcutaneously for surgical purposes, after trials upon himself. He writes us recently (1931) as follows:— ‘ I made my experiments with Cocaine in 1884, when in residence at University College Hospital as H.P. to Sidney Finger. He mentioned that Cocaine, a new drug, was being used in Vienna as an anaesthetic for eye work, and suggested that I should get some of the drug and try it on myself as a local anaesthetic to the skin. He could give me no information about dosage : and as to its toxic effects he knew nothing. 1 obtained it from Martindale’s. I tried the effect of the drug first as a surface application to the skin, but found it quite inert. I then made a solution and asked my friend, the late C. J. Arkle, a fellow resident, to give me the injections and test my cutaneous sensibility to tactile, thermal, and painful sensation, and their distribution around the site of injection. The distance apart at which the points of a compass could be distinguished as 2 points was also investigated. I began with a dose of' IjG grain, and increased to £ grain, 1/3 grain, and £ grain. Fortunately I stopped at the last. As he used to give me 2 or 3 injections successively at a sitting, it was really remarkable that I was not nuni- oered with the transgressors and sent beyond Jordan. I remember feeling some oppression in my breathing, but nothing more. ' Having established the fact that Cocaine injected subcutaneously was a local anaesthetic, and the area of skin anaesthetised around the site of mjec- tion, I asked the late Mr. Little wood, then a House Surgeon at C.C.H., to let me give his next minor operation a subcutaneous injection of Cocaine to test its use in Surgery. He agreed, and 1 injected £ grain over the surface of a bubo that he was going to 9pen. The result was rot complete anaesthesia, but was sufficient to allow him to complete the operation. As iai asy v e this was the first time that Cocaine had heen injected subcutaneousiy for surgical nur&oses. . . , M 1 ‘ The paper containing my results was published m the British Medical Journal at the end of 1884.’ . . . . 1QQ. ^ Carl Roller, who introduced Cocaine local analgesia in ,1884 spates . U is a curious fact that while many substitutes have been tried by a wnole army of investigators, Cocaine, in spite of all its disadvantages tury, has not been supplanted as the most efficient local anesthetic. June, '30,216. _ , s ^ , TT For Notes on Extraction of {Crude) Cocaine see \ ol. 1m. f Since 1928 Cocaine has been made under licence in this c°ynuy by one firm and 9326 ounces were produced in one year.—Ji.M.J. ii./30.151. For notes on Cocaine Addiction, see pages 341, &U. _ Soluble 1 in 10 of 90% alcohol about 1 in 100 to loO of liquidl or soft paraffin ; 10 to 20% of olive oil will assist solubility, iieby so in chloroform (2 in 1), ether (about 1 m 4), oil of boves ar d m y other volatile oils, and 1 in 10 of castor, and other fixed ods, 1 in 2 of anhydrous lanolin (warmed) ; 1 m 0 Pe„ Bioar Soluble in water to the extent of 1 m 1300. In 1 /0 bodium B bonate 1 in 1000. Insoluble in glycerin. Cocaine Po/som»0.-Methods of examination. Useful summary.- B.M.J. i./13,16. Stomach-tube. Toxic effects are best counteracted by amyl nitrite, nitro-glycerin, digitalis, strychnine, or ammonia, with strong coffee by mouth or enema, and ether hypodermi- cally (b minims). Anaesthesia by chloroform and ether may be required to prevent respiratory spasms. H> oscine hypodermically, or 10% solution of Calcium Chloride intravenously have been found safe antidotes for incipient Cocaine poisoning.—L. ii./23,1300. Urethral Injection of 3 grains in retention of urine has caused poisoning. Treatment of acute intoxication from subcutaneous injection of Cocaine, i rocame, Butyn, and similar local anaesthetics. Of drugs with prophylactic value the efficacy increased in the following order : Chloral Hydrate, Paralde- Barbital, Sodium Plienobarbital, and Sodium Amytal. Urethane and Ether not consistent and respiratory stimulants of no value.—P. K. Knoefel and co-workers, Jl. Pharm. & Exp. Therap., Aug., ’30,410. IPi IF'll Bougies of Cocaine ^ grain (0-03 Gm.) or more, with cacao butter. Useful in urethral affections. IF II Cocaine-Lanolin—Martindale. containing 10% Cocaine Hydrochloride, for dental use. A small amount to be carefully sealed in the cavity and left for two or three days acts “ like a charm.” %3| li?H Cocaine-Menthol-Phenol.—Equal parts liquefy and form a paste for inserting into tooth cavities ; stops the pain promptly. Melange Anesthdsique de Bonain, Fn. Cx. Houv. Supp. ’26, is this, using Cocaine Hydrochloride. 0121] ‘Cocaine-Menthol-Bugenol ’—Cocaine, Menthol, Eugenol and Alcohol 90% equal parts. Applied on a pledget of cotton wool, followed by jets of cold air, e.g., from a chip syringe, relieves toothache rapidly. H EQ Camphor 5, Chloral 5, Cocaine Hydrochloride 1, warmed, form an oily liquid which cures toothache. M IF 11 Cocaine in Clove Oil, 5%. Relieves toothache and earache. IS IF 11 Nebula Cocainae Oleosa, 5%. Cocaine Base 1, Oleic Acid 4, Liquid Paraffin to 20. In cauterising laryngeal growths a solution of the base in olive oil has been used to anaesthetise the tracheal mucous membrane and allay the cough. S IF ll Oleum cum Gocaina. A 2% solution in almond oil is mostly used for earache. For the eye a 2% solution in Castor Oil is used, may be combined with Homatropine ; for catheters, a solution in equal parts castor and almond oils is useful. fFH Cocaine Eye Drops, Factory Act, Solution No^ 1. {Specifically exempted from [fp] but caution it is [FI]. See also Dangerous Drugs Acts. For a foreign body in the eye. Dissolve powdered Cocaine (base) 0-5 Gm. in Castor Oil 95 Gm. on a water bath. W hile still warm add 1 Cc. of a solution containing 0-33 Gm. Mercuric Chloride in 10 Cc. of Absolute Alcohol. Mix by rotating. Apply with a camel hair brush.—Issued by the Factory Dept, of the Home Office, 1917. Ethocaine Base 2-0, Chlorbutol 0-5, Castor Oil 191 Gm. may replace Cocaine Eye Drops (Factories Act).—P.J. i/3o,443. A draft idea so far. 1 p| |pX!Unguentum Cocainse (B.P. ’14).—Cocaine 4%. Useful where absorption is required, as in facial neuralgia, shingles, eczema, erysipelas, urticaria, and pruritus (R.O.H. has Cocaine 1, to Soft Paraffin 50 ; heat to dissolve and stir till cold). Assay of Cocaine in B.P. ’14 ointment.—H. J. Foster, P.J. i./2i,479. jjg ptj Petrolatum Cocainse. Is made with Cocaine (base), 1,2,4, and 10%. The 1 or 2% are suitable for eye work, and the 4 and stronger percentages are useful for catheterisation, burns, and for intense sensitiveness of parts, pruritus, etc. HI FT1 Cocainse Hydroehloridum. In most national Pharmacopoeias. C17H21N04HC1=339-6366. To be anhydrous.— F.I. Usual Dose.—io to i grain (0-003 to 0-03 Gm.), but more may be given, in solution, pill or pastil. (B.P. 14) To 1° ^ grain. Hypodermically J to \ grain (0-015 to 0-03 Gm.). Fr. Cx. &. P.G. VI. maximum single dose, f grain; maximum during 24 hours, 2J grains approx. P. ItaLV. \ and 1 gram respectively. Shining, lamellar crystals, with bitterish taste. One part ol Cocaine base=l*12 of the Hydrochloride. Soluble 2 in 1 of water, also in alcohol and m glycerin, insoluble in ether, fats, and oils. It will crystallise with 9-5% of water of crystallisation, but the anhydrous salt is preferred. M. Ft. ibd U Glycerin of Starch is a useful solvent. A solution m this can be applied locally without lint or wool. Keeps well and is economical. —J. T. Hall, B.M.J. i./i7,765. L. i./i7,824. , to prevent precipitation. ... ine hydrochloride in the form of In dispensing White Precipitate with coca % Q Qf water> Rub the an ointment, dissolve the cocainc sa ' od inix, and add the remainder white precipitate down with a little aimona t , of the ointment base—gyg., soft paramn. presence of Glycerin With Phenol, Cocaine Hydrochloride is compatible m pres or Alcohol, but not in aqueous solutions.—P.J. i./25,-w> Uses of Cocaine and its Salts. anaesthetic is a Renders the superficial structure of tl „ t ducous mydriatic, and paralyses the a“°“™^lt^eously Pwith anaesthesia, membrane it blanches the: part simult pain of eczema, Application of an ointment (alkaloid) irritation of urticaria erysipelas, facial neuralgia or shingles, and the irritation or pruritus. , ... a ,0/ anueous solution (Hydro- Bums and scalds. Brush with /o 0\ or pnt. chloride) and apply Cocaine omtmen o ^ aqueous solution Fissured nipples ; also insect bite . spasmodic asthma, Hay fever, influenza,, coryz ’ of an aqueous solution to laryngitis and pharyngitis. A P y relieve irritability of mucous mr ace. May be minimised Spasmodic and painful fecHonsof thev^na. y by vaginal injections of 1 grain in 1 /o ouy In dentistry. For extraction Dental Anaesthetic will be found effectual. For plugging, preparations such as Cocaine-Lanolin, Calorific b luid, Cocaine-Menthol-Eugenol. r 01 email operations. Solutions of Cocaine Hydrochloride have been used in excision of the tonsils, cauterising the turbinated tissue o the nose, painting chancres previous to the application of caustics, lemoving polypi, iridectomy and operation for cataract, squint, and the removal of foreign bodies from the eye. For the eye aqueous solutions of Cocaine Hydrochloride 2 to 4% strength anil for other purposes 4 to 50% : it is necessary to repeat the application of the weakei solutions. No operation should be commenced within at least 10 minutes of the first application. Injurious effects, either local or constitutional rarely follow its use. The nose may be plugged with strips of gauze soaked in 20% Cocaine solution, to which a few drops of 1 in 1000 Adrenalin have been added. In the urethra not exceeding 1% should be used, as absorption is rapid. In the eye 1 to 4%.—H. S. Souttar, B.M.J. ii./i3,70. Finger amputation. Cocaine solution 5%, to which 5 minims of Carbolic Acid and 5 minims of Suprarenalin solution 1 in 10C0 have been added to each ounce of the solution : never exceeding 90 minims, often less. Rectal and prostatic pains are relieved by 4-grain suppositories- A rectal injection checks diarrhoea and dysentery. Whooping Cough often well treated by Cocaine by the mouth, dose being on the basis of 1 gram ter die for an adult. Also of value by painting the external auditory meatus and membrana tympani with a pigment, gg dp] Pigmentum Cocainae et Hydrargyri Perchlondl. Cocaine Hydrochloride 28 grains, solution of Mercuric Chloride drops, Glycerin 4 drachms, Water 4 drachms, after syringing ears twice or thrice daily with Boric Acid lotion. s tor liay fever, Herbert Tilley warns that it may generate Cocaine craving. Cocaine 5 Gm. instead of 0*5 Gm. injected into a horse’s fetlock. Operation performed Sweating after about three hours but no violent Cocaine poisoning. Subsequent recovery.—P.J. i./r5,109. Snake bite well treated by large dose—vide Snake Bite, Therap. Index Deflection of septum operations. Pledgets soaked in Adrenalin solution an I 10 /o Cocaine Hydrochloride, equal parts, then Cocaine injections (5%) into the muco perichondrium.—J. Donald, Pr., April, 1921. For ear operations as local anaesthetic.—Cocaine Hydrochloride. Menthol tmE??’„ iJove anti Rectified Spirit, equal parts.—F. Pearce Sturm’ Enucleation of the tonsil under local anaesthetic. For surface anesthesia a mixture of equal quantities of 10% Cocaine Hydrochloric Solution and Adrenalin Solution used, applied with cotton swabs, and repeated three or four times, followed by infiltration of the tissues, in which the tonsil lies embedded, with a 0% Novocain Solution.—Dan McKenzie, Pr., May, ’22/314. /Vone of the synthetic local anaesthetics equal Cocaine when a&plieil to mucous membrane. Operations should be preceded by Morphine and Atropine hypodermically. In nose operations Adrenalin should be applied followed by Cocaine ; injection being made slowly In throat operations a 5 to 10% solution should be applied first. When there is suspicion of possible danger, one fourth of the ansesthetic only should be used and the patient watched for possible toxic effects. Soluble tablets of Cocaine recommended to allow of solutions being as fresh as possible Jl. A.M.A., July 31, ’20, p. 315, Pres., Feb., *21, p. 39. As a result of comparative tests Cocaine, on the whole, was found preferable to Butyn for aural work.—L. ii./23,1298. Cacaine anaesthesia stated to be increased by the addition of Potassium Sulphate.—Y.B.P., ’24,316. cf. Note to Potassium Sulphate and to Stovaine. None of its rivals appears to have any material advantage over Cocaine.—E. Watson-Williams, Bristol Med. Chir. JL, Autumn, ’25,164, per Pres., April, ’26,146. Better than substitutes, especially in eye work and rhinology.—A. J. Copeland, B.M.J. ii./24,41. Urethral injection of as little as 20 minims of a 4% solution has proved fatal.—Medical Review, Sept., ’28. (Most exceptional we should think.) Direct contact of 5% Cocaine Hydrochloride solution breaks sensory conduction so completely that the strongest tetanic stimulation peripheral to the anaesthetised area is no longer able to produce response, while the same concentration of anaesthetic leaves motor constriction unchanged for about an hour (Santeson)—a selective affinity for sensory nerve fibres which is a quality of all the Cocaine series.—L. i./3o,145. Le FilSiatre’s method o f general spinal anaesthesia with Cocaine. Removal of 25 to 30 Cc. of cerebro-spinal fluid, and forcible injection of 2*5 to 3 Cc. of Cocaine Hydrochloride 2%. 10,000 cases reported. —L. L/29,291. Swabs for applying Cocaine (e.g., the 20% solution for anaesthetising the larynx) should be of non-absorbent cotton wcol.—feir J. Dundas- Grant, B.M.J. i./3°»669. Local Infiltration Ancesthesia is produced by solutions of cocaine (and eucaine, q.v.). Its action commences in three minutes, increases for ten to twenty minutes, and mostly disappears within half an hour. The anaesthesia may be prolonged by applying a triangular bandage when possible above the site of injection; this ha,s also the advantage of lessening the risk of toxic symptoms, as the delay of cocaine (and eucaine) in the tissues renders it innocuous. Cocaine and Adrenalin are used together. For infiltration a 0*01% solution of Cocaine with 3 to 5 drops ol Adrenalin solution 1 in 1,000 to each 100 Cc. is sufficient. (Steruies ol the two are prepared.) Exnerimentallv an ansesthetic dose of Cocaine or Novocain has no effect m the heart, but with Adrenalin added the heart’s action liminished in intensity. Hypertonic injections may be the cause of pain.—E. N. Doubleday, L. L/25,437,451. _ ^infirm* iq necas- Lumbar Puncture Ancesthessa with 2 /o j7,t -pij ionally practised for major operations. Further details, 1/th Fan. Cocaine Ionisation, see Iontophoresis, Yol. 11. Cocaine in Dental Extractions. [MifWTlDental Aneesthetic—Martindale, is used as a local_anses- thefic for extraction. It contains 0-85% Cocaine base ^d lod^em the requisite chemical combination, together with haemostatics and 13 ^-TheTmwnt used varies with the number of In view of the fact that h gram of Cocaine should n 50 minims may be considered a maximum, f e > 1 put at 10 to 25 minims. _ _ , Some tran- The injection is made alongside the teet o e anaesthetics, sitory swelling of the gums may beapprox, as an ordinary The Dental Anaesthetic contains nothing of the nature of Adrenalin, but a small dose of the 1 in 1,000 solution may be added at the time of use if excessive hemorrhage be feared, or it may be injected afterwards in severe operations to arrest primary or secondary haemorrhage. See also Haemorrhage, Dental, Therap. Index. A user of this preparation (P.G.) wrote us (May,527): inioTil TH?1,1 Pjeasure in endorsing the remarks in my letter sent to you m. that I had at that time extracted hundreds of thousands of teeth witli the anaesthetic without even one unsatisfactory operation. During the v aaayeSrs ^at have elapsed since sending that letter, I may state that if o0,(J00 extractions were added this would he a very moderate and certainly muter estimated number up to date, and on every occasion the anaesthetic has done everything I could have wished for. “ before commencing an operation I always examine most carefully the tooth or teeth to be extracted, and the gums, and at the same time question the patient for information. , * * After touching the gums with a little Dentalone or Iodine, I rest the bevelled edge at the point of the needle firmly against the gum and commence pressure or Anaesthetic. In this way, neither the operator nor the patient realises when the pomt of the needle has penetrated the gum, but the bleaching will show that it has taken effect, and at this stage the needle can be injected as far as desired without causing any pain to the patient. The injection should be slow and steady. Although the Anaesthetic will retain its effect for some a 5?e» there is no need to wait as is necessary with some local anaesthetics. After passing the beaks of the forceps through a flame, I proceed to complete the extraction.” Some operators make a practice of spraying the cavity after removal of the tooth, with a little 20 volume Hydrogen Peroxide. The following injections have been recommended :— Cocaine Hydrochloride 3 grains, Solution of Adrenine (t in 1,000) 1 drachm Solution of Hamamelis 7 drachms ; also Eucaine 6 grains, Phenol 5 grains Solution of Hamamelis 1 ounce—P.J. ii./o9,9C. 20 minims of the former contain i gram Cocaine Hydrochloride. (As much as 20 minims of a 10% solution,—10 minims either side of the tooth at 5 minutes interval =2 grains of Cocaine Hydrochloride has been given but this must be considered excessive.) Notes on Tooth Extraction. A 1% solution should be used, 15 to 20 minims of which gives the best results. Congestion always follows the use of Cocaine, and in most preparations Adrenalin (which is also vaso-constrictor) is added to prolong the insensibility and localise the anaesthetic. The injection should be made slowly and as few pricks with the needle as possible. Never push the needle too deep, for injury of the periosteum of the bone with the needle point may be one source of trouble. Rapid injection must be avoided, and never inject into any but healthy tissue. If the gum is septic, cleanse round the tooth to be extracted with some antiseptic on cotton-wool. Use a thoroughly sterilised syringe in good working order. In injecting there should be resistance to the pressure on the piston. Reinsert the needle if resistance is not met with. If the fluid goes into the gum too easily, it may be due to passage into loose cellular tissue, and this sometimes causes after swelling. There should be little danger of cellulitis, sloughing, or necrosis if the above instructions are followed out.—C.D. 58 (Pj Injectio Cocainae Hypodermica, St. Bart.’s H. Cocaine Hydrochloride 4£ grains, Potassium Iodide grains, Thymol % grain, Oil of Gaultheria I minim, Adrenalin Hydrochloride A grain. Distilled Water to 1 ounce. For dental purposes. The addition of Adrenalin to a i% Cocaine solution found to increase its toxicity in proportion to the amount added.—Brit. Dent. Jl., Nov. 15, ’27 1289, P.J. i./24,81. 58 l| Calorific Fluid for dental use. Cocaine Hydrochloride 1, Camphor 10, Clove Oil 4, Ether 25, Chloroform 30, Absolute Alcohol 30. [pi WJA Aurinaria Oocainse Hydrochloridi.—Ear Cones, contain 1 grain in each with Cacao Butter basis. Guttse Cocainse Hydrochloridi, R.O.H., 8 or 16 grains to 1 ounce. 1 0 R.N.H. 2%. Guttse Cocainge cum Adrenina. Cocaine Hydrochloride 5% in Adrenin Solution (1 in 1,000). PIIFlIInjectio Cocainse Hypodermica (B.P. ’14). Cocaine Hydrochloride 1 in 20 in dilute Salicylic Acid solution (0-15%). Dose.—5 to 10 minims (0-3 to 0-6 Cc.). Fr. Cx. 1% directed to be sterilised at 110° C. for 10 minutes. A solution up to the strength of 50% may be prepared in salicylic acid solution 0*15% strength, which is nearly saturated. The BP ’98 injection was hypertonic. Should he hypotonic as it would then mix more readily with the lymph, and be carried off more quickly by the lymph circulation. A solution 0-594 Gm. in 10 Cc. is isotonic. rJ. 1.112,6b 1. Cocaine Hydrochloride Sciutions can be^sterilised by boiling. Recent confirmation of our view.—P.J. 1./31,293 ; m/31,^6. We deal further with the matter in Vol. II. . Intravenous use of Cocaine Hydrochloride is not suitable for man. PI EU Isotonic Cocaine Eye Lotion. Cocaine Hydrochloride 1, Sodium Chloride 1-25, Distilled Water to 100. This is isotonic with the tears with which F4/0 Sodium Chloride solution is isotonic.—Pres. pjHypodermic Tablets are prepared with yb, b> h> b and 2 gram of Cocaine Hydrochloride in each. Lamellae Cocainse, Discs of Cocaine (D.1. 14)• „ . . -i j • • __ 1 rt 1 I jy I LSniCIl^ UOLdllltL•> Uvia v><uva V _ '. T, j ii • i Discs of gelatin, each containing grain of Cocaine Hydrocnlonde, are for ophthalmic use. Also prepared HUES containing rosjpmn ire ior opnrnaimie u&c. mau ^ ~ ‘ \' rsaf rasr in each in combination with g EG Atropine Sulphate, (q.v.), PJ El Froma,tropine (q.v.) and [51 IF 11 Physostigmine (<?.*>.). P PH Pastillus Cocain* Hydrochloridi. T‘5 grain (0-006 Gm.) in Vach (or more if ordered). To allay throat irritation and hoarseness. Also made @ H t 5 grain with Morphine , grain. BjM'Pikda Cocaine Hydrochloridi. i grain (0-012 Gm ) in each (or more, if ordered), with milk sugar. l§[fl! Nebula Cacaime Hydrochloridi.—May be prepared.1,_ or 10%7or more if ordered, with sterile ‘Normal Saline for general us . Sprays for Cocaine Solutions should have fine aperture for the Jet- 3 jflj ‘ Sterules,’ Ophthalmic are prepared con ainmg Hydrochloride Solution 10 grains to the ounce (2'Jf/o)- For “general purposes ® El Large \Ste™^ <^ride Solution wifhP:“in‘ ^'grmn^aiCeT“parHed,rfor painless dental extraction.—(cf. Adrenalin). \ nr more . . 1 o-rain (0-03 Gm.), or more. U Suppositories and Pessaries 2 g1 ( ir ijauppusituxica *-7 • £>“'jTraPRTria S.H. 1926 has Pessus 1 gram in 2 drachms. Ip lnjectio Cocaines et Sodii Bicarbonatis, Cocaine Hydro- chioride f. Sodium Bicarbonate J, Chloretone j, Distilled Water rn lllii ^ to 100. -Dose.— 2 to 4 drachms (8 to 15 Cc.) for urethral injection. ms solution is remarkably efficacious for use prior to passing a catheter. According to our experiments the fact of the Cocaine bemg in part in the basic condition renders the solution more efficacious and anesthetic in effect than a solution of even 4% or 5% Cocaine Hydrochloride, employed in a similar manner. See also ‘Activated Alkaloids.’ fll£j]“ Sterules ” of Cocaine Hydrochloride, Sodium Bicar- bonate ^ and Chloretone (Dry Powder) contain the constituents r ° 1 ounce of the injection on dissolving in distilled water. EH Compound Cocaine Suppository of Cocaine j grain with Mor- 2 grain (Hydrochlorides) is useful for painful hsemorrhoids. ig EJJ Tabeliae Cocainae, Cocaine Tablets, £f ^ and ^ grain with chocolate. The usual dose is gram. ^uSe'~} e-^erI duarter» half-hour or hour, quickly eaten and swallowed. Useiul for sea-sickness (chloroform or alcoholic sickness) and that of pregnancy. Sea-sickness may be overcome by internal use of the following -—Cocaine Hydrochloride 0-2 Gm, Iodine Tincture 2 Cc, Water to 150 Cc 1TSU^iSp00nfl1 2 to 4 times daily- Hore palatable without the Iodine " ’ ifil UP H Pastilli Cocaini Hydrochiorici, P. Jap. IV 0« (4°griins^x“Tnilleac0h005 ^ <1/12 gra«> "ith Sugar l|3] ]PJJ SyrupuS Cocuinss. Hypodermic injection of Cocaine Hydro chloride (B.P. ’14)44 minims, Syrup of Orange Mower to* 1 ounce. Dose.—1 drachm: 1 gram. J3] UJ T rochisci Cocainae Hydrochloridi. grain (0 005 Gm.) in each. T.H. has ^ grain. Brompton H. 1/6 grain in 20 grains. ^Cocaine Hydrobromide also Hydriodide, Sulphate (deliques- n I, I n nz I T n4-/ ttt!-»11 /\ ^ ___l v cent), and Lactate (white amorphous mass) are sometimes used instead of the Hydrochloride with the same dose. @1(0 Cocaine Periodide. C1,H21N01.3I=683-9678. Dose.—1/40 to 1/20 grain (0 0015 to 0 003 Gm.) increased with care. When made by the interaction of Cocaine Base and Iodine in suitable solvent (cf. Alkaloidal Periodides) this compound is ob- tamed in dark purple crystals containing 44-3% Cocaine. The Periodide was made in the author’s laboratories (1923). iliis true Periodide is of interest as, in common with others, e.q. Emetine and Quinine, it retains its Alkaloid in the presence of Physiological Acid, but liberates it readily to Physiological Alkali (IT>% and 15-7% of the Periodide respectively to each solution). Solubility* felightly soluble in Alcohol, almost insoluble in Chloroform and insoluble in Ether and water. Incompatible with alkalis, metal compounds and otherwise as alkaloids. JJ&es. Internally, it is suggested in sickness and abdominal pam. The fact of the compound passing through the stomach practically unaltered suggests its possible utility in duodenal ulcer or other painful affections of the bowel. The local antiseptic action of the Iodine liberated may also be of value. Dispensing Note,—To be given alone in cachet or ‘ slipule ’ (No. 5), preferably after food. PSFUCocainse Nitras, Cocaine Nitrate, P.G. VI. C17H21N04.HNQ3=366* 1876. Dose.—to \ grain (0*003 to 0*03 Gm.). In large colourless crystals, readily soluble in water. Is compatible with silver nitrate, and if used previously in solution lessens the pain caused by the latter salt. H EH Cocaine Nitrite is also prepared for use in an anti-astlimatic spray (vide Tucker's Asthma Cure, Vol. II.). P| IIP I] Cocaines Phenas. Syn. Cocaine Carbolate. Dose.—In pill ^ to \ grain (0*003 to 0*03 Gm.). A slightly soluble pasty compound, used by dentists and given tor gastralgia. Strongly antiseptic and may be used on cut surfaces, as its coagulating effect on albumen prevents too rapid action. SI Id) Coeainae Salicylas, C17H21N04.C6H4.0H.C00H==441*2186. Dose.—to -J grain (0*003 to 0*03 Gm.). Is in minute snow- white crystals, very deliquescent; it forms a solution which keeps well. Soluble 5 in 1 of water, 2| in 1 of alcohol 90%. In spasmodic asthma, the hypodermic injection of a full dose at the beginning relieves the attack. Other Salts, e.g., the Citrate and Formate are in occasional use. Cocaine Addiction. Cocaine fascinates by the rapidity with which it relieves exhaustion and dispels gloom by producing a delightful sense of mental and physical vigour. The habit, according to the late Prof. W. E. Dixon, B.M.J. i./23,545, is not common. News reports concern rather cases of users of the drug for specific purposes than addiction, lhe discomforts caused by Cocaine are readily controlled by Morphine. When the patient learns this, the addiction becomes confirmed. Atropine, or better, Hyoscine is the best for treatment of Addiction of all kinds. De Quincey found benefit from Valerian Cocaine sniffed up the nose is readily absorbed. It nrs powerfully stimulates the brain—the flagging nerve cells are whipped into activity and lassitude and fatigue pass, but a marked depression of the central nervous system succeeds. Abstinence symp urns are less severe than in the case of Morphine. It can be cut off at once.—W. E. Dixon, B.M.J. ii./2i,S21. ordinary In Cocaine addiction, i grain produces veryotiose varies between eerson, 14 grains is usually well tolerated, and. the total ISSh Paradis of the XtZnTJuu! ■areless or evilly disposed persons. r.J. u./24»o* • Forty Years in the Profession and never seen a drug addict.—Legi? lation gone mad. Faddists and cranks passing vexatious laws because lew degenerates have tried to get a new sensation out of a useless life b taking drugs.—E. E. Duffy, B.M.J. ii./26,408. While the U.S. official figures show the use of Cocaine is diminishing, an in England it does not appear to be increasing, in Germany and Switzerlan the habit appears to be spreading very fast.—B.M.J. i./26,487. EDSynthetic Cocaine. Possibilities of industrial production j as outcome of Willstatter’s work.—B. & C.P., Feb. 1924. Synthetic drugs not so habit-forming as Cocaine and Morphine.— Geneva Conference, League of Nations, B.M.J. i./22,724,728. {For further on the Geneva Conferences, see p. 623.) Drug addicts in Cairo and the East generally.—B.M.J. L/30,208. There is a general antagonism between Morphine and smai doses of Cocaine and for moderate depression from Morphine, Cocaine is & fairly effective antidote. This is well known to addicts. It onl; applies to small doses of Cocaine, larger doses are synergistic, and 10 mgr hypodermically should not be exceeded.—Jl.A.M.A. i./29,1473. Prevention and treatment of drug addiction. Smuggling and the “ Yellow ” Press. Mis-use of Cocaine in England nil.—E. Mapother B.M.J. i./31,495. La Cocaine, by Courtois-Suffit (Masson & Cie, Paris) may be consulted. See also paragraphs under Morphine Habit, Abuse of Opium» Consult also Dangerous Drugs Acts (Departmental Com. on Morphine., etc.), Addiction, p. 628, and Vol. II. {Septum perforation, Harrison Federal Law, etc.). Ei Tropacocaine. Syn. Benzoyl-pseudo-tropine. Obtained from Java Coca. The Hydrochloride (P.G. VI.j C8H14NO.C6H5CO.HCl=281-621 is freely soluble in water, has M. pt. 271° C., and is a powerful anaesthetic; in the eye causes neither ischaemia nor irritation of hyperaemia. 3% solution recommended ; anaesthesia quicker than with Cocaine, but more transitory ; the action may be kept up by adding a drop from time to'. time. Mydriasis occurs occasionally but is slight. Injection into* gums in large doses only affected pulse for 10 minutes and did not affect respiration. Aqueous solutions keep well and can be boiled with impunity. Sciatica (severe). Tropacocaine 1 Cc. of 5% solution injected into the dural sac in the lumbar region. Complete cure and no recurrence of pain. (©Tablets (Hypodermic) contain JD- grain. Intraspinal /lncesf/ies/a by Tropacocaine. For operating in hernia, fistula, hemorrhoids and amputations. Five per cent Neutral Solution in Normal Saline—Sp. Gr. 1-016— employed, i.e., 20 minims of this solution is suitable for a healthy person weighing about 11 stone. Maximum dose 24 minims. For a child 1 year old 4 minims is enough. After a lapse of 40 to 50 minutes a second injection of 8 to 12 minims is given if required. 1,295 cases treated with this method at Queen’s Hospital, Birmingham.—J. T. J. Morrison, B.M.J. i./i3,1306. Eclampsia treated with spinal anaesthesia—1-8 Cc. of Tropacocaine solution—strength not stated, after chloroform had been given.— R. H. Paramore, B.M.J. i./3o,15. lenzamine Hydrochloride, Syn. Betacaine, ^Eucaine Hydrochloride, Eucaine or Eucain B., Benzoyl-vinyl-diaceton-alkamine >r Trimethyl-benzoxy-piperidin Hydrochloride, U.S. X., P.G. V. not in VI.). P. Helv. C5H7N(CH3)3(C6H5COO). HC1=283-6416. Trade Mark: Eucaine, 193242 of 1896. Registration renewed 1924. Patent : 20697 of 1896. Became void in the twelfth year. Now public >rop3rty. t)ose.—jV to J grain (0-006 to 0-03 Gm.) or more. A synthetic compound allied to Cocaine, in small white opaque crystals, soluble about 1 in 30 of water (Crystals may deposit on cooling which can be redissolved without harming the salt). 2% solutions are used in ophthalmic work. Solutions may be boiled without decomposing the salt. Sterules, Hypodermic contain Eucaine £ and J grain. For dental extraction. Local Infiltration Ancesthesia (BarJeer) with Eucaine is suitable for very short operations :— Eucaine and Sodium Chloride Sterules are prepared for producing the 1 in 500 solution for infiltration, containing Eucaine 3 grains (0-2 Gm.) and Sodium Chloride 12 grains (0-8 Gm.) to produce 3J ounces (100 Cc. approx.) of solution. This is isotonic. The solution is boiled and on cooling 10 minims of Adrenalin Solution may be added. In the operation 50 Cc. or more (up to 100 Cc.) is injected all round the region to be dealt with. See also Barker’s Stovaine-Glucose Solution and Novocain Solution. Nebula Eucainae. Eucaine 10 grains, Sodium Sulphate 4 grains, Distided Water 1 ounce. Adreucaine Sterules contain Eucaine jV grain and Adrenalin iW^ grain in 8 minims (^ Cc.), for dental and surgical use.. For tooth extraction the contents of one (or two) sterules are injected into the gums ten minutes before operating. Tablets of Eucaine are made grain (0-006 Gm.) for internal use. nguentum Eucainae. „ ., Eucaine 1, Olive Oil 2, Hydrous Wool Fat 7. For pruritus, [enthol 2% may be added. enzaminae Lactas (B.P. T4) Syn. EucAiNiE Lactas. C15H2102N.CH3CH0H.C00H=337-2186. Dose.—| to i grain. (0-008 to 0-03 Gm.). A white crystalline salt with M. pt. 155° C. imno/\ Soluble about 1 in 5 of water and about 1 m 8 alcohol (JO /0). Incompatible with salicylic acid. , . fil For ophthalmic work and in dentistry employ 2 to 3 /0 , for‘ n“' ration 0-1% with Sodium Chloride 0*8% ; for regional anesthesia •5% ; nose? throat and ear 10 to 15%. Solutions can be boiled Slower in action than cocaine, less toxic, and an*sthesia rolonged, while the heart is not affected, nor e PJ1 Sciatica has been treated by injections. • Frethrat Injection. 1 to 2% solutions may be used to relieve pam. Sterules (Hypodermic) of Eucaine Lactate £ grain (0*016 Cm.), also £ grain (0*03 Gm.). Holocain Hydrochloride. Syn. Phenocain. AT n XT /ATT TT The Hydrochloride of para-diethoxyethenyl-diphenylamidine in small colourless shining crystals. Soluble I in 55 of water. Incompatible with Alkalis. Guttae Holocain R.O.H. 4 grains to ounce. As an anesthetic in ophthalmology, 2 to 5 eye drops of 1% solution, but it is not ada/pted for hypodermic use. Sterules of Holocaine Hydrochloride Solution 1% are prepared. * AJypin. (T.M. 322518). Syn. Amydricaine, Benzoyl-tetramethyl- diaminc- ethyl-di-methyl-carbinol Hydrochloride. P.G. VI. CcH5COC2H5CO.[CH2N(CH3)2]2HCl= 314*6836. Dose (Internally).—Ao to 2 grain (0*003 to 0*03 Gm.). Crystalline powder melting at 169° 0. Soluble in Water 1 in 1 and 1 in 4 Alcohol 90%. Solutions 0*025 to 0*5% or up to 10% (strong solutions keep well, but weak ones may become cloudy ; may be sterilised by boiling), efficient in eye work — 2% strength produces insensibility of cornea in sixty seconds. Non-toxic. It produces no mydriasis nor disturbance of accommodation. For lumbar anaesthesia has been used in i to 1 Cc. injections of 2% solution. For infiltration 0*01 to 0*1% solution has been used with same quantities of Cocaine Hydrochloride in 0*2% Sodium Chloride Solution. In sickness and post-operative vomiting internally it acts like Cocaine. *Alypinoids (T.M. 291929, 322519) D. Tablets | grain (0*02 Gm.) with Suprarenm 1/5,000 grain dissolved in 1 Cc. water produce a 2% solution suitable for use in dentistry and minor surgerj\ Aminobenz, ‘ * Orthoform, New,’ the Methyl ester of Meta-amido- para-oxy-benzoic Acid (Methyl-amino-oxybenzoate P. Helv.). C6H3.NH,OH.CO.OCH3== 155*0782. T.M. : Orthoform, 215951/1898, since renewed. Patents: 12,179/1897 and 22,106/1898. Both Expired. Manufacture.—See Edn. XIX., p. 345. Dose.—1J to 3 grains (0*1 to 0*2 Gm.) for stomach ulceration. A white crystalline powder, possessing local analgesic and antiseptic properties. Is slightly soluble in water, in alcohol 90% 1 in 7. The Hydrochloride C6H3.OH.NH2COOCH3,HCl= 191*573 is soluble about 1 in 9 of water; action of base is more prolonged. A 10% aqueous solution of the hydrochloride is used, or 10 to 20% with lanoline or paraffin ointment or collodion solution of pure orthoform or this as a dusting powder, may be employed to alleviate pain in sores or burns but has little action unless there is a breach of surface. ’ Has relieved whooping-cough and laryngeal tuberculosis by insufflation. Insufflatio Orthoformi cum Resorcin, C.L.T.E. Resorcin 24 drachms Orthoform to 1 ounce. * ’ Orthoform Bougies 5%, 4 inches in length with Cacao Butter basis, are prepared* ^Kerocain (T.M. 373550). Syn. 3$c Novocain (T.M. 276477), #PLANOCAINE (T.M. 496218) Para-Amino-Benzoyldiethyl-Amino- Ethenol Hydrochloride. Fr. Cx. Supp. 1920. P. Ital. V., P. Jap. IV., P. Argent. II., P.G. VI., Ph. Ned. V., P. Svec. X., Ethocaine, F.E. VIII., Allocain, Syncaine, Procaine, P. Belg. IV., Procaine Hydrochloride U.S. X. Aethocaine is T.M. 389240. C6H4 (NHa) [C02.02H4N.(C2H8)s] HCi-272-637. Dose, subcutaneously.—-J- to 1 grain (0-012 to 0-06 Gm.). Max. Single Dose per os (Fr. Cx. Supp., 1920) 0-1 Gm. (1| grains) ; Max. during 24 hours 0-25 Gm. (4 grains). A colourless crystalline salt melting at 156° C. Soluble 1 in 1 of water. In absolute Alcohol about 1 in 30. A cocaine substitute. 0-25 to 2% solutions are for hypodermic use. Incompatible with Alkalies, Tannin, Calomel, Potassium Dichromate, Potassium Permanganate and Silver Salts. With the latter use Novocain Nitrate, s.a. JJses.—A powerful local anaesthetic, but its effect is verj^ transient. A drop of 5% solution anaesthetises the conjunctiva sufficient for superficial operations. It is well tolerated by the tissues, but has been called a poor substitute for cocaine. Infiltration Anaesthesia has been practised by 200 Cc. of. 0'5%. Solution in Normal Saline—a maximum dose this is sufficient to anaesthetise the area for most operations. 50 to 75 Cc. is enough for a moderate size elbow. 150 Cc. for a knee. The following Tablets are prepared with addition of Adrenalin . A.) For Infiltration Anaesthesia of Thick Layers of Tissue and Hypodermic Injections in General Surgery. Novocain 0-125 Gm. Adrenalin 0-000125 Gm. Q , mqVpR a 10/ Dose.—One tablet dissolved in 25 Cc. Normal Saline Solution makes a i /0 Novocain Solution. Max. dose.—125 Cc. . „ -wm-wq <T n^al (B.) For Anaesthesia of Nerve Centres and Larger Nerves (Lo^al Anaesthesia). Novocain 6-1 Gm. Adrenalin 0-00025 Gm. emm+irvn makps a *>% Dose.—One tablet dissolved in 5 Cc. Normal Saline Solution makes a ^ /0 Novocain Solution. Max. dose.—5 Cc. C.) For Spinal Anaesthesia. ^00 Novocain 0-05 Gm. Adrenalin 0-000083 Gm. ~ makeg a 5% Bose.—One tablet dissolved in 1 Cc. Normal Saline Solution mates a /„ (Isotonic) Novocain Solution. One to 3 Cc. may be med. (D.) Without Adrenalin. „ _ _ n n Bo se°—One tablet ^Cc sterUe distilled water makes a 2% Novocain Solution. (E.) Dental Tablets. n Bose°—One tablet dissofved'in IWo^lMfag^lT.tlon makes a 2% °|.S f sw~ Novocain 0 02 Gm. Adrenalin Solution (1 in l.Otu) i ui v Chloride 0 006 Gm. Thymol 0 0006 Gm. (F.) Without Adrenalin. Novocain 0-05 Gm. , Q solution gives a 5% Novocain One tablet dissolved in 1 Cc. Normal Saline Solution g Solution. , Qnihio Solution (q.v.) is some- Fischer’s Modification of Ringer s Saline b«u i, / times used instead of Normal Saline foo u i Atropine is the best drug to combine with Novocain and Adrenalin tc the effects of Adrenalin poisoning. Adrenalin has a definite depressant action on the heart.—F. N. Doubleday, B.M.J. i./2 5,455 . ln general anaesthesia, local infiltration of the operation area with Novocain is very important.—J. Ross Mackenzie, L. i./27,165. Injectio Novocains et Adrenalin, R.O.H.—Novocain 8 grains (2% approx.), Adrenalin Solution 2 drachms, Sterilised Distilled Water to 1 ounce. Dose.—Up to 1 drachm of the 2%. In eye work may be employed, e.g., for excision of the lachrymal sac, and for other minor operations. Toxic symptoms during use of Novocain. 2 drachms of 1% Solution with * minim of 1 in 1,000 Adrenalin Solution caused the pupils to be widely dilated and fixed. Consciousness had gone and a cold, clammy sweat broke out Pulse slowed, body became rigid for fully a minute. Recoverv with Strychnine’ —L. i./13,561. Death from use in dental work.—B.M.J. ii./io,2052. Solutio Novocainse, St. Th. H. 4 to 10% in Saline. Solutio Novocainae Composita, St. Th. H. Syn. Dunhill’s Solution, Novocain 3 grains, Adrenalin Solution 7-1 minims, Sodium Chloride 14 grains Water to 3+ ounces. Solutio Novocainae et Adrenaiini. Novocain 4, Adrenalin Solution 10, Water to 100. Sterules, Hypodermic of Novocain, 1 grain (0-02 Gm.), also Novocain $ grain (0-02 Gm.), with Adrenalin 1/1,000 grain in 15 minims (1 Cc.) are prepared. Spinal Anaesthesia with Novocain. 5% solution with Mannitol. Dose varied from 0-06 to 0-08 Gm. of Novocain. No safer than Stovaine and larger dose has to be used.—C. C. Holman, L. i./i6,955. Should be reserved for adults, and should not be used in the tuberculous the syphilitic, or in nervous cases. Specially suitable for operations below the umbilicus.—Brissot (Paris), per Pres., June, ’29,219. High spinal anaesthesia with injection of 15% Novocain 1 Cc. mixed with S Cc. of the patient’s cerebro-spinal fluid. After turning patient over, 50 mgr. Ephedrine hypodermically. In 10 minutes surgeon may commence—he must complete in an hour. Need of a drug to prolong anaesthesia. —C. A. Pannett, L. i./2g,1195. 2% Novocain in 0-9% Sodium Chloride with 1 in 10,000 Adrenalin good for plastic operations of 2 to 3 hours.—C. Abbott- Brown, L. i./29,127S. Adrenalin should not be used intradurally.—C. A. Pannett, ibid., 1332. Spinal analgesia with Novocain the anaesthetic of choice at the Mayo Clinic for almost all abdominal operations.—I. W. Magill, L. i./31,353. Barker’s method of Stovaine-Glucose is not used so much now. Novocain is less toxic—the least toxic of known local anaesthetics. Raising blood pressure by Ephedrine injection simultaneously leads to rapid absorption and diminishes the anaesthetic effect. High spinal anysthesia has many advantages (using 1 to T2 Cc. of 10% Novocain), and is safe if careful technique followed.—Prof. C. A. Pannett, L. i./29,271,291 ; see also W. Howard Jones, L. i./29,3G2, and Reply, ibid., 410. Planocain, Ethocain and Novocain in spinal anaesthesia.—B.M.J. i./3o,1154 ; ii./3o,43. Deaths under spinal anaesthesia. Neocaine (Novocain) mentioned.—Jl. A.M.A., Aug., ’30,234 ; L. ii./3o,650. Sterules of Novocain 0*15 Gm., Caffeine 0T2 Gm., Sodium Benzoate 0-15 Gm. in Water 3 Cc. Dose.—2-5 Cc. of the contents. In spinal anaesthesia the depressing effects have been prevented by the use of Caffeine. The amount should not be sufficient to mask the effects of the drug. A case is reported in which a man of 71 who collapsed whilst undergoing prostatectomy under spinal anaesthesia, recovered on the injection of 0-25 Gm. Caffeine into the spinal subarachnoid space. 15 minutes’ artificial respiration had been unsuccessful.—M.P.C., Mar. 14/23, p. 208. 5k Spinccain (T.M. 494893). Each 2 Cc. ampoule contains 0-2 Gm. Novocain,'2-2 mgr. Strychnine Sulphate, and 14|% Alcohol in Normal Saline. It ilso’ contains Gliadin or Amyloprolamin. . . . , It has been termed a controllable spinal anaesthetic by the introducer. Gliadin (of Starch) is stated to prevent diffusion in the subarachnoid space until the anesthetic has been absorbed.—G. P. Pitkin, B.M.J. ii./29,183; see also E. A. Kelly, ibid., 187, and L. ii./2g,S25. . , _ . _ . , The amount stated is mixed with more or less cerebro-spinal fluid as required, and after injection the table is tilted to direct it to any region desired. In the circumstances of a modern operation a large fall of blood pressure is not greatly to be feared, donnesco gave up Strychnine after 15 years’ trial„ A similar solution to Spinocain, but without the Strychnine, gave equailv good results. An operation of 1-J hours done under it. No evidence to show that addition of Dextrin is not as good as Gliadm. E. Ealkner Kill, L. i./3o,124. T .. . QOC Criticism of Pitkin’s method.—L. Shnlito,. L. ii./29,898. Thought to be an improvement on Stovaine, the use of which was often followed by collapse.—C. L. Granville Chapman, B.M.J. i./3o,799; see also ESpinaiaan^theSia ‘iithfpinocain, using Ephedrin-Novocain first 250 cases—A. Wilfrid Adams, B.M.J. i./3i,785. Death under.—A. Wilfrid ^3 ^c! ^dose of3Spinocain reserved for cases requiring increased duration. A. Wilfrid Adams, B.M.J. i./3i,955. p v a M »,0 ner Most of Pitkin’s claims unsubstantiated.—C. Donald, P.K.b.M. so, per M.A. ’3i,31. regional Anesthesia is a form of local anaesthesia, using a stronger solu^n than thlt for local infiltration. A small quantity is introduced round which supply the parts to be "oitnSteiaAas their course, which is anatomically accessible Th>s form of an estugsia u each 20 Cc. of Solution immediately before use.—For technique, Rood, B.M.J. ii./l2,l(01. . ~ unn. r'lrlfnn B A1 J i./25,647. Methods' dSKttST The mffittdty of punctures aei^GNavocrtj intolerance, and the psychic factor are disadvantages but the or® SSSZS Cade, L. ' ^’particular value for operations on the thyroid and thorax^-L. i./^STfi. Supraclavicular Ansesthetizat ion'’‘‘sta^edTo be convenient and Novocain Solution, with addition of Adrenal - performed free from danger By its use se™r^ in the painlessly and without shock. Definite pa.nestn.sia mu g arm and hand before the injection is made —B.M.J, » ansesthesia — Warning against use of Epinephrin with Procaine m local anesthesia. Paris Med., Oct. 17/25, per Jl. A.M.A. n./25, ^ ^ norfpot relaxation Splanchnic analgesia with Kovocam. A^van Disadvantages of the abdominal wall with less shock and fa § . ,! . cases post. are the extra 15 minutes time to ansesthetisepatient ana n jch would rsMSJftMsSii as saw s. — - *. column between aorta and inferior vena ca ^ J Thp finger is kept ci0Se with the left index finger through the lesser o um^ de of the long fine to the right side of the aorta and the nar and kept there by the needle passed along its dorsum down to the ve tebr id as far as the bone middle finger. The needle is then passed g ^ ^ be ^ a kl d aspiration performed to prove the po' containing 20 drops of 1 in 1,000 vessel, and 30 Cc. of 1%^ovocam . fall back into the abdomen and Adrenalin per 100 Cc. injected. The viscera t n » the left of the aorta render it easy to inject a further 10 Cc. of the somm behind the oesophagus. Intra-arterial anaesthesia, by 50 to 100 Cc. of 0*5% Novocain into an artery, circulation being arrested by a tourniquet. Analgesia develops in 1 to 2 minutes.—B.M.J. ii./i3,392. The applications of local anaesthesia arc limited only by the anatomical knowledge of the surgeon. There is no operation which cannot be carried out successfully by its means.—H. S. Souttar, B.M.J ii./28,1094. Before reducing fractures 20 Cc., 2% Novocain injected at the site to anaesthetise bone-ends and adjacent muscles.—I). Levi, Pr., Dec., ’30,738. Caesarean section. For immediate repair of the perineum. Novocain 4 to 6 drachms of 2% solution with 1 minim of 1 in 1,000 Adrenalin to each drachm of Novocain solution—(Browne), quoted by A. Louise Mcllroy, B.M.J. 11./30,549. Cranial Injuries in War.—Novocain f Gm., Magnesium Sulphate 4 Gm., in water or saline 100 Cc. Boil and when cold add Adrenalin solution 1 Cc. to each 30 Cc. This amount is usually enough to completely anaesthetise wound area.—J. Anderson, B.M.J. ii./i7,42. Kerocain and Cocaine solutions with Adrenalin in concentrated form for yinz^111a conven,ent number of times, e.q., 1 : 40 satisfactory in use. A 15 ,0 Sodium Chloride solution is bactericidal: with addition of 74% Cocaine is slightly less bactericidal and with 74% Kerocain is still less~—H. Mac- naughton Jones, L. i./i8,904. Intrasacral extradural anaesthesia for operations on haemorrhoids, fistulse, and other conditions in and about the anus. Dose—20 Cc. of 2% Novocain to which five drops of 1 in 1,000 Adrenalin solution is added—the amount of Novocain thus exceeds 6 grains. 15 grains have been used in a local or regional anaesthesia and even 35 grains have been used.—S. R. Meaker, B.M.J. i./i9,569. Local anaesthesia in operations on the anal region effected by injection of solution consisting of Novocain 2%, Adrenalin (1 : 1,000) 1% and Phenazone (Antipyrin) 1%. An average injection of 2 ounces, preceded by hypodermic injection of Morphine 1/8 grain and Hvoscine Hydrobromide i/200 grain — E. G. Martin, per Pres, April, ’23,147. Rectal Operations.—A 1 or 2% solution of Novocain satisfactory.— B.M.J.E. i./25,19. Circumcision.—Infiltration over skin area corresponding to coronary glandis with 2% solution of Novocain and Adrenalin 1/1,000 equal parts, about 10 Cc. being injected, simple and effective.—E. Sutherland-Rawlings, L. i./31,520. Novocain Suppositories, U grains (0-1 Gm.) in Cacao Butter 30 grains are prepared. Novocain, Identification of, see Vol. II. Arocan.—Series of local anaesthetics contain Procaine and Adrenalin in various strengths for regional anaesthesia, and for dental and spinal anaesthesia. 3|cBorocaine (T.M. 459625). Syn. Ethocaine Borate. 2(C13H20N2O2).5B2O3.4H2O. “ Patent.—Manufacture covered by Patent No. 26034G (Sir William Pope), application date July 28th, 1925. The compound was first investigated by Gros.—Arch.f.exp.Path.u.Pharm., 1912,132. ’ Criticism of the Patent—Jl. A.M.A., Jan. 7/28 ; L. i./28,512. Difficult to discover in its preparation the element of newness essential for the taking out of a Patent.—L. i./28,512. Not acceptable for N.N.R. on the grounds that the application of a proprietary name to Procaine Borate is not considered to be in the interest of rational therapy.—,31. A.MW. ii./2g,1309. Dose.—1/3 to H grains (0-02 to 0-1 Gm.). Tablets contain 0-1 Gm. with Adrenalin 0-00025 Gm., Sodium Chloride and Glucose. One in 5 Cc. makes a 2% solution, and in 2 Cc. produces a 5% solution. Borocaine was introduced as a substitute for Cocaine. Although a salt of Novocain base, it is stated to be more active but less toxic a -A. J. than Novocain. The difference in properties is due to the fact that Borocaine, being the salt of a weak acid, in solution yields free alkaloidal base by hydrolysis (see “ Activated Alkaloids ”). Uses,—For ophthalmic and dental use, for operations on and examination of the urethra and bladder, and for surface amesthesia in general, 2% solutions are used, and for operations on the nose and throat 5% solutions. (Beta-Borocaine, v. posted, is stated to be better surface anaesthetic.) An account of the borates of some anaesthetic bases (“ borocaines ”) Copeland and H. E. E. Notton, B.M.J. ii./25,547. A 2% solution of Borocaine is an improvement on a 0-5% solution of Cocaine, in urethral anaesthesia, and a 1% solution of the former gives better anaesthesia than a 0-5% solution of Cocaine, but a 0-5% solution of Borocaine has no advantage over a 0-3% solution of Cocaine. Beta-eucaine Borate in 0-5% solution is a perfect urethral anaesthetic and the relaxation is perfect. In 4% its action is equal to \ % Cocaine HC1, but i% is not so good as £% Cocaine.— K. Coyte, B.M.J. i./26,85. Ophthalmology.—Borocaine greatly inferior to Cocaine as regards surface anaesthetic effect. Cocaine is perfectly reliable, whereas the effect of Borocaine is variable.—T. II. Butler and B. U. Gillan, B.M.J. i./2 6,84. 3kBeta-Borocaine (T.M. 465359). Syn. Beta-eucaine Borate. C15H21N02.5HB02. Patent: See Borocaine. Dose.—3/8 grain (0-025 Gm.). Uses,— A surface anaesthetic : Borocaine is preferred for injection* For operative work on the eye, a 0-25% solution is recommended, and for operations on and examinations of the urethra and bladder m general a 0-5 /0 solution is suitable. , . , ... Beta-Eucaine Borate has three times the anoesthetic action on the laboit e , ^ • a „ l 4- ^-^4 Conmna M xrr\ Trf\n n 1 riTlfl P cornea, and T/10 the""experimental t9xicity of Cocaine Hydrochloride, is mildly irritant, causes some congestion, especially m the nose, and in very large doses excites the central nervous system. A. J. Oopeianci, ls.m.j. ' Beta-Borocaine Tablets contain 0-025 Gm., with Adrenalin 0*00005 Gm., Sodium Chloride and Cane Sugar q.s. One dissolved in 10 Cc. makes a 0*25% solution: one in 5 Cc. makes a 0-5/0 solution. , .... Alicea in S— Ethyl-Mydriatine Hydrochloride. A local anaesthetic stronger than Novocain and weaker than Cocaine, .^accountof the slight irritation caused by its acid solutions ana of precipitation bj t'S use is limited. Adrenalin, Ephedrine, Mydnatm are allied chemically. 8. Kubota, Jl. Pharm. and Exp. Therap., Eeb. 1919. VT Anesthone—Ethyl Para-amino-Benzoate. y*fe* /y’’ ‘ Pit. Ned. V., F.E. VIII., P. Belg. IV. Para;^do9^JoL/ Benzoate ; Benzocaine. ^ Anjssthesine (TJ . : - 0 / 1902, since renewed). NH2. C6H4. COO. C2 5— 0 Dose.—3 to 8 grains (0-2 to 0-5 Gm.) in powder or cache s. /Votes on Manufacture,— Edn. VIX-, p. o50. almost Patent 16,684/1903 lapsed m 1908. ^ f insoluble in water, soluble 1 in 8 of alcohol 90 /o a so m o - Olive Oil and easily in Ether, and Chloroform. M.Pt, j0 C. numbing taste. hyperesthesia of the stomach and dyspepsia: local insufflations sometimes with equal amoi S.' fSVha^n^d' jaryngeal urethritis 3 grains, and suppositories 11 111 Ointments 10% for burns, eczema, and intertrigo. Pruritus ctni and ana! fissure. ‘ A.B.A.*—Anaesthesin 3, Benzyl Alcohol 5, and Ether 10, in Sterile Olive Oil q.s. to 100. In pruritus ani 10 Cc. may be safely used at the first treatment— injected in relation to the posterior half of the perianal region through 4 punctures, 2J Cc. at each specified point (provided in a diagram). A week later 5 Cc. are given by 2 punctures, and again another dose after a further week. In the average case, 3 doses—10, 5, and 5 Cc. suffice. Percain 0-5%, Benzyl Alcohol 10%, Phenol 1%, in 5 Cc. Sterile Oil, also used instead of the above. For anal fissure ‘ A.B.A.’ 5 Cc., or the Percain in Oil (5 Cc.) will reduce sphincteric relaxation. Local anaesthetic effect lasts as long as 10 days.—W. B. Gabriel, B.M.J. ii./3o,311. No general reaction or complications. Also gives rapid and brilliant cure in recent anal fissure.—W. B. Gabriel, B.M. J. i./29,1071. Permanent relief of pruritus ani from subcutaneous injections (round the anal margin) of either Benacol—a solution of equal parts of para-amino-ethyl-benzoate and Phenmethylol (t.e., Benzyl Alcohol) in 90 parts of Almond Oil, or 4 A.B.A.’ as above. 4 Cc. of either may be injected at a time and repeated at 3 to 7-day intervals, till the entire perianal region has been injected, 8 Cc. being the average total injected.—W. B. Gabriel, ibid. A.B.A. valuable for ano-rectal complaints—better than Novocain.-—P. Kennedy Murphy, B.M.J. ii./30,162. Large doses of both oily and aqueous solutions as anaesthetics in pain and fissure should be avoided.—P. Kennedy Murphy, B.M.J. ii./3o,4Q8. Anal fissure treated by 2 to 5 Cc. of ‘ A.B.A.’ injections into the sphincter.— W. J. Lvtle, B.M.J. i./31,498. Pruritus ani and anal fissure, and spasm of the sphincters, treated by A.B.A. Pain relieved instantly.—Arthur S. Morley, B.M.J. ii./3o,80. Anaesthesin Emulsion. Painted on the larvnx affords relief in tuberculosis of the larynx. Menthol 24 grains, Gum Acacia, Almond Oil and Water of each 2\ drachms, emulsify and add Anaesthesin 90 grains, Alcohol 90% 10 drachms, and Water 2 ounces, shake well.—Sir James Dundas Grant, Pr., Aug., ’31,260. Pneumococcic (and tuberculous) infection of the throat—in a case of difficulty in swallowing has been greatly relieved by applications of Ansesthesine dissolved in Palm Oil—in form of a spray. *Rhinoculin (T.M. 308800) Cream, Powder and Spray contain: Anaesthesin, Paranephrin, Sub cut in, Glycerin and Boric Acid, for use in hay fever.—Gehe. Anesthone Cream. , . . Anesthone 10%, Adrenalin Chloride 0-005% m Ointment basis. A quantity the size of a pea applied to the nasal mucosa when necessary gives relief in hay fever and as a palliative in allaying irritation, congestion and inflammation of the nasal mucous membrane. Anesthone Tape 1 inch wide for “ packing ” is also made. * Stovaine (T.M. 261296).—Syn. Chlorhydrate d’Amyl^tne, Fr. Cx. Supp., 1920, P. Ital. V., P. Belg. IV., P. Argent. II., F.E. VIII. Amylocaine, Benzoyl-ethyl-dimethyl-amino- fropinol Hydrochloride. C6Hr)CO.C2H5.CH3CO.CH2N(CH3)2.HCl-271-6366. Dose.—Per os and hypodermically ^ to § grain (0-02 to 0-05 Gm.). For lumbar anaesthesia, dose from I to H grains (0-02 to 0-1 Gm.). ' -4 \ .■ Max. single dose. Fr. Cx. Supp. 1920.—0-08 Gm. (1£ grains approx.); max. during 24 hours 0-15 Gm. (2J grains approx.). P. Belg. IV., 0-3 and 0*6 Gm. respectively. In small white crystals, M.Pt. 175° C. Soluble (by experiment) in water about 1 in 13, in alcohol 1 in 3, almost insoluble in ether. Stovaine does not come under regulations of the D.D.A. Uses.—Anaesthetic (2 to 4% in eye work), vaso-dilating, comparatively non-toxic. It is stated not to cause headaches, nausea, vertigo, or syncope. For cauterization, 5% Stovaine found good in nose, throat, and ear work ; 10% used in turbihal operations. In septum operations 10% with 1 in 2,000 Adrenalin. Tonsils removed with 1% solution, but there was much more bleeding than with Novocain. As a laryngeal spray for minor operations 5% solution excellent.—F. Muecke, B.M.J. ii./26,561. Neuralgias in various forms have been treated hypodermically with Stovaine, e.g., 1 to 2 Cc. doses of 1% Solution in 80% Alcohol along the course of the branches of affected nerves in tic douloureux. Infra spinal Anaesthesia with Stovaine. (A.) Stovaine-Glucose Solutions (mainly.) The ideal solution for anaesthesia should produce neither shrinking nor swelling of the blood or tissue cells b}7- osmosis. A. E. Barker employed 1 Cc. injections of 5% Stovaine with 5% Glucose—without Adrenalin. Often the dose may be reduced to 0-8 Cc., sometimes increased to 1-2 Cc. The Sp. Gr. of this solution is 1*0230. (Injectio Thecalis Ansesthetica.—Vic. Park). Using this solution, a small dose of the drug can be employed and the severest operations performed. By carefully adjusting the curves of the spine, either a high or low ansesthesia can be produced by gravitation. The lowering of the head in any operation is not favoured. The best results are obtained bv not altering the level of the body after injection, excepting in cases of the labouring class advanced in life, where the spinal column may be almost rigid —here the pelvis may have to be raised. Usually 5 to 10 Cc. of cerebro-spmal fluid is withdrawn before injection. Any alteration of posture may be made providing the relative levels of head and pelvis remain as before. The equivalent of 0-06 Gm. Stovaine usually found to be sufficient. As rule anaesthesia v/as established in 5 to 7 minutes for the groins ^d S t for the epigastrium. There is almost always pyrexia but no P0^' P , shock. Longest period of analgesia (using 0-08 Gm.) was - hoars, 1 g total dose 0-135 Gm. Highest analgesia—to clavicles. Review of 500 cases from severest abdominal to an ^si£n fiS>arnt^ t ** using Barker’s Solution.—L. McGavm and R. D. O Leary, Pr., Mar. 1912.__ The canal is punctured between second and third iumbar interspace., patient in sitting posture. 5 Cc. of fluid allowed toes P a hour injection made. Anaesthesia within ten minutes, and U -n0st- Headache following relieved by Phenacetim Advantages absence_of P ^ operative shock, complete muscular relaxation,, no' ven g 8 ■ contra- respiratory movements, no starvatmn, and no P°st'cPer. k ‘ ^ w w is heated to 80/90“ C. for 10 mmutes.—N..M.. Be>, U"’%0I1g-claims. it is For abdominal operations spinal ansestneaa and'miiet thoracic respira- a gain to have a completely flaccid abdominal - q , 6 728 : B. P. tick Barker’s heavy solution satisfactory -J. MorlejdB. 11./1 Cole ibid., p. 645 prefers 10% Stovaine solution:mi3ali ne Stovaine preferred to Novocain. 1. S-B ’ solution with maximum Suprapubic prostatectomy —Stovaine 1C /» , anlBSthesia._ dose 0-03 Gm. and without addition of Glucose m spiuai H. M. Page, L. i./ei,800. Abdominal operations.—Spinal anaesthesia with Barker’s formula.— A. H. Southam, B.M.J. ii./ai,592. Laparotomy.—2 Cc. doses of Barker’s formula.—S. A. Lane, L. i./23,129' Stovaine 10% with Sodium Chloride 10%. Dose.—0*75 Cc.—A. Morrison B. M.J. ii./2i,1056. Stovaine-Saline Solutions. Spinal anaesthesia with Stovaine 0T Gm., Sodium Chloride 0T Gm., Dis tilled Water 1 Cc. Results good, but a number of patients would prefer t<r sleep.—R. B. Coleman, B.M.J. i./25,548. The injection should not be made if blood pressure is below 100 mm. Amnesia is induced by Omnopon (2/3 grain) and Scopolamine (1/300 grain) 1| hour before operation, followed by Scopolamine (1/450 grain) after half and afte one hour. The dose of Stovaine is regulated by the condition of the patien- and intraspinal pressure (measured by a special manometer). A 10% Stovaine Saline solution is preferred to Stovaine-Glucose, as it diffuses more rapidly and, with debilitated subjects, or when the spinal pressure is low, a dose no- exceeding 0-5 Cc. is advised. In a few cases causing anxiety the patient’ condition was improved by measures taken to ra/se the blood pressure, viz., compression of the abdomen, raising extremities, or adoption o the Trendelenburg position, or by Pituitary as a cardiac stimulant.-—D. N Kalyanvala, Edin. Med. Jl. Caffeine 2 grains hypodermically as soon as Stovaine has beer administered, to counteract the fall in blood pressure, and keep a second dos* ready in case of emergency (the two “ danger periods ” are immediately afte injection and 20 minutes later): Pituitary Extract a satisfactory substitute Let the maximal dose of Stovaine solution be 0-8 Cc.—Hamilton Bailey, Pr. June, ’27,372. To prevent shock following intraspinal anaesthesia: after removal of 5bo 10 Cc. spinal fluid and the injection of anaesthetic, the spinal fluid is injected intravenously at the bend of the elbow and the operation commenced 5 or C minutes later.—B.M.J.E. i./27,21. Urological surgery.—Spinal anaesthesia ideal. Contraindicated ii hypotension with blood pressure below 100 mm., also in extreme toxicosis the moribund state and the presence of spinal or brain tumours.—B.M.J.E i./27,65. Barker’s Solution used many hundreds of times with patient in Trendelenburg position, 10% Novocain also used.—F. Shipway, L. i./3o,210. Much of the hostile criticism of Stovaine due to faulty technique.—I. W Magill, L. i./3i,353. Combined spinal and splanchnic ancssthesia. For abdominal operation in the neighbourhood of the diaphragm, spinal anaesthesia with 0T Gm. Stovaine (between the 2nd and 3rd lumbar vertebrae), combined 1with splanchnic anaesthesia with 60 to 70 Cc- 0*5% solution of Novocain, given according to Braun’s method., is the anaesthetic of choice. In operations lasting over an hour spinal anaesthesia alone is not sufficient. Anaesthesia may be further prolonged by a further dose of splanchnic anaesthetic and infiltrating the peritoneal and abdominal muscles with 0*5% Novocain in 1 in 200,000 Adrenalin solution. In nervous patients, a dose of Avert in per rectum produces quiet 1 sleep. The combination gives complete and uniform muscular relaxation and reduces diaphragmatic movements to a minimum. The method gave a 50% fall in mortality from abdominal operations.—B. Hughes, B.M.J. L/29,898- Solutio Stovainae, St. Th. H. is 2\ or 5%. Solutio Stovainae et Glucosi, St. Th. H., contains 2\ or 5% with Glucose in addition in each instance. (B.) Stovaine-Dextrin Solution (TYRRELL Gray). This contains Stovaine 3%, with Dextrin, Suprarenin, etc. Dextrin is a suitable addition, it being readily soluble, and innocuous. It appears to help in controlling vomiting delay and absorption. Tyrrell Gray strongly advocated the method for even very young children. B.M.J. ii./13,392 ; L. ii./i3,554 ; see also B.M.J. ii./n,497. 1-2 Cc. of CiiAriTT’S formula, i.e., O'12 Gm. of Stovaine, used in error. Twice without ultimate serious result.—W. Sourasky, B.M.J. ii./26,524. (G.) GDStovaine Strychnine Injection (JONNESCO). Dose. From 0*01 Gm. Stovaine with Strychnine Sulphate I mgr. for ages 1 to 5 years; up to 0-1 Gm. Stovaine with 1 mgr. Strychnine, dissolved in 1 Cc. Sterile Water for adults. The higher doses to be used with caution. The employment of Strychnine in conjunction was thought to render operations above the waist line safe, but the method does not show a high percentage of safety. Stovaine anaesthesia is not entirely devoid of danger — See also A. A. Morrison, B.M.J. ii./2i,745. (D.) Stovaine Caffeine Injection (JONNESCO). Dose.—From 0-02 to 0-05 or 0-1 Gm. Stovaine with Caffeine 0-5 Gm. now preferred to the Strychnine method (antea). 5,000 cases.—T. Jonnesco, Pres. Med., Oct. 28, 1922, p. 929. Favourable results in spinal anaesthesia with Stovaine and Caffeine.— B. Desplas, L. ii./23,1235. Potassium Sulphate 0*25 to 0-5% added to local Anaesthetics, useful— increases the effect, cf. Note to Potassium Sulphate. Tyrrell Gray found spinal anaesthesia of value in diminishing shock, valuable in renal disease, disease of the lungs, and when muscular relaxation is desirable.—B.M.J. ii./io,766. Intraspinal injection of Stovaine does not inhibit uterine contractions but interferes with full relaxation between the pains.—A. W. Bourne and J. H. Burn, B.M.J. ib/30,87. To examine urine and liquor cerebralis for Stovaine see Vol. II. ill 13 Stovaine Solution. For Internal Use. Dose.—For persistent vomiting 5 to 10 minims every 2 hours without either food or drink. Later 3 to 5 minims before a meal:— Stovaine 15 grains. Atropine Sulphate J grain. Morphine Hydrochloride 3 grains, Chloroform Water 1 ounce. Compresses 5 to 10%. Gargle 0*5% (flavoured). Glyco-Gelatin Pastils % grain (9 003 Gm.). Stovaine Snuff for coryza 1 to 5% with Bismuth Carbonate and Milk Sugar is used. Stovaine Ointment for painful wounds and haemorrhoids :— Stovaine 0-7, Adrenalin Solution 20, Paraffin Ointment 100. Phenolaine (T.M. B. 452941). Dose.—For general surgery, e.g., for hernia or appendicitis, use 2 drops of Phenolaine to each ounce of sterile water. Not more than 6 ounces of the dilution should be used at one time. For teeth extraction use 8 drops to one ounce of water. The preparation is stated to contain Methyl, Ethyl, Benzoic and Carboxyl groups and an Amine group. It has been used in a large number of operations without trouble as regards bleeding or subsequent after-effects. It does not produce vasodilation on subcutaneous or intramuscular injection. Amputations of the breast have been conducted with 12 drops in 6 ounces of water. Corneal opacities treated by subconjunctival injections of Bhenolamc see ‘ Ophthalmic Surgery ’ by V. Ncsfield, reviewed.-—L. n.122,1110. Gives prolonged anaesthesia in direct contact with nerve imres. Copeland, B.M.J. iL/24,41. Both Psicaine and Cocaine give rise to symptoms identical in characte though not in degree ; Psicaine is the more powerful stimulant. Irritai effect less than Cocaine and insignificant for practical purposes. It ha relatively little effect on blood vessels. It was found to be more toxic an less efficient than Cocaine.—A. J. Copeland, B.M.J. i./25,10. afe Tutocaine (T.M. 437698). Syn. a-DlMETHYLAMlNO-/3-METHYL-y-^ AMINOBENZOYL OXYBUTANE HYDROCHLORIDE. Used as local anaesthetic in 0-2 to 1% solution. Tutocaine is about three times less toxic than Cocaine, and rather more tha twice as toxic as Novocain. Prom clinical observations a 5% Tutocaim solution has the same ansesthetic effect as a 3|% Cocaine solution.-—E. Watson! Williams, L. i./25,913. For both infiltration and surface anaesthesia the minimal effective concer tration of Tutocaine is £ that of Cocaine or Psicain (about 0-013% for Cocaine The minimum lethal doses for guinea-pigs wele Cocaine 0-05, Psicain 0- and Tutocaine 0-2 Gm. per kilo. The efficiencies, calculated as the rati of lethal dose to minimum effective dose, were 4, 6-3 and 64-5 respectively The anaesthesia is lengthened by the addition of Adrenalin to the solutions The addition of Phenol in small amounts increases potency in surface anse& thesia.—W. Wagner, Arch. Exp. Path., Pharm., 1925,109,64-73 ; J.C.S A. i./25,1503. The most suitable strength for urethral work is £ to 4% with Adrenalin— M.m.W., Oct.’26,1659, per Pres., Jan.’27,7. Tutocaine more toxic than Novocain, but quicker in action. 1 in 500 solution proved a reliable anaesthetic.-—H. Y. Moleswortli, B.M.J. i./30,1s. Bufcyn, Stated to be p-AMmO-BENZOYL-y-E>I-?2-BUTYL-AMIN<r PROPANOL SULPHATE. Dose.—By hypodermic injection 1 Cc. and upwards of J or mor« per cent, solution according to circumstances. Chemically it is allied to Cocaine and Novocain. A white amor phous powder, freely soluble in water. A local ansesthetic quicker and more profound in action than Cocaine. When used in eye work, accommodation is not paralysed For removing foreign bodies from the eye a drop of 1% solution almost immediately produces anaesthesia. Butvn Sterules 1 and 2% 1 Cc. and TaBLETS 1/6 grain (0-01 Gm.) are made One of the latter in 1 Cc. of distilled water (not Normal Saline with whict Butyn is incompatible) makes a 1% Solution. Isotonic Solutions may be made with addition of Potassium Sulphate. A \% solution requires i-34 Gm. in 100 Cc. The absence of dilatation of the pupil justifies its use in glaucoma as an analgesic in combination with Eserine or Pilocarpine. Operations on the < muscles by infiltration with 0-5% solution.—W. M. Beaumont, L. ii./22,304. In operative eye work 1 to 2% Butyn solution used. For profound anesthesia 4% or'5%. Four applications at intervals of 2 minutes. 2%:, applied topically, also suited for nose, ear and throat, e.g., septum resection tonsillectomy and adenoids. In dental work 10 drops or more of £% solution on opposite sides of the tooth to be extracted, with or without Adrenalin : allow one minute to elapse. For genito-urinary work 2% used.—W. M.. Beaumont, B.M.J. i./23,57. Butyn is quite as toxic as Cocaine and less efficient.—L. ii./23,1297. C/~ our p. 342. Possibly ‘ habit forming.’—A. J. Copeland, B.M.J. ib/24,41. Contraindicated where there is a solution of continuity in the mucous membrane, either through trauma or ulceration, as this allows too rapid absorption of the drug.—W. IE Jamieson, Jl.A.M.A. h/29,1519. Pharmacology of Local Anaesthetics (Cocaine and Substitutes),, see Vol. II. Z /o SOluTlOn rOqUllBo U*y/ Irlll in 100 Cc 5% „ „ 0-24 Gm in 100 Cc HICQBEINA (B.P.’U). U.S., Ph. Ned. Y.,P. Ital. V.,Fr. Cx., F.E. VIII., P. Belg. IV. 017H18(€H3)N03,H20=317-1874. Dose,—l to 2 grains (0-016 to 0-12 Gm.). (B.P. 514, £ to 1 grain), Fr. Cx. has maximum single dose 4 grain, maximum during 24 lours 3 grains approximately. P, Ital. and P. Belg. similar. U.S iverage £ grain. Codeine is not really dangerous as an addiction drug. It is wisely excluded from D.D.A.—Sir W. Willcox, P.J. i./'24,2s. Codeine and Dangerous Drugs Bill, 1912.—It was argued at the 1925 Geneva Convention that Codeine could be converted into drugs of addiction. Codeine being usually manufactured from Morphine, it is open to a manufacturer, if Codeine remains exempt from control, as at present, to buy Codeine in the open market without the knowledge of the Government; he can then divert a corresponding amount of Morphine into the illicit traffic and explain its disappearance by saying that he has converted it into the Codeine. It was finally agreed that it should only relate to manufacture, export and wholesale trade.—B.M.J. Sup. March 5/32. An alkaloid from opium or from morphine, in nearly colourless trimetric crystals. Soluble 1 in 130 of water, very soluble in diluted acids, in alcohol 90% 1 in 2, in chloroform and in excess of aqueous ammonia, but insoluble in excess of potash solution. It is a methylic ether of morphine—monomethyl-morphine. Flavor Inf/.—It has a slightly bitter taste, vide Morphine. Uses*—In moderate doses is hypnotic and in frequent small loses it allays cough in phthisis. In diabetes beginning with a £ grain thrice daily it lessens the amount of sugar in the urine. A useful sedative in chronic cystitis with enlarged prostate. For cough following catarrh \ to 1 grain gives relief.—Tilley. In tuberculosis relieves the night cough. Diabetes insipidus under treatment with Codeine.—L. L/14,16. dDCodeine and Glycerin Jelly, Dose.—1 drachm=J grain Codeine. An agreeably flavoured preparation containing in addition to Codeine, Glycerin, Oil of Lemon, Balsam of Tolu. Useful in chronic laryngitis, phthisical cough, etc. Also in ulcer of the stomach. ^D.Fastillus Codeinse. J grain in each. QPilula Codeinoe Composita. Codeine £ grain (increased to 2 grains if necessary), Extract of Nux Vomica £ grain. Extract of Lettuce £ grain or more, lo make one pill, to be taken two or three times a day, for diabetes. Note.—Use Mucilage, not syrup, as excipient. dDCapsuIaa Codeinse et Valerians Composites. Dose.—One or more p.d. according to strength. Codeine I to 1 gram, Valerian Extract 2 grains, Phenol 2 grains, Cascara Extract 14 grains, fn glycosuria, Codeine is the most valuable drug for treatment. The Valerian is a nerve sedative; the phenol intestinal dismfectan ;. The combination has been found helpful. G. Rankin. dDTrochisci Codeinss contain § grain (c-008 Gm.) tE^Capsuise Codeines cum Extracto Cannabis Indies. Codeine 4 grain, Extract of Indian Hemp £ grain. In neuralgia one every 4 or 5 hours. m2 ;P JCodeinse Hydrobromidum, C18H21N03HBr+2H20=416 1268. An anti-spasmodic similar in dose and use to the phosphate. For eye work has been advised to take the place of Ethyl-Morphine— being said to cause less pain. 1'Codeinae Hydrochloridum, Ph. Ned. V., P. Ital. V. C18H21N03.HC1,2H20 = 371-6678. Dose.—J to 2 grains (0-016 to 0-12 Gm.). White crystalline powder soluble 1 in 25. 'PjJCodeinsa Periodidnm. C17H18(CH3)N03.21=553-0358. Dose.—J to J grain (0-016 to 0-03 Gm.). When made by the interaction of Codeine base and Iodine in suitable solvent (cf. Alkaloiaal Periodides), this compound is obtained? as a yellowish-brown powder containing 54-1% Codeine. The Periodide was made in the writer’s laboratories (1923). A considerable proportion (38-5% of the Periodide) of the contained alkaloid is liberated to Physiological Acid and a further marked; proportion (11-6% of the Periodide) is yielded to Physiologiea Alkali when treated with it subsequently. Solubility,—Slightly soluble in Chloroform, soluble in Alcohol j insoluble in Ether and water. In compatible with alkalis, and with salts of metals, and I otherwise as alkaloids. Pha.rmaeo"ocgv. Hoses of I and 4 grain were taken by two of the author’s assistants (J.T.E and C.C.B.). -T.T.E. at the time was suffering from slight insomnia and n persistent cough. The effects of the \ grain dose in relieving both the insomnia and the cough were so gratifying that he continued for a week 01 the treatment, taking 4 grain in capsule form each night. Uses,—Suggested in moderate doses as hypnotic, in common] with other Codeine compounds, also to allay irritating coughs especially of phthisis. The antiseptic action of the Iodine it contains (45-9%) makes the compound a useful addition to therapy. Disne/nsinci Note,—To be given alone, finely powdered, in cachet or * slipule ’ (No. 5) as required, preferably after a meal. \$J\ Codeinse Phosphas (B.P. ’14). U.S. X., P. Jap., Fr. Cx., P.G. VI. J P. Ital. V., P. Belg. IV. C18H21N03.H3P04,2H20=433-2Q64. Dose.—J to 1 grain (0-016 to 0-06 Gm.). Fr. Cx. has max. during 24 hours 5 grains approximately. Slipule No. 5 for | grain. In granular snow-white crystals, soluble 1 in 4 of water. Contains 69-05% of anhydrous alkaloid, and is most suitable for hypodermic injection, 1 grain in 15 minims (l Cc.). dDSyrupus Codeine Phosphatis (B.P. ’14). Dose.—J to 2 drachms (2 to 8 Cc.). Codeine Phosphate 0-5% in a solvent of Distilled Water and Syrup. Sirup us Codeinae. Syn. Jarabe de Codeina, E.E. VIII. Dose.—5 Gm. (1 drachm approx.) with a total of 25 Gm. in 24 hours. Codeine 2 Gm., Distilled Water 20 Gm., Acetic Acid sufficient quantity,, Simple Syrup 980 Gm. CE)Tablets, Compressed, of Codeine Phosphate J and J grain. Cg)Linctus Codeinae, G.H. Dose.—1 to 2 drachms. Syrup of Codeine 1, Syrup of Virginian Prune, 1. St. Th. H. has same strength of Codeine, but different vehicle. CEDSyrupus Picis com Co&eina, v. Pix Liquida. [PUCodeinae Sulphas, U.S. (C18H21N03)2H2S04,5H20 = 786-4252. Average dose.—4 grain (0*0 3 Gm.). Given with advantage in sciatica, also in Morphine habit, q.v. UIICodeiiie-Metliyl-Eromide, Syn. Eucodeine. C17H18CH3NO3.CH3Br=394-2102. Dose.—f grain (0-05 Gm.). Is less toxic than Codeine. CEDRoto! Tablets (T.M. 512087). Dose.—1 to 5 tablets per day according to age and nature of cough. Described as a laryngeal narcotic and stated to contain Codeine 1/6 grain, Broinoform 4 minims, Aconite Tincture 5 minims, and Tinct. Bellad. 5 minims CH>&Veganin (T.M. 469189) Tablets. Dose.—1 or 2. Codeine, Phenacetin, and Aspirin. Antipyretic and analgesic. UJApocodeinEG Hyclrochloriclum, C18H19N02.HC1=317-621. Dose.—A, gradually increased to 1 grain (0"006 to 0*06 Gm.). A greyish powder soluble in water. A good expectorant hypodermically. Solution must be neutral; dose up to 25 minims of 2% solution. Internally, 10 to 30 minims of 1% solution caused no nausea or vomiting, but produced free expectoration. In pill 3 or 4 grains daily may be safely given. Uses.—Is a sialogogue and sedative and increases peristalsis. As Hy/oarfer erase Purgative* 30 minims of 1% solution = I grain (0*02 Gm.), may purge in half an hour or less, but may also prove emetic. IW1 WJ\ Eucodal. Syn. Eukodal (T.M. 402643). Di-hydro-oxy-codeinone Hydrochloride, C1?H2t N04,HCl = 351-6366. The Scheduling of Eukodal as a Dangerous Drug is fully justified. Its use in Germany as a narcotic has been extensive.—P.J. ii.lv8,218. ° White crystalline powder soluble in water. M. Pt. 270° C. Uses.—Analgesic and hypnotic. Used in pleurisy, bronchitis, tuberculosis, and for pain generally. IH1* Dicodid (T.M. 475651). Syn. Dihydrocodeinone Acid Tar- TF ^ Dose.—Tablets contain 1/12 to 1/16 grain (0*005 to 0*01 Gm.) foi interna use. Half a tablet to commence with, not on an empty stomach. White crystals soluble in water. a Dicodide, Eucodal, and Dilaudid.—M. Pts., etc. P.J. 111,(3Iirfjf*TTT nr. a PI Acetyldihydrocodeinone. Syn. ACEDICONE added to Par hb 1920. May not be imported without Licence—Home Office, June, e o . COLCHICUM. Syn. Meadow Saffron. Colchicum Autumnale. (Liliacece). Both Com! and Seeds are B.P. ’14 and U.S. F-I. requires the seed for the preparations of Colchicum. The Corm is in U.S. wi i no less than 0*35% Colchicine. Average dose. 4 grains. The seed U.S. contains not less than 0*45% Colchicine, ^ose-— 3 grains. P. Ital. V. and P. Belg. IV. specify seeds, both with 0*4 /G Colchicine; F.E. VIII., 0*45%. ®Tinctura Colchici (Seminum) (B.P. ’14). Strength 1 in 10 Alcohol 70%, as required by F.I. = Fr. Cx., F.E. VIII. and Ph. Ned. V. B.P.’ 98 was 1 in 5 of alcohol 45%. Dose.—5 to 15 minims (O'3 to 1 Cc.). Fr. Cx.—Max. Single Dose.—25 minims, and max. during 24 hours 100 minims approx.—and P. Belg. have this strength. ®Vinum Colcliici {B.P. ’14). 1 of Corm in 5 of Sherry. Dose.—10 to 30 minims (0-6 to 2 Cc.). Is given in mixtures with alkali and Magnesium Sulphate. In gout, controls the inflammation. 30 minims as lirst dose, then 15 minims, every three hours. It is not objectionable to the taste. Cg) Liquor Antirheumaticus Compositus. Dose.— 30 minims (2 Cc.). Colchicum Wine 15, Spirit of zEther 5, Camphor 2, Compound Tincture of Lavender to 30. A preparation used on these lines in Denmark contains Ammoniacum in addition. ®Extractum Colchici {B.P. ’14). The inspissated juice of fresh Corms—as B.P. ’98. Dose.—\ to 1 grain (0-016 to 0*06 Gm.). U.S. X. is an alcoholic extractive washed with Benzine, evaporated, assayed and adjusted with Starch to contain 1-4% Colchicine. Fr. Cx. extracts seeds with 70% alcohol, not standardised. Max. single dose £ grain, max. in 24 hours 3 grains approx. P. Ital. V. extracts with Alcohol 60% 2% Colchicine, P. Belg. and F.E. VIII. use 70%; 2% Colchicine. JJses.—Removes the gouty swelling and congested state 01 joints by increasing the circulation, and so eliminating the obnoxious metabolic products of the disease. It may be given in pill with Ipecacuanha and Mercury. To abolish the vomiting and diarrhoea often primarily produced (by increase of peristalsis) a small dose of Atropine may be given with it. Cg) Fluidextractum Colchici (Seminis), U.S. X. Dose.—3 minims. Standardised to 0-4% (average) Colchicine. Fr. Cx. F. E. VIII. IFTl Colchicina. p urn PH 1 /NH.CO.CH3\_399.903 C15H9(O.CH3)3^co 0CH3 Zvo. P.G. VI. has C22H2506N+ |CHC13. (Contains 87% Colchicine.) Dose.—TU to Jy grain (0-0006 to 0-002 Gm.) in a pill. Fr. Cx. has maximum single dose grain ; max. during 24 hours % grain approximately. Intravenously has been tried in dose of 1/100 grain with Sodium Iodide and Sodium Salicylate 1 Gm. each in 20 Cc. This active principle is a yellowish crystalline powder, soluble in water 1 in 22 with neutral solution, readily in Alcohol 90% but less in Absolute Alcohol, very soluble in Chloroform, slightly soluble in Ether (1 in 155). It is a weak base, most of its salts being decomposed by water. Of use in acute gout, rheumatic gout, asthma, cerebral congestion, and uraemia. . Phosphotungstic Acid is useful for isolating. Davies anu Grier, P.J. n„/22, »/i»i Colchicine varies internationally 20%. The body with 6 to 7% water (1-5 mol.HgO) should be advised.—P.J. ii./3o,242. ppPilula Colchicinse, Hyoscyami et Nucis Vomica. Dose.—One every three or four hours. Colchicine to grain Hyoscyamus Extract £ grain, Nux Vomica Extract 1 grain, Sugar of Milk £ gram. Rapidly relieves gout—A. P. Luff. Toxic Action. Colchicum affects the gastro-intestinal membrane. It may cause pains m tne bowels, vomiting, diarrhoea, intense thirst, and violent burning in the throat, oesophagus and stomach. Colchicine 34 mgr. taken over a period of 19 days with 6 to 8 drachms of Laville’s Liqueur caused paralysis. The palsy persisted for nearly a month. Even after 6 months not entirely cured.—B.M.J.E. i./15,19. Antidotes,—Evacuate the stomach. Give water and demulcents—white of egg, oil, barley water. Apply heat to feet. Stimulants. HColchicine Salicylate.—Syn. Coichi-sai. C22H25NQ6.C6H4OH.COOH=537-2498. Dose.—tjV grain (0-001 Gm.). A yellowish powder, soluble in water. CE>Capsules contain grain in Methyl Salicylate, rheumatism and gout. Dose.—One every two hours. Gloriosa Superbci (q.v.) contains Colchicine. Used in COLLODIUM, Coll odium Flexile (B.P, ’14). Contractile Collodion with addition of a small proportion of Canada Turpentine and Castor Oil, makes a more elastic film than Contractile Collodion U.S., which contains 2% Camphor and Castor Oil 3% in Collodion U.S. P. Off.—It is proposed to have one collodion only, containing Pyroxylin 2, Colophony 3, Castor Oil 2, Alcohol (90%) 24, and Ether to 100. According to our view it is too thin. Pyroxylin dissolved in acetic ether adheres closely and is pliable. See our experiments under Collodion. Collodium Elasticum, P. Austr., Ph. Ned. V. Collodion 98, Castor Oil 2. Fr. Cx. has Collodion (Fr. Cx. q.v.) 95, Castor Oil 5. Collodion (B.P. ’14) —Syn. Contractile Collodion. Was a solution of Pyroxylin in an ether-alcohol mixture. Keep from naked light. Pure ether answers better. In preparing, add the pyroxylin to the alcohol and afterwards the ether. Collodion (B.P.T4) is far too thin : increase the Pyroxylin by 50 to 100%, the latter in preference.—3. H. Franklin, P.J. i.127,62. We agree.. Acetone is also a good inexpensive solvent, but the film is opaque. U.S. X. has Pyroxylin 4, Ether 75, Alcohol 25. Fr. Cx.—Pyroxylin 5, 95% Alcohol 20, Ether 75. P.G. VI. gives directions for proceeding direct from Cotton Wool, Pyroxylin (dinitrocellulose C6Hs(N02)205=252-0784). . Syn. Colloxilina, F.E. VIII., is prepared by the action of nitric and sulphuric acids on cotton. It is freely soluble in Methyl Alcohol, Acetone, Amyl Acetate, Glacial Acetic Acid and Ether mixed vith an equal volume of either Ethyl or Methyl Alcohol. In making guncotton (trinitro-cellulose) C6H7(NO2)3O5=297*0786 the mixture o acids contains a larger proportion of nitric acid and the time or action is longer. This body is insoluble in a mixture of Alcohol and Ethel. Pyroxylinum, u.S. X. gives double the molecular formula— C12H16(ONO2)4O6-504-1568. Experiments which we conducted to improve ‘ Collodion ’ gave the following :— Collodium Aceto-A£thericum.—Pyroxylin 5, Acetic Ether q.s. to 100. The odour is a slight objection, otherwise the best substitute so far found. Hoes not pucker the skin anything like so much as the B.P. preparation. Is simple in making.—Consistence excellent. Is not more irritating in use than Collodion (B.P.T4). Adheres closely and is transparent. Collodium Acetonum B.P.C.—Pyroxylin 5, Clove Oil 2, Amyl Acetate 25, Benzol 20, Acetone to 100. U.C.H. adopts this. Another formula : Pyroxylin 5, Camphor 1, dissolve in Acetone 90, and make up to 100. Evaporates more slowly than ordinary collodion, but makes stronger him. |U l!Anodyne Colloid.—Syn. Amyl Colloid. Amyl Hydride 4 ounce, Absolute Alcohol b ounce, Aconitine 1 grain, Veratrine 6 grains, Collodion to 2 ounces. For neuralgia, sciatica, lumbago, all muscular pains, etc. The amyl by its rapid volatilization gives prompt relief. Should pain continue the alkaloids are effective by applying a piece of moist spongio-piline over the collodion film. * New Skin ’ is a Collodion preparation. Collodium cum Oleo Crotonis. Croton oil 1 part mixed with 7 parts, more or less as required, of Flexible Collodion, forms a useful counter-irritant; a thin layer painted on quickly dries and its action is limited to the spot to which it is applied. Collodium Benzoini.—Syn. Kelly’s Paint. Add Compound Tincture of Benzoin 3 to Collodion 1, shake until mixed and add Glycerin 1. Keep well corked and shake before use. As an antiseptic covering to slight wounds. It dries slower than ordinary collodion, but gives a harder film. Used in New York. Collodium lodi. Iodine 1 (more or less if required) to 15 Collodion, sustains the action of the iodine and the film protects the part. Recommended for ringworm, alopecia, chilblains and frostbite. Collodium Salicylicum. Salicylic Acid 1, Collodion (f strength) 5. For use on exposed parts like the next preparation. In skin diseases, Salicylic Acid 1 drachm in S said to have amazing results in chilblains, and to be useful in many dry dermatoses. Remarkable results in acute dermatitis, eczema, etc., with ointment of equal parts of Salicylic Acid and Vaseline.—Sir G. A. Reid, Clin. Jl., Dec. 26/23,017. CP) Collodium Callosum. Salicylic Acid 8, Extract of Indian Hemp 1, Collodion (|- strength) GO. A rapid and painless solvent for corns and warts. Cg) Collodium Acidi Salicylici, L. H. is similar, namely Salicylic Acid 1 drachm, Extract of Indian Hemp 20 grains, Collodion 1 ounce. eg)St. Bart’s H. adds Zinc Chloride 20 grains to the ounce. cp) Collodium Salicylicum cum Zinci Chlorido. Salicylic Acid 2, Zinc Chloride 1, Collodion 15. Forms a clear solution. This and the above have proved useful in epithelioma. eg) Mercuric Chloride to the extent of I in 30 or more of Salicylic Collodion may be used to warts. Collodium Salicylicum et Lacticum. Salicylic and Lactic Acids, of each 10, Collodion 80. Lactic Acid, being destructive to morbid growths, is said to increase its efficacy. Collodium Stypticum.—Syn. styptic Colloid. Absolute Alcohol 16, Benzoin 14. Dissolve, filter, and add Tannic Acid 16, Gun Cotton 14, Purified Ether to 100. Mix, set aside three days, and decant. Useful in checking various forms of haemorrhage when it can be brought in contact with the bleeding surface. Camphoid, a substitute for Collodion. A solution of pyroxylin and camphor in absolute alcohol. May be used as a vehicle for the application to the skin of such drugs as iodoform, phenol, salicylic acid, resorcin, iodine, chrysarobin, and ichthyol. Iodoform dissolves in it to the extent of 1 in 10. The preparation dries in a few minutes, leaving a film, which is not easily washed off. Celluloid. Made by dissolving Pyroxylin 50 in a solution of Camphor 25 in ether 100 and manipulating the mass until it has become plastic. It is then dried. Colours may be incorporated. It is supplied in thin sheets and being light, rigid and washable, is useful in surgery for splinting ; it is rendered plastic by rolling up and macerating in hot spirit for a few minutes ; it may then be wrapped round the limb with a layer of wool outside and quickly sets. X.B.—Very inflammable. Celluloid was originally called Xylonite. Soluble according to our work more readily in Acetone than in Amyl Acetate, but the film resulting in the first case is liable to be opaque. Mixtures of these solvents are frequently used. A collodion can be readily made strength 1 in 20 using equal parts of the solvents. (The celluloid should be shredded). Celluloid Splints employing Pexuloid, a special solution. As used at the Hospital for Sick Children, Great Ormond Street, London.—Details Edn. XIX., p.361. ‘ Non-inflammable ’ Celluloid is Cellulose Acetate. It is not actually unburnable, but is as safe as paper. It burns slowly without the evolution of dangerous gases.—L. i./2Q,1283. . , Danger of inflammable films used in hospitals and by radiologists for cheapness.—L. ii.,/31,1310. COLLOIDAL METALS. Certain Metals and Metalloids in the form of Colloidal Solutions are considerably used in therapeutics. General Characters. , The term Colloidal (from KoAAa=glue) was used by Thomas Graham, to distinguish between amorphous substances m solution, which diffuse with difficulty, and Crystalloid substances, whic crystallise easily from Solutions and diffuse quickly from their solutions into a water stratum, or which pass with ease through membranes, e.g., those employed in the process known as 1a ysis. Glue and Gelatin are typical Colloidal substances, iey o no exhibit the property of diffusion in this manner. , The view held now is that colloids and crystalloids are not different kinds but rather different states of matter, the same c emica su - stance being obtainable in one state or the other according to how it is made. Many substances which might be regarded as typical crystalloids have been produced in the colloidal condition. For theoretical study see ‘ Chemistry of Colloids and some Technical Applications/ by W. W. Taylor (E. Arnold). Further details E.P. XIX, p. 362.. The real characteristic of the colloidal state is that the particles are large enough to possess the properties of surface. The Osmotic 'pressure of most colloidal solutions is very small, exceptions being those colloids which are salts of an inorganic base or acid such as Na or Cl respectively, combined with a large- organic ion as the anion or cation. Examples : Soaps and dyes. The particles range in size from OT ^ to 20 /jl/ul. Those of diameter less than 3 to 5 p. show ‘ Brownian ’ Movement. ‘ Brownian ’ movement is due to the perpetual movement of the molecules of the liquid, and to their possession of mass and, therefore, kinetic energy. The colloidal particles are continually being bit by these molecules and their movement is thus maintained. A Colloidal Solution is usually dichroic, i.e., transparent by transmitted and relatively opaque by reflected light. Electrical Properties.—The disperse particles are charged with + or — electricity. In water, amongst the + charged are the Metallic Hydroxides, Silicic Acid and Basic Byes, e.g., Methyl Violet, Methylene Blue and Magdala Red in Water. Amongst the — charged are all the Metals, Metallic Sulphides, and certain Byes such as Indigo, Eosin, Fuchsin, also Mastich, Gamboge and Starch. On passing an electric current into a colloidal solution the + charged particles move towards the cathode and the — towards the anode. Protection.—All metallic colloidal solutions require protection by organic colloid, e.g.. Gelatin, Albumin, etc. Unprotected electrically prepared colloids are unstable. The presence of protectives, unless controlled, and data as to its type, renders reports of effect of no value, as e.g., when Peptone or Silicic Acid is used. Their action in preventing the precipitation of suspensoid colloids is probably due to the deposition of a layer of emulsoid on the surface of the particles. The addition of Sodium Chloride, to render a solution for medicinal use isotonic with blood, according to Bayliss, is unnecessary, as the amount injected is small, and should be given slowly. The protective effect of different substances is called the ‘ gold value,’ i.e., the number of milligrammes of a colloid which are just capable of protecting 10 Cc. of a Gold Solution containing 0-0053 to 0-0058% of Gold from coagulation by 1 Cc. of a Sodium Chloride Solution containing 100 Gm. of Sait in 900 Cc. of Water. The value for Gelatin and Glue 0*005 to 0*01. For particulars of adsorption see Vol. II. A colloid solution should be dichroic, generally fluorescent, show Brownian movement, be indiffusible, stable at increased temperature and be affected by adding certain electrolytes. If stable, protective Colloid is probably present. In ultramicroscopic examination (a) care must be taken to examine the solution in a state of dilution comparable with that of a solution known to have all the particular compound present in the colloidal state. Certain commercial preparations, though showing particles with the ultramicroscope, have been found to contain nearly all the matter present in true solution, and diffusible through parchment. (b) Extent of true solubility of the substance in the liquid must be taken into account. Thus, Iodine is soluble in water 1 in 5,000, and in a colloidal preparation it would therefore be suspended in a saturated solution. The so-called ‘ solutions ’ of Iodine in Oil would, of course, contain a larger amount in true solution. In fact, in many commercial preparations it has been found that the activity is equivalent to the fraction present in true solution.— Bayliss. Tests of Colloidal Sols.—Examination of Colloidal Sols with the ultra-microscope or v/ith l/12tli inch oil immersion and an 8 c. Leitz eye piece, using a specially good dark ground illumination, showed marked difference in amount of movement of various preparations. Colloidal Sols must also show the “Tyndall Effect ”—i.e., when placed in a test cell made of optical glass and subjected to action of a powerful beam of parallel light they show7 the characteristic turbidity.—A. B. Searle, Pres., June, 1920, p. 235. Chemical Methods of Manufacture previously published. In the 19th Edn., Vol. I., p. 365, we provide details relative to Aluminium Hydroxide, Arsenic, Bismuth, Gold, Manganese, Selenium, etc., to which reference may be made. Electrical Methods of Manufacture. The disruption by an electric arc of metals into fine powder and the formation of dark liquids by employing terminals of the metal required was investigated by G. Bredig (1898). A direct current arc is used. The strength of current is 5 to 10 amperes. E.M.F. between 30 and HO volts. Gold, Platinum, Palladium, Iridium and Silver Sols were made on these lines. The cathode is the chief participant in the disruption. Mollinari’s Chemistry, Vol. I., 1912, p. 103-105, gives brief details of Bredig’s Process for making a Hydrosol of Gold (see Jidn. AlA., p. 366). Thco. Svedberg and others have improved upon Bredig’s process. Of the non-metals. Carbon, Silicon, Selenium and Tellurium were made in colloidal condition by the method. High- frequency alternating currents passing between electrodes of the metal immersed in water have been used m making aqueous colloidal solutions of metals. Varying the range of frequency between wide limits, we found the colour supposed to be characteristic of colloidal metals is a result of conditions of the discharge. Thus Gold, on altering the frequency, can be made to give a red, blue or purple solution; in the red solution the partic es are nega- tivelv charged and in the blue solution positively charged. The purple solutions contain both kinds of particles The> red^solution is converted into blue by the action of an electrolyte or electnc hel . Numerous Patents have been taken out for making Colloids ranging from the year 1911-many of these have lapsed by time. For a resume see Edn. XIX., p. 367 8. Our Experience in making Colloidal Metals and their Therapy. The requisite presence of protective renders some of the solutions indefinite. They may contain compounds of the metals with protein decomposition products, i.e., metals combined as organic salts. Therapy.—Physiological trials which we have had conducted from time to time during some years show that the Hydrosols are relatively non-toxic. Excess in treatment should be avoided. The effect may be due to enhanced leucocytosis, the bactericidal power in vitro being slight. Uses.—Infective conditions, e.g., pneumonia, pleurisy, peritonitis, influenza, typhoid, tuberculosis and other febrile conditions, have been treated by subcutaneous, intramuscular and intravenous injections. They have also been used locally in cystitis, gonorrhoea and epididymitis. Copper and Selenium have been tried in malignant disease. The late Sir W. M. Bayliss held that a drug in the colloidal state does not necessarily acquire any special therapeutic qualities.—B.M.J. i./23,193; L. i./22,38. Aluminium Hydroxide, Antimony Sulphide, Arsenic Suiphide and Bismuth Hydroxide Colloids under the T.M. 5^COLLOBELL No. 429532 are in commerce. afcOscol (T.M. 305256) Stibium. Dose.—1 to 4 Cc. intramuscularly in leprosy.—F. G. Cawston, B.M.J. ii./2o,76,855. Dose used 2-5, 3 and G Cc. on consecutive days. Three weeks later 4-5 and 6 Cc. on consecutive days. Results encouraging.—Ct. H. Wildish, B.M.J. i./2 2,55. Leishmania Infantum.—Treated by colloidal Antimony Sulphide, 0-001 Gm. per Cc. Dose.—3 Cc. intramuscularly (buttocks), daily, on alternate weeks. In a fortnight, spleen had decreased in size, and in 4 weeks regained normal position, but patient died from haemorrhage (epistaxis).—R, Samut, L. i./22,995. PULMONAitY Tuberculosis.—0-5 Cc. intramuscularly into the flexor muscles of the arm twice weekly, of value ; the treatment can be carried out in the out-patient clinic without fear of untoward reactions. No ill-effects from some thousands of injections. Injections might be continued until physical signs have cleared up.—P. Moxey, B.M.J. i./27,374. ‘ Creeping eruption ’ successfully treated with intramuscular Colloidal Antimony or intravenous Tartar Emetic injections.—F. G. Cawston, B.M.A. Ann. Meeting, B.M.J. ii./28,207. Calcium. (The Calcium is in a state of combination, not present as such). Dose.—0-5 Cc. to 1 Cc. hypodermically under the skin of the back of the forearm every 5 or 7 days. Strength 1 in 2000. Protective used is Glutaminic Acid obtained from Gelatin. Tuberculosis has been treated with improvement in temperature, haemoptysis and night-sweats. In addition to the injections (0-5 Cc. or less for children) to be given first, then wait a week to see if there is reaction, Calcium Lactate yer os, two or three grains one, two or three times a day. Many cases do not need an injection oftener than once a fortnight.—E. E. Prest, B.M.J. ii./22,283. See also T. C. Graves, L. ii./22,957. Empyema, ischio-rectal abscesses, and hay fever have been well treated with Colloidal Calcium.—E. E. Prest, B.M.J. ii./27,958. Calcium Oleate ( jJcCollobell) 0-05%. Dose.—per os, ^ or 1 drachm; hypodermically 0-25 to 1 Cc. 1 Copper Solution, Colloidal. Martindale. Strength 1 in 2,000. Dose.—5 Cc. subcutaneously, J to 1 Cc. intravenously, to be isotonised at time of use. Sterules 5 Cc. are made. Keeping Properties.—Our experience is that this solution keeps only when sterilised and subsequently fdled into sealed containers. Pharmacology.—A dose of 5 Cc. is tolerated by a cat intravenously or intramuscularly. Isotonisation of the solution is preferable to the omission of salt. Uses.—For injection into inoperable malignant growths. ColloidalCopper on the surface of its particles may supply oxygen necessary A * -l ii n. __J /-vl 4- ■? n r.-4- hrA Ur* to prevent abnormal cell growth. Lrage found the solution active, a Cc. IU LUtJVCUl auUDiliiai ----.-V . _ r injections were made twice weekly to a patient suffering from carcinoma of the liver with improvement.—L. i./i 4,1651. Recurrent cancer growth. Thirty-four injections caused disappearance of a nodule on the liver.—C. Mansell Moullin, B.M.J. i./i8,427. Gold. . i i f „ Manufacture.—We devised the following : Neutralise a Gold and Sodium Chloride Solutionl with diluteifeoaium bonate SolutionTnd adjust the strength to 0*05% Au. With 10 parts of this solution mix 10 Jarts of a solution containing the calculated amount of F^r- reduction. It can be boiled to sterilise. The finished red Hydrosol is to contain 0-025% (1 in 4,000) Gold and the same amount ot protective. Physiological Report. . Rabbit, Wt. 2-3 kg. injected intravenously on successive days with 2 Cc., 3 tolerated exceptforslight dyspnoea after the dose of 5 Cc. Two daysafter the hist dose (io Cc.) of Colloidal Gold this rabbit was given 10 Cc. of Colloidal Selenium, which produced slight dyspnce . A method of preparation.—H. Nicol, J.C.S.I., 28,47,3431, per Vjwiy. Ph *20 115. Sterules of Colloidal Gold Solution 0-025% containing 5 Cc. are prepared and are suggested for injection. The solution may be approximately isotonised by adding 1 Cc. of 5-5 per cent. Sod um Chloride Solution at the time of use. Sterules of this Salt Solu- tlOL“e-^uggested5Cc.=0-C0125 Gm. (* grain approx.) increased, intramuscularly or intravenously. Uses.—See Therapy in general—antea. _ treated by^oUcTdaftfol'?' with bitter tonic, “%‘f '“[1 tctarari of remarkable cases. Natural deep ^ Addiction of ,nd nervous .ymptom, <•“»'"% pj°t “L “/22> 11 H./.6.1S1. addicts successful at Bay Mount. al , , • simiJarly coloured Tests against control inert isotonic rapidiy showed that patients treated wi ® ld l. ii./25,U50. See also and were more successful.—P. Bonsheia, m. / J. 554. our p. Iodine. (Non-Metal.) Colloid Iodine Sol 1 in 2.000—Martindale. Dose.—1 to 4 drachms (4 to 15 Cc.) diluted per os. Not suitabi jor intravenous use. Manufacture. prepared by acting upon Sodium Iodide with Sodium Nitrite b Acid Glucose Solution. The Nitric Oxide evolved must be removed i rl rorLnL ,Cbf a con°1(ial Iodine preparation in a test tube ad- livenSi J Bisulphide or Chloroform, shake and allow to separate. Th a itOo ^! mti°fArufairly d^eP violet colour, which is not increased by adding fq !JLb fd JNi.t.^1.te and Hydrochloric Acid, showing that all the Iodin is in the tree condition. of fIodine ^.Preparations of commerce found to be far below the strength stated and not m the colloidal form.—Prof. A. J. Clark, B.M.J. h/23 273 «Collosol (T.M. 350478; ‘ Collosols,’ T.M. 473310) iodine is supplied in liquid and paste, ointment and oily form. Dose.—l to 4 drachms (4 to 15 Cc.) twice or thrice daily after meals. Intravenously 10 to 200 Cc. Uses.—As a substitute for alkaline Iodides, e.g., in syphilis, rheumatic affections, tuberculosis, bronchial and nasal catarrh. lor rheumatic affections the preparation is advised bv iontophoresis. Collosol Sulphur to be given internally. For catarrh, the effect is to render mucous secretion more fluid and less adherent. Intravenously as much as 300 Cc. have been injected in pysemia and to produce softening of fibrous tissue. Pasta Collosol iodine (Paste Form) for local use only. ™ ?wi0ng’ standinS ulcer? effect is raPjd- H is suggested to apply alternately vuth the similar preparation Pasta Collosol Argentum for bactericidal effect, ihe oil form (3%) and ointment are used for chilblains and ulceration. Iron. A stable Hydrosol of Metallic Iron is difficult to make. Liquor Ferri Dialysatus, B.P. ’85, is a colloidal solution of Ferric Hydroxide, unprotected. ^iDOZAN (T.M. 419403). Described as a ‘Colloidal Iron Concentrate’ containing 5% of Iron. 5 Dose.—l drachm thrice daily after meals, increased to 1 tablespoonful. Has been used in the treatment of anaemic conditions, especially such as are due to an impaired regeneration of blood. Lead. Pharmacology.—A colloidal preparation, actually Lead Albuminate, of strength 1 in 500, prepared by us in 1926, in SteruJe lorm 2-5 Cc. with 0*1% Tricresol, was found to be remarkably tolerated by rabbits. A total of 0-03 Gm. of actual Lead in the form of Albuminate was tolerated. No anaemia was produced. A similar strength preparation of Lead, as Lead Sulqihide, which wTe made, was also tolerated in the same dose. In this instance there was found some impairment of the organs, liver, etc., on p.m. examination. Lena Treatment of Malignant Disease. Malignant neoplasms appeared to be arrested by Colloidal Lead intravenously.—Prof. W. Blair Bell, L. ii./22,1006. Lead workers are apparently immune. Lead thought to be the best agent known at the time for destroying chorionic epithelium.—L. ii./24,139 ; i./26,657. The toxic effects of Lead administered intravenously, using Lead Acetate, Colloidal Lead, Lead Iodide, and compounds of Lead with Thyroiodin and Tleemoglobin.—Prof. Blair Bell, W. R. Williams and L. Cunningham, L. ih/25, 793. 3G7 The specific character of malignant neoplasia* and the action of Lead on malignant growths.—Prof. Blair Bell, L. iL/25,1008. . . . Prof. Blair Beil adopted the unfruitful trophoblastic (or chorionic) hypothesis of the nature of cancer which was first put forward by J. Beard (L. i./02,1758). Xntmvenous ^injectioiis of a Colloidal suspension of Lead (“M.A.”) containing 0-1 % Mercury and 0T% Lead, i.e., 1£ grains of Lead per 100 Cc., and a similar quantity of Mercury, combined with X-ray treatment, gave a decidedly beneficial effect in a case of inoperable cancer. The dose ranged from 2 to 20 Cc., a total of 368 Cc, of Colloidal Lead, containing 5$ grains of Lead, being given over a period of nearly two years. Minimum danger of immediate shock or toxicity.—E. Coke and J. B. Cook, B.M.J. i./26,416. 15 Cc doses of a solution of not less than 0*5% Lead used with no unpleasant reaction. It is important to avoid bad colic, vomitmgamd poisoning due to the use of soluble salts.—Prank Coke and J. B. cook, B.M.J. 1-/-'7»81b. The connection of lead poisoning with the comparative immunity of le workers from cancer.—Prof. Blair Bell, B.M.J. 1./2 ,43^. Debate at the Medical Soc. of London.—B.M.J. i./26,5u. , given The fatal amount of lead is a little more than 0 2 Cm when given in a single dose. Intravenous use.—Prof. Blair Bell, L., i./2b,t>dc U«eof ^Colloidal malignant disease after op^ttonC^“i^ortant that for cancer, whether the disease» be believed to he totally eradicated^^ ^LWeK^ool^Cancer Research Okganisation.-—/The ^lead^si^)eneioTi at Liverpool contains metal, o/^pad^Tn^erum^the Lead in suspension is electrically, and contains 0-5 /o Lead. ph ’ pbo(P04)2. It then converted to the extern of 85/0 into Lead I P > permeable and tend may perform the function of rendering the tumour ^s yien ^26,920; towards the production of encapsulation—W. C. M. Lew is, b.w-.o i L'K’Coordination of Workers. etc.-Prof. .f2ten without efleillnJa: 5 Cc. of a 0-5% Colloidal Lead,^preparation of Prof. Lewis found venously to rabbits, but colloids differ. T P. ^prof j. Dilling, B.M.J. safe intravenously, but slow injections desirabL. U‘Histological Changes in Cancer .^T®fs^f therSionof the neoplasm patients with malignant disease complain of pain h r g of the Lead within a few hours of the intravenous f^f^Ver within two hours of ingiven intravenously to cats is deposit - e 30 Lours after treatment, lection. Details of examination of a human case ou —E. E. Glynn, B.M.J. ii./26,928 profound changes in animal Colloidal Lead in sublethal dof/apprn°fd^sesheading to permanent cure, (rat) tumours—in a small percentage not irreparable changes m the The necessary dose also induces serious, - B ^ .j. ii./26,928. liver and blood-forming organs. E. • ’ ent.—Dosage has been ClmicaS effects of Lead m treat men ^ interval of 10 days two doses of 20 Cc. and two of io Cc. when poss^bi ^ ^ time suitable doses between each. Then a montn s iesd- , , , ^ l20 Cc., i.e., 0-6 um. of Lead, amounting to 10 Cc. at intervals unt growth give smaller doses fron is reached. of'growth, etc., m 41 of the first. Interesting data of cast,^, si t, q3l ,. 227 cases treated.—L. Cunnmgnam, B. • • greeting a solution of Gelatin A method of preparing CMloidal Lead by si bje high frequency arc 0-4% and Glucose 0-5%, adjusted 5S,8oO voltg. 0-4% and Glucose u*o7o, ft j0q0 volt9, the solution d mg — between Lead electrodes of about 10,0uu >readily oxidised.—E. Biscnon The colloid is brown-black m culoiur, aimus ilor , nnd N. B. Blatherwick, JL Pn. & Exp. mer., Colloidal Lead. . . carcinoma of the breast and Two cases well treated in private practice cement following courses of carcinoma of the rectum. Apprecn intervals, with small mje miections—12 Cc. ar wtcn j locally mto the nodules, a total of 12 grains of Lead being given in one case and 10 grams in the other. Xo acute toxic symptoms. The treatment does not appear to merit such wholesale condemnation and adverse criticism as it has received.—E. Talbot, B.M.J. ii./28,1035. The combined action of Colloidal Lead and radiation caused disappearance ot tumours (experimentally) in doses which, by themselves, only result in temporary retardation—J. C. Mottram, B.M.J. L/38,132. Chemotherapy in malignant disease—W. Blair Bell, L. ii./28,164. Correct liver function necessary. Extent and interval of dosage dependent on existing damage.—L. Cunningham and M. M. Batnow, L. ii./2g,655. Colloidal Lead preparations should be tested to be sure that they are free irom toxic effects on rabbits, and that they cause only negligible fall in blood pressure. Myocardial disease a contraindication.—W. J. Billing, Jl. Ph. & Exp. Ther., April, ’29,401. Results in 40 cases confirm Blair Bell’s contention, that in a few persons with inoperable and advanced neoplasms arrest of disease may be obtained from combined use of Lead and X-rays.—L. C. Knox, Jl. A.M.A. L/29,108. Go successes out of 305 cases treated, i.e., 21'5% of successful results. Xo one would suggest that possession of a knife is all that is required for surgical cure of cancer of the stomach, yet some seem to think that for Lead Therapy all that is required is that Lead shall be pumped into the veins.—W. Blair Bell, B.M.J. i./29,437. Lead Selenium Colloid in cancer.—A. T. Todd, L. i./27,575. Suspension of Lead Selenide (D.4s) in a gum ghatti solution of strength Lead (metal) 0-4% and Selenium 0-04% used in cancer.—A. L. Taylor and E. Lloyd, P.J. ii./28,542. ’ Colloidal Lead Phosphate and Tetra-Ethyl Lead appear to be the only Lead compounds suitable for use intravenously in cancer. Tetra-Ethyl Lead emulsion is prepared by shaking 1*6 Gm. commercial Tetra-Ethyl Lead with a mixture made up of 150 Cc. water, 25 Cc. saturated Lecithin suspension and 10 Cc. 1% Sodium Oleate solution. Prepare freshly and shake vigorously before use.—E. Bischoff and others, Jl. Pharm. & Exp. Therap., Sept., ’2 8,109. Lead Selenide Hydrosol preparation by passing Hydrogen Selenide into a solution of Lead Acetate and Gelatin 5%.—B.C.A., ’28,A.704. X-radiation or Radium should be applied with extreme caution, if at all, in cases recently treated with Colloidal Lead Selenide (B 4S).—A. T. Todd and H. M. Aldwinckle, B.M.J. ii./29,S00. Lead Selenide, used intravenously at weekly intervals. The dose ranges from 1 to 5 Cc. initially. Has low toxicity. A rabbit will tolerate 4 Cc. per kilo. As much as 33 Cc. has been given in one dose in man without adverse effects. Reactive effects—pain—thought due to protein poisoning from break-down of cancer tissue. Explanation of action not yet proved. It is thought to be a stimulus to the defence put up against the irritation on invasion of a malignant neoplasm. Combination of radiation with Selenide being worked out. An addition to treatment is Calcium Chloride, to prevent Lead accumulating and furnish a depot for Calcium Assimilation. Vitamin B and Thyroid as tonic and anti-infective. Liver Extract to combat anaemia.—A. T. Todd, L. ii./30,389. W. Blair Bell criticises Todd’s Lead Selenide.—L. ii./3o,550. Reply—The Lead ion may only be a vehicle for the Selenium.—ibid., 611. Reply ibid., 667. Bate of priority of Lead Selenide discussed.—ibid., 713. When expense of the treatment is weighed against possible good effects it seems that Lead Therapy is not the solution to the cancer problem.— A. Soiland and co-workers, Jl. A.M.A. i./29,106. Lead Selenide not curative of cancer.—M.R.C. Ann. Kept., 1928-29, B.M.J. i./3o,560. Colloidal Lead Iodide, containing 0-2% Lead, isotonised by means of Glucose, and containing a trace of Thyroid Extract (less than 0 02%) and a trace of Cresol as preservative, injected intravenously in inoperable carcinoma with complete absence of reaction, and with beneficial results in selected cases, e.g., growths of the solid variety or in the solid viscera, or in situations which are not vital.—B. C. L. Fitzwilliams, B.M.J. i./27,758. Colloidal Lead Phosphate as a substitute for Colloidal Metallic Lead was relatively non-toxic to rats and rabbits. Method of preparation given.— E. Bischoff and X. R. Blatherwick, Jl. Ph. and Exp. Ther., Sept., ’27,86!. Manganese. Colloid Sol Manganese.—Marlindale, 1 in 400. lY$anufactu!re.—~By double decomposition of Manganese Chloride and Sodium Hydroxide, using Glucose as protective. Supplied in two separate solutions, each containing 0-5% Phenol. The Sodium Chloride Content is 0-53%. For use, mix equal quantities of the two solutions. PHYSIOLOGICAL EXPERIMENTS. Subcutaneously in rats 1 Cc. of combined solution given on two consecutive days produced only slight malaise and the animal recovered completely. Intramuscularly, in cats under observation three weeks, 2 Cc. doses of combined solution at weekly intervals were followed by loss of appetite. There was, however, complete recovery. Effects in man should be carefully watched before giving large or frequent doses. It has not, however, appeared in these experiments that 2 Cc. doses would be dangerous for man unless prematurely repeated.—May II/20. . # . if Collosol Manganese is supplied in two solutions, to be mixed at the time of use, producing a 0*25% solution. Also supplied ready mixed in ampoule form. Uses.—Gonorrhoea and sequelae, also eczema, acne and quinsy, have been treated by it—(c/. Pallamine). ~ . , Gonorrhoeal ophthalmia treated by Colloidal Manganese 1 Cc. intramuscularly, repeated, with success.—D. M. Livingstone, B.M.J. i./i9,404. Boils cured by Collosol Manganese.—B.M.J. ii./i8,160. Antral and other suppuration treated by injections into subcutaneous tissues, intermuscular septa or the periosseous tissues.—E. Matson Williams, X>T* M q y IQ2 0 Boils and suppurating glands treated by Colloidal Manganese intramuscularly, 4 Cc. doses. May be very painful.—H. E. Waller 1 res., June 2C- Hodgkin’s disease well treated after Sodium Cacodylate had failed to improve.—B. Samut, L. i./22,17. . . T t Psoriasis treated—6 to 16 intramuscular injections—J. Moore, u.m.j. ii./22,41. Urticaria treated.—B.M.J. ii./23,563. jkCollosol Manganese (Oral). Dose.—A teaspoonful two or three times daily alone or m water. In middle ear affections, internal nasal carbuncle, severe carbuncle on face, and erysipelas. ^Manufacture— By reducing Mercuric Chloride with Hydra- zine, employing Gelatin as protective. Dialyse subsequen y an adjust to 1 in 2,000. Physiological Report. . . ... , f Rabbit wt. 2-0 kg. injected (intravenously on successive days) wi oses o 2 Cc., 3 Cc., 4 Cc., 5 Cc., 7-5 Cc., and 10 Cc. (all lsotonised). Result.—WeK tolerated except for apparent dyspnoea after the 5 d .• Sterules of Colloidal Mercury Solution are prepared containing 5 Cc. of 1 in 2,000 Solution=0-0025 Gw (1/25 grain) Colloidal Mercury. May be isotonised at the time of injection by 1 Cc. ot 5-5% Sodium Chloride Solution. . . oniliaj,. Dose.—Suggested, 5 Cc. =0-0025 Gm. (* gram) intramuscular y or intravenously. , m1 • n.^riproi Uses.—In syphilitic affections; see a!so J if mVgentum antea, and Collosol Hydrargyrum, posted, under Collof g Palladium, Colloidal Palladium. Syn. Pallamine. f Colloidal Manganese is most efficacious m maximum stage, but as there is delay after injecting 1 ® t j to precede, oxidising power is reached, Palladium has )een s g0 —J. E. R. MacDonagh, B.M.J, ii-/i8,31. Epilepsy well treated by Pallamine. \ Cc. doses intramuscularly at 3 day intervals.—A. C. King-Turner, B.M.J. ii./i8,255. Platinum. Manufacture.—This Colloidal Solution we found best prepared chemically by reducing a Platinous Salt, e.g., Chloro-Platinite of Potash of commerce with Hydrazine in the presence of Gelatin as protective. A Colloidal Solution made in this way after previous dialysis can be adjusted to strength 1 in 4,000 (0*025%). Physiological Report. Rabbit wt. 2*3 kg. injected intravenously, on successive days, with doses of 2 Cc., 3 Cc., 4 Cc., 5 Cc., 7*5 Cc., and 9 Cc. Result.—Well tolerated except for slight dyspnoea after the largest dose. Sterules of Colloidal Platinum containing 5 Cc. of 0*025% solution are prepared=0*00125 Gm., Platinum (1/50 grain). May be isotonised for use with 1 Cc. of 5*5% Sodium Chloride. Dose.—Suggested, 5 Cc. =0*00125 Gm. (-% grain) intramuscularly or intravenously. Uses.— See Therapy in general—antea. Intravenously 3 to 7 Cc. Colloidal Platinum caused a rigour in 4 hour, followed by rise in temperature to 104 or 105° F. with perspiration, sickness and headache. Temperature then fell to subnormal—this reaction occurred both in normal subjects and those suffering from diseases characterised by moderate pyrexia—namely subacute pleuritic and pneumonic conditions, and protracted paratyphoid fever—the fall of temperature coincided with a great improvement in the general condition to a great extent—results attributed to a great extent to the Peptone used as protective.—A. G. Auld, B.M.J. i./18,195. Selenium. Manufacture.—An Alkali Selenide is treated with acid in presence of protective colloid. The colloidal solution is to be isotonised with Saline at the time of use, to render it approximately isotonic with the blood. Physiological Report. A recent report was to the effect that 3*5 Cc., 5 Cc. and 10 Cc. injected into the ear vein of a rabbit at about 1 hour intervals were tolerated and the preparation was deemed entirely non-toxic. Sterules of Colloidal Selenium are prepared containing 5 Cc. of 1 in 5,000 Solution=0*001 Gm. (1/64 grain) Selenium. The solution may be approximately isotonised by adding 1 Cc. of 5*5% Sodium Chloride Solution at the time of use. Sterules of this Concentrated Saline are prepared. Dost.—Suggested, 1 to 5 Cc. hypodermically, intramuscularly, or intravenously. Uses.—Has been suggested for use in malignant disease—see also Therapy in general—antea, and lead Selenide. A preparation of colloidal selenium was tried on mice and rats with grafted malignant growths, but without effect. This preparation was non-toxic, whereas that of Wassermann (Selenium and Eosin) is described as being highly toxic. Other compounds of selenium and eosin, found by experiment to be toxic, were tried, but none of these had any selective action on the tumour cells.—C. E. Walker, L. i./i2,1337. Collosol Selenium effected diminution of pain when used intramuscularly and intravenously.—E. Watson-Williams, B.M.J. ii./io,463,516. Malignant disease treated by * Selenium.’ Large doses (5 Cc.) * spell disaster.’ Temporary improvement only can be expected.—A. S. Gillett and C. P. G. Wakeley, L. i./22,804; B.M.J.E. ii./22,15. Intravenous injections daily for 10 days of 5 to 10 Cc. of a 1 in 2,000 isotonic solution definitely and undoubtedly ameliorates patient’s condition and prolongs life in many cases of gastric cancer. Absolutely safe and no contraindications. Repeat treatment after interval of 10 days or a fortnight. Three courses may be given in 3 months, and possibly more, depending on progress of patient.—Stanley Wyard, Diseases of the Stomach, p. 358. Silver. manufacture.—Mix 250 Cc. of 30% Ferrous Sulphate Solution with a Solution of 140 Gm. Sodium Citrate in 250 Cc. of Water. Pour this mixture into 250 Cc. of 10% Silver Nitrate Solution with continual stirring. Wash by decanting with Sodium Citrate Solution 5%, dissolve precipitate in Water, and precipitate again with Sodium Citrate (twice), until it is practically free from Iron. In this manner a dark grey colloidal solution of strength 1% is prepared, which must contain protective Colloid. Finally adjust to the strength 1 in 2,000 for use. 4s an alternative it is stated that well washed Silver Oxide may be reduced by a rapidly stirred 60% Formalin.—A. Pickles, Chem. News, 1918,117,358. Y Hydrazine’Hydrate (1 in 2,000), Hydroxylamine Hydrochloride and Kvpo- phosphorous Acid have also been used to reduce silver. Physiological Report. Rabbit wt. 1-85 kg. injected intravenously, on successive days, with doses of 2 Cc., 3 Cc., 4 Cc., 5 Cc., 7-5 Cc., and 10 Cc. (all isotonised). Result.—Well tolerated except for slight dyspnoea after largest dose. Steruies of Colloidal Silver containing 5 Cc. of 1 m 2,000 boiution are prepared. May be isotonised with 1 Cc. of 5*5% Sodium Chloride Solution. . x . , . . Dose.—Suggested, 5 Cc. =0-0025 Gm. (* gram) intramuscularly or intravenously. . oa. Uses.—In gonorrhoea and cystitis cf. also Therapy, p. oo4> Collosol Argentum (l in 2,000). Dose.—Hypodermically 15 or 30 minims (1 or 2 Cc.). Per os—One drachm (3-5 Cc.) (on an empty stomach, as it inhibits digestion). Gargle.—-One part diluted with three of water (Dilution is necessary on account of frothing of Collosols.) YE , ' ... few drops instilled between the eyelids or as douche diluted with 3 times quantity of water. Locally.—Unailuted or diluted with to 4 parts of Saline Solution (1%), as a swab or lotion. It is chemically prepared. Precipitation by the blood does occur immediately on hypodermic or intravenous mjec ion. Uses —For septic wounds, and ulcers, gonorrhoea (et sequela), cystitis','dysentery, hemorrhoids, and nose ear eye. mouth and skin infections. Pyorrhoea alveolans has been treated byj toji minim injections into the sockets of the ee • P , ^ , treated by internal use. Whooping cough has been treated by SPSfel power. Destructive to typhoid organisms. After 2 Cc., fmnid in the cerebro-spinal fluid, venously in rabbits, the particles could be brain and urine. . _ frir 11C5p Pasta Collosol Argentum is also,mad? w been well "treated. Of the -ter or norma! saline. Sulphur. mwlescent Colloidal Sulphur Solution is manufacture.—A 1 m^1,000 guipiflde and Sodium Sulphite made by decomposition of a fixture of Sodmm bu i with acid in the presence of protectiv to wounds, burns, skin Sterules containing 2 Cc. of 1 in 1,000 solution isotonised at the time of use with 0-4 Cc. of 5-5% Saline. Dose suggested, 1 to 5 Cc. (=0-001 to0*005 Gm.). For use in skin affections and wherever Sulphur is indicated through excessive elimination. Sulphur Coilosol (1%). Dose.—Per os 2 to 4 drachms (8 to 15 Cc.) in a wineglass of water twice daily during or after principal meals. Subcutaneously or intravenously, 1 to 2 Cc. Uses.—Rheumatic and skin affections are relieved. For Injections in rheumatism, v. also Sulphur chapter. The “ Oscol ” (T.M. 305256) brand of Silver has been used in gonorrhoea, septic conditions of the nose, throat and ear, and in wounds, cystitis and acne. Oscol Mercury in syphilis and tonsillitis. Oscol Iodine in all cases where this halogen is indicated. Oscol Sulphur in rheumatic affections. Electrically Produced Colloids. General Directions.— In making these colloidal solutions electrically, by working from the main, our experience is that the intensity of current necessary is considerable—the ordinary wiring for lighting is not sufficient. Special wiring is required as in the case of a power circuit. With this latter, resistance can be introduced so as to adjust the intensity to about 8 amperes. The intensity necessary varies with the type of metal. Pure Distilled Water must be used and the electrodes must be so arranged as to produce a uniform arc beneath the surface. After sparking for sufficient time the solution is standardised. Copper.—We prefer the Chemical Method for this—q.v. Electrocuprol. Dose.—1 to 20 Cc. intravenouslv, isotonised with Saline. A brown solution described as a colloidal solution of Copper Oxide containing 0-15% Copper. Ampoules 5 and 10 Cc. are prepared. Uses.—In malignant disease and tuberculosis. Gold.—We have prepared Colloidal Gold Solution (1 in 4,000) electrically, as described under general directions, the product being bluish purple. The chemical method is better v. antea. *Orargol (T.M. 453759). Ampoules contain 5 Cc. for intramuscular or intravenous injection. A preparation of Colloidal Gold (0-01%) and Silver (0-09%). It is stated that if injected in time it will cut short a serious case of pneumonia, influenza, or erysipelas. Has also been used in bronchitis, endocarditis, and acute articular rheumatism. Encephalitis lethargica of severe type successfully treated by injections of Electro Colloidal Gold and Silver.—A. W. Fuller, L. ii./26,172. Iodine.—The following are available. (See also chemically produced.) Iodeol.—An electrically prepared Colloidal Oily Iodine Solution containing 0-2 Gm. of Iodine per tube of 1 Cc.—a dose by intramuscular injection. Has been used in pulmonary and rheumatic affections. It is stated that 10 minutes after “ application upon the skin ” Iodine can be found in the urine. Capsules containing 0-25 Gm. Iodine, and Ovules, are prepared. Iodargol is similar, containing 0-4 Gm. of Iodine per tube. Stated to be a non-toxic, painless solution for injection by means of an urethral syringe in gonorrhoea and allied infections. Silver.—A 1 in 2,000 solution can be made. The Chemical method is however preferable. Electrargol (T.M. 351388).—A reddish brown solution (‘ stabilised ’) containing 0*025% of Silver. Dose.—1 to 10 Cc. intramuscularly, after rendering isotonic with saline (supplied). Ampoules 5, 10 and 25 Cc. Uses.—In diseases of the genito-urinary organs and infective diseases in general. Intrapleural injections of 15 to 50 Cc. have been made in pleurisy, antiseptic Powers of Colloidals, see Vol. II., ‘ Colloidals.’ For a number of early Refs., see 17th Edn., p. 366, 18th, p. 366, et seq., and [LQth, p. 361, et seq. COLOCYNTHIDIS PULPA, Bitter Apple. Dose.—2 to 8 grains (0-12 to 0-5 Gm.). The dried pulp or pith of the fruit of Citrullus Coiocynthis (Cucur- bitacece) freed from the seeds. Has a markedly bitter taste, is free from starch, and contains only about 3% fixed oil or less (2% B.P. 14 and U.S. X.) whereas the seeds contain 15% or more. Is imported from Smyrna (the best) and Spain. According to U.S. X. must not contain more than 5% of seeds, nor more than 6% of acid- insoluble ash. P. Ital V. Syn. Coloquintide, Cocomero amaro. Antidot&s.—Spirit of Camphor 10 drops on sugar or in milk every £ hour, Laudanum 30 minims (by rectal injection if not able to swallow). Stimulants, demulcent drinks, apply warmth.- Murrell Colocynth Poisoning. A teaspoonful and a half proved fatal. Literature shows that nearly all cases where doses of 110 grams and over have been taken have ended fatally.—R. B. Poe, L. i./i3,io% . . Uses.—A drastic cathartic. A frequent ingredient m aperient pills. For formulse see Index, “ Pills.” Extractum Golocynthidis Compositum (B.P. 14). Dose.—2 to 8 grains (0-12 to 0-5 Gm.). , ... This is in powder form, made by extraction of Colocy^h nd^nmvdered Extract of Aloes, Scammony Resin, Curd Soap m powder and powcle Cardamom Seeds. , . . , -+Vl Extractum Colocynthidis. U.S. X. drerage rfose, 2 g^in. Diluted Alcohol, reducing the extract to powder and diluting with htarcn so that 1 of extract equals 4 of drug. Pitula Colocynthidis Composita (B.P. 14). Dose.—4 to 8 grains (0*2 to 0*5 CJm.). . p • Contains Colocynth Pulp, Aloes, Scammony Resin, Potass u Sulphate, and Oil of Cloves with Water q.s. . Pulvis pro Piiula Colocynthidis Composita consists of ^e^re- dients of the pill less the water. Is more convenient foi dispe g. Ce) Piiula Colocynthidis et Hyoscyami (B.P. 14). Dose.—4 to 8 grains (0*25 to 0*5 Gm.). . with Water a s Compound Colocynth Pill 2, Hyoscyamus Extract 1, witn Water q.s. This is a (B) Poison—cf. P.«J i./26,13, • (©Hamilton’s Pill. Compound Extract of Coloc3mth 2, Hyoscyamus Extract 13 Made into 4 grain pills. Stated to be less griping than the last. Tinctura Colocynthidis, P.G.VI. Dose.—3 to 15 minims (0-2 to 1 Cc.). (Maximum single dose 1 Gm. ; maximum daity dose 3*0 Gm.). Strength 1 in 10 alcohol (90% P. Ital. V. 1 in 10 using 80% alcohol. Colocynthin. C56H84023=1124-6552. The active principle, glucoside, of Colocynth in the form of an amorphous yellow powdezi Has been employed as a hypodermic purgative. Dose.—15 minims of a 1% solution in Glycerin, approximately ^gs It occurs to the extent of 0-6%. It readily reduces Fehling’s Solution. CONIUM. Hemlock. French—Cigue. German—Gefleckter Schierling. Both the dried unripe fruits and the fresh leaves and youn branches of Conium m-aculatum (Umbelliferce), collected when th fruit begins to form, were in B.P. ’98. Dose.—2 to 8 grains (0-12 to 0-5 Gm.). U.S. VIII. Standard 0*5% Conine. (Conium is now removed from U.S.P.) Fr. Cx.—Max: single dose 4 grains, max. during 24 hours 12 grains approximately. Conium fruit contains 0-36 to 0-91% of Conine. For further chemical details on Conium see Vol. II. WVi Coninae Hydrochioridum. Silky needles soluble 1 in 4 in water. FT] Coninse Hydrobromidum. Fr. Cx. Syn. Cicutinje Bromhy dras. F.E. VIII. C8H17N.HBr=20S*0644. Dose.—l grain, increased to 2 grains (0 02 to 0 12 Gm.) in pill F. E. specifies single dose 1/60 grain ©001 Gm.), during 24 hours, 1/12 tc 1/3 grain (0-005 to 0-02 Gm.). Colourless crystalline prisms soluble in water 1 in 2 approx. The Hydrobromide of the liquid alkaloid FjConine (a-n Propyl piperidine). Syn. Coniine, Cicutine C8H17N= 127T406. The base is soluble in Alcohol, Chloroform and Acetone and ir Water 1 in 80. Dose.—Similar to that of the salt. Incompatibility.—Conium preparations are incompatible with alkalies and preparations containing Tannin. ji ntidotes.—Stomach tube and emetic. Give Tannic Acid ana wash out the stomach again. Stimulants ; artificial respiration. Uses.—Conium and Conine Hydrobromide act as direct sedative? to the respiratory centre ; in poisonous doses death is caused by asphyxia. Employed with advantage in all spasmodic affections, especially for whooping-cough and asthma; in neuralgia, epilepsy, and as a sedative in acute mania. grain irs ODlnjectio Coninse Hydrobromidi Hypodermica. 1 20 minims. Dose.—1 to 3 minims (0-06 to 0*2 Cc.). ®Pessus Coninse. Conine 4 minim, Gelatin Mass 20 grains. Cp> Tinctura Conii. Dose.—J to 1 drachm (2 to 4 Cc.). We prepare this with Conium Fruit No. 40 powder, 1 in 5 of Alcohol 60% by percolation, and standardise to 0T% Conine. A quantity of Conium Truit was made into Tincture in the usual way. It was divided into two parts, one of which was labelled and set aside. All the alkaloids were removed from the other half and afterwards dissolved in slightly acidulated water, and the solution made up with Alcohol to volume. These preparations were examined by Wm. Findlay at Aberdeen University. There was not the slightest difference in effect between the two. The query is put as to whether the same would hold good for any of the other so-called alkaloidal drugs ? It is suggested to produce a series of colourless Tinctures of standard strengths, containing all the alkaloids in the proportions fixed by nature.—R. W right, P.J. i./26,256. Cp} Extraction Conii Liquidum, B.P.C. Dose.—5 to 15 minims (0-3 to 1 Cc.). Conium Fruit 100 in No. 40 powder is exhausted with alcohol 60% containing 1-25% of acetic acid (33%), the last portion of percolate concentrated and mixed with the first 85 previously set aside, so as to produce a Liquid Extract “ containing alkaloids equivalent to 1% of alkaloidal hydrochlorides.5’ qr>Extractum Conii, Fr. Cx. Extrait de Cigut, Dose.—Maximum single § grain (0-05 Gm.) approximately, but up to 2 grains are often given to our knowledge—as in Pil. Antim. Conii et Quininse. A firm Extract produced by extracting the powdered fruits with 70% alcohol at 35° C., evaporating the liquor and treating tne residual extract with water, evaporating the aqueous extractive, rejecting the portion not dissolved. We found an extract which we prepared to contain 2^% alkaloids. ® Unguentum Conii. , . T, n The author’s formula is as follows : Extract of Conium PR. Cx. a sufficiency to produce 0T% total alkaloids in the finished Oin - ment, the basis of which consists of Unguentum Lanolini. Gives relief in pruritus ani, and for painful fissures. GOTO CORTEX. Dose, in powder, 1 to 8 grains (0-06 to 0-5 Gm.) 4 to 6 times a day. s imported from Bolivia. Paracoto bark is exported m place f true Goto bark.—N.O. probably Laurinece. T 'Acc^rEufbL'frip'n-the Amazon basi^to determine the source^ !oto bark.—C. W. Mablethorpe, P.J. rlenish, ibid., 381. sveral species of Nectandra contain Cotou . •, V Dbthisis for J7«W.-For cholera, and especially tne diarrhmaot phthisis tor light sweats, and for gout and rheumatism. It is rich m fhich give it a pungent taste. Incompatible with Mistura Cretse. Ixtractum Coto Liquidum. 1 = 1 of bark. Dose.—2 to 6 minims (0*12 to 0-4 Cc.). Tinctura Goto, B.P.O. Coto Bark bruised 1, Alcohol (90%) q.s. to 10. Dose. 10 to 30 minims every 2 hours with mucilage and syrup. Mistura Anti-choleraica Royal Coll. Phys. Form II. Aromatic Sulphuric Acid 15 minims, Compound Tincture of Camphor 30 minims, Compound Tincture of Chloroform, Tincture of Coto, of each 20 minims, Syrup of Orange Flower 1 drachm, Peppermint Water to 1 ounce. pose.-— 1 ounce every 3 or 4 hours. This preparation has been found invaluable. Form I. will be found in the Xth Edition, p. 105. CE) Diarrhoea and Cholera Mixture. (Board of Health.) Aromatic Confection 9 grains, Aromatic Spirit of Ammonia 9 minims, Tincture of Catechu 3G minims, Compound Tincture of Cardamoms 18 minims, Tincture of Opium 3 minims, Chalk Mixture to 1 ounce ( = 1 dose). The following are also of benefit:— CE> Mistura Thielemani. Syn. TlNCTURA ANTICHOLERICA THXELE- mani. Thieleman’s Koleradraaber. Average Dose— 30 minims (1-8 Cc.). Dissolve Peppermint Oil 3 in Alcohol 22 and add to Sydenham’s Laudanum (Vinum Opii Crocatum q.v.) 10 Ipecacuanha Wine 25, Tincture of Valerian (1 in 5 of Dilute Alcohol) 40. CE) Tinctura Anticholerica Conradi.—Conrad’s KOLERADRAABER. Dose. Over 20 years, 40 drops ; over 5 years, 1 drop for each year. Must not be given to a child under 5 years. Tincture of Opium (B.P. ’98) 1, Tincture of Cascarilla and Camphorated Spirit of Ether of each 2, Bitter Tincture of Rhubarb 5. [Spiritus iEtheris Camphoratus is Camphor 3, Spirit of Ether (1 in 4) 17. Tinctura Rhei Amara is Rhubarb 10, Cardamoms 1, Gentian 4, Alcohol (70% by vol.) 100, all by weight.] CE> Guttae Inosemzowi. TlNCTURA ANTICHOLERICA InOSEMZOWI P. Bor. VII. :— Average dose.—30 minims (1-8 Cc.). Extract of Nux Vomica 1 Gm., Tincture of Opium 120 Grn., Alcoholic Tincture of Rhubarb 480 Gm., Tincture of Castoreum 20 Gm., Spirit of Ether 240 Gm., Ethereal Tincture of Valerian 240 Gm., Oil of Peppermint 5 Gm. Pulvis Cretae Compositus, U.S. X. Average dose.—30 grains (2 Gm.). Prepared Chalk 30, Acacia 20, Sugar 50. Cotoin.-Dose.—J to 2 grains (0-03 to 012 Gm.) every 2 or 3 hours in pill or diluted mucilage. 4 grains have been used in dysentery. A bitter principle, in yellow crystalline powder, slightly soluble in water, soluble in alcohol. Melting point, 130° C. The dust is irritating to the nostrils. ® CREOSOTUM. (B.P. ’14), U.S. X., P.G.V., P. Austr., P.Ital.V., P. Belg. IV., F.E. VIII., P. Helv., P. Dan., Fr. Cx. Syn. Kreosotum. Data are in Vol. II. Dose.—1 to 5 minims (0-06 to 0-3 Cc.), increased to 30 or even 60 minims, in capsules, or in cod liver, almond, or olive oil, or emulsified. Soluble in alcohol, chloroform, ether, glacial acetic acid, fats and oils, and 1 in about 150 of water. Creosote (B.P. ’14) is a mixture of phenols—chiefly guaiacol and creosol. The preparation is CE).—P.J. ii./3o,447. The variety most used is from Reechwood. It contains a large percentage of Guaiacol C6H4.OCH3.OH = 124-0974. It mixes clear with Glycerin. It is more soluble in water than the variety from Pinewood, which is anhydrous and mixes perfectly with oil of turpentine, consisting chiefly of creosol C6H3.CH3.OCH3.OH : 1, 3, 4= 138-078 homopyrocatechin-methyl-ether (Morson’s Creosote is representative of this class). Creosote does not cause collodion to gelatinise when mixed with it in equal proportion. Commercial Creosote used for timber preservation consists of Naphthalene oils—a mixture of the heavy oil from Coal Tar distilling at 230—270°, with the residues from the middle oil (170— 230°), after freeing from Phenols. For composition of and tests for Creosote, see Vol. II. Flavoring*—Emulsified, Glyl or Syl Pini excellent, Syl Lavandulae and Syl Amygdalae Amarae are also good ; Mistura Amygdalae Composita, or Essentia Menthae Piperitae. Uses,—Locally as a caustic. It is one of the most powerful deodorisers, antiputrescents, and antiseptics. It is used internally to correct fetor, given to check sickness, for diabetes, added to cod-liver oil for phthisis and applied externally in various skin diseases, and is put into the cavities of carious teeth. Checks gastric fermentation and is an intestinal antiseptic in some forms of diarrhoea. For irritable trachea and congested larynx, causing troublesome cough, the inhalation of creosote from an oro-nasal or 4 ozonic’ inhaler is useful. Hypodermically was administered in 10% solution in almond oil. Pneumonia and Influenza well treated, 10 minims gently rubbing into the right axilla with the finger repeated on the left axilla if required 10 minims at a time, also minim per os. Reduces temperature.—J. E. 13. Wells, 13.M. J. i./i9,481. Pneumonia.—After a wash-out enema, inject slowly well up the rectum 40 drops of pure Creosote shaken in 2 ounces warm milk ; retain for - hours. Repeat if not retained for more than 4 hour ; in adults add 10 drops 1 incture of Opium. Repeat enema twice in 24 hours. For children under 1 year grve 2-10 drops, and older children 5-10 drops,with extra drop tor each year. Almost specific in pneumoccocal conditions ; prophylactic in post-operative pulmonary complications and clears up catarrhal states prior to operation.—Ian Macdonald, B.M.J. ii./3i,llll. Value queried.—H. Sutherland, ibid., 1198. Two half drachms having been taken in error is recorded. Incompatible with silver oxide (7-^-)- Also with calcined magnesia and slaked lime. Aqua Creosoti. Syn. Liquor Creosoti. Average 2 drachms. Creosote 1 in 100 water freshly prepared. dose.— Elixir Creosoti.—Martindale. , . , , . . Dose.—1 to 2 drachms (4 to 8 Cc.) diluted at the time of a ung. Creosote 2 minims, Alcohol 90% 10 minims, Syrup o me (q.v.) and Simple Elixir, B.P.C., 1894, a.a. p-cteq. q.s. to - drachms. Haustus (Mistura) Creosoti (Vic. Park). Dose.—b to 1 ounce (15 to 30 Cc.). . . n A Creosote 3 to 30 minims. Alcohol 90% 15 minims, Compound Tincture of Gentian 15 minims. Liquid Extract of Lieonce 2 drachm, Water to 1 ounce. (If containing 15 minims . CeN) Mistura Creosoti et Potassii Xodidi. Dose.—J ounce (15 Cc.) every three hours until the temperature becomes normal. Creosote \ drachm, Potassium Iodide 1 drachm. Alcohol 2 drachms, Liquid Extract of Liquorice 3 drachms, Water to 6 ounces. Lobar Pneumonia.—The above dose is suitable for adults; for children proportionate quantity. The antiseptic action of Creosote limits the extension of the pneumonic process. The Potassium Iodide content, it is suggested, should be kept down. A dose of 2 to 3 grains with the Creosote 5 minims is a good expectorant, and depressant action is avoided.—M.D.' B.M. J. i./22,334. Mistura Creosoti Composita. Dose.—2 drachms every 4 hours for a child of 5 years. Creosote 32 minims, Calcium Carbonate (precipitated) 128 grains, Potassium Iodide 16 grains, Mucilage Tragacanth q.s., Saccharin 8 grains, Oil of Peppermint or Aniseed 5 minims, Water to 8 ounces. Tuberculous Peritonitis.—In two children, apparently hopeless cases, the above was useful. Petroleum Emulsion and Cod Liver Oil as further treatment. Abdominal tumours diminished and general health improved. Remarkable recoveries. The mixture has also been found very beneficial in phthisis.—H. Lawrie, B.M.J. ii./13,1433. Oleum Morrhuae cum Creosote. Dose.—1 to 4 drachms (4 to 15 Cc.). Contains 14%. In ulcerative colitis, Creosote 3 minims, with Cod Liver Oil 1 drachm thrice daily—Castor Oil having been previously given— increased by 1 drachm daily, until on the 4th day 12 minims with 4 ounce respectively are taken combined. Has proved useful. CE) Perles of Creosote. 1 or 3 minims in each, with oil, also Capsules, 3 and 5 minims, or more, with oil. CE) Creocarb Capsules. Contain Beechwood Creosote 3 minims and Phenol J gr. In the treatment of phthisis. Pilula Creosoti.—Martindale. Dose.—2 to 6 grains (0-12 to 0-4 Gm.). Creosote 1, Curd Soap, in powder, 1. Digested on a water-bath in a wide-mouthed stoppered bottle. As prophylactic against dysentery, e.g., by soldiers on the march. To make a pill containing Creosote 2 minims and Phenol 1 grain, use White Wax 24 grains and Powdered Liquorice 1 grain. Incorporate the Phenol, Creosote and Wax with the powder gently and quickly.—P. Boa. Spiritus Creosoti. Dose.—1 drachm. Creosote 1, Alcohol 90% 40. Lessens cough and expectoration in chronic bronchitis and phthisis. Petrolatum Creosoti.—Martindale. 1 of Creosote in 10, employing “ High Melting ’* Soft Paraffin. Unguentum Creosoti. Creosote G drachms, Yellow Wax 180 grains. Melt, and stir till cold. Used in psoriasis. Caution.—Should not be applied to the abdomen, face, or flexor surfaces of the limbs. CE) Vapor Creosoti, T.H. Creosote 80 minims, French Chalk 30 grains, Water to 1 ounce C.L.T.E. has Creosote 40 minims, Light Magnesium Carbonate 20 grains, Water to 1 ounce. A teaspoonful (C.L.T.E. a tablespoonful) in a pint of water at ■'I J CREOSOTUM. 379 40° F. Useful in chronic congestion of the larynx and trachea, Ind in ozoena, fetor of breath and syphilitic throats. Abscess of lung. Creosote is given internally in doses up to £ irachm, together with inhalations of Creosote and Iodine. For phthisis, it is more sedative in its action if mixed with an equal volume of spirit of chloroform, 5 to 20 minims employed at one time. ©Vapor Creosoti Compositus (Syn. Iniialatio Iodi Composita L.H., Vapor Acini Carbolici Compositus in earlier Edition). Creosote 2, Carbolic Acid 2, Iodine Tincture 1, Spirit of Ether 1, Spirit of Chloroform 2. For early pulmonary tuberculosis by inhalation from a “ Burney Sfeo ” inhaler. It must be continuous and in operation the whole of the 24 hours, excepting meal times. Six to 8 drops are used on the sponge of the inhaler every hour during the day, and two to three himes during the night if awake. Non-irritating, beneficial and does rot cause haemoptysis. Allays pyrexia and cough. The antiseptics make their way into the pulmonary alveoli and the slow ©sorption of the anaesthetic solvents in a dilute condition carry with them ,he antiseptics into the blood and by the blopd stream to the tuberculous oci The Alcohol must be considered as tonic and stimulating as also tne Ether. The Chloroform is locally sedative and reduces cough. Guaiacol, Phenol and Spirit of Chloroform, adding Turpentine wnen necessary, have also been used. ©}Vapor Chloroform! Compositus. L.H. Chloroform 10 minims, Liquid Phenol 25 minims, Alcohol 90% 50 minims, Glycerin 35 minims. Quantity for one inhalation : 60 minims, to be added u a quart jug half full of boiling water for inhalation. SS “ms?PineCSu?iSdrachtns, Spirit of Chloroform 14 drachms Menthol 10 grains (or less), Cinnamon Oil 5 minims. This combination used rna Yeos respirator is not unpleasant The inhalatiorihaseffect m ■educing cough—a matter of the utmost importance it rests the larynx. Dundas Grant.—L. i./n,262. , Note.—Sir Dundas Grant now uses 3 drachms of creosote. TDSolutio Creosoti Composita (was in Brompton H.) , Creosote 1, Spirit of Menthol (20%) 1, Spirit of Chloroform 1, for inhalation. [orson’s Soluble Kreosote. Dose.—Up to 15 grains (1 Gm.) thrice daily. A light brown powder, consisting of the Potassium salts of Sul- honated fractions from Beechwood Kreosote. It contains approx. )% of total Kreosol and Guaiacol Oils. This new preparation is iluble in water with slight flavour and agreeable after-tas.e. I or ronchial affections it is equal to Kreosote. Creosote Carbonate.—Syn. ©©©V TAvm 2p' Bclt^V 5074/I8OO Expired. U.S. X., Ph. Ned. V., F.E. VIII., P. Belg. 11 . Dose.—5 to 20 minims (0-3 to 1-2 Cc.) or considerably increased. A light-brown nearly odourless liquid, Sp. Gr. 1-165, insoluble m ater, soluble in oils. Capsoies contain 5 and 10 minims. It contains the carbonates of guaiacol and creos°!; ,, i tuberculosis, bronchitis, and pneumonia, > “ P ikaline intestinal juices. Manufacture,.—Pass a sufficiency of Carbonyl Chloride into a solutio of Beech Creosote 124 in Sodium Hydroxide 40 in concentrated aqueou. solution. The liquor separating is washed with weak alkali and water. Pneumonia treated by Creosote Carbonate 15 m. every 3 or 4 hours. Guaiacc Carbonate 5 grains better where tubercle suspected.—A. Fletcher. Drugs such as Guaiacol, Creosote, and essential oils are partly excreted h? the lungs, but it is very doubtful whether the small amount so excreted car produce much effect, and the sputum is certainly not rendered less virulen when injected into animals.—Dixon, p. 239. Creosote Valerianate.—Syn. Eosote. Dose.—5 to 10 minims (0-3 to 0-6 Cc.). Capsules 8 minims An oily liquid, soluble in alcohol, glycerin and ether; check gastric fermentation and used for phthisis epidermically. Is not s« toxic or corrosive as creosote. Proposote. Syn. Creosote Phenyl-propionate. Dose.—10 minims (0-6 Cc.). Administered shortly after meals, it passes through the stomach withou causing irritation. The creosote is liberated in the intestine. Useful in tuberculosis and bronchial affections, also in intestinal bacterial infections. Capsule contain 10 minims (equivalent to 5 minims of creosote). For Guaiacol and Compounds, see p. 444. CUPREJE CORTEX. Cupreine, an alkaloid, occurs with Quinine in Cuprea Bark Remijia pedunculata and other species. It is allied to Quinine. Its salts have been similarly employed It can be converted into Quinine by treating with Sodium in Methy Alcohol Solution and heating the Solution with Methyl Iodide. Several Cupreine derivatives have been used :— Quinine (Syn. Methyl Cupreine) is C30H2iN2Os = 324'2032. Cupreine is Ci<,H22X3Oa = 310-1870. Hydrocupreine is Ct<*H,4N2Oa = 312-2032. Methyl Hydrocupreine (Syn. Hydroquinine) is C20H2RN2O2 = 326-2188. Ethyl Hydrocupreine (Syn. Optochin) C£1H28N-*02 = 340-2354. Methyl-Hydrocupreine Hydrochloride. Syn. Hydroquinink Hydrochloride, C20H26N2O2.HC1.2H2O —398-7148. Dose.—Intravenously 4 to 12 grains (0-25—0-8 Gm.) for adults— for malaria and trypanosomiasis. For whooping cough in young, children up to 0 months, I to § grain (0-02—0-05 Gm.), 6 to 12 months,. II grains (0-1 Gm.), from 2 to 14 years, II to 8 grains (0-1 to 0-5 Gm.) intramuscularly. When heated with strong Hydrochloric Acid it loses a Methyl group and is converted into Hydrocupreine, C19H24N202. Soluble*—1 in 8 of water (by our experiments). Ethyl-Kydrocupreine. Syn ^Optochin Base (T.M. 356220). Numoquin. C21H28N2O2=340-2344. Dose.—3 to 4 grains (0-2 to 0-25 Gm.). Max. dose during the day 15 grains (1 Gm.). Not to be given on empty stomach. A whitish amorphous powder with bitter taste. Almost insoluble- in water, soluble in alcohol, ether, chloroform and dilute acids. Uses,—In pneumonia treatment should be begun immediately on diagnosis. It has also been used in malaria. The bacteria in pneumonia are destroyed by Ethyl-hydrocupreine and even the blood drawn from patients so dosed will destroy pneumococci our only instance of specific drug therapy in acute general bacterial disease.—Prof. W. E. Dixon, B.M.J. ii./22,410. in treatment of pneumonia visual disturbances can be safely avoided if OptochinBase is administered in single doses of not more than 3 grains (0-2 Gm.) every four hours, day and night: the drug should not be administered longer than for three days, so that a total day’s dose of 18 grains (1-2 Gm.), and a total dose for the whole period of 54 grains (3-6 Gm.) should not be exceeded. A regular milk diet should accompany the medication. If the slightest visual disturbance occur, Optochin should at once be stopped. For children the dose of the base should be much less—at least a quarter or half the above figures. Unguentum Ethyl-Hydrocupreine 1% in White Soft Paraffin must be freshly made. Efficiency decreases in 3 to 4 days. Used in pneumococcal I and gonorrhoeal eye affections. Vide infra. The action of the compound on the pneumococcus and of ^cVuzin (T.M. 412133) (Iso-octyl Hydrocupreine) on B. diphtherioe is absolutely specific, i and enough can be given by medicinal doses to clear the blood of these micro- , organisms.—W. E. Dixon, B.M.J. i./25,814. Amaurosis following ingestion of a total of 58 grains Ethylhydrocupreine : over 3 days.—B. Alvis, Jl.A.M.A. ii./29,1253. Ethyl-Hydrocupreine Hydrochloride. Syn. ^Optochin (T.M. 356220) Hydrochloride, Ph. Ned. V., C21H28N2G2HCl=376-6992. Dose.—3 to 4 grains (0-2 to 0-25 Gm.). This close should be given with caution. The base {anted) should be employed in pneumonia. The hydrochloride may cause grave visual disturbances. A white crystalline powder soluble in water about 1 in 4. Uses*—Though given internally in some cases (it has been proved effectual in treatment as a prophylactic of common colds), it is mostly used locally in solution 1 or 2% in eye affections. Its use is at first painful. Ulcus cornese serpens has been treated with a 1% Ointment (made with the base) or a 1% or 2% Solution. A pad of sterile woo] or gauze is soaked in the solution and then left on the ulcer for 5 or 10 minutes. After this the 1% solution is instilled' into the eye every hour or so during the day or the ointment applied 5 to 6 times per diem. Note.—Solutions should be freshly prepared. They decrease in efficiency after 3 or 4 days. In conjunctivitis gonorrhoica, and photophobia accompanying eczema tic conjunctivitis, scrofuiar ophthalmia, and keratitis has also proved useful. Pneumococcal meningitis treated by 4 grain intraspinal doses together with anti-pneumococcic serum. One case, with Optochin alone, did not respond favourably—referred to by C. Worster-Drought, M.P.C. June 14/22,ol4. Inhibits pneumococcus in dilution 1 in 1,000,000. G. 1. Langley, L. w 24, • CUPRUM. Cu = 63-57. Copper in Chemistry . anti Process of Extraction, and Purification. G. M. Dyson, .« . n-/3 * 31,76. Medicinal preparations.—ibid. 122. Antidotes to Copper Saits.—Stomach-pump, emetics, whue of egg and milk. Hot fomentations to the stomach, barley water, morphine or laudanum to relieve pain. Colloidal Copper-see Colloidal Metals. Incompatibles with Copper Salts.—Alkalis and alkaline carbonates, also preparations containing tannm ana iodides. € Adjm/stnt to Iron in Anc&micim Ir is claimed that small amounts of Copper Salts assist effect.—See Ferrum. Cupri Acetas Neutralis. (CH3COO)2 Cu, H20=199-6324. Dose.—jV to h grain (0-005 to 0-03 Gm.). Dark green crystals. Applied to ulcers acts as a stimulating caustic. Soluble 1 in 15 approximately of water; only slightly in alcohol. In tuberculosis has been given with Sodium Phosphate 1 grain, Tragacanth Mucilage 4 ounce, or as Pilula Cupri Acetatis, ^ grain in each with Sodium Phosphate 1 grain, Liquorice Powder and Glycerin q.s. The fatal dose per os is said to be 154—184 grains, and 154 to 308 grains of the Sulphate. Cupri Subacetas, Syn. Verdigiis, Aerugo. Is usually of indefinite composition, principally [(C2H302)2Cu+ Cu0-r6H20] = 369-2804, and only partly soluble in water. Occurs in greenish partly crystalline powder. Linimentum TEruginis. i'h. Lond. A decoction of verdigris, vinegar and honey, employed in veterinary work. Cupri Citras. C6H4Cu2O7+2JH2Or360-2102. Greenish powder slightly soluble in water. Unguentum Cupri Citratis. Syn. 4 Cuprung,’ is supplied 5, 10, 15, 20 and 25% strength for use to ulcerations and granulations on the eye-lids. R.O.H. has 5% approx. C.X. 4J% approx. Leprosy.—Copper Citrate, dose 14 grains for an adult intravenously. It is readily made soluble in small bulk by 4 grains oi bodium Citrate.— F. J. Palmer, B.M.J. i./25,8S4 ; ii./25,96. Is supplied commercially as ‘precipitated by adding Caustic Alkali to Cupric Sulphate solution, washing and drying, also ‘ granulated oy heating to partially fuse. Cupri Sulphas. CuS04, 5H2O=249*70S. Average Dose.—J to b grain (0-016 to 0-03 Gm.) ; as astringent ] to 2 grains (0-016 to 0-12 Gm.); as emetic 5 to 10 grains (B.P. ’14). Blue Crystals. Soluble in water 1 in 3|, in glycerin 1 in 2 (but may crystallise out again) ; insoluble in alcohol. Uses._Given internally in very small doses for severe diarrhoea and cholera, usually combined with opium (usually J grain of each), and has been tried as rectal injection also for internal haemorrhage and intestinal ulcers. Ranid Emetic for narcotic poisoning, three or four grains in water every few minutes until vomiting occurs. Also suitable for acute phosphorus poisoning. Locally in eye affections (trachoma) as stimulant, and for gleet. Membranous colitis in children has been treated bv injection of solution of 4 grains to the ounce with a little opium added. In dry skin affections, and in tubercular tendencies, TV grain doses thrice daily, appear to act like arsenic, and are better tolerated. In pyorrhoea alveolaris the gums are ‘ packed ’ with copper sulphate and the patient directed to swab the gum with saturated solution of tannin in Eau de Cologne; the tartar is frequently removed.—Smale and Colyer. Erosion in chronic endometritis has been treated by scarification and bathing with 7 % copper sulphate solution. Actinomycosis and blastomycosis have been treated by internal administration and irrigation with 1% solution. In syphilis, treatment with copper sulphate and potassium iodide may prove useful. Actinomycosis. Treated by injection of 1% Copper Sulphate Solution every few days until softening of the infiltration occurs. For small lesions a few Cc. If extensive, the first injections are given under anaesthetic. Abscesses are opened and scraped and 40 to 100 Cc. of i to £% injected. Destruction of the fungus claimed.—B.M.J.E. ii./a2,42. Trachoma well treated with subconjunctival injections of a 1% solution Copper Sulphate with 4% Procain.—Per Jl. A.M.A. ii./25,1923. Cancer of the Uterus.—After curetting, Copper Sulphate 10% solution used as paint, and when the ulcer becomes callous a series of injections of I Colloidal Copper. Then Radium Radiation.—S. Forsdike, B.M.J. ii./25,839. Fistulas, both tuberculous and osteomyelitic, well treated with injections ' of 2 to 3 Cc. 10% solution.-—Jl.A.M.A. ii./26,714. Ionisation of copper, vide Iontophoresis, Vol. II. Guttee Gupri Sulphatis, R.O.H. 1 or 2 grains to the ounce. Suitable as a lotion for gleet. For styes epilate the lashes affected and : use 1 in 100 lotion ten to thirty times a day. The lashes grow again. Oopper Points in holders, are useful for eye and intra-uterine medication. Alibour Water. Copper Sulphate 21- drachms, Zinc Sulphate 9 drachms, Camphor i drachm, Powdered Saffron £ drachm, Water 40 ounces. This formula is approximately equivalent to Eau d’ Alibour Forte of Fr. Cx. Nouv. Supp., ’26, and with Syn. Aqua Cuprozincica (Eau Cuprozincique), P. Belg. IV. It must be diluted for use with five or six times its volume of water, as a wet dressing in eczema. Eau d’Alibour of the St. Louis Hospital, Paris. Copper Sulphate 4 grains , Zinc Sulphate 6 grains, Camph or Water to 1 ounce. Sycosis barbae well treated. At first apply at night only and a Calauame Lotion during the day.—J. T. Ingram, B.M.J. ii./29,620 ; P.J. n-/29> 397. Ammonio-Cupri Sulphas. Syn. Cupkammonitjm Sulphate, CuS04.4NH3.H,0=245-778. J90SC._110 H grains (0 03 to 0-1 Gm.), with Laudanum after meals. Blue crystals soluble in water. Used in nervous affections Lethal dose stated to be equivalent to 0-05 Gm. of Copper per xilo - » • tried in cancer. Cupri CTiloridum, Cupric Chloride CuC12+2H20=170-516. Dose.—I to 2 grains (0-016 to 0-12 Gm.).^ Lse similar to Coppe Sulphate. Greenish very deliquescent crystals. Lapis Divinus. Cuprum Aluminatum P.G. VI. Qnmhntp 16 Potash Alum powdered 16 are mixed with powdere VV riorcelain dish. &pht S KIfum 1 are then'adde'd and the mass moulded or poured 011 ApladdVatphor 1 to 10, each of the other ingredientsf^h ‘Brass Paste.’ Formed by combining Basic Copper Sulphate 8S with Basic Zinc Sulnhate 14. Tuberculosis, Cutaneous and other forms. Application to the conjunctiva of the everted eyelid resulted in the removal of all tuberculous tissue in a case of 20 years’ duration. A fluid preparation “ Brass Oil ” or “ Bro ” applied on gauze also used.. Further, Picric Brass Paste containing 1% of Picric Acid found more penetrating.—H. A. Ellis, L. i./1g,415- Copper Alanine, Syn. Copper Amino-propionate (CH3.XH2.CH.COO) 2 Cu = 239-796. B. typhosus and colon organisms are less resistant than B.. tuberculosis to Copper salts. As Copper salts have a low toxic value in man especialiy when given per os, inorganic salts of Copper might be more widely used as bactericides. They exhibit a specially high toxicity toward protozoa and might possibly be useful in combating dysentery. Copper Alanine is soluble in blood serum—a matter of importance. It does not precipitate egg white, milk or solutions of caseinogen. Dose of 0-00013 Gm. produced no effect in mice. 3 Cc. of 1 in 300 solution tolerated by rabbits. 2 Cc. of this strength (commencing with 1 Cc.) have been given in inoperable cancer of the breast, without local or general inconvenience. Various low animal organisms were experimented on. Haematococcus which lies on the border between animal and vegetable kingdoms, lethal effect was. seen in 20 minutes with solution of strength 1 in 50,000 and 1 in 100,000* Copper Alanine. Paramoecium was killed with 1 in 100,000 in 13 minutes. Strong effects also observed on amoebae.—J. A. Shaw-Mackenzie, Med. Press,, July 19, 1916. See also Proc. Phys. Soc., Jany. 27, 19x7, Jl- Physiology, Vol. LI. and B.M.J. i./2o,104,174. Copper Sodium Tartrate. A blue crystalline powder containing 15-75% metallic Copper. It has the advantage of being soluble in water to the extent of about 1 in 2. Suggested in protozoal diseases.—W. H. M., 1923. Syphilis. A combination of Copper and Sodium Thiosulphate (Cu- Devenan) of value in syphilis. Spiricidal action considerable, with clearing: up of rash and gummata, but effect on Wassermann reaction very slight. Well tolerated.—B.M.J.E. i./29,102. [j?il Cuprocyan. A double Cyanide of Copper and Potassium, soluble in water and Alcohol.. Contains 22-26% Copper. Can be injected intravenously, hypodermically or intramuscularly. The compound is administered in 2% solution. Hypodermically or intramuscularly 2 Cc. every other day ; intravenously beginning with 5 Cc., then 74 Cc., and Anally 10 Cc., at intervals of 7 days—intravenous injections well tolerated. Intramuscular injections may cause a general reaction. Treatment can be prolonged without inconvenience for many months, but should be suspended occasionally. Good results obtained in tuberculosis and leprosy.—Jl. Trop. Med., Dec. 1/24,316 ; L. ii./2i,1018. Copper salts in pulmonary tuberculosis. Improvement in somo cases.— C. Riviere, B.M.J. i./26,773. DECOCTA. Decoctions of drugs are usually prepared 5% (unless otherwise stated) by boiling the drug in coarse powder with distilled water for 10 minutes and straining. If necessary a few drops of Chloroform will preserve fresh decoctions for a reasonable period of time. For various decocta consult index. The strengths of decoctions of powerful substances should be specified by the physician. Decocta Concentrata are prepared commercially as a genera rule ‘1 to 7.’ They should contain at least 20% Alcohol—as e preservative. Fresh decoctions are preferable. ® DIGITALIS FOLIA. Dose.—\ to 2 grains (0-03 to 0*12 Gm.). Cx* Maximum single dose 3 grains, maximum during 24 hours 15 grains approx. The dried leaves of Digitalis purpurea (Scrophulariacecc) or foxglove collected from plants commencing to flower. Powdered drug (leaf of the second year) to be used entire.—F.I._ (B.P214), P. Belg. IV. and Fr. Cx. adopted. Ph. Ned. V. specifies drying at 55 to 60° C. F.G. VI. requires the leaf in coarse powder in sealed containers to have ‘ official prescribed activity determined by physiological assay—method and data to be supplied later.’ F.E. VIII. Syn. Hoja de Digital, collected in Spain (dried at 55-60°C.) and P. Belg. IV. have Assay Method based on the International Standard Digitalis. P. Ital. V. specifiesc growing wild in Sardinia and Corsica and cultivated ’ and excludes Borago officinalis, Symphitum officinale and Verbascum Tkapsus leaves and has a qualitative test for Digitoxin. Bnternationai StamdczrcS Digitalis Powder and the Assay of Digitalis and its preparations both chemically and physiologically is fully dealt with in Vol. II. q.v. A method of estimating the potency and probable therapeutic dosage by determination of the minimum emetic dose in pigeons. The efficiency of the method was corroborated on human subjects.—P. J. Hanzlik and A. B. Stock- ton, Jl. Ph. & Exp, Ther., April,’29,363-407 ; see also ibid. Sept.*29,67. The International Conference on Biological Standards (July, 1923), fixed on a preparation of dried leaves as best; it contains ail the active principles. In 95% of cases a total dose of 1*5 Gm. per 100 lb., during some days, produced definite therapeutic effect.—B.M. J. i./24,715. Digitalis leaves, we found, should be collected from plants grown in a iry, sunny situation—preferably after a spell of dry weather. These leaves are more active, weight for weight, than the larger leaves of plants cultivated in the shade. The effect of increased sunlight in content of active principles has been noted in other drugs, e.g., Belladonna.—See “Digitalis Assay’’ by W. H. Martindale (H. K. Lewis). For Digitalis Seeds see Vol. II. Digitalis Leaf Tablets are made containing \ grain (0-03 Gm.) )f the same strength as International Digitalis and equivalent to me third of an International Unit. Dried leaf preferred. As vasomotor adjuvants, Papaverine and Quinine are ;ood; both have marked dilator action on peripheral circulation. E. 1. Venckebach, B.M. J. i./3o,181. The biochemical action of Digitalis.—Max Cloetta, Jl. A.M.A. ii./29,146‘2. Uses.—Digitalis is a valuable heart tonic and stimulant diuretic. Digitalis has a narrowing influence upon the arteries. Acting >n the vagus it pulls the reins of the heart. Acting on the heart uuscle it is a most useful whip, at the same time providing it wi 1 ood by improving the circulation. Slowing the heart, it ma es 1 egular also. This slowing gives the heart an opportunity o res mg, 0 secondarily improving contractility, conductivity an exci a u it} . Jy primary action it increases its strength, regulates i s r y 1m v epressing excitability and conductivity. In large ^oses i may icrease excitability causing extra-systoles, perhaps aimims 1 con- A tractility and by causing long pauses do harm to the circulation. AlH these influences vary according to dose, form in which it is given and the conditions of the heart. It may be tried with success in every case where the condition of the heart is the cause of a bad circular tion or troublesome symptoms. In doubtful cases give small doses It should be given a fair trial in every case—especially in the form of powdered leaves. The amount of the drug requisite to produce the first physiologica effect is noted, and the quantity that maintains the heart in th? condition best fitted to carry on the circulation efficiently. It may be that a given amount slows the pulse from 100 to 60 beats pe: minute, and coincident with the slowing there is improvement in patient’s condition. If pushed further there may be still furthe slowing, but there may be untoward effects—thumping of the heart breathlessness, etc.,—the dose is gradually reduced to a point U maintain the greatest comfort.—J. Mackenzie, B.M.J. ii./io,160G H. H. Turnbull reported that giving 15 minims 4 times daily li was found that the average quantity taken before symptoms wer produced was about 6 drachms. If rapid action was desired, larg doses, up to 2 drachms of Tincture per diem, were given and with this sickness (sign of full dose) and beneficial cardiac effects can be prc duced in 36 to 48 hours. If only 1 drachm per diem be given, a perio of 4 to 8 days is usually required to produce satisfactory result. X danger in pushing the drug if type of case is taken into consideratio and result watched. In most cases the nausea was the limit sig and the only cases likely to show bad effects are those with damage auriculo-ventricular bundle in whom heart-block may result. Raise blood pressure is no contraindication to the use of Digitalis, and i often due to some secondary effect of the heart failure. The Choice oe a Diuretic.—Digitalis when given in suitable cases is a saf and efficient promoter of diuresis, but the kidneys must be capable of respondin to its action which is by causing contraction of peripheral blood vessels—thou of the kidney excepted—and increasing the force of the cardiac systole. I; therefore raises blood pressure and forces more blood through the kidneys. I renal disease, however, the blood pressure is often raised already, and to rais^ it still further is to force upon diseased organs, which are already greatl overtasked, an amount of additional work, which, in their crippled state, the cannot perform. Other drugs belonging to this group are Strophanthus, Conva laria, Strychnine and Squill. Digitalis, being a cumulative drug, if continue too long without a pause, when used as a diuretic, even in moderate dose, ma begin to produce signs of depression.—Eustace Smith, B.M.J. i./n,289, et spy The Effects cf Digitalis. Digitalis is unique in Medicine. There is hardly any other condition i which by continuous drug treatment alone a patient may be helped fron complete inactivity to a useful and even active life for many years.—M. Camp: bell, Pr. Jan.’31,38. Considerable delay occurs before Digitalis (and Colchicum) produce the effect even after absorption. It is not perhaps until several hours after intrc duction of the first dose that the patient is under the maximum influence, Th is the reason why the treatment of pneumonia by cardiac tonics is commence early to assist heart’s action in event of it beginning to fail.—P.J. ii./n,15. Auricular, Fibrillation responded well unless pyrexia was presen or unless tlwre were marked fibrotic changes in the heart muscle. Case without auricular fibrillation rarely showed marked improvement. 1 to drachm doses of the Tincture given daily until some definite effect obtained 387 Contrary to general belief, Digitalis does not raise blood pressure by constricting che peripheral vessels and there is no risk in giving it to those suffering from degeneration of the blood-vessel walls. There is no difference betweeS Digitalis, Squill and fetrophanthus in the action on the heart, but the last two showed variation in regard to dose. Aconite had no effect upon the ■ pulse rate. I. W. I rice, B.M.J. i./i 3,484, and earlier refs Digitalis in non-valvular heart disease. Digitalis is more certain than Strophanthns or Squills. Tinctures should be dispensed as such or onlv with alcoholic preparations. J The action of Digitalis is slow—rarely is any distinct change seen before four days. For more rapid effect Strophanthin intravenously *1* to grain.—Cushny, B.M.J. ii.,/12,685 et seq. y Yo° To° Emetic Action of Digitalis. It is impossible to regard Digitalis as emetic by irritation of the gastric mucosa—vomiting caused by stimulation of the “vomiting centre” m the medulla. If clinical experience should confirm this, vomiting after Digitalis will be regarded not so much as a check to the further use of Digitalis, but as an indication that the drug has been absorbed. —L. ii./i3,1014. Withering (1775) advocated the use of Digitalis as having a power over the motion of the heart. It was to be continued ‘ until it either acts on the [kidneys, the stomach, the pulse or the bowels.’ Atropine largely fulfils the want of a remedy (absent at that time) ‘ to counteract the effects of Digitalis if inadvertently the doses be presented too largely, too rapidly or urged to too great a length.’ Digitalis cannot influence heart-rate in presence of febrile stimulation. It has found its greatest successes in uncomplicated [mitral regurgitation associated with the general evidence of cardiac failure. Further Reports on Use of Digitalis. James Mackenzie in the issue of ‘ Heart,’ dated Aug. 31, 1911, recorded results in 40 cases. Of these 20 had mitral stenosis, one was described as ‘ mitral,’ 10 as ‘ mitral and aortic ’ disease, two as ‘ aortic ’ and the rest a [group containing cases of paroxysmal tachycardia, bradycardia and emphysema. Ten of the mitral stenotic cases responded well to the drug, 8 did not. Of the mitral and aortic cases only one responded; neither of the two ‘ aortic ’ oases was notably affected, while in the miscellaneous group 4 improved and 3 did not. The general conclusion was that ‘ cases of auricular fi for s Ha.tsan are more readily and markedly affected than cases with norma! rhythm/—i.e., the form of irregular heart usually associated with mitral disease, especially in younger subjects who have suffered from rheumatic fever, and in whom the cardiac muscle is fairly sound, respond most easily to the drug. It is thought that the diuretic effects of Digitalis may be observed without any perceptible change in the heart. The Tincture was mostly used in dose of 15 or 20 minims three or four times a day ‘ until some definite reaction was obtained.’ Aconite, long regarded as a retardant of cardiac action was quite inert in medicinal doses. Strophanthus though acting well in regulating irregular hearts was never seen to succeed when Digitalis had failed. Atropine was potent in accelerating some hearts retarded by the action of Digitalis.—L. ii./11,956 ; see also B.M.J. ii./i i,S69. Auricular Fibrillation in Pregnancy.—Patient had an intolerance to Digitalis. Vomiting was caused by it, but she became more tolerant to it, and on one occasion took 11 drachms before feeling sick. On several occasions when the heart was beginning to fail it could be definitely ascertained that the amount of urine was decreasing. Under Digitalis the amount increased—sometimes to as much as 90 ounces. In this case the effect of Digitalis was to slow the pulse, improve the pulmonary condition and sometimes to promote diuresis. Digitalis was given just before the child was born—which occurred after the full effect of the drug was established. C. H. Miller, L. ii./i2,1218. . . ... Aortic Incompetence.—Digitalis is not advised. Success with .[Nitroglycerin. G. Evans records, however, improvement from it, with increase in urine elimination.—L. ii./16,249. _ . . . Digitalis and Atropine. Action on the peripheral circulation. 1. Hams, L.i./2i,1072. " , A Digitalis requires at least G hours for complete absorption ifter oral administration and is destroyed or eliminated very slowly, so that I repeated doses are given at about six-hourly intervals it may be stopped at list sign of intoxication when there is little of it to be further absorbed and no chance of severe toxic effect. Thus the maximum benefit is obtainec some days after the commencement. Digitalis was given by the * Ramc:\ Method ’ with doses of li drachms, 1 drachm and \ drachm of the tincture at intervals of 6 hours. In auricular fibrillation with rapid ventriculaa rates and urgent symptoms, prompt slowing and clinical improvement resulted Cases with normal rhythm are not suited for the method.—F. R. Fraser L. ii./22,703. Professor Fraser’s method of producing rapid effect by oral use of digitalin was described as far back as 1875 by G. W. Balfour.—Harrington Sainsbury L. ii./22,885. Auricular Flutter.—Bv pushing treatment a flutter can be converter into fibrillation, which may be replaced by normal rhythm on discontinuing drug. Flutter may persist for years, but when ventricular rate is controlled by Digitalis little additional burden appears to be placed on the heart.— J. C. Bramwell, L. i./2 5,1044. Remarkable uniformity in reaction of cases of auricular fibrillation treated with Digitalis.—A. It. Gilchrist and D. M. Lvon, Jl. Ph. & Exp. Ther., Aug. ’27,319. 54 cases of auricular fibrillation treated with 0T Cc. of Tincture per lb weight, with Sodium Bicarbonate, Aromatic Spirits of Ammonia, and Chloro form Water to 3 ounces. The average dose was 13 Cc., and the averagej pulse before use was 140 and 8 hours after was 91. Toxic effects occurred once and vomiting twice, and the average duration of good effect was 6 days so that small doses were needed at the end of a week. The method is a# measure of urgency only.—G. J. Langley, B.M. J. b/27,1043,1162. Bright’s Disease.—In certain cases when dyspnoea is present the symptoms may be combated with Digitalis, or Ether, by stimulants, and by j expectorants.—Tirard, Clin. Jl., April 5/ii,401. Cardiac Failure.—Digitalis must be pushed to full legitimate limit When it is consequent on fibrillation, digitalis gives its dramatic results. Strychnine, alcohol and camphor doubtful stimulants. There are very few specifics. A general account of the subject which will repay further study.— J. Hay, B.M.J. ii./22,899. Congestive Heart Failure. Rest and Digitalis the outstanding method of treatment. Digitalisation.—Calculate dose in minims by multiplying body weight in pounds by 2J, i.e., a 10-stone patient requires 350 minims. (Initially it is best to give 2/3 of this dose.) In urgent cases if no Strophanthus or Digital! has been given previously, safest to give half the dose at once, i the dose afteu- 6 hours, 1/8 after a further (5 hours, and a further 1/8 after 6 hours. Ofteo not sufficient urgency to warrant more than 90 minim doses three or four time: daily.—Maurice Campbell, Pr. Jan.’31,32. Overwork and Weakness.—Two minims of Tincture thrice daily for a lengthy period with intermissions, as advised in Balfour’s ‘ Senile Heart.’— ‘ D.M.’ in M.P.C., Oct. 26, 1927. A new Digitalis body with true Digitalis action, capable of being eliminateo from a cat within a few hours of its intravenous injection.—Jl. A.M.A. 1923;: 1072, per P.J. i./23,45c. Pneumonia. The Infusion of Digitalis helps the heart to resist depressan action which the pneumonia toxin lias. 1 drachm of the infusion every 4 hours*1 increasing to | ounce every 4 hours, or 3 hours, night and day. Begin abou second or third day.—E. M. Brockbank, B.M.J. i./3o,974. Rheumatic Heart of children treated.—G. A. Sutherland, B.M.J. ii./19,50' Cumulative Action.—In the case of the Tincture this may be ignored! especially as nowadays a large initial dose is given, but more than 2 maximun doses should not be given during 24 hours. The late Prof. Cushny held that any Digitalis preparation which does no produce cumulative effect or nausea must either be inert or else so wealj as to be valueless.—B.M.J. i./25,412. Irritant effect to the renal epithelium may be caused by Digitalis, as the appearance of blood and albumen in the urine of animals after large doses shows.—Cushny, L. i./i7,442. Visual Disturbance due to Digitalis intoxication following excessive dosage. Visual disorders from use of Digitalis more common than supposed —H. B. Sprague and co-workers, Jl. A.M.A. ii./25,719. Antidotes. After emetics give gallic or tannic acid, camphor, nitro-glycenn, coffee or tea, also ether or alcohol. Aconitine yt giain hypodermically to be repeated in ^ hour if heart action improves. Atiopine 1/200 to 1/100 grain hypodermically is advised instead, oy some. Patient should lie down until recovery. J i ICO Hi J)(.( t i 1)1 c with preparations of cinchona and with lead acetate, also with iron salts ^but the blackening is preventable by citric acid) and with iodine and potassium iodide. CeDExtractum Digitalis. Fr. Cx. Dried leaves extracted with 70% Alcohol, evaporated to soft extract. CE> Infusum Digitalis (B.P. ’14). About 1 in 143. Dose.—2 to 4 drachms (8 to 15 Cc.). This is an active preparation. In use it may well be combined : with some vasodilator. U.S. X.—Digitalis 15, Boiling Water 700 ; infuse one hour, filter and add Cinnamon Water 150 and Alcohol ICO, finally cold Water q.s. to 1,000. 1 P. Ital. V. and F.E. VIII. have 1 % in boiling water. Length of infusion not delined. P. Belg. IV. states ‘ prescribed quantities ’ of leaves in water at 70° C. (FDAcetiim Digitalis, Ph. Ned. IV., Digitalis Leaves 1, Dilute Acetic [ Acid (6%) 9, Alcohol (90%) 1. Macerate 5 days. CfD Liquor Digitalis ad usum internum. Ph. Ned. V. Syn. DlGISOL. Dose.—Maximum single 3 Cc. Maximum daily 10 Cc. Preparation.—This is similar to that of the solution for infection following, except that, after the evaporation of the Chloro [ form, the volume of water used to extract the residue is 88% of that t of the Chloroform. Finally to every 88 parts of this solution are added 12 parts of 96% Alcohol. CEDLiquor Digitalis ad Injectionem, Ph. Ned. V. Syn. Digisol FOR INJECTION. Dose.—5 Cc. maximum single and pro die. Preparation.—Macerate one part of powdered Digitalis leaves with 8 i parts of water during 48 hours at a temperature not exceeding 15°, strain and filter. Shake the filtrate with an equal volume of Chloroform during 48 hours, avoiding emulsification. Reserve the Chloroform solution and I evaporate a measured volume of the aqueous layer on the water bath to a thick extract. To this add sufficient exsiccated Sodium Sulphate to form a dry powder. Shake this during 24 hours with a volume of the Chloroformic extract equal to that of the evaporated aqueous solution and filter. Measure (the volume of the Chloroform and distil off. Treat the residue with water [equal in volume to that of the Chloroform, using small quantities at a time ; dissolve 0-8% of sterile Sodium Chloride in the solution and filter. Sterilise by heating on 3 consecutive days for I hour at 70—80° C. Keep in a cool place away from light. , , . .. This solution and also the Digitalis leaves are tested biologically, Die fatal dose of this liquor per kilo for a cat is 2 Cc. I^harmacologtj.— A quantity of this Dutch Liquor made with leaf growm by tne writer in 1927 was examined by the usual cat method. The lethal dose was :—- 1st cat .1*7 Cc. per kgm 2nd cat . . . . • • 2*1 Cc. ,, ,, Average .. .. •• 1*9 Cc. ,, »* This agrees almost exactly with the figure stated in the 1 h. JNied. V. ® Digitalone. Dose.—Hypodermically 8 to 15 minims (J to 1 Cc.). Per os 15 to 30 minims (l to 2 Cc.) cautiously increased. Contains chloretone as preservative and ‘ anaesthetic.’ Physiologically standardised. CE> Tinctura Digitalis. (B.P. ’14.) 1 in 10 of 70% Alcohol=F.I. (as also F.E. VIII., P. Belg. IV. and P. Ital. V.). B.P. 1898 was 1 in 8 of 60% alcohol. Dose.—5 to 15 minims (0-3 to 1 Cc.). Frequently single doses of as much as 1^ drachms are given. Large single doses in many cases preferable to repeated small doses. See Abstracts under Uses of Digitalis. U.S. X. 1 in 10. The menstruum is Alcohol 4 and water 1. Fr. Cx. = F.I. max. single dose, 25 minims ; max. during 24 hours 90 minims approx. In the U.S.P. X. biological assay the tincture, properly diluted, i& injected into the ventral lymph sac of the frog, and should have a minimum systolic dose of not less than 0-0055 Cc., and not more than 0-0065 Cc., equivalent to 0-46 X 10-8 to 0-54 x 10-8 Gm. of Ouabain per Gm. body weight. In preparing the tincture, the Digitalis is first percolated with Petroleum. Benzine until a few drops leave no greasy stain. The Benzine is rejected,, and after exposure of the drug to the air until odour of Benzine disappears, it is percolated with the dilute Alcohol (76%). Physiologically Standardised Digitalis Tincture. Dose.—5 to 15 minims, is available in commerce of strength 0-75 Cc.—Minimum Lethal Dose per 100 Gm. of frog. Deterioration of Preparations.—Physiological Experiments? which we had specially conducted for us (1913) would indicate that there is] only a slight falling off in strength in 12 months. Indeed, we were able to demonstrate that a tincture 12 Years old was quite up to the standard— this was confirmed by physiological test.—cf. L. i./i3,77. We deal with this* matter more fully in Vol. II. An interesting investigation.—Some years ago, as men-: tionecl under Tincturse, we proved experimentally that Tinctures- of various drugs of very closely equal strength can be made eithen by a few hours maceration or by lengthy maceration and percolation We were more especially concerned with Alkaloidal Drugs. Recently (in 1927) we had comparisons made for us of the following; Digitalis Tinctures :— (A) Made by simply macerating and occasional shaking for six hours anc2 then filtering off, using 1927 crop of leaf of our own growing. (B) Made by the BP. '14 process—the percolation taking three days— using the same leaf as in (A). The report showed that in cats (A) Had average M.L.D. 15-2 Cc. per kilo. ^53) 14*7 Oc A Tincture *made from International Standardised Digitalis unde similar conditions had M.L.D. 15*96 Cc. per kilo. (A) was therefore 104 and (B) 108% of the activity of the Standard The results confirm that short maceration is practical?* as efficacious as the lengthy percolation process:. In the case of Digitalis one might have doubted that this was so. Incidentally, a third sample, (C), examined at the same time had 93% of the activity of the Standard. This Tincture was 5 years old. It is the common practice to * pass ’ a Tincture within 25% of Standard. The margin seems, to our mind, rather wide, in view of the proof that a first-class Tincture can be made by the simple process described. Tartario Acid 0-05—0-1% added to the Tincture is stated to be preservative.—Arch. Exp. & Path. Pharm. 24,102,17, per P.J. i./2 5,173. Maceration for 24 hours with 4 ounce of hide powder to the pint is said to, detannate the tincture. Relative value of Tincture and fresh infusion.—In an investigation comparing Alcoholic Tinctures and water-soluble glucosidea from Digitalis, E. Berry found the latter gave the most desirable therapeutic effect. Details for preparing an aqueous solution of glucosides free from Digitoxin and Saponins.—P.J. ii./i5,783. There is no difference between amounts of saponin bodies present in tincture and infusion of Digitalis made from equal weights of the leaf, and therapeutic doses of Digitalis do not contain enough saponins to induce any undesired effects.—Weiss & Hatcher, Jl. Am. Ph. Assn., 6, 1921, abst. C. D. June 24/22, 809. In tropical climates such as that of India, Tincture of Digitalis undergoes deterioration in a short time. Tinctures become darkish in colour on dilution and are evidently considerably weaker in therapeutic efficacy. Dosage used in India far too small. With tinctures of standard strength, doses of at least 20 to 30 minims three times a day should be given, increased for urgent cases to 45 to 60 minims, until the amount calculated by : Eggleston’s method is given.— R. N. Chopra, S. C. Bose and P. De, I.M.G., Mar. ’25,97. In cold countries the average quantity of Tincture of Digitalis required to cause toxic effects varies from 4 to 7 fluid drachms, but in Calcutta the smallest jdose required was 9 drachms and the highest 29 drachms, while the average was well over 14 drachms. Due to loss of potency of Tincture and increased decomposition in the alimentary tract and liver. Toxic effects with B.P. Tincture in 15 m. doses thrice daily very rare in India. To obtain prompt results in grave cases 2 to 3 drachms per day for 5 days should be given. The stage of optimum benefit from Digitalis usually merges into the stage of minor intoxication from cumulation of the drug.—S. C. Bose, I.M.G., Apl., ’2 5,154. In Aortic Disease, when compensation fails, bold doses, e.g., 15 minims every four hours are given with safety. Bronchial constriction following administration of Digitalis, relieved by Atropine.—B.M.J. i./24,715. # . ... Flavoring.—Glvl Coriandri, Syl Lavanclulse; Syrupus Aurantn. Digitalis in Gat Unit Tablets (XJpsher Smith). Each tablet is one standard Hatcher Cat Unit of Digitalis. Twenty- four tablets are stated to be adequate for complete digitalization of any case. See also Digitalis Leaf Tablets—International Standard, antea. cp} Tinctura Digitalis Foliorum Becentum.—Martindale. Dose.—5 to 15 minims (0*3 to 1 Cc.). Prepared from fresh second year’s leaves and chemico-physio- iogically standardised to normal (=M.L.D., 0-75 Cc. per 100 Gm. frog). Kobert and other authorities favour a preparation made by this method. In view of the poor keeping qualities of the leaf, unless properly stored, and the exceedingly complex composition^ of its a-ctive principles, the idea should be welcome.—of. P. J. ii./i3>4o7,573. CeD Glycetract Digitalis.—Martindale. . Dose.—1 to 2 minims. A potent preparation vide Giycetracta. (2D Pilula Digitalis Composite (Bamie’s Pills).—st. g.h. Syn. Guy’s Pill, Addison’s Pill. Dose.—1, as often as 3 times a day. Mercurial Pill 2, Digitalis Leaves 4, Squill 1. In grains for onei pill; in grammes for fifteen. Used in cardiac dropsy. CE> Pilula Hydrargyri et Digitalis Composite, st. bart.’s h. Mercurial Pill 1 grain, Digitalis 1 grain, Squill 1 grain, Extract o:j Hyoscyamus 2 grains. B |5j[i Pilula Von Niemeyer.—Dose.—1 pill thrice daily. Digitalis Powder | grain, Ipecacuanha J grain, Opium Powdes I grain, Extract of Helenium J grain. Used in combating the fever of phthisis. When the fever is o: the periodical type, with pronounced exacerbations and chills, oncj grain of Quinine Sulphate is added to the above formula.—Ex Pres CjDVin de Digitale Compost. Syn. Yin de l’Hotel-Dieu, Yin de Trousseau Digitalis leaves 1, Squill 1% Juniper Berries 15, Potassium Acetate 10 Alcohol 90% 20, White Wine 180—all by weight. jDigitalis Glucosides. IF 1! Digitalin and all other 'poisonous constituents of Digitalis. Digitalis leaves and seeds contain several active crystalline and amorphous principles. We deal only with those actually known tcj be of use and which are available in commerce. FII Bigitoxin (P. Helv.). C28H16O10=542-3648. Dose.—olo tci ttV grain (0-00025 to 0-001 Gm.). Caution.—0*002 Gm. maj] be a fatal dose. P. Belg. IV. and P. E. VIII, have formula C34H5iOn, P. Ital V. C44H70O14. lYlanufOiCtut'G —Grind leaves to fine powder, exhaust with water, anc after drying again, extract with 50% Alcohol. Precipitate liquor with Liquo- Plumbi Subacetatis, collect liquor, drive off most of the alcohol, extract residue several times with Ether, treat with water, and leave to crystallise. Re: crystallise from 85% Spirit, using charcoal to decolourise.—E. Schmidt. The content in the freshly harvested leaves is stated to be 0*25% This is a potent Glucoside stated to have uniform therapeutic activity. Soluble about 1 in 80 of absolute Alcohol, and soluble in Chloroform. Sparingly soluble in Alcohol 90% ; very solubl in more dilute Alcohol. In the pure condition it is stated to be insoluble in water. Ther* is, however, physiological and chemical evidence that it is soluble if the presence of the other glucosides (cf., Am. Jl. Ph., May, 1913). Solutions may be made containing -3% grain (0-001 Gm.) Digitoxir in 15 minims (l Cc.) of Petit’s Liquor. This quantity will approxi mate 40 drops, which may be considered a maximum dose. Suitabl* either per os or as an enema. May also be given in Syrup, Digitoxir: 0*1, Alcohol (90%) 2C0, Distilled Water 750, Syrup to 2,500. Dose.— 1 to 4 drachms (4 to 15 Cc.). (£) Tablets and ® Granules (Pills) of Digitoxin are prepared containing grain (J milligramme). The so-called 4 Bigitaline Pure Amcrphe ’ (Homolle), Fr. Cx 1884. Syn. 4 Chloroformic Bigitalin,’ consists principally of £ Glucoside resembling Digitoxin, and the Bigitaline CrystallisSe Fr. Ox., consists almost entirely of it. Caution.—When Digitalin is ordered (with the relative bold lose) Digitalinum Fulv. Purum (jpostea) should be given. EJ^Nativelle’s Crystalline Digitalin, is probably identical with Digitoxin.. Digitalin Granules, Nativelle grain, also ^ grain. (^Nativelle is T.M. 300453). 00 S Large doses are given to diminish the period of systole and to effect diuresis. Small doses for sedative effect, e.g., in palpitation rnd to relieve dyspnoea associated with mitral stenosis—one Granule every three or four days. Suspend administration periodically if necessary. 3D ♦ Nativelle*s Digitalin Solution. For intramuscular injection into the pectoral or other region free from cedema. Dose.—1 Cc. containing ^ grain (0-00025 Gm.). An oily stable solution. Ampoules are prepared. In cases of as\Tstole amenable to Digitalin an injection is made for :our consecutive days. In milder cases of hyposystole two days Allowing, 1 Cc. being injected on each occasion. In acute cases with mplication of the myocardium and threatening cardiac failure, a angle injection usually suffices to restore the strength of the contraction. May be repeated once or twice. When the case is grave in injection of Caffeine Sodio-Salicylate should be given two hours oefore the Digitalin. In pneumonia, according to circumstances, rom one to four doses. Indications for hypodermic use— The hypodermic method alone is admissible (1) in grave cases where cardiac ailure is imminent and immediate and certain action is required, because in uch cases gastro-intestinal absorption is slow and uncertain. (2) In cases n which it is desirable to safeguard the stomach and to avoid setting up gastric intolerance or embarrassment of cardiac action by a dilated stomach, he hypodermic method must be used, e.g., in typhoid with failing heart, vhere diuresis is essential; in vomiting in arterio-sclerotics, where the stomach )ecomes distended on the slightest irritation. The formula C44 H70O14 is assigned to Digitoxin. Gitalin is pharma- ologically similar.—Arch. Exp. Path. Pharm. 1926,261. Koppe took 1 mgr. of Digitoxin per os without any certain toxic effect, >ut a dose of 2 mgr., taken four days later, nearly produced a fatal result. pProf. Cushny, B.M.J. i./s 5,412. Q1 Digitalinum Pulverisatum Purum, Dose.—T\ to \ grain (0-006 to 0-03 Gm.) three or four times 'aily in pill, tablets, or subcutaneously. Consists of a mixture of )igitalin (Kiliani), Amorphous Digitonin and Digitalein.—M.Am. cf. Driver & Trease, P.J. i./27,624). Non-cumulative, but caution —powerful drug. It is a yellowish-white powder Soluble in /ater and alcohol, nearly insoluble in chloroform. Well adapted for ypodermic injection. We repeat : When ‘ Digitalin * is ordered either for internal or ypodermic use this substance should be supplied. ED Hypodermic Tablets of Digitalin, grain (0*0065 Gm.). DSterules (Hypodermic) Digitalin jV grain, also CE> with Strychnine [ydrochloride grain as heart stimulants. ® Tabelke Digitalini et Nitroglycerini. Digitalin Tl0 grain (0*006 Gm.) with Nitroglycerin grab (0*0006 Gm.). Useful in aortic disease. Where vascular tension is high, th addition of Nitroglycerin prevents increase of peripheral resistance: and thus robs the Digitalis of the influence on the arterioles, ‘ 03j account of which its administration is supposed to be contra indicated.’ Cp) >$cDigalen (T.M. 265442) (Cloetta’s). Dose.—5 to 15 minims. A proprietary solution said to contain in each 1 Cc. (17 minims) 0*3 mgri of an amorphous glucoside of same empirical formula as Digitoxin. Fa oedema of cardiac debility. 15 minims correspond to 2 grains of Digitalis Leaves or IS minims of Tine ture.—B.M.J. ii./c>9,1100. Cg)Hypodermic Tablets, 1 dissolved in 15 minims, makes a solution fa intramuscular use of the same strength as above. Intravenous use void of pain and does not hoemolyse blood corpuscles.— B.M.J. i./i2,60. See also W. L. Symes, L. ii./n,1349. The emergency intravenous dose of Digalen, for patients who have no previously received Digitalis, is 1 minim per lb. weight, i.e.y one-half the fuj therapeutic dose. If necessary give another dose of I minim per lb. weigh and repeat at 2-hourly intervals to a total of not more than 4 injections untl improvement or sign of toxic action, then revert to oral use.—H. E. B. Pardee Jl. A.M.A. ii./28,147. It has probably increased diffusibility on account of its increased solubility —to which is due, it is said, absence of digestive disturbance when giver ■per os.—Pharmacol, p. 16. Cg) Digistrophan Tablets are made, each = 0*1 Gm. Digitalis with in addition 0*05 Gm. Strophanthus. Digitalis Lanata a potent source of glucosides, stated to be nearly 4 time as potent as D. purpurea home grown.—F. Wokes, P.J. ik/29,16. Digcxin.—A new glucoside isolated from D. Lanata, C41H64014 Itl pharmacological activity is i that of Ouabain—S. Smith, J.C.S., Mar., ’3c 508. ELIXIRS. These are generally composed of a weak-flavoured syrup, with fair proportion of alcohol. For list consult Index. Elixir Aromaticum, Aromatic Elixir, U.S. X. Dose.—4 to 2 drachms (2 to 8 Cc.). Compound Spirit of Orange, U.S. 12, Alcohol to 250. Add gradm ally, with constant agitation, Syrup 375, and then Distilled Wate 375.' Mix with the liquid Purified Talc 30, and filter until clear ; the add a mixture of Alcohol 1 and Distilled Water 3 q.s. to 1,000 (Spiritus Aurantii Gompositus, U.S.—Oil of Sweet Orange Peel 4( Oil of Lemon 10, Oil of Coriander 4, Oil of Anise 1, Alcohol to 200 The following saves timeMix the Compound Spirit of Orange wit Talcum (Magnesium Carbonate better), add to this in a mortar gradually th water and alcohol previously mixed, transfer to a wetted filter and when a ‘ through ' make up volume to 818 Cc., then add sugar 318 and shake or peir colate the sugar with the filtrate. Elixir Simplex, b.p.c., 1894 :— Oil of Bitter Orange 30 minims, Rectified Spirit 6 ounces. Dissolve and add Cinnamon Water 7 ounces, Syrup 7 ounces. Filter through paper sprinkled with Kaolin until bright. Dose. 20 minims to 1 drachm. This quantity may be added to the ounce of a liquid medicine. That of B.P.C. 1923 is about I the alcohol strength of above. N.B. Alcohol Soluble drugs quite compatible with the original formula may be insoluble in the current one. Elixir Aurantii Amari. Syn. Elixir of CURACAO. Dose.—2 to 4 drachms (8 to 15 Cc.). Oil of Bitter Orange 4, Tincture of Bitter Orange Peel 20, Alcohol 300, Strong Orange Flower Water 20, Syrup 400, Distilled Water (s.a.) to 1,000. Filter through Kieselguhr. Elixir Rhei, B.P.C.—Syn. Liquor Rhei Dulcis. Dose.—1 to 3 drachms. Dissolve Anethol 0-05 in Alcohol 2-5 and add to Liquid Extract of Rhubarb 25, Syrup 22-5, Glycerin 15 and Water to 100 previously mixed ; filter if necessary. Elixir Rubrum. Dose.—20 minims to 1 drachm (1*2 to 4 Cc.). Solution of Carmine (q.v.) 1, Simple Elixir (B.P.C. 1894) 64. Gives an agreeable flavour and colour to liquid medicine, but is not compatible with acids. Elixir Ficorum (Martindale).—Syn. Syrupus Ficorum. Elixir or Syrup of Figs. Dose.—1 to 4 drachms at bedtime or early morning. Macerate Senna 16 ounces in cold water q.s. to cover twice and decant. In the first liquor heated to boiling, macerate figs cut small 32 ounces. Strain off the liquor as much as possible, and macerate the marc in the second senna liquor previously heated to boiling point. Strain off this second maceration liquor, and evaporate the two combined to 35 ounces. Dissolve in this (hot) sugar 70 ounces. Add, mixed, cinnamon oil 10 minims, oil of cloves 10 minims, chloroform 25 minims in alcohol 90% 150 minims. Make the product up to 80 ounces with water. ENEMATA. Substances administered per rectum are absorbed approximately at the same rate as when administered per os exceptions are Strychnine and Quinine (slower). ^is^aid^hat under the most favourable conditions it is only possible to supply by means of enemata about one-quarter of the mod material 1%l0r® to maintain nutritive equilibrium. Protein even when peptomsed is so badly absorbed as to be of little value (see also Nutrient Enemata infra). The same is generally true of Fat, even when emulsified, but dm viduals vary widely in their power of fat-absorption f s ^ S but allowance must be made for the destructive actmty of bacteria breaking up sugar, so that some at least is lost for PllJposes of A ' bed It 50 Gm. pro die can be digested. Water and Salts are ve * a time to is said that five or six ounces, gradually increasing by o . %mtiont with ten ounces, of warm water given every four hours vnil si < AVc , su{fablv supplemeuUry nouriisl™,e!nt’JSDndta5ESnelnf. 1 to 2' ounces' of Brandy diluted is well absorbed Stimubmt g“e™ea^st™arefui adjustment it is with warm water, e.g1 to 6 ounces, dyv uue „ uniirq nr thnt, of difficult to raise fat absorption above 10 Gm. m twenty-four hours or th protein above 20 Gm. During a course of rectal feeding the bowels should be washed out o ice daily with an enema of tepid water before the nutrient injections are given. This cleans the bowel and washes away poisonous products of albuminous decomposition. The injection of Nutrient Enemata should be given as slowly as possible. Ihe best posture is with the patient on his left side, with his hips raised on a pillow. To avoid thirst not less than 2 pints of fluid should be allowed in the twenty-four hours to an average adult patient. Of Dextrose (in 10% solution), 99% is absorbed. 6% is isotonic with blood and would be found more convenient and less irritating. 15 ounces or more of this Solution four times a day is well retained by an adult if the rectum is well washed out once a day with Saline Solution. The 100 Gm. I or more of Dextrose thus given daily diminishes Nitrogenous waste.—N. Mutch and J. H. Byffel. Enema Nutriens. L. H. Syn. DEXTROSE NUTRIENT ENEMA Dose.—5 ounces every 4 hours, or if patient can retain it 10 ounces every 8 hours. To H pints of milk boiled and cooled add 4 ounce of a reliable Pancreatic Fluid or 4 Pancreatic Tablets. Maintain at body temperature 24 hours, add 11 ounces of Pure Dextrose. Dextrose has been proved to be absorbed by the rectum, hence an important means of feeding patients who cannot take food by the mouth. The Amino-Acids separated by pancreatising the milk are also absorbed.—A. Kendle Short and H. W. Bywaters. Glucose (St. M’s. H.) 1 ounce with Normal Saline 1 pint. The bowel is incapable of absorbing anything other than water and Glucose. ’ Nutrient enemas,’ e.g., milk, beef tea, etc., valueless.—A. Abrahams, Pr. May, '32,527. Enemata to act merely in the rectum and to be retained, may be given in volume of 5 ounces, but for the large intestine and lavage purposes employ one to two pints or more. Glycerin Enemata for laxative effect rareiy exceed 1 ounce. Enema Opii is Tincture of Opium q.s. (e.g., 5 to 20 minims) as desired by the physician, with Mucilage of Starch to 1 or 2 ounces, mixed with gruel 5 ounces. Anaesthesia.—Ether and Olive Oil, see 4 Oil-Ether Anaesthesia.’ Aperient Enemata (1 to 6 pints) are made with Soft Soap, with warm water q.s., e.g., Enema Simplex, L.H., St. M’s. H., 1 ounce to the pint, or with gruel. Marshall gives the following :— Evacuant Enemata. Enema of Sodium Chloride 2 to 5%. Enemata of Chamomile Infusion and other vetegable infusions ; Enemata of Fixed Oils (£ to 1 pint of Olive Oil) for inflammation of rectum associated with hardened f?ecal masses. Enemata for action on rectal mucous membrane contain— Alum 0-5%. Asafetida 5% of Tincture in Starch Mucilage. Boric Acid (Saturated Solution). Bismuth Carbonate or Subnitrate 1%. Ferric Chloride (Strong Liquor) 2%. Infusion of Garlic and similar anti- spasmodic substances. Lead Acetate 1%. (jDMercuric Chloride 0 01 to 0-05%. Mucilage 25%. Oil of Turpentine 0-5 to 1%. lEIl Opium (or its alkaloids), a maximum dose (CP) if containing less than 0-2% morphine). L.H. has Tincture 10 to 60 minims, with Starch Enema to 4 ounces, St. M’s. H. 10 minims with Starch Mucilage 2 ounces. Salicylic Acid 0-3%. Silver Nitrate 0-1%. Tannin 1%. Cf. also in text, Enema Magnesii Sulphatis (et Acida), Enema Naphthalini, Enema Olei Bicini and Enema Olei Terebinthinse. For ulceration of rectum Silver Nitrate 10 grains to the pint, also Salol Enemata 1 to 2 drachms in Turpentine, also Ferrous Sulphate and Copper Sulphate have been used. Enema for thirst after operation (U.C.H.) : 2 pints of hot water. K.C.H., L.H., U.C.H., G.X., R.F.H., R.N.H., E., G.H.W., St. G. H., St.M.’sH., St. Tli. H. and W., give formula} for various Enemata. All Enemata should be given at body temperature. El EPHEDRINA. C10H15QN= 165*125 (C6H5.OH.OH.CH-.CH3.NH.CH8) An alkaloid obtained from Ephedra equisetina (Bunge), Ephedra sinica (Stapf), and other species. It has generally been extracted from the Chinese drug Ma Huang (Ephedra vulgaris var. Helvetica- content about 1%), known 5,000 years ago and now sold in Peking drug shops in small brownish green sticks. The alkaloidal base forms colourless crystalline masses soluble in water 1 in 20, very soluble in Chloroform, Absolute and 90% Alcohol, Ether and Benzol : less readily in Petroleum Ether, readily in Eucalyptus Oil. Ephedra varieties and alkaloid content.—P.J. ii./27,118. Indian Varieties give good yield of pseudo-Ephedrine ; equally active and cheaper.—It. N. Cliopra, B.M.J. ii./3y,90C. Dispensing Note.—Ephedrine preparations should be kept in stoppered amber bottles. Compatibility.—Both the Sulphate and Hydrochloride appear to be compatible in the cold with chemicals likely to be prescribed with them, e.g. the Bromides, Iodides, Carbonates, Bicarbonates, and Sodium Salicylate. Reasonable precautions are needed as Ephedrine is a delicate alkaloid. Pharmacology.—Effects are similar to Adrenalin but more prolonged, the outstanding effect being circulatory stimulation. It has mydriatic powers, but it is not used clinically for that effect. Cumulative effects apparently not produced. The M.L.D. when given per os to rabbits was louncl to be 0*59 Cm. per kilo. - K. K. Chen, Jl. Pharrn. & Exp. Therap., Feb. ’26,61-92. For further information see Refs., postea. Constitution of the alkaloid.—J.C.S.A. i./20,o96. Studies of Ephedrine.—K. K. Chen and C. F. Schmidt, Jl. Pharm. & Exp. Therap. Vol. XXIV ’24,339: Feb. ’26,61: July ’26,64: B.M.J. ii./27,593. Uses.—Asthma and hay fever have been much treated by means of 'its salts. Other suggestions are its employment in obstetric shock and collapse, headache, nocturnal incontinence, and lor analgesic effect in leprosy. Antidotes.—Fatalities may occur through inadvertence or intention. We know of a case of a child of 2i taking 4 grams.— H. Gordon, BALE l/32,73 . Thp duIsp was over °00 and there was continuous hiccoughing, mnet.ic of Salt was ?RenInd liter sugTand Sod. Bicarb, and a hot bath to reduce blood ZfJirP Successful For an adult a strong saline purge is suggested and a Vasodilator if blood pressure is high, which is not ndtessanly the case. I ide refs, under Pharmacology and Asthma pp. o99,4UU. , *Ephetor,in (T.M. 476,189) is Ephedrine synthetically prepared. 4 mgr. of the synthetic are stated to be equivalent to J mgr. of the nVs*£l0s«b~ 'it is pharmacologically similar but considerably less toxic. Clinically, it is inactive 2>er os and has a weak pressor but also a wTeak bronchodiiator effect hypo dermically. Best used as a topical application to the nose, e.g., in hay fever in 2 or 3% solution, when its activity is in every way comparable to that o Ephedrine.—H. Miller and G. Piness, Jl. A.M.A. ii./28,1035. EjEphedrinse Hydrochloridum C10H15ON.HC1=201-6078. Dose.—Adult k to 2 grains (0-03 to 0*12 Gm.) either per os, hypo dermically, intramuscularly, or intravenously. (Caution; I grair has been known to produce slight toxic phenomena.) Colourless crystals readily soluble in Water 1 in 5, and 1 in 12 Alcohol 90%. IP 1| Ephedrine Hydrochloride Tablets, h grain (0-03 Gm.), are made for oral or hypodermic use in asthma, hay fever, Addison’s disease and for shrinking the turbinated bodies. HP lj Ephedrine Hydrochloride Sterules contain and 1 grain (0-016, 0-03 and 0-06 Gm.) in 15 minims (1 Cc.). §PUEghedrinao Sulphas. Syn. Fedrin (C10H15ON)2H2SO4= 428-3256. Dose.—J to 2 grains (0-03 to 0-12 Gm.). The max. daily dose is stated to be 4J grains. This salt, which is soluble in water 1 in 4, and 1 in 22 Alcoho 90%, has M.pt. 235 to 236° C. It is not decomposed on sterilisation. Preparations of Ephedrine and its salts. CeD Nebula Ephedrinae Simplex. Syn. PLAIN EPHEDRINE INHALANT. Ephedrine 1% in Liquid Paraffin with addition of 33% oi Olive Oil. For asthma and hay fever. ® Nebula Ephedrinse Composita. Syn. COMPOUND EPHEDRINE Inhalant. Ephedrine 1, Menthol 1, Camphor 0-5, Eucalyptus Oil 4, Thyme Oil 1, in Liquid Paraffin to 100. Both the above are for use to the nose and in some cases to the throat, with a fine atomiser. For asthma and hav fever, ' i/ Our experiments (1B31) showed:— In regard to the Nebula Ephedrinse Simplex that at least 30% of Vegetable Oil is needed. ® Nebula Ephcdrince Aquosa. Syn. AQUEOUS EPHEDRINE INHALANT. Ephedrine Hydrochloride 1, Glyl Lavandulse 5, Glyl Pini Pu- milionis 5, Water to 100. Intended as spray, by means of a fine atomiser, more particularly for the throat, in asthma and hay fever. C0 Elixir Ephedrime. Dose.—1 to 2 drachms (4 to 8 Cc.) containing J to l grain. Ephedrine Hydrochloride 8 grains (0-5 Gm.), Glyl Aurantii Amari, 4 drachms (15 Cc.), Glyl Cinnamomi 4 drachms (15 Cc.), Water to 4 ounces (120 Cc.). Asthma is wTell treated by 1 to 2 drachms at bedtime: also gives; relief in hay fever. For whooping cough in children J to I drachm. <PD Elixir Ephedopyrine. Dose.—1 drachm well diluted with water three times daily as required. Initial dose in severe cases 2 drachms. A Canadian preparation containing Ephedrine Hydrochloride 1 grain and Amidopyrin 12 grains in each ounce. For use in dys- menorrhoea. dD Unguentum Ephedrinse. Syn, Epredrire NASAL Jelly. Ephedrine 1, White Soft Paraffin 99. For use in hay fever, chronic catarrh, and general atonic condition of the nasal mucous membrane. sjcEphregel* (T.M. 517928). A combination of Ephedrine and Adrenalin as a nasal jelly, producing contraction of the capillary blood vessels with blanching effect, to reduce congestion, e.g., of the nasal mucous membrane, in hay fever, rhinitis, and acute colds. Epinalin. (T.M. 505944). Each Cc. contains Adrenalin 0-0C01 Gm. (=1 in 10,000) and Ephedrine Sulphate 0-02 Gm. (=1 in 50). Nasal spray in asthma and hay fever.—P.J. ii./3o,420. References to Literature. The principal and most important of the Ephedra alkaloids was almost unnoticed until 1924. It was first isolated and named in 1887 by a Japanese, Nagai.—C.D. i./3°>9. Ephedrine should be classed as [FI—J. Grier, P.J. ih/28,269 and P. IT. Marsden Ephedra alkaloids. Ephedrine can exist in six forms. The ratio of Z-Ephe- drine to d-pseudo-Ephedrine varies in Ma Huang. The former is the important base.—T. and II. Smith, P.J. ib/29,606. Most of the supply of Ephedra used at Darmstadt comes from South of Spain.—P.J. i./3i,3ML „ EDhedrine Hydrochloride Estimation. To a solution of 0-5 Gm. m 50 Cc. water add 5 Cc. Nitric Acid and 30 Cc. N/10 Silver Nitrate. Back-titrate excess with N/10 Ammonium Sulphocyanide, using Eerric Ammonium Sulphate. 1 Cc. N/10 Silver Nitrate = 0-02016 Gm. Ephedrine Hydrochloride.— E. Merck, P. J. i./30,477. The writer found a sample 99-2% pure. Synthetic Ephedrin, etc.—It. It. Bennett, L. i./29,l390. Pharmacology, , J ^ , , . „ „ ~ ,. The action of some tertiary amines related to Ephedrine.—I. Jt. Curtis, Jl. Pharm. & Exp. Therap., April, ’29,321. a ,. Insomnia quite a characteristic effect with Ephedrine. Sweating occurs with very large doses. No deaths have been recorded, but some quite serious collapse cases.—Prof. Gunn, B.M.J. 1./29,954. Chronic poisoning following \ grain thrice daily for four months. VY. H. Higgins, Jl. A.M.A. L/29,313. ^ . _ . . „ Doses of 4 to 1 grain orally contract the engorged nasal mucosa and Stop excessive secretion, giving relief for several hours. , Toxic effects have been observed in a few cases, consisting of gicidii b^s, headache, thirst, nausea, palpitation, insomnia, and bladder nTitation. Large and repeated doses should be avoided. Some patients nceo. carefully ieeuiated doses. Yery large doses cause diaphoresis. ^ . a+ 10 mgr. of Ephedrine subcutaneously may cause gangrene and necrosis at the site of injection, “but smaller doses do not. Adrenalin is said to be t o a half times as efficient as Ephedrine.—J. E. Nadler, P.J. u.’27,u , - ibid. 94, 176 (effect on blood sugar intravenously). , in™i A mixture of Ephedrine, Adrenalin and Potassium Sulphate pi aneesthesia as intense as mixture containing Novocain m place o P, j though Ephedrine alone has no anaesthetic effect, bow toxicity. Suggested for use in dental surgery and ophthalmic work.—yer pobAbnt’its toxicity Adrenalin is 100 times more potent than Ephedrine Suiphate, but its toxicity is only 50 times that of Ephedrine injected hypodermically G.D. | -/27,818. The pressor action of Ephedrine is reversed by Ergotamine. 1. B. Curtis, Jl. Pharm. & Exp. Therap., Sept., ’28,41, Asthma. Nausea and vomiting likely if Adrenalin has been previously given. Some tolerance to drug in 15% of 39 cases. Further investigation necessary as to possible renal irritation—red blood cells and casts found in urine of several patients after short course.—L. i./28,144. Many people fail to respond to Ephedrine at all. There is frequently a transient fall in blood-pressure initially, immediately followed by a well-marked rise, or rather, series of rises. The rise is much greater after injection than after oral use, but the latter has more lasting effect. Given by injection the rises rapidly succeed each other and are few, whereas orally the period between rises is longer and the series persists for an hour or more. The fall between rises is often precipitous, but does not go below the patient’s normal blood- pressure, until the rise3 have ceased when it fails considerably be/oiv norma! and remains subnormal for about an hour. During the rises there is a feeling of well-being, but during the afterfall there is coldness, renal pain, hunger pain and sometimes colic.—J. H. Thompson. Discussion at the Roy. Soc. Med., May 14,1929. B.M.J. i.,/29,954. Though it has the advantage over Adrenalin of effectiveness per os and giving longer immunity from attacks, it may cause tremor, palpitation, insomnia, and sometimes inability to micturate, i grain instead of i grain tablets should be made.—Frank Coke, ibid. The first dose seems to act marvellously, but subsequent doses seem to do nothing.—J. Freeman, ibid. A useful prophylactic agent. Psychological effecr of being able to prevent acute attack. Peptone Injections prior to Ephedrine of value.— A. Dingwall Fordyce, B.M.J. i./31,1(36. Ephedrine acts less rapidly than Adrenalin, and only controls minor degrees of bronchial spasm—quite useless in severe paroxysms.—A. F. Hurst. Ephedrine per os for asthma found of value, but may cause subsequent difficulty in micturation.—M. R. Sagar, B.M.J. ii./3o,716. A diaphoretic, analeptic, and sedative in cough, known for centuries in China. Bronchial asthma treated by 0'005 Gm. thrice daily.—Jansen, per P.J. ii./27,10. Hay Fever.—Treated with 1 grain doses per os in capsules, 5 to 10 capsules per week. Toleration varied. Worthy of trial in coryza.—Am. Jl. Med. Sci., Oct., ’26, per P.J. ii./27,10 . Lei ROSY.—Per os relieves nerve pains. More lasting and efficient than Adrenalin injections.—E. Muir, I.M.G., April 28, ’28,198. Ephedrine in painful accompaniments of.—It. G. Cochrane, L. ii./29,551. Leprous reaction. The nerve pains controlled during reaction period with Ephedrine Sulphate or Hydrochloride 1 grain thrice daily.—R. Green, Jl. Roy. Soc. Trop. Med., Jan. 30, '29,376. Low Blood Pressure.—1/8 to J grain produces very satisfactory rise in pressure and no toxic symptoms. £ grain caused giddiness.—H. W. Hales, L. ii./28,360. Chronic vascular hypotension. 9 cases treated. Rise in systolic pressure, remaining up for 4 hours.—L. ii./28,144. Doses of 0'05 to 0*125 G111. per os or subcutaneously, raise systolic and diastolic blood pressure, and decrease pulse rate for several hours. Also stimulate heart action and tend to increase output of urine.—T. G. Miller, Am. Jl. Med. Sci., per Jl. A.M.A. ii./25,l 159. Low blood pressure following influenza, pneumonia, etc. The power of Ephedrine to raise blood pressure appears to be decreased in arteriosclerosis, debility, and hypertension.—Jl. A.M.A., ’31,96,*480. Warning against use in patients with cardiac injury.—Per Pres., Feb., ’29,70. Myasthenia Gravis.—Personal experience of a medical victim after influenzal pneumonia. Progress with Ephedrine after none with Adrenalin apd thyroid.—H. Edgeworth, Jl. A.M.A. i./3o,l 136. Nocturnal Incontinence in Children.—Ephedrine 1 grain at bedtime for child from 10 to 12 almcst specific. Bladder emptied before and 2 hours after going to sleep.—L. E. Parkhurst, B.M.J. ii./3o,1103. Obstetric Shock and Collapse.—1 grain in 8 Cc. Normal Saline intravenously. Also in gynaecological cases to lessen shock of operation.—J. H. Hannon, B.M.J. L/29,954. Poliomyelitis. Intrathecal injection in an effort to check meningeal irritation, and thus proven^ involving the nerve tissue proper.—Arch. Int. Med., Jan., 30,102, per B.M.J.E. i./30,52. Post-operative Collapse.—Ephedrine preferred to Adrenalin.—B.M.J.E. j./3o,16. Shock from trauma or hemorrhage.— Intravenous injection of 15 nwr of value.—C. A. Johnson, Jl.A.M.A. i./3o,1388, per M.A. ’31,376. Spinal Anesthesia.—Of value in restoring arterial tension. Give 0*1 Gm subcutaneously before systolic pressure drops below 100.—Jl.A.M.A /a; 1136’ The fall in blood pressure following puncture is probably one of the greatest drawbacks of the procedure. Might be overcome by Ephedrine.—L. i./31,353. Whooping Cough.—Dose of £ grain per os in watery solution to children of one year, and 1/8 grain for those younger, night and morning, of value. Most useful during second stage. No serious toxic symptoms.—B.M.J E. i./28,28. Useful during second stage. 0*016 Gm. per os night and morning in aqueous solution to children over one year, and 0*008 Gm. under one year.—Per Pres. Feb., ’29,70. ERGOTA. jjp ll 4 Ergot of rye and preparations of Ergots.’ jjplj Ergot of Eye (B.P. ’14).—Syn. Secale Cornutum. P.Ital V., P. Belg. IV. Espolon de Centeno, Cornezuelo de Centeno E.E. VIII. (The latter is assayed biologically.) The sclerotium of the fungus Claviceps purpurea (Pyrenomyceles) on Secale cereale (Graminacece). Dose.—15 to 60 grains (1 to 4 Gm.) in recent powder infused in boiling water. Er. Cx.—Maximum single dose 15 grains. Maximum during 24 hours, 60 grains approximately. The specific alkaloids of Ergot are Ergotoxine and Ergotamine, the total content being 0*1 to 0-2%. The crystalline Ergotinine has been proved to be inert.—Prof. A. J. Clarke, B.M.J. i./27,763, vide posted. Ergotamine and Ergotoxine are the same substances from the pharmacological viewpoint. Whether they should be regarded as different alkaloids of Ergot, the chemist has not decided.—J. H. Burn, in reply to A. O. Bentley, P.J. i./27,565 ; see also ibid. 589, 615 (Ergotoxine Ethanesulphonate), 652, 681. History and Chemistry.—Prof. J. Barger, P.J. ii./2o,470. Heat and moisture, effect of, on Ergot.—G. Tate, P.J. i./2i,485. Cultivation of Ergot.—P.J. ii./2i,87. Polish and Russian Ergots contain 0*06% Ergotoxine, i.e., much less than Spanish or Portuguese.—F. Wokes, B.M.J. i./3o,800. Preservation.—Not more than 1 year old (U.S. X., assayed biologically) and to be kept whole, not powdered.—(B.P. 14) .P.Ital., P. Belg., F.E. and F.I. It should be kept in well closed vessels, adding a little Chloroform or Carbon Tetrachloride to prevent attack by insects. Old Ergot is practically useless. Antidotes.—See chapter on. . Uses.—Almost entirely for its action on the uterus, stimulating muscular contraction, and so to check bleeding after parturition, and from the presence of fibroid tumour, also to promote involution. Ergotin causes spasm of arterioles and rise of blood pressure, by acting directly on the vessels, independently of the central nervous system. It is useful in polyuria. Is also given to check night sweats, spermatorrhoea and menorrhagia. Suggested tor sleeplessness, by causing cerebral anaemia. All diseases in which a drugi nducing muscular contraction is indicated should, according to some authorities, be treated by Ergot, e.g. disturbances of the circulatory system, skin affections, acne rosacea, also nervous complaints (excessive smoking). In surgical shock 15 minims of Injection are useful. h or disordered circulation and for headache (hypodermically), alcoholism, hysteria and in acute inflammatory infections—meningitis, pneumonia, pericarditis, Ergot has also been used. For haemoptysis and pneumonia it is conveyed as of little utility.— B.M.J. 4/30,1007. In chorea it is a useful drug. De-fatted Ergot Preparations. Deiatted Ergot powder probably the best Ergot preparation for giving per os.—VYokes and Elphick, Qtrly. Jl. Pharm., 1929, 2,539. —L. ii,/29,1040. [O^Erboiin (T.M. 510459). Dose.—One or more capsules as required, usually 1 capsule thrice daily, the contents to be emptied on the tongue and followed by a hot drink. A stabilised and standardised Ergot in powder form, supplied in capsules each containing the equivalent of 0*5 mgr. (1/120 grain) Ergotoxine Phosphate. Uses.—For routine in obstetrics ; to induce involution of the uterus ; in post-partum haemorrhage, and wherever Ergot is indicated. The stability of liquid Ergot preparations cannot be relied upon, owing to deficiency of Ergotoxine which tends to decompose in such preparations. Defatted Ergot powder remains stable indefinitely and produces the entire specific effects of Ergot. FH Exfcractum Ergotae Liquidum. 1 = 1 of Ergot. (B.P. *14), ‘ 100%.’—P.I. Dose of B.P. ’ 14 preparation.—10 to 30 minims (0-6 to 2 Cc.) or more. It is best recently prepared (not more than 6 months old). Fr. Cx., 1 = 1 by wt. Maximum dose during 24 hours 6 Gm. Prepared by macerating with water containing 0-05% Tartaric Acid, and further treatment. Samples made with 2% Hydrochloric Acid and 40% Alcohol, 40% Alcohol only, 10% Glycerin and 40% Alcohol, 2% Acetic Acid and 40% Alcohol. First found to be five times as strong as the second.—J. H. Franklin, P.J. 4/27,52. The Liquid Extract of Ergot B.P. ’14, does not contain the specific alkaloid and it is not of any medicinal value. At best it can only be a solution of Histamine. The crude drug will have to be assayed before it is used.—J. H. Burn, P.J. ii./26,665; 4/27,133 ; ii./27,490 ; 4/28,126. Maximum yield of Ergotoxine obtained when extracted with a mixture of Tartaric Acid, Citric Acid or Hydrochloric Acid, in 50% Alcohol. According to J. H. Burn and S. Wokes, the extract deteriorates rapidly.—L. ii./29,1040. Chassar Moir, however, speaks highly of it—perhaps it contains a new body.—B.M.J. 4/32,1119. p. Belg. IV. uses Tartaric, P. Ital. V. Acetic, and E.E. VIII, Hydrochloric Acid in their extractions. Uterine contraction is caused by Ext. Ergot. Liq. B.P. ’ 14 per os, this effect being thought due to the Histamine content.—The Pharmacist of a London hospital. [P I Fluidextractum Ergotae, U.S. X.—Average dose 2 Cc. is prepared by use of 2% Hydrochloric Acid in diluted Alcohol and is then assayed biologically. The U.S. Ext. Ergot. Liq. loses half its activity in 2 or 3 months.—J. H. Burn, B.M.J. i./3o,507. A new method of extraction. The alkaloids and amines removed as tartrates and combined to make either liquid or dry extract. Stated to have given good therapeutic results.-—H. Golaz, per Qtrly. Jl. Ph., ’29,13s. ;PiNormal Liquid Extract (Physiologically Standardised) may he of such strength that 0'66 Cc. will cause a rise in blood pressure of 60 m.m. in an animal weighing 1,500 Gm. A definite amount is given to a cat and tracings are taken of the blood pressure and uterine contractions, i.e., the efi'cet desired when Ergot is given to the patient. JTJj “ Ergot Aseptic.” Concentrated and sterilised liquid extract in 1 Cc. bulbs, representing Ergot 2 Gm. Colorimetric Tests for Ergot Alkaloids. Para-dimethylamidofcenzaldehyde. The credit of employing tins as a reagent producing a colour with Ergot Alkaloids (Ergotamine, Ergotoxine, and Ergotinine-Tanret) is due to H. W. van Urk, who has made observations, using both the alkaloids and Tinctura Secalis Cornuti, P. bled., and the Liquid Extract, P. Eed. The colour is obtainable both as a ring reaction, using dilute spirituous solution with the Sulphuric Acid beneath, and as a reaction on a watch-glass on a water-bath. In the latter instance the material to be tested is evaporated with a few drops of 1% Alcoholic ‘ Dimethyl ’ solution and a little dilute Sulphuric Acid (in the neighbourhood of 2% acid). . . , _ , ... A large number of other organic compounds give various colour effects with this reagent which should be borne in mind, e.g., Phenolphthalein, Pesorcin, Salicin, Morphine, Codeine and Heroin (see Pharmaceutiseh Weekblad, 1929,60, pp. 101 and 473). The colour with Ergot-mine is, however, a marked bluish- violet. Ergotamine and Ergotoxine give a violet purple. The differences in tint do not permit distinction. M. I. Smith of the Hygienic Laboratory, U.S. Public Health Service U.S.) Public Health Deports, Vol. 45, Ho. 26, June 27,1930, abst. P.J. i./3i,105), has issued extensive data with a view to developing the test for assay of Ergot preparations. Van Urk’s method was modified, using a Tartaric Acid extractive. The influence of light on the reaction was studied, inter aha. With decreasing intensity of light the reaction is correspondingly prolonged ano. somewhat less regular. The Acid factor is also of importance. J t is bes^J,o use . Concentrated Sulphuric Acid (containing 2-5 mgr. of the Aldehyde) to the alkaloid in 2 Cc. of 1% Tartaric Acid Sulphuric Acad is preferableit-Hydrochloric Acid. The results approximated the Bio-Assay method of Broom and Clark (Jl. Ph. & Exp. Therap., 1923,59). To 2 Cc. of solution of the alkaloid in 1% Tartaric Acid run in from a burette down the side of the tube exactly 1 Cc. of N/60 DimethyLJ9“J 'Maximum centrated Sulphuric Acid, mix and place in sunlight h possible. Maximum colour is then reached in 10-15 minutes ; diffuse bght needs hours. Bead intensity in a colorimeter against standard Ergotamine ^artrate solution. The method (as-modified by the Brit. Tartari^AcId srfu- Ext. Ergot® Liq., extracting with Ether, and obtaining a lartaric A 1 tion, was applied to a number of liquid extracts of commerce and the remar is made by Smith that the colour is not specific Jor Brgot alkatovte, though the tpot nn broad lines agrees with Eio-Assay results. Itaoes noi aijjerenuuie specifythefhyHologicaUy active Ergotoxine and Ergotamine from the inactive Ergotinine and Ergotamimne. Ammonium Sulpho-Molybdate Colour Test.—Martindale. The author lias carried out investigations with a view to possible improvement of Ergot Assay by colorimetric means. . A number of the customary alkaloidal colour reagents were tried, and in some instances (e.g., the green obtainable by Mandelin’s Phospho-Tungstic Acid) the presence of Tartaric Acid used in the extraction interfered and had to be eliminated. ,ubshot of the investigation is to suggest that Ammonium Sulpho- Mol.vbdate might replace para-Dimethylamidobenzaldehyde. The test may he used as follows : (A) Ammonium Molybdate 1 Gm. is dissolved in Concentrated Sulphuric Acid 100 Cc. To 1 Cc. of the 40 Cc. of Tartaric Acid solution of the alkaloids maoe up to 50 Cc. for convenience (above referred to, which represents 0T Cc. Liquid Extract), is added 1 Cc. of the reagent. A slate-blue colour develops at once and can be compared with a Standard Ergotoxine solution, or with a sealed Standard Tint Tube made with Aniline dyes, and without the aid of expensive apparatus. Or the follovjing may he ’preferable : (P) Make up the acid extractive to 50 Cc. (for convenience in calculation). Evaporate 1, 24, 5,10,124 and 15 Cc. to dryness in white basins. Add 50 mgr. Ammonium Molybdate in powder and 2 drops Sulphuric Acid to each, mixing intimately, and observe the colours against volumes of Ergotoxine Ethanesul- phonate solution, which may be of strength 0-006%. The colour is produced bv Ergotoxine and by Ergotamine. Supposing it to be found that the colour from 12£% Cc. of acid extractive equals that from 5 Cc. of Ergotoxine Ethanesulphonate solution, it follows that L25 Cc. of the liquid extract under examination = 0-0003 Gm. Ergotoxine Ethanesulphonate. Therefore the liquid extract contains 0-02% Ergotoxine (the Ethanesulphonate containing 84% of Base), or, according to the Pharm. Commission’s approximation, 0-033% approx, of Total Alkaloids. From the work done, we admit the proposal as a quantitative test needs further research. It is of interest to remark that though Ammonium Sulpho-molybdate gives various colours with divers alkaloids the slate-blue with Ergotoxine is very- distinctive and delicate. Tryptophane and Skatol do not give the blue colour but a green—except in presence of water. The possibility of slight decomposition of the alkaloids by evaporating must be taken into consideration. ;£> 1; Extractum Ergofte (B.P. ’14.) Syn.—Ergotin (B.P. ’98), Ergotin a Bonjean, P. Ital. V., E.E. VIII., P. Belg. IV. Dose.—2 to 8 grains (0-12 to 0-5 Gm.). B.P. ’14 and Er. Cx.—an aqueous extractive precipitated by alcohol and evaporated. In chronic cases of hsematuria occasionally useful.—Tirard. PH Tablets and Pills, 1, 2, and 3 grains. Dose.—1 to 3. [PI1 Capsules of Ergotin contain 3 and 5 grains (0-2 and C-3 Gm.). (cf. also Capsules Apiol and Ergotin.) •P I 1 Tablets of Ergotin, Senecin Compound contain Ergotin \ grain, Senecin J grain, Hydrastin J grain, Hamamelin 1 grain, Chloretone l grain. Useful in dysmenorrhoea and menorrhagia. Ergodex (T.M. 515019) Dose.—10 to 30 minims. (0'6 to 2 Cc.). Contains 0-03% Ergotoxin. Contains the whole alkaloidal content of Ergot and is suitable for oral use. It retains full activity for 12 months.—B.M.J. i./31,501. (Plllnjectio Ergotse Hypodermica (B.P. ’14). Dose.—5 to 10 minims (q-3 to 0-6 Cc.). Ergot Extract 33% in Distilled Water with 1% Phenol. Should be freshly prepared. Use,-—A dose of Ergotin, injected deeply into the gluteal muscles just before delivery, generally promotes uterine contraction. (IQ! Sterules, Hypodermic contain 10 minims of this injection. j3] iPJj Injectio Ergotina et Morphinae Intramuscularis, S-D.H. Dose.—10 minims (0‘6 Cc.). Ergotine 10 grains, Morphine Acetate 1 grain, Water to 30 minims. gpj] Liquor Ergotse Aminoniatus.—1 = 1 of Ergot. Dose.—10 to 60 minims (O’6 to 4 Cc.). Made with diluted Ammoniated Alcohol. The combination of Ammonia and Ergot is indicated in some forms of post-partum haemorrhage, etc. In dose of J to 1 drachm is useful in second stage of labour when the pains are feeble but the passages are normal. IP 1| Elixir Ergotae cum Ferro.—Martindale. Dose.—2 drachms, repeated if necessary. Dissolve Iron Pyrophosphate (U.S. VIII., no other) 5 grains in 1 drachm of warm water and add to Liquid Extract of Ergo 10 minims, mixed with Simple Elixir (B.P.C. 1894 50 minims). For anaemia and excessive (or diminished) menstruation in young women. Tinctura Ergotae Ammoniata. (B.P. 14). Dose.—30 to 60 minims (2 to 4 Cc.). Strength 1 of Ergot in 4 of finished Tincture. The ammoniated Tincture of Ergot found to be the most potent—far more so than the liquid or other Extract.—H. Spencer, B.M.J. ii.(22,1174. An Ammoniated Tincture found to contain more than one-third the activity of the U.S.P. fluid extract.—C.D., Jan. 15, ’26, p. 71. The only B.P T4 preparation of Ergot where any quantity of the active principle is retained is the Ammoniated Tincture, which retains one quarter, other preparations lose 97%.—Prof. A. J. Clark, B.M.J. i./27,763. (fPT[j Mistura Ergotae Sedativa S.H. Ammoniated Tincture of Ergot 10 minims, Potassium Bromide 7J grains, Potassium Chlorate 7J grains. Glycerin 15 minims, Chloroform Water to 1 ounce. IP 1) Mistura Ergotae Composita. Dose.—h ounce (15 Cc.). Liquid Extract of Ergot 20 minims, Ferric Chloride Solution 10 minims, Quinine Hydrochloride 2 grains, Glycerin 1 drachm, water to J ounce. Mistura Ergotae Alkalina. St. M’s. II. Dose.—1 ounce (30 Cc.). Ammoniated Tincture of Ergot | drachm, Iron and Ammonium Citrate 3 grains, Tincture of Ginger 20 minims, Chloroform W ater to 1 ounce. [jpIErgotinina, Ergotinine Cristallit&e, C3jH4iN506, Fr. Cx. Supp. jDose.—2J(T to rh grain (0*0003 to 0*001 Gm.). Fr. Cx. has the latter as max. single dose. _ . . An alkaloid in minute yellowish crystals, insoluble ^ water. So.uble Alcohol (1 in 200 of 95% FR. Cx.), less in Ether, very Active con- This alkaloid has been proved to be inert. Ergotoxme is the actu stituent, see Absts., p. 401. FH Ergotininse Citras. Dose.—tAq- to 31,, grain (0*0004 to 0*002 Gm.). A soluble salt of the base, in greyish powder. HI Hypodermic Tablets contain ¥Ao and grain. WJ\ Ergotoxine. C35H4106N5=627*3696. Dose, to At grain. Is described as amorphous and hardly soluble in water, and strongly active physiologically (see p. 401) on the uterus raises blood pressure, and is the principle in Ergot that produces gangrene in the cock’s comb on injection. Solutions in dilute Caustic Alkali are injected. Ergotinine is stated to be the Anhydride of Ergotoxine. ipiCornutine is apparently impure Ergotoxine. .El Hypodermic Tablets contain Ergotoxine 1/100 grain, also [Ji]lj[T| with Morphine Sulphate 1/6 grain, and HI with Strychnine Sulphate 1/20 grain, the latter being used in collapse or shock. !H Injectio Ergotoxinae Hyp'odermica 0T2% (Tfo grain hi 8 minims). Dose.—2 to 15 minims (0*Y to 1 Cc.). jpjErgotoxine Ethanesulphcnate—A new white, crystalline, stable and soluble salt. Dose.—^ to grain hypodermically. Ergotoxine Ethanesulphonate 1/100 grain in 1 Cc. replaces Tniectio Ergotse Hypodermica at London Hospital.—C. H. Sykes, P. J. ii./31,513. Ergotamine of Stoll. m the past it has been held that this is identical with Ergotoxine. Pharmacologically, as already stated, they are the same, but it is now established that they are different chemically. The following recent discussion is of interest. Ergotoxine and Ergotamine are the active principles of different Ergots Ergot from fescue (a New Zealand grass) examined.—S. Smith and G. M. Timmis, L. n./3o,652. According to Prof. Stoll, Ergotamine (C33H3SN5O5) is contained in Ergot of Rye and used as Tartrate in making Femergin (vide infra), and it possesses the specific properties of the active principle of Ergot.—L. ii./so 873. Ergotoxine may perhaps be converted into Ergotamine in manufacture. Rye may perhaps be infected with a type of Claviceps, producing Ergotoxine or Ergotamine exclusively in some districts.—Reply to Prof. Stoll by S. Smith and G. M. Timmis, L. n./3o,994. Smith and Timmis maintain as already stated.—L. ii./3o,1148. Prof Stoll’s firm have established a strong presumption of complete identity in action between the two alkaloids, but clinical records exist for the action of only one of them.—H. H. Dale, L. ii./3o,1149. Since the introduction of Ergotamine a number of cases of severe gangrene have been attributed to it by certain authors— B.M.J. ii./3i,1100. Ergotamine Tartrate is official in P. Belg. IV. with formula (C33H3505N5)2.C4H606 + 2CH30H. Femergin (T.M. 414931) Tablets, contain 0*001 Gm. Ergotamine Tartrate (Sandoz). Urticaria of vagotonic or sympatheticotonic origin treated with Ergotamine Tartrate. Dose.—2 to 3 mgr. per os daily for 2 to 3 weeks.—B.M.J.E. ii./ao 44. Graves s Disease.—Ergotamine Tartrate injections, 1 mg. intramuscularly gave improvement, but not in severe cases—Per Pres., Nov. ’29 391. - Or subcutaneously 1/250 grain each morning, repeated in the evening, if tolerated. Suspend for a week or two after 20—25 days.—Per Pres Nov ’^9 391 Migraine treated by Ergotamine Tartrate, 2 mgr. daily, by mouth* with additional 2 mgr. when an attack is threatened—Per Pres., Jan ’29 33 Ergot Amines. v.rnutin (l.M. 27/8bo). A Solution physiologically standardised for hypodermic use, containing Ergotoxine, Tyramine and Ergamine (v. infra). In tvo forms (a) for oial. Dose. 30 to 00 minims to be given per os after labour is completed, every three hours until contraction effected, and (b) for hypodermic use. Dose.— 5 to 10 minims after expulsion of the placenta. In addition to the alkaloid Ergotoxine, Ergot contains certain Amines. Two are 01 importance. (a) p-hydroxyphenylethylamine (Tyramine vide postea) produced by splitting off CO a from Tyrosine. This has an action similar to, though weaker than, Adrenine, produces contraction of the cat’s uterus in the pregnant, and inhibition in the non-pregnant, condition. _Jb) Histamine or Ammo-Ethylglyoxaline C3HtN2—CH3—CII2.NH2. Syn. Ipj3§jErgamine (T.M. 324681) (i.e., /3-Iminazolylethylamine) produced from Histidine by splitting off C02. It is a perfectly stable substance, and solutions can be boiled \without risk of decomposition. There is no reason why Phenol should not be added to Histamine solutions. It has intense action on plain muscle. The plain muscle fibre of the uterus in particular is stimulated to contraction by minute doses. It causes fall of blood pressure. Hypodermic Tablets of Ergamine contain l/65th grain (0*001 Gm.). (Histamine Acid Phosphate is available in commerce.) Spasmodic Asthma in connection with Histamine, see Edn. XIX., Yol. I., p. 407. Histamine, being formed by decarboxylisation of Histidine, which is derived from proteins, it is conceivable that such substances are produced in trauma. This is an explanation of shock differing from that of the acid causation theory (Almroth Wright’s).—L. Hill, B.M.J. l./2i,771. Subcutaneously, Histamine excites a flow of gastric juice in man.—A. R. Matheson and S. E. Ammon., L. i./23,482. Histamine is present in small amounts in enzymatic products, it is found among the hydrolytic products of crystallised albumin and casein, and may be obtained from acid-treated tissues, e.g., the liver, the posterior lobe of the pituitary, and other tissues. It has been isolated from the intestinal wall of the ox and from aqueous extracts of the fish called Magaro. Histamine is thought to occur as a labile precursor, from which it is liberated by acid and heat employed in the treatment of the organ extracts. Protein metabolism of the body may be its true source. Injected subcutaneously into human beings, it produces a violent and intense erythema all over the body, headache, conjunctivitis, parsethesias, vomiting, tenesmus, bronchial spasm and unconsciousness.—J. J. Abel, Jl. Ph. Exp. fher., Feb., ’24,1. , Injury to, or irritation of, the skin causes liberation 01 Histamine or an allied body which produces the reddening.—Per Pres., Oct., ’28,317. Histamine derivatives.—B.C.A. ’28,A. 1145. . , The stimulating power of Histamine Phosiihate on the ureter is grt atm than that of Pituitary Extract. It increases the general tonus of the ureter. C. M. Gruber, Jl. Pliarm. and Exp. Tlierap., Oct., *2 8,207. Further on Histamine, see Vol. I, pp. 662, 665, 667, and Pituitary Ola . Histamine in Relation to Blood Pressure. < . . Histamine is, no doubt, liberated from the tissues m response to injury. Intravenously in cats in a dose of 1 to 2 mgr. per kilo it causes rcspirat y disease, due to contraction of bronchiolar muscles, and rise oi blood pi_ » due to contraction of muscles of arterioles. Profound fall of blood Pie; follows within 4 or 5 minutes. It has a powerful dilating effect on the smallest vessels. The hypothesis of ‘ Histamine Shock is that■the cir brought to a precariously low point by depletion of the central _>■ . » rich corpuscular blood remaining locked m the minute vessels effects its fluid part finding its way into extravascular tissue spaces.> , in man with small intravenous or subcutaneous doses. L g .. bTesg cutaneously (6 to 8 mgr.) cause fall of blood pressure, resp^_ 3^. ls 0£ contraction of stomach, and occasionally collapse. The _lOff (H K. the Human Skin and their Responses, Iliomas Lewis \.i9~/)> b \ • Cheyne-Stokbs RESPIRATION.—Xormal breathing vcon for about 6 hours after small dose of Histamme sub . arms and headache, feeling of warmth, and occasional reddeni 8 injections next neck—symptoms pass off in an hour, following t_ . Woch. day Cheyne-Stokes respiration ceased altogether. * * * ’* *930,1819, per Pres., Xov., ’30,655. . We know of a case in which it was tried (“J^i^the StSg for ^ immediate effect was intense headache and flushing of the face lasting hour. Apomigran. A homoeopathic proprietary containing Histamine and Sodium Sulphate. In one and liver affections. SOI V- "Hydroxyphenylethylamine. Syn. ^ TyRAMIXE (T.M. 309250): Uteramix, Systogex, OH.C3H4.CHaCH2NH2 = 137 0938. Dose.—1/12 grain (0*0G5 Gm.), repealed if necessary. An organic base which is stated to be the chief active principle of aqueous extracts of Ergot. It contributes along with Ergotoxine to the action of Ergot, and is a constituent with the latter in Ernutin. Uses.—its action is similar to that of the suprarenal active principle, but weaker, slower, more persistent and less toxic. Given hypodermically or by the mouth it produces a marked rise of blood pressure, with increased vigour of the heart’s action. Administered in shock or collapse and for producing contraction of the uterus post partum .but it is stated to have no value in obstetrics (r. infra). Guggenheim found doses o f0‘02 Gm. para-oxyphenyl-ethylamine failed to have any influence on parturient women.—P.J. i./13,905. IP II Hypodermic Tablets of Tyramine contain ^ grain (002 Gm.). Other Ergots than that of Rye are equally or more active. Ergot of Fescue grass from New Zealand shows chemically 0*34% alkaloid—Wheat Ergot from Sweden contained 0’12%.—F. H. Carr and H. H. Dale, P.J. ii./i3,130. See also H. A. D. Jowett, P.J. i./i 3,334. Tyramine has no value in obstetrics. Histamine, 2 mgr. hypodermically produces a powerful but short-lived effect and exhausts uterine activity. The specific alkaloid (Ergotamine or Ergotoxine) exerts a prolonged action ideal for use after delivery.—A. Bourne and J. H. Burn, P.J. ii./27,490. BMP Acidum Scleroticum.—Syn. Sclerotinic Acid. = 321-1562. C12H19NO„(?) Dose.—| to | of a grain (0*03 to 0*05 Gm.) hypodermically in 10 minims of water. An amorphous brown hygroscopic acid principle obtained from Ergot. Haemostatic and anti-epileptic. P j] Hypodermic Tablets contain TV grain (0*004 Gm.) Sclerotic Acid. ERYTHROL NITRAS. CH2.0N02—(CH.0N02)2—CH2.ONO2=302*0788. Syn. Erythrol Tetraxitrate ; NiTRO-ERYTHRITE. ERYrTHRO- TETRAXITRAL. Dose.—J to 1 grain (0*03 to 0*06 Gm.), increased to 3 grains or more in tablet form vide infra. In colourless and slightly tar-like smelling crystals, soluble in water about 1 in 20,000, about 1 in 60 of absolute alcohol; melting point, 61° C. It is formed by dissolving erythrol (a sugar obtained from various lichens, e.g., Rocella tinctoria, R. fuciformis, etc.), in fuming nitric acid, and precipitating by sulphuric acid ; is explosive, except when in solution in chocolate. Uses.—x4s a vasodilator like Nitroglycerin and Amyl Nitrite. Its slight solubility as against Nitroglycerin (1 in 800) renders action slower and more prolonged in reducing blood-pressure. Employed in angina pectoris, chronic Bright’s disease, nephritis, aneurism, Raynaud’s disease, dyspnoea, headache, and nervous affections. For angina, to avert paroxysms, even half a drachm a day has been taken. Tabellse Erythrol Kitmtiz.—Mariindale. Dose.—I or 2. Contain grain (0.03 Gm.), combined with chocolate. Tabellas ir an(^ 1 grain (0*008, 0*016 and 0*06 Gm.) are also prepared. Prsecordial pains are promptly relieved by a tablet three times a day. Daily use of the tablets., beginning with £ grain thrice daily and gradually increasing, will ward off attacks. Cumulative effect or tolerance has not been observed. Intermittent closing of cerebral arteries. Various questions to consider as to treatment: Spirit of Nitrous Ether controls the irritable tonicity of the vessel walls ; where symptoms are urgent Erythrol Nitrate £ to \ grain repeated every 3, 4, or 6 hours, as required, is advised.—W. Russell, B.M.J. ii./og, 1110. Melancholia, in which affection the blood pressure is often found abnormally high, is frequently relieved by lowering it. Start with J grain tablets twice daily and slowly increase the dose to two or three grains daily.—Robertson, B.M.J. i/11,800- In arteriosclerosis Erythrol Tetranitrate useful.—M.A. 1911. In aortic disease for relief of serious pain Amyl Nitrite and Nitroglycerin are employed (g.r.). Erythrol Tetranitrate produces little effect until half an hour after its administration, and the maximum effect is produced at the end of an hour ; the arterial tension gradually increases again, but it does not return to its previous condition until about ten hours after the dose has been taken.—Tirard. Asthma, very effective during the paroxysm, especially if followed by some hot drink, e.g., Bovril; relief lasts at least 24 hours.-W. W. W. In lead colic Erythrol Nitrate is an excellent sedative, as it relaxes the painful spasms of the intestinal coats. Hyperpiesis. Iscamylamine. NH2.C6HU. A liquid compound, boiling at 95°C. See also Adrenalin chapter. The retention of this pressor base in the body is the chief causal agent. Reduction of blood pressure the only treatment. Erythrol Nitrate of value before beginning hydrotherapeutic measures.—W. Bain, L. i./2 8,389. Mannitol Nitrate, CH2.ONO2.(CH.ONO2)4CH,.ONO2=452-1104. aSyn. Hexanjtein. Niteomannjte. Dose.—1 grain (0*06 Gm.), increased. The nitrate of the hexahydric alcohol mannite, C6H8.(OH)6 = 182*1092. In light acicular crystals, M.pt. 113" C. ; is less soluble in water but more explosive than erythrol nitrate. Requires extra care. Is used similarly to erythrol nitrate. In angina and asthma its action is not so powerful, but probably more prolonged. Tabellse Mannitol Nitratis.—Martindale. Contain 1 grain (0*06 Gm.) in chocolate basis. Prof. Silvan (Clinique de Bologne, Italy) reported that in cases in which a hypotensive condition represents the predominant symptom, or at least the most apparent cause of many of the morbid points complained of by patients, this substance, with which one can successfully diminish and maintain tor a considerable time a reduced pressure, has given satisfactory and comforting Mannitol in the leaves and cork of the olive tree, seasonal variations.— P.J. i./3i,105. EUONYMI CORTEX. The Root Bark (B.P. ’14) obtained from Euonymus atropurpureus (Celastracece:), the wahoo or spindle-tree. Euonymus Atropurpureus should be carefully distinguished from spurious barks. It should show externally longitudinally striited cork and a tangentially striatified fibre and delicate threads when gently broken transversely, also medullary rays consisting of a single row of cells.—E. M. Holmes, P.J. i./i8,88. Uses,—Possesses tonic, liydragogue, cathartic, diuretic, and anti-periodic properties. Extract of Euonymus (B.P. ’14). Syn. ExJNOYMIIsr. Dose.—1 to 2 grains (0*06 to 0*12 Gm). Tablets, J grain. J to 1 grain cholagogue, 1 to 4 grains cathartic. A brown alcoholic extractive containing calcium phosphate to keep it as powder. In commerce chlorophyll is sometimes added. Fr. Cx. has Euonymine Brune, max. single dose 1§ grains. Pilula Euonymin. Euonymin 2 grains, Extract of Henbane \ grain, for one pill; taken at bedtime. A cholagogue stimulant, producing no depression or headache ; requires to be followed by a saline aperient in the morning. One grain, combined with 4 grains of Iridin, is a successful purge. Extraetnm Euonymi Liquidum. 1 = 1 made with Alcohol (90%) 4, Water 1. Dose.—10 to 60 minims (0*6 to 4 Cc.) Tincfura Euonymi. Dose.—10 to 40 minims (0*6 to 2*5 Gc.) Strength 1 in 5 of Alcohol 45% Liquor Euonymini et Cascara. B.P.C. Bose.—I to 1 drachm. Liquor Euonymini et Iridini. B.P.C. Dose.—1 to 1 drachm. Rub Dry Euonymus Extract 3-63 and Iridin 1-83 with Alcohol 45% 50. Filter and add Potassium Carbonate 1*37 in water 25, and make up with Alcohol 45% to 100. Purgative and presumed cholagogue. Liquor Euonymini et Pepsini (Glagsow Formulary). Dose.—b to 1 drachm (2 to 4 Cc.). Euonymin 155 grains, Pepsin Soluble (Scale) 310 grains, Dilute Hydrochloric Acid 340 minims. Alcohol (45%), 6 ounces. Chloroform Water to 20 ounces. FEL BOVINUM FURIFICATUM. Purified Ox Bile. Dose.—5 to 15 grains (0-3 to 1-0 Gm.). (B.P.T4). A dark greenish brown bitter-sweet mass. Sol able in water and alcohol 90%, insoluble in ether. 3Ian a fact a red by evaporating 20 of fresh ox bile to 5, mixing with 10 of alcohol 90%, separating the precipitate and evaporating the clear fluid to thick extract consistence. It is composed of bile salts, cholesterin, lecithin and bile pigments. It is best given in ‘ Stearettes ’ containing 5 grains. Capsules contain 5 grains. Uses,—An emulsifier of fat and a stimulant to the action of the liver. Has been given in jaundice and typhoid. A small quantity diluted with water may be used as an enema in obstinate constipation. The bile of venomous snakes is said to act as antidote to their poison. Fel Bovlnum Exsiccatum.—Dose.—5 to 10 grains in cachets. Dysentery has been treated with satisfactory results by rectal injection of 1J—2 ounces of fresh bile of sheep. Extractum Feliis Bovis U.S.X. is made by alcohol extraction and adding starch so that 1 of extract equals 8 of ox gall. Tablets of Ox Bile, Glycocholic Acid and Extract of Sage, of each 0T Gin. of value in gastric or duodenal ulcer.—B.M.J.E. ii./29,34. FERRUM. Fe=55*84. Ferram Redactum, Syn. Quevenne’s Iron. Dose.-—1 to 5 grains (0-06 to 0-3 Gm.). Fine powdered iron containing at least 80% (U.S. 90%) metallic iron, prepared by reducing ferric hydroxide with hydrogen. Incompatible with tannin and metallic salts. As the human body contains only about 39 grains of iron, to give large quantities, e.g., 6 to 10 grains per diem is futile.—H. Fills of Reduced Iron require J to J grain Compound Tragacanth Powder to bind them. Trochisci Ferri Redacti contain 1 grain. Ferri Carbonas Saceharatus (B.P. ’14). Dose.—10 to 30 grains (0-6 to 2 Gm.). Ferrous oxycarbonate, rrFeC03 yFe(OH)2, partially oxidized and mixed with glucose (sugar in ’gS B.P.), the mixture containing not less than 50% (B.P.'g8 33%) of its weight of ferrous salt if reckoned as carbonate FeC03= 115*84. P. Ital. V. requires 9*5 to 10*5% Fe. Incompatible with tannin-containing drugs, also with acids and acid salts. Ferri Carbonas Saceharatus Goncentratus. . , Four times as strong as the U.S. preparation, i.e., containing about 60 /0 of Ferrous Carbonate. Uses,—For ansemia and chlorosis of young women, x he dose may be increased up to 10 grains daily of Anhydrous Ferrous Carbonate. Capsules and Tablets of Saccharated Iron Carbonate, contain. 5 grains (0*3 Gm,). Pilula Ferri (B.P’14). Syn. Blaud’s Pill. Dose.—5 to 15 grains (0*3 to 1 Gm.). Each 5 grains contain about 1 grain of Ferrous Carbonate. When palpitation occurs in connection with ansemia or chlorosis, the frequent employment of iron pills or of powders of reduced iron will prooaoly remove the cause and so allay the symptoms.—Tirard. # Massive Iron Therapy—up to 60 grains Blaud’s Pill daily—the m^t effec- tive treatment of secondary amemia.. F errous better than Ferric salts. B. - Discussion.—L. ii./31,531. Vide Ferri Subchlondum. } Subacute combined degeneration of the cord successfully Beaded. by Bland s Pill 150 grains daily, in capsules. Liver treatment may be necessary m addition.—W. Sargant, L. L/32,232. .. , w CW(. as adjuvant to Iron, see Ferrous Chloride and Ferrous For the Estimation of Ferrous Carbonate and Effects on the Blood, see lot. II, Capsules of Bland Pill equal to 5 grains of the pill are made. Tablets, 4 and 8 grains. Dose.—1 to 4 four-grain, or 2 eight-grair Tablets, also made Ijp lj 4 gr. with Arsenious Acid dy gr. Dose.—1 to 4 Capsules (5 grains) are also made in the following combinations “ With Aloes, 4, or 1 grain ; jp4] with Arsenic Tdo> do grain ; with Cascara Extract, 3 grains ; |]p i] with Nux Vomica Extract, J grain with Quinine Sulphate, 1 grain. Ferri Citras. Average dose.—4 grains (0-25 Gm.). Contains ferric citrate corresponding to not less than 16% metallic iron. Garnet red soluble scales with slight ferruginous taste. Ferri et Ammonii Citras (B.P. ’14). U.S. X. Dose.—5 to 10 grains (0-3 to 0-6 Gm.). Yields 31% or 32% ferric oxide (B.Pd 14). Contains 16 to 18% metallic iron (U.S.) Dark red scales soluble in about half their weight of water. P. Off. A neutral compound. It should contain 7 to 8% Ammonium and 53—57% Citric radical (C6H507). Aqueous solution has pH 7-5. In debility and aneemia. Especially preferred in lingering cases cfgastric catarrh after alkalis have ceased to benefit and the stomach is not ready for an acid tonic. Also with Sodium Salicylate in subacute rheumatism of children. In Anemia of Children had no appreciable effect.—X. K. Gibbs, L. ii./29,550. Chlorosis in young persons well treated by Iron. Chronic microcytic anemia in mid-life treated by Ferric Ammonium Citrate, 60 to 120 grains daily for 4 to 5 months.—L. J. Witts, L. i./3i,146. Ferrous salts in 4-grain doses may give results in 6 weeks.—Prof. J. A. Gunn, ibid. Prof. A. J. Clark, P.J. ih/32, and Ferrous Chloride and Ferrous Sulphate. Simple aclilorhydric anaemia treated by Iron and Ammonium Citrate. 90 grains daily increased to 120 grains.—D. C. Hare, B.M.J. ii./3i,889. Ferri et Ammonii Citras Viridis. Dose.—5 to 10 grains (0-3 to 0-6 Gm.). Hypodermically 4 grain in 1 solution, but for this purpose it must be neutralised. Ste^ules 4 (0-03 Gm., 1 grain (0-06 Gm.) and 2 grains (0-12 Gm.) in 1 Cc., also with Strychnine Hydrochloride do grain (0-001 Gm.). Ferri Hydroxidum cum Magnesii Oxido, see Antidotum Arsenici. Ferri Subchloridurn. Sign. Ferrous Chloride, FeCl2 = 126*754. Dose.—2 to 5 grains (0-12 to 0-3 Gm.) in Slipules. May bo prepared by heating Metallic Iron in dry Hydrogen Chloride White feathery crystals, very deliquescent. Us US,—In anaemia in young females. It is probable that the Ferrous Iron is more active than Ferric —See Prof. A. J. Clark, P.J. ih/32, 2. Ferrous Chloride, 2 grains (0T2 Gm.) and Copper Sulphate 1/120 grain (0 0005 Gm.) Slipules. Dose.—One or two after meals daily, carefully increased if desired. Coas adjuvant to Iron. In^fANiEMiA, experiments show that while pure uncontaminated Iron is ineffective, the addition of small amounts of Copper, Gei- manium, Nickel, Arsenic or Manganese make it effective—the results being essentially the same with all the supplementary elements. A large number of other elements tried with negative results.—V. C. Myers and Id. H. Beard, Jl.A.M.A. ii./2Q,1210. See also Prof. A. J. Clark, P.J. i./32, 511. Copper is not contained in haemoglobin but is a constituent in animal and vegetable cells. Copper should be given in conjunction with Iron.—E. Schiff Med. Welt., per B.M.J.E. h/31,82. Idiopathic anaemia in women between 20 and 40 treated.—E. S. Mills, per M.A., ‘31,29. jjcEiidomin Tablets (T.M. 506961).— A proprietary containing Iron 8 mgr., Copper 0-6 mgr., Manganese 0-4 mgr., Zinc 0-3 mgr., Nickel 0-3 mgr., Cobalt 0-03 mgr. and Sodium Germanate 0-005 mgr. Dose.—1 to 3 tablets thrice daily. For use in anaemia in conjunction with a palatable easily-digested diet, rich in Vitamins. Ferri Perehloridum, Syn, Ferri Sesquichloridum, Ferrtjm Sesqtjichlorattjm. Fe2Cl6.12H20 = 540*614. Dose.—2 to 8 grains (0-12 to 0*5 Gm.). Deliquescent yellow masses made by evaporating the stronger official solution and crystallizing. Incompatible with infusions, etc., containing tannin, with the alkalis, alkaline carbonates, iodides, salicylates and mucilage of acacia. With Potassium Iodide in presence of Potassium Citrate a Potassium Ferricitrate is formed, and hence is compatible. Uses.—A well-known tonic in anemia and rickets, has astringent action and is a useful styptic (it may be used in the solid form). Erysipelas.—Large doses of Iron Perchloriie Tincture probably aid phagocytosis.—Whitla, Pract. Med. < See also p. 414. The Perchloride is the most diuretic preparation of Iron.—H. Iron decreases the elimination of uric acid, which may account for the production of headache in rheumatic patients under its influence. H. Its administration may bring on an attack of gout.—W. W. W. Gastric Ulcer has been treated by lavage with 100 Cc. of a solution 01 Ferric Chloride 1 in 1,000 repeated for 4 or 5 days, or a3 required. T. H. orders for Nebula Ferri Perchioridi, 5 grains and Glycerin 15 minims; for Pigmentum Ferri Perchioridi 60 grains to 120 grains of this salt to each ounce of solution. Glycerinum Ferri Perchioridi, G.K., has Ferric Chloride 1, Glycerin to 5. For use as a paint. Glycerin and Chloroform W ater cover its metallic astringent taste. Loeffier’s Pigment for Diphtheria. Menthol 10, Toluol q,s, to 36, Ferric Chloride Solution 4, Absolute Alcohol to 100. To apply on wadding every 3 hours. 1 ainful in use. Dilute Hydrogen Peroxide is preferable. ‘ Gollapsubes * with rectal tube contain Ferric Chloride 1 in 40 with soft paraffin basis for piles. Gossypium Stypticum. Syn. Gossypium Ferri Perchloridi. Saturate Absorbent Wool 85, with Water 100 containing Ferric Chloride 15 and dry. Linteum Stypticum is made similarly. (In Ph. Ned. IV., Gossypium Stypticum contained at least Quinine Hydrochloride, and no iron.) Liquor Ferri Perchioridi FGrtis (B.P. ’14). ^ n Has Sp. Gr. about 1-49. Its yield of Fe,03 is .■-42 Gm. from 5 Cc. Liquor Ferri Chloridi, U.S. X. Contains 10 to 11 Cm. X c in 100 Gm. Average dose.—1J minims (0-1 Cc.), 2°/ o Fe. Liquor Ferri Perchloridi (B.P. ’14). Dose.—5 to 15 minims (0*3 to 1 Cc.). Strong Solution of Ferric Chloride 1, Water to 4. Contains about 5% Fe. Sp. Gr. and Iron content do not agree.—Y.B.P., *24,754. Septicaemia has been treated by full doses of the liquor spread over 3 days. Ringworm treated with strong Ferric Chloride Solution. Do not ivctsh the head during the treatment.—J. H. Garrett, B.M..T. i./i3,390. Liquor Ferri Sesquichlorati (Ferric Chloride Solution), P.G. VI. Contains 10% Iron approx. As in U.S., there is only one strength of this solution. Tinctura Ferri Perchloridi (B.P. ’14). Dose.—5 to 15 minims(0’3 to 1 Cc.). A 25% dilution of Strong Solution of Ferric Chloride with, water, containing a proportion of Alcohol. (14*5 Cm. Anhydrous Ferric Chloride in 100 Cc. approx. U.S. about 13%.) Flavoring.—Syl Aurantii Floris (double dose) ; Syrupus. Owing to the fact that ferric chloride does not remove any of the acid of the gastric juice (as when reduced Iron or Blaud’s Pills are given), this is preferred by many. Thread-wnrms are killed by rectal injection of a drachm of the tincture in 10 ounces of water. Angio-neurotic oedema has been treated with drachm doses repeated if necessary every 20 minutes. Strumous children with tuberculous bone disease or enlarged glands have been treated with 5 to 10 minims, with 10 to 20 minims of solution of mercuric chloride t.d.s. given over long periods. Cutaneous erysipelas. An old effective remedy is local application of Strong Solution of Ferric Chloride, also internal use of Tincture of Ferric Chloride.—F. T. Larkam, B.M.J. i./2i,36. For further uses see Ferri Perchloridum, anted. Mistura Ferri Aperiens. U.C.H. Magnesium sulphate 30 grains, ferrous sulphate 2 grains, diluted sulphuric acid 2 minims, peppermint water to 1 ounce. For the cure of inebriety. [p 1| Mistura Ferri Arsenicalis. U.C.H. Citrate of iron and ammonium 3 grains, Arsenical Solution 3 minims, infusion of calumba to 1 ounce. Dose.—4 to 1 ounce. R.O.H.—Iron and Ammonium Citrate 5 grains, Arsenical Solution 3 minims, Tincture of Calumba 10 minima. Water to 1 ounce. Mistura Ferri Salina. U.C.H. Potassium citrate 22 grains, solution of ferric chloride 24 minims, chloroform water to 1 ounce. The styptic taste of iron is masked in this mixture, as a double decomposition occurs between the iron and the potash salt. Liquor Ferri Dialysatus (B.P. 1885),—-Sp. Gr. 1’047. Dose.—10 to 30 minims (0*6 to 2 Cc.). Better tolerated thpn the strong acid preparations. Contains about 5% Ferric Oxide. To be prescribed as “ drops,” undiluted, or mixed with glycerin. Glycerinum Ferri Dialysati. Dialysed Iron Solution 1, Glycerin 2. Keeps well and is palatable. Dose.—1 drachm (4 Cc.). Dialysed iron is useful as an antidote to arsenic—much superior to the moist peroxide ; 1 ounce doses should be given repeatedly, preceded by a dose of common salt or sodium bicarbonate. FERRUM. 415 Fernim Oxydatum Saceharatnm, P. Atjstr., P.G.VI., Saccharated Ferric Oxide. Dose.—10 to 40 grains (O'6 to 2'5 Gm.). Diliite Ferric Chloride Solution (P G.) 30 (by weight) with Water 150. Then add with stirring a solution of Sodium Carbonate 26 in Water 150 (towards the end of the precipitation before each fresh addition of the alkali one waits for the re-solution of the.precipitate). Wash to free from Chloride, collect on cloth, press slightly, mix in porcelain dish with powdered Sugar 50 and so much Rydrate Solution (Sp. Gr. 1-17) as is required to dissolve on a water bath (not more than 5 to be used), evaporate and dry and mix with Sugar q.s. to make 100. Liquor Ferri Pernitratis (B.P. 1898). Dose.—5 to 15 minims (0*3 to 1 Cc.) A reddish brown solution containing ferric nitrate Fe3 (N03)<5 = 483-912 Sp. Gr. 1*107, contains 3*3% Fe. Uses similar to those of the solution of the perchloride. For children in convalescence from prolonged chronic diarrhoea, 1 to 2 minim doses are useful. Vinum Ferri, U.S. VIII. Average dose.—2 drachms (8 Cc.). Iron and Ammonium Citrate 4, Tincture of Sweet Orange Peel 8, Syrup 10, White Wine to 100. Vinum Ferri Am arum, U.S. VIII. Average dose.—2 drachms (8 Cc.). Soluble Iron and Quinine Citrate 5, Tincture of Sweet Orange Peel 6, Syrup 30, White Wine to 100. Organic Iron Compounds. The haemoglobin content of the blood is thought to increase by the use of some of these compounds. Triferrin. Syn.—FERRI NuCLEINAS, FERRINOL. Dose.—15 grains per diem after meals in divided doses. An insoluble powder said to contain 21% of Iron and nearly 3% of Phosphorus. In anaemia and in phthisis. Liquor Ferri Alhuminati (after Dieterich). A\ as in P. Jap 1907 slightly modified. Dose.—1 to 4 drachms (4 to 15 Cc.). P.G. VI. adjusts by analysis during process of making, so that the ultimate preparation contains 0*39 to 0*4% of iron. Ph. Ned. V. contains 0-^o/o Fe2G3. We give further data in Edn. XIX, p. 415. Liquor Ferri Peptonati (after Dieterich; Liquids to be weighed). Dose.—1 to 4 drachms (4 to 15 Cc.). Dissolve dried egg albumen 10 in distilled water 1,000 ; add to this pepsin 0-5 and hydrochloric acid 14. Digest the mixture for 12 hours at 40 G. (104° F.) cool and neutralize with solution of soda; then add solution 01 chloroxide of iron 120 diluted with distilled water 1,000. Again neutralize exactly with diluted soda solution, collect, and wash, precipitate free irom chloride. , . .. Transfer to a tared bottle and dissolve in hydrochloric acid 1*17, warming slightly, add simple syrup 10, compound tincture of cinnamon 10, aico 10 (90%) 150, and distilled water to 1,000. This solution is clear by transmitted light but opaque by reflected light. Liquor Ferri Peptonati cum Quinina. Dose.—1 to 4 drachms (4 to 15 Cc.) Contains 4% of Quinine Hydrochloride. Elixir Ferro-Manganesii Peptonati. Dose.—1 to 4 drachms (4 to 15 Cc.). Contains, in addition to Iron, 0*1% of Manganese. A useful and palatable hsematinic. Liquor Ferro Manganesii Peptonati cum Haemoglobin (5 grains in the drachm)—suspended, will not dissolve to this extent. Also Liquor Iodo-Ferro-Manganesii Peptonati [0*1% Iodine in combination ( ^ grain per drachm).] In anaemia and chlorosis. Extraction Ferri Pomatum is prepared by digesting Iron Filings in juice of sour apples. That of P.G.VI. and P. Ital. V. contains 5% Iron. Tinctura Ferri Pomata, P.G.VI. Dose.—15 to 30 minims (1 to 2 Cc.). Ferrated Extract of Apples 1 part, Cinnamon Water (P.G., containing 10% of alcohol) 9 parts. Liquor Ferri-Acetatis (B.P. 1898). Dose.—5 to 15 minims (0*3 to 1 Cc.). This solution does not decompose iodides. Pneumonia has been treated with full doses every six hours until crisis past. Liquor Ferri et Ammonii Acetatis, U.S. Basham’s MIXTURE. Average dose.—4 drachms (15 Cc.). Tincture of Ferric Chloride 4, Dilute Acetic Acid 6, Solution of Ammonium Acetate 50, Aromatic Eiixir 12, Glycerin 12, Water to 100. To be freshly made. Particularly useful in anaemia and chronic parenchymatous nephritis. It acts as a good diuretic and diaphoretic.—H. Ferri Xodidum. Fel2=309-704. Dose.—1 to 5 grains (0*06 to 0‘3 Gm.). Crystalline brown hygroscopic masses readily soluble in water. Manufacture.—It is best to employ a wet process, e.g., to combine Iron 0 and Iodine 17 in water q.s., filter and evaporate to dryness. By this method the iron is kept in excess. Clean Iron Filings, previously washed with acid if oxidised, are? preferable to iron wire. Mostly prescribed as one of the following - Syrupus Ferri Xodidi {B.P. T4). Dose.—4 to 1 drachm (2 to 4 Cc.). Contains Anhydrous Ferrous Iodide 5% w/w approx. 10 Cc. 'contain 0-7 Gm. Fel2. It contains 10% of Glucose. F. 1. also requires same content of Fel2. Ph. Ned. V. agrees. P. Belg. IV. and F.E. VIII. have this strength as Concentrated Syrup which diluted 10 times provide ‘ Diluted Syrups ’ containing 0-5% Ferrous Iodide. P. Ital. V. has the same dilute syrup only. For suggestions re making and preservation of the Syrup, see Vol. II. Incompatible with Sal Volatile and with Easton’s Svrup— strychnine iodide, and perhaps quinine iodide are thrown out. Capsules are prepared equivalent to 10 and to 30 minims. Rheumatoid arthritis well treated.—H. W. Exophthalmic goitre and rheumatoid arthritis have been treated with this and Arsenic, frequently with Guaiacum in addition. The Syrup is liable to produce severe headaches.—K. Fraser, Cumberland, School M.O. Report, 1925. When bronchitic cough is bad enough to waken child in the early morning, give 5 to 30 drops Syrup of Iodide of Iron in 1/3 to 1/2 glass of water, thrice daily just after meals, in warm weather. During the winter, these children, especially if under weight, are given instead the Pyrophosphate of Iron, i to I grain, in I to X teaspoonful of Cod Liver Oil.—M. Osthermer, Atlant. Med. Jk, per Jl. A.M.A. ii./s5,635. FERRUM. 417 Ferri lodidi. Dose.—4 to 8 minims (0-25 to 0*5 Cc.). A solution ior diluting 1 to 7 with Syrup to produce the above, i ±ori^ula containing Hypophosphorous Acid (30%) 140 Cc. and Glycerin 100 Cc. per litre as preservatives.-G. M. Beringer. Ferri lodidum Saecharatum. U.S. 1890. Dose.—2 to 15 grains (0-12 to i Gm.). Combine Iron Wire 6, Iodine 17, in Water 20 : when complete, filter on to milk sugar 40, and Reduced Iron I, previously mixed. Evaporate to dryness and add milk sugar, y.s. to 100, This and a similar preparation of P. Jap. IV. contain about 20% Fel2. Uses.— An exceedingly useful tonic, especially in arthritis, ansemia and phthisis. May be ordered in form of cachet. Pilula Ferri lodidi (B.P., 1885). Dose.—3 to 8 grains (0-2 to 0-5 Gm.). Shake carefully in a stoppered bottle Iodine SO, Water 46, with Iron Wire 40 ; add decanted Solution to Sugar 70 ; mix and combine with Liquorice Powder 140. In dividing this into pills, roll them in a mixture of reduced iron and lycopodium, and varnish. IF li Pilula Garrodii (Pilula Ferri lodidi et Sodii Arsenatis E.G.A.) Pill of Ferrous Iodide 2 grains, Exsiccated Sodium Arsenate V<r grain, Extract of Belladonna TV grain. Piluiae Ioduri Ferrosi. Syn. PiLDORAS DE Blancard, F.E. VIII., contain Iron 0*02 Gm. and Iodine 0-04 Gm., i.e. Iron in marked excess. Syrupus Ferri Bromidi, B.P.C., 1901. Dose.—to 1 drachm (2 to 4 Cc.). Dissolve sugar 14 ounces in Distilled Water 6 ounces ; add Bromine 533 grains to Iron Wire, free from oxide, ounce and water 4 ounces in a suitable vessel surrounded with cold water. Shake until the froth becomes white and the reaction is complete. Filter the solution into the warm syrup and add, if necessary, Water to produce one pint. Each drachm contains about digrams of Ferrous Bromide. Ferri Oxalas,Fe (C00)2.2H20=179-8712. ^.—Ferrous Oxalate, PrOTOXALATE EE FeR. P. Belg. IV. and P, Hung. Dose.—1 to 5 grains (0-06 to 0*3 Gm.). Yellow crystalline powder, insoluble in water but soluble in dilute acids. Has been given in anaemia and as a nerve tonic. Ferri Phosphas Saccharatus. Saccharated Iron Phosphate (B.P. ’14). Dose.—5 to 10 grains (0*3 to 0-6 Gm.). An amorphous powder containing at least 60% of ferrous salts calculated as Fe3 (P04)2, 8H20 = 501*6848. Ferri Phosohas Solubilis. U.S.X. is a green soluole sodio-citro- o gradually to Citric Acid 55| Gm. and Sodium Phosphate 76 Gm. in just sufficient cold water to dissolve. Allow to stand 24 hours at about 60° C. to* dissolve and filter. Concentrate at not exceeding 60° C. and scale without heat.—P.J. ii./o9,405. Ferri Pyrophsphas Solubilis, U.S. VIII. Contains ferric pyrophosphate corresponding to not less than 10% metallic iron. Average dose.—4 grains. Syrupus Ferri Phosphates (B.P *14). Dose.—b to 1 drachm (2 to 4 Cc.). One drachm contains 1 grain of anhydrous ferrous phosphate. Keep in bottles quite full. Syrupus Ferri Phosphates Compositus, B.P.C. Syn. Chemical Food ; Parrish’s Syrup (modi fed). Dose.—| to 2 drachms. The old formula was too acid, especially for children. Th$; following we find preferable. Dissolve Iron 0-43 in Concentrated Phosphoric Acid 5-625 (66-3%) with equa vol. of Distilled Water and heat in plugged glass vessel. Cool, filter, and pass Orange Flower Water 5 through the same filter. Boil Cochineal 0-34 in Distilled Water 37-5 for 15 minutes. Filter and wash with Distilled Water to 35, in which dissolve Sugar 70 with heat. Strain through flannel and makeup to 105 by weight. Add while hot the Iron solution, and then with brisk stirring and in small amounts add Precipitated Calcium Carbonate T29? Potassium Bicarbonate 0T0 and Sodium Bicarbonate 0-10 in about 15 o4 Distilled Water in small amounts at a time and shaking well. Add no more til purple colour which sometimes appears has gone. Make up with Distilled Water to 100 by volume and stir. Allow to stand for 12 hours. Syphon of:: clear liquor and strain through flannel.—A. C. Abraham, P.J. i./3i,438. The Cochineal should be used whole. Some favour Cudbear. P. Off.—A similar form, using Sodium Phosphate 1%. For estimation of iron and Calcium in this Syrup, see Vol. II. Capsules of Chemical Food are each equivalent to 1 drachm. CeD Syrupus Ferri Phosphates cum Quinina et Stryclinina (B.PHi) Syn. Easton’s Syrup, Syrupus Trium Phosphatum.—G. H. Jfose.—J to 1 drachm (2 to 4 Cc.)—One drachm represents 1 grain of anhydrous ferrous phosphate, 4 grain Quinine Sulphate anc Vv grain Strychnine. Sp. Gr. approx. 1-290. The percentage ou Strychnine in the syrup is 0-057 w/v, equivalent to 0-044% w/w foil Sp. Gr. 1-29. A new formula. Less acid than the B.P. and keeps better. Iron wire 8-6 Gm., Phosphoric Acid Cone. 42 5 Cc., Hypophosphorous Acid 40 Cc. Strychnine 0'57 Gm., Quinine Sulphate 14-8 Gm., Syrup 668-6 Cc., Distillec water to 1,000 Cc. The Hypophosphorous Acid is added to the solution o Iron and the alkaloids before filtering into the syrup.—J. H. Franklin, P.J i /2 7)*3«)# Easton’s Syrup was dismissed from the U.S.P. Flavoring.—Syl Aurantii Amari. Extractum Glycyrrhize Liquidum covers, but not so good as Syl Aurantii Amari. Uses.—Easton’s Syrup is a well-known tonic preparation. I improves the coagulability of the blood. CE) Liquor pro Syrupo E&stoni. 3 with 7 of Simple Syrup= Easton’s Syrup (i.e., 144 minims with Simple Syrup q.s. to 1 ounce: Add to a Solution of Ferrous Phosphate 5 ounces (produced by dist solving Iron Wire 150 grains in Phosphoric Acid, Sp. Gr. 1-5, 2J ounce; and water q.s. to 5 ounces). Liquor Eastoni sine Ferro 7 ounce; (made by dissolving Strychnine 10 grains and Quinine Sulphate 26 grains in Phosphoric Acid warmed, 2 drachms and adding water FERRUM. 419 19 ^etter recently prepared. The Solution of Ferrous Phosphate Keeps for a moderate time in stoppered bottles, which in Specific Evers,P.J. iL'/YsTl"*.'" sS sugar-^°- M- Caines and N. Both Easton s Syrup and Chemical Food mav throw down Ferric Phosnhate M'b&J.IuW t0 d6P0Sit Quinine ^osphS. ffiS that this Liquor caD be kcpt'alinost eoloffieS^1^^8Sphurous AcUh(5%) ZrrV°^°! \ mm*m U ounces. This is better than Hypophosphorous Aud, whicn has been usea by some. The bottle must be kept stoppered i.e.,a,u must not have access to the Liquor. yp ’ Hypophosphorous Add and Sulphurous Acid must not be used together Easton's Syrup m Two Syrups. (а) Mix Liquor Ferri Phosphatis 5 with Syrup q.s. to 20. (б) Mix Liquor Eastoni sine Ferro 7 with Syrup q.s. to 20. These keep well separately. Mix at time of dispensing. CED Syrupus Triplex. Understood to mean a mixture of equal parts of Easton’s, Fellows’ and Parish’s Syrups. Edin. Royal Infirmary lias 1, 1 and 2 respectively. Physicians should specify in prescribing which formula is intended CE) Elixir Ferri Phosphatis cum Quinina et Strychnina.— Martindale. Dose.—\ to 1 drachm (2 to 4 Cc.). ( e t~h as the B.P. ’14 Easton's Syrup. Prepared with Simple Elixir (’94) in place of Syrup as a vehicle. Easton’s syrup has its equivalent dose in the following pill, which is portable, tasteless, and readily soluble :— (JFlJPilula Ferri Quininse et Stryclininse Pho3phatum. Easton’s Pills.—Martindale. Contain Ferrous Phosphate and Quinine Sulphate of each i grain (0*06 Gm.), Strychnine 3V grain (0*002 Gm.),Milk Sugar 1J grains (0*08 Gm.), Concentrated Phosphoric Acid q.s. Mix quickly, having first triturated the Strychnine with the Milk Sugar, and prepare the pills. Finally varnish with Sandarach Varnish, Also made one-half this strength. Either may be combined [pi] with Arsenious Acid, 6Vgrain(0*001 Gm.). CE) Glyceritum Ferri, Quininse et Strychninse Fhosphatum. u.s. viii. Syn.—Glycerole-Easton. A substitute for the syrup for administration where sugar is not desirable. It keeps better than the syrup and is palatable. Average dose.—15 minims (1 Cc.) containing approximately Soluble Ferric Phosphate 1J grain (0*08 Gm.), Quinine as Phosphate 1-| grain (0*1 Gm.), Strychnine base ^0th grain (0*001 Gm.). jpll Tablets of Easton’s Syrup are each equivalent to \ and 1 drachm of the syrup. (Sugar coated). [Pi] Capsules equivalent to \ and I drachm of Easton’s syrup are also prepared and each combined IP I] with Arsenic -'<3 grain. P1 Pilula Trium Phosphatum „ G.H. is similar to our Formula for Easton’s Pills. Ferri Sulphas(B.P. ’14). FeS01,7H20=278*0092. Ferrous Sulphate Dose.—1 to 5 grains (0*06 to 0*3 Gm.). In clear, pale, bluish green crystals, soluble 1 in 1 4 of water. A saturated solution with some crystals of the salt in excess keeps; better than a weak solution, in the latter oxidation soon takes place- Flfivoring.—Glycerin or Syrup. Relieves anaemia more thoroughly than carbonate or phosphate.— Chlorosis tn Young Females well treated by Ferrous Salts in 4-grain j doses. May give results in six weeks.—Prof. J. A. Gunn, L. i./31,146. See also Ferrous Chloride. Copper as adjuvant to iron. Suggested dose.—1/120 grain oij Copper Sulphate, —e.f. Ferrous Chloride and Copper Sulphate Slipules ,.i p. 412. 1% solution of Ferrous Sulphate prevented development o: ankylostoma ova and all died in 24 hours.—L. i./io,355. Ferri Sulphas Exsiccatus (B.P. ’14). U.S. X., P. Jap. IV.] Dose.—4 to 3 grains (0*03 to 0*2 Gm.). 5 grains=S of the preceding-j Best administered in pill, as :—• Pilula Ferri Sulphatis 3 or 5 grains, with syrup q.s. Dissolving: slowly, these pills do not derange the stomach. If made with lanolin or kaolin ointment as excipient will not crack. Mistura Ferri Cathartica R.O.H. JDose.—1 ounce. Ferrous Sulphate 1 grain, Magnesium Sulphate 30 grains, Dilute Sulphuric Acid 5 minims, Water to 1 ounce. Liquor Ferri Subsulpliatis, U.S. IX. Monsel’s Solution. Dose.—3 to 6 minims (0*2 to 0*4 Cc.). A solution of basic ferric sulphate. When evaporated and scalec forms Monsel’s Salt or Ferric Subsulphate Fe40(S04)5. Dose —\ to 2 grains (0*03 to 0*12 Gm.). A spray of 20 grains to the ounce checks haemoptysis, and internally is not irritating although astringent. Unguentum Ferri Persulphatis.—Ferric Sulphate 10 grains? Almond Oil \ drachm, Conium Ointment to 1 ounce.—Prov. Hosp (General IIosp., Notts.). The name Persulphate may be taken to mean normal Ferric Sulphate Fea(S04)3 as contained in Liquor Ferri Tersulphatis, U.S. Ferri et Magnesii Sulphas. FeSO4MgSO4,6H2O=380*3736. Dose.—2 to 10 grains (0*12 to 0*6 Gm.). Green crystals, soluble 3 in 4 of water. In 10 grain doses has no astringent or aperient action, hence? suitable for prolonged use in chlorosis and anaemia. Ferri et Manganesii Citras. Dose.—3 to 15 grains (0*2 to 1 Gm.). In reddish scales, freely soluble in water. Useful in chlorosis combining the action of the two elements. Ferro-Alumen, iron Alum.—Syv. Ferric Ammonium Sulphate Fe2(S04)n.(NH4)2S04.24H20=964*3728. Dose.—3 to 10 grains (0*2 to 0*6 Gm.). Amethyst coloured effloresi cent crystals, of astringent taste. Soluble 1 in 3 of water (bes. FILIX MAS. with a little sulphuric acid added), insoluble in alcohol. Internally or “:;rOTr^°’ a S° aS an astrin§ent Sargle (2%), throat spray Ferri efc Petassii Tartras (RP.’14). Feeeum Tartaratum. Dose.—5 to 10 grains (0*3 to 0*6 Gm.). Reddish brown scales soluble in water about 1 in 1. Menorrhagia of young females is well treated by this tartrate. Calumbia1lSion!eaSe’ ^ °T the Ammonio*CitrafcG i3 given with alkali in Tinctura Ferii . n.artarata. Perrons Sulphate 8, Potassium Bitartrate 4, Distilled Water 30. Digest 24 hours in a covered vessel, then add Alcohol 68% 70, stand one hour and filter. nl'??rtr.as U-S- VIJtI* Averw0 Dose.—4 grains. Contains not less than 13% metallic iron. JybdMium (Mo = 96*0). This metal is found chiefly as its Sulphide Molybdenite MoS2. It is employed for hardening steel. Unlike ordinary Carbon Steel, Molybdenum Steel has the property of retaining its temoer even when heated to a high degree, hence cutting tools made with it are able to make deep cuts at high speed—the steel may in fact be heated to dull redness without impairing its quality. Molybdenum has Sp. Gr. 8*6. FILIX MAS. The rhizome of Dryopteris (Aspidium) Filix-mas. The Male Fern. Extracfcum Filicis Liquidum (B.P. ’14). Dose.—45 to 90 minims (3 to 6 Cc.). Prepared by ether extraction—the yield being about 9 to 10%. Tt contains {B.P. T4) not less than 20% of Filicin, the anhydride of Filicic Acid, stated to be inactive as a vermifuge. Vide p. 422. P. Ital. V, 20 to 28% Crude Filicin, F.E. VIII, 21 to 25%, P. Belg. IV, 24%. Oieoresina Aspidii, U.S. is also made by ether percolation. Average Single Dose.—30 grains (2 Gm.) once a day. Assay and methods for detecting adulteration of, vide Vol. II. Flavoring*-—The taste of this preparation is horrible. Best prescribed as capsule, or if in a draught, it is best ordered with Mistura Amygdalae, with a little Essential Oil, e.g., Cinnamon. Uses.—For all varieties of tapeworm and ankylostomum duodenale. May be administered fasting and should be preceded and followed by a brisk purgative. The following routine has been successful in obstinate cases. Light food at tea-time—purgative at bedtime (Magnesium Sulphate and Jalap suitable), purgative again in morning, after action give vermifuge. Liquid Extract of Male Fern 1 drachm, Mucilage of Acacia 1 drachm. Cinnamon Water to 1 ounce. After passage of the worm give Castor Oil to remove remaining vermifuge from the bowel, N.B.—We do not consider Castor Oil ideal for the purpose. At any rate, it is not advised before or with a Filix Mas preparation. In a most stubborn case of T. Solium, of which we have information (1927), the method was, however, ineffectual, as also were Infusion of Kousso and Pelletierine Tannate. For a slight modification of the method, see L. ii/27,766. Capsules contain 15 minims (1 Cc.) of Liquid Extract. Dose.— 1 to 4. Yeo mentions Capsules of 7-J minims of Male Fern Extract with 1 grain of Calomel, sixteen for a dose—two every ten minutes. Male Pern Extract (40 minims in an ounce of milk flavoured with Peppermint Oil, 2 minims) must be given on an empty stomach. An aperient, Magnesium Sulphate or Sodium Sulphate, should be taken first in a good quantity of water (8 to 10 ounces).—B.M.J. i./i7,624. We learn from Dr. Wakeman that the tapeworm is rife in Abyssinia. The natives drink cold infusions of Kousso, but this seldom brings away the head of the worm. They much prefer Male Fern capsules when they can get them —these act effectively, especially when followed by 1 to 2 drachms Compound Jalap Powder. Two preliminary doses of Sodium Sulphate at 5 and 8 p.m. on tne preA ious day and a wmter enema in the morning. Then an emulsion of Extract of Filix Mas and Infusion of Senna in Gum Arabic through a duodenal tape. I)ose of Filix Mas, C Cc. for adult to 2 Cc. for child of 5p B.M.J.E. ii./29,61. Tapeworm.'—When all other methods fail, the following (known as the ‘ early bird ’) is often successful: Pumpkin Seed 8 6m., Kousso 4 6m., Pomegranate 4 6m., made in an infusion, to which is added Kamala 4 6m., Oleoresm of Aspidium 4 6m., Glycerin 15 Cc., Mucilage of Acacia 15 Cc., Water to 240 Cc. Give in two draughts 2 hours apart, after usual preliminary treatment. Severe gastro-entcric irritation with vertigo and prostration may result, but it usually gets tne worm. Or give by duodenal tube into an empty stomach the morning after a day’s preparation with milk diet and a cathartic, halt a dose of a Senna Infusion (5 in 100), and 15 minutes later 2 Gm. of Oieoresin ot Aspi iium and 4 Gm. of Extract of Pomegranate Seed mixed with the other half of the Senna Infusion. Remove tube promptly. Whole worm expelled in £ to 2 hours N0 treatment of any kind for tapeworm should be repeated at a less interval than three months.—Jl. A.M.A. ii./28,585. Tuberculous conditions are stated to have benefited under treatment with ctlier-alcohol extract of fresh plant. Children to receive f grain, adults 11 grains, in pills, twice daily for 10 to 15 consecutive days eacti month. Dangers of Filix Mas. Moderate doses almost invariably produce bilirubinsemia and in large doses jaundice. There is risk of chronic ciirhosis of the liver developing.—O. Hannsen, L. ii./22,1183. Toxicology of Filix Mas. A case seriously affected.—L. i./n, 109. Poisoning from use of Male Fern Extract in Castor Oil—-the case was actually Addison’s disease and not parasitic infection.—B.M.J.E. i./i5,44. About 100 cases of serious impairment of vision have been reported following administration of Filix Mas, mostly in South Germany and Switzerland. Per Jl. Trop. Med., April 15, ’25,168. Haustus Fiiicis Maris, L.H. Liquid Extract of Male Fern, 1 drachm ; Syrup of Ginger, 1 drachm; Tincture of Quillaia, h drachm ; Peppermint Water to 1 ounce. Mistura Fiiicis, U.C.H. Dose.—1 ounce. Liquid Extract of Male Fern 1 drachm, Powdered Acacia 1 drachm, Chloroform Water to 1 ounce. Filicin and other Principles of Mal8 Fern. Great confusion exists, relative to the chemistry and clinical results, with the constituents of the rhizome. The statement is generally made that the anhydride body Filicin, on which the Liquid Extract B.P. T4 and the Oleoresina Aspidii U.S. are assayed, is inactive. The dose of Filicin, if given, may be stated as from 5 to 15 grains. In our recent personal knowledge, in a single case, it was not a tsenicide, the ‘ filicin ' having been specially made in our Laboratory FIUX MAS. 423 'll'14 met.hod- Tl»nia ca«s are often exceedingly ,/^fe a5d the foHowmg, from the Presse Medical is of interest 10 timers wSg^tofft! ffi®?B method) ft is Soluble in’ wfhS^H%hSlp^ aA«lodl?cation of thc usual assay l l7' ' .1S soluble m bther, slightly in Alcohol, but insoluble in water It is a combination of various acid bodies.. Given bv the mouth in hS doses, it causes vomiting and diarrhoea. It is eliminated bethelbiKAn mycst.gal.on on tlatworms anil tapeworms showed it to be an excellent helmin thicide : the ingested Filicin reaches the intestine,^impregnates^the tin a passes ini o the blood and then into the bile and returns to the intestines where it again acts pn the parasites-this cycle being repeated many times The a£dgtoS S1™ S^(?p3ulel(ia 011 s?luti0ll>ia 12-grain dSfes for adults! and to children -4- gram lor each year of age. There are no toxic effects if i,lve]?.m suitable doses. Trenia are stated to be expelled in a few hours 7 2(?me ’ b0th an anthel,nintic and Purgative action is obtained.’ Ihe view has been stated that a compound termed Filmaron, a parent substance of h ilicic Acid/ is the active one, present to the extent of 5% in the rhizome. This is a proprietary article of which there is little knowledge. It is noteworthy that the P.G. assay process for * Filmaronoi ’ simply determines Filicin in the oil on the lines of the B.P. assay. Some comparative clinical data would be of great value. A preparation termed Danistol, for use in liver fluke (Syn. liver rot, Distomiasis) in sheep, etc., is stated to contain a derivative of Male Lern (of the formula C44H50O15), in capsule form. They contain Benzol as solvent and a further variety contains Carbon Tetrachloride as solvent. We have worked on the veterinary side of the issue as well, and have knowledge (1927-8) of the utility of a capsule of Filicin in Benzol in the affection named, hut by far the best results were obtained from a capsule containing a filicin in the form of liquid extract with a small dose of Carbon Tetrachloride. Filicic Acid, in conclusion, is sometimes spoken of. It is best to ignore the name. Filicin as above defined may be supplied for it. Aspidinofilicinum Oleo Solutum P.G. VI. Syn. Aspidinolfili- zinol, FilmaronoJ, is a 10% solution in a neutral vegetable oil. For further data re Assay and Adulteration vide Vol IT. Other taeniacides are Kamala (discarded from B.P.), the glandular red powder attached to the capsule of Bottlera tinctoria; Mallotus Philippinensis (Euphorbiaceoe); this may be given in dose of 30 to 120 grains suspended in water ; CowhagC, Dolichos pubes, the hairs adhering to the pod of Dolichos or Mucuna prunens (Leguminosce), dose 1 or 2 grain in treacle or honey: Papain, and Thymol Carbonate, q.v., but an efficient taeniacide is Pelletierine Tannate, q-v., cf. also Carbon Tetrachloride and Oleum Chenopodii. GELATINUM. Nearly colourless transparent sheets or shreds made by extracting animal tissues, bones, etc., with boiling water. Skin Gelatin is the best. It is more pliable and possesses more ‘fibre5 and is suitable for gelatin capsule making. Bone gelatins made from Osseine (acidulated bone) are brittle and hence unsuited. Dose.—Ad libitum per os, and injected. Gelatin taken per os is most easy of digestion, the cleavage products being largely absorbed. It is first converted by pepsin into proteoses and peptones. Trypsin of the pancreatic juice then splits these into amino acid. Sterules of Concentrated Saline Gelatin Solution are prepared for injection into the gluteal region as a haemostatic ; each makes a 2% solution on dilution with boiled water to 5 ounces— sufficient for one injection at 103° F. Injections of this amount are made every third day in the flank or buttock, up to 30 or 40 injections. These constitute the great standby in treatment of haemoptysis of tuberculosis.—English’s System of Treatment, vol. i., 1154. G. W. Davis (L. Sept. 8, 1900) gave 6 ounce subcutaneous injections of 1% Gelatin with Cerebos Salt 0-3% for haemorrhage. The solution is sometimes used stronger, e.c/., 10%,—i.e., the contents of the Sterule diluted to 1 ounce (30 Cc.). Gelatina Soluta Sterilisata, P. Helv. Is 10% in Normal Saline. The utmost precautionary directions are given, including animal experiments to exclude organisms of malignant oedema and tetanus. Liquor Gelatins Sterilisatus, P. JAP. IV. is similar, but strength ol Sodium Chloride 0*5%. The Solution is neutralised with Sodium Carbonate and filled into hard glass tubes containing 10 to 40 Cc. sealed and sterilised thrice each time for 15 minutes at 24 hour intervals. The name of the laboratory and volume of contents to be given on each tube. Solute de Gelatine Injectable.—Fr. Cx. Supp. Nouv. 1926. Substitutes the formula on p. 068 of FR. Ox. n Official Gelatin 10 Gm., Sodium Chloride 8 Gm., Distilled Water to 1,000 Cc. "Neutralise to Litmus accurately by adding drop by drop IS/10 Sodium Hydroxide. Sterilise for 15 minutes at 115° C. in an autoclave. Uses*—To check bleeding from the lungs, from the intestines in typhoid and dysentery, from the bladder and from the stomach in ulcer and cancer of that organ. ‘'These injections may be followed by pain, fever, local swellings and nettle rash. Other haemostatics may be combined with it. , Aortic aneurism is relieved by subcutaneous injection of the solution. _ Secondary haemorrhage well treated. Blood which ordinarily coagulates in 7 minutes clots in 3 minutes after an injection. Dose is about 5 Gm. m a l/0 solution. Very useful in cases of ruptured tubal pregnancy. L. n.,oo,l/8Z. Intrathoracic aneurysm. The solution advised by Lancereauxm 1904 consists of Gelatin 25, Sodium Chloride 7, in Water 1,000 (-*2-5 A). He Injects 200 Gm. at a time and repeats every 4 or 5 days bir J. K. *owlar begins with 50 Cc. of 2% Solution and gradually increases to 100 Cc. and 4/© respectively. Guthrie Itankin says the relief of pain is striking— U. De Havilland Hall. „ . .1 r0/ For visceral pains and for speeding up healing process . SoriOCceof 5 /£ solution injected. Aneurysm (60 cases) well treated uith 100 Cc. 2 f0 solution weekly.—Per Jl. A.M.A. i./26,519. . ,. , It is the most powerful protein-sparer known, being able to save irom destruction half its weight of protein or twice as much as is spared by an ec]ual quantity of carbohydrate. 1 Gm. yields about 4*1 valones. R. Hutchison. GELSEMII RADIX. 425 For GASTRIC ULCER gelatin is very easily digestible A diet of ,,m,i f and sugar has been advised. It ‘ fixes • a grelt deal of tcid 8 ’ «v^tin^,™':edA 8■has,been ar,rested by administration by the mouth. ^nake id. . Oozing hemorrhage due to this occurs from ail mucous B.JoT/ii.632 7 88 Quantitie9 of 5% Gelatin Solution j>““ »?- Ge/citsrsotfoorax. Treatment of empyema thoracis by intrapleural injection of antiseptics. 4 Sterules ’ of Concentrated Gelatin Saline diluted with 9 ounces of boiled water, produce lO ounces of a 2% solution, the contents of one Euflavine ‘ Sterule’ (1 grain) being added at the time of dilution ( = 1 in 5000 or 2 grains to produce 1 in 2,500). Sterules of the Gelatin Solution are also made to produce 2 ounces of 2% on dilution. An initial injection of 5 or 10 Cc. only is given to test response. Should be tried before siphonage, suction drainage or operation.—J Crocket, B.M.J. i./3-r, 684; L.i/31, 758. See also R. A. Hunter, Tubercle, Feb., 1931. Gelatin Solution 5 to 10% containing 5% Calcium Chloride. To arrest haemorrhage.— Vide Calcii Chloridum. Formalised Gelatin.—This has been used with success as a substitute for Collodions. Gelatin Solution 10% in water is stored in wide mouth test tubes holding three ounces each. The tubes are plugged with cotton wool and sterilised at 100° C. for 15 minutes on three successive days. When required for use melt in a water bath and add 1 drachm of Formalin Solution diluted 10 times, i.e., 4% strength of Formaldehyde approx.—the final product will then contain a little over 1% of Formaldehyde (H.COH) or fully 2t% of Commercial Formalin. . The wound is dressed with a thick roll or pad of sterilised gauze, with a piece of stiff gauze above extending beyond the wound. The Formalised Gelatin is applied with a swab on the top of the stiff gauze beyond the limit of the wound—this holds the dressing in place without bandage.—Communicated by the Dispenser, General Infirmary, Leeds. For Formalised Gelatin Capsules vide Formagules. Vernisol (T.M. 221492).—A water-soluble varnish, or jelly which dries and leaves a transparent, flexible coating, non-irritating, and may be medicated with the usual dermatological agents. GELSEMII RADIX. (B.P. T4), U.S. IX. Dose.—5 to 15 grains (0-3 to I Gm.). N.B.—U.S. IX. gave J grain only as average dose. The dried rhizome and roots of “ yellow jasmine ”—Gelsemium nitidum (Loganiacece) (G. semper virens, Aitonl (Loganiaceos) imported from the United States. Must be distinguished from the yellow jasmine cultivated here, which is a species of Jasminum. Uses,—Febrifuge, anti-spasmodic and analgesic. In acute and rheumatic neuralgia, toothache, uterine and ovarian pain and chorea. It is a powerful paralyser, as well as tetanizer, and re - spiratory poison. Large doses contract the pupil and cause giddiness and diplopia. The plant contains at least two alkaloids, one designated Gelse- minine (crystalline), which is highly toxic, and the other Gelsemine, which is of little importance. Antidotes.—Emetics, Atropine or Strychnine hypodermically, Nitroglycerin or Amyl Nitrite ; artificial respiration, stimulants. Accidental death from an overdose in the case of a woman suffering from neurasthenia.—P.J. I./27,558. [FIGelseminina. C22H26N203=366-2188. This base is called by some ‘ Gelseminecausing confusion. Dose.—y$-(5- to grain (0*0006 to 0*002 Gm.). Yellowish-white minute crystals, M.Pt. 160 °C., with a bitterish taste, sparingly soluble in water, easily in alcohol, ether and acids. It forms crystalline salts, and has mydriatic properties. WH\ Gelsemininse Hydrochloridum. Dose.—yb to grain (0*001 to 0*003 Gm.). C22H26N20,.HC1 (?)=402-6838. In white, granular crystals, freely soluble in water. CE> Extractum Gelsemii Pnlvis, Syn. Gelsemin (Extractive)—avoid this name. Dose.—4 to 2 grains (0*03 to 0*12 Gm.) in a pill with spirit and glycerin. The powdered alcoholic extractive (resinoid) of a pale brown colour. CeD Extractum Gelsemii Liquidum. By percolation with a mixture of Alcohol 4 and Water 1. Strength 1 = 1. Average dose—\ minim. Dysmenorrhoea is well treated by 3 minims doses with 5 minims of Tincture of Belladonna thrice daily. For examination nervousness a small dose thrice daily is a tonic. CE> Tinctura Gelsemii (B.P. T4). Gelsemium in No. 40 powder 2, Alcohol (60%), q.s. to 20. Percolate. The tincture is fluorescent. Dose.—5 to 15 minims (0*3 to 1 Cc.), often combined with Bromide of Ammonium or Potassium for neuralgia. Flavoring.—Syl Anethi, Syl Rosae; Syrupus Aurantii. Uses.—For neuralgia of face and jaws associated with carious teeth—15 minims of the tincture every 6 hours may relieve. Neuralgia has been treated by 4 drachm doses thrice daily for two months. Disordered vision may follow even moderate doses. In rheumatoid arthritis it is given with Cimicifuga q.v. Influenza well treated by the following :— Gelsemium Tincture 12 minims, Belladonna Tincture 5 minims, Potassium Citrate 10 grains, Syrup of Orange 1 drachm, Chloroform Water to 1 oz. JJose.—1 ounce every four hours. Afterwards 4 oz. until temperature falls to normal. Headache and backache vanish, with general improvement. The only disadvantage is that Gelsemium may cause ocular disturbance.— W. D. 33. Small and W. O. Blanchard, B.M.J. i./19,241. Mistura Gelsemii R.O.H. Dose.—1 ounce. Gelsemium Tincture 10 minims, Aspirin 1C grains, Sodium Salicylate 10 grains, Potassium Bromide 10 grains, Sodium Bicarbonate 10 grains, Chloroform Water to 1 ounce. For neuralgia and generally as sedative. GLUCQSUM. • Syn. Dextrose, Grape Sugar. C6H1206=180-0936. Liquid Glucose occurs as a viscous mass containing about 20% moisture and of Sp. Gr. 1*6 approx. It is prepared by acting on Starch with Dilute Hydrochloric Acid. Pure Dextrose is an equilibrium mixture of a and /3 Dextrose in white ‘ granular ’ powder. Solid Glucose less pure in yellowish masses containing 10 to 20% of bodies allied to Dextrin, viz., Amylin and Gallisin. Saccharum Amylaceum P.G- VI. White crystals or powder. A 10% solution with 1 drop of Ammonia of the substance dried at 105° C. has a Specific Rotation of + 52-5° at 20° 0., using Sodium light. Glucose Officinal—Fr. Cx. Xouv. Supp. (1926) is pure anhydrous (2-Glucose —a white crystalline powder, with M.pt. 146° C. Two varieties are described (2-Glucose a, got by crystallisation at 30 to 35° C., and (2-Glucose p, by evaporating at 110° C. In solution one form is changed into the other, with resulting equilibrium. A Monohydrate (110 Gm. of which equals 100 Gm. of anhydrous) also exists and is permitted. Glucose of commerce (Liquid) is of two kinds, ‘ Crystal ’ and ‘Neutral.* ‘ Crystal 5 is the neutral variety bleached with Sulphites. It is ‘ water-white* and contains up to 7 grains Sulphur Dioxide per lb. The neutral is of pale yellow colour and is usually free from traces of Sulphur Dioxide, Its flavour is superior to the crystal variety. It has approximately a quarter the sweetness of refined sugar and it is not so good a ^preservative. Analyses of Crystal Glucose showed Dextrose 34 to 48%, Dextrin 30 to 45%, Sulphur Dioxide free and combined 0-03 to 0-1%, Moisture 14 to 20%.—K. H. Robins, C.D., Mar. 31, ’17. If Cotton Wool is treated with Sulphuric Acid one vol. and water three vols. a viscous solution is produced which becomes later as fluid as water. From this Glucose is obtained.—C. T. Cross, C.D. i./17,252. Glucose is now largely used per 0s, per rectum, subcutaneously and intravenously for artificial feeding as a preliminary to severe operations and for wasting diseases. It is usual at a well-known London nursing home to permit patients to eat Barley Sugar (85% Glucose) ad. lib. (1 lb. or more) before operations to prevent acidosis. Glucose Lozenges are available weighing 4 Gm. and containing each Glucose 3 Gm. The following notes are arranged as far as possible under the headings Glucose Feeding {per os). Giiecose injections and Recta? Feeding* Glucose as sclerosing agent for varicose veins and some remarks on the sugar as a surgical dressing aie added. Acetonuria.—A heaped teaspoonful m half a teacup of coll every 2 hours for 4 or 5 doses, appears to give relief practically all cases 99% of cases of vomiting at sea are accompanied by increased acidity and acetonuria.—M. Fawkes, B.M.J. h/25,241. . Persons suffering from sea-sickness air-sickness, cyclic' sickness, migraine, asthma and acute gout, nearly aiways su. r . .go and are relieved by massive doses of Glucose. M. lawke , • • ^ 1 1 i -t t Acute Infections and Cases of Under-nutrition. j f to t ^ daily with food of distinct benefit. (Rormal pcrso ™ n Dodds 500 Gm. in one dose without glycosuria.)— .1. ?z0.^?febrile diseases’ L. i./25,429. Cane Sugar used similarly, good m typhoxd ana febrile diseases. -—J. A. Ryle, ibid. 515. jL Asthma in children : Glucose for prevention and treatment. Sugar as such, not as starch, prevented recurrence in four cases. Thought to be of no value in adults apparently. Also of value in infantile eczema.—A. A. Osman, L. ii./29,1187. (See, however, p. 1283.) Cardiac failure.—1 drachm doses of 5% solution per os apparently saved life.—G. Scott MacGregor, B.M.J. i./21,158 ; see also S. E. Denyer, ibid. 248. Plenty of sugar for the school child. Instinct a good guide.—A. A. Osman, B.M.J. i./31,223. G/ucose injeoi/ons. Barrington-Ward’s Abdominal Surgery of Children advises a full diet and a bottle of barley sugar the day before the operation and more on the morning of the operation. When operation is severe and resistance low 5% glucose subcutaneously. Older children 10% per rectum. As a Summary. Always before a severe operation, (1) when liver efficiency is suspected, (2) when the metabolic rate i3 high, (3) when patient is under-nourished or emaciated : always after a severe operation when blood transfusion is impossible : a fter any anaesthetic (1) where loss of blood has been heavy and blood transfusion is impracticable, (2) in case of shock, (3) vThere it has not been given before the anaesthetic, (4) 'where a rough surgeon has operated, or more than the usual amount of anaesthetic used, (5) where there is a history of epilepsy.—F. P. de Caux, B.M.J. ii./29,1005.—(10% solution is preferred by this writer, given at 100° F.) Glucose Sterules were suggested by A. E. Barker, and can be carried about for serious operations. The contents of one, diluted to a pint with boiled water, makes a 5% solution (isotonic with the biood). A litre of this solution may be injected, and onlv causes evidence of sugar in the urine after repeated injections and only to the extent of 2 to 3% of the quantity given. An aspirator needle about 1 mm. in section and 3 feet of tubing with a glass reservoir above is all the apparatus required. The needle is introduced under the skin in the region of the axilla—the douche is raised 2 feet or so and transfusion proceeds. The treatment is good as regards pulse, general strength and relief of thirst. By this means, water, the first need, is given in large amount with safety, and sugar to the extent of 2 ounces per diem without any demand upon the alimentary tract. Increased action of the kidneys is caused and diluted toxic matters are removed. The solution is also used intravenously with the addition at the time of dilution of 4 to 8 drops of Adrenalin Solution. Glucose Sterules have been used in prevention of post-operative shock, toxaemias of pregnancy, acute and chronic enteritis in infants, cancer, stricture of the pylorus, chronic ulcer, severe neurasthenia, and anuria or oliguria In toxic affections such as appendicitis, bronchopneumonia, and typhoid, the solution has been given per rectum. Solute de Glucose Hypertonique Injectable.—Fr. Cx., Nouv. Supp., ’26. Official Glucose 300 Gm., Distilled Water to 1,000 Cc. Solute de Glucose Isotonique Injectable.—Fr. Cx., Nouv. Supp., ’26, is 5% Isotonic Solution, sterilised at 110° C. in neutral _ When a dehydrating effect is required hypertonic solutions are given intravenously or per rectum, as if given subcutaneously such solutions may cause oedema. Intramuscularly a 10% solution in Saline is relatively safe for raising blood sugar and when other methods contraindicated. 20 to 40 Cc. for infants : 100 Cc. for older children or adults. The maximum rise in blood sugar occurs in 4 hour.—J. Glaser, Jl. A.M.A. ii./28,726. The adult body can utilise only 0-8 Gm. per kilo weight per hour. If given too rapidly is promptly excreted through the kidneys and wasted—Jl. A.M.A. ii./29,1327. Intravenously for adults, 75 Gm. in 300 Cc. of water has been advised ; given during 1£ hours.—L. ii./29,723. Less, it is stated, will not give the maximum therapeutic effect, and more may produce over-stimulation of the Insulin- producing activity of the pancreas. Single repeated doses preferable to prolonged injection. Half dose for a child and quarter dose for infant, but same length of time for injection.—P. Titus and H. D. Lightbody, per Jl. A. M.A. ii./29,947. Bright’s Disease with scanty urine. Contents of a sterule diluted with a pint of distilled water intravenously—effect most satisfactory.—Major G. W. Vincent, Maymyo, Burma, Oct. 4, ’25. Arthritis, Chronic.—Glucose tolerance in. A lowered glucose tolerance is present in a large proportion of cases.—G. L. Kerr Pringle and S. Miller, L. i./23,171. Prom 20 to 60, or even 100 Cc. 10% Glucose into the painful areas of the muscle and subcutaneous tissues gives immediate relief of pain in muscular rheumatism and lumbago. Also used with success in sciatica, etc.—B.M.J.E. ii./3L8. Diabetes, Severe, treated, especially in cases where acidosis threatened.— Sir W. H. Willcox, B.M.J. ii./2i,706. Gastric Ulcer has been treated by giving nothing, not even water by the mouth, and supplying 3 or 4 pints daily of Saline Sugar Solution—the method gives the ulcer every chance of healing. Secondary parotitis^ may, however, occur, special care is hence necessary to use antiseptic mouth washes. The method should be valuable in treating ailments in which natural feeding is difficult, e.g., in the hyperemesis in pregnancy and in cholera. Jaundice.—Intravenous injection of 500 Cc. of a 10% Glucose solution may be indicated two or three times a day to rehabilitated patients with abnormally functioning livers. In jaundice, intravenous injections of 5 Cc. of a 10% solution of Calcium Chloride help to hasten coagulation of blood, prevent post-operative bleeding and neutralise the toxic bile pigments. W. Walters and W. J. Mayo, Jl. A.M.A. ii./25,885. (Edema, Threatened, of the Lung and collapse averted by intravenous injection of 20 Cc. 50% solution.—B.M.J.E. i./i6,11. . . . , Perforation of the Stomach and Duodenum.—The injections help to raise vascular tension lowered by sweating, vomiting and toxaemia. A. it. Barker 3 1VX J i«|i3jI06* Pneumonia.—The heart can be best helped by giving it food and oxygen. The best food is sugar. Intravenous injections of 10/0 Glucose are perh ^s the most valuable when circulatory failing has commenced. \V. il. vvyn , Pregnancy.—Glucose intravenously 5 to 10%, 4,000 Cc. in 24 hours. B. M.J.E. ii./3o,64. See also Vomiting of Pregnancy postea drnnbv Septicaemia.—Continuous giving of Glucose, up to 3 litres a day, d op drop into the tissue of the breast, or into the sapncnous \em, of gre severe cases.—Sir W. Wheeler, L. ii./3I,245. . . , Toxemia with gastric stasis well treated by intravenous ^ec™s ° 10 Gm. (1%) Sodium Chloride, and 100 Gm. Glucose (10 /o>,■ m 1,000 Cc freshly distilled sterile water. Twenty minutes 3 litres being injected daily, supplemented by hypodermoclys < P —Per J1* A»M.A. ii,/25>t)37« , , ,. ^-,-1_t TTGrrlincf and Vomiting of pregnancy.—Glucose injections uaJm. V. • S B. P. Watson, L. ii./22,649. Intravenous injections of 50 to 75 Gin. of Glucose in 200 to 300 Cc. distilled, water (J3,0 solution) used. The addition to the injection of 1 unit of Insulin, to 5 to 10 Gm. Glucose did not seem to have any clinical advantages. Vomiting usually ceased m 12—24 hours—P. Titus, Jl. A.M.A. ii./25,491. W. Thalhimer gives 100 Gm. of Glucose intravenously in as much water as the condition of the patient indicates (1 or 2 litres), the injection taking from 3 to 5 hours, and administers hypodermically 1 unit of Insulin for every 3 Gm. of Glucose. Vomiting usually ceased in 6 to 8 hours.—Ibid. 493. Port-an.esthetic vomitino, to abolish.—More extensive use intravenously desirable—R. J. Clausen, B.M.J. ii./3i,377. Recta/ Feec/?'ng, Absorption of Dextrose (5% solution in Saline Solution when so given) is proved by the way it raises respiratory quotient and abolishes or diminishes acidosis; on the other hand protein absorption is either nil or exceedingly mmute the salts in foods of this kind are absorbed and probably produce what good is done—there is indeed no place in therapeutics for nutrient enemata containing protein and fat—B.M.J. i./n,872. Delayed Chloroform Poisoning treated by rectal injection of Sodium Bicarbonate. Also Glucose Solution £ ounce in 4 pint of Milk by nasal tube and a 10 /<> solution by the rectum four-hourly, in addition to a good supply of Carbohydrate food. Improvement nothing short of marvellous, and recovery perfect.—L. ii./o9,710. Cyclic or Recurrent Vomiting—All food should be withheld from the stomach and rectal feeding substituted. Glucose should be added to the .Normal Saline for rectal use not only as food, but because the adequate use of Aat requires co-operation of active Carbohydrate metabolism.—P.B.S.M., Diseases of Children Sect., Feb., ’io,85. I/ur/cose 1/ems. A mixture of 50% Glucose and 30% Sodium Chloride thought to be the ideal solution. Dose.— 2 to 10 Cc.—not more than 20 Cc. at one sitting, with injections every other day—II. M. Kern and L. W. Angle, 31. A.M.A. iL/29,601. A 50% solution found the blandest and most efficient method of sclerosing. Inject 5 to 10 Cc. and then again 3 to 4 cm. higher : repeat bi-weekly.—G. de Takats, Jl. A.M.A. i./29,778. Up to 5 Cc. of 66% solution. There is a tendency for the clot to break up, and of the recorded instances of nulmonary embolism from varicose vein injections, the majority have occurred with Glucose.—W. Levi, L. ih/30,16. Glucose is not greatly favoured in this country. It is not safe as regards ; embolism, nor will it prevent necrosis if there is an escape. Glucose as Surgical Dressing.—The wound is dusted with powdered glucose and covered with strips of protective silk, having been first cleaned with tampons soaked in hot boiled water. May be painful. In some cases antiseptics may be wanted before the glucose. The sugar acts as a nutrient to the tissues. Also used as moist dressing.—L. i./i3,651. Ulcers dressed with 40% Glucose ; also to replace the Liquid Paraffin in B.I.P.P.—B.M.J. ii./i8,574. Brornidrosis, ozaena, otorrhoea treated by swabbing with 25% Glucose solution. Chronic vaginal discharge treated by 25% Glucose Pessaries in gelatin basis.—T. H. C. Benians, B.M.J. i./i8,669. For Estimation of Glucose in Urine, see Vol. II. Dextrin (P. Heiv.).—Yellowish powder or gum-like masses. Is obtained commercially by heating starch to 200° C. According to P.G.T. it is made by heating potato Starch 150, with Oxalic Acid 4 in water 750 with frequent stirring until a little of the mixture no longer gives blue with Iodine. Dextrin takes up some Iodine without colouring. It is necessary to first saturate the liquid with the Iodine and then add a slight excess to get the coloration. Neutralise with calcium carbonate and evaporate the filtered liquor. Consists principally (there are various other dextrins formed before this) of Achroo- dextrin which is the ultimate product of starch hydrolysis before the grape sugar stage is reached. GLYCERINUM. C 3H 5( OH) 3 ~ 92*0824. Dose.—1 to 2 drachms (4 to 8 Cc.). Intravenously, 1 drachm (4 Cc.) has been given with equal amount of tap water.—J. T. Shirlaw (v. posted.) Manufactured by decomposing fats with alkali or superheated steam. Sp. Gr. 1-2.60. Soluble in alcohol and water in all proportions, but immiscible with Ether or Chloroform. Ph. Ned. V. permits 11*7 to 13*6% Water. Sp. Gr. 1'230-5. Castor-Seed Ferment (Lipase) method of splitting up oils and fats is a satisfactory one for Glycerin production. It is easy to conduct, but the Glycerin is very crude.—C.D. July 10, ’20,978. The Germans when short of fat, increased production of Glycerin by yeast fermentation of sugar in alkaline medium in presence of Sodium Sulphite. Glycerin formed to extent of 36%. Americans produced it by fermenting molasses in presence of Sodium Carbonate.—B.M.J. i./22,115. Glycerin distillation, historical, etc.—F. C. C. B-obb, P.J. i./2i,256. Thousands of tons are used p.a. to prevent freezing in motor-car radiators. Crystallisation of Glycerin occurs occasionally in the cold weather. It seems to have been first observed in 1866 and reported that year at the Paris Exhibition under Napoleon III. The melting point is 17° C.—C.D. Uses.—Internally tends to relax the bowels. Is added to cough mixtures and to relieve forms of indigestion with gaseous distension. As an enema, J ounce alone or with ^ water added relieves constipation, and it reduces piles. Externally 1 with 2 or 3 of water prevents cracks of chilblains and forms an ingredient in a large number of skin applications. It is a useful solvent for many active principles of drugs, standing midway between alcohol and water, cf. Glycetracta. It is also a valuable preservative, cf. “ Aqueous” Tinctures. For burns, soak cotton wool in it and cover with oiled silk. Asa throat pigment, and for uterine application, Glycerin of Tannic Acid may be used double (B.P. T4) strength—1 in 2^ of Glycerin—- Pigmentum Acidi Tamilci, Giycerinum Acidi lannici being 1 in o. Cancer.—IVietahGfism of tumours. . 7 . , J. T. Shirlaw states that cancer frequently develops m people who have previously suffered from glycosuria, of the non-nancrpatsc tyne. but he lias ‘ yet to come across a patient witn true pancreatic diabetes developing cancer.5 In the uompancreatic type the only explanation 101 t le non-combustion of. the sugar is that the fatty acids are not sufficiently unsaturated by the liver ferments and lipase. Combustion of fats and car00- hydrate is therefore incomplete, causing superabundance of fatty acids v\ici possible formation of sa&onins, which owing to. their solvent action the lecithin and cholesterin of the cell are extremely irritating, and the alteration of surface tension produced has a profound influence on tne divisior cells. Glycerin injected intravenously {1 aracnm 1 drachm of hoi led ta p water) thought to combine \\ ' Y acids and form innocuous fat. A case of scirrhus of the breast s showed considerable improvement. Small quantities of tin also' catalyst and assist synthesis of Glycerin and fatty acids into fat and 2 Cc. Stannoxyl intramuscularly were given s.multaneousiy with the Glycerin injection.—B.M.J. i./3i,74. A combination of this kind (glycerin plus fatty aci(^)is Olein presence of Caustic Potash and by Tin. (An appreciable amount of: Olern is formed from Oleic Acid and aqueous Glycerol by ae P Lipase.—J. T. Shirlaw, Biochem. J1.3 193°? Aol. hi, JNo, o.) Gennicidal Action of Glycerin. In strong concentrations in culture media Glycerin acts as a deterrent to growth, the inhibition being of a hindering nature rather than bactericidal. Organisms possess different degrees of resistance to contact with Glycerin, the gonococcus and streptococcus being the most fragile. In the case of the strepto coccus. Glycerin exerts its power after 6 hours and bactericidal power after 8 hours’ contact (in the case of gonococcus the times were 4 and 1 hour). Vastly superior to Potassium Permanganate for antiseptic and surgical use when dealing with an organism like the staphylococcus. Valuable results by intrauterine injections in sept/c conditions of the uterus and its appendages.—A. Compton, L. ii./26,326-28. (v. poster/.) Glycerin when diluted to about 50% is an efficient germicide and rendered possible the introduction of blycer mated Lymph. It killed Staphylococci, Streptococci, Tubercle bacilli, diphtheria and enteric. The only organisms resistant to 40% Glycerin longer than a month were spores of the hay bacillus, spores of B. mesentericus vulgatus, the common pink yeast, and B. coli., when kept in the cold.—S. Monckton Copeman, B.M. J. i./31,513. Glycerin as surgical dressing. Boils and carbuncles, and all kinds of wounds and sores, effectually treated, covered by gutta-percha tissue or oiled cambric. Also good in eczema. Absence of bleaching and maceration of the skin.—D. Kyle, B.M.J. i./31,76. Glycerin 25% to 30% in wet Boric Lint dressing. Effect possibly biochemical.—D. Kyle, B.M.J. i./3i,425. Cellulitis.-—Glycerin in combination with Liq. Hyd. Perchlor. excellent for all kinds of.—H. A. Morton Whitby, B.M.J. i./3i,206. Lymphangitis well treated with Glycerin and Ichthyol.—H. W. Webber, B.M.J. i./31,206. Septic wounds on fingers well treated with Glycerin and Ichthyol.— H W. Webber, B.M.J. i./3i,206. Tuberculous peritonitis treated by Glycerin 1 pint intra- peritoneally—in desperate cases beneficial but toxic.—A. MacLennan. Probably diluted just as good.—D. Kyle, B.M.J. i./31,76. Hygroscopic action of Glycerin is the essence of its success. Use in preference as the B.P. Glycerole 1 in 5 to kill the germs. When drawn out of the lymphatics by the Glycerin they are killed in a pool of Carbolic Acid.— A. Ogier Ward, B.M.J. i./31,118. Tuberculous abscess cavities injected with Glycerin after evacuation of contents and cauterising with Iodised Phenol.—H. A. Morton-Whitby, B.M.J. i./3i,206. Becent wounds as arriving in Casualty Dept, at a London Hospital treated with a mixture of Glycerin 1, Liquid Glucose 6 and Water 3—left on 3 days, then a dry dressing with Boric Acid Powder. Also effective in bromi- drosis. Fetor prevented and in ozeena (with Glucose).—T. H. C. Benians, B. M.J. i./31,285. For osmotic action by Glycerin in conjunction with Ichthyol has also been used. Billroth (i877) said Glycerin is a good disinfectant poured freely on wounds. —A. Hayes Smith, B.M.J. i./31,336. Varicose veins. Intravenous injections of 5 to 10 Cc. 50% Glycerin and Water initially, and 6 days later one or two injections of a 75% mixture. All cases successful.—F. Maignon, per Pres., Jan., ’32,34. Glycerin in Labour. Lymphagogue Action of a 10% Solution of Tincture of Iodine in Glycerin. The Iodine helps to stimulate uterine contraction.— H. J. Phillips, L. U./25,1229,1307 ; Proc. Roy. Soc. Med., Feb. ’26,26. In obstetrics Glycerin is useful, (a) where puerperal sepsis is a possibility, and (b) mild sapraemia or definite septicaemia.—C. Elliott, L. L/29,1057. Glycerin in midwifery advocated. It is powerfully hygroscopic, inhibits bacterial growth, particularly the Cocci and Coli groups, the causai organisms of puerperal sepsis, reduces oedema, and encourages healing of lacerated tissues. Soothing to haemorrhoids. Used as routine at every confinement.—R. Mackinnon, B.M.J. ii./3o,980. A viscous hygroscopic fluid like Glycerin, containing an antiseptic, used during labour, would diminish chance of infection from without and from the vagina. Experiments showed that Phenol is 2b to 3 times less potent in Glycerin than in water (W.H.M.). Lord Moyni- han suggested Acriflavine. Continuous administration of Calcium suits from commeficemef?f of pregnancy to end of the puerperium advised to build up resistance—15 grains of Calcium Phosphate in f ounce of water thrice daily.—J. L. Moir, B.M.J. ii./3o,1066; i./3i,l 18. Acriflavine Tablets (1-75 grains are prepared. One in 4 ozs. of Glvcerin previously heated to 110° C. and cooled makes 1 in 1,000 solution for vaginal injection. The solution is non-irritant and highly toxic to pathological bacteria including the gonococcus. Calcium Therapy is the prophylactic for eclampsia. —J. L Moir, ibid. Glycerin and Acriflavine (1 in 500) for torn perineum.—P. G. Preston. B.M.J. i./31,294. Carbolised Glycerin as an injection in labour, might be of value in preventing puerperal infection. The exact proportion of the antiseptic in the Glycerin is however open to discussion, viz. : (1) The strength must not be sufficient to injure the membranes or cause shock. (2) Glycerin may weaken the antiseptic potency of Phenol. (3) Glycerin in itself is antiseptic, and (4) its physical qualities are ideal for the purpose. We confirmed (1929) that the bacterial efficiency of Phenol in Glycerin is actually less than in an aqueous solution. A suitable strength appears to be 1%. Stronger solutions would introduce a considerable element of risk. As a further suggestion, Thymol in Glycerin would be worth trying, but its smarting effect is pronounced, though no doubt transient. Giauramine in Glycerin 1 in 60 suggested in midwifery, especially when frequent examinations needed and in prolonged or difficult labour. No irritation.—F. H. Lacey, B.M.J. i./3i,36. PEERPEEAL SEPSIS. Glycerin Irrigation up (to 200 Cc. once or tlrrice daily into the uterine cavity or cervical canal) the most effective remedy at our disposal, but should be used at an early stage. Pyrexia as a sign for puerpeial sepsis an entirely unreliable guide—it rarely develops at the outset; pulse rate of more importance. Drainage by Glycerin started as soon as temperature rises to 99° or pulse rate to 90. It is not normal for a woman to suffer from after-pains for the first few days after the puerperium and pam is invariably due to interference with free drainage. Profuse lochial discharge another indication for early treatment.—A. B. Hobbs, B.M.J. n./3i,746. Glycerinum Boracis (_B.jP. ’ 14) is not a mere solution; it has an acid reaction and when mixed with an alkaline carbonate evolves Carbonic Acid ; useful in infantile diarrhoea, in 20 minim doses. Glycerinum Aluminis {B.PP 14). An astringent in chronic pharyngitis ; is less disagreeable than tannin. Gargarisma Alumirus—U.C.H. 2% in Acid Infusion of Boses; C.H.W. 5 grains with Tincture of Myrrh 40 minims to ounce. Glycerin Jelly, for toilet use. . . Gelatin 140 grains, Bose Water 6 ounces ; a fewminutes j a water-bath to dissolve ; add, when cool but still fluid, W hue o gg i • Heat to coagulate completely, and add Glycerin 6 I Avar of grains. Mix well, filter through a hot-water funnel, and bo Ale while warm. Lubricant Glycerin Jelly. Is somewhat softer than the latter. For toilet use and lubrication of Stomach Tubes. Glycerinum Aluniinis efc Acidi Tannici. Potassium Alum (free from iron), in powder, 1, Glycerin 6. Heat to dissolve, and add Tannic Acid 1. An astringent throat pigment. Diluted 1 in 20 as a vaginal injection. Glycerinum cum Aqua Rosas. Glycerin 2, Rose Water 3. An agreeable emollient for the skin. Lotio pro manibus.—Vic. Park. Tragacanth Powder 1 ounce. Alcohol 90% I pint, Glycerin of Borax 2 ounces, Tincture of Benzoin 1 ounce, Thymol 5 grains. Oil of Lavender and Cochineal, Rose Water to 4 pints. Glycero-alcohoh Syn. Petit’s Liquor. Dose.—5 to 60 minims (0*3 to 4 Cc.). Glycerin 333, Distilled Water 146, Alcohol 95% 580. Is used as a solvent of alkaloids and active principles. It has Sp. Gr. about 1. Glyco-gelatin, T.H. Gelatin 1 ounce, Glycerin (by weight) 2J ounces. Orange Flower Water 24 ounces. Soak the Gelatin in the water, then heat till dissolved and add the Glycerin. When nearly cold add carmine solution, q.s. Gelatinum Glycerinatum, U.S. Soak Gelatin 1 for one hour in sufficient previously boiled and cooled water to cover it. Drain and add Glycerin 1, lieat until dissolved, strain hot, and evaporate to 2 by weight. Glyco-Gelatid Pastilles {Soft) The following weigh 20 gr- gr. gr. m. i o i\ if Acidi Borici Acidi Carbolici . . _f Acidi Citrici \ 01. Limonis Ammonii Bromidi J" Apomorphinse c~J\Codeinse .. Bismuthi Carb. .. f Bismuthi Carb., T. H. gr.3 \ J t TYTnrnViirtflP ApaL rrr l f Eucalypti Olei } Cocainm HC1. gr. gr-sV\ gr-TV/ 3 gr- ^Morphinse Acet. Cascara Sagrada. .ocse Extracti fglFUCocainge HC1 gr. 4, % % (T.II. has TV) gr-Ar / gr.24 gr.24 1 T'_! > 1 10; CPJ f Cocainse \ Morpliinae Codeinse .. Convallarise Tinct. Eucalypti Olei . . gr-iVl gr-u’s / gr. m. m. 1 h 9 jLi 1 9 gl'^Tj Heroin Menthol, T.H. (St. Th. H. gr. i) awn Mentho1- lJSLiJ f Cocaine HC1. ( Menthol .. ® ( Codeines .. I Menthol I Eucalypti Olei C£) Morphines Acet. CE) ( Pini Pumil. Olei. |S] < Terpeni Hvdratis. ( Heroin HCL ( Sulphur Proecip. ^ Potassii Tart. Acid. Terebeni .. Thymol [WlPTlTussis—Cocainse et Morphinee grams m. 4 ) ■ gr-A) • gr-A 6 gr. g**A | gr*#o ) g*HV ( gr.TV ) gr-sVi m. 4) grHo m, gr. gr-A ± 8 gr. 5 gr. 1 m. 2 gr-tV gr- iT6 • gr;w the index The Pastils or Jujubes, oval or round shape, are in under Trocliisci6 G ’ (be., of Gum). Marshmallow Pastils, PASTILLES de GUIMATJVE. Boil incised Marsh Mallow Root 100 in Water 400, strain off the liquor. Evaporate to about 80 and mix with Tragacanth 10 and Sugar 1,000, adding Orange Elower Water 10 or more if necessary to make a mass for cutting inot Pastils weighing 20 grains (1'2 Gnu). This basis may be medicated with throat remedies similar to those given under Glyco-gelatin Pastils. Suppositoria Glycerini (B.P. ’14). Gelatin 14, Glycerin by weight 70. Water g.s. to 100, suitably combined. Pour into moulds of 15, 30, 60, or 120 minims or other capacities as required. Contain 70% by weight of Glycerin. This basis may be used for gelatin pessaries. U.S. orders Glycerin 80, Monohydrated Sodium Carbonate 2, Stearic Acid 8, Water 10, in Gm. for 30. Vaginal Suppositories, U.S., are globular or oviform in shape and weigh about 10 Gm. if made with Glycerinated Gelatin, and 4 Gm. if with Theobroma Oil, v. also Ovules. Glycerin Tampons consist of gauze and wool swabs soaked in Glycerin medicated with Ichthyol 5 and 10%, with Izal 4%, also Resorcin 1 and 2%. S. H. has ichthamol 5, 10 and 20%. Hollow Suppositories, composed of Oil of Theobroma. May be filled with 20, 45, or 90 grains of Glycerin ; they are prompt in action. Hollow Suppositories and Pessaries may also be filled with Bismuth and Cocaine Ointment, Gall and Opium Ointment, Liquid Extract of Hamameiis, Hamamelis Ointment, Adrenalin Solution. Cataplasma Kaolini, U.S. VIII*—Kaolin 577, Boric Acid 45, Thymol 0*5, Methyl Salicylate 2, Peppermint Gil 0-5, Glycerin 375 (all by weight). Heat the Kaolin one hour on a water bath and add the rest. Cataplasma Salicylicum Gompositum, Antiphlo- gistine (T.M. 253831), Sorbefacin (T.M. 303921), and Thermofuge are used to relieve infi animations. Pelvic Cellulitis or Peritonitis in Laeour. Hot tampons of Cataplasm Kaolin with 5% Ext. Bellad. Virid., with hot vaginal douches, useful.—E. Kelson Ford, B.M.J. ii./3o,727. ^ Unguentum Glycerini Compositum, St. Th. H. Glycerin 3 drachms, Strong Solution of Lead Subacetate 20 minims. Wool Fat 3 drachms, Lavender Oil 1 minim, Soft Paraffin to 1 ounce. Glycerin Substitutes. (Used during the war.) (See Edn. XIX.) Ethylene Glycol CH2OH.CH2OH. is used as a substitute for Alcohol as a solvent and preservative. . It is non-excisable, non-toxic, non-inflammable, and non-corrosive to metals. Used as an ‘ anti-freeze * and as an ingredient in dynamite, also as menstruum and solvent for preparing fruit essences and flavouring essences : a good solvent for terpeneiess oils. Superior to Glycerin as preservative. May be safely given to animals in doses up to 20 Cc. per kilo daily.—C.D. ii./2 6,438 ; ibid. 428. As a solvent or vehicle for medicinal products it is comparatively innocuous. Intramuscular injections well tolerated in man (M.L.D. in rabbits 6-6 Gm. per kilo). It is said that even 140 Cc. would be needed to cause toxic symptoms in man anfi the fatal dose would be more than b lb. P. J. Hanziik and Go- workers, JI. Pharm. and Exp. Therap., April, ’31,406. W. I. von Oettmgen and E. A. Jirouch, ibid. Aug. ’31,371, draw however other conclusions and say subcutaneously likely to cause irritation. Large doses may cause se\ere gastro-enteritis. GLYCETRACTA (GLYCETRACTS). Strength.—1 = 1 of Drug. Dose.—The equivalent in volume to the close 01 the drug, excepting those standardised, v. posted. For doses see the Index. Glycerin is a good solvent and preservative for medicinal substances. As Marshall remarks, “ Substances which are soluble in water and insoluble in alcohol are to some extent soluble in glycerin. It sliou c be noted that, as a general rule, glycerin extracts must contain at least 25% of glycerin to preserve them. “ Glycetracts,” first described by us, C.D. i./o8,489, have the advantage of miscibility with aqueous vehicles (those of alkaloidal drugs made with a necessary small addition of acid would be incompatible with alkalis). Many are suited both for internal and local use ; they keep well, are cheap, and being free from alcohol, are convenient and suitable for export. The following Glycetracts are perfectly miscible with water:— Glycetract of belladonna. Glycetract of calumba. Glycetract of cascara, Glycetract of chiretta. CE)Glycetract of conium. QDGlycetract of digitalis. Cp)Glycetract of gelsemium. Glycetract of gentian. Glycetract of hamamelis. Cp)Glycetract of hyoscyamus. (jp)Glycetract of jaborandi (almost). Glycetract of quassia. Glycetract of sarsaparilla. Glycetract of squill. Glycetract of senega. Glycetract of senna. Glycetract of taraxacum. Glycetract of valerian. The following can be rendered miscible, as stated later: Glycetract of aconite. Glycetract of catechu. Glycetract of cinchona. Glycetract of coca. CE) Glycetract of colchicum. ] Glycetract of ergot. Cp)Glycetract of hydrastis. Glycetract of krameria. Glycetract of rhubarb. CIDGlycetract of Yirgiuian prune. Method of Preparation. 1. For Drugs containing water - soluble constituents, bitters,. , tannin principles, and some flavouring agents:— (a) Percolation-process.—Tor those drugs which will percolate satisfactorily, without “ blocking,” this method is to be preferred. Macerate 100 of the drug in No. 20 powder in glycerin 50 and water 200 for twenty-four hours, then commence percolation. Reserve the first 50 of percolate and continue percolation with chloroform-water (1 in 1,000) until exhausted. Evaporate the liquor to 50 and add to the reserved portion. Experiments show that this percolation method is suitable for; calumba, cascara (1% of strong solution of ammonia to be added), digitalis (for an alcoholic form see Edn. XIX. p. 432), gentian, hamamelis leaves, krameria, rhubarb, sarsaparilla, senega, taraxacum,, valerian and Virginian prune bark. Glycetract of Virginian prune is. made without heat. (b) Maceration-process—i.e., for drugs which will not percolate satisfactorily. Macerate crushed drug 100 in a hot mixture of glycerin 50 and water 200 for six hours, press off, and repeat maceration with hot water twice. Combine liquors and evaporate to 100. Experiments show that this is suitable for chiretta, liquorice (cold maceration), quassia, senna (cold maceration), squills (cold maceration). 2. Alkaloidal Drugs. For drugs containing alkaloids percolate the crushed drug 100,, with a mixture of glycerin 50, acetic acid 9, and water 191, and proceed otherwise as under 1 (a), making the final product 100 containing about 3 per cent, of acetic acid. This method our experiments show to be applicable for aconite, belladonna, cinchona, colchicum, conium, ergot, gelsemium, hydrastis, hyoscyamus, ipecacuanha and jaborandi. A larger proportion of acid does not yield larger alkaloidal contents. The acetic glycerin mixture extracts the bulk of the alkaloids in most cases. (Beringer used Tartaric Acid 2%, except for Colchicum, Conium and Ipecacuanha, in which Acetic Acid was used.) GLYL AND SYL FLAVORING AGENTS. 437 Glycetracts which do not mix clear with water can be replaced by an aqueous extractive, evaporating and mixing a sufficiency glycerin with the warm liquor, but alkaloidal drugs must be handled by the method 2. The following Glycetracta are standardised :— Glycetract. Alkaloidal Strength. Dose. IPS Aconite . iiRli Belladonna 0-4 % Alkaloids 0*375 (Average) 1 min. 1 to 2 min. Cinchona. 3-0 8 to 25 min. I?PI 0^1! Coca ... ... 0-25 1 to 2 dr. (fbColchicum (seeds) 0-5 (Average) 3 min. dLConium (seeds) ... 0-45 (Average) 3 min. GD Digitalis. M.L.D. 0-1 Cc. per 1 to 2 minims. ICO Gm. frog CE)Hyoscyamus 0-075% Alkaloids (Average) 3 min. Cg)lpecacuanha 1*1 Expectorant 1 to 4 min. [Fli *Nux vomica Emetic 30 to 40 min. 0*75% Strychnine 2 to 0 min. *This Glycetract is best made Avith Hydrochloric Acid—the strength employed is 5 Cc. of Hydrochloric Acid Sp. gr. 1T6 to 100 Gin. of drug. Fluidglycerate of Bucku is made with Buchu 100 Gm., Potash Solution 50 Cc., Glycerin 50 Cc., Water 100 Cc. Fluidglycerate of Grindelia is made alkaline on the lines of that of Buchu. See also Beringer wrho has worked on similar lines.— Am. JL Ph. 1907,410; 1908,525; 1909,312. Giycopasta is the name given to a Glycetract (neutralised if necessary), made into a paste for local use by mixing with Tragacanth 2 to 3%, e.g., the following :— |!p_J] Giycopasta Belladonnae, 0*375% Alkaloids. (Glycerinum Belladonna q.v. is about 0*5% Alkaloids.) |jp 1| Giycopasta Aconiti is the Glycetract alone (no thickening necessary). CE> Giycopasta Hycscyaml, 0*075% Alkaloids. If considered too strong they should be directed to be diluted with Glycerin. ♦ GLYL AND * SYL FLAVORING AGENTS (Martindale). Our suggestion is to employ as flavoring agents to prescribed “ mixtures,” Solutions in either Glycerin or Syrup of pleasant tasting Essential Oils. These are called respectively sfcGlyl (T.M. 320797) and 4c Syl (T.M. 320798) throughout our pages. ‘ Glyl5 and ‘ Syl ’ Flavoring Agents are stable within ordinary limits of temperature. Their use tends to uniformity and time saving, both in prescribing and in dispensing. The preparation of the Distilled Waters hitherto employed, entails unnecessary labour, more especially as several, e.g. Cinnamon Orange Flower, Rose, have poor keeping qualities. . Then again, many of the Aromatic Waters require the addition of either Glycerin or Syrup to render them of use in covering the taste of nauseous medicines. The same applies to Tinctures and Spirits. Fresh infusions of drugs are useful, but though the infusions a * fresh,’ the drugs are mostly dried and have lost much of their arom Of the usual flavoring tinctures that of Orange is the only one >« use to ‘cover’ the taste of a nauseous drug, but a sweetening agea in addition is essential. Syrup of Orange by reason of its utilr has become hackneyed. Glyis and Syls have now been well tried and are much prescribed. Preset ration.— Glyl and Syl flavorings are all of uniform strength—1 of the Essei tial Oil in 500 respectively of Glycerin or Syrup—or approximate 1 minim to the ounce, and are quickly prepared by placing half fcfc required amount of Glycerin (slightly warmed, e.g., by standing tt bottle in a little hot water) or Syrup in a bottle capable of holdir the full amount, adding the Essential Oil mixed with three times r volume of 90% Alcohol in small portions with shaking, then addin the remainder of the Glycerin or Syrup with further shaking. Thus made and allowed to stand a short time for any excess <r Essential Oil to rise (easily removed by passing through a pledge of moist Cotton Wool), the following are perfectly clear. TL solubility of these Oils in Glycerin is remarkable. Glyl vel Syl *Amygdalge Amarae sine HCN. , Anethi. , Anisi. , Aurantii Amari. , Aurantii Floris. , Carui. , Caryophylli. , Cinnamomi. , *Coriandri. , F coniculi. Glyl vel Syl Limonis. *Menthae Piperitse. ,, Viridis. Myristicoe. Pimentse. Pini Pumilionis. *ftosse. Sassafras. Thymi. *Vanillse (1 of Essenc q.v. in S). ,, ,, * Lavandula). The favorites in the series according to our taste are indicated by* Glyl Aurantii Amari, Cinnamomi, Pini (excellent for Terebinthinou drugs), and Thymi are also good. Glyl Pini and Syl Lavandulae together is a. useful combination. Dose.—Of either Glyl or Syl, to flavor an ounce dose of a mixture 1 to 2 drachms, as a general rule, suffices. In the case of Glyl c Syl Menthae Piperitae \ drachm will be ample. Laevulosyls comprise a series of flavouring agents prepared O' identical lines, using Laevulose, where the use of Sugar and Glyceri. are not advised. The dose and preparation is similar. Glyls an preservative—both the Oils and Glycerin are antiseptics. E. O. Howland suggested Glycerins of Lemon and Orange Peel made fror fresh peel.—C.I). i./i4,594. GOSSYPIUM.—Syn. Cotton Wool. With data on Cellulose Products. The hairs of the seeds of Gossypium Barbadense and of other specie of gossypium, freed from fatty matter, employed as a wound dressing Manufacture of Cotton—For details of bleaching and machiner required, see A. W. Gerrard, P.J. i./x6,573. Cotton Wool is soluble in an ammoniacal solution of copper oxide The following surgical forms of Cotton Wool (and Allied Dressings) are in use. See also under the individual antiseptics for medicated preparations. Bandages are made termed Black Cloth, Butterclotli, Calico, “ Cataract ” (of special form for bandaging after operation for), Cr pe (Geneva), Crepe (Velpeau), Crinoline (for silicating and Plaster of Paris), Domette, Elastic Circular Stocking (Stockinette), Elastic (India Rubber Webbing\ Elannel, Gauze, “ Ideal ” (a special elastic bandage), Muslin (for Plaster of Paris), Open Wove (absorbent), Plaster of Paris, Selvedge (white and grey) and Triangular Splint. Battist, Milne’s. A substitute for oiled silk, gutta-percha tissue and jaconet. Can be boiled, and is spirit and greaseproof. Bitii'otii’s Cambric.—Cotton fabric treated by a special process. It takes the place of gutta-percha tissue and oiled silk, being sterilisable. Butterclcth.—As a dressing for applying ointments, liniments, etc. Cellulose Film in three varieties—• 4 Taffetas.’—A yellow film similar in texture to Yellow Oiled Silk and suggested as a substitute for same. It is perfectly greaseproof but swells slightly in contact with moisture, hence though suitable for use with Soft Paraffin basis ointments is not intended for applying dressings containing aqueous medicaments. It is nevertheless sterilisable by moist heat. , . ‘ AseplafUm.’—This modification is colourless and being transparent and sterilisable may be applied direct to wounds. Cellophane (‘Cellafme.’)—This variety is the thinnest and is used as a greaseproof covering for packing pharmaceutical and food products. All the above are unaffected by Alcohol and Ether, but they expand in contact with moisture—contracting again on drying—in some cases this property is of distinct value. . _ , Cellulose Wadding—A cheap absorbent dressing. Is prepared from wood fibre. Cellulose Wadding is in sheet form. Eye Pads are ready cut, round or oval, consisting of a layer of wool between two sheets of gauze. . , , _ . , , _ Felt, thick, coated with adhesive solution, m sheets 28 inches by 18 inches and with soap plaster for bed sores. Gauze Tissue, see Gauze and Wool Tissue. Gauze, White Absorbent, is prepared in 6 yard pieces. Tela Depurata, ~P Ct is similar Gauze and Wool Tissue, plain and medicated with Boric Acid, Carbolic Acid, Iodoform, CE)Mercuric Iodide, [PJMercuro-Zmc Cyanide, Thymol, Picric Acid, are prepared. , . Gauzes, Ribbon, as suggested by C. Stonham, nave a woven edge and are used for plugging cavities and wounds. . , , . The following are made in i, b 1 and 2 inch widths m l2 yard iengths . Alembrotli, Aluminium Acetate, Boric Acid, ’ idQMercuro-Zinc Cyanide, ®Mercuric Perchlonde,also Gauze Tampons, 3 inches long and f to 1 inch m diameter (witli thread attached), coated with soft soap, useful m obstinate constipation. Evacuation occurs in i hour. , *+v. -pnpoivntus Handkerchiefs, Aseptic (Silky Fibre), are medicatedwith Eucaljptus and Fine Oil, and Non-Medicated —For phthisical sufferers. Impermeable Piline.-i the thickness of spongio-pdrae°l “Vn mti- of the waterproof india-rubber backing of the former thcie is an ami septic material, not affected by heat or strong sp liniments in rheumatism, and where warmth is desired simultaneously. Jute, in 1 lb. rolls for rough absorbent purposes. , . Kapok Wool strongly advised as wound dressing. Useful ahsoroent discharges.—B.M.J. i./i8,2<6. , Aa o Sheep’s Wool. Syn. appUed^very day by the patient. Doe^not a°Tids,f m^in^ns ’'*»$**™ May be impregnated with mercuric bmiodi.de 1 m Has many advantages over Cotton Wool. A wrap of sheep’s woo preferable to Gamgee Tissue. Other uses, e.g., rheumatism, pulmonar atfections, suggest themselves. Sheep’s wool not only kills fleas but has no attraction at all for them.- P. Delanoe, per Jl. Trop. Med., July 2, ’23,327. Lint (vide also Steriloid Dressings), absorbent, is made both non-medicate and medicated :—Boric, 50% coloured pink. Iodoform, 10%. Non Absorbent useful for local use. Styptic (10% Ferric Perchloride). Linteum Carptum L.H. is plain absorbent lint. Muslin, Nainsook, width 36 inches. Somewhat softer than butterclotla Is useful for ointments. sfcPontampons (T.M. 307382) consist of a semi-solid slowly soluble medicate cone with a non-absorbent wool tampon attached—the whole encase; in a soluble gelatin shell. For the treatment of gonorrhoea, endometritis, cervicitis, vaginiti.- leucorrhoea, dysmenorrhcea, prolapsus uteri. The following are made:— (A). Cg)Ichthyol Compound—i.e.y Ichthyol 2-5%, Iodine 0T4%, Carbold Acid 0-5%, Powdered Hydrastis 1%. (B). Ichthyol 10%. (C). Protargc: and Ichthyol, each 2%. (D). Cg)Opium and Hyoscyamus of each 2 grain Belladonna 1 grain. All these are made with a Boroglyceride basis. Sanitary Towels, Hygienic, for menstruation, of Sphagnum (q.v.) ar absorptive, deodorant and antiputrescent. Southall’s, Nos. 0, ], 2, l 4 and extra large, and the “ Mene ” are of cotton fabric. Maw’s are i two brands, ‘ ordinary ’ and ‘ superfine.’ sfcKotex (T.M. 426020, Cl. 11) Sanitary Pads are described as made c Cellucotton Wadding of high absorbency. Sponge—Elastic skeleton of an aggregation of minute marine animal,, Spongia officinalis. N.O. Ceratospongia.—C.D. ii./3o,274. Sponges, Carbolised, have fallen into disuse but some surgeons still prefe them to cotton swabs. They are available thin and flat and can b kept in 1 in 20 Carbolic Solution. More suitable than gauze for soakin up blood. Sponge Eduction,—In the treatment of cases of laceration of the fmge* in which a bare and protruding bone or extensive stripping of the skin witl denudation of the deeper parts may render amputation necessary. Th method makes it possible in most cases to save the full length of the stump Flat Turkey Sponge is used, soaked in 1 in 40 Carbolic Solution before th* operation. For details of methods, vide L. ii./ii,1348. Circular Gauze and Wool pads, about 3 inches in diameter. Also sterilised (vide Steriloid Dressings). Spongio-Piline.—Thick felt with waterproof india-rubber backing fo applying warm moist dressings. Tillman’s Dressing is Cellulose Wadding q.v. Tow, Flax, cf. Tenax. Wool, Absorbent Cotton (also non-absorbent). Both the above also in thin sheets measuring 20 by 14 inches. * “ Steriloid ” Dressings. (T.M. 260647). These dressings have been submitted to a temperature of 250° F. for 3 minutes at a pressure of 15 lbs. in an autoclave. Each parcel of dressing i wrapped by a patent method in wool, parchment wrapper, and enclosed in a air-tight dustproof carton or hermetically scaled tin. Bandages (in tins), 2, 2J, 3 and 4 inch. Gauze, plain, absorbent, 1, 2, 6 and 12 yard cartons. ,, Alembroth and Boric, each 1 and 2 yards, fn] ,, Cyanide, 1, 2, 6 and 12 yard cartons. Cp) ,, Biuiodide, 6 yards. . Lint, plain, absorbent, Alembroth, Boric, and lJ?ACyanide. Wool, plain, absorbent, 1, 2 and_8 oz. cartons. ,, Alembroth, Boric, and IP 11 Cyanide, in 1 and 2 oz. cartons. MSwabs, Cyanide. Gauze, 4x4 inches, 12 in carton. In addition. Iodoform Gauze (2 yards) and Carbolised Wool, 50, 1C and 250 Gm. are wrapped with aseptic precautions in similar carton but are not heated. Combined cartons contain 1 ounce of plain absorbent wool with | yard plain absorbent gauze sufficient for a minor dressing and combined cartons containing Alembroth Gauze (6 yards) with wool and gauze tissue suitable for a major operation. Swabs. Cartons contain : 12 small round pads suitable for eye-work; 6 larger round pads (about 2 inches in diameter) ; 12 gauze, 6 inches square ; 12 wool and gauze tissue pads, 3 inches square ; tins contain 10 gauze covered swabs, 4 inches square ; also tins containing 10 swabs 6 inches square (vide also Triangular Swabs). [PllSwabs. Cyanide, 12 in carton, 4 inches square. Triangular Swabs have a pocket at one angle in which the finger or a probe can be introduced. Tor packing a cavity or wound during operation. In tins of 10 and 20 swabs.—Jackson Clarke. Eye Pads, 1 doz. in carton ; Towels (Tins of 4), IS x 32 inch. Wrappers 6 feet long with slit in same, 10 X 2 inches, for abdominal operations, also 3£ feet long. Abdominal Set in flat tin with key, contains 12 swabs 6x8 with tapes, 12 swabs 6x6, with tapes, 4 towels, 32 x 18 inches, 2 thick pads 6£ x 8£ inches (as dressing), with 6 safety pins, 1 bandage 4 inch x 6 yards, 2 wrappers with sleeves, twelve 4 inch x 3 yard gauze rolls and 2 veils. Eye Operation Set, No. 1, tin containing 3 Sterile Sets of the following :—12 small eye swabs, 1 special eye pad, 1 x 2£ inch bandage. (A set can be removed without impairing the others in any way.) Eye Operation Set, No. 2, containing 1x2 inch bandage, 4 eye pads, 4 pieces gauze, 1 oz. wool. Preparation of Medicated Sterilised Dressings. The following notes are based on a paper by Beringer some years ago, and experience of our own in this class of work. Specially cleansed rooms are of course required for work of this kind. All tables, floors, etc., should be scrupulously scrubbed with soap and Cresylic Disinfectant. The tables just prior to use should be washed down with 1 in 500 Perchloride Solution and then may well be covered with sheets of freshly sterilised parchment paper. Operators’ hands, clothing, etc., require usual attention. Cartons, tins, wrapping paper, etc., should be heated in an oven at 120—150° C. for half an hour. Absorbent Gauze. The gauze suitable for use contains about 12 threads to the Cm., both on the woof and on the warp and is about 1 yard wide. This is wrapped and sterilised in convenient lengths for surgeons’ use. Moist Absorbent Gauze. Sprinkle the Sterile gauze with Sterilised Distilled water containing 5% Glycerin and pack in previously sterilised amber glass jars and sterilise again. Boric Acid Gauze, 20% (usually coloured pink). # Impregnate Gauze 100 with boiling Saturated Solution of Boric Acid tinted with magenta. Press out until it weighs 180 and dry. Garbolised Gauze, 5%. Bor this employ Phenol 5, Acetone 50, Water 50, Glycerin 5, to Gauze 100 as under Iodoform Gauze. (Dry.) Iodoform Gauze, 10% (Dry). . Dissolve Iodoform 10 in Acetone 100, saturate Sterile Gauze 100 wnh the solution, evaporate the Acetone. Iodoform Gauze, 10% (Moist). . . Proceed as for Iodoform Gauze (dry) incorporating about 1 /0 Glycerin in the Acetone solution. 0/ /O (PDMercuric Iodide Gauze, 4/0. . Impregnate Gauze 400 under pressure with a solution of Mercuric loaiae l md Potassium Iodide 1, in Water 800. Less Liquid, e.g., M ater 400 will vork equally well by adjusting the pressure. We have also employed for tni9 luantity a mixture of Acetone 200 and MTater 200. .AjiYjLercuro-Zinc Cyanide Gauze, 3%. „ _. .... , , Prepare a suspension of Mercuro-Zinc Cyanide a m Sterne Distilled M a ter 100 tinted with rosaniline and mix evenly by stirring or shaking with Gauze 100. Dry without pressing. Much more water is required than usually adMsed. Picric Acid Gauze, 2%. Picric Acid 2, Water and Acetone of each 50, Gauze 100. Proceed as under Dry Iodoform Gauze. Sal Aiembroth Gauze, 1%. Impregnate Gauze 100 under pressure with a solution of Sal Aiembroth in Water 200 tinted with Anilin Blue. Less water may be used or a mixtu: of Acetone and Water, e.g., Acetone 50 and Water 50. All Gauzes should be sterilised at 120° to 150° C. for half an hour just befou medicating. If a steriliser be available—cf. Chapter on Sterilisation, a less temperatu e.g., 120° C. will be sufficient, furthermore the use of a vacuum apparatu will permit of excess of moisture being drawn off rapidly. The preparation of Wools, and Gauze and Wool Tissues is on simils lines. We give brief notes of procedure under respective headings, e.g Gossypium Carbolisatum, Gossypium Ferri Perchloridi, Gossypiue Sal Aiembroth, etc. National Health Insurance requires the dressing to be issued to the patiei wrapped in dustproof casing. Dental Dressings. For Dental use are prepared :— Aseptic Dental Napkins. Absorbent Dental Rolls. As a substitute for the napkin or rubbc dam. For covering the months of the salivary ducts, a section may t placed on either side of a tooth, or the entire roll may be bent roun the outside of the arch or under the tongue. No. 1, diameter i5e inch No. 2, | inch ; No. 3, £ inch ; No. 4, f inch ; in 1£ or 6 inch lengths Non-absorbent Dental Rolls.—To replace the rubber dam. In crow and bridge work. May be used in connection with the saliva ejecto Sterilised Absorbent Pledgets for wiping out cavities. Asepiic Absorbent Points are prepared for drying pulp canals. Sterilised Bibulous Pcper, in sheets, 3 inches by 10 inches. Carbonised Cotton for filling pulp canals, and for treatment of expose pulps. Artificial Silk (Syn. ‘Rayon) Viscose, Cellulose Acetat ( ^Celanese), (T.M. 411818 and 460218, Class 50). Tests for Silk am Art Silk, and Solvents for same, 'previously in Vol. Edn. XIX. are now transferred to Vol. II. GOSSYPII RADICIS CORTEX. The root bark from Gossypium herbaceum (Malvaceon) and othe. cultivated species is B.P. ’14. It contains about 10% acid resin. Chemical Examination of the bark.—F. B. Power, P.J. ii./m,420. Uses,—The following are given instead of Ergot to check uterine haemorrhage in all its forms. May relieve dysmenorrhoea. Extraction Gossypii Radicis Corticis.—Semi-alcoholic. Dose.—1 to 4 grains (0 06 to 0*25 Gm.) in pill. [jp f Pilula Gossypii Coinposita. Extract of Cotton Root, Extract of Hydrastis, Ergotin, of eacl 1 grain. Dose.—One, 3 or 4 times a day. Extraction Gossypii Radicis Corticis Li^uidum, B.P. ’14. Dose.—\ to 1 draclim. The bark exhausted with a mixture o Glycerin 1, Alcohol (90%) 3 ; 1 = 1. Flavoring.—Syl Lavandulae, Glyl or Syl Cinnamomi. Extractum Gossypii Seminis Palverisatum. POWDERED COTTON Seed Extract. Syn. ^Lactagol (T.M. 252851). Dose.—-1 teaspoonful 4 or 5 times daily given in milk. Said to increase the flow of milk and the nitrogenous constituents of same. According to the Lancet analysis it appears to consist practically entirely of protein substance, the total Nitrogen amounting to 15-68%.—L. ii./i2,702. Edestine. Stated to be the active principle, so far as galactogogue action is concerned, of cotton seed freed from fat, etc.—L. i./i2,830. Effect of Edestine on mammary secretion. Rat experiments. It is a good protein sparer and improves growth, but in large proportion (e.g., 46%) the young die.—G. A. Hartwell, L. i./22,323. Edestine is also obtainable from Linseed by precipitation with water from a 4% Saline Extractive. Vide also Yol. II. Peptic Index. Tinctura Gossypii Radicis. Dried bark of Root of Cotton Plant 1, Alcohol 60% 4. Dose.—1 drachm (4 Cc.) three times a day. GRINDELIA. The dried leaves and flowering tops of the ‘ Gum Plant,’ Grindelia ;Camporum (B.P. '14). The involucre, and often the leaves, are coated with oleo-resin. The medicinal action is due to resins. Uses.—For the spasmodic attacks which occur in asthma, whooping-cough and bronchitis, and given in neart disease to slow and regulate the pulse. Extractum Grindelise (by alcohol extraction). Dose.—2 to 3 grains (0-12 to 0-2 Gm.) three times a day Extractum Grindelise Liquidum (B.P. T4). Exhaust herb with alcohol (90%), distil, add Sodium Bicarbonate to residue and water q.s. with alcohol (90%) one fourth to make 1 = 1. Dose.—10 to 20 minims (0-6 to 1*2 Cc.) at the onset of a paroxysm of asthma, repeated every hour, in sweetened water or milk. Flavoring*—Syl Pini (very good), Syl Lavandulae. Spiritus Grindelia Compositus. Dose.—1 to 2 drachms (4 to 8 Cc.) in water every two to four hours while attack of asthma lasts. Liquid Extract of Grindelia 15 minims. Sodium Iodide 2 grains, Nitroglycerin Solution J minim, Tincture of Euphorbia X llulifera 20 minims, Spirit of Chloroform to 1 drachm. Extractum Grindelise Compositum. Dose.—1 drachm (4 Cc.) with a small quantity of Spirit, e.g., } drachms of Brandy in \ tumbler of hot water. . Liquid Extracts of Grindelia, Chekan and icrba Santa each 1, liquid Extract of Quebracho 3. Suggested for use m asthma. Grindeline. Dose.—1 to 2 drachms in water %hry p^as'sium peciality containing Liquid Extract of Grindm pjiuUfera 20 minims odide 2 grains, Trinitrin grain, Tincture of Eupborbia I flumera minims n each drachm. GUAIACI RESINA. The resin (a constituent to the extent of about 20%) obtained fro Guaiacum officinale or from Guaiacum sanctum (Zygophyllaceos). T1 resin contains chiefly (amorphous) Guaiaconic Acid and other cor stituents. The heart wood of these trees is Guaiaci Lignum B.P. ’14. Dose.—5 to 15 grains (0*3 to 1*0 Gm.). Soluble almost completely in ether, chloroform, absolute alcoh and in sal volatile. 1 Gm. of the Resin shaken with 5 Cc. Petrol, filtered and diluted with 5 C of 1 in 1,000 Copper Acetate Solution should not give a green colour—absent of Colophony Resin. Uses.—In chronic rheumatism and lumbago, and for chron sore throats; added to purgatives is useful in gout and for sluggis liver. It is a laxative in itself. For dysmenorrhcea, 10 grains of the resin three times a day. 1 this causes flatulence or colic add to each dose 1 grain of Dover' Powder. The patient should begin taking it a week before the perioo It is also given to relieve amenorrliooa. Capsules and Slipules (No. 1) of Guaiacum Resin, 5 grains; als Tablets of Guaiacum Resin and Sulphur 3 grains (0-2 Gm.) of each. Useful for gout and rheumatism, cf. Chelsea Pensioner. Elixir Guaiaci—Dose.—1 to 2 drachms. Guaiacum Resin 1C Tragacanth 1, Acacia 1, Syl Pini 50, Simple Elixir to 400. Suggested for use in acute tonsillitis. Tinctura Guaiaci Ammoniata (B.P. ’14). Dose.—4 to 1 drachm. LJ One of Resin in 5 of Ammonia-Alcohol Solvent, with Oil of Lemon aror Oil of Nutmeg as flavourings. Flavoring.—Syl Pini; Syrupus Zingiberis. This is very useful where the uvula and fauces are enlarged. Tinctura Guaiaci. Dose.—1 drachm. 1 in 5 alcohol (90%). Trochisci Guaiaci Resinoe (B.P. ’14). Three grains of Guaiacui Resin with fruit basis. GUAIACOL. C6H4.OCH3.OH= 124-0624. Dose.—1 to 5 minims (0-06 to 0-3 Cc.). U.S. X. has average do* 8 minims. This approximates the max. single dose of the Fr. Cb A colourless refractive liquid, a constituent of Beech-wood Creosot but is also made synthetically from Pyrocatechin, in colourles crystals, melting at about 28° C. Sp. Gr. IT 16 to 1T4 (B.P* ’14 The crystals should be only dispensed when so ordered. The crystal are official in P. Belg. IV., Pli. Ned, V., P. Ital. V. and F.E. VIII. Solubility .—Both forms are soluble in Alcohol, Ether, Oil/ Glycerin, slightly in water, with taste and odour resembling Creosote Uses.—In phthisis, particularly in incipient stages, may b> prescribed in capsules (Guaiacol Carbonate), or cordial, e.g., Guaiacc 13*5, Tincture of Gentian 30, Alcohol (90%) 250, and Sherry to 1,000 two teaspoonsful two or three times a day in water—or as Mistur Guaiacol, vide postea. Antiseptic and antipyretic. It is sometimes rubbed into or painted on the skin, covered by oiled silk ; begin with 10 minims and increase to 30 or more ; do not cover more than the space of the palm of the hand at a time. Mistura Guaiacol, G.H. Guaiacol 4 minims. Alcohol 5 minims, Glycerin 30 minims, Cinnamon Oil 1 minim, Tragacanth Mucilage 1 drachm, Water to 1 ounce. Mistura Guaiacol cum Quinina. Dose.—J drachm gradually increased to 2 drachms, well diluted with water, thrice daily after meals. Guaiacol 30 to 40 minims, Quinine Hydrochloride 20 to 25 grains, Alcohol (90%) 2 ounces, Compound Tincture of Gentian 3 ounces. Water to 8 ounces. The small dose of Guaiacol thus givenis increased by giving Guaiacol Carbonate in Capsules. Pulmonary tuberculosis is treated with Guaiacol, e.g. : Guaiacol 1 drachm, Alcohol (90%) 1 ounce. Syrup of Lemons 1 drachm. Spirit of Chloroform 2 drachms, Water to 6 ounces. Dose.—\ ounce thrice daily. Increase Guaiacol by 2 minims each week until a dose of 12 to 15 minims is given thrice daily, and continue for four months or more. Perles of Guaiacol contain 1, 2 or 3 minims, dissolved in oil. Capsules 2 and 5 minims, best made with Guaiacol Carbonate. Pilula Guaiacol 1 to 3 grains (crystal). Capsules of Guaiacol (Carbonate) 1 grain, with Iodoform 1 grain and Almond Oil 5 minims, are prepared for use in phthisis, also of Guaiacol J grain, with Cod Liver Oil, 5 minims. Injections of Guaiacol 5%, and Iodoform 1%, in sterilised olive oil, have been used in tuberculosis, they are not free from danger. Dose.—One, increased to three Cc., but better per os. Durant’s Injection. Guaiacol 5, Iodine 1, Potassium Iodide 10, Sterile Olive Oil 100. In pulmonary phthisis. For tuberculous uveitis Guaiacol has been extolled. 1 Cc. of 1% Solution injected, but these subconjunctival injections are not approved by all. Injectio Guaiacol lodi et Camphoras, Dose.—4 minims (0*25 Cc.), intramuscularly, increased at three- day intervals to 15 minims (1 Cc.) and this repeated every 2nd or 3rd day. Contains Guaiacol and Iodine (in oily combination as in Iodinol). aa : 10% and Camphor 5%. Sterules of Guaiacol, Iodine and Camphor are made containing | and 1 Cc. of the injection. Rheumatoid arthritis and articular fibrositis, other than the post-infective gouty and gonorrhoeal forms, well treated.—G. Watson Smith, B.M.J. ii./2 5,o4o. Vapor Guaiacol Compositus. Guaiacol and Terebene of each 2, Menthol and Thymol of each 1, Spirit of Chloroform 3. Inhale 5 to 10 minims from an inhaler night and morning. Employed in phthisis. Fuller’s Inhalant. Guaiacol 4, Menthol 2-5, Sydenham’s Laudanum 125, Compound Tincture of Benzoin to 250. Sometimes Terebene 4 is added. Unguentum Guaiacol. Guaiacol 1, Lanolin Ointment (or other suitable basis) 5, useful in orchitis and mumps, and in tuberculosis. Rheumatoid arthritis is treated with Guaiacol 1, Iodine Tincture 7, to be painted on the joints twice daily with a mixture internally of Ammonium Chloride 15 grains, Todine Tincture 5 minims, Carbolic Acid 2 grains thrice daily. Pigmentum Guaiacol.—Guaiacol 1, Olive Oil 1, dissolve. In eye diseases, e.g., interstitial keratitis, irido-cyclitis, vitreous opacities, sympathetic ophthalmia and optic neuritis, Guaiacol found to be more certain diaphoretic than Pilocarpine, Never used in more than 30 minim doses. Caution,—Pigmentum Guaiacol R.N.H. is Guaiacol 25 minims, Menthol 25 grains, Olive Oil to 1 ounce. For use in throat work. Guaiacol 3 drachms, Olive Oil to 1 ounce. Of benefit as a throat paint in infected tonsils.—Hamblen Thomas, Pr., Nov. ’31,557. in leprosy, external and internal use of value. Used externally, the Guaiacol is rapidly absorbed. Pills 0-1 Gm. with Euealyptol 0-04 Gm.—two morning and evening, gradually increased, until 10 pills ( = 1 Gm. Guaiacol) taken daily. Alkaline baths twice weekly, and substantial diet enjoined. Guaiacol Bsnzoas, Guaiacol Benzoate. — Syn. sJcBenzOSOL. (T.M. 97425) C6H4.OCH3.O.CO.C6H5=228-0936. Dose.—4 to 12 grains (0-25 to 0*8 Gm.) in cachet. Manufacture.—The expired patent 5366 (1890) method is misleading. We found that heating Guaiacol crystals 12, with Benzoyl Chloride 15 at 150° C. till Hydrochloric Acid ceases to evolve, then pouring into 100 Cc. of 15% solution of Sodium Carbonate gave a theoretical yield. In small crystals, almost tasteless, nearly insoluble in water. Incompatible with alkalis. Useful in incipient phthisis (especially the diarrhoea of), and in diabetes mellitus. Tablets, 5 grains. Dose.—1 or 2. Guaiacol Camphorate.—Syn. GlTAICAMPHOL. [CgH4.0CH3.0]2(C0)2C8H14 or C2 ,H2806=4I2-2184. Dose.—5 to 10 grains in cachets or 5 grain tablets. Soluble only very slightly in alcohol, insoluble in water ; for night-sweats and diarrhoea of phthisis. Guaiacol Carbonas (B.P. ’14), and majority of Pharmacopoeias. Syn. *Duotal. (T.M. 197371) (C6H4.OCH3.O)2CO=274-1076. Patent 19074/90, now Public Property'. Dose.—5 to 15 grains (0-3 to 1*0 Gm.), gradually increased. Capsules and Tablets, 5 grains. A white crystalline substance, tasteless, and with slight odour, soluble in alcohol about 1 in 200, insoluble in water, slightly in ether, but readily in chloroform and in benzene. Uses.—In phthisis, improves appetite, and lessens cough, expectoration and night sweats, also in typhoid and for bronchitis. In rheumatoid arthritis, both the subacute and chronic forms. It arrests the disease and diminishes size and increases movement of joint and relieves pain by probably inhibiting growth of the specific organism in the intestinal tract, and combining with the bacterial toxins and assisting in their elimination. At first from 5 to 10 grains in cachets thrice daily increasing by one or two grains each week until each dose is 15 to 20 grains—to be continued at least twelve rnontns. At the same time a mixture containing 10 grains of potassium iodide m each dose. Combine with tonics.—A. P. Luff. Guaiacol as anaesthetic in nose, throat and ear operations.—Pres., May, '20, p. 203* * , Guaiacol Cinnamate.—CGH4O.CH3O.C9H7O=254-1092. Dose.—5 to 15 grains (0*3 to 1 Gm.). In white granular crystals, insoluble in water. For intestinal phthisis and vesical catarrh. Splits up into its constituents. Guaiacol Iodide.—C6H4.OCH3.01 =-249-9866. Dose.—5 to 15 grains (0*3 to 1 Gm.). A brown powder insoluble in water, containing about 10% of Iodine used as an intestinal antiseptic, etc., and suggested in phthisis. Note.—Guaiacol Iodide chemically would contain slightly over 50% Iodine. The above is a diluted preparation. “ Iodised Tincture of Guaiacol.” Dose.—1 drachm twice daily. A proprietary medicine used in pleurisy and synovitis of various types.—J. Maberly, L. i./29,437. Potassium - guaiacol -sulphonate. PR. Cx. Supp. II., P. Ital. V., P. Jap. IV., P.G. VI., Ph. Xed. V. ^Thiocol (T.M. 21S605). C6H3(0CH3)0H.S03K = 242-2146. Dose.—15 grains (1 Gm.) thrice daily. Tablets contain 5 grains: Syrup 1 drachm = 5 grains. In colourless crystals with slight Guaiacol odour, soluble in water, 1 in 6, slightly in Alcohol. Contains 52% of Guaiacol. Has been recommended in phthisis, bronchitis and pneumonia, also for intestinal catarrh. It passes unchanged through the body.—J. M. Fortescue-Brickdale, B.M.J. i./is,107. Syrup of Potassium Guaiacol-Sulphonate formula for H.E.—P.J. iL/3 x,265. Calcium-Guaiacol-Sulplionate. Syn. GUAIACYL. Dose.—10 minims (G’6 Cc.) of 5% solution or 1 Cc. of 10% solution subcutaneously. Local anaesthetic. Has been employed intravenously, 0-33 Gm. in 20 Cc., in tuberculosis and pulmonary affections. This dose is equivalent to \ grain of Calcium and 3 grains of Guaiacol. Guaiacolsulphonic Acid and its salts do not yield Guaiacol in the system and they are therapeutically inactive.—Y.B.P., *24,340. HAMAMELIDIS CORTEX ET FOLIA. Witch Hazel Bark and Leaves. Dose of bark, twigs, and dried leaves, 10 to 30 grains (0'6 to 2 Gm.). The bark and leaves, fresh and dried, of Hamamelis virginiana (Hcwnamelidacece)—B.P. ’14. Witch Hazel is imported from the United States ; it possesses astringent properties. Uses,—To check haemorrhages and excessive mucous discharges, and for piles. Liquor Hamamelidis of Commerce, a distillate of the fresli leaves containing about 14% alcohol by volume. Sp. Gr. about 0-980. Dose.—\ to 3 drachms (2 to 12 Cc.), and used externally for piles and by rectal injection for internal piles, and to check epistaxis, bleeding from toothsockets, and is applied to bruises. British Made Liquor Hamamelidis.—We liad occasion in 1918 to distil a small quantity of this from (fresh) leaves cultivated in this country by E. M. Holmes. The aroma was excellent. For piles, 5 minims of a mixture of equal parts of the liquor and glycerin containing 10% of Phenol, have been injected into piles hypodermically, cf. Tom Bird, L. ii./i6,149. Hazel Foam (Martindale). Syn. Skin Food. A soothing, non- greasy ointment basis. May be medicated with all forms of antiseptics and skin applications, e.g.t Ichthyol 3% ; Ichthyol 3 to 10% with Resorcin 5% ; Salicylic Acid 1% ; Liquor Carbonis Detergens 10% ; Cade Oil 5% ; Carbolic Acid 1 to 2J%. Cremor Hamamelidis L.H. Solution of Hamamelis GO minims, Soft Paraffin 120 grains. Wool Fat (Anhydrous) to 1 ounce. Modern Cosmetic Preparations. The usual beauty specialist s advice is to cleanse with Cold Cream and apply Vanishing Cream (e.g., Hazel Foam, antea) and finally powder the face. At night the skin is cleansed with Cold Cream and a skin food applied. Glycerin must upset the metabolism of the epidermal cells of the face. Possibility of increase in the number of rodent ulcers in the next 20 years. The fats in creams block the sebaceous and sweat glands. Perspiration is interfered with and temperature of the skin rises with continued dilatation of superficial blood capillaries, and finally acne rosacea. Formation of comedones is facilitated and acne vulgaris may develop. Wrinkle removers and skin tighteners both contain Zinc or Alum, both bad in the end. Formulae for skin foods are provided, e.g., Liq. Hamamelidis, Ung. Altheas, Ung. Cetacei and Ung. Aquae Rosae of each 1 oz.—R. M. B. Mackenna, B.M.J. i./30,899. See also further abst. under Hair Dyes. Extractum Hamamelidis Liquidum (B p. ’14). Dose.—5 to 15 minims (0-3 to 1 Cc.), A 1 = 1 preparation of the dried leaves made with 45% Alcohol. The liquid extract is representative of the leaves. Varicose Veins and consequent ulcers. The following is good. Saturate a double layer of lint with the liquid extract, cover the part and gently bandage As it dries do not pull off but add more of the extract. Healiiw ranidlv effected.—A. T. Thompson. 0 1 y Flavoring.—Syl Lavandulae, Syl Menthae Piperitae. Hemorrhoids well treated by interstitial injection of 2 to 5 minims of a 10% solution of Carbolic Acid in Liquid Extract of Hamamelis. A patient who had suffered for a year required 7 injections—another case of 15 year*’ duration needed only 5. The greater the number of piles, the greater the number of treatments required. Patients stated that their rectal and general condition was greatly improved after the first injection.—J. Dunbar B.M J. ii./23,808. Sterules of Hamamelis and Phenol of the above strength, £ Cc. are prepared. Carbolised Almond Oil is now largely used in preference, q.v. Hamameiin.—Syn. Hamamelidin. Dose.—h to 2 grains (0-03 to 0*12 Gm.) in pill. The powdered extractive from the bark or (of greenish colour) made from the leaf. A Suppository of J to 3 grains with cacao butter is useful for piles. hexamina. 449 osserst sswsEKisrsa. us LS ‘ 8™' * 80 grain.! ®Suppositoria Hamamelin, Conii et Eucainee. Hamamelin 5 grains, Conium Extract 4 grains, Eucain 4 erain m Glyco-Gelatin to 30 grains. Rub down the drugs first* with a very little warm water. In painful haemorrhoids. H fJSuppositoria Hamamelin et Hydrargyri Composita. Mercurial Ointment 1 grain, Hamamelin 2 grains, Ergot Extract 1 gram, Belladonna Extract 1/6 gram, Morphine Sulphate 1/6 grain Tragacanth q.s., Cacao Butter to 15 grains. h • ingredients were prescribed by the late Campbell Williams with follnwincr mtentThe Mercury to act on prostatic hypenenhaoften^ums^nt wit b^ Hamamelin on the mucous membrane, Ergot on the muscular walls of idonW conftrictorllaT°hen Wf sekiA Morphtoe^anaKflnd vast" Tragacanth for*conSstency>.Ina’ SS ‘°Cal mechanical lubricant and the Tincfcura Hamamelidis (B.P. ’14). Bark, in No. 20 powder 1, Alcohol (45%) q.s. to 10. Dose.—30 to 60 minims (2 to 4 Cc.). To given quite irrationally to check bleeding from the lungs or other organs reachWthpt h wi°hloct1 Jction,is due is converted into sodium gallate on reaching the biood—this substance has no remote astringent action.—B. B. C wn4J1 f°-r Ceding Phes, \ drachm of the tincture in 1 ounce of cold every day —B glVen aS aU enema’and retained>at bedtime or before breakfast, hi?^0n or u dracbms with water to an ounce, is a useful application to bruises and small wounds. Unguentum Hamamelidis (B.P. ’14), This Ointment is largely employed for piles. It may be filled into Hollow oupposnories. A combination ^ riSTI on/ ;- <• * with Cocaine 2% is useful. HEXAMINA. (CH2)6N4 = 140-1256. Syn, Hexamethylenetetramine. (B.P.’14) Hexamethylenamina, P.G.VL, Ph. Ned. V., P. Jap., Fr. Cx. Supp. 1920, E.E. VIII., P. Belg. (D V., Methenamina, U.S. X., Urotropine, Aminoform, ormamine, Cystamine (T.M. 231536). Cystogen, *Metramine (T.M. 262384). Uritone, ^Vesalvine (T.M. 278095) Urisol (F.E.). Trade Mark : ‘ Urotropine5 No. 215652 was Avoided by Order of the Board of Trade. Dose.—5 to 15 grains (0-3 to 1 Gm.) in a large volume of water, or it may be carbonated water. Ph. Ned. V. For children, 3 to 4 grains in water to 5 times during the day. Max. single dose, 1 Gm. Max. daily dose, 4 Gm. Intravenously.—We have knowledge of 1J Gm. dose in 10 Cc. Stronger doses have been given, v.p. 4:52. Manufacture.—Mix 1 Volume of Commercial Formalin Solution with - Volumes of Liquor Ammonise (10%). Allow to stand for a few hours in a 'oosely covered vessel, and evaporate on the water bath to dryness, taking :;are that Ammonia is in excess during the process. Recrystallise from Alcohol. P If commercial Ammonium Carbonate is treated with 40% Formic Aldehyd solution it readily dissolves, even without application of heat, with bris evolution of Carbon Dioxide and formation of Hexamine. Evaporate t dryness on water bath under reduced pressure and sublime or recrystallfe from absolute alcohol. The Ammonium Carbonate should, be about 10°/ in excess of theory.—J.C.S.A. i./20,292. Other Ammonium salts reac- similarly.—Ibid. 373. Flavoring,—-It has only slightly bitter taste. Syl Lavandulae Syl Rosse ; Syrupus Aurantii. Colourless crystals, sublimable. Soluble 1 in of wate with alkaline reaction, in Alcohol 90% 1 in 8, almost insoluble i Ether. A valuable diuretic and solvent of Uric Acid concretions. It burns with intense heat and without soot. A 5 grain tablet will boil test tube half-full of water. . . Sterilisation of Solutions.—We determined there is no dc composition of a 40% solution on heating 20 minutes at 100° C. See Vol. Ij Uses,—It relieves cystitis associated with putrefaction an destroys typhoid bacilli in the urine. The pyuria of tabes dorsalis cholelithiasis and gonorrhoea (early stages) have been well treated. As an urinary antiseptic, Hexamine decomposes, liberating Form aldehyde more readily in presence of acid than alkali, hence tb administration of Sodium Acid Phosphate is advised. It may b well to give the latter an hour or two hours before the Hexamine or at any rate not in mixture form with the Hexamine. U.C.H. directs Mistura Hexaminae No. 1 : Hexamine 10 grain Chloroform Water to 1 drachm, half an hour before food and No. 2 Sodium Acid Phosphate 30 grains, Chloroform Water to 1 drachm half an hour after food. Should never be given immediately after meals, but taken in water £ ho* before meals.—B.M.J. i./24,750. Pharmacology.— We have found that, though the amoui of Formaldehyde liberated from therapeutic doses of Hexamir cannot be sufficient to kill B. Coli, the slow generation of Formaldehyv by the drug in the presence of acid has the desired effect. It is preferat: therefore to raise the acid index of the urine within reasonable limit For details of our work, see Hexamina, Vol. II. A recent investigation.—On maintaining a solution of 1 Gin. of Hexamine 200 Cc. of 0-2% HCl at 40° C., estimations of the liberated For^ffvde show that after 30 minutes 1-5% of the Hexamine had been decornp.^ hou ivi/7 nft™ ‘U hniirs 1S°A dccomvosition had occurred. ' ' 9% and after 3* hours 18% decomposition had occurred. . 'that Hexamine owes its activity to formation of lonnaldehyde is consider a myth.—G. E. R. McDonagli, M.P.C., Jan. 12, 2 7,27. , , Hexamine 5 grains, Sodium Acid Phosphate 30 grains, Mist. Rubra to ounce kept in an ice-box had not changed in a fortnight, but kept m a cupboa did give Formaldehyde reaction.—H. Bodsworth P.J. h/29,95 Hexamine proved conclusively not a diuretic. H. O. Rich and I. J. Hanzi- per Pres., Feb., ’23,84. ArnuL Suppuration and Meningitis. Hexamine has been tried, b> neither it nor Formaldehyde could be detected in the discharge or c-erebi sninal fluid.—D. Guthrie, B.M.J. ii./i6,455. „ ‘1 Bladder Diseases. 20 to 40 grains daily suffice, while m gall bladei infection or purulent meningitis, from 200 to 300 grains daily may be require Give well diluted (2 grains to the ounce of diluent) per os or it may, n necessait bo given bv rectum or subcutaneously. A. C. Burnham. . , 0. Superior to Mercurochrome and Hexyl-Resorcinol in infection by Staj nihu* nnd n coli_Jl. Urol., April, ’26,351, per Pres., Jan., 27,8. Hexamine 3 grains, and Methylene Blue i grain, to enhance the well-knm action of Hexamine.—B.M.J. ii./25»l&. hexamina. 451 Ch offecys tit is. Gall stones are found in about 10°/ nf ^ t the age of 20. In most cases, if not a°ll thpii* j?°dies, .°^ ad peoPle dying after cystitis and as cholecystitis is often not ^Preceded by chole- mus occur therefore at some period in the Jivpf cholelithiasis the former of all adults—the most common of all nhOn™?* ? considerable proportion treatment of cholecystitis often leads to recovl™naTfdlSea®e?' • The medlcal to sterilise the biliary passage by large doses ftf ^ consists in attempting biliary drainage. Knott has shown8He®Jamine and in promoting fWic in spite of alkalinitv as i b"“*ry anti- .^e given to keep the urine permanently alkaliru?+/^/e* alkabs may irritated by the Formalin formed in acM n Prevent>he bladder being one with Hexamine 100 grains to tbp rmnno un.nf,‘ ^wo matures are made each Sodium Bicarbonate andVotasshimcontamlng 1 drachm of the former and one ounce of the latter flTA £ to the ounce. Half ounce and after a tumbler of milk or water lasUhingatSit;ftfnfreakfast, after tea, mixture is increased by 1 drachm each davllfiffhn ,Tke dos8 °f Hexamine is taken three times daily Trwt nl dy untl1 the full dose of 100 grains three times a day for^week^lea^t^n IJe^f1?liue 10 grains « is;rr3fJSSMSW ft bladder irritation 1 1 1 hould drmk water copiously to reduce ss^srsi=i hm-h Tut tJ 8• and n}°.rnmg : and one Luminal Tablet, 1 grain after the bladder ,cofb,ned, ™th the other remedies, whi e not i rhatin" cause of flts-°rganic dirt> ■RromSff If ?° standing, having 3 to 8 tits a day, which 60 grains of McCarthy M™i?is^aLyi./26®834.° Contro1’ was cured this treatment.—B. G. im^r,t, m,lTCT'IOiS' Considerable success with Hexamine and Acid Phosphate internally m inflammatory conditions of the anterior chamber of the eye '30,237 ’ A. r. Sherif, Jl. Pharm. and Exp. Therap ^Eeb prffS?1™' The following mixture taken twice, thrice, or oftener weekly zoaf? nf nrirlnS6 : , Hexaanne, Sodium Salicylate, and Ammonium Bern tn o ’ff h drachms, Potassium Citrate 6 drachms, Chloroform Water Morris, igsi8-' 0UnC<3 S°da Water bef°re ^eakfastl-E. G. McCarthy nI°nL/^ELIJIS> Acu+te- ^h0ild aet- 11 became acutely ill suddenly. Weak- turf" Temperature 104 . Hexamine 10 grains every four hours. After miff nSf-m?Srature •lower but Paralysis more marked. Next day improve- nim fhe evenmg’ after 150 grams had been given, hsematuria with idSnf strangury occurred After three days paralysis ceased and ultimately the renal symptoms. Complete recovery in sporadic cases is rare.— box Edwards, B.M.J. ii./i6,620. caused in a case of acute encephalitis due to Hexamine in doses n-0 grams every 6 hours.—Sir Thomas Horder, B.M.J. i./27,995. idthitPIRAT°RY Affections (acute bronchitis, acute rhinitis, etc.) are treated Rheumatoid Arthritis. The following treatment generally affects a 5ure in about 3 years in early cases, and will always relieve pain. " Hexamine sodium Salicylate and Ammonium Benzoate, of each, 1i drachms, Potassium P2 Citrate 6 drachms, Chloroform Water to 6 ounces—i ounce in Soda Wate every morning before breakfast: Dover’s Powder and Aspirin, 2£ grains c: i each, in tablet, powder, or cachet, night and morning, increased to two nigb and morning if required : Capsule Lipiodol after lunch : and Methyl-Aspriodm Liniment rubbed twice dailv on the painful parts. Meat allowed, but Alcoho prohibited. Also of value'in sciatica.—E. G. McCarthy Morris, 1931- Ringworm of the beard. Treatment.—A 5 to 10% solution of Urotropi is sponged on the part affected. This is allowed to dry and a solution c Dilute Sulphuric Acid 1 to 3% is then sponged over the affected area. Ther were most gratifying results in the condition known a3 “ foul shave. a her the parasite is the ringworm fungus this method is undoubtedly a speciff It cured the most chronic case when continued for 4 or 5 weeks in gradual* increasing strengths.—J. Craik Taylor. Typhoid. 20 grains or more three times in 24 hours with an equal quantit of Sodium Citrate and Sodium Bicarbonate, starting from the beginning * the second week onwards. If cholecystitis appears give ten 20 g^h with sufficient alkali in 24 hours and apply Antiphlogistine over gall-bladd'. region—A. E. Gow, L. i./30,96. See also Therapeutic Index. Infections of the Biliary Passages. Sufficiently large doses (75 graiu per diem) will inhibit growth of bacteria in the bile, e.g., in t\phOid. Whooping Cough. May also be of value, e.g., with Syrupus Thymi. /nfrat/ewotis injection of Hexamine. ... Hexamine Sterules 15 grains (1 Gm.) ill 75 minims (5 Cc.) a prepared, i.e., a 20% solution. Frequent mention in the literatu is made of 40% solution. Acidosis, Non-Diabetic. Due to infection with B. Coli, well treated 1 intravenous injections.—J. Fraser, B.M.J. k/24,571. . . . Chorea in children well treated intravenously. In one case 18 injection increasing from 2 to 6 Cc. of a 5% solution, were made m 6 v eeks. lie recently 10% solution has been used with good results—Per Jl. A.M._ ii./25,1098. Seems to give best results by intravenous injection when t chorea is associated with an infection, e.g., encephalitis or poly art nritis. De Capua, Jl. A.M.A. ii./2o,808. . . . ,. . 0 r. Ank Malarial Coma cured in 10 cases by intravenous injection of a Cc. 40» solution.—J. TJmansky, L. ii./3i,350. _ . Pyelitis of Pregnancy. A single injection of 10 Cc. of the solution often sufficient.—A. Jacobs, Pr., Oct., '27,219. . a , ... Retention of Urine. Treated by 5 to 10 Cc. of 40% Urotropmc Solutio* _B.M.J.E. i./23,05. Has been used in cystitis, pyelitis and toxaemias 294361 Post-Operative Anuria. 7 to 10 Cc. 40% solution intravenously- procedure uniformly successful.—L. L/24,1118. Scabies, severe, well treated. 10 Cc. of a 10/0 solution daily for 3 or days, septic lesions being washed with hot water only during period of injection but course of injections followed up by application of Sulphur Ointment- N. N. Ghosh, I.M.G., May, ’25,221. Vesalvine Tablets 5 grains and Vesalvine Effervescent, 5 gram in 1 drachm arc prepared. Hexamine Triborate Syn. ^ BOROVERTIN (T.M. Ph. Ned. V. (CHo)6N4.3HBQ2=271*909. Dose.—15 to 00 grains (1 to 4 Gm.) daily. manufacture.- By combining 1 molecule Hexamethylenetctrami with 3 molecules of Boric Acid—3HzO are set free and the Boric Acid °°CrvMahIne powder contMning about 50% Hexamethylenetetramine, solul in water 1 hi 13 : taste bitter. Urinary antiseptic, e g., m gonorrhoeal cystit pyelitis, renal calculus and tuberculosis of the bladder and kidneys. *Vea?lvine ‘B.’ Syn. Hexamethylenetetramine Benzoau (CH2)6N4.C6H5.COOH.=262*1724. Dose.—5 to 15 grains (0*3 to 1 Gm.). n Small scaly crystals containing about 53% or the base. Made hexamina. 453 eombmmg equivalent quantities and crystallising. Soluble 1 in 60 of Water and 1 in 2| Alcohol 90%. Uses.—As an urinary antiseptic. *S!T01 1^M- 3f.4369)- , Syn- Hexamine-Sodio-Benzoate. Tablets.—10 grams (0*6 Gm.). Dose.—■One to three dissolved in water twice or thrice daily, in bacterial infections of the urinary tract. J ♦ Uro-Hexoids (T.M. 365610). Tablets of Hexamine and Lithium Benzoate. Dose. One or two after eacn meal, taken whole or crushed and dissolved m water. Urinary antiseptic, diuretic and anti-lithic. In cystitis, pyelitis and tuberculosis of the bladder and kidneys also for chrome posterior urethritis and prostatitis and rheumatic affections ^ VGobIvIh© 3* Syn. Hexamethylenetetramine Saltcyl4te Salurene. (CH2)6N4.C6H4.OH.COOH = 278-1724. i)o5e. 5 to 15 grains (0-3 to 1 Gm.) in water before meals. Colourless prismatic crystals with agreeable sweetish saline taste containing approximately 50% of each constituent. Prepared by combining equimolecular proportions. Soluble 2 in 1 in Water and 1 in 2 in Alcohol. . Uses, This salt should be especially useful as an urinary and 'intestinal antiseptic, e.g., in cystitis, bacilluria, gastro-intestinal catarrh^ colitis, dysentery, diarrhoea, dyspepsia, and all cases beneficially treated by hexamine—it is exceedingly soluble. It doubtless splits up on passing through the svstem into its two constituents,— the Salicylic Acid enhancing the effect of the Hexamine. It cioes not irritate the blaHder like other antiseptics. B. Co Li Infections of Bladder and Kidney. Alkalinization of the urine should be obtained at earliest possible moment. Where this laaled urinary antiseptics often successful. Hexamine Salicylate seems best.—J. Ferguson, B.M.J. i./22,57. An elderly medical man, a sufferer from chronic cystitis for 5 years, informs as that he took 500 Vesalvine Tablets with remarkable benefit. After about o clays, taking 9 a day, the urine became odourless, but remained slightly iuoudy and contained a few ‘ shreds,* though nothing like as bad as before pommencmg the tablets. He found them more efficacious if swallowed whole md the tablets did not disagree with him. Vesalvine ‘ S ’ in his opinion, is the >nly medicine that has given him any relief, though he had tried a great many /aunted cures. It was found later that 2 tablets 3 times a day were equally ifficacious on continuing the treatment.—H. A. Baines, July, 1931. /Vote.—Though so markedly soluble in water there apparently exists a ■oa Cioo/ S0C'a^on *n s°fufi°n, for example, Solutions of strength 1%, 3%, > /o, 12 /0, 25%, 50% and saturated remain clear for months, whilst vigorous libbing on the sides of the vessel will cause a deposition of Salicylic Acid rj' stais. Analysis.—Estimate Salicylic Acid content by titrating with N/10 > odium Hydrate, using Phenolphthalein as indicator. 1 G111. should require ot less than 34 Cc. fiycompatifoJo with acids, alkalis and carbonates, also with lodium Salicylate—it throws the Salicylic Acid out from same— nd otherwise as Salicylates, hence best administered as such, not 1 a 4 mixture.’ It decomposes on heating in water or alcohol, Vesalvine * S * Tablets 5 grains and Cachets 5 and 10 grains Hexamethylenetetramine Camphorate. Syn. ^ Amphotropil (T-M. 338474) [(CH2)6N4]2C8H14(COOH)2=480-376. Dose.—8 to 12 grains (0*5 to 0‘S Gm.). Tablets 8 grains (0-5 Gm. A white crystalline powder made by combining in Alcohol, Chlorc form, etc. Subject of patent 21728/12—now lapsed. Soluble in water 1 in 10 with acid reaction. Solutions ar; hydrolysed to a great extent. Uses.—Urinary antiseptic. An alkaline urine is rendered neutrs or acid by administration. In chronic cystitis, bacteriuria, nephriti Hexamine-Sodium Acetate, Syn. ^cCystopurin (T.M. 288836 (CH2)r,N4.2CH3C00Na+6H20=412-261. . Contains approx. 34% of Hexamine. Cystoformin is similar. Dose.—30 grains (2 Gm.). A crystalline salt made by evaporating solutior of the components in the above proportions. In gonorrhoea and cystitis.— Tablets contain 1 Gm. (15 grains). *Urodonal (T.M. 361117 and 306349). A granular effervescent preparatia of Hexamine with small amounts of Sidonal and Lysidine. Dose.—3 teaspoonfuls during the day. The three components are state* to be useful in removing uric acid and allied bodies. *Felamine (T.M. 396797). *Sandoz (T.M. 439637). Syn. Hexamine Glycocholate. Cholagogue and biliary antiseptic. In catarrhal jaundice, constipatio and enteritis and in the after-treatment of typhoid fever and for gallstone* Tablets contain 5 grains (0'3 Gm.). HYDRARGYRUM. Hg=200-61. Antidotes to Acute Poisoning by Mercuria Saits.—Emetics by mouth, Apomorphine hypodermically ; whi of 1 egg for every 4 grains of Perchloride (avoid excess), or mill- reduced iron; alcohol or ether for collapse ; and opium for pai Uses.—Purgative, cholagogue and antisyphilitic. Purification of Mercury. Allow it to flow in a thin stream throug. a long column of Nitric Acid. Wash and filter through chamois leather. Hydrargyrum cum Creta (B.P. ’14). Syn. Grey Powder. Dose.—1 to 5 grains (0-06 to 0-3 Gm.). Slipule No. 5 holds 1 gral Contains 33^% Mercury. Liable to oxidise in the air. That U.s. X. is prepared with Mercury 3S, Clarified Honey 10, and Pr pared Chalk 57. Moistened q.s. and dried—has sweet taste and somewhat damp. Injectio Hydrargyri Intramuscularis “10%.” Syn. Intb: muscular Injection of Mercury. F. J. Lambkin’s origin formula.—B.M.J. iL/05,1257,1348. Mercury 1 ounce (troy), Anhydrous Lanoline 4 ounces, Liqn Paraffin (Carbolised 2%) to 10 ounces (by volume). Dose,—This contains 1 grain in 10 minims,—the maximum d& once a week. Physicians $}should specify ‘ 10% ’ using the abc name in full to prevent confusion with stronger preparations. Sterules, Hypodermic, are prepared containing 10 minims. Site of Injection.—An area around a point midway betwe* hydrargyrum. 455 Cl7ft and.the anterior superior iliac spine is best.—G. Fernet. . Sterilise Syringe m Liquid Paraffin. Experiments which we conducted showed that this suspending mixture is probably as useful as any. It holds up the mercury even n hot weather—of great importance for accurate dosage. We compared it; inter aha with formula* containing Cocoa Nut Fat and Paraffin Oil but came to the conclusion that they were no improvement, borne preparations yield a heavy precipitate at tropical heat. ihe preparation is slowly absorbed and practically painless. Diarrhoea if caused by the injections, may be warded off by 5 grain Cachets of Bismuth Salicylate. QJj • TIoH-t} W ool l^cit) 50 cincl. Olive Oil 2^ nf i cao p ^ •« *» and cool Triturate Mercury 10 with 10 of the"^ Fat in a sterile" moS adequately, then incorporate the rest of the wool fat Add CamnW in previously dissolved in Creosote 10 and then the Olive Oif Mix We find this formula quite satisfactory. * M1X‘ vve 1111(1 5Si nS .Mercu.rial Cream, weekly injections of Calomel Cream con- ^he same vehicle have been suggested. Dose.—10 cf. also Injectio Hydrargyri Subchloridi minims = k grain of Calomel. Hypodermica. Mercury comes up to Calomel for removing active signs of svphilis 1S- °nly transitoryim comparison with metallic Mercury (f grain CnlomPi /T6,? •nCn,a we^f9r tour weeks and then metallic Mercury). CrcoSui ! P dedbm 01lYe 0l1 lsi ex9eedingly painful. The addition of creosote ana Camphor produces analgesia—and can be given with impunity. f " c«Old. people, broken down Alcoholics, those 111 disease, with Albumin m the urine, tubercular subjects, those with 1 poisoning and gouty persons should not have the treatment. Injectio Hydrargyri. — STAFF SURGEON Adams’ FORMULA. :tt°YALNAvYF0RMULA(G. B. Scott, Roy. Com., on Venereal Diseases). 'syn. Cremor Mercurialis Mid. H. Dose. 5 minims ( = 1 grain of Mercury) given once a week. Mer- oiry 2\J, Anhydrous Lanolin 30, Chlorbutol 2, all by weight, Liquid . araffin to 100 by measure. luile Grise, Fr. Cx., Ph. Ned. V. Syn. Grey Oil, Oleum Cinereum. Dose.— An injection of 2 to 3 grains (012 to 0-2 Gm.) — § to 1 ,rain Mercury approx. (0*04 to 0-06 Gm.), every eight days for » or 6 weeks or up to seven divisions of. the Barthelemy’s syringe v. infra), i.e., 0-07 Gm. Mercury. Mercury 40, Wool Fat 26, Vaselin Oil (Fr. Cx.) 60—all by weight, feasures 100, i.e., 40% w/v. Mercury (0-4 Gm. in l Cc.). Ph. Ned. V. niJ Belg. IV. is similar. Fr. Cx. gives method of sterilising. ^r?dLds elaborate, made with Chloroform and contains Castor Oil, ath Guaiacoi and Camphor as preservatives. Barthelemy’s Syringe (used in France) is graduated so that when used iMi a.40 ^ w/v. Grey Oil, 1 cgr. of Metallic Mercury is contained in each of s divisions ; 14 cgr. or approx. 2£ grains in the syringe-full. Fournier’s Syringe is 4 Cc. in capacity divided into 10 on the barrel so lat each division represents 2 cgr. of Mercury using the 40% w/v. product. Levy-Bing-Lafay-Syringe has piston rod graduated into 15 divisions, ten of which represents 1 cgr. using the above. A 10% preparation, e.g., the Injectio Hydrargyri Intramuscuiaris ' the commencement of the chapter, is preferable. Suppositories containing the 40% Grey Oil in various strength have been used in syphilis. Efficacious, simple and safe. Intravenous Injections of Mercurials are painless, have small dose, a i certain of absorption, rapid of action, and do not salivate. Difficulties of the method, of obtaining consent of patient, possible throri bosis, pysemic infarction, necessary daily injection. Violent dysenter diarrhoeic symptoms or polyuria and even albuminuria may result. Solutions of mercuric cyanide, 20 minims of 1% solution (i.e., J grai oxycyanide, biniodide, succinimide and perchloride have been used. Linimentmn Hydrargyri (B.P. *14). Useful stimulant for enlarged joints and glands. In affections of the peritoneum, involving the lower quadrants the abdomen or pelvis, Mercury is without rival. In appendicit Mercury inunction reduces the pain, mitigates thirst, and effec copious evacuation and urination, also suitable in all cases of infectic of the peritoneal serous membrane. Pilula Hydrargyri (B.P. ’14), Blue Pill. Dose.—4 to 8 grab (0’25 to 0*5 Gm.). Contains 33% Mercury by weight. In raised arterial tension when indicative of danger, a pill twice « thrice weekly, followed by Saline is beneficial.—Brunton. In syphilis, begin with 3 grains a day after the first and last meai increasing the daily dose by 1 grain each week till patient is takir* 2 grains thrice daily. An average dose is 2 grains twice a day. In cardiac dropsy it seems to act complementarity to digitalis ar to prove efficient where latter has failed to increase urinary secretio materially. It is to be avoided if renal disease be present. Whc: diuresis is fully established discontinue Mercury and give a mixtu of Caffeine and Spirit of Nitre with Infusion of Broom Tops. Has good soporific effect in forms of biliousness where sleeplessness is prominent symptom.—W. J. Tyson, Clin. Jl., Aug. 8, ’23,382. 3fcMercurol (T.M. 228096) (cf. Nargol.) A combination of Mercury with Nuclein. Used for gonorrhee injections \ to 2% solutions in syphilis in 2 grain doses. Unguentum Hydrargyri (B.P. '14). Mercury 30%, as required by F.I. Principally used for inunctic in syphilis. To relieve local inflammation and to destroy pediculi. Fr. Cx. (Ongucnt Napolilain). Mercury 1, Benzoated Lard U.S.—Mercury 50, Oleate of Mercury 2, Suet 23, Benzoated Lard 2. P. Svec. Contains Hydrargyrum Exstinctum 36 (i.e., Mercury ‘ killer by rubbing with Wool fat and containing 83-5% Hg.), Benzoated Lard 4 Suet 20, i.e., about 30% Mercury. Unguentum Hydrargyri Mite (Dilutum). U.S. X. Mercuri Ointment (U.S.) 60, Petrolatum 20,4 Unguentum * 20. This is then fore an approx. 30% Hg. preparation—cf. B.P.C. infra. Inunction treatment of syphilis.—5 Gm. is an initial dose a 33% Ointment. Caution. —Directions for treatment of ging vitis if this occurs. Paint with 10% Chromic Acid, or stronger n to even 75%. Give Mineral Waters—Aix la Chapelle, Uriag Harrogate, etc.—I). Freshwater. hydrargyrum. 457 Unguentum Hydrargyri Compositum (B.P. ’14). Mercury Ointment 10, Yellow Beeswax 6, Olive Oil 6, Camphor Flowers 3 This is Scott s Dressing, modified. * For enlarged glands chronic synovitis and syphilitic nodes. Swelling of the ankles is well treated with it. Unguentuin Hydrargyrl Mite, B.P.C. Syn. Blue Unction. Mercurial Ointment 1, Lard 2. Mix. For destroying lice This contains 10% Hg.—cf. U.S. antea. 8 J o pioniote the removal of the effusion of nlourisie^ flip miiViinrr • . Bumej-Ylo1.' * °f Merc'lrial Lanolinum Hydrargyri. Mercury 100, Lanolin (Hydrous) 200, Mercurial Ointment 5 Mutton Suet o0. For inunction in syphilis (effect is rapid); used daily 4 to 8 times after a hot bath. L lAsin8 the various fats (wool fat, mutton suet and the lard—in M-p°i^crCiUlJai Ointment^ was to favour absorption—reference to Liebreich\ work and a paper by A. S. Gubb to the M.P.C., 1886.-P.J i./2i,516 ' tnunction at night probably prevents pullulation of the spirochaete on flip lahWnu°f °lie a l.ia,)litat whlch these organisms find particularly favour- en°77-5eipetuatlon of their sPecies by transmission to another individual SJaly rate m appearS to swarm at night in the tissues of indurated chancres,' (anny), inunctions and baths for in-patients, with weekly grey oil injections for out-patients, gave satisfaction —L. ii./n,l386. -with obstinate callous ulcers on the legs has improved under mid Mercurial inunctions. - uei f One thorough course of inunction of Ungucntuin Hydrargyri § drachm in Lanolm or other base l drachm, in the early stages (first six months) of syphilis Is 01 inestimable value. Kequires care, but mortality is small.—Maj. French. Discussion on the Treatment of Tabes Dorsalis.—Syphilis the important tioiogical factor without which there would be no such disease as tabes nunctions or injections were superior to Mercury by the mouth, and perhans letter by inunction than by injection.—B.M.J. ii./io,1249. Pseudo-tabes— ne result of syphilitic meningitis—treated by inunction.—B.M.J. i./o9,1403. Absorption of Mercurials from Ointments applied to he skin.—The method was to rub a weighed quantity into 20 square iches of surface, and ascertain the amount not absorbed. The greatest bsorption of mercury took place from a lard basis. Hydrous wool fat was Dsorbed to a greater extent than lard, but the mercurial wTas not absorbed itli it, so the absorption of mercury was actually less than from a lard oint- icnt of equal strength. Absorption from a paraffin basis was always than from a Sard base. Of the various mercurials examined, lercuric oxide was the most readily absorbed either as such or in the form of le official oieate, but ointments containing over 10% of the oxide are irritant, mmoniated mercury and mercury salicylate are absorbed almost as well as le oxide. Mercurous chloride was absorbed to a less extent than any of le mercurials examined. The inunction of 4 Gm. of Mercury Qint- lent gave an absorption into the body not exceeding O'12 Gm. of iercury when used for 2 minutes and 0-17 Gm. in 10 minutes.—R. B. ild and Ivy Boberts, B.M.J. i./26,1076. See also our experiments with a variety of Ointments under Methyl-Aspriodine. 1 no instance were we able to trace that the chemicals were promptly excreted the urine. erciiry Amalgam. This is one of the most popular of dental fillings. Black (Cosmos) In use, the alloy is worked up iu a glass mortar with an equal quantity <« Mercury, and the excess of Mercury is squeezed out immediately before fillini in. It is the general rule to employ a double filling, i.e., to insert an initial filling of zinc oxy-sulphate or oxy-phosphate, q.v., and afterwards an amalga when a metal filling is employed, and where depth of the cavity will allow. Amalgam fillings of teeth may cause Mercury poisoning in susceptib* i people.—L. i./26,1275. CE)Hydrargyrum Ammoniatum (B.P. ’14). u.s. x. p. Dan p. Svec. X., Ph. Ned. V., P, Belg. IV. (Precipite Blanc). Mercuric Ammonium Chloride, Hg.NH2Cl=252,0906. Whs Precipitate. A white powder, insoluble in water but soluble 3 hydrochloric acid. (TDUrguentum Hydrargyri Ammoniati (B.P. T4). Strength 5% in Benzoated Lard. Benzoic Acid in the Benzoated Lard causes a faint yellow tinge ; pla lard does not cause the colour.—H. Stout, P.J. i./i7,187. In pruritus and other skin affections. CfL>Unguentum Hydrargyri Ammoniati Dilutum, N,H.W. Equi parts of the B.P. 1898 ointment, (1 in 10 of Paraffin Ointmem and soft paraffin (white). Pustular eczema, resulting from pediculosis capitis in weak children, is well treated with equal parts of this ointment and olid oil, enclosing the head in an oiled paper cap. CE)Unguentum Hydrargyri Ammoniati, U.S. Ammoniated Mercury 1, Liquid Paraffin 1, Hydrous W ool hat White Petrolatum 4. A wet process of making.—P.J. i./22,379. Tinea circinata can be rapidly cured by this ointment. Unguentum Prophylaxis. For prophylactic measures agair syphilis. Metchnikoff suggested the use of Lanolin Ointments cox taining ® White Precipitate 25% or Calomel 25%, or EQ Mercuir Salicyl Arsenate {q.v.) 25%. (Physicians should specify which required when prescribing Unguentum Prophylaxis.) These are k irritating than Mercurial ointment. To be used by inunction tf 4 or 5 minutes after coitus. Lor use in the Xavy—Calomel Ointment 33% made with Lanolin; 5C strength also mentioned in the same paper. . ,, Medical men, students, and nurses advised to have the ointment handy annlv to any suspicious crack about the fingers, etc. . Early application of an ointment of Calomel 10 and Lanolin 20 is said have prevented syphilitic infection by killing the Treponema. L. n./n,13 capsungs of the ointment, with elongated points to be tc off, and ‘ Collapsubes ’ of the ointment are prepared. Unguentum pro Eczema, N.H.W. < Ammoniated Mercury 10 grains, Lead Acetate 10 grains, Z- Oxide 20 grains, Mercuric Nitrate Ointment 20 grains, Soft Paraf l ounce, Lard £ ounce. CtLCremor Lowndes.—Ammoniated Mercury Ointment 1, Zinc Ointmentt Glycerin 2, misce s.a.—Squire. Rlack Precipitate XH2Hg2Cl. = 452-7006. Formed when Ammo- is added to Calomel. The substance is regarded by some asamixt of 'white Precipitate NH .HgCl and metallic Mercury .-P.J. ii./«,260. 459 Hyflrargyri Benzoas. Mercuric Benzoate J7r Cv Hg.(CeH5COO)2.H2O=460-7036. Dose.—-Jjj to grain (0-0013 to 0 006 Gm ) A white crystalline powder, practically insoluble in cold water Akohol 90% 10n Salt aS bel°W’ al8° ab0ut 1 in 180 of’ Hypodermic injection—A daily dose of 1 to 2 Cc„ rising to 5 Cc of a 1 /0 solution, made with the aid of 0-75% Sodium Chloride in water : m preference with the addition of 0-75% to 1°/ of Cnca™* Or weekly, 0-25 G„. i„ 10% fLfa Uses,—dor treatment of syphilis. Intramuscular injections have been given in uterine haemorrhage bepticsemia, pyaemia, erysipelas, puerperal fever, septic sore throat* trP«tpH by Mercury Benzoate Injections-10 Cc. of 1% SolAtton “ 5 mgf per kflo weight). If repeated the body attains a resistance againstStrevto infections while smaller doses inhibit the generalised growth of the Cocci. The method fj1!:r\’‘: uf d ln a11 scf,tlc conditions provided it is applied before the invasion >s‘°° extensive or widespread It is prophylactic rather than curative It hi observed that mothers taking Mercury shortly before or during childbirth dia not suffer from puerperal infections even though the conditions rt'gle’J also that syphilitics undergoing mercurial treatment do not catch the ordinary infective diseases.—B.M.J.E. ii./i3 79. a ^°de of preparation, employing Yellow Mercuric Oxide Acetic Acid (glacial), and Sodium Benzoate. ’ Hydrargyri Bromidum. Mercuric Bromide. HgBr2=360-442. Dose.—TV to i grain (0-004 to 0-016 Gm.). Silvery Scales. Soluble 1 in 250 of Water, decomposes on boiling. In syphilis, in solution with Sodium Bromide thus,—Mercuric Bromide 1-8 Gm., Sodium Bromide 1-03 Gm., Water 100 Cc. is employed in dose of 1 to 2 Cc. of the solution (=0-01 to 0-02 Gm. Hg.) intramuscularly into the buttock. A platinum-iridium needle is essential. Some pain may be caused. Hydrargyri Carbolas. Phenol Mercury. Hg.(C6H50)2.H20 =404-7036. Dose.—h to 2 grains (0-03 to 0-12 Gm.) daily. A whitish amorphous powder, obtained by double decomposition of mercuric chloride and an alcoholic solution of phenol in caustic potash. IPljHydrargyri Cyanidimi. Mercuric Cyanide, Cyanuretum Hydrargyri Fr. Cx. ; P.G. VI. P. Belg. iv. Hg.(CN)2=252-626. (Mercurous Cyanide is not known.) Dose.—o^o to J grain (0-003 to 0-016 Gm.). Fr. Cx. has max. single dose £ grain, max. during 24 hours § grain approximately. Intravenous Dose.—1 Cc. of 1% Solution considered a max. single )ut more has been given, see Intravenous Dose Table et infra. White or colourless, prismatic crystals. Soluble 1 in 12 of ^ater and 1 in 4 of glycerin. It is not decomposed by alkalis ; it is ised as a lotion to syphilitic sores, and given in pills of Vo grain wice daily. Used in diphtheria, grain frequently, with 1 minim hncture of Aconite in honey, employing also a gargle, 1 in 0,000. In syphilis 20 minims of 1 % solution daily with caution. Has alscr been used intravenously. This dose given alternate days. It ha been advised for persistent cerebral headaches of the secondary period.—L. ii./i2,361. Intramuscularly relatively painless but maj cause diarrhoea and albuminuria. If given intravenously as in combined Organic Arsenic and Mercury treatment of syphilis, care must be taken to give strictly intravenously anc not intramuscularly or hypodermically. SteruTes contain ,0 grain (0-005 Gm.) in 1 Cc. also l grain (0-01 Gm.) ii 2 Oc. Syphilis.—One injection of one of the Salvarsan substitutes and nv injections of 1% Cyanide solution per week. Doses of the latter varied witU tolerance of the patient, and it was found that many patients could stan<f 40 to 50 m. Superior to other routine methods.—J. Ernest Lane, L. ii./2i,79(5 Syphilis, nasal and aural, treated by 1 Cc. of 1% solution intravenously7 Much used in Prance. May occasion diarrhoea.—D. Guthrie, Pr., Feb., ’20,131 Acute Syphilitic Nephritis. Albuminuria disappeared after 15 day treatment with intravenous injections of 0-005 to 0-02 Gm., thus renderin possible the use of Arsenic and Bismuth, which were previously contraindicated —Petges, Jl. A.M.A. i./29,1488. llPJJlnjectio Hydrargyri Cyanidl, Plaistow. Dose,.—2 to 10 minims For subconjunctival use. 1 in 5,000 of water. Subconjunctival injections of 20 minim doses of 1 in 4,000 solution will cure commencing senile cataract. Pain is very severe, lastin 3 or 4 hours. Patient should be under light chloroform anaesthesia Metastatic ophthalmia treated by, also given intramuscularly.— Pres. Feb. 21, p. 74. ijJIjPasta Hydrargyri Cyanidi. 1 in 500 in Tragacanth basis fo> smearing on catheters. Pj] Hydrargyri Oxycyanidum, HgO 3[Hg(CN)2] = 974-488. Dose.—1 /16 to 1 /6 grain (0*004 to 0-01 Gm.) per os. Intravenously 1/6 grain (0*01 Gm.) in 75 minims (5 Cc.) or less, hai been given in syphilis. Chemical Composition.—According to P.G. VI. must contain 33- to 35-2% [Hg(CN)2.HgO] equivalent to 15-37 to 16-25% Mercuric Oxide an 84-6 to 83-8% of total Mercury Cyanide. It is a mixture of approx. 34°f Mercury Oxycyanide and 66% Mercury Cyanide. P. Svec. X. is a mixture of the Oxycyanide Hg(CN)2H'gO and Cyanide containing 30 to 40% of Oxycyanide. The compound, from the point of view of irritating effect on the tissues and its failing to attack surgical instruments, should in preference be th crystalline body of the above formula and not HgO Hg(CN)2. P. Helv. give t lie latter formula but the characters and tests agree rather with the compoun HgO 3[Hg(CN)2]. P. Belg. IV. also contains the two compounds. Danner of explosion in manufacture.—HgO Hg(CN)2, sometimes called th normal Oxycyanide, is dangerous to heat. The other compound is not.— F. C. J. Bird, P.J. i./23,383. See also J.C.S.A. L/1922,640. Solubiiittj,—This varies with the proportion of HgO present* We found a commercial sample, of the variety preferred, to be solubl 1 in 17 with a small amount of residue.—1924. The pure salt, i.e., the normal compound (antea), was found to be soluble in 85 b ‘Trade’ Oxycyanides vary.—A. J. Jones, P.J. ii./2o,87 ; i./23,127 sec also Comcy and Balm’s ‘ Dictionary of Solubilities.’ Uses,—In the treatment of syphilis during first week 0*05 Gn: in pill pro die as an average has been given—to be taken when th stomach is full. Should not be used with Potassium Iodide. As a wound lotion 0-2 to 0-6% solutions have been employee 1 in 5,000 to 1 in 10,000 as bladder irrigant—in eye work 1 in 1,000 to 1 in 5,000 and 1 in 200 for instruments, which it is said not to attack. Gonorrhoea treated by irrigation with Mercury Oxycyanide, 1 m 2,000, also Potassium Permanganate, 1 in 6,000 for acute, to 1 m 2,000 for chronic cases.—H. J. Blakesley, B.M.J. i./2i,619. A stock solution of mercury oxycyanide 1 in 30 may be made. One drachm of this to 1 pint of water a good irrigant for the urethra. —F. Kidd, B.M.J. L/24,688. HEJ Mercury Oxycyanide Solubes are prepared 0-2 Gm. each, 1 m 2 litres gives 1 in 10,000 ; 1 in 1 litre—1 in 5,000 ; 1 in 4-0 Cc. 0*5%. Ul] Mercury Oxycyanide Lotion Sterules contain 8-75 grains. Each diluted to 1 pint makes 1 in 1,000 solution, to 1 quart makes 1 in 2,000 solution, 1 in 5 pints makes 1 in 5,000 Solution. 0-2 6m. per litre (1 in 5,000) as a lotion for cleansing the glans and meatus prior to lavage m gonorrhoea.—Pr., Oct., ’10, p. 417. Iodides should he excluded from a patient so treated. Mercury Oxycyanide is good against Staphylococcus, hut is an indifferent gonocide.—H. D. L. Spence, L. b/30,19. Lotio Hydrargyri Oxycyanidi, R.O.H. 1/8, 1/10, 1/16, or 1/20 grain in Water 1 ounce. HyP°Py°n ulcers treated by subconjunctival injections.—T. L. de Courcy, B.M.J. ii./2i,737 Cf. Injectio Hydrargyri Cyanidi. 5J Pasta Hydrargyri Oxycyanidi, L.H. ^ Mercury Oxycyanide 24 grains, Tragacanth 192 grains, Glycerin 4 ounces, vv ater to 20 ounces. A proposed anti venereal prophylactic consists of Mercury Oxvcyanide 0-66 Gm., Potato Starch 40 Gm., Glycerin 50 Cc. and water to 500 Cc~ The jelly formed should be heated on a water-bath for 1 hour. Stated to have a coefficient greater than 1 in 3 Phenol.—J. L. Priston and R. 0. Frederick, Jl. R.N.M.S., Oct., '26,283. jfUQ MercuroZinc Cyanide- Lister’s Antiseptic. A white powder usually supplied tinted with Rosalane (Mauveine Hydrochloride), obtained by precipitation from a cold saturated solution of the cyanide of mercury and potassium by adding a cold saturated solution of zinc sulphate in equi-molecular proportions, or by adding in similar solutions mercuric chloride to zinc and potassium cyanide. The maximum percentage of mercuric cyanide found is 38*5, and the body may be described as a trizincic monomercuric octacyanide— Zn3 Hg(CN)a=604-814. It should contain at least 20% Mercury Cyanide, Hg (CN)2. If carefully made can be produced containing 25%. Estimation process by reduction with hypophosphorous acid.—D. B. Dott, P.J. i./i3,98 ; C.D., Jan. 25, '13. Lister-^-The Investigator ctnzf Surgeon*—Following on Lister’s migration to London (and the Carbolic Spray day), he tried many gauzes treated with preparations of Mercury, but they had to be discarded on account of irritation, until the Double Cyanide of Zincland Mercury was suggested (by the late W. Martindale). This is unirritatingiand is effective.— W. Watson Cheyne, B.M.J. i./25,923. Lister first used (undiluted) carbolic acid in an operation on August 12th. 1865. Many other antiseptics achieved temporary popularity. Lister trv the Mercurial Salts and in February, 1886, the late William Martindale and 1 otassium Cyanide, but this, in common with others, was irritating. Imally the late William Martindale suggested the double Cyanide of Mercury and Zinc which gave Lord Lister entire satisfaction.—“ Chemicus,” P.J. n./15,325. See also Feb. 18, *93, and B.M.J. i./o7,795. A Link with Lister, Harvey G. Kay, John C. Umney and James Hunter, assisted the late W. Martindale in the pioneer work of devising a press for the even distribution of Sal Alembroth, ‘ Cyanide ’ and other antiseptics in the dressings, working under the personal supervision of Lord Lister at 10, New Cavendish Street, London, W.—W, H. M., P.J. i. 27,616. .Lister Centenary, Edinburgh, 1927—B.M.J. ii./26,703. See also Special No. of B.M.J., April 9, ’27, p. 653, and L. i./27,773—786. Upton House, Eastham, as it was in Joseph Lister’s childhood. He wras born there in 1827.—L. i./3o,51. The Lister Ward at the Glasgow Royal Infirmary was nulled down— there never was in the world’s history an act of greater vandalism. The Managers of the Board of the Infirmary were not unanimous, one-third of those who attended the meeting did not approve.—A. Freeland Fergus, B.M.J. ii./3o,448. See also Lord Movnihan, Can. Supplement to the B.M.J. ii./3o,10. Glasgow the cradle of antiseptic surgery. There also, was probably the first change to the modification known as aseptic surgery —under William Macewen. —A. Freeland Fergus, B.M.J. ii./3o,S43. Solubility•—Very slightly in water, more so in dilute acids. Sterilisation.—It ^unnecessary to sterilise Double Cyanide Dressings. [Pi Mercuro-Zinc Cyanide Gauze 3%, is a popular dressing for applying direct to "wounds. It is not so irritant as some of the other mercurial dressings and has the advantage of keeping well without the mercurial salt becoming reduced by the cotton. It is sujDplied in 1, 2, 6 and 12 yard pieces and with colt on wool tissue in 1 lb. packets. It is damped before use with 1 in 20 Carbolic Acid solution. Cotton wool, as also bandages, contains 3%. For suppurating abrasions, boils and skin affections in war Dry Cyanide Gauze covered completely with plaster excellent and rapid. No solution or other antiseptics used.—G. Home, B.M.J. i./i6,I4. For visible clean wounds it is good. To be removed by Hydrogen Peroxide when too adherent.—Casualty Clearing Station experience. —A. Don, B.M.J. i./i6,648. \PT1 Mercuro-Zinc Cyanide Cream may be made by triturating the powder with carbolic lotion, 1 in 20, q.s., for applying to hairy parts adjacent to wounds. Iff.J) Mercuro-Zinc Cyanide Paste. Mercuro-Zinc Cyanide 400, Tragacanth 2, Phenol 20, Water 800, mix. For a first dressing for wounds. Caution : Not to be supplied in metal tubes—especially lead. The paste must be rubbed on in as thin a layer as possible. jp_li Lotion of Mercuro-Zinc Cyanide of strength 1 in 5,000 to 1 in 1,000, is used for wounds. Caution : Shake bottle—not dissolved. IjPj] Unguentum Hydrargyri et Zinci Cyanidi; R.O.H. 1 or 2 in 100 of Soft Paraffin or Lanolin. For syphilitic sores and eczema, also excellent for burns and for granular eyelids. Caution : Not in collapsible tubes. cE>Hydrargyri lodidum Rubrum (B.P. ’14). Syn. Mercury Biniodide, Mercuric Iodide, Hg I2 = 454-474. Dose.—3V to grain (0-002 to 0-004 Gm.). Fr. Cx. : Max. single dose l grain ; max. during 24 hours 1J grains approximately. Intravenously.—grain (0*005 Gm.) in 75 minims (5 Cc.) is usual, but 4 grain (0*03 Gm.) in 150 minims (10 Cc.) has been given. —See R. L. Spittel’s formula. eg) Pills and Tablets contain ri(T, TV, and J grain. Red powder or crystals, soluble in solutions of other iodides, and in solution of mercuric chloride, forming double salts cf. Mercuric Potassium Iodide ; also 1 in 25 of castor oil, or 100 parts of the latter will dissolve 8 of this iodide with 5 of perchloride of mercury, about 1 in 200 ether, in alcohol 1 in 300. Uses.— A powerful antiseptic, less irritant than Mercuric Chloride. As a lotion for the hands or eye wash 1 in 5,000. For wounds 1 in 7,000, vaginal douche 1 in 10,000. Mercuric Iodide Estimation by dissolving in Sodium Thiosulphate solution (Eder and Ulm’s observations).— !. Sandilands, P.J. i./2 6,357. ODXJnguentum Hydrargyri lodidi Rubri (B.P. ’14). Strength 1 in 25. For tinea may be applied to small spots, but not to large surfaces. Too strong for general use on the skin. Exophthalmic goitre has been treated by daily use of this ointment half strength. Parenchymatous Goitre treated by dilute Mercuric Iodide Ointment locally. Improve patient’s general condition and comfort.—E>. J. Harries, B.M.J. i./23,555. eg) Xnjectio Hydrargyri Xodidi Rubri Hypodermica (Ragazzoni)- Dose.—2 to 6 minims (0T2 to 0-4 Cc.). Mercuric Iodide 1 grain, Sodium Iodide q.s., in 64 minims. In syphilis can be used in large doses, but is painful. CeD Sterules Hypodermic, contain grain in 8 minims for a dose. Cg) Injectio Hydrargyri lodidi Intravenosa (R. L. SPITTEL). Dose.—120 to 180 minims (8 to 12 Cc.). Mercuric Iodide 3-24 Gm., Sodium or Potassium Iodide 28-42 Gm., N/l Sodium Hydrate Solution 40 drops or q.s., Water to 1,000 Cc. The solution is rendered carefully neutral using Phenolphthalein, the soda being added last. Often a single injection will produce an effect as phenomenal as Sal- varsan. Used in conjunction with latter in syphilis.—L. i./2o,378. Caution. —An average dose of this contains 0-03 Gm. (4 grain). The amount of caustic soda in the formula in the Lancet paper was unnecessarily large ; we have given the amount needed, after experimenting. CE> Collapsible Tubes of Mercuric Iodide Ointment 1% with catheter attachment are useful for the treatment of gonorrhoea. Cg) Oleum Hydrargyri Biniodidi Syn.—Huile d’Iodure Mercurique. Fr. Cx. Dose.—15 minims (1 Cc.) containing approx. grain (0-004 Gm.) Mercuric Iodide 4, Olive Oil purified and sterilised, 920 by weight. Dissolve at not exceeding 60° C. h Pilula Arsenli et Hydrargyri lodidi. ose.—1 or 2, two or three times a day. Arsenious Iodide, Mercuric Iodide, of each 1 grain, Distilled Water q.s. to dissolve. Sugar q.s. to make 12 two-grain pills (or 1 Gm. of each Iodide in 180 pills). May be combined with 2 grains of Iodide of Iron. Cg) Wool, Mercuric Iodide. £%. Impregnate Absorbent Wool 400 under pressure with a Solution of Mercuric Iodide 1 and Potassium Iodide 1, and spread out to dry. CeD Hydrargyri et Pofcassii Iodidum. HgI2KI, 1£ H20 = 647-5294. Mercuric Potassium Iodide, commonly known as ‘ Biniodide.' Antiseptic Mercury Biniodide Lotions for surgical use or Tablets to prepare same must contain the requisite amount of this salt or its equivalent made with addition of Potassium Iodide, q.s.y v. infra et Solubes. Dose.—to J grain (0-004 to 0-016 Gm.) in pill. Antidotes.—Olive Oil, Milk, White of Egg, Petroleum Emulsion, warm draughts to encourage vomiting,—later Bismuth and Morphine. Manufacture.—Dissolve Mercuric Iodide 45, Potassium Iodide 16i (i.e., approximately equimolecular proportions) in water 30, boiling the mixture for a few minutes, allowing to cool for pure Mercuric Iodide to crystallise out, filter and concentrate the filtrate. Collect the first crop of crystals, rejecting later portions which contain excess of Potassium Iodide. Another method is to use Alcohol 90% 20 instead of the water above mentioned, boil the salts with the Alcohol until almost entirely dissolved and crystallise. Solubility.—This Salt is not soluble in water except in presence of Potassium Iodide, i.e., sufficient at least to produce the body HgI22KI; in other words, the theoretical amount (170 approximately) of Potassium Iodide must be added to 647 (approximately) of the double Salt,—this can be easily shown by experiment, but even an excess of this quantity is desirable in tablet making. Brought into contact with water, 2 (HgI2KI.IJ H20) decompose into HgI22KI=785-938 and Hgl2 (+Aq.). It is, therefore, impossible to prepare Antiseptic Tablets of this substance alone. The body HgI22KI is also formed in solution, when three times the weight of Potassium Iodide, as of Mercuric Chloride, are dispensed altogether— theoretically the proportion is 2-45 to 1, thus :— HgCla + 4K1 = Hgla.2KI 4 2KC1 and this will produce the desired antiseptic effect providing the Potassium Iodide be pure. It makes no difference whether the Potassium Iodide is added to the Mercuric Chloride or vice versa.—P.J. ii./o6,533,557. Soluble also in Alcohol 90% 1 in 1 (without decomposition), 1 in 1 in Ether, and about 1 in 2 Glacial Acetic Acid. For dD Nessler’s Solution V. Vol. II. CE> Biniodide Spirit Lotion 1 in 1,000. Mercuric Potassium Iodide, Potassium Iodide 0-25, 70% Spirit to 1,000. For gonorrhoea dilute solutions are used, also as a pigment or spray for throat in scarlatina and diphtheria. War Wounds. Acts like hypertonic Saline in producing free discharge and requires frequent changing. Rot so painful as iodine.—A. Don, B.M.J. i./i6,648. CE) * ‘ Solubes ’ Biniodide. Contain the equivalent of Mercuric Potassium Iodide 8-75 grains. One in 1 pint of water forms a solution of the strength of 1 in 1,000 —suitable for wounds. For lotions and instruments this may be diluted wdth from 1 to 3 or more parts of water. Mercuric Iodide” Tablets. Method of analysis and results of examination of a number of commercial samples, the majority were found deficient whether on basis of Hgl.KLHH.O (the requisite basis to our mind), or HgIa2KI or Hgl2.—C. E. Sage and S. G. Stevens, C.D. i./32,84. CE)Biniodide Lotion ‘ Sterules 5 contain 8*75 grains. One diluted to b pint gives 1 in 500 Solution or to 1 pint gives a 1 in LOGO solution. If a douche is required in midwifery, 1 in 1,000 Biniodide always used — A. P. Murtz, L. ii./26,72S. Biniodide should come into its own again in midwifery.—B.M.J. L/30,359. To our knowledge a 1 in 5,000 Biniodide uterine douche was badly tolerated after confinement. Fluid stools passed with a proportion of blood and some albuminuria. Some persons seem very susceptible to mercury.—R. T. Slinger. CPyLotio Hydrargyri Biniodidi, L. H. Mercuric Chloride 3 grains, Potassium Iodide S'! grains, Distilled Water to 10 ounces. Strength of double salt, 1 in 500. Septic infections of the skin treated by soaking for 5 minutes in Hvdrogen Peroxide 10 vol., then in Mercuric Potassium Iodide (1 in 2,000) for 5 minutes, then dress with the Biniodide, cover with Cotton Wool, but no waterproof protective.—W. E. Waller, L. i./3i,185. Cp) Mistura Hydrargyri Biniodidi, K.C.H. Dose.—1 ounce (30 Cc.). Solution of Mercuric Chloride 30 minims. Potassium Iodide 10 grains, Ammonium Carbonate 5 grains, Decoction of Cinchona (B.P. ’85) to one ounce. Cp) u.G.H. has Solution of Mercuric Chloride 60 minims, Potassium Iodide 4 grains. Water to one ounce. Cp) St. M.’s H. is identical in strength in Mercuric Chloride. (£) L.H. is Solution of Mercuric Chloride 1 drachm, Potassium Iodide 5 grains, Peppermint Water to b ounce, i.e., it is double the strength. R.O.H. Potassium Iodide 10 grains. Solution of Mercuric Chloride I drachm, Water to 1 ounce. Uses.—The mercury in these mixtures is more rapidly eliminated than when given alone. The potassium iodide acts as a diuretic. For the combined mercury and arsenobenzol treatment, vide p. 194, also Salvarsan by M. and W. Many authorities now advise this. Keloid well treated by the mixture.—P.R.S.M., Nov., ’io. CP) Pilula Hydrargyri lodidi Rubri (£■ grain) et Potassii lodidi (4 grains). Dose.—-One twice daily. CE)Xnjecfcio Hydrargyri Biniodidi (pro vagina). Mercuric Chloride 8 grains, Potassium Iodide 24 grains, Water to 1 ounce, 1 drachm of this to a pint makes 1 in 10,000 approx. CE)Soaps containing respectively 3, 1 and of Mercuric Iodide are prepared. Useful for eczema, acne, scabies, ringworm and desquamation after fevers. (£)Unguentum Hydrargyri et Potassii lodidi. Mercuric Iodide I, Potassium Iodide 1, Water 18, Lard 36, Hydrous Wool Fat 50. Hydrargyri Iodidum Flavum. Yellow Mercurous Iodide. Hg2 I2 = 655*084. Dose.—-J grain (0*008 Gm.). Prepared by double decomposition between freshly made Mercurous Nitrate and Potassium Iodide. (Must not be confounded with the yellow variety of Mercuric Iodide.) Pills and Tablets contain J grain. Employed in syphilis. Hydrargyri Iodidum Viride. Green Mercurous Iodide. Mercury Protoiodide. Dose.—J to 1 grain (0*01 to 0*06 Gm.) gradually increased to 3 grains. Pills contain £ and J and J grain, and Tablets contain & grain,—with opium and pepper to prevent looseness of bowels. Incompatible with other iodides. This salt should be kept from the light, be of yellowish-green colour, and contain slight excess of mercury ; otherwise, as the late W.M. showed, it is unstable and dangerous. Hydrargyri Nitras, Mercurous Nitrate. Hg2(N03)2.2H20 = 561*2672. In colourless monoclinic crystals, generally damp (from adhering acid) and soluble in water, or yellow tinted (from basic salt), then not perfectly soluble in water. Used in syphilitic sores, 1 in 30 or more, as a lotion or ointment, and occasionally internally in same dose as mercuric chloride. Liquor Hydrargyri Nitratis Acidus (B.P. ’14). Used as a caustic for syphilitic warts, and lupus. Urethral injection 1 in 1,000, or more, in gonorrhoea and for syphilitic sore throat as gargle. The Fr. Cx. dissolves Mercury 100, in Nitric Acid (Fr. Cx.) 165 and Water 35, mixed, with slight heat, and evaporates to 225 (all by weight). Sp. Gr. 2*246. Unguentum Hydrargyri Nitratis (B.P. ’14). Syn. Citrine Ointment. Mercuric Nitrate Ointment. Contains about 1 of Mercury in 15 of the finished Ointment. The Mercury Solution, by the B.P. T4 process, consists principally of mercurous nitrate before it is added to the fats. There being also an excess of acid present, the chemical action is thus intensified, and by the time the process is completed, by constant and vigorous agitation, all further chemical action will cease, and the ointment should keep of a good colour for months without generating more gases and thus becoming spongy. Its preparation requires care, skill and attention. For farther details vide Vol. II. Aurinarium Unguenti Hydrargyri Nitratis contains J grain of the official ointment—useful for chronic eczema of the meatus. Unguentum Hydrargyri Nitratis Dilutum (B.P. ’14). Contains 20% of Citrine Ointment. Found to separate at summer temperature. Mercuric Nitrate Ointment 1, Hydrous Wool Fat 1, Yellow Soft Paraffin 3 ; Melt the two latter with gentle heat, remove from flame and add the first and stir while cooling. Keeps well. R.O.H. has 40 grains to 1 ounce (9% approx.) in Soft Paraffin. In tinea tarsi of great value, employed with a brush to the eyelids, also in chronic eczema, psoriasis, and herpes preputialis. In pustular eczema after removing crusts this checks further infection, then employ Lassar’s paste and soothing lotions. Unguentum Acldi Garbolici Compositum. V.H.C. •Mercuric Nitrate Ointment 2, Sublimed Sulphur J, Phenol 1, Sesame Oil 1, Yellow Wax 1. L. H. has Mercuric Nitrate Ointment 2, Carbolic Acid 1, Sulphur Ointment 2. Unguentum Metallorum. r/.Jp'X- 1917 —Mercuric Nitrate Ointment, Lead Subacetate Ointment and Zinc Ointment of eacn equal parts.—G.H. is similar. ' e?^ceP^ Dilute Mercuric Nitrate Ointment in place of Mercuric Nitrate Ointment. y Gt. rsorthern and King's as C.X.—Except Lead Acetate Ointment in place of Subacetate Ointment. Guttae Hydrargyri Nitratis, L.H. (Aural). Mercuric Nitrate Ointment 1 drachm, Wool Fat \ drachm, Olive Oil \ ounce. Liquid Paraffin to 1 ounce. Aurinaria are prepared q.v. antea. Nebula Hydrargyri Nitratis, T.H.—Nitrate of Mercury Ointment 20, Soft Paraffin 20, Olive Oil 120, Liquid Paraffin 120. St. Bart.’s H. is 6%. ‘Nasal Oil,* St. M’s. H. is Dilute Mercury Nitrate Ointment 20 grains, Menthol 2 grains, Lavender Oil 5 minims, Olive Oil to 1 ounce. Cp>Hydrargyri Peptonas. Mercury Peptonate. Dose per os.—\ grain (0*03 Gm.) increased with caution, hypodermically ^ grain. Brown powder containing 10% Mercuric Chloride, soluble in water. Fr. Cx. gives method of manufacture of a Solution. E0 Hydrargyri Perchloridum. Mercuric Chloride, Hydrargyri Chloridum Gorrosivum, U.S. ; Corrosive Sublimate, HgCL — 271-524. (In Northern Ireland a preparation of Mercuric Chloride is also in Part I—a reasonable alteration.) Dose.—Jg- to W grain (0*002 to 0*004 Gm,), but in treatment it may be increased to £ grain. Fr. Cx. : Max. single dose \ grain. Max. during 24 hours 1 grain approximately. Intravenously h grain increased, v., p. 472. In heavy colourless crystalline lumps or white powder. Antidotes,—Emetics, Apomorphine, white of 1 egg for every 4 grains of perchloride, vide also Poisons and Antidotes at end of book. Mercurial poisoning from surgical use of Sublimate especially when left in wounds and cavities should be treated by diuretics. Stimulants for collapse and Potassium Chlorate for stomatitis. Sodium Hydrosulphite (q.v.) has been advised on basis of animal experiments (dogs). 0*1 Gm. per kilo followed by 25 Cc. N. Hydrochloric Acid in i tumbler of water, and subsequently lavage. Give a glass or two of milk and then several raw eggs, followed by emesis or lavage.—Jl. A.M.A. i./27,626. Mercury line on gums. Distinguish from lead line, cf. Plumbum. 44 grains of Mercuric Chloride in the form of soluble tablets taken after a full meal—death followed seven days after. Treatment, lavage of the stomach, antidotes, stimulants and attempts to assist elimination.—L. ii./n,297. Recovery after 8f grains taken by a man of 85. White of egg and water administered, stomach tube passed. Washed out stomach with large quantities of albumen water and milk and water. Strychnine hypodermically and milk A and brandy per os, hot blankets and bottles. All the while bowels very irritable. During convalescence Cremor Magnesiae and brandy in milk. Ultimate recovery.—B.M.J. i./i3,116. Chronic Mercurial poisoning from prolonged use of an ointment consisting of White Precipitate, Besorcin and Camphor.—Per Clin. Jl., Nov. 21, *23,562. For further data of poisoning fatalities, see 17th Edn., p. 462. Soluble 1 in 18 Water at 60° F., 1 in 4 of Alcohol 90% at 60° F., 1 in 4-35 Ether (0-720) at 58-5° F., 2 in 3 of Glycerin. Neutral double salts (more soluble) are formed with Mercuric Chloride in solution on addition of Sodium Chloride, Ammonium Chloride and other Metallic Chlorides. These solutions contain fewer Mercuric ions and are hence less poisonous (taking same weights of Mercury) than solutions of Sublimate. We showed that they are not more antiseptic than Sublimate. Cf. data under Uses, also Chapter on ‘ Antiseptic Powers,’ Vol. II. The late Lord Lister tried one of the Potash Compounds in his earlier work. The B.P. ’14 preparations are ® Lotto Hydrargyri Flava (0*46 to 100, or 2 grains to 1 ounce Solution of Lime), and dD Liquor Hydrargyri Perchloridi, 1 in 1,000 (% grain in 1 drachm approx.), Dost.—| to 1 drachm. Syn. Van Swieten’s Solution, Fr, Cx. Incompafibles.—It precipitates most alkaloids from solutions, and should therefore not be ordered with them : the alkalis and the salts of silver and lead are attacked also. Steel surgical instruments should not be dipped in this solution. It forms insoluble compounds with albuminous fluids (v. infra), also incompatible with bodies containing tannin, soap, iodine and potassium iodide. Incompatible with Borax—mixture of Borax and Mercuric Chloride solutions give precipitate of basic Mercuric Oxychloride. Avoid by adding Glycerin — P.J. i./32,40. Uses.—A powerful antiseptic. 1 in 1,000 solution kills anthrax spores in 15 minutes, the bacilli themselves being killed by 1 in 15,000 in 1 minute. The growth of the bacilli in question is prevented by 1 in 500,000 strength.—Hale White. In blood broth mercury salts have less power than supposed.—L. P. Garrod, B.M.J. i./31,574. 1% soap increases its antiseptic power.—P.J. i./31,547. Its solution does not pass through animal membrane rapidly. For further data vide Antiseptics, Vol. II. Strengths of Perchloride Solutions for use:— Aqueous solutions 1 in 10,000 to 1 in 1,000 may be used for infected linen, the walls and floors of infected rooms, the hands of surgeons and gynaecologists, and as a lotion to superficial wounds. For continuous applications 1 in 10,000 forms an active lotion, but 1 in 500 is the minimum strength (with acid added) for use to disinfect excreta, ef. Sublimate Disinfectant postea. There is risk of poisonous effects from vaginal injections of 1 in 1,000 ; watch for the occurrence of diarrhoea. Glycerin Solutions are also used as surgical dressings. For References and further data re strengths for use, including Intravenous Use, v. p. 471 et seq. CE> Glycerinum Hydrargyri Perchloridi, R.O.H. specifies ‘ 4, 8 or 16 grams’ to Glycerin 1 ounce. U.C.H., is 0-1%. L.H. the same strength, viz., Mercuric Chloride 17i grains, Distilled Water 6 drachms, Glycerin to 2 pints, tinted blue with Liquor Cceruleus, which contains ’turquoise Blue 4 grains in Distilled Water 1 ounce. Distinguish from the following : CED Glycerinum Hydrargyri Perchloridi Alcoholicum, U.C.H.—Mercuric Chloride 35, Glycerin 50, Methyl Blue 0-05, Methylated Spirit to 100. For disinfecting Urine. Caution.—Not for administration. Cp~)Lintn Absorbent Wool, Gauze, or Wood Wool, q.v., may be impregnated with \% of each, Corrosive Sublimate and Glycerin. CE> Mistura Hydrargyri Perchloridi, E.L.—Solution of Mercuric Chloride 10 minims, Water to 1 drachm. CeD Mistura Hydrargyri Perchloridi Composita* Dose.—h ounce (15 Cc.) in a little water in syphilis thrice daily 30 minutes after food, for adult males.—(Caution. —I grain Sublimate per dose) ; females half the dose. Mercuric Chloride 4 grains, Potassium Chlorate 1£ drachms, Ammonium Chloride 3i drachms, Compound Tincture of Cardamoms 1 drachm, Simple Syrup 1 ounce, Water to 8 ounces. The Perchloride ( = i grain per dose) is tolerated by the addition of the other salts. In syphilis the dosage, as stated, has given valuable results.—J. Bain, B.M.J. ii./i2,496. Cg) Gargarisma Hydrargyri Perchloridi, (1 in 1,S00). Mercuric Chloride J grain, Hydrochloric Acid 1 minim, Glycerin 30 minims. Water to 1 ounce. R.O.H. has Mercuric Chloride 2 grains, Glycerin 1 ounce, Water to 20 ounces. For influenza, sore throat, especially quinsy, Solution of Mercuric Chloride 1, Acid Infusion of Rose Petals 1. One tablespoonful in a teacup of hot water as a gargle. CE> Lotio Hydrargyri Acetica. Mercuric Chloride 1, Acetic Acid 75, Glycerin 75, Alcohol (90%) 250, Rose Water 500. To destroy pediculi and detach their ova. Tinea has been destroyed by 3 grains dissolved in an ounce of Spirit of Nitrous Ether. CP) Lotio Hydrargyri Perchloridi, U.C.H. Mercuric Chloride 0'2% coloured with Turquoise blue. L. H. and C. H. W. are 1 in 1,000. R.O.H., 1/8, 1/10,1/16 or 1/20 grain ini ounce. The three last not coloured. (jDLotio Hydrargyri cum Acido Carbolico, E.L. Solution of Mercuric Chloride 1, Dilute Acetic Acid d urpentine Oil o, Phenol Solution (1 in 40) to 24. For pediculi. Gp) Lotio Parasiticida, St. M.’s H. Mercuric Chloride £ grain, Acetic Acid 2 drachms, Water to 1 ounce. Cg) Lotio Hydrargyri cum Q!eo Terebinthmee, U.C.H. Mercuric Chloride 0-6, Methylated Spirit 12J, Turpentine to 100. ® Pigmentum contra Tineam. . Mercuric Chloride 1. Salicylic Acid 9, Phenol 10, Glycerm 80. Alopecia syphilitica.—Mercuric Chlorides grams,Acetic^id 5 miimims, A icohol 90% 8 ounces. Apply with a tooth brush mg ho and morning. Lee also Pomade each evening —Calomel 15 to 30 grains, Salicylic Acid 8 grains, Yaselin 1 ounce.—B.M.J. ii./io,180. Collyrium Hydrargyri Perchoridi, N.H.I. Mercuric Chloride Solution 1, Distilled Water to 3. Dilute with equal quantity of water : strength when diluted 1 in 6,000. CE) Mackenzie’s Eye Wash. Sublimate 1, Ammonium Chloride 6, Belladonna Extract 10, Coccus Cacti 1J, Proof Spirit 55 ; rub together and add Water to 330. Mix with equal parts of boiling water to bathe the eyes.— Caution.—This is about jive times as strong as usually employed. CE) Pills contain A• ~s-2> A' tV» and A grain. Mj IIP 1| Pilules de Chlorure Pills.—Fr. Cx. Mercurique Opiacees. Dupuytren’s Mercuric Chloride 1, Opium Extract 2, Extract of Agropyrum 2 (Extrait chiendent), Licorice Powder q.s. For 100 pills. Each pill contains Mercuric Chloride 0-01 Gm. and Opium Extract 0*02 Gm. CE) Liquor Hydrargyri Antisepficus W.H. Syn. Sublimate Disinfectant.—Local Government Board. Sublimate b ounce, Hydrochloric Acid 1 ounce, Soluble Aniline Blue 5 grains, Water 3 gallons. Liquor Hydrargyri Perchloridi Acidus ( ‘ Typhoid Solution * ) St. Th. H. Mercuric Chloride 1 ounce, Hydrochloric Acid (strong) 25 ounces, Water to 500 ounces. Used only as disinfectant for excreta. CE)Perchloride * Solubes combined with Sodium Chloride and coloured blue, are made of three sizes : (1) 17J grains, making 20 ounces 1 in 500. (2) 8-75 grains, making 20 ounces 1 in 1,000. (3) \ grain, makes 10 ounces 1 in 4,500 (for ophthalmic work). The two stronger solutions may be diluted further with warm water. See strengths of solutions for use for various purposes antea p. 468. CE) Perchloride Lotion Sterules contain 8-75 grains. Each diluted to 1 pint with water makes a pint of 1 in 1,000 solution. Regarding the anomaly of a Solution or other dilution of Mercuric Chloride being a CE) poison, seepAGl. ( Solubes ’ (T.M. 254730) signify material for making solutions for external or local use. A list is given in the Index.) CE) Harrington’s Solution. Mercuric Chloride 0-8 Gm., Water 300 Cc., Hydrochloric Acid 60 Cc., Alcohol 90% 640 Cc. A powerful antiseptic preparation for sterilising the skin before operation. CE) Sublimate-Spirit for Skin Sterilisation. Alcoholic Solution of Mercuric Chloride, 1 in 1,000 of 70% Alcohol, is more bactericidal than Tincture of Iodine, and suitable Aqueous Solutions of Sublimate. A criticism of Mercuric Chloride, Iodine, Picric Acid and Mer- curochrome as skin antiseptics.—J.A.M.A. ii./26,1347; P.J. ii./26,677. CP)Tablets, x£ <j-, A* A and A gra]n are for internal administration CE) Hypodermic Tablets, A» A> A grain. Cg) Wool, Perchloride (‘ Sublimate *) 2%. To prepare, impregnate Absorbent Cotton 100 with 200 of a solution of * Perchloride ’ 4 and Glycerin 2, press to 200 and dry it spread out. Weaker strengths can be prepared on the same lines with less Perchloride. CfDP. Jap. IV. uses Mercuric Chloride 2, Potassium Chloride 2, Water 1,500, Wool 1,000, i.e., 0*2%. Faintly coloured with Scarlet or Fuchsin * S.’ Sublimate-Malachite Green Solution. A useful non-irritant solution.—See Malachite Green. Cg) Unguentum Desinficiens (Neisser-Siebert) P. Svec. X. Triturate Tragacanth 20 Gm. and Wheat Starch 40 Gm. with Glycerin 170 Gm. Dissolve separately Gelatin 7 Gm. in warm water 500 Cc. and add Mercuric Chloride 3 Gm. and Sodium Chloride 10 Gm. to this solution. While still warm add with stirring the Tragacanth, etc., mixture. Warm on water bath until homogeneous. When cool add Alcohol 90% 250 Gm. in small lots.— Swedish Medical Board, C.D., Aug. 5, ’22, p. 204. References and Strengths tor Use. Cataract Operations.'—576 cases, low percentage of eyes lost by suppuration was due to use of 1 in 2,000 Perchloride douche in conjunction with 4% Cocaine solution.—L. ii./o9,1129. Chorea has been treated. Also in paresis, and varicose veins. Empyema has been treated by tappings and injections of I grain Perchloride in ounces of water. Empyema, Pneumococcal.—Irrigation of the pleural cavity with 1 in 40,000 Mercuric Chloride, in treatment. (1 in 20.000 kills the pneumococcus in 2 hours—Choyce’s Surgery).—F. J. Hathaway, B.M.J. i./25,632. Eye Lotions.—1 in 4,500 parts of water, and for lotions for the nose and mouth and for vaginal leucorrlioea the same strength is suitable. R.O.H. gives $, to, tV or <f6 grain per ounce of water for eye lotion. Dangerous in treatment of ophthalmia neonatorum (especially m conjunction with Silver Nitrate drops)—4 recent cases quoted. Frequent washing out with Normal Saline or saturated Boric Acid solution safe and effective.—D. Forbes, L. ii.,/31,1102. „ , , . .. , , FlSTULJE.—Wool soaked in 1 in 2,000 Solution of Sublimate is the beet dressing.—B.M.J. i./n,1048. „ , GLOSSITIS treated by a mouth-wash of Mercuric Chloride 2 grains, Hydrochloric Acid 8 minims, Glycerin \ ounce, Water to 8 ounces. B.M.J. 111,060. Gonorrhcfia and Gleet.—A lotion 1 in 4,000 to 1 in 2,000 is recommended. LUPUS, in initial stage, subcutaneous injection of 1 A solution into affected tissue lias been used.# Malignant Pustule has been treated by use of sublimate as dusting powder without incision or excision. It has also been treated by hypodermic injection of 1 in 1,000 solution. ,, . . ... . 1 1 non Prickly Heat has been treated by rubbing in a lotion of 1 inT^»2v?r,0L^fwr containing Hydrochloric Acid (strong) 2. Allow to dry on. f? n r>„ wash off again after a few minutes. Usually cures m a couple of days. Repea„ 11 Puermral Infection.—Irrigation with dilute Sublimate Lotion has been Stomatitis.—If the surface epithelium is shed the mucous membrane may be brushed with 1 in 5,000 Sublimate solution. Suppurative Otitis Media: Perchloride of Mercw >g Glycerta. 1 m 1,000 successful where all other treatments havefailed. Carbolic And m Glycerin equally good.—T. P. Lowe, L. U./28.250. Aqueous 1 .n 10.U0U 8°iUYPHiLis.-Given in smal, doses, e, A f^’i.'Ace^ftofa^y testinal action and is employed m some forms of diarrhcea of infancy. SYpmimc Treatment pmgna^in the^rm of lub- l?m°a\e%/llt“n\h^eedPaily were sufficient almost always to ensure a healthy child—Amand Routh, B.M.J. i./23,632. intravenous Injection of Perch/oride. Bilhaiiziasis (endemic hematuria).—Associated with this disease is almost invariably the appearance of blood and pus in the urine. Mercuric Chloride intravenously has been given with good results. (Emetine Pcriodide and Auremetine, q.v. for further notes on treatment, have been successful.) Diuretic action of Mercuric Chloride dissolved in serum injected intravenously is marked.—K. I. Melville and R. L. Stehle, Jl. Pharm. and Exp. Therap., Oct., *28,222. Typhoid treated. Dose employed was 001 Gm., but 0-02 Gm. (Caution !) has been used in syphilis.—B.M.J.E. i./o9,28. Acute Bacterial Infections, e.g., pneumonia, well treated by intravenous injections of ^ or iV grain.—J. Burnford, L. i./26,312. Syphilis, septicsemic conditions, influenzal pneumonia, treated intravenously with | grain doses, increased every other day. Nephritis a contraindication and saline cathartics must not be used.—H. Schussler, Jl. Intrav. Therap., Jan., ’25,11. Bacterial infection, 330 cases treated with Mercuric Chloride or Mercuro- chrome, or both. 5 Cc. of a 1 in 1,250 solution of Mercuric Chloride (te grain) in saline as a first dose, repeated if necessary in 12 to 24 hours, according to patient’s condition. Maximum dose 7 Cc. Solution freshly prepared and injected directly into a vein. Among the complications cited are thrombosis, diarrhoea, stomatitis and nephritis.—L. S. Dudgeon, L. i./26,169. Pneumonia, lobar and lobular, acute staphylococcic infections, chorea and subacute rheumatism, chronic infective arthritis of undetermined origin and encephalitis lethargica. Mercuric Chloride intravenously in doses of g* grain to iV grain is very useful, c.g., TV grain in Normal Saline 8 Cc. Intestinal irritation may occur.—H. Pritchard, B.M.J. i./27,794. Injectio Hydrargyri Perchloridi (Intravenous) Gt. Orm. H. contains 1/40 grain (0-0015 Gm.) in Normal Saline 85 minims (5 Cc.) for children under 2 years. For older children 1/30 grain (0-002 Gm.) in the same volume. May be repeated on three successive days. Primary syphilis has been treated by Iontophoresis of a 2% solution. Vide Iontophoresis. Yol. II. C£)Sal Alembroth—Syn. Ammonio-Mercuric Chloride. HgCl2.2NH4Cl,H20=396-532. A powerful antiseptic, but does not combine with albumin quickly and hence is not very irritating. Uses—In medicating dressings CeD Band ages, ®Gauze, ce^Wool Gauze, and Ce>Wool Tissue, 1 or 2% (which are dyed blue), also as an intramuscular injection for syphilis. {Dose, 10 minims of 5% solution. Painful. Slowly eliminated.) Sol able 2 in i of Water, I in 4 of Alcohol 90%, also in Glycerin. Hydrargyri Salicylas. Dose.—-3- grain (0-02 Gm.) (internally). This in our opinion may be regarded as a maximum single dose. Intramuscularly A) grain in 10 minims Liquid Paraffin, increased up to 1 grain. (Cocaine Salicylate may well be added.) Manufacture. When produced by the interaction of Mercury Oxide and Salicylic Acid, the chief constituent is Anhydro-liydroxy-Mercuric-Salicylic Acid of formula /OH c6h%co \Hg O = 330-6412. P.G. VI gives the maximum single dose of this compound as 24 grains (0T5 Gm.), "while P.G. V. gave i grain (0-02 Gm.). It is also official in P. Ital. V. A white powder containing about 59% of mercury, very slightly solable in water (but soluble in solutions of sodium hydrate and sodium carbonate), scarcely soluble in alcohol 90%. Used as an antiseptic and antisyphilitic and as a dusting powder or ointment for sores. Should not be given in large doses with potassium iodide. This is the basic mercuric salicylate as distinguished from the neutral or normal salt (vide below). Hydrogen sulphide distinguishes easily, the normal salt is precipitated at once, this one slowly.. Two mercurous salts are known. As an injection for gonorrhoea 15 minims of a mucilage suspension 1—300 has been used. Three to four injections intramuscularly in 10—14 days of 10 minims of 1 % suspension of Mercury Salicylate in Liquid Paraffin gave excellent results in Bell’s palsy.—P. A. Harry, Pres., Aug., ’26,290. Local skin affections well treated with Mercury Salicylate in Liquid Paraffin injections intramuscularly, 1 grain per Cc. dose.—W. A. Elliott, B.M.J. i./25,551. _ The injection of Mercury Salicylate intramuscularly artificially induces leucocytosis. This accounts for its beneficial action in certain cases of syphilis, in furunculosis, and small infected wounds, and in trachoma. One to three injections often give good results in asthma, hay fever, arthritis, bronchiectasis, and skin complaints. Encephalitis lethargica well treated by 4 injections, each of 1 grain of Mercury Salicylate in oily suspension.—Burr Eerguson, L. i./25,1292. In rabbits, Mercury Salicylate appears to be more rapidly absorbed when in oily suspension, in which instance its lethal dose is 0-03 Gm. per kilo.—Jl. Ph. and Exp. Ther., June, ’26,388. Sterules of Mercury Salicylate, to 1 grain in 1 Cc. of Liquid Paraffin, are made. Hydrargyri Sallcylas, Neutrale. (CsH4.0H.C00)2Hg=474'688. Dose.—Hypodermically % to 1 grain suspended 1 in 10 in Liquid Paraffin. Comparatively non-irritant. Quinine Urea (2%) added relieves pain as follows :— Quinine Urea 2, Water 2, solve and mix with Anhydrous Wool Eat 20. To this add Mercuric Salicylate 10, Liq. Paraffin q.s. to 100. Prophylaxis of Syphilis. The following jelly in collapsible tubes, Neutral Mercury Salicylate 10, Irish Moss 5, Water 85, may be prepared for smearing over the parts. Mercurosaf. Syn. Di - Sodium - Hydroxy - Mercuri - Salicyl - Acetate.—C6H3COONa.OCH2COONa.HgOH.=456-6508. Dose.—| grain (0-05 Gm.) intramuscularly. 1J grains (0-1 Gm.) intravenously in 5 Cc. of water. A white powder freely soluble in water. Used in syphilis intravenously it does not irritate veins. It is less toxic than Mercuric Chloride. Merthioiate. Syn. Sodium Ethylmeiicuri - Thiosalicylate, C2H6.Hg.S.CfiH4.COONa. An American preparation containing 49% Mercury in organic combination. A potent germicide for sterilising tissue surfaces. Less toxic than Mercuric Chloride. Eor general application 1 in 1,000 isotonic solution: for mucous membranes 1 in 2,000 to 1 in 5,000.—N.N.B., Jl. A.M.A. ii./29,1809. Hydrargyri SuhchloriduiXIs Mercurous Chloride, Syn. Calomel, Mercurius Dulcist Ph. Ned. V. Hydrargyri Chloridum Mite. U.S. Syn. Precipite Blanc Fr. Cx., F.E, VIII. (distinguish from British and P. Belg. IV. White Precipitate which is Hydrargyrum Ammonia turn), HgCl=230-103. Dose.—\ to 5 grains (0-03 to 0*3 Gm.). U-S., average laxative 2 \ grains. Fr. Cx. has maximum single dose 15 grains, maximum during 24 hours, 15 grains. Heavy white powder. We have also prepared it as small, soft, scaly crystals for eye work. The Finely Divided Calomel of Duret (Vol. II.) is similar to this. Insoluble in water, ether or alcohol. Incompatible with acids, alkalis (see Lotio Nigra), with sodium and potassium chloride and with bromides, iodides s sulphur, cherry laurel water, and antipyrin. With regard to Calomel and Sodium Chloride, the usual view is that Mercuric Chloride may be formed. Pharmaco/ocgy.—Taken internally, it is converted into Mercury Sulphocyanide with traces of Mercury-Albumin compounds. Since the solubility of Mercury Sulphocyanide is markedly increased by alkali chlorides, salt should be withheld from patients taking Calomel.—P.J. ii./io,438. Uses.—Alterative and purgative. Was always considered a cholagogue, but at the present time is thought to empty the gall bladder only, not to increase the actual amount of bile formed. Most useful purgative for congested liver and dyspepsia generally. To be given at bed-time followed by morning saline draught. Useful where there is intestinal putrefaction, e.g., in dysentery, faecal accumulation, typhoid. For torpid liver J grain doses hourly valuable. As dusting powder to ulcers and many skin diseases (but not to the cornea of the eye if Potassium Iodide is being given). Applied dry relieves pruritus ani. Amcebic Dysentery treated by Calomel and Magnesium Sulphate, followed by Salol, Bismuth Salicylate and Dover’s Powder, 5 grains of each in cachets. —N. Cantlie, Jl. Trop. Med., Feb. 1, ’23,43. Asiatic Cholera might well be treated with 5 grain hourly doses of Calomel —increasing to 10 grains if necessary.—W. E. Fellowes, B.M.J. ii./2i,176. Asthma is relieved by i to 2 grain doses. Diarrhoea.—Large doses of Calomel. 20 grain doses repeated twice in the first 12 hours in the acute enteritis met with in the Tropics with temperatures ranging between 103° and 106° most successful. In dysenteric, diarrhoea 12 grains repeated twice in the 12 hours is perfectly safe, but whether constipation be present or absent 1 grain every three hours in 12 doses results in pronounced salivation in adults—the same would occur with this dosage in children, though they are known to be much more tolerant of Calomel.— H. D. McCulloch, B.M.J. ii./i2,1428. Infants with diarrhoea may receive 2 grains. If vomiting, add equal quantity of Cerium Oxalate.—W. E. Fellowes, B.M.J. ii./2i,176. Enuresis.—Give I grain daily to regulate bowels. Gall Stones are often expelled after^large Moses of Calomel followed by Castor Oil.—Wliitla, Pract. Med. Neurasthenia and Neuralgia.—Intestinal antisepsis is required, Calomel may be useful. Optic Neuritis. Weekly injections of \ gr. have been successful. Peenash. Due to the ravages of the larvae of Lucilia Macellaria. One drachm of powdered Calomel blown into the nose or affected cavity kills the larvae and causes them to drop out; washing out afterwards with a lotion will bring out the deeper seated ones, infections with Dermatobia noxialis also treated in the same way.—B.M.J. i./u,362. Quinsy.—Calomel placed on the tongue in l grain doses and repeated every half hour for 12 to 18 hours stated to abort a quinsy. If used before suppuration occurs it may abort in 18 hours without purging. In two cases where suppuration had begun within the tonsil the method failed and strongly purged the patient.—B.M.J. ii./i2,1249. In Raised Arterial Tension where indicative of danger, \ to 1 grain pill once or twice weekly followed by saline in the morning keeps down pressure. —Brunton. Suspicious cracks or hangnails should have this ointment well rubbed in:—Calomel 33, Vaseline 10, Anhydrous Lanolin 57.—Cf. Unguentum Prophylaxis. Calomel Ointment 30% used as a prophylactic for syphilis in rabbits, provep efficacious up to 8 hours after inoculation with the disease. Death from mercurial poisoning produced by single application of a large amount of the ointment—H. Nichols and J. Walker, per Jl. Trop. Med., June 15, ’23,223. Calomel Tablets, TV, J, i, 4, 1, 2, 3, 4, and 5 grains. Injectio Hydrargyri Subciiloridi Hypodermica. Lambkin’s Original Formula. In syphilis, Calomel 10 grains, suspended in Sterile Olive Oil containing 2% Carbolic Acid, J ounce. Dose.—10 minims injected once a week. Calomel is quickly absorbed but intensely painful, best used only as heroic measure. Morphine \ grain should be given afterwards to relieve pain. Calomel Cream. P. Off.—Contains 5%. Heat Wool Fat 50 and Olive Oil 23 separately at 150° C. for 1 hour and cool. Triturate Calomel in fine powder 5, in a sterile mortar with a little of the Oil. Add the Wool Fat and rest of the Oil and incorporate Camphor 10 dissolved in Creosote 10 and mix. We find the formula satisfactory. Calomel injected with Oil in this way is partly converted into a soluble compound (probably Mercuric) and absorbed by the lymphatics and blood vessels and is partly taken up by Leucocytes and converted into a soluble compound within these.—Marshall. Poisoning, fatal, from intramuscular Calomel injections.—B.M.J.E. i./22,49. GD Lotio Hydrargyri Nigra (B.P. ’14). BLACK Wash. Mercurous Chloride, Glycerin, and Solution of Lime, about 1 in 150. Tragacanth Mucilage is now omitted. Contains ® Mercurous Oxide Hg20 = 417*2. (CeD Precipitate, Red and all Oxides of Mercury ’). Cg) Unguentum Cinereum containing Mercurous Oxide 1 in 10 or 20 of lard has been prescribed for syphilis—distinguish from Oleum Cinereum q.v. CP) Gargarisma Hydrargyri Composita. Black Wash 1 ounce, Potassium Chlorate 10 grains. Water 1 ounce. For syphilitic throats. Pilula Hydrargyri Subchloridi, Rhei, Gascara et Capsicin. Calomel \ grain, Rhubarb Extract 2 grains, Cascara Extract 1 grain, Capsicin grain. Relieves constipation, e.y., that arising from large doses of Bismuth in treatment, see also Mistura Bismuthi, Phenolis et Morphinse. Pulvls Basilicus. Dose.—For a child of 2 years, 4 grains (0-25 Gm.); of 6 years or upwards, 8 grains (0*5 Gm.). Mercurous Chloride 3, Scammony 3, Acid Potassium Tartrate 3, Jalap 1, Ginger 1, Antimonial Powder 1. Suppositoria Hydrargyri Subchloridi, L.H. Contain ^ or 1 giain. Unguentum Hydrargyri Subchloridi.—Syn. Calomel Ointment (B.P. ’14) Mercurous Chloride 1, Benzoated Lard 4. To relieve irritation.—See also Unguentum Prophylaxis. Calomel Cream, L.L. Calomel 10 grains to Soft 1 araffin 1 ounce, Distinguished from that of Lambkin—qr- supra. Hydrargyri Succinimidum, Imido-succinate of Mercury. [C2H4(CO)2N]2. Hg=396-6884. Dose.—By injection, J to -£■ grain (0*016 to 0*02 Gm.). Mercury Succinimide is a white powder, soluble in water about I in 28. Hypodermically in syphilis has been used in 2J% solution Addition of cocaine nitrate diminishes pain. 0] ;l? 1| Sterules, Hypodermic of Mercury Succinimide, contain grain with Cocaine Nitrate ^ grain. HydrargyTi Sulphas. Mercuric Sulphate. Syn. Hydrargyri Persulphas. HgS04=296-67. Dose.—2 to 5 grains (0*12 to 0*3 Gm.). A white powder made by dissolving Mercury in boiling strong Sulphuric Acid. Water decomposes it with formation of yellow Turpeth Mineral, Hydrargyri Subsulphas Fr. Cx. or Mercuric Oxysulphate, HgS042Hg0 = 729-89. It is a prompt emetic in dose of 2 to 5 grains which was given to children in croup and diphtheria to expel false membrane. Does not produce purging. Turpeth Mineral Ointment, Bazin’s Ointment, is 1 in 30 of Benzoated Lard. LTsed for ringworm. Mercurous Sulphate, Hg2S04 = 497-28. A whitish crystalline powder slightly soluble in water and in dilute nitric acid. This salt, as also Mercuric Sulphate mixed with Potassium Bisulphate, is used for construction of electrical cells. CE TJnguentum Hydrargyri Qxidi Flavi. B.P. ’14. (E Yellow Mercuric Oxide HgO == 216-61. (Made by precipitating Mercuric Chloride with Sodium Hydroxide Solution) in very fine powder 1, Soft Paraffin, yellow, 49. The powder and the resulting ointment should be neutral to moistened litmus paper. Incompatibility.—Should not be used whilst patient is taking Iodide—violent irritation may be produced. Used for inflamed eyelids (but caution antea). CE) Pagenstecher’a Ointment 4%, i.c., double this strength; ointments of 1, 2-5, 5, and 10% are also prepared. Syphilitic sores and eczema are well treated by the 1% ointment. Martinc/aJe’s Method of Manufacture. Wc recommend the Yellow Mercuric Oxide to be freshly precipitated and converted into ointment ivithout preliminary drying. This produces a perfectly smooth ointment free from grit. It can be effected by taking the equivalent of Mercuric Chloride to start with. 1-25 kilo of Corrosive Sublimate will produce 1 kilo of Yellow Mercuric Oxide on precipitation with Sodium Hydroxide (Solutions must be very dilute). This is carefully washed until the washings do not react with either Silver Nitrate or Plienolphthalein, and pressed in suitable linen free from “ Huff,” and finally in this moist condition is made up to 10 kilos with Paraflinum Molic (Yellow should be quite as suitable as white). The amount of moisture in the precipitate is easily ascertained and allowance made for, and is reducible, by pressing to a very small amount. Weaker strengths can then be prepared from this 10% bulk, as desired, by dilution with Paraflinum Molle. If kept exposed to light, Yellow Ointment may turn dark on the surface. If desired, the ointment may be kept under water, or be placed in 4 Collapsubes ' (strengths as above mentioned). We examined the contents of such Collapsubes two years after preparation and found them in good condition.—W. H. Martindale, Oph., Nov., 1906 ; L. ii./o6,1459. R.O.H. also adopts this method. 2, 4 and 8 grains to 1 ounce (0-5, 1 and 2% approx.). GD f*asta Flava, Gt. Orm, H. Yellow Mercuric Oxide 15, Zinc aste to 440 (Zinc Paste in this instance is Starch 108, Zinc Oxide 108, Soft Paraffin to 440). CE> Unguentum Hydrargyri Oxidi Rubri. Syn. Red Precipitate Ointment. (B.P. ’14.) Red Mercuric Oxide 1, Paraffin Ointment 9. For use in chronic skin affections. The Red Oxide is crystalline, and the Yellow (by precipitation) amorphous, but they are chemically identical. CeD U.S. VIII. had Red Oxide 1, Water 1, Hydrous Wool Fat 4, Petrolatum 4. Lanolin used for this ointment, if applied over large surfaces may lead to severe Mercurial poisoning and is, therefore, to foe avoided. 20 grains of Red Precipitate taken per os proved fatal.—W.H.M., 1923. CeD Pom made de Lyon, Red Mercuric Oxide 1, Vaseline 15. GD Unguentum Rubrum cum Cantharide. V.H.C. 1904. Red Mercuric Oxide 1, Vinegar of Cantharides 1, Soft Paraffin 6. Hydrargyri Sulphidum Rubrum. Syn. VERMILION, ClNNABAR. HgS = 232-656. Brilliant red powder insoluble in water and dilute acids prepared by subliming a mixture of Mercury and Sulphur. Both this and the black variety, Hydrargyri Suiphuretum cum Suiphure of same composition are not now employed therapeutically to any extent. Black Mercuric Sulphide, AETHIOPS MlNERALIS was in P.G. I. Aethiops Antimonialis.—A mixture of equal parts Black Mercuric Sulphide and Grey Antimony Sulphide. CED Unguentum Rubrum (Blackfriars).—N. H. Vv . Vermilion 6 grains, Red Mercuric Oxide 6 grains, Creosote 2 minims, Lard to 1 ounce. CeD Hydrargyri Suiphocvanidum. Syn. MERCURIC Rhodanidk Hg.(CNS) 2=316*746. White powder slightly soluble in water. Swells up on burning, producing * Pharaoh’s Serpents.’ Hexamine Compounds of Mercurial Salts, Acetate, Cyanide and Sulphate have been made. The inclusion of Hexamine reduces corrosive effect.— C.D., Mar. 31, ’23, p. 436. CeD Flumerin. Syn. Disodium Salt of Hydroxymercuric Fluorescein. C20H9O5.Na2,HgOH=592 682. CEO Of. remarks under Mercurome. A mercurial advocated for the intravenous treatment of syphilis but it has been little used—Details in XIXth Edn. p. 478. CeD #Mercurome (T.M. 454754). Di - Sodium - Dibromo - Oxy- Mercury - Fluorescein, C20H7O5Br2.HgOH.Na2= 750*4984. Patent and Trade iYIarks. , ,, r ,, . * “Mercurome” is a Trade Mark of the author of the Extra Pharmacopoeia in Great Britain and India. . This chemical is known in the United States and some other countries as Mercurochrome—220 soluble ** It is patented in U.S.A. and in some other c™ntnes, but not in England, and “ Mercurochrome ” is a trade mark in ^-^-A. ana some other countries, but not in England. The introductionsfj1ercmy in ^ l . was the subject of patents in 1914-15 ; investigations by E.C. White r^ultedin the synthesis of Mercurochrome in 1920 and his patent m 192,.). I? Lngla , t was first made by the author of the ‘ B,P. in 1923. ®Legally it is not a poison at all, but a substance like this should have been scheduled long ago. Dose, per os.—Our personal experience is limited to 1/12 grain (0*005 Gm.) in Stearettes, but we are aware that larger amounts have been given. Kenneth Walker states he has given 0-9 Gm. (in 3 doses of 0-3 Gm. each) per diem, by means of capsules containing 0T Gm., though usually 0-6 Gm. has not been exceeded, and with this latter amount no toxic effects have been noticed.—B.M.J. i./so,841. Intravenous Use.—Pneumonia and other acute bacterial infections have been treated. Some hold it should be reserved for desperate cases. Dose.—0-002 to 0-005 Gm. per kilo, i.e., 0-13 to 0-32 Gm. per 10 stone (634 kilo) man, preferably in 0-5% or greater dilution. Numerous notes are given in the following pages regarding a 1% solution, but the desirability of this is questioned. L. S. Dudgeon (L. i./26,172) regards “ 10 Cc. of a 0*5% Solution =0-05 Gm.) as tlm maximum that should be used, and after 2 to 3 doses of this strength it is necessary to reduce to 1 in 500.” Note.—3 mgr. per kilo=3 grains for a 10-stone man. 5 — * •• »> >> u >y >> >> i> j> With the full dosage of 5 mgr. per kilo great care is needed and injections should only be given at intervals of 3 days err more. Per- sonally, we do not advise the use of so high a dosage, except m extremely desperate cases, in view of the invariably severe reaction ivhich results. Pharmacology.—-The writer had experiments specially conducted on animals, Dec., 1927, and correspondence in L. ii./a7,1267 and B.M.J. i./3o,761, from which the above doses are deduced. Solutions should not be boiled or autoclaved. Activity is said to be enhanced by the addition of Glucose to the solution for injection at the time of use. The Intravenous Dose with this solvent has been 10 to 20 Cc. of a 0-4% solution (0-1 Gm. in 25 Cc.). It is stated that the procedure tends to create a cumulative effect. —H. W. S. Wright, Pr., June, ’29,376. Toxicity reduced by combining with Glucose immediately before injection (mixtures of Mercurochrome and Glucose give precipitation of Metallic Mercury within 24 hours).—D. T. Macht and W. C. Harden, Jl. Pharm. and Exp. Therap., Mar., *2 8,339. Mercurochrome is extremely toxic to the nervous system. Intraspinal injections cause death rapidly.—Per Pres., Jan., ’28,7. Chemical Characters.—Iridescent green scales. Itcontains approx. 25% of non-ionised Mercury. Soluble readily in water. In absolute alcohol, 1 in 185, in Alcohol 90%, 1 in G5. Insoluble in Acetone, but soluble in a mixture of Acetone and diluted alcohol—See Solution for local Surgical use postea. Insoluble in Chloroform and ether. Stabilising of Solutions. It is stated that 0-18% Ammonia stabilises Mercurochrome solutions. Our experiments (1931) do not support this contention. Biological assay.—A method has been evolved by J. H. Burn and G. K. Elphick by which the average lethal dose of the chemical, i.e., the amount per kilo which will kill 50% of a number of mice, injected intravenously with minute doses, is arrived at. They suggest as a standard that the amount in question, to permit of a sample being passed for medicinal use, shall be not less than 105 mgr. per kilo.—B.M.J. ii./30,865. The matter is of course important in respect of intravenous medication, though the arithmetical deduction involved is open to logical criticism. The author has on numerous occasions submitted samples made in his Laboratories to the Pharmacological Laboratory of the Pharmaceutical Society of Gt. Britain, for examination on the lines indicated, and on the evidence of the Reports received the relative * batches ’ of the chemical have been issued. The writer takes exception to the figure of 105 mgr. being regarded as a hard and fast ‘ standard,’ and has had the opportunity of conferring with another manufacturer, who also holds divergent views from those of the pharmacologists mentioned. One feels most strongly that if the chemical passes the most stringent quantitative tests for the components of the molecule, and is free from ionised Mercury, a margin of error should be conceded by the pharmacological experts in respect of variations in mice. To put the matter concretely, the writer has issued for medicinal use supplies which, though correct chemically, have been reported on pharmacologically as having toxicity figures varying between 115 and 92 mgr. per kilo. Burn and Elphick (Qtrly. Jl. Ph., 1930,3,177) themselves found that the toxicity does not vary in any way with the actual amount of Mercury, except where the Mercury was so much above theory as to render the product impossible of being called Mercurochrome. We notice, further, that other workers have questioned the method : Toxicity should be not less than 23 mgr. per kilo mouse. Only one sample out of 9 tested would have satisfied the standard of Burn and Elphick. H. A. Mitchell, Qtrly. Jl. Ph., 1931, 4,329. i . . The toxic dose of Mercurochrome is much lower than has been previously stated, the average lethal dose for rabbits being about 30 mgr. per^ kiJo.— D. I. Macht and W. C. Harden, Jl. Pharm. and Exp. Therap., Mar., 28,3^9. Toxicities for mice may vary in different laboratories of the same town. Possibly slight difference in feeding materials account for it. J. H. Burn ana G, I). Grevilie, Jl. Pharm. A Exp. Ther., Dec.,’31. , A pharmacologist with whom we were discussing a dose 01 another, entirely different, chemical remarked “ I do not place much reliance on the intravenous method of comparing M.L.D. s. It is difficult to give the injections at constant and equal speeds. Since the above was written a standard is adopted for parison. . , In the opinion of the writer, the essence of the whole maker is to ensure that the substance is chemically correct in respect of Mercury, Bromine, Sodium, etc., and that, in particular, it contains no, or practically no, ionised Mercury, or excess of Sodium. Theoretically it should contain 26'7% Mercury, 21-3% Bromine, and 6-13% Sodium. It should yield no Aeetote reaction. Notes on Chemical Assay of Mercurochrome 220. G. W. Marns, P.J. ii./3o,99. Incompatible with acids and with alkaloidal salts, e.g. Atropine Sulphate, Cocaine Hydrochloride, Novocain, Alypin, etc.— not to be used with the latter as a vesical wash. ITses.—Mercurome has been found of value as a vesical injection in cystitis, pyelitis, and in gonorrhoea. It has been used intravenously in pneumonia, pernicious anaemia, articular rheumatism, and ir septicaemic conditions and numerous tropical diseases. As a general antiseptic in surgery, it has been ex tensively employed in place of Tincture of Iodine, as although it possesses the advantageous properties of Iodine it does not burn irritate, or injure tissue as Iodine may. Mercurome solution for local Surgical use. Mercurome 2 is dissolved in Distilled Water 35, and Alcohol 95% 55 and Acetone 10 are added.. Penetration. The compound penetrates beneath the superficial surfaces in wounds and mucous membranes, and thus increases the field of germicidal activity and sterilises tissues beneath the surface. It also fixes the germicidal agent, prevents it being washed away and prolongs the aseptic period. Stains on the skin are easily removed with a little Chloride of Lime CEDMercurome First-Aid Sterules.—Encased in rayon and cotton. Contain 30 minims of Alcohol-Acetone Solution. CjDMercurome Solution (Aqueous) 1 % is also prepared. CIDMercurome Sterules 0-2 Gm. for dissolving in 40 Cc. of water for intravenous injection (making 0-5% Mercurome Solution). ClDMercurome Sterules 0*3 Gm., for dissolving to make 30 Cc. of 1% solution for vesical injection. GDMercurome Solubes, 4*4 grains (0-29 Gm.). One dissolved in an ounce of Distilled Water produces 1% (approx.) solution. CE)Injectio Mercurochrome (Intravenous) Gt. Orm. H. For children under 2 years 85 minims (5 Cc.) of \% solution = 0-012 Gm. For older children the same amount of a 4% solution *= 0-024 Gm. May be repeated on three successive days. ClDMercurome Gauze (1 in 1000) is prepared. CDMercurome Ointment, 5% in Lanolin basis has been used in gonorrhoea. We have little information on its clinical user. CfDMercurome Bougies, 1% in Theobroma Oil basis, 4 inches long. GDMercurome Suppositories, 1% in Theobroma Oil basis 15 grains. REFERENCES. Anemia, Pernicious.—Intravenously on empty stomach in dose of 3 to 5 mgr. per kilo. Severe reaction, temperature rising to 103 or 104° F. Injection repeated after 3 days in dose £ as large, and again repeated in a further 3 days. Blood counts rose nearly to normal.—Jl. A.M.A. ii./25,302. Antisepsis (Local use mainly).—2-5% solution for surface lesions, for balanoposthitis, or for painting vaginal walls, from which absorption is slight.—H. D. L. Spence, L. i./25,1382. As a biliary antiseptic, it has promise, as it is excreted largely in the bile, and bile collected after intravenous injection is bactericidal.—Rosenthal and White, Jl. Ph. and Exp. Therap., *24,287. 2% Aqueous-Alcohol-Acetone solution effective to disinfect unbroken skin and for wounds, and mucous membranes, and good for pre-operation purposes.—G. F. Reddish and W. E. Drake, Jl. A.M.A. ii./28,716. Infant suffering from staphylococcic suppuration of umbilicus cured by local injections. Pres., June, *25,231. HYDRARGYRUM. 481 3__ i • « / yJ 4 v ux t v/ vCIiqCOj UJJ.1V not improved. Average number of days under treatment 18-5, and average number of treatments 7-6. In pyelitis 10 out of 17 cases cured.—Jl. A.M.A. 11./21,93. Intractable cystitis with frequent micturition and pyuria well treated especially amongst women.—K. W. Heritage, B.M.J. ii./3o,886. In old prostatic cases invaluable. After draining the bladder 30 Cc. of 10% solution injected—there is no need to irrigate.—C. H. Badcock. Chronic Cervicitis.—Responded well when treated with a douche or paint.—L. C. Itivett, B.M.J. ii./3o,866. Discussion on value at meeting of Roy. Soc. Med. Apart from local application in chronic cervicitis, intravenously in appendix abscess, and irrigation m cystitis, the feeling of the meeting was apathetic rather than laudatory.— L- ii./3o,1088. Cholecystitis.—Clinically cured with intravenous injections. As the chemical is stored in the gall-bladder it is possible to obtain its shadow in roentgenograms.—L. Martin and J. H. Hill, Jl. A.M.A. i./29,2135. Mercurochrome intravenously cured 5 out of 8 cases.—B.M.J.E. iL/29,17. Diphtheria Carriers.—5% solution as paint effective.—P. Bousfield, L. i./28,79. Dysentery.—Results of 5% solution, well diluted, by mouth and colonic irrigation, in amoebic dysentery (aose not stated).—Med. Jl. and Rec., Oct. 21, '25,479. Amiebic Dysentery.—Colonic lavage with 1 in 1,000 solution at 110° F. given slowly and retained, a good adjunct to other remedies.—F. Smithies, Jl. A.M.A. ii./28,153. Eczema.—Intravenous use has been successful. Encephalitis.—Recovery following treatment in a case of acute haemorrhagic encephalitis of the cortex.—Per Jl. A.M.A. ii./25,1758. Intraspinai injection of 2 Cc. 0-5% solution beneficial after first injection, but second injection caused untoward symptoms. Effect may be cumulative. —Z. Bercovitz, China Med. JL, per Jl. A.M.A., Aug. 25, ’28,600. Erysipelas.—Well treated with 5% solution applied to affected area with cotton swabs once daily.—Ann. Clin. Med., Get., ’25,333. . 20 cases cured or improved.—Arch. Derm, and Sypnil., April, 2 6,465. Gonorrhcea.—/Is a vesical injection, 30 Cc. of 1% solution is generally used, but stronger have been employed.—L ide R.lMl A., p. 483. See also Urethritis posted . ^ . , A valuable drug, but the stain is a drawback to its use by patient. Young, White and Swartz, Jl. A.M.A., July 9, ’21,93. VOL. I. Q Alternate use of Silver Salt solutions and the compound for acute and chronic gonorrhoea.—Jl. A.M.A., Dec. 8, ’23,1940. _ Intravenous use in dose of 2 to 5 mg. per kilo weight. Results rapid and satisfactory.—Jl. A.M.A., June 14, '24,1914.—Pres., Nov., '24,392 ; Jl. A. M.A., June 20, '25,1891. Intravenously in gonorrhoea and prostatis 20 Cc. 1% solution followed by severe rigor, temperature of 105° P., and passing of crimson urine. Moral effect terrific, but therapeutic effect doubtful.—L. i./28,209. . Excellent results from 2% vaginal suppositories by placing one in posterior fornix every night for 14 nights.—E. W. Johnson, Bost. M. and &.J., Eeb. 19, ’25 353. A real cure in all uncomplicated cases of gonorrhoeal endocervicitis.—L. Brady, Johns Hopkins Hosp. Bull., Dec., '25,400. _ Quick and efficient as a vaginal disinfectant, daily swabbing for 2-8 days with 1 % solution (after washing out vagina with weak Boric Acid solution).— R. S. S. Statham, B.M.J. ii./28,545. Gonococcal vulvovaginitis in children well treated with 0% solution (4 weeks). —Jl. A.M.A., Eeb. 2, ’29,420. Where there is cervical involvement treatment with 1% ointment in equal parts of Hydrous Wool Eat and Petrolatum, instilled into the vagina.—Jl. A.M.A., Aug. 3, ’29,410. . Gonorrhoea, in females, well treated by daily washing out of vagina with weak solution of Boric Acid and swabbing with 1% Mercurochrome solution. 28 days usually sufficient to render smears negative.—R. S. S. Statham, B. M.J. i./28,544. , . x A . . . Leprosy.—Checks rapid retrogression, and m treatment of ulcers, the result of disintegrating tubercles, and in healing of neurotrophic ulcers. Weekly injection into a cubital vein of 2-5 mg. per kilo, using 1% solution.— Jl. A.M.A., Nov. 21, '25,1608. . . _r . _r , Mastitis.—Well treated with 2% solution.—Jl. A.M.A., Mar. 15, 24. Meningococcal Meningitis. Three cases successfully treated without serum by 1 in 10,000 Mercurome in 10 Cc. doses intrathecally.—R. B. Biili- moria, 25th Dec., 1931. Obstetrics.—Pound useful.—B.M.J. iL/26,45. A 4% solution valuable for sterilising birth canal before delivery.—Am. Jl. Obstet. and Gynec., Eeb., '26,219 and July, ’25,61. Adds greatly to the mother’s safety in the event of Csesarean section.— Am. Jl. Obstet. and Gvnec., per Jl. A.M.A., July 13, ’29,150. Ocular Disease treated by Drops, Ointment 1%, and a 1% or 2% Paint. Conjunctivitis—paint both lids at once—cuts short duration. Invaluable in chronic cases. Superior to Silver : less irritating : cannot damage cornea. Two paintings a week. Parinaud’s Conjunctivitis cleared up. Maternity Department of Bristol Royal Infirmary issues 1% solution instead of Silver for the eves of new-born babies. Decrease of ophthalmia neonatorum. Corneal Ulcers can be painted with benefit. Blepharitis benefited by painting. In ophthalmic surgery 1% is painted over the skin of the eyelids.— E. R. Chambers, B.M.J. ii./3o,992. Parinaub’s Conjunctivitis cleared up in 2 weeks by drops : also useful in tuberculous conjunctivitis and in chronic dacrocystitis.—J. Cole Marshall, B.M.J. ii./3o,1102. , ,, Induction of labour by 0-5% Mercurochrome m Glycerin tnrough a catheter into the uterus. Succeeded in about 66% cases. In uterine sepsis 1% by intrauterine injection almost invariably cures.—R. Kelson Eord, B.M.J. * ^Otitis Media.—4 applications (a few drops) of a 5% solution in 50% spirit completely cleared a case outstanding for many months. Otorrhiea.—-5% solution in 50% Alcohol dropped into the canal and middle ear.—JL A.M.A. ii./25,1251. , . _ ,, . ., Plague.—As it has been of value in Rocky Mountain Spotted Eevcr, its use is suggested in plague, beginning possibly with 20 Cc. of 1% solution intravenously, pushing the dose in severe cases. Risk of ptyalism combated with Sodium Thiosulphate intravenously, if needed.—A. Balfour, B.M.J. ^ Pneumonia.—Intravenous injections in children, of 0-005 Gm. per kilo weight; improvement in few hours; disease runs much shorter course. Am. Jl. Dis. Child., Sept., 1924- hydrargyrum. 483 .venously for every\o°lLm^ghf—Followed" 1 1 °C‘ °f l0/o solution intfa- Trop. Ame0r“i9^83a3r.e,y E* Ini Sn HeaUh ProKta . S^roptococcal lobar pneumonia nf k fnthq !?eated oa purely orthodox hoes diec? 4T.tr.®ated,recovered, and the for 3 days of 10 to 15 Cc. of 0-5% sointior,^ dTr,-D +-ly mtravenous injections and larger doses are not recommended—4* ji ^CtiTS mnst be made sl°wly Mercuric Chloride and Mercurochrome L' i-/^9,359. last throw.—P. H. Mitchiner, L i/u 350SS fly retained as a desperate of absolute cure of staphylococcic«,*! ^uinford, however, could speak Though tar from being an ideal &a£ >?s>n.S ?erchloride. approach that we at present possess^Sh T. Horto’ L. f ^perhaps the nearest injectioif of11% Mercurochrome^n1Gh“e °f T ar.thritic knee joint and B.M.J. U./30.727. ieIturt'cnrome ™ Glycerin cleared up.—S. Kelson Ford, hemoglobin count is TOX^o/ovef—China!MedernUSAT0ml:'*icat'i'ons an<1 wken and ’^4,242 ; Jl. A M.A., >4, Ma“ 1 669-67?. ® 6 ^ PCT k,lo-Pres” June, Patient recovered?—'VV™ t.'Bmvman"'Vhgi^a^Wu'ly P“ellf septicsemia- Insep- examinS?onttheabStepreventiveCof oner % <7Iyceri.n solution,’prior to vaginal In cases notadvancedSBeps>.s> W6*4** every morning. C. L. Somerville'B-M J “32,96 keep patlent *" bed for aD bour-- celfSS,DawSr®rysipela’s' fu™ncles, carbuncles, chancroidal ulcerations Jl., Jan., ’26,71 y' 3 8r' per kli° dld not produce reaction.—China Med. weight* OufcalesTreatld1' o3- C-c-so!ution per 100 lbs. body one —H TT el!? ® ooiy 2 injections were needed, and in 6 only 26?trs~e0 ’^ses'goxAo'ial urethritit weh i’retted with 2^ soIution -i.pl ‘WSBSfJSfcC Sgtgjt ”*-a nuf ft Mercm™n™lamBd uretl\ra ’</ gonorrhoea the ideal antiseptic is not yet found Spence, La/30,19s peDetratm~ irritating, and disappointing.—H. D. L. infecKf1 dedPite.™la? 150 «>«es of acute bacterial 2 or 9 rinses nficSi'1 !,“ solution m saline the maximum dose, and after it can bp mVpn ri?trei?g^ redace to 1 TP 500. If the correct dilution is used tea a?ter inWHnii 0PTatQd-n * i KeeVt!ents warm and Sive Aspirin in hot tea ter injection.—L. S. Dudgeon, L. i./26,172. vah^IJtSlfw6 ?ruit C?ruPany Report for 1924 and 1925, it is of great ai.ue ui the Tropics m a variety of conditions. onCo^eilera!i rey^w °I infections treated. 74-4% cured or improved, in 2*6% treatm^S8 ?91ubtfuI» 3*4% Bh°wed temporary improvement, and in 19-6% the cininnmient *ailed. The febrile reaction seems very important, though with ’26A366—13S72endld reSUltS are obtained-—H- H- Y°ung, Jl. A.M.A., Oct. 23, danr,er°U9 drug to use and its many users in other countries are convinced of its merits.—Prof. W. E. Dixon, B.M.J. i./28,897. Q 2 Beginning with 2 mgr. per kilo, or 10 Cc. of 1% solution per 100 lbs body weight, and gradually increasing, at intervals of 2 to 4 or 5 days, about o Cc. at a time, transitory albuminuria is rare and cases of persistent albuminuria unknown.—Jl. A.M.A., April 28, *28,1397. , a+QT,/i„wiien-Hnn Bactericidal power of the blood stated to be reduced. Standardisation desirable.—Sir W. H. Willcox, B.M.J. ii./3o,866. _v -o p Histological stain. Starch stains readily, showing stratifications. Y.a.r., ’26,71. A large number of abstracts dealing with Intravenous use, toxic effects, margin of safe and tox£ f * idiosyncrasy, hypersensitiveness and uses in affections other than those now cited are provided in Edn. aia, p. 479—490. B^he^esultsf of the^author’s examination (in 1925) are in Vol. II, Edn. XIX, ^ After Mercurochrome, rabbit blood w*as found to be bacteriostatic and occasionally bactericidal for colon bacillus f01T15 s; the urme^°F J-bwit thp csime time —H H. Young and Co-workers, Jl. Ph. Exp. iher., Mar., 24,idy. In vitro, 0-1% kills B. Coliund Staphylococcus aureus murme in one minute. _jl Am. Med. Assn., 1919, 1483, abst. P.J. 1./20,6. B.M.J.E. i./2o,_u. The activity of Mercurochrome is reduced if not in immediate contact with the infecting organisms. It is feebly effective in strept both subcutaneously and mtrapentoneally.—E. L. Walker, Jl. Ph. Lxp. ihei., X Added^to’human defibrinated blood outside the body it in no way enhances the bactericidal power of the blood: injected intravenously it uoes not increase the bactericidal action tested shortly afterwards and no special properties are conferred on the bile by such injection.—-L. Colebrook and R. HAenrethid1o£EteI5uig1chemtS^compounds for their ‘therapeutic efficiency in experimental staphylococcic septicemia in ^bits i^uroctaome^nd similar dyestuffs being used m the investigation.—G. v\ . Raiziss ana co worke. s, Jl. Ph. and Exp. Ther., Jan.,’26,447. Arriflnvme in exneri- The action of Mercurochrome, Gentian \10let and Acrina^me m experi mental bacterial infections.—E. L. Walker and M. A. Sweeney, Jl. Ih. ^^ethafconcMitration of*Iodine against S. aureus about 1 in :10,000-Mer- curochrome 1 in 10,000,000—roughly 1,000 times stronger. R. B. Blau, ^' In 'blood °Merciiro chrome is a very weak germicide.—L. P. Garrod, B.M.J. i /31 268 ^KabWte CTcperrniShSlfy'fnf^tcd^'ith Sapiij/fococcMS aureus are beneficially influenced bv^he intravenous injection of the following compounds 48 or 72 hours after^Infection" Metaphen, Mercurochrome 565 (Mercury derivative of Rose-Benzol 3B) and Benzurin (Mercury derivative Benzopurpunn B). The results with the last compound were particularly promism0. Jl. Ph. Exp. T1rhforo’Mercurv-Fluorescein. A compound from which Phenol-sul- phone phthalein i7eliminated in the urine has been given per os as urinary ^I3xnertmentai''nep2hropathy produced by tetrahydroxymercuri-phenolsulphone- phthalein.—Burns and co-workers, J.C.S.A. i./2o,oiu. CD*Novasurol (T.M. 421577). Syn. Meebaphen. A double salt containing Sodium Oxymercuri-orthochlor-phen. oiylacetate, H0Hg.C6H,C1.0.CH2C00Na, and Veronal. Mercury content about 34%. Readily soluble m water. Dose.-An initial dose of 0 5 Cc. of a 10% sdutxon was advised. It causes profuse and rapid diuresis when injected intramuscularly or intravenously. See Edn., XIX., p. 491, but the compound has been criticised adversely. hydrargyrum. 485 stoukTbl disease the dose ■ muscular.—P. Lazarus-Barlow? l'. i./28 m InJectlon Preferable to intra- j. grain~s Ammonium Chlori<le o»—Sir Osman%yf i.tsoJsT1 dWetics consitoe(l dangerous in uremia.-A. A. o^Tmnl7Lproperttes- ?peatef°-B.Mrfrif*o,l04r7PUt int0 the hands ot thc ProfesS“n®™rio"1 GahSboroug^B*M.J.JJ./3 P],048.^ MerCurials is ™rth the risk.-A. produce striking diuresis. A dangerous remedy in its liabilitv tn produce Mercury poisoning.-Maurice Campbell, Pr i Jan ’3i 34 y 4mmoSum atklf ln ?-™eI disease.’uS’in^onjunction with ieenm-J1UR. SstrdU, L lllfoS^ al°ne' T°XiC Symptom8 »<* hvdrovvSalnir ’• 451100). Si/n. Mersalyl, Mercurgan. Sodium te.CH?S,- S&feK) Ca<HaOH) • Phen°Xy ' oiitef Jy to* apti°n of Mercury Acetate and Methyl Alcohol on Salicyh fflmi q^ ro/ TvretlC'aci(?’ and subsequent conversion to the Sodium salt. Contains 39-6% Mercury m a non-ionisable form. ^Je's*T".Chiefly used as a diuretic in ascites and oedema of cardiac and cardiorenal origin, and m ascites resulting from cirrhosis of the liver. nephritis^01^^'00^0, *n acu*'e disease of the kidneys and advanced i ^utravenous route gives better and quicker response. Diuresis begins in m J,n°U^Sandls eomplete in 8—12 hours : best given in the morning. Am- rAQjjrl!!?1 ^^ri0rA?re’/^T^15 dady> for 3 or 4 days before injection, improves response.—G. W. Collins, Jl. A.M.A., Dec. 28, *22,1994, per Pres., Feb., '29,71. p1 Pyc^eruuce 2 Cc. is diluted with 10 Cc. of Saline and given slowly intra- enousiy. in oedema of renal origin with blood pressure and blood urea normal the preparation is useful and probably safe.—Izod Bennett, B.M.J. effects from intravenous injection of doses larger than stated antea.—C. T. Andrews, L. ii./3i,132. As diuretic used in 60 cases.—B.M.J.E. i./3i,65. CR)MeroxyI. o ufjxture containing approx. 50% of the Sodium Salt of 2:4-Dihydroxy- o: r‘dV11yuroxy-mercuri-benz°phenone-21-Sulphonic Acid with Ammonium ^ w +1^iy<droxy-benzophonone-2-sulphonate, Sodium Acetate and Water. wet- dressings and irrigation of wounds 0-1 % solution. For urinary affections 0-o% solution. CDMetaphen. _ 4-NITRO 3 : 5-BISACETOXYMERCURI-2-CRESOL. lor use on infected areas, skin sterilisation and instruments and hands, w°uuds and open cuts : also for instillation in gonorrhoea, and in ophthalmology. Stated to be 11 times more potent than Mercuric Chloride, ana several hundred times more than Phenol. Is only slightly irritating to sKm and mucous membranes in therapeutic dilutions. Usually employed in l m o,000 solution, though up to 1 in 100 may be used. In rhinology it is a useful antiseptic with a shrinking action like Adrenalin, without reaction.—Thacker Neville. ^ CfDNeptal. (T.M. 482137). Hydroxymercuripropanolamide of Ortho- acetyloxybenzoic Acid. A mercurial diuretic used in nephritis, oedema of cardiac or renal origin, and in pleural or pericardial effusions. It is stated to be free from toxicity in therapeutio doses, and to have rapid and prolonged action. Ampoules contain 1 Cc, (jg)Merodicem (T.M. 513602). A Mercury-iodo-Resorcin Sulphoneph- thalein. Active against B. Typhosus. Per os has low toxicity.—D. I. Macht, Jl. Pharm. & Exp. Ther., Nov., *31. Legally none of the last mentioned are Poisons but they should be. For further Organic Mercurial Compounds see Vol. II. HYDRASTIS RHIZOMA. Syn. Golden Seal. Note.—The preparations of this drug should be treated as Poisons in view of their uses, though we know of no actual fatalities from them. Dose.—10 to 30 grains (0-6 to 2 Gm.). The dried rhizome and rootlets of Hydrastis canadensis (Ranuncu- acece). B.P. ’14, not standardised. U.S. is standardised to 2-5% alkaloids (Ether soluble). Hydrastis Leaves and Tops also contain Hydras tine. For assay and data on Chemistry of the Alkaloids, cf. Vol. II. Uses.—Internally it has tonic properties,—action not unlike that of quinine. Is used in intermittent fevers. The drug and its alkaloids cause uterine contraction and are remedies in menorrhagia and dysmenorrhoea. Contains Berberine in addition to Hydrastine (1*5 to 3%). The best stimulant in gastric catarrh from chronic alcoholism. It is useful in fibroid tumours ; does not cause painful contractions. It has been used locally in chronic pharyngitis and in goitre. Externally in chronic inflammation of the mucous membrane, also for cracks and fissures of the nipple. It stimulates ulcers, and as a lotion (1 in 20 of liquid extract) checks profuse sweating, employed in acne and seborrhoca. In gonorrhoea, both locally and internally is of value; as an injection 1% solution of the liquid extract (or combined with 1% of Protargol and 5% Glycerin) is recommended.—H. Cg) infusion of 1 drachm in 8 ounces boiling water useful in vaginal gonorrhoea and leucorrhoea.—H. Flavoring Syl Lavandulae. Glyl or Syl Pini (in bold dose). Cg) Extractum Hydrastis Liquidum. (B.P. T4.). Dose.—5 to 15 minims (0-3 to 1 Cc.) Is made with 60% alcohol, standardised to 2% Hydrastine. Fr. Cx. extracts with 70% alcohol. [FJMistura Hydrastis et Ergotse. Liquid Extracts of Hydrastis and Ergot of each 30 minims, Chloroform Water to 1 ounce for a dose. This is one of the most powerful remedies for menorrhagia, and so also is a mixture of Hydrastis and Hamamelis.—W. W. W. Cg)Mistura Hydrastis Composita, \V.—Liquid Extract of Hydrastis and Liquid Extract of Hamamelis each 15 minims, Cinnamon Water to 1 ounce. HYDRASTIS RHIZOMA. 487 <E> Extraotam Hydrastis. Syn. Hydeastinum.—Prepared by rrtl° Ae eXtra"tlC,n', BMe—2 t0 5 g^inS (0-12 to 0-3 Gm.). m » S o e!Vh°if ^ Stomachic, and tonic, 3 to 6 grains MWwoH ^°T6 Effervescing Sodium Sulphate, is a useful biliaij stimulant and has been used as a dressing to ulcers. E] Hydrastina, Hydrastine. Fr. Cx. C21H21N06=383*1718, D0Z~htO 1-grain (C'°f *° °'06 Gm')- Fr‘ Cx- max. single dose I\ grains, max. during 24 hours 41 grains approx. g An alkaloid in white prismatic crystals, slightly soluble in water about0 "“on11 tl0fOi 9°% 1 in 15°’ ^lorofon/l ini and etW about 1 m 90 ; taste very bitter. HHydrastmse Hydrochloridum. C21H21N06HC1=419-6366. +Aq. Dose.~\ to 1 gram (0*03 to 0*06 Gm.). A crystalline soluble salt; said to act as an expectorant. A crystalline soluble salt; said to act as an expectorant. D B DottStated t0 bG 116° C‘ Wh6n dried near 100° C‘ the M*Pt* is 168° C.— Found to produce uterine action and induce abortion, without danger to the patient, injected hypodermically. El Tablets, Hydrastine Compound.—Hydrastine Hydrochloride £ gram, Ergotm \ grain, Cannabin Tannate £ grain. Efficient in checking menorrhagia and post-partum hsemorrhage. EOHydrasfciriinae Hydrochloridum. Fr. Cx., P. Ital. V., P.G VI P. Belg. IV., C11H11N02.HC1=225-558G. Dose.—\ grain (0*03 Gm.) per os or hypodermically in 10% solution. IR. Cx. has max. single dose £ grain; max. during 24 hours 2£ grains approx. P. Belg. IV. has 30 mgr. and 100 mgr. respectively. A salt of E) Hydrastinine, C11H11N02^= 189*0938+Aq. (Fr. Cx.). An oxidation product of Hydrastine, is allied to Cotarnine. It is probably the active constituent of the drug. In pale citron yellow crystals, soluble 1 in 1 of Water. M.Pt. 212° C. Has been used for internal hsemorrhage hypodermically. Useful in menorrhagia and dysmenorrhoea. CEb Sterules, Hypodermic of Hydrastinine Hydrochloride contain £ and £ grain (0*016 and 0*03 Gm.). ®Tinefcura Hydrastis (B.P. ’14). Dose.—30 to 60 minim3 (2 to 4 Cc.). Prepared 10% of the Liquid Extract in Alcohol 60%. IR. Cx.—1 in 5 of the root by weight. Not standardised. Flavorinxj.—As Extractum Hydrastis Liquidum q.v. Ca>Liquor Sedans. Dose.—£ to 1 drachm (2 to 4 Cc.). A specialty said to contain in 1 ounce Hydrastine (representing Fluid Extract of Hydrastis 30 minims); Black Haw (Viburnum Prunifolium) 60 grains; Jamaica Dogwood 30 grains; with aromatics. To restrain nervous irritability and as ovarian and uterine anodyne. - 488 HYDROGENII PEROXIDI LIQUOR. H2O2=34 0156. Syn. Solute officinale d’ Eau Oxvgenee. Fr. Cx. 12 vol. ‘ HYDROXYL,’ Dose.—J to 2 drachms (2 to 8 Cc.). May be prepared by the action of diluted sulphuric acid on barium peroxide in presence of water. Electrolytic method by treatment of Sulphuric Acid in the presence of Hydrochloric Acid or Hydrofluoric Acid. H^S208 (Persulphuric Acid is first made).— P.J. i./i6,3. 1 Cc. of the B.P. ’14 Liquor yields 10 Cc. of oxygen, or 1*45% of its weight=3-04% by weight H202. It has the second atom of oxygen in loose combination. Twenty volume strength is also available. Hydrogen Peroxide is produced naturally in many ways, as by the oxidation of oil of turpentine, oil of eucalyptus, etc. It is contained in ‘ Sanitas,’ q.v. The solution is used for bleaching hair. It has a harsh bitter taste. Incompatibility,—It readily decomposes, especially in contact with metallic oxide, such as that of Silver or Manganese, these if moist and freshly precipitated cause oxygen to be briskly evolved from it. Ether restrains this decomposition and is used for making Ozonic Ether. Further incompatibilities are Alkalis, Ammonia, Arsenious Salts, Carbolic Acid, Glycerin, Hypophosphites, Iodides, Mercurous Salts, Potassium Bromide, Chlorinated Soda and Chlorine Water. Borax is frequently prescribed with Hydrogen Peroxide to neutralise acidity, but the product is very unstable—a sample titrating 11 vols. entirely decomposed within 21 days.—P.J. i./25,549. For Assay and Preservation, see Vol. II. Uses,—Internally is non-poisonous and has been given for pertussis, flatulent dyspepsia and other affections, but now it is mostly employed locally. It is useful for assisting in removing surgical dressings which adhere obstinately. It is valuable, used undiluted, as a pigment or spray for diphtheria, tonsillitis, laryngeal tuberculosis, stomatitis, putrid bronchitis and non-syphilitic ozsena. For tuberculous and syphilitic ulcers, gangrene, malignant pustule and for purulent discharges it is antiseptic. It is astringent, e.g., in epistaxis, and styptic in removing polypi. Does not precipitate albumin. May be used locally for inoperable uterine cancer, chilblains, lupus, favus and other skin affections, also in gonorrhoea (up to 10 volume strength) occasionally. Wasp and hornet stings are at once relieved. Diphtheritic conjunctivitis is treated with a 10% dilution of the official Liquor. Empyemal cavities have been washed out with diluted solutions, but danger has arisen from embolism by the oxygen evolved. Also employed well diluted in erysipelas, and as an enema in dysentery. Fistula. For cleaning up unhealthy germinating areas and blind pockets, Hydrogen Peroxide is invaluable—on no account should Silver Nitrate be used for this. ^ , Hay Fever is treated by spray of Hydrogen Peroxide into the nose, and on the conjunctiva it proved efficacious, Otorriicea and Otitis may be treated witli the 10 volume solution preferably diluted with equal volume of water. After syringing out with weak boric acid lotion, allow to remain in 15 minutes, syringe out again, and dry carefully. 489 HYDROGENII PEROXIDI LIQUOR. .wittpKyleld^teau^Tvofn^ tre!“ of In contact and even death. Pres., Feb ’2 6 69 xygen whlch may eause serious symptoms for«43°% SOlUti°n °f H^r°gen Peroxide voESSSf in°tWo?al and memtoanous) is treated witli 10 destroys gonMoecf^WiUreduce^corneafopacity136*1 “Wa™ d0uche (104° F'> Centralising Hydrogen Peroxide Solution with Calcium Carbonate and th^ ordinary'add^re'mratinn^Thl,36^ by syril'2in8 wounds in the ear with uie orumary acid preparation. 11ns, of course, must be done onlv it tho mOTe,0p.j!\fi^421S0lUtl0n Would thus raPidly lose its strength.—II. Finne- Gutt^ Hydrogenii Peroxidi et Spiritus, St. Th. H. Hydrogen Peroxide 10 vols. and Methylated Spirit, equal parts. Used as ear drops. Gargarisma Hydrogenii Peroxidi. Hydrogen Peroxide Solution 1 drachm, Sodium Chloride 5 grains Glycerin 30 minims, Water to 1 ounce. {Caution.—In a strong bottle. j Collutorium Hydrogenii Peroxidi. Hydrogen Peroxide Mouth Wash. Hydrogen Peroxide Solution (20 volume) 500, Oil of Peppermint 1 Saccharin Elixir 30, Thymol Water 470. Astringent Hydrogen Peroxide Mouth Wash.—Martindale. The above with 5% of Solution of Aluminium Acetate added. Dilute either of the above with 7 parts of water. For painful ulcers of the mouth in syphilis. Lotio Salox V.H.C. Hydrogen Peroxide Solution (20 vol.) 907, Sodium Chloride 85, Boric Acid 12. 1 or use add one part to 4 of water. CJnguentum Hydrogenii Peroxidi. ^ Hydrogen Peroxide Solution 10, Anhydrous Wool Fat to 100. To be freshly made. Useful in eczema and other parasitic skin affections. Dental Use,—The 20-volume strength can be used for acute or chronic and gouty periodontitis by syringing out pockets around affected teeth. Also for septic root canals. Ozonic Ether. Dose.—J to 1 drachm (2 to 4 Cc.). A solution of about 1*2% by weight of H202 in ether (i.e., 4 volumes approximately). It is miscible with water in all proportions up to three times its volume, possesses properties similar to the above, and is more stable. In conjunction with Tincture of Guaiacum, it is employed as a test for blood, v. Vol. II. Has been given internally for diabetes and whooping-cough, and used for scarlet fever. It bleaches discoloured teeth. Hydrogenii Peroxidum Boratum.—Borated Hydrogen Peroxide. Neutralise carefully (using Phenolphthalein as indicator) Hydrogen Peroxide with caustic soda. Then add 3% boric acid. The preparation is permanent, within reasonable limits. Liberates oxygen on coming in contact with blood or other organic matter. A useful mouthwash. Loss of sense of smell returned (to our knowledge), after the use of this preparation a3 a nasal lotion. ^Hyperol (T.M. 343485 Class 3)4 Solid Hydrogen Peroxide.’ A concentrated Hydrogen Peroxide is obtained by forming the compound with IJrea, CO(NH 2)a.H209 rendered stable with a trace of Citric Acid. One Cm. dissolved in 10 Cc. of water gives a solution of 10 vols. strength. The solid is stable in temperate and sub-tropical climates, but decomposes when heated to 60° C.—Analyst, *26,50. Magnesii Peroxidum. Dose.—15 to 60 grains (1 to 4 Gm.). A white tasteless powder insoluble in water, containing about 20% of Magnesium Peroxide, MgOa = 56-32, with Magnesium Oxide, and is for use where increased oxidation is desired: given for weak digestion, anaunia, and in diarrhoea of phthisis, vomiting, anorexia, flatulence and pyrosis. 5 to 10% added to precipitated or prepared chalk powder makes a good dentrifrice. Tablets and ‘Stearettes’ of Magnesium Peroxide, 3 grains each are prepared. Dentifricium Oxidans. Syn. OXIDISING DENTIFRICE, R.D.U. Hard Soap and Orris Hoot of each 30 grains, Clove Oil 2 minims, Menthol 1 grain, Magnesium Peroxide 1 drachm, Precipitated Chalk 1 ounce. Zinci Peroxidum. Fr. Supp. II. Ektogan, Dermogen, Zn02 = 97-38. A white powder insoluble in water. Used locally in skin affections. Promotes healing of chronic ulcers. For burns and wounds. Incompatible with Corrosive Sublimate. 10% Unguentum or dusting powder is used. Sodii Peroxidum, Sodium Dioxide, F.E. Syn. Oxylith, “ Solid Oxygen.” Na202=77-994. A yellowish white amorphous deliquescent powder, dissolves in water with production of heat and evolution of oxygen. 50% solution has been used in dentistry to whiten stained teeth. Technically used as bleach for sponges, wool, bones, oils, etc. _ _ . . , Unguentum Sodii Peroxidi. 20% m soft white parafhn may be tried with caution in acne. HHYOSCINA. C17H21NO4=303-1718. ( + Aq.). A thick syrupy alkaloid, contained in Hyoscyamus niger, different species of Scopola, Datura alba, the flowers of which yield 0-5%, and other solanaceous plants. It may be obtained from the Mother liquors of the preparation of Hyoscyamine. It is chemically and physiologically equal to Scopolamine. We consider that all the compounds and preparations of this potent alkaloid in this chapter should be deemed $jfJ\poisorM. For further details of the chemistry of this and allied alkaloids, Thorpe should be consulted. See also Lfflvo-Scopolamine posted. Uses.—Hyoscine is a powerful narcotic, especially useful in cases of insomnia, in calming excitement and delirium and producing sleep in acute mania. In such cases even double doses may be given. It is said to have no influence on the respiration, but to increase the action of the heart and circulation. As little as grain dilates the pupil in 18 minutes. The mydriasis is brief. It does not cause dryness of throat. Should be avoided in acute glaucoma. Used largely in conjunction with Morphine in labour, v. posted. It has been, given in vomiting of pregnancy and the tremor of alcoholic excess. HYOSCINA. 491 Chorea, Aoihmatic Attacks, Pertussis and Paralysis Agitans are relieved. Paralysis agitans treated. Give a mixture of Hyoscine 1/200 grain with Pilo- carpme Nitrate i/15 gram and min. iii. of Liquor Strychnine four times daily, gradually increased until the tremor is controlled.—A. F. Hurst, B.M.J. i-'26,845. Vide also postea. .. ooISIS Aqitans* The medicament of choice.—W. Freeman, Jl.A.M.A h./27,1320. Morphine and Cocaine Habits are treated with it, but apparently not without danger. Nocturnal Spermatorrhea is checked by grain doses in Chloroform Water by the mouth.—W. W. W. Diathermasia (thermal stroke in the tropics). Quinine is of no use if malaria has been excluded. Strychnine should be avoided. The patient should be placed in an ice pad, and a hypodermic injection of V,th grain of Hyoscine Hydrobromide should be given to quiet the intense cerebral hyperactivity. For thready pulse TJo grain Digitalin is useful. After diaphoresis small doses of Ammonium Bromide may be given. —Brooke. As hypnotic, not advised in cases other than maniacal as its action is uncertain. In puerperal mania t40 to D grain may be given by the mouth. To quell mania, dose of T$0 grain hypodermically has proved useful. Kidnev disease and feeble state of heart do not contra-indicate its use. Septic pneumonia and influenza may be cautiously treated for sleeplessness.—Sir J. Moore, Pr. January, 1919. Acute mania. The Mowing heavy dose3 are tolerated :—Chloral Hydrate 45 grains, Potassium Bromide 30 grains, Hyoscine Hydrobromide l/40th grain in water to one ounce when required. (Caution—heavy dose). After a few doses the medicine may cease to have effect, even when the Hyoscine is increased to l/20th of a grain. A hypodermic injection (10 minims of a i per cent, solution) of Hyoscine will, however, often subdue. Hyoscine possesses about 5 times the calmative power of Atropine or Hyoscyamine. Hyoscine 1/150 grain, Morphine 1/3 grain. Anaesthetic for the Alcohol injection (q.v.) treatment of neuralgia. Give 20 minutes prior to the Alcohol. —W. Harris, L. i./i3,881. Delirium tremens. Hyoscine 1/50 grain with Morphine 1/3 grain. A sheet anchor, but may be cumulative.—W. Starkey, B.M.J. i./2o,47. (Caution : 1/50 grain is a big dose.—W.H.M.). Post-encephalitic Parkinsonism. Hyoscine Hydrobromide produces quite definite and even marked improvement.—A. J. Hall, B.M.J. i./26,129. Chronic encephalitis treated with Hyoscine Hydrobromide, 1/100 grain thrice daily, and with Harmine.—L. ii./29,794. Antidotes,—Pilocarpine or Caffeine should be administered, also Tannin and Tea, after Emetics and use of stomach pump. Hyoscine poisoning in a five-year-old boy. The child had eaten several tablets, each containing T%o grain of Hyoscine Hydrobromide. Becovery under an injection of I grain of Pilocarpine Hydrochloride.—L. ii./io,884. PH Oleum Hyoscinse, 1% in Castor Oil. Causes a mydriasis which is certain, quick in onset and of transient effect. iJpj] Unguenium Hyoscinse, K.O.H. Hyoscine 1 or 2 grains. Dissolve in Chloroform and add to melted Soft Paraffin 1 ounce at not exceeding 61° C. m Hyoscinse Hydrobromidum. Syn. Scopolamine Hydrobromidum, B.P.T4, U.S., Ph. Ned. V., P. Jap., P. Belg. IV., F.E. VIII., P. Ital. V. Ci7H21NO4.HBr.3H2O. Dose.—2/Rr to tao grain (0-0003 to 0-0006 Gm.), increased to Vo grain. P.G. VI. has maximum single dose 0-001 Gm., maximum 'pro die 0-003 Gm. N.B.—As initial dose we advise tKt or 3 f-g- grain. Patients vary in reaction. In white rhombic c.ystals, soluble 1 in 4 in water (or less), 1 in 14 of alcohol. Melts at 190° to 192°C. U.S. The pure salt (water free) has, according to Schmidt, O.R. for a 6*5% solution at 15-8° C. [a]D=— 25° 45'. Commercial Hyoscine Hydrobromide, though often less leevo-rotatory than this owing to presence of dextro or racemic Scopolamine, according to some does not differ markedly in physiological effect from that of pure Lrevo-Scopolamine. A recent statement, however, is that only Z-Hyoscine is active in producing amnesia; Dextro is useless.—J. Chassar Moir, B.M.J. ii./2 5,514. P.G. VI. requires a 5% aqueous solution, calculated as anhydrous salt, to have a rotation: [a\T> at 20°=—24-75°. On adding 1 drop of potassium permanganate solution (0-1%) to 5 Cc. of a 1% aqueous solution, the red colour should not disappear within 5 minutes (apoatropine). Jowett thought that as both Lsevo- and optically inactive Scopolamine occur in the plant, preparations may vary according to slight differences in v/ays of making.—P.J. i./i3,401. Resolution of Hyoscine and its components Tropic Acid and Oscine. There are possible four isomeric hyoscines.—H. King, C.D. T9,348. P ll Guttae Hyoscinae, R.O.H., 1 or 2 grains to 1 ounce. PIILamellae for ophthalmic use contain -5 ^ (R.O.H.) and ^ grain. 1 Guttae Hyoscinae et Cocainae, St. Th. H. Hyoscine Hydrobromide 0-5, Cocaine Hydrochloride 1-0 0/ /O’ Injectio Hyoscinae Hypcdermica. Dose.—5 to 10 minims 1 grain in 1,000 minims; P ll Liquor Hyoscinae Hydrobromidi, 1 in 1,000 of chloroform water. Dose per os—3 to 15 minims (0‘2 to 1 Cc.). P lj Pilula Hyoscinae Hydrobromidi, ~±})Q to T-J-7 grain. Hypodermic Tablets Tib-* bo. too and TV grain in each. For general uses and References to Hyoscine Salts vide Hyoscine antea. Scopolamine-Morphine Anaesthesia. Scopolamine Hydrobromide to grain or more, and a salt of Morphine } to \ grain are injected on the evening before the operation, and a similar or higher dose in the morning before the opera*’ tion. This alone may suffice to produce deep sleep. If not, Ether or Chloroform may be given until complete anaesthesia occurs. Patients sleep for hours through the first painful periods after the operation. One of the physiological effects of Scopolamine is to induce temporary loss of memory. This is made use of in the “ Twilight Sleep ” method of inducing child-birth. The only successful method of inducing “ Twilight Sleep ” is to give doses according to needs. Hypodermic injection of Morphine-jf to l grain most commonly used. First dose of Scopolamine 1/150 grain ; at the end of one hour a second injection of 1/450 grain is given— injected at hourly intervals controlled by patient’s condition. The number of the Scopolamine injections matters little. The Morphine must not he repeated. Marked absence of maternal shock afterwards. Child usually born with shallow respiration, but artificial respiration improves breathing. A little Chloroform used in the late second stage, and when the head appears give £ or J Cc. of Pituitary Extract.—A. W. Bourne, Clin. Jl., Dec. 19/23,601. Heroin 1/16 grain with Hyoscine 1/150 grain and Hyoscine 1/400 grain as subsequent doses have been used. Scopolamine-Morphine-Atropine Methods :— . Morphine £ grain with Scopolamine grain has been given the night before operation, after thoroughly emptying the bowel, and next morning after a rectal enema a further dose of the same quantity, and an hour before operation, Atropine T}<y grain with Strychnine 3% grain is given subcutaneously. Less Chloroform is needed.—L. i./i i, 737; B.M.J. i./n,757. Atropine essential when ‘ open Ether ’ is used, as Scopolamine when combined with Morphine is insufficient to counteract the injurious results of unstinted doses of Ether.—Dudley Buxton, L. i./n,737. Patients usually pass into profound sleep when operation is finished, lienee need watching until narcotic effects have passed off. The stupor need not alarm if breathing is regular and adequate, and albuminuria or glycosuria are lev own not to be present.—B.M.J. ii. /i i, 1150. No risk to either mother or infant but if pushed to analgesia the risk may be grave. Remarkable absence of exhaustion and shock upon the mother.— \V. 0. Greenwood, B.M.J. i./i7,355. Twilight Sleep not free from danger. Consensus of views.—G. Blacker. L. i./i8,430. See also B.M.J.E. i. /15, 11 ; ii./i5,3. Scopolamine Morphine narcosis in labour. In 25% of cases result very good, in 15% good, and in 10% no benefit.—J. S. Quin, L. i./29,668. ‘ Twilight Sleep ’ given as routine in hundreds of cases.—G. W. Theobald, B.M.J. ii./30,664. Crile’s Anoci-Association, i.e. the exclusion of all harmful associations or stimuli. Scopolamine Morphine employed also Novocain Infiltration with Solution 1 in 400. In abdominal work Quinine Hydrochloride and Urea 5% of each in Normal Saline.—H. B. Butler and E. W. Sheaf, B.M.J. ii./i4,113. Morphine alone, l/6th grain hypodermically, repeated at various intervals throughout labour, satisfactory. The progress of the labour was found to be hurried rather than delayed.—-Louise Mcllroy, B.M.J. i./2i,159. Endangers child’s life when given repeatedly up to shortly before birth.—H. Spencer—ibid, 159. In the Morphine-Scopolamine Method the child was born in 3% of cases oligopnceic—of a blue colour with very shallow breathing. In each case it recovered spontaneously—Morphine not necessarily the cause.—E. W. N. Haultain, B.M.J. i./2i,341. Specially indicated in primiparae. Chloroform only at very end of second stage. Postpartum haemorrhage not more frequent than usual.-—N. Hirschman, B.M.J. ii./22,669. Twilight Sleep has proved far from satisfactory. Diamorphine Hydrochloride analgesic but inhibits uterine contractions. A drug is needed which would give amnesia or analgesia without depressing uterine function.—Allan Vincent. It occurred to us to suggest Hyoscyamine, as an alternative to Hyoscine. Personalty, we are not surprised to find that the Morphine derivatives tend to inhibit uterine contraction. The recent use of Quinine in this matter is of interest, v. p. 102. Investigation of 32 cases by a Committee appointed ty the Section of Ofcstetrics and bynaeco ogy of the R.S.M. in 1917.—The average number of injections of Scopolamine was 4-5. Pituitary Extract 0-25 Cc. was given in 17 cases in the second stage. The average duration of labour after commencement of treatment was 5 hours 41 minutes in primiparse and 6 hours 5 minutes in multiparse. The injections caused lengthening of intervals between contractions which were diminished in strength and duration : voluntary expulsive efforts did not arise automatically : there was thirst in every case, and nausea in some : some complained of pain in second stage : there was sleep between pains in every case : general ansesthesia was induced in 10 cases. One stillbirth resulted, most babies showed apnoea, and all were thirsty for 24 hours. Amnesia and not analgesia the aim. Amnesia was complete in 17 cases, incomplete in 12, and failed in 3. The treatment is good for the mother but needs unremitting attention from doctor and nurse. Xo danger with careful observation. The memory test is useless. Strict precautions must be taken to exclude all adventitious stimuli.—J, St. G. Wilson M.P.C., Nov. 16, *27,407. See also Gwathmey’s Synergistic Theory (Magnesium Sulphate and Morphine), pp. 101, 102. Scopolamine in obstetrics.—Jl. A.M.A. ii./25,1155. Three doses of Hyoscine Hydrobromide given hypodermically at 4-hourly intervals, when regular pains commence (in primipane when cervix is three fingers dilated), and repeat every two hours as long as labour lasts. Up to 8/100 grain used without ill effect. Chloroform given in second stage. Important not to omit last (third) injection even if child about to be born. Excellent results and no ill-effects on babies.—A. M. Claye, B.M, J. ii./3i,12. PJjHyoscine 1/100 grain in 2 Cc. 50% Magnesium Sulphate solution adopted as routine as a reasonable analgesic in labour. Safe and fairly effective. One dose usually enough.—R. Kelson Ford, B.M.J ii./30,726. [fPljSterules containing Hyoscine Hydrobromide 1/100 grain and in 50 % Magnesium Sulphate 2 Cc. are made. HID Sterules, Hypodermic for Scopolamine-Morphine Anaesthesia contain Scopolamine Hydrobromide T}^ grain with Morphine Hydrochloride ^ grain in 15 minims. IP I] Sterules of Atropine Sulphate grain with Strychnine Sulphate ^ grain in 10 minims are for use with these as above mentioned. They are also made with ^ grain of Strychnine Sulphate, iHjjPl) Compound Scopolamine (Hyoscine) Sterules contain Scopolamine jijy grain and Morphine | grain with Atropine Sulphate grain in 15 minims of water. PJfJ Compound Scopolamine (Hyoscine) Tablets contain the same ingredients as the last. [jpjj Scopolamine Hydrochloride ( +2HsO) and pj] Kydriodide have properties and doses analogous to the Hydrobromide. Genoscopoiamine. Stated to be the Nitrogen- oxide of Scopolamine.. Dose.—2 to 4 mgr. (% to grain) during a day. Genoscopoiamine Granules are made, each containing 0-0005' Gm. Dose 4 to 8 granules per day agreeing with the above. Parkinsonism.—It reduces rigidity, muscular liypertonus, tremor and: excessive salivation. This substance has a therapeutic action similar to Scopolamine but is less toxic—the administration may be continued for months.—M. Polonovski and others, L. i./26,929. See also Stramonium* ®HYOSCYAMI FOLIA. Jusquiame.—Fr. Cx. Dose.—3 grains (0-2 Gm.) U.S. Henbane Leaves consist of the fresh leaves ; also the leaves and flowering tops separated from the branches and carefully dried. Collected from the flowering plants.—B.P. ’14, not standardised, cf. U.S., etc., infra. The B.P. ’14 leaves conform with F. I. Cultivation.—For details see Vol. IT. Drying of Soianaceous drugs. Sun v. Shade. No apparent difference in alkaloidal content of Hyoscyamus and Belladonna. Datura however dried in the shade showed 10% more alkaloid than a sun-dried specimen. —-Qtrly. Jl., Ph., 2, 31,265. ZTseSu—Similar to those of Belladonna and Stramonium. Colocynth and other strong purgatives in pills are rendered less painful in action by addition of Hyoscyamus Extract. Hyoscyamus (Tincture) contains varying amounts and proportions of Hyos- cyamine and Atropine and a varying amount of lsevo and inactive Scopolamine. The physiological activity of stereoisomerides varies.—H. A. D. Jowett. U.S. directs dried leaf with or without tops, containing not less than 0*065% alkaloids and not more than 25% of stems, none more than 7 mm. thick. P. Heiv. required 0*1% alkaloids. j|FH Extractum Hyoscyami (B.P. T4). Dose.—2 to 8 grains (0*12 to 0k5 Gm.). This differs from Extractum Hyoscyami Viride, B.P. ’98. It is an alcoholic extract of the leaf, made with 70% Alcohol and conforming with F.I., and is standardised (B.P. ’14) and P. Belg. to 0*3% alkaloids. U.S. X. has 0*25%, P. Ital.V. and F.E. VIII., 0*5% Alkaloids. Glucose is used as diluent. Hyoscyamus Extract contains 0*3% mydriatic alkaloids, including Atropine, and any preparation of Belladonna containing 0*1% or more is a Part I. Poison.—Butherford Hill, P.J. i./26,13. We agree. Of. note under Hyoscine. P G.VI. Contains 0*5% Hyoscyamine. CpjTinctura Hyoscyami (B.P. T4). Bose.—4 to 1 drachm (2 to 4 Cc.). Powdered Hyoscyamus leaves 1 m Alcohol 70% to 10. This conforms with F. I. JFlavoring.—Syl Aurantii Amari, Syl Vaniike; Syrupus Aurantii Eloris. The pain due to pyelitis may sometimes be controlled by Hyoscyamus Tincture in doses of J—1 drachm.—Tirard. Baume Tranquille. Fa. Cx. (Huile de Jusquiaume Composee). Macerate powdered leaves of Belladonna, Hyoscyamus, Solanum Nigrum, Poppy and Stramonium of each 50, with alcohol 200, and allow to stand 24 hours : then add Poppy Seed Olive Oil 5000, warm for 6 hours at 60 to 70 C. Press and allow to deposit, and finally add Oils of Lavender, Peppermint, Bose- mary and Thyme, of each 1, and filter. . . CtOFluidextractum Hyoscyami, U.S. Average dose.' o minims (0*2 Cc.). Strength 1 = 1; hydro-alcoholic percolate, standardised to 0-085% Hyoscyamus alkaloids. The dried leaves are said to contain as much as 0*25% of total alkaloid (of which \ to J may be Hyoscyamine) together with small amounts of Hyoscine and Atropine. The minute dark grey seeds of the plant contain 0*5% alkaloid, also a quantity of oil. Fa. Cx. employs the seeds in ^ ^ --:-- —- r. , Hyoscyamine is also contained in Atropa Belladonna, Duboi t mycporoides, Datura Stramonium, Scopola Carniolica, S. Japomca, and other atropaceous plants. , , . Hyoscyamus muticus. Egyptian Henbane has beer^ .8 if 0*91% Alkaloids by titration. Costs less than 1/20 of lIil ^edicmal drug. Has been imported in America and diluted with irifem°r , as 11 con tains 1 to 1-25% Hyoscyamine. It grows wild all ovei Egypt where it is known by the name of ‘ Sakran,’ the drunken. The alkaloid it contains is practically pure Hyoscyamine. Pilules de Cynoglosse opiates. It is now a drug of extreme importance as a source of Atropine—the hyoscya- mine contained is easily converted into Atropine,—vide Hyoscyamine infra. This laevo-Hyoscyamine has been suggested to replace Atropine for ophthalmic work—vide Atropine. GD Meglin’s Pills.—H^oscyamus Extract, Valerian Extract, and Zinc Oxide each 1 grain.—In sciatica. Lactucarium, U.S. IX. Average dose.—15 grains (1 Gm.). The concrete milk juice of Lactuca virosa (Comjpositce), the strong scented lettuce. Hyoscyamine is said to be a constituent of the fresh plant. Brownish masses with Opium-like odour and bitter taste, partly soluble in Alcohol and in Ether. Tinctura Lactucarii, U.S. 1 in 2. Average dose.—30 minims. Syrupus Lactucarii, U.S. (1 in 20). Tincture of Lactucarium 100, Glycerin 200, Citric Acid 1, Orange Flower Water 50, Syrup to 1,000. Average dose.—2 drachms for insomnia. The Iron content of lettuce is said to vary from 0-00972% to 0-00033%, the variety richest in Iron content being “ May Xing,” and the poorest, the Cos Lettuce. Description of estimation.—A. Lichtin, per P.J. 1/23,358. El HYOSCYAMINA. 01(H ^3X03=289-1874. Dose.—Tjijfr to two grain (0-0003 to 0-0006 Gm.), in cases of mania, increased to T% or grain dissolved in water by means of diluted sulphuric acid, or in a pill. Antidotes. See Atropine. An alkaloid obtained from Hyoscyamus niger and other Solana- ceous plants. It is a stereo-isomer of Atropine (which is inactive), into which it can be converted by heating or acting upon it with alkali. It is in light snow-white crystals. O.R. of Solutions of Hyoscyamine is [a]„=—20-97°. Soluble lin 120 of water, freely in alcohol, chloroform and ether. Is alkaline in reaction, and melts at 108°—109° C. It has been found in Scopola Japonica—q.v. E Hyoscyaminae Hydrobromidum, C17H23N03HBr = 370-1112. Dose.—to yjjir grain (0-0003 to 0-0006 Gm.), increased. In small white crystals, soluble about 2 in 1 water. Does not yield precipitate with platinic chloride (difference from most alkaloids) U.S. M pt. 152° C. (^Hypodermic Sterules of Hyoscyamine Hydrobromide contain J y grain (0-0006 Gm.) in 15 minims. (1 Cc.). El Hyoscyaminae Sulphas (B.P. ’14). (C17H23N03)2H2S04,2H 20 = 712-4816. Dose.—yo y to TJ (r grain (0*0003 to 0 0006 Gm.). In small white granular deliquescent crystals, soluble in water 2 in 1 and about 1 in 4 of alcohol 90%. El Hypodermic Tablets of Hyoscyamine Sulphate contain TJ0 and yo grain. |Fj0 Ophthalmic Discs contain To%0 grain. (JPIjGuttae Hyoscyaminae (vel Daturinae) R.O.H. 0-25%. El Granules of Hyoscyamine grain (00006 Gm.) are used for sea-sickness. Dose, one occasionally a day or so beforehand, and for the first few days on board ; liourty if required. Uses.—As a mydriatic it acts like Atropine, but with greater intensity, while the duration of effect is about equal. ICHTHOSULPHOL. 497 It removes the pain of neuralgia and is given for mental excitement, t.g., delirium tremens. In mania ^ grain may be given hypodermically. Criminology. Suggested use of hyoscyamine to extract ‘the truth’ from unwilling deponents. Could not be used in this country.—L. ii./22,1191. 13 Duboisine from the leaves of Duboisia myoporoides is identical chemically with, and physiologically similar to Hyoscyamine. It is in amorphous very hygroscopic granules. ICHTHOSULPHOL. * Ichthyol. T.Ms.—See 39599(Class 2) and 39600(Class 3), (Names and Designs). 59155, band i (Classes2, 3 and48resp.). ^Ichthyo- latb, No 64841, and *Ichthyolicum 64842. Syn. *Saurolo (T.M. 324693). Ammonium Sulpiio-Ichthyolate. p. itai. v., f.e. viii. Ammonium Bithiolicum. p. Beig. rv,, p. Jap. Patents 10,523/1884 and 6044/1893 Expired. Dose.—10 to 30 grains (0’6 to 2 Gm.) per diem. A viscous, brownish substance, with a disagreeable odour obtained by destructive distillation of a fossil fish deposits. . The total Sulphur is 10-3% of which 8-92 is organically combined and 1-38 is m association with Ammonia. Total Ammonia 3-23% ; 43-74% Water Other refs, m 17tli Edn. Soluble in water, glycerin, chloroform; fats and oils, not soluble to any extent in Ether or Acetone. Uses.—Internally has been given for rheumatism and skin affections, and as an intestinal antiseptic in constipation and dyspepsia. Reduces expectoration and cough. Externally it is used in chrome skin diseases, as eczema, psoriasis, acne, and favus. Applied on wool as vaginal tampon, and as pessaries and suppositories, and as injections 2 to 5% (Lock Hosp.) in gonorrhoea-, cystitis and vaginal discharges. Also applied to cracked nipples and erysipelas. In furunculosis it has been well spoken of. For pruritus and ulcers a 10% solution; may be combined with lead and mercury without the formation of sulphides. For burns diluted with zinc oxide or bismuth (the powder being spread evenly over the surface), or in ointment (10 to 50%). In mumps the swelling and pain are said to be rapidly relieved by inunctions of equal parts of Ichthosulphol and Lanolin. Albuminuria is well treated by Ichthyol internally combined with B. Coli. injections.—F. J. Sadler, L. 4/22,930. Erysipelas in a large suppurating wound on the arm web treated by painting with Ichthyol and Glycerin p. aeq. covered with oiled silk. Simultaneously a mixture containing 2 drachms of Liquor Hydrarg. Perchlor. every four hours. Wound then dressed with hypertonic Saline. Same treatment for a bad case of boils from the trenches also successful.—B.M.J. i./i6,201. Gonorrhcea treated by intramuscular injection of 2% solution Ammonium Sulpho-ichthyolate in doses of 3 Cc. everv 2nd or 3rd day—diluted just before injection— B.M.J.E. i./26,2. Lithium and Sodium Ichthosulphol. Dose of either.—10 to 30 grains (0-6 to 2 Gm.) per diem. Zinc Ichthosulphol, is for external use. Capsules of Ichthosulphol and of Lithium Ichthosulphol, 4 grair (0*25 Gm.) each (or 2 grains of each). Tablets 2\ grains. Collodion 7 parts, with Ichthosulphol 1 part, is used for eczema erysipelas, and other skin diseases. Mistura Ichthosulphol. Bose.—1 to 3 drachms in water. Ichthosulphol 6, Simple Elixir 20, Water 10. Another form :: Ichthosulphol 2, Peppermint Water 7|, Syrup 2j. Pilula Ichthosulphol.^ Ichthosulphol 24, Compound Tragacanth Powder J, Liquorici Powder 1J grains. Make a pill, on hot plate if necessary. Lithium and Sodium Ichthosulphol need less Liquorice. Pessaries of Ichthosulphol, 10% strength, with Cacao butte * basis are used for leucorrhcea, and 2 to 5% in gonorrhoea of th female. Also made with Resorcin, 3%. These must be mad with Cacao Butter basis. See also Ovules. Suppositories of Ichthosulphol may contain 3 grains (0-2 Gm.i with a basis of Theobroma 12 grains The mixture must be almos; ‘ set * whilst pouring into the moulds, otherwise may separate. Th addition of beeswax is not desirable ; indeed a large proportio will render the suppository quite insoluble. May also be made if for immediate use, with Glyco-gelatin basis. Do not overhea the mass, or it may become insoluble. (Physicians should specif which basis they prefer.) The following proportions stated to be satisfactory. Ichth3rol 10, Glyceri 60, Gelatin 16, Water 14. The Gelatin is soaked in the water overnight first — George Roe, C.D., July 2, ’27, p. 49. Tampons, Glycerin-Ichthosulphol 5, 10 and 20% V. Glycerin. Unguentum Ichthosulphol may be made to contain from 20 to 502 with lanolin or with olive oil and lard. For psoriasis and erysi pelas and blepharitis (5%). May be perfumed with otto o rose q.s. Ichthosulphol Resorcin, contains Resorcin 10% for external use. Ichthosulphol Paste for acne rosacea. Ichthosulphol 25, CarbolL Acid 2.V. Dissolve in Warm Water 224, and mix with Starcl 50. Painted on the skin, quickly dries and is easily washed off Pasta Ichthosulphol et Olei Terebinthinae. Ichthosulphol 1, Oil of Turpentine 1, mix. Of value in chilblains Unguentum Ichthyol et Zinci Oxidi, R.O.H. Tchthyol 4 grains, Zinc Oxide 4 grains, Soft Paraffin to 1 ounce. Ichthosulphol Proteinate. Ichthalbin (T.M. 223215). Bose.—f to 15 grains (0*05 to 1 Gm.). A combination of ichthosulphol and albumen ; an odourless ant tasteless brown powder. Used internally for eczema, nervou intestinal affections and during convalescence from fevers. Ichthosulphol Salicyl is a powder made with either 25, 33| o 50% of sodium salicylate for psoriasis, acne rosacea and for rheumati pains, and has been given internally in pills for tuberculosis. INFUSA CONCENTRATA. 499 *Ichthoform (T.M. 222252, Class 2, and 222253, Class 3). Patent 9157/1899 lapsed in 1907. A- compound of Ichthosulphol and Formaldehyde, insoluble in water (OA ton0 3 Gm )P ’ *'9" ^ tubercular di^ases. Dose.-ll to 5 grain" Thigenol (T.M. 260287) is similar but a sodium salt: a 5% ointments relieves eczema. Thigenol Soap contains 10%. *SphagnoI (T.M. 246705).— A native tar product produced from peaty deposits. In blepharitis, eczema, piles, sores and burns. Detergent and relieves insect bites in tropical countries. Ointment (10%), Medical Soap (15%), Toilet Soap (5%), and Shaving Soap 5%, and Suppositories, 3 grain for piles, are made. INFUSA CONCENTRATE These preparations are made of such strength that one volume diluted with 7 of water approximately represents the official Infusion. Farr and Wright recommended dilute Chloroform Water (Chlorofoim 1 in Whiter 1,000) either (a) by Macero-Expression in which the amount of drug required per pint is macerated in 15 ounces of the menstruum in a closed vessel for 24 hours, strained, pressed, and the alcohol or tincture necessary then added and maceration repeated two or three times. The two latter liquors are evaporated and added to the first and made up to one pint. The third maceration may be omitted when dilute alcohol is used as menstruum, and for the second maceration only q.s. need be used to make the expressed liquids, when mixed, measure one pint. The dilute chloroform water is to be used to prepare diluted alcohol when this is employed as menstruum. (6) By Repercolation consisting in moistening half the drug with menstruum and percolating. The other half is then moistened and percolated with the first percolate—percolation being continued in a second percolator until 13 ounces (reckoned on pint formula) are obtained. Add the alcohol and any tincture, etc., in the formula and reserve. Complete the exhaustion. The weak liquors are evaporated and added to the reserved portion. The bulk is then made up to volume (1 pint). When using diluted alcohol as menstruum simply percolate until 1 pint of percolate has been collected from the second percolator. This is the easier procedure. By whichever process they are made concentrated infusions must, to keep, contain at least 20% (for export 25%) alcohol.—W. H. M. 1% of Formalin Solution is also used as preservative, but Alcohol is better. An interesting Experiment,—In Nov. 1926 we pressed the juice from some 8 lbs. of fresh watercress yielding nearly a gallon of liquor—the object being to obtain the chlorophyll, with the idea of retaining the vitamins, intact. It was not heated. Portions were preserved with Chloroform 1 in 200, Toluol 1 in 400, Glycerin 25%, Formalin 1 in 100, Benzoic Acid 1 in 400. They all remained absolutely sweet and unfermented for months. For Watercress, see also Nasturtium. Broom, by (5), but not very satisfactory. Buchu, by (a) using dilute alcohol and add tincture 1 ounce to each pint. Diluted, however, not equal to the fresh article. Calumba, by (a) heating finally to 85° C. for 5 minutes. Gas-1 carilla by (a) adding 6 dr. (B.P.C. 12 dr.) tincture to a pint. Diluted f? good as infusion. Chamomile (6), dilute with alcohol, adding 1 drop of oil fc each ounce of flowers used. Chiretta (b), satisfactory. Glove, not satishn tory. Cusparia (a), good. (£) Digitalis (a), will not keep more than one mont. —B.P.C. Gentian Compound (a), adding 2 drachms of orange and lemo> tinctures to the pint. Hops (a), with alcohol. Use old hops. Orange (b adding tincture 1 ounce. Orange Compound (a), adding 1 ounce orange am lemon tinctures. Quassia (b). Rhatany (a), if with alcohol more body, bu not like official article. Rhubarb (6). Roses (5), with acidulated alcoho: Senega (b), with alcohol and a little ammonia. A little wintergreen oil to t; added to finished product. Deposits in time. Senna (a), with alcohol ant add essence of ginger 4 ounce to pint. Diluted is as good as the fresh infusion Serpentary (b). Valerian (b), with addition of ammonia (B.P.C. uses 0-3U strong solution). Infusum Cinchonse Acidum (B.P. T4). Cannot be prcC duced in a concentrated form. These remarks apply equally to the B.P. T4 Infusions, but Cusparia, Hop] and Sernentary are now omitted. P. Off.—Many infusions may be prepared by maceration with 25% Alcohol. Infusum Quassiae Concentratum (as injection for threadworms i children) should contain no alcohol.—B.M.J. ii./i x,52. Tisanes.—Infusions or teas (usual strength 1 in 10) of herbs are large! used by the laity in France, Italy, etc. Those mostly in use are :—Tilleul fro* flowers of Tilia Europea—Linne. German—Lindenbluthen (anti-spasmodi diaphoretic); Senna and Manna (largely used); Queues de Cerise, cherry-stalk * diaphoretic ; Peppermint; Tamarinds ; Bourraehe, Borage-leaf tea ; Chamc mile ; Mauve :—Malva Sylvestris, Marshmallow-flowers (demulcent); Clnende» couch-grass (kidney-tonic); Aniseed (both varieties), Linseed ; Orge (pear barley). A large number of other tisanes are prepared—Ph. Rotes, Franc and Riviera. Several are contained in the Fr. Cx. They form the basis of domestic therapeutics in France—virtually unknov here.—B.M.J. i./2i,60. IODOFORMUM. Tri-iodomethane. CHI3=393*7938. Dose.—| to 3 grains (0 03 to0-2 Gm.). Manufacture.—By acting upon Alcohol with Iodine in th presence of Caustic Potash (or Carbonate) solution at about 70° C (6KOII + 4I2 + C2H6OH = CHI, + HCOOK + 5HaO + 5KI). It is also produced by the electrolysis of an aqueous solution c Potassium Carbonate, Potassium Iodide and Alcohol. The substance has characteristic odour and contains 96*7 % Iodine A precipitated form is also available. M.pt. 119° C. Antidotes.—Opiates, bromides, diuretics with 5 to 10% c Sodium Bicarbonate locally. Internally we have known it to be badly tolerated-—may brin, out a rash or crop of angry spots. Soluble 1 in 8 of absolute ether, 1 in 10 of ether (Sp. Gr. 0*735) 1 in 12 of chloroform, 1 in 95 of 90% alcohol, 1 in 14 of eucalyptus oil 1 in 10 of collodion, 1 in 60 of vaseline and oil of almonds, and abou 1 in 30 of olive oil. Almost insoluble in water, but dissolves 1 in 1< of Rubini’s solution of Camphor, which disguises its odour Incompatible with calomel, silver and other nitrates, pot assium chlorate, nitrites and methylated spirit. Iodoformum Aromaticum is scented with Coumarin, 1 in 50. To cover its odour it may also be mixed with Menthol, Phenol, Thymol, Oils of Anise, Eucalyptus, Geranium, Peppermint, Rosemary or Sassafras, about 1 or 2%. To remove the smell from the hands, utensils, etc., rub with a little crushed linseed and wash afterwards. Uses.—Antiseptic, anaesthetic and sedative. Useful in gonorrhoea and syphilis (non-irritant). For sores as dusting powder or ethereal solution. Insufflations (q.v.) are used in throat affections. The (10%) ointment is a useful dressing to wounds. Taken internally, Iodoform decomposes, and iodine is soon found in the urine ; being non-irritant has given good results in intestinal haemorrhage, tertiary syphilis and cirrhosis of the liver, also to kill tapeworm. Tuberculous peritonitis has rapidly recovered under Mercury and Chalk | grain with Iodoform J grain thrice daily. Excessive administration may produce symptoms like those of exophthalmic goitre in susceptible persons. Leprous ulcers. Well treated by application of 16 grains to an ounce of Acetone for small ulcers and 10% Iodoform in Eucalyptus Oil for large and sloughing ones— M. C. Lang, I.M.G., May ’30, per M.A. ’31,278. Iodoform Oil (20 grains to 1 ounce of Olive Oil) is useful as dressing in early stages in recovery after operation for fistula—the oil facilitating packing with dressing.—The first few dressings in these cases are usually painful Oleum Iodoformi et Creosoti. Syn. Huile Creosotee Iodoform^e. Heat Olive Oil 70, to 120° C. for 10 minutes. When cold add Creosote 5, Guaiacol 1, and Iodoform 10, lastly Ether 30. Coll odium cum lodoformo. Iodoform 1, Flexible Collodion 12. P. Jap. and Fr. Cx. 1 in 10. Acetone Collodion will dissolve 5%. A pigment to venereal sores, Emulsio Iodoformi. For injection into sinuses. Iodoform, in fine powder, .1 (Alcohol 90% q.s. to moisten. St. Barts., G.H.), Glycerin 7, Boiled Water 2. Mix well in above order. Lister used simply 1 in 10 of glycerin as in L.H. In Glycerinum Iodoformi, K.C.H. (1 in 10) the Iodoform is washed with 1 in 20 Phenol. Most effective before caseation has occurred. For filling a cavity in the bone, after removing caseating tissue, Iodoform 1 and Boric Acid 4 is useful. Injectio Iodoformi. For Bladder Injection. Iodoform, in fine powder, 1, Mucilage of Tragacanth 2, Water 7, This is less irritating than the Glycerin Emulsion (should be diluted 20-—40 times with warm water). Gauze, Gauze Bandages, Wool, and Lint contain 5%, 10% and 20%, British made contain correct quantity —G. Lenthal Cheatle. Gossypium Iodoformi. P. Jap. TV. directs to dissolve Iodoform 1 in Liquid Paraffin 1 and Ether 18, soak cotton wool 18 in same, press gently until of uniform colour and dry. Insufflatio Iodoformi. Iodoform 2, Starch (carefully dried) 1. In specific affections of the throat, antiseptic and mildly caustic. H'FJ Insufflatio lodoformi Composita. Iodoform 6, Boric Acid 8, Morpnine Acetate 1. Iodoform and Eucalyptus Bougies. Cereoii lodoformi et Eucaiyp Iodoform precipitated, 5 grains. Eucalyptus Oil 10 minin: Theobroma Oil 35 grains. To make a bougie 4 inches long. Us*, for acute gonorrhoea. When the symptoms have subsided, at remaining discharge may be treated by Zinc Sulphate injections Iodoform Varnish (Whitehead’s). Benzoin 4, Storax 3, Balsam of Tolu 1, Purified Ether 40 ; dissolw strain, and add Iodoform 4. For surgical application. Pi&mentum lodoformi, Gt. Orm. H. Whitehead's Varnish modified. . Iodoform 1 drachm, Benzoin Varnish 10 drachms. (Benzoin Varni is : Benzoin 4 drachms, Resin 3 drachms. Balsam Tolu 1 drachm, Ether 0-72C ounces.) Cheap and effective : does not retract the skin, dries well, and remai. elastic. Clean, antiseptic, and mildly stimulating.—J. W. Peck, B.M~ ii./31,681. Menci^re’s Solution 4 A.’ Eor embalmment of wounds. Todoform 10, Per vian Balsam 30, Guaiacol 10, Eucalyptol 10, Ether 100. Changes the aspect of wounds, often of the most septic. Previous successr lavage with three antiseptics : Sublimate 1 in 1000, Carbolic 1 in 40, Hydroge. Peroxide 1 in 3. All germs and spores whether anaerobic or aerobic are n- equally sensitive to the three. Thi3 solution employed to soak wicks of gauze or injected into sinuses Bis ‘ B ’ solution also used : differs from * A ’ in the quantity of ether, whio is 1000 instead of 100. May be used instead of or in absence of Hydroge Peroxide. Powerful antiseptics but sparing cells—in contradistinction - Iodine which causes necrosis of cells and leaves a surface which is an exceller culture medium for bacteria.—L. i./i5,269, see also F. C. Madden, use among Turkish wounded, i./i6,614. Pasta lodoformi, R.D.H. Iodoform 6, Tannic Acid 1, Liquefied Carbolic Acid q.s. Cinnamon Paste (iodoform Paste) is used by Dentists and understoo to mean Iodoform Powder mixed into a paste with Cinnamo> Oil. Used for treating septic root canals. Pencils of Iodoform, the thickness of a No. 9 catheter, for uterin? medication, are prepared with Iodoform 15% Pigmentum lodoformi. See Collodium cum lodoformo anted. Suppositories contain I, 3 or 5 grains in each with Oil of Theobrom q.s. For fissure of the anus and irritating hemorrhoids. Unguentum lodoformi B.P. ’14 is 1 in 10 Prepared Lard. The formula unsatisfactory. Iodine is liberated and it turns a dark colour. Potassiur Carbonate 1% added prevents this. R. O. H. has 60 grains to 1 ounce Soil Paraffin. Uuguontum lodoformi cum Eucalypto. R.O.H. Iodoform 8 grains Eucalyptus Oil 72 grains (sic), Hard Paraffin 160 grains, Soi Paraffin to 1 ounce For ozoena. Petrolatum lodoformi (10 %). A useful surgical dressing to wound* Pasta Moorhofi, R.V.I. Mix Iodoform 60, Cetaceum 40, Sesame Oil 40, and add 5% of a mixtui of Carbolic Acid and Camphor, equal parts. Collapsible Tubes (with Catheter attachment) of Iodoform and Eu lyptus Ointment of each 5%, and of Iodoform 5% and Cocaine 2% Ointment are useful for gonorrhoea. Iodoform Substitutes. Thymol Iodide, U.S. Syn. Aristol. Di-Thymol-Iodide. Fr. Ox. [C6H2(0Hs) (C,H7)OI], = 550-0512. Aristol : T.M. No. 93538, 322522 Associated. Syn. Thymol Iodide. Patent : 5079 of 1889. Now public property. Manufacture.—The following formula according to our work is better than the patent. Dissolve Thymol 1-5 and Sodium Hydrate 1-6 in Water 50 ; into this pour with constant stirring a solution of Iodine 6 (probably 4 sufficient), Potassium Iodide 8, in water 50. Yield is about 2-9 from these quantities. The name “ Iodo-Thymol Iodide ” given in the patent does not convey any correct impression. Our analyses indicate a body of the composition Di- Thymol di-Iodide. A brown powder containing about 45% Iodine ; must not be heated above 100° F. nor exposed to light. Soluble in Alcohol and Oils, insoluble in Water. Incompatible with alkalis. Mercuric Chloride, Metallic Oxides or anything decomposing Iodides. Used for psoriasis, lupus, eczema, and for ozaina ; as dusting powder alone or diluted 5 to 50%. Ointments 2 to 10% and Pastes also employed. For blepharitis and conjunctivitis 10% in sterile Sesame Oil Solution is suggested, also for burns and ulcerations. For skin ulcers with equal weight of dried Ferrous Sulphate. (Theobroma basis), 1 grain in 15 grains for haemorrhoids. Suppositoria ‘ Collapsubes ’ of Aristol Ointment 10% for venereal diseases of the urethra. Fcrmamin-Ethy! “lodidum. (CH2)8N4C2H5X ==296-0966. A combination of Hexamine and Ethyl Iodide. The author has prepared this compound, but it is not suitable for internal use. Physiological tests showed that injections of the substance caused cirrhosis of the liver in a guinea-pig. Locally may be useful as an antiseptic. Formidin. (Capsules contain 5 grains.) Bose.—1 to 5 grains (0 06 to 0-3 Gm.) Stated to be a compound of Salicylic Acid, Formaldehyde and Iodine CjsH^OsTs, containing approx. 50% Iodine. A white powder insoluble in water, alcohol and dilute acids. It decomposes in the presence of alkali, hence used as intestinal antiseptic. Applied locally in skin affections. Its action is said to be due to the splitting off of salicylic acid, formalin and iodine. lodoi.—Syn. Tetra-Iodo-Pyrrol. C4I4NH=570-7438. German Patent (35,130/1885) expired. Not a Trade Marl. Dose.—1 to 3 grains (0 06 to 0*2 Gm.). Brownish powder containing 89% iodine, obtained by acting on pyrrol with iodine in presence of alcohol. It explodes if rubbed with mercuric oxide. Decomposes at 140° C. Soluble 1 in 145 of glycerin, 1 in 6 of absolute alcohol, 1 in 21 of 90% alcohol, freely in ether ; also in chloroform and oils. Insoluble in water. Uses.—Painless wound dressing ft r buboes, ulcers, and ear discharges. An ointment, 1 to 5 of Vaseline, and a solution, 3 parts to 35 of alcohol and 62 of glycerin, have been used for granular and chronic conjunctivitis with good results ; and a solution of Iodol 1, Alcohol 3, Glycerin 21, as a pigment in diphtheria. Also Iodol 2, Menthol 1, Almond Oil 96, for throat spray or pigment. 1% of menthol covers odour of Iodol, and is said to render it more active. ‘Collapsubes * with catheter attachment of Iodol ointment 5, with Eucalyptus oil 10% with soft Petroleum basis are made for treatment of gonorrhoea. I 0 D U M . 1 = 126-932. For Manufacture of Iodine from Caliche (Crude Sodium Nitrate u Peru), and data on the Kelp Industry and the History of Iodine, s Vol. IP q.v., also for data as to Iodine being eaten out of the soil in t? Argentine and elsewhere. Iodme in Foods, Waters, etc., is also deat with. Iodine as a by-product in the superphosphate industry.—P.J. i./31,3s. Irish Free State Scheme for marketing Kelp. About £7 per ton pai Iodine factory at New Docks, Galway.—P.J. ii./3o,493. In the Great War, Iodine was largely used in the manufacture of poise i gases and lethal shells. The following medicinal inorganic iodides contain the halogen approximately in these proportions : —Ammonium Iodide (NH4^ 87-5%, Lithium Iodide (Anhydrous) (Lil), 94-75%, Potassium Iodic (KI) 76-4%,Rubidium Iodide (Rb I) 59-75%, Sodium Iodide (Na I 84-6%. Strontium Iodide (Sr I2 + 6 H20) 56-45%. Soluble.—In Water, 1 in 5,000, readily in Alcohol 90%, Ether in 4, Chloroform 1 in 30 about, slightly in Glycerin. Very solubi in Potassium Iodide Solution. For Iodine Assay and the ‘ Iodine Number ’ of Fats, etc., see Vol. Im ^ Antidotes.—Stomach pump, Emetics (Apomorphine Injection Starch, Saccharated Solution of Lime, demulcents and stimulants finally, Opiates. Sodium Hyposulphite would be best chemically. Sodium Tetrathionat is formed which is stated to be non-toxic. A 10% solution will combin (decolorise) \ its weight of Tinctura Iodi Fortis B.P. ’14. Let the patier sip a solution during intervals of vomiting. Skin rash due to Iodine may resemble variola. Incompatible with alkalis, alkaloids, starch, soluble lead an mercury salts, carbolic acid, chloral hydrate and sodium thiosulphate Uses.—Internally is variously used as Tincture q.v. in influenza catarrhs, epilepsy, and to reduce obesity. Typhoid has been well treated with it combined with a little Phenol as a drink._Vid Tincture. Externally.—Irritates the skin, if too strong will blister A counter-irritant painted on chilblains, over inflamed joints, spots o> pleurisy, sore gums and scrofulous glands, to abort boils, and is ii jeeted as tincture to cure hydrocele, cf. also Morton’s Fluid for spin* bifida. For ringworm {cf. Coster’s Paste). Is inhaled to cheel profuse expectoration in chronic bronchitis. Iodine is a powerful germicide. A 1 % solution has been siatec to be equal to Mercuric Chloride 0-5%. Cf. Skin Sterilisation postec and Chapter on Antiseptic Powers, Vol II. Catgut {q.v.) is sterilised by immersion in 1% alcoholic solution Burns are well treated by a 2% alcoholic solution of Iodine. In puerperal sepsis as a douche—vide Injectio iodi._C. H. W. References to literature. See p. 509. Intravenous SocSine Injection. The following have been used: Iodine 1 drachm, Potassium Iodide 1 drachm, Distilled ater 5 ounces, 2 drachms. Dose (adult).—3 to 6 minims intravenously. J. C. Chaudhuri, I.M.G., Feb. ’25,90. It would be better diluted as e.g., m the following : Pneumonia and cellulitus have been treated with initial dose of Tincture 20 minims (1 2 Cc.) in 10 Cc. of Normal Saline, increased by 10 or 20 minims, according to reaction, up to 60 minims.—A. B. de Castro, I.M.G., Mar.’25,141. See also S. N. Datta, I.M.G., Dec. ’25,579. See also Jl. Trop. Med. Sept. 1, 27,225. Pneumonia, erysipelas, cellulitis, rheumatism, septic wounds and bad cases of phagedaenic ulcers well treated. Iodine 24 grains, Potassium Iodide 36 grains, Distilled Water to 1 ounce. Dose, 1 to 2 Cc., diluted with 8 Cc. distilled water and given once or twice weekly.—E. Burke, B.M.J. ii./27,1062. Eye Affections. For papillitis, retinitis pigmentosa, optic atrophy, or optic neuritis, treat root cause, give Iodine intravenously (£ grain each Iodine and Potassium Iodide in 10 Cc. Distilled Water) every 3 or 4 days up to 6 injections, rub Mercurial Ointment into the temples daily and deep Cyanide injections (£ to 1 Cc. Cyanide of Mercury 1 in 2000 with Novopain). Marked progress with this treatment, a notable feature being the rapidly improved vision after Iodine injections. Where there are no prominent veins, the following is given intramuscularly— Sodium Iodide 250 grains, Iodine 200 grains, Ac. Carbol. Liq. 3 drachms, Distilled Water 4000 Cc. 10 Cc. injected into gluteal muscles every 6 or 8 days. The mixture should not be stirred up.—E. R. Shetti, B.M.J. ii./3o,1098. Kala-azar treated by a solution containing Iodine and Potassium Iodide, of each 6 grains, Distilled Water to 1 ounce, approx. 1 grain in 80 minims (5 Cc.) —I.M.G., July ’23,312. Malaria and a variety of other diseases have been treated. CeD Chloroformum Iodi, 1 in 30. Stains less and does not promote desquamation, itching or dermatitis like alcoholic solution. Glycerinum Xodi* Iodine 1, Glycerin 50. Heat carefully till dissolved. A useful pigment, the skin does not harden by repeated application, nor peel off. Water helps solution, cf. Morton’s Fluid. For internal use this preparation is quite suitable diluted with water with which it mixes temporarily. Bose.—On lines of the Tinctura Iodi Fr. Cx. (Bird’s ‘ intensive ’) method of use. It is approx. J- the strength. Glycerinum Iodi, C.X., is Morton’s Fluid, sine Aqua. Xnjectio Iodi Hypodermica Fortissima. Iodine 360 grains, Potassium Iodide 360 grains, Distilled Water drachms. Should measure exactly 1 ounce and contain f grain free Iodine in each minim. Dose.—3 to 5 minims for fibrous bronchocele. A grain of Iodine may be held in solution in a minim of fluid, by employing Sodium Iodide in the proportion of Iodine 3, Sodium Iodide 2, and Water q.s. to 3 volumes. Xodo-Glycerin Solution, injectto iodi, c.l.t.e. Morton's Fluid. Distinguish from Douche which is also called ‘ Injection.’ Iodine 10 grains, Potassium Iodide 30 grains. Water 25 minims, dissolve, add Glycerin to 1 ounce. In spina bifida about 30 minims have been injected into the tumour, also injected into solid goitre. Injectio Iodi, C.H.W., L.H. Iodine Douche.—Weak Tincture of Iodine 2 drachms, Water 1 quart. For injection in puerperal sepsis. Gangrene of the vulva, vagina and cervix has been treated by a douche of normal saline, cutting away the gangrenous parts, th(r giving a weak iodine douche, followed by packing with Balsam of Pear gauze. Indiscriminate douching by women a great mistake.—W. E. Fothergt B.M.J. i./i8,445. Endometritis treated by swabbing and irrigation with a mixture of soiutk of Iodine (1 m 10) 1 part and Glycerin 7.—R. Hobbs, B.M.J. ii./2i,35. lodum Oleatum. (Not for internal use.) An Iodine-Oleic Acid compound containing 10% of Iodine. Whe thoroughly rubbed into any part does not stain the skin, but is rapid! absorbed. Suitable for inflamed joints, enlarged scrofulous gland skin affections, sciatica, sprains, chilblains; should prove of value i i tinnitus aurium. Liquor lodi (B.P. 1885).—Sy?l. LugOL’ S SOLUTION. Iodine 2, Potassium Iodide 3 (U.C.H. has 2), Water 40. Liquor lodi Compositus, U.S. Iodine 5, Potassium Iodide 10 Water to 100. Mistura lodi Composita E.L.—Tincture of Iodine 1 minim, Glycerii of Carbolic Acid 1 minim, Caraway Water to 1 drachm. Iff II Pigmentum lodi et Aconiti. Syn. TlNCTURA Iodi ET Aconit?. Weak Tincture of Iodine 1, Tincture of Aconite (Fleming’s) 1. Periodontitis is relieved by Iodine, or Iodine and Aconite Pigment Pigmentum Iodi ^Ethereale. Iodine Alcohol 90% 3, Methylated Ether 2|. This dries rapidly Pigmentum Iodi et ^Etheris Acetici (J. Dundas Oi'ant.) Iodine 5 grains, Acetic Ether 2 drachms, Glycerin to 1 ounce (dis pensed in a 2 ounce bottle, so as to allow of brisk shaking before appli cation). For the tonsils. Pigmentum Iodi cum Liquore Formaldehydi. Mid. H. 1927. Weak Tincture of Iodine 13^, Formaldehyde Solution 1, Glycerijr to 100. Pigmentum Iodi et Olei Picis. Syn. Pasta Iodi ET PlCIS, Coster’s Paste. Mix Iodine 1, Light Oil of Wood Tar 4, carefully, applying heati: necessary. Ebullition occurs and a part of the oil is oxidised and forms a resinous deposit. I $es,—For ringworm of the scalp; after well shaking the bottle it should be well brushed in with a stiff brush; a scab will be produced which should be removed in a few days, the part cleansed by soaking with oil, and then soap and warm water; after drying, more paste should be applied. It seldom causes pain. Iodine, Choral Hydrate and Carbolic Acid, equal parts, have also been recommended for ringworm. Pigmentum Mandl, T.H. Iodine 6 grains, Potassium Iodide 20 grains. Oil of Peppermint 5 minims. Glycerin to 1 ounce. Used as a throat stimulant. Syrupus Iodo-Tannicus (Martindale). Dose.—i to 2 drachms (2 to 8 Cc.), containing f to 2J grains of Iodine, in water or wine. ^Iodine 2, Tannic Acid 2S Glycerin 20, Water 30, Syrup (with flavourings and carminatives) q.s. to 100. Combine the Iodine and the Tannin in presence of the water, glycerin and syrup q.s. until no indication of free Iodine with starch, cool and add the other ingredients. This contains the Iodine to a great extent in the form of Hydriodic Acid. The Fr. Cx., P. Ital.VF.E. VIII., P. Belg. IV. and Ph. Ned. V. Syrup is only to this strength, viz. 0'2% Iodine. Uses.—Of great value for enlarged glands in children and also as a tonic after removal of tonsils and adenoids. Suggested in lymphaemia, anaemia, dysmenorrhoea and pulmonary affections. Specially useful in cases of chronic lymphadenitis associated with or independent of adenoids. In atrophic rhinitis has given good results especially when combined with arsenic, and in simple bronchocele supplement by the external use of Iodine Oleate or Unguentum lodi Intinctum (q.v.). In arteriosclerosis it is often more valuable than Iodides or Thyroid preparations. Syrupus Tann-Iodo-Phosphoratus. Duse.—| to 2 drachms. Contains 5 grains Monobasic Calcium Phosphate in 2 drachms of the Syrupus Iodo-Tannicus—•Martindale. Tinctura lodi Forfcis {B.P. ’14). Syn. Liquor lodi Fortis, strong Solution of Iodine (B.P. 1898).—PlGMENTUM IODI, LlNIMEN- TUM IODI (B.P. 1885). This is 10% wjv and conforms with F.I. Its composition is Iodine 10, Potassium Iodide 6, Distilled Water 10, Alcohol 90% to 100. U.S. is 7% to/v. Solutio lodi Spirituosa, P. Belg. IV. and F. E. VIII. is Iodine G 5 Potassium Iodide 2*5, Alcohol (90%) 91 (by wt.). Tinctura lodi (Mitis) (B.P. ’14). Dose (for vomiting).—2 to 5 minims (0*12 to 0*3 Cc.). Iodine 1, Potassium Iodide 1, Distilled Water 1 ; dissolve, add Alcohol (90%) q.s. to 40. Should he recently prepared or is liable to contain Aldehyde and Hydriodic Acid. This aldehyde in presence of Iodine and water oxidises, forming more Hydriodic Acid as well as Acetic Acid. The Acetic Acid may become etherised forming Ethyl Acetate.—‘ Pharmacal Notes.’ A little Iodic Acid added to the Tincture will prevent decomposition—it breaks up Hydriodic Acid as formed.—P.J. i./i4,713. Various derivatives of Ethyl Iodide and compounds in addition to HI in Tincture of Iodine, Assay.—P.J. i./3o,415. Chloroform 1 drachm, added to 4 ounces Tincture of Iodine prepared with Industrial Spirit, inhibits its lachrymatory effects.—F. Sloman, P.J. ii./28,419. Flavoring.—Syl Lavandulae, Syl Vanillae ; Syrupus Aurantii. Antidotes.—See under lodum. In the Great War Tincture of Iodine was an invaluable specific against tetanus in wounds. It is largely used as a First Aid Dressing, but plain 2% Iodine in Spirit is preferable see p. 511. References to Iodine Therapy, p. 509. Tinctura lodi (sine Potassn todieio), Teinture d’Iode, Fr. Cx. 1908, P. Hung. (Sometimes called Indian Tincture of Iodine.) Dose.—Max. Single (in Fr. Cx.) 0-25 Gm. (U minims). Max. during 24 hours (Fr. Cx.) I Gm. (18 minims.). Usual Dose in Great Britain.—10 to 25 minims. According to 509. —L. ii./30,918. Loss of free Iodine with ac changes—J. R. Walmsle- Tom Bird (see Uses and Prescribing Notes) this dose can be giv* thrice daily in arthritis. (Usually first week, 10 minims, t.d.p.c second week, 20 minims ; third week, 30 minims.) Composition.—Iodine 1, Alcohol 95% (by volume), 9 by weigh (In making it by volume use 11*03 of the alcohol instead of 9 by wt Sp. Gr. of the tincture is 0*888. 1 Cc. contains 0*089 Gm. Xodin 10 minims contains 0*81 grains. P.G.V. was similar. For P G. VI. see p. Liquor Iodi Simplex, etc., proposals for B.P.- Criticism of proposed Liquor lodi Simplex, formation. Potassium Iodide prevents these P.J. ii./3i,71. Uses and Prescribing Xofes. This Tincture of Iodine is given as a tonic before meals in tube eulosis, also in the commencement of “ la grippe ” and ordinary colds largely used on the Continent with excellent results. In vomitin of pregnancy invaluable, and small doses in sea-sickness. The ‘ intensive Iodine Treatment5 of tuberculosis was advise by L. Bourdreau. Large doses can be given by a gradual increase. H suggested that the method might be of use in other affections. Dr Wm. Ewart, of St. George’s Hospital, tried it for his own arthritis will good result. Tom Bird, L. i./20,546, records, Pres. Feb. 21,190, sue cess in arthritic cases and chronic gout and in 4 rheumatic gout.’ A? muck as 10 grains of I odine ver diem can be given. There may be slight catarrh of the nasal mucous membrane, but no iodism as from Potassium Iodide. The Iodine is probably deposited on the stomach lining and slowly absorbed.—T. Bird. The patient places the dose (15 drops equal approx. 10 minims); in a glass and adds half a tumbler of water. It may also be given in milk, forming an Iodo-Casein compound. The following makes a clear solution : Tincture of Iodine Fr. Cx. 190S. Spirit of Chloroform. Glycerin. Dose.—30 minims (2 Cc.) = approx. 1 grairiof Iodine. (GlycerJnum Iodi, 1 in 50 (v.p.505), is miscible with water temporarily.) It has been suggested (G. Walker, P.J. i./ai,4, L. i./2i,239) to use more of 90% Alcohol, as the 95% is not readily available. It is unfortunate, as the method of using the Tincture is in considerable vogue, that the 10% w/w preparation is now superseded by Fr Cx Supp. II. (1922), and the title of the Iodised Tincture of Iodine (Teinture d’lodV iodur^e) contained in the Supplement issued in 1920, is to be altered to Official Tincture of Iodine (Teinture d’Xode Officinale). This preparation is * Iodine 10 Gm., Potassium Iodide 4 Gm., Alcohol (90 per cent) 136 Gm (It contains & of its weight of iodine.)—P.J. ii./22,162 ; ii./22,609. (The title 4 Officinale* is confirmed by Fr. Cx. Supp. Nouv. 1926.) We advise that un/ess otherwise directed the original 10% w/w of the Fr. Cx. should he dispensed for 'French Tincture.’ Prescribers should order '‘Tinct. Iodi 10% (sine Pot. Iod.) ** to prevent misunderstanding. A comparison of the Tinctures of Iodine of various countries.—M, Shaw and V. Cofman, P.J. i./23,453. >-Equal parts. Tinctura lodi, P.G. VI. is Iodine 7 Gm., Potassium Iodide 3 Gm. dissolved in alcohol 90% 90 Gm Contains 6*8 to 7%. There is only one strength in P.G. Tinctura Icdi Becolcrata, B.P.G. Iodine 2-85, Alcohol 90% 27-5. Dissolve with a gentle heat, and add when cold Strong Solution of Ammonia 6-25. Keep in a warm place until decolorised (it takes some days), after which dilute it with Alcohol 90% q.s. to 100. A useful application for chilblains and for painting on exposed affected parts. The solution contains Ammonium Iodide and Ammonium Todate. Tinctura lodi Becoiorata Fortis was described in the Extra Pharmacopoeia, XII. Edn. and is occasionally ordered. It is prepared as above excepting that after keeping the mixture of Iodine, Alcohol and Ammonia in a warm place until decolorised it is not diluted at the finish with Alcohol to 100. Decolorised Iodine Tincture, Belladonna Liniment, of each 25%, Soft Soap 50%. Useful for chilblains. Tinctura lodi Oleosa. Iodine 1, Alcohol (90%) 9 ; heat to dissolve, and add Castor Oil 2. Repeatedly applied does not crack the skin as the tincture does. Unguentum lodi (B.P. ’ll). Iodine 1, in 25 of a Potassium Iodide, Glycerin and lard basis. The presence of Potassium Iodide (and Glycerin) is essential to the conservation of Free Iodine in this preparation. The Free Iodine content in the Off. Ointment is considerably reduced after keeping for two or three months. A simple mixture of Iodine and Lard becomes rapidly attenuated in Free Iodine content—by chemical addition. Unguentum lodi Intinctlim, Stainless Iodine Ointment.—Martindale. Iodine 1, Oleic Acid 4. Heat to effect absorption and mix with Soft Paraffin 14 and Hard Paraffin 1 previously melted together. Possesses iodising properties (c/. Iodum Oleatum, the liquid equivalent) for use in rheumatic affections, enlarged glands, sprains, and syphilitic conditions. sfclodex (T.M. 3225S9).—A stainless Iodine Ointment (containing 5%, together with a small proportion of free Iodine) to be rubbed on to the part or applied and covered with oiled silk and cotton wool. Also made with Methyl Salicylate. Suppositories are made containing f grain Free Iodine in a neutral base. Ung. Xodermiol. A preparation containing about 5% of Iodine which does not harden or discolour the skin. For enlarged glands, rheumatic affections. lumbago, etc. Also made with Methyl Salicylate. ®Vapor lodi iEtherealis. Iodine 3 grains, Ether 2 drachms, Carbolic Acid 2 drachms, Creosote 1 drachm, Alcohol 90% 3 drachms. Ten minims to be used in an inhaler, e.g., the 4 Ozonic.’ Thymol may be substituted for creosote. References to Iodine Therapy. (For intravenous use, see p. 505). Anthrax. Small amounts of Iodine in solution have been injected. Beri-beri well treated with Tincture of Iodine, 5 drops in a tumbler of water daily.—K. W. Bidley, Jl. Trop. Med., Mar. 2, ’2 5,103. Colds. Iodine 8 or 10 drops of 1 % solution, twice daily, fasting, is specific, —Per Pres., Jan., ’23,14. Corneal Ulcers treated by a 1 : 20 or 1: 30 Tincture of Iodine after preliminary use of Cocaine. The Iodine is taken up on a probe or-glass rodfand held in the air a minute or two for the Alcohol to evaporate, then the ulcer P°reslleScMlth’2o 310^1 7°^ is7the^fore almost solid and cannot diffuse.. antea ,310)O11, See also EVe Affections, under Intravenous Iofa' and^fflcient?—H?Lyon Smithf L'i /is1s45^nC*’Ure °* l0dine' Non-irritati IoSne^iJuaHy'lodteed'sTrerts'or'collosoTlodineJ^K! " A wonderful tonic for children, expecialiy those of tuberculous tendenci* 2 doses of weak Tincture thrice daily in peppermint water Imnrov appetite and imparts vigour.—H. E. Waller. Pres , April, 1917. ' 1 P tincture of Iodine, 5 drops twice daily for adults and 2 dro AAice dady for children, of value in acute diarrhoea or chronic colitis ar 7^P?nrent bacPlary Sse^ery’ peilding bacteriological report. Must not 1 To. de E& “S/^ente™ OT antM“C “io». Endometritis treated by Churchill’s lodire Tincture (dissolve Iodine 1 2i grains and Potassium Iodide i ounce in Water 4 ounces, then add Alcohol 90 c' to 1G ounces) applied subsequently twice a month for three months to t* —B°M J™/ogtolffintly dnmmshes the number of relapses following curettin Erysipelas has been treated by small doses injected. ofSr^TEE{reaM ™th 30 ?• of the 10% Alcoholic Solatia ? • ?di da5 > mcre“sed m some cases to GO m. or more.—F R Fra^e L. l./2o,551. 5C . drops of Lugol’s Solution daily for S days, and 40 or 50 drops for one c ^ days Hospitalisation is reduced to 5 days. Following operatic^ tugol s Solution is given by the mouth and by proctoclysis to combat hype’ thyroidism-A. S. Jackson, L. 1/as,759,825 ; see' also ,T W ® Sj • J,/2UjO O.L* Maximum improvement after 2 to 6 weeks’ treatment, when most ease retapse slowly and a low grade hyperthyroidism persists. Weight increased an B.M.R. reduced to normal limits m 1 to G weeks, when it rises slowly again ° Airee times daily for first few weeks and 5 minims may h* continued in some cases for 6 months, reducing dose on increase of symptom? Dangerous with abnormally firm thyroid, exceptionally severe nervous svim" loss Of weight in first few weeks’ treatment.—L. B. Cole, L. i/27 81E xittlc solid Iodine, sny, ^ clrRclinis should he plsced. in the donnitorv in open cup lor youths up to the age of puberty as they frequently suffer from demctive action of the thyroid, but usually additional small doses of lodin are requisite—Sir James Barr, B.M.J. ii./27,470 New views on treatment of hyperthyroidism with Iodine. Cases of thvro toxic adenoma found m Belgium to react in the same manner to Iodine as trn exophthalmic goitre. I motioning of the dose found efficacious.—L T>autreband& L. i./29,869 ; see also T. P. Hunhill, ibid, 949. Lupus and Phthisis and Laryngeal Tuberculosis have been treated b* evolving nascent Iodine in the system. Potassium Iodide Iff grains at 7 a.m. 2 hours later, 1 oz. Chlorine Water in 4 pint lemonade Late increased. Benefit in a week.—.7. G. Mackereth, N.Z. Med. Jl. Feb PT i./3i,5G9. Further references: Edn. xix. p. 517. * ** * Mercurial Stomatitis. Iodine mouth-wash (4 drachm of the tincture to ar ounce of water) useful.—Yeo. Otorrhoea, Chronic. Iodine Powder. Prepared by grinding up Iodine crystals with Boric Acid to make a 1% preparation. Valuable in After cleansing the meatus, filling with Absolute Alcohol for 10 minutes and drying till completely with the powder by insufflation, and repeat insufflation weekly until the ear heals.—N. Asherson, L. 11-/31,630. Rheumatoid Arthritis treatment. Iodine. Artificial Douthwaite, L. i./3i,785. Smallpox and Chicken Pox.—Iodine applied prevents pitting and aeria dissemination. Tonsils. Diseases of, due to fungi well treated by application of dilute Tincture of Iodine and large doses of Potassium Iodide—as much as 30 crai™ thrice daily—Sir A. Castellani, Pr. Jan. ’30,67. g m pyrexia.—A. H Tuberculous Ulcers and others treated by Sodium Iodide internally 15 grains three times a day with Hydrogen Peroxide and a little Acetic Acid locally on Cotton Wool.—S. A. Pfannenstill, B.M.J. i./25,732. It is generally agreed that patients with systemic disturbance, especially febrile cases, improve rapidly. The administration of minute amounts of Iodine (1/10 or 1/5 grain every 5 days in butter-scotch) was found to give great improvement in pretubercular children when Cod Liver Oil, etc., had failed. Chronic bronchitis and allied conditions also respond well.—K. Eraser, Cumberland, School M.O. Report, 1925. TYPHOID.—A mixture of equal parts of Tincture of Iodine and Pure Carbolic Acid—two or three drops in a tumbler of water by the patient’s bedside, and renewed as required. Fever cut short.—David Walsh, L. i./i3,1346. Varicose Veins treated by injecting 1% solution of Iodine made with Potassium Iodide (Schiassi’s Method).—L. ii./22,1288. Vomiting due to utero-gestation treated by Tincture of Iodine 5 to 10 drops with Syrup and Water.—Yeo. Sterilisation of the shin of operation areas. The Weak Tincture (B.P. ’14) is adequate, preferably made with 70% spirit (vide infra) but the 10% solution (Tinct. Iodi Fortis) in 90% Alcohol has often been used, it may however produce acute dermatitis. The method was advocated by Lionel Stretton— vide B.M.J. i./i2,522, but it had its origin in pre-Listerian days. It no doubt increases leucocytosis in the area operated upon. The skin should be dry before applying. Iodine Sterules encased in rayon and cotton wool. The “ Sterule ” is snapped and the Iodine Solution is absorbed by the material, which is then dabbed on to the part as a First-Aid Dressing to abrasions, cuts, etc. As application to abrasions, cuts, scratches, etc., Weak Iodine Tincture (B.P. ’14) 2 parts, with Ether 3 parts, is used.—B.M.J. ji./io,974. Rusty nail wounds and the like are well treated by packing the cavity with gauze soaked in Tincture of Iodine and allowing it to remain in for two or three days. If sutures are required, the skin along the edges should be painted to prevent stitch abscesses.—L. ii./n,238. The Iodine produces hypersemia, which is the real agent ^ in producing asepsis. The increased supply of blood is not only in the skin itself, but also in the subcutaneous tissue.—L. ii./n,442. Tincture: of iodine made with 70% AScohot sterilised non- sipore hearing organisms in seven minutes whilst if of Official strength 104 minutes ; Sublimate Spirit (1 in 1,000), however, sterilised in 24 minutes. Aqueous solution of Perchloride 1 in 1,000 never sterilised in under 30 minutes (!). Experiments on the skin were also conducted, amongst the conclusions being that Iodine-Alcohol (the Alcohol being 70%) is more potent than Alcohol alone, but. the Sublimate Spirit is better. Neither guarantees absolute sterility.—B.M.J. ii./n,1078. 1% in Benzene satisfactory,—experience in the Balkan Wars.—L. i./i4,76. J. L. Stretton found no reason to alter composition of the solution. Preliminary washing and scrubbing unnecessary and positively harmful. Excellent in abdominal surgery. Coils of intestine, etc., may rest on the_ skin which has been sterilised with it. Grossich’s Solution (10%) is far too strong. —B.M.J. k/15,886. See also ii./i5,278. .. , . ™ In Naval Warfare—on the‘Tiger’ was largely used. B.M.J. ii./i6,o.,b. Gas gangrene may possibly be prevented by local use, see Gas Gangrene. Tetanus cannot be prevented by injecting Iodine—see Tetanus. Its use is very irritating to most skins—may produce dermatitis, and the pain continues for some time after the dressing is applied, If due to Hydnoaic Acid prevent this by adding a small amount of Iodic Acid. Good deodorant. Spirit solutions act like hypertonic salines by inducing serous now. Casualty Clearing Station criticism.—A. Don, B.M.J. i./i6,648. Coal Mines Rs^ulations (First Aid) 1930, made by Board o! Trade under Co Mines Act, 1911,S.R. & 0.1930, No. 91. , • ^ nderground Organization. Dressings etc., to be provided ar i distributed by the owner. ’ Each person to carry a First-Aid Outfit of one large sterilised dressim one small dressing and an ampoule of Tincture of iodine (2<c Alcoholic) or other Antiseptic approved by the B. of T. securely packed. 1 irst-Aid men to keep a First-Aid box Underground containing the above, al Picric Acid 1% and a bottle of No. 1 Eye D rops. The Midwife needs an antiseptic which can be relied on to kr< streptococci on the hands quickly—within 2 or 3 minutes at most- and without previous washing. Only Iodine 0-5 to 1 % and Chloramine T. 1c do this.—D. L. Colebrook, L. ii./3o,369. Fatal dermatitis following Iodine Spirit (2£% in Industrial Spiri tor operation ; Sodium Thiosulphate used to counteract. Pronounced idiosyn crasy no doubt— R. C. Alexander, B.M.J. ii./3o,101. t l-u™£er cafes* B. C. De Bouk, B.M.J. ii./3o,162. A mam applied Tine Jodi Mit. to the arm for rheumatism. Caused a mass of blisters from head t foot. In bed 6 weeks.—L. Schapera, ibid. 194. Jree application to the arms caused dermatitis. Vesicles turning to pus tules. Temperature 103° F. Starch poultices used, also Sodium Bicarbonate subsequently Lin. Calcis. Alcoholic Iodine solutions are in their natur irritants. Their application to areas already denuded of surface protectio open to risk.—O. Thomas Jones, B.M.J. h/31,15. Iodide Eruption, a case of granulamatous form which is rare. Treatmem was Sodium Chloride 10 to 20 grains three times daily after meals. Said t have been attended with dramatic effect in cases of Bromide eruption. Slov recovery.—H. C. Semon. L. ii./26,S03. Iodine in Carbon Tetrachloride 1% used with success a- paint prior to operation .— It. C. Alexander, B.M.J. ii./3o,101. Iodine in Isopropyl Alcohol. Syn. “Propyl.” 1-25% in 70°/ recommended as a substitute for the commonly-used Iodine ii Rectified Spirit. An efficient antiseptic. Is not harmful to the skin has penetration power and evaporation rate equal to Ethyl Alcohol and costs much less. It should be recently prepared.—J. Wicliffe Peck, L. ii./28,444. * Viodar (T.M. 520931). ^ Dose.—1 to 2 drachms (4 to 8 Cc.) of Viodar 1 in 1,000, as a stomacb and intestinal antiseptic and lubricant. This is equivalent tc approx. 1/20 to 1/10 grain of free Iodine. Of Viodar 1 in 200, 5 to 10 minims (0*3 to 0*6 Cc.) is suggested approx, equivalent to 1/40 to 1/20 grain, carefully increased to l drachm (4 Cc.), equivalent to 1/3 grain of Iodine. The dose should be taken with water or milk. A new oily preparation containing free Iodine, to which its violet colour is solely due. It contains no added chemical or colouring matter. It is issued in two strengths, viz., 1 in 1,000 and 1 in 200., forming liquids with low Sp. Grs. (0*888 and 0*893 respectively) but high viscosity. Both are stable at ordinary temperatures in stoppered containers,, but on exposure at room temperature, or more rapidly at body heat, the Iodine contained is vaporised. A small quantity of the preparation in either strength exposed on a flat dish at room temperature rapidly liberates the Iodine, leaving the bland oil quantitatively behind. IODUM. 513 is. il^genera/a^permanent^reparatimi!68 ^ °n St°ra^ and meSo'Ute of Iodine.^3*61688’ Wl“lst the 1 in 200 ^ «*> typical Incompatibility.—Viodar is immknMa flmda The preparation has the incompatibility, of Iodine toT pounds m general, and of oily combinations. Mercurials sbmdd' not be used either per os or externally in conjunction with it r ± + • alkalis will remove the Iodine contained. ’ ^austlc The preparation is however resistant to inorganic acids ir dilnfi^o wrnch are likely to occur : hence it is not attached bv^tric add^ The Iodine would be slowly absorbed on meeting the alkali in the subsequent portions of the digestive tract It is incompatible with Soft Paraffin and Lanolin, and should m preierence be used without any adjuvants. Baotariologaaaj Enw&st'gatsan.—The Drem ration thiib 7? t organisms. a“d & hamol«tieml "*en hi contact with broth cultures of these 0,il!^-~;EXternal use’, as a dres3in§ for wounds and abraded urtaces. Gauze or wool may be impregnated with it, forming a penetrating and occlusive dressing. It may also be employed as a catheter lubricant. The 1 in 1,000 strength should prove adequate : ine 1 m J00 may be too strong for mucous membranes. Skin irritation is rapidly relieved by light applications. It does not stain the skm or cause undue smarting. (The skins of some patients are intensely sensitive to Iodine in any form. The patient’s response to Viodar 1 m 1,000 can be determined by applying over a small area initially.) . Internally in conditions in which an intestinal lubricant is indicated, and where Iodine is prescribed. When Iodine is taken in spirituous solution, as in Tinct. lodi, Fr. Ox., the Iodine is precipitated in the stomach in solid crystalline condition, incapable of being effectively assimilated. The analogous effect can be shown by adding a few drops of the Tincture to dilute Hydrochloric Acid. In the case of Tinct. Iodi Mitis, B.P., and Lugol’s Solution, B.P. ’85, it is only the presence of the Potassium Iodide that prevents a similar deposition. With Viodar, on the other hand, the Iodine is not precipitated in the stomach : it is liberated there, in part for use in the system, by the warmth oj the body, the rest passing into the alkaline portion of the tract for utilisation. Hence, the entire system is under Iodine treatment. The clinical experience of patients is that they have the typical metallic Iodine taste some six to eight hours after taking full doses (1 drachm) of the 1 in 200, the effect is therefore a gradual and persistent Iodine medication. As an Antiseptic for sputum cups, for storing ligatures, relieving gnat cites, and for pouring on the surface of water to kill mosquitoes. VOL. I. t> The Iodine in Viodar is in a free, active, highly diffusible forr differing in this respect from preparations hitherto xised—hence care ar discrimination are advised. Should be valuable for both external and internal use, in the latter ease tB activity of the Iodides being presented in a palatable form.—L. i./3i,89> See also B.M.J. i./31,589. Inflamed and Troublesome Bursa of Foot. Immediate relief and rap absorption of fluid. Simple thyroid hypertrophy and perhaps also in the exophthalmic vanett should be of use. It is certainly absorbed. An occasional dose helps to contr the Coli bacteria in bladder infections.—'W. Wyatt Wingrave, 1931. Trench-foot was treated with the preparation during the war. ORGANIC IODINE COMPOUNDS. The relative rate of absorption of ‘ Organic ’ Iodine in compariso w ith * Inorganic ’ is seen in the case of Iodoprotein, postea. Iodincl—Martindale. Dose.—30 to 45 grains per os of the 25% = about 10 to 15 grains c Potassium Iodide. Capsules contain 30 grains (2 Gm.). Hype dermically 30 to 90 minims (2 to 6 Cc.) of the 25% preparation (Commence with the same dose of the 10% compound.) Sterules, Hypodermic, contain 30 (2 Cc.) and 60 minims (4 Cc. For treatment of tertiary syphilis larger doses slightly warme have been given on alternate days hypodermically. An additive compound of Iodine and Sesame Oil, in strength of 1 and 25% of Iodine, prepared by repeated iodising of Sesame Oil b means of Iodine-Monochloride. The preparation is a thick brow oil. The 25% has Sp. Gr. 1-23 and the 10% T025. It permits c lengthy and continuous administration of Iodine. Either the 10c or 25% preparation may be used by inunction. Soluble in ether and in chloroform, insoluble in alcohol. Uses,—Scrofulosis, convulsions of children, tuberculous infea tions, e.g. of the larynx, pleuritic induration, facial paralysis, arteric sclerosis, gout, bronchial troubles, actinomycosis, and syphilis hav been well treated by internal and local use—in many affectior either inunction or hypodermic injection can be employed. Uteriu fibroids have been treated by injections. It has been found usefi instilled for eye affections. Taken per os it is thought to pass through the stomach into the duodenum,- here it is acted on by the bile and pancreatic secretions and is emulsified. Th greater part of the iodised fat is stored in the tissues, e.g., marrow, liver, etc. Asthmatic affections are relieved by an lodinol capsule cfuickl without causing headache.—Canny Ryall. Rheumatoid arthritis relieved by hypodermic injection of a 1 in 40 solutio of Iodine in sesame oil—1 grain per week.—It. Kerry, B.M.J. i./26,976. See also Injectio Guaiacol Icdi et Camphorae (Watson Smith). In diagnosis, lodipin has been used by injection, but given up in favour < Bromipin which is more fluid. Warning against use in active tuberculos of the lungs. Severe focal and general reactions may be produced.—( Schrcder, L. ii./26,1135. It has also been used in pyelography. lodinol may be given in beer, wine, milk, shaken with syrup c emulsified as Emulsio lodinol :—lodinol 25% 2 ounces, Gum Acaci IODUM. 515 vigorous ag1te«o°"Wair i«imtor6b t0gether ,aud add <1™** with about 12 grains potassium iodide °UnCeS- D°Se °f 2 drachms = lodmol Tablets contain 3 grains of Mia 9*0/ „ , . UbientTperg^POtaSSil,m Iodi<*k' '^~”p to 90 grainf (^0 lodinol cum Extracto Malti. Dose.—1 ounce iso rv \ administration MaIt ExfaaCt (thi°k) to 4‘ A Potable method of *ss';s.3si8imilar’made in io’ 2°' -«*—> wethTSSe^0%e^lP^PySeed 0iI C°ntaining «% by 5 to°20 Cc°V treatment 1 to 3 Cc- intramuscularly. For diagnosis C^psu^O minims (0-4 Cc.) Dose -Two to five with meals. A substitute for the alkali iodides. Employed intra muscularly m asthma, syphilis and rheumatic affections. “ ami :rr.,"f X R?y‘ased n the l; °f . ■'....-I.-: as&igxszr*** n -**•,hc *—« For a fulf^cmsirlers't? used.7 Radiology for exploring delicate cavities, refefenci ioA f ^oo-, °n «fT tIleT techmque, etc., and a number of -n ’ ^ see \ol. II. The following are quite recent. BronS s* Burrell and S. Melville, L. ii./^o,689! 1Atehctatie1 SlTrrvn?• i!i^ H' ni°ptc]que Seche demonstrated.—L. i./3o,l 82. The nf ^ ^ ^S1S rauses a triangular shadow at base of lung unless'cvkWef i?f RAiadmY should always raise suspicion of a bronchiectasis’ A J. Scot^ mediastinal effusion- pleilra’or soIid relative%r‘U?gr%flhW tn1 US+e-d +or P^SS£g-ihr011gh the nose into the bronchi, T)iffprfnlinfr!3 6 -to patlents.—E. H. R. Altounyan, B.M.J. i./3o,719. o/«/ ^fi^i-gn0n8 T °S Bnrton Wood’ L- 1-/30,1339. tongue*—LJfi73o<590by droppmg the ol1 mto the trachea over the back of the LiPi0d01 inieCti0n-A' J' Scott B ¥ fli /qfff of injection specially’suitable for children.—E. Fletcher, it fraiifli / i 'A n Simple technique for introduction into the lungs.— r. rranklm and A. Orley, B.M.J. ii./3i.847. lechmque of intralaryngeal injection.—Mb J. Fenton, L. ii./3i.230 iniected irf1a?frSatA(i-and imhaIogenated oils and esters (including Lipiodol) fo m n fdSt ?,#!/e “7^ LarU °i,s and their distilled esters were and estprlfipp^ ^lng as *?ases for radio-opaque media, Halogenisation e*t% increases irritating properties of oils: distillation of the nnw ir?i,CcoeaS & them. The imhaIogenated bases of some radio-opaque oils v3we fi leumore gating than Olive or Lard Oil.—L. A. Crandall and Coworkers, J . Pharm. & Exp. Therap., Mar. ’3i,353. Jodme addition products of Sesame Oil—Lindblom’s Method.—P. J. i./3i,482. . *0dixi0l /o (sce Vol. II.) as Diagnostic Agent in chest affections is a similar preparation. The oral method is preferable. Good diagnostic pictures of the male urethra can also be obtained without irritating effect, lodipin has been used on similar lines. Iodine-Medol contains 1% Iodine and 5% Creolin in rapidly absorbed base For chilblains, etc. Can be applied to denuded surfaces without producing escharotic effects.—L. ii./3o,989. lodoprotein, Martindale.—Dose.—10 to 15 grains (0*6 to 1 Gm increased if desired. A brown powder containing about 10% of Iodine. Solubility.—The compound is insoluble in water and dilut Hydrochloric Acid ; soluble, however, in dilute alkali, hence it s absorbed in the intestines, and does not derange the stomach. Uses.—In syphilis, arteriosclerosis, gout, rheumatism, exophtha mic goitre, asthma, and in all cases where Iodides are administere beneficially, e.g., scrofula, enlarged glands (orchitis). lodoprotein Tablets 5 and 10 grains ( = | and 1 grain of Iodine). Goitre.—Found most efficacious—swelling reduced and genere health improved.—L. Evans. A dose of Potassium Iodide containing Iodine 191 mgr. and a dose of Iodise Protein containing Iodine 188 mgr. were administered. The whole of tl Iodine from both doses was excreted at the end of 48 hours, but the rate * excretion was different. At the sixth hour 37-7% Iodine was excreted - the case of Iodised Protein, as against 51-4% in the case of Potassium Iodid In the same way the heavier salts of the halogens, such as Iodide and Bromic of Strontium yield up their Iodine and Bromine to the system at a slowel rate than the' correlated salts of Ammonium, Sodium and Calcium. Excr tion may be rightly regarded as the measure of absorption, so that conr naratively insoluble forms of drugs, i.e., those of slower disintegration, ar more likely to exert a longer continued activity.—Pres. Nov. 1911, p. 279. Iodo-Casein.—Dose.—10 to 15 grains (0-6 to 1 Gm.). A yellowish brown powder containing 15% Iodine. As an Xr organic Iodine Substitute. Insoluble in Acid, and partially dissolve in alkaline solutions. lodolait. A palatable preparation containing an lodoprotein compoun equivalent of 2 grains of Iodine to the ounce. Contains no alka Iodides and is less liable to cause iodism. Indicated in arthritis, chronic gout, etc. Calcii Iodofaehenas U.S.N. (C32ll42O2l)2Ca = 970,5992. 3$cSAJOI)I_ (T.M. 322559). A tasteless powder containing about 23% Iodine and 4., Calcium. [nsotulbIc in water ’. used in syphilis, bronchial asthma, artera sclerosis etc Dose ’ 5 to 15 grains (0-3 to 1 Gm.) up to 90 grains per diem after meals. Assumed to be Iron-lodobehcnate. Contains 24-5% Iodine and 5-6% Iron Substitute for Inorganic Iodine and Iron. In syphilis, anaemia, etc. *Iodosiarin (T.M. 318223). Syn. Di-Iodo-Taririnic Acid. CH3(CH2)10CI.CI(CH2)4COOH - 534-1156. Dose.—Tablets containing 3 grains—1 to 3 per diem. Taririnic Acid occurs as its glyceride in the oil of the fruits of Picranui Sow or Tariri—a Simaruba found in Guatamala. Leaflets melting a 50-5° C. The formula given by Schmidt is C18Hg204 not Ci8H3j02 which th above compound would indicate. Iodostarin contains 47-5% Iodine. I sed m syphilis, actinomycosis an arteriosclerosis. Consumption of Alcohol simultaneously is to be restricted as iodism may result. IPECACUANHA. 517 Addf conSfng11over ^0% offilhWki u'5'1 ?9-ter of J>i-todobrasstdic subsequently to. the chief meals makicStafthoXghh ® ' To be taken g Omntci^ine Compounds with (In numerous Pharmacopeias.) eml\c ldA In eX.pec.t10rant' i t0 2 grains (0 03 to 0-12 Go.), as an emetic 15 to 30 grains (1 to 2 Gm.). The dried root of Psychotria Ipecacuanha (.Rubiacece)* from Rio De Janeiro. A second variety is the Minas Ipecacuanha from Brazil. A n is Indian from the same plant, grown in Straits Settlements ; T?°liur yarle,t7 1S kn°wn 111 commerce as Carthagena Ipecacuanha. It is thicker, the annulations less marked (taking the form of narrow merging ridges) and its starch-grains are somewhat larger; this is less expensive, and is not official. FlarmHng of Liquid Ipecacuanha Preparations. Syl Vamllte, Syl Rosse ; Syrupus Aurantii. JJses.—-Expectorant, emetic. If taken in sufficiently large doses i, ls not lts own antidote. Loosens phlegm, e.cj., in bronchitis, whooping cough and croup. In small doses is stomachic and increases the flow of bile. The alkaloid Emetine contained in it has been found to be virtually a specific for amoebic dysentery. Frequent doses, 1 to 2 minims of the Wine of Ipecacuanha sometimes check sickness. For tropical liver abscess Ipecacuanha is specific. It cures the active or latent dysentery which has caused the suppurative hepatitis and prevents further breaking down of the liver substance. Large doses better, than several small ones. Vomiting may be prevented by Chloral Hydrate and Liquor Morphinse. {NT) Hepatitis, Treatment.—The patient should not eat or clunk lor two houis before and after the dose, but twenty minutes previously iF fi101]-^Aa,ke ^ gmins of Chloral. The dose of Ipecacuanha is 30 grains for the first three or four nights, reduced to 25 and 20 gradually, a single dose aaiT being usually sufficient. When the temperature is normal, and the dis- 111 i 2 regi°n of the liver has disappeared, continue for a week with 20 grains daily. Patients should abstain from alcohol in India. Diffuse hepatitis precedes a liver abscess.—B.M.J. ii./io,2039. • diarrhoea well treated by 0-8 to 1 Gm. of the powdered root, p.d., divided into o or 6 doses of 0-2 Gm. Each dose is taken in a warm infusion every two hours. The remedy is well tolerated ; it sometimes gives rise to nausea, but rarely to vomiting. R-P' 14 requires not less than 2% Alkaloids. For the methods of assay of Ipecacuanha and other chemical data see Vol. II. 1.1. agreed the root bark only to be powdered, rejecting the woody portion, lne powder should have an alkaloidal strength of 2%. Fa. Cx. also requires " /o alkaloids and directs it to be estimated for alkaloid on a sample powdered as directed under Poudre d’lpecacuanha : powdering In a covered iron mortar and passing through a fine sieve to the extent of three-quarters of the weight or root taken.—f.g., rejecting the woody portion. U.S. allows both Cephaelis Ipecacuanha (Rio) and C. acuminata (Carthagena) if yielding 1-75% Ether soluble alkaloids. * F.I. uses the name TJragcga Ipecacuanha,—Baill,—P.G. VI. lias this, GeDTablets of Ipecacuanha Powder contain Ag, T% J and 5 grains CE> Pills have been prepared salol-coated with a view to theii dissolving in the intestine only. ‘ Stearettes ’ q.v. are preferable. Op^Extractum Ipecacuanhae Liquidum, J3.P. T4. Dose.—I to 2 minims (0 03 to 012 Cc.). Made by extraction with 90% Alcohol and Standardised to 2% Alkaloid? CE)Fluidextractum Ipecacuanhse, U.S. X. 1 = 1 by hydro-alcoholii percolation. Standardised to 1*5 Gm. alkaloids in 100 Cc. Averag dose.—Emetic, 15 minims ; expectorant, 1 minim. P. Heiv. hat Liquid Extract containing c at least 2% Emetine and Cephaeline.’ CE)Extractum Ipecacuanhse, Fr. Cx.—Extract the root with 70®* Alcohol, and evaporate to firm extract. CEDAn Elixir has been made with Liquid Extract 1, Alcohol 90 °* 1, Glycerin 5, Water to 20 ; may be dispensed with alkalis. Dose.— As expectorant, 10 to 30 minims. i]J>'i]Pulvis Ipecacuanhae Compositus- (Exempted from [g].) Syn. Dover’s Powder (B.P. ’14). Dose.—5 to 15 grains (0-3 to 1 Gm.). Ipecacuanha 1, Opium 1, Potassium Sulphate 8. Is diaplioretii and anodyne ; 10 grains at bedtime for an acute catarrh or coryze followed at once by a hot drink and 5 grains of quinine next morning —Tilley. [glfjPlPoudre d’ipecacuanha opiacee.—Fr. Cx. Mar. single dose 15 grain Max. during 24 hours 60 grains. Is the same but has Potassium Nitrate and Potassium Sulphate 4, vice Potassium Sulphate 8. HHO Tablets of Dover’s Powder, 5 grains (0-3 Gm.). Note.— Dover's Powder is named in Ph. Ned. V. Pulvis Opii Composite see p. 626. FT. Second wanted the name Pulv. Opii et Ipecac. Co. for the preparation containing Ipecacuanha. Aspirin with Dover s Powder, see Aspirin. CIDSyrupus Ipecacuanhse, P.G. VI ; (F.I.) Ipecacuanha Tincture 1, Syrup 9. Fr. Cx. has ‘ Sirop ’ 1 % of Extract made by dissolving Extract 1 in Alcoho 70% 3, and mixing with Syrup 100 ; intended as an emetic. That of F.I. not emetic in usual doses.—Fr. Cx. ®Tinctura Ipecacuanhse.—Fr. Cx. ; P.G. VI. (standardised to e. least 0-194% Emetine=C30H44O4N2), P. Belg. ; P. Hung.—10°* of root by percolation with Alcohol 70%—as required by F.I. CE) Trochisci Ipecacuanhse.—J grain (0 015 Gm.) in each, wit Simple basis (B. P.’14) or Fruit basis (B.P. ’98). CP) Trochisci Morphine et Emetin (TrOCHISCI TtJSSIS) contai Morphine Ai grain with Emetin % grain. In bronchial asthma CE)bJnguentum Ipecacuanhse et Crotonis.—Sawyer. Pulvis Ipecacuanhse 1, Linimentum Crotonis 1, Adeps Benzoatus - A powerful counter-irritant, rubbed on the skin of epigastrium relieves gastralgia. CE)Vinum Ipecacuanhae (B.P. ’14). Dose.—As an expectorant, 10 to 30 minims (0-6 to 2 Cc.) ; a an emetic 4 to 6 drachms (15 to 22 Cc.). B.P. ’14 uses Liquid Extract of Ipecacuanha 1 to Sherry 19. It better, however, to prepare with detannated wine. Is given in 2 to minim doses to allay the vomiting in pregnancy. IPECACUANHA. 519 Mistura Expectorans, St. Th. H • Dose for infants.—1 to 2 drachms HJErnetina. Syn. Ipectoe.—C29H.10N2O1=480-328. Emetine by the methylation of Cephaeline.—C I) Ip] th formatlon ot PytanTj.cX'^loev:1 tor E™«ne.Av. H. Brindley and F. I, I11 Ill3 stable neutral salts the bases are combined with two equivalents of Acid Basic Salts also exist. Both this alkaloid and Cephaelme are laevo-rotatory. . ^VhitfKPKoV^er, darPening on exposure. Soluble in water I m600 at lo5 C 1 m 900 at40°C.—by ourexpts., January, 1924. Soluble aiso m ether, alcohol, and chloroform. ifijEmetine Hydrochloride P. Jap. IV. ; Fr. Cx. Sunn II P G VI Ca9H40ffaO42HCl,6H2O = 661-3512. Ph. Ned V^has^ varying quantity ” of water. drLIt9wItef To 2lT^o/ndJ-E- TT- 19% ™istlVre- P- Be]S- IV- is anhy- EJ h/30242 10_11-5/o (4 mo1-) suggested. International variation.— Dose.—, iQ to J5 grain (0-0006 to 0-0025 Gm.) per os as an expectorant, but larger doses, e.g., J, \ grain are given in ‘ Stearettes ’ and Salol-coated pills in amoebic dysentery. As an emetic per os 1° h grain (0-0G5 ta 0-01 Gm.) has been given. // t/j)0(lenulculltf in amoebic dysentery § grain twice daily for 12 days with examination ot stools for amoebse and cysts.—A. G. Phear. tPe^ Px- Sapp. II. has maximum dose 0-1 Gm. per dose and per diem. P. jap. O-Oo and 0-15 Gm. respectively. i n*'L*rnufc*1:*yG Action. There is a possibility of this from long use, xtR rrrtam^ly m our experience there have been very few reports of anything of the kind. SeealsoVol.il. Poisoning may result. Bad effects on kidneys and liver. Experiments Dale8 Sh°W that grains Per day for man should not be exceeded.—H. H. nr Emetine Hydrochloride 0-12 Gm. intravenously or 1-8 Gm. hypodermically would probably be toxic to a man of 60 kilos. The maximum safe dose for man would be 0 06 Gm. intravenously or 1-2 Gm. subcutaneously. A total dose of nmetme hypodermically even if spread over several weeks is the limit of safety. —Dalmner, Presse Med. per P.J. i./i7,819. , dbse should not exceed 1 mgr. per kilo (i.e., 1 grain for a man) and rotal cose 10 mgr. per kilo. It is slowly excreted and is cumulative.—H. II. Anderson and C. D. Leake, Am. Jl. Trop. Med., 1930, per M.A.,’31,17. Intramuscular injection satisfactory.—P. Figdor, L. ii./i7,258. intravenously \ grain to § grain in 5 Cc. Normal Saline has been given—the best plan in desperate cases.—Sir L. Rogers. Soluble about 1 in 9 in water, but this is not permanent at 15-5° C.—it is safer to use 20 parts of water at least. The addition °f Hydrochloric Acid throws out the acid salt which is less soluble. Injections made with Distilled Water are less irritant than those made with formal Saline. Solutions in ampoules stand sterilising.—Y.B.P., 1919, p. 12. Pharmacology of Emetine,—It depresses and may eventually para, lyse the heart. It is a powerful gastro-intestinal irritant whether given per o or hypodermically. May be source of danger in pathogenic condition.— E. J. Fellini and G. B. Wallace. Am. Jl. Med. Sc., J.A.M.A., 1916, 67, 975 pe P.J. ii./16,413. Uses.—The standard treatment for amoebic dysentery (see als> Emetine Periodide and Auremetine). It has also been successfully used in bilharziasis, cholera, Guinea worm, and Oriental sore (se- p. 522 for references). Morphine habit (q.v.) has been treated. Dysentery, Treatment or, p>y Emetine Injection. When amoebae are taken fresh and vigorous from dysenteric ulcer in the bowel, Emetine has weak action on them. Prof. Dixoi (B.M.J. ii./22,410) maintained that 4 Emetine does not kill the amcebo except in the human body,' but Dobell and Laidlaw (Parasitology June, ’26, L. ii../26,762), conclude that the alkaloid kills E. histolytica by direct action. They conclude further that 1 in 50,000 is th highest concentration of Emetine that the amoeba will tolerate fo more than a short time—this is the threshold value of Emetine. I is 10 times more toxic than Stovarsol. The poisoning process 0* Emetine is slow. A very small amount constantly present in th intestine for days or weeks would probably suffice to make life for E histolytica (though not E. coli) impossible. The Italian view is that streptococci are the active agent rather than amoebae ■—R. Larkin, B.M.J. i.(22,901. Sir Leonard Rogers found that hypodermic injections of this salt were mos" effectual in dysentery. £ grain (— about 15 grains of Ipecacuanha) given a? a trial in first case,—acute haemorrhagic amoebic dysentery—with good result Subsequently two doses of J grain completely cured without producing nausea.1 or vomiting. Two other cases—one chronic amoebic dysentery of years standing and the other acute hepatitis, both cured similarly. In the latten case several \ grain doses were given. Temperature was promptly reduced —B.M.J. i./i2,1424. J. A. Tull Walsh states he used Emetine in dysentery with good results prioi to Rogers.—See I.M.G., Sept., 1891 ; L. ii./12,1179. Hepato-bronchial Fistula of five months’ duration was cured by siw hypodermic injections of 2/3 grain in 5 days.—B.M.J. i./13,574 ; L. /13,1132.: 154G. Amoebic dysentery in Egypt treated by i to 1 grain hypodermically— thrice weekly.— E. J. Harpur and W. B. Waddad, L. i./15,255. Sir R. Ross on the treatment of dysentery. Past experience in India Ipecacuanha given in massive doses. One grain of Emetine Hydrochloride given as a general rule either in one subcutaneous injection or in two doses morning and evening, then given three days consecutively with the same period intermit ted or 5 days on and 5 days oil. One week’s treatment generally efficacious. As to the medicinal treatment of running acute dysentery heaped teaspoonsful of Bismuth Subnitrate are advised 3 or 4 times a da> (Peek’s treatment in Panama). Tannic Acid 10 grains is a useful addition To prevent hepatic abscesses which continue to appear for years after attacks, continue Emetine periodically.—L. i./i6,l. When Emetine fails in dysentery, Decoction of Simaruba Officinalis ini doses of 6 Gm. in 200 Cc. of water, a Wine made of seeds of Brucea Sumatranat or a Decoction of Ailanthus glandulosa recommended. Locally injections of. Thymol 1 in 6,000, Silver titrate 1 in 1,000, Quinine 1 in 1,000 advised- Copper Sulphate 1 in 2,000, Tannin 1 in 500, Potassium Permanganate 1 in 4,000 have also been tried but are of no effect.—Prof. V. Gabbi, L. i./i6,523. Peculiar effects may be produced. In two fatal cases there was inability to swallow after food had reached the oesophagus ; hepatisation of the lungs and action on the heart—Military Surgeon (American) 1917, 40, 58.—Per P.J. i./17,130. IPECACUANHA. 521 theA large b0WCl with °'5% Tannic Acid freatmprit Emetine. As enema m conjunction with Emetine 2? Wat m to l fi O Tr, SS?1 4-’ lodoforni 3> Sodium Chloride 6, Arrowroot Z?> , ater to 1,000. To be given m two enemata in 24 hours. Must be kent in the large intestine for 15 to 20 minutes.—Prof. S. Kartulis, B.M.J. i./i6A 44. ^ sa*d there are nearly 2 million cyst-passers in Ernes ftmrj and the question is often asked why the entamoeba should cause dysentery zoTef-Pe?EE/SS “ the Tr°piCS but not ™ thosedn temperate A case of amoebic dysentery contracted in England cleared up under courses o;2^netme Hydrochloride 1/3 grain hypodermically.—M. N. Russell, L. Tf v?en,5e £!fc-ssnot kill the Cystic Stage of the Parasite.— It kihs the amoebse or active living forms which arc present in the tissues of the bowel the cysts m the Reces are being cast off and only indicate that tmwi aX R l?g amoeb’T m th° howel producing them. If all the amoebse are killed, then there can be no further production of cysts ; the stools become negative and remain so permanently.—G. C. Low, L. i./i7,482. The Relative Failure of Hypodermic Treatment with Emetine with dysentery carriers is probably to be explained by the entamoebse being more or less shut off from the circulation and tissue fluids of the patient. bmall quantities (less than 10 grains in total) given hypodermically rarely rid a carrier of E. Histolytica of his infection. Fuji, courses of the drug (10—12 grains or more) are successful in about one third only of the cases treated. Re-treatment with eeiual or larger amounts of the dru<?—of patients who have already received full courses, offers little hope of success.—Clifford Dobell in Special Report on Dysentery issued by Med. Res. Com. under Nat Health Ins. (II.M. Stationery Office), 1917. An individual who is in the carrier condition may at any time revert to one of acute amoebic dysentery. An infected person frequently suffers from periodic attacks of acute amoebic dysentery when only the large tissue-invading forms of E. histolytica are present in the stool. Between the attacks, when the acute symptoms have abated, the carrier condition maintains.—C. M. Wenyon, Protozoology, Vol. I, p. 190. Emetine injections in con lunation with Bismuth per os (James & Deeks). Bismuth Subnitrate and Emetine Hydrochloride combined cure many cases. Emetine alone seldom cures. Give Emetine Hydrochloride hypodermically, 4 to 3 grains, to the limit of tolerance, then Bismuth Subnitrate, a heaped teaspoon ful (180 grains) in a tumbler of water every 3 hours night and day in severe cases (in chronic cases continue for 2 or 3 months after convalescence with 3 or 4 doses daily). Etiology, symptomatology and treatment of intestinal amoebiasis.—W. M. James and W. E. Deeks, Int. Conf. Trop. Am., ’24,271—308. ~ See also the experiences of Willmore and Martindale in England, p. 528. Results gratifying even in most chronic cases.—U.F.C., ’25,116. In cases resistant to Emetine large doses of Bismuth Subnitrate effective : an important advance.—Sir L. Rogers, Int. Conf. Trop. Am., ’24,316. Possibility of toxic symptoms from the Bismuth attacking the ulcerated intestine. Small intramuscular injections of Bismuth suggested as more useful, in addition to Emetine.—A. R. Paterson, Int. Conf. Trop. Am., ’24,329. Neuritis of nerves of the arm due to excessive ingestion of Bismuth—4 lb. a month. Cured by Sodium Iodide intravenously.—A. A. Eacio, Int. Conf. Trop. Am., ’24,33!. Liver Abscess has been treated by 14 grains hypodermically daily after successful surgical evacuation.—C. B. Pasley, L. i./i5,1076. It may be necessary to repeat the treatment periodically. The prevention and treatment of amoebic hepatitis and liver abscess.—Sir L. Rogers, L. i./22,463,569,677. See also B.M.J, i./22,224,264,345. Int. Conf. Trop. Am., ’24,346-356. G99 Emetine is more efficacious in amoebic lesions of the liver in extirpating entamoeba histolytica than when the parasite invades the bowel wall. Cases recorded show that Emetine should be used only as an adjuvant to surgica, measures, e.q., aspiration.—P. Manson-Bahr and R. M. Morris, L. i./26,69. This does not agree with previous statements—see ibid. 156. Emetine alone is sufficient to cure cases of liver abscess. Pain and inconvenience of aspiration undesirable.—V. S. Hudson, L. i./26,681. Manson- Bahr's reply ibid. Aspiration plus Emetine cures hepatic abscess in the most certain way possible. After an injection of Cocaine, removal of pus relieves the patient. ■—E. Owen Thurston, L. i./26,784. Diagnosis : For Method of Searching Stools and Mucus for Amoebae, see Dysentery „ Vol. II. Amoebic Dysentery. Difficulty in treatment and diagnosis of chronic- cases whose course is often marked by alternating diarrhoea and constipation. Presence of E. histolytica cysts in stools can only be verified in about 30% of cases. In a further 40% diagnosis is supplied by use of sigmoidoscope and remainder is based on course and history of the case.—P. H. Manson-Bahr, B.M.J. ii./2i,1115. Intestinal parasites found in symptomless carriers—E. histolytica, E. coli, Giardia intestinalis, Chilomastix mesnili and B. coli found on examination of stools of 120 patients in Jamaica Hospital.—H. H. Scott, per Jl. Trop. Med., Eeb. 1, ’23,49. Intestinal protozoa endemic in Britain. E. histolytica found in a case of ulcerative colitis in a patient who had not been abroad.—B.M.J. i./2i,276. Bitharzcasis. A total of 14 grains and a further total of 20 grains spread over a long period was not effectual but cure eventually under Antimony intravenously.—A. H. Harkness, B.M.J. ii./2o,890. As much as 0T2 Gm. ^single dose) given intravenously in bilharzia. Ten to 12 injections at 3 to 5 days interval will cure, the total amount given being from 0-85 to 1-05 Gm.—Diamantis, B.M.J. i./2i,70. See also B.M.J.E. i./2o,33. 10 intradeltoid injections with 4 days’ rest between each.—E. Debbas, Presse Med. d’Egypte, Eeb., 1920, per Pres., Eeb., ’21,48. Pour 3 grain doses every third day intramuscularly sufficient. A child will stand 24 grains.—‘ B.H.’ B.M.J. i./2i,5S6. Commence with \ grain initially intramuscularly for an adult and ^ grain for a child and work up to 1 grain for a child of 12. Injections generally given daily for 3 days and then 3 times a week for 3 weeks. Iron and Arsenic as tonic.—E. G. Cawston, L. ii./2i,1049. Japanese Bilharzia disease well treated by Emetine but there may be severe cardiac depression.—F. G. Cawston, B.M.J. ii./21,1031. Emetine Hydrochloride, s to f grain, in 1% Theuol solution intramuscularly, on alternate days, eradicates permanently.—E. G. Cawston, Jl. Trop. Med., May, 1922,112. BronciiopnEUMONIA. in children. Though not a specific, it is of value, the febrile period is shortened, and the stomach is left free from irritation by expectorants. Daily hypodermic injection—up to 4 years, 1/9 grain : 4 to 10 years 1/0 grain : 10 to 15, 1/3 grain. Discontinue if no definite results after 0 injections.—C. It. Wilson, B.M.J. i./28,845. Cholera well treated by hypodermic doses of 0-01 to 0 04 Gm., combined with Camphor injections and Saline.—Renault, I.M.G., July, 1914,271. Guinea Worm. 17 cases treated successfully by Emetine given intravenously and per os.—E. Toumier, per Jl. Trop. Med., Mar. 15, ’23,101. Morphine Habit has been treated with Emetine, see ‘Morphine Habit.’ Oriental Sore. 2 cases cured in three weeks by 2 injections of Emetine Hydrochloride.—Caliceti, per Jl. Trop. Med., June 1, ’23,201. Pulmonary Suppuration. Emetine 1 grain daily for 8 to 12 days, preferably combined with Strychnine, of benefit. In some cases dramatic results, in others of no value, but never known to do harm.—A. J. Scott Pincliin, H. V. Morlock, L. ii./3o,842, Pr., Sept., ’31,345. Pyorrhcea treated by local application of \% solution in the hope of destroying F buccalis the organism thought to be responsible. In addition 1grain hypodermically daily for 8 days, or a dose of •§- grain the first day and IPECACUANHA. 523 T1/nnirtftpvtS1tn+°if a day Ugrain 011 two successive clays. A few drops of Liquid Lx:tract of Ipecacuanha on the tooth brush ps a routine measure Sit: usctul-ew“ as a Prophylactic, or theMtowiSg^Sh-HK 53 Pi^mentum Ipecacuanha? et Arsenici. R.D.H. Sun. Pigmen- tum Liquoris Arsenicalis. To be painted on the ulceration. A drop or two only to be used. Ipecacuanha \\ me Jounce, Glycerin 1 drachm, Liquor Arsenicalis to 1 ounce. Caution Poison !—F. B. Bowman, B.M.J. i /16 373 See also Sir L. Rogers, Ind. Med. Gaz., April, 1915. . Good ^sult from a mouth wash of Emetine Hydrochloride \ grain in water 8 ounces.—B.M.J. ii./i8,188. “ ItHmiMATiSM, acute articular, resistant to all other forms of treatment cured by Emetine.—Troll], per Jl. Trop. Med., May 1, ’23,149. ’ Sprue treated by Emetine hypodermically and Vaccines.—Six L Rogers L. 1./14,101)5. ’ Tubercular Haemoptysis has been treated hy 1 grain intramuscular doses with success. The treatment relieves congestive conditions of the lung generally. Cardiac debility must be alleviated by other means first.—See also B M J i /14 703 * p11? Ui4°?->B0Uger and Chauffard’ BulL de ]’Acad. de Med.,'Jan! 20, 1914 ; ® ‘Sterules’ of Emetine Hydrochloride are prepared 1/6 grain (0-01 Gm.), I grain (0-016 Gm.), £ grain (0-02 Gm.), 4 grain (0-03 Gm.), m 15 minims (1 Cc.), and 1 grain (0-06 Gm.) in 20~ minims (1-2 Cc.). CE) Emetine Stearettes 1/3 grain. Emetine per os in amoebic dysentery gives good effect but not so rapid as hypodermically. 1/3 to 2/3 grains may be given without exciting any great nausea. —Sir C. P. Lukis, B.M.J. i./i3,1357. The Stearettes protect the Emetine from the action of the gastric juice. CDVinum Emetinse. 4 grains of the Hydrochloride in 8 ounces of Sherry. Equivalent to Ipecacuanha Wine. Dose.—5 to 45 minims (0*3 to 3 Cc.). Pj Emetine Hydrobromide.—C29II4()N20,2IIBr,41120 = 714-23S. JDose—as for Hydrochloride.—q.r. for details. White crystalline salt. Soluble about 1 in 70 only, of water, hence the Hydrochloride should be prescribed in preference. The addition of a little Hydrobromic Acid does not affect solubility. CB) Sterules of Emetine Hydrobromide, grain in 25 minims (1-5 Cc.), and 4 grain in 40 minims (2-5 Cc.) are prepared. fH Emetine-Bismuth-lodide. Co9H40N204.2HI.BiI3.HoO(?) = 1344*0192. Dose.—Three grains (0*2 Gm.) [ = approximately 1 grain (0*06 Gm.) of Emetine, or about 60 grains of Ipecacuanha] constitutes the average daily dose given after a full meal or last thing at night. Twelve doses are given in succession to make up the course. A less quantity, it is stated, may only lead to a relapse. A total of 60 to 70 grains (4 to 4*6 Gm.) may be necessary in some cases. A brick-red powder containing approximately 30% Emetine. (1 Gm. Emetine-Bismuth-Iodide=0*4 Cm. nearly Emetine Hydrochloride C29H40N2O4, 2HC1, 6H0O.) Manufacttn*e.—Solve Emetine Hydrochloride 660 Gm. in water 32,000 Ce. and treat with excess of the following solution Bismuth Carbonate 290 Gm., Potassium Iodide 920 Gm , Concern trated Hydrochloric Acid 900 Cc., or q.s. to clear, and water 16,000 Cc Collect precipitate, wash and dry at 40° C. The formula we give for the compound indicates 35-7% of Emetine, bu. the substance is not a very definite compound-—there is chance of loss o> Emetine in the washing. It should contain at least 30%. Solubilities•—Emetine-Bismuth-Iodide vras introduced unde an erroneous view. In contact with Physiological Acid the Emetine of the compound is dissolved, Bismuth Oxychloride being formed It was, in other words, introduced under the mistaken impression that it passed the stomach intact. We gave details of experiment; disproving this in our 17th Edn., p. 517, see also L. i./23,158. Administration,— Preferably as “ Stearettes ” or Salol coated Pills (Keratin coating is of little use). Some, it is true, give ii in slipules or cachets, uncoated, without heeding the vomiting; Even when given ‘ coated5 there are often vomiting, purging; abdominal pain and cardiac depression from it. Uses.—In particular it was advocated by Du Mez for treatment of Entamoeba histolytica infected patients. It was said to be effective: in removing cysts of the amoeba from the faeces of chronic carriers whilst treatment with Emetine hypodermically has been follower ' merely by an early recurrence of cyst-passing. (See also ‘ E.P.lf The two treatments are sometimes combined. A Medical Research Committee Report, reported it cured the majority of carriers. Large quantities are essential—not less than 30 to 40 grains in daily doses of 3 to 4 grains. Histolytica-infected patients treated. Given -per os on a full stomach in cachet. 1 grain thrice daily until 36 grains are given. The results surpassed the most sanguine expectations. Specific. Cysts and amoebae vanished I from feces. No relapses ; whereas with Emetine Hydrochloride there were 17 relapses out of 24 cases treated. It is harmless to the other protozoa of the human bowel.—C. Dobell, B.M.J. ii./i 6,612,626. See also M. W. Jepps and J. C. Meakins, B.M.J. ii./i7,645. From the epidemiological as well as the medical standpoint this destruction of the encysted stage of the entameeba is of paramount importance. Hypodermic use of Emetine does not effect this. Best given at 10 p.m.—C. G. Imrie, and W. Roche.—L. i./i7,17. Emetine Diarrhoea.—Within limits this can be aimed at-—it was aimed at in the old Ipecac, treatment. The bowel is thoroughly washed out—in addition to the specific effect. A few days after the course (12 doses) the stools become normal.—G. C. Low, B.M.J. ii./i7,484. Emetine Bismuth Iodide is of value in early stages and is capable of curing about 50% at that period, but when the disease becomes chronic it has proved a failure. Emetine alone in the acute phase is better, followed by Emetine Bismuth Iodide later. Risk of irritating action of Emetine Bismuth Iodide on the acutely inflamed bowel leading to serious intestinal haemorrhage if used earlier.—P. H. Manson-Bahr, B.M.J. ii./2i,1115. A good deal of the disrepute into which Emetine Bismuth Iodide has fallen may be due to the fact that we focus our attention on the one relapsing case that docs resist all forms of treatment, and forget the 99 that go their way rejoicing. Chenopodium Oil should be tried in cases resisting Emetine treatment.—G. W. Goodhart, L. i./23,157. Vomiting, if delayed (four hoars after taking E.B.l.) does not mean that it will not be absorbed. It appears to indicate that it is beginning to take effect.— P. Manson Rennie, L. ii./22,1374. ® ‘Stearettes ’ of Emetine-Bismuth-Iodide 1 grain (o*06 Gm.), 2 grains (0*12 Gm.) and 3 grains (0*2 Gm.). These pass intact through the stomach and dissolve on reaching the alkaline juices of the duodenum and intestines, providing the alkalinity and bile secretion be adequate to effect the chemical reaction necessary. We proved some years ago that Keratin coating is practically useless. Salol Coated Pills of the same strength are also made. Major C. D. Roe, D.S.O., 4th Gurkhas, Bakloh, Punjab, India, states he was completely cured of Entamoeba Histolytica dysentery (contracted in the Dardanelles) by Stearettes of Emetine-Bismuth-Iodide. iPljEmetine Periodide (termed for short ‘ e.p.i.’) C^H^NoCWei = 1241-920. Dose.—In the treatment of amoebic dysentery the compound has been given as a course of 2 grains (0-12 Gm.) thrice daily for 15 days, after food, generally in Slipules and in conjunction with Slipules'of Exsiccated Ox Bile, 5 grains (0#3 Gm.) each, taken simultaneously. Doses as high as 5 grains of the Periodide, i.e., 1§ grains of Emetine have been given. iYlcztsu facture. By the interaction of Emetine and Iodine in a suitable solvent. The Periodides vary according to the methods used. H. M. Gordon and A. B. Prescott, Jl. Am. Chem. Soc., 1899, p. 237, prepared two different Emetine Periodides by precipitation on mixing a strongly acid solution of Emetine in water with a solution of Iodine in Potassium Iodide. To one they gave the formula C28Hi0N2O5.HI.I7. We are not concerned with a hydriodide-periodide. * E.P.I.’ forms a dark purple crystalline powder containing about 38-7% Emetine and 61-3% Iodine. Solubilities.—Insoluble in water and ether, but readily soluble in Acetone, and slightly soluble in Alcohol and Chloroform. Practically insoluble in physiological acid (0-2% Hydrochloric Acid). Uses.—For amoebic dysenter}^ and other protozoal infections essentially. In addition, it is suggested in sprue, cholera, typhoid and infections where Emetine in other forms has been tried. Brilliant results have recentlv been obtained with it in schistosomiasis. i/ Being insoluble in the stomach, it causes no nausea or vomiting. Schistosomiasis—The oral use clears up the urine of children intensely infected with S. haematobium as quickly and with almost as great certainty as Emetine Hydrochloride subcutaneously and without risk. One grain of the Periodide thrice daily for 15 days was given.—It. M. Gordon, Ann. Prop. Med. and Parasit., Aug. 13, *26.229 ; B.M.J.E. ii./26,76. Eor tropical use, it is suggested, a preparation of Emetine Periodide in Dried Milk (1 grain in 2 drachms, i.e., 8 Gin.) will be of value. Directions.—Two heaped teaspoonsful in 30 ounces (£ cupful) of warm water. The majority of the children apparently successfully treated in 1926 were found to be passing live ova in 193°, but owing to the high degree of infection in the district it was impossible to say whether these were cases of relapse or reinfection.—R. M. Gordon and E. P. Hicks, Ann. Trop. Med., Oct. 22, 1930. Relatively safe, but may cause vomiting unless patients are kept in bed on strict diet. Billiarzia infection often tends to die out of itself, and it seems desirable not to treat very young children, exposed to further infection, until a less toxic and more effective means of cure is available.—E. G. Cawston, B.M.J. b/29,890. Asncebsc Dysentery.—The use of the compound in refractory amoebic dysentery was the result of work conducted by the author for J. Graham Willmore. A continuation of the investigation led to the introduction of Auremetine (page 528), which has been found to be even more effective. Willmore, in his first paper on the subject, (Roy. Soc. Trop. Med. and Hyg., London, May, 1923), dealing with 400 cases, suggested medication per rectum in addition, especially where ulceration of the lower bowel was seen by the sigmoidoscope. Emetine Hydrochloride 1 grain was given daily, intramuscularly, and 1 drachm of Emetol (page 527) daily, per rectum ; each for six days on alternate days. Concurrently, 2 grains of Emetine Periodide were given in Stipules per os three times daily for fifteen days with 5 grains of Fel Bovinum thrice daily in separate Slipules. The periodide was given after food. Stovarsol has also been given with Emetine Periodide (see page 528) in these difficult cases with good effect. Emetine Periodide appeared to be the most efficacious and, at the same time, the least toxic of all the Emetine Preparations then tried. It permitted an intensive course of 90 grains in 15 days, and, if necessary, this was repeated after 10 days’ interval; compared with E.B.I., it therefore shortens the period in hospital. It caused no nausea, vomiting, depression and weakness like E.B.I. No cardiac dilatation, no emetine rash or desquamation and no neuritis, following 120 grains given in 20 days, were noted. The cases treated with ‘E.P.I.’ were the “ insoluble residue,” which had proved refractory to cdl the known methods of anti-amoebic treatment for years. These cases were not refractory to Emetine only. ‘ Bayer 205/ Yatren, Conessine intravenously, Conessine-Bismuth-Iodide, Naphthalene Tetrachloride, Oleum Chenopodii, ‘ T.C.P.’, by the mouth and per rectum, Dimol, Kerol, Proposotc, Creosote, Turpentine, etc., and Rurchi, were all tried without success. Action of Physiofo&icai Acid.—Unlike Emetine Bismuth Iodide, which was introduced under the erroneous assumption that it was not decomposed in the stomach, Emetine Periodide is practically unattacked by physiological acid, even at body temperature for three hours. O11 the other hand, in physiological alkali at 40° C. it is split up gradually into Emetine Base and Alkali Iodide. Emetine Periodide is mso/ufo/e in the stomach but slowly //berates Emetine base in the intestines. Summary.—1. Sigmoidoscopy should be performed with the utmost care, always without an anesthetic, the instrument being guided by the eye, but only sovie 30 cm. of the bowel can be seen. The infection appears to trickle down the bowel. 2. There is nothing to be gained by pushing treatment that does not show early results. 3. Individuals vary in their susceptibility to Emetine. Caution is urged in cases where the myocardium is affected by malignant tertian malaria, influenza, pneumonia, diphtheria, etc. Patients must be kept at rest during its administration in concentrated form. 4. Surgical measures, such as appendicostomy and ccecostomy, may be required to save life in exceptional cases, but they are not followed by a greater percentage of ultimate cure. Reports on Emetine Periodide (mentioned in the Discussion.) G. C. Low tried ‘ E.P.I.* on six cases, most of them chronic resisters, and four of these were apparently going on satisfactorily, as they had not reported themselves again. Two had relapsed : one with well-marked signs of hepatitis and threatening liver abscess (.Entamoeba histolytica cysts in stools); the other parasitically, eleven days after cessation of treatment (E. histolytica cysts in stools). A. Castellani confirmed Willmore’s statements. ‘ E.P.I.’ found satisfactory. It does not cure every case of chronic dysentery, but it is extremely useful. P. H. Manson Bahr had tried E.P.I. in three chronic resistant cases. One relapsed in 50 days, one had remained free from symptoms for three months. , For farther details consult the 18th Edition or the original paper by J. O. Willmore and W. H. Martindale in the Trans. Roy. Soc. Trop. Med. and Hyg., 1923, Vol. XVIL pp. 13—32. Sir William Willcox states that he has used Emetine Periodide with success. Emetol. (W illmore—Martindale.) A solution of Emetine base, 1 grain (OOG Gm.) in 2 drachms (8 Cc.) of Olive Oil, for rectal use in amoebic dysentery. See Edn. XIX., p. 535. Dose.—Two drachms are added to 4 drachms (15 Cc.) or 6 drachms (23 Cc.) of Ether and 8 ounces (230 Cc.) of Olive Oil for use. OTHER PREPARATIONS trued in amoebic dysentepy. Ipecacuarha.—In bolus and cachet, etc., in intensive doses of 30 to 45 grains a day, in smaller doses for months—were even less effective than Emetine Hydrochloride intramuscularly and Emetine Bismuth Iodide. Ravaut’s Paste (Bismuth Carbonate 100, Wood Charcoal 100, Ipecacuanha 4 to 6, Syrup 100, Glycerin 100) appears to have no real curative value. In dose of 2 to 10 tablespoonsful on the first day ; second day a capsule containing 0-1 Gm. Novarsenobenzol, third day the paste, and so on alternately for 10 to 20 days. P. Itavaut claimed in amoebic dysentery that appetite improved and there was no vomiting. Pastils of Ravaut’s Paste were made, each equivalent to half drachm, i.e., two for dose. They can be swallowed whole, and have been well tolerated. Decoction of Simaruba and Granatum was also ineffectual. Kurchi Bark. A decoction of this bark and in compressed form is considered of value. It does not eradicate the infection but it at least keeps the amoebse under control. Activated Quinine (freshly activated with Potash prior to use) was tried as enema but in all of 22 cases there was relapse. Conessine, the alkaloid of Kurchi Bark.—Major H. C. Brown found that this was equally as inhibitory to the growth of free-living amoebee as was Emetine. The toxicity of Conessine in vitro to certain protozoa is increased in presence of alkali. If the toxicity of alkalinised Quinine to amoebce is taken as 1, then Emetine is 5 times and Conessine is 14 times more toxic. It was therefore thought that Quinine base in alkali might be worth trying, Quinine being a harmless substance to begin with, and the results, so far, have been promising. It is probable that the other two alkaloids might be tried under the same conditions.—T. A. Henry, Boy. Soc. Trop. Med., May, 1923. Eor further data and by other observers, and recent results with Kurchi Bismuth Iodide, see Holarrhena. Stovarsol.—In view of the optimistic reports in the French Medical Press, trials were made in 1924 with this compound. . More cases were apt to relapse after it than after Emetine Periodide, but by combining the two drugs—giving 6 grains of Emetine Periodide and 8 grains of Stovarsol on alternate days, 10 each—the results obtained were better than with either drug singly.. ., , . . „ . When hepatitis is present, Emetine Hydrochloride hypodermicahy is combined with the above, and when sigmoidoscopy shows active changes, either Emetol in Etlier-oil or activated Alkaline Quinine is given per rectum in addition. x , T 7. . . , , The claim that Stovarsol (the same is true of CC14) cures lambhasis is absurd and may be dismissed at once ; so far nothing has been found to eradicate this infection in vivo, and the best palliative treatment is still rest m bed, a milk diet and a simple Bismuth and Paregoric mixture with can mnatives. Further, since fractional analysis shows that complete gastric achlorhy dria is usually present in lambliasis severe enough to cause symptoms, it seems illogical to expect better results from medicines given by duodenal tube. Dilute Hydrochloric Acid in doses of 1 to lh drachms had no effect, clinical or other.—J. Graham Willmore, 1924. (Lambha ref. E, Marchoux, Jl. Trop. Med., Sept. 15, ’23,295.) Arsenobenzene and Emetine a useful combination—persist with resistant cases.—Jl. A.M.A. h/26,457, per Pres., Jan., ’27,15. Arsenobenzol, 0-1 Gm. tablets, 2 to 6 daily, found efficacious : cysts destroyed—Presse Med., April, *26,497, per Pres., Jan., ’27,15. Jreparsol, 4 tablets daily, has been used.—Pres., Jan., ’27,15. Recently, good results have been obtained in amoebic dysentery by a combined treatment employing Auremetine with Siovarsol and Bismuth, infra. *[gjj Auremetine (T.M. 471016). Dose.—In amoebic dysentery 1 grain four times daily in slipules to a total of 40 or 60 grains, or even 120 grains,by repeating the course. A combination of the Periodides of Emetine and Auramine containing approx. Emetine 28%, Auramine 16% and Iodine 56%. JPharm acology. The potentialities of the aniline dye Auramine (q.v.) have been described by Fairbrother and Benshaw. It was thought that a combination of Auramine and Emetine might be more effective than Emetine Periodide, and as the result of experiments in the author’s laboratory Auremetine was produced. Like Emetine Periodide it has the advantage of being practically insoluble in the acid of the stomach (only about 5% is decomposed after 4 hours at 40° C.) and it is slowly split up in the intestines with the liberation of the dye and Emetine base. Experimentally 20% of the substance was decomposed after 4 hours in Physiological Alkali at 40° C., but in the human intestine, no doubt, a complete decomposition occurs, since its administration is quickly followed by the passage of orange-coloured faeces. Major H. C. Brown found that Auremetine, using a suspension in gum solution, was inhibitory to the growth of free-living amoebae nearly to the same extent as Emetine or Conessine under the same conditions.—B.M.J. 1/26,526 M.L.D. in rabbits per os of Auremetine is IOO to 125 mgr. per kiio, as compared with 15 to 20 for Emetine Hydrochloride and 50 for Emetine Bismuth Iodide. In cats the figures were respectively 30—40, 15—20, 30—40 mgr. per kilo.—H. H. Anderson and C. D. Leake, Jl. Pharm. and Exp. Therap., July, ’30,273. Auremetine is a stable, dark maroon powder, insoluble in water. Uses.—In amoebic dysentery Auremetine is a further advance in treatment upon ‘ E.P.I.’ Its use is not attended by vomiting, nausea, abdominal pain, or purging. It is less depressing than Emetine hypodermically, and it is not necessary to keep the patient in bed on this account alone. Combined Treatment. The following information, from a paper by J. Graham Willmore and W. H. Martindale (B.M.J. i./26,525), is based on the results of its use since 1924, and has recently'been confirmed (1928). 1. ‘Acute’ (ase3—that is, those with blood, mucus, and E. histoly- ticce in the stools, or found in scrapings at sigmoidoscopy receive :— (a) Auremetine 1 grain in gelatin capsule four times daily after food on alternate days for seven days, and then daily to a total of 40 or 60 grains. (b) Stovarsol 4 grains three times daily for seven days, on alternate days with the Auremetine. Previously 4 grains twice daily for ten days, alternating with the Auremetine days, or even to fifteen days, was given. (c) On Stovarsol days a rectal injection of Emetol, 2 drachms ( = 1 grain Emetine base), in ether 6 drachms and olive oil 12 ounces. (Time retained to be charted.) («) ‘ Panama bismuth ’ three-hourly for twenty days, and then three times daily. -• ‘Chronic’ or cyst-carrying cases are given : (a) Am emetine, and (5) Stovarsol, on alternate days as described above, (c) Panama bismuth,’ three times daily before food. 3. \\ hen hepatic involvement is present 1 grain of emetine hydrochloride intramuscularly, alternate days for six days (that is 6 trains in all), may supplement or replace the Emetol. ' e ‘Panama Bismuth.’—It has been the custom to administer massive doses of bismuth suonitrate (James and Deeks, Panama) in addition ; it is a good adjuvant. In the 4 acute ’ cases a heaped teaspoonful, stirred up in soda water, was given every three hours (during the day, not at night) for twenty days, and then three times daily for an indefinite period ; in the cyst-carriers it was given three times a day from the beginning. Toxic effects should be watched for. See p. 521. Routine sigmoidoscopic examination is important. Toxic Effects of Sfoi/arso/,—Stovarsol is a useful addition but certain individuals may show an idiosyncrasy towards it, especially after repeated courses. At least one death from this drug has been heard of, and one case under treatment developed intense dermatitis with purpuric spots after only 8 grains. The practice of giving one tablet every three hours until twelve have been taken—as advocated by some—is dangerous, and has not been found to give better results than any other method. As a minor measure of precaution patients are given glucose (1 lb. in 1 quart of orange and lemon water, to be taken in twenty-four hours) daily during its administration. Results of Auremetine and Stovarsol.—The cases dealt with were the residue of pensioners infected during, or before, the great war, many of whom had been through every dysentery treatment in the country. 92% of cases treated by the method 4 responded,’ i.e., the patient regained his health, lost all clinical signs and symptoms of his disease (including sigmoidoscopic findings), his stools were negative on repeated examination. It is impossible to guarantee permanent cure of chronic amoebic dysentery. Auremetine has given some gratifying and more hopeful immediate results than any other essayed. Of 570 admissions to hospital during 4 years only one death directly due to dysentery (bacillary) in the series under review. The combined treatment employed since 1924 has been found preferable to Yatren.—J. Graham-Willmore, Proc. Roy. Soc. Med., Nov., 1928. G. Carmichael Low stated he had been treating dysentery for 28 years and agreed with the speaker. 'Remedies recentiy introduced in the Therapy of A mcebia sis. ’ Increasing number of cases reported in persons who have never left the temperate zone. Emetine is the sovereign remedy for amoebic colitis and hepatitis. Combinations of Emetine Hydrochloride, with Emetine Bismuth Iodide, or Emetine Periodide, or Emetol, have also been used : but effective dose of Emetine is near the toxic dose and symptoms of Emetine Poisoning are very common. Bismuth Subnitrate (large doses) wfith Emetine, or Karlsbad Salts, has been recommended for intestinal amoebiasis. Native remedies not sufficiently tried to permit of definite opinion. Enemata of 40% Sugar solution, also duodenal or colonic irrigation of hot water with Magnesium Sulphate, used with good results. Yatren thought superior to Emetine abroad, but opinion divided in this country.. Stovarsol and Treparsol alone more frequently followed by relapses than Yatren, and the former is highly toxic. Willmore''s combined treatment with Auremetine, Bismuth, and Stovarsol, has stood the, hardest tests and stands first in general usefulness among all the remedies at hand, being the least toxic and the most widely applicable of them all ■—Otto Wilner (Peking), Jl. Trop. Med., Aug. 15/28,207. Intestinal amoebiasis. Modern methods of treatment have been further discussed recent!v. Yatren and Emetine Bismuth Iodide well spoken of by Manson Bahr. Raised yellow rash sometimes produced, hence Yatren best given per rectum during the day and the Emetine Bismuth Iodide at night. Sir Aldo Castellani preferred Emetine Periodide or similar drug. J. G. Willmore pointed out that Emetine Bismuth Iodide was introduced under an < erroneous idea. It is decomposed in dilute acid and hence dissolves in the stomach causing nausea. Yatren is opaque to X-Rays and one can see how far it travels.—B.M.J. i./3i,846. Bacillary Dysentery.—Mechanical cleansing by irrigation important. 1% Salt with or without Sodium Bicarbonate 1 drachm to 1 pint, or Eusol 4 oz. to 1 pint. Ether 6 drachms to Olive Oil 12 oz. in acute cases. If the case ‘ hangs fire,’ but never in the acute stages, Silver Nitrate 1 : 2,000 to 1 : 1,000.—J. Graham Willmore, Proc. Roy. Soc. Med., Nov., 1928. Schistosomiasis in a child of 16 successfully" treated with Auremetine. Live ova disappeared from urine in 24 days. Total, dose 47 grains. No vomiting or ill-effects.—R. M. Gordon and E. P. Hicks, Ann. Trop. Med., Oct. 22, 1930. Methyl-psychotrine, Emetamine ami Iso-emetine, see Edn. XIX, j>. 538. [jpA] Cephaeline. C28Pt38N204=466'3124. A crystalline alkaloid, less soluble in ether than emetine, but soluble in caustic alkali solutions, and also darkens on exposure. By Methvlation it is converted into Emetine q.v. lOD Cephaeline Hydrochloride, C23H38N2O42HCl = 539-206. In doses of A to l gr. said to be a more powerful emetic than Emetine. dD Emetin—Extractive. Dose.—Expectorant fig to fig (0-004 to 0-006 Gm.), emetic J to 1 grain (0-03 to 0-06 Gm.), in pill or solution. An extractive substance soluble in water ; must be distinguished from Emetine. LAMELLA. Ophthalmic Lamellae or Discs (cf. Index—Lamellae-—for the various medicaments employed) are prepared with Gelatin and a proportion of Glycerin. B.P. ’14.—The discs are 3 m.m. (J inch nearly) in diameter. Directions are given. |fjj Atropine Sulphate B.P. ’14 weigh fig grain = ^Vo grain in each ; Also prepared containing and grain. HK3 Cocaine Hydrochloride B.P. ’14 weigh fir) grain = Tfig grain in each. Cg) Homatropine Hydrobromide B.P. ' 14 w^eigh 3^ grain — tod grain in each. (g) Physostigmine Sulphate B.P, ’14 weigh fig grain = ygrain in each. C42H84NPOs(?) = 777-6832. Clioline DidStearo-Glycerophcsphate. Dose.—Internally 3 to 5 grains (0-2 to 0-3 Gm.) preferably half an hour before meals, vide Emulsion. This dose may well be increased if it is digested, as an average egg contains 16 grains approx. feuocutaneously to 2 grains (0*05 to 0*12 Gm.) in sterile olive oil every second day. ilTftIItif(lctllV€,—It should be prepared from eg<r yolks by alcohol extraction. For the Chemistry of Lecithin and its examination, ride Vol. II. A yellowish wax-like mass. It is a constituent of the brain 11%, and of yolk of egg 7% ; milk (human, cows’), etc., contains varying amounts, of. Vol. II. Lecithin is broken up by the pancreatic juice into Glvcerophosphoric Acid, fatty acids and choline. Soluble 1 in 30 of 90% Alcohol, Ether 1 in 5, Chloroform, Carbon Bisulphide, Benzol and fatty oils. It combines with certain metals, e.g. Copper. Flavoring*—Prescribed as Elixir or Emulsion q.v. Uses*—Where the phosphates excreted by the urine are high. Given in neurasthenia, various nervous diseases, diabetes, tuberculosis, tabes and general paralysis ; also in all diseases producing a disturbance of nutrition. It is said to cause a marked increase in patient’s weight, and to improve the general well-being; augments the blood corpuscles. Rickets and marasmus have been successfully treated with lecithin, and intramuscular injections of Sterile Oil Solution have also given relief. Use suggested in incipient tuberculosis, osteomalacia, pernicious anaemia, and the like. Has given good results in myasthenia gravis (Gowers). Cancer has been treated by 2| grains Lecithin injections.—J. T. Shirlaw. See also this authority’s work, under Sodii Oieas. Elixir Lecithin. Dose.—2 drachms containing 3 grains of Ovo- Lecithin, thrice daily half an hour before meals. Emulsio Lecithin. Dose.—Half ounce, containing 5 grains of Ovo-Lecitbin, thrice daily, as the Elixir. No very hot fluids should be drunk for some time afterwards, so that the composition of Lecithin may remain unaltered. In menorrhagia 1J to 3 grains of Lecithin thrice daily between the periods has been found useful. Sterules for Intramuscular Injection. Dose.—f grain (0-05 Gm.) of Lecithin in 1 Cc. of oil. Also CE> with Strychnine grain. Capsules and Tablets contain 1J grains (0*1 Gm.). Tabellse of chocolate basis contain I grain. Pilula Lecithin.—Lecithin 1J and 3 grains. Lecithin is contained in Piluia Potentin Composita, q.v. CE>%“Byno” (T.M. 215670, 215671) -Lecithin. Dose.—.One tablespoonful three times a day half an hour before meals. A pro- prietary containing Lecithin, Liquid Malt Extract with Cinchona and! Nux Vomica alkaloids. Digestive nerve tonic and food. Each ounce contains 4 grains of Lecithin. Effervescent Lecithin 3 grains in 1 drachm (a dose) is prepared. Pilula Lecithin cum Ferri lodido.—-Martindale. Contains 2 grains of Lecithin with 3 grains of Ferrous Iodide. Int ancemia to increase metabolism and as a tonic in convalescence. Powdered Lecithin. Dose.—10 to 15 grains (0-6 to 10 Gm..) thrice daily before food as powder or cachet. A light yellowish powder containing 33% Lecithin flavoured with Saccharin and Peppermint Oil. When given prescribed as powders- the dose may be mixed with J wineglass of water. Lipoids. Walker’s “ Organic Chemistry ” suggests there are various forms- of these fat-like substances. (1) Cholesterol (2) Cerebrosides. These contain Nitrogen but not Phosphorus, and on hydrolysis yield among other things Galactose. (8) Phospliatides or Phospho-lipines.—e.g. Lecithin. See also* Sapones and Vol. II. LIGATURES. Catgut Ligatures are obtainable commercially ‘ Raw 5 and Sulpho- Chromic in hanks in sizes Nos. 000,000 (the thinnest) up to No. 8. Preparation of Chromic or Sulpho-Chromic Catgut Ligatures. Lord Lister’s Directions.—Soak the catgut 24 hours in twenty times its weight of ‘ preparing liquid ’-—made as follows :—Dissolve Chromic Acid 4 in water 240 (weights, add Sulphurous Acid Solution (B.P. T4) q.s. to produce green colour of Chromium Sulphate Cr3(S04)2 = 392-172. Then add water to make 480 (weight), next add solution of Mercuric Chloride 2 in water 320 (weight). Dry the catgut on the stretch. The antiseptic Chromium Sulphate Solution, Lord Lister found the nearest approach to the ideal to produce a ligature capable of fulfilling the necessary conditions as to strength, elasticity and asepsis. Ligatures are also supplied in carbolic acid solution 1 in 20, carbolised alcohol, turpentine, and various other antiseptics. Immersion in Clove Oil 8 days, then in Alcohol 6—8 hours, has been advocated for sterilising. A further method is to heat the catgut gradually in Cumene to 70° C., then in the same substance to 170° C. for two hours. Finally to rinse in petroleum benzine. By Cumene or Cumol is intended a hydrocarbon (a) Trimethyl-benzene C«H*(CH8),[1: 3 : 4] =120-0936 obtained by fractionation of Coal Tar, it boils pure at 169-8° or (b) Isopropylbenzene between 160° and 170° C.—when C6H4CH(CH#)2. The latter boils at 152° C.,—the former body is, therefore, more suitable for sterilising catheters. The names Cumol and Cumene, or better Cymene, as distinct from Cumene above are, however, also given to p-Methyl-iso-propyl-Benzene C6H< \C,H 134-1092. This is obtained from Cumin Oil, and can be made from Camphor. It boils at 175° to 176° C., has Sp. Gr. 0-8678 at 12° C., and possesses a pleasant odour. Hardening Treatment.—By soaking 1 hour (a) in 1 in 1000 Potassium Bichromate ; these are two to three weeks—soluble. Or (b) more durable, i.e.y to last 5—6 weeks, use 1% solution for same period. The gut is supplied in Xylol in sealed tubes. Iodised Gut (Claudius’ Method).—Raw gut, which has been previously soaked in Ether to remove fat, is sterilised by soaking in a solution of Iodine 1, Potassium Iodide 1R Distilled Water 100 for ten days. (Some use weak Tincture of Iodine diluted 15 times with 50% Alcohol.) About- 4 ounces of Solution is sufficient for half a dozen hanks. The Gut is then of a brown colour, in a sterile pliable condition and readv for use—remove and place in 3% Phenol or Normal Saline prior to operation. Iodine-Formalin Catgut. Catgut prepared with Iodine and Alcohol is washed with a weak Carbolic Solution ; it is then treated according to its thickness in a 3% Formalin Solution for twenty-four hours, and washed in water. Store in a solution of Alcohol 50% containing 5% Glycerin and 0-5% Iodine. Vide also lodo-Acetone. Fr. Cx. sterilises Catgut in absolute alcohol at 120° C. for 45 minutes in sealed tubes of hard glass. Catgut sterilised with advantage by ether, chloroform, absolute alcohol or petrol in preference to “ chemicals ’’—any one of them will render gut sterile in 24 hours.—G. S. Thompson, B.M.J. i./i7,873. Absorbable Iodine Catgut.—Catgut, defatted by ether, is boiled in absolute Alcohol for an hour, then placed in a solution of 1 part Strong Solution of Iodine and 11 parts of Water for a week. Keep in a solution of 1 part Strong Solution of Iodine and 50 parts Rectified Alcohol. For the preparation of catgut on a large scale only three methods can be considered satisfactory—sterilisation by Formalin or Hydrogen Peroxide and by heat. Of 8 samples examined in 1927, 58 out of 77 ligatures were found infected. Of another batch of 36 not one was found sterile. Sterilisation achieved by treating with a watery solution of Iodine—the Iodine being removed after sterilisation. Catgut prepared by this method is now controlled under the Therapeutic Substances Act.— M.It.C., Spec. Rept. Series, No. 138, W. Bulloch, L. H. Lampitt and J. H. Bushill, B.M.J. ik/29,918. Biniodide is decidely less powerful in killing germs on the elastic layer of the small intestine of sheep, from which catgut is made, than Perchloride. /edine found best. Immersed for 9 days, catgut will absorb 12% of its own weight of Iodine. Glycerin added makes for flexibility.—M. R. C. Report, L. ii./29,993. Therapeutic Substances Act. 42 samples of catgut found contaminated. -—P. Hartley, B.M.J. i./31,1072. Peppermint Oil is bactericidal to staphylococci in dilutions up to 1 in 200. Diffusing power through Agar equals that of Perchloride. Raw catgut treated by immersing first in a Bichromate solution then in 1 in 10 solution of the oil in spirit for 2 hours at 60° C. Finally kept in 1 in 20 Carbolic in spirit. Suggested by Capt. S. R-. Douglas, L. i./31,345.—A. E. Porritt, L. i./31,345. Tabotamp.—Absorbable material made from catgut for packing wounds. Kangaroo Tendon, St. G.H. is washed with Ether Soap, treated with antiseptics and preserved in Alcohol. Horsehair, St. G. H., is boiled in water 10 minutes only. Boeder's Method. Picric Acid, saturated solution in Clove Oil. Leave the gut one week in this. Rinse 10 seconds in water and store in 95% Alcohol. In 4 days it is ready for use. It is an advantage to formalise in 5% solution for 24 hours first.—J. D. S. Sinclair, L. i./i6,212. Silk Sutures are supplied on reels and in hanks, sizes 0, 1, 2, also sterilised in Absolute Alcohol and Phenol Solution. Sterilised by immersing in Olive Oil for 12 hours and then boiling in the same and keeping in Carboiised Spirit, In infantile paralysis silk ligaments cause 'formation of a tough tissue or tendon. Silkworm Gut, extra fine, fine, medium and stout—is made in 10 and 14 inch lengths. Silkworm Gut Sutures are a natural product, being simply strands drawn from the silkworm, and come for the greater part from Spain. There is no synthetic product sold as Silkworm Gut. LITHIUM. Li=6-94. Lithium Salts have long had a reputation for assisting in the elimination of Uric Acid, but their effect is probably analogous with corresponding Potash Salts. They should be given freely diluted. Lithium Poisoning by large doses of Chloride taken experimentally, e.g., 2 Gm. three times a day before meals. In all, 4 doses, i.e., 8 Gm., were taken. After the 4th dose taken next night, there was marked dizziness and sleep was impossible. Weakness and tremors were intense the next day. Ocular and aural symptoms lasted 36 hours. There were no gastric intestinal symptoms and appetite remained good.—L. i./i3,1815. Lithii Benzoas, C6H5COO Li= 127-979. Dose.—2 to 10 grains (0-12 to 0-6 Gm.) or more. Usually a light white crystalline powder, Antilithic, Soluble about I in 4 of water, about 1 in 12 Alcohol 90%. Incompatible with Acid and Sodium Bicarbonate. Lithii Bromidum, Li Br. = 86-756. Dose.—5 to 15 grains (0-3 to 1 Gm.). White, deliquescent, slightly bitter granules, neutral reaction; very soluble in water and alcohol. Contains 91% Bromine as against 67% in Potassium Bromide, hence effect is greater, especially as a hypnotic, and in epilepsy. Lithii Carbonas. Li2C03=73-88. Dose.—2 to 5 grains (0-12 to 0-3 Gm.). Tablets, 5 grains. Soluble in water about 1 in 70. Diuretic, thought to increase the alkalinity of the blood. Lithii Citras. C3H40H(C00Li)3.4H20=281-9214. Dose.—5 to 10 grains (0-3 to 0-6 Gm.). Tablets 5 grains. White crystalline powder. Diuretic. Soluble 1. in 2 of water. Effervescent Lithium Citrate. Dose.—1 or 2 drachms (4 to 8 Gm.). Contains 1 in 20. Vescettes * (T.M. 260597) of Lithia, contain 3 and 5 grains. Lithii Citras Laxativus Effervescens, B.P.C.—30% Sodium Phosphate, 10% Lithium Citrate. Dose.—60 to 120 grains. A diuretic purgative and antilithic. Lithii Gliaiacas, Lithium Guaiacate. Dose.—5 grains (0-3 Gm.) in pill twice a day. Prepared by digesting guaiacum resin in solution of lithium oxide, decanting the solution, evaporating, and scaling it. Contains Lithium Oxide 1, Guaiacum Resin 3. For gout and rheumatism. Lithii Hippuras. CH2NH.C7Hr(OCOO.Li= 185-0104. (May contain 2H20.) Dose.—5 to 15 grains (0-3 to 1 Gm.). I n light white minute crystals, soluble in water 1 in 2J, is a powerful solvent of lithates ; useful in gout and rheumatism, cf. Piperazin. Vescettes contain 5 grains. Effervescent Lithium Hippurate 5 grains in 1 drachm. Lithii lodidum, Li 1 = 133-872. Dose.—1 to 5 grains (0-06 to 0-3 Gm.). White crystalline deliquescent powder containing 94-7% iodine. An antiarthritic and has been employed in syphilis, also in rheumatoid arthritis by iontophoresis, q.v. Umbrenal, a 25% Solution of Lithium Iodide filled in ampoules of 12 Cc. Used as a contrast in pyelographic work. Lithii Salicylas. CcH4OH.COOLi= 143-979. Dose.—5 to 20 grains (0-3 to 1-2 Gm.) for rheumatism and gout. A deliquescent white powder soluble 1 in 1 of water, forming a neutral or slightly acid solution. incompatible with acids and with Sodium Bicarbonate. Varicose Veins have been treated with this Salt with Tutocaine added ; also Lithium Salicylate and Quinine Urethane see pp. 65, 66. Effervescent Lithium Salicylate contains 1 in 30. Dose.—1 or 2 drachms. Lithii Sulphas Li2S04H20 = 109-9396. Dose.—5 to 10 grains (0-3 to 0-6 Gm.). White crystals soluble in Water and Alcohol. Lithii Tartras Acid us. CHOH. COOLi. CHOH. COOH, 1J H2O = 183-0124. Dose.—5 to 20 grains (0-3 to i-2 Gm.). White crystalline powder, used in gouty cases with gum affections. Lithion is a granulated (non-effervescent) preparation composed of lithium citrate, magnesium sulphate, sodium sulphate, etc. Dose. —One-half to one teaspoonful taken in a little warm water. LOBELIA (B.P. 14), U.S., P. Ital. V., P. Belg. IV., F.E. VIII. The dried flowering herb Lobelia inflata (Lobeliacece). Has purgative and emetic properties, but its chief use is to relax spasm of the bronchi in asthma and bronchitis. It is contained in many anti-asthmatic powders (vide Pulvis Lobelise Composita). CE> Tinctura Lobelias U.S. X. 1 in 10 of Alcohol (49% by vol.). Average dose 15 minims (1 drachm as emetic). F.I. agreed 1 in 10 Alcohol 70%. Fr. Cx., Max. single dose 30 minims approx., max. during 24 hours 95 minims approx. CED Tinctura Lobelise yEtherea {B.P. 14). 1 in 5 Spirit of Ether. Dose.—5 to 15 minims until nausea occurs. In atonic constipation with dryness of the faeces the Tincture in 10 minim doses, combined with Cascara, useful.—H. FI ( y Lobeline. C22H2702N=337*2186. . We have taken this formula, having regard to that used in P.G. in describing the Hydrochloride.) A crystalline alkaloid obtained from L. inflata. A powerful respiratory stimulant, but should, be used cautiously m patients with enfeebled myocardium. Probably more effective combined with a cardiac stimulant. Suggested dose (as a soluble salt) 10 mgr. intravenously (CurtL and Wright). Effects not lasting. Used by Sir Wm. Willcox wit! beneficial results in case of new growth in chest associated wit! dyspnoea, and in persistent hiccup. It has been used in coal-ga and Morphine poisoning. Of greater use in respiratory emergency. —B.M.J. ii./26,1226 ; for pharmacology see F. R. Curtis and S Wright, L. ih/26,1255-58. Lobelinc used to prevent coma in Morphine poisoning, restore respiration after anaesthesia, and to counteract effects of gas-poisoning. As an antidot* after taking 8 Cc. of Tinct. Opii: first 3 mgr. given intravenously, then Iff mgr. hypodermically, then a further 3 mgr. intravenously. Patient recovered. —P.J. ih/26,328. j?Tj Lobelinum Hydrochloricum, P.G. VI., P. Belg. IV. c. 22H 27 0 2N.HCl=373-6836. Max. dose.—J grain (0-02 Gm.) : pro die lb grains (0T Gm.). 1 Cc. ampoules of 1% solution are made. Solutions rnust not b heated. IdjLobelin Ingelheim has subcutaneous or intramuscular dose for children To grain (0-003 Gm.). Subcutaneously -7% grain (0-01 Gm.) for adults. In travenously for adults V to To grain (0-003 to 0-01 Gm.) very slowly.—Pres., ’27,68, and makers’ printed matter. [Pil Lobeline Sulphate is also manufactured. White crystals soluble 1 in 1 (by our experiments, 1927). dD Lobeline Sulphate Tablets, A* grain, for hypodermic use as a spina sedative and relaxant.—P.J. i./26,53. Patented method of extraction of alkaloids.—Y.B.P., 1922,11. MAGNESIUM. Mg = 24-32. Magnesii Carbonas Levis (B.P. ’14). 3(MgC03)Mg(H0)2,4H20== 383-358. (This formula is not given in the B.P.). Is preparer by precipitation of Magnesium Sulphate Solution with Sodiun Carbonate. Magnesii Carbonas Ponderosus, similarly in more con centrated solution and by boiling and evaporation to dryness- and washing with water to remove Sulphate. Dose.—30 to 60 grains, or 5 to 20 grains repeated. A useful substance for clarifying liquids from suspended matter. Liquor Magnesii Bicarbonatis (Carbonatis) (B.P. ’14). FLUID MAGNESIA. Dose.—1 to 2 ounces (30 to 60 Ce.). A colourless liquid, containing 10 grains of Magnesium Carbonate in 1 ounce of Carbonic Acid water. Sippy’s Powder. Vuse.—1 to 2 drachms (2 to 8 Gm.) in water. ]STo. 1—Magnesium Carbonate and Sodium Bicarbonate equal parts. No. 2—Calcium Carbonate and Sodium Bicarbonate equal parts. Sippy’s method of treating gastric ulcer was by checking acidity of the gastric juice to prevent further corrosive action. Cf. Maclean’s Powder, p. 224„ Magnesia Levis and Magnesia Ponderosa (B.P. ’14). MgO--=40-32.. These are prepared from the respective carbonates by exposure to a dull redi heat. Poses as for carbonates. Antacid, antilithic, diuretic, laxative. M&ghcsia should never fee prescribed as compressed tablets since they* do not dissolve and may form the nucleus of calculi.—Per P.J. i./a5,470. 3{CB isurated (T.M. 340411)' Magnesia.—Dose.—Half teaspoonful in water after meals. A proprietary article termed ‘ an Antacid,’ in form of a white powder. Mannich and Leemhuis find it to contain approximately Bismuth Carbonate 8, Sodium Bicarbonate 40, Magnesium Carbonate (probably heavy) 52. —P.J. ii./13,257,563. Liquor Magnesii Citratis U.S. XT. Limonade Purgative an Citrate de Magnesie. Fr. Cx. Average daily dose.—12 ounces. Magnesium Carbonate 15, Citric Acid 35, Syrup 60, Potassium Bicarbonate 2-5, Oil of Lemon 0-1, Water q.s. to 350. The formula is unduly acid. The acid should be 30 or less. Further suggestion should be made in the text that where there is Acid intolerance in the adult and in the case of children, a level teaspoon or more of Sodium Bicarbonate should be added after the bottle has been opened and effervescence has ceased.—J. W. England, Am. Jl. Ph. Sept. ’24. Limonada Rog6 in S. America is similar to Fr. Cx.—Ph. Notes. Magnesii Chloridum, MgCl26H2Q =203*3276. Dose.—-30 to 60 grains (2 to 4 Gm.) increased. Deliquescent crystals, very soluble in water. Mild purgative, a dose in b pint of hot water useful for constipation and in dyspepsia and stomach disorders. War wounds have been treated with 1*2% Solution. Magnesii Chloras. Mg(C103)2, 6H20=299*3276. Deliquescent white crystals made by decomposing the barium salt with Magnesium Sulphate. Phtzrmztcology.— Less toxic than Magnesium Chloride. Average lethal dose in rats intra- peritoneally 1*1 and 0*22 Gm. respectively. Purgation and diuresis ensue with either salt—large doses intravenously cause heart failure. Toxic symptoms neutralised by Calcium Chloride injections.—J. L. Ulrich and 4 . A. 8hternov, Jl. Ph. & Exp. Ther., Jan. *29,12. Has been used in form of ointment (20%) on epithelioma of the !ip. Magnesii Hydroxidum, Mg(OH)2=58-3350. Magnesie Hydratee. Fr. Cx. Dose.—5 grains to 2 drachms (0-3 to 8 Gm.). Prepared by decomposition of Magnesium Sulphate 24b with Sodium Hydroxide 8 in solution, the precipitate washed free from sulphate and dried at low heat. According to the Fr. Cx., calcined magnesia is boiled with 20 to 30 times its weight of distilled water 20 minutes. Dry as much as possible by collecting on calico and finally at 50° C. until it no longer loses weight. Thus prepared, Magnesium Hydroxide contains 31% H 2° • . , . , It dissolves more freely in dilute acids than calcined magnesia. It is a recognised antidote in arsenical poisoning. sfcALkagen Tablets (T.M. 347033). Dose. 1 to 3 with water. Contain Magnesium Hydroxide and Peppermint Oil. Tor acidity, flatulence, etc. It is not open to the objection that Carbonic Acid is liberated as m the case of Carbonates and Bicarbonates. Pulvis Magnesii Hydroxidi cum Carbone- Dose.—1 to 2 drachms in a little water after meals. Magnesium Hydroxide 1, Wood Charcoal 2. . Is suggested in dyspepsia. The Magnesium Hydroxide is antacid and the charcoal has the property of gas absorption. Furthermoie, the charcoal would tend to preserve the hydroxide. A little cinnamon powder (1 in 8) is occasionally added. Cremor Magnesia. Magnesia Cream. Dose.—1 to 4 drachms in a little water. A palatable concentrated preparation. Each ounce represents 2^' grains of suspended Magnesium Hydroxide. Antacid withou evolving Carbon Dioxide—hence no distension is caused. I ses.—In indigestion, dyspepsia, acidity, rheumatism, and as ar alkaline mouth wash, forming a film of Magnesium Hydrate over the tootn surface. A useful antidote in case of poisoning by mineral acids Magnesii Lactas-—(C2H4 OH. COO)2Mg. 3H20=256-4448. Dose. 15 to 60 grains (1 to 4 Gm.). White crystalline powder. Soluble 1 in 30 of water. Useful in some cases as a haemostatic where Calcium Salts do not seem to act. A dose of 30 grains usually reduces time of coagulation of the blood 30%, e.(/., from 2 to 1J minutes. The salt can be made ex- I temporaneously by the dispenser, if prescribed in a mixture, from Magnesia, with Lactic Acid g.s. The large dose of the bulky powder, if ordeied in that form, is inconvenient to take. Note.—Magnesium Oxide 1 requires Lactic Acid (75%) about 5 to dissolve it. Oozing of blood from the gums has been well treated by 40 to 60 gram doses. For erosion of bone, due to scurvy, this and the Calcium Salt are valuable.—Sir A. E. Wright, Magnesii Phosphas (Tribasic). Mg3(P04)2,7H20. = 389-1092. Contains approx. 70% Mg3(P04)2. Dose.—15 to 75 grains (l to 5 Gm.). Lsed as an antacid. As employed by A. F. Hurst. Does not produce systemic alkalisation. Has laxative action. See also Tribasic Calcium Phosphate. Tf :tJSae'?i^Se (J‘M‘ f 4i5?31)X A Preparation of Silico-Magnesium salts. j has been advocated for the palliative treatment of malignant disease Magnesmm salts, it is thought, tend to destroy superficial cancerous growths* and they give encouraging results in inoperable cancers. Where the drinking Waiei has a marked content of Magnesia salts, cancer is said to be rare. Magnesia and Silica, perhaps, play the same part in cancer that Lime does in would be required- The Silica , ?c?,ets of Neolyse. Dose.—1 cachet thrice daily before meals for 20 residt k obtainedrUpt reatment for 10 days, and continue until the desired Neolyse injections and Compresses for local use are prepared. Magnesii Sulphas- 8el Anglais, P. Belg. IV., Sel d’Angleterre 8el de Sedlitz Fr. Cx. MgS0,1.7H20=246-4892. Dose. 2 to 4 drachms or 30 to 90 grains repeated (B.P. ’14). Soluble 10 in 13 of water—measuring 18-5. The salt is not hygroscopic. Incompatible with Soda Tartarata and Alkaline Carbonates. FIaeoring.—Glyl Menthse Piperitse, Glyl Cinnamomi. Solutions kept ready for dispensing should be sterilised ; this will effectually prevent the fungoid growth which occasionally occurs. Pharmacology. This salt per os does not act by attracting fluid into the intestine, since the watery stool following ingestion contains none of the salt. This is passed in the solid stool on the following day. It is suggested that its purgative action depends upon a duodeno-colic. reflex analogous to the similar but less painful reflex produced by food.—M.P.C., July, 14, ’26. . Subcutaneously in small doses (5-io grains) Magnesium Sulphate produces a carthartic action.—Prof. Dixon.* Intravenously in large doses it is toxic and may produce death. The non- toxic dose should not exceed OT Gin. per kilo weight and should not be given in a concentration exceeding 10%.—H. J. Stander, Jl. A.M.A. i./29,636. Uses.—Largely employed as an efficient evacuant. Intraspinal Anaesthesia has been induced by injecting Magnesium Sulphate in dilute solution. Chorea treated by 1 to 5 Cc. of 25% Solution of the pure salt. Weaker Solution, e.g., 7-3%, which is isotonic with the cerebro-spinal fluid, was, however, advised—of this 3-4 Cc. -= 1 Cc. of the 25%. See also M.P.C., Oct. ik/22, 303. Dysentery in South Africa was treated by the “ Evacuant Method ”—Magnesium and Sodium Sulphates, Castor Oil, Calomel, also with Ipecacuanha Powder. Epidemic Encephalitis greatly benefited by Magnesium Sulphate, 4 Cc. of a 25% solution, intramuscularly.—E. Matthew, L. h/24,1156. Eclampsia, Suppression of the convulsions in.—Intrathecal injections of 25% Magnesium Sulphate Solution, allowing 1 Cc. for every 25 lbs. (approx.). -—L. ii./i2,1575. Eclampsia.—Intravenously, 10 to 25 Cc. of a 10% solution, gave good results. Convulsions controlled, oedema reduced and diuresis promoted.— Am. Jl. Obstet. and Gynec., Feb.5 25. See also H. Pritchard, B.M.J. i./28,794. The preceding intravenous dose, or 15 Cc. of 25% intramuscularly, repeated at intervals of 2 hours.—B.M.J.E. h/30,63. 5 to 10 Cc. of 25% solution intramuscularly after each convulsion, until controlled. It is not used in coma. Give colonic irrigation, wash out stomach, and leave 60 Cc. saturated solution Magnesium Sulphate in it. Then inject 1,000 Cc. 20% Dextrose solution during 30—50 minutes 2, 3, or 4 times daily. When stomach has emptied itself, inject 5% Syrup water, beginning with 50 Cc. and increasing hourly up to patient’s tolerance, possibly up to 300 Cc. an hour, until patient is conscious.—O. Id. Schwarz, Jl. A.M.A. ii./29,1679. Epilepsy.—1 Cc, of 1 in 5 Solution or 1 Cc. of 1 in 2 Magnesium Chloride hypodermically has been used. Headache, e.g. post-concussional, 4 to 8 oz. 50% Magnesium Sulphate solution per rectum.—A. Feiling, B.M.J. ii./3o,907. Hypopyon Ulcers treated with Magnesium Sulphate Lotion—up to saturated solution. Encouraging.— D. Matheson Mackay, B.M.J. ii./21,738. See also M. Kirkpatrick, per T. D. B., Aug. 15, 1921, p. 83. Liver Changes due to Carbon Tetrachloride or to destruction^of schisto- gomes of great value in treatment.—F. G. Cawston, Pr. Apl. ’31,467. Mental Cases. 2 Cc. of 50% solution injected as sedative. In 82-7% of cases the action was prompt, the patient becoming quiet in 13 to 30 minutes and then sleeping from 5 to 7 hours.—M.P.C. i./23,291. Rheumatism. Injected into the buttock and infra-scapular region. Boat —4 Cc. of 25% Solution daily for the first three or four days and then alternate days.—P.J. i./i2,124. 3 grain doses hypodermically purge and relieve.—- L. ii./ii,481. Hot saturated solution on gauze on the limbs also effective. Rodent Ulcer of the face healed after 5 injections of Magnesium Sulphate. —R. W. Moir, per Pres., June, *23,237. A solution of 35 grains to the ounce useful as lotion in lymphangitis, erysipelas, cellulitis, orchitis, epididymitis and all vague oedemas and swellings.— B.M.J. i./i6,400. Scalds and Burns well treated by a concentrated (25% and over) solution. S. J. Meltzer, Jl. Pharm. & Exp. Therap., Nov., 1918. Tetanus has been treated by spinal, intracerebral and subcutaneous injection—the usual dose being 1 to 5 Cc. of 25% solution. Calcium Chloride is an antidote to Magnesium Sulphate—an injection of 5 Cc. of 5% solution counteracts the effects almost instantaneously. The method was not found of service by our W. O. authorities. Intraspinally it is an anticonvulsant, but it may be better to use dilute solution in large amounts—a pint to a quart of 1 to 2% solution at intervals by hypodermoclysis. Tropical Ulcer treated with wet dressings of Magnesium Sulphate 25§Q solution.—J. F. James, I.M.G., June, ’25,274. Ulcers of the leg treated by soaks of 5 to 10% Magnesium Sulphate solution —J. H. Young, L. i./2q,976. Uraemia successfully treated by slow intravenous infusion of al% solution} (2 Gm. MgS04+7Hs0 in 100 Cc. Distilled Water). Indicated with blood pressure*' rises above 130 mm.—C. B. Watson, B.M.J. ii.,/31,1086. Death following ingestion of 57 Gm. Care should be exercised as toxicity may result without death—idiosyncrasy may exist and the average dose may be: toxic. If toxicity does occur use Calcium salts subcutaneouslv or intravenously.— H. S. Thatcher, Jl. A.M.A. ii./28,1185. Magnesium Sulphate Cream. Mix together exsiccated Magnesium Sulphate 14 lbs. with 11 ounces of' Glycerole of Carbolic Acid (1 in 10) in a hot mortar to make a cream. (The carbolic acid may, however, be omitted.) Pack and thickly cover the wound > with the cream. The dressing of gauze and wool is left unchanged for 3 to 81- days. ^ Profuse discharge of serum takes place, so that more wool may be wanted. After a few dressings like this Magnesium Sulphate solution is used- Good osmotic action and inhibitory effect on the aerobic and anaerobic organisms.—A. E. Morison, B.M.J. i./i8,342. Our method found of service.—A. J. Coulthard, P.J.i.,/30,643. As a Granular Effervescent preparation. Dose.—b to 1 ounce (15 to 30 Gm.), or 1 to 3 drachms (4 to 12 Gm.) repeated, Magnesium Sulphate is frequently more effective, and more palatable. ‘ Vescettes ’ of Magnesium Sulphate, each containing 30 grains. To be crushed and dissolved in a small draught of warm water. Mistura Alba. Dose.—\ to 2 ounces. Magnesium Sulphate 30 grains, Magnesium Carbonate 15 grains, and Peppermint Water 1 ounce. A mild aperient. Magnesii Sulphas Exsiccatus.—If crystallised Magnesium Sulphate be heated at 100° C. it will lose 37—40% moisture. It is a fine white powder without odour with a saline bitter taste, giving a warm sensation to the tongue due to its recombining with water. Almost completely soluble in water. Aqueous solution (1 in 40) should be neutral to litmus paper. Enema Magnesii Sulphatis. b to 2 ounces in b to 1 pint of water. Magnesii Sulphis, V. p. 86. Crignard Rsa tion, Mechanism of.—J.C.S.A. i./2o,30. MALTUM. Maltum. Grain of barley partially germinated artificially and then dried. Yields 70% extract. The acidity calculated as lactic acid should not exceed 0-3%. It should not contain more than 1/100 grain Arsenic, calculated as Arsenious Oxide, to the pound. Maltum F.E. VIII. has Syn. Cebada Germinada. Malti Pulvis- Dose.—1 to 2 drachms (4 to 8 Gm.). Malt flour or entire malt powdered, is added to baked wheaten flour in various proportions to form the popular infants’ foods, and is given to assist digestion. When these are mixed with hot water or a mixture of hot milk and water, the starch contained in the wheaten flour becomes soluble and digested into dextrin and malt sugar. The diastasic property of malt is most active in aqueous solution at 104° F.,—a boiling heat destroys it. A small teaspoonful of malt flour may be sprinkled over or mixed with cooked farinaceous foods,coffee,beer, &c. Diastase. Obtained by exhausting malt with tepid water, precipitating with alcohol, and drying at below 45° C. Is a yellowish white powder or in translucent scales. According to Fr. Cx. diastase converts 100 times its weight of starch into sugar and dextrin. Its use is indicated by the presence of starch grains in the faeces or urine. Extractum Malti.—Syn. Extractum Bynes, Extrait d’Orges. Dose.—1 to 4 drachms. A brownish semi-liquid substance Sp. Gr. about 1 -400, with pleasant sweet taste, consisting principally of maltose (about 50%), with dextrin, dextrose, diastase, proteid, phosphates and aromatic principles. It is made by mixing malt with tepid water (55° C131° F. ), pressing, filtering, and evaporating in vacuo at below 55° C. Extract of Malt and its preparations are prescribed in cases of debility of all kinds, as a restorative, like cod liver oil, but particularly where digestion is weak. It should digest twice its weight of arrowroot starch in 30 minutes at 40° C. (B.P.C., igoi). ft! at fonts? P/lark ( Pharmaceutical) SVia.lt Extract. Under the Agricultural Produce (Grading and Marking ) Act, 1828. and the Malt and Flour and Malt Extract Regulations, 1929, All- English Pharmaceutical Malt Extract is prescribed (with a label, mainly blue) made from home-grown barley. Sp.Gr. must be not less than 1-4, and soluble protein content at least 5% of the total weight. A Lintner value of 25 (method of determining is given) is the prescribed minimum for Diastase. When sold in conjunction with Cod Liver Oil, the mixture must contain 15% of oil.—Ministry of Agriculture and Fisheries Marketing Leaflet, No. 14, B.M.J. ih/29, 1065: L. i./3o,271, ii./3o,672. Determination of activity.—H. L. Hind, P.J. ii./31,363. Further on assay and adulterants, Vol. II. F. E. VIII. incorporates 10% of Glycerin and the finished product must digest five times its weight of potato starch at 40° C. incompatibility. A few yean? ago we determined the compatibility or incompatibility of numerous Soluble Chemicals with Malt Diastase. Broadly speaking, the following are incompatible : Acids, various Inorganic and Organic, also Acid Preparations, Ferric Chloride, Pepsin Preparations, Potassium Permanganate. In Vol. II. ive provide further details. Cf. also ‘ Enzyme Action.’ A mixture of Hydrogen Peroxide and Ferrous Sulphate can liquefy starch similarly to an enzyme. * Radio-Malt (T.M. 468864,476361,468643,476362). A Malt Extract preparation to replace Cod Liver Oil containing V itamins A, B and D, the latter in the form of ^Radiostol (T.M. 477932) produced by irradiating Ergosterol with ultra-violet rays. (See also Radiostoleum and Radiomulsin.) The Vitamin content of the preparation is stated to be greater than that of Cod Liver Oil and Malt Extract, and to be standardised physiologically. It is agreeable in flavour, while the Cod Liver Oil preparation is objected to by many. The undiluted Radiostol possesses 200,000 times the antirachitic activity of Cod Liver Oil, one sixth of an ounce equalling a ton. ♦ Maltaffin. (T.M. Z55Z\l)—Martindale. Dose. One to two teaspoonsful at bedtime. Children, half t one teaspoonful, increased if necessary. A combination of Liquid Hydrocarbon Oil with Malt Extract as a electuary. Suitable for children. The oily taste is largely masked Maltaffin is also made with Hypophosphites, with Cascara, wit Iron, with Glycerophosphates, and with Quinine and Strychnine. Exfr}502<5’ Z0??1/ 4561-93) ,is a T^de Mark Brand of Mad extract. Malt Diastase (antea) m France is called Maltine. "1 ncn (~\ QQQ M. 487573, 269671 & 296716) is stated to have diastasic powe 1 elsewhere)—higher than many of the Malt Extracts on the market Digested se\en times its weight of starch at body temperature.—L. t/09,551 Extractum Malti Liquidum. Dose.—1 to4 drachms (4 to 15 Cc.). In place of evaporating malt infusion to the viscosity of the solid extract, if it be concentrated in vacuo to prevent decomposition of th ferment diastase until it has Sp. Gr. 1-375, and about 7% of alcoho» added, making the finished product of Sp. Gr. 1-250, a liquid extracts formed which is more convenient. Glycerin is added ; Alcohol alone precipitates the diastase.—P.J. ii./o7,732: 5fcB^,n^n 41136 and 41137). A proprietary brand of Liquic Malt FiXt. ® *Bynin Amara. Dose.—2 to 4 drachms well diluted. Contains Quinine Phosphate 1J grains, Iron Phosphate 2 grains Strychnine Phosphate TV grain, in liquid malt extract (Bynin) 1 ounce It is J the strength of Easton’s Syrup. Extraction Malti cum Hypophosphitibus. Dose.—1 to 4 drachms (4 to 15 Cc.). Dissolve Calcium Hypo phosphite 0-5 m water 4, and Sodium Hypophosphite 0*5 in water 1 then add Liquid Extract of Malt q.s. to 100. Extractum Malti cum Cascara. Dose.- 1 to 4 drachms (4 to 15 Cc.). Liquid Extract of Cascara 1 Liquid Extract of Malt 7. This is palatable. Mix and mark ‘ Shake. Extractum Malti Ferratum, G. H., E. Iron Pyrophosphate 2, Water 3. Dissolve and add Extract of Malt 95. Dose.—1 to 4 drachms (4 to 15 Gm.). Extractum Malti cum Haemoglobin. Dose.—} to 4 drachms (4 to 15 Cc.).—Haemoglobin 1, Liquid Extract of Malt 7. Mix and mark 4 Shake.’ Extractum Malti cum Syrupo Ferri Phosphatis. Syn. Malto- ferrose. Dose.—1 to 4. drachms (4 to 15 Cc.). Each drachm contains: Phosphates of Iron 1 grain, and of Calcium i grain, with J grain each of Sodium and Potassium Phosphates. Extractum Malti cum Oleo Morrhuse. Dose.—I to 4 drachms. This preparation should contain at least 15% Cod liver Oil, & * National IViark Aii-Encgiish (Pharmaceutical) IViaft Extract i with Cod Lii/cr OH. • Under the Agricultural Produce (Grading and Marketing) Act, 1928, and the Malt and Hour and Malt Extract Regulations, 1929, All-English Malt Extract of the quality prescribed (q.v.) may be mixed with not less than 15% by volume of Cod Liver Oil of B.P. quality with permissible variation of !%•—■L- ii./3°,672. Extractum Malti cum Fancreatina. Dose.—1 to 4 drachms (4 to 15 Cc.). Liquid Extract of Malt 2, Pancreatic Solution 1. We find this produces a perfectly clear solution without any deposit : on the other hand, made with Pancreatin 2, Glycerin 10, and Liquid Extract of Malt to 100, the result was not satisfactory. Assists digestion of farinaceous food. >fcBronamalt (T.M. 349714, Cl. 42) (previously known as Vibrona Malt). Dose.—1 to 2 drachms with or immediately after meals. Described as a tonic food. A combination of a hydrobromic Extract of Cinchona with a liquid Malt. In cases of impaired nutrition and loss of appetite, especially in children. ^Lacto MaUine (T.M. 156408 Class 42). Dose.—One dessert-spoonful after meals in tea, coffee, milk, wine or farinaceous food. A preparation rich in milk-fat, easily digested. The diastasic fer= rnent acts as an adjunct where there is feeble carbohydrate digestion. Extractum Malti Siccum. Contains about 75% Maltose, 1*5% Phosphates, 5% Albuminoids. Dose.—1 to 2 drachms. A somewhat hygroscopic yellowish coarse powder, easily soluble in water. Is desiccated in vacuo and keeps well. In some experiments, we found British Dried Malt Extract to be more active than foreign, but not quite so active as Extractum Malti. Dry Malt Extract with 50% Paraffin. J)ose.—Infants, one teaspoonful dissolved in slightly warmed milk feed three times a day. Children, two teaspoonsful two or three times a day. Adults, one tablespoonful three or four times daily. Best taken just before or after meals. This has the appearance of a crystalline compound. It emulsifies with water.—L. i./i5,918. sfc Taka Diastase. Dose.—1 to 5 grains (0‘06 to 0*3 Gm.). Taka (T.M. 286557, Class 42). Diastase, Koji, Moyashi—all being ferments and converting agents—included. Originally taken out by Taka- mine. Assigned to Int. Takamine Ferment Co., Broadway, N.Y. A whitish powder obtained by the cultivation of a fungus, Eurotium Qryzce, on bran ; possesses amylolytic properties. Useful for gouty dyspepsia and hyperacidity of the stomach. Taka Diastase in 5 grain Capsules after each meal and at bedtime improves diabetes mellitus,—amount of urine and sugar content lessened.—L. i./n,826. Mead’s Dextri-Maltose. A powder containing 51%. Maltose, 42% Dextrin and 5% Water and at choice, salt free, or containing 2% Sodium Chloride or Potassium Bicarbonate 3%. No. 1 (with salt) is for infant feeding, No. 3 (with Potassium Bicarbonate) for infants who suffer from constipation. No. 2 (salt free) for use by practitioners who prefer to make their owd salt additions.—L. ii./22,520. MANGANESIUM. (See also p. 369). Mn = 54-93. Manganesii Butyras. Mn [C3H 7 C 0 0] 2=229-0392. »ose.-l to 1*5 Cc. of 1% solution intramuscularly—not more than 3 injections should be given with 3 or 4 days’ clear interva between them. Preparation.—Manganese Butyrate is precipitated as a heavy mp l_quid by interaction of solutions of Sodium Butyrate and Manganese Chloride •5s ^iils ^a-shed whh water, dried over Sulphuric Acid, and then washed with Ether to remove free butyric acid. The product is again dried over Sulphuric Acid for some days, and powdered. Characters.—Pale pink powder having only a slight odour of Butyric k lssolves in a^out 6 parts of cold water. The substance is hvdrolised by boiling water with deposition of Manganese Hydroxide.—According to our experiments, 1923. Uses. Boils, carbuncles, erysipelas, whitlows, lymphangitis, lymphadenitis, gonococcal urethritis and abscess formation said to be well treated by Manganese Butyrate Solution (1%). Should be used prior to making incisions in septic lesions.' Two injections should cause the lesion to abort if no pus has formed and if pus has formed the part will come to a head ; then use a dry dressing.—M.P.C., Dec 20/22 In gonorrhoea, the drug ‘ par excellence.’ Intramuscularly into the buttocks on the first and fifth day of the discharge, in doses of 1 Cc. and 1-5 Cc. of 1% solution Results extremely gratifying, the acute stage of the disease being materially lessened. Only two injections should be given.—J. J. Abraham L. i./24,1224. * Staphylococcal and Streptococcal infections better treated than gonorrhoeal. It will ward off an attack of rhinitis, influenza, and other infections providing it is used early. Also used in dermatitis, asthma, and urticaria.— . See also J. E. R. McDonagh, B.M. J. 1/25,655. Miners’ Boils and Carbuncles. Manganese injections recommended —- S. W. Fisher, L. i./3i,750. Vascular Hypertension and Hypotension.—Hypertension and hypotension are stated to be caused by changes in the nature of the protein particles of the plasma. Hypertension is a result of the protein particles leaving the colloidal state and forming true solutions, and is found in cases of chemical intoxication, in some cases of syphilis and diabetes, in pregnancy and at the menopause, and is the natural sequence of old age. The best remedy for acute cases is the injection of 1% Manganese Butyrate solution in doses of 10, 1-5, 2 0 Cc. at five day intervals. In chronic cases, Insulin 20 units is a suitable drug. With all these methods the course may have to be repeated.—J. E. R, McDonagh. M. P.C., Jan. 23 & 30/1924. Manganese Butyrate Sterules. 1, 1*5 and 2 Cc. of 1% solution are made. Manganese Butyrate Solution 1%, 1 Cc. with Sodium Thiosulphate 0*03 Gm. in water 1 Cc. R. B. Billimoria tells us the addition of the Thiosulphate reduces the pain of the Butyrate on injection. Lymphangitis (septic streptococcic), streptococcic and staphylococcic boils, and septic pulmonary tuberculosis cases have been treated. Trimine. Dose.—8 to 15 minims (0-5 to 1 Cc.). A Colloidal Manganese containing Colloidal Iron and a trace of Colloidal Zinc in addition. Advised in conjunction with Colloidal Palladium in treatment of gonorrhoea and complications.—J. E. R. McDonagh, Pr. January, 1920. Manganesii Cliloridum. MnCl2+4H20 = 197-9064. Rose coloured deliquescent crystals. Dementia PRiEcox (but not cases with active organic disease) treated by 30 half-weekly injections intravenously of from 2 to 8 Cc. of a 0-02% solution : then 0-3 Gm. Manganese Chloride per os twice daily for a month. Improves physical condition, but optimum intravenous dose should not be exceeded.— G. E. Reed, Can. Med. Ass. Jl., per M.A. ’31,316. Manganesii Citras, Soluble.’ Dose.—3 to 5 grains (0-2 to 0-3 Gm.). .This, a double salt with Sodium Citrate, and Ferro-Manganese Phosphate Dose. 3 to 10 grains (0*2 to 0-6 Gm.)—are scale preparations. Manganesii Hypophosphis, MnP2H404+H20=203-0168. Dose.— 1 to 10 grains (0 06 to 0-6 Gm.). A white or slightly rose-tinted powder, soluble 1 in 10 of water. A nerve stimulant. Manganesii Oxidum Preecipitatum. Dose.—3 to 10 grains (0-2 to 0-6 Gm.). or more, in pills with syrup. Tablets, 2 grains (0-12 Gm.). Manufactured from Manganese Sulphate by action of Ammonia and Hydrogen Peroxide. Consists principally of Manganese Di-oxide MnCh = 86-83, a bulky blackish brown powder, free from grittiness and entirely soluble in cold hydrochloric 3-ClCl. Uses.—In gastrodynia, pyrosis, and in amenorrhoea taken 3 or 4 times a day before expected period. In chlorosis it assists the action of iron salts and is less irritant than the permanganates. ’ Manganesii Phosphas, Mn3P208.7H20=480-9392. Dose.—1 to 5 grains (0-06 to 0-3 Gm.). A white powder, generally with a pinkish tint, insoluble in water. From \ to 1 grain is given in 1 drachm of syrup of ferrous phosphate Manganesii Sulphas. Syn. Mangani Sulphas, Sulfato de Man- ganeso, F.E. VIII. MnS04-}-4H20=223-0524. Dose, of powder, 2 to 10 grains (0*12 to 0-6 Gm.). A white powder with a faint pink tint, due to a little manganic sulphate, or in pink crystals. Soluble about 1 in l\ water. For jaundice 60 grains is a cholagogue purgative ; not reliable, may cause sickness. Potassii Permanganas. K2Mn208=316-06. (B.P. ’14.) Dose.—1 to 3 grains (0-06 to 0-2 Gm.) in well-diluted solution, or in pill. Capsules contain 1 grain (0-06 Gm.). . Manufacture. -May be prepared by oxidising Manganese Dioxide by the aid of Potassium Chlorate in the presence of Potassium Hydroxide. Electrochemical method. By oxidation of the Manganate in an electrolyser. Surrounding the anode is a solution of Alkali and round the cathode is a solution obtained by lixiviating the melt of Manganese Dioxide and Potassium Hydroxide (Manganate). Dichromates, Perchlorates and Persulphates can be made similarly.—P.J. i./i6,3. Incompatible with all vegetable oxidisable matter, e.g., glycerin, alcohol, sugar, fats and oils, with ammonia, ammonium salts and alkaloids. Poisoning by 15 to 20 Gm. dissolved in water : was treated both by lavage and internally with a cardiac tonic—a digitalis preparation—and also with Magnesia as the presence of hydrochloric acid was alleged. The Potassium had probably produced the toxic symptoms on the heart. Becovery.—L. ii./ii,907. Uses.—The Saturated Solution (1 in 20 of water) is strongly bactericidal, as a disinfectant its colour is an advantage. Even 1 in 1,000 is efficient cf. Vol II. It is a good deodoriser. A dilute solution will dye white hair to a chestnut brown, but this cannot be advised. Gargle, Mouth Wash, or Vaginal Injection 1 of Potassium Permanganate in 5,000 of water is useful. The solution is very nauseous to the taste. Useful for applying to foul ulcers and patches of gangrene, and to carbuncles as mild caustic. References. Amenorrhcea. 1 or 2 grains, in a pill 3 or 4 times a day sbou be given for a few days before the time of the expected period. Also of great value in the Iblae type of young women—florid, not anarm readily tired—pulverettes 2 gr., three times a day after meals. E. K. Mai kenzie, B.M.J. i./25,530. For Gonorrhoea 1 in 10,000 to 1 in 1,000 is used as a warm lr: gation or injection. Injectio Potassii Permanganatis, L.H., has 5 grains in 1 pint, i 1 in 1,600 in round numbers. It is as good (1 in 1,000 solution) as silver preparations. In place injection, irrigation (Janet’s Method) is often used. In cases se early, before acute inflammatory symptoms and purulent discharge have appeared, abortive treatment is sometimes successful, but n likely to succeed after 24 hours. This consists of irrigation of t anterior part of the urethra with this solution.—C. F. Marsha Irrigation with Permanganate for gonorrhoea in the War—no defmi strength adhered to, as the urethra gradually acquires toleration to it. E. T. Burke, L. i./i7,756. Gonorrhoeal Conjunctivitis in the adult treated by prolonged uni termittent stream of 1 in 15,000 to 1 in 20,000 solution.—L. i./i2,91. Gonococcal Stomatitis. Urethral irrigation with 1 in 8,000 Permanganat eyes with 1 in 5,000 Mercury Oxycyanide and 20% Argyrol Drops : mouth was 1 in 5,000 Permanganate. Vaccine. Edwcnil.—A. D. Frazer and J. Mentc* B.M.J. i./3i,1020. Breath, Offensive.—1 or 2 grains in a glass of soda water taken on s empty stomach is a certain cure. Bromidrosis.—Wash the feet first in benzene, then in 1% permanganat (at night). Powder (during the day) with Potassium Permanganate 1 Alum 1, Talc 50, Zinc Oxide 18, Zinc Chloride 18. Bath of borax and benzo also useful. J , , J _ Cholera treated by 2 grains of Potassium Permanganate every i hour ir 2 hours, then 1 pill every 4 hour. These are continued until the stools becoi: green and less copious—this is usually attained in 12 to 24 hours. A wes solution (1 to 6 grains per pint) of Calcium Permanganate is allowed as adrin: 50 grains of permanganates by the mouth in 24 hours have been given witho harm and even larger doses would probably be tolerated—in addition hype tonic’saline injections (q.v.).—B.M.J. i./n,760. Rectal Injections 4 grai to the pint have also been used. # Dermatitis among painters, following use of paint solvents, cured m days by 1 : 1,000 solution Potassium Permanganate.—J. A. Turner, Jl. Indus- Hyg., July ’25,293 ; Per Pres., Oct. *26,351. . . Dysentery, Asylum.—A solution of Permanganate, 1 grain m 20 ounce is used. The patient swallows I to 1 or 2 ounces several times a day. r urgent cases, 20 m. approx, injected deeply into the buttocks—results oft* remarkable.—W. J. A. Erskine, B.M.J. i./25,530. . Epidermophytosis, Intertrigo, Eczema Marginatum and eczematoid nnt worm well treated by solution 1 in 5,000 gradually increased.—S. Eeldnm and B. F. Ochs, per Jl. Trop. Med., June 1/23,198. Lupus nodules have been treated by applying saturated solution or » boring holes with wooden skewer, filling with permanganate and moistening tJ surface with water and repeating a few hours later, using novocain and adrenal! Ozgena. A spray of the Liquor 5 minims with Sodium Chloride 5 grains the ounce of water is useful.—H. Tilley. Pneumonia see Thyroid and fVSanfgan&se postea. Pyodermia well treated with baths containing Potassium Permanganat Copper or Zinc Sulphate or Sublimate— B.M.J.E. ih/25,80. Sloughing and Tetanus-infected Wounds, according to Sir Leonau Rogers, may be well treated with not less than 1 in 500 Potassium Perrna ganate Solution. 547 Smallpox..—p°tassmm Permanganate in saturated solution (w \ usetul for panning the body. If skin sensitive, use 1-5% In confluent cages’ patient put m a bath of this 5% solution, at body temperature for 10minute* Reduces smell and sloughing.—L. ii /22 1103 ‘ ipeiarure, iox 10 minutes. Styptic for serous surfaces.—In’cases of haemorrhage from sunerflcial hSimnm surfaces after separation at adhesions, a few in a folu of hnt—or muslin—with forceps causes blood coagulation ' C mg stops au once. Oxygen is evolved.—J. Dsirne L i /21 1380 JSKS an<1 daCtyIitiS have “ »y packing with onnc™ot°edSby St“ Kdfde.0 Pota88ium Permanganate 1 drachm to the nrpVAtfnule^a^e application of a solution of Permanganate 1 in 1 000 will ES ‘ttse“aSe66°f VENEKEA1 Wlnsey BayiA“ AStKtt 510 6 Cm-for an ^ omiting. of Pregnancy has been treated by 2 to 4 grains Potassium Per- giving immediately afterwards 3 to 4 ounces of water Pataemt keeps this in the stomach 10 to 20 minutes-lving very sthl-then a perhour!1016 °f Warm water’ If necessaiT a further 1 grain of Permanganate War Wounds have been treated by the powdered permanganate. Thyirosci atatf ‘T’c''Gcits Acute Infections, Joint Diseases, Heart Disease'WnosmtPufoTn ?ivEEST?o,’™?i|EAtE.S 0E Pkegkahcy, Disorders of MetaborismE fis” THEskinDrnmR^lvtEMvv^PLAINTS^PclM0NARY Diseases, Diseases of the bkJA Goitre aad Myxcldema, Disease op the Breast etc treated by rectal injections of Potassium Permanganate 1 grain in 1| pints of sterile Warni water. Tne amount is varied according to case, e.g 2 doses of 1 ninf may be found more effective than 1 dose of 4 pint. Warn patients they may m™Swhu pa«1^ 111 th7€.P^astnum within a few minutes, also they may pass long white skins or strings of mucus in the stools. TfaWoid is ghnn simul- 1nglaia t'vice daily, but doses of 61 grains or 5 or 10 grains are p??iptcafe1s1 desiraole. Sometimes the Permanganate may be used per os H. W. Nott B M.J iUAi^ii /aTfoW W*tOT’ bUt tWS te not 60 beMa°^^fi'?CmTrka4ble r.esillts*. . JP is suggested that Permanganate a .spec4flc- treatment consists m rectal injections of 3-10 ounces —HPwaNorim-R solution.(4 grains in 3 pints) every 2 or 4 hours. H w N-mt m^u11#?’109,: Basic principles underlying the treatment.— H. VV t^ott, B.M.J. i./28,94. See also B.M.J.E. ii./2g,43. value of treatment confirmed in 5 consecutive cases of acute pneumonia.— N-,A E°c.h<?; l-!27’ 459- See also &M.J. i./27,539. i,?e ‘UstnbTit.'oii of Manganese in the animal and in foods. The combination 01 -EA?1?1'• f, JJanSanese may have a physiological basis of much significance I5.1V1. J. ‘i./25,4bS. tif fiUrtlnr discussion on the effects. A point regarding casts caused by action of the alkali formed.—J. S. Kellett Smith, B.M.J. i./25,678. A combined cachet of Potassium Permanganate and Thyroid gives effects m cases of neurasthenia accompanied by low blood pressure, not obtained bv giving the two separately. The Thyroxin is probably not destroyed by the Permanganate m this way. The therapeutic effect may be duo to a new substance produced by the reaction of the two.—J. T. Blackie, P.J. i./26,231 ; u.jj. i./2d,306. nuud1 5n1700? solution per rectum 4-hourly of value, even in debilitated cmiaren almost moribund ; in conjunction with antipneumococcus vaccine a g0.°d armamentarium.—A. A. Hearne, B.M.J. i./28,159. H. L. McCormick loicl 3 / /. Snake bite lancets (Brunton’s) are prepared containing the crystals. Directions.—Squeeze the part so as to press out the venom, then cut with the lancet, making several incisions deeper than the bite, and rub in the dry crystals thoroughly, moistening with water if necessary. Tie a ligature or handkerchief between the bite and the heart as soon as possible to prevent the venom gettir into the circulatory system. Equally good in all kinds of snake bite. If a tube of ethyl chloride is at hand spray the part whilst making incision Scokfion Stings are best treated by ammonia or an evaporating lotion the affected part, also Potassium Permanganate as in snake bite.—L. Brunto* L. ii./i5,200. A few drops of strong Permanganate solution injected rouir the part.—A. S. Gubb, B.M.J. 0/23,41. A case of adder bite, treated with Potassium Permanganate Crystals, h rectal injections of Normal Saline, hypodermic of Strychnine and 10 Cc. Normal Horse Serum thrice daily—recovery.—B.M.J. i./i2,420. Bougies of Potassium Permanganate contain 4 grain (0'03 Gm» in Theobroma Oil basis, 4 inches long. Pilula Potassii Permanganatis. 1, 2, 3, 4 or 5 grains with Kaol Ointment, q.s. Caution ! Avoid mixing any easily oxidised substance, lit sugar, glycerin, etc. The pills may be coated with sandarach solutio Tablets contain 1, 2 and 3 grains. To be dissolved. Solubes 5 grains for preparing lotions and vaginal injection to be dissolved in \ a pint or more of water. Lotion ‘Sterules ’ of Potassium Permanganate contain 8-75 grain 1 diluted to 1 pint produces a 1 in 1,000 solution. Permanganate Tablets for purifying Drinking Water. (Laurent’s.) To each litre of water add Potassium Permanganate 0-03 Gm. and Powder Alum 0-06 Gm. After standing 5 minutes, if the solution is not pink a« another tablet or two. Remove excess of Permanganate by Sodium Hyp sulphite 0 03 Gm. and dried Sodium Carbonate 0 06 Gin. After 10 minutr pass through cotton wool. Ingredients may be in tablet form.—P. J. i./i 5,12 Calcii Permanganas. Ca(Mn04)2+5H20=368-008. Dose.—\ grain (0 016 Gm.) in Pills or Capsules (with Liqu Paraffin as vehicle) thrice daily one hour before meals. Deliquescent crimson crystals preferred for making mouth lotior as it has less taste than the Potassium Salt. 1 in 100,000 sterilis water in 5 minutes ; more powerful than the latter. Uses. — Similar to the Potash Salt, e.g., in cholera. Has be- given in rodent ulcer, gastric ulcer and gastritis. Calcium Lactate and Iodide found most effective in removing warts fre the hands. The use of Calcium Permanganate resulted in disappearance ulcers in several cases, removes offensive odour.—G. Arbour Stephens. Sodii Permanganas. Na2Mn:08 = 283,854. In solution, red in colour, is used as a cheap disinfectant. #Cond> Red Fluid (Condy’s & Condy’s Fluid and Condy’s Fluid Co. are covered a large number of Trade Marks, Class 2) is stated to be a mixture of the so* phate and permanganate of soda.—H. R. Kenwood, L. i./26,1055. sfcCond; Green Fluid has Sodium Manganate Na2Mn04 = 164-924 in solution. Zinci Permanganas. Zn(MnO,)2 + 2H20 = 339-2712. Deliquescent brown crystals ; for lotions and injections, 1 grain in 8 ounc (1 in 4,000), where the astringent action of the zinc is indicated. As an e? wash 1 in 1,000 to 1 in 2,000. Injectio Zinci Permanganatis, L. (Urethral). Has 4 grain in 3 ounces (1 in 2,625). For gonorrhoea excellent.—-Campbell Williams. For pyorrhoea alveolaris and oral sepsis as mouth wash it is ve: useful. ‘ Collapsubes ’ with catheter attachment, of Zinc Permanganate in S' Paraffin ; strength 1 in 2,000 for use in chronic gonorrhoea. Zinc Permanganate Bougies, 4 inches long, containing f grain (0-03 Gr in Theobroma Oil basis are prepared, MENTHOL. 549 Manganese Poisoning—cases described Poisoning due to inhalation of dust whil Per Clin. Jl., May 16, ’23,233. grinding the ore.—It. F. Gayle, MENTHOL. Methyl-propyl-phenol Hexahydride. C10H,0O--=156-l 56. Dose, b to 2 grains (0-03 to 0-12 Gm.) or more in a pill with powdered soap, or in solution in olive oil. A white crystalline substance deposited on cooling oil of Peppermint q.v. Obtained from Mentha arvensis, vars. piperascens et glahrata, and M. piperita (Labiatce), it melts at 42 to 43° C. Soluble 5 in 1 of 90% Alcohol, also in Ether 2 in 1, Chloroform 4 in 1 approximately, 1 in I of Olive Oil, and in Petroleum Spirit 10 in 7. Sparingly soluble in water, insoluble in glycerin. Soluble on warming in a strong solution of Sodium Salicylate, but throws out again. Uses.—Given internally, it acts as a diffusible stimulant. Of value in the vomiting of pregnancy and other forms. Its solutions, applied to the skin, affect the nerves of the part somewhat like aconite, and form useful pigments for headache, rheumatic pains and neuralgia. It has antiseptic and amesthetic properties, and gives great relief in prurigo, urticaria and pruritus ani. It liquefies when gently rubbed on the painful part. As an anti neuralgic in toothache and for sciatica 1 in 60 of Alcohol with a little Clove Oil, is employed ; also Menthol Cones. The crystals on cotton wool may be placed in the hollow of an aching tooth Gcznjiizzrs.—It is dangerous to apply an ointment containing Menthol to the nostrils of infants, e.g., for treatment of catarrh,— may cause instant collapse.—Cf. Camphor. Menthol liquefies with an equal amount of either Carbolic Acid, Chloral Hydrate or Thymol, also 3 parts of Menthol and 2 parts of Camphor, 2 parts of Menthol and 1 part of Butyl Chloral Hydrate, and 2 parts of Menthol, with 1 of each Phenol and Butyl Chloral Hydrate. These will relieve toothache. Its Camphor and Phenol combinations are used to medicate oro-nasal 4 Osonic ’ and other dry inhalers, and are most beneficial for arresting and curing colds, and relieving influenza and chest affections. For the inhalation of hot medicated moist air the ‘ Portable Inhaler ’ may be used cf. Creosote and other vapours. Menthol—Camphor and other combinations, diluted with a heavy mineral oil, for spraying into the nares or in spirituous solution, inhaled as above, relieve swelling and irritability of nasal catarrh, contract capillary blood-vessels of mucous membrane, reduce swelling, relieve pain and fullness of head, arrest sneezing, check excessive discharge, and correct perverted secretion, cf. Nebulie. Aqua Mentholis. Menthol 1, Alcohol 15, Distilled Water 1,000 ®Menthophenol. Menthol 3, Phenol 1. Useful as garde 15 drops to the tumbler of water. Menthol Plasters, 10 to 15% in a suitable basis (® if Lea basis) are useful for rheumatism and intercostal neuralgia. Xnjectio Mentholis. Menthol 0-5, Liquid Paraffin 100. Eor use with an Eustachia catheter to the middle ear. Xnsuffiatio Mentholis. Menthol 1, Ammonium Chloride 3, Bor Acid 2, and Lycopodium 6, relieves nasal catarrh. Up 1 Insufllatio Menthol et Cocairue R.F.H. Menthol 3 grain Cocaine Hydrochloride b grain, Boric Acid Powder b ounce, Bismut Carbonate b ounce. U P 1 Pul vis Mentholis CONTRE LE CORYZA. Fr. et Cocaine Compositus. Syn. Poudp Cx. Supp., 1920 Menthol 1, Cocaine Hydrochloride 0-5, Bismuth Salicylate 4 Boric Acid 50*5. CULinimentum Mentholis. Menthol 3, Chloroform 4, Olive Oil q.s. to 16 ; is useful in lumbago neuralgia, sciatica, and ringworm. |P IjLinimentum Mentholis Compositum.—S. H. Menthol 2, Aconite Liniment 1, Chloroform 4, Soap Liniment to 32 In pruritus, Menthol 1, Camphorated Alcohol, Chloroform an Ether of each 3 “ dabbed on ” lessens irritation. Menthol-Paraffin Capsules contain a 1% solution of Menthol i Liquid Paraffin. These have elongated ends, which can be tor off, and the contents dropped into the ear to relieve earache. Mentholeate. Menthol and Oleic Acid p. ccquctlcs. Heat gently t dissolve. Useful in pruritus, etc., where absorption is desired. Linctus Mentholis.—Vic. Park. Menthol 1/16 grain, Glycerin 8 minims, Cherry Laurel Water 10 minima Alcohol 90% 12 minims, water to 1 drachm. Pas till us Mentholis, T .PL, contains b grain. Pigmentum Mentholis.—1 to Olive Oil 4. Painted or injecte into the larynx, or even the trachea, useful in phthisis, and laryia geal disease. Also applied on wool for ear affections. Nebula Mentholis, 0-5 to 2% in Liquid Paraffin or Olive Oil is used fo spray or pigment for throat. Relieves acute laryngitis.—Tilley Vapor Mentholis Citriodoratus. Menthol, Eucalyptus Oil (from variety E. Citriodora), Eau dJ Cologne, and Alcohol 90% of each, equal parts. A little inhaled, e.g., from an Ozonic Inhaler or the handkerchief is valuable for nasal catarrh and influenza. Unguentum Mentholis (3%) et Camphors (2%). Hay feve is well treated with, applied to the nasal passages in small quantity Pigmentum Mentholis cum Guaiacol. Menthol 1 grain, Guaiacc in crystals 1 grain, Oil of Almonds to 1 ounce. In acute tonsillitis, brushing with Menthol and Guaiacol (10% Menthol and 3 or 4% Guaiacol in Olive Oil) often has a good effect.— Dundas Grant, Pr. Mar. 1912. Tabellse Mentholis. Dose—1 or 2, ad libilum. Contain J grain menthol, combined with chocolate. Piluia Mentholis. 4 to 2 grains, Mass with Powdered Soan or half its weight of White Wax previously just melted. ®Tinctura Menthol ZEfcherea, for local application. Menthol 1, X uiified blither 4, and Chloroform 4. In neuralgia. Gossypium Mentholis. 10%. Saturate Cotton Wool 85 with Menthol 10 and Liquid Paraffin 5 in Ether 265 and spread out to ciry. Useful to plug the nose in nasal catarrh. Menthyl Valorianato. 4^ V alidol. Dose.—10 to 15 minims (0’6 to I Cc.). Trade Mark 216165. Patent 3706/1896 now vo/a. The specification contained in the patent method is so exceedingly vague as to lead one to assume that this is not a definite compound. ’ It is admitted to be a mixture of Menthol and Menthol Valerianate Commercially we find the preparation apparently a solution containing about 25% menthol in Menthyl Valerianate. To make true Menthol Valerianate one would proceed by the customary methods of producing esters e.g. •_ (1) Valerianyl Chloride to interact with Menthol with the ’ application of heat; or (2) The passage of dry gaseous Hydrochloric Acid into a mixture of Menthox and. V alerianic Acid in equivalent quantities to saturation point— the mixture being heated with reflux condenser during the process. The product to be finally washed free of Hydrochloric Acid. p A colourless liquid with agreeable odour and free from burning taste of menthol. Nerve sedative. Used in sea-sickness. t Synthetic Menthol (the subject of several patents), as distinct from the B.P. '14 Menthol is an optically inactive isomer. Its B.pt. is about 214—215°. Its M.pt., when quite pure, 34° (Natural Menthol 43°). Commercially the synthetic type is supplied with M.pt. about 30° as it contains a small quantity of an Iso-menthol. In other respects the two are very similar in cooling effect, taste, smell, etc. Physiologically it is 21 to 3 times more ‘ toxic ’ than the ordinary, but Menthol can hardly be so termed. Prolonged inhalation is said to be more poisonous than that of ordinary Menthol.—P.B. 1022 294* Y.B.P., ’23,111. The patented method consists in hydrogenating Thymol under pressure, using a Nickel catalyst. By agitating the liquid portion of the product with the next batch of hydrogenated Thymol an increased yield of crystalline substance is obtained.—P.It., ’24,162. See also ibid, ’24,27?. The synthesis of Thymol and Menthol from p-Cymene and 2-Cymidine. Patent specifications.—P.B., ’24,316. Inactive Menthol with M.pt. 35—36° said to be safe pharmacologically.— P.X. ii.,/27,176. 1B1 MORPHINA. Fe. Cx., f.e. viii. C17H17NO(OH)2,HsO=303-1718. Ill Morphine and Diamorphine (commonly known as Heroin) and their respective salts, preparations and substances containing not less than one-fifth per cent. (one part in five hundred) of anhydrous morphine or any proportion of diamorphine (except certain recognised formulae). See also Opium and 1925 D.D.A. iS Esters of Morphine and their respective salts, and any preparation, admixture, and extract containing any of them. Also Di-hydro- Morphinone (Syn. Dilaudid) its salts, and any preparation, admixture, extract, or other substance containing any proportion of it. (Order in Council, 1930.) The esters do not include and should not be confused with the ethers '■ of Morphine, e.g., Methyl-Morphine (Codeine), and Ethyl-Morphine (Dionine) to which the Acts do not apply.—Home Secretary, P.J ih/29, 276. The following is a useful explanation of the position relative to ‘ Esters ’ :— Amendments to the D.D.A. (Aug. 15, ’29) have revealed a certain amount oru ambiguity in the scope of the Order in respect of Morphine derivatives (Ester; and Ethers). An explanatory Memo, issued by the Home Office stated that the Order applied to Morphine derivatives known as Esters, and not to Morphine derivatives known as Ethers. The inference is tha Morphine Esters are subject to the restrictions applying to Heroin Codeine, which is a Mono-methyl-ether derivative, and Peronine, s Benzyl derivative, are therefore excluded. The reason for this division is possibly due to the fact that Esters (e.g., Heroin) as a class are unstable (easily hydrolised into components), and favour addiction whereas the Ethers (e.g., Codeine), are comparatively stable and do not favour addiction.—J. Tait, P.J. ii./29,604. Dose.—yo h grain (0*006 to 0*02 Gm.). This, the principal alkaloid of opium, is in a white powder, or ir white, shining crystals, Soluble in water about 1 in 5,000 slightly in ether and alcohol 90% ; glycerin 1 in 150, oleic acid J in 10 ; solutions of its salts are precipitated by ammonia and by potash (but re-dissolve in the latter ). It loses about 6% of its weight on drying at 90° C., 3 parts of Morphine are reckoned approxi mately equal to 4 parts of the Acetate, Hydrochloride, or Sulphate Morphine was discovered by Sertiirner in 1806, or possibly earlier by Derosnt (1803).—B.M.J. i./2i,59. Morphine made on large scale at Darmstadt.—P.J. i./3v,380. Incompatibilit!/.—Morphine salts are decomposed by alkalis and solutions are precipitated by vegetable compounds containing tannin, also with iron, lead, manganese, silver, copper, and zinc salts, liquor arsenicalis and potassium permanganate. The alkalinity of glass bottles (especially colorless) may throw our a very appreciable amount of morphine from a solution of a salt. Antidotes.—Emetics should first be given and the stomach tube used. Wash out the stomach with Potassium Permanganate Solution ; give strong hot coffee, or Ammonia, or Ether, Amy Nitrite inhalation. Powdered Charcoal in Water ad lib. Physio logical antidotes are Belladonna and Atropine. o^b gra,in of the latter antagonises 1 grain Morphine (draw off the urine with catheter frequently). The following have also been given with good effect? hypodermically :—Nitroglycerin, Picrotoxin, Pilocarpine, Strychnine Oxygen inhalation, Saline solution intravenously and Brandy pet? rectum. Potassium Permanganate as an oxidising antidote for many alkaloida poisons. Should be \ised with stomach pump and emetics—more potent thaia physiological antidotes. Morphine Suppository (1 grain) given in place of Glycerin—to infant £ months, recovery under permanganate per rectum, and syphoned into the stomach.—B.M.J. i./12,724. . . . . , , Atropine jo grain in doses of gram at intervals brought recovery where 4 grains of Morphine had been injected.- B.M.J. i./o5,1040. Opium Poisoning treated by Earadic current.—L. i./i2,1120. Opium and morphine may poison infants through the mother s milk. Poisoning by apparently 7 grains of Morphine and -<■- grain Atropine (com- , Treatment.- Stomach washed out with Permanganate. Injections of-Strychnine and bleeding. Death.—B.M.J. i./i3 1271. ^ .Morphine poisoning in a baby of 10 days (due to pre-anaesthetic injection of 1/48 grain Morphine) combated by a mixture of 10% Carbon Dioxide and 90% J1XAMA I %9 iU927Ure 18 kn0Wn in the U*S*A- as 10-90.-J. R. McCurdy, Flavoring of liquid preparations of Morphine.—Glyl Rosas, Syl Amygdalae Amarae ; Syrupus Aurantii. Uses of Morphine Salts.—A general and most useful sedative and anodyne for all purposes, preferably hypodermically, but may cause indigestion and constipation. Haemoptysis is well treated by h 1° i graiii hypodermically. Employed in diabetes, but Codeine generally preferred. May be given in renal cases.—For restless painful nights with cardiac dyspnoea. Give a small dose at first. Acute uraemia occurring with a chronic parenchymatous nephritis cured by Morphine and Atropine. The urine was almost solid with albumin. Venesection and Oxvgen also employed.—A. H. Carter B.M.J. ii./i2,1181. Mania may be treated by \ grain dose with chloroform in addition. The two together produce deep sleep lasting several hours. Either alone is comparatively of little avail. For children, contrary to usual opinion, experience showed that Morphine is well tolerated. It is preferable to the various Opium preparations. The initial dose is 1/10 milligramme per kilo of weight hypodermically. In children of 8 to 12 years 0-005 to 0-01 Gm. of Morphine Hydrochloride with Atropine was given.—P.J. ii./i2,810. Cardiac asthma, acute attacks. Morphine ^ grain subcutaneously of great value.—Claude Wilson, L. ii./23,1346. Whooping Cough cured by small doses of Morphine more speedily than by any other remedy.—B.M.J. i./25,1007. Morphine acts only on certain pain centres in the bruin and is therefore wasted in Lead and Opium Lotion and Laudanum fomentations. Rectal Morphine suppositories are efficacious only so far as Morphine is absorbed and carried to the brain. We are apt to fear the secondary effects of Morphine too much, rather than too little, and to forget that large doses of the synthetic products may cause sweating, rashes and sometimes cyanosis. —E. B. Leech, L. 1/24,915. May be given without fear of renal complications secondary to its use.—R. 8. Ackley, Jl. A.M.A. i./3o,79 ; L. i./3o,3(54. Intravenous Use.— Coronary Thrombosis. Violent substernal pain treated by 1/8 grain Morphine and 1/120 grain Hyoscine—as salts—failed to yield, but 1/3 grain Morphine salt intravenously gave dramatic effect. It is not known whether Morphine suits intravenously ate safe, but it was effective in this case.—F. Moor, L. ii./3o,959. In labour Morphine lessens the frequency of contractions, but pains pass off more slowly, so that the work done by the uterus is probably as great as, or greater than before, despite lessened frequency.—A. W. Bourne and J. H. Burn, B.M.J. ii./3o,87. Treatment of Drug Addiction. In Morphine Habit Sparteine Sulphate has been used to replace the Morphine solution, commencing with 4, increased to § grain. four to six times a day. Sodium Bromide and Nitroglycerin Tablets are useful, q.v. Camphor has been given to relieve the craving also Heroin and Dionin. For the insomnia Gamgee suggested Veronal, for the circulatory and respiratory troubles full doses of Digitalis Tincture, repeated hypodermic Strychnine ab grain) injections. For the gastric catarrh Bismuth Carbonate (as much as; 5 Gni.) first thing in the morning, with directions to change resting position as is done in treatment of gastric ulcer. Turkish baths, heart tonics and Sodium Bicarbonate, e.g., as Vichy Water with gradual weaning from the Morphine by the patient himself. With these-' exceptions, ‘ drugs,’ especially hypnotics, should be little used. The habit can be “ knocked out ” in a relatively short time by Hyoscine and Atropine- Sparteine useful, also Bromide.—O. Jennings. Morphinomania cured by Hyoscine. A severe case in which patient was taking 6 to 10 grains of Morphine Sulphate daily.—W. K. Anderson, Pr., June, 1912, per Pres., Oct., 1912, p. 255. Bebeerine in dose of 0T to 0-2 Gm. in conjunction with Helenium has been used. The sensations of Morphine (and cyanide) poisoning.—P.J. ii./22,218. The morphinist is not a mental defective. Drug addiction does not lead to insanity or serious nervous diseases needing custodial care, but it makes the habitue more dangerous to society. It is not difficult to recognise drug addicts in society. Chief characteristics : plausibility and disorderliness. They lie for the sake of lying. They can work and write under the drug but disjointedly and in slovenly fashion. 15 grains of Morphine is an ordinary quantity for a morphinist to use in the 21 hours, though the same person will double this dose in case of any small imaginary trouble. The addict will probably never give information leading, to disclosure of his source of supply, Results of withdrawal are described. Difficulties of treatment. The temperance is dependance on self control, not on control by others.—W. E. Dixon, B.M.J. ii./2i,821. See also Prof. Dixon under Heroin, Opium and Cocaine. Cases of Morphine Addiction over long periods, e.g., a man of 71 who had taken 30 grains daily for 40 years, cured by graduated doses and course of treatment in a few months, and others of an equally extraordinary nature. The conduct of these persons on emerging to. relatively normal life gives grounds for grave anxiety.—Stanford Park, L. ii./26,121; P.J. ii./26,12(3. In a typical case taking 12 grains of Morphine daily the dosage is cut down by 1 grain daily until 6 grains is reached, and this dose is continued until final reduction stage begins, when it is reduced by gradually decreasing amount until final withdrawal 17 days later. Use a solution of 1 grain in 30 minims and give 4 injections in 24 hours, at 8 a.m., 12 noon, 5 p.m. and 10 p.m. The; bulk and appearance of the injection must always be the same and patient musk never have any idea of the size of dose. During the initial stages (up to G grains) both health and mental condition improve, but in the later stages: and on total withdrawal there is great mental distress, insomnia, weakness^ loss of appetite, and other symptoms. Blood pressure should be carefully watched : at withdrawal point the pulse becomes thready and this becomes more marked for 48 hours after withdrawal. If necessary, the injection oil £ grain Morphine will restore pulse in a few minutes. During the final stage; the patient is given the following mixture : Ammonium Bromide 2 drs..„ Potassium Bromide 1 dr., Tincture of Kola 1 oz., Concentrated Gentian Compound Infusion 1 oz., Liquid Extract of Licorice 4 drs., water to 6 oz." one teaspoonful every 2 hours in a little water, continued until 4 days after withdrawal and then for G to 8 weeks without the Bromides. Also add 1/60) grain Strychnine Sulphate to the 8 a.m. injection, and inject 1 Cc. isotonic^ Colloidal Gold twice daily and | Cc. Calcium Glycerophosphate, 3 grains in 1 Cc., once daily. Hot baths of value for restlessness. Alcohol should! never be given either during or after withdrawal. Patient should be quite-- well and fit for work in from 4 to 6 months after withdrawal.—D. E. Stanford! Park, Pri} Nov., ’27,207—307. See also Colloidal Gold. morphina. 555 over erdosaSe bvJ‘‘<Sr!>H^|Slinv<ll<1™^,<1 coyc^ed by tw° successive waves of 1 donna and th? Hn fic^stmS ol.eWa> C^rts of Tincture of Belladonna and the fluid extracts of Hyoscyamfls S Xanthoxylunl of p 22b) and Luminal respectively. When the total dose is reduced to * crafn in 24 hours without discomfort, for two days saline is given in pla?e of the dlvf—^Lanehton1 Wt ^ “A n0,cns'|- Treatment lasts ten to fourteen SteSord pJSkMj.U%’V,1056 ’ 27’ ®' S°e alS° ii‘/27>827> anrt Emetine Hydrochloride in the treatment of alcoholism and Morphine habit. Three doses each $ gram (0-01 Gm.) per day for the first month or two ? ; afterwards i grain twice c any for Morphine patients. For alcoholism | grain i every other day— M. Vivian, M.P.C., Nov. 29, ’22,448. b , T: . J i-t. 1 „ * l1 ....I" l (I! I contain ^ and x grain> ‘ j have tound the i gram Emetine bterules most useful in my patient’s case. Two ! nay s before X got them he 'was very sick and had dry retching and could take ’ ‘ ^ one Sterule twice a day. The first settled his stomach and also enaoled him to take less of the Morphine.’—A private communication. Morphine Addicts—1926 Committee’s Report on Addiction. bee Dangerous Drugs Acts. Morphine Addiction is not characterised hy physical deterioration, apart from the addiction per se. No change in circulatory, hepatic, renal, or endocrine functions even after 20 years’ addiction.— A. B. Light, per M.A., ’31,14. See also Cocaine, Morphine, Heroin, Nicotine and Opium for further consideration of the subject. Morphine 1, Oleic Acid 60. Dissolve. IP X] Oieatum Morphinae. Oleic acid will dissolve as much as one-tenth of its weight of pure morphine. Morphine is added to oleate of mercury to relieve pain [PI BFH Morphines Acetas, Morphine Acetate (B.P. ’14). C17H19N03,C2H402,3H20 == 399-2342. JL i-- ~ o7 ~ Z-'i ~ -Z ~ Dose.—J to 4 grain (0-008 to 0-03 Gm.), which may be increased. A white powder, sol able 1 in 24 of water, also about 1 in 100 in Alcohol 90%, Glycerin 1 in 5. [IP lj Xnjectio Morphinae et Atropinae Hypodermica, Martindale. Contains Atropine Sulphate 1 grain in 3 drachms of injection of Morphine Acetate (1 grain in 6 minims). (See also Sterules, p. 558.) Dose.—1 to 3 minims (3 minims contain half a grain of morphine acetate and W grain of atropine sulphate). The atropine increases the sedative action and counteracts the disagreeable effects of the morphine on the head, stomach, and bowels. ggjJPl] Liquor Morplxinae Acetatis (B.P. ’14). Dose.—10 to 60 minims (0-6 to 4 Cc.). Morphine Acetate 1, Diluted Acetic Acid 2, Alcohol (90%) 25, Distilled Water to 100. CEDPastillus Morphinae Acetatis (% gr.), v. Pastilli. M E] PastiUus Cocainae (f-5 gr.) et Morphinae (W gr.). Ijgj EO Morphine Hydrobromidimi. C17H1(JN03.HBr.2H20 - 402-1112. Dose.—4 to J grain (0-0G8 to 0-03 Gm.). A white powder, soluble 1 in 22 of water and about 1 in 50 alcohol 90%. Given with hydrobromic acid as sedative, affects the head less. H JO) Morphinae Hydroshloridum B.P. ’14, U.S., Fr. Cx., P.G. VI., P. Ital. V., F.E. VIII., P. Belg. IV. C17H19N0qHC1.3H20 =* 375-6678. Dose.—J to \ grain (0-008 to 0-03 Gm.), which may he increased. In silky white crystals or in powHer soluble 1 in 25 of water, about 1 in 67 of alcohol 90% (by expt.), and about 1 in 8 of Glycerin. Guttae Morphinae et Cocainae (Aural), Morphine Hydrochloride 4 grains, Cocaine Hydrochloride 24 grains, Glycerin 1 drachm, Distilled Water to 4 ounce. N.B.—A 'potent preparation. (£)Linctus Morphinae, U.C.H. Solution of Morphine Hydrochloride 3 minims, Chloroform Emulsion 3 minims, Treacle 60 grains, Water to 1 drachm. May be more' agreeably flavoured with syrup of lemon. Dose.—A teaspoonful 3 or 4 times a day ; repeated frequently when cough is troublesome. Taken undiluted, swallowed very slowly. For children of 8 to 14 years, dose 10 to 20 drops. Not suitable for very young children, or in difficulty of expectoration in bronchitis. CeD St. M.’s H. has Morphine Hydrochloride Solution 10 minims. Honey J drachm, Water to 1 drachm. C£)Linctus Morphinae, C.X. Solution of Morphine Hydrochloride 2 minims, Spirit of Chloroform 2 minims, Ipecacuanha Wine 2 minims, Mucilage of Acacia 4 drachm, Water to 1 drachm. CE)Linctus Morphinae Compositus, N.H.I. Dose.—1 drachm. Morphine Hydrochloride Solution 5 minims, Syrup of Tolu and Acid Infusion of Roses equal parts, to 1 drachm. (P^Linctus Morphinae Hydrocyanicus (Ogle’s Drops), St. G. H. Dilute Hydrocyanic Acid 1 minim, Solution of Morphine Acetate 3 minims, Oxymel of Squills to 1 drachm. JU ED Guttae Rosae. Dose.—2 to 10 minims (0-12 to c-6 Cc.). Morphine 1, Citric Acid 0-5, Cochineal Tincture S, Water to 50. For cough,—a useful name and method of giving the drug.—Ph. Notes (Denmark, modified). ®Mistura Morphinae et Phenazoni Composita, Marlindale. Dose.—1 ounce (30 Cc.). Solution of Morphine Hydrochloride 10 minims, Phenazone 10 grains, Tincture of Castor 20 minims, Spirit of Chloroform 10 minims, Syl Lavandulae 1 drachm, Mucilage and Water to 1 ounce. This is virtually a specific for spasmodic dysmenorrheea.—W.W.W. Rubra. Dose.—J to 2 drachms (2 to 8 Cc.) CP)Mistura Tussi in a little water. Dilute Hydrobromic Acid 5 minims, Morphine- Hydrobromide -.jV grain, Diluted Hydrocyanic Acid | minim, Spirit of Ether 5 minims, Tincture of Cudbear 5 minims, Syrup to 1 drachm. This forms a popular winter-cough mixture. P] [Pj] Liquor Moiphinae Hydrochloridi (B.P. ’14). Dose.—10 to 60 minims (0-6 to 4 Cc.). Morphine Hydrochloride 1, Diluted Hydrochloric Acid 2, Alcohol (90%) 25, Distilled Water to 100. H jp 1 Solute de Morphine cMorhydrate pour injection hypcdermique. . Fr. Cx. 2%. Solutio Morphini Hydrochloridi P. Svec. X. is 3%. CE)Mistura Anodyna, N.H.W. (Not in E.G.A.). Solution of Morphine Hydrochloride 20 minims, Sal Volatile \ drachm, Water to 4 ounce. [fg [jp 1] Suppositoria Morphinae. Morphine Hydrochloride J (B.P. ’14) also 4, 1, 14, and 2 grains (taking weight of the suppository as 15 grains). |g]j|p I] Tablets, Hypodermic, contain 4, 4 and 1 grain. Trochisci Morphinae et Emetin v. E me tin. CP)Trochisci Morphinae et Ipecacuanhae (B.P. 14). Contain grain (0-002 Gm.) of Morphine Hydrochloride, with % grain (0-006 Gm.) of Ipecacuanha in each. Useful to allay cough. g [jpl] Morphinae Hypophosphis. C17H19N03.HPH202 = 351-1996. Dose.—4 to grain (0-008 to 0-03 Gm.). A white powder soluble 2 in 1 (by expt.) of water and about 1 in 14 of Alcohol. A very useful salt for injection. H El Hypodermic Tablets contain J, 4, and 4 grain. H El Morphinae Meconas,—Morphine Meconate. Syn.—incorrectly Morphine Btmeconate. (Solid Bimeconate is impossible.) (C17H19NO3)2C7H,1O: + 5H2O = 860-4216. Dose.—| to 4 grain (0-008 to 0-03 Gm.). This, one of the natural salts of morphine in opium, is in white minute acicular crystals, soluble in 1 in 34 of water. It is said to disturb the head and the stomach less than the other salts. [g| [jpDLiquor Morphinae Bimeconatis. Dose.—5 to 40 minims (0-3 to 2-4 Cc.). Morphine (pure Alkaloid) 144 grains, Meeonic Acid 12 grains, Alcohol (90%) 1 ounce. Mix and add Distilled Water to 4 ounces. Filter. One ounce contains about 6-3 grains or 1-45% (w/v) of morphine bimeconate. It is about the same strength as tincture of opium. Jl Fills contain -J grain. jg IQ] Tablets, Hypodermic, contain J and J grain. U[gm Morphinse Periodidum. C17H19N03.2I = 539-0202. Dose.—to 4 grain (0-004 to 0-008 Gm.). A yellowish-brown powder containing 52-9% Morphine. A considerable proportion of Morphine is dissociated in Physiological Acid ;i7-t% of the Periodide), and a considerable quantity (9*1 A of the Penodide) is liberated on subsequent treatment with Physiological Alkali. Solubility.—Soluble in Alcohol, very slightly soluble m Chloroform, insoluble in Ether and Water. . . .. Incompatible with alkalis, metallic salts and otherwise as alkaloids. Uses —The presence of Iodine, to the extent of 47-1 /c, in this body mav enhance the efficacy of the Morphine in it as an ano yne sedative remedy. For sleeplessness it is equal to other Morphine ™Dispensing Note. To be given alone, in cachet or ‘ slipule ’ after food. DPI F lj Morphinae S alphas, (C17HrjN03)2H2S04+5H20 — 758-466. Dose.—| to b grain (0-008 to 0-03 Cm.). In white silky acicular crystals. Soluble 1 in 23 of water, veri slightly in alcohol 90%. Steruies, Hypodermic, of Morphine Sulphate contain, §, |, ^ and J grain (0-008, 001, 0-016 and 0-03 Gm,). FHHypodermic Tablets contain J, J, J, J, J and 1 grain; alsc combined with Atropine as follows :— f Morphine Sulphate §, 1 1 \ Atropine Sulphate % i 6 ' 4 ' 3 > _1 _1 _i _1 0 ' 180' 150' 12 O' 100 1 8 gram i gr- 1 gr- / P] [FTI Hypodermic Steruies contain Morphine Sulphate with Atropine T% grain, and J grain with Atropine TJ0 grain. Morphine and Atropine are given before anaesthesia, effected by gas and ether, to lessen the amount required and to minimise the secretion from the mouth and lungs. Atropine 1 O* p lj Hypodermic Tablets of Morphine Hydrochloride Sulphate and Nitroglycerin -g-J0 grain. Used in asthma. 774-406. [pjF 1 Morphings Tartras, Morphine Tartrate. (C17H19N08)j. (CH.OH.COOH)2, 3HoO Dose.—^ to b grain (0-0C8 to 0*03 Gm.). In small white nodular tufts of acicular crystals, readily soluble 1 in 10 of Avater, slightly in alcohol 90%. JOjP 1 Injectio Morphinae Kypodermica (B.P. 14). Dose —5 to 10 minims (0-3 to 0-6 Cc.). Contains 2-5% of Morphine Tartrate (1 grain in 44 minims). [El] P 1 Liquor Morphime Tartratis (B.P. 14). Dose.—10 to 60 minims (0*6 to 4 Cc.). Morphine Tartrate 1, Alcohol (90%) 25, Distilled Water to 100. |FjEthy 1-Morphine Hydrochloride, P. Hung., Svec., P. Jap. IV.; Fit. Cx. Supp. II. U.S. X., P.G. VI., Pli. Ned. V., P. Belg. IV., P. Ital. V. Syn. 3(cDionm. (T.M. 217175). C2H5C17H18N03.HC1.H20 = 367-6678. Dose.—J to b grain (0-016 to 0*03 Gm.). Maximum dose in 24 hours, 11 grains ; Fr. Cx. Supp. II. says 3 grains (0*2 Gm.), P.G. VI. 5 grains (0*3 Gm.). A white crystalline powder soluble 1 in 10 to 11 of water— W. It. M. by Expt., 1931, and 1 in 25 of alcohol 90% (by experiment). Insoluble in ether. M.pt. is ill-defined; 124° C. usually given is too high for the fully hydrated salt and too low for the salt dried at 115° C.—Dott. Manufacture.—Data on method, see Edn. XIX, p. 565. Morphine contains one alcoholic and one phenolic OH. In this body the II of the phenolic OH is replaced by C2H5. , Uses.—To replace codeine and morphine in bronchitis, pulmonary emphysema, and bronchial asthma, and for whooping-cough. A useful anodyne in glaucoma, iritis, corneal ulcers, etc. Solutions may be from 1 to 5% strength or more. Corneal Opacities, for promoting absorption of an instillation of 5% infusion of crushed Jequirity Seeds, of value.—Lieut.-Col. H. Kirkpatrick, L. i./2i,1304 ; see also Trachoma, Therap. Index. Dionin if used strong enough—5%—and provided a good reaction is set up—seems useful.—T. L. de Courcy, B.M.J. ii./2i,737. May cause “ ophthalmic fireworks,” pain, chemosis, swelling and sneezing. In interstitial keratitis with potassium iodide internally, and yellow precipitate ointment in the conjunctival sac, of service. CfiDGuttae Dionin R.O.H. 1, 2, 5 or 10%. Mid. H. 1927 has 1 to 5% approx. C0Sterules (Ophthalmic) of Dionin contain 5% Solution. CE)Steruies, Hypodermic of Dionin contain J grain (0*01 Cm.). jjp lEthyl-Morphine (Base), has no distinct M.pt. It is soluble about ^ 1 in 500 Water and 1 in 1-|- Alcohol at 25° C. Sl B lDiamorphinge Hydrochloridum. Syn. Diaphorm (.Martindale), Diacetyl-Morphine Hydrochloride, P. Jap. IV., Bn. Cx. Nouveau Supp., P.G. VI. *Heroin (T.M. 322540) Hydrochloride. C17H17(OCH3.CO)2NO.HCl.=405-6522. (B.P. ’14+H20). 0Pre- parations containing any proportion (since Jan. I/29) of Diacetyl- Morphineexcepting Elixir Diamorphince et Terpini c. Apomor- phince, and the four Lincti on p. 560 (by arrangement with the Pharmaceutical Society.—P.J. i./3i,185,187). Dosi2.—J5 to i grain (°*0025 to 0‘008 Gm-)- Maximum dose in 24 hours (P.G.) 0-015 Gm. Er. Supp. II. 0-02 Gm. The Hydrogen atoms of both the alcoholic and the phenolic Oil- groups are replaced by the CH3.CO groupings. M.pt. about 230 C. Aqueous solution must not colour blue with Ferric Chloride (aosence of Morphine). . This body was first produced in London by Beckett and Wright. Diamorphine Hydrochloride forms white crystalline powder, soluble about 1 in 2\ of water and about 1 in 13 of alcohol 90% (our experiments). TjiCOiltpcitibles Both alkalis and acids and other chemicals as morphine. _ Uses.—Sedative for cough, e.g., in phthisis, bronchitis, and laryngitis, also in asthma. Has been given in haemoptysis. Lengthy use must be guarded against. Useful in acute coryza. Often more effectual than Morphine in relief of severe nerve pam It does not constipate. The danger of addiction from its continual use must never be forgotten.—Sir W. \V illcox, P.J.1-'2 1 • . In hav fever the following has been recommended : lierom Tx grain. Atropine Sulphate ^ grain, Caffeine Citrate 1 gram, Salophen 5 grains. In cachet, one every four hours. Recovery after 9 grains is on record. . „ . Although Heroin (hypodermically) is Pre.te“bt!®..g° ^S^rttUpatfent pain after abdominal operations,, care should be t , ( ] |v j /je grain is fullv round from the anaesthetic before Saer doses may be should be givei, repeated if necessary, as the: effect of larger close*»J oe very dangerous to the respiratory centre• Artificial resmation netebMiy two cases.—A. E. M. Woolf, B.M.J. 1-/29,499 , see also ibid., am. Flavoring—Vide Morphine. C p 1 Tablets. Hypodermic, Ar and TV gram. [§yijTabellas yu grain, in chocolate basis for administration per os' [P|!F llMorphinum Diacetylicum, P. Austr. Syn. AcETO-MORPHINE The base of the above salt. Soluble in water 1 in 800. [g]®Glycaphorm. Syn. Glycerole of Diacetyl-Morphine Hydrochloride, Linctus Heroin, Syrupus Heroin. Contains ^ grain Diacetyl-Morphine Hydrochloride in 1 drachir of a vehicle consisting of Glycerin 3, Syrup of Roses 4, Water 1. Dose.—1 to 2 drachms (4 to 8 Cc.). This preparation forms a useful linctus for coughs, and is employed in bronchitis, pertussis, laryngitis, asthma, and similar disorders. (£} Elixir Diamorphinae et Terpini cum Apomorphina, B.P.C- Supp. 1931. (Exempted from [§j|). Dose.—J to 1 drachm (2 to 4 Cc.j diluted. Contains 1/40 grain Diamorphine Hydrochloride and 1/32 grain Apomorphine Hydrochloride, with 5/18 grain Terpin Hydrate in 1 drachm. CfDLinctus Diamorphinae Camphoratus, B.P.C. Supp. 1931. (Exempted.I from [fp]). Dose.—J to 1 drachm (2 to 4 Cc.). Contains 1/40 grain Diamorphine HjMrochloride in 1 drachm, with small doses of Squill and Ipecacuanha. (P^Linctus Diamorphinae cum Ipecacuanha, B.P.C. Supp. 1931. (Ex- empted from [fp|). Dose.—4 to 1 drachm (2 to 4 Cc.). Contains 1/40 grain Diamorphine Hydrochloride in 1 drachm, with a little Ipecacuanha, Hyoscyamus and Tolu. CE) Linctus Diamorphinae et Scillae, B.P.C. Supp. 1931. (Exempted from |||]). Dose.—J to 1 drachm (2 to 4 Cc.). Contains 1 /40 grain Diamorphine Hydrochloride in 1 drachm, with 1 /20 grain Tartarated Antimony and a little Squill and Senega. CfDLinctus Diamorphinae et Thymi, B.P.C. Supp. 1931. (Exempted from [fpp. Dose.—\ to 1 drachm (2 to 4 Cc.). Contains 1/40 grain Diamorphine Hydrochloride in 1 drachm and 1 /32 grain Apomorphine Hydrochloride, with a little Thyme and Tolu. JQjCEDEIixir Thymi et Diamorphinae (Mariindale). Contains Diamorphine Hydrochloride 1/48 grain in Lavender and Syrup of Thyme in 1 drachm—see Thymus Vulgaris. Heroin and Morphine Addiction.—Heroin is used sometimes by injection and sometimes as a snuff like Cocaine. Supplies here and in U.S. were readily obtainable. It was vaunted as a cure for morphinism. The addict prefers it to M’orphine. The Morphine addict has only one or two stools a week, whereas the bowels of the Heroin addict are almost normal. There is not so much pallor or emaciation. In New York Her in is used almost entirely.—W. E. Dixon, B.M.J. ii./2i,82l. British trade in Morphine and Heroin—figures from 1910—1923. The figures for Morphine and salts manufactured fell from 1,033,162 oz. in 1916 to 87,910 oz. in 1923.—B.M.J. ii./24,830. See also B.M.,J. i./2o339. Committee on Morphine and Heroin Addiction (1924)^reported (1) on circumstances in which supplies may be regarded as medicinally advisable, and (2) whether desirable that, preparations containing less than dg amounts should be brought into the Provisions of the acts and regulations. Addictions rare in this country. V1Ciiei1S .!y e’ 1 abuse or danger from any preparation at present excluded, with possible exception of Chiorodyne—there is some risk. Suggestion made that no preparation should be sold under the name ‘ Chloro- contains more than °'1% Morphine.—P.J. i./26,238 ; B.M.J. 1* / 2v)j5yi» .. Complete Prohibition of Heroin probably desirable.—W. E. Dixon B M J 11./27,236. It has been effected. Addicts in Egypt prefer their Heroin intravenously—believed to be due to the rapid relief obtained from intravenous injection of drugs for bilharzia Terrible results follow its use—A. G. Biggam, Jl. Boy. Soc. Trop. Med., Aug' 26, ’29,147. A Egypt has roughly half a million drug addicts. Drugs taken for sexual stimulation, in ignorance of the fact that it is a common cause of impotence — J. D. Bolleston, Brit. Jl. Ineb., 1930, per M.A., ’31,14. Interesting recent data on commerce in Dangerous Drugs in the Near East. ‘ Byng ’ Broom has cleared up situation at home.—Sir Wm. Willcox, L. h/31, 1241. Turkish Government agreed six months ago to control three factories in Stamboul making Morphine and Heroin.—N. H. Linstead, L. i./3i,1242. Traffic in Narcotic Drugs. Egypt with its half million addicts in 14 million population. Chicago gangsters use Heroin and Cocaine.—Per B.M.J. ii./3o,69S. Problem only a small one in this country—Home Office only knows of 250 addicts. England one of the model countries of the world—onb/ 70 prosecutions last year, mostly for minor offences.—E. Mapother, L. i./3i,587. League of Nations Technical Committee on the Heroin Habit Beport. Heroin could be entirely dispensed with—all its beneficial actions can be obtained by other drugs.—L. ii./31,50. See also Dangerous Drugs Acts and Absts. under Cocaine, Morphine, Opium, Nicotine. £1J Morphine-Methyl Bromide. &<yn. MORPHOSAN. ClsH23N03Br.H20 =398-1132. Dose hypodermically, i to J grain (0 008 to 0 016 Gm.). White needles soluble 1 in 20. Comparatively with Morphine it is non- poisonous—it is thought to be 10 times less potent. Uses.—In epilepsy, also for use with Scopolamine q.v. as anaesthetic. [UMcrphine Methyl Chloride. B.CH3C1.2H20 =389-6838. Soluble 1 in 10 water. It resembles Morphine in its reactions with Ferric Chloride, Nitric Acid, etc., but its solution gives no precipitate with Sodium Carbonate or Ammonia, while its acidified solution gives a bulky crystalline precipitate with Potassium Ferrocyanide, Morphine salts yielding no precipitate.—D. B. Dott, P.J. i./2 t,2.32. ■P1Benzyl-Morpbine Tartrate.—Soluble readily 1 in 3.. The Hydrochloride of this base is readily soluble 1 in 200 ; the Sulphate 1 in 170.—D. B. Dott, P.J. i./26,356. HUl^Diiaudid. (t.M. 475650). Syn. DlHYDROMORPHINONE HYDROCHLORIDE. C17H1903N.HC1. = 321-621. Dose.—1/12 grain (5 mgr.) represents a dose of 1/6 to 1/3 grain (0-01 to 0-02 Gm.) of Morphine. This dose is effective for 4 to 6 weeks without increasing. A preparation analagous with Dicodid. Soluble in Water and Alcohol, insoluble in Ether. Stated to be three times stronger than Morphine, and used to replace Morphine. The dose is correspondingly less. HPIlTablets are available containing 0-0025 Gm. of the Hydrochloride. Also issued in Sterules, 1 Cc. =0-002, 0-004 and 0-005 Gm. Made also in combination with H23] Scopolamine Hydrochloride 0-0003 Gm. Introduced to reduce the undesirable secondary effects of Morphine. . In post-operative pain effective in dose of 2/5 the corresponding dose of Morphine. Tends to prevent sleep. No vomiting or headache. Per Qtrly. Jl. Ph., 29,358. Used with beneficial effects in pleurisy, sciatica, facial neuralgia, angina pectoris, and acute arthritis, to replace Morphine, but of no value when Morphine addiction has developed. Unlike Morphine, it is not necessary to increase the dose. It may cause transient nausea, giddiness, and confusion but does not cause constipation or affect the appetite.—O. Leyton, L. i.,32/835. EiPapaverina. F.E. VIII. C20H21O4N = 339-1718. An alkaloid of Opium (0-5 to 1%). M.pt. 147° C. Easily soluble in hot alcohol, but with difficulty in the cold. [IP ijPapaverinae Hydrochloridum. Ph. Ned. V., P. Svec. X., P. Beig. iv., F.E. viii., P. Ital. v. C20H21O4N.HCl = 375-6368. Dose.—J grain (0-03 Gm.) to 3 grains (0-2 Gm.). P.G. VI. gives latter as max. single dose and 10 grains (0-6 Gm.) as max. dose in a day. A white crystalline powder slowly soluble 1 in 40 in water. The* Sulphate is more employed, v. posted. 1? 1 Papaveringe Perioelidum. C20H21O4N.2I = 593-0358. Dose.—\ grain (0-03 Gm.) carefully increased if necessary. When made by interaction of Papaverine and Iodine in suitable; solvent (cf. Alkaloidal Periodides) the compound is obtained as a dark-red crystalline powder containing 57-1% Papaverine, according, to investigations in the author’s laboratories (1923). Solubility.—Slightly soluble in Alcohol, almost insoluble in Chloroform and Ether, insoluble in water. Uses.—Salts of Papaverine have attracted attention by their analgesic action. The Periodide, containing 57-1% of the alkaloid, in conjunction with 42-9% of Iodine in a labile form, suggests id being of value in gastric and intestinal spasms. It is also worthy of i trial in bronchial spasmodic affections. Dispensing Note. —To be given alone, in cachet or ‘ slipule,’ preferably after food. [piPapaverinae Sulphas. (C20H21O4N)2H2SO4 — 776-4192. Dose.—h to 1| grains (0-03 to 0-11 Gm.) per os or hypodermically up to 8 grains (0-5 Gm.) in a day. A white crystalline powder soluble 1 in 2 in w’ater—by expt.— W. H. M. It is said to be non-toxic in single doses of even 1 Gm. A rather feeble central analgesic and a local anaesthetic. Does not induce a habit like morphine. In all kinds of gastric and intestinal spasms (also for the diagnosis of pyloric spasm); in biliary colic ; and in bronchial spasm. Of more doubtful value in pertussis, hyperemesis, and vascular spasm—angina pectoris, acute uraemia and eclampsia. The local anaesthetic action, with vasodilatation, has been used against rhino-asthma, and to mitigate the pain of irritant injections. Ureteral Calculus treated by Papaverine. Tn the case of a man aged 72, after catheterisation and injection of oil had failed 5 Cc. of 2% solution Papaverine Hydrochloride were instilled through a catheter and six days later 5 Cc. of 2% Papaverine Sulphate Solution. Stone was removed from floor of bladder with Young’s rongeur. In another case of a man aged 40, ten days after instilling 5 Cc. of the Papaverine Hydrochloride Solution fragment of stone was dislodged and recovered in bladder washings. Papaverine Sulphate Solution was again instilled and the following day the stone was produced in the urine. In a further case of a man 33, withdrawing catheter to a point just above obstruction, 3 Cc. of the Hydrochloride Solution were instilled and the stone was expelled a few days later per urethra. Striking feature in these cases was the absence of renal colic following the use of Papaverine. It is non-toxic in the dosage employed.—H. A. Fowler, Annals of Surgery (U.S.A.) May, 1917. Tablets of Papaverine (Base) J grain, Hyoscyamine (Base) 3oo gram, and Benzyl Succinate 5 grains. Employed for calmative analgesic effect. j^Eupaverm (T.M. 515055). A synthetic compound, C19Hiri04K with action similar to Papaverine, but stated to be less toxic. Combination of Narcotic Drugs. It has been sho>\n that combinations oi Xarcotic Drugs may be more potent than would be expected by taking the sum of the two substances, e.cj., in tne case of Codeine Diethylbarbiturate-j-Sodium Diethylbarbiturate. In other instances by adding a weak substance to a potent narcotic, marked increase in narcotic power occurs. (The maximum effect, according to Straub, in the case of Morphine -j- Narcotine only occurs with certain proportions.) Tne same exists in the case of the naturally occurring Opium Alkaloids. A mixture oi all the alkaloids of Opium has a narcotic effect not only greater than the Morphine in it will account for, but much greater than a summation of the effects of the different alkaloids would lead one to expect.—B.M.J.E. i./i3,84. Morphine Meconate is stated to be 25% stronger than the equivalent dose of Morphine Hydrochloride—due to the action of the Meconic radical. Burgi’s Theory is as follows :— i Drugs having the same physiological action summarise their therapeutic effect when given together, but drugs of different phar- mocological action given together increase their activity markedly more than the sum of their action when given separately—they probably act on different cells. Thus Morphine, Codeine, Heroin, and Thebaine give results equal to the sum of their effects, but combined doses of Morphine, Narcotine, and Papaverine are 20 to 50% more toxic than the same doses separately. The word Synergism has been adopted to indicate the action of one drug in enhancing the effect of another. llP llCodeonal. Dose.—Two 24 grain Tablets in the evening. A combination of Codeine Diethylbarbiturate (2 pants) with Sodium Diethylbarbiturate (15 parts). It appears that Codeine is the only Opium alkaloid that can form this combination. Soluble about 1 in 30 of w~ater. Uses.—Hypnotic, in disease of the nervous system and pulmonary disorders. It takes effect after about half an hour. P i' Morphine Narcotine Meconate. Syn. ^Narcophisi P.G. VI. (T.M. 341895.) Dose.—4 to 4 grain (0-02 to 0*03 Gm.). Manufacture and Patents (void), see Edn. XIX, p. 569. Yellowish crystals containing about 30% Morphine^ and 4.3% Xarcotine, soluble 1 in 5 in water approximately, but not completely. Uses.—Hypnotic It is similar in action to Morphine and Scopolamine and is used where Morphine is employed, also where Morphine alone is inadmissible (diseases of organs of respiration, etc.). It is stated that the paralysing action of Morphine on the respiratory centre is lessened greatly by adding an equal quantity of Narcotine. In the case of mice the toxicity of the two together is so small as to be hardly measurable. The most increase in narcotic effect is obtained by using equal weights. HEIjJc Spasmalgin (T.M. 397986).—Combination of Papaverine, Omnopon and Atrinal (a Sulphonic derivative of Atropine). In gastric pain, colic and painful menstruation.—L. ii./2o,506. IT Cc. of Spasmalgin Injection or each Tablet corresponds to 0 02 Gm. Papaverine, 0-001 Gm. Atrinal and 0-01 Gm. Omnopon. Dose.—One to two tablets a day increased to four in severe cases. See also Synergistic Method of Painless Childbirth (Gwathmey) toy Rectal Ether Analgesia. MULLS. Anserine Mulls consist of Medicated Ointments prepared with a basis of Goose Grease (Oleum Anseris) depurated and benzoated, spread on calico Bandages. They are prepared 4 and 74 inches wide by 1 yard. Goose fat possesses the highest 'penetrating poiver amongst absorbent ointment bases. The following Medicated Anserine Mulls are made :— Acid Boric 10% Ichthyol 10% Sulphur 10% Acid Carbolic 2% Oleum Rusci 5% Thiosinamin 5% Chrysarobin 2% Scarlet Red 4% Adepsine Mulls are bandages similar to the above, but prepared with Benzoated Lard basis. This is suitable where deep penetration is not so essential e.g., Adepsine Mulls Acid Boric 10 and 20% Acid Carbolic 2 and 4% Acid Salicvlic 5 and 10% Bismuth Carbonate 20% Liquor Carbonis Det. 10% Resorcin 5% Zinc Oxide 10% /Zinc Oxide 20% \ Ichthyol 10% f Zinc Oxide 20% \ Calamine 5% Plaster-Mulls Of soft rubber adhesive plaster basis, spread on cotton cloth. No. % 1 No. 0/ /O 4 Acid Carbolic 5 fHydrarg. ... 20 9 Acid Salicyl. 25 88 J Acid. Carbolic k—% Hydrarg. Perchlor. 10 . /Acid Salicyl. \Ext. Cannabis Ind. 20 2 64 5 LZinc Oxide 10 /Acid Salicyl. 10 66 Ichthyol. 10 i 0 \ Creosote ... 20 7 Pyrogallol... 10 15 Hydrarg. 20 232 Thiosinamin 20 /Hvdrarg.... 20 24 Zinc Oxide 10 1 6 \Acid. Carbolic ... 7-5 74 /Zinc Oxide \lchthyol ... 10 5 White adhesive Rubber Plasters containing^ a proportion of Zinc Oxide spread on pink cotton are also made, 21, 3f and 5 Cm. wide, in spools. NAPHTHOL. Befca-Naphthol (B.P. ’14). U.S., Fr. Cx., P. Belg., P. Austr., Ph. Ned. V., F.E. VIII., P. Belg. IV., P. Ital. V. C10H7OH= 144-0624. Dose.—3 to 10 grains (0-2 to 0-6 Gm.) in cachet or Slipule (No. 00 for 5 grains). Fr. Cx. Max. single close 15 grains; Max. dose during 24 hours 45 grains approximately. Manufacture,— Naphthalene is suiphonated at about 1S0° C. and the resulting /3-Naphthalene Sulphonic Acid is fused at 300° C. with Caustic Soda. Further Notes Edn. XVIII, p. 563. P Naphthol has a faint Storax odour ; when sublimed it is in white shining laminar crystals ; Soluble in alcohol 1 in 2, ether 3 in 4, chloroform 1 in 24, and 1 in 24 benzol; 1 in 12 of olive oil and lard, and 1 in 80 of vaseline. Addition of boric acid increases solubility in water. Incompatible with Camphor, Ferric Chloride, Menthol, Phena- zone and Phenol. Uses,—Internally, in enteric fever ; safe and efficient, but sometimes causes too much gastric disturbance. In dilated stomach, dyspepsia and other disorders. In cholera, as preventive, and in treatment of early stages ; and used as a vermifuge. In kidney disease it is contraindicated. It is a powerful antiseptic and germicide. In advanced scabies, an ointment of 10 to 15% cures the eczema as well as destroys the parasite, but the Compound Ointment L.H. (Kaposi’s Ointment) is preferred.—^-Naphthol 15, Lard 100, Green Soap 50, Prepared Chalk 10. Useful also in psoriasis. /3-Naphthol5, x41cohol 100, Glycerin 10, is a remedy for hyperidrosis of palms, soles and axilke. Pills and Tablets, (3-Naphthol 3 and 5 grains, are prepared. Tablets of Betanaphthol 5 grains (0*3 Gm.) with Phenolphthalein 3 grains (0*2 Gm.). To combat ankylostoma infection. A useful combination. Ankylostomiasis and Malaria. 75% of malaria cases in Malay States are also ankylostomiasis cases. It may be that the ankylostoma worm is as much responsible for malaria as the mosquito. Quinine cannot be given in large or continuous doses. Best results with Betanaphthol and 01. Cheno- podii.—I). Bridges, B.M.J. ii./2i,149. . Ankylostomiasis treated by 30 grain doses caused poisoning. Thymol may be safer.—W. B. Onne, B.M.J. ii./i5,176. . Ascaris infection treated with Betanaphthol showed cure m a large percentage of cases.—C. N. Leach and G. E. Hampton, per Jl. Trop. Med., May 1 *23 145 5 Dyspepsia, Flatulent. Betanaphthol 5 grains, Salol 5 grains and Calomel & grain combined in capsules valuable. A paper on pre-operative treatment of enlarged prostate.—J. W. Thomson Walker, B.M.J. i./2i,71. Trachoma treated by 4 Oxidised Naphthol Camphor.’ The remedy should be freshly prepared, 2 parts of Camphor and 1 of Naphthol warmed gently and filtered, and the mixture allowed to oxidise in a clear glass vessel to syrup consistence and brown mahogany colour. 1 he application is mat e with a small brush well soaked in the solution and then} wiped nearly chy. Four to ten applications suffice.—G. Gerard, Pres., bept,., 2o,3lz. Taenia. Betanaphthol, 15 grains for ten days, on an empty stomach, effectual, after male fern had eliminated everything except the head. J. \>. Tomb. L. i.,/23,1131. Charbon Naphthoic. Dose.—60 to 120 grains. A granular pre paration of wood charcoal, containing 5% /3-naphthol, for use ii ailments of the stomach and intestines.—Ph. Notes, Greece. P. Ital. V. gives:—Beta Naphthol 3, Charcoal 4, Magnesium Oxide 3/prepared with Alcohol 95%, 5. a-Naphthol, F.E. VIII. C10H7.OH = 144-0624 is said to have greater antiseptic power, but given internally causes more irritation Manufacture — This is also made from Naphthalene on similar lines to /3-naphthoL The sulphonation must be conducted at a vert/ low temperature A solution of 1 in 3,500 of water is used to wash out the intestines by rectal injection. Dose.—2 to 5 grains (0*12 to 0’3 Gm.) but larger doses are given Benzonaplithol.—Syn. Benzoyl - Naphthol. Beta-Naphthol Ben-, zoate. Fa. Ox., P. Ital. V., P. Belg. IV. C10H7OOC : C3H5 =248-0936. Dose.—4 to 10 grains (0*25 to 0*6 Gm.) in cachet or suspended. Manufacture—Add Benzoyl Chloride 140 to finely powdered /3-naphthol 144. Then heat to 125° 0. 4 hour and pour the liquid into equal volume oi water. Filter off and recrystallise {twice) from Alcohol, and wash with water.—M.Pt. 110° C. A white crystalline powder. Soluble in alcohol and chloroform, almost insoluble in water. An intestinal antiseptic and diuretic, e.g.„ in typhoid. May be combined with bismuth salicylate. Externally is used 3 to 10% in ointments. Tablets. 5 grains, to be crushed and taken in a little water. Betel. Syn. Naphthaloi, Betanaphthol Salicylate. Er. Cx. C6H4OH.CO.OC10H7=264-0936. Dose.-—3 to 8 grains (0*2 to 0*5 Gm.) in cachets or pills, or suspended in almond emulsion or milk. Manufacture.—Beta Naphthol 144 and Sodium Salicylate 168, are intimately mixed and Phosphorus Oxychloride SO, added with trituration. When solid the mixture is heated until Hydrochloric Acid ceases to be evolved. Recrystallise from spirit. M.pt. 95° 0. Further data, Edn. XIX, p. 572. In small tasteless white crystals, insoluble in water, soluble in alcohol. Useful in rheumatism, cystitis, and intestinal catarrh. Cachets of Betoi and Bismuth Salicylate. 5 grains each, useful as an intestinal disinfectant. Contra-indicated in renal disease. Naphthalene. Ph. Ned. V., P. Ital. V. C10H8= 128-0624. Dose.—2 to 15 grains (0-12 to 1 Gm.) in cachets. A hydrocarbon formed in the manufacture of coal gas. In white crystalline plates (M.pt. 80° C.) with persistent odour. Soluble in Ether 1 in 3, in Alcohol 1 in 25, in Olive Oil 1 in 8, in Chloroform 1 in 14, insoluble in water. Uses.—As an intestinal disinfectant for the diarrhoea of consumption, and of typhoid and for dysentery. 8-grain enemata are useful. Is painless in action, and promotes healing of ulcers. Internally, e.g. in Malt Extract, with success to lessen foetor of urine and stools. A vermifuge in taenia and ascarides. Suppository and ointment (1Q%) are used for pruritus ani. A 10 to 20% solution in oil is successful as a parasiticide in scabies. The vapour is inhaled for whooping cough. Seven doses (1-75 Gm. in all) of Naphthalene taken as anthelmintic in the case of a child six years old caused death.—P.J. ii./'ii,407. Pilula Naphthaiini, 3 grains. A Precipitated Form is also made by adding an alcoholic solution to water. For use as a dusting powder diluted 1 in 10 Mosquitos in wells, etc., can be destroyed by Naphthalene.—B.M.J. ii./x^ ,15. N.C.I.—Naphthalene of commerce with 2% Creosote and 2% Iodoform. Used as a vermicide in the war. Must not be used too freelv. Used in conjunction with Vermiielli. Naphthalene 90, Creosote 2, Trench Chalk 2 might replace.—J. P. Kinloch, B.M.J. i./i6,790. Undervests of butter muslin dipped in a solution of 1% each Naphthalene and Sulphur in benzol or petrol effectual in preventing pediculosis.—J. A. Gunn, B.M.J. i./i7,579. Naphthalene Tetrachloride.—Syn. Naphthalin Hydrochloride* C10H8Cl4=269-8904. Dose.—3 to 12 grains (0*2 to 0*8 Gm.). iVSanufc&cturc.—By chlorinating Naphthalene 400 with Potassium Chlorate 800 and Hydrochloric Acid. Data, Edn. XIX, p. 573. White crystals, melting at 182° C., insoluble in water. Has been used in cases of bacterial intoxication such as colitis with improvement. It is doubtful whether the substance acts as an antiseptic after leaving the stomach. It was tried in 8 grain cachets every 4 hours (night as well).—J. Langford Moore, St. Bart.’s Hosp. Formagules of Naphthalene Tetrachloride contain 5 grains. Bi-chlornaphthalene and Idraefclornapkthalene used in a spray for killing flies in food-shops have caused illness owing to tainted food.—C. E. Sage. El NARCOTINA. Syn. Anarcotine. C19H14(0.CH3)3N04=413-1874. Dose.—1 to 3 grains ((P06 to 0*2 Gm.) or more in a pill. An alkaloid from opium (sometimes as much as 15% of), in white crystals, insoluble in water, soluble 1 in 3 of chloroform, 1 in 100 of 90% alcohol, 1 in 125 of ether, soluble also in benzol. An anti- periodic of great power,—analogous to, if not identical with, Quinine. Has been used in malaria and in sleeping sickness. Hose as above. cj. also Morphine Combination. [jPlNarcotine Hydrochloride PH. Ned. V. . Dose——1 to 3 grains (0*06 to 0‘2 Gm.). White crystals soluble in water about 1 in 4. FI] Cotarnine Hydrochloride. Ph. Ned. V., F. E. VIII. (P.G. VI. gives formula C12H1403NC1+2H20). Syn. ^Stypticin (T.M. 216872). Dose.-—J to l grain (0*016 to 0*03 Gm.) internally or hypodermically, in special cases up to 4 grains in 10% solution. The salt of the base |FJ Cotarnine obtained by oxidising narcotme with manganese dioxide and sulphuric acid, in primrose coloured granular crystals, very soluble in water and alcohol. It w as placed on the market by a British firm long before the Gmrmans boomed it under the fancy name.-F. A. Hocking. M.pt. 125’ C. (Eott). It is allied to Hydrastinine (q.v.). The alkaloidal base Cotarnine is C12H15N0i.3H£0. The hydrochloride is not anhydrous, but loses water on drying, agreeing with the formula (C13HISX03HC1)2.5H:,0.—D. B. Dott. C.D. h/26,7 ; E/32,14. Note P.G. VI formula antea. Cotarnine is generally regarded as anomalous in containing water which cannot be removed, while the dried hydrochloride is anhydrous. But if the latter is regarded as cotarnine chloride and the base as cotarnine hvdroxide, there is nothing anomalous.—D. B. Dott, C.D. h/32,14. Uses.—In all forms of uterine haemorrhage, useful in checking profuse menstruation. 1 to 2% may be used on a tampon. To check bleeding in prostatic haemorrhage f grain per os thrice daily of value.—J. R. Logan, B.M.J. ii./29,1184. Erysipelas, eczema and shingles may be treated with a 5% ointment. CfDTablets of Cotarnine Hydrochloride, § grain (0*05 Gm.). CE> Ointment 2% with Unguentum Lanolini, in herpes and ulcerative balanitis. In more acute similar complaints up to 10% strength. CiDStypticin Wool, 30% and CfDGauze are made. CfDUrethral Bougies of Cotarnine in cacao butter or gelatin contain b grain (0*03 Gm.), four inches long, and J inch in diameter, are used to check bleeding caused by sounds or catheters. [plJCotarnine Phthalate. ^STYPTOL (T.M. 253307). (C12H15N04)2.C6H4C00H.C00H=640-2978. Dose.—J grain (0-05 Gm.), but much larger doses are given by some practitioners, e.g., 10 grains without unpleasant effects, every 2 to 3 hours. Five grain doses suitable for mild cases.—George Foy. An orange red body soluble in water. Contains 73% Cotarnine. CE)StyptoI Tablets £ grain (0*05 Gm.). Myristicin, the constituent of nutmeg, dill and parsley oils, can be used as a starting-point for the synthesis of the base Cotarnine, and thence to produce stypol and stypticin.—Zeit. f. Angew. Ohem., 1911,40. Of. Hydrasti- nine, To/. II. NEBUL/E. These are solutions for application to the throat and nose by the aid of a fine spray apparatus or atomiser. By means of a glass, metal or vulcanite tube, a jet of fine spray may be directed into the pharynx or nares, and if a deep breath be taken at the proper moment some of the spray will enter the larynx. The patient must be taught to carry this out personally. Nebulae are aqueous, or of Liquid Paraffin, Almond Oil or Olive Oil. The following indications may prove useful:—- Antiseptic and Demulcent.—Nebula Alltalina, Nebula Mucin, q.v. Antiseptic and Soothing.—(a) Nebula Acidi Borici—Glycerin of Boric Acid 1 drachm to the ounce ; (b) Nebula Potassii Perman- ganatis, 1/10 grain in 1 ounce of Normal Saline: (c) Nebula Acidi Tannici—Glycerin of Tannic Acid 40 minims, Bose Water to 1 ounce. A J± nalgesic.- jp l] Nebula Cocainae Oleosa, vel Aquosa q.v. Asthma.—(a) Nebula Anti-asthmatica “ Compound Asthma Fluid” q.v. and (b) (jDNebula Lobeliae Composita—Lobelia Tincture, Belladonna Tincture, Stramonium Tincture, of each 10 minims, Ipecacuanha Tincture 5 minims, Sodium Nitrite 10 grains, Glycerin and Rose Water to 1 ounce, (c) Nebula Ephedrinaj Simplex, (d) Nebula Ephedrinae Composita, (e) Nebula Ephedritue Aquosa, q.v. Astringent, (a) CbD Nebulae Zinci Chloridi, 10 to 25 grains, with Rose Water 1 ounce ; (b) Cupri Sulphatis, 5 grains to the ounce ; (c) Ferri Per chloridi, q.v. ; (d) Hydrargyri Nitratis (q.v.). Diphtheria.-—To dissolve membrane, Nebula Acidi Lactici, q.v. Catarrh, Nasal and congestive state of the Eustachian tubes.— IS Ej Nebula Cocainae Composita—Cocaine 2 grains. Cinnamon Oil 5 minims. Menthol 15 grains. Liquid Paraffin to 1 ounce. Nebula Resorcini 1%. Nebula Antipyrini 3%. Catarrh, Dry.—(a) Nebula Eucalypti—Eucalyptus Oil 20 minims, Liquid Paraffin to 1 ounce; and (6) Nebula Eucalypti Composita ; (c) Nebula Mucin, q.v. Hay Fever.—(a) Nebula Suprarenalis Extracti, 5% and 10% ; (6) Nebula Quininae—Quinine Hydrochloride 10 grains, Glycerin and Rose Water to 1 ounce. Phthisis.—(a) Nebula Creosoti Composita.—Creosote 5 minims, Cassia Oil 5 minims, Almond Oil to 1 ounce ; (b) Nebula Iodi Composita—-Iodine 2 grains, Carbolic Acid 8 grains, Menthol 5 grains. Camphor 2 grains. Liquid Paraffin to 1 ounce. 2% Creosote may be added (if made with Almond Oil). Stimulant.—(b) Nebula Mentholis, q.v. ; (b) Nebula Mentholis Composita—Menthol and Camphor, 20 grains each, Cinnamon Oil 5 minims. Liquid Paraffin to 1 ounce ; (c) Nebula Potassii Chloratis cum Ferro.—Potassium Chlorate 15 grains, Solution of Ferric Chloride 20 minims, Glycerin 1 drachm, Water to 1 ounce. (d) Nebula Chlorbutolis Composita St. Th. H.—Chlorbutol 15 grains, Camphor 40 grains, Menthol 40 grains, Cinnamon Oil 8 minims, Liquid Paraffin to 3 ounces. For a common cold where B. Septus is the principal cause of infection, as spray and gargle Potassium Chlorate 10 grains, Solution of Ferric Chloride 15 minims, Glycerin 30 minims, and Water to 1 ounce, are useful. This is said to be of little value after 24 hours, when give a Potassium Chlorate gargle. Tonic.—(a) Nebula Pini Composita, containing Pine Oil, Eucalyptus Oil, Cassia Oil, of each 5 minims, Menthol 5 grains in Almond Oil 1 ounce ; also (b) [gj] [Jpj] the same, with Cocaine 1%. For further formulae, consult Index. Intratracheal medication with medicated oil.—A. R. Friel, B.M.J. i./22,149. NITROGLYCERINUM, P. Jap. C3H5( O.NO 2)3—227*063. Syn. Trinitroglycerin ; Glonoin ; Trinitrin ; Glyceryl Trinitras. Dose.— to Jg- grain (0*0003 to 0*0013 Gm.) increased to ^ grain. ' Manufactured by adding Glycerin to Nitric and Sulphuric Acid mixed A mixture of 3 parts by weight Nitric Acid Sp. Gr. 1*3 and a parts by weight of Sulphuric Acid Sp. Gr. 1*842 is used, and to nitrate 1 part by weight glycerin is added to 8 parts by weight of the mixture. By using; Nordhausen Acid a yield of 230 per cent of Nitroglycerin is obtainable.— Chem. News, Feb. 14, ’o8,74. See also P.J. i./o9,100, and especially ‘ Explosives ’ by E. de Barry Barnett, 1919. The finished and washed Nitroglycerin is mixed with Siliceous Earth, e.g., Kieselguhr. This earth is used for its absorbent power in making Dynamite.—Alfred Nobel’s discovery in 1866. Guncotton is made by mixing with cotton waste from the Lancashire spinning sheds. Other mixtures are known as Gelignite (containing 56-5%), Samsonite, Saxonite and Carbonite (25% with Potassium Nitrate 30, Barium Nitrate 4, Wood Meal 40 and Sodium Carbonate 1%). Cordite.—Stated to have composition Nitroglycerin 30, Nitrocellulose 65, Soft Paraffin 5. Nitroglycerin is a dense, opaque, white, oily liquid, transparent when dehydrated, and of Sp. Gr. 1-600. It has no odour, is slightly volatile, and has a sweet, aromatic, and pungent taste. It is slightly soluble in water, P. Jap. III. gave 1 in 800, freely soluble in ether, 1 in 6 of almond oil, freely soluble in absolute alcohol, and 1 in 15 of 90% alcohol. Nitroglycerin in fatty or oily solution is perfectly safe and stable, but in Alcoholic Solution the substance must be handled with the utmost caution.—Vide infra. Physiologically it belongs to the class of nitrites—probably, therefore, sodium nitrite is formed directly it gets into the blood. Notwithstanding the effect on the vascular system by 1/1600 grain of Nitroglycerin (D. J. Leech) or a fraction of a minim of Amyl Nitrite, even large quantities of the medicinal preparations do not readily cause death.— R. R. Pirrie, Pr., Feb., 1912,259. It is absorbed into the blood practically unchanged, hence its powerful and prolonged action (Brunton)—ex Pharmacol. Physiological action of Nitroglycerin and the Nitrites. Formation of Sodium Nitrite in the blood (Matthew Hay). Gamgee’s work on Methsemo- globin production. Observations of Haldane, Maghill and Mavrogordato on conversion of haemoglobin into a mixture of Methsemoglobin and Nitric- Oxide-Haemoglobin under the influence of Nitrites. Murrell’s work on the effects of Nitroglycerin on the lower animals.—R. R. Pirrie, Pr. Feb., 1912,259. Pharmacologieal action of Nitric Esters.—These bodies act mainly on unstriped muscle fibre and especially on that of the arterioles. The esters of the Monohydric Alcohols (Methyl, Ethyl, etc.) are relatively weak. Methyl Nitrate, for example, injected intravenously is more than ten times weaker than Nitroglycerin, and when given by the stomach more than 100 times weaker. The presence of OH groups (in the higher series) diminishes action as compared with the fully nitrated esters.—C. It. Marshall, B.M.J. ii./i2,644. Lethal dose of Nitroglycerin intravenously in rabbits is 45 mgr. per kilo. Asphyxia the major cause of death.—T. V. Oltman and L. A. Crandall, Jl. Pharm. and Exp. Therap., Jan., ’31,126. Minimal effective dose intravenously in rabbits 0-03 mgr. perkilo.—II. B. Myers and V. T. Austin, Jl. Pharm. and Exp. Therap., June, ’29,229. Tolerance may develop to a marked degree but is of exceedingly short duration. A case recorded failing to respond after 6 months’ use to 500 times the initial dose.— H. B. Myers and V. T. Austin, Jl. Pharm. and Exp. Therap., June, *29,227. Uses.—Especially valuable in angina pectoris and generally to relieve dyspnoea of cardiac, pulmonary, or renal origin. Nitroglycerin, in two minutes after taking a dose accelerates the pulse, relaxes the, arteries, produces a feeling of fullness all over the body, but particularly in the head by a throbbing at the sides of the temples. It also causes headache, which lasts from 15 minutes to several hours, according to the quantity taken ; but to patients accustomed to its use the headache is not felt. In treating angina pectoris, neuralgia, asthma, headache, sea-sickness, and Bright’s disease, its action is like that or amy] nitrite and the other nitrites, but its effects Iasi/ much longer, I or the weak heart of fatty degeneration and of old persons, this lessened tension proves valuable. It has been given in haemoptysis. Stiychnine, Eigot and Belladonna are recommended to counteract the headache produced by large doses. For further notes on treatment see References jjostea. Xnjeetio Nitrogdycerini Hypodermiea. Dose.—1 to 4 minims (0-06 to 0-25 Cc.). Nitroglycerin Solution 5, Alcohol (90%) 2, Distilled Water to 12. Contains about -^to grain in 1 minim. Acts promptly ; useful in collapse, etc., when the patient cannot swallow'. Liquor Nitrogdycerini, 1%. Syn. Liquor Trmitrini (.R.P. ’14). F.E., P. Jap. III. (now omitted), P. Hung., P.G. VI., P. Belg. IV. Ph. Ned. V. gives direction for making direct from glycerin by nitration with Nitric and Sulphuric Acid mixture. Dose.—\ to 2 minims (0-03 to 0-12 Cc.) gradually increased to 10 minims, if necessary, every 3 or 4 hours, in any aqueous vehicle. Trinitroglycerin 1 part by weight. Alcohol (90%) q.s. to 100. Dissolve. Sp. Gr. 0*840. 110 minims contain 1 grain. A colourless neutral liq uid ; 10 Cc. with an equal volume of water keeps clear, but the further admixture of 1 Cc. of water causes opacity (presence of full proportion of Glyceryl trinitrate). Diluted further, the latter separates in oily drops, which explode when struck with a hammer. Should be kept from sunlight. A 5% and a 10% solution in absolute alcohol are also prepared commercially but are not safe for use in dispensing. (Spiritus Glycerylis Nitratis, U.S., has 1% by weight.) U.S. cautions that violent headache may be caused when freely applied to the skin. A little caustic potash solution should be poured over it to decompose should it be accidentally spilled. For the Assay of Nitroglycerin in Solutions, etc., see Vol. II. Incompatibility;—Nitroglycerin is decomposed by caustic alkalis. The alcoholic solution is also precipitated by v'ater in excess. In asthma 4 to 1 minim doses with Spiritus iEtheris Nitrosi 20 minims every hour for 3 doses useful.—Haviland Hall, Tilley. Haustus Nitroglycerins. Nitroglycerin Solution 1 minim, Sodium Bicarbonate 10 grains, Compound Tincture of Cardamoms 1 drachm, Spirit of Chloroform 20 minims, Water to 14 ounces. To be slowly sipped at first symptoms of an attack as restorative in angina pectoris. Capsules (Gelatin) of Nitroglycerin. . Dose.—1 or 2. Contain Tqq grain in oil solution or more or less as prescribed. Tabellae Nitroglycerin!, b.p. 1885. Dose.—1 or 2. Introduced by the late William Martindale in 1878, T10- grain in each. These tablets have the nitroglycerin in solution in chocolate, 24 grains, in a perfectly safe and inexplosive, stable and non-volatile, portable and palatable form. The small bulk, precise dose, and quick action, if w^ell masticated and swallowed, render this mode preferable for administering nitroglycerin, Additional Strengths of Tabeliae. The tablets are also prepared containing ant 25 grain, and 1 milligramme (1/64 grain) for prescribing in foreign countries. (For metric equivalents see table.) The tablets are non poisonous even to children : a surgeon records that on one occasioi two children, one three and the other six years of age, ate betweei them straight away two dozen, grain in each, without any in jurious effects. An employe in the author’s laboratory (1905) ate a piece of the nitroglycerin mass weighing about 2 ounces, mistaking it for ordinary chocolate. A bad headache supervened, necessitating his lying down but he was at work again the following day. Single doses of 5 grains and daily dose of 20 minims of Pure Nitroglycerin tolerated.—B.M.J.E. ii./o5,52. Uses of Nitroglycerin Tablets.—One tablet every three or four hours to relieve or ward off attacks of angina pectoris, asthma sea-sickness, neuralgia, headache, epilepsy, and may be tried for Bright’s disease and dysmenorrheea. In tinnitus aurium has been found useful. A dose of any preparation of nitroglycerin acts more promptly if taken on an empty stomach. In arterio-sclerosia patients are made more comfortable by small doses for a week or two. In sea-sickness there is a cramp of the vessels and ansemia of the central nervous system. The tablets are of benefit—symptoms? quickly alleviated. Repeated doses can be given with perfect safety. Men on our battleships find them of service ‘ through the Bay.’ In asthma they are of immense value during a paroxysm, but it must not be forgotten the spasm may be of a compensatory nature and of value to the patient. Should be carried about in the pocket to be taken immediately any pain comes on in the chest. These not only relieve pain but lessen the dangerous condition of which the pain is a symptom. Tabeliae Trinitrini, Trinitrin Tablets (B.P. T4). Tablets of chocolate, each weighing 5 grains (0*3 Gm.), and containing Ti0 grain (0 0005 Gm.). Dose.—One or two tablets. Tabeliae Nitroglycerini et Caffeinae. Dose.—1 every 4 hours or as required—each containing T-J v grain Nitroglycerin and 1 grain Caffeine ; for use in migraine. WH Tablettae Nitroglycerini et Sodii Iodidi cum Arsenio. Dose.—1 in every four hours. Each equivalent to Nitroglycerin -A0 grain, Sodium Iodide 15 grains, with Fowler’s Arsenical Solution^ minims. This dosage may be considered a routine treatment of aortic disease. The quantity of Nitroglycerin employed is frequently too low, but the above may be given with perfect safety. IFTI Tabellae Nitroglycerini Ti0 grain (0 0004 Gm.) et Strycli- ninae -5-5 grain (0*0025 Gm.). 41so J"Nitroglycerin Ton* r»'r grain with \ Strychnine ^0» A, iU grain In migraine Nitroglycerin, especially if in combination with Strychnine, is of value. It relieves headache almost immediately. Its vasodilator effect lowers blood pressure in the peripheral vessels, and so reduces cerebral and arterial pressure. In high arterial tension where the heart is beginning to fail and such symptoms as irregularity of pulse, giddiness, shortness of breath, or even oedema of ankles begin to appear, Brunton advised to combine cardiac tonics with Vasodilators. Rest is of utmost importance. Tahell98 Nitroglycerini Cornpositae. Contain Nitroglycerin grain. Amyl Nitrite J grain, Menthol grain, Capsicum grain. CL) Tabellse Anti-Asthmaticae. (II.). Dose.—1 to 4 thrice daily. Nitroglycerin ^ grain, Sodium Iodide 2 grains, Potassium Bromide 2 grains, Fluidextract of Euphorbia Pilulifera 3 minims. Tincture of Lobelia 4 minims. Very useful in asthma ; the nitroglycerin depresses the peripheral ends of the vagus nerves and stimulates the heart by removing the inhibitory action of the vagus and relieving blood vessels elsewhere. CDTabellse Digitalini et Nitroglycerini cm. Tfo- grain are also prepared v. Digitalin. Tabellae Nitroglycerini 1/100 and 1/200 grain et Thyroidei Sicci (Standardised—Martindale), J, 1J and 3 grains combine the action of these two remedies. Tabellae Natrico (Brunton-Thrusb). A proprietary remedy, each tablet containing Nitroglycerin 1/250 grain, Crataegus Oxyacantha i grain, Sodium Nitrite \ grain, Potassium Nitrate 2 grains. For lowering blood pressure. Crataegus Oxyacantha is known for its tonic action on the cardiac muscles. References to use of Nitroglycerin. Blood Pressure in Man.-— Maximum pressure at various ages in men, women and children.^ From 8 to 14 it is about 90 mm., from 15 to 21 it is 100 to 115 or 120} from 21 to 65 from 100 or 125 up to 135 or 150, above 65 it may stil be 135 to 150 or up to 200 or higher. In women it is about 10 to 15 min’ lower than in men. In athletic men it may be about 10 to 15 mm* higher than in moderate development. The cases in which low tension, below 100 in men and 80 or 90 in women generally are (1) weakness after some illness, especially in influenza (2) in commencing phthisis, (3) in heavy smokers. , In lowered pressure abundant food (animal), meat extracts, tonics as Iron, Arsenic, Malt, Cod Liver Oil, Hypophosphites, Glycerophosphates, and as cardiac tonics, Strychnine, Strophanthus, Digitalis and Caffeine are advised. In Raised Tension.—High tension, especially in advancing age, though giving rise to sense of power and desire for action both physical and mental may be a danger signal. It is not only a direct cause of cardiac failure or ruptured vessels, but produces atheroma of the arteries, and thus weakening them renders them liable to break. By detecting the rise in time in middle life, tension may be kept down, changes in the arteries leading to arteriosclerosis and atheroma may be prevented and life prolonged. Nicotine is almost the only drug which nearly equals Adrenalin in power of raising blood pressure. Tobacco, tea, and coffee must be prohibited. Mercurials are beneficial, J grain or 1 grain of Calomel, or 3 to 5 grains of blue pill once or twice a week, followed by Saline. Potassium Iodide, in dose of 1 to 10 grains thrice daily useful. The Hippurates, Sodium Benzoate, Sodium Nitrite \ grain, gradually increased to 4 or 5 grains, as also Pulvis Sodii Nitritis Compositus, q.v., all tend to keep pressure down. Nitroglycerin and Erythrol Nitrate act similarly. A doctor was able to keep himself free from attacks of angina by daily use of Erythrol Nitrate for 3 or 4 years, beginning with 4 grain thrice daily, and gradually increasing it. When the pain is acute, Amyl Nitrite is the quickest means of relieving, or a little Chloroform as inhalation. The influence of tobacco smoking as cause of arteriosclerosis is, however, not settled. Clinical writers are disposed to admit Tobacco as at least a predisposing cause, though many deny it.—F. W. Andrewes. Angina Pectoris, Gastric Origin of.—In certain favouring circumstances, tension of the gastric atmosphere is associated with painful attacks indistinguishable from those of angina pectoris. A case of flatulent dyspepsia developed seizures of a painful kind—in the upper intercostal -nerves including the costo-humeral branch. Nitroglycerin effective—seizures always subsiding immediately.—B.M.J. i./n,613. Carbon Monoxide Poisoning.—Tb grain injected, together with inhalation of Oxygen advised.—Pr., Dec., ’o8,842. High Blood Pressure.—Salines, exercise, Sodium Nitrite in 3 or even 5 grain doses, several times daily with a diuretic or diaphoretic. Amyl Nitrite or Nitroglycerin for temporary effect—should not be used too early. ■—J. Henderson, Glas. Med. Jl., April, ’23,209, B.M.J.E. b/23,81. A female out. 47, melancholic in nature, for two years had an attack of hemiplegia, evidently haemorrhagic, blood pressure rose to 170—180 mm. This was successfully reduced to 110—120 mm. by purging daily, and by Nitroglycerin and suitable feeding. Mental symptoms disappeared.—B.M.J. ii./11,1472. High blood pressure. A Trinitrin tablet, in some cases, helps patient to sleep.—Sir H. Ilolleston, L. h/23,521. Chorea.—Nitroglycerin may be given in full doses, and, if necessary, Morphine. Migraine.—Over 80% of cases completely controlled by taking tablets of Nitroglycerin (0T> mg.) over a long period—half a tablet after breakfast, half after the midday meal, and in severe cases a third dose in the evening. Should be chewed, not swallowed.—Dollken, Munch. Med. Woch., Feb., 1928, per Pr., May, *28,334. Mental Disease.—In certain cases depending on cerebral anaemia from vaso-constriction, Nitroglycerin produced rapid cure.—M.A., 1908,37. Morphine Craving relieved.—L. i./o9,l334. In Locomotor Ataxia may be given for long period, in increasing doses, relieving the crisis and lessening the pain.—B.M.J. ii./o7,1823. Myxiedema has been treated with ^ grain doses with purgings. In Puerperal Eclampsia it is strongly recommended. Lowers blood pressure, and increases amount of urine. In epileptic vertigo, small doses relieve. Nephritis, Acute Tubular, accompanied with Dropsy.—Nitroglycerin is valuable as in the following :—Trinitrin Solution, 32 minims, Potassium Acetate, 5 drachms, Compound Cardamom Tincture, 4 drachms, water to 8 ounces. Dose.—4 ounce in water every three hours, until symptoms abate, and then tlirice daily. Iron tonics to be given so soon as the urine is albumin-free.— J. T. Maclachlan, B.M.J. ii./23,473. To reduce the vascular-tension in cirrhosis of the kidney.—Tirard. * i mu iHWHOBHaamB Neuritis, Subacute, a case of, with general dropsy. Nitroglycerin in small doses increased the quantity of urine, and the dropsy disappeared completely in ten days.—B.M.J. ii./o8,1670. Paroxysmal Tachycardia.—It is the treatment.—B.M.J. ii./o4,109. Pneumonia, Acute Lobar.—Pound to aid the action of Digitalis in cases with cardiac weakness—10 minims of Tincture of Digitalis with | minim of solution of Nitroglycerin every three or four hours. Especially indicated when the renal secretion is scanty, and the urine contains more than the usual trace of albumin.—Yeo. Pulmonary Haemorrhage.—The action of Nitroglycerin on pulmonary circulation does not justify its use and experimentally it appears to be contraindicated in haemoptysis.—Per Jl. A.M.A. ii./25,929. * Sea-sickness. Recommended.—A. Sellheim, B.M.J. i./a8,244. Sleeplessness, where psychic or somatic excitement is the cause, endeavour to reduce the reflex excitability of the cord or lower arterial tension by Nitroglycerin or Bromides.—B.M.J. ii./13,1209. Wounds caused by N.G. explosion ; of peculiar churned-up and softened nature, probably caused by the escape of internal body pressure into the vacuum caused by the explosion.—J. L. Thomas, B.M.J. i./i6,89. Methyl Nitrate which is soluble in water to extent of 1 in 30 at 20° 0., is 100 times less powerful than Nitroglycerin when given per os, and when given into the blood stream is about 15 times less. NUTRIMENTA. Discussion of the Protein, Fat, Carbohydrate Inorganic Salts factors of Foods, consideration of “Amino Acids,’’ the Biuret Reaction for Albuminoids, Calorie Values, Yeast Extracts as Foods, Milk Preservation, Bread and. Flour Standardisation, the Bleaching of Flour, and Injurious Admixtures to Flour and other matters.—See V ol. II. We are not self-supporting and would starve on our owTn resources in a short time. We are forced to purchase the food offered through existing commercial conditions—not what ice like.—L. h./3°> 1237. Beef can be brought, in consequence of refrigerating efficiency, from La Plata, 6,232 miles away, at an inclusive charge of 9/l6d. per lb. (less than the cost of rail freight from Glasgow to London) in a condition that makes it practically indistinguishable from home-killed produce (but the taste is umeront. —W.H.M.). There are 14,000,000 acres in Argentina devoted to alfalfa grass of clover type. Crops are cut 6 times a year. The Rail System is Britisn- owned.—B.M.J. ih/30,617. , . , .... .. . , Oosnl&fffcztBOFss of foods may give more efficient nutrition than single foods.—L. ih/30,976. . Preparations of Meat and Biood. Meat is the best blood builder. Anaemic Patients are often found to take very little protein, and marked benefit often occuis on addition to their diet of liberal quantities 01 meat. x. McLester Jl. A.M.A. ii./29,1467. . x Meat Extract is the product by extracting fresh meat with boumg water and evaporation. Contains not less than 75% of total solids. It snould be practically free from Albumin. The yield from meat is about 6 /o* . . , Fluid Meat Extract is identical with above prepared by process, except that it is evaporated at lower temperature and more than 75 and not less than 50% of total sohos. , _rpwnrp nr Meat Juice is the fluid portion of muscle fibre obtained by Pressure o_ otherwise and may be concentrated at a temperature her ■ ydy * point of the soluble proteins. The souds contain not mo c vm/ W ’ 1Kb more than 2-5% NaCl (calculated from total Cl), not less than 12/0 JN., not more thaS 4 « than 2% P.O.. The nitrogenous substances contom not less than 35% coagulable proteins and not more than 40 /Q meat bases. Allen, 1914, Vol. VIII., p. 390. Beef Extract Making. The meat is cut up and all tendons removed. It i then minced and boiled. After settling, the soup is skimmed to remove the fat JNext it is filtered and evaporated to 25 Beaume, and it then contains 16% moisture I he whole process takes 5 days, and 10 lbs. beef gives 1 lb.- B.M.J. ii./3o,617. See also S. Back, P.J. ii./3i,361. Nutritive effects of Beef Extract. The addition of beef extracts? (commercial and home-made) to diet has been shown to increase weight. A urther references on the matter, Erin. XIX., p. 581. Some Meat Extracts are fortified by additions of meat fibre, blood, albumin gather nutritious constituents.—(E. Hutchinson).-—A. E. Tankard, P.J Ci^’BovHl (T.M. 270031, 58405, 76548, 76549, 76861, Class 42, also 605013 A combination of beef extract and finely powdered beef fibrin and albumen widely used as a substitute for ordinary beef tea. Bovril was the commercial extract used m the investigation into the “ nutritive effects of beef extract ” referred to above. Concentrated Beef-Tea. r,\^1:in an(t skins, contains the natural gelatin of the meat, and, diluted, forms a nutritious substitute for true beef-tea. *Meat Juice (Brand’s.—T.M. 441825, Class 42). A teaspoonfui in a wine-glassful of water is a useful tonic. Is prepared by cold process resulting in retention of full activitv of juice of the raw beef. & Ferrocarnis (T.M. 346870). Dose.-- One teaspoonfui in water thrice daily with meals. Described as a flavoured solution of iron in organic combination with concentrated raw meat juice. An Iron Tonic food. Essence of Beef. . A s?ft, transparent, amber-coloured jelly, prepared from beef by exhausting with tepid water. It is agreeable to the palate and stomach of a delicate invalid ; is useful in allaying obstinate vomiting. It is best taken cold by teaspoonsful. Similar essences are made from mutton and chicken. Meat jelly is suitable for ulcerated stomach. Galat.in is a powerful protein sparer, easily digested, and fixes a great deal of acid. Beef, Chicken, Mutton and Veal Peptones are also prepared. Restorative Essence of Beef is made from fresh beef, freed from fat finely chopped up—1 pound mixed with distilled water 8 ounces ; add 5 drops of hydrochloric acid, and 60 grains or less of salt; stir well and allow to macerate lor 3 hours ; strain. The product has an agreeable taste, and should bo taken cold. Dose.—A wineglassful or more (Einger). It is also prepared Peptonised by digestion with pepsin at the bodv temperature. These are best freshly prepared for the patient, but may be preserved a resonable time by addition of formalin or chloroform. *Eatan (T.M. 426998, 427405). An Essence of Beef, described as a liquefied form of liver and animal proteins. Beef and Malt Wine.—Extract of Beef 4 ounces, Extract of Malt 8 ounces, Port Wine 1 gallon (Ph. Form.); or a Meat Juice and Liquid Extract may be used instead of the solid extracts. A ‘ Beef and Malt Wine ’ should contain at least 0T8% of Nitrogen and Phosphorus equivalent to 0-12% of Phosphorus Pentoxide. Of 12 samples examined none contained these amounts.—B.M.J. i./24,919. Further wines are mentioned in the Proprietary Medicine Chapter, Vol. II. Meat Juices, Liquor Carnis and others. Dark, reddish-brown liquids consisting of the expressed juice of meat concentrated at a low temperature in vacuo. A teaspoonfui is added to 3 table- spoonsful of cold or tepid water, and taken in tablespoonful doses or more for sickness or exhaustion. Hot water coagulates the albumen. Haemoglobin. Dose.—1 to 2 drachms (4 to 8 Gm.), C'goo H900 -^154 -^e S3 0179 (?) = 13339-740. The principal constituent of red blood corpuscles. Is supplied commercially in reddish black powder or in scale form. May be given according to condition in cachet, capsule, or mixed with wine. ! It is useful m ordinary secondary ansemia. Haemoglobin solution g res a characteristic absorption spectrum and contains in organic combination iron equal to about J%. Of. Vol. II. for estimation in the blood and further details. It combines readily with oxygen forming Oxyhemoglobin, which is the substance known in trade as haemoglobin. r arterial circulation, haemoglobin is present as oxv-hnnioslohin (oriiliant red m colour) the oxygen of which is given up to the tissues i- its course returning de-oxidised (dark-red) to the lungs by the venous svJtow where it is ready to take up fresh oxygen and so continue^he process. * Haemoglobin Capsules. Cantain 5 grains (0*3 Gm.). Elixir Haemoglobin. Dose.—1 drachm (4 Cc.) or more. Hsemoglobin 10, Water 15, Aromatic Syrup (carefully neutralised) q.s. to 100 (approximately 5 grains in 1 drachm). An agreeably flavoured preparation of hsemoglobin as hsematinic. Elixir Hsemoglobin cum Lecithin.—Dose.—1 to 2 drachms. As aoove with 3 grains of Lecithin per drachm added. Nutrient Powder (Brand’s). On bread and butter or mixed with other food is very palatable— it retains the nutritive value of fresh meat. Albumin Ovi Siccum, Ph. Ned. V., P. Jap. ill. (now omitted). Dose.—Ad lib. The molecular weight of albumin has been given as approaching 14,000. Yellowish, transparent, horn-like pieces obtained by evaporating white of egg at not exceeding 50° C. (the fresh white of egg is used as antidote in case of poisoning by mercurial and copper salts). Should be easily soluble in about 10 parts of water producing a neutral solution. Insoluble in alcohol and ether. Incompatible with mineral acids, alcohol, mercuric chloride, tannin-containing preparations. In hyperchlorhydria and in nervous disorders egg albumen is a food which binds and neutralises Hydrochloric Acid. Albumin Water, for infantile diarrhoea and invalids in general. White of one egg mixed with Sterile Water 8 ounces, Sodium Chloride 5 grains or q.s. and a little whisky or brandy added. Emulsifying agent for essential o//s.-The following was found to be efficient: Egg Albumin powdered 1, Cream of Tartar 4.—P.J. ii./25,521. Emulsifiers.—J. Cofman-Nicoresti, P.J. ii./26,350,369. Albumin Sanguinis. Dose.—Ad lib. Made by inspissating blood serum. Brown hornlike scales, not so soluble in water as Egg Albumin. Milk Preparations. Under-consuim&Hon of milk. Viscount Astor points out that Canadians drink twice as much as English, and Americans three times as much. Dairying and livestock should be the cornerstones of British Agriculture. The number of Grades of milk should be reduced and revised. Position chaotic,—L. i./3i,771. See also D. L. Tucker, B.M.J. i./3t,1137. For a resume of all the Enactments that have resulted from Parliament - ary efforts since 1915, in which year the Milk and Dairies (Consolidation) Act ivas passed (although it did not come into force until 1925) see Vol. //, q.v. also for Millc Analysis. Vol. I. t Infant Feeding. The Enzymes in fresh human milk are Catalase, Amylase, Butyrase, IApas and Peroxidase while cows’ milk contains, in. addition, Perhydridase. W summarise the action of these and other Enzymes in a Table, see Vol. II. ‘ Upper Milk Feeding ’ for Infants and invalids commends itself for certaia reasons, ‘ Upper Milk ’ consists of the upper portion of milk that has stood in a cool place until a cream layer has formed. By diluting with water, or wit# water and whole milk, mixtures are obtained containing a high percentage o fat with a normal percentage of proteid. Upper milks are much superio to cream mixtures for feeding—the fat percentages are more uniform and th* dilutions do not so readily separate as those employing cream. Dried Milk. /Yianufacture.—By spraying milk in a current of hot air or by heating over revolving cylinders. Hygienically and dietetic-ally dried milk shoulc be good. It is superior to condensed milk in protein and fatty matter.— S. Delepine. 5 Cow & Gate ’ Milk. (T.M.’S numerous, Classes 14 & 42). In making thi the temperature does not rise above 98° C. form ore than about 3 seconds. It i not diluted with sugar, either Cane or Lactose. Some products contain as much as 30% to 40% of the gaiter added This is contra to the policy of the makers of an alt-British product. Public Health (Dried iVtitk) Regulations 1023 govern content o_ Milk Fat—vide Vol. II. Dried Milk is much used for Infant Feeding. The ‘ HaS Cream’ Milk is preferred by some authorities for the purpose, a being less rich. This contains perhaps only 1% fat. B. Tuber culosi is killed in the process of desiccation. For infan t feeding and genera use are :— Dried Full-Cream Milk is reconverted into milk by mixing 21 ounce (5 heaped tablespoonful) with 1 pint of hot water. Dried Half-Cream Milk. Employ 2J ounces (5 tablespoonful) to th pint of hot water. Dried Separated Milk (containing 1% of its original butter fat)' Employ 2 ounces (4 heaped tablespoonsful to the pint of hot water In Feeding Trials with the Dried ‘ Full ’ and ‘ Half ’ Cream Mill on infants of the poorest class in London, diarrhoea was practicalk absent throughout. Dried milk is more easy of digestion. Infants are often unable t< take fresh milk even in extreme dilution without recurrence of diarr hoca, yet can digest comparatively concentrated mixtures of drie* milk. Get the child back again on cows’ milk gradually. A teaspoon ful or less to be added to the Dried Milk at first and increased. For infants, Milk in preference to Patent Foods. If Milk is cooke- or pure dried Milk be used, fresh fruit juices or raw meat juice must sup plement.—From a lecture on Infantile Scurvy by T. D. Lister. Disadvantages of Dried Milk in infant feeding. Rickets common. Babie often decidedly anaemic.—J. Burnet, Pr. Mar. 1921. Good standard Dried Milk corresponds to the 3% Standard of the Boarc of Agriculture and Fisheries. Where pure cow’s milk is unavailable Driec Milk is a reliable substitute.—R. J. Blackham, Pr. May, 1921. Protein balance in infant feeding. Combat of the idea that infants will no thrive on cow’s milk unless they are given two or three times as much proteir as is contained in woman’s milk.—E. Pritchard, L. ik/22,44 ; see also R. Carter ibid 99. National Milk Conference, speakers in general in favour of Dried Milk: —L. ii./22,930. nutrimenta. 579 v i toraii? than^spray process mflk-E* Melknbf'B M jT/mWK anti3corbuti« greater or slightly less than that If fresh milwife VT^'S1 may be slightly on methods of manufacture.—J C S 44/25 75i’ vana^lon n°t depending rafedlc'ondensef r IT3'1 c™3' milk «>an evapo- Ste also 0. Haddock, B MJthhus. ' Hartwell> S./25.1073. te»?ofSmoreThanbl 000 pef grlmhf^nLTf'f con. total count of lisemolysing ?oloideJ nmoh lin t -al bacterial count and the process than by by Spray CreaamtaldnLactos'e hav^been^dded.—B.MH? h/?i^757.C°W’S Mi!k’t0 which Human Milk, Artificial. New Milk 30, Cream If, Milk Sugar 1J, Water 18. toseTndVane4 sT^iSl ffunces waterTl^’ X addition of broth has been found good.-E. Pritchard,’ L L/22 83S.1 The Humanised Milk.—Can. Form. Triturate 100 grains of a mixture of Pancreatin 7, Sodium Bicarbonate 28 and Milk Sugar 965,—with Water 2 ounces and transfer T—. 11 • • ^ 0Sj ftnd. cream 4 ounce. Immerse this in water heated to 38° C. for J hour. Afterwards bring to the boil. Human Milk has the average composition:—Fat 3*4%, Milk bugar 6-4%, Albuminoids 1*7% (Casein and Lactalbuinen, cf. p. 582), Mineral Matter 0-2%. Notice the difference between the human mnk and cows’ milk (Vol. II.) in the relationship between the albuminoids and the mineral matter. A mkk is an optimum diet for newly born infants; no substitute can be produced for this. The constituents of cows’ milk may be re-arranged to make them present in proportions almost exactly similar to those in breast muk, but, however completely we may humanise cows’ milk, it is not in our power to make it human, nor to give to its proteins the peculiar stamp of specificity.—A, E. Garrod. . Calonc bases of milk mixtures. The vast majority of milk mixtures used m infant feeding are as unlike human milk as they are unlike unmodified cows milk.—G. E. Powers, per Jl. A.M.A. ii./25,1511. -Humanised milk liable to produce diarrhoea in infants.—L. h/24,867. The ea/c/wm content of human milk is lowest for the first two weeks of lactation, rising gradually to a maximum during the first 4 months. During the first six months a ratio of CaO to P203 per 100 Cc. greater than 1 and approximately 1-3 is probably best for the child.—L. ih/30,93. National Mi<k Conference. Variations in chemical composition of milk. Morning milk of ten cows during a fortnight only reached 3% of fat once, while the evening milk was generally in excess of 4% — B.M.J. ii./22,820. If artificial feeding has to be resorted to, healthy cows’ milk should first be tried ; that known as 4 Certified ’ or else 4 Grade A ’ (Tuberculin Tested) may be more relied on than ordinary milk supply. (Graded Milk is dealt with in Vol. II.) As a general rule dilute with equal quantity of water. A grain of Sodium Citrate to the ounce will increase digestibility (5 and 10 grain Tablets are prepared q.v.), T 2 Milk Sugar, a drachm to the pint, is also a useful addition. FresI Milk is better than Pasteurised, but in case of doubt Pasteurisation: or the use of Dried Milk (q.v.) or Condensed Milk (containing not les than 13% fat) should be considered. Of the last mentioned use 2 teaspoonful of the sweetened variety to 3 ounces of water, adding teaspoonful of cream. (Condensed Milk should not be given afte the child is 4 months old.) Sodium Citrated Milk (2 grains to the ounces makes whole milk feeding, possible and removes necessity of diluting. Results equal to natural milk —C. W. Vining, R.M.J. ii./i5,457 ; see also R. D. Rudolph, ibid, p. 660.— Strongly in favour of undiluted milk heated in a jacketed pan for 40 minute as advised by Budin, with addition of Sodium Citrate. If none of the above are digested, Peptonised Milk must be givei employing Peptonising Powders or Liquor Pancreaticus (g.v.)' After the child is six months old a Malted Food may be given a a supplementary food, but farinaceous foods of all kinds should b discouraged until the child has teeth.—R. Hutchinson. Infants’ Food ‘A 5 for Children up to three months contains all the Mill Solids prepared with aseptic precautions. Three to five heaped tablespoonsfui to be added to a pint of water which has been brought to the boil (and kep boiling for fifteen minutes), and alio wed to cool down slightly in a covered jug When mixed for use, it is similar in composition to human milk. Food * B ’ for Irfants (from three to six months) and Invalids contain the milk solids with a small proportion of cereal carbohydrates treated t* render them assimilable. Prepared for use as the latter. Food ‘ C ’ for Infants (from six months and upwards) and Invalids simila to ‘ B ’ with a larger proportion of farinaceous constituent Five heapec tablespoonsful to be used to the pint of water as above. Cocoa Food is also prepared. Biscuit Foods. Biscuit Powder II lbs., Baked Wheat Flour 1 lb.. Finest Ground Oatmea 6 ozs., Milk Sugar 6 ozs., Powdered Malt 8 ozs., dried at a low temperatur and mixed. A better way is to bake into a biscuit the mixture of wheat flour, fine oat meal and milk, then grind up and mix with the powdered malt. Another formula is :—Baked Flour 1 lb., Biscuit Powder 1 lb., Refined Suga in powder 1 oz, Milk Sugar 6 ozs., Finest Oat Flour 8 ozs., Powdered Mai 4 ozs.—Note Hutchinson’s remarks, sufra. ^Frailac (T.M. 508494, Cow 6a Gate). A reconstituted milk specially devised for frail and premature babies, sjcllemolac (T.M. 487114, Cow 6a Gate). Full Cream Milk Powder containing 311 grains (0*45%) Iron Ammonimi Citrate to the lb. Foi prevention of anaemia in infancy. >{cBrestol (T.M. 475867, Cow 6a Gate). * Humanised Cream,’ plus Cod Liver Oil and concentrated Orange Juice As substitute for dairy cream and Cod Liver Oil emulsions in cases of fa. intolerance and in backward and underweight babies, also in marasmus an# tuberculosis. ^Lacquin (T.M. 483703, Cow 6a Gate). Quinine Milk Powder. Tropii cal tasteless tonic food. 1 teaspoonful=21 grains Quinine. ^Lacidac (T.M. 483501, Cow 6a Gate). A dried milk with addition of 1 drachm Lactic Acid B.P. to 1 pint of milk Made in two strengths: Separated (1% fat) and Half Cream (16% fat), th optimum dilutions being respectively 1 to 9 and 1 to 8 parts of boiled water. Id convalescence, marasmus, eczema, diarrhoea, and vomiting. Half Cream Foods (Cow 6c Gate). A Milk Powder modified with added Lactose and resembling breast milk in the non-fatty solids. In the nervous dyspepsias of infancy and in cases o: fat intolerance. NUTRIMENTA. 581 Pasteurisation of Milk. liie two principal methods employed, are HI H'lnch T>vnnnc« 4 .. . the milk is usually distributed bv cSif.mal fnr^n a Process, m which of a cylinder at a temperature of'72 to 8t“ C and faiThe surtl.ce which the milk is maintained at ahmU O',0 r 5~e P rocess, in cooled. Above 65» C?MrtSrtSSch^es occu? Iapif ly regarded as the most reliable. The consensus of bhiion i^w ? ls,"?uJl y bacilli survive 60-65° n fnr an ™ini1t A i !■ mion is that few tubercle their virulence Impaired! 30 mmutes and tllose escaPinS destruction have Ministry of Health Order, ‘ /VI ilk temp5atOTe^?l4«?o2m)°FIJforihMSEI> ?JK raust have been heated ata S A by the WWCh th° Milk iS k6pt at F- for 30 minutest ^•4Son?st the peases for which milk acts as a vehicle are tuberculosis diphtheria, typhoid fever, paratyphoid fever, dysentery, scarlet fever Malt0’ fever, infective sore throats, epidemic diarrhoea, cholera and food poisoning p vr 1Tess..fye(llie1n)tly foot-and-mouth disease and anthrax.—W. G. Savage Jj.iVi.j. ]1./25,zJ44. ’ ci£?impl?te s*fety f-rom mii^ infe?tion |? impossible unless milk is rendered .reriie of pathogenic organisms immediately before consumption i.e. bv home pasteurisation or scalding, l or relative safety, commercial pasteurisation is the only solution —E. Pritchard, B.M.J. ih/25,245. Pasteurisation of milk is of advantage to the dairyman rather than to the consumer. On keeping raw and Pasteurised milk, the bacterial count in the lamer iounc. jar greater than in the raw milk. As to antiscorbutic properties, Pummer has shown that re-lieated Pasteurised milk contains none.—T. McLachlan, L. n./26,878. hecent O&smons on Pasteurisation of Milk.—Where practised, imection traceable to milk recedes to vanishing point.—Lord Dawson of Penn and 8 other signatories, L. ii./3o,1315. hampering with one of Nature’s foods may be putting the dock hack,—C. Maddock, L. ii./3o,1367. No raw milk—Certified or other—is safe.—Prof. J. C. G. Ledingham, L. ii./3o,1368. What advantage would accrue if Pasteurisation of Grade A (Tuberculin Tested) were made compulsory ? The advantage to wholesale Pasteurising firms is, of course, obvious.—D. M. Connan, L. ii./3o,1368. Lord Moynihan says : “ Every drop of milk taken into my house is boiled as soon as it is delivered. The nutritive value of milk, contrary to general opinion, is not in the least diminished by boiling.’*—House of Lords, Feb.,’31. # Consumption of milk in this country lamentably small (? natural instinct for self-protection.— WJH.tVL). Pasteurisation does not impair the nutritive value.—D. L. Tucker, B.M.J. h/31,1137. “Flash” principle (as carried out at the Middlesex Hcspifcal) the better method. “ Pasteurised ” milk supplied by a well-known firm often found to have a bacterial content of several millions. Discrepancy due to the media used—a richer medium should be used for routine analyses than that recommended by the Min. of Health. Provided the milk is clean the richer medium still gives results within present legal standards. Trouble due to thermophilic and thermoduric organisms, which may actually he increased by pasteurisation. To hide dirty methods, farmers heat milk before sending it to be pooled. Pasteurisation as generally used at present is not the /fast word in the provision of clean, wholesome milk.—J. McIntosh and L. E. H. Whitby, L. ii./3i,148. At the Bladen Dairies (Dorchester) milk is coliected from some 90 farms, is immediately pasteurised, cooled, and packed in cartons, and is on sale in London 24- hours after cow is milked.—L. ii./3i,1087. It could be done far quicker i.e., within S hours, by adopting the writer’s suggestion of refrigeration on the farm and delivery in thermo- isolated containers. See Vol. II., XIX., p. 483. Vitamin value of milk Pasteurised at 145° F. for 30 minutes is undamaged.— Evelina Hospital observations, P.J. i./3o,321. If Vitamin C is destroyed in Pasteurised milk add a teaspoonful of fruit juice.—United Dairies. L. i./3o,13S2. Boiled versus Unboiled Milk.—Experiments on animals fed with milk of another species. Such small differences as were found ini the nutritive values of raw and boiled milk were in favor of boiled milk.—L.G.B. Report. Milk boiled at home for 2 to 5 minutes is in every way to be preferred to fresh or commercially pasteurised milk.—J. Brennemann, per P.J. i./17,23. For further data on Pasteurisation, especially with regard to R- tuberculosis, see Vol. II. Pasteurisation causes changes which considerably reduce the dietetic value of milk. Probable partial destruction of Vitamin Bj.-E. C. V. Mattick andi J. Golding, L. i./3i,667. Milk containing Lactic Acid 0*5% was a satisfactory routine food in the majority of 50 infants aged from 1 day to 0 months in which it vTas tried. The advantages claimed are ease of preparation, relative sterility, and greater digestibility and caloric value. It should not be used in cases of anhydroemic. acidosis until the acidosis has been overcome.—J. A. Stephen and E. It. C. Walker, L. ii./27,65. Condensed Milk standardised under Ministry of Health—(L. i./23* 972, ii./23,529. Further Data from Food Investigation Board, see Vol. II.), Labels to state clearly the types. The composition to be :— Milk Fat. Total solids, including Fat. Full cream unsweetened . 9 0% 31% ,, ,, sweetened ... 9-0% 31% Skimmed unsweetened — 20% ,, sweetened ... — 26% ‘ Berna ’ (T.M. 468128) Condensed Milk contains apparently less cane sugar than the average, hence Fat content correspondingly higher.—Pr. Mar.. 22/227. J Milk*contains more calcium than lime water. Milk is, therefore, of value in hemorrhage—where it is desirable to increase the calcium in the blood—also in many forms of pneumonia. Butter-milk is useful in typhoid and in gastrointestinal disorders of children. In post-partum hemorrhage £ to 1 litre of milk by rectal injection is good as a hemostatic. Whey Powder. This is Desiccated Milk deprived of fat and Casein. It has average composition: Soluble Lactalbumen 14-25, Milk Sugar 74-45, Fats G-27, Mineral Matter, chiefly Phosphate 9-8, Moisture 1*2%. It is employed in conjunction with cows’ milk for producing a milk with a. reduced proportion of Casein, and also of higher Sp. Gr., with the result that the amount of fluid is proportionally lessened. Or it may be prepared with water and cream,—the cream being low in Casein, sugar and ash, but high in fat, whilst the whey is low in fat, but high in ash, sugar and lactalbumen. It may also be used alone to produce Milk Whey by dissolving in water. Human Milk contains on an average 0-8% Casein and 0-6%, Lactalbumen ; Cows* Milk 2-7% to 3% Casein and 0-2 to 0-3%, Lactalbumen. Gf. also p. 579 for other constituents and Vol II. In diluting Cows’ Milk with water to reduce the Casein content it: is obvious that the deficiency in Lactalbumen is rendered still more in error. It is also clear, if the preceding figures be correct, that a breast-fed^ child taking 1,000 Gm. of milk in a day, will receive 6 Gm. of Lactulbumen. A child receiving, say, 600 G?n. of Cows’ Milk would receive only 1-8 Gm., at most, of the same albumen. This lactalbumen is soluble i.e., it does not undergo precipitation with acid and digestion with pepsin and pancreatin before assimilation. Arguing by analogy with the high albumen content in Colostrum which the newly born calf receives (cf. Vol II.) the advocates of Lactalbumen, as an addition to cows’ milk for infants’ milk, claim that it is important to supply tne infant with a form of protein which makes small demand on the digestive glands, and which does not require much transformation before it can be absorbed. Koumiss (Artificial). Syn. ^kepiiir (T.M. 298465, Class 42). Dissolve Grape Sugar I ounce in water 4 ounces, and add 20 grains of yeast and cow s milk 4 ounces. Place in a quart bottle and fill up with milk, cork and wire. Keep it cool and shake it frequently during four days. Koumiss £hus prepared contains some alcohol (1 to 2%) and lactic acid (about 1 to ~ /?)' the original Koumiss of the Tartars was made from mare’s milk by using the peculiar Kephir ferment, which swells up on soaking in milk. This consisted m reality of yeast cells with certain bacteria (B. Caucasicus, Kern). In some respects it resembles mother’s milk more than cow’s milk. Uses. A food used in the Caucasus as a stimulant in exhaustion and in convalescence of phthisis. Was recommended by Metcbnikoff as a nutritive and as an intestinal antiseptic. See also Acidi Lactici Bacilli, this Vol. & Vol. II. Goat’s Milk.—This appears to lie between human and cow’s milk. It is recorded that a baby of seven weeks received 3 ozs. a day, the amount being increased as the natural supply failed, until at three months it was taking six feeds a day of 4 to 5 ounces each and nothing else—the n ilk was given straight as it came from the goat. Digestion was perfect and there was a gain in weight increasing from 3 to 4 ounces to from 6 to 8 ounces each week. A first class food requiring no preparation. The fat is both in large proportion and in finer globules. Not only do goats not suffer from tuberculosis, but tlicir milk has a wonderful effect on children, especially on such as have to be brought up artificially and with whom cow’s milk disagrees.—Brit. Goat Society. Casern Preparations. Casein is the principal albuminoid constituent of milk and is present in solution in the aqueous portion of the milk as an alkali- albuminate, probably as a calcium compound (the alkali in milk is about 0*5%). Some hold that Casein exists as Caseinogen, and that this is converted into Casein by ferment. It is precipitated by dilute acids (e.g., acetic acid, which is utilised in method of estimation, v. Vol. II.). Casein is furthermore precipitated action of the rennet ferment. Casein is present in milk to the extent of 3 to 5% (usually about 3J%). Once thrown out of solution it is not readily dissolved again except with added alkali or hydrochloric acid. Cheese is casein with a considerable proportion of fat. Flocculent Casein, see Casumen, infra (specially prepared) is however, soluble in water. s^Plasmon (Trade Marks numerous in Classes 3 & 42), a soluble milk albumin (Casein). Nutritive and easily digested. Plasmon Biscuits, Arrowroot, Cocoa, and Chocolate are prepared. Contains Phosphorus in organic combination to extent of 1-46%. Total Phosphoric Acid found was 2-88%. Milk protein differs from other proteins in containing Phosphorus in combination. Foi gastric ulcer, this and similar foods are much employed. Chronic diarrhoea in breast-fed infants cured, without weaning, by giving e teaspoonful twice or thrice daily in water or milk for 6 or 8 weeks.—J. Gibbens. L. i./32,289. jfcGiisumea (T.M. 239,245). A soluble form of Casein (Flocculent Casein containing a very high percentage of protein (90%). For use in all case? where there is poor nutrition. It contains practically no fat or sugar. It may be mixed with cocoa, chocolate, bread (10%) for diabetics, etc. Soluble and other Caseins, Modes of Making.—P.J. ii./i2,155. Pigmentum Casein (was in St. M.’s H.). Syn. Unguentum Caseinae Casein 14, Potassium Carbonate Glycerin 7, Vaseiin 21, Zinc Oxide £, Pheno i) Water to 100. If good Casein be used we find this is almost too thick— add a little more water. A basis for skin medicaments. Thymol q.s. mayi be added to preserve it. Proprietary Foods in Infant Feeding. Many proprietary Infants’ Foods are deficient in fat. This may provide partial explanation of the characteristic liability to infeetioi so frequently seen in fat but pasty babies reared on this type oil Food—J. C. Drummond, L. ii./i8,482. cf. Vitamins Proprietary Infants’ Foods are thus classified :— 1. Foods with a basis of dried cow’s milk but mixed with flour. 2. Foods consisting mainly of flours, the starch of which is practically unaltered or altered only by heating. 3. Foods consisting mainly of Hours mixed with a proportion of malt fiouir of malt extract, but containing much unaltered starch which is not converted into soluble products during the process of preparing the food for infants in accordance with the directions given on the package. 4. Foods containing flours, but also containing active diastase or pancreatic ferment, so that if the food is carefully prepared according to the directions on the package the starch is appreciably altered. 5. Foods manufactured from flours, the starch of which has been mainly or partially converted into soluble products during the course of manufactnre. The observation is made that most proprietary foods arc deficient in fat' and also in fat-soluble factor, whilst a number are also stated to be inadequate! with respect to the water-soluble factor, and all are deficient in the antiscorbutic factor.—From Med. Res. Com. Report, per C.D. Feb. 14, ’20. See- also Roy. Soc. Med. Discussion, L. i./2o,604. ^ Proprietary Foods and Milks. A good summary, including Allenbury’is Food, Mellin’s, llorlick’s and a number of nitrogenous foods.—E. Cautley, Pr. July, 1922. Investigations of 106 foods a few years ago carried out by F. J. H. Coutts and J. Baker for the Local Govt. Bd. are referred to by H. C. Cameron, B.M.J. ii./i 5,287. Glaxo (T.M. 364394, 433121, Class 3 and numerous in 42). This infants’ food is a dried milk containing added Lactose. In addition to the standard Full Cream Glaxo there are issued, Xo. 1 or half cream and Xo. 2 or three quarters cream. The Full Cream contains approx. 25-5% Fat and 42-5% Lactose, the ‘ Xo. 1 ’ 15-8% Fat, 49-2% Carbohydrates, the Xo. 2 20 % Fat and 45% Carbohydrates. The Carbohydrates in Xos. 1 and 2 consist of lactose with nearly 10% Cane Sugar. ^Savory & Moore’s Food (T.M. 255039, 329754, 334627) is stated to contain the active enzymes and vitamins of malt. It contains no dried milk. In preparing it for use it is not heated sufficiently to impair vitamins or enzymes. When so prepared it approximates mothers’ milk. * Vitafer (T.M. 324675, 333647, 347470).—A tonic food. Bose.—Two teaspoonsful three or four times daily mixed with milk porridge, cocoa or any fluid food. For children under 10 three teaspoonsful daily ; Infants proportionately. The “Lancet” found Protein not exclusively Casein as some is present as Milk Albumin. Moisture* 6*3%, Mineral Matter 10*7%, total Protein 80-4%, Fat 2*6%. Total Phosphoric Acid as Glycerophosphates 3-84%. Almata (T.M. 424829). humantui-LaLC/°“P79f ^ B has a “ vaIue approaching that of. jutee'and^contaSs^h^needed^minerai^constiUients111'!^^^6^ fruit practice the food has many advantages.—^ 9 Sfport3 sho'v that m It is claimed that the percentage of fat ahsomtirm 1™ ->+ f ^ . ahy:iat if ^r B.M.J. ii./27/78O °f 1 galactagogue and an invalid food.— Bationale of Infants’ Foods.—F. Boles, P.J. ii./31,357. Other Food Preparations. Benger’s Food (T.M. 321220 and others). A wheaten flour preparation containing Irypsm and Amyi op sm. It is used with fresh milk or milk and water It gives nourishment with complete or partial rest to the digestive system The point of the preparation is that if the digestive system, however Xk^an do at a11’ be given it to do to the'extent of 7tsvwerThe fit may be increased by adding cream or upper-milk. *Peptalac. (T.M. 501397, Cow and Gate). Pancreatised Milk, Dextrinised and Pancreatised Wheat. Pre- pared by Roller Process, retaining full mineral and Vitamin content with freedom from pathogenic organisms. For use where powers of digestive tract are deficient. ^Glax-Ovo (T.M. 450299 and 450186). digestible°food.a Bfontotas^Itehm- A palatabIe> readily-prepared, easily- tefesf3%racrtoSe and° 5%°Deftrto. f°°d’ With & high Ca'°riC VaIue' Con' ,,2!U}eP^yn- Vegetable Albumen. A protein mixture obtainable from w heat flour as an elastic mass when moist. PiFG&ctircztiion.—-Knead flour with about half its weight of water to produce a stiff dough. Knead further in running water till free from starch. Wheat I rotem is digested m less time than the majority of animal proteins. Energen Bread (T.M. 337793, 524836.) Contains 40% Protein and only 46% Starch. Its caloric value is 108 Cals. /TJ. oz* (ordinary bread 75 Cals. =1 oz.). Energen Bread and Breakfast Food (Bismeal) are rich m Protein and much reduced in Starch, and are of value in eases requiring strict dietary— E. Browning, 14/3/1930. (1 ,ie subject of Bread is dealt with for the most part in Vcl. II.) NEM. (Kehrung’s Einheit Milch). A unit used by Von Pirquet. The energy contained_ in 1 Cc. of milk. It is based primarily on calorimetry, aided by calculations which deduce the energy requirements of an individual from his body weight and his sitting (not his standing) height. A dietary is based upon it—Sir Gowland Hopkins, L. i./2i,3. DIABETIC FOODS. Sfcarehless Bread (both brown and white) also Biscuits and Flour are manufactured. These are generally Gluten Products (more or less free from Starch) and Bran foods. Previously they were the only foods available for diabetics. Casein (with eggs and butter) has latterly been employed. Casein bread and biscuits (Callard & Co., London) are free from Carbohydrates and are palatable. It is best to give this casein bread with a weighed quantity of starchy bread when desired. ‘ Gluten Bread ’ may contain as much as 55% of starch. It can be made with 7% of starch, but it is not palatable. Home made Diabetic Bread from milk Casein of separated milk with addition of egg white, Salt, Cream of Tartar, etc., as used a Duff House.—E. Spriggs, B.M.J. ii./2i,707, L. ii./2i,960. The Iodine Test is useful for the detection of Starch in so-callec Starch Free Foods and should be applied in cases of doubt. A deej violet indicates unaltered starch; partially altered starch wdll give ? brownish colour. We were informed that many Continental Diabetic Foods offered for their palatability actually contain a higher proportion of Starch than ordinary white bread. Almonds and other nuts are alsc used for making bread and biscuits. Various Sugarless Condi merits, foods and drinks are prepared. Saccharin is used as th>< sweetening agent. Sugar-free Milk for Diabetics.—Prepared by a process of separat ing and washing with warm water, using a dairy cream centrifuga. separator. Pour a gallon of cream into a 10-gallon can, fill witl water at proper temperature for skimming, and thoroughly stir Adjust separator to deliver 1 part out of the original 10. The cream is separated and the reservoir and separator bowl rinsed, while stil running, by adding more warm water. On repeating the process the cream becomes sugar-free. Flavour restored by addition of salt (05-07%) and a little Saccharin (added just before serving).— J].A.M.A.,i92i,76,792, per Y.B.P., 1921,265. The Casein and Salta might also be added back.—W.H.M. The following lists may be useful in assisting the Selection ol Foods for Diabetics :— (i) Foods free from Carbohydrates or containing less than: 1%—Beef, Mutton, Lamb, Pork, Poultry, Game, Sweetbread, Tongue, Fish .1 Turtle, Lobster, Eggs, Butter, Cheshire, American, Dutch and Gorgonzola* Cheeses, Lard, Gelatin and ‘ honest * Starch and Sugar free special foods. (ii) Foods containing a fo proportion of Carbohydrates (percentage of Carbohydrate is indicated).— Liver 1, Sausage (Pork) 1, Crab 1, Crayfish 1, Scallops 3, Asparagus 3„ Celery 3, Cucumbers 3, Lettuce 3, Spinach 3, Oysters 4, Mussels 4, Stilton Cheese 3, Cheddar 4, Rhubarb 4,1 Tomatoes 4, Mixed Pickles 4, Cauliflower 5,,- Leeks 6, Radishes 6, Mushrooms 7, Water Melons 7. (iii) Foods rich In Carbohydrate—Milk 5 or more, Whey 5; Oatmeal (thin gruel) 6, Strawberries 7, Turnips 8, Carrots 9, Beet (fresh) Cranberries and Pineapple 10, Oatmeal (boiled), Blackberries, Dried Peaches 11- Oranges 12, Parsnips, Apricots ^Currants, Walnuts and Filberts 13, Apples and Pears 14, Macaroni (cooked) 16, Calves Foot Jelly, Artichokes, Peas (Green)9 Cherries and Almonds 17, Potatoes and Pears (dried) 18, Figs and Grapes 19y Plums 20, Boiled Potatoes 21, Bananas 22, Rice (boiled) 24, Tapioca Pudding; and Cocoa-nuts 28, Chocolate 30, Mince-pie 38, Chestnuts (fresh) 42, Applet Pie 43, Bread (Brown) 47, Potatoes (fried chips) 47, Bread (White) 53, Rolls 56,,> Lentils (dried) 00, Bread (toasted) 61, Peas (dried) 62, Gingerbread 63, Macaroons 65, Sponge Cake 66, Oatmeal 67, Chestnuts (dried) 74, Sago 78, Tapioca 889 Arrowroot 97, Dried Fruits, i.e., Apples, Apricots, Currants, Dates, Figs.,! Prunes, Raisins 62—78, Meal Flour, Rice, Macaroni, Vermicelli 70—80. In the case of list (ii) much of the Carbohydrates in some of them is in the form of Cellulose, which is not absorbed. The majority of the above figures are from the analyses of Atwater and! Bryant.—L. ii./n,1184. The Carbohydrate Content of common British fruits and vegetables.—M.R.C- Sec. Rept. Series, No. 135, L. i./29,1204. ACCESSORY FOOD FACTORS. The original work of Sir F. Gowland Hopkins in 1912 paved the way for a vast amount of research, and although the chemical constitution of these bodies, to which the name Vitamin was originally given by Funk, remains ill-defined, knowledge of them since our last Edition has advanced to the extent that certain standards have been agreed upon. Recommendations of the Permanent Standards Com" mission of the Health Organisation of the League of Nations. (London, June, 1931.) Vitamin A.—Carotene to be adopted temporarily (pending further investigation as to stability) as International standard, with selected Cod Liver Oil as second provisional standard. International standard to be made from samples of pure Carotene prepared in specified laboratories by Will- statter’s method, and unit to be the Vitamin A potency of 0-001 mgr. of resulting mixture. Vitamin B.—The absorption product of Vitamin B prepared in the Medical Laboratory, Java, by Seidell’s method, the unit being the anti-neuritic value of 10 mgr. Vitamin C.— The Vitamin C activity of 0-1 Cc. of fresh lemon juice. Vitamin D.—Irradiated Ergosterol (as issued by the Nat. Inst. Med. Res.), the unit being the Vitamin D activity of 1 mgr. All Standards to be kept at the National Institute for Medical Research, Hampstead.—B.M.J. ii./31,863. Crystalline products of high activity obtained.—Prof. A. Windaus, R. B. Bourdillon and others, B.M.J. i./3i,1116. By eliminating preparations containing Vitamins from the diet in animal experiments it can be shown that they are essential to growth and freedom from disease, for example, an animal fed merely on pure protein, fat, the carbohydrates and the inorganic salts of food, will die within a short time. The four important Vitamins now defined are A, B, C, and L). An additional fat-soluble factor, Vitamin E, has been proved by animal experiments to be necessary for satisfactory reproduction. Vitamin deficiency diseases are beri-beri, pellagra, scurvy and rickets. Obscure and apparently trivial complaints are probably also to be included.—Prof. Halliburton. F or notes on treatment with substances rich in Vitamins see p. 590. The chief sources and properties of the Vitamins, with the results of animal experiments, are summarised below, but for more detailed information and abstracts from, the literature Volume IF should be consulted. Vitamin ‘ A.’ Fat Soluble. The Growth-promoting also known as Anti-infective Factor. Absence of the ‘A’ Fa'tor, where such foods as milk, u er an eggs are not available, has been proved to be e ore diseases of malnutrition. , .. .. The total absence of any of the factors e^11“ti^ird The^^ of Margarine and White Bread is a ser^^A a fairproportion of ‘ A ’ factor, animal fats—-fish oils in particular—contain a iair propuit Cf. E. Mellanby, L. i./i9,407. Occurrence—Cod-Liver Oil + + +, Cream ++, Green Vegetables ~j—[-. Bananas contain Vitamin A, in addition to B and C — B.M.J.E. ib/24,64. • / W;i septicaemia and acute rheumatism may he related to Vitamin A decency.—H. N. Green and G. Mellanbv, B.M.J. ii./28,695. Hitherto \ itamin B has been considered the only vitamin to play an important part in maintaining the health of the nerves, but it is now shown tliai. Spina/ Cord Degeneration follows on deficiency of Vitamin A. —L. li./31,918. Vitamin A is present in any liver oil—M.R.C. Report, 146, B.M.J. ii.,/30,221 A and D ’ are the only two vitamins about whose chemistry we have any solid knowledge and it is obvious how incomplete their story still is — L. 11./31,1308. T^^^^^ exact relation of, to Vitamin A is, to some extent, problematical. When from liver oils obviously Carotene is not responsible.—L ii /30 417 Significance of Carotene—I,. i./29,499 ; ii./2o,392. ' 5 Carotene—anti-infective function, etc.—B.M.J. i./3c,1013 Carotene as a source of Vitamin A—E. M. Hume and I. Smedley-Maclean, L. i./3o,290. 1 he parent substance, Cholesterol also has claims.—L. i./3i,768. Evaluation of foods might be standardised against value of Carotene — E. M. Hume and H. Henderson Smith, L. ii./3o,1362. Though not identical with Carotene, active Vitamin A preparations when ozonised also produce Geronic Acid. The Vitamin A of Cod Liver Oil must therefore contain in its molecule the same carbon ring as Carotene and could therefore he c/oemed a derivative of' it.—Prof. P. Karrer B.M.J. ii./3 r,622. 5 The substance isolated by Karrer, and also by Drummond and Co-workers was obtained from halibut-liver oil which is vastly richer in Vitamin A than that of the cod.—L. i./32,251. The purified product still produces toxic effects when given in excessive doses.—B. M. J. i./32,144. For Methods of Colorimetric Estimation of ‘ A ’ see Vol. II. Stability of Vitamin A. This Vitamin resists temperatures of 100° and probably 140° C., but it may be destroyed by oxidation. Vitamin ‘ A ’ can be obtained in a concentrated form by separation of the unsaponifiable portion of Cod-Liver Oil (q.v.). Vitamin ‘B.’ Water Soluble. The Anti-Neurotic Factor. This is removed in rice polishings and its absence has been proved to cause beri-beri. See Vol. II. hi ordinary human diet, out of 3 lb. of food, only about 6 oz. contain significant quantities of Vitamin B : ordinary daily diet seriously deficient fn Vitamin B, but the consequent tendency to intestinal atoriia somewhat counterbalanced by widespread use of purgatives.—B.M.J. i./26,239. Vitamin B is important during lactation.—G. A. Hartwell, L. ib/24,956. Occurrence.—Seed Germs, Yeast and Nuts -]—J—f- ; Meat and Milk +. Stability. Comparatively stable at 100° C. and not easily oxidised. Slowly destroyed at 120° C. The dual nature of 1 B' is dealt with in Vol. II. Vitamin 6 C.’ Water Soluble. The Antiscorbutic Factor. Lack of this Vitamin results in scurvy. Occurrence—Cabbage, Lemon and Orange Juice + + +, Meat and Milk -f- • The substances regarded as richest in this vitamin include raw fresh green cabbage leaves, swede juice, sprouted cowpeas, grape-fruit juice, lemon juice (fresh and dried), naarjte juice, orange juice (fresh and dried), raw tomato, tomato iomatoe* much less'value. South AMcan tomatoes mucn less potent than those grown in England. Milk by no means rich m Vitamin 0.—Spec. Rep. Med. Res. Council, L. i./24,364. Y Stability—Gradually destroyed above 50° C. Vitamin C is very sensitive to oxidising agents. Addition of either acid or alkali to water in which vegetables are boiled appears to increase loss of antiscorbutic property-Spec. Report, Med. Res. Conned, L L/24 364 * Vitamin (Antiscorbutic) Tablets, made by the late Sir P W Bassett-Smith’s method (L. i./2o,1102 ; ii./2o,997 ; see also B.M.J. 1 //5 377 385) stor™ lo? over 12 months, were proved to have retained their efficacy, while fresh lemon Jmce imported from Messina, with and without Potassium Metabisulphite had no antiscorbutic power. p u Anti-scmvy Vitamin in Apples.—Closely related fruits vary. As to apples Bramleys Seedling (a, cooking variety) is richer than others. Routine apples m their skins destroys the vitamin to a negligible extent.—M.R.Ci Report, 146, B.M.J. ii./3o,221. Vitamin 6 D.'5 Fat Soluble. The Antirachitic Factor. The observation that rickets could be cured by ultra-violet light did not appear at first to agree with the theory that rickets was a Vitamin- deficiency disease. It has been shown recently, however, that not only irradiation of the skin, but also irradiation of the food has an antirachitic action. Based on these results preparations containing this factor have been manufactured, usually by treatment of cholesterol or a similar alcohol with ultra-violet light, as substitutes for Cod-Liver Oil, see p. 591 and Radiostol. It is held that the identity of irradiated Ergosterol with this Vitamin is established. In high latitudes little ultra-violet light reaches the earth in winter and smoky towns prevent it filtering through. For Rosenheim and Webster’s work on irradiation of Protoplasmic Sterols, see Vol. II. Occurrence.—Cod-Liver Oil -j--}—b* Cream Green Vegetables + +. Similar effects are obtained by the action of sunlight on the skin. Antirachitic Vitamin D of Cod-Liver Oil.—S. G. Willimott and F. Wokes. P.J. ii./26,473,495. Cholesterol or Phytosterol is a parent substance of the antirachitic Vitamin D.’—L. 1/26,273. Fat-Soluble Vitamin is found in association with the Cholesterol of fats, and is increased by Ultra-Violet rays.—Prof. Dixon, B.M.J. i./25,666. See also our. p. 596. Stability—In oily media it is stable to heat and oxidation. Ceno—Milk spring. It is possible for farmers, by feeding their covus on a ty&e of yeast, to provide the public with milk rich in antirachitic and growth-promoting vitamins (D and B).—M. Wachtel, Munch. Med. Woch., ’29,1513, per M.P., Jan. 22, ’30. Calciferol is stated to be pure crystalline Vitamin D. A white substance with M.pt. 114-5° C. Has same empirical formula as Ergosterol. Vitamin D subcutaneously is of little or no value compared with oral use.— J. C. Drummond, L. ii./3i,904. Toxicity of Vitamin D. An agent which, in ignorance, may, and has been, used dangerously.—J. B. Duguid, L. ii./3o,983. Overdosage with Vitamin D studied by L. G. Harris, Dunn Nut. Lab. Cambridge.—M.R.C. Ann. Rept., 1929-30, B.M.J. 1./3i»T68. Milk ordinarily sold throughout the year contains almost no antirachitic vitamin, and a good sample of Cod Liver Oil contains from 5 to 1,000 times as much antirachitic vitamin as current samples of irradiated milk. The latter vary enormously.—X. H. Coward, L. ih/29,1090,1103. I' The second most potent source of Vitamin n o- t,v,„ . , ., die? " rachitic potency of those not ifadfated Eggs mightwell be p“‘t ^ III Itickets is practkaliy unknown in Siam—thanks to sunlight Thpv mn Vitamin ‘E.’ Oil Soluble. The absence of this factor from the diet of animals has been shown to cause sterility, but comparatively little is known of this Vitamin and its relation to the human economy. Further data, Vol. IT. Occurrence.—Wheat Germ Oil + + +, Lettuce and Peas ++. Also piesent m yellow maize and hemp seed and in the unsaponifiable. matter of some vegetable oils. Absent from Cod-Liver Oil. Stability—Not destroyed at 238° and not by acid nor alkali Iron assimilation and Vitamin E.—P.J ii /27 9io for?nightUfn sfcoM monthTf ^regSa^^anf f°? ft l“!83Peri0d> Healthy TildgrennCbyom“ip6 Vitamin ‘ G.’ +1 ^ h^niin P2 is now designated Vitamin G. Cereals contain more Vitamin R than G : milk and meat the reverse. Wheat maize and wos but liver and fresh milk excellent sources-JlTlU S?2cS 'ltamm G> Casein may contain another Vitamin.-—P J i /30 273 '~9y ' Some References bearing on the Vitamin Theory in treatment Vita nun A as an Anti-Infective Agent Puerperal septicaemia treated with Vitamin A concentrates oialiy and subcutaneously, 5 cases made complete recoveries.—E. Mellanby and II. N. Green, B.M.J. i./29,984. Defective Dietary.—On broad lines, we cannot forego the opportunity to point out the poor nutritive value of many of the foodstuffs with i 1 rVofUp[3 l<?d t0 the poorer classes—this is also fully dealt J lie dietary of the people of this country is defective in twn iryvnn-H-o-nf respects (1) ft contains too little of the substances eontainim? Vitamins ; (SI) It contains relatively too much cereal. This defective'dietarv causes destructive action on developing bones and teeth, as the fat-sSuble Vitamins st,mutate calcification, while excess of Sen/ interferes nv<*/i calcification. The widespread development of caries m children s teetii is primarily a problem of defective fpodimr * possible that the defects of diet of women during pregnanev and lact-ition are dy®nte^liMri.<S!andfvc?<tulKreSSS'^1oSPd^1bed^SedUtotht group of deficiency diseases Tuberculosis is always associated with fat deficiency. A lack of knowledge of elementary facts with regard to cooking of food among the women 01 tins country is deplorable. Margarine made t0 produce riokets be remedied by a demand for bread containing Vitamin B, for margarine with a NUTRIMENTA. 591 A^ir^zrzi^ re,ation to 1 he average normal ration of milk fat required by a man is 40 to 50 Gm am" iVr”e t£33S?to^r"™ “Tfhln* keeping0 intTsWoi^another 48 fnrinfni? sPro^s J to t inch long will appear. If cooked in this condition for 10 to 15 minutes they are ready to eat. tw#f vv'pffaf!6 J° ra-w Serinmating beans (eaten to obtain Vitamins). ^asm, a poisonous hsemagglutmative substance contained in beans, peas, Jentils and vetches, and destroyed by cooking. In view of the popularity of raw vegetable diets attention should be called to the danger.— Per Jl. A.M.A. n./2g,1426. In addition to changes that occur in the eye (keratomalacia), Vitamin A deficiency has been found to give rise, experimentally, to a widespread tendency to keratmisation together with a marked loss of fat, despite abundance of fat in the diet. Connection between Vitamin deficiency and cancer ?—Jl A M A li./2S, 2035. Keratomalacia, produced experimentally in children in Denmark (where curiously enough, this disease is most prevalent), showed that in spite of a varied and apparently nutritious diet an almost complete deficiency in Vitamins was established by the substitution of margarine for butter, skimmed milk for whole milk, and the absence of cream or eggs from the diet. Cod-Liver Oil effected a cure.—W. Cramer, L. i./24,633. Beri-Beri.—See Vol. II. Rickets.—-In the treatment of rickets the evidence seems to be that Cod-Liver Oil should be given in conjunction with Calcium Salts or that irradiation should be employed to produce the ultimate same effect as the Vitamin ‘ D.’ The introduction of Irradiated Ergosterol (q.v.) and the more recent standardisation of the Vitamin D unit has placed the treatment of rickets on a scientific basis. Irradiated Ergosterol is stated i to be a specific in the treatment of this and other diseases arising from a deficiency of Vitamin D. . Value of various fats as foods from antirachitic point of view. Cod liver oil, beef suet, butter and egg yolk good.—E. Mellanby, B.M.J. i./22,790. The fact that butter fat is a feeble antirachitic is of great importance in so far as the explanation of the occurrence of rickets in the human being is concerned.—Hess and co-workers, L. ih/21,668. The milk from cows stall-fed and kept in the dark may be of poor quality. The antirachitic Vitamin needs sunlight.—Sir W. Fletcher, L. ii./26,741. Sunlight a more important factor than diet.—B.M.J. ii./26,606. The antirachitic body in Cod-Liver Oil and radiant energy in the form of U/tra-VioSet Sight, both apparently act in the same way—this mode of action is a facilitation of absorption of Calcium und Phosphorus from the intestine into the blood stream—A. Webster and L. Hill, B.M.J. i./2S,957. In Iodine possibly is the source of a number of efficient Vitamin substitutes offering striking parallels with the genuine article. Vitamins A and D, both of which appear to be connected with rickets, act by promoting absorption. Iodine acts similarly. Lack of SocSide means diminished size in animal experiments.—Chilean He view. THE PRODUCTION OF THE ANTIRACHITIC FACTOR BY IRRADIATION. Vegetable oils, dried milk, condensed milk, and wheat flour, exposed to radiations from a Mercury arc lamp, even for 2 minutes at a distance of one foot, acquire marked antirachitic properties, and may be administered in lieu of Cod-Liver Oil. These acquired properties are maintained over long periods. Cream, haemoglobin egg phosphatides,’ Glycerin and Gelatin, do not acquire these, properties. A cheap method for providing Vitamin-eontainin£i foods: protected by Provisional Patent— R. C. Owens, Pres June 26,234. Two minutes’ irradiation activates linseed oil. Irradiated olive, oil can be kept 10 months : Linseed oil 6 months and still possess antirachitic power. Severe active rickets showed bone lesions healed after two months’ treatment with irradiated sweetened con- densed milL Dried milk cases showed healing also in 1 to 2 months —H. M. M. Mackay and H. F. Shaw, L. L/26,8. irradiation of milk and the healing of rickets. The milk wasH exposed to the rays of a Mercury Vapour lamp of the Hanot type twice a day, in a wide shallow dish. There was a remarkable 4 acti- vatnig effect, and dense calcification of wrist bone occurred.— S. J. Cowell, B.M.J. l/25,594. Sixteen out of 18 cases of rickets recovered within four to six weeks when fed with milk previously irradiated for 30 to 60 minutes.— per Jl. A.M.A. m/25,397. Improvement of general condition and of focal lesions in children w,lth iaCti76 b^e tubercuiosis when given irradiated milk. Increase of reci cells.—V. Daw kins and C. L. Pattison, L. ii./26,1315. Value of irradiated milk iu prevention and cure of rickets confirmed ie he cure is more quickly and economically established by irradiated Sk than v^ri°us irradiated commercial preparations. May be of value also in disorders incidental to pregnancy and lactation—the climacteric malnutrition Watson aTd Y'ffnhv^nf T* ^°ne, and some/forms of tuberculosis.—Chalmers in rivets from frm Kmg’ L-u-/29>™4. The therapeutic results . 1-cj CTS, m lnatJiated milk are not s/m&iy due to Vitamin D Wat'son, ,Z!rirtia,£^°r SOUna C,iniCal Potency of treated milk increased nine times by exposure of 8 seconds L i./3o!rie27aS W ^ PreVent rickets. D. Nabarro and J 0 Hickman; Goats’ Milk increased in activity even more than cows’ milk — P.J. ii./27,254. Phytosterol C26l 1440 -J- H20 an alcohol contained in maize, peas beans and the majority of vegetable oils, and Cholesterol obtained from oils although unable to protect against rickets can be endowed with antirachitic powder by ultra-violet irradiation.—A. F. Hess and M. Weinstock, L. i./26,12. Radiostol is prepared similarly from Ergosterol, v. p. 593, 594. Wh°n ^ “"r- Irradiated Orange Juice resuscitated rachitic rats—B.M.J.E. ii./26,2c. Scurvy. To prevent infantile scurvy an adequate amount of Vitamin C must be present in diet. Cows’ milk may be deficient in this in winter.— P. Eggleton and L. J. Harris, B.M.J. ii./25,989. Vitamin theory of scurvy challenged.—R. Hutchinson/B M J. i-/25,603. Germinating Beans and Lemon Juice in treatment of scurvy in Serbian Army. Similar amounts of each given to patients in different wards. 70-4% or patients treated with Beans cured in 4 weeks, as against 52-4% of those tieated with Lemon Juice. Importance of starting antiscorbutic remedies Wiltshire! ° ** °VerC00kiM food--H- W‘ a result of animal experiments, the late Sir P. Bassett- Smith concluded that it is good practice to reinforce the diet of early cases ,to recommend Cod-Liver Oil, Marmite and fresh fruit in all cases. In slight affections, the addition of these Vitamins in man are possibly protective. —Trans. Boy. Soc. Trop. Med., Vol. 17, No. 4, p. 235. Yeast, Irradiated. 0*75 Cm. given daily to rachitic children effects dis- appearance of symptoms m G to 8 weeks.—S. W. Ron and M. Mavzner I, i./3o,794. ’ The antirachitic value of.—S. E. Ron, L. ii./3i 579 VITAMIN PREPARATIONS OF COMMERCE. The problem of preparing stable concentrates of Vitamins A and C has not yet been fully solved, at any rate in respect of foods.—Ph. Socy. Expts., B.M.J. ii./31,72. s^Adexolm (T.M. 514360). A concentrated preparation of * A * and ‘ D.’ Supplied in capsules. For general use in infective processes. Advita. (T.M. 478190, 478191). A concentration of Vitamins ‘A’ and ‘ D ’ of potency 100 times the minimum for Cod Liver Oil U.S. ^Avoleum (T.M. 520609). Dose.—1 to 3 capsules daily. A concentrated preparation of Vitamin * A ’ for use in acute conditions ! where massive doses are required and Vitamin D is contraindicated. ^Bemax (T.M. 481099). A cereal preparation made from germ of wheat, rye or barley. Bran is completely eliminated as makers consider it damages the intestinal wall. Directions.—One tablespoonful daily in milk. Children, a teaspoonful. A tonic food made from the germ of cereals, such as wheat, rye or barley. Analysis.—Protein 37-2, Fat 9, Ash 4-51 (including 2-7% P-.OA. Fibre 1-5, Carbohydrate 41-79, moisture 6-0%. Has high calorific value. Stated to contain a greater proportion of Vitamins B,, B2 and B3 than any other product of its kind. Also rich in ‘ E ’ and contains ‘ A.’ Used in rheumatoid arthritis, in which deficiency of Vitamin B in diet has been found to have adverse effect. Incidence of the disease primarily due to lack of this Vitamin. Also given in constipation, indigestion and nervous diseases. Animals fed with Bemax and cultures of streptococci showed non-penetration of mucous membrane of abdominal cavity and only a few organisms in the lumen of the intestine, while non-Bemax animals showed the whole of the intestine loaded with organisms. Esso gen (T.M. 477726, 477727). The Vitamin ‘ A ’ and ‘ D ’ potency of this preparation is 10 times the minimum required in a Cod Liver Oil of U.S. strength, and in the case of Essogen Capsules 100 times the same strength. Dose.—£ to 1 drachm twice a day of the liquid form. Capsules, one per day. In deficiency and wasting diseases. ajc Metagen (T.M. 420838) is stated to contain the three principal Vitamins, physiologically tested.. Metatone (T.M. 490271). A general tonic and is stated to contain in each fluid ounce Vitamin ‘ B ’ Extract 10 grains, Nucleinic Acid 2 grains, Calcium and Potassium Glycerophosphate of each 4 grains, Sodium Glycerophosphate 2 grains, Manganese Glycerophosphate i grain, Strychnine Glycerophosphate 8/200 grain. Dose.—1 to 4 drachms. Mission Orange Juice from California contains 45% solids, 1-5 /0 acid (as Citric), Fat and Oil 0-12%, Reducing Sugars (Invert Sugar) 5.4%, Cane Sugar (in part added) 34-16% and Vitamins. Useful in general diet, preventing scurvy, in marasmus, and as diuretic, etc. ^Racliostol (T.M. 477932, 486446). Syn. Irradiated Ergosterol. Viosterol is used in U.S.A. to describe Irradiated Ergosterol. Jl.A.M.A. ii./29,1066. Irradiation of Ergosterol with the Mercury-Vapour Lamp produced! the most powerful antirachitic substance known. Ergosterol can also be activated by sunlight.—0. Rosenheim and! T. A. Webster, L. ii./27,622. Uses.—Vitamin D is necessary to ensure Calcium and Phosphorus absorption, i.e., for the treatment of rickets. Suggested; also in general spasmophilia, tetany, laryngismus stridulus (whichi may be associated with Vitamin D deficiency), osteomalacia, hunger osteopathy, and certain idiopathic steatorrhceas. Feeding experiments showed that irradiated Ergosterol”will protect rats, trom rickets in doses of less than 0-0001 mgr—B.M.J. ii./27,888, ibid. 1005. IUCKETS.—Irradiated Ergosterol in doses of 2 to 5 mgr., administered either m Olive Oil or in tablet form, had curative effects incases of rickets, late rickets and osteomalacia. In one case of osteomalacia a striking cure was obtained with daily doses of 10 mgr.—L. ii./27,766 ; see also ibid. 623. Labour: Radiostol of benefit.—R. Kelson Ford, B.M.J. ii./3o,727. Mode of action of irradiated Ergosterol on the myelin forms of Lecithin, itamin O may act on bone cells in rickets concerned in calcification, and speed _ up their Calcium metabolism by acting on the Lipin constituents (especially the Lecithin moiety) of the cells, and by facilitating interchange through the pericellular and perinuclear membranes, enable these cells to extract the Calcium Phosphate from the blood.—C. J. Bond, L. ii./2Q,328. Even minute quantities of irradiated Ergosterol fed to rabbits produced marked injury to wall of aorta and arteries of kidney.—Per Jl. A.M.A. ii./2Q,1428. loxicdy of Irradiated Alcoholic Ergosterol Solutions. Toxic effects only in rats on synthetic diet—but they fail to gain weight at normal rate and show Ma?ar>3oC 289 1 prolonged use*—J• C. Hoyle, Jl. Pharm. and Exp. Tlierap., a^i'^0X^C acR°n due to (a) an unknown toxic substance, which causes arterio- T-wfexcess of Vitamin D, which produces urinary calculi and retar(ls_gi owth. A^diet of bread and milk protects against (a) but not against +Vitamin content of the diet is complete and adequate, up to 1,000 the minimal effective dose of Vitamin H, has no toxic or growth pro- ThemLeAut,°“9a628 G- P’ Cartland “d’co-workers. Jl. Ph. and lip. ot'iSafety of Eradiated Ergosterol. Commercial preparations varied, a standard now accepted.—B.M.J. i./30,158. wl!rn?fleti'PeC(!e8i.of’ animals vary markedly in resistance to excess dosage. thnni)011 tipX!wefn ratSonnl7 occur after giving several thousand times the therapeutic dose, in dogs 20 times the curative doses causes death The evkb^ce^no’intt tw Smre susceptibility with the dog and clinical evidence points that way.—B.M.J. ii./31,352. Possibility of ill effects from—see Vol. II. „ &2H51!*?1 Solution contains irradiated Ergosterol mixed with oi and adjusted to have approximately 50 times the activity of Cod Liver Oil. nose.-—I wo drops or more on sugar. C1 vppTYmhnsuVhn+o IetS7^contajP this Vitamin product together with Calcium ’ V"rI°P- °,sP.bate. Dose.—One twice or thrice dailv 512?°) i! a solution of a Vitamin A Concentrate o°Cod Liver Oil egetahle ol1- Stated to have 20 times the Vitamin content $Eadiomah,'seVMalf&rtractf BmUl8i°n containing Sadiostoleum. ErgOStero1- Induces hea!ing in 3fcVlozin Ung. (T.M. 512877). Agpreparation of irradiated Ergosterol in Arachis Oil, with Zinc Oxide and Lanolin m Paraffin Base. Promotes healing of wounds and varicose ulcers. \ itamin A (B.D.H.) is made irom fresh mammalian liver. Capsule* contain -bTj. ei73ir757 SP 01 COd LiVer 0il- u contains™Vitendn j>. j^Vitmar (T.M. 389337 and 452,194, Cl. 42). Dose.—An eggspoonful after meals every day. Described as a food containing Vitamins A, B and C, suitable for backward and delicate children. It is stated to have a food value i of 400 calories per 100 Gin. 3^: Vitamogen (T.M. 363554). A food stated to be a means of supplying Vitamins readiiy taken which does not upset digestion for children and adults. : In nervous affections, dyspepsia and malnutrition. ‘University Cream,’ Syn. emulsio sevi, u.c.h. Beef suet 40 ozs., : Arachis Oil 5 ozs., Syrup 25 ounces, Benzoic Acid 40 grains, Decoction of Irish Moss 70 ozs., water to 1 gallon. Melt the suet, add the oil and the Benzoic Acid. Heat the Moss Decoction to about 60° C., place in an emulsifier and add the fats at about the same temperature. Finally add the syrup and water. This keeps well and mixes well with milk.—C. H. Hampshire and G. E. G. Hawker, B.P.Conf., 1919. For use instead of cow’s cream in preparing infants’ feeds. It supersedes ‘ Marylebone Cream.’—Eric Pritchard, L. i./2O,607. Butol Emulsion V.H.C. ( sfcButol is T.M. 416621). An emulsion of fats and oils (Beef Dripping, Cod Liver Oil, Arachis Oil and Butter) with Glucose and 5% Cane Sugar—with or without Dextrin, using Irish Moss to suspend. For feeding of children. * New Zealand Cream * as manufactured in New Zealand’s Government Factory and intended for use throughout that country : contains 50% fat, of which 2/3 is animal oil, including fresh New ; Zealand butter and Cod-Liver Oil, and 1/3 vegetable oils, mainly pea-nut; sugars, mainly Dextrose and a little Lactose, made up 40%. Satisfactory in use, readily assimilable, sterile, containing j Vitamins intact, and high caloric value of 180 per ounce.—R. Jewes- bury, B.M.J. l/26,245. A useful Diet Scale. Equivalents of foods (Carbohydrates, proteins and | fats). An ounce of Carbohydrates or protein yields 120 calories, and an ounce of fat yields 270 calories— H. S. Pemberton, B.M.J. h/23,680. El NUX VOMICA. jp~J]and all 'preparations or admixtures containing 0*2% or moie of Strychnine. Antidotes. See Strychnine. . Dose.—1 to 4 grains (0-06 to 0-25 Gm.) in powder. Ir. Cx. [vide infra) approximates latter as a maximum dose during 24 hours. The dried ripe seeds of Strychnos Nux-vomica (.Logantaceas), 1m- ported from India and Ceylon, contain from 0-7 to 1-6% of Strychnine. B.P.’U requires the drugin powder adjusted to l-25% Strychnine. F.I. (Second) recommended a standard of 2-5% total alkaloids. This is in accord with nearly all the pharmacopoeias, including recently issued F.E. VIII., P- Belg. IV., and P. a. • ® British delegates pointed out that a standard base on rW content is best.—E. White, P.J. i./26,294. _ A minute quantitymf copperp^vScPand Sal vilatUe a bluish SMSTir A. ^uhemSCS?es°sfthaUn 2, nor more than 3% (combined, *lkFor%rther details on Assay of Nux Vomica, see Vol. II. 1 lavoring for Nux Vomica preparations, see h^ry Uses.—A bitter stomachic and tonic. Stimulates the bowels hence added to aperients. Increases nervous energy. Given to relieve shock and collapse from anesthetics. Is employed in dyspepsia heart weakness, and as a general tonic in all conditions of debility and neurasthenia. For the aged, this and Strychnine have beer described as the only suitable bitter tonics. In phosphaturia, small doses of Nux Vomica and of Diluted Hydro chloric Acid are often of great service.—Tirard, Med. Treatment. FJ Extraction Nucis Yomicse (‘Siccum ’) (B.P. ’14). Dose.—J to 1 grain (0-016 to 0-06 Gin.), Contains 5% of Strychnine, adjusted with Calcium Phosphate. .. This Extract absorbs moisture : Quantitative data.—F. Wokes P J n./26,188. ’ Fir Cx. conforms with F.I. (Second) making the preparation 16% total alkaloids, with max. single dose f grain and max. in 24 hours li grains approx. U.S. X. piactically agrees with 1.1. (8econd). Isux Vomica Extract elsewlieres abroad is called Extraetum Strychni. P.G. VI, P. Ital. V., F.E VIII and P. Beig. IV. also agree with F.I. (Second). P I; Extraetum Nucis Vomicae Liquidum (B.P. T4). Dose.—1 to 3 minims (0-06 to 0-2 Cc.). Prepared by re-percolating the seeds in powffier with Alcohol 70% (60% is adequate and it leaves the fat behind), defatting with Hard Paraffin, and adjusting the strength so that the extract contains 1-5% of Strychnine. P. Ital. V. has 2*5% Alkaloids. Cp) Tinctura Nucis Vomicae (B.P. ’14). Dose.—5 to 15 minims (0-3 to 1 Cc.), often less. This contains 0-125% of strychnine, and is made on the lines olf B.P. ’98. One ounce contains about J grain of strychnine, or about half the quantity in the Tincture of B.P. ’98, and the same strength as B.P. ’85. It now = approx. F.I. F.I. (Second) recommended 0-25% total Alkaloids = P. Beffi IV F.E. VIII. and P. Ital. V. *' Fr. Cx. prepares by dissolving 1-562 Gm. Extract (Fr. Cx.) in Alcohol 70% g.s. to produce 100 G111. This contains 0-25% combined alkaloids (F j ) Max. single dose, 19 minims. Max. during 24 hours 95 minims approximately* U.% X. is a 1 in 10 Tincture adjusted to 0-25% Alkaloids (Total). [p 1J Tablets equal 5 and 10 minims of the tincture. GDTinctura Ignatise. Dose.—3 to 20 minims (0-2 to 1-2 Cc.). From St. Ignatius’ Beans, the seeds of Strychnos Ignatii (Loganiacece) (containing about U% Strychnine and 1% Brucine) 1 part, and a mixture of 90% Alcohol 3 and Water 1, q.s. to produce 10 parts. A preparation known as P I Goilfctes Ameres de Baume (Fr. Cx.), is of strength 1 in 5. Max. single dose 4 minims. Max. during 24 hours, 30 minims approximately. The Beans termed Feve de Saint-Ignace in Fr. Cx. from wffiich this Tincture with the above Synonym is prepared, contain about 2-5% combined alkaloids. Max. single dose of the powMered Beans 1 \ grains, Max. during 24 hours 5 grains approx. [j?T Cabalonga de Tabasco, Ph. Mex. V.—Mata-perros, veneno del diablo. Strychnos triplinervia, Mart. According to Professor Graham, the seeds contain 1-83% of strychnine and brucine. Used in place of St. Ignatius’ Beans. OLEA ESSENTIALLY The various essential oils used in medicine, prepared either by distillation or expression or a combination of the two, are dealt with under their respective headings. For processes of Assay of Essential oils, see Vol. II. Constitution of Essential Oiis.—J. E. Driver and G. E. Trease, P.J. ii./a7,164. Antiseptic powers of certain Essential Oils. The Carbolic Coefficients obtained by us under certain conditions {vide Vol. II.), for Essential Oils, show that several possess considerable antiseptic power. For example, Origanum Oil (containing over 80% Phenols, e.g., Carvacrol), had almost the same coefficient as Thymol—an acknowledged excellent antiseptic, viz., 25 to 26. Following these came Oil of Thyme containing less Phenols, then • Geraniol, Cinnamon Oils, Clove Oil, and so on in this order. As an outcome of our investigations Saponaceous Solutions of some of the Essential Oils are prepared for physicians’ use under the name- perfumed Formosyls of Almond, Cassia, Cinnamon, Citronella, Eucalyptus (Amygdalina), Eucalyptus (Globulus), Geranium, i Lavender, Lemon, Origanum, Otto of Roses, Rosemary, Thyme s and Wintergreen. Uses.—For disinfection of the hands and skin. A tablespoonful to be poured in the palm of the hand and well rubbed and lathered with i an equal quantity of water for two minutes. For treatment of skin affections local use as paints or lotions is suggested. The strength of ! Perfumed Formosyls is so arranged that when using any of them as [ directed, the quantity contains sufficient Essential Oil to act as a ; bactericide in the light of knowledge which we have obtained com- ; paratively wdth Carbolic Acid. Terpeneless and Sesqui terpeneless Essential Oils are described in Vol. II. OLEA T A. Aeidum Oleicum. U.S. p. Jap. CH3(CH2)7CH : CH(CH2)7COOH == 282-2652. A pale-sherry coloured faintly acid oily liquid (at ordinary temperatures) with a slight odour. Solubilityreadily in 90% alcohol, ether, chloroform, benzol, and fixed oils ; insoluble in water ; it ais- solves most metallic oxides, thus forming indefinite oleic solutions of oleates in an excess of Oleic Acid; such combinations of bismuth, copper, lead, mercury, and zinc are used medicinally ; they are soluble in fats. Oleic Acid also dissolves alkaloids, but not their salts, e.g., Oleate of Aconitine, Oleate of Atropine (2J% perfumed with Otto), Oleate of Morphine and Oleate of \ eratrine are used^ medicma y. Oleic Acid is much more readily absorbed by the skin than oils. Conversion of Unsaturated Fatty Acids into Saturated, e^g.t Oleic into Stearic Acid—C18H3402 + Ha = C18iis602- This ache bT%mn£r + i1P of great importance in the Oil industry-—has keen effected y =>8 ' ' Hydrogen and the liquid fat together at high temperatures m the Presence of finely divided Nickel (or Cobalt, Platinum, etc.) as catalytic agent. Ihe products are used both for food and for soap making. aTmia^—A*145>0C^0118 °f 0idc Add SoaP3 “*■< <B *” in **» t,v?°f?rfSa^ pl!Le ^Ietahic Oleates.—Caspari recommends the prepara n1.0" °f(«) Sodium Oleate and (b) Potassium Oleate Solutions in olace of ordinary Soap somtions. («) W arm 1,217 grains Oleic Acid to 60° C. and add slowh tUpFw11? Sodium Hydroxide (90%) dissolved in a mixture of 2 ounces Dis' nil?6i ?iraiC^mo of Alcohol» stirring constantly until acid neutra f, (UfMP^en?^Iphthalem Solution). Dissolve finally in 3 pints of water ant filter, (b) Neutralise 410 grams Potassium Bicarbonate with 1,156 grain? Oleic Acid m 1 pint of water by boiling. When cold make up to 3 pints. Tc the Solution (a) add Lead Acetate crystallised 819 grains, Copper Sulphate 540 grains, Zinc Sulphate 621 grains, Mercuric Nitrate 711 grains, or to (b Lead Acetate crystallised 777 grains, Copper Sulphate 510 grains, Zinc Sulphate o91 grams, or Mercuric Nitrate 675 grains, each dissolved in U pints of water to produce the corresponding pure Oleates. Capsules of Oleic Acid, 1\ minims. Dose.—One or two daily. These are given for hepatic colic, and to hinder the formation ofi gall stones. Best taken in the morning on an empty stomach. H :P1] Oleanodyne. A special preparation combining the alkaloids aconitine, atropine morphine (0-3%), and veratrine, with oleic acid. It is rapidly absorbed, and forms a strong anodyne liniment, which can be diluted with chloroform, alcohol, or oils. Cupri Oleas, Copper Oleate. (C17H33COO)2Cu=626-0848. (Theoretical formula for Pure Oleate) Add a hot solution of copper sulphate 3 in 8 of water to a hot solution of Castile Soap 8 in 32 and wash and dry the precipitate. When cold it is in solid dark-green masses. It is an oleo-palmitate of copper, containing copper equivalent to about 10% Cupric Oxide. Soluble in ether. Injections of 1 Cc. 1% suspension on 3 consecutive days in guinea-pigs well tolerated. Suggested for use in bronchiectasis, foetid bronchitis, and ulcerative pulmonary tuberculosis.—R. B. Billimoria, Dec.. 1931. Unguentum Cupri Oleatis. Copper Oleate 12, Yellow Soft Paraffin 88. Melt together. For some purposes it may be employed half strength. Ringworm is well treated with it—lightly rubbed in night and morning, also for indolent ulcers, warts and corns, and has been used to remove freckles. Copper Oleate ointment, combined with Cuprase injections, used with success in phagedena, and in sycosis, with Ammoniated Mercury locally — It. B. Billimoria, Dec., 1931. Bougies of Copper Oleate are prepared 4 inches long containing each 5 grains (0-3 Gm.) Copper Oleate with Theobroma basis. Ovules of Copper Oleate, with Cacao Butter contain 5 grains. ®Emplastrum Cupri Oleatis contains 20% of Copper Oleate made with Soap Plaster spread on Adhesive Plaster. For the treatment of malignant disease. These were advocated as adjuvants to Sodium Coumarate treatment by the late L. Drage. Hydrargyri Oleas. Mercuric Oleate (B.P. ’14). 20% Oxide. By acting on Mercuric Oxide with Oleic Acid using slight warmth (B.P., ’85 was 10%). Unguentum Hydrargyri Oleatis (B.P. 14). Mercuric Oleate 1, Benzoated Lard 3. 4 Capsungs * of this ointment are prepared containing \ drachm in each for inunction. SiPIOleatum Hydrargyri (10%) cum Morphina. Morphine (base) 1, is dissolved in 60 of the 10% Oleate. Linimen- tum Hydrargyri Oleatis cum Morphina, R.O.H., is similar. For use where the plain Oleate causes pain. Uses.—For syphilis in secondary and tertiary stages, excessive use to be avoided. In persistent inflammation, especially of glands, and joints (such as synovitis), and in non-ulcerated syphiloderma, these Oleates are more active and cleanlv than mercurial ointment. They are very effective parasiticides for pediculi and ringworm. In rheumatoid arthritis the joints thickened by fibrous adhesions and fibroid thickenings of the synovial and periarticular tissues are treated with Mercuric Oleate. Gieatum Hydrargyri cum Sulphure. Mercuric Oleate 5%, 4, Precipitated Sulphur 1, Ether 3. For pediculi pubis. Ungueatum Hydrargyri Oleatis Compositum. — Brooke’s Ointment.—Mercuric Oleate Ointment (5%), Compound Zinc Paste (Lassar’s Paste) of each 41, Salicylic Acid 6, Ichthyol 12. In (septic) oedema of the face has been applied covered with cotton wool in thick layer and pressed down by cotton elastic bandage. Syphilitic Disease of the Nervous System. A drachm of the 10% oleare as advised by Gowers, to be rubbed in near the affected part twice daily for three or four days, and then once daily for remainder of the week > near the scalp if in the brain, and down the back if in the spinal cord : treatment to be brief, to last eight weeks or so, and to be renewed after two, four or six months. CE Empiastrum Hydrargyri Stearatis. Lead Plaster 6, melt and add Mercuric Stearate [(C17H35COO)2 Hg = 767T56] 2, made by direct combination of Mercuric Oxide 10, with Stearic Acid 26 or q.s.—Melt the acid and gradually stir in the oxide until all dissolved—a sand bath may be necessary. Is a substitute for mercurial plaster. It is pharmaceutically inelegant. WTi Empiastrum Plumbi (B.P. ’14). Syn. Diachylon Plaster. WJlLead in combination with Oleic Acid or other higher fatty acids, whether sold as Diachylon or under any other designation (except Machine-spread Plasters)—May 27/17. We have followed the letter of the law by placing ‘ Preparations of’ m CE). Obviously m doubtful cases they should be treated as §FT . . „ Lead Plaster is a crude Oleate of Lead, made by the combination of olive oil (oleate and palmitate of glyceryl) and oxide of lead heated together in the presence of water. Thus made, e o ea e is more adhesive than when prepared by the oleic acid solution of the oxide. This has been used as an abortifacient.in the> Go^t e.. CE) Empiastrum Resinae, Adhesive Plaster (TIP. 14). Is more adhesive than Lead Plaster. CE>Empiastrum api similar, but less adherent than the latter. is Cp) Emplastrum Adhesivum. nnw'w^ n 0f ™bber> resins and waxes with a filler of absorbed 9[.,„zmc oxide, orris root or starch mechanically mixed The mas -t loot §oof nAbh°US30/° 0f rubbe^ When z™c Oxide is used it should b< lWu 2 %°. tbe Poster mass. Contains no lead. Adhesive Plaster. Taffeta Adesivo, P. Ital.V. Altohol^T^SUPo 1^?wtPieCe?n0n Gm*4? warm water 2*000 Cc-> and adc. 4 or5lavers ttflnpiiiwt? ^i10-Gm- £eeP warm on a w.b. and appb o or d jaj ers to fine silk tissue (allowing each layer to drv senaratelvl tiw SRfc0t Pri™ inGA mLxed Tincture BeS 4PGm.flL a fta£ coatiUo oi Aue. _ Dry, and keep away from air and light. The following ointments are prescribed for eczema, excessive perspiration of the feet, etc. CfD Unguentum Diacfayli. Lead plaster 1, Yellow Soft Paraffin 1. Melt together and stir till cold. Made thus, the ointment keeps well, and does not acquire a disagreeable odour. ® Unguentum Diachyli Carbolisatum (Lassar) is the same with! 2% ot phenol. To be rubbed in I to 3 times a day, or spread on linen and applied ae a plaster. U.s. has Lead Plaster 50, White Petrolatum 49, Lavender Oil 1. Thorii Oleas v. Thorium Compounds. Unguentum Zinci Oleatis (B.P. T4). Precipitated Zinc Oleate I, White Soft Paraffin 1. Melt togethei and stir till cold. For some cases further dilution with Soft Paraffin is advisable. Ibis ointment will cure chronic eczema. Zinci Oieas—Syn. Zinc Oleo-Stearate. (ZTP.T4). (Ci7H33COO)2Zn=627-894S. Theoretical formula for the Oleate. Manufacture—To a solution of Hard Soap 2, and Curd Soap 1 in Water 15, add Zinc Sulphate 1 in Water 2. i r Tt*Si3Preparation than the following Hard Soap in shavings I », Boding YV <n< r 1M) , heat to dissolve. Zinc Sulphate 8, Boiling Water 1G • dissoive and add to former solution: stir well, separate the water from the Oleate, and wash the latter with hot water till free from sulphate, cool, and dry Reduced to powder is useful for dusting on eczematous surfaces and for excessive perspiration. It may be perfumed by the addition °f s’! a thymol, and diluted with kaolin or starch. GD Unguentum Oleatorum, G.H. Zinc Oleate Ointment, Diachylon Ointment and Mercury Oleate Ointment of each equal parts. Zinci Stearas, U.S.X. A white powder yielding 13 to 15-5% of Zinc Oxide. Contains a small Pf?P®J.tl0nc0^ palmitate. Manufactured by precipitating a Curd Soap solution with Zmc Sulphate. 1 Poisoning due to accidental inhalation of Zinc Stearate, see Edn. XIX, p. 604. Bismufclii Oleas. Bi20.(C18H330 2)4 = 1559-02 96. Dose.—5 to 10 grains (0-3 to 0-6 Gm.) but larger amounts would be used in X-ray work. Manufacture.—Dissolve Bismuth Nitrate (cryst.) 960 grains in Glycerin, 40 ounces by weight in the cold. Add to the solution 3 pints of the Sodium Oleate solution (p. 598), wash by decanting, collect and dry. A greyish white unctuous substance. _ UsGS-m—Should prove useful in place of Subnitrate or Carbonate in X-ray diagnosis . It would not be attacked so readily by the stomach juices. Might be tried instead of other Bismuth compounds, e.g., to form a coating on the stomach or intestines in gastric ulcer. Stamii Oleas. Sn(C18H3302)4 (?) = 1243-7296. Dose.—Not used internally. manufacture—Add Stannic Chloride, 566 grains dissolved in a little water to 3 pints of the soap solution (v. p. 598). Uses,—Has been employed in diseases of the nails—overcomes i brittleness, splitting, etc.—Squire. | Uranii Oleas. U02(C18H3302)2 = 832-6848. Dose (suggested).—J to 5 grains (0-03 to 0-3 Gm.). manufacture,—Employ Uranium Nitrate 1,092 grains with 3 pints of the Sodium Oleate solution, p. 598. A yellow substance of plastic consistence. Uses,—Possesses radio-active properties. Suitable for local use to malignant growths and in skin affections as Unguentum Uranii Oieatis.—25% strength in Unguentum Lanolini softened if necessary cf. Unguentum Tfaorii Oieatis. Silver Oleate, Iron Oleate {Dose.—5 to 15 grains) and the Oieates of Strontium, Barium, Calcium and Magnesium have also been prepared. For details of manufacture and properties, see Edition xviii., pp. 605 and 606. Silver Oleate Injections, 1 to 2 Cc. hypodermicallv of a 1% suspension gave good results in gonorrhoeal arthritis, but very painful. Suggested in influenzal pneumonia.—TC B. Billimoria, Dec., 1931. Well tolerated in enteric and septic conditions—B.B.B., 17.6.32. OLEUM CBAULMOOGRiE, incorrectly termed Oleum Gyno- cardise {B.P. ’14 Synonym); U.S.X., P. Argent. II., Ph. Ned. V., P. Belg. IV., F.E. viil., together with notes on 6 Oleum Hydno- earpiP Dose.—5 to 10 minims (0-3 to 0-6 Cc.), increased to I drachm (4 Cc.) in capsules, cod-liver oil, or milk. F.E. max. single 1 Gm., p. die. 5 Gm. The oil (about 33%) expressed from the seeds of Tarahtogenos Kurzii-King. This is an evergreen shrub growing in Chittagong, Burma, and other parts. The fruits yielding genuine Chaulmoogra Oil are distinguished from those of Gynocardia by containing many seeds (average 21) packed close together and facetted by mutual pressure, hence no two are the same identical shape, and having no pulp, the embryo is vertical and cordate, while that 01 Gynocardia is lateral and reniform. _ . .. The oil from Tarahtogenos Kurzii is cold-drawn. it is a yellow oil with an odour of rancid butter and M. pt. of 22 23 C. J he residual cake is valuable for cattle feeding. The Kalaw Tree frequently stated to be the historic origin of Chauimoogn Oil is apparently the Burmese name for Taraktogenos Kurzii.—J. C. Ghos L. i./23,630. Latterly the oil of various species of Hydnocarpus, e.g., Hydncr carpus Wightiana or Asteriastigma Macrocarpa, growing in Sout and West India have attracted much attention (see p. 606) although relatively recently these were regarded as spurious substitute They differ in colour, odour and specific gravity. Oleum Hydnocarpae P. Jap. IV. is obtained from the peeled seeds Hydnocarpus. At 22 to 23° C. the oil almost completely liquefies and s 25 to 30° C. it. melts completely. The name Chaulmoogra has been sometimes misapplied to a smaller see derived from Hydnocarpus anthelmintica, a native of Siam, where it known as Lukrabao. dhis is exported to China and used there for lepro1? in place of the true Chaulmoogra, which may be regarded as the East India remedy. The oil of Hydnocarpus Wightiana Rtae (P. off.), is used in Westei India, and it has been found that all these oils, as well as that of Onchob echinata Oliv., a native of Sierra Leone, contain Chaulmoogric Acid. Oil from H. anthelmintica seeds grown in Ceylon contains glycerides of bot Chaulmoogric and Hydnocarpic Acids and should be suitable for use in lepros: Imp. Inst. Rept., 1929. This and H. Wightiana have been growing in 4 British Possessions since 1925—Sir L. Rogers, B.M.J. i./3i,73 ; see also A. Hill, L. ii./3o,764, for other varieties. Against acid-fast bacilli H. Wightiana is a powerful antiseptic—Sir 1 Rogers. Gynocardia Odorata Cii has a brown colour and odour resemblia painter’s varnish and remains liquid at ordinary temperature down to 4-5° C It is stated to have no therapeutic value in leprosv.—E. E. Francis Chi* Medical Officer, Assam Bengal Ry., Chittagong. It‘does not contain Chau moognc Acid but consists chiefly of the Glyceryl esters of Linolic and Linolin Acids. U.S. X. states the oil from certain sp. of Hydnocarpus--when designate as such and agreeing in physical and chemical characters with Chaulmoogir Oil may replace. Uses.—The oil is applied externally, and given internally aftd meals, for leprosy, phthisis, scrofula, rheumatism, marasmus, psoriasi and lupus. The treatment of leprosy with it has to be persisted i for several years. The theory of its action in leprosy seems to b that it increases the number of leucocytes and enhances the bacteri cidal properties of the blood. Leprosy has also been treated by hall ounce doses per rectum daily. Patients must refrain from salte food such as fish, cheese and vegetables. For phthisis 2 to 4 ounces should be rubbed into the chest weekly Applied to raw surfaces, however, causes great pain. In the knowledge of the writer, a patient suffering from leprosy took over long period, a large quantity of Chaulmoogra Oil Capsules. The dosag employed was two 15 minim Capsules four times daily, increased. He foun that he could take up to 200 minims per diem, but larger quantities had tendency to make him sick. The spots on the face and hands disappeared almost entirely, but there remained the deadened feeling of the tissues o which there was hope of complete disappearance. Emulsio Olei Chaulmoograe. Dose.—\ to 1 drachm (2 to 4 Gm.). We found the following formula satisfactory to produce a liquic Chaulmoogra preparation :— Chaulmoogra Oil 1 ounce, Poppy Seed Oil 2 ounces, Powderec Gum Acacia £ ounce, Cinnamon Oil 6 minims, Saccharin Elixi 45 minims, with Water to make 6 ounces. InjectioOlei Chaalmoogree Intramuscularis— Martindale. Dose, h to 1 Cc., increased to tolerance. Cnaulmoogra Oil and Almond Oil equal parts, sterilised. This and other formulae, e.g., Heiser’s Injection (see Edn. XIX, p. 606), have been given by intramuscularly, but McCoy and Hollman, Public Health Bull., 75, January, 1916, Washington (L. i./i6,790), found the injection of oily preparations of Chaulmoogra badly tolerated—causing abscess heart failure, etc. in cases treated at the Hawaii Settlement. (Sodium Chaul* moograte ‘ C ' on the other hand is tolerated.) The following is said to be 'painless. Chaulmoogra Oil 90, Olive Oil 10 Benzoeaine 3. 5 Cc. injected at body temperature in deltoid region, alternating semi-weekly with 8 Cc. in buttocks.—U.S. Public Health Service, L. i./28,10l! The Oil has also been given intravenously and per rectum, see Edn XIX p. 606. * » ^ See also treatment with Hydnocarpus Oil preparations, p. 606, and with a Vaccine, p. 609, Leprosy Bacillus, Vol. II, and Leprosy, a self-healing disease, p. 608. The leucocytosis produced by Chaulmoogra Oil is a means of transport ! whereby the drug is brought into direct contact with the bacilli in the lymph i' circulation.—China Med. Jl., per Jl. A.M.A. ii./25,931. Capsules of Chaulmoogra Oil contain 5, 10 and 20 grains. Unguentum Chaulmoogrse {B.PS 14) Syn. Unguentum Gynocardlss, 10% in Paraffin basis. Sodii Chaulmoogras, Pure Commercial, from genuine Taraktogenos Kurzii Oil. Dose.—1 to 3 grains (0-06 to 0-2 Gm.) thrice daily or to limit of toleration. Sufficient should be given to saturate the system and over a long period, cf. paper by E. Muir, p. 608. Manufacture?.-— Saponify genuine TaraMogenos oil by boiling with a | sufficiency of strong soda lye and throw out the acid with hydrochloric acid. Wash with warm water until the wash liquor is free from acid and convert ; into the sodium salt.—W. H. M. See also H. C. T. Gardner, P.J. ii./22,154 > and note by W. H. M. Ibid. 207. Fractionation of Chaulmoogric Acid into portions. We originated in 1915 the idea of fractionating the Chaulmoogra acids and introduced them as sodium salts for use. Originally : there were four fractions 4 A? 4 B* 4 O ’ and 4 /).’ It was decided to group ‘ A ’ and ‘ jB’ as also 4 G ’ and 4 D.’ There remain therefore 4 A ’ and lC ’ as described below. We had pharmacological re- j searches made with them before their use in man. Sodium Chaulmoograte “A” Martindale comprises the salts of the higher acids with relatively high melting points. This compound salt contains the true Chaulmoograte and Pa-lmitate and homologues, the acids of which have combined melting point of 50° C. approximately. It represents 50-75% of the total. Sodium Chaulmoograte <4C” Martindale [free from Palmitate), comprising the lower acids with relatively low melting points. It contains the lower homologues with combined melting point of 25 C. approximately. Whilst the “ A ” salt is not soluble in a proportion to permit of the ready administration of 3 or 4 grain doses, it can be given- in pill form. Simultaneously the 44 G ” chaulmoograte. which is readily soluble, is used hypodermically. In this way the total active constituents commercial Chaulmoogric Acid are utilised. So far as we are aware no pharmacologist has been able to poiir to the real therapeutically active constituents of Chaulmoogra C <mc 1 is possible that a fractionation on these lines may enable us t separate the useful from the inert components, (cf. Theory < Action, p. 602). ~ J Sodium Oliaulmoograte <eA” Pills and Gelatin Capsule 1, 2 and 3 grains (0-06, 0*12, and 0-2 Gm.) are prepared. Dose. One thrice daily after meals or ad lib. Sodium Oliaulmoograte “A” Suppositories, 1, 3 and 5 grain (0-06, 0*2 and 0-3 Gm.) or more are also made. Sodium Oliaulmoograte “C” Hypodermic Sterules, 1, 2 an 3 grams (0 06, 0-12 and 0-2 Gm.). Pose• injection may be given deeply under the fat layers— tars is stated to reduce reaction—once or twice a week or as found t be tolerated. Note.—Warm the Sterule slightly if necessary. We have had no adverse reports on the injection of Sodium Chau] moograte “ C,” cf. Physiological Expts. infra. The Superintendent of a Leper Asylum informs us privately tha the Injection ‘ C ’ is much less painful in use than the Chaulmoogr Oil and Camphor Mixture. Physio/ogicaf Experiments with cur Fractions. toilWv^f7Preci'aIIn?0Ilc for 113 with rabbits and cats (for de tails see Edn. X till, p. 609, 610), it became clear that weight for weight— comparing the results on animals with the dosage for man—three grains o our C 1 raction ought certainly to be tolerated even ^venous iy,t but the subcutaneous method would seem preferable. +i 1 118 pomt was ol great importance in view of the need to virtually saturat the system with tne drug. Since that time most extensive use of these “ C * injections lias been made clinically. ~ Sulphuric Acid Test on “ A” and “C” Fractions. Both ‘ A ' and ‘ C ’ Acid fractions give the recognised green colour wit* Sulphuric Acid common to Chaulmoogra Oil. It is preferable to have the fat m excess of the Sulphuric Acid. The ‘ A ’ responds with stirring in a minut* or two. I he C gives it in almost the same time, but is not so marked. Re fere nces Numerous accounts of the Sodium and Potassium Chaulmoogrates, including the work ol Sir L. Rogers on similar lines to our own have appeared Chaulmoogric Acid and Hydnocarpic Acids were found the acids specific against acid-fast bacilli, see Edn. XIX, p. 608. Good results in long-standing infection from the use of Sodium Chaulmoo- gX&te (Martindale) in sutlieient quantity to saturate the system to the limb or toleration, treatment extending over months. Eye affection improved nodules diminished, bacilli disappeared from nasal mucus and antesthetic condition of the skin improved. Intravenously 0-04 Gm. given everv second day followed by an interval of 25 days after each twelve injections. Tn some cases a 1% or 1-5% solution was better tolerated than the 3% solution. Found best anti-leprosy remedies, intense and rapid in action.--E Balbi, (riornaleltahano di Dermat., e Sililog. EascicoloII, 1926, B.M.J.E, h/27. A number of old-standing cases were treated in 1927 by S. M. Allievo at the DermosyphiHtic Cienic of the University of Cagliari with bod mm Chaulmoograte supplied by the author with good results. Lesions and nodules in many cases disappeared and there was marked improvement m the condition of the patient and increase in weight. Most of the cases had received previous treatments with various medicaments, some of them lasting over considerable periods of time and involving hundreds of injections, without appreciable amelioration. * * 20% sofutio? G nr o0^hlm Chaulmoograte were given either intravenously s?me cases course of intravenous injections thrir*p additional pourse of intramuscular, injections being given 1 T^L]^kl7' .Jhe foRowing is a typical course of treatment: roafvT11^ w . Sodium Chaulmoograte was started following a month's „' ' a prjV1t?ils. course °f Antileprol. In all, 40 intravenous injections ^ere given and 50 intramuscular, in three courses, with 20 days’ interval ^ etween each course, the treatment being combined with Hypophosphites by ie m?uth. Treatment lasted about 9 months, during which time the patient was pven 0-58 tan. Chaulmoograte intravenously and 8-88 Gm. intramus- . Toe first- course of 40 injections was spread over 3 months, the second ,p, . injections over 1 month and the third of 40 injections over 3 months. I he injections were well tolerated. A furiho^ Report from Ca&liczri University states : Sodium Chaulmoograte, used with caution, has proved to be tolerated, either intravenously or intramuscularly over a long period of time, and, in association with local treatment, good food, fresh air, etc., is an anti-leprosy preparation in no way inferior to Antileprol or Collobiase, and, moreover, when used Intravenously^ It hus &n undoubted hen&fi- dent action which is more rapid and intense than that of the Chaul- moogra Oil, though perhaps not so lasting.” Collobiase.—An emulsion of the formula : Chaulmoogra Oil 0-36 Cc., Gum Acacia 5 Gm., Distilled Water 500 Cc. Hypodermically commence with 1 Cc., increased by 0-1 Cc. on alternate days, up to a total of 5 Cc., which dose is maintained up to the 20th injection. Intravenously commence with 0-25 Cc., increased by 0-1 Cc. on alternate days up to 2 Cc., which dose is maintained up to the 20th injection. —Antonio Marras, ‘ La Terapia della Lepra ed i Risultati Ottenuti coi Moderni Trattamenti,’ University of Cagliari, 1929, p. 133. ^ Gollobiases is T.M. 401085. Vaccines are also advised by the University, see p. 609. Sodium Chaulmoograte in leprosy.—Best results by weekly intradermal infiltration (10—20 sq. inches of skin at a time). Hydnocarpus Oil itself is not suitable—esters preferable. Progressive improvement from infiltration once a fortnight or even monthly. To raise patient’s resistance give 0 02 Gm. Potassium Antimony Tartrate every second day intravenously with large doses of Calcium and alkalis per os. Pain relieved by Adrenalin intramuscularly or Ephedrine orally or by infiltration.—E. Muir, L. i./3i,1401. Tuberculosis.—A girl aged 15, with a sputum loaded with tubercle bacilli, had the injections and went through a full training as a nurse and died of a recrudescence of the disease 5 years after the injections. The evidence therefore was that the Sodium Chaulmoograte did good.—C. Milne, May 5, 1927. Lima’s Chaulmoograte Pill. Contained Sodium Chaulmoograte, Ginger and an aperient. _ Magnesii Ghauimoogras. Phineas Abraham employed this compound in leprosy.—B.M.J. ii./g2,lll 1,1198. Ethyl Ohaulmoograte. u.s.x., f.b. viii. Syn. Chaulmartin, ^Moogrol (T.M. 410850). Dose.—1 Cc. intramuscularly increased by 1 Cc. at every second or third injection until from 2 to 6 Cc. is reached. Initially it is suggested to mix with equal quantity of Olive Oil. Injections are made deeply in the upper and outer quadrant of the gluteal region. Intravenously, if the above is not tolerated, \ Cc. increased to 1 Cc. usually once a week. ■ZUi (!/'}%(yfuuc* Saponify*the oil and precipitate!the acids. Dissolve tnese in an equal weight of ethyljalcohol and pass in gaseous hydrochloric acid while heating ander^a reflux for 1 hour. Cool, pour into water and wash with sodium 3arbonate solution. Dissolve the oil in ether and dry with anhydrous sodium jarbonate. Filter, and evaporate the ether. . To obtain colourless it may be necessary to distil in vacuo. Characters« A mobile liquid, almost colourless, with very sligl chaulmoogra odour. Sp. Gr. 0-910 to 0-917 (U.S. X. 0-904). Slightly ac i not more than 0-2 Cc. N/10 NaOH). Saponification valr 195 to 200 (I.\. 90—100). M.pt. of mixed acids on saponification 40 to 45° * these data are according to our own experiments, 1923. Uses•—It has been claimed that a preparation of this deseriptio< would be superior for subcutaneous use. H. T. Holman and A. I Dean (Jl. Cutaneous Dis. June, 1919,36? ; Pres. Feb. 21,86), poin to reactions having been caused with subsequent improvement. The Ethyl Esters of Hydnocarpus (W ightiania and Anthelmintica and Ethyl Chaulmoograte in conjunction with Iodine have also been! employed (v. infra). The preparation permits of the simultaneous use of all the acids o the oil, both high and low melting in the form of an injection into th tissues, but we are a little in the dark as to why the ethyl esters shouk be any more suited for the purpose than the Glyceryl Esters, which o course constitute Oleum Chaulmoogrse. To us these Ethyl Ester appear to be chemically too stable—little likely to be split up anc absorbed. The preparation remains in the cells for months, hence mild irritative effect A desirable psychological effect— E. Muir, L. i./3i,1401. Sir L. Roger found the effect too irritating. The efficacy of Chaulmoogra in leprosy lies, apparently, not in the use 0 the Ethyl Ester, but in that of the whole oil, preferably in conjunction witl Pyrogallol Oxide.—T. C. Ghosh, L. i./23,630. Leprosy in Hawaiian Islands. Most prevalent during school age and mos~ common in male sex. Ethyl Esters of Chaulmoogra Oil of benefit in most cases.—W. T. Corlett, per Jl. Trop. Med., Jan. 1, 23,13. 24 out of 300 lepers cured, and 30 convalescent with Ethvl Esters.—K Shiga, I.M.G., July, ’26,355. Iodised Ethyl Chaulmoograte containing 2% Iodine. Dose.—1 Cc. intramuscularly has been reported on. See Edn. XIX, p. CIO, but to our mind there can be no great advantage in the compound.—See alsd H. W. Wade and C. B. Lara, L. i./27,599. Treatment of Leprosy with Hydnocarpus Oil and its preparations. Oleum Hydnocarpi (P. Off.). Obtained from seeds of H. Wightiana, Blume. The pure oil 2-5 Ce., has been given twice weekly and increased by 0-5 Cc. in leprosy. The oil is tolerated well if injected into healthy subcutaneous tissues and only a very few lepers showed the mildest reactions.—Col. Med. Report, No. 209 (Straits Settlements), p. 41, per Jl. Trop. Med., June I/27. The oil is however not suitable for intradermal infiltration over large area. Ester preferable.—E. Muir, L. i./3i,I401. See further abst. under Sodium Chaulmoograte. Hydnocarpus Oil, combining 4% Creosote, the cheapest and most effective remedy, and the one which did the maximum amount of good in all stages.—R. G. Cochrane, R.S.M. Discussion, B.M J. i./2 7, 285. Sodium Hydnocarpate. A preparation obtained from the low melting fraction of H. Wightiana Oil has been used in leprosy, preferably 1% solution in 10 Cc. dose. Sir L. Rogers, Proc. Roy. Soc. Med. 1927, Vol. XX, Sect. Trop. Diseases, p. 146 et seq. Creosoted Hydnocarpus Oil and its esters are the most useful, economical and painless preparation. Sodium Hydnocarpate is specially convenient, but apt to cause endophlebitis and block the veins when given intravenously. The last Indian Census, 1921, gave the number of lepers as 102,513, but it is believed there are 4 or 5 times that number infected. Removal of predisposing causes, causing lowering resistance of patient, are important. Erythrocyte sedimentation test is useful in determining degree of resistance. Desirability of further botanical research into possibility of introducing hydnocarpus trees in British Possessions in Africa where leprosy is rife the fresher the seeds the more active the therapeutic action of the oils.—E. Muir, per B.M. J. ii./3o,1095. Recent advance in treatment of leprosy and its bearing on prophylaxis.— Sir L. Rogers, Pr., April, ’28,209. * ~ Sodium Hydnocarpate “ SteruJes ” 10 Cc. of 1% solution are prepared. ^ Alepol (T.M. 478,936). A selected fraction of the Sodium Salts of Hydnocarpus Acids.— P.J. i./28,209 ; Ind. Jl. Med, Res. Oct,, 27, p. 501 ; L. i./28,73. Dose.—1 Cc. of a 3% solution (increased) intramuscularly or subcutaneously ; intravenously 1 Cc. of 1% solution increased by 1 Cc., up to 5 or 10 Cc. Intravenous injections up to 10 Cc. of 5% solution the method of choice in ‘ mass ’ treatment in the Yambio District of the Belgian Congo. Locally, Acid Trichloracetic is used and ulcers dressed with Hydnocarpus Oil.—A. Cruickshank, Lep. Rev., Jan., ’32,6. Ionisation.—Ionisation of the nasal mucous membrane, using Alepol, Potassium Iodide and Sodium Chloride, in 1% solution, produces in many cases apparently complete cure of leprotic lesions in this site, an electrode being placed in each nostril and kept in position by bandages, and a current of 20—30 m.a. passed for 20—30 minutes.—F. G. Rose (Mahaica Leper Hosp.), B.M.J. i./29,148. Ethyl Hydnocarpate. Syn. Hydnestryle, Hydnocreol (with 4% Creosote). Esters of Hydnocarpus Oil (Id. Wightiania), with equal quantity of Olive Oil, in doses from 0-5 to 10 Cc. intravenously or subcutaneously twice weekly, satisfactory in early cases of leprosy. Of no value where permanent lesions already exist. Effect enhanced by adding Creosote or Thymol to solution.—E. Muir, Ind. Jl. Med. Res., Oct. ’24, per B.M. J.E. L/25,7. This method, using Creosote 4% of the Mixture and subcutaneous infiltration twice weekly, initial dose \ Cc. as stated, increasing by J Cc. has success in India.—R. G. Cochrane, L. ii./26,95. Pound useful at Dichpalli, Hyderabad. Of 180 patients treated in 1923-24 17% were symptom-free, 45% improved and likely to be symptom-free, 35% improved and 3% worse or dead. Of infective cases 63% have become non-infective.—Isabel Kerr, L. ii./25,373. See also Proc. Roy. Soc. Med., 1927, Vol. XX, Sect. Trop. Diseases, p. 135 et seq. The toxic action of Chaulmoogra Oil appears to be due to esters of Hydno- carpic Acid. Ethyl Hydnocarpate intravenously into rabbits causes lower Calcium content of blood, with associated hyposensitivity, followed by incoordination, death following respiratory failure. The toxic dose is 0-5 Cc. per kilo, for rabbits.—B. P. Read, Jl. Ph. and Exp. Therap., ’24, p. 221. Ethyl Esters of H. antheimintica in prophylactic treatment of leprosy are used in the colonies of the Federation of Indo-China. 1st week. 1 Cc. is injected ; 2nd week, 1-5 Cc.; 3rd week. 2 Cc. ; until a dose of 5 Cc is reached. Results sufficiently favourable for lepers to ask for injection instead of rebelling against treatment as formerly.—Presse MSdicale, p Jl. A.M.A. ii./2 5,206. See also item 931. Intradermal injections of Chaulmoogra and Hydnocarpus Esters should Ir accompanied by intramuscular to produce maximum effect. Rig dos* should be pushed where resistance is high—but doses above 10 Cc. harmful —R. Cochrane, T.R.S.T.M., Aug., '31,98. Hydnocarpus Oil and its Preparations injected intradermally, the action largely due to the local irritation, which continues for some time, the estes remaining absorbed inside the local cells, causing breaking down and phage; cytosis of the lepromatous material. There might also be some antigen action.—E. Muir, T.R.S.T.M., Aug., ’31,92. Hydnocarpus Nut, Powdered.—The main treatment in an asylum in tta Malay Peninsula. A popular Chinese remedy, palatable and inexpensive — E. A. O. Travers, R.S.M. Discussion, B.M.J. i./27,285. Further References on the Treatment of Leprosy. Leprosy—Diagnostic Tests. Description and technique of the Histamine Test, which has proven successful.—Lep. Rev., Jan. ’32,18,28. Also the Muller-Ballung’ Reaction.—ibid. International Conference in Manila, January, 1931. The nam- Mycobacterium lepree to replace B. leprcc. H. Wightiana, and H Anthelmintica Oil, in form of Ethyl Esters, and Sodium Salts, mentioned. No special drugs definitely recommended.—R. Gr Cochrane, B.M.J. i./3i,681. British Empire Leprosy Relief Assn. Report, 1930. Shows the work of the Association and the vast area covered. In the yeai 1929-30 over 400,000 doses of anti-leprotic drugs were dispensed. Leprosy in N igeria. A comprehensive survey of the problem. Introduction of leprosy thought possibly due to introduction of Mohammedan Civilisation. The Mohammedan fatalism, prolonged drought, overcrowding, slave trading, th& Annual Feast, and the indifference of the natives, are important factors irs the prevalence of leprosy.—T. F. G. Mayor, Secretary, Nigerian Bch. British Emp. Lep. Relief Assocn. (Lagos), 1930. A ScSf-Heafineg Disease.—Comparison with the well-known self- healing diseases—lobar pneumonia, enteric and small-pox. In these latter there is a short incubation period, rapid onset and rise to a climax when immunity has become sufficient to cause more or less rapid diminution, the* whole course being finished within a comparatively few days. In leprosy there is a similar process spread over as many years. Treatment has to depend on stages of the disease. In the first stage the disease is present in limited form, with few bacilli in the body, little or no immunity and either diminished general resistance (temporary or permanent) or the presence of some other condition which is favourable to the increase of the disease. Diagnose and remove whatever diseased condition, environment or unsuitable diet is lowering tissue resistance. Induce immunity by injection of antigens. Defatted acid-fast antigens may be useful. Destroy the bacilli by injections of fatty acids—the esters of the fatty acids of hydnocarpus—and chaulmoogra oils specially useful. Counter irritation by infiltrating esters into the subcutaneous tissue under skin and nerve lesions, or by external use of 1 to 3% Trichloracetic Acid painted on to lesions every 6 or 10 days. In the second stage—the same remedies, but with care. The bacilli are plentiful and there is danger, in the absence of acquired immunity, of further dissemination. In the third stage. Where a fair degree of immunity has occurred all the above forms of treatment should be pressed. When large injections of the esters do not produce sufficient reaction give Potassium Iodide, beginning with $ grain a day to limit of tolerance.—Ernest Muir, L. i./24,277. OLEUM EUCALYPTI. 609 Chaulmoogric Acid « C * Injection. Martindale. Arising out of the last-mentioned we suggest our low melting acid fraction as such or ^deed total acids without neutralising or reconverting into esters. These preparations should prove reactive and experience suggests, not too reactive, but neutral material as our bodium bait antea is obviously better. Suggested Dose—A 5% solution in Almond Oil of our ‘ C 5 fraction forms a slightly opalescent liquid without actually separating. Doses of 0-05 to 0-2 Gm. in the diluent mentioned would be worthy of trial. l/accine Treatment (J. Hasson) of a case of acute nodular leprosy originating in this country completely successful.—E. Graham Little, B.M.J. ii./26,1034. See also Criticism ibid. 1196. The action of Chaulmoogra preparations in leprosy is very unreliable and limited in scope.—J. Hasson, B.M.J. i/27‘40. Results from the use of these preparations seem propitious in proportion to the remoteness of the reporter.—E. Graham Little, B.M.J. i./27,40. Vaccinotherapy should be used, particularly in the more recent and acute cases. # Initial dose 50 mill., intramuscularly or intravenously, increased to 500 mill., with varying interval between injections. In the florid type intramuscular injections given at 5-day and intravenous at 7-day intervals, and in the mixed or anaesthetic types intramuscular at 3-day intervals and intravenous 6-day. Reaction occurs 4 to 5 hours after, usually ot short duration. An intramuscular course consists of 12 to 30 injections and an intravenous from 6 to 10. The course is followed by a month’s rest, then a course of ; Sodium Chaulmoograte and a further month’s rest before repeating.—Antonio Marras, * La Terapia della Lepra ed i Risultati Ottenuti coi Moderni Trattamenti ’ (University of Cagliari, 1929), PP- 155—157,255,256. Leprosy—Symptoms, Diagnosis, Treatment, and Prevention—by Sir L. Rogers, 2nd Edition.—L. i./3o,518. Calcium in Leprosy, see Therapeutic Index. ^Avenyl (T.M. 469632). For the treatment of leprosy complicated by syphilis. Hydnocarpus Oil with 0-25% of 2-Myristoxy- mercuri-3-Hydroxybenzaldehyde. See B.M.J. ii./27,102. OLEUM EUCALYPTI. Dose.—J to 3 minims (0-03 to 0*2 Cc.) on sugar, emulsified, or mixed with olive oil. U.S. average dose 8 minims. Eucalyptus Oil is distilled from the leaves of numerous species of Eucalypti. The oils which contain the greatest percentage of Eucalyptol are used chiefly for pharmaceutical purposes and the species now being distilled for oil3 of this class are E. Polybractea, E. Cneorifolia, E. Odorata, E. Smithii, E. Globulus, E. Australiana, E. Oleosa, and a few others. As the yield of oil varies greatly with the several species this is a controlling factor. The rectified oils of E. Polybractea and E. Australiana are water white, those of the other species mentioned are tinged slightly yellow when freshly distilled. Oils which contain as much as 70 to 80 per cent. Eucalyptol are now well known, c.g., E. Polybractea, E. Smithii, etc., and have a pleasant, fragrant smell. The oil from E. Citriodora has an odour resembling Vol. I. u Lemon-grass. Mr. George Inglis Hudson, of Glebe, Sydney, Austra lia, was good enough to assist us in this Chapter. Mr. H. G. Smith has done useful research in Eucalyptus Oils. The oil ozonizes the atmosphere whilst oxidising. The pinenesi contained have the principal action in this direction. Sp. Gr. 0-91C to 0-930. It should not cause coughing when inhaled—absence- of volatile aldehydes. Soluble in oils, fats, paraffins, about 3 in 1 of 90% alcohol, in about 3 to 5 vols. of 70% alcohol and in all proportions in absolute alcohol. Uses«—Antiseptic, a popular prophylactic, inhaled or sprayed for influenza and bronchial catarrh. Useful mixed with an equal quantity of olive oil as a rubefacient for rheumatism. Cholera Epidemics.—Eucalyptus 031 10 minims twice daily has a definite prophylactic effect.—Brooke. Measles.—Milne’s Method was to rub the Oil over the body excepting, face and hands, morning and night for the first four days, afterwards once a day until the tenth day. Tonsils and pharynx to be swabbed with 10% Carbolic Oil every two hours for first 24 hours or irrigate mouth and throat: daily with weak Alum Lotion and Glycerin of Borax applied to interior of mouth and to the gums. Mortality lowered. Typhoid Fever treated by 10 minim doses. Reduction in temperature. Ankylostomiasis treated—Eucalyptus Oil 2 Gm., Chloroform 3 Gm., Castor Oil 40 Gm. Bose.—\ to b according to age and condition of patient. Also successful for tapeworm and threadworm, but we doubt if specific—see 01. Chenopodii. Colds arc treated by steam inhalation with the oil, also internally 10—15 minims on sugar every 3 or 4 hours. See also Oleum Cinnamomi. Poisoning effects from 1 to 6 drachms are recorded. Effects were gastro-intestinal irritation and cerebral paresis with vomiting and diarrhoea. Treatment by external stimulation, as on the lines of Opium poisoning. Eucalyptus and castor oil taken in error lor plain castor oil. Three doses of Camphor given hypodermically. Recovery.—L. M. Clresney, L. b/26,131. A pugilist took 3 drachms, as suggested by a ‘ drop.' Intense drowsiness —complete hypnotic effect.—P. C. Garrett, B.M.J. i./25,1172. Poisoning caused by about l ounce. Cyanosis. Strychnine 1/60 grain hypo-" dermically and Mustard 2 drachms by the mouth : after vomiting, stomach lavage.—P. Gibbin, B.M.J. i.,/27,1005. See also ibid., 1133, and A. Keale, B.M.J. ii./27,520. EucalyptoJ, U.S., Fr. Cx., F.E.—Syn. Cineol ; Cajuputol. C10H18O —154T404. Dose.—1 to 4 minims (0*06 to 0-25 Cc.). Is that portion of eucalyptus oil which passes over between 347° and 351° E., and crystallizes at 0° C. It is preferred to the crude oil for use in oro-nasal inhalers. It may be obtained from the oil by the action of phosphoric acid (Eaulding’s Process), with which it forms a crystalline compound. Eucalyptol Phosphate. On addition of water, this splits up setting free Eucalyptol. It is however not difficult to prepare Eucalyptol by Freezing- The Eucalyptol made by the cooling process is of absolute purity.— G. I„ Hudson. Tinctura Eucalypti (Foliorum). Dose.—15 to 120 minims. Eucalyptus leaves in No. 20 powder in alcohol 60% 1 in 5. Haemorrhage from superficial wounds is stated to be capable of arrest by internal use of calcium chloride combined with local application of this tincture. 0 OLEUM MORRHUiE. 611 Pigmentum Olei Eucalypti et Acidi Salicylici. ^ucalyptus Oil 8, Salicylic Acid 1, Olive Oil to 64. Eczema capitis treated by rubbing into the scalp twice a week. Unguentum Eucalypti et Acidi Borici. seOTetions^of rhinitis'. B°ri° Add ^ ^ Petr°leUm to 500' L~ Vapor Eucalypti, T.H. Euc%Ptus 0l1 20 minims. Light Magnesium Carbonate 10 grains, Water to 1 ounce. A teaspoonful in a pint of hot water. (Vic. Park has double quantity of oil.) Vapor Eucalypti Compositus, R.F.H. Eucalyptus Oil 2, Compound Tincture of Benzoin 3 Thymol 1 Spirit of Chloroform to 8. 10 drops at a time to be inhaled through an inhaler, e.g., the “ Ozonic.” Nebula Eucalypti Composita. Form A.—Eucalyptus Oil 5 minims, Cinnamon Oil 2 minims, Menthol 12 grains, Liquid Paraffin containing 2% Aristol to 1 ounce. Form B. Eucalyptus Oil 5 minims, Wintergreen Oil 5 minims, Menthol 5 grains. Liquid Paraffin to 1 ounce for a common cold, sfcEumenthol (T.M. 297687, 301214) Jujubes (Hudson). Contain the active constituents of E. Polybractea Oil, Thymus Vulgaris, Pinus Sylvestris, Mentha Arvensis with Benzo-borate of Sodium. Antiseptic and effective. OLEUM MQRRKUJE. Syn. Oleum Jecoris AselH, P. Belg. IV., F.E. VIII. French—Huile de Foie de Morue. German—Lebertran. P. Ital. V.—Olio di Fegato di Merluzzo. Dose.—1 to 4 drachms (4 to 15 Cc.). The oil (P. Off.) is pressed from codfish livers, Gadus morrhua and filtered at about 0°C.—previously heating and cooling was adopted. Inferior brands are prepared by heating. U.S. X. states ‘ and other species of Gadus.' The oil may be assayed for Vitamin ‘ A ’ potency and should then contain at least 50 units per Gm. For Characters and Tests, see Vol. II. Soluble,—1 in 2 of Ether, slightly in alcohol. Flavoring,—Syl Lavandulae, Glyl Pini, or as Emulsion. '7 See also Oleum Morrhuae Aromat. p. 613. _ .... H Uses,—Nutritive, nervine tonic given in rickets, phthisis, chronic bronchitis, general debility and malnutrition. Cod Liver Oil is rich in Vitamins ‘ A * and * D.’ For its use in rickets and other Vitamin deficiency diseases the chapter on Accessory Food Factors should also be consulted. Concentrated Vitamin preparations are obtained from the ■ unsa&onsfiafoiie #j>©[see p. 613). For Vitamin D Prepara- s1 tions see Vitamin Preparations of Commerce. Vitamin Assay Methods I—Vol. II. H&l&tii/Q rich §*bqss sm if it mm ibis a Scottish Oils rank fiist, then Newfoundland, then Norwegian.—Imperial Committee on Marketing Foodstuffs. The dog-fish produces oil containing twice as much Vitamin ‘ A ’ as Cod Live Oil, and the common European shark an oil with 8 times as much.—Per L i./31,566. ‘ Unsaturated ’ Fatty Acids.—The older theory of the late O. T. William and others was that in tuberculosis the value of Cod Liver Oil depends on the fact that the liver has the power of decomposing fats and yielding these acids to the blood. These have chemically a loose double linkage and ar« capable of exerting chemical action more markedly. Fish, particularly Coc« Liver, and vegetable oils are richer in these constituents ihar animal oils. The effects of Cod Liver Oil on the acid-fast properties O' the tubercle bacillus showed that the oil had attacked the waxy coating of the bacillus and rendered it non-stainable by the usual methods. For this and other aspects (Nitrogen Metabolism), see Vol. II. Trypanosomiasis.—It has been reported on (in conjunction with organic arsenic) favourably. Should be tried in a large number of cases.—Bagshawe- Typhoid Fever.—Cod Liver Oil appreciably diminishes mortality.—Pe Jl. Trop. Med., Mar. 2, ’25,115. . . Prickets.—One of the benefits of Cod Liver Oil is due to its forming a solubF soap with calcium.—B.M.J. i./n,500. (Subsequently the Vitamin conten theory had support and more recently Cod Liver Oil plus Lime. For furthe information, see Vitamins). Promotes gain of strength and height and is better than milk for growing children.—Danish Investigation.—B.M.J. i./3o,79. Tuhercuiosis. Blood Calcium. Dietetic conditions influencing the calcium content of the saliva. A higt calcium content can be produced by a diet having a large fat soluble Vitamii content; a low calcium content by a diet with much cereal and little fa soluble Vitamin. Tuberculous children appear to have a lower calcium conteu than normal.—C. Lee Pattison, B.M.J. ih/26,6. Taking the Oil increases blood Calcium—decreases the coagulation timer Pulmonary hremorrhage with increased coagulation should benefit. A Calcium salts per os caused rise of blood Calcium, intravenous injections 0 Calcium salts not needed.—Jl. A.M.A. ih/25,66. When a patient is for any reason on a ‘ + Lime ’ diet Cod Liver Oil shoulc be given.—Of. Digestive Tract, p. 250. Capsules of Cod Liver Oil 19 minims and Creosote 1 minim ar« for use in phthisis, also made plain, 20 and 30 minims. Emulsio Olei Morrhuae (50%).—Martindale. Dose.—2 to 8 drachms (7 to 30 Cc.). Soak Irish Moss 2 drachms in Water 12 ounces, six hours, boil anc strain off 10 ounces. Allow to cool and add in three portions Cod Live Oil 12 ounces. Then add Simple Tincture of Benzoin 1 ounce, Alcoho 90% 1 ounce, Essential Oil of Bitter Almonds 10 minims, Elixir 0 Saccharin 10 minims. This produces a good white preparation. Ferrated Emulsion of Cod Liver Oil consists of the plain Emulsioi with Citrate of Iron and Ammonium 5 grains per ounce. Emulsion of Cod Liver Oil with Glycerophosphates, V. p. 37. Emulsio Olei Morrhuae et Hypophosphitum. Dose.—2 to 8 drachms (7 to 30 Cc.). Contains the Hypophosphite of Sodium and Calcium, of each 1%, in the form for Emulsio Ole Morrhuae anted. Emulsio Olei Morrhuae cum Lecithin is the above with 5 grain of Lecithin per ounce. Dose.—2 to 8 drachms (7 to 30 Cc.). The Lecithin is to be incorporated with the above finished Emul sion. Pharmaceutically, it is elegant and palatable. 0 OLEUM MORRHUj£. 613 withMM«RXH(T-M-,457^9)- A co“W„ation of Cod Liver Oil nutritious to^P°P P eS' Virginian Prune’ and Aromatics. A Oif500^th“ ?dd atIonce,WatYriA°-fCia GAllm 125 with Cod Liver (or other flavouring, «...)'and Syrup 10^ and’ Water tPfSalicylate 4 Emulsio Olei Jecoris Ferrata_P Y °i A,T. ‘ „ Oleum Jecoris cum lodo. Syn. Olio di Fegaio di Merluzzo Iodato. I. Xtal. V. Contains 0-05% Iodine dissolved by trituration. Oleum Morrhupe Aromaticum. Dose.—1 to 4 drachms. Coumarin 0-01, Saccharin 0-5, Vanillin 0-6, Absolute Alcohol 10-0 Lemon Oil 20-0, Peppermint Oil 3-0, Cod Liver Oil to 1,000. The taste is covered but the odour persists to some extent. Lm'i°Oi?witli'^Ls429023)' A r,rcparation containing 52% Norwegian Cod Cod Liver Oil Vitamin Concentrate. Preparations containing antirachitic Vitamins of Cod Liver Oil in a concentrated form are made by separating the unsaponifiable fraction of the oil. xhe oil is extracted with Formic or Acetic Acid, and the acid extract, amounting to about 5%, is saponified with Alcoholic alkali. The soaps are extracted with Ether. This extract gives on evaporation a brown residue (about 0-1/0 of the oil). Air being excluded : the product is stable for seven or eight months. A 1 Gm. tablet may be made representing the therapeutic activity of a tablespoonful of the oil.—P.J. ii./25,394. . Ether solution of a concentrate of Cod Liver Oil intramuscularly in rickets had similar effect to the oil given per os.—Per Pr., Mar., ’27,199. 3^ Ostelin (T.M. 447886).—Contains Vitamin ‘ D,’ responsible for Calcium- Phosphorus metabolism. 4 minims of it are equivalent to 1 drachm of Cod Liver. Oil. Available in Glycerin and in Malt Extract and Orange Juice, containing the equivalent of 50% Cod Liver Oil: and in tablets containing 4 minims with Calcium Glycerophosphate 2 grains. ^Qscodal (T.M. 480078).—In tablets. Dose.—4 to 2. Adults 2 to 3, thrice daily. Stated to contain Vitamins ‘A’ and ‘ D.* sfc Godlivex (T.M. 460647).—Stated to represent the active principles of I the oil in the form of Milk Chocolate Pastilles which contain the lipoid of the Cod Liver. One is equivalent to one tablespoonful of Cod Liver Oil. S^Moruette (T.M. 455426) Cod Liver Oil Tablets are prepared on similar lines. They contain the fat-soluble Vitamin‘A,’ alkaloids of the Leucomaine class, Cholesterol and Lipochrome-containing bodies, also Phosphorus, Bromine I and Iodine. j Sodium Morrhuate. Dose.—Subcutaneously \ Cc. of a 3% solution slightly increased I up to 2 Cc., two or three times a week until reaction (febrile and local) occurs. When 2 Cc. has been reached give this dose intra- i venously up to 4 Cc. For intravenous use as a sclerosing agent, v. postea. Sodium Morrhuate consists of the Sodium salts of the acids of Cod I Liver Oil* usually purified by means of Ether. Chemical Examination.—The compound on dissolving in water should produce a clear solution. On acidifying with Hydrochloric Acid in the presence of Ether the acids removable by evapora- >j tion are pale yellow in colour and have M. pt. 15-19° C., and Iodine value 143 to 150. There should be no resinous matter insoluble in Ether.—By our Expts. 1931. It should be noted that Cod Liver Oil of good quality consists of about 70% Triolein with about 25% Tripalmitin, a little Tristearin, and a number of glycerides of other acids in small proportion. By a process of fractional precipitation the author has removed the Palmitic and Stearic Acids, thus retaining the ‘ Unsaturated ’ acids. Ganglia treated by Sodium Morrhuate injections 5%, 0-2 to 5 Cc.} after aspiration.—Peter McEvedy, L. ii./3o,902. Hemorrhoids injected with Sodium. Morrhuate.—A. S. Ross, B.M.J. ii./30,86. Sir L. Rogers first used Sodium Morrhuate in Calcutta in 1918 in leprosy and tuberculosis. 3% or more causes strictly localised mild inflammation of the vein wall, followed by firm fibrous occlusion of the vessel. Neither the Hydno- carpate nor Gynocardate nor Morrhuate increase coagulability of the blood, so there appears to be no danger of embolism resulting. 5% solutions probably best.—B.M.J. ih/30,120. Leprosy.—Improvement in 2 or 3 cases after 2 or 3 injections of Sodium Morrhuate.—W. W. Cadbury, per T.D.B. 17/21,279. Lupus.—3% solution intramuscularly, beginning with 0-5 Cc. increased to 3 Cc. gave striking results—the lesions completely involuted in 4 months.— B.M.J.E. k/29,98. See also Sir L. Rogers, B.M.J. i./2i,640. Tuberculosis.—The unsaturated fatty acids of this and Chaulmoogra Oil act in some way on the coating of the bacilli: the coating of these contains unsaturated fatty acids.—Sir L. Rogers, B.M.J. i./i9,147. Animal tuberculosis. Sodium Morrhuate, Soy ate and Hydnocarpate of no avail.—Sir L. Rogers, Pr., Aug., '21,98, but see also B.M.J. ii./23,1251. Sclerosing Agents for Varicose Veins, Sodium Morrhuate has been employed for this purpose on the recommendations of numerous physicians. Dose.—5% solution is most used. Eight injections, giving J to 1 Cc. at each puncture, are spread over a fortnight, the average total dose being 4-5 Cc. Good results. As a rule, except in the largest veins, there is no reaction or pain, and the swellings which may arise are diminished or gone within a week. In cases where there is no immediate result, further treatment is delayed for a month, when the veins usually become occluded or diminished in size—in the latter case an injection of 10% solution usually obliterates the veins.—P. B. Kittel, ‘ Haemodynamics,’ 1929. Technique.—A tourniquet is placed above the vein to be injected. With the patient standing, the injections are made throughout the length of the vein from above downwards. Sodium Morrhuate Sterules, 3%, 1 and 2 Cc., also 5 and 10% 2 Cc. are prepared. Used with success in 187 cases. Free from general toxic effects and local complications slight. As free from pain and discomfort as can reasonably be expected and duration of treatment the briefest possible. Injections of 0*5 to 1 Cc. of 5% solution with patient standing. Treatment given weekly.—T. T. Higgins and P. B. Kittel, L. i./30,69. Used for veins and hsemorrhoids with good result,—A. Stanley R oss, B.M.J. ib/30,86. OLEUM MORRHU2E. 615 S°di™ -^orrbuate for veins not entirely free from danger.— A. H. Winchester, B.M.J. ii./3o,120. Urticariform wheals with pain for a week.—T. II. Treves-Barber, ibid., 60,195. Indolent ulcers—possibly a quarter of a million cases in the U.K. Sodium Morrhuate 5% used for veins. Very tight bandaging.— A. Dickson Wright, L. i./3i,457. See also B.M.J. ii./3i,561. Sodium Morrhuate (2 Cc. average for each injection), 10% found more suita ole than 5%. The latter will do for small veins. Patient seated in chair and no constricting bandage for at least 3 hours after injection. Less toxic than Quinine-Urethane.—E. A. E. Silcock, B. M.J. ii./3o,303. 5% Jess irritant than other solutions and does not cause sloughing in subcutaneous tissues. Painless.—D. Levi, L. ii./3o,16. Has any case of embolism been recorded after an injection for varicose veins ? The clots formed by Sodium Morrhuate, etc., do not cause emboli. Patients should not be put to bed.—W. W. Jeudwine, B.M.J. ii./3o,933. Safest and most effective a 20% Sodium Chloride solution with an active material from saponified Cod Liver Oil, with standardised surface tension of 0*8 and pH 9-9*3, and containing about 0*15% of the Sodium Salt of some resinous compound. 0*5 to 2 Cc. obliterates from 3 to 30 cm. of vein. Normal dose for a vein 5 Cc., and up to 30 Cc. given at one sitting. Relatively slight pain.—T. H. Treves- Barber, B.M.J. i./32,143. We cannot agree with regard to the pain.— W. H. M. Sodium Morrhuate thought to lead at times to immediate thrombus formation.—Reginald Payne (St. Bart’sl, B.M.J. i./32,237. See also matter on Sodium Salicylate and Combinations, also Quinine Urethane for Varicose Veins. God Liver Oil Substitutes. See Maltolivine, ^Marriibin (T.M. 261511), Emulsio Olei Olives, Syr up ns Tarm-Iodo-Phosphoratus. The following oils have a high Iodine value due to the degree of unsaturation and hence are of therapeutic value. Cod Liver Oil 126—166. Soya Bean 122. Poppy Seed Oii 138*1. Maize Oil 111. Sunflower Seed 136*1. Poppy Seed Oil is sold as Salad Oil (Huile d’oeilette). Emulsio Papaveris. Syn. sfcPavimol (T.M. 362836) contains it. Dose.—| to I ounce thrice daily—it has been used in malnutrition. It is possible that the hardihood of the Italians is attributable to i the amount of unsaturated oil they consume.—-W. H. M. The vegetable oils contain no Vitamins ‘A’ or ‘Dh Dugcng Oil from species of halicore, sebaceous animals inhabiting the rivers and bays of N. and E. Australia may have some value. It is superior to Cod Liver Oil and sometimes used by inunction. Mutton Bird Oil as a substitute for Cod Liver Oil—the oil of the young : Sooty Petrel collected on the Stewart Island south of New Zealand advocated for feeding in phthisis and bronchitis.—J. S. Purdy, B.M.J. i./i8,174. OLEUM OLIVE. Dose.—J to 1 ounce (8 to 30 Cc.). The oil expressed, from the ripe fruit of Olea europcea (Oleacece). Inferior brands are obtained by addition of the pulped fruit to boiling wateir and by fermentation processes. For detail of Tests see Vol. II. Thousands of tons of Olive Oil are sold ivith B.P. quality guarantee—most oj; it could never he eaten or used medicinally internally.—C. E. Sage, P.J. iif 30,2. We entirely agree. It is of interest that the best quality Olive Oil bought here makes a bad salad dressing, while on the Continent the cook has no difficulty in producing edible dressing for lettuce.—W. II. M. Uses.—Olive Oil is a nutrient and has laxative properties (videk infra). Often gives relief to patients who have gall stones. It is frequently used warmed to about 90° F. as rectal injection, as much as 10 ounces at bedtime for constipation. In typhoid } ounce doses per os, and a breakfast-cupful by the bowel daily gives great relief. Capsules (Gelatin) of Olive Oil, each containing J drachm. These capsules are also prepared Formalised (Formagules) for lubricating the intestines in cases of habitual constipation. In gastric ulcer given by stomach tube if necessary it may inhibit, the secretion of hydrochloric acid. Hyperchlorhydria is generally associated with gastric ulcer. It can be given for long periods and is harmless. Chronic colitis treated with from 8 to 10 ounces of washed Olive Oil, warmedl to 100° F., injected per rectum at low pressure and retained all night- injections should be continued nightly for a fortnight.—L. ii./s3,1411. A tablespoonful flavoured with Peppermint before meals of value in digestive- disorders and heartburn.—W. Morrell Uoberts, Qtrly. Jl. Med., Jan., ’31,, per L. i./3i,537. Enema Oleosum L.H. Olive Oil 4, Soft Soap 1, Warm Water 16. Emulsio Olei Olivse. Dose.—1 to 2 ounces. Olive Oil 1 ounce, Gum Acacia Powder 25 grains, Simple Syrup’ \ ounce. Water to 4 ounces. Sterilisation, see Sterilised Olive Oil, p. 148. Malt olivine. Dose.—2 to 4 drachms (8 to 15 Cc.). A combination of Olive Oil and Malt Extract, as a substitute for Cod Liver Oil. A nutrient in emaciated and wasting conditions and in colitis of children. OLEUM RICINI. Dose.—1 to 8 drachms (4 to 30 Cc,). Expressed from seeds of Ricinus Communis (Euphorbiacece). Soluble about 1 in 4 or less of Alcohol 90%. Also soluble in ether and glacial acetic acid. Sp. Gr. 0-958 to 0-970. (B.P. ’14.) Saponification No. 180, Iodine Eo. 84. (P.Ital V.? 176-186 and 82-91 resp.). The seeds, but not the oil, contain the poisonous protein Ricin ; the ‘ press cake ’ therefore is poisonous. The purgative action is due to the fatty acids, of which ricinoleic is a principal member. 0 (Ricm. A vegetable toxin or toxalbumin is tremendously potent. When small doses are injected hypodermically immunity is produced, antiricin being lOrmed. This met paved the way for the foundation of serum therapeutics.— jl.J. i./i5,looj Ricin has two biological functions one toxic, and the other antigenic. Potassium Permanganate, Hydrogen Peroxide (30%), Ozone, Chlorine, Bromine, Iodine and Ultra-Vlolet Rays, all destroy the toxic properties without affecting the antigenic. Ricm partially oxidised by Potassium Permanganate, when injected into raboits, developed in them so great an immunity against untreated Ricin that after 2 or 3 weeks they were able to receive 100—120 times the normal lethal dose, and 0-25 Cc. of serum from these rabbits protected mice against a fatal dose of Ricin.—E. P>. Carmichael, Jl. Ph. and Exp. Ther Mar., '20,193—238. Total acidity of the oil (as oleic acid) should not exceed 1%. Pharmaceutical Oil as distinct from Soapmakers’ and other industrial oil does not deposit in cold weather. Limits of Petroleum Spirit Test of solubility of Castor Oil too wide to be of use.—P.J. ii./2g,ll. Flavoring.—Prescribed as Oleum Picini Aromaticum, or with 2 drachms of Tinctura Cardamomi Composita to the ounce, or in capsules, or as ‘ Maricol.’ Uses,—A mild but effectual purgative rarely causing pain. It is rendered more efficacious when mixed with an equal quantity of Glycerin. The oil rubbed on the breasts will often increase the flow of milk. Castor oil is a soothing application to the conjunctiva, and is employed for making solutions of the alkaloidal bases (q.v.). In sprue 1J drachms every morning.—Cantlie, B.M.J. ii./o5,1281. Pharmacology.—It passes the stomach unchanged ; on reaching the small intestine it is saponified by the alkaline pancreatic secretion, being converted into Glycerin and Ricinoleic Acid. This acid is irritant to the epithelium of the intestine thus causing impulses to pass to the local nerve plexus and then to the wall of the intestine. This causes the muscle to contract more—that is, increases the peristaltic movement of the intestine, and thus the contents are hastened on. If the oil were given saponified the Ricinoleic Acid would cause irritation and produce vomiting.—D. Grieve, P.J. ii./2 r,490. Capsules of Castor Oil contain J or 1 drachm. Capsules of Castor Oil, Compound, contain Croton Oil \ minim, with Castor Oil 8 minims. Dose.—One or two. ‘ Castor Oil Pills * have contained Calomel without any Oil. “ Compound Castor Oil Pills ” a proprietary contained vegetable laxatives, chiefly Aloes, with Castor Oil 5% at most. Renamed ‘4 Compound Laxative Pills,” etc., with statement as to content of Castor Oil.—P.J. i-/31,388. Enema Olei Ricini .—Castor Oil 1, Olive Oil 4. Dose. 5 to 10 ounces. ! i Oleum Ricini Aromaticum. Dose.—1 to 8 drachms. Vanillin 1 grain, Peppermint Oil 10 minims, Saccharin 4 grains Absolute Alcohol 60 minims, Tincture of Alkanet 1 m 5 Alcohol (90 /G) 10 minims, Castor Oil 4 ounces. The taste is covered . for c i ren. istor Oil Solutions of Alkaloids, Uses. —Instillation of Castor Oil to the eye allays the irritation msed there by foreign bodies. The alkaloidal bases (no eir sa 'S ssolved in Castor Oil are used in ophthalmic work. They keep well. 'Pj El 2% solution of the combined bases Homatropme and Cocaine have been of great service (q.v.). Solutions 1% respectively of [jp j Atropine, Cocaine ([jg |j? jj 4% will dissolve), dbGelseminine„ Cg)Homatropine, Hyoscine, []pl| Hyoscyamine, and CB>Pilocar- pine have also been used. Physostigmine (Eserine) is used in CB>|% solution. R. O.H. has [jp 111%. Morphine is barely soluble in it to thes extent of [fH |fp 1] \%. In making these avoid excessive heating. Homatropine and Cocaine of each 2% in Oil is the most efficient: cycloplegic.—N. Bishop Harman, B.M.J. i./20,599. Corneal ulcers have been treated with Oleum Scarlet et Atro- piase, q.v. Unguentimi OleiRicini Compositum L.H. Zinc Oxide 1, Soft Paraffin 2, Hydrous Wool Fat 2, Castor Oil 3. Sodium Ricinoleate. Syn. Soricin. The Sodium Salt of Ricinoleic Acid. A powerful detoxifying agent. Solution in water suitably flavoured is used as a mouth wash, and a Sodium Ricinoleate paste, 1 and White Vaseline 3 is used in dentistry. The Ricinoleates prevent anaphylactic action to microbic toxins and increase immunity responses. Sodium Ricinoleate ‘ Stearettes * contain 5 grains (0*3 Gm.) are preferable, owing to intense nausea when taken into the stomach. Good results have been obtained in colitis, eczema, and food asthma. Detoxol Tooth Paste and Detoxol Liquid (used as spray, swab, or gargle) are essentially Sodium Ricinoleate. Periodontal Diseases.—In 1921 Larson stated that pneumococci and streptococci would not grow in the presence of even small quantities of castor- oi! soap, and that tetanus and diphtheritic toxins were found to be completely detoxified when sufficient castor-oil soap was added to reduce the surface tension below forty dynes. Sodium ricinoleate kills streptococcus on contact, neutralises its destructive ferment, and also renders harmless its toxins. The soap should be used both as a cleansing and as a detoxifying agent. By liberally applying it to the gingival crevice, and with a rotating motion of the brush, forcing it into the pockets, the bacteria crowded in the pyorrhea pockets are reached. A. S. Hopkins (“ The Dental Cosmos,” Aug., 1930) outlines a method of detoxification in the treatment of acute and chronic periodontal diseases by sodium ricinoleate 40 %. —Per C. D. Certain virulent strains of bacteria (e.g.y B. tularense, B. pestis and Spirillum cholera9 when immersed in solutions of Sodium Ricinoleate become avirulent. Further, certain bacterial suspensions clear on addition of small amounts.— L. ii./3o,117. Acute Gingivitis.—Trichloracetic Acid as a strong caustic leaves the gums in a weakened state and liable to further infection. Sodium Ricinoleate is better—probably acts by adsorption into the toxin molecule. Apply 33% of yellow variety, or 9% of white, to the dried sockets. Follow with hot Potassium Chlorate and Carbolic mouth wrash.—J. Wheatley, Guys Hosp. Gaz., Jan. 13, ’31 ; P.J. ii./3h227. Sodii Sulphoricinas. Syn. Turkey Red Oil. C17H32O.SO3H.COONa=400-3146. Prepared by the action in the cold (not exceeding 50° C.) of sulphuric acid 1, on castor oil 3 (sulphurous acid must not be evolved), washing with plenty of water and nearly neutralising the product with soda. Concentrated solution of Sodium Sulphoricinate will dissolve iodine, resorcinol and naphthalene, forming strongly antiseptic solutions. It was employed as a Glycerin Substitute in the war. ® Phenol So^o-Sulphorieinate. A mixture of phenol 1, and Sodium Sulphorieinate 4. A thick syrup miscible with water. 20 to 50% solution for papilloma and tuberculosis of larynx and ozsena. Pharyngo-keratosis (mycosis) has been treated with 10% solution, also 10% solution of Salicylic Acid in the sulphorieinate. Magnesii Ricinoleas. Syn. ‘ Maricol.’ Dose.—1 to 4 drachms (4 to 15 Gm.). A white powder, employed in several proprietary preparations known as ‘ Castor Oil Powders.’ As much as 50% of Castor Oil can be incorporated in this way, but the, compound is not a soap. The oil is for the most part free. 3^lodicin (T.M. 376644). Syn. Calcium lodo-Ricinoleate.— As an innocuous mode of giving Iodine without upsetting digestion, being absorbed from the bowel. Capsules 3 grains. In syphilis and ulcerated wounds used with advantage. Ethyl lodo-Ricinoleate. Syn. ^Ethidol (T.M. 437469). Dose.—3 grains (0-2 Gm.) in capsules. A preparation containing 20% combined Iodine and can be heated to 100° C. Stainless, non-irritating locally when used by inunction, almost colourless, and miscible with almond or olive oil. Can be employed a3 injection in rheumatoid arthritis, tuberculous and scrofulous glands, and administered in epilepsy. Successful results have followed inunction in simple goitre and rheumatoid arthritis.—L. i./25,722. OLEUM SANTALI. —In numerous Pharmacopoeias. With data on Copaiba and Cubebs. Dose.—5 to 30 minims (0*3 to 2 Cc.). Santal or Sandal Wood Oil is distilled by steam under pressure from the wood of Santalum album (SantalacecB), the yield being from 1 to 6%. A yellowish oil, with an aromatic odour and pungent taste. Contains not less than 2% of esters calculated as Santalyl Acetate and not less than 90% of free alcohols calculated as Santalol. (Some Pharmacopoeias specify less.) Sp. Gr. 0‘973 to 0*985. It is now generally held that Santalum album is a root-parasite, and that in the absence of suitable host plants, it fails to succeed. For further Characters, Tests and Notes on Manufacture, see Vol. II. Soluble in alcohol 90%, also in ether and chloroform. Flavor in (/. —Best given as Capsule. Uses.—Internally in chronic bronchitis, e.g., a few drops taken on a lump of sugar is found to relieve cough without expectoration. Is much employed in the treatment of gonorrhoea and gleet. It quickly checks the discharge in dose of 15 minims 3 times a day, and with tne use of permanganate, zinc and silver nitrate injections gives good results ; also in 10 minim capsules, for chronic cystitis, with benzoic and boric acids, as adjuvants. Urinary infections due to the staphylococcus. The o ha3 an almost magical effect.—W. K. Irwin, B.M.J. n./25»d • Relative low toxicity of Sandal Wood Oil m comparison with phenol. L. 1/25,1198. Australian Sandal Wood Oil is derived from Fusanus Spicalus j and is largely used in Australia and other countries. This oil might replace the more expensive oil from S. Album. Santalol. Syn. C15H240. Dose— 3 minims (0-2 Cc.) 6 to 12 times a day. The use of Santalol as distinct from its parent substance the oil has been advocated. Even in large doses there is no disturbing influence on the stomach or kidneys in gonorrhoea, cystitis, vesical and bronchial catarrh. Santalol Capsules contain 5 minims (0*3 Cc.). Santalol Formagules, 5 minims (cf. Formagules) are also made. Santalol-Methyl-Salicyl Capsules contain 4 minims (0*25 Cc.) with 1 minim (0*06 Cc.) Methyl Salicylate. Used in gonorrhoea. Santalyl Salicylate Syn. Salicyl Santalol. C15H23C6H4.OH.COO = 340-2184. Dose.—15 to 30 minims (l to 2 Cc.). Manufacture.—We suggest heating Sodium Salicylate and Sodium- Santalol with Phosphorus Oxychloride. Tor a note on a patent since revoked see Edn. XVIII, p. G23. Yellow Oil with balsamic odour free from acrid taste. Stated not to irritate the stomach or kidneys ; given for urethritis and cystitis. Capsules of Santa! Oil are prepared, containing 5, 10, 15 and 20 minims in each. Gonal Capsules are similar. afcSavaresse’s (T.M. 11416) Capsules contain 10 minims, and are prepared with an animal membrane, which generally remains entire until they have passed the stomach. Capsules Of Santal Oil 5 and 10 minims with Methylene Blue 4, 1 and 2 grains are prepared. Mistura Olei Santali. Dose.—One ounce (30 Cc.). Oil of Sandalwood 4, Tragacanth, in powder 1. Mix and add quickly Water to 128. Shake well. Aromatic water with syrup may be used. Mistura Santali Composita. Syn. NlSBET’s SPECIFIC. (This name may be used for the preparation without rendering it liable to stamp duty, providing the formula and this book and page are mentioned on the label.) Bose.—4 to 1 drachm in water or milk thrice daily. Santa] Oil 12£ drachms, Cassia Oil 14 drachms, Pimento Oil 40 minims, Alcohol (90%) 34 ounces. Capsules of Nisbet’s Specific are prepared containing the Oils of i drachm dose of the above in 20-minim capsules. Liquor Santali cum Buchu et Cubeba. Dose.—1 to 2 drachms (4 to 8 Cc.) well diluted. Yellow Santal Wood in powder 4, Buchu in powder 1, Cubebs in powder 1, Alcohol (60%) q.s. to moisten. Macerate 2 days and percolate with more alcohol and press to obtain 20. Liquor Santali Compositus. Dose.—1 to 2 drachms (4 to 8 Cc.) diluted. Mix 2 volumes of Soluble Copaiba with 1 of the last preparation. A thick Liquor which can be almost cleared by adding 4% Potash Solution (1 in 2). Copaiba, the Oleo-Resin. Syn. Balsamum Copaiv^. In numerous Pharmacopoeias. Bose.—\ to 1 drachm (2 to 4 Cc.). Obtained from the trunk of Copaifera Lansdorfii and other species (Leguminosce), imported from the coast of South America. Soluble almost completely 1 in 1 of Alcohol 90%, almost entirely in Absolute Alcohol, Ether, and in four times its volume of Petroleum Ether. That known as Para Copaiba is transparent, yellowish and thinner than the Maracaibo variety, which is brownish and somewhat fluorescent. Sp. Gr. about 0-975 to 0-995 (B.Pd 14). Uses.—Diuretic and stimulant to mucous membranes, chiefly used for urethral diseases, and occasionally for chronic bronchitis. May produce a red rash. Given emulsified with mucilage or saponified, but best in Capsule. See also Liquor Copaibse. Capsules Of Copaiba contain 5, 10, and 15 minims; capsules of Capaiba and Santal Oil of each 5 minims; also Oil of Cubebs and Santal Oil of each 5 minims ; also Copaiba and Cubeb Oil of each 10 minims, and of each 5 minims. Oleum Copaibse (B.Pd 14). Dose.—5 to 20 minims (0-3 to 1*2 Cc.). This is distilled from, and constitutes at least 45% of the oleo-resin. Sp. Gr. 0-896 to 0-910 Soluble in its own volume of Absolute Alcohol (distinguishes ‘ African ’), about 1 in 20 Alcohol 90%. Oil of Turpentine has been used as adulterant—it is recognisable in a distillate. 1 Cc. of the oil in 5 Cc. of glacial acetic acid, and 4 drops of nitric acid added, should not develop more than a faint violet colour (absence of Gurjun Oil). ... Gonorrhoea treated by 15 minim doses at first thrice and then six times per diem with distinct effect on the discharge especially with the larger dosage. —It. Stockman, B.M.J. ii./i.5,128. Haustus Copaibse, St. Bart’s. H. Copaiba 15 minims, Solution of Potash 5 minims, Spirit of Nitrous Ether 15 minims, Mucilage of Gum Acacia 60 minims, Camphor Water to 1 ounce. Liquor Copaibas, Soluble Copaiba. Dose.—i to 1 drachm well diluted. Copaiba 18, Solution of Potash 26. Boil for 15 minutes, dilu e whilst hot with 10 of water, transfer to a bottle and set aside o clarify ; then syphon off the clear liquor from the supernatant oi y portion and the sediment. Make volume of same 36 with water. Flavoring.—Glyl Lavandulae, Glyl Pmi; Extractum Glycyr- rhizse Liquidum, Syrupus Zingiberis. Copaiba 15 minims, Mucilage 1 drachm, Magnesium Sup a e a drachm, Cinnamon Water to 1 ounce. Liquor Copaibse cum Buchu et Cubeba. Dose.—1 to 2 drachms (4 to 8 Cc.) well diluted. p Buchu in powder 5, Cubebs in powder 2, Alcoho ( /o) ^ late and press to obtain 14. Mix 1 part with 2 of Soluble Copaiba. JFlavoring.—See Liquor Copaibse. El OPIUM. Syn. Humbergum, Tabaiaeo. Succus Papaveris Somniferi Capsule • Inspissatus. (The latter, contracted■—Succ. Papav. Inspiss., may b* * used in prescriptions.) Pulv. Succ. Papav. will denote Powderec I Opium. (9*5 to 10*5% Morphine.) P11* Opium and all preparations or admixtures containing 0*2 or more per cent, of morphine.’ (Altered January 3, 1921). [PjMedicinal Opium 4 of the requirements of the B.P I (according to the 1925 D.D.A. 4 mixed or not mixed with neutral substances preparations and any substance containing one-fifth per cent. (one pan in five hundred) or more of anhydrous morphine. Raw Opium includes powdered or granulated, but not medicinal, Opium.—See also Morphine and Diamorphine. Dose.—J to 2 grains (0-03 to 0-12 Gm.). Fr. Cx,—Max. single dose 3 grains ; max. during 24 hours 9 grains. Antidotes.—See Morphine. The inspissated juice obtained by incision of the capsules of Papaver somniferum (Papaveracece) from any geographical source. The Turkey product is best suited for pharmacy. Persian and Indian contain a large proportion of Narcotine. Papaveris Capsulae, Poppy Capsules. (B.P. ’98.) CED“ Poppies, all preparations of, excepting red poppy petals and syrup of red poppies (Papaver rhceas).” Note.—Fleurs de Coquelicot in France = Poppy Petals. In the dried condition the capsules are used to prepare. ®Deccctum Papaveris 1 in 10. This is employed as fomentation in neuralgia, peri-dental abscesses and gum-boils. ®Becoctum Papaveris et Anthemidis. Poppy Capsules 10, Chamomile Flowers 5, \\ ater q.s., boiled 10 minutes to produce 100. Employed as the ! last mentioned. Poppy Extracts—Extraction with /sopro&y/ Afcohol is suitable.— C. T. Bennett and 1). C. Garratt, P.J. ii./26,149. For galenical preparations, Opium B.P. T4 must contain when dried and powdered, between 9-5% and 10-5% of anhydrous morphine. Opium Fr. Cx. must contain 10 to 11% on the drug dried at 00° C. F.l. requires 10%. For the Tincture and Extract (B.P. T4), hiay be used if containing when dry not less than 7-5%, these preparations being standardised when prepared. [5?]lH]Opium P. Jap. IV. assayed according to the directions works out as 10T2 to 11T2% Anhydrous Morphine. F.E. VIII, 9-5 to 10%. HqjlLljOpium. U.S. X. in its normal moist condition contains not less than 9-5% Anhydrous Morphine. Granulated and Powdered Opium, U.S. both contain 10 to 10-5% Anhydrous Morphine. Opii Pulvis, P. Belg. IV., P. Itai. V. is 10%. These are official in addition to lump Opium. For Assay Methods, see Vol. II. It is difficult to understand why the U.S. specifies P. Somniferum and its variety album as it would be impossible to say whether either had been used — E. M. Holmes, P.J. ii./i6,485. Investigations on Indian Opium. The terminal, or oldest, poppv capsules produce Opium of higher Morphine content than the lateral ones, "influence of manures. Indian Opium can be produced containing 20% Morphine as rich, therefore, as Turkey Opium—H. E. Annett, P.J."i./22,192. A Comparison of International Preparations of Opium with special reference to the International Agreement of 1906.—H. B. Stevens, B P Conf 1923 ; P.J. ii./23,110. *’ 0 Tincture of Red Poppy Petals suggested for tinting medicines and foods. Keeps better tnan Syrup—H. S. itedgrove, P.J. i./3i,581. Incompatible with Vegetable Astringents, Alkaline Carbonates, Salts of Mercury, Iron, Lead and Zinc. Uses,—The oldest and most certain remedy for pain, also tends to check inflammation and relieve nervous diseases ; lessens cough, arrests diarrhoea and dysentery (but is not advised for cholera). Externally the liniment is used for rheumatism, neuralgia and sciatica and is added to fomentations, and the ointment is applied to piles and fissures of the anus. Has some power in controlling the amount of sugar in diabetes. Children are very susceptible to its action. It relieves the pain in appendicitis but must not be given for this, as, apart from the danger of the symptoms being masked, opium may paralyse the intestines and cause tympanites. In Cholera even if a certain natural immunity exists it is immediately abolished directly the peristalsis is interfered with by Opium. Looseness of Bowels well treated by Laudanum. In colitis where tenesmus is distressing, and stools contain blood and mucus supplement dose by mouth by rectal injections (2 to 5 minims for a child) with a few grains of powdered Ipecacuanha in 4 oz. of thin boiled starch. Melancholia—the mental pain of—treated by tonics, and in addition 5 minims of Laudanum thrice daily given without patient’s knowledge, rapidly increasing until definite result.—B.M.J. i./n,804. Nervous Irritability is quietened and gives a welcome spur to jaded nerves. For infants dose is I minim of Laudanum for every three months of life. Can be repeated every 6 hours. With care no danger. Peritonitis from perforation of stomach or bowels. Where surgical treatment is undesirable Opium may be safely resorted to. In peritonitis there is marked tolerance to Opium even by infants. In Acute Pneumonia its use may be attended with risk. In uraemic convulsions may be useful. To test truthfulness of statement of Morphine maniacs who have undertaken to cure themselves, the Urine should be examined for Morphine. At the end of 8 days from the beginning of abstinence the drug should have passed completely, from the system. Pruritus Vulve in a severe case, 1 grain doses in pill was the only drug giving relief.—B.M.J. i./i2,472. „ . , _ . Sciatica.—Opium Extract \ grain with Valerian in a mixture every 2 hours or 0ifium Extract \ grain with or without Cocaine Hydrochloride i gram m X) o si tor If the Opium Extract (£ grain) be combined with Belladonna Extract | grain in the suppository, constipation will be prevented. „ Sedative Effects.—* Stage Fright ’ may be treated with o to iu drops of Laudanum. Old refs.—Edn. XIX, p. 626. , , o Given as hypnotic and not to relieve pain. Opium should be taken - to 6 hours before bedtime. , . _ .... , „ - „ Ulcerative Stomatitis, common amongst ill-fed children, has been tie^ted by 2 to 5 drops of Laudanum twice daily. Abuse of Opium, Morphine, and Cocaine. q11Tvnroaoirm nf Opium Conferences under the League of Nations at Geneva. Supp ; , exDort trade in Opium for smoking takes eftect within 15 years alter the League is satisfied the«mugglmg has been efi|ctively stopp.d^ JJ.S A . China stood out.—B.M.J. 1./25,321,419 ,.+Vv LTLi™ (pYPlndin<r February, 1925, is not yet in force. Only the British-Empire Canada and the Irish Free State), the Sudan, and ratifications. A number of countries stand out. ihe position is highly her borders and is raising thousands of tons of Opium y . < • Ind t The efforts of the Advisory Committee and the League of Nations havci not been so successful as was originally hoped in combating illicit traffic irr dangerous drugs.—B.M.J. i./27,804. British Govt. Report for 1926 to the League of Nations on Opium and othei Dangerous Drugs Traffic. A certain amount of smuggling.—B.M.J. ii./27,184. Opium Consumption.—450 mgr. per head per annum might be considered! a provisional maximum amount of Raw Opium (containing an average of 10%, Morphine) for the medical and scientific requirements of countries possessing, a well-developed Medical Service.—L. i./24,720. Conference on Limitaticn of Manufacture (London, 1930). If each producing: nation were allowed the quantity its manufacturers deem appropriate the total would greatly exceed the world’s needs. League of Nations advised that 250 tons of Raw Opium and 6 tons Cocaine suffice for the world’s requirements. Turkish statistics suggest that large quantities of Opium, Morphine, and Heroin pass from its factories into illicit channels—in the first 6 months of 1930 2,282 Kg. Morphine and 4,383 Kg. Heroin were exported (the last amount represents 40 times the amount consumed in Gt. Britain in a year). Russia considers production of Raw Opium and Coca leaf should be limited. Progress in suppression of use of narcotic drugs very slow—amazing that action on lines prescribed by our own Dangerous Drugs Acts has not been more widely adopted.—B.M.J. ik/30,535,572,1094 ; i./3i,1125. For reports of previous Conferences, see Edn. XVIII, pp. 627-8. In Formosa an Opium smoker must have a licence from the Japanese Government. It is difficult if he reforms to induce the police to receive back the ticket.—G. Gushue-Taylor, B.M.J. ii./2i,1010. The drug addict is a product of modern civilization, and addiction is a symptom of a diseased mind ; he is often a psychopath first. Description of Opium smoking ; the Morphine in 10 pipes is only about I grain and 99% of this is destroyed in combustion. These addicts should not be regarded as criminals—they are mental cases. The Harrison Narcotic Law has proved a failure in the U.S.A. The legal cure in this country, on parallel lines, may be worse than the disease.—Prof. W. E. Dixon, B.M.J. h/23,544 (see also abstract under Cocaine). Prof. Dixon’s statements re Opium smoking strongly criticised. To say that the Opium smoker does not form a strong craving, and that he is easily cured, is simply not true. An Opium smoker passes through his cure with intense misery, especially manifesting itself in diarrhoea. The craving is intense.— J. Preston Maxwell, B.M.J. i.(23,1076. In the industrial centres of India there is a growing addiction to the use of ‘ Government Monopoly Opium,’ the quantity consumed per 10,000 of population being 8S lbs. in Bombay, 216 lbs. in Rangoon, and 288 lbs. in Calcutta. Doping of children, by mothers working in cotton mills, unduly prevalent.—Review of the ‘ Opium Evil in India,’ by C. F. Andrews, B.M.J. i./26,495. Indian Hemp in India does not get the same hold on addicts as opium. There is much smuggling of Morphine by ships’ crews. Morphine is abused by hundreds of thousands.—“ Drug smuggling and taking in India and Burma.”—Roy K. Anderson, B.M.J. ii./22,645. Over £1,000,000 worth of drugs seized in New York during year ending June, 1923 ; most of it Heroin.—P.J. i./23,549. The number of drug addicts in New York City was reported in 1918 to be T8% of the population.—P.J. i./26,543. Opium smoking fast being replaced in China by Morphine injections and Morphine intoxication more frequent than ever before.— Per M.A., 1931,13. Egypt.—Addicts increasing, total now 100,000. 500 Kg. Morphine derivatives introduced during the past 4 years through one channel alone. A Morphine preparation with habit-forming and narcotic powers made in Switzerland and not included by the list of drugs prohibited by Swiss Law.— T. W. Russell, Jl. A.M.A. ii./29,1742. Opiate Addiction.—E. Huntington Williams’ book on this subject (MacMillan, 1922). It is written from the American standpoint. It deals with the use of narcotics and their “ Withdrawal ” and “ Gradual Reduction.” In treatment by withdrawal uneasiness and nervousness, followed by yawning, sneezing, watering of the eyes, excessive mucous secretion, extremities 0 becoming cold and clammy sweatings are relieved almost instantly by even a minute dose of the narcotic. The object is to give a non-habit-forming drug, e.g., Codeine or Ethyl- Morphme. Hyoscine or Atropine are given to ‘ groggy * effect limit. In some patients, who are addicted to hypodermic medication, it is worth while changing the method of treatment to one per os., but it should be noted that about 25% more of the medicament is required by this latter method. An important point is the giving of the same quantities of solutions either hypodermically or orally, the patient naturally associating a smaller quantity of diluent with an attenuated supply of drug. Gradual Reduction Treatment in the U.S.A. lasts about two months :— During the first 20 days the amount of Morphine hypodermically is decreased gradually, and the decrease made up either by giving the deficit, plus 25%, by the mouth, or by exactly replacing the amount of Morphine stopped with Codeine Sulphate. A gradually increasing dose of Strychnine, either with the injection or per os should be given. The next 6 to 12 days should see the Codeine entirely replace the Morphine hypodermically, the Strychnine as previously, should be given and the'Morphine per os should be gradually diminished, though, of course, the volumes of all solutions given must remain the same. The daily amount of Codeine must now be lessened, a period of about 10 to 20 days being occupied (according to the honesty and disposition of the patient) in reducing the amount to zero. During these last stages, a bitter tonic should be given and a daily dose of Hyoscine Hydrobromide of l/50th of a grain is required. Acidosis should be treated with Milk of Magnesia, and Cascara is useful for the frequently attendant constipation. The Lambert-Towns Rapid Withdrawal Method is an extraordinary one, in which enormous quantities of Blue Pill are given, together with decreasing amounts of Morphine and increasing quantities of Belladonna, Xanthoxylum and Hyoscyamus Mixture, v. p. 220. The treatment appears to culminate in the administration of 2 ounces of Castor Oil, the nervousness of the patient being controlled with Codeine ! The Pettey Method (George E. Pettey) includes the administration of Scopolamine in 1/200th grain doses, Sparteine Sulphate in 2 grain doses and Sodium Thiosulphate in doses of 20 grains, every 2 hours for 24 hours. Cathartic capsules, containing Calomel, Cascara, Ipecacuanha, Strychnine and Atropine are also given. ~ ,, In these more rapid methods Dionin is stated to be more efficacious than Codeine ; as it is about twice as powerful, it is argued that half the dosage will suffice. This is taken advantage of in . . . Sceleth’s Method, in which Dionine £ gram is combined with Scopolamine, Pilocarpine and Cascara, and an amount varying with the amount of Morphine taken is administered daily for 10 days. Then Strychnine l/30th gram, three times a day for 1 day, and on the following day the dose is halved and continued for a week. Tn about 4% of the cases Scopolamine delirium has been observed. In such cases it should be omitted for a doses. , .... Hyoscine and Pilocarpine constitute, the bases of Bishop s Method \v ith sometimes the addition of Heroin during the act-ice stage. 4 For further on Drug Addiction, see Cocaine, Heroin, Morphine, Nicotine. p j Emplastrum Opii (B.F. 1898). 1 in 10 of Rosin Plaster. Fr. Cx., Opium Extract 1, Elemi 1, Diachylon Plaster (Ir. Ox.) 2. 1H Extractum Opii (Siccum) (B.PAU) is now powdered. P. Austr., Hely., Belg. IV., Hung., P.G. VI., Ih. - . P. Ital. V., F.E. VIII. Foreign Synonym—Extractum Iabaiaco (Thebaicum). Dose,—i to 1 grain (0*016 to 0*06 Gm.). T j + An aqueous extract standardised to 20% of morp me. . .a op s. Fr. Cx. has the same with maximum single dose 1J grains ; maximum in 24 hours 5 grains approximately. P. Jap. IV. has approx, 16*87 to 18*54% morphine. Extractum Opii Liquidum (B.P. ’14). Dost.—5 to 30 minims (0*3 to 2 Cc.). Extract of Opium 0*75, Distilled Water 16, Alcohol (00%) 4. Is of same strength as Tincture of Opium {B.P. ’98), containing 0*75% of morphine. HP] 1| Liquor Opii Sedativus. (Battley T.M. 12765), Dose.—5 tc 10 minim. (0*3 to 0*6 Cc.). A proprietary hypnotic and sedative It contains 1-8% Morphine : 1 drachm contains 1 grain of Morphine Origin of and details of composition of a preparation intended to resemble the latter.—P.J. ii./i4,136,213. (© Linctus Opiatus C. X. Liquid Extract of Opium 2 minims, Oxymel of Squill 20 minims Dilute Sulphuric Acid 5 minims, Treacle 20 minims. Water to 11 drachm. (©> Linctus Scillae St. M.’s H. Oxymel of Squill J drachm, Compound Tincture of Camphor IE: minims, Honey to 1 drachm. © Linctus Scillse Opiatus.-—Linctus Camphorae Compositua St. Bart’s., L. H., Gee’s Cough Linctus, E.L., Linctus Scilhe Compositus E.G.A. Dose.—1 drachm (3*5 Cc.). Paregoric, Oxymel of Squill, and Syrup of Tolu, equal parts. © Linctus Tolutanus cum Opio. Brompton H. uses Syrup of Squill vice Oxymel in latter. jy) Linimentum Opii (B.P.* 14). (Exempted from gg). Tincture of Opium 1, Liniment of Soap 1 ; filter after a few days. A commonly used anodyne for pain. (©Mistura Sodae cum Opio, St. M.’s H. Liquid Extract of Opium 3 minims, dilute Hydrocyanic Acid 2 minims, Sodium Bicarbonate 6 grains. Water to 1 ounce. EDPulvis Cretse Aromaticus cum Opio (B.P.* 14). (Exempted from^). Dose.—10 to 60 grains (0*6 to 4 Gm.). Contains Opium 1 with 39 of Pulvis Cretse Aromaticus, which has dose 10 to GO grains (0*6 to 4-0 Gm.). The latter was the old “ Aromatic Confection.” (©Tablets each 5 grains (0*3 Gm.). gg[PI]Pulvis Opii Compositus (B.P. T4). Dose.—5 to 15 grains (0*3 to 1 Gm.). Opium 10, Black Pepper 15, Ginger 30, Caraway Fruit 42, Traga- canth 3. Contains 1 of Opium in 10. Note.—gg][jpTi Pulvis Opii Com,positus Ph. Ned. V. is Dover’s Powder (B.P. r14), and has Dover’s Powder as Synonym. [pyi]Tablets of Opium \ and 1 grain. (©Tinctura Camphorse Composita.—Syn. PAREGORIC (B.P. ’14). Is known on the Continent as Tinctura Opii Benzoica. Syn. Fr. Cx. ‘ Elixir Paregorique.’ Dose.—\ to 1 drachm (2 to 4 Cc.) Tincture of Opium 50, Benzoic Acid 5, Camphor 3, Oil of Anise 3, and Alcohol (60%) to 1,000. F.I. requires 0*05% Morphine. B.P.*14: approximates this. Fr. Cx. has this strength. S PI PI ®P-G. VI., P. Belg. IV., F.E. VIII. and Ph. Ned. V. have 0-05% Morphine, but amounts of the other ingredients varied. ®p. Jap. has I of Opium in 200. Tinct. Camph. Co. of the Portuguese Pharmacopoeia is a liniment containing 20 times as much Opium as the British tincture.—C. Bousseau, B.P. Conf.,1923. Flavoring.—Syl Coriandri, Glyl Pini; Elixir Aromaticus. CE)Tinctura Opii Camphorata, U.S. Average dose.—1 drachm. Similar in composition, i of Powdered Opium in 250. CDSyrupus Camphorae Compositus, Bristol Infirmary (revised). Dose.—1 drachm ( = laudanum £ minim approx.) occasionally. Benzoic Acid 45 grains, Glacial Acetic Acid 7 drachms 20 minims, Vinegar of Squill and of Ipecacuanha each 10 ounces, Anise Oil 30 minims, Camphor 30 grains, Opium Tincture 2 ounces, 5 dr. 20 minims, Sugar 7 lbs., Caramel q.s., Water to 1 gallon. Pharm. Form, advises at least 2| ounces of Spirit to dissolve the oil, Camphor and Benzoic Acid. Mix the solution with the Laudanum and add to the cold syrup with stirring, then the colour. HSFHTinctura Opii.—Syn. Laudanum (B.P. ’14). Syn. Tinctura Thebaica. Dose.—20 to 30 minims (1-2 to 2 Cc.), or 5 to 15 minims I Cc.), repeated. Contains 1% (B.P'98 was 0-75%) of anhydrous Morphine. 3 to P I! U.S. X. has 1 of Granulated Opium (10 to 10-5% Anhydrous Morphine) in 10 of Alcohol and Water Mixture (Final Alcohol content 17 to 19% by volume). Fat in the opium is removed by hard Paraffin. The preparation replaces Tinctura Opii Bcodorati of U.S. IX.—cf. Edn. XVIII, p. 632. Ph. Ned., P. Hung., P. Belg. IV., and P. Ital. V., contain 1% Morphine, made with 70% Alcohol. Fr. Cx. and F.E. VIII. dissolves 1 Gm. Opium Extract in 19 Gm. Alcohol 70% to produce the same strength.— Maximum single dose 35 minims, and during 24 hours 110 minims approximately. We found Sp. Gr. of this to be 0-902. F.I. requires 10% strength by percolation with Alcohol 70% and to contain 1% Morphine. B.P. ’14 approximates this. In support of the B.P. ’14 method of making Tincture of Opium, and the B.P. T4 process of Opium assay—remarks on A. C. Abraham’s and P. A. W. Self’s papers.—D. B. Dott, P.J. ii./22,205. See also ibid., pp. 12S, 205, 231, 260. For further remarks on estimation, see Vol. II. Flavoring—Syl Menthae Piperitae, Syl Rosae. Uses.—See Opium. Tablets = Tincture of Opium 5 and 10 minims are pared, weighing 2\ and 4J grains. jpll if Nepenthe (T.M. 464) (or Anodyne Tincture) is similar and is given in dose as Tinctura Opii (B.P. ’14). Incompatible with alkalis. 11 contains 0-84% Anhydrous Morphine. P IjTinctura Opii Grocata. Sydenham’s LAUDANUM. Dose. 5 to 20 minims (0-3 to 1-2 Cc.). F.I. requires 1% Morphine. Fr. Cx. Supp. 1920.—Opium 110, Saffron 50, Cinnamon Oil 1, Clove Oil 1, Alcohol 30% 920—all by weight (conforms with F.I.). Max. single dose, 2 Gm. (= 30 minims), max. during 24 hours 6 Gm. (=90 minims) approx. Other continental formulae, e.g., P.G. VI., F.E. VIII., P. Belg. IV., Ph. Ned. V. approximate this. PMVinum Opii Crocatum, as used in Thieleman’s Koleradraber (q.v.), in .Norway, has the composition :—Opium Powder 15, Ceylon Cinnamon 1. Cloves 1, Saffron 5, Malaga Wine 150, i.e., approximating the Tincture of P.G. CgTinctura Opii Ammoniata (B.P. ’14).—Syn. SCOTCH PAREGORIC. Dose.—J to 1 drachm (2 to 4 Cc.). Contains 0*1% Anhydrous Morphine. One ounce contains, quite approximately, J grain anhydrous morphine. Cg> Trochisci Opii B.P. 1885. Contained ^ grain Extract of Opium in each, with liquorice. Cg)Trochisci Sedativi, T.H., contain the same quantity with fruit basis, and are marked ‘ S.’ [gj| [jpl]unguentum opii. 1 of extract in 10 of Unguentum Cetacei. [Flj Unguentum Gailae cum Opio (B.P. ’14). Contains 7-5% of Opium with Gall Ointment (Galls 1, Benzoated Lard 4). Exempted from jpp Collapsible Tubes with rectal tube are for use in haemorrhoids. Prof. Dixon says opium locally has no effect.—B.M.J. ii./o9,329. [fpj ijp 1 Yinum Opii, B.P. 1885. Dose.—10 to 30 minims (0*6 to 2 Cc.). Contained 1 of Extract in Sherry 20, with Aromatics. H HU Opium Concentratum, P. G. VI. Max. single dose.—0*03 Gm. ; pro die 0*1 Gm. The total alkaloids of Opium as hydrochlorides, containing 48 to 50% Morphine. Elaborate instructions are given for preparation. [gj][Jp 1] Hydrochlorates Alcaloideorum Principalium Opii, Ph. Ned. V. Syn. Opialum, Opial. Dose.—Max. per os per diem 3 grains (0-2 Gm.) : hypodermically 2 grains (0*12 Gm.). Contains Narceine Hydrochloride 1, Thebaine Hydrochloride. 2, Codeine Hydrochloride 2*5, Papaverine Hydrochloride 4, Narcotine Hydrochloride 30, Morphine Hydrochloride 50, and Sodium Chloride 10-5° w /o* Sahli expressed the opinion that the combined alkaloids would be the most effective narcotic. The following are brands of the mixed Opium Alkaloidal Hydrochlorides in commerce. mm * Alopon (T.M. 365294). Pose—HQ, to 1/3 grain (0*01 to 0*02 Gm.) A lHht brown powder readily soluble in water. Gastric and intestinal sedative0* also in nervous conditions and in diseases of the respiratory tract. Used’ as an analgesic and hypnotic prior to operation as an adjunct to general anaesthesia. fWHMl34c Alopon Tablets, Oral, 1/6 grain in each. Pose.—1 or 2 tablets, Hypodermic, 1/3 grain. Solution, 2 per cent for Oral use. Single Pose.— 15 to 30 minims, repeated 5 to 15 minims. Glass Capsules,1 /3 gram m each, also 1/3 gram combined with Atropine 1/150 gram and 2/3 gram with 1/150 grain Scopolamine. *Omnopon (T.M. 317126). Syn. Pantopon—Pose per os—l/Q to 1/3 grain ^001 to 0*02 Gm.) thrice daily. For max. dose cf. Ph. Ned. antea. 1 Om of Omnopon is equivalent to 5 Gm. of 10% Opium. Composition.—Morphine 52%, Narcotine 20%, Codeine 2%, Papaverine 2-5°/ Thebaine 1%, Narceine 1*2%, other alkaloids 4%, Water 8 /0, Hydro- chloric Acid w. Watkin Thomas, Bio-Chem. Jl„ Vcl. VI, Part 4,1912. When used as an injection (Ampoules are made) 1 Cc. of 2% solution is injected 1 hour before operation, though the dose should preferably be subdivided and given at intervals, e.g., 4 Cc. 1 hour prior to operation and another A Cc. just before, i.e., as preliminary to Chloroform or Ether anaesthesia. @12 Tablets of 1/6 grain Omnopon each = 5/6 grain Powdered Opium. For internal medication in suitable cases. ?[jpl HFIi Ampoules contain 1-1 Cc. of 2% solution in 25% Glycerin and Water = 25 minims Opium Tincture B.P. 1898. 1 Cc. = J grain Omnopon. Phthisical cough, diarrhoea, dyspnoea of bronchial asthma, etc., are relieved, and in the first stage of labour. Omnopon § grain with Scopolamine 1/150 grain is used as intra-muscular injection to subdue post operative pain. For anaesthetic purposes intramuscular injection of 1 Cc. hours before operation, followed by a local anaesthetic is used to infiltrate the tissues in the pperation area. [jp]1PT, & Qpoidine. (T.M. 419166). Dose.—Tablets contain 1/6 grain (0 01 Gm.). The total alkaloids of opium in a soluble form, one part being equivalent to 5 of opium. It contains about 50% Morphine. The Narcotine in the remainder is thought to ‘ potentiate ’ the Morphine (Straub). Hypnotic, sedative, analgesic and in other respects representing Opium. Hypodermic Tablets and Ampoules contain ^ grain (0-02 Gm.). There is less danger of toxic effects than from Opium, as smaller quantities can be given.—B.M.J. ii./25,804. OVULES VAGINALES. Oviform vaginal pessaries made with Glycogelatin or Theobroma Oil basis. They produce a continued action on the parts in leu- corrhcea, also for ulceration and inflammation of the cervix uteri. Each Ovule weighs 4 drachms (15 Gm.). Medicaments : Alum, 10 grains (astringent). CED Belladonna Extract, 1 grain (sedative). Boric Acid, 15 grains (soothing). Carbolic Acid, \ grain (antiseptic). 1] mCocaine Hydrochloride, | and 1 grain, and |g VI with Adrenalin -Jq grain. Copper Oleate, 5 grains (in malignant disease;. Hamamelis, 10 minims of Liquid Extract (anti-hsemorrhagic). Ichthosulphol 5, 10 and 121% (30 Srain® [D each) (m nlceration antiseptic and stimulant), and Ce) with Belladonna Ext. gram Theobroma basis. Iodine, 1 grain (astringent and antiseptic). Iodoform, 5, 10 or 15 grains (antiseptic). CD Morphine Hydrochloride, i and IS (Flj i grain (anodyne). CD Opium, 1,2 grains (sedative). , . ,1. Quinine Hydrochloride, 3 grains (m leucorrhcea and to check conception). Resorcin, 3 grains (antiseptic). Suprarenal Extract, 5 minims (haemostatic). Tannic Acid, 8 grains (astringent). Made with Theobro™ To be efficient these ovules must be inserted as far as pos whilst the patient is in the supine position with the hips raised, sanitary towel may be worn. Most effectual at bedtime. Theobroma Ovule Mass for Hot Climates. Additions of Wax rais« tlie M.pt. of Theobroma Oil. Our experiments using Theobroma Oi melting at 93° F. and White Wax melting at 142° F., show :— With 2£% added gives M.pt. 90*5° F.; 4% and 5% added gives M.pb 91*5° F. ; 10% added gives M.pt. 103° F.; 15% added gives M.pt. 115° F and 20% added gives M.pt. 122° F. 15% added is best—the resulting mass melts on the mucou: membrane. See also Suppositories. gxygeniujvi. OXYGENE Fr. Cx. O = 16. Oxygen is obtained commercially by the rectification of liquid ai by a process of fractional liquefaction. It is available so made o not less than 98-5% purity. Liquid air as a source of Oxygen, e.g., for aviators at high altitudes—canh*' obtained up to 80% pure. It is sold compressed in CyUnders containing the equivalent o 20 cubic feet (560 litres approximately) for inhalation. It may h« mixed with air at the time, or be passed direct into the patient’;: mouth by a glass tube or from a funnel above the face (the latter method is probably of little use—vide infra.) Sp. Gr. 1T0527 (Air=l). 1 litre weighs 1*429 Gm. at 0° C. anc 760° m.m. pressure. At 20° C. and under normal pressure 1 litre o> water dissolves 28 Cc. of oxygen. Ozone. 03=48. Is known as active or tri-atomic oxygen. It is a very powerful oxidising agent, the third atom of oxygen in the molecule being in the labile conditions The effect of passing electrical currents through oxygen is to produce ozone*- which may be recognised by the peculiar odour. When in large quantity i is irritating to the air passages, causing cough and headache. Mildly ozonises air has been inhaled for phthisis and the spasmodic stage of whooping cough It has been suggested that inhalation of Ozone is injurious to the respiratory tract rather than beneficial in warding off injurious diseases, but this i exaggerated. Experience in the Central London Railway and elsewher proves the contrary. There is no doubt that Ozone does not only mask Tbac smells but destroys them.— Ozonair Ltd. Dysentery has been treated by Ozonised water and air. Surgical use of Ozone. Sinuses healed.—G. Stoker, L. i./i7,797. Octozone. A concentrated and potent form of Ozone, produced by passing Oxygen n a pressure of 5 lbs. through an electroniser in which it is subjected to a silen electrical discharge. True composition not yet definitely decided. It i soluble in water and stored in glass containers retains its properties for soni days. Perishes red surgical rubber in less than 30 seconds. Too pungen to be inhaled, but may be used externally, in the form of a bath, or as loca. application, or by intramuscular or rectal injection. Drinking it dissolved in water acts as gentle laxative. Has rapid action on wounds and ulcers, also in arthritis, neuritis, sciatica, etc.—O. Parkes and C. H. Buckley, L. ii./3i,849> Uses of Oxygen. — Warm the gas by discharging it into a rubber gas bag and keeping in same for an hour or two if possible prior to use. Open the cylinder in an adjoining room so as not to alarm the patient. A hot water box may contain a spiral metal tube through which the Oxygen passes to the patient from the bag. A Wouif’s Bottl containing hot water is also useful—the gas being bubbled through it: Inhalation of oxygen is of great service in pneumonia, bronchitis, asthma, angina ; it relieves dyspnoea, and reduces temperature. May be used after chloroform to accelerate recovery. It is the best cardiac and respiratory stimulant. Severe cases of whooping cough have been treated—give just before onset if possible. In vomiting of phthisis it is said to have been effective. It has been used as an antidote to morphine, opium, strychnine, cyanide, nitrous oxide and carbon monoxide poisoning ; for resuscitation after partial drowning. Intranasal Method advised.—G. Bourne, Pr. Jan., ’24,43. In haemorrhage, anaemia, etc., of doubtful use. Airs of more than 60% of Oxygen may produce pulmonary inflammation. Oxygen-enriched airs are of life-saving value in Pulmonary Obstruction, (Edema, or other deficiencies retarding Oxygen absorption or preventing full saturation of the haemoglobin of the pulmonary blood. Must be used with care.—C. W. Greene, Jl. A.M.A. ii./25,645—650. In congenital heart disease oxygen is of no avail; not indicated by cyanosis i of cardiac origin, when lungs are comparatively clear. Chronic cyanosis of emphysema is temporarily relieved. Specially called for in acute Pulmonary Failure, together with inadequate ability for compensation by the heart and blood. Should be administered over hours or days.—Per Jl. A.M.A. ii./25,1430. Indications for Oxygen Therapy.—W. T. Bichie, B.M.A., 1927, B.M.J. ii./27,915. The Davies and Gilchrist Oxygen apparatus for the quantitative supply of Oxygen. Criteria of successful Oxygen administration are abolition of cyanosis, relief of dyspnoea, and—the most reliable—fall in pulse rate. H. W. Davies, B.M.A., 1927, B.M.J. ii./27,911. The British Submarine, “Poseidon,” was rammed on June 9, 1931, off the coast of China by the Chinese steamer Yuta, and sank m 120 ft. of water, lwo hours later 6 men equipped with the Dcti/is Submarine-Escape Apparatus floated to the surface and were picked up alive by warships Signals were received from 8 other men of 18 known to be entombed m me submarine, but efforts at rescue failed owing to heavy seas. A*1® was invented by B. H. Davis, of Siebe, Gorman, Ltd. A tube is Placed in the mouth, a clip fixed on the nose, motor-goggies over the eyes, and a^ sort 01 waistcoat slipped over the head. On opening the tap of a small cy 1 n attached to the waistcoat the latter expands like a balloon with Oxygen, tne intake of which can be controlled. Lead weights are carried m . the waist. The water pressure is equalised inside »nd outside the conmng tower, which is then opened, the weights are dropped and the ^ minified to the surface. The waistcoat contains sufficient Oxygen a traced and can be supplemented from the submarine s supply, - g man to live and work for several hours— Daily Mail, June 11, i93 • Leonard Hill’s Oxygen Mask is of celluloid with /l,inVvawur 0/alcohol material and heating box for evaporating alcohol f Combustion in the to the oxygen. (The common idea that the i/12 71 body are accelerated by breathing oxygen is erroneon .) • • * ’ Haldane’s Oxygen Apparatus /or inhalation. Improve p bag to attach to cylinder—B.M.J. 1./17,181 , 175 Pleurisy treated by injections of air. B.M.J.L. •/ » A new outfit for administration. L. i./25,yio. . -• , . .. _air. w tt Willcox advises as cardiac Oxygen and Alconol Inhalation.- 8ir .. • rwv2en a wash-bottle stimulant the use of Alcohol yapour mix stream, dipping about is used, the Oxygen passing by the inlet ^Vontaffied Absolute Alcohol. At half an inch or so belowYBe surface» oE the* Alcohol would con- ordinary temperatures the Oxygen bubltE< ^ ins 0f Alcohol per litre). tain from 4 to 5% of Alcohol ^PO^ &teap'eiftSeffect is obtained, and After from three to five minutes the i.uil t P mixture of Oxygen lasts for several minutes. In severe card m|nutes every half hour. The and Alcohol vapour should be given for five minutes eveiy Alcohol vapour is absorbed by the lungs and carried direct to the heart. Th. method is pleasant gml invigorating in pneumonia with cardiac failure, case of heart failure following Chloroform and various surgical operations, angin pectoris, asthma with cardiac failure, septicaemia, typhoid fever, myocardial degeneration, dilatation of the heart, valvular lesions of the heart, collans after epidemic diarrhoea, etc.—B.M.J. ii./io,1408 to 1411 ; ii./io,1562,1658* Carbon Dioxide in conjunction with Oxygen vide Carbon Dioxide. Injection of Oxygen. Endovenous injection of 120 Cc. of oxygen slowly in the case of a patient iz extremis has been practised. Sciatica has been treated by the hvpodermi injection (deeply) of 250—400 Cc. of Oxygen. In the dyspnoea of tuberculosis, gas poisoning, pneumonia, bronchial asthma and operative cases oxygen has been injected subcutaneously until a lump th size of a closed fist is raised. The local emphysema is virtually an artificia lung lasting for hours : results remarkable—the body absorbing that whicll is necessary. Injections might be a treatment for tetanus. The artificial oxygen emphysema is capable of rescuing men from incipient gangrene.— B.M.J. i./i7,702. In pneumonia, as a preventive of Chloroform or post-anaesthetic sickness and in extensive burns and scalds. If sufficient is given to inflate an area o skin equal in size to the palms of two hands the amount given is roughl" 200 Cc. In bad cases give at least 400 Cc. and repeat in 6 hours if absorbed The gas need not be heated or filtered, does not produce or aggravate lung trouble, or cause local or general bad effects. Inject below and outside the nipple or breast.—T. S. Kirk, B.M.J. ii./28,195. Intraperitonea 1 injections. Of value in tubercular diarrhoea, tubercular peritonitis and ‘tabes mesenterica.’—R. S. Grewal, I.M.G., Sept., ’2S,421. For poisoning by asphyxiating gas subcutaneous injection of oxygen advised—vide Poisons at end under Chlorine. Tuberculous affections treated by inflation with Oxygen. Fluid is firs aspirated from cavity.—E. Rost, B.M.J. ii./2i,97S. Atmospheric Pollution.—Its causes and prevention.—See Vol. II Liquid Air consists mainly of oxygen and nitrogen, and when freshly prer pared is a nearly colourless liquid boiling at—190° C. As the more volatile Nitrogen evaporates the temperature rises and the liquid assumes a bluish tinge—the colour of liquid oxygen. With the exception of oxygen ancd chlorine, which has a yellowish tinge, most gases are colourless in the liquid? condition. Uses.—N aw i have been treated with it. For a description of Air liquefying apparatus, Vacuum Vessels, Thermo# Flasks and Hydrogen liquefying apparatus, see Vol. IT. Nitrogen. N= 14-008. Nitrogen is a colourless, odourless, tasteless gas constituting about 77% by weight (79% by volume) of the< atmosphere. Nitrogen prepared from the atmosphere contains 8* small amount of Argon q.v. 1 litre of Nitrogen weighs 1-25072 Gm..i at 0° C. and 7G0 mm. pressure. It is only slightly soluble in water. The Nitrogen group of elements includes Nitrogen, Phosphorus, Arsenic, Antimony, and Bismuth. These are in combination sometimes trivalent and at others pentavalent (Bismuth in its well characterised inorganic compounds is always trivalent—but in organic compounds? also pentavalent). The treatment of haemoptysis in phthisis by artificial Pneumothorax: consists in introducing Nitrogen between the two layers of the pleura through Saugman's or K. Peterson’s needle (described), and thus inducing collapse of the lung. There is no chosen spot for the puncture—it is commonly made- in one of the axillary lines in the seventh or eighth intercostal spaces. The- aim is to find a spot where the lung is healthiest and to avoid the neighbourhood of cavities. A hypodermic injection of Morphine is desirable £ hour before the operation. A local ansesthetic such as Eucaine is also advisable.. The quantity of Nitrogen or air injection is 200 to 300 Cc. Oxygen has also been suggested, but animal experiments were not in favour of its use.—L. ii./11,145 et seq. ; ii./i3,1627 ; B.M.J. i./i4,897. Pulmonary tuberculosis treated by Nitrogen Compression, three separate injections of 500 Cc.—G. Lucas, B.M.J. ii./i5,211. See also L. ii./23,899. Ordinary air used.—B.M.LE. ih/26,15. H. Batty Shaw recommends artificial pneumothorax in the early stages of consumption.'—Pr., Peb., ’24,107. Further refs, 'previous Edns. Widespread impression that the treatment should be withheld until after trial of sanatorium methods, because of danger, to be deprecated. Of 394 cases only 2% died as the result of treatment.—R. C. Matson, L. i./25,790. Some end-results in pneumothorax. Not a ‘ cure-all,’ but, nevertheless an advance in treatment.—S. V. Pearson, L. ii./2s,1024 ; B.M.J. i./26,52. Treatment of acute lobar pneumonia by artificial pneumothorax.—J. J. Coghlan, L. L/32,13. Active Nitrogen. The Hon. R. J. Strutt has shown that Nitrogen, under the influence of an electric discharge, assumes an active state in the same way possibly as Oxygen does in the form of Ozone. This active Nitrogen is reactive with Carbon Compounds.—L. i./i3,1469. PANCREAS. The pancreatic juice of man contains several digestive ferments :— Trypsin, a proteolytic ferment acting in an alkaline medium. Converts protein, albumen, e.g., casein of milk and fibrin, into peptones ; Amylase (Amylopsin) or Pancreatic Diastase which converts starch into dextrin, maltose and ciextrose Lipase (Steap- sin), a lipolytic ferment (emulsifies fats), see also p. 755 ; and a Milk-curdling Ferment Rennin, converting casein into a form of peptone. . T A, .,, The idea that Rennin is present in the Pancreatic Juice is not heid by many (vide Bainbridge and Menzies, ‘ Essentials of Physiology ) who consider that Trypsin is the milk-curdling function. The presence of Rennin would seem to "be unnecessary in view of the active milk-curdling property of the gastric JU1 For invalids, aged persons, and those suffering from weak digestion, or those prostrated by fever or exhaustion, preparations of the pancreas of the pig (an omnivorous animal) may be employed, by means of which food may be partially or wholly digested previous to administration ; their nutrition is thus maintained, and the stomach has time to regain its powers of digestion. , . . , The pancreas is sometimes called the ‘ sweetbread, but the swee bread known to cookery is the thymus gland of the sheep. Thp mncrcas nlavs an important part in enabling the organ is , . \ inlection^andT tlfeTpleen "is^said to ^ssist by producing a hormone which activates trypsinogen and raises the phagocytic mdex. —A. Castellani, Jl. Trop. Med., June la, 25,• intrimiiscnl'irlv HIGH blood pressure treated by a Pancreatic Extract intramuscularly. tlsts1 of pancreatic efflciency.-Carboliydrate, Protein-splitting, Fat-splitting, etc.—G. A. Harrison, L. i./3o,124J,lJU». Pancreatinum, u.s. x. Dose.—2 to 4 grains (012 to 0-25 Gm.). A cream-coloured amorphous powder, slowly and incompletely soluble in water; insoluble in alcohol; consisting principally o: amylase, trypsin and lipase, obtained usually from the hog. Ii digests albuminoids and converts, if of U.S. Standard, not less than 25 times its weight of starch into soluble carbohydrate. Assay process is provided. Fit. Cx. states it loses its activity on warming solutions of it above 50° C Its peptonising action is best in neutral or very slightly alkaline or very slightly acid solution. The Assay process provides for conversion of 12J times its weight of dried fibrin or 50 times its weight of fresh fibrin. Pancreatin Tablets, 2-| grains with Sodium Bicarbonate, are prepared One is sufficient to peptonise half a pint of milk. Liquor Pancreatis, Pancreatic Solution (B.P. ’14). Dose.—1 to 2 drachms (4 to 8 Cc.). Contains amylolytic, the proteolytic, and the milk • peptonising properties of the pancreas. Made by extraction of the fresh pancreas of the pig, freed from fat and external membrane. Pancreatic Juice, obtained iu its inactive form from the pancreatic duct, acquires powerful proteolytic activity by mixing with it a soluble calcium salt and incubation. Test.—Should peptonise 27 times its volume of milk. Incom&atifoifety.—Acids and compounds with acid reaction destroy the proteolytic power. For details of inhibition of Amylolytic Activity, see Vol. II., cf. also Pepsin. Uses and References. Glycosuria.—In certain forms of severe glycosuria depending on excessive activity of the liver Pancreatic preparations are valuable. Pancreatic j uice is the digestive fluid par excellence. Many animals are void of a gastric digestion, but all have something corresponding to pancreatic juice. Dextrose, as far as experiments go, is the best tissue food. The internal secretion of the pancreas determines its utilisation by the organism. Insulin is dealt with at end of this chapter. In chronic pancreatitis, pancreatin in suitable intestinal medicament may be employed with advantage before the operation and also in cases unsuitable for operations.—Whitla. It should be given as digestive towards the end of the normal period of gastric digestions—about two or three hours after a meal. In Sprue, pancreatin in 5 to 10 Gm. doses with 20 to 40 Gm. Calcium Carbonate, three times a day 2 hours after food, has been given with success. The treatment is based on results of experiments, which showed complete absence of pancreatic ferment.—T. D. B. 18/21,50. Glycerinmn Pancreatis, Marlindale, a digestive preparation made from the pig’s fresh pancreas. Dose.—1 to 2 drachms (4 to 8 Cc.). Liquor Fancreaticus (*Benger’s : T.M. 321220). Dose.—I to 2 drachms (4 to 8 Cc.) in water with meals to aid intestinal digestion, or with farinaceous gruel, when cool enough to sip. As an addition to nutritive enemata, a dessertspoonful should be added to beef tea or milk-gruel just before its administration. Will not keep diluted, and presence of acidity or heating over 140° F. destroys the ferment. N.F. gives the following Triturate Pancreatin 128 grains, with Sodium Bicarbonate 6 drachms, and Water 10 ounces, add Alcohol £ ounce, Compound Spirit of Cardamom N.F. £ ounce, and Talc 120 grains. Shake well and filter, adding Water to 12 ounces, then Glycerin 4 ounces. Each drachm represents 1 grain of Pancreatin. Spiritus Cai’damomi Compositus. Compound Spirit of Cardamom, ISLE. Dissolve Oils of Cardamom 4, Caraway 1-5, Cinnamon 1, in Alcohol (U.S.) 1,000, add Glycerin 130 and finally Water to 2,000. Peptonised Milk (v. also Peptonising Powders, infra). Mix two-thirds of a pint of fresh milk with one-third of a pint of water, and warm in a saucepan to a temperature of about 140° F. (or the diluted milk may be divided into twro equal portions, one of which may be heated to the boiling point and then added to the cold portion, the mixture will then be of the required temperature). Add twTo teaspoonsful of Liquor Pancreatis, and half a level teaspoonful of sodium bicarbonate. Pour the mixture into a covered jug and place in a wrarm situation for ten to twenty minutes, then boil the product. It can then be used like ordinary milk. Gr uel can be similarly treated. See also Enemata and Peptonoids of Beef. In the place of the water half a pint of* lime water may be used to the pint of milk. The preparation if desired for early use may be kept at 15° C. for three or four hours ; need not necessarily be boiled. Peptonised Beef Jelly and Chicken Jelly (^Benger). As a restorative, either may be taken alone by teaspoonsful, or dissolve two or three teaspoonsful in a teacupful of boiling water (with pepper and salt). Enriches beef tea, soups, broths, etc. They are readily assimilated by weak digestions. Containing much of the flesh-forming elements of the meat in soluble form these peptonised preparations are superior to non- peptonised extracts. Peptonising Powders. . , . „ Pancreatic enzymes mixed with sodium bicarbonate, m glass tubes. Place the powder into a clean quart bottle with £ pint of cool water, add a pint of fresh milk, and shake. Place the bottle in warm water for ten minutes, then pour the milk into a saucepan and heat quickly to boiling and allow to cool sufficiently for use. If desired, smaller proportional quantities may be Utbs©s.—In gastric ulcer, intestinal catarrh, for infants’ use generally—and in all forms of weakened digestive functions. Peptonising Powder for humanising Milk. _ Martindale. To peptonise milk and simultaneously to increase the Lactose content, Lactose 400 grains containing a small proportion of Pancreatin and Sodium Bicarbonate may be added to £ pint each of milk and cold water mixed and three to four tablespoonsful of cream. Allow to stand at about 40 C. for about 15 minutes and boil or heat the mixture m such a manner that it shall take ten minutes to reach the boiling point. Milk so treated must be kept m a cool place. To be slightly warmed again on feeding. In some instances a further dilution, e.g.y milk 1 to water 2 may be necessary. Ihe result very closely approximates 6-3% Lactose, i.e., the usual content m human milk. Tablets of Pancreatin 5 grains. Sodium Bicarbonate o grains, and Bile Salts 2 grains. Dose.—1 or 2 crushed in water at the conclusion of a meal are prepared for use as an intestinal antisep tic an digestive, and may prevent formation of gallstones. Trypsin. Dose.—8 to 20 grains (0-5 to i*2Gm,). Trypsin is stated to be produced simultaneously with Amyiopsin, and from the same cells in the pancreas. This ieiment is prepare commercially in the form of whitish powder, possessing an odour like pepsin. It changes proteins into peptones m alkaline media. It is inactive at 75° C. One part should peptonise about Htu o. coagulated egg albumen in 1|- hours. Soluble slightly in water, more so in glycerin. It is administered to assist digestion in diabetes, and it is occasion ally employed for peptonising milk. Stearettes of Trypsin, containing 5 grains are useful as passin intact through the stomach. Method of preparation of an active Sterile Glycerin extract. Effective i; prevention of peritoneal and pericardial adhesions.—R. P. Walton, Jl. Pham and Exp. Therap., Dec.,’30,403. For Muller's Trypsin Test for determining the activity of Trypsi Preparations, see Vol. II. INSULIN. Dose.—Commence with 5 units twice a day—half an hour befoir breakfast and supper respectively. Most of the food should be take* in these two meals. If after three days of this dosage glycosuri still persists the dose must be raised gradually, first to 10 and 10, an later 15 units or more, if required. On the 7th day test every tw hours to get a further idea of the effect. By the 11th day all Suga and Acetone may have disappeared from the urine and~ the bloo picture may have become normal. This may represent the permaner. balance of diet and Insulin, but more often the patient’s pancre©; improves so that the 13th day 15 and 10 units are too much-—12 an 8 units may suffice. Patient’s tolerance may continue further, an still less Insulin may be needed. Diet readied must be strictly adhered to. It is well to add 5 Grr: of Carbohydrate and 20 Cm. of fat. This gives 200 calories without ketosis. If well borne, raise to 600 calories. On further increase little protein should be included—8 Cm. with 10 Gm. of fat. Abou 4 units of Insulin are required for each addition to the diet of 5 Gm. a Carbohydrate and 20 Gm,. of fat.—‘ The Diabetic Life,’ R. D. Lawrence 1930. In consequence of revision of Carbohydrate content of foodstuffs— old figures being erroneous—double the amount of numerous vege< tables, e.g., cabbage, spinach, cucumber and tomatoes can be allowe« and lettuce, asparagus and rhubarb contain so little, they can b allowed as extras.—R. D. Lawrence and R. A. McCance, B.M. J. ii./2c 241. Technique of Injection.—Insulin is given subcutaneously (it ma; be given intravenously in coma), the skin having been previous!: sterilised. Wherever possible, patients should always be taugh to give their own injections, the best sites being the front of the thighfc the abdomen and the lower part of the chest. Before breakfast th abdomen is a good site, and during the day the thigh in women anc the skin below the knee in men are the most convenient. Pain i minimised by using a fine sharp needle and inserting at right angle to the skin. To avoid local fatty atrophy the site of injections i changed every week or 10 days and no two punctures should be mad in exactly the same spot within 24 to 48 hours. Treatment of coma. Treat as for collapse, clear bowels with enema, or wash out stomach, and give as much fluid as possible either per os or intravenously, with Sodium Bicarbonate in 2-drachm doses 2-hourly to combat ac-i‘i0S,1^‘ n ^immediately 40 units of Insulin subcutaneously or intravenously ono^1 4 4 'I?1* Glucose by mouth, stomach, or rectum, or intravenously in -.0 /o solution, and repeat procedure every two hours with ha]f initial dose of Insulin and Glucose till consciousness returns, with larger doses after 10 hours if no improvement shows. When consciousness returns reduce Insulin to 10—15 units and Glucose to 10—20 Gm. 4-hourly. Ma nufacture. — Brit. Patent, No. 203,778. Complete Specification accepted Sept. 13th, 1923. 4 A method of preparing extracts of Pancreas, suitable for administration to the Human Subject.’ By F. G. Banting, J. B. Collip and C. H. Best, British subjects, all of Toronto University, took out the Patent in the name of the University. The British rights were offered to the M.R.C. and accepted. The following is an abstract:—A pancreas extract containing the anti- diabetic principle or hormone. It is essential for intravenous or subcutaneous administration that the anti-diabetic principle be purified from the enzymes, proteins, lipoids and salts. Self-digestion (proposed by earlier workers) would allow the enzymes to destroy the active hormone. In this new invention Alcohol is used, which inhibits deleterious action of the enzymes on the hormone; proteins, salts and other substances are removed, as far as possible, from the solution by precipitation. An improved method is also mentioned in the specification, which consists in finely dividing (mincing) the pancreas and mixing it with Alcohol; straining or filtering the mixture to separate inert gland tissue ; treating the filtrate with several volumes of Alcohol; removing the precipitate by filtration and concentrating the filtrate ; treating the latter with Ether; eliminating the Ether; adding Alcohol; centrifugalising the mixture to form into layers, so that the uppermost one consists of Alcohol holding the hormone in solution, the lower layer or layers consisting of fiocculent protein, salt solution, and salt crystals ; subsequently removing the uppermost layer and treating it with several volumes of 95% Alcohol, separating by precipitation any substances which may still be present with the hormone ; then distilling off the Alcohol, dissolving the hormone in distilled water and concentrating the aqueous solution, sterilising it and adding 0-5% Trikresol. In the Picrate Method of purification used in Gt. Britain (Brit. Pat. 216,978, M.B.C. and H. W. Dudley) a saturated Picric Acid solution (4 vol.) is added to a 1 to 1-5% crude Insulin solution in water. The Insulin Picrate is washed, converted into Hydrochloride (by dissolving in N/l HC1 in 75% Alcohol), and finally precipitated with Acetone. The purified Insulin is about 6 times the strength of the crude. For medicinal use dissolve in isotonic salt solution with Hydrochloric Acid, adj usting acidity to p D 3-5 and adding 0-1 o Tricresol. Destruction of the Insulin b:>r digestive ferments prior to preparation obviated by freezing the pancreas immediately after removal.—C.D. i./27,^71. The theory of hyperglyccemia is given in the first patent. Prior to its conversion into glycogen, or its oxidation, glucose (normally) probably becomes altered so as to be more reactive. In diabetes, the sugar absorbed from the intestine is no longer changed into an active form, therefore it cannot be stored in the liver as glycogen, nor oxidised in the tissues—hence the hyperglycoemia and the glycosuria. . , , The relation of the pancreas and diabetes was established by the experiments of Von Mering and Minkowski; extirpation o the pancreas in dogs was followed by persistent glycosuna. i ic pancreas consists of two types of tissue the acinar, secieung the i pancreatic juice (external secretion), which reaches the intestine through the pancreatic duct, and groups of cells, known as tin . Islands of Langerhans.’ The latter show pathological change in varying degree, in most cases dying of diabetes mellitus-- Numerous workers Delieved that this insular portion provided an internal secretion, needed to normal carbohydrate metabolism and they tried to produce extracts of it for treatment, but thes extracts, contained toxic substances, which resulted in their causing local irritation, and they were clinically unsuited. The Islands of Langerhans were proved to contain a substane which lowers the blood sugar, and diminishes or abolishes excretion of sugar in the urine of diabetic dogs. Subsequently, by extracting foetal or adult normal pancreas with Alcohol, they made an extrac which caused a lowering of blood sugar, and the glucose in the urine- when injected into a boy suffering from the disease. The Alcoho> evidently prevented the destruction of the principle bv the digestiv ferments. In short, “ it has been proved, for the first time in the history of medical science, that a product can be made from pancreati glands of mammalia, which will save and has saved the lives o> a number of diabetic patients, many in a state of coma before th« substance was given.'’ On injection, it converts glucose into the active form, and I given at proper intervals blood sugar is maintained at normal level and the urine remains free of sugar. Fat is completely oxidised Acetone bodies disappear from the urine and diabetic acidosis anc coma are prevented—a restoration to normal metabolism. It is also patented in U.S.A., Canada and other countries. Eulogy of the work of Banting and Best.—Lord Moynihan L. ii./30,785. A paper entitled ‘ Insulin and its Manufacture,’ read before Boy Soc. Arts., Feb. 23,27 (Abst. C.D. i./27,263) by F. H. Carr and H. H Dale, provides details. British Insulin and Lilly’s Insulin are prepared from ox pancreas. ^ ‘ A.B. ’ Insulin (T.M. 434638). * Lilly (T.M. 150173, 320305, B.442141 & 2). Banish Leo Insulin is made from pigs’ pancreas, and contains n« preservative.—See Preservatives postea. The Therapeutic Substances 1925 and Regulations 1927 control Manu facture under Licence, Standard, Quality, containers, etc. Further Regulations, Part III., Sec. 9 (2), Aug. 1, ’31 provide for addition: of preservative to preparations like Insulin, sealed in containers, U be tapped from time to time.—L. i./31,1422. For the population as a whole the use of Insulin has shown its value in reduction in deaths from diabetes during early and middle life, but the general use of Insulin throughout the country has been advancing only gradually anc is below the level of maximum need.—‘ National Supply of Insulin,’ M.BX Rept., 1929-30. Chemical Compositions probably Cc8Hi(,203JN18S} a sulphur containing compound composed of amino acids.—B.M.J. i./26,839. Anothe*. but the actual formula may be a multiple of this.—Pres., Pec., ’27,420. It is rapidly destroyed by Trypsin, also Pepsin. This throws light on the fact that Insulin nas very little, if any, effect when given per os. It is stable to neat when its solution is strongly acid. It survives heating to 100° C. for naif an hour. It does not approach the chemical simplicity of Adrenalin or even Thyroxin. Commercial Insulin is composed of at least three substances? the true pancreatic hormone A, the anti-insulin B, and co-Insulin C. A and B have been obtained in crystalline form.—C. Punk, L. ii./26,1244. Further details—Edn. XIX, p. 642. Insulin appears to be as intangible as the 'Vitamins and enzymes. It can be inactivated by Hydrochloric Acid and Ethyl Alcohol and activity restored by Sodium Hydroxide.—Prof. J. R. Macleod, L. ii./3o,518. Distribution in Nature. In higher animals it seems to be strictly limited to the islets of Langerhans in the pancreas. It is to be found also in certain fish. There is evidence also of the presence of something allied in yeast.—H. H. Pale, L. i./23,989. Insulin is present in potatoes, rice, beetroot and celery. A substance having an Insulin-like action in reducing blood sugar has also been extracted from the kidney, sjjleen and muscle tissue of dogs and cattle.—C. H. Best and P. A. Scott, Jl. Metab. Research, Jan., 1923, per Pres., May, ’24,220. Clams yielded Insulin. Collip suggested it must be present wherever Glycogen is found. Later he made it from yeast, confirming Winter and Smith, but this type differs, in that its action in lowering blood sugar is delayed sometimes for a day or two. The same applies to Insulin-like substances from various vegetable sources styled Glucokinin.—Prof. Macleod, B.M.J. ii./23,165. Insulin isolated from yeast. An extract of yeast has an effect similar to Insulin when tested on animals and diabetics.—Winter and Smith, B.M.J. i./23,711,819. Insulin may be obtained from the islet tissues of the cod, the yield, even under unfavourable conditions, being 13 rabbit units per Gm., and the tissue probably contains about 10 times as much, weight for weight, as /mammalian tissue.—Biochem. Jl., 18/24,665. Preparation by Aqueous Extraction. From an extract of the pancreas made with aqueous Formic Acid at — 3 L., proteins and Insulin are precipitated as picrates. The latter is extracted by Acetone and is isolated on dilution with water. Alcoholic Acid converts this to the hydrocldoride, which, although more cheaply and quickly prepared, appears as satisfactorily clinically as Insulin obtained by the .Alcohol method. Average yield 300 rabbit units per kilo of pancreas.—E. 0. Podds and I. Pickens, L. b/24,330. . . ,. . , By adding 5% of Paraldehyde to the extracting fluid the yield was increased to 535 rabbit units ; by distilling off the Acetone this was again increased to 1,040 units, and finally by eliminating the preliminary aqueous extraction and preparing the picrates simply by grinding the pancreas with solid 1 icnc Acid a yield of 1,845 units was obtained—the highest recorded yield, ihe time of the complete process is reduced by this method to about one daw 1j. e. Podds and F. Pickens, Brit. Jl. Exper. Path., April, ’24, per L. 1/24,909. Recommended that Insulin be precipitated from aqueous solution oy Ammonia Sulphate (half saturated), allowed to stand for 24 hours, centri- fugalised, and the supernatant fluid drawn off. The precipitate containing Insulin is dissolved in 70% Alcohol, concentrated to 1/10th its volume ann added to 94% Alcohol, by which Insulin is again precipitated. rmpru Insulin causes delay in blood coagulation, and a case is recorded where ■ employment prior to operation resulted in profuse haemorrhage, due t c„ thrombitic action produced.—B.M. J.E. ii./24,52. C'pi?*“SeJASrich"raetion. of Insulin is *n Acetic Addend precipitated by a Brucine solution. The clear liquidJ;' t.]. ^ • •+f is separated and treated with Pyridine with which a cr^s * ,p>-p . ■ formed. This is redissolved in Acetic Acid and again precipitated with Pyridine. The crystals melt at 233°, and in a dose of 0-01 mg. causes hyoc glycsemic convulsions in rabbits.—J. J. Abel, Johns Hopkins Univ., per Prep Dec., ’26,426. See also Jl. Ph. and Exp. Ther., May, ’27,65. Crystalline Insulin from Cod Fish and Pollock identical in physiologies j activity and Sulphur content with beef Insulin.—H. Jensen and co-worker t Jl. Ph. and Exp. Ther., May, ’29,128. Tablets of Insulin Hydrochloride each equivalent to 10 unit are prepared. To be dissolved in 0-5 Cc. of sterile distilled water. Preservation.—0-3% of Cresol is added to preparations. ^ Doubtful if antiseptic desirable—O. Leyton and E. P. Poulton, L. i./3i,996< T. Izod Bennett, ibid, 1053. Compulsory addition injurious.—F. Sandoi ibid, 1422. Solutions with pH 3—4 are themselves germicidal, but a slight increase c alkalinity destroys germicidal action and actually converts it into a cultur medium if no preservative is present, but the presence of the usual proportio of Phenol suffices to keep it germicidal.—P. Hartley, L. ii./3i,584. Insuli and Preservatives.—Pres., Dec., ’31,406. Units.—A unit was originally taken as the amount of Insulk which on subcutaneous injection can lower the percentage of bloor sugar to 0-045 within four hours in a rabbit weighing about 2 kg, Iron which food has been withheld for sixteen to twenty-four hours Such Insulin was first prepared so that 1 Cc. contains one unit Subsequently the U.S.A. makers brought in a unit with approxi mately one third of the Toronto unit, and the Medical Research Council adopted the U.S.A. unit—i.e., three units, as at presen defined, produce this reduction in blood sugar (to 0*04%) with stand ard conditions (in 2 hours). The average single dose for an aduli is 10 New Style units, i.e., 3 to 4 times the quantity for the rabbit Think in units rather than so-called ‘ doses.’—M.R.C., B.M.J. h/23 737. See also Prof. H. Maclean, L. i./23,1044. As a result of an International Conference, held under the auspices of the Health Committee of the League of /Vat/ons? to discuss the question of biological standards, Great Britain has assumed the responsibility for Insulin, and the National Institute accepted the duty of preparing and! keeping the International standard of reference. Simultaneous determinations made by the National Institute (on material made by that Institute), the Insulin Committee of the University of Toronto, and three other laboratories in the U.S.A. and in this country, varied only between 8-4 and 8-8 units per mg. of the dried preparation, and the International Conference therefore accepted the recommendation of the Toronto Committee that this* preparation, preserved at the National Institute, should be the International Standard for tnulin, and 1 mg. thereof should be taken to contain 8 units of lusufin.—B.M.J. is./26,251. 3^‘a.b.’ Insulin (T.M. 434638) the first British Insulin produced —is free from toxic effects and each clinical unit contains 0 00005 Gm. Insulin Hydrochloride, its activity being adjusted to the International Standard. A solution containing 1-8% Sodium Chloride and N/1000 Sodium Hydrate mixed with equal parts of a commercial brand of Insulin, renders injection painless.—O. Leyton, L. i./24,1082. Suitability of the Case.—The patentees point out that the indiscriminate use of their product is a source of danger. All cases, except those suffering from severe acidosis and coma should be put to bed and given a basal maintenance diet—protein, in sufficient quantity, to replace the daily wear on the tissues, approximately 0*3 Gm. per lb. body weight. Additional calories in food are supplied by carbohydrates and fat in proper proportion to prevent production of acetone bodies. If the urine of patient becomes sugar free on this, it should be gradually raised to an adequate diet for his ordinary duties. Ia he remains aglycosuric the treatment with Insulin is not indicated. 75% of diabetics can be controlled by diet. If at the end of the week s treatment on basal diet, the urine is not free of sugar, the patient requires Insulin. There is no evidence as yet that the treatment is curative. It is not recommended unless the treatment can be continued. The initial stages of treatment should be carried out in connection with facilities for blood and urine sugar estimations. In 1922 the average life of a diabetic was 6 years ; to-day patients who started treatment with Insulin on its introduction 9 years ago are still alive and a growing percentage outlive their life expectancy. —E. P. Joslin, Jl. A.M.A. ii./31,595. Con train di ca tion.—It is dangerous in cases of so-called ‘ renal glycosuria ’ or diabetes innocens, in which the kidney fails to hold back the normal amount of glucose in the blood, i.ethe patient is already in a condition of persistent hypo-glycsemia. Hypoglycmmia: Effects of excessive dose.— There is a rapid fall of blood sugar following a single injection. This blood sugar content reaches a low point in 2 to 8 hours, and tends to return to the original level in 12 to 24 hours. When the blood sugar percentage falls to 0-07 (the normal being 0-1%) under a dose the patient may first complain of hunger, weakness or fatigue ; he may even show signs of a definite neurosis with loss of emotional control, such as crying spells. A lowering to 0-05% produces very acute distress or mental disturbance. These reactions are relieved by food ; 50 to 100 Cc. of orange i juice is effectual or 5 to 25 Gm. of Glucose with the orange juice. When the patient is unconscious give 1 Cc. Epinephrin solution (1 in 1,000), intramuscularly, followed by Glucose per os. Nurse with care, because reactions may occur during sleep.— Banting and co-workers.—B.M.J. h/23,8. The Medical Research Council directions add, that, if necessary, 5 to 20 Gm. of glucose in 50 to 100 Cc. of diluent may be given intravenously, and that out-patients under treatment should carry sugar with them to be eaten at the first sign of these hypoglyccemic reactions. An account of the first 50 cases treated. The danger of a hypo- glycsemic reaction is guarded against by sufficient Glucose given intravenously at the same time. Diabetes in children, it is stated, is > readily responsive to treatment.—Banting, Best, Collip, Campbell and Fletcher, Can. Med. Assn. Jl., March, 1922, B.M.J. i-,/23,8. The secret of success lies in correct balancing of diet against dose employed, j — F. G. Banting, B.M.J. ii./24,376. Hypoglycsemia is dangerous in patients with cardiac complications. ! (Edema may be considerably increased, an attack of angina pectoris brought on, or a paroxysm of auricular fibrillation, per Pres., Dec., 1 ’29,409. VOL. I. X injections of Pituitary given simultaneously with Insu either reduce, or abolish or replace, by a rise of blood sugar, the f due to Insulin. The work confirms, as is known that in cases pituitary insufficiency there is a raised carbohydrate intolerance. Proceedings of Physiological Society, Feb. 1923, M.P.C. May 9/23,30 See also C. M. K. Geiling and co-workers, Jl. Ph. & Exp. The June/29,241. 1 Cc. of 1 in 1,000 Adrenalin Solution, or 10 units Pituitary Extras intramuscularly generally restores consciousness in 5 to 10 minute Patients should always carry sugar in pocket and a notice askb that Adrenalin and Sugar be given if found unconscious.—Job Jl. A.M.A. i./29,2168. The estimation of teiood su&ar can be performed by any medic man with a minimum of chemical knowledge. The equipment costs a fe- pounds/—Prof. H. Maclean, L. i./23,1043. For Methods of conducting the Estimation, see Vol. II. Clinical Experience in English and Scottish Hospitals in less tha 50 cases. It was found that 1 unit of Insulin could provide for the co sumption of 2 Gm. of carbohydrate taken as such in the food of a complete diabetic patient. This is equivalent to 4 Gm. of protein. Hypoglycsem collapse caused by the artificial lowering by Insulin of the blood sugar 1 half its normal level, is at once relieved by giving sugar.—Med. Re Council Rept., B.M.J. i./23,737. Influence of Insulin on acidosis and lipaemia in diabetes. When give t ogether with carbohydrates to patients with diabetic acidosis, verging on com* there is a spectacular effect. Importance of combining the two. If give- alone it may increase the acidosis.—Prof. J. C. Meakins and co-worker B.M.J. i./23,847. insulin in Castor Oil, 100 units to each Cc. Larger doses can t given without causing hypoglycsemic symptoms. Vegetable oils an very slowly absorbed and may cause reaction.—L ii. /3o,410 Insulin in oil gives prolonged effect. Castor Oil the best suspenc ing agent. The injection must not be given intramuscularly bi subcutaneously, e.g., under the skin of the abdomen, the injection bein given before the patient rises in the morning. It is claimed that tb method will lead to a greater number of recoveries.—0. Leyton L. i./29,362,756. Good results with Insulin in Olive Oil.—H. Chabanier, Presse Met per Pres., Eec., ’31, 05. Inunction of Insulin with Lanolin and with lard—rabbit experimentsi The conclusion is that apparently insulin can be introduced by this measure' Crude Insulin extracts could be used.—S. \. Telfer, B.M.J. i./23,715. Inunction in G children. It was proved that Insulin is easily absorber by the intact skin, its action being greater in infants than in children of more advanced years. In the case of an infant of one year, weighing 9 kilos, Insulir: inunction reduced concentration of sugar in blood so successfully that expert ment had to be discontinued prematurely.—L. h/24,407. Insulin used as an inunction in Almond Oil, in Hydrous Wool Fat, and ia Alcohol and Glycerol, was found to have no therapeutic value.—Qrtrly. Jl. Med., Jan., '27,187, per Pres., May, *27,199. W e do not find further statements recently on tins methods Oral Use. “At present there is no other way of therapeutic administration of Insulin but the needle.”—J. Mouzon, Presse. Med., Dec., *29, per M.A. ’31,148. An addition compound with Desoxycliolic Acid gave results. Magnesium Sulphate in water given 20 minutes previously to ensure that stomach is empty of acids and ferments. Action less intensive than by injection, but more suearnbvdsome ca^.H^a,pPearance of glycosuria preceded fall in blood ’29^415 SOme time* LlkelY to prove of value m children.—Per Pres., Dec., i./31/184° Phcsphctui,£state Ver os—not efficacious—R. D. Lawrence, L. siderawi—Oi0TP?tnnnSTllini ^phctungstate, if effective, would be con- lauguine'tti L.H /fi°212 W ’ F<UlCd to lower blood ™gar.-H. H. Insulin Pericdide. , -The author prepared this (1929) in the hope that it might be utilised bv delayed absorption. It was found to act on blood sugar in much the same way as the parent substance, but there was no delay in absorption, and the SnMswdm n0rmal iR the Same Ped0d aS when a elution of y Gluccse —The effect of Insulin thought to be activation of the enzvme CritSsm—Ed^XI^erS16^°f a /3SlUC0Seint° 7glllC0Se i-/23,12,479. . With dogs, injections of Insulin decrease the concentration of Glucose inorganic Phosphate and Pptassium in the blood and increase the concentration 01 Lactic Acid. It is believed that Insulin influences the reversible reaction, Glucose v. Lactic Acid. J. Biol. Chem., *24,58,721, per J.C.S. A. h/24,445. The Zymase group of ferments might have properties similar to Insulin — 0. Leyton, B.M.J. ih/22,1144,1233. Yeast possibly acts on sugar by converting it first into an unstable form. It is by no means certain tn&t diabetes is invariably a disease of the pancreas —Leader, L. h/23,708. GENERAL REFERENCES. Early work.—L. ih/22,398 ; B.M.J. ih/22,991. Prognosis.—A degree of hyperglycsemia may still be present, even when sugar no longer appears in the urine.—D. M. Lyon, L. h/22,1043. If sugar is found and it then disappears, determine if the power of sugar destruction is diminished ; give 100 Gm. glucose in 1 litre of water before breakfast. If the power is diminished sugar is found in the urine \ hour to 3 hours afterwards. If sugar destruction is normal the urine will be free from sugar.—R. T. Williamson, Pr. Oct., 1920. The diabetic fails to store sugar, as shown by the blood sugar becoming excessive. He fails to burn sugar, as shown by his respiratory quotient being too low. The injection lowers his blood sugar and raises his respiratory quotient.—0. Leyton, B.M.J. i./23,707. Insulin greatly reduces the hyperglycsemic action of Adrenalin.— J. H. Burn, per Pres., Oct. 23,334. Pituitrin secretion is increased by injection of Insulin just as it has been shown to increase adrenalin but this secretion is not obvious in the case of the pituitary until the blood sugar has been considerably reduced.—W. E. Dixon and J. H. Wadia, B.M.J. i./26,820. It is unwise to give any carbohydrate at all, except that in vegetables, until the fasting value of the blood sugar has been below 0J2% for some considerable time.—G. Graham and C, F. Harris, L. i./23,1150. The necessity for frequent estimations of blood sugar during treatment is not essential. Do not attempt to get a constantly sugar- free urine—a trace of sugar in the morning is a safeguard.—A. Innes, B.M.J. b/24,55 ; Pres. May ’24,216. x 2 The Gluccse equivalent (i.e., the amount of Glucose which o unit of Insulin can metabolise) varies with the dose given and wr the amount of carbohydrate in the diet. When carbohydrate i gestion is constant the Glucose equivalent per unit becomes pr gressively smaller as the dose is increased.—F. N. Allan, Am. J Phys. ’24, Jan., p. 275, per Pres. May ’24,219. Before operating on diabetic patients it is better to give adequa diet with Insulin (very large doses given), to reduce blood-sug. rather than under-feed.—R. Carrasco-Formiguera, L. i./25,1076. For an emergency operation the procedure is practically the san as for coma (q.v.).—R. D. Lawrence, 4 The Diabetic Life,’ 1930. A standard diet for Insulin treatment.—A. C. Begg, L. k/24,51 In cases requiring three doses a day, the long night period cans- hyperglycsemia to develop. Counteract by giving last dose aft supper and first dose 1 hour before breakfast.—Pres., Dec. ’24,408. Simple control for Insulin injections.—Leave evenil specimen of warm urine in a pint Thermos flask to fermei with a little yeast; flask must be full and lightly corked. Tak gravity of urine before and after fermentation, and difference repr sents amount of sugar in grains per ounce. Plot the gravities as tw curves and when these are in apposition urinary sugar is absent an treatment correct. Errors in diet are at once apparent. Gi> strict carbohydrate-free diet with 3 to 5 ounces of bread. Test fc> ketones with Liq. Ferri PerchSor—Dark brown colour ind cates urgently the need for more bread and more Insulin. Giv Insulin twice daily. If urinary sugar is measured, daily blood suga are seldom required.—F. C. Eve, B.M.J. i./30,9I. See also R.M.* i. /25,1033 (Abst. in Edn. XIX., p. 649.). Satisfactory treatment of diabetics as out-patients, the routine tests beir i blood, sugar and urine estimations, and weight. Colds and similar min« ailments, and overstrain and worry, caused increase in blood-suaar ne centages.—C. J. C. Earl, B.M.J. i./27,831. b P No true case, of diabetes, however severe, proves refractory to Insulk Failure is sometimes due to renal glycosuria without hyperglycsemia Hepat glycosuria is refractory but is not true diabetes. Diabetic cases with cirrhos- of liver take longer but ultimately respond. Some cases of glycosuria may bl refractory owing to disorders of thyroid, pituitary or suprarenal. Diabet* complicated by severe infections ultimately respond to Insulin, if given b enough doses. Many cases of failure of Insulin are due to the patient sui reptitiously increasing the diet—Prof. Marcel Labbe, per B.M.J. i./27,530. Acetonurie vomiting of children from 4 to 6 years well treated with 10 t 15 units of Insulin subcutaneously, followed by carbohydrate meal Effec of Insulin lasted three hours.—Per Jl. A.M.A. ii./25,1167. As much as 200 units a day needed in some cases.—G. Graham B M J ii. /25,702. * ' * Carbohydrate metabolism in health and disease.—Hugh Maclean I 1./26,1129,1242. ’ A review of the later results of Insulin treatment.—A. P. Thomson B M J i./26,613. Blood sugar in the normal and diabetic—C. D. Shapland, L. ii,/26, 58£ Insulin is no longer looked on as a cure for diabetes. Only necessary i about one-third of cases, Le., mainly in patients suffering from complication such as gangrene or acidosis. In true pancreatic diabetes Insulin acts a substitute for missing internal secretions, and in other forms allows physio logical rest for the exhausted gland.—P. J, Cammidge, B.M.J. ii./25,H29. tto^^B!^lSn?A^^ul!/^^86S,,8 reduce the effect 01 In3Ulin 0a Anaphylaxis due to Insulin.—B.M.J.E. ib/25,13. Unl^ one diabetic patient seen who failed entirely to resound to Tnsnlin 1019 and I J c4mmMge^ 1020.' ’ ! 866 alS0 ibid- Prof‘ K* A- Petren- Ihe effect of injections property distributed on the subcutaneous tissues is very little over many years. Intradermic and intra- muscular injections inadvisable and may produce focal necrosis. Prolonged injections into a limited area may produce marked fibrosis and fat atrophy — It. D. Lawrence, L. i./28,1328. Eosinophilia found in 10 out of 20 diabetics treated with Insulin—absent in cases treated without Insulin. No definite explanation available.—R. I). Lawrence and O. Buckley, B.M.J. i./2Q,597, see also ibid, 714. Personal experiences with Insulin. Previously forced to give up work and l\YAon starvation diet. Nov/ able to do 14 hours work a dav.—It. I). Lawrence, B.M.J. i./31,1077. Atrophy (3 cases) of subcutaneous fat at site of Insulin injections, possibly due to presence in Insulin of fat-splitting ferment. Site of injections should be varied as much as possible.—E. A. Carmichael and G. Graham, L. i./28,601. Wasting effect on subcutaneous tissue.—W. W. Jeudwine, B.M.J. i./3i,1145. Local absorption of fat due to Insulin injections.—L. It. Woodhouse Price, L. i./3o,1015. Diabetes Mellitus and Heredity.—The marriage of diabetics is clearly inadvisable, and intermarriage between families vdiere there is even a remote history of the disease is to be discouraged, and where such marriages occur the children and grand-children, even to the third and fourth generation, should be watched and guarded as far as possible from exciting causes likely to develop a latent and inherited defect.—P. J. Cammidge, B.M.J. ii./28,741. See also Joseph A. Parkes, ibid. ii./29,1008. Falla’s treatment is to give back to the diabetic patient active, unrestricted life with aid of Insulin. Variations between 100 and 200 Gm. of fat cause no change in Insulin requirements or increase sugar in urine.—L. h/29,50. Highly purified forms dangerous—greater risk of overdosage. Less potent preparations make for safety.—Chabanier, per Pres., Dec., *29,409. Physiology of Glycogen and the role of Insulin and Epinephrin in carbohydrate metabolism. The intestinal mucosa absorbs hexoses more rapidly than pentoses.—J. J. It. Macleod, L. ih/29,1,55,107. Glucose intolerance in various dermatoses. Abnormalities in blood sugar content.—L. ii./29,H41. Advantages of Rich Carbohydrate Diet.—J. A. Nixon, B.M.J. i./3o,326. See also R.S. Med. Discn., B.M.J. i./si,309. Diabetes as a physiological problem.—Oliver Sharpey Lectures, Prof. J. J. It. Macleod, B.M.J. i./3o,868,918. Diabetic Ccn^a.—Desperate Cases treated by 100 units and large vols. of fluids (Gum Saline) intravenously.—It. D. Lawrence, B.M.J. i./3o,690. Diabetic coma usually due to carelessness on part of patient. Loss of an hour inexcusable delay. Most cases saved by initial dose of 60 units. Rear of hypoglycsemia groundless. Early treatment and sufficient dosage essential; a minimum of 200 units necessary to cure coma with goodly poition of this as initial dose.—W. It. Campbell, M.A. *31,142. Since the war diabetes has apparently become more common.—M.R.C. Ann. Rept., 1929-30, B.M.J. i./si,466. Relatively high carbohydrate diet in diabetes. Results at General Hospital, Birmingham.—R. Gittins, L. i./3i,321. Septicaemia in a diabetic. Inhibition of Insulin action.—R. D. Lawrence and R. A. McCance, B.M.J. ii./3o,749. Asthma.—Five units of Insulin twice daily, gradually increased to 10 or 12 units, with an ounce of Glucose an hour after each dose, for three weeks: together with Ultra-violet lays and Agar-serum Peptone, of value.—A. G. Auld, B.M.J. h/29,992. Patients suffering from carbuncles, gangrene of leg, appendicitis, etc., should: be prepared for operation by treatment with Insulin. Minor ailments, e.g,„ tonsillitis, ‘ colds in the head,’ etc., should always be taken seriously and patient should go to bed. It is better to reduce diet by one-third and add another 5 units to dose of Insulin. The relief of constipation is always of great importance.—G. Graham, L. i./24,65. By injection and local application Insulin is stated to facilitate the cicatrisation of the operation wound and favour healing in non-diabetics.—L.. ii./25,241; see also B.M.J.E. i./26,52. Exophthalmic Goitre well treated by Insulin, 5 to 30 units twice daily.— E. G. B. Calvert, B.M.J. ii./24,835. See also Jl. A.M.A. ii./25,1522, and ibid., 1007. Improvement in 2 out of 4 cases with injections of 60 to 100 units; daily.—R. D. Lawrence, B.M.J. ii./24,753 ; B.M.J.E. ii./24,13. _ Of value only in the pancreatogenous type of exophthalmic goitre, but’ fails in cases of thyroid origin, and those due to primary hypophyseal disease. —O. Klein, Med. Klin., Feb. 12, ’26,248, per Pres., May, ’26,214; B.M.J.E.. i. /26,56. .. A . Hyperthyroidism.—Insulin in treatment.—Jl. A.M.A. ii./25,1098. Action variable and inconstant.—M. R. Castex, Rev. de la Soc. de Med. Intern.. Sept., ’25,471, per Pres., May, ’26,214. Menorrhagia and Metrorrhagia.—Moderate doses injected twice daily- before morning and evening meals of value—usually effective within 2 oir 3 days. The action of Insulin is not specific, but is related to that of the ductless glands other than the pancreas.—B.M.J.E. i./28,13. Pregnancy, Vomiting of.—Combined use of Glucose intravenously with Insulin hypodermically—about 2 Gm. Glucose in 10% solution to each unit of Insulin—of value in excessive vomiting of pregnancy and in eclampsia. Jl. A.M.A. i./26,557. Pulmonary Tuherculosis.—Increased appetite and progressive increase in weight with subcutaneous injections of 5 units before meals.—Morin and Bouessee (Leysin), per Pres., May, ’28,187. Skin Diseases.—Insulin in treatment.—M. Eerond, Le Scalpel, Mar. 6.. ’26,221, per Pres., Oct., ’26,344. Varicose Ulcers.—Insulin injected, and locally, found of value.—P..1- ii. /25,180. Ulcers of leg well treated.—B.M.J.E. ih/25,10. Insulin applied locally (12 units twice a day in the form of a wet dressing) completely healed a resistant non-diabetic ulcer of 5 months’ standing in. 10 days.'—Per Jl. A.M.A. ih/25,473* A Synthalin (T.M. 351691). An Alkyl-Guanidine derivative, with action similar to Insulin, which has been advocated for slight or moderately severe cases of diabetes. It is taken; internally in a single dose of one tablet, containing 10 mgr., 2 tablets 20 mgr.,, or one tablet 25 mgr., at the commencement of a meal. For light and moderate cases— By dietetic treatment the sugar eliminated, must have been adjusted to at most 30—45 grains per day. On the first and third day two 10 mgr. tablets twice, on the second day 2 tablets on one occasion. A respite on the fourth day and then gradually pass- from two 10 mgr. tablets to 25 mgr. Directions are varied for other types. Synthalin lowers sugar excretion by the urine. 1 mgr., is capable of using: IT to 1-2 Gm. of sugar. The substance is not a simple derivative of Guanidine: or even a simple homologue of the Methylene series. It is intended to improve its composition.—E. Frank, Klin. Woch., ’26,45. Preliminary Reports to the Medical Research Council show Synthalin to be; unsatisfactory—L. ii./27,517, ibid., 649. Results uneven.—G. Graham and R. D. Lawrence, B.M.J. ii./27,1143. In rabbits, Synthalin, or Decametliylene-diguanidine, in large doses was toxic. The fate of3 the Glucose was not quite clear : experiments proceeding. H. H. Dale, B.M.J. ib/27,1141. _ _ _ . .. The name Synthalin was applied to the Methyl Ester of Piperony, -Quinoline Carbonic Acid.fe Danger of identity of name for two totally different substances _Y.B.P. ’27 298. Rotes on Synthalin,—A. W, Edwards, P.J. ii./27,292. VrUH^6r0t3},Je£?n ^ r.eferences to Synthalin have been made since our last j_jdition. The following are the most important: ■» ^suitable if not dangerous for use in diabetes in man.—Prof. J. E. Macleod, B.M.J. j./3o,919 ; L. n./3o,518. ’ deduction of blood sugar after oral use due to injury of parenchyma of liver and not to increased capacity of body to burn sugar.—L. ih/31 412. Smce 1927, Synthalin has been continuously used in the Bristol Royal Infirmary, and 70• A of diabetics are now treated with it in place of Insulin. Given correctly, it is devoid of danger and gives Jesuits equal to insulin. Carbohydrate is allowed fairly liberally, the relation of fat to carbohydrate m grammes m the four stock diets being : F/C • 107 * 180 187 • 186, 165 , 220, 170 ; 238. Commence with 2 tablets (io mgr.) beta-Synthalin morning and evening after meals, with 1 tablet of Dehydrocholic Acid to every ^ of Synthalin. Increase dosage in these proportions to limit of tolerance or until diminution of glycosuria occurs &nd then reduce to necessary minimum with rest every third day. A Phosphate mixture is taken thrice daily. Liver replaces meat one day, and sweetbreads half the meat of another day, with Bemax or Marmite daily.—A. T. Todd and Co-workers, Pr. May, ’32,531. Galegin, the alkaloid of Galega Officinalis, has a similar constitution to feynthalin and has been used for reducing blood sugar up to 150 mgr. per day, replacing 20 to 30 Insulin units. No secondary effects observed.—P.J. ii./2 7,563. Glucosone, or aldofructose (one of the oxidation products of Glucose or Fructose) has similar properties to Insulin and is given by the mouth.— P. T. Herring, L. i./27,1000. Intarvin.—An artificial fat made from fatty acids, having an odd number of Carbon atoms and proposed for use in diabetes, on the ground that such fatty acids do not yield ketone bodies on oxidation in the normal or diabetic organism, and might therefore with advantage replace natural fats in the diet (N.N.R., ’25,219). From clinical observations, however, on cases of diabetes meliitus, it would seem that further investigations are needed to substantiate the claims made.—D. Lyon and co-workers, B.M.J. i./25,2U9. Has definite but limited field in diabetic treatment. No toxic symptoms, but pronounced unpalatability.—Per Pres., Dec., ’28,417. ^Sionon. (T.M. 355471).—A purified form of Sorbitol (the Alcohol corresponding to Dextrose) prepared by reduction of Grape Sugar and Fructose. A white crystalline powder with calorific power equal to Glucose. May be given to diabetics up to 30—80 Gm. daily with other foods.—Per Pres., Dec., ’29,419. Can be metabolised more easily than glucose. Quantities up to 3 ounces a day rarely produce diarrhoea.—B.M.J. ii./3o,105. A substance made from liver by the Blotner and Murphy method found completely inactive in rabbits. No oral substitute for Insulin as yet.—P. O. Brett and co-workers, L. b/31,32. PAPAIN, Syn. Papayotin. Dose.—1 to 8 grains (0-06 to 0*5 Gm.). Whitish, amorphous powder, prepared from the juice of the Papaw, Carica Papaya (Passifloracece.). 75% should be dissolved by absolute alcohol. Papaw fruit, fresh, divested of its seeds, in shape like a vegetable marrow, is a refreshing dessert fruit, with flavour something like the melon. It is commonly used as a table fruit abroad. It is thought to have digestive properties. The author has imported the fruit 4 canned * in syrup. The tree is indigenous in India, East and West Indies, Hawaiian Islands, in Ceylon and other tropical parts. The fruit contains Vitamin C in abundance, with less Vitamin A, and still less B— Jl. A.M.A. h/29,672. Manufacture of Papain*—The fruit while remaining on the tree is lightly incised several times at intervals of 2 or 3 days with a bone knife* and juice collected in calabashes containing a little water. The juice is rapidly dried—the coagulated milk being exposed to the sun or artificial heat on glass or linen frames at not exceeding 100° F., subsequently while still warm powder in a drug mill. The natural colour of Papain is light brown. Bleaching is said to be a great mistake. Adulterants include bread, boiled rice, starch and the milk of gutta-percha and the wild cactus. The fruit is sometimes called the tree melon. The leaves are used for wrapping round fresh meat to render it tender. The juice of the fruit is also rubbed into meat for this purpose or a piece of the fruit is placed in the water in which the meat is boiled. A tree bears on an average thirty fruits a year and lasts some 5 years as productive and worth cultivation. A trace of formalin should be added to the juice as collected by scarification. A dozen fruits yield about £ lb. of dried granulated crude papain at one tapping. Huybertsz found the Ceylon Papain will digest 200 or 300 times its weight of albumen, while West Indian only digests 75.—H. F. MacMillan, C.D., Jan. 30, 1915. Assay— Examination showed that 0-4 Gm. Papain will peptonise 100 Cc of 4% Alkaline Casein Solution in 1 hour. Uses.—As a digestive in chronic cases of dyspepsia with acir eructations and painful gastric fermentation. It acts in acid, alkalin or neutral media, has the property of digesting fibrin like pepsin (a much as 200 times its w eight in some eases). It has the property of curdling milk like rennet and might be used as a substitute for th< latter. The Liquid preparations are suitable for use in cases of enlarger tonsils—after persevering treatment, improvement in nasal breath ing can be observed—due to reduction of the swellings. Ulcers and fissures of the tongue have been painted with a solutioi of Papain 1 to 2 in 10 each of glycerin and wrater. Juice from the unripe fruit is very acid and acts as an efficient vermifuge and is also a galactagogue and antiscorbutic.—S. G. Willimott, P.J. ii./28,2!& Elixir Papain.—Martindale. Dose.—1 drachm (4 Cc.) with meals. Glycerinnm Papain.—Martindale. Dose.—l drachm (4 Cc.) with meals as a digestive. It has also been used as a pigment for chronic eczema and vrarts and has been applied to diphtheritic exudation. Tabellre (of chocolate basis) contain 2 grains (0-12 Gm.). Trochisei Papain J grain (0*03 Gm.). IU4 Pilula Papain Composita. Dose.—1 writh meals. Papain 2 grains, Extracts of Nux Vomicf I grain, Belladonna J grain, Aloes £ grain. A digestive laxative. Pul vis Papain Compositus. E.L. Dose.—5 grains (0*3 Gm. Papain 1, Sodium Carbonate 2, Sugar 2. Liquor Papain et Xridin. Dose.—2 to 4 drachms (8 to 15 Cc.). Papain 120 grains, India 150 grains, Glycerin 2 ounces, Sherry 5 ounces, Chloroform Wate* to 1 pint. Macerate 7 days and filter.—From Ph. Form., 1911' p. 890 modified. PARAFFINA. The Paraffins used in Pharmacy are arranged herein in order of consistency, commencing with the Hard and following in rotation with, soxt compounds. Liquid Paraffins of various gravities, and finally the lignt fi actions known as Amyl Hydride, Petroleum Spirit, etc. Paraffinum Durum.—Syn. Paraffin Wax. A mixture of several of the harder members of the paraffin series of hydrocarbons Cs0H4a=282-3276 to C27H66=380-4368 ; obtained, by distilling shale, separation of the liquid oils by refrigeration, and purification of the solid product. Colourless, semi-transparent, crystalline, inodorous, and tasteless, slightly greasy to the touch. Sp. Gr. 0-82 to 0*94. Insoluble in water, slightly soluble in absolute alcohol, soluble about 1 in 80 in ether ; insoluble in Acetone—a fact of value in analysis of mixtures. It burns with a bright flame, leaving no residue. Hard paraffins are supplied with the following- melting points :—100°, 104°, 110°, 115°, 120°, 125°, 127°, 130°, 135° F. (B.P. ’14) employs from 122° to 140° F. U.S. has M.pt. 50 to 57° C. (122 to 135° F.). Geresin. A hard white paraffin prepared from ozokerite or earth wax ; has M.pt. about 130° F. When artificially coloured to resemble yellow wax it is sold as Yellow Geresin. Ozokerit is a hard paraffin obtained from Galiciar deposits. vli Solid Paraffin Injections. For subcutaneous injection in plastic operations this should be hard paraffin with M.pt. 110—115° F. not an extempore mixture. Osed to improve the size and shape of the nose, ear, etc., where abnormal, also for injecting into cavities after previously s wabbing out with antiseptic lotion. The injection should be made in a warm room to allow of the flow of the melted substance through the syringe needle. In facial surgery.—S. Mort, L. il./i9,105. Ozama treated by injecting high melting paraffin into the nasal septum.— B.M.J.E. i./i5,36. Painful Rheumatic Joints.—Envelop the limb (previously shaved) quickly in a thin layer of melted Paraffin at a temperature of 80 to 85° C. and add until layer is 1 to 2 cm. thick. Apply flannel bandage and leave on for ^ hours __Per Pi* June *28 307. Paraffin Wax bath over the whole body applied in sections at a time for applying heat to the skin.—H. W. Hales, L. ii./3i,586. Paraffinoma.—Two cases following Paraffin injections. One ot the rectum due to liquefied hard Paraffin, the other stated to be due to an injection of Camphor in Paraffin Oil in the thigh.—A. T. Bazin, B.M. J. ii./29,1102. Paraffinum Molle (B.P. ’U).—Syn. Petrolatum, U.S. and Petrolatum Album, U.S., Petroleum Jelly, Vaselina, F.E. VIII., Vaselinum P. Ital. V., P. Belg. IV. A white or yellow semi-solid mixture containing some of the softei or more fluid members of the paraffin series of hydrocarbons C 15 B g 2 212*250 to C20H4o=282*336. Melts at 42 to 46° C., or even somewhat ligher (U.S. requires 38 to 54° C.). Is usually obtained by purifying /he less volatile portions of petroleum. I Soluble in alcohol slightly, freely in ether and chloro oim, insoluble in water and in Acetone. When melted, it mixes wi h oi s, ind many waxes, oleates, and oleic acid. j Soft paraffin is not readily absorbed, but is emollient, protective? and useful for surface action, e.g., for compounding with lead,, mercury, zinc, and sulphur iodide. Absorption, It is commonly thought that Paraffins injected, into tissues (as in Beck’s Bismuth Paste) are not absorbed. It was proved in Germany that this only applies to hard paraffin. Intra-artic.ular injections of Vaseline admirable in certain cases of painful and grating joints including morbus coxse senilis and dry traumatic arthritis. For a knee joint 15 Cc., for the hip 20 to 25 Cc. If the joint contains fluid, itse further secretion may only be stimulated by injection of Vaseline.—B.M.J.E. ii./i3,78. 3^ Vaseline (T.M. 1248*3, 479708) Brand Petroleum Jelly is available in yellow and white varieties. It resembles the Vaseline Officinale or Petroleine of the Fr. Cx.— that which remains over after distilling American Petroleum at 360° C. and purifying. 2 to 5% ‘ Paraffin ’ is directed to be added according to season or climate to improve its consistence. High Melting “ Vaseline ” is also prepared with M.pt. 46T° C. (115° F.), suitable for warm climates. Unguentum Paraffini made with Hard Paraffin (M.pt. 54 to 57° C.) 27, Soft Paraffin 70, Beeswax 3, is suitable for use with the atmospheric temperature, 15° 0. May be modified to meet the exigencies of climate and temperature. The addition of 3% Beeswax makes the ointment more uniform. A hard Paraffin with somewhat low melting point, e.g., 46 to 52° C. is best. Our experiments showed it is vTell to melt together and set aside to crystallise (or allowed to cool on the water bath) and then mill, rub down, or sieve again. A small quantity of -wool fat added to soft or liquid paraffins enables the production of a stable Emulsion, red" Vasenol. Ceratum Petrolei is a firmer' oasis than the Soft Paraffin and is a good protective. White Soft Paraffin 2 parts, Hard Paraffin (135° to 140°) 1 part. Melt and stir until cold in an evaporating dish. ‘ Collapsible Tubes * of Soft Paraffin with catheter and rectal attachments are suitable for uterine and rectal medication. The base: may be medicated with antiseptics and astringents ; for formulae, vide Index. Ceratum, U.S. White Wax 30, Benzoated Lard 70. Melted together and stirred until the cerate congeals. In hot seasons and warm latitudes, White Wax 50 or more may replace an equal weight of Benzoated Lard. Paraffin Treatment of Burns. Paraffin “No. 7 ” is made as follows :— Melt hard Paraffin 67-75 and add Soft Paraffin 25 and Olive Oil 5. Then mix in carefully Beta-Xaphthol 0-25 dissolved in Eucalyptus Oil 2, after the mixture has cooled to about 55° C. (The original mentions Resorcin 0-25 to 1% as alternative and that a small quantity of Absolute Alcohol is to be used as solvent). The finished article melts at about 48° C. Method of Use.—Wash the burns with sterile water, dry thoroughly for example with a fan and spray or apply the melted preparation carefully with a flat camel hair brush. Cover with a thin layer of wool and a second coating. Severe burns accompanied by sloughing and in a very septic condition cleaned and became healthy. Cordite, Petrol and Liquid Fire bums healed. Also suggested for frost bite.—A. J. Hull, B.M.J. i./i7,37. Wounds and Burns treated—nothing so effectual.—E. F. Pratt, B.M.J. i./i9,243. ^°?oe^for-mufe“% 10 (containing scarlet), No. 12 Brilliant Green, No. 13 Flavine Wax, No. 14 Dichloramine Wax. The No. 7 with preliminary painting of surface of the burn with 1 in 1,000 Flavine gives the best results.—• A. J. Hull, B.M.J. ii./i7,788. 6 Paraffin No. 7 Modified ’ has been made using Spermaceti and Hard Paraffin p. eq. vice Hard Paraffin. The preparation melts at 49° C. and is filled into rubber-capped tubes for use at time of operation, after melting in the water bath. Ambrine (T.M. 380347).—A similar preparation advised by B. de Sandfort (a compound of Paraffin with 5% Oleum Succini, L. i./i7,318). Applied in similar manner. Results better than those with Picric Acid. Pain alleviated, scar formation prevented. It has elastic and adherent properties.—B.M.J. ii./i6,329,333. Preparations similar to Ambrine used with advantage in eczema, varicose ulcers, neurodeimatitis, intertrigo, fissures and chilblains. Paint on and cover with thin layer of cotton wool, then a second film of paraffin, cotton wool and bandage. Relieves itching.—B.M.J.E. ii./2i,l. Of value in the after-treatment of ear operations.—B.M.J.E. ii./25,88. Dental Wax. Hard Paraffin 1 ounce; Beeswax 6 ounces, melt together, add J ounce Alkanet and keep warm for two hours, then strain and add Tincture of Tolu 2 drachms, Otto of Rose 5 drops. Generally supplied in sheets 6| by 3J inches. Use,—The sheet is warmed over the flame and moulded carefully over the model. It is used for mechanical purposes prior to vulcanisation. Oleum Petrolei Flavum and Huiles Lourdes de Petrole. Heavy Petroleum Oils—products from American Petroleum. Distilling between 280 and 400° C. Sp. Gr. 0-880 to 0-905. Used as a vehicle for Hypodermic Injections. For the suspension of insoluble mercurial salts, such as calomel, salicylate, succinimide, benzoate and yellow oxide of mercury , 1, 5 or 10% mixtures being employed. Vaseiinum Liquidum. Syn. Huile de Vaseline, 4 Vaseline Liquide’, Fm Cx. is prepared from Caucasian Petroleum by purifying the fractions between 335° and 440° C. Sp. Gr. about 0-875, t.e., it approximates Parajfinum Liquidum in character. Rmployed in Huile Grise q.v. F.E. VIII., P. ItaL V. and P. Belg. IV. similar. Paraffinum Liquidum {B.P:U).—Syn. Oleum Petrolei, Petrolatum Liquidum, U.S. Chrismaline, 3^Paroleine (T.M. 248370). Dose.—2 to 4 drachms (8 to 15 €c.). A clear oily liquid obtained from petroleum after the more volatile portions have been removed by distillation. Sp. Gr. 0-So0 to 0-890 (B.P. ’14), For spraying as also for ‘Toilet Paraffin is preferred with gravity 0-865 to 0-870. Pot internal use 0-880 to 0-885 is preferred. Below 0-880 it is not suitable as an internal xubncant. U.S. has two varieties,—one termed Heavy, the other Light Liquid Petrolatum—with different viscosities. A careful clinical comparison of treatment with low (130) yiscosmy Liquid Paraffin Sn Gr 0-8718 and high (230) of Sp. Gr. 0-8902, showed that the latter had a slightly more laxative action and ^er® L yiSous1 oilgas "mo^^atisfacUu^ ffi general? A^stendard^ of not less than 180 should be shoM be at least 0-880 and the viscosity ^ Samples8which we have had examined had viscosities 281 and 290. (We deal further with the question of viscosity m Voi. IP). Russian Oil contains principally Saturated Hydrocarbons while; American petroleum contains a large proportion of the unsaturated: Olefines. The Baku Oils differ from Pennsylvania and other U.S.. Oils in consisting largely of hydrocarbons of the Naphthene group. (Saturated single link ring compounds). American oils are best for chlorinating, c/. p. 48. Russolax is distilled and refined in England. It has high viscosity (275 seconds at 100° F.). TJscs, Liquid and Soft Paraffin are employed as electuaries or lubricants in constipation. Also of use for colitis in childrer internally. By its lubricating action taken regularly, it may avert appendicitis. It has been suggested there is danger of it causing cancer, but we do not agree. It is a good catheter lubricant. It is used as a basis for laryngeal and nasal spray solutions or pigments, containing menthol (1 in 8 or more), cocaine (soluble only 1%)) or otliei medicaments. Alkaloiaal bases and their salts are in generak only very slightly soluble in any of these liquid paraffins. A little Oleic Acid added assists solution. Enteric with constipation in Egypt well treated.—L. ii./i4,231,421„ ^IN from giving Liquid Paraffin as an intestina lubricant “M15 Ly llie t° P00r viscosity, but may also be due to the time of giving the ,'iam C0I,r.esP0Dfis often to the hunger pain described in cases of duodenal ulcer. Give small doses, say 2 dr., and not immediately after food, S SamutlSPrei ° oect°™2o Ut bedtmi0’ increasing gradually if necessary — Given as a lubricant Liquid Paraffin enters the caecum mixed with the iliac contents and keeps the contents of the large bowel soft. In addition it accelerates the passage of the faeces through the large intestine which consequently docs not become overloaded. The whole of the ingested Paraffin can be recovered from the stools—there is no toxic action even with large amounts, mr W. A. Lane was the first to popularise Paraffin for internal use.—J. W. Peck, P.J. 1./14,28,508. its action on the bowel is due in great measure to its ability to form emulsions holding about 15/0 more water than usual in the stool.—Munch. Med. Woch’ per P.J. n./27,4ol. Liquid Paraffin should be cjiuen 4 hour before food. 7 to 10* minims of I met. Belladonna after breakfast and dinner helps the onward passage of contents of unhealthy colons.—A. Greham-Stewart, L. ii./3o,874. Ao ci priori’ reason why Paraffin should replace other iaxattxes. l)iay be irritant. The primary defect in constipation is in the nemo-muscular mechanism controlling peristalsis in the stomach and small intestine, and mass movements in the colon—these movements are not neces- BHJ stimuated by 0ltlier bulky or rough residue.—L. J. Green, L. iL/30,993, in colitis suitability Questioned.—Cascara group preferable. L. J. Green, L. m/30,771. Refer also to E. Spriggs, ibid.. 635. Eczema ani consequent on the taking of Liquid Paraffin for chronic constipation.—R. Gibson, BALL i./27,876. Herpes zoster. Paraffin dressings found of great value for the relief of pam ; effective only during the eruptive period.—Howard Fox, per Pres., Recurrent Generalised Eczema Madidans.—Local use of Liquid Paraffin effective.—B.M.J. u./i3,1013. 4 Wound Dressing.—Medicinal paraffin good.—B.M.J. i./22,940. See also our p. 655. Scottish Shale Oil Industry.—Dermatoses of paraffin workers —Alexander Scott, B.M.J. ii./22,381. Emulsio Petrolei cum Hypophosphitibus. Martindale. Dose.—1 to 4 drachms (4 to 15 Cc.). Some experiments conducted by us in 1907, with a view to making a satisfactory 50% Emulsion, gave the following as the best of a number tried.—Rub Powdered Gum Acacia (good) 4 ounces with Liquid Paraffin 8 ounces, Soft White Paraffin 2 ounces. Cinnamon Oil 24 minims. Then add in two portions a solution of Sodium and Calcium Hypophosphites of each 192 grains. Saccharin Elixir 90 minims in Water 10 ounces. Equal parts of Liquid and Soft Paraffin produce a thicker emulsion. Emulsio Paraffini cum Pancreatino. Dose.—2 to 4 drachms (8 to 15 Cc.). Liquor Pancreaticus 2 ounces included in this formula. Eor the intestinal stasis of tuberculous children drachm doses of this preparation promote healthy function of the bowel. Emulsio Paraffini et Bismuthi. Dose.—One ounce (30 Cc.) first thing in the morning and at bedtime, followed by § tumblerful of moderately hot water. Liquid Paraffin 1 ounce, Clove Oil 10 minims, Sodium Bicarbonate and Compound Tragacanth Powder of each 1 drachm. Emulsify with Chloroform Water \ ounce, and Solution of Bismuth 1 drachm and add in portions Chloroform Water to 8 ounces. The small dose of Bismuth is intentional. In some cases larger quantities may prove constipating. The formula is varied to suit the case, e.g., Peppermint Oil 10 minims may replace the Clove Oil, varying doses of Bismmn Salicylate, or Subgallate, may replace the Bismuth Solution, and where tnere is constipation Vinum Aloes or Compound Tincture of Aloes £ ounce to 12 ounces may he incorporated. Catarrh of the alimentary tract is frequently responsible for toxsemia due to insufficient or impeded action of the liver and pancreas. Inis conditio is often the cause of affections of the circulatory system (heart troubles, etc.), coupled 'with evidence of rheumatoid arthritis and of fibrositis. A. ±>e y horn 0 Milk Casein as emulsifying agent for Paraffin Emulsions. P. J. ii./i3,208. The following are flavoured preparations: Aperfine Liquid. Dose.—2 to 4 drachms (8 to 15 Cc.). Liquid Paraffin flavoured with Oil of Lemon. , , . Aperfine. Dose.—2 to 4 drachms (8 to 15 Gm.) is similar but m paste form. It contains 70% of White Soft Paraffin. These act purely physically, hence produce no evil effect or habit. *Aperol (T.M. 290001), Deiectoi and Internol are prescnbed.. *Cristo!ax (T.M. 375774, 435407). A compound of 50 /0 Liquid Paraffin with 50% Malt Extract in powder fo±m. Fructolax. Dose.—2 to 3 drachms at bedtime. A lenitive and laxative containing about 80% soft Hydrocarbon with fruit basis. jjcMaltaffln (T.M. 355917). A paraffin and malt preparation, v. p. 542. ■. , . „ ^ , • /m m OKQQA9') —a lubricant to the alimentary and and Semprolin Carminative are also preparet. Emulsio Paraffini cum Rhamno Frangula. jDose.—J to 1 ounce (15 to 30 Cc.). Liquid Extract of Buckthorn Bark 1 ounce, Liquid Paraffin ounces. Benzoic Acid 5 grains, Irish Moss Decoction to 8 ounces A mild laxative. # Paraffagar (T.M. 355918). A combination of Hydrocarbon Oil with Agar Agar in the fore of a jelly as an efficient electuary, without weakening effects. Dose.—1 to 2 drachms at bedtime. Children, h to 1 drachm increased if necessary. Paraffagar with Phenolphthalein. Dose.—1 to 2 drachms, containin Phenolphthalein 4 grain in 1 drachm. Constipation of Pregnancy.—Phenolphthalein and Paraffin found best.— W. H. P. Oxley, B.M.J. L/31,7. ^Paraffagar Capsules. Dose.—One or two at bedtime, increased ii necessary. This is a convenient preparation. Confectio Petrolei K.C.H. Syn. Laxar. Dose.—1 to 2 drachms. Agar Jelly 4%, 1 ounce, White Soft Paraffin 1 ounce, Peppermint Oil minims, Cassia Oil 2 minims, Saccharin i grain. Emulsio Paraffini Liquidi cum Agar Agar (50% Paraffin an 0*8% Agar Agar). Dose.—J to 1 ounce or less if requisite morning and evening Children 1 to 2 drachms. We have conducted a number of experiments to provide a satffi factory formula. The following, worked out in the author’s Lahore tory (1927), gives a good result: Dissolve Agar Agar 0*8 in Water 46 and strain hot into the fo- lowing, mixed :—Gum Acacia 2T, Tragacanth 0-3, Sodium Benzoatr 0-2, Liquid Paraffin 50, the last ingredient being made sufficient! hot. Stir vigorously until cold. Finally incorporate Sacchari Elixir 0-5, Vanillin Solution 0T, Lemon OilOT. Emulsio Paraffini Liquidi cum Agar Agar et Phenolphthalein. Dose.—\ to 1 ounce or less if requisite morning and evening. Children 1 to 2 drachms. The formula is as above, incorporating secundum artem Phenolpb thalein 1 grain per ounce dose. Liquid Paraffagar and Liquid Paraffagar with Phenolphthalein ar representative of the two last mentioned. CE)Paraffinum Compositum Liquidum. Can. Form. Mix the following intimately, to make a homogeneous liquid. Campho 3-4, Menthol 1-0, Thymol 0-5, Eucalyptol 1-0, Oil of Wintergreen 3-4, Hydras tine 0-015, and Liquid Paraffin a sufficiency to make 1,000. Is suitable fou use as an antiseptic and astringent ‘ Nebula.’ Nasal passages and throat should be kept clean with a simple oily preparation. e.g., Liquid Paraffin, as they are frequently the paths of infection, for pneu. monia, rheumatic fever, influenza and diphtheria, also for cerebro-spinal fevei and poliomyelitis.—Sir James Barr. Capsules (Gelatin), with pointed ends, of Sterile Liquid Paraffin are made for lubricating catheters, etc.; they contain 30 minims. Wound Dressing with Liquid Paraffin. At one stage in the war there was enthusiasm for ‘ Oil * as a wound dressing for uncomplicated wounds. Casualty Clearing Station results show success with Liquid Paraffin preparations. Gauze used for packing a wound smeared with a Paraffin Paste should be wrung out of Liquid Paraffin or Iodoform-Paraffin 1%.—Col. H. M. W. Gray, B.M.J. i./i7,509. See also Iodine in Paraffin. Lotio Paraffini Composita. Soft Paraffin 3 ounces, Balsam of Peru 2 drachms. Mercuric Oleate 60 grains, Olive Oil 1^ ounces. To be applied with a stiff brush. For parasitic skin diseases. Gauze soaked in paraffin for wounds.—J. Campbell, L. ii./i8,477,495. Crecsoted Oil; (Calot’s formula.) Liquid Paraffin 70 Gm., sterilised by toiling for 4 hour. Allow to cool and add in order (1) Creosote 5 Gm., (2) Guaiacol 1 Gm., (3) Iodoform (sterile) 10 Gm., (4) Ether 30 Gm. Used as a wound dressing. . _ Injection of 10 Cc. weekly of Calot’s fluid with Olive 0/7 m piaca of Liquid Paraffin of distinct value following aspiration of cold abscesses and in treatment of white swellings of joints. Galot’s No. 2 Paste -Phenol Camphor 3 Gm., Naphtliol Camphor 3 Gm., Guaiacol 8 Gm., Iodoform 10 Gm., Lanolin 150 Gm., Spermaceti 100 Gm., of value for injection in sinus formation in disease of hip, spine and knee. 10 Cc. injected into sinus at temperature of 103° repeated every fourth day for 10 occasions. Albuminuria and septic infections causing pyrexia contraindications.—R. Pollock, L. L/27,^0. Otorrhcea.—Calot’s Solution of value. Instil 5 to 10 drops imo ear canal. To get fluid into Eustachian tube close opening of external canai oy presung tragus against canal wall and bringing alternate pressure to bear on it so as to cause pumping action on mixture, and continue until patient feexs medicament in throat. Repeat nightly for a week. When secretion becomes thin discontinue and dry up with insufflations of Boric Acid Powder. 1. liamick, Jl. A.M.A. ii./29,66. » The various Lubricating and Lighting Oils, e.g. Kerosene-xrac- tions between 150° and 300° C. with Sp. Gr. about 0-790 to 0-81 and Mineral Naphtha (to be distinguished from Solvent Naphtha q.v.), are the next fractions, and are mentioned here to render the series more complete. , . . . . . (Note.—During the war and probably since—the benzol, toluol jJJJT fractions were removed from mineral naphtha in great measure, P g a liquid with much higher boiling point. Abel Scholar, L..; j* • Lefroy’s Crude Mineral Oil Emulsion. Syn. Petroleum Insecticide. Crude Mineral Oil (Kerosene) 110, Soft Soap 50 (whale jMl soap: with about 10 of water to form a jelly. For use acting as a The same effect is secured by rubbing a little over the skin. H. maxwen L$Vermijelli\1T5M. 365780). A preparation originMly devisedL f< plants after dilution. The following is similar. W . 347 in con- Petroleum 110, Naphthalene 4.—H. M Lefroy, B.M.J. i./i5,8i/. junction with 4 N.C.I.’ (q.v.), was used ^ tlm war. commerce. Favus has been cured by soaking with Potrole fraction Solar Oil.—A product of Shale Oil distillation It is the after the Benzene and Kerosene have distilled, ^ p. • 104-4 Used as a high grade fuel o.h-aD. >>-h; , ^ between JdSS-'o;>*»»».»“”*35’- Wounds, swabbing out with Petrol gave good resuics. B.M.J. ii./i6,327. . Of great value for cleaning cuts, abrasions, septic wounds and burns ; als L in the early stages of diphtheria and similar diseases—by swabbing the naso pharynx with lint soaked in petrol it is possible to cut the disease down to minimum.—G. A. Stephens, Pres., April, ’23,140. Petrol Poisoning resembles drunkenness. Treatment: little to t done beyond placing patient in fresh air and keeping him warm.—B.M.« i./i 5,769. Antidote.—Camphor Injections and Oxygen mav be tried. Tetra-Ethyl Lead. A very active and dangerous poison, far more so than any inorganic Lea compound—only a few mgr. a day wil j cause cumulative poisoning. In th works of the Standard Oil Co., New Jersey, 5 employees died and 30 otheir were affected. For treatment large quantities of alkalis recommended.— B.M.J. L/28,61,04,75. Further investigation necessary.—Ibid., 363,366. In a family car using 107 galls, of Ethyl Petrol (3-5 Gm. Lead to the gall 75% of the lead went into the air and the rest into the car parts.—Daily Mai April 13, 1928. Ethyl Petrol acquitted.—L. i.,/30,820. Report of proceedings of Committe- of Enquiry.—B.M.J. L/28,770,871,1033,1073. Tetramethyl Lead of comparatively low toxicity compared with other Lea compounds. M.L.D.’s of a number of organic Lead compounds given.—J. fc Buck and I). M. Kumro, Jl. Pharm. and Exp. Therap., Feb., ’30,171. For further details of Motor Spirits, see Yol. II. Ligroin is the fraction distilling between 80 and 120° C. Petroleum Benzine or Benzoline is the fraction between 60° am 90° C. with Sp. Or. about 0*690. This is used for cleaning purposes Distinguish from Benzene (Benzol), the product obtained from Co© Tar, q.v. Petroleum Spirit. Syn. PETROLEUM Ether. Used for heatint cauteries. Has Sp. Gr. 0*67 to 0*7, and distils over below 60° C C5H12=72 0936 principally. JBenzinum Purificatum U.S. is Purified Petroleum Benzine witfi Sp. Gr. 0*634 to 0*660 at 25° C. and B. pt. 35 to 80° C. Benzine (preferably spelt Benzin) means Petroleum Benzin. Petroleinum, P. Belg. IV. and P. Jap. have Sp. Gr. 0*64 to 0*67 with B. pt. 50° to 75° C. Er. Cx. has with Syn. Gazoline, Sp. Gr 0*65 to 0*67, and to distil over entirely below 85° C. Petroleum Spirit.—With Sp. Gr. 0-640 contains always a large fraction boiling below 40° C., and with Sp. Gr. 0-700 contains a large amount distilling above 60° C.—Tyrer and Gosling, P.J. ii./i2,157. Petrole l^ger. Fr. Cx. has Sp. Gr. about 0*6, and distils entirely below 50° C. Amyl Hydride. Syn. Pentyl Hydride ; Pentylene; Hydramyl~ Mainly C6H12=72*096. Obtained by the fractional distillation of Petroleum Spirit. Sp. Gr. 0*625 to 0*649, boiling point abouti 30° C. It is very inflammable; applied locally, is not absorbed* but rapidly freezes the part by evaporation. Rhigolene is similar. FELLETIERINA. C8H16NO=141*125. Dose.—2 to 6 grains (0*12 to 0*4 Gm.). A mixture of alkaloids obtained from pomegranate stem and root bark, Punica Granatum (B.P. 1898), (‘ Granatum ’ U.S.) (Lythracece), in minute shining white crystals. The alkaloids are at least four in number, their amount varies between 0*5 and 0*7%. In addition 20% Tannin. Granati Cortex (Root Bark). P. Ital. has Syn. Melograno. Fluidextractum Granati, U.S. Average dose.—30 minims (2 Cc.). 1 = 1. A glycero-hydro- alcoholic extractive. ~ " J Pelletierine is /3-2-piperidyl propaldehyde or in other words the aldehyde of Comne. Though a secondary base it does not react with Nitrous Acid. The alkaloids of Pomegranate root seem to be entirely racemic though orisinallv believed to be optically active.—Hess and Eichel, Ber., 1917 ° Felletierinae Sulphas, Punicine Sulphate. (Fr. Cx.). (C8H15N0)2H2S04=380-3256. Dose.—2 to 8 grains (0-12 to 0*5 Gm.). A brown syrupy liquid, freely soluble in water, sometimes as crystalline mass. As a remedy for tape-worm : 5 to 8 grains taken fasting, followed by a full dose of compound tincture of jalap; for 13 years, half the above dose, and for infants one-tenth. Fr. Cx. provides complete method of manufacture from the pomegranate root bark. In the final stage of extraction the combined pelletierine and isopelletierine are present as sulphates in aqueous solution which on slow evaporation yield a 4 crystalline residue ’ of the two salts. The mixture is called ‘Pelletierine Sulphate’for short. The dose is usually 0-3 Gm. with 0-4 Gm. of Tannin and 2-5 Gm. of Syrup. Max. single dose is 0-4 Gm. Pelletierine Tannas (b.p.’14). Dose.—2 to 8 grains (0-12 to 0-5 Gm.). A mixture of the Tannates of the Alkaloids in greyish powder only slightly soluble in water, but soluble about 1 in 80 of alcohol 90%. As a taeniafuge, 8 grains followed in 2 hours by an ounce of castor oil proved an effectual dose, causing neither colic nor headache. The Hydrobromide with same dose is a brownish viscid liquid. Granati Cortex. Better results in tapeworm by passing into duodenum by Einhorn’s catheter. 150 Gm. of powdered root bark infused for 12 hours in a litre of water, and boiled down to one half. Before use, warm to 100° F. and give three doses of 65 Cc., at half-hour intervals, followed by laxative, after which catheter is withdrawn. Only two failures in 19 cases.—L. ii./26,1354. PEPSINUM. Dose.—5 to 10 grains (0-3 to 0*6 Gm.) either with or immediately before or after meals, in a pill or cachet. It is not unpalatable sprinkled on meat like pepper. The gastric juice of man is believed to contain several distinct digestive ferments, the chief being :— a. Pepsin.—This changes protein (fibrin, albumen, etc.) into peptones in an acid medium, 0*2% of Hydrochloric Acid being the most advantageous. To this the medicinal pepsins owe their activity. . b. Curdling ferment, which curdles the casein of milk ; this is very active in the stomach of the calf, and will permit of its being dried ; it is contained in the preparations of rennet preserved with salt, known as: Essence of Rennet. Syn. Liquor Seriparus, Liquid Rennet. Dissolve Sodium Chloride 40 in water 810, add Alcohol 190 and macerate Rennet (calf’s stomach) 100 in the mixture for three days with frequent agitation, then filter.—N.F. Ph. Form, gives three other formulae-—one with Glycerin and Boric Acid as preservatives. Rennet can clot 400,000 times its weight of Casein in Milk—C.D. ’19,543. Rennin. Rennet Ferment in powder form. One grain dissolved in about \ ounce of water will in an hour or two curdle a pint of milk under ordinary conditions. (To be kept at blood heat.) Rennet Tablets are prepared and are of considerable convenience. One will curdle a quart of milk. Pepsin may be used in cheese-making instead of rennet. It is impossible to detect any difference between cheese made with pepsin and that made with rennet. The pepsin solution is : Sodium Chloride 2 lbs., Boric Acid 3 ozs., Water 1 gallon. Dissolve by boiling, then cool to 104° F., and add Pepsin 13J ozs.—C.D. ii./i 7,761. Pepsin is a light yellowish brown or white powder, or in translucent grains or scales, prepared by drying under 100° F. the fresh mucous lining of the stomach of the pig, sheep, or calf. It has a faint, not disagreeable odour, is moderately soluble in water. Rubbed with water, it makes a glairy mixture. Pepsina Porci is generally preferred. Pepsin is supplied to dissolve 2,500 (B.P. ’14), 3,000 (U.S.), and 5,000 times its weight of freshly coagulated and integrated white of egg. For various other Assay methods, see Vol.II. Incompatibility according to our experiments, depends to a great extent on concentration of the diluent fluid. A small quantity of electrolyte seems essential to enzyme action. Salts present in quantity hinder the enzyme. The following if present in strong proportion prevent action:— Alcohol, Copper Sulphate, Potassium Salts (Chloride, Alkalis, Extract of Malt, Bromide, Iodide), Alum, Magnesium Sulphate, Sodium Chloride, Paraldehyde, Hexamethylenetetramine. Further details, see Vol. II. Asbestos, as also Aluminium Hydroxide, has the power of removing Pepsin and other ferments from solutions, c/., p. 139. Flavoriu <7.-Syl Lavandulae, Syl Coriandri, or as Elixir Pepticus. Soluble and Insoluble Pepsins (Commercial). Insoluble Pepsins are of two kinds, one precipitated by salt, and one made directly from the selected membranes without digestion, but purified by washing in spirit. These require a small quantity of Hydrochloric Acid to effect solution in water. Soluble Pepsin is made by self-digestion of the membranes and subsequent dialysis of the resulting Peptone, thus leaving the peptic power in a soluble and more isolated form. It is then dried on glass plates, being sold in scale or powder form. Uses.—As a digestive, small doses, either in form of powder, or cachets, or one of the following preparations with or after meals are useful. The Tabellae, masticated, are specially convenient. In sprue and hill diarrhoea, Pepsin has given good results. In vomiting due to utero-gestation, pepsin in dose of 7 to 8 grains has been advocated as of service.—Yeo. Pepsin and Hydrochloric Acid given immediately after eating may inhibit carbohydrate digestion in the stomach. It should not be taken until from 30 to 45 minutes after eating—Prof. Diner, Jl. A.M.A., per Pres., Feb., ’20. Gastric and Duodenal Ulcers (600 cases) cured by subcutaneous injections of a 1% Pepsin solution (freed from albumin by pressure filtering through clay and containing Phenol). Begin with 0*2 Cc. thrice daily or every other day, increasing by 0-1 Cc. to 0-5 Cc., repeating this for 12 injections and then decreasing in the same way to 0-2 Cc. Injections said to be harmless and painless. Give Olive Oil before meals and Bismuth after meals. Avoid Belladonna and Sodium Bicarbonate, and give mixed diet.—K. Glaessner (Vienna), L. i./3^,78. Glycerinum Pepsin! {B.P. ’14). Dose.—1 to 2 drachms (4 to 8 Cc.) in water. A solution of Pepsin 8% strength in Acidulated Glycerin and water. This is a very active solution. If made with good scale Pepsin keeps indefinitely. Elixir Pepticus. Dose.—J ounce after each meal. Glycerin of Pepsin 8, Dilute Hydrochloric Acid 1, Aromatic Syrup to 32. Liquor Pepticus (Benger’s). Dose.—1 to 2 drachms (4 to 8 Cc.) in a wineglassful of water with meals. An active solution of the ferments in weak alcohol. Liquor Pepsini et Caffeinae. Martindale. Dose.—2 to 4 drachms in water after meals. The above dose contains 5 to 10 grains of Pepsin with 1 to 2 grains of Caffeine. As a digestive and restorative. The presence of Caffeine is stated to increase the activity of Pepsin. Cel) Elixir Pepsini Bismutlii et Strychninae. Dose.—1 drachm (=Pepsin \ grain, Bismuth and SodiunyTartrate 2 grains, Strychnine At grain). The formula is provided in XIXth Edn., p. 6G3. Tabellae Pepsini. Dose.—1 or 2 with or after meals. These have 3 grains of pepsin in each in combination with chocolate, they are palatable—a handy form of providing the digestive. Tabellae Pepsini et Bismuthi. Dose.—1 or 2 just before or with meals,—contain 3 grains bismuth oxynitrate added to the above. Tablets of Pepsin, compressed, 3 grains (0*2 Gm.). Tabellae Pepsini et Caffeinae. Contain 3 grains Pepsin with 2 grains Caffeine. Dose.—1 to 2 after a meal. Digestive and tonic. Vinuni Pepsinae. Dose.—1 to 2 drachms with meals. Pepsin 3, Diluted Hydrochloric Acid 3, Sherry to 60. For sale without a Wine Licence in the U.K. Pepsin Wines must contain 1 of Hydrochloric Acid {B.P.) in 80 of the total product. ^cPeptenzyme (T.M. 229531). Dose.—10 to 20 grains (0*6 to 1*2 Gm.) before or after meals and at bedtime. A preparation containing the enzymes which enter into the process of digestion. Suitable for varied types of indigestion. afcPeptenzyme Elixir. Dose.—1 to 2 drachms (4 to 8 Cc.). Is also made, pleasantly flavoured. Extractum Gastricum. Dose.—1 to 2 draclimi PEPTONE. 1 eptone is either in form of a brown paste or a whitish readily soluble powder. J rcr* f>r.ePare(l from meat (the proteins and albuminoids),, -^her acidulation and heat under pressure, or by artificia digestion with pepsin or trypsin, and freed from saline matter, f y Products may be treated by allowing to stand at room temperature V1** 5 their bulk of 70% Sulphuric Acid. Water is ?K?2la?d the mixture cooled and neutralised with Barium Hydroxide, an(£ » iLr' Ff-°n^ S0^1t10.11 dried in vacuo. Phosphoric Acid may also be employed Alternatively Casern or Geiatm are operated upon in alkaline solution, the last-mentioned by aid of Pancreatin. Certain types of peptone have been extensively used in bronchia'' asthma by the process of immunisation with non-specific protein vide infra. Pepfconised Beef. A chocolate-coloured paste, having a bitter taste and the odour of extract of beef ; prepared by artificially digesting beef b}^ means oi: acidified fresh gastric juice and concentrating the solution. It k sometimes added to beef tea, but is too unpleasantly bitter to be readily taken by patients. Enemata, v. infra. FcEm yis: is manufactured by digesting 1 kilo of beet with 10 litres of water (containing 4 Gm. of hydrochloric acid per litre) witln pepsin 10 Gm. for 8 hours at 50° noth frequent shaking. Termination oil reaction shown by absence of precipitate with nitric acid on adding to a little? °* the filtered liquid. Evaporate. 1 kilo yields 250 Gm. approximately. In ILL. \ 111 directions are abbreviated. Peptone made with Pepsin audl lartanc Acid is employed m Vinum Peptonae. F.E. : Peptone 5, Glycerin 5 Malaga 90 by weight. Dose— 1 tablespoonful (15 Gm.). Peptonoids of Beef. Lean Beef, finely minced, 8 ounces, Pancreatin 60 grains, Sodium Bicarbonate 60 grams, Water 1 pint. Digest 3 hours at 130° F. with constant stirung ; neutralise with hydrochloric acid, boil, strain and press. As enema 1 ounce with normal saline 3 ounces, p.r.n. ^Garnrick’s Liquid Peptonoids (T.M. 4799277 and ~9o85)— Beet, Milk and Wheat is a predigested food. Dose.—table- spoonful at intervals. May be dispensed by registered chemists without requiring a spirit licence to be taken out, providing it forms a constituent ofc a bona-jide medical prescription given by a duly qualified medical practitioner. Also applies to * Panopepton (T.M. 231581).—P. J. i./i i,568. Beef Peptone with Malt. Dose— 2 to 4 drachms. A palatable nutrient. PROTEIN THERAPY. Ski n Reactions. It is possible to determine by skin reactions whether an asthmatic is sensitive to vegetable and animal proteins, and the subsequent' treatment is by (1) segregating him from the offending protein, (2) by ‘ desensitising’ him with the specific ‘ antigen,’ or (3) 4 desensitising ” him with gradually increasing doses of 4 non-specific ’ protein. The pioneer in introducing Cutaneous Tests was, we believe, I. C. Walker.. For Refs, to original papers, see Edn. XIX. Skin Test Solutions. n* Various workers speak oiAnaking the Test Solutions by 4 Solution ” in N/I0 Sodium Hydrate—i.e., maceration of the protein preparation for a period of time in the alkali. Solutions supplied for the purpose, which we examined, appear to be without this alkaline sol- \ent—— i.e., they are made by macerating the protein in water or saline. They contained no preservative. They should contain 0*5% Irikresol, with controls of a similar composition. Test Solutions may be arranged in groups :— Animal Proteins:—Various meats (beef, mutton, veal fish, egg, milk, butter and cheese. chicken, game), Furs and Feathers v—Uorse, dog, cat, sheep, rabbit, chicken, goose, etc. Cereals Wheat, barley, oats, rice, tapioca, sago, corn, rve. Fruits :—Various. VegetablesVarious (potatoes, cabbage, etc.). FungiMushrooms Beverages Beer, wine, tea, coffee, cocoa. Bacterial:—B. Coli, etc. Moulds :—Aspergillus, Penicillium. Pollens:—These, for use in Great Britain, should be of typical indigenous British grasses and trees rather than from plants indigenous abroad. (It is stated that grass pollens are similar in effect while the nollen of “ flowers ” differ.) 1 ollen Ophthalmic Test Solutions are prepared of seven graduated strengths. The solution is dropped on the eyeball and a positive reaction is indicated by slight reddening of the eye. Technique.—Cleanse the skin on the inner side of the forearm with Ether and place a drop of protein upon it. Scratch sufficiently to break the skin without producing bleeding. Do the same on another place on the forearm, using a drop of control fluid. A + reaction shows in a few seconds by a zone of hypersemia spreading outwards—followed in 20 to 30 minutes by the production of a definite urticarial wheal, of at least £ inch in diameter with little or no effect at the control. Asthmatics show sensitiveness only occasionally to a particular protein, hence the skin test is only reliable in a small percentage of cases.—W. Langdon Brown, B.M.J. ii./25,205. Hay fever in U.S.A. is attributed to Ragweed (Ragwort) and pollens.—I. C. Walker, Jl. A.M.A., Sept. 20/782. Asthma, hay fever, urticaria, angio-neurotic oedema, may be classed in the group of toxic idiopathies. Hypersensitiveness may possibly be acquired, e.g., by constant contact, as in bakers with flour proteins but it is improbable that the condition arises de novo from absorption of foreign protein via the subcutaneous tissues or a damaged mucous membrane.—Sir H. Rolleston, L. ii./2i,231 ; B.M.J. ii./21,233. In the majority of asthmatics the trouble is due to inhalation of dandruff from fur, feather or hair of domestic animals.—F. Coke, B.M.J. i./2i,372 and 615. See also J. Freeman, Pr., Jan. ’26,73 ; Mackenzie Wallis, B.M.J. ii./2i,796. This tendency to develop toxic symptoms is markedly hereditary. Idiosyncrasy towards more than one substance is the rule.—H. W. Barber, B.M.J. ii./2i,554. Not more than 50% of all cases give it. 130 test substances used at New York hospital. In asthma cases giving a negative protein cuti-reaction, bacteria play a prominent part. In skin tests the grass pollen reactions are greater than those of food proteins. Any grass pollen can be used for the test but the pollen of each kind of flower is different. Some cases of epilepsy give definite + protein skin test.—J. Freeman, Mackenzie Wallis, Fran Coke (Histamine may possibly be concerned in production c asthma), A. E. Gow, and others, B.M.J. ii./2i,196. With a protein to which the patient is very sensitive, the blu& from the original injury to the skin does not fade, but graduall spreads and deepens, and begins to irritate and smart. At oth» times, the wheal is almost absent and a large area of redness is tk chief sign of the reaction. This is only of value when the contr or other tests give no reaction at all. It may be delayed for 4 a even 7 hours. Analysis of 270 cases.—A. Latham amd F. Cok Pr., ii./22,12i. 80% of asthmatics found to suffer from some form of All erg Common moulds form allergens to which 50% of asthmatics a sensitive. 1 in 1,000,000 dilutions often have decided therapeut effect. Allergen-free chambers used in treatment.—W. Storm va; Leeuwen, B.M.J. ii./27,344. While van Leeuwen finds that ^ fumigatus which flourishes extensively in Kapok is one of the chi causes of asthma in Holland, where most mattresses are stuffed wit the material, F. Coke advises its use in pillows to replace feathers.- Leader, ibid., 355. Strong support for van Leeuwen’s work.—I Kennedy, ibid., 517. If a patient is sensitive to feathers alone he will be relieved of his asthn if put on Kapok Bedding. The house dust of patients’ own houses used i< desensitising patients. Reactions with proteins are extraordinarily specific.- P. Coke, B.M.J. ii./27,517. Skin reaction helpful. A patient, emaciated and profoundly depresse highly sensitive to cereals, had same removed from his diet, with the dramat result of 16 lbs. gain in weight in a month.—W. Langdon Brown, B.M. ii./22,758. See also F. Coke, ibid. 760. Asthma in childhood.—Of 50 patients, 40 were child asthmatics. Nine we positive to pollens, one to dog, one to cat and one to bacon.—A. Dingwa. Fordyce, L. i./23,175. The abstracts under Sensitisation in Asthma should also be cost suited. Peptone Immunisation in Bronchial Asthma. The treatment of bronchial asthma by immunisation with sme graded doses of Peptone has been employed with success. To A. G. Auld is due the credit of introducing (in 1917) this metho of ‘ Non-specific protein therapy.’—B.M.J. i./i7,580 ; ii./x 49; i./20,567; i./2i,69G ; i./22,835 ; i./25,448,762 ; ii./26,732 i/27,829; L. i./23,790. Though Peptone acts as a non-specific desensitiser, it is by it means certain that a protein to which the patient is sensitive aiwaw acts specifically and not in the same manner as Peptone. In th method it is unnecessary to find the protein that is the antigen. A satisfactory immunising process is characterised by a sligl leucocytosis, particularly re the large mononuclears, and by increa; in hsemoglobin and red cells.—A. G. Auld, B.M.J. i j22,835. To test a Peptone as to suitability for clinical use. (a) Add an equal volume of saturated aqueous Ammonium Sulphate Solution to a 10% solution of the Peptone and stir with a glass rod. If satisfactory, a sticky precipitate, which adheres to the rod, comes down. The sample should also respond to half-saturated Ammonium Sulphate— this precipitates the primary proteoses. .(&) Add to a few Cc. of a solution, in a test tube, two or three drops of strong Nitric Acid. A copious white precipitate is immediately produced, consisting of primary proteoses. On heating, the precipitate entirely dissolve s, and re-appears on cooling. Uses.—The treatment has been applied not only to asthma, but also to such of its congeners as hay fever, associated skin affections, angio-neurotic oedema, cyclic vomiting, periodic diarrhoea, and the migraine-epilepsy syndrome ; in short, to such conditions as exhibit an anaphylactic character or sensitisation. Cases resisting treatment Many of those with chronic bronchitis and developed emphysema, and cases presenting any degree of cyanosis, even without bronchitis ; also those in whom, apart from asthmatical paroxysms, a more or less oppressed condition of the respiration is practically never absent. Where there is a family history of asthma from childhood one may get benefit for two or three weeks and then bitter disappointment. In such, a mildly toxic dose has to be given. In difficult cases a mixture of Peptones sometimes succeeds best.—A. G. Auld, B.M.J. i./2o,568. See also Serum Peptone, p. 664. Technique. Two distinct procedures have been evolved : (1) Intravenous ; (2) Intramuscular. (l) Intravenous Treatment. A 5% solution of Peptone, of a special type, is employed. It contains 85% Protein, 60% of which represents primary and secondary Proteoses in the proportion of 1 to 6, i.e., there is a high content of the secondary bodies. The hydrolysis has not been carried to the Amino-acid stage. It does not contain substances irritant to the tissues on injection. Care is taken (a) to prevent the delicate albumoses being decomposed by excessive heat; (b) to neutralise the solution ; (c) to determine the solution is sterile. Contamination may cause grave consequences. The solution is in effect a culture medium for bacteria in the event of chance contamination. Peptone Sterules for Intravenous use, to comply with these First Dose 0-3 Cc. ( 5 minims). Second j } 0-5 „ ( 8 ” 1 Third y y 07 „ (11 ” 1 Fourth y 1 0-9 „ (131 ” \ Fifth 99 1*1 „ (17* „ ) 99 Sixth Dose 1-3 Cc. Seventh ,, 1-5 Eighth! to 1* Tenth J (20 minims). (25 „ ) 9 9 1-5 ft (25 99 ) Continuation Course (Intravenous; oi repmnc ._TW In addition to the above, a set of six doses is arrange doses each of 2 Cc. (30 minims) and 2-5 Cc. (40 minims). The injection is given slowly intravenously m the arm, no after dressing being necessary. The doses are adminis err every oui or fifth day. The dose must be varied in certain cases. Shading-off Courses (intravenous). The procedure according to A. G. Auld (B.M. J. i./25,448) is safe. Writing concerning the intravenous technique, this authority advises dosage up to the tenth dose as hitherto, and alter the tenth; dose cases are broadly divisible into three classes. In one class the? patient is quite well, and usualty expresses surprise at his condition ;; in another he is much better, but not yet quite well; and in a third; he may be but little better. In the first class, two additional doses of 2 Cc., approx, mav be given and then there is a shading off to complete the treatment with the following weekly dosage : 1*5 Cc., T2 Cc., TO Cc., and 0-6 Cc. This completes the course. In the second, if the patient is standing the Peptone well, the dose may be increased to 2 Cc. and 2-5 Cc., employing the Continuation Course. Them there :s a weekly reduction to complete the treatment, namely, with a dosage« of 2-2 Cc., 1-5 Cc. and 0-9 Cc. If, however, during the treatment the patient has an attack of asthma, reduce the dose considerably, say, to T5 Cc. Continue with this for two or three weeks and then reduce to 1 or 0-6 Cc. In the third type of case Auld advises that Peptone, dissolved in the serum from the patient’s blood, be injected intravenously. Vide Serum-Peptone. Shading-off Courses for Class I. are arranged of six Sterules, containing 2 Cc., T5 Cc., 1*2 Cc., 1*0 Cc., 1*0 Cc., 0-6 Cc., and Class II, containing three Sterules, 2-2 Cc., 1-5 Cc., 0*9 Cc., are prepared. (2) Intramuscular Treatment. Peptone]: Sterules for Intramuscular use are made of ;7£%, strength in the same range of ten doses (0-3 to^l-5 Cc.) as also a Continuation Course (Intramuscular) of six doses, three of 2 Cc. and three of 2*5 Cc. Dosage for children.—The 7£% solution is also used intramuscularly commencing with 0-3 Cc. (5 minims). Intramuscular technique is as efficacious as the intravenous in the majority of adult cases. Adrenalin which is acknowledged of utility in asthma has been used satisfactorily in conjunction with the Peptone treatment. Serum Peptone. The intravenous injection of Peptone dissolved in a serum obtained from the patient has given good results in cases where Peptone alone proved unsatisfactory. Run 2 or 3 ounces of blood into a sterile 4-ounce glass tube, and allow to stand corked at room temperature till next day. Allow no food for 5 hours before bleeding, so that the serum is clear. Pipette off and add an Agar solution, made by mixing one part of Agar with 1,000 of Saline well boiled. One volume of this is shaken with 4 volumes of Serum, and the mixture incubated at 37° C. for an hour. Peptone Powder (Armour No. 2) is added, preferably in 24 or 3%, increasing to 5%, and the mixture is incubated for a further hour. Phenol 0-5%, vide infra, mixed with about 15 minims of Saline is then added in two portions with shaking. To a patient with quiescent asthma this solution is given in 14 Cc. doses intravenously every 3, 4 or 5 days, increasing gradually to 3 or 4 Cc.—A G Auld, B.M.J. ii./26,732 ; i./27,829. In preference, the blood should be obtained just prior to an attack. The following is now advised : Incubate the Agar Serum for about 2 hours at 37° C. Then 4 Cc. of a 30% Peptone Solution mixed with 21 minims of Phenol is added to each ounce of the Agar Serum.—B.M.J. i./28,171. Chloroform (3 or 4 drops) now employed as a preservative instead of Phenol, as giving a clear mixture for a considerable time.—A. G. Auld B.M.J. i.j29,991. Witte s Peptone.—This brand of Peptone is made at Itostock in Germany. It is much more toxic in effect. According to Auld (B.M.J. i./2i,G96) it contains too much primary proteose in relation to secondary (roughly 1 to 2), whilst in Armour’s the proportion is 1 to 7. Borne cases of asthma and hay fever are remarkably sensitive to intravenous injection of Witte’s Peptone. 0*2 Cc. of 2% solution caused vomiting: the patient’s eyes became suffused, and in less than five minutes his back was covered with urticaria.—A. E. Gow, B.M.J. ii./2i,237. Histamine to extent of 0-00335 Gm. in 100 Gm. was found in Witte’s Peptone. Its presence in Peptone is responsible for dyspnoea, flushing, etc., sometimes produced. It is useless in the immunizing process, if not actually harmful. . Armour No. 2 Peptone never gives the Histamine effect. It may be safely given to young children. Witte’s Peptone is best given with a weaker Peptone. Physiological testing suggested. The dermal (scratch) test may give evi- > dence as to the presence of Histamine in a strong Peptone solution. All : individuals give a marked though varied response to extremely dilute Hista- j mine solutions. Ergamine can be used as control. Preparations giving a i large wheal are unsuited. Confirm by intravenous injection of a small dose.— t A. G. Auld, B.M.J. i./2i,698 ; i./22,835. Anaphylactic asthma successfully treated with Witte’s Peptone. Initially I hypodermically 0*3 Cc. 2% solution, with sufficient Sodium Carbonate to j suspend and neutralise it in Normal Saline, increased every fifth day by 0-2 Cc. up to sixth injection (1-3 Cc.), when symptoms disappeared ; this dose repeated l further three times and patient discharged cured.—I.M.G., June, ’26,285. The M.L.D. c£ Witte’s Peptone is about 0-3 Gm. per kilo in the unansesthetised ) dog.—E. G. Gross, Jl. Pli. and Exp. Ther., Mar., *27,359. Anaphylactic shock (in the dog) in part due to specific effect on the hepatic 3 veins. It causes an obstruction, probably the result of constriction.—J. P. \ Simonds and W. W. Brandes, Jl. Ph. and Exp. Ther., Feb., *29,170. “ Peptone Witte Special 30.” Stated to be less toxic than Witte’s ordinary Peptone. Fatal dose 80—100 i mgr. per 100 Gm. rat, against 40 mgr. Auld has used 5% solution, which i produced no irritation subcutaneously or intramuscularly, and satisfactory i intravenously, but the latter must be used rather cautiously. Besults from Germany and elsewhere show that non-specific treatment may well replace specific, even if the allergen can be discovered. The proteose of the patient J takes up the allergen and excretes it (Oriel), which alone is sufficient reason for injecting Peptone.—A. G. Auld, L. i./3i,S04. For further$iote onYWitte's Peptone see PeptoneSterules 10%, 10 Cc. Sensitisation in asthma.—It is known that if an animal is injected with a dose of some foreign protein, e.g., wnite of egg, normal horse serum, etc., and after a sufficient incubation period, a second injection of the same protein be given, profound symptoms will take place, leading even to death in a few minutes. Asthmatics, soon after being exposed to the article to which they are sensitive, have their eyes running, and asthma develops. Our knowledge of wha actually happens between the first sensitising dose and the secon , is a matter of theory. With regard to predisposing factors, tens o thousands of injections of antitoxic horse sera were given during e war, but, for various reasons, these did not induce sensitisa ion. Theories apart, man can become sensitive, just as animals. eas 40 deaths are recorded from the injection of horse sera in man, c ue y in asthmatics, who we reasonably suppose to haveieen or®e~ asthmatics.—A, Latham and F. Coke, Pr., Aug. 22/ . ee a so B.M.J. 1/21,312. P Asthma begins far more frequently in babyhood or early childhood than at any other time, and the great majority of these cases are sensitive to some protein. Compound Licorice Powder, holly, fac powders, silk, linseed, and Aspirin, were among the causes of sensitisa tion. In certain cases, Peptone given intravenously is valuable.— Frank Coke, B.M.J. i./27,955. fr» children, where the attacks are of the clear-cut spasmodi kind, Peptone is particularly useful. It is of most use intravenously The initial dose should be small and carefully given, because th patient may be sensitive to the Peptone and have an attack of sick: ness or more grave anaphylactic symptoms. More commonly wheir a large dose is being given the patient will immediately flush, fee uncomfortable, and be sick. Subsequent doses in such event mus be given into the muscle or subcutaneously. The value of Pepton- when given in large doses to promote protein shock is not so certain nor so convenient for use as an intravenous dose of T.A.B. or th Mixed Coliform Vaccine. A course of Peptone usually consists o: twelve doses given twice weekly, but there is no great harm, ofter great benefit, in giving the course for six months, the large dose being given at weekly intervals. Hundreds of injections given witi no alarming results—with one exception.—Frank Coke, B.M.Jr i./28,468. Treatment of asthmatic attacks in children is best made by Adrena lin solution 2 to 3 minims. Treatment of the tendency is more difficult and important and consists in regulating the patient’s life diet, possible removal of adenoids and tonsils, and sometimes the us of a vaccine prepared from sputum obtained during an attack. A lengthy course of a mixture of small doses of Potassium Iodide witi full doses of Belladonna or Stramonium and Arsenic of value.— R. Hutchison, B.M.J. i./27,783. Asthma in children.—Peptone and like compounds not advisable as they may lead to dangerous results in very hypersensitive cases.—W. R. F. Collie L. ii./3o,567. Epilepsy.—Twenty cases of haut mal type (average age 18 years)' Peptonejintravenously arrested fits in 9 and lessened frequency in s. further 6. (Bristol Royal Infirmary and Stoke Park Colony fo::» mental defectives.)—F. H. Edgeworth, B.M.J. ii./2O,780. See also: A. G. Auld, ibid. 840. Intramuscular injections proved of great benefit in a man of 35 who had suffered from fits for 15 years. The first dose of Peptone brought improvement The full course of injections was given, terminating with the Continuatior- Course. 8hould be tried in resistive cases.—G. It. Hull, Pr., Oct., 1922. Peptone Sterules (1 and 2% strength, Intravenous), as an aid in Vaccine treatment. In Vaccine Therapy, as an aid to overcome hypersensitiveness, met with, especially in treating the arthritic group of infections^ Peptone has been well spoken of. A course of 10 injections intravenously is advised as follows :— On the first day 0T Cc. of a 1% solution ; on the second day 0-2 Cc. of 2% solution; on the third day 0-4 Cc. of 2% ; on the fifth day 0-8 Cc. of 2%; on the seventh day 1-4 Cc. of 2%, and thereafter, at three or four days intervals, T8 Cc., two or three times. Having reached 1-4 Cc., a subcutaneous dose of vaccine can be given at the same time. This may be rather larger than the one the patient was sensitive to before treatment. No reaction, it is stated, will occur.—H. Warren Crowe, B.M.J. i./23,l046. Peptone recommended for anaphylaxis in vaccino-therapy by L. Moinson.— L. ii./29,1097. Varied forms of chronic non-infectious diseases treated by the Danyss method.—subcutaneous injections of heterogeneous bacillary proteins—or by Nolf’s method—intravenous injection of Peptone or heterogeneous injection of bacillary proteins. Gow used B. Coli or B. Typhosus, 25 mill, to 100 mill, killed bacilli, suspended in 10 Cc of normal saline, increasing in subsequent doses. Intravenous injection of 10% Peptone is efficacious, but decidedly more exciting to administer.—E. J. Sadler, L. i./ 22,929. Pep to no per os. Dose.—7\ grains (0*5 Gm.) twice daily one hour before the two principal meals. In view of the presence of Peptone practically constantly in the stomach or alimentary canal, the giving of Peptone per os looks like carrying coals to Newcastle.—A. G. Auld. Migraine in dyspeptics, benefited by grains of Peptone per os, J- hour before the three chief meals.—Pagniez and Nast, L. ii./2o,143. Migraine successfully treated with Peptone, 1 grain twice daily.— B.M.J. i./30,1159. In some epileptics small doses found of value.—R. L. Mackenzie Wallis and W. D. Nicol, L. 1/23,741. Urticaria, has been treated with success. It is a manifestation of the anaphylactic state, French dermatologists advocate the ingestion of 0-5 Gm. Peptone one hour before each meal.—B. Hallam, B.M.J. ii./28,880. Abstracts from literature on Non-Specific Protein Therapy. 1. PEPTONE. Pyrogenic Therapy. 0 Protein Shock’ of American workers.) A full pyrogenic reaction, viz., good rigor, high pyrexia, body pains, profuse sweating md usually sickness and diarrhoea are often salutory. Amenable to tne ueatment are arthritis, neuritis and neuralgia, certain skm affections and jubacute or chronic inflammatory exudations.—A. G. Auld, B.M.J. ii./2 ,oz. Pyrethorapy for G.P. /* with Typhoid Vaccine, see Typ or . Scientific basis of Non-specific Protein Therapy.—-In man% oases non- specific vaccines and serums although empiric are as active as the p • Peptone (intravenously) gives a less violent reaction than vjee . common active principle is, no doubt, a product of protein d~c P , * rhe toxic effect of Witte’s Peptone is well kmowm, but so-called peptone poisoning is produced by proteoses and albumoses, and Pfote u produces town completely to peptones have little toxicity. Witte sP p P Qn’ >n heating with acid or alkaline Alcohol, Vasodiiatm. 1- Ghn-y1 0f >f this, and the minimum lethal dose of the peptone wa^ 4 g . P q nouse, while the minimum lethal dose of Vasodilatm w 10f)gn ^ tfistamine in Witte’s Peptone is not more than 3 mg . P ffecte(i py the iractically non-toxic. With regard to the blood c g liave a strong nethod, there is no doubt that these protein ymphagogue action, and produce increased penn proffon Therapy causes a :specially in the liver and in the skin. Non-specifics Pi vashing out of the Ussue fluids into ^^g^cient to show which of these S5y oJchiJcltoicaltaportance,—A. 3. dark, B.M.J. 0*3,815. Eleven out of 20 bronchial asthma patients ‘ more or less * improved witr H intravenous injections of a 5% solution, the doses increasing from 0-5 to 3 cry 4 Cc. The writer agrees with Dr. Auld that the intervals of recurrence of tl n attacks become less frequent after Peptone Therapy.—P. Boot, ‘ The Trea } ment of Bronchial Asthma by Intravenous Injections of Peptone,’ Re vie v. n L. i./26,6 . In British East Africa bronchial asthma (which is very common) has bee: H treated intramuscularly, commencing with 2 Cc. doses, at intervals of 5 c B G days. Smaller doses were found practically useless for adults. In ail thee-1 cases (of G months to 5 years’ standing) beneficial results were obtained f improvement being usually noted after the third injection.—E. E., June, *2 a Chronic cases op urticaria, seborrhoea, seborrhoeic eczemas, depi matitis DUE to irritants, and chronic skin conditions generally, where thi patient is sensitised, are affections in which excellent results were obtaine using ‘ Sterules ’ Peptone 5%, injected intravenously. It is essential to use reliable brand of Peptone and one that is Histamine-free. In acute condition/ the intramuscular injection of 5 Cc. of the patient’s blood giving a furthe injection of 10 Cc. five days later, and continuing with this quantity at interr vals of 5 days, seemed to give good results. The reduction of the pil value 0. the urine (if it is to be hyperacid) to normal by means of an alkaline mixture it also advocated.—H. B. B. Hull, Jl. R.N.M.S., April, *26,147. In military medical practice the method of value in cases 0 local densitisation such as seborrhoeic dermatitis that has been scratched am infected with a skin staphylococcus, and of general sensitisation such ail urticaria. The graduated doses are ‘ fool proof ' and an overdose in a flight sensitive patient is impossible. They have a remarkable effect on most case of asthma.—Jl. R.A.M.C., Nov., ’26,400. Migraine.—In the treatment of migraine, resistant to the commone methods, some cases (7 out of 20) showed marked improvement a#ter 8 tv 10 injections of a 5% solution, from 5 to 25 minims being injected at a time each dose being increased by 5 minims.—L. ii./27,241. Dermatitis Herpetiformis.—Peptone subcutaneously said to have given good results in a few cases.—Jl. A.M.A. ii./25,631. Arthritis.—Good results in rheumatic or fibrositic conditions and toxcemi«< states, e.g.t urticaria. Contraindications, marked debility, tuberculosis- diabetes and advanced cardio-vascular disease. Primary dose, 0*4 Gin. 0 Peptone for a man, 0-3 Gm. for woman, intragluteaily with injections at 5 or 0 day intervals of twice preceding dose. Three or four injections usually effected cure. Dosage regulated to obtain reaction temperature of about 101° E.—E. Bulmer, Edin. Med. Jl., per B.M.J.E. h/25,8. Rheumatoid arthritis showed marked improvement from use of Peptone.— J. Eason, L. ii./26,1065. Arthritis deformans treated with peptone intramuscularly, 0 2 Gm. dosffl weekly.—Goodall, B.M.J. i./23,512. Diarrhoea Haemoptysis.—Often rapidly effective in. Pyrexia should: never follow.—B.M.J.E. i./26,3. Colitis and Haemoptysis.—Favourable results with Peptone. Excellent- effect in asthma confirmed.—H. Pollitzer, per Jl. A.M.A. ii./25,2001. in anthrax, intramuscular injection of Peptone 3% in doses of 30 Cc. daily in 43 cases. The results were as good as those obtained when a normal oir specific serum was used.—R. F. Vaccarezza and co-workers, per T.D.B. 19/22,897. Pneumonia, subsequent to operations involving the upper abdomen,, thought to be anaphylactic in origin, the protein shock coming from the; intestines. Desensitisation before the operation with Peptone 0-3 Gm. ini Normal Saline 2 Cc. is now carried out when time permits in all abdominal! sections and no case which has had Peptone has developed pneumonia.— M. Dixon, B.M.J. ii./27,985. 2. OTHER AGENTS. Chronic Arthritis.—T.A.B. Vaccine intravenously produces rapid improvement in 80—90% of cases, which is maintained in between 50—60%, the types responding best being acute and subacute, PEPTONE. 669 where disease is confined to the periarticular tissues. Injections of no use unless all possible foci of infection removed. Reactions severe, but contraindications few—disease of myocardium, gross, kidney disease, chronic alcoholism, tuberculosis and syphilis being; the chief. Cases of the menopause group of the chronic villous type and those showing achylia do not do well. Initial dose 100 mill, (in private piactice 50 mill.), increased at each subsequent dose by 100- mill., 4 days elapsing between inj ections. Dosage should be regulated to produce rigor, sharp rise of temperature, quick fall, and profuse perspiration. Of 50 cases treated 44 were discharged after 4 weeks as definitely improved.—W. Yeoman, L. h/26,1246-50 ; see also Leader, 1265. In a small percentage of cases miraculous results with non-specific agents, either protein or preparations of B. typhosus. More might be done to search for that part of the protein molecule that is therapeutically active.—A. Goodall. L. ii./26,1065. The results in rheumatoid arthritis from Typhoid vaccine intravenously may be as much attributable to stirring-up of focus of infection as to stimulation of the defensive mechanism of the body, and the ultimate factor in determining cure may be the response to the antigenic activity of the infecting organism, this response being evoked not directly but indirectly by the protein injected. —E. M. Dunlop, B.M.J. ii./24,1110. In addition to injection of proteins, e.g., proteose preparations and bacterial vaccines, which are efficacious in cases of arthritis, including rheumatoid arthritis, other measures for producing non-specific effects have been employed, e.g., the artificial abscess following subcutaneous infection of Turpentine, and even artificial interposition of another infection. There i s justification on the laboratory side. In pigeons, a relative immunity to B. avisepticus has resulted from injection of B. coli, vaccine.—T. J. Mackie, B.M.J. 1./25, 91. Fibrositis—a large proportion of cures and improvement by protein shock therapy, using a combination of toxin and bacterial protein.—G. Paul, L. ii./25,7ll. Articular rheumatism (300 cases) treated by massive doses of Sodium Salicylate, 10 Gm. increased by 2 Gm. daily to 18 Gm., and Sodium Bicarbonate 20 Gm. increased to 36 Gm., combined with shock induced by Colloidal Silver injection, Peptone or Milk. Large quantities of water taken.—Brux. Med., June 14, ’25. Per Pres., Feb., ’26,77. See also Colon B. Vaccine and Therap. Index. Sciatica of the sacro-iliac joint: T.A.B. vaccine intravenously gives the best chance of removal of symptoms in the shortest possible time.—W. Yeoman, L. ii./28,1119. Asthma. True cases of bronchial’asthma benefited by prolonged injections of P.T.O. dilutions, beginning with 0-5 Cc. of 1 in 1,000,000 and gradually increasing. The treatment must be kept up for a year at least and injections twice a week are given for the first 4 months, then once a week for 4 months, and lastly once a fortnight.—T. Nelson, Pr., June, ’27,382. Tuberculin in treatment of asthma acts merely by virtue of its Protein content.—L. Ilofbaver, W. Klin. Woch., Dec. 3, ’25,1311. Pres., ’26,158. Malta Fever.—Protein Therapy a useful adjuvant in the treatment of.— Per. Jl. A.M.A. ii./25,1999. Gastric and Duodenal Ulcer has been treated by protein therapy. Disappearance or reduction in 29 out of 51 cases.—V. Gromer, Med. Klin., June, ’26,991, per Pres., Jan., ’27,19. Histologic study of the ulcers did not reveal any curative effect from Protein Therapy on peptic ulcers.—Per Jl. A.M.A. ii./25,1013. Diabetes Mellitus well treated by Protein Therapy.—B.M.J.E. i„/2 6,25. Recent References to Protein Therapy in General. Asthma, hay fever, eczema, urticaria, angioneurotic oedema and migraine appear to be intimately correlated and interchangeable.—G. W. Bray, B.M.J i./30,387. Treatment by desensitisation, though still empirical, has given very goocl results in some cases.—L. ii./3i,1140. It is an undeniable fact that a small injection of animal protein in high! dilution has very marked effect on the spasmodic attack associated with asthma.—T. Nelson and A. D. Porter, L. ii./31,1344. Asthma due to protein sensitiveness (dog). Opinion divided as to Peptone.— C. J. Murphy, L. i./31,813. Asthma well treated.—J. Mowbray, L. i-/3x,813 Urinary Proteose. . . . Proteose in the urine excreted in anaphylactic and allied conditions. Tft& substance gives the Biuret reaction. It is not coagulated by heat, but by Lead Acetate : nor by half-saturated Ammon. Sulph., but is by full saturation Gave intradermal reactions in dilution 1/100,000 in horse sensitives. The* proteose contains the antigen to which the patient was sensitised. Used in urticaria, etc.—G. H. Oriel and H. W. Barber, L. ii./3o,231. Injections of autogenous urinary proteose incredibly specific in conditions such as chronic urticaria, angio-neurotic oedema, eczema, prurigo, dermatitib herpetiformis and psoriasis. Only infinitesimal doses necessary, e.g., 0-025 to. 0-1 Cc. of a dilution of 1 in 10 million, or even 1 in 100 million. Having found the dose on -which patient improves progressively decrease rather than increase* it.—H. W. Barber, L. ii./3i,1267. ‘ Specificity ’ questioned. Chief peculiarity not specificity, but property of producing intense local inflammatory reaction in certain individuals, the- significance must be interpreted cautiously.—R. M. Lyon, G. H. Percival and C. P. Stewart, B.M.J. i./32,136. AnEphylExis Several cases of sudden death following injection of foreign protein, e.g.,, serum, pollen, etc., have occurred in the past 5 years. A study of.—R. W. Lamson, Jl. A.M.A. ii./29,1778. For treatment of hay fever with Pollen Extracts see Hay Fever. Peptone Ointment.—In abscesses of the sweat glands and bartholinitis„ an Ointment of Peptone 10, Distilled Water 10, Lanolin 20, Vaseline 60, lias, been successfully used.—M. i93U Pt. II.,207. Milk Injection. Sterilised. Dose.—5 to 10 Cc. intramuscularly but much smaller doses have been used in certain affections. Milk Sterules 5 and 10 Cc. are made. (The milk in preference should be freed from the bulk of its fat.) The gonococcus cannot resist a high temperature. It has been observed that if an intercurrent febrile disease arises whilst a patient is suffering from gonorrhoea or an acute epididymitis complicates the case, the urethral discharge may cease without returning. Schmidt and Saxyl reported in 1916 that protein reactions could be produced by milk injections. Hence these injections which have the power of raising body temperature might have effect on the gonococcus. The method was tried in acute and subacute stages of gonorrhoea, injections into the gluteal muscles of sterilised milk in 5 Cc. doses, 10 Cc. into each buttock being given. Chill, general malaise and rise in temperature followed ; normal in 24 hours. Dangers nil and results good.—M. W. Browdy, L. i./23,874. Acute Gonorrhoea treated with milk injections combined with local treatment. Initial dose 4 Cc., increased by 2 Cc. Duration of treatment shortened.—B.M.J.E. ih/24,86. Milk injections in gynaecology.—B.M.J.E. i./25,13, Infantile convulsions tinted with milk injections. After giving 10 mnims into the child s thigh the effect was magical. ? Anaphylaxis the actual cause of the fits, and whether the injection of milk desensitised the c , • Also found successful in diarrhoea.—W. A. Wilson-Smith; B. P. Sabawala, B.M.J. i./23,238. * x Subcutaneous injections of milk in infants.—B.M.J.E. i./2 6,30. Interstitial keratitis well treated with combined treatment of Neosal- varsan (intravenously) and milk (intramuscularly).—Van Lint, per Pres., Erysipelas and eye affections have been treated by Milk injections. f Bapid recovery in 15 cases following intragluteal injection of 5 Cc. Contraindications : pulmonary tuberculosis and chronic recurrent hematemesis.—B.M.J.E. i./2 8,85. G.P.I. Milk Therapy considered superior to anti-syphilitic treatment. Injections of 10 Cc. of sterilised milk under the skin of the abdominal wall. 40 cases of G.P.I., many of chorea, and several of epilepsy treated by this method in Budapest.—L. i./24,1231. Leprosy well treated by intravenous Miik injections. 12 cases treated with sufficiently good results to enable them to resume their employment. The treatment is drastic and dangerous and especially applicable to the late and more hopeless forms of the disease.—-K. A. Dyce Sharp, Trans. Boy. Soc. Trop. Med., Jan., '28,308. Lobar Pneumonia.—Injections of 10 Cc. of milk repeated once or twice. Of 23 cases treated 6 died.—H. B. Eichelbaum, U.F.C., '25,205. PHENOLPHTHALEINUM. B.P. ’14, U.S., Pk. Ital. V., P.G. VI., P. Belg. IV., F.E. VIII. Syn. >jcPuRGEN (T.M. 243986 and 286636 Assoc.), ^cLaxoin (T.M. 253802), Dihydroxyphthalophenon. CfiHa<c(Q6ri4-°H)2'-o=318-1092. Dose {B.P. ’14).—2 to 5 grains (0-12 to 0-3 Gm.), but larger doses are used. To be given in preference in fine powder e.cj. in Slipule (ISTo. 1 for 3 grains) or as effervescent. A crystalline substance M.pt. 250 to 253° C. made by interaction of Phenol and Phthalic Anhydride. Soluble 1 in 10 of alcohol 90%, but only 1 in 600 of water. Pharmacology. Phenolphthalem is dissolved in the bile and alkali in the intestine, and being now slightly irritant to the intestine, causes peristalsis. It is partly absorbed and excreted by the liver, and so acts again and again in the intestine—it acts hence for a few days as a mild aperient.—D. Grieve, P.J. ii./2i,490. Uses.—As a purgative. Ordinarily \ to 3 grains is sufficient, but patients confined to bed require from 3 to 10 grains. Does not irritate the kidneys. It is satisfactory for prompt action, as in jaundice. It is more active than Cascara and less griping, and has been found ideal in intestinal toxaemia. Skin eruptions from Phenolphthalein in U.S.A.—B.M.J.E. i./22,81. Pres., May,'22,182 ; July, 240 ; B.M.J.E. L/23,81 ; Clin. Ji., Dec. 19/23,011. Capable of destroying red blood corpuscles and inducing toxic degeneration of the kidneys, cases cited.—Per Pres., Jan., ’23,15. We ho<ve never come across any of these bad effects. Phenolphthalein Tablets, 2, and 4 grains are made. Under the name “ Purgen,” is supplied as “ Infants ” containing: Purgen | grain, “ Adults’ Purgen ” 1J grain, and “ Strong Purgen ’* grains. CEDTablets Phenolphthalein Compound. Phenolphthalein 1 grain. Strychnine Hydrochloride grain* Belladonna Extract (B.P. ’14), grain. These weight* grains; (0-15 Gm.). A useful combination. Tabellae Phenolphthalein with Chocolate Basis are made 4, 2 and 4 grains, also Tabellae Phenolphthalein (4 grains) cum Extract® Rhei (3 grains). Effervescent Phenolphthalein. Dose. One to two teaspoonsful in half a tumbler of warm water a good half hour before breakfast. Contains 3 grains per drachm. A satisfactory mild laxative taken first thing in the morning. *Feen-a-mint (T.M. 493257, 440391, 524533). A laxative preparation for constipation, containing Phenolphthalein with Gum basi& for chewing. Phenolsulphone-phthalein. ‘Phenol Red* U.S. X. Dose. (By injection) grain (0-006 Gm.). Employed as a tesU for permeability of the kidney. See Vol. II. Testing of ampoules withPhenol Red.—J. Pritchard, P. J. i./3o,539„ Fluorescein.—Tetraoxyphthalophenon Anhydride. Resorcin-phthalein Anhydride. C20H12O6 = 332*0936. In yellowish red powder, sparingly soluble in water, more so in presence of an alkali, e.g., Sodium Hydroxide, forming Sodium Fluorescein showing a green fluorescence. Sodium Fluorescein. Syn. Uranin, Obturin. Red crystalline powder, readily soluble in water, forming a red. solution with intense greenish-yellow fluorescence. Activated (irradiated) Fiuorescein in treatment of' cancer. Slightly alkaline (not neutral) solution of Sodium Fluorescein sprayed or painted widely over the surface of the growth, followed by Radium or X-Ray irradiation of moderate penetration. Oral use.—Capsules of Sodium Fluorescein 1 Gm. (in 2 capsules), to 3 Gm., half an hour before treatment, or as a ‘ swallow ’—Sodium Fluorescein 5, Sodium Bicarbonate 3, Glycerin 2, Water to 100—for growths in pharynx, etc., when it is impossible to spray (actually 1 drachm has been given in error for 1 Gm. without unpleasant symptoms.) Feeling of sickness in some cases. It is excreted by the kidneys. Paint.—Sodium Fluorescein 2*5, Sodium Bicarbonate 3, Glycerin 2, in Distilled Water 100. Intravenous Injection.—For lung cases. Sodium Fluorescein 5, Sodium Bicarbonate 3, in Normal Saline 100. Inject 20 Cc. slowly, e.g., in 3 minutes. “ Sterules ” containing 20 Cc. are made. Treat immediately after injection. Nodule Injection.—Same as for Paint. Bladder Injection. —Sodium Fluorescein 2-5, Potassium Fluorescein 2-5, Sodium Bicarbonate 3, in Normal Saline 100. Leave for 10 minutes and then remove, leaving about 4 ounces. Enema. Same as bladder injection. Decant as much as possible. Too strong concentration of Fluorescein may cause X-Ray erythema. X-mys.—Dosage, oH : filter 4 mm. Aluminium ; spark-gap (between points) 7 inches ; kilovoltage 110 ; miliiamperage 4. Time taken 10 to 15 minutes. 3 weekly doses given followed by 3 weeks’ rest. Cycle repeated for 6 months and then occasionally up to a year or longer. 120 cases treated at Royal Northern Hospital between 1927 and Nov., 1930— 33 died and apparently 23 recovered (alive and well Nov., 1930). Other hospitals and private reports in addition. Allied dyes also investigated.— S. Monckton Copeman, B.M.J. i./3i,658. See also Franco-Brit. Med. Review, Oct., 1930: Jl. of State Medicine, Vol. XXXYI, No. 11, p. 642 : Claude Gouldesbrough, B.M.J. i./3x,767. The external application causes no pain, and there are no unpleasant symptoms from the internal use, except yellow coloration of the skin, which disappears.—S. Monckton Copeman, B.M.J. ii./28,223. Rapidly growing, i.e., more malignant, growths responded particularly. In breast cancers, enlarged glands in the axilla disappeared under Fluorescein per os, although not themselves directly activated. In superficial secondary growths, e.g., recurrent nodules on or near the scar of an operation wound, good results were obtained by injecting with a needle a few drops of Fluorescein solution into the substance of the nodule prior to irradiation. Treated in thi3 way, secondary nodules, even of considerable size, may disappear with unexpected rapidity. Cases previously regarded as inoperable were, in certain instances, after activated Fluorescein, found, at a comparatively early stage, to have undergone such changes as to render them amenable to surgical intervention with satisfactory results.—S. M. Copeman, Frank Coke and C. Gouldesbrough, B.M.J. ii./29,233. Criticism.—J. H. Douglas-Webster, B.M.J. ih/29,367,983 ; S. M. Copeman, ibid. 929. Effect of Activated Fluorescein on growing beans.—Results suggest that the intensifying action of Activated Fluorescein on X-Rays is negligible.—S. B. Wigoder, B.M.J. ii./3o,643. In reply, S. Monckton Copeman points out that the summary is somewhat obscure in view of the fact that Fluorescein would only be ‘ activated * when irradiated. The fluorescent property of the drug is greatly enhanced by being definitely alkaline—in this may be the cause of absence of success in some instances in treatment of cancer. A fairly soft ray is necessary.—B.M.J. ii./3O,709. Uranin may be used as proof of death by injection. There is no reaction in case of death but if death is only apparent, the integument and the eyes turn green in a few minutes.—P.J. ii./n,436. Differentiation of meningitis from other diseases with meningitis symptoms. Sodium Fluorescein per os. Dose.—0*025 Gm. per kilo for infants and 0-05 6m. per kilo for older persons.—B. E. Bonar and L. G. Bailey, Am. Jl. Dis. Child., per P.J. ii./30,411. Liquor Fluoresceins, R.O.H. Fluorescein 8 grains and Sodium Bicarbonate 12 grains in 1 ounce. Useful to diagnose corneal lesions. The ulcers and parts denuded of epithelium take a green colour, which persists for 2 or 3 hours. Loss of substanee in con junctiva is denoted by a yellow coloration. Ophthalmic ‘ Sterules * of Fluorescein solution are cleanly in use. VOL. I. Y -I The Rkodamines have remarkable tinctorial power—the red dye class, as * G extra * especially. The colour in a milligram of a solution contain! 0-000,000,000,0001 Gin. is discernible.—L. i./i3,184. A representative of the group of Rhodamines is : c6h3nx(c2h5)2 HOOC . C6H4, C < /> O which is obtained by heating for sevei C6H3=N(C2H5)2C1 hours at 200° C. one molecule of Phthalic Anhydride with two molecul Diethyl-m-amido-phenol. Fluorescent substances may play a defensive role in the skin, and an opposii one in the blood stream.—P. Redington Peacock, B.M.J. ii./25,584. Isamine Blue. A Sulphonated-naphthylated Pararosaniline of high molecular weigl stated to be non-toxic. Investigations of its value in cancer have been co ducted, using a 0-8% aqueous solution and a 5% solution in Glycerin. I persistent staining of body tissues is an objection to its use and results she no superiority over Activated Fluorescein (anted).—S. Monckton Copema Jan., 1931. Distinct and maintained improvement in 10 out of 18 cases of malignaa tumours. First day, 5 Cc. 1% Eosin ; 2nd to 8th day, 10 Cc., then 2 day rest, followed on 11th day by 5 Cc. 0-5% Isamine Blue with 1% Glycerin, an on the 12th day 10 Cc. Isamine Blue and 2 Cc. Glycerin, followed by 6 daiH doses of 20 Cc. Isamine Blue and 4 Cc. Glycerin. All injections given intra venously.—Bernhardt, per Pres., Feb., ’31,75. Induction of inflammation in treatment of malignant and other local disease Isamine Blue intravenously or intraperitoneally sometimes stains grafte tumours in rats. Inflamed tissues accumulate this dye, Trypan Blue an others.—H. Burrows, L. ii./29,603. Sodium Tetraiodophenolphthalein. Syn. ‘ Iodo-Ray,’ Tetiothalein Sodium, Iodeikon, *Opaci: (T.M. 478,478), *Cholumbrin (T.M. 481,225), Piliophen, ‘ T.I.F (This, and the parent acidic substance were mentioned under th names Antinosin and Nosophen in E.P. IX (1898), with b Gm doses.) /C6H2I2=0 ' COONa.C6H4.C < = 865-7844. \C6H2I2.ONa (It is of interest to compare the above formula with that of the corre sponding Di- Sodium Salt of Phenolphthalein. COONa.CtH4.C <£‘£.0% to indicate the position of the Iodine atoms, distinguishing from Sodiui Phenol-tetraiodoplithalein, described later.) Che inical Characters, A blue-coloured powder, somewhat hygroscopic, with slightly aromatic taste, readily soluble in distilled water and almost in soluble in Alcohol. An aqueous solution may throw out on standing owing to absorption of Carbon Dioxide and deposition of the acidic body. On the addition of Hydrochloric Acid to a solution th* cream-coloured Tetraiodophenolphthalein is precipitated. Assay. The Iodine content may be ascertained by fusion with Chloride-free Soda lime, adding Sulphurous Acid, dissolving in Nitric Acid, adding excess of Silver Nitrate and back-titrating the uncombined Silver with Ammonium Sulpho cyanide. The compound should contain not less than 53%. Theory is 58.6% Sodium Content (Alkalinity). In the author’s laboratory the percentage of free and combined alkali it determined by adding excess of standard acid, heating to expel C02 and then titrating back with N/10 Sodium Hydroxide to a pale blue colour. The sulphated ash yield is a good control. Theory for total Sodium is 5-31%. Toxicity, a compound. should have a tolerated intravenous dose for animals of toxic Symptoms.0 “ mentioned »* «»ham and otbST 1 higher' do“6es From animal experiments which we have had conducted we find it is not S7aStatom IeSUltS ™th »**• *“• «■» ■ arra*: sai- usl*g ^Jeeh l Formula 4 Gm. approx, intravenously as the limit dose. We had the above toxicity confirmed (1926) with a sample specially made. Immediate death occurred with 260 mg. per kilo in rabbits. Our criticism would be that the dose needed for a shadow is rather near the lethal dose. In addition, one might assume with reason that man would be more sensitive tnan the rabbit. An investigation by the Pharmacopoeia Commission on 7 commercial samples showed httie variation—0-37 mgr. per Gm. weight of mouse for the least and 0-27 mgr. per Gm for the most toxic sample. The conclusion was that the compound from makers of good repute should show no important divergence of toxicity.—J. Barba-Gose, Qtrly. Jl. Ph., ’29,396 ; L. i./3o,522. TJses,—The compound is not advised for intravenous use. This compound has been submitted to extensive trials as diagnostic of cholecystic disease by the method of X-Ray visualisation known as Cholecystography. It has been advocated as the most suitable of numerous chemicals which, following intravenous or per os administration, are excreted by the liver into the gall-bladder, rendering it opaque. The method was originated by the work of Graham and others in the U.S.A., and was discussed at numerous meetings here, e.g., at the International Congress of Radiology held in London on July 1, 1925. (See a paper by R. D. Carman on work at the Mayo Clinic, L. ii./25,67). Iodine having a heavier atomic weight than Bromine it is expected the compound containing this halogen would yield a better shadow than the analogous Tetrabromphenolphthalein, other things being equal. The latter is not used now. ORAL USE. Dose of ‘ Iodo-Ray 5 per os for an adult.—A total of 3 to 5 Gm. usually suffices, based on a figure of 0*04 to 0-07 Gm. per kilo. This dose may be given either (a) in the form of * Stearettes * or other medicament coated so as to pass through the stomach and dissolve promptly on reaching the alkalinity of the duodenum, thus obviating vomiting, or (6) in ‘Stipules* (plain uncoated capsules), with the possibility of vomiting following. Technique of Administration, * Stearettes 5 and * Slipules ’ are prepared containing 0*5 Gm. each (10 giving 5 Gm.) and 0-3 Gm. (16 giving 4-8 Gm.). The former are used in preference, as fewer are needed to obtain the total dose Slipules—containing 1 Gm. are also made. Large draughts of water are often given with the substance. The ‘ Stearettes 5 or ‘ Slipules * one or more at a time at 10 to 15 minutes intervals, are taken either during the evening meal or within Y 2 two or three hours after.. If given about 6 p.m., it should be pos sible to get good X-Ray pictures the next morning. . following procedure has given satisfaction :—The patient b given a fat-containing meal. (Fat is given in order to empty the gall-bladder.) Two hours afterwards, the patient being in bed 10 of the ‘ Slipules ’ (0-5 Gm. each) are taken, two every \ hour During and after the taking of the ‘ Slipules ’ the patient is to lie or his right side. No food should be given during the period of tlid X-Ray examinations and no breakfast should be taken the following; morning. Oral.Administration art One Dose. This is the acidic form of the compound and may be prepared by admixture of 4.25% Citric Acid. The dose is therefore a suspension of the white acid body which reverts to the blue soluble Sodium salt in the intestinal canal, to collect in the gall-bladder, as generally known. The author manufactures the one dose type under the name 1 lodo Ray.’—Single Dose. Similar preparations are *Opacol (T.M. 499708), Iodeikon and Shadocol. The position of the gall-bladder shadow and the rate of its emptying varies? with the type of bodily habitus. Only very mild toxic symptoms (such slight epigastric discomfort) were exhibited in a very few of 100 students in whom the method of diagnosis was tried. Five 1 Gm. capsules dipped in Stearic Acid were given for a dose, during the evening meal, a fair quantity of water being taken. A radiogram was taken 14£ hours later, without breakfast, and then 2 hours after with fatty meal, and 16 hours after taking ther capsules a second radiogram is taken. With a current of 30 m.a. the distance* of the tube from the individual should be 36 inches, exposure 4 to 6 secondsr and spark gap 5 inches. The tube is centred over a point a hand’s-breadth to the right of the spine of the second lumbar vertebra and the radiogram m taken with the abdomen towards the film at the end of inspiration. Certain normal individuals who fail to give a shadow on the first investigation may on a second investigation give a positive result. Thus a negative cholecystogram, in the absence of clinical evidence, is less reliable than positive cholecystographic evidence of disease.—F. Davies, B.M.J. i./27,1138. intolerance.—Vomiting, nausea and purgation maybe experienced. The vomiting has been eliminated by the injection of a little Adrenalin solution.. Atropine has also been given prophylactically. Period at which X-Ray Pictures are taken. Three X-Ray examinations are usually necessary between 10 and 24 hours after taking the Iodo-compound, the best pictures being generally obtained at about 16 hours. The shadow of a normal bjadder is seen well defined at the 12th hour, it is increased at the 1 5th, and there is diminution in size and density at the 20th hour. A 5-inch spark gap may be used, the tube being kept a good distance away (F. Melville), References to Oral Use. A correct diagnosis obtained in 95% of 467 patients.—E. V. Graham and co-workers, Jl. A.M.A. ii./25,953. In the majority of cases the gall-bladder can be seen clearly after oral use, which produced less frequent and less severe toxig symptoms.—A, F. Hurst, B.M.J. H./25,115X« Diagnosis treatment and prevention of gall-stones. The salt is absorbed into the portal circulation and excreted in the bile. It v;en reaches the gall-bladder, the mucous membrane of which absorbs water from the bile and so leads to its gradual concentration, until about 12 hours after the pills are swallowed a shadow can be seen—a good account. As to treatment, biliary antiseptics, e.g., Urotropine iarge dose, even up to 300 grains a day.—A. F. Hurst, B.M.J. n./26,677 ; L. i./26,966. ( Hexamine—-its action as foiiiary antiseptic ) Oral metnod employed almost exclusively at Middlesex Hospital. Variations in the strength of gastric and pancreatic juices causes trouble in perfecting a capsule coating. Possibility of local damage due to extravasation a serious diawback to intravenous use. Technique— The patient is prepared as for an ordinary skiagram of the gall-bladder. An ounce of Castor Oil is given one night and £ ounce the next. Light breakfast and a very light lunch are permitted on the following day, and an ordinary skiagram of the gall-bladder is taken m the afternoon. Tea and bread and butter are permitted on the same aay and another small meal at 12 p.m., during which the drug is swallowed m Vhe The.close given is 5 Gm. (4 Gm. if the patient weighs ii? xF 0 ]bs.), administered in £ Gm. capsules. A cup of tea only is given on t ™foIlowmg morning and X-Ray examinations at 10 a.m.f 2.30 p.m. and 4,30 p.m.—T. Izod Bennett and co-workers, L. ii./26,20 ; B.M.J. ii./26,195,681. Oral use is quite accurate enough for routine. Ill-effects insufficient to cause alarm— J. H. Anderson (Ruthin), B.M.J. ii./26,682. Oral use (Iodo-Ray ‘ Stipules’) gave correct diagnosis in 92% of 100 consecutive cases._ A faint shadow of gall-bladder after giving the dye once does not warrant diagnosis of a pathological gall-bladder. Early cases of Cholecystitis may give normal shadows. Occasionally a normal gall-bladder may fail^to give a shadow.—P. G. McEvedy and J. E. Sheret, L. i./27,1120. Except for 8 complaints of nausea and one case of vomiting, 125 patients were quite unaffected by the drug. The diagnosis was confirmed in 94*3% of cases.—J. H. Mather and W. R. Williams, B.M.J. i./27,G14. Use per os here better than in U.S.A.—L. ii./27,982. Oral use in the Mayo Clinic good—may well be repeated in doubtful cases. Only a few patients need be submitted to the more uncomfortable and dangerous intravenous method.— G. B. Eusterman, Jl. A.M.A. i./28,197. . Combined Cholecystography and Barium Test Meal an invaluable diagnostic aid in female patients presenting the cliolecysto-duodenal syndrome.— D. P. D. Wilkie, L. ii./27,1228. Unpleasant effects from oral use eliminated by mixing the salt with white of egg and then adding to cooked cream of wheat (about 4 ounces). Films as good as by other oral methods.—H. Morris, B.M.J. i./28,305. Death coincident with oral use in a man of 62. The relation of the taking of the compound to the onset of acute hepatic degeneration found p.m. could not be stated.—G. E. Dyas and S. C. Dyke, Brit. Jl. Radiol., March, ’28. Functions of the biliary passage in relation to their pathology. The paper deals, inter alia, with anatomic functions of the bile-ducts, effect of removal of the gall-bladder, gall stones, biliary stasis, biliary trouble in pregnancy, relation of biliary effects to pancreatic disease.—D. P. D. Wilkie, L. ii./26,689. Expulsion of the contents of the gall-bladder in response to fat feeding is a vita/ function of its musculature and is independent of mechanical factors. General conditions influencing smooth muscle tonus must foe considered in interpreting the motor phase of any cholecystographic series.—W. J. M. Scott and L. R. Whitaker, Jl. A.M.A. ii./28,9. Value now questioned. No rules can be followed. Good roentgenologic technique needed. Resume of errors in technique.—L. R. Whitaker, Jl. A.M.A. ii./28,141. Administered orally to dogs, even in massive doses, produced no degenerative or necrotic changes in the liver or kidneys. Jl. A.M.A. ii./27,196. In dilutions up to 1 in 100,000 has marked bacteriostatic action on staphylococci and streptococci, but only slight action on colon bacilli. In the higher concentrations it is definitely germicidal and may have therapeutic value imr some types of cholecystitis.—A. C. Nickel, Jl. Pli. and Exp. Ther., Nov., ’29,365.. Absence of any shadow is the surest sign of disease.—L. ii./29,400. Sliadocol causes little nausea or diarrhoea: after absorption from the? intestines the dye is excreted by the liver into the bile and reaches the gallbladder by way of the cystic duct. In the gall-bladder water is absorbed and.: the dye becomes concentrated so as to be opaque for X-Pays. There are: numerous factors mitigating against efficacy, so that probably not more thaihi 50 to 60% of diagnoses are correct.—T. C. Hunt, L. ii./2g,755. When it is remembered that the dye is excreted into the bile and the bile:* containing it is concentrated to a marked degree by the norniaSJy'•functioning; ga.lt-bladder, it will be realised that in this country, where the dye is nearly always given per os, the shadow forming shows it is being adequately absorbed from the intestine, that it is being normally secreted by the liver, that the liver secretions are passing freely into the gallbladder, and that the gall-bladder is adequately concentrating the bile. Too- many gall-bladders are being operated upon simply because of absence of a shadow—(we agree.—W. H. M.).-—A. J. Walton, L. i./3o,338. Duodena! tube method of giving.—Satisfactory results. For References, see Edv. XIX, p. 682. Sodium Bromide per os has also been given, q.v. The di-Iodo compound of Atoplmn, Syn. ^Biloptin (T.M. 474564) has- been suggested for use in cholecystography instead of the Plienolphthaleini compounds.—Pres., Oct.., ’27,880. Infra venous Use. Many authorities are of the opinion that this technique should not be employed as a routine method. The injection into the blood stream of a concentrated (10% or more) solution of a Phenolic body of this kind, containing 58-6% of Iodine, in the massive dose of 5 Gin., as has been advocated, is a procedure which cannot possibly be undertaken without a grave element of risk. There is the probability that the substance is in part decomposed by the labile Carbon Dioxide present, resulting in thrombosis. It is not a definite crystalline compound, e.g., like Sodium Iodide—on the contrary, it is liable to variation according to technique in manufacture. Furthermore, any slight decomposition following storage of the chemical in the dry form, through the action of the atmospheric Carbon Dioxide, is negligible in the case of oral use, but the same is not true from the aspect of a compound to be injected into the blood stream unless the solution is filtered just before use. I11 brief, if the surgical operation of an injection can be replaced by a simple per os diagnostic that procedure should be the method of choice from the aspect both of the patient and the radiologist. We are also inclined to think that intolerance in some cases must have actually been due to abnormality of the patient. Certain results of which we have knowledge would otherwise be entirely incapable of explanation. Analogy with a solution of Sodium Carbolate.—W.H.M., B.M.J. ii./26,620. Technique of intravenous use. The quantities are modified by some. For alpatient of 115to 160 lbs. (52^0 724 hilos) 3 Gm. is dissolved in 24 Cc. or 3*5 Gm. in 28 Cc.—the most recent accounts advise 40 Cc. as the volume of water. For patients of less weight reduce PHOSPHORUS. 679 dose is given (in two inj ections at an interval of b hour) hrst thing in the morning. Breakfast is omitted. At noon a glass o mi i is taken, and the evening meal as usual. Water per os is ahowed at all times. Transitory jail in blood pressure.— 0-5 to 1 Cc. of Adrenalin solution intramuscularly has been used to relieve this. For a large number of Abstracts on Intravenous Use, see Edn. XIX. pp. 683-685. Bismuth Tetraiodophenolphthalein, Syn. Eudoxin Dose.—5 to 8 grains (03 to 05 Gm.j. A reddish brown powder insoluble in water given in stomach and intestinal affections. Phenoltetrachloiphthalein as liver function test, and the Bromsvl- phalein Test are dealt with in Vol. II. Sodium Tetrabromphenolphthalein. Syn. Bromo-Ray, Bkomeikon. n H2Br> = 0. ^6H2Br2ONa. COONa.CGHt.C<( — 677*7214 Dose.— The dose per os is from 4 to 7 6m., according to weight of the patient, the average dose being about 5 6m. It is given as ‘ Stipules * containing J to 1 Gm. during the evening meal, frequent draughts of water being taken. The ‘ Slipules ’ are preferably given two or three at a time at short intervals. This compound is a pale mauve powder readily soluble in distilled water. Both the powder and solutions should be preserved from the action of the air, as Carbon Dioxide is slowly absorbed. Solutions can be sterilised by heating in a boiling water-bath. X-Ray pictures are taken at 12, 15 and 20 hours.—R. D. Carman, L. ii./25,67. ‘ tocfo^Ray ’ v. antea is more generally used. Further data on Intravenous Use, etc., see Edn. XIX., pp. 686, 687. PHOSPHORUS P=31-02. (JE[)In Irish Free State and Northern Ireland : Phosphorus and all preparations (and admixtures, Northern Ireland) containing it in a free state. Dose.—r-Jo- to ^ grain (0-0006 to 0-003 Gm.). Max. single dose (B.P. \14) -A- grain, Fr. Cx. grain. Max. during 24 hours y-V grain. Phosphorus is obtained by converting Calcium Phosphate (of bones) into the soluble Superphosphate by heating with Sulphuric Acid: this is reduced to metaphosphate by heating with charcoal and finally by further heat is converted into normal Calcium Phosphate with evolution of vaporised Phosphorus. A poisonous, non-metallic element melting at 110° F., igniting at a slightly greater heat, and forming white fumes of phosphoric anhydride. German Shells contained Phosphorus, yellow and red.—B.M.J. i./i5,259.. Capable of producing localised gangrene and anaerobic bacterial infection ;; more barbarous than expanding bullets. We had occasion to examine a shell! of this kind ourselves—it contained the red variety. Antidotes.—Give Copper Sulphate 3 grains every five minutes-: (see Antidotes to Poisons), or Hydrogen Peroxide \ drachm ini 1 ounce of water, repeated every 15 minutes. Potassium Permanganate 1% solution per os is also good chemically, or Magnesium Sulphate J ounce. Give demulcents. Previously French Oil of Turpentine was advised, but Oils in general are unsuited. Inject normal saline solution and give alkalis as soon as the vomiting and purging subside. Matches.—The use of Yellow Phosphorus is prohibited in Great Britain, Germany, etc. “ Strike-anywhere ” matches usually contain Tetraphosphorus Trisulphide. Safety Matches contain an oxidising mixture (Potassium Chlorate, Manganese Dioxide, Lead Peroxide Pb02, etc.) on the match and Bed Phosphorus on the box. Necrosis of jaw bone caused by work in Phosphorus Match Works. There are two types known as phosphorisme (anaemia, albuminuria and fragility of ! bones) and ‘ Phossy jaw.’ Scarlet Phosphorus sets up acute structural changes in the brain.—Sir T. Oliver, B.M.J. ii./2i,lll. Phosphorus necrosis, in consequence of the introduction of the Sesqui- sulphide method of making matches, lias entirely disappeared.—Sir Thos. Oliver, Industrial Legislation and Hygiene, B.M.J. ii./a5,530. Soluble about 1 in 320 of absolute alcohol, about 1 in 200 of ether, about 1 in 25 of chloroform, about 1 in 100 each of oleic acid, almond, olive, castor, tlieobroma oil, and suet; in half its weight of 1 carbon bisulphide, almost insoluble in water ; combines chemically with oils of turpentine and peppermint, forming non-luminous and comparatively non-poisonous liquids. Uses.—Phosphorus has been given as a nervine stimulant in various affections of the central nervous system and in neuralgia ; and in leucocythannia, and some skin diseases. There is, however, no evidence that the central nervous system is ever in a condition of phosphorus starvation. The evidence that phosphorus retention is increased by giving organic and inorganically combined pdiosphorus is conflicting. ALB.—Preparations should be recently made and kepi from light. Elixir Pliosphori. Add Compound Tincture of Phosphorus 1, to Glycerin 4. Dose.—15 to GO minims (i to 4 Gc.) in water. Contains ^ grain in one drachm A palatable well tolerated ‘ fluid ’ form of Phosphorus. Oleum Pliosphoratum (B.P. ’14). P. Belg. IV. Dose.—1 to 5 minims (0-0& to 0-3 Cc.), on sugar or in perles. Contains about 1% (by weight) of Phosphorus in prepared almond oil. (B.P. ’14 is flavoured with Lemon Oil.). P. Ital. V. is 0T% in Olive Oil. Flavoring.—Emulsified and Glyl Rosee added, taste is covered, but more usually given in Perles or Pills. Oriental Sore. Best results in old intractable cases with extensive ulceration, the oil being dabbed on after removing the scab, every other day. When ulcerative process not well developed and lesion is nodular, inject 3 to 5 m. hypodermically round or into nodule once or twice weekly ; injection practically painless. No general reaction and local reaction slight, but signs of acute inflammation occasionally develop. The delayed action of Phosphorus on the liver should be kept in mind.—A. Castellani, Jl. Trop. Med., Nov. 2, ’25,377. See also ibid. June 1, ’23,194. Rickets and osteomalacia and certain cases of very chronic malarial cachexia : in these as an adjuvant to Quinine and Arsenic, a dilute preparation of 4 m. Phosphorated Oil in 5 m. diluent is used.—B.M.J. i./23,283. Phosphorus Solutus P.G. VI. Dose.—Max. single 3 minims (0-2 Cc.) : pro die 10 minims (0-6 Cc.). Heat Liquid Paraffin 194 by weight 10 minutes at 150° C. Cool to about 60° C. and dissolve Phosphorus 1 (cleaned from external layer and free from water) by shaking in a stoppered bottle. Allow to cool and add Ether 5 by weight. Oleum. Phosphoratum P. Svec. X is Phosphorus 1, Liquid Paraffin 94, Ether 5. Perles of Phosphorus. Contain T^, and grain. Pilula Phosphori (Martindale). Dose.—1 to 3 grains (0 06 to 0-2 Gm.). Phosphorus 1 and Oil of Theobroma q.s. to 100. Pleat the oil to 150° C. and sustain the heat for 5 minutes. Strain and weigh 99 into a wide-necked bottle with an india-rubber cork, and when cooled to 65° C. add the Phosphorus, cork and shake well till the fat begins to solidify. In rolling it into pills, divide into suitable lots, and beat each in a mortar to render it plastic before applying it to the machine, then work off quickly and cover with sandarach solution. The mass contains 1% of Phosphorus in perfect solution. A few drops of chloroform added during manipulation checks oxidation. When phosphorus is to be combined with other ingredients in a pill, the following is best used :— Sevurn Phosphoraium, 10%. (Martindale). ,, Phosphorus 1, Pure Carbon Bisulphide 5. Dissolve and add Prepared Mutton Suet 9. (Sevum Praeparatum, is the purified internal fat of the sheep, M. pt. 45 to 50° C., prepared by me -ting and straining. Sevum Benzoatum is the same digested with 3 /0 Benzoin at 60° C. B.P. 514.) Add a little of the suet at first, mix quickly, add the remainder, mix thoroughly and allow the bisulphide to evaporate. May be used to make the following pills. They are perfectly stable as there is no interaction or decomposition. Pilula Phosphori (A grain) cum Ferro (3 grams). Compound Phosphorated Suet 10 grams, Reduced Iron 150 graim, t°“PH " d Tragacanth Powder 10 grains, Chloroform 15 minims. Mix, and add quickly, Mucilage of Acacia q.s. Divide into 50 pills (or into 750 pills if the quantities be taken m grammes) Cover with Sandarach Solution. They are also made with CeQNux Vomica (g grain). Filula Phosphori (% grain) cum Quinina (1 grain). Phosphorated Suet 10 grains, Quinine (base) 38 grains (= 50 grate Sulphate), Chloroform 20 minims. Mix quickly, and add Compound Tragacanth Powder 10 grains, Mucilage of Acacia q.s. Mix, and divide into 50 pills (or into 750 pills if the quantities be taken in grammes). These pills are also made with Reduced Iron 3 grains and with Reduced Iron (3 grains) and |Jlj Strychnine (¥\y grain). U3]Pilu]a Phosphori (% grain) cum Strychnina (At grain). Prepare as Pilula Phosphori cum Quinina, with Strychnine Ife grains vice Quinine 37 grains. These are also made with Reduced Iron (3 grains). Dose.—Any of the above pills are best taken directly after meals.. No exception is taken to pharmacists making the Phosphorus preparations herein mentioned, according to the formulas of the late W. Martindale, but in other instances in the book rights are reserved —W. H. M. Tinctura Phosphori Composita. Fmmula devised by W. Martin- dale, 1st Edn. E.P. 1883. Dose.—3 to 12 drops on sugar. Phosphorus 1, Chloroform 85. Warm gently in a stoppered bottle till dissolved, and add the solution to Absolute Alcohol to 500- Shake well and keep in the dark. Becomes acid on keeping. Phosphorus Pentachloride. PC15 =208-34. Manufacture.—Pass chlorine q.s. into a cooled solution of phosphorus 1 in carbon disulphide 4 unti a portion removed no longer gives phosphorescent residue when evaporated ol paper. Then remove the carbon disulphide by filtration with aid of reduced pressure, e.g., water pump. A yellowish white crystalline mass fuming in moist air, employed chemically in numerous reactions, for example, substitution od hydroxyl groups with chlorine. Zinci Phosphidum, Zn3P2=25ST5. Dose.—A) to | grain (0-003 to 0-02 Gm.) in Pill. Fr. Cx.— Max. single dose ^ grain; Max. during 24 hours J grain approx A grey powder. With acids yields phosphoretted hydrogen. Phosphorus determination in vermin killers.—Y.B.P., 1919,124.° Acidum Hypophosphorosum, U.S X. H3P02= 66-0434. Dose.—2 to 5 minims (0-12 to 0-3 Cc.). A colourless liquid, strength 30 to 32%. Latter has Sp. Gr. 1-136. On heating, water evaporates and the acid decomposes at 130° to 140° C forming hydrogen phosphide, which ignites, and phosphorous acid. The latter decomposes at 160° to 170° C. into hydrogen phosphide and phosphoric acid; finally the last portions of unoxidised phosphorus burn out at a highei temperature (U.S.). Hypophosphites. There is no reliable evidence that they exert a physiological effect or influence any pathological process.—-Jl. Am. Med, Assn ner P.J. i./i6,247. ’’ Acidum Hypophosphorosum Bilutum. Average dose.—8 minims. 10% strength. Sp. Gr. 1-042 at 25° C. This strength is termed Acidum Hypophosphorosum in F.E. VIII. Uses.—Its Salts are mostly employed. It may be added to Syrup of Ferrous Iodide to preserve same. Ammonii Hypophosphis. NH4.H2P02=83*0748. Dose.—1 to 6 grains (0-06 to 0-4 Gm.). In white deliquescent tabular crystals, soluble 5 in 6 of water. Insoluble in alcohol. It has a nauseous saline taste. Incompatible like the Calcium Salt. Nervine tonic. Calcii Hypophosphis. Ca(H2P02)2= 170*1532. Dose.—3 to 10 grains (0*2 to 0*6 Gm.). White crystalline salt, with nauseous taste, soluble 1 in 7 of water. Prepared by heating phosphorus with milk of lime until phosphoretted hydrogen ceases to be given off, then filter and evaporate to crystallise or precipitate with alcohol. Incompatible with oxidising agents. Uses.—Nervine tonic and aphrodisiac. Checks night sweats of phthisis, and is used in acne. In epilepsy has proved serviceable. Mistura Calcii Hypophosphitis. Calcium Hypophosphite 5 grains, Saccharated Lime Solution 1 drachm, Peppermint Water to 1 ounce. Barii Hypophosphis. Ba(H2P02)2—267*4412. Dose.—\ to 1 grain (0*016 to 0*06 Gm.). White crystalline salt soluble in water 3J. Prepared in manner analogous to the above and its properties are similar. Fern Hypophosphis. Fe(H2P02)3=250*9468. Syn. Ferric Hypophosphite. Dose.—1 to 5 grains (0*06 to 0*3 Gm.) in a pill. In commerce is a whitish amorphous powder with a chalybeate taste slightly soluble in water, but more so in presence of Potassium Citrate. Liquor Ferri Hypophosphitis Fortis, B.P.C- Dose.—10 to 30 minims (0*6 to 2 Cc.). Uses._Tonic in anaemia, neurasthenia and disturbed nutrition. Pi] Pilula Ferri Hypophosphitis cum Strychnina. Strychnine Av grain. Ferrous Hypophosphite 2 grains, lo make one pill (oi in grammes to make 15). Dose. 1 twice or thrice daily. Magnesii Hypophosphis—Mg(H2P02)2,6H20 = 262*4848. Pose._3 to 10 grains (0*2 to 0*6 Gm.). hite crystalline salt soluble in water, about 1 in 4J. Potassii Hypophosphis, KH2P02= 104*1316. Dose.—1 to 6 grains (0-06 to 0-4 Gm.). , ... A deliquescent granular white powder, having a nauseous, bi e ta^tp Soluble 1 in 1 of water. Incompatible as the Calcium Salt. Aurantii Floris ; Glyl Ros*. Elixir Simplex Sodii Hypophosphis (5.P.’14).NaH2PO2=88-0326(+H2OPh.Ned.Y.) Pose —3 to 10 grains (0*2 to 0*6 Gm.). A white granular deliquescent salt, with a ratter, ,n“ss°"s *as.te- Soluble I in 0-63 of water, and freely soluble in alconol. Lxp os with an equal weight of Sodium Nitrate. See also Calcium Salt. TTeps —In phthisis, and as nutrient in wasting diseases generally. ¥Zvorlnt-Sassafras, Syi Lavandula, Syl Amygdala, Amarse ; Syrupus Aromatic us. ®Syrupus Hypophosphitum Composite, U.S. VIII, Average dose.—2 draclims (8 Cc.). Ferric and Manganese Hypophosphite, of each 2-25, with Sodium Citrate ' / r» n rp 11 ret r\ I C! O I m tirn 4- O C\ 4-1 /“i _ 1 r -W'v . • ^ „ 3f~ r r> i ' 1 T . -,7 x -v/x V7U VH mu VV lull UUUiUiU W IllclVf •/5 are first dissolved m water 30, then Calcium 35, Potassium 17-5, and tt r vr, tUA x > lucu oo, jrocassium i/*d, and Sodium Hypophosphites 17-5 are dissolved in water 400, with Diluted Hypophosphorus Acid 5. Quinine (base) IT and Strychnine (base) 0T15, with Hypophosphorus Acid 10 are then dissolved in water 30. Finally, Sugar I r.) is dissolved m the mixed solutions and made up to 1,000 with water.. Chloroform 1 in 500 added we find improves its keeping qualities. It contains appi oximately 32o gram of Strychnine Hypophosphite in a drachm. in phthisis and like cases, hypophosphites raise the nervous power and improve condition of the secretions. They are given in sufficiently large doses for at least 6 months. (FD1 ablets of Compound Hypophosphites each weighing 2 and 4 grains and ec[ui\ alent to and 1 drachm of the above are prepared. CE) Fellows * Compound Syrup of Hypophosphites (T. M. 20267) is stated to contain m 100 Gm., Potassium, Manganese and Calcium Hypophosphites each 1-2 Gin Iron Hypophosphite 1-4 Gm., Quinine Hypophosphite 10 Gm. btrychnme Hypophosphite 0-02 Gm. Dose.—Medium adult, 1 drachm. Children in proportion. CfDFulvis Hypophosphitum Compositus. Dose.—1 to 4 grains (0.06 to 0 25 Gm.). Calcium Hypophosphite 37i, Sodium Hypophosphite 20, Manganese Hvpo- phosphite 22, Quinine Hypophosphite 1^, Strychnine Hydrochloride Trituration g.v. 1J, iron Hypophosphite 2*, Milk Sugar to 100. Five grains=T^ grain Strychnine Hydrochloride, approx., i.e., 1 drachm of the U.S. VIII Syrup. ® Glycerol Hypophosphitum, Glycerol of Hypophosphites.. Dose.—1 drachm (4 Cc.). A sugar-free tonic. Dissolve Calcium Hypophosphite 160 grains, Manganese Hypophosphite* 80 grains, lotassium Hypophosphite 160 grains, Quinine Hypophosphite* 80 grams. Strychnine Hypophosphite 24 grains in Distilled Water 3 ounces and add Strong Solution of Ferric Hypophosphite (B.P.C.) 4 ounces Hypo- phosphorus Acid . di a chins, Glycerin to produce 20 ounces. Each drachm contains Strychnine Hypophosphite grain and Quinine Hypophosphite t grain. ^ Care must be taken to distinguish the above preparations which contain strychnine from the following preparation, which contains none :_ Syrupus Hypophosphitum U.S.IX had Hypophosphite * of Calcium 45, of Potassium 15, of Sodium 15 with diluted Hypophosphorus Acid 2, Sugar 600 Glycerin 50, Water q.s. to 1,000. Average dose.—2\ drachms. PHYSOSTIGMATIS SEMINA. Calabar Bean (B.P. 1898). Syn. Ordeal Beans, from West Africa. Dose, in poivder.—1 to 4 grains. History of introduction of the drug.—-Gordon Sharp, P.J. i./i6,619. The poisonous properties of the ripe seed of Physostigmavenenosum (Leguminosce) are chiefly due to Physostigmine, which is contained in the cotyledons only, the content being about 0-25%. Details of other constituents: Edn. XVII, p. 640. Antidotes.—Emetics, Atropine or Belladonna, Chloral, Strychnine, Tannin. Potassium Permanganate 10 grains in 1 pint of tepid water, by stomach tube, repeated in \ hour. Stimulants freely. Therapeutic doses of Physostigmine are incompatible with thos of Atropine and Hyoscine and observations on man and animal suggest that large therapeutic doses of Atropine or Hyoscine ar capable of preventing death from Eserine. A fatal intramuscular dose of Physostigmine Salicylate in the cat is stated to be 0-001 Gm. per kilo.—S. Weiss, Jl. Ph. & Exp. Ther., Apl. ’26,188. Uses of JPhysostignia.—Causes increased peristalsis with liquid, motions and excessive urination. Sweating and salivation are effected, the pulse frequency is lessened and blood pressure increased. Preparations of Physostigm a and solutions of its alkaloid Physostigmine J to 1%, applied topically to the eye, contract the pupil, and are antagonistic to atropine. As a myotic the solution acts in 5 to 15 minutes and the pupils remain contracted for 12 hours. It is employed to overcome the over-dilatation caused by Atropine, Homatropine and Cocaine.— G. Sharp, P.J. i./i6,619. Traumatic tetanus has been well treated with extract | grain every hour then i grain every 2 hours ; or give Physostigmine hypodermically, and increase every hour, so as to paralyse, little short of arresting, the breathing. For chorea also it is given in smaller doses. In paralysis it arrests muscular wasting and improves muscular power. In hemiplegia or paraplegia give doses of t6 to 11o grain of extract frequently.—It. CE>Extraetum Physostigmatis (B.P. 1898). Dose.—i to 1 grain (0-016 to 0-06 Gm.). An alcoholic extract containing three-fourths of its weight of milk sugar. Yield about 2 to 5%. CDTinctura Physostigmatis B.P.C. Dose.—5 to 15 minims (0-3 to 1 Cc.). Calabar Bean, in No. 40 powder, 1, Alcohol 90% q.s. to 5. It is antagonistic to strychnine, but is not to be depended on as a remedy for poisoning by mux vomica or strychnine. IFHFhysostigmina. Syn. Eserine. Ci5H21N302=275-1878. Dose.—T% to grain (0-0006 to 0-0013 Gm.). In colourless crystals, slightly soluble in water, freely in ether, soluble 1 in 180 of vaseline. Solution in castor oil, \ to 1% (by weight), keeps well for ophthalmic use. Myotic activity of Eserine mainly due to the Urethane group on the molecule. —E. Stedman, Biochem. Jl., Vol. NX, No. 4, 719. CE^Unguentum Phy sos tigniiine, R.O.H. Physostigmine 1 grain, Soft Paraffin to 1 ounce. Disso ve 111 Chloroform and mix at not exceeding 91 C. [jOiPhysostiaaninae Salicyias, U.S., P. Atjstb., Fr. Cx., P-G. VI., — P. Belg. IV., F.E. VIII., P. Ital. V., Cl5H21N302.CeH4.(0H) COOH = 413-2346. T)nop—"jl. to Wr grain (0-001 to0-003 Gm.). , r 1-, In Needle-shaped or Columnar crystals. Soluble 1 £ ™ Wc°’£ water ; much used as a myotic in solution. Not so liable to tum p as that of the sulphate. srfe tricrsr.&ta is - l opium to check the resulting diarrhoea. If no action give a turpentin enema the following day. The muscular coat of the intestine ii directly stimulated by Eserine. IFH Physostigminae Sulphas, p.g. vi., Ph. Ned. v., f.e. viii. (C15H21N302)2 H2S04 = 648-4512. Dose.—-^q to grain (0-001 to 0-003 Gm.). (B.P.’14, to grain) In yellowish granular crystals, deliquescent and soluble about 4 in | of water. Solution becomes pink, but does not lose much in efficacy' . In doses of T-^ grain (0-0006 Gm.) of value in tympanites a occurring in typhoid fever. CEDGuttae Physostigminae R.O.H. and St. Th. H., J, 1, 2 or 4 grain to 1 ounce. St. M.’s H. 0-5%. In glaucoma the 0-5 to 1% drops are suited for prolonged use. The 1% solution instilled two or three times a day is of value. It contract the pupils and greatly improves vision.—Jl. Trop. Med., Sept. 1, ’26,303. IS ED Guttae Physostigminae cum Cocaina, St. M.’s H. Physostigmine Sulphate 0-25, and Cocaine Hvdrochloride l-25> in Water 100. CE)Guttae Physostigminae et Quininae. Liverp’I Eye and Ear Inf. Physostigmine Sulphate 1 grain, Quinine Sulphate (Bisulphate) 4 grains Distilled Water 1 ounce. Cfpfnjectio Physostigminae Sulphatis Hypodermica. !%• Dose.— 1 to 4 minims (0-06 to 0-24 Cc.). CE)Lameilae Physostigminae (Suiphatis). (B.P. T4). Each contains grain (0-000065 Gm.) for ophthalmic use. Sterules ’ of Physostigmine Sulphate Solution 4 grains to the ounce are prepared, also [g] [gjj ‘ Sterules ’ of Physostigmine Sulphate, 1 grain with Cocaine Hydrochloride 4 grains to the ounce. CEDUnguentum Hydrargyri Oxidi Flavi cum Physostigmina. Physostigmine 0-25, Soft Paraffin or Lanoline (anhydrous) 100 5 heat tiii dissolved, and add, when cold, Yellow Mercuric Oxide 1. P or corneal ulcers in scrofula, solution of 2 grains to an ounce may be dropped into the eye ; also in mydriasis and glaucoma. Diagnosis of glaucoma, a lecture on.—Lieut.-Col R. H. Elliott, B.M.J. i./20,279. CE)Mistura Eserinae Composita L.H. Dose.—4 ounce (15 Cc.). Eserine Sulphate & grain, Tincture of Nux Vomica 10 minims, Compound Infusion of Gentian to i ounce. CEQTablets of Eserine with Trunecek’s Serum (q.v.). No. I contain 0 00025 Gm. Eserine in each, with the salts of 50 Cc. of Trunecek’s Serum. No. II contain in addition to the constituents of No. I atropine 0-00005 Gm. each, for use in the severest forms of intestinal inaction and in obese diabetic patients. Both forms of Tablets weigh 8 grains (0-5 Gm.) each. Maximum dose of either—6 tablets per diem. Eserine I grain given intravenously by mistake caused great flow saliva and incontinence of urine and faeces. Atropine and Strychnine and Oxygen given. Temporary blindness and deafness. Ultimate recovery.—B. L. Slater, B.M.J. ii./22,1120 PILOCARPINA, CuHie02N2=20S-1408. Fa. Cx. An alkaloid obtained (0*5%) from Pilocarpus micropliyllus (Maranbam Jaborandi) and other varieties. Jaborandi was introduced into Britain by the late W. Martindale. Easily soluble in water. Soluble in alcohol, ether, chloroform and benzol. For details of Assay, see Vol. II. Uses of Pilocarpine and its Salts. A powerful sudorific and sialogogue ; after a time a large dose acts as an emetic, contracts the pupil of the eye, and causes approximation of vision. The sweating and salivation from a full do3e persist for 2 to 5 hours, the symptoms come on in about 10 minutes after taking the dose if external conditions are favourable. Hypodermically the alkaloid acts in 3 to 5 minutes. A reduction of temperature occurs. Jaborandi and pilocarpine have been used in a variety of diseases, most successfully in asthma, dropsy and uraemia, and as antidotes to belladonna and opium poisoning. For hiccough small doses every 2 or 3 hours are of value. Children proportionately are not affected by the drugs so much as adults. Externally promotes growth ot the hair, e.g., in alopecia. In alopecia i grain of the nitrate increased to i grain injected into the scalp is recorded to have made hair grow. ° Small doses grain) check night sweating of phthisis and do not over-dry the skin. Puerperal convulsions have been treated by injections. Relieves nerve deafness, also itching of jaundice and assists passage of gallstones. # , Pneumonia is treated by hypodermic injections of grain and more, or given per os. In tinnitus aurium (acute labyrinthine) hypodermically, it is o B.M.J.E. i./2i,85. , j npHvitv of most other glands has no effect Pilocarpine which causes marked acti y M ckenzje jp EXp. Physiology, on the secretion ol the mammary gland.-K. jttacKenzie, Dec., iqii ; see also Pituitary Extract. Antidotes to Pilocarpine and Jaborandi preparations . Strangury may be caused by Pilocarpine & !PlPilocarpins3 Hydrochlondum,vTH ^ o’ 244-6056. P. Ital. Y., P. Belg. IV., 7, bv mouth or hypodermi- Dose.—515 to J gram (0-003 to crvstals slightly deliquescent caily- In minute.granid« 19^ C and very soluble m water, ld.p Uses.—Vide antea. GDHypodermic Tablets contain | grain (0-01 Gm.). FJ Pilocarpinae Nitras. C11Ht602N2.HN03=27M566. Dose.—^ to i grain (0-003 to 0-012 Gm.). Fr. Cx., F.E. VIII., and Ph. Ned. V. Max. single dose grain approx, pro die f grain. In minute white granular snow-like crystals, but may be obtained in large white prismatic crystals. Soluble 1 in 8-2 of water, but very slightly in cold alcohol. This salt, preferred in England, was; the first pure preparation of Pilocarpine prepared,—it was obtained by the late W. Martindale from an alcoholic solution. The lg] Phenale and Salicylate have similar dose and properties. CeDTablets of Pilocarpine Nitrate ^ and grain to be given per os. CB)Guttae Pilocarpinae R.O.H. Used to contract the pupil of the eye. CE> Ophthalmic * Sterules’ are prepared 1, 2 or 4 grains to 1 ounce. CEDIrcjectio Pilocarpinae Nitratis R.O.H. Dose.—2 to 6 minims. Pilocarpine Nitrate 20 grains, Distilled Water 1 ounce. G.II. has the following. ‘ Remove the patient’s night-shirt, wrap closely in a warm blanket, and cover with two more blankets. Put hot water bottles to his feet, and give hot drinks freely. After sweating has ceased, remove blankets gradually, dry the skin and leave him between warm, dry blankets.’ CEDHypodermic Tablets, T\, J, £, J, £, and b grain (0-006, 0-008, 0 01, 0 016, 0 02 and 0 03 Gm.). CfDSterules, Hypodermic, J, J grain. CIDOphthalmic Discs, grain, combined wfith gelatin. CE)Lotio Pilocarpinae, for the hair. Pilocarpine Nitrate 2 grains, Quinine Hydrochloride 8 grains, Glycerin 2 drachms, Rose Water 6 drachms. If so ordered, Cantharides Tincture 1 drachm may be usefully combined with above quantities. Applied locally, and used internally or hypodermically, Pilocarpine seems to have an action in promoting the growth of hair in alopecia or dandruff. Used also in ®Ointment, 4 grains to the ounce of a mixture of wool fat and soft paraffin ointment. CR)Granular Effervescent Pilocarpine Nitrate. Dose.—1 drachm containing A grain for use in throat affections. ®Bromocarpin. Syn. Syrupus Pilocarpine et Potassii Bromide Dose.—For children 3 to 7 years of age 1 to 3 drachms daily ; 7 to 15 years 1 to 6 drachms daily ; adults J to 1 ounce daily, all spread over the day. To be taken before meals. Stated to have the composition Potassium Bromide 10, Pilocarpine Hydrobromide 0-005, Orange Syrup and Glycerin q.s. to 100, by weight. In epilepsy and nervous affections. CE)Extractum Jaborandi Liquidum (B.P. 1898). Syn. Liquor Jaborandi. 1 = 1 of leaves ; in 45% Alcohol. Dose.—5 to 15 minims (0-3 to 1 Cc.). CE)Tinctura Jaborandi (B.P. 1898). 1 in 5 of 45% Alcohol. Dose.—30 to (30 minims (2 to 4 Cc.). CgyLinimentum Jaborandi. Jaborandi Tincture 1, Cantharides Tincture 1, Soap Liniment 4. For hair falling off, apply with friction. PILUUE, As the excipient for pills intended to be varnished, use equal parts of powdered gum acacia and tragacanth with syrup q.s. Glycerin, if used at all is best mixed with alcohol. It is unsuited for hygroscopic drugs such as soft extracts, squills, aloes, etc. For these mucilage of acacia or syrup is preferred, and tragacanth in moderation is useful as a ‘ hardener.’ For insoluble metallic salts, glycerin of tragacanth (q.v.) may be employed, adding, if necessary, a small quantity of powdered acacia or althaea to give firmness. For Aloes Pills Compound Decoction of Aloes is sometimes used. For Camphor a little Tragacanth or Soap and Castor Oil; if with Quinine, Tragacanth and Glucose Syrup, q.s. Unguentum Kaolini {q.v.) works satisfactorily for oxidising agents such as potassium permanganate. For Oils soap is best used. Syrup of Glucose is also employed; this is prepared by heating Glucose 1, with Syrup 2, v. also Glucantha. Codeine and other Pills given in diabetes should not be massed with Syrup of Glucose. Fill Varnish (Martindale). Sandarach 1, in Absolute Alcohol 1. Sandarach, Syn. Gum Juniper, is a resin from Callitris quadrivalvis (Coniferce). Alcohol Sandarachi, B.D.H. For dental use. Sandarach 2, Alcohol (90%) 1. In Coating Pills with Gelatin the pills are held on needles or by suction in a frame and dipped in a solution of 1 part of gelatin in 4 parts of water. In Pearl-Coating, the Pills are first covered with a mucilage of tragacanth 4 grains to 1 ounce with half a drachm of syrup added ; they are then coated by rotating in a pot with French chalk. The Sugar-coating of Pills is effected by placing them in a hemispherical metallic pan kept warm, while making eccentric revolutions, and are altei- nately moistened with syrup, and dusted with finely-powdered sugar, till dry and uniformly covered. Methods of Coating Tablets, Pills, Capsules, etc. to render them insoluble in the Gastric Juice but soluble in the Intestines. Various substances have been suggested for coating pills, tablets and capsules to render them insoluble in the stomach but soluble in the intestines, i.e., on reaching the duodenum. Drugs, or example, which irritate the mucous membrane and the administration of which is liable to induce vomiting, and substances intended to act solely on the intestines, and the anthelmintic drugs, have been so given. The recent important requirements relative to Iodo-Raytj.v., should also be mentioned. Keratin, as usually employed, seldom brings about the desired effect. Keratin is an ammoniacal solution of horn no^contlin mofsture Sn Gr about 1-02 In using Keratin the pills must not contain moisture ofVeaeteblepowdersAs a pill basis employ Kaolin with Suet, coat 3 to 6 timegs whh the Solution and finally roll in apowder- A COatl"g of wax prior to the Keratin coating is sometimes employed. Benzonaphthoi Varnish .-Benzonaphthoi 6, Tanmgen 10, Salol 20, Alcohol (90%) 30, Ether 1AA q1ca r no better result with it. 100 has also been recommended, but we obtained Salol applied melted is more efficacious. 1£ to 3 grains of Salol applied in this way is suitable for a 3 to 5 grain pill. Cf. Bismuth Compound Pills. Stearettes (T.M. 322854) (Martindale) are made with a coatin, containing Stearic Acid inter alia. Stearic Acid alone is useless —it cracks on drying. Aceto-Salicylic Acid 2 to 5 grains. Aloes 2 to 4 grains. Antipyrin 1 to 5 grains. Areca 2 to 5 grains. Calcium Sulphide \ and 1 grain. Carbolic Acid i to 1 grain. Emetine-Bismuth Iodide 1, 2 and 3 grains. Ferrous Sulphate, Exsicc, 3 grains. Iodo-Ray 0-3 and 0-5 Gm. Ipecacuanha i to 2 grains. Magnesium Peroxide 3 grains. Menthol 4 to 1 grain. Methylene Blue £ to 1 grain. JSTaphthol Bismuth 2 to 5 grains. Ox Bile 5 grains. Pancreatin 1 to 2 grains. Phenol Bismuth 2 to 5 grains. Potassium Iodide 5 grains. Quinine Aceto-Salicylate i to 2 grains Quinine Salicylate 4 to 2 grains. Quinine Sulphate \ to 3 grains. Reduced Iron 1 to 3 grains. Sodium Salicylate 2 to 5 grains. Thymol i to 1 grain. Trilactine. Stearettes should as a general rule be given immediately afte a meal—i.e., when the stomach is acid. Pills.—The ‘ Stearette * coating is also applicable to pills bu with greater difficulty. Tablets are easier to operate upon. Foimagllles (Formalised Gelatin Capsules). Where the digestive functions are normal, these should pass tffi stomach intact and break up in the intestines. The following Formagules are Aloes 2 to 4 grains. Asafoetida 5 grains. Copaiba 5 to 10 minims. Creosote i to 2 minims. Eucalyptol £ to 1 minim. Guaiacol Carbonate 1 to 4 grains. Ichthyol 1 to 5 grains, lodinol 10 minims. suggested:— Male Fern Extract 10 minims. Methyl Salicylate i to 1 minim. Ox Bile 5 to 10 minims. Quassia Extract 2 grains. Salol 2 to 10 grains. Santal Oil 5 to 10 minims and Com pounds. Santalol 5 minims. Formagules should be employed for substances which irritate gastric mucou membrane, neutralise acidity of stomach, or are to act on intestinal membram but not in the stomach, e.g., to destroy worms. They should be quite recently made. The hardening effect of formalising continues on keeping. Sahlis Glutoid Capsules are made on these lines. A revised list of pills in general request is contained in the Index ^Pulverette (T.M. 293309) Powder Pills (Patent) are of specia manufacture. These have a thin coating easily crushed. Cachets of wafer paper are useful for enclosing nauseous medicines and drugs that do not yield all their activity to any solvent* and those whose suspension in fluids is difficult or inaccurate owing: to non-diffusibility or decomposition. Capsules, Soft Gelatin, are used for nauseating oils, etc., v. Index' *Slipules (T.M. 419586). This Registered Trade Mark is applied to hard gelatin capsules of the ‘ slipover 5 variety ; the number of the slipule for a dose of the medicament is frequently shown. Content m Sodium Bicarbonate. 55 4 J} 55 55 „ 15 55 55 5 5 5 59 4 55 3 ,, 55 55 „ 17 55 55 55 5 > 9 5 55 2 ,, 55 55 „ 18 55 55 5 5 6 > 9 6 55 1 ,, 55 55 „ 20 5 5 55 59 6 99 8 55 0 ,, 55 55 „ 22 5 5 5 5 5 9 7 j 3 10 55 00 „ 55 55 „ 24 5 5 9 5 9 9 8 5 9 15 55 000 „ 55 55 ,, 26 55 55 55 10 5 5 25 3 7 - 7 J J J J J —vr « y y } JJJLW 5 J i-lt/ They distinguish from the soft variety of Gelatin Capsule, PINUS. Pin us Sylvestris. Syn. Scotch Fir or Pine. From the wood of this tree (principally in America, France and Russia) much of the oleo-resin, common turpentine, oil of turpentine, Gum Thus or American frankincense, resin or colophony and tar (vide Pix Liquida) are produced. From its leaves also are prepared an extract, volatile oil and wool. By ‘ Turpentine,’ i.e., Terebintbina N.F. and P. Svec. X, and in other countries, is meant the concrete oleo-resin obtained as exudate from various species of Pinus. Synonyms for this natural product are Gum Thus, Thus Americanum and Common Frankincense as mentioned. Bordeaux Turpentine is a variety obtained in S.W. France. True Frankincense is generally understood to be Oiibanum from Boswellia Carterii and other species. Oleum Terebinthinae (Rectiflcatum) B.P. T4. (Syn. Camphine), is distilled from the Oleo-Resin Turpentine obtained from Pinus Sylvestris and other species of Pinus. Sp. Gr. 0-860 to 0-8?0. Almost entirely distils between 156° and 180° C. without appreciable residue. O.R,. varies from different countries. Collection of Turpentine in the Landes Department of France, from Bordeaux to Biarritz ___jp j jcn 245 Oleum Terebinthinse ^Etliereum, Fr. Cx., is distilled from P. Pinaster in France. Sp. Gr. 0-864 at 15° C. See V 61. 11. for further data. Capsules of Oil of Turpentine, 5 and 10 minims each. Dose.—1 or more. Uses.—Effect of Oil of Turpentine on tub kidneys. Large doses produce sense of warmth in the stomach, accelerate circulation, and cause feeling of exhilaration with vertigo and fullness in the head : nausea and catharsis often ensue. In small doses frequently repeated it stimulates the kidneys, but if continued too long causes painful irritation of urinary vessels, and even violent strangury and inflammation of the kidney.—U.S.D. In internal haemorrhage 10 minim doses often successful. In enteric has been given as capsule or emulsion with Spirit of Chloroform 10 minims every two or three hours. Anthelmintic (3 to 4 drachms or more) generally given with Castor Oil. Also given to remove faecal masses (with Castor Oil) and to remove bile concretions. . , in , Large doses, 2 drachms and more, have been given. I or children oi iu to 12 as much as i ounce with equal quantity of Castor Oil. # Haemostatic action of Turpentine when brought into immediate contact with the surface. Arrested haemorrhage in a bleeder under opeiauon. Use as a compress by soaking lint in it and squeezing nearly dry. ^buppoit by a pad of wood wool and fix with a firm bandage, lhe surrounding skin may blister. Also successful in secondary haemorrhage m war wounds. Value when taken by the mouth doubtful. Refs., Edn. A.IX, p. OfU. An old-fashioned styptic for packing a tonsil bed. R. S. Stevenson, L. ii/25,1332;i Tvi'iim?1, \1 ou rCe doses with castor oil. No injurious effect on the kidneys dosp^r^°rninTY^iPfr^u mm^r/ tj^r^ugh Cleansing of the bowel by small divide. 1 OMnep Wtbru!vi r?iVf2 HCastor Oil prepares the ground for an enema o In most 1 pmt.glY®? slowiy. Next day, or day after, repeated in1 nm™ mf??0®8 the a^?u?t of -turpentine may then be reduced to £ oune wh nii pni?7-cn ?nnCf-S) thls 1S administered on alternate days throughout th BIJ?/iTl95he disease and continued until convalescence is established — wGir eMV^nimS Hirpentine Emulsion (e.g., U.S. X. q.v. or made stronger.— n boif S nva capsule of 5 minims Oil of Cinnamon two or four-hourly ant L forrhl0 \G il ennema| aad apply heat to the abdomen, if there is n haemorrhage. A. E. Gow, L. i./3o,39. See also Therap. Index. nnrnnRIiTiS’7~In <?ase,s. of a chronic hind, urethral chancroid and specifl N fhis, local applications of Turpentine to the urethra by means of s catheter have given very satisfactory results.—L. i./n,982. Death of a man of 39 following drinking of 6 ounces of Spirits of Turpentine? cavitv °fThTf^iCSete!y macerated and lying in small pieces in the gastri. if/31 77 lhS Wal1 °f the stomach felt hke leather.—F. P. Maitland, B.M.J Turpentine Punch. Ten drops of turpentine on a lump of sugar addec p° a lvlae'?lass of ordinary whisky punch for septic pneumonia.—Sir J. Moore ±r., jam, 19, per Pres. Sterules of Rectified Turpentine 15% in Olive Oil, 1 and 2 Cc are made for intramuscular use. Skin affections treated by Turpentine injections. Uose.—0-5 to 1 Cc. intramuscularly every 4 to 7 days for adults ° weekly for infants up to 5, and 4 minims for older children. Used in skin affections caused by an infective agent ori in which, as in pityriasis rosea or pemphigus, some form of microorganism may be the causative factor. A 15% solution in Olive OiD with 0-5% each of Ansesthesin and Quinine Hydrochloride is used- The composition of Terpichin is similar. In some cases no benefit* e.g., in erythema, urticaria or purpura. The best results were? obtained in pyogenic conditions of the skin, associated with poor: general tone, e.g., in ecthyma, furunculosis, sycosis vulgaris, lupoid! sycosis, abscesses and erysipelas. In severe cases of varicose ulcer the lesions became cleaner and rapid formation of granulations and epidermal tissue followed. The general effect is thought to be> increased local cell metabolism.—L. ii./22,1287. Turpentine Injections (10% to 20% in Olive Oil) at Mount Sinai Hospital, the site selected, was the intersection of an horizontal line drawn from the posterior axillary border and a line one or two finger’s breadth below the brim of the pelvis. At this part the needle easily strikes the periosteum, upon which the injection is made. Good in some cases of acne, especially good in ulcer of \he, legv“Med* llec-> Jan- u> 1922 ; Pr., Aug., ’22,188 ; Jl. Trop. Med., June Chilblains of the legs treated with Turpentine injections.—B.M.J. i./2 3,1194. Artificial abscess formation in non-specific immunisation.—See also Peptone p. 669. Emulsum Olei Terebinthinae, U.S. X. Average dose.—£ drachm (2 Cc.). Emulsify Turpentine Oil 15, Acacia 5, with water 10, then add water to 100 Another form turpentine Oil and Quillaia Tincture, of each 20 minims water to 1 ounce. ’ Enema Olei Terebinthinae, St. M.’s H. Turpentine Oil £ ounce, Starch Mucilage to 10 ounces. L.H. has Turpentine I to 4 drachms, Enema Simplex to 1 pint. The Oil is mixed with £of the Simple Enema. This is given and followed by the other half of Simple Enema. Enema Simplex is Soft Soap 1 ounce, Warm Water to 1 pint. For flatulent distension of the colon of great value. On diagnosis of appendicitis, if considerable flatus, an enema of Turpentine Oil is of value. Some give a dose of Calomel, but the peristalsis set up may be harmful. Stokes’ Liniment, N.F. Syn. Linimentum Album. Mix one entire egg with Rose Water 85 Cc. Strain and add Turpentine Oil 100 Ce., then Acetic Acid 20 Cc. Shake thoroughly to emulsify and finally add Lemon Oil 4 Cc. Linimentum Album, N.II.I. Syn. LINIMENTUM COMMUNE. Turpentine Oil 4 drachms, Soft Soap 66 grains, Ammonium Chloride 11 grains, Boiling Water to 2 ounces. Linimentum Terebinthinse (B.P. ’14). Contains Turpentine Oil 65%. Knight’s method is satisfactory.—Mix Solution of Potash (B.P. ’98) 3 ounces with water 3 ounces in a bottle, add Oleic Acid 7 drachms previously mixed with Oil of Turpentine 3 ounces, and mix gently. To this emulsion add Turpentine 10 ounces with Camphor 1 ounce dissolved in it, in portions of 1 ounce or more at a time. Liquor Potassse, B.P.’g8 was 5.85%. Linimentum Terebinthinse Aceticum. Syn. St. John Long’s Liniment. Emulsify Turpentine 3 ounces, Rose Water 2i ounces, Acetic Acid 5 drachms, Oil of Lemons 1^ drachm with yolk of one egg. A useful counter- irritant. Distinguish from Lin. Tereb. Acet., B.P. '14. Gossypium cum Oleo Terebinthinse. Syn. Turpentine Wool R.D.H. Cotton wool or gauze soaked in the oil and squeezed dry, packed into the tooth socket as a stupe. „ Spiritus ‘ Antiparalyticus.’ — Turpentine Oil 4, Oil of Amber 4, Camphorated Spirit 64, Solution of Ammonia 28. Used as a liniment. Sapo Olei Terebinthinse. , . , , Turpentine 1, Soft Soap 2, Glycerin 1. As a vermicide also a stimulant local application. , ,. ... . .. 2k “Sanitas ” Fluid, (T.M. 64575), the solution resulting from the action of water upon air-oxidised turpentine, containing as its active principles hydrogen peroxide, thymol, a soluble camphor, and some camphoric acid. A household disinfectant and oxidiser. Ron-poisonous, does not stain linen. Is used in midwifery. “Sanitas ” Oil has Sp. Gr. 09o. A strong oxidising agent. For inhalation in phthisis. Diluted with spirit used as spray m a room, or 1 in 8 to 20 of olive oil for skin affections (Other T M s are 33175 34778, 407550, 48108 and 444095.) SaAas Bactox” (T.M. 279528). A disinfectant of the coal tar order for medical use. Extractum Pin! Sylvestris. Fir-wool Extract. A thick brown liquid, soluble in water and with pme odour; - to 4 ounces are added to a 30-gallon warm bath for rheumatism. Oleum Pini, on of Fine. Dose.—\ to 3 minims (0*03 to 2 Cc. .. The oil of the leaf of Finns Pumilio (Conifera) was official in the B.P. 1898 and is in U.S. X. It is used more In a pure oil not more than 1% distito below 165 C^-Fmnemore^ ^ The oil distmed from the fresh^eaveso^Pi)^ .citato gQ of ester8 (^alcuSted aPsbornyl acetate, with alcoholic potash. The aroma of this oil is entirely distinct rrom P. pumilio and P. Sylvestris. -powerful or soporific or Mosquito Larvje and PuMJ.-Pine OH. has a powertm ^ paralysing effect on, resulting mp their 1dec ^ t one of the latter, is Pine Oil, in the proportion l of nine parts of th and effective in destroying all stages oj. Anopneime anu Am. Jl. Hyg., per Jl. A.M.A. n./25,22l.. Syrup us Pini Pumilionis—Martindale. Contains KneOU I* ta60 in a dilute Glycerin and Syrup Solution. O ®(pLinctus Pini, Terpin et Heroin.—Syn. Elixir or Syri of Pine, Terpine and Heroin.—Martindale. Dose.—1 drachm (4 Cc.). Resembles the foregoing with additio: of grain Heroin Hydrochloride and \ grain of Terpine Hydral per drachm. Both are useful soothing antispasmodic preparation. Elixir Pini et Terpin Hydratis (Simpiex). Dose.—1 drachm (4 Cc.) dilated. Similar to the last mentioned, but without Heroin and containiir a minimum of Alcohol, for children’s use. CeD Pinheroin. Dose.—1 drachm every 2 or 3 hours, if necessary. Contains Heroin Hydrochloride & grain, Terpine Hydrate 1 grain wit Essence of Canadian Pine. A special preparation as a respiratory stimulan:; Cp} ® Glycogelatin Pastils (q.v.) are prepared containing each ^ minim Pumilio Pine Oil with i Terpene Hydrate, and A grain Heroin Hydrochlorid: Artificial Venice Turpentines—Mix Resin 17, Linseed Oil (boiled) 1 Oil of Turpentine 8, or dissolve Resin in Oil of Turpentine ; is mostly employe* m the Arts. The true article exudes from the branches of the larch, Lan Europoea (Coniferce). Common turpentine and artificial products consistii: of colophony, resin oil and oil of turpentine, are often employed. Larch bark is an astringent (owing to Tannin content) and diuretic. Alcoolat de Fioraventi. Syn. Balsamum Eioraventi, Fr. Cx. Venice Turpentine (Terebenthine de Meleze) 10, Elemi 2, Storax 2, Gaibanu:. 2, Myrrh 2, Laurel Berries (Baies de Laurier) 2, Aloes 1, Galangal 1, Ginger Zedoary 1, Ceylon Cinnamon (Canelle de Ceylau) 1, Cloves (Girofles) 1, Raisin (Muscades) 1, Origanum Dictamnus flowers (Dictame de Crete) 1, Alcoht (80%) 60. Macerate 2 days s.a. and distil to obtain 50. It is used as embrocation in rheumatism. For alopecia, Liquor Ammonise 1, Baume Fioraventi 15, Spirit of Camphor 1 Apply with friction after washing with soap. Balsamum Located!.—Venice Turpentine 18, Yellow Wax 12, Oiive Oil 1< Balsam Peru 2, Dragon’s Blood 1. For chilblains (even if broken).—Ph. Xote: Dutch Drops, Haarlem Drops.—For lumbago and rheumatism. Ph. Form says :—Form now generally adopted in Denmark and Hollan is :—Heat to 165° C. in an iron vessel, large enough to allow some frothim Linseed Oil 4 and Sulphur 1, with stirring, until mixture drops off the stirn with a glassy appearance. Remove from the fire and add 15 parts (by weigh of Oil of Turpentine, and agitate until solution is complete or nearly so, the filter. The liquid should be limpid and of a brownish-red colour. PIPERAZIN. Fr. Cx., F.E.VITI. Diethylene-diamine. HN<^Sj2’^^2/NH= 86-094. 2*2 (Piperazine Hydrate with 6H20 is in addition official in Fr. Cj: Supp. 1920. It contains 44-33% Anhydrous Piperazin). T.M. : The word Piperazine by itself is not registered. A firm registere 166600/1892, a device embodying the word but disclaiming exclusive use c the word. Patents : All expired. Dose.—4 to 10 grains (0-25 to 0-6 Gm.), or 15 grains daily. Manufactured by the action of sodium glycol on ethylene-diamir hydrochloride.—Further details, Edn. XIX, p. 702. Colourless alkaliu deliquescent crystals of saline taste, soluble about 4 in 7 of water. Melt at 104° to 107° C., B.pt. 145° C. jFlavoring*—Glyl Sassafras, Glyl Caryophylli; Syrupus Aurantii Uses, —Given internally for the uric acid diathesis, in gout am rheumatism, and urinary calculi. Said to prevent change fron glycogen into sugar in diabetes. PIX LIQUIDA. 695 hvTth^ hS™*,*a+Vght,that °wmg to impaired power of excreting Uric Acid cLSfn!nl wi-?vSer7ed aC(mmulation occurs in the blood and that in P«°.^o^fBmrate Was d®p0Slted in tissues, e.g., cartilages, giving afpnriiiv +a p?,ro:55ysm of Scut- Of recent years the opinion has ^e%*e.d Aa°k to closely resemble the original, but it is unfortunately useless to administer a base and expect it to reach any spot in the body in sufficient quantity to have a chance against the Sodium which is so abundant in the blood and tissues.—Sir A. E. Garrod. Incompatible with alkaloidal salts, iron salts, quinine, sodium salicylate, spirit of nitrous ether. Effervescent Piperazin contains 5 grains in a drachm. Dose.— 1 drachm (4 Gm.). Also made with Phenocoll. 5 grains per drachm. Tablets and 6 Vescettes ’ of Piperazin, 5 grains (0-3 Gm.) to be crushed and taken in a draught of warm water. Glycero-Fiperaz. -— Syn. Piperazin Glycerophosphate, Basic. (C4H10N2)2C3H5(OH)2PO4H2 = 344-2782. Dose.—5 to 10 grains (0-3 to 0-6 Gm.). A granular white salt very soluble in water, neutral to Litmus and containing 50% Piperazin. Our work has shown that this salt is the most easy of the kind to prepare and the most stable. It does not deliquesce as do the neutral i and acid salts. Benzo-Piperaz. Piperazin Benzoate—C4H10N2(CvH6O2)2=33G-1976 and Salicyl-Piperaz. Piperazin Salicylate—Dose 2 to 5 grains —C4H10N2(C7H6O3)2 = 362-1976 are crystalline salts also suggested for therapeutic use. Piperazine compounds of substituted Phenyl-arsinic Acids subject of patent 252099.. Sidonal, New. Dose.—30 grains (2-0 Gm.). Trade Mark 229305/1900 was removed from the Register in 1914. Said to be the anhydride of Quinic Acid. White crystalline powder, soluble about 1 in 2 of water, and about 1 in 11 of alcohol 90%. For gout. Tablets contain 74 grains. The original Sidonal was Piperazin Quinate. Details of the Patent (No. 11420/1899, which became void) in Edn. XVII, p. 650. Piperidinse Tartras. Syn. Piperidine Acid Tartrate. CIL CH2.CH 2VCH,.CH ^235-1406 - 2* 2 The tartrate of the base piperidine made by reducing pyridine in alcoholic solution, with sodium amalgam or from Pipeline by distillation with Soda Lime or by boiling with Alcoholic Potash. Dose.—15 grains (1 Gm.) three times a day. Colourless pleasant- tasting crystals, readily soluble in water. Uric acid solvent. Effervescent Piperidine Tartrate. Dose.—1 drachm or more ; 5 grains in 1 drachm. FIX LIQUIDA. Syn. Pix Pini, U.S.X. Tar (B.P. ’14). Known in commerce as Stockholm Tar, obtained by the distillation of the wood of various species of Pinus (Coniferce). Further details in Vol. II. t Dose.—2 to 10 grains (0-12 to 0-6 Gm.) in a pill with lycopodium, or in perles (2J grains each). As a diuretic and in bronchial catarrh and for coughs, it is useful and has been given for gastro-intestinal catarrh. Soluble about! 1 in 1 of alcohol 90%. On account of their antiseptic properties both Wood and Coal Tar and preparations of them have been used for surgical dressings. The former yields Creosote, q.v. Aqua Picis. Tar Water.—Syn. Aqua Picea, Eau De Goudron.. Tar 1, Sand 3. Mix and add distilled Water 200. Macerate with shaking for 24 hours, filter. Dose.—5 to 10 ounces (150 to 300 Cc.)- Pix Burgundica. Burgundy Pitch (a misnomer as it comes from Normandy) the exudate from Picea excelsa (Coniferce), was employed in making Emplastram Picis (B.P. 1898). Oleum Picis Rectificatum, Light oil of Tar. u.s. x. Dose.—1 to 5 minims (0-06 to 0-3 Cc.). A distilled oil of Pine Tar, known also as Rectified Spirit of Tar with Sp. Gr. about 0*9, sherry-coloured or reddish; antiseptic. Pilula Picis Liquids. Dose.—1 to 5 grains (0-06 to 0*3 Gm.). Tar 1, Soap 1, Compound Tragacanth Powder J, Licorice Powder 2f. Useful for coughs and for haemorrhoids—best freshly made. Syrupus Picis Pini, Syrup of Tar, U.S. X. South American Syn. Jarabe Brea. Dose.—2J drachms (10 Cc.). Mix Rectified Oil of Tar 1, with Water 450 and shake 15 minutes. Set aside 24 hours, filter and dissolve Sugar 850 in the filtrate and make up to 1,000. CED A to A grain of apomorphine hydrochloride may also be added to each dose. Useful in chronic bronchitis and winter cough. CP)Syrupus Picis cum Codeina. P. Helv. Codeine 1, Sugar 505, Tar Water 324, Glycerin 150, Dilute Alcohol 20. Dose.~l to 2 drachms (2 to 8 Cc.). Unguentum Picis Liquids. Tar ointment {B.P. ’14). Contains 70% of Tar in a basis of Beeswax and Lard. U.S.X. has Pine Tar 50, Yellow Wax 15, Petrolatum 35. Useful in psoriasis and chronic dry eczema. Unguentum Picis Compositum. Ringworm Ointment, Ph. Ned. V. Heat together Water 20, Tar 16, Resin 4, and add with stirring Starch 16 mixed with Water 30, then Venice Turpentine 4, Acetic Acid 30% 8, and Water to 100. Ether-Soluble Tar Paste. Syn. E.S.T.P. In making this preparation Tar is distilled in steam and the Ether- Soluble distillate incorporated in a Zinc and Lanolin basis. It is preferable to Crude Coal Tar as being cleaner and better tolerated. Most useful in infantile eczema, chronic eczema with lichenification, lichen simplex chronicus (Widal) and pruritus ani.— H. W. Barber and G. B. Dowling. Oleum Cadinum. U.S., P. Helv. Fr. Cx. Supp. 1920.—Syn. Juniper Tar Oil. Oleum Juniperi Pyro-ligneum. Huile de Cade. By distillation of wood of Juniperus Oxycedrus (B.P. ’14) and some other species (Coniferce or Pinacece). This oil varies enormously. For Characters, Tests, and Besults of some Experiments see Vol. II. In most cases of psoriasis a seborrhcea of the scalp will be found. This is well treated with Soap and Water followed by a Salicylic Lotion, Oil of Cade 1 m 5 of Olive Oil and gradually increasing strength till the pure Oil is used. A good deal is distilled m Spain. Extreme limits of Sp. Gr. observed during twenty years—0-955 to 1-064. Methods of making. Contains, if genuine (fioni J. Oxycedrus), high proportion of Cadineneand does not give reaction for pine tar— C. T. Bennett, P.J. ii./2i,166. Oleum Cadini Aceticum. Acetic Acid 1, Cade Oil 10. This and the former are used for alopecia. The following are used in psoriasis and dry eczema. Unguentum Olei Cadini et Sulphuris. Cade Oil 10, Sulphur 1, Vaselin 15, Lanolin 15. Unguentum Olei Cadini. Melt Yellow Beeswax 1, add Huile de Cade 1, and stir till cold. Lard may be used as 8, diluent if a weak ointment be required. Unguentum Betulae Compositum, St. G. H. Huile de Cade 1 drachm, Resorcin 10 grains, Ichthyol 10 grains, Oil of Sweet Birch 10 minims, Lard to 1 ounce. Oleum Fagi Pyroligneum, Beech Tar. On the Continent used as a source of creosote. I Linimentum Picis (Lassar). Beech Tar 4, Birch Tar 3, Olive Oil 1, Alcohol (70%) 1. Oleum Kusei Pyroligneum. Said to be obtained from Butcher’s Broom. Is really identical with Oleum Betulce Pyroligneum, Birch Tar. A yellowish-brown oil from Betula Alba (L.). The above Oils are used instead of Tar in skin affections. The odour of russia leather is due to Birch Tar. They are all miscible with fats, but do not blend perfectly with alcohol, i Huile de Bouieau is obtained by distillation of Betula Alba. No reason why Birch Tar should not be distilled in England or Scotland.—E. M. Holmes, P.J. i./2i,5G8. Unguentum Kusei Compositum. Birch Tar 30, Calamine 45, Resin Ointment 120, Zinc Ointment 120, Carmine Trituration 4, Liquid Paraffin 15. For chilblains, eczema, prurigo and psoriasis, and for irritation due to piles. i Ung. Sedresol (Ferris). (^Sedresol, T.M. 278084.) A combination of Beech-tar, Zinc Oxide and antiseptics. Sedative, antiseptic and healing in eczema, psoriasis, erysipelas, shingles, erythema, seborrhcea, dermatitis, pruritus ani and vulvse, in inflammations and eruptions of the skin, and in burns and scalds. PLUMBUM. Pb=207*22. lead, its History and Occurrence.—G. M. Dyson, P.J. h./3°> 286,302,387. Medicinal and allied aspects.— ibid. 406. PI limbi Acetas. Syn. Sugar of Lead, Saccharum Saturni. Pb.(CH3C00)2.3H20—379-3036. Dose.-—1 to 5 grains (0-C6 to 0-3 Gm.). . Colourless crystals or masses soluble in water 1 in less than 3 , in Alcohol (90%) 1 in 30, in Glycerin l in 2. Incompatible with Carbonates, Soluble Ghlondes, Sulphates, Tannates, Potassium Iodide and Opium preparations. The Subic tate is incompatible with Acacia Mucilage. Uses.—Astringent, e.g., in severe diarrhoea, and as a hsemostat (of doubtful value) in gastric ulcer; it is a powerful poison. Ex ternally for eczema, leucorrhoea, gleet, pruritus and for bruises. Inoperable cancer treated by Lead Acetate sometimes with improvemer:; 1£ grains daily for first week, then twice a day until patient becomes past yellow. Growths of the uterus do not seem to respond.—G, C. Belches B.M.J. ii./25,1040. Lead is an extraordinary poison as regards its selective actio; It acta on the nervous system. It may act on the central nervous system, b It also acts on. the peripheral—hence in chronic poisoning causes peripnex: neuritis. Lead may cause gout—* poor man’s gout,’ as it is often calle; Lead occurs in the urine of everybody at the present dav.—Sir \ Willcox, M.P.C., Nov. 12, '30. intravenously Lead causes marked blood changes and there may t action on the nervous system, on the eye, kidneys, liver, and so on.—Sir W Willcox, M.P.C., Nov. 12, ’30. Distribution of Lead in the body.—L. i./3o,826. Antidotes.—Emetics or Stomach Tube, Magnesium or Sodiur Sulphate followed by stimulants. Atropine in full doses relieves colic and keeps bowels open. Plumbic optical neuritis due to poisoning with lead paint treated wit Dilute Sulphuric Acid and Saline laxatives, hypodermic injections of Piikj carpine (the latter continued for six weeks): after the first few days Potassiu: Iodide, 5 grains thrice daily for a child of 8 years. Potassium Iodide must be used with caution—sudden death may occr due to the entrance of a large amount of soluble lead salt. Ocker’s treatment with Sodium Hyposulphite (0-6 Gm.) in industri. poisoning in the States, also the intravenous injection of Calcium Chlorid 15 Cc. of 5% solution relieves colic.—B.M.J. ii./26,844. Care must be taken to distinguish a Lead line from a Mercurial gum line a in lead workers.—L. U./12,1138,1106. Cf., Hydrargyrum, p. 467. Lead poisoning from face enamel, which on analysis showed a very hig. lead content.—H. W. Woltman, per Clin. Jl., Jan. 24, '23,48. Industrial poisons.—Lead, Arsenic, Mercury, Phosphorus, Radio-activ substances—upon the different organs.—Sir Thomas Oliver, B.M.J. ii./28,83 The Incidence of Chronic Nephritis in Queensland, Australia, found ti be due to the use of White Lead paint on veranda railings—transferred b cliildren from the hand to the mouth by nail-biting and thumb-sucking, am by the imbibing of rain-drops from the veranda rails. A combination cq Titanium White and Zinc Oxide suggested as a good substitute for Whiff Lead paint.—B.M.J. ii./29,1211. Modern Treatment of Lead Poisoning.—Constipation treated R Magnesium Sulphate : colic by local heat, Amyl Nitrite, Nitroglycerin am Atropine. Calcium Chloride, 20 Cc. of 5% solution, given very slowly intra venously. Attempt elimination by Acid Phos. Dii. or Ammon. Chlor.—E Hunter, L. ii./29,901. Lead poisoning treated by artificial acidosis, produced by large doses a Ammonium Chloride, and by Parathyroid (Collip.).—L. ii./29,1106. Lead storage and excretion in bones, and effect of Ammonium Chloride — L. L/30,1005,1006. Cumulative effect of infinitesimal doses, e.g., from lead in tla domestic water supply. Chief symptom a strange lethargy of body am mind—usual symptoms of plumbism absent. The remedy is simple, namely stop ingestion of lead. No medicinal treatment is necessary.—N. Porrit B.M.J. ii./31,94. Abortifacient Use.—Morphine and a course of Mist. Alba successful Blue Lead lines on gums disappeared. Children born in each case. In on the woman admitted taking 60 grains of Lead Acetate in a fortnight.—E Craik, B.M.J. ii./26,908. For some details of Lead Poisoning in the Potteries, etc., see Vol. II* 699 Glycerinum Plumbi Subacetatis (B.P. ’14). This is similar to Liquor Plumbi Subacetatis Fortis (B.P. ’14) with glycerin for the solvent in place of water. Liquor Plumbi Subacetatis Fortis. Syn. Goulard's Extract. An improved method of making is the following: Triturate Lead Oxide (Litharge) in powder 320 Gm. with 100 Cc. of Distilled Water to xorm a smooth paste, and. transfer to suitable bottle, washing in the remainder of Litharge with 650 Cc. of Distilled Water. Shake well with Acetic Acid 240 Gm., and shake vigorously for several minutes then occasionally for 30 minutes. Set aside for 24 hours, shaking occasionally; filter and pass through sufficient Distilled Water to produce 1,000 Cc. Sp. Gr. 1-275 to 1-300. Piace 6 Gm. in a 250 Cc. flask ; add 25 Cc. of recently boded Distilled Water, and 200 Cc. of N/10 solution of Oxalic Acid. Shake for several minutes, and dilute with Distilled Water to the mark, again shaking vi^roTs,17* > ^ter through a dry filter, rejecting the first 20 Cc. To 50 Cc. oi the filtrate add approx. 150 Cc. of Distilled Water and 5 Cc. of Sulphuric Acid diluted with 5 Cc. of Distilled Water ; warm to 80°, and titrate with N/10 Permanganate, maintaining the temperature above 60°. Deduct the number of Cc. of N/10 Permanganate required from 40. Each Cc. of the difference corresponds to 0-01036 Gm. of Lead. Titrate another 50 Cc of the original filtrate with N/10 Sodium Hydroxide, using Phenolphthalein. Deduct the number of Cc. of N/10 Permanganate from the number of Cc. of the Soda required. Each Cc. of the difference equals 0-006 Gm. of Acetic Acid.—P. A. Berry, Austr. Jl. Ph., June, ’30 ; Chem. Eng. and Mining Rev., Aug., ’30 (Melbourne). Sp. Gr. of Goulard’s Extract, B.P. T4, should lie between 1-275 and 1-29, and the Lead Subacetate content between 26-5 and 28%.-—J. E. Woodhead P.J. i./31,28. Liquor Plumbi Subacetatis Dilutus (B.P. T4) is 1 of the Concen- 1 trated Liquor with water q.s. to 80. I In chronic eczema the Glycerin of Subacetate of Lead is useful, i It should first be applied diluted 1 part with about 7 of glycerin, or i better 1 with 7 of water, and the strength gradually increased; it I desiccates the eruption without producing a hard crust. Some } uterine affections are well treated with the diluted glycerole. For 1 inflamed joints after injury to bruised surfaces, lead lotion (warmed) 1 is useful. It should be used with caution to the eyes if the cornea j is damaged. In gonorrhoea, compresses are used prior to injections. Liquor (or Lotio) Plumbi Lactatis is 1 part of Solution of Lead 1 Subacetate to 9 of Milk. A little Eau de Cologne may be added. For nettle rash and any skin irritation. Burns may be treated with Lotio Plumbi, some state, without danger from 1 absorption. ! Incompatibility with Phenol. See p. 15. Unguentum Plumbi Subacetatis (B.P. ’14.) Strong Solution of Lead Acetate 1 in 8 in a compound basis. Jelly-fish stings. Apply the following ointment. Lanolin 1, Paraffin Ointment 3, Almond Oil 4, Lime Water 8, Strong Solution of Lead Subacetate 4, Clove Oil tV Said to be superior to Carron Oil for this purpose.—Brooke. Unguentum Glycerini Plumbi Subacetatis Diiutum. Unguentum Glycerini Plumbi Subacetatis, B.P. 1898, with equal amount of Adeps Lanse Hydrosus. Unguentum Glycerini Plumbi Subacetatis, B.P. ’98* Glycerinum Plumbi Subacetatis, B.P. ’98, L Unguentum Paraffini Injectio Plumbl L.H. (Vaginal). Strong Solution of Lead Acetate 60 minims, Water to 1 pint. Lotio Plumbi Talei et Amyli. (Formula of Boeck). Dilu Lead Subacetate Solution, Talcum, Starch, and Boric Ac: Solution (1%) of each 10 by weight, Glycerin 4, Campha Water 25. Relieves itching. Linimentum Bceckii, P. Svec. X. Dilute Lead Subacetate Solution 6, Talcum 18, Starch 1$ Glycerin 8. dL Lotio Plumbi et Opii. Tincture of Opium 1 to 159 of Dilute Lead Acetate Solutic (1 drachm to 1 pint). Although used to a certain extent in this form, Opium is said to li entirely devoid of peripheral anaesthetic effects and Lead likewise because the precipitation of proteins is prevented by the intervention of the epithelium. Lotio Plumbi Spirituosa. Lead Subacetate Solution 1, Glyceric 2, Alcohol (90%) 4, Rose Water to 32. Relieves piles promptly. Lotio Plumbi Evaporans, R.O.H. — Diluted Solution of Lea Acetate 4, Alcohol 90% 4, Water to 100. Plumbi Nitras, Pb(N03)2 = 331*236. Colourless or opaqi crystals. Soluble in water about 1 in 2. Ingrowing toenail treated with Lead Nitrate as dusting powde Remove scab that forms next day. Apply a little strong Phenff first,—this prevents pus which may form.—B.M.J. ii./i3,746,939. Plumbi Carbonas. Certjssa, Ph. Ned. 2PbC03,Pb(0H)2=775*675(f Heavy white insoluble powder, soluble in dilute Acetic and Nitri Acids. Used as dusting powder for burns. 1 to 10% ointmem in skin diseases. Pasta Plumbi cum Cupro.—(A) Lead Carbonate 8 ounces, Map tich Varnish (q.s.) about 2 ounces, to make a thin paste. (B) Coppe* Sulphate, Zinc Sulphate and Lead Acetate of each 40 grains, rubber together. Mix A and B and add Linseed Oil 1 ounce. This ha been used with success in bad cases of erysipelas.—Ph. Notes. Plumbi Iodidum Pbl2=461*084. Yellow crystalline powder. Used to reduce swellings. Very slightly soluble in water. 5 to 10% Ointment in skin diseases. Plumbi Oxidum. Syn.—Litharge. PbO=223*22. Yellowish-red powder (Massicot) or scales. To prepare Leac Plasters. Minium, P. Belg., Red Lead, Pbs04= 685*66. Made by heating Massicot. Plumbi Guaiacolas. Syn. Lead GuAlACOLATE. This compound has been prepared in the author’s laboratories It is a white insoluble powder containing 45*71% of lead. Theory for Pb(OH)2 . Pb(C6H40CH80)a=63-21%. It may prove of value in medicine. PODOPHYLLIN. byn. Podopiiyi.lt Resina. Dafor't^i1;0 1 %T ( o0/6 :°,0;06 Gm’> as a °holagogue and aperient The tt f tl 8 5°. *° h,0Urs before Producing evacuation Tle resm from the dried rhizome of Podophyllum pdtatum— Berbendacea, (B.P. ’14 and U.S.X.J-American Mandrake, or May Apple, sometimes called Vegetable Mercury as it is a powerful bniaiy purgative and may be combined with a small dose of calomel fnrl ^®atment 01 gallstones. It is useful in removing ankylostoma ana other worms Yellowish powder, soluble in aqueous ammonia and almost completely m 90% Alcohol. yT%ts_/or Podophyllum Besin.—D. B. Dott, P.J. i ho 213 287 lenot less than 75% SOIllbl’e in’ eth'er> and Podophylli Indici Resina (B.P. ’14). From P. Emodi (also B.P. ’14). Is richer in Podophyllotoxin than that from P. peltatum. Podophy llotoxin. 5Ofi(O.CH3)3-b2H2O=480-2184. than ?f ?odoPhy1i% It is more certain in its action Tt £ w 4 d Siglv^ m aose of A to 1 grain, to children 4 to 4 grain. DnS d^1?lster?d dissolving 1 grain in 2 drachms of 90% alcohol. Dose. 8 to 20 drops m a teaspoonful of syrup. For f urther details of this body, see Vol. II. dDPiluIa Podophyllin Composita. Podophyilin £ grain, Barbadoes Aloes 1 grain, Capsicum \ grain. Dry Extract of Belladonna J grain, Excipient q.s. for one pill weigh - ing 3 grains. One or two form a biliary aperient dose. ® Pilula Podophyllin et Quininae (Poore’s pm). Quinine Sulphate 1 grain, Podophyllin T\ grain, Milk Sugar grain, Dry Extract of Belladonna \ grain, Extract of Aloes 1 grain. To make one pill, or, if the quantities be taken in grammes, 15 pills, weighing 3 grains : useful ‘ dinner pills,’ must be taken with food. ® ‘Dinner Tablets 5 are similar; weigh 3 grains. They are recommended not coated for prompt action, Tinctura Podophylli (B.P. ’14). Dose.—5 to 15 minims (0*3 to 1 Cc.). Podophyllin 3*65% in Alcohol 90%. Flavoring,—Syl Lavandulae (double dose), Syl Amygdalte Amarse ; Syrupus Zingiberis, Elixir Saccharini. In dose of 2 to 4 drops in tea or coffee, taken night and morning, is useful in sick headache and biliousness, where the bowels and liver are sluggish in worried and overworked patients, and in chronic | diarrhoea with cutting pains and high-coloured motions. Also relieves constipation with clay-coloured motions following diarrhoea of infants, 1 or 2 drops on sugar twice or three times a day. Tinctura Podophylli Indici (B.P. T4) is also made same strength. i Tinctura Podophyllin Ammoniata. Podophyllin 1, Aromatic Spirit of Ammonia 50. Dissolve, and after standing, decant. Is miscible with water. Dose.—10 to 20 minims (0*6 to 1*2 Cc.), diluted, as a purgative and cholagogue. The sal volatile acts as a corrective. POTASSIUM. K=3910. Sources of Potash Safts.—Potassium Chloride is obtained fror: the Strassfurt mines, also as Sylvine at Mulhouse in Alsace, and could b worked commercially from Fellspars in Scotland.—Sir T. E. Thorpe, B.M.JT i. /18,64. Potassium can be distilled unchanged in dry Oxygen.—L. i./3o,26. Potassa Caustiea, Potassii Hydroxidum. KOH= 56-1078. Manufactured electrolytically or from the Carbonate ano Calcium Hydroxide. White deliquescent sticks or cakes. (B.P. ’14 not less than 85% pure. Soluble in water 2 in 1, and about 1 in £ io/v. of 90% alcohol. In compatibles.—Acids, metallic salts, and alkaloidal salts; Antidotes.—Any dilute vegetable acid, fixed oils, stimulants not stomach pump or lavage. Given in mixtures as Liquor Potassse (B.P. ’14, 5% w/v.), wel diluted; also used as a caustic- Liquor Potassse per os caused remarkable improvement in cases of inoperabl* malignant disease.—D. M. Gall, L. i./24,1104. A Liquor containing 5 Gm. of KOH in 100 Cc. has Sp. Gr. 1-045. P.G. YI is 15% ivIw. Flavoring.—Syl Menthse Piperitse, Syl Amygdalae Amarae Liquor Alkalinus, Brandish. l)ose.—For adults, up to 2 drachms. For ages 14 to 18 years 2 drachms for children \ to 1 drachm diluted. All these doses should be given dilutee with milk or syrup. This liquor contains about 5% Caustic Potash. In scrofula.—Hager. Vienna Paste.—Caustic Potash 5, Slaked Lime 6, made into & paste with Alcohol. Used as an escharotic. Pasta Loadinensis is similar. Caustic Soda and Unslaked Lime of each equal parts, rubbed together in a warm mortar—made into paste wher required for use as a caustic. Substitute for Removal of Tonsils.—‘ London Paste,’ freshly made from, the powder with a little Alcohol useful. About 8 weekly applications sufficient —H. Norman Barnett, L. i./29,872. Potassa Sulphurafca (B.P. ’14). Liver of Sulphur. Deliquescent yellowish brown masses, smelling of sulphuretted hydrogen. Used in skin affections. Balneum 2 ounces to 15 gallons. Unguentuin Potassae Sulphuratae. Liver of Sulphur 1, Sodium Carbonate 1, Lard 8. For ringworm. Potassii Acetas. CHsCOOK= 98*1234. Dose.—10 to 60 grains (0*6 to 4*C Gm.). Deliquescent white crystals, masses or powder. Diuretic and uric acid solvent. Soluble in Water 2 in 1, in Alcohol (90%) 1 in 2. Flavoring.—Syl Pini, Syl Lavandula^ Syrupus Aurantii. XJses.—Is given to render the urine alkaline and has been employed in puerperal eclampsia. Diuretic in dropsical affections andi has febrifuge properties. Mistura Diuretica, st. m.'s h. Potassium Acetate 20 grains, Sodium Nitrite 4 grain, Spirit of Junipei 4 drachm, Tincture of Ginger 10 minims, Water to 1 ounce. " The following is a useful mixture Potassium Acetate 20 grams, Solatia of Ammonium Acetate 2 drachms, Vinegar of Squill 20 minims, Infusion c Broom 2 drachms, Water 4 ounce. Mistura Diuretica, N.H.I. Potassium Acetate 15 grains, Potassium Nitrate 7* grains, Vinegar o Squills lO minims, Decoction of Broom-tops (B.p. ’85) to i ounce. Potassil Benzoas. C6II5C00K.3H20=214'1858. Dose.—15 to 20 grains (l to 1*2 Gm.). White crystals. Soluble in water 1 in 1| and in alcohol (90%) 1 in 20. Uric Acid Solvent. Flavoring.—Syl Aurantii Floris, Syl Vanillse; Syrupus Aurantii. Potassii Bicarbonas. KHCOs= 100-1078. Dose.—5 to 20 grains (0*3 to 1*2 Gm.). White powder or crystals soluble 1 in water 4. Insoluble in Alcohol (90%). Antacid, diuretic, and Uric Acid solvent. It is most valuable in acute rheumatism. Flavoring.—Syl Cinnamomi, Syl Lavandulae. Potassii Bichromas. K2Cr207=294-2. Dose.—TV to ^ grain (0*006 to 0*012 Gm.), in pill with Kaolin Ointment or in Capsule has been used in dyspepsia and gastric ulcer. Soluble I in 10 of water. Antidotes. See Antidotes to Poisons. In phthisis (2£ minims of 10% Solution in water) either alone or in a tonic mixture in a wineglass of water after food, at first twice and later three times daily, produced improvement in several cases. May produce vomiting at first.—L. ii./io,1484. Dermatitis may follow the contact of Potassium Bichromate with the skin of susceptible persons. This may be avoided by frequently rinsing the exposed skin with a saturated solution of Sodium Bisulphite and then water. —Jl, A.M.A. ii./25,850. Potassii Bromidum, KBr= 119-016. Dose.—5 to 30 grains (0-3 to 2 Gm.). Slipule No. 0 holds 10 grains. (Kalium Bromatum, P.G., Fr. Cx., P. Hung., is Potassium Bromide. Kalium Bromlcum abroad is Potassium Bromate KBrOs. Some countries, e.g., Sweden and Holland use Brometum to convey the Bromide.) Colourless or white crystals with saline taste. (Soluble in wrater 1 in less than 2, and in about 200 of alcohol 90%. It should be at least 97% pure. Incompatible with Mineral Acids, Mercury and Silver Salts. Flavoring.—Glyl Rossb, Syl Vanillse; Syrupus Zingiberis, Extractum Glycyrrhizse Liquidum. Uses.—Hypnotic and sedative, and is given as a drink cure. Often given with other bromides, cf. Sal Bromatum, and with Chloral Hydrate, Arsenic or Belladonna. Epilepsy.—Potassium Bromide with Nux Vomica will keep a patient free from fits whilst treatment is persisted in. In recent epilepsy should be given for a long period (not less than two years). If no benefit from 45 to 75 grains per diem some other remedy should be tried* (It is cumulative.) Addition of Belladonna may be useful where there is incontinence. The following mixture has been recommended :— Potassium Bromide 1 ounce, Potassium Iodide 2 drachms, Ammonium Bromide 3 drachms, Ammonium Carbonate 1 drachm, Tincture of Calumba 1 ounce. Water to 6 ounces. One teaspoonful before each meal and three teaspoonsfui at bedtime. If petit mol exis alone, or co-exists with complete epilepsy the dose of Ammoniu Bromide must be increased and that of the other diminished. Bromism.—To avoid the onset give Fowler’s Solution of Arseni; and maintain the antisepsis of the bowels by purgatives and sale Patients saturated with Bromides exhibit anaesthesia of the pakr —a little known but useful diagnostic. Tickling the palate with feather is a good means of eliciting the information. The effect « Bromides is enhanced by adding Potassium Bicarbonate in dos«* equal to about a quarter of the total Bromide given. Small doses, e.g. 5 grains once a day long continued, are bett* than larger doses for shorter periods.—M. Craig, L. ii./i 7,979. Bromide intoxication has been treated with 100 Cc. Normal Saline increase to 400 Cc. intravenously. Erections in Gonorrikea.—15 to 35 grains with Lupulin 1 to 2 grab and Camphor 1 to 2 grains in a cachet, two to four daily. Puerperal eclampsia is treated with it combined with Belladonna. Forty-five operations, including two gastro-enterostomies and two lip canc operations, done under local anaesthesia from injection of a 1% solution Potassium Bromide.—Jl. A.M.A. ii./25,235. Tablets contain 5 and 10 grains. CE> Mistura Dysmenorrhoeiea, E.G.A. Potassium Bromide 15 grains, Sal Volatile, Tincture of Hyoscyami-' а. a. J drachm, Spirit of Chloroform 10 minims, Water to \ ounce. CED Elixir Quinque Bromidorum. Can. Form. Potassium and Sodium Bromides of each 10, Ammonium Bromic б, Calcium Bromide 3, Lithium Bromide 1, Tincture of Cannab Indica 6, Aromatic Elixir, sufficient to make 120. Dissolve tk Bromides in the aromatic elixir, add the Tincture of Cannabis Indies' and filter if necessary. One drachm contains 15 grains combine Bromides. Cg)MJstura Bromidi et Digitalis. St. M’s. H. Dose.—4 to 1 ounce (15 to 30 Cc.). Potassium Bromide 20 grains, Digitalis Tincture 5 minim Potassium Citrate 15 grains, Compound Tincture of Cardamom l drachm, Chloroform Water to 1 ounce. Potassii Carbonas. Syn. Salt of Tartar. K2C03= 138-2. Dose.—5 to 20 grains (0*3 to lm2 Gm.). White deliquescent powder. Soluble in water 4 in 3, insoluble i alcohol 90%. Employed externally ; internal properties similar i those of the Bicarbonate. Commercially contains about 16% Ha( Potassii Chloras. KC103= 122-557. Dose.—5 to 15 grains (0*3 to 1 Gm.). Manufactured by passing chlorine into water holding lime or magnes in suspension, treating the clarified liquid with Potassium Chloride, ai crystallising the resulting chlorate from the liquor. Colourless crystals wi saline taste. Soluble in water1 in 16. Incompatible with Oxidisable substances. Ferrous bait Sugar, Nitrites, Calomel, Hypophosphites, Vegetable Powder Potassium Iodide. Uses. —Antiseptic and a powerful oxidising agent. Is useful POTASSIUM. 705 stomatitis e.^. m children and m sore mouth arising from Mercurial treatment. Must not be given when the kidneys are diseased. of^OO^c^of'^vholeTloo^fniil?1 ^h?rate- Recovery following transfusion Bj.J.B%2i30hO!S^L°Wii^.8eCOnd transfusion aftCT 3 Less toxic than Potassium Chloride. Average lethal dose in rats infra- PTehr^:°J(aCnh:%“e80‘82 L' Water sterilisation by Chlorine liberated from, vide Vol. II. Lozenges weighing 20 grains, and Tablets weighing 5 grains, plain and Cp with Borax and Cocaine Yin? grain, are useful to allay irritation and improve the voice. Gargle, spray, mouth wash may be 2% strength. Chlorine Gargle is made from it. Pulvis Potassii Chloratis Compositus, C.L.T.E. Potassium Chlorate, Borax, Sodium Bicarbonate, equal parts, solids of Forms the Collunarmm Potassii Chloratis Ccmpositum, C.L.T.E. Directions— One teaspoonful to be dissolved in a quarter pint (4 tumbler) of tepid water. Half of the solution to be injected with a syringe"along the floor of each nostril night and morning. Afterwards blow the nose freely. Cllioratifrice, a tooth paste, contains this Salt. For spongy gums and to prevent Tartar and act as a general antiseptic. Potassii Chloridum. KC1= 74-557. Has been advocated for use in place of table salt by gouty and rheumatic individuals ; the following is better to taste :— Pulvis Potassii et Sodii Chloridi Compositus.—Oliver. Potassium Chloride 16, Sodium Chloride 8, Lithium Benzoate 1. A half- drachm measureful to be taken. The late Sir W. Roberts advocated Potassium Chloride for increased arterial pressure. Oliver found a tendency to indulge in the use of salt in advancing age (over 65). When Potassium is ingested in excess of Sodium, a loss of the latter takes place from the system. Table Salt containing 50% each Sodium and Potassium Chloride, to automatically supply Potassium salts lost in the preparation and cooking of food. Apart from the problematical relation of Potassium deficiency to cancer. Potassium is a valuable addition to dietary and effective in preventing gout and rheumatism.—F. S. Bose, P.J. ii./26,411. Potassii Gitras. C3H4(OH).COOK)3, H20 = 324-3566. Dose.—15 to 60 grains (l to 4 Gm.). A white powder obtained irom citric acid and potassium carbonate. Flavoring.—Syl Anisi; Elixir Saccharini; Syrupus Pruni Virginians. Uses.—It has diaphoretic, diuretic, and febrifuge properties. It has expectorant uses in the early stages of bronchitis and tracheitis. Also for gout, and in enuresis where the urine is over-acid. Large doses are useful for the acidsemia of diabetes. (Edema in disease of the gastrointestinal tract in infants removed. Appears to act better than other diuretics.—Pr., May, 1911, p. 686. Neurotic Dyspepsia.-—Sip early in the morning a tumbler of hot water containing a teaspoonful of it.—B.M..T. ii./n,1529. Lactation improved by 15 grain doses.—B.M.J. 1./17,e05. ‘ Vescettes ’ of Potassium Citrate, 15 grains. To be crushed and taken in a draught of warm water. |P llPotassii Cyanidum. Syn. Potassium Cyanuret (an old name Kalium Cyanatum, Cyankali, Cyanure de Potasse. KCN G5T08. Fr. Cx. Dose.—to J grain (0*005 to 0*016 Gm.). Fr. Cx. has max. single dose ^ grain. Max. during 24 hours § graii A crystallised salt or in fused masses Antidotes.—See Acid Hydrocyanic. IP UTrape Varieties. In addition to the B.P. ’14 salt (about 90 pure) are * Gold Cyanide * 98 to 100%, really a double Cyan! of Potassium and Sodium, but, we understand, the B.P. ’14 artic is also used for gold extraction. 30% pure is supplied in stick this is ' silver cyanide,’ for silver extraction. Potassium Cyanate, KCNO, is made by oxidising Potassiu Cyanide or Ferrocyanide. Colourless crystals readily soluble water. We have no information as to the Cyanate having been us in medicine. Potass ii Ferrocyanidum. K4Fe(CN)6,3H20=422*3348. Dose.—8 grains (0*5 Gm.). Said to be physiologically alma without action. Potassii lodidum. KI= 166*032. Dose.—5 to 20 grains (0 3 to 1*2 Gm.)—often much increased. (Kalium Jodatum, P.G., Fr. Cx., is Potassium Iodide. Potassium Iod KIO., is called Kalium Jodicum in German. Some countries, e.g., Sweet: and Holland, use Jodetum to convey the Iodide.) In white or colourless cubic crystals or Small Granular Cryst- soluble in less than its own weight of water, and in 12 parts Alcohol 90%. A slightly alkaline solution keeps better than an acid one. If compatible in solutions with Spiritus HHheris Nitrosi, Sa of Iron (except Ferri et Ammon ii Citras and Liquor Ferri Acetati Salts of Bismuth, Lead and Mercury, with Liquor Strychninae Hydi chloridi, with Quinine Sulphate and other alkaloidal Salts, Silv Nitrate and Potassium Chlorate. Flavoring.—Syl Lavandulae, Glyl Menthae Piperitae, S Vanillae, Extractum Glycyrrhizae Liquidum, Syrupus Zingiberis. Uses.—In universal use in the later stages of syphilis, in arteri sclerosis and certain cases of gout and rheumatism. For actinomycosis it is specific ; very large doses are given. 1 one case (severe) it was only when the dose reached 240 grains dm that improvement began. Carbolic Lotion 1 in 80 was quite suf cient locally. Thomassen’s Method is 10 grains thrice daily £ the first week, 15 grains the second, and 20 grains the third, i creased to 35 grains. Sporotrichosis and blastomycosis, also r spond.—A. Castellani, L. i./2o,943. In actinomycosis not found effective.—Colebrook, B.M.J. l/22,7 Rheumatoid arthritis best treated by 10-grain doses thri daily with Guaiacol Carbonate.—A. P. Luff ; see also Guaiacol Cai In fibrositis it is perhaps the most valuable drug. It appears act by removing the hyperplasia and serous exudation in the fibrous tissues. Full doses (10-12 grains) with Nux Vomica or Syrup of Glycerophosphates.—A. P. Luff. x °£™tmSsium Jodide *n large doses is a survival of the old Aix-la-Ghapellu treatment tor late specific lesions—quite unabsorbed. doqpsl0(VnV™!™SS than Potassium Iodide or Sodium Iodide in large doses. 10 grains of Potassium Iodide thrice daily for less than a week has produced violent catarrh with discharge from eyes and nose, swelling of eyelids and pustular eruption. Tincture of Iodine 5 m. thrice daily is well borne.—' Indian Physician,’ C.D., April 2, '21,475. * A fosopj&tfona -,7 i- j v tlic< 0 solution, even with soap present, is not absorbed by the skm, but when applied as an emulsion in such substances as Vaseline, Lanoline and fctearic Acid, it can be detected in the urine within 12 hours.—J C.S A. i./25,1116. Asthma is treated by Potassium Iodide in 5-15 grain doses twice or thrice daily. Extract of Stramonium may be added. Reliable both during the paroxysms and in the interval.—Yeo. In aneurism moderate to full doses.—Yeo. The addition of Ammonium Bromide is often useful. In arteriosclerosis 3 to 5 grain doses thrice daily with Potassium Bicarbonate 5 to 10 grains, Sal Volatile 20 minims, and an ounce of Gentian Infusion continued for four months at a time with interruptions of ten or twelve days. One or two tablets of Nitro-glycerin as well to promote vascular relaxation.—Yeo. Iodine Therapy. Iodides may prevent or retard arterial changes and arrest them. Iodine metabolism no doubt responsible. The duration of life may be extended in the future.—W. Mitchell Stevens, L. i./3o,1235. In tinnitus aurium associated especially with vertigo, due to labyrinthine disease, may be used in large doses. Also used in middle-ear disease in dry forms. Acute parotitis is favourably treated by painting the swelling with Iodine and giving Potassium Iodide internally. Obstructive lymphangitis well treated with Potassium Iodide.— S. L. Rodriguez, per Clin. Jl., Feb. 14/23,83. Tuberculous expectoration is greatly assisted by its use. Cardio-vascular Syphilis.—Potassium Iodide the most efficacious treatment, though explanation of its action is difficult. Iodine by inunction may be substituted. Mercury is not more effective than Arsenic, but safer. 0-3 Gm. Rovarsenobenzol at intervals of a week over long periods, till 5 Gm. have been taken. Iodide and Mercury continuous, and a course of Organic Arsenic added from time to time.—Carey F. Coombs, B.M.J. ii./3o,893. Leprosy.—Extremely useful in the last stages of recovery, but should only be used in patients maintaining a high resistance and tolerating full doses of Ilydnocarpus esters.—E. Muir, T.R.S.T.M., Aug., ’31,94. In lobar pneumonia for the combined use of Potassium Iodide and Creosote, vide Mistura Creosoti et Potassii lodldi. In bronchial aefections the Iodides cause a watery exudation through the bronchial mucous membrane, hence of utility. ^Saiodine (T.M. 453,485, Cl. 42) is an Iodised Table Salt. Suitable for use as a goitre prophylactic. Both for the table and cooking purposes. Exophthalmic fsoiirCj discussion ora. Small doses of Iodide, e.g. Sodium Iodide 3 grains daily, for 10 days each spring and autumn found efficacious in girls in reducing the number of cases of goitre z 2 in districts where it is endemic, and it is not unreasonable to expec: that by reducing the tendency to simple goitre in early life, we ma also lessen the number of cases of Graves' disease occurring in late- life. This preventive treatment is, however, quite unsuited for tho& who already show signs of hyperthyroidism.—G. R. Murray, ii./22,908. Speakers differed on the question of Iodide treatment Goitre is endemic in the valleys of E. and N.E. Lancashire. 2\ or 3 grains (t Sodium Iodide thrice daily for six weeks, then discontinued for a month any resumed indefinitely. Large goitres disappear.—R. Stewart, B.M.J. ii./2i,84 Iodine (Potassium Iodide) in small doses will prevent and cure simp goitre. Chlorine to some extent also prevents thyroid enlargement. lodir deficiency comes about through absence of Iodine from food, vegetables, et —R. McCarrison, B.M.J. i./22,636. Goitre and Calcium have obvious relationship. The viscosity of tk thyroid secretion varies immensely. This depends on its Iodine content. J limestone districts (Switzerland and Derbyshire) large goitres contain hr thick colloid are usual. This ‘ colloid ’ is poor in Iodine. These goitre vanish under use of Iodine or Thyroid preparation rich in Iodine. The Icdiir combines with the Calcium to form Calcium Iodide. Further, fat taken above normal requirements will form soaps with tit fatty acids combining with all the Calcium (and other alkalies) present. Th* will lead to Calcium starvation. The part played by fat in the prcduetic of goitre is only a link in the chain of Calcium absorption or starvation-j S. Pern, B.M.J. ii./22,532. Switzerland has attacked the goitre problem. Chatin’s hyeothes (enunciated in 1850) is thought to be correct there, namely that it is correlate with a low Iodine content of drinking water. Baumann concluded that the (goitrous) thyroid gland seeks, by increase size and surface to make up for the lack of Iodine in neighbourhoods whe the supply is scanty. Chatin demonstrated how poor in Iodine is the uaV 1 in Alpine Valleys. The same has been found in L.S.A. The sea spray thought responsible for carrying the Iodine hundreds of miles from the sex coast and from the Great Salt Lake. Dosaqc. As small an amount as 0T mgr. of Potassium Iodide thought to have ant goitrous action. Table salt could be used dietetically. ‘ Vollsalz * containhr 0-25 to 0-5 Gm. Potassium Iodide to every 100 kilos in use in the Canton < Appenzell. A sensible measure.—L. i./23,660. The Swiss Goitre Commission (1922) after exhaustive investigations fix* the maximum amount as 1 part Iodine in 200,000 parts of salt. This is tl amount adopted in this country. Marine in the U.S.A advises 1 in 500 mildly goitrous districts.—J. A. Gocdfellow, B.M.J. i./25.331. The amounts of Iodine recommended by the Swiss Commission are tc small for goitrous districts. Five to 10 mg. of Iodine weekly is sufficiei for prevention among school-children, and 10 mg. per week should be giv* during pregnancy and lactation.—Medicine, 1924.3,453, per P.J. i./25,546. Promising results obtained in Graves’s disease with a daily dose of 15 dro] of 1 in 20 aqueous solution of Potassium Iodide, containing 0*0033 Gi Potassium Iodide per drop.—B.M.J.E. ih/24,49. Sweets containing 1/10 grain of Iodine given every 5 days are a goc preventive measure for children, and in many cases sufficient to effect a cur The aim should be to ensure that the thyroid receives its normal Iodii requirement, which is about 2 grains per year. Most cases of nocturn incontinence also cured by the use of these sweets—K. Fraser, Cumberlan From a trial in several Derbyshire schools Iodised sweets not recommende —P. H. J. Turton, L. ii./27,1170. Iodine given over long periods without thyroidectomy does not cure exop tfiqlmie soitre Use of Lugol’s Solution prior to operation increases percental of patieSts who can be operated on in one stage.—H, M, Clute, J). A.M.A Jan. 9, ’26,105. SErrs p™ s sstKKS' 7L isa-e fo/* an adult being 10 trig, daily for not longer than one month, the patient being kent under- verv ciose observation during this time.—0. P. Kimball, Jl. A.M.A.ih/25,1710* fT>_P^asf°.Y’ £?ts a Pure supply of water from a highland lake is immune from goitre. 1 ossibly the particles of inorganic mineral matter of a cal- careous nature m the turbid water of some of the Swiss glacSfiivers and of the Himalayas are causative.—Sir James Berry, L. h/26 269. o.J^V‘Ln0t cleaT that a11 en<iemic goitres are of the same order, or due to the same cause, and no agreement as to the amount of Iodine required to prevent S 7fiirS has bee*n reac1he4- The use of Iodine in experimental work in ^ew Zealand was not conclusive m prevention. The goitre problem seems to be a domestic one for each locality.—B.M.J. k/25 321 P lodme over a long period should not be given to adults and when used periodically frequent observations of the pulse and weight should be made. Inder no circumstances should Iodine be administered to adults with fetai adenomas, with or without symptoms of hyperthyroidism, except for short period prior to operation. Instances of the dangers of exciting hvp^rthv- roidism given.—C. L Harstock, Jl. A.M.A., ’26,1335, per P.J. ii./26,303. ‘ IvT- • h/°^‘, ioed‘ d,scusslon on Iodine therapy in exophthalmic goitre.— ±>.M. J . l./26,41 8. In exophthalmic goitre it is to he avoided. Iodine is being poured into the system m excess by thyroid secretion.—B.M.J. ii./c>5,1249. See also Sodium Iodide, p. 768, Endemic Goitre, Vaccine Chapter and Goitre, Therapeutic Index. Chlorination of Drinking Water was objected to by James Uli\ei (M.I.C., July 6, 2;) as causing possible elimination of or deficiency in iodine, but by an extensive investigation in the author’s laboratory m 1928 i929> working on 25 litre quantities it was proved that this does net occur in the Metropolitan Water Board supplies. The town-dweller is not deprived of the Iodine he needs— °ee VoJ. II m which the subject is dealt with in extenso. Animal nutriti in importance of Iodine in experiments with pigs. Complete mineral salts added to the feed at the rate of ^ ounce per head per day, containing Potassium Iodide, give better results than the incomplete salts (Potas- t sium Iodide omitted). There is less Iodine in water in chalky districts, i.e., in water containing an abnormally high proportion of Lime.—J. C. Bushton, s Stalls. Farm Institute, Penkridge, Stafford. The importance of the place of Iodine in life and nature is dwelt upon in a pamphlet by S. L. Bensusan from the aspect of nutrition of animals and plants, public health, and medicine.—De Gruchy & Co., Ltd., 48, Mitchell Street, London, E.C. See also ‘ Iodine for Live Stock,’ by F. E. Corrie. Foot and Mouth Disease. Painting with Iodine said to be valuable—-both curative and preventive. I The disease has been prevented in foals by feeding Iodine to the mare during gestation and thus transmitting to the offspring. Many farming areas are void of Iodine in soil and vegetation. Iodine painted on put an end to navel- ill. The ingestion of Iodine advised. 6 to 8 ounces Potassium Iodide mixed with 100 lbs. salt to be placed where cows have access to it. For pregnant mares 1 teaspoonful Potassium Iodide in the feed twice monthly.—Trans. Highland and Agric. Soc. Vol. XXXVI, 1924. Sterules, Hypodermic, of Potassium Iodide contain 5 grains. Pilula Potassii lodidi.—Contains 1 grain or more- Potassium Iodide 1 grain, Sodium Carbonate Exsiccated J- grain, with Tragacanth and Syrup. Tablets and Capsules contain 5 grains. Potion Ioduree Potassium Iodide 0-5 Gm., Syrup of Orange 25 Cm., Distilled War 100 Cc., to be taken in three portions during the day. Linimentum Potassii Iodidi cum Sapone (B.P. ’14). Mix fresh Curd Soap in fine shreds 16 with Water 80, and Glycerin 8, iit porcelain dish on a water bath. When dissolved, pour the liquid on to Pot: sium Iodide 12 in powder in a mortar. Triturate briskly until cold. 8 aside 1 hour ; and add Lemon Oil 0-8. Iodine cannot be traced in the urine after its use—cf. p. 707. A soft Jelly-form Liniment of Potassium Iodide and Soap may produced with Soft Soap Potassium Iodide 1£, Glycerin 1, Water 10. rli following is somewhat stiffer: Soft Soap 1, Potassium Iodide II, Glycerin Water 10.—P.J. ii./o4,376. Nascent Iodine Treatment in tuberculosis, etc., is dealt with on p. 510 Potassii Nitras KN03=101T08. Syn. Nitre. Dose.—5 to 20 gral (0*3 to 1*2 Gm.). Should be given well diluted. Flavoring.—Syl Rosae, Glyl Lavandulae, Syrupus Tolutanui Uses,—Diuretic, to be given in dilute solution with cautio Its chief use is in the preparation of powders for burning in asthn: In chronic pericarditis great alterations in the area of dullness may foil the employment of diuretics such as preparations of Potassium Nitrate, Sqi Digitalis or Scoparium. In pneumonia has been tried in full doses. The diet should be salt-fir The effect is remarkable ; temperature falls in a few hours. Give 60 grain solution every 3 hours for the first day, and then gradually reduce the d each succeeding day. To increase circulation in the lungs nitroglycerin L, Ao gr. every three hours.—H. G. Hughes, N.Y.M. 31., Sept. 9, 1911; Pr Dec. 1911, p. 300. For further abstract of this paper see Edn. XVIII, p. 7 Poisoning by Potassium Nitrate.—B.M.J. i./n, 1,052. A n t i(1 otes. See Poisons and Antidotes. Fumus Potassii Nitratis (Nitrated Papers). White blotting-paper, impregnated with 20% Nitre solution, relieve asthma these are burnt and the fumes inhaled. Asthmatic Pastilles are prepared in cones containing a mixture chlorate and nitrate of potassium. ® Pulvis Lohelise Compositus. Asthma Powder. Potassium Nitrate 240, Boiling Distilled Water 240. Dissolve a add to Lobelia in powder, Stramonium Leaves in powder, Black 1 in powder, 240 of each. Mix well, dry, and add Oil of Anise The fumes of half a teaspoonful or more to be inhaled six or eig: times a day and the bedroom fumigated with same. 3^Himro<r Cure (T.M. See 169003 and 25857) Bliss’s Cure, and the Gre Mountain Cure resemble the above. * ® Potter’s Asthma Cure (T.M. 444921,507208) contains 30 % Stramoni and 15% Lobelia.—P.,T. 1./28,528. Cr) Asthmatic Cigarettes contain Stramonium treated with Nitre. HIT] Cigarettes d’Espicare said to be made of the following ingredients Belladonna Leaves 51, Hyoscyamus Leaves 2-f, Stramonium Leaves 2f, P landriuw Aquaticum 1, Opium Extract II, Cherry Laurel Water a sufticiei and a little Potassium Nitrate.—Yeo. , x 4c® Dr. Blosser’s Remedy (T.M. 345235, 457723) (Cigarettes) conts 18*5% Stramonium. Exibard’s Abyssinian Powder contains plant powders and balsams. 3(cGarfield’s Tea (T.M. 282807, 91086) is stated to contain:— Senna 30%, Couch Grass 33%, Balmony 201%. Dandelion 3%, Centaury & Pellitory 3%, Mallow 3%, Chamomile h%, Hyssop 3%, Peppermint 1%. POTASSIUM. 711 Potassii Sulphas (B.P. ’14). K,SO,= 174-278. Dose.—15 to 45 grains (1 to 3 Gm.). Saline, slightly bitter taste. in the^ngyrS»ated by 4 to * «“*" <* “W* followed Potassium Sulphate 0;25 to 6-5% added to local anesthetics whether bv CorH.M.eW.0Gray, °f nerV6S eullances anesthesia.- Potassium SuIphocarbolate 10 grains in a dose as (above). Useful m gastric and intestinal fetor. Potassii Mitris. KN02= 85-108. Dose.—I to H grains (0-016 to 0' 1 Gxn,). A crystalline deliquescent powder. It is a vasodilator, improves the cerebral circulation and is given for migraine, asthma and epilepsy. Pulyis Potassii Nitritis Composites. 1 e J Potassium Nitrite ^ grain, Potassium Nitrate 18 grains, and Potassium Bicarbonate 25 grams; mix and dispense in parchment paper. This dose may be given every morning in a tumbler of water to reduce blood pressure ; is diuretic. Has thus checked recurrent epistaxis. Should be tried for gout. Pulvis Sodii Nitritis Compositus.—Brunton, Sodium Nitrite J to 2 grains, Potassium Nitrate 10 to 20 grains, and sometimes Potassium Bicarbonate 10 grains—in a tumbler of water every morning—to reduce blood pressure. May be taken for years. Potassii Piiosplias. Bi-Potassic Hydrogen Phosphate. K2HP04== 174-2278. Dose.—1 to 10 grains (0-06 to 0-6 Gm.). A deliquescent granular powder; is given as an alterative in phthisis and urinary affections. Potassii Phosphas Acidus. Dl-HYDROQEN Potassium PHOSPHATE, Mono-Potassium Phosphate, KH2P04= 136-1358. Dose.—15 to 60 grains (1 to 4 Gm.). Colourless crystals, readily soluble in water with acid reaction. Sai Poi veil restum. Syn. Glaser’s Salt. Dose.—30 to 120 grains (2 to 8 Gm.). A mixture of Potassium Sulphite and Sulphate, has a sulphurous odour, has been given for dyspepsia and for chronic skin diseases. Sal Enixum is Potassium Bisulphate. KHS04= 136-1678. Potassii Sulphocyanas (Sulphocyanide). Syn. POTASSIUM THIOCYANATE. KCNS== 97-168. Dose.—J to 3 grains (G-05 to 0-2 Gm.). Not legally |jpH or CE) but to be supplied with caution. Made by fusing Potassium Cyanide with Sulphur'. Has been employed as antispasmodic and anodyne—hi phthisical cough and catarrh, dyspnoea, and mania. PIypertension. Dose.—\\ grains in 1 drachm of water three times daily after meals for first week, twice daily for 2nd week, and once daily for 3rd week, and then daily or every other day.—-L. T. Gager, Jl.A.M.A. i./28,84. Good response. Start the treatment cautiously.—B.M.J.E. b/30,4. Sedative and hypotensive in neurotic patients; relieves vertigo and other subjective symptoms. Prolonged treatment necessary. 44 grains daily not effective, but 15 grains was.—M. H. Finebey B.M.J.E. ii./30,41. There is no clear evidence as to its clinical value in essential hypertensi and its hypotensive effect is almost always accompanied by distressing & reactions {weakness, fatigue, drowsiness, and gastro-intestinal symptoms) whet given in large doses for short periods or small doses for long periods. Artei sclerosis a contraindication.—D. Ayman, Jl. A.M.A. i./3i,1S57. Both Sodr and Potassium Thiocyanates produced very disagreeable side-effects.—W. Egloff and Co-workers, ibid. 1942. Exfoliative cJe rmatstis following use of 11 grains th times daily for a week.—C. R. Weis, Jl. A.M.A. ik/29,988. Acute diffu u erythematous dermatitis caused.—B.M.J.E. ih/29,96. See also Sodium Sulphocyanide. Tooth Powders, Pastes and liquid Dentrifices. Suggested use of t or other alkaline sulphocyanide in neutral media. For powder 1 to 14 precipitated chalk. For liquid dentifrice 1 to 8 of alcohol. Subject of pat* —F. J. Rhodes, No. 20879 of 1914-—P.J. ii./i5,362. Potassii Tartras.—Normal or Neutral Potassium Tartrate. (CHOH)2COOK.COOK, 4H20. = 235-239. Dose.—30 to 240 grains (2 to 15 Gm.). Crystalline powder with bitter taste made by neutralising Ac Potassium Tartrate with Potassium Carbonate. Has purgative a :, diuretic properties. Soluble.—About 5 in 3 of water. Potassii Tarfcras AcidllS. (B.P. T4). Syn. Potassii Bitartr- Purified Cream of Tartar. (CHOH)2COOK.COOH= 188-14 Dose.—15 to 60 grains (1 to 4-0 Gm.). The crude tartar deposited during the fermentation of wine— crystallised. A white powder with acid taste soluble 1 in 200 water. Diuretic and cathartic. Is employed in acute renal disea Where the urine is thick and alkaline, this salt neutralises and pa duces normal appearance. Puerperal Eclampsia.—The convulsions may be the signs of oedema of brain, hence aim at treating the oedema rather than the defect of the kidne Very small frequent doses of Potassium Bitartrate caused increased diurc in a case and effected cure of eclampsia.—B.M.J.E. i./13-TO ; B.M.J. i./i3,12. Ilaustus Imperialis, K.C.H., Imperial Drink. Potassium Bits trate and Tartaric Acid of each 1 ounce, Sugar 16 ounces, Lem Oil 12 minims, Boiling Water 1 gallon. Carbuncle on the neck was treated by Cream of Tartar Powder a& dressing. Renewed from time to time and irrigated with sterile watr Potus imperialis, G.N.C. Lemon Syrup 1J ounces, Acid Tartre of Potassium 1 drachm, Water to 20 ounces. Potassii Boro-Tarfcras. Soluble Cream of Tartar. Dose.—20 to 40 grams (1-2 to 2-5 Gm.). An amorphous white powder. Potassium Acid Tartrate 5, Bor 2. Dissolve with heat in water, q.s., and evaporate to dryness. Sol able to extent of 1 in 1 of water. Uses.—Similar to that of Cream of Tartar. Epilepsy has been treated with it—as much as 3 Gm. daily, someth combined with Bromide.—B.M.J.E. i./22,57 ; L. i./22,446.—Cf. Sodi Borate. . , , .. Better results when combined with Gardenal than with either separate commencing with 1-5 Gm. Borotartrate and 0T5 Gm. Gardenal daily in th doses, continued for 3 years.—B.M.J.E. ii./29,85. QUINIDINE, CINCHONIDIME, CINCHONINE and cinchona febrifuge. llie Medical Research Council, Special Report No. 96, 1925, concluded that Quinidine is at least as efficacious as Quinine in malaria. ^nere is no indication of a preferential action of Quinidine on benign tertian, or of Quinine on subtertian infections. The depressant action of Quinidine on heart muscle may, however, limit its use. A mixture of the crystallisable Cinchona alkaloids might replace Quinine and be of great value as well as being cheaper.— B.M.J. ik/25,488. L. iL/25,510. C. & D. ii./25,434. Curative effects of Quinine, Quinidine, and Cinchonine found the same for all forms of malaria and, except for the greater cardiac depression caused by the last, no difference in toxicity.—Dale and James (First Internat. Malaria Conf., Rome). B.M.J. ii./25,970. There findings negative, in part, the opinions of Hugh W. Acton (L. h/22, r> i 0 tilat a i various (I4 or more) closely related alkaloids in Cinchona Hark exert a destructive action on the malarial parasite, but differ in the oe»ree o^ destructive power. According to him, in benign tertian infection dextro-rotatory Quinidine is more efficacious than the lsevo-rotatory Quinine. In a previous paper (L. i./2o,1257) Maj. Acton pointed out that malarial [ fever should be regarded, not as one disease, but a group of three different 1 fevers due to three distinct parasites, and two at least of these, in his opinion require different alkaloids of Cinchona Bark. Cinchona Febrifuge as produced in India for the last 50 years from ‘ Red Bark ’ has contained : Cinchonidine 40, Cinchonine 30, Quinine , 20, Amorphous Alkaloids 10. Cinchona Febrifuge Tablets contain 4 grains oi the mixed alkaloids. i Useful in benign tertian fevers, but might be better borne and more effective * ]f Quinine and the useless and toxic alkaloids were left out. The Quinine j could be added to treatment, if desired.—S. M. Klages, Dec., 1927. Quinidine Sulphate, 10 grains per os twice daily for 21 days, gave cure | percentage 62-9, and Cinchonidine Sulphate 63-1. The efficacy of the total i alkaloids is thought to be dependent on the Quinidine content or the i Cinchonidine and Quinidine combined. Maj.-Gen. Hehir finds benign tertian forms probably over 75% of cases met 1 with, and not 50%.—L. i./2o,1382. IThe products of Cinchona in the treatment of malaria.—B.M.J. i./26,154. The following formula is said to be superior to any other in prophylaxis and superior to Quinine in chronic cases of malaria fever as a remedial measure : Powdered Cinchona Febrifuge 10 grains, Citric Acid 20 grains, Magnesium Sulphate 20 grains, Spirit of Anise 10 minims, Syrup to £ ounce. Dose, i ounce 2 hours after meals.—T. H. Bishop, I.M.G., Dec., ’24,644 ; ibid. April, ’25,193. Benign tertian malaria well treated with a similar mixture. Cheap and suitable for mass treatment.—O. A. R. Berkeley-Hill, I.M.G., July, ’26,333. Cinchona Febrifuge. Warning against deficiency in alkaloids or presence of harmful ones.—L. i.,/23,148. Standardisation of Cinchona Febrifuge. In recent years C. Ledgeriana has been encouraged (to increase Quinine production) at the expense of the other alkaloids. Recent, samples of Cinchona Febrifuge suggest they have been made from C. Ledgeriana after the extraction of the Quinine, and they contained greater amounts of Amorphous Alkaloids and Quinidine. Although it is believed that Cinchona alkaloids have equal anti-malarial action it is important to have a definite standard.— B.M.J. 1/30,27. Still a variable product.—D. Hooper, P.J. i./29,631. Details of Public Analyses and a modified Howard and Chick Estimation process.—J. A. Goodson and T. A. Henry, Qtrly. Jl. Ph., ’30,238. Hydroquinine is the most activeof the alkaloids on bird malaria, follow by Quinidine, Quinine, Cinchonidine and Cinchonine in descending or« Separation of the Quinine is wasteful from the economic standpoint. Ther i no reason why Cinchona Febrifuge should be so varied in composition Goodson and Henry, Qtrly. Jl. Ph. iih/1930,238, see also B.M.J. ii./3o,96f. Totaquina, containing 70% Cryst. Alts, of which not less than 17 Quinine, suggested by Malaria Comn., R. Socy. Trop. Med., June 16/32 Quinidina. C20H24N2O2=324-2032. When crystallised from Alcohol, the base contains 1 molecr Alcohol of crystallisation. The Alcohol is completely removal at 120° C. Quinidine free from water and Alcohol melts at 1G8° When crystallised from boiling water it contains 1JH20. Quinidine is soluble 1 in 2,200 in water, i in 750 boiling water, 1 30 Alcohol 90%, 1 in 20 Ether. Its solution in Sulphuric Acid has a blue fluorescence, as in ti case of Quinine, and it gives a similar Thalleiocjuin reaction, differs from Quinine in M.Pt., and its Acid Tartrate and the Hyd odide are only slightly soluble. Quinidinse Sulphas. U.S. X., Ph. Ned. V., F.E. VIII., P. Belg. 1 (C20H24N2O2)2.H2SO4+2H2O= 782-5132. Bose.—5 to 10 grains (0-3 to 0*6 Gm.). U.S. X. states 5 grai four times a day as average. Slipule No. 00 holds 6 grains. I auricular fibrillation an average is 6 grains (0-4 Gm.), thrice daily. Occurs as needle crystals, soluble about 1 in 100 in water. ZTses.—In addition to its efficacy in malaria, Quinidine, alone in combination with Cinchonidine (vide Preparations infra) shoi be tried in all forms of fever, and wherever Quinine has been us: hitherto, e.g., in influenza, neuralgia, nervous headache, comm catarrhs and as a general tonic. Quinidine undoubtedly superior to Quinine Hydrochloride in cases wh resist Quinine.—Hans Ziemann, per Cliinimim, 72. Quinidine is believed to be specific in auricular fibrillation. References to treatment of Auricular Fibrillation. By fibrillation is meant an incoordinated, tremulous and flickef ing movement of the muscular wall of the auricles, which is in a sta of continual agitation. The fibrillating auricles might be compare with the weak fibrillary twitchings which occur in the muscles * the body when they are undergoing paralysis and atrophy. Tit fibrillations of the auricles may amount to as many as 500 a minute the ventricular rate may be 120, 140 or even 200 in rare cases. Mao! of the impulses fail to excite any ventricular contraction. Tinct. Digitalis 10 minims every 4 hours or 15 minims every 6 hours shorn be given daily, carefully watching the effect by counting the pulse twice a d by auscultation. One should endeavour to find the daily quantity necessa to keep the heart about normal rate. Some patients feel best when t heart’s rate is kept as low as 50.—C. H. Cattle, B.M.J. i./2i,521. See all Oliver-Sliarpey Lecture by Thomas Lewis.—ibid.,. 551. Auricular flutter associated with arrhythmia perpetua or delirium cor treated by Quinidine. In one case 15-5 Gm. had to be given before tJ arrhythmia could be controlled. Usual dose to begin with, 0-3 Gm.—slow increased. As mu ch as 2 to 3 Gm. can be given in 24 hours.—B.M- J.E. i./2i>& A study of 400 cases.—D. S. Brachman, L. i./2i,374? Quinidine Sulphate thought to have definite power to terminate paroxysms by restoring normal rhythm. The percentage of successful cases has varied up to 66%. _ A record of 13 cases. Dose 0-4 Gm. given in gelatin capsules, thrice daily is sufficient to ensure a progressive retardation of auricular rate for the first few days. Majority of successfully treated cases re-established normal mechanism. Quinidine has a remarkable action on the auricle and the action is of a potent nature.—A. N. Drury and C. C. Iliescu, B.M.J. ii./2i,511—515. Auricular fibrillation of itself not a dangerous or serious disease. Quinidine not free from danger.—J. Mackenzie, B.M.J. ii./2i,576. ■Return to normal cardiac rhythm in some cases. Its use is not without danger, the risk of embolism being a real one. Bibliography of the method.— A. W. M. Ellis and A. E. Clark-Kennedy, L. ii./2i,894. Dose of 2 to 3 Gm. p.d. One patient died.—J. Hay, B.M.J. 1/22,564. Rhythm restored. Commence with moderately large dose—1-25 to 1*5 Gm. p.d. for 3 or 4 days. If beat becomes regular 1 Gm. p.d. for one or two weeks, then Digitalis and Quinidine alternately for 4 or 5 days.—B.M.J.E. iL/22,1. See also J. Hay and others, B.M.J. ii./22,1079. Sometimes without the patient being conscious of it. Small doses should be given.—B.M.J.E. ii./22,37,74. In paroxysmal tachycardia it has little or no effect. I11 auricular flutter likely to prove of value. In a small proportion of cases with established auricular fibrillation Quinidine restores rhythm.—J. Parkinson and J. W. McK. Nicholl, L. ii./22,1267. Successful, but not suited for extensive structural changes in the heart, especially if response to Digitalis is not good.—E. R. Eraser, B.M.J. i./23,507. The dosage of Erey—six grains is given the first day, two doses the second, three the third and so on till a maximum of 10 doses may be reached. The majority of case3 are restored on the second, third or fourth day. The dose i3 repeated every two hours, starting at 5 a.111. Pulse recorded hourly.—J. G. Emmanuel, L. 1-/23,1050. In over 50% of cases Quinidine restores the rhythm temporarily, but only in a much smaller number is the action permanent. When fibrillation is due to abnormal rhythm, Quinidine therapy may be highly satisfactory, but when the myocardium is severely and permanently damaged control of the ventricular rate by Digitalis is of more benefit than restoration of normal rhythm. To the patient fully Digitalised (by massive oral doses) 3 grams of Quinidine are given, followed, if no idiosyncrasy after 12 hours, by 6 grains every 3 hours for 5 doses. When necessary, the procedure is repeated on two following days. If the normal mechanism is not then restored f urther treatment is not likely to give a permanent result. Quinidine tends to increase the ventricular rate, but Digitalis may be given simultaneously to counteract this.—J. C. Bramwell, L. i./25,1043. I11 heart affections in old persons predisposed to polyuria, Qumidme was found to be diuretic.—L. ii./26,924. The treatment is difficult and is best undertaken with electrocardiographic control, as toxic effects on the heart are fairly frequent. A dose of 6 grains every 2 hours for a maximum of 5 doses to normal rhythm, then 1 gram thrice daily for 6 to 12 weeks, first reducing the pulse frequency to between cSO and 100 while at rest in bed.—G. J. Langley, B.M.J. i./27,1043. Of 27 cases definite and lasting benefit was obtained in 9. Having got the patient fully Digitalised give a preliminary dose of 0-^ Gm. Qumidme . z4 hours later give 0-4 Gm. and repeat every 2 hours for 5 doses or till normal rhythm returns—if necessary, another 5 doses may be given on each 01 the two succeeding days. When first relapse occurs give a holding aose of 0-4 Gm. p.d. for 4 to 6 weeks, and half that dose for the next - or o months. J. C. Rramwed and R. Ellis, L. ii./28,966. TACHYCARDIA.—Quinidine Sulphate the only therapeutic measure and successful in many cases. Dosage high—as much as 120 grams ■ y. 1 • Strauss, Am, Jl. Med. Sci., ’30, per M.A., 31,51. . Quinidine Sulphate Slipules and Tablets; 5 grams (0*3 Gm.) and 6 grains (0*4 Gm.) are made. Elixir Quinidine. Martindale. Contains 10 grains (0*6 Gm.) per \ ounce (15 Cc.) dose (cj. also Elixir Quinidine-Ginclionidine). Quinidinae Sulphas Acidus. C20H24N2O2.H2SO4-f4II2O = 494-341 Colourless crystals, soluble 1 in 8 in water. Quinidinae Hydrochloridum. P. Ital. V. Co0Ho4N209.HCl+H.,CU 378-6836. “ “ Colourless silky crystals, soluble 1 in 60 in water (according to or experiments). Quinidinae Hydrochloridum Acidum. C20H24N2O2.2HCl+H2 = 415-1484. Colourless crystals, soluble 1 in 4 in water. Sterules Quinidine Acid Hydrochloride. 5 grains (0*3 Gm.) in 75 minims (5 Cc,), also 10 grains (0-6 Gm in 150 minims (10 Cc.), for intravenous use, and 5 grains (0”3 Gm: in 30 minims (2 Cc.) for intramuscular injection. Quinidine compounds have been given intravenously in heai affections. This compound, by reason of its solubility, is suggeste- for intramuscular injection both in malaria and heart affections. Quinidinae Feriodidum. C20H24O2N2.2I= 578-0672. Dose.—14 to 3 grains (0-1 to 0*2 Gm.), increased if necessary. When made by the interaction of Quinidine and Iodine in suitabll solvent (c/. Alkaloidal Periodides) this compomid is obtained as a. orange powder containing 56-1% Quinidine, according to investige tions in the author’s laboratories (1923). Pharmacology :— This Periodide is largely split up by Physiological Acid (39% of the Periodic!! being liberated), while a further 12-7% (of the Periodide) is rendered free b* subsequent treatment with Physiological Alkali. II grains produced no noticeable effect. A 3 grain dose, however, cause- free perspiration 4 to 5 hours after taking, together with feeling of cold. Soluble in Chloroform, slightly soluble in Alcohol, almost in soluble in Ether, insoluble in water. Uses,—This form of Quinidine may be of use for the treatment o auricular fibrillation of the heart, and it is well worthy of trial in benign tertian malarial infection, in comparison with the 4 ordinary Quinidine and Cinchonidine preparations. In the steadying of rapid heart in hyperthyroidism used with great effect.— ry s. A. Dispensing Note. To be given alone, in cachet or ‘ slipule,’ prefer ably after food. Cinchonidina. C10H 2 2N20=294-1876. Usually, in commerce, in small colourless leaflets, with M.pt: 202-5° C. Sol able about 1 in 4000 of water, and about 1 in 20 0 Alcohol. It does not give the Thalleioquin reaction, and its solution in Sulphuric Acid is not fluorescent. Cinchonidina Sulphas.—(C19H22N20)2H2S04, 3H20=740-4976 (From alcohol crystallises with 2H20.). Dose.—1 to 10 grains. In silky white needles from mother liquor of Quinine Sulphate. Soluble* 1 in 60 of Alcohol, 1 in 100 of water (more so with a little acid). Uses,—Therapeutically, in malaria, this has properties on a par with Quinidine. It has been used in other forms of fever, and in neuralgia, and otherwise as Quinine. Slipules and Tablets 5 grains each (0-3 Gm.) are made of this salt- Elixir Cinchonidine. Martinclale. Contains 10 grains (O’6 Gm.) per \ ounce (15 Cc.) dose. Elixir Quinidine—Cinchonidine. Martindale. Contains 5 grains of each per $ ounce dose. Cinchonidine Hydrochloridum. C19H22N20.HCi-f-H20-= 348-668. Dose.—1 to 10 grains (0*06 to 0-6 Gm.). Colourless crystals, soluble 1 in 30 in water. Cinchonidine Hydrochloridum Acidum. C19H22N20.2HC1 + H20=385-1328. Dose.—1 to 10 grains (0*06 to 0*6 Gm.). Crystals readily soluble in water. Sterules for intramuscular injection, lb grains (0*5 Gm.) in 23 minims (1*5 Cc;). Cinchonidine Periodidum. C19H22N20.4I=801 -9156. Dose.—1J to 3 grains (0-1 to 0*2 Gm.) increased. When prepared by the interaction of Cinchonidine Base and Iodine in a suitable solvent (cf. Alkaloidal Periodides) this compound is obtained as a brownish-red powder, containing 36-7% Cinchonidine. Pharmacology :— According to our experiments it is not markedly split up either by Physiological Acid or subsequent treatment with Physiological Alkali, differing in this respect from both Quinine and Quinidine Periodide. It was prepared in the writer’s laboratories (1923). lb grains gave no noticeable effect in a normal. A 3 grain dose, however, caused free perspiration 4 to 5 hours after taking, together with feeling of eoleb Sol ability.—Slightly soluble in Chloroform ; almost insoluble in Alcohol and Ether. Insoluble in water. Incompatible with alkalis, salts of metals and as alkaloids. Uses.—The body may have a field of utility (e.g. in malarial infection) especially in cases where other c Bark ’ compounds have been found ineffective or badly tolerated. The content of Iodine (63-3%) renders it suitable for administration in conditions where Iodine is efficacious. It may prove of service in influenza. Dispensing Note.—It is preferably given, finely powdered, alone in cachet or ‘ slipule ’ (No. 1) after meals. Ginchonidinae Salicylas. C19H22N2O.C6H4OH.COOH =432-2344. Is useful as a tonic and antiperiodic in neuralgia, rheumatism, sciatica, etc. 5 grains every 2 hours in Slipules (No. 00) or cachets. Cinchonina. Ci?h22n2o=294-1876.] Dose.—1 to 10 grains. . . . Cinchonine salts are the cheapest of the alkaloidal salts of Cinchona, lueir nauseous bitter taste is objectionable, though as prophylactics some have thought them superior to quinine. # Idiosyncrasy to Quinine. A lady had had 30 grains of the Bihydrocliloriao intramuscularly daily for three days, and subsequently 45 grains daily per os. This produced dermatitis. She could, however, take Cinchonine base, 16 grains a day.—W. Fletcher and B. A. O. Travers, B.M.J. h/23,629 Ginchoninae Hydrochloridum. C49H23N2O.HCl.2H2O—366.6836. Dose.—1 to 10 grains or more. . ocn/ In white acicular crystals, soluble 1 in 30 of water and 1 m2 of alcohol 00 /c . (Commercial samples we find vary.) Cinchonine Acid H>drochloride. Ci9H2aNaO.^HCl — 367-1172. Solution 1 in 2 by intramuscular injection—dose 7£, 10 or la grains—or tl e Acid Hydrobromide in malaria equal to or better than quinine. Sir B. Eogej s B.M.J. ii./18,459. Cinchoninae Sulphas. (C19H2aX20)3H2S042Ha0 =722-482. Bose.—1 to 10 grains or more. . -fe*iarA c°lpm]ess, short rhombic prisms with a vitreous lustre. Soluble? m 70 cold water 1 in 10 alcohol 90%. Dilute solution in Dilute Sulphur Aclp sppul? not be markedly fluorescent (absence of Quinine and Quinidinr T.?^r^Sul^?Carb?la5' C19H22.Na0.C6H4.S02H.0H (?) = 468-294- xn reddish white needles. Antiseptic febrifuge. „An. examination of the polarimctric rotations of concentrated solution ot acid salts of the Cmchona alkaloids showed that when heated at 126° < J°r. ^ hours decomposition took place rapidly in the Bisulphate of Quinin Qumidme, Cmchonidme and Cinchonine. The Bi-hydrochlorides, however Quinine and Qumidme were unchanged and of Cmchonidme and Cinchonk only very slightly decomposed at the same temperature. The acid sulnhat were completely altered by 4 hours heating at 141° C., whereas the con sponumg hydrochlorides were effected to the extent of 0-4% in the case •< Quinine, ranging to 7-7% with the Cinchonine. Doubt is expressed as to the toxicity of Quinicine and Cinchonicine —B 11 Howard and O. Chick, B.P. Conf., 1923: P.J. ih/23,92. Quinetum. This name has been applied variously in the past. It shout Dc used lor the mixture of amorphous bases of Cinchona Bark, the crystallisab a.kaloids having been previously removed. QUININA. Er. Cx., P. Hung., P. Svec., U.S. X., P.E. VIII. ^d9H20^r2O*CH3.QH-{-3HaO=37S-25. ph. Ned. V. is anhydrouE Dose.—I to 4 grains (0-06 to 0*25 Gm.) or more (if anhydrous, . parts equal approximately 4 of sulphate). Antimalarial Dose {U.S~ 15 grains daily. Quinine base can be produced with 1, 2 or 3 II20. it forms additive compounds with Hydrocarbons, e.g., 1 molecule Qiiinio T1 molecule C0H(i. A body has also been made consisting of 2 molecule Qumme, 1 molecule Hydrocarbon and 2H20. Combinations with Aim Acetate, Ethyl Acetate, Toluol, Dimethylaniline and Hitrobcnzol also wit Essential Oils, e.g., Lavender, Pine, Rosemary, also with Terebcne, Terpinec have been made.—Schaefer, 8th Hit. Cong. App. Chem., H.Y., Sept,, 19T2 So!^ -Slightly in water (1 in 2,600), 1 in 40 of ether anc about 1 in 1 oi alcohol 90%> also in dilute acids, 1 in 3 of chloroform: and in aqueous ammonia. Antipyrin increases its solubility in water Its solution in diluted sulphuric acid is fluorescent, lsevogyrate, ano gives, with chlorine water and ammonia afterwards added, a green colour due to Thalleioquin. Uses,—The most valued Cinchona alkaloid, in white powder/ It is not so bitter as its salts, hence may well replace them. It is readily absorbed by the acid of the stomach, and quite ae effective as the salts. It can be detected in the mine 10 minutefc after taking. In wasting diseases, e.g., tuberculosis, Quinine retard*-i protein breakdown and may be prescribed with advantage. Quinine and Sodium Bicarbonate Tablets, 3 grains (0*2 Gm.j each. Quinine (base) acts more promptly and powerfully than an equa- weight of any of the salts and is less disturbing to the stomach- Tablets would disintegrate more readily if prepared with Sodium Bicarbonate (3 grains of each), which would also help to counteract/ acidosis in hsemoglobinuria.—S. M. Klages, Dec., 1927. See also Quinine Hydrochloride, Sulphate, etc., and p. 737, for malaria treatment. Tercentenary Cinchona Celebration. See Cinchona. While the production of synthetic Quinine would undoubtedly be a triumph for organic^ chemistry, the more economic method of production will lie in the proper utilisation of the Cinchona plant. A plea for an experimental station.—Prof. Greenish, L. ii./22,23G. It has been synthesised, but at present the synthetic is more costly than the natural. Production.—Dutch data. The present production it appears is in excess of commercial demands, though millions are suffering from malaria owing to lack of Quinine.—B.M.J. 1/25,700. The total present world-production of Quinine is 600,000 Kg. per annum, made in 14 factories, and it is doubtful whether this is sufficient for the world’s needs. Question as to possibility of increasing supply should be seriously considered.—Health Committee, League of Nations, L. i./24,720. Onr Dominions are unable to produce all the Cinchona Bark and its alkaloids required.—Sir D. Prain, P.J. iu/27,9. Extraction of Quinine anp Strychnine from solutions of varying Hydrogen-ion concentration.—N. Evers, P.J. ii./22,90. Fatty compounds of Cinchona alkaloids used to destroy and keep clothes free from moths, usually by soaking or spraying with a Petroleum or Carbon Tetrachloride solution. Used in dry-cleaning plants in U.S.—P.J. ii./27.580. Acidum Quinicum. Syn. Kinic Acid. C6H7.(0H)4C00H+H20=210*1092. Dose.—A to 8 grains (0-25 to 0*5 Gm.). An acid contained in Cinchona, principally combined with the alkaloids and with calcium, forms white crystalline masses, soluble in water about 5 in 6, and in alcohol 90% 1 in 35. It is decomposed into hippuric acid in the system. This and Lithium Quinate in similar dose are used in gout and rheumatism. [1?TQuininse Cacodylas. C20H24N2O2.(CH3)2AsO2H—462*1878. Dose.—Per os and hypodermically, 1 \ to 4 grains (0*1 to 0*25 Gm.) This salt has been suggested for intravenous use in malaria, 7J grains (0*5 Gm.) in 20 Cc. It has approximately the same toxicity as Quinine Acid Hydrochloride and Acid Hydrobromide. Quininse Camphoras. 2(C20H24NaO2).C8H14(COOH)2= 848*5312. Dose.—1 to 10 grains. An insoluble powder. Contains 76*4% Quinine. Quininse Citras. 2(C2oH24H202).C3H4.OH(COOH)3+7H20 = 966*578. Dose.—-1 to 5 grains (0*06 to 0*3 Gm.). Soluble 1 in 900, has, therefore, little taste. Given suspended in mixture. Contains 67*1% Quinine. Ferri et Quininse Citras (B.P. T4). Dose.—5 to 10 grains (0*3 to 0*6 Gm.) in solution, or m pills with simple syrup or mucilage of acacia (not in excess, as, unless made very hard, they lose shape). Alcohol 60% with Glycerin 5% is also a suitable excipient. Contains about 15% of quinine, in greenish deliquescent scales. It has an agreeable bitter, chalybeate taste. Largely used as a general tonic. . Incompatible with Tannin and Alkalis, also with Ihosphorie Acid (Ferric Phosphate may be thrown out), unless considerably diluted prior to mixing. . _ 1 Flavoring.—Glyl Vanillee, Glyl Menthae Pipentae (bold dose), Syrupus Zingiberis. Effervescent Citrate of Iron and Quinine. Dose.—1 drachm (4 Gm.) = 3 grains of the salt. 1 ablets of Iron and Quinine Citrate 3 grains. Syrupus Ferri et Quininae Citratis. Dose. 1 drachm (4 Cc.). ] in 20 of Orange Syrup. EE Ferri Quininae et Strychnine Citras (q-v.) contains 1% (r Strychnine. ®Sirop Neurotonique. Dose. 2 to 3 drachms (8 to 12 Cc.) in a little water after meal- Iron and Quinine Citrate 0-50, Strychnine Nitrate 0-01, Liqui Extract of Kola 5-0, Sodium Glycerophosphate 5-0. Dissolv with slight heat in Orange Syrup, q.s., to 100. Quininae Formas Acidus (“ Neutral ” in France). C20H24N2O2.(H.COOH)2=416-2344. Dose.—1 to 5 grains (0*06 to 0*3 Gm.). Long white needles containing 77-9% Quinine, M.pt. 95° C. Quinina? Formas Neutralis (“Basic” in France). Syn. CHINO) form, Quinoform. C20H24N2O2.HCOOH=370*2188. Dose. 1 to 5 grains (0*06 to 0*3 Gm.). Subcutaneously 1 U 3 grams. (Stated not to be painful.) Prepared by using a very small quantity of water, in which th*< Quinine is .placed and the acid added. Crystals melting at 132° laevorotatory. Contains 87-5% Quinine. A general tonic. Suitable for hypodermic use. Solubility—Varies according to conditions of manufacture. Some com mercril samples we found were only soluble in 600 of water and 110 of Alcohol- \v e found that a 1 in 20 solution can be made extemporaneously by dissolving 1 gram of the base in 19 Cc. of water containing 0T25 gram of Formic Acidl but we could not make the salt more soluble than 1 in 55 of water and 1 in i of Alcohol, there being dissociation. Sterules, Hypodermic, J grain (0*02 Gm.) and £ grain (0*05 Gm.). Guttae 1 in 50 have been employed satisfactorily in asthenopia. Quininae Hydrobromidum, U.S. X., P. Helv., P. Belg. IV. Fr. Cx and P. Ital. V. term this ‘ Basic ’ Quinine Hydrobromide Kyn. Quinine Bromide. C20H24N2O2.HBr+H2O = 423-1426. Dose. 1 to 5 grains (0-06 to 0*3 Gm.) or more. Antimalaria, Dose (U.S.)—15 grains daily. White acicular crystals, soluble 1 in water 40. (P. Helv. 60 : Bete ‘50 to 60.’) * Contains 76-6% of Quinine. Quinine is given with an excess off hydrobromic acid to lessen the cinchonism sometimes caused by large doses. Is valuable in acute rheumatism. In malaria for oral administration, hypodermically or intravenously. Exophthalmic Goitre has been treated by 5 grain Capsules given to the limit of tolerance (3 or 4 Capsules p.d.)—for months or even years. In 24 grain doses thrice daily one of the best treatments.—J. B. Alexander,, Clin. Jl., Aug. 15, ’23,394. See also Quinine Sulphate. Tablets contain 3 and 5 grains, also 3 grains, with Phenacetin, 5 grains. Hypodermic Tablets of the Salt contain 4 grain. Tropical abscess has been treated by aspirating and injecting into the cavity I % solution of this Salt. Quininae Hydrobromidmn Acidiim. (Fr. Cx.—‘ Neutral.’) C20H24N2O2.2HBr+3H2O=540-1076. Dose.—\ to 2 grains (0'03 to 0*12 Gm.) hypodermically. In yellowish rectangular prismatic crystals, or in powder. Contains 60% of Quinine. &olllble 1 in 7 of water, and is well adapted for hypodermic injection. It is non-irritating. The additional hydrobromic radical tends to prevent quinism. Sterules, Hypodermic, contain 2 grains (0,12 Gm.) Injectio Quininae Hydrobromidi Acidi Hypodermica. 2 grains in 1 Cc. Dose.—§ to 1 Cc. Used where quinine cannot be borne by the stomach. In malarial fever and subsequent rheumatism. Quinines Hydrockloridmn. B.P. ’14. U.S.X., P. Helv., P. Jap., P. Hung., P. Ital. V., Ph. Nee. V., P.G. VI. In F.E. VIII., P. Belg. IV. and Fr. Cx. termed 4 Basic.’ Syn. Quinine Hydrochlorate. C20H24N2O2.HCl+2H2O-396-6992. Dose.—1 to 10 grains (0-06 to 0-6 Gm.). Stipule No. 0 holds 5 grains. F.E. has max. daily dose 2 Gm. This salt contains 81-7% base against 73*5% in the sulphate. Soluble 1 in 40 of water, 1 in 3 of 90% alcohol. Two salts with a common ion lessen each other’s solubility. The less solubility in Ringer’s Solution (1 in 110) is due to its slight alkalinity, also to the fact that it contains a slightly greater number of Chlorine ions.—J. H. Crawford, B.M.J. i.,/22,874. Quinine Hydrochloride 2 with Antipyrin 1 will dissolve in 4 of water. fncom&atifoSo—Similar to Quinine Sulphate. Uses and References— It is sometimes better tolerated than the Sulphate. Subcutaneous or intravenous injections useful where not tolerated by the mouth. Giemsa’s Injection contains Quinine Hydrochloride 10 Gm., Water 18 Cc., Ethyl-Urethane 5 Gm. The volume of product is 30 Cc., so that 0*5 Gm. is contained in 1*5 Cc. of solution for injection. See also Quinine and Urethane, p. 734. As a fever prophylactic quinine hydrochloride 3 grains with phenacetin 5 grains is largely used in Portugal.—Ph. Notes. For the paroxysmal headache or neuralgia so common after malaria the following mixture is recommended :—Quinine Hydrochloride 3 grains, Tincture of Cimicifuga 5 minims, Citrate of Caffeine 2 grains, Spirit of Chloroform 10 minims, Compound Infusion of Orange to 1 ounce, twice daily. Solute de Quinine pour injection hypodermique. 4r. Cx. Quinine Hydrochloride 3 Gm., Antipyrm 2 Gm., Water to 10 Cc. Special instructions as to sterilisation are provided. For use in Malaria, see pp. 738,739, and for toxic effects, p. 743. In acute tonsillitis, Quinine internally and as mouth-wash useful; also with Dilute Nitric Acid in cachectic cases of vesicular stomatitis. Wounds treated by Quinine Hydrochloride 1% solution as wet dressing, also 1/10% with 1/10% of Hydrochloric Acid as continuous drip. Active in ri£ding heavily contaminated wounds of the gas bacillus. Quinine is especially effectual m a menstruum of pus—K. Taylor, B.M.J. ii./is,923 ; L. i./i7,294„ anal fissure treated by Quinine Hydrochloride Racking (5 grains) and! Quinine suppository. Granulation good—H. G. Leyton B.M.J. i./i8,314. Mistura Quininae cum Ferro. Dose. | ounce thrice daily in water 30 minutes after food. Quinine Hydrochloride 30 grains. Tincture of Ferric Chloride J ounce, Glycerin 1 ounce, Water to 8 ounces. Bad cases of secondary syphillis do well on this. Lotio Quininae HydrochloridiR.O.H.4 grains to 1 ounce. For corneal ulcers, cf. p. 730. Tablets, I, 2, 3, 4, and 5 grains. Pessus Quininae (flat shape).—3 to 5 grains of Quinine Hydrochloride in Theobroma Oil basis. A valuable remedy for leucorrhoea. A solution of Quinine arrests the movement of spermatozoa. Coniraee&tives. The following is a resume of the chemical substances and preparations of tnem used for the purpose of contraception, with statements as to their relative values :— 4: 15ircon Tablets (T.M. 500913) said to contain Chinosol, Zinc Sulpho- carboiate, Sodium Bicarbonate and other suitable antiseptics and deodorants. —L. 1./31,392. Chinosol is believed by some to be injurious. The following statements have been made :— As a few women apparently' absorb sufficient Quinine to cause sleeplessness and slight digestive disturbances, a suppositorv of Chinosol in Cocoa-butter is recommended by The C.B.C. Med. Research Committee — L. ii./27,42. Chinosol in anyr medium is not tolerated by a considerable number of women. Its use frequently produces inflammation and discharge, whilst sterility is stated in one instance to have been caused by it. A Lactic Acid Pessary in conjunction with an occlusive pessary found most efficient.—Norman Haire L. n./27,143. See also ibid., L. ii./27,256,308 and 360. Koromex. A Lactic Acid Jelly used in conjunction with a pessary. The spermaticide alone only satisfactory in 66-8% of cases.—L. ii./29,1128. A jelly containing Chinosol, Boric Acid and Lactic Acid best as spermicide. Contraceptives may not be sent by post in U.S.A.—L. ii./3o,l352. Effervescing Tablets.—These are employed to some extent abroad, but the evidence is that they are exceedingly uncertain for the purpose, owing to the fact that they do not readily dissolve, and hence fail to function. J^Speton (T.M. 402940) Tablets are an example of this type. J^cSemori Tablets (T.M. 496938,496937)—froth-producing and germicidal.—L. ii./29,623. Lactic Acid.—It is well known that the secretion of the vagina is acid, owing to the presence of 0-9% Lactic Acid, which is secreted by Doderlein’s Bacillus. In the act of coitus, alkaline secretion is passed by the mucous membrane for the purpose of neutralising the acid. It has been suggested therefore to employ 1% of Lactic Acid to overcome this alkalinity^ Lactic Acid Pessaries for vaginal use, are prepared with Theobroma basis weighing 20 grains, or a larger size 8 Gm., containing 2% of Lactic Acid. Lactic Acid Jelly of a non-greasy type contains also 1% Lactic Acid, together with a small proportion of Boric Acid and a minute quantity of Thymol as preservative. Gontraceptalene is a preparation of this kind. Mercuric Chloride and Formaldehyde the most spermicidal substances out of 36 tested on guinea-pigs, the killing concentration of eachbeing 1/256%. Hexyl Resorcin kills at 1/64%, soaps at 1/32%. Formaldehyde and Hexyl Resorcin, inter alia, likely as contraceptivess. Quinine Bisut&hate and Chinosot only kill at The Spermicidal Powers of Chemical Contraceptives, J. R. Baker, Jl. Hygiene, Vcl. XXXI, No. 2, April, ’31,213. Fatentex, a contraceptive jelly, was found to be a Glycerolc of Starch preparation, containing 20% Boric Acid, and Metag, described as an improvement on Patentex, was found to consist solely of Tragacanth Mucilage and a trace of Boric Acid. Quinine Suppositories are well known and are supplied as follows:— 3 or 5 grains of Quinine Hydrochloride in either Theobroma or Gelatin mass. Quinine Pessaries were found to fail in 71% of cases. ^cRendell’s Quinine Pessaries. (T.M’s. numerous.) The Cocoa Butter is subject to a process of filtration, to eliminate fibrous matter. The Quinine also is filtered through Jap Silk. Where Cocoa Butter hinders the action of Chinosol and Quinine on sperms a new fat called Cocoala, which is nearly odourless, has not this defect.— J. It. Baker, L. ii./3i,325. Schereschewsky’s 40% Quinine Ointment holds a high position for disinfection against venereal disease in Germany. 1 in 1,000 Perchloride is reliable.—L. 1/22,292. Quinine and Chinosol have small spermicidal value. The mechanical action of Cocoa Butter of some value.—L. i./3o,367. Quinine Urea Hydrochloride Tablet 2 grains used in conjunction, with Dutch cap—dissolved in a little water in it.—Helena Wright, L. ii./3o,332. Douches.—The following are recommended :— (a) 1% Lactic Acid solution ; (b) Normal Saline ; (c) Vinegar, 1 drachm to the pint; (d) Potassium Permanganate, 1 in 4,000. Douching faded to prevent conception in 74% of cases. See also Contraceptive Section, Report of the 5th International Neo- Malthusian and Birth Control Conference, 1922 ; Pr. July, ’23,80. Also ‘ The Comparative Value of Current Contraceptive Methods ’ read at Internat. Kongress fur Sexualforsc-hung, Berlin, Sept. 16, ’26. Sterilisation of men and women described, also Dutch ring pessary—said to give, little inconvenience.—Birth Control Conference, L. ii./22,195. Birth Control and the State. C. P. Blacker says no really satisfactory contraceptive exists. Chemical preparations give no security.—L. i./2 6,76G. Modern methods of birth control are causing an increase of involutional insanity among women.—L. L/26,660. Graf’enberg’s Silver Ring Method. A simple and efficient method of ensuring temporary sterilisation, consists of the introduction into the uterine cavity of a flexible ring of coiled silver wire (diameter 2—3 cm.), which is removed, and, if necessary, replaced after a year. After removal the woman is as liable to conceive as if it had never been used. The ring sets up a non-inflammatory hypertrophy of the mucous membrane, rendering it incapable of acting as a nidus for the ovum. Method harmless in the absence of genital infection and its value lies in the fact that its reliability depends on the skill of the medical attendant and not on that of the patient. Used by Grafenberg in 1,100 cases over 10 years without a single failure.—Norman Haire, B.M.J. ii./29,1134 ; see also 1/30,45,129,726. The method is far from harmless. In many cases it has been necessary to remove the ring owing to metritis and parametritis or persistent bleeding from the uterus.—Lcunbach (Denmark), International Medical Group for the Investigation of Contraception (from Hon. Mrs. Fairer, 13, Lansdowne Crescent, London, W.), L. ih/30,1438. . Birth Control on trial. No method practically effective m the majority of cases.—Mrs. L. S. Florence, B.M.J. h/30,658. . Contraceptive action of pessaries with Cocoa Butter basis probably largely due to mechanical action, i.e., the covering of the cervix with a thin film impeding the ingress of the spermatozoa.—L. ii-/31,258. A good germicide is not necessarily a good spermancide. J. L. Baker L. ii./3o,1438. Tinctura Quininae (B.P. ’14). Dose.—\ to 1 drachm (2 to 4 Cc.). Quinine Hydrochloride 1, Tincture of Fresh Orange 50. A very agreeable form of taking small doses of Quinine. Hydrochloride of Quinine is used as first suggested by W. TV hitfield. Vinum Quininse (B.P. ’14). Dose.—\ to 1 ounce (15 to 30 Cc.). Contains one grain of Quinine Hydrochloride dissolved in one ounce of Orange Wine. The Customs and Excise Commissioners allow its sale without licence if {a) It is prepared in accordance with the B.P. ’14 directions. (b) That sales are made only by duly qualified chemists and druggists ; and (c) It is labelled to show that it is to be used as a medicine. The word “ Dose ” should appear on the label in bold. type. This should not exceed the B.P. T4 dose—viz., £ to 1 oz.— but the Board do not object to the use instead of the words “ one or two tablespoonsful,” or half a wineglassful.” Quininae Hydrochloric!um Acidum. Quinine Di- or Bi-Hydrochloride. In Fr. Cx., P. Ital. V. and F.E. VIII. is termed 4 Neutral5 Quinine Hydrochloride. C20H24N2O2.2HCl= 397-1328. ^ .B. Fr. Cx. adopted the salt +21 H20. Crystallised from alcohol the bait contains alcohol and water of crystallisation. Left exposed to the air tins loses its alcohol and the Salt changes to one with 24 molecules of water, becoming at the same time opaque. Dose.—1 to 10 grains (0*06 to 0*6 Gm.) Antimalarial dose (U.S.) 15 grains daily. \ to 2 grains (0*03 to 0*12 Gm.) hypodermically j F.E. has max. daily dose 2 Gm. In white or yellowish white crystalline crusts. B.P. ’14 states in amorphous powder. Is claimed to be soluble 1 in 1 of water. Contains 81-6% of quinine. Uses.—This is the most suitable salt for injections which have: to be sterilised (cf. Bi-Sulphate), and it is considered the best salt1 for intravenous use in malaria, septicaemia, etc. The hydrochloric radical is not as irritating as the sulphuric to the stomach. Intravenous Injection of Quinine Acid Hydrochloride. Dose.—An average dose may be considered as from 4 to 15 grains (d 25 to 1 Gm.) though Sir L. Rogers, B.M.J. ii./i7,381, states that 5 to 11 grains commonly produces cinchonism, and some hold that neither the intramuscular nor the intravenous dose should exceed 5 grains (0*3 Gm.). Dilution.—Some use an exceedingly dilute solution (e.g. as low as 1 in 300). Others advise even a 10% solution. Personally we recommend a medium of 1 in 40 or 1 in 50. Newton Pitt advised 4 grains (0*25 Gm.) in 150 minims (10 Cc.) i.e. 1 in 40. A. G. Phear found 10 grains in 300 minims (20 Cc.) saved many lives in Macedonia. Bale of injection.—This, as with all intravenous procedure, should be slowly performed. Danger of rapid intravenous injection of Quinine solution in malaria. There may be dangerous fall of blood pressure with concentrated solution. The whole problem turns on the amount of Quinine passing through the heart every second. The amount of Quinine injected into a vein at the bend of the elbows should not be more than 1 /120th grain per second or J grain a minute. This will mean 10 grains will require 20 minutes. For Quinine Hydrochloride intravenous injection the solution should not exceed strength of 1 in 300—to be given at the rate of 10 Cc. per minute for patients ovev 15 years of age. Half rate for children under 15. Tables s owing effect on systolic, diastolic and pulse pressures after intra- venous injections of dilute solutions of Quinine Bihydrochloride.— ' 4 y- Brahmachari, L. ii./22, 175, Jl. Trop. Med., July 1/22,209-211. 1 or further details of intravenous use in Malaria, see p. 739. A 5-grain tablet (uncoated) of Quinine Bibydrochloride daily just before dinner a fairly efficient prophylactic. Coated tablets practically useless often being voided before the coating dissolves. Results of 20 years’ residence in Sierra Leone.—\V. Addison, B.M.J. L/32,263. 1 (7 «I(in1^rTrnr?atlS3ntv by 1 ^uluiiic Biliydrochloride intravenously W grams m 10 Gc.).—R. Kharegab, L. n./25,626. B.^Ratten fwF (°'3 Gm° ln 10 Cc* llas been employed. See Puerperal Sepsis.—One or two injections of 10 grains produced gocd results.— P. Liston, B.M.J. ii./a7,959. 1 gocu intravenouBly (at first) and intramuscularly (subsequently) Quinine Acid 11 Cl 5 grams in 10 Cc. in puerperal fever. On the first 3 or 4 days one injection intravenously and subsequently intramuscularly.—S. G. Luker BMJ i./3o,261, see also 270 (with Strepto serum); see also A.C. Hill, ibid. ’ As /oca/ anvesthetic 1 to 1 % solution (for mucous membrane a 10% solution may be applied with cotton wool) is injected into the tissue —L. ii./io,840. Quinine and all its derivatives are general protoplasmic poisons and in proportion as they exert this action they act as local anaesthetics.—W. E. Dixon and Premankur De, .11. Ph. and Exp. Ther., Oct., ’27,407. Tonsillectomy.—As a local anaesthetic Quinine Hydrochloride £ grain in 2 drachms of water superior to 0-2% Cocaine (5 Cc.). A small amount of 20% Cocaine first applied.—E. J. Brown, Jl. A.M.A., July 28, ’23,321. Cancer.—Quinine often of value for relief of pain. Injection intramuscularly of 20—30 Cc. Quinine Biliydrochloride solution 10% every other day, and 1 Gin. Tier os on alternate days.—Per Chin inn m, 220. Quinine Biliydrochloride (7b grains intramuscularly) is a pcweiful inducer of leucocytosis, but it appears to have no advantage over Novaisenobenzol or Mercury, and injections are painful.— G. R. S. Thomas, L. h/25,1292. Intramuscular injections given in large numbers without tetanus being caused (as result of muscle fibre necrosis). Pain does not occur unless some solution gets into the subcutaneous tissues. However, intravenous injections are more rapid and painless. 0-6 Gm. in 10 Cc. water.—M. 8. Nawaz Ahmadi (Uganda), B.M.J. ii./3o,621. Liver Abscess.—After exploratory aspiration repeated irrigation of an abscess cavity with Quinine Bihydrcehloride 3 to 5 grains per ounce may render subsequent operation unnecessary. Chronic Constipation.—Rectal use best—5grain suppositories.—B.M.J.E. t/30,8. Isotonic Quinine Acid Hydrochloride Solution contains 0*565 Gm. in 10 Cc.—P.J. i./i2,357. Sterules, Hypodermic, contain 2 grains (O'12 Gm.) also 3 grains (0*2 Gm.), 5 grains (0*3 Gm.) also 15 grains (1 Gm.) in 2 Cc. for Malaria also 4 grains (0*25 Gm.) in 10 Cc. and 10 grains (0*6 Gm.) m 20 Cc. for intravenous uses. Also Sterules, Hypodermic of Quinine Acid Hydrochloride 5 grains (0*3 Gm.) with Antipyrin 3 grains (0*2 Gm.). Tablets 1, and 5 grains. Tablets, Hypodermic, 1, 2, and 3 grains. Quinina? Hydrcchloro-Carbamidum.—Syn. Urea-Quinine. U.S. X. (A variety is afcNikalgin (T.M. 366289.)—B.M.J. i./i8,254.) C20H24N2.O2.HCl CO (NH2)2,HC1+5H20= 547*258. Dose.—5 to 15 grains (0*3 to 1 Gm.). In small prisms, soluble 1 in about 1 of water. Contains 59*2% V Quinine. Used hypodermically in malaria 2 to 5 grains and in cholera, in as large as 12 to 15-grain doses. The latter is U.S. X- hypodermically (one dose daily) as average. As local anaesthetic analgesia persists for 4 to 6 hours, even tc several days. Used in America for malaria in which marked anaesthesia was noticed at the site of injection, hence its trial as a Cocaine substitute 4 to 5 Cc. hypodermically of 1% solution (up to 3% is harmless). In 10 tc 30 minutes produces anaesthesia ; at the same time it acts as a haemostatic Healing of wounds is, however, delayed owing to thickening of the edges due to hormous exudation. In operations on haemorrhoids 2% solution has caused sloughing. J. E. D. Jones writes us 5 Cc. of 1% solution injected to ease pain in a case of sprnal injury. Anaesthesia was prompt and profound and lasted 2 day& without ill effect afterwards—far superior to Cocaine and Morphine. 1 arnless operations. Results with Quinine Urea Hydrochloride and witl Novocain.—P. Lockhart-Mummery, Pr., Feb., 1920. in tonsilitis and in tuberculosis of the larynx 10% solution or less is suitable —even A) or 50 /0 may be used. Apply by spray, sponge, brush, etc. A teaspoonful or so of solution may be taken in the mouth and used to bathe the= tonsils by swaying the head from side to side. Haemorrhoids injected with Quinine Urea Hydrochloride 5 to 10%, solution. Enemata of Sodium Bicarbonate used for washing out the bowej mstead of soap in U.S. A.—non-irritating—L. J. Hirschman, B.M.J. ii./2i,155 Hie injection is to be got between the vein and the mucous membrane off the lecturn, and not in the vein itself. It is seldom necessary to give more than o Cc. at one sitting. Injections given at weekly intervals, 0 to 8 being the average number required— C. Howard, L. U/29,20. Sloughing after 5% Quinine Urea for injection in haemorrhoids. Never inject an external pile or a prolapsed internal pile without first reducing it and never inject a pile that is already sclerosed.—L. i./3o,1027. Pruritus ani, vulvas, and scroti, well treated as follows: render part clean, apply Mercuroclirome solution as antiseptic, inject small area with ?°«VI1(!re ^han 10 Cc. 1% Procain, inject £ grain Morphine hypodermically* infiltrate remainder of diseased skin with Quinine and Urea Hydrochloride;' solution 0-25 to 0-5% (as much as 200—300 Cc. may be used). Itching a.rr®8'v'^conations healed and skin becomes normal in few days.—JL A.M.A., Sept. 6, ’24,700. Exophthalmic goitre and thyroid enlargement treated by injections ok 4—3 Cc. of a 4% solution of Quinine Urea Hydrochloride into the thyroid.. Af ter a few treatments the goitre becomes smaller and when it is one-thud of original size the treatment can be stopped, as the shrinking will continue; until 110 tumour is perceptible. The drug is believed to act through its necrotic action on the parenchyma of the gland—H. G. Lougliran, Med. Jl. Austral., 27,263, per Pres., May, ’27,173. Prom point of view of acidity no advantage in this salt over hydrochloride. —J. H. Crawford, B.M.J. i./22,874. Steruies contain 3 and 5 Cc. of 1% solution for subcutaneous use. Sterules of Urea-Quinine with Eucaine J grain each for dental use are prepared. Suppositories contain 5 grains for use in painful haemorrhoids. Ointment 20% in Lanolin and Soft Paraffin. Quinine Hydriodidum. Syn. Quinine Iodide. C20H24N2O2,Hl = 452-143. Is in minute pale-primrose coloured, slightly soluble crystals. Quinine Hydriodidum Acidum. Syn. Quininas Iodidum Acidum. C20H24N2022HI,5H20=670-1608. Is in golden crystals, soluble about 1 in 20 of water. Contains 48-4% Quinine. Must be kept from the light. Quiniuse Hypophospllis. c20h24n2o2, H3P02-2iT20=426-2818. In crystals or powder. Soluble 1 in 35 in water, or even less if pure.—D. B. Dott, P.J. l/22,64,87. More soluble in alcohol 90%. Contains 76-05% Quinine. Quininse Lactas, Quinine Lactate. C20Ha4N2O2.CH,.CHOH.COOH=i414-25. A granular white powder, soluble 1 in 10 of water ; said to be well tolerated. Contains 78-3% of quinine. Suitable for hypodermic injection. For gonorrhoea, 1% solution forms an excellent injection. Dose of each of the above.—1 to 5 grains (0*06 to 0-3 Gm.) or more. Quinine-Mannitol Injection. Suggested Dose.—15 to 30 minims (1 to 2 Cc.) hypodermically, containing 9 to 4 grains of Quinine Base. A suggested intravenous dose is 1 Cc., diluted to 10 or 20 Cc. just prior to use, but clinical information obtainable on it is meagre. Pre&ara tson. The solution has the following composition : Quinine Base 12 Gm., Boric Acid 8'4 Gm., Mannitol 7-5 Gm., Distilled Water to 100 Cc. Uses.—This new solution of Basic Quinine for injection was designed to replace acid solutions. Alkaloidal salt solutions on entering the tissues are decomposed by the alkalinity of the blood ; free base is liberated before absorption. Hence it is better (see Activated Alkaloids), to use when possible, an alkaloidal base in solution. The necrosis caused by Quinine salts locally is no doubt due to the deposition of the base at the site. Such Quinine can have no immediate efficacy. When Quinine-Mannitol comes in contact with blood a large proportion of the Quinine (larger than in the case, of Quinine Acid Hydrochloride) is present in solution in the basic condition, and, therefore, in all probability, is more readily absorbed and is less likely to be deposited. Quinine Base is more active against free-living protozoa than the hydrochlorides. Further, J. A. Sinton found better results in malaria by the use of alkalies with the Quinine. H. W. Acton has also recorded the increased activity of the salts towards paramcecium in presence of alkali. For f urther details, see a paper by W. H. Martindale, L. i./26,455. So'me ^experiments, kindly conducted by Major II. C. Brcwn, showed the toxicity to mice intravenously to be practically the same as that of a Qumme Acid Hydrochloride solution of equivalent strength. The letual dcse of the solution, suitably diluted 12 or 24 times, was found to be about 1 Gc. per kilo body-weight (approx. 120 mg. of Quinine per kilo). A small point, which needs obvious mention, is the possibility of the cumulative effect from the 1* grains of Boric Acid, if repeated “ibib, perhaps negligible. The addition of Mannitol to injections is occasionally referred to and recommended in the literature. The above comparative results with Quinine Acid Hydrochloride are of value in respect of a toxicity dose of Boric Acid. Me nave not seen the toxic dose of Boric Acid by injection m any work of reference* Quinine-Mannitol K ferules.—2 Cc. containing 0-24 Gm. (4 grains) of Quinine according to the above formula are prepared. A woman of 19, married and 6 months’ P^nthaJ foT malar i^naradtes ■nerature for over 2 months. An examination of the blood for malaria parasites profe^positive Mannitol-Quinine was given intramuscularly the following day. From the first injection the fever abated, appetite increased, the jaundiced colour disappeared and her general condition improved.—Julio A. Santos, Porto Rico, 1928. A further intimation from the same source conveyed that the preparation did not cause pain and irritation as other types of Quinine. Pneumonia.—Intramuscular injection of a 3% oily solution of Quinine with Camphor and Terpenes of value. The basic Quinine alkaloid thus, administered is conducted to the lungs, where it exerts anti-bacterial effect.— L. M. Flewelling, B.M.J.E. h/29,98. Quininse Nucleinas. Dose.—1 to 5 grains (0 06 to 0-3 Gm.). Yellowish powder containing G0% quinine and 40% nucleinic acid. Insoluble in water. In syphilis has been employed as 5% suspension in Olive Oil. Intramuscular injections of 10 Cc. were used, assisted by intravenous injections of the hydrochloride. See also Quinine Hydrochloride, and compare Quinine Urethane. Quininae Periodidum. C20H24N2O2.3I=704*9992. Dose.—1J to 3 grains (0*1 to 0*2 Gm.) (in Slipule No. 5) When made by interaction of Quinine and Iodine in suitable solvent (cf. Alkaloidal Periodides) this compound is obtained as a dark-red powder containing 46% of Quinine, according to investigations in the author’s laboratory (1923). This Periodide is almost completely resistant to Physiological Acid, only 1*6% of the Periodide being liberated, while on the other hand a large proportion (9-3% of the Periodide) is liberated in Physiological Alkali. Soluble slightly in Alcohol, almost insoluble in Chloroform and Ether, insoluble in water. Uses.—In all forms of fever, especially malaria. In influenza, the combined effect of Quinine and Iodine may be of value. In general it is a tonic. Many persons do not tolerate the irritant effects of Quinine Sulphate or the Hydrochloride. It contains a large proportion of Quinine, which passes through the stomach without discomfort. Dispensing Note.—To be given alone, in cachet or ‘ slipule,’ preferably after meals. Quininse Phosphas. 2[C20H24N2Oo], H,PO4 + 8H2O=890*5746. Dose.—1 to 6 grains (0*06 to 0*4 Gm.). Is in acicular crystals like the sulphate, but harder and denser. Contains 72*8% quinine Composition varies with manufacturers. Soluble 1 in 420 of water. Quininae Salicylas. F.E. VIII., P. Ital. V. C20H24N2O2.C6H4 (OH)COOH+H2O=480*2656. Dose.—2 to 6 grains (0*12 to 0-4 Gm.). White crystals, sparingly soluble in water, and about 1 in 60 of alcohol 90%. Incompatible with mineral acids—salicylic acid maty crystallise out. Contains 68*8% of quinine. Should be given suspended in water, or in cachets, or pills with syrup of glucose ; recommended for diarrhoea and neuralgia, rheumatism and sciatica. In rheumatic fever virtually inert.—R. Stockman. Tablets 3 grains (0*2 Gm.). Dose.—1 to 2. Capsules contain 5 grains (0*3 Gm.). In dengue Quinine Salicylate 5 grains every four hours has proved useful.—Brooke. rv Quininae Acetyl-Salicylas. C20H24N2O2.CH3.CQOC6H4COOH=504-2656. Dose.—1 to 5 grains (0-06 to 0-3 Gm) Useful antipyretic and antiseptic compound. Contains 64-3% Quinine. Melting at 167° C. Soluble in Water 33, Alcohol 1 in 40, Chloroform 1 in 10. Immediately decomposed by Acids and Alkalis. Tablets, 3 grains are prepared. ^Quinisan (T.M. 502838). Syn. Quinisal, Quinine Bisalicylo- SALICYLATE. Dose.-—1 or 2 tablets two-hourly, 4 to 6 times daily. Bor use in influenza, corvza, tonsillitis, neuralgia, etc.—L. ib/30, 1382. Quininae Sulphas. Quinine Sulphate (Termed ‘ Basic ’ Quinine Sulphate in Er. Cx.,P. Ital. \. and F.E. VIII.). (C2nH24N202)2.H2S04 + 7HoO = 872-5912. Br. Cx., P. Jap., Ph. Ned. V. and P.G. VI., 8H20. B.P.T4 74H20. U.S. X. ‘ 7 or 8’ H20. B.E. and P. Ital. have 8H20., P. Belg. 7H20. This is the principal quinine salt, it contains 73-5% (B.P. T4-). Dose.—.1 to 5 grains (0-C6 to 0-3 Gm.), tonic ; 5 to 15 grains (0-3 to 1 Gm.), antiperiodic. Slipule No. 0 holds 5 grains. B.E. gives max. dose pro die 2 Gm. White bitter crystals. Soluble 1 in 800 of cold water, 1 in about 100 of 90% alcohol, 1 in 40 of glycerin. It is rendered more soluble by the addition of Antipyrin. Over Dose.—100 grains of Quinine Sulphate taken in one dose in error Hot infusion of coffee gave great relief and holding hands in hot water, 'temporary deafness was caused.—E. T. Jones, L. i./14,277. See also Ill Effects. postea. _ „ Fatal poisoning in child of 21 following ingestion of 26 five-grain tablets (sugar-coated) Quinine Sulphate.— S. G. Wilbmctt, L. ii./3iJ133. Quinine Sulphate stoeage.—Loss of water and consequent increase of alkaloidal content.—C. E. Sage, P.J. ii./27,204. General alkaloidal test suggested by Pharm. Committee for B.P. would result in chaos.—B. F. Howard, P.J. ii./31,49. . Water content varies among the National Pharmacopoeias, v. supra. 1 he Dihydrate containing 4-5 to 4-7% water should be International. B.Eder, P.J. ii./3o,242, It is prescribed in pill, cachet, slipule, tablet or mixture if in mixture 1 minim of Dilute Sulphuric Acid to the grain of salt will render more soluble (with fluorescence). lor pills 1 drop of strong Sulphuric Acid as excipient for 5 grains. In com p a ti hie with alkalis and alkaline carbonates, also incompatible with Liquor Ammonii Acetatis (unless distinctly acid in reaction), iodides, and astringent infusions containing tannin. The addition of a small proportion of sodium hypophosphite may overcome the incompatibility with potassium iodide i.e., the formation of herapathite (quinine iodosulphate).—To prevent coagulation of the precipitate when prescribed with alkalis, mucilage of acacia should be ordered. With Phenol in a pill may liquefy. Flavoring._Glyl Vanillse, Glyl Menthie Piperitse(bold doses); Syr up us Aurantii. Liquid Extract of Yerba Santa in 4 drachm dose, diluted takes away the taste to some extent. Prescribing Note.—To overcome the taste to some extent Mistura Quininse Effervescens, p. 732 is advised. I ses. i or all forms of fevers, and as prophylactic ; wards oh remittent fever. For neuralgia and nervous headache ; it combats whooping cough, influenza (Ammoniated Tincture) and hay fever. It increases uterine action, and is the most used tonic drug ; antiseptic in typhoid, phthisis and pneumonia. Pills of Quinine, Atropine, and Arsenic (q.v.) will frequently stop the development of a 45 cold.” If Quinine dearness occurs, or for large doses, hydrobromic acid should be used. In labyrinthine disorders, it is very uncertain—often intensifying the symptoms. May be administered by Iontophoresis. Quinine afreets metabolism. The total solids excreted by the urine may drop 40% within 24 hours after a single dose. Stipules contain 1, 2, 3, and 5 grains. Klein discovered that quinine is excreted (and therefore presumably absorbed) more slowly when given hypodermically than when given j)er cs. In malaria it is a good plan to give bother os and hypodermically simultaneously, so (hat if rejected by the stomach there will be no loss of time. Children bear quinine well. A child of ten will tolerate an adult dose, a child of five will take 5 grams twice daily, and a child of one year will take 3 grains twice daily without risk. Quinine should be kept up in full doses for about a fortnight alter the fever has ceased, and then continued in doses of 10 grains twice daily on two consecutive days in each week. If the drug is stopped, even after two or three weeks of thorough treatment, relapses are the rule, and it is geneiaiiy only after the occurrence of the relapse that the average hospital patient begins to take seriously the advice to continue the use of the quinine. For Malaria treatment with Quinine, see p. 7 37. Quinine in Various Affections. Anemic Dropsy. Quinine is a reliable diuretic, but does not produce results in healthy or non-cedematous persons—Per Chininum, 206. Bedsores treated by an ointment of Quinine alkaloid 4 grains, Oleic acid i 12 grams, dissolved on a water bath and mixed with Resin Ointment 1 ounce, said to be useful.—Pres., Nov., 1911, p. 2S1. Blacrwater Fever.—No evidence that Quinine administered by any method during an attack increases severity or influences progress of the disease apart from its effects 011 malaria —L. S. Dudgeon, Pr., April, 1921, p. 283. Quinine H^emoolorinuria occurs in people suffering from chronic malarial cachexia, induced by several attacks of malaria, for which Quinine in small, irregular and insufficient doses has been taken. Disease precipitated by taking comparatively large doses of Quinine during an attack of fever. Recovery after stopping all Quinine until hsemoglobinuria disappears, and then giving the drug (bihydrochloride) in small and increasing doses preceded by Calcium Lactate.—N. Cantlie, Jl. Trop. Med., Feb. 1, ’23,40. Common Cold.—The late R. W. Allen considered Quinine a useless drug theoretically. It is only antiseptic in strength of at least 1 in 500 solution, and a few grains daily internally are not likely to reach the nasal mucus to disinfect it. Dyspeptics should not have Quinine. Tablets should be taken with food, and never given to patients on a hydric diet. Case recorded in which 17 tablets of Sulphate of Quinine were emitted in two stools in 48 hours.—R. le Dentu, per Jl. Trop. Med., Nov. 1, ’23,336. Diphtheritic Ophthalmia and all cases of infective and sloughing ulcers of the cornea are treated with 1% solution with the smallest possible quantify of dilute sulphuric acid. Exophthalmic Goitre.—Give 0-8 Gm. Quinine Sulphate in two portions and increase slowly daily for 8 days, then 8 days’ rest and so on until appearance or definite results, when reduce to 3 days a week till cured.—Per Chininum, 204. See also under Quinine Hydrobromide. Influenza.—2 grains every 2 hours gave striking results—also valuable as a prophylactic, 2 grains every 4 hours—H. B. Gladstone, B.M.J. i./29,534. To induce sleep.—Quinine—1 to 2 grains at bedtime stated to have excellent effect (from the ‘ Hospital9).—P.J. ii./is,526. Labour. ‘ Medicinal induction ’ (Castor Oil and Quinine).—2 ozs. of castor oil is given and an hour afterwards A an ounce of a mixture containing quinine sulphate 10 grains, dilute sulphuric acid 10 minims, glycerin 20 minims spirits of chloroform 5 minims, and water to A ounce. One hour after a simple enema is given. Two hours later another dose of the mixture, also three hours later and again after four hours. Forty grains of quinine are used. Greater percentage of successes than with Pituitrin. Less danger with Pituitrin when preceded by Quinine course. Quinine is definitely able to act upon a closed cervix.—K. V. Bailey, B.M.J. i./26,18 ; L. i./26,282. Effect of Quinine on tiie Uterus.—It does not excite the normal pregnant uterus and therefore will not act as abort.ifacicnt in health, but it will excite the uterus in pathological conditions and strengthen uterine contractions in labour.—B.M.J. i./23,156. Stimulant action of Quinine in labour is very small.—A. W. Bourne and J. H. Burn, B.M.J. ii./3o,87. Quinine in norma! labour. A small dose for 3 weeks prior to the date. Quinine Sulphate 1A grains, Dilute Nitro-hydrochloric Acid 3 minims, Syrup Aurant. £ drachm, Water to 2 drachms. Bose.—2 drachms with water thrice daily before meals. Two 8 oz. bottles will carry the patient over the 3 weeks. —D. A. Mitchell, B.M.J. k/30,144. 10 grains Quinine Hydrochloride effectual in late delivery.—B.M.J. i./3o,628. Babies bom dead under Quinine induction.—D. I). Bitchie, B.M.J. i./3o,414. The Medical Faculty of Vienna report that Quinine is not an abortifacient — A. Haberda, Jl. A.M.A. ii./29,163. See also Quinine in Malaria. Pneumonia.—Quinine given in the earliest possible moment very closely approaches a specific. Continuous treatment with small doses every two or three hours. Quinine is inimical to the progress of most acute infections. In the case of pneumonia it acts remarkably in limiting the spread of consolidation and in altering for the better the entire aspect of the disease. Calomel must be given at the outset to cleanse the whole alimentary tract. Sodium Sulphate may be combined with the Quinine.—W. J. J. Arnold, B. M.J. ii./i3,102. Puerperal Septicaemia well treated by internal use of 2 grains every four hours : also used with advantage in perityphlitic abscess, gall bladder abscess and empyema immediately after operation and prior to and alter operations in bone and joint disease.—V. J. Glover, L. i./i7,352. Collunarium Quininae, Quinine Nasal Douche. Quinine Sulphate 1, Water 1000. Used in hay-fever. If a stronger solution he required, use the Acid Sulphate or Hydrochloride of Quinine ; avoid excess of acid. Mistura Chlori ciim Quinina (Burney Yeo). . To Potassium Chlorate, in powder, 30 grains, in a 12-ounce bottle, add Hydrochloric Acid 60 minims ; cork and shake well to liberate chlorine ; absorb this by gradually adding, and shaking after each addition, Distilled Walter q.s. to 11 ounces; add Quinine Sulphate 24 grains (or 36 grains if ordered), Syrup of Orange 1 ounce. Dose.—1 ounce (30 Cc.) every 2, 3, or 4 hours for typhoid ; it quickly cleanses the tongue. Pills and Tablets of 1,2, 3, 4, and 5 grains are prepared. Perles of Quinine Sulphate contain li grains (01 Gm.) in each. H'ffiJ Pilula Quininge Hydrargyri et Opii. Quinine Sulphate 1^ grains, Grey Powder 1 grain, Opium ^ grain Quassia Extract q.s. thrice daily after food. In syphilis Quinine is useful before or after a course of Mercury. Acts beneficially in any septicaunic state with fever, whether due t< gonorrhoea, syphilis, or enteric. Quinine, Opium and Mercury are shee anchors m early syphilis. ® Pllula Quininae Ipecacuanhae et Camphorae. Dose.—One night and morning. Quinine 2 grains. Ipecacuanha J grain, Camphor J grain, Liquid Caibolic Acid ^ minim, have been advocated as preventive of plague. Nim fumigation (burning Azadirachta) also suggested. iP lPulvis Quininge Compositus. Dose.—One powder. Quinine Sulphate 5 grains, Phenacetin 5 grains, Arsenious Acid J-r giain, Nux Vomica Extract ^ grain. Milk Sugar (q.s.) to 12 grains. One powder (or cachet) every four hours till the fever breaks. This is used as a fever remedy in Demerara and is excellent.—Ph. Notes. O PlPulvis Quininse, Arsenii, Hydrargyri et Ipecacuanhae Compositus.—Dose in Cachets.-—One at eleven, another at bedtime. Quinine Hydrochloride 5 to 7 grains, Arsenious Acid 1/36 to 1/24 grain, Compound Ipecacuanha Powder 3 to 4 grains, Calomel 1/10 to 1/6 grain. In chronic malaria with enlarged spleen. Each ingredient serves a useful purpose—-the Mercury for its antiseptic effect, the Arsenic enhances the activity of the Quinine, the Opium, not only from its traditional use in malaria, but also liom the writer s experience is of value as an addition to the prescription — Cantlie. _. * Old English ’ Fever powder. Quinine Bihydrochloride 3 grains, Arsenious Acid 1/36 grain, Compound Soap Pill I grain, Calomel 1/12 grain. Three times daily in a cachet. Malaria well treated. The following daily dose made up in the form of a pill recommended as prophylactic Quinine Bihydrochloride H grain, Arsenious Acid 1/100 grain, Compound Soap Pill 1/10 grain. Calomel 1/25 grain.—Jl. Trop. Med., Aug. 15/22,265. Quinine has taken the place of Opium in the treatment of malaria with poor results—efficacy of the old “ English Fever Pill.” Evils of State interference —Sir J. Cantlie, Jl. Trop. Med., Jan. 15, ’23,30. Mistura Quininae ElTervescens. Quinine has a reputation in colds, but it is best given in effervescence. The following prescription is useful :— Mixture A.—Quinine Sulphate 2|- grains, Citric Acid 10 grains, water to £ ounce. lure B.—Potassium Bicarbonate 10 grains, Ammonium Carbonate grains, Syrup of Orange 1 drachm, water to 1 ounce. One tablespoonful of Mixture (A) with two of Mixture (B) in effervescence thrice daily.—Leonard Williams, per C. A D., June, 1921. Roseberry’s Chlorine Water Mixture (Modified). An infant suffered from vomiting and diarrhoea and was unable to take milk or foods such as Glaxo. The usual antiseptic and astringent infantile powders failed to cure The modified Roseberry’s Mixture containing Quinine Sulphate with Salol 4 grains, Mucilage of Tragacanth q.s., and Chlorine Water to 1 ounce, thrice daily, gave no lasting relief. Rectal Saline was also tried. Finally, as last resource, when the child was not expected to live, weak tea infusion saved its life.—Capt. G. H. Wood, per Jl. Trop. Med., April, 15, ’22,109. Tinctura Quininse ^mmoniata (B.P. ’14). Dose.—J to 1 drachm (2 to 4 Cc.). Quinine Sulphate 2, Alcohol (60%) 90 ; mix and add Solution of Ammonia 10. The Quinine precipitates on adding to water ; a few grains of Tragacanth will suspend the precipitate ; with syrup of orange it is palatable, and bears dilution better; it remains bright if mixed with aerated water. Should be kept in the dark, or it will become discoloured. Ammoniated Quinine Slipules and Tablets are prepared, each equivalent to 1 drachm of the preceding Tincture. Ammoniated Quinine Tablets. Analysts’ findings on trade varieties. Ammonia likely to be lost.—P.J. i./3i,499. Mistura Quininse Composita, L. H. Syn. Broadbent’s Mixture. Dose.—\ ounce (15 Cc.). Ammoniated Tincture of Quinine 1 drachm, Solution of Ammonium Acetate 2 drachms, Compound Tincture of Camphor \ drachm, Ammonium Carbonate 2 grains, Peppermint Water to 4 ounce. Mistura Quminse Ammoniata, St. M.’s H. Dose.-—J to 1 ounce (15 to 30 Cc.). Ammoniated Tincture of Quinine 1 drachm, Solution of Ammonium Acetate 2 drachms, Sodium Nitrite 1 grain, Tragacanth Mucilage 1 drachm, Chloroform water to 1 ounce. Tablets Ammoniated Quinine Compound, each equivalent to Ammon- iateu Tincture of Quinine \ drachm, Capsicum 4, grain, Camphor ,4 grain, Caffeine Citrate i grain, Aloin -40 grain. Serviceable in influenza. Tablets Quinine Acid Sulphate 1 grain with Camphor grain, also this combination CeD with Aconite Tincture 1 minim. [Pli-FllTablets, Quinine, Camphor, Morphine, and Atropine. Camphor | grain, Quinine Sulphate 4 grain, Morphine Sulphate ,3r grain, Atropine Sulphate goVo grain. For common colds, especially where excessive running at eyes and nose. Quininse Sulphas Acidus, Quininse Bisulphas, U.S., Ph. Ned. IV., Ph. Jap. 111. (now omitted), P. Hung. Termed ‘ Neutral ’ in Fr. Cx„ P. Ital. V. and F.E. VIII. C20H24N2O2.H2SO1+7H2O = 548-388. Dose.-—1 to 10 grains (0-06 to 0-6 Gm.). P.E. gives max. dose pro die 2 Gm. Tablets, £, 1, 2, 3, 4 and 5 grains. Usually masses of crystals ; 59 T% of Quinine. Soluble 1 in 10 of water, and is therefore a suitable salt for preparing eye lotions. Three grains to an ounce of water has a specific action on ophthalmic diphtheria. Incompatible with Potassium Iodide. Dispensing Note.—The heating of concentrated solutions is undesirable. The Acid Hydrochloride is best for injections. Cf.,p. 718. Malaria Treatment.—Quinine Bisulphate 4 grains in 20 minims of 0-5% Saline solution subcutaneously once daily for five consecutive daj s m alternate flanks. In addition Arsenious Acid l/20th grain per os and also o giams (only) of Quinine well diluted in the early morning—-continue loi amonth. C. A. Johnston, B.M.J. i./i8,586. We should prejtr the Hydrochloride or Acid Hydrochloride. For Malaria treatment, see also p. 737 Cystitis treated by Quinine Bisulphate 1 in 2,000 as an irrigating solutior Irritation is not noticeable. It will inhibit growth of B. Typhosus in th strength of 1 in30,000.—E. McDonald, Jl. Am.M. A. i./i5,505,per P. J.i./i5,287 Tablets of Quinine Rhubarb Compound, contain Quinine Acic Sulphate I grain, Jalap 1J grains, Calomel 1 grain and Rhubarl 1J grains ; are given to check malarial poisoning. In purulent ophthalmia, hypopyon and keratitis, Guttce containing 3 grains with 12 grains of Boric Acid per ounce are useful. (PjEsanofele.—A proprietary preparation in pill form containing in eacl Quinine Bisulphate 0*09 Gm., Arsenious Acid 0-0009 Gm., Iron Citrate 0-02 Gm., Extract of Bitter Herbs 0-145 Gm. Used in malaria. Bose.—For a child 3 to 6 years: two pills daily preferably in the morning:. e.g., one at 6 and another at 9. For 7 to 14 years two at 6 and two at 9. Fou adult six daily, e.g., two at 5, 8 and 11 a.m. respectively. Fifteen day constitute a course. QuinincS Tannas, Quinine Tannate, P. Jap. (30% Quinine). P Helv. (30—35%), P.G. VI., Ph. Ned. V., P. Ital. V. and P. Dan (30-32%). P. Austr. and P. Hung, give method of making from the sulphate. Dose.—1 to 4 grains (0-06 to 0-25 Gm.). An amorphous yellowish white powder, obtained by the decomposition of the sulphate with a solution of tannin, contains about 30% of Quinine (U.S.> between 30 and 35%) and is slightly soluble in water and about 1 in 3 alcohol 90%. Being almost tasteless it is recommended for children to be given in milk, but the slow dissociation in the intestines may bo a disadvantage. With 1 molecular proportion of Neutral Quinine Sulphate to a little more than 3 of Tannic Acid the precipitation is complete. Tabellce Quinince Tannatis. Contain 1 grain in a chocolate basis. Suitable for children. As a prophylactic to malaria. Have also been given for whooping cough and as a stimulant in entero-colitis in children, and with ergotin for sweating. ®Quinine and Urethane (Hydrochloride). Dose.—\ to 3 grains (0-03 to 0-2 Gm.). Employed hypodermically, as it is non-irritating. Obtained by heating Quinine Hydrochloride 3 with Urethane 15 and Water 3 parts. For details of Urethane, see p. 818. Malarial Coma.—The only treatment found of value was Quinine Hydrochloride 0-4 Gm. with Urethane 0-2 Gm. in 15 Cc. Normal Saline intravenously ; also valuable for persistent fever and chronic forms of malaria. Painless. Intramuscularly not advised.—Richet and W. B. Griffin, B.M.J. i./i7,190. Malarial Anemia.—The following was useful in Salonika during the war : Quinine Bihydrochloride 0-8 Gm., Urethane 0-4 Gm., Distilled Water 2 Cc. Intramuscularly in gluteal region. In infants intramuscular injection of 0-05 Gin. Quinine Formate daily, and later every other day, for 8 to 10 injections.—Leon Tixier, per Chininum, 127,129. Lobar Pneumonia.—Intramuscular injections of 5 Cc. of a solution of Quinine Hydrochloride 0-5, Urethane 0-25, and Water 5-0, of value; repeat in 24 hours and again in 48 hours if necessary.—Per Chininum, 178. Varicose Vein injection. The Quinine-CJrethane method was originally popularised by Genevrier in Trance. The injection contains Quinine Hydrochloride 4 Gm., Urethane 2 Gm. in Distilled Water 30 Cc. The solution can be ooiied and is strongly antiseptic. Crystallises out when cool but redissolves on immersing in hot water for a few seconds. Initial injection \ Cc., and subsequently 2 to 3 Cc. Injections may be given with the patient sitting or lying down (v. R. Payne, postea)— in the latter case, a pneumatic tourniquet is applied to the middle of the thigh before the patient lies down. Clean the skin with Ether and introduce needle of syringe not quite filled with solution into the lowest segment of the vein, the skin overlying the vein being drawn aside before introducing the needle. Withdraw the piston slightly and allow blood to flow into the barrel before any fluid is introduced. Inject j to 4 Cc. according to size of vein and hold needle in position for 30 seconds before withdrawal. Press a pledget of wool on puncture and repeat the process 4 inches up the limb. When the total number of injections has been given clean with Ether and seal punctures with Collodion dressings. Sittings are given at weekly intervals, 6 sittings usually sufficing. Injections may be successfully given, without fear, in the region of the saphenous opening. Aftereffects. Patients should be told that small and thin-walled veins will swell up rapidly to four times their original size. The swelling passes off in a few hours and is of no importance. Sensations of fullness, aching, or tenderness sometimes occur lasting three or four days; a feeling of contraction of the leg following one month after obliteration of the internal saphenous vein passes in a few weeks. QjJdema of foot and leg occurs in about 2% of cases from 5 to 7 days after injection, persisting for some two weeks. Itching of the overlying shin (following treatment by any sclerosing solution) is relieved by application of Ichthyol and Lassar’s Paste.—A. H. Douthwaite, ‘ The Injection Treatment of Varicose Veins ’ (H. K. Lewis), 5th Edition, 1929. Over 6,000 injections, given without the production of embolic mishap, are sufficient testimony to the safety of one of the greatest additions to modem therapeutics.—A. H. Douthwaite, ibid. This procedure has been chiefly used at Bart’s. Injections of 2 Cc. can generally be relied on to thrombose 5-6 inches of a vein. Injections are needed at approximately 4-5 inches along the course of a vein. In this way the whole saphenous tract may be treated to within about 4 inches of the saphenous opening. Contraindications 2 .Deep thrombosis, acute pinebitis, mtra- abdominal tumours, cardio-vascular disease, skin diseases, pregnancy. Inc injection should not be given during menstruation.—-It. I. Payne, L. , u./29,dld. Quinine-Urethane is painless at the time, but followed m 2 or 3 days by thickening along the vein.—Alan Perry, L. 91/29,901. . 4. Quinine-Urethane given hot!—about 200 I., by warming m hot water. Enhances the action.—P. Reynolds, B.M.J. ii./3o>268. May cause cramp 5 or 6 hours after. Clot remains red and painful foi 6 weeks. With thin-walled veins action severe. D. Levi, L ii./3°»16. Quinine-Urethane the most satisfactory for veins. Patien never allowed to stand during injection9 a toumique being used and released when needle is in lumen of the vein and before th* injection.—Reginald Payne (St. Bart’s.), B.M.J. i./32,237. Varicocele successfully treated by Quinine-Urethane injection (Douth waite’s formula)—one injection of 1 Cc.—H. M. Hanschell, B.M.J. ii./28,915 Angioma of the loiver lip treated by 14 injections over 6 months, com mencing with 0-5 and increasing to 1 Cc. Injections through sound skir near margin of tumour. Treatment painless.—Graham, Jl. R.A.M.C., April 1930. Hydrocele of the tunica vaginalis treated by injection of Quinine- Urethane solution 2 Cc. without pain or discomfort.—F. C. Pybus,.B.M.J i./3o,239. Haemorrhoids treated with Quinine Hydrochloride 0-8 Gm., Urethane 0-4 Gm. in Normal Saline 2 Cc.—Bellot, L. i./2g,1072. Good results by injection of 3 to 5 Cc. 5% solution perivenously (into the submucous tissue round the piles), repeating the injection at weekly intervals on opposite sides.—A. H. Douthwaite, ‘ The Injection Treatment oi Varicose Veins’ (H. K. Lewis), 5th Edn., 1929. Perivenous Administration. The needle is first introduced into the lumen of the vein and then withdrawn until its point is felt to slip out of its wall into the adjacent tissues, when 2 minims of solution are injected. There is immediate but transient pain and subsequent swelling, redness, tenderness and local oedema, usually passing off within a week. This method is rarely necessary, but of value in dealing with large isolated dilatations. It should never be made with solutions other than those of Quinine.—A. H. Douthwaite ‘ The Injection Treatment of Varicose Veins ’ (H. K. Lewis), 5th Edn., 1929. Varicose ulcers well treated, with Zinc Gelatin ’in addition.—R. Gibson and A. B. Somerford, B.M.J. i./28,978. Cp) Quinine and Urethane Sterules, 2 Cc. for Varicose Veins, are prepared. CE> Solutio Quininac et Urethani (for varicose veins), St. Til. H. Dose.—5 Cc. intravenously. Quinine Hydrochloride 5% and Urethane 2.V% in Distilled Water. See also Sodium Morrhuate, Sodium Salicylate, Sodium Chloride, Glucose and Therap. Judea'. Quininse Valerianas. ‘Basic’ Quinine Valerianate, Er. Cx., P. Ital. IV. C20H24N2O2,C4H3.COOH=426-2814. Dose.—1 to 4 grains (0-06 to 0*25 Gm.). White crystals, or powder with slight valerianic odour, contains 76% of Quinine, soluble 1 in 80 to 90 of cold water. Pills containing 1 grain each of the Valerianates of Quinine, Iron, and Zinc. For nervous headache and hysteria. For treating paroxysmal sneezing, H. Tilley finds these useful. (©Capsulae Valerianatum Composite. Form I. j)ose.—One thrice daily. Valerianates of Quinine, Iron and Zinc 1 grain each Nux Vomica Extract J grain, with or without Cascara Extract 1 grain. Taste and odour covered with Saccharin and Mint. Total weight of Capsule 10 grains. Nervine tonic. [ElCapsulae Valerianae Compositae, Form II. Lose— One after meals thrice daily. Valerian Extract 2 grains, Phenol 2 grains, Strychnine Hydrochloride l/40th grain, Codeine 1 grain, Rhubarb Extract 1* grains. Total weight of Capsule 10 grains. Tonic, antiseptic and nerve sedative for use in dyspepsia.—G. Rankin, B.M.J. i./i5,1036. Quinine Eihylcarbonate. p. Jap., p. Heiv., u.s. x., Ph. Ned. v., F. E. VIII., P. Belg. IV., P. ital. V. Syn. #Euqttinine (T.M. 317242), C„H 0.C0 OC H 1ST O PaGmtffl 1 370° (18/12 ^5 fnd.C20 29 . f18 9gpublic property? German 585068 (1897b ^^.^al^A^toclUnf3^10n °f 123748 (30/1/00)- U‘S* Patent ]Jose.~3 to 15 grains (0*2 to I Gm.) in cachet. F.E. gives max. dose pro die 4 Gm. Manufacture.—By action of Ethyl Chiorocarbonate (B.pt. 94° C ) on Quinine. Notes on, see Edn. NIX, p. 741. v p ' ^®®dle crystals, M.pt. 89 to 91° C., with little taste, sparingly soluble in water, more so by addition of dilute acid; easily soluble in alcohol. Intended to replace quinine. Tablets contain 8 grains Whooping Cough has been treated with it. Other salts of Quinine in occasional demand are the Hydro- cliloro-sulphate, lodate and Suiphocarbolate. Aristoquiniae. Syn. jJcAristochin. (T.M. 322521). CnmiNUM Carbonicum, P. Ital. V„ Ph. Ned. V. . P9^20fdai5^,^a^2 = ^41^45-^4P5 = 674-3908. The carbonic ester of quinine 15 ArP0 ^asteless powder containing 96-1% of quinine. Dose.—1 to 10 grains (0 06 to 0-6 Gm.) according to age. Obtained by heating Quinine with Phenyl Carbonate. Further data on manufacture and Patents, see Edn. XVIII, p. 729 and XIX, p. 742. Insoluble in water. Given for malaria, typhoid, influenza, and in small doses for pertussis. tncomvatgib/e with Acids and Alkalis. Analysis. The compound should be free from Chlorine. A commercial sample contained 6-9%.—L. ii./2i,400. Quinoidine. —Dose.—2 to 4 grains (0*12 to 0*25 Gm.) thrice daily. The name given to a mixture of alkaloids (discovered by Seturner, 1830) 111 the mother liquor after the crystalline alkaloids have been separated. It occurs generally as a dark treacly compound or as a hard mass. ■i. if ^ie^e substances being amorphous and hence, perhaps,more readily absorbed, it has been suggested are of greater value than the Sulphate and Hydrochloride of Quiume. Benign tertian cases required 9 to 131 grains of Quinoidine to stop fever; Malignant tertians required an average quantity of 10 to 16 and Quartan cases an average of 22 to 24 grains. [pLaverain Tablets. Dose.—Up to 6 or 12 during the day. Contain Quinoidine 2 grains, Ammonium Picrate 4 grain, and Arsenious Acid 100 grain. The Picrate is employed asan anti-malarial drug in addition to the quinoidine. The Arsenic acts as tonic. The preparation is said to be prompt m reducing malarial fever, and specific for the malarial parasite—good in prophylaxis. A preliminary purge to be given (Calomel and Soda) washed down with Mistura Alba. Maj. Waters, Ind. Med. Gaz., 1916. See also D. G. Marshall, L. ii./i8,417. Quinine Salts in Malaria. For the Etiology of Malaria and a Classification of the Parasites, see Vol. II. According to the theory elaborated by Sir R. Ross and D. Thomson parasites continue to breed in the blood by the known method from the moment of infection until the last of them has died out. The number of parasites in high fever runs from 5,000 to 300,000 per cub. mm. of blood. Even if there were originally 1 parasite per cub. mm. it would mean 3,000,000 in the body. Unfavorable Vol. I. A A climate, fatigue, etc., tend to precipitate relapses in malaria. Wlr the infection continues there is a constant struggle with varyii fortune between the invaders and the opposing forces. Accordit to Lipkin, Quinine is concentrated in the suprarenals, kidneys ar spleen ; cast out quickly from the lymphatic glands and the blooo and destroyed by the liver and muscles. Large numbers of tl plasmodia are hence likely to escape any dose we can give. Tl lost plasmodium must be destroyed. Anything under 6 grains a week appears useless in the large majarit of cases and anything over 15 grains daily seems only 1 be required when there is fever, and say, for a week or for night afterwards, followed by 10 or 15 grains daily for months. T& grains daily carried out rigorously for 3 months (84 days) is sufficie in the majority of cases.—Sir Ronald Ross, B.M.J. ii./2i,l et seq. Oral Use. The following routine treatment of malaria has given good result t the average length of treatment being 7 days :— I. Alkaline Mixture (Sinton) (for adult) Sodium Bicarbonate 60 gr Sodium Citrate 40 gr., Water to 1 oz. II. Quinine Mixture (Sinton) (for adult) Quinine Sulphate 10 gr., Citrfl Acid 30 gr., Magnesium Sulphate 60 gr., Water to 1 oz. On the first day 4 doses of I and 2 of II, the latter 15 minute | after the former : for next 4 days 3 doses of I followed after 1 minutes by 3 doses of II : and for next 2 days 2 doses of I followe by 2 doses of II, a total amount of 180 grains Quinine Sulphate i solution being taken.—K. V. Raju, I.M.G., May, ’25,212. Quinine said to act better in treatment of malaria when given in a alkaline medium. Arguments have been brought forward to sho that malaria is an acidosis—results of experiments.—Maj. J. A. Sinton, J Trop. Med., April 2, ’23,116. See also * Alkaloidal Notes’ and Quinim Mannitol. Optimum daily dose 30 grains—should cut short attack in week.—J. A. Sinton, B.M.J.E. i./31,78. The International Heath Board, U.S.A. made a vast malarial survey i one of the counties of the State of Mississippi. Over 30,000 people wer examined and the conclusion was that Quinine will cure all cases of malaria) fever if it is given in the right doses for a sufficiently long period. Based o these results, the National Malarial Committee of the TJ.S. Public Healt Service adopted what is known as the standard treatment for malaria in tb U.S.A. In the leallet on the Standard Treatment it is stated that, to b most effective, Quinine should be taken one dose (10 grains for a person c 15 years or older), every night before retiring, for eight weeks without intermissict If a person is ill with acute malaria he should take the dose according to hi age about three times each day for not less than three days. This will sto the fever or chills and fever. He should then take one dose every night fa eight weeks to get the malaria out of his system. Said to be 100% efficient.— See also C. C. Bass, N.Y. Med. Jl., June 20, 1923, per Jl. Trop. Med., Aug. IE ’23,270. Given in 10-grain doses 2 hours before the expected rigor, paroxysm, or accessic of pyrexia, followed by 5 or 10 grains in 4 hours, the attack can be overcome i 3 days. The treatment must be continued 8 or 10 days in 9 or 15 grain dose daily. This suffices in the majority of cases, both as curative and prophylactic —Catholic Medical Guardian. Quinine by the mouth is absorbed into the system in about half the time i: which it is absorbed from an intramuscular injection.—A. E. Horn, Int. Coni Trop. Am., ’24,560. Malaria control on a large scale is easily effected by use per os—not inferio to other modes.—J. W. Van der Spek, Chininum, 51. soSS ttr»lT 0S> 1%^ ^ °f Quini-- (H^Kd^ 4/ounces ot water. Continue for two" months^ Stone Dteon^B M.j! Quinine in combination with Arsenic, in the treatment of chronic forms of hSiff1-!?’ ir^ileneitic.len^ than Quinine alone. Methylene Blue used in combination with Quinine m cases of quartan fever which do not react to Quimne alone-R, N Chopra per Jl. Trop. Med., Feb. 15, ’23,69. M° bub tertian Cerebral Malaria treated with Quinine and Galyl—the quinine f.er os ^grains thrice daily) and intravenously (0-8 Gm.) over a period of time and the galyl (0 - G111. to 0-4 Gm.) subsequently intravenously —A \Y Falconer and A. G. Anderson, L. ii./i7,486. *’ ‘ vv‘ Malaria in the Saloniea Army. Quinine per os, e.g., the sulphate, found preferable to intravenous use—the intravenous method produces the shortest ?iUnn9n+e« system. Intramuscularly in oil gives the longest retention. Arrhenal 0-2 to 0-3 Gm on two successive days, alternating with two davs of treatment with 2 Gm. of Quinine.—L. ii./i7,358. It was found in a case of idiosyncrasy that Cinchonine base q.v. was better tolerated than Quinine Acid Hydrochloride. A \yriter deplores fetish ’ of giant doses to reduce high temperature in malaria. Cinchona preferable to Quinine. In hyperpyrexia use of anti- pyretics such as Aspirin, Antipyrin, etc., until moderate temperature attained when Qumme may be resumed.—Jl. Trop. Med., Aug. 15, ’22,266. 8ubtertian infection and benign tertian the most generally distributed_ quartan the least. The first the most amenable to Quinine. Begin with 1,) giams pei os, increased daily to 30 grains. Neosalvarsan given as adjuvant. Arsenic and Iron injections more advisable than drenching with Quinine — P. Manson Bahr, B.M.J. i./3i,23: L. i./31,843. Malaria control in Italy.—L. W. Hackett, Trans. Boy. Soc. Trop Med April 25, ’2g,477. ’* See also Quinidine, Cinchona Febrifuge, p. 713 and Quinoidine p. 737. Intravenous Injection (Quinine Acid Hydrochloride )• For details of doses and strengths of injections, see p. 724. Malaria in Macedonia.-—The first essential was found to be an initial dose of calomel, followed if necessary by a saline aperient. Moderate cases received^ Quinine Sulphate 45 grains (the supplies of Hydrochloride being short) divided into 3 equal doses, for at least 3 days and longer if pyrexia persisted. 30 grain doses then continued. In more severe cases 60 grains p.d. per os were given, or in part intramuscularly. In cases of persistent vomiting or marked digestive disturbance oral quinine is either rejected or remains largely unabsorbed, and the advantages of the intramuscular method are very great. It was found convenient in these cases to give two intramuscular injections, each of 20 grains, one in the morning, the other in the evening, supplemented by 20 grains of the bihydrochloride by mouth in the course of the day. As soon as the severer symptoms were under control oral administration of quinine was resumed. On the earliest appearance of cerebral symptoms 10 g/rains of the Acid Hydrochloride intravenously in 20 Cc. of diluent saved many lives—A. G. Phear, L. i./2o,195. There is no decisive experimental proof of the superiority of injections nf Quinine.—Sir. B, Boss, B.M.J. i,/2o,130, VOL. I, A. A 2 Malaria is not more readily cured by intravenous medication. 90% of t Quinine injected intravenously disappears from the blood within one mini and is stored in the tissues, but intravenous medication will always have a m<r or less restricted field of usefulness.—B.M.J.E. ii./22,33. Observations on 1314 cases of malaria by intravenous injection of Quini —Capt. N. Cantlie and El Sach Yusef Effendi Moubarak, Jl. Trop. Me Feb. 15/24,38. Quinine intravenously 4 to 1 Gm., in 40—50 Cc. Saline, 2 to 10 times dai gave good results in 164 cases of malaria; no general or local reactions complications.—Med. Sci., July, ’25,266, per Pres., Jan., ’26,28. Quinine Bihydrochloride efficacious intravenously in acute and chro: malaria, and in cases in which malaria complicates other diseases: also ue in pneumonia and septicaemia with success.—B. Rattan, B.M.J. ii./2 7,39. Intravenously in chronic malaria. Violent and excruciatingly pain reactions, but of great efficacy.—Pierre Millous, per Chininum, 102. Quinine intravenously is no better than by any other method and has maa disadvantages (thrombo-phlebitis, cinchonism): reserve for severe attacks. J. W. Van der Spek, Chininum, 50. Cerebral malaria well treated by Quinine intravenously-—0-5 Gm. the Bihydroclioride in 10 Cc. of water slowly injected—followed by cisteri puncture—W. Cordes, U.E.C., ’25,199. Pernicious malaria well treated with intravenous injection of Quin! Bihydrochloride 5 gr. in 20 Cc. Normal Saline with 10 m. Adrenalin Chlors solution.-—K. N. Chatterji, I.M.G., Dec., ’2 5,584. Experiments in animals (sheep) indicated that Quinine Sulphate suspend in oil was weight for weight about 2*6 times less toxic than an aqueous soluti of Quinine Bihydrochloride, when both were injected intravenously.—J. Shircore and co-workers, Dar-es-Salaam, 1927. Intramuscular Injection of Quinine Salts. Hundreds of intramuscular injections of Quinine given over period of 19 years without a single distressing result. Injection always given in the gluteal region, choosing the highest point whe the muscle is deep enough to sink the needle in—not the ordinal short hypodermic needle, but one long enough to make sure of givir the injection well into the muscle. Injections should never be give into the arm.—R. A. Murphy, I.M.G., Jan., *25,48. Intramuscular injection efficient and practical—danger of necrosis insigni cant. Only the more soluble salts of value.—N. P. Macphail, Int. Coi Trop. Am., ’24,95. In the discussion which followed, C. C. Bass consider*1 Quinine hypodermically or intramuscularly had no place in treatment malaria and was a ‘ formidable procedure.’ General trend of opinion, howeve in favour of Macphail’s views, with the reservation that intramuscularly should be used only as a last resort in comatose or dangerous cases. Sir Rogers advocated use of Cinchonine in placebf Quinine—more rapidly absorbe less pain and no induration. Muscular necrosis an invariable occurrence with intramuscuia administration of Quinine in malaria. Damage is intensified, in case alkaloid, by use of solvents such as Ether, Alcohol, Olive Oil or Creosote, ar natural fat. Necrosis evident one hour after injection in man, and with ten minutes in animals.—Jl. Trop. Med., Jan. 1, ’23,12. Intramuscular use of Quinine Salts was condemned by the Medical Servi of the E.A.E.E.—A. R. Balmain, B.M.J. i./2o,381. Necrosis of muscle caused by Quinine injections into the buttocks—it w not possible to determine form of Quinine.—P. Figdor and D. D. Pinnot B.M.J. ii./22,14. Quinine Bihydrochloride exerts its influence on the tissues in two ways- (a) presence of the acid radical causes irritation, cedent and pain, (b) the base, acting as a protoplasmic poison, causes death of t surrounding tissues. The salts of the four main alkaloids of the Cinchona ba all cause oedema, irritation and necrosis.—H. W. Acton and R. N. Cliopr Ind. Jl. Med. Res., Oct., ’24,251; B.M.J.E. h/25,60. of alkai01(}al salts of Quinine should be considered coa^enfraS i i 9 non ^ Vvllve .ia presence of these bases at a high S??rn?«£ ’ Aro! L-Ji00? aad thc™ 1S danger of tetanus with imperfect o 1 !^frfa 1(f9k a* m1etk°d the only method of administering Cinchona t^Ia^cly 111 grav,e ca^3> e.q., cerebral malaria, Quinine Base should be injected intravenously.—H. W. Acton and R. X. Chopra, Ind. J Mac^uteS 1^7,1289’. *4 1 Per JL Tr°P- Med- JaIL 15> ’23>32' Ste aUo . Quinine intramuscularly readies the blood only a little at a time, whereas PoHclin?coSFeblt16rei9i98 th° parasites in maximum strength.—Xicotra, Subcutaneous Injection of Quinine finds few advocates. A single drop getting into the skin produces necrosis. Weak solutions, mixed with Urethane recommended.—J. W. Van der Spek, Chininum, 50. Tetanus from Quinine injections.—Remember that in sterilising a syringe cold Alcohol does not kill spores, neither does boiling water, nor boiling oil. To kill spores the syringe must be boiled in 5% Phenol for 10 minutes, or be autoclaved.—S. H. Daukes, M.P.C., Dec., ’29. Absorption and Excretion of Quinine— See also expts. byM. Xierenstem, B.M.J. 1./18,428 ; L. i./n,1221. Estimation of Quinine in (hioocS. — An accurate method ^iaborated by E. B. Vedder and Z. M. Masen is described in the Am. Jl. Trop. Med,, \ ol. XI, Xo, 3, p. 217. According to Acton and Chopra, a concentration of 1/150,000 is necessary for direct parasiticidal action, which corresponds to 6-7 mgr. per litre—a concentration of 10 mgr. per litre is regarded as the toxic limit for man.—Jl. Trop. Med., Oct. 15, ’31,350. Malarial Helapses, The best for old cases was a system carried out by M. Harrison m an Investigation of Treatment mi der direction of Sir Ronald Ross. It was used on 49 chronic cases, mostly of benign tertian. Only 10-2% relapsed. Fever was reduced in 12 to 24 hours, and no asexual parasites could be found after 48 hours. Patient to remain in bed 12 days (this period may be reduced) and to receive intramuscularly in each deltoid muscle 15 grains of bi-hydrochloride daily with 10 grains of Quinine Hydrochloride in Mixture Xo. 1 (infra) thrice daily, totalling 60 grains of Quinine daily for the 12 days. Patient is then allowed up and receives for three days Mixture Xo. 2 four times a day (60 grains of Quinine daily by the mouth). Patient is then put on Mixture Xo. 3 four times daily for 14 days (20 grains of Quinine daily). Light work allowed. Anticachexia Mixture No. 1. For a dose after food :— Quinine Hydrochloride 10 grains. Tincture of Ferric Chloride 5 minims, Solution of Strychnine Hydrochloride 5 minims, Hydrochloric Solution of Arsenic 5 minims, Dilute Xitro-Hydrochloric Acid 5 minims, Magnesium Sulphate £ drachm, Syrup of Tolu | drachm, Glycerin 10 minims, Water to 1 ounce. Anticachexia Mixture No. 2. As Xo. 1, but add Quinine Hydrochloride 5 grains and Dilute Xitro-Hydro- chloric Acid 5 minims to the dose. Anticachexia Mixture No. 3. As Xo. 1, but reduce the Quinine Hydrochloride 5 grains and Dilute Xitro- Hydrochloric Acid 5 minims in each dose.—B.M.J. i./i8,428. In the majority of relapsing cases, Quinine ioer os is adequate—■ 20 grains either daily or twice weekly during stay in hospital. Where this is inadequate combined oral and intramuscular administration (60 grains daily for 4 days).—E. B. Gunson and co-workers, L. i./i8,866; W. Fletcher, L. ii./i 8,432. In * anti-relapse quinine prophylaxis' a short intensive treatment, e.g., up to 180 grains of sulphate or hydrochloride in 3 days, effects cure in a substantial proportion of cases.—L. i./i8,301. Relapses can be cut short by Quinine Sulphate in solution 10 grains three times a day for a week. After the week give 10 grains regularly once a day.— Sir Ronald Ross, per T. H. Jamieson, B.M.J. i./io,739. Prophylactic Use. Prevention. It has been proved by Warrington Yorke, S. B James and others, that Quinine given to a patient just previously t his being bitten by infected mosquitoes is of no avail in preventin or delaying the onset of the attack. It is important to know whether other remedies may be effective in this way. On the first clay of the month give a dose of Calomel and after the bowe are well cleared, 15 grains of Sulphate in dilute acid after a good meal. Repea this on the 15th of the month. Pay attention to bowels at all times.—P Yeates, B.M.J. i./i8,603. The only prophylactic for troops is 1/20 grain Arsenious Acid daily. Quiniii is curative only.—C. A. Johnston, B.M.J. i./i8,586. Thorough treatment ranging from 5 to 10 grains on two successive daj per week up to 20 grains daily, failed to prevent incidence of malaria in Salonie in 1916-17. It was estimated that at ieast 80 to 90% cf units weie infectrr The prophylactic quinine was dropped in 1918 as no dose that could be tolerate- had any protective value to troops exposed under campaigning conditions.— G. T. Rawnsley, B.M.J. i./i9,501. Quinine prophylaxis is a so-called preventive measure. The late J. ( Me Walter at the Cambridge B.M.A. Meeting, 1920, exploded the doctrine tlia Quinine prevented malaria. Capt. Cecil Alport in “ Malaria and Its Treatment shows that the treatment at Salonika was a colossal and expensive failure, jt, good mosquito net is the best preventive. The difficulty of getting natives to take Quinine prophylactically, or after discharge from hospital, overcome by issuing pink sugar-coated tablets, calle ‘ Pink Tonic Tablets,’ containing Quinine 2 grains, Reduced Iron £ grail Arsenious Acid 1/50 grain, Extract Nux Vomica i grain. Effects beneficia and tablets readily taken.—U.E.C., '25,112. /Vo genera! rule can be prescribed for Quinine pro phySaxis.—Can only be decided for each individual, or body of individuals when all circumstances relative to malaria in the particular place are knowi The investigations of several workers to solve the question, “Must a ma; coming home from the tropics continue to take Quinine ? ’’—the answer 2 “ Yes.’’ A study of induced malaria—Lt. Col. S. P. James, T.R.S.T.M. Mar. 13, ’31,477. Malaria during Pregnancy. Experiments showed that Quinine in certain concentrations causes cor traction of both the longitudinal and circular fibres of the uterus. 1 in 300,00 has no effect, lin 44,000 produces a tonic spasm which, if sustained, woul cause asphyxia of the foetus from constrictions of the placental sinus. _ lh concentration could only occur if the patient was nearly poisoned with Quinine Therapeutically, as soon as malaria is diagnosed, which is a matter o urgency in pregnancy, give Quinine or Quinidine at once. Divide dosage int 2£ or 5 grain doses every 2 or 4 hours.—H. W. Acton, L. i./2i,21(j. The treatment of malaria in pregnant women.—J. Dhairyam, I.M.G April,’25,165. , . , . ~ Heavy doses of Quinine given in malaria during pregnancy, e.g., 10 On (per os and intramuscularly) in 7 days, and 31 Gm. in 17 days. Children boi alive and well.—Adam, per Chininum, 134. The ecbolic action of Quinine is negligible during the early months of preg nancy, and in the later stages it may be combined with an opiate. Quiniri treatment should be instituted in all pregnant malaria patients. I er Pres Nov.,’ 28,373. Malaria in England. 011 at Woi Ratal cases of acstivo-autumnal malarial fever m England.—A. J. nai E. H. Williams and J. S. C. Douglas, L. i./i8,734. .. Treatment in England. Discussion of Qumme Dosage.—B.M.J. 11./19,744 see also Sir W. H. YVillcox, ibid., 796 and L. u./i9,U05 ; Sir It. Ross, 863 T. H. Jamieson, L. ii./i9,266 : S. P. James, ibid., 1016. Antimalarial measures in England. Dangerous areas and Quinine pic phvlaxis.—A. Macdonald, B.M.J i./19,669. . . , oic Anopheline Mosquitoes in Great Britain. Three species of Anophele- indigenous in Great Britain. Of these, two—A. Macuhpenms and A. Bifurcatu —are known to be malaria carriers, but in view of relative infrequency an. Q many other factors, can hardly be viewed as a source of danger in spreading ma.ana.—B.M.J. ii./i8,63. See also L. ii./i8,151 and B.M.A. Discussion, B.M.J. i./i9,490. ’ Fatal case of malignant tertian malaria contracted in North of England.— E E.Giynnand J.C Matthews, B.M.J. ii./2o,811,871,T.D.B., Vol. 17,1921,136. i n England, Anopheles mosquito is not a danger, thanks to efficient sanitary service. Malaria used to be quite common in this country—A. W. Alcock, L. m/25,34. _ 5 Benign tertian malaria in Romney Marshes in the past. Ague never seen now—due no doubt to Quinine introduction. Opium was also consumed. Bum Lodly (Laudanum) asked for in grocer’s shop.—F. William Cock, B.M.J. !./3L.42. British mosquitoes. Culex pipiens and Theobaldia annulata common in all parts, the latter a fierce and poisonous biter.—J. F. Marshall, Hayling Island, L. i./3o,1372. Mosquito control in England.—L. 0/31,821. General References to Malaria. Malarial Commission, league of Nations, Conclusions. The thirtieth anniversary of the discovery by Sir Ronald Ross that. Anopheles mosquitoes are hosts and carriers of the malarial parasite. One of the most important conclusions is that anti-malarial measures should be limited to reduce severity and as far as possible incidence. Quinine is not an effective prophylactic for new infections and relapses. The killing of adult Anopheles important and should be urged by educational propaganda.—Lt.-Col. S. P. James, Adviser on Trop. Dis., Min. of Health, B.M.J. ii./27,340. Malarial fever is the principal and gigantic ally of barbarism. What we call the Dark Continent should be called the Malarious Continent, and for centuries successive waves of civilisation have broken themselves in vain upon its shores.—Sir Ronald Ross, Cbininum, 20. The anti-malarial campaign during recent years—with specimens of pictorial posters as used in India, U.S.A., Dutch East Indies, Algeria, France, Roumania and Russia.—J. W. Van der Spek, Chininum, 145—172. Italy 40 years ago formed one immense focus of malaria, but owing to continued efforts the officially infected zones now only occupy one-third of total In the last resort, it is the well-being of the population which results in the transformation and disappearance of malaria.—L. Raynaud, per Chininum, 56. Dr. Andrew Balfour estimated the direct annual cost of sickness and death attributable to malaria in the Empire at 250,000,000 dollars to 300,000,000 dollars, and the annual world death-roll at 2,000,000.-11. A.M.A. ii./25,1571. Report of the Malarial Research Unit in Palestine.—JJ. A.M.A. ii./25,1084. Malaria in Europe.—L. iL/25,25. Expenditure on mosquito eradication in many parts of the world has been more than justified, and of economic value.—J. T. Clarke, B.M.J. i./3o,840. AntimaSariaB action of drugs can be estimated experimentally on animals.—G. M. Findlay, B.M.J. ii./3o,783. Ross last. Kept., 1929.—Malarial districts—Assam, India, Ceylon—need special knowledge for control of the problem locally. Rubber growers, tea- planters, gold and tin mining companies, advised to send men to the Ross Institute for instruction.—Sir Malcolm Watson. Ross Inst. Rept., 1930.—The fifth annual report records the work of SirR. Ross and staff. Sir A. Castellani has continued his researches on fungi and fungal diseases and others have contributed valuable research work on tropical diseases—malaria in particular. The report details the findings of the Ross Malaria Expedition of 1928-29 in India and Burma, and gives maps, statistics, and a list of publications of interest and importance. Ill Effects from Quinine. Quinine Amblyopia.—12 5-grain tablets of Quinine caused giddiness, nausea, vomiting and loss of sight within three hours. Recovery under Amyl Nitrite inhalation and Sodium Nitrite in 2 grain doses.—II. and R. Gainsborough, per Pres., Feb., ’23,75. Quinine Hvdrochloride, 39 grains in a malaria patient, caused severe vomiting, deafness and dilation of pupils. Total blindness for 7 weeks, after which vision was restored for 2 months, permanent blindness supervening Possibly due to the effects of Alcohol and tobacco on the nerve fibres and ganglion cells.—J. S. Du Toit, per T.D.B. 19/22,710. Quinine blindness caused by 20 Gm. Stomach lavage, enema ta, etc Central vision reappeared after 15 days, but peripheral vision'and vision fc colours returned more slowly.'—Pres., Jan., 1913,203. GO grains of quinine in hot whisky and water caused delirium and collaps* An enema of hot coffee, strychnine and digitalin hypodermically, and he bottles produced rapid improvement. The quinine acted as depressant t the respiratory and cardiac systems.—H. Gooch, B.M.J. ii./26,115. Deafness.—All perception of light lost and deafness caused by quinin sulphate 30 grains, lasting for months.—P. C. Plummer, B.M.J. ii./25,1062. Quinine over lengthy periods will produce deafness.—A. S. Gubb, B.M.J. i. /2o,131. Death from 48 5-grain Quinine Bisulphate Tablets.—H. M. Raven, B.M.t ii. /27,59. Urticaria following Quinine treatment of maiaria. One cured by injection of Adrenalin and the other by Calcium Lactate jper os.-—Maj. T. A. Hughes I.M.G., Jan., ’26,7. Acute cinchonism produced by Quinine Sulphate ; 200 grains taken durin 72 hours, together with a like amount of Potassium Bromide.-—G. P. Adsheac Jl. R.N.M.S., April,’26,145. Further on Quinine from, various aspects, see Vol. II., q.v. alsofo Malarial Parasites. Induced Malaria for G.P.I., see Paralysis—| Therapeutic Index, this Volume. ^Plasmoquine (T.M. 474634) Simplex. Syn. :£PLASHM0CHir| (T.M. 466698) Beprochin. C,9H29ON8 — 315-2502. A11 Alkyl-aminoqumoline derivative. Slightly soluble in water! The use of this drug in malaria has been a process of development 1 Eor a number of expressions of opinion, 1927-28, see Edn. XIX. 1 p. 750. The following are recent statements arranged chronologically.— I Plasmoquine is discontinued in favour of :— Plasmoquine Compound. Syn. BEPROCHIN COMPOUND. Tablets contain 0*01 Gm. Plasmoquine and 0T25 Gm. Quinine Sulphate. The following scheme of dosage and treatment is now advised 1st week, 7 days 2 tablets thrice daily (0-06 Gm. Plasmoquine, plm: 0-75 Gm. Quinine thrice daily) : then a further 4 weeks' treatment (with 4 days’ interval between each week) of 12 tablets daily. Ii subtertian malaria the first period should be 5 days, followed bv 4 days’ break, and the subsequent 5 courses of 5 days each instead of 7 Tablets now contain twice the amount formally dispensed. l)oes not- replace Quinine, but affords an alternative treatment ir patients unable to take Quinine. Occasional signs of relative in tolerance are slight cyanosis, dyspepsia, colic, and splenic pain.— P. Manson-Bahr, L. ii./28,497. In general, harmless. Destruction on gametes evident, but large-seal experiments needed to prove efficacy.—De Melo, Jl. A.M.A. ii./29,176fc Harmless in Quinine hsemoglobinuria when taken after attack has subsided.— Ibid., 1770. No one should take Plasmoquine who is not under close daily medical super vision. It cannot replace Quinine in the mass treatment of malaria.-—I ii ^2q §34 * The late Sir A. Balfour recommended the use of Plasmoquine in tertiai infections—1 to 2 tablets 5 times a day. In sestivo-autumnal or doubl infections Plasmoquine Compound one tablet five times a day.—Jl. Roy Soc. Trop. Med., Jan. 30, ’29,399. Prevention of malaria. Beprochin had prophylactic powers.—Lt.-Co S. P. James and co-workers, L. K/31,1248. “ England should have done it.”— W. H. M. An effective prophylactic against malarial infection.—S. P. James, W. D. Aicol and P. G. Shiite, L. ii./3i,342. See also P. Manson-Bahr, ibid., 425. A review of recent experiences—Ibid., 535. In malignant tertian malaria not more effective in preventing relapses than Gum me. A drug needed with the same action but less toxic and which would not omy cure attacks, but prevent relapses. Before attributing remarkable curative properties to a new anti-malarial one should ascertain whether cases could not be as easily cured w!th moderately small doses of Quinine.—Col. !8. P. James, B.M.J. i./32,101. Quinine is one of the most remarkable drugs ever known, and little is known of its action and the factors governing its action. Prof. Warrington Yorke, ibid. Plasmoquine highly specific for Plasmodium vivax but much less so for the merozoites of the subtertian. Of value in pregnancy and in the convalescent stages of blackwater fever. There is undoubtedly idiosyncrasy to it as to Quinine.—P. H. Manson-Bahr, ibid. Alone it has no anti-relapse effect but given with Quinine it has.—Lt.-Col. S. P. James, R.S.T.M. June 16, ’32. sjcAtebrin (T.M. 349660). Syn. Erion. A new anti-malarial synthetic allied to Plasmoquine, soluble in water with bright yellow colour and fluorescence. Tablets contain O'l Gm. Dose— 0-3 Gm. daily for 5 days. Used in malignant tertian malaria, in only 1 of 17 cases did it fail to effect permanent cure. Action the reverse of Plasmoquine, i.e. of little use prophylactically.—S. P. James and Co-workers, L. 1./3 2,1062. Compares favourably with Quinine and superior in preventing relapses.— R. Green, L. h/32,826: see also ibid. 847, and Prof. W. Schulemann, B.M.J. J./32,100. RESORCINUM. Syn. Resorcinol. B.P. ’14., P. Ital. V., P. Belg. IV., F.E. VIII. (latter specifies for external use). C6H4(OH)2= 110-0468. Dose.— 1 to 5 grains (0-06 to 0-3 Gm.). Metadihydroxybenzene is in white crystalline plates, melts at 230° F. (=110° C.) and is easily volatilised. Preserve from light. Manufacture.—Benzol-Disulphonic Acid is prepared by heating Benzol with fuming Sulphuric Acid and the liquor poured into water to which Milk of Lime is added. The solution is filtered and the filtrate treated with Sodium Carbonate. It is again filtered and the filtrate evaporated and afterwards fused with Sodium Hydrate. The melt is cooled and dissolved in water, acidified with Hydrochloric Acid and, after boiling off the Sulphur Dioxide and filtering off tarry matter, is extracted with Ether and then recrystallised from Benzol. For a more detailed account, see Edn. XVII, Vol. I, p. 681. Soluble 1 in 1 of water, 2 in 1 of alcohol, 1 in 20 of olive oil. Incompatible with Spt. of Nitrous Ether, and caustic alkalis. Uses.—Resorcin has useful antiseptic properties. It coagulates albumin, and has a caustic action on the skin, but a 2% solution is not irritating. A 5% solution may be injected into the bladder without causing any irritation, in inflammatory affections of this organ, likewise in vesical catarrh after gonorrhoea ; 5 to 10% solution is of service also in syphilitic sores and skin diseases; and a 1% solution is useful as an eye lotion in conjunctivitis. Given internally, but with great care, it has been used as an antipyretic but it cannot be recommended. In whooping cough and hay fever, 10 minims of 2% solution, or this strength used as spray, is of service. Epithelioma and rodent ulcer have been treated with ointments and plaster up to 30% strength. It is applied locally to condylomata and mucous patches. A pigment of 10% relieves irritation of tubercle of larynx. For eczema and alopecia, cold cream with 2% of Resorcin is useful. In the form of paste it has proved useful in ichthyosis—favours desquamation and removes effete horny layer. In gastric ulcer 2 to 5 grain doses have antiseptic action. Resorcin is dangerous over large surfaces. A paste containing 25 to 30%, Resorcin in Gelanthum proved fatal. Tablets, 3 grains (0-2 Gm.). Dose.—1 to 3. Glycerinum Resorcin, G.H. Resorcin 4, Distilled Water 4, Glycerin to 15. In chronic urethritis resisting treatment, a single injection (25% Resorcin) in fresh cases has been found beneficial. Lotio Resorcini. Syn. Spiritus Capillaris. Resorcin 1, Ether 1, Castor Oil 1, Eau de Cologne 10, Alcohol (90%) 35. Useful for dandruff and alopecia. Soap and alkali must be removed before use, or hair may be discoloured. Lotio Resorcin et Acidi Salicylici. Salicylic Acid 30 grains, Resorcin 1 drachm, Spirit of Rosemary 1 ounce, Saponin 1 drachm, Lanolin 1 ounce, Aqua Mellis to 10 ounces. Dissolve the Salicylic Acid and Resorcin in the Spirit of Rosemary, melt the Lanolin, add the Saponin dissolved in a little water, place in a warmed mortar, add the Spirituous Solution just mentioned and the Aqua Mellis in parts to make a cream. Lotio Resorcini Composita, St. M.’s H. Resorcin 10 grains, Methylated Spirit 1 drachm, Water to 1 ounce. Lotio Capillaris.—A stimulant to the growth of hair. Resorcin 5, Capsicum Tincture 15, Otto of Rose q.s. Castor Oil 10, Alcohol 90% to 100. Cg)Lotio Excitans, St. G. H. For the scalp. Resorcin 5 grains, Mercuric Chloride i grain, Glacial Acetic Acid 3 minims, Chloral Hydrate 10 grains, Cantharides Tincture 20 minims, Alcohol 60% to 1 ounce. Cg)St. J. H. has Mercuric Chloride 10 grains, Glacial Acetic Acid 30 grains, Chloral Hydrate 3 drachms, Tincture of Cantharides 1 ounce, Alcohol 60% to 1 pint. CE>Lotio Resorcini Pilocarpinse et Cantharidis. Resorcin 80 grains, Pilocarpine Hydrochloride 15 grains, Cantharides Tincture 1J ounces, Tincture of Capsicum 4 drachms, Spirit of Camphor 6 drachms, Castor Oil 10 to 60 minims, Oil of Lavender 30 minims, Alcohol 90% to 8 ounces. A useful stimulating lotion in alopecia prematura for use after exfoliative treatment. Lotio Resorcini et Acidi Borici. Resorcin 1, Compound Tincture of Lavender 10, Glycerin 10 Saturated Solution of Boric Acid 80, as a mouth wash. Nebula Resorcini.—For a cold, spray nostrils with 1% solution. Gargarisma Resorcin, E.L. Rnsorcin 15 grains, Glycerin 1 drachm, Water to 1 ounce. Unguentum Resorcini, R.O.H. Resorcin 8 grains, Soft Paraffin to 1 ounce. Unguentum Besorcini Compositum. ihie’s Paste. St. J. H. Resorcin, Zinc Oxide, Starch, of each 5% approx, in Soft Paraffin. Has been used stronger for bromide acne. Resorcin liquefies with Menthol, Camphor or Phenol, and a small amount of any of these may well be added so as to form a uniform ointment. Unguentum Resorcini et Acidi Saiicyliei. Syn. Castellani’s Ointment. Resorcin 60 grains, Salicylic Acid 10 grains, Lanolin and Soft Paraffin to 1 ounce. The most popular remedy for Dhobie itch in Africa and Asia. Pasta Resorcini Fortior (Lassar and St. M.’s II.). Resorcin 20, Zinc Oxide 20, Starch 20, Liquid Paraffin 40 ‘ Mitis ’ 10, 25, 25 and 40 respectively. Pasta Resorcini et Zinci Qxidi, K.C.H. Resorcin 1, Glycerin 1, Zinc Oxide 1, Paraffin Ointment (white) to 8. Baculum Resorcini.—Resorcin 3, Wax 2, Lanolin 5. Resorcin Monacetate. Syn. #Euresoi (T.M. 355476). lyn&nuVc&Gturo,—Mix Resorcin 440 and Acetyl Chloride 320 and allow to interact completely in an open dish. Then heat to 100° C. for \ hour. Cool, wash free from acid with water, and dry over exsiccated Sodium Carbonate. A honey-like mass. Dissolves 10 to 30% in acetone, for use in acne, seborrhoea and sycosis. Euresol pro Capillis is the same perfumed. It is directed to be made into a Hair Lotion by mixing 2 parts with Alcohol 70%, 32 and Water to 48. Removes damlrufl and itching. Thio-resorcin. Yellowish powder slightly soluble in alcohol ; as a substitute for Iodoform ; 5% Ointment in skin diseases. Hexyl-Resorcin. Syn. j^Caprokol (T.M. 460019). 1:3 Dihydroxy-4-Hexylbenzol, CgH3(OH)2.(CH1j)5.CH3.= 194-1404. Dose.—2 to 10 grains (0-12 to 0-6 Gm.) thrice daily. Paiorsts—The manufacture of Hexyl-Resorcinol and allied compounds is covered by a number of British Patents dating from 1923, owned by American manufacturers. In 1927 they were the subject of an action in the Couits Details in Edn. XIX, p. 753. . , ,T , The compound is a stable one, forming white crystals, M.pt. 65° C., soluble in wrater 1 in 1,700, readily in Ether, Chloroform and Alcohol, and in oils. . Us€S.—A powerful germicide, the Phenol Coefficient ranging from 46-52. Its power is retained in both acid or alkaline urine even in high dilution. Given by the mouth, the compound is secreted in the urine at a rate producing continuous action in the urinary tract. Chronic B. coli infections and Staphylococcus infections have been treated with it; it acts best in early cases. Pyelitis anc cystitis caused by organisms other than B. coli are cleared up in a tew weeks. B. coli infections require, on the average, about as many months. It is of value in disinfection of wounds draining the unnary tract, and tuberculosis of the urinary tract. Continue treatment until sterility of the urine has persisted for a fortnight at least. Gelatin Capsules containing 0T5 Gm. in 25% Olive Oil Solution are taken immediately after each meal thrice daily, three to four being taken on each occasion ; they must not be taken on an empty stomach. B. coli infection may need 60 to 90 days’ continuous treatment. Caprokol Solution for children is made, each drachm containing 0T Gm. in 2J% solution in Olive Oil. In the preliminary experiments a total of 45 Gm. produced no toxic symptoms, but since then much larger amounts have been given without toxic effects. Urinary tract infections due to Staphylococcus albus, Staphylococcus aureus, Streptococci, some strains of B. pyocyaneus and B. coli have been cleared up with Hexyl-Resorcin alone by mouth.—V. Leonard, Jl. A.M.A., Dec. 20, I924- The bactericidal power is probably due to its being a powerful surface tension reducent. Hence administration of Sodium Bicarbonate is contraindicated and excessive intake of' fiuids must foe avoided, as they both increase the surface tension of the urine and rob the compound of bactericidal action. So far as is known, nephritis is not a contraindication. Children seem to tolerate relatively larger doses than adults.—V. Leonard and A. Wood, JL A.M.A. ii./25,lS55-—59. Pyelitis.— Successful in only 1 case out of 14.—Am. Jl. Dis. Child., Sept., ’26, per Jl. A.M.A. i./26,1506. Pyelonephritis, Chronic.—Improved symptoms and reduced pus in urine, but did not eradicate infection.—W. F. Braatch and E. P. Catlicart, Jl. A.M.A. 1 ./2 7,1632. About one-third of cases cured, with an additional 20% of symptomatic cures: about 43% will be improved, and 25% remain unchanged. Coccus infections respond more certainly than bacillus or mixed infections. A higher proportion of cures is likely if the treatment were combined with other methods. Details of treatment of S2 cases of acute and chronic pyelitis and prostatitis.— C. W. Eberbach and it. D. Arn, Jl. A.M.A., Aug. 14, ’27,514. Test for Hexyl-Pesorcinol in body fluids.—D. C. Elliott and H. G. Barbour, Can. Med. Assn. JL, Aug. ’25,787, per Pres., Jan., ’26,49. Tissue Disinfectant.—Hexyl-Pesorcinol is claimed to be effective when 0T Gm. is dissolved in Glycerin 30 and Water 70 Cc., and pathogenic microorganisms are stated to be destroyed in less than 15 seconds. Undiluted the solution may be used for lavage of the urethra, bladder and buccal mucous membranes, and mixed with 2 vols. of water it may be instilled into the normal conjunctival sac.—B.M.J.E. ii./27,100. For the intense pruritus of creeping eruption continuous application of 1 % Hvdro-Alcoholic solution successful.—G. Giglioli. Jl. Roy. Soc. Trop. Me<L, Jan. 30, ’29, 444. Anthelmintic effect (hookworm, trichinus and ascaris) stated to be good, but unlikely to displace other drugs owing to the need for strict and intelligent co-operation of patient.—L. ii./3 i,S3. Ilexyl-Resorcin—Solution S.T. 37. A solution in aqueous Glycerin withlcnv surface tension (37, compared w ith water 77 dynes per sq. cm., and hence thought to have increased penetration. It is a non-toxic and non-irritating, antiseptic, and may be used as such or diluted with water. It is employed in mouth, nose and throat cases and for open wounds. * SACCHARIN (T.M. 392328, 332891, 304767, 332892). Glusidum (B.P. ’14) U.S X., Ph. Ned. V., F.E. VIII., P. Ital. V. Syn. —Gltjcusimude, jfcSaxin (T.M. 198,971) Benzoyl Sulphonic Imide. Benzosulfiiinidtjm, Orthosulfimidum Benzoicum, Imide Orthosulfobenzoique, P. Belg. IV. C6H4: S02CO: NH = 183-107. Dose.—h to 2 grains (0-03 to 0-12 Gm.) or more. A derivative of toluol in white, intensely sweet, crystalline powder. Its aqueous solution has an acid reaction; it forms crystalline sweet salts with alkaloids and metallic bases. Solutions of alkalis and their carbonates dissolve it, forming compounds. Soluble 1 in 400 of water, in alcohol 90% 1 in 38, in ether 1 in 100, incompletely in chloroform, and in glycerin abou jin 50, slightly in oils and fat, also in acetone. Use.—Instead of sugar for diabetic and obese patients. Saccharin (insoluble) is sold in sweetening powers 300, 450 and 550—the above remarks refer to “ 550.” Influence of Saccharin on the catalases ol the blood.—Some of the recent work on Saccharin lias had a tendency to ascribe to this compound an action beneficial to the processes of oxidation in the blood, particularly in diabetes. F. C. Becht finds there is no evidence that it produces any change in the catalytic power either in the positive or the negative direction per os. 4 Gm. per kilo is a powerful gastro-intestinal irritant. Given intravenously it produces a marked decrease in the catalase content of the blood. There is no difference from the normal in the case of an animal with pancreatic diabetes. —Jl. Pharm. and Exp. Therap., Oct., 1920. Giusidum Solubile, U.S. X. C6H4.S02C0.NNa 2H20=24M274. Syn. Saceharinum Solubile, P.G. VI. contains about 90% of Saccharin iu combination with soda. In yellowish granular, micro-crystalline masses, easily soluble in water, and therefore convenient for flavouring purposes. 1 in 2,000, or 2 grains to an 8-ounce mixture, is ; sufficient. to 2 grains (0*03 to 0*12 Gm.) or more. Elixir Glusidi, B.P.C.—Syn. Elixir of Saccharin. Dose.-~5 to j 20 minims. Gluside 5, Sodium Bicarbonate 3, Alcohol 12-5, Distilled Water q.s. to 100. 1% added to mixtures for flavouring. Saccharin Tablets. Contain £ grain with Sodium Bicarbonate q.s. Dulein. p-Phenetqlcarbamide,P.G. VI. C2H6.OC2H5.NH.CONHo= 180-1094. Dose.—Tablets are made containing j grain (0*05 Gm.). White crystalline powder, M.pt. 172-174 C. Slightly soluble in water, readily in Alcohol. Can be boiled. Used as a substitute for sugar, and stated to be innocuous. SACCHARUM PURIFICATUM. Syn. Saccharose, Sucrose. C12H22011=342-17I6. Crystals or powder, soluble 2 in 1 of water. . . In addition to the Refined Sugar obtained from the juice of the Sugar Cane—Saccharum officinarum (^mmiwacece)—-various grades of granular cane and beet sugar both with and without the addition of “ blue ” are marketed. For the manufacture of Syruw a sugar without the colouring matter is essential. B.P. 14 and U.S. allow also beet sugar. S"fherBritirfi'sugaPrs^sWy) Act, 1925, P?^3kro^hesu^;nttu^ a subsidy for the period of ten years ( ^ FWh'qhVlinmta molasses manufactured from home-grown beet. 1 he English climate is exceptionally favourable for beet t ThP iidvRates on Sugar (exceeding 98° polarity) manufactured Deiveen 30th sfpt!ri9y3? and 1st Ogct., i934 are 6s. Gd. per cwt. On Molasses (it "50 l'HE EXTRA PHARMACOPCEIA. g containing less than 70 and more than 50% of sweetening matter) made? during the same period, £2 19s. 4d. per ton. Further data on acreage, tonnage, Subsidy paid hitherto, see Edn. XIX T o/. 1, pp. 755, 756. In the case of any new factory constructed since the Act, it is a conditior of payment of subsidy that not less than 75% of the gslant a net mac hin ery installed shall he of British manufacture: unless the Minister of Agriculture dispenses with this condition. How the Plant makes Sugar—a book giving a comprehensive account of the whole subject of sugar.—G. Fairrie, Liverpool, Fairrie & Co., 1025, abst. L. i./2o,584 . Relative Sweetness of Sugars.—If the sweetness of Sucrose is rated as 100 Levulose deserves a value of 173, Glucose 74, Maltose 32, Galactose 32, and Lactose (Milk Sugar) 16— Jl. A.M.A. ib/25,977. For the Estimation of Sugar by means of Folariscoye and other Methods see Vol. II. Uses,—In heart disease, as also in cancer and phthisis, large amounts are of service. It is changed into glycogen and thence to glucose in the system. It has been given intravenously as strong as a 50% solution, but an isotonic solution (920-6 grains per pint, i.e., 10-5%.—P.J. i.129,325) would appear preferable. It is added to infants’ foods made of dried milk. Sugar with carawray infusion is used to hasten and increase mammary flow in Egypt, as well as to bring about a speedy involution of the uterus. In various morbid conditions, anaania, adynamic varieties of rheumatism m neurasthenic manifestations of neurotic persons, Cane Sugar is beneficia —i lb. to £ lb. for an adult to be slowly eaten daily and a lump or two at odd times through the day or night, but not just before a meal. Cardiology. Incipient rheumatic endocarditis may be prevented fron passing into permanent, valvular disease by prolonged rest, the administration of Sodium Iodide and application of blisters.—Caton. Chronic heart failure aided by Cane Sugar.—W. Gordon, B.M.J. i./2i,13. Eczema, psoriasis and prurigo well treated by intramuscular injection of 2 or 5 Cc. of an 8% solution of Saccharose—Per. Jl. A.M.A. ii./25,1999. Arthritis. Tolerance for sugar is often diminished.—Pringle and Miller M. P.C. 31/23,85. Syrupus (B.PI 14). Sugar 1, Water to 1J by weight, Sp. Gr. 1-33. U.S. X. orders Sugar 85, Water to measure 100. Weaker strengths of syrup do> not keep well. Potassium Carbonate 1 grain in 12 ounces of Syrup has been found to prevent crystallisation. A few drops of Chloroform per ounce of Syrup will prevent fermentation_ C. 1)., Aug. 22, 1922, p. 310. Pest temperature for producing syrup free from Invert Sugar thought tc: be 90° C.—W. J. Reardsley and F. J. Bolton, Qtrly. Jl. Ph., ’29,204. Invert Sugar is prepared by action of dilute mineral acid on Cane Sugar. Consists of a mixture, possibly a loose combination, of equal weights of Grape Sugar (Dextrose) and Laevulose. A useful substitute for cane sugar in dyspepsia—more easily borne in gastritis- invert Sugar forms in simple syrup on keeping—that made bv cold process- produces more than hot. In 18 months it may reach 6%.—P.J. ii./i6,545. Lsevulose.—Syn. Diabetin, Fructose. C6H1206 = 180-0636. A whitish crystalline powder (also honey consistence), freely soluble in water, reducing Fehling’s Solution." It is laevorotatory. Manufacture from Cane Sugar. See Edn. XIX, p. 757. Inulin from dahlia bulbs or chicory root which contain 6 to 12% is also: suitable for producing pure Laevulose. A stronger sweetening agent than cane sugar; has a pleasant; flavour. Specially suitable for diabetics. Jerusalem Artichokes proved beneficial in diabetics, with only slight addition to the Insulin dosage. A definite increase in blood sugar followed but less than that produced by Lsevulose. Baked artichokes raised the respiratory quotient in all cases.—per Jl. A.M.A. ii./25,544. The uses of Lsevulose.—Pres., July ’26,279. Icevw/ose test for fiver efficiency. All ordinary sugars, glucose, cane sugar, etc., when ingested, raise the concentration of sugar in the blood, but not lsevulose. Thus, with 50 Gm. of glucose, the blood sugar concentration is increased in the first half hour from the usual 0-1 to 0-16 or 0-17%, returning to normal in about H hours. There is no rise with lsevulose. This lack of power on the part of lsevulose depends on an intact liver. If there is a definite lesion of the liver, lsevulose acts, more or less, like glucose, i.e., there is a marked increase in blood sugar.—J. C. Spence and P. C. Brett, L. ii./21,1362 ; B.M.J. ii.,/22,1061. See also Prof. Maclean, ibicl., 1060 and G. King, L. i./27,388. Lsevulose Tolerance Test for hepatic efficiency in patients with epilepsy.— M. Gosden and J. Tylor Fox, L. 1./29,1351. The most valuable and sensitive of all liver function tests and best shows early impairment. A healthy liver can dispose of 50 Gm. Lsevulose taken by the mouth without rise of blood sugar.—Sir Wm. Willcox, L. ii./31,3. Galactose test for liver efficiency. Give 40 Gm. in 400 Cc. water to the fasting patient and collect samples of venous blood, at half- hourly intervals for 2 or 3 hours. There is no great rise in blood sugar curve, except where hepatic cells are grossly damaged. Thus normal persons, or those with gross obstructive jaundice, or pernicious anaemia and alcoholic jaundice, show little or no rise of blood sugar, but in those with catarrhal or toxic jaundice, with malignant disease with secondary deposits in the liver, and with cirrhosis following syphilis or alcoholism, Galactose causes definite increase in blood sugar.—D. T. Davies, L. i./27,380. A ; Galactose Test for hepatic efficiency better than Lsevulose.—A. W. Elmer and M. Scheps, L. ii./3o,187. , . , m , Identification of Inulin and Maltose by a mycological method, tables and formulae.—A. Castellani and F. E. Taylor, Jl. Trop. Med., Feb. 15, 23,06. Saccharosan and Glucosan. It has been suggested to modify Saccharose and Glucose by heat to produce carbohydrates (‘ Anhydro-Sugars ) which can be given to diabetic patients without their affecting blood or urinary Glucose. The writer has prepared both the compounds for trial. Animal experiments showed that Glucosan given by the mouth caused no change in the respiratory quotient and it was absorbed to the extent of on. y 30%, the absorbed fraction being excreted unchanged in the urme. it is unlikely therefore that the substance can be prontably included m the diet of diabetics.—B.C.A., ’26,A.973. SANTONINUM. Dose.—1 to 3 grains (0-06 to 0-2 Gm.) in sugar. U.S. X. Average dose.—1 grain. J?R. Cx. : Max. single dose, \ i grains ; max. din ing 24 hours, 5 grains approx., F.E. VIII. 4 grains. Slipule No. 5 holds 2 grains A neutral crystalline principle. The inner anhydride, or lactone of Santonic Acid, C15H]8O3=246-1404, obtained from Santomca the dried flower-heads of Artemisia mantima var. Stechmarmmna (to n- positce). Syn.—Levant Wormseed, Flores Cmce (Gynie) i Wurmsamen. Ormesukker (Danish) is a Confection ot Santomca. * matcsItV wiDf?r U,ie se^>usually near to where fresh watea HHpo 4 fhe sea and the shore is subject to inundations at spring PX 1*/30’24* “ant on Essex coast.-Jr. C p Santomn ofrom Scottish-grown Artemisia maritinui, 0-81%.—J. Couttss ir< a^roY<4^re^ lowers of a variety of Artemisia maritima, growing in thfF SantoMn —L3 i/23 80S6 6nt substitute for the expensive (Russian origin. Santonin made on large scale at Adlershof.—P.J. i./31,379. Artemisia hrevifolia (Wallich) found to contain about 1% Santonin. In occurs from Kashmir to Kumaon at 7,000 to 9,000 ft. altitude.—Prof. Greenish 1 . J . l./2I,Z, Furthur notes on the leaves, root, stem and flowering tops of A. Brevifolic as a source of Santonin.—Prof. Greenish and C. W. Maplethorpe, B.P. Conf. 1923 ; P.J. m/23,94. * Brevifolin is a member of the aromatic ketone series associated with the naturally-occurring Z-camphor—also a ketone—and with the terpenes natura to the herb Artemisia brevifolia.—T. H. Smith, P.J. ii./29,604. The examination of true and false Santonicas.—T. E.' Wallis and E. J_ Mowat, P.J. 11./25,149. Soluble 1 in 40 Alcohol 90% and in Oils (1 in 200 of Castor Oil), in Chloroform 1 in 3. Also in Caustic Soda Solution. Insoluble in water. Turns yellow in sunlight. P.G. VI. gives a test for the presence of foreign organic matter, alkaloids and Artemisin in Santonin. P. Ital. tests for Salicin, Brucine, Sugar, etc Uses. It is an anthelmintic for round (Luvubvici) and threadworms (Ascarides), but is inoperative against tapeworm (Taenia). It colours the urine orange, and in too large a dose may cause objects to appear of a green or yellow colour. A greenish yellow or saffron colour may be produced in the urine, and if the urine be alkaline a purplish red. A 2 or 3 grain dose of Calomel is given after a dose of Santonin, followed by a saline purge six hours afterwards, the flow of bile being particularly useful in making the worm let go its hold. As an anthelmintic it is very active in an oily solution, e.g.t Haustus Santonini et Olei Ricini, Santonin in powder 4 grains, Castor Oil 3 drachms. Mix and emulsify with Mucilage of Acacia 4 drachms, Syrup 1 drachm, Saccharin J grain, Peppermint Water to 14 ounces. Taken fasting in the morning this makes a dose for a child of 6 to 12 years, but caution.—Poisoning has occurred by Santonin given in oily solution. Given in powder it is not absorbed and consequently is non-toxic though acting equally well on the parasites. The usual custom is to give the Santonin in powder on two or three nights, following by Castor Oil in the morning. The general opinion seems to be that Salts, not Castor Oil, should be used as a ‘ wash out * after giving Santonin,—Paterson. Santonin poisoning by £ grain. This dose in two drachms of Castor Oil brought away from a five-year-old girl a large number of thread worms and a few round worms, but the child became weak and looked like dying After three weeks recovered, but was completely blind and remained so for three months.—L. ii./io,1693. Urinary Incontinence.—Santonin may effect a cure. Pills and Tablets, -J, J, I, 2 and 3 grains. Dose.—As Santonin. Confectio Santonini Composita. E. Lc Dose.—1 drachm for a child 2 to 5 years. Santonin 1, Powdered Ginger 1, Jalap 3, Sulphur 4, Senna Confection 51. Pulvis Santonini Composite, Gt. Orm. H. Santonin 1§ grains, Compound Scammony Powder 2 grains, Calomel \ grain. Castor Oil or a saline next morning. Trocllisci Santonini. (B.P.’ 14) 1 grain (0*06 Gm.) in each; one every night for a few nights then an early morning aperient. Suppositorium Santonini contains 3 grains (0-2 Gm.) or more. Should be inserted every 2nd or 3rd night, for three times. Golden Santonin. Syn. Chromo-Santonin. £ Dose.—2 to 5 grains (0*12 to 0*3 Gm.). ~ A modification of ordinary Santonin formed by exposure to sunlight. Enteric is stated to have been usefully treated, also a type of ‘ sprue * (3 grain doses morning and evening in oil), and dysentery. Sodii Santonin as, NaC16H1904.3^H20=349*1998. Dose.—£ tol grain (0*016 to 0*06 Gm.) for adults. White crystals. Should in preference be given in Salol-coated pills or stearettcs. Has been used as anthelmintic.—T. A. Henry, P.J. i./23,2s. details, Edn. XIX, p. 760. Eurther SAPONES. Sapo Animalis or Curd Soap is mainly Sodium Stearate. Sapo Duros or Castile Soap is mainly Sodium Oleate. Sapo Mollis (all are B.P: 14) Syn. Sapo Viridis, is mainly Potassium Oleate (made with Olive Oil; U.S. Linseed Oil). Sapo Medieatus, P.G. Vl.ismade from Lard and Olive Oil and is chiefly Sodium Oleate. ... a 1 m Sapo Kalinus, P.G. VI., P. Austr. is made with Linseed Oil. Soluble about 1 in 4 water and 1 in 1 alcohol 90%. Sapo Amygdaiinus, F.E. VIII. is made of Almond Oil and Caustic Soda. . Saponification is outlined in Vol. II, in which also are details on the composition of Pharmacopceial Soaps, Toilet, Shaving and other Soaps, the use oj he sen and Mottle, Transparent Soap, Saponification Nos. of Oils, etc. Sodii Oleas. Syn. Eunatrol. CH3(CH2)7CH : CH(CH2)v,COONa= 304*2544. In 2 and 4-grain pills and is given to dissolve gallstones. Useiul as cholagogue. Capsulse Sodii Oleatis contain 5 grains. Capsulse Sodii Oleatis Compositae. Martindale. .... N Dose.—One night and morning or 2 at night with hot water. ““ Sodium Oleate I grain, Phenolphthalein 4 gram. Salicylic Acid 12 grains, Menthol, 1 grain. A mildly aperient antiseptic lor gallstones. Carcinoma treated with Sodium Oleate by J. H. VVebb (Me iourne) on Shaw-Mackenzie’s Theory that Sodium Oleate and various tissue extracts act as co-enzymes, i.e., activating the dormant Prohpase. 20 grains of Sodium Oleate daily in pill form for a year and 30 injections of 10 Cc. of Sodium Oleate solution-beginning.with \U.and increasing to 5%—Albert Wilson, Edm. Med. Jl., May, -5,248-9. cf. pp. 755, 756. Sterules of Sodium Oleate 0-8% 2 Cc. and 1% 1 Cc. are made. Oleic Acid and Sodium Oleate were found on injection to modify the growth! of tumours, confirming the clinical observations of Shaw-Mackenzie in 1913 The procedure might be useful to prevent regrowth after operation.—L, i./25,1193. Subcutaneous injections of 1 to 3 Cc. of Sodium Oleate solution 0-8% have been found of benefit in cancer of the breast.-—J. Shaw Mackenzie, Jl. Trop Med., April 1, *27,85. Sapo Superadipatus, Ph. Ned. V. Anhydrous Wool Fat 4, Potash Soap 16, Hard Soap 80. Sapo Superadipatus cum Pice Liquida, Ph. Ned. V. Anhydrous Wool Fat 4, Liquid Tar 5, Potash Soap 11, Hard Soap 80. Sapo Superadipatus cum Sulfure Precipitate, Ph. Ned. V. Anhydrous Wool Fat 4, Precipitated Sulphur 10, Potash Soap 16, Harr - Soap 70. Sapo Mollis Peroleatus.—Tallow 32, Olive Oi 15, Potassium Hydroxide 8; Sodium Hydroxide 2, Borax I, Distilled Water 100. Dissolve the Potassiun and Sodium Hydroxides and Borax in Water, then heat to boiling, add th* tallow and oil—boil until well saponified and proper consistency when cold.— Ex Edinburgh Infirmary Pharm. To Soften Water, i.e., to precipitate Calcium Salts, to prevent them forming insoluble soaps in lathering, add a little Sodium or Potassium Car bonate. Filtration through wood ashes was formerly used for laundry work For Chalky and other Waters, see Vol. II. Medicated Soaps. (H)Biniodide, containing £%, 1% and 3% mercuric potassium iodide, reliable antiseptic. Carbolic, toilet and medicinal, strength 5%, 10% and 20%. Formosyl toilet and medical 10%. Ichthyol 5% and 10%, in skin affections. Ichthyol and Salicylic Acid. ,, ,, Sulphur 5% each. Lanolin and Ichthyol. jfcNeko (T.M. 482656), 1% Pot. Merc. lit Iodide, for skin affns.,wounds and instruments. *Sphagnol (T.M. 246705)5 and 15%. Cg) Sublimate 1%. Sulphur, Camphor and Balsam O' Peru, of each 5%. Sulphur, Camphor, and Carbolic AcidL of each 5%. ^ Vinolia (T.M. numerous) medical. ^ Wright’s Coal Tar contains the equi valent of 15% of phenol combinec to be unirritating. The* oil, for scenting * are of the> highes' antiseptic value, containing, e.g. thymol, carvacrol and cinnamm aldehyde.—cf. Essential Oils, Vol II. For details of the manufacture of Medicated Soaps (direct from Cocce Nut Oil and Soda Lye), vide E.P., XV, p. 713. The preparation of Benzene and Turpentine Soaps, the latter havingr considerable bleaching power.—P.J. ii./27,514. Linimentum Saponis (B.P. ’14). Soft Soap 4, Camphor 2, Oil of Rosemary 0-75, Distilled Water 8-5, Alcohol 90% to 50. Epidermophytosis well treated by U.S.P. Soap Liniment. Whitfield’fe Ointment disappointing.—C. S. Butler and co-workers, lnt. Conf. Trop. Am.* ’2 4,522. Spiritus Saponis Kalinus (Spiritus Saponatus, P.G. VI.). Saponify Olive Oil 6, with Liquor Potassse (15%) 7, and Alcohol 7| by agitation until it mixes clear with alcohol and water. Add then Alcohol 224 and Water 17 ; filter. Soap and Spirit Lotion. Soft Soap 1, in Alcohol 90% q.s. to 2. Spiritus Saponis Kalini, P.G. VI. is a solution of Potash Soap 1, in Alcohol (90%) 1. Ether Soap. Dissolve Soft Soap 32 in Alcohol (90%) 20, allow them to stand 24 hours and decant carefully from any sediment, then add Methylated Ether Sp. Or. 0-720, 52 parts. As a detergent prior to operation. Cp)Eiher Soap with Mercuric Iodide, contains 1 in 1,800* Mercuric Iodide 25 grains, Potassium Iodide 4 ounce, Soft Soap 2 lbs., Alcohol 90% 1 pint. Ether q.s. to 5 pints. ^Foimosyl Glycerin Soap. (Distinguish from ‘ FormosyV) A yellowish liquid (prepared scented and unscented) containing 40% of Glycerin. A bland and soothing preparation for delicate skins. It is a constituent of Salicifrice. ^Sterilla (T.M. 300899).— A Liquid Surgical Antiseptic Scap >|c Synol Soap(T.M. 362164).—A liquid soap containing Cresols and Camphor. Pasta Mackintosh. Mackintosh Paste R.V.I. Soft Soap 7, Powdered Pumice Stone 7, Prepared Chalk 7, Water I, Cyllin 1. Aluminium Soaps are used in water-proofing textiles, and in making certain plastic materials used as substitutes for rubber, leather and celluloid, also (Aluminium Stearate) as lubricating oil thickeners. Ammonium Soaps are employed in vanishing creams and other toilet preparations. Ethanolamine is a substituted ammonia made from ethylene, present in the gases evolved from oil wells. Ethanolamine soaps are in the experimental stage, but may find uses as emulsifiers and as absorbents for acid fumes. Copper Soaps are used for preserving fishing nets and in making anti- fouling paints for ships’ bottoms, depending on the poisonous properties of copper salts. Soup and water washing proved to be of no or value m washing woollen undergarments. Garments when washed with soap and water were found to contain dead skin cells, sticky lime and magnesium salts of fatty acids, along with a quantity of other bodily secretion and organisms. Bolton advises that no soap should be used for washing garments worn next the skin. Bolton's method of washing garments worn next to the skin. Turn the garment inside out, soak in warm water for 10 to 30 minutes and wring it out. Then soak the squeezed garment in a wood or earthenware bucket of cold water containing about £ ounce Hydrochloric Acid B.P., which should make the bath slightly acid to the tongue, for about 10 minutes : wring out, and rinse in warm water. Then soak in a bucket of warm water containing about 4 ounce of Strong Ammonia for about 10 minutes and work it about. Wring out, repeat with Ammonia if necessary and finally rinse in warm water. The Hydrochloric Acid dissolves the Lime, Magnesium, and Iron compounds which have been formed by interaction of the salts in the perspiration, and by the fatty acids of the skin fat. The Ammonia saponifies the fatty acids from the sweat fat still remaining undissolved as soluble salts. The same process can be used for sponges and for the human body. Search for a specific treatment of tuberculosis. The main idea underlying treatment in bacterial disease, it is suggested, is the production of the lipolytic or fai-splitting ferment lipase in the tissues. Serum proteins, various tissue extracts, Sodium Oleate and inorganic Calcium Salts will stimulate this lipolytic action. The same principle in part underlies treatment by vaccines and tuberculins in which enzymes and lipoids are present in varying degree. The tubercle bacillus is known to contain protein, lipoids, fatty acids, phosphate and calcium in addition to a large amount of fats and waxes. In view of this interpretation of the action of vaccines and tuberculins, the products of ferment and bacterial digestion may prove more serviceable than vaccines. It is noted that the serum of patients recovered from tuberculosis markedly accelerates or activates the fat-splitting action, compared with a decreased power in the acute stages. The former contains the products of digested or partially digested tubercle bacilli, the result of lipolytic or bactericidal action. Such products- fatty acids or particular soaps derived from the action of the lipolytic ferment on the fats and lipoids of the tubercle bacilli may be not only protective or act as stimulants of lipolytic activity but the initial action of the ferment may liberate other contained activators.-—J. A. ShawT-Mackenzie, B.M.J. i./2i,402, The idea has been made use of in the Sodium Morrhuate Treatment, q.v. See also p. 753, Carcinoma treated. . Blood serum of recovered mice shows that a natural and increased production of lipase and of fatty acids in the tissues are important factors in the/ protective mechanism. Sodium Oleate, inter alia, increases the action of: lipase in vivo and in vitro (J. A. Shaw-Mackcnzie).—\Y. J. Simpson, L. 1./22, 404 ; cf. our p. 753. Lipase Preparation for Injection. A highly active Glycerin suspension of Castor Oil Lipase, made according: to the method of Armstrong and Ctosney, was prepared in the author’s laboratories in i927; Castor Oil Lipase material, kept dry for two years, lost its lipolytic activity. It was proved that treatment of the Lipase material with 5% Sodium Chloride did not appreciably alter its activity, also that a clear filtrate, e.g., after centrifugalising a suspension of de-ricinised material in 50% Glycerin and Water was void of fctt-s&fittincg power. The conclusion of the experiments was that such a preparation was useless for clinical use, being toxic. A Soy Bean extractive was also unsatisfactory. SINAPIS. Mustard. The dried ripe seeds of Brassica nigra (Semen Sinapis, P.G.V., P. Austr., E.E, VIII., P. Ital., P. Belg. IV.), andB. alba(N.O. Crucifer cz), powdered and mixed. The condiment sold as mustard consists of this mixture from which the cortical portion of the black seed has been removed. Uses.—ALs an emetic a tablespoonful in half a pint of warm water. In small doses is a stomachic and appetiser. Externally a counter irritant when applied as a poultice, or added to hot water and used as a foot bath. It may blister tender skins. Linimentum Sinapis (B.P. T4). Volatile Oil of Mustard 3-5% in a Castor Oil, Camphor and Alcohol mixture. Oleum Sinapis Expressum. Sp. Gr. 0-921 to 0-923. The average content of Expressed Oil in the black seeds is 26%. In the white 27%. Used as a rubefacient. Comparison of Chinese Colza Oil (ex Brassica Campestris v. Chinoleifera), Black Mustard, White Mustard, Rape Oil and other varieties.—P.J. i./2i,519. Oleum Sinapis Volatile. Average dose (U.S. X.).—J minim (0*008 Cc.). Consists principally of Allyl-iso-sulphocyanide. Er, Cx. and P. Belg. IV. make the chemical synonymous with Oleum Sinapis Aethereale. Sp. Gr. 1-014 to 1-025. B.P. T4 requires a content of 92% of this substance. Sot able about 1 in 50 of water, readily in ether and alcohol. This solution is suitable as a rubefacient. Percentage of volatile oil from Black Mustard seeds varies from 0-63 to 1-23, according to geographical source. English seeds yielded 1-07%.— Einncmore. Volatile Oil of Black Mustard is a powerful antiseptic. It has been used as a preservative for wines, 1 in 100,000 stated to be effective without affecting their odour or flavour.—Einnemore. Cochlearia Armoracia, radish, turnip, watercress, contain mustard oils.—Wild, P.R.S.M., Ther. Sec. Minimum fatal dose of Allyl-iso-suiphocyanide is stated to be 1 minim per kilo. It cannot be recommended for internal use. Excessive inhalation of the essential oil into the nostrils is dangerous. Allyl Sulphide, Allyl Isothiocyanate, Acetate and Allyl Alcohol investigated as to action on rabbits and pithed frogs—the Isothiocyanate is most powerful and the Acetate the least. They all affect the respiratory system and the circulation. A complete research into the physiological action of these bodies. —B.M.J. ii./i i,609. Vide also Oleum Allii Essentiale. Spiritus Sinapis, P.G. VI. Oil (volatile) 1 to Alcohol (90%) 49. s^Musterole (T.M, 350827, 496249, 515576). A counter-irritant for rubbing into the skin as i^reventive against chills and for rheumatic pains. Thiosinamin.—Syn. Ehodallun, Allyl-thio-urea, Allyl-Stjlpho- carbamide. F.E. VIII. SC.NH.C3H6NH2= 116-1384. Dose.—Intern ally \ gradually increased to 1J grains (0-03 to 0*1 Gm.) (with caution—in capsule or alcoholic solution). Hypodermically lj to 3 grains as in the form of Injectio Thiosinamin et Sodii Salicylatis vel et Antipyrin. (T.M.: Eibrolysin is no longer a Trade Mark. Mo. 271208 expired 1919, through non-payment of fees. Fibrolysan No. 319G29/1909, is also wound up.) Manufacture.—To essential oil of mustard 456 6m. add in portions strong solution of ammonia 200 Gm. in Alcohol 200 Cc. The mixture becomes hot (or slight warming may be required to promote interaction)—cool down below 40° C. and shake until the odour of the mustard oil disappears. Evaporate at 40° C. to about 650 Gm. and leave to crystallise. lie crystallise from water. The crystals have melting point 74° C. Evaporate mother liquor and wash further crop of crystals with water and then with ether. Slight modifications of this process will be necessary as experience shows. Start ivith good Mustard Oil. Soluble in water 1 in 18, alcohol about 1 in 2, and in ether. Flavoring.—It is practically void of taste. Uses.—To some extent internally, but chiefly by injection (vide infra) with Sodium Salicylate, for absorbing fibrous and scar tissue. Has been used for keloid and in scleroderma. Tinnitus aurium has been treated by 5% aqueous solution hypodermically with improvement, dose being increased from 6 to 35 minims, also a 10 /0 solution and a 20% Glycerin Solution. Should be tried before operating on the middle ear or labyrinth for this trouble. . . . Pericardial adhesions have been treated by o. gram doses m 80 minims of water, every other day in the flanks, for 30 days. . . Scar keloid resulting from a burn received 5 injections of Thiosinamin of 0-2 Gm. with each, 1 day’s interval. Produced poisoning symptoms, sweating, headache (lasting 2 to 8 days). Ultimately the treatment vas curative (after 18 injections). . . . , v. Caution is needed whenever the patient experiences lieaaaclie after the first injection of Thiosinamin. To our knowledge it may cause transient poisonous symptoms. Injectio Thiosinamin et Sodii Salicylatis. Dose.—1 to 2 Cc. every two or three days. Stemles of this Compound Thiosinamin Injection prepared with a special solvent are made 1 and 2 Cc. for use either mtramuse ary or hypodermically, are prepared. 1 Cc. contains approxima e y 0-06 Gm. (1 grain) of Thiosinamin and 0-09 Gm. (1| grains) approx. >fUses'‘-For^eflxing scar tissue, in strictures of the gullet, urethra and 'ctum to stenosis tf the pylorus, rheumatoid arthritis, Dupuytren s con- raction and eye affections (corneal infiltrations). Massage and to middle r the use of bougies In W^‘Ste^Uon^?totuch isTubtfto)and sir discuse and for tinnitus (but the r . x_„i .rnicpipc once or twice 1 pleural adhesions injected locally, or into the gluteal musejes on« or twice 'eekly according to severity of case, tn lnpns has been rued, ft may alue in arteriosclerosis, chronic rheumatism and P _ e- ; yn„ a case 0j Remarkable effect was obtained we are^formed, ^attog^casejl jntracted tendons m a horse. The tendons vve p00f rested 1C fetlock joint became permanently flexed reS'e“ 1 the ground. Action restored to normal a few weeks after injection. Injectio Tliiosinamin et Plienazoni.—Martindale. Syn. Cica TRICINE. Dose.—8 to 15 minims (J to i Cc.). = IT grains to 3 grains (0*i t( 0*2 Gm.) Thiosinamin, 2\ to 5 grains (0*16 to 0*3 Gm.) Phenazom. and 1/20 to 1/10 grain Eucaine Lactate. It has been used in the treatment of cicatricial tissue. A usefu injection, non-toxic and non-irritating. Other substances have the power of providing concentrated aqueon solutions of Tliiosinamin—Sodium Biborate, Urethane, Benzoates, Cinnamatee Glycocoll, etc. Unguentum Tliiosinamin.—Martindale. Tliiosinamin 1, Oleum Anseris Benzoatum to 10. In warn weather 5 or 10% of White Wax may be necessary. Unguentum Thiosinamin et Antipyrin. — Thiosinamin 10% Antipyrin 16*5%, in Oleum Anseris Benzoatum. ‘Anserine’ Mulls of Thiosinamin are prepared 10% strength. Thiosinamin-ethyl-iodide. Syn. *Tiodine (T.M. 294293), Thiodin S = C (NH.C3H5) (NH2 C2H5I) = 272-1104. Prepared by heating Thiosinamin and Ethyl Iodide under a reflui condenser. Forms white crystals melting at 68° C. SolubV readily in water and 1 in 1 in Alcohol (by our experiment). Ampoules are prepared containing 3 grains (0*2 Gm.) of Tiodin* Dose.—The contents of one ampoule every other day. Actinomycosis.—5 cases treated hypodermically with rapid and complei success.—T. G. Moorhead, B.M.J. i./29,419. iodolysin (T.M. 312078).—A similar preparation, stated to contain 43' Thiosinamin and 47% Iodine. Iodolysin solution for oral use, 30 minini containing 1 grain Thiosinamin and 1 grain Iodine, also Injection (hyp dermic), 15 minims, containing 14 grains of each. Ointment and Pigme?s (local) arc prepared. To soften cicatrices and promote absorption of fibre tissue. Rheumatoid arthritis improved by Iodolysin internally.—B.M.J. iL/22 1040. Pills arc made equivalent to 71 grains of Potassium Iodide. In rheumatc: arthritis—2 to 6 pills daily after food. Well tolerated and less depressii than Potassium Iodide.—Sir T. Holder, Clin. Jl., July 11, ’23,330. Iodolysin Capsules contain 2 grains (0-12 Gm.). Dose.—1 thrice daily max. Urticctria may arise from internal use—often an idiosyncrasy. Low use in the case of a bruised semilunar cartilage of the knee, although successf caused absorption in the system, with swelling of the face and irritatii eruption locally.—H. A. Spencer, Johannesburg, Oct., 1930. Thiodotoxyl. A solution containing 10% each of Atoxyl and Th. sinamin-ethyl-iodide. Used in treatment of cancerous growths. SODIUM. Na=22-997. A soft white metal, decomposing water. Is prevented fro» oxidisation by keeping under mineral oil. Sodii Acetas. CH3C00Na,3H20 = 136-0672. Average dose.—15 grains (U.S. X. 25 grains). Colourless crystals or white powder. Soluble in water about 1 in: with alkaline reaction, and about 1 in 35 in alcohol 90%. Uses.—To some extent as a diuretic. It is excreted as carbonat Flavoring,—Glyl Pini, Syl Lavandulae; Syrupus Aurantt Sodii Chloridum. NaCl= 58-454. Dose.—10 to 60 grains (o-6 to 4*0 Gm.). White cubical crystals. (Natrium Chloratum in German is Sodium Chloride. If the Germans wish to convey Sodium Chlorate they state Natrium Chloricum.) Soluble 1 in 2f of water (not more in boiling water) in Alcohol 90% (about 1 in 200). Flavoring—Syl Ooriandri, Syl Menthse Piperitae. TTses.—Although in common use is not requisite to those having ordinary mixed diet, but is necessary to vegetarians. Given in excess leads to scurvy, while insufficient salt leads to anaemia, debility and oedema of face and ankles. Large doses are emetic. Asa purgative maybe given in dose of 120-240 grains. As a laxative, 75 grains in a tumbler of cold water, it is stated, acts efficiently and without pain. Rectal injections are used to kill threadworms. Hypodermically or into the veins as Normal Saline Solution, q.v. Saline Solution, Normal. Physiological Salt Solution. This should be isotonic with the liquid of the blood corpuscles and possess the same osmotic pressure as the liquor sanguinis. For man a solution of sodium chloride 0-9% (U.S. X. 0-85%), or approximately 80 grains to the pint of boiled water, freezing at closely— 0-56° * C., is generally used for intravenous injection in haemorrhage, uterine flooding, or collapse. The injection should be made at least at 105° F. (this is important), into any convenient vein, the rate of injection varies ; it may be as rapid as a pint in ten minutes, or as slow as 8 ounces per hour (see refs, infra.). Injections are also made into the rectum. Solute de Chlorure de Sodium Isotonique, Injectable. Fr. Cx. Supp. Nouv. (1926) is 0-8% sterilised at 120° C. for 15 minutes. Fortunately only c&n approximation to an isotonic solution is necessary, as mucous membranes are practically insusceptible to changes in osmotic pressure within fairly wide limits. The solution should be slightly alkalised. 0-1% Sodium Bicarbonate is sufficient.—Marshall. Isotonic Sodium Chloride for Ophthalmic use is 1*4%. Rules for Isotonic solutions—P.J. k/29,325. , The Lacrvnial Secretion is stated to contain 1-3% Sodium Chloride and 0-5% Albumin It has tommigBerted to now is SodiumThloride 0-8, Potassium Chloride 0-0075, Calcium Chloride 0 01, Sodium Blmb^te 0-01, to 100. Chloride 0-02, Sodiun^Bicarbonate 0-015, Mstilled'waterto lOO.-P*. W»,857. P. Jap. IV. in 58MSS5 & «|^iSrerebro-spinal miid °‘ ssr 0 042’ Solution, Sterules are prepared for lilution : 1 produces 1 htre. Ringer’s Solution are also made. ‘ Solubes ’ for producing 100 Gc. or Ringer Fischer’s Modified Ringer *rhinridp 0-04 Potassium Chloride 0-02, DiffiTwK6 100.’ CS\e%oyed in surgical practice instead of NTormal Saline, e.g., for dissolving Kerocam. A Fluid having advantages over Ringer’s or Tyrode’s Solution This solution possesses constant value of 7-52 at 37°, is isotonic with blood* is steritisable and contains calcium and potassium in a ratio approximating to that in arterial blood. Similar relation exists between total uni- and bivalent positive ions. Stock Solution contains sodium chloride 10-5 Gm. potassium chloride 0-5 Gm., magnesium chloride 0T Gm., calcium chloride 0-3 Gm., nh phosphoric acid 5 Cc., and 50 Cc. of water. For use filter 50 Cc. and add 1 litre of water, heat and when cool saturate with oxygen, and add 5 Cc. of sterile n/t sodium carbonate solution.—J.C.S.A.,, 1922, i., 964. Saline Solution Sterules contain ill saturated solution sufficient for two pints. ‘ Solubes ’ Sodium Chloride, 20 grains each, are useful for producing extemporaneously 5 ounces of a normal saline solution. Uses and References.—Largely employed in surgical shock by intravenous and rectal injection; also in post partum haemorr hage. Particularly useful in the haemorrhage of typhoid. Also aids recovery from poisoning by Carbolic Acid, Morphine and Alcohol- Vomiting, recurrent of infants (given per rectum or subcutaneously),, cholera, pneumonia, uraemia, relapsing fever, delirium tremens,,, tetanus and diphtheria have been well treated by subcutaneous ancB intravenous use. Eclampsia has been treated by intravenous injection in severe cases, bur the treatment is condemned by others as being dangerous, especially wher® kidneys are involved. Gonorrhoea.—1% Saline solution lias many advantages over a 1 in 10,000 Potassium Permanganate solution for posterior irrigation.-—B.M.J.E. ii./29,4S; Surgical Shock.—Saline Fluid injected to the extent of 300 Cc. perkilo>. causes embarrassment and failure of respiration. When the causes of shock arc active an injection of fluid cannot force recovery.—J. D. Malcolm, M.P.C. May 17, ’22,420. Instead of Saline injections, Gum Saline-Bayliss (Sodium Chloride 2 Gm.. Potassium Chloride 0-05 Gm., Calcium Chloride 0-05 Gm., Gum Acacia 5 Gm.. Distilled Water 100 Cc.) is advocated for loss of blood if actual blood transfusion is impossible.—H. Pritchard, B.M.J. 1./27,793. See Acacice Qummi. In certain mental diseases in which there was a toxic element a litre 0 Ringer-Locke injected twice weekly.—J. P. Steel, B.M.J. ii./27,1177. Plombiere douches can be given at home—1£ to 2 pints slowly. Norma saline at 100° F. Two or three douches a week the maximum. Three week for a course. Use a rubber rectal tube, with end lubricated. Tube inserteu. 3 inches—generally 2 to 24 inches (it depends—some say 6 inches), patien being on left side.—B.M.J. ii./25,545. Rectal injections of Saline 2 pints to which Aspirin 15 grains and Brand. 1 ounce were added, following operation in consequence of traumatic ruptur of the spleen.—W. H. Cam, B.M.J. i./i6,200. Hypertonic Saline Solution.— Sodium Chloride 5% in distillec water with |% Sodium Citrate added (the proportion is sometime varied up to 10% of salt and 1% Sodium Citrate). Cholera.—Before giving hypertonic intravenous injections of saline precede with an alkaline injection of Sodium Bicarbonate 2 drachms, in wate 1 pint.—L. M. Chattergee, T.D.B., Vol. 19, 1922,740. In the collapse stage give intravenous injections of Hypertonic Salim solution, with Calcium Permanganate os, % to 2 grains increased to grains to the pint and in 2 grain pills every l hour for first 3 hours and then hourly till stools become green. Give Sodium Bicarbonate intravenous! up to 320 grains. Control temperature by cold sponging and iced wate- rectal injections. Prevent ursemia by increasing blood-pressure—Digitalii Stronhanthin, etc.—Sir L. Rogers, L. ii./i 5,219. Hypertonic Saline intravenously no better than carminative 4 Cholera Mixture containing a little Opium —J. W. Tomb and G. W. Thompson, Trans. Roy Soc. Trop. Med., April, ’27,516—521. Sir L. Rogers replies supporting his views on value of the injections.—ibid., Nov., ’27,200. One of tile effects of injecting Hypertonic Saline into the circulation is a diminution in the volume of the brain—hence of use in post-contusional or post-concussional states—for relief of headache—even 100 Cc. of 30% solution can be given, but usually 50 Cc. of 15% effective—A. Feiling, B.M.J. ii./3o,907. Toxemias of later pregnancy. —Hypertonic Saline — harmful,— V. J. Harding and H. B. Van Wyck, B.M.J. ii./3o,589. Acute intestinal obstruction well treated immediately after operation by 20 Gm. Sodium Chloride intravenously in 10% solution 30 Cc. at a time during 48 hours (maximum 70 Gm. for a man of average weight) with 1 litre physiological serum subcutaneously during the same period.—B.M.J.E. i./28,32. Varicose veins have been treated by injection with strong Saline as sclerosing agent. Large amounts—10 Cc. for one injection, up to 20 or 30 Cc. at one time ; or with 5 or 10 Cc., 3 or 4 injections at one sitting. A more adherent and exclusive thrombosis and a better end-result than with other agents.—Gillespie and Strobel, B.M.J. ii./3o,60. Sodium Chloride 20% (as used by Linser of Tubingen and McPheeters of Minneapolis) the ‘ safest as far as systemic reaction is concerned.’—T. If. T. Barber, B.M.J. i./30,219. Retards clotting of the blood, and incapable of giving rise in the ordinary way to any thrombosis, either at time of injection or subsequently. Probably the most efficient and safest to use and will remain so until the ideal solution is discovered.—ibid., B.M.J. iL/30,60. 4 to 10 Cc. of 20% solution gives good results, but is not certain in its effects and causes cramp-like pains.—A. H. Douthwaite, ‘ Injection Treatment of Varicose Veins ’ (H. K. Lewis), 5tli Edn., 1929. Salt Packs, i.e., by packing wounds with Salt or Salt Tablets in gauze, i were much used to wounds in war. Antiseptic Power cf Hypertonic Saiine. The inhibition of growth, e.g., of Staphylococcus pyogenes aureus and Bacillus Coli by 5% hypertonic saline, experiments showed, is very slight. With 10 or 12% salt, there was no proliferation of the organisms in question.—L. Garrett Anderson and co-workers, L. i-/16,1119. Hypotonic Saline Solution St.G.H. is 0*3%. Trunecek’s Serum for nervous ailments and high arterial tension. Dose.—Subcutaneously 1 Cc. to commence with, increasing by 02 Cc. May also be given by rectum and mouth. Sodium Chloride 492, Sodium Sulphate 44, Sodium Phosphate lo, Sodium Carbonate 21, Potassium Sulphate 40, Water to 10,000. Tablets of Trunecek’s Serum are prepared 5 grains each, i.e., equivalent approximately to 5 Cc. of the serum. Daily dose o m with meals. Administration per os is equally effective. For atheroma and sclerosis of arterial coats. Trunecek’s Serum has a freezing point—3-29 C. and an osmotic pressure 5-875 times greater than blood serum—i.e., it is strongly hypertonic. Cheron’s Serum.-Sodium Chloride 2, Phenol 1, Sodium Phos- phate (Na2HP04, called Neutral Phosphate in France) 4, Sodium Sulphate 8, Distilled Water to 100. Gelatin Saline and Glucose Sterules are described, pp. 424, 428. Gum Acacia with Sodium Chloride for intravenous injection) to replace blood lost by hemorrhage, see p. 1. Hayem’s Solution. Sodium Chloride 5, Sodium Sulphate 1C Water 1,000. Sterilise. Cantioir.—This must be distinguishe from Hayem’s Blood Examination Fluid which contains Sublimate Artificial Sea Water. — The following has been advised fo> injection as enema :— Sodium Chloride 27, Magnesium Chloride 3, Potassium Chloride 1, Mag nesium Sulphate If, Calcium Sulphate 1, Distilled Water to 1,000. Natural Sea Water has been injected hypodermically in eczema ant digestive disorders : see Edn. XVIII, p. 745. Aetheitis treated by injections of sea water, the dose varying from 10 t: 500 Cc.—T. E. Lawson, Pr., Aug., ’27,122. Enema Sodii Chloridi, N.E.H. Sodium Chloride J ounce, Warm Water 10 ounces. Use from 1 t. 6 ounces for children according to age. Dechlorination or Salt-free Diet. Nepueitis has been treated by this (in many forms of nephritis the kidney fail to eliminate salt). Copious diuresis sets in, oedema disappears and remain more or less absent so long as the treatment is kept up. Eood should I cooked without it. The salt-free diet is, however, often disappointing. U should be tried where heart and lungs are hampered by excessive oedema and in migraine and chlorosis. The theory of salt retention does not, howeve wholly explain oedema following gastro-enteritis in children nor all cases c oedema in Bright’s disease. Epilepsy has been treated by Sodium Chloride reduction. Reduce tl salt in the diet and the absorption of Bromide will increase. The combine* treatment, e.g., with Bromide Tablets containing 2 grains of Salt and IS grair of Bromide to be used to salt broth, satisfactory. Carbohydrates increase the retention of water while fats diminish thirs 1 f no salt be added to the food the body loses 15 to 25 6m. of sodium chloric! and 1£ to 21 kilos of water ; a saltless diet is therefore itself diuretic. Generali speaking, the intake of water and salt increases the quantity of water taken u by the tissues and consequently may cause oedema.—P. E. Morhart, B.M.J.E L/26,86. See also Table Salt containing 50% Potassium Chloride under Pota:* sium Chloride. Sea Water. According to Pasquier, Sea Water is a gentle purgative after being saturate with Carbon Dioxide, the dose being 1 to 1 pint.—C. D. L/30,88. Sea Salt. Syn. Bay Salt, Citean Salt. Obtained from Sea Water, which contains about 2-7%. In warm countries the water is allowed to evaporate in the air, and in cold countries it is allowe to freeze, when the ice is removed and the mother liquor then evaporated — C. D. i./30,88. Bromine Therapy is due to disturbance of the normal Chloride in the bod by Bromine. If part of the normal Chloride is replaced by Bromide a smaller quantity of the latter is needed to produce an effect. A diet with low sa content is unpalatable. A double salt of Glutaminic Acid has been usee; and a modification containing 60% Bromine renders it possible to give Bromio and reduce salt intake. The preparation should be useful where the miners salt and water balances are disturbed. Used in various oedemas wher dehydration is required.—B.M.J.E. L/30,12, Baths of Common Salt (or Tidinan’s Sea Salt), about 2 pounds t each bath, act as a tonic and stimulant, e.g., in chronic rheumatism. Sal Marinum Artificiale.—Potassium Iodide 1, Potassium Bromide Calcium Chloride 40, Magnesium Sulphate 200, Bay Salt 760.—Ph. Note ^Gerebos (T.M. 227704) Salt. Sodium Chloride with 4% of phosphates, mostly Calcium Phosphate, less deliquescent than Salt. Is intended to replace the phosphates removed in the preparation of food. Sodium Phosphate stated to be added to Table Salt to-day to prevent its going moist.—B.M.J. iL/27,28. Digestive Salt. Syn. sjePEPSALlA. (T.M. 90722.) This consists of Sodium Chloride and Pepsin. Pulvis Sodii Ohloridi Compositus. Sodium Chloride 6, Potassium Chlorate 1, Alum 1, Boric Acid 1, Borax 6. A saltspoonful in a half tumbler of warm water as a gargle is very beneficial for inflamed conditions of the throat. Unguentum Sodii Chloridi. K.C.H., St. Bart.’s H. Unguentum Salvas R. V.I. Sodium Chloride and Soft Paraffin, equal parts. R.N.H. has Sodium Chloride 1, Sodium Bicarbonate 1, Soft Paraffin to 4. liingworm (of hairy regions). Croton Oil treatment is painful. Use this Ointment instead. Pub in daily, after bathing the head with very hot water. Even more painful than Croton Oil.—A. Whitfield, L. i.A3,1124. Sodii Bromidum. NaBr — 102-913. Dose.—5 to 30 grains (0-3 to 2 Gm.). Slipule No. 0 holds 10 grains. Tablets, 5 grains (0*3 Gm.). Dose.—1 to 6. In slightly deliquescent granular white crystals, tasting like common salt; soluble 8 in 9 of water. (Natrium Bromatum P.G., PR. Cx., P. Hung., is Sodium Bromide. Natrium Bromicum abroad is Sodium Bromate NaBr03. Some countries, e.g., Sweden and Holland, use Brometum to convey the Bromide.) Flat 'ovinij.—Syl Menthue Piperitae, Glyl Coriandri; Syrupus Aromaticus (double dose), Syrupus Zingiberis. Uses.—In insomnia, maniacal attacks and hysteria. Full doses combat morphine habit. A mixture of bromides in the proportion of sodium bromide 2, potassium bromide 2, and ammonium bromide 1, is said to have a better action than one salt alone It is used as substitute for the salt in the ‘ saltless ’ ( ‘ hypo- chloridization ’) treatment of epilepsy. (See also Sodium Phosphate*) The theory is that diminishing the chloride increases the readiness with which bromide enters the blood stream and nerve elements. cf. Dechlorination, p. 762. The addition of 20 drops of Sal Volatile, or 5 drops of Fowler’s Solution to the treatment prevents the rash which often disfigures patients taking Bromide. Delirium Tremens in America treated by subdural injection of 1% Sodium Bromide Solution after removing 50 or 60 Cc. of cerebro-spmal fluid. Delirium controlled.—Boston Med. & Surg. J1., Oct. 30, 1913 I D. ii./i3,la62.. Tabes.—Intrathecal injection of Sodium Bromide recently tried. 1% solution used. In spastic patients, 1-6% (isotonic with body fluids.) 10 Cc. of cerebro-spinal fluid removed and the same quantity of solution introduced. —L.i./23,607. _ . q Gall-bladder and gallstone pictures obtained in 60% of healthy persons and over 80 % of those with diseased gall-b la eld eis, o administration by the mouth of a single dose of 10 to 20 Cm. kednm^ Bromide or Strontium Bromide dissolved in 100 or 150 Cc. of water. Bontgei ogi, 111s taken at 5 to 12 hours afterwards. Patient should be on’s ei> light diet the preceding day.—Presse Med., Aug. 29, ’25, per Jl. A.M.A. n./25,l~b0. See also ibid, ii. /2 5,74. 1M Urinary Racliolocsy, Ammonium Bromide preferable to the Sodiu salt, a 25% aqueous or Glycerin solution being used.—B.M.J.E. ii./27,10s Eczematous Processes. Sodium Bromide intravenously, 10 C of a 10% solution, said, to be beneficial. Two to 5 injections usual sufficient, but up to 15 may be necessary. Chronic eczema showc least response.—Jl. Intrav. Therap., Jan. *26,20. 3$c Sedobrol (T.M. 347485) Tablets weigh 2 Gm., and contain IT to 1-2 Gi of Sodium Bromide and 0T Gm. Sodium Chloride, in addition to vegetal! extractives and fat. Suggested for salt-free Bromide Treatment or diet—t tablet being simply covered with 100 to 200 Cc. of hot water to produce bouillon for use in nervous affections, epilepsy and migraine. Dose.—1 to 3 tablets pro die. Sodii Bicarbonas. Syn. Sodii Carbonas Acidus, Sal de Vices F.E, VIII. NaHC03-84-0048. Dose.—5 to 30 grains (0-3 to 2-0 Gm.). Occurs in small white crystals or powder. Soluble 1 in 13 <r i water ; 20 parts are neutralised by 17 of Citric or IS of Tartaric Acic Is largely employed in dyspepsia and is of value in diabetes. A litt] rubbed on to the gum or placed in the cavity of a tooth, may sto* toothache. Large doses very useful in infantile vomiting; t neutralise the acid intoxication in these cases 100 grains are give when attack threatens, or smaller doses, e.g., 10-15 grains every hoi2 on premonition or attack commencing. It is given in rheumati affections and in gastric ulcer and found of value in suppression c urine. Incompatible with acids and acid salts, and with metallic an alkaloidal salts. Bismuth, Magnesium and Lithium Benzoates and Salicylates are incon patible with Sodium Bicarbonate. It is also incompatible with Aspiriir Acetates of Lead and Zinc liberate C02 from it. Flavoring.—Svl Lavandulae, Syl Amygdalae Amarae ; Syrupu Aurantii, Elixir Simplex. Sodium Bicarbonate Stemles, 3 Gm. in 45 Cc., are prepare* for dilution as required. Sterilisation by heating at 100° C. in th Sterule converts approx. 5% of the Bicarbonate into Carbonate. Diabetic coma treated by intravenous injection of 1 litre of 3 to 5% solutio* slowly (in I to £ hour). Isotonic Sodium Bicarbonate Solution is 1-35 Gn with water q.s. to 100 Cc., or use 1-29%.—P.J. b/29,325. In a normal person 2 drachms of Sodium Bicarbonate per os will usuall render the urine alkaline in 24 hours. In chronic nephritis the effect i produced by the same dose, but in pregnancy toxaemia a larger dose is required; —L. i./i3,13G0. Influenza.—Sodium Bicarbonate, 20 to 30 grains four times hourly, relieve* abdominal pain and distension, and probably inhibits growth of the strepto coccus and neutralises its toxin, the organism being in the bowel.—H. G Butler, L. i./22,198. Bost-partum eclampsia treated by intravenous injections of 3% Sodiuu Bicarbonate Solution, 250 Cc. and 350 Cc. three hours later.—X. P. MacPhaii U.F.C., ’27,171. See also H. P. Wilson, Jl. A.M.A. i./27,380. Pyrexia in infants of a few days or weeks old may often be due to pyelitis in which Sodium Bicarbonate with abundant water is of use.—L. ii./25,510. Collutorium Alkalinum Compositum (was in R.D.H.) Sodium Bicarbonate 15 grains, Sodium Chloride 10 grains, Sodium Salicylat 1 grain, Thymol, Menthol i grain each, Glycerin of Borax 1 drachm, Thymo Solution to 1 ounce. One part to be used in 4 of water. Lor post-rasa- catarrh. Coliunarium Alkalinum Gompositus, R.O.H. Nasal Douche. b odium Bicarbonate 2 grains, Borax 2 grains, Sodium Chloride 2 grains, Sugar 5 grams, Water to 1 ounce. Nebula Alkalina, T.H. Sodium Bicarbonate 15 grains, Borax 15 grains, Carbolic Acid 4 grains, Glycerin 45 minims, Water 1 ounce. Dobell’s Solution is appiox. half this strength. Nebula Sodii Bicarbonatis. Sodium Bicarbonate 20 grains, Glycerin 1 drachm, Water to 1 ounce. Bain dit de Vichy. Fit. Cx. Sodium Bicarbonate 500 Gm. dissolve in the bath at time of use. Sodii Carbonas. l\Ta2C03,10H20=286*15. Lose.—5 to 30 grains (0-3 to 2-0 Gm.). tVSanufcictar&.—From Sodium Chloride either by (the Solvay or Ammonia process) interaction with Ammonium Bicarbonate and subsequent ignition (Sodium Bicarbonate is an intermediate product), or by converting it into Sodium Sulphate and the action of heat on a mixture of the Sulphate with Carbon and Calcium Carbonate (Leblanc process). Soluble in less than 2 of water and effloresces in the air. Uses,—Internally in gout and skin diseases and for ‘acidity.’ A lotion, 2 grains to the ounce, relieves eczema. 1% is used as mouth wash or nasal douche. Instruments are boiled in a 1% solution to sterilise and to prevent rusting. Exposure of sodium carbonate to moist air results in its gradual transformation to the hydrogen carbonate. (15—20% in 13 days.)—J.C.S.A. ii./2i,639. Diabetic Coma.—The intravenous injection of 30 ounces of 3 to 4% solution affords best chance of restoring patient, but the Bicarbonate would seem preferable. A 5% solution has caused death. Ringworm.—Melt the end of a piece of ordinary washing soda the size of a walnut by holding against a red hot poker, and rub freely into the affected part (hair cut off if necessary). Practically painless and stated to be infallible. Apply Boric Ointment if necessary.—B.M.J. i./i3,49S. Liquor Sodii Oarbonatis R.O.H. To Sterilise Instruments.-—Sodium Carbonate 1 ounce, Sterile Water to 80 ounces. Boil Graefe Knives 4 minute, other instruments 3 minutes. Sodii Carbonas Exsiccatus, Approximately 107 of the exsiccated salt are obtained from 284 of the crystals. The salt is seldom used internally as such. Sodii Carbonas Monohydratus. U.S. X. Syn. Sodii Sesqui- carbonas Na2C03H20=124*0096, is known in commerce as Concentrated ‘ Crystal Soda,* and used as a Bath Salt—water softener. It occurs in small silky crystals. Sodii Chloras, Sodium Chlorate. F.E. VIIL NaC103= 106*454. Dose.—10 to 30 grains (0*6 to 2 Gm.). Less toxic than Sodium Chloride. Average lethal dose in rats intraperi- toneally 6 Gm. and 5 Gm. per kilo respectively.—J. L„ Ulrich and V. A. Shternov, Jl. Ph. & Exp. Tlier., Jan., ’29,10. Caution. ■—Not to be rubbed with combustible substances. Colourless crystals with saline taste, soluble 1 in less than 2 parts of water, and 1 in 34 of 90% alcohol. . Used in diphtheria, stomatitis, sore throat, and in urethritis. Tablets of Sodium Chlorate and Borax, 5 grains. Useful in loss of yoice and relaxed throat. Gargarisma Chlori. Syn. Euchlorine Gargle. Mix in a pint bottle Sodium Chlorate in powder, 10 grains wit I Hydrochloric Acid, 30 minims and let the gas generate and replae j the air in the bottle, then cork the bottle, and let it stand for tw i minutes ; lastly add gradually shaking after each addition, Distille; Water to 1 pint. This is a good antiseptic, cf. Vol. II. According to the hypothesis that 4NaC103 ( = 4 x 105-71) are decompose by 12 HC1 (= 12 X 36-5) yielding 12 Cl (= 12 x 35*5) (in part ? as ClOj. this gargle contains about 10 grains of Chlorine, in other words it is abon 0-125% Chlorine. Useful to remove follicular patches, e.g., in diphtheria 2 or ounces in a quart jug may be used as an inhalation (cold). If salivation shows itself in Mercurial treatment of syphilis, Sodium Chlora ■ or Potassium Chlorate mouth-wash or Sodium Chlorate internally 10 to 2 grains best.—W. Ivnowsley Sibley, Pres., Mar., ’21,162. Poisoning by Chlorine.—Treatment will be found unde Poisons at end of this volume. Sodii Citras. 2C3H4(OH) (C00Na)3+UH20=714-2316. Dose.—10 to 60 grains (0-6 to 4 Gm.). Granular crystals or powdei Intravenously, rabbits tolerate up to 0-4 to 1*6 Gm. per kilo suitably diluted, or approx. 6-4 to 25-6 Gm. per 10 stone man (o Meeh’s Formula q.v.). Solubility—1 in 3 of water. Is given as a cooling saline iu ft preference to Potassium Citrate. Sodium Citrate with 2H30, in small crystals which are perfectly dry am remain stable, is now the article of commerce. This is official in the U.S. X 5 parts of this = 6 parts of the powder with 54H20 as above.—See also C. A Hill, P.J. i./23,153. Video ring.—Glyl Aurantii Amari or Syl Vanillse. Uses.—Sodium Citrate is oxidised into Carbonate in the systern and hence has alkaline effect. It has anticoagulent properties ant is added for this reason to blood in transfusion. Solutions of strength 3-8% are used for washing out syringes am apparatus in blood transfusion and a small quantity (about 10 o 15 Cc.) is mixed with the blood at the time it is drawn from th< vein. See also refs, under Blood Transfusion. Sodium Citrate Tablets.—5 and 10 grains. These are used for infant feeding—(1) For weaning the healthy infant; (2) for increasing the amount of milk taken in the 24 hours (3) for correcting milk dyspepsia (prevents formation of large clots) (4) for the avoidance of scurvy. In the case of a child 4 months old commence with proportion o 1 grain to the ounce of milk, increase to 3 grains if necessary. Som< add in addition double the amount of Sodium Bicarbonate. The Citrate is thought to influence the clotting of milk by precipitating tli bulk of the Lime Salts. Some claim, however, that the Citrate redissolveji the precipitated Salts. For Hospital Patients prescribe 2 grains to each ounc of milk (first brought to the boil). If 4 ounces of milk are given every 3 hour 8 grains in 1 drachm of water may be ordered (others advise 1 grain only U each ounce). SODIUM. 767 fJrMiaSy/atients do wel1 011 a Pure milk diet (24 to 3 y-dl *Uted ai]d Sodium Citrate added with advantage, but several difficulties arise m use of milk for nephritis.'—Pr., Aug., ’09,157. Mi^r^ri^^r»HIm’ir04^ler+* hthaemic ’ conditions.—Large doses found valuable. Migraine and inveterate neuralgia m gouty adults have been treated. strength—L Tf?2*226* Subconjunctival inJection of solution 4-05 to 5-41% ^,f^°RAHAGE- jaundic® Prevented by injection of 30 Cc. of 30% Aqueous ►solution, 15 Cc. intramuscularly into each buttock.—M.P.C., Nov. 29, ’22,446. Intramuscular injection of Sodium Citrate causes prompt reduction of coagulation time of blood. A 30% solution used, 15 Cc. being injected into each buttock, preceded by injection of Novocain.—B.M.J.E. iL/24,50. Intravenously prevents haemorrhages at operations or delivery’and from mucous membranes, e.g., epistaxis or metrorrhagia, ltise of vascular tension ^A°we<I 1 rw, following solution: Sodium Citrate 20, Magnesium Chloride 10, Water 100 ; inject 15 to 40 Cc—Per Jl. A.M.A. i./26,1170. Malaria, amoebic hepatitis and relapsing fever treated with salts of organic acids, e.g , citrates, tartrates or acetates. Suitable base, e.g., Ammonium: stimulant, Sodium ; non-toxic, to be taken into consideration. Their use advocated in practically all diseases due to protozoal parasites.-—S. L. Rodrigues, M.P.C., Jan. 17, ’23,50. Pneumonia. 30 to 40 grains every two hours may cause rapid lysis. Sea-sickness well treated by rectal injections of Sodium Citrate, 1 drachm to the pint, repeated according to retention and results. Also by the mouth from maximum dose of 14 dr. every two or three hours, downwards.—B.M.J. l/25,140. ^ Thrombosis (threatened or present).—Citrates given with good results.— F. E. Tylecote, M.P., Mar. 27, ’29,261. Venous Thrombosis as occurring in enteric treated by intravenous injections (up to i pint) of 0-5% Sodium Citrate—good results.—H. F. Marris, B.M.J. li./i 7,822. Wright’s Solution.—Sodium Chloride 4, Sodium Citrate 1, Water 120. For sinus washing.—Pye’s Surg. Handicraft. dDCitronin. Dose.-—1 or 2 drachms at intervals of not less than 3 or 4 hours. A preparation containing in each drachm Sodium Citrate 24 grains, Citric Acid { grain,Potassium Guaiacol Sulphonate 1 grain, Cascara Evacuant f minim, Fluid Extract of Ipecacuanha 3/8 minim, Ethylmorphine Hydrochloride 1/32 grain. For treatment of bronchitis. It loosens the dry cough within a short time. Liquor Sodii Ethylatis (B.P., 1898). Is prepared by dissolving Sodium 1, in Absolute Alcohol 20, keeping the latter cool by a stream of cold water ; has Sp. Gr. 0-867, and contains 18% of C2H5ONa. Rapidly becomes brown. Uses,—Effective caustic for nsevi and moles and lupus ; also in hypertrichosis. Applied with a glass rod for 2 or 3 successive days. Eo water should be allowed to touch the part. Liquor Sodii Methylatis. ^ Is prepared on lines similar to the above, employing Methyl instead of Ethyl Alcohol. It is available containing 2, 5 and 10% of Sodium Methylate. Sodii Ethylas in dry form is to be stored in sealed tubes. Sodii Hydroxidum. Soda Caustica. NaOH=40-0048. Dose.—J to 1 grain (0-03 to 0-06 Gm.) well diluted. In coarse white powder, fused masses, or moulded sticks. Sodii lodi&um. Nal= 149-929. Dose.—5 to 20 grains (0-3 to 1-2 Gm.). (Natrium Jodatum, P.G., Fr. Cx., is Sodium Iodide. Sodium Iodate called Natrium Jodicum in German. Some countries, e.g., Sweden an Holland, use Jodetium to convey the Iodide.) A white crystalline deliquescent powder, soluble 3 in 2 o water and 1 in 3 of alcohol 90%. Must be distinguished from th hydrous salt containing 2H20, which crystallises from cold solutions Flavoring.—Glyl Amygdalae Amarae, Syl Cinnamomi. Uses similar to those of the potassium salt q.v. incompatible with Bismuth Salts, Ferric Salts, Strychnine, Spirit o Nitrous Ether (unless made alkaline) and with Quinine Sulphate.—cf. Potassiui Iodide. Mediastinal Growths.—Sodium Iodide 2 or 3 grains with 5 to 7 grains o Chloral every 3, 4 or 6 hours relieves the dyspnoea. The Iodide may hav some effect in causing absorption—not of the tumour, but of the adventitious materials about it, while the Chloral acts as sedative and antispasmodic.— Pr., May, 1911, p. 005. Chronic Rheumatism.—Full doses of Sodium Iodide with Guaiacum givu good results. Goitre is thought to be due to LACK OF iodine in food or water. A Rochester, New York, 20 parts of Iodine in the form of Sodium Iodide ha been added to every billion parts of tap water twice a year for two weeks i the hope of supplying to the human system and the thyroid gland the neede element to prevent goitre in young children. It has been suggested to us sea water in place of common salt. See also Potassium Iodide. intravenously.—Sodium Chloride and Sodium Iodide are practicall; of similar toxicity, and are almost twice as toxic as Sodium Bromide.—E Loeser and A. L. Konwiser, Jl. Intrav. Therap., Jan., ’26,7. Asthma.—1 to 2 Gm. in 10 to 20 Cc. of water has been advocated intra venously.—B. R Loewy, Am. Jl. of Clin. Med., May, 1921. Goitre well treated by six intravenous injections on alternate days o 6 grains in 5 Cc. water.—Reddi, lnd. M.G., Mar., ’27 ; Pres., May, ’28,159. Herpes Zoster.—Intravenous injection of Sodium Iodide 20 Cc. 10®/, solution on the 1st, 2nd, 4th and 7th days (some patients less): also a dustin powder of Zinc Oxide, Camphor, Starch and Morphine. All cases cleared uj in less than 17 days.—Pres., Oct., ’31,352. Syphilis of the Central Nervous System.—Injection of SodiumIodide solution 10%, from 10 to 100 Cc., seemed to have beneficial effects. Th< dissolving of Salvarsan substitutes in Sodium Iodide solution is suggested.— Jl. Ph. <fe Exp. Ther., June, ’26,355. Paresis.—Usual dose 1 Gm. in 10 Cc. water. Doses of 100 Cc. 10% generally well tolerated at 4 to 7-day intervals. Give preliminary test dos< of 20 Cc. As much as 30 to 50 Gm. has been injected in one dose.—Jl. A.M.A ii./29,1753. [jPl)Mistura Sodii Iodidi Composita. Dose.—1 drachm (4 Cc.) thrice daily for an adult. Sodium Iodide \ drachm, Sodium Benzoate 3 drachms, Arsenica. Solution | drachm, Tincture of Pulsatilla 1 drachm, Tincture oi Baptisia 3 drachms, Syrup of Orange 1 ounce, Chloroform Water to 8 ounces. In tuberculosis this mixture is of service. Calcium Salts in large q uantities also essential Sodium iodide as Fyelographsc Ffledium. U.C.H. has a Solution of Sodium Iodide 15 Gm. in distilled water to 50 Cc. Pyelography.—13-5% Sodium Iodide (Cameron) is best. Renal function and pyelography are mutually interdependent.—L, i./29,llC0. Prolonged anuria in a woman following injection of Sodium Iodide 15% to pelvis for pyelography. Relieved by£venesection.—D. D. Pinnock anc W. Matthews.—L. ii./31,529. SODIUM. 769 ethane Sulphonate. Syn. ^Abrodil (T.M. 357434). l.CH2.S03Na= 244-0046. 1 A white crystalline powder containing 52% Iodine firmly held. It does not react with Nitric Acid or Silver Nitrate. Soluble in water, ; m ii Solutions may be sterilised. A 4% solution is isotonic with the blood. On in^rayenous injection 47% is excreted after 1 hour, 76% after 3 hours, 89% at 9 hours, and 93% after’24 hours, he., 3 hours after injection the bulk of it has left the bodv. antiseptic.—L. i./3i,950. ^ J ^ Sodii Nitras. NaN02= 85-005. Dose.—5 to 15 grains (0-3 to 1 Gm.). Has saline, refrigerant and diuretic properties. Sodii Nitris, NaN02=69-005. Dose.—1 to 2 grains (0-06 to 0-12 Gm.). Is obtained by reduction of Sodium Nitrate by fusing it with lead. In white, deliquescent, crystalline granules, or in sticks, with a cooling saline taste, soluble 2 in 3 of water ; useful in angina pectoris and in epileptiform convulsions,—action similar to amyl nitrite. Pharmacology. Minimal effective intravenous dose in rabbits 1-5 mgr. per kilo.--H B Myers and V. T. Austin, Jl. Ph. & Exp. Ther., June, ’29,227. Lethal dose 80 to 90 mgr. per kilo. Asphyxia the major cause of death.—T. V. Oltman and L. A. Crandall, Jl. Pharm. & Exp. Therap., Jan., ’31,126. Compressed Tablets contain 2\ grains each. For asthma 3 to 5 grains frequently repeated ; specially useful with hyoscyamus. Hypodermic Sterules, I Cc. contain J grain (0-01 Gm.), ^ grain (0-02 Gm.), and J grain (0-05 Gm.). Even J grain distinctly affects the circulation, yet large doses do not cause death.—D. J. Leach. The modern treatment of high tension by nitrites had been recommended in the time of Queen Elizabeth—nitre and blood-letting were advocated to prolong life—the nitre contained nitrites. In granular kidney valuable. High tension of the pulse is natural to the disease. Raised arterial tension when dangerous is well treated by i grain doses, gradually increased to 4 or 5 grains. See also Pulvis Potassii Mitritis Compositus and Pulvis Sodii Nitritis Compositus. Tablets of Sodium Nitrite J grain, with Sodium Iodide 3 grains, also prepared 1 grain with 5 grains. To ward off attacks of asthma, 1 every 2 or 3 hours. In attacks of paroxysmal pain, in aortic insufficiency, Sodium Nitrite 2 grains with Sodium Iodide 3 grains thrice daily afford great temporary relief.—Yeo. Tabellae Sodii Nitritis Composites (G. Oliver). Dose.—One or more as required. Sodium Nitrite £ grain, Erythrol Nitrate f grain, Mannitol Nitrate I grain, Ammonium Hippurate 1 grain. A combination of the slowly acting vasodilators, of some promise.—G. Oliver, Studies in Blood-Pressure. VOL. I. B B Poisoning of an infant by taking 3| grains Sodium Nitrite misread fi 3 Sodium Citrate.—L. ii./i7,162. Sea-sickness. Claims for, not established. Not comparable with thr > injections of Strychnine 1/32 grain and Atropine 1/100 grain hypodermical every 6 hours.—A. Vavasour Elder, M.P.C., Oct. 10, ’28,305. Sodii Phcsphis.—Na2HP03-f-5H20=216T, white crystaUir powder soluble in water. Soclii PhosDkas Neutralis. Syn. Tribasic Soditjm Phosphatji Na3PO4+12H2O=380*1982. Used for softening water and for boilers, preventing incrustation jj Soluble in water with alkaline reaction, dissociation giving Sodiui II Hydrate. Sodii Phospiias (B.P. ’14). P. Ital. V., F.E. VIII. Syn. Hydroge jj Di-Sodic Phosphate ; Tasteless Purging Salt. Na2HPO 12H20=358-209. Ph. Ned. V. and P. Belg. IV. have 2H20. Dose.—i to | ounce (8 to 15 Gm.) or 30 to 120 grains (2 to 8 Gm Jj repeated. Colourless crystals or white granules. Soluble 1 in 7 of water, is very efflorescent, loses 63% of i weight when heated to dull redness. Has an alkaline reaction. l lavoring.—It is practically tasteless. A mild aperient, well suited for a delicate stomach ; small dose antacid and diuretic, useful in bilious sick-headache and jaundic For hepatic calculi, 60 grains 3 times a day, with grain sodiua arsenate added, is given if any evidences of gastric intestinal catarrH Fireproofing.—Fairly concentrated solutions of sodium phosphat ammonium phosphate, sal ammoniac, or sodium tungstate (20%) are s useful. Dry Powder Fire Extinguisher. Sodium Chloride 15, Ammonium Chloride 15, Sodium Bicarbonate 2 Mix and pack in thin glass vessels readily broken on throwing into fire.-. P.J. ii./25,393. ^ Nuf (T.M. 470152, Class 47). A white powder recommended for cleanh purposes was found to consist of Sodium Phosphate in a partly effiorese state. Stated to be a natural product. Sodii Phosphas Eifervescens (Martindaie). Dose.—1 to 3 drachms (4 to 12 Gm.). A convenient and pleasant mode of taking this useful purgativ Introduced by W. Martindale, and subsequently included in B.P. ’9< In exophthalmic goitre and neurasthenia of value. As nervine tonic in stomach dilatation—must be persevered wit! ‘ Vescettes ’ of Sodium Phosphate. 30 grains. Dose.—1 to 6 crushed and taken in a draught of w^arm water. Sodii Pliosplias Exsiccatus. Na2HPG4= 142-0218. Dose.—10 grains to 2 drachms in some warm liquid. sjcAlka-Zane (T.M. 485303). , .. ,, Dose.—1 teaspoonful in a glass of cold water 3 or 4 times daily after mea An Alkaline Phosphate preparation. An antacid-diuretic, promoting elm nation of acid products of metabolism and maintaining * alkali reserve. Sodii et Ammonii Phosphas. Syn. Microcosmic Salt. Na(NH4) HP04+4H2G = 209-1264. Used in chemical analys with the blowpipe and for estimation of Magnesium. SODIUM. 771 °lhy“rotien Sodium Phosphate Dose.—30 to 60 grains (2 to 4 Gm.). TlfT p13’!^1?!1! ab°l‘V in 1 o{ water’ and 1 in 300 of alcohol 90%. The i5.P. 14 Salt is 70/0 pure. Is given in alkalinitv of urine with „ooc. results. Particularly useful m cystitis, and after operations on the bladder to keep the urine acid. If diarrhoea occurs; stop its use for a time. F _ a, calcium oxalate stone may be assisted by employing this salt owing to its solvent action on calcium oxalate. The salt given by the mm th eas S^C1‘ I^W0 .0lmces Per diem in 100 ounces of distilled water were administered, and in six weeks no symptoms of stone remained The solvent action oan be demonstrated in vitro. The treatment is advised in cases of Calcium Oxaiate deposit without stone formation Mistura Sodil Acid-Phosphatis L.H. Dose.—A- ounce (15 Cc.). L Hdpimhtinid Fh°^tatew3°e grfins’ R®d Mixture i ounce (Mistura Rubra ±i. r uchsm TA>?y gram, Water £ ounce). Mistura Sodii Acid-Phosphatis Gomposita L.H. With each dose of the previous, patient to take Hexamine 5 grains. Regarding the latest theories of Hexamine Administration see Hexamine. Mistura Antiseptica. Liverpool Royal Infirmary Pharm. (1022) Dose.—B alf ounce, well diluted with water. Sodium Acid Phosphate 20 grains, Hexamine 10 grains, Syrup 20 minims Water to half ounce. ’ y ’ Sodii Sesquiphosphas. Na3H3P208=262-0544. Average dose.—30 grains (2 Gm.) pro die in divided doses. This salt may be considered as a combination of equimolecular proportions of the Ortho-phosphates,—Na2HP04 and NaH2P04. It is virtually neutral to both blue and red litmus. It distinguishes itself as an Ortho-phosphate Compound by not coagulating Albumin, and by yielding a yellow precipitate with Silver Nitrate Solution. Soluble with ease in water Joulie employs this salt where the ‘ Ratio of Phosphoric Acid ’ is deficient and the Ratio of Acidity ’ is normal. It is not at all objectionable to the taste. Hyper-acidity will rapidly yield to the ordinary Sodium Phosphate, e.g., in the form of Effervescent Sodium Phosphate, q.v. See also Vol. II. Sodii Pyrophospilas, Na2P407+10H20=462-230. P. Helv. IV., P. Ned. IV., U.S. VIII., F.E. VIII. Dose.—5 to 30 grains (0*3 to 2 Gm.). Is obtainable by heating the Orthophosphate, Na2HP04+H20. White crystals readily soluble in water. Uses similar to those of the Phosphate. Sodium Silicate and Potassium Silicate. Syn. Soluble Glass, Water Glass, both of which are used for impregnating bandages; also Sodium Silicofiuoride, Syn. Sodium Fluosilicate; Silicosis, and the subject of Glass, are now dealt with in Vol. II. Sodii Persulplias, Sodium Persulphate. Na2S203=238T14. Dose.—1 to 3 grains in water before meals. In small white granular crystals, soluble in water. In tuberculosis and chlorotic and neuropathic subjects stimulates appetite. Useful in hyper-acid dyspepsia at the onset, also in gastric cancer. A strong oxidising and bleaching agent. Liberates about 13% active oxygen. If it is desired to avoid production free sulphuric acid, the persulphate may be mixed with ll times its weight Solium Carbonate. 3 to 10% solutions as gargle and dressing. Suitable f wounds requiring moist dressing and where disinfection necessary. For sms ulcers may be used as dusting powder, with equal quantity of powdered tal Odourless and non-toxic. Tetanus treated by intravenous injection of fresh 5% Sodium Persulpha solution given—60 Cc. each day—preferably in 2 or more doses injected slowl the injection taking some 5 minutes. A reaction often appears—nausea ar vomiting for \ hour. Three cases, with good effect.—L. i./i 8,188. For Ammonium and Potassium Per sulphates, see Vol. II. Sodii Sulphas Acidus. NaHS04-f-H20= 138-0804. Syn. Sodiu: Bisulphate. In crystals or in fused masses, is recommended to purify wate which may have typhoid contamination ; 15 grains to a pint of wate* destroys B. typhosus after 15 minutes contact, as also B. enter itidD Spirillum cholorce and internal parasitic worms. Nauheim Bath Salts are prepared with this Salt and Sodiur: Bicarbonate. The Nauheim Water contains in addition Sodiur and Calcium Chlorides, cf. List of Mineral Waters. Fused Sodium Bisulphate Tablets, 5 ounces and packets c Sodium Bicarbonate for making Effervescing baths were th subject of a patent now expired. Effervescing baths are believed by many to have a more marked effect lowering blood pressure than ordinary water at similar temperature. Sander Carbon Dioxide Baths, with an impermeable cover c air foam, are used as an equivalent of Nauheim and Royat treatmen in diseases of the heart and circulatory system. Sodii Sulphas. Glauber’s Salt. Na2S04.10H20=322-21. Dose.—J to | ounce, or 30 to 120 grains repeated. The form knowrn as ‘ Feathery Crystals ’ is handy for dispensing Soluble about 1 in 3 of water—also in Glycerin ; insoluble in Alcoho Flavoring,—Glyl Vanillse, Glyl Mentha? Piperitse. Infantile diarrhcea.—Small doses have been advised—about 6 graii initially for a baby under 6 months in Dill Water. Children over 6 montl can take 10 to 20 grains without producing aperient action. Sodii Sulphas Exsiccatus. Na2S04.H20= 160-0696. Dose.—J to 2 drachms (2 to 8 Gm.). On drying, Sodium Sulphate Cryst. loses about half its weight. Sodii Sulphas Elrervescens.—Martin dale. Dose.—A teaspoonful or more in half a tumbler of water, take half an hour before breakfast is an efficient evacuant. Sodii Magnesii Sulphas Effervescens —Martindale. Dose.—A teaspoonful or more in half a tumbler of water taken ha an hour before breakfast. These aperients are palatable and convenient to use when travelling ‘ Vescettes ’ of Sodio-Magnesium Sulphate. Each equivalent t 60 grains of the above, to be dissolved in a little warm water. Sodium and Magnesium Sulphates are useful in clearing out tb intestinal tract and lower the blood-presspre (in arteriosclerosis). SODIUM. 773 Sodu-Magnesii Sulphas Effervcscens cum Caffeina— Martindale. Dose.—One teaspoonful or more. A useful “ pick-me-up ” and for headaches. ‘ Vescettes ’ of this preparation contain 60 grains. Chloro-Sodio-Magnesian Aperient.—Martindale Dose.—A teaspoonful or more. An efficient saline purge, useful in migraine and other forms of headache ; also in constipation, and for assisting digestion and relieving depression by increasing the action of the liver, intestines, an,Z- ^neys, and promoting free excretion of waste products. . activity and palatabihty of the last five preparations may be increased, especially in winter, if taken in warm ivater. The combination of the salts of sodium and magnesium makes a more active puigative, but the effervescent sodium sulphate alone is more pleasant. Sal Carolinum Factitium, p.g. vi., Ph. Ned. v., p. Beig. iv. Artificial Carlsbad Salt. Dose. 20 to 60 grains (1*3 to 4 Gm.) in warm water. Mix Dried Sodium Sulphate 22, Potassium Sulphate 1, Sodium Chloride 9, Sodium Bicarbonate 18, all m fine powder. 6 Gm. per litre or 53 grains to 1 pint of water is similar to Carlsbad W ater. Marienbad Salt is similar. Marienbad Salt Tablets may be prepared containing 60 grains of the mixture. Marienbad Antiobesity Tablets. Dose.—One or two at bedtime. Aloes a grain, Rhubarb 1 grain, Cascara Extract £ grain, Marienbad Salt l- grain, Eucus Extract l/6th grain.—P. J. F. " m * ‘ Marienbader * No. 154288 and 154289, also ‘ Marienbader Tabletten No. 242596 are on the Register. Sal Emsanum Facticium, Ph. Ned. V. Sodium Sulphate Exsiccated 10, Potassium Sulphate 10, Sodium Chloride 265, Sodium Bicarbonate 715. Sal Hunyadi Janos Facticium, Ph. Ned. IV. Desiccate Magnesium Sulphate 950 to 500, add Sodium Chloride 50 Sodium Sulphate Exsiccated 450. #Sal Hunyadi Janos (T.M.’s. numerous). Sal Vichy Facticium, (T.M.’s numerous). Ph. Ned. V. Sodium Phosphate (cryst.) 20, Potassium Sulphate 50, Sodium Chloride 80, Sodium Bicarbonate 850. Sal Wildungense Factiicum, Ph. Ned. V. Potassium Sulphate 5, Calcium Carbonate 190, Magnesium Carbonate 190, Sodium Chloride 240, Sodium Bicarbonate 375. To make artificial Wildungen Water use 4-6 Gm. per litre. Dose of each.—20 to 60 grains (1*3 to 4 Gm), increased as required. Sodii Sulphis. ]STa2S03,7H20=252-1632. Dose.—5 to 20 grains (0*3 to 1*2 Gm.). Colourless efflorescent crystals (keep in stoppered bottles). Soluble in water 1 in 2, in Glycerin 1 in 25 ; slightly in Alcohol 90%. Incompatible with acids. Antiseptic. In dilatation of the stomach the late Sir Wm. Broadbent mended as antiseptic treatment Sodium Sulphite 5 to 10 grain doses, with Sodium Bicarbonate and Nux Vomica between meals. As a lotion for skin affections and sores of the mouth, and internally for sarcince in the stomach. Sodii Sulphis Exsiccatus contains about 90% Na2S03 = 126-054. Is used in photography. Being in dry powder is convenient for transit. Sodii Sulphis Acidus. Syn. Sodii Bisulphis. NaHS03= 104-064 Dose.—5 to 30 grains (0 3 to 2 Gm.). White powder soluble 1 in 4 of water. Incompatible with acic Has antiseptic properties. In stomatitis and skin affections. Wai are stated to disappear by applying a solution. Intravenously 2 Cc. of a 5% solution (max. dose) injected in diabetics can rapid transient decrease of Ketone bodies in the blood and urine. It uni with Acetone to form an insoluble compound.—0. Pucoko, Jl.AJVL ii./29,1184. We have no f urther knowledge of this injection. Sodii Metabisuiphis. Syn. Sodium Pyrosulphite. NTa2S03S< = 190-114. Made by passing Sulphur Dioxide into a hot conce trated aqueous solution of Sodium Sulphite. Suggested Dose.—2 to 5 grains (0*12 to 0-3 Gm.). Sodium Metabisulphite 20 grains, Alcohol 90% 1 ounce, Fepp* mint Oil 5 minims, Glycerin 2 ounces. Has been used as an antisep throat pigment. It is said to be a specific to kill yeast fungus in t intestines. In photographic use is similar to the Potash Salt, q.v~ Sodii Sulphidum, Na2S,9H2O=240-1944. Yellowish deliquesce crystals soluble in water. Employed in skin affections and 25 to 40% Aqueous Solution as depilatory. Balneum Sulphuris Alkalinum (see also p. 791). Sodium Sulphide 2 ounces, Sodium Chloride 2 ounces, Sodin Bicarbonate 1 ounce. To be added to 50 or 60 gallons of hot wat< Soda Tarfarata. Sodii et Potassii Tartras. (B.P. ’14). Rochel Salt, Seignette Salt. (CHOH)2.COONa.COOK-f 4H20 282-1826. Dose.—120 to 240 grains (8 to 15 Gm.). Colourless crystals. Soluble 1 in 14 of water. Also in Alcohol 20% (Wt.) at 25° C. 1 in 2-82, 50% 1 in 40-7, 70% 1 in 332 80% 1 in 1665.—Seidell. }Flavoring.—Syl. Lavandulae, Syl. Rosa?; Syrupus Aurani PulvisSodseTartarat£eEffervescens(R.P.’14). Syn. SeidlitzPowd? Sodium Potassium Tartrate, in dry powder, 120 grains. Sodium Bic bonate, in dry powder, 40 grains, in the blue paper. Tartaric Acid, in < powder, 40 grains, in the white paper. B.P. ’14 states approx, these figu in metric terms. * Extra Strong * (3 drachms Rochelle Salt) and * Bou Strength ’ (4 drachms) are also supplied. A Patent was obtained for Seidlitz in 1815 by T. E. Savory of Bond Strc London. ‘ Alkaline ’ Seidlitz Powders are made with additional GO grains Sodium Bicarbonate. „ , . „ , , Seidlitz Powder in Italy is composed of Magnesium Sulphate 15, Sodr Bicarbonate 2, Tartaric Acid 2.—Pli. Notes. PulvJs Effervescens Compcsitus, U.S. X. is similar to Seidl Powder B.P. Sodii Tartras (NButrale). (CHOH.COONa)22rl2^:=230*Oo64. Dose.—As aperient \ to 1 ounce. Diuretic, 15 to 60 grains 3 pcated. White crystalline powder comparatively tasteless. Solul in w ater I in 2. Relaxes the bowels and increases the flow of urir SODIUM. 775 Soaii Sulplioeyanidum. Syn. Sodium Rhodanide, Sodium Thiocyanate. C i N.S.Na= 81-065. Dose.—I to 5 grains (0-06 to 0-3 Gm.). 90^ CryTt solSle in water 1 in 0‘3, and 1 in 0-6 of Alcohol be forrd «pfui fr?^™aGtl°« °?-the nervaus system, is an analgesic and may Favoiirabip oeweV vCm-S arterhif sclerosis, and chronic nephritis, reported CilC^ on pains of tabetics and in angiospastic migraine has been and°nGW ^™*?aUmxrann ammonium thiocyanates were tested on rabbits was split ofl* and these salts did r-> tension. Sodium Sulphocyanate remarkably C1?-S* A teaspoonful of 8% solution ( = 5 grains) well diluted ^nh vvater three times daily after meals.—J. B. Nichols, Am. Jl. Med. Sci., rtov^ 25,735; per Pres., July, ’26,278. Other statements on the treatment have appeared:— 1j10 dose usually recommended is 2 J grains twice or thrice daily after meals three weeb^^10 mix^ure* bfp ^ grains daily tolerated over a period of In hypertension, causes fall in systolic figure usually with no change in cardiac rate, -oess effect in cases with kidney damage or arteriosclerosis. Has a sedative effect and is often mildly hypnotic.—A. G. Smith and E. P. Eudolf, Can. Med Assn. 31., Sept,, ’28, per B.M.J.E. ih/28,86. Hypertension thought due to spasm of the arterioles rather than structural arterial changes. Start with 2 grains thrice daily, increasing after 7 to 10 days % I'! grains if necessary. Systolic and diastolic pressure reduced. Toxic effects m some cases—J. F. Borg, B.M.J.E. ih/30,28. Pressure can be lowered considerably without ill effects, except rarely dermatitis.—B. D. Budolf, L. ih/31,935. See also Potassium Sulphocyanide. Sodii Taurocholas, KaC26H44NS07=:537-4082. Dose. 2 to 6 grains (0*12 to 0-4 Gm.), in pill, keratin-coated to prevent solution until it reaches the bowels. A whitish powder, prepared from pig’s bile, soluble about 2 in 1 of water. It has been recommended for gouty obesity and dyspepsia. Scdii Glycocholas. NaC26H42N06== 487-3326, Dose.—2 to 6 grains (0-12 to 0-4 Gm.). A similar salt, soluble I in 2 of water and 1 in 3 of alcohol 90%, which appears to be a useful cholagogue for congestion of the liver, gallstones, constipation and melancholia. These salts produce slight fall of blood pressure, the taurocholate more than the glycocholale. Bile salts are the only certain cholagogues.— Sir Humphrey Boilcstcn, L. i./25,1207. Pediculosis.—Bile Salts assist oily emulsions to penetrate shell cf louse's egg. Sodium Taurocholate 10 Gm., Oleum Eucalypti 50 Cc., Water to 1,CC0. Solve the Taurocholate in water, add the oil and shake well. This emulsion is wTell rubbed into the head to wet the hair completely. Wrap in cap or towel. Wash with soap and wrater next morning, and a fine tooth comb to be used daily for a fortnight.-—B. A. Peters. Gonorrhoea, Prophylactic.—Bile Salts prevent growth in vitro (Castellani). A solution of Sodium Taurocholate 2 to 4 Gm. in Glycerin £0 Gm. to be applied to the meatus and over the glans before coitus.—Pres., Feb., ’21,77. Infantile Marasmus treated by Bile Salts (increasing fat assimilation). Average dose i grain of the mixed Sodium Glycocholate and Taurocholate for infants of three months.—E. F. Kerby, L. i./2i,272. Bile Salts have been used locally to the conjunctiva. Bile Salts per os lower blood sugar inrabbits and dogs.—Prof. J. B. Maclccd, L. ii./3o,519. Gall-stones obtained in the meat industry in S. America arc sent to Japan for preparation of dyes.—B.M.J. ii./3o,618. Acute !feus. Human Bile used successfully in 9 out of 13 cases. Freshly secreted hums bile from a choiecystomy preferable, but can be kept in an ice-chest for week. Give 2 oz. of bile in 4 oz. Saline per rectum and repeat every 4 hor until definite improvement is seen and bowels have been opened, reverting bile if vomiting returns. Causes no discomfort and no difficulty in retentic Only Water, Orange Juice, and G lucose allowed until ileus is overcome. Be Ox Bile and vomited human bile have also been used, but both cause ace pain and are not so effective as fresh human bile.—It. St. Leger Broekme; L. ii./27,320. Acute intestinal obstruction. The action of human bile often dramatic. L. i./29,442. Cholalic Acid. Syn. * Colalin. (T.M. 271422) Cholic Aci C24H40O5 = 408-292. An active constituent of bile in amorphous yellowish powdo Soluble in alkalis, particularly caustic potash, and in alcoh about 1 in 1 ; insoluble in acids, ether and water. Colalin Tablets (J and J- grain in each. Dose.—One three times dai before food) also contain a little magnesium carbonate. Uses.—Stimulates the liver and increases flow of bile. Has slig depressant action on heart. Solubl in the alkaline juice of the sms intestine—not dissolved in the stomach. For biliousness, mela cholia, recurrent sick-headache and intestinal indigestion. Should constipation occur due to the action the bile has on absor tion of fats, Colalin Laxative (Colalin combined with the principl of Cascara) may be given. Tablets contain 1| grain each. Dose.-. One thrice daily. Decholin (T.M. 489836). A powerful cholagogue, consists of Dehydi cholic Acid. Given intravenously or per os 2 tablets thrice dail3r. Power? stimulant (warn patient) to bile excretion and probably also to the liver ce< themselves.—T. C. Hunt, L. ii./3o,1002. * Opobyl (T.M. 481135). Contains hepatic and biliary extracts, Extracts of Boldo and Combretu Podophyilin and Euonymin. For hepatic and biliary insufficiency. 5*cPa biline (T.M. 397235) has similar composition and same uses. Tablets B.S.C. Contain Bile Acids, Pancreatic Extract, Duodenal Membrane, Ipecacuan and Emodin. For constipation, gall-stones, etc. Desoxycholic Acid. C24H40O4 = 392*312. manufacture.—Obtained by reducing Cholic Acid (Syn. Cholalic Aci C2lH405 with Zinc and Acetic Acid.—Further data Edn. XIX, p. 783. Sodium Desoxycholate. Spray Solution. — Sodium Desoxycholate 4, Quinine Hydrochloride 0 Glycerin 25, Water to 100. For septic throats. Tablets. —Contain Sodium Desoxycholate 1 grain, Quinine Ethyl C bonate l/8th grain, Peppermint Oil l/20th minim, Ammoniated Glycyrrhs 2 grains. Also made with Flavine 1 in 1,000. For infected threats. Bile salts appear to possess a solvent action on pneumococci, also on amce and spirochetes. Sodium Desoxycholate was found to be 10 times. m<i powerful than Sodium Cholate or Sodium Taurocholate. The addition Quinine enhances the action.—F. M. Wells, B.M.J. ii./r7>C. SPHAGNUM. Turf Moss or Bog Moss, Botanical,—There are numerous varieties of Sphagnum indigenous to Great Britain. Large tracts of it are found in Scotland, the English lakes, Dartmoor, Ireland and N. Wales. The large concave leaved plant is Sphagnum Cymbifolium. S. Papillosum is only distinguishable under the microscope from it. S. Cuspidatum has long tapering branches and narrow tapering leaves and grows in water. S. Acutifolium is small, usually in compact tufts with small leaves of various tints. The other common species are mostly intermediate. S. Contortum is like a small Cymbifolium with curved rather stiff branches, S. Reflexum with flat edged leaves and S. Squarrosum with leaves bent back. The plant consists virtually of a large collection of delicate resilient capillary tubes or perforated cells having the effect of a very fine sponge. These cells readily take in water and hold it firmly—the water can be squeezed out without the cells collapsing—(this is the case even after the application of hydraulic pressure.—W. H. M.). Uses,—For some years past the writer has advocated the use of dried sphagnum as the absorbent dressing par excellence for imbibing discharge of any description. It was no doubt used for centuries by soldiers to staunch wounds in war and was also brought into service by blast furnace workers as a protective against heat and as a dressing for burns. The plant in its dry condition will absorb upwards of 20 times its weight of water or discharge. For taking up urinary discharge in bladder, kidney and dropsical affections the material is pre-eminently suitable. The dressing is also useful as a bedding for insane persons. When cotton wool is placed in contact with a liquid, the fluid seems at once to seize it, its bulk becomes diminished, and its surface wet, each fibre having become saturated with the moisture. Moss, on the other hand, seizes the liquid ; its bulk becomes rapidly and enormously increased. The absorbed liquid does not lie on the surface or between the fibres, but is shut up within the capillary cells of the moss ; thus, though it is full of liquid, it does not feel wet, and though it may be full of pus it appears clean. One of the advantages of moss as an absorbent is that the discharge when absorbed by it spreads—diffuses c[uickly in all diiections until the moss is all soaked, rendering it therefore more efficient as a dressing. Cotton wool has not this action the absorption is relatively local—upwards from the discharging surface. Patients state that the dressing is cool while cotton dressings are not. Moss dressings are cheap, deodorant and antiputrescent; hence they are invaluable as applications to foul ulcers or septic abscesses. The dressing may &© wrung out in antiseptic /ohon equivalent to a 1% Lysol just prior to use, though a vast number of the moss dressings used in the war were not sterilised or treated with antiseptic in any way—and this m all probability infection of the wound. Sublimated Moss (0-25% Mercuric Chloride) is also available, ^team Sterilisation is unsatisfactory. . , , , , The writer who started the industry m this country, has had considerable experience in the preparation of Moss Dressings oth m the compressed form, and as muslin covered bags of convenient size for the use of the dresser. ‘ Cavendish ’ Moss Sheets are of size 24 by 15 inches by inch approximately in thickness ; two of these approximate 1 in weight. They are handy for transit, a cwt. packing into a sm case. In use the sheet is lightly broken up and teased out by t nurse and placed between folds of butter muslin or gauze, desired, the entire dressing so made is rung out in antiseptic loti in many cases it will be satisfactory to slip the compressed dressi under the bed sheet as it is. Gauze Covered Moss in the same size and sheet is also prepar ready for use. Moss (Loose) Dressings in muslin bags size 12 by 8 inches, 10 6 inches, and 7 by 5 inches. Moss Pillows 18 by 18 inches are made. Moss dressings are especially suitable for wounds suppurating freely, such wounds the best results will be obtained when the mess is applied do A thin layer of gauze is wrung out of a waim antiseptic lotion and laid cn wound ; over this, and overlapping it freely, are placed the damp bags moss as required. After each bag has been wrung out of the waim loti the contained moss must be lightly opened out with the fingers ; this is d easily owing to the elasticity of the material. Lastly, the bags are hi comfortably in position with a bandage. This treatment of the moss-bag recommended whether the dressings are in the loose or compressed foim, se whether they have been sublimated or sterilised by steam.— C. W. Cathc Sphagnum pads very useful, placed under wounds to collect excess: irrigant antiseptic in the Carrel Dakin method.—B.M.J. ii./i7,597. Sanodora Moss Sheets are impregnated with various essent oils : Bergamot, Birch Tar, Camphor, Clovm, Citronella, Eucalypt Citriodora, Lemongrass, Sassafras and Wintergreen. They e used for absorbing objectionable odours and perfuming the atm sphere in closets, cloak-rooms, kitchens, factories, warehouses, e They are of use as fly deterrents. * ‘STERULES.’ (T.M. 260408, 469165). ‘ Sterules ’ contain solutions made with special care for hypoderm intramuscular and intravenous use ; also for inhalation and ophth mic and ionic purposes. Hypodermic, Intramuscular and Intravenous Sterules are fla shaped or with the two ends pointed. sterules for Inhalation are made of Amyl Nitrite, Aroma Ammonia, Chloroform, Ether, Ethyl Iodide and its combinatio and similar compounds. (See individual headings.) Sterules of Dry Chemicals, e.g., 1 Mercurome,’ and ‘Tylcalsi for making solutions extemporaneously, are also convenient. The Ophthalmic Sterule is inserted through an Ejector, and its * breev end is snapped off at the file mark. It is drawn further through the eje* held horizontally, and the other end is broken off at the file mark. A ‘ breech ’ end of the ejector is now covered with the index finger, and the & part is pressed with the thumb and second finger to release a small quant (sufficient for one application in eye work) of a sterile solution. The file ma are situated i inch from the ends of the * Steruie.’ For list of medicaments in ‘ Sterule ' form, see Index. ^STRAMONIUM. Dried leaves B.P. ’14, and dried ripe seeds, B.P. ’98, of Datura Stramonium (Solanacece). Syn. Thorn Apple. U.S. X. requires not less than 0*25% stramonium alkaloids in the leaves when assayed as for belladonna. F.E. VIII .standardised as latter. P, Belg. IV. and P. Ital. V. not standardised. Fr. Cx. has max. single dose, 4 grains, max. dose during 24 hours, 15 grams approximately. Jjses»—Its action is similar to belladonna, and it is employed for the same purposes. Is a usual ingredient in cigarettes and the fumigating powders employed in asthma. Tincture and Extract of Stramonium have been used in Parkinsonism.—v. postea. The leaves and seeds contain Baturire, which is identical with Hyoscyamine (q.v.) together with Hyoseyamine and Hyoscine. in Spanish the plant is Yerba de liuaco, ‘ Plant of the Graves/ The thorn- apple is used in South America in form of a drink which gives hallucinations in the nature of communication with the spirits of ancestors.—P.J. ii./i2,686. Individual plants of D. Stramonium gave 0-47, 0-55, 0-52 and 0-46% Alkaloid and D. Tatula, 0-47, 0-63 and 0-65%, thus showing a marked variation.— Int. Cong., 1912. Cultivation.—The whole plant can he harvested with or without the root without fear of the total alkaloid content falling below 0-25%.—G. B. Koch, Am. Jl. Ph., Jan., 1919, C. 1)., ’19,303. Datura Motel Seeds from India contained 0-23% of total alkaloid consisting of Hyoscyamine and Scopolamine in proportion 2 : 1 together with a little Atropine. The capsules contained 0-1% of total alkaloid consisting of Scopolamine only.—P.J. ii./12,579, see also P.J. ii./o5,230,617. Prom the seeds of Datura fastuosa var. Flor. coeiul. jplen. which plant is said by many authorities to be identical with D. alba, Schmidt obtained Scopolamine 0-216%, Hyoscyamine 0-034%, and traces of Atropine. The var. D. fastuosa flor. alb. ylen. gave slightly less of the constituents. D. Alba, which grows wild in the Phillipines, as a source of Atropine and Hyoscyamine.—P.J. ii./16,297. The leaves of D. fastuosa v. alba and D. metel as also seeds of the former are B.P. ’14. Tincture of Seeds 1 in 4, Alcohol 70%. Dose.—5 to 15 minims. Stramonium seeds contain about 15—30% of a fixed drying oil. The seeds and leaves have about the same alkaloidal strength—average 0-22%. A key for distinguishing various species of Datura.—H. A. Timmerman, P.J. i./27,574. Honey collected by bees from D. Stramonium has been wrongly stated to be toxic. Observation showed that the flowers in question are not visited by bees. They are pollenated by night-flying insects with long proboscides.— H. Deane, P.J. ii./i3,134. Assay of Stramonium. Various methods criticised.—C. M. Caines, P.J. ii./3o,90. Datura isotsirsci is common in Cairo. Symptoms are those of Belladonna poisoning. Writer has never seen a fatal case, though many remained on verge of death for hours.—L. ii./2i,1065. p jExtractum Stramonii (B.P., 1898). Dose.—to 1 grain (0-016 to 0-06 Gm.). An extract of the seeds in No. 40 powder prepared with Alcohol 70%. U.S. X. Extracts (Pilular and Powdered) are assayed to 1% alkaloids. The average yield of extract from the leaves is 20%. In spasmodic asthma the extract is found better than the tincture. Sufficient should be given to be slightly toxic. Most patients show toxic effects on taking J grain in 24 hours. CE^Tinctura Stramonii (B.P. ’14). Dose.—5 to 15 minims, 1 of leaves to 5 of 45% alcohol. I'.S. X. 1 in 10 of diluted alcohol standardised to 0-025% Alkaloids. Parkinsonism has been treated by Stramonium in pills « cachets, in progressively increasing doses of 0-05 or 0*10 Gm. to lim of tolerance ; given preferably during meals. To avoid habituation administer for 20 days with intervals of 10 days.—B.M.J.E. i./26,5' Chronic encephalitic Parkinsonism. Besults equal to those from Hycsci hypodermically are obtained by giving Stramonium Extract, U.S.P. per os dose of O'25 Gm. to 1 Gm. or more thrice daily, the average dost being O'75 Gm. Similar results obtained from Ext. Stramon. Exsic« B.P.C., Stramonium Leaves, and the Tincture B.P. ’14. The leaves have di advantage of excessive bulk. Therapeutically it was found that 1/100 gra Hyoscine hypodermically = dried leaves 1 Gm. = Ext. Stramon. U.S. 0-25 Gi — Ext. Stramonii Exsicc. 0-25 Gm. = Tinct. Stramonii 3 drachms. > actual curative effect is possible. Palliative treatment essential. The val of Hyoscine in idiopathic paralysis agitans was shown by Erb in 1906 : ehrcD encephalitic Parkinsonism is similar clinically. Per os medication needed replace irksome routine of three hypodermic injections daily. 80 cases we on the Extract for 6 months. Many were in a satisfactory condition c 0-5 Gm. thrice daily. One or two were getting more than 1 Gm., the large dose being 1-375 Gm. thrice daily. It is evident that the doses of Tinctu hitherto used by others for the purpose were far too small.—C. Worste Drought and T. B. Hill, L. h/30,1225. 45 to 60 minims of B.P. Tincture thrice daily increases ability to perfor rapid movements. Mental condition improved. May be continued for lor period.—E. A. Carmichael, Qtrly. Jl. Med., ’29, per Pres., June, ’29,224. Stramonium Leaf of value as a palliative, in daily doses as high as 15—c grains, given in small doses every hour or two up to limit of tolerance. Who good results are obtained decrease to 71 grains daily, which can be tolerate for months. Occasional diarrhoea or mydriasis may occur, disappearing c discontinuance.—Shapiro (Illinois), per Pres., June, ’29,224. Tincture of Stramonium, U.S.P., 20 to 70 minims given 3 or 4 times daD per os. Toxic manifestation rare and evanescent.—A. L. Jacobsen and 1 Epplen, Jl. A.M.A. ii./29,2027 ; B.M.J.E. i./30,38. Asthma.—Tinct. Stramonii 15 to 20 minims thrice daily is a maximua dose. Tinct. Hyoscyamus 20 minims, combined with an intestinal antisepti is most potent in controlling the abnormal muscular activity, and arresting tt mental symptoms in ‘ spastic ’ conditions of the colon, but will cause dryness r the throat. Warning regarding large doses of Tenet Stramonii.—T. Stacey Wilson, L. ii./3o,107. CEJMistura Antispasmodica, N.H.W. (not in E.G.A.). Tincture c Stramonium, Tincture of Lobelia (Ethereal), Tincture of Opium of eat 6 minims, Chloroform Water to £ ounce. ® Mistura Aslhmatica’, N.H.W (not in E.G.A.). Tincture of Stramonium, Tincture of Lobelia (Etheieal) • each 10 minims, Ether 15 minims, Potassium Brcmide 10 grains, Chlorofon Water to £ ounce. (g)Mistura Potassii lodidi cum Lobelia, E.G.A. Dose.—J ounce (15 Cc.). Potassium Iodide 5 grains, Ethereal Tincture of Lobelia 10 minims Tinctur of Stramonium 10 minims, Spirit of Chloroform 10 minims, Water to £ ounce STRONTIUM. Sr= 87*63. Strontium is a relatively innocuous alkaline earth-metal. Its salts are relatively slowly absorbed. Investigations at the Johns Hopkins University have shown that Strontiun can be deposited in the bones with a resultant decrease of Calcium content It is capable of transmission to the young from the mother and gives rise t STROPHANTHUS. 781 a form of Strontium rickets,” which is not combatable with Cod Liver Oil. '°,bear ln its possible abnormal physiological behaviour. The 192 3ieper p1 J°?%3n.573 Strontmm iu therapy is suggested.—Jl. A.M.A., June, Strontii Bromidum (B.P. ’14). Syn. Koronium (Coronium) Bromide SrBr2+6H20=355-5556. Dose.—5 to 30 grain (0-3 to 2 Gm.). In deliquescent crystals, 97% pure with bitter saline taste, soluble in less than an equal quantity of water. Flavoring.—Syl Lavandulae, Syl Menthse Piperita?. Used in gastric affections, dyspepsia, and vomiting of nervous origin ; also in epilepsy instead of the Potash salt. this salt may decolorise Compound Tincture of Cardamoms in a mixture. —P.J. 1./14,670,698. Tablets contain each 5 grains (0-3 Gm.). Effervescent Strontium Bromide. Dose.—1 drachm (=10 grains). ‘ Vescettes ’ of Strontium Bromide contain 10 grains. Strontii Bromidum Exsiccatum. Dose.—4 to 24 grains (0-25 to 1-5 Gm.). On drying Strontium Bromide it loses most of its water of crystallisation, 4 parts are about = 5 of crystals. Strontii Carbcnas. SrC03= 147-63. Dose.—5 to 30 grains (0-3 to 2 Gm.). Strontii lodidum. Sri 2+6H20=449-5876. Dose.—5 to 20 grains (0-3 to 1-2 Gm.). In white crystalline masses, freely soluble in water. Exophthalmic goitre of children has been treated with this and the Bromide, also asthma, rheumatism, and chronic endocarditis. Strontii Lactas. Fr. Cx. (C2H4 OH.COO)2Sr-f 3H20=319-7548. Dose.—5 to 30 grains (0-3 to 2 Gm.). A white crystalline powder, very soluble in water, of service in albuminuria and Bright’s disease. May be combined with iron in the albuminuria of pregnancy. To increase coagulability of the blood 15 to 30 grain doses useful. Tetany can be prevented or relieved by the continuous oral administration of Strontium Lactate. It acts by decreasing the permeability of the gut to Calcium excretion and by reducing the excitability of the motor nerves.— Am. Jl. Physiol., ’26,75,378, per B.C.A., ’26,A.318. Strontii Salicylas, u.s. x. [C6H4.0H.C00]2Sr+2H20=397-7392. Dose.—5 to 20 grains (0-3 to i*2 Gm.). A white crystalline powder, slightly soluble in water and in alcohol. Used for chronic gout, and a good intestinal antiseptic. Intravenously, 10 Cc. of 5% solution, has proved useful in chronic affections of the joints. The lactate may be given orally, and, in severe pain, the bromide intravenously in place of the salicylate.—Per P.J. ii./26,287. STROPHANTHUS. B.P.’U, F.E. VIII, P. Ital. V., P. Belg. IV., U.S. X., P.G. VI. B.P' 14 describes the seeds of Strophanthus Kombd (Oliver), (Apocynacece) freed from the awns, of a fawn colour, and covered with hairs. include also S. gratus ; the last mentioned officialises that variety under a separate heading. P.G. VI. mentions only S. gratus. U.S. X. is standardised and gives an average dose of 1 grain. P. Hung, gives max. single dose grain (0*05 Gm.) : max. in 2- hours, 015 Gm. Commercial history of.—E. M. Holmes, P.J. i./o6,312. >S. Kombe and >S. hispidus give a green colour with Sulphuric Acie and S. grains red. do Extractum Strophanthi {B.P. ’14). Dose.—l to 1 grain (0*016 to 0*065 Gm.). o seeds are first percolated with purified ether, and then with 90% alcohol; the alcoholic percolate concentrated and mixed witli milii sugar, so that 2 parts oi extract in poivder= 1 part of seeds. (©Tinetura Strophanthi (B.P. ’14). Dose.—2 to 5 minims (0*12 to 0*3 Cc.). /Vote,—It was reported to us (1923) that a number 0 pr-?lCrn^10n! contfJniDg Tincture of Strophanthus and Xux Ycmica in mixtun yitn Cnioroiorm Water caused severe diarrhoea in nearlv every case, lliei is a possibility of hydrolysis. The Tincture as ‘ Drops ’‘would be piefeiabltt rophanthus oeeds de-fatted with Ether in Xo. 30 powder 1 bv nercolaticj] with Alcohol (70%) q.s. to 10. Is four times the strergth of the A P Jc! }cuPQwav°?\ This $°n.f°rm.s ™th*\L 1U-S- X* is 1 in 10 with Aicoho: l9iii910 Vol*)’assayedblol°glcally* Ital. Y., E.E. VIIIand P. Belg. IV.alsc lR. Cx. has F.I. strength with max. single dose 3 minims approx. Max during 24 hours 12 minims approx. Physiologically Standardised Tincture of Strophanthus.—Standards adopted vary with different makers. Some adopt M.L.D. 0-000 Cc. per 100 Gm. v eight of frog. Strophanthus tincture properly stored loses little in activity SeealsoVol.il. For a note on the Chemical Assay oj the seeds, also for other methods, of making tinctures, see Vol. II. (©Tabeiloe Strophanthi, equal to 1 minim of Tincture {B.P. ’14) combined with chocolate. Dose.—2 to 0. (©Tablets, Compressed, are also prepared equal to 2 and 5 minims of the Tincture. £J0 Strophanthm. HillStrophanthin and all other poisonous constituents of Strophanthus. Dose. ;jJo t° too grain (0*0002 to 0*0006 Gm.) hypodermically. U.S. X. gives average daily dose, intravenously T% grain. It is irritating at the site of injection. Dose by the mouth 1 to 4 mgr. and up to 4 mgr. a day ; by intramuscular: injection 1 to o mgr, e d.uy End by intravenous injection to 1 mgr. End up t* 2 mgr. a day has been recommended. Given by the mouth it is often il tolerated and strychnine (1 to 3 mgr. in the day) is the best antidote. Si£i of overdose : headache, sense of tightness in the chest and prsecordia, mailet slowing or bigeminy of pulse, marked rise in blood pressure, caidiac arhythmia; insomnia, and nausea are least seen with the intravenous use of the substance. Little success in heart affections obtained with the ding taken pti cs. Contraindicated where there is a high blood pressure and marked arteric sclerosis and to those with acute or chronic nephritis or granular kidney. A white glucoside, or “ mixture of glucosides from S. Kombe” (U.S.). Soluble in water and alcohol 90%, allied in its physiological- action to digitalin. It is customary to distinguish k-Strophanthin from S. Koinbh-Strophan- - thin from S. hispidus and g-Strophanthin from S. gratus. Uses.-—As a cardiac tonic and diuretic. Resembles digitalis iff- effects but acts far more promptfy. It is stated that the Tincture acts in from ^ to 1 hour, while Digitalis Tincture takes from 24 to 48 hours. Occasionally of service where the latter has failed or is not tolerated. Especially valuable in mitral stenosis, but unsuitable in aortic disease ; pulse improves in force and rhythm, dyspnoea and palpitation are lessened, appetite is increased, action of bowels and perspiration not affected—non-cumulative. Of value in renal insufficiency. It is a better diuretic than Digitalis because, while it accelerates the circulation, it does not readily constrict the arterioles. In heart failure, intravenous injection of 8—12 minims of 1 in 1,000 strophan- thin solution (1 to f mgr. of the base) has been successful. In urgent heart cases Strophanthin intravenously is of unmistakable value. —W. Gordon, B.M.J. i./2i,13. Strophanthus as diuretic cf. action of Digitalis, p. 386. Caution.—To our knowledge, the drug occasionally acts in an unaccountable manner—loss of consciousness has followed an ordinary dose in a weakened patient. Cg) Tablets, Hypodermic, contain Strophanthin grain. GeD Granules de Strophanthine, Fr. Cx.,^ mgr. and are coloured pink. Cp) Poudre de Strophanthine au Centieme. Fr. Cx. Max. single, dose J grain. Max. during 24 hours \\ grains approximately. Strophantliin Cryst. C3fJH4G012.9H20 = 760*4992. P.G. VI. Syn. Ouabain, Ouabain Arnaud, Gratus Strophanthin. Dose.—J to 1 mgr. (1/250 to 1/60 grain) by injection. I The crystallised active principle of S. gratus Seeds and Acocanthera Ouabaia Wood. A stable product having well defined toxicity. i Uses in general as for Strophanthin above. Strophanthin Sterules contain 1/400 grain, 1/250 grain, and 1/60 grain. El STRYCHNINA (-B.P. ’14), Fr. Cx., f.e. viii. jjp ^Preparations or Admixtures containing 0-2% or more. [pjjApplicable to Northern Ireland and Irish Free State also, and Salts of Strychnine. C21H22N202=334-1876. 7)1_L to W grain (0*001 to 0-004 Gm.). Fr. Cx.—Max. single dose ^ grain. Max. during 24 hours i gram approx. T e alkaloid obtained from Nux Vomica, St. Ignatius beans V ; > the seeds of other species of Strychnos. In characteristic colourless crystals (not coloured by strong nitric acid: abse“e.°£“0r e Exceedingly poisonous. Its absorption m the rectum is even mor„ rapid than in the stomach, smaU mtestme, oesophagus or colon It is supplied pink to cover brown tint forming m hot chma es Tn wnter 1 in 2,800 (according to our expts., 1924), about lW of Sfe 60%. 1 in 150 of alcohol 90%, 1 in 400 of absolute alcohol 1 in 6 of chloroform, nearly insoluble m ether. Antidotes.’—Apomorphine Injection or Emetics followed by wafhfrg outlhi stomach with Potassium or Calcium Permanganate solution 2 to 5 grains per pint, then give Potassium Bromide 4 drachm dose repeated in 2 drachm amounts every hour if necessary. Chloral in J to 1 drachm doses. Charcoal ad lib in water. Chloroform or Ether Anaesthesia. Amyl Nitrite and Paraldehyde. Art. resp. Strychnine compares with Brucine in toxicity as 33 : 4—Wright and Dixcn_ r lavorinfj.—Eor Strychnine Salts and preparations containing Strychnine, Syl Aurantii Amari, Syl Menthse Piperita) (very full dose). Pilula Strychninae contains 7%, ffV» and grain. SEDFerri et Strychnines Citras. Average Dose—2 grains (0*12 Gm.) in solution. In scales varying in colour from garnet red to yellowish brown, freely soluble in cold water. It contains 1% of Strychnine, and Ferric Citrate corresponding to not less than 16% Metallic Iron. te lFerri, Quinines et Strychnines Citras. Dose.—3 to 6 grains (O'2 to 0-4 Gm.). Similar to the former with about 15% of Quinine. EO Strychnines Arsenas. C2iH22N202.H3As04,|H20=485'1488. Dose.—dt to TV grain (O'OOl to 0'004 Gm.). In small white acicular crystals containing 68-72% Strychnine, soluble 1 in 34 of water. In phthisis by hypodermic injection of j% mixture with liquid Paraffin. Dose.—4 to 15 minims daily. In addition to this acid salt there is another of composition C21H22N20(H3As04)2H20. Soluble 1 in 16£.—Dott, P.J. ii./n,173. It contains much less Strychnine (42-8%). [PS Strychnine Acetate is soluble 1 in 44, the Hydrcbrcmide 1 in 70, the Hypophosphite (one of the most soluble salts) 1 in 3-3. Dose of each as for Hydrochloride. JPlj Strychnines Hydrochloridum. C21H22N202,HC1,2H20== 406-6836. Dose.—-eV to grain (0*001 to 0'004 Gm.). Small trimetric prisms, soluble 1 in 35-5 of water (by our experiments) ; alcohol (90%) 1 in 73. The formula according to D. B. Dott should be 4C,1H,N.>OoHC1.7HoO.— C.D., Jan. 1, ’27. “ A 1% (wjv) solution is strongly hypotonic; 0-079 Gm. Sodium Chloride or 0-442 Gm. Glucose to every 10 Cc. renders it isotonic. A case recorded where life was in danger, had ^0 grain doses increased to J grain pro die in a month. A Chinaman with beri-beri (paralysis of) had up to } grain t.i.d. Recovery in both cases. [jplj Liquor Strycbninae Hydrochloridi (B.P. ’14). Dose.—2 to 8 minims (0*12 to 0*5 Cc.). Strychnine Hydrochloride 1, Alcohol (90%) 25, Water to 100. For hypodermic injection. Dose.—2 to 6 minims. Incompatible with Liquor Arsenicalis, alkalis, e.g., Sodium Bicarbonate, Sal Volatile, Bromides and Iodides. A small quantity of Glycerin added in place of equivalent of the spirit, prevents crystallisation of the salt round the neck of the bottle. It is safer to prescribe Tincture of Nux Vomica in preference to Solution off Strychnine Hydrochloride when there is danger of incompatibility. Strychnine Hydriodide is liable to be precipitated by incompatibility between a salt of Strychnine and Potassium Iodide. The solubility of Strychnine Hydriodide (1 in 45 at 25° C.) is decreased by presence of excess soluble Iodide.—JL Am. Ph. A., Aug., *31,763, per P.J. ii./3i,265. .We found recently (Feb. 1932) that Strychnine Hydrochloride 1/25 grain with Potassium Iodide 5 grains in Water 2 drachms deposited in cold weather —-and markedly in 1 drachm ; also 1/50 grain with 5 grains threw out in 1 drachm but not in 2 drachms of water, 1/100 grain with 5 grains in 1 drachm (and 2 drachms) remained perfectly clear. ^ith regard to Strychnine with Bromides, correspondence between the .ate W. Martmdale, Sir W. Gowers, F. A. Rogers and A. J. Townley, 32 yeais ago, is of interest. W. Martindale found no deposition of Strychnine in an acid mixture with Lithium Bromide. F. A. Rogers confirmed this. A. J. lownley, however, pointed out that Strychnine Hydrobrcmide is more prone to be precipitated from acid solution than the Hydrochloride, but this fact does not constitute any real danger, because dilution in a mixture is invariably more than sufficient to redissolve any Acid Hydrobromide precipitated —P J. | 11./1900,389,449.465. iginjectio Strychninae Hypodermica (B.P. ’14). Dose.—Hypodermically 5 to 10 minims (0*3 to 0-6 Cc.). Dissolve Strychnine Hydrochloride 0-75 Gm. in recently boiled and cooled Distilled Water 100 Cc. CfDMistura Strychninae Fbcsphorica. R.N.H. Solution of Strychnine Hydrochloride 3 minims, Dilute Phosphoric Acid 10 minims, Syrup of Ginger 30 minims, Water to 1 ounce. Fll Strychninae Nitras, u.s., p.g. vi., p. Beig. iv., p. Hung. P. ltal. V., F. E. VIII. Dose.—to TV grain (0*001 to 0*004 Gin.) P. Hung, gives max. single dose J grain (0*01 Gm.), max. in at day l grain (0*02 Gm.). P.G. VI. gives half these amounts ; F.E. VIII. Pt, and T\ grain respectively. C21H22N2O2.HNO3=397*2034. Colourless needles, soluble 1 in 60 of water ; in 45 at 25° C. U.S. i feljTablets, Hypodermic, yiU, iroo iV> io grain. !F H Injectio Strychninae, Arsenii Iodidi et Quininae. — Strychnine Nitrate 1 grain, Arsenious Iodide 2 grains, Quinine Lactate 1 drachm, Distilled Water to 3 ounces. Dose.—Up to 1 drachm hypodermically for adults. Specific to reduce temperature in influenza attacks and almost any grave affection. Also prophylactic, e.g. in malaria. Tabellae Nitroglycerini et Strychninae, v. p. 572. El Strychninae Periodidum. C21H22N2O2.2I=588-0516. Dose.-—1/100 grain (0*0006 Gm.) carefully increased, if desired. Obtained by combination of Strychnine and Iodine in a suitable solvent as a dark red powder, containing about 56% of Strychnine. . Solubility.—Soluble in Chloroform, slightly soluble in Alcohol, insoluble m Ether and water. It splits up with Physiological Acid, liberating 13 t°/ of alkaloid, and a further 10% to Physiological Alkali. Uses.—This novel form of the well-known alkaloid may be worthy of trial Dispensing Note.—To be given in form of Levigaticns (g.v.) in ‘ slirule ; (No. 5) or cachet. FH Strychninae Sulphas, U.S. X. Fr. Cx., F.E. VIII., P. Ital. V. (C21H22N 202)2H2S04-j-5H20= 856*5288. Dose—it to p* grain (o*ooi to 0*004 Gm.). Fr. Cx. Max. single dose per grain ; max. during 24 hours £ grain approx. F.E. -1- and ir grain respectively. The neutral salt is in prismatic crystals, soluble 1 in 62 of water • j. ifx r\ D ~r 1 1 • —• 1 T-r y-v • * _ _ y 0 0 M.pt. 200° C. It contains 5JH20 ; i.e. there is usually a loss on drying of 11*44% approx.—Dott, P.J. i./i2,425. IF ll Hypodermic Injection I in 100. Dose.—1 to 6 minims. [IP 11 Tablets, Ar, -V and Ao grain each, for administration per os. jjjMfl Hypodermic Tablets Thu, Ar> % and f7T grain. W% Stryclininse Sulphas Acldiis. Syn. Hulle’s Soluble Strychnine. C21H22N202.H2S04+2H20:= 468-2944. Dose.—to TV grain (0*001 to 0*004 Gm.). In white silky acicular crystals with a slightly acid reaction,, soluble 1 in 42 of water. [FT1 Strychninse Valerianas. A non-erystallisable salt supplied in aqueous solution equivalent to 25% of the base. Dose.—2V minim to minim ( = T^,j to grain of the base). A useful nervine tonic. Uses of, and liefer cnees to Strychnine Salts. In cases of heart disease in which Digitalis is inadmissible, Nux: Vomica and Strvchnine are used as heart stimulants and for this? purpose they are often combined with Caffeine. Patients almost dead from failure of the heart in the course of chronic cardiac disease may apparently be brought round by subcutaneous injection ot Strychnine, but some doubt its efficacy.—Hale White. Strychnine has powerful action on the vasomotor system, with the property of stimulating liberation of Adrenalin. It has no direct cardiac action o" value, but acts through the Adrenalin.—O. S. Gibbs, B.M.J. i./31,5S2. For old people, Strychnine and Nux Vomica have been described as the onl£ useful bitter tonics. Cardiology.—Strychnine has been unduly discredited.—W. Gordon; B.M.J. i./2i,13. Progressive Muscular Atrophy.—To arrest, Strychnine hypodermicall;:' the only treatment. Acts more directly than by mouth.—Gowers, Disease of the Nervous System. Myasthenia.—Strychnine hypodermically is frequently beneficial, but no- curative.—L. i./io,355. Chorea minor, incontinence op urine, gastralgia, drink craving.— Strychnine is useful internally. Puerperal Sepsis.—In severe cases with failure of circulation often c great value hypodermically.—B.M.J. ii./og,1038. Sea Sickness.—Strychnine Sulphate A, to A grain with Atropine Sulphat grain, either hypodermically or by the mouth in preference (but then leB efficient), and repeated in a few hours if necessary. Surface of body shoul be kept warn.—B.M.J. ii./io,1199. Gastric Atony.—To produce any beneficial effect very small doses c Strychnine must be used.—T. Izod Bennett, B.M.J. i./23,369. Strychnine as diuretic, cf. action of Digitalis, p. 386. Strychnine used in drug smoking in China. Mixed with Heroin, Cam Sugar, and Milk Sugar in pill form.—L. i./26,110. ® SULPHONAL. (CH3)2.C.(S02.C2H5)2=228-2488. Sulphonmethanum, B.P/14, U.S. X., Fr. Cx., P.G, VI., P. Hung. P. Belg. IV., F.E. VIII. Syn. Dimethyl-Methane-Dii ETHYLSULUHONE. Manufacturers and wholesale and retail vendors must label Poisor and treat otherwise as CeD* Manufacture*—By oxidation of a compound of ethyl-mercaptan an acetone,—See N. Evers, Chemistry of Drugs, 1926. In colourless crystals or powder, tasteless and odourless, solnhl* about 1 in 450 of water. In alcohol 1 in 80, freely in hot alcohol. Melts at 125-5° C. Dose. 10 to 30 grains (0*6 to 2 Gm.). In cachets or suspended with mucilage. P.G. VI. and Fr. Cx. Supp. 1920 have max. single 1 Gm.; max. during24hours2 Gm. (F.E. 1 and 3 Gm. respectively)* Should be finely powdered and followed by a draught of hot fluid. Unless in solution, a dose should be given an hour before sleep is desired. Antidotes,—See chapter on. . Uses.—Hypnotic, but is not curative of pain; does not affect digestion, pulse, or temperature, especially desirable for nervous subjects. Useful in chorea. Is slow in action on account of slight solubility ; 30 grains may be given in solution in 1 ounce of brandy with 2 ounces of boiling water added (= about 140° F.). For calming motor excitement of the Insane. — Fatal accidents seldom occur if given with care and patients watched. If given undissolved it may remain a long time in the alimentary canal. As far as possible it should be given in solution. To give 20 grains, i pint of a hot tev erage at least is needed—milk or whisky. Watch carefully for renal irritation. It should not be given over a long period without a break nor to persons j suffering from chronic constipation. Contraindicated in chronic alcoholism. — G. M. Poberston, Jl. Mental Sci., April, 1911. Ilcematoporphyrinuria, followed by increasing weakness, faccid paralysis and death, after lengthy treatment with Sulphcnal (£0 grains daily lor three i months).—Wilfred Harris, L. ii./22,854. Enuresis well treated with small doses.—L. ii./i7,72g, ef. Thcrap. Index. Cp) Tablets, 5 grains (0 3 Gm.). Dose.—1 to 6. Should be crushed and taken in warm water. CeD Capsules contain 5 and 10 grains. CE) Effervescent Sulphonal contains 5 grains in 1 drachm. I ®Haustus Sulphonal. Sulphonal 20 grains to 1 ounce of Mistura Mucilaginosa (Mucilage of Gum Acacia 2 drachms, ;< Syrup 30 minims. Water to 1 ounce.) (Was in G.H.) ‘Reversed Sulphonal, ’ i.e., Diethyl-methane-dimethyl-sulphcne, is probably j included as Cp) by the Order in Council. It is not a homologue of sulphonal 1 but a metameride.—E.M.J. i./i3,836. 3 (£} Methyl-Sulphonal (B.P. ’14). Syn. #Trional (T.M. 279228) —Fr. Cx. Uiethyl-sulfone-methyl-ethyl-methane. Fh. Ned. VI., P. Belg. IV., P. Helv., F.Jap., P. G. VI., F. E. VIII., Sulplion - ethyl - metha num, U. S.X. T.M. No. 279228 is the signature of a firm. Patent 16333/i888 expired. N.B.—Conditions of Sale as for Sulphonal q.v. CH3.C2H5.C.(SO2.C2H5)2=242-2604. Dose.—10 to 20 grains (0*6 to 1*2 Gm.), in cachets, in a large cup 1 of hot liquid. Fr. Cx. Supp. 1920 gives latter approx, as max. 1 single, and during 24 hours. P.G. VI. has max. during 24 hours 30 grains. An oxidation product of mercaptol made by the condensation of methylethylketone with ethylmercaptan. In minute crystals, soluble 1 in 320 of water (we find in practice, 1 in 420), in alcohol 90% about 1 in 11, and in ether. M.pt. 76 to 76-5° C. Uses.—Has hypnotic action between that of sulphonal and tetronal. Has cured chorea. U^ful for the insane. Tetronal is the better sedative, Trional is more effective in sleeplessness connected with neurasthenia and organic brain disease. Both are useless in insomnia due to pain, and in morphine and cocaine habits. CEDTablets, 5 grains (0*3 Gm.). Dose.—1 to 6. Recovery after effects of 125 grains.—L. i./o3,1096. Poisonings by Trional successfully treated by Strychnine injections, Smelling Salts, and 1 drachm doses of Sulphate of Magnesium every four hours.—L. i./io,104. Cp) Haustus Trional, 30 grains to Mucilage Mixture 1 ounce. (Was in G.IT., cf. Haustus Sulplional.) ^PplyinS Hans Meyer’s Theory q.v. (Therapeutic Index—Insomnia), to these methane derivatives of the Sulphones, the coefficient of Trional is 4-48, Tetronal 4-04, Sulphonal only T59, wdiich is in practice about their activity. Trional best of the three, Sulphonal should be dropped, Tetronal too dangerous.—B.M. J. i./o9,554. SULPHUR. S=32-06 Production of Flowers of Sulphur and Roll Sulphur at Rotherhithe. ‘ Ground ’ Sulphur is made by grinding Sulphur as imported. The latter is not B.P.—Prof. H. G. Greenish, P. J. i./26,541. Dose— 20 to 60 grains (1-2 to 4 Gm.) in milk or treacle, with confection of senna, or as Pulvis Glycyrrhizee Compositus. Sublimed sulphur in fine powder, for use either internally or externally, is preferred to Precipitated. Soluble.—Freely in Carbon Bisulphide and Benzyl Chloride: in Petrol, Benzol and Toluol approx. 1 in 4 ; in Chloroform P33% w/v, in Almond Oil 0-8%, Olive Oil 0*5%, Cotton Seed Oil 0-5%, and in Sesame Oil 1*3% w/v (by our experiments, 1931). No crystallisation takes place after 24 hours’ standing at the above concentration limits at summer temperature, but would probably crystallise in winter. Uses.—Internally it has no action on the stomach but a certain proportion administered is converted into alkali sulphides in the intestines with consequent mild laxative effect. Given internally it has been employed for skin affections, occasionally benefiting chronic eczema with much itching. Hale White says its powers in bronchitis and rheumatic affections are doubtful. Externally sulphur is commonly used to cure scabies and for acne. Sweating of the feet has been treated by drachm doses thrice daily. In diphtheria Sulphur as an insufflation caused death in a child of 9. The practice (dangerous), it appears, is common in South Wales.—L. ii./i6,29. As an antiseptic, Sulphur suspended in glycerin has been injected into suppurating sinuses. Sulphur Lotum, U.S. is washed with ammoniated water. ‘ Colloid ’ Sulphur prepared by precipitating sulphur from polysulphides with an acid in the presence of albumin, is said to be a better antiseptic than ordinary precipitated sulphur.—cf. p. 371. Ssix Affections.—The skin has been painted with a solution of Sulphurate Potash 1 in 2, twice. The part is then subjected to Acetic Acid Vapour or dabbed with 5 to 10% Acetic Acid. Sulphur is adherent as a thick coating. —B.M.J.E. i./i3,96. SULPHUR. 789 Disulpliide1.—Sabouraud^B^JL^il/^^QS1^^^^ S°1Uti°n °f Su'phur “ Carb°n i^HE Geoin (singularly intractable) treated by means of on linf iw d-ny?ppl(mgla 6% Hyposulphite of Sodium Solution 37 Tartario ^inutes5 followed by painting with 6 /olartaric Acid Solution.—J. M. H. MacLeod, Pr., Dec., ’i2,827. _Subhiir?Hrpmin^?Po/f t &n by intr amuscular in i&ctian, mnqolptj nr twvf^T S-ee(J-(bl mjected in 6 minim doses deeply into trunk i norpaq^rl in fhpgfP’n Hpection repeated after three days and dose rapidly an f n^ APmje^jlons.to 3°—45 minims. Total of 10 injections vP-n iHp® hnfffce; J fmoaths/ Alarming reactions—increase of pain, fever and f^blo^ ™hS« S pailnS lost an.d motility increased. Should not be used in lpp?£ hiere pai? .1S. not marked unless increased motility is Seed Oifhive been useUd Contammg 0 001 Gm* of SulP^ir * 4 Cc. Poppy -A. T. Todd, B.M.J. i./27,1050. A Sulphur Paste (5%) has been tried.- Oleum Sulphuris. Syn. Sulfosin. Dose. 0*5 increased to 10 Cc. intramuscularly—supraperiosteally on tlie lateral surface of the femur. A 1% solution, or suspension (soluble on warming), of Sulphur in Olive Oil. The injections set up a febrile condition of short duration. The aim is to reach 104 F. gradually. Repeated injections may have therapeutic effect in general paralysis, neurosyphilis, and other syphilitic and certain 11011-syphilitic—lesions of the central nervous system. Better than malaria infection treatment.—K. Schroeder. L. ii./29,1081 ; ii./30,549. High fever produced. Treatment of G.P.I. worth trial.—N. G. Harris, 3°,1069. Good pyrexial reactions.—W. H. Shilvock, L. ii./3o,347. ^ Consecutive temperatures of 104 or 105° F., as in induced malaria, not ootamed with Sulfosin.—VV. G. Patterson and S. It. L. Switzer, L. ii./3o,348. 1 annul and useless. A number of other methods—‘ experiments ’—ineffective, in Vienna.—L. i./3o,375. iR=h temperatu:re within 24 hours. Produces considerable leucocytcsis.— T. D. Power, L. n./3o,1289. Suitable for advanced cases of G.P.I., because harmless, especially on a degenerate myocardium. Results compare favourably with malarial pyrexia. —J. H. H. Laptain, L. i./3i,635. Dementia Pilecox treated, starting with 1 Cc. and increasing by 1 Cc. up to 12 injections. Sweating, loss of appetite, leucocytosis, and rise cf temperature. Progressive dementia may be prevented.—P. C. Collingwccd Fenwick, L. i./31,241. Persistent Psychosis.—The pyrexia and leucocytosis caused is of limited value.—D. Macmillan and A. McNae Wyllie, L. i./3i,909. Sulphur Sterules, 1% solution in oil, 1 to 10 Cc., are made. CGnfectio Guaiaci Composita, L.H. * Chelsea Pensioner.’ Dose.—-1 drachm (4 Gin.). Guaiacum Resin in powder 2, Sublimed Sulphur 4, Mustard 4, Potassium Nitrate 1, Rhubarb Root 1, Treacle to 64. Acid Potassium Tartrate is added to some formulae. St. M.’s H. has Guaiacum Resin 10, Magnesium Carbonate 10, Sublimed Sulphur 15, Treacle 60. This is a more usual formula. Confectio Sulphuris (B.P. T4). ^ Contains 45% Precipitated Sulphur with 11% Acid Potassium Tartrate. Dose.—1 to 2 drachms (4 to 8 Gm.). Confectio Sennae et Sulphuris. C.H., U.C.H. Dose.—1 to 2 drachms (4 to 8 Gm.). Confection of Senna 1, Confection of Sulphur 1. Pulvis Guaiaci Composite (Chelsea Pensioner). Dose.—20 to 40 grains (1*2 to 2-6 Gm.). Guaiacum Resin, Precipitated Sulphur, Heavy Magnesium Carbonate, Gum Acacia, and Potassium Bicarbonate, equal parts. The Confection (v. above) is more used. Jephson’s Powder. Dose.—60 grains (4 Gm.). Precipitated Sulphur 2, Guaiacum Resin L For tonsillitis, acne, and constipation. Tablets of Precipitated Sulphur 5 grains with Potassium Acid Tartrate 1 grain are prepared. ‘ Stearettes ’ of Sulphur 5 grains each are prepared. In the alimentary canal the action of Sulphur only takes place at a point where its contents have ceased to have an acid reaction, and the formation of H2S and Sulphides will be hastened by an increase in alkalinity. ‘ Stearettes 5 of Sulphur are hence suggested in the treatment of acne, furunculosis, urticaria, etc. Trochisei Sulphuris {B.P. ’14). Dose.—1 to 6. Contain approx, precipitated Sulphur 5 grains and Acid Potassium Tartrate 1 grain. For skin ana rheumatic affections. Garrod’s formula is 4 grains of the Sulphur with 1 grain of Potassium Acid Tartrate in each. See also Pastilli. Unguentum Sulphuris (B.P. ’14). 1 to 9 Benzoated Lard. Scabies is treated by Sulphur Ointment after washing with soft soap. Use equal parts of the B.P. Ointment and Vaseline. Unguentum Sulphuris et Zinci cum Kaolino. Sulphur 4, Zinc: Oxide 3, Kaolin 1, Benzoated Lard 8. For sweating of the feet. ®Unguentum Sulphuris cum Hydrargyro, U.C.H. Sublimed Sulphur 30, Sublimed Mercuric Sulphide 2, Ammoniatedi. Mercury 2, Arachis Oil 12, Lard 54. Useful in skin diseases. Unguentum Sulphuris Gamphoratum E.L. Precipitated Sulphur 10, Phenol 15, Camphor 15, Solution of Coal Tar 151 Vaselin 220, Benzoated Lard to 440. Unguentum Wilkinson. Syn. Wilkinson’s Ointment. P. Jap. IV. Triturate together Sublimed Sulphur 1, Tar 1, Potash Soap 2, Penzcatctt Lard 2, Purified Talc 0-5. (Tar, P. Jap. is Ircm seveial species cl Unguentum Sulphuris Hypochloritis. Sublimed Sulphur 12, Essential Oil of Almonds 2, Prepared Lardl 84 ; mix and add with quick manipulation Sulphur Chloride 2 (ai Reddish Liquid S2Cla= 135-034). Keep in a stoppered bottle; is sometimes mp.de double this strength. Useful in acne, psoriasis and scabies. Unguentum Sulphuris lodidi {B.P. i8gS). Contains Sulphur: Iodide 4 (S^^33 7-984), Glycerin 4 ; mix in a warmed mortar,/ and add Benzoated Lard 92. For tinea. Unguentum Sulphuris et Naphthcl Salicylatum. Tinea circinata can be rapidly cured by an ointment of Sulphur % drachm, Salicylic Acid 10 grains, Naphthol 3 grains, Yellow Soft Paraffin 1 ounce. SULPHUR. 791 Sulphuretted Hydrogen Solution. Is prepared by saturating Distilled Water with Hydrogen Sulphide (HoSl To preserve, add a little Carbon Di-sulphide. * g ouipmoetJi.bj. Lotio Sulphuris cum Sapone. Sjlphur 30> Sau de Cologne 60, Glycerin 4, Soft Soap 4, Rose Water to 500. Is recommended for acne of the face.—W W WT Lotio Sulphuris, C.X. Precipitated Sulphur 20 grains, Glycerin 10 minims, Methylated Spirit 15 minims, Lime Water 2 drachms, Water to 1 ounce. 1 Lotio Sulphuris Composita, C.X. Precipitated Sulphur 15 grains, Zinc Sulphate 15 15 grams, Water to 1 ounce. grains, Sulphurated Potash SulplldQUci Charges are lor dissolving in water to produce sulphur baths for use in skin diseases, gout and rheumatism. Balneum Sulphuratum. St. Th. H. Sulphurated Potash | to J ounce per gallon. St. M.’s H. is 10 ounces to 30 gallons. Pomatum Asitipsoncum, F.E. Syn. Helmerich’s Pomatum* Sublimed Sulphur 10, Distilled Water 5, Almond Oil 5, Potassium Carbonate 5, Lard 35. All by weight. Is used for scabies. Pr. Cx. has poppy seed oil vice almond oil. * Danish ’ Ointment for Scabies. Dissolve 1 kg. Sublimated Sulphur at gentle heat in 2 kg. 50% w/w Caustic Potash Solution. Mix without heating 225 Gm. each of Vaseline and Anhydrous Lanoline, and add 375 Gm. of the Sulphur solution. Prepare fresh Zinc Plydroxide by mixing 28 Gm. Zinc Sulphate and 40 Gm. 20% Sodium Hydroxide, and add to the ointment ; add Liquid Paraffin to 1000 Gin. ; and Benzaldehyde 5 Gm. to check unpleasant odour produced when the ointment is placed on the skin. Efficacy due to the polysulphides. The ointment is soft, of dark brown colour, and not unpleasant odour. After cleansing, rub the ointment lightly all over the body, covering all skin; wait 15 minutes and then go to bed. Take second bath at same time next day, and wear fresh underclothing, and cure is finished. Clothes are disinfected.—Svend Lomholt,’ L. ii./20,1251 ; see also Jl. A.M.A. ii./25,1748. A certain cure for scabies or itch.—A. Cannon, E.M.J. i./3o,148. Composition of Danish Ointment discussed:—E.M.J. i./3o,e&5 (W. H M) 1080,1204. ' 5 v ^Contramine (T.M. 422175). Syn. Diethyl-ammonium di- ETHYL-DITHIOCARBAMATE. SNH2(C2H6)2CSN(C2H6)2=222-307fi* Dose.—Intramuscularly f grain (0-05 Cm.) to 4 grains (t-26 Cm.) inltc2 Cc. of cold sterilised water or saline. Must not be heated. The usual initial dose (intramuscularly) is 0425 Gm. in 1 Cc. Occurs as white crystals, soluble 1 in 2 4 of water. Manufacture.—An addition product of Carbon Bisulphide and Diethylamine. This is a general reaction for primary and secondary alii hatic amines. Uses.—In the chronic complications of gonorrhoea, including stricture, chronic epididymitis, conjunctivitis and iritis, and varied forms of muscular rheumatism, also in chronic skin affections—acne vulgaris, acne rosacea seborrhceic eczema and chronic dermatitis. Contramine Pessaries are convenient for chronic cervitis and endometritis. Local application of Contramine solution may assist healing of chronic ulcers. In cases of sinuses in muscles, closure is often obtained by intra- muscular injections around the lesion. In severe cases of metal intoxication 0-125 Gm. may be injected Intramuscularly every day till 6 or more doses have been given. In other cases two injections of 0-125 Gm. with a week’s interval usually suffice. Salvarsan-Jaundice, causation and treatment with aid of Contramine.—F. Chamberlain, L. i./22,733. Thio-Histamine. Dose.—May be injected intramuscular!}7 in doses of 0-001, 0-002 and 0*003 Gm. on three successive days. If a second course is given at least 4 weeks must elapse. A Sulphur compound derived from Histamine (q.v.). Uses.—In neuritis action similar to Contramine but quicker, hence more suited in acute cases, as against Contramine in chronic cases. Believes pain. Selenium (Se=79-2) and Tellurium (Te= 127-5). The element Selenium was originally discovered by Berzelius in the Lead Chamber-deposits in the manufacture of Sulphuric Acid. It occurs in various Blendes and minerals,—with Lead, Copper, Silver, Iron, etc.—at least three allotropic varieties are known. The chief source of Selenium is Iron Pyrites in which a part of the Sulphur is replaced by Selenium. Traces of Selenium occur in Bismuth preparations. Selenium and Tellurium belong to the Sulphur group. Selenates and Tellurates are highly poisonous—unlike Sulphates. Colloidal Selenium, see Colloidal Metals. Selenium OXide. Dose.—1/64 grain (0-001 Gm.) internally 3 to 4 times daily increasing the dose gradually. Cancer has been treated with this, on the assumption that it conveys Oxygen to the Sulphur in the organism, thereby increasing secretion of Sulphuric Acid in the urine. It has been observed that Sulphuric Acid excretion is lessened in cancer patients. Selenium preparations do not easily lose their effectiveness as oxidising agents. In the body they constantly move between the higher and lower degrees of oxidation, and their oxidising power is thereby constantly regenerated. For use in cancer. See p. 370. Conductivity of electricity by metallic Selenium is increased by light. This is made use of in the Optophone invented by Dr. F. d’Albe, which enables the blind to read print.—B.M.J.i./2i,574. For Organic Selenium Compounds, see Vol.II. Tellurium in Syphilis.—Experiments on rabbits showed that apparently Tellurium injected becomes soluble by combining with tissue protein. Tellurium Metal, the Oxide TeOs, and the Iodoquinate, have been used clinically by Fournier and others with disappearance of spirocheetes. 5 Cc. of 5% Tellurium suspension intramuscularly in £ to 1 Cc. doses at intervals of 5 to 7 days. Toxicity appears to be slight. Methyl Telluride excreted with strong smell of Garlic a disadvantage, persisting 6 to 8 months. Less of hair pigment observed. Tried in Wassermann-fast cases with apparent success.— A. D. Frazer, L. ii./3o,133 ; see also C. Levaditi, B.M.J. ii./28,537. SUPPOSITORIA. Suppositories containing various Medicaments weigh, when prepared with Cacao Butter, 15 grains and upwards. They are preferred with both ends conical shaped so as to pass more easily and be retained by the sphincter muscle. Suppository Mass for Use in and Export to Hot Climates, (a) Gelatin Basis. As pointed out under Ovule Masses, it is almost impossible to make a basis that shall stand temperatures above 100° F. and yet melt at body temperature. The best one can do is to fortify with Gelatin so that the melting point is not much above 98° to 99° F. Bougie Mass (q.v.) carries out these conditions when there is a sufficiency of adherent moisture on the part. (b.) Theobroma Basis.— The B.P. 14 statement on the subject is, “ More or less Beeswax may be used in place of Theobroma according to prevailing temperatures,” 5 to 10% is commonly employed. We consider 15% is best, but it must be remembered that different samples of Theobroma Oil and White Wax each have somewhat different melting points. Certain Melting Points we find are yielded by mixtures in proportions stated under “ Ovule Masses for Hot Climates.” The remarks there given apply equally to Suppositories with Theobroma Oil basis. Urethral Bougies. These are of gelatin basis in two lengths, namely, inches and 4 inches, and are directed to be dipped in "warm water prior to insertion. For various contents, see Index. (U.S. requires 7 Cm. = 2J inches, weighing about 2 Gm., and 14 Cm. = 5J inches, weighing about 4 Gm. respectively.) They are also made of Cacao Butter of any length up to 6 inches if desired, and of six sizes, with the following diameters :—No. 1, £ inch ; No. 2, eV inch; No. 3, yy inch; No. 4, inch ; No. 5, J inch ; No. 6, 1% inch. For the treatment of gonorrhoea in its various stages Those of Cotarnine (q.v.) are used to check bleeding. The U.S. Urethral Bougies made with Oil of Theobroma are 7 Cm. and 14 Cm. long and weigh about 1 and 2 Gm. respectively. i 1 Gj 1 io Aurinaria. Ear cones or aural bougies made with Cacao butter basis. Acidi Borici 1 grain. Acidi Carbolici -,V grain. [Fll Cocaine Hydrochloridi i grain. Unguenti Hydrargyri Nitratis £ grain. Iodoformi £ grain. >'FU Morphinse Hydrochloridi A,-, £ grain, atque cum Cocaina grain. Wf\ Morpliinae yo, Cocainas Acidi Borici 1 grain. m Morphinae is grain, Ext. _Bellad. £ grain. IFll Opii, d JP1] £ grain. Plumbi Acetatis £ grain, atque yum Acid. Borico 1 grain. Plumbi Acet. et Opii £ grain. Zinci Sulphatis £ grain. Zinci Sulphocarbolatis £ grain. They should be retained with a pledget of cotton wool. Tampons.—For vaginal and uterine medication the following are made. The pledgets are globular in shape, about 1£ in. in diameter, composed of wool, gauze covered. Glycerin Tampons.—Saturated with glycerin. Argyrol Tampons, containing 1, 5 and 10% Argyrol in Glycerin. Ichthyol Tampons saturated with 5, 10 or 20% Ichthyol in Glycerin. Iodoform Tampons, S.H., with5% Iodoform in Glycerin. TABLETI7E. (Compressed Tablets), In the preparation of Tablets the material has to be granulated, to make it flow easily from the machine ; this is effected by moistening with a little alcohol or 'water (to which, if desired, a minute quantity of mucilage diluted about 1 to 4, may be added), rubbing through a suitable sieve (No. 16), and drying ilm'oughly either by slight heat, or better, by exposure to the air if sufficiently dry at the time. The decomposition, melting points or volatility of the chemicals to be compressed must be borne in mind, Salol, Beta-Naphthoi, Benzoic Acid, Sulphonal, Trional and Phenacetin should not be heated. To obviate the sticking referred to, lubrication with Boric Acid (2%), or spraying with a solution of Soft Paraffin or Cacao Butter in 1 in 6 each Ether and Alcohol, or less of the latter are resorted to in some instances. Substances already in small crystals, e.g., Potassium Chlorate and Ammonium Chloride, do not require this treatment. Tablets to dissolve like lozenges require half their weight of a mixture of equal parts of Acacia and Tragacanth. Owing to Incompatibili ty, Sodium Bicarbonate and Calomel, Saccharin and Rhubarb, Salol and Camphor, Salol and Thymol, Caffeine Citrate with Acetanilide and Antipyrin, Salicylic Acid and Iron Compounds, Chloral and Alkalis, Mercuric Chloride and Metals, oxidising agents, e.g., Potassium Chlorate and Permanganate, with Charcoal, Sulphur, Iodine or Sugar, should not be compressed together. Five or ten per cent, of potato starch thoroughly dried is useful to ensure rapid breaking up of the Tablet. Deliquescent compounds should be treated with Gum Acacia or Tragacanth. Similarly, if the powder is of a very dusty nature the judicious use of a little of these gums or of glucose is an advantage. Fibrous drugs may have 5% Dextrin. Many substances if compressed too hard are liable to cause the tablet to crack—this is particularly the case with Phenacetin and Antipyrin—the least possible amount of pressure should be applied that will produce a permanent tablet. ‘ Capping,’ i.e., splitting off of the surface of the tablet is due to too much pressure, or, it may be, a worn-out punch, or to moisture or too much lubricating powder. The majority of 5-grain Tablets are made to weigh grains with Milk Sugar. Substances of small dose, e.g., Arsenic, Morphine, and Strychnine are made up to a definite weight, e.g., I grain with this diluent. Further notes on the subject, Edn. XIX., p. 802. Stearettes, i.c., Tablets coated so as to be more likely to dissolve in the intestines than in the stomach, vide p. 690. Tablet Triturates are made in metal or vulcanite moulds which are worked by hand, yielding 50 to 2C0 at a time, the weights ranging frem ■§ giain (0-03 Gin.) to 1 grain (0-UG Gm.) and the diameters between l and & inch, and t inch in depth. The active ingredient is mixed with lactose or "Sugar, the whole being massed together with a little alcohol or alcohol and water. For Hypodermic Tablets, Sterilised Milk Sugar, or Cane Sugar is a useful diluent. These are prepared under aseptic precautions. A little Doric Acid is useful as lubricant. Dried Neutral Sodium Sulphate, Sodium Chloride and Ammonium Chloride are also employed in some instances. Hypcdeiniie Tablets are well made in a Tablet Triturate mould with holes 3% in. in diameter, the plate being I0—k in- in depth. Notes on Manufacture of Tablets.—P. J. ii./o8,276 ; ii./n,422. For List of Tablets in general demand, see Index. TEREBENUM. Dose.—5 to 15 minims (0*3 to 1 Cc.). A colourless liquid consisting of dipentene and other hydrocarbons, produced by the action of sulphuric acid on oil of turpentine and distillation. Sp. Qr- 0*862 to 0*866—B.P. ’14. It has an agreeable odour resembling fresh-sawn pine-wood. Boils at 160 to 172° 0. U.S. Soluble about 1 in 4 alcohol 90% and in all proportions in absolute alcohol or chloroform. It is not miscible with water, but may be emulsified by mixing it with one sixth its weight of tragacanth powder, then adding water and shaking. Uses.—An agreeable antiseptic, disinfectant, and deodoriser. The vapour is a useful sedative and antiseptic inhalation in whooping cough and in hay fever. 5-minim Capsules or Pastils are made. Useful in dysentery per os. In excess it may produce albuminuria and hsematuria. Whooping CouGHcured by 1 to 2 minims on sugar occasionally.—L.ii./29,S4. PftuitiTUS.—Recurrent cases often accounted for by worry. Terebene on sugar is a good intestinal disinfectant and stimulant, also useful in urticaria iu children, e.g., in a mixture with Magnesium Carbonate.—L. ii./i2,968. Vapor Terebeni, T.H. Terebene 40 minims, Light Magnesium Carbonate 20 grains, Distilled Water to 1 ounce. A teaspoonful in a pint of water at 140° F. for inhalation. Lor medicating antiseptic respirators, 10 drops of a mixture of equal parts, Terebene, Phenol, and Spirit of Chloroform, is often used. Terpinum Hy&ratunb U.S. X. Fr. Cx., P. Hung. Pli. Ned. V., P. Belg. IV.—Syn. Terpine. C6H8(0H)2.CH3.C3H7+H20= 190*1716. Dose.—2 to 6 grains (0*12 to 6*4 Gm.) or more, in cachets, slipules, or pills, or suspended. Prepared by acting during cold weather upon Rectified Oil of Turpentine 4, Alcohol 80% 3, with Nitric Acid 1 in fiat dishes. Crystals separate after several days, and are recrystallised from 95% Alcohol rendered slightly alkaline. Yield 12% of the oil taken.—Caspar!. Sir W. A. Tiiden, Prof. W. H. Perken, and J. C. Umney on Terpenes.— P.J.L/12,581,651,723,756,817; P.R., July, 1912. A derivative of oil of turpentine in prismatic crystals, soluble in water about 1 in 250, 1 in 44 of alcohol 90%, and about 1 in 6 in oils- Flavoring.—Prescribed as Linctus Pini Terpin et Heroin q.v. Uses*—Lessens cough ; has been used with success in bronchitis, chronic and subacute ; it assists expectoration, e.g., in initial catarrh of phthisis; useful as a haemostatic in bleeding from lungs. Diuretic. Terpinol. Dose.—li minims (0*1 Cc.) or more in pill, or gelatin capsule. An agreeably aromatic liquid, containing bodies of the composition Cj0Hie* 13o-12i8 and C1oH:18 = 138*1404. Is obtained by the action of dilute sulphuric acid on terpene. Miscible with alcohol in all proportions, but insoluble in water. It is used for lung affections ; if it disorders the stomach it should be given with meals. In pulmonary haemorrhage in 3 drop doses used with advantage.—I, W. Allan, Glas. Med, Jl., Nov., 1913, Methylene Blue dissolves in boiling Terpinol producing a colourless solution - the colour, however, precipitates again on cooling.—W. T. Robinson. Terpineol. Syn. Terpilenol. C10H17OH = 154-1404. A product of fractional distillation of Terpinol, Sp. Gr. 0-940 used for disguising odour ot Iodoform and for scent making (in the name of Artificial Lilac). Syn. Cinvl Alcohol, described—Allen, 1911, Vol. IV, p. 280. THEOBROMA. The seeds of Cacao, Theobroma Cacao (Sterculiacece). When heated and deprived of husk and membrane, these yield Cocoa nibs. The nibs ground, and most of the oil pressed out, produce, when reduced to powder, the best forms of Cocoa for use as a beverage. Cacao Shell as cattle fodder.—P.J. i./3i,371. For further details on Cocoa, see Vol. II. Oleum Theobromatis, Syn. Cacao Butter. Cacao Oleum P. Belg. IV. The concrete oil of the seeds (yield about 45%). Melting at about 86 to 91*4 F. (30 to 33° C.), i.e., below the temperature of the body, is much used for suppositories. For substances which lower the melting point of the oil, and for export to hot climates, it is well to add 5 to 15% yellow wax. (Cf. ‘ Ovules.’) Note on Cacao butter and substitutes.—P.J. ii./oo,158. To deodorise for cooking, it has been suggested to heat the oil in an open pan to 370° P. for five minutes and cool again, and, to give it butter consistence, to add to each 4 parts of cacao butter melted, 5 parts of cotton seed oil. Pasta Theobrcmatis, Chocolate. This is made by grinding the nibs into a paste, with sugar and vanilla or other flavouring added ; it should contain not more than 50% of sugar and about 25% of fat (Oleum Theobromatis), and be free from gum, added starch, or other admixture. The author uses chocolate for the preparation of medicated Tabellae. It is useful for many medicines. The solvent action of its fat renders it eminently useful for fixing Nitro-glycerin, Erythrol Nitrate, Mannitol Nitrate, Menthol, and alkaloids. For list vide Index—Tabellae. Theobromina. Ph. Ned. v. C5H2(CH3)2N402= 180-0944. Syn. Dimethyl-Xanthine, San- tiieose. Dose.—1 to 5 grains (0*06 to 0*3 Gm.). This alkaloid constitutes about 1 to 2% of the seeds, in white crystalline powder, sparingly soluble in water, alcohol and ether. Caffeine is trimethyl-xanthine. 2% solutions may be obtained with aid of Tri-Sodium Phosphate. Uses.—As a diuretic, relieves cardiac and renal dropsy (but some think it bad therapy to put extra work on diseased kidneys), and in angina pectoris, 20 to 30 grain doses spread over 24 hours lessen the frequency and severity of attacks. Given in cachet and pill. Determination of Theobromine by methylation to Caffeine.—P. A. W. Self and W. It. Rankin, P. J. ii./31,75. Has elective action on elimination of chlorides, and increase of urinary chlorides follows. Some hold it should be limited to nephritis with oedema, accompanied by chloride retention. In other forms may be harmful — H-M.J.E. i./30,74, THEOBROMA. 797 Theobromine-Sodium-Sodio Acetate. Syn. Theo-Sod-Acet. *Agurin (T.M. 235517, 322517). C7H7N402Na+NaC2H30* =284-504. 7 7 4 .i 2 3 * Dose. 10 to 15 grains (0*6 to 1-0 Gm.), up to 45 grains daily in fresh solution. 6 Slipule ’ No. 00 holds 10 grains. White crystalline hygroscopic powder soluble 1 in 2 of water and about 1 in 200 of alcohol 90%. In dropsy, sciatica and neurasthenia. Is strongly diuretic in action. Not to be given with acid substances, nor with sugar or gum, and in general incompatible as for Theo-Sodo- Sal q.v. To be preserved from the air, the C02 of which tends to decompose it. Relieves cardiac dropsy. Tlieobrominse et Sodii Salicylas (B.P. T4).—Syn. * Theo-Sodo-Sa’, *Diuretin (T.M. 223214). P. Austr., F.E. VIII., Ph. Ned. V. P. Ital. V., P. Belg. IV. C7H7NaN402+C6H4(0H)C00Na= 362-1196. Dose.—10 to 20 grains (0*6 to V2 Gm.). Max. dose pro die 90 grains. Slipule No. 00 holds 10 grains. Manufacture.—Rub Theobromine 18 to a paste with water 10. Dissolve Sodium Hydroxide 4 or q.s. in water 8 and add to the Theobrcmine until clear. Add Sodium Salicylate 16, filter and evaporate on a water bath : or in vacuo. A sodio-salicylic compound containing about 50% of sodium-theobromine in white powder, soluble 1 in 1 in water (a little Sodium ! Salicylate added will often ‘ clear ’ a strong solution). This solu- i bility we find refers to the freshly made compound. It is rapidly decomposed in moist air with absorption of C02 and liberation of Theobromine—hence less soluble in water. It must be kept in stoppered bottles. B.P. requires 40% Theobromine, U.S.P. 46-5%. Theory for Na2 ► 0i4H12N4O5 is 44-19% Sodium Salicylate and 55-81% Sodium Theobrominee. C. T. Bennett and P. B. Windie recommend new method for analysis.—P.J. : i./2i,472. Ifncorn&atibtes : Theobromine Sodium Salicylate and Theophylline 3 Sodium Acetate are incompatible with Ammonium Salts, Sodium Bicarbonate : and all acid salts, alkaloidal salts, free inorganic and organic acids, and •' Aromatic Spirit of Ammonia.—J. W. Plenderleith, P.J. i./23,364. Flavoring—Glyl Lavandulae, Syl Vanillae; Syrupus Zingi- ^ beris, Extractum Glycyrrhizae Liquidum. Uses.—Diuretic (cf. Theobromine), without affecting nervous system and causing sleeplessness. Safe for scarlatinal dropsy of children. In angina pectoris it lessens the frequency of attacks. Given for cough. Tablets contain 5 grains. Angina Pectoris treated with Purine-base Diuretics of value, but little to choose between any of the Theobromine preparations. To avoid tolerance, over a long period, the following (or some of them) were used on alternate weeks—Theobromine 5 grains, Theobrcmine Sodium Acetate 10 grains, Theobromine Sodium Salicylate 10 grains, Theobrcmine Calcium Salicylate 7\—10 grains, Theophylline 2 grains, Theophylline Sodium Acetate 4 grains, Theophylline-ethylenediamine 1+—3 grains. Pour doses daily usually given (often best taken in the middle of a meal) for the first 4 days of each week. Will not give complete relief, but more helpful than any other drugs used.— N, C, Gilbert and J. A. Kerr, Jl. A-M-A. i./29?202, Theobromine Calcium Salicylate. Syn. # Calcium-Diuretin, Theocalcine. Ca(C7H7N402)2+Ca(C6H40H.C00)2= 712-3912. Dose.—7 to 15 grains (0*5 to 1 Gm.). Tablets, 7J grains (0*5 Gm.) each. Manufacture.—Prepared similarly to the Scdium salt frcm Theobromine, Calcium Oxide, and Calcium Salicylate. A white powder slightly soluble in water, containing about 48% Theobromine and 11% Calcium. Uses.—Similar to Theobromine Sodium Salicylate. For arteriosclerosis 30 grains have been given daily. Asthma.—Calcium Diuretin taken once or twice in the evening stated to be an almost certain preventive.—B.M.J.E. i./26,16. Iod - Calcium - Diuretin. Syn. IODO — THEOBROMINE - CALCIUM— Salicylate. Tablets contain 7J grains Calcium-Diuretin, and 1J grains Potassium Iodide. Dose.—One thrice daily after food : may be increased temporarily to> 2 tablets thrice daily. As improvement sets in the smaller dcse should be* resorted to and may be maintained for lengthy periods. In hypertonia, angina pectoris and asthma. Rhodan-Calcium-Diuretin. Syn. Rhodan-TheobrOMINE-CalcIUM- Salicylate. Tablets contain 7J grains Calcium-Diuretin and 1J grains s Potassium Sulphocyanide. Dose.—One tablet thrice daily after food : 2nd and 3rd weeks one tablet thrice daily : 4th, 5th and 6th weeks one tablet once daily. Crush in a iittk water or milk before swallowing. For treatment of hypertonia of climacteric or sclerotic origin, and in rena cases. Xoio-theobromine. (Syn. Theobromine Sodium-Iodo-Salicylate). Dose.—2 to 10 grains (0*12 to 0*6 Gm.). White powder, containing about 40% Theobromine with 22% Sodium Icdid* and 38% Sodium Salicylate, soluble in water, is a good diuretic and hcai stimulant, increasing blood pressure. In cirrhosis of the liver and acut* nephritis. Theobromine-Sodio Sodium Iodide. Syn. Eustenin. C7H7N402.Na.NaI ==352-0126. Dose.—8 to 15 grains (O’5 to 1 Gm.). Has been given in arteriosclerosis, angina and aortic aneurism. Compound Theobromine Tablets. Dose.—Up to six during the day, increased if necessary. To be ccntim ec for 10 days a nd then stopped. Theobromine 3 grains (0-2 Gm.) Potassium Iodide H grains (0T Cm. Potassium Nitrate 3 grains (0-2 Gm.) and Sodium Nitrite 1/12 grain (0-005 Gm..; A preparation on these lines is used abroad in treatment of artericscleicsk angina pectoris and excessive use of tobacco. Theobromine Valerianate. Dose.—5 grains (0*3 Gm.). A loose combination embodying the propertic of the two constituents. Theophylline, U.S. X. Dimethyl-xanthine. (Isomeric with Theobromine). Syn. *Theocin. (T.M. 247465, 322570) C5H2(CH3)2N402=- 180-0944. (See also p. 244.) Dose.—3 to 6 grains (0*2 to 0*4 Gm.). White crystalline powder, soluble 1 in 200 (by experiment) of cold wate: and about 1 in 90 of Alcohol (90%). M.pt. 269—272° C. Marked diuretic Has been found useful in heart affections attended with symptoms ofc congestion, and nephritis with dropsy. Tablets weigh 4 grains. THYMOL. 799 (contracted to ‘ Theo- Theophylline-Sodio Sodium Acetate phylline Sodium Acetate ’). C 5H 2(CH3) 2N4 0 2Na. N aCH3CO 0=284-2238. times8(la"ify*after8mea]s<0'12 £o °’25 Gm-> Solved in water, three or four Agrahi iu'lf rninlms of ^Cincture ofOranget68 °f M<altho1 brf“> «• Compounds^Uealte™^ ^ ^ lia0S °f th® analogous Theobromine of YardilcZ^^ ^ a^ou^ ^ *n 20. For oedema and dropsy be given simultaneouslycltable neuroPatnic individuals. Paraldehyde may Aratate.°Analys?s.-GPfw!PeSeT?be Thcol>romine Sodium Sodium Acetate Tablets—4 grains are prepared. bala-ce^tmi0mfvit0 digixalisTTtheraPy in dropsy often “tips the ani kl3*eys *?*• . Has Proved suitable when both heart IfnAtU-!ih-e ao^?n 18 often veTy striking—within an hour. continuflthe’dmg?-^ I sSthet&°i7t^4410 ^ 1118 °mUo ™ „[S*“~Appeared to act as a renal irritant as well as diuretic Sown L ii A6 SG3 te CaSGS‘ The same is true of Himetin —Langdcn /n ^06214.) Theophylline Ethylenediamine (C7H8N4Oa)8. (EH2. ch2. ch2. NH,)2. Dose. Tablets contain 1^- grains (0*1 Gm.), 3 or 4 of which may be taken daily. Luphyllin Suppositories contain O'36 Gm. Luphyl’iii Ampoules, ± Cc., contain 0-48 Gm. One to 3 ampoules may ~e given ciany intramuscularly. Intravenously half an ampoule is given with 9 Gc. 20% Glucose, or with distilled water, and is injected slowly. Yellowish white crystals with ammoniacal odour and alkaline reaction. Uses.—In oedema of cardiac and renal origin and in cases associated with arteriosclerosis. When cardiac debility is present Digitalis to be given fcr some days beiore.^ Effect is noticed shortly after taking and usually reaches maximum on the nrst day. Within two or three days 15 litres of urine may be passed, when treatment should be discontinued and only resumed if necessary. It is stated there is no irritation of the kidneys. B.P. ’14, Acido Timico, F.E. VIII., P. Belg. IV., P. Ital V. C6H3(CH3)(OH)C3H7,I : 3 : 4, = 150-1092. Dose. | to 2 grains (O'03 to 0*12 Gm.), in pills with soap and a trace of Alcohol, or in oily or aqueous solution. Anthelmintic Dose.—15 to 30 grains (1 to 2 GM.). U.S. states 2 Gm. divided into 3 doses. E.E. states max. in 24 hours 1 to 2 Gm. A Phenol obtained from the oils of Thymus vulgaris, Monarda punctata (Labiatce) and Carum copticum—"Umbelliferce. The oil of the last mentioned is B.P. ’14 as Oleum Ajowan with not less than 40% Thymol. . Oeymuxn gratissimum Oil as a source of Thymol (39-15%). Widelysprcad m East Indies, Ceylon, Java, tropical Africa and Central America. Cultivated on the Ivory Coast.—P.R., 1923,14,154; Y.B.P., ’23,113. Monarda Punctata Oil contains 60% Thymol. Origanum hirtum growin in Crete and Dalmatian coast contains 60—67%. Mosia Javcnica 44% Wild Thyme of France 20%. U.S. allows synthetic, e.g., from Cymene or meta-Cresol, or made from Piperitone derived from various species of Eucalyptus. Owing to competition of synthetic Thymol it is no longer profitable t< prepare natural Thymol from Indian Ajowan Seed. Ajowan Seed grown ir Seychelles gives twice the yield of oil of Indian Seed.—Imp. Inst. Kept., 1925: 0311111.-^/1. Ajowan. The drug is given in the dose of 10 to 30 grain; (0-6 to 2 Gm.) as Extractum Ptychotis Liquidum P.I. Aqua Ptychotis P.I. (Omam water) made by distillation with the fruit if given in the dose of 1 or 2 ounces (30 to 60 Cc.). The dose of the volatile oil is 1 to 3 minims (0-05 to 0-2 Cc.). Thymol is in large transparent crystals melting at 111° F. having the odour of thyme and a burning taste. Soluble 1 in 1,500 of water, 1 in 200 of glycerin, 1 in 8 of alcohol and glycerin, equal parts ; soluble in fats and oils, and 8 in 3 of alcohol 90%, and freely soluble in ether, acetic acid and caustic alkalis Liquefies Menthol, Chloral Hydrate, Camphor and Phenol. Uses.—Externally a powerful antiparasitic, also for certain stages of eczema and psoriasis (see Unguentum) and for burns (see Volckmann’s solution). A powerful antiseptic. (Our experimentE prove this, cf. Antiseptic Powers, Vol. II.). It is also a good deodorant. May colour the urine green. The administration simultaneously with or immediately after a large dose of a solvent ot thymol, e.g., alcohol, should be avoided. May be inhaled (see Vapor)- Ankylostomiasis.— Extensive experience indicates maximum dose of 60 grains for je healthy adult man and 45 grains for a woman, and in pregnant women, 0 cases with very bad infection, and in elderly patients, or these with hear disease, or extreme debility, 30 grains or less, the dose being given in two 0 three divided doses of 15, 20 or 30 grains, each at one or two hour interval; followed by strong saline purge. Give in hard gc/atin capsules Do not repeat in less than a week, and prohibit alcohol, fats, vinegar, and othe solvents of Thymol on day of treatment. The dangers of Thymol are over rated, but untoward effects in patients with chronic disease of the intestin and in oedematous patients. Most effective on hookworms, but? usually fails to remove heads of tapeworms.—K . N.Chopra and A. C. Chandler ‘Anthelmintics and Their Uses’ (Balliere, Tindall & Cox, 1928). Ankylostomiasis treated by -1 drachm dose of Beta-Naphthol and Thyme 4 drachm in a one ounce draught, repeated.—H. G. Phippen, B.M.J. i./23,371 Thymol, 3 cachets of 15 grains, given at intervals of 2 hours—routin'* treatment.—N. Cantlie, Jl. Trop. Med., Feb. 1, ’23,42. In large doses causes gastro-intestinal irritation, tinnitus and deafnrse dyspnoea with slowing of respiration, acceleration and then slowing cf pub and fall of temperature. It is best given with eguai Quantity of Lactose or Sodium Bicarbonate.—Jl. A.M.A. L/29,744. For mode of infection, details of the parasite and further notes on- treatment of anhjlostomiasis, vide Carbon Tetrachloride this Vol, and 1 Vol. II. (Bacteriological Notes). Ttenia.—One or tvTo doses of 5 grains in the early morning with a tumblerfu of water generally causes tapeworm to be passed in a stool in the evening.— George V. Perez, B.M.J. ih/13,49. Goitre.—Cases treated by 10 grain doses twice daily. Patient’s dietary should contain no solvent of Thymol. Give as coarse powHer and wash dowi:; with draught of vTater. In some cases swellings in the neck disappear rapidly (3 Xaphthol also beneficial.—L. i./13,368. THYMOL. 801 S7i •c? in Sterilisation. A 5% Alcoholic Solution of Thymol has been used m the place of Iodine Tincture prior to operation Two applications are made with an interval of five minutes three minutes after second application the operation may be started Thymol Disinfectant (Martindale). septic8 poTCrr^f°EssmitiaiaCOiIsa(9nw.)OUritni^Sa”note’it3^ an^" having a Rideal-Walker Carbolic Acid Co-efficient of 8. It is employed as a general disinfectant and for instruments and in less strength for use to mucous membranes. For Medical Purposes a 0-1% n/r’"'111!, tlle dl,utlon wlth water, forming a white emulsion will have the same bactericidal power as a 1% Solution of Phenol’ A stronger proportion than this (which would contain 1 of actuai Thymol m 3,000) cannot well be tolerated—hence should be used witn caution as it causes a temporary stinging sensation. lor General Disinfection 1 in 200 (one tablespoonful to 5 pints). Liquor Thymol. 1 in 800 of warm water. This saturated aqueous solution is used diluted as an antiseptic gargle, undiluted it is too strong. Lotio Potassii Thymatis U.C.H. Thymol 8, Solution of Potash 120, Glycerin 16, Water to 1,000. Blistura-OIeo-Balsamica — Syn. Balsamum Vit^ ’ Hoffmanni. Tincture of Life.’ Dose.—1 to 4 drachms in water. Oils of Lavender, Thyme, Lemon, Nutmeg and Orange Flowers of each 4 ; Oil of Cloves and Cinnamon 3 J of each ; Balsam of Peru 101 • Alcohol 90% to 1,000 ; allow to stand a few daj^s, then filter. A remedy for snake bites in Africa. A carminative stimulant. Pastilli Thymol contain :;!V grain. Pigmentum Thymol. Thymol 1, Ether 10, and Spirit 5, or Thymol 1, Petroleum Oil 18, used as pigments in ringworm of uhe scalp—whilst acting as parasiticides they dissolve the fat, loosen the hairs and thus help epilation. 2\ to 5% in a mixture of chloroform and olive oil also used. Sapo Thymol St. G. H. Thymol 5, Soft Soap 240, Alcohol to 480. Thymaglycine [Martindale).Dose per os.—10 to 30 minims (Qm to 2 Cc.). A palatable preparation containing Sodium Benzoate, Glycerin Menthol, Essential Oils, and Thymol Water. As such, or diluted, is beneficial in rhinitis, pharyngitis, quinsv, to brush the gums, and in gastric and intestinal catarrh." For spraying into the throat and nostrils, may be diluted 1 to 3 with water. For vaginal irrigation dilute with 20 times its volume of warm water. Colitis is treated with an irrigation diluted 1 in 6. To ward off colds douche the nose with Thymaglycine as such or diluted 1 to 3 of water. In measles the necessity of wiping out the mouth with a preparation of this kind is often forgotten. As a preventive against microbic infection—it is most important to wash the nasal mucous membrane and the throat (tonsils in particular) with an antiseptic lotion. Colitis in children. 5 to 10 drops in paraffin or water well tolerated and effectual. It also acts well against threadworms and lias been found of meat value in whooping cough. VOL. I. c c 5k Glycothymoline (T.M. 231933). Said to consist of Potassium Carbonate Sodium Benzoate, Sodium Borate, smaller portions of Sodium Salicylate Thymol, Menthol, Glycerin and Alcohol, coloured with Cochineal. Employe* in catarrhal conditions of the mucous membrane of the nose, throat, stomach intestine, uterus and vagina. Spiritus Thymol. Dose.—3 to 15 minims (O'2 to 1 Cc.). Thymol 1, Alcohol (90%) to 10 ; for medicating the wool of respirators. In scabies, where the infection is limited and recent, this- solution is suitable for short applications. Volckmann’s Thymol Solution. Thymol 1, Alcohol 20, Glycerin 20. Dissolve and add to water 1,000. Used as a spray and antiseptic lotion, as for burns. Unguenfum Thymol. , L. H. has 20 grains to the ounce of Soft Paraffin. Dissolved mi- heat. Applied half strength to the skin, keeps off gnats, etc. Usee in the later stages of eczema and for other skin affections. Unguentum Thymolis Compositum St. Th. H. Thymol 5, Boric Acid 30, Zinc Oleate 60, Hydrous Wool Fat 120 Yellow Soft Paraffin to 437-5. Vapor Thymol, T-H. . . Thymol 6 grains, Alcohol 90% 1 drachm, Light Magnesium Car bonate 3 grains, Water to 1 ounce. A teaspoonful to a pint of wate at 140° F. for inhalation. Stimulant and antiseptic. Thymol Carbonate.—Syn. Thymotai. Dose.—5 to 15 grains (0-3 to 1 Gm.). A nearly tasteless, colourless, crystalline powder not dissolved ir the stomach. Employed in ankylostomiasis. May prove usefu against tsenia and other worms. Tablets contain 10 grains. Thymoform Tablets. Dose.—One occasionally. Contain Thymol and Formic Aldehyde in a Cane Sugar basis a. an antiseptic throat lozenge. TINCTURE. Tinctures are made by 'percolating the drug in more or less fin powder with the menstruum (usually alcohol) in a percolator, or b. macerating in a closed vessel for a time with shaking or stirring.. We proved that in many cases a few hours’ maceration was effective a the customary ‘ seven days ’ or more. Compare our findings in respec of Digitalis Tincture, p. 390. Non-Alcoholic, ‘Glycerin,’ or ‘Aqueous’ Tinctures. Some of these are in occasional demand, but the alkaloidal ones can ha little activity, unless a suitable acid can be used to ensure their solution. 1J Glycetracta, with which we have experimented, should replace them. Ethereal Tinctures of certain drugs are made, e.g., Belladonna1 Capsicum, Iodine and Menthol. For the dispensing of resinous tinctures m mixtures, Mucilage # Acacia yields satisfactory mixtures with most Tinctures excepj in the case of Tinct. Benzoin! Co., Jalapse, Myrrhse, and Tolu. Ta Mucilage is best diluted with as much water as possible, and tbi tincture then added. . If Salts be present in the mixture the above rule applies, except l TRAGACANTHA. Tinrta-! P 9Ta,rS’ Wher° TraS'l'!anth Mucilage should be used. salts but if auv l"' 1 rellulref' n° suspending agent in the absence of .alts, out if any be present Mucilage of Acacia is best used. Tragacanth Mucilage answers well for suspending Tinct JalaDte To^Por^wr’p111* W USpeSS for,T"?ct- Benzoini Co., Quinime and combined LTV ; WT* C°' a?d TmcL TollI> the two mucilages add the tincturo'and ialtiy add the Tinctura Hydrastis, which in absence of salts requires no susnend- j)f,g^°®“t’,ftno"?d 9aVe t11 addltlon of Mucilage of Tragacanth if salts , ,?,r.esen9, Tinctura Lupuli and Tinctura Cimicifugie require no addition either m presence or absence of salts alsojfk8'Wdatas“ey,aphJf 9?459mber °* T1“ctures.-P.J. ii./o7,738. Sec _ ^arious Alcoholic strengths used in making Tinctures and their relative advantages.—A Dutch communication, P.J.iiy26,36. reJatne TRAGACANTHA, Dose. 2 to 10 grains (0-12 to 0-6 Gm.) or more. From Astragalus gummifer and some other species (Leguminosce). Gelanthum (Unna’s Jelly). 1 onleat-m a stpc^1 ?-mth-Tragacanth 110 grains, Gum Acacia 30 grains Gelatin 1-0 grains, and Distilled Water 10 ounces, for 4 hours ; press the paste through muslm, mix well and add Glycerin 6 drachms, heat again in a water bath for an hour, and add Thymol Water q.s. to 12 ounces.—Ph. Form, ^modified1 This is similar to the formula in E.L. A basis for various antiseptic applications for skm medication. * Glycerin of Tragacanth (B.P. T4). Tragacanth, in powder, 1, Glycerin 3. Mix, and add Water 1. Useful pill v X C1P 1 b II Xj • ‘ Cremor-Siec. ’ Preparations.—Desiccating Creams for application to the skin. A small portion rubbed on the part in a thin layer rapidly dries and forms a protective coating. The’ followino- medicaments can be incorporated in the basis :—- __ Adrenalin 0T%, Alum Acetate 5%, Argyrol 2%, Boric Acid ^ /o> Napnthol 5%, Cade Oil 10%, Capsicln 2%, Ghrysarobin 5%, Cicatricine 10%, ggj]Cocaine 2%, Collargol 2%, Formosyl 10%, Ichthyol 5 and 10%, Ichthyol-Resorcin 5%, Iodoform 5%, Lactic Acid 5%, Liquor Carbonis Detcrgens 5%, Menthol 5%, CEDMercuric Chloride 1 ill 5,000, Phenol 2%, Resorcin 2 and 5%, Salicylic Acid 2 and 5%, Sulphur 10%, Thymol 0T%. The basis contains 25% of Zinc Oxide. Cremor Emolliens. Syn. SKIN CREAM, U.C.H. Tragacanth 1, Methylated Spirit 7, Glycerin 14, Olive Oil 3% Simple Tincture of Benzoin 2, Water to 100. Muciiago Tragacanthse {B.P. T4). Dose.—1 drachm to 1 ounce (4 to 30 Cc.) or more. Improved formula suggested by the writer:— Pour Alcohol (90%) or Spirit of Chloroform 120 minims into a 20-ounce dry bottle and add Tragacanth, in powder, 60 grains. Shake till evenly moistened C c 2 and add Distilled Water q.s. to 10 ounces. Shake again qmckly to make a uniform mucilage. This keeps much better than mucilage of acacia One: part to 3 of aqueous fluid will suspend heavy powders. 1 lie also Resinous. U.S. X. directs Tragacanth 6, Glycerin 18, Water to 100. Mucilago Marantce. Dose.—Ad lib. Triturate Arrowroot 6 drachms with water 2 ounces to make a smooth paste; and make up with boiling water to 1 pint. Heat until semi-transparent.. Cool and add spirit of chloroform 2 drachms To suspend Bismuth and other suitable heavy medicaments this and a. similar preparation of cornflour has been found useful. It will suspend bismutl salts in a proportion as high as 1 drachm to the ounce. Gpl. Cattel. Pulvis Tragacanthae Compositus (B.P. ’14). A mixture of Tragacanth, Gum Acacia, Starch, and Sugar. Dose.—10 to 60 grains (0-6 to 4 Gm.). Is used as last preparation, 10 grains to 1 oz., specially useful for bismuth oxynitrate. TRITURATIONS, U.S. Diluted powders of active substances made with Milk Sugar. 1 in 10. Vide Index for Triturations prepared and their doses Levitations are of strength 1 in oO :— gFJLevigatio Aconitine (base) .. .. Dose 1 to f grains. iP llLevigatio Hyoscinse Hydrobromidi .. „ i ,, \ >, [p jjLevigatio Hyoscvaminae (base).. .. „ J „ 1 „ TROCHISCI. Lozenges are prepared with six different flavourings (B.P. 14). ibost with Fruit Basis are prepared with Black Currant paste, Sugar anc Tragacanth, but are harder than the Fruit Lozenges of commerce— viz., Benzoic Acid (J grain), Catechu (1 grain), Eucalyptus Gum (1 grain), Guaiacum Resin (3 grains), Extract of Krameria (1 grain), anc |?3|D1 Extract of Krameria (1 grain), combined with Cocaine Hydro* chloride (^o grain). Simple Basis.—Sugar 49C, Gum Acacia 19L Mucilage 35, Water q.s. 'Use in.—Ipecacuanha (1 grain), Reduced Iron (1 gram) and Santonin (1 [gram Rose Basis is as above, but with addition of Otto. Used, in Compcui Bismuth Carbonate (2 grains), Potassium Chlorate (3 grams) and JScdiu Bicarbonate (3 grains)—the last mentioned not B.P. ’14. Tolu Basis contains Tolu Tincture 10, Water 10, Sugar 482, Gum -Acacia It Mucilage 354, Water q.s. Used in Acid Tannic (* gram), Phenol (Carbol Acid) (1 grain), (B.P., ’98) CE^Morphine Hydrochloride (* grain) a* CE)Morphine Hydrochloride (rk grain), with Ipecacuanha (& gram). Orange (Tincture) is used to flavour Sulphur Lozenges (5 grains). Lemon Juice with Sugar, Acacia and Tragacanth is used for Phenol Lozeng ‘ (B.P. T4) G grain). , . c „ , , a. « In the index those with R have Bose basis ; S have Simp! Sugar basis ; ‘ T ’ have Tolu basis ; ‘ G’ have Gelatin basis, and am the commonly sold Pastils or Jujubes of oval or round shape (tk latter are frequently “ sugared ”). Vide also Pastilli Glycogelatin. UREA. 805 m, . . , UNGUENTA. llie principal Omtment Bases areLard, Benzoated Lard, and Lard with Oleic Acid (for Alkaloids); Paraffin, Soft (White or Yellow , and Hard Paraffin, and their combination Paraffin Ointment (White or Yellow) ; and Wool Fat (and Hydrous). Almond 0.1, Beeswax (Yellow and Waite), Camphor, Glycerin, Olive Oil, Spermaceti, Prepared and Benzoated Suet, Palm Oil, Cocoanut Oil ana Sodium Stearate are also used. Unguentum Simplex (B.P., 1885) was composed of White Wax 2, benzoated Lard 3, Almond Oil 3. Goose Grease is readily absorbed (cf. Anserine Mulls). Lard and Olive Oil are absorbed to the extent of about 15% after two minutes rubbing. Hydrous Wool Fat is absorbed 20% providing me proper amount of water is present. Olive Oil assists. A basis of Hydrous Wool Fat and Glycerin of Starch is largely absorbed. It is relatively non-greasy. Lassar’s Paste (q.v.) forms an excellent Protective Ointment, as also does a mixture of Hydrous Wool Fat 1 with Soft Paraffin 3. sftEucerin (T.M. 297268, 297270) Anhydrous.—A mixture cf 5 rarts rf Oxycholesterms from Wool Fat with 95 Paraffin Ointment. This with an etc1—Gehe^1^ °f Water gives * Eucerin Purum ’ miscible with other salves, For other ointment bases cf. Crembas, Adeps Lance. Mulls, Mcllin, etc. UREA. CO(HH2)2=; 60*0472. Syn. Carbamide. Pose. 10 to 60 grains (0*6 to 4 0 Gm.), thrice daily, may be given m a mixture flavoured with lemon syrup, but much larger doses are commonly now given both in therapy and as diagnostic. Hypodermically a 1 in 6 solution has been given, but it is seldom used that way. It forms colourless crystals. Soluble 1 in 1 of water and in alcohol 90% about 1 in 7b Urea is synthesised by acting on Phenyl Carbonate iCO(O.Cfi Hs),-214-0781 with Ammonia, the products of the reaction being Urea and Phenol (Phenyl Carbonate is made by passing Phosgene, i.e., Carbonyl Chloride, CO Cl.-=68*914 into dilute Sodium Phenate solution.) Wohler in the year 1828 succeeded in converting Ammonium Cyanate into Urea; it was the first animal product made by a purely chemical synthesis. E. Werner holds that Urea is of the formula H3N<^ . m Te*ation with Ammonium Salts in general, and mates oyamc Acid the most significant decomposition product. Urea is cmniricser.t even m the lowest forms of plant life.—B.M.J. it/23 ,1020. ’ Chloride is available in cylinders. It was one of the early (and anger0US2- Sase%used h1 the war. The treatment was venesection, which was sometimes effectual. Warmth and stimulants are required at the same Lime. inq/r<Tr Sr>y ot)^ain6d from Calcium Cyanamide by hydroly sing with lu/o ±i2ou4 at 50 C.—P.J. i./16,45. . Uses* Urea bas diuretic properties and is given to some extent in gout and kidney disease. In the past it was given in phthisis. It bas marked bactericidal properties and has been suggested for use to wounds. For tbe estimation of urea in urine see Vol. II. Grave genuine nephrosis (nephritis with oedema, without hypertension or hematuria). Complete recovery under treatment with Urea up to 100 Gm. daily.—D.M.W., Nov. 13, ’25, per Jl. A.M.A. ii./25,2058. A useful diuretic in doses of 30 to 60 Gm. a day in a small amount of water after meals in cases of heart failure with oedema.—Arch. Int. Med., Oct. 15, ’25, per Jl. A.M.A. ii./25,1753. See also B.M.J.E. L/26,2. After ingestion of 100 Gm. Urea by normal persons the Urea-Nitrogen of the blood can be raised to a figure comparable with that obtained in chronic; nephritis. When blood Urea exceeds 70 mg. per 100 Cc., headache, dizziness*a and somnolence may occur. It can be given over long periods and has been, administered in doses above mentioned in advanced cardiac decomposition., With continuous administration, daily urine volume can be maintained att almost constant level. Its use as a diuretic deserves greater popularity.-— Jl. A.M.A. ii./25,2036. Scar Tissue.—Best results in softening of, obtained by injection under non-adherent scars of a concentrated solution of Urea. Care necessary as necrosis caused when injected under an adherent scar.—PerPr., April, ’26,332 Haustus Ureae Gomposita. (Urea Concentration Test). K.G.H.. Dose.—3J ounces (100 Cc.), less for children. Urea 4| drachms, Tincture of Orange 15 minims, Water to 3| ounces. Tiiio-Urea. Syn. Tliiocarbamide C3(NH2)2 = 76-1072. Obtained by heating dry Ammonium Sulphocyanide in an enamelled vessel to 170° C for an hour, then cool rapidty and extract the unaltered Sulphocyanide with cold, strong Alcohol and crystallise the residue repeatedly from hot water 1 Crystals soluble 1 in 10 in water—with difficulty in Alcohol. [PlJUreides.—The designation in the Poisons Schedule is ((AM Poisonous UreidesA Ureide is a compound of an Acy (or Acidyl) radical with the residue of Urea thus :— NH0CO.NH0 NHoCO.NH.CO.CH, Urea. Ureide of Acetic Acid. Analogous are the Amides to Ammonia :— NHj NH3.CO.CH3 Ammonia. Amide of Acetic Acid. When the Acyl radical is from a dibasic acid one H atom of each NH2 ma* _co be replaced as in Barbituric Acid. CO <CnH—CO/>CH2 These are Cyclic Ureides. Some held that only these are involvec Adalin and Bromural are Ureides, but not cyclic. Any Alkyl, Acyl c Metallic Derivative of Barbituric Acid is included, even if proved to be non poisonous. We have reasons to regard Adalin, Bromural and othe recent additions to the book as JP1]. We also take the view that combinations containing a high proportion of Ureides cannot be brought reasonably into the CE) Admixture Clause We should welcome an addition to IIP ll bringing in * or preparations of Barbiturates in any proportion.’ The name Diureide is usually given to bodies containing two urea residue e.g., Uric Acid and Caffeine. fWTl Barbitonum (B.P. ’14).—Malonurea. Syn. Diethyl-malony urea. Diethyl-Barbituric Acid, P.G. VI., Fr. Cx. Supe: 1920, P. Helv., P. Svec., P. Jap. IV., Ph. Ned., V., P. Svec. X Barbitalum, U.S. X., P. Belg. IV., F.F. VIII., P. Ital. V Malonal. ^Hypnogen (T.M. 279688), Deba, Veronal. Wholesale and retail vendors must treat as IFJ. (C2H5)2: C : (CO.HN)2: CO or C8H12N2Oa= 184-1096. Dose,_5 to 10 grains (0*3 to 0*6 Gm.)—should be dissolved it UREA. 807 lnbr vr v7t S lOU-d \e k?pt open and the kidneV*»» uwKn? ST pv V V{; s'nSle dose °‘75 Gm. max., per diem 1-5 Gm.; 1 e Cx. Supp., P Belg. IV. and P.E. VIII. 0-5 and 1 Gm. respectively. 1. ital. V., 1 and 2 Gm. respectively. J rh^ttlT5 grfUS> ^ su£icient f°r an ordinary case of insomnia. an.Lti Vt0ms P°ls?nm9 ore-somnolence, unconsciousness, subsequently coma, cyanosis and cold extremities. 50 grains might be legarded as the average minimum fatal dose. pump, lavage and enemata. Coffee, Strychnine, later diuretics. Ac^Ta^onicTcId i^CHrS? UT Tth the DJethyl ester of Malonic e.g., i664/igo3^ X4^014/i9o^2 C°°^ 2 N° l011gCr a British Pateiit' Vide> ou?EdnSXyni,epf079a in~J' B‘ C°hen’ practical Organic Chem. See also A white crystalline powder melting at 191° C. (U.S. 187 to 190°) Soluble 1 in 145 water at 20° C., and about 1 in 9 of alcohol 90°/’ more soluble in hot water, and in alkaline solutions. Boiling with alkalis decomposes it. In Ether, 1 in 25. It is also soluble in Acetone anlAce^ iAher. In Chloroform 1 in 35—by our experiments. Pharmacology-No tolerance developed in cats after long continued administration of hypnotic doses. Cumulative effect developed during first few days, but disappeared later with continuance of dose—due to absorption initially lagging behind excretion.—JS. B. Eddy, Jl. Ph. & Exp. Ther., Nov.,’29,271,282. Uses, Soporific in nervous restlessness, insomnia and depression, or maniacs and in cardiac trouble. Does not affect temperature or respiration. May cause erythema. Produces sleep without subsequent depression. Tolerance to it may be established hi some cases. Bee, however, Pharmacology, supra. EDMalonurea Tablets, 5, 8 or 10 grains, or in Cachets. (Caution : for dose v. antea). E] Suppositories 4 to 8 grains (0*25 to 0*5 Gm.). Treatment of acute Verona! Poisoning. If within 4 hours of taking the drug, repeated lavage of the stomach with warm water, then introduce through the stomach tube a pint of hot strong coffee with some milk in it and an ounce of Castor Oil. If patient is seen 6 hours or so after talcing the drug the poison ha3 passed into the intestine, but rapid washing out of the stomach and giving coffee may still be advised, unless patient is in extremis. Othei measures cardiac stimulants (Strychnine 1/30 grain with Digitalin 1/100 grain every 4 hours) warm Normal Saline subcutaneously, rectal injection of 15 oz. of Normal Saline containing ^ ucose. If much cyanosis Oxygen. If pulse feeble Oxygen should be passed through a wash bottle of Absolute Alcohol. If urine is not freely excreted give Caffeine hypodermically. The coma may last several days—feed, therefore, with warm milk and coffee every 4 hours—by stomach or nasal tube carefully passed. —Sir W. H. Willcox, L. ii./i3,1178 ; Int. Cong. Med., Aug., 1913, Pests and Toxicological Analysis in case of Veronal Poisoning._— Poisoning Effects. A case of gangrene of the skin following a large dose of Veronal and Pyra midon.—L. ii./ii,479. Hemiplegia caused by Veronal in aged persons.—B.M.J. ii./io,375. Veronal has the peculiar property of counteracting unpleasant effect o> morphine.—L. ii./o8,1223. Veronal owes activity to Ethyl groupings—this body is more powerful thar the corresponding Methyl Compound, whilst Proponal (v.p. 810) possesses tb maximum activity in the group.—B.M.J. i./og,554. Review of hypnotic drugs, Chloral bodies, Sulphone Compounds, TJreideft and other bodies with allied effects.—Sir W. H. Willcox, B.M.J. ii./13,66]. Veronal 921 grains taken with poisoning symptoms by a retired prize fighter. Recovery. Treatment hypodermically Strychnine and Digitalir stomach pump, lavage with weak Sodium Bicarbonate (tube passed wit difficulty after warming and oiling it). Half pint strong black coffee an 2 ozs. brandy passed in, later hypodermic injections of Camphor Linimen (20 minim injections) every £ hour (latter valuable—keeps the heart going an overdose is impossible) and more Strychnine.—B.M.J. i./i3,2£0. Another case, non-fatal after taking 125 grains in one dose, according to th patient. Treatment, lavage with dilute Permanganate; Atropine Sulphait l/50th grain hypodermically repeated twice within two hours. The stcmac washing was probably useless as absorption had presumably already occurred yet he returned to consciousness after four days.—B.M.J. ii./i3,20. Veronal (and Luminal) Rashes.-—Veronal should not be used in skin case j especially of the bulbous type. Erythematous rash (in some areas it ws sheet-like as result of coalescence) after Luminal, 3 grains a day.—G. Perne j B.M.J. H./13,312. Rash following administration of 10 grains of Medinal every night ftr 3 nights.—P. W. Mathew, B.M.J. h/26,323. Veronal poisoning—fatal case. Recovery of the drug from tissues arl urine.—B.M.J. i./14,853. A case of recovery from 125 grains ibid. 854, ar: after 35 grains ibid. 856, and after 100 grains ibid. 1015. For other cases see Edn. XVIII, p. 792. Medinal poisoning, a case. Cumulative toxic effect same as Veronal.-] L. h/26,391. Recovery after taking as a single dose about 200 grains of Veronal. Cor. plete unconsciousness lasted 113 hours and there were other grave symptom —S. M. Wells, B.M.J. ii./27,826. j Death from probably 50 grains of Veronal taken for sleeplessness in tB belief by the victim that he could take more than most people.—A. Dear B.M.J. ih/27,192. Veronal is excreted slowly and unchanged in the urine : in cases of pcisonb increase the efficiency of the kidneys by injection of /arse volumes c: 5% to 10% Dextrose solution. A woman who had taken 60 grains w given 1£ litres 5% Dextrose 4 hours later. In 6 hours she passed 1,1C0 C urine, and 11 hours later showed no symptoms of the drug.—Am. 01. P I Oct., ’30,599. Dangers of the Barbituric Hypnotics. Speaking generally, the Veronal derivatives are on the wTiole more powerful and therefore more potentially dangerous, than Veronal itself, but a confus nomenclature makes it possible that a doctor who has found Veronal unsat factory, may turn to an alternative drug, and only learn by bitter experien that it is the same thing under a new name.—B.M.J. i./25,128. Reasons of Veronal poisoning—its potency, no evidence of habit, delay action, and that in every case of death the victim has tried to procure immedka sleep.—G. Archdall Reid, B.M.J. i./25,630. In patients with any cardio-renal affection, Veronal and other hypnot must be given with caution, as their excretion must be necessarily delayed, case mentioned in which there was ophthalmoplegia as well as coma af~ taking 14 grains.—E. P. Scott, L. i./25,658. Discussion on Barbituric derivatives and allied hypnotics.—G. Malco Dyson, P.J. L/26,385. . Medinal found innocuous in medicinal doses and stated to be rapid absorbed and eliminated.—L. i./26,464. UREA. 809 0mltflSe'Ci°n<^i*’*^epr,0^°e^e^I^e^r^1^1^® condMo^of nOTmafsfeep^ «/ wf&tassessa^“a repeated, and covering oniy 6 doses. Patients should h? warned against daily doses and should receive oniy one each week Warnmg to practitioners re glowing advertisements, which are seriously dan8er to th« pubik-sir • & i./27,983 f S°S*o ttid.'^l.lOSS^nd^s^ctall^im^^iiesf18’ In therapeutic doses these drugs may have no toxic effect on metabolism ard no cumulative action.—C. Worster-Drought, L. ih/27,768. . Barbituric preparations are dangerous not only when taken in big doses bn t m small doses frequently repeated, causing definite hepatic insufficiency-. Carteaud, Jl. A.M.A. 1./29,662. Chemists in Constantinople doing nothing but search fcr new substances which would have the same effect as the Veronal group,— Poisons & Pharmacy Bill, Committee Stage in the lords’, Bil J. 1./ 3 I ,608. El Veronal"Sodium. Syn. Barbitalum Solubilb U.S. X., Ph. Ned V. *Medinal (T.M. 304403). P.G. VI., P. Svec. X.,* P. Ital. V. Graphically it may be represented thus :— C2H5^ .CO.N ^s_._XT C2H5>B<C0 NH>COXa=:206,0988. Dose.—5 to 10 grains dissolved in water either before or not less than one hour after meals. In most cases 5 grains is sufficient for an adult. P.G. VI. has max. single dose 12 grains (0-75 Gm.) approx. (i.e., the same as for Veronal). Wholesale and retail vendors must label “ Poison ” and treat other- wise as |P1 Patent 19,411/1904 and 2566/1905 became void in 1913. Manufactures—Rub down Diethylbarbituric Acid 184 Gm. in a mortar with about 200 Cc. of -water and then add Sodium Hydroxide puie 40 Gm. previously dissolved in water q.s. and estimated. It should be as fiee from CO2 as possible. Evaporate to dryness on water bath. It may te regarded as an acid salt. If a proportion of alkali sufficient to make the Di-Sodium body is used, decomposition sets in on drying. White crystals soluble 1 in 5 in cold water. It has properties and uses similar to Veronal antea. It is useful in sea-sickness. incompatifaie with Ammonium salts, e.g., the Bromide, and with acids. And with Chloral Hydrate.—P.J. i./3i,503. In preference, give it alone. Solutions of Medinal decompose on heating, forming crystals of Di-acetyl-urea.—per P.J. i./28,521. HP jfl Vercnal-Sodium Tablets are made, 1, 24 and 5 grains (0 06, 0-15 and 0*3 Gm.). Hypnotic effect is also obtained by the use of Suppositories medicated with C-4—0-5 Gm. Even small doses, e.g., 1 grain three times a day, in seme instances, produce a lengthy sleep—at night. It is stated that toxic signs do not appear with less than 15 grains daily,, whilst an adequate sedative effect at the menopause is obtained with 1 to: 2 grains three times a day, half an hour after meals.-—J. H. Hannan, Pr., Oct. *27 263. Sea-sickness. Veronal 8 grains or Sodium-Veronal which acts faster, taken on board, is valuable.—T. Zangger, L. ii./2i,630. Pharmacology. Magnesium Chloride 2 parts combined with Sodium Barbital 1 part hastens onset and lessens persistence of narcosis without appreciably increasing: toxicity.—H. G. Barbour and W. F. Taylor, Jl. Phaim. & Exp. Therap.,, July, ’31,331. . . Animal experiments show that fear and excitement definitely dimmish the soporific action of Medinal.—P.J. i./25,444. CE)3|c Veronigen (T.M. 374804). Dose.—1 drachm (4 Cc.) diluted about one hour before going to bed. For nervous sleeplessness in children 10 to 20 minims diluted. A liquid preparation of Veronal as hypnotic. C£)Neurinase. Dose.—(As hypnotic or sedative) 1 drachm (4 Cc.) in the; j morning and 1 to 4 drachms (4 to 15 Cc.) at bedtime. 1 drachm contains 1 21 grains approximately (0T5 Gm.) of Veronal. A preparation of Veronal with Valerian, suggested for use in nervous.! insomnia and neurasthenia. fyjO Chineonal is QUININE HlETHYL-BARBITURATE. Dose.—10 grains (0-6 Gm.) for adults, in fevers, neuralgia, etc. ' [F^^Planadalin (T.M. 409581). Syn. Carbromalum U.S X. and F.E. V11L, Uradal, Bromodietiiyl-acetyl-urea, adalin, Pli. Ned. V., P.G. VI. (no dose), P. Svec. X., nyctal. SaS5> c <Br C91I5 CO.NH.CO.NH, = 237-0334. ;2A 15 W-.—-2 . _ We consider it safest to regard this a [j?U Poison, though it is an open-chain compound and not a derivative of Barbituric Acid—see also p. 806. A further note is given in Edn. XVIII., p. 793. Patent 2333/iqio expire 1. ‘ Adalin ’ is no longer on the T.M. Register. Dose.—As sedative 5 to 10 grains (0-3 to 0-6 Gm.) t.d.s. ; as hypnotic 10 to 15 grains (0-6 to 1-0 Gm.) followed by hot drink half an hour before bedtime. F.E states 0-25 to 0-5 Gm. P. Belg. states max. single dose 1*5 Gm. and p.d, 3 Gm. Tablets, 5 grains each. Tasteless crystalline powder. M.pt. 115°—116° C. Soluble 1 in 5,000 in water. A hypnotic of medium strength. The cyclic structure of the urea, derivative of Diethyl Malonic Acid (Veronal) according to E. Fischer makes?.1 it a much more powerful hypnotic than Diethyl Acetic Acid, of which Adalin^ may be looked upon as a derivative.—B.M.J. ii./i3,48. Much less toxic than the allied compounds.—Sir W. H. Willcox, B.M.J- ii./27,1141. fFTPrononal. Syn. Dipropyl-Barbituric Acid. (C3Ht)2C(CO.NH)2CO=212-1408. Dose.—2 to 8 grains (0-12 to 0-5 Gm.). [Fll Tablets 1J grains. Wholesale and retail vendors must label “ Poison ” and treat wise as F1 Manufacture.—Probably made under the Veronal patents (expired)) but no licence was registered at the British Patent Office.—0. D. A homologue of Veronal in white crystalline powder, as hypnotic, UREA. 811 veiy slightly soluble m water, more so in Alcohol. It is readily dissolved by alkalis—hence probably acts on reaching the intestine V ery narrow margin between therapeutic and toxic dose. Whilst 5 tod grams are hypnotic, 7J grains approximate danger zone. luore poisonous than Veronal.—Sir W. H Willcox T ii ho nso E]*Soneryl(T.M. 432474). Syn. Neokal. Butyl-EthyLbIkbiI turic Acid. C4H9. -CO—NEL „ 0 <C0—NH>C0 = 212 1408. addition, there is marked anaig^sic^ffert'oi^rato138 Kmav t*1. M ho,ur’ in ?02e’rbUVn-n° CaSs less ,than i hour after food. A larger dose*5 f^Ysrains in ~ IS pi Soneryl 1 ablets 1 grain are made. ’ A white, crystalline powder with slight bitfor i • , water. Said to be three times as active*an h^notfc as'Vc™ For rectal use Suppositories 0-1 Gm Subcutano compound, containing 0-05 Gm. (of the comnouridl u!Li? PlP.erszine Intravenously, 0-1 Gm. in 20 Cc. of Normal Sahne h Cc* IS Uscd‘ ^Tt has not the toxicity of Morphine and is not habit-forming.—p.j. h/23,170. IQjNembutal. Syn. Pentobarbital Sodium, Sodium iso-Amytais Sodium Ethyl-Methyl-Butyl-Barbiturate. The acidic substance has the composition; CH3.CH2.CH2(CIIg)CHV r, M'O.IGK rn C2H3^ L<-CO.NIP>CO =226-1564. The Sodium Salt may be indicated thus : ^Jill's p-^'CO.N C2II5 > c<co.NH>CO]Sa-^248-145(?. wllite, crystalline powder, with slightly bitter taste. Very soluble m water, freely in Alcohol, practically insoluble in Ether Aqueous solutions are alkaline to litmus. Dose.—Ii grain capsules per os and per rectum. For intravenous use ampoules of 7|- grains to be dissolved at the time of use in 10 Cc. of water, and injected at the rate of 1 Cc. per minute 10 minutes before operation, the amount given being determined by the effect. 1/100 grain Atropine is given hour before operation, and in adults 1/6 to 4 gram Morphine. When the oral or rectal route is used the hypodermic injection is given at the same time as the Nembutal capsule. Uses.—A ‘basal hypnotic/ the supplementary anaesthetic being Nitrous Oxide and Oxygen, with addition of Ether when necessary. The sedative effect continues for 1 to 5 hours after opera- tion. Intravenous injection bridges the gap between consciousness and unconsciousness before general anaesthesia, it also lessens the amount of anaesthetic required, diminishes or obviates post-operative nausea. The chief disadvantage is post-operative restlessness in about 10% of cases.—I. W. Magill, L. h/31,74. Order of hypnotic efficiency (in conjunction with Nitrous Oxide)—Nembutal Avertm, Phanodorm, Pernocton. Avertin safest, but efficiency decreased owing to short duration of narcosis.—O. W. Barlow and co-workeis, Jl Pharm and Exp. Therap., April, ’31,377. ’ Iiarm* Placed in the following order of merit as basal hypnotics—Nembutal Sodium Amytal and Pernocton. Nembutal the most outstanding anesthetic drug to date.—I. W. Magill, L. 1./31,353. Many fatal cases of poisoning seen from Barbiturates: beyond a certain point cases were hopeless. Luminal very dangerous.—Sir W. 'Willcox, ibid. 354. Nembutal ‘ 844 ’ suitable for preliminary medication in anaesthesia. Intravenous injections must be madefresh. Undesirable to boil.—B.M.J. i./ 31,359. As basal pre-anaesthetic hypnotic Nembutal intravenously in 108 cases— better than Amytal or Pernocton. Effect can be increased by giving Morphine simultaneously.—S. Rowbotham, L.i./3i,439. Childbirth.—Combined oral use of Nembutal and Chloral Hydrate gave 62% of painless labours in 60 cases without ill-effects to mother or children. Initial dose (when os uteri is two-fifths dilated and regular pains present) iNembutal 3 grains, Chloral Hydrate 30 grains (in 3 ozs. sweetened home-made lemonade). First ‘Repeat* dose of 14 grains and 30 grains respectively after two hours, and subsequent similar doses at 3-liourly intervals, to a total of 7£ and 120 grains in 12 hours. Chloral given 10 minutes after Nembutal to obviate vomiting. Not contraindicated in heart disease or albuminuria. May be given by mid wives.—J. V. O’Sullivan and W. W. Craner, L. i./3 2,119. Picrotoxin, either intravenously, intramuscularly, or subcutaneously an effective antidote against acute poisoning (Amytal, Pernocton" and Nembutal) in anemais. In man probably safe in doses equal to that of Strychnine, symptomatic effects determining further increases. Over-treatment, resulting in convulsions, corrected by small dose of the Barbiturate first taken.—H. Maloney and co-workers, ,11. Pharm. & Exp. Therap., April 31, 480. ED * Amytal (T.M. 506448). Syn. Aso-Amyl-Ethyl-Barbituric Acid. (CH3)2CH.CH^H,>c<CO.N|>co=226.1564 A white, crystalline powder, with slightly bitter taste ; soluble in Alcohol and Ether ; very slightly in water ; insoluble in Paraffin Hydrocarbons. M.pt. 153-155° C. Saturated aqueous solutions are acid to litmus. Dose.—As sedative, J- to j grain (O’02 to 0*04 Gm.), twice or thrice daily per os, with water or hot milk. As hypnotic, 1| to 5 grains (0*1 to 0*3 Gm.), 1 to 14 hours before retiring. As local or general anaesthetic, 3 to 10 grains (0*2 to 0*6 Gm.) according to age, etc. As anti-spasmodic in tetanus to control convulsions, 6 to 12 grains (0*4 to 0*8 Gm.).—N. N. K., Jl. A.M.A. iL/30,1178. Uses.—A sedative and hypnotic in the control of insomnia and as a preliminary to surgical anaesthesia. A hypnotic rather than a true anaesthetic. May be combined with spinal anaesthesia.—J. T. Mason and J. E. Baker, L. i./3o,1302. In obstetrics, 30 mgr. per kilo bodyweight per rectum produces effective anaesthesia and amnesia, with little, if any, effect on the baby.—H. L. Drabkin, Jl. A.M.A. ii./29,1175 ; see also ibid. 1339. ED * Sodium Amytal (T.M. 506448). Syn. Sodium /<so-Amyl- Ethyl-Barbituric Acid. (0H3)3CH.CH2.CH c2h ’>£ <c8:NH>C0Na = 248-1456. This Ureide is isomeric with Nembutal. It is a white, friable, hygroscopic, odourless, granular powder with slightly bitter taste ; very soluble in water, in Alcohol about 1 in 1, and practically insoluble in Ether. Dose.—As sedative or hypnotic in capsules containing 3 grains (0*2 Gm.), per os, repeated if necessary at 6-hour intervals. As a pre-anaesthetic 3 to 10 grains (0*2 to 0*6 Gm.)—but only safe for use in this way by experienced workers familiar with the literature. As antispasmodic in tetanus, 6 to 12 grains (0*4 to O'8 Gm.) to control convulsions.—N. N. R., Jl. A.M.A. ii./30,1178. It is also given by the following methods : Rectally.—Not exceeding 15 grains (1 Gm.), with a maximum of 1*5 Gm. in 3% aqueous solution, followed immediately by injection of 1 oi 2 ounces of water Intravenously has been given in dose of 5 to 15 grains (0-3 to 1 Gm.) in 10% Solution at rate of 1 Cc. per minute. Blood pressure has to be watched continuously. There are many contraindications. Ifide criticisms Infra. _ > . Intramuscularly not more than 5 Cc. of 10% solution should be injected at any one point. Pharmacology.—Average fatal dose orally for dogs 125 mgr. per kilo ; rectally and intravenously in 10% solution, 200 and 70-75 mgr. per kilo respectively.—E. E. Swanson and H. A. Shonle, Jl. Pharm. & Exp. Therap., Eeb. ’31,305. Uses.—Primarily, as hypnotic for the pre-anaesthetic preparation of the patient, but not as an anaesthetic agent. Causes marked drop in blood pressure intravenously.. Unconsciousness lasts 3 to 6 hours. Safer per os or per rectum. In medicine, useful ioi the control of convulsions in unmanageable cases and as a specific for strychnine poisoning (extensive American bibliography).—L. G. Zerfas, B.M.J. n./3°>c9/, L Ei&°$insufficient pulmonary ventilation mperltod t.1 sleep, (24-48 hour,j) after operation, and a large number require catheterisation.—J. R Mason and J. E. Baker, Sur. Gynec. & Obstet., May, 30, per L. i./3o,1302. Gastric and duodenal ulcer treated. Checks secretion of gastric juice. procedure'to7Women of average weight 1/8 to 1/6 grain V• 1/150 to 1/200 grain Scopolamine, and 6 to 9 grains Sodium Amytal ^tramus^rdarly whin compactions are regular and occurring at .less than 0 m^nteintervals—injections repeated as indicated Intravenous injections 10-mmute l •. f cond ^ta^e of 6 to 10 grains during several pains, and fionSed^;SSt is"Strolled. uSpid in action and tea* range of safe dosage. No harm to mother and laboui not delated. A. P. J:llmrtaiJandiotum Am?tai as analgesics in confinements 8 grains at Oxide or rectal Avertin in preference.—8. Riddell, L. i./31,1c- WH * Bormigene (T.M. 367615). *Bromural (T.M. 284555 Syn. a-Brom-iso-Valerlanyl Urea. P.G. Vi., Uh. JNeo. V., CONH,=223-O198. . safest to regard M "r^pimd" by condensing the chloride of CH)!ch'CHBrtiOCU+ (NH^CO =(CH,)?CH.CEErC0.NH.C0.»H2 + HC1 Dose.—5 to 10 grains in water, dissolved by Caustic Colourless crystals, soiuble vith d^culty M.pt.about 145 C 5oda and precipitated by Bromine. Is said to induce sleep u Inch «kkhb IIP ll Bormigene Tablets contain 5 grains (0-3 Gm.). This and Adalin cause a diminution in blood pressure, but are without effect on the heart—experiments on rabbits. Adalin is the more lethal.— J.C.S.A. i./i3,1023. 1? ll ♦ Phanodorm (T.M. 456G41). Syn. Phanodorn, Cyclo- HEXENYLETHYL BARBITURIC ACID. C12Hl6O3N2= 236*1408. Dose.—Average dose 1 tablet (3 grains). In mild insomnia, II grains ; obstinate insomnia, 3 to 6 grains. Larger dose not repeated in less than 12 hours. A white, crystalline powder, with bitter taste ; soluble in Alcohol and Ether, only slightly soluble in water. bses. As hypnotic. In nerve affections to be taken in warm water. Allonal (T.M. 428271). A combination of Allyl-isopropyl-Barbituric Acid 1 gram and Amidopyrin 1$ grains, in tablets. _ Pos.e‘ 4 2 tablets as sedative or hypnotic in simple cases of insomnia ;; i to 4 ^ analgesic and hypnotic. ‘ Worked better than Morphine.’—M. A. Burns, N.Y. Med. Jl., April 19, ’22. Two tablets quickly relieve pain in neuralgia, neuritis, rheumatism, sciatica etc Is not habit-forming, and has low toxicity. Act mere than 4 tablets daily advised. Death following overdose of Allonal. Birmingham Coroner investigated the death of a woman who had taken 10 tablets a day for more than a year. It was stated that the Law was loosely drafted to permit of Allonal being treated as a CD 1 01son (Makers state [PI). I erdict: Death due to misadventure tliiough a sell-adnnnistcredoAeidcsc.—P.0. 1./32,117. Allonal contains some uncomb med lyranndon, and is regarded as an ‘admixture’ and a Part II Poison.—H. N. Lmstead, ibid, 119. L. C. Bennison, also consulted by the authorities in respect cf the ease states that his work showed Allonal to be a molecular ccmbinaticn and to be- regarded as HI].—P.J. h/32,139. It is a'definite compound with a well-known formula, ard no mere ‘ cer tab s ” a poison than Prussic Acid does. K. 0. Owen, P.J. i./32,130. It has been marked [Pi] for the last two Editions—since 1924.—W. H. M. EH* Sedormid (T.M. 489462). Syn. Allyl-Isopropyl-Acetyl- Urea. C9H1602N2= 184-1408. Dose.—-4 grains (0-25 Gm.) in tablet. As sedative, 1 tablet. As hypnotic, 1 or 2 tablets 20 minutes before retiring. Slightly soluble in water, tasteless. M.pt. 194° C. Sedative in cardiac neuroses, Graves disease, disturbances of the climacteric, nervousness and mental diseases. Stated to be rapidlv decomposed in the system, avoiding accumulation. CD Somnifen. (# Somnifaine is T.M. 453520). A solution of the Diethylamixe Salts of allyl-isopropyx-barbituric acid and Veronal. Dose. 2 Cc. intramuscularly deeply. In twilight sleep to be preceded by Morphine £ grain and Hyoscine 1/1G0 grain. Considerable risks are attached. Any improvement only temporary.— W. S. Dawson and M. B. Barkas, L. iL/26,1155. Intravenously or intramuscularly produces deep sleep lasting a number cfc hours.—L. ii./26,662. For surgical anaesthesia 0-01 Gm. per kilo intravenously, never passire 0-07 Gm. It must be combined with Morphine hypodermically.—1. Macdonald L. i./26,463. Results too uncertain.—L. i./3o,473. |F! Pernocton (T.M. 488342). Syn. Pernoston, Sodium Butyl- b - brom allvl- barbiturate. C11H14O3N2BrNa=325-0382. Issued in ampoules containing 3J grains in 2-2 Cc. Average hypnotic dose intravenously 3 Cc. (containing 4J grains), given at the rate of 1 Cc. per minute. Resembles Sodium Amytal in action, but is a more powerful hypnotic. In addition, there is less restlessness during recovery period. No fall in blood pressure. The solution is ready for use.—- E. I. McKesson and K. C. McCarthy, B.M. J. ii./3O,902. Pernocton advocated.—E. I. McKesson, L. ii./30,797. Not acceptable in U.S.A. for N.N.R. on the grounds that the name is therapeutically suggestive and lack of critical evidence that routine intravenous injec- t ion of potent narcotics is desirable or safe.—Jl. A.M.A. ii.f 31,1002. Dental Work.—Pernocton intravenously. A good anaesthetic, conducting operation under Gas and Oxygen through a Magill tube. Nembutal ana Avertin also suitable, but no advantage over Pernocton.—R. R. Macintosh, Brit. Dent. Jl., Feb. 15,1932. Ill * Dial. (T.M. 381421 *Dial Ciba, T.M. 35S718.) Syn. Diallyl-Barbiturlc Acid. P. Svec. X. with max. dose 0-3 Gm. (C3H5)2C<^;^>CO=2260898. A further homologue of Veronal employed as hypnotic. Tablets contain 1J grains. Dose one half to three tablets in water. Insomnia well treated by di-allyl-barbituric acid—a tablet on the tongue with a salt spoon of cognac emulsifies and is easily taken. Preferable to other hypnotics. It is relatively assimilated while Veronal is passed to the extent of 80% as such!—Watson Smith, P.J. i./i8,219. Recovery after taking 2-7 Gm. of Dial.—B.M.J .E. n./27,103. _ jQ] fc OUiacetin (T.M. 379525). Hypnotic and antineuralgic, analgesic and Antipyretic.—M.P.C., May 2,’22,362. . 1JL . f Tablets contain 4 grains of Allylparacetammophenol and 12 grams^ of Dial. Nocturnal fits in epilepsy often respond to this (i to 1 tablet at night, or twice daily) when other remedies fail.—C. Worster-Drought, L. 11./25, QQO 1 AQK Pfl4c Didial (T.M. 376649). Tablets contain 1/3 grain of Diallylbarbiturate of Ethylmorphine, and 1£ grains of Dial One to 3 tablets employed for the induction of Twilight Sleep. EI * Luminal (T.M. 337916).—Phenyl-Ethyl-Barbitubic Acid. P.G. VI., Ph. Ned. V., P. Svec. X., F.E. VIII., P. Belg. IV., P. I tab V. Syn. Phenobarbitalum, U.S. X. & Gardenal (T.M. 412226) is the French equivalent. °6H5>C^CaHN >00=232-1096. C9H; Wholesale and retail vendors must label “ Poison ” and treat other- Dose.—In simple insomnia 1J to 5 grams (0-1 to 0 3 Gm. dis- olved in hot water, where there is excitement 5 to 6 grams "I 2 grains (0*8 Gm.)—latter is maximum dose—as stated m r. be 0. A modification of Veronal, an Ethyl group being replaced byj. >henyl radical, hence the action is intensified. (Details of synthe . '.A.C.S. 1918, 40.723.) White powder with slight bitter taste, Imost insoluble in water. Soluble in Alcohol 90,0 in sleeplessness associated with pain, migraine, chorea, children’s convulsions, in mental conditions, etc. Bowels to be kept open and kidneys in good working order. For references to its use, a?id toxic effects, see under Luminal-Sodium. Luminal Tablets J, I and 1J grain are made. [H^Luminal-Sodium.—P.G. VI., P. Svec. X Sodium Pheno- barbital. C12H11O3N2Na=254-0988. Dose.—Per os 1 to 2 grains (0-06 to 0T2 Gm.), once a day. . Hypodermically J to 3 grains (003 to 0*2 Gm.) daily in 20% solution is used, e.g., in epilepsy, but the matter is sub judice. P.G. VI. states max. single dose 6 grains (0-4 Gm.) ; pro die 12 grains (0*8 Gm.). A wdiite crystalline powvler, readily soluble in cold water. Solutions must be freshly prepared with cooled boiled water. Incompatible with Ammonium Salts as they decompose quickly, e.g., the Bromide and Acid salts and otherwise as caustic alkalis. In preference give it alone. Luminal is more poisonous than Veronal.—Sir W. H. Willcox, L. ii./i 3,1180. Luminal Sodium Tablets 1 grain are made. Epito&sy. T25 cases compared under Sodium Luminal and Bromide. Patients with diurnal fits whilst under Bromide showed malted nducticn of the number under Luminal. They felt brighter. Cases with more than four fiiS a month also showed improvement, but not so marked, and so on. 35 were I either not improved or deteriorated while the remainder did tetter under, Luminal, the cases least affected were those whose fits occuned in bouts at considerable intervals. A class of epileptics probably exists who are more refractory to bromide treatment than others. Hose used, 6 grains a day of the Sodium salt-. It wrould be converted into the acid by the acidity of the gastric juice. Giddiness and drowrsiness sometimes observed. Ro signs of formation of habit.—F. Golla, B.M.J. ii./2i,320. Given in solution with hot milk or wTater, in doses of one or two grains once a day, usually at bedtime. Continental observers consider 3 to 41 grains can safely be given to adults over prolonged periods, under adequate supei vision. Reduction in lit incidence and increase in weight. Best results in cases of major epileptic attacks.—J. Tylor Fox, L. ii./2i,558. borne say it is at best a palliative and not a specific.—Jl. A.M.A., Aug.. '20,588; Pres.,Feb.,’2i,67. Used in epilepsy of varied types even where large doses have to be given in an attempt to influence forms of mid-brain tremor—with good effect.— W. Johnson, L. ii./22,27o. To give more than 4 or 5 grains a day, in general, is to ask for toxic effects.—ibid. 288. It arrests seizures but also checks normal play of the nerve centres and is liable to produce a physical and mental torpor. L. Cheinisse La Presse Med Jan. 14, ’22, see also Ther. Gazette, Dec. 21—the drug thought not to cure’* prolonged use dangerous and withdrawal requires care.—C.H., June 17 1022 p. 66. ’ * * Admirable in cases of convulsions ; lessens number of attacks and in seme cases stops them. Reputed danger in sudden suppression of Luminal is exaggerated. Depression and complications are due to too strong doses— doses vary according to age of patient and intensity of malady —B Cones La Grice Medicale, July-Aug., ’22, per Jl. Trop. Med., Dec. 1, ’22,383. * Never more than 11 grains to start—Jl.A.M.A., Sept., ’22,788. As palliative superior to bromides. Should be discontinued gradually.—Per Pres. Jan. 23,23. ’ Except in epilepsy, Luminal is very disappointing. A sudden cessation may cause the same symptoms as a large dose.—S. Grossman, L. ih/25,677. In major type of fits useful, but is of no value in hysterical fits. Tolerance is apt to occur, so that the results in the first 3 months may be the best. Outside a resident institution, 3 to 4 grains should be made the maximum dose in 24 hours—L. ii./25,713. See also ibid. 728,840,892,943. Status epilepticus well treated by hypodermic injection of Luminal-Sodium from 1 to 3 grains. Solution should be freshly prepared—W. J. T. Kimber, B.M.J.1./26,16. Some striking results: stopping its use followed by an increase of fits — J. Tylor Fox, L. ii./27,589. See also W. Johnson, L. ii./27,733. Epilepsy treated by Luminal. Doubtful whether 5 or 6 grains should be exceeded as a single dose per os. Rashes and poisoning symptoms—headaches, vertigo, lethargy, etc. Also of use in migraine, insomnia (1 to i grain at bedtime), aural vertigo. Recurrent attacks well treated. Also in cutaneous affections with a neurotic factor.—W. Russell Brain, L. ii./29,867. Hypodermic injection of H grains effective in severe pain, such as tabetic crises and herpes zoster. Relief in 20—30 minutes.—L. Gunther and H. M. F. Behneman, per Jl. A.M.A. ii./28,S32. /W/ffra/ne.—Bromide failed in migraine, and in a few cases Aspirin, and in others Pyramidon (gr. vii) with Cannabin Tannate (gr. iii) cut short the duration of the headache. True migraine, which in its characteristic type is notably hereditary, has been treated with best success by Luminal. The dose, as a rule, should not be more than f grain thrice daily at first, reduced to twice daily after a fortnight if the result is good, and later to once daily at bedtime. After a week various cutaneous rashes may be seen, but are unlikely if the above dosage is not exceeded.—Wilfred Harris, B.M.J. ii./22,786. See also R. Hearn, B.M.J. ii./22,893. Arterial blood-pressure in S5% of cases of hypertension, decreased by Phenobarbital. Large doses produce marked toxic sjmptcms.—Per Jl. A.M.A. ii./25,1427. Vomiting of pregnancy completely controlled by i to 1 grain of Luminal nightly, but tends to recur if drug is omitted. Non-toxic in this dose over long periods.—A. Elliott, B.M.J. ii./31,1119. Toxic Effects of Luminal. Scarlatinaform rashes produced by Luminal 1 grain bis die.—I. Sachs B.M.J. ii./25,1098. Eruption resembling measles following use of 0T Gm. of Luminal-Sodium daily for 11 days.—Per Jl. A.M.A. ii./25,707. Dermatitis, with total loss of hair and nails, following daily administration for three weeks of 0*1 Gm. Luminal.—B.M. J.E. ii./24,53. See also Jl. A.M.A. i./22,1199, Pres., Jan., ’23,23. A case of Luminal poisoning.—L. ii./25,596. It has generally been found that the effective dose of Luminal is veiy near the toxic dose, more than 3 grains daily producing ataxia—J. H. Bannan, Pr., Oct., ’27,262. Luminal rash, 41 cases. It seems that the cause must be a selective tissue reaction to the drug dependent on constitutional factors about which we are still ignorant.—W. C. Menninger, Jl. A.M.A. ii./2 8,18. Cp)Theominai.—A combination of Theobromine 0-3 Gm. and Luminal 0-03 Gm. has been used in arteriosclerosis, angina pectoris, cardiac rfiecticrs and climacteric disorders. 3$c EJbon-Ciba (T.M. ,343704). Cinnamolyl-p-oxyphenylurea. C6H5.CH : CH.CO.OC6H4.NH.CO.NB2=282*1252. Insoluble crystals, stated to have antipyretic and antiseptic action. Used in pulmonary tuberculosis (60 grains daily increased), for infectious catarrhs of respiratory tract,and in chronic endocarditis. Asthma. Relief in long-standing cases—30 to 60 grains a day.—BA).J. i./25,641. Dibromin.^.Dl-BROM-MALONYL-URElDE Br2: C : (CO.NH)2: CO.-285-8C36. White crystals, containing approx. 56% Bromine, m capsules containing 6 grains (0*4 Gm.). In contact with infected tissues the Bromine is liberated and exerts an oxidising effect on micro-organisms. Its solutions are practically non-irritating and do not coagulate serum. Used for irrigations, wet dressings, moist packings, douches and gargles in solutions of 1 :10,000 to 1: 500.' Advisable to begin with weak solutions, gradually increasing strength as the irritability of the tissues subsides. In presence of 1% Peptone solution the Rideal Walker Coefficient is reduced to 0-8 compared with 50-0 in the absence of organic matter. Hypochlorites and Permanganates are also greatly reduced in germicidal power in presence of organic matter.—M.P.C., Nov. 19, *24,412. Nirvanol. 77-PHENYLETHYLIIYDANTOIN. C6H5. /CO.NH >C< I =206T096. c2h5 nh.co Dose.—4 to 8 grains (0-25 to 0-5 Gm.) Formed by combination of Urea and Glycol. A tasteless crystalline powder, slightly soluble in water. Hypnotic and sedative. Not to be administered over lengthy periods. Dose.—In chorea, 0*3 Gm. 'per os daily for a child of 9-14 years. In most cases 8 to 14 days after beginning of treatment there is a well marked morbiliform rash accompanied by pyrexia. The drug is then stopped. It causes a change in the blood, viz., a true eosino- philia reaching its maximum just before appearance of the rash. In addition there is generally a leucopenia. Conjunctivitis and oedema of the eyelids should be watched for and treatment stopped immediately. Report of 6 cases with beneficial results. Originally advocated as hypnotic, and as a sedative in epilepsy and various types of psychoses.—F. J. Poynton and B. Schlesinger, L. ii./2g,267. Bose.—0'25 Gm. from 5 to 9 years, half of which is given twice a day. 0.3 Gm. given in two doses never exceeded. The aim is to produce a reaction and stop and in any case it is stopped in 14 days.—F. J. Poynton, Index of Treatment, 1931. Symptoms improved and attack sometimes cut short in a dramatic way. Only to be used under constant supervision.—C. F. T, East and E. R. Cullman L. ii./3o, 190- At'ter-results disappointing. Only exploitation of a new sedative whose super-excellence has yet to be proved. Doubtful whether it will outlive the popularity due to its novelty. Adalin preferable.—R. Miller, M.A., ’31,99. Purpira haemorrhagica, nephritis, and a fatal case of dermatitis exfoliati/a, have followed its use in chorea. Effective, but catastrophe can neither be seen, foreseen nor prevented.—L. ii./3i,545. SOURETHANE. [jpjQAZZ “ Poisonous ” Urethanes, label “ Poison ” and treat otherwise CO(OC2H5)NH2= 89-0626. Sy Wholesale and retail vendors ynust as !PTl- n.—Ethyl Carbamate, Fr. Cx., F.E. VIII., P. Ital. V. Dose.—10 to 60 grains (0-6 to 4 Gm.). Tablets, 5 grains (0-3 Gm.). Colourless crystals (M.pt. 48-50° C.), inodorous, with saline taste. Manufacture.—By heating several hours in an autoclave or metal tubes, Urea Nitrate in excess of Absolute Alcohol at 120 to 130° C. and extracting first with water and this solution with Ether several times, Ammonium Nitrate is formed. Distil to rectify (B.pt. 180° C. without decomposition). C0(NH2)2.HN0,-i-C2H60H = NH4N08-f CO(OC2H6)NB2.-— Bunte Zeit. f. Chem., A. 151,181. Incompatible with Caustic Alkalis and with Acids. Soluble I m 2 of Water ; 1 in 1 of Alcohol 90%. Fr. Cx. states 1 in 1 of Water and 1 m 0-6 of Alcohol (95%). Uses. Hypnotic, produces normal sleep, the heart is not anected ; especially suitable for children; in cases of delirium tremens, and in acute mania and tetanus. Quinine and Urethane, see p. 734. VALERIANAE RHIZOMA. -^e rhizoma and roots of Valeriana officinalis and of V. Wallichii (V, Indica), (Valerianacece), collected in the autumn. —B.P. ’14 contain volatile oil and two alkaloids. Uses.-—A. valuable drug, capable of restoring mental efficiency and relieving mental misery, e.g., in hypochondriasis or melancholia. Ammoniated Tincture of Valerian in \ dr. doses and 7£ grains Potassium Bromide. Is Borneol the active principle of Valerian ? —J. S. Manson, B.M.J. ii/28,842. Aicooiature Stabilisee de Valeriane (and a similar preparation of AEscnlus Hippocastanus, the horse chestnut) are now in Fr. Cx., Nouv. Supp., 1926. The Valerian preparation is made by adding the fresh entire roots to 95% alcohol, equal parts by wt., while maintained boiling on the water bath for 20 minutes, allowing to cool and repeating the process ; finally making up any loss. (In the case of the Horse Chestnut Aicooiature, the fresh non- decorticated chestnuts (Marron cl’Inde) are used, employing 75% alcohol throughout.) No doses are given. Other Alcoolatures, e.g., d’Aconit, d?Anemone Pulsatille, are in Fr. Cx. (1908). If the enzyme be killed by stabilising before drying, the root has only a small degree of odour. The author tried the procedure on a cwt. of fresh Valerian recently (1927) and must confess the ultimate dried root and liquid preparations had little less odour than the customary preparations. History and uses of Valerian.—J. Grier, P.J. i./29,303. Sec also N. Smodlaka, P.J. ii./2i,402. Oil from Indian Valerian Root contains a sesquiterpene hydrocarbon and a small quantity of sesquiterpene alcohol. Combined Valerianic Acid and Formic Acid and a small quantity of free Valerianic Acid and other constituents present.—K. Bullock, P.J. ii./26,152. Extractum Valerianse Liquidum. 1=1 Hydro-alcoholic. Average dose.—30 minims (2 Cc.). Extractum Valerianae. Dose.—1 to 5 grains (0-05 to 0-3 Gm.), is made by concentrating the last mentioned. Misfura Valerianae Composita, R.F.H.—Tincture of Valerian 3, Foetid Spirit of Ammonia 2, Camphor Water to 48. Tinctura Valerianae Animoniata {B.P. T4). 1 in 5. Dose.—J to 1 drachm (2 to 4 Cc.). U.S. X. 1 in 5 of Sal Volatile. An antispas- modic and nervine tonic. Flavoring.—Glyl Coriandri, Glyl Menthse Piperitse, Syrupus Zingiberis, Extractum Glycyrrhizse Liquidum, Tinctura Carminativa. Acidum Valerianicum, Fr. Cx., P. Helv. Dose.—1 to 5 minims (006 to 0 3 Cc.), in syrup or in gelatin capsules. Consists principally of optically inactive Isovalerianic Acid (CH3)2.CII.CH2.COOH. with more or less dextrorotary Methyl-Ethyl Acetic Acid, (C2K5) (CH3)—CH : COOH= 102-083. An oily liquid, Sp. Gr. about 0*93. Given in hysteria and nervous affections. Ferri Valerianas. Ee2 (C5H902)2(0H)4=381-8516. Dose.—3 to 15 grains (0-2 to 1 Gm.). A nervine stimulant and emmenagogue, and is used in anaemia. Sodii Valerianas. C5H902Na=: 124-0672. Dose.—1 to 5 grains (0-06 to 0-3 Gm.). In white crystals ; used as a nervine sedative. Zinci Valerianas. Zinci Valeras. (C4H9COO)2Zn=267-5204. (B.P. ’14+2H20). Dose.—1 to 3 grains (0-06 to 0-2 Gm.). White powder or in pearly crystals, very slightly soluble in water. Soluble in alcohol. Pills 3 grains each. This is given as a nerve and general tonic, e.g., after hay fever, and as prophylactic, but pharmacologists say it has no efficacy. Incompatible.—Acids and metallic salts. (See also zinc salts.) Amyl Valerianate. Iso-valerianic Iso-amyl Ester. C5H11.C6H902= 172-156. Dose.—2 to 5 minims (0-12 to 0-3 Cc.) in capsules or diluted in alcohol. A mobile liquid, Specific Gravity 0-85S. Miscible with Alcohol. Is employed as a sedative and antispasmodic. Has been recommended as gall-stone solvent. Is known as ‘ Apple Essence.’ Elixir Valeriana? et Eromidi.—Martindale. Dose.—4 ounce (15 Cc.) diluted. Valerian Extract (Recent) 5 grains, Sodium Bromide 5 grains, Calcium Glycerophosphate 5 grains, Aromatic Elixir 2 drachms. Peppermint Water to \ ounce. A sedative preparation. Bromival. A Canadian Elixir of Bromides and Valerian, in which the Valerian taste and odour is effectively masked. Contains 90 minims Ammoni- ated Tincture of Valerian per ounce. Dose.—\ to 2 drachms well diluted, as a nerve sedative. Borneol-iso valerianate. Si/n. HYSTEROL. Gelatin capsules contain 4 grains. A valerian substitute. In neurasthenia hysteria, etc. The action of Borneol is to diminish reflex irritability vhile valerianic acid acts as antispasmodic. Lest taken after meals to prevent eructations. SUSlTrivalin.—Dose per os 8 minims (0-5 Cc.), hypodermically 8 to 15 minims (4 to 1 Cc.), once to 3 times daily. A solution of Valerianic Acid with Morphine Valerianate 1/3 grain (0-02 Gm.). Caffeine Valerianate 1/18 grain (0-0037 Gm.). Cocaine Valerianate 1/12 grain (0-005 Gm.) in 1 Cc. Said to have the therapeutic effects [of Morphine witheut disadvantages. Anodyne, e.g., in painful dressings, inoperable cancer, gallstone, colic and neuralgia. As tonic in delirium, mania and hysteria. IPIMICapsules are made=4 Cc. of the above. The combination is in the proportion of one molecule each Caffeine Valerianate and Cocaine Valerianate and 4 molecules Morphine Valerianate. ®¥T]Trivalin js made in combination with Hyoscine Valerianate l/115th grain (0-00056 Gm.) per Cc., for treatment of the insane. Dose.— 0-25 to 0-5 Cc. ZINCUM. Zn= 65*38. T° prepare Arsenic-free melt in a clay crucible and add about 15 grains or oodium to a pound in small bits at intervals, ltemove the scum, av oiding iron implements, and repeat in another clean crucible. Granulate by pouring into water when almost solidified. Metabolism. Zinc takes a part in the normal metabolism of plants and animals. Com deprived of Zinc becomes chlorotic : it acts as a catalytic fertiliser for maize : animals on a Zinc-free diet do not flourish: the Zinc content of yolk of egg, milk and spermatic fluid, is high.—L. ii./26,191. Abnormal amounts of Zinc may enter and leave the body for years without causing symptoms detectable clinically or by laboratory examinations.— L.ii./26,530. Incompatibilities of Zinc Salts.—Alkaline carbonates, and alkalis in general, vegetable infusions and milk. Antidotes.—Alkaline Carbonates in warm water, Demulcents, Milk and Egg, Tea and Tannin solutions. Zinci Acetas. (CH3COO)2Zn. 3H20=237-4736. B.P. T4 and U.S, have 2H20. Dose.—1 to 2 grains (0-06 to 0-12 Gm.) as a nervine tonic, but pharmacologists have no evidence of its utility. 10 to 30 grains for an emetic dose. White crystals with faint acetous odour. Soluble in water 1 in 2-5, about 1 in 40 of alcohol 90%. Used as astringent lotion (J to 1%). Zinci Benzoas. Zn(C6H5.COO)2= 307*458. White powder, soluble in water. Examination of.—P. J. ii./i3,6S6. Zinci Bromidum, ZnBr2=225-212. Dose.—2 to 5 grains (0-12 to 0-3 Gm.) in water. White deliquescent powder. A little dilute hydrobromic acid will make a clear solution. Incompatible with alkaloids and salts of heavy metals. Has been used with success in epilepsy. Zinc Carfoonas. ZnC03.(ZnH202)2,H20=342-1868. . . Employed for tender surfaces, and to check perspiration. GDZinci Chloridmn (B.P. T4). ZnCl2= 136-294. 'PlZinc Chloride and liquid preparations of Zinc Chloride except preparations Intended for soldering or other industrial purpose, provided they are contained in closed vessels labelled “ Poisonous,” and bearing the name and address of the seller and the special purpose. In deliquescent masses soluble 1 in 0-34 of water. fp) Gausticum Zinci Chloridi. , . , 0 0, i i Zinc Chloride 4, Solution of Antimony Chloride 2, Starch 1, glycerin q.s. yT) Colledium Zinci Chloridi. 1 in 6 of collodion. ID Colhztoriimi Astringens, R.B.H. Zinc Chloride 5 grains, Zinc Sulphate 10 grains. Water to 1 ounce. Guttse Zinci Chloridi, R.O.H. and St. Th. H., i, 1 or 2 grains to 1 ounce. ED Q Cuttac Zinci Chloridi cum Cocainae Hydrochlorido. b 1 or 2 grains to ounce with Cocaine Hydrochloride 10 grains to» ounce. CE> Guttas Zinci Chloridi cum Adrenalin, R.O.H. See Adrenalin. CED Guttae Zinci Chloridi (Aural) R.N.H. Zinc Chloride 4 grains,,] Glycerin 2 drachms. Alcohol (90%) to 1 ounce. CE> Liquor Zinci Chloridi (B.P. ’14). Sp. Gr. 1*530. Pour minims of this solution = 3 grains of solid Zinc Chloride. On diluting* a trace of hydrochloric acid will be necessary to clear it. loses.—A powerful odourless caustic, antiseptic, and anti-putrescent. The liquor is a strong deodorising antiseptic solution ; it i& very poisonous. Ten grains to the ounce of water may be used as at stimulant lotion to wounds and ulcers. Also used as Paste with Starch and Glycerin. In the treatment of erosion of teeth is useful to touch painful spots, or th. addition of a little to Chloroform-Mastich forms a useful paint.— 8 male an Colyer. CE> Lotio Zinci Chloridi, R.O.H., 4 or 1 grain to 1 ounce. ! °r wounds Zinc Chloride solution 40 grains to the ounce was much favoure by Lord Lister. Prevents the occurrence of putrefaction in spite of access c septic material. Importance of free drainage.—G. T. Beatson, L. ii./i5,121— Tuberculous Ulcerations. Pain abolished and ulcerations healed after 5. applications of solution of 3 Gm. Zinc Chloride in 10 Cc. 80% Alcohol. Repea every 3 weeks : Tincture of Iodine applied daily.—Per Jl. A.M.A. i./27,1039' ® Injectio Zinci Chloridi, L.H. for vaginal use. Zinc Chloride 5 grains, Water to 1 pint, i.e., 0 06% or 1 in 1,600 in roun numbers. Zinci Citras. [C8H4(OH).(COO)3]2Zn8+ 2H20=610*2492. Dose.—3 to 12 grains (0*2 to 0*8 Gm.). White powder witT metallic taste, not perfectly soluble in water. Has been used foa epilepsy. H Zinci Cyanidum. Zn(CN)2=117*396. An insoluble white powder with antiseptic properties. Cf. Mercuro-Zinc Cyanide. IFH Zinci et Potassii Cyanidum. Zn(CN)2.2KCN = 247 612. Dose.—to 1 grain (0*006 to 0‘06 Gm.). A soluble cyanide, possessing the properties of hydrocyanic acid. Zinci Iodidum. Znl2=319*244* Average dose.—1 grain (0*06 Gm,), A white deliquescent powder turning brown on exposure. Eu cerebral, spinal, and nervous diseases in the third stage of syphilis Zinci Lactas. (C2H4.OH.COO)2Zn, 3H20 = 297*5348. Dose.—b to 3 grains. (0-03 to 0-2 Gm.f Max. pro die 10 grains. (Ha been used in France up to 3 Gm. for a dose!—Dorvault.) White crystals soluble 1 in 60 of water. In epilepsy. ZINCUM. 823 Zinci Oxidum, Zinc Oxide, ZnO = Sl-38. Dose.—3 to 10 grains (0*2 to 0-65 Gm.). Tablets, 2 grains. Has been used for nervous debility, migraine, hysteria, cf * Zinc Acetate. Chiefly employed locally. Has definite bactericidal properties. While it is a most neutral so far as toe cells of the skin are concerned it is split up by alcid producing micro! cs into disinfectant compounds—Haxthausen, Brit. Jl. Derm. & Syph., 1928, per Pres., Oct.,’29,330. ’ ’ Mistura Zinci Oxidi, E.L. Zinc Oxide 1 grain, Glycerin 10 minims. Water to 1 drachm, for 1 children. Cp^Mistura Zinci Oxidi cum Opio, E.L. contains Tincture of Opium, J minim in 1 drachm of the above. Unguentum Zinci (B.P. ’14). Zinc Oxide 15% in Benzoated Lard. Unguentum Wilsoni. Syn. WILSON’S OlNJMENT. P. Jap. IV. Zinc Oxide 5, Benzoic Acid 1, Lard 30. Unguentum Zinci Carbolisatum. Zinc Oxide 10, Phenol 2, Soft Paraffin S8. Dermatitis is well treated with this. Unguentum Zinci cum Acido Salicyliec. Salicylic Acid 40 grains, Zinc Ointment 1 ounce, Soft Paraffin 1 ounce. Petrolatum Zinci Oxidi. Zinc Oxide 1, White Vaseline 9. For surgical use starch is sometimes added, cf., Pasta Zinci cum Amylo. Linimentum Zinci Spissum, Zinc Liniment, P. Svec. X. Zinc Oxide 200, Salicylic Acid 1, Adeps Lanse 100, Olive Oil 300, Lime Water to 1000. Cremor Zinci. Zinc Oxide 3, WThite Vaseline 17, Perfume q.s.—For nursery use. Cremor Zinci, St. M.’s H. Dissolve Lanolin 3 in Olive Oil 8 by heat, sift Zinc Oxide 8 into the mixture and whip up with Lime Water 8. Useful in acute eczema (drying stage where there is much redness. Cremor Zinci et Calaminae, V.H.C. Prepared Calamine 1, Zinc Oxide 1, Lime Water 4, Almond Oil 4. Gelatinum Zinci. Unna’s Paste. Gelatin 4, Water 16, soak 12 hours, then heat to dissolve, and add Zinc Oxide 6 previously rubbed down with Glycerin 12. For use it is melted and applied with a brush to eczematous surfaces. Ichthyol, Hesorcin and other medicaments may be added. Varicose Ulcers treated by the above after thoroughly cleansing the leg or foot with Soap and Spirit, Alcohol, Mercuric Chloride Solution 1 m z,Ul tc 1 m 4 000 or 1 in 40 Carbolic Lotion. The Paste previously melted and cooled is poured over the ulcer, which has previously been disinfected with Bydrcgen Peroxide or Mercuric Chloride or Carbolic Lotion. The part is then dried and the paste is bandaged on with a gauze bandage. Another ayer of paste is app'Fed • this is covered with a bandage, and so on until iour layers have been applied ’ Mav be left in many cases undisturbed for weeks, but it is safer to dress again after two1 or three days with Salicylic Talc if any discharge, it forms a new skin, pliable and slightly elastic. Clvcerin '1 A nreDarat.ion of the composition Zinc Oxide 1, Oelatin z, ciyccnn a, tVate? 4 parts of value in arthritis, dermatitis, erysipelas, erythema nodosum md simplex, myositis, periostitis, phlebitis and varix of the leg, synovitis. ‘ tennis leg,’ minor thrombosis and contusions and sprains of joints of limts. It is the treatment par excellence for chronic varix and acute phlebitis. Method: of preparation and application of dressings.—'W. Muir Smith, B.M.J. i./27,l37. Varicose ulceration well treated by moist paste bandage of Cellan-Jones.— E. Garden, B.M.J. i./3x,652. Gelatin Compound Phenolised.—Gelatin 625 parts, Zinc Oxide 250, Glycerin 1,900, Water 1,900 containing 1*5% Phenol. Heat till liquid and: apply with brush, apply spiral bandage, and brush on another layer, repeat: to total of three bandages and four layers of the preparation. For chronic: ulcers, unhealed secondary burns and varicose veins.—N. FT. R., Jl. A.M.A„ ii./29,1809. A further modified form : Zinc Oxide 10, Glycerin 10, Glue 4, Gum Acacia 5„ Water 30. Spread on bandages for varicose ulcers.—C. J. Cellan-Jones,, B.M.J. ii./560. Pasta Zinci cum Amylo, St. M.’s H. Zinc Oxide, Starch, Soft Paraffin, Lanolin, of each equal parts. For intertrigo and disordered perspiration. 3fcPellanthum (T.M. 261943), containing 20% Zinc Oxide, is m special preparation and is cooling and soothing for irritable surfaces.. Compounds are Ichthyol, 3%, 5%, 10% ; Ichthyol, 10%, with: Resorcin 5% ; Salicylic Acid 1% and 2% ; Liquor Carbonis Detergent 10% and 15% ; Huile de Cade 5% ; Phenol 2% with Menthol 2%. Lassar’s Paste for Eczema. Syn. Morris’s Paste. Zinc Oxider 24, Starch 24, Salicylic Acid 2, Yellow Soft Paraffin 50. = Pastas Zinci Composita. U.C.H. Useful in chronic and acute eczema when weeping. In iiritating conditions, the acid may be omitted. It may be retained and increased in amount when* there is less inflammatory reaction and where much scaling has cccuiicd. Pasta Carbonis et Zinci. Soak Gelatin 16 in a portion of the total Glycerin required (20), and a portion of the water (50 in all required), for 12 hours. Make a paste of Boric Acid 6 Zinc Oxide 6 and Charcoal 18 with remainder of liquids, mix on water bath, and pour into suitable vessel to set. For leg ulcers the Charcoal is a useful addition. Boric Lotion fomentation: should first be carried out to clean the ulcer. If tending to be sluggish Bed: Lotion helps. CP)Pilula Zinci cum Belladonna, T.H. Zinc Oxide 2 grains, Extract of Belladonna J grain. Dose.—T or 2.. Zinc Oxide, Starch, Boric Acid, and powdered Orris Root, and: mixtures of these, are employed for the toilet. Pulveres Conspersa (Dusting Powders), St. Th.H. include Pulv. Acid, Acid Boric Co., Pulv. Ac. Boric, et Amyli, Pulv. Calomel et Ac. Boric and others. Calamina Prseparata B.P. 1885. Syn. Lapis Calaminaris Praiparatus. Impure zinc oxide prepared by calcining native Calamine (zinc carbonate) and reducing it to an impalpable powder. Genuine Calamine is useful as a dusting powder, and for making lotions, and may; be mixed with Carmine Triturate to produce the desired tint. Linimentum Calaminse, G.H. r ^ Calamine 20 grains, Zinc Oxide 15 grains, Soft Soap 15 grams, Olive Oil 4 drachms, Water to 1 ounce. ZINCUM. 825 CataiWnQm7i CaAam!nSBr Composite. U.C.H. is Prepared r-SKuSdto fi» Swo 3 w°o1 F*‘3 “ Lotio Calaminae U.C.H., E.L. FwtwV, Calami.ne 9> 2ine Oxide 5, Glycerin 3, Water to 100. Elutriate the calamine and zinc oxide by triturating them in a mortar with successive portions of the water and decanting from the siliceous matter and add the glycerin. Used in eczema, especially where the surface is red and tender, also to conceal acne spots on the face. ® One gram of mercuric chloride may be added to 6 ounces as antiseptic. CE)Lotio Calaminae E.G.A. (Lotio pro Acne, N.H.W.) is 20 grams each of Calamine and Zinc Oxide and 20 minims of Glycerin to the ounce of Water. For chilblains on the hands this lotion and the following made double or treble strength allay the intense irritation. . cutaneous affections, e.g., of rheumatic origin a lotion of this kind is useful.—J. Galloway, Pr., Jan. ’i2,76. Lotio Calaminae Oleosa, St. M.’s H., E.L. Calamine 40 grains, Zinc Oxide 20 grains. Lime Water 3 drachms, Olive Oil 1 ounce (E.L. to 1 ounce). In chronic eczema, e.g., to a freely weeping surface with redness and itching apply with brush or cotton wool swab or spread on thin washed butter muslin. Very important that the inflamed surface should not be treated with a hot thick dressing. Perchloride 1 in 2,000 to 1 in 3,000 may be desirable addition. Ungaentum Plumbi cum Calamina. 4 ERYSIPELAS DRESSING,’ St. G. H, Lead Plaster 18, Calamine 2, Olive Oil 9, Lard to 48. Zinc Oxy-Phosphate is employed as a dental filling. It is supplied in the form of dried powdered zinc oxide in various colours, with the ‘ liquid,5 which consists of phosphoric acid. These are mixed intimately prior to use as a flooring when not too near the pulp. Zinc Oxy-Salphate. Consists of calcined zinc sulphate and zinc oxide ; mucilage of acacia is used to mass. 10 grains (as much as lies on a sixpence) mixed quickly with at least 5 drops of the Fluid makes a good mass which sets as hard*as stone. Eletcher’s Artificial Dentine is similar. Zinc Oxy Chloride. The ‘ powder * is of zinc oxide and the ‘ liquid 5 zinc chloride solution. Mix thoroughly. Sometimes used as a root-filling and for sensitive dentine ; will irritate a live pulp. Zinci Salicylas. Zn(C,H4.OH.COO)2+3H2O=393-5048. Dose.—1 to 5 grains (0*06 to 0-3 Gm.). White crystals soluble in water 1 in 24, and in alcohol 1 in 2-5. As dusting powder and may be combined with gelatin (v. Gelatinum Zinci). Internally is used as a substitute for the Valerianate. Zinci Sulphas (B. P. ’14). ZnS04.7H20=287-5492. Dose.—1 to 3 gr. (G'G6 to 0*2 Gm.) tonic; 10 to 30 gr. (0-6 to 2 Gm.) emetic. Fr. Cx. Max. single and daily dose 15 grains. Soluble 1 in 0*65 water at 59*5° F.—P.J. i./o2,552. Uses.—For gleet and gonorrhoea J to 1% injections are given, frequently combined with alum or sometimes Ferrous Sulphate. Austr. (1906). Syn. Guttje Collyrium Astringens Luteum. P. Horsti. Horst’s Eye Wash. nf141^loni1um Chloride 2, Zinc Sulphate 5, Distilled Water 890, dissolve and Sn2’ +dloSf°ived m diluted Spirit (Sp. Gr. 0-895) 100, then add conjuncHvitis180^ 24 hours and filter- As an astringent lotion is used for np^r,nn^Vr^UIf containing \ grain of Zinc Sulphate and 10 grains Boric Acid per ounce preferable to organic Silver Compounds.—L. ii./n, 1570. (nSi?8 of zinc or copper salts in collyria may be relieved by using a saturated solution of potassium chlorate instead of water.—B.M.J. i./26,928. in t (carriers) cleared up by means of 1-2% solution m the lalmouth Steam Atomizer.—B.M.J. ii./i6,673. in ™orosis can be rapidly cured by emetic of 20 grain doses for 6 to 8 days, • morning fasting, of zinc sulphate. Iron sulphate (common) originally given by an old dame.—B.M.J. ii./o8,1145. Lotio Rubra U.C.H. Zinc Sulphate 0-5, Compound Tincture 2, “aYen(^er 2-5, Water to 100. L.H. has Zinc Sulphate 2 grains. t uchsm 5^(7 grain and Water to 1 ounce. R.O.H. Zinc Sulphate 1 giam, Compound Tincture of Lavender 15 minims, Spirit of Rosemary B.P. 15 minims, Water to 1 ounce. ‘ Solubes ’ Zinci Sulphatis are equivalent to 2 and 10 ounces respectively of the above lotion. Solubes ’ Zinci Sulphatis et Aluminis contain 10 grains of each, for dissolving in a pint, more or less as required, of warm water. ‘ Collapsubes ’ of Zinc Sulphate 1 grain in 1 ounce of gelatin basis are for gleet and gonorrhoea. Lotio Zinci Sulphatis. Zinc Sulphate 0-25 or 0-5% in Distilled Water. Guttm Zinci Sulphatis, R.O.H., 4, 1 or 2 grains to 1 ounce. Lotio Sulphatum. Zinc Sulphate 30 to 40 grains, Alum 30 to 40 grains, Ferrous Sulphate 20 grains, Copper Sulphate 2 grains, Water 8 ounces. Collyrium Zinci Compositum, N.H.I. Zinc Sulphate G grains, Boric Acid 30 grains, Distilled Water to G ounces. Ophthalmic Discs of -*1^- grain Zinc Sulphate. Points of Zinc Sulphate are moulded for intra-uterine use. Points of equal parts Zinc Sulphate and Alum, and of Copper Sulphate are also made. Injectio Zinci Sulphatis L.H. for vaginal use. Has 60 grains in 1 pint of water, i.e., 0-69% or 1 in 144-9. Cere bro - Spin al Fever. Disinfection of air with Levick’s Steam Spray containing 1% Zinc Sulphate see Cerebro-Spinal Fever. Lotio Alba (McKenna). Zinc Sulphate and Sulphurated Potash of each H drachms, Water to 4 ounces. Acne vulgaris is well treated with this— cf. J. F. Christie, B.M.J. 1./37,1032. SUPPLEMENTARY LIST OF DRUGS. per T.D b! l8/2?fs5C.ed ophthalmia by means of jequirity.—G. McPherson, Absiathiam. Syn. Wormwood. Dried leaves and tons of Artemisia Absinthium L., A .0. Compositee. The active ingredient is the oil (1°/ ) Its use is tonic and digestive. Infusion 1 in 20. Dose-1 to2^ounces The oil *s °n1\tamed m ^e drmk Absinthe. Other essential oils, e.g., anise coriander constitueifts6rmint’ hyssop’ angelica an^ melissa are stated to be additional Absinthe-drinking in England. Absinthe should be prohibited in England \ ermouth and Chartreuse contain the Oil of Wormwood.—C. W. J Brasher -L'. W 30,944. ’ Acacise Cortex (B.P. ’14). A. arabica and A. decurrens. Dried bark kept for OT1.ef ^far* Dec act am (i?.P.’14). Dose.—£ to 2 oz. 6% in water. Astringent, suitable as gargle or lotion. ’ runfinS1 P* JAP- IV.,E.E.YIII. Syn. Dimethyl-Ketone. CH3CO.OH3 =58-0468. Dose.—60 to 90 minims (4 to 6 Cc.) daily. A colour- lc3ss, light, inflammable, neutral liquid, with ethereal odour and camphora- ceous taste, contained in crude wood spirit, obtained by the drv distillation of acetates ; also by the destructive distillation of wood and by the fermentative action of Weissmann’s Clostridium acetobutylicum on starch (mashed maize).—C.D. i./27,58b. It is miscible with water, alcohol, ether, chloroform, and oils, and is a ready solvent of fats and resins, pyroxylin, celluloid and many other organic substances^ It takes up about 25 times its volume of acetylene. If pure its Sp. Gr. is 0-795 to 0-8. B. pt. 56-5° C. It is largely employed in the manufacture of chloroform. Pharmacology.—It is particularly potent when a number of just active doses are given; inhibits respiration and heat and produces fall of blood pressure.—J.C.S. A. i./i 922,794. It occurs in small quantity as a normal constituent in the urine, also (frequently in large amount) in that of diabetics, cf. Vol. II. We have determined its Antiseptic Power using B. Coli Communis as test organism.—See Chapter on Antiseptics, Yol. II. Acetone Bacillus. Fermentation of Starch, Butyl Alcohol and Acetone, separated by fractionation.—B.M.J. i./22,115. Acetone has been used in dyspnoea. It has also been given as an anthelmintic, and used for cleansing the skin prior to operation. lodo-Acetone.—Iodine 2% in Acetone is used to sterilise catgut. First steep in ligroin to free from fat.—Vide also Iodised gut. Acetophenone. Syn. Hypnone. C6H5CQ.CH3 = 120-0374. Dose.—to 5 minims (0-1 to 0-3 Cc.) in almond emulsion, or with mucilage or syrup and peppermint water, or in Capsules containing £ minim. A colourless! liquid, with odour of Bitter Almonds. Insoluble in water, but soluble in alcohol and oils. Used as an hypnotic requires care. Acidum Chromicum. Syn. Chromic Anhydride.—(B.P. '14), P.G. VI. Cr03 = 100-01. In deliquescent,crims on crystals. A powerful oxidising agent. Caution : incompatible with alcohol, glycerin, and other oxidisable substances. Soluble about 5 in 3 of water. Liquor (B.P. ’14). dylomata and lupus sweating feet 5 to 10y0 ijuwuu, jh icuv^mutu ^ secondary syphilis of the pharnyx the so-called snail-track ulcer treated with a solution (10 grains to the ounce).—For mucous and warty patches 5% is Ulcerative stomatitis. The organisms concerned are obligatory anaerobes Chromic Acid relieves pain and removes the necrotic tissue. Used warm 1 in 200 to 1 in 400 and applied with wool round a probe. Immediately after the uso of the chromic lotion paint the affected area with a mixture of 20 grains' ot Ohloretone to the ounce of equal parts gylcerin and spirit. B. fusiformii Vaccine successful m the acute stages—Sir K. Goadby, L. i./i6 959 Rodent ulcer treated by Chromic Acid solution, 10% strength’ applied with a brush daily with alternately Boric Acid and Zinc ointment. At first the ulcer may actually increase in size. It is less drastic than Arsenic and does not: affect healthy tissue cells.—A. Dingwall Kennedy, B.M.J. ii./22,844. Chromium Plating.—The process consists in wiring the articles to* a frame ready for theplating vat, the actual plating (anything up to 15 mins ) unwiring, swilling, and polishing. Current 500 to 1,000 amps, and 4 to id) volts. Solution contains 50% Chromic Acid. Fumes contain the acid forced up in spray by the evolution of Hydrogen at the cathode. Lassar’s Paste* modified with a preponderant base of Vaseline smeared on hands and arms before work, and a little instilled into each nostril. Soap containing free* Lanolm used m some works. Dermatitis treatment—double strength Calamine solution. When oedema subsides scrub spots with gauze soaked in spirit dry, and wrap in lint and Lassar’s Paste. Chromium ulcers should be cleaned and dressed with Zinc Oxide and Vaseline. Ulceration of the nose treated with gauze soaked in Flavine 1 in 1,000.—H. B. Trumper, B.M.J. i /31 705 Acidum Cinnamicum. Syn. Phenylacrylic Acid. Cinnamylic Arm C8H5CH : CH.CO.OH = 148-0624. Dose.—Per os, * to i grain Intravenously (in oil) A> to An grain. Made by oxidising Cinnamon Oil or by acting upon Benzaldehyde with Acetyl Chloride. Transparent micaceous crystals M.pt. about 130° C., slightly soluble in water, soluble in alcohol, ether and oils’ Uses.—Has been used to induce leucocytosis. Mostly given as Sodium OctlU • Sodii Cinnamas.—Syn. Hetol. C6H5CH : CH.CO. ONa = 169*0516 Dose— 3 to 5 grainsper 05, or hypodermically as Glycerin Solution. Soluble 1 in 11 water, in glycerin 1 in 10. Uses—Pulmonary tuberculosis has been treated by intravenous injection of 0T Gm. in 10 Cc. normal saline over lengthy periods (Landerer). The cinnamates have vasodilatory action (Oliver), harmless even on prolonged use. Cystitis and influenza have been treated. Glycerinum Sodii Cinnamatis. Dose— 30 to 60 minims injected. This 10% solution in glycerin is made bv heating to not exceeding 180° C. and has been used hypodermically and intravenously in tuberculosis and cancer; it causes a general leucocytosis Steru’es contain 30 minims each.—cf. Injectio Sodii ortho-Coumaratis posiea The papers by the late Lovell Drage in the Lancet, British Medical Journal and the Second International Congress of Surgery at Brussels have been collected in book form, with a preface by Sir Squire Sprigge. It is stated that Lovell Drage had the true spirit of the investigating physician, and that he showed this spirit alike towards the problems of medical life and towards the solution of scientific questions. Drage felt keenly that it was a reproach to medicine that the mortality from cancer should be so high, and should shew signs of rising, at a time when advances in diagnosis and treatment were being recorded. He ardently advocated that the medical treatment of cancer should receive attention, with the hope of co-operation from his colleagues Strontii Cinnama3 (C6H6.CH: CH.CO.0)2Sr = 381*7392. Dose— 2 to 5 grains (0-12 to 0-3 Gm.). A white powder, soluble about 1 in 120 of water and about 1 in 50 of a mixture of glycerin and water equal parts and about, 1 in 100 of alcohol 90%. This has been used similarly to the Sodium Salt Sodium Phenyl Propiolate.—Syn. Thermiol. C8H5C • C.COONa = 168*037 Is supplied in 25% solution. Has been used in laryngeal and pulmonary tuberculosis by inhalation of 0-5 to 3% solutions. Note the treble linkage in the side chain indicating a more active body than the parent Cinnamic Acid Cinnalde iyd tm.—C6HSCH : CH.COH = 132 0624. Syn. Cinnamal P Austr. Dose.—1 minim. The aldehyde from cinnamon oil. A colourless liquid with cinnamon odour. Sp. Gr. 1*054 to 1*056. Soluble in alcohol in all proportions. Capsules (Gelatin), 1 minim, have been used in malignant disease and in tuberculosis, especially in pulmonary cases. Ac dum Caumancum,—- Syn. o-Hydroxycinnamic Acid. C6H4OH.CH : CH.COOH = 164*0624. Brownish crystals, M.pt. 200° C. the meta-acid melts at 191° C., and the para- at 206° C. The use of this Hydroxy compound (as Sodium Salt) was a step forward from Cinnamic Acid as an Further lwS08i- (c/r the superiority of Salicylic over Benzoic Acid. as c inn ami o acld sta*\as }n the same relationship to salicylic acid as cmam does to benzoic acid—introduction of the Acrylic summing hardl v Iomhfplgiht y fn chi^°form, in alcohol 1 in 12 or less, i/ethcr 1 in 36', thpfL! hP to?p!after* 11he coumarates have action of vasodilators, and they may be taken for prolonged periods without harm—Oliver. P H n° VnS°fLV>n5??ma5rtlsV A 22 %adueous solution of Sodium o-Coumarate ol-beeY used m cancer and tuberculosis. Dose.— tbrice weekly when possible between the growth and healthy subjacent tissues or m the course of lymphatics proceeding from the i01 tbY gr0Yth> or 0VF a iar§e serous sac like the peritoneum. In glandular and early cases of pulmonary tuberculosis Drage reported good results. In cancer he held that few drugs exert more definite action. Sterules contain 2d minims of the injection ; also made with Kerocain > grain; also vith Kero sain 5 grain and Adrenalin Solution 10 minims. 4 Fibrocoumarin ’ feterules contain Sodium coumarate injection 25 minims, Thiosinamin f grams and Kerocain, § grain (suitable where tissue is cicatricised) also this formula with Adrenalin Solution 10 minims. JfcTylniarin (T.M. 283966). Syn. Acidum Acetyl-o-Coumaricum. 0113000.0,5114.011; CH.COOH = 206-078. Dose.—5 to 10 grains thrice daily after food. Colourless crystals, M.pt. Io0° C. Soluble slightly in water, in alcohol 90% 1 in 19. In tuberculosis and as a general intestinal antiseptic. Tylmarin Dusting Powder has been used to cancerous growths which have broken down. Large open sores can be materially benefited. Tylmarin Sodium. Syn. Sodii Aceto-Coumaras. C6H4O.CO.CH3CH : CH.CQQNa = 228-0672. Dose.—5 grains. Decomposed in the stomach yielding Tylmarin in amascent condition as initial product. Crystals readily soluble in water and in Alcohol (90%) 1 in 2. Tylmaiin-Quiniae. Syn. Quinine Aceto-Coumaras. C20H24NaO2. C6H4O.COCH3.CH : OH.COOH =530-2812. Dose.—3 to 5 grains. Contains approx. 60% Quinine and 40% Tylmarin, soluble very slightly in water, in Alcohol 90% 1 in 9, in Glycerin 1 in 30. Antiseptic and febrifuge. Tylmarin-Tkorium. Syn. Thorii Aceto-Coumaras. Th(QH)4[Th(C6H4O.CO.CH8. CH CH.COO)4]2 = 2404-9636. A buff coloured powder containing approx. 35% of Thorium Oxide. Has radio-active power on a photographic plate. For local use in malignant disease Coumarin. Syn. Coumaric Ahnydride. C8H602 = 146-0468. Colourless crystals with aromatic odour and taste contained in Tonquin beans from Dipteryx odorata (Willd.) and D. oppositifolia (Willd.). (JS'.O. Leguminosce)y also in Woodruff. It is made synthetically by boiling Salicylic Aldehyde with Acetic Anhydride and Sodium Acetate. Soluble in alcohol, ether and oils, but not to any extent in water. Sublimes unchanged. One part will disguise the odour of 50 of iodoform. AcidumGallicum Syn. AcidoAgalico,F.E. VIII. CGH2(OH)3COOH-f H20 = 188-0624. Dose.—5 to 15 grains. Crystals or crystalline powder of brownish colour Soluble in water about 1 in 100, in glycerin 1 in 12, in alcohol 90% 1 in 5. Properties and uses similar to Tannic Acid, q.v. Acidum Hydrofluoricum HF = 20-008. Syn. Flucric Ac d of commerce redistilled for medicinal use. Manufactured by the action of Sulphuric Acid on Fluor Spar (CaF2) in lead or platinum vessels. It contains about 30% of the gas, emits suffocating fumes, and requires to be kept in gutta-percha or leaden bottles. „ ... . , , Bad burns may be produced in a delayed manner. Swelling of thumb and finger consequent on handling a cracked gutta-percha bottle ol the acid. Ihe skin became distended to bursting point with intense pain. Blisters were punctured. 1% Phenol compresses and later Normal Saline, ^odium Bicarbonate bath or preferably Ammonium Carbonate suggested as best treatment.—F. C. C. Robb, P.J. i./2o,560. . . - Anidum Hyde off none um Dilutum. Dose. 5 to 15 minims, contains 0-2%. Even thus diluted should not be kept in glass bottles for use. Has been given for goitre. Ammonii Fluoridum NIT4F = 37-0392. Dose.—4 grains may be consider? more than a maximum—W.H.M. (an experiment on liimself for Sir Wnr Gowers). This salt (soluble 5 in 6 of water) has been suggested to diminis- enlarged spleen and in goitre in doses of 5 to 20 minims of solution, 4 grain in an ounce, after meals (supply in a gutta-percha bottle). For plithis inhalation from a 1 in 500 solution has been recommended. /ncompatible with Nitric Acid, Quinine Salts, Spirit of Nitrous Ether an<- soluble Calcium Salts, but compatible with Tinctura Eerri Perchloridi. Calcn Fluoridum. CaF2 = 78-07. Dose—l to \ grain suitably diluted. Whit powder insoluble in water, has been advocated for improvement of the teetH and building up bone. Ferri Fluoridum. Feiric whh Fenous Fluoiide Dose.—A. to £ grain. A purplish grey insoluble powder, possessing haematini properties has been used for enlarged spleen. Quinirae Fluoridum. C20H24N2O= HF = 344-211. Dose.—gV to £ grain. In relieving enlarged spleen ana ia rickets. Sodii Fiuoridum. NaF = 41-997. Dose.—W to £ grain. Antisepti in phthisis. Active against Staphylo and Streptococci and B. pyocyaneus an<r fairly so against B. aerogenes capsulatus—cf. ‘Specificity in Antiseptics Vol. II. Mixed with meal is a specific for killing beetles and cockroaches Acidum lodicmn HI02 = 175-9398. Dose.—1 to 5 grains. White crystalline powder very soluble in water. Iodic acid is a remarkabl i deodorant and preservative even in a 1 in 2,500 solution. It is employed ia ozsena, for deodorising offensive urine, as an irrigant in empyema (strengtl 1 in 500) and for leg ulcers, as a mouth wash, e.g., in inoperable epithelicmau and as a throat swabbing in diphtheria. Found useful in extensive burnin (1 in 500 solution). Internally a drachm of a 1 in 100 solution, well dilutees has been given in gastro-intestinal sepsis, as in typhoid fever. The calcium salt is principally employed. Calcii lodas. Ca (103)2, 6H20 =498-0376. Syn. Calcinol. Dose.—3 to 4 grains three times daily in solution. Tasteless, odourless powder, soluble in 3S0 parts of water at 11-5° C. Act equally well in an acid or alkaline medium as a deodorant and anti-putrefactivei A useful dusting powder. Lolio Calcii Icdatis (saturated aqueous solution is employed in septic and suppurating wounds. A warm saturated solution is used as a vaginal douche or bladder irrigant; efficient as a mouth wash o gargle. Should prove useful in pyorrhoea alveolaris. An ointment 2% though specific in eczema. A solution or a 10% insufflation with bismuth carbonate may be useful in otorrheea. May prove of value in foetid breath. Hydrargyri lodas, Hg (I03)2 = 550-474. Dose.—£ to ^ grain. A white powder, strongly antiseptic. Soluble with the addition of Sodium Chloride to the extent of 2% in water. Potassium Iodide also assists solubility It attacks disease organisms with both its component ions, and contains only half as much Mercury as the Perchloride. In a pronounced sycosis of hairy parts of the face an ointment containing 4% effectual. Sodii lodas, NaI03 = 197-929. 14 grains in 5% solution (about saturated have been injected for acute and chronic articular rheumatism. Zinci lodas.—Zn(I03)2 = 415-244. White powder. Soluble about 1 in 50. Use similar to the calcium salt. Acidum Maiicum. Syn. Hydroxysuccinic Acid, C2H3(OH)(COOH)2 = 134-0268. Dose.—1 to 5 grains. White deliquescent crystals soluble- ii water 1 in 1, and in Alcohol 1 in 14-. Hasbeen used as throat spray in diphtheria and other throat affections. Possesses properties similar to Tartaric Acid, li phthisis much larger doses—up to 2 drachms have been given. As an antiseptic, found to be specific against the gas bacillus (B. aeregene capsulatus). Acidum Meconicum. C7H407,3H20 =254-078. "White crystals slightly soluble in water. Forms soluble salts with Opium Alkaloids. It occui in good opium to extent of 5 to 8%. Has little physiological action. For method of assay of the Acid in the drug vide P. Van der Wielen.— P.J. ii./i3.114. cf. also Vol. II. As Meconic Acid readily forms a tri-sodium compound it wTas for long regarded as a tribasic acid. It contains, however, only two COOH groups and an additional OH enables it to form tri-compounds with stronger bases?: With alkaloids it only forms dibasic or monobasic salts. Although in boiling water it evolves C02 and becomes slowly converted into Comenic Acid, i" may be dried on the water bath to constant weight losing only its water oh hydration.—D. B. Dott, P.J. i./2i,232. Acid'xtnOjmio'in. OsOi = 254-8. Syn. Osmium Tetroxide, Hyperosmic Acid. Bose.—A to A grain. In wax-like yellow crystals. Its vapour is intolerably pungent. Soluble slowly about 1 in 50 of water. It is poisonous and a powerful oxidizing body. It is used in microscopy; fat and medullary matter are blackened by it. This and Potassium Qsnate 1% solution in 2 to 10 minim doses have been injected hypodermically (painful) for neuralgia, for strumous glands, goitrous swellings, sarcoma, and cancer; also sciatica and muscular rheumatism, and given internally in epilepsy. Liquor Acidi Chromo-Aee^o-Osmici (Flemming’s Strong Solution). Mix Glacial Acetic Acid 100 with Osmic Acid 8in water 400, and Chromic Acid 15 in water 1,500. Cancerous growths have been treated : 8 Cc. injections at edge of tumour, or 1 Cc. just beneath its surface. Also for fixing, in histology. CE>Acidum Oxalicum. (C00H)22H20 = 126-0468. ‘Poisonous—not to be taken ’—Soluble Salts of Oxalic Acid. In Gt. Britain and A7. Ireland, Oxalic Acid is (pf and soluble salts of Oxalic Acid are in Section 5 of the 1908 Poisons and Pharmacy Act (Poinonous Substances) : whereas in the Irish Free State Oxalic Acid and all Oxalates are CR), and therefore can only be sold by registered persons. In addition, soluble salts of Oxalic Acid must there be labelled * Poison,’ ' Poisonous,' and ‘ Hot to be taken! For farther conditions of sale see p. 38. White crystals soluble in water about 1 in 9 ; a powerful poison, made by acting on wood, sugar, starch, etc., with Nitric Acid. The cerium and iron salts are used in medicine. A German patented process for production consists in passing Acetylene gas through Nitric Acid (S.G. 1-305).—P.J. h/25,13. The toxicity of thisacid in dilute solution and ofitssalts is due to their forming an insoluble calcium salt, a sufficient quantity of calcium in solution being essential for the welfare of the organism. Strong solutions of the acid are poisonous by corrosive action. Toxic symtoms and cardiac depression can be relieved by giving soluble Lime Salts. Antidotes, — Apomorphine Injection, Calcium Saccharate Solution, Chalk, Castor Oil, Stimulants. Do not cgit/e alkalis, Soda, or Potash which form soluble oxalates. Treatment with infusion of isotonic or hypertonic solution of Glucose has been successful as retention of urea seemed to be the principal disturbance. Sal Limmis.—Salt of Sorrel or Sal Acetosella, Salauetos. Commercial samples are mostly Potassium Quadroxalate, K.H.C204.C204.H2.21130. No evidence that Potassium 13 inoxalate, KH.C2O4.H3O (Syn. Acid Potassium Oxalate) is now a commercial salt.— I. A. Purdie, C. & D. i./25,198. Is used for removing ink stains, iron mould, cleaning leather, etc., and removing the colour from calico printing. Has been given for scurvy. Dose. £• to k grain. Is very poisonous, with which word it must be labelled. Acidum Succinicum.—C3H4.COOH.COOH = 118-0468. Dose.—5 to 10 grains (0-3 to 0-6 Gm.j. . . _ , . Occurs on destructive distillation of Amber, as the oxidation product of a number of substances rich in carbon, e.g., fats and fatty acids treated with Nitric Acid. Also by fermentation of Malic Acid (Calcium Salt)—Liebig, or of Tartaric Acid, which is Dihydroxy-Succinic Acid. Colourless crystals Soluble in Water 1 in 20, in Alcohol 1 in 9. Amxncnn Suicinas—C2H4(COONH4)2 = 152-1104. Dose.—2 to 5 grams. Crystalline salt soluble in water and alcohol. In spasmodic pains, particularly spastic contractions of the uterus. Scdii Succinas.—C2H4(C00]Na)2+6H20 —2/0-1218. Dose.—2 to 5 grains in catarrhal jaundice. Soluble 1 m less than To water. Has also been given in delirium tremens.—M.Am. Poiassii Succinas. C2H4 (C00K)2+3H20 =248-278. A deliquescent powder; has been used in doses of 5 to 10 grains to control haemorrhage. Fern buccmas. Ferric Succinate, a reddish-brown insoluble powder, removes biliary calculi and relieves hepatic colic. J _ . t> , Ajojantiieea. Syn. Toxicophliea. Hottentots Poison Bush. A. Venenata is employed in South Africa, here referred to. Probab y contains Ouabain or allied glucoside. Extractum liquidum (1 — 1) from the leaves. Suggested dose 2} to 7| minims, a substitute for digitalis. ... gt]Aconitum Laciniafam is the probable source of Nepaul Aconite. Syn- iish or Bikh. „ . . , . gj Cincture 1 in 8 of 90% alcohol. Dose.—1 minim hourly. Adspji Prsepamt is B.P. ’14.—Syn. Adeps Suillus, Axungia, Ph. Ted V Adeps Lotus P. Dan. ’ I The purified fat of the hog, Sus scrofa (Linn.)—from the ‘ flare ’ or ‘ omentnm. contains 60% triolein (sold when separated by freezing and pressure as ‘ Larc: f Oil’), v. Sapones, Vol. II. The remainder is palmitin and stearin. Solubb & in ether 1 in 22, hardly soluble in alcohol. Adeps luduratus is for use in the tropics. The liquid constituent is removed to a great extent by pressure- J Adeps Benzoatus {B.P. T4) is made with 3% Benzoin. To be avoided as « j basis for eye ointments. Adonis vernalis (P. Austr., Ph. Ned. V.).—Contains a hygroscopic glucosidcle Adonidin which resembles Digitalis in action. Dose.—In powder, 3 to (E| grains; of infusion 1 in 40, 4 drachms; of Adonidin, i to 4 grain dailv L Epilepsy has been treated with it combined with Bromide. Ticcti re.—Leaves & and Stalks employed 1 in 10.—Bose.—10 to 30 minims. Adonidin is a lcc-a F anaesthetic. In chronic glaucoma, iritis, and irito-cystitis 1% solution haL E been used, 3 drops relieve pain. Five mgr. of Adonidm in 0-5% solution an efficient diuretic in cardiac ti anasarca.—per Y.B.P., ’27,218. See also Y.B.P., ’26,237. Adonite, a sugar (C5H7(OH)5), occurs in the plant. The crystals have sweet? d taste, are very soluble in water, less in spirit. M.pt. 102° C. It is employed: U as a Bacteriological Sugar in fermentation reactions—cf. Vol. II., B. Typhosus, f iEsculus Hippoeastanum.—Horse-Chestnut. Marron d’lnde Fr. Cx. Ropy . SUPP.-26. _ Tincture of Seeds 1 in 10 proof spirit has been given for painful u haemorrhoids. Bose.—10 minims night and morning. Also emmenagogue C A liquid extract has been used, painted on or rubbed in, in rheumatism and: . neuralgia. Kastanol.—Extractum Hippocastani Liquidum with 8% camphor:: I used in rheumatism.—(Austria.) Ph. Notes. Chestnuts contain from 21 to 47% of Starch and Acorns from 55 to 57%, the! total sugar in addition being 11 to 19 and 6 to 9% respectively. On hydrolysis |i with acids about 30 gallons of absolute alcohol could be obtained from aiJ ton of nuts.—L. ii./17,757. TEsculin, CiSH1609.1£H20 =-367-1482, a glucoside, soluble in water, to whichi L 2 to 3% Sodium Carbonate is added, also soluble in alcohol. Solutions have! a blue fluorescence, and have been used similarly to Quinine in X-ray and! U Finsen light treatment {q.v.). Bose.—1 to 5 minims of 5% solution. An ointment containing AEsculin used for prevention of sunburn.—Pres, ti July, *26,285. We have prepared an ointment 2% strength in yellow paraffin. U which has been tested by ultra violet light and found to be effectual. O their ; bases, e.q., soaps, etc., not satisfactory. Alcoolature Stabiliste suggested by the late Professor Bourquelot. In the case of horse chestnuts, Alcohol of 75% strength is employed for stabilisation and extraction. See also Valerian. Castanea vesca, the ordinary sweet Spanish chestnut. Infusion 1 ounce ofi [ dried leaves in 1 pint boiling water. Bose.—4 ounce to a wineglass 3 or 4 time&fl daily, or better 4 to 1 drachm of fluid extract every 3 to 4 hours. For whoopingJj cough.—E. M. Holmes, P. J. i./3o,158. .ZEthusa Cynapium.—Fool’s Parsley, Lesser Hemlock. Contains a smalllH amount of volatile alkaloid, with the properties of Conine; calculated hydrochloride constitutes 0-0003% of the entire fresh herb. A larger proportion under favourable conditions, may be produced leading to poisonous^ properties. It also contains a volatile oil. 0-015% of the entire fresh plant and. resin 0-8%. Has narcotic properties. Garden Parsley, vide Apiol. iEthyi Bromidum. P.G. VI, Fr. Cx., P. Jap., P. Helv. jF.thanoii Bromidum, P. Belg. IV, F.E. VIII, P. Ital. V. C2H5Br. Syn. Hydro- bromic Ether. A colourless, very volatile liquid with a strong peculiar odour and a sweet isle warm taste, becoming brown by exposure owing to decomposition, brominer l being split off. It has Sp. Gr. 1-4735 and boils at 38-8° C. P.G. dilutes with spirit to improve keeping properties. Soluble 1 in 85 of water and miscible? with alcohol 90% and ether. For local ansesthesia it may be used as spray, or simply short covered, contact for neuralgia. It may be added to Menthol Liniment, gcmnoi'crin {q.v.) contains 5%. Ethyl Bronide Sterules. Encased in cotton wool and rayon, contain 5 minims in each; are convenient for use when crushed. Useful in asthma and epileptic convulsions. Ethylene Bnmide.—OEHiBra^ 187-8632. This is poisonous—distinguish from the above. Bose.—1 to 2 minims in alcoholic solution or oily solution hypodermically or in Gelatin Capsules. A colourless liquid, of Sp. Gr. 2T63, soluble 1 in 4 of 90% alcohol, insoluble in water. Reduces frequency and intensity of attacks in epilepsy. Agar-Agar—Japanese Isinglass. P.G. VI, U.S.X,P.Svec.X,P. Jap.IV., F.E. VIII Membrane-like strips, i.e., the dried jelly of Gelidium cornenm, a sea-weed, and other species. G. corneum is collected in Japan from the rocks between May and October, and dried and cleaned by alternate wetting and drying in the sun. It is then extracted with boiling fresh water and the liquor strained off, filtered, and cooled, and dried in wooden trays.—P.J. ii./26,372. 1 in boiling water 200 forms on cooling a transparent jelly, suitable for invalids. It has little nutritive value—it is not digested—but is useful for treating constipation, especially of the type where the stools are hard and dry owing to complete absorption of liquid from the digestive tract. For this purpose it is best crushed into small pieces like bran—termed Flaked Agar. Clinical experience shows that finely powdered or even sand-like powder is not efficacious. Teaspoonful doses occasionally of the dry substance in flake form sprinkled in little moist food, e.g., stewed apples, act as mild aperient in that it softens the fasces, but should be employed at first in moderation, as it may possibly cause obstruction. By taking up moisture it increases the volume of the faeces and promotes peristalsis.—See Cascara Jelly also. It is used in preparation of culture media for bacteria (q.v.); also for finishing calicos, silks, etc* Production of Agar.—P.J. ii./26,372. Agar-Agar—detection and estimation.—J. Xing, Analyst, 1925. Vanilla, Almond and Raspberry flavoured Flaked Agar are prepared. Linseed appears to act, as regards weight yield of faeces, better than Agar- Agar.—88%. increase against 48%, but not so well as Psyllium, 97%. Did not depend on humidity.—B.M.J.E. i./i4,59. ^Thaolaxine (T.M. 319983), described as Agar-Agar with Rhamnaceous Extracts, in form of Scales, Cachets, Tablets and Granules. A laxative in treatment of chronic constipation. :#:Jubol (T.M. 313263). Tablets of Agar-Agar with biliary and intestinal glands extract. Bose.—3 tablets at bedtime. —Gehe. ^cParaSfagar and other preparations with liquid paraffin are prepared, q.v. Agaricas Albus,—Syn. Polyporus Officinalis, Boletus Laricis, Fungus Laricis (P. Austr.), P. Ital. V. Polypore de Melese (Fr. Cx.). Purging Agaric. Dose.—10 to 30 grains. Light, spongy pieces. Large doses purgative, small ones astringent for night sweats, diarrhoea and to diminish bronchial secretion. Tincture 1 in 10 of 60% alcohol. Bose.—20 to 60 minims. Extract— Dose.—k to 2 grains. Prepared by exhaustion with 60% Alcohol, yield is ibout 6%. Not to be confused with the fly agaric, Amanita Muscaria, which contains 15] Muscarine and Synthetic Muscarine or Choline Nitrous Ether. See Edn. XVIII, n. 808. Constitution of Muscarine being studied by M.R.C.—B.M.J. i./3o,560. Aeidum Agaricum. Agaricin P.G. VI, Ital. V, Helv. and Jap. and Dan. OHaC(OH)(GH)(Oi8H3 3)(COOH)8l£H20. Syn. LaricicAcid. Dose.—J to i grain is given to restrain the sweating of phthisis. Max ’Angle dose (P.G. VI and Ital.) li grains. Agrimonia Eupatoria (Rosaceoe).—Common agrimony. Mild astringent. Elixir Agrimonies Composifum (Lunan). A special preparation of agrimony, ’hubarb, toad-flax (Antirrhinum, Linaria), barberry, caraway, chamomile, landelion, parsley, is in demand in incipient appendicitis ; stated to avert an operation, and in any condition of the stomach and alimentary canal likely to rroduce inflammatory symptoms. Bose.—1 drachm in water thrice daily ; i,s hepatic stimulant: mild astringent. Mistura Agrimonies Compcsita. Vose.—i- ounce thrice daily, is of similar composition for gall-stones, and to )revent~their formation—stated to prove effectual. A-rronvBum, Triticum (B.P. ’14) or Couch Grass. Dried rhizome of A. B.P. ’14). Bose.—1 to 2 dr. Made 1 = 1 with boiling water, and 25% 1c. 90%. Flavouring.—Syl Lavandulae; Aqua Anethi. Triticum Repens (genuine) is a commercial rarity. The chief, if'not the VOL. I. D D only substitute is the rhizome of Cynodon Dactylon, the clog grass. Spain : j apparently the geographical source of the material of commerce.—J. Small« B.P. Conf., 1919. Alchsmilla Arvensis (Rosacea). Parsley Piert. Small annual plants wit: |f green flowers. Is superior to buchu in some instances. Infusion of leave! 1 in 10. Dose.—1 to 2 ounces. Aletris Farinosa, B.P.C.—Star Grass, Colic Root, (Dioscorea q.v. is ale n called Colic Root). From the rhizome of this are prepared a fluid Extras t with diluted alcohol, 11.8. (1890, 1 = 1). Dose.—5 to 15 minims, and a Cordi-k ur Elixir (B.P.C. containing Liquid Extract of Aletris 25, Liquid Extract ar .Liquorice 6, Simple Elixir 45, Water to 100). Dose.—4 to 1 drachm, as | imed as uterine tonics. Extractum Aletridis Lipiidum, B.P.C. 1 = 1 hi percolation with Alcohol 45%. Alginoid Iron. Syn. if: Algiron (T.M. 283697). Dose.—2 to 15 grain: k Alginic Acid from seaweed is combined with iron, forming an insoluble brow f powder containing about 11% of iron. Does not constipate: is given D r anaemia. Pills and pellets are prepared. Also compound pills with Extra t Cascara I gr.; [£>2 Arsenic grain ; jgl] with Arsenic grain and Stryci f nine T% grain. Allium Sativum.—Garlic bulb (Liliaceoe). Dose.—h to 2 drachms. Garl I preparations have been given in pulmonary phthisis and bronchiectasis. The fc are useful in eases of dilated bronchi with fetid expectoration. Succu I Dose.—10 to 30 minims. Extract = inspissated juice. Dose.—4 to 10 grain ji Pill contains 4 grains extract. Ole im AUii E13 3 at '.ale —This Oil is excreted through the lungs and skin—H not apparently by the kidney. Its principal constituent is usually taken it H be Allyl Sulphide (C3H5)2S = 114T44. Stimulant, expectorant and stomachi |i In cnronic bronchitis, pneumonia, also in cholera and tuberculosis, All I Sulphide can be made by interaction of Alcoholic Potassium Sulphide wnB Allyl Iodide. Dose of either the Natural Oil or Allyl Sulphide, 4 to 2 minim U in Capsules, 4 minim of Allyl Sulphide per kilo weight may be taken as leth k dose. Laryngeal tuberculosis treated by 4 to 1 drachm, two or three times a da J of the Garlic Juice with Tinct. Lavand. Co. and Svrup. Simplex, also gargle cE spray (or combined), or for internal use, accompanied by poultice (or blist ft of pulped garlic externally-—latter also to tuberculous ulcers. Fresh jui<i is not so severe in action as the pulped garlic. The juice should never 1 fi applied to broken surfaces. Lengthy application of poultices (3 to 4 weell with changes) may be required, but effect should first be tried for a few hour# as some are more susceptible than others. It was held by W. C Minchi fl who advocated the treatment, that Allyl Sulphide is specific in all tuberculo H lesions in accessible situations, or in those which can be rendered accessibl [1 Thus, every case of tuberculous disease in the leg, foot, aim, hand, testicle etc 1 gets well under Allyl Sulphide treatment. Ally! Sulphide certainly has fair! high germicidal power, cf. Vol. II, Carbolic Coefficients. The following were finally adopted as modes of treatment:— Enpla3trum Allii.—Fresh garlic q.s., pulped, 2 lbs., to this add i lb. la warmed to a cream, and mix thoroughly. Spread on thin butter-muslin ail apply to the part, changing the dressing about every 24 hours. Unguentum Allyl Sulphidi, 0-1 %— increased in strength if desired—in Glcu Anseri Benzoatus, could replace above as being more expeditious to prepail Inhalation.—Fresh Garlic Juice 56, Alcohol (90%) 7, Eucalyptus Oil («*! Citriodora) (Bayard) 1. 4 ounces is sufficient for three weeks’ treatment pulmonary tuberculosis. The juice is fresh and not filtered. Patient to 1: inhaler in a respirator at least 1 hour night and morning. Capsules of AT Sulphide, 2 minims, can be used in addition if practicable. For lupus apply the fresh juice at night and allow to dry, wash off in mornir and apply a bland ointment. Suppuration of wounds controlled by Succus Allii diluted with 3 or 4 pair Distilled Water. Notable improvement in 48 hours. A case of empyeir: remarkably cleaned out with this lotion. Stronger than this (1 with 2 water) caused pain. Later 1 with 9 of water used when suppuration definite controlled.—V. Gabriel, L. ii./i5,603. Whooping Cough has been treated by Garlic juice per os— T. Mark Hove B.M.J. ii./i6,15; i./i7,2S4. 1 ^ 1lllce-rJ ^ve been successfully treated by rectal injection of the juice diluted with three times quantity of water. bas b(?en ?ureci by placing the fleshy scales of the onion round the joint and keeping in place with a bandage. ?ia;Sn570f fci?e,1VlM treated by 20% Garlic Tincture.—Pr., June, ’22,443. nifi t- frr,?3; ^^Jfbeletti). A preparation for intramuscular injection, and in bbi form, in phthisis ; also combined with Tuberculin. Allium oepa, the ordinary onion, is of less strength than Allium Sativum.— x .o . 1./ 20,o40. Allium Porrium—The common leek also contains Allyl Sulphide. PnJS. i'Sfono/ the common Alder. Uses.—Astringent and tonic. Contams about ^0 /Q of Tannin. Liquid Extract—1 = 1 of the bark. Dose.— flNt nSilS!mr iM^de ^ Pprf°Iation with 45% Alcohol. Set aside the rpm;nn?w°Sf of the whole), and continue percolation with • * the Alcohol,.concentrate and add to reserve portion. Was With wall ?mianci5r-’ AAiLl(lUia Extract of the leaves, prepared by boiling If and ad^mg Alcohol q.s. to preserve, has also been used. In 140 cases of cancer, pain, cachexia and exhaustion diminished. fsee mS?e an Extract from the fresh leaf by Gray’s method MYmeiYAo^l ^agazme> May, 1907, modified by a private communication) SKengt? 3“5 °f fresb leaf. The leaves were finely rnrnce d wrlil nS ' wafer at not exceeding 80° C. On concentration to a servativeyCerm added to the extent of 33% (Le., content of 25%), as pre- ^Alstpnia constrict a, B.P. ’14. Bark used in Australia as a febrifuge. n tt’ 1xr!o^?3ew crystalline alkaloid, Alstonine or Chlorogenine. Atnnhm Ano/3 n^r42!7!22,6?’ has been isolated from it, Tincture, 1 in 8 iri 7a *P0SS\ i2 to 1 drachm. Should be less, 5 to 20 minims. Influ- bas.been treated by Tincture in 10 minim doses. Three other alkaloids conUHctaMj'bespedfled. en prescribi"S the tincture that of A. Alstonia scholaris, H.P. ’14.—Dita bark, from India and the Philippines, fbers an Mkiiloid, Ditaine, syn. Echitamine, C22I128N 204 nylky juice of the tree forms a substance resembling gutta-percha Tincture, 1 m 8 Alcohol 60%.. Dose.-i to 1 drachm.—These two drags arc undei one monograph. Infusion.—1 in 20 boiling water. Tonic in malaria in chronic diarrhoea and advanced stages of dysentery. ^arsbuiallow, dried root of Althcea officinalis (Malvaceae) from second years growth and deprived of the periderm. Contains A spa rag in (/.y. Is mucilaginous and used m pill making to give ‘ body.’ Amadou.—Oak agaric, Surgeons’ agaric, Touchwood. Polyyorus foment- anus L. A fungus prepared with alkali and nitre, in light brown elastic pieces employed as a mechanical haemostatic. It is included in P Austr under the name Fungus igniarius. Ambergris.—A substance /ouncl floating on the surface of the sea—in si uthern hemisphere, valued for its perfume which is generated on keeping or so> g“y beIievctl t0 Le an A fSa™pleV- 1i0S^i)iy gcnuine>’ had M.pt. 75° C. with a small amount of substance which did not melt at 100° C. It was of grey colour with little SlkW dS eiQ°rexTtefnt °f 93-?% in Petroleum Ether which extract had lief. Index (70 ) l-49o, Iodine No. 107T, Acid value 1, Sap. No. 4*4 ; this portion presumably containing the Ambrein was soluble in absolute Alcohol on warming and melted to a clear sticky amber liquid at 42° C.—all of which dgAmSia«e scarcely those of the adulterant ozokerite.—Evans’ Anal. Notes Amyene. Syn. Iso-Amylene. C5H19 = 70-078. ‘ Maximum™24 houre8-0 Gm.’ P-G‘ VL *** maxtoum single dose 4’° Gm- ,A^0l0U,rleSS ef pungent taste and odour, resembling a mixture of Cr n»o on82oaiBPnf°r9i ?o0lpb5erin 8 Parts °f water, also in alcohol. Sp. chlom \ and m°rfki°ebvriot' o16 ^ HyJmotlc, occupying a position between on ?I,ifad paraldehy de. Upsules contain 10 minims in each. Dose.—3 to 6 3 drachms suspended with Tragacanth Mucilage \ ounce, flavoured with \nmght UP t0 2 ounces ** the dose, have been ^4n as a night P D 2 Amylene-hydrate Carbamate. NH2.CO.OC(CH3)2.C2H5 = 131-1094. Syn, *AponaI (T.M. 339355). Dose.—15 to 20 grains (30 max.) mild hypnotic. Stated to induce easy and calm sleep in 20 to 30 minutes, also to be free from ill effects on gastro-intestina tract or other organs. In insomnia due to nervous debility. Said to be made by action of Urea Hydrochloride on Amvlene Hydrate (Dimethyl-ethyl-carbinol).—P.J. ii./n,442 ; B.M.J. i./i2,733. Amylum.—Starch is obtained from the common wheat (Triticum Sativum) maize (Zea Mays), rice (Oryza Sativa) and potato (Solarium Tuberosum, N: 0. Solanacece). Tapioca Starch. Syn. Manihot, Manioca or Mandioca Starch, from Brazi may form a commercial competitor of the varieties in use. Starch and its structure.—Prof. Larg and co-workers, P.J. ii./27,398. Anacardium occidentals.—Cashew Hut. The pericarp of this contains s vesicating oily liquid, which consists of 10% of Cardol (to which the vesicatin; properties are due), and 90% of Anacardic Acid, C22H32Os = 344-256. Th oil has been used in leprosy, ringworm, ulcers, corns and internally as a vermis fuge. Tincture, 1 in 10 Alcohol 90%. Dose.—2 to 10 minims. Anacardi Folia were in Ph. Ned. The marking nut, from A. Officinarum, pcssesse similar properties. Ananassa Sativa (Pine Apple). Has been used among the natives in SoutH< Africa for diphtheria and diphtheritic sore throat. The fresh fruit juice contains an active proteolytic enzyme, Bromelin, whic'. is destroyed when the juice is heated, or the fruit is canned. Bromelin digestr 1,000 times its weight of protein in a few hours and operates equally well rA acid, alkaline or neutral medium.—S. G. Willimott, P.J. ii./28,219 ; II ii./28,455. Tinctura Ananassae (Sativae). Dose.—(As digestive) 25 to 30 minims witl? meals, is prepared by macerating Ananassa Sativa 1 for three weeks in Alcohc (90%) II, adding Glycerin 2 and making up to 4 with Alcohol 90%. Afte tonsillotomy, painted or sprayed on, prevents the formation of membranou looking exudation, and the stump heals in a few days. Useful in chronii tonsillar abscess. Has been used for dissolving necrosed tissue in quinsy tonsillitis, boils, etc. Butyric Ether C3H7CO.OC2Hr>. Syn. Ethyl Butyrate, has odour or pineapple. Sp. Gr. 0-9 nearly. B.pt. 120° C. Diluted 1 in 20 or 1 in 10 it spirit is used as pineapple essence. ? Anchusa Officinalis (Boraginacece). Alkanet, causes the heart to stop'! diastole, it yields 5 to 6% red amorphous resin “ Alkannin,” and contain; two red substances, has some relationship to action of Curare.—L. i./o6,974. Equal parts of Alcohol 90% and Benzene (Benzol Cryst.) used for evaluatio of Alkanet Hoot, comparing with a standard.—W. A. N. Markwell and B. J Walker, P.J. ii./3o,429. Anethi Oleum.—Distilled from fruit of Pevcedanum graveolens. It is yellow oil with odour resembling caraway. Sp. Gr. 0-900 to 0-920 appror Soluble 1 in 3 of 90% alcohol. Some normal distillates of dill-fruit have lower Sp. Gr. than 0-905, but, since the oil is for medicinal purposes, and th carminative principle is carvone, a high"proportion of the latter should trl ensured by the minimum Sp. Gr. indicated. English Dill Oil varies in Carvon: content, and in its physical constants with different seasons.—Pinnemon A high Sp. Gr. should put the analystror user: on-his guard for admixtun with caraway oil. Anhalonium Lewinii.—Mescal Buttons, the tufts of young leaves of th plant are eaten by the Mexican Indians to produce intoxication acccmpanie by visions. Effects due to alkaloids, e.g., Mescaline. A liquid extract of commerce diluted, on an empty stomach, had no effect 5 50 minims. 100 minims, however, in 15 minutes produced slight dyspncf and transient headache, then intermittent tetanoid spasms in hands and fee with sensation of ‘ delightful feeling of irresponsibility.’ ‘Review of Lewin’s work, E. White’s" and Prof. Dixon’s researches. T. U.S.A. its use is prohibited. Has been used in neurasthenia, and1 hvsteri and in asthma (Therap. Gaz., 1888).—H. B. Eigg, P.J. ii./?i,240. An interesting account of the physiological and psychological effects pr< duced.—D. N. Buchanan, M.A., 1031,12. Visual phenomena from Mescaline Sulphate 0-2 Gm. doses. Hallucinations— carpets with dots—meadows of buttercups and daisies—chairs revolving 01 donald CVifphiir iIes,ca-l|?e ad^ction in the great cities of Europe. Mac- aonam Oritchley, Prof. Dixon, L. ii./3o,863: BMJ ii ho fioo Linn1S1 UJmbeUiffr'^)' f 1)116(1 ripe frui't of Pirnpivella Anuvm, Star AnS^ Contains Oieum Anisi which is also distilled from the almost N'P- Magnoliacea>.), the latter being that used carminative rvvKnrwL C0untipr* . -9ose.\—£ to 3 minims. Aromatic and carnunative Colourlessor yellowish oil congealing between 10 and 15° C. 2 gallons 2 Distil VallTnS 0'9G9(?*.* A{2aa. Amsi—Anise Fruit 1 pound, Water —5 to 20 mSims 1 8 Sprntus Amsi.— 1 m 10 in Alcohol 90%. Dose. 7ofato 1 Pcp?ermlnt 9i] 1S> Saffron Tincture 5, Alcohol Anefhnl iP tS ^H contain Cinchona, Rhatany, Cloves, etc. Anetnol (P Belg. iV., P. Austr., P. Jap. III). —148T430 The A^eoh°MfQOfi °-m ahe Anis.e 0118 melts at 20° C., B.pt. 230° C. Soluble in Tn ? 3 approximately. Dose.—I to 2 minims. SSd® ®ollc ?*ve 2 minims of Anise Oil followed by a drachm of castor oil. Flowers . ‘ EB§lisb * or ‘ Roman/ Chamomile 1 lowers, ihe largest, most double, and w’hitest flowers are preferred 3 P%f°(toM1(k to°8nffrflinseiTefiC -n large/??eB* In addition to the Extract] flowers inARnUwariwfo%nd 0li> a Tincture, 2 of single fresh nowers in. Alcohol (90/Q) 3, and Water 1, are made. The latter is used for summer diarrhoea of children. Dose.—3 to 10 minims. Oiemn Distilled from the flowers of the Roman chamomile, alcohol ° 905 t0 ° 915 'B*P* 14^’ feoluble m less than its own voi. of 90% h ^L'31131110?111® Flowfs are those of Matricaria Chamomilla. They ep4«S‘-j!as;qnetolTah.!5TOn0n “ the ftcId8> caused a bu,ious Anthoxanthum odoratum.—Sweet Vernal Grass. Flowers develop odnnr nf comaarm on drying. Tincture, 1 of fresh-flowering herb in 10 of 40 O V spirit (making allowance for the moisture the plant contains) Uosc —2 to 8 ir«erna u>!an'iT ddu*?? as a nasal lotion for hay fever. Apis Mellifica.—The Honey Bee. A Tincture. Bose.—1 minim hourly is said to relieve urticaria. See also Add Formic. >5 13 Apocymnn. American Indian Hemp Root. U.S. VIII. Syn Apocynum Cannabinum, Canadian Hemp. Average dose (of root in powder) 15 graiZ Does not contain Alkaloid and is not in Poisons Schedule, but caution : a pSmrful drug. Stated to be a rapid and efficient cardiac stimulant, aisi an active diuretic occupying a place between Digitalis and Caffeine, non-cunmhftive A powerful emetic, diaphoretic, cathartic and anthelmintic and diuretie employed m cardiac dropsy and Bright’s disease. The active princiffe is Sand ipocynmSiarin? ne n°n'glu009idal substail“ called variously Cynitoxin Tinctura. 1 in 10 of Alcohol 60%. Dose.—5 to 60 minim* tbp Hpniu™ (10%) is about 1£ times more toxic than Tinctures of Digffa-is’and RoSS nearly six times less toxic than the Tincture of Strophanthus (i.e. tb?e £’ P >98 Tincture winch was i as strong as the B.P. ’14). Produces ftd/i /iVfwe best on patients with cardiac disease and a failing heart Eankfnext to btrophanthus as regards toxicity to frog’s heart aid it is more toxiftl/n digitalis and squill. JNo special difference in action on the kidneys but apocynum is most likely to produce hsematuria owing to its irritant properties -L. i. 10,81. Uraemia is warded off by the profusldIm^it?Sc« aSd bourne USG in r°movmg Pruritic effusion. Decoctum 1 in 60. Dose.—£ to Fiuidestraefcum, U.S. VIII. Dose.—15 minims l = i cri alcoholic. Useful in dilatation of heart, mitral, and other valvullr lesion^ d xt Had* great reputation among substitution. Good Apocynum is many uK'moreactiv^thSn^lt^M a heart stimulant.—H. H. Rusby, P.J, ii /2Q 312 J-ugrcans as Arachis Hypogcea. (Syn. Pea Nut, Gound Nut Goober Hut TVfAmiio Chinese Almond.)—The seeds of the plant form the ‘ uea n7i 8 m’ Have dry, brittle envelope and yellowish-wlffte kernel Vc/ r?iC?/“erce’ drying oil (40 to 50%) which is B.P. -U wilh Sp."si6 to 0 92h ‘Roup'd down they are employed as cake for cattle. Eating the kernels causes a desire to drink.—L. i./i7,670. Emulsio Olei Arachis cum Glucose. Gt. Orm. H. . « Pea Nut Oil 15, Saccharated Lime Solution 4, Gum Acacia 2f, Oil of Cassia 1/40, Oil of Cloves 1/40, Chloroform 1/10, Liquid Glucose 30, Decoction of Irish Moss to 60. j _ _ ., . . . . Arbutin. 013H1607 + |H20 =281-1326— A crystallised glucoside obtained from the leaves of Arctostaphylos Uva-ursi (Ericaceae) V .S. X. (Fluid-extractum 1 — 1 Glycero-liydro-alcoholic). Dose.—Average 30 minims. Bearberry, and other ericaceous plants. Soluble 1 in 8 in cold water. It is given for chronic cystitis and vesical catarrh, in dose of 5 to 15 grains with sugar; is not poisonous. Infusion (B.P. T4) 1 ounce to 1 pint of boiling water. Antiseptic; also as vermifuge for dogs 60 to 100 grains. Arbutin, given per os is partly decomposed with formation of Hydrokinone, but most of it is absorbed by the kidneys.—Dixon. For preparation of True Arbutin see Edn. XVII, p. <81. Busserole Fr. Cx. = Uva Ursi Folia. Average close (U.S.) 30 grains. Iniusum Uvae Ursi Concentratum, B.P.C. by b. process under Infusa Con- centrata. Dose.—^ to 1 drachm. Areaa, Semen Arecae, P.G. IV, Betel Nut. B.P. Add. 1874.—From Areca Catechu (Palmacece). Dose.—1 to 4 drachms. Is astringent, and is used as a vermifuge, especially for dogs; is also used ah a masticatory and added to dentifrices. Contains several alkaloids, the most active being @r I A recoline (about 0-1%). C811 j3NO2 = 155T094, a liquid which forms a crystalline soluble [Pi]Hydrobromide, P.G. VI, Fr. Cx., P. Helv., P. Hung., P. Bor. HI P Svec. X., F.E. VIII, C8H13N02,HBr. Fr. Cx. gives maximum single dose 0-0005 Gm (r% grain approx.) and maximum daily dose 0-0015 Gm. Ch grain), approx. Its physiological action is allied to that of pelletierine and pilocarpine. It is sialogogue and diaphoretic. Resembles physostigmine as a myotic, 1% solution suitable. Serviceable in glaucoma. The Alkaloids have been chemically examined.—J.C.S.A., Feb., 1919, P- 93. Betel Nut Chewing. The ingredients are betel leaf, areca nut, black catechu, lime turmeric, paste and tobacco leaf. Details as to betel nut (oral) carcinoma. In Siam betel nut chewing is more done by women than men. The habit prevents decay of teeth, but leads to chronic changes of mucous membrane of the mouth, causing loosening and loss of teeth.—A. G. Ellis, B.M.J. ii./2i,S08; Jl. Trop. Med., June 1,’22,149. . , Tenaline a liquid specialty, used m veterinary practice: is an efficient vermifuge. Dose.—1 minim for each pound of the weight of the dog. Arnicse Flore3 (B.P. *14).—A. montana. Dried flower heads. Acrid stimulant equivalent in effects to Arnica rhizome. Tinctura. Dose.—I to 1 drachm. 1 in 10 Alcohol 70%. ... . . , . . . ■ Arnica dermatitis.-—Arnica often used by the public for bruises and injuries,, but may produce dangerous rashes. Under saline purges and sedative ointment rash and irritation subsided. Arnica Root found adulterated with the roots of Asclcpias vincetoxicvrn,, distinguished by yellow colour of section, large Calcium Oxalate cells and small starch grains.—Per P.J. ii./25,312. , T A- Arum Maculatum.—The berries of the plant known as Lords and Ladies act as an irritant poison causing excoriation of the mouth and sometimes- bleeding and convulsions, and the tongue sometimes swells so as to till the: mouth and prevent swallowing. The swelling is best reduced by bleeding. For further details of the plant see a description by E. M. Holmes.—P.J. i /15,324. Succus Ari prepared from the leaves. Dose.—1 drachm. Has- been used in neuralgia. , Asafetida.—Gum resin obtained by incision from the root of Ferula lama and probably other species. Coat pills first, with mucilage and afterwards with Pill Varnish to cover the odour—not with silver, which would blacken. Nprvine stimulant expectorant and carminative, Emulsum Asafcetidse, U.b. Asafcetida 40, Water to 1,000. Enema Asafetidae, L. H. Tincture of Asafetida, t ounce Starch Enema to 4 ounces, -juncture (B.P.’14), X in 5 Alcohol 70o/ noseto 1 drachm. U.S. 1 in 5. Average close—15 minims. Flavoring.—Syl Menthce Piperitse, Syl Limonis, Syl Coriandri. Syrupns 7incribeiis not much good. liquor Antihystericus. Dose.—\ to 1 drachm. On the Continent a mixture is used of Camphorated Spirit of Ether and: Asafetida Tincture equal parts. Threatened appendicitis. Flatulent distension often remarkably improved by moderate dose of castor oil combined if necessary with enemata of Turpentine and Asafoetida. Change in iliac swelling is often effected. Chemical details on Asafetida XVIIth Edn., p. 782. Asclepias incarnata.—White Indian Hemp rhizome. Is a speedy, potent and reliable diuretic.—Pr. xxiii. 141. Tincture, 1 in 10. Dose.—5 to 40 minims. Asclepias tuberosa.—Pleurisy Hoot. Is expectorant and diuretic. Tincture, 1 in 10. Dose.—5 to 40 minims. Asparagin. Syn. Althein. Amido-Succinic Acid Amide C2H3(NH2> (COOH). (CONHa), H20 = 150-094. Dose.—1 to 2 grains. White crystals, having a slight acid reaction. May be obtained from Asparagus officinalis, and the roots of liquorice, belladonna, etc. Soluble 1 in 50 of water, also in acid and alkaline solutions, insoluble in absolute alcohol and ether. An aqueous solution dissolves freshly precipitated mercuric oxide, and this has been used for hypodermic injection in syphilis. Has decided diuretic effect. For cardiac dropsy and chronic gout one grain is given three times a day. Aurantium. Aqua Aurantii Floris (B.P. T4), Aqua Naphae, Ph. Ned, V. Dose.—4 to 2 drachms of the diluted water. Distilled from the flowers of the bitter orange, Citrus Aurantium, var. Bigaradia. It is a saturated solution of the oil, and must be diluted immediately before use with twice its volume of distilled water. Oleum Aurantii Duicis expressed from the fresh peel of the fruit of the s weet orange, Citrus Aurantium. (Oleum Aurantii Amarce is obtained from the peel of the fruit of the bitter orange.) Sp. Gr. at 15° C. 0-847—0-852 Q.R.-1-960 to 4-98° at 20° 0. (at Messina). Terpeneless Oil of Orange is prepared, being many times more potent in flavour and soluble in 60% spirit, cf. Vol. II. Oleum Neroli. The oil obtained in the distillation of above flowers is used in perfumery. Dilution with twice its volume of absolute alcohol preserves it. Dor analytical data, vide Vol. II. Cortex Aurantii {B.P. T4 and Indicus).—Dried and fresh outer peel of the Bitter Orange (in India other varieties may be used if aromatic and bitter). Tincfcura Aurantii {B.P. T4). 1 of fresh peel in 4 of Alcohol (90%). Dose.— i- to 1 drachm. Boa says that 90% Alcohol is too strong—it takes out the whole essential oil content, terpene, citral, etc. About 10% only of Essential Oil of Orange Peel is flavouring and is soluble in comparatively dilute alcohol, therefore make the Tincture using equal volumes of 90% alcohol and water. Some have suggested 70%. Mixtures containing Salts of Iron will become dark in colour with allpreparations of orange peel. Syrupus Aurantii {B.P. T4). Tincture of Orange 1, Syrup 7. Dose.—£ to 1 drachm. Vinum Aurantii. Grange Wine {B.P. T4).—Made by ‘fermentation of a Saccharine Solution to which fresh Bitter Orange Peel has been added.’ It contains 12 to 14% by vol. of Ethyl Alcohol, in practice a boiling 25% Sugar Solution is poured on to the peel and allowed to stand for 24 hours. Yeast is added and the liquor fermented at 20° C. for 3 days. It may be necessary to fortify with spirit. Avena Sativa.—Tincture of the oat, 1 in 5 made with 60% alcohol, in 20 minim doses relieved pruritic condition induced by eruption in dermatitis. Azadirachta Indica. The bark was in I.C. Add. Generally called Mma Uadirachta. Syn. Nim or Neem, Margosa, is common throughout India— mostly planted. In malaria its efficacy is very doubtful —I.D.C., 1916. Mar^osis Acid.—From Oil of Margosa Seeds. The Sodium and Potassium Salts being soluble can be given per os. The Calcium and Zinc Salts for local use in skin affections.—Chatterjee & llay, Ind. Jl. Med. Res. 1910, 5,656 abst., Y.B.P. 1919, 182. See also Ind. Jl. Med. Res Oct., 1920. . In tropical granulomata Sodium and Potassium Margosates m 2^ to 3 gram doses in 4% solutions intramuscularly have been tried, but caused irritation. Intravenously blocking of the veins occurred. Ethyl Margosate as aAurther step has been employed; it is non-irritant and has antiparasitic and bactericidal properties.—K. K. Chatterji,L.ii./25,1063. _ Badiane. Fit. Cx. 1908 is Star Anise Fruit q.v. Temture de Badiane. Fit. Ox. 1884. 1 in 5 by weight, Alcohol 80%. , A _ , , Balsamum Gurjunae.—Gurjun Balsam, Wood Oil. Dose.—l to 2 drachms. From Dipterocarpus turbinatus and other species. Used in gonorrhoea and as an expectorant, given with malt extract. To test for vide Copaiba. Balsamum Peruvianum {B.P. T4). Dose.—5 to 15 minims. From trunk of Myrocylon Pereirce, U.S. Toluifera Pereira {Leguminosce). A viscid liquid insoluble in water, soluble in chloroform, absolute alcohol and glacial acetic acid ; slightly in ether and petroleum benzine. Contains Cinnamein an* Cinnamic Acid. Sp. Gr. between 1-14 and 1-158. “Synthetic” Balsam may be detected by shaking 2 Gm. with 10 Cc. of Petroleum Spirit. Evaporat (| the Petroleum Solution on a v.ater bath, dry on same 10 minutes, cool, an< add three drops Nitric Acid 1-38. Mix. Peru Balsam gives a golden yellow colour.. Inhalation of a few drops of vapour 1 in alcohol 2 in a little hot wate: useful in pharyngitis. As a dressing to wounds, if aseptic, may be left fo: 20 days if necessary. Scabies has been treated with a paint of Balsam 3; Glycerin 1. But test for albumin in urine both before and during treatment:] Balsamum Lanolinatum.—Lanolin 5,000, Vaselin 2,000, Balsam Peru 12! Otto 4.—Ph. Notes (Denmark). C'.X. has Inguentum Balsami Peruvianii Peruvian Balsam 1, Lard 7. Wyatt Wingrave’s formula : Balsam of Peru 20. Trikresol 5, Vaselin q.s. to 100. Mix warm. CED Lotio Balsami Peruviana.— MacNaughton Jones suggested in alopecia a preparation of Peru Balsam I drachm, Spirit of Rosemary 1 ounce, Tincture of Cantliarides 4 drachms Pilocarpine Nitrate 2 grains, Almond Oil 1 ounce. This is applied at nigh and washed off next morning with a borax and spirit lotion. For scabies an ointment containing Peruvian Balsam and Sublimed Sulphu 4£% of each, in Soft Paraffin.—W. Kncvslej Siblev (Treatment of Skin Diseases). Menciere’s Solution, q.v. contains Peruvian Balsam. Balsamum Tolutanum (B.P. ’14). Dose.—5 to 15 grains. Obtained fromj the trunk of thMyroxylon Toluifera (N.0. Leguminosce). Recently preparer is soft, but becomes brittle in cold weather. Soluble 1 in 1 alcohol 90%. A standard of total aromatic acids is required. Syrupus Tolutanus (B.P. ’14)' Dose.—| to 1 drachm. This is made by digesting the balsam and water ont che water bath 4 hour. U.S. is Tincture of Tolu (1 in 5 of Alcohol 94-9% vol. 5 parts, Sugar 82, Magnesium Carbonate 1, Water to 100 s.a. Tincturs (B.P. ’14) 1 in 10 alcohol 90%. Dose.— 4 to 1 drachm. The balsajn has th properties of the Cinnamic and Benzoic Acids it contains. Saotihn. Dose.—1 to 5 grains. An extractive from Baptisia tinctoria, in * mall doses a laxative, in large doses a cathartic. Tincture 1 in 10 of Alcoho* 60%. Dose.—5 to 30 minims. The Mother Tincture of Baptisia (Homoeo pathic) has a reputation for treatment of boils. Baptisol a phenol respon sible for the blackening of the leaves on bruising or treating with cliemica agents.—P.J. ii./i5,761. U^Earii Chloridum — Barium Chlorafcum, P.G. VI. BaCla2HaO. Dose.— i to 1£ grains. Max. single 3 grains or 9 grains per diem. Colourless crystal line plates, with bitter saline taste. Soluble 1 in 24 of water. Solution i destructive to bacteria. Incompatible with sulphates, phosphates, tartrate and carbonates. Mostly used for analytical purposes, but is of value as a heart, tonic ; ha alterative properties; has been tried for syphilis and scrofula. Also 1% i solution as eye wash m scrofulous inflammation. \ aricose veins are treateco] by internal use, and applied locally over the distended vessels.—B. Barium Chloride, 0-03 Gm., three or four times daily by the mouth is sometimes o value in Stokes-Adams attacks.—L. i./27,401. In the form of Barium Waten (vide Mineral Waters) it has also been used for glandular swellings. Antidote, —Sodium Sulphate. Typhoid has been treated with Barium Chloride per os with good results in 33 out of 35 cases. Dose.—1 to 14 grains, increased progressively to 7§ grains thrice daily for 6 to 7 days with intervals of 3 to 5 days.—per Pres. June, ’29,224. No bad results except vomiting. 1-5 Gm. each day in dividec d oscs for 5 days, with 5-day interval, then repeated for further 5 days.—E Petrina, B.M.J.E. i./3i,96. CEDBari:. Nitras Ba(NO*)a = 261-376 and (£)Barium Acetate (CH8COO)oBa— 255-413 are employed in place of the chloride ioi testn ^. Bassia Latifolia. Mowra Flowers in India. A potable spirit can b« prepared from them as they contain much fermentable sugar. The seedt; yield Mowralt Butter melting at 24° to 25° C.; this fat is also suitable for candle an l 4 > 10 u iking (of. B Tjongifolia), also as a food, but it soon becomes rancid: in the hot climate. Bassia Longifoiia. N.O. Sapotaceoe. The seeds of this tree growing in Southern India and the Malay States are called Mowrah Seeds. Syn. Blip Nuts ; they yield 43 to 52% of yellowish solid fat, Illipi Butter, M.pt. 42° C and solidifying at 36° C., containing about 80% of stearin and is suitable fc candle making. The residue contains a Glucoside ‘ Mowrin.* This yields ‘ Mowric Acid.’ Both have a digitalis-like action, but they have an injurious Uiipi Butter is similar to Oacao Butter. It may generally be distinguished by absence of the typical odour of the latter. Sp. Gr. 0-857. Viscosity at 50°, 103-7 (against Theobroma Oil 99-9). M.pt. 33° C. Iodine Value 31-5. M.pt. of fatty acids 52-8° C. Saponification Value 190. It is much used as a Chocolate Fat. The cake is poisonous and can only be used as manure. In commerce, Illipi Fat is however now a generic name for numerous articles—hence the above data may vary. Refs.—Lewkowitsch, Chem. Technology & Analysis of Oils, Fats and Waxes, iQ2 2. Tate Si Pooley, Analyst, June, ’21,229. lllipe {Borneo) Tallow. Chemistry of.—C.D. i.,/30,751. Beberinse Sulphas. S>jn.—Buxine and Pelosine. Probably a mixture of Sulphates of Berberine and Nectandrine. Bose.—1 to 10 grains ; if in a mixture a little Aromatic Sulphuric Acid covers its bitterness. It is in scales, and is prepared from the bark of Nectandra RodiccA, Bebeeru bark. It is also contained in Pareira Boot. It is freely soluble in water. Beberine Hydrochloride is in reddish brow scales. Use, antipyretic and tonic as Quinine; useful for menorrhagia. T . „ _ Belas Frucfcus (Bael Fruit), B.P. T4.—ASgie marmelos {Ridacece). Fresh half ripe fruit. Mild astringent. The fresh fruit is useful in dysentery and in dyspepsia. Extractum Liquidum {B.P. ’14). Dose.—1 to 2 drachms. Syrup M%\0 Marmelos Co. Dose.—Half to 1 ounce with water thrice daily. Is a proprietary in India, containing Bael Boot, Cyperus Botundus, Ginger and Plectranthus Zeylanicus. Stomachic in diarrhoea and dyspepsia. Eerberinae Carbonas C20H17NO4 HaC03 + 2Ha0 =433-1874 or -f5HaO. Dose.—2 to 5 grains. .... . . „ Although contained in Hydrastis and Calumba, is obtained principally from the bark of Berberis vulgaris and other species of Barberry. In bitter yellowish crystals, insoluble in water. Its salts, the Hydrochloride, Phosphate, and Sulphate, are bright yellow in colour, and soluble in water, the hydrochloride about 1 in 400, the phosphate 1 in 12, and the sulphate 1 in 150. Dose of each.—2 to 6 grains. Given for indigestion, diarrhoea, malaria, and sickness in pregnancy. Injections of 0-25 Gm. Berberine Sulphate in 1 C'c. Distilled Water said to be effective in oriental sore. Inject into the sore, and repeat after a week.—B. L. Varim, I.M.G., *27,62,84. This is insoluble, but £ grain Berberine Phosphate in 1 Cc. has been used. 4 grain of the Sulphate in 1 -5 Cc. Water. Hypertonic and Isotonic Saline strongly recommended in conjunction. Better than Tartar Emetic intravenously.—P. V. Karam- chandani, L. i./3o,78. Successful treatment of oriental sore with 3 Cc. of 2% Berberine Acid Sulphate. Two to four injections effected a cure in 6 cases.—Pres., Oct., ’31,355. Berberine Sulphate in oriental sore was introduced by Capt. P. V. Karam- chandani, I.M.G., 1927,566.—L. i./31,392. Berberis Berries (Baies) are official in Fr. Cx. as ingredient in Eiectuaire diascordium. Berberis aristata and other species. Histological study.—G. B. A. Short, B.P.C., 1926, C.D. ii./26,262. Berberis {B.P. ’14).—B. aristata {Berberidacece). Dried stem. Tonic. Extract is known as ‘ Basot ’ in India. Used in intermittent fever. Liquor Cone., I.C. Add., 1900.—Dose.—£ to 1 drachm. Alcohol 20%, 1 in 2. Tinctura, B.P. *14. Dose.—£ to 1 drachm. Alcohol 60%, percolate 1 in 10. Berberis Aristata and other species. Study of structure of the stems.— G. B. A. Short, P.J. ii./26,189. Betel. B.P. *14.—Piper betle. {Piperaceoe). Dried leaves. The fresh leaves are contained in Pan (Beng.). Stimulant, narcotic, masticatory.— Externally in sore throats. Bisfcorta Snakeweed, Adderwort. Polygonum bistorta L. P. Belg. IV. Estraetum Bxstorfcse, P. Belg. IV. A dry aqueous extract prepared from the root. Has astringent and mucilaginous properties. Sirupus Bistortee, P. Belg. IV. a 5% solution of the extract in syrup. Used chiefly in haemorrhages and mucous discharges, per os or by injection, or gargle. Blepharis Capensis.—The Cape Gooseberry of South Africa. Tincture, 1 in 8 of 90% Alcohol. Dose.—15 minims (1 Cc.). Has been used in snake and insect bites and for toothache. Blighia Sapida.—Vomiting sickness of Jamaica caused by poison produced by the immature fruit.—B.M.J. ii./17,109. Boldoa fragrans (Peumus Boldus). Dose— 1 to 3 grains in cachet oej capsule. The leaves, from Chili and Bolivia, resemble those of Sweet Gak (Myrica Gale), but are more aromatic. In dyspepsia, liver affections, rhemj matism, and as a diuretic for atony of the bladder. Tinctura Boldoae, 1 in 5 of 90% alcohol. Dose.—10 to 20 minims. The inhabitants in South Ameria take half a litre of strong decoction a day for hepatic diseases. BduIuc Nat.—The Seeds of Coesalpinia bonducella are used in India as a tonic and febrifuge—generally mixed with black pepper for the purpose. Brucea Sumatrana.—A plant indigenous to China and S. Asia. The seed: known as El Kossam is said to be useful in dysentery, diarrhoea, and menorr-' hagia— Cf. B.M.J. i./n,1403. HEOBrueine, C2lH2,N204 + 4H20 =466-2812. Dose.—A to i grain. An alkaloid from Strychnos Nut Vomica seeds—small white acicular crystals- with bitter taste. Very soluble in Alcohol and Chloroform. Its salts ar soluble in water. Like Morphine it gives a red colour with nitric acid (sen Water Analvsis), which Strychnine should not. It is said to possess only TV of the physiological power of Strychnine. For epilepsy the HE) Hydrochloride:-. O23H23N2O4.HCl = 430-6836, has been given as liquor, same strength as Liquo:» Strychnin*, in 10 minim doses increased until 4 a grain is reached. In] Brucine Sulphate (C23H2r)N204)2.H2S04 = 686-5132-f-Aq. White crystals soluble 1 in 80 in water. Bryonia. Syn.—Vitis alba ; White Bryony. B. dioica is the only species commonly found in this country—hence callee English Bryony. Contains an amorphous glucosidic bitter substance ane an amorphous alkaloidal principle—intensely bitter. Chemical Notes an( refs. 17th Edn., p. 785. Tinctura Bryoniae. B.P.C.—From bruised fresh roots of Bryonia alba o> B. dioica (Cucurbilacece) a tincture is prepared corresponding in strength t* 1 of dried root to 10 of alcohol (60%). Dose.—1 to 10 minims (0-06 to 0-6 Cc. or more. Useful in pleurisy. Believes the pain and allays the cough. In large doses it is an active cathartic, used for dropsy. It also checks metrorr rhagia. The fresh plant applied to the skin will cause vesication. Buchu (B.P. T4). The dried leaves of Barosma betulina (Butacece) contain volatile oil and mucilage. Carminative and diuretic. Buchu has antiseptic action in irritability of bladder and for gonorrhoea. The infusion (1 in 20 boil ing water) is representative of the activity of the drug. Dose.—1 to 2 ounces? Flavoring.— Svl Aurantii Floris, Syl Lavandulae; Syrupus Aromaticue Tincture (B.P.'*14) 1 in alcohol 60% 5. Dose.—4 to 1 drachm. Fluidextract: U.S. Dose.—30 minims. 1=1 hydro-alcoholic percolate. Buchu Cultivai tion and differentiation from other members of the N.O. Butaceoe in South 4frica. The dried leaves of B. betulina should yield 1-45% of oil.—P.JI ii./2i ,308. Bulbocapnine, C„H1904N. . Dose— o-l Gm., either per os or subcutaneously once or twice daily.—Pe Pres., Sept., *29,312,-314. , An alkaloid from Corydalis tuberosa D.C. (Fumanaceae), known also a j C cava C. bullosa-, and Bulbocapnus earns—first isolated by Freund anM» Josephi in 1893. Insoluble in water but soluble in alkalis and precipitates from them by C02 or Ammonium Chloride. Solutions oxidise slowly to u green colour. . . . , . Of value, as a sedative, in tremor of various origins—paralysis agitanes choreic disorders, multiple sclerosis, and hemiplegia. In paralysis agitar. i it is better than Atropine, Morphine, Luminal, or Scopolamine.—Pres., Sept., »2q 312. In dose as above hypodermically or per os, of value in the treatment of th« sequelae to epidemic encephalitis in children.—L. i./2o,968. . „ Meniere’s disease well treated. One tablet of 0-1 Gm. per os daily is sufii cient to prevent vertigo, while the acute attack is treated by 0-1 Gm. hypo: dermicallv which at once relieves.—W. S. Thacker Neville, B.M.J. ii./su*4* Bute* Semina (B.P. fU).—B.frondosa. (Leguminosce) Dried kernels freer* from test*. Contains Moodooga Oil. Anthelmintic like Santonin.— P.J.jy* 446 ; E.P.T. i./550 ; Pg. I.h/454. Pulvis (B.P. >U).-Dose.-10 to 20 gram* Caapi or ‘ AyahascoP the root or rhizome of the woody vine BamsteruSj caapi, is used in Bolivia as a stimulating beverage. It gives coinage snu fortitude in facing danger and suffering. Three alkaloids have been isolated, one being related to Morphine. This drug and Mir 6 (a muscular paralysant of the Nightshade family) may have therapeutic applications.—L. ii./25,30. Cajupati Olsiim. From leaves of Melaleuca Leucadendron and other species. Sp. Gr. 0-919 to 0-930. Further chemical notes : 17th Edn., p. 785. Gastric flatulence is at once relieved by Spirit of Cajuput 8 minims, Sal Volatile 25 minims, Spirit of Chloroform 15 minims. Spirit of Peppermint 12 minims—taken in a wineglass of water.—A. P. Luff, B.M.J. i./i^,635. Leueadol—A redistilled oil of Cajuput boiling below 235° C., fractionated from the high-boiling constituents. A yellow liquid, Sp. Gr. 0-922, and Cineol content 78%. Has been employed in chest affections by injecting into the bronchi. It is miscible with 40% Iodinol in all proportions, with which it has been used for diagnosis. Mix with Olive Oil up to 5% for Oleothorax, or weaker for intratracheal injection. Calendula OMcinalis (Composites). Dried florets. Dose.—15 grains. Tincture 1 in 5 Alcohol 96%. Dose.—5 to 20 minims. Applied to wounds, and is given in amenorrhoea. It has diuretic and stimulant properties. Calumba (B.P. ’14). Dried root, sliced, of Jateorhiza Calumba (Mem- spermaceoe). . A , Non-astringent tonic for simple debility and indigestion. Can be given with Salts of Iron. Infusion 1 in 20 (cold water); Tincture 1 m 10 Alcohol 60% (U.S.X. 1 in 5). Flavoring.—Glyl Aurantii Amari (double dose), Glyi Lavandulae, Syrupus Aurantii Amarae. Was represented in I.C. Add. by Coscmium fenesiratum (false Calumba Root). Calumba is sometimes termed * ILeicLix I^rctsori*9 Cambogia, U.S., P. Austr. Dose. J to 2 grains. tE. Ox. Gomme Gutte. Yellow Gum Resin from Garcinia Hanburii (Guttifercs) growing in Siam, powerful purgative. May cause severe griping. Will expel tapeworm. rarely now given alone. ,. Canella Alba. Wild Cinnamon (Magnoliacece) contains Aromatic Oil. Cannabis Sativa (Urlicaceoe), Russian hemp-seed, oil-free (extracted by Benzine) has been used in form of decoction, strength 100 Gm. m l litre, heated gently and evaporated (without boiling) to 250 Cc. 35 to 50 Le. of the resulting liquor are given to children in the food. The dried hemp seed freed from oil contains 1*5% Phosphorus in organic combination as against 1% before the fat is removed. Children are said to greatly improve under the treatment. , , TT , ,. . * Emulsio Seminum Cannabis.—10% in water. Used as a potion against gonorrhoea, two glasses daily. Notes. . 1 . Capillus Veneris, Maidenhair. capillus veneris L. (Filicinees) A Is — IU /o Hi VYcltOi. w ow vi. evo km 1 Has slight sedative properties—(Russia) Ph. Syn. Capillaieb, P. Belg. IV. Adiantum rr.rmius vcilctlo xj. A Fluid Extract, 1- 1, is prepared from the leaves with boiling water with 25% Spirit and 5% Orange Flower Water added, also Capilli Veneris Sirupus, consisting of 25 of the Fluid Extract with 9<5 parts of syrup. A popular cough medicine on the Continent. An infusion of 1 ounce to a pint of boiling water is taken in wineglassful doses. Carbo Animalis. Animal Charcoal. B.P. 85. Carbo Ammalis Pun- fieafcus B.P. ’85 was treated with hydrochloric acid. Car do Ligni (B.l . 14), U.S Wood Charcoal. Dose.—Q0 to 120 grams. Made by burning wood, e.a. willow, to red heat with access of as little air as possible. j.n cachets 01 as charcoal biscuits as an absorbent in distension of the stomach, e.g., m <dyspepsia. Is antiseptic, and is used externally as a poultice to foul ulcers. Cocoa Nt t Charcoal was employed by Dewar owing to its remarkable poweis of absorbing ^ases to improve high vacua. , , ., , Charcoal as an absorbent might be useful m cholera typhoid, gastroenteritis—P.J. U./12,98. As antidote. Nee Poisons and Antidotes. 4 test for activity of medicinal and other Charcoals by exposure to water and other vapours. Active Charcoal will absorb 50 to 100%, or even more, of moisture. The water figure is slightly higher than that for Alcohol or Turpentine. Palv. Carbo. Dig. as ordinarily dispensed for medicinal purposes is inactive. The author suggests improvements m the inanufactuie and the adoption in the B.P. of tests for activity.—H. Brmdle, P.J. n./28,84 , C.D. U ^skNorit (T.M. 359695, 484598). Syn. Activated Charcoal. Dose.—5 Gm. in water three or four times daily. A variety of vegetable charcoal with high adsoromg qualities, containing 85% ashless vegetable charcoal and less than 5% mineral matter. Uses. Similar to ordinary charcoal in gastric and intestinal affections. Locally useful for suppurating wounds and ulcers. Norit Tablets, 5 grains each. Useful protective against infection via the tonsils and air passages. It adheres to the mucous membrane. By the use of Norit the strength of such solutions as 1% Mercuric Chloride and 1% Morphine Hydrochloride could be greatly reduced.—L. i./23,342. Experiments in vitro on absorption of poisons showed that the new’ plant Charcoal, ‘ Supra-Norit,’ was in all cases more active than ‘ carbo animaiis’ (Merck).—J.C.S., A. i./25,736. Activated Charcoal adsorbs or inactivates Strychnine, Brucine, Adrenalin, Histamine and Tyramine. With Ephedrine and Acetyl-choline adsorption or destruction is not quite complete.—E. Saunders and co-workers, Jl. Pharm. and Exp. Therap., June, ’31,177. Carbonis Bisulphidum. CS2 —76*12. A clear liquid wTith characteristic odour Sp. Gr. 1-268 to 1-269. Very slightly soluble in water, but readily in Alcohol, Ether and Chloroform and the fixed and volatile oils. Dissolves Phosphorus Sulphur and Lubber with avidity. Is poisonous, but has been employed in treatment of phthisis. . Acute poisoning by, respirations very slow (about 12 per minute). Expiration deep, prolonged and blowing ; heart not much affected, but pulse weak. In tuberculosis, inhaled, useful, has no disagreeable after effects. Is parasiticide. In fibrinous pneumonia small doses with water have been used. Carbon Bisulphide Regulations. S.R. & O., 1927, No. 198, amended by S.R. & O., 1927, No. 865.—C.D. ii./27,420. Odourless Carbon Disulphide. Carbon Disulphide is shaken with Mercury separated, and allowed to stand for a short time in the presence of 2% of pure fat. On distillation, practically odourless Carbon Disulphide is obtained. —P.J. i./25,518. Cardamomi Semina. Dried ripe seeds of Elettaria Cardamomum (Scita- minacece). The seeds should be removed from their pericarps when required for use. Given in atonic dyspepsia. Contained in Pulvis Aromaticus. Tinc- tura Cardamomi Composita (B.P. ’14). Bose.—4 to 1 drachm. Cardamom Seeds 1-4% with liavourings. Raisins now omitted and 45% Alcohol vice 60%. Tincture, U.S., 1 in 5 Alcohol (48-9% vol.). Compound Tincture, U.S. X., Cardamon 20, Cinnamon 25, Caraway 12, Cochineal 5, Glycerin 50, Alcohol (48-9% vol.) to 1,000. Compound Cardamom Tincture is incompatible with Aikaloidal salts, Bismuth Oxide, Oxycarbonate and Subnitrate: employ Liquor Bismuthi in preference. It is also incompatible with metals of the alkaline earths and with Sodium Bromide.—P.J. i./o6,218. Colour of Compound Tincture of Cardamoms depends on change of 2?H. buffer salt added—to give a constant pH of 7—stabilises. There should be no contact with Iron or Copper in percolation. 60% Alcohol should replace 45%.—It. It. Bennett and G. Middleton, P.J. ii./26,173. Carminum.—Red colouring matter, containing about 50% Carminic Acid, C17H18Oio - 382-1404, prepared from the cochineal insect—Coccus Cacti {liemiptera), the dried fecundated female insect reared on Nopalea Coccinellifera and other species of A opalea. The sun-dried insects, if killed by sulphur or charcoal fumes, are silvery colour and designated ‘ silver grain,’ owing to deposit of wax on the surface. If killed by hot water and dried artificially the 4 black grains ’ are produced. It is insoluble in water, but entirely soluble in aqueous ammonia. Is used to colour toilet preparation* and for staining in microscopy. Nature and Structure of Cochineal. An exhaustive paper.—Am. Jl. Ph., Aug., 1913. Carminic Acid is a hydroxyantlirapurpurin.—J.C.S.A. i./2o,442. Carmalum.—Carminic Acid 1, Ammonia Alum 10, Distilled Water 200 Heat to dissolve. Cool and filter. Suitable for staining after csmic acid,c/. Mayer’8 Carmalum. Liquor Carmini. Carmin 1, Distilled Water q.s. to . moisten, Strong Solution of Ammonia 1, dissolve, and add W7ater 10. Used to colour toilet preparations, etc. Tinctura Cocci (B.P. T4). 1 in 10 Alcohol (45%). Bose.—5 to 15 minims. Liquor Cocci, Liquid Cochineal.—Cochineal (not bruised), Potassium Carbonate, of each 1, Distilled Water 8. Heat in water-bath for half an hour, gradually add Acid Potassium Tartrate 1, stir well, continue the heat, and add Potash Alum (in powder) 1; heat five minutes more, strain through absorbent wool and pour over contents,, of strainer sufficient Distilled Water to make strained product measure 8; ~ when cold add Chloroform 1% by volume. As indicator in titrations the tincture may be used. Suitable for titrating alkaloids with mineral acids, the alkaloids giving the same colour as mineral alkali. Ipecacuanha Alkaloids give trouble however. Garni Oleum. Syn. Oleum Cari, U.S.—Caraway Oil. Lose.—£ to 3 minims. Distilled from fruits of Carum Carvi (Umbelliferce) (content up to 7%), and rectified. Colourless or yellowish oil. Sp. Or. 0-910 to 0-920. Soluble in equal vol. of 90% Alcohol.-—B.L. T4. Oarvanum, P. Austr. Syn. Oarvoi. Ci0H14O-=150T092. A yellowish or colourless liquid prepared from the oil has Sp. Gr. 0-960—0-964. Soluble I in 2 diluted alcohol. See also Allen, 1911, Yol. IV, p. 214. Caryophylli Oleum.—'Clove Oil. Lose.—£ to 3 minims. Colourless to brownish oil. Distilled from the flower buds of Eugenia Caryophyliaia (.Myrtacece). Sp. Gr. 1-047 to 1-065. B.L. T4. Soluble 1 in 3 of 70% Alcohol. Should contain at least 85% Eugenol J5.P.T4 (80% P. Ital. V.). Aromatic carminative. Given with advantage both internally 3 to 5 minims, and injected hypodermically in phthisis 5 minims in oiive oil. A satisfactory disinfectant for the hands (said to be even more efficient than Mercuric Chloride), catheters, catgut, etc. . Castor Oil as an adulterant to the extent of 10% has been found m Clove Oil. The Oil was dextrorotatory. Treated with steam the residue was easily detected. Sap. Y, 179, soluble in 90% Alcohol, insoluble in Petroleum Ether. Clove Oil from islands of Pemba and Zanzibar—6% obtainable from the roots and 20% from the buds. The former contains higher percentage of Eugenol.—C.D., 1923,98,136. . _ , ^Tinctura Caryophyiii 1 in 8 Alcohol 90%. Digest 10 days. Lose. -20 to 40 minims or more ; valuable aromatic, carminative and stimulant. , In senile hatulence good effects by powdered cloves, better even than a fluid preparation. Spirit of cloves is absorbed in the stomach, but tne woody fibre passes on to the seat of the complaint. 5-grain Stearettes are prepared. Catha Edulis. Syn. Kat or Khat. Dose.—1 drachm to £ ounce (4 to 15 Gm.) infused in about 6 to 8 ounces of hot water as required. A sprig 01 about 10 leaves weighing about 10 grains is chewed at a time by natives. The shrub grows wild in Abyssinia and along the East Coast of Africa, it is cultivated for native use in Arabia. The taste is slightly astringent, and ax- the same time sweet and resembling licorice. ,. . w Three alkaloids were isolated by Stockman—Cathme (very soluble m water) Oathinine (less soluble) and Cathidine (insoluble). . ..._ In man they all act chielly on the cerebrum and spinal cord, causing stimma fcion or much excitement according to dose, and Cathine alone induces slig The herb is a stimulant narcotic. It has been known for generations for its sustaining power. The activity of the leaves when used m an ^sion ia the same manner as tea or coffee, or when chewed (as by the^abs), is stated causa ‘staving Dower,’ wakefulness and refreshment. luither detans m our An. x"iTpP272 and XVIII, p. j»l. It is thought to have power m strengthening the action of the bowels. Extractum Cathse. DooC. 2% 10 grains (0-18 to 0-6 Gm.). A solid extract made with 60 /<> Alcohol, l *=4 of leaves for use in pill or Tablets (2£ grains each. Lose. 1 to 4). hi-milim Dose.—1 to 5 minims ^0*06 to 0'i GC.;. Stretch 2 = 1 prepared with Alcohol 60%. This preparation should be recently made.’ Efbr/esccnfc Catha and Phenolphtiialein.— —1 to 2 teaspoonfuis in £ tumbler of warm water a gooa £ fast. A tonic laxative combining the effects 01 the active • d wifn the mild Durgative properties of Phenolphthalem. Ca^a, Milk and Sv^fODhdMhata -MarUndale. Dose.-A. tablespoonful in a small cupful (4yto 5Pounces) of hot water. Similar to Milk ft l.iif.irm of (Jatha Forms an agreeable beverage. Ga.ha Co^oa ldilk. 1) . —1 c'aSSpoonini, mixed with a small cnplnl ol hot, nearly boiling, water, tWCi3Y-iiia1!B f““u)°r Drieibarlc ol Groton Eluteria (Euphorbiaccm). Con- t„-an- Ain and 0-5 to 3% Volatile Oil, also the bitter principle cascarniin /, 1 ? racted bv Acetone) together with resin and tannin. Aromatic tonic. v‘ Ini usual Oaswrilte, I in boiling distilled water,20. Infuse 16 minutes. Tincture, 1 in 5 Alcohol 70%. Lose, £ to 1 drachm. 840 f™w [B P’ ’i4^ . DoJf-.~1 drachm to 2 ounces, from pods of Cassia lad'-^ to e]n™rln°l™)kn 1>ried cylindrical brown fruit 20 mm. in diam. rtwfnl p° ^ V gA S\Cass® eu hatues. Mild aperient. the° Beaver" Pit Pr;ed P^putial follicles and secretions fron: t hiniO y Vn fu n hh> (R°de!u\a)> JI1. brown pieces. To contain not mor aan 4J /0 insoluble in hot alcohol. Stimulant and antiepasmodic Is give* w it/r8D?vlthrrM!fe1laavP ?CAUre -1 inl0, pose.—i to 1 drachm, suspended iff damposTta! M ge of Acacia- See also Mistura Morphine et Phenazon, tT comife.rc.ial varieties Canadian and Russian. Zfr?nCillT\idTlQhmh Compound TiTcture TlaVen<£ teaaUnooAfn? Stwffp^ph°r 4 drachm8> Spirit of Nitrous Ether 1 ounce. A tec^spooniul m water for nervousness or sleeplessness. Catechu (R.P. 14). Syn. Catechu Pallidum. Dried extract of leaver and young shoots of Uncaria Gambier (Rubiacece.). Gambir US is the drtee of'af^bier(Rubiace^: Soluble in ^ater tothcexten! oi aoour ou./o (U.S. 70%). Astringent m diarrhoea. Dose_6 to 15 vrsinc. Aincture 1 in 5, Alcohol 45% with Cinnamon 1 in 20. (Tinctura Garnbi Composita U.S .—-Average dose, 1 drachm; 1 in 20 Diluted Alcohol witV Cinnamon 1.in 40). Trochiscus Catechu contains 1 grain. For relaxed throat Catechu Nigrum From Acacia Catechu. Mav be used in other parts o the Empire. Catch ’ is obtained from the heartwood of tWs tree P thni'DoseC~\ to 4 grains. Resinoid from root of Caulophylhm Mnlictfoides blue cohosh, pappoose, or squaw root. Contains an alkaloid vVhich is chemically Methylcytisine, Cj8H16ONs M.nt 137° C fCvtfam. occurs in Laburnum seeds and in the common gorse.) It also contains tw« giucosides which are saponins.—F. B. Power and A. H. Salway C D i /T, 202 Liquor Caulophylli et Pulsatilla. B.P.C. Dose.—1 to 2 drachms Timilfl Extract of Caulophyllum 25, Liquid Extract of Pulsatilla (1 = 1 with 60^ Alcohol) 5, Glycerin 15, Alcohol 60% to 100.—P.J. ii lio 393 th 60 ^ A sedative in dysmenorrhcea and uterine disorders ’ >JcPulsa (T.M. 481,423). Dose -2 drachms diluted with 1 ounce of wate thrice daily. When the period begins, increase to every two hours A preparation containing Caulophyllum and Pulsatilla with carminatrtee’ it complete1cure f dySmen01Thaia- If *>r a *ew occasion”effecti bedri Ligni Oleum chiefly from Juniperus Yirginiana (Conifera1 • family Cupressinece) yields a stearoptene Cedrene Camphor (Cedrol) FC b’ CftVie: an oleoptene Cedrene C15H24, the odour of which is distinct and stronger thaS the Camphor and taste finally peppery. Oil largely used in perfumery als* in a tuickened form by concentration in vacuo, in microscopical work wit# oil immersion lenses. Paraffinum Liquidum is also used for this. * It is also the product of distillation of chip shavings and sawdust of pencil cedar (J amencana and J bermudiana). It resinifies rapidly and is suggested as an addition to Paraffin for burns—M. Hartog L i /17 475 gg Cedrus Atlantica. The essential oil distilled from the wood ‘ Sun J Bp- Or- 0-0517, [«]d- + 488 at 20“ C. Soluble 1 in 3 to 4 ofTcoho?eS% Capsules contain 8 minims. pose.-Up to 6 per diem p.c. Said to be usefu *-N S D.18’ bronclut19 and sk,u “ff^tions. Ointment 25% with VaeelinS Distillation of Cedar sawdust in Morocco ehow-ed a content of r,tv .11 c.era Alba is Yellow Wax (Cera Flam) bleached from the honeycomb oi ms AT✓ 111 fir.a. (T7'Hnip.r)nr)tprn\ Hf m & a q ^ m - , “ycoillu UJ Apis Mellifica (Hymenoptera), M.pt. about 61—64° C To detect _™th Slphuric.rAci(J’ wh!ch oxidises the wax—-leaving the paraffin ud changed - this may then be extracted with ether. Paraffin'lower™M.pt Wax made from flaxes similar to beeswax.—'W. Honnevman P T Cera Aseptiea. Horsley’s Wax. An aseptic wax for surgeons'uee -Yelloi Wax 7 Carbolic Acid 1, Olive OU 2. It is employed wS at a temperature such that its consistence is just sufficiently soft for easy manipulation It is heated at temperature of boiling water 5 minutes and then poured into Saline or Mercuric Chloride solution at 105° F. from which it is used during the operation.—P. Sargent, B.M.J. ii./2a,1200. As a plugging for the exposed cancellous bone in drainage for empyema in tuberculous children—free drainage effected.—Denis Browne, L. ii./so,7S6. Oxycroceum Plaster. P. Relv. Yellow Wax 35, Colophony 25, Elemi 10, Galbanum 5, Myrrh 5, Resin 12, Crocus 1, Extract Rhatany 2. Modified formulae are given in P. Edin. and P. Lond. Cereus (Cactus) Grandi darns (Night-blooming Cerevs). Syn. Cirio de Flores Mayores. _Ph. Mex. Y. Liquid Extract (imported), 1=1. Dose.- prietary * Cactina Pellets ’ was in demand. Cactus grandiiiorus. Two similar species used, accounting for divergent views.—H. H. Rusby, P.J. ii./29,313. Cerii Oxalas. P. Jap., Ce2(C204)3, 9H*0 = 706-4004. Syn. Cer Oxydp- LOXALAT. Dose.—3 grains. A white insoluble crystalline powder. Incinerated it loses 53% of its weight. Uses.—In vomiting, particularly that of pregnancy, also in chronic diarrhoea, hysteria, epilepsy and migraine. Cerii Sulohocarbolas. Syn. Cerii Phenol-Splphonas. Bose— 1 to 5 grains (0-06 to 0-3 Gm.) Ce2[CGH4(0H)S03]fi-=1318-854 ( +Aq.). _ A well-defined crystalline salt resembling the corresponding thorium body in appearance, suggested for therapeutic use by G. T. Morgan. Introcid and Dextrocid. Iodine and Cerium compounds m treatment cr malignant tumours.—Spencer Mort, L. i./io 105. , Cetaceum Spermaceti. Syn. Blanc de Baleme Fr. Cx. White unctuoufc crystalline substance (M.pt. 46—50° C.), obtained from Physeter Macroeephalvs and other species of whale, e.g., Hyperoodion rostratus.—T.J. n./i3,68- 4ne spermaceti from the latter is somewhat harder and quite equal m miahty Consists chiefly of Cetyl Palmitate, C15H34CO.OC,G>H33--480-512. Soluble in chloroform 1 in U and in Ether about 1 in 7, also m hot alcohol. Is com tained in Cold Cream g.v. Unguentum Cetacei (B P. 14h c.™tai™ Liquid Paraffin in place of Benzoin and Almond Oil. A good addition to theobroma suppositories for hot climates. ivrnc« wns at Cetraria Islandica (Discomycetes or Discohchcves), Iceland Moss was at nnp timp a ‘ throat remedy ’ in form of decoction, jelly, or lozenge. Chemical data 18th^Edn P 821 Lichenoids composed of it lubricate and sooth« the mucous membrane of the throat. To be slowly dissolved in the mouth, SspSlly ’tospeatowto suffer wfth dry mouth and throat ,“as Stogogue JhrWWrP Jauv 8 iosi p 40 Contains Glucoside Castelin. ''Cheiranthus Cheiri (Crucify 0-0006 Gnfwill prod™™ ^•msueaeoaus^^ " CheUdonium° mSus.^Sreiater YTh™treSJly expressed an old remedy for warts and opacit - -oform pas peeI) much used as a juice preserved by \,0 volu d f 10 to 60 minims, and in some remedy for cancer, givenmternally m ^ m0Se.—\Q to 30 minims) from cases with striking results. A ^.ldp^ion into diseased tissue, and, diluted, the dried plant has1 been used for “ ^H1.N0fi,H20 = 371-lh8, has been as a lotion. An alkaloid> chS*de°Hv(,ro“hjoride and a Sulphate have been isolated, melting at 135 C. e y j)0se.~~S grains twice a day. sued as morphine substitutes m cancer. . Chenopodium Anthelmintieum. Linne (Chenopodiacece). Contains a Volatile Oil, Official in U.S. X. Average Dose (U.S.).—15 minims (Ph. Red. V. has max. pro die 22 minims). For round worms 10 minims on sugar or in emulsion ; has given good results in ascarides, 0-25 to 0-5 gram in sugar and water, and following this in an hour or two with a dose of castor oil. The treatment may be repeated after a day’s interval. The sole constituent of the oil active against hookworms, is ascaridole (60 to 70%), which is unstable.—T. A. Henry, C.D., Oct., 1921, p. 555; P.J. i./23,2s ; P.J. ii./2i,349. Liquid Extract 1<=»1. Dose.—£ to 1 drachm. Experiments showed that 1 in 10,000 of the Oil kills living ascarides, while Eucalyptol does not kill in several days in 1 in 2,000 Solution.—H. Pruning. Chenopodium paralyses but does not kill round and hook-worms, which must be expelled by free purgation.—Dixon, p. 421. A method for the determination of Ascaridol in Chenopodium Oil. The U. S.P. method is shown to be unreliable.—H. Paget, Analyst, *26,170. Ankylostomiasis.—The oil is best taken in conjunction with Thymol at suitable intervals. Dose.—16 minims in two capsules followed by 2 ounces of Castor Oil in 4 hours. Thymol in doses of 5 grains.—Report on public health of Jamaica, C.D. January 13/17. Uncinariasis Commission of the Orient. The Oil in small doses is more efficient than similar dose of Thymol.—L. i./2i,235. The maximum individual dose for hookworm appears to be 1 Cc., but three capsules, each containing 0-5 Cc., may be given at two-hourly intervals, followed three hours later by 1 ounce of Magnesium Sulphate.—L. i./22,1057. Oil is preferable to Thymol, though the after-effects—giddiness, deafness, burning in stomach and headache—aremorepronounced.—Rockefeller Foundation Report.—T.D.B. 18/21,117. Signs of collapse after Chenopodium treated with 1| Cc. Pituitrin intramuscularly.—D. C. Richards, per Jl. Trop. Med., Feb. 15/23,69. Dangers of Chenopodium Oil. Many cases of poisoning recorded—some fatal. No other drug should be given with the anthelmintic.—B.M.J.E. L/24,57. 20,000 worm cases treated by a fresh mixture of 1 part with 7 of Carbon Tetrachloride.—Jl. Trop. Med., Feb. 1/24,31. The secret of its correct use is to prevent absorption. Give in one sufficiently large dose and expel from the intestines by aperients.—B.M.J.E. ih/24, 86. Fatality after taking 10 Gm. within a week.—per Jl. A.M.A. i./26,1175. Cases showing heavy ovum count were given full hospital diet, an Iron and Arsenic tonic thrice daily, and Chenopodium Oil 20 minims on one day a week for three doses.—D. D. McCarthy, Jl. Roy. Soc. Trop. Med., Jan. 30,"’30,402. Children of about 12 years of age may receive 20 minims, washed out with salts 3 hours afterwards. Brings away A. lumbricoides. One dose not always sufficient. A child of 3 received 2 minims, finally working up to 10 minims.— T. W. 8. Paterson, 24/7/28. See also Carbon Tetrachloride, Thymol, and Therapeutic Index. Chicle, the basis of American chewing gum, is stated to be the juice of A dims sapota, a tree found in Southern Mexico, British Honduras and in Central and Northern South America. It is obtained, like rubber latex, by tapping, and the milky fluid is boiled until it coagulates and is then pressed.—C. & D. if 2 5,802. Personally, we have been informed that one of the Spurges is largely collected in Australasia for the purpose of making chewing gum. Chirata.—Swertia Chirata (Gentianacece). Entire plant. Bitter tonic given in indigestion for anorexia and torpid liver with constipation. Dose of powder 20 grains. Fluidextract, U.S. VIII. Average dose.—15 minims. Tincture (13.P. *14) 1 in 10 Alcohol 60%. Dose.—£ to 1 drachm. Might be made with Alcohol 45%.—P.J. ii./o9,142. Infusion 1 in 20. Dose.-—£ to 1 ounce. Japanese Chiretta. Swertia Chenensis is more bitter than the official.— V. Oof man B.P. Conf. 1919. Chlorophyll.—The green colouring matter of plants extracted first by ether, then alcohol—in which latter the chlorophyll is soluble, leaving the waxy matter behind, or it can be produced by Acetone extraction. Supplied commercially in solid extract and liquid form. Oil soluble and water soluble varieties are available. Further information on Chlorophyll, see Phyllcsan (T.M. 409946), Vol. II. Chondrus Crispus (Qigartinacece), Irish Moss. Carrageen, Fh. Ned. V., P. Belg. IV. Employed as decoction, Moss \ ounce, Mater 1| pints boiled down to 1 pint. Flavoured with a little sugar and lemon juice. Demulcent and nutritive. Contains about 60% Carbohydrate, 7% Protein, and 10% more or less of ash. Sieuta Virosa (Umbelliferce), Water Hemlock, Cowbane, or Wild Parsley contains Cicutoxin, a substance giving rise to convulsions by action on the spinal medulla. Poisonous to some animals, though eaten by sheep without killing them. Cases of poisoning.-—G. A. Stutterheim, Y.B.P. 1919, 179. Cimieiragss likizoma (B.P. 1898), TJ.S. Dose.-—15 grains. The rhizome and rootlets of Cimicifuga racemose!, Actoea racemosa (Linn.), black snakercct or black coliosh. Indigenous to the United States and Canada. Contains the resinoid Cimicifugin, also a small quantity of Isoferulic (hesperetic) Acid and a trace of an alkaloidai body. Dose.—1 to 6 grains in pill. Useful in chronic rheumatism, lumbago, sciatica, chorea, and amenorrhcea : also as a tonic and antispasmodic and to excite contraction of the uterus (?) liquid Extract (B.P. 1898). 1 = 1 of Cimicifuga exhausted with 90% alcohol. Dose.— 5 to 30 minims. Fluidextract U.S.X. 1 = 1. Average dose.—15 minims. Tincture (B.P. 1898). Syn. Tixctura ACTiEiE. 1 in 10 of 60% alcohol. Dose.—30 to 60 minims or 5 minims every hour. Flavoring, Syl Vanillse, Syl Rosas; Syrupus Aromaticus. . . „ _ , In rheumatoid arthritis, 15 minims of tincture with 5 minims of tincture of gelsemium thrice a day. . , , , . , . Snake Root, in India, is termed bo bom, has the appearance of dried gmger, and is white in section. It is eaten in pieces size of a pea after poisoning. The snake charmers use it to stupefy snakes. (This Indian snake root has evidently no connection with Cimicifuga.) Snake stone is saici to be obtained from a frog,-—it is also used in India after poisoning. It is stated to “ cure.”—For details see L. i./i 1,892,1535. . In chorea Liquid Extract of Cimicifuga from fresh herb mJ- to 3 m. doses for a child of 12 years. Liquid Extract of Gelsemium, 1/3 to 1 minim may be given in conjunction, as also Liquid Extract of Scutellaria laterifona a reliable sedative. 2 minims for a dose for a child. Should insomnia be present give Hyoscyamus (not mixed with the above;—3 to 4 minims of Tincture in water every half hour, beginning late afternoon until sleep occurs. —Pres., July, 1913,244. *So°sS0C—l^ablet*thrice daily after meals,increased if necessary. A preparation containing Cimicifugin, Bromides, and combined Phosphorus. For deCificus Benedicts. Syn. Carduus Benedictus, Chardon Benit, The -Dipaapri Thistle P. Belg. IV. Cmcus benedictus L. (Composees;. The flowering plant is used. It is odourless and has a bitter taste. A tonic diaphoretic and emmenagogue. Useful m dyspepsia, intermittent fevers, and loss of appetite, and in warm infusion 1 ounce to pint of boili g '"if’mtrm Rusbyi) The bark of a South American plant, stated to Sn eSa'in expectorant properties and to be, in addition, tonic and laxative Cft Syrup of Cocillana Compound a specialty. Each drachm con- tfininn Thictuire of Cocillana 5 minims. Tincture of Euphorbia Pilulifera 15 m n ms Sv?up of Wild Lettuce 15 minims, Fluid-Extract of Squill1 minim, Fluid Extract Senega i minim, Tartrated Antimony ,,, grain, Gascarm 1 grain HcSin Hydfoehloride A grain, Menthol rJ5 grain. Dose.-* to 1 drfWhWria Amoracia fresh Horseradish Root. Siaiogogue, stomachic. and“l“d“etfe Yields pungent volatile oil or, moistening or rasping. Used as Spirifcus Armqraci^ Gompositus (A. commonly known as stone-root grains of the powder are *1*°. "sceLn "ts in America probably used the fresh stomach and cystitis. 1 ncture is said to be really useful—something of root for ^e ,‘iver The tincture is sam no y namc F claim, Liquid i&tract^are^prepared^ontahdngj^n Addition, Cascara and Pepsin as hepatic stimulants. Dose of each 1 drachm. Condurang° CoHex, p.G. VI., P. Ital. V., P. Belg. IV.— Dose, in powder, l.> to 60 grams (1 to 4 Gra.). The stem bark probably of Marsdenia cundurango, deichenbach fil. from Peru. Is bitter and acrid. Alterative, a supposed specific for cancer, syphilis, and dyspepsia, and with hydrochloric acid in enuresis is a stomachic and stimulant. Extractum Liquidum B.P.C., 1901. 1=1 of Bark m 60 powder exhausted with 60% alcohol. Dose.-—10 to 60 minims. Alcohol 45% is a good menstruum.—P.J. i./oi,747. Infusum, 1 m -0 of hot water. Dose.—4 to 2 ounces (15 to 60 Cc.). Vinum, PG VI. Liquid Extract of Condurango 10, (1 = 1 made with alcohol 1 and water 3), Aromatic Tincture 1, Sugar 9, Sherry 80. (Aromatic Tincture P.G. VI. is Cmnamon 5, Ginger 2, Galangal (Alpinia Officinarum) 1, Cloves 1, Cardamoms 1, Dilute Spirit 50). Dose. 4 to 1 ounce (15 to 30 Cc.). Tincture 1 in 10 Alcohol 80%. Convaliaria Majalis (Liliacece). Lily of the Valley.—(Entire plant.) Two glucosides have been obtained from the plant: Convallarin, a purgative. (Dose.—3 to 4 grains); and Convallamarin (Dose.—4 to 2 grains). A cardiac stimulant, and diuretic used in preventing arrest of circulation in chloroform narcosis. Its action is so feeble as to be almost of no value in medicine. Tincture, B.P.C. Dose.—5 to 20 minims, 1 of flowers in 8 of Alcohol 60%. The drag’ is an old remedy for dropsy. Extract (Aqueous). Dose—2 to 8 grains, in pill. Fluid-Extract. Dose.—8 minims. 1=1 of dried rhizome and roots. The flowers are stated to be more active than the root. Coriandri Fructu3. Dose.—20 to 60 grains. Dried ripe fruit, Coriandrum 8 at iv um (Umbelliferce). Aromatic and carminative. Oleum Coriandri. Dose. J to 3 minims, Sp. Gr. 0-87 to 0*885. Is contained in preparations of rhubarb and senna to prevent griping. Aqua Carminativa P. Austr.—Peppermint Leaves, Roman Chamomile Flowers, Fennel Fruit, Coriander Fruit, Caraway, Orange Peel, of each 15. Distil to produce 1,000. A pleasantly flavoured aromatic water. Coronilla varia.—An aqueous extract of the leaves and flowering tops is used in cardiac affections ; does not derange digestive functions. Dose of Extract is 14 grains (0-1 Gm.) three or four times daily. Tincture 1 in 8 by percolation. Dose.—30 to 60 minims. Costus Syn. Kunth, Kuth or Koot Root, Saussurea Lappa N. O. Composite. The root of this plant (about 5 ft. high), of wdiich the Kashmir Government have the monopoly, contains a small amount of Essential Oil (we obtained 0-015%). In powder it is used for preserving furs, etc., from moth. The oil is used as a basis for perfumes : the powder for sachets. A Liquid Extract 1=1 made by percolation with 90% Alcohol to exhaustion and concentrating. Used for the treatment of asthma : 4 to 2 drachms stated to stop paroxysms. It may be taken as such in a little wnter (to cut short a paroxysm), or in the form of a mixture, taken 3 to 4 times daily, containing— Potassium Iodide or Potassium Bromide 5 to 10 gr., Tinct. Belladonna 3 to 5 m., Borax 2 gr., Liquid Extract of S. lappa 4 to 2 dr., Spt-. Chlorof. 10 m., Water 1 oz., for continued administration. Has no cumulative action. Is not claimed to produce a permanent cure.—R. N. Chopra, I.M.G., Anl. *28,189. Ind. .11. Med. Res., *29,351. Crataegus Oxycantha (N.O. Rosacecn), Syn. English Hawthorn, Haw. Dose.—2 to 15 grains thrice daily. Liquid Extract of the fruit, 10 to 15 minims. Contains a cyanogenetic glucoside. A cardiac tonic, in dyspnoea, hypertrophy, valvular insufficiency and heart oppression. Crocus, Saffron (B.P., 1898). The dried stigmas and tops of the styles of Crocus sativus (Iridacece) Linn. Every filament should give a blue colour on placing in Sulphuric Acid. It is a curious old delusion that saffron tends to bring out the rash of measles. Cubeba (B.P. *14). Dose.—30 to 60 grains in cachets. The dried unripe full-grown fruit of Piper Cubeba (Piperacece). The genuine—imported from Java—give a crimson colour with sulphuric acid, and are free from mace-like taste and odour. Cubeb Cigarettes are useful for catarrh and excessive bronchial secretion. It is sometimes added to Eerrier’s Snuff, q.v. Oleum Cubebae, U.S. IX. Dose.—5 to 20 minims. Colourless, pale green or greenish yellow oil, with camphoraceous odour and characteristic taste. Soluble 1 in 20 in alcohol 90%. At least 60% should distil between 250° and 280° C. Capsules contain 10 minims. For combinations v. Oleum Santaii. Used in bladder and urethral affections. Suppositoria 10 grains each for astringent effect. Tinciura Cubebse, 1 in 5 Alcohol (90%) (B.P. T4). Dose.—4 to 1 drachm. In chronic bronchitis as an expectorant. Flavoring.—SylAurantii Amari, Glyl Pini. Oleo-resina Cubebse (B.P. 1885). Dose.—-5 to 30 minims. Trochisci Cubebse, T. H., marked ‘ C.B.' \ grain each (U.S. IX. \ grain) with fruit paste. Dose.—1 every 3 or 4 hours, \apor Cubebse cum Limone, T.H. Cubeb Oil 4 drachm, Oil of Lemon 10 minims. Light Magnesium Carbonate 20 grains, Water to 1 ounce. Has stimulating effect in chronic bronchitis. Cueumis (Sativus).—Cucumber.—The juice of the fruit is in French Codex to prepare Unguentum Cucumeris—Syn.—Fr. Pommade aux Concombres :: Cucumber Juice 1,200, Lard 1,000, Veal Suet 600, Balsam of Tolu in Alcohols 90%. q.s., 2, Rose Water 10. A cooling ointment, used like cold cream. Cacurbiise Semina Praeparatse. Melon Pumpkin Seeds (B.P. T4). Dose* —3 to 4 oz. bruised with water or milk. Fresh ripe seeds of C. maxima (Cucurbitacece), deprived of testa and tegmen. Anthelmintic.—Give first a saline purge and afterwards Castor Oil. [MICacara. Syn. Curare, Ourari, Urari, Wourara, Wourali. Dose- —■% to i grain. The South American Indian arrow-poison, produced from species of Strychnos and other plants (Loganiaceoe). A blackish-brown dry extract, with bitter taste ; contains some resin, but is nearly all soluble in water. Two varieties of Curare are said to be made, one from the fresh bark of the branches of S. Gubleri, strong (for larger animals) and the other (weak, for small birds, etc.), from S. toxifera. Curare is an extract of different plants of which the active principle is derived from the bark of various kinds of a Liana-like South American Strychnos. Commercial “ Calabash ” Curare is derived from S. Toxifeia : “ Pet ” Cuiaie from S. Castelnaei together with Cocculus Toariferns (Menis$ermocece), while “ Tube" Curare is from unknown plants.—B.M.J. ii./n,218. Use of Wourali as arrow poison in South America.—Sir J. Bland-Suttcn, B.M.J. ii./22,932. „ , . . Antidotes.—(There is no tetanus—poisoning is not like that of Strychnine.) Artificial Respiration, Stimulants—brandy, hot gin, sal volatile freely. Ligature if wound ; this may be cautiously loosened and tightened again to admit a little of the poison at a time to the system. Wash the wound.—Murrell. This and Curarine have been given hypodermically in hydrophobia and fer strychnine poisoning. Tetanus treated by Curare after antitoxin had failed. Subcutaneous injections of two, increased daily to five mgr. An attempt to raise the dose to six mgr. led to transient paralysis of the respiratory muscles, causing dyspnoea. The dose of 5 mgr. was continued. The convulsions which sometimes occurred every hour subsided. Patient received 63 mgr. in 14 days.— B.M.J.E. i./2i,93. [^Jilypodermic Injection. 10%. Dose. 1 to 6 minims. Use sterile distilled water, q.s., to form a thin paste, transfer to a funnel plugged with absorbent wool, and gradually add wTater q.s. jUl,Hypodermic lablets contain -A grain of Curare. . . , T1 ^ r „ a Mason and Wheeldon murder conspiracy against Mr. Lloyd George and Mr. A. Henderson, March, 1917. See Edn. XVIII., p. 825. It was stated that no fatal case has been recorded in literature of curare poisoning. [MjCurarina. C19H36NaO =298-2188. Another formula :—C18H35X. Dose• _~r: i. grain (?). This, the active principle of Curare, is a powerful poison, in yellowish powder soluble in wrater and alcohol. Cusoarise Gortex.—The dried bark of G. F ebrifuga. Syn. Angostuia Bark.* Stimulant and tonic. In diarrhoea, dysentery and dyspepsia xmicn employed in South America and West Indies. Dose of powdered baik, 10 to 30 grains. The Bark is stated to contain Cusparme C20Hie.i\C>2, Cuspareme CX8H19N02, and Galipoidine C18H15X02. . ^ , Cydonise Vulgaris Semina (Quince Seeds). Contain a gum Oydomn— about 20%. One part of the seeds, with 40 of water, yields a thick jelly used as mucilaginous agent in toilet preparations. Mucilage of quince is official in some Pharmacopoeias, the strength varying tiom 1 in ^5 m the Austr., to 1 in 100 in the Belg. The strength of 1 m 50 of cold water or rosewater is the one generally preferred. Macerate with the cold water foi from 4 to 2 hours, and strain without expression. Decoction of quince is made by boiling for ten minutes. Preservative is necessary. Such Creams are A Medicated with Witch Hazel, Borax, or Tincture jAJBenzoin. Irish Moss Decoction, 1 in 30 is similarly employed. Cynogiossum Officinalis, Sound's tongue (Boraginacece). Has demulcent properties. May act similarly to Curare. Cypress Oil. The oil of various species has been substituted intentionally or carelessly, e.g., C. Lusitanica gives a larger percentage of oil and is cheaper —-E. M. Holmes, P.J. i./23,107. It is employed to give persistence in perfumery.—W. A. Toucher, ibid. 181. iJEfl Cytisine, CuH^InijG = 190-1002. Syn. Uiexine. Is an alkaloid obtained from Cytisus Laburnum. It is also present in JJlex europceus-—the common furze, [gj Cytisine Hydrobromide, a freely soluble salt, dose, to § grain, has diuretic properties. It benumbs the tongue. The Glucoside contained in small dose produces hyper-excitability. Mild doses feeble cardiac tonic—diuretic. Poisoning by Laburnum Seeds. Expectant treatment and recovery.—B.M.J. ii./i7,676. Dainiana. Syn. “ Bohadschia ” (Aphrodisiaca), Hysterionica, Baylahuen. The leaves of Turnera diffusa var. aphrodisiaca and other species (Turneraceae) possess aphrodisiac properties. Useful in melancholia. Said to be tonic and diuretic. Contains bitter substances, resins, and volatile oil. Liquid Extract of Bamiana, 1 = 1, made with alcohol 60%. Lose.—£ to 1 drachm. Flavoring.—Glyl Pini, Syl Itosse, Syl Lavandulae. Extract Lose.—2 to 10 grains. CjPbMistura Damianse Composita. Lose.—1 to 2 drachms. Sodium Hyp'ophosphite 5 grains, Calcium Hypophosphite 5 grains, Liquid Extract of Bamiana i drachm, Liquid Extract of Nux Vomica 2 mmims, Chloroform Water to 2 drachms. CEDPiiula Damianse Composita. Extract of Bamiana 2, Phosphorus T%, Extract of Nux Vomica Liquorice Powder q.s. to 3J- grains. Lose— One, two, or three times a day. Dammar as used in this country for varnish making and for microscopic work is the East Indian Dammar from L. Orientalis.—It occurs in small yellow resinous pieces somewhat larger than wheat. It is partially soluble in alcohol and soluble in chloroform. Dio3corea vilio3a. Syn. Wild Yam, Colic Boot, Rheumatism Root. (Aletris Farinosa Rhizome q.v., is also called Colic Root.) Liquid Extract. Lose.—^ to 1 drachm. Used in colic, spasms, stomach and intestinal irritation. Has antibilious and diaphoretic properties. Divi-Divi. A dye extracted from the seed pod of a small tree growing wild in the peninsula of Goajira (Venezuela). Dragon’s Blood. Resin from Loemonorops Lraco is the chief ingredient in mahogany varnishes. Distinguishes Benzine from Benzol, cf. Benzol. Drosera rotundifoiia.—The leaves of Sundew (Fr. Cx. entire plant), yield a greenish-brown, odorous, very acrid resin, Glucose, Citric Acid, and probably Malic Acid, and a ferment which converts Albumen into Peptone. Have been recommended for chronic bronchitis, asthma and to ease the cough of phthisis. Tincture, 1 in 10 of proof spirit. Lose.—1 to 10 minims. Fr~ Cx. 1 in 5 alcohol 60%. In pertussis, small doses of the 1 in 10 Tincture. Whooping cough, paroxysmal stage. Drosera not found specilic. In doses beyond min. Hi ter in die of the 10% tincture it is irritant.—B.M.J. ii./25,1222. Echium Vuigare (.Boraginacece) Vipers’ bugloss hassome relationship to Curare in action, causes same symptoms as alkanet q.v. with more hypersestliesia and greater weakness of the muscles. Elaterium (B.P. 1898). Lose.—% to \ grain. The dried sediment from the juice of fruit of Ecballium Elaterium (Cucurbitaceoe). A powerful hydragcgue cathartic, useful in renal or cardiac disease complicated with dropsy. In Cyprus we understand the peasants take the fresh juice of the fruits by the nostrils for jaundice.—Ph. Notes. Pilula Elaterii Composita, St. Bart.’s H. Elaterium I grain, Compound Extract of Cclocynth 2 grains, Calomel Ingrains, Capsicum \ grain. Tinctura Elaterii Composita. Lose.'—10 to 30 minims. Elaterium in powder 1, Chloroform 50, macerate 2 days, then add Alcohol (90%) 200, and Compound Tincture of Cardamoms 250, macerate 5 days more and filter. Is more active than a corresponding dose of the powder. Elaterinum. (B.P. ’98, U.S.). Syn. Momordicin. CaoH3805 = 348-2184. Lose.—% to % grain. The crystalline neutral active principle (to extent of at least 20%) of Elaterium, insoluble in water, soluble in chloroform (about 1 in 12) and sparingly in alcohol. For the Chemistry of Elaterin, see Edn. XV., p. 815. Pulvis Elaterini Compositus (B.P., 1898). Elaterin 1, Milk Sugar 39. Lose.—1 to 4 grains. Exnbelia (B.P. T4). Dose.—1 to 4 drachms. Dried fruit of E. ribes and E. roousta (Myrsmacece). Anthelmintic, especially for tapeworm. Emblicse Fruetus. Black or Cbebulic Myrobalans. "* Terminalia Chebula (Uombretacece), is B.P. 14. The dose of the powder ranges from a few grains to 2 dr. Dried mesocarp of the fruit is employed—astringent in action. It is a valuable styptic.^ Purgative in large doses (1 to 2 dr.), but may constipate after purging. Reduces albumin and blood in the urine, and is said to have similar action on glucose. The natives employ it in perineal injuries caused during child-birth, eczematous sores and prolapsus ani—as gargle and dentrifice in spongy gums, and as injection in diarrhoea, internally stomachic and cholagogue. Unguentum, B.P. T4 (and 13] cum Opio, B.P. T4), are equivalent to gall ointment (and with Opium). The fruits of the various species of Terminalia (five principal varieties) are largely used in tanning. The kernels contain 36% to 37% of a nondrying oil. Equisetum Arvense P. Austr. ‘ Cat’s Tail.’ The sterile shoots contain Equisetic Acid, said to be identical with Aconitic Acid. Erigeron Canadenga—Fleabane. The oil distilled from the herb. Dose.— 5 to 30 minims. Sp. Gr. 0-850 to 0-890. Capsules contain 5 minims, and a Liquid Extract of the leaves is prepared. Bose.—30 to 60 minims. Oil has been thought to have astringent and haemostatic properties, especially in uterine, urinary and nephritic affections, dysuria, strangury. The fresh herb may yield 0-5% of oil, which on keeping will deposit resin and crystals. The oniy known constituents are Limonene and Terpineol.—Finnemore. Erodium Cicutarium. Storks-bill (Geraniaceie). Liquid Extract. Doset 15 minims three or four times daily, 1 *=1, has been used instead of Hydrastis. Macerate 100 of the powdered herb in 60 of a mixture of Alcohol 90% and water p. eq. for 24 hours. Then percolate until 80 of percolate are secured. Reserve this and percolate to exhaustion. Evaporate this to 20 and add to the reserve.—P. Van der Wielen. Eryngium Marifcimum. The Sea Holly. Decoction of fresh leaves, 1 in 10, preserved with 20% Alcohol. Bose.—A wineglassiul three times a day. For kidney or bladder trouble. The root of E. campestre is used similarly. Erysimum. Syn. Sysimbrium Officinale. Fr. Cx. Syn. Herbe aux Chantres. An old remedy for hoarseness. Sirop d’Erysimum a proprietary. Bose.—£ ounce thrice daily, in a teacup of infusion of the same plant, is given in catarrhal laryngitis. Erythrophlceum. Casca Bark.—Syn. Sassy Bark; Ordeal Bark. The bark of Erythrophlceum Guineense (Leguminosce). Tinetura Erythrophloei. 1 in 10 Alcohol (90%.) Dose.—5 to 10 minims. Contains the alkaloid Erythrophleine in small amount.—C. W. Maplethorpe, P.J. H./23,85. Brio Erythrophlceinm Sulphas. Dose.—.to to tz grain in pill. Yellowish granular crystals, very soluble in water. Has the combined, action of Digitalin and Picrotoxin, and is a local anaesthetic for eye-work in 0-05 to 0-25% solution. Antidote.—A prompt emetic or use of stomach pump, with subsequent stimulants. Has been used for the treatment of sensibility of dentine, ihe sensibility in a cavity filled with the alkaloid was in 24 hours absolutely abolished. CEL)‘ Throphleol,’ is a solution (50%) of Erythrophleine Sulphate in Eugenol. Esparto Grass from Spain and N. Africa is a source of wood pulp m paper making. It is boiled with Caustic Soda to dissolve away the fleshy parts, the fibrovascular tissue of the nature of wood being left. It is then bleached. The trade in the grass amounts to 200,000 tons per annum- A by-product of great value in the grass amounting to 31% is a wax and oil mixture. C. T. Cross C T) i j i ^7 25^ Eucalypti Gummi {B.P. ’98). Syn. Kino Eucalypti {B.P. T4). Red Gum. Dose.—5 to 20 grains in powder. . , AAO/ An exudation from E. rostrata {Myrtacece)> and other species. feO to 90 of it is soluble in cold water, almost entirely soluble in Alcohol (90 /0)- used in diarrhoea, and relaxed throats, and as astringent generally. To be distinguished from the common Australian or Botany Bay kmo, said to be from E. resinifera (Myrtacece) The latter is very resinous and little soluble in water; was included as Kino Eucalypti in 1.0. Add. Decoction. Dose.—2 to 4 drachms, 1 in 40. Bo.fi and strain. Used as gargle and for diarrhoea, Liquid Extract, B.P.C, Dose.—30 to 60 minims in water. Eucalyptus Gum 25, Distilled Water 65. Dissolve by constan shaking, strain and add Alcohol 90% 10 and water q.s. to 100. A styptic insufflation 50% in starch. A powerful astringent in haemorrhage and re laxed conditions of the larynx and trachea. Suppository, 5 grains in eac2 with cacao butter (pressed dry). Syrup. Liquid Extract of Eucalyptus Guru 5, Sugar 3. Dose.—30 to 60 minims. Tincture. 1 in Alcohol (90%) 4 In maceration. Dose.—20 to 40 minims. 1 to 7 of water as a gargle. External hsemorrhage of any form could probably be stopped by local us- of this tincture combined with internal use of Calcium Chloride. It is useful in dental work, and to cuts caused by accidental injury. Trochisci Kin Eucalypti (B.P. T4). Contain 1 grain in each. Trochisci Eucalypti Composite Potassium Chlorate 2 grains, Cubeb Powder J- grain, Eucalyptus Gur grain with fruit paste, and are marked C.E. Useful'! in congested and relaxe throats, especially when mucous secretion is arrested. Eugenol, U.S.—Eugenic Acid, CsH3(OH). (OCH8). C8H5, 4:3: l=164-0936> A colourless oily liquid (B.pt 251° to 253° C.), darkening on exposure. I is the chief constituent found in oil of cloves. It has a strong clove odoui and is a powerful antiseptic and antiputrescent. Is employed by dentists Causes reduced sensibility of mucous membrane, but not complete anaesthesia Useful with wool fat in eczema. Eupatorium. Average dose.—30 grains. Dried leaves and flowering tops c Eupatorium perfoliatum (Composite) Linne. Thoroughwort or Indian Sage Tonic and diaphoretic ; in large doses, emetic and aperient. Employed i dyspepsia, and the infusion (1 in 20. Dose.—1 to 4 ounces or more) has bee:u given in tapewoim. Liquid Extract, 1 = 1. Dose.—30 minims. Euphorbia Peplus (Euphorbiacece). Petty Spurge, Devil’s Milk. In cases of dyspnoea whether of pulmonary or pncumo-gastric origin. Mod fies secretion in asthma and suppresses attacks. The fresh plant has a acrid juice, which, when dried, imparts its virtues both to water and alcoho Decoction. 45 grains to the pint. Dose.—1 teacupful (diluted if preferred) or 4 times daily, preferably between meals. Elavoured, e.g., with Glyl Lavari dulse or Syl Rosso. Extract. Dose.—7£ to 30 grains. Tincture. (1 in by 45% Alcohol.) Dose.—30 to 60 minims during the day. Euphorbia Pilulifera. (Euphorbiacece.) Australian Snake Weed or Cat Hair. For asthma, bronchial affections, paroxysmal dyspnoea, larynges spasm, whooping-cough, angina pectoris, in coryza, and hay fever. Contain Gallic Acid, Quercetin and a Phenolic substance C2SH18015 ; also a glucosid and a minute amount of alkaloid. Extract (Aqueous). Dose.—% to 1£ grain.4. Tincture. Dose.—10 to 30 minims. 1 in 5 of alcohol 60%. E. Pilulifera was first introduced by Carr-Boyd of Townsville, Queenslanc in 1880 as an asthma remedy and became known as the ‘ Queensland Asthm. Herb.’ The plant that has passed under the name Euphorbia Pilulifer Linn, is really E. hirta, Linn. This alteration is awkward, but the difficult can be lessened by using the name Euphorbia Pilulifera Jacquin as a synonyD —E. M. Holmes, P.J. i./23,162. Fevillea cordifolia. N.O. Cucurbiiacece. The Segra Plant (Snake Vine The seeds, termed locally “ Antidote Cocoon,” are used as an antidote again*: snake and other poisons in Jamaica. Ficus Carica.—The acrid sap of the common fig produces dermatitis o the skin. In Southern Europe the Sap is in use as a counter-irritant or vet cant. Occasionally it gives rise to ulceration. Fconiculi Fructus. Fennel. Dried ripe fruit of Fceniculum vulgare N.O (Jmbdliferce (cultivated) (B.P. T4), contains Volatile oil. Congealing poir not below -f- 3° C.—U.S. Dose.—5 to 15 minims. Sp. Gr. 0-960 to 0-99C Soluble in an equal vol. of 90% alcohol. Constituent anethol, aromatic. Given to infants in form of Aqua Fceniculi. Fcenugreek. Trigonelloc Fcenu-grceci Semina (Leguminosce). The herb largely grown in India and Egypt. Contains a large proportion of mucilage an about' 5 % oil. Chief use, veterinary. An Egyptian preparation. Helba, made from Fcenugreek Seeds—when soaked they swell into a pasty conditio like a pudding—in Cairo this is hawked in the streets, and the cry of ‘ Helba is a familiar one. It prevents fever, and is valuable in many ways, e.g., i stomach complaints in the Cairo district. The seeds may be ground to powdo and swallowed in about 1 or 2 teaspoonful doses. Or the seeds infused i water for a few hours and the supernatant liquor employed. Or a handfi of the seeds js soaked in a basin of water for from 12 to 24 hours, then removed and placed in an unglazed flower-pot (which has been previously kept under water i hour) and allowed to. sprout during 3 or 4 days. When the plant has grown to about 2 inches it is ready for use. It is eaten raw along with the seeds. This sprouted remedy is best and most employed. It has been tried in diabetes.—Geo. H. Stephenson, Cairo. Directions for use in diabetes. One eggcupful of the seeds is added to 1 pint of cold water and simmered down slowly to°a gill (5 ounces). Strain and drink the liquid cold on an empty stomach each''morning before breakfast.—A. Charlton, 8/7,1931. Numerous patients affirm its value. The treatment can be spread over a long period and is combined with strict diabetic control and white meat. Fragaria Vesca. Strawberry. Sprue treated with Ethereal Strawberry Extract. Zilva showed that it was possible to extract by alcohol the fat- soluble factor from vegetables and that this extract also contained the anti- neurotic and to small extent the antiscorbutic factor. An Ether extract of the Alcohol extract contained a substance which promoted the recovery and renewed growth in rats declining on account of fat-soluble factor. Clinically, in typical sprue cases, with usual diet, has been found beneficial.—A. Castellani and K. C. Browing, B.M.J. i./22,718. Frangula. Rhamnus Frangula Bark (Rhamnacece), Buckthorn Black Elder or Alder Buckthorn, Fr. Bourdaine. It grows all over Europe and in America. Should be one year old. Contains Emodin, etc.—Y.B.P., ’23,223. Cathartic especially for haemorrhoids and chronic constipation. Liquid Extract B.P. ’85 1=1. Dose.—1 to 4 drachms. Common Buckthorn in this country is R. catharticus. Syrupus Rhamni, B.P.C. Dose.—i to 1 drachm. Is prepared from Common Buckthorn Berries. Evaporate fresh buckthorn berry juice 50 to 30 and set aside 12 hours, filter and dissolve sugar 65 in the filtrate with heat, strain and cool. Mix Strong Tincture of Ginger 0-52 with Alcohol 3T2, add to the Syrup and finally water to 100 by weight. Laxative action of Alder BucJcthornBark due to a stable amorphous glucoside, Glucofrangulin, a new kind of 'anthraglucoside.—P.J. ii./25,37 ; ii./26,738. afcNormacol (T.M. 467415). 1 Dose.—1 to 2 drachms in a glass of water once or twice daily. A preparation of dried plant mucus of the Bassorin type containing a little Buckthorn Extract (Fr. Bourdaine). It is also made without Rhamnus Extract (‘ sans Bourdaine ’). For treatment of habitual constipation. Bassorin is the name given to the insoluble portion of many gums—Acacia, Tragacanth, etc. It swells up with water, but is not soluble. Fucus Vesiculosus (Fucacece). Bladder or Sea Wrack. Preparations of this, being rich in Halogen Salts have had reputation for reducing corpulence. Contains Mannite. Fucus may contain as much as 0-21% of Iodine. Liquid Extract, B.P.C. 1=1 of Bladder Wrack in 45% Alcohol. Dose.—1 or - drachms before meals. It is recorded a lady lost 20 lb. in 9 weeks when taking the liquid extract, without bad results. . ,, . In thyroid gland disease bladder-wrack was found to increase the thyroid secretion markedly. Chronic subcutaneous fibrosis treated by Fucus combined with a moie or less strict diabetic diet, exercise and massage. . 3k Infegar Capsules (T.M. 421774). Dose.—1 or 2 at bedtime. A preparation of Fucus Vesiculosus, Ox Bile and Pancreatin. Laxative, cholagogue and intestinal antiseptic useful in intestinal catarrh and colitis Galangal (Zingiberacece). Indian Root, China Root in 2 varieties . UjS® from Alpinia galanga, Willd., and ‘ small ’ A. officinarum. Dose—lb to 30 grains. Aromatic tonic. Contained in ‘ Hippocras,’ g.v. . Galbanum (B.P. 1898). Dose.—b to 15 grains. Gum resin from f erula Galbanifiua (Umbelliferce) and other species. Expectorant and stimulant. Galega offieinalis, or goat’s rue, an effective galactagogue when given to nursing women. An extract is prepared. Dose.—5 to 10 grains. Tephrosia virginiana is also known as goat’s rue, but is not the drug intended Galium Aparine.—The plantlCleavers or "Goose Grass. Is 5acid, astringent, and diuretic. Has been used in dropsy, jaundice, scrofulous scaly eruptions, epilepsy and obesity. Succus Gali’% Dose.—1 to 2 drachms ; and Extractmu Galii, 5 to 20 grains. For psoriasis. Galla. Dose—7i grains. Excrescences on Quercus infectoria (Cupuliferce), caused by deposition of eggs of Cynips Gallce Tinetorice (Hymenoptera). Astringent. Contain Tannic and Gallic Acids. XJnguentum Gallm (B.P. ’14), 1 to 4 of Benzoated Lard. Gentianse Radix .—Dried rhizome and roots of Gentiana Lutea (Gentianacece). A bitter tonic. Yields 30 to 40% of Aqueous Extractive. This is largely used as a pill excipient. Gentian (P. Jap.) is ‘ Ryutan.’ Prof. Greenish on Powdered Gentian.—P.J. i./i2,201. Gentiopicrin Ci„H2oOg—an ‘ anthermic ' glucoside is contained to extent of 1*5%. Has properties allied to quinine. Dose.—20 to 30 grains in malaria.—Y.B.P., 1913,127. Notes on Gentian.—H. Stanley Redgrove, P.J. i./29,374. Pasfilli Sfomachici, P. Jap. IV, Sodium Bicarbonate 0-25 Gin., Ryutan 0*1 Gm. Infusum Gentianse Compositum (B.P. ’14). Dose.—l to 1 ounce. An infusion of Gentian Root, Orange Peel and Fresh Lemon Peel. (Dry may be used in the Tropics.) Infusum Gentians© Aromaticum (was Brompton H.), Gentian Root 2 ounces, Lemon Peel 6 drachms. Orange Peel 3 drachms, Boiling Water 1 gallon. Tinctura Amara. P.G. VI. Gentian Root 3, Centaury Root 3, Orange Peel 2, Orange Berries 1, Zedoary R,oot 1, Diluted Alcohol (67 to 69% volume) to 50. Mistura Gentianse Alkalina. Brompton H. Sodium Bicarbonate 15 grains, Gentian Infusion to 1 ounce. (rg)Previously contained Hydrocyanic Acid, 3 minims.) Elixir Gentianae Aeidum. Martin- dale. Dose.—1 to 2 drachms in a little water. Concentrated Compound Infusion of Gentian 20 minims, Taraxacum Juice 10 minims, Dilute Phosphoric Acid 21 minims, Sherry 20 minims, Glycerin 7£ minims. Infusum Gentianse Compositum Concentratum. Dose.—30 to 60 minims. Gentian and Orange Peel in No. 10 pdr. each 2, Lemon Tincture 2, Orange Tincture 1, Alcohol 90% 3*5, Diluted Chloroform Water to 20 by process (a) for infusions (q.v.) 1 part diluted to 8, resembles B.P. ’14 Infusion. :jcGencydo. (T.M. 424634). A preparation for hay fever made from plants containing lime salts and vegetable acids. (The lime treatment of hay fever is thought by some to be important.) Ampoules stated to contain Gentiopicrin 0-01 Gm., and Extractum Cydoniae Seminum 0*01 Gm. for injection. A liquid containing the same ingredients is used as a paint for the nose, as also an ointment. Geranium Maculatum (Geraniacece).—Cranesbill root. Dose.—15 grains to 1 drachm is a powerful astringent; contains about 16% of tannin ; used in diarrhoea, and locally in relaxed conditions of the mucous membranes. Geranin, a dried extract, is given in dose of 1 to 5 grains. Liquid extract, 1 = 1. Average dose.—15 minims. Germanium Dioxide. An American method of treatment of pernicious anaunia, less toxic than arsenic. Causes in animals a distinct rise in the number of blood cells, but in practice the results were negative.—M. G. Alexander, B.M.J. ii./22,979. It is stated to have no haematopoietic effect and is toxic.—Per Pres., Jan., ’26,2. Ginseng. Dose.—15 grains to 1 drachm. The name applied in China to roots of probably several plants to which are attributed miraculous properties. The active principle of Ginseng is a glucoside. The Chinese actually count live kinds of Ginseng. According to them the tme Ginseng, ‘ Panax ’ Ginseng, acts on the spleen, which is to them the centre of life : Adenophora acting on the lungs : Scrophularia on the kidneys : Polygonum Bistorta on the liver: Salvia Multiorrhiza on the heart. The true wild-growing root from Manchuria is most prized.—From Stuart’s Chinese Materia Medica. As much as would lie on a penny was taken thrice daily without any noticeable effect.—H. Gilbert Carter, Sept., 1926. Glaucium Luteum.—Yellow-horned or Sea Poppy. 1 drachm doses of Liquid Extract have been given in glycosuria. ...The alkaloids Glaucine, Protopine and Chelerythrine are present. Gloriosa Superba, N.O. Liliacece. A poisonous plant common in Upper Burrnah. Contains Colchicine.—Clewer, Green and Tutin, J. C. S., 1915, 107,835 ; F. L. Pyman, C.D., July 31, ’15,164. Glucosides. Principles found mainly in plants, possessing the property of being converted into glucose or an allied sugar and one or more simpler or more complex products^ by* the action of . dilute acids, alkalis, enzymes or simply by heating with" water and taking up the elements of water in the reaction, i.e., hydrolysis. Examples are Amygdalin, the Digitalis Giucosides, Phlonazin, Salicin ; Bourquelot on.—B.M.J. i./2i,59. A review of Giucosides.—J. E. Driver and G. E. Trease, P.J. i./27,622. Recent work on.—E. G. Bryant, P.J. i./28,213. Glycogen [C6H10O6]n.—A body allied to starch—a white odourless powder soluble in water with opalescence, insoluble in alcohol. Bose.—1£ to 2 grains. It occurs in the liver, blood, horseflesh, etc. It is said to be changed at death into glucose, maltose and isomaltose ; given medicinally said to improve nutrition. Glycyrrhiza. Bose.—5 to 20 grains or more. _The peeled root and subterranean stem of G. glabra (Leguminosce)—B.r. T4. Aqueous extraction usually yields 24 to 38% Solid Extract. Bose.—5 to 60 grains. Extract Liquid (B.P. T4). By cold exhaustion with Chloroform Water 1 = 1, contains | of its volume of 90% alcohol. Bose.—| to 1 drachm. Incompatible with acids. Elixir Pectorale.—Syn. Liquor Peetoralis. P. Ban. King of Denmark’s Chest Mixture. Bose.—1 drachm. Extract of Liquorice 1, Fennel Water 3, Anisated Liquid Ammonia 1. Note a further form below. (Liquor Ammonii Anisatus.—Syn. Esprit Ammoniacals Anise consists of Oil of Anise 1, Alcohol 25, Solution of Ammonia 5. Several of the Foreign Pharmacopoeias gave similar formulae, e.g.,'that of P. Dan. 1908 and P.G. VI.) Liquor Peetoralis, P. Svec. X. Licorice Extract 200, Fennel Water 600, Ammonia Solution 9% 35, Anise Oil 2, Alcohol 90% 163. Note a further form above. CR) Liquor Peetoralis Benzoicus, P. Svec. X. Tinctura Opii Benzoica 1, Liquor Peetoralis 3. Glycyrrhizinum Ammoniatum. Bose.—\ to 5 grains. Glycyrrliizin is contained in the root as the Ammonium Salt—further details Vol. II. Readily soluble garnet coloured, shining scales. It possesses a persistent sweet taste. The acid precipitated from it is bitter-sweet. A grain will flavour 6 ounces of water. It may, perhaps, be considered as the Ammonium Salt of Gly- cvrrhizinic Acid which, according to Tschirch, has the formula C41H.,0,«X)OH)#. . ^ P M „ r Liouorice preparations cover the taste of ammonium chloride, alkaline iodides, cascara, magnesium sulphate., quinine sulphate, ipecacuanha, and aloes, hence is in Mistura SennEe Composita, Decoctum Aloes Compositum and Confectio Senna?. . t n . In addition to the extracts, dried ‘ Liquorice Juice/ or Spanish Liquorice, is sold, that bearing the stamp of SoJazzi being most prized. Pontefract Cakes of Liquorice and ‘ Pipe Liquorice,’ are useful in allaying tickling coughs. Trockisei Giycyrrhizm, Brompton H., commonly known as ‘ Brompton ’ Cough Lozenges, or ‘ Brompton Blacks/ contain Liquorice Extract 3 grams, Anise Oil i minim in each (Acacia basis). Pastilles de Reglisse.—Liquorice pastils, much used in France. pul vis Glycyrrhism Compositus. (B.P. T4). Syn. P ui.vis Pectoralis (Kurellce). Senna and Liquorice of each 2, Fennel 1, Sublimed Sulphur 1. White Sugar 6£. Mix. . . .. Bose.—1 to 2 drachms, mixed with water or milk, taken early m the morning, is a mild and agreeable laxative. For constipation and hepatic disease, n is pleasant to take, and effectual without catharsis. U.S. uses oil of ieunel, which makes it less granular, it is also prepared sine Saccharo (Hewlett) with halt the above dose, more palatable. Poudre de Reglisse Composes. Syn. Pulvis Liquiriti^ Compositus Fr Cx contains Liquorice 14, Senna (washed with alcohol and powdered) H, Fennel 1, Sublimed Sulphur 1, White Sugar 5. pg VI Coarsely cut Marshmallow Knot 8, Liquorice Boot 3, Orris Boot i, l’ussilago Farfara (Coltsfoot) Leaves 4, Verbascum The6 prickly fruit of Pedalmm Mutex. A remedy for nocturnal seminal emissions, incontinence of urine and impotence. Is rich m mucilage. Of aS infusion 1 in 10 of boiling water (stand 2 hours) dose. Should be freshly made. Liquid Extract 1 =1, made with Alcohol 90% Bose.—20 to 60 minims. Burra Gookeroo is believed «o be identical with Pedalmm Mutex fruit. It is used similarly m India, though by some it is identified as Tribulus lanuginosus (Zygoyhyllaceoe). Guaycuru {Mice braliUensis). Emmenagogue (?) Infusion, taken freely. Astringent. For dysentery.—Ph. Notes, River Plate. Guarana. P. Hung. Dose.—10 to GO grains in powder, or infused in a cup of boiling water. The seeds of Paullinia Guyana, P. sorbilis (Sapindacece). roasted and moistened with water, made into a hard paste, roiled into cylinders' and dried. Imported from Brazil. The drug contains 2-5 to 5% Guaranine* which is identical with caffeine, q.v., together with tannin gum, etc. Is recommended for sick-headache. A nervine tonic. Dose.—4 to 5 grains or more. Methods of preparation of Guarana by the Guarani Indians.—P.J. ii./io,577- Liquid Extract. Dose.—| drachm. Standardised to 4 Gm. (average) Alkaloids in 100 Cc. Prepared by percolation with Diluted Alcohol. Tincture. Dose.— 4 to 1 drachm. Macerate Guarana 1, in Alcohol 60% q.s. to produce 4. Gymnema Sylvestre (N.O. Asclepiadacece). An Indian creeper whose leaves- when chewed relieve sweet taste of sugar. Decoction of powdered leaves has been used in diabetes, but found of no value.—Chopra, Bose and Chatterjee.. per Pres., Dec., ’29,421. Hcsmatoxyli Lignum, Logwood. (B.P. *14.) The unfermented heart-wood of Hcematoxylon Campechianum (Leguminosce). Of sweetish astringent taste The fermented chips used by dyers are deep red in colour, have lost the sweet taste and the hematoxylin is oxidised to Hcematein, Ci6H1206. Preparations of logwood, colour the feces and urine red, and stain linen. Incompatible with acids and lime water. Certain metallic salts (notably iron) produce blue colour ; mercuric salts brown. The decoction is a remedy for diarrhoea and some forms of urinary hemorrhage. Liquid Extract, B.P.C. 1 = 1. Dose.—^ to 2 drachms (2 to 8 Cc.). Extract. An aqueous extractive! completely soluble in water. Average dose.—15 grains. Deeoctum Sappan 1 in 20 of Sappau Wood (Ccesalpinia Sappan, Leguminosce. is B.P. T4 and is similar to Logwood. Hematoxylin. C.6H14064-3H20 = 356-156. Usually in yellowish granulan crystals, slowly soluble in water, easily in alcohol. Alcoholic Solution 0-2%i is used as indicator—yellow in acid and purple in alkaline solution. Alsr for staining in microscopy, vide Vol. II. Logwood cultivation in Jamaica.—P.J. i./26,328. Harmine and IXarmaiine. Alkaloids contained in the seeds of Perganun llarmala, a strong-smelling herbaceous plant N.O. Rutaccce. It is the Wile Rue of Dioscorides. Further details on Botany, Chemistry and Pharmacology 17th Edn., p. 799. (ffanisterine from Banisteria caapi is an identical alkaloic. chemically and pharmacologically.) The pharmacology of Banisterine and Harmine, showing they are identical —J. A. Gunn, L. i./29,1140 ; P.J. L/29,220. Harmaline lias a toxic action on trypanosomes in vitro, but no curative effect on the disease in man. It is thought inferior to Quinine for acut* malaria. Harmine failed to cut short acute attacks. I11 three cases o relapsing fever it proved remarkably successful. Trypanosomiasis treated by llarmala alkaloids (Gunn)—not found curative Review of tropical diseases.—R. Hewlett, Pr., April, ’21. Harmine has been used in Parkinsonism. Harmaline and Harmine wer< tried in malaria.—J. A. Gunn, L. i./29,769. Harmine 0-04 Gm. hypodermically thrice daily useless in Parkinsonism causes toxic symptoms.—T. R. Hill and C. Worster-Drought, L. ii./29,647,675 Harmine—a therapeutic revival.—Per Pres., June, ’29,225 : see also ibid. Sept-., 29,312. Harmol and Hannalol are two further alkaloids which have recently beex introduced. Harmol differs from Harmine by the substitution of a Phenol! for a Methoxy group, and Hannalol differs from Harmaline in the same mannei and this substitution diminishes the toxicity for mammals and for protozo' and abolishes the convulsive action. Harmalol is only 1% soluble in cold water. Harmalol Hydrochloride in doses of 4/5 grain hypodermically or by mouth has slight but deftnite effec in relieving muscular rigidity in Parkinsonism, but has no effect on the tremc: or mental condition and does not relieve salivation. Not so good as Hyoscint but of value as an adjuvant.—H. A. Cooper and J. A. Gunn, L. ii./si,902. Recent pharmacological studies suggest Harmol as one of the most powerful coronary dilators, having marked effect, 1 in 200,000, on rabbits. Suggeste for clinical trial in angina pectoris.—J. A. Gunn and R. C. MacKeith. Qtrly Jl. Ph., ’3U33. Hedera Helix (Araliacece). Ivy—juice of leaves has been used to ulcer The berries are said to be purgative. Leaves of ordinary common Ivy, taken by a child, caused poisoning. Intense scarlatiniform rash produced (as in the case of Rhus toxicodendron). Emetics failed to act. The stomach was washed out and a stiff dose of Castor Oil was given.—P. H. J. Turton, B.M.J. ii./25,294. Hederin—a glucoside with Digitalis-like action, but is injurious to the heart and blood corpuscles.—B.M.J. i./i2,61. Heliotropin, CsH,OaCH2COH =150-0468. Syn. Piperonal, a Methylene derivative of Protocatechuic Aldehyde, when pure is in shining white flaky crystals with Coumarin odour, slightly soluble in water, freely in alcohol, much used in perfumery. Usually manufactured by oxidation of safrol with chromic acid. Helonias dioiea.—False Unicorn Root. Is used in colic and in atony of the generative organs ; also employed as an abortifacient. ‘Helonias Compound.’ Aloes 9 oz., Helonias 14 oz., Tansy 14 oz., Oil of Pennyroyal 1£ oz., Oil of Cassia 1 drachm, Cayenne £ oz., Myrrh 8i oz. in 1 gallon of 17% Alcohol. Dose.—1 drachm in a cup of hot water, sweetened, twice daily. For promoting menstruation. A case in which a man was proved guilty of supplying a noxious drug to procure miscarriage.—P.J. ii./24,342. Sometimes known as Egyptian Privet—it resembles common privet. Henna, Lawsonia inermis (Lythracece). The powdered leaf is employed as a hair dye, usually in conjunction with indigo, e.g., the following :—Apply a paste of Henna 1, Indigo 2, for varying periods according to the shade required—one hour for light brown. 1$ hours for darker—should be tried experimentally before use. Henna stains the skin as well as the hair. In some cases Cupric Chloride and Pyrogallol are used in conjunction with Henna, and again Borax is occasionally an adjuvant, the idea being no doubt that the pyrogallol oxidises more readily in alkaline solution. The quantities relative to the Henna in such cases are exceedingly small. It is employed internally and locally in jaundice, leprosy, and skin affections. ■creknnn For an account of History, Botany, Cultivation and^ Chemistry of Henna and Shampoo formula, see E. M. Holmes, P.J. k/24,437. The constitution of Lawsone.—J.C.S.A. i./2o,626. Holarrhena Antidysenterica (.Apocyanacece). Syn. according to some Wrightia Antidysenterica, Bengali Kurchi or Coorchi, a small deciduous tree found throughout India. An infusion of the bark (and ?ee(Js) has remarkable effect in dysentery. The plant, as also H. Congolensu; from the> Co g contains Conessine C1SHJ0K. This alkaloid has strong tohibitory act:ion on amrebse—equal to that of Emetine. It is 50 /0 less toxic than the latter. Conessine salts can be given per os and intravenously, but subcutaneously 1 produces necrosis at site of injection. Suggested dose of Powdered Bark 2 to 5 grains. A Liquid Extract 1 = 1 was tried with good result.—I.E>.0 19 £, H, C. Brown, B.M.J. i./22,963 ; F. L. Pyman, J.C.S.T., Feb., 1919, P- Kurchi tablets are made 5 grains. ,, rpTT1Pflv in vo2IJe Antidysenteric value compares favourably with any other remedy in vogue and depends on use of entire seed or bark, ^common _ ^ a]so 60—120 grains of powdered bark in 3 or 4 poi Lions. L. ./ , T. A. Henry and H. C. Brown, ibid., 108. , Alcresfa Amoebic Dysentery.—Comparative treatment of ca^s with leresta Ipecac, Emetine injections, Emetine injections plus Bs p , Bismuth Iodide, Yatren, Stovarso and Kurch Barck showed that tne mst two gave the best results, the ratio of probaole ernes to laihire^s these cases being 1 : IT.-—R. Knowles, I.M.G., » P_ grajn doses Total Kurchi Bark alkaloids used with success m amoebiasis 2 gram intramuscularly or liquid extract orally. - \\ 3f ’ k gjavq ;n amoebiasis Kurchi Bismuth Iodide. Dose.-4 grains dady for 10QW In acute amoebic infections nine * to 1 gr^1?/rc^)se5PT1f >?Q Tjer M A ’31 17. advised.-H. W. Acton and Ni R. Chopra I M G Sept 29, per m.a., 3 ,1/. Holarrhena var. also contain the alkaloid Holar.hemne. See also our page 527. h Wthvi-ethvlamme. C8H4OHC2H4N(CH3)2. Hordenme. # p.Oxy-pheny l-dimetLy y * f malting. Leger, Comptes Alkaloid obtained from arie - - compound has been synthesised. gSf- 1 fith IEdn 10p8’834 ’ The substance resembles Tyramine q.v. Dose unoertifn but"! &a has been given. Suggested in hyperchlorhydros.s, A decoction of the plant <H. Arborescent) is stated to have been used with advantage by the Cherokee Indians in calcuhi diseases.—U.S.D. (Liquid Extract of Hydrangea may be prepared 1 = 1 wit! 45% Alcohol.) Eydroeotyle asiatica, Ph. Ned. V. Water Pennywort Leaves. The umbelll ferous herb is used in India for skin diseases and ozaena in 4 to 10 grain dose internally ; it is added to lard as an ointment, also to poultices, and used a snuff in ozsena. Contains 15% of a volatile oil. Hydroxylamine, HH2OH = 33-0314. Its strong reducing and antisepti properties suggest its use. in tinea and psoriasis. Does not stain the skin The Hydrochloride, NH8OH.HCl = 69-496, is freely soluble in water. Sole, tion 1 in 1,000 of equal parts of glycerin and alcohol or ointment with adep Ian*, successful in lupus, ringworm and parasitic sycosis. May produe smarting. For notes on Manufacture, Chemical and by Electrolysis of Nitric Acid, $e Edn. XIX, p. 863. Hydroquinone. Syn. Quinol, Hydrochin on. C6H4(OH)2l : 4=110-0468 Dose.—£ to 5 grains. An isomeride of Resorcin C«H4(OH)2l : 3, and Pyro catechin 1: 2. For a note on Chemical Method of Manufacture, see Edn. XVIII, p. 835. Electrolyt.ical deposition is more economical than the chemical methoc Theory of the reaction.—P.J. i./i6,3. Poisoning by Hydroquinone—20 grains recovered from dejecta.—A. Mitche and J. Webster, B.M.J. ii./i9,465. Soluble 1 in 20 of water, in alcohol about 1 in 4. It possesses stronger antiseptic and antipyretic properties than Resorcin. Is used as a photograph developer, q.v. Kysterionica. Syn. Aplopappus Baylahuen (Composite) Remy. Froo> Chili. Recommended in malarial and chronic dysentery, flatulent dyspeps and_diarrhcea. Liquid Extract. Dose.—5 to 15 minims.—H.S.D., p. 1394. 13Ibogaine. C62Hc#N«Gs = 806-5628. An alkaloid obtained from to Iboga (syn. aboua, or obouete or liboka) (X.O. AcaiUhacece), Tabernant/f Iboga, Baill., a plant growing in West Africa, particularly the Congo. Sad to have aphrodisiac and sustaining powers. Too large a dose may produtr tetanus and convulsions. The plant has been tried in sleeping-sickness The base is soluble 1 in 28 alcohol 95% at 15® C. Insoluble in water. M.p> 151° C. Its solutions are kevorotatory. In solution the substance oxidise but keeps well in crystalline form. It has been given in dose 0-005 Gun (Yr grain). 131 Ibogaine Hydrochloride has been given in influenza, and I angina pectoris and other heart affections. Ichthyocolla (P. Beig. IV., F.E. Vlll, P. Xtal. V.) Isinglass. The swimmin bladder of certain species of the sturgeon and hake ; dried and sliced int i thin pieces. About 3 drachms to the pint of warm water forms a jelly. 1 used for refining wine. Added to milk to prevent formation of tough cure; difficult of digestion. Isinglass Piasters on Muslin, 8 inches wide, yard roL (also 11 inches by 5 yards). Also Tapes, I, 4 and 1 inch, 10 yard length;: Also Isinglass on Silk, 7 inches wide, flesh-coloured, black and white, ar made. P. Jap. gives method of making Court Plaster.—“ Emplastrur i Adhtesivum Anglicum.” Sinclair’s Glue.—Glue 50, water 50, glycerin 2, calcium chloride 2, thymol I For applying extension in fractures instead of plaster. Melt on water bat when required and apply with the hand, using a bandage if necessary. The following is more elastic:—Isinglass 50, glue 50, water 50,~ calcim: chloride 2, tannin 12, glycerin 2, thymol 1.—B.M.J. ii./i7,60. The Thymol content is excessive. One-tenth of the amount in either c the above is ample. ‘ Blistering ' of the skin has occurred in its use whie j we attribute to the amount of Thymol.—W. H. M. Inula Helenium (Compositce).—Elecampane. Root contains Inulin allie to Starch and Helenin. Dose.—J to 2 grains a stearoptene, in white crystals- insoluble in water, but freely in alcohol. Is antiseptic, used in ozeena, keep, off insects, and internally for phthisis, malarial fevers, infantile and catarrhs diarrhoea ; checks bronchial secretion. Inulin from this and from Dahlia and Helianthus is the same. It is present in Burdock root to the extent c 45%, Dahlias 20%.—Holmes. Extractum Imilse Liquidum. 1 = 1. Dose- 10 to 60 minims. Extractum Heienii (solid) is also made. Ipomma batatas is the Sweet Potato which is used as a vegetable in man parts of the world—Persia, India, Japan, China, etc. The roots contain from 3 to 10% of sugar and 9 to 15% of Starch, which occurs m larger proportion in plants grown in sub-tropical countries. The Starch is a commercial product and is known as Sweet-Potato Starch.—- Kraemer. cf. Maranta, postea. Ipomcea. B.P. 14. Syn. Orizaba Jalap Root. Mexican Scammony Root. Dried root of 7. orizabensis Ledenois (Convolvulacece-). To yield not less than 15% total resins.—U.S. X. Resina Ipcmceae U.S. X. is prepared by adding water to the Alcoholic Extract. Dose.—3 grains. See Jalap. Iridin. Syn. Extractum Jridis. Dose.—1 to 3 grains in a pill alone or with extract of henbane, or with one grain of Euonymin. The dark brown powdered extract made with Alcohol 60% from the root of the blue flag, Iris versicolor (North America). Has a bitter, acrid taste, possesses cathartic,, alterative and diuretic properties, given in hepatic and intestinal disorders. 7ns Florentina, I. Germanica, etc. (Italy), yield Orris Root of perfumery, containing ‘Butter of Orris’ about 0-15%, a sweet-scented fatty substance. Tinctura Iridis is prepared from the root, 1 in 8 Alcohol 90%. Sneezing treatment for prevention of adenoids satisfactory. Powdered Orris Root and soap used to lightly touch the nasal septum. It is not sniffed up the nose.—L. ii./i8,240. Ispaghula, B.P. T4. Dose.—45 to 150 grains. Pinkish brown boat-shaped seeds of Plantago ovata (Plantaginacece). Much valued as demulcent =■= Linseed or Barley.—Decoctum. Dose.—k to 2 ounces. 1-5% in water. Has beneficial mechanical action in chronic dysenteries.—R. N. Chopra, I.M.G., Aug., ’30, per M.A., ’31,159. Ixora Coecinea. Syn. Flame Tree. Dose of the powdered drug.—30 to 45 grains with aromatics. In dysentery. Tincture. Dose.—1 to 14- drachms in water twice or thrice daily as tolerated, increased if necessary. 1 in 5 alcohol 60%. Mistura. Dose.—One ounce thrice daily as tolerated, increased if necessary. Tincture of Ixora 1 ounce, Peppermint Water to 8 ounces. Jalapa. * Syn. Bryone or Meceoacan Noir. Dose.—5 to 20 grains. The dried tubercles of Ipomoea Purga (B.P. *14), U.S. Exogonium Jalapa (Convolvulacece). A powerful purgative producing watery stools, is apt to gripe ; must be avoided if the bowels are inflamed. Used to reduce dropsy of Bright’s disease, and to relieve ursemia. The Extract (Dose.—2 to 8 grains), Resin and Tincture are mostly used. Tinctura Jaiapss Ccmposita. Dose. \ to 1 drachm. Contains 8% Jalap with Scammony Resin and Turpeth. A modification of B.P. Assay Process.—H. E. Dale, P.J. ih/27,516. See also D. B. Dott, P.J. i./3o.213,287. Jalapfe Resin, P.G. V.T., P. Xtal. V., F.E. VIII., P. Belg. IV. and U.S, Bose.— 2 to 5 grains. Contains two glucosidal resins, about 90% Convolvulm (Syn. Jalapergin), soluble in alcohol, but insoluble in ether [this should be termed Jalapik, as understood in England (dose 1 to 5 grains)], together with about 10% Jalapin (Mayer), (Syn. Orizabtn), soluble in ether and m alcohol. The latter, the principal constituent of spurious Jalap (Ipomoea svmulans and 7. orizabensis), is identical with Scammonin (dose, 1 to 5 grains) from scammony root, Convolvulus Scammonia (Convolvulacece). It is cheaper and less active. The average yield of resin from Jalap is about 10%. Fr. Cx. requires 7 /0. B.P. T4 requires to contain not more than 15% ether-soluble. For further data on Jalap and Scammony Resin, see Vol. 77. # Pulvis Jalapse Compositus (B.P. T4). Dose. 10 to 60 grams. Contains 30% Jalap with Ginger and Acid Potassium Tartrate. A new Jalap resin, known as ‘ Regina de Batata de 1 urga, and extracted from the tubercle of Convolvulus Operculatus, is extensively used m Biazil. It possesses the same properties as the official Jalap, but is practically devoia of 3 any subsequent constipating action. Dose. 0-^o to 2 Gm. u. v. i./25,854. . . , * ,, , , Jugiandin,—An extractive prepared from tne inner bark m tiie root of Juglans cinerea, the North American butter-nut; is an hepatic stmmiant and cathartic. Dose.—2 to 5 grains in pill. Spintus Nueis Juglandis, distilled from Juglans regia, the common European walnut, is an antispasmodic and for checking sickness of pregnancy. Dose.—1 tv 4 drachms. Folia Juglandis are in P. Austr. : also in P. Belg. (and Fluid Extract) and P. Helv. Walnut hair dye. A formula for this was given in Edn. XVIII, but it is not satisfactory. Certain hair dyes of the kind owe their efficacy to aniline dyes. Juglane. A French preparation of the European Walnut (Fr. Noyer), for use in diabetes. -Juniperi Oleum. Oil distilled from fruit of Juniperus Communis (Coniferce} , , rectifl;ed B P. 14. Sp. Gr. 0-852 to 0-890, increasing with age. Soluble (when freshly distilled) 1 in 4 of 95% alcohol, becoming less soluble with age. Resembles Turpentine in medicinal uses. A genito-urinary stimulant, bpicifus 1 in 10. Dose.—5 to 20 minims. Spiritus Juniper! uomposnus. Dose. 2} drachms. Oil of Juniper 8, Oil of Caraway 1, Oil of Fennel 1, Alcohol (99%) 1,400, Water to 2,000. Terpeneless and Sesquiterpeneless Jumper Oil is stable and soluble in comparatively weak alcohol. Vinum Diureticum, P. Helv. Dose.—J to 1 ounce. Juniper 15, Squill 10. Orange 1 eel 10, Absinthe 5, Angelica 5, Sweet Flag 5, Dry Southern Wine 1,000. Oleum Jumperi Ligni. A trade name for Fictitious Juniper Oil supposed to be made from the wood, but is generally a mixture of Juniper Berry Oil and Turpentine ; cf. also Juniper Tar Oil. Kaladana (B.P. ’14). Syn. Pharbitis Seeds. Dose.—30 to 45 grains Dried seeds of Ipomoea hederacea (Convolvulacece). Purgative and Anthelmintic—equivalent Jalap.—Give dose 60 to 120 grains.—I.D 0 Puivis Kaladana} Compositus, B.P. ’14. Dose.—10 to 60 grains. Kaladana 50/0. Equivalent to Pulvis Jalapse Compositus. Tinctura, Dose.—k tc 1 drachm. 1 in 5 of Alcohol 70%. Kaladanee Resina. Dose.—2 to 8 grains Useful hydrogogue.—I.D.C. Kala signifies black and dana means seed. Other seeds are collected in place of genuine. Chemical and Histological Research on the seeds andL resin—II. C. Kassner, P.J. i./?4,155,182,207,231,261,306,328,357. Kauri Gum. A resin obtained from Dammara Australis in Australia and New Zealand.. Dental Compo. Contains Kauri Gum. This is used foi taking impressions of the mouth and teeth for plate preparation. Directions. —1 lace the cake of Compo in moderately warm water for about two minutes or s° to soften—do not employ boiling water. The Compo should be kneaded with uhe wet Ungers until it has hardened somewhat; by this proceeding it becomes almost cool. The Tray should be warmed for a short time before placing the Compo into it. The surface of the Compo is then smoothened with the hand, a little vaseline is rubbed on the surface, and the tray is held for a second or two over a Bunsen flame. It is very important that the surface of the Compo should be heated in this way before inserting into the mouth., After inserting wait for 2 or 3 minutes. On removal, place the tray bearing the impression in cold water. Kauri ‘ Gum.’ Its collection and commerce.—Jas. B. Aitken, P.J. i./i5,550.' Kava-Kava. Syn. Awa Root, B.P. T4.—Piper methysticum (Piperacecej rom the Polynesian Islands. Liquid Extract. B.P. ’14.' 1 in 1 of alcohols 90 and 45%. Dose.—30 to 60 minims. In gonorrhoea it is not equal to copaiba or santal oil. Further data Edn. XIX, p. 865. Kino (B.P. ’14). U.S. X. Dose.—5 to 20 grains. The dried juice from trunk of Pterocarpus Marsupium (Leguminosce). Partly soluble in water, almost entirely in alcohol 90%, nearly insoluble in ether. Astringent for diarrhoea, and as Trochisci for relaxed condition of the throat. Its powder is also insufflated to check epistaxis. Tincture, 1 in 10 of a mixture of Glycerin. Alcohol and Water. U.S. 1 in 10 of equal parts alcohol (94-9% vol.) and water. Dose.—30 to 60 minims. The tincture may gelatinise, due to enzymes. Incom&atitoio with mineral acids and alkalis and with substances: precipitable by the tannin it contains. The constitution of Kino Tannin, with list of references to the literature relating to Kino.—A. McGookin and I. M. Heilbron, Jl. Ph. & Exp. Tiler., Jan., ’26,421. Butea Gum.—Bengal Kino may be used to replace in certain parts of the Empire. Krameria) Radix. Rhatany Root (B.P. T4). The dried root of Krameriu argentea (Para) and K. triandra (Peruvian). Both contain about 8% of a tannin. Astringent in relaxed throat, also in tooth powders when gums are liable to bleed, and in mouth washes, also for bleeding from nose and bowels^ and for diarrhoea. Tincture (B.P. ’14). 1 in 5 of 60% alcohol by percolation. Dose.—30 to 60 minims. Should yield 5% extractive. Flavoring.—Glyl Mentha) Viridis vel Piperitie, Glvl Pini; Glycerin, Syrupus Aurantii. Trochisci are made with the Extract, as also [§) !MJ with Cocaine Hydrochloride grain. Kratom.—Leaves of Mitragyne speciosa are chewed by the natives of Siam and Bangkok. Habit-forming, but not harmful. Used as restorative; enables workers to withstand great fatigue and torrid heat.—C.D. i./3o,702. Kukm Oil. Syn. Candle Nut Oil from New Zealand, Fiji Hawaii, etc. obtained from the seeds of Aleurites Tribola. Syn. A. Moluccana (in Index Kewensis)—m amount equal to 60*8% of the decorticated nuts or 19*8% of S?.7nSA?n^-Se?idS--.lP' Gr. 0-920-0-9274, S.V. 184-204-2, I.V. 114-2— 163 7. Medicinally it has cathartic properties. Suitable for soap, varnish making and other uses. Dries more quickly than linseed oil. . Labdanum. &yn' Ladanum, the exudate from Cistus var. was employed in the war by the Greeks for wounds.—Sir Charles Ballance L i 120 5 Lachnanthes Tinctoria.—Spirit Weed, Red Root. A tincture = 1 ’ in 10 of proof spirit of this United States plant; is used to check the cough in phthisis. t0 10o^mims- References to Alabone’s treatment by Lachnanthes : 17th Edn., p. 80o. Lactose— Saccharum Lactis, CiaH220ll5H20 =360-1872. Milk Sugar. l>)ose, ad lib. Used for # weakly children. Is said to be a useful addition to Magnesia as a laxative, it increases the solubility of the latter by combination. The organisms capable of fermenting Lactose are less frequently present in normal mouths than those in which dental caries exists—a point which must have some bearing on the etiology of dental caries.—Sir Kenneth W. Goadby, L. ii./o9,lS96. Government Lactose Factory at Crewe under Ministry of Agriculture. Previously valued at £19,000, sold for £3,000.—C.D. h/27,393. A dose of i to 1 oz. in the morning in a large cup of weak tea a useful laxative. Of value in flatulence and spasm of the colon.—T. C. Hunt, L. ii./si,872. Laminaria Digitafa, ‘ Sea Tangle.’ From this seaweed ‘’laminaria Tents ’ are made for gynaecological and surgical use. Placed in contact with moisture they swell to three times their original size in dry state. The Laminaria is sterilised by drying after immersion in acetone, chloroform or alcohol 90% under pressure at 133° C., or by placing in Saturated Solution of Iodoform in Ether or in Sublimate Solution. Lappa. Burdock. Roots of Arctium Lappa, Linne, or other species of Arctium. On the Continent called Bardana, e.g., Inf. Bardanoe Spirituos (external): Bardana 2, water (boiling) g.s. to 15, strong alcohol 5, to be rubbed into the scalp. Ph. Notes, Denmark. Liquid Extract, 1 = 1 by Diluted Alcohol. Average dose.—30 minims. In skin affections and gout. The use of a tincture of the seeds has largely replaced that of the root in U.S.A., especially in the treatment of psoriasis, acne and prurigo.—C. & D. i./25,216. Lasiosiphon (Lasiosiphon Meisneri). Dose.—2 to 5 grains. The root of this South African drug resembles Mezereon in its properties (there are several species—this is considered the most active). The bark of the root when chewed produces a scorching sensation, due to acrid resin, in about fifteen minutes. Tincture of the root 1 in 10 Alcohol 90%. Dose.— 10 to 60 minims. Found efficacious in chronic skin affections. liquid Extract. 1 = 1. Dose.—2 to 5 minims. Lasiosiphon Bassorin Paste, consisting of the Liquid Extract thickened with 3% Tragacanth; may be of service for local use. Lathyrus Sativus.—A poisonous horse pea.—P.J. b/i3,795. Lathyrism and other plant poisons.—B.M.J. ii./25,847. See also Ralph Stockman, Jl. Ph. & Exp. Therap., Sept., ’29,43. Lauri Fructus.—Laurus nobilis (Lauracece). The ripe fruit, Laurel or Bay Berries, contains fixed 30% and volatile oil 1%. In rheumatism, ieptand in. Dose.-—£ to 2 grains. A resinoid powder obtained from Culvers Root, Leptandra. (Veronica) Virginica (Scrophulariacece). Supposed to promote the flow of bile without irritating the bowels; useful in dyspepsia. Acts well with podophyliin. Liquid Extract. 1 =1 of Leptandra by diluted alcohol. Average dose.—15 minims. Solid Extract (Powder form, 1 =4) of drug by concentrating same and adding Glycyrrhiza. Average dose—4 grains. Levisticum officinale.—Lovage. A decoction in milk (a fresh leaf and stalk to a quart), allowed to simmer 2 hours. Dose.—3 to 5 ounces. For renal dropsy. Limonene. Dose.—10 to 20 minims (on sugar or in water). This Terpene exists in several modifications, the dextrorotatory ([a T) — + 106*8°) is contained in Lemon, Bergamot, etc., Oils, the Icevo ([a D = —105°) is in Pine Needle Oil and Peppermint Oils. Inactive Limonene (==Dipentene —i.e.f + and — Limonene in equal amounts) is contained in Oil of Camphoe Swedish and Russian Terpentine OH, etc. They do not differ greatly in taste and odour. Limonene has been used, in place of Turpentine Oil both by inhalation ano internally. Stated to be of value in pulmonary disease associated with copiou expectoration, e.gr., purulent bronchitis, bronchiectasis, gangrene and phthisica cavities. As a deodorant of foul smelling expectoration it is said to act well; Sputum decreases in amount. The substance is also valuable as a stomachic and externally in stimulating liniments. Dermatitis in marmalade workers due to irritant action of Limonene present in both orange and lemon peel. Grease a preventive.—S. G. Horner L. ii./31,961. Lemon Syrup. Two formulae : Lemon Oil 1 minim, Alcohol 90% 20 minims Syrup to £ ounce, or dissolve Citric Acid 2 in Lemon Tincture 5, strain i necessary, and add Syrup 50 ; vide also infra. . T'inctura Limonis.—We have found the following formula of P. Boa equa in flavour to the B.P. formula, as follows : Fresh Lemon Peel, cut small, 25> alcohol (90%) 52 and distilled water 48 mixed. Prepare by maceration This, is, therefore, weaker in spirit than the usual. For Syrup of Lemon.— Citric acid 4 ozs., sugar 5| lbs., distilled water 42 ozs. or q.s. tincture of lernor as above 5 ozs. Heat the water to boiling, add first the sugar, then the citrir acid, and stir till dissolved. When cold add the tincture of lemon, and mi> by shaking. Finally, add distilled water q.s. to make to 100 ozs. Thi Syrup we And as good as, if not better than, the B.P. Syrup. The taste i sharper—it is somewhat stronger in Acid, we found by titration about 25% stronger. For Oleum Limonis vide Vol. II. Tinct. Limonis Fort. B.P.C. contains little A or C Vitamin, but contains almost as much B as Yeast. Cortex Limonis B.P. found to contain appreciable amounts of Vitamin.— S. G. Willimott and F. Wokes, P.J. ii./25,164 ; ii./26,184. Linum.—Seeds of Linum nsitatissimum (Linacece). Decoction, 1 in 2C demulcent or crushed for use as a poultice. Contains Oleum Lini, 30 to 40% Sp. Gr. 0-930 to 0-940 I.V., not less than 170. Used as enema and with lime water as Carron Oil, _ q.v. Max Seed or Linseed (Grains de Lin in France) In habitual constipation. One teaspoonful to be taken floating in a tumblei of water before breakfast. Appears to act better than Agar-Agar. Tung Oil from Aleurites Ford'd, irritant and poisonous, is a substitute for Linseec Oil.—Lewkowitsch gives particulars. Linseed, two teaspoonsful taken whole with water for deficient bulk ir. intestinal contents in constipation.—W. Glegg, B.M.J. i./3i,206. Lonicera Periclymenum.—Common honeysuckle and L. xylosteum (flag honeysuckle).—(Caprifoliacecc) Flowers or berries are poisonous. Luetm.—An extract from the Locust Bean Kernel (Oeratonia Siliqua N.O. Leguminosae). Used largely in the manufacture of foodstuffs, and i& supplanting Gum Tragacanth as being more economical. To make a jelly oj mucilage add powder slowly to water, stir and boil. Lupulmuin. (B.P. 1898.) Bose.—-2 to 5 grains in pill. Yellow powder— lupulinic-glands—separated from the strobiles of the hop—Stimulus Lupulu : (Moracece). Aromatic and bitter, and contains resin and volatile oil. It: insomnia and for alcoholism. Inhalation 30 grains to a pint of warm water Has been used in gastro-intestinal diseases—enteric and dysentery. Shoulc be fresh. 5 to 15 grain doses. Stimulates the general and local circulation and improves the tone of the alimentary tract by its digestive properties.— Tincture (B.P. 1898). Bose.—£ to 1 drachm. Dried strobiles 1 in 5 alcoho (60%). More aromatic if made from fresh hops. Smoking the dried strobiles has a somniferous effect. Liquid Extract. Bose.—5 to 15 minims. An alcoholic extract, 1 = 1. Solid Extract by concentration. Bose.—2 to 6 grains Kent Hops contained 2-4% Tannin and 7-9% Ash, Choline, traces of a volatile alkaloid, l-Asparagine, Essential Oil and Resinous matter 14% Potassium Nitrate and Sugar.—P.J. i./i3,845. Hop-growing industry. Kent had 16,260 acres, Sussex 2,420 acres undes cultivation in 1925.—F. Gr. Hobart, P.J. ii./26,323. Lyconerdon giganteum.—Puff Ball. Forms a soft and comfortable surgical dressing. The dusty powder is a powerful haemostatic. This and other fungi as styptics. History of and uses. Heating in an oven to render aseptic does not reduce its haemostatic power. Troublesome bleeding W^3,437.th extracti0n can be 8t°ppeil With it. It is not poisonous.—B.M.J. diacSP°^4”aTin^oomlpreSji°J tbe ®!“1>moss Lycopodium clavatum (Lycopo- USw-j- fi?-e °* m Quantitative microscopy.—T. E Wallis BP Bonf rnm . Maidis stigmata. Syn. Corn Silk. The thread-likestismfataofnMrW iPcon“fneZnc£erUof urfn« T ?iure„tic- Used noe?uS innn ■ 6 °LuruV liquid Extract, Dose.—1 drachm. Infuse corn siik ,000 twice With water q.s. to cover. Evaporate liquor to 400 Cover anrl this l0withawate?^oali?vV t0 dfposit* ^er an(1 evaporate to soft extract. Of mis i, with water 10, gives a clear solution. A Svruv mav be made of r irmi.i iXSCt t “Sp!° Syr?p 1° 10.' El Maidis oSSSSMSif® Lafhaid Estraet “toP“hms.ln P‘aC6 °f “80t- ^-15 to 60 «rains- 7inr^p),Cwhieh" ffj11. °f the Brazilian root Brunfelsia hopeana Benth. (Sola- shomi it tn tfhn iuse^ m rh?umatic affections. Experiments have l -h-e gla/}ds’ especiahy the kidneys. Liquid Extract 1 = 1. wutf" q to 30 minims thrice daily.—N.S.D. It is frequently combined nn^i,So1Cy Jate?raS m tde foffpwmg. Elixir Manaca and Salicylates ; each SfllievlaefpU?9SaMaiiaCT*fm grain?.’ SoJiuni Salicylate 64 grains, Potassium Salicylate 32 grams, Lithium Salicylate 8 grains. Dose.—1 to 2 drachms. Mandragora. Mandrake. M. Autumnalis (Solanacece). lhe root is often forked and is sometimes similar to the human body in ®ffaPJy tt is poisonous with effects allied to belladonna. Conta ns an alkaloid Much confusion exists over the name Mandrake. The Mandrake, as pharma- cists understand the Museum specimens, is to be assoc ated with M. officinarum L. (this includes two varieties, a vernalis, p autumnalis — * European ’ Man- drake). English, or false, ‘ Mandrake 5 is Bryonia dioica. American Mandrake is 1 odophyllum peltatum. The late E. M. Holmes assisted with these data in determining the type of ‘ Mandragora ’ to be used for whooping cough, as suggested by a French writer (H. Leclerc, Bull. Gen. Therap., 1925, 176,78 I925,182). The assumption is that B. dioica was really needed. t .p • ^°^m.es went into the matter of Mandragora in detail. He concludes if Mandrake is asked for by a herb-using customer he should be shown Podophyllum Peltatum. He is not likely to ask for Byrony Root under that name, and if Tinct. Mandrake is asked for a doctor’s scrip should be required.’— P.J. L/30,127. See also ibid., p. 72. Manna, U.S. X. Average dose.—ounce. Saccharine exudation from Fraxinus Ornus, Linne (Oleacece), and other species. In flattish, somewhat three-edged pieces. Contains Mannitol {syn. Mannite, P. Ital., Ph. Ned. V.) (a non-fermentable sugar which does not reduce Fehling’s Solution), C0H8(OH)6 = 182-1092, to extent of 74% and Dextrin about 20%. Has mild laxative properties. The author has suggested this sugar as an ingredient for an iojection of Quinine ; v. ‘ Quinine-Mannitol.’ A report issued by an expedition of entomologists from the Hebrew University of Jerusalem states that Manna is not an exudation from the tamarisk tree, but is an excretion from the bodies of the coccid insects, the amount varying with the abundance or scarcity of the winter rains. According to the late E. M. Holmes this does not prove that the tamarisk Manna is the Manna of Scripture, wh ch occurs 011 plateaux in Central Africa, resembles coriander seed, is white in colour like hoar frost, sweet to ta3te, melts in the sun, and if kept overnight is full of worms in the morning.—C.D. ii./27,429. Maranta. Syn. Arrowroot Starch, from M. arundinacea {N.O. Maran- taceoe) is in some slight demand as an article of diet. 1 tablespoonful to the pint of hot water produces a demulcent mucilage. Florida Arrowroot from Zamia Floridana, A. De C. N.O. Cycadaceoe.—T. E. Wallis, C.D., 1923, p. 378. See also Ipomaa Batatu'i. Marrubium.—Horehound. Dried leaves and flowering tops of Marrubium Vulgare, Linne (Labiatae). Average dose.—30 grains. Given in lung affections —has tonic properties. Infusion 1 in 20 of boiling water. Mastich (P. Belg.), yellow, brittle, resinous tears obtained from Pistacia lentiscus (Anacardiacex): insoluble In water, but partly in Alcohol 90% VOL. I. E E also soluble in Ether 2 in Hand in Chloroform 2 in 1, also readily in Acetone. Alcohol Mastichi, R.D.H.—Mastich 2, Alcohol 90% 1; dissolve. Harvard Liquid is similar; this is employed for covering a cottonwood dressing so as to form a temporary dental covering, e.g., during the treatment of canals with an antiseptic such as Formosyl. Esther Copal is R.D.H. (Copal Solution). —Copal 1, Ether 1, dissolve. For covering cement fillings to protect from the saliva. Zanzibar Copal is a fossilised resinous body obtained from Tra- chylobium Hornoman nianum (Leguminosoe); Vateria indica (Dipterocarpeoe), Indian ; the Brazilian is from Eymencea species and other plants. Australian Copal is Gum Kauri, q.v. ^ . Microscopic Varnish. Mastich i ounce, Caoutchouc 15 grains, Chloroform 2 ounces ; macerate and filter. Mastix is official in P. Belg. . . Ph. Form, supplies an account of the use of this and other Resins m the manufacture of varnishes, polishes, lacquers, stains, etc. Benzo Mastiche. Syn. ^Mastisol (T.M. 524195).—A solution of Mastich in Benzol (with other ingredients) for wounds and general surgical use. It is stated to act as a harmless disinfectant by arresting the micro-organisms on the skin, etc., where applied—virtually entangling them. Its action is rapid and quite painless, excepting for a temporary burning sensation when first applied. There is no danger of eczema which has resulted with use of Iodine. The asepsis produced is absolute. Wethocf of use—In wound treatment the temporary first aid bandage, if any is removed and even it blood-smeared, is painted straight away with a sufficient covering of the preparation, and then a dressing applied. Slight injuries may have a layer of sterile gauze first to draw off the wound secretion. Previous washing, disinfecting with soap, Alcohol, etc., is not required. Useful in burns and corrosions of the 2nd and 3rd degree, the whole area being painted over and covered with cotton wool. . m . _ __ ,, , , . Housner’s Glue. Resin (commercial) 50, Venice Turpentine a, Methylated. Spirit, 50, Benzene 25. For applying extension in fractures.—C. Max Tage* B.M.J. ii./i7,290. The following have also been suggested (1) Dammar 250, Castor Oil or Linseed Oil 30, Benzol 100, Sodium Bicarbonate 50, Amyl Acetate a few drops. ^ A (2) Colophony Resin 300, Venice Turpentine 20, Castor or linseed Oh 10 Benzol 700, Sodium Bicarbonate 60, Amyl Acetate a few drops.—K. Dieterich p.j. i./i5,100. See also B.M.J. i./25,441, and MencRre’sSolutions. Spiritus Adhesivus Resinosus. P. Svec. X. Terebmthina (i.e., Common Frankincense from Pinus var. esp. P. pinaster—Solander) 7*o, Colopnony Resin 18*5 Alcohol (90%) 4. , , ,, Pistacbia Lentiscus Oil (Mastich Leaf Oil) contains Pmene ana probably other Terpenes. Has an odour resembling Rue and Savin Oils. Melaleuca Viridiflora (illyrtacece) — Indigenous to New Caledonia. * Gomenol (T.M. 215925.) Syn. Essentia ex Niauli, E.E. VIII. At French proprietary, is stated to be a distilled essence of, with Sp. Gr. 0-921 given in rhinitis, laryngitis, and other diseases of the respiratory system. I is also used in a variety of conditions as a general antiseptic. For injection purposes (chest examination) dilutions in Olive Oil are used, m strength varying from 0-5 to 5%. cf. Leucadol. . Gomenol 5% in Olive Oil used to replace a pleural effusion, harmless and © value. Liquid Paraffin has been used in man—it remains unabsorbed f© 14 months. Hard paraffin (M.pt. 39° C.) has been tried in raobits. F. €r Chandler and S. R. Gloyne, ‘ Tubercle,’ Sept., 1927. Oleothorax. Olive Oil or Liquid Paraffin, with 0-5 to 5% Gomenol (Oliv Oil preferable). Not an alternative to Pneumothorax. Must- never b attempted in a virgin pleural cavity. Disinfectant and compressing ac,,io on the lung. Chief indication in pyo-pneumothorax, when acute stage ha subsided. 5 or 10 Cc. maximum initial injection, increased to 30—50 Cc. at next1 injection, and subsequent doses doubled 01 trebled according to response Iniect bv Ju&et blood transfusion syringe or a 30 Cc. syringe using shoi TiPrMlle with 1 mm. bore. Warm the oil, and when treating effusions aspiratt first — H. M. Davies, L. ii./3o,203. T . a , ... QTV Pates Pectorales au Gomenol are also made. In influenza, broncnitis an corvza and with Vaseline Oil as Ear Drops. Pm Notes. _ .. , I Melissa Officinalis (Labiatce * Balm ’ was in U.S., 1890, Eau ae Melisse dd Cannes Syn. Alcoolat de M&isse compost, Fe. Cx. German Carmeht Oeist. Spiritus Melissa? Compositus ; digestive ; twenty to twenty-five drops twice a day, is also used as an application in rheumatism, etc. For history, see Edn. XVIII, p. 842. Mentha Pinerita (Labiatce) Peppermint. Oleum Menthze Piperita is distilled from the fresh flowering plant, Sp. Gr., 0-900 to 0-920. Soluble 1 in 4 of 70% alcohol. Should contain at least 50% menthol, free and combined, and not less than 5% of ester3. Spiritus. (B.P. T4.) 1 in 10 alcohol 90%. In coryza the use of this oil instead of menthol is advised. Warm a few drops and inhale. It removes headache from pressure in the frontal sinuses. It has been confirmed radioscopically that Peppermint, and in a lesser degree Fennel and Chamomile, has a sedative effect on the stomach and a mild stimulating effect on the intestines.—P.J. ii./26,680. Oil of Peppermint increases bile secretion ; Oil of Thyme does not. A 50% solution of camphor in Ethereal oils produces paralysis of the bile ducts for a long time ; a 20% solution in Oil of Peppermint produces paralysis for a short time, followed by polvcholia.—Per Jl. A.M.A. ii./25,711. Catgut is sterilised with the oil, see p. 533. Possibility of production of sufficient Peppermint Oil to meet all requirements within the Empire. Cultivation experiments going on in Cyprus, Tanganyika, Africa and Burma.—Imp. Inst. Rept., 1930- Men thee Viridis Oleum, is distilled from fresh flowering Spearmint. Forms a clear solution with an equal vol. of 85% alcohol, the solution becoming turbid on further dilution. (The turbidity is noticeable with a double volume of alcohol.—W.H.M.) Soluble 1 in 3 of 90% alcohol.—B.P. ’14, Menyanthes trifoliata. Syn. Trifolia Fibrina.—Bogbean Leaves or Buck- bean. Are bitter tonic, emmenagogue, antiscorbutic, vermifuge and febrifuge : large doses are purgative and emetic ; contain Menyanthin, a glucoside. Infusion 1 in 20. Dose.—2 to 6 ounces, taken hot, early in the morning daily, useful for functional amenorrhoea. Liquid Extract with Liquorice, 1 in 2. Dose.—£ ounce. The leaves are in P. Dan. Mesembryanthemum var., N.O. Aizoacece. A specimen submitted to us from South Africa (1927) showed the presence of a minute quantity of alkaloid, with Mayer’s Reagent, and a small amount of Tannin. Glucosides absent. A preparation of the plant has a local reputation in phthisis. A . tincture 1 in 10 of the dried plant in Alcohol 60% was prepared. Mesembryanthemum crystallinum is the well-known ice-plant of the gardens. Methyl Chloridum, CH,Cl = 50-4804. This gas made by distillation of Methyl Alcohol, Sodium Chloride and Sulphuric Acid is supplied compressed in cylinders. As local anaesthetic it is valuable in neuralgia, sciatica, rheumatism. Spray the part for 5 or 6 seconds only. If effect too strong, apply Glycerin. . , , . Intoxication occurring among workmen at refrigerating works employing Commercial Methyl Chloride. A toxic agent, cumulative in action and detected in urine as Ammonium Formate.—H. M. Baker, Jl. A.M.A. i./2 7,1138. See also T. M. Legge and H. B. Porteous, B.M.J. b/30,414,751. # Methylene Chloride. CH*C12 = 84-9306. Used as anaesthetic m Germany under the name of * Solaesthin.’ Unsuitable for complete narcosis, but may be used to relieve the pains of labour by a process of intermittent administration.—Pres., Sept.,’23,319. See also B.M.J.E. i./25,18. Mezereum. Dose.—8 grains. Dried bark of Daynne Mezereum (Thymelacece) and other species. Contains a crystallisahle substance (Daphnetm), which is isomeric with iEsculin (q.v.). Has been used as an epispastic for many years, and stimulant. _ _ ... Moil bum. Syn. Salve Soap-Tuna. Prepared by boiling Lard 400 with Caustic Potash 56 in Water 400 and Alcohol 90% 40. Allow to stand 12 hours at 50—60° C., then add Glycerin 150. A white soap, containing about 1l /0 excess of fat. As a basis for ointments for rapid absorption. It is readily washed off with water, with which it form3 a lather. It leaves the skin fresh and supple, and makes no grease spots on linen. MoUinum Hydrargyri and Mollinum Pofassii lodidi contain potassium iodide. Not incompatible with mercuric chi01 ide. Is used with respectively 3 to 5% of phenol and salicylic acid and thymol, and with birch tar 10 to 20% for psoriasis ; with 30 to 50% of sulphur or 10 /0 ot storax for acne and scabies—with 5% of chrysarobin ornaplithoi; ana with 10/0 uC ichthyoi, resorcin, iodoform, naphthalene or CP^white precipitate. E E 2 Monsonia ovata. A Cape Geranium. Is closely related to and used in same manner as Geranium Maculatum.—N.S.D. A South African plan used as a native remedy for dysentery. Tincture, 1 in 8, Alcohol (90%) Dose.—1 to 4 drachms every 3 or 4 hours. Liquid Extract 1=1. Dose.— 10 to 30 minims. In dysentery with excellent result. Must he used fearlessly as to dose. Effectual in 3 days where Ipecac, and Bismuth fail.—R. A. J. Asbury, L. ii./15,1318. Monsonia bifiora. As prophylactic to. haemorrhage in enteric fever at the seventeenth or eighteenth day, contains an active principle entericin—neither alkaloidal nor glucosidal. Dose.—i to 4 drachms every 4 to 6 hours. Mori S TC3U3.—Mulberry Juice. Dose— 1 drachm. The juice of the fruit of Morus nigra (Moracece). Mild laxative. Used in the form of Syiupus Mori. Mulberry Juice 20, heat to boiling point and filter. Dissolve sugar 36 in filtrate and add Alcohol 90% 21- to the liquid. Moschus (B.P. 1898). Musk. Dose— 5 to 10 grains. The dried secretion Grain Musk from the preputial follicles of the musk deer, Moschus Moschiferus (Ungulata). A useful nerve stimulant in cases of exhaustion in fevers and blood poisoning. Of value both for nervous excitement or nervous collapse. Is effective in obstinate hiccough and infantile convulsions. Mistura Mcschi. —Musk 5 grains, Gum Acacia 5 grains, Syrup of Orange 1 drachm, Rose Water to 1 ounce. Tincture, 1 in 20 Alcohol 50%. Dose.—1 drachm. A Tincture of Artificial Musk has been used in whooping cough. In cardiac failure of acute pneumonia it has been given with camphor in pill. We have known 10 grain cachets to be successful in pneumonia. A powerful heart stimulant. 1 grain with 1 grain of quinine m a pill every four hours. Worth trying in influenza.—A. Ransome, B.M.J. i./10,307. The odour of Musk is due to muskone Cj5H2rO or ClfiH30O. The butyl derivatives of many aromatic nitro-hydrocarbons are sold as Artificial Musk. Musk Baur is trinitro-meta-butyl toluene C6HCH3(NO C(CH3)3 Musk,’Civet and Castor. Notes on the chemistry of these aromatic anim ■ secretions.—C.D. U/30,288. . . Muira-Puama.—This drug, which comes from Brazil, has been described as belonging to Lirioswa Ovata. Miers (fanr. Olacacece). It is said to contain an alkaloidal crystalline substance (we could not confirm this), an amorphous^ bitter substance, a little fat, and two kinds of resinous acids.. Brazilian drugs,; vary however. It has an irritating action, also tonic aplircdisiacal propcities.. Used in nervous disorders. _ _ , , P'lula Potentin Composita.—Martindale, contains Muira Puama Extract 1 grain with Ovolecithin 1 grain. A useful nerve stimulant and aphrodisiac. Dose.—3 to 6 per diem before meals. Myriein. Dose.—2 to 5 grains. The powdered extract of Myriea Cerifera. An astringent and stimulant, and in large doses, emetic. For diarrhoea and jaundice. . _ . . , » Mydstica, Nutmeg (B.P. T4). Dose.—5 to 15 grams. Dried seed df Myristica fragrans (Myristicacecr) with testa removed. Aromatic ami carminative. Contains Nutmeg Oil. Syn. Oleum Nucis Moschatse. Dose — 4 to 3 minims. Colourless or yellow with Sp. Gr. 0-870 to 0-925. Solubles in. 3 volumes of 90% alcohol. Has properties representative of the seeds.. ihe expressed or concrete oil of nutmeg of yellowish colour contains Mynstinn.. CioHldO, = 206-1092. It is occasionally employed as a gentle local stimulant- Spirit of Nutmeg. Dose.—5 to 20 minims. Poisoning by nutmeg—thieff cases.—B.M.J. i./og,K)05. Although Oil of Nutmeg and Mace only cause fatal poisoning in a rabbit in doses of 10 to 12 Cm and a single nutmeg 1 capable of producing serious effects in man, it should be remembered.that Oil of Nutmeg is very variable, some containing hardly, any mynsticm. The narcotic property of Nutmeg is attributable to myristicin, and it appears from experiments on animals that this substance when associated with the other constituents of nutmeg is more readily absorbed than when in the pure state Nutmeg does not appear to contain any other substance of physiologica action on animals. Linimentum Myristicae L.H.—Oil of Nutmeg 1, Olive Oil 3. . . Terpeneless Nutmeg Oil, 1 is about equivalent to o of the original Oil Ce^atum Nucistae. Syn' Muslmtbalsam. Stomachic Balm. w‘ Yellow Wax 2 Arachis Oil 1, Oleum Myristicse G, melted together and strained and moulded into tablets—used for rubbing abdominal region in infants (Hager). Myrrha (H.P. *14). Dose.—-5 to 20 grains. Yellowish or reddish gum resm from Commiphora Myrrha, Off. (BaUamodendron Myrrha, B.P. ’98), and other species. Soluble in water to the extent of about 50% (forms whitish emulsion on trituration with), the remainder being mostly soluble in alcohol 90%. It is soluble in alkalis, e.g., Potassium Carbonate. A favourite constituent in mouth washes, e.g., Tincture of Myrrh and Borax, 1 of each in Eau de Cologne 20. Nitric acid should give with genuine myrrh a transparent dirty yellow liquid. False myrrh may give a bright yellow solution and bdellium is not dissolved. Tincture (B.P. T4) 1 in 5 alcohol 90%. Flavoring. —Glyl or Syl Menthse Piperitse or Lavandulae ; Extractum Glycyrrhizae Liquidum. For description of the literature of Myrrh, see E. M. Holmes, P.J. ii./i3,116. Myrtillus (Vaccinium Myrtillus).—Bilberry or whortleberry, the Blueberry of Canada. An extract or jam has been employed with good results in dysentery, and has been painted on the tongue in stomatitis. It is said to be of great value in typhoid, rendering the intestine aseptic. Suppositories containing 1 Gm. of the extract, and a liquid extract 1=2 of bilberry are prepared. An enema is also used. Dose.—2 ounces p.d. The fruits are in P. Austr. In chronic colitis the preserved juice and the liquid extract of the berry are excellent.—G. W. Major. Myrtol.—A constituent of myrtle oil; has been recommended in putrid affections of lungs and air passages. Expectoration lessened, but no effect on bacilli. Dose. -5 to 15 minims on sugar. Capsules contain 2 and 5 minims. Myr tiffin prepared from Blueberry Leaves by extraction with Alcohol 6% and the protein removed by precipitation occurs as a yellowish white powder freely soluble in water. It has been given per os to build up tolerance when the blood and urine have been made normal with Insulin or diet, and although less prompt, powerful and certain than Insulin it deserves clinical trial.— E. M. Allen, L. ih/27,18. See also Pres., Feb., ’28,62 Overdosage with Blueberry Leaf Extract is without detectable effects and its use in diabetes is therefore without undesirable effects.—L. B. Shipinor, Ji. A.M.A. ii./29,950. . EJNarceiiia.—023H27NO3,3H2O =499-2654. Dose. $_ to 1 gram An Opium Alkaloid soluble in alcohol, hardly m wa„er. Hypnotic sedative 9f doubtful utility. [jHNarceme Hydrochloride is m Ph. Ned. V Action is similar to morphine, but is not largely used in medicine. . Nasturtium Officinale (Cruciferae). Syn. Watercress. Held m considerable repute for supposed medicinal virtues, e.g..., in treatment of chlorosis of young o-j ris and in ulcers, for centuries past. Xenophon advised. Persians to feed child’ren on watercress to improve growth. Animal experiments confirmed improvement of growth. Striking improvement in general condition and m amelioration of chronic constipation in patients fed on watercress in 1 oor Law Institutions. Found to have retarding effect on growth 0f experimental cancer * suggested due to Vitamin content, but more probably some other factor. A alucoside, in the form of a Potassium salt, found present m plant. Also contains Vitamins A especially, also B and C and salts of Potash and Hon and considerable amount of Iodine.—S. Monckton Copeman, P.J. 11./2 5,386. Na shirt i Officinalis Dose.—2 to 4 draenms. . Thetre?Suice of the plant, obtained by thoroughly pounding.and pressing j -J.T -1 Phlnrnfnrm ftddpd to 400 pstrfcs. OP ill liofc W6cittl6r /o spirit. Oontlns thetalk^ o Te Chlorophyll o?f the leaf, also salts of Potassium Iron^and Iodine. See also an interesting experiment on the subject of preservation, p. 499. . , , __ Unguentum Nicotinse.—1 % in Adeps. Lan^ . n n r . =162-1252 smoking or snuff) containing f iJh) volatile alkaloid rom 0-5 to 5% combined as Malate or Citrate. The minimum fatal dose of Nicotine intravenously for etherised, dogs is 5 mgm. per kilo.—J. E. Thomas and F. E. Franke, Jl. Pharm. & Exp. Therap., Oct. *28,134 A solution of Nicotine in water can be detoxified by exposure to Ultra- Violet Rays.—A. J. Pacini and II. McGuigan, Jl. Pharm. & Exp. Therap., June, *30,244. Post encephalitic Parkinsonism treated by Nicotine. Cases which may benefit are those where voluntary muscular control is intact, but movement is hampered by excessive plastic tone. Nicotine base is used. Signs of intolerance are nausea, fainting, tachypnoe, and are watched for. Patient is kept in bed. Initial dose ■£% grain ter die. If no appreciable change in pulse chart, the dose was increased to A, or J grain ter die. Immediate results indisputable. —H. Moll, B.M.J. i./26,1079. Infusum Tabaci 1 in 20 has been ordered as an ingredient in a hair lotion thus.—B.C.D. i./i5,363. References to Tobacco.—Toleration to Nicotine. Normal animal tissues have the power to destroy a small quantity of the alkaloid. There is evidence to show that the destruction of the Nicotine is brought about by ferment action.—W. E. Dixon. Somewhat similar toleration is that of Alcohol and Morphine. Perfusion of the heart with Nicotine, animal experiments.—L. ii./i7,759. Nicotine nearly equals adrenalin in power of raising blood pressure. Tobacco must be barred where raised high tension indicative of danger. The influence of Tobacco as cause of arteriosclerosis, cf. p. 574. The Lancet Laboratory conducted an enquiry into the toxic factor in Tobacco. Pipe mixtures contained the largest amount of Nicotine (2-04 to 2-85%), Egyptian, Turkish and Virginian cigarettes came next with 1*38 to 1*8%. A British cigar contained less (1-24%) and a Havana cigar least of all (0-64%) The cigarette (from any tobacco) yields least of its Nicotine to the smoke, while the pipe yields a very large proportion (70 to 80% in some cases) of its Nicotine to the smoke reaching the mouth of the consumer. Cigarette smoke contains, however, Furfural (a harmful substance) especially the cheap Virginian cigarettes—this is practically absent in the smoke both of the cigar and pipe. Further the cigar, pipe and Egyptian and Turkish cigarettes all yield Ammonia, which is an antidote to Furfural and Aldehydes generally. The cheap Virginian cigarettes contain very little Ammonia. Tobacco 100 Cm., as cigarettes, yield when burnt in conditions approximating those which occur in smoking : HCN 0*08 Cm., Pyridine 0*146 Gm., Nicotine 1*165 Gm., NHS 0*36 Gm., Carbon Monoxide 410 Cc. (No CO is produced in Opium smoking.) . Ordinary Virginian tobacco, from which cigarettes are made, contains \ weight for weight nearly twice as much Nicotine as Manila cigar tobacco, but when burnt during smoking the smoke from the cigar contains more than twice the amount of Nicotine as that from the cigarette. Generally speaking, most of the Nicotine in smoking is destroyed during- combustion. Carbon Monoxide poisoning liable to occur from cigarettes in excess. All the symptoms are in evidence in the man who smokes 20 cigarettes, s a day.—Prof. Dixon, B.M.J. ii./2i,819 ; L. ii./2i,1071. Carbon Monoxide in tobacco smoke. The amount varies according to rate; of smoking. In general, a normal sample of cigarette smoke will contain, between 0*5 and 1 % of CO. A cubic foot of straight coal gas contains as much CO as 4 cigars. CO may apparently replace oxygen in the blood without^ serious harm.—Prof. H. E. Armstrong, B.M.J. i./22,992. Anti-cigarette League in Chicago made some exaggerated statements re- Cigarettes—L. ii./2i,927. Increase of cigarette smoking.—B.M.J. W3<v09. Chronic Nicotine poisoning from tobacco on the arteries, heart, eyes, etc. far worse than Opium and Cocaine evil—probably victims number 1,000 to 1 of the latter.—W. V. Furlong, B.M.J. i./22,862. „ . - Tobacco (a well-known and popular cheap brand) dust, used as snutt, iouna to contain 0*66% of solid Cannabis Indica, caused poisoning symptoms. R. L. E. Downer, B.M.J. ii./23,521, ibid., 586,590. Tobacco smoke is powerfully germicidal, containing inter alia Pyridine, s potent germicide. It rapidly destroys the cholera vibrio and the bacilli ol- pneumonia. Nicotine is as toxic as Potassium Cyanide. A cigar weighing 6' Gm. and containing 5% Nicotine kills, if eaten. 100 cigarettes smoked in one day may cause death. About one-third of the nicotine contained appears in smoke, and much is left in the last part of the cigar. Moist tobacco is worst, no Nicotine being destroyed.—Per Jl. A.M.A. ii./25,314. Average Nicotine content of ordinary Tobacco products in TJ.S.A. is 1-77%, and of “ denicotinised ” 1-28%.—Jl. A.M.A. ii./.28,583. Nicotine content of Tobaccos varies. Certain of them contain only § to ^ of the quantity present in a high Nicotine brand.—L. i./29,1313. Denicotinised Tobacco. Analyses by the Lancet showed that the Nicotine, with one brand, has been reduced by 10 to 20%. Physicians are warned not to recommend denicotinised Tobaccos without further evidence than manufacturers’ assurance, since in Germany some samples were found to have more than the normal content of Nicotine.—L. ii./25,32. German view of Nicotine. German brands of so-called Nicotine-free cigars gave upwards of 420 and 320 mgr. per 100 Gm.—presumably in smoke. Nicotine deadly to adolescents.—Prof. Kionka, L. i./26,563.. IVlQcticctS As&oots of Tahc&oco—a, good historical summary. A ‘ drug of addiction ’ only in a humorous sense but hardly accurate. Psycho- 1 ogical tests on medical students show that smoking lowers mental efficiency in 10 to 23%, especially in imagery, perception and association.. Effects on the heart described. Effect on athletics doubtful. The irritating effect on the throat ascribed variously to Eurfurol, Pyridine and Ammonia—not to Nicotine.—Sir H. Rolleston, L. i./26,961. The Effects o! Tobacco Smoking. , , (a) On the digestive system.—Sir H. Rolleston ; (b) From the nervous and mental aspect.—Sir R. Armstrong Jones; (c) The physiological effects.— Prof W E. Dixon, Pr., Jan., *27,1—28. See also W. E. Dixon on the habit. —B.M.J. ii./27,719. mi , , 128 000 000 lbs. of tobacco are consumed here every year, there is marked physical deterioration of the Dutch people. The consumption of tobacco m Holland per head has trebled in the last 50 years and is now eight times as great as that of the average European.—B.M.J. ii./26,265. I Nicotine Salicyia.e, crystals freely soluble in water. 1% Ointment m skm affections useful. IPT 5k ‘ X L AH* (T.M. 350770, cl. 3). Fumigator contains Nicotine 37-5/o. It {s an Agricultural and Horticultural Poison. See note under Arsenic. Has CaA^MX)rcUngI!to^'Solliiiann6,am/*Han2lik,s “ Experimental Pharmacology ” (1028) the poison produces a very complex mixture of effects successive stimulation and paralysis of a variety of central and peripheral structures, and amongst these stimulation and paralysis of the receptive mechanism of 8tAPIolutionof one ounce of Nicotine in ten gallons of water is used as an insecticide for hop-spraying-500 gallons are used per^cre It iBtte best incppfiHde as it kills apple and plum aphides. It is also used as a sneep dip. _0 D The addition of Saponins to Insecticide Emulsions is an advantage. virifio (Labiatce) Ba«il Plant so called Mosquito Plant—was thought to have repelling effect on Mosquitoes. Others say that it neithei repels nor attacks, in fact the mosquitoes just ignore its presence. The Oil from New Caledonia plant contained 18% while Oil from West Africa contained 32 and 52 /0 xhymoJ, to wmcn enect ^ \ TJtvhplIifercp) Water dropwort—the most dangerous and virulently6poismious^^all^British native plants. It contains no. alkaloid Contains^ ellow essential oil with unpleasant odour and \ stem^ias - dropwort. Poisoning from, due to Coniine content.—L. i./3X,1309. 1;i tto jr Hose—S- to Oleum Crot°ng 14)- sfngle dose 0-05 Gm. ( = 1 minim approx.). 1 nunmi.. FR. Cx. gives max. single aos Expressed from seeds to 0-900. Soluble in Ether and in Olive Oil. A powerful skin irritant, will blister, and even cause suppuration and scarring. It has been found possible to immunise animals to the poisonous effects of Croton Oil by gradual increasing dosage of ‘ Crotin.’ Has been employed for tinea. The liniment well diluted may stimulate growth of hair on bald patches. Also used as a counter-irritant, but may produce powerful inflammation. In pneumonia of great benefit. Internally so violent a purgative that it is rarely given except to lunatics for obstinate constipation, and in cases of apoplexy (one or two drops placed on the back of the tongue). May be given as Compound Castor Oil Capsules, q.v. Antidotes.—Olive Oil or milk as diluent. Opium to relieve pain and irritation. Oleum Crotonis Compositum. Mix Blistering Liquid B.P. C drachms and Almond Oil 1 ounce. Allow Acetone to evaporate and add Croton Oil 40 minims. Used as a paint once a wreek in whooping cough—a success.'—W. J. Midelton, B.M.J. i./23,746. Anon Arrow7 Poison is believed to be a paste made by pounding the soft parts of Croton Tigilium : refs., 17th Edn. Croton Gubouga.—Has a reputation in the Eastern Transvaal as a remedy for malaria. The seeds and bark have been used. Prof. Greenish, P.J. ii./i8,. p. 289, found an acrid constituent. Oleum Croton Elliottiani s, to re called ‘ Oleum Elliott * to distinguish: from Croton Oil. Dose.—1 to 3 minims. Capsules are prepared containing: 4 minim in each. Dose.—Two capsules at night for laxative effect. It must* be given in capsules—three to five for purgative effect. The oil of the seed of this East African plant has Sp. Gr. at 15° C. 0-9242 to 0-9246, Acid value 15-5 to 15-9, Saponification No. 188-5 to 189-4, Iodine Value 143-0 to 147-5. The yield of oil from the seed is about 30%. Further on medicinal action, see J. Thecdore Cash and W. J. Billing Jl. Pharm. and Exp. Therap., Vol. VI, No. 2, Nov., 1914, and our Edn. XVIII,, p. 847. Oleum Graminis Citrati (B.P. T4). Indian Oil of Verbena or Lemon Grass. Distilled Oil from entire herb. Carminative, vTith agreeable odour contains Citral, Citronellal, etc.—E.P.I. i./243. O’eum Rhodii.—The source of ‘ Lignum Rhodii ’ of the older writers ha& never been accurately determined. One writer says the wood wras brought? from the Canary Islands, e.g., the w-ood of Convolvidus Scoparius and Con->, volvulus Floridus. Another suggestion is that the vrood used was Genistc* Virgata or G. (now Cytisus) Canariensis.—E. M. Holmes, P.R., Eeb., 1911. Oleum Rosae. Syn. Otto or Attar of Rose. Distilled from the fresh flowers- of Rosa damascena (3,000 yield 1). For Characters and Tests, see Vol. II Rosettol.—An artificial Otto, probably more penetrating than the natural oil It is entirely free from Stearoptene, i.e., is fluid at ordinary temperatures - Liquor Rosae D ilcis.—Otto of Rose 8 drops, Carmine 2 drachms, Potasl Solution 4 ounce, Alcohol 90% 4 ounce, Glycerin to 10 ounces. Ph. Point uses Syrup, but w7e find glycerin much better—no deposit. Useful for scenting and colouring pharmaceutical and toilet preparations. Pelvis Rosae Ccm posltns. Dose.—Ad libitum. Oil of Rose and Chloroform of each 1 (od> combined 4 drops), Acacia 145 (grains), Sugar 840 (grains), Solution of Carmin 13 (drops). Useful to dilute powders such as Calomel, Grey Powder anc Jalapin, also to colour and flavour mixtures—4 or 4 ounce in 6 ounces. Cnguen turn Aquae Rosae (B.P. ’14). Syn. Ceratum Galeni : Unguentum Galeni Cold Cream. White Beeswax 18, Almond Oil 61, Borax 1, Rose Water 2G Otto of Rose 0-1.—E. W. Lucas, B.M.J. ii./i3,1013. Ung. Aquae Rosce, P.G has Syn. Ung. Leniens Alb. A suggested formula for Cold Cream :—Liquid Paraffin 61, Cera Alb. 1£ Rose Water (undiluted) 20, Borax 1, Perfume q.s.—H. Stanley Redgrove P.J. i./30,427. Oleem Sesami. Syn. Benne Oil, Gingelli Oil, Teel Oil. Expressed from S. indicum (Pedaliacece). Saponification No. 189—193, and Iodine No. 103 to 114. Samples examine'* varied between 87 and 110. It has Sp. Gr. at 15° C. 0-920—0-924. Solidifyin point 4° C. It does not readily turn rancid, is easily saponified even by col- process, is a semi-drying oil, neither gummy nor sticky, readily absorbec It is thinner than Cotton Seed Oil. It may be used instead of Olive Oil in various parts of the Empire.—B.P. T4 EmulsioOlei Sesami. Sesame Oil 600 Gm., Water 300 Cc., Solution of Sodiur Hydrate (Sp. Gr. 1-33) 6 Cc. Bose per diem.—2 to 3 ounces. Used by Prof. Arloing in the treatment of diabetes. Origanum Majorana (Sweet Marjoram) and 0. Vulgare (French Codex, Common Marjoram) (Labiatce) have been used medicinally. Value is attributed to the essential oil contained as an aromatic tonic. A number of varieties of Origanum are distilled in various parts of S. Europe. Full data Edn. XVIII, p. 848. Carvacrol occurs to the extent of 80% in some, whilst Thymol preponderatesjn Thyme Oil. The latter in commerce is often called Origanum Oil. As a remedy against hookworm infection, Carvctcroi has been suggested in U.S.A. Its cost (made from Turpentine) would be low. It is liquid at body temperature, hence would come in close contact with the intestinal wall. Experiments showed it has about same toxicity as Thymol.— A. E. Livingston, Hyg. Lab. U.S. Pub. H. Serv. Abst., C.D., June 24, ’22,817. Originim Vulgaris.—Essential " Oil from various parts of Italy. From Sicily the yield was 1T06% by distillation, and 2-88% by Acetone extraction. It contained 50% of Thymol.—Y.P.B., 1922,78. Pastinaca Sativa, also known as Peucedanum Sativum, Wild Parsnip, rubbed on the skin caused blisters. Cured by solution of Tannic Acid.—E. Saville Peck. P.J. ii./3o,219,239 ; see also Y.B.P., ’20,173. Pceonia Officinalis. The red peony of the gardens. The root has acid taste. The Greeks possibly used it as a wound-dressing.—Sir Chas. Ballance, L. i./2o,5. Pareira (B.P. 1898). Average dose.—30 grains. Dried root of Chondro- dendron tomentosum. Uses.—Similar to those of Buchu. Employed in chronic inflammation of the genito-urinary tract. Extracturn Pareirse Liquidum (B.P. 1898). Bose.—4 to 2 drachms. Extract the Pareira Root with boiling water. Evaporate the liquor until it contains 33^% extractive matter. Add to 3 volumes of such, Alcohol 90% to produce 4. Passiflora Cerulea. Tincture made by macerating the crushed flowering herb in an equal weight of 90% alcohol used in insomnia. Bose.—30 minims at bedtime. The leaves contain a notable proportion of Prussic Acid.—H. Leclerc, Bui. Gen. de Therap., P.J. ih/20 220. n. _ .. , Patchouli —Genuine Patchouli is from Pogostemon Patchouli (Bell) Labiatce. The yellow’volatile oil is contained in the glands in the epidermal cells, in the hairs and in the central leaf tissue. The chief supplies of the leaf come from the Straits Settlements, and recently from the West Indies. Description of various Patchoulis of Commerce.—Java from Pogostemon Heyneanus, Khasia from Microtsena Cymosa, Chinese M. Robusta, etc. Contains Cadmene 40 to 45% and Patchouli Alcohol.—E. M. Holmes. . pectin_A~complex carbohydrate contained mrmany fruits and vegetables. It has a 'sweetish, glutinous taste. It reduces Fehling’s Solution before hvdrolysis, i.e., as such. When boiled witlUsugar in acid media it forms a ieflv Pectin is used extensively in the manufacture of jams and jellies. Pectin-Sugar-Acid Gels can be obtained with 0T25% Pectin, but jams usually contain 0-5 to 1%. For 1% Pectin the lower limit for sugar content is 50 /0, and the higher 75%. Less than 66% sugar grows moulds and yeasts. Gooseberry juice, apple and lemon, are used commercially as additions where the fruit is not rich, e.g., strawberry, cherry, raspberry, blackberry, rhubarb. # S Back P T ii /31 44. A colourless solution of Pectin termed Certo is sole! for’ domestic jam-making and reduces time of boiling. The optimum noiditv is uH 3-2—3-6.—P.J- n./3i,294. Pectin manufacture.—P.J. n./29,388. Pectin, on treatment with alkali, yields pectic acid, methyl alcohol and acetone. The methyl alcohol found in rum is attributed to the decomposition of the pectin of the sugar cane, and the methyl alcohol and acetone present m cider orp derived from the pectin of the apple juice. . AiZZlvectul— A colloidal isotonic solution of Pectin for use m hemorrhage. Islon-toxic by ingestion up to 80 Cc. 1% solution, and has no contramdica- UOp.Spo T? S—Ripe s“d°ofCumrbu'aPwo (CucmUtaceu), Pumpkin Average i ounce Said to be a good remedy for tapeworm, given before break- £aph£S'RadiatS^-The&uitf c^Vby The Malays Katjany-idgo beans hSloSnSeC “h 8Phi.okidzin. A glucoside from various rosaceous trees, in pinkish-white crystals, sparingly soluble m water in alcohol 9U% 1 in 4, and in ether, and induces artificial diabetes (glvcosuria) in doses of at least 15 grains. The drug is a valuable mild tonic suitable for children; a substitute for quinine. Lose.—Tonic 5 grains, Antiperiodic 15 grains. Diminished Phloridzin glycosuria indicates disease of the kidney, and complete absence of sugar should be regarded as a sign of advanced renal disease.—L. i./o7,717, see also Vol. II. Phytolaccin. Dose.—1 to 5 grains. Extractive from Phytolacca Decandra, Poke Root (Phytolaccacece).—U.S. VIII. Has emetic, cathartic and alterative properties. Has been used in rheumatism and syphilitic affections. A tincture 1 in 10 alcohol 45%. Dose.—3 to 10 minims. Fluidextract, U.S. VIII., 1 = 1 by Diluted Alcohcl. Average dose.—Emetic 15 minims; alterative 1^ minims. Locally for painful mammae. ^Pichi —Leaves and twigs of Fabiana imbricata ; useful in gravel and some kidney diseases. Liquid Extract. Dose.—10 to 60 minims. Has given good results in gonorrhoea and cystitis and complications. Picrorhiza (B.P. ’14). Dose.—10 to 60 grains. Dried rhizome of P. Jcurroa. (.Scrophulariacece). Toniu, antiperiodic, aperient. This and Amphicome Emodi are called Kaur. Inferior to quinine.—I.D.C. Extraction Liquidum. Bose.—15 to 60 minims. 1 in 1 Alcohol 60%. Tinctura. Dose.—£ to 1 drachm. 1 in 4 Alcohol 45% (was 1 in 8). [S^Picrotoxnum (B.P. 1898). C45H50Oi9 —S94-39. . . lUn&e.—A* to As grain. Er. Cx. Max. single dose.—& gram, max. during ’single dose.—As. Dose. loo w 25 ^.V. ~ — . — -• ax — , , . J 24 hours TV grain approximately. A neutral crystalline principle obtained from the fruits of Anamirta paniculata (N.O. Menispermacece.)—or Cocculus Indicus (growing on the Malabar Coast); does not form salts. Nearly entirely soluble 1 in 330of water, and 1 in 13 of alcohol 90%, and about 1 in 500 of fats • its taste is bitter. The substance is thought to be a compound of Picrotoxinin with M.pt. 201° C. and Picrotin 249° C. The combined substance melts at about 200° C. Lsevorotatory, a -29-26 at 16° C. (Absolute alcoholic solution of 4-1 Gni. in 100 Cc.).—Er. Cx. Gives good results in checking night-sweats (does not like Atropine cause dryness of the throat), also employed in epilepsy and chronic alcoholism : overdoses cause stupor, delirium and convulsions (by acting on the medulla) It increases the secretion of the mucous and perspiratory glands. Its action in checkin^ night sweats is explained by Cushny as probably due to its increasing the respiration and thus preventing that stimulation of the nervous mechanism of perspiration which occurs through the partial asphyxia. Antidotes.—Administer emetics, use the stomach tribe, then give Chloral and Potassium Bromide, then stimulants. _ „ . ('p'lHvDodermic Injection.—1 in water 3o0. Dose, o to 6 minims. CP)Liquor —Picrotoxin 1, Glacial Acetic Acid 30. Dissolve and add Distilled Water to *250. Eilter. Dose per os— 2 to 12 minims in water. Is palatable and keeps in solution at all temperatures. , , . . , , , g)PiU5 of A, A, A, or T,U grain form suitable doses for checking night- sweating of phthisis taken for 2 or 3 nights successively. The drug is slightly cumulative may thus be temporarily stopped with effects persisting. A pill of Picrotoxin A grain, Atropine grain with Agaricin gram, is said In addition to the body Picrotoxin which (recurs m the seed only, the tasteless alkaloid Menispermine has been found in the pericarp of the fruit. Structure of Cocculus Indicus. Sections of fruit and seed.—T. E. Wallis, 1 Pimento^Allspice). Dried full-grown unripe fruit of Pimenta officinalis■ (Mvrtacece) From W. Indies. Oleum Pimentae. Dose.—£ to 3 minims Sp.^Gr. 1-030 to 1 055 O.R., 0° to—4° ; R.I. 1,508 to 1,535 ; Soluble 1 in 3 of i 700/ alcohol Eugenol content not less than 60% by volume. Stomachic and antispasmodic.—Put into hollow teeth to relieve pain. A snuff composed of Powdered Pimento with addition of 3 minims of Eucalyptus Oil to the ounce is advisea for hay fever to promote a healthy discharge of pituitary mucus in which the pollen grains are killed and washed away. The allspice is a local stimulant and antiseptic Pimento Leaf Oil contains 89% Eugenol. Pimis Canadensis —The hemlock spruce of the U.S.A. Syn. Abies Canadensis A fluid extract Is used as an astringent in leucorrhcea; and given internally for diarrhoea, haemoptysis, and night sweats. Dose.—10 to 69 minims, also a distilled colourless variety in commerce. Pirnis Strobus. White Pine of America—the Syrup of the bark in that country enters frequently into Cough Syrups. Piperina. Ct7Hi90#iSr = 285*1562. Dose.—1 to 10 grains. A crystalline principle from the fruits of Piper nigrum and Piper longum (Piperacece). Melts at 130° 0. (266® F.). Insoluble in water, soluble in alcohol. It has febrifuge, stomachic and antiperiodic action. Oieoresina Piperis. Average dose.—\ grain. Is prepared by acetone extraction of pepper. Piscidia Erythrina. Jamaica Dogwood (where it is used as fish poison) Extractum (Alcoholic) from the bark. Dose.—2 to 5 grains, and Liquid Extract 1=1. Dose.—20 to 120 minims. In neuralgia, toothache, bronchitis, pertussis, insomnia, and dysmenorrhoea. Pistoia Gout Powder.—Several authorities give Bryony Root 2£ drachms. Gentian 2£ drachms, Chamomile 2| drachms, Colchicum Root 5 drachms, Betony Root 10 drachms. Mix and divide into 365 powders. Dose.—1 to be taken each day of the year in a full glass of hot or cold water.—Ph. Form, Have also been advocated for rheumatism. Platinum, Pt. = 195-2 Sp. Gr, 21-5. This metal is capable of being heated to very high temperature without melting. It resists all acids except Aqua Regia and is hence used to make analytical apparatus. Platinic Chloride PtCl42H01 + 6H20 = 518-0512. Precipitates Ammonium and Potassium from Solutions. Solution of Platinic Chloride (B.P.T4) is 5% in water. Has been given in syphilis in § to £ grain doses. Potassium Chloroplatmite K2Pt014. Crystals soluble in water. “Used in photography in acid toning baths. Potassium Chloroplatinate K oPtCl6 is almost insoluble. It is the compound resulting in Potash Estimations. Rhotanmm An alloy of the rare metals with properties similar to those of Platinum. * Used for making crucibles, dishes and the like, for analytical laboratory purposes. _rT Po’ygomim Hydro-piper L. (Polygonacece) Water Pepper, Has been used for dropsy and the allied P. Aviculare for difficulty in passing urine—both have some action on the kidneys. Popuiin.—Benzoyl-Salicin. From Populus tremuloides (Sahcac^oe) ^ Dose. —1 to 4 grains. Has antipyretic properties. P^iTnula» Gbecnica causes acute dermatitis in susceptible persons. A„ J. Paif_l i /21 427. Dermatitis venenata produced artificially by rubbing Primula Obconica leaves into the scarified skin—R. Cranston Low, B.M.Jj ii./2i,559. See also A. Whitfield, L. ii./21,61. Prum Virginians Cortex. Syn. Wild Cherry Bark. The bark of Primus serotina (Rosacece) contains amygdahn. It possesses bitter tonic properties, with more or less sedative ones. The preparations in use_the tincture and syrup—are used to palliate the cough in phthisis, pertussis and bronchitis, in palpitation of the heart, and debility of the digestive organs. The Syrup is also a useful flavouring ageno. . . . t> i rDO^frhirs (DP '14). Dose.—30 to 60 minims. Virginian Prune Bark, approx? 1 in 6. 10% Glycerin approx, used as an addition. ®Syrup (1UV14). Dose.—l to 1 drachm. Virginian Prune Bark, 15 A, ®Syrapas BeYd?aehm.HSatQurato0Distiiled Water 10J with Benzaldehyde, dissolve Sugar 15 to the liquid, and add 0 01 per cent, of Hydrocyanic acid.— ^ l4oraiiUcoryliioiia (N.O. Leguminosce). The seeds are in use in India as remedy for sldn diseases. The oil of this species is advocated tor use in leuco- derma (white leprosv).—J. C. Ghosh, P.J. ii./2o,o4, . o in Psyflii Semina.—The small dark brown seeds of P. puheana fr m S. Europe. The best w etv is said to be Piantago Psyllium L. or Fleawort, known locally oo ‘ rlwnwiiaintain ’_H B Figg, P.J. i./3i,29. The testa contains a large amount'of mucilage.’ A Mucilage or Decoction lh% is employed In France a demulcent chink similarly to the Ispaghula preparation In India. The SeMinrSSd Compound!-iC°cSar preVniJxon^rSistmTV a 50% ^ Svn. Santalum Kubruin U.S. X. Heart-wood of Pterocarpas sanlaliims (Legummosm). Contains santahn, and’is used as a colouring agent in compound tincture of lavender. Fulegium Pennyroyal (Labiates). Oleum Pulegii, Oil of Pennyroyal Dose.—I to 3 minims. Sp. Gr. 0-927 to 0-962. Rotation + 13° to + 35° ‘ * It comes from Spain, S. France and Algeria, and contains 80% Pulegone — Encourages menstruation—administered in form of a hot tea at bedtime. !s reputed to produce abort on. This is distinct from the oil passing under that name m U.S. VIII., i.e., Oleum Hedeomae from Hedeoma Pulegioides (Labiatce) indigenous in X, America, which has similar properties. It is similar m composition.—ibid. Poisoning by Essence of Pennyroyal—4 drachms taken—caused delirium and Camphor taste m the mouth. Hot tea given produced profuse vomiting. As a general treatment give an emetic and avoid Alcohol. Pulque is the fermented sap of Agave Americana and A. Mexicana (Amarylli- dacece). See Edn. XIX., p. 879. Aguamiel Ph. Mex. \. is from the stem of Agave salmiana. in which inflorescence has been prevented by cutting off the flowering parts. Popularly used locally as an antiscorbutic and in the treatment of gonorrhoea. Pulsatilla. Anemone Pulsatilla (Panunculacece). Syn. Pasque Flower the entire herb is used. Contains Anemonin, a crystalline substance. Liquid 7w?C rP?se~2 to 5 mmims. Tincture 1 in 10, Alcohol 60%. Pose, o to 30 mmims. In dysmenorrhoea and amenorrhoea. . Dysmenorrhoea relieved by Pulsatilla. Not used in cases where the amount is excessive, lasting six days or more. Most patients were unmarried The mixture given was Tmct. Pulsatilla 4 drachms, Spt. Chlorof. 2 drachms, Chloroform water to 6 ozs. 2 drachms to be taken as soon as menstrual (or premenstrual) pain begins and every three hours while pain continues—F. C. Coley, B.M.J. i./22,13. See also ‘ Pulsa.’ . Pyrcthri Flores.—I he dry flow ers of Pyrethrum roseum and P. carneum ?;S a Vowder to keep off insects. Those from Dalmatia are from Pyrethrum (Syn. Chrysanthemum) cineraricefolium (Composites) A Tincture, 1 in 4 Alcohol 60% is used as an insecticide lotion. Encouraging ieS+n^f from the use of a new Pyrethrine obtained from cineraricefolium as an anthelmintic. Ascaris lumbncoides of the pig and taenias of the dog died when placed in a dilute solution. Excellent results said to have been obtained in human beings infected by various worms and by giardia. It is being tried on the hookworm in Egypt.—J. Chevalier, Bull. Acad. Med *28 446 per L. ii./28,457. *» The powdered drug may be puffed from bellows into the room to kill! mosquitoes. 1 lu *vlilL Dalmatian Insect Flower prefers sunny, pebbly, calcareous bill-sides dry and without irrigation, and a fairly dry atmosphere. The seed in commerce' i! ‘lPHoTmeys, PM i./i^.E ^ t0 PrCVCnt gemination. Details of culture"- Pyrethrum can be grown in this country. Samples agreed with thn<?P from Dalmatia. The stalk contains little of the toxic principle. Xo difference between closed and open flowers. Petroleum Extract with Rape Oil kills •„buTnA-{Jg1:./?P.3.8?: _...JPVreth.r’lm cultivation in England possible.. and -- -.,.-,718.. Extract of Pyrethrum'Flowers ~aimeli''o(‘veiy‘lfttie uaPfor fly prevention" Acetone m a good solvent.-C. E Sage. Notes on chemistry and some com-' mercial products.—C.D., Feb. i./3o,130. *Sbelltox .(T.M. 501877 501878, 502687, 502686, Cl. 2). An efficient, liquid insecticide Harmless to human beings. Employed bv means of a sprayer. * Kex “ (T.M. 471583, Cl. 2) is also a good fly-killer * Pysect (T.M. 500486, Cl. 2). A concentrated liquid extract ol Pyrethrum flowers biological y tested.1 ounce to 1 gallon makes a wash for insect pests m the garden. Double Strength is also made, and a ‘ Concentrate’ for large scale users. Pyrethri Radix.—Pellitory Root (B.P.'U), Fk. Cx. Average done —3ft grains. Dried root, of Anacyclus pyrethrum (Composites). A useful sialogocue causing considerable salivary eflusion ; is used in the form of '1 inchire T in 5 whicli might be made with 60% alcohol. Must be given with caution to children, as it is powerful m effect. Glycogelatin Pastils are made containing pc?ler f-r -dry.neA8 ° ^ m?uth- To Promote a continuoul flow of saliva a nd thus irrigate the ducts and so prevent ascending infection.. Tinctura Pyrethri Composita. Tincture of Pyrethrum (Root) 2, Clove Oil 1, Camphorated Chloroform 1. As tooth-ache drops.—C.D., Oct., ’2i,16. Pyridina. Pit. Cx. C5H5N = 79-047. Dose.—5 to 10 minims daily increased. A colourless alkaline liquid, Sp. Gr. 0-980, with persistent odour, miscible with water and alcohol, boils at 243° P.; obtained from many organic substances by dry distillation ; is contained in and combined with nicotine m tobacco smoke. It is probably the relieving agent of various cigarettes and powders smoked or burnt for asthma and whooping cough. A drachm ot it is placed on a plate in a small room in which the patient remains from MJ to 30 minutes three times a day. Is employed for making Denaturalised Alcohol.—See Alcohol. It is stated to be less toxic than nicotine. 2}c TJrosefectan B (T.M. 486502,513201). Syn. ‘ D.40Z A pyridine derivative containing 51-5% of Iodine used in pyelography, Ampoules contain 15 Gm. in 10% Invert Sugar solution. Dose.—20 Cc. intravenously (less for children) warmed to 100 P. Staten to be well tolerated. . ,, Por anatomical information only, a single pyelogram 20-30 minutes alter the injection suffices, but for urological purposes exposures are made at 10, ou, and 50 minutes. Before the second and third exposure the bladder should he emptied. When renal function is normal the best films are often obtained m 2 to 5 minutes after injection ; with function abnormal the best results may not be obtained for 6-24 hours, and if function is completely suspended it is impossible to obtain a pyelogram. . . , .. To be used with caution in patients with severely impaired liver tunc won or acute or chronic uraemia, and where the urinary disease is accompanied oy severe general disease. . , ... .. . Uroselectan B, in excretion urography. Non-toxic and rapidly elimmc,ted in a concentrated form. Small dose.—Prof. v. Lichtenberg, B.M.J. i./3Uozo, G33 Recent advances in diagnostic methods in renal affections. Technique of injection of Uroselectan B and Abrodil.—R. Ogier Ward, B.M.J. n./oU-Uo , Roy. Soc. Med. Discussion.—L. i./31,757,767. , ,, The substance was preceded by {Jroselectan, Syn. Iopax, without the sumx ‘ J3 * The following are references to the earlier solution, which was employed in strength of 40 Gm. in 100 Cc. warm water intravenously. Excretion bears a direct relationship to renal function.—E. J. H Loth and H W 8 Wright B M.J. i./3o,778. Photos taken at £, 1, and 2 hours. It renal function" normal,’ a shadow of the whole excretory urinary.tract obtaioedm 4 hour ; if subnormal, it is less dense and delayed. Of & pathology of kidney disease, especially hydronephrosis—K. Heritage and n. °g180 G^1 caiUDegWen^intravenously in a man of 60 kilos, but clinically, 40 Gm. K stated Cannot be given per os. Should not be given when both kidneys^re damaged.—Prank Kidd, L. Ji./3o, 128; see also K. Heritage, presence of ureteric obstruction a clear ureterogram may be got. Useful in severe cystitis where catheterisation is difficult; in proiuse hsema- Hirln iirpt.hral atrictare and enlarged prostate, and in the subsequent examma- UoTbl a ktoftheaters of which have been transplanted No only a poor one, may be seen in pathological renal conditions.-K. M. Cooke, L'OaisliS(B.P. -14).—Jamaica Quassia. Wood of Picriena, orP™ra™:* excelsa (Simarubacece). Contains picrasmin. infusion m . g employed as a bitter tonic ^nronw.-Syl \amlho Sy^Eos® , ^yrupus 45°/'^By reLci?l°mje“tJm Slfufe'of a strong infusion will get rid of t^woSs Jnd n ~ «= ^SrmfoQrUnfr= YbVdru^Tuassiato free from tannin, hence compatible with iron brePyAt?OuLsia Infusion 1 ounce, Spirit of Rosemary ®Lotio Quass ae. Liquefied Carbolic lambllafcryltals, 400 S M soluble aiso in acid and S78 caustic alkaline solutions. Increases secretion of salivary glands and kidneys, and stimulates digestion. Dose.—^ to § grain. Quassia Suppositories containing £ grain Extract with gelatin basis (15 minim size) are prepared. These have been found valuable for removal of thread worms in young children. Infantile fits in hospital practice are often due to worms. These suppositories are simple and convenient to use in comparison with Enemata. The strength mav be increased. Quassin, Fr. Cx. has formula C32ElsO10 = 586-3276. Max. single dose.— gram. F.E. VIII. average dose ^ grain; p.d. f grain. Surinam Quassia diners slightly from Jamaica Quassia. Thread-worms have been discharged on the third day by 2 grain Quassia Extract Pills (Keratin coated)—one morning, noon and night. Previously 2 ounces of compound decoction of Aloes. Anti-smoking Gum.—Quassia made up in form of a chewing gum—a substitute for smoking for the use of patients suffering from tobacco amblyopia who feel the loss of their tobacco. Finely ground Quassia 1 in gum mass 12 is not too strong for excessive smokers, particularly if there be an alcoholic complication. Where this is absent 1 in 20 is strong enough. It creates appetite. Quebracho (Aspidosperma Quebracho) Park from Argentina contains fUT Aspi- dospermine. Tonic, febrifuge and antispasmodic. (fe-Tincture of Quebracho 1 in 5 alcohol G0%. Dose.—1 drachm. (£9 Liq. extract 1 = 1. Dose.—10 minims. Quebracho Bark is subject to considerable variation. Examination of a sample submitted.—G. It. A. Short, P.J. 1./26,103. lied Quebracho Bark recognised as distinct in the Index Kewensis. Contains distinct colouring matter in the heart-wood. Physiological examination needed. Used in making Tannin Extract.—E. M. Holmes, P.J. h/26,4; iL/29, 194. Quercus Suber, the Cork oak, flourishes in the Maritime Alps. In the Cork industry, bark of trees over 2 ft. in circumference (about 10 years old) is used.—P.J. h/30.77. Quillaia sapoharia (Rosacew). (B.P. ’14). Syn. Panama Bark (Soap Bark). Contains quillaic acid, C19H,u01o = 418-329 and sapotoxin, C17H28O,0 = 408-2184, closely allied to saponin. Has a sweetish but acrid after-taste and possesses emulsifying properties, causing frothing in water in which it has been macerated. Its lather kills pediculi of scalp. Soap-bark has been used as an expectorant in bronchitis, contra-indicated in inflammation of the intestines or stomach, or ulcerated condition of the mucous membrane. Is used for emulsifying tar preparations. Tincture (B.P. ’14), 1 in 20 of Alcohol (60%). Five minims of this will emulsify 1 drachm of fixed oil. Fluid extract, U.S. VIII. 1 = 1. Average dose.—3 minims. The powder has very marked sternutatory properties. Acne Lotion—Decoction of Quillaia 4 ounces, Eau de Paris 60 minims. Ammonia Solution 40 minims. Use night and morning. It has poisonous properties. Examination of Quillaia Bark and Commercial Saponins. The Sapogenin assay method is best.—J. Cofman-Xicoresti & S. B. Tallantyrc, B.P. Conf., 1920. Ranunculus Ficaria (N.O. Ranuuculacece.) Syn. Pilewort or Lesser Celandine. An ointment is prepared by digesting the fresh Pilewort with melted lard 24 hours. Suppositories are made containing 72 grains of the ointment and 18 grains of Spermaceti; also, more convenient, a smaller size, containing 45 grains of the ointment and 15 grains of Spermaceti; have been employed in haemorrhoids. Historical notes vide L. i./i7,42. Resina (B.P. ’14).-—From the crude oleo-resin of various Pines after distilling Oil of Turpentine. Yellow resin soluble in Alcohol 90%, Ether and Benzol. Unguentum Resina) contains Resin, Yellow Beeswax, Lard and Olive Oil. Ceratum Resinae U.S. X. Resin 7, Yellow Wax 3, Lard 10. (Ceratum, U.S. White Wax 3, Benzoated Lard 7.) Rkei Rhizoma (Radix).—Dose.—3 to 10 grains repeated. Single dose.— 15 to 30 grains. Rheum officinale and other species (and the variety R. Palmatum, U.S. X.) (Polygonacece) grown in China and Thibet, partially decorticated and dried. Todaiwo P. Jap. IV. is Chinese Rhubarb. For Constituents see Vol. IT. Flavoring— Syl Vanilla), Glyl Pini. Laxative and stomachic ; often given with Sodium Bicarbonate, especially to children. Extract made with 60% Alcohol. Dose.—2 to 8 grains. Fluid Extract 1=1 made with Alcohol 75% approx. Dose.—15 minims. Pilula Rhei Ccmgcsita Soap and Syrup of Glucose. Pulvis Bhei Compositus (B.P. T4), Gregory s Powder. Dose.—10 to 60 grains. Gregory's Powder, stored in closed bottles keeps indefinitely. Analyses of a number of samples.—J. F. Liverseege, P.J. ii./26,144. Syrupus Rhei Aromaticus, U.S. Dose.—2-| drachms. Aromatic Tincture of Rhubarb 150, Potassium Carbonate 1, Syrup to 1,000. Tablets of Rhubarb Soda and Ginger contain Rhubarb 3 grains, Sodium Bicarbonate 2 grains, Ginger 1 grain. Tinetura Bhei Composita (B.P. T4). Bose. £ to 1 drachm repeated, 2 to 4 drachms single dose. 1 in 10 of 45% Alcohol flavoured with Cardamom and Coriander. Tinetura Rhei Aromatica, U.S. X. Dose.—- 60 minims. Rhubarb 20, Cinnamon 4, Cloves 4, Nutmeg 2, Glycerin 10, Alcohol 50, Water 40. _ _ _____ Pilulse ex Franck. Syn. Pildoras de Franck, F.B. VIII. Powdered Rhubarb 1 Gin., Powdered Aloes 4*5 Gnu, Powdered Jalap 4-5 Gm. Mix with a sufficient quantity of syrup and make 100 pills. Dose.—1 to 3 pills. Acute bacillary dysentery.—Rhubarb 1 teaspoonful of powder in cachets every one, two or three hours, until the rhubarb appears m the stools. Stated to be magical.—R. W. Burkett, L. ii./2i,254. . 4. mixture consisting of Compound Rhubarb Powder 1 oz. (sometimes 2 oz.) and Chloroform Water to 2 oz., in bacillary dysentery in children, causes rapid disappearance of symptoms, but of no use in adults. Dose. I teaspoonful every 2 hours to a child of 2 years.—A. Castellam, Int. Gonf. drop. Am., 24Rhubarb Leaves.—Notes on use of.—L. i./i7,708. Poisoning by,;ibid.K84/. Air dried leaves contain over 0*2% oxalates reckoned as Oxalic Acid with Malic Acid 0-3 to 1-7%.—W. Kirby, P.J. i./i 7,497 ; Rhus aromatica* (Anacardiacece) (Sweet or Fragrant Sumach). I he bark of this Canadian and U.S. plant contains Tannin and Volatile Oils.- 5 to 30 grains has given results in incontinence of urine. Said to act on the muscle fibre of the bladder. Liquid Extract 1 = 1. Adult dose,. 10 to o3 c minims. 6 minims thrice daily to children imder two years, and 10 minims to °! RhuT Glabra1,Vs. X. Smooth Sumach Bernes (dried, ripe fruit of Rhus Glabra Linnc). Average dose.—15 grains. Fluid Extract U.S. s ^lycL hydro-alcoholic extract, 1 = 1. Dose—15-minims (1 Cc.). Diuretic. I he bark is also occasionally used as a tonic and astringent. __p . T ^ ^^ct^r^^i^wU^to^lS^rojuims^^IiViporto^frontNorth^meric^ ^TormStEtching, buS, erVcmatous and herpetUonu rash. For a applied6 to WJlfAW to produce 10TlnltZTsaZfuinaria CantdfJs&l\ oHithl softToth, is a remedy for the irritation, as also Calamine Lotion. i_o°/ or 10% solu- 5,ftfcrd«,5£vr,^ay£!«.*S;‘ •>« «■—“ Poison Oak dermatitis. E^Ugi^^^Armancanate—recovery rapid. A 5% Swab skin with 6% Potassium ^ertnai^a wiil act a3 Ferric Chloride solution m 50% Glycerin, washea rree^y preventive of dermatitis.—Ami. Jl. Phann., Jun ^ dried unexpanded Rosie Gallicm Petala (.B.P. l4)- Acidum and Syrup Rosse Kver^seWnS ^ hydro-alcoholic. nmi+ted) Macerate Rose Petals 1 in dilute and mix with the liquor Honey 9, Glycerin 1, and evaporate to 10. Bnbia Tinctoram (Rnbiaceaz), Dyer’s Madder. The root of this plant is known in Germany as Krapu-wurzel. A native of Southern Europe and the Levant—cultivated in Holland, etc. A dye stuff yielding Alizarin, Xantho- purpurin, etc.,. not to be confused with the Indian Mudar (Calotropis). It has been used in amenorrhoea and rachitis. Rubidium Bromide, RbBr. Colourless crystals, soluble 1 in 1 of water. Has given good results in epilepsy. Dose.—5 to 30 grains. Rubidium Ammonium Promide, RbBr3NH4Br., has been stated to be more favourable than Potassium Bromide in some cases and an average dose of 90 grains daily is advocated. R ’bidium Iodide, Rbl, is soluble in water about 1 in 1, and is employed for the same purposes as Potassium Iodide, as in syphilis and coryza. Some authorities give 5 grains as max. dose. Caesium Chloride, CsCl, is stated to increase biood pressure and retard the heart movements to a slight extent. The Bromide is supposed to control epilepsy better than the other Bromides. Caesium and Ammonium Bromide (CsBr + SNH^r) is also prepared. White crystalline powder, readily soluble in water. Dose.—15 to 45 grains in epilepsy. Caesium resembles the quaternary Ammonium bases in effects. Studies on Pharmocology of Rubidium and Caesium.—Hancke & Koessler, J. Biol. Chem. 43 ; 579 Sept. ’20 ; Kulz & Pauls, Arch. Exp. Path. & Pharm. 110 ; 351-363, 1926. Rubus Chaimunoms (Rosacea?).—Cloudberry, Norwegian blackberry, mars h or dwarf raspberry. Also grown in Newfoundland. Known in Russia as Moroshka and in Germany as Torfbeere, Maltebeer, Woollenbeere, and Zwerg Maubeere. The leaves of this are diuretic, useful in nephritis, cirrhosis of liver and cardiac affections. Infusion, 1 in 12. Dose.—l ounce ; fluid extract, dose, £ to 1 drachm. Fruit is antiscorbutic and used for haemoptysis, will also abate fever. Rubus villos^s, a species of Blackberry. R. Idceus = Raspberry. Rum ex Acetosa, the Common Sorrel, found to contain 1-36% Pota ssium Binoxalate. Oxalis Acetosella, Wood Sorrel, contained 0-86%.—J. A. Purdie, C.D. i.,/27,127. Rumex obtusifolius — the dock. — Dried root was found to contain 0-447% of iron. Ferascol (T.M. 315389) TABLETS.—A preparation with nucleins as base ; contains 3% of iron. Used in treatment of anaemic girls. R’imex Crispus.—Yellow Dock (Polygonacece,). The root contains Emodin, Chrysophanic Acid and Rumicin,—the last (Syn. Rumin). Dose.—1 to 4 grains in scrofulous affections, dyspepsia, astringent and tonic. Tincture 1 in 10, Alcohol 50%. Dose.—1 to 10 minims. Unguentum Rumicis.—Fresh Yellow Dock Root 1, Benzoated Lard 2, warmed two hours and strained. Used like Chrysarobin applications. Rufa Graveolens—(Rutaceo>). Dose.—10 to 30 grains. Contains about \% Volatile Oil Sp. Gr. 0-880 (consisting of Methyl Nonyl-Ketone CH3CO. CpHifi and Methyl-heptyl Ketone). Dose.—2 to 5 minims. In amenorrhoea and menorrhagia. Large doses have been given to procure abortion. Confectio Rutse. Dose.—1 to 2 dr. Fresh Rue, Caraway, Bay Berries of each 14, Sagapenum U Black Pepper i, Honey 16. Add the first three in powder by degrees to the Sagapenum melted in the Honey with water q.s. Carminative and antispasmodie. Sometimes used as enema in infantile convulsions. St. G. H. has Rue 6, Caraway 6, Bay Berries 6, Black Pepper 1, Asafcetida 1, Honey 64, Water q.s. 180 grains of this with 20 ounces of Chamomile Infusion to prepare Enema Rutce.—St. G. H. dPi] Sabina, U.S. VIII. Average dose.—74 grains. Fr. Cx. has this as max. single dose. Max. during 24 hours 15 grains. Tops of Juniyerus Sabina (Savin), Linn6 (Conifera?). [fpj) Oleum Sabinse. Dose.—1 minim. Has emmenagogtie and abortifacient properties. dPTjFnguentum Sabinse, B.P. '85. Melt Lard 16 and Wax 3 on a water bath, add fresh Savin tops bruised 8 and digest 20 minutes and express through calico. Freshly made is used in conjunction with blisters in rheumatoid arthritis, see Cantharides. Sagarenum.—Dose.—10 to 30 grains. A gum-resin with taste resembling asafoetida, and properties similar to this and galbanum, for use in amenorrhoea and hysteria. Salep.—Tubera Salep, P.G. VI., Ph. Ned. V., P. Belg. IV. Dried tubers of various species of Ophrydinae—Orchis mascula and others. (N.O. Orchidaccoe.) When fresh have hitter taste. They are immersed m boiling water on collection and dried ; contain mucilage and have nutritious and ’ allay gastro-intestinal irritation. Mucilago Salep 1/o, RG. v L rresn. made. Salep is much sold in the Indian Bazaars as an article ot diet. Salix nigra—The bark of this, the black or pussy willow, is used as a sexual sedative, tonic and astringent, and given for gonorrhoea and spermatorrh , Liquid extract, 1 in 1. Dose.—\ to 1 drachm, Ilavonng — Syl Lavandulae. Solid Extract. Dose— 1 to 5 grains. Relieves ovarian pam and nocturnal emissions. Salvia. Sage (Ldbiatce). Dose.—15 to 30 grains. Dried leaves, aromatic, astringent, tonic. _ , „ /r> „ Sambuci Flores (Sawbucus nigra—Capri folia cw), Elderberry ’q8\ Infusion and pomade are used as ^omestic remedies for sores, bruises, etc. A ana Sambuci (B.P. *o8) is prepared from the fresh'flowers, (or powers preserved with common salt), a frequent ingredient m lot ions ** th|g^-s and skin. Contains the glucoside Sambunignn. E. Bourquelot, B.M.J. TTneuenturn ViGde, St. G„ H. Gum Elemi 14 drachms, Prepared drachms. Olive Oil 20 minims, Turpentine 40 minims, Copaiba l drachm, Green Elder Ointment to 1 ounce (apoth.). , WrifWq.nrflT1t Sanguinary Canadensis (Papaveracece) Blood Rootom^?ciM drug emetic, tonic, for cough. Average dose—2 grams. The commercial g contains 3 to 4% total Alkaloids. , . 1 s ,•« made A resinioid Extractive Sangumarm. Do-e.—\ to 1 gram, Is SawcHsorta OffHnahs. torn. PomiuM (N.O. nosacem): Greater Burnet. Syn. Garden d Has astringent and hemostatic properties: also diuretic. Commonly l0Sansiv?era1TnS,Sed rhizome of Sansiviera tbyrsiftora (South Africa). We found it to contain no alkaloid The r°ot nosscsaca 1lawjfave Propertto, tt “ free from griping action, and pleasant toi take. The a^rsaXImintic, and the fresh root at a time, and swallow the juice for > Should be given in OIRVeocninS are toxic ducosides contained In Sareaparilla CuillaK ete The word “ Saponin » ta * ,^^5 ^ the author had solu- free ghmosides. A sample of SaT><E*1Tln o vb r,o°I 1 in 3. Death from bility, Water 1 in 2, Chloroform 1 Lp-riod with the symptoms of central Saponins is preceded by a long incubation P *.aiTlg i in 100,000. Saponin copioue^klrf sccretion^hy^the Action of dilute spray, gargle or irrigation. Saponins are anthelmintic and diuretic. , . - advantageous.—Na. The addition of Saponin to g Trease/P.J. i./a7,623. Saponins, various, described. J. t. D ^ i8q8L (Liliacece.) Con- Sarsee Radix, SarsaparilD. Srntlax or p 691. Liquid Extract stituents.—Saponins and allied bodies, see 17th Edn P-^ p l8 (B.P. 1898). Dose.-2 to 4 drachms. Liquor and as a Dose.—'2 to 8 drachms. In xS«!°n Tt was™f doubtful value even 150 years “ blood purifier ” and in syphilis. It was ot aouut ago. Incompatible with Alkalis. „ + ounces Deeoctum Zittmanni Fortius. Dose. •> *? ^iTltain at 35° to 40° C. for Sarsaparilla (cut small) 200, Water 5*~00, ™ sPrecipitated Cinnabar 2. 24 hours, then add Potash Alum 10, ZT.L pi-u s d Anise and Fennel of Heat on ’a water-bath for three hour.. and[ add^Bruisett ^ Conti„ue each 10, Senna leaves (cut smaU) 5°, T.iquorice iu . f water through the heating for 15 minutes, strain and press, passing marc to make up to 5,000. 0iinces. Decoctum Zittmaimi Mitms. 3 to 6 ou Bark Cardamoms and Sarsaparilla 100, Water 5,200, stronger decoction. Linuorice of each <3. Proceed as m 1 ? syphilis and wasting diseases. Both these preparations have_been usea Sassafras Radix (B.P. 1898). S. officinale, or S. variifolium (Lauracece> The^ oil {Oleum Sassafras, U.S. X), containing Safrol, destroys the vitality 0 pediculi; it should be applied with a stiff brush, but not touch the skin yet, if so, a little bland oil allays the irritation it causes. Sairo [C6H3C,H5(OOCH2) 1:3:4] =162-078. Obtained from sassafras oil, camphor oil and other volatile oils, is used for scenting cheap soaps, also in manufacture' of heliotropin, and as an anodyne liniment in subacute rheumatism. Colourless liquid. Optically inactive. Soluble in an equal volume of strong alcohol and in 30 of 70% alcohol. Bose.—20 to 30 minims. The Sp. Gr. of the oil is usually 1-068 to 1-086. O.R. + 1° to + 3°. It is used for all lice and nits in pediculosis. In treating ringworm, the hail is cut close round to identify the patches, and the oil applied twice a day by a brush. This is continued for a few weeks if necessary. Non-irritating and pleasant to use, prevents spread of the infection, and destroys the fungus. The oil in capsule form (3 minims) may have the power of reducing body I weight. As an insecticide for dogs and cats Safrol, or Oil of Sassafras, may be extremely I toxic in some cases.—P.J. ii,/25,576. Saw Palmetto.—A palm growing in America. Possesses sedative, tonic and U diuretic properties. Is largely used in urethritis, gonorrhoea, dysmonorrhoea. u impotence, cystitis. A liquid extract 1 = 1. Bose.—b to 2 drachms. Flavoring.—Glyl Lavandulae (full dose). A solid extract is also prepared-! Bose.—3 to 5 grains in pill or tablet. Is also frequently combined with Santa! I in a miscible form.—‘ Sanmetto.’ Sabal (was in U.S.) is the partially dried I ripe fruit. Scammoniae Radix (B.P. T4). Convolvulus Scammonia (Convolvulacece)» containing about 10% Resin and 15% Sugar. Scammonium (B.P. 1898)- Bose.—5 to 10 grains. Emulsifies with water. The gum resin exuding from* the living root on incision. Scammonim Resina (B.P. T4). Bose.—3 tc 8 grains (0'2 to 0’5 Gm.). Prepared by exhausting the root of Orizaba Jalap, with Alcohol 90% and pouring the concentrated tincture into water in a thin, stream. Occurs in greenish lumps. Soluble almost entirely in Alcohol andi Ether. Scammonin is this substance purified. Purgative in obstinate constipation. Produces copious watery evacuation in a few hours. Does not act until reaching the duodenum. For further details of C. Scammoniai and Ipomoea Orizabensis, see Vol. II. Criticism of B.P. Tests for Scammony.—D. B. Dott, P.J. h/30,213,287. Scilla (B.P. '14). Bose.—1 to 3 grains. The bulb of Urginea Scilla (Liliaceee)> (U. maritima, U.S. X), with membranous outer scales removed, cut into clicesi and dried. Resembles Digitalis in action. It is also expectorant and more< diuretic. Preps, are : Acetum Scillae, strength 1 in 4-5 w/v in dilute Acetic* Acid.—J. H. Eranklin and G. G. Hammond, P.J. ii./22,S5. Bose.—5 tc< 15 minims. Pilula Scillm Composita and 'tincture, 1 in 5 of 60% alcohol. A manufacturer’s Tinct. Scilire B.P. found to be exceptionally strong physiologically, creating a dilemma for him.—C.D. k/27,287. In U.S. X. are Acetum 3 in 10 ; Fluidextract, 1 = 1 Alcoholic. Average.' dose.—14 minims. Syrup = Vinegar of Squills 45, Sugar 80, Water to 100 5 CfDSyrupus Scillee Compositus, Average dose.—30 minims = Fluid extract of Squill and of Senega each 80, Antimony Potassium Tartrate 2, Syrupus q.s to 1,000. Tincture, U.S. 1 in 10. Squill Preparations U.S. X. are now biologically standardised, cf. Digitalis Vol. II. Poudre de Scille.—Er. Cx. Max. dose during 24 hours, 15 grains. Er Cx. has Extract (Alcoholic), with max. doses provided, also 'Tincture 1 to E Alcohol 60%, max. single dose 25 minims, max. during 24 hours 85 minim# approximately. As a heart tonic it is not satisfactory used by itself. It seems to spend its force on the auricles, leaving the ventricles hardly affected at all. Its gluco-- sides are failures.—G. Sharp, P.J. i./i6,347, cf. action of Digitalis. ^Anasarcin (T.M. 250285) Tablets contain Scillipicridin and Scillitoxin. For Hats.—Liquid Extract of Red Squill (there are 2 varieties—the red TJrginea Maritima, is preferred in Erance) is efficacious. Add to bread ancS milk. Comparatively harmless to larger animals, advocated by Min. 0 Agriculture.—P.J. ii./2 7,524. The rat-poisoning substances appear to b® present in significant amounts in the Red Squills only.—E. R. Winton, J1 Virus not Ph. and Exp. Ther., June *27,137. Barium Carbonate is deadly, advised.—L. ii./22,1081. See also F. W. Smith, P.J. i./2i,139. Scopola Carnioliea (Scopolina atropoides) and S.Japomca contain Solanaceous alkaloids. See Edn. XVIII., p. 857. c . 77 . ln. o—_k tn i (a frrfiina r>rip.ri hp.rh of Scutellaria lateriflora, to 15 grains. Dried herb Used in the form of Scutellaria. Dose, 5 to 15 grains. Dried herb of Scutellaria lateriflora. Linne (N.O. Labiate). Used in the form of dry, greemsn-brown powdered extract (scutellarin). Dose, 1 to 5 grains. For epilepsy, insomnia, and hiccough. Liauid Extract 1=1. Dose, 6 to 15 minims. QTTO In epiiepsv a simple infusion or extract appears to stimulate the kidneys and increases output of urea and uric acid. In chorea effects even more marked. Sempervivum tectorum. Common Eouseleek. The bruised recent leaves are employed as cooling applications to burns and other external inflammations. Suecus (preserved with 20% Alcohol) is said to cine warts. » Senecio—Ragwort. Senecio Jacoboea and S. aureus {Composite) are emmenagoguesf and have been employed in amenorrhea and dysmenorrhoea 60^ minims"'1 Tincture0 fin proof if^iU toTdractos lenS is a dry extractive. Two alkaloids, m Senecionine and Senecme are contained. * Excellent in gastralgia and dyspepsia. Tablets Senecio Compound. A proprietary preparaticn. PnWilla gpnecio Oo A proprietary containing Senecio, Hydrastis, Rulsatiiia and aromatics Dose.—In dysmenorrhoea. 4 to 1 drachm two ot three times rin iv K em uenaaoEue 2 to 4 drachms. A uterine and nervine tonic. . ss Tm? new'aikalcids'iso^ated.—'fi?SeMC?foliiIoTf.pt.0Ui4°0C^and KI Senech ^fSlSivin riein^on1 Wco3£1SSi An expectorant, contains benegm. niiusic *15 minims> The alkali contained forms infusion of commerce is apt to deposit^ owmgUi ac a [g ^ >alne- Fluld. Mif “S.» i»MSU». 1 " S 4I"“ the Continent. . % 1 in 10O boiling water ; infuse £ hour. Tisane de Polyoala (Ropt)-(FR. Cx.), lin luu o « content &om lt3 solution of pH =- 7-3 and arange of anantiu^ iiom o^ defibrinated human idded to tubes containing 1 Cc. of a l/o enspension g ^ The hemolytic Dlood in Phosphate buffer mixture, aiU , ^^ ^lyBis occurs. The results index is calculated from the tube> where t0^ ^°^ied residue could vary iromfs^'^S-^with'^corresiKindhig variation of the haemolytic index from )r C. angustifolia (East Indian or r-.OXy.metliyl-antiiraqumone), bo Cathartic Acid. Constituents are Em >, ceT,nge jYuctus of both these Chrvsophanic Acid, etc. The legumes ^^rth^leaves —Tschirch. Experi- varieties are in use. These are H. M. With ence has shown that the legumes are more a- ive it 0 (illfu6ion) acts only aid of radio-graphic pictures it no action on peristalsis of the on the colon (peristalsis of). It has lnue ui small intestine and stomach. enitive Electuary. Dose.—-QQ to 120 grahif^ContaSS fefna Oii^stead^ffruifwoSd^^vent'grittiueas in taste. ConfecUo Somme et Piperis L.H. Equal parts of Confection of Senna and Confection of Peppe Elixir Sennse, B.P.C. 1901. Syn. Liquor Senn^i Dulcis. Dose.—1 to drachms. In this preparation the Cathartic Acid, not being subjected to Ion exposure to heat, is preserved from oxidation ; Cathartic Acid is sometime.' prescribed in doses of 4 to 8 grains in pills but is unstable. Extraction Senn (Leguminum) Liquidum, B.P.C. Dose— 1 to 2 drachms. Strength 1=3 R. Stockman concluded by comparing effects of preparations from the who fruit, from the pericarp freed from seeds, and from the uncrushed seeds, tha the second is best.—B.M.J. ii./i5,128. Elixir Sennse Leguminum, MartindaZ Dose.—1 to 3 drachms, is prepared, as Elixir Sennse, B.P.C. 1901, using legume instead of leaves. Mistura Sennse Composita.—Syn. Black Draught (B.I ’14)- Dose.—1 to 2 ounces. Syrupus Sennse (B.P. ’14). Dose.—1 to drachms. 1 drachm = 4 drachm of leaves approx. Tinctura Sennse Composi“. (B.P. ’14.) Dose.—4| to 1 drachm repeated, 2 to 4 drachms for a single dos* J Senna 1 in 5, with carminative. Tinctura Sennse Leguminum. The sam strength as above using legumes in place of leaves. An accurate method of identifying broken commercial samples of Alexandria!, and Indian Sennaa. The vein islet numbers of 4 sq. mm. give different figure for different species. The method is also applied to Buchu, Coca, and Dig; talks.—F. A. Levin, Qtrly. Jl. Ph.’29,17. 3$cPrancl (T.M. 511369). Prune .Telly. Contains Prunes, Gree Ginger and about 74% Senna. Sir James Paget’s prescription for constipe tion and colitis—action continues several days. Clears the colon of fsecs matter and relieves toxaemia. Serpentarise Rhizoma (B.P. ’14), U.S. X. Average dose.—15 grains (1*0 Gm. Dried rhizome and roots of Aristolochia Serpentaria (Virginia Serpentary) c of A. reticulata (Texas Serpentary) (Aristolochiacece). Bitter tonic. Infusio> (B.P. ’98), 1 in 20, Concentrated Solution 1 in 2 (B.P. ’98), Tincture (B.P. ’1* 1 in 5, 60% Alcohol. Liquid Extract, 1 = 1 Hydro-alcoholic. Dose.—5 t 15 minims. Tincture, U.S. VIII., 1 in 5 of Alcohol and Water in proportion of 65 and 35. Sethia. This name is given to a few species of the genus Erybhroxylo> (N. 0. Linacece). S. Acuminata leaves are used in Ceylon as a vermifuge and anthelmintic —C.D. i./3o,340. Shea Nuts and Shea Butter. From the Shea tree, Butyrospermum\ Parki Kotschy (N.O. Sapotacecv), a native of W. Africa. The pulp of the fruit 5 eaten by the natives and by animals. The nuts are 14 in. in length and 1 ir in diameter, with shells of a light brown colour ; the dry kernel is firm and c a dark chocolate-brown colour and varies in weight from 3 to 5 Gm. Th ‘ Butter ’ when clean and well-prepared is greyish or yellowish-white and no unpleasant odour, and consists of Oleic Acid 60%, Stearic Acid 30—35%, an Laurie Acid 3—4%. Used largely as food in W. Africa, and in Europe i candle and soap-making—they grow in immense quantities on the Gold Coae —Bull. Imp. Inst., Vol. X (1912), No. 2. Feeding experiments with Shea Nut Cake and Butter being conducted.— Imp. Inst. Kept. 1930. Shellac.—A resinous substance formed by a scale insect, Tachardia Lacc• (fain. Cociidce, ord. Ilemiptera), which lives on a large number of trees, e.g~ Butea frondosa, Picas religiosa, Schleicheratrijuga, Shorearobusta (Wild Lac The plants specially cultivated for Lac are Acacia arabica and Cajanu indicus. Simaruba officinalis (Simarubaceoe).—Syn. Mountain Damson. Dose — 15 to 30 grains. Infusion 15 grains to 1 ounce in boiling water (infuse 1 minutes). Dose.—1 ounce. Has bitter taste, is astringent, and useful is dysentery. Contains a colourless crystalline bitter gluooside. Decoctur? Simarubse et Punicae Granati.—Add Simaruba Bark, Pomegranate fruit rin<f and Gum Arabic of each 15 Gm. to a litre of water and boil down to 4 litre* Dose.—30 Cc. three or four times daily. Cures dysentery rapidly. (Egypt.. —Ph. Notes. The quantities and the ingredients have been varied from tim«j to time. The Ministry of Health replaced Cinnamon for the Acacia.—C. D 1920,1320. See also Mar. 26, 1921,442. Solanum Carolinense.—Horse-nettle. A native of Southern U.S. A liquid extract 1 = 1 is employed in epilepsy. Dose.—15 to 60 minims.—H. Solanum Dulcamara (Caules Dulcamaroe, P. Austr.) (Solanacece).—Wood>- Nightshade. Bittersweet. The dried herb is employed. Sedative analgesic* Solanum Nigrum.—Black or garden Nightshade. The leaves are said to be eaten boiled in the Isles of France and Bourbon and Hawaii Islands. E. N. Cust, Director of Research, Directorate of Agriculture, Rustam- Baghdad, writes us {1932):—‘The plant which is common in Iraq is eaten by the Arabs, who call the plant “ ’inab-uth-tha’ lab ” or “ ’inab-udh-dhib (which means fox’s grapes or wolf’s grapes). I have myself eaten the raw berries on several occasions though not in large quantities.’ The Wonderberry is stated to be from a luxuriant form or hybrid of Solanum Nigrum and to be edible (cooked). Containing 0-3% of Solanine. Tomatoes also contain this alkaloid. It is taken as a diuretic for skin diseases and the juice for the enlargement of the liver. e f , , Solanum So&omeeum.—The fruit of this plant is the apple of Sodom—when ripe is a pale yellow berry averaging 1 inch in diameter. Employed for destroying parasites in S.A., also for itch, ringworm, etc.—Juice of the fruit is extremely acid and bitter—it also contains Solanine.—Oliver. . Solanum Tuberosum. Extractum Solani Liquidum.— The concentrated juice of the potato preserved with glycerin has been used in synovitis, gout, lumbago, and lheumatism—as also Liniment, plaster and Ampoules. Mosaic disease of tobacco leaf and other plants, leaf roll of the potato, ana Botrytis of grapes compared with animal diseases. Leaf roll and mosaic are carried by aphides.—V. H. Blackman, B.M. J. ii./22,718. < 1 Sorbus Aucuparia.—The Mountain Ash. A liquid extract is preparea, 1 — 1 • Dose.—10 to 30 minims. A useful mild aperient; also has diuretic and emetic properties. Berries have sialogogue effect. They act best when not too ripe. —'W. Johnson Smyth, B.M.J. i./28,243. . Sorghum. Chinese Sugar Cane. Aniropogon arundmaceus {Grammew). Indigenous in China and India and cultivated in U.S. Proprietaries such as ‘ Lithiated Sorghum Comp./ are popular in America in bladder affections. Soya Bean,.- Glycine liispida (Leguminoscc). Cultivated m ( hma and Japan for human use and latterly in America and Europe, chiefly foi forage, method of use in the East is to boil until soft and then ferment in a warm cellar—the resulting ‘ cheese ' being known as * Natto.’ , , . It contains 38-5% Protein (on dry) and 20% fat. lor this reason, no doubt, the Chinese and other rice-eating people require so little meat. It^ contains practically no Starch—the latter fact is said to be due to presence of a diastase m the bean capable of converting Starch formed, two-thirds into Sugar, one third into Dextrin. Has been used as an addition to ordinary diabetic dietary. Soy Flour is even more serviceable, containing almost 3 more 1 rotein than tne bean, this being due to the removal of the fibrous hulls, which contain but little Protein. For further data see Edu. XVIII., p. 860, and NIX., p. 887. ‘Synthetic Milk’ made from it is indigestible and its adoption was found, impossible in Germany even during the war. An improved Soy Meal wbette and is almond-like in taste. In protein value, the haricot bean is the only serious competitor. It should be tried on a large scale amongst the poorei classes.—T. R. Parsons, L. i./27,267 ; ibid., 241. ^ in o times Soya Bean Milk. The shells are removed afterbakmgoveimght-mo.times the weight of water to beans, then ground and boiled for 5 minutes and Altered through a sieve. To every 1,000 Gm. of Aerate add ^ G" - 0 ;; arf; viously made into a paste with some of the filtrate, 60 Gm. of -ugar • Calcium Lactate, and 1 Grn. of Salt. The addition of Cod Liver Oil is essential. _Tubercuious3children and others with bad nutrition have be<with the meal. The Berczeiler Process (a Hungarian developmentofrdeaI1^ the bean renders it suitable for human food, removing making it keep. The product is termed Soyolk. Soya Flour contains about 4 times as much protein as Wheat Flour and about 15 Suggested as addition in making bread, biscuits, and contectione y. Cr^lovolk. (T.M. 495050, 502253, Cl. 42). A flour made from the Beans containing*20% of fat which does not turn rancid. It has high content (45 /o) of Protein, 16% Carbohydrates, principally Sucrose and Lextrin, no Starch, nr>q Vitamins A B D and E. Suggested as a basic food for infants, ^.e., blend with other ingredients and reduce the protein and gcrease thfl e.g., with Lactose. The Iodine value is high—132, against human miiu lau 4<iSaobee?0'A8 mikture of Soy Bean Flour 67-5% and Barley Flour 9-5%, plus 01jve Oil 19%, Sodium Chloride 1*3%, and Calcium 2-7%, the approx, analysis bemg Fat 22-50, Protein 33-20, Carbohydrate 32*61, Ash ~ ” * ' TT r -- -r ,■-Ash 8-51, Moisture 3-18. I sed as a milk substitute for infants with milk idiosyncrasy. Infants take it" well d!gest it, and thrive on it.—L. W. Hill and H. C. Stuart, Jl. A.M.A. ii J 29,986 ; see also ibid. 989. 1 Narcosan (T.M. 493964). A preparation made from Soy Beans. Stated, to be specific for drug addiction but proved to have no merit. Beport of Com- mittee appointed by Mayor of Hew York after trial in 100 cases.—A. Lambert, Ji. A.M.A. i./29,147. * S°ya Oil has Iodine Value 121 to 123. P. Svec. X has 115 to 137. It is much used m soap making. P. Svec. X gives formulae for Sapo Kalinus* opiiitus Sapoms. Kalini and Lmimentum Saponis Camphoratum, using it- For further particulars see P.J. ii./x i,407. Cf. Iodine Numbers of-Fats. HJISparteinse Sulphas Ci5Hs,;N2.H2S04.5H0 = 422-3734 (water content! varies), in. Cx. Dose.—£ to 1 grain increased. Fr. Cx.—Max. single dose<\ t grain, max. during 24 hours 4 grains. ihe sulphate of a volatile liquid alkaloid, CxSHa.-X2 = 234-2488, in colourlespi crystals. Soluble 3 in 2 of water, and about 1 in 6 of alcohol 90%. Obtained from the leaves and branches of Broom, Cytisus scoparius. It contains also a crystalline principle Scoparin. CED Hypodermic Tablets contain i grain. Sparteine possesses little digitalis action ; it acts like conine, atropine., curarme and cocaine but feebly. In its resemblance to conine it acts on the- central nervous system. Like atropine it paralyses the vagus nerve, but only in very large doses, it also paralyses the motor nerve-endings, and in this! respect resembles Curarine. it perhaps also paralyses the sensory nerves— when injected it anaesthetises like cocaine.—Gordon Sharp, P.J. i./i6,348*. Dr. Samuel Johnson passed 20 pints of urine in 24 hours after taking the; infusion.. in the past it has been given in morphine habit. In post-operative- suppression of urine. Large doses—-1 to 2 grains hypodermically every 3 to 6 hours—have been given. The pharmacological action of Sparteine and related alkaloids.—B. St. A- Ileathcote, Jl. Ph. & Exp. Ther., June, *26,431. [GjOxyspar'Ana, C15H24NaO = 248-2032 is an oxidation product of Sparteine- Acts a: a cardiac stimulant. The Hydrochloride and Sulphate are prepared. Scoparin CjjHj-jOu, a phenolic body in broom tops. Has definite diuretic action in doses of 5 to 8 grains.—C.D. i.,/30,58. ISO Sparteine Periodido. Ci5HasN,.3I = 615-0148. Dose.—$ to 1 grain, increased if necessary. 3 grain doses have been given., Black crystals containing 38% of Sparteine. Pharmacology. On treatment with Physiological Acid, it is to a large extent I split up (12-4% of the Periodide is liberated to this solution), while subsequent I treatment with Physiological Alkali liberates only a small amount. No discomfort caused and no untoward symptoms observed from £ and 1 grain doses. Solubility.—Soluble in Chloroform, slightly soluble in Alcohof, insoluble in Ether and water. May prove of service as a new method of giving the active principle of Broom as diuretic. Dispensing Note.—To be given alone, in cachet or ‘ slipule,’ preferably after meals. Spigelia. Sp. Marilandica (Loganiacece), Indian Pink-root. Average dose. —60 grains. Fluidextract, U.S. IX. 1 = 1 diluted Alcohol. Average dose 1 drachm. Is employed for round and tapeworm, but is very potent. Stannum, Sn = 118-7 Tin. Given internally pure tin powder is probably not absorbed. Was formerly used as a tseniacide. From 4 to 15 Gm. were given suspended in syrups or made into an electuary and followed in from 3 to 6 hours by a brisk cathartic. Some of the salts (chiefly Chloride) are credited with vermicidal properties. In dose of 1/16 to £ grain the chloride has been used as an antispasmodic in chorea, epilepsy and other convulsive diseases. Stanni Oxidum (Stannic). SnO* = 150-7. Greyish white in colour. Used chiefly technically and as cosmetic diluted, e.g., as nail polish. Distinguish from Stannous Oxide SnO which is dark grey—nearly black. ‘Putty powder * is usually a mixture of tin and lead oxides or a stannate of lead, used for polishing glass. Jungman’s Tooth Powder. Tin (Stannic) Oxide 15, precipitated chalk 60, soap 4, sugar 5. Flavour with mixed oils as for Blair’s Tooth Powder; mix these first with the sugar.—P.J. 1./2 2,263. :4cStanifonn. (T.M. 495430 anti 479512.) Methyl Stannic Iodide. Used in the form of powder 3% with kieselguhr or ointment in the local treatment of boils, ulcers, carbuncles, whitlows, acne, eczema, burns, chilblains, etc. Methyl Stannic Trilactate. An aqueous solution as spray in nasal catarrh. Stannoxyi (T.M. 379084) Tablets. Contain metal tin and oxide of tin. Bose.—Four to eight, children two to four per diem at any hour in the day either in water or eaten dry. 2 Cc. ampoules for intramuscular injection, also Liquid for internal use are made. For boils, carbuncles, furunculosis, acne and styes. It has been found that tin workers never suffer from boils. Powdered tin is a popular remedy for this complaint. In France, Gregorie & Frouin tried doses of from 0-5 to 1 Gm. of powdered tin or oxide of tin in 50 cases. Small quantities of Tin act as catalyst and assist synthesis of fatty acids and Glycerin into fat. 2 Cc. of Stannoxyi intramuscularly, in conjunction with 1 drachm of Glycerin in 1 drachm of boiled water intravenously, gave good results in scirrhus of the breast.—J. T. Shirlaw, B.M.J. i./3i,74. Cf. Glycerin Chapter. _ _ _ . . Tin. History of, and process of extraction.—G. Malcolm Dyson, P.J. l./ 3 x 299 Staphisagrise Semina (B.P. ’14). Average dose (U.S. IX.).-—1 grain. The seeds of Delphinium Staphisagria, Larkspur (Ranunculacece) contain about 30% of oil and the white crystalline alkaloid. (E) Belphina. - Delphinine. Dose.—6h grain increased to £ grain. Soluble in water, alcohol and ether. This acts chiefly on the nervous system, first upon the bulb, next on the sympathetic. Given internally in toothache, neuralgia, earache, rheumatism, dropsy, and spasmodic asthma. Locally an alcoholic solution or ointment, containing 2 to 8%, causes tingling and transient redness like veratrine. CPC One part of the Oil expressed from the seeds to 6 or r2 of perfumed olive or almond oil effectually kills pedicuh of all kinds. Remove nits wdth a mixture of vinegar and proof spirit, dp Unguentum \D.D. 14)* For scabies and to kill lice. Cp) Fluidextraot U.S. IX. 1 = 1 Hydro-alcoholic. Average dose.—1 minim. ^ ,, ,, „ T.niin Sfar-hisas'Tise. Syn. Lotio pro Capife. or. Hart s x±. Boil Stavesacre Seeds 1 drachm with Dilute Acetic Acid 24 mmims and water 1 ounce 1 hour, cool, strain and add Quinine Sulphate 1 gram, Glycerin 24 minims, Oil of Sassafras 1 minim and make up to 1 ounce with water. 8 vl vatic a 13 S IX. (Euphorbiacece), Queen’s Root. Dose —-Average 30 grains. Contains Volatile Oil and Alkaloid (?). Large doses emetic, cathartic ; small doses alterative. Is employed m scrofula, cvrVhilia iauudice and for piles. Fluidextract U.S. IX. 1 = 1. uose. uu mhAms! Liquor Sfillingise Composite is McDade’s Succus Alterans for Sy SWrax Preiaratos’14). U.S. Thick brownish liquid compound obtained from' JAquidambar orientalis (Bamamfdacece). Contains Cinnainyl “mate (Styradn) and ether Cinnamic larce nroportion of Storesm, C36H55(OH)* = 538-4524. it shorn a contain zu/G Cmnamicf Acid. Ointments of 20% in Benzoated Lard are used m parasitic 8kpmSvit™rn4 Alcohol Syn. Hydrocinnamyl Alcohol occurs in Storax as ahSami?cPAcid ester. It is a thick colourless oil (Sp. Gr. 1-007) with odour restmS Chmamic Alcohol and hyacinths. It is used in hyacinth, narcissus, ^cfertainrf the fonSentsfit |ssajd, are extracted from storax before! “constentefo"tiSifn“and detectfon ofadulterants.-YBP. ’*7,158 Pheny! propyi acetate, allied to Styracm is a synthetic substance used in manufacture of Synthetic perfumes and fruit essences. Ceinum —Amber obtained from a fossil reran found m Germany. Oleum ? uceinum. Useful in persistent hiccough, asthma, whoop- Olive" Oil is rubbed upon rheumatic parts ^en^e^e^^Succin^Becfiflcatum^as^Sp. Gr. 0-950 approximately. Genume uieum . almos^ entirely derived from the crude resm s“ btoed frot “ony {^in. . It has7 Sp. Gr. 0-850 to 870. like the genuine oil it consists chiefly of Terpines, B.P.C. has Amber Oil 1, Clove Oil 1, Olive Oil 2, as Linimentum Succim Compositum. ^ Artificial Amber The most important constituents stated to be Phenol Formaldehyde and Ammonia boiled together in a porcelain crucible. Glacia Acetic Acid, Sodium Sulphite, Soda and Hydrochloric Acid are added and the mixture boiled until resinous mass formed.—B.M.J.E. ii./2i,45. Sumbul Radix (B.P. 1898). Syn. Musk-root. Transverse slices of the; root of Ferula Sumbul (Umbelliferae). Nervince sedative and antihysteric Contains aromatic volatile oil, and resin. Tincture 1 in 10. Dose—SO tc 60 minims. Fluidextraet, TJ.S. IX., 1 = 1 hydro-alcoholic. Average dose 30 minims. Symphytum ofacinale (N.O. Boraginacece).—The Common Comfrey plant having yellowish or purple flowers, perennial, grows on banks of rivers and ditches. Boiled with the root, has been used as a poultice for cancerous: tumours, also for haemoptysis and kidney disease with blood in the urine, as a; decoction or syrup. Boot pulped was used to stiffen bandages for fractures According to investigation of C. J. Macalister and colleagues this plant., which has been used from Saxon days as a * vulnerary herbal,’ contains Allan- toin. Titherley and Coppin found 0-6 to 0-8% in the air dried material. A strong (mucilaginous) Infusion of the root. Syn. Mucilago Symphyti Dose.—1 to 2 ounces. Comfrey Boot in coarse powder 1, Boiling Water 20— infuse 20 minutes, strain, cool, and add Chloroform 1 in 500. Applied to am ulcer measuring 3 by 4 inches involving the skin and deeper structures oveir the upper thorax, for about a week, cleaned it and produced a distinct growth' of epithelium from the margins. Concentrated Infusion.—Dose.—2 to 4 drachms. Suitable for dilution 1 with 3 of water. Liquid Extract. Dose.—2 to 4 drachms 1 in 4 by extracting the drug in coarse powder with water, and preserving with 20% of 90 %> alcohol. Solid Extract. Dose.—5 to 10 grains is prepared by extracting; the drug with water at about 65° C. and evaporating and powdering. Elixir Symphyti. Dose.—b to 2 drachms diluted is also made. Liquid Extract applied on lint to saturation has been found useful to cure- old ulcers. The nightly application of the Infusion was found to be the only\ remedy for pruritus ani in a case where sleep was prevented for weeks together.- Internal use of the Tnfusion satisfactory in gastralgia,—eases pain of gastric ulcer.—W. Bramwell, B.M.J. i./i2,12. It is an old remedy for coughs and weak chests.—B.M.J. i./i5,748. Thi& plant and S. tuberosum have both the same properties, resembling the Common- Borage, Borago Officinalis (/f. Tisanes) in many respects, both yielding* Allantoin-containing infusions.—B.M.J. i./i2,336 (Historical Notes—Prosper H. Marsden. Ibid., pp. 344, 393). Allantoin.—C4H8N403 = 158-0788. Dose of Saturated Solution (0-3 to 0-4%) i to 1 ounce three or four times daily. Soluble in water 1 in 260,* in alcohol 90% 1 in 2,360, in alcohol 80% 1 in 1,700, in absolute alcohol 1 in! 5,000 (all by experiment). This substance is obtainable in brilliant crystals with indefinite melting point, i.e., decomposes. Manufacture.—May be prepared artificially by oxidation of Uric Acid in Alkaline Solution in the cold . Uses.—Allantoin is a cell proliferant and is used locally as the Saturated Solution. For chronic varicose ulcers, boils, wounds, burns, etc., and after skin grafting. The dressing is applied on lint or gauze and covered with gutta percha tissue, renewed as required. Some use alcoholic solutions (0-5%) Allantoin Ointment 0-3% in soft paraffin suggested for bed sores.—W.H.M.. Allantoin is present in animals and in plants, e.g., in the fetal allantoic fluid (hence the name), also in the urine of pregnant women, and in small amountFi in normal urine. It may be derived in the latter from vegetable foods—it appears to come from these. It may pass practically unchanged through the* human being. It is present in wheat germ, bread, French beans and green, peas. Although the Allantoin in the human embryo may be a foetal waste product, in the economics of nature it may have a function to perform regarding cell multiplication, especially as it is not at once eliminated from the maternal circulation. Allantoin is not poisonous. It favours rather than inhibits the growth off organisms—demonstrated by experiments on simple forms of life from sea water. Further B. Coll, Staphylococci, Streptococci and Tubercle Bacilli are not affected by presence of 0-2% in the culture medium. In Comfrey rhizome it is abundant in the spring but almost absent in the summer (June). Allantoid (15 minims of 0-4% solution) injected into hyacinth bulbs in process of growth causes them to flower more rapidly. Metaphcsphoric Acid in conjunction with Allantoin has been tried in tubercular sinuses and skin affections internally and hypodermically with promising result.—C. J. Macalister, B.M.J. ii./i2,702. Tamarindus Indiea (Leguminosce). Dose.—1 to 8 drachms. The preserved fruit 9ontains Tartaric Acid and Potassium Acid Tartrate in considerable quantity, and added sugar about 30%. It is also imported pressed into i solid mass as pulp. Pastiili Tamarindorum Compositi, P. Aus. Add. VIII. ‘Hindu Dates. —Tamarind Pulp 10, Senna in fine powder 3, Sugar 5, Wheat Starch 1. Mix on water bath. Divide into Pastilles weighing about 40 grains each and cover with chocolate. Useful laxatives for children and invalids. Tanacetum, Tansy.—Leaves and tops of Tanacetum vulgare. An aromatic bitter used as a vermifuge, but may cause dangerous irritation. Liquid Extract, 1 = 1. Dose.—15 to 30 minims. Tannia (N.O Aracece). The tubers of this plant contain a large amount of Starch and Calcium Oxalate. They play an important part in the diet in the Tropics. It is necessary to boil the parts used at least two hours to become edible.—A. Clark, Jl. Roy. Soc. Trop. Med., Mar. 9, *29,453. Taraxacum officinale (Compositoe) (B.P. ’14). Dose.—30 to 120 grains Its preparations are : Exfcractum from fresh root. Dose.—5 to 15 grains. Liquid Extract (B.P. ’98), 1 = 1. Dose.—i to 2 dr. Flavoring.—Syl Limonis, Syl Cinnamoni, Syrupus Zingiberis. Suecus (B.P. *14), 3 of expressed juice with 1 of alcohol 90%. Dose.—1 to 2 dr. Facts and fancies about Dandelion, and other Compositce from the botanical aspect.—J. Small, P.J. ii./16,157. Taxus Baccata.—The Yew. iHjTaxine, an alkaloid, is a constituent. Dose.-—TJ0 to elr> grain. Is said to have an action on circulation. The berries are poisonous. Description.—E. M. Holmes, P.J. ii./i5,638,641. Poison probably obtained from Yewberries was used on arrow heads by the Greeks of old.—Sir C. Ballance, L. h/20,5. Terebinthina Chia, P.L.—Dose.—5 to 10 grains. Oleoresin from trunk of Pistacia Terebinthus ; was used for cancer of the female generative organs. Teucrium Seordium (Labiatce).—Water Germander. Dose.—10 to 20 grains. Contains a volatile oil and a bitter principle. Given for haemorrhoids and pruritus ani. Diaphoretic; tonic for scrofula, gout, dropsy, flatulence. Liquid Extract. Dose. — | to 1 drachm. CE) Electuaire Diascordium, * Diascordium ’ Fk. Cx. Water-Germander Herb 50, Red Rose petals 20, Bistort Root 10, Gentian 10, Tormentilla 10, Barberry Berries 10, Ginger 5, Long Pepper 5, Canella 20, Siam Benzoin 10, Galbanum 10, Gum Arabic 10, Carbonate of Iron 20, Opium Extract 5, Mellitum Rosse—Mellite de Rose Roime 650, Malaga Wine 100—by weight throughout. 15 grains of this Electuary contains 0*006 Gin. (about grain) of Opium Extract. Thallium Tl = 204-39. This element, resembling lead on the one hand and Potassium on the other, was discovered by Crookes by spectral analysis in residues of sulphuric acid manufacture. Thallium Acetate. T1C2H802 = 263*4134. Dose.—li to 3 grains was tried in syphilis, but is not equal to mercurials ; if given an hour before the commencement of a sweat, was found of value 111 the night sweats of phthisis. Loss of hair and arrest of perspiration accompany its use. E&iiation in Ringworm—it has been much advocated for this, the direction being to admihister it only to children wh9 have not reached the age of puberty in certain specified dosage based on weight of the child. Details, .see Edn. XIX., p. 891. At least 24 deaths are recorded. 3 deaths at Wemb- JeyB7rpnt'Refl95—B M J i /28,659 ; L. L/29, U05 ; B.M.J. i./3o,589 ; Toxi- oology? Use not justiAed.%. B./3O.1840. ' A gbtl 1 of 101 —l ii /3i,913. After-results at St. George's Hospital, not encouraging. Anything but'epilation by X-Ray treatment is a waste oi tune.-L. Haden °Ttaitam Sulphate2 mixed with grain (1 in 1,000) useful to kill wild rats in the Hawaian Islands.—P.J. iL/3i,22S. Thebaine Hydrochloride Ph. Ned. V. C19H21NOs.HCUH2Q = 356*6444. Dose.—£to 1 grain ier os increased with care, Hypodermically T\r grain. The salt of an alkaloid of Opium, soluble about 1 in 15 of water. Has bee used in neuralgic affect on». Thuja Oceidentalis.—Arbor Vitae. A Tincture is prepared, of the drie young tops in 10 of 70% alcohol. Dose.—2 to 5 minims (0T2 to 0-3 Ocj Thuja has an irritating action on the skin, and has been employed to remow warts and fungoid granulations from ulcers ; internally for amenorrhoeo. pulmonary catarrh, and worms. ^ Ecthol (T.M. 224,575). Dose.—1 drachr. well diluted. Is said to contain Thuja oceidentalis and Echinacea angustifolia Employed in all forms of septic conditions, e.g., typhoid, erysipelas, diphtheri acne, etc., also locally for any kind of pustular formation ; as wound dressing, diluted with 2 to 10 times volume of boiled water. -Thymus Vulgaris (Labiate). Thyme. Extractum Thymi Liquidum P. Helv. 1 = 1 Dose.—5 to 30 minims. Flavoring.—Syl or Glyl Pini, or Lavan dulse, Syrupus Aurantii. Pertussin, a proprietary article for whooping cough contains this drug. Dose.—1 to 4 drachms repeated. Syrupus Thymi (PL Notes). Liquid Extract of Thyme, 1 Syrup 7 has similar properties and dost S! With a small dose of Diamorphine a virtual specific for hacking cough! The following are two useful mild sedative preparations for cough: CEDE Linctus Thymi et Diaphorm. Dose.—1 drachm as required. Diamorphin rh grain, Syrup of Thyme to 1 drachm. C£> El Elixir Thymi de Diaphorm. Dose.—1 drachm as required. Diamorphine A grain Compound Tincture a Lavender 15 minims, Syrup of Thyme to 1 drachm. Oleum Thymi. Dose.—3 minims. Distilled from the fresh herb—cji Origanum Majorana. It contains 25% Phenols (Thymol and Carvacrol). “ Red ” Thyme Oil on rectifying is converted into White Thyme Oil. T* prevent this turning red again it is frequently distilled with a large amount ck Turpentine, or indeed the white variety is simply a dilution with Turpentine Oil of Red Thyme is obtained from the fresh herb, Thymus Vulgaris anc other vars. in Southern France. Spanish Thyme Oil is probably derived from a species of Origanum. Tragcpogon Pratense (Compositce). ‘ Goat’s Beard.’—Poisoning by seed; of, called ‘ Gipsy Nuts,’ has occurred. Give Emetic : Strychnine hypod. Ulmus fulva (Ulmacece).—The Slippery Elm, U.S. X. (Ulmus campestris is common in Europe). The inner bark of fibrous texture has a highly mucilagin-t ous taste ; in powder is much used as a demulcent. It should be free from starch. Ten grains shaken with an ounce of water should form a thick jelly- like fawn coloured mass. Decoction—1 in 8. Dose.—2 to 4 ounces. A.- mucilage 1 in 16H was Official in U.S. VIII. Glycogelatin Pastils are prepared containing 2 grains. Urginea.—Indian Squill. JJ. indica and Scilla indica are B.P. ’14 and preparations Acetum, Pilula Ipecacuanha) cum Urginea, Pilula Oomposita Oxymel Urginea), Syrupus and Tinctura correspond with Squill preparations: for use in the Tropics. Vanadium (V = 50-95).—Meta-Vanadic Acid, HVOs = 99'9578 and Sodium Meta-Vandate, NaVOs = 121-947. Of these the last has been used in chlorosis..* phthisis, and rheumatism as tonics and antiseptic. Dose.—1/32 grain or 1/55; the quantity injected hypodermically. Soluble in water, 2 in 1; decomposer in the presence of organic matter. Yanadine.—A liquid preparation of French manufacture, said to contain a vanadium salt and sodium chloride. Is used for gastralgia and dyspepsia. Vanillin. U.S.X. Methylprotocatechuic Aldehyde. C8H3OH.OCH3.-, COH. 4:3:1 = 150*0624. Occurs in white acicular crystals, having a strong: odour if obtained from Vanilla planifolia (Orchid,acoe) (the cured full-grown, but immature fruit), but is mostly made synthetically from guaiacol or front eugenol or from coniferine, a glucoside obtained from coniferous woods Soluble in alcohol, ether, and oils, sparingly so in water. Use suggested in atonic dyspepsia as an excito-motor stimulant. For employment as test vide Vol. II. Solutio Vanillin.—Vanillin SO grains. Alcohol 90% to 1 ounce> For ordinary purposes \ drachm will flavour a pint of medicine. Essence of Vanilla 1 in 8 by macerating Vanilla Beans 1 finely ground with Sand 1,- in a mixture of Water 2, and Alcohol 90% 6. From this are prepared GlyL and Syl Vanillae q.v. Elixir Vanillin! Compositum : N.F. Dose.—\ to 1 drachm. Mix Compound Spirit of Vanillin 20, with Alcohol 80, add Glycerin 25, then Syrup 300 and Water 550 in several portions with shaking. Then Tincture of Caramel 20 (Caramel 1. Alcohol 2-5, Water to 10). Finally Water to 1000. Filter with Kieselguhr. Spiritus Vanillini Composites : N.F. Y. Dose.—i to 1 drachm. Vanillin 40, Oil of Orange 10, Oil of Cardamom 2, Oil of Cinnamon 1, are dissolved in a sufficiency of Alcohol to make 200. Up1 eratrina (B.P. 1898). Ph. Ned. V. Dose.—B to A grain. A mixture of alkaloids, chiefly amorphous veratrine and crystalline Cevadine, from Cevadilla seeds—Schcenocaulon (Asagrnea) officinale (Liliacece)—in greyish white masses, taste, bitter and acrid. . Nearly insoluble in water; soluble 1 in 3 of 90% alcohol ; 1 in 6 of ether. It is used as an antipyretic icith caution, and circulatory sedative in fevers and acute inflammations—resembles Aconitine in its general effects. Large doses cause vomiting and purging ; sometimes for neuralgia, spasm, rheumatism and gout. Externally in the form of ointment for neuralgic pains and swellings. Caisieora. Its sternutatory properties are most marked. CefQleatum Veratrinse Veratrine 2, Oleic Acid (by weight) 50, Olive Oil to 100. Useful for neuralgia. Stronger, e.g. 10% is employed as a pigment. CEDUnguentum Veratrinse (B.P., *98). Veratrine 1, Oleic Acid (by 'weight) 4 (1 grain = 2 drops); warm gently to dissolve, add Lard 45. Prolonged use may produce rash. Useful for neuralgia and sciatica, rubbed in twice daily. Qp)Acetum Cevadillae, E. Cevadilla Seeds crushed 10, Methylated Spirit- 10, Acetic Acid 18, Water 72. Macerate 7 days. P.G, VI is also 10%. For external use. Veratine in poliomyelitis.—P.J. ii./3i,343. Veratri Viridis Rhizoma.—Green Hellebore Rhizome. Dose, in powder.— 1 to 5 grains. The dried rhizome and rootlets of Veratrum viride (Liliacece), imported from and official in U.S. It contains protoveratrine and other alkaloids. Its powder excites sneezing. V. Album is similar. A powerful Cardiac, arterial, and nervous sedative In puerperal eclampsia small doses hypodermically said to be of value, giving chloroform until the veratrum takes effect. Tinciura 1 in 10 of 90%.—B.P. ’85, 1 in 5. Dose.—5 to 15 minims. Veiatrcne.—A proprietary preparation, 1 Cc. of which is equivalent to 20 minims of tincture. In eclampsia. , The rhizome of V. album (Liliacece) While Hellebore, emetic, purgative and parasiticide, contains alkaloids. Similar to those of V. Viride. Both the preceding must be distinguished from Helleborus Niger (Ranun- culacece), or Christmas Rose, which is purgative and emmenagogue and has strong sternutatory properties, and is now little used. H. Niger and H. Viride—a comparative study. It is not possiole at present to find any character enabling one to distinguish with certainty between these rliizomes and roots.—T. E. Wallis and A. M. Saunders, P.J. iL/24,90. Yerbaseum Tbaosus P. Dan. Great Mullein (bcrophulai'iacece). Has been used in phthisis; 'has anodyne demulcent and diuretic properties. Tincture 1 in 8, Alcohol 60%. Dose.—20 to 60 minims. Verbena Officinalis.—Vervain. Has been used as a remedy for epilepsy, ivescettes. (T.M. 260597). Effervescent Salts m compressed form. To be crushed and added to a small quantity of water preferably warm. For various formulse see Index. . - . . Viburnum Opulus.—Used as antispasmodic as a Decoction 2 ounce in 1 pint of water. Dose.—A tablespoonful to a wineglassful. It was accidentally discovered that all the commercial supplies of ‘ Viburmim oprdus ba^.°ou- sisted of the bark of Acer Spi atum, which has no known effects on the animal system—they have strong resemblance m appearance. A totally macti e preparation had been used for years.—H. H. Rusby, P.J. u./j&oid. Viburnum —Black Haw (B.P. ’14). Ph. Ned. V. Bark of V. prumfolvum (CaprifoUac'eoe). Antispasmodic, diuretic,, nervine tonic. For dyBmenorrhcoa and threatened abortion. Extractum Liqmdum (B.P. 14). Dose.—I f.f drachms 1-1 Alcohol 70%. Tincture 1 in 20 Alcohol 60%. Dose.—2 to fdTi Elixir Viburni pkmifolii, B.P.O Tincture of Cardamoms 7-5, Aromatic Elixir to 100. VhV^ is Liquid Extract of Viburnum 50, Dry Extract 01 Hydrastis 1 75, O Coriander 0-5, Oil of Caraway 0-5, Glycerin to 100. Vinca major—Great Periwinkle Herb. Is astringent, ana nas been us for menorrhagia. Infusion, 1 in 10. Dose.—A wineglassful frequently Liquid extract, 1 to 2 drachms. Viola Odorata.—Has been used in cancer both internally and externally as a _ Liquid Extract (2 = 1 of fresh leaves). Dose.—Internally, 1 drachm and Liquor Violas Glueosidi. Dose.—ounce thrice daily. Syrupus Violas.—Macerate fresh flowers 2 in alcohol 90% 1, 8 hours, pres and add water to 2, filter and add syrup 18, used as flavoring. lonone.—Artificial violet perfume made by action of alkalis on a mixtur of Citral and Acetone in presence of water. It has composition Ci3H290, anc is an oily liquid with Sp. Gr. 0-935. It contains a-ionone (Sp. Gr. 0*932)) haying the sweeter odour, resembling Orris, and 6-ionone (Sp. Gr. 0-946> which more resembles the fresh violet flower. Synthesis of lonone.—P.JT ii./29,289. _ lonone is better blended and matured a month with other perfumes, e.Q lonone 574, Bergamot Oil 174, Terpineol 14, Heliotropin 9, Benzyl Acetate 3^ Musk-Xylol 34. About 0-5 to 0-6% of this blend for face creams.—P.J i./3o,4. Viola Tricolor.—Flowering plant of Wild Pansy. Is stated to contain Glucosides similar to V. odorata, also Salicylic Acid. Is used externally as an ointment, and a poultice. Dose.—10 to 60 grains in infusion. An infusion in milk 1 in 10, useful in acne vulgaris. Viscum album.—Mistletoe (Loranthacce). The berries are said to be emeti and purgative. The plant contains Viscin, a kind of birdlime—Japanese Birdlime, which has been used as a plaster and is largely employed for makin sticky fly-papers. Has been given for epilepsy and hysteria. Dose, in powde 10 to 60 grains. Recommended for chorea.—W. W. W. Liquid Extrae 1=1. Dose.—15 to 60 minims. H yperpiesia treated by extract of viscum injections intramuscularly C centigrammes night and morning) and per os in pills (15 centigrammes nigh and morning).—B.M.J.E. ik/26,17. In albuminuria said to be of value. Solid extract used, 0-1 to 0-3 Gm. j per diem ; acting best when blood pressure and tension is high. jfcGuipsine (T.M. 310351) pills stated to contain 0-05 Gm. of active prii I ciples of this drug. Fresh mistletoe contains a volatile alkaloid and tw- saponins and emetic and cathartic resin. Guipsine is stated to contain [ai | these excepting the resins. It lowers arterial tension due to a central vase motor action, and is without any depressing action on the heart itself. Fc use in arterio-sclerosis. Xanthoxylum.—Dried bark of Xanthoxylum Americanum (Miller), Norther Prickly Ash ; or of X. Clava-Herculis (Linne), small (Southern) Prickly Asr (N.O., Rutacece), Fluidextractum. U.S. IX. 1 = 1. Average dose.—30 minim Hydro-alcoholic. Stimulant, employed in rheumatism. For further varieties of Xanthoxylum, see Edn. XVIII, p. 867. Xysmalob num.—A bitter crystalline glucoside (0-3%) from the root c Xysmalobium undulalum (N.O. Asclepiadacece), R.Br., a South African nativ remedy for dysentery and as a bitter tonic. Toxic and has Digitalis-lik: action!—J. M. Watt, Jl. Ph. & Exp. Therap., Mar.,’30,261. Isolation c Glucoside.—Trans. Roy. Soc. S.A., 1927,XIV.,353. Vage. A note on.—E. M. Holmes, P.J. ii./27,111. See also Y.B.P. ’27,26-) Yerba Santa (Eriodictyon ghdinosum or E. calif or nicum).—Leaves ar aromatic and sweetish, often agglutinated together ; they are stimulant i bronchitis, phthisis, and other catarrhal affections. Fluid extract, 10 to 4 minims. E. californicum is Official in U.S. Fluid Extract 1 = 1. Averac dose, 15 minims. Contains crystalline Eriodictionone C15H70 (OCHs).(OH) rf3!Yohimbine Hydrochloride, C2lH?(!Q.,N2-HCl. P.G. VI. The salt o an alkaloid (M. pt. 234° C.) obtained from Yohimbe bark by extraction wit Acetic Acid, precipitating c. Sod. Carb. and recrystallising from alcoho Pausing stalia Yohimba (Rubiacece) is a reputed aphrodisiac 1% solution i Alcohol. Dose.—5 to 15 minims. Yohimbe is used by the Cameroon nativee CP)Tablets contain A grain. Dose.—1 thrice daily ; may be increased t five. (Avoid excess.) It has erotic powers. If the internal administratio not successful, injections of 7 to 15 minims (4 to 1 Cc.) of a 1% solution ma;;, be tried. A few drops of a solution 4 to 1 % strength act as an anaesthetic when applies to the cornea. True Yohimbe bark contains at least 4 alkaloids totalling 0-3 to 1-5%. History, botanical sources, chemistry, tests and characters of Yohimbe.— Prof. J. Small, P.J. i./22,283,311 ; Y.B.P., ’27,56-59 ; P.J. ii./25,17. Zingiber (B.P. ’14). Dried rhizome (scraped) of Z. officinale (Seif ami- nacecp). Dose— 5 to 15 grains. Must yield 5% to Alcohol and 8-5% to Water. P.G. VI. has the rhizome not scraped. Fluidextract. U.S. 1 = 1, alcoholic. Dose— 8 minims. Syrup (B.P. ’14). Dose.—% to 1 drachm. Ginger 1, Alcohol 90% q.s. to 2 by percolation, add Syrup q.s. to 40. Puivis Aromaticus U.S. IX. Dose.—15 grains, Saigon Cinnamon 35, Ginger 35, Cardamom 15, Nutmeg 15. Tinctura Carminativa, B.P.C. Dose.—2 to 10 minims. Essence of Ginger 6-25 (B.P. 1885), Cardamom Seeds, bruised, 6-85, Oil of Cinnamon, Oil of Caraway and Oil of Clove of each 1*04. Macerate the Cardamoms in Alcohol (90%) 75 for a week, decant, express, and dissolve the oils in the mixed tinctures, adding Alcohol (90%) q.s. to 100. Tinctura Zingiberis Fortior, Essence of Ginger, B.P. 1885. Ginger 1, in Alcohol (90%) 2. Dose.—5 to 20 minims. Tinctura Zingiberis (B.P. ’14). Dose.—30 to 60 minims. 1 in 10 Alcohol 90%. Gingerin. Dose.—i to 1 grain. The treacle-like oleo-resin of ginger made by percolation with ether or acetone and subsequent evaporation. Added to purgative pills to prevent griping. Gingerol of Grier confirmed by A. Lap- worth. It has been converted into a crystalline derivative and further broken down by the latter investigator into a crystalline pungent principle. Finally gingerol has been synthetised on these lines.—P.J. i./i7,201. See also ii./17,172,205. ‘ Hippccras ’ Dose.—As required, Ginger,” Cloves, Mace, Nutmeg, Galangal, of each 1 drachm, Cinnamon 2 ounces, White Wine 11 gallons, Sugar 40 ounces, Digest 3 days. Stomachic and antispasmodic.—From an old herbal. Mistura Carminativa. Dose.—1 ounce (16 Cc.). Tincture of Ginger 3 drachms, Compound Tincture of Cardamoms 9 drachms, Tincture of Capsicum 1 drachm, Spirit of Ether 3 drachms, Spirit of Chloroform 11 drachms. Peppermint Water to 6 ounces. A dose every 2 or 3 hours useful in dyspepsia.— Sir W. H. Willcox. Ginger cultivation in Jamaica.—P.J. i./26,324. Research by the Imperial Institute has resulted in a high-grade Ginger available from Nigeria equal in all respects to best Jamaica.—Imp. Inst. Kept. 1930. Notes on Ginger.—H. S. Redgrove, P.J. ii./so,54. VACCINES AND ANTITOXINS. Vaccine Therapy may be defined as—“ to exploit in the interest of infected tissues, the unexercised immunising capacities of the uninfected tissues in other words, to stimulate the chemical machinery of the patient to elaborate the required specifically bacterio-tropic substances. In some infections, e.g. . furunculosis and other staphylococcal infections, and in bronchitis and other infections of the respiratory tract due to the pneumococcus, the results have been striking. In many other diseases, such as typhoid fever, gonococcal infections, septicaemia and endocarditis, encouraging observations are on record. Vaccines have given valuab e results in the prophylaxis of disease. With regard to the Antitoxin Treatment Behring showed that the toxins of the diphtheria bacillus when injected into a suitable animal effected an immunity, that the serum of this animal gave protection against the disease when injected into another, and that it could be employed for treating the disease in the human body. The antitoxins contained in this animal blood serum combine: with the toxins in the blood and tissues of the sick person; by so: doing they neutralise the 'power of the toxins, and thus he recuperates. The Toxins of diphtheria and tetanus are extra-cellular “ soluble’' toxins excreted by the bacteria, found in the fluids in which they are cultivated. But in the case of typhoid and plague, the toxins= are apparently inherent in the bacterial cell; and anti-endotoxins- are not readily produced. Antibody is a substance found in the blood serum, resulting from- the inoculation into the animal of a foreign protein termed its antigen.. Thus, if a foreign protein, e.g., egg albumen be injected, the blood! serum acquires a new property, that of precipitating a solution of: egg albumen, such as was used for the injection. Here the albumeni is the antigen and the new property is assumed to be due to a new substance—an antibody called precipitin. Antibodies are always* specific, for example, diphtheria toxin acting as an antigen leads toi: the production of diphtheria antitoxin which has no action on the toxin of tetanus. Antibodies may be classified according to effect produced on combining with corresponding antigen, thus :— Antibody. Antitoxin ... Precipitin . Agglutinin ... Cytolysin (including Bacteriolysin and Hseinolysin). Opsonin . Antigen. Toxin Coagulable Protein Cells, bacteria, etc. Cells, bacteria, etc. Cells, bacteria, etc. Action. ... ISTeutralisation. ... Precipitation. ... Clumping. ... Prepares cells, bacteria,, etc. for solution by~ complement. ... Prepares cells, bacteria, etc., for ingestion by phagocytes- It is not certain that opsonin should be classed as an antibody- Possibly all the true antibodies play the part of an opsonin. Two substances are required for the lysis of the microbe—the so-called immune body produced during the injection treatment— the other known as the complement exists already in Normal Serum and is not elaborated in increased quantities by the injections. The immune body is supposed to possess two affinities, one of which binds it to the bacterium and the other satisfies itself by combining with the complement. The possession of this double affinity of the bacteriolysin is recognised in its name of amboceptor. It must be regarded as an intermediary body which on being added to the bacteria during the process of immunisation gives the complement, existing already in the blood serum the power of attacking them. The complement—not the immune body, destroys the bacteria. In antitoxin treatment, a serum which already contains the antitoxin is introduced into the patient’s circulation and this has the power of uniting with the toxin to form an inert substance. Contrast this with Vaccine treatment wherein the tissues of the body are stimulated to form the necessary antibodies for themselves. Immunity may be (1) Natural where the organism is naturally insusceptible to the infection; (2) Acquired (a) developed as result of recovery from infective disease, or by artificial introduction of gradually increased doses of bacteria or toxin—this is active immunity ; (b) produced by introducing an antibody to the infecting substance in the shape of animal serum previously immunised,— this is temporary or passive immunity. When a person is exposed to infective disease there may be natural immunity, or he may acquire same and develop power to resist the poison. On recovery, immunity will persist for a longer or shorter time rendering him less liable to contract the disease again. In the future, antibodies may possibly be increased in the organism by methods other than the injection of dead bacilli. The old theory of specific antibody formation is giving way to the idea of specific antibodies as retained biochemical derivatives of injected antigens— rendering possible the test-tube duplication of antibody production. Diphtheria toxin exposed to a large excess of Trypsin is claimed to act as a specific diphtheria antitoxin.—Jl. A.M.A. ii./29,1387. Immunity Reaction consists essentially in the exercise of certain capacities of defence on the part of the body cells in response to the exercise of certain capacities of offence on the part of bacilli, c-o cci or protozoa, which cause the disease. Certain practical aspects of immunity.—R. A. 0 Brien, B.M.A., 1927, B.M.J. ii./27,975. Biological principles in immunity, ibid. 978. Loots# Immunity in infections diseases. Besredka claims that certain tissues have a very low resistance for certain bacteria, though the other tissues may be able to deal with them easily. Hence, he argues, if the weak tissues be immunised the whole animal becomes immune to the infective organism. Thus he claims that the skin is the weak spot in the case of anthrax, staphylococcic, etc., injections, and the gut wall in typhoid, dysentery etc. If these are immunised by local treatment then the animal becomes immune. He also says this is not accompanied by the formation of antibodies in the circulation. A iaree number of cases of infections localised in the skin or in the bone have been treated with antibacterial dressings. In the majority of cases the have been tmaxea ,, s eirm]0yed. Furunculosis, boils, osteitis, filtrate th8QT^[0^ric^ finfectTons? were treated with success. (This is osteomyelitis a ,, thenrv that vaccine therapy should be based not on supposed to justify th J theorythe receptive cell, but A study of the use of ^fSs^and6Spri's’ed Section of the InagueofA au am ,and c P person contracted the disease, ImIK this method of vaccination had completely stopped the ^ destroyed. Organisms so injected Bacteria injecte jeve} than the point where introduced. Gastric are never faJmembrane are good barriers against the passage if baoteria“& the Cd^ Ba "taken !ato the mouth may be absorbed through the buccal and pharyngeal mucous membrane. Bacteria introduces into the body by any route are always excreted into the intestinal tract.— Teale and Embleton, B.M.J. i./22,437. Gratia repeated Besredka’s experiments and finds that though his fact, are partly correct his explanation is very doubtful. He considers the mos likely interpretation is that when the bacilli are injected into the skin thev are able to multiply and give off their toxic properties, to which the anima. reacts by forming immune bodies. Besredka’s hypothesis of local immunity is not in agreement with observed fact.—A. Gratia, per B.M.J.E. ik/24,72. ** Antiviruses are substances of microbic origin capable of local vaccination without the introduction of antibodies. They are selective in their action and affect only a certain group of cells known as ' receptives,’ e.g., the staphylo* coccus vaccine has a selective affinity for cells of the skin and certain mucou. membranes. Oral vaccination against typhoid is now taking its place in ordinary practice. Antivirus dressings soaked with filtered cultures im bouillon (or a mixture of Lanolin and Vaseline incorporating the antivirus left in place for 24 hours are being successfully used in a variety of staphylcu coccal and streptococcal infections, and in many ocular affections, e-g blepharitis, conjunctivitis, ulceration of the cornea, and keratitis —Prol: Besredka, Proc. Oct. 1929, per M.A. ’31,393. See also B.M.J.: h/2 1020 ; E. C. Plummer, ibid. iL/27,46. Antivirus Therapy. Besredka’s idea that cuti-immunity can be produce' by applying cultures of the organisms to the skin, or by using broth filtrates- Inhibitory power non-specific, but therapy a specific.—B. F. Hunwicke P.J. ii./3o,359 ; L. ii./29,771. Anti-virus results in this country not the same as on the Continent.—B.M.H ii./so,142. Digestibility of Bacteria. Although of nitrogenous base, bacterial cell are not digested by powerful proteolytic ferments. They can live and multipl in solutions which split up proteins of which by chemical analysis they haw been shown to be composed—hence their vitality in the intestinal tractt Digestion and adsorption experiments. Their lipoidal envelopes protect then —C. E. Dukes, B.M.J. i./22,430. Bacteriophage.—F. W. Twort in 1915 described the fundamental character of the filter-passing lysin—or virus—associated with different bacteria. H was shown that it infected bacteria and could be transmitted from cultur to culture. Two years later d’Herelle, of the Pasteur Institute, gave the nam. c bacteriophage ’ to the contagious filter-passing material causing bacteria* lysis.—L. i./25,845. d’Herelle says that the bacteriophage is a living corpuscular element1 independent of the lysed bacteria, which displays vital properties of assimilai tion and adaptation.—Comptes ltend., per Jl. A.M.A. ii./25,1337. The bacteriophage is not a living virus but a lytic substance produced by the bacteria themselves.—J. Bordet, Ann. de l’lnstit. Pasteur, Sept. ’25 per Jl. A.M.A. ii./25,1675. The bacteriophage can only be propagated in living bacterial cultures ancr is a product of bacterial growth rather than of bacterial disintegration. Action of Bacteriophage upon Bacteria may be summed up as follows Exposed to the action of bacteriophage many bacteria become phagogenic; grown in presence of bacteriophage the virulence of many organisms is altered.: the cultural properties of the bacteria and the character of solid colonies may also be altered ; the antigenic properties of bacteria may be modified by the bacteriophage and the bacteria are killed and lysed. Organisms most sensitive to the bacteriophage are members of the typhoid-dysentery-colon group* less susceptible organisms including diphtheria bacillus, plague bacillus, the bacillus of haemorrhagic septicaemia, staphylococci, streptococci and the cholers vibrio. Variation in virulence is a marked characteristic. It is extremely stable to heat and chemical reagents. Also possesses antigenic powers ancL various antibodies can be obtained by appropriate manipulation. While d’Herelle holds it is an ultra-microscopic living organism capable of preying, on living bacteria, others hold that it is a ferment or catalytic agent and: Kateshima suggests name ‘ Ferment d’immunite bacteriolysant.’—Jl. Trop» Med., Sept. 15, ’26,323. is snortedto be a llV^g ^8anism’ and the contention Phenol^ >a.ntJsePtlcs such as Mercuric Chloride, can be deleterious influence of which the bacteriophage 535, ibid559?d* The ture of the hactenophage. C. Prauznitz, L. U./27, —B.MUJ.ETii^26 1006CiflC baCteriophage in staphylococcal and other infections. a billion times richer in lytic particles than the original, but less stable, made by Krueger and Tamada— Jl. A.M.A. ii./2o 1735. terYonSTf8^bac^riolytic agents represented 'by bac- age.i d Kereile. Nature, conditions favouring bacteriolysis, culture media, and properties.—F. W. Twort, L. ii./3o,1064. Polyvalent bacteriophage.—L. ih/29,621. •R r^ews OH ^Many disagree with him profoundly.— ii./3o,56o. Bacteriophage theories.—L. 1./31,79. pf110*™ treated by bacteriophage. Results highly favourable. Ind. Med. Res. Memoirs reviewed.—L. ii./3o,647. I —T / ' ' B^terioph^y is a genera! phenomenon possibly involving all bacteria d Herelle, Can. M.A.J., May *31, per Jl. A.M.A. iL/31,448. Of 41 cholera patients treated with bacteriophage 7*3% died : out of 107 untreated with bacteriophage 65*4% died. Intravenous saline injections helpful m prolonging life and giving bacteriophages time to attain exaltation m virulence.—B.M.J, i./28,365. Bacillary dysentery. In general very satisfactory.—J. London, I.M.G., July, 30, per M.A. 13 159. ’ A number of further (earlier) abstracts in Edn. XVIII., p. 873. Anti-Sera are made as Polyvalent as possible, i.e., many strains of the bacterium are employed for inoculation. In the preparation of Anti-tox:in the toxin is injected subcutaneously into the animal, e.g., the horse, with strict aseptic precautions. The toxin is usually at first mixed with anti-toxin or the animal has a large protective dose of anti-toxin given before the inoculation is started. Some reaction, rise in temperature and malaise occur. Further injections are made at intervals. The quantity injected is gradually increased, and subsequently the injections may be intravenous. The blood is removed from the animal by the aid of a large sterilised canula, from the jugular vein, 6 to 12 litres may be collected in sterile flasks. The clot is allowed to form by standing 24 to 48 hours, and the serum is decanted into sterile bottles after the addition, by some manufacturers, of 0*3% of Trikresol or 0*2% of Phenol. Some of the disadvantages of Serum Therapy.—Certain types of bacteria, e.g., the Streptococci and B. Coli are only general names for very numerous families, and the antibodies efficient against one member may be altogether without effect on another member of the family. Polyvalent sera have been attended with some success but many failures may still be ascribed to this difficulty. Further, the added immunity in the use of a serum is limited in kind and extent. They may be deficient in certain necessary properties, e.g.f may not be sufficiently anti-endotoxic, etc. Again, the Serum may render the patient hypersensitive to future injections of serum from that animal from which the antiserum was prepared. To guard against this it is necessary to inquire before use whether and when the patient has been previously treated with an antiserum. Vob. I. jr Coming now to the more detailed consideration of Vaccines th following table, giving approximate initial doses for treatment anc for prophylaxis in the adult, which we have arranged, should b» useful for reference :— Vaccine. Acne Bacillus Actinomycosis Table of Vaccines. Arranged alphabetically. Prophylactic dose. Initial. Pinal. Not used. 99 Cholera B. Coli Combined for Colds B. Dysenterise Gonococcus Kay Fever ... B. Influenzae M. Catarrhalis M, Melitensis Meningococcus B. Pestis ... Pneumococcus Staphylococcus Streptococcus Strepto. Rheumaticus Tuberculin. A,F. ... ,, B.E. ... 99 500 mill. 2000 mill. 100 „ 2000 100 „ 1000 500 „ 2000 Not used. 25 units 1000 units 100 mill. 2000 mill. 250 „ 2000 „ 1000 „ 2000 „ Not used. 500 mill. 1000 mill. 250 „ 2000 „ Not used. 250 mill. 2000 Not used. Therapeutic dose. Initial. Pinal. 5 mill. 500 mill! 5 „ 100 „ or 0-001 mgr. 0-02 mg Not used. 5 mill. 500 mil 50 „ 1000 5 „ 25 ,, 25 units 10 mill. 99 99 10 50 50 50 10 100 5 5 99 99 99 99 99 1000 iooo ;; 500 uni” 2000 mil 1000 1000 2000 1000 2000 1000 1000 1000 99 99 99 9> 99 99 99 0-00001 Cc. upwards 0-00001 Cc. upwards 0-00001 Cc. upwards ,, T.R. ... Tuberculins, Various, see Tuberculin Chapter. B. Typhosus (and 500 mill. 2000 mill B. Paratyphosus) B. Whooping Cough 500 „ 2000 „ In Prophylaxis the above doses are suitable in the majorit of cases. The Intervals between doses should never be less tha. 50 mill. 5 „ 1000 mil 2000 99 7 days and may be extended to 14 days with advantage. In Treatment as regards dose it is a safe rule to follow that th more acute the infection and the more ‘ toxic ’ the patient th smaller the initial dose. The doses above stated are sufficientlj small except possibly in severe generalised infections with marker toxsemia in which perhaps the dose may be halved. As regard Intervals there is no general rule but the smaller the dose tb shorter should be the interval between doses. Thus in septicsemi cases where minimal doses are employed these may be required dailj or every other day. Clinical signs, the focal and general reaction! afford the necessary guidance. Combined Vaccines. The simultaneous use of a combination c organisms does not entail reduction in doses of the constituents. Doses f or Children: Under 3 years. 1/5 adult dose. From 3-7 years. 1/4 adult dose. From 7-10 years. 1/3 adult doe Prom 10-14 years. 1/2 adult dos- Varieties of Vaccines. The following are in use. (1) The ordinary type of vaccine which is a suspension (emulsion of the killed or attenuated bacteria in Normal Saline with, as a rul* }-% Phenol or Trikresol as antiseptic. * (According to the Therapeutic Substances Actf 1925, the nature an the percentage proportion of antiseptic substance must be stated on ?ofbr~SubseqUent t0 Feb* 6’ 19289 als° Therap. Subs. Act. (2) ^Detoxicated Vaccines (T.M. 392346). Thomson evolved \e idea of treating bacteria, e.g., the gonococcus, with an alkaline solvent, whereby the stroma or bacterial protoplasm and the toxic endotoxin are dissolved. On treatment with acid or acid salt the stroma is again precipitated, the idea being that the toxin is in the solution—the latter is rejected and the bacterial substance, after washing and suspending in slightly acid medium, is used therapeutical ly. (See L. i./i9,374,1102,1123 ; i./2i,795,849.) (3) The toxic products of the bacterial growth, either e.g., as in the case of Maliein in an albuminous medium, or as in Tuberculin A.E'. in a medium which is protein-free. The former clearly contain the. products of metabolism of the protein-containing medium, while the latter contains only the toxic excretions of the bacilli and small amounts of endotoxin liberated by autolysis. Preparation, and Standardisation of Vaccines:— A Vaccine is best prepared from the organism isolated from the patient, but in case of B. 'Tuberculosis this is not essential, and there are many obstacles in the way in other diseases, e.g., in the case of Gonococcus it may be difficult to secure a pure culture, and the loss of time may be of immense importance. In the case of tubercle a stock Tuberculin is used while a special one is being prepared from the case. The organisms are then devitalised by a temperature of 60° C. for 1 hour, and the Vaccines introduced into \ and 1 Cc. tubes. Preservative, e.g., Trikresol or Carbolic Acid as mentioned, is added. The vaccine is standardised by direct counting, comparison with various standard tubes or by the opacity method of Gordon. Standardisation of Vaccines—a note on the McFarland, compared with the Brown and Kirwan methods.—Maj. EL C. Brown, L. ii/25,941,995. The theory of Immunisation depends on the human being having a sufficiency of anti-bacterial substances to kill off the infecting organism. If the latter gains access and colonisation begins, the destruction of a portion of the invaders strengthens the defence. The bacterial invasion, if not too large, may as the result of the destruction of a few of the bacteria in question, lead to self immunisation and recovery, and the introduction of a bacterial vaccine may form the turning point, producing, as it does, the reinforcement of the defending forces that was necessary. General References to Vaccine Therapy. Eye Work.—Correct diagnosis essential. Ophthalmia neonatorum depends on infection of several organisms—the Gonococcus, Streptococcus, Staphylococcus and others. In Vaccine Therapy, by imitating nature, antibodies are created at the site of injection, distant from the original infection, and these circulating in the blood stream exert a beneficial effect on the distant lesion. Tuberculin, Staphylococcic and Streptococcic Vaccines, as also Gonococcic Vaccines, have proved themselves of value in eye work.—J. W. H. Eyre. B.M.J. ii./io,1310. A questionnaire answered by 1261 physicians showed only 17 thought Vaccine Therapy generally useful for treating infections diseases; 140 F F 2 reported harm from stock vaccines; and 17 cases of asthma followed use of vaccines in patients hitherto immune. — L. Hektoen and E. E. Irons, Jl. A.M.A. i./29,868. Vaccines compared with antiseptics. The antiseptic method was largely employed in the war, but it made the wounds no better—every microbe multiplied. Staphylococci and streptococci remained behind after perpetual irrigations with Hypochlorite. Government might with advantage forbid antiseptics. Optochin, though it will kill pneumococcus in 1 in 400,000 dilution in serum, did not give striking results in practice. Flavine, though not killing the white corpuscles instantaneously, does so on slight ‘ cooking.’ The Profession is therefore thrown back on Vaccine. Therapy. Vaccine Therapy should be used in incipient and localised infections and in septic wounds.— Sir A. Wright, B.M.J. ii./3o,735 ; L. ii./3o,960. In conditions in which the body is sensitised, e.g., exophthalmic goitre, gouty conditions, and asthma, vaccines should not he used.—Sir Wm. Willcox, ibid. 962. On Vaccine Therapy and immunisation in vitro.—Sir Almroth Wright, L. ii./31,225,277,334. Mo proof exists of the therapeutic value of vaccines.—D. Embleton, B.M.J. i./31,355. Antigen Therapy is now entirely empirical, but it would be foolish to suppose that we have seen the limits of the method of active immunisation.—Sir T~ Border, L. i./32,170. Autogenous Vaccines? i.e. Vaccines prepared from cultures obtained directlv from the patient, should be used (a) when the infecting agent belongs to an ill-defined group, e.g. £. Coli infections ; (b) when the infection is severe and it is felt to be too great a risk to wait and see whether stock vaccine is effective ; (c) when treatment with stock vaccine has failed.—A. Fleming, B.M.J. i./2i,254. Autogenous Vaccines, advantages of. Recent advances in vaccine therapy —II. E. Annett, B.P. Conf., 1919. Autogenous Vaccine doses advised by separate pathologists ranged from 100,000 to 400,000,000 streptococci. Uniformity desired.—H. Balme, B.M.J. i./31,604. See also A. G. Shera, ibid. 685, and reply 726; and H. Warren Crowe, ibid. 767. . , _ ... _ Fallacy of putting up autogenous vaccines m rubber-capped bottles. Difficulty of'measuring 0-1 Cc. in a syringe. Sealed ampoules in graded doses: preferable.—G. Bousfield, B.M.J. ii./3i,827. Technique of Injecting a Vaccine. The skin should be sterilised with Iodine or Diluted Cresylio Disinfectant; too strong applications should be avoided. The best sites are : (1) the arm, preferably the upper arm near the insertion of the deltoid ; (2) 1J inches below the centre of the* clavicle ; (3) high up on the buttock near the spine ; (4) the flank. The inoculation may be made either into the subcutaneous tissue as sites (1) and (2) above or into the muscles (site 3). The ampoule should be shaken before use, as the emulsions settle. Local and General Effects of the Injection. (a) Local. . , , _ • In 12-24 hours there may be some redness, swelling, pam, and tenderness- at the site of inoculation, and for an area of 2-3 inches around it. (!) One of the results is the production of a local hypersemia round and lit the infected focus ; this is best seen in cases of iritis, laryngitis and acute* skin infections. (2) Other effects are a rise in temperature in about 12 hours which should not exceed 1-5° F., a rise in pulse rate, which should not exceed 9Q beats a slight feeling of malaise and perhaps a little headache ; these should all pass ’off within 24 hours : if the temperature and pulse were previously unduly high they then should assume a better level, and the malaise an« headache should' be succeeded by a feeling of increased well-being. Other clinical symptoms should also improve. If none of these result Wh dose employed was too small. ntw^±Lreinoculation i3 retrogression of the patient or failure to skin and cornea, still higher doses are advisable. Acne. The Acne Bacillus, Syn,, Bottle Bacillus, may alone be the cause of acne, especially of the non-pustular forms,—-in the majorit}7, of cases, however, it is associated with the Staphylococcus. Acne Bacillus Vaccine, Syn., Acne Bacterin, is indicated in the a Dove cases where comedones are the principal features. Combination with polyvalent staphylococcus albus vaccine may be advisable. 1 nitial dose, 5 millions ; then increasing dose3—a final dose of 500 millions may be wanted. The interval between dose3 is 7 to 10 days. Ampoules are prepared each containing these doses. Bor cultivation of the Bacillus and preparation of Vaccine see Vol. II. Vaccine treatment seldom of value in acne punctata. Autogenous better than stock vaccines.—H. G. Adamson, L. if25,401. Acne Bacillus and Staphylococcus Mixed Vaccine is prepared as follows :— Acne, 5 millions with Staphyio. 100 and 250 millions ; Acne, 10 millions with StaphyJo. 250, 500, 1,000 and 2,000 millions ; Acne, 20 millions with Staphyio. 2,000 millions. Anthrax, The following serum has been used considerably :— Anti-Anthrax Serum (Sclavo’s). Each tube contains 10 Cc. An Antibacterial Serum, stimulating the activity of the phagocytes. Prepared by immunisation of asses at Siena in Italy.—( Legge). Dose.—In three or four different parts of the skin of the abdomen, injections of 40 to 80 Cc. are given at one time. After 24 hours if there has been no improvement either in the general or local condition, further injections of 40 to 80 Cc. are to be made and repeated next day if necessary. Begin treatment early. Rise in temperature following the injection is favourable. Sometimes a rash develops three to eight days after, with or without febrile symptoms : it is unimportant. The Serum keeps two years in the dark—a slight deposit in it is negligible. Technique.—Disinfect the skin with Ether, and then with a 2 per 1,000 Sublimate solution or with Ether Soap. After injection wash the site of injection again and apply a drop or two of Collodion. For intravenous injection in severe cases 10 Cc. or more repeated after 2 or 3 hours if necessaiy into, where possible, one of the superficial veins at the back of the hand, distended by pressure on the forearm.—L. ii./o5,803. Resuits with Sclavo’s Serum.—Reduces temperature and increases feeling of comfort. Wool-workers appear to acquire slight forms of Anthrax giving them immunity. A case of recovery by Sclavo’s Serum first intravenously, then in the loin and subsequently per os. (Undoubted cases of internal anthrax rarely show the bacillus in blood or pericardial or pleural effusion more than 24 to 36 hours before death, hence justified in diagnosing by clinical symptoms.)—-E.M..T. i./1 r,751. . In a successful case treated there- was apparently an incubation period of 10 days,—rapid amelioration after injection and recovery without excision of the pustule,—most cases have been excised.—B.M.J. ii./ii,103. < Skin vaccination against anthrax, from experiments on 11 guinea-pigs, coniers immunity, including all the organs. The animals proved resistant to several times the fatal dose injected into the brain.—Comptes Rend., July 10, '25, per Jl. A.M.A. ih/25,1259. Anti-anthrax serum alone, i.e. without surgical excision of the local lesion, is the treatment of choice. 50 to 100 Cc. are given intravenously, and the injections continued daily until temperature drops to normal. It is best to begin with 50 Cc. normal saline solution containing 5 drops of serum. Also of value prophylactically in 10 Cc. doses subcutaneously.—A. E. Hodgson, L. ii./28,594. ‘ ^ Anthrax treatment. Serum 80 to 300 Cc. as a preliminary repeated until temperature is normal. ‘ 606 * in dose of 0-9 Gm. daily for three days, and a fourth dose after a week. Large doses advised.—C. G. Brentnall, L. ii./3°> 1174. Fatal case of anthrax. Eusol fomentations and Sclavo’s Serum used.— A. L. K. Rankin, L. i./3x,407. Serum Anticarbimcosum. Syn. Suero Anticarbuncoso, F.E. VIII., is made by hyper mmunisation preferably of the horse. Anthrax Protection. _r _ . 4 disinfection station erected near the wool warehouses at Mersey Hocks under the auspices of the Home Office treats wool arriving from the East by a method by which not only is the natural protection of the anthrax spores removed but the spores themselves are subjected to destructive effect of Formaldehyde. The material is first washed with an alkaline warm soap solution and then disinfected at 102° F. with 2 or 24% Formaldehyde Solution for 20 minutes in 2 stages of 10 minutes each, then dried and cooled.— B.M.J. ii./si,952. Plate ibid. opp. 933. , . , Sevmour Jones’ ‘ Formic Mercury ’ process. Hides, skins, etc., are treated in the ‘ soak ’ process with Formic Acid 1 to 2% and Mercury Perchloride 0*02%.—L. ii./ir,1260. Shaifinfg brushes infected conveyed anthrax infection probably due to disease in the animals from which the hair used in their manufacture was originally obtained.—R. R. Elswortliy, L. i./i6,20. See also E. H. Snell and E. W. G. Masterman. L. i./i6,242. A, Similar source of infection. The serum promptly used saved patient s life A swab examined at Torquay from a pustule found to contain Anthrax B at 11 p.m. ’Phoned to Martindale’s for serum which was placed on the train leaving Paddington at midnight. It was administered to patient before 6 a.m. and undoubtedly saved patient s life. C. Owen, P.J. WT7>62. Wool and mohair even when washed clean may yet be contaminated with anthrax.—L. i./26,107. . i , ,, , •, , Mortality from malignant pustule (a variety of external anthrax) reduced in Italy to'5-3% since the introduction of treatment by anti-anthrax serum, —B.M.J.E. i./26,42. B. Influenza Pneumococcus Streptococcus M. Catarrhalis 7% 2% 3% Bronchitis and Pulmonary Catarrh.—The bacteriology of bronchitis is broadly speaking the same as that of the common cold. The predominant organisms in their order and occurrence are : present in 40%. M. Paratetragenus present in 23% 52% B. Friedlander group 53%. B. Septus 72%. Streptotlirix (Sputum to be examined after washing out the mouth and throat, and expectorating into a sterile bottle immediately on waking.) The marked relative absence of B. Septus is notable. The infections of the lower passages are commonly mixed ones. The pneumococcus may be regarded as a frequent cause of bronchial catarrh and the most dangerous to the patient. Note also that B. Influenzae may be resident in the bronchi or pulmonary cells without giving localised though marked constitutional symptoms.. The sputum voided may be almost nil. Doses of the Vaccines are given under the various headings. Autogenous Vaccines are more likely to be efficacious than stock ones and it must be remembered that variation in the flora is liable to occur during, the progress of immunisation, hence repeated examination necessary. ■, ’P1’011?*11^18 IS pre-eminently suited for Vaccine therapy—old age and a ciesperate condition of the patient are not contra indications to treatment. bronchitis treated with autogenous vaccines. If possible, the sputum should not be allowed to get cold. Nasal cultures to be sent in addition.—L. Mackey, B.M.J. ii./22,715. Catarrh, Nasal and Tracheal. The organisms principally involved— either singly or mixed in setting up acute catarrhal infections of the respiratory tract are the B. Influenzas, Pneumococcus, B. Septus, Streptococcus and M, Catarrhalis. The organisms appear in cycles. Thus B. Septus may be found in 80 to 90% of the cases in each epidemic for two or three successive years and then disappear altogether for 4 or 5 years. Combined Vaccine for Colds and Influenza (jfcWimpole Institute, T.M. No. 392346). Syn. B. Influenzae, Pneumococcus, Streptococcus, B. Septus and M. Catarrhalis Vaccine. The composition of this vaccine is altered slightly from time to time to suit prevailing epidemics; for general use at present it contains B. Influenzas, Pneumococcus, Streptococcus, B. Septus and M. Catarrhalis in the proportions 2: 1: i: l: 1. Ampoules for Hypodermic Use contain 25, 50, 100, 250, 500 and 1000 millions of each organism respectively with exception of B. Influenzce which is double. Initial dose.—The contents of an ampoule containing 50 millions of each organism. Children of 10 to 15 years receive half doses. A dose of 100 millions as a preventive against colds in those subject to such attacks, followed in 7 days by one of 250 millions, and again after 7 days by one of 500 millions, which may well be repeated or increased to 1000 millions if no marked reaction ensue, has proved very efficacious. It is also suitable for immunising against and treatment of influenza. The earlier the treatment is begun the better (with patient in bed); inoculation is best in the evening between 7 and 10. Has proved of value not only in the treatment of catarrhs, acute and chronic, but also in pulmonary phthisis, where bronchitic symptoms are conspicuous—in such cases where Staphylococci or Streptococci are the secondarily infecting organisms no good can be expected from its use. Anti-catarrhal vaccine evidently of value as patients come regularly in the autumn for a dose.—H. H. Mills, B.M.J. ii./3°,735. Common colds may be caused by -hiteratofe virus, Report on Public Health Subjects Min. Health Report, No. 57, 1930. Set about observing oyer a lengthy period the flora of the respiratory tract of a sample of the community and compares findings with the incidence of respiratory diseases. In the winters 1925-26 and 1926-27 there was an increase of respiratory diseases in Manchester, but whilst in the former there was little or no ‘ flu,’ in the latter there was. There is some evidence that ‘ flu ’ is produced by Indol-produc- ing heemophilic bacilli.—B.M.J. ii./3o,569. The organisms may be secondary. —Prof. A. Fleming, B.M.J. ii./3o,736. Common cold infection due to filter-passing virus incapable of growing on known culture media.—John J. Abel Fund, L. ii./3o,1192. Micrococcus Catarrhalis Vaccine.—Of service ill nasal tracheal and bronchial catarrhs, both acute and chronic, in bronchitis and bronchitic asthma and in catarrh of the middle ear, when the causal relationship of this organism to the attack has been demonstrated. Initial dose of 10 millions may be repeated in 5-7 days. In chronic cases 1000 millions or more may be ultimately necessary. Ampoules contain 10, 50, 100, 250, 500, and 1000 millions. M. Catarrhalis is one of the constituents of the Combined Vaccine for Colds antea. M. Catarrhalis infections may begin at any part of the respiratory tract—characteristically with an inflamed feeling of the fauces and naso pharynx. Chronic tracheal catarrh is frequently due to infection by this organism or M, paratetragenus, to which secondary infection by staphylococci, streptococci, pneumococci, and other organisms may be added, or to the pneumococcus alone. Cultivations from the trachea showed that non-Gram-staining Cocci are present in 78% of normal throats, and 68% of catarrhal throats. M. Catarrhalis is well known as a cause, of common colds and of influenza, bronchitis, and pneumonia. Causes very irritable cough with scanty viscid expectoration. It grows best on blood agar, and produces no acid in glucose broth. B. Septus causes a mild pharyngitis with painful throat, muscular pain, with, however, no temperature and little or no nasal catarrh,—probably a common cause of stiff neck and muscular rheumatism. B. Friedlander occurs in many acute and chronic colds, and may cause very profuse coryza. Chronic Nasal Catarrh treated by Autogenous Vaccines ; a good proportion of cures.—L. Mackey, B.M.J. ii./iq,159. Directions for taking secretion for preparations of an Autogenous Vaccine, If in the throat, the mouth is to be washed out in the morning with sterile water, and the throat to be gargled, as also teeth washed with same, then patient is to spit once into a sterile bottle. If, on the other hand, the infection is in the nose, the entrance to the nostrils should be washed with soap and water and discharge blown into a sterilised bottle, or better, post-nasal swabs should be taken. See also Influenza and Pneumonia. Cerebro-Spinal Fever, Syn. Cerebro - Spinal Meningitis. Malignant Purpuric Fever, Petechial Fever, Spotted Fever. Characters of Cerebro-Spinal Fever. It is an acute epidemic disease, characterised by profound disturbance of the central nervous system, indicated at the onset chiefly by shivering, intense headache or vertigo, or both, and persistent vomiting ; subsequently by delirium, often violent, alternating with somnolence or a state of apathy or stupor ; an acutely painful condition with spasm—sometimes tetanoid—of certain groups of muscles, especially the posterior muscles of the neck, occasioning retraction of the head, and au increased sensitiveness of the surface of the body. Throughout the disease there is marked depression of the vital powers; not unfrequently collapse ; and in its course an eruption of vesicles, petechial, or purpuric spots, or mottling of the skin, is apt to occur. If the disease tend to recovery the symptoms gradually subside without any critical phenomena, and convalescence is protracted ; if to a fatal termination death is almost invariably preceded by coma. After death the enveloping membranes of the brain and spinal cord are found in a morbid state, of which the most notable signs are engorgement of the blood vessels, usually excessive, and an effusion of sero-purulent matter into the meshes of the pia mater and beneath the arachnoid. The name ‘ Spotted Fever ’ given to this disease is a misnomer , as the spots are by no means constantly in evidence. Useful “Remarks on Cerebro-Spinal Fever in Gamps and Barracks” by Sir Wm. Osier, include the following. The disease spreads slowly or indeed not at all from foci of prevalence in various parts of a country. It has prevailed chiefly in the winter arid spring months ; an epidemic rarely lasts into the summer. It has a higher death rate than any acute infection except plague and cholera but the total mortality is not great as the case incidence in the community is low. It will kill within 24 hours—or less. As a rule the organisms disappear from the naso-pharynx of healthy “ carriers ” in the course of a few weeks. The organism (meningococcus) is a fence in an^ndividual*o^p6}?uPread in.tde community and of intense viru- the omnium o oncei^.as passe(i the portais of protection. Whether taSSSn? » v wiiiidiion essential, ail winnows to be open day and night. Blood-sucking insects are now known not to convey the disease, in some cases septicaemia occurs. The meningococcus docs not noopq^riiv produce nasopharyngeal catarrh but catarrh!?^conditions nredfsnosS to infection-°- Worster-Drought kndT ills5 KcSy.- Debat?:—°Clety of Medicine (Section of Epidemiology and State Medicine) Various strains of the organism exist—to one of which the name nara- imporfmi^nart tm?n give?' fT/]e hf“lthV carriers seem to play the most men^nso^nrSfi^oifn tfe pread of the disease. Discrimination between the meninltis dSes^ccS, hTrlrel™ * matter °* SOme ^iportance-gonococcic TnIliQSiVhf!!! ffm eT>i?S-ii T,llc disease has assumed very virulent characters. 1Df if kl.ped anything between 20,000 and 40,000. Descrip- “ ai0ld division or the infection into five general types.—E. N. Butler, L. Clinical features in children.—F. E. Batten, L. i./i5,964. Gordon .and Murray carried out a systematic examination of a number of cerebro-spina, fluid meningococci and divided same into Fa ir Groups Tvpes , dypes I. and II. are the main groups. P. Tildes confirms their results.—Jj. 1./1 o,92. . inhibitory action of saliva (normal) on the meningococcus. The action is cue to its content of living bacteria (streptococci). Hence avoid contamlna- tion with saliva m taking swabbings from naso-pharynx.—M. H. Gordon, B.M.J. l./i 6,849. Age incidence. In the epidemic of 1914-1915 and 1915-1916 the most susceptible age was under 5 years—he., during infancy and early childhood, there was a marked falling off of cases after adolescence was passed. The least susceptible age apparently was 35-40. It is a weather disease associated with the sudden saturation of the atmosphere with water vapour. The nasopharyngeal mucous membrane is then more easily traversed bv the meningococcus.—A. Crompton, L. ii./i7,14. Lumleian Lectures, Epidemiology. Mode of spread of infection. Path of meningeal invasion. Clinical forms—a very exhaustive paper.—Sir H Kolleston, B.M.J. i./i9,4Q6,536. Meningo. Carriers, Study of.—D. Embleton and co-workers.—L. ii./i9,679. Bacteriology and Diagnosis,—A diplococcus, evidently Diplococcus intracellular is meningitidis (Weichselbaum), has been isolated from the cerebro-spinal fluid, and from the brain membrane and the purulent exudate. The old view concerning transmission was that the organism, by whatever way transferred, gained lodgment in the naso-pharynx and thence migrated to the base of the skull and the mengines. The present view is that infection takes place by direct contagion and that it is primarily a blood infection, localising later in the central nervous system—indeed, it frequently remains confined entirely to the blood stream, not invading the central nervous system at ail. For this reason it is now usual to make blood cultures, as well as spinal fluid ones.---Stitt. The organism resembles the gonococcus M. CatarrJialis, M. flavus, etc., in morphology, in being intracellular, and in its non-staining by Gram’s method. It requires special media for its cultivation and is recognised by its growth, sugar and agglutination reactions. It will not grow at a temperature below 25° C. and without precautions against drying it will die out even at 37° C. The organism is grown on Nasgar Medium (v. M. Gonorrhoea, Vol. II., or preferably on Gordon and Hine’s Trypagar. Gordon’s Memorandum on cerebro-spinal meningitis to the L.G.B. Characters of the Meningococcus detailed. M. Catarrhalis likely to be confused with it.—L. i./o 7,598. “Chocolate” Medium made by heating 3 pts. of defibrinated bullock’s blood with Trypsin Agar and 1% Glucose until it becomes a glossy opaque solid medium of chocolate colour. Results of cultivation of the meningococcus more successful than those with Serum—trypagar medium and others. —H. W. Crowe, L. ii./i 7,201. West’s Swab for taking swabbings from the posterior wall of the pharynx consists of a wire in a bent glass tube and resembles Bellock’s sound in glass instead of metal. These obviate the use of a tongue depresser. Inoculations are made direct onto Nasgar Medium and grown for 24 hours. Likely colonies can be cultivated on plates and incubated at 37° C. and at 23° C. Colonies growing at 37° C. and not at 23° C. and having the requisite appearance are taken as meningococci. (N.B.—Whatever medium is used cultures must always be prepared immediately.) The combination of either rash or vomiting, squint or rigidity of limbs,, and opisthotonos, with a clinical picture otherwise resembling Influenza is very strongly suggestive of the graver disease.—E. Hobliouse, B.M.J. i./15,419. Diagnosis depends to a very great extent on realising there are three distinct stages of the infection, viz.—(1) Catarrhal, (2) Septicemic, (3) Meningeal.— A. Lundie, D. J. Thomas, and S. Fleming.—B.M.J. i./15,466. Lvmphocytic meningitis. Cases in which with acute symptoms are just like those of cerebro-spinal fever, the cerebro-spinal fluid though under high pressure contains no polymorphs and no meningococci but lymphocytes in excess. Never fatal.—W. P. Herringham, B.M.J. i./i7,832. Effect of culture media on agglutination of meningococci. Individual strains of meningococci when grown on nut Nasgar media become more agglutinable than when they are grown on legumen agar, with or without the addition of blood.—I. Walker Hall and G. E. Tilsley, L. ii./2i,494. Sugar (reducing Fehling’s Solution) is absent in the acute stage, but may return in some degree as the infection recedes. Treatment and Disinfection of Carriers. Carriers are much more common in winter than in summer—the disease is peculiarly one of cold, inclement weather. Young children are most susceptible and contact with a carrier is more dangerous for them than for an adult. Most cases cease to be carriers within a few weeks and it is a question whether treatment of carriers is of much avail, as some persist in the carrier state in spite of any treatment or environment.—Stitt, 1927. Prophylactic in cerebro-spinal meningitis and influenza for treatment Tincture of Iodine mixed with an equal quantity of honey—two or three drops of the mixture on the tongue several times a day effectual.—J. A. Taylor, B.M.J. i./21,776. Inhalation (? sprav) composed of Iodine 12 Gm., Guaiacol 2 Gm., Thymol 0-5 Gm Alcohol 200‘Cc. with Potassium Iodide 6 Gm. used five or six times •1 day ’Swab the throat out with a 3 to 5% solution of Iodine in Glycerin. Used in the French Army.—Sir Wm. Osier, B.M.J. i./i5,lS9. Antipyrin, Phenacetin and Opium are useful. Hydrotherapy in the form, of the tub bath at 9S° is recommended. All cases bear stimulants well. No* drug* seems to have any specific effect. Calomel and a counter-irritant in the form of Liquor Iodf or Liquor Epispasticus over the cervical spine gives- some relief to the headache. Cardiac tonics advisable, Phenacetin and Caffeine* if temperature unduly high. Chlorodyne gives great relief. Soamin 5 grains intramuscularly on alternate days thought to be secreted m the cerebro-spinal fluid and to have deterrent effect, but it is not without danger. Repeated lumbar puncture even in severe cases, with removal of from \ to 1 ounce cerebro-spinal fluid together with injections of Saline. Excellent results—better than serum.—M. Foster. Spraying with Permanganate (1 in 1000) is of some service. Disinfect ail articles likely to be contaminated with discharge with 5% Cresol. Tartar Emetic, 4- grain doses intravenously. Temperature normal in 60 hours.—S. Neave, L. i./i6,1101. Zinc Sulphate 1*2% as a steam spray or 1% Chloramine solution directly applied for treatment of ‘ carriers.’—M. H. Gordon and M. Flack. Cerebro-spinal fever in R.A.F. in January and February, 1931, at Uxbridge among recruits. Treatment—Antimeningo Serum sheet-anchor in previous attack, but the type of Meningococcus in this outbreak differed, being Type I. instead of Type II. as previously. Saline irrigation by subarachnoid lavage. Naso-pharyngeal douche and gargle of Permanganate 1 in 5,000, or Sodium Bicarbonate and Borax of each 2 drachms, with Liq. Phenol 1 drachm, and Sugar i ounce, to 1 pint Water, efficient, with Zinc Sulphate 1% in conjunction by means of Levick’s Steam Spray.—H. E. Whittingham, T. M. Kilpatrick and E. W. B. Griffiths, B.M.J. i./3i,1101. Antimeningoeoecus Serum cl the Lister Institute. (Special provisions apply in the manufacture of this Serum under the Therap. Subs. A (and Regns. 1925, 1927.) Dose.—30 Cc. (except when less than this amount of cerebro-spinal fluid can be removed), intraspinatty by lumbar puncture (gravity method) at the earliest possible moment and repeated daily for at least 4 days. In children under 5 it is inadvisable to give more than 10 Cc. In severe fulminating cases the dose if possible should be 45 Cc. Patient should lie, after the injection, with head and shoulders low and pelvis raised. It is also used intravenously, e.g. a small dose intraspinatty and massive dose intravenously.—(Herrick 1918). Sixteen cases by lumbar puncture. Vaccines 250 million subcutaneously at the time of first dose of serum. 2nd dose 500 million increased to 2000 million.—C, Worster-Drought, B.M.J. ii./i6,689. . , . . For the purpose of standardising antimeningococcic serum, endotoxin of the meningococcus extracted by a modified Besredka’s method. M. H. Gordon, B.M.J. i./i 8,110. See also ibid, ii./18,335. . . Cerebro-spinal meningitis in Bombay. Treatment with intrathecal injections of Anti-meningococcic serum of the Lister Institute reduced period of illness, prevented the chronic lesions and types of infection, resulted in complete restoration of health in all but a small number ox the recovered and greatly diminished fatalities.—P. T. Patel, L. ii./26,541. . . . . ,. f Streptococcal meningitis successfully treated by intrathecal injection of anti-meningococcal serum.—C. W. Vining & H. P. Ihompson, B.M.J. ii./2 4,667. Influenzal meningitis. A case recovered under Anti-meningo Serum ^tia- venously and intraspinally. Influenza bacillus found in cerebio-spmal u . Onlv three cases of recovery on record—J. Gibbens, L, In spite of overcrowding epidemic meningitis is much less frequent m the Navy than in training depots ashore due to seamen becommg^immunised y contact with carriers of Ar. meningitidis in the training depots. 8. I. Dudley, ^ Specific univalent serum in preference to multivalent.-H. Stanley Banks, Overcrowding as factor in cerebro-spinal fever outbreaks. The Navy is “STt*1 8mol;utesn?h°enr’e^pi(vltyrf animals being extremely variable it is impossible to determine by tests, its therapeutic activity. Conference on Standardtsaton. Great Britain, America, F ranee ana Germany all adopt different methods at present. I urther work to be carried 0TTLVIi.ilqufres4keningococcic Serum to have a titre 1:100 in complement deviation test and in bacteriotropic tests, a title of at least 1. ioou. Double, quadruple and eightfold strength is also prescribed. For Cerebro-Spinal Fluid, Examination of, vide Vol. 11. Cholera. The disease is marked by the presence of the Spirillum cholerce. Anti-Cholera Vaccine. Syn. Cholera Vibrio Vaccine.—As an immunising agent only. A dose of 500 millions may be followed by constitutional disturbance, local redness, pain and swelling of the corresponding lymph glands, effects which should pass off within three days. A dose of 1000 millions should be given five or six days later and will probably jxroduce less reaction. This dose should be repeated or doubled after a further 7-10 days. Pull immunity is reached about a week later and persists for six months to a year. Inoculation was compulsory in the Austrian Army after cholera broke out in the Serbian campaign. 1 Cc. of an emulsion of dead cholera bacilli was given subcutaneously and repeated 4 to 6 days later.—B.M.J. i./i6,G5. Cholera inoculation was discussed at the German Medical Congress, Warsaw, 1916 (B.M.J. i./16,27). There was difference of opinion as to the probable duration of resultant immunity. Bor military purposes double inoculation (Cholera and Typhoid) was practised in urgent times—the cholera to be repeated in 6 months, the typhoid in 8.—B.M.J. i./i6,192. Prevention arid treatment by saline transfusion. See Normal Saline. The prophylactic Vaccines of Maffkinc- have been used with success in India by employing a growth of the spirillum, the virulence of which has been increased by growth in the peritoneal cavity of guinea-pigs. They are :— (1). Weak. (2). Strong. The dose of these preparations is 1 Cc. The second is injected 3 to 5 days after the first (the weak) one. They have to be freshly prepared. A comprehensive report on recent advances in knowledge of cholera.— Lt.-Coi. J. H. T. Walsh, T.D.B. 18/21,69. Pish or shellfish origin of cholera in London in 1854. Need of regulating sale of small fish from shallow areas.—W. II. Hamer, L. ii./22,7G3. A par1-cholera vibrio isolated from several cases.—T. Kabeshima, T.D.B., Vol. 19, 1922/738. ‘Appalling’ death rate of cholera in Mesopotamia—40%. Probably a large percentage was bacillary dysentery. Dilute rice water instead of milk diet and Magnesium Sulphate, enough to get several motions, and on no account Opium. This procedure was effectual.—Lieut.-Col. Henry Smith, B.M.J. ii./22,1049. House infection in cholera. Statistical Investigation found of value in India.—Lieut.-Col. A. G. McKendrick, B.M.J. ii./22,1266. India may still be regarded as the home of cholera and Bengal as the endemic home, the evidence being that cholera in the rest of India' is dependent 011 cholera in Bengal.—A. B. Pry, I.M.G., July '25,307. The continued existence of cholera a disgrace to India. Every other civilised country of the world has freed itself of the cholera menace and if a determined effort were made in India the same result would be obtained.— I.M.G., Pel). '25,75. Cholera epidemic in Russia. Encouraging figures under American Relief Administration.-—L. ii./22,306,421. Pilgrims and cholera. The religious Pairs and Festivals have a sinister influence.—L. ii./22,673. During the first 6 months of 1922, 29,264 cases occurred in the three Soviet Republics of European Russia, 4,963 in Caucasia and 1,864 in Asiatic Russia. —B.M.J. i./23,971. Precautions against cholera in Roumania. Isolation of persons from infected parts of Russia.—L. L/23,46. Alkaline Starch Medium for isolating Cholera Vibrio from faeces in the case of Carriers. The cholera organism alone of all the intestinal organisms acidifies starch (M. H. Gordon). Emulsify Powdered Agar 30 Gm. with cold water 250 Cc. Emulsify separately Peptone 10 Gm. and Sodium Bicarbonate 1-5 Gm. in a further 250 Cc. of water. Mix and add water 500 Cc. Dissolve in the steamer, clear with egg and filter. Emulsify Potato Starch 10 Gm. in some of the (cooled) medium and add to the rest. Sterilise by the fractional method. Add Litmus solution to make it blue. Cholera colonies acquire a faint pink more quickly (24 to 26 hours) than the allied vibrios.—H. Graeme Gibson, B.M.J. ii./i6,454. Por isolation from water see Vol. II. It is stated that 11*8% Alcohol will kill the Cholera vibrio in 4 hours or less and that 7-8% will cause its disappearance in one day.—B. B. Brahmachari, per Jl. Trop. Med., Sept. 1/27,225. Cholera and entero colitis antivirus orally gave favourable results.—Prof. Besredka, L. i./2g,1092. For further references vide Previous Editions. Cold Vaccine. Nee Catarrh. Anti-Colon Bacillus Serum. Dose.—10 Cc. or more. Is prepared from horses which have been immunised against a number of types of B. coli principally from cases of peritonitis and puerperal fever. Supplied in 25 and 50 Cc. vials. The action of this serum is chiefly bactericidal, though also possessed of antitoxic properties. In acute B. Coli infection of the kidney, Dudgeon has advised 25 Cc. of the Serum daily for three days, combined with Calcium Lactate to avoid rashes, joint pains, etc., better in his opinion than vaccines. Investigations on B. Coli showed conclusively that these micro* organisms vary in each host; and that probably there are many, species which exhibit the same microscopical and cultural appearances. Colon Bacillus Vaccine is used in the treatment of post-surgical suppuration in abdominal cases, such as sinuses which refuse to heal after operations upon the appendix, gall bladder, kidney, or intestines ; also in bacilluria complicating tubercular cystitis, in the nephritis of pregnancy and in endometritis, when due to infection by B. Coli. Initial doses of 5 million organisms may be repeated at intervals of 7-10 days, and may be gradually increased till 100 millions or more are being given. If the doses employed cause any disturbance of the general conditions as evidenced by rigors or rise of temperature this must be taken as indication either of pus under pressure or if not this, for diminished subsequent dosage. Discharging sinuses should, if possible, be kept open, as closing is likely to result in rigors and severe constitutional disturbance. Immunisation of the patient 3 to 4 days prior to abdominal operations in cases where the presence of pus is suspected is to be advocated—for this purpose a dose of 500 millions may be employed. In cases of bacilluria the urine should be kept well alkalinised by full doses of Sodium Citrate or Sodium Bicarbonate. Ampoules contain respectively 10, 25, 50, 100, 250, 500 and 1000 million organisms. . „ , Vaccine treatment of B. Coli infections oi the urinary tract is commonly practised with generally favourable results. Appendicitis 22 cases with anti-colon B. Serum 20 Cc. dose and vaccine 100 million a few days later.—A. Cowan Guthrie, B.M.J. „ Arthritis treated bv B. Coli Vaccine intravenously— ‘ non-specific therapy. —MlerandLusk, Jh IniTiled. Assn., Jan. -16,1756 ; see also B.M.J. i./x8,196. Rheumatoid arthritis treated by Bacillus Coli Vaccine intravenously 50 to foo mUlions for first dose, with patient in hospital. Rise in temperature a few hours after injection (100 or 103° F.). Subsequently up to oOO million or more given The method thought, at least, to be an adjuvant to more ree^rdsed.1 methods.—E. J. Perkins and C. B. White, B.M.J. W*3,411. Hay fever treated by Autogenous B. Coli Vaccine, .see Hay Fever. See also Protein Therapy. Diphtheria Antitoxin, Serum Aiitidiphthericum, P.G. VI., U.S., P. Ital. V., F.E. VIII., P. Belg. IV., etc. (Special provisions regarding the manufacture of this Antitoxin are made under the Therap. Subs. Act 1925 and Regns. 1927. The Antitoxin combats the disease in the human subject. It retains its activity for 10 months if kept in a cool and dark plaee. Dose.—Should be stocked in phials containing 8000 units for treatment, and 500 units for prophylaxis ; the former should contain the 8000 units in less than 10 Cc. A curative dose can then be given (intramuscularly) in one injection. For prophylaxis, 500 units .should not be contained in less than 2 Cc. Not less than 8000 units to be given for any age ; larger initial doses, e.g., from 16,000 to 30,000 units, are required when the case has been delayed until the 3rd or 4th day from onset.—Min. Health Memo., 1922. The immunity is claimed to last 3 weeks. Warm the Antitoxin by standing in water at 40° C. for 10 minutes. Do not wait bacteriological diagnosis. Cleanse the skin with Ether Soap, and inject in the flank or between the scapulce. In a sense too much cannot be given. Intravenously 30,000 to 50,000 units for a desperate case (neutralises toxin more rapidly). Up to 300,000 units have been given intravenously.—B.M.J. H./31.014. In toxic cases give a preliminary injection of Antitoxin Intra- tmu&cMicgrSy ; 1 hour later make a resting blood-sugar estimation, and inject together intravenously (very slowly at 37° C.) 32,000 to 100,000 units antitoxin and 20 Gm. Dextrose in 50 solution ; make further blood-sugar estimations at 1, 1J, and 2 hours after, and if the last figure shows a return to normal give 10 to 30 units Insulin intramuscularly, and subsequently Glucose by mouth or intravenously. Case mortality reduced from 35-9% to 22*5% and noticeable reduction of serum-sickness.—E. C. Benn and co-workers, L. l/32,282. Sometimes given per anum and per os, but opinion is, in general, against these. The number of immunising units contained per Cc. varies in the different pharmacopoeias and with different manufacturers. Antitoxin units discussed at Conference on Standardisation (Paris). The Erhlich Standard Unit should be considered as the international standard. —L. ii./22,1294. Standardisation of Sera and biological products. System of checking national units of antidiphtheria serum by the international unit (supplied from the Copenhagen Institute) working well. American, British and German units tested and found identical. Proposed unit for Tetanus antitoxin half the existing American unit. Further investigations proceeding with dysentery, pneumococcus, anthrax, Malta fever and other sera.—Health Committee, League of Rations, L. i./24,720. U.S. X. has Antitoxinum Diphthericum. Syn. Serum DlPH- THERICUM PURIFICATUM, CONCENTRATED DIPHTHERIA ANTITOXIN (U.S. IX.), with potency of not less than 350 Antitoxic units per Cc., and Average Dose, Curative 10,000 units : Protective 1000 units. A solution of the Antitoxin-bearing globulins, containing Sodium Chloride and preserved with not more than 0*5% Phenol or 0-4% Cresol. Removal of serum albumen may reduce the untoward serum rashes which frequently occur with ordinary Antitoxin. The purification is based on precipitating the euglobulin and albumin, and the pseudo-globulin rich in antitoxin remains. Another method consists in adding the specific antigen to an antiserum and obtaining an antigen-antibody complex, which is then split into its two components.—L. i./2 9,292. P. Jap. IV. Liquid Serum is 500 Ehrlich units in 1 Cc. In addition to the liquid sera, Dried Serum (U.S. IX., F.E., P.G. VI., P. Jap. IV.) in amber coloured scales is manufactured by evaporation at a temperature not exceeding 40° C., or by means of Sulphuric Acid in vacuo. This is more suitable for export. The scales are dissolved in sterilised water. It is not soluble in hot water (above 50° C.), nor in alcohol. The directions given by each maker should be followed. As higher potencies are now used than formerly, rashes, pain and swelling which sometimes result, are less frequent. Calcium lactate is said to relieve the rash, pain, etc. _.. For extracts from the (earlier) literature on this Antitoxin and notes on the Schick Test, Serum Rashes, Untoward Results and Diphtheria Carriers, Diphtheria Endotoxin and Toxin-Antitoxin see Vol. II. Large initial doses of antitoxin given as early as possible are successful m diphtheria.—B,. Davison, B.M.J. ii./2i,918. The child requires as large a dose of Antitoxin as the adult. Intramuscular injection best, deeply into the vastus extemus, not the gluteal region, wot less than 6,000 units. Importance of the recumbent position m bed m tieat ment—not even a pillow should be allowed for a minimum of 3 weeks. I. n. X^Value^f^biphtheria Antitoxin limited to first three or four days of the disease. Early diagnosis and treatment essential. All suspicious cases should be injected at first sight.—D. MacIntyre, L. 1./2 6,855. Intravenous injection of Diphtheria Antitoxin. Give it slowly. It should be the method of choice.—Poul Iversen, L. 1./23,694. TUPTrTUTRIA PROPHYLACTIC (TOXIN-ANTITOXIN MIXTURE see also VoL\, 1 p/ doses have been used in America and elsewhere with excellent results. Toxin-B?mVe I./2 5.10. Manganese-effect on agglutinms.-B.M.J. JfT:Ju- ’2 ^aneritoneal Ration, g adV<lnwdd ‘lafw23C994°aTt gives better results than intravenous or intra- SSlph?it ms 'child! Feb. ’,5.214, per Pres., Jan. ,6,15. In tox.c •S ssssf wjssAss swears iniections of toxin instead of Pa™on ^. A hours, hut there was no 12,000units of antitoxinjjew conclusive evidence that the serum save y entical with Klebs-Loefiler Cutaneous infection with dipht ero^ Shrewsbury, B.M.J. i./3I?539. bacillus, except m toxm production. J • • Dysentery. The Lister Institute supplies Anti-Dysentery Serum consisting of the serum of horses which have been immunised against the dysentery bacillus (Shiga, Plexner, etc., types) in 20 Cc. vials. (Special 'provisions regarding manufacture are in the Therap. Subs. Regns. 1927.) Dose.—Preventive 20 Cc. subcutaneously : curative an initial dose of 40-60 Cc. intramuscularly on the outer side of the thigh (into the body of the vastus externus), repeated daily till improvement sets in. For a grave case, 60-100 Cc., repeated daily if necessary. Some dilute 60-80 Cc. with 150-300 Cc. Normal Saline and give intravenously (Graham’s experience in the war). In any case, give it early. Stools are stated to return to normal rapidly in successful cases, but treatment to be continued. Pains and temporary rashes may result, which need, however, not alarm. It is stated that while much of the endemic dysentery prevailing in tropical and sub-tropical countries is caused by pathogenic amoebae, epidemic dysentery due to B. dysenteric^ occurs all over the world, and this bacillus is also found in asylum or institutional dysentery, in some sporadic cases of ulcerative colitis and in certain forms of summer diarrhoea. Keeping Properties. The serum appears to retain its * toxin '- neutralising power for at least 1£ years, the dry powdered Shiga B. being used as test toxin.—A. T. McConkey, B.M.J. L/17,11. Serum Antidysenterique Pr. Cx. Supp. 1920, is obtained from horses immunised with B. dysenterise (Shiga). Tested for its antitoxic power. The League of Nations Commission on the Standardisation of Serum, Serological Reactions and Biolcgial Products proposes to adopt a standard serum prepared and distributed by the Danish State Serum Institute to establish the international antitoxic unit. The serum is prepared for distribution in such a way that 1 unit is contained in 1/200 Cc., and a dilution of 1 : 200 contains 1 unit in 1 Cc. A test dose of a dysentery toxin is defined as a quantity, that when 1 Cc. of the serum dilution is mixed with it, the mixture shall cause death in one-third of the mice receiving it by intravenous injection. When a toxin is thus standardised it may be used in titrating serums.—B M J ii./28,lll. Fulminating cases received large doses assisted by Magnesium Sulphate 1 drachm three times daily for the first few days. In bad cases Morphine needed and for very severe tenesmus a suppository containing Cocaine £ grain and Iodoform 3 grains is useful. Rectal lavage with 1 in 1000 Copper Sulphate and Mist. Simarubae often benefits chronic cases. Generally there is distinct rise in temperature within 12 hours of injection which may last 48 or 72 hours Good prognostic sign.—J. B. Fisher, B.M.J. i./i7,43. See also G. A. Finlayson, B.M.J. i./17,46. Bacillary dysentery in the Royal Naval Division.—Surg.-Gen. H. D. Rolle- ston, B.M.J. i./i7,258. See also ibid. ii./i7,539. In the Snlonica Forces, dysentery was hardly less in importance than malaria. No figures are available to show the relative frequency of the amcebic and bacillary forms. The latter was the dominant form, and though amoebic cases were present throughout, it was only late in the season of 1917 that the extent to which this form (the amcebic) prevailed came to be recognised. Evidence of a widespread amoebic infection in its most insidious form carried about by apparently healthy people, finally accumulated. The opinion expressed early in the same year by Lieut.-Col. Graham (L. i./18,51) that less than 3% was of amoebic type had therefore to be reconsidered in light of later knowledge—Col. A. G. Phear, Proc. Roy. Soc. Med., Vol. XIII., 1920, pp. 57-100. Serum Treatment of Bacillary Dysentery.—B. G. Klein, L. ii./iq 775 W. E. Waller, ibid. 778. ' ’ Bacillary Dysentery.—Med. Res. Com. Report on—reviewed, B.M.J. ii./ig. 283. 1 Bacillary dysentery in Northumberland and Durham. In mild cases in children serum not needed. Severer cases in adults responded well.—J. A. Charles and S. H. Warren, L. ii./29,626. Vaccine B. Dysenterise. Syn. Anti-dysentery Vaccine (Therap. Subs. Act 'proper name). Dose for prophylaxis 250, 500, 1000 mill, at intervals of 7 to 10 days. Initial dose for treatment 5-10 millions. For immunisation and treatment, practically atoxic ; supplied in ampoules 50,100, 250, 500 and 1000 millions. Directions for preparation of Dysentery Vaccine including experiments demonstrating that the toxicity of an emulsion of B. Dysenteric can be reduced or entirely destroyed by dilute hypochlorous acid (1 in 1000 dilution of Eusol) or Hydrogen Peroxide and that the injection of an emulsion of this kind in which the toxin has been destroyed produces a satisfactory degree of immunity.—H. It. Dean and It. S. Adamson, B.M.J. i./16,611. Dysentery Vaccine (Carbolised) reduced mortality in East Africa. Work of late P. H. Boss.—L. ii./29,1284: Vaccine therapy 'per os reduced morbidity and mortality from dysentery: Both prophylactically and therapeutically as effective as serum: Of 3,600 men treated in the Bhine Army none contracted dysentery, while 471 cases occurred in untreated men.—Prof. Besredka, L: i./29,lG92. Criticism by W. E. Harvey, Prof. A: Fleming and others. ‘Difficult to know what antivirus is/—ibid, 1093,1157: For details concerning differential diagnosis of Bacillary and Amoebic Dysentery and other Bacteriological data see Vol. II. Endemic Goitre in certain parts of India, is held by McCarrison to be due to intestinal intoxication. He has followed this up by treating patients with Vaccines prepared from mixed cultures of all the coliform organisms grown from the fseces. Initial dose of 150 millions increased at intervals of one or two weeks to 350 or 500 mi llions. From four to seven injections being required in most cases. Perfect hygiene of the bowel essential. Goitre incidence of 23% reduced to 2% simply by installation of good water supply. It contained no Todine Where goitre arises despite these measures, Iodine intake assumed insufficient.-—R. McCarrison, B.M.J. i./24,9S9. See also our pp. 709, 768 and Goitre Therap. Index. 0onorrliffiS {See also Venereal Diseases Act, 1917, and Therapeutic Index.) Gonococcus Vaccine. Ampoules contain 10, ^o, 50, 100, 2o0, o00 and 1000 million Cocci respectively. In preparing the Vaccine, cultures are taken from cases suffering from a severe first attack, which has been untreated by antiseptics. Dose —In acute urethritis and such complications as prostatitis vesiculitis, epididymitis, the initial dose is 5 millions, and by judicious use of the vaccine Sirpntinn and severity of the disease may be materially shortened. In conjunctivitis and iritis Onftial doses 250 millions) and arthritis (initial dose 100 millions) it is stated to be specific. The diagnostic dose m cases ot arthritis of doubtful origin is 500 millions {vide Streptococcus Bheumaticus vaccine) A series of injections will certainly free any case of chronic gleet from the gonocoS infection, although it may not succeed in stopping discharge “Iniial'dom ml/be'repeated'at’intervalsof 7°days, and gradually increased „n“maximumdoser & 500 .million cases receive benefit from the injection m.to.^h®QlV^hrrt mgllt and mornmg The Section of gonococcal vaccine usually gives rise to. a reaction, which mav be local or general. The local reaction consists in redness and swelling $ the site of injection. The general reaction is manifested by a use of. temperature accompanied by increased pain and tenderness in the affected joints to the case ofgonorrhceal arthritis). Both reactions usually subside within twentv-four horn The reactions are said to be less marked after small than lame doses and to be absent in cases free lrom gonorrhoea. . U lheB acute ’stages of gonorrhma and cases vactollreatammt urethritis, provided the disease is localised to the urethra, vaccine treatmen is unavailing. Gleet resists ordinary treatment because the prostate is the seat of mischief ; if this gland is massaged every other day for a minute or so* by inserting a finger per rectum all the secretion is squeezed out, consequently if an injection of Silver Nitrate 1 per cent or Copper Sulphate 5 per cent be now given, the prostate absorbs the solution, and a gleet which has persisted, for months or years may not infrequently be cured in a fortnight. Gonorrhoeal prostatis and vesiculitis. Vaccines of value in some classes.— A. Cambell, B.M.J. ii./23,456. Metastatic gonorrhoea. Opening remarks in Discussion before the Soc. for Study of Venereal Diseases. Question as to use of Broughton Alcock’s method of using live gonococci intravenously.—Sir T. Horder, L. i./23,1304. Autogenous Vaccine of great value.—Sir W. Willcox, L. i./23,1314. Autogenous vaccines of higher value than stock vaccines. It does not matter how small a dose is given at first, it can easily be increased rapidly until there are signs that the vaccine is taking effect. In gonorrhoeal rheumatism care should be taken not to increase the dose by too large an amount daily—the regular emptying of the prostatic focus, and massage every 5 days, the best form of treatment.—Maj. A. T. Frost, L. i./23,1314. Simultaneous injections of autogenous vaccine (6000 million bacterias per Cc.) with protein of value in gonorrhoea. Initial dose of vaccine 0-2 Ce.n increased by 0-1 Cc. to 1 Cc.—A. Tansard, Presse Med., Sept, 19. ’25, per J1 A.M.A. ii./25,1433. Non-specific Protein (Milk) Injections in gonorrhoea—see p. 670. Hay Fever.— Hay fever is caused by a soluble toxin which is innocuous to normal individuals. In hay fever patients the occurrence of some of the reactions associated with the production of immunity,—precipitation of pollen extracts by the patient’s serum and complement! deviation during the season has been shown. Pollen toxin is capable of giving rise to the production of antibodies. Spontaneous cures occur, i.e., by active immunity production, but more usually patients develop a condition of hypersensibility, each successive season. A Hay Fever Reaction Outfit is supplied for determining (a) whether a: patient is susceptible to pollen toxin, (b) the degree of such susceptibility- (c) the dosage of pollen vaccine suited to any case. Hay Fever Vaccine. Ampoules contain 50, 100, 500 andd 1000 ‘ units.’ Immunisation should be commenced in susceptible persons during February with an initial dose of 25 units :—subsequent doses as above with 7 to 10 days’ interval. In treatment the initial dose may be determined by the ophthalmic reaction or failing this give 50 units initially. ‘ Rush ’ inoculation in hay fever. Injections given every 1| to 2 houre throughout a 14-hour day. Initial dose ranges from 20 to 30 units to 10O or 200 Pollen units according to severity of diagnostic reaction.—J. Freeman., L. i./3o,745. For a consideration of Cutaneous Tests, Reactioyis from,, and Nonspecific Frotein Therapy in asthma, liay fever and numerous allied affections, see p. 660 et seq. Influenza Bacillus Vaccine. The organism only occasionally occurs alone ; frequently it is; accompanied by the Pneumococcus, Streptococcus, M. Catarrhahs, or the Bacillus of the whooping cough. Many cases of so-called ‘ Influenza ’ are due to the Pneumococcus, Streptococcus and M- Catarrhalis either separately or together and in these the Combined Vaccine for Colds, p. 903, is used. In influenzal septicaemia or endocarditis, the initial dose is 10-25 millions, in true acute influenza 100-250 millions. Chronic influenza, especially if complicated by sinusitis or antral trouble, may persist for years if untreated, and large doses of vaccine, 1000 millions or more, may be needed for its cure. Ampoules containing 10, 25, 50, 100, 250, 500 and 1000 millions are prepared. There is no danger in giving it during an epidemic of influenza, but those already acutely infected should receive smaller doses, e.cj., T or the normal. For prophylaxis begin with 100 millions, and follow in 7 days with 250 millions and increase up to 1000 millions. Apparently vaccination with organisms other than the Pfeiffer bacillus has given the same doubtful results in prophylaxis as when mixed strains of the Pfeiffer bacillus have been employed. In view of the doubt regarding the causal relationship between B. influenzce and the disease influenza it would be well to change the name of this organism to Pfeiffer bacillus.—Stitt. The pros and cons of the matter in regard to epidemiology were fully dealt with in Vol. I., Edn. XIX., p. 923, with lengthy bibliography. Some pathological aspects of influenzal pneumonia.—Sir Thomas Oliver Int. Conf. Trop. Am., ’24,821. M. J. Bosenau considers Pfeiffer’s bacillus clearly a secondary invader.—ibid., 831. War Office Conference Vaccine was revised to the following formula : B. Influenzae ... ... ... 400 millions 1 _ Streptococci ... ... ... SO ,, dn 1 Cc. Pneumococci ... ... ... 200 ,, J It originally contained 60 millions of B. Influenzce. With the increase in proportion of the first mentioned, the vaccine may prove a powerful reinforcement to measures of protection. Dose £ Cc. with a further 1 Cc. after 10 days’ interval. Table of results over wide area.— Sir W. B. Leishman, L. i./2o,366. . , . , , , . . 0 Pfeiffer’s organism causal of influenza m certain troops but not in oflims. -—J. W. Edington, L. ii /2o,340. . The following were the conclusions of the Conference on Vaccine therapy in Influenza. . , , ,, Pfeiffer’s Bacillus plays a most important part in the production oi the symptoms and complications of the disease but the existence of some as yet undiscovered virus may be regarded as possible. Pneumococci and Streptococci are chiefly responsible for the gravity of the secondary pulmonary complications. The vaccine to be polyvalent and made from organifaii isolated in the current epidemic to be sterilised at 55 C. for £ hour and con- taiPre^erable toTnoculate men before exposure to infection, but no bariu m treating a body of men among whom influenza had already 1broken out but individuals not to be inoculated who already had fever or at the time suffering from catarrh. Further advice was :— Not advisable to inoculate children under 3 years of age. From 3 to 7 years—1 of the full doses. From 7 to 10 years—£ of the full doses. (a) Children. Above 16 years—full dose. For treatment of severe cases and complications , , • rases (a) The vaccine is most likely to be of use m subacute and chiomc c s .. Here the initial dose should be 1/5 the first dose ^bove. vaccine is not (b) For severe cases of secondary broncho-pneumon ^ T .. , g advised but if it is desired to try it give 1/20 the first dose. B.m.j. u./ > 47W4 H ’Wvm/points out that 1000 million B. Influent may confer immunity while that from 30 prohably asts but a few da He lasting several montns, wnne man unm * million B employs 100 million each pneumococci anduronhvl™is For influenzae, and after seven days, double the STSuon b! each pneumococci ““i°same Influenzae as soon after onset as possible. For broncho-pneumonia the same dose, repeating or even increasing every other day or sometimes daily. 1$ million as advised by the Conference cannot be adequate.—L. ii./i 8,642,874 See also Pr., Feb. 1919 and B.M.J. i./2o,254. Investigation oi Influenza epidemic. Photographic records of cultures on* Crowe’s Medium from throat and sputum. Constant presence of a pneumo- like streptococcus.—D. Thomson and It. Thomson, L. i./29,388. Avoidance of a city area by an institution staff during the pandemic ot 1918 resulted in no influenza.—E. A. Hainsford, L. i./29,635. The possibility that a virus is the essential factor of influenza is considered] in the system of Bacteriology in relation to Medicine (M.B.C.), but evidence is held to be unsatisfactory. The apparent identity of the Koeh-Weeks Bacillus with B. influenza; is commented on.—L. i./3o,517. Canine distemper. Causative organism not isolated, but probably duei to a filtrable virus analogous to that of equine influenza, swine fever and- fowl plague. The B. bronchisepticus (Ferry) and various strains of staphy- lococcus and streptococcus are found.—L. ii./2i,1038. Dctodcated Anti-Influenza Vaccine. As now advocated (1930) by D. and B. Thomson, consists of Influenza Streptococci (Thomson) 25,000 million, Hsemolytic Streptococci 2,500 million;! B. pneumosintes 2,500 million, B. influenza (Pfeiffer) 5,000 million, Pneumococci (5 types) 10,000 million, B. Friedlander 2,500 million, M. catarrhalif 2,500 million per Cc. Dose for prophylaxis 3 injections of 10, 20, and 50 thousand million at weekly intervals, and for treatment half these doses at 3 or 4 day intervals. Detoxicated Anti-Coryza Vaccine contains the same organisms in different proportions. For a general description of Detoxicated Vaccines, see p. 899. For further information on B. Influenza?, vide Vol. II. Pneumonia. Sources of the Pneumococcus and Modes of Infection.—Pneu monia is rarely caused by auto-infection from the germ so commonly present in the throat in health, but is usually due to infection with pneumococci present in the air, dust, etc. The specific antigenic substance from the pneumococcus is saic: to be a complex carbohydrate.—M.R.C. Rept., 1924-5. Pneumococcus Vaccine (WlMPOLE Inst.). Ampoules for Hypo dermic use contain 25, 50, 100, 250, 500 and 1000 million organisms This Vaccine, besides being of service in pneumonia (it should* be given early), is also used in empyema, especially in children (in adults, combination with a streptococcal vaccine may be advisable); in nasal and laryngeal, catarrh, asthma and bronchitis, periostitis otitis, endometritis, and pyosalpinx, where initial doses of IOO millions may be employed, when due to this organism. Dose.—10 millions initially is repeated or increased at intervals ot seven days, according to clinical symptoms. Cases of delayed: resolution in pneumonia are benefited by injections of 50 to 100. millions every 8-10 days, while routine treatment of all cases ot pneumonia during the first week by doses of 25-50 millions whenever there is a rise in the temperature has been practised. In pneu-; mococcal eye infections an initial dose of 250 millions is appropriate, and in pneumococcal septicaemia 10-25 millions. It is probable that a large percentage of failures with stock vaccines is due to the vaccine not conforming in type with the infecting: organism. Stock vaccines must be polyvalent, and polyvalent iir each of the types peculiar to the country. Autogenous vaccines are clearly preferable. The percentage of cases of pneumonia due to bacteria other than pneumococcus is probably very much greater than is supposed. This was verified by the experience of the widespread epidemics in 1918-19 of so-called4 Spanish-flue.’ In cases where pneumonia is said to supervene upon influenza, the infection is a double one from the beginning, and much may be done to prevent the pneumonic attack by giving 25-50 million doses of Pneumococcal Vaccine, combined with 50-100 millions of B. Influenza, as early as possible during the influenzal attack. Pg*Gg3fay!cs.€ztic &m. Sir A. E. Wright found that doses up to 40,000 million produced nothing more than a slight constitutional disturbance and slight rise in temperature. Lister advises a vaccine of four types containing 6,000 millions per Cc. of each type, making a total of 24,000 million per Cc. Of this 1 Cc. is given as initial dose twice repeated at intervals of 7 days. Borel holds similar views and he inoculated Senegalese troops m Prance with initial doses of 82,000 million without ill effect. For white races work of investigators of the liockefeller Institute shows that initial doses of 1,000 million each of the prevalent strains can be safely used and that with lower doses full immunity may not he secured. After 7 days either 1,000 or 2,000 million is given and a further 2,000 million 7 or 14 FI O TTQ lo'f’OT* • Prophylactic injections in the 1918 epidemic of 199’million pneumococci and streptococci and 50 million B. Influenzae for the first dose and after a week double these doses clearly gave some measure of protection.—W. i±. WVaccination8oi healthy young adults gives protection for a short time against lobar pneumonia due to the fixed types, but of no value in terminal or broncho-pneumonia.—W. H, Park, Int. Conf. irop. Am. 24,834,bt>6. No advantage in using 1,000 millions of detoxicated vac^i^^QO n^lions of ordinary vaccine will produce the same or better results. \v. H. Wynn, ^ Good results from doses of 100 million for an adult and 50 million for a C^ree~from^risk’and appears to be°of value in many incipient cases of pneu- ^acute'feSp^^nia.-W H. Wynn, B.M.J. ii./ 274°as (rt*Pneumocock™Workat tile l^ckefeUer Hospital divided454 cases °f or 13 and Tyfe IV?or X I °f~ r»nd^Fearentii7ftS m'ost often prescni in epidemics. They are B.M. J. 1-/3-*-?G61. • -p t? Armstrong B.lVI.tl. i./32,187. A .iisswri-i *“• ***** “*>■' • until temperature falls. TTS LT/rTiumoToioi (see antea) have in general a high of specificity a homologous serum is necessary. Ihe immune serum against Type TheuTof s“rukshould therefore be confined to oases proved to be oi Type T. For details of manufacture of this serum see Cole & Mooi Jl. Exp. Med., Baltimore, 1917, XXVI., 537-561, also other referene pej B.M.J. i./i8,58. A dose of 90 to 100 Cc. of the serum repeat eight-hourly unless contraindicated till at least 250 Cc. have be given is advised : also a preliminary intradermal test to remove « risk of anaphylaxis. If there is any indication of its existence t use of very small doses (initial 0-025 Cc.) intravenously slow injected is recommended every half-hour, doubling the dose ea time until 25 Cc. have been given. Ministry of Health Report No. 13 (1922) confirms that it has not yet be* found possible to prepare a_ serum for cases of pneumonia not due to Type.. The pneumococcus and Pfeiffer’s bacillus are both common inhabitants of t: upper respiratory tract, non-pathogenic and harmless saprophytes apparently healthy people. They are both intimately associated with ‘ coir but the pathogenicity of Pfeiffer’s bacillus is uncertain. It is, however, kno^ to be toxic and its presence cannot be regarded as innocuous. It will probat take some years to prove whether Pfeiffer’s bacillus is, or is not, the can of influenza. Conference on standardisation. The Conference accepted the Aineric*/ Types I., II. and III., as standards for international purposes. The ten Group X to replace Type IV.’ (a collection of heterogeneous strains). L. ii./22,1293. Bacteriological and clinical observations on pneumonia and empyemo with specific reference to the pneumococcus and to serum treatment. Me Res. Council, Special Report Series 79—Type I. Serum investigated clinica gave encouraging results in 6 cases.—B.M.J. ii./23,618. Felton’s Serum of value in lobar pneumonia of Types I. and II.—J Cow and co-workers, L. ii./3o,1387-1394. Pane’s Antipneumccoccic Serum. Supplied in two strengths, Nos. 1 and 2. Dose.—15 Cc. of No. 1 repeated, if necessary, in 24 hours, is of vah especially In severe cases with high temperature and rapid pulse Improv tone of pulse where there is great heart weakness. The toxin secreted by t coccus appears to act on the muscles of the heart and weakens it Site of Injection.—Subcutaneous tissue of the abdomen. If patient very vTeak the Serum may be given per rectum—the bowel bei previously washed out by an enema of vrarm salt solution. Diagnosis.—In suspected cases examine the fauces for pneumococci T use of antiseptic gargles may check further infection. Pneumococcal Meningitis treated by Pane’s Antipneumococcic Seru per os. 5 Cc. doses mane, no food being given for two hours before or tx hours after. Dose per os double that necessary hypodermically. Dumb puncture simplified by Eucaine and Adrenalin hvpodermically._W Bros bent, B.M.J. ii./i6,586. Pneumonia treated with serum intravenously and Adrenalin 70°/. clear up rapidly.—Renaud, B.M.J.E. ii./21,9. Pyorrhoea Alveolaris.—It is probable that in very early cas; of pyorrhoea alveolaris the bacteriology of the condition mav k a relatively simple one, Streptococci, Pneumococci, Staphylococ and M. Catarrhalis alone or in combination being probable cause? later on, secondary infection by spirochetes, streptothrices ar vibrios inevitably occurs and these may entirely replace the origin invaders. Observations have shown that Vincent’s Fusiforr Bacillus alone may be responsible for most intractable ulcer while cultures of the above organisms in liquid media are intense toxic ; the view, therefore, that they may be responsible not onl for the local but also for the general toxic symptoms in advance1 cases of pyorrhoea is more than j ustified. IT. K. Box’s view of the pathology.—L. i./25,84,153. Autogenous vaccines of advantage in pyorrhoea alveolaris when associated with energetic local treatment, but useless without it. —G. B. Pritchard, L. i./27,92. ^Genozo (T.M. 488639 and 493518) Tooth Paste. A neutral preparation containing a detoxicated vaccine, to develop resistance against pyorrhoea and purulent infections. Relapsing Fever.—See Vol. II.> also Salvarsan chapter. Rheumatism. Pathogenesis and Treatment of Rheumatic Fever (and Chorea). Rheumatic Fever—an acute specific disease. Diplococcus Rheumaticus,—an organism found by Poynton and Paine growing in short chains, Gram. + , forms Lactic, Formic, and Acetic Acids and curdles milk—is the supposed cause of the disease. The organism has a strong vitality on Blood Agar. It may be shown in all rheumatic lesions, though with difficulty. It is believed that the S. Rheumaticus is a variety of S. fcecalis, and other streptococci have been found in cases of rheumatism, but S. Rheumaticus is the most common variety. . The organism produces \ Gm. of Formic Acid (also Acetic Acid) froni a litre of culture. The urine of rheumatic patients contains up to 0*2 Gm. in a day s urine. Salicylates administered decrease the amount. This acid is not known to be produced in like amount by streptococci from other sources. Streptococcus Rheumaticus Vaccine (Wimpole Institute) for complications of rheumatic fever. Initial dose 5 to 10 millions. In doubtful cases of rheumatic arthritis a dose of 250 to 500 millions of Streptococcus Rheumaticus may be given diagnostically, and the temperature observed every four hours for 24 hours ; a marked temperature or local reaction will assist greatly in establisiimg ie diagnosis. Ampoules containing doses of o, 10, -5, 50, 100, and 250 millions are prepared. Fvtreme caution in the use of this Vaccine is necessary. Even 500,000 may cause a most unpleasant reaction and until the urine is free from organisms more than 5 million can seldom be given. TlmVASP OF THE MOUTH ASSOCIATED WITH RHEUMATOID ARTHRITIS .—Auto - tss “fefon has been Sfe Kw doses\ietogVor^4 da)2 aM E a week.-K. Stone, Pr„ Sept. '2 BapU improvement follmvin^s^utaneous B. fallax is an organism occasionally is organism to autogenous cases of puerperal sepsis. Adv'sable to add the "»anunn ^ whether teeth, tonsils, or bowel, i-. W29,ro 'd i the year 1928-1929 at A questionnaire sent to was no evidence, of greater'benefltln^hose^ treated with autogenous vaccines than in the vaccine group as a whole and it would appear that vaccines show no better prospc of .iraprovement or cure of infective arthritis than other methods of treatmei —P. M. Congdon, L. i./32,180. Compulsory notification of acute rheumatism' in Kensington justified. B.M.J. i./3o,707. B. Coli Vaccine intravenously in rheumatoid arthritis, see B. Coli. Septicaemia, Anti-Streptococcic Serum. . Dose•—30 Cc. early in any form of septicaemia, and repeated eveJ six hours if necessary. Injections are made under the skin of t] abdomen or flank or at the seat of inflammation, if any, as in erysip las, so as to produce good local effect. Usually supplied in 10 C phials. The preparation of the Lister Institute introduces a large numb of strains (haemolytic, non-hsemolytic and S. fcecalis). They a obtained from a number of infections, e.g., erysipelas, septicaemi endocarditis, uterine infections, influenza, appendicitis, etc. Special Anti-streptococcic Sera for use in Erysipelas, Fiieroer Fever, Scarlatina, Endocarditis and Rheumatic Fever, are obtaii able. - F?VER and the varied forms of septicaemic infection followh childbirth have been treated in many instances with it with good results Serotherapy results in puerperal infection are inconstant. Preferably giv« intravenously in the earliest stages i also used locally—50 Cc. introduc* into uterine cavity daily. To prevent acclimatisation of infective organisr large doses (60—100 Cc.) must be given for the first three or four days and t treatment then suspended. In benign cases, vaccines are preferable, but th< are useless and even dangerous in profound general depression and asthenii very acute septicaemia, or with cardiac, renal, or adrenal deficiencv. Du still largely empirical, but preferable to begin with small ones.—B.M.J. i./25,24, Anti-streptococcic serum in septicaemia hardly justifiable—serum siclme* An effective method of immunising donors needed—L. Colebrook, R.M i./25,G59. Antistrepto Serum, 50 to 70 Cc. during labour, or a few daj^s prior to onst; if trouble anticipated. Badiostoleum in addition.—S. J. Cameron and 1 Thomson, B.M.J. i./3i,350. Streptococcic septicaemia treated with Scarlet Fever Antitoxic Serui S. haemolyticus isolated. Given subcutaneously or intramuscularly, and nev more than 20 Cc. at a time. Burt-White never gives less than 20 Cc ar always intravenously.—A. B. Itosher, L. i./3o,129. Morbidity in puerperal sepsis mainly due to a single cause, the Streptococci pyogenes. Vaccines a failure.—P. P. Armstrong and W. Shaw, B.M.J. i 28,1084. Indicated in simple septicaemia or sapraemia. Erysipelas, endocarditi carbuncle and acute rheumatism have been treated with it. Scarlet Fever Antitoxin. Syn. Scarlet Fever Streptococci:! Antitoxin Concentrated (Globulin). Dose for treatment.—10 Cc. usually establishes normal temperatua in 36 hours and the quarantine period is shortened in many ease by nearly 50%. If given early, it generally arrests the progress c complications and may lessen the severity of complications alread developed. Prophylaxis.—2*5 Cc. for children of 5 to 15 may confer passiv immunity for 10 to 14 days. Diagnosis. (Schultz-Charlton Reaction.)—The diluted ant: toxin is injected intradermally into an area where the suspected rafc is most marked and will, in the case of scarlet fever, produce the characteristic rash-fading. Scarlet fever, confirmed by a marked Schultz-Charlton reaction (intradermic injection into the rash of 0-2 Cc. horse scarlet fever antitoxin) and a positive Dick test, treated by 25 Cc. unconcentrated scarlet fever antitoxin intramuscularly.—E. H. R. Harries and co-workers, B.M.J. i./26,864. Scarlet Fever. Prophylactic inoculation. The subcutaneous injection of 0-0001 Cc. of the blood of a scarlet fever patient into children produces no reaction but confers a degree of active immunity sufficient to prevent occurrence of the disease on introduction of the virus contained in 0-15 Cc. of blood.—I. Takahashi, L. ii./2i,645. Immunity conferred by a toxin which had been detoxicated by the addition of an equal volume of 2% Sodium Ricinoleate solution. There were only negligible reactions and the preparation has the advantage over the ordinary toxin-antitoxin mixture of not sensitising the child to. Horse Serum. Since it is possible to effect immunisation in one dose, the chief objection to active use against diphtheria and scarlet fever is removed.—W. P. Larson, Minnesota, L. ii./25,824. See also L. ii./26,1231. Specific antitoxin in the treatment of scarlet fever.—A. G. Robb, B.M.J. i./26,ll ; ibid. L/26,26. By injection at 5 to 14-day intervals of gradually increasing doses of 1 in 1000 dilution of scarlet fever toxin (commencing with 0-2 Cc.). the majority of Dick-positive reactions are rendered Dick-negative without ill-effects, but larger injections necessary to confer lasting immunity in cases originally strongly Dick-positive.—W. T. Benson and G. W. Simpson, L. i./27,283 ; see also D. S. Sutherland, ibid. 291. The important questions as to the most suitable doses, of toxin to administer» the total amount which should be given, and the duration of immunity resulting, remain as yet unanswered.—Stitt. .. . , . . Intranasal immunisation against scarlet fever by application of toxin to the nostrils.—B. A. Peters and S. F. Allison, L. i./29 1035.. Intravenous antitoxin in scarlet fever. 10 to 20 Cc. dose m acute stage stops the acute process in a few hours.—H. S. Banks and J. C. H. Mackenzie, L. i.?29,381 ; H. S. Banks, L. i./29,1248. Tr _ T7 Further on Dick Test and Prophylaxis, see Vol. 11. Control of scarlet fever in a children’s hospital. D. McClean, L. i./2/,48o. Autogenous Vaccine may be of value. Anti-streptococcic Serum has been a failure in a large number of cases of erv«inelas pysemia, etc. The streptococcus is a very large genus. Scarlatina Antitoxic serum used in puerperal septicaemia with mortality 29-6%. In every case S.pyogenes haemolyticus was found.—H. Burt-White, L None’of'the methods at present available is sufficiently accurate to allow a uniformity in the dosage of scarlatinal antitoxin in any way approaching that of diphtheria antitoxin.—R. Cruickshank, L. 11./28,^75. Streptococcus Vaccine may be employed in localised infections, as erysipelas, lymphangitis, ulcers, sinuses, tonsillitis, adenitis and mastitis; also m asthma and bronchitis, and in generalised infections such as sc ^ pvsemia, provided the Streptococcus has been proved to be responsible. dose in very acute and in generalised infections shoii^i be 5 01 at the ™ millions; in more chronic conditions a dose of 25, n95 50 100 Ampoules for Hypodermic use are supplied containing 5, 10, 2o, 50, 100, 02 and 500 millions. Septic Sores and Nile Boils well treated with Streptococcic \accme m the former and Staphylococcic in the latter.—H. Warren Crowe L. n./i8,067 Hemolytic Streptococci often present y.^hroat ^abbmgs espeeial^j where tonsils are enlarged, also in cultures t^_Ph^?5es kifluenza^d margin or in nose. Largely prevalent m scar^t ^ lobar pneumonia. In respiratory complications the actual cause of the disease may s° act on the respiratory mucous membrane as to render it suscepti to attack by these streptococci.—J. M. Beattie, B.M.J. ii./2i,786. See a J. H. Dible, ibid. 789. Infection of the teeth and gums : a useful classification of the various co plications arising. Intestinal infections frequently result from dental inf tion. FlombUres colon irrigations or autogenous vaccines made from 1 streptococci found in the teeth and intestine may be of value.—Sir Willi; Willcox, B.M.J. h/23,53. ?rU?R?E/IlAL Fevek-—Autogenous Streptococcus Vaccine found efficient in B.M.J. ii./22,644. Previous refs, in 18th Edn., p. 909. septicaemia well treated with local dressings of gauze impregnal with streptococci, the dressings being changed from three to five times in \10^s; .r less than three dressings were applied.—Presse Med., per A.M.A. h./25,730. Operations on the lower part of the alimentary tract liable to suffer inf tion. len days before give a vaccine of streptococci and B. Coli. repeat three days before the operation, and on the night before, 8 Cc. of 2%'Nucler Acid.—P. P. 1). Wilkie, B.M.J. ii./23,189. -o Noi)0sum treated by antistreptococcic serum.—A. H. Cart B.M.J. ii./23,414. Osteo-arthritis of the hip joint treated by vaccines made from streptoco obtained from foci of infection.—H. Warren-Crowe, B.M.J. ii./26,834. streptococcus \ accine and Staphylococcus Vaccine, combined with ac< bacillus, have no therapeutic value—omitted from N.N.R.—Y.B.P., *26,21 Milk epidemic at Brighton Jan. 1930. Streptococcus brevis isolated frc the throat and S. longus non-hcemolyticus from gland in the neck on incisio lhe condition corresponded to what is known as Dupuytren s phlegmc Infection traced to milk—a milker suffering from some pyogenic streptococci condition such as whitlow.—A. Cowan Guthrie, Med. World, Nov. 28 *30 Coley’s Fluid. * Contains the combined toxins of Streptococcus Erysipelas and B. prodigiosi Supplied by the Lister Institute in 2 Cc. phials. As now prepared is a moc flcation of the original method. Dose.—Inject a dose daily into tumour, or neighbourhood of turnon beginning with 0*25 minim into the tumour, or 05 minim elsewhere, and little or no reaction increase by 0-25 or 0-5 minim daily till a rise of tempers ture to 102-104° F. is reached. For first few doses dilute with boiled wat< to ensure accurate dosage. If depression follows injections give at long intervals. Uses —In Inoperable cases of malignant disease, especially sarcoma. Coi tinue injections till reaction has calmed down and temperature fallen. Mixed-cell sarcoma treated locally, excision and Coley’s Fluid 1 to 3 mini doses successful.—B.M.J. ii./i3,1484. The treatment was not given a fair trial in London, but Coley*s claims t cure 10 to 12% of inoperable^sarcomas were undoubtedly valid. Three case saved by it.—J. McNamara, B.M.J. i./28,1134. Cases of lymphosarcoma and Hodgkin's disease respond readily. The* diseases should no longer be regarded as absolutely hopeless.—Ann. Surges Oct., 1928. Staphylococcus Vaccine (S. albus, S. aureus and S. citreus) als<. Mixed Faccine—S. Albus and S. Aureus in equal proportion. Dose.—Initial 100 millions, increased to 1000 or even 500 millions. In cases of acne, Staphylococcus albus is commonly associated with the Acne Bacillus (q.v). In boils, carbuncles, sycosis, ulcers, and sinuses generally, and in acute generalised infections, such as pyaemia, ulcerative endocarditis, septicaemia, and peritonitis, either S. Albus or S. aureus may be found, but the S. aureus is relatively the more common. The mixed vaccine may if necessary be used. Boils.—In nine cases out of ten 100 million Staphylococci will cure.—Si A. E. Wright. Fuhunculosis.—If no improvement after three or four injections make an autogenous vaccine.—A thole Boss, Pr., July, T 3,100. Eczema, acute.—When the suppuration is not controllable by ordinary means and the stage of “ chronic ” pus infection is reached has been well treated. Staphylococcic toxins. Burnet and Kellaway’s investigations.—L. ih/30, 975. Tetanus Antitoxin. (Special provisions are made as to the manufacture of this Antitoxin under the Therap. Subs. Act 1925, and Begns. 1927.) The Lister Institute advises as follows :— (1) In Acute Tetanus. At first sign of tetanus give very large doses energetically and continuously—16,000 to 20,000 U.S.A. units beneath the spinal arachnoid (in the usual position for lumb ar puncture) and the same amount intramuscularly on the outer side of the thigh into the body of the vastus externus muscle. If no improvement at end of 12 to 18 hours repeat the doses once a day for 3 to 4 days. Later diminished doses subcutaneously, but patient is not out of danger for a long period. Warm the serum, first to 99 or 100° F. before injecting. Rise in temperature with rashes which should pass off. (2) Premonitory Symptoms, General restlessness suddenly changing to a desire for rest and vice versa. Unreasonable outbursts of temper. Increased nervousness. Sleeplessness with distressing dreams and may be nightly delirium. Temporary giddiness, violent headache, excessive yawning, diffuse backache. Trembling of the tongue which is put out to one side. Some local swelling, without redness, of the injured member and throbbing of its arteries notwithstanding mat trie limb is raised. Slight jerking may follow pressure on the flexor tendons and increased irritability of the muscles. A profuse sweating and darting pain m various parts. Difficulty in micturition, due to spasm of the sphmctei vesica?, which may last from a few minutes to half an hour. _ Changes m the facial appearance, the patient looks anxious, through there is as yet no muuff- donicus. Increased flow of saliva, spasmodic cough. Earache, stiffness at angle of jaw. Difficulty in swallowing. Tremors and clonic spasms which are not painful and may not attract attention. Pam persisting after muscular contraction induced by effort. (3) Prophylactic Use of Antitoxin anil Treatment ? to 6^^hours before SsSitioSfif toe tetter is needed. Use Iodine in the local treatment of the wound as it has strong destructive action on etanus Toxin. Intramuscular injections are preferably given m the outer side of the t g 1 (into the body of the vastus externus muscle). U.S. X. has ail Antitoxin Tetamcum Crudum. Syn. Aml- tetanic Serum, having a potency of not less than 150 units per Lc. : and a purified serum, Antitoxinum Tetonicum, with a potency of not less than 300 units per Cc. The latter is a solution of the antitoxin-bearing globulins. In both products the amount of preservative must not exceed 0*5% Phenol, or 0*4/^Creso . p0se._(Hypodermic) of either of these 10,0u0 units. Protective 15 Experience gained in the first year of war confirmed the opinion that 500 to 1000 U.S.A. units is sufficient prophylactic dose for ths majority of cases. In severe wounds repeat once or twice at in tervals of a week.—A. T. MacConkey. P. Jap. IV. has Liquid Serum, with not less than 5 Behring units in 1 C also Dried Serum of potency at least 50 Behring units in 1 Gm. P. Ital. V., has ‘ Natural ’ Serum, liquid containing 3 Behring units or 155 Rosenau-Anderson units per Cc., also Dried Serum 30 and 1500 unir respectively. For treatment at least 3000 units intrathecally (intraspinally). At tl same time 10,000 units to 20,000 units intravenously and subcutaneous!; To be repeated as frequently as the course of the disease seems to demand — Sir D. Bruce, B.M.J. ii./i5,593. See also below, W.O. Committee Memorandum.'—The best results are obtained by ire trathecal (intras&inaS) injection at the earliest stage repeated f« three or five days and supplemented by intramuscular doses. When opera ing at the site of wounds give as prophylactic 500 units or more intramuscular! two days before the operation. Intravenous injections should not be mar owing to risks of anaphylaxis.—Detailed method of giving intrathecal inje" tion.—B.M.J. ii./16,647,660. Sir D. Bruce, L. i./i7,680,986, see also F. W Andrews and T. J. Border, ibid. 6S2, F. Golla, ibid. 686 ; M. Greenwood, ibid. 687 ; J. Gow, ibid. 689. Effectual daily dose is about 10,000 to 12,000 units—the bulk of it to 1; given intravenously. There is grave danger in interfering with the infecte surface of a wound when tetanus has declared itself. This does not apply It amputation above the site of injury.—R. G. Abercrombie, B.M.J. i./i6,339. The duration of the complete passive immunity conferred by a dose « Antitoxin is short—enormous doses would have to be given to obtain inr munity for a length of time. 250 U.S.A. units would protect a man—weigh for weight as compared with a guinea-pig—for a week. 500 units wouB allow for the man being twice as susceptible.—A. T. MacConkey and P. Homer, L. i./x7,259. Anaphylactic Shock.—The danger of this is negligible when the prophy lactic dose is contained in such a small quantity as 2 to 3 Cc. of horse serunr In curative treatment where massive doses have to be given the case is differen Small subcutaneous doses rapidly increased remove risks.—L. i./i7,105,114. Prophylactic injection prolongs the incubation period enormously on ir fection. Tetanus may therefore occur after wounds have healed. Five mill cases treated intramuscularly and subcutaneously, all recovered. Six cast* intrathecally. Fourteen intravenously—some of these by a single dose c 3000 U.S.A. units. 13 recovered.—H. R. Dean, L. i./i7,673. Delayed tetanus treated with large doses of serum—a total of 236,500 uni# given intrathecally after lumbar puncture. Acts quicker than intramusculsi or subcutaneous.—S. E. Denyer, L. i./2i,1356. The toxin of Tetanus is transported to the central nervous system alom the motor nerves. Therapeutic use of Antitoxin is fully justified and indee; imperative.—F. Ransom, L. ii./x 7,928. Intramuscular route and large doses in tetanus needed, with Chloreton. (15 grains in Olive Oil per rectum) as a depressant of refiex excitability D. Bell, B.M.J. i./3i,7b. Better results obtained by giving large doses (50-100 Cc.) subcutaneous! by the intraspinal route under Chloroform anaesthesia, ending with subarachnoit injection of 10-30 Cc. The Chloroform impregnates the lipoids of the nervou system rendering it impossible for the toxins to become fixed—an exampfi of ‘ phyiaxis.’—Rene Cruchet, B.M.J. i./32,86. Preparation of Tetanus Antitoxin, The method of preparing Tetanus antitoxin consists in rendering animals in: mune to the tetanic poison by repeated inoculations of increasing quantitie of the tetanus toxin, after first protecting them with a large dose of tetanr antitoxin. The animals are then bled and the serum prepared and preservec Units of Immunity.—The U.S.A. unit established by a Decree of Congre^ is commonly employed. It consists of ten times that amount of Antitoxii which when mixed with the Standard Test dose of toxin and injected be neath the skin of a guinea pig weighing 340 to 370 Gm. saves the life of tb animal for more than 96 hours. For further information see McConkey.— B.M.J. ii./14,609, and ii./x5,849. Intern. Conference at Paris.—L. ii./22,129^ The Commission on the Standardisation o£ Serum, Serological Reactions and Biological Products under the League of Nations proposed to adopt the following anti-tetanic unit: “ The unit is to be determined with a standard serum in such a way that its relation to the American unit is exactly 2 International to 1 American unit.”—B.M.J. ii./28,111. , Dry pulverised Anti-tetanus Serum as a Wound Dressing.—Ims is dusted on wounds which may have become infected with dust, mud, etc. Infection may thus be prevented ; in addition apply antiseptic dressing. Tetanus may also result in new-born children owing to infection at the umbilicus after birth—sometimes from Fuller’s Earth. -W. W. W. Intra-Cerebral Injection of Anti-Tetanic Serum has been practised. The injection must be concentrated and free from antiseptic. A blunt needle is used. . , "Subdural injections of large doses encouraging. 1500 units given through a drill in the cranium in addition to intraspinal and intramuscular injections. One patient received 38,000 units intravenously and intramuscularly m a 00? units injected’into the cisterna magna cured tetanus after lumbar route failed.—T. O’Carroll, B.M.J. i./3i,74. It has been determined that tetanus spores free from toxin and exL aneoys micro-organisms do not produce tetanus, but the spores remain quiescent to the tissues for long periods, and when an Injection of Quinine or Calcium Chloride or Lactic Acid is given, necrosis of the tissues surrounding the site of injection occurs and should any of these dormant bacteria gain access to this locality they may light into activity and Produce tetanus. H. JLeale. For Veterinarv use the Lister institute supply loOO units for prophylaxis. TheVhorse injected with Tetanus Antitoxin is not rendered. pcrmanenUy immune Protection is a matter of weeks or months at the outside. B. jaliax. A rather rare anaerobe of war wounds, producing a soluble toxin giving rise to oedema. Not a very pathogenic organism.—btitt. Trypanosomiasis, Vide Vol II. TUT!Src«tots Milk as source of Infection, vide Vol II. under B Tuberculosis. See also Nutrimenta, Boiled v. Unboiled Mute. vol. 1. mmmmmm Poor Law Order hof tlie Area within which the patient resides ; but hea6 patient who has of' passenger or member of^the crew of u=dr simila1r structure belonging to His M^e4vPt’hIeS?ng Multiple notification results but steps are taken to as* saaas •-”a milk, and every bovine ammai suhermg ir tuberculosis is to be clironic cough, and showing de«n>teclSanTnimal is to notify a police destroyed. Every person » f^yfauthority.' Veterinary surgeons in private constable, or inspector oJ h ‘illsnector of local authority. Owing to lack Jnitte.es, very veteri^ e^ons necessary for every cuiosis under the Order, vvnoiew11 . /27,722-725. county of aD> S1f: '1' J tN Phthisis—Tuberculosis causes immunity— t„f Sstanee°is strong may succumb to it. There is a menacing danger of the infection of new areas ; absolute rest in bed ir: the early stages will avoid it. Some degree of immunity to bovine tuberculosis can be induced in calve by injecting them with cultures of the human type. Similarly in man tho disease tends to confer some immunity, and it is on the acquisition of tho new or improved powers of resistance which are the cause of the immunity slight though may be, that the hope of recovery mainly depends. In man as in the ox, the severity of a tuberculous infection is largely determined by the number of Bacilli gaining entrance at the start. In its tendency to pro' duce immunity tuberculosis differs from other diseases only in degree. During; the course of infection the powers of resistance are constantly increasing. Immunisation of cattle against tuberculosis.—L. i./31,879. A tuberculosis patient, under a doctor, will improve for a time, no matte what drugs, vaccines, or treatment be employed, owing to the nursing, regula tion of food, exercise and sleep, etc. If this were recognised, ‘ treatments would diminish. Records must be kept for years before the value of a remedy can be gauged.—W. E. Dixon, B.M.J. i./25,813,815. ^Etiology, prevention and Treatment. Every sanatorium should realise that sputum—contaminated dust of dwellings, streets, buildings and public places, inhaled and ingested with the air and in food—is the most frequen cause. “ It is a filth disease ” (Simon).—Sir R. Douglas Pow^ell, Pr., Jan 3:922, p. i. Tuberculosis in Wales. Mortality rate on the wiiole higher. More acut* than in England. Many leave their country homes for London or for th big industrial centres of Wales itself and many get infected with tuberculosi and go home again to die—perhaps infecting a whole household before th«. end. Nature is gradually getting rid of tuberculosis by a process of un conscious vaccination.—S. Lyle Cummins, B.M.J. i./22,338. During the war 40,000 men wrere discharged from the British army wit! diagnosis of pulmonary tuberculosis. This wTas not due to recent infection -—A. Latham, L. i./22,263. Retrospect of 40 years in tuberculosis. In the matter of treatment th< method of inhalation of antiseptics thought to be the most futile. With regard< to Tuberculin there is little hope of the discovery of any drug that can destroy the bacillus without damaging the delicate tissue cells—or reach the microbe entrenched in masses of necrotic tissue, but ‘ success may ultimately b<> achieved on these lines.’—Percy Kidd, L. ii./2 2,1211. Dogs as carriers of disease to man from animal parasites and tuberculosi (and rabies). Tuberculosis in the dog can be diagnosed by tuberculin injections.—T. W. M. Cameron, L. i./22,564. The share of the sun in prevention and treatment of tuberculosis.-—A llollier, B.M.J. ii./22,741. League of Nations Report on mortality from tuberculosis in various countrie during the last 50 to 80 years.—B.M.J. i./31,1127. In Glasgow' 12% of the population live 111 one-apartment houses and 48% ii two apartments. Domiciliary treatment of advanced cases in such condition impossible. Preventive methods employed. Death-rate there from phthisi now a quarter of what it was in 1870.—A. S. MacGregor, B.M.J. ii./3o,725. About 36,000 people die from tuberculosis every year in England and Wales though the death-rate in 1929 was 44% less than in 1918. Next to noth-' sng is done for after-care, though money is devoted to new Sana toria.—B.M.J. i./3o,836. Printers have a high mortality from tuberculosis, though a low genera death rate.—L. i./29,679. Eowler’s suggestion ,to inoculate milk with live tubercle bacilli as a pro phylactic against tuberculosis never thought of.—E. N. Moos, L. i./3o,832 The Indian populations of Manitoba and Saskatchewan are literally soaker in tuberculosis.—A. S. MacGregor, B.M.J. ii./3o,725. Outlook on tuberculosis.—Sir R. W. Philip and others, B.M.J. i./31,239. For the relationship between human and other forms of Tuberculosis and tests to distinguish types of B. tuberculosis, see Vol. II. Hospitals for Treatment of Tuberculosis. The Insurance Act method a dealing with tuberculosis has failed. The lines of prevention laid dowm ai> impossible. If the respiratory route is the one by which human tuberculosi; is engendered wre have no right to ask a number of perfectly healthy men ana: women to act as physicians, nurses, etc., etc., in institutions for the care of tuberculous pulmonary disease. Adequate sanatorium treatment for the poor—other than those of the so- called early cases of pulmonary tuberculosis—does not exist. The ultimate fate of these cases is sad in the extreme—they return from a stay in the fresh air to a bed-ridden end under the care of health visitors and tuberculosis officers. The other way of tackling the tuberculosis problem, however, is based on the view that every member of society is infected with the tubercle bacillus in early life and only those develop the disease, the soil of whose bodies is non-resistant. The great purpose of the Insurance Act based as it is on assumptions rather than on fact, of trying to stamp out tuberculosis by prevention, is rendered null and void by making the advanced tuberculous subject live in his own home. The advanced consumptive needs more help than he gets. The paper concludes with an eloquent appeal for the bed-ridden men, women and children sent home for domiciliary treatment, a burden to themselves and their relatives. 4 Observation * Hospitals are needed for doubtful cases as also Invalid Homes where those suffering from pulmonary tuberculosis may be nursed and treated until they are fit to earn their living or until they die. These Invalid Homes need not be in the country. They may m fact be in the heart of populous centres and therefore near their families without being a burden to them.—H. Batty Shaw, B.M.J. ii./i9,97. Tuberculins. There is no consensus of opinion either as regards the proper variety of Tuberculin to use or the correct dose to employ. The preparations now described are Old Tuberculin, Albumose-Free Tuberculin or T.A.F., Tuberculin T.R., Bacillary Emulsion or B.E., Beranek’s Tuberculin, Raw’s Vaccine, and certain other modifications. Tuberculin, Old, Tuberculin Koch. P.G. VI. That of P. Belg. IV. and P. Ital. V. is similar. This is an amber coloured liquid—a mature glycerin broth culture of the tubercle bacillus [typus humanus) concentrated to its volume, and filtered, with the addition of 0*5% Phenol. It is supplied m 1 Cc. bottles. Dilutions are made with 0-5% Phenol. The Therap. Subs. Regns. 1927 define Old Tuberculin as proper name for this : if with the suffix ‘ T 9 the tuberculin his been made from a case of human infection, while ‘ P.Td indicates made from bovine infection. ,, “tfpSto test is not good for standardisation.-Von Pirquet tests In ags7andaiTTuber0c«Unafor IniTna.tanai tse’ established by Permanent Standards^'commission of the League of Nations Standard preserved at thp State Serum Institute, Copenhagen. B.M.J. n./31,810. •, It has been used (a) as a J>ia(/nosUc both m man and oeast see p. 935, and (6) for treatment, but this is now lirtle used purpose. Tuberculin A.F., q.v., replaces it. It is however sail used in the ‘ Dispensary ’ treatment of Camac Wilkinson q.v. ThTtubercufin seems to act upon the tuberculous lesions, and even partly destroys them—it is not definitely destructive to the tubercle bacilli- or their surroundings, and subsequently there is a risk of further symptoms from blood poisoning dependent on this. The tuberculin may cause a serious fall in blood pressure, leading ever to a fatal issue ; in other cases there have been congestion anc: haemorrhage or other irritant effects have been produced. Contra-indications for the injection are laryngo-tuberculosis, cardiac troubles, diabetes, nephritis and pregnancy. In epilepsy and neurasthenie should be given with the greatest caution. The general reaction usually sets in about 8 to 16 hours after the injectloni more or less severe attack of shivering, with headache and pains in the limbs At the point of injection, redness appears after 1 to 2 hours, and gradually; an infiltration shows itself varying in size from that of a farthing to that o: half-a-crown, the absorption of which may take several days. The height of the reaction is indicated by a profuse outbreak of sweating a lessening of all the other symptoms and a more or less speedy return of thei temperature to normal. Generally the entire reaction is over in 24 to 3& hours. There may be slight lassitude, and in the case of phthisis an increased expectoration, disappearing in a few days. In lupus patients, besides the general, a marked local reaction sets in. Sequels to the injection of Tuberculin. E. Hoke states he has seen herpes zoster, Quincke’s oedema, periodontitis, urticaria, polyneuritis, fatal anaphy lactic shock follow use of Old Tuberculin—per Clin. Jl., Dec. 26/23,622. Tuberculous Meningitis treated with daily intrathecal injections of 1-2: mgr. of Old Tuberculin (T.A.) suspended in cerebro-spinal fluid by lumbai puncture.—C. Worster-Drought, M.P.C., June 14/22,514. Genito-urinary Tuberculosis : massive doses of P.T.O. ; P.T. and Old T. to 1-5 Cc.—It. Creasy, L. i./2o,542. See also B.M.J. i./27,4bl. Unguentum Tuberculin (Old):—Lupus vulgaris has been diagnosed and treated by use of Old Tuberculin Ointment—5% of Old Tuberculin in a basisi of Soft Paraffin. This is well rubbed in for one to two minutes and is alsc. applied by means of a bandage to the affected area—the part being previously cleansed and crusts, if any, removed. On removal of the application varying degrees of hypersemia and swelling are seen in the actual lupus tissue with a moderate amount of hyperaemia with reddish papules extending one- or two inches into the surrounding healthy skin (Moro reaction q.v.). After cleaning the surface, similar applications for treatment are made for the- next three or four days, till the lesion closely resembles that produced by: the application of a Salicylic Acid Plaster. This typical reaction only obtains! in the actual disease and does not extend into the surrounding healthy skin The pain produced may be considerable. ‘T.Q.A.i.c., Tuberculin-Original Alt, is a germ-free Tubercle Bacilli bouillon culture (typus humanus), resulting from filtering mature cultures. The proper name under the Therap. Subs. Regns., 1927 for this is Tuberculin Bouillon Filtrate, (i.e., Tuberculin B.F., U.S.), with or without the suffix T.O.A. or P.T.O., i.e., from human or bovine source. P.T.O. = Tuberculin B.F. Bovine U.S. Dilutions greater than 1 in 10 do not keep well. It has been used in the ‘Dispensary Treatment,’ q.v. Asthma and hay fever have been treated with it on empirical lines, vide Therap. Index. Vacuum Tuberculin and Vacuum Bovine Tuberculin are also issued analogous to T.O.A. and P.T.O. concentrated to 1/10 volume—for treatment of special cases (Dot for diagnosis) where a mild effect is desired. Initial dost 0T Cc. of 1 in 100,000 dilution twice or thrice a week, at most doubling on second occasion. If reaction occurs 8-dav interval after complete abatement of symptoms. Diluent Normal Saline with 0-5% Phenol. Tuberculin A.F. (Albumose-Free). P.G. VI. Dose (Initial).— 0-00001 Cc. in pyrexial cases ; 0-0001 Cc. in apyrexial cases. Subsequent doses are determined from a study of the resulting reactions —constitutional, or general and focal. As a rule, reactions should! be allowed to subside before a fresh injection is given. A light amber coloured liquid, the product of the tubercle bacillus grown in a special culture medium free from albumoses and peptones, evaporated to y1^ its volume and finally filtered. It may contain 0-5% Phenol and is standardised at Frankfurt-a.-M. This preparation, as already indicated, may well replace Old Tuberculin. It is used as diagnostic subcutaneously by conjunctival, intracutaneous and percutaneous application. For treatment it is employed subcutaneously where a fold of skin and underlying tissues can be raised. Reactions obtained are thought to be specific, and anaphylactic symptoms are excluded in consequence of the absence of non-specific proteins. ‘ Tubercle Vaccines.’—The proper name under the Therap. Subs. Regns. 1927 for preparations made from the bacillary substance by growing the organism on artificial media. They are suspensions of the killed organisms or products derived from them :—• Tuberculin ‘ T.R. ’ (of commerce). Human, Bovine and Mixed Types. Dosey initial (subcutaneous)—0-00001 to 0*0001 Cc. according as the case is pyrexial or not, rising gradually to 0*2 or even 1 Cc. Dilutions are made in 1 Cc., using 20% Glycerin as diluent. N.B.—Doses should be stated in decimals and by no other method. Although a stereotyped increase of dose is not advised the following scheme will be useful as a guide (reading downwards in each column) :— 0-001 Cc. 0-01 Cc. 0-002 „ 0-02 „ 0-003 „ 0-03 ., 0-004 „ 0-04 „ 0-005 „ 0-05 „ 0-006 „ 0-06 „ 0-008 „ 0-08 „ 0-1 „ 0-00001 Cc. 0-0001 Cc. 0-00002 „ 0-0002 „ 0-00003 „ 0-0003 „ 0-00004 „ 0-0004 „ 0-00005 „ 0-0005 „ 0-00006 „ 0-0006 „ 0-00008 „ 0-0008 „ As a rule weekly injections are given. Several commercial preparations made on the lines of Koch’s directions for T.R, are available. ‘ T.R.’ of Koch contained 2 mgr, of solid substance, not 10 mgr. as originally stated. An enormous amount of confusion was caused by this and indeed by the use of mgr. basis of dose at all. It may be recalled therefore that :— 0-00001 (TWW> Cc. of ‘T.R.’ = 0*00002 (^k) m£r* (or 0*00000002 Gm.) of solid substance. . _ _ . 4 JBold 9 Dose,—The large doses advised by Koch, starting from 0*0002 Cc. and repeated every second day with moderate increase of dose so that a rise of temperature greater than 0-9 F. was avoided—are not now generally administered. The jEnglish School start with smaller initial dose (as already outlined) and do not look for any marked rises in temperature. Tuberculin Bacillary Emulsion, (of commerce) (Human Type, Bovine Type, or the two mixed are available) — Dose._0-00001 to 0-00002 Cc. as a rule to begin with. For further details see below. Vol. I G G As proof of the immunising properties of his “ T.R.” and other; preparations Koch demonstrated the production of specific immunis--1 ing bodies which he called Agglutinins. The difference between ‘ B.E.’ and ‘ T.R.’ is that B.E. contains the entire body substance of Tubercle Bacilli whilst with T.R. the soluble constituents of thee Bacillus are first rejected. The soluble Endotoxins are thought to play an important part in the production of Agglutinins and are contained in ‘ B.E.’ ‘ B.E' is, therefore, a suspension of entire pulverised Tubercle Bacilh in a mixture of equal parts Glycerin and Water. 1 Cc. contains 5 mgr~ of thoroughly dried Tubercle Bacilli. The dose is increased carefully at a rate which causes little or nc: rise in temperature (1° F.) and with intervals of about 1 week- With the small initial dose stated it is very exceptional for any reaction to appear. Should a rise occur, the dose should not be exceeded and temperature must have reached its previous level. Table for conversion of Boses of Human or Bovine 0-00001 (1/100,000)] Gc. = 0 00005 (1/20,000) Mgr. o-00002 (1/50,000) Cc. ._. 0 0001 (1/10,000) Mgr. o- 00003 (3/100.000) Cc. = 0 00015 (3/20,000) Mgr. 0 00004 (1/25,000) Cc. 0 0002 (1/5,000) Mgr. 0-00005 (1/20,000) Cc. = 0 00025 (1/4,000) Mgr. 0 00006 (3/50,000) Cc. = 0 0003 (3/10,000) Mgr. 000001 (1/12,500) Cc. = 00004 (1/2,500) Mgr. 0 0001 (1/10,000) Cc. — 0 0005 (1/2,000) Mgr. 0 0002 (1/5,000) Cc. — 0 001 (1/1,000) Mgr. 00003 (3/10,000) Cc. = 00015 (3/2,000) Mgr. 0 0004 (1/2,500) Cc. = 0 002 (1/500) Mgr. 0 0005 (1/2,000) Cc. = 00025 (1/400) Mgr. 00006 (3/5,000) Cc. = 0 003 (3/1,000) Mgr. 0 0008 (1/1,250) Cc — 0004 (1/250) Mgr. 0 001 (1/1,000) Cc. ■— 0005 (1/200) Mgr. 0 002 (1/500) Cc. — 0-01 (1/100) Mgr. 0 003 (3/1,000) Cc. = 0015 (3/200) Mgr. 0004 (1/250) Cc. = 002 (1/50) Mgr. 0006 (3/500) Cc. = 0-o3 (3/100) Mgr. 0008 (1/125) Cc. = 0-04 (1/25) Mgr. 001 (1/100) Cc. = 0-05 (1/20) Mgr. 002 (1/50) Cc. = 01 (1/10) Mgr. 004 (1/25) Cc. = 0-2 (1/5) Mgr. Substance TO convert me auuve Daumciiy m of a milligramme into decimal part of a Gm., carry the decimal point three places to the left. Thus 0-00005 Mgr.=0-00000005 Gm. Dilutions are best made with 0-8% Sodium Chloride and 0-5%: Phenol. A 1% Dilution of the original is sometimes called ‘c Dilution No. 1,” a 0-1% is No. 2 and so on. Not used as a diagnostic. c ■L Hold Dosage (c/.,p. 929), was advocated by the German school. Starting with the same initial dose (0-00001 to 0-00002 Cc.), at one or two days interval, the dose was rapidly increased from twice to five times the dose at each injection, until definite reaction appears with a rise of 2| to 5° F. in temperature. As soon as such violent reaction develops much longer pauses, 6—8 days, were made. The injections were increased to 4 Cc. undiluted 13.E. Koch regarded the immunisation as complete only when the patient could tolerate this without reaction. The larger doses of 2 to 4 Cc. were only injected at intervals of 2 to 4 weeks. In exceptional cases (English dosage) the initial dose may be as minute as 1/1,000,000 mgr. Bacillary Substance with gradual rise —the limit being—1/500 mgr. Bacillary Substance (=0-0004 Cc.), Average doses are respectively 1/20,000 mgr. (=0-00001 Cc.). 1/5,000 mgr. and 1/2,000 mgr. diluted in 1 Cc. Sir A. E. Wright recommends doses of 1/4000 mgr., and rarely goes beyond 1/1000 mgr. in treatment.—Stitt. Tuberculosis treated by Insufflation of bacillary emulsion of dead tubercle bacilli, 1/5000 to 140 mgm. 3 times a week—results encouraging.—O. E. Paget, per Clin. Jl., April 18/23,192. Tuberculosis Immunising Vaccine (Nathan Raw). Syn. Tubercle Vaccine R.’ N. Baw states that virulent tubercle bacilli—after years of subculturing—can be attenuated. The present cultures (subcultured monthly) represent the 216th generation—still true to type, but even when injected in large quantities into animals they are non-tuberculogenic and avirulent.—B.M.J L/25, 741. In his opinion this remedy should be of greatest value, not only in curing the disease, but also in its prevention, by protecting the human body against attack. Cattle can be rendered immune to virulent bovine bacilli by previous inoculation with virulent human bacilli. There is a marked antagonism in the human body between human and bovine infections. These two organisms cannot flourish in the body at the same time. Extended clinical investigation at Liverpool showed that the human body is attacked by two quite distinct forms of tubercle _the one conveyed by direct infection and attacking chiefly the lungs (so-called consumption) ; the other, the surgical form, conveyed by milk from tuberculous cows and developed in the first few years of life. A vaccine made from bovine cultures should be used in the treatment of human infections and vice versa. Raw's Vaccine is a bacillary emulsion of the bacilli containing all the products of the bacillus. It is non-toxic and avirulent, and produces no reaction even in large dose. Dose.-—0-001, 0-002, 0-003, 0-004, 0-005 and 0-006 mgr. for immunising susceptible children at weekly intervals, repeated in three months. For treatment of the active disease, commence with 0-001 and increase to a maximum of 0-025 mgr. Twelve injections should be G G 2 given at intervals of seven days. Vaccine should be freshly made* Results in suitable cases excellent.—N. Raw, B.M.J. i./21,595* L. i./2i,693. See also B.M.J. i./2.5,741 and L. i./2i,1305. Results of treating 88 cases of tuberculosis with N. Raw’s Vaccine during, 12 months.—N. Raw, Pr., Apl. 22/229. Tuberculosis immunity. As a result of the treatment of over 3,000 cases of tuberculosis with every preparation of Tuberculin, the author is convinced that a vaccine prepared from an attenuated anci yon-pathogenic culture, free from all toxins, gives far the best results.—Nathan Raw, Pr., Nov. 23, 317. Dreyer’s Tuberculosis Vaccine. Some years ago Professor .Dreyer introduced a ‘Defatted or ‘DiapWte’ Vaccine. This was given a thorough trial under the auspices of the Medical Research Council but the hopes entertained for it were not realised. E. S. T. Burrell, Recent Advances in Pulmonary Tuberculosis ’ (Churchill, 1931). General References to Use of Tuberculins. For earlier References, see previous Edns. For and Aqainst Tuberculin. H Battv Shaw says : If Tubercle Bacilli gam access to the body they surround themselves with an almost impenetrable ring of fibrous tissue, caseous or calcified material, then any subsequent development at, a remote part, c a of the skin or subdermic tissues, of ‘ sessile tuberculin or tuberculo- amboceptors by means of injections of Tuberculin or Tubercle Bacilli, may be quite unable to reach the Tubercle Bacilli. B.M.J. i./i3.0-1. The ideal Tuberculin has not yet been found and the method of its action on healthy and unhealthy cells respectively has not been satisfactorily worked out In svite of all research the treatment of any individual case must be more or less of a leap in the dark.—Editorial, B.M.J. ii./i3,1243. Tuberculin in certain cases acts ‘ like a charm, m others it does little or no good, and in others again does actual harm. Except in cases of asthma, much improvement with Tuberculin cannot be expected m subsensitive Sses (e!yVthose which react to a 1 in 10 dilution of Old Tuberculin).—F. E. GUExperSiental tuberculin treatment with guinea-pigs ineffective and harmful—l. S. P. Davidson, L. i./25,13. , .. . .. Tuberculosis in the Tropics. No good result seen following Tuberculin, and in many cases chance of recovery destroyed.—Sir James Fowler, L. 11Evidence to show that Tuberculin is specific both in diagnosis and in treat- ment—F. G. Griffiths, B.M.J. i./27,827, ibid.S97. . .. . Combined type of tuberculins plus B. Coll found capable, especially m tubercular disease of the bones, but certainly, if judiciously given, m any t bercular disease—of giving extraordinary sense of well-being and comfort with as* a rule, improvement in appetite.—R. Robertson, Pres., Feb., 20. Tuberculin treatment. Focal reaction important Dose should be regu-- lated so that ‘ lumps ’ at the seat of injection do not form. One must find the tuberculous content of the patient before the disease can be attacked successfully.-—R. Robertson, Pr., Ma^ , 22/o54. ,. . Tube^ulin “ offers a certain cure in 90% of early cases.” Four essential uoints • (i) Not to be given when patient has intermittent or continuous. Twrexia (ii) Dose to be given twice a week, (iii.) Persistence until large Hnlpt nro reached ' (iv.) Temperature taken four times a day. Recommends; beginning with P T.O 0 0005 Cc. gradually .increased to 1 Cc., then P.T. 0-005. Cc increased to 1 Cc., then Old T. 0-05 Cc. increased to 1 Cc. After a reaction i e 'either general (rise in temperature, nausea and perhaps vomiting) local- or focal at site of tubercular disease, no further doses should be given for one week Then unless the reaction is unusually severe, the same dose should he civen In a few very sensitive cases it may be necessary to begin with as, lfttle as 0-0000002 Cc. T.A.F. Minimum time for first course, five months. ~?he improvement ocrasionlilT^llomng'the Tuberculin reaction may be cpMinfter the shock following other substances, e.g. Normal Horse Serum. \ from this action Tuberculin has no therapeutic value whatever. An over- doserinayI1do considerable harm, but it is safe in experienced hands and its dangers have been much exaggerated.—L. S. T. Burrell, ‘ Be cent Advances in Pulmonary Tuberculosis; (Churchill, 1931). 0* ^1- tuberculosis specialists replying to a questionnaire only 5 used Tuberculin as the main form of treatment. The majority counselled against its use in all but quiescent or slightly active cases, and 63 reported harmful results.—L. Hektoen and E. E. Irons, Jl. A.M.A. k/29,869. . Tuberculous Asthma can be ameliorated or cured by the following technique. Commence with 0-1 Cp. Tuberculin liniment and double weekly till 1 Cc. is. given. A Tuberculin rash often appears in due course at the site of application, usually accompanied by amelioration of the asthma. If not, proceed to injections, commencing with T.A.F. 0-0001 Cc. and increasing weekly. If reaction or an attack of asthma ensues return to the liniment. —E. E. Gunter, B.M.J. i./29,575. Tuberculin Dispensary Treatment.—W. Camac Wilkinson read a paper at the B.M.A. Meeting 1910. He reviewed the contraindications usually accepted and pointed out that Tuberculin acted like magic in cases of haemorrhage, apart from complications. Tuberculin never failed when Sanatorium methods succeeded. In the first stage pulmonary tuberculosis could be cured with certainty by Tuberculin, in the second permanent results are obtained in 40 to 60% of cases. A further paper dealing with laryngeal tuberculosis ; some remarkable results are described. Only early or suspected cases are suitable for this form of—Dispensary—treatment. The treatment should be refused to all presenting evidence of mixed infection.—(Leader) B.M.J. i./i i,265. From a study of his papers his usual treatment is first a course of ‘ P.T.O.,* then * P.T.* (may be repeated courses), then Tuberculin Old—or more recently Tuberculin “ The dosage (at the Portsmouth Municipal Tuberculin Dispensary) is approximately as follows:—First dose of ‘ P.T.O.* is from 0-00025 to 0-005 Cc.—increased gradually to 0-5 or 1 Cc. When this has been reached without reaction (over 100° F.) P.T. (which is said to be 40 to 50 times as powerful as P.T.O.) is given, i.e., after 0-5 Cc. of ‘ P.T.O.* the usual dose of 1 P.T.* will be 0-01 Cc. until 0-5 to 1 Cc. is taken without reaction, when a short course of Old Tuberculin with a maximum of 0-5 to 1 Cc. is injected.” In support of large doses of Tuberculin subcutaneously.—W. Camac Wilkinson, B.M.J. i./23,675. Regarding Municipal Tuberculin Dispensary Treatment, we provided a number of abstracts of the literature in our 17th Edn., p. 895. Pulmonary tuberculosis treated with Tuberculin. Method of Camac Wilkinson used as above outlined. In all about 40 injections were given, lasting over a period of six months; good results obtained. W. Stobie, B.M.J. ii./22,473. . . . . _ In a criticism of C. Wilkinson’s book, ‘ The Principles of Immunity m Tuberculosis,’ it is asked, ‘ If tuberculin is of such high value, why, after so many years, is it so little used ; or, rather, why is it feared and condemned ? —B.M.J. i./26,1039. Prophylactic vaccination of the newty-horn against tuberculosis. ♦ B.C.G.’ (Bacille Calmette-Gusrin), a strain of tubercle bacillus grown on glycerinated Ox Bile, first described by Calmette in 1909, was subcultured 230 times up to January, 1921, when vaccination experiments were started, and was then incapable of producing tubercles. Caused a general disease in calves resembling typhoid fever, clearing spontaneously after 15—20 days without producing slightest tubercle formation. 4 B.C.G. now cultivated on potato and glycerinated veal broth or Sauton’s Asparagin medium ; cultures must not be more than 10 days old. Administered in milk at body temperature in three doses and harmless even in new-born infants. Up to end of 1925, 1317 new-born infants treated (of which 586 bad been in contact with tuberculous cases). Of this number, 10 died of tuberculosis by end of first six months. Final judgment cannot yet be given.—L. ii./26,I046. None of the children vaccinated in 1922 (and left exposed to contamination) with Calmette’s B.C.G-. bacillus vaccine have died, and only 0-5% of those vaccinated in 1924 have died from presumed tuberculosis. It has proved entirely harmless for all infants vaccinated more than three years ago.— Presse Medicale, per Jl. A.M.A. ii./25,474. Of 882 cases reported on from one to two years after vaccination there were 7 deaths from tuberculosis and 72 from other diseases, and of 87 reported on more than two years after vaccination there were no deaths from tuberculosis. The conclusion is that mortality from tuberculosis among vaccinated cases is 0-8 per 100 living and from all cases 8‘9 per 100 as compared with 26 per 100 in the same age group of children bom of tuberculous parents or living in tuberculous environment.—L. i./27,936. Vaccination against tuberculosis (Calmette Vaccine).—B.M.J. i./26,581. See also L. i./25,1353. Statistics show a striking difference in the tuberculosis mortality in France existing between infants who have been vaccinated by the .method of Prof. Calmette and those not so vaccinated. The procedure is to give 3 doses, each of 10 mgr. of a non-virulent strain of tubercle bacilli during the first 10 days of life, and the figures represent the mortality calculated on each of the first two years of life.—Leader, B.M.J. i./27,845. See also ibid. 897, 1082, in which limitations in the value of the statistics are expressed by M. Greenwood. Destructive criticism of ‘ B.C.G.’ Figures unsatisfactory. Calmette’s claims ‘ optimistic.’—B.M.J. i./28,364. Prophylactic inoculation of adults with B.C.G.—L. ii./28,931. Over 300.000 doses issued by the Pasteur Institute during the past 7 years without a single accident. The oral route only should be used by the general practitioner.—per Pres., July ’29,253. 3 doses given per os according to Calmette’s prescription during the first 10 days of life, repeated at 1 year, and again at 3 years. After the first 10 days it may be given subcutaneously, if 2 negative cuti-reactions obtain at 8-day intervals—dose 0-01 mg. to 0-5 mg.—per Pres., July '29,254. May be a dangerous procedure owing to possible transmutation of the microorganism into a virulent form by cultivation on a medium containing its antiserum.—Petroff (U.S.A.), per Pres., July ’29,254. The Ukrainian Commission reports that it is harmless.—per Pres., July *29,255. Vaccination with B.C.G. on a large scale might usher in a new era in the campaign against tuberculosis. Norwegian proposals.—J. Heimbeck, L. ii./29,887. , , Conservative attitude apparently justified.—L. ii./28,473 ; B.M.J. ii./3o,G95. To attempt to protect persons by Tuberculin or tubercle bacilli appears to be wrong! procedure.—L. S. T. Burrell (Mitchell Lecture), B.M.J. ^Popular education regarding cause and natural history of tuberculosis is improving matters. B.C.G. a remarkable experiment on so large a scale.— Sir It. Philip, B.M.J. i./31,43. Discussion.—R. Carswell, ibid. 155, D. J. Gair Johnston 155, and J. Gibbcns, 156. Prof. Calmette’s statements on B.C.G. to Roy. Soc. Med. The untreated child is auto-vaccinated by milk, food, dust, etc. In Calmette’s method an attenuated strain (230 passages) of living organisms is employed. Mention of first child treated (born of tuberculous mother and grandmother): 10 years after the child is healthy and well.—B.M.J. h/31,1070,1080. # B.C.G. tried on calves. Interim Report, Cambridge University. Raises resistance to a virulent experimental infection. Intravenous injection best. —Prof. J. B. Buxton, L. i./3i,393. Cattle immunisation against tuberculosis. A survey of work. The resistance of the calf can be raised, but not invariably.—L. i./3i,826. Still regarded by the National Association for Prevention of Tuberculosis as being in the experimental stage.—L. ii./31,260. The Lubeck Disaster. . „ . , , B.C.G. caused tragedy at Lubeck. 50 out of 246 infants developed symptoms of acute tuberculosis, with 14 deaths.—L. i./3o,1137. Prof. Deycke and Dr. Altstadt were both found guilty of manslaughter by negligence in 68 cases and of injury by negligence in 131 cases and were nnw^enGe€vito 2 years and IT years imprisonment respectively. -tv*® Presiding judge said that although according to some experts B.C.G. v accine under certain conditions may become virulent the disaster had actually been caused by an exchange of B.C.G. with other virulent bacilli or by contamination. The negligence in the case of Prof. Deycke was that he had prepared, the vaccine in a laboratory where such contamination or exchange was possible, and m the case of Dr. Altstadt (Director of the Lubeck Health Dept.) in not testing the cultures before distribution and in not immediately stopping distribution as soon as he was informed that there was something wrong with them.—L. i./32,365. The following additional (unclassified) preparations are used in treatment :— Beraneck’s Tuberculin consists of a mixture of tubercle-broth filtered free irom bacilli and concentrated in vacuo, with an extract of the bacilli made with phosphoric acid. It is stated to contain exotoxins and endotoxins and acts like a vaccine, strengthening the bacteriolytic power of the protective cells ; it also exercises a bactericidal or attenuating effect on the Tubercle Bacillus. It is supplied in 6 dilutions, T.Bk, to T.Bk0, viz., 1 :10 to 1 : 1,000,000 for use. Spahiinger’s Tuberculosis Vaccine. Method of preparation of the vaccines disclosed by M. Henri Spahlinger as a result of financial assistance on the part of a small group of people (H.H. The Aga Khan, Lord Crewe, Lord lioseberry, Lady Seaforth, and Sir Arthur Stanley). Methods of preparation of a bovine vaccine for cattle immunisation and of a harmless vaccine for human prophylaxis. The original cost of £2 a dose now reduced to about 2/-. Tubercle bacilli for making the vaccine are grown under environments of food, heat, etc., natural to the disease. They are emulsified with normal saline in the absence of oxygen, then placed in ampoules and kept in the cold and dark for a year or longer and allowed to die a natural death. They thus retain unimpaired the chemical and physical structure by reason of which they are effective vaccinating agents. This replaces customary animal passage from human beings and subsequent culture on artificial media, different from the original environment which, it is claimed, alters the character of the organism. It is held that a vaccine made on the latter lines cannot deal with the disease in an animal of the group from which it was originally taken.—B.M.J. L/32,252. Tor a number of statements relative to Spahiinger’s Scrum, 1922-1927, see Edn. XIX., p. 946. A new Cultivation on blood serum unsterilised by heat so as to stimulate conditions in the human body, and the inclusion of part of the filtrate in successive cultures.—H. Hyslop Thomson, B.M.J. ii./26,587. TUBERCULIN REACTIONS FOR DIAGNOSIS. Subcutaneous test. . The test in the human being (not usually considered safe). An initial dose of 0-2 Cc. of a 1 in a 1000 dilution of old tuberculin is injected subcutaneously. If no rise of temperature follows, give 1 Cc. of a 1 in a 1000 dilution at least 48 hours later. If again no rise of temperature occurs give 0*5 Cc. of a 1 in a 100 dilution. Finally, if necessary, 1 Cc. of a 1 in a 100 dilution. A rise of 2*3° F. or more occurs in tuberculous subjects, some 6 01 more hours after the injection of tuberculin. The test for veterinary use. . . . The animal is confined to its stall for 24 hours before the injection is made and its temperature observed. 3 to 4 Cc. of a 1 in 10 dilution are injected subcutaneously in the neck. The temperature is taken 6, 9, 12, 15, 18, 24 and 36 hours after inoculation. If there is a rise of temperature of T4° C. or more the animal should be regarded as tuberculous. With a rise of temperature from 0*8— T4° C. the diagnosis is doubtful and the test should be repeated after one month. N.B.—This test has been proved to be of the utmost value for the diagnosis of tubercular infection in cattle. Occasionally in animals with advanced infection the test is negative. In these cases, however, the diagnosis can usually be arrived at by other means. In a few cases, in animals suffering from echinococcus infection a slight positive reaction has been obtained. After a dose of Tuberculin in cattle, a further dose during six months may fail to again produce a rise in temperature. Tuberculin Tests of Cows. Unless test be carried out with most scrupulous care doubtful results are numerous.—Capt. S. R. Douglas, L. ii./22,929. As diagnostic, stated to be reliable. Tubercle can be stamped out from our herds.—Prof. S. H. Gaiger, B.M.J. ii./22,961. Further refs. Edn. XVIII. Tuberculin Committee’s Report. Tuberculin Tests in cattle. Subcutaneous test unsatisfactory under farm conditions, and ophthalmic test only be regarded as subsidiary. Complete confidence in intradermal test.—B.M.J. i./25,797. Cutaneous test (von Pirquet). Cleanse the inner side of the forearm with ether and alcohol. Make two similar scratches with a sterile needle 3 inches apart (avoid drawing blood). On one scratch, place a drop of 1 in 4 old tuberculin in sterile water (pure old tuberculin is sometimes used), keep the other scratch as a control. Examine at 12, 24 aud 36 hours. A positive reaction occurs in from 3-24 hours and is usually at its height at 36-48 hours. The skin becomes red and slightly raised on each side of the scratch over an area 10 mm. broad, reactions under 5 mm. should be regarded as doubtful. Constitutional reactions following cutaneous Tuberculin Tests.—Am. Rev Tub., Sept. ’25, per Jl. A.M.A. ii./25,1583. A delicate indicator of tuberculous infection in childhood.—It does not fail even in massive tuberculous disease.—C. McNeil, B.M.J. i./23,673. Intradermic test (Mantoux). Intradermic injections of 04 Cc. are made into the cleansed forearm of :— 1. 2. 3. 4. 5. >1 yy yy Normal saline (the same as is used for diluting the tuberculin). 1 in 10,000,000 Old Tuberculin in normal saline. 1 in 1,000,000 1 in 100,000 1 in 10,000 ,, A positive reaction appears in 6-S hours, maximum 24-48 hours, subsides 0-10 days. The skin at the site of inoculation becomes infiltrated and hypersemic in severe reactions vesiculatiou occurs. (Routine tests may be made with No. 1 and 4 only.) The usual technique is to inject 04 Cc. of 1/1000 Old Tuberculin intra- dermally. Extremely valuable in children. Negative result excludes tuberculosis, strongly positive suggests active tuberculous disease with bad prognosis, and mild positive suggests tuberculous infection ameuable to open-air treatment.—W. F. Gaisford, L. i./3i,521. 100-fold or less dilutions used in a volume of 04 Cc.—L. i./si,873. Mantoux Test more delicate than von Pirquet’s Test. The latter is equivalent to 04 Cc. of 1 in 10,000 Tuberculin given intracutaneously.—D. J. Dow and W. E. Lloyd, B.M.J. ii./31,186. So far as adults in this country are concerned a positive Tuberculin reaction has no diagnostic significance whatever.—S. L. Cummins, B.M.J. i./29,336,522. Criticism by W. C. Wilkinson, ibid. 621. Percutaneous test (Mcro). An ointment made of lanolin and old tuberculin in equal parts is rubbed on to the skin of the chest. A positive reaction is shown by the development of reddening and papules. Tuberculin Ointment (for percutaneous use—Philip). Tuberculin Original Koch 10 to 50, Eucalyptol 5, Eucerin to 100 ; Beraneck’s Tuberculin is also suggested. Percutaneous exhibition of Tuberculin exerts a remarkable influence on the first buddings of tuberculosis in childhood. Continued observations, over long periods, show it is capable of effecting the nearest approach to d!etuber- culisation yet realised. Used as diagnostic and therapeutic agent, the twofold aspect must be kept steadily in view. The local stimulation by Tuberculin at each tuberculous focus is an important step. When Tuberculin is rubbed firmly into the skin of a tuberculous patient it is freely absorbed and exerts a specific curative influence. Generally, a 25% preparation is convenient. In young subjects, or where there is doubt as to the number and extent of foci involved, begin with 10%. The actual amount of Tuberculin used in a straightforward case (using, say, 25% dilution), may be approximately 0T Cc. The ointment containing this quantity is rubbed (worked) into the cleansed skin, over an area of 1 or 2 square inches, by means of a small glass rod. Repeat once weekly.—Sir Robert Philip, B.M.J. i./23,493. Tuberculin Old or P.T.O., or equal parts of both, mixed with Compound Camphor Liniment in proportion of 1 to 5 minims to 1 drachm, used for local application, e.g. in abdominal disease or pulmonary tuberculosis. An ointment using Anhydrous Lanolin employed for lupus or adenitis.—J. Crocket, B.M.J. i./22,679. Patients treated by 0-01 Cc. T.A.F. diluted with a suitable quantity {e.g. 0-5 Cc.) of Compound Camphor Liniment rubbed into back of upper arm. If no reaction the dose is doubled at next sitting and doubling continued until 0T Cc. tuberculin is reached, after this the dose is increased with caution to 1 Cc. of tuberculin. Interesting to note that all cases of asthma reacted to 1 in 10 or 100, not one to 1 in 500. Tuberculin used as test to sensitiveness by von Pirquet’s reaction, as modified by Ellis, initially.—P. E. Gunter, B.M.J. i./26,1083. For the Serum Diagnosis of Tuberculosis, see Vol. II. Typhoid Fever, Anti-Typhoid Inoculation. In the war each nation initially employed for immunising purposes preparations of the B. Typhosus alone without realising the importance of the Paratyphoid organisms. The vaccine had to be amended to include the latter when the overwhelming preponderance of Paratyphoid imection was realised. Sir W. H. Willcox (L. i./i6,454) for example in detailing his experience in the Dardenelles Area of a large number of cases, states that while Typhoid cases were 13;5%, Paratyphoid constituted 86-5%. The Paratyphoid on subdivision gave ‘ A ’ 47-5% of total, ‘ B ’ 29% and non-agglutinabie Paratyphoid 10%. In fact the Paratyphoid cases were in his judgment considerably more than 6-4 times as numerous as the cases of typhoid. In normal times in the past paratyphoid has been a relatively uncommon disease. The virulence of the paratyphoid organisms is much lower than that of B. Typhosus or thousands of lives would have been thrown away. The immunity created by prophylactic inoculation with T.A.B. Vaccine remains at a high level for at least six months -piobably for twelve, and should an inoculated person contract the disease, its severity is diminished and the percentage mortality lowered. A single positive Widal Test is of no value, but a study of the agglutination curve for the several organisms was proved to be essential foi correct diagnosis in cases which had been inoculated with ‘ T.A.BI ' An outbreak of Paratyphoid 4 B’conveyed by ice-cream.. 63 cases at Norwich, June, 1926.—V. F. Soothill and G. L. Leggat, L i./27,1233. The case incidence for 1920 was 2,739, as compared with 2,779 in 1925, 4,121 in 1924, and 3,211 in 1923.—Sir George Newman’s Report for 1926, B.M.J. ii./27,458. Anti-Typhoid-Paratyphoid Vaccine (T.A.B.) (:Therap. Subs. Regns. 1927 name) is made from cultures of Typhoid and Paratyphoid ‘ A an(^ \ ^ ’ organisms, ampoules containing 500, 1000 and 2000 millions of each organism. For ijiiMitmisitif/.—These doses are given in series at intervals of not less than 7 days ; the interval of 10 days is to be preferred. An interval of 14 days is even better. (Some give only the 500 and 1000 millions at 10 days in urgency.) The dose is given subcutaneously into the tissues of the upper arm just below the insertion of the deltoid. For children the dose may be on the lines of Gaubius’ Dose Table. Thus a child of 7 would receive 1/3 average dose. According to a report to the Medical Research Committee by G. Dreyer, A. Duncan Gardner, A. G. Gibson and E. W. Ainley Walker —(see L. i./i8,498)—on Prophylactic Typhoid plus Paratyphoid inoculation (T.A.B. vaccine) 1000 million Typhoid and 750 million each ‘ A ’ and 4 B ’ per Cc. should be given in doses of 0-5 and 1 Cc. as first and second dose to ensure protection. The interval between the first and second should be lengthened from 10 days to 18 or 20 days. Technique. —Pul) the area with antiseptic solution. A good fold of skin and underlying subcutaneous tissues is lifted firmly between the left thumb and forefinger and the needle plunged boldly and quickly to the depth of about an inch, the tissues released and the injection given slowly into the tissues. The puncture may be touched with weak antiseptic or dried and a little collodion applied. The patient should take no alcohol whatever during the 24 hours preceding and after the injection. Contraindications.—Alcoholics react more strongly than others. Kidney disease requires caution and there is possibly slight risk in the case of old standing tuberculosis. Effects.—Tenderness at the place of inoculation is at its worst in about 18 hours. Redness may be caused. Give free use to the arm the day after injection. Malaise begins in about 6 hours. Occasionally a rigor. There is usually headache and a slight degree of pyrexia Occasionally temperature up to 101° F., rarely 103° F. F.E. VIII, specifies T.A.B. Vaccine containing 1000 mill. T. with 750 mill, each A and B per Cc. Anti-Typhoid Vaccine (plain) is also made. Dose 1000 million and 10 days later 2000 million. F.E. VIII. has these two strengths. Anti-Typhoid-Paratyphoid-Cholera Vaccine (T.A.B.C.) (Therap. Subs. Regns. 1927 name). Syn. Castellani’s Tetra Vaccine. No. 1.—One Cc. contains 500 million B. typhosus, 375 millions each B. paratyphosus ‘ A ’ and ‘ B ’, also 5000 million Cholera Vibrio. No. 2.—Contains double quantities of No. 1 per Cc. Dose.—1 Cc. of No. 1, followed by 1 Cc. of No. 2, after customary interval. Dysentery Vaccination (almost simultaneously) has been conducted with the above. Plain Anti-typhoid Vaccine and 6 T.A. are also used for treatment. Dose.—50, 100, 250, 500,1000 and 2000 millions. An initial dose of not less than 250 millions can be safely used—these to be repeated or increased under guidance of the clinical signs and symptoms, It might be of value to give a vaccine of B. Coli and Streptococci to raise the immunity against these organisms before they can take an active part in the process of destruction of the tissues (as in the later stages of typhoid). T.A.B. Vaccine of undoubted value in treatment of enterica ; curtails pyrexia, limits toxsemia, and prevents complications.—M. L. Treston, I.M.G, Oct. *26,479. Small doses of Anti-Typhoid Vaccine should be used at first, viz. 50 million, and gradually increased. Dose reduced with pulmonary complications, and treatment suspended on occurrence of intestinal hsemorrhage, also in hyperpyrexia, syncopal attacks, and much enlargement of spleen. Cardiac complications not contraindicated except during early stage.—B.M.J.E. l/26,43. Intravenously Anti-Typhoid Vaccine found of value in the treatment of typhoid fever. Large initial doses must be avoided. A febrile reaction exceeding 40-5° C. is inadvisable. The initial dose should be about 120 mill. B. typhosus, gradually increased to 200 mill, if necessary. Perforation, severe heeinorrhage, severe myocardial degeneration and severe second infection are contraindications. Mild haemorrhage, pneumonia, mild myocardial degeneration, meningeal symptoms and severe toxsemia are indications for use yd smaller doses than usual.—K. D. Fairley, per Jl. Trop. Med., Dec. 15/23,388. Efficacy of Vaccine treatment still unsettled after 30 years. Barely 4000 cases have been treated. Intramuscular injection of no value intravenous injection of & forrn&lisccl Vctccmo of sovcr&l strains shortened duration oi the disease.—B.M.J.E. i./28,112. Internal Administration. . . . In an outbreak of typhoid in the Pas-de-Calais, vaccine was given to some 1 200 individuals in pill form. The results compared with a control group, in which ordinary prophylactic inoculation _was carried out subcutaneousl>, showed encouraging results, pointing to an increased efficiency of Besredka s oral method. (Besredka claims that rabbits could be immunised against typhoid, paratyphoid, etc., by feeding with cultures of the organisms, aher a preliminary treatment with bile).—3. Pratt Johnson, L. 11./22,753. Anti-tynhoid vaccine administered per os gave excellent results m an outbreak among natives employed in a gold mine near Germiston (b.A.). Doses Sisted of 40,000 mill V. typhosus) given for 2 or 3 auccess.ve days,- A J Orenstein and J. H. Pine, per Jl. Trop. Med., oept. 15/23,_J2. Prophylactic typhoid vaccination of 850 subjects by the mouth. Nine developed typhoid from one to twelve months alter vaccination. No A^ariatoof'Bewedfch typho\d7fmmunisation by oral administration of a vaccine is°used by the S. African Institute for Mathcal Research, and thou- if natives have been vaccinated by this method, which consists in giving 22%a Ucpdd Suspension of MUed B.lyphosus malaise Is ^tete^to^ollow^M tomumsation is^siipposed to be as efficacious “Good*'results’from^rophylactic inoculations obtmned |n Ameru;an_ and Japanese Armies. for'tvpho'id. Of 4410 men treated with mevents^the <S*B, typ&sus on colls still healthy and Wt0 8ubcutane* ous injection quicker rateVr’American troops during tile World Warhwa“n0a37 per 1000, oi‘ a total of 1529 cases in an army of 1,500,000, as compared with 141-59 per 1000 in the Spanish-American War, or 20,926 in 148,000. During the World War every American soldier was given 3 doses of Anti-typhoid vaccine or one of Lipovaccine before reaching France.— Jl. A.M.A. ii./a8,32. Disseminated Scierosis well treated by weekly infra” i/enoiss injections of anti-typhoid vaccine — dose injected sufficient to induce febrile reaction. The Doses usuaSiy ait/en. are 10, 25, 35, 50, 70, 100, 125, 150, 175, 200, 225 and 250 million.— W. H. M. Reaction makes patient ill for a couple of days. Encouraging results—30*6% showed marked improvement. Of 29 cases of the slow, steadily progressive type, 8 were greatly benefited. Improvement maintained up to 2 years.—Sir J. Purves-St-ew^art, Med. Ann., 1925,393. Better results with a treatment of Anti-Typhoid Vaccine, Neo-Salvarsan and Calcium Chloride. The ATeo-Salvarsan is dissolved in Calcium Chloride solution (10 Cc. of a 10% solution), and the vaccine also mixed with Calcium Chloride. Initial dose of vaccine 25 mill, progressively increased. 11 injections of Calcium Chloride and vaccine, alternating with 11 of Neo-Salvarsan in Calcium Chloride, i.e., 22 injections in all, spread over 11 weeks. 1st dose Neo-Salvarsan 15 cgr., 2nd 30 cgr., and remaining 9 each 45 cgr., making a total of 4-5 Gm. Feeling of intense glowing heat immediately after Calcium Chloride injection and nauseous taste after Calcium-Neo-Saivarsan. Of 64 patients so treated 40 were much improved, 6 of whom became symptom- free : 16 were improved, and 8 showed no improvement. Older patients and longer duration of diseaseless favourable results. Recent cases with symptoms mainly of cerebellar type specially favour-able.—Sir J. Purves-Stewart, Med. Ann. 1926,420. Rheumatoid Arthritis treated by ‘ (T.A.B.)’ Vaccine, see p. 668 and Therapeutic Index. Earlier References to Typhoid. Typhoid Carriers, vide Vol. II. Living Attenuated Vaccine containing living typhoid organisms (attenuated by heat at 50° C.) gives a higher degree of immunity than the use of dead organisms (given subcutaneously). The strain of organisms should be non-virulent but rich in antigen as determined by animal experiments. The immunisation is only partial.—A. Castellani, L. i./i3,595. Eitcrspacing of doses.—Some cases did well on daily doses. Medium dosage, say 100 millions may be given to begin with gradually increased to 200 or 300 millions with interval of 24 to 48 hours between each dose. The Vaccine treatment seems to make average cases mild, severe cases into average and only the very worst cases are not favourably affected. Clinical improvement five days after a dose of 2 millions.—F. J. Sadler, Q. Jl. Med., Jan., 1912. Much smaller doses were used than those now suggested. Two cases of Paratyphoid B. Infection treated with Vaccine prepared by cultivating from the faecal material on Conradi Drigalski medium (q.v.) and killing the organisms by heating 45 minutes at 58° C. In this way Vaccine is ready in 48 hours.—W. M. Crofton, B.M.J. ii./i3,1373. See also Edn. XVIII., p. 933. Vaccinia. Vaccine Lymph {Therap. Subs. Regns. 1927 name). Syn. Glycerinated Calf-Lymph. Vaccimim Variolee, U.S. X. Syn. Vaccino Antivaioloso, Vaccino Jenneriano, P. Ital. V. Vaccimim Antivariolicum P. Belg. IV. “ Cowpox, or rather the artificially inoculated form of the disease termed vaccinia, is nothing more nor less than variola modified by transmission through the bovine animal.”—Encyclopaedia Britannica, to which S. Monckton Copeman contributes the article on Vaccination. Eor an abstract of the monograph dealing with the objections urged to vaccine lymph, the needs for efficient vaccination, etc.— Vide L. ii./ii,1504. The Vagcination Order, 1929 (framed on the Report of the Rolleston Committee) instructs Public Vaccinators to make single insertions of lymph instead of the previous 4 insertions, multiple insertions being available to those desiring them. Re-vaccination is to be encouraged at the ages of 5 to 7 and 14 to 16. In a covering letter, the importance of primary vaccination in infancy is emphasised, and as 4 post-vaccinal nervous disease ’ occurs mainly in children of school age or adolescents who have never been vaccinated, it is not considered wise to press for vaccination of suoh persons (unless directly exposed to infection) while the small-pox prevalent in this country retains its mild character. The new Order came into force on Oct. 1, 1929. (L. iL/29,399,411.) Glycerinated Calf Lymph has advantages over that obtained even from healthy children (as used in the past). Attenuation by passage of the organism through an animal of greater resistance to the disease than man is known as € Jennerisation.5 The place oi insertion should be small, otherwise the reaction is too great. The amount of protection afforded seems to be greater than tnat afforded by humanised lymph. Glycerinated lymph is recognised as the safest lymph for vaccination, and by the Vaccination Acts Amendment Act, 1898, it is enacted that if a child has not been vaccinated when four months and one week old, the puolic vaccinator of tne district shall visit the home of the child, and shall offer to vaccinate the child with Glycerinated Caff Lymph free of charge. To meet the requirements of the Th&rc&&. Su&s. Act, 1925 and Re&ns. 1927, the animals used must be healthy, the animal after Ivmph collection shall be examined p.m., the lymph must be treated with Glycerin or other partial disinfectants (v. postea), 1 shall be continuously in cold storage at below 0° C. ; each tube shall contain enough for one human subject. A label on tne box or carton must show the proper name, name and address of maxer numoer of licence, a distinctive batch number, the date of completion _of manufacture after testing for organisms, and a statement that tne potency cannot be relied on for more than 7 days unless it is kept at below 10° C. . In emergency a larger amount may be issued in sterile oontamers of larger dimensions. T , The seed lymph used in this country is derived from Calf Lymph received from Cologne in 1907, its quality being maintained by cutaneous passage through the rabbit (repeated wansferenoe ^ calf to calf being found to lead to detenoration).-Min. Health Com. of Vaccination, B.M.J. ii./28,266. Renner’s Vaccine Lymph is free from pathogenic organisms. It has been frequently found good and active on testing it eleven months after having taken it from the animal. . Vaccination Lancets of special form are convenient. W Vaccine Injectors of Rubber are prepared of different forms and Vaccination Shields are sine qua non in careful vaccination. N.B.—Vaccine Lymph is destroyed in potency in 36 hours at 37° C. (!)„ and a temperature of 51 C. destroys it in 5 minutes. Ice chests are arranged for the brovt. Lymph to maintain at 10° C. Even a temperature of —180° for a long' period (11) weeks maintains lymph active. Kept 1 year at —5° C. was found moie active than that kept at -+10° C. same time.—A. Newsholme, M.O., L.G.B. Ufforoform water has been recommended to replace Glycerin to kill off extraneous bacteria, more rapid effect. Urgent demands for vaccine as in an epidemic, could be met by this method with a supply of vaccine in 14 da,\ s, instead of the month or 6 weeks necessary for glycerination. A rapid process of rendering Calf Lymph bacteria-free.—M. Coplans, Jl. drop. Med., Apl. 15, ’26,122. Lor the storage and use of lymph it is recommended to mix lymph 50 parts, glycerin 25 parts, and water 25 parts.—Pr. lx. 284. Dijiilcd Calf Vaccine. Diluted 10 to 50-fold with N/5.0 Phosphate solution P ,/ 01 with salme or sterile water. Deduces risk of post-vaccinal encephalitis, and gives more satisfactory ‘takes.’—S. P. Pedson, L. iL/29,920. tJifTcs'on ££(%* ciiacgnos/a of smaii-ipox and c LIic chief points generally relied upon to distinguish chicken-pox from small-pox are the following; distribution of the eruption, which is found most abundantly on ^e trimx, and more thinly on the face and hands. in young0children eruP^don from the palms, soles and palate, especially (c) ihe absence, or short duration, and unimportant character of the pre- erupti v 0 stfigG. erupti a^serice umhilication of the vesicles in the earlier stages of the (e) The absence of a pre-eruptive stage. Ail these characteristics, however, may fail. In many cases the distribution of the eruption, when scanty, is the same on the face and extremities as on the trunk. poie throat, accompanied by an outbreak of papules, though usually associated with small-pox, may appear in chicken-pox. Umbilication is often not seen in small-pox at any stage of the eruption, while a slight amount may be seen m chicken-pox. A pre-eruptive stage may occur in chicken-pox similar to that in small-pox. Other important points, pointing to diagnosis in favour of chicken-pox are the absence of lumbar pain, the presence of elliptical or oval vesicles, continued fever after appearance of eruption, and collapse of the vesicles on being punctured in one spot only. There are, however, two really reliable signs, at present much neglected which should have preference over all others. (a) 1 he early vesiculation and crusting of the papules, which mav occur in so short a period as thirty-six hours. (b) the contemporaneous presence of papules, vesicles and crusts on various parts of the body.—A. T. Brand, B.M.J. ii./22,823. Cases are missed leading to a sequel of 5, 10, 15 or more deaths, as the case may be. Lemarkable difficulty in recognition. Importance of young men familiarising themselves with the subject.—W. McO. Wanldyn, B.M.J. ii./ 2 2^/ /DjJUTOjjLvjyii* Diagnosis. The Voluntary Service fund, of 64, Gt. Portland Street, W 1 issues Accurate diagnosis of Smali-pox ’ (3rd Edition, 1927, price 6d.). There is nothing standing between our people and a small-pox catastrophe but the eternal vigilance of the Medical Profession.—L. i./29,907. FloccuiaUon test for small-pox. The reaction is carried out with a suspension of the crusts from a suspected case, and a specific flocculating serum made in the rabbit. The reaction found to be specific and of diagnostic value — L. ii./29,992. Origan of Vaccination. Benjamin Testy, a Gloucestershire farmer, m 1714, inoculated his wife and family with cowpox to protect them from sinal -pox. He was stoned for it. In 1796 E. Jenner, the inoculator of smallpox In Ins district, established the practice of vaccination which the whole world ultimately gripped.—C. Dukes, L. ii./2i,1190. A treatise, historical, bacteriological, giving the method of manufacture of calf vaccine, the glycerination of the same, the filling into tubes, and the bacteriological examination of lymph.—W. H. M., C.D. ii./oi,629. Jentier Centenary Celebrations,—An interesting address by Sir W. Hale-White.—B.M.J. i./23,204 ; L. i./23,137,521 ; Jl. Trop. Med., Feb. l/23,46. Varieties of small-pox.—J. C. McVail, B.M.J. ii./23,338. A concise account of Vaccination as first discovered and practised by Edward Jenner.—See a Lecture by It. T. Hewlett, P.J. i./i3,398. Studies of the viruses of vaccinia and variola.—M. Gordon, B.M.J. ii./25,715. L. ii./25,826,874. See also M. Coplans, Jl. Trop. Med. 15/’26,122; ibid. May 1/ 26,133. Combined use of living virus and Immune Serum for immunisation against virus infections. Immunisation against vaccinia and yellow fever has been obtained in monkeys bv using Immune Serum and living virus.—J. M. Findlay and E. Hindle, B.M.J. i./3i,740. Criticism of immunisation against vaccinia. —J. Bland, B.M.J. i./3i,871. Need! for cosn&ui&ory vaccination. Germany has a law which enjoins vaccination and re-vaccination (made compulsory in 1874). Even if the prevalent (mild) type of small-pox can be trusted to breed true, there still exists, side by side with it, the old dangerous type. We may experience a reversion to the horrors of the 18th century.—Prof. Greenwood, B.M.J. i./3o,398. . . , , Four out of every five of the population of tins country are unprotected by vaccination—(the reproach of Britain.—B.M.J. i./25,621). In an epidemic in Toronto 3000 deaths from small-pox resulted from one mistaken diagnosis of chicken-pox. Discussion of the differential diagnosis of the common exanthemata.—L. i./22,531. Statistics and Genera! References. Half century of Small-pox and vaccination.—J. 0. Me'vail, B.ivl.J. i./i9» 297 339 373 40S. Small-pox in Nottingham, June to August 1921, possibly by infection by contact with imported rags, clothes and the like.—B.M.J. n./21,660. # Inoculation against small-pox in the Shetlands prior to discovery 01 vaccination. The bacteria were killed by peat smoke and camphor and tne virus attenuated by keeping for years underground.—B.M.J. u-,/2^f1r onn Vaccine Lymph subcutaneously as protection against small-pox. 800 patients were tried—the injection given m the arm. 82 A showed focal reaction but no superficial vesiculation except wnere the needle had scratched the skin. These cases were classed as successful. Twelve of the cases were revaccinated in the usual way and did not ‘take.’ This was regarded as proof that they were protected.—Ind. JL Med. Bes., toOctober Small-pox in London. 19 cases during the period July 26th to October 13th 1922. The outbreak originated m Stepney—a youth of lb. He infected ciy t)ptrohs —For fuller dctO/ils soo B.M.J* ii• # . j » t) j. nnx Treatment of Solution of Izal used in 190.. instead of Potas- ohSfpp’rfnaneanate On removal from bath, patient completely bandaged m Tyms oPaISo® G^u/e bandages. The ilea was to prevent pnstula Ion by outside organisms. Some cases were confluent, but, m general, the result in ™listed 9tatlitic# there owing to climate and the long journey from 'as • * TvrP(i Feb 1/23 35 addition of Glycerin to powder.-N Canthe. Jl. Trop. Med *|j>. 1/23, Small-pox cases in Willesden.—B.M J. il/26,600 , L.11./2 ,7 . Small-pox and variolation m Paiestme.—L. i./26,M2. cold winter Spring “to mSt* ir^^l'mall-pox.-Sir^: lingers, B.M.J. i./28,300. See also L. exfyeHencG as Public Vaccin- /mpress/ons of 30 years P q overnment Lymph gives better ator9 coversnfs 40,000 whpn fresp put apt to lose activity results than others. Absolutely re . hie w ’put. only 5% of working in hot weather. Perfect results m40^oiIntoday_ Segleci toAothiloften the cause of many weeks’ suffering and the real origin of the anti-vaccination movement. Successful vaccination protects against variola absolutely for 10 years, considerably for 15 years, slightly for 25 years: and not at all after 30 years. The best answer to objectors claiming exemp ti°n, on the ground that they have been done before, is “ If you do not require it, it will not take, so there is no harm in trying.”—P. S. Edmunds, M.P.C. Jan. 12/ 2731. It is advisable for all vaccinated persons to keep their bowels well open with saline purgatives— G. G. Bigby, B.M.J. i./27,779. Pending changes in the administration of Vaccine under the new Poor Lav Keiorm Bill control to be transferred from Boards of Guardians to County Councils and Boroughs—J. Bennett, L. L/27,271. An exceedingly mild form of small-pox has been endemic in this country ^or several years. Ought we not seriously to consider whether a disease which causes such slight constitutional disturbance, so few deaths, and so few (i:. any) after-results, really calls for the elaborate and expensive system 0 hospitalisation maintained for it ? Moreover, the results of vaccinia are noi negligible, and while the number of deaths from small-pox is much over-' stated, there is a possibility that those from vaccinia may be understated Is protection against the present type of small-pox worth the price being paid for it ? Our views about vaccination are changing and would change ever: more quickly had it not been a part of the Official creed.—J. W. Carr, L ii./28,757. May not small-pox be in process of becoming gradually as innocuous in this country as plague and cholera have already become ? It is a tragedy for & child previously healthy to die from post-vaccinal encephalitis, and it is at least fair to ask whether the need for the prevention of small-pox justifies the* sacrifice of healthy young lives.—J. W. Carr, L. ii./28,893. Dr. Carr’s letter is vitiated by his refusal to face the probability of the future re-introduction of severe small-pox, or the reversion of the present mild type to a severe type. —Sir L. Bogers, ibid. 947. Hsemorrhagic non-pustular small-pox. A case in China—A. Cannon and S. W. Phoon, B.M.J. ii./3o,283. Small-pox (variola minor), of a mild character, showed increased prevalence during 1930 in London and some parts of the provinces. The total number of cases was 11,839, with 28 deaths. Analysis of 10 years’ figures suggests, that in an area where the disease has succeeded in establishing itself it tends, to increase to a maximum during the 4th or 5th year of incidence and then declines. The present downward trend gives hope that during the winter of 1931 the country may be relieved of the incubus of weekly infectious which have ruled during the last decade.—Sir George Newman’s Annual Bept. for 1930, B.M.J. ii./3i,658. Post-Vaccinal Rashes, Herpes, etc. Heroes tester and chicken-pox rashes appearing at the same time. The association is still a matter of speculation. A case of chicken-pox and herpes eruptions within a period of six weeks.—B.M.J. i./26,697. A child developed a profuse varicella rash following a severe attack of shingles in her grandmother who lived in the same room.—B.M.J. L/26,902. Painting the face once or twice daily with a 1 % solution of Potassium Permanganate, and the arms and hands with Tincture of Iodine once daily, prevents severe scarring and pitting in small-pox.—A. Castellani, Int. Conf. Trop. Am. ’24,769. Most post-vaccinal rashes accidental, due to absorption of products from vaccine pustule : specific eruptions less frequent and generalised vaccinia very rare. Bash usually appears on 11th day. In cases of doubt treat as smallpox.—H. D. Chalke, L. i./3i,5Sl. Encephala-my el it is following vaccination.—L. ii./26,504. Encephalitis developed in thirty-four cases among 240,000 children vaccinated during a year and a half, at a time when epidemic encephalitis was prevalent. Better advises to refrain from vaccination during an epidemic of encephalitis.—per Jl. A.M.A. ii./25,779. Possibility of post-vaccinal tetanus.—J. C. McVail, B.M.J. iL/25,355. Ministry of Health Committee Report on Vaccination. Investigations to produce lymph free from extraneous organisms, e.g. by growing the virus in vitro in contact with chick embryo cells, or by inoculating rabbits intra-cerebrally (the neuro-vaccine of Levaditi) have been carried out. Accepted methods of testing for potency—Gin’s Test, Sobernheim’s Test, Groths Test, Calmette-Gu6nn s Test. The present method of inspecting the patient on the 7th day should be dropped and replaced by inspection during the second week, with an obligatory second inspection in the third week, also the adoption ot stational as distinguished from domiciliary vaccination. There 18 n?r.e\, eilce that vaccine increases liability to disease either generally or specifically, or aggravates disease already established. The Committee acquitted the vaccinia virus of being the sole cause of &ost-vaccinal encephalitis7 but is unable to exonerate vaccina- tion from playing some part, and considers that the co-operation of vaccinia with the viruses of poliomyelitis, encephalitis, or some unknown neurotropic virus, must for the present be accepted as a working hypothesis. The Committee considers that for all practical purposes the period of effective immunity after vaccination may be regarded as not less than 7 years. Owing to the prevalence in this country during the last 5 years of a very mild type of smallpox there has arisen a marked disinclination to submit to adult vaccination, the small-pox causing little discomfort, whereas vaccination means abstention from work for manual workers. The Committee recommends the reduction of trauma to a minimum and considers it possible to secure 100% insertion success by application of lymph to a single linear insertion \ inch long.—B.M.J. ii./28,266. Post”Vaccinal Encephalitis* League of Nations Commission Report. The report quotes extensively from the Rolleston Committee’s Report (see above). The fact is emphasized that the term post-vaccinal does not necessarily imply propter-vaccinal, as coincidental disease of the brain and nervous system must be allowed for in the millions treated with vaccinia yearly. Encephalitis also occurs as a complication of numerous infections, e.g. measles and toxcemia. The Commission, however, considers that there are practical reasons for viewing post-vaccinal encephalitis as a separate pathological and clinical entity. The risk may be exaggerated. From 1923-1927 only 139 cases were reported in Holland (41 fatal) yet this has been sufficient to cause temporary suspension of vaccination law’s relating to children. In England and Wales 62 cases, with 36 deaths, occurred from November 1922 to November 1923, and 25 cases with 12 deaths between January 26 and September 27, the bulk occurring in children from 3 to 13. The Commission concludes that the virus of vaccinia itself is not responsible, but rather some unknown factor—a filter-passsing or latent virus. Only the treatment to which the lymph seed is subjected determines the quality of the lymph, the origin of the strain used being of no significance. While'the passing of the vaccine through rabbits is unobjectionable, neuro- lapine obtained by intracerebral injections in rabbits, and testicular-lapine, differ from ordinary vaccine. The medical officers of vaccine institutes should themselves undertake human vaccination to study the potency of the lymph they make, the bare report * successful * or ‘ unsuccessful,’ being of no value when the vaccine reaction is not described in detail. In primary vaccination the proportion of insertion successes should be noted, and in revaccination the reaction should be described as one of three classes : (1) Reaction of primary vaccine tvpe (Jenner’s pustule), (2) accelerated reaction (vesicular reaction) : “ modified vaccine,” (3) allergic or early reaction (papular reaction). The technique and methods used in different countries should be carefully defined and recorded, and judged in respect of immunity afforded, so that a satisfactory technique for universal adoption may be evolved. B.M.J. ii./ 28 582. Vaccinia affords better protection against small-pox than small-pox against vaccinia. Discussion on post-vaccinal encephalitis. Prof. J. G. G. Eeding- ham, L. i./29,231. . ... , A fatal case of Post-Vaccinal Encephalitis after primary vaccination of a boy aet. 14, with Government lymph, 4 insertions, 3 of which ‘took well.’ Patient died 16 days after vaccination, duration of illness being 6 days.— G. N. Grose, L. ii./29,381 ; cf. ibid. h/29,221, and B.M.J. ii./29,324. Further investigation is essential. The vaccinia virus has not been put definitely out of account as a possible etiological agent and the present strain of vaccine used in this country should be scrapped anc. replaced by a stock vaccine from a country where rabbits are not utilised or by a new stock of variola vaccine cultivated without the rodent accessoryM. Coplans, W. G. King and W. J. R. Simpson, B.M.J. ii./29,30. Acute disseminated encephalo-myelitis following vaccination.-—C. I>. Coy! and E. W. Hurst, L. ii./2o,1246. Post-vaccinal encephalitis in Germany and Sweden. In Germany very rar after re-vaccination and relatively uncommon when primary vaccination i performed under the age of one year.—L. i./3o,525. Lesions of disseminated encephalomyelitis following small-pox indistinguisb able from those of the disease following vaccination, measles, etc.—A. G Troup and E. Weston Hnrst, L. i./3o,566. Small-pox and vaccination in light, of modern knowledge. Post-vaccina encephalitis considered.—J. McIntosh, L. i./3o,618. Zoster, varicella, and encephalitis. Lumleian Lecture on.—W. R-usse Brain, B.M.J. i./31,81,104. A review of recent data. Netherlands, England, outside Europe, Cor tinent. Pathology.—L. i. /si,Q7. Alastrim. Derived from a Portuguese word meaning ‘ to spread about Amaas, Kaffir Pox and Milk Pox, in different countries, appear synonymous The term, ‘ mild ' small-pox, is a misnomer. Vaccination is of greatest value but does not afford absolute protection. Points of difference between smal pox and alastrim.—L. M. Moody, Int. Conf. Trop. Am. *24,760-767. Suggestion to call the two types of small-pox Variola Major and Variol Minor (Alastrim or “ Para-small-pox ”).—L. L/25,92. For differentiatio and interrelation.—See also ibid. 29, 101, 153, 199, 205, 225, 352, 359. Outbreaks occurred in East Anglia and in Jamaica in 1920. The diseae on the whole is of extraordinarily mild character. On recovery there is n deep pitting or scarring. The characteristic odour is absent.—L. ii./2i,128© L. i/2 2,403,502. See also B.M.J. iL/22,65,283 ; J. P. Leake and J. N. Fore* per Jl. Trop. Med., June 1/2 3,199. Report of outbreak in Antigua, B.W.I.—E. W. R. Branch and W. I. McDonald, Jl. Trop. Med., June 15/23,215. Blood studies in small-pox with special reference to alastrim.—Prof. W. E Hoffmann, Jl. Trop. Med., June 15/23,217. Whooping Cough (Pertussis). Whooping Cough Bacillus (Bordet Gengou) Vaccine. For details of the Bacillus, v. Vol. II. Is of service in lessening the violence of the paroxysms and shorten; ing the duration of the attack. Initial dose for infants, 5 millions The dose is to be repeated or increased every 4 or 5 days. Ampoule contain 5, 10, 25, 50, 100, 250 and 500 millions. As B. Influenzas and the Pneumococcus commonly accompan, Bordet’s bacillus in these attacks the combination of half the dos indicated above of the B. Influenzae and of J the dose indicated abov of the Pneumococcus is likely to prove beneficial. A Vaccine of thi composition is supplied under the name Compound Whooping Cong Vaccine. Whooping Cough Vaccine appeared of little utility.—D. Paterson and J. M Smellie, B.M.J. i./22,713. But good as prophylactics.—J. F. Rey, ibid. 783 Of 100 cases of whooping cough in children from 0 to 12 years, treate with Bordet-Gengou Vaccine, good results w^ere obtained in all but four Three injections intramuscularly of 3000 million bacilli usually sufficient —B.M.J.E. i./26,56. SENSITISED VACCINES (SERO-VACCINES). Vaccines whic/ have been treated with the corresponding antisera prior to their use See Edn. XVIII., p. 938, and Edn. XIX., p. 956. Immunogens (T.M. 430546). A series of vaccines of high activity and relative freedom from bacterial cells and toxins. The following are made : Gonococcus Gonococcus (Combined), Pertussis, Pertussis (Combined), Pneu mococcus; - Pneumococcus (Combined), Streptococcus, Streptococci* (Combined). A type of antigen, based upon washing off 24-hour Agar growths of e.g. the typhoid bacillus, with Normal Saline, agitating to make a homogeneous suspension, and centrifugalising. Both with this and other organisms the antigens obtained in the washings were found to be more potent than broth filtrates. The toxic principles are left behind, the washed bacteria being practically as toxic as before treatment. Intramuscular injections thought to be best. Promising reports in connection with streptococcal, pneumococcal and gonococcal infections are forthcoming. Initial dose of the most useful concentration is 0*5 Cc. with rises to 2 Cc. or more.— Sir Thos. Horder and H. S Ferry, B.M.J. ii./26,177. Criticism of Immunogens. Detoxicated and defatted-vaccines found to be clinically inert.—Geoffrey Shera, B.M.J. ii./26360,1243. Residual Vaccines (Autogenous). The vaccines are washed in combination with Hydrogen Peroxide. Of 380 cases, covering a wide range of infections, 294 (81-5%) were successfully treated.—C. E. Jenkins, B.M.J. i./28,340. 3fc Phylacogens (T.M. 343296) are filtered, sterilised (72 hours) cultures of pathogenic micro-organisms preserved with. Phenol 0-5%. The cultures in question include those of Pneumonia, Rheumatism, Gonorrhoea, Erysipelas, and ‘ Mixed Infection ’ (advised ‘ in the treatment of all infections, acute or chronic, in which the condition is not due to a specific micro-organism). Nephritis is a contraindication to their nse subcutaneously. Intravenous injection is contraindicated in nephritis, in arteriosclerosis, and in cases with severe and dangerous cardiac involvement. The initial dose should always be given subcutaneously. Phylacogens are supplied in 10 Cc. vials for hypodermic or intravenous use.—Ther. Gaz., Apl., 1911. >fc Edwenii (T.M. 514601). Do*e.—2 Cc. hypodermically—sometimes \ Cc. or less to begin. Doses up to 6 Cc. may be needed. In acute infections repeat dose once or twice in 24 hours; in chronic infections, or convalescence, 2 or 3 doses a week. Described as the ‘ natural antibody,’ consisting of Calcium in the form of Bicarbonate, a Calcium vehicle in the form of a nucleo-protein, and an unattached globulin element obtained from serum. Uses.—In endotoxic infections, but without effect on exotoxic infections or protozoal infections, asthma, influenza, measles, mumps, otitis media, pertussis, tuberculosis, etc. Contraindicated in conditions in which a sudden swelling might cause embarrassment, or an increase of secretion cause trouble (e.g. bronchitis with much secretion), also in cholecystitis and appendicitis. —S. G. Biilington, L. i./24,431; Med. World, Jan.-Mar., 1929, and Apl., 1930. In canine distemper.—Vet. Jl. Nov., 1928 ; Brit. Dental Jl., Dec., ’20. ^cAntibacsyn (T.M. 522462, paration on similar lines. class 2 and 522463, class 3, is another pre- ANIMAL ORGANOTHERAPY. ANIMAL GLANDS AND TISSUES AND THEIR PREPARATIONS. The word Endocrine (derivation: evSov within; Kpivetv to separate), meaning 4 any internal secretion, is still much in vogue though it remains customary to speak of 4 ductless glands ’ and 4 glands with internal secretion.’ We continue to include in this chapter a number of ’ Organo- therspeutic ’ medicamenta in addition to the endoci ine glands. Insulin, however, is dealt with under Pancreas on p. 6o6. Current views on internal secretions critically examined. I rof. Swale Vincent, L. ii./22,313 ; L. i./25,739 ; B.M J. i./25,695. Of the preparations of the 42 organs advertised and prescribed only one—the Thyroid—was of proven value when given by tl mouth.—Prof. Swale Vincent, L. ii./25,332 ; B.M.J. ii./25,1055. Endocrinology and multiple claims, menstrual, vesical, et reminiscent of all that is bad in theory and practice of therapeutic —Ralph Stockman, P.J. ii./30,556. Glands of the body divided into 3 groups. (1) Those whic discharge a secretion where it has to exercise its chemical activitie e.g. the salivary glands. (2) Those which also have an intern secretion which finds its way direct to the blood stream, e.g. t pancreas. (3) The ductless glands, e.g. the thyroid, parathyroa suprarenal and pituitary.—W. Martin, P.J. i./23,232. Recent Advances in Endocrinology.—A review of the work frc 1922-1930.—Pres., May, *31. Animal Membranes for surgical use. In addition to Goldbeater’s Skin, the peritoneum of the ox, t gastro-intestinal mesenteric attachments of the sand-shark, Gc charias littoralis, has been used, one of which produces 2 or 3 squa feet of gossamer-texture strong material which can be kept in alcotn Bone Marrow, Bed, Extract. The marrow of ox and veal-bones and sheep’s ribs has been us as a remedy for pernicous anaemia, chlorosis, scurvy, purpur haemophilia, debility, lymphadenoma and rickets. # Marrubin (T.M. 261511).—Syn. Glycerin Extract of Ri Bone Marrow, Medullary Glyceride. Dose.—1 to 2 drachms, increased if desired. A thick brown liquid, made by extraction of the veal-bone marroo Employed as a substitute for cod-liver oil. Marrubin has had beneficial effects on weak children, and is sui able for the treatment of anaemic conditions. Secondary anemia.—Desiccated Red Bone Marrow and Spleen, in eqo proportions, given thrice daily in 5 grain doses, gave very definite iruprov rnent in 41 out of 46 cases. Treatment continued for 6 or 8 weeks.—B.M.J. 1-/25,17. But not of value in pernicious anaemia.—Pres., May, ’26,228. Pulmonary tuberculosis improved by treatment with Spleen Extra and Bone Marrow, which definitely increased production of erythrocyt and haemoglobin.—per Jl. A.M.A. ii./25,1513. The following are made with dose 1 to 2 drachms :— Marrubin cum Pepsina, Marrubin cum Pepsina et Quinina, Marrub cum Bismutho et Pepsina, Marrubin cum Bismutho et Ferrur These are nutrient and digestive. C£) Marrubin cum Bismutho et Strychnina, containing to * grain Strychnine in 1 to 2 drachms respectively. Tonic. Also combined with Cascara, Tinctura Laxativa, Podophylli Hypophoaphites, and with Ferric Phosphate. IIP 1] Marrubin cum Arsenio. Containing in each drachm gra Arsenious Acid. In pernicious anaemia useful. ^Virol. (T.M. 251002). A preparation of bone marrow, wit malt, egg, and lime. Has nutrient properties for infants. if Bynotone (T.M. 399827).—A combination of Bone Marro (12-i%), Yeast Extract, together with Haemoglobin and Malt Extrac In malnutrition in infants, adolescents and adults. Brain and Spinal Cord Extracts. These, separately or .mixed together, may be tried for the relief of locomotor ataxy, chorea, epilepsy, and melancholia. Cerebral Tablets, 5 grains. Myelin Tablets contain 3 grains. i bromboplastin. Made by chopping up and extracting fresh ox brains with equal amount of normal saline—leaving in refrigerator 48 hours, pressing through, cheese cloth and adding to the extract thus made after diluting with £ its quantity of salt solution 0‘3% Trikresol. Effectual haemostatic, especially for oozing surfaces. Much used in cases of hsemophilia in the States, e.g. following removal of tonsils and in surgery of bones, glands and nose generally. It maintains its haunostatic potency for many months.—A. E. Hess, L. ii./i5,780. Anaphylaxis from.—Jl. Ph. Exp. Ther., Nov., 1919. , Ox brain may have beneficial effect on the neurological phenomena of pernicious ansemia, but is not suitable for routine treatment of subacute combined degeneration of the cord unless combined with liver. Suitable cases, i.e. those whose neurological condition failed to respond to prolonged liver treatment, improved when given 480 Gm. of minced brain (in 3 or 4 doses with orange juice) daily.—C. 0. Ungley, L. h/32,227. Spinal Cord Extract. Ppse.-—5 to 20 minims thrice daily by the mouth or hypodermically. 1 minim is equivalent to 1 grain of fresh spinal cord. Spinal Cord Tablets, 2£ grains. Corpus Luteum {see also Ovarian Extract).—The yellow material separated from the inert substances of the ovaries, and desiccated. 1 = 5 of fresh substance. Dose.—5 to 10 grains in capsules or tablets three times a day. In disordered uterine and ovarian functions, for menstrual irregularity, whether from excess, deficiency or pain ; for the vomiting of pregnancy, and for nerve disturbances arising from change of life and consequent upon the removal of the ovaries. There is close complementary relation between the thyroid and the ovaries. Administration of Corpus Luteum and thyroid gland is of value in correcting the various forms of neuroses connected with ovarian atrophy, tl as also been tried in anaemia, chlorosis, and Graves’ disease. The Corpus Luteum secretes twro hormones, i.e. the female sex (follicular) hormone and the specific luteal hormone, which act in an entirely different and partly antagonistic manner to each other, the former accelerating ovulation and estrus and the latter inhibiting and delaying. Both are active during pregnancy. Oral use of extracts containing luteal hormone of no practical value.—Jl. A.M.A. i./26,14?3. Tablets are prepared equivalent to 1 grain of Desiccated Corpus Luteum—5 grains of fresh substance given in nausea of pregnancy. Possible association with eclampsia. A compound isolated which produces necrosis and changes very similar. It is not present in the placenta. Jt. E. Mackenzie Wallis and II. G. E. Williams, L.L/22,784. Sterility is said to be capable of treatment by glands. W omen with scanty menstruation should receive Corpus Luteum, 5 grains, gradually increased to three times this amount. When associated with excessive obesity and oligo- menorrhoea or amenorrhcea they should be treated with thyroid, | grain thrice daily.—B. Solomons, B.M.J.E. iL/22,72. Corpus Luteum m the migraine of pregnancy alwTays has good effect. Luhrs, per Pres., Oct. „3,349. Two substances have been separated from Corpus Luteum called luteolipqid and ‘ lipanin 5 The former has inhibitory action on the menstrual function, the latter stimulated the growth of the genitalia and promoted menstruation, —per Pres. Oct. 23,350. Corpus Luteum preferred to Ovarian substance in vomiting of pregnancy—also recommended for melancholia, obesity and sterility.—per Pres., Oct. 23,351. daifvAg°menSin (T‘M' 368559)‘ ]Dose-—1 to 3 tablets, each 1/3 grain, thr , Preparation of early ’ Corpus Luteum of the cow. For retarded sex~ development and genital hypofunction, e.g. functional amenorrhoea, di organs--BtlJ KfaydlO* menopause’ steriIity and hypoplasia of geni ii^omnen8tae; 86856°)- (Prepared under British Patent I 113,311.) Dose.—1 or 2 tablets thrice daily. J/traet of the hormone from older Corpus Luteum. Regulates and sta Uses (inhibits) menstruation. For dysmenorrhcea.—B.M.J. ill25,910. I he Lancet tound that this preparation injected subcutaneously into fern rats produced oestrus—L. i./27,551,764. Duodenal Membrane Liquid Extract. Syn. Secret Extract (glycerinated). Strength, 1 minimal grain of the fre mucous membrane of the pig. Dose.—5 to 20 minims. TabR represent 5 grains. Secretin can be extracted from the duodenal membrane with 0-4% Hvd. chloric Acid ; nearly neutralise whilst boiling to precipitate proteins, wb the ^ecretin will be left in the filtrate. It is by no means permanent. Secretin is soluble in water and alcohol.—Bambridge and Menzies, ‘ Esse tials of Physiology,’ 1920. ’ C/se-s. _In all pancreatic insufficiencies, where true organic change has e occurred. It aids protein digestion ; an important factor in raising low ui output to noimal, indicated in gastro-enterostomy and jeiunostomv * distinct value m nephritis of intestinal origin; increases peristalsis and indicated m all cases of stasis.—Beveridge, per Pres., Oct. ’2s 344. Mechanism of pancreatic digestion and function of Secretin.—J. *Mellant Jl. Physiol., May *25,85 ; per Pres., May ’26,208. See also Vcl. II. (Organotherapy). afc Secreiogcn Elixir (T.M. 365397.) Dose.—1 to 2 drachms (4 o L*c) A proprietary preparation of Secretin intended to replace Pepsin and A<r mixtures as indigestion remedy. It is stated to contain pyloric prosecrei (with 1/20% ot Hydrochloric Acid to change it to secretin) and duoden secretin. Secretogen Tablets (5 grains) containing the duodenal and pa; creatic secretins are suggested particularly in faulty digestion of starch wi fermentation and flatulence. ’ Leeches. Ilirudo Medicinalis and H. quinguestriatia—the latte the live striped Australian leech, is also included in B.P. ’14. (I o remove leeches lodged in the throat, e.g., from drinking wat containing Lwmatis A ilotica. Paint the leech with strong cocaij solution (15 or 20%) and remove with forceps or let it be coughc up, patient lying with head hanging. Menthol in Paroleine al suggested. Aspirin has been found to expel leeches from the stomac in the East, cf. p. 71.) Hirudin. Syn.—Leech Extract. An active principle from leeches. Dose, intravenously, 0-02 to 0-3 Grn. 50 Cc. Normal Saline. Solutions must be freshly prepared. Has been us in treatment of puerperal eclampsia—theory in the 17th Edm, p. 914. It has the property of maintaining blood in a fluid condition,—1 mgr.’ms. be dissolved in 0-25 Cc. Normal Saline for the purpose.—this quantity w prevent 7-5 Cc. blood from coagulating without otherwise altering its cor position. Kidney.—Kidney substance has been given in nephritis an other kidney troubles, but the evidence of its value is conflicting. Phenolphthalein should not be given simultaneously. Masshs treatment said to be essential. Nephritin (T.M. B. 493875) Tablets. Dose.—Four tablets four to eight times a day. Dose to be reduced as improvement occurs. These contain the cortex and convoluted tubules of the kidney, with its internal secretion. Liver, Desiccated.—1 = 8 of fresh substance. Dose.—5 grains increased to an ounce, on the basis of recent advocacy in pernicious aiicemia employing Powdered Liver Extract {vide infra). It increases diuresis, thus mitigating toxsemia by removing accumulated toxins. Pernicious (Addisonian) anaemia has been treated at the suggestion of Minot and Murphy in U.S.A. by means of diet embodying large amounts of mammalian liver, cooked and raw, with plenty of vegetables and fresh fruit, but little fat. Whipple bled and then fed dogs on liver. This led to the discovery that pernicious anaemia can be averted, if not cured, by means of liver. Calves’ or cows’ liver 250 Gm., beef or mutton 120 Gm., vegetables at ieast 300 Gm., fruit 250-500 Gm., cream and butter 40 Gm., milk 240 Gm., potatoes or cereals to make up 2000 or 3000 calories, i.e., a diet rich in iron and purin derivatives and proteins, particularly liver, much fruit and fresh vegetables, and relatively low fat. Liver has power of regenerating the blood. Nutritive value equal to red bone marrow.—B.M.J. ii./26,650. All cases treated with benefit. Minot and Murphy, B.M.J. ii./27,674. A further statement is : liver or kidneys 200 Gm.; red muscle meat or heart upwards of 125 Gm.; green vegetables not less than 300 Gm.; fruits (grape fruit, oranges, etc.) 400 Gm.; fats restricted to 70 Gm.; bacon, cheese, and dried foods to be avoided; milk to be limited to 240 Gm., starchy foods not to be taken in excess.—Sir W. H. Willcox, L. 11-/27, 778. See also 3. H. Anderson and E. I. Spriggs, L. ii./27,958. Of 20 cases 19 were successful at Newcastle Infirmary. Dose to be controlled by blood counts. WTien cured 8 ounces of liver thrice weekly maintains condition.—J. C. Spence, B.M.J. ii-/27,881 ; L. ii./27,1026. See also G. Bourne, Pr., Dec.,’ 27,373, and B.M.J.L. ii./27,84. _ ./or,. Prelim. Rept. by Med. Res. Council with results in 34 cases.—L. i./28,514. Liver Preparations of Commerce. For convenience and keeping in hot climates, the phai macis can provide the preparation in a palatable form for the treatment. In addition to the above Desiccated Liver Substance with dosage as stated, the following Extracts are available. Concentrated Fluid Extract of Liver is of strength 1 ounce represents 8 ounces of fresh liver. Dose.—f to 1 tablespoontul daily, divided into 3 doses with meals, each with the juice of an orange. Dose.—The contents of two tubes, each=4 lb. V*5G Gm.) of fresh liver. _ ,. mvio tit T? r* orivps the following method. To 100 kilos J,£2SS*5S?£ e jo%, ^0^09 Cc.a50% (vou Utrfte™ mlt toVE” Idd 10 litres o^Absolute Aleohol and remove evaporated in vacuo to a small bulk and then poured with stirring into 10 v of Absolute Alcohol. The toffee-like material which forms is pulled into shr to expose fresh surface to the dehydrating action of the Alcohol, which renewed as required. When the material becomes brittle it is filtered off £ dried in vacuo over Sulphuric Acid, powdered rapidly and again dried, and tl oka m^° tubes, each of which should contain an amount equivalent 250 Gm. of the original fresh liver.—P.J. 1./28,299. Another method consists in precipitating one part of the concentrated pressed juice with 2 parts of Acetone and drying the product below 60° C r.J. ll./28,479. It is reported that red blood corpuscles content and Hcemoglo percentage improve remarkably after a month’s treatment. Erythgen Liver Extract. Dose.—I to 4 drachms thrice dai Capsules, 1 to 4 thrice daily. ^Hepatex (T.M. B. 511881). A liquid extract. Dose.—1 drachm 2 ozs. fresh liver. ^Hepatex (T.M. B. 511881) P.A.F. A purified and potent extract (5 Cc. = 100 Gm. fresh liver) gh intravenously or intramuscularly. Practically free from prot and does not affect blood pressure. Dose.—5 Cc. undiluted injected in 2 to 2J minutes, either week or per day according to severity of case. Intended to supp ment oral therapy during critical stages, but may be used as e treatment.—J. F. Wilkinson, L. ii./3i,791. It is intended as a companion to Hepatex for use where liver per o not desirable or is only partly effective, or where speed is essential Home-made Liver Extract. Extract 10 ozs. minced beef li with cold water. Precipitate inert proteins by boiling and strain The clear yellow liquid obtained equals in activity the origi amount of liver when ingested. Volume of liquid should be ab< 18 fluid ounces.—P.J. ih/31,50. Raw liver may be cut up into small pieces and put in cachets e immediately swallowed. The method dispenses with cooks, mine machines, and cooking apparatus, and treatment may be con tiny without nauseating.—D. G. Falconer, Pr., Dec., ’31,687. Vitamin B content in commercial preparations. 10 out of contained adequate amounts.—E. Gilroy, L. ii./3i, 1098. References to Use in Pernicious Ancemia. Reports from hospitals confirm it is a specific—L. 4/28,863 : II. F. Bre^ and F. R. Fraser, B.M.J. 4/28,165 ; ibid. 178,188, and M.R.C. Rept., U 398,463. See also Pres., Jan. ’28,3 and 47-56. If treatment is discontinued, relapse will occur. Combined with ol methods, 3 or 4 ounces of minced liver a day is effective. Over-use of li may cause gout or chronic nephritis.—C. H. Melland, B.M.J. ih/29,11. Report of Committee of Harvard Medical School—Jl. A.M.A. ii I29 144 Decline in mortality caused by Liver Treatment.—P. L. McKinlay,’ L. 29,1086. A case not responding to liver treatment for over years. Patier weight well maintained throughout.—A. C. Hampson, L. h/30,22. Liver Therapy may be largely symtpomatic.—L. L/30,92. Intravenous use would be ideal.—Janet Vaughan, B.M.J. L/31,5 Intravenous injection of Liver Extract.—W. B. Castle and F. H. Las! Taylor, L. i./3i,857. If no definite reticulocyte response by 5th day it is not worth while 1 listing with liver treatment.—S. C. Dyke, B.M.J. i./3i,584. Glycerol of Pepsin and an acid mixture should be added to the liver tre ment (raw fresh juice).—H. C. Keates, B.M.J. i./3i,894. Secondary Anaemici. In pernicious anaemia it is an established treatment. In some cases of secondary anaemia the therapy is effective in producing reticulocyte response and raising blood count. Best results after haemorrhage. Give Iron simultaneously, e.q. Pil. Ferri, 5 grains, three times a day.—S. C. Dyke, L. h/29,1192,1206. Liver of little value—L. ii./3o,704. Diabetes. Liver was regarded as unsuited for diabetics because of its Glycogen content; it is now known to contain a blood-sugar reducing substance when taken by mouth, non-toxic and with effect similar to Insulin. ISO Gm. of raw liver may have an effect on blood sugar of diabetics equal to that from 10-15 units of Insulin.—II. Blotner and W. P. Murphy, Jl. A.M.A . L/29,1336. The preparation made on these lines of Blotner "and Murphy had rso effoc t on diabetes —R. D. Lawrence, L. ii./3o,1179. Haemophilia. Value of Liver treatment demonstrated by Pickering.— B.M.J. i./3i.33. Tiirombopenic purptjra of moderately severe grade with oozing from gums and ecchymoses rapidly yielded to Liver treatment.—F. H. Jacob, B.M.J. i./3i,33. Disseminated sclerosis treated by liver, lightly cooked, $ lb. daily, with remarkable results. Method evolved in the hope that the nervous system might benefit, on the lines of pernicious ansemia.—A. Goodall and J. E. Slater, B.M.J. i./3i,789. Depressor principle of hepatic tissue. It is a non-protein. The active agent is soluble in 80% Alcohol, can be separated from an accompanying pressor substance, and further purified by solubility in Ether. It depresses arterial tension and maintains it at subnormal level for a long time.—Jl. A.M.A. ii./25,194,251,750. Anabolin. Dose.—\ to 2 Cc. intramuscularly daily. Tablets. Dose.—1 to 3 a day, for use per os, are also made. The preparation is a liver extract stated to stimulate hepatic detoxication and reduce high blood pressure, with consequent improvement in health. Anabol is T.M. 457107. Lymphatic Glands. Tablets 5 grains each. Dose.—1 thrice daily. Have been used in enlarged tonsils and adenoids. The method consists in supplying lymphoid tissue artificially. Mammary Gland. Tablets contain 2 grains of desiccated gland. Has been used in the treatment of uterine congestion, fibroid tumours and in menorrhagia. The endocrine basis of pernicious vomiting in pregnancy, substance by mouth or hypodermically (10% extract) produces good results.—W. Dickson, Pr., May’26,365. .. . Mammary Extract is inactive.—J. H. Burn, C.D. 11.2/6,727. Mammary startlingly Mucin. Dose.—5 to 10 grains (0*3 to 0'6 Gm.). This is the essential constituent of the secretions of mucous membranes, buccal, nasal, pharyngeal, etc. It is precipitated from these by alcohol and by acetic acid. The saliva produced by the sub- maxillary and sublingual glands contains it, but not the parotid. It may be procured from areolar or connective tissue, and from bile. Taken internally, e.g. Tablets, containing Mucin 5 grains with Sodium Bicarbonate 5 grains, relieves painful'digestion A? 5 In the form of Nebula containing Mucm 5 grams, Sodium Bicarbonate o grains, Menthol 1 grain, Lime Water i ounce, anywhere been found of value in dry catarrhs, rhinitis, etc., pharyngitis, and where incrustations are present on the laryngeal uumg. , u comnlaints Snnerior to all other treatment m many throat and stomach complaints, eiTS nlcS. Powdered hog’s stomach possib y only acts by virtue ot tiie Mucin contained.—W. Stuart-Low, B.M.J. u./3 Muscle Extract (Extract of Heart Muscle). In angina pectoris and intermittent claudication. Inhalation of Amyl Nitrite tends to abolish a phenomenon of muffling heart sounds on contracting a muscle. Some sort of antispastic substance may be at work during the contraction of active skeletal muscle. Might be obtained fr skeletal muscle of a healthy young animal to counteract the spa of angina pectoris. Still in experimental stage.—M. S. Schwai mann, B.M.J. i./3o,855. A powerful depressor in vascular disease. Mvoston (G. Henning, Ber also used.—M. S. Schwartzmann, B.M.J. i./3i,493. ^Lacarnol (T.M. 492088). Dose.—On the 1st day 1 Cc. intramuscula once or twice a day, and 15 or 20 drops per os. On following days per os or dose being reduced until 5 or 10 drops are given two or three times da i ^nr,e^t^l^t of heart muscle. True angina pectoris and other forms benefit —B.M.J.E. i./3i,82. Myoston, Eutonon, Myotrat, Kallikrein, Lacarnol, Angioxyl, etc., all h essentially similar action ; none can replace Digitalis in myocardial weakr_ or cardiac irregularity. Use not entirely without risk and caution necesss Irecise use and limitations still to be determined.—L. ii./3i,28. Ovaries. Tablets, 5 grains. ^ In dysmenorrhcea and menorrhagia, and for climacteric ailmer Chlorosis, mental disease and haemophilia have been treated. See u Corpus Luteum, p. 949. Osteomalacia treated with Ovarian substance.—Pres., Oct. ’23,34s. Graves’ disease in women treated with Ovarian Extract, a series of to 20 injections of the fresh product being given, 0*2 to 0-25 Gra. injec daily. Injections associated with administration of Hyoscvamus.—B M J i./26,31. For earlier references, see Edn. XIX. p. 963. Ovarian Hormone.—Standardisation is by noting the power to prod oestrus in ovariectomised animals, a large number being used. The unit Chstrin is taken as the amount required to produce oestrus in 50% of the anin tested, 20 animals being used for each test.—K. A. Coward, B.M.J. iL/27 10 See also ibid. ii./2 5,705 and Sistomensin. Preparation of the hormone from pigs’ ovaries, according to method Allen and Doisy ; Hermann and Frankel, and Dickens, Dodds and Wrig —L. i./26 26. Activity of, confirmed at the Middlesex Hosp.—Swale Vince B.M.J. ii./25,1056. A brown oil, soluble in Alcohol and free from Choi terol. Produces continuous oestrus in ovariectomised animals. Effective the mouth. Has marked depressor effect, and inhibits blood-sugar red ing action of Insulin.—Dickens, Dodds and Wright, Biochem. Jl., ’25, XI No. 5, 853 ; per Pres., May ’26,216. Method for obtaining ovarian hormone in a water-soluble form by extr tion from placenta.—E. Dickens and co-workers, L. h/27,1016,1182 : see a E. Laqueur, L. i./z7,1126, re ‘ Menformon.’ From the ovary at least three different substances can be obtained—(Estr Corpus Luteum Hormone, and Interstitial Hormone. (Estrin when inject subcutaneously into spayed rats produces typical cestrus ; Corpus Lutei is concerned with the prevention of ovulation ; and the interstitial hormc causes a secretion of the posterior pituitary lobe.—W. E. Dixon. B.M J 27,213,1070. Hot until extracts are made from animals’ ovaries during either pro-cestn or the early months of pregnancy can any uniformly satisfactory therapeu results be expected.—B. Whitehouse, L. h/27,1279. 3$c ‘ Varium ’ (T.M. 260858) is a trade brand of Ovarian Extract. Ovamammoid Compound Capsules. Dose.—1 thrice daily 4 hour before meals and one at bedtime. Contain 1 grain each Ovarian Extract and Mammary Gland Extract. Used in neurasthenia, hysteria, insomnia, chlorosis, amenorrhoea and d’s menorrhoea. Stated to be a galactagogue and emmenagogue. Solutions of ovarian residue without corpus luteum, 1 Cc. intramuscular!* used as a routine in labour. Uterine contractions increase rapidly in for and frequency without increased pain. Also of value in placenta preevia. D. C. Macdonald, B.M.J. ii./29,517. Ovary hormones, recent work on.—L. ii./29,1108. Oil and water-soluble ovarian extracts—oestrus-producing hormone. Clinical deductions.—L. ik/29,1367,1373. (Estrus-producing hormone in crystalline form.—L. i.,/30.,94. Amenorrhoea treated with CEstrin. Menstruation re-established or affected. —E. C. Dodds and J. D. Robertson, L. i./3o,1390. (Estrin in ovarian deficiency—H. Gardner-Hili and J. Forest Smith, L. i./3i,464. jfcMenformon (T.M. 467043). An ovarian hormone preparation. Increases metabolism in female but not in male castrates and has an anti-masculine effect. It may be given subcutaneously.—E. Laqueur and S. E. de Jongli, Jl. A.M.A. ii./28,1172. Theelin. The ovarian follicular hormone isolated by E. A. Doisy. Used in amenorr- heea and disturbances of the menopause. Issued in 1 C’c. ampoules for intramuscular injection. Ovarnoa (T.M. 507052). Dragees containing 0T5 Gm. desiccated ovarian gland. For ovarian disorders. ^Frogynon (T.M. 492156). A preparation of the female cyclical hormone given yer os. Stated to be of value in climacteric disturbances, defective menstruation, etc.—B.M.J. ii./29,1205. Pineal Body. Syn. Conarium. A small reddish grey vascular body situated behind the third ventricle which is embraced by its two peduncles. The functions of the pineal gland are little known. Extracts of it act as diuretic and galactogogue. There appears to be some antagonism between the pineal and pituitary bodies. It may have an effect upon nutrition and growth, upon sexual development and upon intelligence.. It has some connection with accumulations of fat in the subcutaneous tissues. Pituitary Gland. Syn. Hypophysis Cerebri. A small reddish-grey vascular body, a ductless gland, weighing in man about 10 grains, situate at the base of the brain. The average total weight of the Gland in the ox is 2-5 Gm. ; anterior part being 2 Gm. and posterior 0*5 Gm. It is said that 8,000 head of cattle are required to produce 1 lb. of dried posterior gland—one would have expected nearly twice the amount—arguing on a 20% dried substance yield. Anatomically, the gland consists of three parts—the anterior lobe, the pars intermedia, and the posterior lobe. The anterior lobe is the larger, and is made up of cubical or polygonal epithelial cells, —in structure it is rather like the foetal thyroid. Disease of this portion is associated with acromegaly. The pars intermedia lies between the anterior and posterior lobes and is developed in connexion with the anterior lobe. The posterior lobe is connected with the floor of the third ventricle, from which it is developed by the neck or infundibulum=a funnel. In man both neck and body are solid with traces of a cavity in the neck. Physiologically.—In the earlier days the function of the gland was thought to be secretion of nasal mucus, hence the name (pituita— mucus or phlegm). Removal of the entire gland leads to depression, muscular weakness, dyspnoea and emaciation. Removal m the anterior lobe leads to genital infantilism (c/. however J. A. Walton, infra). Insufficiency of the pituitary gland is associated with weakness, wasting, etc. Excessive secretion is followed by jb_ arterial tension, polyuria, glycosuria and acromegaly. Histology indicates that the anterior portion is the active part, t posterior being merely a vestigial structure, but physiologically t opposite is the case—an extract of the whole gland may be us: therapeutically, but the posterior lobe is of greater importance a value, as described later. Functions of the Pituitary Gland. The anterior and poster i parts appear to have entirely different functions. The anterior lobe controls metabolism and growth of the skeleton. Sho* oyersecretion be delayed until adult life, there will be an irregular overgrov of bone and connective tissue, giving rise to acromegaly. In addition, ii probable that the overgrowth of the gland is associated with changes the sexual glands, for most cases of acromegaly are clearly asexual. Pars Intermedia. It is held by many that ail the effects described as c yhanges in the posterior lobe are really due to changes in the pars intermed Posterior Lobe. The effects of administering extracts of this portion 1 well known. _ (1) Pressor effect. (2) Depressor effect. . (3) Diuretic effect. (4) Galactagogue effect.—The increased flow of m m lactating women is only of short duration ; the daily flow is not increase It is increased excretion rather than increased flow (Blair Bell). (5) Stimulative effect on unstriped muscle. (G) Effect on carbohydrate tolerance. Many diseases of the pituitary gl& are associated with distinct and definite change in the patient’s tolerance Carbohydrate, so not infrequently there is glycosuria, e.g. in acromegalv. T paper contains a good account of acromegaly and surgerv of the pituita gland.—J. A. Walton, B.M.J. ii./22,835. Pituitary ‘ extract ’ is secreted into the cerebro-spinal fluid (Cushing, cr firmed by Dixon). The only substance increasing the action of Pituitary cerebro-spinal fluid was ovarian extract—B.M.J. i./23,lO0. Histamine is present in the hypophysis. It plays an important role stimulant for the gastric and intestinal musculature and as a dilator of cai laries during digestion. We daily consume a considerable amount of it J. J. Abel and S. Kubota, Jl. Pharm. and Exp. Therap., June, iqiq, a Kov., 1919. J. H. Burn and H. H. Dale demonstrated that histamine air adrenalin are antagonistic that by acting respectively as dila“ and constrictor they maintain and adjust circulation of the blood to t needs of the tissues. The injection of adrenalin into the blood stream cor spends to that outpouring from living gland which accompanies und emotional stress due to anger or fright. Obviously this latter is abnornx and the objective of curative medicine must be to restore harmonious work! of the secretory organs and the liberation of minute amounts of regulate hormones.—-Trend of Therapeutics, C.D., Oct. 10/26,603. Dispituitarism, Obesity and Infantilism. An account of the functio of the pituitary gland and treatment.—L. Tidy, L. ii./22,597. Ovarian conditions determine the liberation of Pituitrin. The ovari drug is set free in the circulation ; it causes the liberation of Pituitrin a the uterus is affected.—Prof. W. E. Dixon, B.M.J. ii./22,410. Berman suggests that the posterior portion of the pituitary gland responsible for the differentiation of sexual types. The failure of the poster portion of this gland therefore makes hermaphroditism. Of the anten portion of the gland, it is more or less established that failure in the ma is an essential condition, if not the sole cause of ErAich’s syndrome. Son element of power in character make-up is undoubtedly attributable to t pituitary factor. Imagination is another psychic factor that we have na also be associated with the pituitary. In short, a rough classification important hormones would be :—thyroid for creation / pituita. for subjective power and cztirenal for obiectii/e kom/c —H. Crichton Miller, B.M.J. ii./22,552. The influence of the ovary on pituitary secretions—a probable factor parturition.—W. E. Dixon and E. II. A. Marshall, Jl. Physiol., Dec/24,2' per Pres., May ’2 6,200. The pituitary gland has a definite function in determining the conservats or excretion of water and chlorides, and it is possible that this control is exerted over other constituents of the urine as well. Chloride and phosphate excretion may be affected in opposite directions by pituitary extract.—It. L. Stehle and W. Bourne, Jl. Physiol., July ’25,229, per Jl. A.M.A. ii./25,855. Pituitary gland not essential to life. Providing the hypothalamus is not injured, complete removal of the pituitary does not lead to death in animals. •—Pres., May ’26,200. See also Jl. A.M.A. ii./25,2037. Relation of the anterior lobe to the reproductive organs.—C.W. Bellerby, L. i./28,116S. Dried Pituitary Preparations. Of these, there are three, made respectively from the Entire Glands, the Anterior Lobe and the Posterior Lobe :— (i.). Pituitary Body, Dried (Entire Gland) of the ox. Dose.—1 to 3 grains (0*06 to 02 Gm.) thrice daily. Eive parts of fresh gland yield about 1 of dried gland. Tablets of this dried entire gland contain 0-06 Gm. (i grain). Uses.—Has been employed to improve metabolism, to raise arterial tension, to increase diuretic action and to improve appetite. Given in menstrual disorders and in exophthalmic goitre and with Thyroid (q.v.) in obesity. Small doses, e.g., i grain of desiccated gland, are thought to be practically useless in most cases. Five to ten grains thrice daily may be regarded as a minimal dose. Very large doses, e.g., 100 grains thrice daily, have been given without any apparent ill effects. F.E. VIII. has a"preparation of this kind. l=-4 of fresh gland. (ii.) Pituitary Substance Dried (Anterior Lobe only). Dose.—1 to 4 grains (0*06 to 025 Gm.). 4*5 parts fresh substance yield 1 part of dried substance. Tablets 2 grains each. Uses.—Has been thought to exercise a stimulating action upon growth. The anterior lobe has been given in certain types of obesity, also in later stages of acromegaly but not earlier stages ; also in bronchial asthma. An increase of secretion by the anterior lobe before completion of growth produces gigantism, and if growth is completed before this hypersecretion the result is acromegaly. Overgrowih of the lobe is associated with changes in the sexual glands : undergrowth results in infantilism. It also seems to have specific influence on the female gonads (this factor is utilised in the Zondek Asckheim test for pregnancy).—Pres., May, ’31,967. The test has been adversely criticised. , „ _ . , 7nr»dplr rnrmidprs the sex-stimulating autocoid to be of a dual nature, one rinenine of the follicle and the other the formation of the coreus "uSf teS e? ivefy Prolan A and Prolan B, making four autocowf in the anterior lobe affecting growth, oestrus, corpus luteum and “zotSndShheim’s^piegta^y Test of no value, but clinically the test (inie^nofurineolTatient into.mice and corpora hemorrhagica) seems reliable.—Prof. B. 0. Dodds, L. i./3o,8b,dy. also B.M.J. i-/3o,150. w, me the Sex-factors Rho-one and Rho-two, duLUdenoid type of child often improves on combined treatment, 1. Bodley Scott and F. W. Broderick, Pr., Oct., i92I> P- , ... Infantilism and certain types of amenorrhoea, associated with minor degrees of infantilism treated with anterior lobe by the mouth.—H. Gardin Hill and J. F. Smith, L. ii./26,222. Extracts of the anterior lobe of Pituitary Gland, of the Ovary, and of tl Mammary Gland, are likely to have no therapeutic action when given bv t2 mouth.—.J. H. Burn, P.J. i./27,356. (iii.) Pituitary Substance Dried (Posterior Lobe only). Sy PlTUITARIUM. U.S. X. Dose.—1 to 4 grains (006 to 0*25 Gm.). (U.S. average J grair 4*5 parts of the fresh substance yield about I of dried substance. Uses,—Has been used in exophthalmic goitre, acromegaly and tl its action on the circulatory system, to relieve cardiac dilatatic in intestinal paresis, diabetes insipidus, amenorrhoea and enuresis. For further details see Pituitary Extract—the liquid equivalen Liquid Pituitary Preparations: (t) Pituitary Extract Liquid of Entire Gland 66 Special. Dose.—\ to 1 Cc. intramuscularly into the buttock. Stem! J and 1 Cc. are prepared. Strength 1 = 1 of fresh entire gland. Use.—This has been tried in certain types of acromegaly attribu able to disease of the pituitary. It is advised to start with J C daily and watch the case. Whole gland Pituitary, if combined with Thyroid, effective in pituita disorders.—F. Edmonds, B.M.J. i./3i,498. (ii.) Pituitary Extract Liquid (Anterior Lobs). “Sterules,” Hypodermic, of this preparation, 1 Cc. and 2 C (in each instance) are made of 20% and 40% strength of fresh glan They have been given tentatively in retarded growth in childrc with some evidence of benefit, but it is generally considered th the anterior lobe yields no activity to aqueous media so far as can I detected.—Cf. F. W. Gamble, Chairman’s Address, B.P. Conf., 192 and J. H. Burn, C.l)., ii./26,727. Antuitrin. A preparation of the anterior lobe of the pituitary for n in diseases of metabolism, delayed development and derangement of t genito-urinary system. Dose, hypodermically 0*5 to 1 Cc.—L. h/22,22. (iii.) Pituitary Extract Liquid. (Infundibular—i.e., from tl posterior lobe.) Syn. “Pituitary (Posterior Lobe) Extract'; (Therap. Substances Regulations 1927, name), Extractu: Hypophysis Cerebri Liquidum, Liquor Hypophysis, F.E. VIE Liquor Pituitarii U.S. X. Dose.—b to 1 Cc. of an extract of Fresh Infundibulum (10 uni per Cc., assayed biologically as described infra), given intramuscular to secure prompt action and to avoid superficial sloughing from loc vaso-constriction. May be repeated at 1 hour intervals. A sterile solution containing the active principle of the posteri lobe of the gland of the ox. 4 Sterules ’ of Pituitary (Posterior Lobe) Extract.—|r and 1 Cc. a prepared containing 5 and 10 units respectively. Doses of 4 Cc. are usual for obstetrical purposes and 1 Cc. or mo> or surgical requirements, to raise blood-pressure in surgical sho« and post-anaesthetic collapse. In urgent cases the Extract may be administered per rectum or intravenously diluted with Normal Saline. In labour, a dose of 2 units may be expected to hasten a sluggish labour, provided that it is not given before the os is about half dilated. This dose may be safely given at any stage if there is no mechanical obstruction, and its effect may last longer than an hour, which is the least interval at which a dose can be usefully repeated. *—A- Bourne and J. H. Burn, P.J. ii./27,485. See also L. ii./27,560 ; J1 Obstet. and Gynec. Vol. 34, No. 2, 249. Infimdin (T.M. 349279). *Pitibulin (T.M. 384472), Pituitarin, ^Pituglandol (T.M. 417404) and #Pituitrin (T.M. B.440186) are solutions of the Infundibular Extract. Tetlielin has not all the properties of Pituitary Extract and is believed to be the mother substance of the active principle of the posterior lobe.—T. B. Robertson and L. A. Ray, Austral. Jl. Exp. Biol, and Med. Sci., Dec. 16, ’25, 173, per Pres., May *26,200. For further details see Edn. XVIII., p. 953. The growth-promoting properties of Tethelin are unmistakable.—Richardson and Horning, Med. Jl. Austral., Mar. 10, *30, per Pres., May ’31,194. Preparation of Pituitary Extract is by exhaustion with acidulated water. Recognition*—Pituitary liquid gives the biuret reaction. _ Alkaloidal \ precipitants such as Phosplio-molybdic Acid, Phospho-tungstic Acid, Bromine Water, etc-., all give faint but distinct precipitates of the active principle. Assay.—U.S. X. assays biologically, comparing activity of the water- soluble principles upon the isolated uterus of the virgin guinea-pig wnh that of a standard preparation. The Second Conference on Biological Products, decided it was desirable to express all Pituitary Extracts in units of activity ; the activity corresponding to 0-5 mgr. of the st&ndcird powder is ono unit. Tiius, th.6 extract of the u.o.i • contains 10 international units per Cc. B.M.J. ii./25,534. . , The standard powder contains the activity ol 7 times its weight of fresh gland, hence the International requirement for a 10 unit preparation, in terms of fresh gland, is that I Cc. should contain the activity of 35 mgr. of fresh gland. In other words, the U.S. N. and other 10 unit preparations are actually 3*5% extracts of fresh gland. Assuming a loss of 2/5 activity in manufacture, it should, we understand from Dr. Burn, be possible to produce a 10 unit prepay ation by making a 6% extract of f resh substance. The League of Nations Commission on the Standardisation of Serum, Seio- loSeal Reactions and Biological Products recommended that the dry prepara- tfon of the Acetone-extracted fresh posterior lobe substance of ox-pituitary be now definitely adopted as the International Standard preparation for the WofogTcfl^evaluYtion Pof j^^Uons.of.tto ^or tobe whether containing all the active principles of the liob , I x - ■nj'iTicinle onlv, m separate solution. D.LVi.J. u./2o,±ji. -mo stendaXatto S Pituftory Extract against Histamine is recognised as unsound.—ibid. ^ TH^paneutic Substances Regulations} 1921. Stan™ Probation is a dried Acetone-extracted substance from posterior lobes kept at the Nat. Inst, of Med. Research Hampstead. The Unit is the activity corresponding to that p«Jyo,5MBr. ^ standard Preparation when extracted by an ap- "ry »«5 (units per Cc.), Batch No. and Licence No., and name and addre of manufacturer. The expiry date for preparations is two years, though this is not stated the Act. Therapeutic Substances Act. Two samples of Pituitary in 1930 failed 1 reach the standard.—P. Hartley, B.M.J. i./3i,1072. Earlier Reports on £ hysioiagica! Examinations. \ve may recall that in 1917-1919 we had a number of examinatior made of our preparations by a Professor of Physiology in London The reports were devoted to Blood Pressure, Kidney Volume, Fla of Urine, and Action on the Uterus and Milk Flow. These repor were highly favourable. Full details are given in the XVIIIU Edn., pp. 954, 955. Pituitary Extracts made with different concentrations, 0-05% to 0%, Acetic Acid, giving extracts of pH 7-0 to 3-4, showed no deterioration their oxytocic activity.—A. Stasiak, Jl. Ph. & Exp. Ther., July ’26,7. Uses.—Pituitary (Posterior Lobe) Extract causes uterine coj traction and has a special action on uterine muscle. It stimulat 1 unstriped muscle, especially affecting also the arteries, spleen ar j intestinal muscles. Should not be injected during the first stag of labour, because if the os uteri is not fully open the energet' contractions may cause a rupture of the uterus. It keeps bloo pressure raised for hours; but in no way supersedes or takes t! place of Saline infusions. It is useful in shock and has contr over post-partum and other uterine haemorrhage. Contra-indications maybe heart disease, arteriosclerosis and kidn* disease. In arterial disease of the aged sudden increase of blood pressure l pituitrin might cause apoplexy.—L. i./i5,289. See also M.P.C., Jan. 7/20. N.B.—The Extract produces arterial degeneration if administered t j long—it is a remedy for emergency, not routine use. When a second or subsequent dose is wanted the fresh dose w not produce more than a small fraction of its effect unless son time has elapsed. Exophthalmic goitre has benefited. Effect on the kidneys pom to use in suppression of urine. May control haemorrhage, e.g., : typhoid fever. Its effect upon metabolism has led to its use acromegaly and skin affections. See also the following abstracts f‘ further uses. References. Acromegaly. Some good appears to come from its use in a fair proportk of cases.—Guthrie Itankin, L. i./o9,28. Pitiutary body and optic chiasma lesion with acromegaly benefited tl Pituitary and Thyroid Extracts. Special Extract of the anterior pituitam lobe alone—used with some sign of benefit.—L. i./n,303. Addison’s Disease : Two cases benefited—O. Leyton, B.M.J. i./i5,245. F. Golla was the first to use Pituitary Extract. Subcutaneous injectic produced marked rise of blood pressure and diuresis. Action on the uter said to last longer than that of Ergot. Useful in treatment of hasmorrhag: intestinal paresis and shock.—L. ii./io,1828. Cancer as palliative.—J. H. Norgate, per Pres., June ’23,238 On the hypothesis that the anterior pituitary in cancer is over-active ai the posterior under-active, 5 cases of advanced cancer were treated wi Pituitrin 0-5 to 2 Cc. twice daily and Theelin 0*25 to 0-5 Cc. once daily, with low carbohydrate diet. All showed regressive changes in the tumours air Reduce^^L^P^HH; follolvin? injections controlled by Morphine, changes deemed ^riue- ou^put falls below 20 ounces. Regressive temperature vari«3 between 97“ aad 99“.- intestinal toxemia well treated with Pituitary J y ^1(! pel os‘—{»la8. Jed. Jl., Sept. ’13,177. frauaht wHhfd^il^acy Ex-tfract A0 Promote peristalsis in young infants is SU\ m TXtr /d |o5’ since lfc readl]y Produces intussusception.—J. A. Foote, 1 Cc. of extract.—E. Obermer, Jl. A.M.A. iJ./25,722. Constipation due to Morphine corrected by B. M.J. L/26,17. n J>ar?>lytic distention of ‘intestines—possibly of value in.—New and Non- Ofi. ^ Remedies, 1914. See also G. R. Murray, Clin. Jl., Aug. 1/23,364. pia&etes. Subcutaneous injections of Post-Pituita ry markedly antag- omse the effect of Insulin on blood-sugar in normal and diabetic individuals. —R. D. Lawrence and R. F. L. Hewlett, B.M.J. L/25,998. 1 .Growth and sugar tolerance increased in children by Pituitary anterior lobe per os.—H. Gardiner-Hill, B.M.J. ii./25,1056. -n insipidus treated by 2 Cc. of injection hypodermically.— H.M.J. 11./18,197. Antiaiuretic effect marked.—M. Davidson, L. ii./2o,401. See also P. J. Cammidge, Pr., Oct. ’20,244. A combination of dried Pituitary Extract 1/10 gr. and Ergotin 1 gr., in a capsule three times daily, has been used with success in diabetes insipidus.— C. E. de M. Sajous, Pr., July '24,66. The preparation of a solid Tartrate Principle of Pituitary infundibular substance, with an action on the isolated uterus from 1,000 to 1,250 times more powerful than Histamine-acid-phosphate.—J. J. Abel and co-workers, Jl. Ph. and Exp. Ther., Yol. XXII./23,289. Its antidiabetic action in diabetes insipidus.—ibid. 317. Pituitary Extract by the mouth in a case of diabetes insipidus proved quite useless to control diuresis, even when dried gland corresponding to 2 Gm. of fresh gland was administered daily in Salol-coated pills.—O. Leyton, B.M.J. i./26,303. Posterior Lobe Extract 1 Cc. subcutaneously of value in diabetes insipidus. *—P. Carnot and M. Peron, Paris Med., Oct. 24, '25,339, per Pres., May '26,202. Intranasal administration of 1 Cc. liquid extract applied with a spray (also by insufflation of powder) successful in many cases of diabetes insipidus.— per B.M.J.E. iL/28,82 ; also ibid. L/29,21. Gaiactacgogue action.—The effect on the Mammary Gland is too transient to admit of therapeutic use.—Pres., May *31. Hemoptysis : Pituitrin, \ to 1 Cc. intramuscularly, the best immediate remedy.—W. H. Wynn, per Clin. Jl., Jan. 24/23,47. Bleeding stopped in a case of haemophila after one local application and one subcutaneous injection.—Pres., May ’24,213. Hemorrhage, post-partum. Probably safe in the third stage of labour, and in the induction of labour, if used cautiously. Rarely safe in the first stage, and rarely, if ever, in the second stage.—A. M. Mendenhall, Jl. A.M.A. i./29,1346. Heart failure successfully treated. Immediate effect required which could not be obtained from digitalis, strophanthus, etc.—L. i./15,289. As a temporary cardiac stimulant in acute diseases, such as pneumonia, Pituitrin has been found successful, when Strychnine and Camphor have failed.—G. R. Murray, Clin. Jl., Aug. 1/23,364. Labour. Useful in full-time pregnancies as a means of inducing strong labour pains, especially where pains have already set in, but have become weak or ceased—i Cc. in the late first stage acts like a charm. A quick labour often occurs after it.—B.M.J. i./14,906,1046 ; B.M.J. ii./i6,781. It is of little use in cases of abortion, having little effect in the early months Appears to act best in the latter part of the second stage. L. ii./i2,544. B.M.J. i./i9,432. . 0 5 Cc. every & hour with Chloroform anesthesia. Partial anesthesia maintained and uterus kept active.—A. F. Martin, B.M.J. ii./22,672. It is important to see that clots as well as placenta are quickly removed. Give Liquid Extract of Ergot 1 drachm immediately after delivery of placenta, and 2 grain Ergotin Pills at 4 hour intervals.—-R. Bone, B.M.J. 1./19,^28. Its use during labour.—W. Blair Bell, B.M.J. i./25,1027. Vol. I. II H The action of Pituitary Extract on the uterus.-—L. ii./26,343. The dangers of use in obstetrics.—M. Pierce Rucker, Jl. A.M.A. ii./25,163 Intravenous injection in the third stage of labour. The interval betwee the birth of the foetus and the passage of the placenta was reduced by on< half and the loss of blood was also diminished by almost one-half in injectc patients.—per Pres., May ’2 7,193. When Pituitary is used to induce labour it should not be repeated once paii are established, otherwise great danger is incurred.—W. A. Scott, Am. J Obst., Oct. ’26 ; per Pres., May ’28,180. A dose of 2 units, if given before os is half dilated, hastens course of sluggis labour and is safe in any stage, providing there is no mechanical obstruction Ampoules containing only 2 units should be available, as this dose appea safe at any stage.—A. W. Bourne, and J. H. Burn per B.M.J. i./28,273 P.J. i./28,125. Investigation re dosage of Pituitary in labour.—J. H Burn, P.J. L/27,13 Good results claimed by giving a tablespoonful of Castor Oil in the mornir and injecting 2 drops Pituitary Extract solution hourly throughout the da; By this procedure labour is stated usually to terminate in 18 hours. Pr< longed administration causes arterial degeneration. Itasal Method of administration safe and efficient for accelerating labor already in progress. Insert a pledget of cotton wool moistened with 20 minin Pituitary Extract under the anterior end of the inferior turbinate of or nostril, withdraw after an hour or two and, if necessary, apply a fresh pledge to the opposite nostril.—Hofbauer and Hobiner (Baltimore); per Pres., Me ’28,180. Migraine well treated by 0-5 Cc. intramuscularly once weekly—prolonge improvement.—B.M.J.E. i./28,92. Polyuria reduced by the pituitary extract increasing the capacity of th kidneys to secrete a concentrated urine. Effect useful in diabetes but trati sient, lasting for a few days only.—B.M.J. ii./i6,298. Enuresis in children well treated with injections of Pituitary Extract.- per Jl. A.M.A. ii./25,1434. Intravenous administration of Pituitary Extract produces a definite diures in ansesthetised animals. Injected subcutaneously it controls a diures produced by intravenous administration of 120 Cc. Ringer’s Solution, injecte at the rate of 4 Cc. per minute, but if injected at the rate of 12 Cc. per minul no anti-diuretic effect occurs.—Qrtly. Jl. Exper. Physiol., May ’25,119, pc Jl. A.M.A. ii./25,932. In the unanaesthetised animal subcutaneous injections of Pituitary ma. inhibit diuresis for 4 or 5 hours. This can be overcome by oral administrt tion of 1*5% Sodium Chloride solution.—A. McEarlane, Jl. Ph. and Exi Ther., Aug. ’26,206. Serum shock and serum sickness well treated with Pituitary Extra* or Adrenalin Solution 1 Cc.—W. M. Crofton, Pres., June ’23,235. Oxytocin. Syn. *Pitocin (T.M. 496396) and *Vasopressi (T.M. 490452). Syn. *Pitressin (T.M. 496398). Sir H. H. Dale and others have shown that the actions on the bloc pressure and on the uterus are due to different substances. Separation of the oxytoccic and pressor principles of the posterior lot (termed a and /3 Hypophamine respectively) as stable water-soluble powder B.C.A.,— ’28,A554. See also H. W. Dudley, Jl. Pharmacol, ’23,21,10: P.J. ii./26,115. . . Uses.—Oxytocin possesses the stimulant action 01 Pituitary whereas Vasopressin has no such effect, even in large doses. Oxytoci may safely be used in labour by those who have refrained from usin Pituitary Extract, because of the danger of ‘ Pituitary shock It has the same action as Pituitary Extract, but is without any c its vasometer effects.—A. W. Bourne and J. H. Burn, L. ii./28,69* Each Cc. of 4 Pitocin ' contains 10 oxytocic units, and it is thus identic^ in activity with ‘ Pituitrin.’ Dose.—5 to 15 minims (0‘3 to 1 Cc.) intrfc muscularly. If used before delivery is completed; small doses are usee repeated if necessary in 20 to 30 minutes. 4 Pitressin ’ is used for the treatment and prevention of surgical shoe dlstensionntEach Cc^conti'S?'^'S’ and in °??es,of Post-operative intestinal pressor artiv^v evh^Vort W n 1° Pres®or ™its (one pressor unit betas; the . Ity exhibited by 0-5 mgr. Standard Powdered Pituitary US P ) haSf+^US do?^S. the Pressor activity of ‘ Pituitrin/ * '* thJbloodtl0^0pthrii??f«t"?1HU1Taw prvnfiples <0xyt°cin and Vasopressin) on me mood.—I. R. Curtis and J. W. Pickering, L. ii./28,695 T.osse^eTtL^nwA? etlc activity. Vasopressin (but not Oxytocin) possesses me power ot Pituitary extract of inhibiting the hypoglycEemic effect coaaulabUit v “‘ravenously after hemorrhage princes tacrS coagulability.—Kamin (Detroit), per Pres., May ’29,183-186, Phyone (<^VC0, I cause to grow). Zar^ofTbe6 lit? growth-promoting substance from the jears glandu- Phvoi?P A Pe.th?d of Preparing a potent, non-irritating Phyone extract suitable for clinical use.—H. B. Van Dyke and Z. Wallen- Lawrence Jl. Pharm. and Exp. Therap., Dec. ’30,413. thyreotropic in nature, in the anterior pituitary.—E. A. E mew and B. P. Wiesner, B.M.J. i./3o,777. 1928hie9,iBdM.jndf/3oP560CiPleS “ Pituitary-—J- H- Bum. M.R.C. Ann. Rept, Placental Hormones. The human placenta contains at least three hormones (1) the sex hormone Oestrin (now known as Theelin), obtained by extraction with Ether of an acidified aqueous extract, or of Alcohol-soluble fractions from the latter; (2) an oestrogenic hormone, suggested name Emmenin, an 85% Alcohol-soluble material present in the original extract, but with the Oestrin removed ; (3) the anterior-pituitary- like substance precipitated from the original extract by Alcohol. These are alike in their oestrogenic effect on the immature female rat, the second factor being very similar to Oestrin in physiological effects, but ineffective in the castrate and presumably functions by stimulation of the intact ovary : it is not so effective orally as Oestrin. The third fraction differs from Emmenin in being ineffective orally, producing corpora lutea in the immature rat coincident with induced oestrus, causing increase of rate of growth of accessory sex glands in the immature male. Of the three, only Oestrin is obtainable from pig and cow placenta, suggesting that in the human placenta hormones exist absent in lower mammalian forms. These three principles are the specific products of placental tissue functioning and are actively related to the condition of pregnancy.—J. B. Collip, Ann, Meeting, B.M.A. Can., 1930, B.M.J. ii./3o,1080 ; L. iL/30, 697. Emmenin. Dose.—In dysmenorrhoea, which it has relieved, the equivalent of 25 Gm. placenta daily for 17 days, beginning with cessation of menstrual period, increasing during week preceding menstruation to 75 Gm. daily, continued till onset of flow and then stopped for a week. Emmenin does not alter normal menstrual cycles, has encouraging effect in dysmenorrhcea, corrects amenorrhoea of recent origin, definitely lengthens cycles in polymenorrhoea, relieves menopausal symptoms of recent origin but not in castrates. The Anterior-Pituitary-Iike principle. Dose.—1* to 2 Cc. = 25 Gm. placenta subcutaneously. Arrests certain fonns of metrorrhagia.—A. D. Campbell and J. B. Collip, B.M.J. ii./3o,1083. ; L. ii./30,697. Serum, Horse, Normal.— Syv. Antiiytic Serum. Horse Plasma (Liquid) is supplied in 10 and 25 Cc. vials. Dose.-—1 to 2 drachms. Employed locally, internally and subcutaneously. In the case h h 2 of old wounds and ulcers, an antitryptic substance in it may preveni the destruction of newly-formed epithelium by the proteolytic fer ments contained in pus. ^ Antilusin (T.M. 310899) ‘ A ’ for use per os and Antilusin ‘ B ’ for loca application, are preparations of this kind. Haemophilia, purpura and pernicious anaemia have been treated with it also as a food in tuberculosis and in typhoid. (Byno-plasma contains 1 drachm sheep’s plasma in every J ounce) A dose of tuberculin in 10 Cc. of Normal Horse Serum is less likely t< cause the rise of temperature than the same dose in 10 Cc. of Saline. Chronic Gastric and Duodenal Ulcer Treated..—The serum is give! by the mouth 3 or 4 times daily directly after food in £ ounce of water. 60 o 80 Cc. may be given in 24 hours. The serum must be fresh—if it does no produce a good reaction in 24 to 36 hours it is useless for the purpose. Hypersensitiveness to horse serum—5 Cc. caused death.—P. B. Gurd an< E. Emrys-Roberts, L. i./2o,763. Bums well treated with Normal Horse Serum. First bathe the partii warm Normal Saline, remove devitalised tissue, spray with serum, containin 0-35% Cresol, and cover with rubber tissue. Good end-results without scai —S. It. Monteith and R. O. Clock, Jl. A.M.A., i./29,1176. Coagulose..—A dried serum containing the fibrin ferment required to cc agulate blood—used in haemorrhage hypodermically after re-dissolving. Haemostatic Serum. Syn. Haemoplastin. Dose.-—1 to 2 Cc. injecte intravenously or subcutaneously and repeated every 4 to 6 hours until hsemor rhage controlled. A serum derivative stated to promote clotting of the blooc Coagulant haemostatics should be applied locally at body temperatur and the wound should not be allowed to cool; keep if possible at 37-5° C1 Application of haemostatics by continuous irrigation is inadvisable. Coagule thromboplastin, cephalin, protagulin, haemoplastin and flbrogen among? those reported upon.—J. W. Pickering and A. Hemingway, B.M.J. i./26,102< In a severe case, haemoptysis arrested by intrapulmonary injection c Coagulen.—A. J. Morland, L. h/25,1238,1257. _ ^cCcagulen-Ciba (T.M. 372474).—Successful use m a case of typhoi with mtestinal haemorrhage.—L. C. I). Irvine, L. ih/25,918. In two cases of haemoptysis and one of haemorrhage Coagulm-Ciba 5 Gn n 200 Cc. water was given with good results in ounce doses every two hour —B. W. G. Stewart, Jl. R.N.M.S., Jan. *2 6,64. Snake Venom. Syn. Venene. * Crotalin ’ from the rattle snake was first used for the treatment of epileps in America. In S. Africa the mixed venoms of cobras and puff adders wen tried bv Russell—S. African Med. Record 1922, Vol.20, p. 209.—Lieut,-Cc KlTheTMedical Association of S. Africa declined a paper by Mr. FitzSimoi on the treatment of epilepsy by snake venom, and the Editor of the Medic; Journal of S. Africa refused to publish same on the grounds that there ws nothing new in the treatment, and that it could no more be called a ‘ curi for epilepsy than common salt is a cure.—B.M.J. i./2o,34. The preparation has been widely used for epilepsy in South Africa, andM FitzSimons in a paper read before a combined meeting of the British ar South African Associations for the Advancement of Science in July, 192 reported encouraging results. There seems to be a prima-facie case U invest igation of the claims. The benefits claimed may be due to desensitisatioi •—L. ii./30,915. Spleen Substance Desiccated. Dose —5 to 10 grains (0-3 to 0-6 Gm.) 1 part represents 5 of the fresh splee Has been used in annemia, tuberculosis, myxcedema, etc. Value in typho and malaria possibly due to splenic hormones . . , . . Extract of pig’s spleen stated to give 100% of recoveries m tuberculos= of first degree and 75% in all—several hundred cases treated since 190 One or two injections of 5 Cc. intramuscularly (thigh), or subcutaneous (abdomen) dailv for adults. Oral route (in syrup) for prophylaxis, or adjuva to injections ; 4 tablespoonfuls given daily with meals to adults, representi- 25 Gm. spleen tissue. Dose injected, or per os, proportionally less for children. Treatment absolutely harmless.—Bayle, Presse Med., Sept. 23, ’25, per JL A.M.A. 1L/25,1434. Pres., May’26,227. Calcium metabolism stimulated by spleen, preparing suitable Calcium Salts for the blood stream and body ceils. Splenic and parathyroid extracts suggested for treatment of pulmonary tuberculosis.—per Pres., May ’2 6,227. uJcSplenex (T.M.499914).—A liquid extract of Spleen Substance (4 ounces — 2i lbs. raw spleen), sweetened and flavoured. Dose.—4 to 1 tablespoonful daily for 3 weeks, with a week’s interval between courses.—Pres., Apl., *29,147,257. Kormcnal (T.M. 330346). Dose.—15 to 20 Cc.— less for children. Said to be a solution of the Hormone of the spleen to which peristaltic action is due. Two forms are made—for intramuscular injection and for intravenous use. Castor Oil (1 ounce) is to be given simultaneously with the intramuscular injections. The intramuscular dose produces, on injection in equal quantities into the right and left gluteal muscles, an effective evacuation. For use in chronic constipation and acute intestinal paralysis. Effects said to be lasting. 20 Cc. Ampoules are prepared, has also been given per os. Two cases benefited by a single injection. Effect difficult to understand.— O. Leyton, B.M.J. i./i5,246. L. Levi quotes many authorities, mostly French and German, to show that Splenic Extract is useful in malaria, typhoid, tuberculosis, in haemorrhagic conditions such as menorrhagia, and in anaemia.—per Pres., Oct. 23, 341. - Stomach Desiccated. Syn. 3$cExtemak (T.M. 511536), Ventriculin, Gaster Slccata, ^ Byno-Eugastrol (T.M. 516043). Dose.—\ to 1 ounce (15 to 30 Gm.) per diem in water = approx. 200 Gm. fresh material. Pennicioas anosmia. Following on the demonstration by Castle (B.M.J. i./2g,1120) that the stomach normally secretes a substance which can extract a blood-maturing principle from meat, E. A. Sharpe concluded that the feeding of stomach should have the same effect in pernicious anaemia as liver. Whole desiccated hog stomach (30 Cm. = 190 Gm. fresh tissue), and hog stomach defatted with Petroleum Benzine (30 Gm. = 218 Gm. fresh tissue) produces satisfactory haematopoietic remission. The preparation has little odour and practically no taste. 15 to 30 Gm. equal in effect to 300 Gm. to 600 Gm. fresh liver.—E. A. Sharpe, Jl. A.M.A. ii./29,749. . Mucous membrane and muscular layer of hogs stomach effective. Slightly better than liver therapy. Symptoms such as glossitis and paraesthesia show more ready response. The effect on the reticulated erythrocyte and mature erythrocyte counts and general symptoms good.—Sturgis and co-workers, Jl. A.M.A. ii./29,93 : J. Wilkinson, B.M.J. i/30,236; A. Renshaw, i./so,334; Castle and Lock, i./29,H20. Resume.—B.M.J. ii./30,437. 15 to 30 Gm. daily gave increase in red blood cells as great, or greater than, with liver.—Sturgis and Isaacs, B.M.J.E. ii./29,100. A patient on liver treatment had a severe relapse and recovered under Ventriculin.—A. Renshaw, B.M.J. i./3°>334.^ ^ee Stokes, B.M.J. ii./3o,582, and G. T. Allerton, L. n./3o,795. *Byno Eugastrol (T.M. 516043). A concentrated extract of hog stomach.—B.M.J.i./3i,5S9. , , 1 ounce daily of service at commencement, afterwards decreased to maintain an erythrocyte count of 5 millionsM, Brockbank, Pr., Oct., ’31,449, *Extcmak (Benger), (T.M. 511536). Bose.—25 to 30 Gm (\v eighed) daily in three portions. A light-coloured powder. 2 Gni. 100 Gm. fresh whole stomach. Should be mixed fresh wit] milk, otherwise a junket-like mass is produced. Undoubtedly better than liver. Erythrocytes and hemoglobin increased 157°/ and 94% respectively, compared with 90% and 77% respective^ Wlth liver. Hydrochloric Acid and Pepsin do not appear to b' necessary for relief of symptoms.—J. F. Wilkinson, B.M.J. i./3i,85 See also C. S. Don and C. E. Jenkins, ibid., 158. Hog stomach better than ox or sheep. Interesting account o long treatment of a case with large amounts. Normal initial dos< m a severe case need not exceed 1 to H ounces daily.—J. F. Wilkin son, B.M.J. i./3i,585. Suprarenal Gland. An average sheep’s gland weighs about 2 Gm. (30 grams). The glands are situated at the top of each kidney. The fresh gland was first given to relieve Addison’s disease, then dried preparations were used, also liquid extracts, and lastly ar active principle, Adrenalin, which, in the form of its hydrochloride is now used both internally and externally. The compound is however thought to be destroyed by the stomach, but Hale White say; gastric contents have no effect on it and he attributes absence oi efficacy per os on the mucous membrane of the stomach and intestines to dilution, and adds that it is not absorbed by these. Preparations of Adrenalin cause contraction of small blood vessels when applied locally, blanching the skin or mucous membrane. Locally there is an astringent action, and capillary bleeding, epistaxis and menorrhagia are checked ; useful for bleeding after tooth extrac- tion, and of \aluc applied to the nostrils for hay fever and coryza. 11 is applied by the surgeon to check bleeding and blanch the parts for operations on the eye, ear, nose, throat and larynx. Adrenal Glands are a source of power. They control the sympathetic system, and thereby dominate the ‘ tight ’ and ‘ bight ’ reactions —H Crichton Miller, B.M.J. ii./22,553. s‘ n See also abstracts under 1 Pituitary ’ and * Thyroid.’ The active principles of the Thyroid and Suprarenal Gland are supplemented by the supply of Oxygen—diminution of same has a very definite effect on the central nervous system. Asphyxia brings about an accelerated secretior <>f Lpmephrm, chiefly due to lack of Oxygen. On the other hand the balance of C02 cannot be ignored. Its excessive removal from the blood bring- about prompt and dangerous fall in blood pressure, due to depression of the vaso-motor centres of the bulb and spinal cord.—Prof. J. C. Meakins, L. ih/22 230. Uses*—The gland is really only effective when its preparations are injected or when they can reach the actual bleeding surface—hence will stop hamate- mesis, but Dot haemoptysis; it may also be given to relieve syncope from chloroform. Its use has been suggested in Graves’ disease and Addison’s disease. For further details see Adrenalin. Raw Adrenal gland of value in post-influenzal debility—1/6 gland thrice daily on an empty stomach. Also of value in preventing] attacks of asthma.—L. J. Picton, B.M.J. i./27,641. Suprarenal Gland, Dry. Dose.—J to 3 grains, three times a day. Tablets, Compressed, each equivalent to J and 1 grain of Dry Gland Substance, are prepared. Suprarenalum Siccum. U.S. IX. Average dose. — 4 grains. Suprarenal glands of animals which are used for food by man, freed from fat, cleaned, dried and powdered. Contains 0-4 to 0-6% epinephrine and if assayed biologically 1 Gm. contains the equivalent of 10 mgr. laevo-methylamino-ethanol-catechol (adrenalin). Ash limit, 7%. In practice we find an average sheep’s gland weighing 30 grains yields 5 grains of dry powder. Addison’s Disease.—O. Leyton, B.M.J. i./'i 5,245, says it needs 20 to 30 grains thrice daily continued indefinitely. Addison’s disease treated by 1 drachm dried ‘ extract ’ of whole suprarenal (Armour) thrice daily. Patient collapsed and died.—T. Thompson, L. ii./3°, 7S6. Insignificant therapeutic value.—Hoskins and Sleeper—Pres. May, *31,185. G. R. Murray states that he has never seen permanent improvement in Addison’s disease as a result of treatment with Suprarenal Gland.—Clin. Jl., Aug. 1/23,363. Exophthalmic Goitre.—Suprarenal gland eulogised.—L. ii,/i2,216. See also Hector Mackenzie, L. ii./io,815. Suprarenal Snuff. Dry Suprarenal Gland 1, Menthol 2, Ammonium Chloride 6, Boric Acid 4, Lycopodium 4, for use in hay fever. Insufflation Powders for hay fever, of the following formula?, have been suggested :— (1) Adrenalin 1, Zinc Stearate 100, Heavy Magnesium Carbonate 000. (2) Adrenalin 1, Zinc Oxide 100, Bismuth Subcarbonate 400. (3) Suprarenal Gland Substance 1, Zinc Stearate 20, Zinc Oxide 80. Tabelise, Chocolate, contain J grain of dry substance equivalent to 4 grains of fresh gland, and are agreeable for i nternal use. Liquid Extract of Suprarenal Glands. Dose.—TO to 15 minims (O'6 to 1*6 Cc). Hypodermically, 1 to 5 minims as such or diluted with normal saline. Prepared with glycerin, strength 1 = 1 of fresh gland. It was with this preparation that all the early valuable results were obtained. Por local application rarely used stronger than 10%. Suppositories contain 3 minims of Liquid Extract in 15 grains of Gelatin basis; to check bleeding piles. g Jj Suppositories, Suprarenal with Morphine.—These contain L A v — m. — grain of Morphine Hydrochloride in addition. i 4 Suprarenal Ointment.'—Liquid Extract of Supiaienal Gland o0 minims, Liquid Paraffin 2 drachms, Hydrous Wool Fat to 1 ounce. It may be scented with Otto of Rose. Nebula Extracti Suprarenalis.—Contains 5% of Liquid Extract. For use as spray in hay fever and coryza. Adrenalin. B.P. ’14. (Adrenalinum). P. Belg., Fr. Cx„ ^ED* V., P- Ital. V. Syn. Adrenine, 5ft Hemisine (-L.il. 2o02o0), 3ft Renaglandin (T.M. 480619), Suprarenin,, Takamina F.E. VIII., Adnephrin, Paranephrin, Vaso- Cons trie tine (T.M. 288888), * Vasotonin (T.M. 326554). Levoreninum Lsvorenine, P. Belg. IV. Epineplirina, U.S. X. Latter gives average Hypodermic dose 0*0005 Gm. (1/120 grain). Hie empirical formula usually given is ChH, oNO,== 183-112. t.e. (OH)2. C6H?.CH(OH).CH8. NH. CH3. It is an active principle of the Suprarenal gland, light brown powder or in grey crystals (first prepared by Takamine). It appearsi to maintain a proper degree of contraction of the arteries and hence to correct blood pressure. U.S.P. X. assays biologically, comparing rise in systolic blood pressure oi the dog alter intravenous injection with that produced by a standard extract. Colorimetric Assay.—Ammonium Molybdate colours with Adrenalin las it contains a Catechol group). As standard, Adrenalin or Tannin can be used Reducing substances, e.g., Ferrous Salts, Alcohol, Bisulphites, should be absent’ —J. Rae, P.J. ii./3o,451. Soluble slightly in hot water, also more readily in Hydrochloric Acid, and Boric Acid Solution forming corresponding salts. From concentrated solutions it is precipitated by alkali. Aqueous solutions of its salts are laevorotatory. Insoluble in alcohol, ether, chloroform, petroleum ether and i other organic solvents. Oleic acid is a poor solvent. Hot precipitated by ordinary alkaloidal reagents. It is chemically a powerful reducing agent. On heating above its melting point (263° C.) it decomposes with i an odour resembling opium smoke.—Fr. Cx. B.P., 1914, states- M. 1 1. 205 to 212 C. with partial decomposition. We found commercial Adrenalin to darken at 194° C. and melt at 204° C. Prescribing note—It is best prescribed alone in Solution (vost) as it oxidises rapidly, especially in neutral or alkaline solution. Manufacture.—The suprarenal glands are reduced to pulp and macerated, excluding oxygen as much as possible, in warm (50° to 80° C.) water or very dilute acid for 5 hours, the mixture being then heated at 90° to 95° C to coagulate albuminoids. This aqueous extractive is evaporated and extracted! with alcohol. Precipitation from this liquid of impure Adrenalin follows by means of ammonia. It is purified by ether-alcohol, and re-precipitation with ammonia or fixed alkali. Suprarenin P.G. VI.—Ortho - Dihydroxyphenylmethylamino- methylcarbinol. Syn. Ortho-dioxyphenylethanolmethylamine is synthetic Adrenalin with allied properties. Laevorotatory. Natural laevogyrate Adrenalin possesses a vaso-constrictive action which is more than double that of the racemic (synthetic) product, the exact relationship beiug, 1 — 0-46, and from this may be inferred the dangers attendin'* the use of a product not possessing the full activity of the official substance! —Tiffeneau, (J. It., May 28/21, p. 708. r-Adrenalin in small doses of order of 0*01 mgm. increases the blood pressure to a somewhat less degree than 1-Adrenalin, the difference in activity in general is about 10-15% but may be 25-30%. As dose is increased to 0*05 mgm. this difference becomes less apparent and with the usual therapeutic dose of 0*04 to 0-1 mgm., there is no disadvantage in the use of the synthetic racemic compound.—J.C.S.A., 1/22,891. Suprarenin synthetic identical in all respects with adrenalin is available.—B.M.J. ii./26,168. History of Adrenalin.—H. A. I). Jowett, P.J., ii./26,118. Synthetic Adrenalin usually corresponds to the active natural lawo form, out some preparations appear to be the cheaper racemic form and therefore much less efficient, since dextro-Adrenalin is about 15 times less active than the lawo compound—0.1)., May, 10/24,678. Synthesis of Adrenalin.—P.J. ii./29,289. Substances possessing an Adrenalin-like action have also been found in putrefying meat, vide Hydroxyphenyletfoylamine. Liquor Adrenalin! Hydrochloricus. Adrenalin Chloride Solution. Dose.—10 to 30 minims (0.6 to 1.8 Cc.) by the mouth. Adrenalin 1, Chloroform 5, Sodium Chloride 9, Dilute Hydrochloric Acid 3, Distilled Water, freshly boiled and cooled to 1,000. T he original preparation contains 1 of Adrenalin Chloride in 1,000 of Normal Saline Solution, with 0-5% of Chloretone, as in F.E. VIII. and P. Belg. IV. Hypodermically, \ to 1 Cc. injections of the 1 in 1,000 Solution are given or it may be diluted with Normal Saline Solution 10 times (or less). Dilutions may be prepared freshly as required. Liquor Epinephrinae Hydrochioridi. U.S. X. is the same strength Assayed biologically. Average dose.—Q'5 Cc. hyxiodermically. Decoloration of Solutions.—It is best prescribed alone. The solution is liable to turn brown on exposure. Oxidising agents produce this effect, e.g., Hydrogen Peroxide on neutralising. Loss of activity is proportional to this coloration. In some experiments which we conducted we found that a small quantity of formalin added retards the coloration of Adrenalin solution, as also does Sodium Hyposulphite. Uses.—Locally applied, it is of great value in arresting local haemorrhage, the part becoming blanched—hence its use in superficial wounds and abrasions, in tooth extraction and nose bleeding and during operation to stop capillary haemorrhage. Applied locally the vascular constriction lasts J to 2 hours. Solutions are useful in coryza, hay fever and asthma. It may be given by the mouth to check haemorrhage from the stomach or injected into the rectum, bladder and uterus for bleeding. It reduces the swelling in giant urticaria. It is of no value in haemoptysis; of little use in remote haemorrhage however given, in fact the rise in blood pressure may increase the haemorrhage. Hypodermically, it does not materially raise the blood pressure, as the local vascular constriction prevents absorption. Intravenously it is successful in surgical shock, circulatory failure and asthma.—Mitchell Bruce. Action on the Heart. According to the makers of the body, injections of it are followed at first by an acceleration in the pulse rate and a simultaneous contraction of the muscular coat of the peripheral arteries. This causes an immediate rise in blood pressure and excites the cerebral vagus centre, which in turn slows the heart beat and strengthens the cardiac contractions. Apart from this indirect vagus action, adrenaiin stimulates the heart directly. Excessive doses over-stimulate the cardiac muscles and predispose the heart to fibrillary contractions. Given per os in small doses it does not increase blood pressure unless there is suprarenal insufficiency, on the contrary 3 to 5 drops in a little acidulated water may be Given to reduce hyper&iesis* In nose operations, submucous injection of 10 minims of 1 in 10,000 solu lion with 5 minims of 1% Cocaine Hydrochloride is utilised to lessen blooc how. Asthma.—1 to f> minims hypodermically gives prompt relief. Continue*: daily use has no harmful effect.—G. R. Murray, Clin. Jl., Aug. 1/2 3,363. Many cases get relief from an injection.—T. Drummond, B.M.J. i/23,320. In status asthmaticus the continuous injection of Adrenalin in small quanti ties, up to even a drachm in $ hour, the only cure.—A. F. Hurst, B.M.J. ih/29 297. (Evatmine contains Adrenalin and Pituitary.) Collapse has been treated by 0-5 to 1 C'c. injections every 1 to 2 hours Intravenous injections of Saline (q.v.) with 6 to 8 drops of the Solution to th litre, are practised, also in chloroform syncope and other forms of heart failure Pertussis.—Children have taken 1 to 3 drops per os or less, according to age every 3 or 4 hours with good effect. Intractable hiccough.—In a fit of violent and painful hiccough, lavag< with Silver Nitrate, and general ansesthesia under Chloroform were equally unsuccessful,—finally two doses of 10 drops of Adrenalin Solution caused it t< cease.—P.J. ii./i3,808 ; C.D., Jan. 10,’14. Gastric ulcer.—Probably the best drug to control haemorrhage. To rais blood pressure in shock and in pneumonia repeated small doses—1 Cc. of i in 1,000 every hour required.—O. Leyton, B.M.J. i./i5,245, Adrenalin should not be injected in Chloroform anaesthesia. Stokes-adams attacks well treated with Adrenalin Solution (5 m. doses subcutaneously.—A. G. Phear and J. Parkinson, L. i./22,933. Post-an^estiietic Vomiting checked by 5 to 8 minims Adrenalin Chlorid Solution per os.—V. Macdonald, per Pres., Jan. ’23,5. Vomiting in malaria well treated with 7 to 8 minims—one dose sufficient.— E. Lomax Wood, per Jl. Trop. Med., Aug. 1/22,248. Vertigo.—A lasting cure was obtained by giving 20 drops per os a day.— per Pr., Sept. 23/232. Fractures treated by Adrenalin solution 10 drops and Calcium Phosphat o-l Gm., twice daily, in addition to usual treatment.—Pres., May ’24,206. Alopecia.—following a history of scarlet fever, fright and malaria—wel treated by injection and dried thyroid per os.—Pres., May ’24,207. Gas gangrene.—Epinephrin, 0*5 Cc., injected in vein at elbow, saved a cas apparently moribund.—per Jl. A.M.A. ii./25,1435. Giant urticaria or Quincke’s oedema specifically treated by Adrenalii Hydrochloride, 2 m. of the 1 in 1,000 solution intramuscularly daily for 4 or days, followed by Suprarenalin 1 gr. and Dry Thyroid J gr. twice a day 01 an empty stomach for three weeks.—H. W. Acton, I.M.G., May ’25,200. Urticarial eruption successfully treated by 10 minims Adrenalin hypoder mically.—J. R. Keith, B.M.J. ih/25,1005. Pyloric stenosis.—Adrenalin intramuscularly in the forearm has dr cidedly beneficial effect. Given 10 minutes before feed in form of F mg doses of Suprarenin Hydrochloride in 1 in 1,000 solution from 3 to 5 time daily. Good results in some cases when combined with use of Atropine.— J. L. Meagher, B.M.J. i./26,89. Rheumatic heart block well treated with Adrenalin solution 4 m. hype dermically—a total of 32 m. in 5 days.—G. A. Sutherland—Pres., May ’26,191 Adrenalin intravenously inhibits uterine contraction before delivery. Thi administration of Ether has a similar effect.—A. Bourne and J. H. Buri P.J. ii./27,490. Adrenalin is rendered inactive within a few hours in contact with colloids and organic Silver compounds.—per Pres., May ’27,188. Adrenal Therapy—a review of literature.—Pres., May, ’29,180. Chemical factors in control of the circulation—Adrenalin Vasopressi Histamine, Acetyl-Chlorine.—H. H. Dale, L. i./29,1179, 1233,1285. Adrenalin idiosyncrasy.—Some people show toxic effects with small dose of Adrenalin, especially when given simultaneously wit certain local anaesthetics, e.g., Novocain. In dental practice thi could be eliminated by avoiding use of solutions stronger tha.i 1 . 100,000. Surgeons should avoid the use of Adrenalin by using a general anaesthetic, when it is found by a small preliminary injection that idiosyncrasy exists. Its use is contraindicated when operating on patients with Graves’ disease.—H. E. Symes-Thomp- son, L. L/24,745. _o/n^r' .An anaemic boy of lo had his nose packed with gauze soaked m 20% Cocaine Hydrochloride and 1 in 4,000 Adrenalin half an hour before operation for hypertrophied turbinates and adenoids. Patient collapsed under further injection of 5 minims of 1 in 1,000 solution. The symptoms may have resulted from antemia of the bulb.—J. Allan, Pres., 1913. Tetany following the use of Cocaine and Epinephrin (1 in 1,000) is of fairly fiequent occurrence. It is not a drug intoxication but is due to a combination of hypoparathyroidism, hyperventilation, and Epinephrin in nervous patients. 9,mcldy relieved by Parathyroid Extract subcutaneously.—S. E. Roberts, Jl. A.M.A., il/29,906. A lady gave herself 20 minims of the solution hypodermically for asthma and repeated it every two hours, with little relief for six doses. On arrival home she had administered 120 minims of undiluted solution. Her condition was alarming, she collapsed and her pulse was almost indistinguishable but improved quickly on use of Amyl Nitrite—F. R. Sawdon, B.M.J. iL/22,866. Intravenous injection of Adrenalin 40 times more dangerous than subcutaneous.—L. L/24,744. With long use there is risk of arteriosclerosis.—B.M.J.E. i./26,lG. /ntracardia.c Injection in resuscitation, No drug known comparable with Adrenalin in efficacy to start an arrested heart or to antagonise the action of Chloroform. The power of Adrenalin, to antagonise a muscular paralysis, has not been sufficiently realised. For resuscitation in cardiac arrest artificial respiration should be resorted to first by the usual methods. If at the end of 3 or 4 minutes no pulse can be felt, and especially if no heart beats can be heard on auscultation, adrenalin should be injected into an external jugular vein. The abdomen should be opened high up, one hand inserted in the opening, passed up over the left lobe of the liver and the heart massaged intermittently.—J. A. Gunn, B.M.J. i./2i,9. See also C. Walker, ibid.} 46 and J. P. Lockhart-Mummery, ibid. 100. (According to the last authority it was possible to revive a cat 20 minutes after all signs of life had ceased. In use it was found more effective to inject a 1 in 50,000 solution of Adrenalin intravenously than to inject into the heart.) When used for resuscitation, it i3 necessary to temporarily establish an artificial circulation to carry the drug to the periphery. It acts on the peripheral vessels, chiefly the peripheral arterioles, hence the intravenous injection is necessary in 2 parts or more, and in dilution of about 1 in 50,000.—J. P. Lockhart Mummery, B.M.J. i./2i,582. Intracardiac (right ventricle) injection of 1 Cc. of Adrenalin solution. The patient was considered dead. Heart action had definitely stopped. A few seconds later there was commencement of the heart beat and 2£ hours afterwards the patient could walk a few steps.—C. Bodon, L. 4/23,586. In a case of anaesthetic syncope in which heart and respiration ceased for 10 minutes, 5 minims of a 1 :1,000 solution injected gave immediate results— K. li. Hill, Clin. Jl., Feb. 28/23,101 ; see also J. G. Reed, B.M.J. L/24,820, and Jl. A.M.A. ii./25,1096. x £ Of 34 cases quoted in the literature of cessation of heart s action during anaesthesia treated by intracardiac injection of Adrenaiin, 00% have survived. Useless after 5 minutes.—Pres., April ’26,14.1; see also E. 0. Stuart, L. ik/25, 1208 stillborn infants responded to Adrenalin byT intracardiac injection. M. Cardwell, B.M.J. ii./2o,038. Gr. Ventricular activity re-established in Stokes-Adams attacks by intracardiac injection of Adrenalin.—L. i./27,401. A warning is issued against the incautious use of intracardiac injections in Chloroform syncope, since it enhances the already existing irritation of the parasympathetic. For the first injection no more than 4 minims of the 1 in 1,000 solution in warm saline should be used, repeated or increased to 8 minims later.—Presse Med., ’26,84, per Pres., Feb. ’2 7,65. The injection might damage the myocardium.—Sir F. Shipway,but not considered likely by Prof. Gunn and Sir E. Sharpey Schafer.—L. ii. /31, 797. Cardiac massage thought preferable. Adrenol Solution.—A solution of the Adrenal active principle in oily Folution. Suitable for spray with an oil atomiser. Dissolve Adrenalin 1 with Alcohol 7 and Hydrochloric Acid q.s. (0-2 of actual HCl = 0-6 of B.P.’14 Acid approximates theory : we find in practice a little more maj'- be necessary), then add Absolute Alcohol q.s. to 12-5 and make up to 1,000 with Castor Oil. Eucalyptol 5 may be incorporated if desired. Adrenalin Inhalant.—A preparation containing Adrenalin Chloride 1. in 1,000 made with aromatised Hydrocarbon Oil. Is soothing and astringent in inflammatory affections. Dilutions Tor use. As spray the Adrenalin Chloride Solution in Normal Saline is diluted to 1 in 2,500, or even 1 in 5,000 parts is effective in the nostrils or within the uterus. Adrenalin Tablets are made containing -Jz grain (0-001 Gm.) and -0^0 grain (0-0003 Gm.). Steruies, Ky pc dermic of Cocaine Hydrochloride -j- grain with Adrenalin tctcw grain in 15 minims for dentists’ use are prepared. 13 p 1 Tablets of Adrenalin (yj^ grain), with Cocaine Hydrochloride (r grain) are prepared for dental use. They will fit into cavities where pulp has to be extirpated, or may be dissolved in 15 to 30 minims of water forming a solution suitable for ordinary cases. Steruies, Hypodermic of Adrenalin Chloride Solution (contain 10 and 15 minims) with elongated ends, which may be snapped off; these are a great convenience, particularly in dental work to check hcemorrhage after tooth extraction. The 15 minim size are for use with the /3-Eucaine Powders in Infiltration Analgesia. CPtlnicctio Adrenalin Composite—Vic. Park. Adrenalin Hvdrocliloride Solution (1 in 1,000) 5 minims, Atropine Sulphate 1/200 grain, Strychnine Hydrochloride 1/100 grain, in 10 minims of Distilled W ater. Steruies, Ophthalmic of Adrenalin Chloride Solution are prepared. In these, the activity of the solution persists, in all probability for years, owing to their being hermetically sealed. Styptic Gelatin. Gelatin I V grains, Adrenalin Solution 15 minims, Water q.s. to 60 grams— contains Salicylic Acid 1 grain to the ounce to pre- this quantity for a dose . Biuve. Suggested for internal hemorrhage. Suppositories, Hollow, of Cacao Rutter are prepared, containing 10 minims of the Solution (15 and 30 grain size). As also 1 in !,0OG of the Adrenalin Chloride in the Theobroma mass. For haemorrhoids. !3)!FTSuppositories of Adrenalin, Cocaine, Hamamelis and Formidin contain Cocaine Hydrochloride f grain, Hamamelis Extract 3 grains and Formidin 3 grains. Germicidal, analgesic and tonic astringent. They may be made 15 grain size with 1 of Adrenalin in 1,000 of the basis. Guttae Adrenalin Gum Acido Borico R.O.H. , , Adrenalin Solution 1 drachm. Boric Acid 10 grains, Sterile Water to 1 ounce. Guttae Adrenalin Cum Zinci Chloride R.O.H. Adrenalin Solution 1 drachm, Zinc Chloride 1 gram, Sterile Y\ ater to 1 ounce. Guttae Adrenalin Cum Zinci Sulphate R.O.H. . Adrenalin Solution 1 drachm, Zinc Sulphate 2 1° " grams, ±>oiic Acid 10 grains, Sterile Water to 1 ounce. Solutio Adrenalin! Composita, St.Th.H. Adrenalin Hydrochloride solution, 1 in 1,000, 5 minims, Atropine Sulphate 1/200 gram, Strychnine Hydrochloride 1/100 gram, Distilled Water to 10 minims. ®[pTrochisci Adrenalin contain each Adrenalin, T0Vo gram ; Heroin, t^q grain; Ipecacuanha, -g^ grain; Bed Gum, 2 grains , Hose basis q.s. to 20 grains. These are astringent and sedative. _ -| • /A • I Unguentum Adrenalin. Adrenalin base 1, Lanolin Ointment 5,000, scented with Geranium Oil. Useful in the nostril in acute coryza and inflamed mucous surfaces. In neuralgia, neuritis and reflex or referred pain, small quantities may be rubbed in with advantage. fSP i!Adrenalin Catheter Lubricant.—Adrenalin (base) 1, Cocaine 10 Atropine 10. Dissolve the Adrenalin in Hydrochloric Acid (B.P. 14,) as (0-6 is usually sufficient) diluted with Absolute Alcohol oJ. Dissolve the alkaloidal bases in Oleic Acid 20 and mix this and the Adrenalin Solution with sufficient Castor Oil and Absolute Alcohol in proportion of 4 to 1 to make 1,000 of the lubricant. the pressor action is produced when taken by the mouth. The action, though Iss ma?ked?is more prolonged than of Adrenahn,-\V. E. Dixon & H. H. Dale, B.M.J. H./o9^DT0 ; J" other amine, are present in normal as Sho^ bv w Bain (see L. Lf 28,989), from urine in most urme but absent ™ Their retention is thought by him to be the cause cases of high blood Fissure. b blv to some renai defect. Palliative measures of hyperpiesis and isi due P derived from purtefactive nitrogenous material b"be1 avoided. Ueit extracts should be absolutely prohibited. See also our pp. 407, 408. Lrevo-Glaucosan. A solution of synthetic lievo-rotatory and inactive suprarenin. For instillation treatment of glaucoma. The eve drops produce a burning sensation, hence it is stated Holocam Drops 1 to 2% should be used first. The preparation must not be mif0'thtr1LievoyG™ucosan fOT^^mGaaucosan—syn. Histamine have any Neither tatriocular tension, and their action is neither S£m nof dramatic. The dilatation o£ the pupil by Lsevo-Glaucosan is unifornn nor aramauc g not rai3e tension; in secondary glaucoma it ruptures VoFh "a^d S-gF/u^ causeFsevere reaction and pain and are daBger t0 the WkLfaF"byAmericanL^^^“-pVes^Nov.-29,386. = 6 of fresh gland tissue.) Suprarenal Cortex, Desiccated. (1 Lose.—2 to 5 grains thrice daily. This has been used experimentally on the grounds that the cortex nas a function distinct from the medulla. Function of Su&rarena! Cortex. in association^rith'I“dePend«nt and antagonistic. The cortex is closely n association with internal secretion of the pancreas in carbohydrate mpta> It fsmsmanon?rtte^teinthineXt^nahleCreti0" of the ■»« a$ton. it l antagonistic to the thyroid. The parenchyma cells of the nituitarv no?ebut0?f1thJrJ}.e^,UT» f°ae:i '3 hWired’ .whether the medulla functions or not, but it the medulla is destroyed the eosinophil cells atrophy The cortex is essential to life which can be maintained with£ of one cortex* Its secretion lowers blood pressure and does not coagulate blood. It is soluble in water or Alcohol, is neither protein nor fat, is antagonistic to Adrenalin and InWbits secretion ot that substance by the medulla.—Tokumitsu, B.M.J. i Pa 40 0™on’s DISEASE has been proved to be due to destruction of the cortex Severni American workers claim to have isolated the cortical autacoid which have variously termed . ‘ Cor tin ’ (Hartman, Brownell, Dean and Mac- Art hur), Interrenin(Goldzieher), and ‘ Interrenalin* (Rogoff and Stewart) and most recently Swingle and Pfiffner's Extract infra. By means of the last- named it is claimed that life may be maintained indefinite^ in adrenalecto- mised animals.—All the preparations mentioned have given good results in Addison’s disease.—Pres., May, '31,188. m ^2^iCaV,^rr^?,nf^(fcp'7M- Td Pr'ffT)' Svn■ *E»cortonc (T.M. 5-2708). Dose. 10 to 20 Cc. intravenously or subcutaneously in divided doses daily. As much as 20 Cc. have been given at one time Addison’^ disease well treated. Thought to have an action In the crisis analogous action of Insulin in diabetes.—L. Simpson, P.R.S.M. II/12/30, Jl. A.M.A. Jan. 24, 31. ^Epinine. (T.M. 320407). Syn.—3-4 HmYDROXYPHENYLETHYLN methylamine. (OH)2.C6Ii3.CH2.CH2.NH.CH3= 167-1094 was obtained by Pyman J.C.S. 96 (1910) 264, from l-Keto-6-7 dimethoxv- 2-Methyl-tetrahydro-isoquinoline by beating it with Hydrochloric Acid at 170 to 175° G. * It differs from Adrenalin by the absence of an aliphatic OH (cf formula) It is supplied in 1% solution to be diluted with Normal Saline It resembles Adrenalin in action, but the rise of blood pressure though not so intense is said to be more prolonged. For use in ophthalmic work 0-1% as a stvntic to bieeding surfaces 0-1 to 1% hypodermically 1% and intramuscularly 0T% solutions are used. Testis.—The use of an extract from the testicles of animals was asserted to reanimate sexual power. Liquor Testicularis, Orchic Fluid. Syn. ORCHIDIN, Testiculin. Lose.—15 to 30 minims hypodermically, or by the mouth. Prepared from the testes of animals, by maceration with glycerin and subsequent filtration under pressure with carbonic acid. Cg) Sterules of Testicular Extract 10 minims, Sodium Glycerophosphate 2 grains and Strychnine Hydrochloride 1/50 grain are made. Tablets of Didymin. (Testicular substance), 5 grains. Steinach Operation.—22 cases. Contraindicated in advanced senilitv or seriously impaired cardio-vascular apparatus. , The operation is harmless It causes increased thyroid activity and stimulates other glands if dilinquent • increases activity of interstitial cells.—H. Benjamin, per Pres., Oct. 1023 357* J.A.M.A. says no instance of “ rejuvenation ” has been reported.—Ibid J358* Results of injection of Testis substance, (ram’s or goat’s) in 650 patients.’ Neurasthenia, senility, loss of sexual appetite, melancholia, etc., were benefited acne cleared up, asthma was relieved and tuberculous patients improved. ^ HypSe^rmic injections of Orchitic Extract 1 Cc. twice weekly, for 6 to 9 doses, gave good results in cases of loss of virility and general weakness. —E. C. Plummer, Pr., Dec. ’27,388. . Oral administration of a preparation of testes and adrenals in 70 tu er culous patients and 14 seniles indicated practically no efficacy. V. Koren Testicular Extract is* inactive.—J. IT. Burn, C.D. ii./26,727. Orally, administration absolutely useless. Of 15 grafting operations there had been some improvement in 30—40%; Advised m paralysis agitans, as 2 out of 5 cases showed marked benefit.— Kenneth Walker, L. i./-.5,740. Funk and co-workers have prepared from human urine an active extract called Androkinin. Koch (Chicago) has also prepared an active testicular extract but states that to produce in man etfects on sex characters equivalent; to those observed on capons the daily dose would need to represent 5 . bull’s testes tissue or two gallons of normal urine (1) —I ies., ma,}, 3B- ^Te^tofian (T.M. 414020).—Dose.—A tablet three times daily after meals* 4 preparation of the hormones of the reproductive glands and of the glands of internal secretion. Suggested for use in impotence. Thpiv^an (T M. 414021).—Dose.—As for Testogan. . , A rrrenaration made on similar lines for women. Suggested for infantile A preparation mau0 on frigidity, sexual disturbances in obesity ^&r’?Strt^dtaoide^. climacteric symptoms, amenorrhcea, neum- thfima hvpochondria and dysmenorrheea. . They are also made in ampoules for intragluteal injection. Thymus Gland, Desiccated, the call. Has been given to improve the defective nutrition m childhood, Graves’ disease, haemophilia, for anaemia, chlorosis and leucocythsemia, rheumatoid arthritis, and diabetes. iSkili^mSymus Glamt A child can take 15 to 20 grains in 24 hours.—W. MacKenzie, B.M.J. I. Liquid Extract of Thymus Gland. 1 = 1. Gener'Topinion ^'^^^^^g^^th^^extirpati'Yproducea'noappredc endocrine organs “f^endSe function is no greater thantlrat tOTany othIrfl^mphoid^structnie.—Pres.^May, ',-he flrst two to fall Slightly after the eleventh ye ^ l3%proxlmately equal in the two sexes first foui yearsofhfe, alter w absolutely heavier in the female.—• until eleventh year, when it tends to De ansonne y ii./25,1996. A. B. Bratton, Jl. Path. & Back (Edm)^Ock mu3t hav^ thymic x4YhexaminatioXn before operative procedures^are undertaken. J. V. Fisher, Jl. Lab. & Clin. Med., tfeus'** has anv existence. We No evidence that stahia tnymico-iy i y chiidren, die ior no apparent have to accept the fact tlmt a few peop j ^pej theygtate of the thymus and the reason—such deaths cann (‘ Lymphaticus ’ Committee. L. i./3i,594 lymphatic glands.-Report of Stat“ (TJt 264148). Nucleotin- Acidum Thymimcum Syn ^Sotool- ( G , after meal9. phosphoric acid. Oose.-6 ^grains (Kossel)=635-351. Approximate composition . Cm J? ’ ein3 present in food containing A product of the metabolism of the nu ™ P ^ [t p033egseg affinity and C!,,Pl°yed iU the treatment °f 9 m ?cirt w,m dissolve 1-3 of Uric Acid at 100° P. in vitro. affections,^especiallyNeuritisSeS y m,ram"scuIar “•*=«<»> in severe gouty ^h/o with, ease 1 in 5, stronger solutions mav bo 'nrcns'rpd Tmt if i<a mostly prescribed as Thyminic Acid Tablets, 4 graSsfand Fn Sets Thyroid Gland. ibis gland and preparations made from it, have been employed for relieving myxoedema, cretinism, lupus, psoriasis and chronic eczema. Ic is also used in obesity, menstrual disorders, neurasthenia, insanity, migraine and chronic rheumatic affections. The methods employed have been (1) by feeding with the glands; (2) by grafting (Victor Horsley); (3) by the exhibition of Thyroid Solution by the mouth or hypodermically; (4) by Dry Thyroid in powders, cachets or tablets. Success has been most notable in cases of myxoedema m which prolonged treatment is necessary ; obese and insane persons and weak-minded children have also improved under its use. i 0I* administration of thyroid gland preparations, is (1) a stimulating one—metabolism is increased by a process of katalysis; and (2) the production, by means of the parathyroid tissue present when sheep’s gland is used, of a substance which has the eftect of neutralising the toxic results of this metabolism. It should be noted that the Thyroid preparations on the market (mostly made from sheep’s thyroids) are obtained from parathyroid as well as thyroid tissues; deficiencies, therefore, in both these glands in man are met by feeding with these preparations. Si^ns of thyroidism must be carefully watched for during administration of Thyroid preparations. One lobe (| gland) of the sheep’s gland, we find, weighs on an u\ eiage about 35 grains and yields about 9 grains of drv thyroid. Thyroid gland treatment of myxoedema and cretinism. o F v?rigma\ c?5e r°f myx®dem.a flrat treated (hypodermically) years ago (by Murray) with Liquor Thyroidei enjoyed health by taking lo minims of \ %ly™eaCll d&y—fb ounces in the course of the year—less than a gallon l i yars. As to other uses of thyroid, the marked emaciation caused bv excessive secretion m exophthalmic goitre indicates its employment in obesity m some cases good results with adequate diet. Also sometimes valuable m rickets, rheumatoid arthritis and nocturnal enuresis. As it improves the skin m myxoedema it has been used in psoriasis and other cutaneous diseases. G. L. Murray, B.M.J. ii./i3,LG3 ; L. ii./13,201. Murray’s patient f?Sk Thyroid for 28 years. Atrophy of the thyroid need not shorten life provided this substitution treatment be fully maintained.—B.M.J. L/20,359. In exophthalmic goitre Thyroid is totally unsuited—it aggravates the condition, cf. Potassium Iodide. Arsenic and Ergot internally with Iodine locally reduced the swelling in a case but it returned subsequently surgical measures produced good effect.—L. i /11 735 ’ Use of Suprarenal gland is successful, v. p. 967. * Myxoedema, on the other hand, is speedily improved by Thvroid and a more or less complete cure is established. 4 The results,’ says Osier, 4 are unparalleled by anything m the whole range of curative measures. Within a few weeks a poor feeble-minded toad-like caricature of humanity may be restored to mental and bodily health. V. Horsley had previously to Murray’s work practised transplantation of sheep s thyroid gland into the tissues of a mvxoedematous patient. Later McKenzie showed internal use of Thyroid preparation equally good. Lhe patient must continue to take the preparation more or less all his life Cretinism—1Thyroid treatment. Results vary from complete idioev to noimality.—A. E. Naish, L. L/25,91. locv Of^hp Thvrn?H the The Applied Anatomy and Physio- Sure. i92 6 xiM06 “d L Pearse- Brlt- Joum- th? W^riQhnS5'^ Preparations may cause rapid pulse, * racing ’ of thvrSTnoiioS w o’i headache> Pruritus, and even delirium. Chronic muscula:?w been observed—the symptoms being emaciation, Thvrniri ^lmess.’ loss of hair, dilated pupils, and general debility. Thyroid, Excessive use of (Police Court Case).—L. i./i2,751. ouantitvin ondoSG °f ?hyroid fed to Soats produces no effect—the same C^k B M /Ti /-5 S4?lmtS °Ver a period ProduceB symptoms.—Prof. A. J. Thyroxin.—C15H4404NI4 (Harington)=776-8212. (The formula given in U.S. X., as found by E. C. Kendall, is believed to be incorrect.) Dose. The preliminary daily dose should never exceed 0-2 mgr. For an adult case of myxoedema the dose is about 1J mgr. Normally, an individual cannot take more than 2 mgr. a day continuously without developing signs of hyperthyroidism. U.S. X. gives l/120th giain (0-0005 Gm.). The dose is taken whole per os with half a tumbler of water one hour before meals. Thyroxin Tablets of the Sodium Salt are available of strength 0-2, 0-4, 0-8, and 2 mgr. For intravenous use the dose in crystals not tablets is dissolved with aid of a drop of 10% Sodium Hydroxide Solution in 1 cc. of water. Solutions must be fresh, pose from 1 to 10 mgr. The amount is determined by the basal metabolic rate. _ 1 mgr. increases the rate of an average adult 2%. With a myxcedema patient the maximum effect is produced on the tenth dav after a single injection. Caution—The action of Thyroxin persists for about 15 days. Wait until effect has passed off before giving a further injection. Stabs 3ity.—Thyroxin may be boiled for hours in Baryta Solution without decomposing. Preparation,—C. R. Harington received the Harrison Memorial Prize for his work on this compound. He describes in the Biochemical Jl., Vol. XX. No. 2, p. 293, a new method, using a dilute Barium Hydroxide solution for extraction. The method gives a yield of about 0-12% from the dry Thyroid gland, as against 0-0011% obtained by Kendall, using Sodium Hydroxide. The Thyroxin finally obtained is perfectly white (though the preparation of commerce is yellowish), and crystallises in rosettes and sheaves of fine needles, darkening at 220° C., and melting with decomposition and evolution of Iodine at 231° 0. to 233° 0. Physiological tests gave a reaction typical of those described by American investigators for Thyroxin. Though thyroxin reproduces the therapeutic action of thyroid, it is stated not to be present therein, but is produced during process of extraction. Thus the nature of the thyroxin-yielding substance is still a problem to be solved, as also what are the essential materials from its formation (presumably tryto- phane and iodine). J. Huxley at Oxford stated that low forms of life, e.g., tadpoles, under treatment with it, develop to the adult stage with greater rapidity than those without it. It might be utilised, the speculation goes, in influencing the sex of the offspring in man. Thyroxin being an Iodine derivative of Tryptophane a substance normally present in the circulating blood as a product of protein digestion, there is a constant supply of raw material for its manufacture. In hyperthyroidism there is over-production and an abnormally high catabolism—the action of Thyroxin as a catalyst increases tissue destruction.—Pres., Oct., 1022, 311,334. Synthesis of Thyroxin. Hydroquinone monomethyl ether is combined with Tri-iodo-nitrobenzene, yielding the diphenyl ether CH3.0.C6H4.0.C6H2l2.N02. The nitro group is successively changed into an amino group, a cyanide group, and an aldehyde group, which is then condensed with Hippuric Acid. Hydrolysis with Sul- phurie and Hydriodic Acids yields the amino acid, H0.06H4.0,C6H3T2.CH3. CH.NH2.COOil. On iodising, Thyroxin is produced having the following structural formula : I I HO <~> —0- <“> CH3.CH(NH2)COOH I I After purification, the substance was found to have the properties of natural Thyroxin, both products being the racemic form. Thyroxin is present in the thyroid as a constituent of a.complex protein, being liberated by digestive ferments in the intestine, so that its action may not be absolutely identical with the gland substance.—C. It. Harington and G. Barger, Pres., May, ’27,161. C. It. Harington (Biochem. Jl., ’26,300), in his work on the structure of Thyroxin, showed that Deiodothyroxin, a degradation product,w as a amino- /3-4*(j'-hydroxvphenoxv)-phenyl-propionic. Acid. H0.C6H40 — C6H4.CH3 CH N Ho. CO OH. It is obtained by shaking Thyroxin in an atmosphere of Hydrogen with Palladium Hydroxide—Calcium Carbonate as catalyst—the Iodine atoms being replaced by Hydrogen.—G. Barger, B.M.J. i./26,1092; ii./26,1234 : iL/27,861. ‘ L. ii./26,192 ; L/27,719. P. J. ii./26,734 ; ii./27,609. The isolation, chemical constitution and synthetisation of Thyroxin.—Prof. Barger, C.D. ii./27,700. Synthesis of Thyroxin.—P.J. U./29, and 363,364. The cost of synthetic Thyroxin is half that of the natural.—T. B. Parsons, Daily Mail, Dec. 18,’30. Thyroxin was not patented by Harington. There is no master patent.. A foreign manufacturer may become possessed of some patent which, of minor importance itself, may cut out the British maker in price. Vitamin D— Steenbock patented the irradiation of foods to make them antirachitic. The Britisher in general may be exploited.—L. i./3o,720. Hoffman-La-Roche relinquished claim to British Patent 318582 in respect of Thyroxin.—L. i./3o,1434. Uses.—The substance is thought to represent the therapeutic activity of the gland. It has been estimated that the body of a normal adult contains in all about 14 mgr. of Thyroxin, and that the daily rate of destruction of the substance is 1-1-5 mgr. : according to this calculation, therefore, a daily dose of 1-5 mgr. would be required to maintain the basal metabolic rate of a completely thyroidless individual at the normal level. Under favourable conditions during its preparations it may be said that 1 lira. (15 grains) of desiccated thyroid contains approx. 1 mgr. of Thyroxin, and this fact mav be used to advantage in determining for a given patient the dose of Thyroxin, if a change is made from desiccated thyroid to Thyroxin. A general qiiickener of metabolism. Uses and Abuses of Endocrine Therapy. —W. Langdon Brown, B.M.J. ii /2s,1051. , , The thyroid hormone alters the balance normally held between output of sirnar from the liver and its removal from circulation under the influence of Insulin secreted by the pancreas, by accentuating the response of the liver and thereby increasing the hyperglycemia produced by Adrenalin, and reducing the effect of Insulin.—J. H. Burn, P.J. i./26,292. Function of Adrenalin may be to control oxidation.—H. E. Armstrong, Proc Hoy Soc., ’25,98,202. Moureu suggests the same as to Thyroxin. If this is confirmed it is remarkable that the two endocrine principles thus far isolated have similar function and are active at centres. Oxidation being one of the main functions of the living organism it is to be expected that the process is subject to rigid control in all its variations ; even Insulin at least serves to catch and prepare sugar for oxidation—P.J. i./26,369. Myxoedcma.—Striking results with the synthetic product in two cases. —L. i.?27,883. (rp, . . Tt is calculated that one mgr. of Thyroxin causes an average increase of 2-8% in the B.M.R. In myxoedema, dried Thyroid I grain should be given once a day, increasing to twice a day at the end of one week, to l grain twice daily at the end of another week, and later to 1 grain twice a day—H. Gardiner- Hill, L. ii./27,621. In patients previously treated with dried Thyroid, 1 mgr. of synthetic Thyroxin produces action analogous to that of 0-2 Gm. of the dried gland. The initial dose of synthetic Thyroxin in the adult should not be more than 0-5 mgr.—per Pres., May, ’29,158. A case of myxcedema with B.M.It. 60-1% returned to normal after 6 or 7 weeks of oral administration of synthetic Thyroxin in total dosage of 3 mgr. An adequate substitute for gland preparations, but larger doses are necessary —per Pres., May, ’29,158. The natural Thyroxin is much more active than the synthetic— Sehitten- helm and Eisler, per Pres., May, ’29,158. The therapeutic use of Thyroxin is limited by the necessity for intravenous administration, as owing to its extreme insolubility it is absorbed irregularly when given by the mouth. Thyroxin probably exists in the gland as a constituent of a peptide or protein, but attempts to increase the solubility by preparing simple peptides containing Thyroxin have so far been unsuccessful. —Ashley and Harington. See also Tests for Thyroid activity, p. 981. Liquor Tliyroidei, Thyroid Solution (B.P. 1898). Dose.—5 to 15 minims (0-3 to 1 Cc.), freshly prepared. 100 minims represent one entire gland. It is better to add glycerin 15 to 20 of the sliced and bruised tissue, macerate 24 hours, press, and make up to the required volume with glycerin and water partes (Equates. Mixtures should be prescribed with Chloroform Water. It was a mistake to de-officialise this. It is a convenient mode of taking. During the war it was unavailable and patients had to be put on dried gland. They preferred to go back to the Liquor when it became available again.— W. Martin, P.J. L/23,233. Fla vor ing.—Glyl or Syl Aurantii Floris, Glyl or Syl Amygdalce Amarse; Syrupus Limonis. Assay.—The author suggests Standardisation with a content of 0’025 Gm. organically combined Iodine per 100 Cc., vide Vol. II. Hypodermic and intravenous injection of Thyroid Prepara tions. Our experiments showed that Liquor Thyroidei B.P. even with the addition of 0-5% Phenol is not sterile. Further work showed that spores were not killed by boiling for £ hour in sealed ampoules, but a temperature of 120° C. for i hour in the autoclave was sufficient to kill all bacteria. This treatment causes coagulation of the albuminoid constituents and in all probability is injurious to the active thyroid principle. Finally, experiments were made by the method of partial or intermittent sterilisation at 60° 0. for I hour for 10 successive days. In this case gelatinisa- tion was less pronounced, but even this preparation was not sterile. Injections can, however, be made by means of a sterilised porous clay filter.— W. H. M. Expts., Nov., 1920. Thyroideum Siccum. Dry Thyroid (B.P. ’14). Syn. “Thyroid Extract.” (Avoid the name “ Extract.”) Thyroidine P. Belg. IV. Dose.—J to 4 grains (0-03 to 0‘05 Gm.), in cachets. Should not exceed 15 grains daily.—-W. W. W. Prepared from healthy fresh glands of sheep; the surrounding fat, etc., is first removed; the glands are finely powdered after dry°- ing at not exceeding 40° C. ; and finally the substance is freed from fat by Ether percolation. (One part equals about 5 of fresh gland.) Assay,—The author standardises this Reparation to 0-2% Iodine in organic combination. U.S. has this as average, P. Belg., IV. 0*2%. Iodine in thyroid present in two forms, but only that present as Thyroxin is physiologically active. The Pharmacopoeia Commission reports that Iodine should be determined in terms of Thyroxin Iodine. Inorganic Iodine should not exceed 10% of total Iodine.—C. R. Harington and S.S. Randall, Qtrly. Jl. Ph. ’20,501. See also T. McLachlan, C.D. i./32,85. P.G. VI. requires at least 0T8% Iodine with precise methods of detection of adulteration with Iodine compounds. P. Ned. specifies Thyroid must be desiccated at 30° C. and adjusts to 0*3% with Lactose. F. E. VIII. specifies sheep, ox or other animal used for food. 0-2% combined Iodine. P. Ital. V. is similar. For Method of Assay, see Vol. II. In many samples examined the Iodine content rarely, if ever, fell below 0-25% for Thyroideum Siccum.—W. Martin, P.J. b/23,233. Tlivroid ‘ Extract’ is an unfortunate name to indicate Thyroideum Siccum (R.P. ’14). The fresh glands basis also introduces grave misunderstanding. Myxcedema, a case did no good with a course on the latter basis but when dosage of Thvroideum Siccum was given there was improvement at once.—A. E. Carver, B.M.J. ii./i7,515. M. H. Martindale, in support of this letter drew attention to the necessity of standardising Thyroideun Siccum.—Ibid. 570. See also A. Goodall, B.M.J. i./i 4,1351. Standardised Thyroid Tablets, 1J and 5 grains (01 and o-3 Gm.) (We discard the old fresh substance basis for Thyroid Tablets a* being unscientific and misleading. H. W. Pames repeats our advice which has been in the book for some 20 years to prescribe as Thyroideum Siccum.—L. i./32,168. For a number of notes on the matter se<: Edn. XIX., p. 988, and Vol. II.). 1% Sodium Chloride or Potassium Nitrate as preservative is said to b desirable.—F. G. Hobart, P.J. i./26,329. * Thyrogiandlin. (T.M. 279708), is a trade brand of dry Thyroid Dose.—3 to 5 grains. ‘Four Gland’ Tablets. Syn. Compound Thyroid Tablets Martindale. Dose.—One or two twice daily for adults,—youn^i children in proportion. These Tablets contain 1 grain each of Thyroid, Thymus, Suprarena and Pituitary Gland substance. A treatment in mental and physical deficiency based on th therapeutic action of the internal secretions—the combined action of the internal secretions is aimed at. Correlated action in variou diseased conditions between the thyroid and thymus gland, th suprarenal gland and the pituitary gland, etc., is proved also be tween the thymus and the suprarenals and testicle and ovary, ais between the suprarenal, pancreas and pituitary and so on. In short physical, mental and metabolic changes occur as result of interferenc with the internal secretion of nearly all the ductless glands. The above tablets have been given in myxoedema, in cretinism and infantilism with good mental and promising general results Active rickets improved by half a tablet twice a day. Tablet containing extracts of the pancreas, testes and ovary also sug gested.—A. S. Woodwark, St. Bart.’s Hosp. Rep. Vol. XLVIII. ‘Three Gland’ Tablets—omitting the suprarenal gland—have also been employed on the same lines. Elixir of ‘Four Glands,’ Martindale, is also prepared. Dose.— 1 to 2 drachms= 1 to 2 * Four Gland 5 Tablets. Elixir of ‘ Three Glands,* Martindale. Dose.—1 to 2 drachms = 1 to 2 ‘ Three Gland * Tablets.—These Elixirs have also been employed in the same conditions as the Tablets. Mixed Gland Tablets, No. 1 (Male), contain Thymus Gland 2 grains, Thyroid Gland l/5th grain, Pituitary (Anterior Lobe) £ grain, Suprarenal Gland i grain, Didymin -g grain, Cerebrin 4 grain; JS’o. 2 (Female) contain Thymus Gland 2 grains, Thyroid Gland l/5th grain, Pituitary (Anterior Lobe) i grain, Suprarenal Gland £ grain, ‘ Varium ’ k grain, ‘ Mamos ’ 4 grain, Cerebrin 4 grain. . .... . For pluriglandular therapy in instances in which it is difficult to determine which gland constituent is at fault. # Hormotone (T.M. 365396) is described as a combination of hormones derived from the thyroid, pituitary, gonad and suprarenal glands. Each Tablet contains 1/20 grain of desiccated Thyroid and pituitary. Dose.—One or two tablets thrice daily before meals ; not more than six per day. Stated to favour metabolism and increase mental, nerve, and muscular activity. L. ii/i3 84 Hormotone without Post-Pituitary. Tablets are also made for use in neurasthenia associated with high blood pressure and all hypertensive conditions. Hormonigen Tablets. Dose.—One or two tablets before meals. Contain Thyroid, Pituitary, Ovary and testes. In neurasthenia and for pluriglandular therapy. ^ Incretone (T.M. 482917). Dose.—l to 2 teaspoonsful before meals—children less. Contains Thyroid, Pituitary and Gonads. For use m asthenia, general debility, etc. Statedtolnciude ‘ all the mineral constituents of the organism,’ plus Thymus, Parathyroid, and Suprarenal extracts. In tablets or granules for tuberculosis debility, pregnancy, lymphatism, asthenia. Tests for Thyroid Activity. Ba^al Metabolic Rate (B.SVS.R.) means the rate of energy exchange m the bodv as seen under basal conditions (after elimination of movement, digestion, etc.). A relatively simple way of determination (as described by Benedict Jl. A.M.A., July 23, 1921, p. 247, and Krogh, Brit. Ass. Rep., 1921, n 445) is to measure the oxygen consumption of the patient during a given neriod Air plus oxygen is rebreathed in a closed-circuit apparatus m which the exhaled CO.* is absorbed, the diminution in volume of the gas indicates the amount of oxygen consumed. The B.M.R. does not vary as much as 10°/ * In hvperthvroidism it rises to 25 or 50% above normal, or even more ; while in deficiency the rate falls below normal. To maintain it at normal. 19 to 14 mgr. of Thyroxin, Boothby has calculated, must be present in the civstem The Thyroxin is used up at the rate of about 0-5 mgr. a day. In a pflSe of mvxcedema this amount would have to be given daily intravenously. Timinr Thvrnidfti (B.PJq8) estimated to be 10 minims or . R. Murray, Clin. Jl. Aug. 1, T , 01Q Determination and interpretation.—H. I. Moore, ij. 1./2 5,^19. Many cases of hyperthyroidism are diagnosed as neurasthenia and treated with tonics with little improvement Determination of the B.M.R will easily differentiate hyperthyroidism from other conditions.—H. W. Riggs, per Pres., May, ’21,188. References to Thyroid Treatment. General References. It is worthy of note that arsenic and iodine were used in the treatment of myxcedema long before these were found in the thyroid gland. Numberless reports of the relief of myxoedema and cretinism have been recorded. Opinion varies as to its value in obesity. Has been used successfully in lupus, psoriasis, in pityriasis rubra, ichthyosis and alopecia ; and in enuresis. Position of the thyroid gland in the endocrine system—a powerful activator of metabolism. Co-operates with the adrenals and pituitary and antagonises pancreas and parathyroids.—W. Langdon Brown, B.M.J. if 2 2,85. The thyroid is the gland of creation. Has anyone ever heard of a myxcede- matous artist ? Crichton Miller asks again for subthyroidic creators—be it of works of art or of children. The woman of artistic ability ceases to create works of art as soon as she is taken up with the maternal function.—B.M.J. ii./22,552. The thyroid apparatus is primarily concerned in controlling the direction of protein synthesis within the body, the thymus being the reserve store of nitrogen.—G. Scott Williamson.—L. ii./23,1337. Taking thyroid apparently caused disposition to chilblains. Any good in the past attributable to thyroid taking probably due to parathyroid contained.—I). C. Nasmyth, L. i./26,99. See also I. G. Cobb ibid.260. Thyroid, the only endocrine substance which has any effect when given orally.—S. Vincent, Pr., Dec. *31,613. Thyroid Therapy—a review of literature.—Pres., May, *29,167. Specific References. Acromegaly improved.—B.M.J.E. L/96,51 ; L. ii./96,614. Alopecia.—Its association with thyroid dysfunction. Report of a case cured by thyroid treatment.—per Pres., Oct. *28,323. Amenorrhcea.—The function of the thyroid is (just before onset of menstruation and early in pregnancy) to stimulate calcium excretion which may take place from the uterus or failing that from kidney or bowel.—B.M.J. i./o9,597. Dysnienorrhoea and even amenorrhcea are often marvellously benelited.—II. Ewan W aller, Pr., Aug., ’12,279. Arterio-SCLKROSIS.—Thyroid preparations are useful.—B.M.J. i./o6,121. Constipation.—Thyroid in 4 Gm. doses for 10 days increases peristaltic action. The dose is stated to be well tolerated by infants.—Pr., July, ’30,253. We advise caution. Dercum’s disease treated by 5 grains thrice daily. After two weeks reduced pain and alleviated numbness and tingling and reduced size of swelling.—B.M.J. ii./oQ,516. Enuresis, nigiit terrors, etc.—Original doses used were too large. Of value for children who show failure to grow.—W. Langdon Brown, L. i./25,739. ECZEMA of infants. Suggestion for use in obstinate, and where the thyroid is thought to be functioning badly—well borne even by young infants and has proved successful.—Pres., June, 1911, p. 163. X-llays on thyroid glands (Rabbits),—effects.—B.M.J. i./i2,28. Eclampsia should be treated prophylactically with thyroid. Belief of giddiness, swelling and check to albuminuria pronounced.—B.M.J. i./i3,1272. In auto-intoxication of pregnancy and impending eclampsia. Full doses.— L. ii./o3,307. Chronic subcutaneous fibrosis treated by thyroid gland (or Liquid Extract of Eucus) diabetic diet, exercise and massage. Unless the obesity can be reduced, the prospects of improvement are slight.—B.M.J. i./n,354. Deafness in old people has been well treated by a small dose twice daily. Epilepsy in women also ; number of fits reduced. There would appear to be some ciose connection between endocrine insufficiency and poisoning from intestinal absorption. The addition of an intestinal antiseptic, e.q.y Ben- zonaplithol or Calomel or Ichthyol, is useful.—F. J. Sadler, L. i./22,930. Dupuytren’s contraction believed to be indicative of thyroid insufficiency. Thyroid gland thought to have improved cases. 14 grains daily and in one case 163 doses were given. R. Black, B.M.J. L/I5j328. Goitre.—Thyroid medication apparently has a regulating effect on the calcium of the organism.—B.M.J. i./o9,597. Theories have been promulgated to show that types of goitre depend on the relative proportions of Calcium and Iodine in the blood.—Pres., Oct., 22,360 ; May, ’24,186. Unilateral exophthalmos following use of Thyroid. A case of myxoedema. 3 21 grains daily taken during a year. Suggestion to limit sale of Thyroid.— T. Gillman Moorhead, B.M.J. i./3i,442. Hyperthyroidism is generally considered to be typically manifested in Graves’ disease, and that many of its clinical symptoms are directly due to excess of thyroid secretion is proved by the fact that removal of portions of the Thyroid gland materially lessens or entirely eliminates the ill effects of the excess. The clinical signs of Graves’ disease are not primarily all due to the increased thyroid secretion. The protruding eyeball for instance is now looked upon as the result of suprarenal excess.—H. Stanley Jones, Pres., Oct., 1922. The problem of hypothyroidism, concerning the signs of which a small volume might be written, is the discovery of the underlying cause.—Pres., Oct., 22,314. Infantile or adolescent myxoedema cured by Thyroid treatment—case described.—R. Hutchinson, per Clin. Jl., April 18/2 3,183. Graves’ disease is usually secondary to some pre-existing chronic infection. It is usually associated with dental defects, tonsil and nasopharyngeal troubles, with rheumatism and with colonic disturbance. Give Tinct. Iodi Mitis 5 minims t.d.—H. Ewan Waller, Pres., Oct., 1922. Hemophilia controlled by the liquor.—B.M.J. ii./oo,1375. Hay fever.—1 to 3 tablets daily will benefit.—M.A., 1908,37. Hyper- and Hypo-Thyroldism — The thyroid gland the. storehouse for Iodine—without it the gland cannot functionate properly. Tincture of Iodine in treatment better than organically combined Iodides. In mastitis the larger nodular masses in the breast often readily dispersed by Thyroid, Iodine and decalcifying agents. Enlarged prostate similarly treated. An account of Albert Abrams’ methods.—Sir J. Barr, Pr., June, 1921. The ultimate effect of the activity of the thyroid in situ is to raise the blood pressure, and the same result is produced by administering Thyroid, (jross misuse of Thyroid had occurred through its recommendation as a means of reducing blood pressure.—H. Ewran Waller, Pr., May, ’13,881. Hypothyroidism and the ‘vicious circle.’ The forces of nature are often successful in breaking it. Owing, however, to the extraordinary instability of the thyroid, the reactions provoked by disease appear readily to paralyse the process of recuperation. In the case of the cretin the physician has a magic vrand. In other cases the remedy is less striking, because the mischief is less apparent.—J. B. Hurry, Pr., April, ’22,283. Ante-.N4.tal and post-natal influences of the Thyroid.—The presence of a living foetus in the uterus appears to have a direct influence m exciting the thyroid into activity. It has been called the female gland because it plavs a more important part in the physiology of the female than in that. of the" male. A woman may show7 few signs of hypothyroidism m pre-marricd life, but when put to the larger test of pregnancy the thyroid may fail adequately to respond. A liberal supply of thyroid hormone is most essential duriU gestation, and, if not forthcoming, disturbances of health are inevitable -affecting the mother, or foetus or both These disturbances can often be lessened or relieved by administration of tiivroid substance. I hyroid deficiency mav result in abortion, premature labour or abnormalities of the chud. The comparative difficulty of rearing male children may be due to the fact that mothers of male children are unable to supply sufficient thyioid through their milk. Cow’s milk varies in its Iodine content, and may be deficient in thyroid. Some cows persistently give a milk too low m Iodine content, and cow’s milk in the summer shows a higher percentage o,. Iodine than in the winter. Hyperthyroidism in pregnancy, if not excessive, inay be ot advantage rather than otherwise. Disturbances m the thyroid function are the prelude to disorganisation of the functions of other endoermes.— H. Stanley Jones, Pres., May, ’24,180-182. Infection an important factor; influenza one of the chief precursors, and rheumatic fever the next. A useful outline of the chief symptoms of hyperthyroidism. Any child developing an enlarged thyroid at or before pubeity should have Iodine treatment. Average adult dose, 10 minims French Inn ture of Iodine or Lugol’s solution, in milk, once daily—halve this dose for a child of 14. Treatment given for two weeks in every month ; no toxic symptoms with doses less than SO minims when given over considerable period. See that pulse rate does not increase and gland does not become intense and hard. Elimination of sources of focal infection—teeth, tonsils, etc.—important and rest essential. If patient loses weight Insulin useful. 15 units daily. Thyroidectomy if necessary should only be undertaken after adequate Iodine treatment.—H. J. Starling, Clin. Jl., Feb. 8 and 15, ’28. Borax in small doses has been advised in hyperthyroidism, v.p. 12. Menopause.—Endocrine insufficiency.—The neurasthenic discomforts of the climacteric in women treated byl/10 grain B.P. Thyroid Siccum once daily. This is safe from risk of over-dose. Nephritis with oedema and albuminuria without hypertension.—Dried Thyroid 0-05 Gm. daily for several weeks, may give excellent results in.— Presse Med., Aug. 15, *25,1093, per Pres., May ’26,187 ; Jl. A.M.A. ii./2 5,1010. Obesity (‘ Girdle ’ obesity and * Froelich syndrome ’). See also Obesity— Therapeutic Index. Treatment by Thyroid and whole Pituitary Gland. Tablets of each gland (dried substance) are prepared, containing £ grain, 1 grain, etc., up to 5 grains. Beginning with the smallest dose, 1 tablet of each is given, 3 times a day before food for 14 days. The dosage is increased each 14 days until a reduction in weight of 2£ lbs. weekly is obtained, and this dosage is continued until normal weight is restored. Disappointment with Pituitary medication by the mouth nearly always due to timidity in dosage ; give suitable doses. Some have tried Anterior Lobe only, but the whole gland is apparently better. Thyroid in obesity in adolescents did good.—H. Gardiner-Hill, B.M.J. i. /2 5,096. The nervous excitation provoked by Thyroid medication to reduce weight may last for weeks and be disastrous.—B.M.J.E. i./2 5,30. Certain cases of obesity, adolescent goitre and defective goitre treated by giving thyroid and pituitary simultaneously.—H. Gardiner-Hill, B.M.J. ii. /2 5,1057. Pneumonia. Manganese and thyroid treatment, seep. 547. Pruritus vulv^e well treated with dried Thyroid gland obtained direct from slaughter house, 0T Gm. being given per os daily. Pruritus completely ceased after 2 weeks treatment but returned after discontinuation of treatment. 0 05 Gm. of the dried Thyroid substance daily was found to keep the pruritus at bay.—A. Bregmann, per Clin. Jl., Nov. 28, ’23,575. Raynaud’s disease.—Thyroid toleration. A patient did not improve until ‘ 17 grains of thyroid gland ’ were given a day.—H. W. Barber, L. i./22, 453. Rheumatoid arthritis.—With mercurial inunction as adjuvant; remarkable results in a month—B.M.J. i./io,1770 ; see also L. i./io,643. Of 100 cases of rheumatic arthritis 70 felt distinct benefit after administration of combination of thyroid, pituitary, ovary and testes per os.—A. G. Watson, Pres., Nov. *26,411. Menopausal arthritis should be treated with Thyroid £-2 grains daily.— G L Kerr Pringle, Pres., Nov. ’26,390. But J. H. Hannan, B.M.J. ii./27,15, says it should not be given at the menopause owing to its Adrenal sensitising action. . . _ Skin affections.—Psoriasis, alopecia, ichthyosis and xerodermia of unknown origin. If the gland is smaller than usual (found by palpation) try thyroid.—B.M.J. i./i3,1037. Acne in youth is sometimes referable to hyper- ^A^efirfite relation traced between the activity of the thyroid and certain skin diseases Distinct improvement, e.g. in ichthyosis and eczema, following use of dried Thyroid and Calcium Chloride.—F. M. Pottenger, Endocrinol, Mar.-Apl. *26,105, per Pres., Oct. *26,343. Psoriasis —Success is sometimes rapidly attained by the use of Thyroid 3 grains daily and externally Hutchinson’s Paint (equal parts of Liq. Carbonis Detergens, Rectified Spirit, Lead Subacetate Solution, B.P.).—E. C. B. Ibotson, L. i./25,1182. Tertiary syphilis.—Good results have been obtained with Thyroxin.— G. R. Murray, Clin. Jl., Aug. 1, 23,362. Young children treated—Pres., May, ’24,195. Para-thyroid Gland. These are four minute bodies embedded in the thyroid. They contain no Iodine. Then internal secretion possesses hormones which exert a powerful influence on the nervous system. (Sir E. Sharpey Schafer.) The glands are as essential to life as the thyroid. On experimental removal, in addition to causing tetany and death hi a few days, the lime content in the tissues is reduced, there is increased Calcium and Nitrogen excretion, increase in amount of absolute and relative Ammonia in the urine and increase in the Ammonia content of the blood. Parathyroid in effect, is held to regulate metabolism. It is also thought that thyroid secretion promotes metabolism and parathyroid renders the products formed innocuous. Uses,—In tetany, tetany of pregnancy, tetany of childhood, epilepsy, paralysis agitans, sprue (with Calcium Lactate) and eclampsia. Desiccated Para-thyroid Gland. Dose.—1/60 grain (0*001 Gm.) to 1J grains (0*1 Gm.) thrice daily. The fresh parathyroid gland weighs on an average 0*09 Gm. This yields from 0*015 to 0*02 Gm. of desiccated powder, he., 1 = 5 approximately of fresh substance. r&fogets contain 1/20 grain (0-003 Gm.), 1/6 grain (0-01 Gm.), 1 grain (0 016 Gm.), and £ grain (0-03 Gm.) Desiccated gland. There is not enough Parathyroid in the country to keep one small manufacturing laboratory going.—H. H. Dale, L. ii./2 6,199. Paratnyroid Extract (Liquid) (Collip), may be prepared by treating the glands with 5% Hydrochloric Acid for one hour at 100°. The solution is made alkaline after removal of fat and proteins. Hydrochloric Acid is then added to give maximum precipitation, and the solution is filtered. It is suggested that the potency of Parathyroid extracts can be estimated by the rise in Calcium in blood-serum of dogs.—J. B. Collip, E. P. Clark and J. W. Scott, Jl. Biol. Chem., 63, Mar. ’25, p. 395 ; 64, p. 485. Parathyroid, ovary and pancreas require some special method of extraction to obtain active preparations. It is necessary to break up combinations with lipoids to get water soluble preparations. Collip’s preparation is effective given per os.—Swale Vincent, B.M.J. ii./25,1055. Collip’s Parathyroid used in a case where puathyroid gland had been removed in error. Injections proved curative.—L. i./26,874. Parathyroid has a sedative effect on nervous tissues and promotes healing from effects of chronic sepsis. (Vines). Collip appears to have isolated the active principle.—W. Langdon Brown, B.M.J. ii./25,1051. Parathormone-Lilly (T.M. 481885) (Collip’s Extract). A solution of the active principles of parathyroid gland of cattle. Believes symptoms of parathyroid tetany and increases Calcium content of blood serum. Claimed to be specific in tetania parathyreopriva and to relieve acute and chronic tetany following thyroidectomy, so-called idiopathic tetany and infantile tetany. Use may be attended by great danger unless due precautions are taken to avoid overdosage.—Pres., May ’26,191. Endocrine factor in producing immunity and susceptibility of the teeth to caries. The parathyroids, pars anterior of the pituitary, medulla of suprarenal, with possibly the thymus gland, regulate absorption and fixation of Calcium, while the gonads (ovary and testes) and possibly the thyroid, regulate excretion.—E. W. Broderick, L. ii./2i,1216. Danger of overdosage. The hypercalcemia induced is not due to improved assimilation but is the cause of an increased loss of Calcium. Not to be used to promote Calcium assimilation, as it has the contrary effect.—Jl. A.M.A. i./26,352. Long use bad as ‘ immunity ’ is acquired against it.—J. C. Aub, M.A., ’31,348. Paroxysmal tachycardia. Parathyroid l/10th gr. thrice daily used with remarkable effect.—C. Dukes, B.M.J. ii./2i,987. Elixir Parathyroid with Calcium Lactate, Martindalc. Dose.—l drachm (4 Cc.), increased if necessary. Contains 1/20 grain Dried Parathyroid Gland and 3 grains of Calcium Lactate in 1 drachm. Calcium deficiencies treated by Parathyroid.—Varicose ulcer, found to improve under intramuscular injection of Calcium salts up to a point but did not proceed to complete cure ; under Parathyroid, healing was more rapid in cases at rest and in early cases. l/lOth grain of dried gland was given until laboratory tests showed that the ionised Calcium had returned to normal.— W. B. Groves and H. W. C. Vines, B.M.J. ii./2i,40,152,687 ; L. ii./2i,1383 ; B.M.J. i./22,791. Leucocytic activity is stimulated.—ibid. i./23,106. There is little evidence of a relationship between the calcium factor and the detoxicating function, but clinical results show a parallelism between the restoration of the calcium balance of the blood and improvement in general health.—H. W. C. Vines, Pres., Oct. 1922,339. Tetany treated. Some good results have been reported.—Prof. Swale Vincent, L. i./23,130. Tetany, following removal of right lobe of thyroid gland benefited from parathyroid l/10th grain hypodermically, and large doses of Calcium Lactate.—Davies, B.M.J. i./23,512. Parathyroidectomised dogs can be kept alive without symptoms of tetany by diets containing (1) large amounts of lactose or (2) large amounts of Calcium salts.—Pres., May, ’24,199. Gastric, duodenal and varicose ulcers well treated.—L. Williams, B.M.J. h/23,1010. Sprue.—Parathyroid 1/10 grain twice daily, with Calcium Lactate 10 or 15 grains 3 times daily gave good results.—H. Harold Scott, L. ii./23,876 ; B.M.J. ii./24,308, and V. Coates, ibid. 623 ; C. F. Shelton, B.M.J. ii./25,844. But there is no statement that the author tried Calcium Lactate without the Parathyroid.—Prof. Swale Vincent, B.M.J. ii./25,1056. Vines says Scott obtained equally good results without Calcium at all, using the Parathyroid alone.—B.M.J. ii./25,1059. Sprue.—No conclusive evidence of efficacy.—Dan T. Davies, L. i./3o,203. All the older remedies reviewed. Certain cases did well with Calcium and Parathyroid.—Lt.-Col. H. W. Acton, B.M.J. i./3i,222. Delation between the parathyroid and the pancreas.—Pres., May, ’24,200- Tuberculosis. In view of the Calcium loss, characteristic of, parathyroid should be tried. Psoriasis treated by Parathyroid 1/10 grain once daily.—B.M.J. i./24,772. Spasmodic rhinorriicea treated by Calcium Lactate 15 grains and Parathyroid 1/10 grain twice daily.—W. M. Mollison, B.M.J. ii./29,1052. Use in tetany, oedema, epilepsy, haemorrhage, jaundice.—Pres., May, ’28, 165-8. Acute parathyroid tetany relieved and controlled without use of parathyroid ; the parathyroids do not perform a metabolic function indispensable to life.—Dragstedt, per Pres., May, ’29,172. Parathyroid Therapy—a review of recent literature.—Pres., May, ’29,174. Otosclerosis treated by Dried Parathyroid, 1/3 or £ grain daily, increased to 1£ or 2 grains. Hearing and general health improved.—E. Watson Williams, L. i./29,814. Progressive muscular atrophy treated by Parathyroid Extract 1/10 grain hypodermically daily, Cod Liver Oil per os 1 ounce twice daily, and Calcium Chloride in solution 15 grains thrice daily.—T. H. Thomas, B.M.J. i./28,978. Standardisation by means of incubation with a known amount of Guani- dine (excess of this can be shown in the blood and urine in tetany, and ir animals Parathyroidectomised).—H. W. C. Vines, B.M.J. ii./23,559. See alsc Vol. II. Thyroidectin. Dose.—5 grains in capsules. The dried blood of thyroidec tomised animals. Has been given in Graves’ disease on the theory that the serum of sucl animals contains substances which would neutralise the excessive formatioi of thyroid. Thyroidectomised Goat’s Milk has also been used. BLOOD TRANSFUSION. 9S7 . , BLOOD TRANSFUSION. titqt* Ie TfI1VaKi0f f operation is due to the brilliant results achieved in the waTr- „ • en, l6s loss of oxygen carriers and blood volume to be replaced. rv1^firi10U|ly -l\ pei1'?5)^s bef°re an operation, the administration of 200 to 500 cc. of blood with a little Sodium Citrate added is resorted to. The mortality influenza and pneumonia might be lessened by its use. Blood diseases, hemophilia, purpura haemorrhagica are also treated. There is, however, an in- ompatibihtj/ ^ of bloods of certain individuals. Two such incompatibles cannot act as donor and recipient ’ respectively. Landsteiner s Law of iso-agglutinins. There are present in human blood two agglutmabxe substances, A and B, which react wdtli specific agglutinins, a a?a, 11 blood contains an agglutinable substance, it will contain the agglutmm wmch reacts with the alternative agglutinable substance. Blood wlucn contains A will contain b agglutinin and vice versa. Numbers are used ror the groups. Thus Group II. possesses the agglutinable substance A and agglutinin b Group III. the substance B and agglutinin a, Group IV. has both agglutmms but no agglutinable substance, and Group I. has both A and B but neither agglutinin. The Law is : “ In any blood there are always present agghitanms against the agglutinable substances absent from the same blood.” With samples of serum from known Groups II. and III. it is possible to test any blood before a transfusion. For practical purposes the corpuscles of the donor should not be agglutinated by the recipient’s serum, for although theoretically the donor's serum may agglutinate the recipient’s corpuscles this serum is so largely diluted that this need not be considered. Since the corpuscles of Group IY. are agglutinated by no serum of any other group, the members are ‘ Universal donors,’ and generally a Group IY. ; blood is chosen. See however S. C. Dyke, L. ii./27,910. Directions for testing.—Into a ‘ Wassermann * tube is placed a little N/10 sodium citrate in normal saline and four or five large drops of blood from finger are added. On to one end of a micro slide is placed a drop of Group II. serum, and on the other a drop of Group III. serum, to each of which is added a little of the corpuscle emulsion, each mixture being stirred with a glass rod and the slide gently rocked. Agglutination is visible to the naked eye, and appears as a deposit, the particles of which may get larger until in some cases a few crimson dots float in clear serum. Albuminuria, cardiac debility and marked obesity would exclude the donor. —E. F. Skinner, B.M.J. i./23,750. See also ii./25,516. Alternative procedure.—Some blood is taken from the recipient and centrifugalized to separate the clot. A few drops of the donor’s blood are taken into a 1-5% solution of Sodium Citrate and shaken up. A drop of the serum is mixed wfith a drop of the corpuscular emulsion on a slide and a cover glass placed on it. If no agglutination in 5 minutes the donor's blood is suitable. No need to determine the group.—S. Wyard, Clin. Jl., May 2/23, 206. Sodium Citrate 10 Cc. 2% added to 100 Cc. of blood as collected and the mixture filtered through gauze.—H. Pritchard, B.M.J. i./27,793. References.—Lists of ‘ Universal Donors ’ are kept.—II. Wallace Jones, Pr. Mar., 1921. Malignancy and blood grouping.—All four groups liable to malignant disease, but groups 1 and 3 peculiarly susceptible.—M.P.C., Nov./22,301. Kimpton-Brovm method. A small amount of 3-8% Sodium Citrate used in the tube before puncturing the vein.—AY. B. Gabriel, L. i./26,1255. Medico-legal significance of groups. It is impossible to identify the father of a child, but it can be stated with certainty that the alleged father is not the father in fact.—L. ii./28,711. 1 Gm. Sodium Citrate in 60 Cc. water for each 450 Ccs. blood. An interesting paper with diagrams.—G. Keynes, Pr. Oct., ’31,422. B.M.A. Discussion, London, Oct. 26, ’31. Prof. A. Fleming.—Whole blood largely replaced by citrated or defibrinated blood—the latter leaves the leucocytes undamaged, and easiest to apply. Immuno-Transfusion beneficial in some desperate cases. Procedures (1) introduction of Nuclein into the donor (2) injection into donor of hypertonic saline, increasing bactericidal powrer. PL. L. Tidy.—In ansemia, haemoglobin below 30% an indication for transfusion and below 25% transfusion imperative. O. L. Keynes.—Indicated in haemorrhage and shock ; in pre- and post-operative conditions—gastric and duodenal ulcer ; in haemorrhagic diseases ; in blood-diseases—septicaemia ; in bacterial infection—pneumococcal peritonitis. Calls on the London Blood Transfusion Service (voluntary donors) consistently increasing—2,000 calls during 1931— more than 100 hospitals called for its services. Good effects in more than 50% of cases. J. 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CQ O >3 HP 03 (» Cl Jh cl O a) 09 a s S u ri > O a) i3 h h « m3 CQ >ft> T3 i—i 03 O 4P u o > a) fe o X3 0< >» H CO rd Tj tH T—I o ■+P to 03 r-H . CQ O >3 hp ce » 3 .3 a H •oo C J •rt 43 a-oj) 2 3 2 © f3^ £ POISONS. The Chemist and Druggist is legally qualified to supply poisons and ‘ poisonous ’ substances—the latter being differentiated in their significance, cf. p. 992*—without a medical man’s prescription. In view of the exacting nature of the Poisons and Pharmacy Act, 1908 (8 Edw. 7, ch. 55), it is of importance to be able to determine the position of any poison in the Schedule thereto, which is in two parts. We provide the Schedule and further details of the Act. As in past Editions we show Part I. Poisons by means of the sign _and those in Part II. by Cg). These signs precede the names of the poisons— once, as a general rule, under its main heading. In determining whether an alkaloid is a poison or not, we take the dose and the uses in each case into consideration; there are few on the borderline between poison and non-poison. A small amount of misuse of Cocaine has occurred in this country, but many of the reports are grossly exaggerated. The Cocaine Substitutes remain completely unrestricted. They are, further, not touched by the Dangerous Drugs Acts (q.v.). As a further criticism, Mercuric Chloride cannot be bought by the public except under [Jpjy restrictions, but any quantity of aqueous solution (an ounce will dissolve in a pint) can be legally obtained as a C£) poison. In Northern Ireland, however, 'preparations of in addition to the chemical itself. Sublimate are Pharmacists, it may be said, guard against misuse of poisons, which they alone are permitted to sell in open shop. Local authorities who license persons other than legally qualified chemists, to sell “Poisonous substances used exclusively in agriculture or horticulture ’’ should realise the seriousness of the duty entrusted to them. Fac ilities are granted for more easily obtain - ing arsenic and nicotine. Provisions are made for mineral acids and soluble salts of oxalic acid to be labelled “ Poisonous.” According to the Act, a body corporate, or in Scotland a firm or partnership, may carry on the business of Chemist and Druggist if the business is under the control of a qualified superintendent. Certificate of qualification of bona fide superintendent must be exhibited in the shop. The word Pharmacist can be used by Chemists and Druggists but not by companies. At a B.M.A. meeting it was resolved that the sale of Arsenical preparations, included in Section II. of the P oisons and Pharmacy Act 1908 (i.e.y in the Schedule of Poisons), should be limited (1) on the part of the seller to properly qualified and competent pharmacists, and (2) on the part of the purchaser to those who had obtained a licence for their possession.—Sir William Willcox, B.M.J. ii./22,374 ;P J. ii./22,127. The poisons Schedule is unintelligible.—."Rutherford Hill "P.J.,i./26,13. Amendment of the Pharmacy Act, defining.Wholesale Sale, needed. Difficulties, re agricultural Arsenicals and insecticides for. P.J. i./26}505. Commission appointed to enquire into safe of poisons, retail and wholesale: keeping, distribution and supply.—B.JVl.J., 11/20,^60. Departmental Committee Report on the Poisons and Pharmacy Acts. B M J i /3c 554 * The* present system of Scheduling Poisons is inadequate to keep pace with the launching of new drugs. Drugs of the Quinophan group are not even on the Poisons Schedule, and can be sold by any unqualified person.—Sir Win. Willcox, B.M.J. i./si,597. (2) (3) SCHEDULE OF POISONS. Applicable to GPvEat Britain. (Under the Poisons and Pharmacy Acts as amended to date.) Part 1 (marked (PJ in our text). Not to he sold by retail unless the purchaser is known to, or introduced bv some person known to, the seller who must be a registered Chemist and Druggist or registered medical practitioner ; also before delivery of the poison entry to be Blade m poisoD-book of (1) date of sale, (2) name and address of pur- chaser, (3) name and quantity of article, (4) purpose for which it is wanted— attested by signature of buyer and if necessary of the person introducing IJ11’ and Biust be labelled with (1) name of article, (2) the word “ Poison,’' the proportion which the poison or poisons bears to the other ingredients (4) name and address of seller. See also Regulations re bottles etc. p. 993 Aconite, Aconitine and their preparations. Alkaloids.—All poisonous alkaloids, not specifically named in this Schedule and their salts and all poisonous derivatives of alkaloids. (Altered March 3, 192 5J . Arsenic, and (all) its preparations except preparations used exclusively in agriculture or horticulture for the destruction of insects, fungi, or bacteria or as a sheep wash or sheep dip if the preparations are : ' d) Contained in a closed package or vessel distinctly labelled with a notice of the special purpose for which the preparation is intended ; and bold upon an order in writing given by or on behalf of a person, firm, or body corporate known to the vendor, and Purchased for the purpose of the trade or profession of such person firm, or body corporate. (Altered March 3, 1925 and August 14, ’26! See- P.J. i]./26,102.) See also Arsenic Act. Atropine, and its salts, and their preparations. Belladonna, and all preparations or admixtures (except belladonna plasters) containing 0-1 or more per cent, of belladonna alkaloids. Cannabis (the dried flowering or fruiting tops of the pistillate plant of C. sativa) and resins from it. (Added March 3, 1925.) Cantharides and its poisonous derivatives. *Goca, any preparation or admixture of, containing 0*1 or more per cent of coca alkaloids. Corrosive Sublimate. Cyanide of Potassium and all poisonous cyanides and their preparations. *Diamorphine (also known as Heroin), and all preparations or admixtures containing 0-1 per cent, or more of diamorphine. (Added January 3, 1921 ) Diethyl-Barbituric Acid and other alkyl, aryl or metallic derivatives of Barbituric Acid, whether described as Veronal, Proponal, Medinal, or by anv other trade name, mark, or designation, and all poisonous brethanes and Ureides. (These \were transferred from Part IT. to Part I. in 1918.) Digitalin and all other poisonous constituents of Digitalis. (Added March 3 1925.) *Ecgonine, and all preparations and admixtures containing 0-1 per cent, or more of ccgonine* (Added January 3, 1921.) Emetic Tartar, and all preparations or admixtures containing 1 or more per cent, of Emetic Tartar. Ergot of Rye and preparations of ergots. Lead, in combination with Oleic Acid, or other higher fatty acids, whether sold as Diachylon or under any other designation (except machine-made Plasters). (Added May 27th, 1917.) Nux Vomica, and all preparations or admixtures containing 0-2 or more per cent, of Strychnine. * Opium, and all preparations or admixtures, containing 0*2 or more per cent, of morphine. (Altered Jan. 3, 1921.) (T1NCTURA OPII (LAUDANUM) B.P. ’14, is 1%.) Picrotoxin. Prussic Acid and all preparations or admixtures containing 0-1 or more per cent, of Prussic Acid. Savin and its oil, and all preparations or admixtures containing Savin or its oil. See also Dangerous Drugs Acts. Strophanthin and all other poisonous constituents of Strophanthus. (Added March 3, 1925.) Tobacco, any preparations or admixtures containing the poisonous alkaloids of Tobacco, other than Tobacco for smoking or Snuff, and for use in horticulture, etc., if packed, sold, etc., as sections 1—3 under Arsenic. (Added March 3, 1925 and Aug. 14, ’26.) See also Arsenic Act. PART II. (marked (£} in our text). Must be labelled with (1) name of article, (2) the word “ Poison,” and (3) the proportion of the poison, (4) name and address of seller who must be a registered Chemist and Druggist. Almonds, Essential Oil of (unless deprived of prussia acid). Antimonial Wine. Barium Salts, all except the Sulphate. (Added March 3, 1925.) Cantharides, tincture and all vesicating liquid preparations or admixtures of. Carbolic Acid, and liquid preparations of, and its homologues containing more than 3% of those substances, except preparations for use as sheep-wash, or for any other purpose in connection with agriculture or horticulture contained in a closed vessel distinctly labelled with the word “ Poisonous,” the name and address of the seller, and a notice of the agricultural or horticultural purposes for which the preparations are intended. (For Order in Council re Liquid preparations containing not more than 3% of Phenols, see page 992.) Chloral Hydrate, Chloroform and all preparations or admixtures containing more than 20% cf chloroform. Eigitalis. Mercuric Iodide. Mercuric Sulphocyanide. Cxalic Acid. Poppies, all preparations of, excepting red poppy petals and syrup of red poppies {Papaver rhceas). Precipitate, Red, and all oxides of Mercury. Frecipitate, White. Strophanthus. Sulphonal and its homologues, whether described as Trional, Tetronal or by any other trade mark, name, or designation. {Added April 14, 1913*) Zinc Chloride and liquid preparations of zinc chloride, except preparations intended for soldering, or other purely industrial purpose, provided that they are contained in closed vessels labelled with the word “Poisonous” and bear the name and address of the seller and a notice of the special purpose for which the preparations are intended. {Added January 3, 1921.) All preparations or admixtures which are not included in Part I. of this Schedule, and contain a poison within the meaning of the Pharmacy Acts, except preparations or admixtures the exclusion of \vhich from this schedule is indicated by the words therein relating to carbolic acid and chloroform, and except such substances as come within the provisions of Section 5 of the Poisons and Pharmacy Act 1908. Tobacco for Smoking, or snuff and machine-spread Lead Plaster are excluded from this clause (March 3, 1925). Note.—The last paragraph in the Schedule brings into Part II. many preparations and admixtures not defined in the Schedule.—-in particular preparations and admixtures of vegetable drugs containing poisonous alkaloids should be borne in mind even though the drugs themselves are not m the Schedule. All such preparations are clearly indicated in our pages with the letter CE>. Reference should be made to the body of the book in cases of doubt. ORDERS IN COUNCIL. Poisonous Substances. The Mineral Acids and Disinfectants. Hydrochloric, Nitric and Sulphuric Acids. Soluble Salts of Oxalic Acid. Liquid Preparations containing more than 5% by weight of free Ammonia. All Liquid Preparations sold as Carbolic, Carbolic Acid, Carbolic Substitutes, o?' Carbolic Disinfectant, containing not more tJian 3% of Phenols. For each of these Poisonous substances see the body of the book. These substances when sold by retail must be labelled : (1) . With the name of the substance. (2) . “ Poisonous ” (not “ Poison ”). (3) . “ Not to be taken ” (printed on the label). (4) . With the name and address of the seller, and any of them in liquid form must be in a bottle distinguishable by touch. The wording of the Order, it will be observed, specifies ‘ Phenols 5 whereas the wording in the Schedule of Poisons (Part ll.) is carbolic Acid and its Homologues. This wording is intended to apply also to Phenoloids where the word 4 phenols * is used. Many deaths occur annually due to Hydrochloric Acid. The Ministry of Health drew attention in 1928 to the danger of disinfectants given gratuitously or otherwise by local authorities in beer bottles, etc., and advised they should be in poison bottlesjlabelled^boldlyjn.red “Disinfectant —Poison—Not to be taken.”—P.J. ii./.z8,411. Agricultural and Horticultural Poisons. (Ses also p. 172.) Chemists and Druggists sell these substances under the same laws as apply to other Poisons, i.e., the Pharmacy Acts, 1808, the Poisons and Pharmacy Act, 1908, and, if they contain Arsenic, the Arsenic Act, 1851. Other persons may, if they obtain licences for this purpose from the local County or Borough Council, sell Agricultural and Horticultural Poisons under Section 2 of the Poisons and Pharmacy Act 1908, subject to the .Regulations made by Order in Council of 2nd April, 1909, and amended 1920, which require that “ all poisonous substances shall be kept in a separate drawer or closed receptacle ” and “ sold at a separate counter ” or “ part of counter,” that “ A poisonous substance shall not be sold except in a closed vessel or receptacle as received from the manufacturer, which vessel or receptacle must be of sufficient strength to withstand rough usage, securely closed and free from leakage, and distinctly labelled with the name of the substance and the word * Poison/ and with the name and address of the seller, and with a notice of the special purpose for which it has been prepared,” and that “ Each bottle, tin, drum, or cask shall have the word ‘ Poisonous * indelibly printed, marked, or branded in easily legible characters in a conspicuous position apart from the label, and the label must bear the word ‘ Poison.’ ” Purther, the bottles must be distinguishable by touch from ordinary bottles. Note particularly Section 2 of the 1908 Act, “ nothing exempts any person so licensed from the requirements of the 1808 Act and the Arsenic Act.” Provisions almost identical apply to Ireland (both Northern Ireland and the Tree State). Illegal sale of Horticultural Poisons. Prosecutions at Birmingham. The substance was not labelled ‘ Poison.’ The name and address of the companies were not printed, and the sale was not entered in Register.—L. i./3i,1200. Regulations for the Keeping, Dispensing, and Selling of Poisons . in Great Britain. Of Section 1 of the Act.) the 1868 Act m Pursuance That in the keeping of poison each bottle, vessel box or naelwure <*> ta mannei different fiom that m which bottles or vessels containing T or(Lnary articles are secured in the same shop, etc. • or ’* ° { ) In0r v2tsX°fnVwhSfp1hrnn(}?red distinguishable by touch from the bottles (A T °r 111 wbl£h ordinary articles are kept in the same shop ; or for dlngerouTLtic!es0r P 8® kepta r00m or cupboard set apart rendered distinguishable by touch from ordinary medicine bottles and that there also be affixed to each bottle (in addition to the name of the article and tent^of^^^Pn+^p111811^10^1^118!\ts u®e). a label giving notice that the contents of the bottle are not to be taken internally. WHOLESALE TRADING. Wholesale trading is exempt from the provisions of Sections I.—XV of the Pharmacy Act, 1868, to which reference must he made. ’ J Attention is specially drawn to Section 17 of the Act:_ It shall he unlawful to. sell any poison either by wholesale or retail wmess the box {etc.) is labelled with the name of the article and the word Poison and name and address of Seller . . . but the provisions of this Section shall not apply to Sales by wholesale dealers to retail dealers m the ordinary course of wholesale dealing.” SALES TO MEDICAL MEN. These are now governed by Section 3 of the 1923 Dangerous Drugs and Poisons (Amendment) Act, q.v. El POISONS THROUGH THE POST. (To Medical Men, etc.) This matter, which, in the past, caused pharmacists misgivings is now dealt with by the ‘ Amendment as to Dealing with Medical Men in ggn Poisons in general in Section 3 of the Dangerous Drugs and Poisons (Amendment! Act, 1923, see page 998, to which reference should be made. SALE OF ARSENIC. {Applicable to Great Britain and Northern Ireland and the Irish Free Stale ) On every sale of Arsenic, in addition to the requirements of the Poisons and Pharmacy Act, 1908 ("see Poisons Schedule), the following provisions of the Arsenic Act (1851) are to be observed. Particulars of sale to be entered ‘ a book by the seller as follows in Date of Sale. Name and Surname of Purchaser. Purchaser’s place of abode. Quantity 1 Purpose of Arsenic j for which sold. I required. Condition or Occu- - - pation. (Purchaser’s signature.) (Witness.) (Seller’s Signature.) Or if purchaser cannot write, seller to put the words “ cannot write.” No person shall sell Arsenic to any person who is unknown to the person selling such Arsenic, unless the sale be made in the presence of a witness who is known to the person selling the Arsenic, and to whom the purchaser is known, and who signs his name, together with his address, to such entries before the delivery of the Arsenic to the purchaser, and no person shall sell Arsenic to anyone under full age. The orders from retailers to wholesalers must be written. The Arsenic if colourless must he coloured with at least fs of its weight of Indigo or Soot, unless sold in a quantity of not less than 10 lbs and for a purpose (not for use in agriculture) for which such admixture would render it unfit. Penalty for offence is a fine not exceeding £20. Vol. I. 11 The Act is not to prevent sale of Arsenic in medicine under a prescription of a legally qualified medical practitioner. “ Arsenic ” includes Arsensotis and Arsenic Compounds? and all other colourless preparations of same. LABELLING OF POISONS ORDER, 1924. Pursuant to Section 4, Sub-section 2, of the Dangerous Drugs and Poisons (Amendment) Act, 1923. The name of the poison and the 'proportion which the poison (or poisons), bears to the other ingredients in every preparation must be stated, as percentage or otherwise, thus altering Section 17 of the Pharmacy Act ’68 to that extent. B.P. or B.P.C. preparations sold with or without dilution need have only a reference to these works and when sold with dilution the proportion to the total ingredients, the label of pills, tablets, cachets, etc., must show the amount in each and the number in the container. This does not apply to Dispensing. In force since Jan. 1st, 1926. The late Sir William Glyn-Jones suggested that the decisive test to be applied by pharmacists in any case is given by the question : ‘ Is this article as I sell it, an article the sale of which is by the Pharmacy Acts confined to Pharmacists ? ’ If the answer is yes, it comes within the Labelling Provisions and the Order applies. Ammonia and other ‘ poisonous ’ substances are outside the Order.—P.J.iL/25, 716. SCHEDULE OF POISONS APPLICABLE TO IRISH FREE STATE [In accordance with the Sale of Poisons (Ireland) Act, 1870, and Amendments by Orders in Council.] PART I. Aconite and its preparations. Alkaloids,—see Strychnine. Arsenic and its preparations. Cantharides. ♦Coca, any preparation or admixture of, containing 1 or more per cent, of coca alkaloids. (Added Dec. 8, 1921.) Corrosive Sublimate. Cyanide of Potassium and all metallic cyanides. ♦Diamorphine (also known as heroin) and all preparations or admixtures containing 0T per cent, of diamorphine. (Added Dec. 8, 1921.) ♦Ecgonine and all preparations or admixtures^containing 0T per cent, of ccgonine. (Added Dec. 8, 1921.) Emetic Tartar. Ergot of Rye and its preparations. ♦Opium, and all preparations or admixtures containing 0-2 or more per cent, of * Morphine. (Added Dec. 8, 1921.) Prussic Acid. Savin and its oil. Strychnine and all poisonous vegetable alkaloids and their salts. PART II. Almonds, EssentialjOil of, unless deprived of its prussic acid. Ammoniated Mercury. Belladonna and its preparations. Cantharides, the tincture and all vesicating liquid preparations of. Carbolic Acid (see Phenol). Chloral Hydrate and all its preparations. Chloroform. Corrosive Sublimate, Preparations of. Diethyl barbituric Acid and other alkyl, aryl, or metallic derivatives of barbituric acid, whether described as Veronal, Proponal, Medinal or by any other trade name, mark or designation ; and all poisonous urethanes and ureides. (Added July, 1914J Ether, Sulphuric._ *These also apply to Dangerous Drugs Acts in N. Ireland and Irish Free State. Mercury, Binicdide of. Mercury, Red Oxide of. Morphine, Preparations of. Nux Vomica and its preparations. Opium and all preparations of opium or poppies. Oxalic Acid and all oxalates. Phenol, commonly called carbolic acid. Phosphorus and all preparations containing it in a free state. Poppies, all preparations of (See Opium). Strychnine, Preparations of. wh^ieSoS^?OURd1Cwtai?i!ngiaily ofJ ,the poisons mentioned in this Schedule when prepared or sold for the destruction of vermin. n^o?c+egardw^/f sa^ °* Agricultural and Horticultural Poisons and Soluble S n Arsenic, also Acid. Hydrochloric, Acid. Nitric, Acid. Sulphuric, ™ QQ°oH&and Ammonia m the body of the book. Vide also Orders in Council PP* 99o. NORTHERN IRELAND. The Pharmacy and Poisons Act (N. Ireland), 1925. The Poisons Schedule of this Act is similar to that of Great Britain, excepting Part I. Preparations of Corrosive Sublimate’ in addition to Corrosive Sublimate : Sulphuric Ether : Chloral Hydrate and its preparations ; as to Arsenic andTobacco, the alterations of March ’25 and August ’26 do not apply. Part 11. : Phosphorus and all preparations and admixtures containing it in ^ IPGG Scfl/tjG* The Arsenic Act 1851 applies, as also the D.D.A. 1920-1925 with some modifications. Dangerous Drugs Feguiations Northern Ireland, 1929, are in force. ,.-jdogiilations as to Sale of ‘ Poisonous ’ Substances and Agricultural Poisons differ to an extent from those in Great Britain. ‘Known to the se//erd—The knowledge should be sufficient to enable the seller to judge of the accuracy of the name and address which the purchaser gives, or to give the authorities sufficient data to enable them to identify the purchaser. (Quoted from Glyn- Jones ‘ The Law of Poisons and Pharmacy,’ re Potassium Cyanide refused to be supplied to a medical man to kill wasps.)—P. J. ii./22,276, Medical Press, Sept. 6th, 1922. PHARMACY AND POISONS BILL. (Main contents of the Bill as amended by the Pharmaceutical Soc.) Dispensing.—In shops, is restricted to chemists. In hospitals or doctors’ surgeries, by, or under the supervision of, a chemist or medical practitioner. Resist nation.—All chemists and druggists would become Pharmaceutical Chemists (the higher Examination would become a Fellowship). Poisons.—The creation of a Poisons Board of 14 members to be an Advisory Committee to the Home Secretary to draw up a new Poisons List, to be divided into two parts : Poisons in Part restricted to Chemists. Poisons in Part II., restricted to other recognised and approved sellers. The Poisons Board to have power to include in Part I. substances (not poisons in the common meaning of the term), such as Vaccines, Sera, Insulin, Pituitary, etc.—P.J. i./3i,12,36,84 ; i./32,201. The original Bill passed all its stages in the House of Lords and was awaiting further consideration on second reading in the Commons when Parliament dissolved.—P.J. ii./3i,311; B.M.J. i./3i,772. At time of going to Press it is being introduced into present Parliament. In Victoria (Australia) only Registered Chemists are allowed to sell substances mentioned in Part III. of the Second Schedule of the 1915 Poison Act. These include Bromides, Camphorated Oil, Phenacetin, Phenazone, and Phenylcinehonic Acid.—P.J. ii./28,174. I I 2 DANGEROUS DRUGS ACTS. —SUMMARY. The following is merely a summary of main requirements concerning prescribing and dispensing.—Vide posted. The Acts appiy to :— Opium (Medicinal) \ Preparations containing 0-2% or Morphine and its Salts f more of Anhydrous Morphine. Morphine Esters, Salts and preparations. Benzoyl Morphine and preparations (restricted to licensees). Cocaine (and synthetic), Ecgonine and their Salts, and preparations containing 0T% or more of the alkaloidal bases. Ext. and Tinct. Indian Hemp (as such), Heroin, and its Salts, Dihydro - Oxycodeinone (Eucodal) and its Salts, Dihydro- codeinone (Dicodide) and its Salts, and preparations containing any proportion of Diacetylmorphine (except those exempted), Dihydro - Oxycodeinone or Dihydrocodeinone or Dihydromorphinone (Dilaudide) or Acetyldihydrocodeinone (Acedi- cone)—restricted to licensees. A prescription for these drugs must show : (1) Patient’s name and address. (2) Date. (3) Total amount of the drug ordered (unless a preparation of the B.P., B.P.C., or N.H.I. Drug Tariff when the amount of the preparation may be given). (4) Prescriber’s usual signature (not initials) and (5) Address. (6) If the prescriber requires, the intervals up to three, at which the*prescription may be repeated. Dental Prescriptions marked 4 For local dental treatment only.’ Veterinary Prescriptio?is marked 4 For animal treatment only.’ in Dispensing the Pharmacist must: (1) Know the signature. (2) Be satisfied that the prescription is genuine. If possible make sure that the medical practitioner, dentist or veterinary surgeon is on the Register. (3) Mark prescription with date of dispensing. (4) Retain prescriptions 2 years, in order, tied together. (5) Record in book (D.D.A.), on the day or next day, and copy in Prescription Book. This applies both to wholesale and retail. See -< Section 3 of 1923 Act. r Supplies to Medical Men (etc.). All Sales of Dangerous Drugs (including preparations) and Part I. Poisons to be entered in Poisons Book and the signed older to be retained 2 years. There must be name and address (and date) and the nature and amount of the poisons. Chemist must be satisfied as to genuineness. If by post must be by Registered Post. In addition, entry to be made in Cocaine, etc., Registers. Medical men may only have Dangerous Drugs so far as is necessary for the practice of their profession. The stock of dangerous drugs must he kept in a locked cupboard. The key is to be kept by the chemist or a qualified assistant, DANGEROUS DRUGS ACT, 1920, ^ (10 & 11 Geo. V., Chapter 46.) 3 fient points from the 1923 and 1925 Acts incorporated. \k \ 1 hwughout' our pages 'means drugs or preparations coming within the provisions of these Acts. (In this Summary of the Acts, Rules ami Orders, ‘ medical practi- < ™eans dung qualified, i.e., registered medical practitioner ’ ; dentist means registered dentist ’ ; ‘ veterinary surgeon ’ means registered veterinary surgeon.1—W. H. M.) I*—Sections Itlo 3 relate to Importation intoani Exoortation from the United Kingdom of Raw Opium. (U.K. includes Great Britain Northern *r)sb State and 6.1.). 1928, No. 982. im^^Tionallv^oh?hfcd Ffufred ?piu?‘ Import and Export totally and Section 5.—Any person manufacturing, selling or dealing in, oi having m possession prepared Opium, being occupier of Karel SeSStK? or frequenting a place used for smoking, is guilSy PART III. Cocaine, Morphine, etc. (as detailed in Section 8). Section 6 sorti!1?! \nfa Exporfc prohibited, except under licence. Section 7, Sub- or otherwise^Shforised6* ^ ^ distribution to be limited to persons licensed Sub-section 2--Authorisation—under this section—of persons keeping open shop under the Pharmacy Act 1868 (as amended 1908). Sub-section 3.—Nothing herein derogates from the provisions of the Pharmacy Act 1868, as amended 1908. Section 8, Sub-section 1.—The drugs to which this part of the Act applies are Medicinal Opium, Morphine and its Saits, Cocaine ap_d synthetic Cocaine, Ecgonme, and their Salts : Diacetyimorphine {Heroin) and its Salts; also— Extracts and .Cinctures> of Indian Hemp (not including medicinal preparations containing the Extract or Tincture as ona of the inure* clients), Benzoyl-Morphine and its Salts (to be supplied bv Licence only—S.R. & O., 1928, No. 925), Dihydro-oxycodeinone (Eucodal) and its Salts, Dihyciracodeinane (Dicodide) and its Salts,^ and any preparation, admixture, extract, or other substance containing 1,5th per cent, or more of Morphine, ll/Oth percent or more of Cocaine or Ecgonine, or any proportion of DiaceivJ* morphine (certain preparations are exempt by S.R. & 0. 1931, No. 300 see p. 560), Benzoyl-Morphine, Dihydro-oxycodeinone, or dihydrocodeinone ’ Also Esters of morphine and their respective Salts, and to aiiv preparation admixture and extract containing any of the said esters (added Aug. 15, 1929—b.it. & O. 1929, No. 650). Further, Dihydro-morphinone (Dilaudide) and its Salts, and any preparation, admixture, extract, or other substance containing any proportion of Dihydro-Morphinone (added June 13, 1930—S.lt. & 0., 1930, No. 520). (Dilaudiae, its salts, preparations, etc., may not be imported into, or exported irom the United Kingdom and Northern Ireland without a Licence issued by the secretary of State), auso Acetyldihydrocodeinone (Acedicone)—• fi»Cld0Cl J 11110, -L i/Ou. Sub-section 2—By Order in Council this part of the Act may apply to new derivatives of Morphine, Cocaine, or alkaloids or other dim's (Percentage is dealt with under Section 5 of the 1923 Act q.v.). ' PART IV —Section 9, Sub-section 1.—Application of Customs Acts. Section 10, mb-section 1.—A constable or person authorised by a Secretary of State has power to inspect books or documents relating to dealings and stocks (see also Amendment in the 1923 Act). Sub-section 2 —Any person delaying, or obstructing, or failing to produce, or concealing, or attempting to conceal books, stocks, drugs or documents shall be guilty of an offence (an Amendment made in the 1923 Act is included herein). Section 11.—Refers to regulations which may be made under this Act. Section 12.—Refers to Licences (including payment of a fee). Section 13.—On indictment (Assizes or Quarter Sessions) or Summary Conviction heavy punishments involved and the offender’s authorisation may be withdrawn. Sub-section 2B.—(From the 1923 Act.) If any person attempts to commit an offence, or solicits or incites another person to commit it, he shall, without prejudice to any other liability, be liable on summary conviction to the same punishment and forfeiture as if he had committed it. Sub-section 2C.—(From the 1923 Act.) Where a person convicted of an offence is a company, the chairman and every director and every officer concerned in the management of the company shall be guilty of the like offence unless he proves that the act constituting the offence took place without his knowledge or consent. Sub-section 3.—Refers to time of bringing proceedings both against a company and also (from the 1923 Act) against a person attempting or soliciting or inciting another person to commit the offence. Section 15 of the 1920 Act, Sub-section 1.— “Raw Opium” includes powdered or granulated Opium, but does not include medicinal Opium. '* Prepared Opium ” means prepared for smoking including dross and residues remaining after Opium has been smoked. “ Medicinal Opium ” means raw Opium artificially dried. (A correct definition appears in the 1925 Act, q.v.). Section 16.—In application to Ireland the Act has effect subject to :— (a) A reference to the Poisons (Ireland) Act 1870, the Pharmacy (Ireland) Act, 1875, and the Pharmacy (Ireland) Act 1875 (Amendment) Act, 1890, being substituted for reference to the Pharmacy Act, 1868, and (b) Reference to the Pharmaceutical Society of Ireland being substituted for the Pharmaceutical Society of Great Britain. DANGEROUS DRUGS AND POISONS (AMENDMENT) ACT, 1923. (1 Wt May, 1923.) (13 & 14 Geo. 5.) An Act amending the Dangerous Drugs Act, 1920, and Section seventeen of the Pharmacy Act, 1868, and to prescribe the method of calculating percentages in liquid preparations for the purpose of the Poisons and Pharmacy Act, 1908, and the D.D.A., 1920. 1. —(l) This sub-section to be inserted in section 10 of the Dangerous Drugs Act, 1920, after sub-section (1), concerns searching of premises under Authority of Justice of the Peace. (2) Amendments in this sub-section of Section 10 of the 1920 Act have been made in our pages. 2. This section in several sub-sections, is to be substituted in the 1920 Act bringiDg in a wider scope of definition of a person guilty of offence, e.g. with regard to false declarations, also as to aiding and abetting in any place even outside Great Britain in an offence punishable under any corresponding law in force in that place. The salient points of sub-sections 2 and 3 of this section we have incorporated in the 1920 Act. Amendment as to dealing with Medical Men in [Pi! POISONS IN GENERAL. 3—l(i) So much of section 17 of the Pharmacy Act, 1868, as requires an entry in the Poisons book signed by the purchaser, shall not, subject to the following conditions, apply where the purchaser is a medical practitioner and the purchase is made by him for the purposes of his profession. (2) (a) There must have been received by the seller before the sale a written order signed by the purchaser stating his name and address and the name and quantity of the article to be purchased. (5) The seller must be reasonably satisfied that the signature is the signature of the person purporting to sign it, and that that person is a medical practitioner. (c) The article sold, if sent by post to the purchaser, trtust be sent by registered post (d) The seller must enter in the Poisons Book, in the column assigned to the signatures of purchasers, the words ie signed order ” with the date on which the order is executed and must preserve the order for two years from the date of the entry. It a seller is reasonably satisfied that a medical practitioner desiring to purchase the poison urgently requires it for his profession, but by reason of some emergency is unable before delivery, either to furnish to the seller an order in writing duly signed, or to attend and sign the Poisons Book, the seller may send the poison to the purchaser to Ibe handed over to him either in exchange for such an order or on an undertaking by the purchaser to furnish such an order within 24 hours. If the purchaser by whom the undertaking has been given fails to deliver a signed order, or if any person for the purpose of obtaining delivery of the poison under the foregoing proviso makes a statement which is to his knowledge false, he shall be deemed to have procured the commission of an offence under the said Section 17. (3) This section applies also to dentists and veterinary surgeons. 4. —(1) Where any poison to which Section 17 of the Pharmacy Act, 1868, applies is supplied in accordance with a written N.H.I. Prescription given by a medical practitioner the seller shall not be required to make any entry in the book (Poisons Book) in accordance with the said section. (Note.—This does not exempt Dangerous Drugs in D.D. Register). (2) Section 17 of the Pharmacy Act 1868 shall have effect as if, for the words “ labelled with the name of the article and the word poison and with the name and address of the seller of the poison,” there were substituted the words “ labelled with the name and address of the seller of the poison, with the word ‘ poison,’ and with the name of the poison and in the case of a preparation which contains a Poison as one of the ingredients, with data as to the proportion which the poison hears to the other ingredients as may be prescribed by Order." The Labelling Order 1924 is given antea p. 994. 5. —For the purposes of the Schedule to the Poisons and Pharmacy Act 1908, and of section 8 of the Dangerous Drugs Act, 1920, percentages, in the case of liquid preparations shall, unless ether provision in that behalf is made by regulations under those Acts respectively, be calculated on the basis that a preparation containing one per cent, of any substance means a preparation in which one gramme of the substance, 'if a solid, or one millilitre of the substance, if a liquid, is contained in every one hundred millilitres of the preparation, and so in proportion for any greater or less percentage. 6. —(Sub-section 2) “ Corresponding law ” in the 1920 Act, as amended by this Act, means any law stated in a certificate purporting to be issued by or on behalf of the government of any country outside Great Britain to be a law providing for the control and regulation in that country of the manufacture, sale, use, export and import of drugs in accordance with the provisions of the International Opium Convention signed at the Hague 23/1/1912, and any statement in any such certificate as to the effect of the law mentioned in the certificate, or any statement mentioned in any such certificate that any facts constitute an offence against that law, shall be conclusive. (Sub-section 3). This Act shall not extend to Northern Ireland, except in matters in which the Parliament of Northern Ireland have not power to make laws. DANGEROUS DRUGS ACT, 1925. (15 & 16 Geo. V., Chapter 74.) (In operation since Sept. 25, 1928—S.R. <Sc 0. 1928, No. 634). Section 1.—Extends restriction of import and export of Coca Leaves, Indian Hemp (and Resins of), and all preparations as in the case of Raw Opium (S.R. & O. 1928, No. 982). See Principal Act. Section 3.—Amends the list of drugs in Part III. of the 1920 Act, and includes any proportion of DJacctylmorphane. (Since brought up- to-date by further additions.) Section 4.—Medicinal Opium means Raw Opium, adopted in accord with the B.P., whether powder, granulated, or any other form, and whether or not mixed with neutral substances. Section 5.—Power to exclude preparations. The salient points are incorporated in the 1920 Act, ante a. DANGEROUS DRUGS (CONSOLIDATION) REGULATIONS, 1928 MADE UNDER SECTION 7 OF THE 1920 ACT FOR CONTROLLING THE MANUFACTURE , SALE, POSSESSION, AND DISTRIBUTION OF DANGEROUS DRUGS TO WHICH PART III. OF THE ACT APPLIES—S.R. & 0. 1928, NO. 981. Regulation 1—Manufacture, (a) Only an authorised person may manufacture (b) on authorised premises, (c) in accord with the terms and conditions of his authority. Supply and procuring of drags and preparations. Except as provided a person shall not offer to supply or procure to or for any person, including himself, either in Great Britain or elsewhere, or advertise for sale, (a) unless authorised, (b) otherwise than in accord with the terms and conditions, (c) if the drug, etc., is to be supplied to or procured for a person in the U.K., unless he is authorised to be in possession, or to or for a person authorised, otherwise than in accord with the terms and conditions of that person’s authority. In regard to (c), the administration of a drug, etc., by, or under the direct persona/ supervision, and in the presence of, a medical practitioner, or by a dentist for dental treatment, shaft not he deemed supplying. 3-“Possession, (i) A person shall not be in possession unless authorised. (2) (a) A person to whom a drug, etc., is lawfully supplied on a prescription by a medical practitioner, dentist, or vet. surgeon, or to whom a drug is lawfully supplied by a medical practitioner or vet. surgeon, dispensing medicines, is authorised to be in possession. Provided that if a drug, etc., is supplied by, or on a prescription given by, a medical practitioner to a person tvho was at that time under treatme nt, whether for addiction or otherwise, from and being supplied with a drug, etc., by, or on a prescription givenhy,another medical prezetitione r, that person is not authorised to he in possession of the drug, etc., supplied by, or on the prescription given by, the first-mentioned medical practitioner if he did not, before the supply thereof to him, disclose that he was hc:ng treated and supplied by the other medical practi ti oner. (6) A person shall be deemed to be in possession if the drug is in his actual custody or is held by any other person subject to his control or for him or on his behalf. 4. —Delivery to messengers. (1) Where a drug is to be lawfully supplied to anyone (‘ the recipient ’) otherwise than by, or on a prescription given by, a medical practitioner, the person supplying (‘ the supplier ’) shall not deliver it to a person who purports to be sent by or on behalf of the recipient unless that person (o) is an authorised person under the Acts, or (b) produces to the supplier a written statement signed by the recipient that he is authorised by the recipient to receive the drucg on the latter's behalf, and the supplier is satisfied that the document is genuine. (2) A person to whom a drug or preparation is so delivered is an authorised person, but for such period only as reasonably suffices for the delivery. 5. —General authority. (1) (a) medical practitioners, (b) dentists, (c) veterinary surgeons, (</) pharmacists dispensing at a public hospital or institution, (e) persons in charge of a laboratory used for research or instruction and attached to an institution approved by the Secretary of State, (/) persons appointed by a local authority as analysts for the Sale of Food and Drugs Acts, 1875 to 1907 : are authorised, so far as may be necessary for their profession or employments, as members of their respective classes, to be in the possession of and to supply the drugs, but a dentist may not supply drugs otherwise than by his personal administration to persons receiving treatment from him. (2) An ‘ institution’ is a University, university college, public hospital, or other like institution. 6. —(1) Persons keeping open shop for the retailing of poisons are authorised (a) to manufacture at the shop in the ordinary course of their retail business (i) extract or tincture of Indian Hemp: (ii) any preparation; and (b) subject to the provisions of the Regulations, to carry on at the shop the business of retailing, dispensing or compounding drugs or preparations. (2) Every drug or preparation in the actual custody of a person authorised by this Regulation shall be kept in a locked which can be opened only by him or by some assistant of nis^ being a pharmacist. of Authority, (i) if any authorised person is convicted of an a p+U+n,?g<?inst,tlae or under the Customs enactments as applied by the MnthrXu Secretary of State may, by notice in the Gazette, withdraw his authqnty, atrer consulting the Council of the Pharmaceutical Society of Great iintam (2) it the person whose authority is withdrawn is a medical practi- m u?r’ dentlst’ °r vetennary surgeon, the Secretary of State may, by notice ■ manner, direct that it shall be units,wfui for that person B^scnptions. _ (3) If the Secretary of State suspects that a medical practitioner or dentist is supplying or prescribing drugs to or for either mmseii or any other person otherwise than properly required for medical or dental treatment of himself or that other person, the Secretary of SffL/Mr, to a tribunal constituted as stated in the I irst Schedule, and, it the tribunal so recommend, may, by notice in the Gazette withdraw the authority of the practitioner or dentist to supply procure, or be in possession and give directions to him as under paragraph (2) of this Regulation. 8 —(D A prescription means a prescription directing the supply of a drim and given either by a medical practitioner for medical treatment, by a dentist ioi dental treatment, or by a vet. surgeon for animal treatment. (2) The prescription must (a) be in writing and be signed by the person jawing it with his usual signature and be dated by him, and (6) except in a health insurance prescription, specify the atfdress of the person giving it, (c) specify the name and address of the person for whose treatment it is given, or, if it is given by a vet. surgeon, of the person to whom the article pt scribed is to he delivered, (d) have written thereon, if given by a dentist, the words J For local dental treatment only,’ and, if given by a vet, surgeon, the words ‘For animal treatment only,’ (e) specifiy, if it prescribes a preparation contained, or compounded of preparations all of which arej contained, in the B P the B.P.C., or the N.H.I. Drug Tariff, the total amount of the pro- pa ration, or of each preparation, as the case may be, and in any other case the total amount of the drug to he supplied, 9—(1) A person shall not supply a drug on a prescription (a) unless the prescription complies with the above, and (b) unless in the case of a health insurance prescription he has no reason to suppose that it is not genuine, or, in the case of any other prescription, he either (i) is acquainted with the signature of the person by whom it purports to have been given, and has no reason to suppose that it is not genuine, or (ii) has taken reasonably sufficient steps to satisfy himself that it is genuine. (2) If a prescription expressly states that it may, subject to the lapse of a specified interval or intervals be dispensed two or three times, the drug may be supplied a second or a third time after the specified interval or intervals, but otherwise a prescription shall not be taken to authorise the drug to be suppiied more than once. (3) The person dispensing shall', at the time, mark on it the date on which it is dispensed, and, in the case of a prescription which may be dispensed two or three times, the dates of the second and third time, and, unless it is a health insurance prescription, retain it and keep it on the premises to be available for inspection. 10. —Marking of packages cr bottles. (1) No person shall (a) supply a drug unless the package or bottle is marked with the amount contained, or (6) supply a preparation, unless the package or bottle is plainly marked (i) in the ease of a powder, solution, or ointment, with the total amount contained and the percentage of the drug contained, or (ii) in the case of tablets or other similar articles, with the amount of the drug in each article and the number of articles contained. (2) This does not apply to a lawful prescription. 11. —Records. (1) Every person authorised to supply shall (a) keep a register and set out as in Parts I and II of the Second Schedule true particulars as to every quantity of drug or preparation obtained by him and supplied by him whether to persons within or without Gt. Britain, (b) a separate register or separate of the register shall be used for each of the various classes of drugs and preparations, (c) the entry must be made on the day on which the drug is received, or which the transaction takes place, or, if that is not practicable, on the following day, (d) a separate register shall be kept in respect of each set of business premises, and, subject to the approval of the Secretary of State, an authorised person may keep a separate register for each department of the business, (e) no cancellation, obliteration, or alteration, shall he made, and any correction of an entry must be made by way of a marginal or footnote giving the date of correction, (/) the authorised person shall, on demand, furnish particulars required as to the obtaining or supplying or as to stocks, (g) the register may be used for entries required under Sect. 17 of the Pharmacy Act 1868, but, save as aforesaid, not for any other purpose. (2 )The entering in the register shall not apply to (a) a medical practitioner who enters in a day book particulars of every drug or preparation supplied by him to any person, with the name and address of that person, and the date of supply, and enters in a separate book kept for the purposes of the Regulation a reference to each entry in the day book which relates to the supply, or (b) a person keeping cpen shop for the retailing of poisons who enters in a separate book kept for the purposes of this Regulation a proper reference to each entry in a Pharmacy Act book which relates to the supply of any drug or preparation. (3) References in the separate book must be made in chronological order, and the book must be kept in separate parts relating respectively to each of the several ciasses of drugs and must not be used for any other purpose. (4) The entry in the day book or separate book must be made on the day an entry would have been required to be made. (5) Every register, separate book, or day book in which any entry with respect to the supply of a drug or preparation is made, and every Pharmacy Act Book containing an entry referred to in the separate book shall be kept on the premises to which the register or book relates or where the prescription was dispensed, so as to be available for inspection. (6) Every entry and every correction must be made in ink, or indelibly written. (7) (i) A drug or preparation administered by, or under the direct supervision and in the presence of a medical practitioner or a dentist shall not be deemed to have been supplied by him; (ii) a ‘ proper reference ’ means a reference entered in the separate book under the same date as the entry in the day book or Pharmacy Act book, and otherwise such as to enable the entry to be easily identified. 12. —Export. (1) If any drugs or preparations authorised under the law of any country outside the IJ.K. to be exported therefrom to any destination outside the U.K. are brought into the U.K., no person shall without authority from the Secretary of State, cause or procure those drugs to be diverted to any other destination. (2) The destination to which any drugs are authorised to be exported shall be taken to be that stated in the authority for export from the country of export. 13. —Special provisions, for ships. (1) The master of a ship not carrying a medical practitioner is authorised (a) so far as necessary for compliance with the Acts relating to merchant shipping, to be in possession of drugs and preparations, and (b) subject to conditions imposed by the Secretary of State, and Board of Trade instnotions, to supply drugs to members of the crew. (2) Where a drug is supplied to a member of the crew entry in the official log-book, in accordance with para. 5, Sect. 240, of the Merchant Shipping Act, 1894, of the treatment adopted shall be sufficient record, if the entry specifies the drug supplied. (3) The master of a foreign ship in a port in Gt. Britain is authorised to purchase and be in possession of such quantity of drugs or preparations as may be certified by the M.O.H. of the port, or the assistant M.O.H. to be necessary until the ship reaches its home port. A person who supplies a drug or preparation on such a certificate shall retain the certificate and mark it with the date the drug supplied and keep it on his premises for inspection. 14. —All registers, records, books, prescriptions, and other documents kept, issued, or made in pursuance of the requirements of these Regulations must be kept, in the case of a register, book, or other like record, for two years from the date of the last entry, and in the case of any other document for two years from the date it is issued or made. 15. —The Secretary of State may, subject to such conditions as he may prescribe, exempt any hospital or other public institution from any provision of these ^Regulations. 16. Nothing in these Regulations shall apply to any of the preparations mentioned in the Third Schedule or to a drug or preparation denatured as approved by the Secretary of State. _ *7. (i) In these Regulations the following expressions have the meanings hereby assigned to them. “ Authority ” means (a) any licence issued by the Secretary of State under Sect. 12 of the principal Act, (b) any authority granted by ithe Secretary of State under that Section and (c) any genera] authorisation ; and the expression ‘ Authorised’ shall be construed accordingly. “ Drug ” means any drug to which Part III. of the principal Act applies, other than benzoyl-morphine or a preparation, admixture, extract or other substance containing benzoyl-morphine, or a preparation within the meaning of these Regulations : “ Preparation ” means any preparation, admixture, extract or other substance containing such a proportion of a drug (other than benzoyl-morphine) as is sufficient to make the preparation, admixture, extract or substance a drug to which Part III of the principal Act applies : “ Principal Act ” means the Dangerous Drugs Act 1920, and references to that Act shall be construed as references to that Act as amended by any subsequent enactment or as extended by any Order in Council made under subsection (2) of section eight of that Act. (2) For the- purposes of these Regulations but subject to any limitation attached to his authority : (a) a person authorised to manufacture shall be deemed authorised to supply; and (6) a person authorised to supply shall be deemed to be a person authorised to be in possession of, to procure, to offer to supply or procure, and to advertise for sale. 18.—These Regulations may be cited as the Dangerous Drugs (Consolidation Regulations, 1928, and shall come into operation Jan. 1, 1929. The Regulations set out in the Fourth Schedule are repealed : Provided that this repeal shall not affect any order made or any direction or authority given under the said Regulations. Home Office, W. Joynson-HicJcs, Whitehall. One of His Majesty’s Principal 14th December, 1928. Secretaries of State. FIRST SCHEDULE. Constitution of Reference Tribunal for the purpose of Reg. 7, (3). Separate tribunals to deal respectively with persons practising in England and Scotland. Consisting, in the case of a medical practitioner, of three medical practitioners, and in the case of a dentist, of three dentists, together with a legal assessor, the members of the tribunal and the legal assessor being appointed by the Secretary of State, SECOND SCHEDULE. Form of Register. Part I.—Drugs or preparations obtained. (The class of drugs and preparations to be at the head of each page.) Date on which Name. Address. Amount Form in received. of person from whom obtained which obtained. obtained. Part II.—Drugs or preparations supplied. (The clasg of drugs and preparations to be at the head of each page.) Authority Name. Address. of person Date of to whom Form in trans- article Amount which action. of person to supplied to be supplied supplied whom supplied. in possession thereof. In case of supply on a prescription, the ingredients of the prescription. Cereoli Iodof. et Morph.. B.P.C Emp. Opii, B.P., 1898. Lin. Opii, B.P. Lin. Opii Ammon, B.P.C. Pasta Arsenicalis, B.P.C. Pil. Hydrarg. c. Opio, B.P.C. Pil. Ipecac, c. Scilla, B.P. Pil. Plumbi c. Opio, B.P. Pil. Digitalis et Opii Co., B.P.C. THIRD SCHEDULE. Exempted preparations. Pil. Hyd. c. Cret. et Opii, B.P.C. Pulv. Cretse Aromat. c. Opio, B.P. Pulv. Ipecac. Co., B.P. (Dover’s Powder). Pulv. Kino Co., B.P. Suppos. Plumbi Co., B.P. Tablett* Plumbi c. Opio, B.P.C. Eng. Gall* c. Opio, B.P. Ung. Gall* Co., B.P.C. 1 1 IT 4-1 cillft; L o. J Ay. JL • VJ • 1931(ski o® 193?feNoU300) are £?nsoMation> Amendment Regulations, Elixir Diamorphin* et Terpini c. Apomorpliina, B.P.C. Lmctus Diamorphin* Camplioratus, B.P.C. Linctus Diamorphin* c. Ipecacuanha, B.P.C Lmctus Diamorphin* et Scillse, B.P.C. Linctus Diamorphinse et Thymi, B.P.C. Iatcs€Se ^)re^>ara^ons neverth£less come under the Sale of Poisons and Pharmacy FOURTH SCHEDULE GIVES LIST OF REGULATIONS REPEALED (1921-1928). n ?°^P.nT\L GENERAL EXEMPTION ORDER, 1924. By Order dated August 9, 1924, certain hospitals and other institutions are exempted from operation of the Regulations on compliance with certain SSbstltUftC5 and revAokeslan Order on the same subject G August 15, 1921. Exempted aie .—Any hospital or infirmary, asylum poor iaw institution or sanatorium supported by any public authority or out of public funds or by a charity or by voluntary subscription in which the drugs are dispensed by a medical practitioner or a pharmacist or—in a poor law Institution—a dispenser whose qualifications and appointment are approved Ho i1C ^ Health it the conditions of Schedule I. (below) are complied with, or, if there is no such dispenser, if the conditions of Schedule II. (below) are complied with. * , _ , , Schedule I. L Orders for supplies must be signed by one of the medical nrartitirmprq attached to the hospital, or by the pharmacist. piactitioners and recmd^ U)1 be kept1 ^ the chargc oi the Person responsible for dispensing, x*udicine ouly t0 bc.dispensed for use of an individual patient, etc. 4 & 5. ihc person responsible for dispensing the drugs shall at the time of dispensing any piescnption stamp, or otherwise mark, the prescription, and shall keep records (to be kept 2 years). ’ G. block preparations in wards or out-patient department shall only be fmH?rmrvnn^ei/e,qU1S1H10n ,ot ,ihe in charge, who shall keep the drugs * 11'71 rA ocb a.n4.u y\ on,y be used by her under medical super- vision. • A requisition shall be marked in the dispensary, and filed, and a copy or note of the requisition kept by the sister in charge. 8. Precautions shall be taken to prevent any theft of the drugs. Preparations may be prescribed by any name known in the hospital. * Ti?-dvi f sl tT>1Ug in t ils , ('hedule shall affect any medicine or other substance to which tne Regulations do not apply. Schedule II. Supplies aie to be to, or on, the order of, a medical practitioner attached to the hospital (not the dispenser), and he must certify that the supply is necessary for the treatment of the patients. The matron is to be responsible for keeping the drugs (in a locked cupboard) and for using or administering them and recording their purchase, but they are only to be used, etc., under the direction of a medical practitioner attached to the hospital. Except so far as the Schedules apply, the Regulations must be observed—for instance the chemist supplying a hospital must record the supplies, get them signed xor and mark the packages as on ordinary sales. NURSING HOMES. The exemption does not apply. SPECIAL AUTHORISATIONS. (H O. Aug., 1921.). Laudanum to Farmers and Stock-owners. Farmers and stock-owners may, in certain circumstances, be granted by the Chief Officer of Police and authority to obtain Tincture of Opium for treatment of animals from the person specified in their Authority. Purchaser must sign Poisons Book. Not more than 32 fluid ounces may be supplied on each order. Cocaine in Castor Gil to Factory Occupiers. (Factory & Workshops Act, 1901.) Wfi A preparation for the treatment of injury to the eyes, consisting of not more than 1 part of Cocaine in 200 of Castor Oil, with not less than 1 part in 3,000 of Mercuric Chloride, may be sold to the occupier of a factory or workshop to which the Factory and Workshop Act, 1901, applies. British Steam Fishing Vessels are also authorised to be in possession of this solution under conditions by the Home Office, Dec. 30, 1927. Preparations of Opium to Mid wives. Preparations containing Opium (but not Morphine tablets) may be sold to certified and practising midwives so far as is necessary for their midwifery practice. They must sign the Poisons Book, and must be introduced if strangers. Statutory Rules and Orders (S.R. & 0.), (May 20), 1921, No. 864, Concerning RAAV OPIUM. 1. No person shall supply or procure, or offer to supply or procure Raw Opium to or for any person whether in the United Kingdom or elsewhere, or shall advertise Raw Opium for sale —(a) unless licensed or authorised ; or (b) otherwise than in accord with the terms and conditions of the licence or authority. 2. No person shall supply or procure, or offer to supply or procure Raw Opium to orf or anyp erson who is not licensed or authorised to be in possession of it. Possession. 3. No person shall be in possession or attempt to obtain possession of Raw Opium (added by Order of October 2, 1922) unless (a) licensed to import or export, or (b) licensed or authorised to supply, or (c) otherwise licensed or authorised to be in possession of it. Records. 4. A person who supplies Raw Opium shall (a) enter in a register kept for the'sole purpose all supplies purchased or obtained and all dealings effected (including sales or supplies to persons outside the U.K.) as shown in the schedule ; (b) make entry with respect to purchases on the day it is received and with respect to sales or supplies by him on the day on which the transaction is effected; or if not reasonably convenient on the day following; (c) if he carries on business at more than one address keep a separate register for each set of premises ; (d) keep the register available for inspection ; (e) not cancel, obliterate or alter any entry or make any untrue entry. Any mistake in an entry may be corrected by a marginal note or footnote giving the correct particulars and dated. The registers are to be kept 2 years from date of last entry (S.R. & O., Oct. 2 1922, No. 1086). General Authorisations are provided. Delivery to Messengers. 7 Delivery shall not be made to a person not licensed or authorised to be in possession who purports to be sent by or on behalf of a licensed or authorised person unless he produces an authority in writing, signed by the person licensed or authorised to receive it on his behalf and unless the person supplying is satisfied that the authority is genuine. (In the case of Raw Opium there is no exemption for prescriptions.) “ Possession.” 8. Raw Opium in the order or disposition of anyone is in his possession. Application to Ireland. 9. As under Section 16 (a) of the Act, q.v. S.R. & 0., March 28, 1922, No. 298. Concerning Marking Raw Opium for Export. Packages for export otherwise than by parcel post, shall be marked on one side and on top with lettering at least two inches in height, with the words Raw Opium, Net Weight,” and the number of pounds, the whole enclosed by a rectangular border at least one-half of an inch in width. Packages sent by parcel post shall be marked in conspicuous and indelible biock lettering with the words, “ Raw Opium, Net Weight,” and the number oi pounds, the whole enclosed by a rectangular border. , marking shall be on the package itself, and not on a label, or ticket, or other thing attached thereto. No words, letters or figures, except those prescribed shall be placed within the rectangular border. „ ^ S.R. & O., Oct. 2, 1922, No. 1086. -NT 1,o?Rgulation 3 of the Regulations of 20th May, 1921 (S.R. & 0. 1921, No. 864) amended. We have made the addition. 2. The registers to be kept for two years from the date of the last entry. . See also S.R. & O. 1923, No. 311 ; 1924, No. 1292 (Diversion of Raw Opium m transit). DANGEROUS DRUGS BILL, 1932.—The object of the Bill is to enable the Government to ratify the International Convention of 1931 to restrict the manufacture of dangerous drugs, including Codeine and Dionine. It is stated that a large illicit trade in Morphine is conducted in the Far East, and the trade has been concealed by the manufacturers stating that the Morphine has been converted into Codeine—when such is not the case. The new Bill will not after the existing Regulations in respect of the supply of Codeine and Dionine by retail or to patients in a hospital. Sir Malcolm Delevigne said the Bill would not hamper the Medical Profession, or hinder genuine scientific research, but will, it is hoped, effectively curtail illicit practices.—B.M.J. Suppt. i./32,79; P.J. l/32,214; *0.1). i./32,30S. MORPHINE ADDICTS. Morphine addicts are defined as persons who, not requiring the continued use of a drug for relief of symptoms of organic disease, have acquired, as a result of repeated administration, an overpowering desire for its continuance and in whom withdrawal of the drug leads to definite symptoms of mental or physical distress or disorder. No obligation to keep record of morphine or other drugs if prescribed or personally administered.—From Departmental Committee Report on Morphine and Heroin Addiction 1926.—B.M.J. i./26,814. Numerous suggestions as precautions in treatment of Addicts were made There is danger with regard to 6 Chiorodyne/ see pp. 287, 561. It was reported there is no present need for the prevention of addiction, to lower the limit of morphine content now fixed (0-2%). The position as regards chiorodyne might be met if it could be secured in some way that no preparation should be sold under the name of ‘ Chiorodyne ’ which contained more than OT per cent, of morphine. Historical Evolution of the Acts. In cases of infringement it was recommended that medical men should be dealt with by a specially constituted Tribunal instead of the Courts. At the Second Opium Conference (Feb. 1925) of the League of Nations recommendations that all preparations containing Heroin and the Cannabis preparations were to be placed under the D.D.A. were made. These are not yet legalised.—Sir W. Willcox, P.J. i./26,507. The Veronal group commonly leads to addiction. They produce cerebral symptoms and an abnormal mental condition. Should only be supplied on medical prescription and the prescription should be retained, i.e., Sects. 5 and 6 of the 1921 Regulations should apply.—Sir W. Willcox, P.J. i./26,508. References to the Dangerous Drugs Regulations. The passage of the Dangerous Drugs Act, 1920, endeavoured to give legislative effect, so far as Great Britain was concerned to the obligations mcurreu under the International Opium Convention signed at the Hague 1912. An Advisory Committee was appointed by the Council of the League of Nations. Smuggling widely prevalent.—L. i./2i,919 ; B.M.J. ii./2i,329. Analysis of 185,000 Insurance Prescriptions in Scotland, May, 1922. Opium ver se or in various forms of admixtures occurred 13,587 times (7-3%) : total quantity 111 lbs. Cocaine in various forms 347 times (0TS /0); total quantity 1043*57 grains. Morphine 10,690 times (5*7%). Demonstrative proof of the comparatively small use of narcotic drugs in medicine, and of the rarity of preparations containing 0-2% Morphine or Diamorphine, or 0T% Cocaine.—P.J. ii./22,285. Cocaine Dental Anesthetics. In view of the Dentists Act 1921, the authority under the Dangerous Drugs Act, 1920, to certain unregistered dental practitioners to purchase dental anaisthetics containing Cocaine, was withdrawn Nov. 30, 1922. The penalties in regard to offences under the D.D. Acts are ridiculously excessive. Dangerous Drugs should only be supplied on medical prescription and should not be dispensed by a medical practitioner except in cases ot emersencv —Sir W. Willcox, P.J. i./26,544, D.D. Acts, their Application by the Physician and the Pharmacist.’ Ibid 507,522. TUero tiro He Unite financial sacrifices in respect of trading in winch the pharmacist has had long-standm0 rights.—See also L. i./26,1071. _ £ Kingsbury case. Appeal allowed with costs. He did not supply . at in fact rnven the patient only sufficient doses of the drug to last until his next visit An important point concerning ‘ administration under direct personal supervision/ etc.—B.M.J. ii./26,948. A legally qualified medical practitioner must—under the Medical Act 1858—be registered. D.D. prosecution, B.M.J. i./27,819. For a medical man to have to write the quantity 9f Morphine or Cocaine is contrary to the strict privacy of a medical prescription. W. G. McNab, Exec. Meeting, N. British Branch Pharm. Socty, July, 1926. . A summons against Mr. R. L. Dillon, charged with obtaining Morphine simultanemsly from two doctors without disclosing to either that he was bei^gtreatedby thn other, was dismissed. There had been no concurrent treatment.—L. i./2 8,1296. .... . f Prosecution and conviction (5 months in Second Division) re scrips or 8 grains of Heroin.—B.M.J. i./30,53. # . An addict, an unauthorised medical man, ^possession of 11 grams of Morphine Sulphate, bound over m the sum of £100. r.J. 11.J3°A1 Veterinary Surgeon case at Southampton: irregularities; dismissed. P.J. ii./30,417,475. An Appeal (Liverpool) against a conviction that Register was not available for inspection. Police Inspector called to see it while manager m charge of shop out at lunch and book locked up. Someone should be m charge to produce it. Appeal dismissed.—P.J. ii./3°,576,590. D.D.A. Wholesale Druggist Sundries firm paid 15s. fine and 5 guineas costs. Dangerous Drugs in an unlocked desk ; four girls working m the office. -P.J. ii./3o,522. •viHwl™ Povt; EepoP l9.29 t? Leag«e ol Nations makes it clear that • Drug in 1Q9.Q ^ 11S- country** 70 persons were proceeded against n 1929 under the Act 34 imprisoned, 20 fined, and a few deported.—B.M.J. vi • ii /?835*‘>8ACt 1920 Ie Manufacture> Sale> etc*> of Benzoyl Morphine.—P.J. D.D (Consolidated) Regulations 1928 as to retail sale to the public of from jin I® **“ tlum °'1% of Heroln effective Further References to cases in 1928. See Vol. II., Edn. XIX, p. 68. POINTS OF ASSISTANCE. nf ^®ce ^as issued a third edition of its memorandum on the duties JJ.01and dentists m respect of the Dangerous Drugs Acts and Regula- fV- Unquestionably the law is complicated and increases the cares of the practitioner, but the Home Office has reasonably met the interests of the liofessmn m the matter of the Reference Tribunal and the machinery for withdrawing a practitioner s authority under the Acts.—L. h/29,933. i + Orders',’ ’ in Wholesale Dealings re Part I. Poisons. The intention of the alteration of Section 17 of the Pharmacy Act 1868 is to le/^Sli18116^ 0rclers from aU Persons except retail chemists.—C. D.*, June Wholesale dealing in Dangerous Drugs cannot be conducted without licences. A letail pharmacist can supply the drugs against ‘ signed orders,’ but a phar- niacist doing a wholesale and retail trade must apply for licences in respect of the wholesale side of his business. The licences run to about £13 p a with 2s. 6d. each for every licence for export. ^ Points fic&ijte to he Forgotten in practice are:— All the drugs covered by the Acts are 12] Poisons. Dentists' and veterinary surgeons' (not doctors’) prescriptions must have the amount of the drug stated on the label. N.H.I. prescriptions need not have doctor’s address ; must not be repeated : must be kept as hitherto and sent to Pricing Bureau. P Typewritten prescriptions are accepted as ‘ written.* The inclusion of the words “ to attempt ” to obtain the drugs is to deal with a person who tries to obtain through misrepresentation, even though the chemist discovers the fraud before parting with them. 81 Doctors may WTite prescriptions for themselves. Telephone orders from medical practitioners may be executed, but the written order must follow within 24 hours. luu Nursing Homes are not authorised persons. BookWl'C AnalydS and Teachers requiring the drugs must sign the Poisons Persons in charge of a laboratory must prove that the Institution to which it is attached has been approved by the Home Office for Dangerous Drugs Act purposes.—Malhnson. A foreign medical practitioner, unless registered in England (see Medical and Dental Register) is not a medical practitioner under the Act, cf. L. H./29 When in doubt—refuse to dispense, if the doctor is not known. J he chemist is not legally bound to supply anything. DANGEROUS DRUGS ACT TABLES. We have made the following calculations which should be of assistance to Medical Practitioners. following, and any Quantities of drugs above the following, are within the meaning of the Act, MIXTURES, INJECTIONS, NEBULAE (SPRAY SOLUTIONS) and other liquid preparations. ‘ Drug.’ Percentage LIMIT OF ‘DRUG’ ALLOWED IN A MIXTURE, ETC. Amount per FLUID OUNCE. i Morphine (Anhydrous Base) 0-2 & grain ,, Acetate 0-28 1 % ,, ,, Hydrochloride. 0-26 1 o ,, Tartrate . 0-27 1 -- 97V ,, Sulphate . 0-27 1 AP- ,, Hypophosphite 0-25 1 ;i At* g- Liquor Morphinae Acetatis B.P.T4 28-0 135 minims ,, ,, Hydrochloridi. B.P. 20-0 125 „ ,, ,, Tartratis B.P.T4 27*0 130 „ Inject io Morphinae Hypodermica 10-8 52 n (Tart.) B.P.’14 Cocaine (Base) 0-1 re grain ,, Hydrochloride ... B.P. *14 ... 0-112 i ,, Nitrate 0-12 * 1 ” X 0 ) Injectio Cocalnae Hypodermica. B.P.T4 2-24 10 minims Extractum Cocae liquidum (0-5% 20-0 96 „ alkaloids) Diamorphine (Base, i.e. Diamorphine Nil Nil under the Act) Diamorphine Hydrochloride (Heroin Nil Nil Hydrochloride) Opium Medicinal B.P.’14 (Raw 2-0 8f grain Opium artificially dried containing 10% Anhydrous Morphine) Extractum Opii Liquidum. B.P.T4 26-6 128 minims (0-75 Anhydrous Morphine) Extractum Opii Siccum. B.P.T4 ... 1-0 4| grain (20% Anhydrous Morphine) Liquor Opii Sedativus 13-3 64 minims (1-5% Morphine) Tinctura Opii (1% Anhydrous Morphine) 20* 96 „ Pul vis Opii Composites B.P.T4 20-0 87i grains (10% Opium) Pulvis Cretae Aromaticus cum Opio. 80'°'i Ss s 350 B.P.’14 (2J% Opium) j!|fai Pulvis Ipecacuanhae Composites (10% 20-0 > ° 7S 874 „ Opium) Pulvis Kino Composites (5% Opium)... 40-0J 175 „ PILLS AND TABLETS. ‘ Drug.' Limit Percentage Allowed] Pilula Ipecacuanhae cum Scilla. B.P. *14[About5% Opium (0‘5% Morphine)] g PilulaIpecacuanhae cum Urginea. B.P. *14 [About 5% Opium] Pilula Plumbi cum Opio. B.P.*14.. [About 12% Opium (1*2% Morphine)] Pilula Saponis Composita. B.P.*14 [About 20% Opium (2% Morphine)] 40’0 but exempted if\ not admixed 1 Irre- with other ac-jspective tive ingredient f of 40*0 \ weight ( and 16*6 but exemption! size of as above. Ipill or 10'0 not exempted j tablet. Limit Amount Allowed in One Grain. Pilula Morphinae Hydro- chloridi Pilula Morphinae Sulphas Pilula Morpinae Tar- .. tratis Cocaine Base Cocaine Hydrochloride Cocaine Nitrate.. Extractum Cocae (Solid) 2% alkaloids gr. 3715 1 370 _1 io<5 <5 890 8S0 2*0 M tt Diamorphine (Base) .. Diamorphine Hydro- .. chloride Opium. Extractum Opii Siccum Pulvis Opii Compositus Pulvis Ipecacuanha Compositus Pulvis Kino Compositus i_ 1000 S70 fh __1_ 100 1 gr. >» tt tt tt tt tt LOZENGES. Generally made to weigh 20 grains. ‘ Drug.' Limited Amount allowed in Lozenges. Morphine Hydrochloride.. Cocaine Hydrochloride Diamorphine (Base) Diamorphine Hydrochloride Opium. Extractum Opii Siccum Trochiscus Krameriae et Cocainae- -cf. Cocaine Hydrochlor. above. grain.. [The B.P. ’14 ts „ . .Troch. Morphinae nil. .. (^ grain) are nil. . .therefore outside § grain .. the Act.] X 5 tt • • LINIMENTS AND LOTIONS. • Drug.' Limit Percentage Allowed. Amount per I Fluid Ounce. I Linimentum Opii. B.P.*14 .. 40*0 (Exempted 192 minims (0*5% Morphine) if not ad- *T‘J mixed with [ •• other active ingredients.) Tincture Opii .. 20*0 90 „ (in a liniment or lotion) Oleatum Morphinae (1 in 60) .. 120 68 „ SUPPOSITORIES, PESSARIES, OVULES AND TAMPONS. * Drug.’ Limit Amount Allowed. Morphine Hydrochloride.. Cocaine (Base) Cocaine Hydrochloride .. Extractum Cocae .. (2% alkaloids) Diamorphine (Base) Diamorphine Hydrochlor. Opium. B.P.*14 Plumbi Composila. B.P.’14 Extractum Opii. B.P.’14 Iggrain in 125 grains, or o'- gr. in 15 grains jt >» »> ^50 »» »» 200 »» 15 ,, -?cU ** ** »» »» so >, 15 ,, 12* „ „ 250 „ „ | „ 15 „ None allowed. 5 grains in 250 grains, or fb gr. in 15 grains The Off. Suppositories are exempted. 2* grains in 250 grains or ^5grain in 15 grains • BOUGIES. 2* inches made with Oleum Theobromatis weigh 20 grains. 2* „ „ „ Bougie Mass weigh 25 grains. 4 ,, „ ,, Oleum Theobromatis weigh 40 grains. 4 „ „ ,, Bougie Mass weigh 50 grains. ‘ Drug.’ Limit Amount. Morphine Hydrochloride.. Cocaine Hydrochloride .. Opium. B.P/14 .. ts grain in 20 grains (A in 25, & in 40, & in 50 grains). 4V *» tt 20 ,, (3V in 25, 4% in 40, yV in 50 grains). | „ „ 20 „ (* in 25, f in 40, 1 in 50 grains). OINTMENTS, PASTES, ETC. 4 Drug.’ Limit Percentage Allowed. Amount Per Ounce (Avoir.). Morphine (Anhydrous Base) 0*2 1 grain Morphine Hydrochloride 0* 26 111 -*-80 »» Cocaine (Base) 01 7 1G »» Cocaine Hydrochloride .. 0*112 * M Unguentum Gallse cum Opio. B.P.*14 Exempted. Opium •• «• •• •• • • 2*0 8J Extractum Opii SJccum 1-0 41 ,, EXAMPLES OF [S PRESCRIPTIONS. Note : According to the D.D. Regulations if B.P. or B.P.C. or N.H.I. prepns. are used solely in a prescription it suffices to state the amount of the ‘ Dangerous ’ 'preparation. Otherwise calculation must be made as in the instance of Trochisci Menthol et Heroin, p. 1013. The name and address of patient and the date and the medical practitioner’s usual signature and his address must appear on every prescription. R Morphine .sV grain Sodium Bicarbonate . 8 grains Magnesium Carbonate. 7 grains Fiat pulv. 1, mitte tales 60. Rig. 1 t.d.s. Total amount of Morphine 2 grains. To be repeated on July 21 st, 1933, and on August 11th, 1933, only. B. Mason, M.D., 317, Harley Street, London, W.l. The qualifications need not actually be stated. R Liquid Extract of Opium ... 2 ounces Extract of Belladonna ... ... 1 ounce Glycerin to ... . bounces Sig. To be applied on lint 2 or 3 times a day. Total amount of Liquid Extract of Opium 2 ounces. I* Ext. Coca? Liq. 1 drachm Syl Vanillas . 1 drachm Elix. Saccharin ... ... ... 5 minims Aq. ad ... ... ... ... £ ounce Send 16 ounces. Sig. Coch. mag. p.r.n. Total Coca Alkaloids, 8| grains. To be repealed on July 21 st, 1933, and August 11th, 1933, only. R Cocaine Hydrochloride. 4% Menthol .21% White Soft Paraffin .q.s. Send 4 drachms. Sig. The ointment for the nose. Total Cocaine liydrocliloride, 11 grains. R Morphine Hydrochloride Theobroma Oil to 1* ... i grain ... 15 grains M. ft. Suppos. 1 ; mitte 36. Total Morphine Hydrochloride, 18 grains. Pulv. Gretas Aromat. c. Opio ... 10 grains Ext. Nucis Vom. . grain Misce etfiat Slipule i. Mitte XII. Sig. 1. to be taken thrice daily between meals. Total amount of Pulv. Crctse Aromat. c. Opio. 120 grains. Jnjectio Morpliinas Hypoderinica, B.P. 10 Cc. Plant ampullae XX. Sig. i. s.o.s. Total amount of Inj. Morph. Hyp. 10 Cc. R Pulv. Opii . ... 3-75 Gm. Pulv. Gallee ... ... ... 12-5 Gm. Ung. Hamamclidis ad ... 50 0 Gm. Fiat unguentum. Sig. m.d.a. Total Opium Content, 3*75 Gm. R Cocaine Hydrochloride. iV> grain Morphine Hydrochloride ... grain Fiat aurinariurn ; mitte 20. Sig. One to be inserted when the pain is severe. Total Cocaine Hydrochloride, 2 grains. Total Morphine Hydrochloride 4 grains. Fiat bougie 1,— R Cocaine Hydrochloride. £ grain Theobroma Oil . q.s. 4 ins. in length ; mitte XII. Sig. To be used as directed. Total Cocaine Hydrochloride, 6 grains. Resorcin.40 grains 0. m _ Solution of Cocaine Hydrochloride, i% to 4 ounces. oig. io be used in nasal spray 3 or 4 times a day. Total Cocaine Hydrochloride, 8f grains. 5 Morphine Bimeconate. grain Butyl Chloral Hydrate ... ... 3 grains , ._ Gelseminine Hydrochloride ... 200 grain * ^atpilula, mitte 8. Sig. 1 every half hour until 4 pills are taken and then every hour for 4 hours. Total Morphine Bimeconate, 1 grain. Trochisci Menthol c. Heroin, TUh grain, 1 ounce. Sig. Take one for cough. Total Heroin Hydrochloride, If grains. R Cocaine Hydrochloride. \ grain Adrenalin... ... ... ... grain Glycogelatin basis . q.s. Fiat ovule i. Mitte XII. Sig. m .d.u. Total Cocaine Hydrochloride,... 6 grains 1^ Tinct. Opii . Acid Sulph. Aromat. ... ... aa 2 drachms M. ft. guttce. Sig. Guttce viginti ex aqua quotulie sumendce. Total amount of Tinct. Opii 2 drachms. EXAMPLE OF DENTIST’S PRESCRIPTION. Name and address of the patient. 1* Cocaine Hydrochloride.10 grains Adrenalin Solution .10 minims Distilled Water to . £ ounce Total Cocaine Hydrochloride, 10 grains. (Dispenser must state this on label.) Apply with a pledget of wool to the part occasionally. FOR LOCAL DENTAL TREATMENT ONLY. To be repeated at intervals specified. (Usual signature, date and address.) EXAMPLE OF VETERINARY SURGEON’S PRESCRIPTION. Name and address of Owner of dog. I* Opium in powder .20 grains Sulphur Ointment to ... ... 1 ounce Total Opium content, 20 grains. (Dispenser must state this on label.) For the dog. FOR ANIMAL TREATMENT ONLY. (Usual signature, date and address.) EXAMPLE OF ‘SIGNED ORDER.’ By Medical Man complying with 1923 Act foi postal transmission of 5M] Poisons in qenerai (whether Dangerous Drugs or not). Please send me (by Registered Post):— Opium Medicinal in powder, 4 ounces. Ext. Cocse Liq., 1 lb. Morphine Hypophosphite, 1 ounce. Diamorphine Tablets, A grain, 100. Liq. Strych. HC1., 4 ounces. Ext. Nucis Vom. Liq., 4 lb. dtmtt _ (Usual signature and address). OR “terinary surgEonS should be given by a dentist The requirements of the Act are in addition to the provisions of Sect. 17 Phcy. Act 1868. The purchaser must be known to the seiier or be introduced. Failing this, the pharmacist should refuse to supply. VENEBEAL DISEASE ACT, 1917, nrAnc^ct to prevent the treatment of Venereal Disease (syphilis, gonorrhoea 80ft chancre) otherwise than by duly qualified medico.! foUowhfg is af^uml^—t0 COntro1 the supply of Remedies therefor. The }•' any area in which this section is in operation, a person shall not, unless he is a duly qualified medicoi practitioner, for reward either direct or indirect, treat any person for venereal disease or prescribe any remedy therefor, or give any advice in connection with the treatment thereof whether the advice is given to the person to be treated or to any other person. (2) This section shall operate in any area to which it is applied by order of the Local Government Board, or, in Scotland and Ireland, the Local Government Board for Scotland and Ireland respectively : Provided that no order shall be made in respect of any area until a scheme for the gratuitous treatment of persons in that area suffering from venereal disease has been approved by the Local Government Board, or in Scotland and Ireland, the Local Government Board for Scotland and IrelLnd respec- tively, and is already m operation. p 2. —(1) A person shall not by any advertisement treat or offer to treat any person for venereal disease, or prescribe or offer to prescribe any remedy therefor, or offer to give or give any advice in connection with the treatment thereof. (2) On and after the first day of November, 1917, a person shall not recommend to the public by any notice or advertisement, or by any label or words written or printed, affixed to or delivered with, any packet, box, bottle, phial or other mclosure containing the same, any pills, capsules, powders, lozenges' tinctures, potions, cordials, electuaries, plaisters, unguents, salves ointments, drops, lotions, oils, spirits, medicated herbs and waters chemical .and officinal preparations whatsoever, to be used or applied externally or internally as medicines for the prevention, cure, or relief of any venereal disease 1 Provided that nothing in this section shall apply to any advertisement made by any local or public authority or made with the sanction of the Local Government Board, or in Scotland and Ireland the Local Government Board for Scotland and Ireland respectively, or to any publication sent only to duly qualified medical practitioners or to wholesale or retail chemists for the purposes of their business. 3. —Penalties : Imprisonment, with or without hard labour, for not exceeding two years, or on summary conviction to a fine not exceeding one hundred pounds, or to imprisonment, with or without hard labour, for a term not exceeding six months. National Council for Combating Venereal Disease. Meeting at Edinburgh Resolutions.—L. i./i9,352. DENTISTS ACT, 1921. Came into force November 30th, 1922. Expressly restricts practice of dentistry to registered dental practitioners. Under the Act about 8,000 hitherto unregistered dental practitioners were added to the Dentists Register. No person can now enter the dental profession without going through the dental curriculum and obtaining a diploma or degree. Exceptions are in the cases of registered medical practitioners, registered pharmacists and minor dental work in a public service under conditions approved by the Ministry of Health. Regulations adopted by the newly constituted Dental Board (obtainable from the office of the Board), 44, Hallam Street, W., post free 2s. 8d.), deal inter alia with the keeping of the Register. Persons registered under the new Act include those in practice for 5 of the 7 years prior to July 28,1921 ; members of the Incorporated Dental Society and pharmacists who applied for registration showing that immediately prior to that date they had a substantial practice in dentistry.—Refs. : B.M. J. Supp. i./22,19 ; B.M. J. ill22,283, 894,1099,1113, 1199 ; P.J. ii./22,527. THERAPEUTIC SUBSTANCES ACT, 1925. (15 <fe 16 Geo. 5., Ch. 60.) An Act to provide for the regulation of the manufacture, sale, and importation of vaccines, sera, and other therapeutic substances, {1th August, 1925.) 1. This Act applies to : (1) Vaccines, sera, toxins, antitoxins and antigens. (2) Sahsarsan (Dioxy-diamino-arseno-benzol-di-hydrochloride) and analogous substances used for the specific treatment of infective diseases. (3) Preparations of the specific antidiabetic principle of the pancreas known as insulin. (4) Preparations of the posterior lobe of the pituitary body intended for use by injection. and any other therapeutic substances, afterwards called ‘ substance,' which may from time to time be added as being substances the purity or potency of which cannot be adequately tested by chemical means. 2. —(1) To manufacture for sale any substance to which this Act applies a licence from the licensing authority is required. (2) The licence continues in force for such period as may be prescribed (2 years), but may from time to time be renewed for a like period. (3) The conditions under which the substances are manufactured, and the premises, must satisfy the licensing authority. (4) A licence may be revoked or suspended if the licensee fails to comply with the requirements. (5) This section does not apply to the preparation by a medical practitioner for any of his own patients or for and at the request of another practitioner, if specially prepared with reference to the condition, and for the use, of an individual patient. 3. —(l) Importation into Great Britain or Northern Ireland necessitates standards of strength, quality and purity, and the substance is to be consigned to a person licensed by the licensing authority to import; or to a person engaged in scientific research holding a special licence to import. (3) Substances prohibited come under Section 42 of the Customs Consolidation Act, 1876, and any Act amending or extending. 4. —(i) Joint Advisory Committees frame regulations. 5. —(i) The joint committee has power to make regulations for prescribing standards, tests, adding to the Schedule, prescribing the forms of licences, including inspection of premises and plant, and to take samples, and to exclude any substance used solelv for veterinary purposes. If advertised or sold as a proprietary medicine or contained in such medicine, such accepted scientific name, or name descriptive of the true nature and origin of the substance, as may be prescribed shal] appear on the label. Date of manufacture shall be stated on all vessels or packages, and the sale is prohibited after the expiry of the prescribed period. Contravention of the Act renders a person liable on summary conviction to a line not exceeding £100, and on second or subsequent convictions to a fine and imprisonment with or without hard labour for not exceeding 3 months, and in either case goods to be forfeited and licence may be revoked or suspended. 7.—(1) The licensing authorities are for England and Wales, the Minister of Health : for Scotland, the Scottish Board of Health : for Northern Ireland, the Minister of Home Affairs for Northern Ireland. THERAPEUTIC SUBSTANCES REGULATIONS 1931, No. 633. PART I. Interpretation, etc. Addition of sterilized surgical ligature and suture to the 1925 Act. PART II. Licences for Manufacture of Therapeutic Substances. 6. —Applicant to satisfy the licensing authority that upon issue or renewal of licence the conditions set out in No. 7 of the Regulations will be observed. 7. —(a) Concerns provision of adequate staff and premises for manufacture (6) And for tests of the strength, quality and purity of the substance including housing for animals used, the licensee shall maintain staff and premises to carry out tests or make arrangements with some institution approved for such tests to be regularly carried out on Ills behalf. (c) Records of manufacture and tests to be kept with batch-number. (d) Inspectors may inspect the premises and plant and the process of manufacture and the means employed for standardising and testin'* and may take samples. (e) Any changes in the expert staff responsible and in the premises or plant to be reported. (/) Samples to be furnished on request. (g & h) Batches may be withheld from sale. (i) Licensee to comply with Barts III. and IV. and further requirements if necessary. PART III. Provisions with regard to names of substances and to containers, etc. 8*—If any substance is advertised or sold as a proprietary medicine or is contained in a medicine the 4 proper name ' of the substance shall appear on the label in the manner prescribed in this Bart of these Regulations. 9.—The substance is to be sealed in a previously sterilised glass container. (Ligatures and sutures may be in containers other than glass.) 10. - (1) Labelling. The following are required:— (a) The proper name of the substance in letters not less conspicuous than those in which the proprietary name, if any, is wnitten or printed, and following immediately after or under such proprietary name. (b) The number of the licence under which the substance is manufactured preceded in the case of Import licenses by the words 4 Import License.' (c) A distinctive batch number. (d) The name and address of the maker, date of manufacture, and statements of toxicity if required, nature of antiseptic if any, are also enforced, also date of removal from cold storage at a temperature not exceeding 5° C. 11. —The sale of a substance after prescribed date is prohibited, but a practitioner may override this, if his attention has been drawn to the date and he is satisfied it is required by the urgency of the case. PART IV. . Standards of strength, quality and purity, and tests for determining. Tests for living aerobic or anaerobic bacteria are to be made in the case of:— (a) Sera and solutions of serum proteins for injection. (b) Certain bacterial vaccines. (c) Toxins, antigens, and mixtures of toxins or antigens with serum. (d) Solutions of insulin. (e) Dry preparations of insulin intended for therapeutic use. (/) Preparations of the posterior lobe of the pituitary body. 16.—The tests are to be applied :— (a) To samples taken from each batch of the substance before filling and sealing the containers : and (b) To the contents of sample containers when ready for issue. 1 7.—(a) In the case of samples taken from the batch at the time when the test is made, the quantity taken for test shall be not less than 0T% of the total volume of the batch if the volume is not more than 10 litres, and not less than 10 Cc. if the volume is 10 litres or more, but shall in no case be less than 1 Cc. if the batch is contained in a number of bulk containers, samples in these proportions shall be taken from each of such bulk containers and separately tested. (b) In the case of the contents of sample containers, the number shall be not less than 1% of the total filled from the batch, if this number is not more than 1,000, and not less than 10 if the total number is more than 1,000. 18. —Defines method of preparing and using media. 19. —(1) In the case of samples taken from the batch one-half of the total volume of the sample is to be used for aerobic and one-half for the anaerobic test. (2) In the case of the contents of sample containers, the contents of each container shall be tested for aerobic and anaerobic organisms. When the volume in each container is 2 Cc. or more the contents shall be divided into two approximately equal parts, one for the aerobic and the other for the anaerobic test. (3) The inoculated tubes shall be incubated at 37° C. for seven days and examined after incubation, permanent records being kept of such examination of each tube. 20. —(1) If at this examination no growth is visible in any tube, the sample has passed the test. (2) If at the examination a growth is visible, further samples may be taken and the tests repeated. The taking of samples from' the batch may, if necessary, be repeated twice, if the same organism is visible in more than one test, the batch shall be treated as not sterile and the material contained in the batch shall not be issued or used as part of a further batch unless and until it has been re- sterilised and has passed the tests. 21. —Emergency Regulations. 22. —Ereedom from abnormal toxicity is ensured by injecting 0.5 Cc. of the serum into a normal mouse. PART V. Licences for Import of Substances. 23 and 24.—Broadly, the applicant must furnish a written undertaking signed by, or on behalf of, the manufacturer that the manufacturer will comply with the Regulations as to manufacture and testing. PART VI.—25. Research Licences.—Special modifications apply. PART VII.—26. Substances Manufactured or Imported for Export only. The licensing authority may dispense with any of the requirements of the Regulations, if necessary. PART VIII. Substances for Veterinary Use only. 27.—Containers to be marked ‘ to be used solely for veterinary purposes ’ Jn respect of ligatures and sutures the labelling of wrapper affixed to package in which the container is issued, suffices. FIRST SCHEDULE provides forms of application for licences. SECOND SCHEDULE PART I. Vaccines, toxins, antigens, sera and antitoxins. & ’ (A) .Provisions applicable to the production of Bacterial Vaccines. (2) Defines a bacterial vaccine. ^ ?ne name °f a vaccine is the name of the micro-organism followed by the word ‘ vaccine,’ except in the following : Anti-typhoid vaccine. Anti-typhoid-paratyphoid vaccine (T.A.B.), Anti-typhoid-paratyphoid-cholera vaccine (T.A.B.C.), Antiplague vaccine, Whooping cough vaccine, Anti-dysentery vaccine. (6) label on the container must indicate composition :— (a) Number of micro-organisms per Cc. or (b) V eight of dried substance of micro-organisms per Cc. or (c) Number of micro-organisms or weight of dried substance of a .organisms used in preparing 1 Cc. of the finished product. (B) Special provisions re Vaccine Lymph (Vaccinia). c, fv ProPer name is ‘ Vaccine Lymph.’ Kstan of Establishment, Housing of animals, Precautions to observe are dealt with Glycermation and cold storage, tests of gas-producing anaerobic organisms, living haemolytic streptococci and potency are included. PART II. Toxins and antigens. (A) Provisions applicable to reagents used in the Schick Test for the diagnosis of susceptibility to diphtheria. 1 —(1) The reagents used in the Schick Test are two, Schick Toxin and Schick Control. Their proper names respectively are ‘ Schick Test Toxin ’ and Schick Control.’ (2) Schick Toxin is a sterile filtrate from a culture on nutrient broth of the specific, organism of diphtheria (Corynebacterium diphtherice). It may be issued either (i) undiluted, or (ii) already diluted with /ox salme solution to the strength proper for use in the test. (3) Schick Control is prepared from the same batch of Schick Toxin as that with which it is issued for sale, by destroying the specific toxicity at 70° C. for a time not shorter than 5 minutes. 2.—Tests for Potency. (B) Provisions re Diphtheria Prophylactic. (C) Provisions re Tuberculins and other preparations from the Bacillus tuberculosis and its cultures. PART III. Provisions re production of all sera from living animals. PART IV. Provisions re particular sera and antitoxins. (A) Anti-Bacterial Sera and Antitoxic Sera for which no potency test is prescribed. (B) Anti-dysentery serum (Shiga) and other anti-dysentery sera. (C) Diphtheria antitoxin (proper name). (D) Tetanus antitoxin (proper name). (E) Gas-gangrene antitoxin (Perfringens). THIRD SCHEDULE. Arsphenamine and derivatives. PART I. Re Arsphenamine and derivatives. The standard preparations are kept in the National Institute for Medical Research, Hampstead. Biological tests are applied and tests for maximum toxicity and for therapeutic potency. PART II. Special provisions re Arsphenamine. Chemical and physical. PART III. Special provisions re Neo-arsphenamine. PARTS IV. and V. Special provisions re Sulpharsphenamine and other derivatives. FOURTH SCHEDULE. Insulin :—Proper name. Special conditions of licence. Standard. Units. Quality. Tests. Container. Label. FIFTH SCHEDULE. Pituitary (Posterior Lobe) Extract :—Proper name. Standard Preparation. Unit of standardisation. Quality. Tests and Label. SIXTH SCHEDULE. Sterilized Surgical Ligature and Surgical Suture. Tests for Sterility and Labelling. Refs. B.M.J. Supp. ii./25,105: P.J. ii./25,286 ; P.J. i./31,542. MERCHANDISE MARKS ACT, 1926. This Act renders it illegal to sell (Wholesale or Retail), or to expose for sale (Retail) in the U.K. imported goods with label, etc., which is, or might be taken to be, the name or Trade Mark of a manufacturer, dealer or trader, or the name of a place in this country, unless there is an indication of foreign origin, e.g., ‘ Made in Germany,’ or ‘ Empire.’ Two Orders in Council have been made as to exemptions, one relative to Petroleum and liquid products thereof, and the other to uncompounded drugs icliich are sold for medicinal purposes, provided they are not under a proprietary name. Other Orders referred to Gold and Silver Leaf, Glue and Gelatin, Tooth Brushes, Honey, Cotton Wool, Rubber Goods, Scientific Glassware, and so on. IMPORT DUTIES ACT, 1932. (29th Feb., 1932.) 22 Geo. 5, Ch. 8. An Act to provide for a general ad valorem duty on goods produced or manufactured in a foreign country, discriminating in the case of goods produced or manufactured within the Empire, and exempting goods already chargeable with duty under other enactments and goods specified in the First Schedule. Provision is made for setting up an Import Duties Advisory Committee for the purpose of giving advice and assistance to the Treasury, and for recommending additional duties or the discontinuance of duties. The Act does not take effect in respect of Empire goods until November 15, 1932, or some later date fixed by Parliament, and neither the general ad valorem duty nor any additional duty is chargeable in respect of Empire produce. In the case of discrimination on the part of any foreign country, by means of imposition of duties or prohibition or restriction of imports, on British or Empire goods, the Board of Trade is empowered to impose supplementary duties on goods imported from that country. Goods imported with a view to re-exportation are exempt. first schedule. The following are amongst the goods exempted : Gold and silver, platinum, wheat and maize in grain, meat but excluding extracts in airtight containers, whale oil, cotton, flax, hemp, cotton seed, rape seed, and linseed, newspapers, newsprint, wood pulp, esparto, metallic ores, iron pyrites, unwrought copper, sulphur, phosphates of lime, potassium carbonate, chloride and sulphate, mineral potassium fertilisers, cinchona bark, radium, scientific films, soya beans and cork. THIRD SCHEDULE. Goods are not deemed as having been manufactured in the British Empire unless a proportion of their value (S.R. & O. 1932, No. 85) is derived from material grown or produced in the Empire. In the case of goods manufactured from material not wholly grown or produced in the Empire, only such proportion of their value as corresponds to the proportion of Empire material is free of duty. Goods manufactured in a bonded factory in the U.K. from dutiable material of Empire origin are free from duty. Customs. Imperial Preference. (S.R. & 0. 1932, No. 85.) To be cited as the Import Duties (Imperial Preference) No. 1 Regulations 1932. Dated March 1st. 1932. Goods shall not be deemed Empire produce unless at least 25% of their value is derived from materials grown or produced or from work done in tfie British Empire, TRADE MARKS. The 1905 Trade Marks Act defined a Trade Mark as follows . A trade-mark shall mean a mark used, or proposed to be used upon or in connection with, goods for the purpose of indicating that they are he goods ol the proprietor of such trade-mark by virtue of manufacture, selection certification, dealing with, or offering for sale ” » It is important to realise that Trade * Marks can exist as Common Law Trade Marks. An unregistered trade mark can be protected by a passing off action, i.e., for an injunction and damages. A trade mark must contain or consist of at least one of the following essential particulars : or ^particular banner company» individual, or firm represented in a special in ^hL business a^Uie appi*cant for registration or some jiredecessor (3) An invented word or invented words. (4) A word or words having no direct reference to the character or quality of the goods, and not bemg according to its ordinary signification a geographical name or a surname. (5) Any other distinctive mark. But a name, signature, or word or words, 11 /,al1 within the descriptions in the above paragraphs (1), (2), (3), and (4 shall not, except by order of the Board of Trade ok the Court be deemed a distinctive mark. .v,r!'^viks, T*-ay registered in fifty classes, and the legal protection of the Tiade Mark is restricted to the class in which it is registered The Classes of goods with which the pharmacist is mostly concerned are the following. (We give them in order of frequency):— I. Chemical sulsiances used in manufacture, photography or philosophical research, and anti-corrosives. & v y 1 L Chemical substances used for agricultural, horticultural veterinary and sanitary purposes. ’ HE Chemical substances prepared for use in medicine. XLil. Substances used as food or as ingredients in food. XLI11. Fermented liquors and spirits. XL1V. Mineral and aerated waters, natural and artificial XLVII. Candles, common soap, detergents illuminating heating or lubricating oils,: matches, starch, blue, and other preparations for laundry purposes. * XLVIH. Perfumery (including toilet articles, preparations for the teeth and hair and perfumed soap). We indicate Trade Marks by the * preceding the name of the article and have added the numbers thus : T.M. 320021 to each, so far as our searches at the Patent Olfice have indicated. Having to consult these numerous classes omissions may have occurred. As the Patent Office Public Index is continually under revision it is possible that alterations may have been made subsequently. We shall therefore welcome information as to corrections for consideration in a future edition. The provision of the numbers enables any person by the payment of a small fee at the Patent Office to obtain information as to the status of the Trade Mark in question—date of registration, date of payment of renewal fees details of assignment and so on. This information could not reasonably be incorporated in our pages. The late 8. W. Woolley, Editor of the “ Chemist and Druggist ” (London) did excellent service in showing up the anomalous condition of the law in regard to Trade Marks—particularly in respect of Trade Marks for Patented Articles. When an article has been introduced as new and has been first manufactured under a patent, the name by which it is known becomes common property as soon as the expiration of the patent rights put an end to the monopoly in the manufacture and sale of the article, and although the name may, down to that time, have identified the goods with the maker of them, it is no longer available for him as a Trade Mark or Trade Name. “It is impossible to allow a man to prolong his monopoly by trvffig to turn a description of the article into a Trade Mark. Whatever is mere description is open to all the world.”—Lord Justice James, in Cheavin v Walker (1877). When it is understood that a Trade Mark, by renewal every fourteen years, can be continued indefinitely, and that renewals of the Trade Marks applied to patented articles are made after the expiry of the patent, the extent of the continuance of the monopoly will be realised. The Patents, Designs and Trade Marks (Temporary Rules) Act 1914 and the Rules made under it with which we dealt very fully in our 17th Edn., p. 956 et seq. were “ to continue in force during the continuance of the present state of war in Europe and for a period of 6 months thereafter.” It may be recalled as an important point that certain Trade Marks, e.g. Aspirin, Lysol, Metol, Urotropin were avowed (meaning legally invalidated or made of no effect). These words are public property and the rights which the registration originally gave to the owners have come to an end. Certain words were on the other hand, temporarily ‘suspended,’ e.g. Salvarsan, Neo-Salvarsan and Novocain. The Patents and Designs Act, 1919, strengthens the provisions for the protection of British Industry in the Act of 1907. The 1919 Act is concerned ‘ for the prevention of abuse of monopoly rights ’; if within four years from the date of a patent, the invention is not worked within the United Kingdom on a commercial scale, or if the demand for the patented article in the United Kingdom is not adequately met, and for other reasons, the Comptroller may grant ‘ licences of right' (exclusive or non-exclusive) to any applicant on such terms as he (the Comptroller) may decide or may even revoke the patent. Section 11 enacts that the specification for an ‘ invention relating to substances prepared or produced by chemical process or intended for food or medicine * sha/i not include a. claim for the substance itseif, except when prepared or produced by the special method or process of manufacture described and claimed (in the specification) or by its previous chemical equivalent. Any applicant is prima facie entitled to a licence for a food or medicine patent. . Registration of assignments, etc., of patents is made compulsory. The term of a patent is to be sixteen years instead of fourteen, and existing patents and licences are extended for two years accordingly. Proprietary Medicines often called erroneously ‘ Patent ’ are dealt writh in Vol. II. The Trade Marks Act, 1919, in force since April 1st, 1920, divides the register of trade marks into two parts ; part A is to consist of those marks already registered and those hereafter registered under the previous Acts (which, with some amendments, remain in force), part B is to contain a new class of marks, for any mark which has been in use for two years may be registered, under the new Act, unless deceptive or closely resembling a mark already registered. This is apparently intended to permit the registration of many marks which could not be registered under the previous Acts. Registration in part B will, however, only be prima facie evidence of ownership: it will never become conclusive, whereas registration in part A is generally conclusive after 7 years. An important new provision is Section 6 :— ‘ Where in the case of an article or substance manufactured under any patent.a word trade mark ..../s the name or only practicable name of the article or substance so manufactured, ad right to the exclusive use of such trade mark,.shad cease upon the expiration or determination of the patent&c. There is also a provision against registration of a word ‘ which is the only practicable name or description of any single word chemical element or single chemical compound as distinguished from a mixture.’ These two provisions are intended to prevent the” abuse of trade mark law. . _ , _ . ^ Conference on Empire Patents, June, 1922, m London. To institute a system of granting patents, which should be valid throughout the British Empire. Need of having an agreement on the definition of the word ‘ inventor ’ and the rights of importers to obtain a patent. There is a divergence of practice between the United Kingdom and some of the Dominions. A Commission of legal, technical and business men, and Government officials, necessary There is a semi-chaotic state of things.—C.D., Aug. 26, 1922. Patenting of Medical Inventions. Proposed scheme of Dedicated Patents. _B.M.J. i./3o,957,1204 (corresp.). Sir H. H. Dale, Suppt. ibid, if 31,266. Departmental Committee on Patents and Designs Acts. Recommendations.—B.M.J. i./31*641. THERAPEUTIC INDEX OF Internal Remedies and Chemicals Injected are in Roman type. Vaccines as a general rule are for hypodermic use. Remedies for local or external use are in italics in a separate 'paragraph. Great care should be taken as the Index is merely intended to refer the reader to the text. Abortion, Threatened.—Hydrastis, Quinine, Sumbul, Viburnum, pruni- folium. Abscesses, General, to abort.—Aconite, Belladonna, Calcium Sulphide, (e.g. in Stearettes, Mang. Butyrate, Quinidine Preps., Quinine, Staph. Vaccine. Locally.—Acid Carbolic, Argenti Nitras, B.I.P.P., Colloidal Iodine, Dakin’s Solution, Eusol, Hydrogen Peroxide, Tincture of Iodine, Unguentum Belladonna, Ung. Iodi Intinctum. See also Wounds. Abscesses, Dental. Locally.—Boric Acid Lotion, Copper and Zinc Ionisation, Dental Solubes, Formosyl, Borated Hydrogen Peroxide, Iodates. Abscess Liver, Tropical.—Antimonials, Arsenicals, Auremetine, Emetine Injections, ‘ E.P.I.,’ Ipecacuanha, Vaccine of Organism if isolated, Quinine Injections. Achlorhydria. Ac. Hydrochlor. dil., Gentian, Tinct. Nucis Vom., Pepsin with Acid., Pancreatin c. Alkali. Achlorhydria in a variety of conditions cured by Pepsin and Hydrochloric Acid.—T. H. Oliver and J. F. Wilkinson, B.M.J. ii./3o,1048. Acidity of Stomach.—Alkalis, Ammonia preps., Aperfine, Belladonna, Bismuth preps., Bismuth and Pancreatin, Bisciniod, Calcii Carbonas, Carbo Ligni, Charkaolin Granules, Cremor Magnesiae, Magnesii Carb. or Oxide, Oleum ‘ Elliott * Caps., Potass. Bicarb., Sodii Bicarb. An ounce of Almond Oil (internally), q.v., first thing in the morning, repeated before other meals if necessary. See also Hyperchlorhydria. Acidosis.—Administer purgative, wash out stomach, then subcutaneous, or better, intravenous injection of Sodium Bicarbonate Solution. Sodium Lactate or Sodium Citrate per os—Glucose Rectal Injection. Acidosis in diabetes, starvation, various poisonings, cyclic and periodic vomiting, etc.—Alkalis, Alcohol. See also Diabetes. Laboratory observations on acidosis.—G. Matthew Fyfe, B.M.J. L/2 7,800 Acidosis, of Gastric Ulcer. — Calc. Phosph. Tribasic., Magnes. Phosph. Tribasic. Acne.—Acid Camphoric, Arsenic, Brominol, Calc. Chlor. intrav., Calc. Sulphid. Stearettes, Facxin, Ftexin Extract, Guaiacol Hypophosphites, Liquor Anri et Arsenii Bromidi, Liquor Auri et Hydrarg. Brom., 01. Morrhuae, Phosphorus, Pot. Brom., Quininse et Ferri Citras, Sod. Brom., Stannoxyl, Sulphur (and Colloid), Sulphur Stearettes. Turpentine in Oil Injection, Vaccines. Locally.—Acid Carbolic, Acid Lactic, Acid Nitric, stabs, Anserin Mulls, Medictd., Calamince Lotio, Hydrarg. Perchlorid. Lotio, Ichthyol, Ichthyol- resorcin and Salicylate, Iodates, Isopropyl Ale., Lotio Sulphuris cum Saponel, Quillaia Lotion, Ung. Resorcin Co.. Colloidal Metals (Silver, Mercury, Sulphur), ‘ Cremor Sicc.’ preps., Sulphur Colloidal, Sulphur Ung., Sulphur Hypochloritis Ung., Sulphur Iodid. Ung., Thymol Ung., ‘ X ’ Bays. Use plenty of hot water to the face and wash night and morning with soap and spirit—then Calamine Lotion and allow to dry on.—B.M.J. i./i7,604. In intractable acne vulgaris, gastric acidity should be tested. Cases with a low acidity benefit from a mixture containing dilute Hydrochloric Acid, Cascara Sagrada and Tincture of Nux Vomica.—per Pres., Oct., ’26, 346. Hence continued infection of the face probably takes place from the scalp, A spirit shampoo should be used weekly.—H. G. Adamson, L. i./25,401, X-rays in acne.—J. B, Higgins, L. ih/29,609. Acne Rosacea.—Finsen Light and ‘ X ' rays. Acne Rosacea cured in 5 weeks by Tartrated Antimony, 1/16 grain per os thrice daily after meals, combined with application night and morning of a lotion containing Sulphur, Zinc Oxide and Magnesium Carbonate. Good results also in furunculosis and ulcerative legs.—L. W. Bain, B.M.J. iL/29,51. Acromegaly.—Pituitary Extract, Thyroid Extract (guardedly), Potassium Iodide, and a Mercurial Salt (value doubtful except where there is a specific taint). Headache of, relieved by Antifebrin, Phenacetin, Exalgin, Magisal, Migralgin, Phenazone. Sweatings of, by Zinc Oxide, Atropine or Picrotoxin.—L. i./o9,28. See also Elephantiasis. In nearly all cases there is a definite change in the pituitary gland which takes the part of an adenomatous overgrowth. For a useful account of the clinical signs and operative procedure, see J. A. Walton, B.M.J. ii./22,838. See also our page 956. X-ray treatment should be tried in acromegaly.—R. A. Young and W. J. Adie, L. ii/29,876. See also Ateliosis.—Therap. Index. Actinomycosis.—Cupri Sulph., Sol. Argent. Nit. Injectio 20%, Hyd. Pot. Iod., Potassii Iodid., or Sodii Iodid., Salicylates. Thomassen’s Iodide Method, Iodi Injectio, Iodine Injection, Actino. Vaccine. See also Vol. II. Argent Colloidale, Cupri Sulphas, ‘ X ’ Rays. Tincture of Iodine in milk. Dose.—5-10 minims in half a cup of water three times a day. ‘ Effect almost incredible.’—H. Chitt-y, B.M.J. i./26,419 ; i. J29,347. See also Pres., Oct., ’29, 345. Radium treatment cured.—per Pres., Oct., *26,346. Vaccine used, the nidus of infection a tooth.—W. R. Judd, B.M.J. ii./26,887. Actinomycosis of the tonsils. An interesting case.—B.M.J. i./3o,148. Addison’s Disease.— Arsenic, Iron, Phosphorus, Suprarenal preparations. Adrenalin hypodermically may increase blood pressure a little. Treatment at Guy’s Hospital. Hydrochloric Acid 2 drachms thrice daily with 10 ounces of water containing sugar and orange juice. B. acidophilus culture is given three times daily, and a tablespoonful of Charcoal morning and evening. An autogenous vaccine, prepared from the hoemolytic Streptococcus isolated from duodenal contents, is injected in increasing doses. Anaemia is treated by Arsenic, and when necessary by repeated transfusion, and the spinal symptoms by exercises. The best results only obtained by this combined attack.—A. E. Hurst, L. i./2 5,1212. Enteric-coated capsules of suprarenal cortex of service.—B.M.J.E. ik/29,43. Adenoids.—Cod Liver Oil, Iodine, Iron, Liq. Perro-Manganes. Pept. cum Haemoglobin, Liq. Iodo-Perro-Manganes. Pept., Syrup Iodo-Tannicus. Locally.—Ammon. Chlor. Snuff, Glycerin vel Liquor Ferri Perchlor. Nasal Injection of Tannic Acid, Nebulce (q.v.) ‘ X ’ Rays. Orris Root Powder and Soap on septum to induce sneezing. Adnesions, Fibrous, Peritoneal, etc.—Injectio Thiosinamin et Phenazoni, Inject. Thiosinamin et Sod. Salicyl. /vdiposity. See Obesity. Ague.—See Malaria. Alouminuria.—Acid. Gallic, Agmel, Basham’s Mixture, Eerri Cacodylas, Euchsine, Juniper Oil, Nitroglycerin, Vinum Diurecticum, Viscum. Differential Diagnosis, see Vol. 11. Polyuria associated with pituitary disfunction.—E. B. Vemey, L. h/29,539. Alcoholism.—Acid Hydrocyanic, Ammonium Cliloride, Arsenic, Atropina, Auri Chlorid., Capsicum, Chloral Hydras, Cinchona, Colloidal Gold, Digitalis, Hydrastis, Hyoscinse Hydrobromidum, Hyoscyamus, Lupulin, Mistura Anti- dipsomanica, Mist. Belladonna Xanthoxyli et Hyoscyami, Mistura Eerri Aperiens, Mistura Magnes. Sulph. Co., Nux Vomica, Phosphorus, Picrotoxin, Stramonium, Stryclmine, Atropine and Strychnine hypodermically to keep the patient away from drink ; Apomorphine if mad drunk. Eor insomnia of; Elix. Chloralamide. D. E. Stanford Park on treatment of inebriety and drug habit.—L../22,691: ii. /24,491, v. also our pp. 365 and 554. Useful Outline of Treatment. Calomel at bedtime, “ Salts * or Seidlitz in the morning. Acute gastritis is treated by £ grain doses of Calomel every half hour for 5 hours followed by _ Salts/ Apomorphine hypod. for acute alcoholism. Nervous patients receive Bromide well diluted per os and Strychnine 1/30 grain hypodermically every six hours. Suspend Strychnine after six days and give then -1 ounce every hour of the following mixture Tinct. Capsici 1 drachm, Liq. Extract of Quassia and Tinct. Ignatia (or Nux Vomica) of each 1£ drachms, Water to 8 ounces—A. M. Rosebrugh, B.M.J. i./i4,704. Ammon. Chlor. is an antidote to excess. Albuminuria cleared up under Quinine.—Is albuminuria a contraindication to use of Quinine in pregnancy ?—W. M. Hewetson, B.M.J. i./3o,761. Albuminuria—a general resume.—J. C. Spence, L. i/29,623. The following is a useful ‘ draught ’ on the morning after a ‘ big dinner ’ Sodii Bic., Pot. Brom. aa. gr. 20, Tinct. Card. Co., Tinct. Gent., Co., aa 1 drachm. Aq. ad H ozs. (Calomel 5 grains if bowrels not already loose).—C.D. Alkalipenia.-—with reference to acidosis, as observed in children. A normal adult wants approximately 75 grains (5 Gin.) Sodium Bicarbonate to render the urine alkaline, and an infant 20 to 40 grains. In acidosis approximately 100 to 200 Gm. are required to produce an alkaline urine. Over 200 Gm. death ensues.—A. I). Symons, L. i./22,G27. Alopecia.—Arsenic, Arsenic and Iron Injections, Haemoglobin, Iron, Pilocarpine, Strychnine, Thyroid Gland (Standardised) Preps., either Tabs, or Liquor. Locally.—Ammon. Liquor, Amyl Nitrite with Pilocarpine TLair Lotion, Burt's Fluid, Cantharides preps., Carbon Dioxide, H. F. C., Hyd. Oleas, Hyd. Perchlor. vel Subchlor., Lin. lodi, Liq. Curb. Deterg. 20% Lotion c. Glyc. 10%, Chrysa- robin, Lotio Capillaris, Lotio Balsami Peruvian, Lotio Excitans, Lotio Besorcini, Lotio Mtheris, Comp. Baume Fioraverti, Lin. Jaborandi, Lotio Resorcin et Ac. Salicyl., Lotio Resorcin, Pilocarpin et Canthar., JJng. Cadini, Spiritus Acid. Lactic, * X ’ Rays (small doses). Seborrlmic Alopecia treated with Saturated Solution of Sulphur in Carbon Bisulphide (Inflammable).—Sabouraud. Good results from application of Cholesterol solution.—per Pres., Oct., ’29, 334. Alopecia areata.—Malcolm Morris advised patient to cut a lemon or two (or limes, if necessary), to sprinkle the cut surface with Goa PowMer and to rub the part.—Sir N. Walker, L. ii./29,214. Anterior Lobe Extract 1 Cc. hypodermically once, twice, and then thrice weekly successful—L. ii./3i,l363. Amenorrhcea.—Actsea and Cimicifugin, Aloes, Apiol, Cantharides, Caulo- phyllin, Corpora Lutea, Hewees’ Mixture, Ergot and Apiol Caps., Elixir Ergotse cum Ferro, Gossyp. Rad. Cortex, Guaiacum and Apiol, Iron Salts, Mang. Oxidum, Mist. Senecio Co., 01. Rutae, 01. Pulegii, Pil. Aloes et Myrrh., Potass. Permnng., Pulsatilla, Savin, Senecio, Tanacetum. Thyroid Gland (Standardised Liquor and Tablets). Amoebiasis.—Auremetine, Ipecacuanha or Emetine Injection or ‘ Stear- ettes ’ or Salol-coated pills of Ipecac., Emetol, Emetine Periodide, or Emetine Bismuth lodid. Intestinal amoebiasis. Symptomatology. Why the same infection should produce active diarrhoea in one and chronic constipation in another cannot at present be determined.—P. Manson Bahr and C. B. V. Tait, L. ii/29,1028. See also Dysentery. Anaemia.—Arsainin, Arsenic, Cacodylates, Calcii et Ferri Glycerophosphas, Calcii Hypophosph., Calcii Phosph., Chlorophyll preps., Cholesterin, Corpora Lutea, Elix. Gent. Acida, Elix. Hamioglobin, Ferri Bromid., Ferri Perchlorid., Ferrous Chloride, Liquor Ferri Hypophosph., Ferri Iodidum, Ferri Perchlorid., Glycerol Glycerophosphatum, Ferri Phosph., Ferri Sulph., Ferruin Dialysat., Glycerol Glycerophosphatum cum Medulla rubra, Lecithin Elixir and Emulsion, Liq. Ferri Albuminati, Liq. Ferri Pept., Liq. Ferri-Mang. Pept., Liq. Iodo-Ferro-Mang. Pept., Liq. Ferro-Mang. Pept. cum Haemoglobin, Manganese Cit., Marrubin, Malted Glycerophosphates, Nucleinic Acid, 01. Morr- liuse, Phosphor., Pil. Ferri Garb., Pil. Ferri Sulph., Quinine preps., Quinine et Ferri Chlor., Saccharum, Sirop Neurotonique, Sodii Hypophosph., Spleen Substance, Strych. Cacodyl., Syr. Iodo-Tann., Syrupus Tann-Iodo Phosph., Vinum Tann-Iodo Phosph. Leukaemia successfully treated by inoculation of malaria, 3 Cc. of blood from a malarial patient being injected subcutaneously.—per Pr., June, *26,433. in rat experiments, inorganic Iron Salts were useless for nutritional anaemia, whilst the ash of liver, lettuce, or maize was highly effective. It was found that the effect of the liver extract or ash could he imitated by the use of small amounts of Copper in conjunction with inorganic Iron.—B.C.A., ’28,A790. Anaemia, Pernicious.—Arsenicals, Benzol Capsules, Four Gland Tablets. For Liver and Hog Stomach (Yentriculin) Treatment see p. 951. It is stated that Iron is an absolute poison—the liver already contains excess to draw upon—but arsenic does good. Achlorhydria the fundamental predisposing cause. Hydrochloric Acid in large doses should always be tried.—T. Houston, B.M.J. ii./24,1209. Repeated doses of Calomel 2 grains, at first twice a week for six weeks, afterwards once a week for further six weeks, and finally once a month. Improvement most marked.—J. C. Terrier, B.M.J. i./2i,932. Treatment should consist of radical oral sepsis, giving Hydrochloric Acid, regular use of sour milk, and inoculation with a vaccine made from Streptococci, isolated from patient’s duodenum by means of a Ryle’s tube—A. F. Hurst, B.M.J. ii./22,978. Daily injection of 100 mgr. Tryptophane and 200 mgr. Histidine gave rise in blood count.—L. i./31,256. Marmite said to be equal to Liver in India. For Blood Counting and Staining see Vol. II. Anaesthetics by inhalation.—A.C.E., Acetylene, iEther (and with Alcohol and Oxygen, and Gas and Oxygen), iEthyl Bromid., C.E., iEthyl Chlorid., and with Nitrous Oxide, iEthyl Iodid., Chloroform (and with Oxygen and Hyoscine-Morphine), Ethanesal, Ethylene, Nitrous Oxide, Somnoform. For a ‘ rough sketch ’ of Chloroform Administration v. p. 283. Gas and Oxygen extremely useful, many cases being dealt with which would not stand a more toxic drug.—Sir Crisp English, B.M.A., L. ii./23,302. Vernon-Harcourt Regulator, see p. 282; Shipway’s App., p. 282. For treatment if danger arises with Chloroform, see p. 283 ; with Ether p. 97, with Ethyl Chloride, p. 106, and Nitrous Oxide, p. 142. Alcohol intravenously. Heart arrest—Adrenalin by intracardiac injection or intravenously. Anaesthesia, Intra-Spina!, see Kerocain, Stovaine, etc. Anaesthetics Local.—/Ether, Acid. Carbolic, Adrenol (throat spray), Adreu- caine, /Ethyl Chlorid., Alopon, Anesthone, Apothesine, Avertin (amnesic in childbirth), Butyn, Benzamine, Cocaine (and Substitutes), Cocaine Ionised, Erythrophlceince MCI., Ice, Kerocain, Menthol, Methyl Chloride, Papaverine, Paraldehyde {intravenous), Percain, Phenolaine, Quinine, Quin-Eydrochloro- Carbamid., Stovaine, Tropacocaine, Tropacocaine Infiltration and Intraspinal Injection, Scopolamine-Morphine Injection, also Scopolamine-Morphine-Atropine, Magnesium Sulphate Intraspinal Injection, Spinocain, Stovaine with Dextrin (Tyrrell Gray). /Ether-Saline intravenously, Ether in Oil per rectum. (Many of these are, of course, injected.) Potassium Sulphate 0’5% added to local anaesthetics for intraspinal injection enhances action. Anaesthetics, Hypnotics to use with.—Avertin, Barbiturates, Morphine, Nembutal, Paraldehyde, Scopolamine, Sodium Amytal. See also Hypnotics. Anal Fissures. {Locally).—‘ A.B. A.,’ Belladonna Ointment, Carbolic Acid, Glycerin Aloes, Ichthyol, Iodoform Suppositories, Percain Injection, Quinine ECl. packing and suppos., Ung. Conii. Quinine Urea Hydrochloride injections, afterwards swabbing with French Tincture of Iodine and Tinct. Benz. Co. 1 oz. each, Camphor 1/3 oz., Chloral Hydrate 1/3 oz.. Phenol 1/3 oz. Soothing effect.—C. Howard, L. i./3i,914. Analgesics '(Anodynes).—Acetanilide, Atropine, Belladonna, Butyl Chloral, Camphor, Cannabis, Chloretone, Cocaine and substitutes, Codeine, Conium, Gelsemium, Hyoscyamus, Hyoscine, Morphine, Opium, Orthoform, Phenacetin, Phenazone. _ ^ _, 7 ^ Locally.—Methyl-Aspriodine, Ung. Methyl Salicyl. Co. Anaphrodisiacs.—Bromides, Iodides, Opium, Belladonna, Hyoscyamus, Salix Nigra, Stramonium, Purgatives. Aneurism.—Aconite, Amyl Nitris, Calcii Chlorid., Digitalis, Ergotina, Iodoprotein Tabs., Morphine, Nitroglycerin, Potassii Iodidum, Veratrum. Gelatin Injection. Diagnosis.—‘ X ’ Rays. Angina Pectoris.—Aconite, AEther, iEthyl iodid., Alcohol, Amyl Nitris, Arsenic, Chloroform Inhalation Capsules (not with low blood pressure), Digitalis, Digitalin cum Nitroglycerin Tabellin, Erythrol Nitrate Tabella), Hoffmann’s Anodyne, Hydrogen Perox., Ibogaine, Mannitol Nitrate Tabellae, Morphinse mj. hypod., Muscle Extract, Nitroglycerini Liquor and Tabellse, Papaverine, Phenazone, Sodii Nitris, Sod. Theobromine-Sodium Iodide. Tab. Sodii Nitritis Comp., Theobromine, Theobromine Aceto-Salicyl, Theobromine Sodium Salicylate, Theophyllin Sod. Acet., Trilactine. The following powder recommended for treatment: Aspirin 3 grains, Quinine v alerianate 3 grains, Caffeine 2/5 grain, Powdered Opium 1/5 grain—to be given m a cachet every two hours.—per Pr., Mar., ’27,201. Paravertebral anaesthesia of first, second and third ganglions bv 1% Novocain solution, and subsequent injection of 5 Cc. 70% to 80% Alcohol into each ganglion, of unquestionable therapeutic value and gives both immediate and remote results—Pletnow, Jl. A.M.A. ii./29,1667. Injection of 10 Cc. of 1% Stovaine solution under the skin at the site of the most severe pain gave definite relief, when nitrites, etc., had failed. Valuable m patients with angina pectoris due to coronary spasm.—B. M.J.E. iL/31,7. X Rays have been used in France—anterior and nosterior applications of varying doses. Angina, Pain of—Amyl Nitrite. Carbonic Snow. Ankylostomiasis (caused by Ankylostomum duodenale).—Carvacrol, Carbon Tetrachlor., Eucalyptus Oil, Filix Mas, 01. Chenopodii c. Thymol, Pelletierine, Podophyllin, Tablets Betanaphthol and Phenolphthalein, Terpine, I etrachlorethylene, Thymol (not suitable for the old or verv young), Thymol Carbonate. Betanaphthol treatment. No untoward effect with 50 to 75 grain doses, of the powdered drug.—C. N. Leach and G. E. Hanrpton, per Jl. Trop. Med. May 1/23,145. See also Sept. 1, 22,285. . Ankylosis. Locally.—Chlorine from Sodium Chloride, also other drugs, by ionisation. Anodynes. See Analgesics and Neuralgia. Anorexia.—Calumba, Capsicum, Cascarilla, Chiretta, Cinchona preps. Gentian, Ignatia, Nux Vomica, Quassia, Quinine, Strychnine, Syr. Kolse Comp. Anthrax.—Acid. Carbolic, Camphor Injection, Iodi Tinct. Inject., Sclavo’s Serum. N.A.B., 0-G Gm. intravenously daily, or on alternate days, specific ; will save life and render surgical intervention unnecessary. Treatment generally adopted throughout S. Africa—A. B. M. Thomson (Durban), B.M.J. ii./3i,921. Report of a case so treated with success at St. Olave’s Hosp., Rotherhithe.— «J. J. Coglilan and H. J. Shorvon, ibid. Widely used in this country.— C. G. Brentnall, ibid. 966. Anthelmintics.—See Worms. Antidotes.—See Chapter ; they are also fully referred to in the text: see also list of Emetics in tliis Index. Antipyretics. See Fever. Antiseptics for Hands, Instruments, etc. (See also Chapter on).— Acid. Lone, Carbolic, Alcohol, Clove Oil, Diffusol, Ether Soap, Formosyl, Harrington’s Solution, Hyd. Einiod., Hyd. Oxycyanid., Hyd. Perchlor., Iodine Tincture (q.v.), Izal, Ol. Sinapis (much diluted), Metaphen, Perfumed For- mosyls, Tannin in Alcohol, Thymol Disinfectant. Antiseptics for Wounds.—Act'd. Boric. Lotio and Ung., Acid. Carbolic Lotio and Eng., Acid Salicylic, Lotio and Ung., Acriflavine, Alcohol 75% (•steriliser of skin), Allantoin, Aluminii Acet. Lotio, Anserin Midis medicated, Aristol, Benzoin Co. Tinct., Brilliant Green, Brumphenobis, Cheatle’s Green Spray, Cloramine T., Collodium,, Colloidal Metals, Dakin’s Solution, Diffusol, Eupad, Eusol, Formosyl, Glycerinium Iodoform, Hydrarg. Biniod., Hydrarg. Perchlor., Iodoform W ool, Iodine in CCli} Iodine in Liq. Paraffin, Iodine in Spirit, Iodised Carbon, Iodine Colloidal, lzal, Kelly’s Paint (Cotlod. Benzoin), Liq. Hydrogen Peroxidi, Mercuro-Zinc Cyanide, Mercurome, Perchloride Solubes, Phenol and Camph. combined, Potass. Permang., Resorcin, Mendere’s Solution, Malachite Green (and with Sublimate), Metaphen, Proflavine, Salol, see Chapter on Antiseptic Values, Vol. II., and Chapter on Wounds in this Index. Antiseptics, Intestinal.—Acid. Boric, Acid. Carbolic, Acid Iodic, Asprio- dine, Benzonaphthol, Bisciniod, Bism. Salicyl., Calcii Sulphid. Stearettes, Carbo Ligni, Charkaolin Granules, Dimol, Ichthyol, Ichthoform, Kaolin, Koumiss, Mercurials, Methyl-Aspriodine, Myrtillus, Naphthalene, Naphthol, Phenol-Bismuth, Phenyl-Aspriodine, Pil. Bism. Sod. Sal. and Salol, Quinine Acetyl-Salicyl, Quinine Salicylate, Salacetol, Salol, Sedasprin, Sodii Hyposul- prns, Sod. Oleat Co. Capsules, Sulphocarbolates, Trilactine, Trilactine Milk, d ylcalsm, Tylmarin, Tylmarin-Quinine. Many of these drugs may be prescribed for local action in Stearettes and Fonnagules, q.v. Antisepses for the Mouth.—Formalin Tablets (Internal). Formosyl Mouth Wash, Liq. Antisepticus, Thymaglycin. Antiseptics Urinary.—Acid Iodic and Iodates, Benzoic and Boric Acids, Cystazol, Salol, Hexamine, Hexamine-Ilesorcin, Hexyl-Resorcin, Mercurome t o > ur^t.hTal in3ectdon). Methylene Blue, Tylmarin, Uro-hexoids, Vesalvine u anct B.’ See also Cystitis. Zinc. Sulphanilas (urethral injection). . Roy. Soc. Med. Discussion. Many antiseptics are in use—but the bladder is not lined with glass. Mercurochrome intravenously in a dose of 4 mgr. per kilo in 1% solution is employed, but occasionally results in rigors, vomiting and diarrlicea, and should only be used as a last resort. Hexamine in a dose of 5 Cc. of a 10% solution intravenously ; per os it is intolerable to some, probably due to the HCOH formed. Hexamine in general not well spoken of. Hexyl Resorcin Stockman found ineffective in eradicating the infection, and could not understand the reputation of Salol as a urinary antiseptic. Cuthbert Dukes, from experiments in tie-in catheter cystitis cases, obtained best results with alkalis.—L. L/29,661. Mercurochrome, 300 mgr. thrice daily per os in Salol-coated pills, yields 30% antiseptic urine, but irritates digestive tract; Hexyl-Resorcin, in 25% Olive Oil , 0-6 Gm. thrice daily, has less antiseptic value than Mercurochrome and same objections ; Hexamine, 15 grains thrice daily, causes indigestion, and the excretion of bactericidal urine is uncertain ; Methylene Blue gave insufficient concentration in the urine to be of antiseptic value ; Pyridium, 0-2 Gm. thrice daily p er os, a very weak antiseptic ; Salol has no place as a urinary antiseptic, as the Phenol content in the urine never reaches germicidal strength.—B. A. Thomas and I. K. Wang, Jl. Urology, per Pr., Sept., ’29,228. Antlspasmodics. See Asthma, Convulsions and Epilepsy. Anuria, see Urine, Retention of Aortic Disease.—Ammon. Carb., Camphor Injection, Erythrol Nit. Tabellae, Ferri Iodid., Ferri Perchlor., Iodides, Nux Vomica, Sodii Salicyl., Tab. Nitro-glycerin et Sodii Iodid. cum Arsen.—See also Angina Pectoris. (Test for Syphilis: Anti-syphilitic treatment.) Aphonia.—See Voice, Loss of. Aphrodisiacs, see Debility and Nervous Debility. Aphtha?. See Stomatitis. Appendicitis.—Combined use of Belladonna and Salicylates (see Tinct. Bellad.). Glucose feeding per rectum. Purgative e.g., Calomel 2 gr. ; Ice bag, Magnesia, Bismuth Subnitrate; Codeine if pain excessive, diet and regulation of bowels.—Robin’s treatment. Mercurochrome. Glycerin Bellad. and hot fomentation alternately. Move the bowels not before the 4th or 5th day and not until the 7th if abscess forming, when Calomel and a Saline Aperient should be given if necessary. A Saline mixture with Hyoscyamus is useful. Causation, diagnosis and treatment.—A. Rendle Short, L. i./25,215,269. Castor Oil should not be given as it further, inflames the already irritated gut, causing the appendicitis to take a more violent course than it otherwise would.—G. M. Tanner, L. i./27,970. Appendicitis, Threatened. For incipient, Elixir Agrimonise Co., Trilactine. . Nasal sinus infection as a causal factor in appendicitis.—P. Watson-Williams, Pr. April, 1921. Arterial Tension, Raised.—Aconite, Antimonial preparations, Potass, lodidum, Pulv. Sodii Nitritis Comp., Sod. Sulphocyanide, Veratrum, Viride. Increase in blood cholesterin does not raise blood pressure. The real factors producing it are unknown and the therapy of high blood pressure at present is miserable quackery ! Cholesterin is capable of producing arteriosclerosis in rabbits. Arteriosclerosis of the small vessels in man effects an increase,—I. Harris and I. J. Lipkin, B.M.J. i./3o,587. See also Arteriosclerosis, Blood Pressure and Vasodilators. Arterial Tension, Lowered.—Pituitary Gland Preparations raise tension of the blood vessels.—See Cardiac Tonics. Hypotension treatment.—B, L/29,889. o Arteriosclerosis.—Acetyl-Choline snbcutan., Adrenalin, Aspriodine, Benzoates, Calc.-Theobromine Salicyl., Camphor, Citrates, Coramine, Erythrol Nit. Tabellse, Pacyl, Iodoprotein, Sodium Hyposulphite, Sodium and Magnesium Sulphates, Strophanthus, Syrupus Iodo-Tannicus, Iodolysin (Inj.), Thyroid preps., Trilactine ; Depressor Agents, e.g., Hippurates, Pot. Iodide, Nitroglycerin Tabellse, Tabellse Sod. Nitritis Co. Por pre-sclerosis Diuretics, finally Theobromine and Digitalis. The most useful drugs are Amyl Nitrite Nitroglycerin, Erythrol Nitrate and Sodium Nitrite.—W. Lyne Blight, L. i./is,1167. Arteriosclerosis and Bright’s disease are too closely associated to suggest a chance coincidence and many observations point to the conclusion that one or more of the causes of Bright’s disease are concerned in the production of arteriosclerosis.—Geoffrey Evans, Pr. Jan. 1922, p. 38. Nature and Classification of types of arteriosclerosis.—Goulstonian Lectures, Geoffrey Evans, B.M.J. i./23,454,502,548 ; L. i./23,579. Avoid excess of readily fermentable carbohydrates. Give green vegetables and fruits.—W. E. Deeks, Diet and Disease, 1927. Arthritis—See Gout and Rheumatism. Arthritis Deformans —See also Rheumatoid Arthritis and Rheumatism Chronic. Iodine Ionised, Sulphur injected. Peptone intramuscularly. Treat as in early phthisis.—Cod Liver Oil, Creosote, Guaiacol, tonics, hsema- tinics. Later, Iodine and Iodides.—C. W. Buckley, Pr. June 22/412. Sulphur metabolism in arthritis deformans.—A. P. Cawadias, L. i./2 7,1283. Ascarides.—See Worms. Ascites.—See Dropsy. Asphyxia.—Oxygen, Carbon Dioxide and Oxygen. Schafer's prone pressure method is effected by pressing on the small of the back (thus compressing the abdominal viscera and pushing the diaphragm upwards) for three seconds, turning over on the right side for three seconds, and repeating until resuscitated. This allows mucus and water, in the case of drowning, to run from the mouth. Sylvester’s, Howard’s, and older methods described.—Problems of Asphyxia, Brit. Assn. Cent. Meeting, L. ii./31,795. See also N itrous Oxide—treatment of dangerous symptoms. Asphyxiating Gases. See Antidotes to poisons at end. Asthma.—Adrenalin subcut., JEtliyl Iodid., Amidopyrin, Ammon. Brom., Ammon. Iodid., Amyl Nitris, Antimony, Arsenic, Aspriodine, Atropine Valerianate, Belladonna, Bromides, Caffeine, Caffeine Tri-Iodide Cap. (Billimoria), Calcii Chlorid (?) q.v., Calc. Brom. intrav., Calc. Theobromine Salicyl, Cannabis, Chloral Hydras, Chloroform, Codeine, Coramine, Ephedrine, Erythrol Nitras, Euphorbia Peplus et pilulifera, Ext. Grindel. Co., Glucose feeding, Grindelia, Hyd. Salicyl, Hydrarg. Subchlorid., Hyoscine, Iodinol, Iodoprotein Tabs., Jaborandi, Lobeliac Tinct. and Tinct. AEtherea, Lobeline, Magnes. Hyposulph., Mannitol, Menthol, Naphthol, Nitroglycerin, Papaverine, Paraldehyde, Peptone Injections, and per os, Physostigma, Pilocarpine, Potass. Iodiduin, Rut® Confectio, Salol, Sedasprin, Sodii Iodid. and intravenously, Sodii Nitris, Tabs. Sod. Iodid. and Sod. Nit. combined, Stramonium, Spiritus Grindeli® Co., Strontii Iodid., Syr. Pilocarp. et Pot. Brom., Tabellse Anti-asthmatic®, Tylcalsin. An emetic may afford great relief. Aspirin relieves some cases ; in others unsuited.—B.M.J.E. ii./22,33. It dries the mucous membrane of the nose and therefore possibly aborts attack by reducing bronchial secretion.—Clin. Jl. Jan. 17/23,35. Acid. Sulphur os. Vapor, Adrenalin—as spray. Oxygen has been injected. Vaccine B. Influenza, Pneumo., Strepto., M. Catarrh., or M. Paratetrag. acc. to predominant organism present, preferably Autogenous. By Inhalation.—Ammonii Brcmidi Vapor, Arsenical Cigarettes, Chloroform Vapor, Coca or Eucalyptus leaves smoked, Compound Asthma Fluid (as spray), Cubeb Cigarettes, Ozcnic Inhaler, Potass. Fit. fumes, Pulvis Lobelia Co., Pyridine, Stramonium fumes, Vapor Conince. Grindelene does good in severe attacks of asthma. Eor all chronic conditions nothing so good as a combination of potassium iodide 5 grains, and magnesium sulphate 1 drachm, in 1 ounce of w7ater thrice daily, 2 hours p.c.— E. Jepson, B.M.J. ii./17,650. Adrenalin 5 to 10 minims injected three or four times a day good. Begin when the breathing is pretty bad.—B.M.J. i./i6,36. Patient’s own blood 5 to 10 Cc. subcutaneously in asthma and in migraine. — C. H. Wildish, B.M.J. ii./2i,598. Horse Serum (q.v.) is contraindicated in asthmatics, n nr J S be relaxed by paralysing the vagal terminations (Atro- ?n l w JV ■ ne)’, ^y ^mulirtmg the sympathetic (Adrenalin or Cocaine), The f pl?m Ts-le- (hmyVKltn,?i> Benzyl Benzoate, Papaverine) r«S f“-kv *?ye.n by injection (Atropine, Hyoscine, Adrenalin, Cocaine, Snfv! kfe^imhilathIon B sVay At™P‘ne- Cocaine, Adrenalin, Nitrites .Benzyl Esters). Asthma Powders should be avoided, as they tend to set iro iW°n=C$eaS; and Per 08 <Atr°Pine, Benzyl Benzoate).-?. Hamill, B?M j n/25,d69, q.v. If specific determining factor can be determined, either remove or avoid it 5% 1™1™lse specifically or non-specifically by Peptone.—P. Hamill, B.M.j’. Treatment of asthma—H. N. Chopra and H. W. Acton, I.M.G., Mar., ’25,101. An all-round attack recommended, i.e., consideration of psvchical aspects, remove sources of peripheral irritation, employ exercises for chest development desensitise where practicable, restore balance in favour of the sympathetic or attend to general hygiene.—W. Langdon Brown, B.M.J. ii./25,205. For I. ood Asthma.—Sod. Ricinoleas. Asthma and anaphylaxis. Asthmatics should not receive horse serum. Most of the deaths that have occurred after horse serum have been in the horse, asthmatics.—F. Coke, B.M.J. i./2i,372,582. This subject is dealt with on page 661 et seq. Tuberculin Treatment of bronchial asthma and hay fever. ‘ T.O.A.’ employed subcutaneously ; initial dose 1 Cc. of 1 : 100,000 dilution. The authors cannot explain why a state of hyper-sensitiveness to tuberculin increases the susceptibility for allergic reactions, nor why small amounts of tuberculin have curative effects.—W. Storm van Leeuwen and H. Varekamp, L. ii./2i,1366. 0T Cc. of 1 in 1,000 dilution of Old Tuberculin in Saline used as Intradermal lest. For treatment dilutions ranged from 1 in 1,000,000 to 1 in 100. With marked reaction to the Test, it is well to begin with 0-1 Cc. of the 1 in 1,000,000. Injections given weekly.—J. Maxwell, B.M.J. i./3o,854. Results of treatment of 500 cases examined at Edinburgh. Autogenous vaccines from a laryngeal swabbing well spoken of.—D. M. Lyon and R. M. Murray-Lyon, B.M.J. i./3o,987. Asthma Research Council, collecting statistics of all kinds—L. i./2g,36,50. Asthma observations in Edinburgh. Exposure to dust an aggravating factor in 48% of cases. Foods complained of by 38%—more than half incriminated potatoes.—L. i./29,517. Asthma Research Council Report. Among those suffering from certain allergic conditions and treated with Glucose and Ammonia to combat intestinal and liver disturbance 50% had no attacks and slightly less than 50% improved. Investigations proceeding—B.M.J. ih/30,145,1138,1140. Special asthma number.—Pr., July, 1929. Adrenalin 3 minims and Ephedrine Sulphate 0-025 Gm. by the mouth, or in 3% spray, for asthma in children.—W. R. F. Collis, L. ih/30,569. Atelaciasis, to prevent .—Carbon Dioxide and Oxygen as prophylactic. Ateliosis or Lorain’s Disease.—This condition may be regarded as the exact reverse of gigantism. It occurs generally early in life. The patient remains small and stunted and never arrives at full development. Cases have improved after the pituitary gland lias been entirely removed.—J. A. Walton, B.M.J. ii./22,839. Athlete’s Foot.—Castellani’s Paint, Ung. Acid. Salicyl, Mycozol. Auricular Fibrillation.—Digitalis, Quinidine. See also Cardiac Tonics. Auricular fibrillation in children.—H. Cookson, L. ih/29,1139. There is always Calcium deficiency. Ringer’s solution containing about double the usual amount of Calcium Chloride and 2 ounces of Syrup of G lucoso to the pint is a good drink which should be drunk freely.—Sir J. Barr, B.M.J. h/30,774. Aural Discharge.—Hexamine (?). Trichloracetic Acid for closing of perforations. Baciliuria (B. Coli).—Collargol, Hexamine and Sod. Phosph. Acid (separately), Hexyl Resorcin, Pyridium, Sandal Wood Oil, Vaccines, make urine alkaline, e.g. with Pot. Bicarb, or Sod. Cit. Alkalis (Sod. Bicarb, or Pot. Cit.) in large amount for B. coli infections In infancy until the urine is definitely alkaline (no degree of alkalinisation can completely inhibit). Then Hexamine and Acid Sodium Phosphate until the urine is acid—then the alkalis are given again.—X. Douglas Wilkinson, B.M.J. ih/30,412. B. coli infections often get well spontaneously. Give plenty of fluid. Hair, Lepper and Martland found the greatest concentration of HCOH in the urine, after giving Hexamine, was 1 in 20,000, whereas anything less than 1 in 5,000 is said not to be bactericidal. They found that only when the pH of the urine had fallen to 4 are effective doses of HCOH liberated. The urine should be collected under Toluene and the pH tested with Phenol Red.—Proc. Roy. Soc. Med., Jan. 28, quoted by D. Nabarro, B.M.J. ii./3o,417. Balanitis (Locally).—Lotions of Lead Acetate, Zinc Salts, Silver preparations, Tannin, or Zinc Oxide Powder. Basedow’s Disease.—See Exophthalmic Goitre. Bed Sores. Locally.—Acid. Tannic, Alcohol, Allantoin, Anserine Mulls, medicated, Argent. Nit. in Nitrous Ether solution, Glycerin, Glycerin Aloes, Iodoform Gossyp. and Ung., Iodine Colloidal, Peruv. Bals., Perfumed Formosyls, Tannin, Iodoform and Starch Powder, Resorcin, Sphagnum, Symphytum Preps., Ung. Rusci Co. Beri-Eeri.—Extract. Oryzse Liq., Rice Bran, Phaseolus, Strychnine. Rice should be eliminated. Vitamin-rich food (beans, peas, barley), wheaten flour,—not overmilled'—oatmeal to be substituted. Yeast and rice polishings extract said to be curative. Strychnine, Arsenic, and Silver Nitrate are in repute as soon as the muscular hypera3sthesia has subsided. A routine which has found some favour is the following :— Magnesium Sulphate 60 grains, Dilute Hydrochloric Acid 20 minims, Tincture of Orange 1 drachm, Infusion of Calumba to 1 ounce. Thrice daily for a week, and repeated after a few days intermission. If much oedema, the following may be of use :— Solution of Ammonium Acetate 1 drachm, Potassium Nitrate 10 grains, Potassium Acetate 15 grains, Camphor Water to 1 ounce. Thrice daily. If the heart shows signs of failure, a mixture of Digitalis, Ammonium Carbonate and Compound Spirit of Hither may be used with advantage.—Brooke. See also Accessory Food Factors in this Volume and Vol. II. Bile, Deficiency of.—Ammon. Chloride, Bismuth and Opium, Chirata, Colalin, Fel Bovin., Hepatic Stimulants and Antiseptics, e.g., Elix. Gentian Acidum, Salol, Hydrarg. cum Creta, Pancreatised Milk, Sodii Glycocholas, Sodii Phosph. Efferves., Sodii Sulph. Efferves., Sodii Salicylas, Taraxacum. There are only two substances known wliicli are really cholagogues ; bile itself and Sodium Salicylate—P.J. ii./2i,490. Bilharzial Disease.—Antimony Pot. Tart, intravenously, also Antim. Soda. Tart., Antim. Ox. lnj., Auremetine, Emetine Periodide, Emetine Injection, Eouadin, Hydr. Perchlor., Methylene Blue, Thymo-benzene. Biliary Concretions.—See Gall Stones. Biliousness (See also Constipation).—Calomel, Chirata, Colalin, Elixir Gentian Acid, Euonymin, Iridin, Leptandrin, Podophyllin, Sanguinarin, Seidlitz Powders, Sodii Phosph. Efferves., Sodii Salicyl, Sodii Sulph. Efferves., Sodio-Magncs. Sulph. Eff. . _ „ Magnesium Sulphate 5 Gm., with Peptone 2 Gm., and Licorice Powder 1 Gin., in half a glass of tepid water, stated to be a very active remedy for evacuation of bile from the liver, as well as from the bile-ducts and gall-bladder. Effect enhanced by adding Vichy Water or 2 tablespoonsful of Glycerin. Kaolin, 5-10 Gm., may also be added. After taking, patient should lie on right side for 10 minutes and wait half-an-hour before breakfasting. Treatment continued for 10-15 days in each month.—per Jl. A.M.A. ii./25,551. Bites and Stings (Insects,—Mosquitoes, etc.). Locally.—Ammonia, Cocaine, Emp. Bellad., Eucalypt. Ol. (to ward off), Formalin rubbed in, For- mosyl Hydrogen Peroxide, MosJcitin, Ol. Betulae (with Olive Oil), Onion Juice, Phenol, Pulegii Oleum, Sodii Bicarb., Spiritus Chloroformi, Thymol, Vinegar. Citronella Oil with Carbolic Acid good in warding off mosquitoes. The Quinine Acid Hydrochloride and Cod Liver Oil ointment under Sunburn is advised.—B.M.J. ii./26,718. . Gnat-bite inflammation relieved by saturated solution of Magnesium Sulphate. _r h Jamieson and E. Hernaman Johnson, B.M.J. i./31,57 ; also rub the skin*with 20% Solution to keep off insects. . . , Wasp stin«- poison besides its toxic effect on the heart diminishes the coagulability of the blood . Calcium lactate in 20 grain doses two-hourly and Cardiac stimulants effective.—P.J. ii./i3»559. ... c . .. , ~ . A lotion of Cedar Wood Oil 1£, Citronella Oil 3|, with Spirit of Camphor to 8 as a prophylactic against mosquito, midge and fly bites. The sting of a yasP should first be removed, and in the case of a bee Ammonia applied, T r? t? a<Lld’ vincgar. Tincture of Aloes with solution of Cocaine useful —A. C. Roxburgh, L. i./2 7,1146. dtinffc ^n°Cr^ use °f 20 % Aloes in 60% Spirit for bees’, wasps’, and hornets’ Pn<mRC TiC^f jR-aiAn Wmediately antl Prevents or greatly reduces swelling.— irugnat, JI. A.M.A. i./29,1897. -r t,drer- /BitoorIncisions and drainage until Antivenin can be obtained.— -d.JM.J. i./3o,387. Viper Bites.—CAlc. Chlorid. intravenously. See also Snake Bites. revention. The following _ have been advised for destruction. For in oao/^ heaps, etc., Chloride of Lime, Sulphate of Iron either powdered or in 20 % solution, Borax, Colemanite (crude Calcium Borate), Slaked Lime, Potassium Permanganate. For use indoors, Formalin, Alcohol and water. As deterrents, Pyrethrum, Paraffin, Cresol. Carbolic Acid. For spraying outside walls or canvas of hospitals, etc., Berlece’s Soin. v. infra may be used. U se m the evening or early morning. Another formula is Commercial Formalin 1 ounce, water ^ pint, milk £ pint. Fly Exhibition, Zoological Gardens, C.D., June 5/1915. 5 ’ To kill fiies a 1% solution of Sodium Salicylate is better than Formalin. Uf the latter T2o to 2-5% of Commercial Formalin is the best strength. F ormaddehyde as a poison for house-flies. Formula recommended : 40% Formaldehyde 5, Lime Water 50, Sugar 2-5, Water 42-5. Should be exposed m a trap protected from air, and the prevention of flies falling in, thus making it acid.—Lloyd, T.D.B., Vol. 17, 1921/123. Cod Liver Oil has a specific toxic action on all flies, mosquitoes and ticks. Sprinkled on the surface of water it is more effective than Petroleum in the destruction of larvse.—Lang, P.J. i./i4,593. Pastilles for burning have been advised, made of the following : Phenol 6 drachms, Potassium Nitrate 1|- ounces, Insect Powder 5 ounces, Charcoal 10 ounces, and Mucilage of Tragacanth sufficient quantity. A sponge dipped m Spirit of Camphor will also impregnate the ah and act as deterrent — Ind. and East. Drug., Oct., ’25,238. Berlece’s Solution— Sodium Arsenite 20 Gm., Treacle 100 Gm., Water 1 litre. Steep grass in tins and hang it up.—B.M.J. i./i5,1006. Powdered Hellebore (Veratrum Album and V. Viride) \ lb. to 10 gallons of water applied at the rate of this amount to 8 bushels of manure is an effective larvicide. Has no injurious effects on the manure or plants.—U.S. Dept, of Agriculture, L. ii./i5,559. Insectifuge.—To prevent flies from settling on man and horses.—Pyridine 1 Thymol i, Safrol 5, Oil of Birch Tar 5, Sperm Oil to 100. Does not irritate the skin. A small quantity to be smeared on the temples, behind the ears and on the head or on leather of harness. Kerosene is also effectual. The following Spray Solution should be useful:— Naphthalin 10, lJhenol 10, Camphor 5, Lemon Oil 5, Thyme Oil 2, Lavender Oil 2, Savin Oil 2, Methylated Spirit to 500. Aloes is a local sedative as in Friar’s Balsam. A saturated solution in Tincture of Tolu is good against insect bites.—F. W. Cock, B.M.J. ii./i8,256. Sanodora Pads may be useful. The black flies on the river banks in Canada are kept off by a mixture of Kerosene and Oleum Succini.—C. E. Sage. Pine Oil is said to deter Anophiles. See also Malaria Chapter, Vol. II. Jelly Fish Slings.—See p. 699. Scorpion Stings.—Lister Institute supplies Anti-Scorpion Serum. Dose equivalent to 10 Cc. of original serum. The injection should be made directly into the site of the sting as soon as possible. See also Snake Bite Lancets. Blackwater Fever.—Caffeine Sod. Benz., Calomel, Eff. Saline, Intravenously Sodium Chloride, Quinine Acid. HC1. per os and intramusc., Digitalis, Sternberg’s Mixture, Salvarsan, Strychnine, Cholesterin, Meth. Blue intrav. A disease of metabolism the final stages of which, resulting in ‘ blackwater,’ are intensely influenced by any process of pyrexia coincident with it or pre’- ceding it. Treatment.—Keep patient warm, sponge with warm water; in case of pyrexia, sponge with cold water, with Vinegar and Lime Juice added, keeping Ihe brain cooled by compresses. On signs of cardiac failure small doses of champagne or brandy and soda water given—soda water could be taken ad lib. Warm blanket baths for delirium or rising temperature. A mixture containing the following has been used with good results : Spirit of Nitrous Ether, Potassium Bicarbonate and Potassium Nitrate. In case of bad malarial history or anamia without such, 1 grain doses of Quinine should be given in addition, alternating with mixture, as soon as stomach can stand it. Suggests trial of Thyroid to stimulate lymphoid system.—G. Rome Hall, Jl. Trop. Med., April 16/23,120. ^ Calomel 5 to 10 grains, Effervescent Saline. Intravenous injection of Normal Saline Solution, Quinine in nutrient enema (not milk), also Digitalis, and Strychnine in the same form. Rectal Salines, Camphor in Oil, Strophanthin, Tinctura Iodi, Bismuth, Adrenalin (to stop vomiting). One should watch the heart, give fluids, stop vomiting, watch for complications, especially suppression of urine, syncope, hyperpyrexia. Quinine should not be given, as it may increase the haemolysis. ■—Stanley E. Denyer, Clin. Jl., Oct. 3/22. Sternberg’s Mixture. Sodium Bicarbonate 10 grains, Solution of Mercuric Chloride 15 minims, water to 1 ounce. Every two hours for the first day and every three hours after until the urine clears. This in preference to ordinary diuretics.—D. G. Marshall, L. ii./i8,417. The urine clears up more quickly with immediate subcutaneous injection of 5 to 10 ozs. of Normal Saline, and \ to 1 oz. Magnesium Sulphate is beneficial. The following mixture every hour in 5 oz. of water prevents nausea and restlessness : Sodium Bicarbonate 20 gr., Bismuth Carbonate 10 gr., Tinct. Chlorof. et Morph. Co. 5 min. (‘ Sternberg’s Mixture ’ causes vomiting.) Large quantities of fluid should be given and patient should not be moved for at least 14 days.—E. P. Carmody, B.M.J. i./25,106. Sodium Bicarbonate intravenously, 10 to 20 ounces, of strength 150 grains to the pint, curtails duration of attack, prevents blockage of kidney tubules, and avoids suppression of urine.—W. E. Cooke and H. Willoughby, L.~i./29,334. Sodium Bicarb, orally and the Citrates of Lemonade. Sodium Bicarb. 10 Gm., Glucose 10 Gm., given in 1,000 Cc. initially and large amounts (up to 21 Gm. in 24 hours) repeatedly during treatment. Quinine could be taken when the urine was kept alkaline.—C. C. Chesterman, L. h/29,1355. See also C. P. Downison, ii./29,47. Give alkalis as follows : Sodium Bicarb. 2£ oz., Calc. Carb. 5 oz., Mag. Carb. 5 oz., and Bismuth Carb. 10 dr. One teaspoonful every two hours in water from 6 a.m. to 10 p.m., and then a double dose. Boiled water freely every i hour. Absolute rest. 3 or 4 doses of Calomel £ grain at £ hour intervals. Soap and water enema at onset and enemas of weak Permanganate twice daily. If temperature like subtertian fever, and parasites are found, give 1 dr. Tinct. Cinchona thrice daily, carefully increased in a day or two, and if no recurrence of blackwater add Quinine Dihydrochloride. If hcTmoglobinuria develops stop all food and give nothing but boiled water till urine is clear for 3 days and alkaline in reaction. This only fails where vomiting uncontrollable, when alkalis intravenously may save patients.—J. Forbes, Kenya & E. Africa Med. Jl., Trans. Roy. Soc. Trop. Med., Nov. 25/29,317 ; Jl. A.M.A. ih/29,1686. Blackwater fever in London. A11 analysis of 14 cases studied during the last 7 years.—P. Manson-Bahr and E. G. Sayers, L. h/27,273. Blood transfusion good.—P. H. Manson-Bahr, B.M.J. h/30,17. See also Yol. II., special chapter on. Blastomycosis.—Potassium Iodide a useful drug.—A. Castellani, L. i./2o,943. Successfully treated by (1) Iodoform, (2) an ointment of Salicylic Acid, Ammoniatcd Mercury Ointment and Zinc Oxide, (3) B.I.P. ointment.—N. Cantlic, Jl. Trop. Med., Feb. 1/23.44. Carbon Dioxide Snow.—Jl. A.M.A. i./28,13G7. Saline intravenously—1500 Cc.—A. Patrick, B.M.J. ii./i8,404. See also Yol. II. Bladder.—See Albuminuria and Cystitis. Bleeding of Gums.—Magues. Ladas. See also Gums Inflamed and Spongy. Bleeding, to arrest—-See Haemorrhage and Epistaxis. Blepharitis.—See Conjunctivitis. Blistering Applications.—Acetum, Collodium, Emplaslrmn and Liniment of Cantharides, Capsicum preparations. t#Iood Pressure, to Increase.—Pituitary Extract; next in potency is Caffeine. Calcium Lactate moderately effective and Strychnine disappointing. Digitalis to be reserved for cardiac cases. Blood Pressure, to Reduce—- (i.) Heart Depressants.— Aconite, Arsenic, Mercury, Potass. Salts, Quinine, Salicylic Acid, Veratrum Viride. (ii.) Vasodilators.—Acetocholine, Amyl Nitrite and Nitrites, Arsenic, Mercury Pulv., Quinine, Pot. Nitrite and Sod. Nitrite Co., Salicylic Acid.— See also Vaso-dilatcrs and Angina. (hi.) Purgatives. The nourishment of the cardiac muscle is conditioned by the blood pressure in the aorta. A plus pressure often means increased cardiac vigour. A minus pressure often entails cardiac malnutrition. All high blood pressures are not evil.—P. M. Chapman, Pr. Jan. 1921. Thyroid and Manganese in abnormal pressure. Potass, and Sod. Sulphocyanides have recently been given. Luminal lowers pressure and has sedative elfect. The Sulphocyanides are of value in doses of II to 2 grains thrice daily after food, the dose being increased daily.—John Hay, B.M.J. ii./3i,47. A raised Cholesterol content the most constant blood change found—often above 200 mgr. per 100 Cc. Veratrum Viride (Veratrone), I to 1 Cc. intramusc. or per os of value, but must be used with caution as fall of blood pressure may be alarming in susceptible patients. Acetylcholine intrav. also of value—• 0-05 Gm. increased to 0T Gm. daily—but extremely dangerous. Venesection still unsurpassed. I11 the sallow, toxic type, Pilocarpine 1/10 grain hypod. G or 12 days, followed by hot wet pack and massage, with colon lavage twice weekly : fruit and fish diet, and Vichy before meals.—A. H. Douthwaite, B.M.J. ii./29,844-847. Table salt in liyperpiesis. When renal, cardiac, or cerebral complications are present, give non-pressor table salt, if craving is felt, consisting of Ammonium Hippurate 1, Potassium Nitrate 4, Potassium Chloride 25. In emergencies, as threatened or actual apoplexy, lumbar puncture. Venesection up to 500 Cc., followed by fasting for a couple of days, gives relief. For toxaemia resulting from intestinal stasis Pot. Permang. 1 grain per rectum in a pint of water every morning for 3 weeks, with Calomel 2 grains at night twice weekly, followed by Saline mane. In lesser grades. Pot. Chloride 2 grains t.d. in a tumbler of water. For cardiac types, Theominal is diuretic and lowers pressure. Iodides of little use. French Tinct. Iodi 5 minims in water or milk p.c. better. Sodium Sulphocyanate, 3 grain tablets per os, where organic changes in the arteries are absent. Choline derivatives, e.g. Pacyl, per os, and Acecoline parenterally. Animasa, a muscle extract, of benefit in sclerotic cases.—J. F. Halls Dally, B.M.J. ii./3o,10. High blood pressure etiology. Due possibly to presence in excess of a specific amino-acid. This may be due to retention resulting from renal disease, to over-production, or more probably to some impairment of hepatic function whereby this body is not efficiently destroyed.—Ii. G. Waller, B.M.J. ii./3o,595. Vegetarian diet not ideal. Butcher’s meat might be allowed two or three times a week. Copious amounts of fluid not good. Iodides head the list of useful drugs. Digitalis (though paradoxical) often good.—Sir Thos. Horder, B.M.J. i./30,741. In uncomplicated hypertony give Mistura Alba as routine treatment. Drinking large quantities of water often beneficial.—I. Harris, L. ih/31,1.045. Dropping cigarette smoking caused fall in blood pressure.—II. H. Sangui- netti, L. ii./3o,1291. Radium Chloride solution by mouth or injection in treatment of high blood pressure.—N. Mutch, L. ih/31,1013. Further animal experiments necessary. —A. T. Todd, L. ii./3Lll02. Histamine has been suggested. Blood, to increase coagulability of, see List p. 250. Boils and Carbuncles.— Acid. Sulph. Dil., Alkalis, Arsenic, Bisciniod, Calcii Lactas, Calx Sulphurata, Ferri Perclilor., Hyd. Salicyl., Hypophosphites, Iodates, Faexin, Manganese Colloidal, Mang. Butyrate, Nuclein, 01. Tereb. in Oil Inj., Stannoxyl, Sulphides, Sulphur Stearettes, Sod. Silicas intrav., Sulphurous Waters, Syr. or Pil. Sulphatum, Trilactine, Yeast, Strepto., or Staphylo. Vaccine. Acidin : An albumen-HCl compound found useful. Locally.—Argent, Nit., Belladonnce Glycerin (as pigment and on poultices), Carbolated Camphor, Cataplasm Salicyl. Co., Cremor sicc. preps., Bismuth Oleas, Eupad, Hydrog. Per ox., Glyc. Acid. Carbolic, Borated Hydrog. Perox., Glycerin, Iodo-Acetone, Iodine Colloidal, Liq. Sodce Chlorinat. Diluted, Lini- mentum Atropince, Mercy,rome, Methysal Balm, Pot. Permang. Pencils, Sphagnol, Stanni Oleas, Sulphur Iodide, Thorii Oleat. Ung. Subcutaneous injection in the abdominal wall of 10 Cc. Antistreptococcal Serum. Improvement rapid and complete, without destruction of tissue or scarring.—B.M.J. i./24,766. Potassii Tart. Acid has been used as a dressing in Carbuncle. Boils at once aborted by applying No. 88 Plaster Mull.—B.M.J. ii./26,814. Sodium Cacodylate hypodermically on alternate days rapidly clears up furunculosis.—B. Ghosh, Ind. Med. Gaz.; per Pres., Oct. ’28,324. Paint boils with Contractile Collodion.—W. J. Robbins, L. i./3o,946—or Yiodar—W. H. M. Botulism—A form of food poisoning. Symptoms correspond closely with those in so-called sausage poisoning met with in Germany and other countries where sausages and ham are eaten in an imperfectly cooked condition. See also B.M.J. i./i8,511. Botulism—cases of so-called—indistinguishable from types of Polio-Encephalitis or more accurately Meningo-myelo-encephalitis. Exemplified in epidemics of the Heine-Hedin disease.—F. G. Crookshank, L. i./i8,699, see also C. H. Melland, B.M.J. i./18,559, also Wilfred Harris, L. i./i8,568. The first appearance of botulism in Great Britain was in the Loch Maree- food (sandwich) case. Bacillus Botulinus, being anaerobic, could grow in a sealed tin of food, the taste and aspect of which would not be altered.—B.M.J. ii./22,481. BotLs Sinus Antitoxin.—Available from the Ministry of Health. Dose.—Intravenously 20 to 50 Cc., warmed to body temperature, and injected very slowly. Repeated daily, if necessary. To be used immediately upon appearance of symptoms, also prophylactically 10 Cc. intramuscularly, to be followed by larger doses intravenously, if symptoms appear. Risk of serious symptoms from horse serum possible. If likely, a preliminary dose of 0-5 Cc. antitoxin should be given subcut.—B.M.J. ii./22,604 ; L. ii./22,732. For the Paisley outbreak of milk poisoning due to B. Aertrycke see B.M.J. ii./22,728 and Vol. II. Botulism. Outbreaks in U.S.A Patients were freely purged and received Potassium Permanganate internally.—B.M.J. i./22,893. Botulism, also Salmonella poisoning.—W. G. Savage, L. ii./29,1107. Outbreak in Ireland due to infected milk.—W. D. O’Kelly, Jl. Trop. Med., Mar. 15/23,95. B. botulinus infection of canned spinach. 0-5 Cc. of infected spinach juice per os killed guinea pigs in 18 hours. Of 174 samples B. botulinus (Type A) was found in 0.—S. A. Koser, per Jl. Trop. Med., June 15/22,208. Brain, Sudden Cerebral Lesions.—If gouty—Lithia, Potash with some diuretic, Nitrous Ether and Spirit of Juniper to which some Digitalis may be added—more if thrombosis is suspected than if haemorrhage is probable. If thrombosis be present, reduce blood coagulability, e.g., by lemon juice, (cf. p. 250). For haemorrhage, chalk in a little suitable acid, q.s. to dissolve, to increase the tendency to clotting. Calcium Lactate or Chloride best if procurable in time. Arsenic hypodermically, e.g., \ gr. Sodii Arsen.—Gowers. Breast, Inflammation of.—All Antipyretics. Locally.—Belladonnce Ext. Glycerin, and Linim. Breath Fetid.—Acid. Salicylic, Calcii or Pot. Permang., Camphora, Cremor Magnesias, Creosoti Vapor, Elf. Potass. Ap. c. Sulphocarb., Formosyl Mouth- Wash, Myrrh with Borax Tincture, Formalin Tablets to suck, Thymaglycin. Bright’s Disease. See Nephritis. Bromidrosis.—Potassium Permanganate Wash. Perfumed Formosyls. The following said to be invariably curative.—Wash the feet, dry and dust withBoric Acid Powder, then put on a pair of socks steeped in a saturated solution of Boric Acid and dried. Powder shoes inside with Boric Powder. Each day soak the feet twice for 10 minutes in Boric Acid Solution and continue as above. Glycerin well spread over the soles and toes before putting on the socks—■ repeated as required. Successful. Prevents formation of noxious products. Swab with glucose (q.v.).—T. H. C. Benians. See also Perspiration, Offensive. Bronchiectasis.—Acid. Sulph. Dil., Creosote Inhaler, Hyd. Salicyl. Diagnosis : Lipiodol. Bronchitis, Acute.—Aconite, iEthyl Iodide, Ammon. Acet., Liquor Antim. Tart., Apocodeinse Hydrochloric!., Atropine Methyl Bromide, Codeine Jelly, Ether injections, Glycaphorm, Hexamine, Ipecacuanha, 01. Cedri Atlantic, Oxygen, Papaverine, Squill preparations, Vesalvine ‘ S.’ Vapor Benzoin, Camphor or Eucalyptus, Counter Irritation, 01. Succini. 01. Eucalypt. has been injected with Olive Oil. Bronchitis Chronic.—Acid. Nit. dil. and Inhalations, Allium preps., Ammon. Carb., Ammon. Chlorid., Apomorph. Hydrochl., Aspriodine, Benzoates and Benzoin, Tinct., Caffeine Periodide, Calcii Sulphid., Cimcifuga, Citronin, Codeina Cough Jelly, Creosote, Dionin, Ether injections, Eucalyptus Oil, Euphorbia, Grindelia, Heroin, Iodoprotein Tabs., Ipecacuanha, Magisal, Morphine preps., Morrhuee 01., Morson’s Soluble Kreosote, Piscidia, Potass. Cyanidum, Potass. Iodid., Prunus Virginiana, Pulsatilla, Scilla, Senega, Inf. Polygalse Co., Syrup Picis cum Codeina, Syrupus Picis Liquids, Tar, Terpine Di-iodide, Terebenum purum, Terpin Hydrate, Terpinol, Tolu Balsam, Tyl- calsin and Tyllithin. Vaccine of organism present, e.g., Pneumo., B. Septus, B. Influenza, etc., preferably autogenous. Antimony and Opium, Tinct. Camph. Co., and with Ipecacuanha. If much bronchial spasm and tough expectoration give decalcifying agents.—Potass, or Sod. Cit. Later tonics. Vapores.—Acid. Carbolic, Acid. Sulphuros, Benzoini Camphorcc, Creosoti, Cyllin, Terebeni, Iodi, Croton 01. IAnim., Iodi Linim., Ethyl Iodide, Guaiacol, Nebulae, q.v., Oxygen inhaled. Bronchial Secretion is increased by :—Alkalis, especially Carbonate and other salts of Ammonium, Antimony Salts, Apomorphine, Benzoin, Camphor, Iodine, Ipecacuanha, Jaborandi, Peru Balsam, Quillaia, Senega, Squills, Sulphur, Tar, Terebene, Tobacco, Tolu Balsam, Turpentine. Bronchoceie. See Goitre. Broncho-Pneumonia and capillary bronchitis in infants.—Mist. Paraldehyde and Potass. Iodid. Whisky in small doses. Emetine Hypod. Glucose feeding per rectum. Broncho-Spirochaetosis.—A peculiar form of bronchitis with Sp. bron- chialis, as described by Castellani in 1905, as causal agent. The Tartar Emetic mixtures of Castellani q.v. are advised. Sub-acute and chronic cases have been treated with Lipiodol. A course of 3 to 6 injections of 2 Cc. intramuscularly. One series of injections usually sufficient, but may be repeated 2 weeks later or lodotannic Syrup given 3 times daily for 15 days, followed by 2nd, 3rd and 4th course with one week’s interval between each.—Najib Earah, Jl. Trop. Med., April 2/23,103. Bruises.—Locally.—Arnicce Tinct. (well diluted), Calendula, Hamamelis, Hydrastis Tinctura, Lot. Plumbi et Opii, Hazel Foam. Bubo.—Locally.—Chlori Aqua, Hydrarg. Oleat., and cum Morphina, Hydrarg, Ung., Hydrogen Peroxid., Mercurome. Burns and Scaids.—Locally.—Acid. Boric Ung., Ac. Tannic (First Aid directions, see p. 88), Alcohol, Allantoin dressing, Anserine Mulls medicated, Calamin. Lotion, Acriflavine Emulsion, Canon Oil c. Menthol 2 grains per ounce, Chloretone 10% Ointment, Cocaince Ceratum, Cremor Sicc. preps., Fcexin Poultice, Glycerin as an application (good), Horse Serum, Hyd. et Zinc. Cyanid. Ung., Iodised Phenol, Mastiche Benzol, Iodoform, Lanolin, Lini 01. c. Aqua Calcis, Picric Acid (badly spoken of lately. Toxic effects.—P.J. w./3i,461), Scarlet ‘ R,, Sodii Hyposulph. (moist dressing), Thymol Ung., Vaseline, Zinci Oleat. Ung.f Zinci Ung., Hazel Foam, Volckmann’s Solution, Zinc Peroxid. Burns of slight extent—S.V.R. or Meth. Spirit relieves. Thorough antiseptic cleansing of the affected part and thereafter dusting with equal parts of Boric Acid and Bismuth Carbonate (not nitrate). Amyl Salicylate liberally poured over found excellent—e.g., for Acid Burns. Anaesthetic and Antiseptic.—Boake, Roberts & Co., Ltd. Burns ‘ X ’ Ray, see “ Radiology.” Paraffin preparations, e.g., that known as 4 No. 7 ’ and the proprietary Ambrine are melted and sprayed on to act as an impervious protective. Lanolin best application for burns. 20% Vaseline may be added, followed by weak Permanganate and then Normal Saline—L. ii./25,1238. Favourable results with Ultra-Violet light—C. B. Heald, L. i./25,1162. /nPnnSSIi!iS/ s9,al^.c<^ in following solution : Standard Eusol solution 1 part U-0/o), 10 A Saline solution 2 parts (Sodium Chloride 4%), Water 2 parts. Dressings must be thoroughly wet when applied and must be changed frequently.—W. R. Wilson, B.M.J. i./27,55. Several layers of gauze, wrung out in hot Wright’s hypertonic saline (5%), (after removal of dead tissue).—D. Mackenzie, B.M.J. i./27,421. Waxed paper with Carbolic Oil advised—A. Masterman, B.M.J. ii./27,590. Acnflavme and Paraffin Wax. Flavine 0-2, Eucalyptus Oil 2, Olive Oil 5, Soft Paraffin 25, Hard Paraffin 67-8—P.J. ii./27,451. The toxsemia following serious bums in children is due to acidosis which may be treated, by giving dibasic Sodium Phosphate, 20 to 30 grains every 4 hours, in addition Glucose in 5% solution should be given and treatment for shock carried out. Local applications which have been tried are Absolute Alcohol: Picric Acid : a mixture of Aluminium Acetate 2% in Alcohol—10 parts, with a 5% Alcoholic solution of Methylene Blue 1 partAdrenalin 1 m 10,000 ; Tannic Acid solution 2*5%, or ointment 5%, in a basis of equal parts of Lanohne and Vaseline ; Sodium Bicarbonate 10% and Paraffin No. 7. —Prof. J. Fraser, B.M.J. i./27,1089. Spread a thick layer of Kaolin Powder daily on the burn ; cover with Gauze and a thin layer of Zinc Ointment.—Per Pres., Oct., ’29,336. Ihe following ointment applied on lint as soon as possible gives excellent results, l alamme 30 grains, Zinc Oxide 30 grains, Oil of Terebene 15 minims, Fellow Vaseline to 1 ounce.—J. A. Hendry, B.M.J. ih/29,1031. Spray or paint a 1% Silver Nitrate solution 011 burn and expose for 1 to 5 minutes to Mercury Vapour or Tungsten Arc lamp at 6 to 20 inches distance, or to real sunlight for 4 hour. No dressings used. Repeat if necessary in 24-36 hours—B.M.J. ii./29,668. Pain following removal of scabs relieved by spraying with a solution of Aspirin m water—Dickson Wright, B.M.J. ii./si,310. Burns with Liquid Phenol.—The following did well :—Sponge with strong washing Soda (e.g., 1 in about 5)—dilute Sodium Hvdrate Solution might be better—cover very thickly with Ung. Acid Boric and Ung. Zinc. p. <xq., wrap in lint and bandage.—W. H. M. Calculi, Biliary.—Alkalis, Ox Bile, Oleic Acid, Sodii Benzoas, Sodii Bicarb., Sodii Glycocholas, Sodii Oleas, Soap, Caps. Sod. Oleat. Co. Cholic Acid 0075 Gm. and Hexamine 0-225 Gm., three or four doses daily, suggested for biliary lithiasis.—Y.B.P., '27,271. Calculi, Urinary. Ac. Acetic, Dil. Douche, Alkaline Carbonates, Ammon. Benz, and Phosph., Aqua destillata, Calcis Aqua, Mineral Acids (for Phos. phatic), Piperazma, Potass. Citras, Sodii Benz, and Hippuras, Sodii. Phos. Acid, Triticum. Detection of by * X ’ Rays, q.v. Examination of vide Vol. II. The following draught saved a doctor’s life.—Tinct. llyoscy. £ drachm, Clilorodyne 20 minims, Liquor Potassae 25 minims, Aq. Camph. ad 1£ ounces. A jagged calculus was passed.—C.D. Papaverine Sulphate 5 Cc. of 2% Solution given by a catheter has expelled. Bladder irrigation with 15% Hydrochloric Acid (Caution : very strong !) for calculus. Patient could retain 50 Cc. for £ hour.—B.M.J.E. ih/21,6. Cystinuria. The formation of calculi can be controlled to a certain extent by large doses of Sodium Bicarb.—J. F. H. Stallman, L. ii./2«s,375. Avoid excess of carbohydrates ; give green vegetables and fruits—W. E. Deeks, Diet and Disease, 1927. Cancer (for Palliative Treatment).—Alnus Glutinosa, Arsamin, Arsenic preps., Chelidonium, Chloral Hydras and Opium preps, (as sedatives), Cinnamic Aldehyde Caps., Condurango, Elixir Antimonii Cinnamicum, Ext. Violas Liq., Goat Serum, Glucose feeding. Plumbi Acet., Sodii Cmnamas, Sodii Oleat, Sodium Fluorescein and Irradiation. For Palliative Local Use.—Acetone, Acid. Arsenious, Acid. Carbolic, (caustic), Acid. Carbolic. Glycerin, Acid. Chromic., Acid. Lactic, Acid. Salicylic, cum Oleo, Benzole Injection, Coley’s Fluid, Colloidal Copper, Colloidal Lead, Colloidal Selenium, Cupri Sulph. Pigment, Cupri Oleatis Empiastrum, Ovules and Bougies, Eusol Injected, Fibrocoumarin and Comps., Formalin plugging and injection, Glycerin intravenously with Stannoxyl as adjuvant, (Shirlaw) Hydrarg. Nit. Acid., Liq. Hydrog. Perox. (in inoperable uterine), Injectio Antimonii, Inj. Bismuth Carb. (see Radiology), Iodic Acid, Iodinol, Iodo- Acetone, Iodoform, Lecithin Injn., London Paste, Methyl Violet, Morphine, Morphinse Oleat., Oxygen injected suggested, Quinine Hydrochloridi Injectio, Liquor Potassii et Sodii Hypochloritum, Quininse Salicylas, Radium, Resorcin, Sodium Orthocoumarate, Sodii Phosphas Acid, with Hydrochloric Acid, Symphytum Cataplasm, Thoriac Comps., Ung. Thorii Oleat., Uranium Salts, e.g., Oxide as Dusting Powder, Tylmarin-Thorium, Vienna Paste, ‘ X * Rays, Zinci Chlorid, and Pasta, Zinc Mercury Iontophoresis. Potassium Chlorate, 10 grains in milk three times daily, and Lead Acetate i grain, three times daily, in cancer of the tongue.—B.M. J. ii./26,408. Cocaine. Cancer sufferers tolerate large doses—diagnostic ? Pituitary prolongs patient’s life in cancer. It cuts off blood supply from the growth.—Per Pres. Jan. ’23,13. Goat Serum (prepared at the Lister Institute) in malignant disease.—Intramuscular injections in i ounce amounts produced improvements. It unquestionably attacks the growing outskirts of the tumours. The goat never suffers from cancer and it is believed that the animal’s serum contains some chemical property which can resist cancer. Possible to judge whether a case be cancerous or not by condition of serum. Shaw Mackenzie’s test consists in adding Sodium Oleate ; saponified and Ether extracts of cancer tissue and of cholin, respectively to the suspected serum in suitable quantities. After incubation at 37° for some IS hours, a cloud, or ring, or turbidity appears at the junction of the fluids with carcinoma serum but not with normal and non-cancerous serum—cloud in part due to Cholesterol.—Albert Wilson, Edin. Med. Jl., May, ’25,248. See also Sodii Oleas, p. 753. Nitrogen in Cancer.—Nitrogen confers 011 protoplasm the property of instability. Liberation of Nitrogen in cancer brings about increased instability of protoplasm of the adjacent cells, leading to their more rapid proliferation. The spleen and liver are concerned with the excretion of Nitrogen compounds. Primary tumours of the spleen are rare. Its cells have power to resist the Nitrogen compounds it has to deal with. Uric Acid formed in the spleen is dealt with by the liver. Cancer for the most part occurs after middle life, when the functions of the spleen and lymphatic glands begin to fail, and Nitrogen in consequence accumulates in the blood and tissues. The protoplasm of the cells prior to that time has not been subject to irritation and fails to respond to the ‘ whip ’ (Sulphate of Ammonia must be applied to young and tender plants). Treatment, hence, would be to supply ferments normally acting on nitrogenous bodies, i.e., spleen and lymphatic gland preparations. The idea was tried with Spleen Extract with promise.—J. T. Shirlaw, Pr., March, 1918. . . . . Cancer may perhaps be caused by a fat-soluble toxin being present m the body for a long period. For a time it may be destroyed by the liver, but later fatty degeneration will ensue, the detoxicating action being lost, and free toxin is then nresent to attack some other tissue.—E. D. M. Hocking, L. ii./3o,154. Early rodent ulcers up to the size of a shilling treated as follows: Ring the ulcer with Novocain 2% and firmly scrape with a sharp spoon ; the tumour comes away and a clean raw area is left. Apply a pencil of C02 Snow for 60 seconds and then a dry dressing. There is cedema for a day or two but practically no pain and the ulcer heals rapidly under Boric Ointment. The resulting scars are very smooth and fine. Recurrences infrequent and successfully treated by a repetition.—J. E. Smith, B.M.J. ii./28,443. Gastric Carcinoma.—Pain disappears rapidly with adequate doses of alkali; Orthoform locally also reduces pain, or washing out the stomach. Bismuth Subnitrate, Tincture of Belladonna, and cold compresses also of value — E. Podolsky, Int. Jl. Med. & Surg., July, ’30. ...... , nno Deaths from Cancer.—Percentage increase m England and Wales from 1903- 1930 compared with 1902 figures. 1903, 4-37 ; 1912, 33-91; 1921, 65-12 ; 1929, 104T1 ; 1930, 107*67 (provisional).—B.M.J. i./3i,916. Sodium Fluorescein Paint, Injn., etc., c. ‘ X ’ Rays. For Diagnosis, vide Cancer, Vol. II. . Cancrum Gris.—Arsemcals, e.g., Galyi intravenously. Carbolic Burns. See Burns. For poisoning, vide p. 14 et seq. Carbuncle.—Small doses of autogenous vaccine may be useful in chronic stage When operation inadvisable, locally Magnesium Sulphate and Glycerin Carbolic paste.—H. E. Griffiths, L. L/25,38. See also our pp. 539, 1033. Cardiac Mitral Stenosis.—Oxygen inhalation. Decalcification of the blood, vide p. 252, Camphor. Cffdiac Tonics.—Adrenalin, Caffeina, Camphor, Cardiazol, Crataegus, Digitalis, Is ltroglycenn, Ouabain, Pituitary (Posterior lobe), Scilla, Sparteine Sulphas, Strophanthus (Strophanthin intravenously), Strychnina, Thyroid, thyroid and Manganese, Veratrum Viride. Drugs acting upon the heart directly :— The force of contraction may he increased byApocynum, Barium Salts, Convaliaria, Digitalis, Erythroplceum, Physostigmine, Snarteine, Squill, Strophanthus, Suprarenal Preps., Veratrum. Rate of the Cardiac beat is increased by:—Atropine, Caffeine, Cocaine, Hyoscyamine. Both force and the number of beats are increased by Alcohol, Anaesthetics, Chloroform, Ether, Quinine. The vagus centre is stimulated by :—Aconite, Alcohol, Apocynum, Atropine, Butyl Chloral, Chloral Hydrate, Chloroform, Cocaine, Digitalis, Ether, Hydrastis, Hydrocyanic, Acid, Hyoscyamine (early in the inaction), Nicotine, Picrotoxm, Pituitary Ext. (posterior), Squid, Stanhisagria (Delphinine), Strophanthus, Strychnine, Suprarenal, Veratrine.—H. W. Digitalis is of greatest value in chronic valvular disease and in heart fatigue after acute disease or strain—Sir R. Douglas Powell, Pr. May, ’i4,C12. ii Higitalis most striking in cases with rheumatic origin. Only caned for when rapid ventricular rate leads to symptoms on the part of the patient; not called for in all cases of weak and rapid cardiac action. The therapeutic benefits are obtained wrhen the later manifestations of heart disease have appeared not in the inflammatory or toxemic stages.—G. A. Sutherland, L. h./23,1222. Auricular Fibrillation.—Digitalis, Quinidine. Strychnine has little or no direct action. Pituitary has no direct action, but. is truly a stimulant because of arteriole contraction and probablv effect on capillaries. Camphor and compounds have a different foundation—detectable in failing heart. According to Trendelenburg they may be actually harmful m heart failure.—L. m/29,1049. cardiac Depressants. Both force and the number of beats are decreased try Acetanilide, Aconite, Antimony, Arsenic, Bromides Chloral Hydrate Emetine, Ac. HCN, Lobelia, Phenacetin, Phenazone, Pilocarpine, Veratrine The vagus may be depressed by Large doses of many of the above drugs and drugs which diminish the blood pressure such as Amyl Nitrite and Cocaine.-H.W. Caries.—Calcii Chlorid., Calcii Hypophosph.,'Calcii Phosph., Calcium Iodate. Caries, Dental—Calcii Sulpliidum (for Pyorrhoea), Pyorrhoea Vaccine. Locally. Arsenical Baste, Dental Solubes, Lanolin and Cocaine. I/actic Acid Bacilli, Baramonochlorphenol, Lotio Acidi Citrici et Phenolis, Salol or Formosyl Mouth Wash or Tooth Paste. Bee also Dentistry, local applications. Essentially a post-partum phenomenon and preventive methods effectual any time throughout life. The supposition that dental caries results from structural defects due to insufficient Vitamins is completely untenable as is shown by the fact that teeth which have been ‘ filled ’ are'no more liable to caries than they were before. A tilt at ‘ Dental Propaganda.’—J. Sim Wallace M.P.C., June 11,’30,497. ’ If J. Sim Wallace’s diet rules were observed dentalcaries could be abolished. —D. McKenzie, B.M.J. h/30,516. Cataract, to prevent Senile.—Iodides, Mercurials (Hyd. Cyanid) Tonics.—Quinine and Iron, Strychnine, Bismutol Injns. Cararact treated by bathing the eyes with a lotion of Calcium Chloride 4 Sod. Iodide 4, Water 500—Br. Jl. Oph., Aph/20,192 ; Pres., Feb./2i 72 ’ By washing the eyes with Mercuric Chloride 1 in 6,000 before and after Cocaine anesthesia, sepsis is abolished.—E. R. Shetti, B.M.J. ii./so 1098 Catarrh, Bronchial.—See Bronchitis. 1 ’ Catarrh, Gastro-intestinal,—See Gastritis. Catarrh, Nasal.—Aconite, Ammon. Chlor., Arsenic, Camphor, Cinnam. 01 Cubebs, Elix. Cal. Chlorid., Glycaphorm, Magisal, Linctus Pini Terp. et Heroin Mist. Anti-catarrhalis, Pilula Atropine Quinine et Arsenici, Quinina Tab’ Quin. Camph. Morph, et Atrop., Tylcalsin, Tyllithin. Vaccines. Locally.—Adrenalin, Alum Spray, Argent, Colloidal, Borated Hydrog Perox Camphor inhalation, Carbolised Smelling Salts, Comp. Asthma Fluid, Dobell’s Solution, Ethyl Iodide inhaled, Eucalypti Oleum, Eusol, Guttce Chlor of. Menthol Co., Liq. Alum. Format., Menthol Inhalation, Injection, Wool and Snuff, Menthol and Camphor Inhalation, Ozonic Inhaler, Peptone Injections, Potass. Permang. as Nasal douche (very dilute), Resorcin as Nebula, Sod. Desoxycholas, Thyma- glycin, Ung. Belladonnce, Ung. Morphince cum Acid Tannic, Zinc Ions. Nothing so efficient as a tine spray of Formalin Solution, £ to |% applied early.—Tilley. Formosyl Gargle, diluted is better.—W. H. M. A warning against the use of nasal lavage—attacks of acute middle-ear inflammation and its complications often result from some of the injected solution passing up the Eustachian tube.—A. H. Cheatle, L. ii./25,1141. The writer has used Formosyl GairgSe to nose and throat at least twice a day for years. In the initial state Morphine Sulphate | grain or Dover Powder 10 grains at bedtime with hot gruel usually arrests. If the dry initial stage passed and the nasal fluxion thoroughly established a draught containing Opium, Ipecacuanha, Salicin, Ammonium Acetate and Camphor is useful, or substitute Spirits of Nitrous Ether for the Opium.—Yeo. Acute nasal sinusitis. Nasal inhalation of mentholised steam for four minutes every hour or two hours. Menthol 10 grains to the ounce of Tinctura Eucalypti or Alcohol (90%) 1 drachm to be added to a jug half full of boiling water. Menthol is not suited to young children. When discharge begins freely an alkaline lotion may be sniffed or sprayed into the nose.—Sir St. Clair Thomson, Pr., Jan., 1921. In the shivery stage, Dover’s Powder 10 grains. For the profuse watery discharge stage, Tinct. Opii 5 minims every 4 hours. For the sticky discharge stage, give alkaline mouth-wash. For a sore throat, Tincture of Aconite 2 minims, Potassium Chlorate 5 grains, Solution of Perchloride of Iron 20 minims, Solution of Mercuric Chloride 10 minims, Solution of Strychnine 2 minims, Glycerin 1 drachm, Chloroform Water to 1 ounce. The dose to be used as gargle and then swallowed.—C. and D., June, 1921. Recurrent ‘ colds in the head.’ A daily dose of i minim Licpior Atropine Sulnhatis for 10 days is often of value.—F. Stoker, Pr., Nov. ’21,348. Parathyroid and Calc. Lact. in Spasmodic Rhinorrhcea. Intractable nasal discharge. For offensive crusting, Iodoform 30 grains Bismuth Subnitrate 60 grains, Liquid Paraffin to 1 ounce. Subsequently Hydrogen Peroxide with equal parts Normal Saline (warm), and increase strength until stinging. Subsequently Calamine 60 grains, Glycerin 1 drachm, Water to 1 ounce.—A. Lowndes Yates, L. i./3o,285. Common cold aborted in 24 hours by one drop Tincture of Iodine or 3 to 5 drops Sodium or Potassium Iodide in glass of water. Subacute and chronic cases well treated by subcutaneous injections of Sodium Iodide solution 5% at 1 to 4-day intervals.—Per Pr., Jan. ’28,65. Catarrh, Uterine.—Acid. Carbolic. Glycerin., Boracis Glycerin., Camphorated Carbolic Acid, Iodoform Gossyp. and Pessus, Plumbi Subacet. Glycerin. Opii et Amyli Enema, Ung. Adrenalin, Ovules (see List) and Tampons, Zinc. Sulph. Uterine Pencils, and with Alum, Zinc and other Ions. Catarrh, Vesical.—See Cystitis. Cathartics.—See Constipation. Caustics.—Copper Salts, Nitric Acid, Potassa Fusa, Silver Salts, Sodium Ethylate and Methylate (vide Meningitis), Vienna Paste, Zinc Chloride. Cellulitis.—Glycerin in conjunction with Liq. Hyd. Perchlor. Cerebro-Spinal Fever.—Antimeningo Serum.—-Antim. Pot. Tart, intra., Hexamine, Opium, Phenacetin, Phenazonum, Vaccine Treatment, Flexner’s Serum. See article in Vaccine Chapter. Locally.—Liq. Iodi or Liq. Epispastic over the cervical spine. Iodine in Glycerin as swabbing, Levick’s Zinc Sulphate spray, Permanganate Spray (1 in 1,000). Meningococcus Carriers.—Acriflavine, Di-Chloramine T., Flavine Spray, Cerebro-spinal Fever.—Sir H. Rolleston, L. i./i9,411, 593, 645. Persistence of Carriers.—D. Embleton & G. H. Steven, L. i./i9,788. Determination of type of meningococcus.—A. S. Gordon Bell, L. i./i9,887. Intraventricular injections of serum good.—B.M.J.E. i./24,73. Chancres., Soft.—Antim. Pot. Tart, intrav., Arsenobenzol, Bismuth zoate. Locally.—Eydrarg. Flav. LLydrog. Perox., Iodic Acid., Pb. Acet. Lotio, Resorcin. Lotio, Eydrarg. Nig. Lotio, Eydrarg. Subchlor., Iodof. Pidv. and Ung., Liq. Garb, det., Mercurome, Chapped Skin.—A dd. Boric. Ung., Camphor Ball, Ceratum Petr old, C olio- drum, Glycerin, cum Aqua Rosce, Hazel Foam, Cucumeris Ung., Lanolin, Thorii Cleat. Ung., Ung. Phenoboric, Viodar, Zinc Cream, Zinc Oleate. Cheiropompholyx.—(Dermatitis between the fingers, previously called Dyshidrosis.)—1 drachm Formalin to a pint of water as wash for hands without drying, or eq. pts. Salicyl. and Benzoic Acids in Lanolin (15 grains a.a. to 1 oz.), or Ung. Hyd. Ammon. Dil. 10 grains to 1 oz., or Silver Nit. 2 grains in Spirit. Ether. Nit. 1 oz., applied to the papules when first appearing, often aborts.—B.M.J. ii./3o,626. The cause is usually Epidermophyton inguinale, also thrush (Monilia albicans). Treatment.—G. B. Dowling, L. ii./31,145. Cbeyne-Stokes Respiration.—Histamine has been specifically advised. Chicken Pox, see Varicella. Chilblains.—Calcii Chloridum, Calcii Iodidum, Calc. Lactas. Locally.—Acid. Boric. Ung.} Acid. Camphoric, Acid. Carb. Ung., Aconit. Linim., Balsam Locatelli (even if broken), Bellad. Lin., and Linim Co., Lin. Iodi et Bellad., Cajuput 01., Calamine Lotion (extra strong), Colds Chlorinat. Ung., Capsid. Linim., Canon Oil, Collodium Iodi., Eucalypti 01. Ung., Glyc. Plumbi Subacet. Ung., Hazel Foam, Hydrogen Perox., Iodine Colloidal, Iodi Tinct. Decolor., Iodi Ung., Iodoform Wool and Ung. Oleanodyne, Pasta Ichthyol et 01. Tereb., Plumbi. Subacet. Glyc., Picric Add Sol., Thorii Oleat. Ung., Paraffin No.7. Tinct. Capsid fort. Ung. Zinci Oxidi, Viodar. If unbroken the following may do good :— (1) Immersion of the parts once or twice a day in warm water, with subsequent—(2) Gentle friction with Camphorated Alcohol. (3) Use of a dusting powder,—Bismuth Salicylate 1 in Starch 10, or dressings with Zinc Ointment or Lassar’s Paste, Ichthyolated if required. Paramonochlorphenol as a 2, 5 or 10% solution in glycerin or in alcohol. Ointment as follows, equally effective :—Paramonochlorphenol, 1, 2, or 5 parts; Vaseline 50 parts, Lanolin 50 parts. Calcium Lactate seldom relieves. Thyroid and large doses of Iodine is usually of great value. Give Calcium Parathyroid and Cod Liver Oil in the thin hypotonic scrofulous patient with acroasphyxia.—H.W. Barber, L. ib/26 311,1180. 1 * Sodium cacodylate injections £ grain. Three injections at intervals of about two days good.—W. It. Grove, L. i./26,312. Calcium Chloride, 10 grains three times daily. The Lactate not so good, and Parathyroid £ grain once or twice.—E. A. Milner, B.M.J. ii./c6,917. Obese people preferably treated with Thyroid and Lugol’s solution, but thin people do best on Calcium.—J. F. Christie, B.M.J. ii./2 7,1032. Chilblains unbroken—paint with Tinct. Capsid and Lin. Camph. Co. equal parts. For broken—Ung. Resince k oz., Ung. Acidi Carbolici k oz., Zinc Oxide 2 drachms, Vaseline to 2 ounces.—T. M. Hovell, B.M.J. ii./ig,668. For irritation. Liq. Plumbi Subacet. Fort. 2 dr., Lin. Camph. Ammon. 6 dr., 01. Sinapis Essent. 2 m. Shake in a bottle. To be freshly made. A very strong Salicylic Collodion (1 in 8) excellent.—Sir G. A. Reid, Clin. Jl., Dec. 20/23,017. Chloasma.—See Freckles. Chlorosis.—Arsenic, Arsenic and Iron Injection and Drops, Iron Salts, Hypophosphites, Manganese Salts, Marrubin, Myrrh et Aloes Pil., Phosphorus’ Santonin, Sirop Neurotonique, Sodii Persulphas, Trilactine. Diminish fluids in the body by Caffeine, Magnes. Sulph., Zinc Sulph. Suppress menstruation by hot injections or Amyl Nitrite. Cholera.—Atropine injection, Calc. Permang. (with Hypertonic Saline), Camphora, Carbo Animalis, Charbon NaphtoK, Charkaolin Granules, Chloro- morphise Liq., Copper Salts, Coto and Cotoin, Erythrol Nit., Helba, Hyd. c. Greta, Hyd. Subchlorid. c. Opio, Hydrog. Perox., Hypod. injections of Quinine, Kaolin, Mannitol Nit., Menthol (for vomiting of), Morphina, Nitroglycerin, 01. Allii Essent., Opium, Plumbi c. Opio Pil., Resorcin, Salol, Sedeff, Sulphurous Acid, Tinct. Capsici or Cayenne in Brandy, Tinct. Chlorof. Co., Tribromo- phenol-Bismuth. Nitrates, the sheet anchor, following on intravenous injection of hypertonic saline to combat the collapse stage.—G. B. Sarkar. Tannin rectal injection, Saline Solution rectal injection, Cholera Vaccine, cf. Multiple Vaccines, Cholera and Typhoid, also Tetra, Penta and Hexavaccines oj Glucose, Subcutaneous and Intravenous Injections. Confc/0piu1?1 Iargely used* Some hold it is dangerous. aG^ carnjma^lves it can cut short the disease. Kaolin is successful •0U/\!Xi1irian-fS^0^ Wa£eY'-. Torrste’s Essentia! OH mixture sJnhurir AHH^rS * 9^?ut £?’ ^mper Oil, of each 5 m., Aromatic of cvprv V\m’’ 4 m* this b drachm doses in an ounce clnviv^ lLh?U\ t0T I or.3. honr/- ^ses vomited should be repeated, to Stn ^ and astringent, quickly arresting diarrhoea ; it is safe with eo arainTnf^r1^ peT?ons; P or collapse stage, 3 to 4 pints isotonic Saline, of 2-0? g^pr ^?l?f0dmS tticarbqimte per pint added, intravenously, at the rate tions nf Hypertonic tealme (Rogers) not specific. Rectal injec- eivpr wWPfi kamS Sahne (with 120 grains Sodium Bicarbonate) should be TbP P^pSfoi -fPS® +as been mIercome but suppression of urine still persists. essential oil mixture, one drachm three times a dav, during epidemics affords almost absolute protection.-J. W. Tomb, L. ii./36,722. P A n?^deT< vrPTe^e/ntlXo and cur,e’ aTd wil1 c3ear 110 typhoid in 24 hours.— ,Y«pS ’ i-/27,98. See also G.O.F. Sealy,B.M.J. i./22,918. It is no nf wffpr C0Qllaps.e- Pungency obviated by giving 4 dr. every i hour in ounce MaJ/26 if)5feUCkmg 106 mmimises tendency to vomiting.—J. W. Tomb, I.M.G., minims, Aromatic Sulphuric Acid 5 m., in water 4 oz. (less doses for aft n *?}ve e\eJX £ Pour for 8 doses and every \ hour for a further 4 doses, after which the acid is omitted, and Cresol alone in same dose continued at onJro+o1Iiterv,ajS- *or an°ther 12 doses, at 2-hourly intervals for another dav, and at 3-hourly intervals on the third day.—F. J. Palmer, I.M.G., April, 25,155. Cholecystitis.—See Gall Bladder. Cholelithiasis.—See Gall Stones. Chordee.—Aconite, Belladonna, Bromides, Camphora, Cannabis, Canthar, I met. (one minim hourly). Chloral Hydras, Hyoscine, Hyoscyamine, Morphinse mj. hypod., Opn Suppos. A. Chorea. -Actsea, Adalin, Antimonials, Arsenic, Bromides, Aspirin, Asprio- dme, Brommo!, Bulbocapnine, Cacodylates, Cannabis and Chloral. Calcii Chiorid. or Lactate, Calcii Pliosph., Camph. Monobrom., Chloral Hyd., Cimici- fuga Fxt. Liq., Codeine, Conium and Conince Hydrobrom., Ferri Bromid., Ergot hern Phosph., Formates, Hexamine intrav. (of children), Hyd. Perchlor Gel- sern. preps.,. Iodides, lodoprotein, Magisal, Mag. Sulph., Morrhute 01., Nirvanol Nitroglycerin Tabellae, Phosphorus, Physostigmine, Salicylic Acid, Sedasprin’ Sod. Salicyl., Strychnine, Sulphonal, Tylcalsin, Tyllitliin, Valerianates, Zinc. Brom., Sulph. and Ox. Calcium Chloride intramusc. and Parathormone gave benefit, the latter in a dose of 4 minims twice daily for a child of 4, 5 minims for a child of 7, and 6 mmiras for one of 10 years.—E. C. Warner, L. ii./3o,719. Chromium Dermatitis and Ulcers.—See Chromium. Cicatricial Tissue.—Cicatricine, lodolysin, Injection Thiosinamin et Sod. Salicyl., Ung. Thiosinamin et c. Phenazon, Urea. Cirrhosis of Liver.—Amimon. Chiorid., Iodides, Acid Nitro-hyd. Dil. Calcii Chiorid., Calcii Lactat., Sodium Phosphate. Climacteric Disorders see Menopause. Coeliac Disease.—Clinical features. Treatment a high protein diet with only moderate carbohydrate and very low or absent fat, with vitamins salts and water. Skimmed milk powder, to which powdered Casein (Casec ) is added. Bovril added later, and late, small amounts of carbohydrate_ Prof. L. Parsons, L. i./3i,61. Cold, Common.—See Catarrh, Nasal. Colic, Hepaticand Renal.—Opium, Morphine, Belladonna (in large doses) Papaverine (Biliary), Amyl Nitrite, Chloroform, or Ether Inhalation. Colic, Intestinal•—ZEther, Benzyl Benzoate, Calcis Aqua (for infants) Cajaput 01., Camphora, Cannabis, Chloroform, Chloromorphise Liq. Elixir Gent. Acid., Menth. Pip. 01., Morphine, Opium, Tinct. Carminativa, Bromides Chloral, Hyoscyamus, Peppermint, Ruta, Valerian. Colitis.—Aperfine, Bism. Salicyl., Hydrastis, Isphagula, Kaolin, Methylene Blue, Naphthalene, Naphthalene Tetrachlor., Psyllium, Salicylates, Said'Sod Ricinoleat, Thymaglycin, Trilactine, Vaccinum Myrtillus, B. Coli Vaccines * Saline and Boric Enemata Copper Sulphate injection, Oils, Thymaglycin Glucose, Subcutaneous and Intrav. Injection. Zinc and other Ionisation f* Mucous.—Bismuth Sod. Salicyl-Salol Pi]., Carbo. Enema Bism. et Sod. Sahcyl., Emulsio Paraff. c. Bismuth et c. Pancreatin. Astringents, e.g., lannin and Nitrate of Silver, and sedatives, e.g., Bismuth Salts, Kaolin, Salol, H-naphthol and mtest. antiseptics, Sod. Bicinoleat, Yaccinium Myrtillus. &CK/i/7u(s _L TCLTISJUSIOYI. Empty colon by lavage. Bismuth (2 ounces) in bread and milk every week. W here much fermentation add an ounce of Charcoal. For clearing the bowel Castor Oil—Lord Dawson of Penn. Antidysentery Serum in large doses intravenously miraculous. 40, 60, 80, and 100 Cc. on successive days, and then 100 Cc. for a few additional days — L. Hurst, B.M.J. ii./26,990. Colonic lavage c. Dimol. Colitis, Ulcerative.—Anti-dysent. Serum, Bism. Carb., Calc. Sulphid. Stearettes, Ipecac., Methylene Blue, Pot. Permang., Silver. Vaccines. Enema Bismuth. Subgallat., 01. Morrh. c. Cresot., Emulsio Sulphuris injected through an artificial anus. Direct treatment of the colon essential. Starch and Opium enema, simple colonic washes with Sod. Chi or. 1 drachm to 1 pint or Sod. Bic. 2 drachms to pint. Albargin Enema, 20 grains in 30 ounces Normal Saline, increased to 30 grams.—H. L. Tidy, B.M.J. i./3o,135. Zinc Sulphate ionization. \% up to limit of tolerance, with a special flushing electrode. At first only a little may be tolerated with 2 or 3 m.a. of current, but finally 3 pints may be held with 20 m.a. for 15 minutes or longer.—J. Burn- ford, B.M.J. ii./3o,640. See also J. Curtis Webb, B.M.J. iL/30,757. ^annin locally (1 or 2 grains to 1 oz.) given after preliminary lavage with low pressure by means of a soft catheter : Hyd. Perox. 1 dr. to the pint without lavage may be better than Tannin. Anti-dysentery Serum.—A F Hurst, B.M.J. i./31,693 ; L. i./31,636. Collapse and Fainting.—Adrenalin, intracardiac inj., JEther liypod., ZEther Spt., and Spt. Co., Alcohol, Ammon. Arom. Spt., Ammon. Vapor, Amyl Nitns., Camphor Inject., Capsules Aromat., Ammonia, Cardiazol ,Curschmann’s Solution, Digitalis and Inj. Hypod., 20 m., Erythrol Nit. Tabs., Mannitol Nit. Tabs., Nitroglycerin Tabs., Oxygen and Alcohol, Sal. Volat. For Rectal Feeding, see p. 395. Post-operative collapse. 0T 6m. Ephedrine in 1 litre of Saline intravenously slowly until blood pressure steady.—B.M.J.E. i./3o,16. Comedones.—Fowler’s Solution. Locally—Ac. Carbolic, Calamine Lotion, Calx Sulphurata, Resorcin, Vaccine Staphylo. See also Acne. Conjunctivitis.—Locally.—Acid. Boric, Acriflavine, Alumen, Alum Aceto- Tart., Argenti Acetas, Argenti Fluoridum, Argent. Iodid. Recent, Argenti Nitras, Argyrol, Belladonna, Borax, Colloidal Silver and Mercury, Coll. Adstring. Lut., Cuprung, Hyd. c. Morphina Oleat, Hyd. Oxid. Flav. Ung., Hyd. Perox., Mercurome, Resorcin, Zinc. Acetat. vel Sulph. Lotio, Zinc Ions. Sodium Bicarbonate in warm 3% solution is the most generally serviceable cleansing solution in treatment of blepharitis— R. A. Greeves, L. ib/23,997. Conjunctivitis, Diphtheritic. Locally—Formaldehyde, Hydrog. Perox., Iodol, Quinince HCl. vel Sulph. Lotio., Resorcin, Methylene Blue. Corrosive Sublimate 1 in 8,000—eyes washed every 2 hours. Lids painted c. Silver Nitrate 2%.—N. Cantlie, Jl. Trop. Med., Feb. 1/23,45. Constipation. (1) Laxatives :—Agar, Aloes, Aloin, Aperfine, ‘Bitter-free Cascara,’ Calomel, Cascara (Capsules, Elixir, Jelly, Mistura Laxativa, Pastils), Castor Oil (useful with Glycerin p. ceq.), Emulsio Paraff. c. Rhamno Frang., Fsexin, Maricol, Elix. and Syr. Ficorum, Felamine, Guaiac. and Sulph. Tabs., ‘ Hindu Dates,’ Maltaffin, Mist. Cascara Co., 01. Olivse, Oleum ‘ Elliott * Capsules, 01. Ricini Aromat, Paraffagar, Paraffinum Liq. and Molle, Eff. and Tablets Phenol- phthalein, Pil. Cascara Co., Prunol Prune Jelly, Pulv. Glyc. Co., Rhamnus Frangula, Rhubarb preps., Senna (Elixir, Conf.), Sodii Hyposulphis, Sulph. Conf., Tinct. Laxativa, Trilactine Tabs., or Milk. Tab. Phenolphthalein with Hyd. c. Creta aa. 2 gr. is a useful combination. (2) (a) Secretion Stimulants.—Ammon. Chlor., Jalap and preps., Magnes. Chloride and Cit., Normal Saline (1 pint) mane sum. Saline Waters, Seidlitz, Sodii Chlorid., Sodio-Magnes. Eff., Sodii Phosph. Eff., Sodii Sulph. Eff. (b) Hepatic Stimulants.—Aloes, Colocynth, Ipecac., Iridin, Jalap, Mist. Hepatica, Podoph., Rhubarb, Sodii Glycocholas, Sodii Sulph., Elixir Gent. Acid, (c) Cholagogues—Blue Pill, Calomel, Fel Bovin., Euonymin Sjj thought to be bj' relieving the intestine), Grey Powder, Magnes. nivrv?ride’ ^ ' ^en^1, Filulse Laxantes, Scammony (Pil. Conf.), Taraxa- tum preps. TTi^xriS-^e S^rT^ chola-gogue, but Turpentine, Sod. Benz., Sodium Salicyl., Buonymin, and Podophylloresm, possess a moderate effect.—Dixon. Excitants of—Choline HC1, Ignatia, Nux Vomica, Senna, Strychnine, Pil. Bellad. Nucis Vom. et Cannabis. (4) S&asm ReFievcrs.—Asafcetida, Belladonna, Bromides, Chloral, Hyoscyamus preps., Peppermint, Valerian. « Werve ron/cs.rArsenical preps., Caffeine, Quin. Ac. HC1 Suppos., Sodn Glycerophosphas, Zinc Valerianas. ’ d-I* Hydrarg. Subch., lihei, Cascara, et Capsicin would have combined effect. Pituitary Extract lias been used to counteract intestinal toxsemia. Ersomatu. and Prilactine, Injection and Suppositories. Fel Bovinunn Gauze Tampons coated with Soap are used. Hypodermic Purgatives.—Mom, Apocodeine, Colocynthin, Hormonal, Physostigmme. intestina! Paresis.—Enema Ammonice. Contraceptives, see p. 722. Convulsions.—Amyl Nitris, Ansesthetics, Carnph. Monobrom., Chloral, Chloral and Morphine, Chloroform, Conium, Morphine, Moschus, Podophyllin, Pot. Acetas, Pot. Brom., Rue, enema of—(for infantile), Urea-Bromine, Santonin, Sodu Brom., Sodii Nitris, Syr. Pilocarpin. et Pot. Brom. Chloral Suppositories. Convulsions, Puerperal.—See Eclampsia. Cornea, Inflammation, and Ulcers of. Locally.—Argent. Iodid. Rec., Atropine, Belladonna, Boric Acid, Cocain. Hydroch., Duboisine, Eserine Fluorescein (diagnostic), Iodi. Tinct. (Cocaine before and after painted on) Scarlet R. and Atropine in Castor Oil, Ilyd. Oxid. Flav. ling., FLyd. Subchlorid Inf. Abri, Pilocarpine and Quinine Lotion, Mercurome. Dionine 5% useful, see p. 558. Hyd. Oxycy. Injections, see p. 461. Phenol Carnph. applied with match, see p. 16. Mag. Sulph. up to saturated solution, see p. 539. Corneal ulcer well treated with an ointment containing Atropine and Yellow Mercuric Oxide of each 1%.—P. G. Doyne, L. n.'z7,132. Corneal Ulcers respond well to ultra-violet light.—W. S. Duke-Elder M A ’31,119. ’ Successfully treated with Atropine and bandage and silvering of the lids Septic and hypopyon ulcers are cauterised with Camphor and Carbolic (equai parts) and paracentesis of anterior chamber repeated as required. Iodine injections intravenously hasten cure.—E. R. Shetti, B.M.J. ii./3o,1098. Corns. Locally.—Acetic Acid (glacial), Carbolic Acid, Collod. Callosum Cupri Oleas, Fowler’s Solution of Arsenic, Formalin, Lin. I odi., Ung I odi Intinct., Iodum Oleatum, Salicylic Ions, Thorii Oleat. Ung. Corns, Soft. > Locally.—Durine, Perfumed Formosyls, Silver Nitrate Solution 1 in 3 applied, every 4 or 5 days. Coryza.—See Catarrh, Nasal, and Hay Fever. Cou?h--~VAPt Hydrobromic Acid. Hydrocyanic, Bellad., Carnph. and Creosote inhaled, Carnph. Co. Tinct., Chloral Hyd., Codeina and Periodide Conium, Cynoglossum, Elixir Pectorale, Elix. Pini Terpin et Diacetyl Morph ’ Gee’s Linctus, Gelsemium, Glycaphorm, Guttse Rosie, Hyoscyamus, Lichenoids, Tinct. Carnph. Co., Tinct. Expcctorans (Antimonii), Tinct. Menthol Tinct. Morph. Comp., Tinct. Morph. Hydrocyanicus, Tinctus Terp. Heroin Co., Tinct. Thy mi et Diaphorm., Pastilli Pectorales, Ozonic Inhalers Tia Pectoralis, Marrubium, Mist. Apomorph. Co., Mist. Tussi Rub., Morphime Tinctus and Troch., Morphinse et Ipecac. Troch., Opium preps., Pastilli varii q.v., Picis Liq., Pil., Prunus Virg., Rami Syrup, Spirit Chlorof., Syr. Coccillame Co., Syr. Ferri lodid., Syr. Pini Pumil., Syr. Thymi c. Diaphorm, Tab. Formalin Tabellae Glycyrr., Terpin Hydrate, Terebenum, Terpinol, Troch. Tussis Tinct’ Benzoin Co., Tylcalsin, Tyllithin, Vapor Creosot. Co. (Phthisical cough) Post-snfluenzai Cough.—Ammon. Iodide with Tinct. Benz.’ Co with counter-irritation by a stimulating liniment to front of the neck.—Eric Pritchard, B.M.J. i./3 r,725. Sir F. Semon’s scrip : Morph. Hydrochlor. f grain, Apomorphine Hydro- chlor. i gram, Acid. HC1. Dil. 10 minims. Syrup of Figs 4 drachms Syrup Pruni Yirg. 2 drachms, Water to 6 ounces. 1 to 2 drachms every hour. Biological antagonistic action of Morphine and Apomorpliine. Good for all spasmodic coughs— H. C. Semon, B.M.J. i./31,769. The cough may he attributed to a pharyngitis. Glycerin Tannin Paint good.—W. A. Marris, ibid. Mercury Vapour Lamp the only remedy any good. Internally, Syr. Bromo- form for children, or Elix. Bromoform for adults.—G. Richardson, B.M.J. i./31,086. Crelinism.—Thyroid Preparations. ‘Three Gland’ and ‘Pour Gland’ Elixir and Tablets. Suprarenal gland. Cystitis.—Acid Camphoric., Acid Lactic, Aconite, Alkalis, Ammon. Benz., Betol, Belladonna, Benzoates, Boric Acid, Buchu, Collinsonia Can., Copaiba, Gokhru, Hexamine, Hydrastis, Juniper, Liquor Potassae, Magnesii Boro-Citras, Pareira, Pyridium, Salol, Sod. Salicyi, Sorghum, TYiticum repens, Uva Ursi, Yesalvine ‘ B ’ and Yesalvine ‘S’, B. Coli or appropriate Yaccine. Locally.—Argenti Fluorid., Iodidum and Nitras, B. Ac. Lactic, Irrigation, Cocaine Lactate, Colloidal Mercury and Silver, Creolin Solution, Iodine Douche, Formosyl, Mercurome, Quin. Bisidph. 1 in 2,000, Zinc Sulphanilas. Treatment Rotes: Drinks containing Pot. Citrate., Conf. Senna and Conf. Sulphuris p. ceq. Phenacetin and Ext. Hyoscyamus in 5 grain doses, and if pain very acute and vesical tenesmus present a rectal injection of 2 drachms of Starch containing Antipyrin and Laudanum. Urinary antiseptics as the inflammation declines. Locally.—Dilute Boric Acid Solution useful. If chronic, Silver Nitrate 1 grain per ounce carefully instilled (in a child 3 ounces may be used and left in the bladder). When the vesical end of the mucous membrane of the canal becomes involved the passage to be swabbed out with Liq. Phenol through a speculum and immediately washed with Sodium Bicarbonate Solution to check action. Acute Cystitis.—Phenacetin and Ext. Hyosc. 5 grains each t.d., Anpropriate Vaccine. Local Treatment.—Instillations, irrigations with Permanganate 1 in 2,000, Protargol, etc. Cystitis, chronic.—Ammon. Benz., Buchu, Cinnamates, Grindelia, Hexyl- Resorcin, Juniper, Salol, Sandal Wood, Santalol Caps. Locally.—Eusol, Uydr. Ferox. (5 to 10 VoL), Mercurome, Quinine. Croup, False.—See Laryngismus Stridulus. Cysfinuria, see Calculi. Dandruff, see Seborrhcea. Deafness.—Pilocarpine, Otoscicrol. Sex also Earache. In old people, Thyroid Siccum £ gr. twice daily. Eor deafness hot baths containing a lb. of Magnesium Sulphate is sometimes effective in a minority of chronic cases. To be used with caution in elderly people. 10 minutes’ immersion enough. Exhausting. Treatment by the enunctories is an old-established method.—J. Adam, B.M.J. i./31,621. Debility.—Acidin, Alcohol, Aperflne, Arsenic preps., Bismuth and Pan- crcatin, Bone Marrow Extract, Bovril, Calcii Hypoph., Syr. Calcii Phosph., Calc. Glyceroph. c. Lacte, Caps. Valerianat, Catha Milk and Glyceroph., Cinchona preps., Conf. Glyceroph. Co., Elixir Eerro-Manganes. Pept., Elixir Gent. Acid., Elix. Hsemoglobin c. Lecithin, Emuls. 01. Morrh. c. Lecithin, Eerro- camis, Eormates, Glycerophosphates, Glycerole Hypoph., Hsemoglobin Capsules, llelba, Iron Salts, Laeidac, Lecithin Pulvis, Liq. Pepsinae et Caffeine, Maltum, Malted Glyceroph., Marrubin, Malt Ext. c. Haemoglobin, c. Pancreatin, c. Hypoph., Malt Ext. cum Syr. Eerri Phosph., Morrhuao 01., Phosphorus, Pil. Potentin Co., Pil. Lecithin c. Eerri lodid., Pulv. Glyceroph. Co., Quassia, Quinine preps., Sirop Neurotonique, Sod. Cacodyl., Strychnine, e.g., Cacodyl, and Formate, Syr. Eerri Phosph. c. Quin, et Strych., Syr. Format. Co., Syr. Kolco Comp., Syr. Glyceroph. c. Format., Tylmarin, Trilactine. See also Anaemia. Eor overwork : 2 minims of Tinct. Digitalis thrice daily for lengthy period. —‘ D.M.’ in M.P.C., Oct., ’26,1927. Delirium Tremens (and see Alcoholism).—Ammon. Carb., Apomor- phina, Bromides, Camph. Monobrom., Capsicum, Chloral, Colloidal Gold, Digitalis, Elix. Quinidine, Hyoscine, Hyoscyamine, Opium preps., Paraldehyde, Phosphorus, Quinine preps., Sod. Brom. Intrathecal injection, Sod. Chlor. injections, Strychnine, Sulphonal, Valerianates. Hyoscine, Sulphonal and Veronal in.—R. Eager, B.M.J. i./2o,114. Dementia Praecox—treatment.—T. Beaton, L. h/25,1145,1197. Sulfosin Injns. S/SV |aUcjn> V,°-L Iodi- Thenacetin and Caffeine, enns.ry. Locally.—Alcohol Sandarachi, Borated Hvdr Per or Tint mi n {~'°?).al/ Solution, Dental Anaesthetic, Cornyo Rubber Wax Rmr> form PasfeUCF^nosvl<M’ ^tofPMeine.Gossyp. Arsenios., Eyd. Perox., lodo- ■ArsenieaUs, Zinc oijchio " "pLfh'caTmpT^’ MV Amal°am’ Pasta DeTb^hireN^f-ScotoeT1 Nitrite' VUe also OMoroform, etc. Dercum’s Discs se.-—Thyroid (q.v.). AUnq^Buturate LParamV^n fMJwCp-’ Acid ?or\c Lotion, Anserine Mulls, iviung. fyfffWaic, Paraffin l\o. 7, Perf. Formosyls, Pot. Permana Una Ar Sahcyl 50[/o, Ung. Rusci Co., Carbolised Zinc Ointment. ’ industrial dermatitis bakers’ itch, sugar itch, water rashes Form si in dermatitis, trom cutting oils, Tar, etc.—Hall Stewart, B.M.J. 1J22 498. Dermatitis exfoliativa neonatorum, pemphigus neonatorum 5(Hitter’s Disease). A fatal case.—R. McDonald Cairns; BAI.J. i./aTlsS. Dermatitis venenata caused by latex of plants or appendages—C Pardo- Arsenical dermatitis.-—Contramine, Sodium Thiosulphate locally. Balers dermatitis.—All minor cracks, abrasions, etc., should be at once “ ^I1oo/I?dl?e1?r Silver Nitrate. Metchnikoff’s Ointment (Mercury Sub- thloride 33 ^ m Anhydrous Lanolin) most satisfactory, applied freely, rubbed m, and covered to exclude air. Evacuation of the vesicles hastens healing All cracks are painted with Silver Nitrate, 15 grains to the ounce of Spirit of Nitrous Ether, before applying ointment—N. Howard Mummery, L. ii./as 647 Lime dermatitis.—h requent changes of dust-laden underclothing, alteration of employment, and nightly application of emollient grease to skin of face hands, and arms. Over-sweating or abnormal dryness are predisposing factors—W. J. O’Donovan, L. i./2 5,599. * Dermatitis among painters. Paint solvents can cause the irritating vesicular eczema, liirpentine, Thinner and Naphtha being the worst.—J. A. Turner, L. ii./25,1033. Chromium dermatitis.—B.M..J.E. ii./25,51. Meiol dermatitis.—See p. 307. Dermatitis due to dyed fur. Get rid of the fur and use Zinc Oxide cream._ ,Roxburgh, Pi., May, 25, per P.J. i./s5,590. See also Paraphenylene- diannne, p. 306. Dermatitis ‘ X Ray ’ {Local use).—Boric Acid Ointment, Radium. See also Eczema, Psoriasis, etc. Keratosis accompanying.—Carbonic Snow. Bhobie’s Itch.—Manson says produced by Microsporon minutissimum and is really inflamed erythrasma and not trichophvton ringworm Vleminckx’s Solution cures—used at first diluted three or four times. Bub aieas with a 10% solution of Chrysarobin in eQual parts of Acetone and Methylated Spirit. In the evening wash off and use a 5% Benzoic Acid and 3% Salicylic Acid Ung. Next day reapply the Chrvsarobm.—-A Whitfield, L. i./23,1125. Unguentum Resorcin et Ac. Salicyl (Castellani) is popular Dliobie’s Itch Ointment (Deeks) for itch and pruritus ani.: Salicylic Acid 20 gr., Mercury Ammoniat, 20 gr., Bismuth Subnit. 1 dr., Eucalypt. Oil 1 dr Adeps Lanse (Anhyd.) to 1 ounce.—W. E. Deeks, U.F.C., ’25,256. Relapses with the Itch Ointment prevented by a powder of £ oz Sod BP in 8 oz. Talcum powder.—B. O. Connor, Int. Conf. Int. Am., ’24 498 * Diabetes Insipidus.—Arsenic, Adrenalin, Belladonna, Ergot, Gallic Acid Lithium Salts, Lithion, Opium, Pituitary Injection. * Diabetes Mellitus.—Insulin. Diabetic Foods. Glucose per rectum especially where acidosis threatens. Pituitary Extract Lactose {q.v.) is stated to be assimilated by diabetics. Allan’s Dietetic Treatment*—Regulated fasting and gradual dieting—metabolic processes are given chance of recovery. In dieting it is now understood the proteins and fats might be deleterious as well as the carbohydrates.—Sir A. Garrod, B.M.J. ii./2i,706. See also P. J. Cammidge B.M.J. i.J 17,503. Of 143 cases treated by fasting 52 died—r. J. Cammidge, B M J ii hi 708 ./Etiology and Treatment—P. J. Cammidge, Pr., June 22/399 ' " * Negligible glycosuria—O. Leyton, Pr., Jan. 1922, p. 113 Glycosuria of malarial origin. A case with 0-85% Glucose cleared up on treatment with Quinine. Another case starting with 2% Glucose was evidently chronic malaria though parasites were not found. Strict diet. Finally under intensive Quinine treatment with ordinary diet the sugar disappeared.— A. Castellani and J. Graham Willmore, B.M.J. ii./2i,286. See also G. A. Harrison, ibid. 630. A diet of 900 calories, mostly fat, produces the same fall in B.M.R. as fasting—less dangerous and more successful in desugarization.—L. H. Newburgh and P. L. Marsh, per Jl. Trop. Med., June 15/23,224. Amino-Acids Content, Significance of. Vide Amino Acids, Vol. II. Restrict diet to animal proteins, leafy green vegetables and fresh fruits. More Insulin is given than necessary.—W. E. Peeks, Diet and Disease, 1927. Further refs. Edn. XIX., p. 1052. Van den Bergh Reaction.—In diabetes meilitus. In 130 patients liver injury was absent in only 34. Routine performance of the test may assist in prevention of diabetes.—Brit. Jl. Exp. Path., June, *26,155, per Pres., Jan., *27,13. Coma of :—See also Insulin. Hypertonic Saline and Gum Acacia. Exceedingly large doses, e.g. 500 Cc. of 5% Sod. Bic. intrav., also Sodium Bicarbonate 40 Gm., Levulose 30 Gm. in water, 1,000 Cc. by drop enema. Langdon Brown's Mixture for control of acidosis : Sod. Bic. 1 drachm, Pot. Cit. 30 grains, Calc. Lact. 5 grains, Mag. Carb. 5 grains, Chlorof. Water to 1 ounce. Action of Alcohol on blood sugar in diabetes. A dose of Brandy is capable of lowering the fasting blood sugar in a diabetic—this is brought "about after absorption into the blood stream. Of value in diabetic coma.—J. C. Hunt, L. i./3o,121. Theories of ketosis and acidosis as a cause of diabetic coma are not supported by the amounts of Aceto-acetic Acid and the alkali reserve content of the blood.—E. C. Dodds and J. D. Robertson, L. i./3o,852. Diagnosis of diabetes meilitus. Should be based on a very considerable loss in power of storing and/or burning sugar, or evidence that the power is decreasing.—O. Leyton, L. i./3o,1168. For the thirst of:—Pastillus Acidi Citrici c. Limone. Diaphoretics.— Acting peripherally :—Nicotine, Pilocarpine. Warmth (local application) and Alcohol (internally) perhaps act in the same way in addition to their vascular action. Acting centrally :—Ammon. Acet., Amm. Cit., Antim. Salts, Ipecac., Opium. Mode of action doubtful:—Pot. Acet., Pot. Cit.,—and feeble : •—Aconite, Colclficum, Lobelia and Salicin. Anhidrotics or Antihidrotics.— Acting peripherally,—Atropine by acting on the ends of the nerves in the glands, Agaricin, Hyoscyamine, Stramonium. Cold (local application). Mode of action doubtful.—Acids, Nux Vomica, Picrotoxin, Quinine, Zinc Salts. Diarrhoea.—Acid. Camphoric., Carbolic., Gallic, Hydrochloric Dil., Lactic., Sulpli. Dil. and Aromat., Agaricus albus and Agaricin, Anthemidis Tinct., Benzonaphthol, Benzyl Benzoate, Bisciniod, Bismuthi et Cerii Salicyl., Bism. Salicyl. Tannas, Cajuput Oil, Calc. Carb., Calc. Salicyl.,Campliora, Catechu, Charkaolin Granules, Cinnamon, Cloves, Conradi’s Drops, Coto, Cotoin, Cretse Arom. Pulv., and cum Opio, Cupri Sulph., Cyllin Syrup, Eucalypt. Gum, Liq. Ferri Pernit., Fcrri Salicyl., Guaiacol Carb., Hsemotoxylin, Hyd. Perchlor., Hyd. Subchlor. (large doses, q.v.), Ipecac., Kaolin, Lacidac, Mist. Antiseptica, Mistura Diarrhoea, Naphthalin, Naphthol, Opium preps., Plumbi Acet., Pulv. Ipecac. Co., Pulv. Kino Co., Quin. Salicyl., Resorcin, Roseberry’s Mist., Ricini 01. and Aromat., Sedeff, Silica Gel., Sodii Phosph., Sod. Salicyl., Syr. Aigle Marm. Co., Tliieleman’s Mist., Sodii Sulph., Trilactine Tablets or Milk, Tyl- calsin, Tyllitliin, Whey Powder, Zinc Sulphocarb. Acid. Tannic, Suppos., et cum Opio, Amyli Enema, et cum Opio, Galloe Suppos. et cum Opio, Tannin rectal injection, Turpentine Stupes. See also Dysentery. Diarrhoea Infantile. Saline injections either by the skin or bowel are of great and saving value in acute summer diarrhoea.—W. J. Tyson. Calomel in large doses has been advised. See also A. V. Neale, B.M.J. H./31,382. See also Coeliac Disease. Diarrhoea of Phthisis.—Goto and drugs as for diarrhoea, q.v. Kaolin. Bism. Carb., e.g. 4 drachms to 2 ounces in milk. Calc. Chloride, |-1 grain intram, or intraven. at intervals of 2 or 3 days with Bism. Carb. per os, say 1-2 drachms thrice daily. Injections should be continued for 2 or 3 weeks.—F. Savy, L. ii./25,674,781. A. F. Hurst recommends Ac. HC1. dih 30 to 60 minims with each meal.—ibid. 727. Diphtheria.—Acid. Salicylic., Aconite, Antitoxin, Ferri Perchlorid., Kaolin, Sodii Benzoas, Sodii Chloras, Sodii Hyposulphis, Toxin-Antitoxin Mixture as prophylactic. Normal Saline (in grave toxEemic states). Locally.—Acid. Benzoic. Nebula, Acid. Carbolic. Glycerin, and Nebula, Acid. Lactic Nebula, Acid. Sulphuros. Nebida, Argent. Nit. Swab, Clilori Gar gar., Formalin Spray, Hydrogen Peroxide, Iodic Acid, Iodised Phenol (Pigment, Gargle and Inhalation), Loeffler's Pigment, Menthol Pigment, Naphthol cum Camphora, Ozonic Ether, Papain, Resorcin, Sodii Benzoatis Nebula, Sodii Chlorinat. Liquor, Toluol. Spraying the throat with Hydrarg. Perchlor. 1 in 1,000 has saved life. For sustaining blood pressure Adrenalin 2 to 3 minims hypod. every 6 to 8 hours. Aspirin, Phenacetin and Dover’s Powder. Combined Tablets are made. Diphtheritic Infections of the Skin.-—Zinc Ions. Dipsomania.—See Alcoholism. Disinfectants.—See Chapter on, Yol. II. Disseminated Sclerosis—See Sclerosis, Disseminated. Diuretics.—See Dropsy, Renal. See also Ammon. Acet., Cantharides, Digitalis, Novasurol, Pil. Hydrarg., Theobrom. Sod. Sal. Dropsy, Cardiac.—Adonidin, Apocynum preps., Asparagin, Baillie’s Pill, Digitalis, Elaterium, Erythrophlceum, Pituitary (Entire gland), Strophanthus, Theobromine Aceto-Salicyl, Theophylline. Pil. Hydrarg. (avoid if renal disease present). Sodium Chloride-free diet. Dropsy, Hepatic.—Ammon. Benzoas, Ammon. Chlorid., Hydrarg. Sub- chlorid., 01. Juniperi, Sodii Bicarb., Sparteinas Sulphas. Dropsy, Renal.—Ammon. Acet., Cit., Tart., Apocynum, Bismuth Carb., Buchu, Caffeina, Cantharides Tinct., Elaterium, Hydrarg. Pil., Iodo-Calfeine, Coramine, Ephedrine, lodo-Theobromine, Jalapa, Pilocarpine, Pot. Acet., Pot. Tart. Acida, Pot. lodid., Pot. Nit., Quinine, Salyrgan, Scilla, Scoparius, Sodii Iodid., Theobromine and Salicyl, Theophylline, Urea, Vinum Diureticum. Pot. Permang. Injection.—See Uraemia. Dupuytren’s Contraction.—Fibrolysin, Injectio Thiosinanamin et Antipyrin (see also Sir J. Barr, under Calcii Chlorid). Thyroid Gland and Three and Four Gland Tablets. 5% Salicylic Acid Ointment found effectual in several weeks.—D. A. Alexander, B.M.J. i./23,794. Dysentery.—Determine cause. Alum Inject., Antidysenteric Sera, Argenti Nitras (Rectal Injection), Belae Fructus, Benzyl Benzoate, Bism. et Cerii Salicylas, Bisciniod, Bismuth Tart. Solubile, Calcii Salicylas, Cannabis, Cassia Beareana, Calomel, &c. (evacuant), Charkaolin Granules, Cynoglossum, Dec. Simaruba et Punic. Granat., Elix. Agrimon. Co., Emetine Bismuth Iodide, Emetine Injections, Emetine Peri- odide, Eucalypti Gum, Fsexin, Guarana, Flamamelis, Helba, Hyd. Perchlor., Hyd. Subchlor. (large doses), Hydrog. Perox., well diluted as enema, Ipecac. ‘ Stearettes ’ or ‘ Formagules,’ Holarrhena, Krebisote, Ipecac. Co. Pulv., Mag. and Sod. Sulphates, Naphthalene, Opium, Plumbi Acetas, Pot. Permang., Salicylic Acid by Rectal Injection, Sedeff, Silica Gel., Simaruba, Tannin, Tri- laetine, Tylcalsin, Tyllithin, Terebenum purum, Terebinth 01. and Stupes of, Yeast, Dysentery Vaccine. Ether and Caffeine hypodermically when patient in extremis. Excellent results with injections of 10 Cc. of a 10% solution of Calcium Chloride with Morphine, subcutaneously.—Jl. A.M.A. ii./25,1521. Amoebic Dysentery and ‘ Carriers.’—Auremetine, Conessine, Emetine Injections and Emetine Periodide or Emetine Bismuth Iodide (vide Ipecacuanha chapter), Simaruba, Stovarsol. Calomel for obstinate amoebic dysentery, in doses of 0-03 Gm. 12 times a day for 3 days, followed by 3 days’ treatment with Bismuth Subnitrate (0-5 Gm. 12 times daily).—G. Beijnen, per Jl. Trop. Med., Aug. 1/23,256. Lamblial dysentery well treated with Carbon Tetrachloride.-—M. Khalil and I. Sliawky, Jl. Trop. Med., Sept. 15/23,285. Yatren yer os and as irrigant following appendicostomy. Stovarsol well spoken of or a mixture of Tincture of Ferric Chloride 20 in., with Mercuric Chloride Solution £ dr., in -.V oz. of water, further diluted when taken—thrice daily, continued for months and given with a nightly dose of Liquid Paraffin. —It. E. Drake-Brockman, L. i./26,905. Bacillary Dysentery.-Emetine, Silver Gelatose (i.e. Albargin), q.v. Enema 1 to 11- pints, strength 1 grain to 1 ounce. Formalin diluted as rectal injection (painful). Rhubarb (q.v.) stated to be magical but no effect on bacilli in laboratory. Readiiy responds to saline treatment and if given early Magnesium Sulphate, a drachm every two hours, will relieve.—An Indian physician, C. and D., Sept. 1921, p. 378. High incidence of cases at Claybury found during winter months. Strict observation and permanent isolation needed.—W. S. Dawson and W. Moodie, L. ii./a i,225. Ripe apples mashed into a puree cured dysentery even with high fever. An old recipe revived.—Professor Moro, L. i./3o,526,672. Acid formation to kill intestinal dysentery (and typhoid) organisms. Orange and Lemon juice kill B. typhosus. With regard to the Apple Pulp treatment of dysentery, it seems probable that the pulp in bulk might not be neutralised in the system and hence be capable of acting where the inflammation is situated. ■—MacKenzie Douglas, L. ii./3o,789. See also Typhoid. Dvsmenorrhoea.—AcRea, Hither Spt. cum Opii. Tinct., Amyl Nitris, Apiol, Belladonna Suppository, Benzyl Benzoate (?), Butyl Chloral Camphor, Cannabis, Cannabis and Chloral, Castor, Chloretone, Cibalgin, Elixir Ergotae c. Ferro., Ephedropyrin, Gelsemium preps., Gossypii Rad. Cort., Liq. Caulopli, et Pulsatilla, Guaiacum Resin Cachets, Mist. Dysmenorrhoeica, Mist. Morphin. Phenazon. Co., of W. W. W., Opium, Ovules Morphine, Mist. Senecio Co., and others, Piscidia, Potass. Bromid., Pulsa, Pulsatilla, Salix nigra, Saw Palmetto, Senecio, Serpentaria, Sodii Salieylas, Styptol, Stypticin, Syr. lodo- Tannicus, Tab. Ergot Senecin Comp., Valerian, Viburnum. Potassium Bromide 160 grains, Cldoral Hydrate 80 grains, Nepenthe 80 minims, Elixir Viburnum Co. 2 ounces, Water to 8 ounces. £ oz. t.d.s.p.r.n.ex ag.—found useful. Gland Tablets.—Corp. Lut., Pituitary, Ovarian, Testic. Thyroid, with other measures, brings relief in some cases. Atropine 1/200 grain thrice daily commencing 2 days before period of value when dilatation needed but refused.—B. Venn Dunn, B.M.J. i./31,971. Dyspepsia.—Acid. Carbolic, Acid. Nit. Dil., Acid. Hydroch. Dil., Acidin, Alkagen Tabs., Aloin, Ammon. Carb., Ammon. Chloridum., Arsenic, Bisciniod, Bismuth Comps., ‘ Bismuth and Pancreatin,' Cajuput 01., Calcii Peroxid., Capsicum, Caps. Valerian Co., Catha Milk and Glyceropli., Cerii Oxalas, Cliarbon Naphtole, Condurango, Creosote, Creosoti Valerianas, Diascordium, Elixir Gent. Acid, Faexin, Gentiana, Gingerin, Hydrarg. cum Creta, Hydrastis, Hydrocyanic Acid, Hysterionica, Lecithin Elixir and Emulsion, Leptandra, Liquor Pepsinae et Catfeinae, Liq. and Tabellae, Papain et Iridin, Lithia-Bism. Citras. Liq. Bism. Tart., Magnesia Cream, Magnesii Hydroxidum cum Carbone, Mist. Carminative, Nux Vomica, 01.4 Elliott ' caps., 01. Valerianae, Pancreatin, Papain Glycerin, Pepsin, Pepsin and Bismuth Tablets, Podophyllin, Quassin, Quinine, Rhei Rad. Pulv., Sal Polychrestum, Sedeff, Serpentary, Sodii Bicarb., Sodii Hyposulphis, Sodii Sulphocarb., Sodii Taurocholas, Sodium Bism. Citras, Sodium Citrate for adding to Milk, Spirit Meliss. Comp., Tab. Bismuth Pepsin et Cascara, Thyroid and Manganese, Tinct. Bellad., Tinct. Caryophylli, Tinct. Rhei Aquos, TTilactine, Troch. Antacidi., Pulv. Dyspeptic Co. A few drops of Hydrochloric Acid to reinforce the action of the gastric juice, e.g., 10 to 15 drops in 1 pint of sweetened water, as a drink during or after ixi0cils# Benzonaphthol in small dose with Magnesium Carbonate and a little charcoal in the middle of each meal used in France.—B.M./F.W.XV. Arteriosclerotic dyspepsia. Abernethy’s rules—allow 6 hours between meals, chew well, rest after, dine off one dish.—T. C. Hunt, L. ii./3o,1005. For Faeces Examination, see Vol. II. Dyspnoea.—^ther Spt., iEthyl Iodid., Alcohol, Ammon. Carb., Amyl Nitris, Erythrol Nitrate Tablets, Euphorbia Peplus, Lobelia and Lobeline, Morphine, Nitroglycerin, Oxygen and Alcohol, Oxygen injected, Ozonic Ether, PI. Caffein Tri-Iodid. Co., Quebracho, Sodii Nitris, Strychnine. Earache. Locally.—Atropium Liquor or Oleatum (diluted), Chloroformi Vapour, Cocaina cum Oleo, Glyc. Acid Carbolic 6 grains to ounce, slightly warmed, 2 or 3 drops, Guttce Spiritus c. Formalin, Liquid Paraffin (for soft wax in the meatus), Menthol-Paraffin Capsules, Morphinm Oleatum (diluted), Opii Tinct. cum Oleo Oliverce, Ung. Lanoboric Camphor at. See Aurinaria, also Nebula?. Ecbolics.—Ergot, preparations, Cayenne, Ginger, Helonias, The Hellebores, Lead, Myrrh, Oil of Pennyroyal, Savin, all drastic purgatives. Eclampsia.—Amvl Nitrite Sterules, Chloral Hydras., Erythrol Nitrate labellae, Morphine, Musk, Nitroglycerin, Papaverine, Parathyroid, Pilocarpine, \ eratrum, Thyroid, Sodium Acetate Injections 4 drachm to the pint. Sod Thcarb. 250 Cc. 3% Solution intrav. repeated 3 hours later. Routine Treatment-Purgatives, e.g., Jalap, Mag. Sulph., Calomel and Croton Oil. Diaphoretics.—Pilocarpine (of great value). Nerve Sedatives— Bromides, Chloral- Morphine in varied dose. Calcium Chloride, Calcium Gluconate, Potassium Chloride, Serum Treat- ment, removal of colostrum, hot packs and hot air bath, Oxygen, the injection of air or Oxygen and Potassium Iodide into the mammae, and lumbar anaesthesia have also been used. Venesection combined with the endeavour to eliminate the poison and dilution with Saline Transfusion. (Not advised by all.) Strogonoff’s method includes Morphine subcutaneously and Chloral per rectum m alternate doses and at stated intervals. The Dublin method includes Morphine (alone) in total doses of £ to 14 grains.—T. W. Eden, B.M.J. ji./22,675. The pregnant woman absorbs more toxins than normal from the intestinal canal. These should be detoxicated and conjugated by the liver, Calcium being the most important chemical in the processes involved. Calcium intake is insufficient—further, the foetus demands it.—G. W. Theobald, L. i./3o,1119, A Veratrine preparation at first sign of a lit and Morphine and Hyoscine used later.—K. Kelson Ford, B.M.J. ii./3o,726. Ecthyma.—01. Tereb. in Oil injection. Eczema.—Arsenobenzol and Arsenicals, Ca. Lactate, Ca. Iodid., Harrogate Water, Iron Salts, Milk and Glyceroph., 01. Morrhua, Phosphorus, Sod. Cit., Sod. Brom. intrav., Sod. Ricinoleas, Sod. Silicas intrav., Sulphides, Sulphur, Thyroid, Three Gland and Four Gland Tablets, Trilactine (Tabs, and Milk), Vaccine Staphylococcic. Locally.—Acid. Boric., Acid Camphoric. Lotio and Ung., Acid Carbolic, Lotio and Ung., Acid Salicylic Ung. and 01., Acid Picric Solution \ to 1% and 01., Aiibour Water, Alkaline lotions, Anserine Mulls Medicated, Argent. Nitrat. Sol. (particularly for mucous surfaces of anus, vulva, etc.), Balsamum Lanolinatum. Bismuth Nit. Glycerin, Colloidal Silver, Mercury, etc., Calaminm Lotio (et Oleosa), Calcii Chlorid., Ungt. 6%, Calcis Aqua, Calcis IAnim., Chrysarobini Ung. (weak), Cremor Sicc. preps., Creolin, Cupri Sulph., Diachyli Ung., Ether- Soluble Tar Paste, Formalin, Moist (for dry condition), Formosyl, Formosyl Huile de Cade, Hydrogen Per ox., Ichthyol and Collodion and paste of, Iodates, Kaolin Unq., Lanolin Lotio Nigra, Lotio Plurnbi Lactat., Formosyl dusting powder, Methylene Blue, Naphthol, Paraffin No. 7, Pellanthum preps., Perfumed Formosyls, Pigment Old Eucalypt. et Ac. Salicyl., Sodii Curb., Sulphur Colloidal, Ung. Hyd., Perox., Ung. Thorii Oleatis, Ung. Rumicis, Ung. Rusci Co., Vleminckx's Solution, ‘ X * rays and Light Therapy, Zinci Boras, Zinci Cremor, Zinc Ions, Zinci Oleat. TJulv. and Ung., Zinci Ung. , Ointment of Liquor Carbonis Detergens 1, Ung. Hyd. Nit. 3, Ung. Simplicis 4. Also Liq. Carbonis Det. in Lotion c. Liq. Plumbi a.a. 3 to 4%. Seborrhoeic eczema may be due to a relative acidosis. Alkalis, e.g., Sod. Bicarb. 1 drachm, Pot. Citrate 30 grains, Calc. Lact. 5 grains, Mag. Garb. 5 grains, Chloroform Water to 1 ounce.—H. M. Barber and H. C. Semon, B.M.J. 11./18,245. Eczema of Infants, obstinate.—Thyroid Gland has been suggested. Infantile eczema well treated by Purified Coal Tar and Zinc Oxide of each 2 parts, Corn Starch and Vaseline of each 10 parts.—H. MacCormac, L. ii/23,242. In obstinate cases a Tar Paint: Crude Coal Tar 1 ounce, Collodion 1 ounce, Acetone 1 ounce. Applied with brush, repeated every two or three days.— H. G. Adamson, L. i/25,350. Lotio Hyd. I lav. applied with gauze swab 4 or 5 times daily effective for eczema of infants and adults on face, hands, arms, or scrotum. Discontinue after 8 or 10 days and apply Ammoniatcd Mercury Ointment.—Per Pres. Oct., "29,342. Anal and vulvar eczema. Paraffin preparations per os should be forbidden: leakage may cause re-infection. Prevent rubbing of clothes. X-Rays, High Frequency and Low Tension Diathermy, Zinc Ionisation, Ultra-Violet Light. Menthol Ointment, 4 grains to the ounce, relieves irritation : Cocaine 2% also useful: also Hyd. Ox. Flav., 1 grain, to 1 ounce of Paraff. Moll., Calomel 20 grains, Zinc Oxide 1 dr., Paraff. Moll. 1 ounce.—A. Savill, L. L/29, 680,731. Acute facial eczema yields very readily to the following cream : Stearic Acid 15 Gm., Borax 0-4 Gm., Ammonia (0-92) 6 Gm., Water 78-6 Gm.—Per Pr., Dec., '29,444. Obstinate cases cured by daily bath of 2 lbs. Sodium Bicarbonate to 20 gallons water, with change of linen and an ounce of Magnesium Hydrate twice daily. A case of 18 years standing cleared up in 3 days.—S. A. Leader, B.M.J. ii./31,323. Electric Current Injuries.—See Radiology Vol. II. Elephantiasis.—Arsamin, Pituitary Extract. Non-filarial elephantiasis.—J. E. Schofield, B.M.J. i./31,795. An early case cured by protein shock. Four injections of T.A.B. vaccine.—■ W. E. Cooke, L. i./28,390. Non-specific protein (Vaccine 800 million) also T.A.B. intravenously had good effect.—G. Carmichael Low, B.M.J. H./30, 1065 ; L. h/30,72. T.A.B. Vaccine, from 25 to 800 millions, with a pressure bandage : successful.—L. McGolrick, B.M.J. ii./3o,957. Emetics.—Apomorphine A grain inject, hypod., Antim. Tart. 1 to 2 grains, and Vinum 2 to 4 drachms, Ipecac. 30 grains, and Vinum 4 to 6 drachms, Mustard a tablespoonful, Sodii Chloridum a tablespoonful, Zinci Sulphas 20 to 30 grains. See also Poisons and Antidotes. Emphysema.—Iodides and Iodine preparations, e.g.. Caffeine Tri-Iodide. If patient too stout add Thyroid to the Iodine. If excess of lime in the blood Sodium or Potassium Citrate or Limonade Purgative. Coramine. Keep bowels open with Sodii Sulph. Empyema.—Hydrogen Peroxide for washing the pleura (10%). Douching with Dakin’s Solution. Streptococcal, and Pneumo. Vaccine. Injection of 2% Formalin in Glycerin (Murphy’s).—H. Wade, B.M.J. ii,/21,150. Closed drainage in empyema. Irrigation with Dakin’s Solution.—J. D. McEachern, B.M.J. i./3i,389. See also W. Mitchell, ibid. 516. Empyema thoracis. Aspiration and Oxygen replacement of the effusion. Repeated puncture of the chest wall may be needed, using 1% Novocain.— H. Morriston Davies, B.M.J. i./31,569. Encephalitis, Epidemic (previously called Encephalitis Lethargica. See also Vol. II.). Keep patient at rest and free from worry ; give Ammonium Bromide or Chloralamide if necessary.—Wilfred Harris, B.M.J. i./2i,47. Aetiology. Outbreaks have followed epidemics of influenza also of poliomyelitis. Pathology. A small coccoid organism has been isolated, filtrable, present in the secretion of the naso-pliarynx. The cerebro-spinal fluid shows only a moderate degree of lymphocytosis. Urea and sugar are definitely increased. Acetone is present in small amount. Symptoms. Stupor is the most characteristic feature, lasting for a varying period. There is a focal disturbance of the nervous system, e.g. paresis of the ocular muscles.—Pres., Aug./2o, p. 290 ; Feb./2i,65. See also A. Howell, Pr., April, 1920. B.M.A. Discussion on, opened by Ivy McKenzie, B.M.J. ii./27,532. Pathology, by J. Godwin Greenfield, ibid. 535. Chronic encephalitis, G. Riddoch, ibid. 537. Mental aspects, by R. MacNab Marshall, ibid. 539. Allied to polio-encephalitis, but not identical.—B.M.J. ii./21,205. The Ministry of Plealth issued a pamphlet (1924) on, revising that of 1921. Tiie residual symptoms or sequelae are resistant to every therapeutic measure. .—C. M. H. Howell, B.M.J. i./25,437. There is derangement of carbohydrate metabolism with hyperglycemia suggesting a toxa3inia acute in onset but becoming chronic. Hyoscine of undoubted value though temporary. Start with 1/150 grain once a day hypodermically increased if necessary to 1/50 grain. Per os larger doses may be employed thrice daily, preferably after meals.—P. K. McCowan and co- workers, B.M.J. i./26,779 ; L. i./26,802. In many cases transient or permanent relief with diminution of stupor follows withdrawal of cerebro-spinal fluid. Hypnotics not advised. Hex- amine, if given, should be in small doses with caution. Belladonna has been advised by Hall in chronic forms.—A. Salusbury, B.M.J. i./26,1073. Chronic cases treated intraspinally with Casein, £ Cc. of 10% solution added to 10 Cc. Normal Saline, starting with small dose, e.g. 4 mgr.—B.M.J.E. ii.,/24,63. Hexamine, 10 to 12 Gm. per diem, intravenously or intramuscularly, with oral use to limit of tolerance. Intraspinal injections of 1 to 2 Gm. per day also given. Sodium Iodide, 50% solution intravenously in doses slowly increasing from 6 to 20 Cc. per day, used by some. Sodium Salicylate, 1 to 6 or even 8 Gm. per diem intravenously, in 4% solution, said to be brilliant.— B.M.J.E. ii./26,26. Convalescent serum intraspinally spoken favourably of in acute cases, but of no use in Parkinsonian syndrome.—Per L. k/2 7,193. Treatment by induced malaria.—P. K. McCowan and L. C. Cook, L. ii./2 7, 861. Appreciable improvement after treatment by ultra-violet rays. The entire body was exposed to radiation twice weekly for 6 to 7 weeks, the maximum exposure being 10 minutes to both back and front at a distance of 16 inches from a Mercury-Vapour lamp, or preferably 3 lamps used simultaneously.— H. N. Jaffe, B.M.J. ii./27,1219. Acriflavine Inj. Intrav. has been advised. Bulbocapnine for sequelae. For sequelae—Stramonium has been advised. Difficulty of Diagnosis.—Of 16 cases 11 were other conditions, including tuberculous meningitis, brain abscess and brain tumour.—J. C. Earl, L. i./25,873. Difliculties with children. Most liable to be confused are gastro-enteritis, tuberculous meningitis and pneumonia.—J. L. Halliday, L. i./25,763. The relation of paralysis agitans to the Parkinsonian syndrome of encephalitis.—Bene Cruchet, L. ii./2 5,263. cf. Parkinsonism. Encephalitis Post-vaccinal, see p. 945. Endocarditis.—Aconite, Arsenic, Belladonna, Caffeina, Collargol, Coron- illse Ext., Digitalis, Fsexin, Ferric Chloride, Nuclein and Anti-Streptococcic Serum and Vaccine, Pituitary Extract, Pneumo. Vaccine, Sod. Cacodyl., Veratrum. Locally.—Belladonna Plaster, Blisters, Ice Bag. Endocarditis Bacteriology, diagnosis and treatment. Positive blood cultures in the chronic cases by no means invariable. Almost entirely streptococci.—Sir Thos. Horder, L. i./26,695,745,850. Endocarditis, Rheumatic.—Gentian Violet intrav., Tylcalsin intrav. Endometritis.—Locally.—Injectio Formalin, Copper Sidphate (and Ionised) also Zinc Ions. Local use of Churchill's Iodine Tinct. Pond's Tampons. Swnbbing and irrigation with a Solution of Iodine (1 in 10) 1 part and Glycerin 7 parts.—B. Hobbs, B.M.J. ii./2i,35. B. Coli Vaccine. Enteritis.—See Gastroitis and enteritis. Enuresis.—Arsenic, Atropine, Belladonna (q.v.), Bromides, Buchu, Calc. Phosph., Camph. Monobrom, Ephedrine, Ergot, Ferri Iodid., Ferri Perchlor., Hyoscine, Hyd. Subchlor., Hyoscyamus with Sodium Bromide, Hexamine, Bi’q. Strych." Lycopodii Tinct., Nux Vomica, Phenazone, Pot. Citras, Bhus Aromat., Bhus Tox., Thyroid Extract (Standardised Preps.). Belladonna, Hyoscyamus and Bromide may help for a time, or even cure. ■—S. A. Tucker, L. ii./3O,706. Nocturnal incontinence in children. Ext. Ergot. Liq. 5 minims to a child of 5 years, with 2\ minims Ext. Glyc. Liq. and a drop of Peppermint effectual in a fortnight. Worth trying.—A. Patton, B.M.J. ii./3o,981. Mustard and pepper taken by boys found responsible for nocturnal incontinence.—T. W. Bothwell, B.M. J. h/31,42. All drugs found useless. Train the child to empty bladder during the day at increasing fixed intervals.—J Pereira Gray, B.M.J. ii./3o,906. Epidermomycosis (Athlete’s foot). Castellani’s Paint, Ung. Ac. Salicyl., Mycozol. Epididymitis—Aconite, Antimonial Wine, Calcii Chlor. intrav., Iodides, Saline Purgatives, Gono. Vaccine. Locally.—Atropine Suppos. (1/75 gr.) and hypod., Colloidal Mercury and Silver, Ice, Iodine, Guaiacol, Iodum Oleat., Lin. Potassii lodid., Ung. Iodi Intinctum. Heat, with moisture, Mercury, and Belladonna Ointments. Epilepsy.—Adonis, iEthyleni Bromid., Ammon. Bromid., Amyleni Hydras., Amyl Nitris, Antifebrin, Argent. Cyanid or Nit., Arsenic, Arsen. Brom., Atropine, Anri Bromid. and Chlorid., Belladonna, Bismuth Sod. Pot. Tart. Injn., Borax, Bromalbumen, Bromal Hydras, Brominol, Calcium Bromide, Calcium Lactate, Camph. Monobrom., Cannabis, Chloral, Elix. Calcii Chlorid., Hex- amine, Hyd. Biniodid., Liq. Auri et Arsenii Bromid. and Liq. Auri et Hyd. Brom., Luminal Sodium, Magnes. Bromide, Manganese Bromide, Mist. Brominol c. Nux Vom., Nitroglycerin Tabellse, Ozonic Ether, Peptone Therapy, Picrotoxin, Pot. Boro-Tart, Pot. Brom., Pot. Nitris, Santonin, Snake Venom, Sod. Brom., Sodii Nitris, Thyroid, Valerianates, Viscum album, Zinc Salts. Parathyroid. Prevent constipation.—Cascara, Calomel, etc. Pot. Brom. 1 ounce, Pot. Bicarb, i ounce, Liq. Arsenicalis IT drachms, Liq. Arsen, et Hyd. Iodide 3 drachms, water to 8 ounces. Signa : Two drachms in water after meals three times a day. ‘ Marvellous in effects.’—P. J. i./15,150. Hexamine and in conjunction with Ammon. Brom. and Sod. Cit.—McC. Morris, see p. 451. Hexamine it is thought helps to destroy the cause of the fits—i.e. B. Coli. Blood sugar usually low. Glucose 50-100 Gm., or sugary foods, combined with Luminal and Bromides, recommended.—Pres., Jan., '27,18. Cholesterol of the blood plasma in epilepsy is subnormal, especially at time of fits.—M. Gosden, J. Tylor Eox and W. Russell Brain, L. ih/29,12. Episcleritis.—A seasonal disease of the eye occurring particularly in certain humid districts—to be differentiated from tuberculous episcleritis. The disease is chiefly superficial, involving the episcleral tissues. Antirheumatic remedies are given for two or three weeks or more. Given soon after the onset Colchicum shortens its course, e.g. Tincture B.P. (of seeds) in 15 m. doses thrice daily with Sod. or Mag. Sulpli.—P. A. Harry, Pres., May ’20,198. Epistaxis.—Acid. Gallic., Aconite, Acetanilide, Calcium Chloride and Elixir Eerro-Alumen, Ferr i Perciilorid. Hamamelis, Terebinth. Oleum. Locally.—Acid Tannic., Adrenalin, Alumen, Amyl Nitris (inhaled), Terri et Quinince Chloridum, Ice, Hamamelis, Hydrogen Peroxide. The best position during an attach of epistaxis is reclining in an easy chair with tie hands clasped behind the head, and the collar loosened. No styptic—plain dry wool is all that is necessary. Cold may be applied to the nape of the neck or to the bridge of the nose with the idea of causing reflex contraction of the bleeding vessels ; if it is not quickly successful it should not be persisted in. Hot water (at 115° F.) injected may prove successful. If this fails, introduce a strip of ribbon gauze, about 18 inches long, soaked in equal parts of Adrenalin Chloride (1 in 1,000) and Cocaine Hydrochloride (20%), so as to bring it in contact, as far as possible, with all parts of the nasal mucosa ; after 5 or 6 minutes the plug should be withdrawn and an attempt made to discover the bleeding spot by means of a head-light and speculum ; should the bleeding spot be discovered it may be possible to control it by direct pressure or by application of the galvanocautery, or if the bleeding persists the nose should be packed with strips of ribbon gauze.—E. W. Eoughton, Pr., Oct., 1910. Epithelioma.—Radium, see also Cancer. Erysipelas.—Acetanilide, Aconite, Aconitina and Granules of, Antifebrin, Antistreptococcic Serum, Belladonna, Digitalis, Ergot, Feexin, Faexin Extnact, Fcrri Perchlor., Mang. Butyrate, Milk Injections, Nuclein, Veratrum viride, Streptococcal Vaccine, Buttermilk internally and locally. Locally.—Acid. Picric Pigment, Acid. Sulphuros. Lotio, Argent. Nit., Bella- donnee Glycerin., Calamincc Lotio, Creosote, Gossyp. Acid. Boric., Ichthosulphol, Iodine, lodii Tinct. injected (q.v.), Iodum Oleat.um, Ung. Iodi Intinctum, Liq. Alum. Acet., Liq. Fe. Perchlor., Mag. Sulpli. Solution, hot fomentation, Oleoge Comps., Ol. Tereb. in Oil Iniectio, Pasta Plumbi cum Cupro. Liq. Ferri Perchlor. 20 or 25 m. thrice daily acts almost as a specific. Collodion locally helps.—B.M.J. i./2o,352. Stock vaccines subcutaneously of S. erysipelatis or S. pyogenes, polyvalent streptococci, and a combined staphylococcus and streptococcus. Also a ‘ Hospital ’ vaccine. Results most unsatisfactory. A cold saturated aqueous solution of Magnesium Sulphate, containing 10 to 20% Glycerin, favoured.— W. T. Benson, L. ii./30,1280. X-Rays good.—II. H. Jamieson and F. Hernaman-Johnson, B.M.J. i./3i,57. Excellent results with dressing containing Alcohol 96% 50 parts, Sublimate solution (l m 1,000) 1 part: or, if Sublimate solution not tolerated, 1 to 1-5% t opper Sulphate solution.—S. Kruger, per M.A. ’31,180. Erythema.—-Febrifuge Salines, Aconite, Anthemis, Calcii Lactas, Salicin, Salicylates, SaloL Trilactine, Sulphur Stearettes. Locally.—Diachyli Ung., Hazel Foam preys.. Kaolin and Lotio, or Una., layav. Inf us.. Perfumed Formosyls, Plumbi Subacet. Lotio., Vaseline, Zinci Uriel, and Ung., Ung. Thorii Oleat, High Frequency Current, Pellanthum preps. Erythema nodosum—an acute specific fever.—J. O. Symes, B.M.J. ih/21, •J; Uninfluenced by Sodium Salicylate but cured by Calcium Chloride with local sedatives and rest.—H. Hallam, B.M.J. ii./2i,917. E rythreeclema.—Attention to diet and painting the gum with 1% Chromic Acid to prevent secondary infection, the main points. Large doses of Atropine or Calcium Lactate suggested.—J. S. Fowler, B.M.J. h/2 5,1078. Erythrcedema polyneuritis (Pink Disease).—Vitamin B, Marmite in large doses, Calcium.—L. i./29,926. Erythraemia.—Phenylhyclrazine. Espundia.—Antim. Pot. Tart. Exhaustion.—Nervous and Muscular —Oxygen Inhalation (and with Alcohol), Amyl Nitrite, Stimulants, Catha Milk and Glyceronhos., Coca preps., Coca Wine. Cf. other headings, e.g., Anemia, Collapse and Fainting, Debility, Food, Haemorrhage, Nervous debility, etc. Exophthalmic Goitre (Graves’ Disease).—Arsenic, Calcium Salts, Digitalis, Ergotamine Tart., Fucus, Iodine, e.g., as Lugol’s Solution, Iron Salts. Pituitary Dried (Posterior lobe), Quin. Hydrobrom. Sulph., Suprarenal, Sodii Phosph., Thymus Gland, Thyroidectin. Locally.—Acid Sulphuros, Tinct. Iodi Oleosa., Ung. Iodi Intinctum, and Iohydrin, X raps. * X ’ ray treatment is best.—G. R. Murray, B.M.J. ii./i3,163; L. ii./i3,200. Arsenic, Bromides, Belladonna, and Quinine Hydrobromide.—G. R. Murray, B.M.J. 1/22,906. Treatment of exophthalmic goitre.—F. R. Fraser, B.M.J. i./26,555. Great importance is attached to the anaesthetic used in thyroid surgery, and either local anaesthesia (Novocain 0-25%), or open Ether or Ether by the intratracheal route, is advised.—T. P. Dunhill, B.M.J. ii./27,1089. Keep patient one week in bed under observation before commencing treatment. Give light diet with no stimulants and large quantities of fluid, with one pint of rectal saline daily, and 3 minims of Lugol’s solution thrice daily. Excellent results, but if discontinued symptoms tend to return.—A. J. Walton, B.M.J. i./28,83. A diet rich in carbohydrates advocated.—II. Moll, B.M.J. iL/28,52. Iodine causes only temporary amelioration. X-ray therapy gives material improvement in only 52% of cases, and if improvement is not obvious in 6 months the case should be operated upon. Operation gives 80% cured or improved.—C. S. D. Don, B.M.J. i./29,1112. Drug treatment mainly symptomatic—Quinine, Ovarian products, and Suprarenal cortex. Thyroid, Opiates, Iodides, and Digitalis, were avoided. Rest and change essential.—I. Bram, L. ii./29,994. Young patients with primary Graves’ disease, recovery can be effected without surgical treatment.—F. R,. Fraser, B.M.J. ii./3o,811. Vaccines should not be given in exophthalmic goitre or gout.—Sir W. Will- cox, B.M.J. ii./3o,736. (Iodoform has tendency to produce symptoms of exophthalmic goitre in susceptible persons.) See also Goitre (sim&Se). Eye : Cptic Atrophy. Retinal extract has been very unexpectedly successful. Eje: Pupil, Contractors of.—Arecoline in 1% solution, Jaborandi and Pilocarpine, Opium and Morphine, Physostgima, Physostigmine. Eye : Pupil, Dilators of.-—Atropine Salts, Cocaine, Baturine, Duboisine, Fyhedrine, Homatropine and llyoscine salts, Hyoscyamine, Nicotine, Oleum Hcmatropinae. Organic Extracts, e.g., suprarenal and pituitary, have marked effect as pupil dilators,—thymus, ovary, muscle and kidney less. Eye: Local Dilator, but Contracts when given internally in suitable doses—Gelseminine. Ocular pain. Acriflavine, 1 in 4,000 for irrigation (but is not germicidal), before operation and after. Heat, and hot sponging and fomentations good. Dionine unreliable—very severe conjunctivitis had followed. Massive doses of Salicylates, Milk injections—Freeland Fergus, and discussion, B.M.J u./25,506. Fainting.—See Collapse. Fat, to reduce, see Obesity. Favus.—See Parasites, Vegetable, on skin. Fetid Breath.—See Breath, Fetid. Perspiration,— See Perspiration, Fetid ; Nasal Discharges.—See Ozaena. Fever.—Acetanilide, Acid. Salicylic, Aconite. Amidopyrin, Ammon. Acet. Liq. and Carb., Alasil, Ammon. Cit., Antimony, Aspirin, Benzyl Benzoate, Bisciniod, Cinchonine, Cinchonidinse Sulph., Cryogenin, Digitalis, Gelsemiam, Granules d’Aconitine, Mist. Arsen. Quin, et Ferri, Magisal, Phenacetin, Phen- azone, Pulv. Quininse Comp., Pot. Borotart., Pot. Acet. Chloras and Citras, Pilula Antimon. Conii et Quinin., Quinine preps., Quinetum, Salicin, Salipyrin, ^od. Salicyl., Tylcalsin, Tyllithin, Veratrum Viride, Warburg’s Tincture, Helba, Quinine Acetyl-Salicylate. Aspirin, Phenacetin and Dover’s Powder combined. Tablets are made. Fibrosis, Chronic Subcutaneous.—Fucus, Thyroid, Diabetic Diet, Massage. Fibrositis, Acule.—Amidopyrin with Aspirin. Locally.—Chloral et Menthol, Methyl Aspriodine, Pigment Camphorae. See also Rheumatism. Dover Powder at night gives rest: Aspirin 15 grains 6-hourly relieves pain and is often specific. For chronic fibrositis Lugol’s Solution 5 minims twice daily. Thyroid promotes better metabolism.—E. B. Clayton and J. L. Livingston, L. i./3o,1420. Filariasis.—Organic Arsenic Compounds. Pepper and Capsicum, e.q.y Tinct. Capsici, thought to be prophylactic. Antimony Sod. Tart., also Antim. Pot. Tart, suggested but corroboration needed. Mechanism of filarial periodicity.—P. Manson-Bahr, L. ih/29,47. Fissures of Nipples. Locally.—Acid Boric, Acid. Tannic Glycerin., Alcohol, Argent. Nit. pigment, Cocainoe Eydroch. Liquor, Collodium Flexile, Hydrastis Tinct., Styptic. Colloid., Tinct. Benzoin Co. Fistula in ano (Tuberculous). Locally.—Cupri Sulph. Injn., Hydrogen Perox., Inj. Bismuth Subnit., Iodine Suppos., Iodoform Oil after operation, Pot. Permang. (packing with), Zinc ions. Flatulence.— Acid. Carbolic, Acid. Sulphuros., iEther Spt., Asafetida, Anise, Anethol, Aq. Carminativa, Betol, Bisciniod, Bismuth preps., Cajupub 01., Capsicum, Carbo Ligni, Caraway, Cardamoms, Chloromorphiae Liq., Cinnamon, Cloves and Tinct., Coriander, Creosote, Fennel, Magnesia preps.. Month. Pip. Oh, Myristica, Naphthalene, Naplithol, Nux Vomica, Pepsin preps.. Sod. Bic., Sodii Sulphis, Sulpliocarbolates, Tinct. Carminativa, Trilactine Zingib. Tinct. Treatment of.—T. L. Hardy, L. ii./s5,345,394. Flies to Ward Off. See Bites and Stings. Folliculitis, Pustular.—Bismuth Oxychlor. Frig. Food Products.—See Chapter on Nutrimenta, (also Infant Feeding), Casein Preparations. For invalids are : Benger’s Food, Catha Milk and Glyceroph., Conf. Glyeeroph. Co., Enema Nutriens, Ferrocarnis, Herogen, Peptonoids of Beef, Milk and Glycerophosph., Nutrient Suppositories, Pep- tonised Milk, Peptonised Beef Jelly, Trilactine. For Diabetic Foods, see Nutriments, Vol. I. For Bread Standardisation, Flour Bleaching, and Caloric Values of Foods, see Nutrimenta, Vol. II. Artificial Feeding.—Dextrose (Glucose) Enema, Glucose Injection. Fractures, for applying extension in.—Sinclair’s Glue, Heusner’s Glue. Framboesia.—Organic Arsenic Comps. Efficacy of Sulfarsenol and Silver Salvarsan is about equal. Three injections are necessary to cure the lesions. Sulfarsenol is equally efficacious either intrav. or subcut., but intram, is too painful. Silver Salvarsan intravenously does not produce any bigger fall of systolic pressure than Sulfarsenol—there is 1J0 fall of blood pressure after subcutaneous injections of the latter.—R. Knowles, Jl. Trop. Med., Dec. 1/23,360. See also Yaws. liri1'?1!,''.’8' p“s‘u?ar-—Bismuth Oxychlor. with Tnrnr,!?H^ t 8n.°™ 91 9°}& water in a cold room best. Friction stages anfttw S!1 ?.r with Spirit and Soap Liniment useful in early cotton wnni^Tf the limbs should be raised on pillows and wrapped in Snirit 5ll.stejs form or discoloration rub with Turpentine or with KPeen .^0 Bmiodide—or with Iodine—A. W. Mayo-Hobson. e rPCarrnnP ni] ™18ed sIlghtly—smeared with some ointment, Movnihim11 wwl S 2 79 Co(?aine useful- Wrapping up causes pain.—B. tioJ hoy i6 tbere 1S I^101.st gangrene, and especially where toxic absorp- H- Jocelyn Swan. Counter irritants Wax Poao bui ?? n0£ materially affect speed of recovery.—C. Frn;fhii0B?^ 1Zim5nand,^rcJ1 Powder.—F. McG. Loughnane. Fm«osis?C^e Boiis. 5% CalCm“ Chloride--B.M.J.E. U./*5,80. NiDUK-?top?oH?atcae,taerIni- A“tim' °X > and Antim' Pct- Tart' For mitlal A?m^eST?nfd H^Patic Colic.—^Ether Spt., Amyl Nitris, Amyl Valeria- Hp\4miplUDM£e «°SfI mum Inf., Caps. Sodff Oleat. Comp., Chloral Hydras, of tthpr nrui ^r’ Sulph., Mercurials, Morphine preps., Nitroglycerin, Perles Bpn7nfliA ^urP®^atine, L>il Sodn Oleat, Podophyllin, Salicylates, Sodium Benzoate, Sodium Glycocholate, Various Mineral Waters, q.v. tho an attack of indigestion, pain and tenderness over the gall bladder, the patient shoidd remain in bed on light (not too milky) diet. Give a mixture Snirit nfr'hf’ kodmm Salicylate, Sodium Benzoate, Sodium Bicarbonate, See aL^L^72^1207and Infusl0n of cloves-—Sir H. Bolleston, L. i./23,40. OTpn cholecystitis, hepatic calculus, ulcerative colitis, and in some cases of S x?81?1111^ J°?d .rers^lts are obtained by duodenal lavage, e.g., Argyrol " ? Protargol 0*75 to 1*5%, Silver Nitrate 1 in 20,000, Magnesium Sulphate and Jutte s solution, tne latter consisting of Sodium Chloride 0-9% and Sodium Sulphate 0-9%, using 1 to li litres for a lavage.—L. i./25,1309. Cholecystitis.—Sodium Glycocholate 3 grains with Urotropine 7 grains in . cachets, one mgho and morning.—W. Bain, L. i./29,495. Blood Cholesterol estimation in cholelithiasis. 1 Cc. of blood or plasma is mixed with 5 Gm. Plaster of Paris and dried and extracted with Chloroform 20 Cc. Acetic Anhydride and Sulphuric Acid is added, and the colour compared with that- produced using pure Cholesterol. The average content is raised in cholelithiasis. Whole blood Cholesterol is markedly raised in severe obstructive jaundice.—li. H. O. B. Bobinson, L. ii./29,540. Gall-Bladder Visualisation— lodo-ray (Tetraiodophenolphtha- lem), Sod. and Stront. Bromide. Gangrene.—Nitroglycerin, Amyl Nitris, Quinine Hydrochloride, Sodium Nitrite. Locally. Acid Carbolic, Acid Nitric, Creosote, Flavine, Hydrogen Perox Iodine Injection (vagina), Saline Injection (vulva). Periarterial injection of Alcohol in gangrene of the extremities. 2 to 3 m at four points round circumference of artery and into outer coat—S. Handle v B.M.J. ii./26,1121. ’ Gangrene of toe cured by placing foot as often and as long as possible in warm water, gradually raised to a point just bearable, containing 5% Sodium Bicarbonate. Toe smeared at night with warm Glycerin and Belladonna and enveloped in cotton wool.—J. P. Gray, L. ii./26,1347. Gangrene arising from Arteritis.—Acetylcholine. Gas Poisoning. See Gas under Antidotes to Poisons. Gastralgia—Acid. Hydrocyanic. Dil., iEther Spt., Alkalis, Belladonna, Bisedia, Biscimod, Bismuthi Gxy-Bromid., Bismuth Oleas, Bismuthi Salicylas, Bismuth Tart. Solub., Bromides, Calcis Aqua, Cannabis, Catha Milk and Glyceroph., Cern Oxalas, Chloroform, Chloromorphite Liq., and Cocaina Codeina, Creosote, Ginger, Magnesia, Cremor Magnesite, Mang. Oxid., Pepsin’ Sedeff, lodates, Chloretone, Cyanides, Menthol, Nitroglycerin, Trilactine Locally.—Linim. Sinapis, Ung. Ipecac, et Crotonis. * Gastric Secretion, tc diminish.—Atropine small dose in large vol of water on empty stomach. To increase secretion wash the stomach with a weak pilocarpine solution, or employ Sodi. Bic. Magnesium Oxide and Bismuth Oxycarb less stimulating. Small doses of Hydrochloric Acid in achlorhydria only have psychic effect.—T. Izod Bennett, B.M.J. h/23,366. Gastritis and Enteritis.—Acid Hydrocyanic, Acid Lactic, Alasil, Alkalis, Ammon. Clilor., Aperffne, Bismuth preps., Bisciniod, Caffeine, Calcii Permang. and Salicylas, Carminatives and Sedatives, Collargol, Glucose feeding, Hexamine, Hydrastis, Hydrog. Perox., Ispaghula, Kaolin, Mist. Catarrhalis, Pot. Cit., Saline Transfusion, Salines, Salol, Sanguinaria, Sodii Sulphis, Strontium Salts, Tar Perles, Trilactine Tablets, Milk, etc. Vide also Catarrh, Gastric. Chronic Gastritis.— Wash stomach each morning before breakfast with Hydrogen Peroxide 1 dr. to the pint until no more mucus comes away. Give small amount of HC1. for achlorhydria.—A. F. Hurst, L. ii./29,1027. Gastric Ulcer.—See Ulcers, Gastric- Hfematemesis of.—Adrenalin, Beef Peptones. Giddiness.—See Vertigo. Gingivitis, see Gums, Inflamed, also Vincent’s Angina. Glanders.—Mallcin. Mercurial Inunctions, Salvarsan. Glands, Enlarged.'—Calcii Chlorid., Ferri Iodid. and Iron Salts, Ferri Cacodylas, Iodoprotein Tabs., Iodum, Morrhuse Ok, Potass. Iodid., Sodii Iodid., Syrupus Iodo-Tannicus. Locally.—Cadmii Iodid. Ung., Hydrarg. Oleat. and Emplast., Iodi Decolor. Tinct., Iodoform, lod. Ung.,Iodi. Inti net., Ung. Iodermiol, Pot. Iodid. Ung. Glandular fever.—An acute infectious disease, principally of cluldren ; rapid enlargement of the cervical glands ; less constant enlargement of liver, spleen, axillary, inguinal and other glands. Outbreaks.—H. Letheby Tidy, and E. B. Morley, B.M.J. 1./21,452. See also G. Evans and W. A. Robb, B.M.J. i./3o,1039. Glaucoma.—Physostigmince Sulph., Pilocarpina Nit. (2%), Alkaloidal Oil of Physostigmine (1%), Arecoline, Adrenalin (0-01%), Dionine 5 or 10% or pdr.—B.M.J.E. ii./25,10. Glaucosan. Iridectomy constitutes a drain for a limited time. Good results from combined administration of 1-5 to 2-0 mgr. Adrenalin (according to age and weight of patient), a cachet of 0T to 0-2 Gm. Ergotin, and 1 to 2 Gm. Calcium Chloride in aqueous solution.—L. i./27,13S0. Congestive glaucoma. Combined use of Morphine £ grain and Nitroglycerin (an alkaline mixture containing Bicarbonate and Citrate of Potash and Soda with 1 minim of Liq. Trinitrini, for a dose every 3 hours), cuts short an attack. ■—J. Burdon-Cooper, B.M.J. ii./25,510. Glossitis.—Hydrarg. Perchlor. in Lotion (2 gr. to 8 ounces). Glycosuria.—See Diabetes. Goitre.—Goitre is prevalent in magnesian-limestone districts, e.g., Derbyshire—hence ‘ Derbyshire Neck.’ Ammon. FJuorid., Arsenic, Barii Chloridum, Belladonna, Bromides, B. Coli Vaccine, Hyd. Biniodid., Hydrastis, Iodum, Naphthol, Phosphorus, Pituitary Gland Dry (entire gland), also Posterior lobe alone, Pot. Iodid., Quinine Pcriodide, Sodii Iodid., Syr. Ferri Iodid., Thymol, Thyroid feeding and preps., Thyroid and Manganese, Trilactine. Locally.—Acid. Acetic, inj., hypocL, Hydrarg. Biniodid, Ung. Hydrarg. Oleat., Hydrarg. Ung., Iodi inj. hypod., T.H., Ung. Hyd. Iodid. {diluted), Iodi Linim. and Ung. Zinc Salts, Cocaine, Ionisation, ‘ X ’ rays. Small doses of Potassium Iodide (q.v.) or Sodium Iodide efficacious in districts where it is endemic but this is unsuited for those who already show signs of hyperthyroidism.—G. R. Murray. It. is added to salt. Vide Sod. Iodid. For 1924-7 opinions on World Endemicity and suggestions re Vitamin deficiency causative, see Edn. XIX., p. 1004. See also this Vol., pp. 708, 913. Different varieties of goitre react differently to various forms of Iodine. Colloid goitre reacts best with simple compounds, e.g., Iodide of Iron : rapidly increasing or recurring varieties of adenoparenchymatous goitre do not react to Iodine, but disappear with Thyroid : patients with myxeedema fail to improve with Iodine : exophthalmic goitre improve only with Lugol’s solution—Iodides have little effect and Thyroid increases hyperthyroidism.— A. J. Walton, B.M.J. i./28,83. Iodine supply in foods higher in N.E. Scotland, where endemic goitre is non-existent than in English countries where it occurs.—J. B. Orr, B.M.J. i./3i,460. Goitre, Exophthalmic see Exofhthalmic. Hyd. Perchlor L o tion**fyr a° s m i°h°UI Vaccine, Vaginal Douche with Tyloalsia and Tyllithlu. So°e als? Gonorrhea.’ fomeDta«°“. Santalol, intravenouslv^helnftil useful In chronic arthritis Sodium Iodide DavtJ Lees, L f/fr 642 lmpressed by ortho-iodoxy-benzoic Acid.- fromethenmaeatS “<§TTllt Irrigatin8 the Wadder wS^rlff161101 urethritis), Uva Ursi, Gonococcu^Uccine! MiS Carbolic. Acid. Salicyl 2% alcoholic solution comyresses Tnrifri ^c^P/lc* Acriflayine, Argenti Acetas, Nitras Injection and Bougies Argent r°^-’flSnnhI?i,l?dul-’ ?°Hgies Urethral, CoUdpsubes various S InS)’ Lollargol Colloidal Ag and Hg„ Glyc. Plumb. Acet. (compresses) Hydro™ Oxycyanul. Hydrarg. Perchlor., Hydrog. Perox., lodargol Iodofonni Cereohm Neilsert BimiefPProdalZ^P ?Iar%amse Colloidal, Mercurome, Metaphen, Chlorid.j ^I^Mng.fa^^Su^i^xarfZfzvnSsShMnUalf^Pdr ^fcmaieCp<es’- EVotSfoSsiS’ Araenti IOdidUm> OvulAZillTt text, ins“on“ jV®1™ t0 W“h G°norrhma ?l female treated by solution of Methylene Blue 1 Glycerin 25 gf SOakCdL «“ -iutio^’Sti U0^ WtfoV Irrigations with Dichloramine-T 1 in 4,000 also^Albargin* samestranoth* Picric Acid 1 m 400 to 1 in 200 is an extremely potent germicide and mves good results when tolerated.—D. Lees, B.M.J. ii./2i,480. S 3 g00<1 Gout.——Acid. Quinic., Acid. Thyminic, Arsenic, Aspirin, Aspriodin^ Alam‘1 Lromal Hydras., Oaffein Tri-iodide, Cimicifuga, Colchicine Salicvlas ('OamnlpO* Colchicum, Elix. Acid Salicyl. Co!, Formates S^ SS m TfmaCV-Ia°<1,0nlt-fcnlodolysln’ Jro? P^ps., Lithium Salts, Lithion, Magnes et Sodii Sulph., Phenazou and with Codeine, Phenoquin ind NeopWoSSta Piperazin Glyceroph., Phenyl-Aspriodine, Phenyl-Sedasprin Pinerarin arm Phenocoll Eff., Piperidine Tartras, Pistoia Powders, Potass AcetP Cit lodd Pot. Chloride as Table Salt, Sodii Bicarb., Benz., HippS; Iodid’., Ph'osph ’ Salicyl, Sesqmphos. and Taurocholas, Solani Ext. Liq., Syr Eerri lodidi Trilactine, Tyilithin, Urea Quinate, Veratrum. ’ ldl> Locally.—Amysal Borax Solution Cade Oil, Cocaine Ionisation, Chloroform Liniment, i^ollod. Salol, Ionised Lithium, Methysal Balm, Nauheim Bath Salts Ung. lodermiol, Radium. X Rays are useful. Ra Emanation Inhalation Salicylic Acid, also Iodine Ionised. • A bacterial toxin is the primary factor. Adequate removal of the intestinal contents at the commencement ot attack will reduce the synintoms_Diff Acetic Extract of Colchicum B.P.^-is best, the S®S?bei^f to 6 grams —J. fe. Matthews, B.M.J. ii./ig,271. For Acute Gout. Tinctures of Colchicum, Aconite, Jalap Co., and Quinine ot each P- cq. 30 drops thrice daily in hot water. Local application compresses soaked with Methyl Salicylate or Laudanum.—Pr., Aug. ’26 130. Colchicum relieves pain and shortens the attack, but of no value in prevents11- Thenoqum (Cinchopen) of most value, but may produce unpleasant after-effects Apt to be used where there is any disturbance, e.q., urticaria or gastric intestinal upset —G. Graham, Geoffrey Evans, W. Langdon Brown and others.—B.M.J. n./2o,888. vu’ Granular Eyelids.—See Ophthalmia Tarsi. Granuloma Inguinale.—Antim. Pot. Tart. Graves’ Disease.—See Exophthalmic Goitre. V0L- L L L Growth, to Stimulate.—Pituitary gland dry (anterior lohe) has been thought to. See also Debility, Marasmus, etc. Guinea Worm.—Emily, a French naval surgeon, succeeded m killing the parasite by injecting Mercuric Chloride solution 1 in 1,000 into the body or the worm.—Sir P. Manson, Tropical Diseases. See also J. Graham I orbes, L. i./2o,837. Injections tried subcutaneously into the protruding head. NLA.B. 0-15 Gm. in 20 Cc. Distilled Water used.—O. G. Grey, L. m/2o,10J. Antimony Tartrate used intravenously.—,T. W. S. Macfle, L. i./20,b54. Gums, Inflamed and Spongy. Locally.—Acid. Carbolic., Ac. Trichloracetic. Alumen, Borated Hyd. Per ox., Catechu, Cocaine, Cremor Magnesia, Formosyl Mouth Wash, lodi Tinct., et cum Aconiti Tinct., Iodine Colloidal, Eramerice Tinct., Liq. Antisepticus, Magues. Lact., Myrrhce et Boracis linct.. Potass. Chloral., Pastil, Tablet and Troch., Pyrethn Tinct., Soda Chloras and Troch., Thymaglycin, Zinc Chloride. Acute ulcerative gingivitis—Thymol-water, and after drying swabbing with 5% Silver Nitrate Solution, and again washing with Thymol— C. J. Golyer, B.M.J. ii./i8,396. ^ . .. - . K Touch the gum margins with wool saturated in Chromic Acid solution l m o. After about a minute Hydrogen Peroxide 10 vols. should be applied, three or four Chlorate of Potash tablets should be sucked daily between meals. S. H. Woods, Jl. It.A.M.C., Oct.,’26,248. . . 1# .. _ Haematemesis.—Acid Sulph. Dil., Acid Tannic, Adrenalin. Alumen, Argenti Nitras, Ergota, Gum Acacia Sterules Injection, Hamamelis, iron Persalts, Peptonised Milk, Plumbi Acet., Suprarenal Extract, Terebinth. Ol. Haematuria.—Acid. Gallic., Antimony, Camphor,. Cannabis, Erigeron Canadense, Ergota, Hamamelis, Bhus aromatica, Terebinth. Ol. Vesical Injections of Adrenalin, Alum, Gallic Acid, Hamamelis. Haemochromatosis.—A peculiar morbid condition shoving an accumulation of free iron-containing pigment in the liver, pancreas and retroperitoneal glands.—T. Shawn Dunn, L. ii./2i,334 ; S. Linley Heald, B.M.J. ii..{22,542. Haemoglobinuria.—Ammonium Chloride, Calc. Pact., Iron ionics. Haemophilia.—Calcii Cliloricl. cind XtRctus, lilix* bod. Magncs. Chloric!., Carbonas and Lactas, Hamamelis, Hydrastis, Iron Persalts, and for surface bleeding see local remedies under Hoemorrhage. Phenazone in Fern Perchlor., see Phenazone. Blood Transfusion. Haemoptysis.—Acid Pyrogallic., Acid. Sclerotic., Acid. Sulph. Dil., Alumen, Alum. Aceto. Tart. Amy/ Nitrite Steru/es, Atropine, Bromides, Calcium Lactate, Chloral, Digitalis, Ergota, and Ergotin, Gum Acacia with Saline, Hamioplastin, Hamamelis, Morphine, Nitroglycerin, Phenazone, Bectal Injection of Calcium Chloride, Turpentine, Viscum preps. Locally.—Syray of Alum or MonscVs Salt Solution, Hcmnoplastm, Turpentine. Very little evidence that Calcium salts, Gelatin, and homoplastic sera, of anv value bv producing clotting. Blood ought to be expelled, not retained in the lung.—II. H. Carleton, Bristol Med. Chir. Jl., Spring, 1928.—Per Pres., Aug. *28,133. , X1 . _ ,. On pharmacological grounds Ergot should do more harm than good. Emetine 3 grain hypodermically three or four times a day worth trying. Amyl Nitrite and Nitroglycerin has the support of many clinicians. Adrenalin cannot be justified on experimental grounds, but given intratracheally ever back of the tongue said to be effective (1 Cc. of 1 in 1,000 Soln. in 2 Cc. of water.—Munch. Med W. Feb.,’28), but this cannot be done in an emergency when blood is welling up into the mouth. Semi-sitting posture best. Coagulen-Ciba hypodermically. May be tried direct into a cavity in severe recurrent and dangerous haemorrhage.—F. G. Chandler, L. i./3o,589. Hsemorrhahe of Wounds*—Calcium Chloride and Lactate, Digitalis, Ergota Ergotin, Eerri et Quinines Chlorid., Ferro-Alumen, Gelatin, Gum Acacia with Saline Injection, Terebinth Ol. (locally, value internally doubtful). Blood Transfusion. See also Wounds. , n , . . . . Hemorrhage from bullet wounds in chest has been controlled by inhalation of Amy Local Surfaces.—Acid. Nitrite. Hucm Applications to Wounds and Bleeding Tannic, Albumen, Amadou, Catechu, Cupn Sulph., Cupn Sulphocarb., Erigeron Oleum, Eucalyptus Gum, Eusol, Eerri Per chlorid., Ferro-Alumen. Hamamelis, Hi/droa Perox. MonseVs Solution, Potassium Permanganate, Proflavine, Sphagnum Dressings, Styptic Colloid., Thromboplastin, Tinct. Benz, Co., luipen- tine, Zinci Chlorid. Liq. See also Wounds. 1 H^M HAL THERAPEUTIC index OF DISEASES. 1059 D,ClltaJ’ after Extraction.-— Tinct. ^ectio^Feni Perchlor., Tannin If extensive lacerS^%4i^f hi#0’ Zmc SulVhate with Morph. Acet. c.g., Zinc Sulphate 8 crrainq keen necessary, anodyne mouth wash, Water to SSSS c“ 6 graiDS’ M°rJ,hine :4cetatc 2 ^ains! 160°°Uf'thL™fOOd hi7lng ?n insufficient amount of fibrinogen coagulate. at Pn^iCp„,r0f0rmT? ate^ <2%>' sandarach Varnish. ° coagulates at with small o uanti ty VaUU m Vaselmo> or Potass. Permang. and Kaolin Gaiize soaked in Oil of Turpentine good.—L i /2- inor, tS'» -rest. Loeatty.—Adrenalin, Mum, Haemorrhage from the Nose.—See Epistaxis. Cifioride, Ergot, Lead Acetate with oVP5 ’n™ Acac. Intrav., Suprarenal preps., Turpentine Cam CMor, SZefTSf flnrinf™1™’ AlUm‘ Copper Satts’ Gdat'inu™ Cu?sthnmmds8fniUn^rle ?ndPos‘ Partum— Amyl Nitris, Camnhor In]., Acaclawdth Snw’-w a i?’ ?fgot- preP3-, Ferri et Quinin® Ohlorid., Gum QQCn?Vvlth Saln?°> Hydrastin, Normal Serum, Pituitary Ext Strvchnina and Salts Suprarenal preps.. Mist. Ergot, c. Ferri. Blood Transfusion Ergot and JlcS?ci”! ,M-Ume”’ FerP PercMorid., Qossyp. and Liquor. af ter birth of cwld usef m to preveot h™Ti“iU-m ^?etaJe> 2 to 3% solution used, never failed to arrest hremorr- h nhw? inertia of uterus at childbirth.—Per Pres., Jan., ’23,33. of thSi? thG commonest cause and often responsible for the death of the child. Ether the best anaesthetic.—E. Vipont Brown, L. h/231338 flCri^Vfn?termeibIe°^g+of tlle menorrhagic type Calcium Lactate, 60 fadium mftramuscuI.ar injections of Pituitary are useful. Jxaamm Bromide left m the uterine cavity is sometimes curative. Chronic cervicitis contraindication.—S. Gordon Luker, B.M.J. i./27,912. Haemorrhoids. Suitable laxatives are Cascagar. Conf. Piper., Conf. Sennre mUrfU'S‘ S.eT ft" Pulv.Glycyrrhlza, Co., ‘Hindu Dates.’ Samiviera mt. Liq% Stillmgia, Sulphur, Trilactine. Ext. Coca Liq. q.v., an emergency dose acts like a charm. Locally—Acid Boric Ung., Bismuth Oleas, Bism. Subiodate, Conince Ung Gallm cum OpioUng., Collapsubes—Bismuth, Calcium Chloride Injection for bleeding, Cupri Oleas, Glue, and Ung. Chrysarobin, Ilamamelid. Liq., Iodine Cupp os., Lotio Plumbi Spmtuosus, Perfumed Formosyls, Ranunculi Ficarce Lng., bod. Morrhuate Inrns., Stovaine Ointment, Suppos. Bellad. et Morph.. ^UPP- o ocainet Morph., Supp. Harnam., Conii et Fucaince, Supp. Hamam et Hydrarg.Co., Supp. Ecemorrhoidal, Supp. Suprarenal et Morph. Una Adrenalin, Ung. Bismuth et Cocain, Ung. Hyd. Subchlor. for irritation, Ung’ Thorn Cleat, Zinc Ions. ' Injection treatment —1 to 2 Cc. 5% Phenol in Almond Oil.—A. S. Morley L.1./28,545. For details of Injection of Carbolic Acid in Hamamelia— latter very painful—see Hamamelis, also Sodium Salicylate. Calamine freely powdered on a pad useful.—J. C. Lyth, B.M.J. i./2i 265 Quin. Urea HC1 and Quinine Urethane Injn. q.v. 1 Inject sphincter ani with local anaesthetic and inject each pile with l to 1 Cc. of J6 /0 Alconol, starting with the higher internal piles. Piles completely shrivelled up by the next day—per Pr., Eeb. ’29,132. Hair, to Promote Growth of, cj. Seboerhoesa.—Bone Marrow, Haemoglobin and Tomes. Locally.—Amyl Nitrite, Cantharides, Laborandi Liniment, Pilocarpine Lotion Resorcin Lotion, Sublimate in Spirit Lotion. Hair, to Remove.—Thallium Acetate has been given internally for eDila- tion in ringworm, but we do not advise it. ' y Locally.—Barium Sulphide, Calcium Sulphide, Corrosive Sublimate Alcoholic Pigment {with caution). Glucose Paste, Pigmentum Thymol, Sodii Sulphid. 25 to 40%, Aq. Sot., X ’ rays, Electric Needle. Halitosis. See Breath, Fetid. L L 2 HAY—HEE Hay Fever.—For Diagnosis : Protein Skin Tests. Arsenic, Aspriodine, Belladonna, Calcn Lactas (full doses), Calc. Brom. intrav., Camphor, Ephedrine, Grindelia, Hyd Salicyl, Ethyl and Hiacety Morph. Hydrochlor., ‘ Old English Fever Mixture, Peptone inins., 1Potass, lodid., Quinine preps., Hay Fever Vaccine, B. Coh and ca^arrhai organisms, Vaccine Autog. (?). Thyroid. r, p 7 rnrhnliwd Locally—Acid. Salicylic. Pulv., Adrenahny Bismuth. Co. Pulv., Carbolisea Smelling Salts. Comp. Asthma Fluid, Occam Hydroch. Liquor., Touche of Metctmc Iodide, 1 in 2,000, Eucalypti Ol., Hyd. Perox. Nasal Spray Menthol Menthol and Camphor, Nebula, Pigment. Antiseptic., Pimento and Eucalyp. Snuff, Pulv. Lobelia Comp., Quinince Collunarium, Stramonium Twebem. ; Vestibule of the nose treated with Silver Nitrate BO grains to the ounce, high up on the outer wall and the floor from * to | mch backfromthe oriiice. No application to the mucous membrane.—M. Agar, B.M.J.^u./2o,125. Desensitisation with pollen, or on non-specific lmes with Peptone q.v. Headache, Bilious or Sick.—Caps. Ol. Elliott, CWoro-Sodio-Magn. Aperj, Colalin, Elixir Gent. Acid., Euonymm, Guarana, HydrastisJ^dm, Liqo a Tabellse Pepsinse et Caflfeinae, Ol. Riemi Aromat.,^kenacclan,' “Ldio- Podophyllin, Sodii Citras, SodiiPhosph. Efferves., Sodu Sulph. Eflerves., bod.o Magnes. Sulph. Eff. and with Caffeine, Sedeff. # Headache, Congestive or InflammaloryActsea, Colclucum, Ergot-, Ammon. Chlorid., Antimony, Hydrarg. Subchlorid., Mancol, Phenazone, Riemi OU Salicylates of Sodium, etc., ■ Headache, Nervous.—Acid Hydrobromic, Acid Hydrocyanic, Acteea, Amidopyrin Ammon. Arom. Spt., Arsenic Atropine, Aun Bromidum, Belladonna, Bromides, Butyl Chloral, Caffeine, Calc Lactate Camphora Cannabis, Chlnmlnmidp Oibalsin Cimicifugm, Ehx. Acetamhd Co., Ehxn -Anti iNeuiai tricum Elixir Caffeina' Ergotamine Tart., Ferri Valerianas, Gelsemrum, Glucose feeding, Guarana, Ibogaine, Iodo-Caffeine, Iodo-Theobromme, Iron Salts Kola Magisal, Phenyl-Sedasprin, Methylene Blue, Migralgm, Nitroglycerin Phenacetin, Phenazone, Quinin. Valer., Sedasprm, Syr. Neurotonic, Sedeff, Sodii Citras, Theobromine, Lithium Benzoate, Trilactme, Tylcalsm, 1 tinctures of gentian ami cardamomsprobably have the desired effect. If due to fatigue 10 mains of phenazone with 1 dr. of spt, ammon. arom., and perhaps a little genl ian is'indicatcd. If of influenzal origin, 10 grams of sodium salieylate with 0 grains of phenacetin and the same adjuvants will probably act as magic. Migraine,^isemsionm.—Peptone t}|eI£PX?-roII1}si?f-fir luminal> grams; "• Tw? to”!olm drachlim o75o'»/fsdution of Mag.' Sulph.' an hour before rising; in iont to lie semi-prone on his right side for an hour, and then to take a t mnb'erful of hot water or hot weak tea ; no food for a day or half day previous. Treatment once a week or once a fortnight. Fate, eggs, chocolates, cocoa, coffee and alcohol strictly limited.—H. C. Rook,5 trains Pot Lauder Brunton’s prescription of 20 grams Sod. Sal. and 15 gram P . Timm aiwflvs gave relief.—«T. W. Vcatinan, B.M.J. i./-2/,2l.x. madach?^PoSto-.-Caffeinc Sodium Benzoate 0-1 Gm Pyramidon and Sodium Salicylate of each 0'2 Gm. One or two cachets a dav • ^Differential diagnosis of abdominal migraine, gall stones, and cholecystitis. MlwaSe'weU treated with Peptone injections.—J. Mowbray, L. i./31,813. Headache due to obstruction of frontal sinuses. Adrenalin Chlonde 1 m 4 (inn 1 drachm and Saturated Boric. Acid Solution 1 drachm used in an atomizer f oimtimes daily gives relief.-B Podo^ky Int. Headache, Post-concussional.—4 to 8 ozs. 50 A Mag. bulpn. per reciu n. "^Headache duetto high blood pressure.—Vinum Antim. Tart., Cannabis, also Vasodilators Heel Painful caused bv numerous influences. A prevalent cause of acSe pain of sudden onset round the heel is a true teno-synovitis of the tendo Achillis. Compound Mercury Ointment is curative. W. Fletcher t. 4-1, P May 22/345. Hemiplegia.-—See Paralysis. Hepatic Colic.—See Calculi B;Pary ■jFSWssus mssbjmr. ,,x %%?%*<*«£; FKrTh relief fooS T^lna™8 QuIck and complete Caffeefi5eeCitrltter fillSe $ °oW? gave re,lef of ^ : Phenazono in amino d ’ salicylate, Salicin, of each 5 grains aM°8? f°llr h°UrS “ *d.-S.lS a cUre-inCio^^more^M^1^11!? %htly applied eveiT second day effects Sulphur, M.,^50 On,.. C-aUSe? di^PP^rancePofVafAfta 3 to 4 f6W dayS- Se°°nd injecti0n a»i&so^; cAhW^ Ca^\neIl^^d^qqk'1^?d^*’' ^^'^^rh-^Triiac^inef'v^criaTi^Tinct00^’ ^°- with Atropine-«"**»• Carbon Dioxide inhalation the most reli’abie cure. Place an ordin^rv ™™>r bag tightly over the mouth and nose and instruct patient to breathe intuit —l!%\/3?A4pS the expired air the concentration of COa in the blood is raised! Hodgkin’s Disease.—See Lymphadenoma. Hookworm.—See Ankylostomiasis and Worms. Hordeolum. Locally. Argent. Nit., Uydrarg. c. Morvhina Oleat Tn I; Tmcf Vng Hydrarg. Oxidi Flam, Ung. Metallorum. ’’ 1 d al8oy<Edema?S1S‘ Locallv~lCaiaplasma Salicyl. Co., Scott's Dressing. See Hydrocele.—Iodine injected, Morestin’s Fluid. Hydrophobia.—-Immediate use of Actual or Electric Cmderu nr m °r °ther CaUStiC PaSte at hand‘ Antirabic Yafcine. Hyperchlorhydria.‘—Alkalis, Belladonna, Bismuth and Pancreatin ^ ^ 01 • AYam. of Stomach Contents, ‘ Belladonna be3t to inhibit secretion •oS1'jhPSrb0 Lev Bi» Calc' £hosC" E^infCeriumOxalate?Gly^ Sodium Brom?deL2 to fh/S (1‘Sge d,ose3t OIivs>, Pepsin, Sedeff. ouumm momme, z to 6 Cm. a day. Harmless in doses of 6 to 7 Dm even vhen continued for some time.—B.M.J.E. 1/26 60. um* even Hyperhidrosis. &ee Perspiration, excessive. Hypsrpiesia and Hyperpiesis.—See Blood Pressure to reduce Cardiae in?2^d §nd ^Py’ Cardiac; also Vasodilators, Acetocholine and ot. and k od. Sulphocyanides are recent remedies A monograph on the study of 47 cases by H. Batty Shaw. Its cause is a oxin of protein origin and pre-renal in site of production —L i /22 437 Hyperpiesis thought to be a condition of permanent hypertension’ Anv ystolic pressure persistently as high as 170 ram. mercury or over comes hdn ie category.—Geoffrey Evans, B.M.J. ii/25 1167 y comes into Hyper and Hypo-Thyroidism, v. p. 983. ’ For the cardiac complications of hyperthyroidism OniTiidinp . msidered superior to Digitaiis.—Presf, May “7 m M Sulphate is Hypertrichosis.—See 11 air to Remove. ' ’ ’ * Hypnotics.—See also Insomnia. HYS—INF i Basa/ Hypnosis.—The patient is protected from psychic shock—no recollection of journey to operating theatre or of induction period, allows great reduction of quantity of anesthetic, abolishes or reduces post-operati\ e nausea and vomiting, and gives amnesia or sleep for definite period alter operation. The most valuable basal hypnotics are Paraidehyde or Avertm per rectum, or Barbiturates.—I. W. Magill, ii-i-/31,353. # Would ha_ ^ an immense amount of mental anguish and suffering during the wt • Shipway, ibid., 354. Mistake to base dosage entirely on weight ot patient. A W. Matthew, ibid. „ , ,.T , Other pre-anaesthetic Hypnotics are :—Sodium Amytal, .Nembutal. Hysteria.—Actaea, Allii 01. Essent., Amyl Nitris, Asafetida, Auri Bromi- dum Anri Chlorid., Belladonna, Broni-a bumen, Calcium, Magnesium, Man ganese and other Bromides, Cannabis Indica, Iron Salts, ajq. Antahystericus, Lupull Tlnct., Magisal, Nux Vomica, 01. Succim Ovarian Gland, Phosphorus, Pulsatilla, Quinine Preps., Sedasprm, Sedeft, Spirit Ammon. i.rom., byi. Pilocarpin et Pot. Brom., Stryclmine, Sumbul, Valerian and Vaierianates, Zinc Salts. Ichthyosis. Locally.—HesoTcin (q.v.) and Salicylic Acid. Ileus, Acme.—An emetic. Saline intrav. . ,, . • n4 A ease with stercoral vomiting successfully treated witli rectal injection ol human bile 2 ounces in Saline 4 ounces. In one case vomited. Me; was Elected into the same patient, hut when possible freshly secreted human bile fioni^^ cholecystographv case was used. This may be kept m an 1 _ least a3 week without losing any of its potency. Ox bile was not saHsfactoiy. E. St. Legcr Brockman, L. ii./s7,320,992. Hypertonic Saline (20/0) mtrav • MU. --7 * l ' * ' , . Ileus following operations .—Human bile Pcr, 2 v° aWusef u? — Saline every 4 hours. Hypertonic Saline (a quart of o /0) mtrav. also usen . A. H. Southam, L. i./a8,42. Anti-Gas-Gangrene Serum suggested BroPhylacrically prior t operation, as there is evidence of the presence of tlie exotoxm ot JS. in the small intestine in such cases. Dose.—40 Cc. intrav. and a iurtne 40 Cc. intram. See B. W. Williams, L. i./~7d O' - . Prmiunction wit> A cute intestinal obstruction—accessory treatments m conjunction w it operation : gastric lavage and other procedures as above mentioned. A. I ,UKclmlem’fc is dehydration. Give 2| to 8* pints N. Saline intrav.- H. C. Corry, B.M.J. i./3h219. .. .. r -n M T i/-o 1161 Jleus, active and paralytic— H. Tyrrell Graj, B.M.J. i./0o,lib . See also Constipation, Choline, etc. . , — „ thenKCftSn Oinfftig^ EltlnSr Lotion of PotPermang 15B* 10 grain water 1 ounce, applied daily.—.T. A. Scott, B.M.J. n. Impetigo Contagiosa.—Best results followed the application of Acnflavn Emulsion 1 in l,00a—J. F. Christie, B.M.J. 11./27,1033. Impotence.—Arsenic, Auri et Sodii Cliloridum, Cannalus lnd and CannaH as, Cantharides, Coca and Cocaine, ^SVomlt Tannas, Cantharides, coca ana <-ocame, NuxYomk Yohimbine to our knowledge caused unpleasant subsequent euec, . Incontinence of Semen.-Arsenic Auri et Sodii Pho^hfBandaFerrirphos^>.rc?1Quin?^trstrych. Syrup., Gokhru, Hyosei Hvoscyamine, Phenazone, Salix nigra. Incontinence of Urine.—See Enuresis. Indigestion.—See Dyspepsia. S “th sodii Bmarh ) to add tomilh, Koumiss. Chapter * Nutrimenta, Accessory Food Tactois, e . INF—INF THERAPEUTIC INDEX OF DISEASES. 1063 Uelsemium, Granul^R^ Antimony, Belladonna, Digitalis, Phenazone, Quinine, Salicin, YeratiFim g* Subchlorid et cum 0pio> °Pium, lafluenzT-lTetn Co-; GlV^- Pb. Subacet, Iodine Ionised, Ilimdo. Spt„ Alasil. Ammoni^icet ii^CAn«m°nTifV^Ca*’an-**i?-e’ Aotea> ^th- Nit- Phor, Cinnamates, Colloidal Metals P fv rwhVAvrI10dln e’ Bclladonna, Cam- Hexamine intrav , H1ydral^^chlo^EimrqvnCT^Illdlne,r?0^^1^es, Gelsemium, Injection Strych-Arsen 'lid andoSir, Pulv-> Iodi Tiact., e.ff., Ozonic Inhaler (clears the ho ad 5SS™10ns Eucalypti 01. Menthol, faiiure, Menthol and Camnhn- d/u^a§lsalj Hang. Butyrate, Musk for heart Quinine preps, P^nSfisfflSrin^irS? M?1rphine preps*> Phenacetin., 'tstgsxt "u Tn“S"wSfr “"p- I"n"“B- For sweating of-Amyl Nit. A minim doses internally. See also Coupm*c;nxa-l Cough, Lysol Inhalation, Mist. Apomorph. Co. 8°,ver’s “r>aa•10 s™1"®. Tinct. Iodi 1 m. hourly for 6dosesSb™„^w"ftre*lee feeds and give of iKiatiom-aa rSd^lT/io ?05ChriSt’S H“pita‘ School-Results Influent—If Wylie, r7./“32564°% so!ution to 1; Pints of water checked deS'tr°W °T inkm gr°Wth 0fB' Pn$mnza-—F. T. thfright tidf ofthe''heart^Tnnes0?^"0? wilh, °yanosis and dilatation of themmUSClCS °r relaxeS used—J. H. Hurst, L. 1/27,412: 9 but 3‘ No heart depressants Venous!Aoler^ted’and effect “'en in 24 hTu^ -D%? f1,™ Blindness as a sequela. Recovery.—S.“ E. Denver EM Ti/^ 99q |U^“d,9U58. SaIiCyIate f0rmcd SOlub,e in the AmLnte-N:M Falser! wcry°4 h^rsf TenpIratmifa!l?to\ormaHn'& uiinine ^drSridSj'USlStta IndTs^irta Stfpelt Ifte?Yho* °‘ hours, and fourth dose after another 5 hours Then <riv?haif 3 h0Llrs’ or 4 hours for 1 or 2 days. For children of 5 to el fpowdYTto d?Y,'!&&ip0wder : 15 t0 10- S 17,iS^8 Nesne’ral Aspirin 5 grains, Phenacetin 2\ grains, Dover’s Powder 2\ grains, for influenza in children. Between 2 and 5 years, £ dose every 2 hours : from 5 to 12, 1/3 dose 2-hourly, and over 12 full dose. Also valuable m measles and mumps.-—H. J. Chitterbuck, B.M.J. h/29,714. . . Camphor a valuable drug given as follows : Camphor £ grain, Quinine Hydrochloride 3 grains, Aspirin 5 grains. Two powders daily. Per ir.. May, ’29,334. See also Pneumonia. J „ 7 . Insanity.—Tresh Brain Extract has been tried. See also Mama. Insect Bites, vide Bites rnd Stings, also PARASITES and PEDICULOSIS. Insomnia.—Acetanilide, Ammon. Brom., Amyleni Hydras. Antifebrin, Bromoprotein, Butyl Chloral, Camphor, Cannabis Indica and Cannabm, Chloralamide, Chloretone, Chlorobrom, Coca, Codema Codemial, Dial Diamorphine, Enema Sedativum (post operation), Guttse Castorei Co., Hyos cyamine, Lactucarium, Liq. Bromo-Chloral Co., Lupulm, Morphine, Narco- phine, Nitroglycerin Tabellse, Opium, Paraldehyde (intravenously0, phanodorm, Phenazone, Phenyl-Sedasprin, Pituitary Extract (?), Quinine at bedtime, Scopolamine HBr., Sedasprin, Sedeff, Sodn Bromid. Soneryl, Stramonium, Strychnine, Sulphonal, Thyroid and Manganese, Trional Urethane, Valerian, Veronal and Veronal Sodium. , Paraldehyde best mere ‘ nightcap ’ in mild cases (heroic doses are mentioned 4 oz. on occasion every four hours); useful for quick action. Hyoscme is *. strongest in emergency, and. is safe up to l/50th and probably up to 1/33u grain hypodermically, e.g., m acute delirious mania. E. V > att Smith, ur. Sept., 1921. Intertrigo. Locally .—Acid Boric, and Ung., Acid. Tannic Glyc., Bism.l Ung. Calam. Lotio, Calcii Carb., Calebs Aqua, Camphor, Cremor Sicc. preps : Formosyl Cream, French Chalk, Fullers’ Earth Hazel Foam lodi Tmct dilute^ with 3 times volume with Eau de Pans, Iodine Colloidal, Liq. Carb. Dev diluted equal vol. e. Eau de Paris, or Ichthyol diluted with water 50 time. Kaolin, Methylene blue, Pellanthum preps., Perf. FormosyIs, Scarlet Ung., UnC Thorii Cleat, Vaseline, Zinci Cremor and Ung., Ainci Ol^t Puln, Zinc Sahcj If of mycotic origin, apply Benzoic Acid and /me Oxide 1 Gm. each, 1 30 Gm. Petrolatum.—Jl. A.M.A. i./2/M039. Intestinal Antiseptics.—See Antiseptics. Intestinal Obstruction.—See Ileus. Intestinal Worms.—See Worms. lodism— Acid Sulphanilic. Preps, containing ammonia. Iritis —Find out cause.—Colchicum, Hydrarg. Perchlond., and SubchloricI Iodum, Oil of Gaultheria, Potass. lod., Pilocarpine, Tylcalsm intrav. Locally.—Atropina Ung., Atropince Sulph. Guttoe and Lamellae, Belladonna Duboisine, Dionine Scopolamine. Jaundice—Acid.^Nit.-Hyd. Dil., Aloes, Ammon. Chlorid., Benzoate UlMr Gent. Acid., Calcii Chlorid., Cinchophen (of new born), Euonymi Kerri Buccinas, Hydrarg. cum. Crete.Hydrarg. bubedOT To relieve skin irritation dilute Nitric Acid Lotion or Sodium Bicarbono SdutionHazel Foam, Liquor Carbonis., Ung. Rusci. Comp., Formosyl Crea? ' Diagnosis of, v. Bile in Urine, Vol II. Jaundic«E’Epidemic of Campaigns, ’and of Tetrachlorethane poisoning. 11, fnirpr avoid excess of protein. Give in a mixture of Sodium Bicarbona liftrr'iiim Potassium Citrate 30 grains, Sodium Sulphate 30 grams, thr. d'lilv 1 Calomel should not be given in repeated doses. Treatment m t !‘J; fiie Case is (1) early (pre-jaundice), or (2) with marked toxeem or (3) noSed -lr W. H. wfllcox, B.M.J . i./r6,297. See also L. l/i9(8i 929 and ii./i9,419. TnnfnrM toxto Jaundice. Lumleian Lectures. ,. . . "nofirhfinri classification, liver functions, morbid anatomy and histolo Delmitio , c . -plates of microscopical sections of 6 recent fa comprising Phosphoras poisorung, cirrhosis following N.A B. in ect o sSute necroSs; alcoholic cirrhosis, eclampsia, and delayed Chlorofc poisoning. Sir Win. Will cox, L. ii./31,1. A summary of chemical poisons which have caused toxic jaundice.—Ibid. 58. Enteric group, protozoal poisons, and auto-intoxication.—Ibid. Ill ; B.M.J. i./3i,552,595. Crave familial jaundice. . The prognosis for infants’life is bad. It is thought to be due to fcetal toxaemia of maternal origin. Prophylaxis should consist m care of the mother’s diet and administration of intestinal and biliary antiseptics, e.g., Hexamine, Sodium Salicylate, minute doses (l/20th grain) of Calomel, Naphthalene Tetrachloride, Salol, Guaiacol. Ballantyne recom- Chloride. The infant should have Calomel in small doses.—■ SnvtI. Rolleston, Pr., Jan., 1920. See also A. P. Agnew, Pr., Sept., 1920, p. 217. Epidemic catarrhal jaundice. M.Health Hep. on outbreak.—B.M.J. ii./27,108 ihe risk of haemorrhage in operations to be anticipated by Calc. Chloride 10% 5 Cc. intrav. for three days.—W. E. M. Mitchell, L. ii./i 7,270. Kala Azar.—Organic Arsenic Comps, q.v., Antimony Oxide, also Antimony Pot. or Sod. Tart. Injection. Eourneau ‘ 309 ’ and Bayer ‘ 205 * have been reported on. Urea Stibamine. i Iodine by mouth and intravenously gave good results. Forty minims of the following solution given : Iodine 6 grains, Potassium Iodine 6 grains, Distilled Water 1 ounce. Injected intravenously every other day up to 5 injections, and then 10 drops of Tincture of Iodine by mouth thrice daily for a week.—Brachio, I.M.G., July, 1923, C.D., Feb. 23/24,259. Kala-Azar ” (Oxford Univ. Press), by L. E. Napier, deals with epidemiology, etiology, pathology, symptomatology, diagnosis and treatment. Cure rate with the newer Antimony compounds now 95%.—B.M.J. i./28,1069. Keratitis, Interstitial.—At Massachusetts Hospital results were decidedly in favour of antisyphilitic treatment.—L. ii./25,764. Kidney Permeability Tests.—Methylene Blue, Indigo-Carmine, Phenol-sulphone-phthalein, Phloridzin, Uroselectan. Thorium-Sodium Citrate as pyelographie medium. Renal disease—diagnosis.—H. MacLean, L. i./2 5,1213. Estimation of rson^prstc/n nitrogen of the bio oct, urea concentration, b/oor/ urea, etc,, in ronai disease.—Prof. Maclean, B.M.J. ii./22,1067. See Vol. II. Keloid.—Formalin Injection, Mist. Hydr. Biniodid., Radium, ‘ X ’ Rays. Labour.—See Uterus, to Contract. Laryngismus Stridulus.—Aconite, Amyl Nitris, Belladonna, Bromides, Chloral, Coninae Hydrobrom., Emetine, Gelsemium, Piscidia. Laryngeal Ulcers. Locally.—Lactic Acid, also Quinine HCl. Acid, as 'pigment and nebula. Laryngitis.—Find out cause. Aconiti Tinct. or Pastil., Ammon. Acetat. Liq. and Ammon. Chiorid., Antimonials, Antipyretics, Calomel, Codeine Jelly, Creosote, Cubebs, Diacetyl and Ethyl Morphine, Glycaphorm, lodoprotein, Linctus (various), Lichenoids, Phenyl-Aspriodine, Pulsatilla, Terebene. Locally.—Counter-irritation, fomentations, leeches.—Adrenalin, Inhalations of Ammon. Chiorid., Sprays of Creosote, Menthol, Thymol, Tinct. Benzoin Co. ; Belladonna and Conium, Juniper, /Ether Acetic, Insufflatio Morphince et Bismuth and of Catechu, or Menthol, or Tannin, Oxygen and Alcohol Inhalation, Pastils, 1 Ammon. Brom., Pigments of Cocaine, Menthol, etc. Leishmania Affections.—Antimony injections and Arsenicals. Local leishmaniasis (Delhi sores, etc.) well treated by scraping and lightly applying solid KOH and dressing.—E. J. E. Risk, B.M.J. i./2i,267. lodobismuthate of Quinine per os, with Emetine intravenously, caused rapid amelioration in American Leishmaniasis.—Per Jl. Trop. Med., Mar. 15/26,98. Leprosy (see also Vol. II.).—Antimony Colloidal, Chaulmoogra preps. Guaiacol internally and locally, Milk Injections, Sodium Morrhuate injected, Sodium Chaulmoograte ‘ A ’ (Pills, and * C ’ Sterules, Cupri Cit. Hydnocarpates). Vaccine made from a nodule from patient’s arm used. Strength 200 mill, per Cc. Initial dose 0T Cc. increased.—Sir N. Walker, L. iL/24,542. For adhesions.—Ac. Trichloracetic Paint. There is no specific cure, but the following clears up active signs in early cases: (1) treatment of accompanying disease, (2) rectification of diet, (3) gradually increasing exercises, (4) injection of Hydnocarpus Oil and its preparations, (5) external applications, (6) surgical intervention when necessary. Vaccines intravenously are useful in certain cases and in the third stage of the disease : Hydnocarpus Oil is the most efficient treatment in the first and second stages.—E. Muir, R.S.M. Discussion, B.M.J. i./27,284 ; L. L/27,339 1006 Ephedrine for nerve pains. At the Mabaica Leper H ospital, British Guiana, ^bp_ ^ost successful treatment was Ethyl Esters of Chaulmoogra intramusc. with locally Trichloracetic Acid, and in nodular cases solid Carbon Dioxide., Sodium Hydnocarpate and Hydnocreol promising. Sodium Morrhuate and lhymol ineffective. Ionisation or Ultra-Violet radiation accelerates healing of ulcers.—E. G. Rose, Trans. Roy. Soc. Trop. Med., Mar., ’2 8,488. Recent advances in the treatment and prophylaxis of leprosy.—Sir L Rogers, B.M.J. ii./29,961. Leucocythernia.—Benzol Capsules. Arsenical preparations, Cacodylates, Digitalis, Glycerophosphates, Iodine, Iodoprotein, Iron Salts, Marrubin, Phosphorus, Syrupus Iodo-Tannicus, Syrupus Tann-Iodo Phosphoratus. Leucorrhcea.—Hsematoxylin, Iron Salts, Manganese preps., Mineral Acids, Myrrh. Vegetable Tonics, Fsexin Ext. Locally.—Acid. Boric. Lotio, Acid. Carbolic. Lotio, Copper, Zinc or Iodine Ionisation, Alumen, Ammonio-Ferric Alum, Boric Acid in Powder, Formosyl Pessaries, Kaolin Insufflation, Hydrastis, lodates, Mercuric Chloride, Ovules of Alum or Carbolic Acid, etc., Naphthol, Pess. B. Ac. Fact., Pessus Quinince, Pot. Permang., Quini.HCl., Tampons, Tannic Acid, Sodii Bicarb, and Belladonna, Sodii Perboras, Tannin and Alum Injection, Zinci Sulphocarb. Good results with ‘ dry cure,’ e.g., Aluminium Oxide powder or Silver Nitrate—B.M.J.E. h/26,40. Leukaemia.—See Anaemia. Leukoplakia.—Radium. Lice to kill.—See Parasites, Animal. Lichen planus.—Acid Phosphoric c. Strych., Arsenicals. Locally—Acid. Salicyl TJng., Ether-soluble Tar Paste, Liq. Carbonis Deterg. 10 m. to 1 dr. to oz. of water or Calam. Lotion. See also Eczema. Liver Abscess, vide Abscess, Liver. Liver Function Tests.—Bromsulphalein, Sod. Salicyl. Van den Bergh Test. Loa Loa Infections.—L. ii./29,765. Locomotor Ataxy.—Alum. Chlor., Arg. Nit., Arsamin, Arsenobenzol Cannabis, Brain and Spinal Cord, Chloralamide, Colloidal Mercury and Silver, Ergot, Hexamine, Hyoscine, Inj. Ac. Nucleinic, lodinol, Iodoprotein, Keratin, Lipiodol, Mercurialised Serum, Mercury Benz., Morphine, Morrhuse 01., Nitro- glycerin, Pot. Brorn., Pot. Iod., Quinine, Sod. Brom. Intrathecal injection, Sod. Cacodyl., Sodii Salicylas, Strychnine (with acid), ‘ Three Gland ’ and ‘ Pour Gland ’ Elixir and Tablets, Thyroid and Manganese. Locally.—Mercury Inunctions. Cataphoresis of Cocaine Solution, Radium. I Intrathecally. Salvarsanised blood from sane patient. Lumbago.—Ammon. Chlor., Aspirin, Aspriodine, Belladonna, Camphor ’ Monobrom, Cimicifugin, Colchicum, Elixir Acid. Salicylic. Co., Methyl-Aspriodine, Morphine, Plienazone, Phenyl-Sedasprin, Potass. Iodid., Quinine, Sedas- prin, Salicylates, Seden, Tylcalsin, Tyllithin. All Purgatives, e.g., Chelsea Pensioner. Locally.—Aconite Liniment, Amyl Salicylate, Amy sal, Atropince Linim., Belladonnce Linim., Capsid Linim., Chaulmoogrates, Chloroform Liniment, Heat Bays, lodum. Oleatum, Menthol Linim,, Menthol Plaster, Methyl-Aspriodine, Methysal Balm, Guaiacol, Iodine and Oleogen Salicylicum, Opii Linim,, ling. Iodi Intinctum., Ung. lodermiol, Picis. Empl., Veratrince Ung., ‘ X ’ Rays. Static Electricity. Lupus.—Ac. Nucleinic Inj., Arsenic, Bismuth Injections and per os, Cacodylates, Gynocard, 01., Hydra rgyri Biniodidum, lodum, Morrhuse 01., Phosphorus, Quinine preps., Salicin, Sod. Morrhuate Injm, Thyroid Gland, Tuberculins. Locally.—Acid. Chromic., Acid. Cinnamic, Acid. Pyrogalic Emp. and TJng., Acid. Salicyl. 50% TJng., Arsenobenzol, Ami chlor., Bism. Oxyiodogall., Chaulmoogra preps., Sod. Morrhuate, Bismuth Iodas, ‘ Brass Paste ’ and preps., Camphora Salicylata, Carbonic Snow, Carbon Tetrachloride c. Iodine, Cicatricine, Cupri Oleas, Ethyl Chloride, Finsen Light, Hydrarg. Nitras, Krysolgan, Hydl Per ox., Iodine Ions, Iodoform, Lactic Ions, Lassar’s Paste, Oleata, Pot. Permang., Radium, Resorcin, Thiosinamin, Thymol Iodide, Tuberculin, Uranium Oxid. Ung. and Injectio, ‘ X ’ Rays, Zinc Chloridum, Zinc and other Ionisation. Fehling’s Solution injected in lupus.—G. N. Meachin, L. i./i9,528. A treatment using Liq. Hyd. Nit. Acid, Zinc and Carbolic and Brookes” Ungt.—A. R. Somerford, L. i./28,1173. Dietetic treatment. Light and every agency to improve general nutrition. —B.M.J. ii./3o,539. Lupus pernio treated by Sodium Morrhuate subcutaneously, also by Iodised Cod Liver Oil—5 Cc. of a mixture of Tinct. Iodi 1 in Cod Liver Oil 20. Fever caused. End results good.—0. Blatt, L. ii./3o,1410. Lupus Erythematosus. Arsenicals, Quinidine Caps, and Elix. Locally.—Acid. Carbonic., Bismuth Oxycluor. Ung., Hydrarg. Biniodid, Finsen Lamp, Aurichlor. Injections, gold and Sod. Thiosulph. Injn., Radium Ung. Thorii Oleat., ‘ X ’ Bays. Mercuric Chloride in Spirit 1 in 240 alternately with a Zinc, Boric Acid and Bismuth Ointment.—R. Thomson, Pharmacist, Elgin, N.B. Freezing with Carbon Dioxide and ionisation with Zinc Sulphate Solution are the most useful.—J. M. H. McLeod, Pr., April, 22/236. Lupus, erythematosus—modern treatment. Krysolgan and Sanocrysin. H. Haldin-Davis, B.M.J. i./3o,432. Sanocrysin, also Colloidal Gold per os.— N. Toomey, B.M.J. i./3i,801 An autogenous Strepto, Vaccine made from the excised tonsils of a patient was curative.—H. Barber, L. k/22,366. Lupus leishmaniasis. A leishmaniasis of the skin resembling lupus vulgaris hitherto unclassified. History of case.—J. B. Christopherson, Jl. Trop. Med., June 1/23,203. Antimony Tartrate intrav. Lymphadencma.—Arsenic, Coley’s Fluid, ' X * Rays. Coll. Manganese lias been used. The co-existence of Hodgkin’s disease and amoebiasis. E. dysenteric and Councilmania found in stools.—A. Kofoid, O. Swezy & L. M. Boyers, Ji. A.M.A., Feb. 18/22,532. Also in inguinal gland.—ibid. Apl. 15/22,1147. Suggested Hodgkin’s disease i3 amoebiasis of lymphatic glands. I11 17,000 examinations of 7,000 persons there was a monthly average of 16-5% showing infection with E. dysenteric. Amoebiasis endemic in U.S.—ibid. Proc. N.Y. Path. Soc., N.S., Jan.-May, ’22. Liberal doses of Neokharsivan intravenously, in conjunction with ‘ X ’ Rays.—Sir T. Horder, L. i./25,337. Lymphadenoma cases put to Intradermal Tuberc. Test conclusion was that the Tubercle B. plays no part in causation.—J. Maxwell, L. ii./3o,289. Yeasts : a study of, to obtain evidence on etiology of lymphadenoma.— K. Stone, L. ii./3o,577. Lymphangitis. Manganese Butyrate, Glycerin and Ichthyol. Malaria.—Antim. Ox. injn., Arsenicals, Arsamin, Arsenobenzol, Cinchona Febrifuge, Cinchonidine Sulph., Cinchonine Acid HC1., Elix. Berberinc, Inj. Strych. Arsen. lodid. and Quin., Mannitol-Quinine, Methylene Blue, Old English Fever Pdr., Pulvis Quinin. Comp., Quinin. Sulph., Quinidine, Quinine and Quinidine Periodides, Quinine base (for children, also in preference to a salt when there is haemoglobinuria), Giemsa’s injs., Phosphorated Oil, Quin. Hydrobrom. injections, Quin. HC1. internally in preference to Sulph., Saiicin, Salicylates, Sod. Cacodyl., Sod. Cit. and Acetates and Tartrates, Steriloid Quinine and Quinidine, Tylcalsin, Tyllithin, Tylmarin, Urea. Maicur.al Rola&ses.—Bold injection treatment with Quinine Acid Hydrochloride combined with Mist. Anticachexia 1 and 2. See p. 741. Neosalvarsan combined with Quinine in the treatment of chronic and relapsing malaria has been well spoken of.—B.M.J. h/24,918. Pregnancy complicated by malaria.—Quinine, see p. 742. Malarial Coma.—Quinine-Urethane intravenously, q.v. Relapsing Fever.—Bismuth Sod. Pot. Tart. Malignant Pustule.—See Anthrax. Malignant Tumours.—See Cancer. Malta Fever.—See Mediterranean Fever. Mammary Abscess. See Breast, Inflammation of. Mango Toe.—Castellani’s Paint. Mania.—Apomorphine, Atropine, Bromides, Cannabis Indica, Chloralamide, Chloral Hydras, Chloroform, Conine, Diacetyl and Ethyl Morphine, Digitalis, Gelsemina, Hyoscine salts, Hyoscyamine, Malourea, Morphine preps., Opium preps., Paraldehyde, Syr. Pot. Brom. et Pilocarpin, Sulphonal. Marasmus.—Arsenical preps., Conf. Glyceroph. Co., etc. Elix. Haemoglobin, Emuls. 01. Morrhuae ,c. Lecithin, Lecithin, Iron preps., Lacidac, Maltffin, Meat preparations, Milk and Glycerophosphates, Marrubina’ Radiostol preps. Mastitis See Breast, Inflammation of. Measles.—Aconite, and Pastil of, Mther Nit. Spt., Ammon. Acet. Liq. Amidopyrin, Ammon. Carb., Belladonna Tincture, Calc. Sulphid., Cinnamon. Powder for prophylaxis, (Germanmeasles), Ipecacuanha, Nuclein inj., Potass. Tart. Acidus. 01. Eucalypt. all over the body ; Carbolic Oil 10% to the tonsils and pharvnx. Aspirin, Phenacetin. and Dover’s Pdr. combined. Tablets are made/ Convalescent Serum in Measles.—Dose now used 5 to 7 Cc. intramuscularly in the buttock.—D. N. Nabarro and A. G. Signy, i./3i,12. Pooled adult serum of 11 or 12 probationers with definite history of measles in childhood used successfully as prophylactic.—L. i./3o,519. The malady is not aborted, but incubation period increased and disease rendered very mild. Immunity lasts for 4£ months.—A. N. Kingsbury, L. i. /27,7. A safe and reliable agent in the prevention and attenuation. Eirst-day injections less satisfactory than injections on the 2nd to 6th dav after exposure. A wider recognition of its value and its application in Public Health administration is justified.—W. Gunn, L. ii./28,693. Effective. Donors should be arranged for in fever hospitals. Animal sera not effective.—L. i./29,1104. Method of preparation. Should be used for prevention, i.e. production of passive immunity—or preferably, and where possible, for attenuation, i.e. production of active immunity. Of no use therapeutically.—D. N. Nabarro and A. Signy, Hospital for Sick Children, L. i./29,1106. Of great value in hospital work.—D. W. Nabarro. L. ii./3o,635. Measles in a man of 57.—B.M.J. i./3o,586 ; even at 76.—Ibid. 676. Aspirin 5 grains, Pulv. Ipecac. Co. 24- grains, and Phenacetin grains for measles.—H. J. Clutterbuck, B.M.J. i./3o,1153. Mediterranean Fever.—Acriflavine intrav., Intestinal Disinfectants, e.g., Benzonaphthol, Salol, Hexamine, Trilactine, Vesalvine ‘ S,’ etc. Boil the milk. M. Melitensis Vaccine. Dried Yeast for peripheral neuritis of. Melancholia.—Bile Salts, Bromides, Brominol, Camphora, Coca and Cocaine, Cannabis and Cannabin Tannas, Damiana, Elixir Gent. Acid., Elix. and Emulsio Lecithin, Musk, Nitroglycerin Tabellse, Nux Vomica, 01. Elliott Caps., Opium Tinct., Phosphorus, Pil. Potentin Co., Pituitary Gld. Entire, Syr. Glyceroph. Co., Syr. Neurotonique, Tabellie Erythrol Nitrate, Valerianates. Meniere’s Disease.—Acid. Salicylic., Bromides, Caffeine, Gelsemium, Pelletierine. Diminish fluid intake, so that patient loses weight and is thirsty (fruit and vegetables = fluid). Promote loss of water and give salt-free diet. Bulbo- capnin as valuable as Ephedrine is in asthma : Ol Gin. daily to prevent vertigo and OT Gm. hypodermically for acute attacks.—W. S. Thacker Neville, B.M.J. ii. /31,55. Meningitis.—Discover cause and treat according—e.g. if C.S. Antimeningo. Serum, Belladonna, Calomel, Hexamine (?), Iodides, Opium, Veratrum. Lumbar puncture, Antiseptic Injections, Mercurial Injections. Proteinometer for examining cerebro-spinal fluid to enable diagnosis of acute meningitis.—E. Temple Grey, B.M.J. i./3o,205. Meningitis, Basic.—Iodoform Ungt. inunction to back of neck. Menopause.—Caulophyllum, Viburnum, Hydrastis, Ovarian Substance and Corpora Lutea desiccated. A neurotic woman at the time of the climacteric may complain of sore tongue. Many of these have achlorhydria, and some benefit with Hydrochloric Acid and Parathyroid with Calcium salts.—Langdon Brown, B.M.J. i./3o,529. The transient hypertension and glycosuria common at the change of life may be due to hyperadrenalism—Cuthbertson. The whole train of instability of the endocrine glands is set going by the ovarian insufficiency upsetting the mental as well as the physical balance, leading to gloominess, apprehensiveness, and irritability. Ovarian preparations, e.g. Corpus Luteurn, are beneficial, especially for flushing and other vasomotor disorders—the dose advised by makers is often too small. Thyroid when signs of myxoedema. Even mild hyperthyroid symptoms : excitability, tachycardia, flushing, and loss of weight, are definite contraindications. Rest, Bromides, Belladonna, Quinine Hydrochloride, are to be used for hyperthyroidal states.—G. Riddoch, B.M.J. i./3o,987. Menorrhagia.—Acid. Sclerotic., Acid. Sulph. Dil., Amyl Nit., Beberinse, Sulphas, Bromides, Calc. Chlorid., Cannabin, Cotarnine Phthalate, Digitalis Elixir Ergotce cum Ferro, Ergot, Erigeron Oil, Erodium Cicutarium, Ferro- Alumeu, Hamamelis (see note infra), Hydrastis, Iron Persaits, Lecithin Elix. and Emails., Mist. Senecio Co., Monsel’s Solution, Mammary Gld., Ovar. Old., Pacyl, Pituitary Gland, Dry (entire gland), Plumbi Acetas, Sodii Citras, Thyroid, Viburnum, Zinc Ions. For severe menorrhagia Tinct. Hamamelidis in small doses does no good, but 1 drachm every 2 hours up to 4 ounces inthe period are effectual.—W.W.W. Migraine.—See Headache, Nervous. Milk, to Increase Flow.—Acid. Lactic., Galega. (Goat’s Rue), Ext. Gossypii Pulv., Jaborandi, Malti Ext., Meat Extracts, Marrubin, Pituitary Extract (?), q.v.. Potass Cit., Thyroid Gland. During lactation, as soon as milk engorgement shows itself, give Potassium Citrate 15 grains, Ammonium Carbonate 3 grains, Chloroform Water 2 drachms, water to one ounce, four-hourly.—R. Larkin, B.M.J. i./i7,765. Milk, to arrest Flow.—Agaricus albus and Agaricin. Locally. Belladonna is generally thought useful. Drugs excreted by the milk which hence affect the child.—Anise Oil, Dill Oil, Garlic, Turpentine, Copaiba Oil (and probably all volatile oils), Sulphur, Rhubarb, Senna, Jalap, Scammony, Castor Oil, Opium, Iodine, Antimony, Arsenic, Bismuth, Iron, Lead, Mercury, Potassium Iodide. These must be given with care. Copaiba or Turpentine will make the milk so nasty that the child will not take it. The purgatives may cause diarrhoea in the child. Opium should not be given in large doses to the mother. On the other hand, Mercury, Arsenic and Potassium Iodide may be given to the child by being given to the mother.—H.W. See also Arsenobenzol. Moles.—Liquid air, Caustics. Liq. Sodii Ethylatis. Hairy Moles.—Treatment should be Electrolysis followed by freezing, Radium, ‘ X ‘ Rays, cautery, and chemical caustics not advised.—H. 0. Semon, L. i./25,l360. Morphine Habit.—Berberine, Camphor, Cocaina, Codeine in ‘ Withdrawal,’ Coll. Gold, Dionin, Emetine, Hyoscina, Mist. Belladonna, Xanthoxyli and Hyoscyami, Nitroglycerin, Nux Vomica, Sodii Bromidum, Sparteinpe Sulphas. Mosquitoes, to ward off.—■See Bites and Stings. Mumps.—See Parotitis. Myalgia (Muscular Rheumatism).—Actsea, Ammon. Chlorid., Asprio- dine, Atropinse inj. hypod., Elixir Calcii Chlorid., Calcii Lactat., Ibogaine* Iron Salts, Morphinee inj., Pot. lodid., Salicylates, Sedeff. Locally—Anserine Mulls medicated, Belladonnas Glycerin and Linim. Capsici Empl. and Linim., Camphor Lin. and Comp., Clove Oil, Ether Spray, lodi Linim., Menthol, Methyl-Aspriodine, Methysal Balm, Veratrince Ung.—See also Lumbago. Myasthenia Gravis.—Lecithin, Electricity. Mycotic Affections of Skin.—Ethyl Iodide inhalation. Myxcedema.—Arsenic, Iron Salts, Nitroglycerin, Pilocarpine, Spleen Substance, Strychnine preps., ‘ Three Gland ’ and ‘ Four Gland ’ Elixir and Tablets, Thyroid and Manganese, Thyroid preps. Sir J. Cantlie attributed puffiness in various parts of the body in women to the open chest clothing so much in vogue. He had excellent results from Four Gland Tablets. Puffiness cured and depression removed. Thyroid in myxcedema must be given with exactness. Divide therapy into (1) dose to restore patient to normal B.M.R., (2) the dose needed to maintain. In average adult 0T3 Gm. of dried gland thrice daily can be given. Keep patient in bed at least a week and continue until B.M.R. is between -10 and -5. The maintenance dose is usually about 0T3 Gm. per day, and this must be continued throughout life. If complications are present keep in bed and give Thyroid in very small amounts. If heart is involved, Digitalis and rest before treatment; if anaemic, transfusion ; if chronic nephritis exists the dose should be kept small, diet reduced in protein and watch kept on blood urea nitrogen. —C. C. Sturgis and W. B. Whiting, Jl. A.M.A. ii./2 5,2013-17. Nasal Catarrh.—See Catarrh, Nasal. Naevi. Locally.—Acid Carbonic, Acid. Chromic., Acid. Nitric., * X ’ rays Collodium, Sodii Ethylas, Zinci Chlorid. Iodid. and Nitras. Liquid Air. High Frequency Current. Ncevi cured by injection of a minim of Quinine-Urethane into 4 or 5 different Places m the nsevus, repeated two or three times at fortnightly intervals — G. B. Dowling, L. ii./29,1251 ; M.A. *31,324. Nephritis.—Treat according to the cause. Aconite, Alkalis Basham’q Mixture Buchu, Calcii Chlorid. Copaiba, Digitalis with Goklju, Haustus Imperialis, Iierdei Dec., Hydrastis, Iodo-Caffeine, Iodo- 1>0fc‘ FopIod-> Plllv- Potass. Nitrit Co. (Biunton) bait free diet, Salyrgan (oedema), Santal Oil, Scoparius Sod. UmaylTjlarT]P^fnbMm’ ^^omine Aceto-Salicyl., Thyroid, Tritieum Repens, (of pregnancy) S h Solutlon mJected may Prolong life. B. Coli Vaccine *rdliaJine ^cetates, Tartrates, Citrates and Bicarbonates of Sod. Pot. and Ammon, probably act on the renal epithelium. The slight excess of saline constituents thus produced in the blood stimulates the renal epithelium to excrete them. They draw with them a certain amount of water and the flow is increased. _ Cardiac Tonics —Digitalis acts directly on heart muscle and frtciics and increases flow of urine by quickening flow of the blood through Wnkldne^rCSpe?all^.useful where blood pressure is low or the heart failing before resistance too high for it. Caffeine, Theobromine and allied drugs.— These stimulate both heart and renal cells. Theobromine-Sodium Salicvlate is more potent than Caffeine. Where condition of the kidneys is the main cause begin with Alkaline Salts.—Herringham. ^ 1 Acute nephritis in childhood. Diuretics are probably harmful and should never be used. In uraemia, Magnesium Sulphate intravenously is of* undoubted value.—L. G. Parsons, B.M.J. ii./26,367. Interstitial nephritis.—Generous milk diet, green vegetables and fresh fruits restrict animal proteins and limit carbohydrate intake. Prohibit artificially- sweetened puddings, etc.—W. E. Deeks, Diet and Disease 1927 J Ischcemic nephritis (due to arterial degeneration) and toxic nephritis (an inflammatory reaction to bacterial or other toxins) described.—D. S, Russell L. 1./30,z(J4. ’ Chronic parenchymatous nephritis with oedema, but without much evidence of ~A0Anpsm^fBMJ.ei.lfofi7?i ^ rCSUlted Clearing Up the cedema- Chronic nephritis. \ alue of alkalis in. To be used except in rare instances where a preliminary estimation has shown a decrease in the plasma Bicar- b on ate. May be useful tor promotion of diuresis.—A. A. Osman, L. ii./3o,945. _ { de lirme, sP°uld bc kept alkaline by giving basic ash foods, i.e. milk and \ egetables (with reasonable variety of meat, fish, and eggs) together with adequate aikahne salts.—D. M. Lyon, D. M. Dunlop and C. P. Stewart, L. U./3I,iUJLo. Classification of Bright’s Disease—B.M.J. i./3o,206. Nephrosis .—A group of cases of Nephritis with oedema with good prognosis r^fd Kflcal.ly >vlth diets rich m protein, and Thyroid. There is enormous loss of Albumin m cases of tins type—T. Izod Bennett, L. i /31 115 S. aureus and other organisms suggested as cause of nephrosis.—L. C.‘Bruce ±j. 1./31.20b. * Nervous Debility, Nervousness.—Acid. Hydrobromic., Acid Phosph Dil., Arsamin, and other Arsenic preps., Asafetida, Atropine Valer., Antiseptics, e.g., Calomel, Bisciniod, Bromides, Brominol (et c. Lact Exsicc ) kgiiauw nna,, navana. uo. 1 met., .Lecithin (Ehx. and Emuls.), Liq. Auri et Dscn. Broin., Liq. Auri et Hyd. Brom., Liq. Antihystericus, Liq. Eerri Mang. A?PA*ir: piqWlod°-1<e™ Liq. Testicularis, Magisal, Marrubhi 01. AII11 Essent., 01. Morrhuae, Ovarian Subs., Phanodorm, Pil. Potentin Co Phosphorus, Pot. Sulphocyamd. Quinine preps., Salicin, Sedasprin, Syr. Kokn Comp., Sod 11 Phosph., Spt. Mehss. Co., Strychnine, Sumbul, Sirop Neuro- tonique, Suprarenal Gland, ‘ Three Gland ’ and ‘ Four Gland' Elixir and tablets, Theobromme-Litluum Benzoate, Thyroid (and with Manganese) Tnlactme, Valerian preps., Vanadates, Veronal. Neuralgia.—Discover cause— Acetanilide, Aconite, Actaea, JEther (injected), Alcohol injections, Ammon, Carb., Ammon. Chlorid., Arsenic Aspirin Atropine Valer. and Salicyl., Belladonna, Bromides, Butyl Chloral 'Caffeine Cannabis, Chloral Hydras, Cibalgin, Cinchonine, Cinchonidine, Colchicine, Conium and Coninse/Elixir Antineuralgic, Elix. Caffeine, Elix. Gent. Acid. Exalgin, Gelsemium, Hyoscyamine, Iron Salts, Lecithin Elix. and Emuls., Liq. Bromo-Chloral Co., Magisal, Methylene Blue, Neuralgic Pills and Powders, Nitroglycerin, Phenacetin, Phenazone, Phosphorus, Pil. Butyl Chloral _ c, Camph. et Gelsem., Pil. Potentin Co., Pulv. Morphin. Eff., Quinine, Quin. Urea Inj. (acute facial), Salicylates and Salol, Sedasprin, Sedeff, Syr. Gly- ceroph. Co., Syr. Hypoph. Co., Syr. Pilocarpin. et Pot. Brom., Thyroid and Manganese, Tylcalsin Tyllithin. Locally.—/Ethyl Chlorid., Aconiti Linim., Aconitince TJng., Bellad. Collod. et Tinct. /Etherea, Linim. and cum Chloroform, Chloral Hydras c. Camphor arid cum Menthol, Chloroform, Ting. Iodi Jntinctum, Menthol Linim., Methyl-Aspno- dine, Methysal Balm, Morphince Cleat., Oleanodyne, Radium, Salicylic Ions, Veratrince XJng. Neuralgias of the head and neck.—AViifred Harris, L. i./23,150. Nocturnal trigeminal neuralgia cured by non-toxic diet, supplemented by a glass at each meal of a solution of Sod. Sulph. 10 Gin., Sod. Phosph. 5 Gm., Sod. Bic. 5 Gm., in a litre of water.—Jl. A.M.A. ii./as,2058. Trigeminal neuralgia.—Cases treated with Trichlorethylene symptoms relieved.—M. A. Glaser, Jl. A.M.A. i./si,920. . Tic douloureux treated by milk injections, 5 Cc. deeply into gluteal muscles. Definite fever aimed at. Phenobarbital 0-5 to 0-75 grains, with 10 grams Calcium Lactate after meals. Method on trial.—B.M.J.E. ih/30,93. Neuritis.—Discover cause.—Arsenic, Aspirin, Iodides, Mercurials, Salicylates, Sedatives—Nitroglycerin, Phenazone, Electricity. Locally.—Hydrochloric Acid (q.v.). _ Causation and symptomatology of multiple neuritis, alcoholic neuritis. Lead and Arsenical neuritis. Diabetes, beri-beri, diphtheria and other infections associated with.—T. Grainger Stewart, B.M.J. ii./25,461. Optic neuritis. Treat root cause and Iodine intrav. and Mercury inunctions to temples. Neurasthenia.—See Nervous Debility- Night Sweats.—Acid. Camphoric., Atropine and inj. hypod.,. Atropine Methyl Bromide, Belladonna, Coto and Cotoin, Guaiacol Carb., Elix. Qumin- dine, Hyoscinse, HBr., Iron Salts, Picrotoxin, Quinine preps., Strychnine. Nipples, Fissures of, and Sore.—See Fissures of Nipples. Nits.—See Parasites, Animal. Nocturnal Emissions.—See Incontinence. Nose Bleeding.—See Epistaxis. # Nymphomania and Satyriasis.—Bromides, Camphor, Conium, Hyoscme. Obesity.—Alkalis, Belladonna, Bromides, Fucus, Iodinol, Iodoprotein Iodum, Pot. Iodid., Saccharin vice sugar, Sodii Mag. Sulph., Thyroid. Aperient The use of W cit^rs Exogenous obesity.—Most cases respond to diet and exercise. Thyroid is seldom necessary or advisable. „ , . Endogenous obesity.—B.M.R. and tolerance for sugar are usually abnormal When of Thyroid origin, the gland acts as a specific, £ grain daily increased gradually until patient loses 1 to 2 lbs. a week—even 15 grams a day may be required. In obesity of Pituitary origin, the fat distribution is characteristic, especially round the girdles, and is commonly found in children and adoxescents, usually with disturbances of growth and genital function. Give Thyroid and whole-gland Pituitary, i grain of each daily increasing until patient loses 1 to 2 lbs. a week. Also of value m obesity following childbirth, or at the menopause when diet and exercise are ineffective.—H. Gardiner-Hill, L. i./25,740 ; ii./25,1035. See also J. L. Masterman-Wood, Pr., Sept.,’27,165, and our page 984. ..,,- Carbohydrate tolerance m obesity.—R. S. Allison, L. i./27>537. . Corpulence. Cause and cure. Some cases are alcoholic m origin.—W. I<. Christie, L. i./3o,895. Slema.—Calcii^LacLas (of feet), Calcii Chlorid., Calc. Gluconate, Crategus, Euphyllin, Salyrgan (injtd.), Theophylline Sodium Acetate. Locally.—Cataplasm Salicyl. Co., Antiphlogistine, Lin. Pot. Iodid. cum Sapone, Mag. Sulph. Solution, TJng Hydrarg. Co. (of Ankles). Milk freed from Sodium Chloride and Potassium Chloride of value in the treatment of oedemaA small quantity of Lactose is added and the milk sterilised.—BuH, de i Acad, de Med., Nov. 3, ’25, per Jl. A.M.A. ii./25,1997. Ui/dema, Angioneurotic. Post-Pit. gland per os and ini., Thyroid, B. Coli Vaccine autogenous. * —fiufe suff°catmg pulmonary oedema, treated by Pituitary, Atropine, D^italm, Amyl Nitrite and Antimony Tartrate injections.—B.M.J. II26,696. Ophthalmia,—See Conjunctivitis. Ophthalmia Tarsi Locally.—Acid. Boric. Lotio and UngGlyc. Plumbi Subacet. Ung., Copper bidphate, Eyd. Ox. Flav. Ung., Iodoform, Ung. Sphagnol. Optic Atrophy, various types of: A large group of substances gives rise to the disease called toxic amblyopia ’ : Methyl Alcohol, Tobacco, Ethyl Alcohol, Quinine, Lead, Carbon Bisulphide and Arylarsonates.—R. E. Wright, B.M.J. l./23,o(Jo. Orchitis.—Acetanilide, Aconite, Antimonials, Iodoprotein Tabs., Pot. lod., Saline aperients. Locally —Belladonna Glyc. et Ung., Guaiacol, Iodi TinctOleosa and Ung., Mag. Sulph. Solution, Mercurial Plaster, Mercurome (?). Oriental Sore.—Berberin Acid Sulph. Injn. (3 Cc. of 1—2%), Carbon Dioxide Snow. Emetine, Emetine Injection, Organic Antimony and Arsenic, Phosphorated Oil (Castellani). * Osteomalacia.—Lime Salts, Parathyroid, Phosphorated Oil Osteomyelitis.—B.I.P.P. Otitis and Otorrhea —Aconite, Antimonials, Aurinaria, Iodides, Saline aperients, Pneumococcal Vaccine. Locally.—Acid. Chromic, Acid. Tannic, Alum Insuff., Argenti Nitras and Bismuth InsuffL, Bromphenobis, Calomel, Calot’s Solution, Carbonis Bet. Liq., Luliin. 1 erri Perchlor., I ormosyl, Glucose Solution as swab, Glycerin, Glyc. Eyd. Perchlor Eyd. Perox., Ichthyol. Iodates, Iodi Tinct., Iodoform Wool and Insujji., A aphthol, x *erfumed Formosyls {diluted), Pot. Permang., Besorcin Salicylic Acid, Thymol, Turpentine, Xeroform, Zinc Chloride Chronic ear suppuration treated by B.I.P.P.—E. Stoker, L. ii./io,200. Potassium Iodide 10 grains taken well diluted every 4 hours. Every 2 hours external meatus tilled with H202 retained 10 minutes. Nascent Iodine liberated in tissues of middle-ear cleft.—S. P. Sturm, B.M.J. ii./26,lll8 Otitis Media.—Mercurome, Acriviolet. Spirit drops wrong in acute stage, but after. 10 drops of 15 grains Boric Acid in ounce 45% Spirit to soak for 10 minutes—F. Holt Diggle, Pr Jan • ’30,110. For suppurative, paint ulcers c. Arg. Nit. Izal or Resorcin 9o’grains to ounce Glycerin Boric Acid—W. J. Harrison, ibid., 116. Otosclerosis.—Parathyroid. Ovarian Pain.—Ammonii Clilorid., Bromides, Castor. Tinct., Corp. Lut. Morphine preps., Ovarian Subs., Plienazonum, Sumbul Tinct. Oxaluria—Normally, Oxalic Acid is passed to the extent of 15 to 20 mgr in 24 hours. If this rise to 30 mgr. it becomes pathological. Choose food rich in Magnesium and poor in Calcium—meat, Hour, nuts, apples, peas potatoes—as Magnesium Oxalate is soluble—Sir W. Willcox, B.M.J i / 25 605’ Ozaena.—Locally.—Alum, Creosoti Vapor, Formosyl, Glucose as \'swab Glycerin {with Glucose), Eyd. Perox. {and Borated), lodoformi Ung., Menthol spray and pigment, Nebula Formaldehydi, Pot. Permang., Sodii Chlorinat Liq., Sodii Chlorid., Thymaglycine, Zinci Sulphocarb. Zinc. Chlor. et Sulphas Paraffin, high melting, injected into nasal septum. Pancreatitis.—Pancreatin Stearettes. Loewi’s Test for acute pancreatitis.—Instil 4 drops of fresh 1-1,000 Adrenalin Solution into one conjunctival sac ; wait 5 minutes and instil another 4 drops then wait half an hour. Dilatation of pupil, not infrequently eccentric and* often conspicuously oval in form, indicates positive reaction. Negative result implies nothing.—H. Bailey, Pr., Aug., ’26,122. Panniculitis.—Caffein Cit., Magisal and Pyramidon combined. Paralysis.—Iron Salts, Nuclein Injn., Parathyroid, Post-Pit. preps. Strychnine. Paralytic Distention of Intestines.—Pituitary Ext. (posterior). Paralysis, Hemiplegia.—Acetyl-Choline, Arsenicals, Ergot a, Iron Salts Mercurialised Serum, Nux Vomica, Phosphorus, Physostigma. Paralysis, Paraplegia.—Arsenic Comps. Organic (Stovarsol) Ergot Mercurialised Serum, Phosphorus, Physostigma, Strychnine. Tryparsamide. Some cases received eight 2 Gm. injections at weekly intervals.—M. Brown and A. R. Martin, L. ii./26,699. General Paralyses Treated by Malaria.—The principle is that remissions in chronic disease may occur after an attack of acute specific fever. Many methods of producing artificial fever have been tried, e.g., with (1) chemical substances, e.g., Sodium Nucleinate, Sulphur Injections, p. 789, (2) toxalbumins, e.g., Tuberculin, staphylococci, (3) acute disease. The latter is the most efficient. Subcutaneous injections are given of 2 to 4 Cc. of blood from the vein of a patient suffering from benign tertian malaria. The malaria is cured by quinine. Finally, Neo-Salvarsan intravenously.— W. L. Templeton, B.M.J. i./23,895 ; L. i./24,1017 ; i./26,427. The donor’s blood should be given before he receives any Quinine. Onset and course of the inoculated malaria differs from ordinary tertian malaria, and as a rule after 4 or 5 attacks of tertian it becomes quotidian, with often high temperature. As little as 7 grains of Quinine Bisulphate twice daily for 3 days and then once a day for 4 days will rid patient of malarial parasites. Then Neo-salvarsan is given.—J. Gerstmann, B.M.J. ii./25,481. In treatment of general paralysis a rigor on alternate days is followed by greater benefit than a daily rigor. Allow the primary attack to go on 4 or 5 days then give 3 to 5 grains of quinine to temporarily check and wait for relapse. In this way the temperature is nearly always of the true tertian character with rigors on alternate days.—Leader, On Report of First Results of Laboratory Work on Malaria in England.—Col. S. P. James and P. G. Shute, B.M.J. ii./26,79. Striking improvement in some cases.—R. Eager, B.M.J. i./28,1025. See also P. A. O’Leary, Jl. A.M.A. ii./28,544. Rupture of spleen, and death, following induction of malaria. Watch should be kept for undue enlargement of spleen, especially if patient has previously had malaria.—N. G. Harris, L. ii./28,500. G.P.I. treatment at Horton Mental Hospital by malaria.—L. l/29,287. Allow at least 8 rigors. Malaria effectively cured by Quinine. N o relapses with inoculated malaria—compared with 50% relapses with mosquito bites. Follow up with 3 Gm. Tryparsamide intrav. and 0-2 to 0*4 Gm. Bismuth intram, weekly in 10-week courses with intervals of 4 weeks.—R. Lees, B.M.J. ii./3i,338. For a number of earlier refs., see Edn. XIX, pp. 1080, 1081. 'iyphoid Vaccine (Pyrotherapy) as a substitute for above. T.A.B. contg. 1,000 mill., B. typhos. 750 mill., B. paratyph. ‘ A ’ and ‘ B,’ to 1 Cc. intrav. for 10 days, starting with 300 mill, total, and rising to 6,000 : then 6 weeks’ interval and recommence with 1,500 mill., rising to 20,000 in 10 days, with 4 injections of Novarsenobenzol in the interval. Remission induced. Contraindications—arteriosclerosis, pulmonary disease, myocardial and advanced cardio-vascular disease, and marked focal infections.—J. M. Mackenzie, Br. Jl. Ven. Dis., 1929, per Pres., Sept., ’29,302 ; L. h/29,288. Protein Therapy in insanity. Patient’s serum used. Witte’s Peptone 5% intramusc. has been used by Videla.—J. R. B. Robb, B.M.J. i./3o,1169. Rat-bite fever instead of malaria less weakening. Fever controlled by Novarsenobenzol after 32 days. 2 deaths attributed to the treatment in 72 cases.—Per Pres., Sept., ’29,301. Lysozome, a powerfully antibacterial substance in normal saliva. In G.P.I. and Parkinsonism the concentration of it is diminished. The infection in the latter disease is thought to travel via the saliva.—L. S. Penrose, L. ii./3o,689. Paralysis Agitans.—Atropine, Bulbocapnine, Hyoscine, Luminal, Mor- Parasites, Animal, on Skin. Locally.—Acetum Cevadilice, Anserine Mulls Medicated, Benzol, Chloroform, Cresol Soap (S. M. Copeman), Formosyl and Perfd., Hydrarg. Ammon. Vng., Hydrarg. Oleat., Lefroy’s Petroleum Emulsion, Hydrarg. Perchlorid, Lotio and Vng., Lotio Hydrarg. Acetic, Lotio Parasit., X C.I., Naphthalin Vng., Ol. Cajuput, Ol. Sassafras, Paraffin Liq. (friction with), Phenoloid Disinfectant—dil.,PyrethriFlor. Tinct., StanniOleas, Staphisag. Ol. or Vng., Sulphur Baths, Lotion, and Vng., Sulphurated Lime Lotion. Thymol, Westoran, Westropol. Clothes Louse.—Soak undervests in 1% Naphthalene and Sulphur in Benzol or Petrol. See Naphthalene. Immerse in gasoline, petrol or paraffin, or scald the clothes.—From a pamphlet by B. F. Cummings, issued by the British Museum (Natural History) Trustees. 30% Borax in powdered black onl!eh°™ root stated to prevent re-infection. Lice are tilled by Cresol Powder S/o (Formalin is inactive), Sulphurous Acid, CS2 and CC14.S02 from burning Sulphur in a stove best for rooms. Westoran and Westropol have been advocated. N.C.I. (q.v.) has been much used, also Vermijelli. Para-dwhlor.-Benzol is active, but causes burns on the skin. Clove oil also. I he best powder is Rl aphthaline. Menthol is preferable in odor. It repels mosquitoes and fleas as well. For Bed Bugs Kerosene is best (Iodoform has no deleterious action on these). Pyrethrum is more powerful on bed bugs than on lice.—A. Castellani and T. W. Jackson, L. i./i6,39. tytisme from. Gorse.—Compared with Naphthaline, Cresylic Acid and others. It might be toxic to impregnate garments. Iodoform does not improve enect of Naphthaline. An emulsion of equal parts of common Cresol and feoap used in 5% solution in warm water is best, but might irritate the skin.— A. Bacot, B.M.J. ii./i6,447. See also B.M.J. ii./ig,603. Exnosutre at C. for 10 minutes is lethal to lice and their eggs. Wax Thermometer employed. Ampoules containing wax with this and somewhat higher melting point and glass beads would be useful in hot air sterilising chambers.—B. Emrys-Roberts, B.M.J. i./i8,509. See also Pediculosis Capitis infra. Parasites, Intestinal.—See Worms. Parasites, Vegetable, on Skin. Locally.—Acet. Cevadillce, Acid Carbolic, Acid. Chrysophanic Ung. Acid. Sulphur os., Argent Oleas, Cupri Oleat. (for favus), Formol, Formosyl, Hydrarg. Oleat., Eyd. Perox., Lotio Parasiticidus, Perfumed Formosyls, Petroleum (for fames), Phosphor. 01., Picrotoxin Pigment, Pyrogallol, Sassafras, Sodii Hyposulph., Thymol, Ung. Thorii Oleat. Paratyphoid.—See Typhoid. Paresis.—Hydrarg. Perchlor. has been used. Sulphur injections. See also Paralysis antea. Parkinsonism, Post Encephalitic.—Banisterine, Tinct. Bellad., Hyoscine Hydrobrom., Strammonium, Nicotine Injections. See also Encephalitis, Epidemic. The Parkinsonian syndrome, the name derived from its resemblance to paralysis agitans, is the most frequent and characteristic of the sequelae of epidemic encephalitis.—L. i./25,608. Parkinsonism together with the ‘Apache Type ’ in encephalitis lethargica. —A. Hancock, B.M.J. i./25,906. Marked relief in chronic cases of Parkinsonism and disturbance of sleep, following continued administration of Hyoscine Hydrobromide 1/100 grain thrice daily by mouth, but not curative and symptoms returned on suspension. —A. G. liobb, B.M.J. ii./25,046. Treatment of Parkinsonism syndrome, following encephalitis, by malaria. ■—R. N. Craig, L. ii./2 7,800. Parotitis (Mumps).—Aperients, Saline, Iodides, Plienazone, Salicylates. Locally.—Glycerin of Belladonna to neck, Iodine, Methysal Balm. Pellagra.—See Vol. II. Pediculosis Capitis (Lousiness).—See also Parasites, Animal, antea. Head Lice.—Use 2% Phenol. Kills nits, also. If necessary cut the hair short and apply Kerosene, Petrol, Paraffin, Turpentine (cf. Sapo Olei Tcreb.), Benzene or Xylol—not to be allowed to remain long on the scalp.— B. F. Cummings (British Museum). Acetic Acid 10% dissolves the substance by which the nit is attached to the hair. Kerosene and Olive Oil equal parts left on for 24 hours and then wash off. 5% Mercuric Oleate in ether is effective.—P. S. Lelean. For female children where the hair is long, thoroughly soak the hair in 1 in 40 Phenol Solution. It is not desirable for children under five. Patient lies on a bed with head over the edge—the hair hangs over a basin. Sluicing with the Solution is continued for ten minutes, particularly over the ears. The hair is then wrapped in a flannel like a turban.—A. Whitfield. Sodium Taurocholate (q.v.) Emulsion has been used. Pediculi,—to kill in room, i.e. after infection.—Nitrous fumes or Sulphuric Acid as suggested under Malaria, Vol. II. Methods of killing lice and nits by heat.—W. W. O. Beveridge, L. ii./2o,681. Light Wood Tar Oils for destruction of Lice on hair-clad areas.—A. Bacot, B.M.J. ii./ai,853. Lice destruction on hair.—E. S. Burt Hamilton, B.M.J. ii./31,968. Pericarditis.—Aconite, Caffeine, Digitalis, FaBxin, Lotio Quassise, Mercury preps., Nuclein, Opiates and Musk (to relieve pain), Potass, and Sodii Iodid.. Salicylates. Belladonna Emp. and Liniment, Leeches, lee, Blisters. Peritonitis.—Acetanilide, Aconite, Anti-Gas Gangrene Serum, Colloidal Metals, Digitalis, Hydrarg. Subchlorid. cum Opio, Hyoscyamus, Opium and Belladonna, Phenazone, Tuberculin, Veratrum Viride. For collapse Cursch- man’s Sterules, Caffeine Sod. Salicyl, etc. Vaccines. Turpentine or Belladonna, Stupes or Poppy-head fomentations. For Pelvic.—• Collargol Suppository. Tn diffuse septic peritonitis there is fatal absorption through the thoracic duct. This explains why good results follow the administration of Opium. —W. A. Costain, L. i./23,1288. Treatment of acute cases. Purgatives thought useful in preventing paresis or obstruction—3 grains Calomel given 24 hours after operation. Success depends on early and quick operation, suprapubic drainage, Fowler position, and administration of salines, either by rectum, or, if intolerant, subcutaneously into the chest.—F. Jeans, L. i./a5,729. Artti"’GctS"Garacir&ne Globulins (W.). It has been found that there is clinical resemblance between the toxaemia of acute obstruction and peritonitis with ileus and the toxaemia of gas-gangrene. The serum is given intrav. in 10 Cc. or larger doses. Peritonitis, Tuberculous.—Glycerin intraperitoneally in desperate case has been given. Pemphigus neonatorum. Syn. Ritter’s disease. A rare but highly contagious disease of the skin, occurring usually between the 4th and 14tli days after birth. S. aureus found, of haemolytic type.—B. H. Jones, L. b/29, 174. 50 cases.—F. G. Collins and H. Campbell, L. L/29,227. Perspiration, Excessive.—Acetyl-choline, Acid. Agaric., Acid. Phosph. Dik, Acid. Sulph. Aromat.. Atropine and inj. hypod., Atropine Methyl Bromide, Belladonna, Ergot, Pilocarpine, Picrotoxin, Quinine preps. Ac. Chromic (of feet), Diachyli Unci., Emol, Formosyl, Kaolin, Naphthol sol. in Ale. and Glyc., Tannin., Zinci Oleat, Pulv. and cum Thymol., Zn. Oxid., Zinc Curb., Zinc Borate, Pasta Zinci et Amyl., ‘ X ’ Bays (see Radiology). Equal parts of Lead Plaster and Linseed Oil applied as a plaster under a bandage and left on 48 hours.—W. H. Rnbinson, B.M.J. i./2i,216. Perspiration, Fetid.—Mineral Acid and Vegetable Acids (Calcii Sulphas as in Contrexeville Water), Sulphur (of feet), and Tonics. Acid. Carbol. Lotio and Ung., Ac. Salicyl. Pulv. cum Talco, Alum. Acet. Lotio, Atropine Lin., Borax, Diachyli Ung., Formosyl, Glyc. Plumb. Subac. Ung., lodates, Ung. Sulph. Zinc, et Kaolin (of feet), Zinci Oleat. cum Thymol. Pertussis.—See Whooping Cough. Pharyngitis.—See Throat, Inflammation. Phlebitis.—Warm compresses and rest the limb with it raised. Potassium Citrate. Hexamine with Sod. Sal. and Am. Benz—E. G. McCarthy Morris, see Hexamine. Phosphaturia.—Acid Sodium Phosphate and general tonic treatment. Phthisis.—Acetocholine (for sweats), Acid. Camphoric., Acid. Cinnamic and Salts, Acid. Coumaric., Acid Fluoric and Ammon. Fluoride inhalations, Acid. Hypophosph. and Hypophosphites, Acid. Lactic, and Lactates, Acid. Malic., Acid Sulphuros, Acriflavine hypod., Allium preps., Arsenic (and organic comps., e.g., Arsamin), Aspriodine, Atropine (for night sweats), Auri Chlor. Benzoates, ‘ Brass Paste ’ (local), Cacodylates, Calcii Iodid. Elixir, Calcium Colloidal, Cerium Salts, Cholesterin, Cinnaldehyde Caps., Codeine (for cough), Creosoti Elixir and Comps., Crotalin, Durant’s Injection, Elix. Haemoglobin c. Lecithin, Emuls. 01. Morrhure c. Lecithin, Emulsio Paraff. c. Pancreatin, Emulsio Petrolei, Eusol, Ferri Perchlor., Formalin Inhalant, Glycerophosphates, ‘ Gold treatment,’ Guaiacol, Camph., Carb., Cinnam., or Phosph., Guaiacol-Salol Hyd. Succinid., Iehthyol Capsules, Inj. Cacodyl. Co., lodof. and Creosote Oil, lodof. and Benz. Chloride, lodof. Glyc. Inj. (Abscess), Iodine, ‘ Nascent.’ Iodoform in Ether intrav., lodof. and Menthol Inj., Liq. lodi Fort, (sinuses) Iodi Tinct. (tonic), Lecithin, Liq. Ferri Mang. Pept. c. Hsemogiobin, Iron Salts, Krysolgan, Maltolivine, Marrubin, Mist. Creosoti Co., Mist. Guaiacol. c. Quin. Mist. Sodii Iodid. Co., Muthu’s Inhalant, Naphthol-Camphor (inserted in joints), N. Horse Scrum, Neb. Formalin, 01. Morrhuse c. Creosoto, 01. Olivte cum Acid. Oleic, Oxygen, Palladium Chloride, Periodides of Codeine, Quini- dine, etc., Phenol Sodii Sulpho-Ricinas, Pil. Niemeyer (fever), Piscidia Pot S*imt!* vii’iSif1111 ^UG piaePi'! E^dium, .Resorcin (Laryngeal), Salicin, Sanocrysin, iecfed SnWn011^?6? fc>°Hn Iluoridum, Sod. Hypophosp., Sod. Morrhuate In- S TnS?T Substance, Strych. Cacodylas, Sugar Feeding, Suprarenal Gland, inimr-Hnn ^T10’ J1arfcarrrL,meOc’ -fiodiuc, Tuberculin Ointment, Philip’s by 0™ n1/^be-fCU vS\ Trilactme (intestinal), Trypsin, Tylmarin and Comps., runhf^rm(pentomtis),^Terebinth, Urea, Vanadates, Vap.-Creosot Co., Vap. Sterules C°’’ Verbasc* Thapsus, Yeast. For Haemorrhage of, Amyl Nitrite Artificial Pneumo-thorax. Aural tuberculosis in infants. Iodine Tincture weak, then strong, applied. On no account syringe the ear—Hydrogen Peroxide is bad.—W. Stuart-Low, 1 r., July 22/07. Qi!“n0-rjrsiviT^ ^ial wben the doctor is at his wits’ end to try to stay mil x?C-n,g, bllater?J disease. May produce metallic poisoning and patients se-y eight under it. Drugs should not be used for night sweats. Calc. Lact. m ?rams thnce daily alter Calc. Chlorid. intrav. or Hsemoplastin intramusc. for haemoptysis.—W. A. Dickson, B.M.J. i./3o,376. Tuberculous Glands .—Acriflavine, Badium, Guaiacol. See also Phthisis. Tuberculous Joints.—Zinc Chlor. Solution, Iodised Phenol. Diagnosis.—See Tests, p. 935. , r p£y??sis, P* the feet. Induce desquamation. Whitfield’s Ointment — M. B. Hutchings, Jl. Trop. Med., Jan. 1/23,208. Piles.—See Haemorrhoids. Pink Disease. Syn. Feer’s Disease.—A disease of childhood characterised by raw beef hands and feet,’ irritability, sweating, cold extremities, tachycardia, raised blood pressure, salivation, hypotonia and phtohobia. Dietetic a Probable etiological factor.—L. ii./3i,541. See also R. Hutchison, ibid. 9^9. ’ Pituitary Disease.—Pituitary combined with thvroid of value per os — L. i./29,555. X-Ray treatment.—F. Roberts, L. i./3i,807. See also Acromegaly. Pityriasis. Locally —Acid. Chrysophanic Ung., Boracis, Glyc. and Lotio Chaulmoogrce Ung., Glyc. Pb. Subac. Ung., Hyd. Oleas, Huile de Cade, Lotio Besorcim, Picis Ung., Perfumed F'ormosyls. I he rash of streptococcal pityriasis frequently disappears on applying Zinc Ointment either per se or containing Coal Tar 1 to 2%, or Anthrarobin 0-2%. —H. Haxthausen, L. ih/27,373. Plague.—Serum and Vaccine. Bubonic plague treated with Neo-salvarsan and Pituitary injection.—R. Mansoor, B.M.J. ii./22,127,190. Early cases of Bubonic well treated with Iodine intrav. 5 to 10 Cc daily for 4 days of solution of 18 grains Iodine and 36 grains Pot. Iod. in 4 oz N Saline. Mixture containing Pot. Iod. and stimulants every 4 hours. Buboes treated by 1/16 grain Mercuric Chloride in 2 Cc. of water livpod. in lymphatic area drained by groups of glands in which bubo formed.—I.M.G., Feb., ’26,63. For further details, see Vol. II. Pleurisy.—Aconite, Ammon. Acet., Antimony, Apocynum, Bryonia, Colloidal Metals, Morphine preps., Pot. Iodid., Quinine preps., Sodii Salicylas, Sterilised Paraffin, Veratrum. Locally.—Blisters, Cataplasm, Salicylic Co., Salicylic Ions, Ung. Hydrarg. Pleuritic Effusion (Recurrent).—Intra-pleural Injection of Formalised Glycerin has been practised. See p. 124. Calc. Chlor. per os. Iodoform intraplcurally, as an emulsion in Glycerin, Olive Oil and Ether (1 in 9), in 1 or 2 doses of 1 to 2 Cc., gave good results.—Per Pr., April, ’28,264. Pleurodynia.—See Myalgia. Pneumonia.—Aconite, Adrenalin, Ammon. Carb., Cit. and Chlor., Aspirin Belladonna, Caffeine, Caff. Sod. Salicyl, Calc. Chlor., Camph. Sterules, Chlorai and Digitalis (and with Nitroglycerin), Colloidal Metals, Creosot, Carb., Mist, Creosoti et Potass. Iodid., Digitalis, Ethyl Hydrocupreine ibose, Ferri Per- clilor., Guaiacol, Hyd. Perchlor. intrav., Hydrogen Peroxide intrav., Hyos- cyanius, Iodine intrav., Liq. Fe. Acet., Nuclein inj., 01. Allii Essent., Phen- acetin, Phenazone, Pilocarpine, Pot. Nit. and Salt-free diet, Quinine preps.. Salicin. Salines. Sod. Cit. (30 to 40 grains every 2 hours), Serum, Saline transfusion, Sod. Salicyl Injn., Strophanthin, Strychnine, Thyroid and Permanganate Inj. Locally .—Vaccina, Cataplasm Salicyl. Co., Tee Bags (so placed as to include the inflamed area), Leeches, Oxygen (and with Alcohol).—Sir Jas. Barr says of no use, B.M.J. i./28,643. Blood Transfusion. A case pulled through by shouting to patient to keep breathing and free use of Atropine, with Vaccine. A good leucocytosis in early stage is favourable. When defective the old remedy—a large blister, may be valuable, e.g., Liquor B-pispast. freely painted on the back.—Sir J. Barr, B.M.J. i./i4,69. Pot. Iod. 4 grains, Pot Cit. 10 grains, Liq. Ammon. Cit. 4 oz., Water to one ounce—every four hours.—J. A. W. Pareira. Iodine intravenously. 20 to 30 minims of Iodine Tincture diluted with 9 Cc. of N. Saline. Success.—D. M. Baillie, L. i./rg,423. Patients will stand large doses of Quinine.—S. S. Cohen, Pres., April, ’20,167. A medical man on his own attack. He prescribed his own treatment. Lay on his back with head raised enough for the mouth to be above the bedclothes. Breathing : slow and shallow, and no moving. Diet: extremely spare—-drank a lot of water ; plenty of fresh air ; Gaultheria Liniment good for pains. Morning rises of temperature experienced. Happy termination.— L. i./22,721. Alcohol (whisky and soda) used freely. Digitalis q.s., to reduce pulse rate. If temp, was 104° F., 1 or 2 grains of Antifebrin added. A high temp, has an exhausting effect on the heart. Opium given to soothe cough. The prescription was therefore : Quinine 1 grain. Digitalis Powder ) or J grain, Antifebrin 1 or 2 grains, Opium Powder i grain : in powder or pill—one every 2, 3 or 4 hours.—J. T. Maclachlan, B.M.J. i./23,897. See also Influenza. Treatment of acute lobar pneumonia.—John Hay, B.M.J. ii./27,477. Abdominal distension as a complication of pneumonia may be treated with Pituitary intrav., 0-2 units being a safe dose for a child of 3.—L. B. Cole, L. ii./s 7,881. Acute pneumonia in early childhood.—B.M.J. ii./s7,582. Pot. Permang. 1 in 7,000 per rectum 4 hourly and Pneumo Vaccine.—A. A. Hearn, B.M.J. i./28,159. A review of remedies old and new, all of which have been lauded as ‘ cures.’ It is time that some sort of precise knowledge resulted from the wealth of material.—W. H. Maidlow, B.M.J. i./28,238. A clearing-house required to collate clinical records.—J. S. Dick, B.M.J. i./28,285. Sodium Nucleinate good, Potassium Permanganate better, and Collosol Manganese best.—H. L. McCormick, B.M.J. i./28,377. Oxygen of no value in pneumonia—the right treatment is blood-letting.— E. Thompson, B.M.J. i./28,643. Elimination should be promoted, and Liquor Ammon. Acetatis and Potassium Citrate, long established by experience, are being justified by the exacter knowledge of pharmacology. Sedatives of great value. Morphine need only be withheld in generalised bronchitis with exudate blocking the tubes.—Lord Dawson of Penn, B.M.J. i./31,447 ; L. 1./31,626. Pneumo Vaccine, minimum dose 100 mill., or 200 or 300 mill, of pneumo, strep to and influenza for adults. Temperature falls.—W. H. Wynn, ibid., 448 ; also N. Raw, ibid. Italian Serum also mentioned. Poisons.—See Aniidoies under each heading in the text, and Emetics also special Chapter at end. Poliomyelitis, Acute.—Incubation period 2-10 days, average 3-4 days. Home contacts should be excluded from school for at least 3 weeks and if paralytic signs are absent and general health good the child may be readmitted after 6 weeks. Immune serum 10 Cc. intraspinally daily for several days from one who has passed through an attack and who is free from syphilis taint. Hexamine is usually given (10 grains every 4 hours) in acute stage, but doubtful if of much value.—E. Earquhar Buzzard, B.M.J. ii./2i,225. Rest is essential. All patients should be isolated in the acute stage. Incubation period said to be 4 or 5 days.—B.M.J. ii./26,947 ; L. iL/26,1070,1085,1088. Ultra-violet light and diathermy useful.—C. B. Heald, L. L/25,1162. Convalescent Serum of value only when given in the pre-paralytic stage. Intrathecal route safe and effective. Prophylactic use subcutaneously or intramuscularly during epidemics probably preventive.—W. H. Kellogg, Jl. A.M.A. ii./29,1931 ; see also L. i./29,1205. Polypi. Locally.—Hydrogen Peroxide (and Borated)—styptics. Aural Polypi—discussion on removal of.—J. S. Fraser and S. Young, B.M.J. ii./22,467. As a matter of routine Zinc Chloride and Alcohol drops instilled for a week before removal of a polypus, when bathed in pus.—Sir J. Dundas Grant, ibid., p. 468. Polyuria. —To reduce output—pituitary. See also Incontinence. Portwine Stains.—Radium. Post-Partum Haemorrhage.—See Haemorrhage. Pregnancy—See Uterus, to contract. Pregnancy, Vomiting of.—Aconite, Adrenalin, Argent Nit., Arsenic, Belladonna, Bismuth and Pancreatin, Cerii Oxalas, Chloral, Chloroform, Cocaine, Corp. Lutea, Creosote, Hydrocyanic Acid, Iodides, Iodi Tinct. m.i. in ounce Aq. every two hours. Ipecac., Menthol, Morphine preps., Nux Vomica, Pepsin, Phenazone, Pot. Permang., Quinine, Spt, Nucis Juglandis. To increase elimination of toxic degradation products.—Calomel with Sodium Bicarbonate. Glucose injections useful.—V. J. Harding and B. P. Watson, L. ii./22,649. Prickly Heat.—Hyd. Perchlor. Lotion (q.v.) made with Dilute Hydrochloric Acid. Prolapsus Uteri.—Quinine injected. Prostration.—Amyl Nitrite Stern!es, Catha and Coca preps., Oxygen Inhalation, Stimulants. See also Collapse. .Rectal Injections, see Enemata. Prurigo.—Arsenic, Bromides, Cantharides, Iron Salts, Pilocarpine, Quinine, Sodii Carb., Trilactine. Locally.—Ac. Carbol. Lotio and Ung., Ale. Isopropyl, Borax, Cocaina, Iclithyol, Iodine Colloidal, lodof. TJng., Liq. Ammon. Dilut., Liq. Hyd. Perchlor. Pig- mentum Chloral Co. L.H., Liq. Pb. Subac. I)il., Pilocarpine, Staphisagria, Sulphur TJng., Tar, TJng. Rusci. Co., TJng. Sulph. cum Hydrarg., Anderson's Ointment. Flexural prurigo in children. Pix Liquida the best locally. Sedative drugs are helpful.—W. J. O’Donovan, B.M.J. ii./3o,956. Pruritus Ani, Vulvae, etc. Locally.—‘ A.B.A.’ injected for p. ani. Acid Carbolic. Lotio, and TJng., Acid. Picric, Acid. Salicylic. TJng., Acid Sulphuros. Lotio Alkalis, Aloes, Alum Lotion, Anderson’s Ointment, Argent. Nit. in Sp. /Ether Nit., Bismuth, Ca. Lact., Calomel dusted on, Carbolic ancl Cocaine Lotion, Carb. Deterg. Liq. Lotio 2%, Chloretone, Chloroformi TJng., Cocain, Ung., Conii TJng., Ether-soluble Tar Paste, Formosyl, Gallce cum Opio Ung., Glyc. Plumbi Subac. Ung., Hyd. Oleat et cum Morphinee, Hyd. Subchlor. TJng., Hydrastis Liquid Extract and Hamamelis injected, Iclithyol Suppos., Lotio Nigra, Mentholeate, Menthol et Boracis Lotio., Naphthulin Ung. and Suppos., Orthoform, Percain Injn., Pot. Cyanid. Lotio., Sod. Silicas intrav.. Sod. Salicyl, Sod. Thiosulph., Tampons var., Tannin, Tinct. Cannabis, Ung. Acid. Boric., Una. Rusci Co., TJranii Oleas, Radium. Dhobie’s Itch Ointment (sec Dhobie’s itch) relieves.—It. C. Connor, Int. Conf. Trop. Am., *2 4,498. Pruritus ani and pruritus vulva) of mycotic origin—treatment.—A. Castel- lani, U.F.C., *25,249. Olive Oil 1 drachm taken in a little milk at bedtime found to give splendid results.—P.J. i./3o,34S. Wash with a sponge dripping with water (no soap), dry well and apply after each evacuation Zinc Oxide and Powdered Starch equal parts with Glvcerin q.s., to make a paste. Avoid grease.—B.M.J. i./3o,1118 : see also 1160. Carbolised Vaseline 1 in 5 every second or third day. For the irritation an ointment of Menthol and Boric Acid in Lanolin (Ung. Sorbefaciens).—B.M.J. iL/30,86. ting. Metallorum well spoken of.—B.M.J. ii./3o,626. Threadworms (Enterobius vermicularis) and pruritus ani. Santonin and Calomel. Rectal injection on retiring of 2 ozs. of salt water solution (2 tablespoonfuls to the pint) prevents itching during the night and eventually cures the disease. Auto-inoculation always the cause of prolonged infestation, and the hands must be washed every time the surface of the body or an undergarment is touched.—W. P. Macarthur, B.M.J. h/30,1196 ; ii./3i,336. Psittacosis (Parrot’s Disease). Due to a filterable virus—work at London Hospital.—B.M.J. ii./3°,535. Characterised in man by an atypical pneumonia, weakness and depression, and signs of a profound infection. Time of incubation about 10 days, the symptoms being headache, fever, anorexia, restlessness, delirium, vomiting, diarrhoea and albuminuria bronchopneumonia sometimes supervening. Death occurs in about one-third of cases. Disease more common than is supposed— erroneous diagnosis easily made.—Per Pres., Sept., *29,308—310. History, case records, clinical signs, incidence.—A. P. Thomson, L. ii./29,115. A study of 27 case;s, five of which died. Prior to the 1929-30 epidemic, practically unknown in this country. The town of Cordova (Argentine) had numerous cases in 1929. Cases in this country connected with green Amazon parrots. Incubation period 8-13 days. Lungs involved in all cases. A typhoid-like state developed : sometimes incessant vomiting : pulse slow" in relation to temperature : latter very high from the onset.—R. Hutchison and co-wrorkers, B.M.J. i./3o,633. 3 cases with 2 deaths.—H. R, Fisher and R. J. Helsby, B.M.J. i./3i,887. Summary of necropsy.—D. S. Russell, idem. 8S8. Psoriasis.—Arsenic, Harrogate Water, Hydrarg. lodid. Viride, Iron Salts, Morrhuse 01., Quinine, Sod. Pot. Bism. Tart., Sod. Salicyl intrav., Sulphur, Thyroid, Trilactine, Tylcalsin (and intrav.). Locally.—Acid. Carbolic, Acid. Crysoplianic, Acid. Pyrogall., Acid. Salicyl., Anserine Mulls, Betulce Pyrolig. 01., Carbonic Snoiv, Cocaine Ung., Carbonis Peterg. Liq. Lotio., Formosyl, Euile de Cade, Naphthol, Picis Ung., Pot. Sulph., Pusci Pyrolig. 01., Salicin, Sodii Carb., Sulphides {in baths), Sulph. Hypo- chlor. Ung., Thorii Oleat. Ung., Thymol Iodide, Ung. Creosote, Ung. lodi Intinctum., Ung. Pusci Co., Alkaline Baths. Ammoniated Mercury 1 dr., Liquor Picis Carb. 4 ounce, Paraffin Ointment B.P. 6 ounces wrell rubbed in vrith a piece of flannel. If it fails, try Chrysarobin Ointment avoiding face, hands and scalp and stop treatment if Chrysarobin erythema appears on any part.—H. G. Adamson, L. i./i 7,223. Acute rapidly spreading psoriasis treated with Fowler’s Solution per os, sulphur bath and sulphur 2% in Salicylic Vaseline to the scalp and 1% to the body.—E. Fleming Griffin, B.M.J. ii./2i,41. Baths containing an emulsion of Oil of Cade and Chrysarobin used in extensive cases of psoriasis as an alternative to their application as ointments. •—R. Sabouraud, per L. i./23,1318. Chrysarobin in acute cases may be disastrous. Soothing remedies needed. Oily Calamine with small proportion of Ichthyol. Terpichin, a preparation containing Turpentine, Quinine and a local anaesthetic, intramuscularly, useful: Tar also—Tar Ointment, Salicylic Acid Ointment, Mercur. Nitrate Ointment dilute, Lead Subacetate Ointment, in equal parts. It is tenacious and requires rubbing—this, of itself, is good.—R. W. MacKenna, B.M.J. ii./26,338. See also J. H. Heaney, B.M.J. ii./27,1136. f Chrysarobin and X-Rays advised.—E. F. Skinner, B.M.J. ii./26,341. Monilia as a possible factor. Monilia-like organisms found in 85% of stools of persons with psoriasis * similar, or identical, organisms cultivated, or demonstrated in the skin scrapings in 25%, and present in the blood in 14% * The injection of an emulsion of the killed organism was curative.—M. S. Fleischer and M. Wachowiak, Arch. Dermat. & Syph., per Jl. A.M.A. ii./25,746. Colloidal Gold per os.—N. Toomey, B.M.J. i./3i,801. Ptyalism.—See Salivation. Puerperal Fever.—Acid. Boric, Acriflavine Injection, Antifebrin, Anti- pyrine, Anti-Strepto. Serum (Scarlatina Antitoxic Serum), Calcium Phosphate per os., Ferri Perchlorid., Jaborandi, Mercurochrome intrav., Nitroglycerin, Opium, Peptone intrav., Pilocarpine, Pot. Brom. combined with Belladonna, Quinine (2 grains every four hours) (V. J. Glover, L. i./i7,352), Rivanol intrav. Sodium Nucleinate, Streptoco. Vaccine, Sulpharsphenamin, Terebinth. 01., Saline transfusion, Stimulants. Vaginal Injections, Mercuric Iodide Solution, or of Cyllin, Irrigation with Injectio lodi., C.H.W. : also with Acriflavine in Glycerin. Give a quickly acting aperient, Croton Oil (or ‘ Oleum Elliott ’), Saline injection, Morphine, Thyroid (30 to 40 grains), Nitroglycerin subcutaneously, Veratrum Viride, Pilocarpine, Oxygen. Acid Sulphuric dil. 25 to 35 minim doses has been advised in puerperal infection, in all labours. Swabbing out uterus with Iodine, then douche, Strepto. Serum and subseq. Quinine intrav.—B.M.J.E. i.j24,68. Streptococcic Serum, Collosol Iodine intravenously, Sodium Bicarbonate 0-9% intravenously.—G. Fitzgibbon and J. W. Bigger, B.M.J. i./25,773. Good results from immuno-transfusion, i.e., transfusion with blood from donor immunised three hours previously with stock vaccine.—B. P. Watson, B.M.J. ii./25,1126. Glycerin of value—assists uterus to drain by promoting flow of lymph.—■ H. J. Phillips, B.M.J. ii./25,L125. Iodine intravenously ‘ a most efficacious remedy,’ £ grain in 2 Cc. Sterile water on 4 consecutive days.—S. R. Ingle, I.M.G., July, ’26,346 (1 grain of Potassium Iodide needed to dissolve it.—W. H. M.). Magnesium Sulphate intrav. Incidence and mortality greatly reduced.— Pres., Jan. ’27,19. Well treated by Colloidal Silver intrav., from 15 to 25 Cc. repeated daily for 4 or 5 days.—A. M. N. Pringle, B.M.J. ii./28,468 ; also H. H. Brown, ibid. 548. Infection due to B. cerogenes capsulatus treated by Weinberg Anti-gas Gangrene Serum.—F. Ivens, L. i./29,606. Infectious puerperal fever apparently derived from a case of scarlet fever —result of an invasion by an air-borne organism and not due to involvement of the genital tract through direct contact. All infected women should be isolated.—A. Leyiand Robinson and G. E. Cuttle, L. i./3o,67. Source of Infection. S. hcemolyticus (throat) carriers are very prevalent but are not a danger to parturient women.—E. F. Murray, B.M.J. i./3o,814. Liability at some seasons greater than others. Strict supervision essential. —E. F. Murray, B.M.J. ii./3o,514. Hajmolytic streptococci associated with severe and fatal puerperal infection. Milder form caused by variety of organisms—non-haemolytic streptococci, B. coli, etc.—A. L. K. Rankin, L. ii/30,189. Anairobic streptococci found in blood stream probably as sequel to intrauterine manipulation and trauma.—L. Colebrook, B.M.J. iL/30,446. See also R. R. Armstrong and H. Burt-Wliite, ibid. 497. Puerperal fever in a nursing home.—J. S. Manson, B.M.J. ii./3o,558. Sepsis might disappear if maternity hospitals were outside cities.—L. i./31, 322. Eight years’ investigation at Aberdeen. &. hcemolyticus (an aerobe) in uterine cultures in large proportion of cases, and in the bulk it occurred alone. Also in septic abortion. B. coli in a smaller proportion. Order use of masks and more careful antiseptic treatment of the hands advised. Droplet infection from throats of carriers frequent cause.—John Smith, Rept. Dept, of Health for Scotland, B.M.J. i./3i,191,805 ; L. i./3i,264. S. hcemolyticus most found, but some cases of acute sepsis due to Staph, aureus—cannot be explained as being caused by contamination during investigation. S. aureus not a common organism in cultures made from the circulating blood. Antiseptics put into the blood stream not the slightest use.—R. J. Rowlette, B.M.J. i./3i,100. Purgatives.—See Constipation. Purgatives, Hypodermic. — Aloin, Apocodeine, Colocyntliin (may be emetic), Physostigmine. Purpura.—Calcii Chlorid., Ergot, Iron Salts, Phosphorus, Quinine preps., Oleum. Tereb., Liver Treatment. Purpura Haemorrhagica.—Blood Transfusion. Pyajmia.—Autogenous Vaccine. Pyelitis.—Benzoates, Collinsonia, Erigeron Oil, Hexamine Camphorate, Pyridium, Vaccine. Locally.—Mercurome, Colloidal Silver. Fluid intake restricted, not more than 300 Cc. daily from the 2nd to the 4th day. 1 Gm. Hexamine and 1 Gm. Sod. Salicyl. with a little Phosphoric Acid 3 times a day. Hot air baths twice a day. From the 5th to the 7tli day drugs discontinued and the system flushed with large quantities of water.— Daniel, per Clin. Jl., June 27/23,310. Pyelographic Solutions.—Sod. Iodide, Sod. Iodo Methane Sulphonate. Pyloric Stenosis—Atropine. Pyorrhoea Alveoiaris.—Colloidal Silver hypod., Vaccines. Locally.—Antiseptic mouth washes, e.g. Lotio Acidi Citrici et Phenolis, Argyrol, Eusol, Emetine HCl. Solution i % applied locally and injected. Cremor Mag- ne8ice, Formosyl T. Paste. Vide Emetine and Pigmentum Ipecac, et Arsen. PYR—RHE L. Williams decries the fashion of wholesale teeth extraction or ‘ pyorrhoea ’ and quasi-pyorrhoea—Vitamins are necessary.—B.M.J. i./23,101J. Animal parasites of the mouth in relation to dental disease. Pescrip of protozoa found in pyorrhoea alveolaris, and animal experiments mtecting with these organisms.—C. A. Kofoid, H. C. Hmshaw and H. G. Johnston , Jl. Am. Dent. Assn., Aug. ’29. .Pyrosis —Acid. Hydrocyanic,, Acid. HC1. DiL, Acid. Nit.Dil., Add. Sul- phuros., Bismuth preps., Carbo Ligni, Cerii Oxalas, Cremor Magnesite, < g nesia, Sod. Bic., Sodii Sulphocarb. Quinsy.—See Throat Inflammation. Rabies.—See Hydrophobia. Rat-bite Fever.—Arsenobenzol. Raynaud’s Syndrome.—Acetylcholine. Rectum and Colon Ulceration.—See Colitis. . Rectum, Prolapse of.—Alcohol Injection vide Alcohol Bets. Relapsing Fever.—Sodium Arsanilate. See also Malaria. Remittent Fever.—See Malaria. Restoratives—See Debility. Rheumatic Endocarditis.—See Endocarditis. Rheumatism, Acute Articular.—Acid. Phosphoric, o 1 - Acriflavine Injn., Actsea, Aspirin, Aspriodine, Benzoates, ^£fnTe‘P1^0j^,hY(?11 cbirnm Faixin Ferri Perchlor., Guaiacum, Lemon or Time Juice, Lithio , Magisal, Opium, Ozonic Ether, Phenacetin, Phenazonum, Phenyd-Aspriodine, Phenocoll Pot. Acet., Bicarb., Cit. or Nit., Quinine preps Salicm. (bold dose), Sali^vlates Salol Sedasprin, Sod. Bicarb., Sod. Sesquiphosph., Thyroid an Manganese, Tylcalsin per os and intrav., Tyllithin, Tylmarin, Tylnatrm per os ^Lo^aUyJ—MethyL Aspriodine Balm and Linim., Methysal Balm, Ung. Agotan. See also Absts. under Sodium Salicylate, Aceto-Salicylic Acid, Salol, etc. B. Coli Vaccine intravenously in recent arthritis. Rheumatism Chronic.—Actsea, Alasil, Antimonium Sulpliurat., Arsenic, Asnhin Aspriodine, Bisciniod, Caffein Salicyl., Cmchomdmse Sancylas ^nJQfo^tZ ^•’SaitcX/0/o1rdmaf" Kadfum Emanatton Inhalation, llhus, Saiol? Sodii Boro-Salicylas, Sodii Formas Sulphur, Trilactine, Tylcalsin, Tyllithin, Xanthoxylum. rcpnilv Alcoolat de Fioraventi, Atropinae Linim., Bellad. Linim. and Linim. -p0tni Cnm'nh Co Linim Capsici Bmp. and Linim., Chloral cum Camphor., Croton Oil Lin., Ethyl Chloride Spray Furoh/vtvs Oil Qlycopasta Aconiti et Bellad., Iodine, Cocaine Solution and t TctiUpd Lin Menthol Comp., Lithium Iodide Ionised, Mag. Sulph. 2&MethTlfp'riodimBaZ and Lin., Methysal Balm, Methyl Salicyl. and. pioaer ami Ung , 01. Succini, Potassii Lactas, Sal. Mann. Artif., Sassaf. Oil, Sod Salicyl. c. Sod. Iodid. intrav., Ung. Agotan, Ung. Iodermiol, Ung. lodi HSoval^ offending*teeth. . Colon Lavage. G^mlodi'(“iLrerWod&ed1 grains,0 Alcohol 90% 1 drachm, Glycerin to 1 ounce. See also Tinct. Iodi Fr. Cx. 1908, tor intensive treatment. VI*..LLW - HiiAiimatoid Arthritis. Seek infective focus.—--Actsea,, Aorenalm, Alasil, M?enic Aspirin, Aspriodine, Colchicum, Ferri Iod. Sacch., Formates, Guaiacol nJrh hb Guaiacol-Iod. Camph., Formates, Hexamine Hyd. Salicyd, , r : Guaiacol-Iod. Camph., Formates, Hexamine, Hyd. Salicyl., Todoo’rotein todolysn Lithium, Magisal, Morrhure 01 Pot. Brom. and Iodid.; Sedasprin, Sulphur Injections, Strontn Salicyl intrav., Tylcalsin, Ty*1iiifl?;«l abscess hv Turpentine Injection (non-specific immunisation). ffcMv—Byd, OleJs c. Morph., Radiant Heat, ‘ X ’ Rays, Ung. Satnrm with Caniharides, Iodine and Salicylic Ions, Blister applied to the spine. B. Coh Vaccine intravenously. eU/t'CTC'C/ vtivi --- Pmtesn Shock, e.q. Milk injections, 4 Cc. increased, or T.A.B. Vaccine or po“1bfy a vaccine made from teeth or bowel. See Absts., p. 60S. Pathway of infection—mouth, teeth, gums and tonsils.—G. L. Kerr Pringle, Pi\, Oct. 1921, p. 229. . & ’ The terms * rheumatoid arthritis * and ‘ osteo-arthritis * are unsatisfactory and confusing : Chronic arthritis * preferable—A. G. Timbrell Fisher, B.M.j. 11./25,599. Association with thyroid function. Thyroid useful; some remarkable successes —L. 1/25 986. Confirmation by L. J. Llewellyn, L. i./25,1203. Arthritis in childhood.—F. J. Povnton, L. i./a5,807, Conference on Rheumatic Diseases, Bath, May, 1928.—B.M.J. h/28,852-58. Rheumatic diseases a good classification dealing with rheumatic fever (acute rheumatism), subacute rheumatism, muscular rheumatism, lumbago, sciatica, rheumatoid arthritis, osteo-arthritis, gout (acute and chronic), in tabular form.—A. Glover, L. i./3o,609. Classification and enumeration of some remedies—W. S. C. Copeman, B.M.J i /3°,942 • see also. N. Mutch, B.M.J. i./3i,383. lonsillectomy in chronic arthritis. The tonsils are a focus of infection in certain cases.—A. B. Pavey-Smith, L. i./29,170. Excessive pain relieved by lotion as follows : Potassium Bicarbonate I ounce, Juncture of Opium 2 drachms, Glycerin 2 ounces, Rose Water to 12‘ounces. Apply warm on lint.—E. Podolsky, Int. Jl. Med. & Surg., July, *3o. Tii ^ Eric Acid theories and restriction of meat hold no sway now. L Jombieres’ treatment good. Pot. Permang. per os and by injection good adjuvant. Nitrites have favourable influence on blood sugar curve.—B. Cohen, B.M.J. i./3o,70. Acute and subacute rheumatism in children. Sod. Salicyl. intram, of advantage. Temperature normal in 24 hours and pains gone. 1 grain for each year in 1 Cc. wrater once a day for 4 days—but does not control rheumatic cardiac disease. There is no specific drug for the cardiac infection, but cases benefit by Digitalis—E. C. Warner, L. ii./3o,719. Rheumatoid Arthritis can be cured by combined Hexamine treatment (see p. 451).—E. G. McCarthy Morris. Treatment by a combination of blood transfusion and Insulin of considerable benefit when other methods fail—W. S. C. Copeman, B.M.J. ii./3i,1130. ‘ Pyretic ’ treatment used at Lansdown Hosp., Bath, since 1890. Hot blankets bath, vapour cabinet and couch. The principle is to envelop the patient in a warm (100-105° F.) moist atmosphere (exposure to visible steam being avoided). See P. Wilde, The Pyretic Treatment, 1928 ; Charles Sundell, Archives of Med. Hydrology, May, 1927. Rhinitis.—See Catarrh, Nasal. Rhinitis Atrophic.— Borax., Zinc Sul- phanilas packing. See also Catarrh, Nasal. Rickets.—Acid. Phosph. Dil., Calcii Hypopli. Syrup., Calcis Liq., Calcii Chlorid. Elix., Calc. Lactas, Phosph., Lacto-phosph., Syr. and cum Ferro., Cinchona preps., Emulsio 01. Morrh. c. Glyceroph., Ferri Phosph., Syr. Ferrii iodid., Foods A, B and C, Glyceroph., Glyc. Glyceroph. c. Med. Rub.,' Lecithin Emulsion, Liq. Ferri Hypoph. Co., Liq. Iodo-Ferro-Mang. Pept., Malt Ext. c. I hemoglobin, c. Pancreatin, etc., Marrubin (and Comps.), Milk and Glyceroph., MorrhuaB 01., 01. Morrh. Phosp., Phosphorated Oil, Radiostol preps., Sodii Phosph., Sulphur, Thymus, Thyroid, ‘ Three Gland ’ amt 4 Four Glaud ’ Elixir and Tablets, Trilactine. cf., Accessory Food Factor Chapter. ^ -*-i * SLm/ Sunlight, Artificial Riga’s Disease.—See Pyorrhoea Alveolaris. Ringworm.—See Tinea. Rodent Ulcer. Locally.—Chromic Acid, Scarlet 4 R* Carbonic Snow, Radium, 4 X ’ Rays, Zinc Ions. Saint Vitus’s Dance.—See Chorea. Saliva, to promote.—Ether, Ginger, Horseradish, Iodides, Jaborandi, Mercurials, most Emetics, Mustard, Pelletierine, Pepper, Physostigma, Pyreth- rum Glyco-gelatin (Pastils of), Sorbus Aucup. Berries, Tab. Formalin, Tobacco. Saliva, to check excessive.—Acid. Hydroch. Dil., Atropine and Belladonna, Chlorates, Goto, Picrotoxin. Of syphilis after excessive Mercury : Sodium Chlorate. Locally.—Acid. Boric., Alumen, Borax, Chlorates, Creosoti Vapor, Formosyl. Sarcinae.—Ac. Sulplmros., Betanaphthol, Bisciniod, Calcii Chlorid?, Salol, Sodii Hyposulphis, Sodii Metabisulphis, Sodii Salicylas, Sodii Sulphis. Lavage. Scabies. Locally.—Ac. Sulphur os, Calcis Sulphurat. Lotio, Cyllin, ‘Danish ’ Ointment, Hexamine intrav., Hydrarg. Perchlorid, Ung., Formosyl and Perfumed, Nascent Sulphur, Liq. Carbonis Deter gens, Lotio Alba Mackenna, Lotio Boeck, Manganese Butyrate, Naphthalin Ung., Naphthol Ung., Peru Balsam, Pig. Thymol, Potass. Sulphurat., Balnea, Styracis Ung., Sulphur Ung., Ung. Ac. Salicyl 50%, Ung. Resorcin Co., Ung. Rusci Co., Ung. Thorii Cleat. Scalds.—See Burns. Scarlatina.—Aconite, Ammon. Carb., Antistreptococcic Scrum, Belladonna, Calcium Sulphid., Ozonic Ether, Pot. Cit., Potassii or Sodii Chloras. Locally.—Antiseptic Gargles and Mouth Washes, Compress of Salicylic Acid 2% in Alcoholic Solution. m . Renal complications in scarlet fever. To prevent. Alkalis given—Sodium Bicarbonate 25 grains with Potassium Bicarbonate 5 grains four-hourly until urine is alkaline to litmus—in 3 or 4 days. Also Tinct. Iodi Mitis 20 minims in milk four-hourly, and Thyroid 4 grains once a day for a fortnight, as suggested by McDonagh’s work.—B. A. Peters, B.M.J. i./3i,1094. Scar Tissue.—To relax and remove. From gullet, stomach, also uterine adhesions.—Cicatricine and Inj. Thiosinamin Sod. Salicyl. Sciatica.—Acetanilide, Actsea, Alasil, Alum Aceto-Tart., Aspirin, Asprio- dine, Bisciniod, Cap. Colch. Salicyl., Codein, Colchicum, Conf. Guaiae. Comp., Ether Inj., Lithii Citras, Methylene Blue, Morphime hypod., Oleanodyne, Phenazone (and Injected c. Cocaine), Opium Ext. with Valerian or Suppos, with Cocain, Piperazine, Pot. lodid., Quin. Salicyl., Salol, Sedasprin, Soda Salicvlas, Strychnine, Terebinthinse 01., ‘ Theo-Sod.-Acet.’, ‘ Theo-^odo- Form,’ ‘ Theo-Sodo-Sal.’, Thyroid and Manganese, Triiactine, Tylcalsm, Tyllithin, Tylcalsin intrav., Quin-Urea inj., Vaccines. . . Locally—Aconitines Ung., Bellad. Lin., Chlorof. Lin., Ether m3., Menthol c. Camph., Menthol Lin., Methyl-Aspriodine, Methysal Balm, Ung. Iodermiol, Veratince Uvg. Injection into sciatic nerve, where it crosses neck of femur of 1% solution of Quinine and Urea Hydrochloride, specific for sciatica.—B.M.J.E. ii./26,90. Sclerosis, Disseminated.—Bulbocapnine, Parosan, Sod. Cacodyl, Typhoid Vaccines Intravenously (Sir J. Purves-Stewart). . Sp hernia insularis, the name given to what is thought to be the causal organism of disseminated sclerosis. Autogenous vaccine employed.—Sir J. Purves-Stewart, L. h/30,560,612. Existence not corroborated. M.R.C., B.M.J. i./31,425,513,514. . -i Scrofula.—Arsamin and other Org. Arsenic, Calc. Lact., Calcii Chloral., Calcii Phosph., Calcii Sulphid., Elix. Hsem. c. Lecith., Ext. Malta urn Iodmol, Ferri lodid. Syr., Ferri Phosph., Hyd. lod. Virid., Iodoprotein Tabs., lodum, Marrubm and Comps., Morrhuse 01., Quinine preps., Sodii 1 xiosphas, oirop Neurotonique, Syr. lodo-Tannic, Syr. and Vinum Tann-Iodo-phosph., Chaul- moogra Oil. Locally.—Pot. Sulphurat., Lotio Alba, Mackenna,. Intrasacral epidural injection in treatment of sciatica. Tsormal oaline, about 100 Cc., "apparently as good as various strengths of Aovocame. \\ . Evans, L. ii./3o,1227. . _ • ^ , Scurvy.—Arsenic and Iron, Calc. Fact., Lime or Lemon Juice, Phosphorus, Potass. Chloras and Citras, Red Bone Marrow, Sodii Citras, Sodii Lact. Scurvy, Infantile.—Lemon Juice after removal of acids—the equivalent of 6 to 12 lemons daily.—A. Harden, S. S. Zilva, and G. h. Still, L. i.jig,!*. Orange Juice concentrated at 37° C. under a partial vacuum lound much more efficacious than Lime Juice in the prevention of scurvy. J. L. Priston, Jl. R.N.M.S., Jan., ’26,1. Of., ‘ Water-Soluble C ’ Accessory Food Factors. ...... Sea-Sickness.—Acid. Hydrobromic., Antipyrine, Amyl Nitns (inhaled), Bon Voyage, Chloralamide, Chloral Hyd., Chloroform and 1 met. Co., Chlorot. Caps., Cocainse Hydrochlor., Glucose Feeding, Hyoscyamina gr. per os good), Iodi Tinct., Morphine inj. hypod., Nitroglycerin Tablets (*„-?» gr.), Phenazone, Pot. Bromid., Sedasprin, Sedeff, Sod. Brom., Sodn Citras per rectum, Sodii Nitris, Malourea and Sodium Malourea. Counter-irritants to stomach, Ice-bags to the spine. Ipecacuanha Wine to 2 to 3 minim doses is specific. A. T. Thompson. Sedative treatment: Liquor Iodi Fortis, Dilute Hydrocyanic Acid, a.a. 12 minims, Water to 6 ounces. One ounce every 10 minutes. lour doses r taken effectual. Then Aperient: Black Draught. Subsequently tonic, Potassium Bromide, Strychnine, Gentian, etc. Successful.—A. H. Hare. As preventive, 1/60 grain Atropine Sulphate per os, followed by two 1/120 grain at i-hour intervals. Also give for treatment.—B.M.J.E. ii./26,75. A good dose of sea-water is the sailor’s remedy for seasickness. Half a tumbler of sea-water from a Winchester labelled ‘ Mistura Oceani Pacifici ’ cured all but 4 of 66 men paraded sea-sick op a voyage from Hew Zealand to S. Africa.—J. S. Purdy, B.M.J. ii./25,628. Glucose in 3 drachm doses produced an effect superior to that obtained with Atropine, Strychnine, Chloral, Bromides, Alkalies, and the various patent medicines.—G. H. Oriel, L. ii./27,813. See also ibid. 1146. Prophylaxis important. Take two meals a day, breakfast and dinner, for 7 days before, eating meat at one only and avoiding soups and made-up dishes, with bread and an apple at midday : reduce Alcohol, drink water freely and smoke little. The third day before sailing eat nothing but drink water freely. That night and the next take 5-grain Blue Pill and the following mornings Seidlitz powders or salts. Paith essential. A good remedy is 1 minim Tinct. lod. in a teaspoonful of milk every half-hour and mustard leaf to pit of stomach. Drive patients out of cabins into fresh air. In cases of dangerous exhaustion keep patient in a warm sea-water bath at 90—95° F., bandaging the eyes.—R. A. Bennett, B.M.J. i./28,753. Sea-sickness and the labyrinthine theory.—T. Gwynne Maitland, B.M.J. i./3i,171. See also Capt. Martin Flack, ibid, 176, and ketosis in sea-sickness, J. R. Marrack, ibid, 178. Seborrhcea. Locally.—Formosyl Ointment, Isopropyl Ale. (diltd.), Resorcin Lotion and Ointment, Sulphur and Salicylic Acid Ointments, Thorii Oleat. Ung. Chronic seborrhcea capitis in children. After epilation, swab with a 2£ vol. H202. Mop away, and spray with Clieatle’s Malachite Green solution composed of equal parts 2% Malachite Green in 80% Alcohol and 2% Mercuric Chloride in 80% Alcohol. Painful at first, but a valuable aid. Backs of ears, the axilla?, and the groins, should also be sprayed. Protein shock by 0T Cc. T. A.B. intravenously on the 19th evening after X-ray epilation, so that the period of fever corresponds to the time of epilation. When the hair falls, change over to Lotio Glycerin. Plumbi Subacet. thrice daily until skin is a natural colour.—W. J. O’Donovan, B.M.J. ii./30,957. Seborrhcea is common in African natives, though the bald man is seldom seen among them—hence not responsible for baldness. Endocrine metabolism probable cause.—L. k/30,33. Acidosis and seborrhcea. No evidence to suggest presence of acidosis in seborrhcea.—J. T. Ingram and F. S. Fowweather, B.M.J. i./31,839. Dandruff to Remove.—Wash the head with soap and spirit and then dry. Rub in well an ointment of Precip. Sulph. 15 gr., Salicylic Acid 15 gr.. Soft Paraffin 1 ounce, or if greasy applications disliked a lotion of Salicylic Acid 2 drachms, Castor Oil 3 drachms, Eau-de-Cologne 1 ounce, S.Y.R. to 6 ounces. In chronic cases Sulphur Prsecip. b ounce, Glycerin 2 ounces, water to 4 ounces. Senescence (Physical Deterioration) and Senility. A paper re work at Chelsea Hospital.—L. i./22,874. See also Leonard Williams, L. ii./27,1179. Septicaemia and Pyaemia.—Acriffavine, Antistrepto. Serum and Vaccine Antistaph. Vaccine, Ferri Perchlor., Gentian Violet inj., Ilyd. Perchlor. intrav., IUyd. Benz., Nuclein, Quinine, Resorcin, Salicin, Sulphites, Saline Injection, Sod. Cacodyl, ‘ S.U.P.’ compds., Thyroid and Manganese. Dakin’s Solution must not be given intravenously. Shingles.—See Herpes Zoster. Shock, Surgical.-—Adrenalin, Brandy hypod., Caffeine Sod. Sal., Calc., Chlorid. Injn., Camph. in Ether, Coramine, Ergot, Ether, Gum Acacia in Saline (or plain), Morphine, Oxygen with Alcohol, Pituitary, Suprarenal, Strychnine. Ihtracardiac injection of Adrenalin Solution 1 Cc. Sickness.—See Vomiting, also Sea-Sickness. Sinuses, Tuberculous.—Iodoform preps., Creosoted Oil. !Skin.—See Eczema, Psoriasis, etc. The urine in skin affections is always more acid (pH 4*8 to 5-8) than normal (6.4 to 6.8). Alkalies of value, e.g., Sodium Bicarbonate 30 grains, Potassium Bicarbonate 25 grains, Potassium Citrate 20 grains, Compound Cardamom Tincture 30 m., Peppermint Water to 1 ounce, thrice daily increasing or decreasing to render urine normal.—F. C. Doble, L. i./25,272 ; see also ibid. 407,464,465,516. Skin affections due to yeast-like fungi (monilia, pityrosporon, blastomyces, coccidioides).—J. M. H. MacLeod, B.M.J. i./3o,1119. See also Monilia, Yol. II. Skin Disinfection.—See Skin Sterilisation. Skin Irritation. Locally.—Acid. HCN. Dil., Cremor Sicc. preps., For- mosyl Cream, Hyd. Perchlor., Lot. Calam., Sodii Carl)., Zinc Cream, see also Eczema. Skin Proliferants.—Allantoin, Acriflavine, Symphytum, Scarlet R. Skin Sterilisation.'—2% Iodine in 70% Alcohol, Mercuric Chloride 1 in 500 in Spirit, to 1 in 2,000. Biniodide and Spirit. Eau de Cologne, Metaphen, Perfumed Formosyls, ‘ PropylTinct. Iodi. Sleepiness..'—Tea, coffee, Digitalis, Pituitary or Thyroid suggested. Sleeping Sickness.—Sec Trypanosomiasis. Sleeplessness.—See Insomnia. Small Pox.—See Variola. Smell, Loss of Sense of.—Borated Hydrogen Peroxide. Smoking Habit, Excessive.—Wash the mouth out with Silver Nitrate, 1 in 250. Anti-smoking gum, Formosyl Pastils. Snake-bite. First /Ua\—Apply tourniquet a few inches above bite and then give immediate subcutaneous injection of Antivenene supplemented by incision and suction if the bite has been inflicted by a large snake and symptoms are severe. Repeat every half hour.—L. ii./29,1102. Alcohol and Ammonia, Antivenom Serum, Pot. Permang., Strychnine inj., Calcii Chlorid. inj., Tinct. Ammon. Co., Mist. Olea-Balsamica. Locally.—Chloroform, Chloral cum Camphora, Cocaince Hydroch. Liquor, Hydrogen Peroxide. . 1 .. . Spray the part with Ethyl Chloride, whilst making incisions and rubbing in Potass. Permang. Gelatin Inj. for haemorrhage. Cocaine Hvdrochlor. injected in full doses at the site of puncture caused by fangs of the snake not only relieves the pain, but causes reduction of the swelling if promptly used. Well combined with permanganate. Oozing haemorrhage is reduced by taking large quantities of gelatin solution 5%, per os. J. C. Fox. See also Bites. . ,. _ , TT TT , ^ ,/r T Snake bite in India. Single serum impracticable.—H. Harcourt, B.M.J. i/31,252. Sneezing, Spasmodic,—Calcii Chlorid „ , Spasm.—iEther, Ammon. Arom. Spt., Amyl Runs, Atrop. inj., Belladonna, Benzvl Benzoate, Cajuput 01., Camphora, Chlorof. and inhaled, Chloromor- phise Liq., Ervthrol Nitrate Tablets, Ext. Grmdelse Liq. (of larynx). Mannitol Nitrate Tablets, Menth. Pip. 01., Mistura Jitheris cum Ammonia, Opium, Papaverine (Gastric and Intestinal), Piscidia . .. . Tjrn Spasmophilia.—In infantile tetany large doses are given. Also Ac. MCI. and .Ammon. Chlor. Speech Fright.—See Stage Fright, also Nervousness. Spermatorrhaea.—See Incontinence of Semen. Spina Bifida.—Iodo-GIycerin injection. Iodine Liniment. Sporotrichosis.—Potass. Iodid. . . , , ^ T} 77 Sprains. Locally.—Arnica, Fomentations (hot) of Poppy-head or Belladonna, or cold with vinegar, or spirit lotions, Lead and Opium Lotion, Lotio Ammonii Chloridi. When chronic, Liniments of Belladonna, Chloroform, Camph. Co., Lin. Tereb. Acet., Badiant Pleat, ' X ’ Bays. Spring Catarrh.—See Catarrh. t Nasal and Hay Fever. Sprue.—Calcium and Parathyroid (Harold kjeott), Castor Oil, Cyllrn, Koumiss, Milk Diet, Pancreas Fresh, Pepsin, Santonin, Sys Powder, Tnlactme- Milk and Tablets after Milk meal. „ , ... ... . . . Sodium Bicarbonate 10 to 20 ounces of 2 to 4% solut on intravenously slowly in addition to per os doses.—A. Castellam, B.M.J. W 21,338. Hydrochloric Acid, 15 minims of 0;2%, before, and 10 grams of Pancreatm after each meal, no dietary precautions being taken whatever. T His treatment has been adopted along the entire coast of Queensland, o. M. Lambert, ner J1 Trop. Med., Oct. 15/23,323. See also T. R, Brow, ibid Oct. 16/22,330. Tropical sprue closely related to pernicious anaemia, is a deficiency disease in which well-chosen food is of great value. C. Elders, L. i-/25,75. Colonic lavage with Dimol Solution. . „ . Sprue treated by high protein diet by N. H. Fairley also by Calcium Chloride 2% solution intravenously ; dose 1 Cc. increased to 3 Cc. M. uovei, B.MJ. ii/30 61 Calcium Chloride 10% 4 Cc. dangerous intravenously—W. D. M. Lioyd, B.M.J. i./28,662. Stage Fright.—Cannabis with Laudanum. Geisemium (a v ) Taudarmm Ule and nf °fee JMorell Mackenzie), also'witli Sal Vo& ^ ^ , atei- Three deep inspirations valuable, e. i ylorus ; Urethra, etc.—Cicatricine, Opii. Tinct q v Itfngs!— sfeBile?. Gland Sicc-’ TesticuIar Gland Sice., Corpus Iuteum. Stomach Dilatation. Sodium Phosphate as nervine tonic As anti. napVithol°P^eSodmMaffriA^ra^Tn,7_^*SmivrMi Salol, Betol, Benzo- Mag. A per., I rilactme Milk. See also Gastric Secretion. Bisulphis Sodii Chloral ’ Laudanum> Pot' CMoras. s^. Hyposulph., Sodii Carbolic, Acid. Picric as paste (stomatitis mercunalis), A cut. Salicylic, Acid. Sulphuros, Alumen, Borax Glue and MpJ Til T? ^ua> (y°Mut°niim Hydrog. Perox., Cupri Sulph., Formosyl Mouth Wash Hydr. Perchlor. Lotion 1 in 5,000, Iodine Colloidal, Liq. Alum. Accto Tart as mouthwash, Myrrhce et Boracis Tinct., Perfumed Formosuls (diluted) SWA Mouth Wash, Sodii CMoras, Potass. Chloras.-See Pastils «lluted), Salol in 5>00° Hyd‘ °XyJy-Wash- Ulethra CopperVulphate feholutton.2' (ip,lfw?J etS’-Sbine^ ?dth hot Boracic fomentations at night, frequent effe^^n«e^sl*Tlbble™CB.M!j!0u!/29,$6?C^011 * “ matter forms’ “ Styptics.—See Hemorrhage. Sunburn and Freckles. Locally,—Msculin Ungt. 2% in Vaseline, Hazel j'oam, Lone Acid Lotion, Corrosive Sublimate Lotion, Lactic Acid Lotion, Sfna^sZtPd^nT^ln FoJymo8yl1 (d]¥™), Mistura Amygdalae, Thorii Oleat. bftff' diluted to a cream, Lng. Plumbi Carbonatis. Sunburn. Qtiimne the most effective protecting substance. The following diaSP° xlse '■ Ommne Bi-hydrocMoride 5, Water sufficient quantity to solve. Anhydrous Lanolin 40, Lavender Oil 1, Soft Paraffin to 100 As preventive : Acid Tannic 10, Spirit 25, Water to ioo A win freelu to exposed parts of the shin before going out of doors.—II. W. Barber. J y Sunstroke.—Ammon. Garb., Apomorphina, Atropine, Bromides, Digitalis, Ergot, Hyosema, Morphmse inj., Quinine, Sedasprin, Veratrum. Purgative enemata, Sinapis Emplastrum. Sunstroke in the Tropics cured by Pilocarpine hypodermically with 1 or 2 minims of Croton Oil—J. McOscar, B.M.J. iL/23,310. Suppuration. Staphylo Vaccine. Locally.—Wound remedies, q.v. Sweats.—See Night Sweats. Sweating Feet.—Alum Acet., Formalin, Formosyl, Pulv. Salicyl. cum Talco. Sycosis. Locally—Arsenobenzol, Bismuth Oleas, Ichthyol, IAq. Hydrarg. J crchlor., Hydrog. Perox. {I to 2 vol.), Iodides externally, Ol., Tereb. in Oil Injectio, Manganese Butyrate, Uranii Oleas, Sulphur, Ung. Cupri Oleat 10%, Ung. Hud. Ammon., Ung. Hydrarg. Bit., Ung. Hydrarg. Sulph. Flaw, Ung. Thorii Oleat., A Bays. Synovitis.—Ext. Solani Liq. lias been advised, Mercurials. Syphilis.—Antim. Sodii Tart., Arsamin and other Organic Arsenic Comps., Arsenobenzol nlono and with Mercury and Injection of Patient’s serum after, Auri Color., Barii Chlorid., Bismuth Subnit. Injection, Bismutol and other Bi. Preps, (watch mouth), Calc. Todo-ricinol., Fcrri lodid. Syrup, Hyd. c. Creta, Hyd. Cyanid.,. Hyd. et Pot.. lodid., Injectio Hydrarg. Intram, and other Mercurials, lodinol, lodoprotein, Iodum, Iodine Colloidal, Mercurialised Serum, Mang. Butyrate, Metaphen, Mist. Quin. c. Ferro, Mist. Hyd. Perchlor. Co., Myosalvarsan, N.A.B. (and Guaiacol Glucose Sterules for dissolving). Pot. lodid. Pil. Quin., Hyd. et Opii, Protargol, Quin. Hydrochlor., Quin. Hvdro- chlor-Carbamid. and Hydr. Perchlor., Quin. Iodo-bismuthate, Quin. Xucleinas, Quin. Periodide, Salicin, Sarsaparilla preps., Sod. lodid., Syr. Ac. Hydriodici, Tiodine. For Methods a? Diagnosis.—See Vol, SI. Locally—Arsamin PasteHydrarg. Lanolin., Hyd. Oleat et c. Morphina, Hydrarg. Ung., Iontophoresis of Potass. lod. Solutions. Ung. Prophylaxis. Organic gastric syphilis. Neokharsivan, Potassium Iodide, and Mercury inunctions.—D. Smith, B.M.J. ii./3o,773. Syphilitic Sore Throat.—Locally.—Alum Gary., Borax Garg., Chlorine Garg., Colloid Silver, Collutorium Hydrog. Perox., Hyd. Cy. Garg., IJyd. Perchlor. Garg. and Pastil., Pot. Chlorat. Garg. Pastil, and Troch. Syphilitic Ulcers.—Acid. Chromic, Acid Pyrogallic, Arsamin, other Org. Ars. Comps., Collod. Salicyl. c. Hyd. Perchlor., Dusting Powder of Calomel and Bismuth, Hyd. Acid. Nit. Liq., Hyd. Flava and Nig. Lotio, Hyd. Iodas., Hydr. Naphthol, Hyd. Cleat. Morph, etc., Hyd. Subchlor., Collod. Ioclof.,Iodof. Wool, Ung. Resorcin, Zinci Chlorid. Iodid. and Nitras, Ung. Antimonii, Ung. Arsenii, Anserin, Ung. Iodi Intinct. Internal Remedies, see Syphilis. Tabes Dorsalis.—See Locomotor Ataxy. Tachycardia.—Amyl Nitrite, Atropine, Cactus, Digitalin, Nitroglycerin, Parathyroid, Sparteine, Strychnine. Taenia.—See Worms. Tartar on Teeth, to dissolve.—Lotio Acidi Citrici et Phenolis Tattoo Marks, to remove.—Acid. Salicylic, Tannin and Silver Nitrate. —Ac. Nitric. (Ph. Form.), Glycerin Papain (?), Iontophoresis. Refs, to Briault’s work.—P.J. ii./r2,557, see also C.D. ii./i2,272. Tetanus.—Anaesthetics (to relax spasms), Antitoxin, Amyl Nitris (checks spasm of glottis and resp. muscles), Bromides, Cannabis, Chloral Hydras, Curara, Luminal-Sodium Ink, N. Saline Injections, Paraldehyde intrav., Parathyroid, Physostigmine, Sodium Persulphate. Oxidising Antiseptics.—H30£, Permanganate, Chlorine and Iodine are adverse to B. Tetani (use latter locally), but Phenol and Magnes. Sulph. have no apparent effect. Curare (q.v.) cured after Tetanus Antitoxin failed. No limit to the total amount of serum that can be given. Chloretone in 20 grain doses three or four-hourly best for painful spasms.—C. Worster-Drought, L. i./26,726. Tetany.—Parathyroid. Some good results have been reported.—Prof. Swale Vincent. L. i./23,130. Large doses of Calcium Lactate in coniunction. —Dan T. Davies, B.M.J. i./23,512. Stront. Lactate, 01. Morrhuse. In infantile tetany Calc. Chloride, Ac. Hydrochlor. or Ammon. Chlor—q.v. Dan T. Davies, L. i./3o,202. Thirst, to Relieve.—Acid. Citric., Acid. Phosph. Dil., Acid. Sulph. Aro- mat., Acid. Tartaric., Coca, Formalin Tablets (Internal), Haust. Imperialis, Mucin, Pot. Chlor. Tablets, Pot, Cit., Pot. Tart. Acid. Thrombosis, Coronary.—Give Morphine freely tI to f grain subcutaneously or intravenously, then Tincture of Digitalis in 20 minim doses every 6 hours up to 2 drachms (with care). Later give Theobromine Sodium Salicylate 15 grains thrice daily.—G. S. Haynes, Pr., Sept.’3i,379. Throat, Inflammation of, and Tonsilitis.—Aconit. Tinct. and Pastil, Aspirin Ammon. Brom., Antimony, Belladonna, Broadbent’s Mixture, Calc. Sulphide, Elix. Sod. Lact., prior to operation, Ee. Salicyl., Formalin Tablets (Internal), Guaiacol, Lichenoids, Liq. Ferri Perchlor., Phenazone, Quinine HC1 Acid, as sorav or paint, Quininse Salicylas, Salicylates, Sodii Benzoas, Sodii Bicarb., Solubes (various), see Index, Strepto. or other Vaccine, Tab. Formalin (to suck), Tylcalsin, Tyllithm . , „ . Locally —Adrenalin Spray, Benzoin Tinct. Vap., Chlorates in Troch., Cocaine (Pigment of), Colloidal Argent and Hydrarg., Guaiaci Troch., Iodi Vapor, Mousel’s Sol., Sod. Perbor., Thymaglycine. Throat, Relaxed Sore.—Ac. Carbol. Pastil., Ac. Tannic Glycerin, Alum ond Glyc Aluminis, Alum Aceto-Tart. Liq. and Alum Format. Liq., Ammon. Chlorid Vapor, Argent. Nit., Benzoin Tinct. Vap., Bism. Past Elixir Guaiaci, Ferri Perchlor. Pig., Guaiaci Troch., Hydrastis Tinct., Iodine Colloidal, Lichenoids Phenoloid Tablets, Pini Sylvest. Vapor, Solubes (various), see Index. FOLLICULAR Tonsilitis— Eusol. Calcium Sulphide said to be specific. Thrush (Aphthae).—Bismuth preparations, Gentian Violet, Iodine Colloidal, Iodoform, Mineral Acids, Quinine preps., Sod. Bisulphis, Sodii Chloras, Sodii Sulnhis ’Tab. Formalin to suck. ‘ Locally —Acid Boric, Acid. Sulphuros, Alumen, Borax, and Glyc. of, Dakin’s Solution 'Formaldehyde Pigment, Iodol, Lotio Nigra et Glycenni, part, ccq., Potass. Permang., Sodii Chlorinat. Liquor. Thrush treated by swabbing with Gentian Violet solution l/0.—per Pr., Dec., '27,393. ‘ a Tic Douloureux.—See Neuralgia. TIN—TOO uln^no/ f V°P;acd7 Sycosis. Locally.—Ac. Carbol. Glyc., Ac. Salicyl. hHi'i /*? 7° • Acid Sulphur os, Croton Oil, Chrysarobinum Cuvri Oleat Una Hvf pirZ ehfr^fehvle’, ** lod^Hyd PelctLZ:, And pS'^rZLZh %' Petroleum of Commerce, Picrotoxin Pigment, Pig. Sodii c“ un°" k”>1 Appiy Whitfield’s Ointment or first mop with Tincture of Iodine then rnh 50- ^X Tinea Tarsi.—See Ophthalmia Tarsi. Tinea Tonsurans and Circinata. PerMorTiPIZLIUr?3? andV?°^oi^ Ag. and Eg., Cuvri Okas, Ferri Iodised Phen/d Tea/' rCj'^o Iodi et Olei Picis Pigment, Sulvhur STaThcVh° ^cid, Scdii Curb. Cryst. melted hot, UnaSulfh^k^hthllinr BU’ ^.Potass Sulphurai., Ung. Sodii Chloridi, C ng.^Ulph A aphthol Salicylat., Ung. Thorn Oleat., ‘ X ’ Pays. with 20Cr^nf a1Cllre0d .b? Gram’s Solution, 5 Cc. intrav. diluted B.M.JTd/afl0 tfll serum : 2 injections given at interval of 8 days.-- andiTseTnfter^at^0?81^8 °j equal parts of Sodium Chloride and Vaseline, out ihe stump/l“S7 J5r 08 a superfloiaI foUlculltis “d for bringing n Chrysophanic., Acid Sulphuros., Borac Glycerin IS vlriou Tionok Cf^ SulP*-’ Sodii Hvvosulph.T.otio. 2 dril'ms Tinpt,,™ t V ' f40ll?'vm« lotion is recommended. Resorcin A aiachms, Tincture of Benz. Co. to 1 ounce.—A. Castellani L i ho 943 M^hvlM/ed^nirit^asollltion.of Ac^ Salicylic 1 drachm in U ozs. evmMJorninf ,L lv,r d ai^’T scrapmS every night and without scraping ev£P. jnormng use three months or longer.—R. Craik, B.M.J. i./2o 185. i i n f 1Iian1UO,, iy °iS'S or eczematoid ringworm well treated by swabbings with TinV0,00,rT "Ven rrQ 5£?° soluti?n of Potassium Permanganate-L ihfJ2,1>78 f l.w.lU effect a cure in six days if applied Salicylic Collo- ,, . . . ——- 7 jj.i . >vxii cucuLr ci cure m si thickly on lint twice daily. Salicylic Ointment takes longer, dion useful for small or scattered lesions.—L. ib/22 791. Ring wo) vi of feet and hands.—Ung. Ac. Salicyl, Mycozol. rirnzworm V, aSiLm djftP°sjs ringworm. Fluorescence of hairs infected by B MJ f/3179igl flltered throu^h 8lass containing Nickel.—J. Kinnear, Tinnitus Aurium.—Brominol, Iodinol, Pilocarpine Injection. P’ ™p°ur of Chloroform or Ether or a few drops of 5% Methyl Salicylate in Parolein through a catheter.—L. i./26,150. crr^^S lfw,the pillsatmg f°rnb Bromide (useful at bedtime and often gives atedfcwi}hfvp?HaM0tpu 8edPlves/. Paraldehyde, Potass. Iodide (where associ- ated with vertigo), Pilocarpine (111 cases showing Meniere’s symptoms). Thiosmamm (hypod.) lodum Oleatum. 1 Toenail, Ingrowing.—Lead Nitrate as dusting powder. Tonics. See Anaemia, Debility, Fevers, Rickets, etc. Tonsillitis—Nee Throat and Pharyngitis. Clrromc tonsillitis treatment. Indications for enucleation.—J. S. Fraser, Li. 1./20,408. ’ x TonsiUomycosis.—BocM application of Glycerin Borax, Carbolic Lotion 1 in 20, or dilute J met. Iodi Mit. 1 in 2 ; internally, Salicvlates, Aspirin, l yramidon or Potassium Iodide.—Sir A. Castellani, Jl. Trop. Med., Aug. 15,31, Cu ( J, instead of tonsillectomy.—London Paste. Toothache.—Atropine Methyl Bromide with Aspirin, Pil. Butyl-Chloral Hyd. c. Gelsem., Gelsem. Tinct., Magisal, Piscidite Ext. Fluid., Quin. Tinct, Ammon., Sedasprm. Locally.—Acid. Arsenics., Acid. Carbol. c. Collodion, Benzyl Ale., Butyl- Chloral c Menthol Caryoph. 01, Chlorof. c. Camph., Chlorof. c. Mastic, Cocaine, l ocame-Menthol-Lugenol, Cocaine-Menthol-Phenol, Creosotum, Eugenol, Iod. et Aconiti Tinct., Liq. Sodii Carbol., Menth. Pip. 01., Opii Tinct., Pasta Arseni- calis, Lot. Per many., Pyrethri Tinct., lies. Carbolica, Sod. Peroxidum. Toothache Remedy.—N. F. 5th Edn. 1926, consists of Cinnamon Oil 10 Phenol 20 and Methyl Salicylate 30. . * . Toxaemia. Anti-Gas-Gangrene Serum (of acute intestinal obstruction ntrav dose 10 to 25 Cc.), Calc. Chlor. intram., Digitalis, Ether, Purgatives, Diuretics, Jaborandi, Sal Volatile, Stimulants, Strychnine. 1 oxcemia. Alimentary.—Acid HC1., Emulsio Paraff. et Bismuth, Glucose injections, Kaolin, Charcoal, Liq. Chlori, Trilactine. Trachoma.—-Abrus. Preps.—Radium Rays—good results. Acid Carbonic Snow, Copper Sulphate (and Ionisation of), Silver Salts. See also Cancer, a I11 ■u s^a§e Silver Nitrate solution 10 grains per ounce, or Copper sulphate applied as stick, to the conjunctiva. Balloon the fornix with sub- c?nilinctlv,- mJeption of Saline, including 4 minims of 4% Cocaine and 4 minims oi Adrenalin Solution. Treatment of complications such as trichiasis and panrms, the latter occasionally by peritomy and corneal ulceration by use of Scarlet ~ /0 m Olive Oil are called for later. Dionine for promoting absorption or corneal opacities and installation of 5% infusion of crushed Jequirity Seeds are oi value. Secondary infection is combated with Zinc Sulphate and Silver IN itrate drops. In gonococcal and streptococcal infections eye baths of Saturated Magnesium Sulphate Solution are useful.—Lieut.-Col. H. Kirkpatrick, L. i./21,1304. The disease is divisible into four stages, each type requiring special care with caustics—Perchloride, Silver Nitrate, etc.—A. F. MacCallan, L. ii./a6,919. Review of recent claims for various drugs—Chaulmoogra Oil rubbed into conjunctiva by a glass rod—Olive Oil massage. Painting with Copper Sulphate as satisfactory as any.—W. S. Duke-Elder, M.A. ’31,110. Trichinosis.—Ergota, Ergotin, Liquor Arsenicalis. Combat gastro-intestinal symptoms and fever with Bismuth, Salicylates and Quinine. Later, Dimol, when true nature of disease found. Antimony Tartrate, intravenously, possibly of use.—D. A. Rice, L. ii./22,799. Trypanosomiasis and Tick Fever.—Mist. Antim. et Pot. Iod., Methylene Blue. Locally.—Arsenic (Sodium Arsenate), Arsamin and other ora. arsenic comps, q.v., Antim. Oxid. Inj., Antim. Sodii Tart., Auramine (?), Fourneau ‘ 309,’ Bayer ‘ 205,’ Novarsenobenzol and injection of patient’s serum treated with. Tuberculosis, Laryngeal.—Ac. Lactic Spray or Pigment, Ac. Picric Inhalation, Boric Acid Insufflated, Cocaine (Lozenges and Spray), Eusol, Quttce Cinnam. Co., Iodoform, Iodine Inhal., Menthol in Olive Oil, Morphine, Pastils of Cubebs, Pot. Chlorate or Ipecac., Silver Nitrate Spray, Tuberculins, Vapor Creosot Co., Vap. 01. Pini Sylv. Important to clear the nose of catarrhal and purulent secretions. Wash out nose with Sodium Salicylate and Sodium Chloride of each 48 grains, Sodium Biborate 96 grains, Glycerin 82 minims, Menthol Water (1 in 1000) to 2 ounces—a teaspoonfui in an ounce of warm water.—Sir James Dundas Grant, Pr. Aug. ’31,257. Tuberculosis, Renal.—Mild ‘cystitis’ cases should be regarded with suspicion. Surgical methods.—C. A. R. Nitch, L. i./25,l,34. Tuberculosis.—See Phthisis. Typhoid Fever.—Barii Chlorid., Carbo Anim., Cinnamon Oil, Carbolic Acid, Cinchona Aiks., Charkaolin Granules, Emetine Hyp., Guaiacol, Hyd. Sub- chlor., and Perchlor., Hydrog. Peroxide, Iodates, Iodine Tinct., and Phenol dil. to drink, Magnesii Salicylas, Mist. Chlori c. Quin., Naphthalene, Naphthol (a), Olive Oil, Phenyl-Aspriodine, Platinum Coll., Salol, Santonin, Sodii Acid. Sulph. as water disinfectant, Sodii Chloras, Soda Chlorinata, Sod. Nucleinate Inj., Sulphur, Sulphurous Acid, Thymol, Vaccines and Sensitised Vaccines, (T.A.B.), also Multiple Vaccines (Castellani), Trilactine Milk, Turpentine Oil (per rectum). Haemorrhage, Intestinal from : Calcium Chloride, Crocq’s Pill, Argenti Nitras, Ergot, Pil. Plumbi Acetatis cum Opio, Turpentine, Haemoplastin. Locally.—Allantoin, Alcohol Compresses, Colloidal Ag. and Hg., Hyd. Per. chlor. intrav. Glucose feeding per rectum, see also Enemata. Enteric fever in 1929-1930. High death-rate.—B.M.J. i./31,808. Typhoid treatment. Disinfection of excreta with equal volume of 1 in 20 Carbolic. Washing of patient. Cradle if temperature rises above 103° F. Before discharge, stools and urine to be examined three times at 5-day intervals. Carrier treatment unsatisfactory. A resume of necessary attention to the bowels. For distension Carbohydrates cut down. When colon is mainly affected Tinct. Asafetida 2 drachms in Starch Mucilage 4 ounces per rectum. Other treatments : Emuls. OI. Tereb., Capsules 5 minims of Oil of Cinnamon, VOL. I* MM Collosol Kaolin 3 drachms in Water 4 ounces ; Eserine 1/200 grain with Strychnine 1/60 grain may be needed or Pituitrin £ Cc.—-A. E. Gow, L. i./30,37,90. Orange Juice has been advised. Heart Failure in.—Caffein Sod. Benz., Camphor, e.g., Curschmann’s Solution. Venous Thrombosis in—intravenously 0-5% Sodium Citrate up to £ pint. Typhus.—Sod. Salicyl intrav. See also Vol. II. Ulcers.—The following are chiefly for local use : see text. Ac. Boric., Ac- Carbolic., Ac. Chromic., Ac. Lactic, Ac. Salicyl., Alii Succus, Allantoin, Argent- Nit., Bism. Oxyiodid., Borated Hydrogen Her ox., Brilliant Green, Calc. Sulphide• Stearettes, Carbo., Colloidal Metals, Cupri Acet., Cupri Oleat. Ung., Elix• Calc. Iodid., Eusol, Formosyl, Glyc. Bellad., Hamamelis, Horse Serum, Hydrogen Peroxid., Iodates, Iodoform, Iodol, Methysal Balm, Naphthalin, Nuclein Inj., Oxygen, Unna’s Paste, Pasta Amyli Iodid., Paste Carbonis et Zinci, Parathyroid, Paraffin No. 7, Plumbi Subacet. Glyc. and Ung., Pot. Biborate Solution, Pot. Permang., Radium, Resin Ung. and Res. Ung. c. Chlorof., Resorcin, Salol, Sanitas, Scarlet ‘ R,' Sod Cit. locally to soften, Sphagnum, Strepto. Vaccine, Toluol, Trilactine. Ung. Pheno-Boric., Ung. Pot. Chlorat. et Zinci, Ung. Thorii Oleat., Zinci Chlorid., Zinci Oleat. Ung., Zinc Perox., Zinci Sulph. Solube as Lotio, Zinc and other Ions, Pot. Biborate Solution. Tropical ulcers well treated as follows :—Daily bath for 1 hour with Mercuric Chloride 1 in 2,000, followed by Boric fomentations every 4 hours ; the following ointment then applied—Zinc Oxide, Salicylic Acid, Ammoniated Mercury Ointment, Vaseline, equal parts. Put on i inch thick and leave for 3 days without dressing. Leg should be rested. Bapid improvement.— N. Cantlie, Jl. Trop. Med., Feb. 1/23,38. Natural healing of ulcers. Too many fomentations—dry dressings better.— N. H. Joy, B.M.J. i./31,80. Ulcer, Duodenal.—Cocaine Period., Mist. Bismuthi Phenolis et Morphine, Kaolin for lubricant effect. Pulv. Bismuth Co., MacLean. Succus Allii diluted with three times quantity of water. To counteract constipation resulting from Bismuth give Pil. Hyd. Subchlor., Ithei, Cascarae et Capsicin. When active symptoms subsided a tonic of Papain 2 grains, Phenol 2 grains, Strychnine ^ grain, Codeine I grain, Rhubarb Ext. J grain.—Guthrie Rankin, B.M.J. ii./io,181. Ulcer, Gastric.—Aperfine, Argenti Nit., Ferri Perchlor., Gelatin, Glucose, Inf. Svmphyti, Kaolin for lubricant action, Mist. Bismuth, Phenol et Morph., Pulv. Bismuth Co., MacLean, Horse Serum, N. Saline Inj., 01. Olivae. Sod. Cit., Calc. Phosph. Tribasic, Mag. Phosph. Tribasic, Sippy’s Powder. (1) promote healing by nourishing food ; (2) “ fix ” the gastric acid and so prevent it from interfering with healing by ensuring that the food contains a large proportion of protein ; (3) prevent distension of the stomach by small feeds. Milk and egg diet supplemented by Iron and Bismuth. Pain disappears early, vomiting quickly subsides and relapses are rare.—Hutchison. Diagnosis.—See Stomach Contents Examination. Toxic symptoms from very large doses of alkalis in peptic ulcer.—A. F. Hurst, L. [./23,1288. Peptic ulcer—aetiology of. Various stages of acute ulcers produced by Histamine injections. It may be a factor in producing it clinically.—L. O'Shaughnessy, L. i./3i,177. Gastric and duodenal ulcer. Good immediate medical results by means of rest in bed, milk diet and alkalization.—A. Rendle Short, B.M.J. i./31,435. Undulant Fever.—Trypaflavine, see also Mediterranean Fever. Uraemia.—Aconite, Atropine, Bromides, Caffeine, Cannabis, Digitalis, Elaterin Pulv. Co., Erythrol Nitrate, Hyd. Subchlor., Lithii Hippuras, Nitroglycerin, Papaverine, Parathyroid, Pilocarpine, Saline Purgatives, Saline Solution, Scilla, Sodii Benzoas, Strophanthus, Venesection. Uraunia and Albuminuria treated by 1 Cc. of 1% Pot. Permang. hypod- Almost complete suppression of urine reacted to 10 drops of 1% solution- Some local pain at site of injection, but this is relieved by hot fomentation. -—F. V. Davison, L. i./i 6,430. Treatment of uremia. 5% Glucose given to a patient with a large white kidney and considerable oedema—patient much brighter. Query as to efficacy of Calcium Lactate and alkalis.—Prof. F. G. Langmead, L. i./3o,407. Suggestion to give 6% or 7% Glucose. Parathormone in large doses diminished oedema.—-E. P. Poult on, ibid. Large doses of alkali effective.—A. A. Osman, loia. Caffeine Sodium Salicylate in 2 grain doses valuable in promoting excretion of the kidney.—Sir W. Willcox, ibid. . Diagnosis. Blood urea estimation of value in combination with clinical signs.—A. A. Osman and H. G. Close, B.M.J. i./3i,1065. Uraemic Convulsions—Bromides, Chloral (per os or per rectum), Chloroform, Jaborandi, Morphine, Saline Solution, venesection or catharsis, may prolong life. Urethritis. Locally—Argent. Nit. (0-02 to 0-1%) Irrigation or combined imth Hydrogen Peroxide (1 to 2 volume) ; Glyc. Resorcin, Many. Butyrate (In].), Mercurome, Santalol (per os), Turpentine by catheter. See also Gonorrhoea. Uric Acid Diathesis.—See Gout, Rheumatism. Urinary Calculi.—See Calculi. Urine, To render Acid.—Aspriodine, Benzoic Acid, Sod. Phosph. Acid (the natural acid of the urine), Salicylic Acid (increases acidity slightly). Large doses of Citric or Tartaric Acid. Urine, to render Alkaline.—Potassium, Sodium, Lithium, Calcium Tartrates, Citrates and Carbonates. Post-operative urinary retention treated by emptying the bladder by catheter and giving injection of Glycerin 50 Gm., Boric Acid 5 Gm., Sterilised Water 5 Cc. Micturition established in 15 to 30 minutes. Only one failure in 175 cases.—B.M.J.E. i./26,20. Urine, Blood in.—Ammon. Chlor., Calc. Lactas : Iron Salts. Urine, Incontinence of.—See Incontinence. Urine, Retention of.—Hexamine intravenously. Glucose intrav. feeding Post-operative Retention of Urine.—Pilocarpine intrav. 1/8 grain, or per rectum i grain, often successful where Urotropine fails.—per M.A., 1931,10. Brief experience favourable.—A. R. Short, ibid. Urine, Tests for Albumin, Sugar, etc.—See Vol. II. ^Urinary Antiseptics.—See Antiseptics, Urinary. “Urticaria.—(For Diagnosis, Protein Skin Tests). Bromides, Calcii Lactas, Cream of Tartar, Elix. Sod. Lact., Ephedrine, Ergotamine Tart., Magnesia Cream, Manganese Butyrate, Milk and Glycerophosph., Mist. Alba, Peptone Inj., Pituitary, Sodii Bicarb., Sulphur (Stearettes), Terebene, Trilactine. Desensitisation.—J. T. Ingram, L. ii./31,128. Locally.—Acid. Benzoic, Boric., Carbolic Lotio, Hydrocyan. Dil., Chloroform, ■ Cremor Sicc. Preps., Liq. Hamam., Ung. Coca,in., Perfumed Formosyls, Plumbi cum Lacte Lotio, Sodii Curb., Balnea, Zinc and Starch Powder. Uterus, Catarrh of.—See Catarrh, Uterine. Uterus, To promote Contraction of.—Cimicifuga, Cornutine, Ergot > Preps., Gossypii Bad. Cortex, Hamamelis, Hydrastis, Pituitary Ext. Liq. (Posterior lobe), Saccharum. If malaria be diagnosed in pregnancy give Quinine or Quinidine at once— divide dosage into 21 or 5 grain doses every 2 or 4 hours.—See p. 742. Uvula, Relaxed.—Locally.—Gargles of Alum, Catechu, Ferric Chloride, Kino, Pigment of Glyc. Tannin, Pot. Chloras, Rhatany, Kino or Tannin Lozenges, i Zinc Sulph. or Zinc Chlor. Gargle and Pigment. Vaginitis.—Ovules var. (q.v.), Argent. Proteinas, Formalin Dil. (q.v.), Pess. Ac. Lactic., B. Ac. Lactic Paste in milk freshly made and smeared on, Thyma- glycine diluted. Varicella. Chicken pox is air borne. It may uncommonly be conveyed by air on the third day, but apparently not afterwards. See Table of Diseases. Vesicles should be painted with Iodine from the first; prevents scarring. Varicose Ulcers.—Calcii Chlorid., Calcii Iodid., Parathyroid Gland. Locally.—Allantoin, Flavine, Silver Chloride suspension. See also Ulcers. Unna’s Paste over layers of gauze after packing with Zinc Ointment. A ; bandage is wound round and at each turn it is painted with Unna’s Paste. If possible allowed on for a week—repeat later.—J. Devane, L. ii.,/27,865. . Unna’s Paste has been modified for treatment. Hunt’s bandage method for varicose ulceration. The surrounding tissue is protected with vaseline and the ulcer covered with strips of g. p. tissue. Non- absorbent wool completes the dressing.—B.M.J. i./3i,124. Indolent ulcers treated with elastic bandage and injection. Vicious circle converted into a ‘ one-way street.’—D. WTright, B.M.J. i./31,399. MM 2 Aspirin Powder sprinkled on floor of ulcer analgesic—effect lasts 4 to 7 days. —A. D. Wright, L. U./31,913. Varicose Veins.—Tinct. Nucis Vom., Tinct. Hamamelis in Spt., Iodine Injection (Schiassi’s Method). Ext. Hamam. Liq. lightly applied. TJnna’s Paste modified on bdge. Quinine and Urethane intrav., Sodium Morrhuate, Sodium Salicylate injections (Sicard and Paraf ), also Lithium Salicylate and Tutocaine. Glucose, 3 Cc. of a 66% solution ; k Cc. Glycerin of Phenol; as also Iodine have also been used with good results.—A. H. Douthwaite, B.M.J. ii./26,554, and a brochure 1927 (H. K. Lewis). Elastoplast Bdges., p. 267. Variola.— Hydrarg. cum Greta (q.v.) 10 grains ter die, appears to abort. Variola, To prevent pitting.—Acid. Boric. Ung., Acid. Carbolic 01., Argent. Nit., Calcis Linim., Colloclium, Hydrarg. Ung., Iodine Dilute, Phenol pure, Styptic Colloid., Zinci Oleat. Ung. Pot. Permang. (q.v.) Bath 5% or less. Izal Dilution, Bath of. Vasodilators.—Acetylcholine, Amyl Nitrite Sterules, Benzoates, Erythrol Nitrate, Hippurates, Mannitol Nitrate Tablets, Nitroglycerin Tablets, Sodium Nitrite, Spirit of Nitrous Ether, Thyroid Extract. Venereal Diseases.—See Syphilis, Gonorrhoea, Chancroid. Vermicides.—See Parasites and Worms. Vertigo.—Acid. Hydrobromic (with a little Quinine), Adrenalin per os Ammon. Spt. Arom., Aspriodine, Nitroglycerin Tablets, Caffeine, Guarana, Quininse Valerian, Strychnine, Zinci Yaler. Small doses of Mercuric Chloride arc recommended by Sir J. Dundas Grant. —Pr., Aug., '27,99. Vincent’s Angina. Vincent’s spiroehsetse and Fusiform Bacilli—infection of mouth, eyes and penis. Mixture of Arsenic and Ipecac, as also the Pigmentum Ipecacuanhce et Arsenici (q.v.) applied to the mouth, cleared up the condition.—F. B. Bowman, L. ii./i 7,536. Salvarsan topically or thorough irrigation with Iodine. Hydrogen Peroxide Gargle, Sod. Perborate Paint and Wash, Trichloracetic Acid said to be specific. Voice, Loss of.—Cocaine, C.L.O. Emulsion, Formosvl, Lichenoids, Pastils, Menthol, Ozonic Inhaler, Pot. Permang. Solube, or Solube Phenol, dissolved as gargle, Pot. Chlor. and Borax, Rhatany, Solube Borax Co. Throat Pastilli ^Glycogelatin, q.v.), Tab. Formalin (to suck). Amyl Nitrite and other Vasodilators in hysterical aphonia.—Vide Amyl Nit. Vomiting.—Acetanilide, Arsenic, Acid. Carbolic, Acid. Hydrocyanic. Dil., Ammon. Bromid., Beef Essence (Brand’s), Bisedia, Bismuth preps., Calcii Chlorid., Calcis Aqua, Chloral, Chloroform preps., Coca and Cocaina, Cremor Magnes., Elixir Gentianse Acidum, Hydrog. Perox., lodi Tinct., Magnes. Carb., Morphin. livpod., Nitroglycerin., Nux Vomica, Pot. Bicarb, c. Acid. Citric Mist., Elferves., Sedeff, Sodii Phosph. Eff., Yin. Ipec. in minim doses, N. Saline per rectum. Of infancy, Sod. Bicarb. ; of Pregnancy, see Pregnancy. Vcmiting Post Operative.—Adrenalin per os, Chloretone, Cocaine subcut. Sec also Vomiting if patient able to take internally. For vomiting after Chloroform—a few drops of Chloroform on Sugar. Vomiting, Cyclic or Recurrent.—Glucose Injection, Rectal Feeding. Sod. Bicarb. 1 dr. in N. Saline intrav. Warts and Corns—Lime Water internally. Locally.—Ac. Acetic Glac., Ac. Carbol., Ac. Nitric, Ac. Chromic., Ac. Picric, Ac Trichloracetic, Arg. Nit., Carbonic Acid Snow, Collodium Callosum, Collod. Salicyl., Collod. Salicyl. c. Ac. Lactic, Formalin, Glyc. Papain, Hydrarg. Nitras, 01 Cinnam., Iodi IAnim., Liq. Arsenicalis, Paraform Collod., Potassce Liquor, Radium, Liquor Sodii Ethylat., Magnesium, and Zinc Ions, ‘ X ’ rays. Calcium Carbonate or Phosphate 2 parts, Hydrous Wool Fat 3 parts, applied over a period of 4 to 6 weeks, is said to have been effective. Water Purification.— Chlorination, Copper, Iodine, Permanganates, Potassium Iodate, Sodium Persulphate and Acid Sulphate. Wax in the Ears.—01. Amygd. then syringe or Hyd. Perox. or diluted c. equal vol. of Glycerin, syringing afterwards, Glyc. and Sod. Bic. Saturated Solution. _ , , Whitlow.—Hydrog. Perox., Mang. Butyrate. Whites.—See Leucorrhoea, Whooping-cough (Pertussis).—Ac. Benzoic and Benzoates, Ac. Carbolic i* -Hydro cyan. Dil., Adrenalin, Allii Succus, Alumen, Amyl Nitris, Apomor- pmne (minute doses), Atropine, Atropine Methyl Bromide, Belladonna (almost specmc), Benzol, Bromides, Bromoform Ether injection into the buttock (children under 1 year 1 Cc.), Bryonia, Caffeine Tri-iodide Pil. (Billimoria), Calcis Aqua, Calc. Sulphid., Benzyl Benzoate, Camphor Elixir, Camphora Monobrom., Chloral, Cocaine HC1. (on the basis of one grain thrice daily for an adult), Codeine Jelly, Conium, Gelsemium, Glycaphorm, Grindelia, Hexamine, lodme m small doses, Ipecac., Lobelia, Morphine, 01. Succini, Oxygen inhala- tion, and with Alcohol, Ozonic Ether, Papaverine, Phenacetin, Phenazonum, d°t. Brom., Quinine, Senega, Sodii Benzoas, Stramonium, Syrup Thymi, and Ext. Liq., Syr. Pini Terp. Heroin, Tab. Formalin (to suck), Vaccines, Thymaglycin, 10 m. doses for children diluted useful. Argent. Nit. 2% as Pigment, Ethyl Iodide Inhaled, Oxygen subcutaneously (L. i./2 7,89), Pigment Cocaine et Hyd. Perchlor., Succini 01. as Liniment, Vapor Cornua’, Fumigate room with Tricresol or Sulphurous Acid, Resorcin as Nebula, Trichloracetic Acid, Vapor and Liniment Terebeni., ‘ X ’ Rays. Croton Oil 1 ounce, Cantharidin 3 grains, Strong Acetic Acid 1 drachm, Almond Oil to 8 ounces painted weekly back and front for whooping cough. Aborts within 14 days.—W. J. Midelton. Full doses of Carbolic Acid, Belladonna and Ipecac, with 1 m. a day for each year of child’s age of Adrenalin Solution.—B.M.J. ii./2i,224. A mixed vaccine usually beneficial. Small dose of Belladonna, Bromide, and, if severe, Morphine and Antipyrin. In later stages, where there is no bronchitis, Benzyl Benzoate.—T. Izod Bennett, L. i./23,198. Even in small infants large doses of Vaccine. Favourable results.—L. ii./3o, 1304. ' * Worms (Intestinal):— Ankylostoma Duodenale (Hookworm). See Ankylostomiasis. Ascarides (Threadworms).—Acid Carbolic 2 grains i hour ante cib. and Ung. Hyd. to rectum for a few nights. Alum. Subacet., Carbon Tetrachlor., Chenopodium Oil, Enemata Aloes, Sodium Chloride, Salicylic Acid, Thymaglycin, Thymol or Quassia, Quassia, Suppositories. Filix Mas has cured. Methyl Aspriodine should be tried internally. Chloroform 3 to 4 Gm. kills the parent organisms and prevents development of ova. May well be combined with Castor Oil or Olive Oil. Effective against ascarides, as also against Ankylostoma, Oxiurides, and Tricocephalus. Acute ascariasis associated with trichuris trichiuria (whip worm). Santonin and Salol effectual.—C. Bussell Corfleld and B. Hirson, L. i./22,995. Ascaris lumbricoides infection and Strongyloidosis treated with Santonin or Oil of Chenopodium.—N. Cantlie, Jl. Trop. Med., Feb. 1/23,42. Bismuth Carbonate, as suggested by Loeper, a specific. For an adult 3 doses of 20 grains, at intervals of 4 hours, and for a child under 7 years 10 to 40 grains per dose. Simple and instantaneous cure.—G. Simpson, B.M.J. ii./29,604. Correspondence on treatment.—B.M.J. ii./3i,517. Lumbrici (Round Worms).—Areca, Calomel, Chenopodium, Jalap, Naphthalene, Santonin (with garlic draught), Spigelia, Conf. Santonin Comp., Turpentine. Tcenia (Tapeworm).—Calomel, Cousso, Filicin, Filix Mas, Kamala, Oleum Terebinth c. 01. Bicini, Pelletierine, Pepo, Thymol, Terebene. Trichuris trichiuria effectively treated with Thymol or Oil of Chenopodium. —N. Cantlie, Jl. Trop. Med., Feb. 1/23,42. Many of the above drugs may be prescribed as Stearettes or Formagules, q.v. Colonic lavage with Dimol. Wounds.—Allantoin, Aseptafilm (applied as covering), Brilliant Green, Chloramine-T, Collodions, Cyanide Paste, Dakin’s Solution, Glycerin and Glucose (combined), Glucose Powdered, Eusol, Formalised Gelatin, Hydrogen Peroxide, Iodine Tincture, Kelly’s Paint, Liq. Alum Acet., Mastiche Benzol, Metaphen, Petrolatum lodi, Mercuric Chloride or Biniodide Lotion, e.g. from a “ Solube ” 1 in 2,000 Mercurome.—Bandages, Gauzes, Lints, Wools medicated with Boric Acid, Carbolic Acid, Iodoform, Mercuric Iodide, Mereuro-Zinc Cyanide, Picric Acid, Thymol Iodide, etc. See also Antiseptics. For Skin Sterilisation.—See Iodum, p. 511, and Sublimate, pp. 468, 470,PIei’curome, p. 480. For the 10 years prior to 1925 Sir J. Bland Sutton said he had abandoned dressing dry wounds. Where drainage is unnecessary, dressings are unnecessary. Once daily the line of incision and the sutures are smeared lightly with Tincture of Iodine or similar antiseptic and left exposed to air, or merely in contact with clean underclothes. The wound heals rapidly, safely and soundly, with minimum discomfort and minimum expense.-—B.M.J. ii./25,826. Wounds in War.—Wre dealt fully with this matter in the Seventeenth Edn,, p. 1015, et seq. The salient points are now incorporated in the body of the book. “ Back to Lister.,f—A discourse on antiseptic surgery.—Sir Rickman R. Godlee, B.M.J. i./i5,515. Lister’s Strong Antiseptic Mixture consisted of Carbolic Lotion 1 in 20 containing l/500th part of Corrosive Sublimate. Employed successfully for washing out recesses of wounds.—Arthur Edmunds. Hydrargyri et Zinci Cyanidum. Cyanide Gauze. ‘ Quite good for visible clean wounds.’—A. Don, B.M.J. i./i6.648. Dry Cyanide Gauze also found excellent for ‘ suppurating' abrasions, boils and skin affections.’ Iodine. Wounds in naval warfare are frequently septic owing to the circumstances. In the ‘ Tiger,’ routine practice was first to wash with soap and water. After removing all foreign matter to dehydrate by flooding with S. V.M. and then sponge with 10% dilution of Tincture of Iodine in Methylated Spirit and insert drainage tubes and then cover with gauze.—B.M.J. ii./i6,598. Some say it is irritating, and that the pain continues for some time, but we do not think this is generally acknowledged. Wounds which are to heal by granulation, Quinine-Urea Hydrochloride 1 in 600 should be liberally injected as a prophylactic against pain.—R. E. Farr, L. ii./29,1199. Yaws.—Arsenobenzol, Novarsenobenzol, Salfarsenol, and Silver Salvarsan. Bismuth Compounds injected. Bismuth Oxychlor. Ung. Sodium Bicarbonate in 1 drachm doses together with Copper Sulphate locally. Potassium Iodide 10 to 20 grains for adults, 2 to 5 grains for children thrice daily. If ansemic Ammonio-Citrate of Iron. Locally.—Mercuric Nitrate Ointment (1 in 3 Soft Paraffin). See also Frambcesia. Yellow Fever.—Serum of Convalescent Patients tried. See Yol. II. Zoster.—See Herpes. ANTIDOTES TO POISONS. Fuller information regarding many of the following is provided in the body of the book. Acetanilide.—Emetics. Inhalation of Ether and Oxygen.—Stimulants, e.g., Brandy, Coffee, Strychnine. Acetylene.—ds Carbon Monoxide. Acid Carbolic.—Saccharated Lime Water is best from the chemical standpoint. Magnesium, Sulyhate or Sodium Sulphate {latter in preference) 4 oz. in 4 pint or more of warm water is wrong theoretically. Soft stomach tube with utmost caution. Apomorphine as emetic, but it does not always ‘act.’ Egg White, Stimulants, Oil, Weak Iodine Tincture, within limits give same quantity of Tincture of Iodine as of Liquid Phenol taken, Saline transf usion. See p. 14. Sulphates, e.g., Magnesium Sulphate, render inert all Carbolic Acid ivith which they come in contact. Till Sulphates in the body are overcome the Carbolic group cannot act on the tissues.—E. B. Leech, L. if 27,453. Acid Carbolic Burns on Skin, see Burns Therap. Index. Acid Cresylic, see Acid Carbolic. Acid Hydrochlor.—Alkalis, Chalk, Canon Oil, Lime Water. For acids squirted in the eye, douche well with weak Carbonate of Soda solution or O'5% Caustic Potash and plenty of water. To prevent sepsis use Sublimate 1 in 6,000.— E. Clarke, Pr., July, ’27,30. Acid Hydrocyanic. Sym&toms.—Oiddiness, staggering, insensibility, eves fixed and glistening, pupils dilated, violent gasping for breath, pantin'/ respiration. The poison is readily eliminated by the breath, so if life can be maintained for even half an hour recovery is probable. Inhalation is as dangerous as swallowing or even local application or dropping in the eye. If seen in time, stomach tube or emetic. Stimulants, Ammonia {inhale), Sal Volatile ad lib. If patient cannot swallow give brandy as enema or hypodermically. Alternate hot and cold douches, artificial respiration about 20 in the minute, Atropine hypodermically, or 30 drops of Tinct. Bellad. per os, repeated. Sod. Thiosulph. 10 Cc. 10 to 30% soln. intrav. See also Potassium Cyanide. Acid Nitric.—As Acid Hydrochlor. Acid Oxalic.—The best is a mixture of Chalk (Whiting) and Saccharated Lime Water ; subsequently stomach tube. Bo not give Soda or other Alkali.— Barts. Apomorphine, Castor Oil. Acid Phosphoric.—ds Acid Hydrochlor. Acid Sulphuric.—Magnesia and other alkalis {Lime), Carr on Oil. Aconite.—Apomorphine, Stimulants, Amyl Nitrite, Atropine Sulph. grain hypod. Digitalis Tincture, 20 minims hypod. Keep patient lying down. Aconite and Belladonna {as Liniment).—Emetics, Stimulants freely —if not reta ined, dilute and give per rectum. Warmth.—Murrell. dDthyl Chlorid.—Weak Ammonia Vapour. Hot flannels to heart. See also p. 106, or proceed as under Chloroform, p. 283. Alcoholism Acute.—Empty stomach by syphon or stomach-pump or injection of rh grain apomorphine, wash out and fill with strong coffee, Amyl Nitrite Inhalation, heat to extremities, counter-irritation and injection of % grain Strychnine.—Whitla. Powdered Charcoal -} ounce in water is efficacious. Alcohol Methylic.—ds preceding. Alkalis Caustic.—See Potash Caustic and Ammonia. Alkaloids.—Emetics, Tannic Acid, Potass. Permanganate, Amyl Nitrite. See also alkaloid in question. Animal Charcoal, a tablespoonful or more in water, pumped out again and repeated. Afterwards rinse out ivith water containing the ordinary antidote, and then a suspension of Charcoal and Magnesium Sulphate if a purge is not contraindicated. Ammonia.—Vinegar well diluted, Lemon or Orange Juice, Acetic Acid. Tracheotomy may be necessary. Bronchitis kettle, Morphine. Amygdalae Amarae Oleum Essentiale vide Acid Hydrocyanic. Aniline.—Emetics, artificial respiration, fresh air, oxygen, bleeding or transfusion. Aniline poisoning. Modus operand!—Lempriere, B.M.J. ii.J30,892; H. M. Roberts, ibid. 980. Antifebrin.—See Acetanilide. Antimony Compounds.—Strong Tea or Tannin Solution (SO grains in warm) water). Bepeat as often as vomiting occurs. When this subsides give white °f eQd rn milk or water. Stimulants, Morphine when all symptoms subsided. Antipyrin.—See Phenazone. Aqua Fortis.—As Acid. Hydrochlor., q.v. Arsenic.—Emetics (wash out stomach with warm water). Antidotum Arsenici, p. 174, or if not ready, Liquor Terri Dialysatus ad lib. or Magnesia ad lib. Aspirin.—Swelling of face and tongue occurs very occasionally.—Sod.-Bicarb. Atropine.—Emetics, stimulants with Morphine or Pilocarpine, £ grain repeated. (The latter is doubtful.) See also Alkaloids. Baibitonum.—See Veronal. Barium Chloride.—Emetics, Sodium Sulphate. Battery Fluids.—See Acid Sulphuric. Battley’s Solution.—See Morphine. Belladonna.—See Atropine. Benzol.—Emetics, Artificial Bespiration, Douche with alternately hot and cold water over chest from a height, Stimulants. Biniodide of Mercury.—e.g., in Antiseptic Tablets taken in error.—See Hydrargyri et Potassii Iodidum. Blistering Fluids.—As Cantharides. Bromine.—See Chlorine. Butter of Antimony.—Vide Antimony. Butyl-Chloral Hydrate.—Emetics, Caffeine, Coffee, Atropine. Caffeine.—Stomach tube, Emetics, Nitroglycerin, Apomorphine, Hypodermic Injection of Morphine £ grain with A tropine f grain. See also p. 245. Calabar Bean.—See Physostigma. Camphor (and Camphorated Oil).—Emetics, Stimulants, Caffeine injection. Cannabis.—Stomach tube, Emetics, Stimulants, Artificial respiration. Cantharides.—If seen early, Stomach tube. Emetics. If mucous membrane much blistered give White of Egg in barley water or thick gruel—no fat.—Barts. Morphine if much pain. Carbolic Acid.—See Acid Carbolic. Carbon Monoxide and Dioxide.—Artif. respiration, Oxygen, Stimulants. In Carbon Monoxide poisoning, Glucose per os or subcut. or intrav.—Bleeding has been recommended in all cases unless contraindicated by the general condition. The quickest and most effective for Carbon Monoxide is Oxygen mixed with about 5% C02 through a mask, or make patient inhale as much as possible of expired air of another person.—Prof. J. S. Haldane, B.M.J. if 26,35 and B.M.J. ii./30,17 ; see also Y. Henderson, ibid, if 26,41-46. Carbon Dioxide relieves the symptoms before the gradual replacement of CO by 0 has taken place—probably a double action. The increased ventilation raises the oxygen tension in the alveolar air and the C02 stimulates the circulation. The latter has probably the greater immediate effect.—Prof. Haldane, L. iif 31,796. The possible presence of Nitric-oxide-hcemoglobin must be considered in suspected cases of CO. poisoning. Boil a watery solution of the blood. If red colour and other chemical reactions or spectroscopic appearances are due to Nitric oxide-hcvmoglobin, coagulum will be pink.—H. A. L. Banham, J. S. Haldane and T. Savage, B.M.J. iif 25,189. Water Gas, Coal Gas, etc., recent data.—L. if 31,224. Carbon Monoxide poisoning.—American Memorandum.—B.M.J. 1-/30,302. Coal-gas poisoning deaths.—B.M.J. if 30,355. Asphyxia, from coat gas.—The poisonous ingredient is the Carbon Monoxide, which is lighter than air. Artificial respiration. Keep patient warm. When conscious enough to swallow give hot coffee or tea—a few drops at first— with great care, to test ability to swallow. Hypodermic injections of Oxygen all over the body safe and efficacious, in addition to Oxygen inhaled. Stimulants, Strychnine, Camphor and Ether, do more harm than good. Do not dash cold water on patient.—I). A. Coles, L. iif 30, 1413. Coal gas poisoning might be treated icith Hydrogen Peroxide, mixed with Normal Saline, intravenously.—Sir W. Willcox, B.M.J. iif 30,17. Carbon Monoxide gas poisoning.—H. Hartridge, L. if 28,1137-40. Coke stoves may be a source of danger by CO production.—Sir B. Spilsbury, B.M.J. iif30, 17. Modern treatments to eliminate the CO from the blood as quickly as possible. A mixture of 7% Carbon Dioxide and 93% Oxygen recommended—successful m XJ.S.A.—R. Richards, B.M.J. ii./30,16. , Sarb°n Monoxide poisoning. Experiments by the author of the paper, l idvag experiences in a steel chamber icith various concentrations of the gas. fdental symptoms began when the haemoglobin was 30 to 40% saturated, especially of memory of recent happenings. Carbon Monoxide poisoning may cause STi\lrr fi¥fwriieJm to Alcohol intoxication— Prof. Haldane and Sir W. Willcox, R.1V1.J. ll.l30,17. Caustic Potash, etc.—See Potash. „ Shl,ora/ anc! Chloralamide.—Eeep patient awake, Strong Ammonia to nostrils, stomach tube or emetics at once followed by Amyl Nitrite, Coffee, Oxygen. Picrotoxin, Strychnine N grain, repeated if necessary in l hour. Artificial Respiration on slightest sign of failure continued some hours if necessary. Chloral and Morphine (Combined).—Stomach pump or emetic Arouse patient, but not to walk about. Ammonia to nostrils, cold then warm douche to head and chest. Atropine A gr. hypod. repeated. Strychnine A- gr. hypod if Chloral symptoms predominate. J Chlorine and other Irritant Gases.— Aecohol (Whusky Brandy, etc.) to be inhaled from a cloth soaked with it as with Ether in addition. We have found this good.—W.H.M. Sodium Bicarbonate about 10% solution inhaled through a respirator better than alcohol per os. Inhalation of Dilute Ammonia Oxygen subcutaneously into loose LiSS'iCQ • OXYGEN inhalation by passing a tube connected with a gas cylinder to the back of patient s mouth and opening and shutting the tap about 15 to 16 times a minute but it may only cause f urther irritation. For the cardiac weakness Camphorated Oil subcut. Emetics have proved useful. I- pint of Salt and Water or 8 grains of Copper Sulphate followed by large draughts of lukewarm water Pilocarpine should be injected to promote shedding of the epithelium—if this is not efficacious use Potassium Iodide. Simultaneously Morphine —J B Berkart. Liquor Atrop. Sulph. 9 minims. Water to 6 ounces. Dose.—i ounce. Removes tightness across chest. Warm Aqueous Vapour is a good, sedative. Subsequently ordinary methods of treatment of acute bronchitis. Sodium Hyposulphite in respirator solution. Venesection advised — Sir E. Sharpey Schafer. Fumes from Explosives in mines, accidents from. In all cases first produce emesis (Apomorphine Hypod.), then stimulants Ammonia or preferably Pituitein.—L. G. Irvine, B.M.J. if 16,162. Dichlor-ethyl-Sulphide (Mustard Gas, Yperite), Phosgene, and other gas poisonings.—B.M.J. ii./18,138. The first mentioned, though usually called a gas, is an oily liquid which rapidly soaks clothing and causes blisters difficult, to heal. The effect is a delaying one and is more marked on moist surfaces, e.g., from perspiration at the axillae and fork. We had occasions during the war to make preparations to be used to counteract effects—an Ointment of Chlorinated Lime seemed best. Iodine Picric Acid and others were tried. Use Sod. Bicarb. Sol. 1% for eyes. A sulphur compound allied to Mustard Gas, which produces acute oedema of the lungs when injected intravenously.—B.M.J. L/23,819. In treatment of the painful lesions apply any soothing application and inject 1% Manganese Butyrate 1 to 2 Cc, intram. on 3 occasions at 4 days’ interval.—J. E. It. McDonagh, Brit. Jl. Derm, and Syph., Eeb., 1924. Nitrogen Peroxide and other gases.—SODIUM CARBONATE 20% solution. Mustard Gas caused 150,000 casualties in the British Army alone; under 4,000 (or 1 in 40) died, while about 700 were rendered permanently unfit. It is, however, one of the least lethal methods of putting an enemy out of action._ Review of Chemical Warfare, B.M.J. i./25,847. The late effects of poison gas.—L. i.J2 6,1213. Tear-Gas (Chloracetophenone). Burns of skin should be promptly washed with a 50% Alcoholic solution of Sodium Sulphite, or Glycerin or Alcohol may be used ; for the eyes, 0-4% Sodium Sulphite dissolved in 25 Cc. Water and 75 Cc. Glycerin.—W. D. McNally Jl. A.M.A. L/32,46. Diph en ylchlora rsine, Diphenylaminechlor arsine, and Diphenylcyanarsine {three ‘ sneezing gases * contained in German ‘ Blue Cross ’ shells) react with Chlorine to produce non-irritant compounds, and inhalation of Chlorine rapidly relieves irritant symptoms. None of the therapeutic measures used during the ivar had more than a palliative effect.—D. C. Walton and W. A. Eldridge, Jl. Ph. (Sc Exp. Ther., Mar. ’29,256. Bromine.—We have found both dilute NH3 and Alcohol Inhalation good. Treatment: with animal expts. Stramonium fumes good.—W. L. Symes, b.m.j. a./15,12. Chlorodyne.—As Morphine, q.v. Chloroform Inhalation.—Amyl Nitrite, Artificial respiration—see p. 283. Inversion of the body. Strych., Caffeine or Adrenalin Injections, the last into the heart or intravenously. Chloroform {Swallowed).—Amyl Nitrite. Stomach tube or Emetic. Large draughts of water containing Sodium Carbonate, say 1 drachm in 1 pint. Lavage with warm oil, e.g., Olive, Almond, Sesame, then Saline transfusion. Coal Gas.—As Carbon Monoxide. Cocaine.—Stomach tube, Amyl Nit., Ether hypod. (5 min.). Strychnine hypod. Codeine.—^Is Morphine, q.v. Colchicum.—Evacuate the stomach, Demulcents, White of Egg, Stimulants. Colocynth.—Spirit of Camphor, Laudanum, Stimulants, Strong Tea, Opium Enema. Condy’s Fluid.—See Pot. Permanganate. Conium .-Stomach tube, Emetics, Tannin, Stimulants and A rtificial respiration. Copper Salts.—Stomach tube, Emetic, White of Egg, Milk, hot fomentations to stomach. Corrosive Sublimate.—See Hydrargyrum. Creosote.—Acid Carbolic, q.v. Curare.—Artificial respiration, Stimulants freely—see p. 851. Cyanides.—See Acid Hydrocyanic and Potass. Cyanide. Dial.—^4s Veronal. Digitalis.—Emetics, Aconitine Nitrate -r^ grain hypod.—repeated in \ hour, or Atropine ^lo to iris grain hypodermically. Tannin, Camphor, Nitroglycerin, recumbent position. Dover’s Powder.—As Morphine, q.v. Emetics are:—Ipecacuanha in powder 30 grains or % to 1 oz. of wine. Apomorphine {/0 to i grain hypodermically), strong Salt solution {tepid), Olive oil, Copper sulphate (2 to 8 grains in ivater), Tartar Emetic (4 to 1 grain), Mustard 1 tablespoon in i pint of water. Zinc Sulphate 30 grains in ivater. Ergot.—Stomach Tube, Emetics, Purgation with Castor Oil or Mag. Sulph., Tannin, Stimulants, e.g., Amyl Nitrite, Nitroglycerin gr. Patient to lie down. Exalgin.—As Acetanilide. Foxglove.—See Digitalis. Fungi.—A large proportion of deaths are due to Amanita phalloides, which peels like a common mushroom , but has bulbous part at base of stem, also yellowish green colour at edges and white gills ; it grows beneath trees ; the poison is a toxalbumin—Phallin, not an alkaloid. Stomach pump and Emetics {Ipecac. 25 grains or Salt Solution), Castor Oil, Atropine and Belladonna, Brandy, Spirit of Chloroform, Sal Volatile, Morphine for the pain, and administer normal Saline. Potassium Permanganate has been suggested to decompose any Phallin left in the stomach. On no account give Tartar Emetic where there is contraction of jaw muscles, or in the case of children. Apomorphine h gr. {or grain or less for a child) may be preferable. Give any purgative {not senna or jalap). If delirium and convulsions set in ether or chloral may be necessary {the latter may also be given in Enemata). Finally for abdominal pain Morphine or opium, but always begin with an emetic. Mushroom poisoning. Recurrence of symptoms after 8 months, though no mushrooms eaten in the interval.—Jl. Trop. Med., Mar. 15/23,94 ; Aug. 1/22,249. Gases.—See Chlorine also Carbon Monoxide, Nitrous Oxide. Gelsemium.—Emetics, Atropine or Strychnine hypodermically, also Nitroglycerin or Amyl Nitrite. Artificial respiration, Siimidants. Heroin.—See Morphine. Hydrargyrum (Mercurial Salts).—Emetics, Apomorphine, White of one Egg fo? every 4 grains of Per chloride (avoid excess), then Stomach tube or Emetics, Reduced Iron, Alcohol or Ether for collapse. {Canon Oil made with Cod Liver Oil was given on one occasion where 43£ grains had been taken.) Charcoal, cf. Alkaloids. See also pp. 454, 467. Hydrarg. Potass. Iodide (Biniodide Antiseptic Tablets taken in error).— Olive Oil, Milk, White of Egg, Petroleum Emulsion, warm draughts.—See p. 464. Hyoscine,—Emetics, Pilocarpine Injection. Hyoscyamus.—Vide Atropine. Hypnotics.—Vide Drugs in question. Iodum.—Stomach tube, Emetics {Apomorphine), Starch, Saccharated Lime Solution, or Sodium Hyposulphite, Demulcents—finally Opiates. Jaborandi.—Atropine jfc grain hypodermically or 30 minims of Tincture of Belladonna at once arrests symptoms. Laudanum.—As Morphine, q.v. Lead.—See Plumbum. Lime in the Eye.—Put in Milk or Lard or Saturated’ Sugar Solution and douche the eye with 10% Neutral Ammonium Tartrate Solution. To prevent sepsis 1 in 6,000 Sublimate.—E. Clarke, Pr., July, ’27,30. Luminal.—See Veronal. Lunar Caustic.—As Silver Nitrate. Lysol.—See Acid Carbolic. Matches.—As Phosphorus. Mercury.—See Hydrargyrum. Monkshood.—See Aconite. Morphine.—Keep patient awake. Emetic first {Apomorphine ^ grain,— vomiting is induced with difficulty), then stomach tube even if Morphine taken hypodermically. Wash out stomach with Potass. Permang. 10 grains in half a pint of Tepid Water {Morphine, even when given subcutaneously, is partly eliminated by the stomach lining). Saline Transfusion, Stimulants. Hot and cold Water poured on head alternately, drying in intervals. Ammonia to the nose. Strychnine, Atropine, ^ grain hypodermically, or if not at hand 30 m. Belladonna Tincture for every grain of Morphine, artificial respiration or Oxygen if necessary. —Murrell. Carbo Animalis often repeated, cf. Alkaloids. Mushrooms.—See Fungi. Mustard Gas.—See Chlorine. Nepenthe.—See Morphine. Nickel—Purgation. Nicotine.—See Plants, Unidentified. Nightshade—See Atropine. Nitrobenzol.—See Oil of Mirbane. Nitroglycerin {as used in blasting ivork).—Maintain recumbent position. Apply ice to the head, give Ergot per os or hypod.—Murrell. Nitrous Fumes.—See Carbon Monoxide and Chlorine. Nitrous Oxide {Dental).—Vide page 142. Novocain.—As Cocaine. Nux Vomica.—See Strychnine. Oil of Mirbane.—Copper Sulph. (2 to 8 grains), or other Emetics, Stimulants, Atropine, Artificial Respiration, Calomel, Bismuth. Oil of Vitriol.—See Acid Sulphuric. Opium.—See Morphine. Paraffin (Paraffin Oil of Commerce).—Stomach tube or Emetic. Paraldehyde.—See Chloral. Paris GreenCharcoal, cf. Alkaloids and Arsenic. Petrol Poisoning. Fresh air and warmth, Camphor injections, Oxygen. Phenacetin —Stimulants : Brandy, Coffee, Strychnine. Phenazonum. Brandy, Ether, Strychnine, Oxygen. Phloroglucin.—Charcoal, cf. Alkaloids. Phosgene.—See Chlorine. Phosphorus. Oil of Turpentine has been recommended bvt not other oils, 1 ctass. 1 ermang. Solution 1% per os Murrell advises 3 grains Copper Sulphate every five minutes until vomiting is induced. To be continued 1 grain every fifteen minutes with a little Morphine if rejected. Epsom Salts as purgative. Charcoal, cf. Alkaloids. Oxidising agents, e.g., weak Hydrogen Peroxide, may be given—E. B. Leech, L. i./27,453. * Physostigma. Emetics as Mustard, Zinc Sulphate, Apomorphine, Pot. Per- mang. by stomach tube, Atropine -f0 grain, or in bad cases Strychnine A- grain hypodermically, stimulants freely. Pilocarpine.—See Jaborandi. Pit Gas.—See Carbon Monoxide. Plants, Unidentified. Stomach tube, Emetics, Aperients, Treat symptoms, Artificial respiration. Plumbum.—Emetics (Zinc Sulphate or Ipecacuanha), stomach tube, dilute Sulphuric Acid i drachm in water ; Magnes. or Sodium Sulph., Poultices to abdomen ; Morphine hypodermic., for pain. See also Plumbum in text. Potassium Eichromate.—Emetics, Mag. Curb., Barley Water, Arrowroot or thick Gruel and stimulants. Potash, Caustic. Dilute Vegetable Acid, Fixed Oils. Not stomach tube Potassium Chlorate.—Stomach Tube, Emetics. Stimulants. Potassium Cyanide. Ferrous Sulphate Solution, large draughts, stomach tube, J^wictics, StiuiulctYitSy Avtificictl respiT(itio7i,—See also Acid Hydrocyanic* Martin s Antidote consists in formation in the gastro-intestine of Prussian Blue. Thus 30 Cc. of Ferrous Sulphate Solution 23% strength, 30 Cc. of Caustic Potash 5%, and 2 Gm. of Magnesia ; the two former to be kept in sealed ampoules, to be mixed and taken immediately.—B.M.J. i./i3,271. Sod. Thiosulph., 10 Cc. 30% intrav. Potassium Nitrate.— Stomach tube or Emetics, Mucilaginous Drinks, White of Egg, Stimulants, Atropine if sign of heart failure. Potass. Permanganate.—Lavage of Stomach, Warmth, Strychnine hypod, “ Ptomaines.”—Finely powdered Charcoal is suggested as a suitable antidote after eating tainted or suspicious food (as under Fungi). Rat Paste.—See Phosphorus or Arsenic. Red Precipitate—As Ilydrarg. Give White of Egg freely followed by lavage of stomach. Salt of Sorrel or of Lemons.—See Acid Oxalic, Savin.—See Plants, Unidentified. Scopolamine.—See Hyoscine. Sewer Gas.—See Carbon Monoxide. Sheep Dip.—(?) Arsenic, Silver Nitrate.—Common Salt in demulcent drink (avoid excess), White of Egg, Milk. Stings, Wasp, Bee, etc.—Ammonia or any Alkaline Solution. See also Therap. Index, Bites and Stings. Stramonium,—See Atropine, Strophanthus.—After evacuation by emetics and Stomach Tube, Tannin and stimulants. Anaesthetics to relieve spasm. Strychnine.—Stomach Tube, Emetics, Potass. Permang., Chloral, Amyl Nitrite. Charcoal ad lib. Acid Tannic, Potass. Brom. (i ounce in water with 30 grains of Chloral Hydrate). Patient may be kept fully under Chloroform or Ether. Artificial respiration if possible (most important). Saline transfusion# Sublimate.—See Hydrargyrum. Sulphonal.—Emetics, Stomach Tube, Strong Coffee, Strychnine, Artificial respiration. Patient to remain lying doivn. Sulphuretted Hydrogen. —Iodised Starch (5% Iodine rubbed into Starch with a little water and dried). Inhalation of Chlorine best. Prolonged inhalation of Sulphuretted Hydrogen, even in as low a concentration as 100 parts per million, is reputed to induce symptoms of chronic intoxication\. Strictly speaking, it is an irritant gas.—Jl. A.M.A. ii.j25,119 ; also L. IF. Smith and co-workers, ibid. 177. Tetrachlorethane.—See Jaundice, Vol. II. Tobacco.—See Plants, Unidentified. Trional.—See Sulphonal. Turpentine .—Empty stomach by pump or tube or give emetics—Apomorphine if necessary, Mag. Sulph., Demulcent Drinks. Verdigris.—See Copper. Vermilion.—See Hydrargyrum. Vermin Killer.—As Strychnine or Arsenic, q.v. Veronal.—Empty stomach by pump and enemata. Coffee, Strychnine, Artificial respiration, later diuretics. See also several recent abstracts of poisoning cases under Veronal. Weed Killer.—See Arsenic. Weever and other poison fish cause intolerable pain. Trawlers should have permanganate lancets on board, Chlorinated Lime, also Gold Chloride injections relieve pain.—M. Evans, B.M.J. ii.j21,200. White Precipitate.—See Hydrarg. White of Egg freely. Zinc Salts.—Not stomach tube. Washing Soda. Milk and White of Egg Olive or any innocuous oil. Morphine. Treatment of Poisoning.—E. B. Leech, L. 1;2 7,452. Occupational diseases of ear, nose and throat, and their prevention. Anthrax, Lead poisoning, Mercury, Phosphorus, Nitrous fumes, Chlorine ulceration j compressed air illness, glanders.—E. H. Westmacott, B.M.J. ii./25,886. Electric Shock as from Live Electric Wire, also Lightning Shock and bums. Separate from live wire by catching hold of clothing or by using a good thick layer of cloth (dry) or a newspaper. If necessary cut a live wire with long iron scissors in wood handles. For burns Boric compresses. Raise the head. Artificial respiration. See also Vol. II., Radiology Chapter. Whether a shock is fatal or otherwise does not depend upon the voltage (pressure). The amount of current (amperes) which any pressure can force through a body and the path it takes determine whether fatal or not. A rabbit generally survives 2,000 volts, not because it can stand a larger current through its body than any other animal, but because the skin of a rabbit offers such a high resistance that even 2,000 volts cannot force enough current through to kill it. On the other hand 20 volts has killed a horse, whether it is the iron shoe held on by steel nails or the frog of the hoof, the fact remains that 20 volts can force enough current through the horse to kill, provided it enters and leaves at the hoofs, where the resistance is very low. Sometimes 200 volts will kill a man, while under other circumstances he would hardly feel it.—A. J, Abraham. INTRAVENOUS DOSES. The following are results of our experience, or have been collected from various authentic sources. Intravenous injections call for great care. The be slTall> freely diluted, in isotonic solution and slowly injected. The therapy in respect of some of the chemicals is entirely new and we should welcome suggestions from clinicians to extend the information. Statements in some Medical Journals—especially foreign—as to the amounts of chemicals employed intravenously have sometimes amazed us. We have proceeded on the side of caution in giving limit doses. We recommend trying half or even Quarter doses or less at first, freely diluted, where the method is new. The injection of foreign substances into the blood serum is in itself a risky business. Changes in blood pressure, collapse, shock and symptoms bordering on anaphylaxis may occur.—L. i./26,241. Use a needle having a flat bevel with no shoulder and a sharp point, avoiding the drawn out point which may puncture the further side of the vein, or the lumen may fail to completely enter it.—H. Pritchard, B.M.J. i./27,792. Every kind of intravenous injection except Normal Saline has at some time or other proved fatal—not to be embarked on lightly.—L. J. Witts, L. ih/30, ^59. Sterile solutions for injection. Intravenous injections to have no antiseptic. Pharmacopoeia Revision recommendations.—P.J. H./3i,S. Indigo- Carmine advised to be autoclaved—we do not.—P.J. ii./31,9,49. Intraperitoneal injection for certain drugs, Adrenalin, Pituitrin, Caffeine, Atropine, and Quinine, is stated to be more practical than intravenous injection, and should be used when both rapid and lasting effect is required.—W. H. Zeigler, Jl. A. Pharm. Assoc., Feb. ’25,86 ; C. & D. i./25,462. CHEMICAL. AMOUNT. VOL. OF DILUENT. Acaciae Gummi.. 16 Gm. (or more) 250 Cc. (or more in proportion). Acriflavine, see Euflavine Adrenalin.. 0-5 Cc. of 1 in 1,000 solution Usually added to 250 or 500 Cc. Normal Saline—to be given within 20 to 40 mins. Amiodoxyl Benzoate .. 0-75 Gm. (?) 100 Cc. N. Saline. Antimonii Oxidum 0-0006 Gm.—0-0012 G111. 1 to 2 Cc. Glyc. + Aq. Antimonium Tartara- 0-03—0-1 Gm. 3—10 Cc. turn (Antim. Pot. Tart.) Antimon. et Sod. Tart. 0-03—0-1 Gm. 3—10 Cc. Antitoxins, See body of the work. Arsamin .. 0-01 -0-05 Gm. 1 Cc. Arsenobenzol 0-3 or 0-4 Gm. 300 Cc. Bayer 4 205 ’ 1 Gm. (?) 10 Cc, Caffeinae Sodio-Benz.. . 0-12 Gm. 5 Cc. Calcii Chloridum “ Chaulmartin ” 0-25 G111. 0-5—1 Cc. 5 Cc. Choline Hydrochloride 0-6 Gm. 180 Cc. Cocainae HC1. Enormous dose necess ary—not suited for use. Colchicine 1/100 grain Has been tried c. Sod. Iod. & Sod. Salicyl 1 Gm. each in 20 Cc. Colloidal Copper w fl in 2,000 0-5—1 Cc. Colloidal Gold .. 0 1 in 4,000 5 Cc. Colloidal Mercury fc w ' p? 1 in 2,000 5 Cc. Colloidal Selenium 1 in 5,000 1 to 5 Cc. Colloidal Silver. . Coramine. . H m U in 2,000 1 Cc. 5 Cc. Undiluted. Bigitalinum Pulv. Pvr. 0-0006 Gm. (1/100 grain) 10 Cc. Digitoxin . . 0-00015 Gm. (1/400 grain) 10 Cc. Emetinae HC1. . . 0-03—0-04 Gm. (Rogers) 5 Cc. Euflavine . . 0-25 Gm. 50 Cc. INTRAVENOUS DOSES. CHEMICAL. Ephedrine HC1... Ether for Anaesthesia Eusol Ferri Cacodylas Gentian, Violet Glucose Glycerin .. Hexamine . Hexamine with Sodium Iodide 1 Gm.. . Hydrargyri Cyanidum. . Hydrargyri Iodidum (c. Sodii Iodid, q.s.) Hydrargyri Qxy- cyanidum Hydrargyri Per- chloridum Indigo Carmine Iodi TincturaMitis'Ol Lobelin Ingelheim Locke’s Solution Magnesium Sulphate Mannitol-Quinine AMOUNT. $ grain (?) 5% in N. Saline 50 Cc. 0-06 Gm. 0-2 Gm. (in 5% solution) '4 Cc. 1| Gm. increased 1-5 Gm. 0-012 Gm. (1/5 grain) Many (female) patients could stand twice the amount.—J. E. Lane, L. ii./ai,796 0-005 Gm. (Larger quantities in less 0-005 Gm. (1/12 gr.) (0-012 Gm., i.e. 1/5 gr. has also be 0-002 (Gm. 1/32 grain) (Larger quantities in less 0-02 to 0-04 Gm. f.) 1-2 to 2 Cc. (We suggest less to try) .. 0-003 Gm. 500 Cc. 1-0 Gm. 1 Cc. Mercurome Morphine Salt 0-05 Gm. (?) \ to 1 grain Novarsenobenzol Oleum Chaulmoogrse Paraldehyde Peptone .. Peptone .. Phenolsulphonephtha- lein Quinidinae Hydro- chloridum Acidum .. Quininae Hydro - bromidum Acidum . . Quininae Hydro- chloridum Acidum .. Quinine-Urethane Ringer’s Solution Saccharum Sanocrysin .. 0-6 Gm. or 0-6 Gm. (See page 604), give Sod. 5 to 15 Cc. Graded doses as follows : 0-3, 0-5, 0-7, 0-9, 1-1, 1-3 Cc. and 4 doses of 1-5 Cc. (Further doses, 3 of 2 Cc., 3 of 2-5 Cc.) 8—10 Cc. increased by 2 Cc. every other day until 18—20 Cc. given 6 mgr. 0-3 Gm. to 0-6 Gm. 0-5 Gm. 0-25 to 0-6 Gm. 1 Cc. divided 500 Cc. (more or less) 10-3% (isotonic) 0-125 Gm. (?) VOL. OF DILUENT. 5 Cc, v. p. 99. 5 Cc. 80 Cc. 500 Cc. or more. 4 Cc. 10 Cc. 20 Cc. 1-2 Cc. 5 Cc. vol. have also been given) 5 Cc. in 1-2 Cc. (20 minims) en given). 5 Cc. vol. have also been given) 10 Cc. 10 Cc. N. Saline (Baillie, L. i./i9,423). more or less 10 Cc. 20 Cc., but clinical data awaited. 10 Cc. 10 Cc.—Haynes, Pr. Sept. ’3i,379, vile also our p. 553. 10 Cc. 120 Cc. Chaulmoog. in preference. 150 Cc. 5% Solution, neutralised (For asthma a 7i% Solution is given intramusc. v. pp. 663, 664.) 10% Solution, neutralised. (For septicaemia.) 2 Cc. 5 to 10 Cc. 10 Cc. 10 to 20 Cc. For veins, see p. 735. (?) CHEMICAL. Selenium.—See Colloidal Silver Salvarsan Sodii Bicarbonas Sodii Bromidum Sodii Cacodylas Sodii Chaulmoogras .. Sodii Chloridum Sodii Cinnamas Sodii Citras Sodii Glycerophosphas Sodii Iodidum .. Sodii Iodidum \ Sodii Salicylas f Sodii Morrhuas.. Sodii Salicylas .. Sodii Thiosulphas (Hyposulphis). . Strontii Salicyl .. Strophanthin Sulfarsenol T.A.B. Vaccine . . Tryparsamide .. Tylcalsin Urea-Stibamine Vaccines & Sera AMOUNT. 0T Gm. Coma has been treated with a litre of 3 to 5% solutions in portions. 1-35% is isotonic. 1 Gm. 0-05 Gm. (massive amounts, even 3 Gm. in 5 Cc. are mentioned. 0-03—0-06 Gm. 0-9% 0-1 Gm. 0-4 Gm. 0-2 Gm. (increased) 1 Gm. (Larger amounts in the same vol. are mentioned) 1 Gm. of each 0-06—0-12 Gm. (This to follow course of subcutaneous injections) 1 Gm. 0-3 to 0-6 Gm. 0-05 Gm. i to 1 mgr. 0-06 Gm. 10-250 mills. 3 Gm. 0-5 to 1 Gm. 0-1 Gm. incr. See Individual Items. VOL. OF DILUENT. 10 Cc. 10 Cc. 1 Cc. 1 to 2 Cc. 500 Cc. (more or less) 10 Cc. 10 Cc. added to blood in transfusion. 5 Cc. 20 Cc. 20 Cc. 2 to 4 Cc. For varicose veins see p. 614. 20 Cc. also 3 Cc. increased of 20 to 40% for varicose veins. 5 Cc. 10 Cc. 10 Cc. 10 Cc. or more. 1 Cc. 10 Cc. 10 to 20 Cc. 2 Cc. PROPORTIONAL DOSE TABLE ACCORDING TO AGE (Gaubius). Eor an adult suppose the dose to be 1 or 60 grains. Under 1 year will require iV >> 5 99 99 p 99 99 1» 8 99 99 3 99 99 6 >> 10 99 99 4 99 99 1 4 >> 15 99 99 7 99 99 1 3 >> 20 99 9 9 14 99 99 1 2 >> 30 99 99 20 99 99 § » 40 99 21 to 60, the full dose, or 1 „ 60 99 Above this age, an inverse gradation must be observed. Young’s Formula.—For children under 12, add 12 to the age, and divide the age by the amount thus obtained thus for 8 years g%rp2 = § of adult dose. Prof. W. J. Hilling says Young’s and Gaubius’ methods are of little value. The best formula after the 10th year is to multiply the adult dose age x 5 age. by — foo~ or by ~20_ ^bis be found gave a curve which when plotted out coincides more closely than other systems with the curve obtained by plotting out the percentages of adult weight at ages obtained from birth to 21 years, which he considers is the average adult age. The new formula, he states, results in doses which correspond closely with those demanded.—B.M.J. ii./i9,1177. INDEX & P0S0L0GICAL TABLE. rJ1HIS index supplies the name in Latin as far as possible and adult dose (if used internally) of most of the drugs and preparations described. The doses are based on personal experience, or are culled from the best authorities. For Acids look under the word Acid. For Salts, vide Latin name of the base. For Effervescent Preparations, see list under the word Effervescent. Some items, e.g., some ofthe Pilulse have purposely no page— i.ethey are not further described in the book. Customary Acid, or Ac. Acidus,-a,-um, etc. Ale. — Alcoholic. Aik. = Alkalinus, etc. Av. — Average (Dose). Caps. = Capsula, etc. C. = cum (with). Co. = Compositus, etc. (or compound. Cone. = Concentratus, etc. Eft. = Eft'ervescens, etc. Emplast. = Emplastrum, etc. Emuis. = Emulsio, etc. Expt. = Expectorant. Extr. = Extractum, etc. Eluidextr. = Eluidextractum. Glycerin = Glycerinum, etc. Glyceroph. = Glycerophosphas, etc. Gr. (in Index only) = grain (s). HBr. = Hydrobromidum, etc. HC1. = Hydrochioridum, etc. Hyd. = Hydrargyrum, etc. Hyp. = Hypodermicus, etc. Ini'. = Infusum, etc. Inj. = Injectio, etc. olio wing Increased. - Linimentum, etc. - Liquor or Liquidus, etc. M. = minim (s). Mag. ^ Magnesium, etc. Mang. = Manganesium, etc. Mist. = Mistura, etc. Potass. = Potassium, etc. Quin. = Quinina, etc. Pad. f= Padix, etc. Hep. = liepeated. Salicyl. = Salicylas, etc. Sol. = Solutio, etc. Spirit. = Spiritus, etc. Strych. = Strychnina, etc. Syr. = Syrupus, etc. Tinct. = Tinctura, etc. Ung. = Lnguentum, etc. or Ointment. Yin. = Yinum, etc. ’85 = B.P. 1885. ’98 = B.P. 1898. ’14 = B.P. 1914. Vol. II. = Vol. II. of this work. Vide also List of Abbreviations at commencement of the book. CONTRACTIONS have been found necessary, e.g. the Incr. = Linim. Liq. Name. Dose. Page A. B. A.’ . ... 350 A. B. C. Liniment 92 ,, Powder 11 Abbey’s Salt . V. II. Abbreviations ... XXXY.et^ea. Abdominal Dressings ... ... 441 Abies Canadensis ... 874 Aboua ... ... ... ... 860 Abrodil. ... 769 Abrus Precatorius ; Abrin ... 827 Absinthe ... 827 Acacia Catechu ... 846 Acacia? Cortex ... ... 827 ,, Gummi 1 & V.II. Acacia Gum Injection, Intravenous . 1 A.C.E. 283, 285 Acedicone . 357, 997 Accessory Food Factors 587 & V. II. see also Vitamins Acetarsone, 4 grs.186 Aceite de Palo (Ph. Notes) — Copaiba . 621 Acetaldehyde ... 121 Acetamide ... ... ... 6 Acetanilide, 2 to 5 gr. ... 2 & V. II. and Meth-blue tubes ...V. II. Acetannin, 5 to 15 gr. ... 90 Acetate d’Ammonium Dissous. 145 Acetic Anhydride . 4 Acetic Ether, 45 to 60 m. ; 15 to 30 m. rep.105 Acctomorphine 559 Acetone, 60-90 m. daily 827 & V. II ,, Bacillus . 827 ,, Chloroform, 1 to 5 m. 282 ,, ,, (Chloretone)... 243 ,, in Ether .V. II. ,, in Urine .V. II. Acetonitril .V. II. Aceto-p.-amido-salol (Salophen) 83 Accto-phenone, 1^-5 m. 827 & V. IT. Acetopyrin, 8 to 15 gr. ... 329 Acetosal 68 Acet-para-phenetide . 326 Acet-phenetidin, 5-15 gr. ... 326 Acetum ... 4 ,, Cantharidini ... ... 265 ,, CevadilJse . 891 ,, Digitalis, Ph. Ned. ... 389 ,, Ipecac., B.P. ’98, 5 to 30 m. ... ... — ,, Scillae, 5-15 m. ... 882 ,, Urgine.T, 5-15 in. ... 890 Acetylarsan, 1 cc. inj. ... 188 Acetyl-Atoxyl, i grain 186 & V. II. ,, -benzoyl-aconine ... 93 ,, Brom Salol, 5 gr. ... 83 ,, chloride... . 4 ,, Choline HC1. f grain hyp. incr. 5 ,, Iodo-Salol, 5 gr. ... 82 „ -Methyl-Salicyl, 10 to 30 gr. . 74 Name. Dose. Page Acetyl-Morphine HC1. A? to £ gr., 559 ; base, ^ to „ 12 gr. ...560&V. II. ,, -p.-amido-salol, 10 to 15 gr. 83 A V. II. „ Phenylhydrazine, l£grs. 308 ,, tannin. 90 Acetylation, effect of.V. II. „ process for oils ...V. II. Acetyldihydrocodeinone ... 357 Acetylene . 288 ,, Dichloride ... 289 ,, Tetrachloride ...V. II. Acetysal 68 Ache des Marais . 165 Achorion Schoenleinii 1088 & V. II. Acidin, 5 to 15 grains. 40 ,, -Pepsin Tabs., 1 or 2 ... 40 Acido Agalico.829 ,, Timico . 799 Acidol, 1 to 8 gr. . 6 ,, Pepsin Tabs., 1 or 2 ex aq. p.c.... ... ... 6 Acid. Abietic .V. II. „ Acetic., 33%, 5-15 m. 3&V.II. ,, Acetic. Dil., 5%, £to 1 dr. 4 ,, Acetic Glaciale ... ... 3 ,, Aceto-Acetic .V. II. ,, Acetyl Amino-oxy-phenyl- arsonic . 186 „ Acetyl-Bromo-Salicylic, 5 gr. 78 ,, Acetyl-Coumar 5 to 10 gr. 829 ,, Acetyl-Iodo-Salicylic,5 gr. 76 ,, Acetyl-Salicyl., 5 to 15 gr. 68 V. II. ,, Acetyl-Tannic . 90 „ Agaric, £ to \ gr. 833 & V. II. ,, Allyl-iso-prop. barb. ... 814 ,, Amido-acetic, 10 to 30 gr. 4 & V. II. ,, Amido-Succinic-Amide, 1-2 gr. ... 839&V. II. ,, Aminic., 2 to 10 m. ... 31 ,, Amino-caproic; amino- formic .V. II. „ Amino-glutaric.V. II. ,, Aminophenylarsonic ... 184 „ Aminophenyl Stibinic ...V. II. „ Amino-propionic ...V. II. ,, Amino-succinic.V. II. ,, Anacardic . 836 ,, Aniline-arsenic. 184 ,, Arsanilic 184 ,, Arsenic., 1/64 to 1/12 gr. 178 & V. II. „ Arsenios., 1/64 to 1/16 gr. 173 & V. II. ... 180 ... 180 ...V. II. ... 212 p. 601 ... 806 8 ,, Arsenoic. ,, Arsinic, Arsonic ... ,, Aspartic. ,, A uro-chloric „ Azelaic, Edn. XIX., ,, Barbituric Comps. ,, Benzamido-acetic Name. Dose. Page Acid. Benzoic., 5 to 15 gr. 6 & V. II. „ Boricum, 5 to 15 gr. 9 & V. II. ,, ,, Detection, in Milk V. II. ,, Boro-Salicyl. 10 ,, Bromo-Saiicylic.V. II. ,, Butyl ethylbarbir. ... 811 ,, Butyric. 49 ,, Cacodylic., ito2gr.180cfey.il. ,, Camphoric, 10-20 gr. ... 262 ,, Carbamic ...V. II. ,, Carbazotic, i to 2 gr. ... 56 ,, Carbolic., 1 to 3 gr. 13 & V. II. ,, ,, Camph. 16 ,, „ Commercial ... 26 ,, „ Liq., 1 to 3 m. ... 15 ,, ,, Liq. et Iodum ... 18 ,, Carbonic 22 ,, Carminic ... ... ... 844 ,, Cathartic, 4 to 8 gr. 883, 884 ,, Chaulmoogric ... ... 603 ,, ,, ‘ C ’ Injn. ... 609 „ Chloracetic.(mono-,di-, tri-,) 24 „ Cholalic (Cholic) 776 & V. TI. ,, Chromic ... ... 827 <fe V. II. ,, Chrysophanic., £-£ gr. 291, 883 „ Cinnamic, 1/20-1 gr. 828 & Y.II. ,, Citricum, 5 to 20 gr. 25 &Y. II. ,, Coumaric ...828 cfe Y.II. ,, Cresylic., 1 to 3 m. 26 & V. II. ,, „ Phenol in.’V. II. ,, Desoxycholic . 776 ,, Diacetic ... ... V. II. „ Di-allyl-barbituric, f to 44 gr. 815 5) 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 Di-chloracetic . 24 Diethylbarbituric ... 806 Di-iodo-Taririnic ... 516 Pimeth.-arsinic., \ to 2 gr. 180 Di-nitrosalicylic ... ... Y. II. Dipropylbarbituric ... 810 Eugenic ... ... 854 fast bacteria ... . Y. II. Ferrocyanic ... ...Y. IT. Filicic, 6 to 15 gr. ... 423 Fluoric ... ... ... 829 Formic., 2-10 m. 31 & V. II. Fuchsin ... ... ...Y. II. Gallic,, 5 to 15 gr. 829 <fe V. II. Gluconic ... ... 257 Glutamic = Ac. Glutaminic Glutaric ... ... ...Y. II. Glutaminic ... 762 cfe V. II. Glycerophosph., 5 to 10 m. 33 cfe V. II. Glycuronic ... ...Y. II. Group, effect of ...V. II. Hexenyl Barbituric ... 814 Hippuric., 5-20 gr. 8 & V. IT. Hydriodic. (10%), 5 to 10 m. 37 Hvdrobrom., Cone. ... 37 „ Dil., 15 to 60 m. ... 38 Hydro-Ferro-Cyanic ...Y. II. Hydrochloricum, 31*79%, 2-6 m. ... 38 cfe V. II. „ Dil., 10%, 5 to 20 m. 39 Name. Dose. Page Acid. Hydrochloricum, Physiol. 131 „ Hydrocyanic. Dil., 2%, ,, 2-6 m. 40 cfe V. II. ,, ,, (Scheele), 1 to 3 m. 40 „ Hydrofluoric. Dil., 5-15 m. et C-nc. ... ..._ 829 ,, Hydrofluorsilicic... ...V. II. ,, Ilydroxybutyric ...Y. II. ,, Hydroxy-cinnamic ... 828 ,, Hydroxy-succinic., 1 to 5 gr.830 ,, Hyperosmic., 1/64 gr. ... 831 ,, Hypochloros. ... 41 & V. II. ,, Hypophosphoros. ... 682 ,, ,, Dil., av. 8 m. ... 682 ,, Iodic., 1 to 5 gr.... 830 & V. II. ,, Iodo-behenic ... ... 516 ,, Iso Amyl-ethyl Barbituric 812 ,, Kinic., 4 to 8 gr. ... 719 ,, Lactic., 75%, 15 to 30 m. 48 & V. II. ,, Lactic. Dil., 30 to 120 m. 49 „ ,. Pess. cfe Jelly ... 722 „ Lactic Bacilli ... 52 & Y. II. ,, Lithic ... ... Y. II. ,, Magenta.Y II. „ Malic., 1 to 5 gr. 830 & Y. II. ,, Malonic.807 ,, Margosic ... ... 839 ,, Meconic ... 830 & V. II ,, Metaphosph. ... 889 cfe V. II. ,, Meta-vanadic. ... ... 890 ,, Molybdic. ... ...Y. II. ,, Monochloracetic ... 24 ,, Naphthalen cSulphonic V. II. „ Nitric., 70%, 1 to 4 m.... 54 „ „ Dil., 10%, 5 to 20 in. 55 ,, Nitric Fumans ... ... 55 ,, Nitro-hydrochlor. Fort. 55 ,, Nucleic ... ... 278 & Y.II. ,, Nucleinic. (Sol.), 15 m.... 278 ,, Nncleotin phosphoric ... 975 ,, Oleic. (Caps., 7£ m. 598) 597 & V. II. ,, Ortho-coumaric ... 828 cfe V. II. „ Osmic., sol. 1%, 2 to 10 m. 831 ,, Oxalic. ... ... 831 cfe V. II. ,, Oxy-benzoic., 5 to 20 gr. 58 ,, Oxybutyric .V. II. ,, Oxyformyl-amino-phenyl- arsonic 188 ,, p. Oxyphenyl-amido-acetic 5 ,, Oxyphenyl-arsonic ... 192 „ Pelargonic Edn. XIX, 601 ,, Perboric. 13 ,, Perchloric .Y. II. ,, Phenol-sulphonic . 20 & Y. II. ,, Phenyl-acrylic., 7% to | gr. 828 „ Phenylcinchoninic, 8 to 15 gr. 316 (See also Tabs. Phenoquin). ,, ,, Ethyl-baibituric ... 815 „ ,, Quinolin-carbonic . 316 Name. Dose. Page Acid. Phosphor. Cone., 66'30%, 1 to 4 m. 55 & V. II. „ Dil., 10% 5 to 20 m. 55 A V. II. „ Phospho-Molybdic. ...V. II. ,, Phospho-tungstic ...V. II. ,, Phthalic ... ... ... 9 ,, Picramic V. II. ,, Picric., i to 2 gr. 56 & V. II. ,, Propylbarbituric ... 810 „ Prussic. Dil., 2-5 m. ... 40 „ Pyrogallic. 57 & V. II. ,, ,, Oxydat. 58 ,, Pyrolignos. Crudum, and Rectif. ... ... ... 4 „ Pyrophosph. ... ...V. II. ,, Pyrotartaric ... ...V. II. ,, Quinic., 4 to 8 gr. ... 719 ,, Quinoline-carboxylic ... 316 ,, Ricinoleic. ... ... 618 ,, Rosolic ... ... ...V. II. ,, Salieylic., 5 to 20 gr. 58 & Y. II. ,, ,, in food.V. II. ,, Salicyl-sulphonic. ...Y. II. ,, Santoninic (Soda Salt) ... 753 ,, Sclerotic., £-f gr. ... 408 ,, Silicic .V. II. ,, Sozolic ... . 20 ,, Stearic. ... ... 84 & V. II. ,, Stibinic Compds. ... 164 ,, Succinic., 5 to 10 gr. S31 & Y.II. ,, Sulphanilic., 5 to 10 gr. 307 ,, Sulphocarbolic ... ... 20 ,, Sulpho-vanadic ... ...Y.II. ,, Sulphuric., 95%, 1 to 2 m. 85 & Y. II. ,, „ Aromat., 5 to 20 m. ... 85 ,, Sulphuric. Dil., 10%, 5- 20 m. ... 85 ,, ,, Fumans. ... 85 ,, Sulphuros., 30-60 m. 86 & Y.II. ,, Sulphonc-dichloramino- benzoic (Halazone) ... 48 ,, Tables ... ... ...Y. II. ,, Tannic., 5 to 10 gr. 88 & Y. II. ,, ,, for burns ... 88 ,, Tartaric., 5-20 gr. 90 & V. II. ,, Telluric ... ... ...Y. II. ,, Thyminic, 5 to 10 gr. ... 975 ,, Timico ... ... ... 799 ,, Trichloracetic ... 24 & V. II. ,, Trichlorphenic ... ... 21 ,, Trinitrophenic . 56 ,, Uricuni and Estimation V. II. ,, Valerianic, 1-5 m. 819 & V. II. ,, Vanadic., meta. 890 Acids, Action of on Metals ...Y. II. Fatty Unsaturated 597,612,615 ,, Mineral, Sale of ... 992 Acne, Bacteriology of.V. II. ,, Lotion . 825, 826 ,, Vaccine ... ... ... 901 Acocanthera ... ... ... 831 Name. Dose. Page Aconite Napellus Leaves, Root and Preps. ... 90 & Y.II. Aconitina 1/600-1/200 gr. 93 & V. II. Aconitinae HBr.HCl., Nit. 1/600 gr. hyp. 93 ,, Oleat., 1 in 50... ... 93 Aconitum Laciniatum ... 831 Acorn (vide Aesculus) ... 832 Acqua del Pagliari . 135 Acridine Compounds ... 297&V.II. Acrifiavine . 297 & V. II. 77 Antiseptic Power 298 & Y II. 77 Emulsion . 300 7 7 in Gonorrhoea 301 7 7 Intrav. Injection ... 300 77 Literature ... 300 77 Neutral (Euflavine) 303 7 7 Patents and Mfre. ... 297 77 Prophylactic Use ... 299 7 7 Soap Paste 300 7 7 Starch Poultices 300 77 Strengths for Use ... 299 77 Subcut. Injection ... 300 77 Tablets-0-87 & 1-75 grains ... 299, 433 77 Therap. Coefft. 298 7 7 Uses ... 299 et seq. 7 7 Wounds, Suppurating, and axis 299 Acrosyl ... 29 ... 849 ...V. II. 706 & V.11. ... 128 ... 843 ... 672 ...V. II. 713 Actaea Racemosa Actinium. Actinomycosis ... Activated Alkaloids ,, Charcoal ,, Fluorescein Activators Acton on Quinidine, etc Adalin, sedative, 5 to 10 gr., hyp., 10 to 15 gr. ... 810 ,, Characterisation ...V. II. Adams’ Mercurial Injection ... 455 Adamson’s Ringworm Ointment 1088 Adderwort . 841 Addiction, Cocaine ... ... 341 ,, Heroin . 561 ,, Morphine ... ... 553 (See also Drug Addiction.) Adepsine Mulls ... ... 564 Adeps and Adeps Benz ; Indu- ratus; Lotus; Suillus. ... 832 Adeps Lanae and Hydros. ...93,94 Adexolin . 593 Adhesive Plaster . 600 Adnephrin . 968 Adonis Vernalis (Adonidin, £ to £ gr.), 3 to 6 gr.832 Adonite. 832 & Y.II. Adormidera, F.E. =Papaver ... — Adrenalin, 968 ; Action on the heart, 969 ; Catheter Lub. 973 ; Dilutions, 972 ; Chlor. Sol., 10 to 30 m., 969; Name. Dose. Page Adrenalin— in Chlorof. Anaesthesia, 970 ; Color Assay 968 ; Decoloration of Sol., 969 ; Idiosyncrasy, 970; Inhalant, 972 ; Intracardiac Injection, 971 ; Ointment, 973 ; References, 970 Solution, 969 ; Sterules, 972 ; Styptic Gelatin, 972 ; Suppos., 972 ; Tablets, 1/65 and 1/200 gr., 972 ; Tests, V. II. ; Uses ... 969 As test in eye work.—W. M. Beaumont, B.M.J., June30/28,1104. Adrenine ... ... ... 968 Adrenol Solution . 972 Adsorption ... ... ...V. II. iEdes aegypti.V. II. Advita ... ... ... ... 593 JEgle Marmelos 841 Aerugo.382 Aeroplane Dope .V. II. Aesculin, Aesculus ... 832 & V. II. Aethanoli Bromidum ... ... 832 iEther, 45 to 60 in. ; or 15 to 30 m. rep.,95;ImpuritiesV.II.; with Atropine, 99 ; in saline 99 iEther Aceticus, 45 to 60 in. ; or 15 to 30 m. rep. • • • 105 JEther Camphoratus • • • 260 „ Copal ... • • • 866 „ Methylat. • • • 96 ,, Nit. Spirit • • • 104 ,, Officinalis ... 95 ,, Petrolei ... 656 ,, pro narcosi • • • 95 ,, Puriflcatus, 10 to 30 m. 95 ,, Purissimus • . • 95 ,, Spirit Camph. 376 ,, Sulphuricus iEtherolea in P. Svec. = 01ea 95 Essentialia q.v. ... — Aethiops Antimonialis ... 477 Aethiops Mineralis ... 477 JKthocaine . ... 345 JEthusa Cynapium ... 832 iEthyl Bromidum 832 & V. II. ,, Chloridum ... 105 ,, Iodidum 106 & V. II. Afridol Violet. • . • 314 Agar, ‘ Flaked ’ Almond, Vanilla, Raspberry, etc., flavoured 1 dr. ... 833 Agar and Blood Agar Media ...V. II. Agaricus Albus, 10 to 30 gr. ... 833 Agaricin, i to £ gr.833 Agaric, Surgeon’s . 835 Agave Mexicana ... ... 876 Agglutinating Sera, Standard...V. II. Agglutinins . 894 Agomensin Tabs., 1 to 3 ... 950 Agotan, 8 to 15 gr.316 Agricultural Poisons 172, 989, 992 Agrimony . ... 833 Agropyrum . 833 Name. Dose. Page Aguamiel . ... 876 Agurin, 10 to 15 gr. ... 797 Air, Iodine in ...V. II. ,, Liquid . ,, Testing for Iodine ...V. II. ...V. II. ,, ,, for Acetone ...V. II. Aix-la-Chapelle Treatment ... 707 Airol, Airoform, Airogen Ajenjo, F.E. = Absinthe. ... 232 Ajowan . ... 800 Albargin. ... 172 Alanine ...V. II. Alasil, 1 or 2 tablets ... 73 Alastrim... ... 946 Albumin Vegetable ... 585 „ Ovi siccum ... ... 577 ,, Sanguinis ... 577 ,, Tannicum ... 89 & V. II. ,, Tests ...V. II. ,, WTiter ... 577 Alcaptonuria . ...V. II. Alchemilla Arvensis ... 834 Alcohol, Absolute, 108 & V. II.; and Oxygen, 631 ; Allyl, 114 ; Amylic, 114 ; Caprylic, V. II.; Diluted, 108 et seq., for burns, 112 ; Duty, Current, 109 ; Duty free, 117 ; Injections, 111, 112 ; Isopropyl, 118 & V. II. ; Mastichi, 866 ; Methylic, 30 to 60 m., 114 & V. II. ; Methylated, 115 ; Prohibition, 112 ; Propyl n., 119 ; Sandarachi . 689 Alcohol, Industrial Meth. ... 115 Alcohol Camphre . 260 Alcoholism . 113 „ Gold in, 365, 554, 1023 Alcoolat Melisse Comp., 20 to 25 drops. 866 ,, de Fioraventi. ... 694 Alcoolature d’aconit . 91 Alcoolatures Stabilisees, Vale- riane and Aesculus ... 819, 832 Aldehyde group, effect of ...V. II. Aldeliydum Absol. et Dil. 121 & V. II. ,, Formicum 122 & V. II. Alder Buckthorn . 855 Alembroth Preps.472 Alepol ... ... ... ... 607 Aletris Cordial, \ to 1 dr. ... 834 Aletris Farinosa . 834 Algse in water.V. II. Alginoid Iron, 2 to 15 gr. ... 834 Algiron, 2 to 15 gr.834 Algodon, F.E. = Gossypium. Alibour Water ... ... 383 Alkagen Tabs., 1 to 3 ... ... 537 Alkali Bismuthyl Tartrates ... 234 „ Physiological . 131 Alkaline Meth. Blue .V. II. Alkaloids, Activated. 128 „ Detection of ...V. II. „ Passage thro’ system V.II. Alkaloidal Bases . 128 Name. Dose. Alkaloidal Notes Oils ... Periodides ,, Iteagents Alkanet ... Alkannin Alkaptonuria ... Alkarsin Alka-Zane Alkyl groups, effect Alkylene Series Page 128 &V. II. ... 617 ... 131 ...y. 11. ... 836 ... 836 ...V. II. ... 180 ... 770 ...y. 11. 288 Allantoin and Dressing 888 & V. II. Allen’s Dietetic Treatment ... 1045 Allen’s Fehling Test .V. II. Allergy ... 662 Allium Sativum, | to 2 dr. ... 834 „ Cepa . 835 „ Porrium . 835 Allocain, 345 ; S.349 Allonal, 1 to 2 Tabs. 814 Alloxan .V. II. Allspice.874 Allyl Alcohol . 114, 756 „ Isopropyl malonylurea ... 814 „ Isoprop.-Acetyl Urea ... 814 Isosulphocyanide ... 756 phenyl cinchoninate ... 318 834 & y.n. ... 757 757 ... 835 ... 585 ... 147 ... 837 16 ... 835 ... 137 132 &V.II. Name. Dose. Aluminii Tannas. ,, Trisulph. Aluminium Soaps ,, Stearate ... Aluminium, soldering of Aluminium vessels Alumnole Alypin, 1/20 to J gr. Page 89 ... 135 ... 755 ... 755 ... 134 ... 134 ... 137 ... 344 & V. II. ... 344 ... 946 ... 835 ... 457 293 5? Sulphide, £ to 2 m ,, Sulphocarbamide ,, Thio-urea... Allylene . Almata ... Almizcle, F.E. =Moschus. Almond, Bitter ,, Chinese •„ Oil, Carboliscd Alnus Glutinosa Alocol Tabs. Aloe, 2 to 5 gr. Aloin, £ to 2 gr. (£ gr. = 1 gr. ext.) ... ... ... ... 133 yy Arseno-phenol. 191 Alopon, £ to $ gr. 628 yy •‘azo-benzene-azo /3 Alpha Naphthol, 2 to 5 gr. ... 566 thol . 326 Alsol ... ... ... ... 136 yy azo-Toluene . 312 Alstonia ... . 835 yy Benzoic Ethyl Ester ... 349 Althaea ... 835 Aminobenzoyl-diethylamino- Alum. Ammon, vcl Potass., 5 to ethenol HC1. 345 10 gr. ... 134 Aminobenz. 344 Alumen,U.S.—Potash Alum.... 134 Aminoform, 5 to 15 gr. 449 Alum, Box Carmine Exsicc. ... Iron, 3 to 10 gr. Points ... Ust. ...y yy yy yy yy 11. 844 134 420 135 134 Aluminii Acetas Neut. and Basic 135 Aceto-Tart. 136 Chloras ... 136 ct V. II. Chlor., 2 to 4 gr. ... 136 Formas . 136 Hydroxidum 137, 364 Naphthol-Sulphonas. 137 Silicas ... 137&y.II. Stearas . 755 Sulphas . 135 yy yy yy yy Alypinoids Amaas. Amadou . Amalgam Hg. Amani Institute . Amanita Phalloides, see Fungi Antidote Chapter. Amanita Muscaria . 833 Amapola, F.E. =Flos Papaveris Amaranth . 313 Amatol.V. II. Amber, Amber Oil, 887 ; Artif. 888 Ambergris .835 Amboceptors . 894 & V. II. Ambrine.651 American Indian Hemp ... 837 Ametox. 87 Amido-acet.-p-phenetidin HC1. 327 Amido-acids .4, 5 & V. II. Amidofebrin . 329 Amido-phenol (p.) V. II. Amido-Succinic Acid Amide ... 839 Amidol and Hair Dye ...y. II. Amidopyrin, 5 to 8 gr., and Comps. ... 329, 330 ,, allyl-prop-barbiturate . 814 ,, Diethyl Barbiturate and 330 „ Sulphamino-benzoic Acid 330 Amines.V. II. Amino Acids .V. II. Amino group, effect of ...V. II. Aminophenol (p.) .V. II. Amino Phenylarsonic Toluene Sulphonate ... Edn. XIX., p. 209 163 83 144 733 144 144 yy yy yy Amino-Stiburea Amiodoxyl Benzoate ... Ammonia, Cloudy, Household Ammoniated Quinine, 4 to 1 dr. Ammonia Liquida . ,, Sterules . Ammoniacum, 5 to 15 gr. Ammon. Acetas, 10 to 30 gr.... Benzoas, 5 to 15 gr.... Bicarb., 3 to 10 gr. ... Bithiolicum ... Broinid., 5 to 30 gr.... yy yy yy yy 145 7 140 497 139 Name. Dose. Page Ammon. Carb., 3 to 10 gr. 140 99 Carbamas 140 9 9 Chlorid., 5 to 20 gr.... 141 99 ,, Inhaler Citras, 30 to 60 gr. ... 141 9 3 145 99 Cupri Sulph. 383 9 3 Cyanas 805 3 3 Eluorid., 1/24 to i gr. 830 99 Hippuras, 5 to 10 gr. 9 99 Hypophosph.,lto6gr. 683 33 Iodidum, av. 5 gr. ... 141 33 Mercuric Chloride ... 472 33 Molybdate . Y. II. 99 Nitras (Baciiluria treated. 141 A. L. Clark, L. ii/32,512) Ortho-iodoxybenzoate 83 Persulphas.V. II. Phosphas, 5 to 20 gr. — Picras, i to igr. 57 & V. II. Rhodanid (Sulpho- cyanid.).V. II. Salicylas, 5 to 30 gr. 60 Soaps. 755 Sod. Phosph. ... 770 Succinas, 2 to 5 gr. ... 831 Sulphas ... ... 143 Sulpho-Molybdate 404 & V. II. Sulpho-Ichthyolas,10 to 30 gr. daily ... 497 Tartras ... ... 146 Valer., 1 to 8 gr. ... 143 Ammonal ... ... ...V. II. Amoeba buccalis . 522 ,, coli ... .V. II. ,, histolytica, 520 & V. II. Amoebiasis ... ... 520 et seq. ,, Willmore’s Treatment ... 528, 529 Amoebic Dysentery, Emetine in 519 et seq. Ampere, see Iontophoresis ...Y. II. Amphotropin, 8 to 12 gr. ... 454 33 33 Dulcis 33 33 33 33 33 99 99 99 9 9 99 ... 344 147, 148 . 147 .y. ii. Tertiary... 835 .Y. II. . 360 ... 656 . 31 Amydricaine Amygdala Amara : Amygdalin Amyl Acetate Alcohol, 114 Butyrate Colloid ... Hydride . -meta-Cresol Nitris, 1-5 rn., Hyp. |-1 m. by mouth, 2-5 m. inhaled ... 148 & V. IT. Nitrite Sterules, 1, 2, 3, 4, 5, 6, 10 m. ... 149 Nitrite and Pilocarpine Hair Lotion . 153 Phthalate ... ...V- II. Salicyl. ••• 68 Yalerianate, 2-5 m. 820 & V.II. Amylamine (iso) ... 409, 973 Amylase . 633 & Y. II. Name. Dose. PAGE Amylene Amyleni Hydras (Caps. 10 m.), 30 to 80 m., 835 & V. II. ; 835 Carbarn. • • • 836 Amylocaine • • « 350 Amylopsin • • • 633 Amylum... • • • 836 Amy sal. • • • 68 Amytal, I to | gr. • • 9 812 Anabol, Anabolin • • • 953 Anacardium • • • 836 Anacyclus Pyrethrum Anaemia, Liver Diet, • • • 951; 876 Stomach, 965; v. also Therap. Ind. Anaesthesia by Alcohol, in Glucose intrav. ... 112 ,, by Chloroform ... 282 ,, Cocaine Ionisation...V. II. Anaesthesia by Cocaine Infiltration ... ... ... ... 33/ Anaesthesia by Cocaine Lumbar puncture ... ... ... 337 Anaesthesia by Ethylene ... 288 Anaesthesia by Eucaine Infiltration ... ... ... ... 343 Anaesthesia by Novocain, Intraarterial ... ... ... 348 Anaesthesia by Novocain-Sup- rarenin Infiltration ... ... 345 Anaesthesia by Oxygen and Gas, 142 ; Ether, 97 et seq. ; Oil of Orange in, 99 ; Ether and Saline, 99 ; Ether Intramuscular, 100 ; Ether Intratracheal, 100 ; Pharnygeal, 100 ; Oral, 103 ; Rectal 97, 103 Anaesthesia by Scopolamine Morphine ... ... ... 492 Anaesthesia, Oil Ether. 100 Anaesthesia by Synergism in labour (Gwathmey). 102 Anaesthesia by Quinine 725, 726 Anaesthesia Spinal by Mag. Sulph.... ... ... ... 539 Anaesthesia by Tropacocaine ... 342 Anaesthesia by Stovaine 351 et seq. Anaesthesia by Urea Quinine ... 726. Anaesthesine, 3 to 8 gr. 349 & Y. II. Anaesthetic, Dental . 337 Anaesthetics General, Local— v. Therap. Index. ,, Pharmacology of ...Y. II. Anaesthol ... ... ... 285 Analgesine, 5 to 15 gr. ... 327 Analysis of Patent Medicines V. II. ,, of Prescriptions ...V.II. ,, Blood Urine, etc. ...V. II. Anamirta Paniculata ... ... 874 Ananassa Sativa ... ... 836 Anaphylaxis, see Protein Therapy and.... ... ...Y. II. Anarcotine, 1 to 3 gr. 567 Anasarcin Tablets; . 882 Anatomic Specimen Soln. .... 20 Name. Dose. Page Anchusa ... ... . _ g3g Anderson’s Ointment ... 228 Andira Araroba ... .* 292 Anesthesine (Anestlione), 349 ; Cream, Emulsion, and Tape 350 837 836 ...V. II. 149, 1025 ... 954 ...V. II. ... 851 ... 836 ... 751 296 et seq. 304 & V. II. Bed. 305 329 947 & V. II. ... 948 ...V. II. 837 837 Anethol Anethum Angier’s Tablets Angina . Angioxyl Angstrom Units Angostura Anlialonium Anhydro Sugars Aniline Dyes Aniline (Aniline Oil) .. Gentian Violet, Y. II. 320 ; Sulphate, £-3 gr. Anilipyrin .. Animal Organotherapy „ Membrane Anions, Anode- Anise Fruit and Preps. „ Oil . Wf Ankylostomiasis 421, 610, 800, 848 873, 1026 & V. II. Annatto and substitute ...V. II. Anoci-Association ... ... 493 Anocide. 309 Anodyne Colloid . 360 „ Tincture . 627 Anogeissus latif . 2 Anopheles var. 742 et seq. & V. II. Anotal.318 Anserine Mulls.564 ,, Thiosinamin. 758 Antexema .V. II. Anthelmintics, 421, 423 ; see also Worms, Therap. Ind. & V. II. Anthemidis Flores ... ... 887 Anthemis Cotula. . 837 Anthoxanthum Odorat. ... 837 Anthraquinone bodies 276, 883 & V. II. Anthrarobin . 308 & V. II. Anthrax Serum. 901 Bacillus .V. 11. „ Infn. Shaving Brushes 902 ,, Treatment of Wool... 902 Antibacsyn . 947 Antibacterial Sera ... 897 et seq. Antibodies . 894 Anticatarrh Salts . 19 Anti-cholera Vaccine. 908 Anti-colon B. Serum. 909 Antidote Cocoon . 854 Antidotes, see The Poison in question and .1095 Antidotum Arsenici, £ oz. every 5 or 10 minutes . 174 Anti-Dysentery Serum ... 912 „ „ Vaccine ... 913 Antifat.V. II. Antifebrin, 2 to 5 gr. 2 Name. Dose. Page Antiformin .V. II. Anti-gas-gangrene Globulins (W.) 10 Cc. ; See Ileus, Peritonitis and Toxcemia, Therap. Ind. Antigen.. Antilusin, Antilytic Serum 963, 964 Antimeningococcus Serum ... 907 Antim. Arsenas, 1/100 gr. inc. 154 „ Chloridum .V. II. „ Fur dermatitis.V. II. „ Nig. Purif.154 „ Oxidum, 1 to 2 gr. ... 154 „ „ Injections ... 154 ,, Pentasulphid. ... 154 „ Pot. Tart. ... 156 & V. IT. „ „ in C. S. Fever ... 907 ,, Sodii Tart., 4 gr. intrav. increased ... 157, 162 Antim. Sulphuratum, 1 to 2 gr. 154 Antimon. Tartarat. / Diaphoret, 1/25 to 1/8 gr. \ 156 & \Emetic, £ to 1 gr. ... / V. II. Antimony Butter .V. II. ,, Colloidal . 364 „ Comps., Organic 163 et seq. & V. II. „ Crocus . 154 „ Metal ...163&V. II. „ Phenyl and Quinonyl Berivs. 164 „ Poisoning ... 158 & V. II. „ Toxicology ...V. II. „ Vitamin Tests ...V. II. Antinosin . 674 Anti-pneumo Serum . 917 Antiphlogistine . 435 Antipyretics ... 326, 327, 1054 Antipyrine, 5 to 15 gr. ... 327 ,, Acetylsalicyl, 8 to 15 gr. 329 ,, Caffeino-cit.,8 to 15 gr. 248 „ Salicyl., 15-30 gr. ... 328 Antirrhinum . 833 Antiseptic Crede . 170 „ Inhalation ... 378, 379 „ Dental Solubes ... 18 Antiseptics, Biliary . 451 ,, for storing Instruments—Thymol Disinfectant. ,, Glycerin and Car- bolised Glycerin 432, 433 „ Table of.V. II. ,, Mercurome ... 477 ,, Oils Essential as 597 & V. II. „ Specificity of ...V. II. „ Urinary per os ... 300 See also Disinfectants. Antisera, 897 ; Prepn. of ... 897 Anti-smoking Gum . 878 Anti Strepto-Serum. 920 „ „ -Vaccine ... 921 Name. Dose. Page Antitoxins .893 See also Disease or Organism and Vaccines. Antityphoid Inoculation ... 937 Antivenene .V. II. Antivenereal prophylaxis. See Ung. Prophylaxis. Antivirus .896 Antuitrin ... . 958 Anturic Bath Salts .V. II. Anusol Suppos. ... ... 233 Aperfine, 2 to 4 dr.653 ,, Liquid, 2 to 4 dr. ... 653 Aperient Waters ... ...V. II. Aperitive Elixir, 4 to 1 dr. ... 133 Aperol.653 Aphrodine, cf. Yohimbine. Aphthous Fever .V. II. Apiol Liq., 3 to 6 m., 164, V. II and Ergotin Caps., 165 White (Cryst.) Apis Melliflca ... Apium Graveolens ,, Petroselinum Aplopappus Apocodein, HC1., 1/10 to 1 gr Apocynum ... . Apomorphinse HC1., A to £ gr. by mouth ; 1-20 to 1-10 gr. hypoderm. Apomigran Aponal, 15 to 30 gr. Appendicitis Apple Essence ... Apple of Sodom Apples, Antiscorbutic Applicatio Acriflavine Apricot Oil Aq. Ammon. Fortior, U.S. Ammon., U.S., 15 m. Amygdalae Amarse Anethi, £ to 2 oz. ... Anisi, £ to 1 oz. ... Aurant. Flor., £ to 2 165 837 165 164 860 357 & V. II. , 837 165 & V. II. ... 408 836 1027 & V.II. ... 820 ... 885 Vit. in 589 ... 300 ... 148 144 144 147 dr. . 837 839 & V. II. . 240 Bromoformi, 1 to 4 oz. ... Camphorae (Cone. 167), $ to 2 oz.260 Carbolisata 16 Carminativa . 850 Carui, £ to 2 oz. ... ... — Chlorof., £ to 2 oz, ... 286 Cinnamomi Cone. 167 Coloniensis v.Eaudc Cologne. Creosoti, 2 dr.377 Cuprozincica ... ... 383 Destillata ... ...V. II. Fceniculi, £ to 2 oz. ... 854 Formalinata. . 123 Haemostatic (Alum) ... 135 Hamamelidis ... ... 447 Hydrogenii Dioxidi, £ to 2 dr. 488 Laurocerasi £ to 2 dr. ... 147 Mellis . HI 55 55 55 55 55 55 55 55 55 Name. Dose. Page Aq. Menthae Piperitae, £ to 2 oz. — „ Menthae Viridis, £ to 2 oz. — ,, Menthol ... ... ... 550 Naphae ... ... ... 839 Picis, 5 to 10 oz. ... 296, 696 Pimentae, B.P. ’98, £-2 oz. — Pruni Macroph.147 Ptychotis. 800 llegia . 55 Rosae, 1 to 2 oz. ... ... — Sambuci . 881 Saturnina = Liq. Plumbi Subac. Dil. — ,, Sedativa . 260 Aquae Concentratae ... ... 166 Arabic Glossary .V. II. Arabinose for B. typhosus ...V. II. Arachis ... ... ... ... 837 Araroba . 291, 292 Arbor Vitae . 890 Arbutin, 5 to 15 gr. ... 838 & V. II. Archil ... ... ... ...V. II. Arctium Lappa 863 Arctostaphylos Uva TJrsi ... 838 Areca, Arecoline and HBr. 838 & V. II. Argein.171 Argentum . 167 ,, Vitellinatum ... 170 Argenti Acetas 167 ,, Chloridum ... ... 167 Citras (Itrol) ... ... 170 Cyanidum, /4 to gr. 167 Fluoridum ... ... 170 Todid. Recent... ... 167 Lactas (Actol), £ gr. ... 170 Nitras, £ to £ gr. 168 & V. II. Nitras, Fusus ... 169 Nitras, Indurat. et Mitigat.169 Nucleinas ... ... 279 Oleas (£ to £ gr. ?) ... 601 Oxidum, £ to 2 gr.. ... 170 Potass. Iodid. ,.. 168 Proteinas ... ... 171 Argentic Hair Dye .V. II. Argentide ... . 167 Argento-Proteinum Mite, 170 ; Fort.171 Argentum Colloidale, 4 to 2 gr. 170 (See also Colloids.) Collosol ... ... 371 Crede . 170 " Proteinic ... 170, 171 Argon .632 Argyria . ... 169 Argyrol 170 Arhemapectyl. 873 Aristocliin (Aristoquinine), 1 to 10 gr. 737 Aristol, 503 ; Aristolochia ... 884 Arithmetical Memoranda (V.I.) xliv. Armoraciae Radix . 849 Arneth Index.V. II. Arnicee Flores 838 55 55 55 55 55 55 55 55 Name. Dose. Arocan Series ... Aromadendral ... Aromatic Confection ... Aromatic Elixir, 4 to 2 dr. Arrhenal, 2/5 to 3 gr. Arrow Poisons Arrowroot Arsacetin, \ gr. Arsamin, f "to 3 gr. ,, Paste Arsanilic Acid Page . 348 .V. II. . 626 . 394 183 & V. II. 851, 872 804, 865 186 & V. II. 184 & V. II. 185 184 55 Succinyl Derivs. ... 190 55 Malonyl Derivs. ... 191 55 Glutar. Compds. ... 191 Arsenic Compounds Organic 179 & V. IT. 55 Act . 989, 993 55 Agricultural Use ... 172 55 and Iron Drops and Injections ... 178 55 Anilide ... 184 55 Antidote, I oz. every 5 • nuns. ... 174 * 5 Chlorid. Vitam. Test...V. II. 55 Eating ...V. II. 55 Horticultural Use 173, 989, 993 55 Sulph. Colloidal ... 364 55 Tests ...V. II. 55 Wood Preservers ...Y. II. 55 55 55 Arsenic, White, 1/60 to 1/15 gr. 173 Arsenical Cigarettes . 179 ,, Fibre, 177 ; Paste ... 176 Arsenii Bromidum, 1/60 to 1/12 gr.176 Iodidum, 1/20 to 1/5 gr. 177 Trioxidum . 173 Trisulphid . 185 Arsenious Wool ... ... 177 Arscnium, 172 & V. II. ; dimethyl . 180 Arsenobenzene, 0-1 to 0-4 G111. 191 Arsenobenzol, 0-1 to 0*4 Gm.... 191 Assay .V. II. Uses in syphilis ... 192 Hereditary syphilis, 198 ; para-syphilis ... 198 Other diseases . 193 After effects . 196 ‘ Alternating ’ v. ‘ Concurrent’ . 190 Arsenic Retention ...V. II. Bactericidal power ... 192 Bismuth with . 194 Chemotherapeutic Index 192 Combined with Bi or Hg. 194 Contraindications ... 196 Deaths under . 197 Doses . 194 et seq. Doses, Interval between. 194 Dose, Maximum ... 197 Dysentery, for. 528 Glucose with . 194 Injection Method ... 194 Jaundice.197 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 Name. Dose. Page Arsenobenzol, Local Anesthetics in . 197 Local use 198 Manufacture . 192 Mercury, combined use 194,195 Neo, 0-15 to 0-45 Gm. ... 199 Neurosyphilis . 198 Patents, Details of ... 191 Preparation of Injn. ... 194 Rectal Use . 194 Serum of patient used ... 198 ,, Silver, 0-1 Gm. 199 ,, Sodium Formaldehyde Sulphoxylate, 0-15 to 0-45 Gm. . — ,, Standard preparation ... 191 ,, Suppositories . 194 ,, Syphilis in Women ... 196 Tests Physiological 191 & V. II. Therapeutic Subs. Act ... 191 Toxic effects and Treatment . 197 „ Sod. Thiosulph. for 197 See also 87. Uses . 192 Warnings and contraindications . 196 ,, War Office Method ... 195 ,, Wassermann’s Reaction, Effect on .V. II. Arsenobillon . 191 Arsenoic Bodies . 180 Arsenphenolamine . 191 Arsinic Compds. . 180 Arsonic Compds. . 180 Arsphenamin . 191 Arsybismol . 187 Artemisia Maritima et var. 751, 752 ,, Absinth. -. 827 Arterial Tension . 573 Arthritis, Rheumatoid, 69 et seq., 919 ; B. Colt in, 909 ; see also Protein Therap. and Therap. Index. Anthrytin . 83 Artichoke . 751 Artificial Cream Act .V. II. .j First case under V. II. pneumothorax ... 632 Respiration ... 142 Silk.V. II. Arum Maculatum . 838 Arylarsonates. 180 Asafetida, 5 to 15 gr. ... 838 Asaprol V. II. Asbestos.139 Asbestosis, Pulmonary ... 139 Ascaridole .848 Ascaris, 752 & V. II. (and see Worms, Therap. Index). Asclepias . 839 Aseptafilm ... *. 439 Aseptic Wax .846 Aseptol. 20 Asparagin, 1 to 2 gr. ... 839 & V. II. 55 55 55 55 Name. Dose. Page Aspergillus . 662 & V. II. Asphyxiating Gas, poisoning by, see Carbon Monox. and Chlorine . 1096, 1097 Aspidium (and oleo-resin) ... 421 Aspidinofilicinum Oleo Solution 423 Aspirgran . 68 Aspirin, 5 to 15 gr. ... 68 & V. II. ,, Absorption of... ...V. II. „ Chewing Gum ... 70 „ Hydrolysis of and Tests. ...V. II. „ Potass. Cit. with 70 ,, Tablets, 5 grs. and 8 grs. ... 70 ,, Throat bath 71 Aspirinoids 68 Aspriodine, 5 gr. 76 & V. II. „ Tablets, 5 gr. 77 ,, Salts 77 Aspro . ... 68 Asteriastigma. ... 602 Asthma Cigarettes ... 710 „ Cure, Potter’s 710 ; (Tucker’s) ... ...V. II. „ Fluid Comp. ... ... 207 ,, Peptone Inin, for ... 662 ,, Powders ... 710 ,, Sensitisation ... 661 et seq. ,, Skin Tests 661 et seq. „ Spray ... 207 „ Atmospheric Pollution V. 11. Astragalus Gummifer ... 803 Atebrin, 0-3 Gm. 745 Atocin Tablets, 71 gr. ... 316 „ 5 gr. c. Aspirin, 21 gr . 316 Atomic Disintegration ...V. II. Atomic Weights ... xlvii. Atophan, 8 to 15 gr. ... ... 316 Atophanyl . ... 317 Atoquinol . ... 318 Atoxyl, £ to 3 gr. 184 & V. II. Atropa Belladonna 204, 217 Atrophic rhinitis, see Therap. Index. Atropina, 1/200 to 1/100 or 1/16 gr.204 Atropine Steriloids . 130 Atropinae Methyl-Bromid., 1/64 to 1/32 gr. ... 209 „ Oleatum . 209 „ Salicyl, 1/60 gr. ... 207 „ Sulph., 1/200 to 1/100 or 1/16 gr. ... 207 Atropine, with Ether. 99 Atta ..• ... »«• ...~V. II. Attar of Rose ... 872 Auld on Protein Therapy ... 667 Aural Bougies. 793 Auramine ... ... 322 & V.II. „ Emetine Periodid 1 gr. q.d. 528 Aurantii Cortex, 839; Elor....V. II. Auremetine, 1 gr. q.d. ... ... 528 Name. Dose. Page Auri Brom., 1/64 to 1/5 gr. ... 211 ,, Chlor., 1/64 to 1/16 gr. ... 212 ,, Cyanid, 1/60 to 1/12 gr. ...V. II. ,, et Potassii Cyanid., 1/64 to 1/3 gr. . 212 ,, et Sodii Chlor., 1/30 to 1/12 gr. 212 „ Triclilor., 1/64 to 1/16 gr. 211 ,, ,, Acid . 212 Auricular Fibrillation 387, 714 Aurin .V. II. Aurinaria . ... 793 ,, Cocain. Hyd., 1/10 gr. 339 ,, Hydrarg. Nit. ... 466 ,, Scarlet . 312 Auristillse, Syn. Guttse Auribus N.H.I., see Guttse Auribus ac. Boric, and Guttse Auribus ac. Carbolic. Aurum 211 Autoclaves .V. II. Autunite .V. II. Ava, Awa Root ... ... 862 Avantine ... ... ... 118 Avena Sativa, 839 ; Avenyl ... 609 Avertin ... ... 241, 352 Aviation Spirit.V.II Avoleum . 593 Axungia ... ..832 Ayahasco .842 Azadirachta ... ... ... 839 Azafran, F.E. = Saffron. Azahar (Flores., F.E. = Aurantii Flores. S39 Azobenzol and comps. ... 310 Azotite d’Amyle. . 149 Azurl.and II., Azur II.-Eosin V. II. 33 B.C.G. & Criticisms ... 933, „ Lubeck Disaster id« j j. ••• ••• B T P P ’ 1 >• j.• jl • • • • • • • • B.M.R. Baccelli’s Mixture, \ to 1 oz... Tetanus Method Edn. XIX. Bacilluria. See Bac. Coli Vaccine & V. II. Bacillus Abortus Ac. Butyrici ... ,, Lactici Acetone Acne . Acidophilus ... „ Blocks Aerogenes Caps. Aertrycke Anthracis Asthenogenes Bordet ‘ Bottle ’ Botulinus Bouchard’s cus ... 934 934 929 231 981 175 931 33 3) 33 33 33 33 33 33 33 33 33 33 33 ...V. II. ...V. II. 52 & V. II. ... 827 901 & V. II. 53 & V. II. ... 54 ...V. II. ...V. II. 901 & V. Ii. ...V. II. ... 946 & V. II. ... 901 & V. II. .V. II. B. Bulgari- ... 52 & V.II Name. Dose. Page Bacillus Bulgaricus 52 et seg. V. II. ,, Butter .V. II. Caucasicus 52 et seg. & V.H.. Coli Communis 909 & V. II. in Urine & Water ...V. II. Differences between B. Coli & B. Typh. ...Y. II. Diphtheria) 910 et seg. & V.II. 99 9 9 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 9 9 99 99 99 99 9 9 99 9 9 99 99 99 99 99 99 99 99 99 Doderlein Dysenterise Enteritidis Eriedlander Eusiformis Angina) Gartner’s 722 & V. II. ... 913 & Y. II. .V. II. ... 902 & V. II. (Yincent’s ... 918, 1092 .V. II. Gas Gangrene... 1075 & V.II. Glanders Gunther’s Hoffman Huppe’s Influenza) 902, ,..V. II. ...V. II. ...Y. II. . V II 903, 914 & V. II. Klebs-Loffler 910 et seg. & V. II. Koch-Weeks ... 916 & V. II. Lepra). 608 & Y. II. Malignant CEdema ...Y. II. Mallei V. II. Massol V. II. Mesentericus ... ...V. II. Morax-Axenfeld ...V. II. G^dematis Maligni ...V. II. Oppler-Boas.V. II. Paratyphosus . 937 & Y. II. Perfringens .Y. II. Pest is.V. II. Pfeiffer’s ... 915 & V.II. Pneumo, Eriedlander 902 A Y. II. Pneumosintes Edn. XIX. p. 923 Proteus Pyocyaneus Putrificus Bheumaticus Septus Shiga’s Sporogenes Subtilis Suipcstifer Sulphur ...Y. II. ...Y. II. ...Y. II. ... 919 ... 903 912 & V. II. ...V. II. ...V. II. ...Y. II. ...V. II. Tetani . 923 Timothy Grass ...V. II. Tuberculosis ... 925 & Y. II. „ Human & Bovine differences ...Y. II. ,, in Butter, Milk, faeces, Urine, etc. Y. II. Staining .Y. II. Typhosus and P-typhi 937 et seg. & Y. II. ,, in Urine and Water ...Y. II. Vaginae ... 722 & V.II. Variability of ...V. II. Name. Dose. Page Bacillus Yincent’s Fusiform 918,1092 ,, Welchii, V. II. ; Serum 10 Cc. used in Peri- tonitis and Toxaemia 1075, 1089 „ Whooping Cough 946 & V.II. „ vVisps. ...V. II. ,, Xerosis ...V. II. Bacteria, Acid-fast ...V. II. ,, Digestibility of ... 896 ,, Mutability of ...V. II. Bacterial Emulsions ... ... 899 Bactericides. See 30 et sen. & Y. II. Bacterins . 893 et sea. Bacteriological Notes ... ...V. II. (See also Bacilli.) Bacteriolysins. ... 894 Bacteriophages ... 896 Baculum Chrysarobini... ... 291 ,, Besorcini ... 747 Badiane ... 839 Bael Fruit ... 841 Bain de Vichy ... ... 765 Bain dit de Vichy ... 765 Baking Powders ...Y. II. ,, „ Alum in ...V. II. Bakuclii ... 147 Balata ... ... 268 Balbi on Chaulmoogra... ... 604 Balm . ... 866 Balmain’s Paint ...Y. IT. Balmosa ... 67 Balneum =about 25 gallons. ,, Aik. = Sodii Garb. 6 ozs.-50 galls. Aniyli, £ lb. Bituminis . 296 Boracis, 2 ozs. Furfuris (Bran.). Picis Curb.296 Potassa) Sulphuratae . 702 Salinum . 762 99 Sulphuris, 702 ; Aik .... 791 Balsam Aniseed ...V. II. 9 9 Canadense ...V. II. 99 Copaiba) ... 621 99 Fioraventi ... 694 99 Gurjunse, £ to 2 dr. Lanolinatum ... ... 839 99 ... 840 99 Locatelli ... 694 99 Peruv., 5 to 15 m. ... 839 99 Tolut., 5 to 15 gr. ... 840 99 Vita) Hoffmanni, 1 to 4 dr. ... 801 Bamber Oil . < • HH hH Bandages, 17, 258 ; Bubber, 267 ; Elastoplast 267, 439, 440 Bandrowski’s Base .Y. II. Banisterine . 842, 858 Banting on Insulin . 637 Baptisia (Baptism, 1 to 5 gr.)... 840 Barberry .841 & Y. II. Barbitalum,. 5 to 10 gr. ... 806 „ Soluble, 5 to 10 gr. 809 Barbitonum, 5 to 10 gr. ... 806 Name. Dose. Bardana Barfoed’s Test Barii Acetas ,, Carbonas... „ Chloridum, £ to 14 gr. „ Hypophosph, I to“l gr. „ Nitras . ,, Oleas . ,, Sulphas ... ,, Bulky ... ,, Gelatineux Sulphid., £ to 1 gr. ,, Depilatory Thiosulph >5 5) Page 863 V. II. 840 216 840 683 840 601 216 216 216 215 215 216 216 II. 840 216 351 Barium Meal ,, Platino Cy. Screens...V ,, Water ... Bariumised Wool Barker’s Injn. ... Barley ... Barley Sugar ... Barmsule Barolac Barium Sulphate Barosma, var. ... Barr, Sir J., on Lime Salts Barthelemy’s Syringe Basal Hypnotics : Avertin .241 Nembutal ... ... ... 811 Paraldehyde. 121 Sodium Amytal . 812 Basal Metabolic Rate ... 981 Basham’s Mixture, av. 4 dr. ... 416 Basic Alkaloidal Prepns. ... 129 Basil ... ... ... ... 871 Bassia, var. ... ... 840, 855 500, 540 ... 427 ... 277 ... 216 ... 842 ... 250 ... 455 Bassorin (Lasiosiphon) Paste ,, See also Normacol. BathWater ... ... ...V. Baths, Artif. Sea Water „ Nauheim and Salt ,, Sod. Bisulph. Battiste ... Battley’s Liq. Opii Baume Analgesique . ,, de Fioraventi ... ,, de Vie = Dec. Aloes Co. ,, Tranquille Bay Berries Bay Rum 863 II. 762 772 772 439 626 67 694 Bay Salt Bayer ‘ 205 Baylahuen Bazin’s Ointment Bearberry Leaves ,, Bark (misnomer) Bebeeru Bark Beberin HC1. and Sulph. Beck’s Bismuth Paste . Bee Tincture . Beech Tar Beecham’s Pills Beechwood Creosote ... Beef Preps., 576 ; and Wine . 313. ...V ...V 376, Malt 495 863 114 762 526 852 476 838 , II. 841 841 231 837 697 II. 444 576 y y yy Name. Dose. Page Beef Peptone with Malt, 2 to 4 dr.660 ,, Peptonised Jelly of ... 635 ,, Tea Cone. 576 Beer .V. II. Beet Sugar . 749 Beggiatoa .V. II. Behring’s Diph. Antitoxin ... 910 Belse Fructus ... ... ... 841 Beleno, F.E. =Hyoseyamus (leaves, seeds) . — Belgian Glossary .V. II. Bell. Prof. W. Blair, Lead in Cancer . 366 et seq. Belladonna Leaves, 1 gr. 217 & V. II. ,, Plasters . 218 Pul vis . 217 Root, | gr. 217 & V.II. Bemax 593 Benacol ... ... ... ... 350 Benedict’s Tests (and Modifs.) .V. II. Benger’s Food. 585 Liq. Pancreaticus ... 634 „ Pepticus. 659 Bengue’s Balsam .V. II. Benne Oil . 872 Benzal Chloride . 309 Benzaldehyde, |m. ... 147 & V. II. ,, Green. 323 Benzaldehyde-HCN . 147 Benzamine (HC1.) 1/10 to £ gr. 343 Benzamime Lactas, 1 to £ gr.... 343 Benzene, 5 to 10 m. 308 Benzidine .V. II. Benzine. 309, 656 Benzocaine, 3 to 8 gr. ... 349 Benzoic Sulphimide . 748 Benzoin, Siam, Sumatra ... 7 Benzoin Varnish . 502 Benzol, 5 to 10 m. ... 308 & V. 11. „ Capsules, 5, 10, 15 m. 309 ,, Chloride . 309 Benzol - azo - Benzol - azo - B- Naphthol . 312 Benzol Mixture ... ...V. II. Benzo-Mastiche ... ... 866 Benzoline . 309, 656 Benzonaphthol, 4 to 10 gr. 566 & V.II. „ Varnish ... 689 Benzophenol ... 14 Benzo-Piperaz., 2 to 5 gr. ... 695 Benzo-purpurin .V. II. Benzosol, 4 to 12 gr. 446 Benzosulphinidum . 748 Benzoyl-Chloride . 309 „ -Ethyl-dimethyl-amino propinol HC1. ... 350 ,, Glycocoll ... 8 & V.II. „ -Hydrate, 5 to 15 gr. .. 6 „ -Morphine .V. II. „ -N aphthol, 4 to 10 gr. . 566 ,, -Peroxide . 9 „ -Pseudo-Tropine ... 342 „ -Salicin.875 -Sulphonic-Imide ... 748 yy Name. Dose. Page Ben zoyl-Tetrameth-di-amino- eth.-di-meth.-carbinol 344 Benzyl Acetate ... 311 ,, Aceto Salicyl ... ... 311 ,, Alcohol ... 310 ,, Benzoate,2to6m.(diluted) 310 ,, Carbinol ... 312 ,, Chloride ... 309 ,, Cinnamate ... 312 ,, ' Cinnamic Ester ’ ... 310 ,, di-chloride ... 309 ,, Morphine Tart. ... 561 ,, Succinate ... 311 Benzylidene Chloride ... ... 309 Beprochin &. Compd. ... ... 744 Beraneck’s Tuberculin... ... 935 Berberime Carb, HC1., Phosph., Sulph., 2 to 6 gr. ... 841 Berberis var. ... 841 Berczeller Process ... 885 Bergamot . ...V. II. Berginisation ... ...V. II. Beri Beri 588, 873,1030 & V. II. Berkfeld Filter.V. II. Berlece’s Solution .1031 Berna Milk . 582 Bernsteinsaure (Ac. Succinic)... 831 Besredka on Vaccines per os 895, 939 Beta-Borocaine, f grain ... 349 Betacaine, 1/10 to | gr. ... 343 ,, - Borate, f gr.349 Betaine HC1., 1 to 8 gr. 6 & V. II. Beta-Eucaine Borate 349 ; HC1., 343 ; Fact., £ to £ gr.... 343 Beta-Naphthol, 3 to 10 gr. ... 565 ,, Benzoas, 4 to 10 gr. 566 ,, Naphthol Salicyl ... 566 Betel . 838, 841 Betol, 3 to 8 gr. ... 566 & V. II. Bettendort’s ltcagent ...V. II. Betula Alb.697 Betula lenta, 58 ; Betulol ... 67 Bhang.263 Bial’s Test .V. II. Bicreol, 1 to 5 Cc.222 Biddie.115 & V. II. Bieber’s ltcagent .V. II. Biebrich Scarlet ... 312 A; V. II. Bilberry 869 Bile Beans .V. II. Bile, Human, for ileus. 776 Bile Acids & Salts . 775 Bile Tests .V. II. Bilharzia (and Therap. Ind.) 158, 472, 522 Biliary Antiseptics ... ... 451 Bilibubin .V. II. Billimoria B.B., Silver Oleate Inins. ... ... ... 601 Billroth’s Cambric . 439 Biloptin ... ... 678 Bilsen kraut=Hy oscyamus ... 494 Bimital.187 Name. Dose. Page Biniodide Lotion, Solubes and other preps. 464 et seq. Soap ... 465, 754 B.I.P.P.’ Bi-quinyl . Birch Tar, 697 ; Birch, Sweet Birch White, Oil of Bircon Tablets Bird Lime (Japanese)... Birth Control. Bisedia, 1 dr. Bish . Bisciniod, £ to 1 gr. Biscuit Foods. Bisglucol . Bismarsen . Bismogenol . Bismolan Bismosal, £ to 1 dr. Bismostab . Bismurung Bismuth Metal for injn. Bismuth in Syphilis ... Bismuth and Soamin ,, Comps. Organic Bismuth Acetamino-oxyphenyl- arsonas . Alkali Tartrates Arsanilas (Shircore) . ,, Suspension, 0-5 to 3 Cc. with Arsenobenzol Arsenphenamine Sulphonate Benzoas, 5 to 20 gr. ... 6-naphtholas Carbolas . Carb., 5 to 20 gr. ... Cinch. Iodid., £ to 1 gr. Citias, 2 to 5 gr. . „ Gauze Colloidal . Cream (Bicreol) et Amnion. Citr., 2 to 99 99 99 99 9* 99 9 9 99 99 99 99 99 99 99 99 5 gr. 231 238 58 697 ... 722 ... 892 ... 722 ... 226 ... 831 ... 227 580, 584 ... 222 ... 203 ... 230 ...V. II. ... 226 ... 222 ... 229 ... 221 222, 236 ... 238 ..V. II. 187 234 238 238 194 203 223 234 234 223 227 226 226 364 222 225 9 9 99 99 99 99 99 99 99 99 99 99 99 et Cerii Salicyl., 5 to 20 gr.230 Emetine Iodide 523, 526 Dallas, 8 gr. ... 233 Hydroxyd, 5 to 20 gr. 228 & V. II. lodophenol. 21 Meats ... 223, 229 Mucilago . 229 Nitras Cryst., 5 to 10 gr. ... 227 Nucleinas, 20 to 40 gr. 279 Oil-soluble Salts ... 238 Oleas, 5 to 10 gr. ... COO Organic derivs. ...V. II. Oxide hydrated ... 228 Oxidum, 5 to 20 gr.... 228 Oxybenzoas. 223 Oxybrom, 5 to 7 gr.... 229 Oxycarb., 5 to 20 gr. . 223 Name. Dose. Page Bismuth Oxychlor. 5 to 20 gr. . 228 Oxyiod id. 5 to 10 gr.. 229 Oxyiodogallas ... 232 Oxynitras, 5 to 20 gr. 230 Oxysalicyl, 5 to 20 gr. 229 ‘Panama’ ... 520,529 Pancreatin, 1 to 2 dr. 227 Paraffin Emulsion, 1 oz. mane. 653 „ Injection ... 231 Paste (Beck’s) ... 231 Phenas, 10 to 30 gr.... 234 Pot. et Sod. Tart,... 235 ,, Sterules ... 237 Potass Tartrates ... 235 Pyrogallas, 2 to 8 gr.. 234 Salicylas . 229 Sod. et Pot Tart. ... 235 „ Sterules ... 237 Sod. Tart Neut. ... 234 Sod. Tart Acid, 2 to 5 * • • • ••• ••• Subcarb., 5 to 20 gr. Subgallas, 8 gr. Subnitras, 5 to 20 gr. 55 55 55 55 55 55 55 55 15 55 55 55 55 55 Subsalicyl, 5 to 20 gr 229 ; Basic Sulphocarb., 4 to 8 gr, Tannas, 10 to 30 gr. . Tart Normal 235 223 233 230 & V. II. 230 230 233 238 gr. ... 235 ,, Hoot ... ... .. . 881 ,, Test Meals ... 223, 229 ,, Serum ... .V. II. „ Tetraiodophenolph - ,, Staining. .V. II. thalein ... 679 „ Sugar Estn. .V. II. „ Tribromphenas, 5 to See also Insulin. 20 gr. ... 21 „ Transfusion . . 987 Bismuthyl . ... 222 ,, Urea Estn. .V. II. ,, Tartrates ... ... 234 „ in Urine ... .V. II. Bismutol Sterules ... 237 ,, Viscosity of . Blosser’s Remedy . .V. II. Bismutose, 15 to 30 gr. ... 233 . 710 Bisoxyl. ... 228 Blue Gum Tree (Eucalypt.) .. . 609 Bistort and preps. ... 841 Blueberry . . 869 Bistovol ... 187 Blue, Methylene, 1 to 4 gr. .. . 325 Bisurated Magnesia, £ dr. ... 537 ,, Isamine, 674: Night, Bisuroids . ...V. II. 325 ; ‘ Blue Paint, y Bites, Insect . ... 1030 324 ; Patent A, 325 Bitter Apple, 2 to 8 gr. ... 373 Various .V. II. Bitter Bush . ... 847 ,, Unction, 457 ; Pill . 456 Bitter Sweet ... 884 Bodo Caudatus. . 301 Bitter-free Cascara, i to | dr ... 275 Body Vermin, see N.C.I., Vermi - Bitumarine ... 297 jelli, Lefroy’s Emulsion, also Bitumen... . ... 297 Parasites . . 1073 Biuret Reaction ...V. II. Boeck’s Lotion and Liniment.. 700 Blackberry, Norwegian ... 880 Bogbean. . 867 Black Draught, 1 to 2 ozs. ... 884 Bog Moss . . 777 ,, Haw . 487, 891 Bohadschia Aphrodisiaca . 852 „ Precipitate ... 458 Boldoa Fragans . 842 ,, Wash ... 475 Boletus Laricis, 10-30 gr. . 833 Black-water Fever 730, 1031 & y.II. Bolton, John A. on Washing . . 755 Blair Bell’s Calcimeter ...V. II. Bolus Alba . 137 Bladder Wrack ... 855 Bonain’s ‘ Mixture ’ ... . 334 Blair’s Gout Pill ...y. ii. Bonduc Nut . . 842 Blair’s Tooth Pdr. ... 249 Bone Marrow Extract, Red . . 948 Name. Dose Blanc de Baleine Blanc de Perle Blancard’s Pill ... Blastomycosis Therap Blaud’s Pill Bleaching Pdr. ... Blepharis Capensis Blighia Sapida Bliss’ Cure Blistering Fly Blistering Liquid Blood Agar Benzidene Test Bilirubin... Calcium in Carbon Monoxic Coagulability of Colour Index Corpuscle Tests 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 Page ... 847 ... 228 417 Ind. & V. II. 411 & V. II. 41 & V. II. ... 841 ... 842 ... 710 264 et seq. ... 266 ...V. II. ...V. II. y ii 253 &V. II.’ in ...V. II. 250 & y. II. ...V. II. Estn. V. II. Donors. 987 in Faeces.V. II. Groups ... . 987 Guaiacum Test.V. II. Haemoglobin Estn. ...V. II. Hyd. Ion Concentn. ...V. II. Leucocyte Count ...y. II. Lime Salts in .V. II. Platelets... ... ...V. II. Precipitin Test.V. II. Pressure 150, 409, 573, 775, 1033 & V. II. Name. Dose. Page Bon Voyage £ oz., 38 ; Tabs. 38 Bonjean’s Ergotin . 404 and Green ... 324 Boracite, 60 grs. 12 Borage. 500, 888 Borated Hydrogen Peroxide ... 489 Borax, 5 to 20 gr. 12 Bordeaux Bx. ... 313 Bordet-Gengou Reaction Gono. Syph., Tuberc. ...V. II. Boric Acid . 9 ,, „ Lotion 11 ,, ,, and Starch Powder and with Zinc ... 824 ,, Cream . 11 ,, Gauze, Lint & Wool 9 ,, Petroleum Jelly... 11 Bomeol Salicyl. 68 Borneol-isovalerianate... ... 820 Bornyl Acetate. ...V. II. Borocaine, £ to 1£ grains 129, 348 Borovertin, 15 to 60 gr. ... 452 Borrel’s Blue . ...V. II. Borrelia recurrentis ...V. II. Bosch Yaws . ...V. II. Botany Bay Kino, 5 to 20 gr. 853 Botol Tablets, 1 to 5 v.d. ... 357 Botulism and Antitoxin 1034 & V. II. Bouchard’s Remedy ... 39 BOUGIES, 267, 793 ; Aural ... 793 ,, ‘ X ’ Rav ...V. II. URETHRAL GELATTN, 2£ and 4 in. (dip in warm water) Proteinate, -93 yy yy y y y y yy yy yy yy 172 334 568 172 yy y> yy yy y y yy yy yy yy Argent. £ grain Bellad, Ale. Ext., 1£ gr Bellad. Ext., 1£ gr., etc Ext. Opii., 1 gr. Cocaine, £ gr. ... Cotarnine HC1., £ gr... Ext. KramericC, 1 gr... Leistikow’s Neisser’s Opium, 1 and 2 gr. Silver Nitrate, £ gr. Zinc Acet., Chlor. and Stilph., £, £ and 1 gr., etc. — ZincSulphocarbolate,£gr. — URETHRAL WITH CACAO BUTTER (dip in Catheter Oil). 793 Bellad., Ext. Rad., £ gr. BismuthOxychlor.,5,10gr. and c. Lead Acet, 1 gr. Cocaina, £ gr. 334 Copper Oleate, 5 gr. ... 598 Cotarnine HC1., £ gr.... 568 Eucalyptus Oil, 10 m. Eucalyptus Oil, 10 m. Iodoform, 5 grs. Iodoform, 3 and 5 gr. } 502 yy yy yy yy yy yy yy yy yy yy yy yy yy yy Name. Dose. Page BO 0GIES, Lead Acetate, £ gr., f gr. Mercurome . 480 Neisser’s ... ... 172 Opium, 1 and 2 gr. ... — Orthoform, 5% ... 344 Potass. Permang.,£ gr. 548 Proflavine, £ gr. ... 304 Silver Nitrate, £ gr.... 169 Stypticin, £ gr. ... 568 Tannic Acid, 1 gr.,and with Opium, 1 gr. — „ Zinc Chlor.and Sulph., £ to 1 gr. — ,, Zinc Permang., £ gr. Bouleau, Huile de, . Bourdaine • ••• Bovnl . Bow’s Liniment .\ Brachylsena = Elliptica in diabetes.—J. M. Watt, P.J., June 30/28, 602. Brain Extract ... Brand’s Meat Juice ,, Nutrient Pdr Brandish’s Solution Brandy . Brass Oil, Paste & Picric Brassica var. Braxy . Bread and Flour in London Tea making ... North Country Potato Starch in Standardisation... Starchless Vitamin B in Wholemeal v. White „ Yeast used for making...V. II. Breast Feeding . 582 Bredig’s Process . 363 Brestol.580 Brevifolin . 752 Brilliant-Green. 324 <fc V. IT. ,, Ointments ... 325 British Spas .V. II. Broadbent’s Mixture, £ oz. ... 733 Brock, J. H. E. on lirst use of Cocaine ... . 333 Brom-Albumen, 10 grs. ... 240 Bromal Hydrate, 2 to 5 gr. ... 239 Bromeikon . Bromelin . Brometone, 5 gr. Bromides, Estimn. of ... Bromidia, £ to 1 dr. Bromine Sterules „ in Org. Comps., liberation of ... 78 & V. II. Brominol (10%), £ oz. =20 gr. Pot. Brom. ... 240 „ (33%), 10-60 gr. ... 239 „ Mixture, £ oz. ... 240 Bromival, £ to 2 dr. 820 Bromocarpin, 1 dr.-loz.acc.to age 688 548 697 855 576 . II. 949 576 577 702 113 & V. II. 383, 384 ... 756 ...V. II. ...V. II. hops...V. II. ...V. II. ...V. II. ...V. II. ...V. II. ... 585 ...V. II. ..V. II. 679 ... 836 ... 241 ...V. II. 281 & V. II. 239 & V. II. Name. Dose. Page Bromodiethyl-Acetyl-Urea ... 810 Bromoform, i to 2 m. ... 240 Brom-iso-valerianyl-urea 833 & V. II. Bromo-cresol purple .V. II. phenol and Thymol blue V. II. Bromol, % to 2 gr. 20 ... 240 ... 679 ... 21 ... 21 ... 857 ...V. II. ...V. II. .. 239 & V. II. ..813 & V. II. gr. ... 814 543 Bromo-protein, 10 gr. ... Bromo-Ray, 4 to 7 6m. Bromphenobis, 5 to 20 gr. ,, Gauze ... Brompton Blacks Brompton Cough Specific Bromsulphalein Broinum Bromural, 5 to 10 gr. ,, Tablets, 5 Bronamalt, 1 to 2 dr. Bronchial Asthma, Peptone in 662 Bronchiectasis, Iodinol and Lipio- dolin... ..515&V. II Bronchitis, Vaccines in (See also Therap. Ind.). Bronchoscopic Insufflation Brooke’s Ointment . Broom ... . Broth, Nutrient Brownian Movement ... Browning on Acrifiavine ,, Brill. Green Brown’s Bronch. Troches Brucea Sumatrana Brucella Abortus Brucine and Salts, 1-12 to i Bryant’s Sherry Edn Bryony 902 ...V 223 599 886 II. ... 362 298 et seq. ... 324 ...V. II. ... 842 ...V. II. _ gr. 842 XIX. p. 519 ... 842 Bryone (Jalap) Bryonia (var.). Buba Buchu. Buckbean Buckthorn . Buffer Solutions and Salts Bug] oss . Bugs to kill . Bulbocapninc ... Bulgarian Bacillus 52 et seq Bungpagga . Bunter’s Nervine Burdock Burgess’ Oint. and Pills Burgi’s Theory . Burgundy Pitch Burn, J. H., on Pituitary Burn, J. H. on Ergot .. Burnet, Great = Sanguisorba off. Bums, Paraffin Treatment Picric Acid for ... Tannin for See also 1035, 1036. Burney Yeo’s Catarrh Mist., 145 ; Chlorine and Quinine Mixture, 1 oz. . Burow’s Solution . 135 Burri’s Ink . ...V. II. Busserole . «... 838 ... 861 ... 842 ...V. II. ... 842 ... 867 ... 855 ...V. II. ... 852 ... 1074 ... 842 & V. II. ...V. II. ...V. II. ... 863 ...V. II. ... 563 696 959 401 881 650 56 88 731 Name. Dose. Page Butcher’s Broom Tar ... 697 Butea3 Gummi, 862 ; Semina ... 842 Butol Emulsion . 595 Butter Analysis .V. II. ,, B. tuberculosis in ...V. II. ,, of Antipiony .V. II. „ Nut . 861 ,, of Orris 861 Buttercloth . 439 Buttermilk . 54 & V. II. Butyl-Choral Hyd., 5 to 20 gr. 242 Butyl-Ethyl-Malonyl-Urea ... 811 Butyn . 354 & V. II. Butyric Ether. 836 Butyrospermum . 884 Buxine.841 Bynin (et Amara), 2 to 4 dr. ...542& V. II. ... 965 ...V. IT. ... 532 ... 964 ... 948 Byno-Eugastrol Bynol . Byno-Lecithin, i oz. ... Bynoplasma, ^ oz. Bynotone . Caesium Compds.880 Cacao and Cacao Butter ... 796 C. B. Q. Tabs, and Lin. ...V. II. C. E.. 285 Caapi ... 842 Cabalonga de Tabasco ... 596 Cachets .• ... 690 Cachets, Oxyquinotheine ... 248 Cacodyle, 180 ; “ New ” ... 183 Cacodyl Oxide ... ... 180 Cacodyliacol, \ to 2 gr. ... 181 Cactus, 847 ; Cactina Pellets ... 847 Caesalpinia Bonducella... ... 842 Cadmium Sulphate .V. II. ,, Tungstate.V. II. Cad uni V. II. Caffeina, 1 to 5 gr. ... 244 & V. II. Caffcime Citras, 2 to 10 gr. ... 245 „ „ Eff., 1-2 dr. ... 245 ,, Di-iodo-hyd. 247 ,, HBr., £ to 5 gr. ... 246 ,, IICl., i to 5 gr. ... 246 ,, Hydriodid., £ to 5 gr. 246 ,, Salicyl., 1 to 4 gr. ... 246 ,, Sodio-Benz., max. 45 gr. p.d.246 ,, Sodii Iodid., 2 to 10 gr. 248 ;, Sodio-Sal., 1 to 5 gr.. 246 ,, Tri-Iodid., 2-4 gr. ... 247 „ Valer., i to 3 gr. ... 247 Caffeine-Chloral, 3 to 8 gr. hyp. 247 Cagliari University on Chaul- moogrates . 604, 605 Cajuput, 843 ; Cajuputol ... 610 Calabar Bean, 1 to 4 gr. ... 684 Calabaza E.E. = Cucurbita Calamina Prsep. . 824 Cal Apagado, = Calc. Hydras. Calcidin.255 Calcii Aceto Salicyl, 5 to 15 gr. 72 „ Bisulphis.V. II NN 33 35 33 33 33 33 33 33 53 33 33 33 33 33 33 33 33 3v 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 3 3 Name. Dose. Page Calcii Bromid., 10-20 gr. ... 239 „ Cacodylas, i to 2 gr. ... 180 „ Carbide.Y. II. „ Carb. Prsecip., 15 to 60 gr. 249 „ Chloridum, 5-15 gr. ... 249 as haemostatic ... 252 „ Cyanamidum .V. II. Pluoridum, h to | gr. . 830 Pormas, 3 to 5 gr. ... 32 Gluconas . 257 Glyceroph., 3 to 10 gr. 33&Y.II. „ Solubilis. 34 Giiaiacol-Sulphonat. ... 447 Hippuras, 5 to 20 gr. ... 9 Hydras. 257 Hypochlor. (Chlorinat.). 41 Hypoph., 3 to 10 gr. ... 683 lodas and Preps., 3 to 4 gr. 830 Jodidum (in dilute solution), 2-4 gr. 255 ,, Iodobehenas . 516 Iodo-Bicinoleas. 3 gr. ... 619 Lactas 10 to 30 gr. 49, 250 et seq. & V. II. „ Becens. 50 Lactoph., 3 to 10 gr. ... 51 Laevulinas . 257 Margosas. 839 Monosaccharate ... 256 Naphthol-sulphonas, 10 to-30 gr.V. II. Nitras .V. II. Oleas . 601 ,, Colloidal. 364 Permanganas 548, 760 & V. II. Peroxid., 3 to 10 gr. ... 255 ,, Phosph. (Tribasic), 5 to 15 gr. 255 Acidus, 5 to 20 gr. 256 Di-Acid, 5 to 20 gr. 256 Di-basic, 10 to 30 gr. 256 Monoacid, 10 to 30 gr.256 Monobasic, 5 to 20 gr.256 Saccharas, 8-30 gr. ... 256 Sodii Lact. 51 Sulphas, 20-30 gr. ... 258 Sulphid., I to 1 gr. ... 258 Sulphis.V. II. Sulphurat. Sol. ... 259 Supcroxidum . 255 Tungstas .V. II. Calciferol . 589 Calcinol, 3 to 4 gr.830 Calcium V. II., and the Blood 250 & V. II. Carbide .V. II. Colloidal . 364 Deficiency and Parathyroid . 986 Diuretin, 7 to 15 gr.... 798 Gluconate ... ... 257 Hydride .Y. II. Sandoz. . 257 Calculi ... V. II. Calendula .843 33 33 33 33 3 3 33 33 33 3 3 33 33 33 Name. Dose. Page Calf Lymph, Glycerinated, etc. 940 Californian Syrup of Figs ...V. II. Caliche ... Y. II. Calmette-Guerin on Vaccina- tion of Newborn . 933 Calomel, 4 to 5 gr. ... ... 473 ,, Cream, P. Off. & L.L. 475 „ ,, Lambkin, 10 m. 475 ,, Duret’s ... 474 & Y. II. ,, Ointment . 475 Calorex Glass.Y. II. Calorie Values of Food ...V. IT. Calorific Fluid. 338 „ Wool. 270 Calot’s Creosoted Oils. 655 Calotropis. Syn. Mudar I.C. Add. See Edn. XV., p. 852. Calox .255 Calumbse Badix . 843 Calvert’s Sugar Estn. ...Y. II. Calx Chlorinata ... 41 & V. II. „ Sulphurata, i - 1 gr. ... 258 Cambogia, 1 to 2 gr. 843 Cammidge on Diabetes ... 1045 Cammidge’s Tests .V. IT. Camphine . 691 Camphoid . 361 Campho-Phenique . 200 Camphor.(and artif.), 2 to 5 gr. 259 & Y. II. Camphor Ball 260 ,, Essential Oil of ... 259 „ Linim. . 261 „ Monobrom., 2 to 10 gr. 262 „ Salicyl., 1 to 5 gr. ... 262 ,, Synthetic ... 260 <fc V. II. Camphorated Carbolic Acid ... 16 » Chalk . 260 ,, Chloroform ... 286 >» Wool . 262 C'amphre de Persil . 165 Canada Balsam, Xylol, etc. ...Y. II. Canadian Hemp Boot. 837 Cancer.Y. II. The subject of Cancer is decilt with in Vol. IT. with the latest refs, on all aspects—Campaigns, Causation, Death Rate, D lag nos is, Gye’s B rork,Radiu m in, X Rays, etc., etc. Cancer, Lead in. 366 & V. II. „ Sodium Oleate in 753 & V. II. ,, Sodium Fluorescein with N rays . 672 (See also Therapeutic Index 1036, 1037 Candle Nut Oil 863 Canella Alba . 133, 843 Cane Sugar .749 & V. II. Cannabin Tannate, 2 to 10 grs. 264 Cannabinol . 263 Cannabis lndica . 263 Cannabis Sativa ... 263, 843 Canned food poisoning ...V. II. Cantharis, 1-16 to £ gr. ... 264 Name. Dose. Page Cantharidinum... 265 Canton’s Phosphorus ... 258 Caoutchouc and Liquor 267 Cape Geranium... • • • 868 Cape Gooseberry • * • 841 Capillaire . • • • 843 Capillus Veneris Capps’ Method. • • • 843 • • • 182 Caprokol, 2 to 10 gr. ... • • • 747 ,, Capsules, 3 to 4 thrice daily 748 ,, Solution 748 Caprylic Alcohol !”v . II. Capsicin, 1-20 to 1-10 gr. • • • 269 Capsicum, i to l gr. ... • • • 269 Capsicum Gamgee Tissue • • • 271 ,, Wool • • • 270 Capsogen . • • * 271 CAPS., Gelatin (Gl = Glass) ... 690 ,, Allyl Sulphid., k, 1, 2 m. 834 ,, Ammon. Quin. = 1 dr. Tinct. • • • 733 9 9 99 99 99 99 9 9 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 Amyi Nitrite (Gl.), 1, 2, 3, 4, 5, 6 and 10 m. Amyl Salicyl, 3 m. Amylene Hydrate, 10m. Apiol, 3, 5 and 10 m. ... ,, 5 m., Ergotin, 2 grs. Arsamin, 1 and 2 gr. ... 1 gr. c. Blaud, 5 gr. c. Quinin., 3 grs. Benzol, 5, 10 and 15 m. Benzyl Benz., 3, 5 m. Benzyl Succ., 5 gr. c. Papav., k gr. Blaud Pill, 5 gr. (and comps.) Brometone, 5 gr. Brominol, 33%, 2 Gm. Bromoform, k m. Calc. lodoricinoleate, 3 grs, • • • • Calc. Permang., 1 gr.... Carbol. Acid, 1 and 2 gr. Cascara (mild). Cascara (strong) ,, (mild) c. Euony- min, 1 gr. Castor Oil, k, 1 dr. (and Co.) ... Celery Oil, 3| and 5 m. Chaulmoogra Oil, 5 to 20 gr. Chemical Food, 1 dr. Chloretone, 5 gr. Chlorodyne, 5 m. Chloroform, 5 m. Chloromorph. Sol., 5 in. Cinnamic Aldehyde, 1 m. Cinnamon 01. 2 k m. c. Quin. 1 gr. Cinnoxyl Cod. L. Oil, j, 1 dr. ... 149 68 835 164 165 185 185 185 309 311 312 412 241 240 240 619 548 19 274 274 274 617 165 603 418 244 287 286 286 828 296 312 612 Name. CAPS. 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 *9 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 9> 99 99 99 Dose. /Cod. L. Oil, 19 m \ Creosote, 1 m. Codein c. Ext. Cannabis Codeinae et Valerianae Comp. Colchicine Salicyl. =1/250 gr. Copaiba, 5, 10, 15 m.... / Copaiba, 5, 10 m. 'I \ Cubeb 01., 5, 10 m. / Co paiba, 5 c. Santal, 5 in. Creocarb . Creosotal, 5, 10 m. Creosote, 3, 5 m. Creosote Valer., 8 m_ Cubeb Oil, 10 m. Cubeb, 5, c. Santal Oil, 5 m. ... Cyllin, 1 and 3 m. Damiana Ext. (30 m. Liq.). Easton Syrup = \ & 1 dr. et aa.c. Arsen.,l/50gr. Ergot, and Apiol Ergotin, 3 and 5 gr. ... Erigeron Oil, 5 m. Ethylene Bromide, 1 m. Ethyl Chlor. (Gl. Spray form), 3, 5, 7 & 50 Cc., also Tubes (local) ... Ethyl Iodid. & Co. (Gl.) See also Sterules. Ext. Filicis Liq., 15 m. Fehling’s Sol. (Gl.), 1 Cc_ ... ...V Fel Bovinum, 5 gr. ... Fcrri Carb. Sacch., 5 gr. Ferri Glyceroph, Co. 1 It &.... ... ... Filix Mas Ext., 15 m. Formalised Gelatin ... Formidin, 5 gr. Glutoid... Glyceroph. = k dr. &1 dr. of Syrup . Guaiacum Resin, 5 gr. Guaiacol, 2, 5 m. ,, 1 gr., c. Iodoform, 1 gr. Guaiacol, f gr. c. Cod L. Oil, 5 m. Guaiacol Carb., 5 grs.... Gynocardia (Chaulmoogra), 5 to 20 gr. Haemoglobin, 5 gr. Hypnone, £ min. Ichthosulphol, Amm., or Lith., 4 gr., also aa., 2 gr. ... ... ... lodicin, 3 gr. lodinol 25%, 2 Gm. ... Iron Carb. Sacch., 5 gr. Iodide = 10 & 30m. Svr ••• * * • Page 612 355 355 359 621 621 621 378 379 378 380 850 621 29 852 419 165 404 853 833 106 108 422 II. 410 411 34 422 690 503 690 36 444 445 445 445 446 603 577 827 498 619 514 411 }> ... 419 NN 2 55 55 5 5 55 5? 55 >5 55 55 55 55 55 55 55 5 5 55 55 55 55 55 55 55 55 Quin. Salicyl., 5 gr. Name. Dose. Page CAPS., Izal 2 m. (& with Cod Liver Oil, 5 m.) ... 30 Kerol. 30 Lecithin, 1| gr. ... 531 Male Fern Ext., 15 111. . 422 „ Menthol Paraffin ... 550 „ Methyl-Aspriodme, 5 & 10 ST SI ,, Meth. Blue, 2 gr. ... 325 ,, Myrtol, 2 and 5 111. ... 869 ,, Nisbet’s Specific, 20 111. 620 Nitrite of Amyl (Sterules) . 149 Nitroglycerin, 1-100 and 1-10 gr.571 01. Allii, i, 1, 2 m. ... 834 Apii Graveolens, 34 and 5 m.165 ,, Cedri Atlant, 8 111. ... 846 ,, Chaulmoogra, 5-20gr. 603 ,, Elliott, i 111. (three to 5). 872 ,, Gaultheria, 10 m. ... 66 ,, Turpentine, 5, 10 m.. 691 Oleic Acid, 7i 111. ... 598 Olive Oil, I dr. ... 616 Ox Bile, 5 gr. ... 410 Ovoniammoid ... 954 Papaveris . 622 Paraffagar . 654 Paraffin (for Catheters) 654 Paraldehyde,20,30,40m. 121 Phenalgin ... ... 3 Phosphorated Oil, 5 111. 680 Potass Todide, 5 gr. ... 709 Potass Permang., 1 gr. 515 728 690 75 Salih’s Salol, 5 and 10 gr. Santalol, 5 111. ... 620 ,, 4 m. c. Methyl Salicyl., 1 m. 620 Santa! Oil, 5 and 3 0 111. e. Methylene Blue, i, 1 and 2 gr. ... 620 Santa! Oil, 5 to 20 111. 620 Savaresse, 10 m. ... 620 Sod. Chaulmoograte ‘A.’ 1, 2 and 3 gr. ... 604 Sodium Oleate, 5 grs.... 753 ,, ,, Co.,m.etn. 753 Sulphonal, 5, 10 gr. ... 787 Syr. Easton, \ & 1 dr. (et. c. Arsen) ... 419 Syr. Fe Iodid ... 416 Syr. Fe. Ph. Co., 1 dr.... 418 Terebenc, 5 and 10 111... 795 Terpinol, 1-1 m. ... 795 Turpentine, 5, 10 m. ... 691 ,, Valerianatum Co., 1 t.d. 736 Capsuloids ... ... ...V. II. ‘ Capsungs ’ Hydrarg. Oleat Ung. 599 Protargol Ointment ... 171 Eng. Prophylaxis ... 458 Captol.280 55 55 Name. Dose. Page Caracol, F.E. = Helix Aspera et var. Caraway.845 Carbamide, 10 to 60 gr. or more 805 Carbarsone 0'25 Gm. 188 Carbassus. See Gauzes Carbazole Antimony Compds. 164 Carbo Animalis and Ligni ... 843 Carbohydrates ... 586 V. II. Carbol-Fuchsin Solution ; Gentian Violet.; Methylene Blue ; Methyl Violet; Thionin ...V. II. Carbolic Acid. 13 ,, ,, Lotion ... ... 16 ,, Coefficient ... ...V. IT. ,, Gauze; Oil . 17 Carbolised Almond Oil, 1 to 2 Cc. hyp.. 16 Carbolised Camphor, 16 ; Glycerin, 433 ; Iodine Sol., 18 ; Olive Oil, 17; Resin, 19; Smelling Salts, 19 ; Wool ... 17 Carbon Bisulphidum, 844 & V. II. ; Bichloride, 290 ; Dioxide, 22 ; Monoxide, 870&V.II. Carbon Tetrachlor., 10 to 45 m. in several capsules ... 271 Carbonate Titrations ... ...V. II. Carbonised Cotton . 442 Carbon Tetrachlor, Iodised ... 273 Carbonic Anhydride . 22 Carbonic Snow. 23 Carbonite . ... 570 Carbonyl Chloride . 805 Carborundum ... V. II. Carburetted Gas .V. II. Carbromalum, 5 to 10 gr. ... 810 Carcinoma, V. II.; and see Therap. Index this Vol.; Radium and X-Rays in ...V. II. Cardamomi Semina . 844 Cardiazol, 1| grains . 263 Cardiazol-Ephedrine . 263 Carduus Benedictus . 849 Carica Papaya 647 Carlsbad Salt, True and Art if. . 773 Carmalum .844 Carineliter Geist . 866 Carmine 844 Carnauba Wax V. II. Carnotite .V. II. Carnrick’s Peptonoids ... 660 & V. II. Carotene ... . 587 Carrageen . 848 Carrel-Dakin Treatment ... 44 Carron Oil . 257 Carter’s Little Liver Pills ...V. II. Carui Fructus ... ... 845 Carum Copticum . 799 ,, Petroselinum ... ... 164 Carvacrol . 873 Carvonum . 836,845 Caryophyllum ... ... ... 845 Casca Bark . 853 Cascagar, 1 teaspoon to 2 tablespoons .274 Name. Cascara, 55 >5 3 3 Bose. Page 3 to 15 gr. ... 274 & V. II. BitteT-free, £ to i dr. 275 Caps., 274 ; Pastils... 276 Jelly, 1 to 4 dr. ... 274 Cultivation, Substitutes, Wood ...V ...V 00 «fe V Cascarets Cascarilla, Cascarillin Casein .58 ,, Bread Caseinogen Cashew Nut Casse en Batues Cassia Acutifolia, Angustifolia ,, Fistula and Pulp ,, Fructus . Castanea vesca . Castela Nicholsoni Castellani’s Antimon. Tart. Injn., 4 to 1 Cc. Castellani’s Fuchsin Paint Castellani’s Ointment Castellani’s Tetra Vaccines ... Castile Soap .V Castoreum ... . Castor Oil, 1 to 8 dr. ,, ,, Powders . ,, Solutions of Alkaloids... Casumen . Catalase .V II. II. 845 II. 585 583 836 846 883 846 846 832 847 157 320 747 938 .II. 846 616 619 617 584 It. Cataplasma Kaolini . 435 Cataplasma Salicyl Co. ... 435 Catarrh, 1038 ; Vaccines for 903, 904 Catechol ..V. II. Catechu Pallidum, 5-15 gr. ... 846 ,, Nigrum, 5-15 gr. ... 846 Catgut ... . ... 532 ,, Ligatures ... 532 ,, Absorbable ... 533 ,, M. It. C. Beport on ... 533 ,, Peppermint Oil for ... 533 ,, Picric Method 533 Catha . ... 845 ,, Cocoa Milk ... 845 ,, Milk and Glyceroph. ... 845 ,, Phenolphthalein Elf. ... 845 Catheters . ... 267 Catheter Oil, 17 ; Salol Oil 76 Catheter Lubricant, 17, 460, 652 ; (Adrenalin), 973 ; Surgi- cal Lubricant 17 Cathode ...V. II. Cat’s Hair, 854 ; Cat’s Tail ... 853 Caulophyllin, 1 to 4 gr. ... 846 Caustic. Mitigated and Tough . 169 „ Barii. ... 215 „ Potash. ... 702 ,, Zinci Chloridi ... 821 Cavendish Moss ... 778 C.E., 285 ; Cebada Germinada, 540 ; Cedar Wood Oil, 846 : Cedrene . ... 846 Cedrol ... ... 846 Cedrus Atlantica ... 846 Celandine, 847; Lesser ... 878 lNges, see p. xxvi. 1125 Name. Dose. Page Celanese . 442 & V. II. Celerina ... ... 248 Celery ... ... 165 Cellafine ... 439 Cellon ...V. II. Cellophane ... 439 Cellulase... ...V. IT. Celluloid, 361 ; Splints ». i Plates 361 Cellulose Products ... 439 ,, Acetate . 442 & V. II. ,, Wadding and Tissue. 439 Celnio. ...V. II. Cement, Portland ... 139 Ceno Milk Spring ... 589 Cephaeline (and HC1.), Emetic 1/12 to 1/6 gr. ... 530 Cephaelis Ipecac. ... 517 Cera Alba, Flava ... 846 ,, Aseptica ... ... 846 Cerasin Bed ... 312 Cerato Laudanizado, F.E. = Sydenham’s Laudanum, 1 to 9, Ceratum, U.S., 650; Galeni, 872 ; Nucistae, 868 ; Petrolei, 650 ; Besin<e Cerebos Salt . Cerebral Extract Cerebro-Spinal Fever ... 4 Carriers’ 3 3 3 3 878 763 949 904 906 Treatment 906,1039 „ „ m B.A.F., Jan. 1931 907 Cerebro-Spinal Fluid i.’.'v II. Cereoli vide Bougies Ceresin. 649 Cereus, IN ight-blooming 847 Cerevisise Ferment, £-1 oz. 276 Cerii Oxalas, 3 gr. • • • 847 ,, Oxidum. ...V II. ,, Sulphocarb., 1-5 gr. • • • 847 Cerium. ...V II. Ceruleinum (Indigo Soluble) ...V II. Cerussa . • • • 700 Cetaceum • • • 847 Cetraria ... • • • 847 Cetyl Alcohol (and Palmitate) 847 Cevadilla Seeds, Cevadine • • • 891 Ceyssatite . • • • 139 Chalk’s Bottles • • • 208 Chagas' disease ...V . II. Chalk, Camphorated ... ... 260 Chalk Mixture, £ to 1 oz. 249 Chamomile Flowers 500, 837 Champagne . ...V .11. Chandler on Iodinol Biag. ...V. II. Chanvre Indien 1 » t 264 Chaparro Amargosa • • • 847 Charbon Naphthole, 60 to 120 gr. • • • 566 Charcoal (Animal, Wood) • • • 843 Chardon Ben it. 849 Charkaolin Granules ... • • • 138 Chatin and Goitre ...708 & V . II. Chaulmartin 605 Name. Bose. Page Chaulmoogrates . 603 Recent Clinical Trials with 605 Chaulmoogra Esters . 605 ,, Oil, 5-10 m. ... 601 ,, Ointment ... 603 Cheatle’s Green Spray. 324 Cheatle’s Paste.462 Chebulic Myrobalans. 853 Cheese, 54, 583 ; Chekan ... 847 Cheiranthus Cheiri . 847 Chelidonium Majus . 847 Chelsea Pensioner, 1 to 2 dr. 789 790 Chemical Food, 4-2 dr. ’ 418 Chemotherapy." 192 „ Index. 192 Chenopodium. 848 Cheron’s Serum. 761 Cherry Bark, Wild .. 875 ,, Laurel Water. 147 Chestnut (Horse) . 832 ,, (Spanish) . 832 Chewing Gum Coca ... 332, 848 Chian Turpentine . 889 Chicken Ess., Peptones ... 576 » Jelly. 635 „ Pox and Small Pox 942, 988 Chicle .848 Chicory.750 Chiendent . 500 Chilblains ... ... ... 1040 Childbirth, Gwathmey’s Method 101 (See also Twilight Sffiep.) Children, Boses for Alt. ... 1104 Chillie Paste (Smedley’s) ... 270 Chillprufe Garments . 755 China Clay, 138 ; Root ... 855 Chiniofon, 15 grs.319 Chineonal, 10 gr. . 810 Chinese Almond, 837 ; Ink ...V. II. Chinina, etc., vide Quinine Chinoform, 1 to 5 gr. 720 Chinolini Tart., 5 to 15 gr. ... 315 Chinolinum, 3 to 10 m. ... 315 Chinosol, 1 to 5 gr. 315, 722 <fc V. II. Chirata, 848 ; Japanese ... 848 Chlor-Sparklet Apparatus ...V. II. Chloral Caffeine hyp., 3-8 gr.... 247 ,, Camph. (et c. Cocain)... 280 „ c. Menthol, c. Phenol, et c. Thymol ... 549 ,, Formamidum, 15 to 45 gr.281 ,, Hair Stimulant ... 280 „ Hydras, 5-20 gr. 279 & V. II. ,, Tannin. 280 Chloralamid, 15 to 45 gr. 281 & V. II. Chloralamide and Biphenyl- amine Pastilles .V. II. Chloramine-T., 46 & V. II.; Bact. Power, 47 & V. II. ; Gauze, 47 ; Ointment, 47 ; and Tabs, 8-75 and 43-75 grains. 47 Chloratiirice . 705 Page 46 185 243 48 243 243 243 350 287 212 212 1097 ...V. II. Name. Bose. Chlorazene C'hlorazol Blue, 3B. Chlorbutol Chlorcosane Chloretone, 5 to 24 gr. ,, Inhalant ,, Solubility ... Chlorhydrate d’Amyleine Chloric Ether, 30 to 40 m., or 5 to 20 rep. Chloride of Gold, Commercial ,, ,, ,, and Sodium Comm. Chlorides as Impurity Estn. ...V. II. ,, Titration .V. II. Chlorine as Antiseptic.V. II. Chlorinated Eucalyptol ... 47 ,, Paraffin (Liquid & Hard). 47 Chlorination of Water Supplies V. II. Chlorine Gargle. 766 ,, Poisoning by... ,, in Water {See also Water.) Chlorobenzols. 309 Chlorobrom, 4 to 1 oz. 281 Chlorodyne (Caps., 5 in.), 5 to 10 m.287 & V. II. ,, N.H.I. =Tinct. Chlorof. et Morph., ’85. 287 ,, Recommendation as to Strength 287, 561, 1006 Chloroform, 1 to 5 m. ...282 & V. II. ,, Antidotes. 283, 284 Collapse during. 283 Bangers. 284 and Ether Anaesthetic ... 285 c. Ethyl Iodide, Sterules 107 Inhalers. Oxygen-Anaesthesia Pink . Ste rules, 10, 20, 30, 60 m., and G., 5 m. A conit i, 1 in 1 . Camphorat lodi, 1 in 30 . ,, Mastiche ... Chloro Mercury Fluorescein ... Chloromorphiae Liquor, 5 15 m. ... Chloron apht halene Chlorophenols ... Chlorophyll Chloro-Sodio-Mag. Aper or more Clilor-San Chloryl Anaesthetic Chocolate ,, Culture Medium >> >> )> >> >> >» » >) to 282 283 282 283 91 286 505 286 484 ... 286 ... 567 21 & V. II. ... 848 1 dr. ... 773 Cholagogues Cholecystitis, Hexamine in 46 105 796 906 & V. II. , 1042 451 Cholecystography ,, Large doses in 677 675 Name. Dose. page Cholera, 908 ; Mixtures, 376, 1041 ; Treatment, 760 ; Vaccines, 908, 938 ; Vibrio 908 & V. II. Cholesterol ... 94, 592 & V. II. For Syph. Test .V. II. Cholesterol and Vitamin D. ... 589 „ in Blood and Urine V. II. ,, Metabolism ... 95 Choline ... . 5 & V. II. Cholme Hydrochlor, 0-6 Gm. intrav. . 5 „ stearo-glyceroph., 3 to ^ , 5gr. ... 531 & V.II. Cholumbrin ... ... ... 674 Chondrodendron toment. 873 Chondrus . 848 Chrismaline .651 Christmas Bose. 891 Christopherson’s Bilharzia Treatment .158 Chromic Anhydride . 827 ,, Catgut (Lister) ... 532 Chromium Plating . 828 Chromii Sulphas . 532 Chromo-santonin, 2 to 5 gr. ... 753 Chrymotherapy . 23 Chrysarobinum, \ to \ gr. 291 & V. II. Chrysarobin Acetates ... 292 Chrysoidine . 326 Churchill’s Iodine . 510 Chyluria .V. II. Chymosin .V. II. Ciba Dial, 14 grs.815 „ Elbon .817 Cibalgin 330 Cibrola... . 34 Cicatricine, 8 to 15 m. ... 758 Cicfa .V. II. Cicuta, Virosa ... ... ... 849 Cicutine, ^ to 2 gr.374 Cicutime HBr., £ gr. 374 Cider .V. II. Cigarettes, 870 ; Asthma, 710 ; Cubeb, 850 ; d’Espic ... 710 Cignolin 292 Cigue .374 Cimex Var.V. II. Cimicifugee Bhizoma, 15 gr. ... 849 Cimicifugin, 1 to 6 gr. ... 849 & V. II. Cimolite 138 Cina ... 751 Cinchona Calisaya, * gray,’ Lan- cif., Officinalis, etc. ... 292 & V. II. Cinchona Febrifuge, 4 gr. ... 713 Cinchona Cultivation 292, 293 & V.II. Cinchona Tercentenary Celebration . 292 Cinchonae Succirubrse Cort., 5 to 60 gr. 292, 293 ,, Alkaloids, Tests ...V. II. Cinchonidine ... 713, 716 & V. II. „ Bismuth Iodide, £ to 1 gr. ... 227 „ HC1. (<fc Ac.), 1 to 10 gr. 717 5 > Name . Dose. Page Cinchonidine Salicyl., 5 gr. ... 717 Sulph., 1 to 10 gr. 718 & V. II. Periodide, II to 3 °r, 131 717 Cinchonina and HCJ. and Ac. ’ HC1., 1 to 10 gr. 717 &V. II. „ Sulph., 1-10 gr. ... 718 ,, Sulphocarb. ... 718 Cinchophen, 8 to 15 gr. ... 316 Cinematography, X-ray ...V. II. Cineol, 1 to 4 m. ... 610 & V.II. Cinnabar = Bed Mercuric Sul- .phide.477 Cinnaldehydum (Cinnamal), . 1 m. 828 & V. II. Cinnamolyl-oxyphenyl Urea ... 817 Cinnamomi Cort., 10-30 gr. ... 295 Cinnamon Paste, Dental 296, 502 Cinnamon, Wild . 843 Cinnamyl Cinnamate. 887 Cinnoxyl Caps. 312 Cinyl Alcohol. 796 Cirio de Flor. May.847 Citean Salt . 762 Citral .v. II. Citrated Milk . 579, 766 Citric Acid . 25 Citrine Ointment . 466 Citronelke Oleum .V. II. Citronin 767 Citronenol .V. II. Citrus var.839 Claret.V. II. Clarke’s Blood Mixture ...V. II. ,, Soap Solution ...V. II. Claudius’ Iodine Solution ... 532 Clayton Gas .V. II. Ciearsol 29 Cleaver’s Grass 855 Clemens Solution, 1 to 5 m. ... 176 Cloud-berry . 880 Cloudy Ammonia . 144 Cloves.845 Clubmoss Spores . 865 Cnicus.849 Coagulant Haemostatics ... 964 Coagulen Ciba. 964 Coagulose . ... 964 Coal Gas, poisoning, see Carbon Monoxide ... 1096 1097 „ Mines Begns.512 ,, Tar . 296 „ „ Derivatives ... 296 & V.II. „ ,, Disinfectants, 27, et seq. & V. II. „ „ Inhaler and Vaporiser 296 ,, ,, Soap. 754 Coca Chewing Gum . 332 Cocse Folia, 30 to 120 gr. 331 & V. II. „ , History of ... 331 Cocaina, 1/20 to £ gr. ... 333 Tests, Manufacture ...V. II. Cocaina, Uses ... .... ... 332 Name. Dose. Page Cocaina, First Use of in Surgery 333 „ c. Oleo 2% • • • • 334 Cocainse Carbolas • • • 341 „ HI, HBr. „ Hydrochlor, (ts • • . 340 ' 1 to Igr.R.ZV14 335 & V. II. ,, Lactas ... ^ to 340 ,, Nitras ... i gr. 341 ,, Nitris 341 ,, Phenas ... • • • 341 ,, Salicyl ... • • • 341 ,, Sulph. ... Cocaine * Activated ’ • • • 340 • • • 128 ,, Abuse of • • • • 341 ,, Antidotes • • • 334 „ Bougies, | gr. „ Dental Use • • • 334 • • • • 337 ,, Ear Cones . Eye Drops (Factory 339 _ Act) ... 334, 1005 „ Eye Lotion, Isotonic... 339 ,, in Castor Oil. 334 „ in Clove Oil ... ... 334 ,, Lanoline . 334 „ Local Infilt. Anaesthesia c. ... ... 337 ,, Lumbar puncture ... 337 ,, Menthol-Eugenol ... 334 ,, Menthol-Phenol ... 334 ,, Periodide, 1/40 to 1/20 gr. incr. ... 131, 340 ,, Poisoning . 337 ,, Sniffing . 341 ,, Sterilisation of Sols. ... 339 ,, Substitutes 342 et seq., 989 „ ,, Unrestricted Sale of . 989 ,, Synthetic . 342 ,, Tests for .V. II. ,, for Tooth Extraction... 337 „ Uses of ... ... 335 ,, versus Synthetics 33(5, 337, 342 Cocculus Indicus ... ... 874 Coccus Cacti ... ... ... 844 Cochineal, Liquid, 844 ; Indicator V. II. Cochlearia Armoracia ... 849 Cocillana, 849 ; Cockle’s Pills...V. 11. Cock’s comb, Ergot assay ...V. II. Cocoa, 790 ; Food ... ... 580 ,, Nut Charcoal ... 843 ,, Nut Oil, Shampoo, Stearin and Soap ... 84 Cocoala ... ... ... ... /23 Cocktail habit ... ... ... 113 Cocomero ... ... ... 373 Cod Liver Oil, 1 to 4 dr. 611 & V. II. ,, ,, Emulsions ... 612 Name. Bose. Page Cod Liver Oil, Substitutes ... 615 ,, ,, and Rickets ... 591 ,, ,, Vitamin Concentrates ... 613 Codeina, l to 2 grains ... 355 & V. II. ,, Dangerous Drugs Act ’32 ... ... ... 355 Codeine Glycerin Jelly, 1 dr. ... 355 Codeinse HBr., i to 2 gr. ... 356 „ HCl.,ito2gr. 356 & V. II. ,, Periodid., 1 gr. 131, 356 ,, Phosphas, i-1 gr. ... 356 ,, Sulph., av. ^ gr. ... 357 Codeine Methyl-Brom., £ gr. ... 357 Codeine-Sodium Diethylbarbi- turate, 5 gr. ... ... ... 563 ... 357 ... 563 ... 613 29 & V. II. Codeinone Compds. Codeonal, 5 grains Codlivex... Cofectant Coffee and De-caffeinated ...V. II. Cognac ... ... ...113&V. II. Cohen’s Salicyl Mist. 1 to 2 dr. . 61 Cohosh, Black, 849 ; Blue ... 846 Coke, F., on Skin Tests 662 et seq. ,, Asthma Treatment ,, Oven Oils . Cola Acuminata . Colalin Tabs., & to } gr. ; Colalin Laxative Colcliici Cormus, 2 to 4 gr. ,, Semina, 3 gr. Colchicine, 1/100 to 1/32 gr. 358 & V ,, Salicyl. (Caps Colchisal Colcothar . Cold Cream ,, Vaccine, 903 ; See also ... 1038 Colds, Min. Health Rept., 1930 903 See also 1038, 1039. Coleman’s Wincarnis ... ...V. II. Coley’s Fluid ... ... ... 922 Colic Root (Aletris) ... ... 834 ,, ,, (Dioscorea) ... 852 “ COLLAPSUBES ” OF OXNT- 2I0 gr.) 666 27 248 776 357 357 .11. 359 359 85 872 MENTS, p. 11 :— t ,, Aristol, 10% ... 503 * ,, Atropine, 2, 4, 8 gr., per oz. ... ... 209 * ,, Atrop., 4 grs. & Cocain. 8 grs. per oz. ... 209 * „ Atrop., 2 grs. & Iodof. 209 * ,, Atropine, 2 & 4 grs. per oz. c. Ung. Hyd. Ox. Flav. 209 § „ Bism. Morph. Coe. ... 225 ,, Bism. Subgallate ... 233 * ,, Boric Acid Dint. ... 11 Those marked * are of small size for ophthalmic use. f Are for urethral use. § For rectal use. **For vaginal or uterine use. The last three with suitable attachments. Name. Dose. Page “ COLLAFSU1ES” OF OINTMENTS—cid. :— * ,, Boric Acid in White Petroleum Jelly, 1 in 60 3 3 Boric Cream. 11 ^ § 1 3 3 ,, Petroleum Jelly 11 f „ Dermatol, 10% 233 § „ Ferri Perchlor. 413 § „ Gall and Opium 628 § „ Hamam. (et c. Co- caina) 449 * 33 Homatropine and caine ea. 2% f „ Hyd. Iodid. 1% 463 33 Hydrarg. Salicyl. 473 33 Hydrasts (5% Liquid Extract). **t§ „ Iodoform, 5%, et Co- caina, 2% 502 t „ Iodoform, et Euca- lypt., 5%. 502 t Iodol, 5 %, et Euca- ... 503 f§** „ Lanolin & L. Cream ... — ) ) Lubric. Jelly ... 433 * 5 5 Methysal Balm 67 * 3 j Pagensteclier’s, 1 to 10% . 476 4 » Paraffin, Soft... 650 J f * \ Petroleum Cerate 650 S J t „ Picric Acid, \% 57 t „ Silver Proteinate 171 3 3 Surgical Lubricant ... 17 ** 3 3 Tannin, 10% ... — § „ Ung. Gall. c. Op. ... 628 * 3 3 Ung. Hyd. Ox. Flav., 1 to 10% . 476 ) > Ung. Prophylaxis 458 t 33 Zinc Permang., 1 in 2000 548 f 33 Zinc Sulph., 1 in 500 826 t 33 Zinc Sulphocarb., 1 in 500 . — Collargol (Colloid Silver) 170 Collasan... 138 Collinsonia Canadensis. 849 Collip’s Parathyroid . 985 Placental Hormones ... 963 Collobell preps. 364 Collobiase ... .. 605 Collodium (contractile) 359 «« Acetonum. 360 7 7 ^ 3 Aceto-ASthcricum ... 360 3 3 Anodynum. 360 • • Belladonnse... 218 7 7 3 3 Benzoini 360 Callosum 360 / 7 l t Cantharidis (var.) ... 266 7 7 « * c. 01. Crotonis, 1 in 7 360 7 7 Elasticum. 359 7 7 33 Flexile, B.P. ’14 ... 359 Name. Dose. Page Collodium Ichthosulphol 498 3 9 Iodi, 30 gr. in I oz. 360 33 c. Iodoform. 501 33 Kelly’s . 360 3 3 Paraformi. 128 3 3 Salicyl . 360 33 Salicyl. et Lact. 361 3 3 „ c. Hyd. Perchlor. 360 33 ,, c. Zinc. 360 33 Salol, 76 ; Styptic... 361 3 3 Vesicans . 266 1 9 Zinci Chloridi 821 Colloidal Metals . 361 33 Antiseptic Powers ...V . II. 33 Doses, see Individual Solutions in text. 33 Electric properties ... 362 33 „ MethodsforCopper, Gold, Silver 372, 373 3 3 Patents on ... 363 33 Physological Expts. 365, 366, 369, 370, 371 ,, Solutions, Aluminium 364 ,, ,, Antimony ... 364 ,, ,, Arsenic. 363 ,, ,, Bismuth. 363 ,, ,, Calcium. 364 ,, ,, Copper (1 in 2000) 365 ,, ,, Gold (1 in 4000) 365 „ „ Test in C.S. Fluid V. II. ,, „ Iodine ...366 & V. II. ,, ,, Iron . 366 ,, ,, Lead . 366 ,, ,, Lead Iodide ... 368 ,, ,, ,, Phosphate 368 „ ,, ,, Selenide ... 368 ,, ,, Manganese ... 369 ,, ,, Mercury(lin2000) 369 „ „ Palladium ... 369 ., ,, Platinum (1 in 4000). 370 ,, ,, Protectives for... 362 „ ,, Selenium (1 in 5000). 370 ,, ,, Silver (1 in 2000) 371 „ „ (Collargol) ... 170 ,, ,, Sulphur, 788 ; (1 in 1000) ... 371 ,, Therapy and Uses ... 364 „ Verification & Tests 362, 363 Collosols, Argent, 371 ; Hy- drarg, 371, et seq. ; Iodine, 366; Manganese, 369 ; Selenium, 370 ; Sulphur ... Colloxilina . Collunarium Aik. Comp. ,, Alum, T.H., 1% ... ,, Pot. Permang., Liq., 6 m. in 1 oz., T.H. ,, Potass. Chlorat Co. 372 359 765 705 Those marked * are of small size for ophthalmic use. t Are for urethral use. § For rectal use. ** For vaginal or uterine use. The last three with suitable attachments. A Page 731 55 5 5 55 55 55 5? 55 55 55 55 Name. Dose. Colhmarium Quininse ... ,, Zinc Sulph., 0-1% ... — „ Zinc Sulphocarb., 1 in 250 — Collutorium Acidi Benzoici ... 7 Acidi Tartarici ... 90 Alkalinum Co. ... 764 Astringens. 821 Formalini . 125 Hydrogen Perox. ... 489 Pot. Permang. ... 545 Collyr. Adstring. Lut. 826 Horsti. 826 Hyd. Biniodidi. ... 463 Hyd. Perchlor., N.H.I. 470 „ Zinc Co. 826 Colocynth. Pulpa, 2 to 8 gr. ... 373 Colocyntliin . 374 Colon Bacillus and Vaccine ... 909 Colonic Anaesthesia ... ... 100 Coloquintide . 373 Colostrum .V. II. Colza Oil . 756 Comfrey.888 Combined Cold Vaccine ... 903 ‘ Complement' 894 ,, Deviation, Syph. ...V. II. Comp. Asthma Fluid. 207 Compral, 71 grs. . 330 Conarium . 955 Condensed Milk . 582 Condurango, 15 to 60 gr. ... 850 Condy’s Fluids. 548 Conessine . 527, 859 Confectio Aromatica = Pulv. Cretae Aromatica, 10-60 gr. ... 626 Confectio Glyceroph C., 1 to 2 dr. 35 c. Malt, 1 to 2 dr. . 35 Guaiaci Co., 1 dr. ... 789 Petrolei, 1 to 2 dr. . 654 Pipcris, '14, 60-120 gr. — ltosae Gal. 879 liutae, 1 to 2 dr. ... 880 Santonini Co., 1 dr.753 Scammoniae Co., ’85, 10 to 30 gr. ... — Senna1, 60-120 gr. ... 883 ,, et Piper. Sulphuris (et c. Senna) 60 to 120 gr. Tcrebinthinae, ’85, 60 to 120 gr. 55 55 55 55 5 5 55 883 789 Congo Red ... ,.. V. II. Congreve’s Elixir V. 11. Conii Folia and Fruits, 2 to 8 gr. • • • 374 Conine, \ gr., incr. ♦ • • 374 Coninae HBr., HC1., £ gr. inc. 374 Conjunctivitis ... • • • 1042 Conradi’s Koleradraaber • • • 376 Constipation . • • • 1042 Contents . • • • iii. Contraceptalene • • • 722 Contraceptives ... • • • 722 Contractile Collodion ... • • • 359 Name. Dose. Page Contramine Intram., £ to 4 grs. 791 ,, Pessaries ... 791 Convalescent Serum in Measles 1068 Convallaria Majalis . 850 Convolvulus . 861 Cooper’s Weedicide stated to contain 36% of Arsenious Oxide by weight. Inquest on Mrs. Greenwood, June 16/20. Coorchi, see Ivurchi. ... .. 859 Copaiba, 30 to 60 m. 621 „ Oil, 5 to 20 m. ... 621 ,, Soluble . 621 Copal Solution ... ... 866 Copeman, S. M., Sod cein in Cancer Copper Alanin ... ,, as adjuvant to „ Comps. ,, ,, Colloidal Hair Dye Ionisation Oleate ... Points ... Soaps ... Sod. Tart. 55 55 55 55 Fluores- 672,673 . 384 Iron 412, 420 382 et seq. ... 365 .V. II. .V. II. 598 135, 383, 826 755 384 84 622 . II. 263 570 Copper, Water Sterilisn. with...V. II. Copra . Coquelicot Fleurs de Corallin ... ... ...y Cora mine Cordite. Cordova’s Modifd. Eusol. See Edn. XVIII., p. 56. Coriander . 850 Oork _.878 Corn Ergot and Silk, 865 ; Oil 615 Comezuelo de Centeno ... 401 Corns, Collodions for ... ... 360 Cornutine, i to £ gr. p.d. ... 406 Coronilla . 850 Coronium Bromide . 781 Corpora Lutea, 5 to 10 gr. ..! 949 „ Tablets, 1 gr. ... 949 Corrosive Sublimate ... ... 467 Cortical Hormone . 974 Cortin .974 Corydalis .’ 842 Coscinium ... . 843 Cosmetics ... ... .” 448 Coster’s Paste ... * 506 Costus.850 Cotarnine HC1., i to i gr. incr. 567 ; Plithalate, £ gr. incr. 568 & V. II. Coto Cort., 1 to 8 gr. 375 Cotoin, £ to 2 gr.376 Cotton Medicated . 439 „ Seed Ext. Pdr., 1 dr. ... 443 „ „ Oil . 261 Couch Grass . 500, 833 Coulomb .V. II. Coumaric Anhyd. . 829 Coumaric Treatment ... 829 Name. Hose. Page Coumarin . 829 & V. II. Councilmania dysenterise ...V. II. CourtPlaster,860 ; Courtauld’s Art Silk, V. II. ; Cowbane ... 849 Cow & Gate Milk . 578 Cowhage, 1 to 2 gr. 423 Cowpox.940 Crab’s Eyes = Calcii Carb. ... 249 Craie Preparee 249 Cramer’s Test ... ...V. II. Cranes bill Root. 856 Crataegus Oxycantha ... ... 850 Cream Artificial Act, 1929 ; Ice ; Assay, etc.Y. II. New Zealand ... 595 Preservatives ; Reconstituted ; Regulations V. II. Salicylic . 60 of Tartar (Soluble, 712), 20 to 60 gr. ... 712 & V 3? II. II. II. 33 33 33 Creams, M.pts. of .V CTeatinin, Creatin ... ...V CrCde’s Silver (Ung. 171), § to 2 gi... ... ... Crembas . Cremor Acid Salicyl ... ,, Emolliens Frigid. Hamamelidis ... Hyd. Zn. Cy. Lowndes ,, Magnesiae, 1 to 4 dr. ... ,, “ Sicc ” preparations... ,, Zinci et Calaminae ... Creo-Camph. Cream ... Creocarb. Capsules . Creolin ... Creophen . Creosol ... Creosotal, 5 to 20 gr. Creosote Carbonate, 5-20 m. ... Perles, 1, 3 m. Phenyl Propion, 10 m „ Yaler., 4 to 12 gr. .. Creosoted Oil. Creosotum, 1 to 5 m. incr. 376, 444, & V. II. Cresineol .Y Cresol, 1 to 3 m. ... 26 & V ,, Soap Soln. Cresylic Disinfectants. Cresyl hydrate. Creta Gallica . ,, Pra^parata, 15-60 gr. ... Crile’s Anoci-Association 99, 493 „ Tube . 97, 283 Crisalbine . 213 Cristolax ... ... ... 653 Crocus ... ... ... ... 850 Cromessol ... ... ... 127 Crosby’s Balsamic Elixir ...Y. II. Crotalin, 964 : Crotin. 872 Croton-Chloral Hyd., 5 to 20 gr. 242 ,, Eluteria.845 ,, Gubouga . 872 170 94 60 803 872 448 462 458 538 803 823 200 378 29 29 377 379 379 378 380 380 655 II. . II. 27 27 26 139 Name. Dose. Page Croton-Tiglium. ... 871 ,, Elliottianus ... 872 Cryogenin, 3 to 24 gr.... 8 & V. II. Cryptopine . ...V. II. Crystal Soda . ... 765 Crystal Yiolet.324 & Y. II. Crystalloids .361 & Y. II. Cubeb Cigarettes ... 850 Cubebin. ...V. II. Cubebse Fruct., 30-60 gr. Cuca, see Coca. ... 850 Cucumber Ointment ... ... 851 Cucurbit* Semina Prsep., 3 to 4 oz. 851, 873 Cudbear. ...V. II. Culex var. ...V. II. Culture Media. ...V. II. Cumene, Cumol. ... 532 Cuprea Bark ... 380 Cupreine and Comps. ... ... 380 Cupri Acet., 1-12 to I gr. ... 382 ,, Alanin . ... 384 ,, Alloxanas ...Y. II. ,, Amino-propionas ... 384 ,, Ammon. Sulph_ ... 383 ,, Arsenis, Tooth to Ath gr. 178 „ Chloridum, 1 to 2 gr. 383 & V. IT. „ Citras . ... 382 ,, Glycinas. ...Y. II. ,, Hippuras. ...V. IT. ,, Nucleinas ... 279 ,, Oleas . ... 598 ,, Oxidum. ... 382 ,, Sod. Tart ... 384 ,, Sod. Thiosulph_ ... 384 ,, Subacetas ... 382 ,, Sulphas.,! to|gr. ; emetic 5 to 10 gr. ...382 &V. II. ,, Sulphocarbolas ... 20 Cuprocyan . ... 384 Cuprol. ... 279 Cuprum, 381 & V. II. ; Alu- minatum . ... 383 “Cuprung”... ... 382 Curara, Wth to 1 gr. .. ... 851 Curarina, „ A to A gr. ... 851 Curdled Milk .52 & V. II. Curdling Ferment ... 633 Curd Soap ... 753 Curie Wafers, Y. II.; Curicones, V. II. Curschmann’s Solution, 15 m. hyp. ... 261 Cusparia. ... 851 Cusso, ’14, ! to 4 oz. • • • Cutaneous Tests ... 660 Cutch, see Catechu nigrum ... 846 Cutieura. ...V. II. Cyanamide . ...V. II. Cyanide Gauze and Paste 439, 441 Cyanine Dyes. ... 315 Cyanuretum Hydrargyri ... 459 Cyclic Ureides. ... 806 Cyclohexanol ... ... 290 Cyclohexenyl Barbituric, Acid 814 Cydoni* Semina ... 851 Name. Dose. Page tyllin Preps., 1 to 5 in. 29 & V. II. Cymene.. Cyna . 754 Cynips Gallae.! 856 Cynodon.834 Cynoglossmn. 852 Cynotoxin ." g? Cypress Oil . 852 Cystannn, 5 to 15 gr. ... ... 449 Cystazol Tabs., 1 to 3 in water 453 Cystm .v. II. Cystitis, Mercnrome in ... 481 Cystoformin . 454 Cystogen, 5 to 15 gr. ... 449 Cystography with Silver Iodide 168 Cystopurin, 30 gr.454 Cytisine, 852 ; Cytisus Laburnum 852 Cytisus Scoparius . 886 Cytolysm . 894 Czapeck’s Medium .y. n. Daccol Vaccines . 932 Dahlia .. 750 Daisy Powders.y. jj. Dakin’s Hypochlorite Solutions 44 & V. II. >> ,, Daufrcsne’s Modfn. 45 Dalby’s Carminative.y. u. Dalmatian Flowers . 876 Damaroids .V. II. Damiana . 852 Dammar.852 Damson, Mountain . 884 Dandelion . 889 DANGEROUS DRUGS: ACTS SUMMARY ... 996 1920 Act. 997 ,, Appeal Case (Livpl.) ... 1007 ., Castor Oil Cocaine for Factories .1005 Drugs applied . 997 Exempted products ... 1004 Fishing Vessels.1005 ,, General Authorisations... 1000 „ Hospitals .1004 ,, Laudanum to farmers ... 1005 Marking of Packages ... 1001 Mid wives .1005 Morphine Addicts ... 1006 ,, Nursing Homes ... 1005 „ Prescriptions, 1000 et seq ; N.H.1.1001 ... 1008 ... 1005 Records ... 1001, 1002 References .1007 Special Authorisations 1004, 1005 ,, S.R. & O's under, 1005 et seq. DANGEROUS DRUGS ACT, 1923. ,, Amending Sales ... 998 ,, ‘ Signed Orders ’. 998 ,, Percentages . 999 „ Supplies to Medical Men 996 3 3 3 3 3 3 33 33 33 ,, Points of Assistance ,, Raw Opium 3 3 33 33 33 33 Name. Dose. page D.D.A. CALCULATION TABLES 1009 „ Examples of Scrips ... 1012 of Dentist’s Scrip... 1013 ,, Vet.-Surg’s Scrip 1013 _ . ?? * Signed Order ’ . 1014 dangerous drugs act, 1925 ... ... . 999 D.D. (CONSOLIDATED) REGU-' LATIONS (1928) 1000 DANGEROUS DRUGS ACT, 1932.1006 (Received Royal Assent, March, 24,’32) Danish Glossary .y. II. „ Ointment . 791 Danistol Caps 423 Danysz Method . 667 Daphne Mezereon . 867 Datura var. 495, 779 Daturae Folia et Semina ... 779 Dat urine . 779 Daufresne’s Modifd. Dakin Soln. 45 Davis & Gilchrist Oxygen Apparatus . ‘ ... 631 Davis’ Pills .V. II. Deadly Nightshade . 217 Dearborn Preps. .V. II. geba .806 Decalcified Dietary . 252 Dechlorination. 762 Decholin ... ... ... 770 Decocta, 384 ; Concentrata ..! 384 Dec. Acaciee Cort. 4 to 2 oz. ... 827 Agropyri, 4 to 2 oz ... 833 Aloes Co.. 4 to 2 oz. ... 132 Apocyni, 4 to 1 oz. ... 837 ,, Cannabis Sativ., 1 oz. ... 843 ,, Cetrariae, ’85, ad lib. ... 847 „ Chondri .848 ,, Cinchona?, ’85, 1 to 2 oz. 294 „ Cydoniae 851 Eryngium, 5 oz. 853 Eucalypti, 2 to 4 dr. ... 853 Euphorbia? Pepli, 1 teacup . 854 Granati Cort., B.P. ’98, 1 in 5, | to 2 oz. Haematox.’14, 4 to 2 oz.... Ispaghula?, £ to 2 oz. ... 861 Levisticum, 3 to 5 oz. ... 863 33 33 33 33 33 33 33 33 33 ” Linum .864 ,, Papav. (et c. Anthem.) ... 622 „ Pareirce, ’85, 1 in 16, std. hot, 1 to 2 oz. „ Psyllii, ad lib.875 „ Sappan, 4 to 2 oz. ... 858 s, Scoparii and Tarax., ’85, 2 to 4 oz. ... ... ,, Simaruba? et Granati, 1 oz. 527, 884 ,, Tritici, 4 to 2 oz. 833 „ Ulmi, 2 to 4 oz. 890 ,, Viburni Opuli . 891 ,, Zittmanni F. et Mit. ... 881 Dedicated Patents 1021 & v. Preface Name. Dose. Page Peeks’ Bismuth Pdr. ... 521, 529 ,, Ointment .1045 Defatted Tubercle Vaccine ... 932 Delafield’s Stn. .V. II. Delectol ... ... ... 653 Delhi Boil .V. II Delphina, At to f gr. 887 Delphinium ... ... ... 887 Dengue Fever.V. II. Dental Anaesthetic, 10 to 25 m. 337 Arsenical Fibre&Paste 176,177 Compo ... ... 862 Dressings, Sterile ... 442 Extractions ... ... 338 Fillings ... ... 825 Mastich ... ... 866 Paste, Cinnam. ... 296 Plasters, 269 ; Rubber 267 „ Solubes, Antiseptic ... 18 ,, Wax ... ... ... 651 Dentifrice Oxidising ... 490 Dentist’s Scrips for ® Drugs, 5* 55 55 5 5 55 55 55 55 see 996 et seq. .1015 . 46 215, 259, 774 & ... 1045 ... 233 ... 490 ... 660 ... 776 899, 916 ... 618 ... 618 ...V. II. Dentists Act Dentures, to clean Depilatories Derbyshire Neck, 708 Therap. Index. Dermatitis Dermatol Dermogen De sensitisation Desoxycholic Acid Detoxicated Vaccines Detoxol Tooth Paste ,, Liquid Developer, Photographic Devil’s Milk . Dewees’s Mixture, 1 oz. ... 133 Dextrin 130 Dextrose, 427 ; Enema ... 396 D’Herelle on Bacteriophage ... 896 Dhobie’s Itch ... ... 1045 &V.1I. Diabetes, 1045, see also Insulin. Innocens . 644 Mell., Insulin in, 636 et seq. Operations in ... 644 ,, Pituitary in ... 642,961 ,, Tests .V. II. See also Insulin. Diabetic Foods, 584 ; Urines .V.II. Diabetin.* 750 Diacetyl-Amino-Azo Toluol ... 313 Diacetyldihydroxyphenyl-isatin 27 6 Diacetyl-Morphine HC1., A to £ gr. ... ... ••• 559&A.1I. Diacetyl Tannin, 5 to 15 gr. ... 90 Diachylon Plaster . 599 Dial Tabs., 14 gr. Dose, -} to 3 Tabs. ..815 & \ . II. Dialacetin, 1 to 1 tablet ... 815 55 55 55 Diamalt and with Oil Diamide Diamido-azo-benzene HC1. Diainidodipheny] 542 V. II. 326 V. II. Name. Dose. Page Diamidophenol HC1. = Amidol. V.II. Diamino-AcridineSulphate, 303; HC1., 297 ; Patents, 297 ; Antiseptic Power, 298 ; Uses 299 Diamino-Methyl-Acridine Chlor. 303 „ „ „ HCL... 297 Diamorphinse Hydrochloridum, Aj25 to 1/8 gr., and D.D. ^Restrictions 559, 997 & V. II. Diaphorm, 1/25 to 1/8 gr. ... 559 Diaplyte Vaccines Diarrhoea Mixtures Diascordium Diastase, Malt, syn. ... 932 ... 376 ... 889 Maltine 541 & V. II. ... 633 ,, Pancreatic Diastasic Power, Expts. on ...V. II. Diathermic Treatment ...V. II. Diazo Reaction ... ...V.II. Dibromfluorescein ... ...V. II. Dibromin ... ... ... 817 Dibrom-malonyl-ureide ... 817 Dibromo-oxy-Mercury-Fluores- cein ... ... ... ... 477 Dichloramine-T ... 47 & V. II. ,, in Eucalyptol ... 47 Dichlorbenzol o & p. ... ... 309 Dichlorethylene ... ... 289 Dichlorethyl-sulphide 1097 & V. II. ...V Scale Dichloride of Ethylene Dichlornaphthalene Dick Test and Prophylaxis Dicodid Didial, 1 to 3 Tabs. Didymin Diet, Salt-free, 762 Dietary, Defective Dietetics . Diethyl Ammon.-Diethyl thiocarbamate Diethyl barbituric Acid Diethylene-diamine, 4 to 10 gr. Di-ethyl Malonate . Di-ethyl-malonyl-urea,5tol0gr. Diethyl-sulphone-dimethyl-me- thane, 10 to 20 gr. ... Diethyl Sulphone Meth-Eth. Methane Diffusol Digaien, 5 to 15 m. Digestive Salt. Digisol, max. 45 m. per os ,, for Injection, max. 5 Digistrophan Tablets ... Digitaline, Cryst., siu to too gr. Digitaline, Amorphe, £5 to so gr. Digit alinum, Native lie granules, yip tte 600 gr. ... Pulv. Pur., to- to i gr 289 567 . II. 357, 997 ... 815 ... 974 ... 595 ... 590 575 Di- ... 791 ... 806 694 807 806 786 787 29 & V. II. ... 394 ... 763 389 389 394 392 392 Cc. 5? 393 393 Digitalis, Folia, i to 2 gr. 385 & V.II. Assay ... 390 and V. II. Cat Unit Tablets ... 391 Cultivation, etc. ...V. II. Cumulative Action ... 388 Deterioration of preps. . 390 55 55 55 55 55 55 55 55 55 Name. Bose. Page Digitalis, Dosage in India ... 391 Fibrillation treated ... 386 Flowers ... ... ...V. II. Glncosides ... 392 & Y. II. International Standard 385 & Y. II. Lanata ... ... ... 394 Leaf Tablets, | gr. ... 385 Maceration v. pereoln. ... 390 Physiological Standardisation 389, 390, 391 & V.II. ,, Seeds ... ... ...Y. II. Digitalone, hyp., 8 to 15 in. ... 390 Digitonin .Y. II. Digitoxin, to gr. (granules I mgr.). 392 & Y. II. Digitsaponin ... ... ...Y. II. Digoxin. 394 Dihydromorphinone, HCT., 1/12 gr. ... ... ... ... 561 Di-hydrog. Pot. Phosph., 15 to 60 grs. <11 Dihydrocodeinone Compds. ... 357 Di-hydroxybenzene . 745 Di-hydroxy-hexyl Benzol ... 747 Dihydroxyphenylmethylamino- methyl Carbinol ... ... 968 Dihydroxyphenylethyl Methyl- aniine ... ... ... 974 Dihydroxyphthalophenon ... 671 Dilaudid, 1/12 grain . 561 ,, Tablets 1/24 gr. ... 561 Dill Fruit, . 836 Billing, Prof. W. J., on Proportional Dose ... ... 1104 Dimethyl-Amido-Antipyrin ... 330 ,, ,, Azo-Benzol ...Y. II. -Amidobenzaldehyde...Y. II. as Test for Ergot, etc. 403 312 118 105 836 . II. 827 786 21 327 55 55 55 55 55 55 55 55 55 55 55 ...Y 55 55 55 Dimol 55 Benzol Carbinol Ether - Ethyl-carbinol Gly oxime -Ketone, 1-1£ dr. Meth-dieth. Sulphone Methoxy phenol -oxy-quinizine... Xanthine ... 796, 798 Pulvcrettcs, 2 to 4 ... 21 Preps. ... ... 21, 22 See also Improved Form, L. ii./32,76. Dinitrobenzols ... ... 310 Dinitro-cellulose . 359 Dinner Pills and Tablets ... 701 Diogen(developer r>.P.J.i./o7,429.)^ Dionin, i to £ gr. . 658 Dioscorea ... ... ••• S52 Dioxyanthraquinone. 276 Dioxydiamino-Arsenobenzol ... 191 Diphenyl Nucleus Arsenicals ... 191 Diplienylamine.Y. II. Diphenylcarbazid & Mercurome Edn. XIX. p. 490 Name. Dose. Page Diphtheria Antitoxin ...910 & V. II. ,, Anatoxin.Y. II. „ B. Y accine, see Edn. XIX., p. 917. ,, Carriers ... ...Y. II. 7 7 y y Antitoxin ‘ Cone.’ 910; Units, 910 & Y. II. y y Endotoxin... ...V. 11. y y Immunisation ...Y. II. y y Infective Period ... 988 y y Intrav. use 910, 911 5 5 Medellin Disaster ... 911 55 per os ... 911 i 5 Pigment for ... 413 55 Prophylactic 910 & Y. II. y y Schick l est for ...V. II. yy Standards ... ... 910 y y Toxin-Antitoxin 911 & Y. II. y y Toxoid ...Y. II. Diplo. Intracellularis ... ... 905 5 5 Lanceolatus ...Y. II. 3 ) Bheumaticus ... ... 919 5 ) Scarlatinse ...Y. II. 1 1 Weichselbaum ... ... 905 Diplosal, 15 gr. 68 Di-potass. Byd. phosph, 1 to 10 grs. . ... 711 Dipterocarpus ... ... 839 Diseases, Infective Periods ... 988 1 * Index... ... 1022 Disinfectants .27, 124, 545 For storage of Instruments—Thymol Disinfectant. „ Sale of ... ...992 & Y. II. ,, Standardisation ... ...Y. II. Disinfection of Booms 124, 127 & Y. II. Dismenol . 330 Di-Sod. Methylarsen, to 3 gr. 183 Di-Sodium Dioxy-Diamino- Arsenobenzol Dimethylene Sulphonate.202 Disseminated Sclerosis and T.A.B. Yaccine ... 940 Distemper .916 & V. II. Distomiasis 273, 423 Dita Bark and Ditaine ... 835 Di-thymol-iodide ... 503 Di-Ureides ... 806 Diuretic, the choice of a ... 386 Diuretin, 10 to 20 gr. ... ... 797 Divi Divi . ... 852 Dixon, Prof., on Opium Smok- ing ... 624 Doan’s Pills and Ointment ...V. 11. Dobell’s Solution ... 765 Dochmiasis, see Ankylostom, » Dock, Yellow ... ... 880 Dodd’s Pills . ...Y. II. Dog Grass ... 834 Dogwood, Jamaica 487, 875 Dolichos Pubes. ... 423 Dols Flannel .. ...Y. II. Name. Dose. Donovan’s Sol., 5 to 20 m. “ Dope ” Doremus XJreometer ... Dormigene, 5 to 10 gr. Dorset’s Egg Medium. Doses, Metric and Imperial .. ,, Proportions aec. to age Dose Table, Intravenous Douches, Contraceptive Dourine ... Dover's Powder, 5 to 15 gr. Dowzard Process Dracunculus . Dragendorff's Test Dragon’s Blood... Drainage Tubing . Dressings, Dental, 442 ; N.H.I., 442 ; Sterilisation of, 441 & V. II. ; Dressings, Steriloid... Dreyer’s Vaccine Dried Milk Dridustsols ... ... ... Drop Measure Tables.V Drop wort Prosera Rotundifolia. Drug Addiction: Cannabis, 624 ; Heroin. 560 ; Opium, 623, 624 ; see also Cocaine, Page 177 V. II. V. II. 813 V. TI. xl. 1104 , 1102 ... 723 ...V. II. ... 518 ...V. II. ...V. II. ...V. II. ... 852 267 440 932 578 106 , II. 871 852 II. 997 et seq. ... 273 ... 421 204, 497 506 Morphine, etc., and V. Drugs, Dangerous, Acts Dry Cleaning . Dryopteris Duboisia and Duboisine Ductless Glands. See Thyroid, Parathyroid, Pituitary and Suprarenal and V. II. Dugong Oil, 615 ; Dulcitol ...V.JI. Dulcin, f grain.„,••• 749 Dum Duni Fever—type ot Kala- Azar.. ...v. 11. Dunbar’s Hay Fever Serum, 914 ; and Edn. XIX. p. 919. D undasGrantsInhalat ionFluid 286 ,, Acetic Ether, Iodine and Glyc. Pigment (.Tinct. Iodi Fr. Cx., Acetic Ether and Glyc. p.aeq. also prescribed.—C.D. ii.j32,172, 244.) Dunham’s Soln., V. II.; Tassel V Dunhill’s Solution .• Duodenal Membrane Tabs, and Extract, 5 to 20 m. ... „ Ulcer. 964&Therap. Ind. Duotal, 5 to 15 gr.446 Duplitised Films X ray ... v .11. Duralumin . Durant’s Injection ... ••• 445 Duret’s Calomel .. .474 & V. II. D urine. ••• Dusart’s Syrup, 2 to 4 dr., ol ; Wine. , Dusting Powders, Formosyl ... l^o (See also 137, 824.) .II. 346 950 Name. Dose. Page Dutch Drops, 694 ; Glossary...V. II. Duty-free Alcohol ... ... 117 Dye Excretion Tests ... ...V. II. Dyed Fur ... ... 306, 1045 Dyer’s Madder ... ... ... 880 Dyes, Aniline, 297 ; as Antiseptics, V. II. ; for foods ...V. II. (See also Individual Colors). Dynamite ... ... ... 670 Dysentery, 912, 1047 ; Anatoxin, V. II.; Serum (Bacilli) ... 912 & V. II. ,, Amoebae, Search for .V. II. ,, Auremetine in ... 528 ,, Carriers 521, 1047 & V. II. Combined Treatment 528 ’’Peking Results 530 ,, Ipecac, in ... ... 517 ,, Panama Bismuth 521, 529 ,, Treatment ... 519 et seq. ,, Treatment with E.P.I. 525 ,, Vaccine,50 to2,000mill. 913 ‘E 107 ’ 241 E.M.F. .V. II. Eade’s Pills ... ... ...V. II. ‘ E.P.I.’, 2 grs. 525 Ear Cones, 793 ; Cocaine ... 339 Earth Nut Oil ... ... ... 837 Easton’s Syrup (also Pills and Tablets, 419), \ to 1 dr. ... 418 Easton’s Syrup in 2 Syrups ... 419 Eatan ... ... ... ••• 676 Eau d’ Alibour 383 Eau Cuprozincique ... ... 383 Eau de Botot ... ... ... 837 de Cologne ... ... 114 de Goudron, 5-10 oz. ... 696 de Javelle ... ... 42 de Labarraque . 42 de Paris . 114 de Mellisse des Cannes ... 866 Oxygenee ... ••• 488 „ Sedative. 260 Ecballium Elaterium ... 852 Ecgonine Derivs. 333, 997 & V. II. Echitamine ... ... ••• 835 Echium ... ••• ••• 852 Ecthol, 1 dr. well diluted ... 890 Eczema Marginat, Therap. Ind. Eczoline Preps. ... ...V. II. Edestine.443 Edington’s Soln. ... ...V. II. Edmunds’ Cell ... ••• 29 Edwenil effervescent salts (“ gr.” in drachm understood —dose, 1 dr. or q.s.) : Ammon. Brora., 5 gr. Antipyrine, 5, 10, 15 gr. ... Bath Salts ... ... • • ■ Caffeine Citr. 2\ gr. and c. Pot. Brom., 5 gr. 245, 246 947 140 328 772 Name. Dose. Page EFFERVESCENT SALTS—contd. Caffeine HBr., 24 gr. ... 246 Cat,ha Phenolphthalein, 1 to 2 dr. .845 Chloro-Sodio-Mag. Aper. ... 773 Glyceroph. 36 Iron <fc Quin. Citr., 3 gr. ... 720 Lecithin, 3 gr. . 532 Lithium Citrate . 534 ,, Hippuras, 5 gr. ... 534 ,, Salicyl, 2 gr. ... 535 Magnesium Citrate, 1-2 dr. or q.s. ,, Sulphate, ^-1 oz. . 540 Phenacetin, 5 and 10 gr. ... 326 ,, 5% et Caffeine, 24%. 326 Phenolphthalein, 3 gr. ... 672 Pilocarpine, gr. 688 Piperazin, 5 gr. (etc. Pheno- coll).695 Piperidine Tart., 5 gr. ... 695 Potass. Citrate (Vescettes,) 15 gr. . 705 Salic-in, 5 gr. ... ... ... 75 Sodio-Mag. Aper. (et c. Caff- ein, 773) . 772 Sodium Citro-Tart., 1 or 2 dr. „ Phosphate, 1 to 3 dr. 770 ,, Salicyl., 5, 10 grs. ... 63 ,, Sulphate, 1 dr. or more 772 Stront. Brom., 10 gr. ... 781 Sulphonal, 5 gr.787 Ve sal vine, 5 gr. . 452 Egg Medium .V. II. ,, Yellow ... ... ...V. II. Eggs, Dried & Liquid ... ...V. II. Erhlich’s Diazo Reaction ...V. II. “ Ehrlich-Hata ” ... ... 191 Ehrlich Stains and Tests ...V. II. ,, Theory V. II. Ektogan ... ... ... 490 El Kossam ... . 842 Elaeosacchara, P.G. (q.v.) Elastica ... .267 Elastoplast Bandages. 267 Elaterinum, 1-40 to 1-10 gr. 852 & Y. II. Elaterium, 1-10 to £ gr. ... 852 Elbon-Ciba, ; 30 to 60 grs. pro die ... ... ... ... 81/ Elderberry Flowers . 881 Elder Buckthorn . 855 Elecampane ... ... ... 860 Electrargol ... ... ... 373 Electrocuprol. 372 Electric Current Injuries 1101 &Y.II. ,, Shock ... ...1101 & Y.II. Electricity, Medical .Y. II. Electrolux Apparatus.Y. II. Electrolysis .V. II. Electromotive Force .Y. II. Electuaire Diascord, 15 gr. . ... 889 Elephantiasis, see Filariasis Therap. Ind. & Y. II. Elettaria Cardam.844 99 55 55 55 55 55 55 55 55 55 55 5 5 55 55 55 55 55 55 Name. Dose. Page Elixirs ... .394 Elixir Acetanilid. Co., i to 1 dr. 3 ,, Acidi Salicyl. Co., 1 to 2 dr. ... . 59 Agrimoniae Co., 1 dr. ... 833 Aletridis, 4 to 1 dr. ... 834 Ammon. Brom. 1 to 2 dr. 140 Antineuralg., 1-2 dr. ... 245 Aperitive, | to 1 dr. ... 133 Aromat., i to 2 dr. ... 394 ,, Arsamin (4 gr.), 1 dr. ... 184 Aurantii Amari, 2 to 4 dr. 395 Bismuthi, 60 m. ... 226 Caffeinae, 1 to 2 dr. ... 245 Calc. Chlor., 1-2 dr. ... 255 ,, Iodidi, 1 dr. ... 255 Camph., 30 to 60 m. ... 260 ,, Monobr., 4 dr. 262 Cascara, 30-120 m. ... 274 Chloralamidi, 1 oz. ... 281 Cinchonae, 30 to 60 m.... 294 Cinchonidine, i oz. ... 717 Cocse, 1 to 4 dr. 332 Creosoti, 1 to 2 dr. ... 377 Curacao, 2 to 4 dr. ... 395 Diamorph. Camph., 4 to 1 dr. ... ... ... 560 Diamorphinae et Terpin c. Apomorph, 4 to 1 dr. 560 Diamorph. c. Ipec, 4 to 1 dr. ... ... ... 560 Diamorph. et Scilla, i to 1 dr. ... ... ... 560 Diamorph. et Thyrn., | to 1 dr. ... ... ... 560 Duodenalis, 4 oz. ... 950 Ephedrinae, 1 to 2 dr. ... 398 Epliedopyrin, 1 to 2 dr. 399 Ergotae cum Feno, 2 dr. 405 Ferri Phosph., c. Quin et Strych., £ to 1 dr. ... 419 Ferro-Mang. Pept., 1 to 4 dr. ... 415 Ficorum, 1 to 4 dr. ... 395 Formation, Co., 1 to 2 dr. 33 Four Gland, 1 to 2 dr.... 981 Gentian Ac., 1 to 2 dr.... 856 Glusidi, 5 to 20 m. ... 749 Glyceroph, 1 to 4 dr. ... 35 ,, c. Format., 1-2 dr. 36 Guaiaci, 1 to 2 dr. ... 444 Haemoglobin, 1 dr. or more 577 ,, c. Lecithin, 1 to 2 dr. 577 Heroin, Pini et Terpin, 1 dr. ... ... ... 694 Ipecacuanhae, 10 to 30 m. 518 Lecithin, 2 dr. 531 Manaca Salicyl, 1 to 2 dr. 865 Papain, 1 dr. ... ... 648 Paraldehyde, 1 to 3 dr. 121 Parathyroid, with Calc. Lact., 1 dr.986 Paregoric, 4 to 1 dr. ... 626 Pectorale, 1 dr.... ... 857 J) 99 )) 99 n 9 9 99 99 99 99 n 99 99 99 99 99 99 99 99 Name. Bose. Page Elixir Pepsin, Bism., Strych., 1 dr.‘ ... 659 „ Pepticus, i oz. 659 ,, Phosphori, 15-60 m. ... 680 ,, Pini et Terpin Simp. ldr. 694 ,, Pini, Terpin et Heroin, 1 dr.694 ,, Quiuque Brom., 1 dr. ... 704 ,, Quinidine, £ oz. 715 ,, ,, et Cinchon, \ oz. 717 „ Rhei, 1 to 3 dr. 395 ,, Rubrum, 20-60 m. ... 395 ,, Sacc-harini, 5 to 20 m. ... 749 ,, Secretogen, 1 to 2 dr. ... 950 ,, Sennae (et Legum.), 1 to 3 dr.884 „ Simplex, B.P.C. ’94, 20- 60 m. 395 „ Sodii Brom-aceto salicy- lat., 4 oz. rep. ... 71 ,, Sodii Cacodyl, 30 m. ... 182 „ ,, Formatis, 2 dr. ... 32 ,, ,, Fact., 1 dr. ... 51 ,, Symphyti, i to 2 dr. ... 888 ,, Three Gland, 1 to 2 dr. 981 „ Thymi et Diaphorm, 1 dr. 560 890 „ Valerianae et Bromidi, i oz. ... 820 ,, Vanillin Co., 4 to 1 dr.... 890 ,, Vesalvine ‘ S,’ 1 dr. ... 453 „ Viburn. Prunif. (& Co.)... 891 ,, of Vitriol, 5-20 m. ... 85 Eliiman’s . ...V. II. Elm ... 890 Eisner’s Reagent .V. II. Embalming ... .V. II. Embalmment of Wounds ... 502 Embelia, 1 to 4 dr. ... ... 853 Emblic Myrobalans, 1 or 2 ... 853 Emery’s Method ... ...V. II. Emetina (Aik.)... ...519 & V. II. „ HBr. Hyp., £ to f gr ... 523 ,, HC1. Expect. 100 to A gr. 519 „ „ Hyp., i to f gr. ... ,, for Liver abscess ... 521 ,, Panama Bismuth, with 521, 529 ,, Periodide, | to 2 grs. 131, 525 ,, ,, in Dried Milk ... 525 „ ,, Slipules, 2 gr. ... 525 „ ,, Discussion on paper 525, et seq. ,, Steriloids... . 130 Emetin (Extractive) Expect ib to jo, Emetic, | to 1 gr. ... 530 Emetine and Amoebae ... ... 520 ,, Bismuth Iodide, 1 to 3 gr. 523, 526 & V. II. ,, Diarrhoea ... ... .524 ,, Dysentery Treatment 520 „ „ „ with Bismuth 521 „ Stearettes, 1, 2 & 3 gr. 525 Emetique, Max. single, 3 grains 156 Emetol, 2 dr. ... ••• 52/ Name. Dose. Page Emmenin . 963 Emodin. 855, 883 Empirin, 5 to 15 gr. 68 Emplast. Ac. Salicyl. Sap. 59 Emplast Adhesivum. ... 600 3 3 „ Ang. ... 860 3 3 Allii. 834 3 3 Bclladonnae ... 218 33 ,, Extensum 218 33 Calefaciens ... 265 3 3 Cantharidini ... 265 3 3 Cantharidis Liq. 266 3 3 Capsici (various) 269 33 Cupri Oleatis 598 3 3 Diachylon ... 599 33 Hydrarg. Stearatis ... 599 3 3 Menthol. 550 33 Mouches de Milan (Em- platre) . 265 33 Opii. 625 3 3 Picis . 696 33 Plumb i . 599 3 3 Resinae 599 33 Saponis 599 3 3 Vesicans . 266 Emulsifiers 577 Emulsin 147 Emuls. Acri flavine 300 33 Agar. c. Paraff. Liq. 4 to 1 ounce, children I to 2 dr. . 654 33 Amygdalae, av. 4 oz. ... 148 3 3 Arachis c. Glucose 838 3 3 Asafoetidae, 4 dr. 838 3 3 Barii, ad lib. ... ... 216 3 3 Barii et Bism. ... 216 3 3 Benzyl Benz., i to 2 dr. 311 3 3 Bismuthi et Paraffin!, 1 oz. ... ... ... 653 3 3 Butol. 595 3 3 Chloroformi 287 3 3 lodinol, 2 dr. ... 514 3 3 Iodoformi 501 3 ) Lecithin, \ oz. 531 3 3 01. Arachis c. Glucose... 838 3 3 ,, Chaulmoograe, £ to 1 dr. 602 33 ,, Gynocardri, £ to 1 dr. 602 3 3 ,, Morrhuae, 2 to 8 dr. 612 3 3 ,, „ Ferrat., 2 to 8dr. 612 3 3 ,, c. Lecithin, 2 to 8 dr. 612 33 ,, Morrhuae et Glycer- oph., 2 to 8 dr. ... 37 33 ,, Morrhuae et Hypoph., 2 to 8 dr. 612 3 3 ,, Olivae, 1 to 2 oz. ... 616 33 ,, Papaveris, 4- to 1 oz. 615 3 3 ,, Paraffin c. Agar, $ to 1 oz. 654 33 „ „ c. Phenolph- thalein, 4 to 1 ounce 654 33 ,, Paraffin! et Bismuth 1 oz. 653 13 ,, Paraffin c. Pancreatino653 yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy Name. Dose. Page Emuls. 01. Paraffin e. Rhamno Frang. ... ... 554 Petrolei c. Hvpoph., 1 to 4 dr....' ... 653 ,, Terebinth., 1 dr. ... 692 Salol, i to 1 oz. ... 76 Santonin . 752 Seminum Cannabis ... 843 Sesami, 2 to 3 oz. p.d. 872 Sevi . 595 Encephalitis, Epidemic (lethar- gica) ... 1050 & V. II. ,, PostVaccinal 944,945 Endocarditis Serum ... ... 920 Endocrine Glands . 947 Endolytic Tubes .V. II. Endomin Tabs., 1 to 3 ... 413 Endo’s Medium .V. II. Endotoxins ... ... ... o94 Enemata, various ... ... 395 Enema, Ammoniae ... ... 144 Asafoetidae, 5%. 396, 838 Barii Sulphatis ... 216 Bismuth Sod Salicyl., 1 pint. 232 Chloral, 4 oz. ... 281 Dextrose ... ... 396 Evacuans . 396 Ferri Chloridi (Liq.), 2% 396 Glucose . 396 Glycerin, i oz. ... 396 Jlyd. Perchlor., 0-01 to 0-05% 396 Lith Aceto-Salicyl c.Sod. Brom. ... ... 73 Mag. Sulph., £ to 2 oz. 540 Nutriens ... ... 396 Olei Iticini ... ... 617 Olei Terebinth.,0-5 to i % 396, 692 Oleosum ... ... 616 Plnmbi Acet., 1% ... 396 Quinine, Alcohol-Ether 102 liutae ... 880 Sedativum, 5 oz., diltd. 73 Silver Gelatose ... 172 Sodii Chloridi ... ... 762 Stimulant,for Thirst,etc. 396 Tannin, 1% 396 Energcn Bread ... ... 585 Enesol (injected), 1 gr. in 30 m. ^ 183 Eno’s Fruit Salt ... ...V. II. Entamoeba Cysts, Search for... 522 & V. II. Coli ... ...V. II. histoytical 520 et seq. & V. II. ,, Nana .V. II. Enteric Fever. See Typhoid. yy yy Enterococcus . Enzyme Action. Eosin Stains Eosote, 5-10 m. Eparseno Ephdera var. . .V. II. 540, 633 & V. II. .V. II. . 380 . 198 . 397 yy yy yy yy yy Name. Dose. Page Ephedra, Antidotes . 397 Ephedrine . 397 & V. II. Elixir, 1 to 2 dr. ... 398 HC1., i to 2 gr. ... 398 ,, Tabs., £ gr. ... 398 Inhalant, plain ... 398 ,, comp. ... 398 ,, aqueous... 398 In asthma ... 400 Ointment. 399 Pharmacology of ... 399 Sterules, I, 4, & 1 gr. 398 Sulphate, 4 to 2 gr.. 398 Synthetic ... ... 397 „ with Novocain ... 346 Ephetonin ... ... ... 397 Ephregel . 399 Epilepsy, non-specif. protein, 666 ; Luminal, 816 & Therap. 1052 Epinalin ... ... ... 399 Epinephrin . 968 Epinine 974 Epsom Salts .. ... 538 Equisetum Arvense ... ... 853 Erasmus Wilson’s Lotion ... 144 Erbolin Capsules, 1 t.d. ... 402 Erepsin ... .V. II. Ergamine ... ... ... 407 Ergoapiol . 165 Ergodex, 10 to 30 m. per os ... 404 Ergosterol Estimation ...V. II. ,, Irrad. 589, 592 et seq. & V. II. Ergot, 15 to 60 gr. ... 401 & V. II. Ergot Amines ... ... ... 406 ,, Aseptic. 403 ,, Chassar Moir’s findings 402 ,, Colorim. Assay ... 403 ,, ,, Am.Sulpho-Molybd. 404 ,, ,, p-Dimethyl Method 403 (Allport and Cocking add trace Fe. Chlorid.—P.J. ii./32,235.) ,, Defatted Prepns. ... 402 ,, Of Maize . 865 ,, Physiol. Standardised 403 & V. II. Ergotamine . 401, 406 ,, Tartrate. 406 Ergotin, 2 to 8 gr.404 Ergotinine Cristallis6e, 1/200 to 1/64 gr.... 405 & V. II. „ Cit., 1/150 to 1/30 gr. 405 Ergotoxine, 1/100-1/50 gr. 401 et seq.f 406 Ethane sulphonate, tJo to 51o gr. hyp. 401,406 Erigcron Can. 853 Eriodictyon .892 Erion, 0-3 Gm. ... 745 Ernutin, 30 to 60 m. ... 406, 408 Erodium ... . 853 Erucse Semina (Sinapis) ... 756 Eryngium .853 Erysipelas Dressing, 825 ; Serum 920 Erysimum .853 Erythgen Liver Ext., 1 to 4 dr. 952 yy Name. Hose. Page Erythrol Nitrate i- to 1 gr. incr. 408 -p, ^ ' &V.II. Erythrophlceinae Suiph., 1/40 to ^ 1/24 gr.853 Erythrophloeum . 853 Erythrosins .V. II. Erythrotetranitral,$tolgr.incr. 408 Erythroxylon Coca, 30 to 120 gr.331 Esanofele . 734 Esbach’s Picric Solution ...V. II. Eserina, TiC to A gr. 685 Eserinse Salicyl., 685 ; Suiph., 1/60 to 1/20 gr.686 Esparto.853 Espolon de centeno . 401 Esprit var, vide Spiritus ... — ,, Ammon. Anisat. ... 857 Espundia .V. II. Essence of Beef . 576 Essence of Ginger, 893 ; Vanilla 890 ,, ,, Rennet . 657 Essentia, see Oleum. Essentia Yerba Buena (Ph. Notes)—Mentha Sativa. Essential Oils asAntiseptics597&V.II. ,, ,, in Cholera ... 1041 Essential Oils, Terpeneless ...Y. II. Essogen.593 Ester Bencil-benzoico. 310 Esterol-Stearns 311 Ethanesal . 96 Ethanol., U.S. fryn. of Ethyl Alcohol. Ethanolamine ... ... ... 755 Ether 55 95 Anaesthesia by various methods ... 97 et sen. 5 5 Chloric ... . 287 5 5 Convulsions . 96 5 5 Green . 282 55 Ozonic . 489 55 Perles, 3 m. in each 104 5 5 Petroleum . 656 5 5 Rectal Use . 97 55 Regulations N. Ireland...V. . II. 5 5 Soap, etc. Merc. Iodide 754, 755 5 5 Soluble Tar Paste 696 55 with Atropine ... 99 5 5 with Olive Oil. 100 5 5 with Oxygen and Alcohol 98 5 5 w-ith Oxygen and Gas ... 98 5 5 with Paraff. Liq. Oral-Use 103 55 with Saline v. also JEther. 99 Ethidol, 3 gr.. 619 Ethiops Mineralis 477 Ethocaine Borate, a to 14 grains 348 Ethocaine HC1., 1/5 to 1 gr. ... 345 Ethoxy Diamino Acridine Lact. 304 Ethyl Acetate ... ... ... 105 ,, Alcohol ...108&V. II. „ Amino-benzoate ... 349 Bromide (Sterules, 5 m.) 832 „ Butyrate ... 836 <fc V. II. Name. Dose. Page Ethyl Carbamate, 10 to 60 gr. 818 „ Chloridum (Bulbs, tubes and bottles, 106) ... 105 ,, ,, Dangers . 106 ,, ,, Medictd. Solns. ... 106 ,, ,, with Eau de Cologne 106 ,, Chaulmoograte, 1 Cc. in- tram. . 605 ,, ,, Iodised . 606 ,, Cinnamate . 310 ,, Hydnocarpate ... ... 607 ,, Hydro-Cupreine, Base 3 to 4 gr., 380 : HC1., 3 to 4 gr. ..381 ,, Iodide . 106 ,, ,, Sterules, 5 m. ... 107 ,, ,, c. Chlorof. Sterules 107 ,, -iodo-ricinoleate, 3 grains 619 „ Bead . 656 ,, Methyl Phenyl-cincho- ninate . 318 ,, Morphine (Base) ... 559 ,, ,, HC1., i to | gr. ... 558 ,, Nitrite Sol., 15 to 60 m. 104 ,, Ortho-Hydroxy-Benzoate 68 ,, Oxide . 95 ,, Petrol .V. II. ,, Salicyl . 68 Ethylene . 143, 288 ,, Bromide, 1 to 2 m.... 832 ,, Dichlor.289 ,, Glycol ... .... 435 „ Tetrachlor. 290 Eucaine Borate. 349 ,, BCl. 1/10-| gr. ... 343 ,, Lact. i to i gr. 343 & V. II. ,, c. Adrenalin ... ... 343 Eucalypti Folia, 5 gr. 609 ,, Gummi, 5*20 gr. ... 853 Eucalyptol, 1 to 4 m. ...610 & V. II. ,, Chlorinated. 47 ,, Phosphate, 1 to 5 gr. 610 Eucodal. Eucerin ... Euchlorine Gargle Eucodeine, f gr. Eucortone . Eudoxim.. . Eullavine (Tablets, per grain 303) ,, Tabs, for Solutions, 0 & 1-75 grs. Eugallol. Eugastrol . Eugenol.845, Eukodal. Eumenthol Jujubes Eunatrol . Euonymi Cortex Euonymin, 1 to 2 gr. ... Eupad . Eupatorium . Eupaverin . Euphorbia Peplus, Pil. A V. II. , 357 , 805 , 766 . 357 . 974 679 87 303 303 58 965 854, 874 . 357 , 611 , 753 , 410 , 410 , 43 . 854 , 563 , 854 33 33 Xamf. Dose. Euphyllin Tabs. 14 gr., 3 or 4 in cl. ,, Amps., 2 Co. ,, Suppos. Eupnine, 1 dr. Euquinine, 3 to 15 gr. Eureka Weed Killer. Euresol.747 & „ pro Capillis . Eusol .42 & Assay, etc. Intravenous Use ,, Uses . Eustachian Self-Inflator Eustcnin, 8 to 15 gr. Eutonon. Euxenite . Evans’ Antiseptic Tliroat Pas titles. Evatmine . Evonymine Ewald’s Breakfast . Exalgine, 4 to 2 gr. ... 3 & Exibard’s Pdr. Excise Duty . Exogonium . Explosives, vide Page 799 799 799 247 737 V. II. V. IT. 747 V. II. V. IT. 43 43 286 798 954 . II. V V ac. Picric IT. 970 410 . II. , II. 710 109 861 3 3 3 3 33 33 33 33 3 3 Apocyni Liq., 15 m. Belie Liq., 1 to 2 dr. Bellad. Sicc., {-I gr. Belhich, Fol. av. } gr. „ Liq., H'in. ,, Yiride, i to 1 Bistort*. Bone Marrow, 1-2 dr. gr 837 841 218 219 218 219 841 948 Name. Dose. Page Ext. Cascar* Sagracl* Liq., 0 to 60 m. ... ... 274 ,, Cascara Aromat. Liq., 30 to 60 m. ..275 ,, Catha Solid., 24 to 10 gr. 845 ,, Liq., 1 to 5 m. ... 845 Caulophylli Liq., 8 m. ... 846 Cerebri Liq., 5-10 m. ... 949 ,, Cerevis. Ferment., 3 gr. 277 & V. II. Cerii Liq., 1 to 10 m. ... 847 Chanvre. 264 Chekan, Liq., i—3 dr. ... 847 Chelicl. Liq., 10 to 30 m. 847 ,, Chenopodii Liq., 4 to 1 dr. 848 ,, Chin*, 1 to 4 gr. ... 294 ,, Chiratae Liq., 15 m. ... 848 „ Cigue, f gr.375 ,, Cimicifug* Liq., 5-30 111. 849 ,, Cinchon* Liq., 5-15 m. 294 ,, Coca, 2 to 15 gr. 332 „ Liq., 4-1 dr. ... 332 Colchici, i to 1 gr. (B.P. ’14) . 358 ,, Collinson, Liq., 15 to 30 111. 849 „ Colocynth., av. 4 gr. ... 373 ,, Colocynth. Comp., 2 to 8 gr. 373 33 33 33 33 33 33 33 33 33 Extomak, 25 to 30 Gm. 966 ✓ / 60 111. 850 EXXRACTA: 3 3 Conii, max. £ gr. Fit. Cx. 375 (vide also Fluidextr.) 3 3 ,, Liq., 5 to 15 m. ... 375 33 Acocanther* Liq. max. 33 Convallari*, 2-8 gr. 850 4 111. (?) . 831 3 3 Coorchi Liq. 859 33 Aconiti Bad. Ale., max. 33 Corn Silk, Liq., 1 dr. 865 4 gr. 91 3 3 Coronilla, 1| gr. 850 33 Agarici, 4 to 2 gr. 833 33 Costus Liq., T to 2 dr. ... 850 33 Agropyri Liq., 1 to 2 dr. 833 33 Coto Liq., 2 to 6 111. 375 33 Aletridis, Liq., 5 to 15 111. 834 33 Damian*, 2 to 10 gr. ; 33 Alkanct ... 836 Liq., 4 to 1 dr. 852 33 Allii, 4 to 10 gr. 834 33 Digitalis, Fit. Cx. (U.S., 33 A ini Glutinos* Liq., 10 to av., T gr.) . 389 30 m. 835 3 3 d’Orges . 541 33 Aloes, 1 to 4 gr.... 132 33 Duodenal Liq., 5 to 20 111. 950 33 Anthemidis, 2 to 8 gr. ... 837 33 Ergot*, 2 to 8;gr., B.P.’ 14 404 33 33 33 33 3 3 33 33 Liq., B.P.T4, 10- 30 m.402 Phys. Stand. 402, 403 Chassar Moir on ... 402 Colorimetric Assay 403, 404 Erigcron Liq., 30-60 m. 853 Erodii Liq., 15 m. ... 85 3 33 33 33 3 3 Brain, 5 to 10 111. Buchu Liq., 30 111. Bynes (and Liq.), 1 to 949 3 3 Erythroxyli Liq., 4-1 dr. 332 33 3 3 842 33 Eucalypti Gum. Liq., 30 to 60 111. ... 853 4 di. ... ... 541, 542 33 Euonymi, 1 to 2 gr. 410 3 3 Cacti Grandi. Liq., 1 to 33 ,, Liq., 10 to 60 m. ... 410 10 m. ... . 847 33 Eupatorii Liq., 30 111. ... 854 3 3 Calumb*, ’85, 2-10 gr.... — 33 Eupliorbi* Pepli, 74 to 3 j Cannabis Inch, £-1 gr. ... 264 30 gr. . 854 33 ,, Liq. 1| 111. ... 264 33 Eupliorbi* Pih, J to 1^ gr. 854 3 j Capill. Vener . 843 33 F*cis . 277 33 Capsici Liq., 1 111. 269 33 F*xin, 3 gr. 277 3 3 Carnis ... . 576 33 Fellis Bov. . 411 33 Cascar* Sag., 2 to 8 gr. ... 274 >3 Ferri Pomatum 416 ? 5 ?? 55 5 5 5 5 55 55 Name. Dose. Ext. Filicis Liq., 45-90 m. Frangulae Liq., 1-4 dr. ... Fuci Yesic., 3 to 10 gr.... ,, ,, Liq., 1 to 2 dr. Galega, 5 to 10 gr. Galii, 5 to 20 gr. Gastricuni, 1 to 2 dr. ... Gelsem Liq., 4- m. Gelsem. Pulv., -J—2 gr. ... Gentian ae, 2 to 8 gr. Geranii Mac. Liq., 15 111. Glaucii Liq., 1 dr. Glycyrrhizse, 5-60 gr. ... ,, Liq., 30-60 ni. Gokliru Liq., 20-60 m. ... Gossypii, 1 to 4 gr. ,, Liq., | to 1 dr. ... ,, Sem., 1 dr. Granati Liq., 30 m. Grindeliae, 2 to 3 gr. ,, Liq., 10 to 20 m. ... ,, Co., 1 dr. Guaranae Liq., \ dr. Haematoxyli Liq. (& Solid, av. 15 gr.), i to 2 dr. ... Hamamelidis Dest., \ to 3 dr. ,, Liq., 5-15 m. Helenii . Hippocast Liq. ... Holarrhenae Liq.... Humuli, 2 to 6 gr. Hydrangea Liq. ... Hydrastis, 2 to 5 gr. ,, Liq., 5-15 m. Hyoscy., 2 to 8 gr. ,, Yiride, 2-8 gr. Hypophysis Liq., i to 1 Cc. 958 Hysterionicae Liq., 5 to 15 Ill • ••• * Infundibular, 4 to 1 Cc.... Inulae Liq., 10-60 in. ... Ipecac Expectorant 1 \ to 2 m. L 1 Emetic, 15 f Ito 20 m. (’98)J Iridis 1 to 3 gr. Jaborandi, 2 to 10 gr., (B.P. ’85) . ,, Liq., 5 to 15 m. ... Jalapee, 2 to 8 gr. Kavae, 5 to 10 gr. „ Liq., 30 to 60 m. ... Kolae Liq., 10-20 m. ... Kramerise, 5-15 gr.; Liq. 15 m. ... ... ... Kurchi Liq. Lactucae, 85, 5-15 gr. ... Lappa- Liq., 30 m. 55 55 55 55 5 5 55 55 55 55 55 55 55 5 5 55 55 55 55 55 55 55 55 55 55 55 55 55 5 5 55 55 55 55 55 55 55 55 55 55 55 55 55 Ipecac. Liq. Page 421 . 855 855 . 855 . 855 . 855 . 659 . 426 , 426 . 856 856 856 857 857 857 442 442 443 657 443 443 443 858 858 447, 448 ... 448 ... 860 ... 832 ... 859. ... 864 ... 860 ... 487 ... 486 ... 495 ... 495 860 958 860 518 518 861 688 861 862 862 248 859 863 Lasiosiphon Liq., 2 to 5 m. 863 Leptandrae, av. 4 gr. ... 863 „ Liq., 15 111. 863 Leeches. 950 Name. Dose. Page Ext. Liver Dessic., 2 tubes = 1 lb. Liver ... ... 951 ,, ,, Liq., 1 oz. =4- lb. Liver . 951 ,, ,, Home made ... 952 ,, Lupuli, 2 to 6 gr. ... 864 ,, ,, Liq., 5 to 15111. ... 864 ,, Maidis Stig. Liq., 1 dr.... 865 ,, „ Ustil. Liq., A to 2dr. 865 ,, JVlalti (Liq., 542), 1 to 4 dr. 541 ,, ,, National Mark 541 _,, ., Ferratum, 1 to 4 dr. 542 „ ,, c. Cascaral to 4 dr. 542 ,, ,, c. Haemoglobin, 1 to 4 dr. ... 542 „ ,, c. Hypophos., 1 to 4 dr. ... ... 542 ,, ,, c. Glyceroph., 1 to 4 dr. ... ... 36 „ ,, c. Iodinol (1 oz.)... 515 ,, ,, c. Oleo Morrhuse, 1 to 4 dr. 542 ,, ,, Nat. Mk. ... 543 ,, ,, c. Pancreatin ... 543 ,, ,, Sicc., 1 to 2 dr. ... 543 ,, „ c. Syr. Ferri Phosph., 1 to 4 dr. ... 542 ,, ,, Paraff. ... ... 542 ,, Manaca Liq., 10-30 111. ... 865 „ Meat ... 576 ,, Menyanthis Liq., | oz. . 867 ,, Monsoniae Liq.,10 to 30 111. 868 ,, Muira Puama ... ... 868 ,, Myrtilli Liq., 2 ozs. p.d.... 869 ,, Nucis Vom., I to 1 gr. ... 596 „ ,, ,, Liq., 1 to 3 111.... 596 ,, Opii Siccum (20% Morph.), I to 1 gr. ... 625 „ „ Liq. (0-75% Morph.), 5 to 30 m. ... 626 ,, Papaveris Caps. 622 ,, Parathyroid Liq. ... 985 ,, Pareirae Liq., 30 to 120111. 873 ,, Physostigmat., i to 1 gr. 685 ,, Phytolaccae Liq., 11 m. (Emetic, 15 m.) ... 874 ,, Pichi Liq., 10 to 60 m. ... 874 ,, Picorrhizae Liq., 15 to 60 m. 874 ,, Pini Canad. Liq., 10 to 60 111. ... ... ... 874 ,, ,, Sylvestris ... 693 ,, Piscidiae, 2 to 5 gr.; Liq. 20 to 120 m. 875 ,, Pituitary Gland Infund., } to 1 Cc. ... 958 ,, ,, Entire Gland, | to 1 Cc.958 ,, ,, Ant. lobe, 1 Cc. ... 958 ,, Pulsatilla Liq., 2 to 5 111.. 876 ,, Pyrethri ... ... ... 876 ,, Quassiae, 3 to 5 gr. ... 877 ,, Quebracho Liq., 5 to 10 m. 878 ,, Quillaia Liq.878 ,, Quinquina Bouge Liq. ... 294 „ Bed Bone Marrow,! to 2 dr. 948 Name. Dose. Page Ext. Rhamni Frang., 15 to 60 gr.; Liq., 1 to 4 dr_ 855 ,, ,, Pursh., av. 4 gr.... 274 ,, ,, Fluid ... 274 ,, Rhei, 2 to 8 gr. 878 Rhus Aromat. Liq., 10 to 30 m. 879 ,, Rice Polishings ... 873 & V. II. ,, Rubi Chamsemori Liq., £ to 1 dr.880 „ Salieis Nig. Liq., £ to 1 dr. 881 >, ,, Solid, 1 to 5 gr. ... 881 ,, Sanguinariee, Liq., 14 m. 881 ,, Sansivicrse, 10-20 gr. ; Liq., 2 to 4 dr. ... 881 ,, Sarsa? Liq., 2 to 4 dr. ... 881 ,, Saw Palmetto, 3-5 gr. ; Liq., 4 to 2 dr. ... 882 „ Scillso . 882 ,, Scutellaria Liq., 5 to 15 m. 883 ,, Secretin, 5 to 20 m. ... 950 „ Senecio, Liq., 20-60 m.... 883 ,, Senega? Liq.883 ,, Sennse Leg. Liq., 1-2 dr.. 884 ,, Serpcntar. Liq., 5 to 15 in. 884 ;, Solani Tub. Liq., 1 to 4 dr.885 ,, Sorbi Liq., 10 to 30 m.... 885 ,, Spinal Cord, 5-20 111. ... 949 ,, Stramonii, £ to 1 gr. ... 779 ,, ,, in Parkinsonism 780 ,, Strawberry Eth. ... 855 ,, Strophanthi, £-1 gr. ... 782 ,, Strychili, £ to 1 gr. ... 596 ,, Sumbul Liq. U.S., av. 30 m.888 ,, Supra-renal Liq., 10 to 15 m. . 967 „ ,, Sicc., £ to 3 gr. ... 967 ,, Symphiti, 5 to 10 gr. ... 888 ,, ,, Liq., 2 to 4 dr. ... 888 ,, Tabaiaco, £ to 1 gr. ... 625 ,, Tanaceti Liq., 15-30 m.... 889 ,, Taraxaci, 5 to 15 gr. ... 889 ,, ,, Liq., £ to 2 dr. ... 889 ,, Thymi Liq., 5 to 30 m. ... 890 ,, Thymus Gland, £-2 dr.... 975 & V. II. „ Thyroid = Thyroid Sicc. 979 ,, Thyroid Liq. ... 979 & V. II. ,, Tritici Liq., 1-2 dr. ... 833 ,, Uvse Lrsi Liq., av. 30 m. 838 ,, Valerianae (Liq., 30 m.), 1 to 5 gr.819 ,, Viburni PruniL, 2 to 10 gr., Liq., 60 to 120 m. 891 ,, Yincae Majoris Liq., 1 to 2 dr. ... ... 892 ,, Violae Liq., 1 dr.... ... 892 ,, Yisci Liq., 15 to 60 m. ... 892 Water Germander Liq., 4 to 1 dr.889 ,, Yeast . 277 & V. II. ,, Yerbae Santee, 10 to 40 m. 892 Name. Dose. Page Eye Lotion Cocaine (Factory), 334; & Lotion Iso-tonic^ 339 ; Operation Sets, 441 ; Pads, 439, 441 ; Rods, 208 ; Wash, Mackenzie . 470 Factory Act Eye Drops ... 334 Faeces, Exam, of .V. II. Faex Medicinalis, £ to 1 oz. ... 276 Faexin, 1 dr.277 Faexin, Extr. Pills, 3 gr. ... 277 „ Extr. Tablets, 3 gr. ... 277 Faivre’s Cachets . 248 Faraday’s Electro Chem. Equiv. Y.II. Farastan . 318 Farrant’s Medium .V. II. Fats, 597; as foods, Iodine Nos., Melting Pts., and Sapon. Figs. Y. II. Fatty Acids unsaturated ... 597 Eavus . 1083 & Y.II. Fedrin, 4 to 2 gr.398 Feenamint . 672 Fehling’s Solution and Modifs.. Y. II. Felamine . 454 Fel Bovinum Purif., 5-15 gr.... 410 „ Exsicc.,5tol0gr. 411 Fellows’ Syrup of Hypophos- phit.es, 1 dr.. 684 & Y. II. Felsol .329 Eelt .439 Femergin Tablets (Sandoz) ... 406 Fenedina . 326 Fenina.326 Fennel.854 Ferascol 880 Ferments, see Enzymes. Ferri Alginas, 2 to 15 gr. ... 834 „ Arsenas, 1/16 to £ gr. ... 178 ,, Cacodylas, £ to 5 gr. ... 180 „ Carb. Sacch., 10-30 gr.... 411 „ „ Cone.411 „ Chlorid., U.S. = Ferri Perchlor.413 „ „ (ous.) 2 to 5gr. ... 412 ,, ,, c. Cupri Sulph. ... 412 ,, Citras. av., 4 gr. ... 412 ,, et Ammon. Cit., 5 to 10 gr. 412 ,, ,, Virid., 5 to 10 gr. . 412 ,, ,, Sulpli., 3 to 10 gr.. 420 ,, „ Tart,, U.S,, 4 gr. . 421 „ et Mag. Sulph., 2 to 10 gr. 420 ,, ,, Mang.Citras, 3-15 gr. 420 ,, „ Potass.Tart., 5-10 gr. 421 „ ,, Quin.Citras, 5-10gr. 719 » ,, „ Eft'., 3 grs. ... 720 ,, et Quin, et Strych. Cit. 3 to 6 gr.784 „ Strych. Cit., 2 gr. ... 784 ,, Fluoridum, A to £ gr. ... 830 ,, Formas, 1£ to 3 gr. ... 32 „ Glyceroph., 1 to 5 gr. ... 34 „ Hydrox. c. Mag. Ox. ... 174 „ Hypophosph., 1-5 gr. ... 683 „ Iodidum, 1 to 5 gr. ... 416 „ lodid. Sacch., 2-15 gr. . 417 Name. Dose. Page Ferri Lactas, 1 to 5 gr. 51 99 Lactoph. et Calcii (Syrup) 51 99 Nucleinas, 15 gr. 415 99 Oleas, 5 to 15 gr. 601 99 Oxalas, 1 to 5 gr. 417 99 Oxydat. Sacch., 10 to 40 gr. ... 415 99 Oxypersulphas (Monsel’s) 420 99 Peptonat. Liq., 1-4 dr. 415 99 Perchlor. (wool, 413), 2-8 gr. ... ... ... 413 99 Persulph. . 420 99 Phosphas Saccharatus, 5 to 10 gr. 417 99 ,, Solubilis, 4 gr. 417 97 Pyrophosph., U.S., 4 gr. 418 99 Salicylas, 3 to 10 gr. ... 60 99 Sesquichlor. 413 9 9 Subchlor., 2 to 5 gr. ... 412 99 with Copper . 412 99 Subsulph. . 420 99 Succinas ... 831 99 Sulphanilas 307 99 Sulphas (Granulat., U.S.j, 1 to 5 gr. 420 99 ,, Exsicc., i to 3 gr. . 420 ,, ” with Coirper ... 420 99 Tersulph. . 420 99 Valerianas, 3 to 15 gr. ... 820 99 t aiuiiaiitto, kj lkj jgi. ... Lj^yj Ferrier’s Snuti'. 225, 232 Ferrino], 15 gr. 415 Ferro-Alumen, 3 to 10 gr. ... 420 Ferrocarnis, 1 dr. . 576 Ferro Mang. Phosph., 3 to ]0 gr. 545 Ferropyrin, 3 to 8 gr. 329 Ferro-Silicon .V. II. Ferro-Titanium.V. II. Ferrous Chloride, 2 to 5 gr. ... 412 ,, „ with Copper... 412 Ferruginous Ampoules ... 37 Ferrum ... .411 & V. II. ,, Redaction 1 to 5 gr. ... 411 ,, Tartaratum, 5 to 10 gr. 421 Ferula Foetida 838 F6ve de St. Ignace . 596 Fever, see Diseases in question, also Table p. 988. Fever Powders. 732 Fevillea ... ... ... ... 854 Fibrin ... ... ... ...V. 11. Fibro-coumarin Sterules, 25 m. 829 Ficus Carica . 854 Field Day .V. II. Fig. .854 Filaria ... Therap. Ind. & V. II. Filicin . 421, 422 Filmaron .423 Filix Mas .421 Filter passing Cold Virus ... 903 Filter passing Influenza Virus 916 Fin sen Reyn Lamp .V. II. Fir, Douglas & Oregon.V. II. ,, Scotch .691 Fir Wool, Oil and Extract ... 693 Name. Dose. Page Fire Extinguisher ... 770 ,, Proofing . ... 770 First Aid Outfits, Iodine for ... 512 Fischer’s Modifd. Ringer Soln. 759 Flag . ... 861 Flagella Stains ... ...V. II. Flaginac . ...V. II. Flame Tree . ... 861 Flavoring Agents ... 437 Flavine. 297 & V. II. Flax Seed, 864 ; Tow ... ... 440 Fleabane ... 853 Fleawort . ... 875 Fleming’s Liq. Chrom. Acet.- 831 Osmic . Fleming’s Tinct. Aconite, 1 to 5 m. 92 Fletcher’s Artif. Dentine ... 825 Flies to ward off, vide Therap. Index, Bites and Stings. Finnemore’s Liq. Arsenicalis... 175 Finish (Spirit Varnish) ... 117 FLOjR, Analysis, Bleaching of, Improvers, Nat. Mark, Potato in, Wholemeal, etc.V. II. Flour, Wholemeal Roughage of V. II. Fluid Magnesia, 1-2 ozs. ... 536 Fluidextr. Aconiti, av. £ m. ... 92 „ Agropyri Liq., 1 to 2 dr.833 ,, Apocyni, 15 m. ... 837 „ Bellad., Rad., f m. . 219 „ Buchu, 30 m. ... 842 ,, Calami, 15 m. ... — ,, Cannab. Ind., 1| m. 264 ,, Capsici, 1 m. ... 269 ,, Cascara . 274 „ ,, Aromat., 30m. 275 „ Chiratse, 15 m. ... 848 ,, Cimicif., 15 m. ... 849 ,, Cinchonse, 15 m. . 294 ,, Cocse, 30 m. ... 332 ,, Colchici Sem., 3 m. 358 „ Conii, 3 m., U.S. 0-45% Conine ... ,, Convallar., 8 m. ... 850 ,, Ergotse, 30 m. ... 403 ,, Eriodictyi, 10-40 m. 892 ,, Eupatorii, 30 m. ... 854 „ Frangulae, 1-4 dr. . 855 „ Geranii, 15 m. ... 856 ,, Granati, 30 m. ... 657 „ Guaranae, 30 m. ... 858 „ Hamamelid. Fob, 15m. 448 ,, Hyoscy., 3 m. ... 495 „ Ipecac., Emetic, 15 m. Expt., 1 m.... 518 ,, Lappae, 30 m. ... 863 „ Phyto./Emetic. 15m. \ lac. \ Alterat.,Hm. J „ Pilocarpi, 5 to 15 m. OSS ,, Pruni Virginianae (Glycero - hydroalcoholic), 30 m. — „ Quassiae ... ... 877 „ Quillaiae 3 m. ... 878 Name. Dose. Page Fluidextr. Rhei, 15 m. ... 878 Rhois Glab., 15 m. . 879 Rosso, 30 m. ... 879 Rubi, i to 1 dr. ... 880 Sanguinarise, 1| m. 881 Sarsaparillse, 2 to 4 dr. 881 •Scillse, 1 in 1, If m. 882 Scutellariae, 5 to 15 m. 883 Senegse, 15 m. Spigelise, 1 dr. Staphisagrise, 1 m. . Stillingise, 30 m. ... Stramonii, 1 m. (0-25 per cent, alk.) ... Sumbul, 30 m. Tritici, 1 to 2 dr. ... Uvso Ursi, 30 m. ... Valerianae, 30 m. ... Viburni Prunif. 1 to 2 dr. . ,, Xanthoxyli, 30 m. . ,, Verba Santa, 15 m. ,, Zingib., 8 m. Fluid-glycerates . Flumerin . Fluorene . ,, Arsonic Acid Deri vs. Fluorescein, 672 & V. II. ; in ,, Cancer... ,, Mercury Comps. . ,, Sodium, Oral,Paint, intrav., etc., in Cancer. ... ... .. .A >> yy yy yy yy yy yy yy yy yy yy yy yy 883 886 887 887 888 833 838 819 891 892 892 893 437 477 190 190 672 477 Fluorine . Fly Deterrents & Destruction Fly Papers, Arsenic ,, ,, Sticky Fly, Spanish or Blistering Fceniculi Fructus Fcenugreek . Folin and Wu Method Folin’s Blood tube Fontana’s Stains Food and Drugs Act, 1928 Food Colours . Foods, 575 et seq. & V. II. Values of various, V ...V 672 IT. 1031 II. ... 892 ... 264 ... 854 ... 854 ...V. II. ...V. II. ...V. II. ...V. II. ...V. II. Calorie II. ; Diabetic, A.B.C. 585 ; Infants’, 80 Foods, Doctoring of ; Iodine in ; Poisoning; Preservatives...V. II. ,, Vitamins in ... 587 & V. II. Food Iron .V. II. Food Poisoning.1034 Fool’s Parsley. 832 Foot and Mouth Disease ... 709 Foot Powder . 137 Foemagules (Benzol, 309 ; Olive Oil, 616 ; Santalol,. 620) 690 ,, Naphthalene Tetrachlor 567 Formaldehyde 122 & \ . II., in Food, V. II.; Glycerin, 124: Formaldehyde Tablets, Internal ... . 128 Name. Dose. Page Formaldehyde, Production by Bacteria .V. II. Formaldehydum Polymerisation = Paraform. 127 Formalin, Formol, 122 & V. II.; Chlorof. Sols., 125 ; Disinfecting Tablets 128 ; Gargle 126 ; Inhalation, 125 ; as Meat, etc., Preservative ...V. II. Room Fumigation. 124 Tabs. Internal . 128 Formalinsapa. 126 Formalised Gelatin . 425 ,, ,, Capsules 690 Formamide . 125 Formamin . 449 „ Ethyl Iodide ... 503 Formamint Tablets . 128 Formanilid, 2 to 4 gr. 125 Formidin . 503 Formin, 5 to 15 gr.449 Formol.122 Formosyl, 125 ; Dental Dressing, 126 ; Mouth Wash, 126 ; Gargle, 126; Glyc. Soap 755; Pastils, 126 ; Pessaries, 126 ; Tooth Paste, etc. 126 Formosyls, Perfumed ... 597 Formyl Terchloride, 1-5 m. ... 282 Formyphenarsine . 188 Fotus Acid Borici, 6 dr. to 1 pint ,, Belladonnae, 1 to 2 dr. of Tinct. to 1 pint ,, Opii, l to 2 dr., to 1 pint ,, Papaveris, 2 ozs. to 11- pints, 15 minutes; foment at 120° F. ... Fouadin 163 Fouchet Test .V. II. Four Gland ‘ Tablets ’ ... 980 Fourneau ‘ 309 ’ 314 Fournier’s Syringe . 455 Fowler’s Solution, 2 to 8 m. ... 175 Fragaria 855 Frailac . 580 Fraisse’s Ferrug. and Serum Ampoules . 37 Frambcesia .V. II. (See also Arsenicals Organic). Frangula .855 Frankincense. 691 Fraser’s Root.843 Fraser’s Tinct. Strophanth. Edn. XIX.,791 Fraxinus ornus 865 Fredericia’s COo tensimeter, see Edn. XVIII., p. 376. Freeman’s Chlorodyne.V. II. Freezing Mixtures .V. II. French Chalk, 139 ; Glossary...V.II. „ Polish . 117 Friar’s Balsam, £ to 1 dr. 7 & V. II. Frigidaire Cabinet .V..II. Frohde’s Reagent ..V. II. „ with Ergot. 404 Name, Hose. Page Frohlich Syndrome . 984 Frost Bite .1055 Frost’s Solution .V. II. Fructolax, 2 to 3 dr. 653 Fructose... ..750 Fruit Preservatives .V. II. Fuchsine, Basic and Acid, or ‘ S,’; and Carbol Solution.V. II. i to 4 gr.320 ,, Ointment . 320 5/ Paint (Castellani) ... 320 ,, Aniline Green ...V. II. Fuchsine Sulphurous Acid Test V. II. Fucus Vesiculosus . 855 Fuller’s Earth. 138 Fuller’s Inhalant . 446 Fulmar Oil . 139 Fumigation of Booms, 124, 127 & V. II. Fumigators .124 & V. II. Fumus Potassii Nitratis ... 710 Fungi poisoning by (.see Poisons and Antidotes). Fungus igniarius, P. Austr. ... 835 Laricis. 833 , 1045 V. II. Fur Dyes . 306 Fur, Antimony in . ,, Dermatitis 306, 1045 & V. II. Furfural ... ... ... 128 Furze .851 Fusel Oil . 114 Gaertner Group of Bacteria ...V. II. Galactose ... ... ... 751 Galangal, 855 ; Galbanum, 5 to 15 gr. ... ... ... ... 855 Galega, 855 ; Gale, Sweet ... 842 Galegin.647 Galium Aparine, 855 ; Galla, 7\ gr. av. 856 Gall Bladder Visualisation ... 675 ,, ,, ,, Sod. Brom. 763 ,, Treatment ... 675, 1055 ,, Stones ... ... ... 677 Gallate de Bismuth . 233 Galvanometer.V. II. Gambir, 846 ; Gamboge, l to 2 gr.843 Gamgee (Gauze and Wool) Tissue 439 Ganja .263 Garcinia Hanburii . 843 Gardan Tablets, 1 or 2 ... 330 Gardenal, 1£ to 5 gr. 815 Garfield’s Tea 710 Gargar, Acidi Benzoici ... 7 Acid Carbolic ... ... 17 Acidi Tannici ... ... S9 Aluminis ... ... 433 Carbol ica . 17 Chlori ... ... ••• 766 Formaldehydi ... 125 Formosyl . 120 Hyd. Co.475 Perchlor. ... 469 99 99 99 99 99 99 99 99 99 Name. Dose. Page Gargar, Hydrog. Perox. ... 489 ,, Potass. Chlor. ... 705 ,, ,, Permang. ... 545 ,, Besorcini . 746 Garlic, i to 2 dr. ... ... 834 Garrod’s Lozenges . 790 Gas, Dental . 141 Gangrene, V. II. ; Globulins Serum in Peritonitis and Toxaemia, Therap. Ind. 1075,1089 Mantles .V. II. -Oxygen Anaesthesia ... 142 Oxygen and Ether ... 100 Poisoning. 1096 & V.II. Vide also Bespirator Soln. p. 87 Gasoline . 655 & V. II. 99 99 99 99 99 99 99 9 9 965 225 965 V. II. 1090 1104 V. II. 66 V. II. 778 442 233 21 17 462 315 439, 440, 441 480 56, 439, 442 Gaster Siccata, i to 1 oz. Gastralka, 1 dr. Gastric Extract, i to 1 oz. ,, Contents Examn. ,, Ulcer . Gaubius’ Table of Dosage Gauducheau’s Stain ... Gaultheria Oil, 5 to 15 m. Gautiers Pills ... Gauze-covered Moss ... Gauze, Alembroth ,, Bismuth Subgallas Bromphenobis Carbolised Cyanide Chinosol Iodoform Mcrcurome Picric ... Gauzes and Gauze Tissues 439, 440, 441 ,, Tampons 439 Gazoline ... ... ... 655 Gee’s Cough Linctus, 1 dr. ... 626 Gefieckter Schierling ... ... 374 Gelanthum .803 Gelatin, Comp. Phenolised ... 824 Glycerin ... ... 434 Injections ... ...1,424 Nutrient (Bact.) ...V.II. Lamella) Ophthalmic... 530 Pastils. 434 Sterules ... ... 425 Styptic. 972 Gelatina Sol. Steril.424 Gelatinothorax... ... ... 425 Gelatinum . 424 „ Calcii Chloridi, 5 to 7 Cc. 255 Formalisat. . 425 Zinci, and with Ichthyol, Picis 5%, Besorcin 3% 823 Gelignite ... ... ... 570 Gelineau’s Dragees, 1 p.d. increased to 3 ... ... 154 Gelsemii Badix, 5 to 15 gr. 425 & V. II. Gelsemin (Extractive), -J-2 gr. 426 Gelsemine . 426 9 9 99 99 99 99 99 Name. Dose. Page Gelseminina, 1/100 to 1/32 gr. 426 & V. II. Gelesmininae HC1., 1/60 to 1/20 gr. 426 Genasprin, 5 to 15 gr. 68 General Paralysis, treatment by malaria inocn. ... 1073 Genoscopolamine, \ mgr. ... 494 Gencydo. ... 856 Genozo Tooth Paste ... ... 919 Gentianae Radix ... 856 Gentian Violet.321 & V. II. Geraniol... . ...V. II. Geranium Mac., 1 to 5 gr., 856, Cape. ... 856 Gerhardt’s Test... ...V. II. German Chamomile ... 837 ,, Glossary ...V. II. ,, Measles ... 988 ,, Silver. ...V. TI. Germander ... 889 Germanin ... 313 Germanium ... 856 Germicides, 27 ; Chapter on ...V. II. Gerrard’s Test Solution ...V. II. Ghati or Ghatti Gum ... 2 Ghee 54 Giardia ... ...V. II. Giemsa’s Injection, 721 ; Stain V. II. Gin . ...V. II. Gingelli Oil . ... 872 Ginger. ... 893 Gingerin, £ to 1 gr. ... 893 Gingerol. ... 893 Ginseng. ... 856 Gipsy Nut . ... 890 Gitin, Gitalin .393 & V. II. Glanders.* ...V. 11. Glands Ductless (see a/so Gland in question).947 & V. II. Glanduhe Supraren. Sicc., 4 gr. 967 ,, Thyroideae Sice., \ to 4 gr. 976 Glaser’s Salt, 30 to 120 gr. ... 711 Glass for Technical Work ...V. II. Glass, Soluble ; or Water ... i ( 1 Glauber’s Salt ... ... 772 Glaucium Luteum ... 856 Glaukosan ... 973 Glauramine ... 323, 433 & VII. Glaxo . ... 584 Glaxovo... 585 Giiadin in flour. ...V. 11. Glonoin Sol., £ to 2 m. ... 569 Gloria Tonic . V 11 Gloriosa Superba ... 856 Glossaries ...V. II. Glossinia Palp., Morsitans,V. 11. etseq. Gloves, Rubber Operation ... 268 Glucosan . ... 751 Glucosazone . ...V. II. Glucosid.es ... 856 Glucosone 647, 758 Glucosum . ... 427 „ Feeding. ... 427 ,, Gamma. ... 643 „ Media . ...V. II. Name. Dose. Page Glucose Estn. in Blood, 642 & v. Blood „ Intrav. Injn. ... 428, 429 ,, Rectal Injn.430 ,, Surgical Dressing ... 430 „ Syrup . 689 ,, Tests for, in Urine ...V. II. ,, Sterules (for feeding) ... 428 ,, Varicose Veins. 430 Glucusimide, Glusidum,£to2gr. 748 ,, Soluble, £ to 2 gr. 749 Glutaminic Acid . 762 Glutathione . 279 Glue .361 Gluten, 585; Bread, 585 Glutoid Caps. . 690 Glycaphorm, 1 to 2 dr. ... 560 Glycerin, 1 to 2 dr.431 ,, Acidi Borici ... 10 & V. II. ,, Carbol., 1 in 5 ... 17 „ Hydriodici, 20 m. 37 ,, Tannici ... 89, 431 Agar .V. II. Aloes . 132 99 9 9 „ Aluminis (c. Acid Tannic, 434) ... 135, 433 ,, Amyli, 1 to 8 — „ Antiseptic Power 433 & V. II. ,, Atropinae.208 „ Belladonna . 219 „ Bismuthi Nitratis ... 228 „ Bismuth, et Sod. Tart., 1 dr., Edn. XIX., p. 663. „ Boracis, 1 to 6. 433 ,, Carbolised 1% in labour 433 ,, c. Aq. Rosa3 . 434 ,, Di-acetyl-morphina?, 1 to 2 dr.560 d Eastoni, 15 m. 419 ,, Ext.Bone Marrow, 1-2 dr. 948 ,, Eerri Dialysat., 60 m. ... 414 „ ,, Perchlor. 413 ,, Germicidal action ... 432 „ Glyceroph. Co., 1 to 2 dr. 35 ,, ,, c. Medulla Rub., 1 to 2 dr. ... 36 „ Hyd. Perchlor. 469 ,, ,, Ale. (caution not for Administration) ... 469 ,, Hygroscopic action ... 432 „ Hypophosp., 1 dr. ... 684 ,, Injn. in cancer. 431 „ lodoformi . 501 ,, lodi (and Morton’s) ... 505 „ Irrigation. 433 „ Jelly, 433 ; Micro ...V. II. ,, Labour. 432 ,, Lubricant . 433 ,, Pancreatis, 1 to 2 dr. ... 634 ,, Papain, 1 dr. c.c. , ... 648 ,, Pepsini, 1 to 2 dr. ... 659 „ Pessaries. 435 „ Phosphori = Elix., 15 to 60 m.. 680 „ Plumbi Subac.. 696 Name. Dose. Page Glycerin for Puerperal Sepsis 433 Resorcin. ... 746 Rose Water ... ... 434 Soap Liq. ... 755 Sodii Cinnam., 30 to 60 m. 828 Spirit ... 112 Substitutes ... ... 435 Suppositories ... ... 435 Tampons. 435, 793 Tinctures, vide Glv- cetracta ... 435, 802 Tragacanth ... ... 803 Glyc. Calf Lymph ... ... 940 Glyceritum Boroglycerini ... 10 ,, Fe., Quin., Strych., 15 m. 419 ,, Phenolis ... ... ... 17 Glycero-alcohol, 5-60 m. ... 434 ,, Piperaz, 5 to 10 gr. ... 695 Glycerole Easton, 15 m. ... 419 Glycerophosphates ... 33 et seq. Glyceroph. de Sod. Crist. ... 35 Glyceryl Antimonite ... ... 155 „ Carbonates ... ...V. II. ,, Trinit., 5-J0 to A? gr. 569 GLYCETRACTA 435 et seq. ,, Aconiti, 0-4% alk., Av. 1 m. „ Bellad., 0-375% alk., 1 to 2 m. ,, Calumbse, 10-20 m. ,, Cascara, \ to 1 dr. ,, Catechu, 5 to 15 m. ,, Chirettse, \ to 1 dr. ,, Cinchonae, 3% alk., 8 to 25 m. ,, Cocse, 0-25% alk., 1 to 2 dr. ,, Colchici, 0-5% alk., Av. 3 m. ,, Conii, 0-45% alk., Av. 3 m. ,, Digitalis, 1 to 2 m. Ergot*, 10 to 30 m. Gelsemii, 5 to 15 m. Gentian*, 15-30 m. Hamamelid., 5 to 15 m. Hydrastis, 5-15 m. Hyoscy., 0-075% alk. Av., 3 m. Ipecac., 1-1% alk., Expt., 1 to 4 m. Emetic, 30 to 40 m. Jaborandi, 5-15 m. Krameri*, 5-15 m. Nucis Vomicae, 0-75% Strych., 2-6 m. Pruni Virg., 5-30 m. Quassiae, 2 to 5 m. Rhei, 5 to 30 m. Sarsae, 2 to 4 clr. Scillae, 1 to 5 m. Senegae, 5 to 20 m. Sennae, | to 1 dr. Tarax., £ to 2 dr. Valerian, 5 to 20 m. Glycin,’ 5; Glycine, • •• 4; Glycine Hispida ... ... 885 Glycine & Glycinamide Arsenic Compds. ... ... ... 190 Glycocoll, 10 to 30 gr.... 4 & V. II. Glyco-gelatin and Pastils ... 434 Glycogen, 1| to 2 gr. ...857 & V. II. 9J Glycol (Ethylene) 435 Name. Dose. Page Glycolactoplios. 35 Glycopasta Aconiti, Bellad., Hyoscy. . 437 Glycosuria .V. II. (See Insulin.) Glycothymoline . 802 Glycyrrhiza, 5 to 20 gr. 857 & V. II. Glycyrrliizin. Amm., | to 5 gr. 857 & V. II. Glykaline .V. II. GLYL 437 Amygd. Ess. sine HCN. ; Anethi; Anisi; Aurant. Amar. ; Aurant. Flor. ; Carui; Caryophylli; Cin- nam. ; Eceniculi; Lavandulae ; Limonis ; Menthae Pip. ; Menthae Vir. ; Myrist. ; Pimentae ; Pini; Ros* ; Sassafras ; Thy mi; Vanill* 438 Glymol = Paraff. Liq. q.v. Gmelin’s Test ... ... ...V. II. Goa Powder ... ... ... 292 Goat Serum in Cancer... ... 1037 Goats and Malta fever.V. II. Goat’s Beard . 890 „ Milk . 583,592 ,, Rue ... ... ... 855 Goitre, 510, 708, 709, 768, 913 ; and Therap. Ind. ... 1053, 1056 Goitre and Iodine in Water ...V. II. Gokhru ... ... ... ... 857 Gold and Sodium Chloride ... 212 ,, Beater’s Skin ... ... 948 ,, Chloride, 212 ; Soln. ...V. II. „ Colloidal ... ...365 & V. II. ,, Cure ... ... ... 211 ,, for Syph. diagnosis ...V. II. ., “ Cyanide ” 706 „ Treatment of Phthisis ... 213 .. Sodium Thiosulph. ... 213 V II • •• ••• » • .I.-*.* 753 „ Seal, 10 to 30 gr. 486 Gomenol and Pate ... ... 866 Gomme Arabique 1, Senegal 1, Goutte ... ... ... 843 Gonal Capsules.... 620 Gonoccocus, Vaccine ... ... 913 in Urine.V. II. ,, Culture Media ...V. II. Gonorrhoea ... 913, 1057 & V. II. ,, Mercurome in 480, 482 Goober Nut ... ... ... 837 Goose Grass ... ... ... 855 ,, Grease ... ... ... 564 Gordon and Hine’s Trypagar V. II. Gordon’s Panoptic Stain ...V. II. Gorit (Calc. Perox.), 3-10 gr.... 255 Gorun Cachets ... ... 317 Gossyp. Rad. Cort. ... ... 442 Gossypium . 438 Gossyp. Arseniosium ... 177 ,, Camph. . 262 Capsici . 270 Golden Eire ,, Santonin Name. Dose. Page Gossyp. Carbolisat. 17 Ferri Perchlor. ... 413 } 5 Hyd. Iodidi ... ... 463 Hyd. Perchlor. 469, 471 > 5 Iodoformi ... 501 ?? Menthol. ... 551 jy 01. Terebinth. ... 693 ? ? Sal Alembroth ... 472 ,. Stypticum ... 413 Goudron de Houille ... ... 296 Goulard’s Extract ... 699 Gout, 695 ; Powders, 875 ; see also Therap. Ind.1057 Goutt.es Ameres de Baume 4 m.596 Gowland Hopkins’ Method ...V. IT. Gowers’ Haemo. Solus.V. II. Grafenberg’s Ring . 723 Grains de Lin. 864 Gram’sMethodSolns.and TableV. II. Granati Cortex ... 656, 657 Grant’s, Sir D., Inhalation and Insufflator ,, ,, Pigment Iodi Granula Dioscoridis, 1 to 5 ... Granules Aconitine and Nitras, \o mgr. Granules AtropineSulph., 1 mgr. ,, Digitaline Nat. ,, Digitoxin, 2I0 gr. ,, Hyoscy amine, 1 hrly. ,, Strophanthin, mgr. Grape Sugar Gratus Strophanthin Graves’ Disease, see Goitre Exophthalmic. Gray’s Stovaine Dextrin Inj. ... Green, Brilliant ,, Malachite ,, Mercurous Iodide Green Mountain Cure Gregory’s Pill=Pil. Coloc. Co. ,, Powder 10 to 60 gr. ,, Salt.V. II. Grey Oil, 2 to 3 gr. ... 455 ,, Powder, 1 to 5 gr. ... 454 Griffith’s Mixture, 1-1 oz. = Mist. Ferri Co. . Grignard Reaction ... ... 540 Grindeline, 1 to 2 dr. 443 Grindelia . 443 Griserin ... ... ... ... 319 Grossich’s Solution ... ... 511 Ground Nut Oil . 837 Groundsel ... 883 Guaiaci Resina (& Lig.) 5-15 gr. 444 Tests for Blood .V. II. Guaiacol (Liq. &), 1 to 5 m. 444 & V. II. ,, Cryst., 1 to 4 grs. ... 444 „ Benz., 4 to 12 gr. 446 & V. II. ,, Cacodyl., i~2 gr. ... 181 ,, Calc. Sulphonate ... 447 ,, Camph., 5-10 gr. ... 446 ,, Carb., 5 to 15 gr. 446 & V. II. 286 506 176 93 207 393 392 496 783 427 783 352 324 323 466 710 879 Name. Dose. Page Guaiacol Cinnam.,5-15gr. 447 & V.II. ,, Glucose Sterules, 2 Cc. ... 200 ,, Iodide, 5 to 15 gr. ,, -Iodine Oil ,, Pot. Sulphonate... Guaiacyl Guaicamphol. ... Guanidine, Guanin Guarana, 10 to 60 gr. Guaraniiie, 1 to 5 gr. ... Guaycuru,; 857 ; Guaza Guimauve Pastils Guinea Worm ... Guipsine. ... 447 ... 445 447 & V. II. ... 447 ... 446 986 & Y. TI. ... 858 244, S58 ... 263 434 1058 & V.II. ... 892 Gum Acacia, 1,V.II; Ghatti(Indie.) 2 ,, Acac. Intravenous ... 1 ,, Chewing. ... 848 ,, Chicle ... ... ... 848 ,, Glucose ... ... ... 2 ,, Plant ... ... ... 443 ,, Red . ... 853 ,, Thus ... ... ... 691 359, 570 Gun-Cotton Giinzburg’s Capsule and Test.. A Gurjun Balsam, 1 to 2 dr. ... Gut, Chromic, Iodised, etc. ... Guttae Ac. Carbol., 17 ; Adrenalin, c. Ac. Boric, et c. Zinc Chlor., et c. Zinc Sulph., 973 ; Arsen ct Ferri, 5 drops, 178 ; Atropinae Sulph., }, 1 and 2%, 208 ; Atropime c. Co- caina, 208; Atropinaec. Zinco, 208; Atropinae et Quininae, 208 ; Pastor. Co. l’dr., 846 ; Chlorof. cum IVlenthol Co., 286; Cinnamom. Co., 379; Cocainae Hydrochloridi (& c. Adren.), 339 ; Cocainae 01eosae,334(andFactory Act) Cupri Sulphatis, 383; Da- turinae, 1%, 496 ; Dionin,559; Eucainae, 343 ; Ilolocain, 344; Homatropinae, 1% (et c. Cocaina), 210 ; Horsti, 826 ; Hydrargyri Nitratis (Aural), 467 ; Hydrogen Perox., 489 ; Hyoscinae,0-5%(et c.Cocaina), 492 ; Hyoscyaminae, 496 ; Inosemzowi, 376; Iodi Farrer, 1081 ; Morphinae et Cocainae (Aural), 556 ; Physo- stigminae, 686 (et. c. Cocaina), 686; Physostigminae et Quininae, 686; Pilocarpinae, 688; Pro. Auribus Ac. Boric., 10 ; Pro. Auribus Ac. Carb., 18 ; Quininae Formatis, 2%, 720 ; Rosae, 2 to 10 m., 556 ; Sodii Arsenitis et Ferri, 5 m., 178; Zinci Chloridi (et c. Cocaina), 821 ; Zinc Chlorid (Aural), 822 ; Zinc Chlorid. c. Adrenalin, 822; Zinc. Sulphat 826. II. 839 532 Name. Dose. Page Gutta-Percha and Tissue ... 268 Gutzeit’s Test ... ... V IT Guy’s Tonic ... ... ...v! II Gwathmey’s Synergistic Method ioi ’ n 102 Gymnema var. 858 Gynocardia Odorata ... 602 Gypsum (Oalcii Sulphas) ... 258 Haarlem Drops. 604 Hemacytometers ... ’’ v IT Haematein (Haematin) ...858 & V Ii’ Hamiatoporphyrin ...787 & V. Ill Hematoxylin.858 & V. II. Hsematoxyli Lignum ... . 858 Hemoglobin and Caps, 1 to 2 dr. 576 & Hemoglobinometers ... V* n Hemolysin . 894 Hemoplastin . 964 Hemoptysis . 151. 1058 Hemorrhage . 1058, 1059 HemorrhagicInfectiveJaundiceY. II Hemorrhoids. 448, 1059 Hemostatic Serum, 964 ; see also 252 et seq. Haft'kine’s CholeraProphylactic 908 ,, Plague Vaccine ...V. II. Hafnium .y. n. Hair Dyes, 305; Amidol. V. II. ; Copper, V. II. • Henna, 305, 859 ; Ilydrog. Perox., 489 ; Inecto,- 306 ; Iron Tannate, V. II. ; Lead, 305 & V. II. ; “ One Solution,” V. II. ; Pot. Permang., 545 ; Mrs. Potter’s Walnut Juice, 306; Pyrogallol, Y. II. ; Paraphenylene, 305 ; Sensitization Test, 305 ; Silver.Y. II. Hair Lotion, Amyl Nit. and Pilocarpine ... 153 ,, ,, E. Wilson’s ... 144 ,, ,, Resorcin ... ... 746 Hair's (Dr.), Cure for Asthma Y. II. Halarsol. ... 188 Halazone Tablets 48 Haldane Oxygen App.... ... 631 Half-Cream Foods 578, 580 Hall Edwards COa App. 23 Halliburton’s Test ...Y. II. Hall’s Wine ...Y. II. Hamamelidin, to 2 gr. ... 448 Hamamelidis Cort. et Fol. ... 447 Hamilton’s Pill. ... 374 Hammond’s Remedy ... ...Y. II. Handkerchiefs, Aseptic ... 439 Harcourt Y. Regulator ... 282 Hardback ... .., ... 849 Harington, Thyroxin ... ... 977 Harmala, Harmine ... 858 Harmol and Harmalol... ... 858 Harrington’s Soln. ... 470 Harrison Federal Law... ...Y. II. Name. Dose Harrison T.B. Stain ' Hartley’s Test ... Hartshorn and Oil Harvard Liquid Hashish ... Page ...Y. II. ...Y. II. ... 143 ... 866 ...263 & Y. II. ) 3 281 281 621 377 161 422 712 571 752 .. 787 .. 788 .. 806 .. 850 ..V. II. 762 Haust. Ch’oralamidi, 1 oz >> 5? , Co., 1 oz. ,, Copaibe, 1 oz.... Creosoti, | to 1 oz. ,, Emeticus purgans, 1 oz. ,, Filicis, 1 oz. Imperialis . Nitroglycerini, 1£ oz. ... Santonini et 01. Ricini, li oz. „ Sulphonal, 1 oz. ,, Trional, 1 oz. „ Free Co., 34 ozs. Hawthorn . Hayem’s Blood Fluid !.! ,,, Solution (Serum) ... Hay Fever, 661, 914 ; Nebule 569 ,, ,, Vaccines. 914 „ ,, Reaction Outfit .,. 914 (See also Protein Theraoy and Therapeutic Index;) Hazel Foam and Comps. ... 448 Head and Headache Powders Y. II. Heal-All.849 Health Resorts.V. II. Heart, Auricular Fibrillation 386, 714 „ Extract. Syph. Test ...V. II. „ Muscle Ext.953 Heat as Antiseptic .Y. II. ,, Tieatment, Radiant ...V. II. Heberden’s Ink = Mist. Ferri Arom., ’85, 1 to 2 oz. Hedeoma . 876 Hedera and Hederin ... 858, 859 Hehner’s Test.V. n. Heiser’s (Chaulmoogra) Injn. i to 10 Cc. ... 603 Helalin. ... 849 Helba . ... 854 Helenin, \ to 2 gr. ... 860 Helianthin ...V. II. Heliotropin . ... 859 Helium. !—1 M Hellebore, Black, Green, 1-5 gr., White. ... 891 Heller’s .Test . ...V. II. Hellige Colorimeter ...Y. II. Hehnerich’s Pomade ... ... 791 Helonias dioica. ... 859 ,, Compound, 1 dr. ... 859 Hemisine ... 968 Hemlock (Lesser, 832) ... 374 ,, Dropwort ... 871 ,, Spruce, 874: Water 849 Hemolac ... 580 Hemp, Canadian, 837 ; Russian 843 Henbane, 494 ; Egyptian 204, 495 Henna. 305, 859 Hepatex, 1 dr. =2 oz. liyer ... 952 Name. Dose. Page Hepatex, P.A.F., 5 Cc. intrav. or intram. ... 952 Hepatic Abscess ... 517 et seq. ,, Inefficiency (Lsevulose) Test ... 317, 751 Herbe aux Chantres ... ... 853 Heroin HC1., A- to | gr. 559 & V. II. ,, Addiction . 560 in any proportion gg 559, 997 Herpes and Chicken pox. ... 944 Hervea. 249 & V. II. 828 866 267 290 291 Hetol, 3 to 5 gr. Heusner’s Glue Hevea Brasiliensis Hexachlorethane Hexalin ... Hexamina Hexamethylen-tet- ramine, 5 to 15 gr. 449 & VII. ,, Experiments with, 450 and V. II. ; in Cholecystitis, large doses ,, Benzoate, 5 to 15 gr. ,, Borate, 15 to 60 gr. ,, Camphorat., 8 to 12 gr. ,, Glycochol ,, intrav. injn. ,, Lithium Benz. ... ,, Mercury Compds. ,, Salicylate, 5 to 15 gr. ,, Sod. Acet., 30 gr. ,, Sodium Benzoate Hexanitrin, 1 gr. Hexyl-resorcin, 2 to 10 gr. 747 & V.1I. ,, Solution ‘ S.T. 37,’ for local use . 748 Hey’s Green Paste . 325 Hiera Picra, 3 to 10 gr. ... 133 High Explosives ... 305, 569 ,, Frequency .V. II. 677 452 452 454 454 452 453 477 453 454 453 409 631 710 889 832 8 & 9 950 950 Hill’s (Leonard), Oxygen Bag . Himrod’s Cure . Hindu Dates . Hippocastanum ‘ Hippocras,’ 893 ; Hippurates Hirudo ... Hirudin ... Histamine 407, 662, 665, 667, 956 „ Shock ... 407, 667 ,, in relation to blood pressure ... 407 Histidne ... ... 407 & VII. Hodman’s, Anodyne 60 to 90 m. 104 Hog Stomach ... ... ... 965 .. 385 859 .. 188 ..V. II. Hoja de Digital Holarrhena Holarsol Holloway’s Ointment & Pills. Holocaine HC1. ... 344 & V. II. Homatropinae HBr., 1/80-1/20 gr. ... ... 204, 210 „ HO., 210 ; Salicyl., 1/80 to 1/20 gr.210 Homatropine . 204, 210 Honey, V. II.; Water... ... 114 Honeysuckles.864 y y Name. Dose. Page Hookworm, see Ankylostom. Hop Smoking.864 Hordenine . 859 Horder, Sir Thos., Cacodyl & Nuclein Inns. ... ... 182 Horder, Sir Thos.. Immunogens 947 Horehound, 30 gr.865 Horlick’s M. Milk tabs. ...V. II. Hormonal, 15 to 20 Cc., Children less .965 Hormones Pancreas . 633 ,, Placental . 963 ,, Suprarenal. 974 Hormonigen Tabs., 1 or 2 before meals 981 Hormotone Tabs. . 981 Horrocks’ Method .V. II. Horse-chestnut ... 819, 832 Horse-hair . 533 Horsenettle . ... 884 Horse plasma. 963 Horseradish . ... 849 Horse Serum .963 Horsley’s Wax. 846 Horst’s Eye Drops ... ... 826 Horticultural Poisons, 172, 989, 992 Hospitals and D.D.A. ... ... 1004 Hound’s Tongue . 852 Household Ammonia. 144 Hou«eleek . 883 Hiibl’s Iodine Solution ...V. II. Huile Camphree . 261 ,, ,, Sterilisee ... 261 Creosot. Iodof. ... ... 501 de Bouleau . 697 de Cade. 696 de Foie de Morue ... 611 d’lodure Mercurique, 1 Cc.463 de Jusquiaume Co. ... 495 d’oeilette . 615 de Petrole ... ... 655 de Vaseline . 651 Grise Injectable, 2 to 3 gr. 455 Lourdes de Petrole ... 651 Hulle’s Soluble Strychnine ... 786 Human and Humanised Milk... 579 Human Bile . 776 Humanised Cream . 579 Humbergum . 622 Humulus Lupulus . 864 Hunyadi Salts ... ... ... 773 Hurst’s Alkaline Treatment (Ca) 255 : (Mg.) . 538 Huxham’s Tincture, to 1 dr. 294 Hycol . 29 Hydnestryle .607 Hydnocarpus, var. ... 602, 606 ,, Eth.. Esters ... 607 Hydnocreol .607 Hydramyl . 656 Hydrangea .859 Hydrargyrum ... 454 & V. II. Hydrarg. Exstinctum ... 456 Hyd. Ammoniat. . 458 33 33 55 5 3 35 33 33 33 33 33 33 33 33 3 3 33 3 3 Name. Hose. Page Hvd. Ammon. Chlor. (Sal Alembroth) ...472&V.IT. Benzoas, 1/50 to 1/10 gr. 459 Bichloridum = Perchlori- dum, 1/32 to 1/16 gr.... 467 Bijodat (Biniodid) ... 462 Biniodidum, JB.P/14, A to yo gr. 462 & see also 464 et seq. ,, Solubles ... ... 464 Bisulphid. or Bisulphuret, P.L. ’51= Vermilion... 477 Bromidutn, 1/16 to £ gr. 459 Carbolas, £ to 2 gr. ... 459 Chloridum mite ... 473 Chloridum, B.P.’ 14 = Sub- chloridum, £ to 5 gr. ... 473 Chloridum Corrosivum... 467 „ Mite,U.S. = Subchor .473 c. Creta, 1 to 5 gr. ... 454 Cyanidum, 1/20 to £ gr.... 459 Exstinctum ... ... 456 Iodas, £ to £ gr.... ... 830 Jodidum Flavum ... 466 „ „ (-ous), £ gr. ... 466 Iodidum Rub., 1/32 to 1/16 gr. ...462&V. II. ,, Viride, £ to 1 gr, ... 466 Nitras ... ... ... 466 Nitroso-Nitrate ... ...V. II. Oleas ... ... ... 598 Oleatum, 5, 10, 20 & 25 % et (c. Morphina) ... 599 Oxidum (-ous) ... ... 475 Flavum ... ... 476 Rubrum, £ to 1 gr. 477 Oxycyanidum ... 460 & V. II. Oxysulphas ... ... 476 Peptonas, per os, £ gr.., hyp., £ gr.467 Perchloridum(Wool, Gauze, Lint Wool, 469 471), 1/32 to 1/16 gr. 467 & V. II. ,, Intrav. use ... 472 Persulphas, 2 to 5 gr. ... 476 et Potass. lod., 1/16 to £ gr. ... ...464 A V. II. ,, ,, Solubes ... ... 464 Protoiodid, £ to 1 gr. ... 466 Rhodanidum ... ... 477 Salicyl (Basic), £ gr. ... 472 „ Neut., ,0 gr. incr. 473 Salicyl.-Arsonas. 183 Stearas ... ... ... 599 Subchloridum, £ to 5 gr. 473 ,, Buret’s Form Cryst. 474 Succinimid., £ to £ gr.476&V.II. Sulphas,Subsulph.,2 to 5gr. 476 Sulphidum. ... ... 477 Sulpliocyanidum ... 477 Sulphuret c. Sulph. ... 477 et Zinci Cyanidum 461 A V. II. Hydrastin, 2 to 5 gr. ... ... 487 Hydrastina (Aik.), £ to 1 gr. 487 A V. II. 33 33 33 33 33 3 > 33 ) 3 3 3 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 3 3 33 33 33 33 33 33 33 33 33 33 Name. Hose. Page Hydrastine HC1., £ to 1 gr. 487 & V. IT. Hydrastinine HC1., £ gr. 487 A V. II. Hydrastis, 10 to 30 gr. ... 486 Hydrazine ... ... ...V. II. Hydrazobenzene ... ... 310 Hydriodic Ether . 106 Hydrobromic Ether ... ... 832 Hydrocephalus Test ... ...V. II. Hydrochinon ... ... ... 860 Hydrochlorates Ale. Princip. Opii ... ... ... 028 Hydrocotyle Asiatica, 4 to 10 gr. 860 Hydrocupreine. 380 Hydrogen Borate . ... 9 „ IonConcent.ofBloodV.il. ,, ,, Indicators ...V. II ,, Liquet. App. ...V. II. ,, Peroxide, £-2 dr. 13, 488 A V II Solid .* 490 Borated... ... 489 „ ,, Mouth Washes. ^ 489 ,, Transmutation of ...V. II. Hydrogenated Fats ... 597 & V. II. Hydrogenit ... ... ...V. II. Hydrophobia ... ... ...V. II. Hydroquinine HC1. ... ... 380 Hydroquinone, £ to 5 gr. ... 860 ,, Hevelopers ...V. II. Hydroxylamine HC1. 860 Hydroxycodeine ... ...V. II. Hydroxy-phenylethylamine 408, 973 Hydroxvphthalophenon, 2-5 gr. 671 ‘ Hydroxyl,* 488 ; Group, effect of ... ••• •••' • II. Hyoscina ... ...490&V. II. Hyoscinse HBr., 1/200 to 1/100 gr. or less ... 491 „ HC1. & HI., 1/200 to 1/100 gr. or less... 494 Hyoscine-Morph. Anesthesia 492 Hyoscyami Folia, 3 gr.... ... 494 Mutic. Fol. ... 495 Hyoscyamina, 1/200 to 1/100 incr.496 Hvoscyamine HBr. et Sulph., 1/200 to l/lOO gr. ... 496 & V. IT. Hyper and Hypo. Thyroidism 983 Hyperglycemia 037 Hyperol ... ... • • • 490 Hypertonic Saline . 760 Hypervitaminosis ... 594 & V. II. Hypnal ... ... ... ...V. II. Hypnogen ... ... ••• 806 Hypnone, 1£ to 5 m. ... ... 827 Hypo and Hyperthyroidism ... 983 Hypobromite Sol. ... ...V. II. Hypochlorite ... ... 44 & V. II. „ Hakin’s ... 44 & V. II. Hypod. Injections. See Sterules. Purgatives: Aloin ... 133 Apocodeine, 357 ; Colo- cvnthin, 374; Hormonal 965 33 Name. Dose. Page Hypod. Sterules, see Sterules. ,, Syringes, etc. to sterilize Thymol Disinfectant. ,, Tabs., v. Tablets. Hypod. Hypophamine. ... 962 Hypophosphites 682 et seq. Hypophysis . ... 955 Hyjjro ... . ... 29 Hypotonic Saline ... 761 Hysterionica 852, 860 Hy sterol. ... 820 t-X Ba.Meal ... ... 216 Ibogaine and HCL, gr. ... 860 Ice Cream ...Y. II. Iceland Moss ... 847 Ichthalbin, f to 15 gr. ... 498 Ichthof orm ... 499 Ichthosulphol (Ichthyol) ... 497 . ,, Ammon. Lith. Sod., . and Zinc Salts... 497 ,, Paste ... 498 ,, Proteinate ... 498 ,, Resorcin ... 498 ,, Salicyl ... 498 ,, Tampons ... 793 Ichthyocolla . ... 860 Ichthyol, 497 ; Ichthyolate ... 497 Icterus Index ... ... 317 Idozan ... ... 366 Ignatia Amara Beans ... ... 596 Ihle’s Paste . ... 747 Ilex Paraguayensis ... 249 Illipi (Nuts and Butter) ... 840 Tinkle Orthosulfobenzoiquc, 4 to 2 gr. . 748 Iminazolylethylamine... 407 A V. II. Immune Body ... 894 & V. II. Immunisation ... ... 894 et seq. Immunity, Local . 895 Immunity Reaction . 895 Immunogens ... ... ... 946 Imperial Drink ... ... 712 Impermeable Pilerie ... ... 439 Import Duties Act (1932) ... 1019 ,, & Imperial Pref. Order 1019 Indamine Reaction ... ... 306 Incretone, 1 to 2 dr. ... ... 981 Incubation periods of infectious diseases . ... 988 India Rubber ... 267 ,, ,, Paste for Hulls ...V. II. Indian Hemp, Amer., 837 ; White, 839 ; Indian Squill... 890 Indian Ink ... ... ...V. II. Indian Lemon Grass, 872; Licorice, 827; Pink Root, 886 ; Root.t 855 Indican ... .Y. II. Indicators for Analysis ...Y. 11. Indigo . ... ...Y. II. „ -Carmine, v. Synopsis of B.P.’32 changes and ...Y II. Name. Dose. Page Indol Reaction Y. II. Indoxyl. Y. II. Industrial Methyl. Spirit ... 115 Inebriety 113, 115, 205, 294, 365 Inecto.306 Infant Feeding ... 578 et seq. „ Foods “ A,” “ B,” “ C,” and Cocoa ... ... 580 ,, Starch for ... ... 580 Infectious Diseases Table ... 988 Infra-Rontgen Rays.V. II. Influenza, 914, 1063 ; Yaccine, 903, 914; Bacillus, 914 & V. II. ,, Infective Period ... 988 ,, Epidemology ... 915,916 ,, Filtrable Virus of ... 916 ,, and pneumonia ... 915, 916 ,, War Office Conf. Yaccine 915 ,, Detoxicated Yaccine ... 916 Infundibular Ext., 4 to 1 Cc. ... 958 Inf undin . 959 lnfusa Concentrata . 499 Infus. Alchemilla, 1 to 2 oz. ... 834 ,, Alstonise, 4 to 1 oz. ... 835 ,, *Anthemidis, 1 to 4 oz.... 837 ,, *Aurantii, 1 in 20 (& * Co.), 1 to 1 oz. ,, Bardanae Spir. 863 ,, *Buchu, 1 to 2 oz. ... 842 ,, *CaIumbae, 4 to 1 oz. ... — ,, *Caryophylli, i to 1 oz.... ,, *Cascarillae, £ to 1 oz. ... 845 ,, *Chiratse, i to 1 oz. ... 848 ,, Cinch. Acid, i to 1 oz. ... ,, Cocae, 4 to 8 oz.... ... 332 ,, Condurango, i to 2 oz.... 850 „ *Cuspariae, 1 in 20, 1. to 2 Q2 ,, Digitalis, B.F. ’*14, i to ,, Ergotae, 1 to 2 oz., B.P.T4 ,, Eupatorii, 1 to 4 oz. ... 854 ,, Gentian Aromat. ... 856 ,, Gentianae Co., 4 to 1 oz. 856 Cone. 500, 856 ,, Gokliru, 10 oz. daily ... 857 ,, Hydrastis . 486 ,, *Krameriae,lin20,|toloz. Lini, 1 in 30 ,, Liquorice, 1 in 90, ad lib. ,, *Lupuli, 1 in 20,1 to 2 oz. ,, Marrubii ... ... 865 ,, Menyanthis, 2-6 oz. ... 867 ,, Polygalae Co., V-1 oz. ... 883 ,, *Quassiae, 4 to 1 oz. 500, 877 ,, *Rhei, 1 in 20, 4-1 oz. ... ,, *Rosae Acidum, f-1 oz.... 879 ,, *Scoparii, 1 in 10,1 to 2 oz. ,, *Senegae, i to 1 oz. ... 883 *Sennae, \ to 2 oz. ... 500 ,, *Serpentariae, i-1 oz. ... 884 *Also Cone., i.e.s 8 times strength, v. pp. 499, 500. Page 884 888 888 870 838 892 892 379 834 Name. Dose. Inf. Simarubae, 1 oz. ,, Symphiti, 1 to 2 ozs. » ,, Cone., 2 to 4 dr. ,, Tabaci . ,, Uvse Ursi, £ to 1 oz. „ * Valerianae, 1 in 40, £ to 1 oz. ,, Vincae Majoris, 5 oz. ,, Viola) Tricolor ... Inhalatio lodi Co. Inhalation Allii Sativ. Inhalations, Continual, 125, 378 : Oro-nasal ... ... 379, 549 Inhaler, Ammon. Chlor. ... 141 ,, Nasal Ozonie, Ozonic, Portable . 549 Yeo’s . 379 Injections, To sterilise ...V. II. INJECTIONS, HYPODERMIC Inj. Acid, Carbol., 5-20 m. ... 18 „ „ Chaulmoog. ‘ C ’ ... 609 „ „ Lactici (laryngeal) ... 49 ,, ,, Salieyl. (rectal) ... 59 ,, Adrenalin Co.972 Aluniinis, et c. Zinc (Vaginal) 134 344 154 156 157 162 357 166 168 177 178 Alypin c. Suprarenin Antimonii Oxidi, 15 to 30 m. ,, Ox. Fortior. Antimonii Pot. Tart. Caste! lani, £ to 1 Cc. Antinionii Sod. Tart. Apocodeinae, 30 m. Apomorph., 5 to 10 m. ... Argenti Nit (urethral) ... Arsen. Iodid., 6 m. Arsen, et Ferri, 1 Cc. ... Arsen, et Strych., 5 to 10 m. i 79 Arsen, et Strych. et Quin., 5 to 10 m.179 Atropina), 2 to 8 m. ... 208 Atrop. c. Strych. 205 Bismuthi intrav., 0-2 Gm. in 1 Cc. 222 Bismuthi Subnitratis ... 231 Brou ... .V. II. Cacodylate Co., av. 17 m. 183 Caffeinae Hyp., 1 to 6 m.... 247 Camph. Guaiacol & Iodine, 4 to 15 m. ... 445,514 Camphorae Hypod., 10 to 30 m.261 See also Sterules Hyp. ,, Hyp. Hither, 10 m. 261 C'ocainae Hyp. (5%), 5 to 10 m. (ZYP.T4), 339 ; Barts. ... . 338 Cocaine et Sod. Bic. (urethral) ... 128,340 Codeinae Phosph. Hyp., 1 gr. in 15 m. ... ... 356 Coninae HBr., 1 to 3 m. ... 374 Curare Hyp., 1 to 6 m. ... 851 *Also Cone., i.e., 8 times >> 55 55 55 * 5 55 5 5 55 55 55 5 5 55 55 55 55 55 55 5 5 55 55 55 55 5 5 55 5 5 55 55 55 Name. Dose. Page Inj. Curschmann’s, 15 m. ... 261 Durant’s. 445 Ergotse Hyp., B.P.’U, 5 to ^ 10 m.404 Ergotmse et Mornh., intram., 10 m.405 Ergotoxina), 2 to 15 m. ... 406 Eucain, Lact. (urethral) ... 343 Fibrocoumarin, 25 m. ... 829 Guaiacol (Durant) ... 445 Guaiacol c. Iodoform ... 445 Guaiacol c. Iodo et Camph., 4 to 15 m. ... 445,514 ,, Heiser’s .. ... 603 „ Homatropinae, 1 to 6 m.... 210 Hyd. Biniodidi (vaginal)... 465 Cyan., 2 to 10 m. ... 460 Intramusc., 10 m.... 454 ,,' Surg. Adams, 5 m. ... 455 Iodid., Pvagazzoni, 2 to 6 m. . 463 lod. Intrav. Spittel . 463 Lambkin, 10 m. ... 454 Oxycyanid. ... 460 Perchor. Intrav., Gt. Orm. Hosp., Ao gr- 472 Subchlor., 10 111. 455,475 Succinimidi, £ to Vo gr.... ... ... 476 Hyoscinae, 5 to 10 m. ... 492 Hyoscyaminae, 1/200 gr. inc. 496 lodi. Hyp. Fortiss, 3 to 5 m. ... 505 lodi, C L.T.E. (also Douche) 505 ,, Carbolisati (Uterine) 18 ,, Intravenous ... 505 lodi Guaiacol et Camph., 4 to 15 m. ... 445,514 lodoformi (bladder) ... 501 ,, c. Guaiacol. 445 lodolysin... 758 Lecithin, 1 Cc.531 Luminal-Sodium, £ to 3 gr. 816 Mannitol-Quinine ... 727 Menthol . 550 Mercurochrome Intrav. ... 480 Morphinae Acet., 1 to 3 111. 555 ,, et Atropinae, 1 to 3 111. 555 Morphinae Hyp., 5-10 m.... 558 Nitroglycerin, 1 to 4 m. ... 571 Novocain et Adrenalin ... 346 Nuclein, 15 m. ... ... 278 01. Chaulmoogr. 603 Physostigmin., 1 to 4 111.... 688 Picrotoxini, 3 to 6 m. ... 874 Pilocarpin Nit., 2 to 6 m.... 688 PI Limbi (vaginal) ... ... 700 Pot. Permang. (vaginal)... 546 ,, Permang. (urethrai) ... 546 Quin. HBr. Ac., £ to 1 Cc. 721 „ HC1. Ac. . 724 ,, c. Phenazone ... 725 >5 strength v. pp, 499, 500. OO 55 55 55 55 9 5 55 Name. Hose. Page Inj. Quin. Intrav., 4 to 15 gr. 724 ,, Ragazzoni, 2 to 6 m. ... 463 „ Sal-Alembroth, 10 m. ... 472 ,, Salinae et Gum Acac. ... 1 ,, Salvarsan, 192 ; c. Novocain 198 ,, Sodi Arsenitis et Ferri No. 1 and No. 2,1 Cc. ... 178 ,, Sodii Arsen, et Strych., 5 to 10 m. ... ... 179 ,, c. Quin., 5 to 10 m. ... 179 Sodii Cacodyl., 15 m. ... 182 (Hyp., Intrav. ; & ltectal) Sodii Chloridi ... 759 et seq. ,, Cinnamatis, 10% sol., 30 to 6O111. ... 828 ,, Coumaratis, 25 m. ... 829 ,, Morrhuat. (3%), \ to 4 Cc.613 ,, j» 5% for veins, k to 1 Cc. ... 614 ,, Nucleinat. 281 ,, ,, Salicyl., 15 to 30 m.... 63 ,, Strychnine, Arsen, lod. et Quin., up to 1 dr. ... 785 „ Strych. Hyp. (B.P.’l4), 5 to 10 m.785 „ „ Sulph., 1 to 6 m. ... 786 ,, Thecalis Anesthetic ... 351 ,, Thiosinamin et Phenazone, ,, 8 to 15 111.758 ,, Thiosinamin c. Sod. Salicyl., „ 15 to 30 111. ... ... 757 ., Zinc Chlor. (vaginal), 822 ; ,, Sulphatis (Vaginal) ... 826 Insect Bites ... 1030 Insect Flowers, Dalmatian ... 876 Insecticides, Horticultural, etc. 876 ,, Petroleum ... 655 See also Cresol Soap Soln., 27 ; ‘ N.C.1.,’567 : Therap. Index, Bites and Stings and Parasites, Animal. Instruments, to Sterilize, ...V. II. ,, Thymol Disinfectant 801 Insulllatio Bismuth, et Morph. 232 ,, Eucalypti Gum ... 854 ,, lodoformi&Comps... 502 ,, Menthol (A Comps.) 550 Orthoformi c.Resorcin 344 Paraformi ... ... 128 Suprarenal ... ... 967 Insulllator Drops ... ... 286 INSULIN, Manufre. ... 636, 637 ‘ A.B.’ ... 638,640 Aqueous Extrct. ... 639 Blood Sugar Estn. ...Vr. II. British ... 638, 640 Castor Oil Soln. ... 642 Chemical Composition. 638 Clinical Experience (Early) ... ... 642 Coma treatment of 637, 645 Contraindication ... 641 Control for Injections (F. C. Eve) .. 644 5 5 55 55 79 55 55 55 55 55 55 55 55 • y 55 55 55 55 5 5 55 NiMF. Dcse. Insulin Crystalline Danish Leo Diet . Distribution ... Excessive Dose from yeast, fish, etc. Glucose Equivalent G lucose per os or intra with ... Hyperglycaemia 637 Hypo. Injection Technique Inunction of ... in various atfns. Lilly . Oral Use Patent. Periodide Phosphotungstate Picric Acid Meth. Pituitary with Preservation Refs., general Standard Suitability of case Tablets... Therap. Subs. Act. Units ... Zymase ferments relation Insurance Scrips and D.D.A 996, 1001, 1007,1008 Intarvin lntegar Caps. Intemperance, see Inebriety & Therap. Index. Intensive Iodine Treatment ... lnternol . Intestinal Pills, etc. Intracardiac Injns. Intravenous Dose Table 55 5 5 55 55 55 5 5 55 55 Pag % 63*. | 63' fi 63*8 63*? 64 I 63“ £ 64 I 64 m 64: & V.II .. 64 , 85-| 50? 65J 68£ 971 1102 lntra-spinal Anaesthesia 342, 345, 351 Inula Helenium lnulase ... lnulin Invert Sugar I nvertase lnvigoroids lodoeosin lodargol lodatol ... lodeikon Iodeol, 1 Cc. lodermiol Ung. lodex, and with Meth. Sal. lodicin Iodides Estn. ... Iodine .504 ,, Albumen Comps. Colloid Sol. Color Limits ... Comps., Organic Dermatitis from Douche 86C ...V. II 750, 860 750 & V. II. V. II .55 55 55 55 & V. II. V. II 372 515 674 372 509 509 619 V. II. V. II. 516 366 V. II. 514 512 505 I FOR B.P. ’32 CHIEF CHANGES, See p. XXvi . 1155 3 f 3 3 3 3 3 3 33 3 3 33 33 53 Name. Dose. Page Iodine lor Livestock ... 709 & V. II. „ Deeding Expts. with 70Q v TT ,, Formalin Gut ... 533 and Goitre 709, 768, 913 in Acetone . 827 Air.V. II. ,, Benzene . 511 ,, Carbon Tetrachlor. 512 Dichlorethylene ... 289 Drinking Water 709 & V. II. „ Foods .Y. II. ,, Isopropyl Ale. ... 512 „ Soil Y. II. „ Spirit . 511 ,, Water (see also Water), 707,768,913 & Y. II. Intrav. Injn. 505 ‘ Nascent ’ Treatment 510 Numbers of Fats ...V. II. Organic Estimation ...Y. II. ,, Sterules (Skin) ... 511 lodine-Medol ... 516 Iodinol 10%, 30 to 45 gr. 514 & V. II. „ 25%, 30 to45 gr.514& V. II. „ 40% .515 & V. II. ,, c. Ext. Malti, 1 oz. ... 515 ,, Tablets . 515 Iodinosol ... ... ... 60 lodipin ...’ 516 Iodised Gut, 532 : Phenol and dil. injn. 18 : Salt 707 : Sweets ... ... ... 708 ‘ Iodised Tinct. of Guaiacol’, 1 dr. 447 Iodo-Acetone ... ... ... 827 ,. Caffeine, 2 to 10 gr. ... 248 ,, Calcium-Diuretin Tabs. t. d. p.c. ... ... 798 Casein . ... ... ... 516 Cinchophen . 318 Cyanin ... ... ... 316 Eosin and Fluorescein ... Y. II. Clyc. Sol. 1 in 50 ... ... 505 Phenol ... 21 Protein 10 to 15 gr. ... 516 ,, Tabs. 5 & 10 gr.... 516 Tannin Syrup, l to 2 dr.... 506 Theobromine, 2 tolO gr.... 798 lodolorm (A Praecip.) £ to 3 gr. 500 & V. II. ,, Aromat. ... ... 501 „ and Eucal. Bougies... 502 7, Dressings 501 et seq. Oil . ... 501 Paste. 502 Pencils ... ... 502 Petrolatum ... 502 Tampons ... ... 793 Yarnish ... ... 502 Iodol, 1 to 3 gr. . 503 lodolait, 1 oz. ... ... ... 516 lodolysin Caps., Inj., Sol., Pigment ... ... ... ... 758 3 3 33 33 33 33 33 33 3 3 33 33 3 3 33 3 3 33 33 33 33 33 33 Name. B>ose. Page lodo-pyrrol . 503 Iodo-Itay . 674 Assay . 674 Duodenal Tube Method 678 Dose. 675 For Cholecystography 674 Intravenous Use 675, 678 Intolerance ... ... 676 Oral Use ... ... 675 Deferences, Oral ... 676 ,, Intrav. ... 678 Single Dose ... ... 676 Slipules, 0'3 0’5 Gm. . 675 ,, Sodium content ... 674 ,, Stearettes, 0'3 & 0*5 Gm. . 675 ,, Technique. 675 ,, Toxicity . 675 ,, Uses 675 ,, X-Ray Pictures ... 676 Iodo-Salicin ... ... ... 75 lodostarin Tabs., 3 gr., 1 to 3 t.rf. ... ... ... ... ol6 Iodum. 504 & V. II. ,, Colloidal. 366 ,, Oleatum, 10% 506 Ionic Medication ... ...Y. II. lonone ... 892 Iontophoresis .... ... ...V. II. lopax .877 Ipecacuanha, 4 to 2 gr. exp., 15 to 30 gr. emetic ... ... 517 Ipomnea. Orizabensis etvar. 860, 861 Iridin, syn. Irisin, 1 to 3 gr. ... 861 Iris Florentina, Versicolor ... 861 Irish Moss . 848 „ Free State Poisons Schedule . 994 Iron Alum, 3 to 10 gr. 420 ,, Colloid . 366 Iron and Arsenic Drops, 5 drops (And Inj.) . 178 ,, Comps., Organic ... 415 ,, in conjunction with Copper ... 412, 420 ,, , Foods... .V. II. ,, Tannate Hair Dye (See also Ferrum).. ...V. II. Irradiated Ergosterol ... ... 593 ,, Fluorescein ... ... 672 ,, Foodstuffs ... ... 591 „ Milk. 591, 592 ,, Oils ... ... ...V. II. Irving’s Hefe-vitamin Tablet- ten ... ... ...278 A V. II. Isacen, 2 to 4 granules. 276 Isamine Blue ... ... ... 674 Isatin ... ... ... ...V. II. Isinglass and Preps. ... ... 860 ,, Japanese ... ... 860 Islands of Langerhans ... 638 Iso-amyl-amine... ... 409, 973 Iso-amylene ... ... ... 835 Isomeric Compounds.V. IL Name. Dose. Isomorphous Compounds Isopral . Isopropyl Alcohol „ Benzene ,, Iodine ... . „ Tinctures Spirits ... Isotonic Boric Acid Lotion Cocaine Lotion Quinine Injection Saline Solution Sugar. Solution Sod. Bic. Solution Isotopes Ispaghula, 15 to 150 gr. Istizin, 2 to 6 gr. Italian Glossary Ivy . Ixora, 30 to 45 grs. Izal; Caps., Fluid 119, 119, 59 5> Page .y. 11. . 291 . 118 . 532 512 120 120 11 ... 339 ... 725 ... 759 ... 750 ... 764 ...y. n. ... 861 ... 276 ...V. II. ... 858 ... 861 30 & V. II. Jabon, F. E. = Sapo Jaborandi, 5 to 60 gr. 687 & V ...V 487, ...y, !”v. Jacobson’s Soln. Jalapa, 5 to 20 gr., J a lapse. Resina 2 to 5 gr. Jalapin, Jalapurgin Jam preservatives Jamaica Dogwood James’s Fever Powder ,, Powder, 3 to 6 gr Japan Wax Japanese Isinglass JarabeJF.E.—Syrup) Brea ... Jasmine, Yellow Jateorhiza Calumba ... Jaundice, Epidemic 1064 <fc \ Jecovol ... ... ... ... Jelly Fish Stings . Jenner Centenary Celebrations Jennerisation ... Jcnner’s Stain ... ... ...\ Jensen’s Modif. Gram Method \ Jephson’s Powder, 60 gr. Jequiritol Serum, Jequirity ... Jerusalem Artichokes Jesuit Tea Jeyes Fluids Johne’s Disease Jonnesco’s Injections Jorrison’s Test ... ... ...A ‘ Joule ’ ... ... ... ...y 30 & V ...V. 347, .II. 310 861 861 861 H. 875 II. 161 n. 833 696 425 843 . II. 37 699 943 941 . II. . II. 790 827 751 249 II. II. 353 II. II. Joulie’s Phosphate . 771 Jubol Tablets — 833 Juglandin, 2 to 5 gr. ... 861 JugJane Jujubes, 434 ; see also Trocliisci « n > 862 Jumble Beads ... 827 Juniper Tar Oil . 696 Jungmann’s Tooth Pdr. 886 ■ Juniper Oommunis 862 ,, Sabina ... 880 Juniperus Virginiana. 846 Name. Dose. Page Jusquiame . ... 494 J ute )... ... .j. ... 439 Kaffir pox ... 946 Kahn Syph. Test ...V. II. Kakodyle ... 180 Kala/Azar 156, 160, 163, 1065 & V. II. Kaliurn Bromatum ... 703 „ Brometum ... 703 ,, Bromicum ... 703 ,, Jodatum ... ... 706 ,, Jodetum ... 706 ,, Jodicum. ... 706 Kallikrein ... 954 Kaladana ... 862 Kalmopyrin, 5-15 gr. ... 72 Kalzana Tablets ... 50 Kamala, 30 to 120 gr. ... 423 Kangaroo Tendon ... 533 Kaolin, I to 1 oz. ... 137 Kaolin, Colloidal ... 138 Kapok. 439, 662 Kaposi’s Ointment ... 565 Kaputine ...y. 11. Karox . ...V. II. Kasak, 1 to 2 dr. (children), adult 4 oz. ... 275 Kasena, 1 dr. (children), adult 2^ oz. ... ... ... 275 Kastanol, 832 ; Kat. ... 845 Katanga Radium • t-H HH Kataphoresis ; Kathions, Kathode ...V. II. Kauri Gum ... 862 Kavae Rhizoma... ... 862 Kaylcne and Kaylene-Ol ... 138 Kay’s Preps. ...V. II. Keating’s Lozenges ...V. II. Keene’s Cold Cure ...y. 11. Kefir, 5S3 ; Kelene ... 105 Kelp, 504 & V. II. Kelly’s Paint 360 Kepad ... 44 Kepliir ... 583 Kepler Malt and Oil .... ...y. 11. Keratin, 8 gr., and for Pills ... 689 Kermes Minerale ... 154 Kernel Oil ... ... 147 & V. II. Iverocain, 1/5 to 1 gr. ... ... 345 ,, with Adrenalin, Tabs. and Sols. ... 345 Kero! and Caps... 30, 526 & V. II. Kerosene ... 655 Ketone Group, etl'ect of ...y. 11. Kharophen 4 grains ... 186 Kharsivan ... 191 Khars ulphan ... ... 202 Khat ... ... ... ... 845 Kidney Extract ... 950 Kidney Tests .806 & V. II. Kieselguhr ... 139 Kiliani Test . ...V. II. Kineurine, 3 to 8 gr. ... ... 35 Kino, 5 to 20 gr. ... 862 ,, Eucalypti, 5 to 20 gr, . ... 853 Name. Dose. Page Kjeldahl Estimation ... ...V. II. Kleinenberg’s Stains ... ...V. 11. Knob Root ... 849 Knyvett Gordon Stain ...V. II. Koch’s Tuberculins ... ... 927 Koko ...V. II. Kola Nut, 10 to 20 gr. ... 248 Koleradraaber ... ... 376 Koller, Carl, on Cocaine ... 333 Kolynos Dental Cream ...V. II. Koot ... ... ... ... 850 Koppeschaar’s Sol. ...V. II. Koromex ... 722 Koronium Bromide ... 781 Kossam Seeds ... ... 842 Kotex Sanitary Pads ... ... 440 Koumiss... ... ... 583 & V. II. Kousso, \ to \ oz. • • • Krameria . ...’ 862 Kreatinin . .,.V. II. Kramer’s Method ...V. II. Kjapp Wurzel ... ... 880 Kiatom ... ... 862 Kreosote, 1 to 5 m. incr. ... 376 Soluble, up to 15 gr. 379 Kresapol . ... 30 Kresolum (and Liq.) ... 26 Kryogenin {vide Cryogenin) • . ♦ Krysolgan ... 214 Krystal Violet, c/. Gentian Violet .321& V. II. Kukui Oil ... 863 Kunth ... ... ... 850 Kurchi ... ... 527, 859 ,, Bismuth Iodid. 4 grs. ... 859 Kutli Koot ... 850 Labarraque’s Liquor ... 42 Labdanum ... 863 Labelling of Poisons Order ... 994 Laburnum ... 852 Lacarnol, 1 Cc. in tram., and given per os. ... ... 954 Lacca ... ... , .•. ... 884 Lacbnanth.es ' ... ... 863 Lacidac ... ... 580 Lacmoid... ...V. II. Lacquin ... ... 580 Lacrymal Secretion ... 759 Lactagol, 1 dr. ... ... 443 Lactalbumen ... ... ... 582 Lacteol ... ... ... ... 52 Lactic Acid Bacilli Cultures 52 & V. II. ; Liq., .52 ; Curdled Milk, 52 & V. II. ; Added to Milk, 49, 582 ; Local Use, 54; Suppos. Vaginal, 54, 722; Tablets ... .. 52 Lactobacilline ... ... ... 52 Lacto-Dextrin ... .... 585 Lactogen ... ... ... 579 Lactomaltine, 2 dr. ... ... 543 Lactophosphate de Calcium ... 51 Lactose ... ... ... 863 Lactuca, Lactucarium, 15 gr. k 496 Dose. Name. Ladanum Lsevo-glaucosan Lsevo-Scopolamine Lmvulose ,, Test, Liver Page . 863 . 973 . 492 ... 750 & V. II. Efficiency 317, 751 Lsevulosyls . ... 438 Lambert-Towns Method ... 625 Lambkin’s Injections, 10 m. 454, 475 Lamblia ... ... ...V. II. Lamellae ... ... ... 530 Atropine, 1-5000, 1-500, 1- 200, and 1-100 gr. 208, 530 fAtropine, 1-5000, and") 1-1000 L Cocaine, 1-200 fAtropine, 1-200 gr. \Cocaine, 1-100 gr. Cocaine(K.P. ’14) 1—50 gr. f Cocaine, 1-200 & 1-50 \ \Homatrop, 1-200 & 1-50 / Homatropine, 1-100 gr. (B.P. ’14) ... 211 530 Hyoscine, 1-50*0,1-20*0gr. ... * 492 Hyoscyamine, 1-5000 gr. ... 496 Phvsostigmine 1-1000 gr. ' (B.P. ’14), ... 530, 686 Pilocarpine, 1-500 gr. ... 688 Scopolamine 1-500,1-200 gr. 492; Zinc Sulph., 1-250 gr. ... 826 } |208 ... 208 339, 530 211 Lamels, Ophthalmic Gelatin Laminaria Extraction, V. II Tents ... Lamplough’s Saline Lanai Adeps Lancet C.A. Coeltt. Lancets, Vaccination Landsteiner’s Law Langdale’s Preps. Langdon Brown’s Mixture, 1 Lange’s Gold Test Langerhan’s Islets Lanolin and Anhydrous, 93,94 Cream, 94 ; Ointment Lanolinum Hydrargyri Lanthanum .. Lapis Calamin. Pncp., ,, Divinus ... Larkspur Lappa, 863 ; Larch Bark Lard ... ... ... Larix ... Lassar’s Paste. Lasiosiphon ... ... Lathvrus Laudanosine Laudanum, 5 to 30 m. 824 Sydenham’s 5 to 20 m Laughing Gas Lauri Fruct., Oleum ... Laurocerasi Eolia Lavandula Laverain Tabs., 5 or 6 p.d. Laveran’s Staining Method Laville’s Gout Cure z. . 530j ! 863; .V. LL . 98 .V. II. . 941 . 987 .V. II. 1046 .V. II. . 638 .V, 94 457 II. V 388 887 694 832 694 824 863 863 II. 627 627 . 141 . 863 . 117 .V. II. . 737 .V. II. .V. II. Name. Lawsonia Laxoin 2 to Dose. 5 gr. Page 859 671 654 Lead Absorption, Test for ...V. II. 99 and Lead Selenium pounds in Cancer 368 & V. II. 99 Colloidal ... 366 9 9 Guaiacolate ... 700 99 lodid Coll. ... 368 99 Paint Regulations ...V. II. 99 Phosph. Coll. ... 368 99 Poisoning 698 & V. II. 99 Salts as Antiseptic ...V. 11. 9 9 Selenide ... 368 & V. 11. 9 9 Tetra Ethyl, 656 ; in Cancer ... ...V. II. League of Nations re Cocaine, Opium, etc. ... 342,623,624 Lebertran ... 611 Lecanora .V. II. Lecithin, 3-5 gr. (Powder, 10 to 15 gr., 532) ... 531 &V. II. Leeches, 950; Leek ... ... 835 Leech Ext.950 Leek, House ... 883 Le Lilliatre’s Cocaine Anaesth.... 337 Lefroy’s Crude Oil Emulsion 655 Legal’s Test ... ... ...V. II. Leishmania Infns. Antimony in 155, 160, 1065 & V. II. Leishman-Donovan Bodies ...V. II. Leishman’s Stain ... ...V. II. Leistikow’s Bougies . 172 Lemco Meat Wine ... ...V. II. Lemon Grass, 872 ; Juice, 588 ; Syrup ... S64 Lenigallol, 58 ; Lenirobin ... 292 Lenitive Electuary . 883 Lentine ... ... ... ... 306 Leprosy, Bacillus ... 608&V. II. ,, Chaulmoogra in ... 601 ,, Diagnostic Tests ... 608 ,, Etiology, Diagnosis ...V. II. ,, Manila Congress ... 608 ,, Recent Clinical Work with... ... 604, ,, Relief Assn. Brit. Emp. Rept. A self-healing disease Vaccine Treatment ... See also Therap. Ind. Leptandrin, II to 2 gr. Leptospira, V. II.; in Water, \ L.E.S. Medium ... Leucadol Leucin ; Leucite Leucocytosis Levick’s Steam Spray Levigations Levisticum Officinale Levorenine Levulose Liver Test ... Levulosyl Levy-Bing Lafay Syringe 99 605 608 608 609 863 . II. ...V. II. ... 843 ...V. II. ...V. II. 826, 907 ... 804 ... 863 ... 968 II. 751 438 455 750 & V 31' Name. Dose. Page Libanol ... ... ... 846 Lice, to Kill ... 1073, 1074 Lichenoids, 1 or more ... 847 Lichens ... ... ... ..A r. IT. Licorice ... 857 9 9 Indian. 827 Ligatures var. ... 532 Light Green 325 Light Treatment ... ...\ r. II. Lightning Stroke 1101 Lignum Rhodii 872 Ligroin ... Lilac Artificial = Terpineol 656 Lily of the Valley 850 Lime Salts, Therapy ... 250 ct seq. Limnatis 950 Limonade Purgative ; Roge ... 537 Limonene, 10 to 20 m. 863 Limonis Syr. 864 Linct. Ammon. Brom., 1 to 2 dr. 140 99 Apomorphinae c. Codeina 1 dr JL vll • ••• ••• ••• 166 y y Bart’s 1 dr. 626 99 Camph. Co., 1 dr. 626 9 y Codeinae, 1 to 2 dr. 357 99 Diamorph., 1 to 2 dr. ... 560 9 9 Expectorans, 4-1 dr. Gee’s, 1 dr. 154 y y 626 y y Heroin, 1 to 2 dr. 560 y y Mentholis, 1 dr. ... 550 y 9 Morph., 1 dr. 556 y 9 Morph. Co. N.II.I. 1 dr_ 556 y 9 Morph. Hydrocyan, 1 dr. 556 y y Opiatus, 1 dr. 626 y y Pini Terp. Heroin, 1 dr. 694 y y Scillae, 1 dr. (and Co.) ... 626 y 9 ,, Opiatus, 1 dr. 626 y y Terp. Pini et Heroin, 1 dr. Thymi et Diaphorm, 1 dr. 694 9 9 890 9 9 Tolu c. Opio, 1 dr. 626 Lindenbl fit hen 500 Liniment, A.B.C. 92 Linim. Aconiti and Co. 92 y y Aconiti et Chlorof. 92 y 9 Airuginis ... 382 y y Album, 693 ; Ammoniae 143 9 y Atiopinae ... * ... 209 y 5 et Chlorof. . 209 y y Belladonnae 219 y y ,, iEthereum 221 v* 9 y Bcllad. c. Chlorof. 219 y y Betuiae Co. 67 y y Boeckii ... 700 y y Calaminae et Co.... 824 , 825 y y Caleis 257 99 Camphorae 261 y y ,, Ammon. 260 y y Cantharidis Co. ... 266 y y Capsid (and Dx.) 270 y y Carron 257 y y Chloral Co. 280 y y Chloroformi . 286 y y Crinale 265 y y Crctonis ... 872 99 Hydrargyri . 456 Name. Dose. Page Linim. Hydrargyri Oleat. c. Morph. ,, Iodi, syn. Tinct. 599 Iodi Fortis ... ... 507 „ Jaborandi ... 688 ,, Long’s . ... 693 ,, Menthol (& Co.) ... ... 550 ,, Methyl Aspriodine 80 ,, Meth. Salicyl 67 ,, Myristicse. ... 868 ,, Opii ... 626 ,, Picis . ... 697 ,, Potass. Iod. c. Sap. ... 710 ,, Ravogli. 18 ,, St. John Long ... ... 693 ,, Salicyl (Methyl) ... 67 ,, Saponis ... ,, Sinapis ... ,, Stokes’ ... 754 ... 756 ... 693 ,, Succini Co. ... 888 ,, Terebinth. ... 693 ,, ,, Acet. ... 693 ,, Zinci Spissum ... 823 Linseed and Oil ... 864 Linteum Ac. Carbol, 5% 17 Linteum Stypticum ... 413 Lintner Value. ... 541 Lints . ... 440 Linum Usitat. ... ... 864 Lipase (Lipolytic Ferment) 431,633, 755, 756 & V. II. Lipiodol ... 515 Lipoids ... 532 & V. II. Lipoiodine ... 517 Liqueur de Labarraque 42 Liquid Air ... 632 Liq. Acid. Chromici ... 827 ,, ,, Chrom.-Aceto-Osmici 831 ,, ,, Hypochlorosi Comp. (Eusol) ... 42 ,, ,, Osmici, 2-10 m ... 831 „ „ Salicyl. 59 ,, Adrenalini Hydrochloricus, 10 to 30 m. ... 969 ,, Aikalinus, Brandish ... 702 ,, Aluminii Acetici ... ... 135 ,, ,, Aceto-Tart. ... 138 ,, ,, Chloridi ... 136 Aluminii Formatis ... 136 >> yy yy yy yy yy yy yy yy yy Ammonia), 10 to 20 m. ... 143 ,, Domest. ... ... 144 Ammon. Fort., 3-6 m. ... 144 ,, Acet., 2 to 6 dr. ... 145 „ „ Fort., '85, 25-75 m. 145 Ammon. Anisat. ... ... 857 Aromat. ... 146 Cit., 2 to 6 dr. ... 145 ,, ,, Fort., ’85, £-l£ dr. 145 Ammon. Tart. ... ... 146 Antihystericus, £-1 dr. ... 838 Antim. Chlor. ... ...V. II. Antirheumatic, 30 m. ... 358 Antisepticus, 1 dr. ... 10 Argenti Nitratis ... 169 Arsenicalis, 2 to 8 m. ... 175 yy yy Name. Dose. Page Liq. Arsenicalis, Neutralis N.Z. Form. ... . 175 ,, Arsenici Bromatus, 1 to 5 m. 176 ,, ,, HCL, 2-8 m. ... 175 ,, Arsen, et Hyd. lodidi, 5 to 20 m.177 ,, Atrophue Salicyl ... 207 ,, ,, Sulph., 1%, £ to 1 m. 208 ,, Auri Ars. Brom., 5 to 10 m. 211 ,, ,, Hyd. Brom., 5 to 10 m. 211 ,, Battley, 5 to 10 m. ... 626 ,, Berberidis Cone., 4 to 1 dr. 841 ,, Bismuth. Amnion. Cit., 30- 60 m. ... ... ... 225 ,, Bismuthi Cone., 15 to 30 m. 226 ,, Bismuth. Sed., 1 dr. ... 226 ,, ,, Tartratis, £ to 1 dr.... 235 „ Bituminis ... ... 297 ,, Bromi ... ... ...V. II. ,, ,, Arsenitis, 1 to 5 m. ... 176 ., Bromo-Chloral Co., 1 to 2 dr. . 280 ,, Calcii Chloridi, 15 to 45 m. 255 ,, Calcis, 1 to 4 oz. ... ... 257 I ,, ,, Chlorinat. 41 ,, „ Lactat., £ to 2 oz. ... 50 ,, ,, Lactoph. ... ... 51 ,, ,, Sacch., 15 to 60 m. ... 256 ,, ,, Sulphurat ... ... 259 ,, Calumbse Cone., £ to 1 dr. (B.P. ’98). ,, Caoutchouc . 267 ,, Carbonis Deterg. 296 & V. II. ,, Carmini, 40 gr., 1 oz. ... 844 ,, Carnis ... ... ... 576 ,, Caulophylli et Pulsatillse, 1 to 2 dr. ... ... ... 846 ,, Chiratae Cone., 1 in 2, £ to 1 dr. (B.P. ’98). ,, Chloromorph., 5-15 m. ... 286 ,, Cocci ... ... ... 844 ,, CocainaeHCl. (Inj.), 5-10 m. 339 ,, Cceruleus ... ... ... 469 ,, Copaibae, £ to 1 dr. ... 621 ,, ,, c. Buchu et Cubeba, 1 to 2 dr. ... 621 ,, Copaiba et Buchu et Cubebse c. Santal, 1 to 2 dr. ... ... ... 620 ,, Cresol Sap. ... 27 & V. II. „ „ Co. U.S.X. 27 ,, Creosoti, av. 2 dr. ... 377 ,, Cuspariae Cone., 1 in 2, £ to 1 dr. (B.P. ’98). ,, Digitalis ad usum intern., max. 45 m. ... ... 389 ,, Digitalis pro Inj.,max.5 Cc. 389 ,, Donovani, 5-2u m. ... 177 ,, Fastoni pro Syrup, 418; ditto sine Ferro ... 419 ,, Epinephrin, 0‘5 Cc. ... 969 ,, Epispasticus ... ... 266 ,, Ergotse Ammon., 10-80 m. 405 ,, Etiiyl Nitritis, 15 to 60 in. 104 Name. Dose. Page Liq. Euonym n et Cascara, 4 to 1 dr.410 „ ,, etlridin, ito 1 dr. ... 410 „ ,, et Pepsini, £ to 1 dr.... 410 ,, Ferri Acet., 5-15 m. ... 416 ,, ,, Albnmiiiati, 1 to 4 dr. 415 „ „ Chlorid. U.S., 1£ m. ... 413 ,, „ et Ammon. Acet., 4 dr. 416 ,, „ Dialysat., 10 to 30 m. 414 „ ,, Hypoph. Fort., 10 to 30 m. . 683 ,, ,, Iodidi, 4 to 8 m. ... 417 ,, „ Pept. (c. Quin., 415), 1 to 4 dr. ... ... 415 ,, „ Perchlor, 5-15 m. ... 414 ,, ,, ,, Fortis, 1 to 4 m. 413 ,, ,, Pernit., 5-15 m. ... 415 ,, ,, Persulph.420 ,, ,, pro. Syr. Easton ... 418 ,, ,, Sesquiehlor. ... 414 ,, ,, Subsulphat., 3 to 6 m. 420 ,, ,, Tersulphat. ... ... 420 .,, Ferro-Mang.Pept. c. H®mo- globin, 1 to 4 dr. ... 416 ,, Flavus . 16 ,, Fluoresceinae ... ... 673 ,, Foimaldehydi (& Sap.) 122, 126 ,, Fowleri, 2 to 8 m. ... 175 „ Gelatin Sterilisat.... ... 424 „ Glonoin, 4 to 2 m. ... 571 ,, Gutta Percha . 292 ,, Hamamelidis, \ to 3 dr. ... 447, 448 ,, Helalin c. Pepsin et c. Cascara, 1 dr. ... ... 849 ,, Hoffmann ... ... ... 104 ,, Hyd. Nitiatis Acid (B.P. ’14). ... 466 ,, ,, Perchlor.,(B.P.’l 4), I- 1 dr. ... ... 468 33 33 33 3 3 33 33 33 33 33 33 ,, ,, Acid caution only for disinfecting 470 Hydrarg. Antiseptic ... 470 Hydrogenii Pcrox., 4 to 2 dr. ... ...488 A V. II. Hyoscin® HBr., 3 to 15 m. 492 Hypophysis, 1 to 1 Cc. ... 958 lodi Co., TJ.S. ... ... 506 „ (B.P. ’85, 506), Fortis 507 ,, Simplex (P. Off.) ... 508 Iodo Ferro Mang. Pept., 1 to 4 dr. ... ... 416 Jaborandi, 5 to 15 m. ... 688 Kramcri® Cone., £ to 1 dr. (B.P. ’98). — Mag. Bicarb., 1 to 2 oz. ... 536 ,, Cit:, ay. 12 oz. (div.)... 537 Morphin® Acet.,10 to 60 m. 555 ,, Bimec, 1'45%, 5 to 40 m. 557 „ HC1., 1%, 10-60 m. 556 „ Tart., 1%, 10-60 m.... 558 Natrii Silicici ... ...V. II. Nitroglycerini, \~2 m. ... 571 Opii Sedativus, 5-10 m. ... 626 Name. Dose. Page Liq. Pancreatis, 1 to 2 dr. ... 634 „ Pancreaticus, 1-2 dr. ... 634 ,, Papain et Iridin, 2 to 4 dr. 648 „ Pectoralis, 1 dr. 857 „ Pectoral Benzoic ... 857 ,, Pepsini et Caff., 2 to 4 dr. 659 ,, Pepticus, 1 to 2 dr. ... 659 ,, Picis Carbonis, 296 ; Ligni 296 ,, Picrotoxini, 2 to 12 m. ... 874 ,, Pituitarii, 4 to 1 Cc. ■ ... 958 ,, Plumbi Lactat. ... ... 699 ,, Plumbi Subacet., Dil., Fortis 699 ,, Potass®, 10 to 30 m. ... 702 ,, Potass. Arsenat. et Bromid., 1 to 5 m. ... ... 176 ,, Potass. Arsenit., 2-8 m. ... 175 „ Potassii Permang., 2-4 dr. —■ ,, pro Spirit. Amm. Arom. ... 146 „ pro Syr. Eastoni ... ... 418 ,, Protargol ... ... ... 171 ,, Quassi® Cone., 4-1 dr. ... 877 ,, Bhei Cone., 4 to 1 dr. (B.P. „ „ 9 Dulc., l*to 3 dr. 395 ,, Bos® Dulcis ... ... 872 ,, Santali c. Buchu et Cubeba, 1 to 2 dr. ... 620 ,, ,, Co., 1 to.2 dr. ... 620 ,, Sars® Co. Cone., 2-8 dr. ... 881 ,, Sedans, 4 to 1 dr.... ... 487 ,, Seneg® Cone., 4-1 dr. ... 883 ,, Senn® Cone., 4-1 dr. ... —• ,, Senn® Dulcis, 1-3 dr. ... 884 ,, Seriparus ... ... ... 657 ,, Sodii Arsenatis, 2-8 m. ... 179 ,, ,, Carb. for instruments 765 ,, Sod® Chlorinat., 10 to 20 m. 42 „ ,, Chirurg. U.S.X. ... 45 ,, ,, Carbolatis ... ... 18 ,, ,, Ethylatis ... ... 767 ,, ,, Hydroxidi, U.S., 5% ; P.G.V., 15% ... — ,, ,, Hypobrom. ... ...V. II. ,, ,, Methylat. ... ... 767 ,, Stillingi® Co., 1 dr. ... 887 „ Strych. HC1., 2-8 m. 784 & V. II. ,, Testicularis, 15-30 m. ... 974 ,, Thymol, 1 in 800 ... 801 ,, Thyroidei, 5 to 15 m. ... 979 ,, j, Assay ... ...V. II. ,, Tolu pro Syrup ... ... 840 ,, Trinitrini, 4 to 2 m. ... 571 ,, Viol® Glucosidi, 4 oz. ... 892 ,, Zinci Chloridi ... ... 822 5) VU1VI1UA ••• * * * Liquores Concentrati. (See De- cocta and Infusa cone). ... Liquorice, 857 & V. II. ; Compound Powder of, 60 to 120 gr., 857 ; Liquorice (Indian) 827 Lisbon Wine ... ... ... 115 Listerine Antiseptic, 1 to 2 dr.... 10 Lister, Links with . 462 ,, centenary . 462 Lister’s Antiseptic ... 461,1094 ,, Carb. Bdges. 17 33 33 Name. Dose. Page Lister’s Birthplace ... ... 462 „ Cyanide Dressings 461 et seq. ,, Ward at Glasgow pulled down.462 Litharge . 700 “ Lithiated Sorghum Co.” ... 885 Lithii A ceto-Salicyl, 5 to 15 gr. 73 ,, Benzoas, 2 to 10 gr. ... 534 „ Borate.V. II. Bromid., 5-15 gr. ... 534 Carb., 2 to 5 gr. ... 534 Citras, 5 to 10 gr., 534 ; Effervesc. (and Lax.) 1-2 dr. . Formas, 1 to 5 gr. Guaiacas, 2 to 5 gr. Hippuras, 5 gr. incr. ... ,, Eff., 1 dr. Iodidum, 1 to 5 gr. Phenyl-cinchoninate ... Quinas, 5 to 15 gr. ,, Salicylas for Varicose Veins. . ,, Eff., 1 to 2 dr., 535, 5-20 gr. ,, Sulphas, 5 to 10 gr. „ Sulpho-Ichthyolas, 10 to 30 gr. daily ,, Tart. Acid., 5-20 gr. ... Lithion, \ to 1 dr. Lithium Litmopyrin 5 to 15 gr.... 33 33 5 i 3 3 33 534 32 534 534 534 535 318 719 65,66 535 535 497 535 535 534 73 Name. Dose. Lopion ‘ Lords and Ladies ’ Lore tin >.. Lotio Acid. Acetici ,, ,, Benzoic 33 33 3) 33 33 33 33 33 33 33 33 33 33 33 37 33 33 33 33 33 3 3 33 33 3 > 33 3 3 33 33 33 33 33 Borici, 4% ,, c. Zinc Sulph Carbolici (et c. Co- caina) .. 16 Citrici et Phenolis 26 Hydrocyan. c. Sodio 41 Picric, 1% ... 56 Salicyl. c. Borace ... 59 Tannic Sulph. ... 89 iEtheris Composita ... 104 Alba McKenna. 826 Ammonii Chloridi ... 141 ,, et Cantharidin ... 266 Balsami Peruvian ... 840 Bismuthi 232 Boeck ... 700 Calaminae et Oleosa ... 825 Calcii Sulphurat. ... 259 Calcii Iodat.830 Capillaris 746 Crinalis. 280 Evaporans ... 118, 141 Excitans ... 746 Hyd. Acetica, 469 ; Binio- didi, 465 ; Flava 468 ; Nigra, 475 ; Perchlor 469 : c. Acid. Carbol Page 215 838 319 4 7 11 11 Litmus Paper and Sol. ...V. II. 469 ; c. 01. Tereb. • • • 469 Liver Abscess.521 & V. II. 33 Hyd. Oxycy. R.O.H. • • • 461 ,, Diet ... ... ... 951 33 ,, Zinc. Cy. ... • • • 462 ,, Desicc., 5 gr. incr. ... 951 3 3 Krameriae Co. • • • 7 ,, Extract, -home made ... 952 33 Paraffini Co. • • • 655 ,, Intrav. use ... 952 33 Parasiticida • • • 469 ,, Pernicious Anaemia ttcL. 951 33 Picis Carb. Aik. et Arom. 296 ,, „ Cone. El. Ext. 33 Pilocarpinae (hair) • • • 688 1 oz, = 1 lb. Liver 951 33 Plumbi Detergens • • • 296 ,, „ Pdred. Ext. 2 tubes 951 33 ,, Evaporans... • • • 700 ,, Fluke 273, 423 33 „ et Opii • • • 700 ,, Function Test. ... ...V. II. 33 ,, Lact. ... • • • 699 ,, of Sulphur ... 702 33 ,, Spirituosa ... • • • 700 Tests ... ...751&V. II. 3 3 ,, Talc, et Amyli • • • 700 ,, ,, VandenBergh ...V. II. 33 Pot. Thymatis ... • • • 801 Lloyd, V. E., on Syphilis— 33 pro Acne 825, 878 L. June 30/28, 1320. 33 pro Capite • • • 887 Lloyd’s Reagent ...V. II. 33 pro Manibus • • • 434 Lobelia and Lobeline ... ... 535 33 Proflavine • • • 304 Lobeline HC1., 1/3 gr. ... ... 536 33 Quassiae ... • • • 877 ,, Sulph. Tabs., A gr. ... 536 33 Quininae HC1. • • ♦ 722 Locke’s Solutions ... 759 33 Resorcini (and Co.) • • • 746 Lockyer’s Hair Restorer ...V. II. 3 3 ,, et Ac. Borici • 0 • 746 Loeock’s Wafers ...V. II. 33 „ et Acid Salicyl • • % 746 Locust Bean ... 864 33 ,, Pilocarp. et Canth. 746 Loeffier’sMeth. Blue and Serum V. II. 33 Rubra • • • 826 ,, Pigment (Diph.) ... 413 33 Salox • • • 489 Loew’s Theory ... ...V. II. 33 Sod. Hyposulph. • • • 87 Loewi’s Test ...V. II. 33 Staphisag. • • • 887 Logwood ... 858 33 Sulphatum • • • 826 London Paste ... 702 33 Sulph. et c. Sapone • • • 791 Longevity . ... 150 33 ,, Co. ... ... • • • 791 Lonicera var. ... ... 864 33 Zinci Chloridi • • • 822 Name. Dose. Page Lotio Zinci Sulphatis. 826 Lotion Ammoniacale Camphree 260 Lovage.863 Lowndes Cream ; vide Cremor Lozenges, Bases for, 804 ; See also Troehisei Lubeck Disaster ... ... 934 Lubricant Glyc. Jelly ... 433 Lubricant Surgical . 17 Lubricating Oils . 655 Luctin.864 Luetin Skin test for Syph,, Edn. XVIII. Lugol’s Solution = Liq. Iodi, ’85, 6 to 10 m. . 506 Lumbar Anaesthesia ... 337,351 Lumbricus, 752 and Theiap. Index 1093 Luminal, l1, to 5 gr. ... 815 & V. II. ,, Tablets, i, £, 1 and 1| gr. ... 816 ,, Sodium, i to 3 gr. ... 816 ,, Tablets, 1 gr. ... ... 816 ,, in Epilepsy ... 816 Luminous Paints ...V. II. Lunar Caustic 168 ; Mitigated, Toughened ... 169 Lund’s Oil 17 Lupulin (Lupulus, 2 to 5 gr.) ... 864 Lycoperdon Gig. ... 864 Lycopodium ... 865 Lycryl, 30 ; Lyddite ... ...V. 11. Lymph. Calf, Glycerinated ... 940 ,, Encephalitis following 944, 945 Lymphatic Gland Tabs., 5 gr. 953 Lysidine ... 454 Lysoform ...V. II. Lysol 27,28,30 ; Assay ...V. II. ,, Martindale 29 Lysozome ... 1073 Lytta, A gr. ... 264 M.L.D. =Minimum Lethal Dose of Digitalis Tincture... 390, 391 Ma Huang McConkcy’s Broth, etc. ... 397 ...V. II. Mac Crorie’s Stains ...V. II. McDade’s Succus, 1 dr. ... 887 McDonagli’s Preps. ... 315 MacLean’s Pdr. 4 to 2 dr. ... 224 Mache Unit ...V. II. Mackintosh Paste ... 755 ,, Sheeting ... ... 268 Mackenzie S. on Cancer and T.B. 753, 755 Mackenzie’s Cure, V. II. ; Eye- wash ... ... 470 Maclagan’s Test ...V. II. Maclean’s Blood, Exn. ...V. 11. Madeira ... ...V. 11. Madame Rachel ...V. II. Madder ... ... 880 Magenta, ^ to 4 gr., 320 ; Acid V. II. Magisal, 5 to 15 gr. ... 74 & V. II. Name. Dose. Page Magisterium Bismuthi ... 230 Magnesia Cream, 1 to 4 dr. ... 538 „ Mixture .V. II. Magnesia Levis and Pond., 30 to 60 gr., 5 to 20 gr. rep. ...536 Mag. Acetyl-Salicyl, 5 to 15 gr. 74 & V. II. „ Benzoas, 5 to 15 gr. ... 8 ,, Borocit, 15 to 30 gr. ... 12 ,, Bromid., 10 to 20 gr. ... 239 ,, Cacodylas, | gr. 181 ,, Carb. Levis., Pond., 30 to 60; 5 to 20 gr. rep. ... 536 ,, Chaulmoograte. 605 ,, Chloras. 537 ,, Chloridum, 30 gr. or more 537 ,, Citras ATer., 30 to 120 gr. ,, Formas, 3 to 10 gr. ... 32 ,, Glyceroph., 3-10 gr. 34 & V. II. ,, Hydrox., 5 to 120 gr. ... 537 ,, Hydrox., c. Carbone, 1 to 2 dr.537 ,, Hypochlorite . 45 ,, Hypoplios., 3-10 gr. ... 683 „ Hyposulphis, 0-5 Gm. per os., also 10 Cc., 10% intram. 86 ,, Lactas, 15 to 60 gr. ... 538 ,, Oleas . 601 ,, Peroxid., 15 to 60 gr. ... 490 ,, Phenyl Cinchoninate ... 317 „ Pliosphas Tribasic 15 to 75 grains. 538 ,, Pyrophosphas .V. II. ,, Ricinoleas, 1 to 4 dr. ... 619 „ Salicyl, 10 to 30 gr. ... 61 ,, Silicas . 139 ,, Sulphas, }-£ oz. ; 30-90 gr. rep. ...538&V. II. ,, ,, Injections 101, 102, 539 ,, Sulphas EfL, %-l oz. ; 60- 180 gr. rep.540 ,, Sulphas Exsicc. 540 ,, Sulphate Cream. 540 ,, Sulphis, 10 to 30 gr. ... 86 ,, Thiosulph. 0-5 Gm. per os. ; also 10 Cc. 10% intram. 86 Magnesium . 536 & V. II. Maidenhair . 843 Maidis Stigmata, 865 ; Ustil- lago, 865 ; Maize Ergot, 865 ; Oil ... ... ... ... 615 Maize Starch, 836 ; Oil 590 & V. II. Malachite Green ... 323 & V. II. ,, ,, Sublimate ... 471 Malarene .V. II. Malaria, v. Ther. Ind., 1067 ; Etiology, V. II. ; General Befs., 743 ; in England, Measures against . 742 ,, Inter-Health Board on 738 ,, Plasmochin in ... 744 Name. Dose. Page Malaria, Prevention of 742, 744, 745 ,, Prophylaxis 742, 744, 745 ,, Quinidine and Cinchoni- dine in 713 et seq. ,, Relapses ... ... 741 ,, Sir R. Ross on. 737 ,, Ross Inst. Repts. ... 743 ,, Treatment of Paralysis 1073 ,, Types and Parasites ...V. II. „ ,, Staining Methods V. II. See also Quinine and Salts Male Fern {& Caps.) ... ... 421 Malignant disease, Radium in...V. II. Malignant (Edema ... ...V. II. Malignant Purpuric Fever ... 904 Malignant Pustule ... 902 &, V. II. Mallein ... ... ... ...V. II. Mallophene 1£ grs. ... ... 308 Mallotus ... ... ... 423 Malonal, Malonurea, 5 to 10 grs. 806 & Y. II. Malonyl-Arsanilic Comp3. ... 191 Malt, 540 ; Assay of.V. II. Incompats. with ... 541 Extract, 1 to 4 dr. ... 541 ,, Liq., 1 to 4 dr. ... 542 and Cascara, 1 to 4 dr.... 542 ,, Hsemogiobin, 1 to 4 dr.542 ,, Hypophosph. (and with Oil), 1 to 4 dr. 542 Malta Fever ... .Y. II. Maltaffin and combinations, 1 to yy y y yy yy 615, dr. Malted Foods. Malted Glyceroph., 1 to 4 dr. Maltine and Preps., 1 to 4 dr Maltoferrose, 1 to 4 dr. Maltolivine, 2 to 4 dr. Malva ... ... Mammary Gland Manaca Mandelin’s Reagent Mandioca Mandl’s Pigment Mandragora Mandrake, 865 ; American ,, English = Bryonia dioica, q.v. Manganese Colloidal ... Mangan. Brom., 1 to 3 gr. Butyrat Cliloridum. . Citras, 3 to 5 gr.... • • Ferro Phosph., 3 to 10 gr Glyceroph., 1 to 5 gr. .. Hypoph., 1-10 gr. Ox. Prsecip., 3-10 gr. .. Phosph., 1 to 5 gr. ,, Sulph., 2 to 10 gr. .. Manganese Thyroid Treatment Manihot Manilla Grain Manioca 542 580 36 542 542 616 500 .. 953 865 ..Y. II. .. 836 .. 506 .. 865 .. 701 yy yy yy yy yy y y yy yy 369 239 544 544 545 545 34 545 545 545 545 547 836 837 836 Name. Dose. Page Manna, 1 dr. to 1 oz. ... 865 & V. II. Mannitol (Syn. Mannite) ... 865 ,, Nitrate Tabs., 1 gr. • • • 409 & Y. II. ,, Quinine, 1 to 2 Cc. hyp. (?) . 129, 727 Manson’sStain ... ...V. II. Mantoux Test. ... 936 Manures, Artificial ...V. II. Maran = Bals. Copaibse —• Maranta 804, 865 Margarine ...Y. II. ,, Vitamins in ... ...V. II. Margosa Seeds ... 839 Mariahuana ... 263 Maricol, 1 to 4 dr. ... 619 Marienbad Salt & Tabs., 60 gr. 773 ,, Tab. (vegetable) ... 134 ,, Antiobesity Tabs. ... 773 Marigold = Calendula ... ... 843 Marjoram. ... 873 Markets, Drug, Ldn.—C.D. June 30/28,851. Marmite ... ... 277 &-V II. Marras A., on Chaulmoogra ... 605 Marris’ Atropine Test ... ...V. II. Marron d’lnde ... 819, 832 Marrow, Glyc. Ext. ... ... 948 Marrubin, 1 to 2 dr. ... ... 948 „ Compounds ... ... 948 Marrubium, av. 30 gr. ... 865 Marsh Mallow, 500, 835 ; Pastils, 434; Marsh’s Test ... ...Y. II. Marshall’s Lysol . 28 Marylebone Cream ... ... 595 Massicot ... ... ... 700 Mastiche Test for Syphilis ...V. II. Mastich, 865 ; Leaf Oil ... 866 Mastisol ... ... ... 866 Matches ... ... ••• 080 Mate ... ... ••• ••• 249 Matricaria Chamomilla ... 837 Maubeere, 880 ; Mauve (Malva) 500 Mauveine HC1. ... ... ... 461 May Apple ... ... ... 701 May Weed ... ... ... 837 May-Grunwald Stain.V. II. Mayer’s Phenolphthalin Test ...V. II. Mayer’s Reagent & Stains ...Y. II. McCrorie’s Stains .V. II. McKenna’s Lotion . 826 Meadow Saffron . 357 Mead’s Maltose ... ... 543 Measles. 088, 1068 Measles, Convalescent Serum ... 1088 Meat Extracts, 575 et seq. ; Juice 575, 576 Formalin Detection ...V. II. Mechoacan ... ... ... 861 Meconine ... ... ...V. II. Meconin-Morphine-Narcotine... 563 Medellin Disaster . 911 Medicated Dressings . 441 „ Soaps . 754 Wines .V. II. Name. Dose. Page Medicine Stamp Acts ... ,..V. II. ,, Concession .V. II. Medinal, 5 to 10 gr. ... 809 & V. II. Mediterranean Fever .V. II. Medullary Glyceride, 1-2 dr. ... 948 Meglin’s Pill ... ... 496 Melaleuca. ... 843, 866. Melange de Bonain ... ... 334 Mel Depuratum .V. II. ,, Bosatum ... ... ... 879 Melampyrite V II • • • • • • ~ • JL JL • Melanuric Fever V II Melia Azadirachta . 839 Melinite ... V II • •• • « • < • JLX« Melioidosis .V. II. Melissa Off. 866 Mellitum Mercurialis from M. Annua v. Fr. Cx. Melograno Melon Pumpkin Seeds Melting Points of Pats Meltzer’s Lubricant Memoranda Menciere’s Solutions . . 656 851 ,.V. II. 17 . xliv 502 Mendeleeff’s Periodic Table ...V. II. Mene Towels Menformon 440 955 Meningitis, Cerebro-Spinal 904, 1039 „ Serum .907 ,, Conf. on Standn.of Serum 907 Meningococcus, 905 et seq. ; Culture Media, 906 ; Swab for 906 Menstruation, Diapers of Cotton 440 Mentha Piperita et Viridis ... 867 Menthofax ... ... ... 67 Menthol, l to 2 gr. ... 549 & V. II. ,, Camphora et c. Phenol... 549 ,, Paraffin Caps ... ... 550 ,, Plaster ... ... ... 550 ,, Snuff, 550 ; Spray 550 ; Wool, 551; Valerianate 551 ,, Synthetic ... ... 551 Mcntholeate, 550 ; Menthols lienol ... ... ... 550 Menyanthes ... ... ... 867 Merbaphen ... ... ... 484 Mercaptan ... ... ... 786 Merchandise Marks Act 1019 & V. II. Mercurgan ... ... ... 485 Mercurial Cream, 10 m. 454, 455 „ Injections Intrav. 456, 472 Ointments, Absorption by the skin ... ... 457 Mercuric Ammon. Chloride ... 458 Benzoate, M to iV gr. ... 459 Biniodide, 5* to ^ gr. ... 462 Chloride 3'5 to ^ grain ... 467 „ Cyanide ... ... 459 ,, Gauze ... ... ... 441 ,, HexamineCompounds ... 477 Iodide Soaps . 465 „ Wool ... ... ... 463 „ Nitrate Ointment ... 466 „ Oleate and Comps. ... 598 33 33 33 33 33 Name. Dose. Page Mercuric Oxycyanide ... ... 460 Oxysulph. . 476 Potass. Iodide, 1/16-1/4 gr. ... ... ... 464 ,, Bhodanide ... ... 477 Vide also Hydrarg. Mercurius Dulcis ... ... 473 Mercurochrome “ 220 ” 477 & V. II. See also Mercurome. Mercuro Zinc Cy., 461 ; Bandages, Cream, Gargle, Gauze, Paste, Wool, etc., 441, 462 et seq. Mercurol ... ... 279, 456 MERCUROME . 477 & V. II. ,, Bactericid. Actn. ... 484 Biological assay ... 478 Cumulative effect ... 478 Bougies ... ... 480 Chemical Characters 478 Diphenyl Carbazid. Test, Edn. XIX... 490 Dose . 478 Dudgeon on Dose ... 478 First Aid Sterules ... 480 Gauze ... ... 480 Gonorrhoea ... ... 481 Incompatibilities ... 480 Intravenous Use 478, 480 Ointment ... ... 480 Penetration, See Pre- & 33 33 33 33 33 33 33 face & 480 ,, Pharmacology ... 478 „ References ... 480, 483 ,, Skin Antiseptic ... 480 ,, Solubes . 480 ,, Stains, to remove ... 480 ,, Standard Prepn. ... 479 ,, Sterules, Intrav. & vesical ... ... 480 ,, Suppos.480 ,, Surgical Use ... 480 „ Uses ... 478, 480 ,, Vesical Injection ... 481 Mercurosal .473 Mercurous Chloride,473 ; Iodide, 466 ; Nitrate, 466 ; Oxide 475 Vide also Hydrarg. Mercury Amalgam . 457 ,, and Arsenobenzol ... 194 „ Colloidal 369 Comps. Organic. 484 Hexamine Salts ... ... 477 Peptonate ... ... 467 Salicyl Arsonate -p-1 grain intram.... ... ... 183 ..V. II. 33 33 33 33 Vapour Lamp See Irradiated Milk, etc. Merodicein . Meroxyl . Mersalyl 0-5 to 2 Cc. Merthiolate . Mescal Buttons . Mesembryanthemum 486 ... 485 ... 485 ... 473 ... 836 867 &V. II. 55 55 Name. Dose. Page ‘ Meta 5. ■ ... 122 & V. II. Meta-benz.-carbazide ... ... 8 cresol .... ... ... 26 Diamidobenzo 1HC1. ... 806 ,, -dihydroxybenzene ... 745 ,, -phenylene diamine and HC1. 306 & V. II. Metacetaldehyde ... 121, 122 Metag ... ... ... ... 723 Metagen ... ... ... 593 Metaldehyde . 121, 122 Metal Alloys as Pyrometers ... V. II. Metallix Tubes ... ... ...V. II. Metals, Action of Acids on ...V. II. ,, Colloidal ... ... 361 Metallic Oleates ... ... 598 Metaphen ... ... ... 485 Metarsenobillon ... ... 202 Metatone 1 to 4 dr. ... ... 593 Metchnikoff’s treatment 52 & V. II. Methanal ... ... ... 122 Methanol ... ... ...V. II. Methenamina, 5 to 15 gr. ... 449 Methyl-acetanilide, i—2 gr. ... 3 Acetyl-Iodo-Salicylate ... 78 Alcohol ... ...114&V. II. Aldehyde . 122 Amidobenzaldehyde (p.) V. II. Amidophenol, HOI. ...V. II. Amino-oxv-benzoate ” 344 & V. II. ,, Amino-phenol-sulphate V. II. ,, Aspriodine ... 78 & V. II. Balm ... ... 80 Capsules, 5 and 10 gr. 81 Injection ... 81 Liniment ... ... 80 ,, Pigment ... ... 80 Atropine Brom. and Nit. 209, 211 & V. II. Benzol ... ... ... 312 Benzoyl Ecgonine ... 333 Chloridum ... ... 867 Codeine Bromide, | gr. 357 Cupreine ... ... 380 Cytisine ... ... ••• 846 Ditannin ... ... 90 & V. II. Eosin = Prime rose in Dye industry Green . Group effect of ... ...V. II. Heptyl. Ketone ... 880 Hydrobenzoate ... ...V. II. Hydro-Cupreine HC1. 4 to 12 gr. . 380 -hydroxybenzene ... 26 Iodide . J08 Isopropylbenzene ... 532 Iodo-Aspirinate ... '8 Morphine = Codeine, q.v. -nonyl-ketone ..880 Nitrate . 1)75 Orange .... ' .' • Phenol ... ••• 55 55 55 55 55 55 55 55 55 55 5 5 55 55 5 J 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55' 5 5 55 55 55 55 55 55 55 Name. Dose. Page Methyl-phenylchinolincarb. ... 318 phenylcinchoninat. ... 318 propyl-phen. Hexa hyd. 549 -protocatechuic Aid. ... 890 Bed ... ... ...V. II. -Salicyl, 5 to 15 m. ... 67 Sedasprin... ... ... 82 Stannic Iodid. & Lact. 886, 887 Sulphonal, 10 to 20 gr. ... 787 -Theobromine ... ... 244 Thioninse HC1. ... ... 325 Violet ... ... ... 321 ,, Xanhines ... 244, 796 Methylated Spirit (Mineralised and Industrial) 115 et seq. ,, ,, Drinking ... 115 & V. II. ,, Begulns., 1930, 115; N. Ireland ... ...V. II. Methylene Azur ... ...V. II. „ Blue, 1 to 4 gr., 325 ; Stains ... ...V. II. „ Chloride ... ... 867 Methylenum Cceruleum ... 325 Methylic Alcohol ... ... 114 Methynol ... ... ...V. II. Methysal Balm ... ... 67 Metol, 306 ; Developer ...V. II. Metramine, 5 to 15 gr. ... 449 Metrazol li gr. ... ... 263 Metric Wts., etc., XL et seq. Meulengracht Test ... ...V. II. Mezereum, 8 gr. ... ... 867 Mianin ... ... ... ... 46 Microbene ... ... ... 30 Micrococcus Catarrhalis ... 903 Gonorrhoese ...V. II. Melitensis, see Vaccines this Vol. and V. II. ,, Meningitis ... 904 Microsporon Audouini & Eurfur V. II. {See Bingworm Therap. Ind.) Microcosmic Salt ... ... 770 Microscopic Media, ... ...V. II. Varnish ... ... ••• 866 Microcurie ... ... . ...V. II. Midges, To kill ... 1030 & V. II. Midwifery, Antiseptics in 28, 301, 432 Migraine Powders ... 248 & V. II. Migrainine, 8 to 15 gr— ... 248 Migralgin, 8 to 15 gr. ... ... 248 MILK ... ... ... , ••• Analysis and Bacteriolo* gical Exmh. ... ...V. II. Arsenic in ... ... 197 5 7 55 55 Boiled v. Unboiled 55 ” Casein Certified 582 ... 583 & V. 11. ... 579 & V. II. Citrated ... ' .0 579, 766 Condensed ... 582 & V.1I. „ Berna -w ... '582 ” Consumption 1931, opinion... ... ... 581 ,, and Cream Begulations...V. II. Culture Medium ...VvII. Curdled ... ... 52 &V. II. 55 55 55 55 Name. Dose. Page Milk and Dairies Acts ...V. n. „ Diet for adults in illness erroneous . 251 „ Direct supply, Thermo- isolated .y. n. „ Dried .578 „ Poods . 578 et seq. „ and Glycerophosphate ... 34 » Goats’ . 583 » Grade A.579 & V. II. „ Human . 582 „ „ Artif. . 579 „ Injns. Sterile, 5-10 Cc. 55 55 55 55 55 55 55 55 55 55 55 55 55 5 5 591, 49, intram.... Irradiated in rickets Lactalbumen in ... Lactic acid Added to National Conf. ... Pasteurised ...581&\ ,, Vitamins in ... ,, in cartons Peptonised . Pox . Preparations Preservatives Refrigerated in Scalcones Sour . Special Designations Order Sterilised St. Ivel Lactic ... ...V V. II. et ...V. 52 & V 679 592 582 582 579 . II. 587 581 580 946 577 II. seq. II. II. Sugar ... 581 ... 581 ... 54 863 & V. II. „ Sugar-free . 586 „ Synthetic . 885 ,, Thermo-isolated ...V. II. ,, Tuberculin Tests ...V. 1L ,, Tuberculosis Order, ’25 V. II. >, ,, Animals slaughtered under V. II. ,, Unsweetened Condensed V. II. „ ‘Upper’ 578 ,, Vacuum bottles for ...V. II. ,, Veterinary lnspectn. ...V. II. (See also Cream ,, Whey Powder ... ,, Wooldridge, Prof, on Miller’s Mouth Wash ... Milliamperc . Millicurie and detruites Millon’s Reagent Milne’s Eattiste ,, Eucalypt. Inunction Milton. Minchin’s Garlic Preps. Mineral Acids Sale Mineral Naphtha Mineral Waters Mineralised Meth. Spirit Minium = Red Lead Minot & Murphy Diet Minpar. Minro-Psyll. 2 to 4 dr.... Mirbane . Mire . •) 582 V. II. 115, V. II. V. II. V. II. 439 610 45 834 992 655 . II. 115 700 951 xli 875 309 843 Name. Dose. Page “Mission ” Orange Juice ... 593 Mistletoe, 10 to 60 gr. ... 892 Mist. Ac. Aceto Salicyl, 4 gz. ... 70 ,, JEtheris, c. Ammon., # oz. 104 „ ,, Camph, 1 oz. ... 104 „ Agrimoni® Co., 4 oz. ... 833 „ Alba, £ to 2 oz. ... 540 „ Ammoniaci 4 to 1 oz. ,, Ammon. Brom.Phenazoni et Caffein®, 1 oz. ... 140 ,, Ammon, e. Ether, 1 oz. ... 104 „ Ammon. Picratis, £ oz. ... 57 ,, Amygdala?, ^ to 1 oz. ... 148 „ Anodyna, i oz. 557 ,, Anticachexia, No. 1, 2 & 3, 1 oz.741 ,, Anticatarrhalis, 1£ oz. ... 145 ,, Anti-cholerica, 1 oz. ... 376 ,, Anti-dipsom, i oz. 205, 294 „ Antimalarica (Baccelli) 15 to 30 Cc. . 176 ,, Antim. et Pot. Iod. (Cas- tellani) 1 oz. 157 ,, Antiseptica, 4 oz. ... 771 ,, Antispasmodica, \ oz. ... 780 „ Apomorphine Luff., 4 oz. 166 ,, Arsenii Quinin® et Eerri i to 1 oz.175 ,, Aspirin, i oz. 70 ,, Aspirin et Pot. Cit. | oz.... 70 ,, Asthmatica, 4 oz. ... 780 ,, Baccelli, £ to 1 oz. ... 175 ,, Balsam Co., 1 oz. ... 7 ,, Basham, 4 dr. 416 ,, Belladonna, Xanthoxyii et Hyoscy.,6 to 8 mins. 220 ,, Bismuthi, 1 oz. 223 „ Bismuth Astring, 1 dr. ... 223 „ ,, c.pepsina, 1 to 2 dr. ... 226 „ Bismuthi, Phenolis et Morph., 1 oz. ... 227 ,, Boro-Benzoat., 1 oz. ... 8 ,, Broadbent, i oz. ... 733 ,, Bromidi et Digitalis, £ to 1 oz.704 ,, Brominol c. Nuc. Vom., i oz.240 ,, Butyl-Choral, 1 oz. ... 243 ,, Calc. Chlorid., } oz. ... 255 ,, Calcii Hypoph., 1 oz. ... 683 ,, Calc. Lact., £ to 2 oz. ... 50 ,, Camphor®, 260 ; Cone. ... 167 ,, Capsici Sed., i oz. ... 270 ,, Carminativa, } oz. ... 893 ,, Cascar®, 1 dr.275 ,, ,, Co., i to 1 oz. ... 275 ,, Catarrhalis Anti- 1£ oz.... 145 ,, Chest, 1 dr.857 ,, Clilori c. Quin., 1 oz., (Yeo’s), 731 ; Rose- berry’s. 732 ,, Cholera, 1 oz.376 ,, ,, Tomb’s Ess. Oils, 4 dr.1041 ,, Copaib®, i to 1 oz. ... 621 Name. Dose. Page Mist. Creosoti, 4 to 1 oz. ... 377 ,, ,, Co., 2 dr. 378 ,, ,, et Potass. Iodid. 4 oz., quartis horis 378, 707 ,, Cretae, 4 to 1 oz. 249 ,, Damianae Co., 1-2 dr. ... 852 ,, Dewees’ Emmenagogue, 5 y y y yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy >y 4 oz. ... ... ... 133 Diarrhoea, Bd. Hlth. 1 oz. 376 Diuretica, 1 oz. ... 702, 703 Dysmenorrh., 4 oz. ... 704 Eserinae Co., 4 oz. ... 686 Ergotae Alkalina, 1 oz. ... 405 ,, Co., 4 oz. ... 405 ,, Sedativa, 1 oz. ... 405 Essential Oils, 4 dr. ... 1041 Exalgin, 2 to 4 dr. ... 3 Expectorans 1 to 2 dr. ... 519 Febrifuga, 4 oz. 145 Eerri Aper., 1 oz. ... 414 ,, Aromat.,’85,1 to 2 oz. ,, Arsen., 4-1 oz. ... 414 ,, Ferri Cathartic 1 oz. 420 ,, Co. 4 to 1 oz. ,, Salicyl, 1 to 2 dr. ... 61 ,, Salina, 1 oz. . 414 Filicis, 1 oz.422 Gelsemii, 1 oz. ... ... 426 Gentianae Aik., 1 oz. ... 856 Guaiaci, 4 to 1 oz. Guaiacol, 1 oz. ... ... 445 ,, c. Quinina, 4 to 2 dr.... 445 Hepatica, 1 to 2 dr. ... 275 Hexaminae, Nos. 1 & 2, 1 dr. each ... ... 450 Hyd. Biniodidi, var. ... 465 ,, Perchlor., 1 dr. ... 469 ,, . „ Co., 4 oz. ... 469 Hydrastis Co., 1 oz. ... 486 ,, et Ergot, 1 oz. ... 486 Ichthosulphol, 1 to 3 dr. 498 Iodi Co., 1 dr.506 Ixorae, 1 oz. inc. ... 881 Langdon Brown’s, 1 oz.... 1046 Mag. Sulph. Co. (Mist. Alba), 4 to 2 oz. ... 540 Malarial, Anti-, 1 oz. ... 741 Morph, et Phenazon Co., 1 oz. ... ... ... 556 Moschi, 1 oz. ... ... 868 Mucilag. ... 787 Olei Ricini, 1 to 2 oz. ... — Olei Santali, 1 oz. ... 620 Oleo-balsamica, 1 to 4 dr. 801 Paraldehydi, 1-2 oz. ... 121 Parald. et Pot. lod., 1 dr. 122 “ Patent ” et Camph. ... 104 Phenazon. Expect., 1 to 2 dr. ... ... 328 Pot. Brom. et Digitalis, 4 to 1 oz. . 704 Pot. Iod. c. Lob., 4 oz.... 780 Quininae Ammon., 4 to 1 oz. ... ... ••• 733 Quininse. c. Ferro.,4 oz. t.d. 122 Name. Dose. Page Mist. Quininae, Co, 4 oz. ... 733 „ „ Eff. . 732 ,, Roseberry’s, 1 oz. ... 732 ,, Rubra, q.s. ... ... 771 ,, Santali Co., 4-1 dr. ... 620 ,, Senecio Co., 4 to 1 dr. ... 883 ,, Sennae Co., 1 to 2 oz. ... 884 ,, Simarubae et Granati ... 884 ,, Sinton . ... 738 ,, Sod. Ac. Phos., 4 oz., 771 ; Co., 4 oz. ... ... ,, Sodae cum Opio, 1 oz. ... ,, Sodii Iodid, Co., 1 dr. ... ,, ,, Salicyl, 1 oz. .. Sod. Sulphocarb. 4 oz. Sp. Vini Gall., B.P. ’98, 1 2 oz. ... ... Strych. Phosph., 1 oz. ... Thielemani, av. 30 min.... Tomb’s Ess. Oil ... Tussi Rubra, 4-2 dr. Tussis Luff., 4 oz. ” Valerianae Co., 1 oz. ,, Zinc Ox. (et c. Op.), 1 dr. 823 Mitigated Caustic ... ... 169 Mixed Gland Tabs. ... ... 981 Modelling Wax . 651 Molasses ... ... 6, 276 Molecular Wt., effect of ...V. II. Mollin, var., 867 ; Molybdenum, 421 : Molybdenite ... 421 yy 771 626 768 66 20 785 376 1041 556 166 819 Molybdic acid Momordicin Monarda Monazite Monel Metal Monilia, var., V. II. Monochlorbenzene . Monochlorphenol Mono-Potass. Phosph., 15 to 60 grs. ... ... ... ... 711 Monsel’s Salt, 4 to 2 gr. ... 420 „ Sol., 3-6 m.420 Monsol and Preps. ... ...30,31 Monsonia, var. . 868 Moodooga Oil ... ... ... 842 ...V. II. . 852 799, 800 .V. II. .V. II. balcanica...V. II. . 309 21 605 .. 502 .. 314 .. 868 .. 613 ... 127 ... 231 ... 936 551 & V. II. Moogrol ... Moorhof’s Paste Moranyl . Morbilli, 988 ; Mori Succus Morelix. Morestin’s Fluid Morison’s B.I.P.P. Moro’s Tuberculin Test Morphina, 1-10 to 4 gr. ,, Steriloids ... ... 130 Morphinae Acetas, 555 ; Diacetyl. and HC1., 1/24 to 1/12 gr., 559, Base, 560 ; HBr., 555 ; HC1., 556 ; Hypophos- phis, 4 to 4 gr., 557 ; Meco- nas, 557 ; Periodid., 1/16 to 4 gr., 131, 557 ; Sulphas, 558 ; Tartras, 1/8 to 4 gr*, 558; Oleatum (1 to 60) . 555 FOR B.P. 32 CHIEF changes, see p. XXvi. 561 561 561 624 555 Name. Hose. Page Morphine Methyl Brom., liyp., i-i gr. . Morphinse Methyl Cldorid. Morphine Addicts, 553, 561, 623, 1926, Com. Report... 1006 „ Habit. 553, See also Opium ,, ,, Emetine in ,, „ Esters and Ethers 551, 552 „ „ Goldin ... „ Injection with Sulph. „ Intravenous use ,, Narcotine Meconate, i to £ gr. ,, Scopolamine ... MorphosanHypod, i toi gr. ... Morson’s Soluble Kreosote, up to 15 gr. Morton’s Fluid. Moruette Cod L. Oil Tablets ... Morus Nigra . Moschus, 5-10 gr. Mosaic Disease. Moss Accouchement Sheets, Compressed Sheets, Dressings, Loose Gauze-Covered Towels, Pillows, Sterilisation 777, 778 Mosquitoes and Malaria 365, 554 Mag. 102, 103 553, 1103 563 492 561 379 505 613 868 868 885 742, 743 & V. II. „ Plant. 871 „ to ward off .V. II. „ and Bites and Stings ... 1030 Moss, Iceland, 847 ; Irish ... 848 Motenol.V. II. Mother’s Advice .V. II. Mothcrsill’s Remedy ... 244 & V. II. Motor Spirit . 655 <fc V. II. Moulds cause Asthma. 662 ,, Inhibition of ...V. II. Mountain Ash. 885 ,, Damson . 884 Mouth “Washes, 76, 89, 126; Pennang., 545 ; Peroxide ... 489 Mowrali.840 Much’s Modified Gram, vide Edn. XY11I., p. 540 Mucilago Acacke, adlib. 1 ,, Amyli, 12 gr. to 1 0z. • • • ,, Bisinuthi ... 229 ,, Cydonii. ... 851 ,, Gummi Indici ... 2 ,, Marantse ... 804 ,, Salep ... 881 ,, Psyllii . ... 875 ,, Symphiti ... 888 ,, Tragacanthse ... 803 ,, Ulmi, 4 dr. ... 890 Mucin, 5 to 10 gr. ... 953 & V. II. Mucuna Pruricns, 1 to 2 gr. ... 423 Mucus ... ...V. II. Muirapuama ... 868 Mulberry Juice ... 868 Mullein, Great. ... 891 Name. Dose. Page Muller’s Fluid, V. II. ; Trypsin Test...V. II. Mulls, Adepsine, Anserine ... 564 Thiosinamin . 758 Mumps.. 988 Murexide ... ... ...V. II. Murray on Goitre ... *707 „ on Thyroid ... 976,981 Muscarine . 6, 833 Muscle Extract . 953 Mushroom Poisoning.1098 Musk (and artif.) 315, 868 & V. II. „ Hoot . ... 88 8 Muskatbalsam.868 Muslin.440 Mustard . 756 & V. II. Mustard Gas ... 1097 & V. II Musterole . 757 1 Muthu’s Inhalants . 125 Mutton Bird Oil, 615 ; Essences 576 Mycobacterium leprae ... 608 & V. IT. Mycozol 60 Mydriasine .209 Myelin.. Mylabris sp.265 Myosalvarsan, 0-3 to 0-6 Gm intram.202 Myoston 954 Myotrat 954 Myrica Acris, 114 ; Myrica Gale 842 Myricin, 2 to 5 gr.868 Myristica ; Myristicin ... 868 Myrobalanum, 4 to 1 dr. 853 Myrosin..y. n. Myroxylon Pereira . 839 „ Toluif.840 Myrrh, 5 to 15 gr.869 Myrtillin . 869 Myrtillus, 869 ; Myrtol, 5 to 15 m. 869 Myrtus Cliekan 847 Myxcedema, Thyroid in, 976, 978 and Therap. Ind. “N.C.I.” ... .;. ... 567 N.E.M.585 N.H.I. Dressings . 442 Nabarro on Measles Conv. Serum, 1068; Tick Fever, V. II. and Sleeping Sickness, vide Edn. XVIII., p. 565. Nagana ... ‘.V. II. Nail Polish .886 Nainsook . 440 Naphthalene, 2 to 15 gr. 566 & V. II. Naphthalene Tetrachlor., 3 to 12 gr. 567 Naphtha, Mineral ... 115, 655 „ Solvent, 312 ; Wood ... 114 Naphtlialol, 3 to 8 gr. ... ... 566 Naphthol a-, 2 to 5 gr. incr. ... 566 „ B-, 3 to 10 gr. ... 565&V.II. „ Benzoate 566 Naphthol Bismuth, 10 to 30 gr. 234 Napbthol-Campli. Oxidised ... 565 Name. Dose. Page Naplithol-Charcoal . 566 „ Phthalein ... ...V. II. „ Salicyl. 566 Napkins, Dental . 442 Naranja, F.E. =Aurantii Amarae Cortex Nareeina. § to 1 gr. & HC1. ... 869 Narcophin ... ... ... 563 Narcosan_ ... ... ... 886 Narcotic Drugs Combinations... 563 Narcotina, 1 to 3 gr. ... 567 „ HC1., 1 to 3 gr. ... 567 ,, Nargentol. 279 Nargol.279 Nasal Douches v. Collunaria ... — ,, Inhalers ... ... ... 549 „ Oil.467 Nascent Iodine Treatment ... 510 Nasgar Medium ... 906 & V. II. Nasturtium ... ... ... 869 National Benzol Mixture ...V. II. National Insurance in D.D.A. See D.D.A. Nativelle’s Digitaline Granules, doand ^0gr. ... 393 ,, ,, Solution, 1 Cc. ... 393 Natrium Bromatum, 763 ; Bro- metum, 763 ; Bromicum, 763; Chloratum, 759 and Chlori- cum, 759 ; Jodatum, Jodi- cum, Jodetum ... ... 768 See also Sodii Natto ... ... ... ... 885 Nauheim Baths, 254 ; Salts ... 772 Neatsfoot Oil . ...V. IT. Nebulae ... ... ... ... 568 Nebula Acid Boric . 568 ,, Acid Lactic . 49 ,, Acid Tannic T.H. ... 568 ,, Alkalina.. 568, 765 y> >> 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 Analgesic * • • 568 Antiasthmatica ... • • • 568 See also Comp. Asthma Fluid Antipyrini • • • 569 Antiseptic • • • 568 Astringent; Catarrh 569 Chlorbutol Co. ... ■ • • 569. Cocainae HC1. • • « 339 Cocainae Co. • • • 569 Cocainae Oleosa ... 334 Creosoti Co. • • • 569 Cupri Sulph. • • • 569 Diphtheria • • • 569 Ephedrine Aquosa • • • 398 „ Simp. 398 ,, Comp. • • • 398 Eucain HC1. • * • 343 Eucalypti, 569 ; Co. • • • 611 Ext. Supra-renal 569, 967 Ferri Perchlor. ... • • • 413 Formaldehyd. Muthu • • a 125 Hay Fever • . • 569 Hydrarg. Nit. • . • 467 lodi Co. • • • 569 Name 55 55 55 55 55 55 55 :. Dose. Page la Lobeliae Co. • • • 568 Menthol (Co., 569) ... 550 Mucin 953 Phthisis, 569 ; Pini Col (et c. Cocaine)... • • » 569 Potass. Chlor. c. Ferro ... 569 Potassii Permang. • • • 568 Quininae ... ... 569 Besorcini 569, 746 Sodii Bicarb. ... 765 Sodii Salicyl, 20 gr. to oz. . Aq. Stimulant ... 569 Suprarenal 569, 967 Tonic ~ 569 Zinci Chlor. vel Sulph. ,16 to25gr. in oz. ... 569 Zn. Sulphocarb., 5 gr. to oz See also Yapores. v • •• ••• • • • 1 Necator var. Nectandrine Neelsen’s Sol. Neem, Nim Neisser’s Bougies, 172; Stains \ Neisser-Siebert Ungt. Neko Soap . Nembutal, 1| gr. per os ,, Intravenous Neoarsaminol ... Neo-arsenphenolamine Neoform... Neokharsivan ... Neolyse Neon Neonal ... . . Neophenoquin Tabs., 5 to 15p.d. 318 Neopine... ... ... ...V. II. Neoprotosil and Capsules ... 167 II. ... 841 ...V. II. 839 II. 471 ... 754 ... 811 ... 811 199 A V. II. 199 & Y. II. .... 21 ... 199 ... 538 ...V. II. 811 199 & V. II. ... 199 ... 163 ... 163 222, 237 ... 319 627 Neo-Salvarsan Neo-Silver Salvarsan Neostam Neostibosan Neo-Trepol Neotropin Nepenthe, 5 to 20 m. Nephritin, 4 tabs., 4 times a day 951 Nephritis ... 1070 & Y. II. Neptal ... ... ... ... 485 Nernst Lamps.V. II. Neroli Oil ... ... ... 839 Nessler’s Solution andModifns. V. II. Nestle’s Dried Milk Nettle ... ... ..i Neuralgic Pills ,, Powders, 16 gr. Neurasthenia, Gold in Neurinase, 1 to 4 dr. Neurine.. Neutral Bed. ,, „ Egg Medium Neutralisation Table ... New Skin ... ... “ New Zealand Cream ” Niccolum and Salts Nicholson’s Blue 579 ... 31 ... 243 ... 245 ... 365 ... 810 6 ...V. II. ...Y. II. ... xliv 360 & V. II. ... 595 ...V. II. ...V. II. Name Dose. Page Nickel Carbonyl ... ...V. II. Nicotiana Tabacum ... ... *869 Nicotina, 1/6 to 1 gr. ... 869 <fc V. II at- Vi ^Salicylas, 871 : Tart ...V. II. -Might-blooming Cereus 847 Night Biue .; 325 Nightshade, Deadly . 217 „ Black, Woody 884, 885 JSigrosm ... ... V TT Nikalgin, 5 to 15 gr. ... j" *725 NihkeiSark .295 Nile Blue . 323 Nim ... ... ... ... 839 Nipagm.V. n Nirvanol . qi o Nisbet’s Specific . 620 Nitre, 710 ; Nitrated Papers ... 710 Nitrifying Bacteria ... . V II Nitrite of f|-l m. by mouth \ \ ' Amyl \2-5 m. inhaled / 148 „ Sterules. 149 Nitrobenzol . 309 & V. II. Nitro-celluloses ...359&VII Nitro-erythrite, £ to 1 gr. ... 408 Nitrogen . 632 ,, Active ... ... ... 633 ,, Glucoside Antimony Comp. 163 „ Monoxide. 141 ,, Peroxide 1097 & V. II. Nitroglycerin, 1-200 to 1-50 gr. incr. 569 & Y. II. ,, Solution, £-2 m. incr. 571 & Y. II. „ Tablets, 1-600, 1-400, 1-200,1-100,1-75,1-50 A 1-25 gr., also £ and 1 mgr. 571 et seq., Y. II. (See also Tabellae). Nitro group and Basic Nitrogen, effect of .V. II. Nitrolim .V. II. Nitro-mannite, 1 gr. 409 Nitron. 55 Nitropropiol ....V. II. Nitrosalicyl Test .V. II. Nitrous Oxide, 141, with ether, 98 ; Nitrous Oxide & Oxygen 98, 142 Nizin .307 Nolf’s Method. ... 667 Non-specific Protein In j ns. ... 662 ,, „ in Bheumatoid Affns. 668, 909, 940, 1081 Non-staining Scarlet. 312 N ordhausen Acid ... ... 85 Norit, 5 Gm. 3 or 4 times daily 843 „ Tablets, 5 gr.844 Normacol . 855 (obtained from Astragalus Sp. (Sterculiacece)—a good laxative.—E. B. Parsons, Pr. J uly ’32, P.J. ii./32,113.) ,, Saline Solution. 759 770 380 Name. Dose. Page Normyl Treatment, See Edn. XVIII. ... . 608 Nosophen . 674 Notification of Diseases ... 988 ,, Tuberculosis ... 925 Novalgin, 7£ gr. . 330 Novarsenobenzol ... 199 & V. II. ,, Injection Methods ... 200 Patents and T.M.’s ... 199 Pos<rs.200 Guaiacol-Glucose with 200 in dis. other than Syphilis ... 201 Suppos.202 Novarsenobillon ... 199 & V. II. Novasurol .484 Vovatophan, 8 grains. 318 Novocain, 1/5 to 1 gr. 345 & V. II. „ Borate. 129 „ Suppos. H gr. 348 „ -Suprarenin Tabs, and Solns.345 „ with Strychnine ... 347 Noyer 862 Nuclem, Nucleol, 15 gr. 278 & V. II. Nuf . Numoquin . Nutmeg.868 Nutnmenta . 575 & V. II Nutrient Agar, Broth gelatin ...Y. II. ,, Powder, Brand’s ... 577 Nux Vomica, 1 to 4 gr. 595 & V. II. Nyctal, 5 to 15 gr.810 N ylander’s lieagent .Y 11 Nylofanol . *316 Nynalgin . 330 Oak Agaric .835 Obesity, 956, (* Girdle ’), 984, and Therap. Ind.1071 Obiturin, See Sod. Eluorescein 672 Obstetrics, Pituitary in, 959, 961 Octo-iodo-phenolphthalein ...V. II. Octozone . 630 Ocynium . 799, 871 Oenanthe Crocata . 871 Oenantlie Eistulosa . 871 Oestrin.963 Ogle’s Drops, 1 dr.556 Ohms .Y. II. Oil of Amber . 887 Oil-Soluble Bi Compds. ... 238 Oil Sterilised, 148 ; of Lemon Grass, 872 ; of Mirbane ... 309 See also Oleum. Oil of Orange in Anaesthesia ... 99 „ Tar . 696 & Y. II. „ Vitriol 85 „ Wintergreen. 66 Oil Ether Anaesthesia ... 100 Oils, Iodine, Nos. of .V. II. Essential. 597 & Y. II. „ Antisep. power of ...V. II. Oiled Calico, Silk, etc. ... 268 >1 39 99 33 33 39 39 99 39 33 33 9* Name. Dose. Page Oiled Silk Dextrinised ... 268 Oiled Silk Protective ... ... 268 Oils, Alkaloidal ... ... 617 Ointment Bases, 805 ; m. pts. V. II. Ointments, Absorption ... 457 See also Mulls and Unguenta, Old English Fever Powder ... 732 Olea Essentialia ... 597 & V. II. Antiseptic power of ...V. II. „ ‘ T ’ & ‘ S ’ free ...V. II. Olea europoea ... ... ... 616 Oleanodyne ... ••• ••• 598 Oleaia, 597 ; Prepn. of 598, 601 Oieatum Aconitinae, 1 in 50 ... 93 Hydrarg., ... 59 Seiseq. c. Morph. ... ... 599 c. Sulph. ... ... 599 Morphinae, 1 in 60 ... 555 Yeratrina?, 1 in 50 ... 891 Olefiant Gas . 288 Oleo-res. Aspidii, 30 gr. ... 421 Capsici ... ••• ••• 269 Copaiba) ... ••• ••• 621 ,, Cubebae, 5-30 m. ... 851 ,, Piperis, av. i gr. ... 875 Oieosaccari, P. Ital., q.v. Oleothorax ... ••• • •• 866 ‘ Oieum ’ 85 Oleum Abietis I to 3 m. ... 693 Acid! Salicylici. 60 Adipis=Lard Oil. Ajowan, \ to 3 m. ... 800 Allii Essent., F-l m. ... 834 & V. II. Amygd., 147 ; Sterilisat. 148 Ess. (et s. HCN) ... 147 Persicae ... ... 148 Anethi, I to 3 m. ... 836 Anisi, £ to 3 m. ... ... 837 Anseris ... ••• °64, 8O0 Antbemidis, i-3 m. ... 837 Apii, £ to 3 in. (Celery) 165 Arachis ... ••• ••• 837 Aseptic (Sterilised) ... 148 Atropinae . 209 et Scarlet . 31~ Aurantii, 839 ; with Ether 99 Terpeneless 839 & \. II. Benn6 . 872 Bergamot ••• 11. Betulae, 5 to 15 m. ... 67 ,, Pyrolig. ... ••• 697 Cadinum. 696 & V. II. „ Acetic . 697 Cajuputi, £-3 m. ... 843 Camphora) Essent. ... 2o9 Camphorat. . 261 Cantharidatum. 26b Carbolicum . Carui, £ to 3 m. ... ••• 84° Caryoph., £-3 m. 84o & v .11. Cassiae, £-3 m. ... 290 Cedri var. . 846 Celery, £ to 3 m. ••• lb<-> 33 33 33 33 • 3 3; 39 3 3 33 33 33 33 33 33 33 33 33 33 .33 33 33 __3 3 33 33 33 33 33 3 3 _ 3 3 33 33 33 33 33 33 3 3 33 33 33 33 Name. Dose. Page Oleum Chauhnoogra), 5-10 m. incr. ... ... ... 601 Recent Investigations with 604, 605 Chenopodii, 10 m. 273, 526, 848 Cinereum ... ... 455 Cinnamomi, £ to 3 m. ... 295 Citri ... ... ...V. II. Citronella) ... ...V. II. c. Cocaina, 2% ... ... 334 Cocois Nucif. ... 84, 805 ,, Colza ... ... ... 756 Copaibae, 5 to 20 m. ... 621 Coriandri, i-3 m. ... 850 Cotton Seed ... ... 261 Crotonis, £ to 1 m. ... 871 ,, Comp. ... ... 872 Croton Elliott, 1 to 3 m. 872 Caps., £ m., two to 5 . 872 ,, Cubebae, 5 to 20 m. ... 850 ,, Cypress! ... ... ... 852 Dugong ... ... ... 615 “ Elliott,” 1 to 3 m. ... 872 Erigeron, 5 to 30 m. ... 853 Eserinae ... ... ... 618 Eucalypt., $-3 m. ... 609 Fagi Pyrolig.. 697 Foeniculi, 5-15 m. ... 854 Gaultheriae, 5 to 15 m. ... 66 Gossyp. Sem. ... 261 & Y. II. Graminis Cit. ... ... 872 Gynocardia), 5 to 60 m. ... 601 Hedeomae ... ... 876 Helianth. = Sunflower Seed 615 Homatropinse ... ... 210 ,, c. Cocaina ... 210 Hydnocarpa) ... 601, 606 Hyd. Biniodidi, 1 Cc. ... 463 Hyoscinae... ... 491, 618 lodoformi et Crcosoti ... 501 Jecoris ... ... ... 611 ,, c. Iodo ... ... 613 Juniperi, £ to 3 m. ... 862 ,, “ Ligni,” 862 Pyro. 696 Eauri ... ... 863 I^avand., \ to 3 m. ...V. II. Lemon Grass ... 872&V. II. Limonis, 4 to 3 m.V. II. Terpeneless ...V. II. Lini. ... ... ... 864 Lithanthracis . 296 „ Lubricans . 17 „ Maidis ... ••• ••• 615 „ Majorani ... ... ... 873 Mastiche ... ... 866 „ Mentha? Pip., \ to 3 in. ” 533, 867 & Y. II. ,, ,, Yiridis, ^-3 m. ... 867 ,, Morrhua), 1 to 4 dr. 611 & V. II. Yitamin ‘ A ’ & ‘ D ’ in 588, et seq. 611 TTnsat. acids in ... 612 Vitamin preps. ... 613 Aromat., 1 to 4 dr. 613 33 33 33 33 33 33 93 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 3 3 93 33 33 33 33 33 33 Name. Dose. Page Oleum Morrhu*, c. Creosot, lto 4 dr.. 378 „ Myrcise . t... 114 „ Myristicse, 4- 3 m. . ... 868 „ Myrti, 869 ; Neatsfoot ...V. II. » Neroli . 839 & V. II. » 5iauli . 866 ,, Mucis Arachis . 837 >> ,, Moschat* ... ... 868 „ Olivse (sterilised, 148), J to 1 oz. ... 616 A V. II. „ Origani . 873 „ Palm* . 805 ,, Papaveris, i to l- oz., or ad lib. 615 „ Patchouli 873 „ Peach Kernel . 148 ,, Pennyroyal, 1 to 3 m. ... 876 ,, Petitgrain .V. II. „ Persic.148 ,, Petrolei (A Flay., 651) ... 651 ,, Petroselini . 164 ,, Phosphorat., 1 to 5 m. ... 680 ,, Physostigmin*. 618 ,, Picis Rect. ... 696 A V. II. „ Pilocarpinse . 618 ,, Pimentae, i to 3 m. ... 874 „ Pini Pumil.693 ,, Pini Siberic.693 ,,' Ptychotis, 1 to 3 m. ... 800 „ Pulegii, 1 to 3 m. ... 876 ,, Ithodii . 872 ,, Picini, 1 to 8 dr. ... 616 ,, ,, Aromat., 1 to 8 dr. 617 ,, Posse . 872 A V. II. ,, Posmarini, 4 to 3 m. ...Y. II. ,, Pusci Pyrolig. 697 ,, Putse Grav.880 ,, Sabinse, 1 to 4 m. ... 880 „ Santali, 5 to 30 m. 619 A Y. II. „ ,, Australian ... 620 ,, Sassafras... . 882 ,, Scarlet et Atropinse ... 312 ,, Sesami . 872 ,, Sinapis Ex. A Volat. 756 A V. II. „ Soya . 615, 886 ,, Stapliisagriee . 887 ,, Succini, 1 to 5 rp. ... 887 ,, Sulplmris. 0*5 to 10 Cc. intram.... . 789 ,, Terebinthinse Pcct., 2 to 10 m. as Anthelmintic, 3 to 4 dr. ...691AY.II. 99 99 99 Subcut. in Arthritis 669 Terebinth. gEther. Theobromatis Thymi, 3 m. Tiglii, 1 m. Veratrinse Verbense Indie. ... ,, Wintergreen Olibanum Olio di Fegato Merluzzo Iodato 99 99 99 ... 691 ... 796 799, 890 ... 871 ... 891 ... 872 ... 66 ... 691 ... 611 ... 613 Page 800 628 629 * 456 674 676 Name. Dose. Omam (A jo wan) . Omnopon, £ to $ gr. ... Omnopon A Scopolamine Onguent Napolitain . Opacin .. Opacol. . Operation Gloves, see Yeedi p. 268 Ophthalmic Bottle . 208 ,, Lamels, see Lamels. ,, Solvent (Harman) ... 210 Opial, Opialum .. 628 Opium, i to 2 gr. ... 622 A V. II. ,, Thebaicum = Opium Fa. Cx. ,, Concentratum ... ... 628 „ Conference .League Nations 623 ,, Limiting Mfre. ... 624 Consumption ... ... 624 Paw . 622 Abuse of ... Q>23 et seq. „ Smoking 624 ,, Granulatum . 622 ,, as Dangerous Drug 997 A seq. Opobyl.776 Opocalcium . 981 Opoidine, & gr. per os. ... 629 Opsonins . 894 A V. II. 99 99 99 Optochin Base, 3 to 4 gr Optochin HC1., 3 to 4 gr Optophone .. Orange Flower Water ... ,, Juice Vitamins ... “ Oil ” jj vyii •• • • • • ,, Wine . Orargol. Orarsan, 4 grains Orcein and Orcin Orchic Fluid . Orchidin... . Orchil.. Orchis Mascula Ordeal Bark, 853 Orders in Council Organic Analysis Chart Organic Ars. Compds. . Organotherapy Orge Oriental Sore ... Beans ... 380 ... 381 ... 792 ,..V. II. - ... 588 839 A V.3IL ... 372 ... 186 ...V. II. ... 974 ... 974 >..V. II. 880 684 ... 992 ...Y. II. ... 179 947 A V. II. ... 500 ...V. II. Origanum Sp., 873; Orizaba Jalap, 861 ; Orizabin,l to 5 gr. Ormesukker Oro-nasal Inhalations Orphol. Orpiment Orris Root Orseille ... Orthocresol Orthodiclilorbenzol Orthoform, l|-3 gr., HC1. Orthosulfimidum Benzoicum, to 2 gr. . Orthotoluidine, 306 ; Ortol Oryza Sativa . Osazone . Oscodal 861 751 379, 549 V 234 185 861 , II. 26 309 344 74.8 V. II. 836 Y. II. . 613 Name. Dose. Page Oscol Stibium and. others ... 364 Osmium Tetroxid., 1/64 gr. ... 831 Osmo-Kaolin, 1 dr. or more ... 138 Osmotic Pressure ... 362 & Y. II. Osseine ... ... .. 424 Ostelin ... ... ... ... 613 Otalgan ... ... ... ... 328 Otosclerol ... ... ... 849 Otto of Rose ... • ... ... 872 Ouabain ... 783, 831 & V. II. Ourari ... ... ... ... 851 Ovaltine ... ... ...V. II. Ovamammoid Capsules ... 954 Ovarian Gland ... ... ... 954 „ Hormone ... ... 954 Ovarnon... ... ... ... 955 Oviol ... ... ... ... 613 Ovo-lecithin, Elixir, Emulsion, Inj., Pills, Powder, Tabs., etc. ... #. 531 et seq. Ovules, see List... ... ... 629 ,, Cupri Oleat ... ... 598 ,, Masses, Tropical ... 630 Qwbridge’s Lung Tonic ...V. II. Oxalis ... ... ••• ••• 880 Ox Bile, 5 to 15 gr.410 Oxycroceum Plaster .... ... 847 Oxygen, Cylinders, Davis Escape Apparatus, 631 ; Inhaln, App., 630 et seq. ; ‘ Solid,’ 490,630; Water ... ... 13 Oxygen content of the air ...V. II. and Alcohol Inhaln., 631 ; Ether ... ... 98 Injections ... ... 632 Mask ..631 Oxyhsemoglobin. 6/7 Oxylith 490 Oxymel Scillse, £ to 1 dr. ... „ Urgineae, £-1 dr. ... 890 Oxymethylene . Oxyntin, 5 to 15 gr. ... ... 39 Oxy-Quinoline Sulphate ... 315 Oxyquinotheine Cachets ... 248 Oxysparteina (HC1. and Sulph.) £ to 1£ gr. ... 886 Oxytocin ... . • • • • • Oxyuris. 1093 & V. II. Ozokerit 049 Ozone ... ••• ..*630&V-IL Ozonic Ether, £ to 1 dr., 489 ; Inhalers... . 649 .873 . 17 . 990 .V. 11. ... 29 • •• • •« ••• PaCOlOl ... .... ... •'•■rr ? ‘ Packets ’ Preventive.v. 11. Pacyl Tablets, 1 or 2, twice or r thrice daily ... ..n Pads, gauze and wool ... J4U Pagenstecher’s Ointment ... 4/6 Pagliari’s Soln. ••• ••• i3° Paeonia ... P-O., 50% W11 & CE) Ph. Pacolin ... Pacolol yy yy Name. Dose. Page Paints, Cellulose ... ...V. II. „ Luminous ... ...V. II. Pakes’ Disc ... ... ...V. II. Palladium Chloride ... ...V. II. for Iodine in water ...V. II. „ Carbon Monox., etc. ... ...V. II. „ Colloid. . 369 Pallamine ... ... ••• 369 Palm Kernel Oil ... ... 148 Palmetto ... ... ••• 882 Pan ... ... ... 841 Panama Bark ... ... 878 ‘ Panama ’ Bismuth ... 521,529 Panbiline ... ... ••• 776 Pancreas ... ... ... 633 ,, Insulin from. 637 Pancreatic Diastase ... ... 633 ,, Solution, 1-2 dr. ... 634 Pancreatinum, 2 to 4 gr. 634 & V. II. „ and Bismuth, 1 to 2 dr. 227 Pane and Renzi’s Serum ... 918 Panflavin Tabs., 1 hourly ... 302 Panopepton Panoptic Stain ... Pansy, 10 to 60 gr. Pantopon, £ to £ gr. Papain, 1 to 8 gr. Papaver Somniferum Papav. Capsulse Papaverine Periodid. £ gr. ... Hydrochlor., £ to 3 gr ,, Sulphate, £ to 1£ gr. Papaw Fruit and Juice Papayotin, 1 to 8 gr. ... Paper Bibulous Dental Papoose Pappenheim’s Stain Para-aeet. -phenetid in, 5 to 15 gr yy yy 660 & V. II. ...V. II. ... 892 ... 628 423, 647 ... 622 ... 622 562 & V. II. 131, 562 ... 562 ... 562 647 647 442 846 V. II. 326 349 Para-amido-Ethy 1-Benzoate Para - amino - benzoyldiethyl- amino-ethanol, HC1. ... 345 Para-Amidophenol .V. II. Paracoto Bark ... ... 3<5 Paracresol . 26 Para Dichlor Benzene ... 309 Paradimethylamidobenz aide. Ergot Test 493 ,, -Urobilin Test., P.G. ...V. II. Paraffagar, 1 to 2 dr. ... ... 654 „ Caps., 1 or 2 ... 654 c. Phenolphthalein 1 to 2 dr. 654 „ Liq. £ to 1 oz. ... 654 „ c. Phenolph., £ to ” 1 oz. . 654 Paraffinum Comp. Liq. ... 654 Paraffin Amer. and Russ. 48, 651 Chlorinated ... ... 47 Clrlorinatum ... 47, 48 Detection of .Y. II. Dur. (& Sterilised) ... 649 Injections .. ... 649 Iodine in... ... ... 512 yy yy yy yy >y Name. Dose. Page Paraffin Liq. (Sterilised, 148), 651 & V. IT. 48 ... 650 651 V. II. 48 650 55 55 5 5 Naphthenes in “ No. 7 ”. ,, Modif. Molle, 649 ; Iodine val Olefines in Treatment of Burns Viscosity of ... 651 & V. II. ,, with Acrifiavine ... 300 Paraform .127 & V. II. „ Collodion . ,, Snuff. Paraguay Tea. Paraldehydum, 30 to 120 m. 121 & V. II. „ Caps., 20, 30, 40 m. ... „ as Anaesthetic Paralysis, Treatment of by malaria . Para-monochlor-phcnol Paranephrin . Paraphenylenediamine Parasites to Kill Parasitotropic Compds., 191, 520 & V. II. Para-thormone Lilly. Parathyroid Gland Desicc., 1/60 to II gr. . Tablets ... . Refs, ttment ... 985, 986 ,, Standardisation and Calcium ... . Tara Toluene Sodium Sulplione Chloramide ,, Sulphone Chloride Paratyphoid Vaccines, 937 ; Bacillus . 937 & V. II Paregoric (Scotch, 628), I to 1 dr • ••• • • • ••• • • • Pareira, av., 30 gr. Paremetol, 1 to 2 dr., Edu. XVIII p. 526. 128 128 249 121 122 1073 21, 1040 ... 968 ... 305 ... 1073 985 985 55 55 T> 985 986 46 46 626 873 Name. Dose. Page Pasta Coll. lodi . 366 Flava . 477 Formalin! 128 Hydrargyri Cyanidi ... 460 Hyd. Zn. Cy.462 Hyd-Oxycy. ... ... 461 Ichthosulphol et c. 01. Tereb. 498 Ihle.747 lodi et Picis . 506 Iodoformi Cinnam. ... 502 Lassar’s. 824 Londinensis . 702 Mackintosh . 755 Moorhofi.502 Plumbi c. Cupro. ... 700 Ravaut. 527 Resorcini, Fort. Mitis, et c. Zinci Oxido ... 747 Theobromatis . 796 Lnna . 823 Vienna . 702 Zinci c. Amylo. 824 ,, Composita ... 824 ,, et Gelatini ... 823 Pasteurisers . 581 Pasteurisation of Milk 5S1 & V. II. (See also Milk.) Pastilles, Asthmatic ... ... 710 Guimauve . 434 or Ju.iubes v. Trocliisci R^glisse . 857 Pastiili, Glyco-gelatin. 434 ,, Acid Boric 11, 434 Acidi Carbolici, \ gr. 19 Aconiti Tinct. 1 m. ... 92 Ammon. Brom., 1 gr. 140 Bismuth Carb., 3 gr. c. Morph. Acet., 1/40 gr. 225 Cascara . 276 Cocae Ext., 21 gr. ... 332 Cocainae HCl., 1/10 gr. (et c. Morphina), ... 339 J) 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 Habit and Alcoholism 365 , 554 (Milk Sugar) 340 Parkinsonism ... • • • 1074 55 Codeimc, I gr. 355 ,, Stramonium in • • • 779 55 Formosy' . 126 Parolcine • • • 651 5 5 Glyc. Thymol and Amyl Parosan, 3 tabs, daily • • • 188 Crcsol . 31 Parrish’s Ch. Food, 1-2 dr. ... 418 55 Marsh Mallow 434 Parsley, Garden, 164 ; Fools, 55 Menthol, I gr. 550 832; Parsley Piert, 834 ; 55 Morphinoe, 1/30 gr. ... 555 Wild. • • • 849 55 Pine Terpine Heroin ... 694 Parsnip, Wild • • • 873 5 * Pyrethri . 876 Pas de Calais Work on Typh. 55 Ravaut’s Paste 527 Vaccines, ver os 939 5 * Stomachici 856 Basque Flower. • • • 876 55 Stovaine, 1/20 gr. 353 Passiflora 873 55 Tamarind Co. 889 Pasta Acid. Salicyl. • • • 60 55 Terebini 795 ,, Arsamin ... • • • 185 55 Terpheroin Co. 694 ,, Arsenicalis • • • 176 55 Thymol, 1/32 gr. 801 ,, Bismut hi Beck • • • 231 55 Ulmus Fulv. 890 ,, Bismuth et lodof. • • • 231 Pastinaca Sativa . 873 ,, Carbonis et Zinci • • • 824 Patchouli . 873 ,, Coll. Argent. • • • 371 Pates Pectorales . 866 Name. Dose. Page “ Patent ” Medicines.Y. II. “ Patent ” Mixture . 104 Patentex . 723 Patenting Medical Inventions 1021 Patents & Des. Act, ’32.—v. Preface Patents and Trade Marks 1020 et seq. Patents, Conference on Empire 1021 Patents, Dedicated, 1021 & .. Preface Patents, Designs and Trade Marks (Temp. Rules) Act ... 1021 Patents and Designs Act (1919) 1021 Patent Blue ... ... ... 325 Paullinia Sorbilis ... ... 858 Pausinystalia ... ... ... 892 Pavimol, £ to 1 oz. incr. ... 615 Pea Nut Oil ... ... ... 837 Peach Kernel Oil . 148 Pear Essence ... ... ...V. II. Pearl Disease = Tuberculosis of Serous Membranes of Cattle, see Tuberculins Bovine. Pearson’s Antiseptic Fluids 31 & Y. II. ,, Arsenic Solution 179 Pectins ... ... ... ... 873 Pedalium Murex . 857 Peenash ... ... ... 474 Peganum Harmala . 858 Pellagra ... ... ...V. II. Pellanthum and Comps. ... 824 Pelletierina, 2 to 6 gr. 656 & V. II. Pelletierinai HBr. Sulph., Tan- nas (2 to 8 gr.), etc. ... 657 Pellidol.313 Pellitory.876 Pelosine ... ... ... 841 Pencils, Iodoform .„ 602 Penicillium .C. LI. Pennyroyal . 876 Pentobarbital Sodium ... 811 Pentachlorethane ... ... 290 Pentamethylenetetrazol ... 263 Pentasulfure d’Antimoine .... 154 Pentyl Hydride (Pentylene) ... 656 Peony ... . ..873 Pepo, av. 1 oz. 0/6 Pepper . Peps .' Pepsalia ... ... ••• Peptalac... ... ... ••• 685 Peppermint ... ••• ••• 86/ Pepsodent . • _ ^66 Pepsin, 5 to 10 gr. 657 et seq. A \ . II. ,, Soluble & Insol. ..658 Pepteiizyme, 1 to 2 dr. ... 659 „ Elixir, 1 to 2 dr. ... ^ 659 Peptic Index .V. II. Peptolac... ... ... ••• 685 Peptone .Tr 660 „ Bile Test .V. II. Peptone Immunisation in Asthma ... ... ••• 66^ Indications & contraindications ... ... 663 Technique . 663 33 33 33 yy yy y y yy yy yy yy yy yy yy 319, 350 xiii yy yy Name. Dose. Page Peptone Sterules, Intrav. ... 663 ,, ,, „ Cont. Course 663 Shading off 664 ,, Intram. ... 664 ,, ,, Cont. Course 664 ,, Doses for children 664, 666 Witte ... ... 665 ,, ‘Special’ ... 665 in Arthritis ... ... 668 in Epilepsy ... ... 666 in Yaccine Therapy ... 666 Per os. (0-5 Gm. t.d.a.c.) 667 Nolf’s Method ... 667 Danysz... ... ... 667 Ointment ... ... 670 References ... ... 667 ,, Serum (Patient’s) ... 664 Peptonised Beef, 635, 660 ; Beef Essence, 576; Beef Jelly, 635 ; Chicken Jelly, 635 ; Beef and Malt, 660 ; Milk ... 635 Peptonising Powders ... ... 635 Peptonoids of Beef ... 660 & V. II. Peracrina ... ... ... 302 Perborates ... ... ... 13 Percain ... Percentage Table Perchloride, see Hyd., also Solubes. Perchlorethylene . 290 Perenyi’s S0I11. ... ... ...V. II. Perfumed Formosyls ... 597 Perfumes, Synthetic ... ...Y. II. Periodic Table of Elements ...Y. II. Periodides, Alkaloidal ... 131 Periwinkle ... ... ... 891 Perles Apiol, 3 m., 1 or 2 ... 164 ,, Camph., Monobr. 2 gr. ... 262 ,, Carbolic Ac., 1, 2, gr. ... 19 ,, Chloroform, 3 m. ... 286 ,, Creosote, 1, 3 111. ... 378 ,, Ether, 2 m., 1 to 4 ... 104 ,, 2 in., c. Tereb., 3 m. Guaiacol, 1, 2, 3 m. ... 445 Izal, 2 m. (Caps.), et c. 01. Morrh., 5 m. ... 30 Phosphorated Oil, 1/100, 1/65 & 1/32 gr., 1 or 2 681 Quin. Sulph., 1£ gr. ... 731 Tar, 2£ gr. . 695 Perlsucht. See Tuberculin P.T. Permanganate. See Pot. Permang. Permutit ... ... ...Y. 11. Pernocton ..815 Pernoston ... ... ... 815 Pernicious Anaemia, Liver in, 951 ; Stomach ... ... 965 Peroxide of Hydrogen ... 488 ,, Mouthwashes ... 489 Peroxidase ... ... ...V. II. Peroxides in Ether ... ...V. II. Persil Persio, V. II.; Persulphates ... 771 yy yy yy yy yy r 1176 FOR B.P. 32 chief changes, see p. xxvi. 99 99 99 99 99 99 99 99 99 99 99 99 99 99 Name. Bose. Page Pertussin 1 to 4 dr.890 Pertussis (Whooping Cough) ... -p t> , , , 946, 1093 Peru Balsam, 5 to 15 m. ... 839 Peruscabina ... ... 310 Pessaries, Mass for ..! 435 „ Hollow, 435 ; (q.v., for . List); Rubber ... 268 Pessaries with Ca ao Butter, 15, 20 (flat shape), 30, 60 or 120 gr. :— Pessus Acidi Borici, 10 gr. ... 11 A^-£actic2% ••• 722 Acidi Tannici, 10 gr. ... 89 /Acid Tannic, 10 gr. V \ Morphine, 1 gr. / Atropine, 1/20 gr. ... 209 Bellad Ext, li gr. ... 220 Bismuth Oxychlor., 10 gr. 229 Chloral Hydrate, 10 gr.... Cocainse, 1 gr. 339 Conmae, i m.374 Formosyl . 126 Glycerin.435 Glycerin Ac. Boric ... 10 Ichthosulphol, et c. Resorcin .498 Morphmae, 1 gr., et c. Bellad. Ext., 2 gr. „ Opii Pulv., 2 and 3 gr. „ PIumbi Iodidi, 5 gr. (et c. Atropina, 1/20 gr.). Potassii Bromidi, 10 gr. Quin. HCJ., 3 to 5 gr. ... 722 Zinci Ox., 10, 15 gr. Zinci Sulphocarb., 5 and 10 gr. . Petechial Eever .. 904 Petit’s Liquor. 392, 434 Petitgrain .y# 44 Petrol, 655 A V. II. ; Poisoning , 655, 1100 Petrolatum, 649 ; Liq. 651 „ Ac. Boric ... 12 „ Atropinae ... ... 209 Cocainae 1 to 10% 335 Creosoti . 378 Iodoformi. 502 „ Zinc Oxidi. 823 Petroleine . 650 Petroleinum . 656 Petroleum, Burning, 655 ; Benzine, 309, 656 ; Cerate, 650 ; Emulsion 1 to 4 dr., 653 ; Ether, 656 ; Insecticide, 655 ; Jelly 649 ; Spirit . 656 Petrole I6ger . 656 Petroselinum Sativum ... 164 Pettenkofer’s Test .V. II. Pettey Method.*625 Petty Spurge. 854 Peucedanum graveolens ... 836 Peucedanum Sativum ... 873 Peumus Boldus..* 842 Pexuloid ... ,,, 361 99 99 99 99 99 99 99 Page 915 & V. 11. ...V. II. ... 814 ... 477 ... 862 Name. Dose. Pfeiffer’s B. P.H. Values Phanodorm, 3 grains Pharaoh’s Serpents Pharbitis . Pharmacist’s Qualification ... 989 Pharmacy Act, Poisons Schedule 1990 Pharmacy and Poisons Bill ... 995 Phaseolus . 873 & V. II. Phasin. kqi Phellandrene ... ... .'"y. h Phenacetinum, 5 to 15 gr. 326 &V. II. „ c. Caffein, Eff. 1-2 dr. 326 Phenalgm, 5 to 20 gr. ... 3 & V. II Phenazine Compds. ... . 298 Phenazonum, 5 to 15 gr. 327 & V II Eff., 5, 10, 15 gr. in dr. *328 Salicy 1. ... 328 & V. II. ... 326 ... 749 . 310 815 344 )) 99 Plienetidin . Plienetolcarbamide f gr. Phenmethylol ... * * * Phenobarbitalum 14 to 5 gr. .. * Phenocain Phenocoll HC1., 8 to 15 gr. m two 327 & V. II. Phenol 1 to 3 gr. ... 14 & V. II. Bismuth, 10 to 30 gr. ... 234 Campliorat. 49 Iodized, 18; Lotion ... 16 Mercury, 4 to 2 gr. ... 459 Phthaleinum, 2 to 5 gr. 671 & V. II. ,, Tablets ... 672 Phthalin ... y n Fed . 672 & V. II. Sod.-Sulphoricinas ... 619 Sodique. ... 43 Sulphonephtlialein, 6 mgr. „ . . 672 & V. II. Tetrabrom. phthalein Sod. Sulphon. ...V. II. ,, Tetrachlor. phthalein ...V. II Plienolaine .. 353 Plienoloids . Phenoquin, 8 to 15 gr. ,, Tablets, 4 and 8 gr. Phenosalyl . Plienyl-acetamide, 2 to 5 gr. Phenyl-Alanine amine Aspriodine, 5 gr. -carbonate 9 9 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 27, 992 .. 316 .. 316 21 2 ..V. II. ... 304 82 & V. II. 805 dichlor. arsine .V. II. -dimethyl-iso-pyrazolone, 5 to 15 gr.327 Ethylhydantoin, 4 to 8 gr. 818 group, effect of.V. II. hydrate, 1 to 3 gr. ... 14 -hydrazine 14 gr. 307 & V* II. propyl-Acetas . 887 „ Alcohol ... ... 887 Salicy 1, 5 to 15 gr. 75 & V. II. Name. Dose. Page Phenyl-semicarbazide ... ... 8 ,, serines ... ... ...V. II. Phenylene-diamine, Meta, 306 ; Para ... ... ... 305 Phloridzin . 873 & V. II. Phloroglucin .V. II. Phosferine ... ... ...Y. II. Phosgene ... ... ... 805 Phosphates in Urine ... ...Y. II. Phosphorated Oil, 1 to 5 in. ... 680 ,, Suet, 1 in 10 ... ... 681 Phosphatides ... ... ...Y. II. Phosphorus, 1/100 to 1/20 gr. 679 Pentachloride ... ... 682 55 55 Peries, 1/65 & 1/32 gr. ... 681 55 681 et seq. ... 6S0 ... 681 ...Y. II. ...V. II. ... 315 ... 1075 947 848 & V. II. 963 131 Pills ,, Poisoning. ,, Solutus .. Phospho Tungstic Acid Photographic Developer ,, Sensitisers Phthisis. Phylacogens . Phyllosan . Phyone ... Physiological Acid and Alkali Physiological effect in comparison with chemical constitn. V. II. Physiological Salt Solution ... 759 „ Standardisation ...Y. II. (See also Digitalis, Ergot, Stro- phanthus, etc.). Physostigma Sem., 1 to 4 gr. ... 684 Phvsostigmina,l/lQ0to 1/50 gr. 685'& Y. II. „ Salicyl, 685 ; Sulph., 1/60 to 1/20 gr. ... 686 & Y. II - - 874 592 874 877 877 56, 439, 442 Phytolaccin, 1 to 5 gr. Phytosterol Pichi Picraena Picrasmin Picric Acid Wool, Gauze 55 55 Solution (Esbach’s) V. II. }5 ,, Brass Paste ... 384 Picrocarminc ... ... ...Y. II. Picrorrhiza, 10 to 60 gr. ... 874 Picrotoxinum, 1/100 to 1/25 gr. 874 & Y. II. Pigment Acidi Picrici et Camph. 56 „ ,, Tannici ... ..; Aetheris Acetici, et Iodi (D. Grant) (See also correspondence.— C.D. ii./32,172, 244.) Antiseptic . Argent Nit. JEther Camphorse Chloral et Menthol ■ ... ... ••• Casein Chloral Camph. et Co. ... ChTysarobini, et c. Pyro- gallol ... ... 291, 292 Cocainse et Hydrarg. Per- chlor. 55 55 55 55 55 55 5 5 55 431 506 18 169 262 584 280 Name. Dose. Page Pigment contra Tineam 469 5 j Delineans... ... 170 55 Eucalypt. Olei et Ac. Sal. 611 5 5 Eerri Perchlor. 413 5 5 Guaiacol 446 j j Iodi, 507; c. Liq. Eor- maldehyd., 506 ; et Aconiti 506 55 Iodi iEthereale ... 506 ,, ,, et Aeth. Acet. (D. Grant) 506 (See correspondence.—C.D. ii./32,172, 244). j ,, et Olei Picis 506 5 ,, Carbol 18 j Iodoformi, Gt. Orm. H.... 502 Iodolysin 758 > Ipecacuanlise et Arsenici 523 j Liq. Arsen. 523 j LoefUer ... ... ... 413 5 Mandl 506 j Menthol. 550 j ,, c. Guaiacol 550 5 Methyl Aspriodine 80 j Salol 76 5 Thymol ... 801 5 5 '** ±XJ Piidoras see Pilulse Piiene, Imperm. Spongio ... 439 Pilewort and Suppos. ... ... 878 Piliophen ... ... 674 & V. IT. Pilocarpina ... ... 687 & V. II. Pilocarpinse HC1., 1/20 to 1 gr. 687 ,, Nitras, 1/20 to 4 gr. 688 & V. II. ,, Phenas ... ... ... 688 ,, Salicyl., 1/20 to i gr. ... 688 Pilocarpine Hair Lotion 688, 746 Pilocarpus ... ... ... 687 PILtILiE . 689 Excipients, 689 ; Gelatin-ctg. 689 ; Keratin, 689 ; Pearl Sugar-ctg., 689 ; Salol-ctg., 76, 690 ; Stearette Coating 690 ; Varnishing ... ... 689 "Ac. arsenios, 1/50 gr. ...1 Quin. Sulph., 1 gr.I ' Strych. Sulph., 1/64 gr. ... f Phosphori., 1/50 gr. ...J Acidi Arsen., 1/120 to 1/20 gr. 174 Ac. Arsen, et Eerri Redact.... 176 Acidi Carbolici, 2 gr— ... 19 Aconiti Tinct. = 2 m., 1 hourly 92 Aconitinse, 1/600 to 1/200 gr. 93 Addison’s ... ... ... 392 Aloes—4 to 8 gr. ... ... ,, Cascara et Hyos. ... 132 ,, et Asafetidse, 4 to 8 gr. ,, et Eerri, 4 to 8 gr. ... 132 ,, Nuc. Vom. et Bellad ... 132 Aloin, l/lO and 1 gr. ,, Co., 1 a. cib. ult. ... 133 ,, Strych. et Bellad. ... 133 Aloin, i gr. ; Podoph., i gr., Ext. Cascara, 1 gr., Ext. Bellad., h gr., Oleores. Capsici, £ gr. . Alophen ... ... ... 134 Name. Dose. PiJllIqp •- Alterativa S.H. :—- /Pil. Hyd., 2 gr. ...\ \Pil. Rhei. Co., 3 gr. .../ Aluinmii Chloridi, 2 gr. Antidipsom :— f Strychnine, 1/60 gr. ... i Atropine, 1/200 gr. LQuin. Sulph., 2 gr. Antimonii Conti et Quin. . Aperiens=Hyd. Col. Ipec. et Hyos. “ 78 ” U.C.H. Argent. Cyanidi, 1/60 gr. ... ,, Nit., 168 ; et c. Morph., ^ £>!*• • • • ... ... Arsamm, $ gr. Arsenicalis, 1/120 to 1/20 gr. „ et Strych., 1/50 gr. ... Arsen. Hyd. Iodid. Arsen. Ferri et Hyd. Iod., lor 2 ; Asafetid. Co., 4 to 8 gr. Asiaticae, 1 or 2 daily Aspirin et Arsen.* Atropinae, 1/200 to 1/60 gr., 1 h-S' ,, Arsen., et Quin. Baillic. Belladonnae, Nucis Vom. et Cannabis Ext., 4 gr. each Beta-Naphthol, 3, 5 gr. Bismutho-Sodii Sal. cum Saloi Blancard Page 136 161 167 170 184 174 176 463 463 176 71 209 209 392 220 565 232 417 411 456 243 Blaud’s Ferrug, 5 to 15 gr. Blue, 4 to 8 gr. Butyl Chloral, 3 gr. / „ Hydr., 3 gr. \ Gelsemininae HC1., 1/200 gr.J"'16 Butyl Chloral 2 gr., Camph. 1 gr., Ext. Gelsem, I gr. ... 243 Caffeinae, 1 to 5 gr. ... 244 Caffeinae Triodidi Comp., s.t.d. 247 Calcii Chloridi, 5 gr. 249 ,, Permang., { to 2 gr. ... 548 Calc. Sulph., 1/12 to 1 gr. ... 258 Camphorao .262 ,, Monobrom., 3 gr. ... 262 „ Salicyl., 1 to 5 gr. ... 262 Cannabin Tannate 2, 3, 4 gr. 264 Capsici Co. ... 269 Cascara Ext., 2 gr. ,, Co., 1 h.s.276 ‘ Castor Oil *.617 Cathartic Co., U.S. IX. :— Ext. Col. Co., 2£ gr. ; Gamboge, i gr. ; Hyd. Sub- chlor., 2 gr. ; Jalap lies., 2 gr., approx, in 2 pills for av. dose. Cereviseae Ferment vide Faexin. Champney, Syn. Pil. Hydrarg. Perchlor. Co. Barts. Mercuric Chloride 1/32 gr., Aloes Extract. Nux Vomica Extract, Belladonna Extract £ Page Name. Dose. Pilulae :— grain each. Used in salpingitis.—Langford Moore, P.J. L/20, 39. Chlorure Mercurique Opiacees 470 Cocainae HC1., 1/5 gr. ... 339 Codeinae Co., J to 2 gr. ... 355 (Mucilage as Excipient not Syrup.) Colchicinae, Hyosc. et Nuc. Vom.359 Colocynth. Co., 4 to 8 gr. ... 373 „ et Hyos., 4 to 8 gr. ... 373 ,, c. Ipecac. Aperient, ^U.C.H., ‘ 78 ' i.e.— Bil Col. Co., 2 gr. c. Pil A Hyd. 14 gr. Pulv. Ipecac. / i gr. & Ext. Hyoscy. 1 gr. J Compound Bismuth ... 232 „ Laxative ... 617 Conmae HBr., £ gr. ... 374 Convallariae Ext., 2 to 8 gr. ... 850 Creosoti, 1 in 2, 2-6 gr. ... 378 £rocq.;. ... 170 Cupn Acet., £ gr.382 Damianae Co., 1 t.d. ... 852 Digitalis Fob, £ gr., 1 t.d. „ Opii et Quin. (Heim’s) Digitalis, b gr., Ipecac., i gr.; Opii, £ gr.; Quin. Sulph., 1 gr. „ Co. St G.H. 392 Digitoxm, 1/250 gr. 392 ‘Dinner ’ 70i Diureticao S.H. :— / Pil. Hydrarg. Pulv. \a.a. \ Scillae Pulv. Digital. /1 gr. Donovani .463 Dupuytren . 479 Easton’s (et c. Arsen., 1/60 gr.), 2 or 3 daily. 419 Elateru Co.852 Emetine Bism. Iodide, 1, 2 and 3 gr., Saloi, ctd. ... 525 Ergotini, 1, 2 or 3 gr. ... 404 Ergotin, gr. 3 ; Strychnine Sulph., gr. 1/64 ; Ext. Can- nab. Ind., gr. 4 (Owen Lankestcr). Euonymin, 2 gr. ... 449 Euonymi Co., Bart’s. :— Ext. Euonymi, 1 gr. ; Ext. Aloes, 14 gr.; Ipecac., I gr.; Ext. Hyoscy, 1 gr. Exalgin, 4 to 2 gr. ... 3 Ext. Bellad., i gr., £ gr., \ gr. Extr. Cannab Ind., I to 1 gr. 264 Ext. Hyoscy.,lgr., Ipecac. ,Jgr. Ext. Nucis V., i gr., i gr., i gr., Saloi, 2 or 3 gr. Faexin Ext., 3 gr.277 Ferri Arsen, (et c. Strych. HC1., gr. 1/60) ... 176 „ (Blaud),Carb.,5tol5gr. 411 „ Carb. Sacch., 4 gr. ... — 1 c.eib. ... . Strych. 2 683 417 417 419 420 411 Name. Dose. Page Pilulse :— Ferri Glyceroph., „ Hypoph. c or 3 p.d. ,, Ioclidi, 3 to 8 gr. ,, Iod. et Sod Arsen ,, Quin, et Strych. Phosph. (et c. Arsen.) „ Sulph. Exs., 3, 5 gr. ... ,, Redact, 1, 2 gr. ,, Redact!, 1 gr., Ext. Nux. Vom., £ or I gr. ,, Sulph., 1 gr., c. Strych., 1/30 gr. ,, Franck’s ... ... 879 GalhaniCo. (B.P. ’98), 4to8gr. Garrodii ... ... ... 417 Gossypii Co., 3 or 4 daily ... 442 Gout— Pil. Hydrarg. gr., 1; Ext. Colchici, gr., £; Pil. Col. c. Hyos. gr. 1£. Gregory = Col. Co. ... Guaiacol, 1 to 3 gr. ... Guy’s ... Hamilton Hoedemaker ... Hutchinson, N.H.W. = c. Cret., Pulv. Ipec a.a. gr. 1. Hydrargvri, 4 to 8 gr. Hyd. et Digital. Co.... / Pil. Hyd., 24 gr. \ Pil. Coloc. Co., 2£ gr f Pi1. Hyd., 2£ gr. \ Pil. Rhei Co., 2£ gr _ /Pil. Hyd., 1 gr. \ Third \ Pil. Col. c. Hyos., 4 gr. /night f Pil. Hyd., li gr. ") J Ext. Col. Co., 2 gr. I 4 Ipecac., £ gr. f Ext. Hyos., 1 gr. _ J /Pil. Hyd., 3 gr. \ Opii Pulv., £ gr. Hyd. c. Creta, I, 4 gr. rKyd. c. Creta, 1, 2, £ gr. \ ' ' " t. / Hyd. , Co., 373 445 392 374 71 456 392 > 460 466 463 465 466 4 P. Ipec. Co., 1, 2, 3 gr _ Hyd. Oxy. Cyanidi. 1/10 gr. Hyd. Iod. Flavi, i gr. Hvd. Iod. Rub., 1/50 to £ gr. Hyd. Iod. Rub., 4 gr., et Pot. Iod., 4 gr. ... ... ••• Hyd. Iod., Vir., £ to £ gr. ... Hyd. Iod. Vir., B.S.H.—Hyd. Iod., £ gr., Opium £ gr., Ext. Gent., 2 gr. Hyd. Perchlor., 1/40 to 1/12 gr. „ Co., see Pil. Champney ’’ Subchlor., £ to 3 gr. ... Hyd. Subchlor. Co., 4 to 8 gr. fHyd. Subchlor., 2 gr " g Coloc. Pil., 2 gr. I Pil Rhei Co., 2 gr. (Army Pill iNo, 9.) 470 Name. Dose. Page Pilulse :— / Hyd. Subchlor., 1, 2 gr. \ \Pil. Col. c. Hyos., 3, 4 gr. / /Hyd. Subchlor., 1, 2 gr. \ 4 Opii Pulv., £ gr., 1 gr. / ilyd. Subchlor., Rhei, Cas- cara et Capsic. ... ... 475 Hyoscinse HBr., 1/400 to 1/150 gr. ... ... ... 492 Hyoscyaminae, 1/200 gr. incr. 496 Ichthosulphol Ammon., 2£ gr. Lith. & Soda (of either 1£ gr.), 4 to 12 daily ... 498 Iodoformi, £ to 3 gr. Ioduri Ferrosi F.E. ... ... 417 Ipec. c. Scilla, 4 to 8 gr. Ipecac, c. Urginea, 4 to 8 gr. Ipecac. (Salol ctd.) ... ... 518 Iridin, 2 gr., 1 h.$< ... ... 861 Laxativse Co.... ... ... ■ 133 Lecithin, 1£ and 3 gr. ... 531 ,, c. Ferri Iodid. ... 532 Lithii Guaiacatis, 5 gr. ... 534 „ Luff’s. 359 (Colch. Hyos. Nux.) Meglin ... ... ... 496 Mentholis ... ... ... 551 Meth. Blue, I, 1, 2 gr. ... 325 Monckton ... ... ... 176 Morphinae Mec., HC1., Sulph., £ gr. ... ... 556 et seq. Naphthol-R., 3-5 gr. ... 565 Naphthalini, 3 gr. 567 Neuralgic . 243 Niemeyer ... ... ... 392 Opii Pulv., I and 1 gr. Papain Co., 1 c. ib. ... ... 648 f Pepsin, gr. 1, Quin. Sulph. £ -< gr. 1, Strych. 1/30 gr., Ext. > £ Tarax. gr. 2, Gowers j Phenaloin ... ... ... 134 Phosphori(Martindale), 1/100, 1/50 & i/30 gr., 1 p.c. 681 ,, c. Ferro et c. Nuc. Vom. ,, „ Ferro. Quin. et Strych. ... ... 681 ,, c. Quin. . 682 ,, c. Strych. et c. Ferro... 682 Picis Liq., 1 to 5 gr., 1 or 2... 696 Picrotoxini,l/100tol/30gr./i.s. 874 „ Atrop. et Agaricin ... 874 Plumbic. Opio, 2-4 gr. (about 121% Opium) Plummer’s, 4 to 8 gr. (Hyd. Sub. Co.) ... ... ••• Podophyllin, 1/30 to 1 gr. ... 701 ,, Co., 1 or 2 h.s. ... 701 ,, et Quin, c.cib. ... 701 Poore ... ... ... ••• 701 Potassii Bichrom., 1/10 gr. 703 „ Iod., 1 gr., or more ... 709 ,, Permang., 1 to 5 gr. ... 548 Potentin Co. ... ... ... 868 Quin. c. Bellad. ... ... 219 Quin. Hydrargyri et Opii ... 732 Name. Dose. Page Pilmae :— Quin. Ipecac, et Camphora ... 732 „ Salicyl, 2-6 gr. ... 728 ,, Sulph., 1 to 5 gr. ... 731 ,, Yaler. 1 gr., (and Co.) 736 Bhei Co., 24, 3, 4 and 5 gr. ... 878 /Pil. Bhei. Co., 4 gr. \f , \Ext. Nuc. Vom., 1- gr. S / Pil. Bhei. Co., 2£ gr.\ 7 B \Ext. Tarax., 2^ gr. S ’ Bufi=Pil. Aloes et Myrrh ... Salol, 24 gr. 75 Santonin 4 to 3 gr. ... ... 752 Saponis Co. B.P.' 14 (20% Opium), 2 to 4 gr. Scammon. Co. (B.P. ’98) 4-8 gr. ... ... ... ... Scillse Co., 4 to 8 gr. ... ... 882 Sodii Arsenat., />, 1/64 gr. 179 ,, Cacodyl., i gr. ... 182 ,, Chaulmoograte * A,’ 1, 2 &.3 gr. ... ..., 604 ,, Oleatis, 2 and 4 gr. .... 753 Spender, E.G.A. — Eerri. Sulph., 2 gr., Aloes 1 gr., Ext. Bellad., $ gr. Strych. 1/100 to 1/25 gr. ... 784 Sulphatum ... . 259 “ Third f Pil. Hyd., 1 gr. 1 Night ” i and Col. c. V IHyos., 4 gr. J Triplex, 1 to 3 ... ... 132 Trium Phosphatum ... 419 TJnna’s Chaulmoograte ... 605 TJrgineoe Co., 4-8 gr. > ... 890 Valerian Co. = Trium Valerianatum ... ... 736 Zinci c. Bellad., 1 or 2 ... 824 „ Phosph., t/j to i gr. 1 t.d.682 Zn. Valer. Co., E.G.A. =Zn. Valer, 14 gr., Asaf., 2 gr., Ext. Ballad., 1/12 gr. rimento, Leaf Oil, Snuff ... 874 Pimpinella, 881: Anisum ... 837 Pine Apple, 836 ; Essence ...V. II. Pinewood Creosote . 377 Pineal body ... ... ••• 655 Pinenes, V. II.; Pinheroin, 1 dr. 694 Pink Pills, V. II.; Pink Boot, Indian ... ••• ••• 886 Pinus Canadensis, 874 ; Pumilio, 693 ; Siberica, 693 ; Strobus, 875 ; Sylvestris . 691 Piper Betle ... ... ... 841 Piper Cubebse ... .... 850 Piper Long, and Nig. 875 Piper Methystic . 862 Piperazin, 4 to 10 gr. ; Tabs., 5 gr., 694 & V. II. ; Benz., Glyceroph. ; Salicyl, 2 to 5 gr. 695 Piperidine & Acid Tart., 15 gr. 695 & V. II. Piperin, 1 to i0 gr. ... ... 875 Piperonal ... ... ••• 859 Name. Dose. Page Piroplasmosis ... ... ... 185 Piscidia, 875 ; Pistoia Powders 875 Pistacia Lentiscus, 865 ; Oil ... 866 - " “ ' ..696 ..V. II. ..V. II. .. 959 .. 347 .. 962 .. 962 .. 959 .. 958 955 & V. II. Pitch, Burgundy Pitchblende Pitfleld’s Stains Pitibulin Pitkin on Spinocain Pitocin, 5 to 15 m. Pitressin... Pituglandol Pituitarium U.S Pituitary Gland i gr. Anatomy and Physiology ... 955 Assay ... . 959 Contraindication to use of ... 960 Dry Entire 1 to 3 gr. t.d. 957 ,, Anterior Lobe, 1 to 4 gr. 957 ,, Posterior Lobe, 1 to 4 gr. 958 Eunctions of ... ... ... 956 Galactagogue Action ... 961 Histamine in ... ... 956 In labour, 959, 960, 961 ; small doses... ... ... 959 International Standard ... 959 with Insulin ... ... 642 League of Nations on ... 959 Liquid Ext. Entire Gl. Special, 4 to 1 Cc. intram.... .... 958 Liq. Anter. Lobe. 1 & 2 Cc. 958 Liq. Ext. InhmdiA, 4 to 1 Cc. intram. ... ... ... 958 Obesity treated ... 984, 1071 Oxytocin ... ... ... 962 Phys. Examn. Author’s ... 960 Pitocin and Pitressin in ... 962 (Posterior Lobe) Ext., 4 to 1 Cc, ... .A ... 958 Becognition ... ... .;. 959 Beferences ... ... 960 Separation into 2 principles 962 Sterules Anterior Lobe 1 and 2 Cc. ... ..958 Sterules Entire Gland, i and 1 Cc. .. ... 958 Sterules Posterior Lobe 4 and 1 Cc. ... ... ... 958 Tablets Entire gld. 1 gr. ... 957 Therap. Subs. Act. ... ... 959 Three principles in ... ... 963 Units as Standard ... ... 959 Uses and Befs. 957 et seq. & V. IT, Vasopressin ... ... ... 962 Pituitarin, Pituitrin. ... ... 959 Pityriasis ... ... ...V. II. Pityrosporon Malassezii ...V. II. Pix Burgundica ... ... 696 Pix Carbonis . ... 296 ,, Liquida, 2 to 10 gr. 695 & V. II. ,, Lithanthracis ... ... 296 Placenta ... ... ... 963 Plague j Serum and Vaccine ...V. II. Planadalin, 5 to 10 gr. ... 810 Planocaine ... -...• • .;. 345 Plantago Ovata . 861 Name. Dose. Page Plasmochin ... ... ... 744 Plasmodium vivax, etc. ...V. II. Plasmon Preps.... ... ... 583 Plasmoquin Simplex. 744 ,, Compound ... 744 Plaster Mulls ... ... ... 564 ,, of Paris and Bandages 258 Plasters, Rubber, White Adhesive, 564 & V. II. v. also .. 268 Plastic Surgery. See Paraff. Dur. Plasticisers Plata Coloidal Plata Vitelina Platinocyanide ... Platinum and &V. II. ; Colloidal... Pleurisy Root ... Plimmer’s Stain Plombieres Douche Chloride, Plumbi Acet., 1 to 5 gr ’ 3 3 Carb. ... 3 3 Guaiacolas 3 3 Iodid. ... Lactas ... 5 5 Nitras ... Oleatum >3 Oxidum , .V. II. ... 170 ... 170 ...V. II. 875 ... 370 ... 839 ...V. II. ... 760 ... 697 ... 700 ... 700 ... 700 51 ... 700 ... 599 . 4 ... 700 Plumbum ... ...697 & V. II. Plummer’s Pill = Pil. Hyd. Sub. Co. Pluriglandular Therapy ... 981 Pneumobacilius & Coccus, 903, 916, et seq. & V. II. Pneumococci, Types 917 & V. II. Min. Health Rep.915 Pneumonia .916 & V. II. ,, Optochin in . 380 ,, Vaccine,10m.to2,000mill. 916 ,, and Influenza, 917 ; and Therap. Index... Rockefeller Inst. Work... ,, Serum, 20 to 30 Cc. „ ,, Pane Pneumothorax, Artificial PodophylliRes. Alndica., 1-1 gr. Podophylli Rhiz. Podophyllin, 1 to 1 gr . Podophyllotoxin, 1/10 to i gr. /01 & V • JL_L* Pceonia ••• • • • 8 / 3 Points, Alum ana Copper Sulph. 135 o^O Poison Bush, 831 ; Oak, or Ivy 879 Poisons, Antidotes to ... ••• 1095 (And see Drug in question.) Agricultural 172, 989, 990, 992, 993 and Pharmacy Acts ... 989 Arsenic Act ... ... 993 B.M.A. Resolution ... 989 Commission of Enqy. 989 Gases.. *096 Disinfectants. 992 ‘ Known to Seller ’ Defined ... ••• 905 1076 917 917 918 632 701 701 701 33 33 33 3 > 33 33 33 33 Name. Dose. Page Poisons, Mineral Acids ... 992 ,, Orders in Council ... 992 „ Part I. & Pt. II. 990, 991 ,, 1923 Amendment Act re Sale of Pt. I. Poisons ... ... 998 ,, Regulations for Keeping 993 Sales to Medical Men 993 ,, Schedule ... ••• 990 ,, ‘ Signed Orders ’ for 999 ,, Horticultural and Agricultural (e.g., Acid. Arsenios, Ac. Carbolic, Ac. Hydrocyanic, Cupri Aceto Arsenis, Nicotine, Mercuric Chloride) 172, 989, 990, 992 ,, Irish Free State Sched. 994 ,, Labelling of, Order 1924 . 994 ,, Northern Ireland Sched. ... ... 995 ,, Phenols and Homo- logues ... ... 992 , Through the post ... 993 ,, Wholesale Trading ... 993 {See also Dangerous Drugs Acts.) ‘Poisonous’ Substances ... 992 Poke Root ... ... ••• 874 Polarimeter .V. 11. Polenske No. .v • H• • Politzer Apparatus . 286 Pollacci’s Solution ... ... 135 Pollens & Vaccine ... 661, 914 {See also. Protein Therapy.) Polonium .-*v-IT* Polygala. — 883 Polygonum bistorta ... ... 841 Polygonum var. . 875 Polyneuritis; Polyomyelitis ... 1077 Polyporus Foment.835 Polyporus Officinalis. 833 Polyvalent Sera ... ... 897 Pomade Max ... ... ... 26 6 Pomatum Antipsoricum ... 791 Pomegranate Bark . 656 Ponunade aux Concomb. ... 851 ,, de Lyon . 177 ,, Reclus.328 Pontampons . 44° Ponselle’s Medium .V. 11. Poore’s Pill . ••• 701 Poppy Capsules ...622 & V. II. Poppy, Horned. 8ob Poppy Seed Oil... ... ••• 615 Populus, Populin, 1 to 4 gr. ... 8/5 Portable Inhaler . 549 Portland Cement ... ... 139 Portuguese Glossary.V. 11- Poseidon Disaster . 631 Post-Vaccinal encephalitis 944, 945 Potassa Caustica . 702 Potassa Sulphurata, 2-8 gr. ... /02 Potass. Acetas, 10-60 gr. ... 702 Name. Dose. Page Potass. Argent. lodicl. 168 „ Arsenis, 1/32 to 1/16 gr. 178 „ Benzoas, 15-20 gr. ... 703 Biboras. . 12 Bicarb., 5-20 gr. ... 703 Bichrom., 1/10-1/5 gr. 703 Binoxalas . 831 Bismuthyl Tart. & Pot. Sod. Bi. Tart. ... 235 Bisulphas . 711 Bitart, 15 to 60 or 240 gr. 712 Boro-tart., 20 to 40 gr. 712 Bromid., 5-30 gr. 703 & V. II. Cantharidas, 1-400 to 1-200 gr. hypod. ... 267 Carb., 5 to 20 gr. ... 704 Chloras, 5-15 gr. 704 & V. II. Chlorid. 705 Chloroplatinite (and ate) 875 Chromate .V. II. Citras, 15-60 gr. ... 705 „ Elf., 1 dr. ... — Oyanat. 706 Cyanidum (1/12—E gr.) 706 & V. II. Dihydric phosph. ... 711 Eerrooanidum, 8 gr. ... 706 & V. II. Forma 1-6 to 3 gr. ... 32 Glyceroph., 3-8 gr. ... 35 Guaiac-sulphon., 15 gr. 447 & V. II. Hydroxidum ... Hypophos., 1 to 6 gr. lodidum, 5-20 gr. Margosate Metabisulphis ... Myronate Nitras, 5 to 20 gr. Nitris, i to 1| gr. Oleas Osmas ... Oxalas Acid Percarbonas Permang., 1 to 99 99 9 9 99 99 99 99 99 99 99 5 9 99 99 99 99 9 9 9 9 9 9 99 99 9 9 99 9 9 99 99 9 9 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 Snake B. 702 083 706 ... 839 ...V. II. ...V. II. ... 710 ... 711 598, 753 ... 831 ... 831 ...V. II. 3 gr. 545 <fc V. II. Lancets 547 Permang. Spray for C. Sp. Fever . 907 Persulph. .V. II. Phosphas, 1 to 10 gr. ... 711 ,, Acid . 711 Picras . 57 Pyroborate . 12 Quadroxaiate ... ... 831 Salicylas, 5 to 30 gr. ... 61 Silicas.V. II. Silver Iodid.168 Succinas, 5 to 10 gr. 831 Sulphas, 15 to 45 gr. ... 711 ,, and Amnsthetics ... 353 ,, Acid ... ... 711 Sulphocarb., 10 gr. ... 711 Sulphocyanid., f to 3gr. 711 Tart., ^ to 4 dr. ... 712 Name. Dose. Page Potass. Tart. Acid, 15 to 60 gr. 712 ,, Telluras .V. II. ,, et SodiiTart., 120-240gr. 774 Potassio-Mercuric Iodide 464 & V II. Potassium . 702 & V. II. Potato, Starch, 836 ; in Bread V. II. ,, Sweet ... 800 Poterium Sanguisorba ... 881 Potion Gommeuse . 1 Potion Ioduree, 3 oz. in dil. ... 710 Potter’s Asthma Cure ... ... 710 Potter’s Walnut J uice Hair Dye 306 Potus Imperialis . 712 Poudre contre coryza. 550 ,, d’lpecacuanha Opiac^e, Max. single, 15 grains 518 ,, de Beglisse Co. ... 857 ,, de Scille 882 „ de Strophanthine au Centieme, Max. single i gr. 783 Powell’s Balsam .V. II. Prayer Beads. 827 Pre-Anaesthetics, see Basal Hypnotics. Precipitate, Black, 458 ; Bed, 477 ; White 458 Precipite Blanc. . 473 Precipitin . 894 Preface ... ... ... ... iv. Prescriptions, Analysis of D.D.A. 1007 Preservative Solution ... 20 Preservatives in foods ...V. II. Prickly Ash . 892 Primula obconica . 875 Privet.859 Procaine. 345 & V. II. Proflavine, 303 & V. II. ; Bougies, 304 ; Patents, 303 ; Antiseptic Power, 304 ; Tablets ... 304 Progynon .955 Prohibition . 112 Proof Spirit .108 & V. II ,, ,, Conversion Factors 110 Prophylactic Ointment 458, 461, 471, 473 Proposote, 10 m. ... 380, 526 Proponal, 2 to 8 gr. ... 810 & V. II. Proprietary Foods, 584 ; Medicines, V. II. ; Bill, V. II. & Preface ‘ Propyl ’ (Iodine Soln.) ... 512 Propyl Ale. Normal . 119 „ „ Iso.118 & V. II. Propylene . 118, 288 Propyl-piperidine . 374 Protargin Mild, 170 ; Strong... 171 Protargen . 171 Protargol and Sterules of ... 171 ,, Jelly. 171 Protective Colloid . 362 Protein Therapy . 660 ,, Non-specific in Arthritis 668 ,, Skin Tests . 660 ,, Shock ... ... ... 667 Name. Dose. Page Proteins, Food.V. II. Proteose, Urinary . 670 Protoxalate de Fer, 1 to 5 gr. 417 Protozoa, see Amoeba'. Pruni Yirginianae Cortex 875 & V. II. ... ... 884 . 147 . 40 ... ... 353 ... 1078, 1079 . 875 .1079 . 517 . 875 . 875 1100 & V. II. .V. II. Prunol Primus var. Prussic Acid Psicaine Psittacosis Psoralia ... Psoriasis... Psychotria Ipec. Psyllii Sem. Pterocarpus Ptomaines Ptyalin ... Puerperal Sepsis Glycerin Acriflavine Iodine... ... ... Serum... and see Therap Index. Puff Ball Pugh’s Stain . Pulegium . Pulque ... • • • ••• ■ * • Pulsa, 2 dr. ... ... ... Pulsatilla ... ... ••• Pulveres Conspersa . Pulverette Powder Pills Pulv. A.P.C., 12 grs. Acetanilid Co., 3 to 5 gr. Alkalinus Co., 1 dr. Aloes c.Canella, 3 to 10 gr. Amygdalae Co. ... Antimonialis, 3-6 gr. ... Aromat., 15 gr. ... 844, 893 Aspirin Co., 12 gr. ... 71 „ Quin, et Amido- pyrin, 10 gr. 71 Basilicus, 4 to 8 gr. ... 475 Bismuth Co. MacLean 1 dr. 224 „ „ N.H.I., £ dr. 225 „ L.H., 1 dr. 225 ,, c. Morph. ... 232 (Not for internal use.) Calc. Chlorinatae Ac. Boric Calcii Glycerophosph. c. Lacte Exsicc., £ oz. Catechu Co. ’14,10-60 gr. Cinnamoni Co., 10 to 60 gr. Cretae Aromat., 10to60gr. ,, Aromat.c.Opio,10 to 60 gr. Cretae Co. (U.S.), av. 30gr. Doveri, 5 to 15 gr. ... Dyspeptic Co. ; Bism. Carb., Sod. Bic., Mag. Carb. ed.p. ceq., dose 1 drachm Effervescens Co. Elaterin Co., 1 to 4 gr— Glyceroph Co., 1 to 2 dr. ,, cum Lacte, £ oz. ... yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy ... 433 ... 301 920, 1079 ... 864 ...Y. II. ... 876 ... 876 ... 846 ... 876 ... 824 ... 690 ... 71 3 224 133 148 161 44 34 295 626 626 376 518 )) 774 852 36 34 Name. Dose. Page Pulv. Glycyrr. Co., 60 to 120 gr. 857 ,, ,, ,, sine Sacch. 857 ,, Gregory, 10 to 60 gr. ... 879 ,, Guaiaci Co., 20-40 gr. ... 790 ,, Hypoph. Co., 1 to 4 gr. 684 ,, Ipecac. Co., 5 to 15 gr.... 518 ,, Jacobi (Antimonial), 3 to 6 gr.161 ,, Jalapae Co., 10-60 gr. 861 ,, Kaladanae Co. 10 to 60 gr.. 862 ,, Kino Co. ’14 (5% Opium), 5 to 20 gr. ... ... — ,, Lecithin, 10 to 15 gr. ... 532 „ LiquiritiaeCo.,60tol20gr. 857 ,, Lobeliae Co.710 ,, MacLean, 1 teaspoonful 224 ,, Magnes. Boro-Cit. Co. ... 12 ,, Mag. Hydrox. c. Carb., 1 to 2 dr. ... ... 537 ,, Menthol Cocaine Co. ... 550 ,, ‘ Old English ’ Fever ... 732 ,, Opii, £ to 2 gr. ... ... 622 ,, Opii Co., 5 to 15 gr. ... 626 ,, Papain Co. ... ... 648 ,, Pectoralis, 60-120 gr. ... 857 „ Pil. Coloc. Co. 373 ,, Potass, Chloratis Co. ... 705 ,, Pot. Nitritis Co., 43£ gr. 711 ,, Potassii et Sodii Chloridi Co., £ dr. ... ... 705 ,, pro Pedibus ... ... 137 ,, Quin. Co., 12 gr. ... 732 ,, Quin. Arsen. Hydrarg et Ipec. Co. ... ... 732 „ Ithei Co., 10-60 gr. ... 879 ,, Bosae Co_ ... ... 872 ,, Salicyl. c. Talco. ... 59 ,, Santonini Co., 5 gr. ... 753 ,, Scam. Co. ’14, 10 to 20gr. — ,, Sodae Tart. Eff. ... ... 774 ,, Sodii Chloridi Co. (gargle) 763 „ „ Nitritis Co. 574, 711 ,, Succ. Papav. Cap., £ to 2 gr. ... ... ... 622 ,, Tragacanthae Co., 10 to 60 gr. ... ... ... 804 „ ZinciOleat.Co.(p.Pedibus) 137 Pumpkin ... 851, 873 Punica Granatum ... ... 656 Punicine... ... ... 657 Purgatives, 1043 (see also Hyp. Purgatives). Purgen, £ to 8 gr. ... ... 672 Purging Agaric... ... ... 833 Salt, Tasteless ... 770 Purin derivatives ...633 & V. II. See also Nutrimenta. Purpuric Fever, Malignant ... 904 Pussy Willow. ... 881 Putty Powder. 886 Pyelography . ...Y. II. ,, Abrodil ... ... 769 ,, Sodii lodid. ... 768 ,, Urosclectan ... 877 Pyman’s Amyl Cresol ... 31 Name. Dose. Page Pyoktanin . 821 Pyorrhease ... ... ... 199 Pyraloxin ... .... 58 Pyrorrhoea alveolaris (Emetine in, 522), . 918 Pyramidon, 5-8 gr., and Salts, 8-15 gr. 329 & V. II. Pyra zolonum-Phenyl-di-methyl. Salicyl.328 Pyrene = Carbon Tetrachlor. Pyrethri Flores and Radix ... 876 Pyridine, 5 to 10 m. 870, 877 & V. II. „ Carbonic Ac. Diethyl- ... ... 263 . 308 ... 444 & V. II. ... 57 & V. II. 58 to 8 gr. 234 ..y. 11. 58 58 ... ... 667 1073 amide Pyridium, 14 grains Pyrocatechin ... Pyrogallol 4 to 14 gr. ,, Acetate ,, -Bismuth, ,, Hair Dye ,, Oxidatum ,, Triacet. Pyrogenic Therapy . ,, for G.P.I. ... Pyroleum betulse, lithanthracis, oxycedri and pini Extractive Page. 7251 128, 527, 738r 727 & V. II.. ...Y. II.. ... 741L ...y. 11.. Name. Dose. Quinine, as Local Anaesthetic Quinine ‘ Activated ’ ,, Base prepns. ,, Estimation ,, ,, in blood ,, and Bacteria ,, Ether and Olive Oil Mixture for Rectal Anaesthesia . ... 1022 ,, Excretion.V. II. ,, . Haemoglobinuria... ... 73Cj ,, Hydrogenation..V. II. ,, as Local Anaesthetic ... 725: ,, and Black Water Fever... 73C ,, Soln. Isotonic . 725! ,, in Precipitating Labour... 102, 7311 ,, in various affections ... 73C „ Ionisation ... ...V. II „ production . 7j.SU „ Synthetic ... 719&V. II ,, Tests for.V. II ,, Wound Treatment ... 72E Quinine in Malaria . 737: ,, absorption and excretion 7413 ,, Ill effects of ... 743. 74^ Tar residues, P. Svec. . intramuscular use ... 74(5 Pyrometers ...V. II. ,, necrosis from ... 74(5 Pyromucic Aldehyde ... ... 128 ,, tetanus from ... 74E Pyronin. ...V. II. 5 5 intravenous use ... 73(1 Py rosin. ...V. II. 5 5 in England ... 742 Pyrotherapy . ... 667 • 5 5 oral use (Optimum Dose) 738 (See also Typhoid Aaccine.) 5 5 Paramecia Tests ...V. II Pyrotherapy in G.P.I. ... 1073 55 pregnancy, during ... 742 Pyroxylic Spirit, 30 to 60 m. ... 114 55 prophylactic use ... 742 Pyroxylin . ... 359 5 5 relapses. ... 741 Pysect ... ... 876 5 5 standard treatment . t (U.S.A.) ... 738 Quackery . ...y. 11. 5 5 subcutaneous use ... 74E Quadronal ... 329 5 5 toxic effects 743, 748 Quadro-nox ... 329 5 5 with Calomel ... 7311 Quarantine ... 988 5 5 ,, Arsenic ... 7311 Quassia, Quassin and Supposi- Quinina) Acetyl-Salicyl., 1 to 5 tories ... . 877, 878 gr. ... 7211 Quaternary Compds. ...V. II. 55 Aceto-Coumaras, 3 to Quebracho . ... 8/8 5 gr. ... ... 8211 Queen’s Root ... ... 887 5 5 Acid Hydrochlor. 724 & V. II Quercus Subcr. ... 878 55 Bi-HCl., 1 to 10 gr. ... 728 Queues de Cerise ... 500 55 Bisulph., 1 to 10 gr. ... 73S Quevenne’s Iron ... 411 55 Bromide, 1 to 5 gr. ... 72(3 Quillaia ... ... 878 55 Cacodylas, 14 to 4 gr. ... 71£ Quinanyl ... .... ... 320 5 5 Camphoras, 1 to 10 gr. ... 71£ Quince ... . ... 851 55 Carbonate ... 735 Quine turn .. .... 718 55 Citras, 1 to 5 gr.... ... 7111 Quinic Acid ... 719 55 Di-ethyl-barbiturate ... 81(0 Quinidine ... 713, 714 & V. 11. 55 Di-HCl., 1 to 10 gr. ... 72-4 ,, in auricular fibrillation ... 714 55 Ethylcarb., 3-15 gr. ... 735 ,, Hydrochlor. ... 716 55 Ferri Citras, 5 to 10 gr. ... 7111 ,, ,, Acid ... 716 55 Fluorid., 1-20 to 4 gr. ... 83(0 ,, Periodide, 14 to 3 gr. 131, 716 5 5 Formas, * Basic ’ (subcut. ., Sulph., 5 to.10 gr. 714 & V. II. 1 to 3 gr.), 1 to 5 gr. ,, ,, Slipules, 5 and 6 gr. 715 and ‘ Neutral ’ ... 72a ,, Sulph. Acid ... 716 55 Glyceroph., 3 to 8 gr. ... 35 Quinina, 1 to 4 gr. (Antimalarial 55 HI and HI. Acid, 1 to 5 15 gr.) ... 718 gr. ... 72( 99 „ Dose. P\be Qumina, HBr. 1 to 5 gr. ... 720 ” ” Acid., | to 2 gr. FPI 1 /kyp.) ••• 721 ” HU, 1 t<p 10 gr. ... 721 & V. 11. ” j, Acid., 1 to 10 gr., 4 to 2 gr., hyp. 724 ” » lntrav. Inj. 4 to 15 gr- ... 724, 739 *» ,, Carbamid., 5 to 15 gf. . 725 „ -Sulph., 1 to 10 gr. 737 Hypophosph., 1 to 5 gr. 726 Iodas., 1 to 5 gr. ... 737 lodicie and Acid ... 726 Iodo-Bismuthate ... 238 Lactas, 1 to 5 gr. ... 727 Mannitol. 129, 727 Nasal Douche . 731 Nucleinas, 1 to 5 gr. ... 728 Periodid., 1£ to 3 gr. 131, 728 Phosphas., 1 to 6 gr. ... 728 Salicylas, 2 to 6 gr. ... 728 Sod. Bic. Tabs., 3 gr. ... 718 Sulphas (Acidus, 1 to 10 gr., 733 & V. II.) 729 & Y. II. Sulphocarb., 1 to 6 gr.... 737 Tannas, 1 to 4 gr. ... 734 Tylmarin, 3 to 5 gr. ... 829 and Uran. Chlor., 3 to 6 gr. V. II. Urea, 5 to 15 gr. ... 725 and Urethane, f-3 gr. ... 734 ,, Veinlnjn. £ Cc. incd. 735 .. Valerianas, 1 to 4 gr. ... 736 Quinisan Tabs., 1 or 2. 729 Quinoform, 1 to 5 gr. 720 Quinoidine, 2 to 4 gr. 737 Quinol, £ to 5 gr. . 860 Quinoline, 315 ; Blue. 316 „ Tartrate . 315 Quinolyl Derivs. of Antimony 164 Quinones .V. II. Quinoxyl .319 babies ... Radiant Heat .. Radiology ladiomalt ladiomulsin ladiostoleum .. ladiostol Pellets ...Y. II. ...Y. II. ...V. II. ... 541 ... 594 594 541, 594 594 ;ADi0M and Radioactivity, Chemical properties, Emanation, Mfre., Rays, a, p and y, Therapeutic use in cancer, etc., V.II. Ladon ... ... . .y* Lagazzoni’s Injection ... ... 463 Lagweed, Ragwort ... 601, 883 ^ami Syrup .. ••• Lamsay on Ra. Emanation ...V. li. ranunculus Eicaria . ,ape Oil . '56 ^asot .Sii raspberry . tt ,at poison, Arsenical.V. 11. Name Dose. Page Rats, Squill, etc., for. 882 Ravaut’s Paste ^97 Ravogli’s Liniment ... *" ig Raw’s Tuberculin ... 931 §a£.0IY;. 442&V.II. Rebipel Agar.y tt Reclus Pomade ... ... ’323 Reconstituted Cream ... Y II Rectal ether ... 97, 100'k ' seq. Rectal Feeding, see Enemata ... 395 Rectified Spirit ... ins Recurrent fever ... *“y TT Red Biddie .115 &V. II.' ,, Bone Marrow ... ... 948 „ Gum, 5 to 20 gr. ... 853 » . 700 ” xtlz‘i ’" % / ••• ••• 116 „ Neutral (see also Neutral R.) V.II „ Precipitate 477 » J00! , TTT. 863 ,, Sanders Wood . 875 „ Scarlet . 312 „ Soudan III. . 326 ,, Water Fever . 185 Redwood Viscometer.Y. II Refrigeration .23 & V. II. Regional Anaesthesia & Novocain 345 Relapsing Fever ... 185 & V. II. Remijia Species . 380 Remittent Fever applied to varied malaria types v. V. II. „ „ Bilious .V. II. Renaglandm . 968 Renal Function Tests.V. II. Rendell’s Quinine Pessaries ... 723 Renner’s Lymph . 941 Rennet,Essence, 657 ; Tabs. ... 658 Rennin ... 583, 633, 657 & V. II. Resina.878 ,, Carbolica, R.D.H. ... 19 „ Ipomoese. 861 ,, Jalap, 2 to 5 gr. ... 861 Resistance, Electric .V. II. Resorcin, 1 to 5 gr. ... 745 & V. II. ,, Blue .V. II. ,, Hair Lotion . 746 ,, Hexyl, 2 to 10 gr. ... 747 Ichthyol. 498 -monacetate . 747 phthalein Anhydride ... 672 ,, Test for HC1. and Ligne- fied Tissue .Y. II. Resorcinol . 745 Respiration, Artificial. 142 Respirator Solution . 87 Rest Light ...V. II. Reudel Bath Saltrates ...V. II. Revelliod’s Method ... ... 232 Rhamni Catharticus. 855 ,, Frangulse Cortex ... 855 ,, Pursh. Cort., 3 to 15 gr. 274 Rhatany Root. 862 Rhei Radix, 15 to 30 gr. 878 & V. II. Rheumatism Root (Dioscorea) 852 IT Name. Dose. Page Rheumatism Serum and Vaccine (v. also Therap. Index) ... 919 Rheumatoid Arthritis—B. Coli and B. Typh. in, 668, 909, 940, 1081 ; Notification. 920 Rhigolene . 656 Rhinoculin ... ... ... 350 Rhodallin . 757 Rhodamines, 674 ; Rhodinol ...V. II. Rhodan-Calcium-Diuretin Tabs. 1 t.d.798 Rhotanium . 875 Rhubarb Leaves, 879 ; Root ... 878 Rhus Aromat., 870; Glabra, 879 ; Toxicodendron... ... 879 Rice, 836 ; and Beri-Beri 588 & V. II. Richardson’s Solution ...V. II. Ricinus ... ... ... ... 616 Rickets, 1082 (see also Accessory Pood Factors, 591, 592 et seq.) Rickets, Light in relation to ... 591 Rickettsia ... ... ...V. II. Rideal-Walker Coefficient ...V. II. ,, of Ess. Oils ... ...V. II. Ringer’s Solution ... ... 759 Ringworm, 1088 & V. II. ; Ointment 696 ; Infective period 9S8 ,, Thallium Acet. for ... 889 Rivanol ... ... . 304 Rochelle Salt, 120 to 240 gr. ... 774 Roche’s Embrocation ...V. II. Rodinal ... ... ... ...V. II. Roeder’s Gut ... ... ... 533 Roentgen Rays V. II. Rogers, Sir L., on Dysentery 519, 520, 521 Romanpwsky’s Stain.V. II. Rongalite ... ... ... 200 Room Disinfection 27, 124, 127 & V. II. Rosa Damascena, 872 ; Gallica 879 Rosalane ... ... ... 461 Rosaniline HC1., i to 4 gr. ... 320 ,, Acetate ... . 321 Rosebcrry’s Mist., 1 oz. ... 732 Roseine and Acetate ... ... 321 Rose Oil ’ ... ..* ... 312 Rose Otto ... ... ... 872 Roseola, Epidemic . 988 Rosettol ... .•• ••• t 872 Rosindol Reaction .V. II. Rosolic Acid ... ... ...V. II. Ross, on Malaria Relapses 738, 741, 743 ,., Inst. Repts. Rothera’s Test ... Rouge, Polishing Roux’s Stain . Rubber, India, Bandages Rubber, Dental ,, Gloves.- Rubella ... Rubia Tinctorum Rubidium Salts. Rubine ... 743 II. i 85 .V. II. . 267 . 267 . 268 . 988 . 880 . 880 . 320 Name. Dose. Page Rubini’s Camphor, 2 to 5 m.... 262 Rubus Chamaemorus, etc. ... 880 „ Villosus... ... ... 880 Rue, 880 ; see also Harmine ... 858 Ruhmkorff Coil... ... ...V. II. Rum ... ... ... ...V. II. Rumex Sp., Rumicin, 1 to 4 gr. 880 Rusby, H. H., on Cinchona.— C.D. and P.J., Oct. 5, ’29. Ruspini’s Styptic .V. II. Russ. Hemp Seed ... ... 843 Russian Paraffin Liq. ... ... 652 Russolax, 2 to 4 dr. 652 Ruta ... ... ..... ... 880 Ryutan ... ... ... ... 856 Sabadilla (Ceyadilla). 891 Sabal ... ..... ... ... 882 Sabina ... ... ... ... 880 Sabouraud’s Pastelles, Milk Serum... ... ... ...V. II. Sabouraud - Rousseau Sensitisation Test, re Hair Dye ... 305 Saccharas Eerricus ... ... 411 Sacch. Ferric Oxide, 10 to 40 gr. 415 Saccharated Iron Carb., 10 to 30 gr. ... 411 Sacch. Iron Phosph., 5 to 10 gr. 417 Saccharides ... ... ...V. II. Saccharin, i to 2 gr. ...748 & V. II. „ Tablets . 749 ,, Soluble, i to 2 gr.... 749 Saccliaromyces Cerevisiae (see also Yeast) . 276 Saccharosan ... ... ... 75] Saccharose . 749 Saccharum Amylac.427 ,, Lactis ... ... 863 ,, Purificat. ...749 & V. II. ,, Satumi, 1 to 5 gr. 697 Saclis-Georgi Reaction.V. II. Sacred Bark ... ... ... 274 Saffron.850 Safranine Test ... ... ...V, II. Safrol, 20 to 30 m. ... ... 882 Sagapenum . -.. 880 Sage ... .881 Sage, C. E., on Merc. Biniod. Tablets . 464, 465 Sahli’s Caps . 690 St. Ignatius Bean . 596 St. Ivel Lactic Milk and Cheese 54 ,, Jacob’s Oil .V. II. St. John Long’s Liniment ... 693 Sajodin, 15 gr. 516 Salacetol, 10 to 30 gr. ... 74 & V. II. Sal Acetos ... ... ... 831 ,, Alembroth Bandages, Wool, etc., and Injection 472 A V. II. ,, Ammoniac v. Ammon. Chlor. ,, Carolinum, 20 to 60 gr. ... 773 ,, de Vichy, F.E. . 764 ,, Emsanum, Fact., 773; Hunyadi Janos, Vichy, Wildungen .... ... 773 Name. Dose. Paoe Sal Enixum ... 711 „ Limonis .831 & V. II. „ Marinum Artif.762 „ Polychrestum, 30 to 120 gr. 711 „ Sedativ. de Homberg ... 9 Salad Oil . 261, 615 Sale of Food and Drugs Act ...V. II. Salep .880 Salicifrice . 755 Salicinum, 5 to 20 gr. ... 74 & Y. II. Salicyl. Piperaz, 2 to 5 gr. ... 695 „ Salicylate, 15 gr. ... 68 „ Sulphonic Acid ...Y. II. Salicylic Cream, 1 in 64 ... 60 „ Gauze, Lint, Wool ... 60 Salicyl Santalol. 620 Saligenin, 10 gr. . 74 Salicylosol . 60 Saline Gelatin. 424 „ Hypertonic . 760 „ Hypotonic . 761 „ Normal.759 ,, Solubes, Sterules ... 760 Saline and Ether . 99 Salipyrin, 15 to 30 gr. 328 Salit (inunction), \ to 1 dr. ... 68 Saliva .V. II. Salix, var., Nigra, Discolor ... 881 Salmonella bacteria .Y. II. Salodine. ... 707 Saiol, 5 to 15 gr., 75 & V. II. ; c. Camphora, 76; Catheter Oil, 76 ; Collodion, 76; Emulsion, 76 ; Mouth Wash, 76 ; Pill Coating 76, 690 Salophen, 10 to 15 gr.... 83 Salt, Table, for salt-free diet. 762 : with Pot. Chlorid. 705 „ Iodised ... 707 ,, Baths, 762, 772; Salt free diets 759, 762 ,, of Sorrel. ... 831 „ of Tartar, 704 : of Lemon 831 ,, Packs . ... 761 ,, Anti-Catarrhal, etc. ... 19 Salts, Mineral in foods... ...V. II. Salufer. ...Y. II. Salurene... ... 453 Salvarsan, 0T to 0*4 Gm. ... 191 ,, Silver, 0-1 Gm. ... 199 Salvarsanised Serum ... ... 198 See also Arsenobenzol. Salve Soap . ... 867 Salvia ... 881 Salyrgan, | to 2 Cc. ... „.. 485 Sambuci Flores. ... 881 Samsonite ... 570 Sanaphos, 2 dr. 35 Sanatogen ... 35 Sandal Wood Oil, 5-30 m. ... 619 Sandarach Solution ... 689 Sander’s Wood, lied ... ... 875 Sandor C02 Baths ... 772 Sandoz Felamine ... 454 Name. Dose. Page Sanguinaria ... 881 Sanguisorba . ... 881 Sanguinarin, % to 1 gr. ... 881 Sanguis Draconis, 852 ; Sangui- suga, vide Hirudines ... 950 Sanitary Towels . 440 Sanitas and Preps. ... 693 & V. II. Sanodora Moss Sheets ... 778 Sanocrysin . 213, 214 Sanogyl. 198 Sansiviera . ... 881 Santalol, Caps., 5 m. Forma- gules ...620&V.II. „ Methyl Salicyl., 4 m. ... 620 „ Salicyl-ester, 15 to 30 m. 620 Santalum Pub. 875 Santal Oil . ... 619 Santheose . 796 Santoninum, 1 to 3 gr. 751 & Y. II. „ Golden, 2 to 5 gr. ... 753 Sanusin Sempules ... ... 233 Sapo Amygdal. Anim., Dur., Kalinus Medic., Moll., 753, 754 & Y. II. ; Moll, peroleat, 754 ; Venetus,Virid, 753 etseq. (See also V. II.) „ Lanolin ... ... ... 94 „ 01. Tereb. 693 „ Superadipat ... 754 „ Thymol . ... 801 Sapones. ... 753 & V. II. Saponification, Bolton’s way without soap ... 755 ,, Nos. of Fats... ...V. II. Saponins ... . ... 881 Sapotoxin ... 878 Sappan . ... 858 Sarcinse . ...Y. II. Sargol . ...V. II. Sarkosin . f..V. II. Sarsse Radix, Sarsaparilla ... 881 Sassafras . ... 882 Sassy Bark . ... 853 Sauce Preservatives ... ...V. II. Sauerin. ... 52 Saurolo ... ... 497 Saussurea . ... 850 Savaresse’s Capsules ... ... 620 Savory and Moore’s Food ... 584 Savin Oil, 1 m. ... 880 Saw-Palmetto, \ to 2 dr. ... 882 Sawyer’s Ointment ... 518 Saxin ... 748 Saxonite... ... 570 Scabies Ungt. See also Therap. Ind. ... ... ... ... 791 Scales’ Benedict Test ... ...Y. II. Scammonise Rad. (Res., 3- 8 gr.) 861, 882 Scammonin, 1 to 5 gr. 861, 882 Scammonium, 5 to 10 gr. 861, 882 Scarlatina Antitoxin, 920 : ; Vac- cine ... 921 pp2 920 II. 312 625 990 40 178 723 511 II. . 374 .V. II. . 171 . 154 .V. II. . 891 .V. II. 890 .A Name. Dose. Page Scarlatina, Infective Period ... 988 ,, Dick Test & Prophylaxis, 921 ; Schultz- Charlton Reaction ... 920 & V. II. ,, Serum . Scarlet Colors ... ...312&A ,, Non-staining . Sceleth's Method Schedule of Poisons Scheele’s Acid ... Scheele’s Green, 1/100 to 1/25 gr. Schereschewsky’s Quin. Ung. Schiassi’s Method Schick Test in diphtheria Schierling Schiff’s Reagent Schindler’s Jelly Schlippe's Salt Schmiedeberg’s Rules ... Schcenocaulon ... Schultz-Charlton Reaction Scilla, 1 to 3 gr., 882 Tnrl icfl Sclavo’s Anthrax Serum 901 & V. II. Sclerosis Disseminated & T.A.B. Vaccine ... ... ... 940 ,, C.S. Fluid Exam. ...V. II. Scoparin... ... ... ... 886 Scopola var. ... ... ... 883 Scopolamine ... ... ... 491 „ HBr., 1/200 to 1/100 gr. 491; HC1. & HI. „ Nitrogen Oxide ,, La3\ro. Morphine Anaesthesia, 492; with Atropine ... ft ,, c. Ether Saline Scotch Paregoric, 1-1 dr. Scotch Fir . Scott-Wilson Test .A7 Scott’s Dressing . ,, Emulsion .V Scurvy (& Therap. Ind.) 589, 592 Scutellaria (Skull-cap) ... 883 Sea Holly, 853 ; Poppy, 856 ; Salt and Artificial, 762; Tangle, 863; Water and Artificial, 762 ; Water, Iodine in, V. II. ; Radium in, V. II. ; Treatment. Seaweed, Seawrack Sealcones . Sealed Tubes of Gelatin, 424 Glucose, 428 ; Saline See also Sterules. Secale Cornutum, 15-60 gr. .. Secondary List of Drugs Secret Remedies Secretin Extract Secretin (and Tabs., 950), 950 & V. II Secretogen Elixir, 1 to 2 dr. ... 950 Section cutting and Stains ...V. II. 494 494 492 493 100 628 691 . II. 457 . II. . 762 . 855 .V. II. ! 760 . 401 . 827 .V. II. . 950 Name. Dose. Page Sedasprin, 5 gr. ... 78 <fc V. II. ,, Salts ... ... ... 78 ,, Liberation of Br. ... 78 “ Sedeff,” 1 to 2 dr. in aq. ... 225 Sedicyl Tabs., 1 or 2 ... 5 Sedobrol, 1 to 3 p.d. ... ... 764 Sedormid, 1 tablet ... 814 Sedresol ... 697 Segra ... 854 Seidlitz Powder. ... 774 Seigel’s Syrup. ...V. II. Seignette Salt, 120-240 grs. ... 774 Sel Anglais ... 538 „ de Barnit. ... 90 „ ,, Javelle. ... 41 ,, ,, Sedlitz. ... 538 Selenium ... 792 ,, Colloidal ... 370 ,, Comps. Organic ...V. II. ,, Lead in cancer ... 368 ,, Oxide ... 792 Self-Inflator Drops ... 286 Seliwanoff’s Test ...V. II. Sellard’s Test. ... ...V. II. Semen Stains and Tests ...V. II. Semolina ...V. II. Semori Tablets... ... 722 Sempervivum. ... 883 Semprolin Emulsion ... ... 653 Senecio var. ... 883 Senegae Radix ... ... 883 Senna (and Pods), 10 to 30 gr. 883 Sensitol Red, etc. ... 315 Sensitised Vaccines ... 946 Septicaemia Serum ... 920 Sera Chapter . ... 893 Sero-Vaccines ... ...946 & V. II. Serpent Venom. ... 964 Serpentariae Rhizoma ... ... 884 Serum Agglutination ... ...V. II. ,, Anti-carbuncosum ... 902 ,, ,, -Colon B. ... ... 909 ,, ,, -Diphth. and Purif. 910 & V. II. „ „ -Dysentery ... 912 ,, ,, -Gas Gangrene, see Peritonitis and Toxaemia, Therap. Ind. ... 1075, 1089 „ -lytic . 963 ,, -meningococcus ... 907 ,, -pneumococcus (Pane, 918) 917 ,, Streptococcic ... 920 ,, Tetanic ... ... 923 Colloidale Completum... 2 Diphtheria, 8,000 units (Proph. 500 to 1,000 units)... ...910 & V. II. Dysentery . 912 Endocarditis ... ... 920 Erysipelas ... ... 920 Ferruginous . 37 Haemostatic . 964 Horse . 963 Name. Dose. Page Serum Nevrosthenique ... 37 ,, Normal Horse ... ... 963 „ Peptone is asthma ... 664 ,, Puerperal Fever ... 920 ,, Rheumatic Fever ... 920 ,, Scarlet Fever ... ... 920 (See also diseases or organisms and Vaccines.) Serums ... ... 897 Sesquiterpeneiess Oils ... ...V. II. Sethia var. ... 884 Sevum Benzoatum ... 681 „ Phosphoratum... ... 681 ,, Prseparatum ... ... 681 Sextol ... ... 290 Shadocol . ... 676 Shale ... 309 Shavg. Brushes and Anthrax ... 902 ,, Soap ... ... ...V. II. Shaw-Mackenzie on Lipase in Cancer and Tuberculosis 753, 755 Shea Butter and Nuts... ... 884 Sheep Dip Regulations ... 173 „ Wool ■. ... 439 Shellac. ... 884 Sheltox. ... 876 Sherry. ...V. II. Shipway’s Apparatus ... ... 282 Shircore on Bismuth Arsanilate 238 Shirlaw on Cancer Treatment 431 Sidonal, New, 30 gr. ... ... 695 Sigma Reaction ...V. II. Sigmoidoscopy. 522, 526 Signed Orders ... ... 1014 Sil-Al., 1 dr. ... 138 Silica, Y. II. : Silicon Carbide V. II. Silicates, Soda and Potash ...V. II. Silicosis ... ...Y. II. Silk, Artificial, 442 & V. II. : Sutures ... 533 Silkworm Gut ... ... 533 Silk, Tests for. ...V. II. Silver Colloidal... ... 371 ,, Gelatose ... ... 172 ,, Hair Dye ...V. II. ,, Ionisation ...V. II. ,, Nitrate, F to i gr. ... 168 ,, Mitigated ... ... 169 ,, Toughened ... 169 ,, Oleate Injn. (Billimoria) 601 ,, Oxide, £ to 2 gr. ... 170 ,, Protein,Mild,170 ; Strong 171 ,, Salvarsan ... ... 199 Simaruba ... ... 527, 884 Sinalbin, Sinigrin, Sinapis ... 756 Sinclair’s Glue ... ... ... 860 Singleton's Ointment ... ...V. II. Sionon ... ... ... ... 647 Sippy’s Powder... ... 224, 536 Sirop des Cinq Racines ... 165 ,, d’Erysimum, £ oz. ... 853 Sirupus Codeinse, F.E., 5 Gm. 356 (See also Syrupus.) Sistomensine Tabs., 1 or 2 ... 950 Skatol in Ergot Assay 403, 404 yy yy yy Name. Dose. Page Skin Food, 448 ; Cream ... 803 Reactions... ... ... 660 Tests ... ... ... 660 Sterilisation, 470; (Mer- curome, 480); Iodine, 511 ; Thymol, 801 ; Yiodar ... ... ... 513 Skull Cap = Scutellaria ... 883 Sleeping Sickness (see Trypanosomiasis, Therap. Ind. and Y. II.) Slippery Elm Bark ... ... 890 Slipules ... ... ... ... 691 (See also Individual Drugs.) Smallpox . 942, 988 and cbickenpox diagnosis 942 Flocculation Test ... 942 in England ... 943 et seq. Smedley’s Paste ...270 & V. II. Smelling Salts, Carbolised ... 19 Smilax Sarsaparilla ... ... 881 Smith’s Modifd. V. Urk. Ergot Assay... ... ... ... 403 Smith’s Solution . 18 Smoking, Anti- Gum. 878 Snake Bite, 1085 ; Lancets ... 547 root, Black ... ... 849 Venom ... ... ... 964 vine ... ... ... 854 weed ... ... 841, 854 Soamin, £ to 3 gr. increased ... 184 Soap Bark ... ... ... 878 Liniment ... ... ... 754 Solution, Ethereal ... 754 and Spirit Lotion ... 754 Soapstone ... ... ... 139 Soaps, Castile, Household, Shaving, Medicated, etc., 754 et seq., & V. II. ,, Resin and Silica in ...V. II. ,, Solution, Standard ...V. II. Sobbrol ... ... ...V. II. Sobee ... ... ... ... 885 Soda Caustic . 767 ,, ‘ Crystal ’ Cone. 765 Tartarata, 2 to 4 dr. ... 774 Acetamino - fiuorenone- arsonate . 190 Acetas, 15 gr. ... ... 758 Aceto-coumaras... ... 829 Acetylaminophenylars, £ gr. ... ... ... 186 Acetylamino oxyphen. ars. 187 Acetyl-Arsanilate, £ gr. ... 186 Acetyl-Salicylate, 5 to 15 gr. ... ... ... 74 Am.-Phenyl-arson., f to 3 gr.184 & V. II. Antim. Thioglycollate, Edn. XIX.169 Arsanilas ... ... 184 with Mercury & with Arsenic Sulphid., & c. Antim. Tart. ... 185 Arsenas, 1-40 to 1-10 gr. 179 yy yy yy yy yy Sodii yy yy yy Name. Dose. Page Sodii Arsenis, 1-64 to 1-16 gr. 176 ,, Arseno-phenyl-Dimethyl- Aminopyrazalon-Methy- lene Sulphoxylas ... 203 ,, Aurothiosulphate ... 213 ,, Benzoas, 5 to 30 gr. 8 & V. II. ,, Biboras, 5 to 20 gr. 12 & V. II. ,, Bicarbonas, 5-30 gr. ... 764 ,, ,, Sterilisation ...V. II. ,, Bismuth Cit. ..236 ,, Bism. Tart, for Injection 234 „ ,, ,, Acid 2 to 5 gr. 235 „ Bisulphas. 772 „ Bisulphis, 5 to 30 grains 774 „ Bi-uras ..V. II. „ Boras .12 & V. II. „ Boro-Salicyl, 5 to 45 gr.... 10 ,, ,, Tart., 20 to 40 gr.... 13 ,, Bromid., 5-30 gr. ... 763 ,, Butyl-Bromallyl Barbiturate . 815 „ Cacodylas, £ to 1 gr. 181 &V. II. ,, Carbolas ... ... ... 18 „ Carb. (Exsicc., 3 to 10 gr., 765) ; 5 to 30 gr. ... 765 „ „ Acid . 764 ,, ,, Monohydrat ... 765 ,, Chaulmoograte, Pure Commercial ... 603 ,, ,, ‘ A ’ 1 to 3 gr. per os 603 ,, ,, ‘ C ’ 1 to 3 gr. hyyod. 603 „ Chloras, 10 to 30 gr. ... 765 ,, Cliloridum, 10-60 gr. ... 759 & V. II. ,, Cinnamas, 3 to 5 gr. ... 828 ,, Citras, 10 to 60 gr. 579, 766 ,, „ for Blood Transfusion ... 766, 987 „ Citro-Tart. Elf., B.P. ’14 1-2 dr. . ,, Coumaras Sol., 25 m. ... 829 , ,, ,, c. Novocain, 25 m. 829 ,, ,, et Adrenalin, 35 m. 829 ,, Desoxycholas . 776 „ Dibrom - oxy - mercury lluorescein ... ... 477 ,, Dimethylarsinas, £ to 1 gr. 181 „ Dioxidum ... ... 490 ,, Dioxydiamido-arseno-bcn- zene-mono-methane Sulplionate ... ... 199 „ Dioxy - diamino - Arseno- benzeno dimethylene Sulplionate ... ... 202 ,, et Ammon. Pliosph. ... 770 „ et Mag. Sulph. Elf., 1 dr. or more ... ... 772 „ et Mag. Sulph. c. Caffeina 1 dr. or more. 773 „ et Potass. Tart., 120 to 240 gr. . 774 ,, Ethyl Mercuri-thiosalicyl 473 „ „ -Meth-Butyl Barbit. 811 „ Ethylas (and Liq.) ... 767 Name. Dose. page Sodii Eluorid, 1-20 to £ gr. ... 830 & V. II. ,, Eluosilicate .v.Il ,, Formaldehyde Sulfinite... 200 „ Formas, 1-6 to 3 gr. incr. 32 „ Glyceroph., 5-10 gr. 35 & V. II „ Glyco-cholas, 2-6 gr. ... 775 ,, Gynocardas(Chaulmoogra) 603 „ Hippuras, 5 to 30 gr. ... 9 „ Hydnocarpus, 10 Cc. 1% 606 „ Hydrosulphid. 88 „ Hydrosulphis. .. 87, 174 „ Hydroxid. 7 67 ,, Hydroxyam. - phenylars. 186 ,, Hydroxy-MercuryEluores- cein ... ... ... 477 „ Hydroxy-Mercury Salicyl. Acet. ... 473 „ Hypobrom., Sol.V. n. „ Hypochloris ... 42 et seq. „ Hypophosph., 3-10 gr. ... 6S3 „ Hyposulph., 10-60 gr. ... 86 & V. II. ,, ,, as Arsenic Antidote 174 „ Ichthosulphol . 497 „ Iodas, 1£ gr. Hyp. #4. 830 ,, Iodidum, 5 to 20 gr. ... 768 ,, Iodo Methane Sulphonate 769 „ Indigo Sulphonas ...V. II. ,, Iodohydroxyquinol Sulph. 319 „ Lactas, 5 to 10 gr. ... 51 ,, Mag. Sulph. Eff., 60gr. ... 773 „ „ „ c. Caffein ... 773 „ Metarsenis ... ... 176 ,, Metabisulpli. 2 to 5 gr. 774 & Y. II. „ Methylarsonas,2/5to3gr. 183 „ Methylat.. 797 „ Molybdate ... -...V.H. „ Monoboras . 13 ,, Morrhuas Solution (3%), 1 to 4 Cc. (Injected) ... 613 „ ,, Intrav. as sclerosing agent, 5%, 4 to 1 Cc.614 „ Nitras, 5 to 15 gr. ... 769 „ Nitris, 1 to 2 gr. ... 769 „ Nitrophenyl-propiolas ...V. II. „ Nitroprussidum ...y. n. „ Nucleinas, £ to 2 gr. ... 278 ,, ,, c. Sod. Cacodyl 182 „ Oleas, 2 to 4 gr.. 753 „ ,, in cancer. 753 „ „ in Tuberculosis ... 755 „ o-coumaras, 5 gr. in sol. 829 „ Palladium Chlor.V. II. ,, Para-amino-phenyl - arso- nate, i to 3 grs. ... 184 „ Perboras.13 & V, II. ,, Permang....548 „ Peroxidum . 490 ,, Persulph., 1 to 3 gr. 771 & V. II. „ Phenas ... v.. ... 18 ,, Phenol-2?-sulphonas, 5 to 15 gr. ... 20 Name. Dose. Page Sodii Phenol-sulphoricinas ... 619 ,, Phenoltetraiodophthalein, see Edn. XIX. TT TT TT TT f TT TT TT TT TT TT TT TT TT - TT TT TT TT TT TT TT TT TT TT TT TT TT TT TT Tf T9 TT TT TT TT TT TT TT TT TT TT TT TT TT TT TT TT Phenyl glycinamid Ars,.\. 188 Phenylpropiolas ...828 & V. II. Phosphas., i to \ oz. ... 770 Phospbas Ac., 30 to 60 gr. 771 & V. II. ,, with Hexamine ... 450 ,, Eff., 1 to 3 dr. ... 770 „ Exsicc., 10 gr. to 2 dr. 770 ,, Neutral (Tribasic) 770 Phosphis. 770 Pot. Bism. Tart.... ... 235 Potass. Tart., 2-4 dr. ... 774 Pyroborate . 12 Pyrophosph., 15 to 60 gr. 771 Pyrosulphis, 2-5 gr. ... 774 Rhodanidum ... ... 775 Ricinoleas ... 618 ,, Paste.. 618 ,, Stearettes ... 618 Salicylas, 10 to 30 gr. 61 & V. II. „ Ionisation ...V. II. Santonas and Santoninas 753 Sesquicarb. ... ... 765 Sesquiphos., 30 gr. in die. 771 Silicas ... ... ...V. II. Stearas ..753 Silicofluoride .V. II. Succinas, 2 to 5 gr. ... 831 Sulphanilas, 5-15 gr. ... 307 Sulphantimonas. 154 Sulph., £ to i oz. ... 772 ,, Eff., 60 gr. or q.s. 772 ,, Exsicc., $ to 2 dr. 772 ,, Acidus ...772 & V. II. Sulph.-hydrate ... ... 88 Sulphidum ... ... 774 Sulphis, 5 to 20 gr. 773 & V. II. ,, Exsicc. ... ... 773 ,, Acid, 5 to 30 gr. 774 Sulphocarb., 5 to 15 gr. 20 & V. II. Sulphocyanid., 1 to 5 gr. 775 Sulph.ichthyol,10to30gr. 497 Sulphoricinas ... ... 618 Tart. Neutrale, | to 1 oz. 774 Tartro-Bismuth ate ... 234 Taurocholas, 2 to 6 gr. 775 & y. ii. Tetraborate . 12 Tetrabromphenolphthalein, 4 to 7 Gm. per os ... 679 Tetraiodophenolphthalein, 3 to 5 Gm. per os ... 674 See also Iodo-Ray. Thiocyanas . 775 Thiosulph., 10 to 60 gr. 86 & '\^. II. Thiosulph. Intrav. ... 37 „ Uras Acidus ... ...V. II. ,, Valerianas, 1-5 gr. ... 820 . Vanadas, 31* gr. ... „ ••• 89r° Amytal, 3 to 9 gr. 242, 812 TT TT T9 Name. Dose. Page Sodium Caffeine Iodide 248 ?> Fluorescein 672 TT iso-Amytal, 1£ gr. 811 TT Luminal ... 816 TT Tylmarin, 5 gr. 829 1 ? Veronal, 5 to 10 gr. 809 Soil, Iodine in ... ... ...V . II. Solfesthin 867 Solanum, var., 885 ; Sodo- ma3um 885 Solar Oil. 655 Solazzi ... ... ... ... 857 Solganal... 215 Sols, Colloidal ... ... 361 et sea. 9 > ,, Iodine ... 366 Solubes. 470 TT Antimony Pot. Tart, lOgrs. 161 ? J ,, Sod. Tart., 10 grs. 162 T T Antiseptic Dental 18 ) } Biniodide, 1 in 1 pint = 1 in 1,000 464 ) T Dental ... 18 TT Hyd. Oxycy, 0-2 Gm. ... 461 ) y Ionic ... ... ...V . II. T T Perchloride . 470 1 to tumb. =1 in 4,500 1 in pint = l in 1,000 1 in pint = l in 500 TT Phenol, 5 & 20 gr. 15 TT Potass. Permang., 5 gr.... 548 5 y Ringer’s Soln. 759 y y Sodii Chlorid. 760 y y Zinc Sulph, et c. Alum ... 826 T T Zn. Sulphocarb., 2 & 10 gr. 20 TT tin. umpuouu/i v.j u xu 51, Soluble Glass.V. II. ,, Rreosote .379 Solurol, 5 to 10 gr. ... ... 975 Solute de Chlorure de Sodium Isotonique ... ... 759 „ Gelatine Injectable ... 424 „ Glucose Hypertonique ... 428 ,, ,, Isotonique ... 428 ,, de Quinine hypoderm. ... 721 ,, de Valer. Ammoniaq. ... 143 „ Morphine (HC1.), 2% ... 557 ,, Off. d’Eau Oxygenee ... 488 Solutio Adrenalin Co. 973 ,, Aluminii Acet.... ... 135 „ Burowi. 135 ,, Chloreton Co. Inhal. ... 244 „ Creosoti Co.379 „ de Cacodyl Iodo-mer- curico ... ... 183 „ Dakin ... ... ... 44 ,, Ethocaine var. ... 346 „ Hypochlorit Sodii ex Dakin ... ... 45 „ Iodi Spirituosa ... 507 ,, Malachite Viridis et Hyd. Perchlor. ... 324 „ Novocain var. 346 „ Phenolis . 16 ,, Quinina) et Urethani, » 5 Cc.... Salina c. Acac.... 736 1 Name. Hose. Page Solutio Stovainae . 352 ,, ,, et glucosi ... 352 ,, Vanillin . 890 Solvent Naphtha . 312 Somnifain * 814 Somnifen ... ... ... 814 Somnoform . 106, 832 Soneryl, 1 to 2 grains, 811 ; „ Tabs. 1 grain. ... 811 ,, Suppos. . 811 ,, Piperazin comp. ... 811 Sorbefacin . 435 Sorbus,.885 Sorghum.885 Soncin. 618 Sorrel .880 Soudan Red III. . 326 Southall’s Towels ... ... 440 Soya . 615, 885 & V. II. Soya Oil 886 Soyolk.885 Spanish or Blistering Fly ... 264 ,, Glossary .V. II. Spahlinger’s Vaccine. 935 Spas and Health Resorts ...V. II. Spasmalgin Tabs, and Inj. ... 564 Spasmine, 5 to 15 gr. ... ... 311 Name. Hose. Page Spirit Amygd. Amar., av. 8 m. 148 ,, Anisi, 5 to 20 m. ... 837 ,, Antiparalyticus ... 693 ,, Armoraciae Co., 1 to 2 dr. 849 ,, Aurantii Co., U.S. ... 394 ,, Cajuputi, 10%, 5 to 20 m. 843 ,, Camphorae, 5 to 20 m. ... 260 ,, ,,Fort., 2 to 5 m. ... 262 ,, Capillaris 746 ,, Card Co. 635 ,, Chloroformi, 5 to 40 m. ... 287 ,, Cinnamomi, 5 to 20 m. ... 295 ,, Coloniensis ... ... 114 ,, Creosoti, 1 dr.378 ,, Henaturalised ... ... 115 ,, Bilutions, 108 et seq. & V. II. ,, Buty and Rebate ... 109 ,, Frumenti ...113&V. II. ,, Glycerin. 112 ,, Glyceryl Nit., av. 1 m. ... 571 ,, Grindeliae Co., 1 to 2 dr. 443 ,, Hyd. Biniodidi. 464 ,, Isopropyl 118 ,, Juniperi, 5 to 20 m. ... 862 ,, ,, Co., U.S., 2 dr. ... 862 ,, Lavandulae (10% of Oil), 5 to 20 m. Spasmodin, 2 to 6 m. (in solution) . 310 Sparteinae HC1., Sulph. i to 1 gr. 886 & V. II. Sparteine Period, £ to 3 gr. 131, 886 Spermicidal Substances ... 722 Spearmint . 867 Spermatozoa ... ... 722 & V. II. Species Pectorales . 857 Spenglcr’s Tuberculin, Edn. XIX 945 ... 847 ... 722 499, 754 ... 777 ... 1083 7 ...V. II. ... 886 ...V. II. An- Spermaceti Speton Tabs. Sphagnol and Preps. ... Sphagnum (see also Moss) Spherula insularis Sphygmograph, Varnish Sphygmomanometers Spigelia Marilandica ... Spinach ... Spinal Anaesthesia. See aesthesia & Drugs in question. Spinal Cord Ext. (5-20 m.) ... 949 ,, „ Tabs., 2£ gr. ... 949 Spinocain ... 347 Spirillum Cholerae . 908 ,, Obermeieri.V. II. See also Spirochaeta. Spirit Weed ... ... ... 863 Acidi. Lactici ... ... 49 Adhesive Resin. 866 Aetheris, 60 to 90 m. ... 104 ,, Camph. ... ... 376 ,, Co., 60 to 90 m. ... 104 Aether. Nit., 15 to 60 m. 104 & V. II. Ammon. Aromat., 60 to 90 m. ... ... ... 146 Fetidus, 60 to 90 m. 146 yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy Melissse Co., 20-25 drops Menthae Pip., 5 to 20 m. Methylatus . ,, Industrial Myrciae . Myristicae, 5 to 20 m. Nuc. Jugl., 1 to 4 dr. ... ‘ Power * . Prohibition Proof Rebate ... Rectilicatus Rectiflcatissimus Saponatus, var. , Sinapis, P.G.V. . Surgical Tar 867 867 115 115 114 868 861 117 ... 112 108 & V. II. ... 109 108 & V. II. ... 108 ... 754 ... 757 ... 117 ... 696 ,, Tenuior ... ... 108 et seq. ,, Thymol, 3 to 15 m. ... 802 ,, Vanillin Co., £ to 1 dr. ... 891 ,, Varnish ... ... ... 117 ,, Vini Gallic ... ... 113 ,, „ Rect. & Dil. 108 & V. II. ,, ,, Vitis ... . 113 Spirits Act, 1915 ... ... 109 Spirobismol ... ... ... 238 Spirochaeta, Pallida ... 193 & V. II. Spirochaeta, Huttoni ... ...V. II. ,, Recurrentiss ... ...V. II. ,, pallidula ... .V. II. Spirochaetosisicterohaemorrhagica V. II. Spirocid, 4 grains ... ... 186 Spironema Pallidum ... 193 & V. II. Spleen Desicc., 5 to 10 gr. ... 964 Splenex ... ... ... 965 Splenomegaly, Tropical, v. Kala Azar. Name. Bose. Page Splints, Celluloid . 361 Spodumene ... ... ...V. II. Sponge Eduction ... ... 440 Sponges, 440 ; Surgical ... 440 Spongio Piline . 440 Sporotrichosis ... ... ...V. II. Spot Wing, A. Maculipennis ...V. II. Spotted Fever ... ... ... 904 Sprays (Cocaine) ... ... 339 Sprue ... ... 855, 986 & V. II. (see Therap Ind.) Spruce, Hemlock Spurge, Petty Squaw Root Squill 882 & V. II Indian Stabilarsan . Stabilised Tinctures ... Staining Methods Stains, To remove Staniform Stainless Iodine Ointment Stamm's Test ... Stamp Medicine Concession Stannum Stanni Oleas ,, Oxid ... ... ... Stannoxyl Injn., 431, 887 ; Tabs Staphisagrise Oieum & Ung. ... 874 ... 854 ... ... 846 Red, 882 ; ... ... 890 . 198 819, 832 .V. II. .V. II. ... 887 ... 509 ...y. 11. ...v. 11. ... 886 ... 601 886 887 887 ,, Sem., 1 gr. . 887 Staphylo. Alb., Aur. & Vaccine 922 & Y. II Star Anise . Star Grass . Starchy Foods. Starch, 836 ; and Boric. Powders Starchless Bread . Stavesacre ... ... Steapsin... ... ...633 & V. II. Stearettes ... ••• ••• 690 Calcii Sulphidi, 1 gr. Emetine HC1., i I gr. ... Emetine Bisin. lodid., 1, 2 & 3 gr. Faexin Ext. Fel Bovini, 5 gr. Iodo-Ray 0-3 & 0-5 Gm. Magnesium Peroxid., 3 gr. Sod. Ricinoleate, 5 gr. Sulphur, 5 gr. Trypsin, 5 gr. Other Comps. Stearoptene, Otto Stearin ... Steatite ... Stedman’s and Powders Stegomyia calopus, fasciata Steinach Operation Steinkohlenteer. Sterilla 3) 33 33 33 33 33 33 33 33 33 33 837 834 580 824 585 887 258 523 525 277 410 675 490 618 790 .. 636 .. 690 ..V. II. .. 84 .. 139 Steedman’s ...V. II. .V. II. . 974 . 296 . 755 Sterilisation of the Skin 470, 480, 511 Sterilisation, Chapter Sterilised Dressing, Prepn. ol ..V. II. .. 441 Name. Dose. Page Sterilised Milk, 581, et seq. ; Olive Oil, Paraffin, etc. ... 148 Sterilisers ... ... ... 581 ,, Tubes for ... ...V. II. “ Steriloid ” Dressings. 440 Steriloids. Atropine 1/400,1/200,1/100 gr. 130 Cocaine 1/60, 1/50, 1/30 gr. 130 Codeine 1/16, 1/4, 2/7 gr. ... 130 Diamorphine 1/50, 1/30 gr.... 130 Emetine, 1/18, 1/14, 1/9 gr. 130 Morphine, 1/160 gr. ... ... 130 Quinidine, 1/60 gr. 1/50 gr.... 130 Quinine 1/60 gr. ... ... 130 Strychnine, 1/360,1/180,1/90 gr. ... ... ... ... 130 Sternberg’s Mixture .1032 STER0LES, HYPODERMIC. 778, each containing :— Acac. Gum (Intrav.) ... 1 Acid Nucleinic, f gr. ... 278 ,, „ c. Sod. Cacodyl, 1 gr. ... ... 182 Aconitine Nit., 1/600 gr. ... 93 Adrenalin Sol., 10 to 15 m. 972 Adrenalin Solution 1/1000 gr. with Cocaine, § gr. 339, 972 Adreucaine, £ Cc. ... ... 343 JEther, \ dr. 97 Amyl Nitrite, 15 m., hyp. dose, 1 to 5 m. ... ... 153 See also Sterules, Inhalation. Antimon Ox. Inj., 15, 30 m. 156 „ Pet. Tart., I to 2 gr. (Intrav.) ... ... 161 „ Sod. Tart., £ to 2 gr. (Intrav.) ... ... 162 Apomorph. HC1., 1/10 gr. ... 166 Aq. Best., 1 dr.211 Arrhenal, i and | gr. ... 183 Arsamin, j- and i gr. in 15 m. 184 Arsenic and Iron = £ and 1 mgr. As203 in 15 m. 178 ,, and Strychnine = 10 m. 179 ,, Strychnine&Quin.lOm. 179 Arsenii lodidi, 1/100 gr. ... 177 Atrop. Sulph., l/IOO gr. ... 208 Atropine Sulph. Too gr* c* Strych., /s gr.494 Auri Chlor. (see also Gold Colloid) . 212 Auri et Sod. Chlor., ^ gr. ... 212 Benzamine, I and i gr. ... 343 Bismuth Metal 0-2 Gm. ... 222 Bismuth Sod. Pot. Tart. 3 gr. 237 Bismuth Salicyl, 2 gr. ... 229 Bismutol ... ... ••• 237 Butyn 1 and 2%, 1 Cc. ... 354 Cacodylatum Co., 15 m. ... 183 Caffeine and Novocain ... 346 Caffeine Sod. Benz., 2 gr. in 1 Cc. & 5 Cc. Intrav. 246 „ Sod. Sal., 1, 2 gr. ... 247 Calcii Format., f gr. ... 32 Name. Dose. Page Sterules, Hypodermic—contd. Calc. Chlorid, 5 & 10%, 5 Cc. 250 Calc. Glyceroph., 1, 2, 3, 4 gr. 33 Camphor (in oil), 1^ and 3 gr. 261 ,, 4 gr. in Ether, 15 m. 261 Camphor,3gr. &Guaiacol,2gr. 261 Carbolised Almond Oil, 1 Cc. no/ Choline Chlor.! 0*6 Gm. Cone! (Intrav.) ... ... ... 5 Cicatricine, 15 m. ... ... 758 Cinchonidine HC1. Ac. 7£ gr. (Intram.) ... 717 Cocaine, HC1.1/10, £ and £ gr. 339 ,, £ & Adrenalin, 1/1000 gr. (Conephrin) 339, 972 Cocaine eh Sod. Bic., Dry (Urethral). 340 Codeine Phosph., 1 gr. ... 356 Colloidal Metals, see “Sterules” of Metals in question. Copper Colloidal, 4 Cc. ... 365 Creosote (in oil), £ gr. ... — Curschmann’s Soln., 1 Cc. ... 261 Diamorphine, HC1., 1/12 gr. 559 Digitalin, Pulv., 1/10 gr. ... 393 „ 1/10 gr. c. Strych. HC1. 1/100 gr. . 393 Dilaudid ... ... ... 561 Dionin, £ gr. 559 Emetine HBr., £ & £ gr. ... 523 „ HC1., £ to 1 gr. 523, 555 Enesol, 2 Cc. 183 Ephedrine HC1, £, £, 1 gr. ... 398 Ergot Inj., 10 m. ... ... 405 Eucain, HC1. & Pact., £, £ and 1 gr. 343, 344 Eucaine & Sod. Chlor. (Dry- lilled) .343 Euflavine ... ... ... 425 Eerri Am. Cit., £, 1 & 2 gr. (and both c. Strych., 1/60 gr.) ... ... 412 Eerri Glyceroph., £ gr. ... 34 Eibrocoumarin, 25 m. ... 829 „ 25 m. c. Adrenalin, 10 m. ... ... 829 Gelatin Cone., for 5 ounces... 424 ,, ,, for 2 ounces 425 ,, ,, ,, 10 ounces 425 Glucose (Intrav.) . 428 Glyc. Sod. Cinnam. 829 Gold & Sod. Chlor., 1/20 gr.... 212 „ Coll., 5 Cc. (1 in 4000) 365 Guaiacol (in oil) £ gr. ... 445 „ Cacodyl., £ to 2 gr. ... 181 „ Camphor & Iodine, £ and 1 Cc. ... ... 445 "Guaiacol-Glucose, 2 Cc. (1%), for Novarsenobenzol ... 200 Gum Acac. (Intrav.) ... 1 Hamamelis Ext. and Phenol. 448 Hexamine, 15 grs. (Intrav.) 452 Name. Dose. Page Sterules, Hypodermic—contd. Hydrarg. Coll., 5 Cc. (1 in 2000) 369 Hyd. Cyanid. 1/12, £ gr. (Intrav.) . 460 Hydrarg. Lambkin, 10 m. ... 454 Hyd. lod. Bub., 1/12 gr. in 8 m. 463 „ Salicyl., & to 1 gr. ... 472 ,, Salicyl-Arsonas, 1 gr. in 30 m. . 183 ,, Succinimid., £ gr. c. Cocain. Nit., £ gr. ... 476 Hydrastinine HC1., £ & £ gr. 487 Hyoscine HBr., 1/100 gr., 494; et c. Morph., £ gr. ... 494 Hyoscine HBr., 1/100 gr. in 50% Mag. Sulph. 2 Cc. ... 494 Hyoscine Comp.494 Hyoscyamine HBr., 1/100 gr.496 Inj. Hydrarg. Intramusc., 10 m. . 454 Iodine, for skin sterilising ... 511 Indigo Carmine .V. II. lodinol, 30 & 60 m. 514 Iron and Arsenic— No. 1 —£ mgr. As203 ... 178 No. 2 = 1 mgr.178 Iron Citrate, £, 1 and 2 gr. ... 412 „ „ £, 1 & 2 gr. with Strychnine, 1/60 gr. 412 „ Glyceroph., £ gr. ... 34 Lecithin, £ gr. . 531 Locke’s Soln. Cone. 759 Magnes. Hyposulph., 10 Cc. 10% intram. 86 ,, Sulpli., 50% 1 Cc. ... 103 Mang. Butyrat., 1%, 1, 1£ and 2 Cc. 544 Mannitol-Quinine, 2 Cc. (?)... 727 Mercurial Injn., 10 m. ... 454 Mercurome, 0-3 Gm., vesical inj.480 ,, 0-2 Gm. Intravenous ... 480 Mercury, Colloidal 5 Cc. ... 369 Mercury Salicylate, 1/10 to 1 gr. . ... 473 Mercury Salicyl-arsonate 1 gr. 183 Methylene Blue . 325 Milk, 5 & 10 Cc. (intram.) ... 670 Morph. Sulph., £, £, £ & £ gr. 558 „ „ £ & £ grain in 50% Mg. Sulph. 1 Cc. 103 Morph., £ gr. c. Atropine Sulph., 1/120 gr., and £ gr. c. too gr* 558 Normal Saline Cone, for 2 pints . 760 „ ,, for isotonising Coll. Gold ... 365 „ ,, „ Sulphur ... 372 Novocain, £ gr. ... ... 346 Name. Dose. Page Name. Dose. Page Sterules, Hypodermic—contd. Sterules % Hypodermic—contd. Novocain, i gr. c. Adrenalin, Sod. Cacodyl, £, f, 1, li and 1/1000 gr. 346 2 gr. 182 „ 0-15, Caffeine 0-12 ,, 1 gr. in Nuclein and Sod. Benz. 0-15 Soln., 1 Cc. 182 Gm. ... 346 Sod. Chaulmoog. Nucleinic Acid, f gr. 278 ‘ C,’ 1, 2 and 3 gr. 604 ,, „ c. Sod. Cacodyl Cinnam. (Glyc., 30 m.) 828 1 gr. 182 Formate, I, i gr. 32 01. Terebinth in Oil 692 Glyceroph., 3 gr. 35 Peptone Intramusc., graded 664 „ 1A c. Strych. Caco- ■ ,, . „ cont., course 664 dyl.,1/64,1/20 gr. 35 ,, Intrav., graded 663 J 5 Hydnocarpat., 10 Ce., ,, ,, cont., course 663 1 °L 607 ,, ,, Shading off 664 Ilyposulph., 0-2, 0-45 „ in Vaccine Therapy ... 666 and 0-6 Gm. intrav. 87 jrnenoisuipuonepnuncutuu ... Phosphorated Oil, 5 minims and i m. In 5 m. Oil Pilocarpine Nitrate, 1/10, i, gr. • • * • • * ••• Pituitary Ext. (Infundib.), \ and 1 Cc. Pituitary Ext. (Anterior), 1 and 2 Cc. (20 and 40%) ... Pituitary Extract, \ and 1 Cc. Entire Gland Special ... Platinum CoU., 5 Cc (1 in 4000) 370 Potass. Iod., 5 gr. 709 Quinidine HC1. Ac. 5 & 10 gr. Intrav. 5 gr. Intram 681 688 958 958 958 Quin. Formas, $, f grain yy 716 716 720 35 721 Glyceroph., i gr HBr. Acid, 2 gr. HC1. Acid, 2 gr., 3 gr., 5 gr. and 15 gr. ,, 4 & 10 gr. Intrav. „ „ „ 5 gr. c. Anti- pyrm, 3 gr. ... ,, Hydrochlorocarbamid., 3 and 5 Cc., 1% ,, Mannitol, 2 Cc. (?) ... „ Iodo-Bismuthate, 0-17 Gm. . ,, Urea (& c. Eucaine), 3 and 5 Cc. ... „ Urethane (for veins), 2 Cc. ... • • • Ringer’s Sol. Cone. ... Saline Cone., for Gold, 365 ; for 2 pints. Scopolamine-Morph., 1/100 and i gr., and with Atrop. (See also Sterules, Hyoscine.) Selenium Coll., 1 to 5 Cc. (1 in 5000) ••• Silver Coll., 5 Cc. (1 in 2000) Sod. Arsenatis et Strych.,10m. 179 „ „ „ et Quin., 10 m. 1/9 Bicarbonate, 3 Gm. (Intrav.) ... ••• Chloride Cone, for 2 pints ... , ••• , ••• Cone, for Coll. Gold ... 725 725 725 726 727 238 726 736 759 760 494 370 371 764 760 365 yy 5) yy yy yy yy yy yy yy 768 614 769 278 182 829 754 yy lodid. 1 Gm. (Intrav.) Morrhuate 3 %, 1 and 2 Cc., 614 ; 5 & 10%, 2 Cc..... Nitritis, &, |, f gr. Nucleinate, | gr. ,, c. Sod. Cacodyl, 1 gr.— o-Coumarate Sol., 25 m. 829 ,, c. Kerocain, 1/5 gr. 829 ,, et Adrenalin, 10 m. Oieat. 0-8%, 2 Cc. and 1%, 1 Cc. Pot. Bism. Tart., 3 gr. 237 Salicyl., 1 Gm. (and c. Sod. Iod., 1 Gm.) (Intrav.) ... ... 66 Salicyl. 1 Cc. 30% for haemorrhoids ... 63 3 Cc. of 20, 30 and 40% for varicose veins ... ... 63 Stovaine, i, i, f gr. 350 ,, c. Caffeine ... 353 Glucose Sol., 1 Cc. 351 Strychnine, 1 Cc. 353 Strophanthin, i to 1 mgr. (Intrav.) ... ... ... 783 Strych. Formate, 1/60 gr. ... 32 Strych. Sulph., 1/100,1/50 gr. 785 Sulphur Coll., 5 Cc. 372 ,, 0-001 Gm. in oil ... 789 also 1 to 10 Cc. of 1% for producing fever. 789 Testicular Ext. c. Glyceroph., 2 gr., c. Strych., 1/60 gr. 10 m. ... ••• 974 Tliiosinamin Comp., 1 & 2 Cc/ 757 with Antipyrin = 15 m.... 758 Tuberculin Dilutions 927 et seq. Turpentine in Oil ... ... 692 Tylcalsin 0-5 and 1 Gm. (Intrav.) . 73 Urea-Quinine and c. Eucaine 726 Water Distilled, 5 Cc. ... 211 STERULES, INHALATION ... 778 Ammonia 3 m. ... ... 114 Amyl Nitrite, 1 to 10 m. ... 149 yy Name. Dcse. Page Sterules, Inhalation—contd. Chloroform, 10, 20, 30 and 60 m., also 1, 2, 4 oz. (Anaesthetic) . 286 Ether, 1 and 2 oz. 96 Ethyl Bromide, 5 m. ... 832 „ Iodide, 5 m. 107 ,, c. Chlorof.107 ,, ,, ,, et Menthol 107, 108 Trichlorethylene, 10 m. ... 289 STEEPLES, IONIC ...778 & V. II. STERULES LOTION for diluting to 1 pint:— Hydrarg, Perchlor. 470 ,, Biniodid. 465 ,, Oxycyanid ... 461 Potass. Permang. ... ... 548 Saline Soln. (for 2 pints) ... 760 STERULES OPHTHALMIC ... 778 Adrenalin Chlor.972 Atrop. Sulph., 1%. 208 ,, Sulph., £% with Cocaine 208 Cocaine HC1., 10 gr. to oz. (and tube form). 339 Dionin, 5%. 559 Fluorescein et Sod. Bic. ... 673 Holocaine, 1% 344 Homatropine, IIBr., 1% (et c. Cocaine, 2|%). 210 Physostigmin., 4 gr. to oz.... 686 ,, 1 gr., et c. Coc., 4 gr. 686 Pilocarpine Nit., 1, 2 and 4 gr. per oz. ... 688 Protargol, 10 and 25% ... 171 STERULES LARGE (TUBE FORM) 10 min., Cocaine HC1., 5, 10% 339 Stibamine Conrpds. ... ... 163 Stibinc, Phenyl, Quinolyl and Xenyl Compds. ... ... 164 Stibium Sulph. (various) ... 154 Stibnite ... ... ... ... 154 Stillingia, 30 gr. ... ... 887 Stockholm Tar, 2 to 10 gr. 695 & V. II. Stockman on Salicylates 62 et seq. .693 . 406 .V. II. . 965 . 268 . 868 . 849 . 887 . 853 V. II. Stokes’ Liniment Stoll’s Ergotamine Stomach Contents Exam. ,, Dessictd., i to 1 oz ,, Tubes. Stomachic balm Stone Boot Storax ... Storks-bill Stout Stovaine, i to f , max. 2| gr. 350 & V. II. ; Stovaine-Dextrin, 352 ; Gargle, Ointment, Pastils, Snuff, Soln. (internal) 353 Stovaine-Caffeine ... 352, 353 Stovaine-Glucose ... ... 351 Stovaine-Strychnine ... 347, 353 Stovarsol, 4 grs. 186, 527, 529 Name. Dose. Page Stovarsol, Dermatitis cured by Strontium Brom. & calc, chlor. intrav. —H. C. Semon, L. ii-/32,341. „ Sodium . 187 Stramonium . 779 Strawberry . 855 Streptococcus vor. V. II. ; Serum ...920&V. II. ,, Haemolytic, 921; and see Influenza. ,, faecalis ... 920 & V. II. ,, in Milk Brighton Epidemic ... 922 ,, Lebenis .V. II. „ Pyogenes .V. II. ,, Bheumaticus. ... 919 „ Salivarius .V. II. ,, Vaccine . 921 Strong’s Counting Method ...V. II. Strontium . 780 Strontii Brom. (Exsicc., 4-24 gr.,781); 5-30gr. ... 781 ,, Carb., 5 to 30 gr. ... 781 ,, Cinnam., 2 to 5 gr. ... 828 ,, lodid., 5 to 20 gr. ... 781 ,, Laetas., 5 to 30 gr. ... 781 ,, Oleas, 5 to 20 gr. (?) ... 601 ,, Salicyl., 5 to 20 gr. ... 781 ,, Sulphidum . 215 Strophanthi Semina ... ... 781 „ Phys. Std. ...782&V. II. Strophanthin, 1/300 to 1/100 gr. 782 & V. II. Strychnina, 1/64 to 1/16 gr. ... 783 „ Antidotes . 783 ,, Tests .V. II. Strychninae Acetas, 784 ; Arsenas, 1/64 to 1/16 gr., 784 ; Cacodylas, 1/30 to 1/10 gr., 183 ; et Fe. Cit. 2 gr. 784 ; et Fe. Quin. Cit. 3 to 6 grs., 784 ; Formas, 1/64 gr., 32 ; Glyceroph., 1/64 to 1/20 gr., 35 ; HBr., HC1. and Hypo- phospli., 784 & V. II. ; Nitras, Phosph. Acid., Sulph. (785) and Sulph. Acid, ] /64 to 1/16 gr., 786; Periodid, 1/100 gr., 131, 785 ; Valeria- nas, 1/25 to 1/10 m. ... 786 Strychnos, var. 596, 597, 783 Styptic Colloid, 361; Gelatin, 972; Wool.413 Stypticin, 1, | gr., or if urgent up to 4 gr.567 Stypticin Gauze and Wool ... 568 Styptol, I gr. incr.568 Styrax Prep., av. U.S., 15 gr. 887 Styryl Quinoline . 316 Sublimate Disinft., 470; Malachite Green Soln., 324, 471 ; Spirit, 470 ; Soap, 754 ; Gauze, Wood Wool. 469 55 55 5 5 55 ’5 Name. Dose. Page Submarine Escape App. ... 631 Succinimide, Edn. XIX ... 476 Succinum ... ... ... 887 Succinyl Derivs. of Arsanilic Acid ... ... ... ... 190 Succus Allii, 10 to 30 m. ... 834 Alterans, 1 dr. 887 Ari, 1 dr. ... ... 838 Conii, B.P. ’98, 1 to 2 dr. Galii, 1 to 2 dr. ... ... 855 Limonis (see Neutralisation Table) ,, Mori, 1 dr. . 868 ,, Nasturtii Off. 2 to 4 dr. ... 869 ,, Papav. Somnif. (Cap. Inspiss. (and Pulv.), d to 2 gr. ... ... 622 ,, Scoparii, ’14 1 to 2 dr. ... ,, Sempervivi, 5 to 15 m. ... 883 ,, Taraxaci, 1 to 2 dr. ... 889 ,, Urticse, 1 to 4 dr., incr. ...tt 31 Sucrase ... ... ••• ...V. II. Sucrose, Sugar, 749 & V. II. ; Intrav. use (See also Glucose) 750 Sudan Red ... ... ••• 326 Suero Coloidal Completo ... 2 Sugar Beet, 749 ; Cane, 749 ; Chinese, 885 ; Coating, 689 ; Grape, 427 ; Inverted 750 ; of lead 697 ; Subsidy. 749 Sugars, Bacteriological ...V. II. Relative Sweetness. 750 Sulfarsenol ... • •. ••• 202 Sulfosin, 0-5 to 10 Cc. intram. /89 Sulphaqua Charges . 791 Sulpharsenobenzene . 202 Sulpharsphenamine . 202 Sulphate de Ba. Gelat. ... 21b Sulfato de Manganeso ... 545 Sulphonal, 10 to 30 gr.... 786 & V. II. ,, Reversed . 787 Sulphone-ethyl-metliane ... 786 Sulphoxyl-Salvarsan, 8-12 Cc. 20- Sulnhonmethanum . 78b Sulphur .SOtoMfr. ... ^ 7|| Dioxide and Trioxide 86 Injections . 789 Iodidum . 790 Lotum . pp Paste ... ••• '89 Praecip., Sublirn., 20 to 60 gr.788 Soap . 754 ,, Sterulcs ... /89 Sulphurated Lime Depilatory... 2o9 Sulphurated Potash v. Potass. Sulphuretted Hydrogen 791 A V. 1L . Sulph. Chlor. and Hypochlor. 790 SUM Compds. Sumach, 15 gr . „ Smooth, 15 gr. ••• 879 Sumbul Radix, av. 30 gr. ... 888 Sundew .00 55 5> 55 55 55 55 55 55 55 55 55 55 Name. Dose. Page Sunflower Oil ... ... ••• 515 Sunlight ... ... 591 &.V.II. SUP Compds. . 314 Superol ... ... ... ... 315 Supplementary Drug List ... 8^7 Suppositories, 792 ; Hollow, 435 ; Mass for hot Climates, 792; Vaginal _ 135 Suppos. Acidi Borici, 3 gr. ... 11 Carbol., 1 gr. ... j-9 Lact. B. 54 Tannici, 3 gr., and with Morph., d or Opium, 1 gr. 89 Adrenalin, 10 m. ... 972 ,, c. Formidin. Cocain and Hamam. ... 972 Aloes . 131 Argyrol. J70 Aristol, 1 gr. ... ... 503 Arsenobenzol ... ... 194 Bellad., Id gr. 220 ,, et Morph., i gr. 220 Bisciniod, d gr. ... ... 227 Bismuthi Oxychl., 10 gr. 229 ,, Salicyl., 10 gr. ... 230 „ Subnit., 10 gr. ... Chloral, 5 gr.281 55 55 55 55 55 55 55 55 55 55 55 ,, Chrysarobin, 1£ gr. ... 292 ,, Cocainae, & to d gr., et c. Morphina, d gr. 339, 340 „ Cocainae Vaginal, 1 gr. ... 339 „ Collargol (& Co.), 2|- gr. 171 ,, Coliinson Ext. 819 ,, Cubebae, 10 gr. 80I ,, Eucalypti Gum, 5 gr. ... 8a4 Ext. Myrtilli ... # ... 869 Gallae, 5 gr., et c. Opio, 1 gr. Glycerini... ... ... 435 Haemorrhoidal ... ... 233 Hamam Co. ... ... 449 Hamamelin, 1 and 3 gr. 449 ,, et Hvdrarg. Co. ... 449 Hamam., Conii et Eucain 449 Hollow ... ... ••• 435 ,, Vaginal ... ... 435 Hvdrargyri Inj. 456 „ Subchlor., £, 1 gr. 475 Ichthosulphol, 3 gr. ... 498 Iodermiol. 509 lodex . 509 Iodoformi, 1, 3, 5 gr. ... 502 ,, c. Eucalyp. Oil., 5 m. Malourea, 4 to 8 gr. ... 807 Morphinae, d to 2 gr. ... 557 Novarsenobenzol, 0T Gm. 202 Novocain, Id grains ... 348 Olei Ciaerei . 456 Opii, 1 gr. . Quassiae Ext., £ gr. ... 878 Quin. HCL, 5 gr. ... 723 „ HC1. Carbarn., 5 gr. 726 Ranunculi . 878 Salvarsan. 1^1 Santonini, 3 gr. 73 » 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 Name. Dose. Page Suppos. Sod. Chaulmoograte ... 604 „ Supra-renal (et c. Morph.) 967 „ Thymol Iodide. 503 „ Veronal, 4 to 8 gr. ... 807 ,, Veronal Sodium, 0-4-0-5 Gm. ... 810 Supplementary List ... ... 827 Suprarenal Cortex, 2-5 gr. ... 974 „ Gland, 966 & V. II.; Ext. Dry, Liq., Inj. (Hypod.), Snuff, Insuff. Pdrs., Nebula, Spray, Suppos. (et. c. Morph., 4 to 3 gr.), Tabellae, Tablets 1 or more, Ung. ... 967 Suprarenin ... 968 „ Synthetic ... ... 968 Suprarenalum Sicc. U.S. ... 967 Supsalvs. . ... 194 Surgeon’s Agaric ... 835 Surgical Dressings ...438 & V. II. „ Moss . ... 777 ,, Lubricant ... 17 ,, Soap ... ... ... 754 ,, Spirit . ... 117 Suspension d’lodobismuthate de Quinine, 1 Cc. ... ... 238 Sutures ... ... 532 Swabs, Steriloid, Triang., etc. 440, 441 Sweetbread ... ... ... 633 Sweet Gale, 842 ; Vernal Grass S37 Sydenham’s Laudanum, 5 to 20 m.627 Syls, 1 to 2 drachms ... 437 Amygd., Anethi, A nisi, Aurant. Amar., Aurant. FI or., Carui, Caryoph., Cinnam., Fceniculi, La- vand., Limonis, Menth. Pip., Meiith. Vir., Myrist., Pimentse, Pini, llosae, Thyml Vanillao. Symmetrica Urea Compds. ... 806 Symphytum var. ... ... 888 Syncaine ... ... ... 345 Synergism of chemicals with Morphine, etc. ... 102, 563 Synol Soap ... ... ... 755 Synopsis of chief B.P. ’32 Changes . ... xxvi Synthalin ... ... ... 646 Synthetic Milk ... ... ... 885 Syphilis... 192, 454, 10S6 & V. II. „ Arsenic & Mercury comb, treatment ... 194 ,, Bismuth in ... 221 et seq. ,, Wasscrman Comple- nientDeviationTestsV. II. ,, and Parasypli. differtn. V. II. Salvarsan in ... 191 et seq. ,, War Office Treatment 195 „ Mercuric Oleate inunction ... ... 599 Syringes Hypod. . 455 Name. Dose. Page Syrupus.750 ,, Acid Hydriodic,30to 60m. 37 ,, HSgle Marm. Co., i to 1 oz. 841 ,, Apomorph. HC1., £tol dr. 166 .,, Aromat., £ to 1 dr. ,, Aurantii, ’14, i to 1 dr.... 839 ,, Benzaldehydi HCN. \ to 1 dr. .... 875 ,, Bistorta. 841 ,, Bromoformi, i to 1 oz.... 240 ,, ,, Co. P. Ital. ... 241 ,, Calcii et Fe. Lactoph., 1 to 1 dr. ... 51 ,, ,, Lactoph. i to 1 dr. 51 ,, Camph. Co., 1 dr. ... 627 ,, Cascarae Aromat., £-2 dr. 274 „ Chloral, £ to 2 dr. ... 281 ,, Cocainae, 1 dr. 340 ,, Cocillanae Co., § to 1 dr. 849 ,3 Codeinae Phosph.,4 to 2 dr. 356 ,, Cyllin, 10 to 60 m. ... 29 ,, Digitoxin, 1 to 4 dr. ... 392 „ Dusart, 2 to 4 dr. ... 51 „ Eastoni, \ to 1 dr. ... 418 ,, ,, Liq. pro., 9-18 m. 418 ,, Eucalypti Gum ^-1 dr. ... 854 ,, Ferri Brom., i to 1 dr. ... 417 ,, ,, et Quin. Cit., 1 dr. 720 ,, ,, Iodidi, 4 to 1 dr. ... 416 ,, ,, Phosph., 4 to 1 dr. 418 „ ,, Phosph. Co., i to 2 dr. ... ... 418 „ ,, Phosph. c. Quin, et Strych.C Easton’), i to 1 dr. ... 418 „ Ficorum, 1 to 4 dr. ... 395 ,, Formatum Co., 1-2 dr. ... 33 ,, Glucosi.. 689 ,, Glyceroph. Bobin, 1 to 4 dr.. 37 ,, ,, Co., 1 to 2 dr. ... 36 ,, ,, c. Format., 1 dr. ... 36 „ Heroin, 1 to 2 dr. ... 560 ,, Hypoph., 2 dr. , ... 684 „ ,, Co., i to 2 dr. ... 684 ,, ,, Fellows’, 1 to 2 dr. 684 ,, Iodo-Tannic, £-2 dr. ... 506 ,, Ipecac. ... ... ... 518 ,, Kolae Co., 1 to 2 dr. ... 248 ,, Lactucarii. av. 2 dr. ... 496 ,, Limonis, 4 to 1 dr. ... 864 ,, Mori, 1 dr. ... ... 868 „ Neurotonique 2 to 3 dr— 720 ,, Parrish’s 4 to 2 dr. ... 418 „ Picis Liq., 1 to 2 dr. ... 696 „ ,, c. Codeina, i to 2 dr. 696 „ Pilocarpin. et Pot. Brom., 1 dr. to 1 oz. 688 „ Pini Pumil., 1 dr. ... 693 ,, Pini Terpin Heroin, 1 dr. 694 ,, Pruni Virg., | to 1 dr. ... 875 ,, Bami, acc. to age. ... 241 „ Bhamni, £ to 1 dr. ... 855 „ Bhei. ’14, 1 to 2 dr. ... — „ ,, Aromat., av. 2 dr. 879 Name. Dose. Page Syrupus Posse, £ to 1 dr. ... 879 ,, Scillse (& Co.), 30 to 60 m. 882 ,, Senegse, 1 dr. ... ... 883 ,, Sennse, £ to 2 dr. ... 884 ,, Sulphatum, 4 dr. ... 259 ,, Tann-Iodo-phosph., £ to 2 dr.507 ,, Thymi, 1 to 4 dr. ... 890 „ Tolu., £ to 1 dr. 840 ,, Triplex, 1 to 2 dr. ... 419 ,, Trium.-Phosph.,£to 1 dr. 418 ,, Urginese, £ to 1 dr. ... 890 ,, Violdd, adlib. ... ... 892 ,, Zingib., 4 to 1 dr. ... 893 Sys Specific ... ... ... 249 Sysimbrium ... ... ... 853 Systogen .... . 408 T. A. B. Vaccine ... ... 938 T.A.B.C. Vaccine . 938 T.A.M. B.C. Vaccine, Edn. XIX 949 T.C.P. 68, 526 T.I.P. = Sod. Tet. iodo. phenol phthalein. ... •. 674 T.X.T.. ... 315 Tabaci Folia ... ... ... 869 Tabaiaco ... ... ••• 622 TABELLiE, Chocolate Tablets 796 ,, Antiasthmat., 1 to 4 t.d. 573 ,, Antimonii Sulph. (0-01 Gin.) ... ... ... 154 ,, Apomorph., 1/100,1/50 gr. 166 ' Bism. et Pepsin. 3 gr. 226, 659 „ c. Cascara 1 gr. 227 ” Caffeinse Cit., 1 gr. ... 246 „ Cocainse, 1/20 to £ gr. ... 340 „ Diacetyl Morph., 1/10 gr. 560 „ Digitalin, 1/10 gr., et Nitroglycerin, 1/100 gr. 394, 573 Erythrol Nitratis, £, £, £, 1 gr., 1 or 2 ... 409 „ Exalgin, £ gr. 3 Glonoini, 1/100 gr. ... 572 Heroin, 1/10 gr. 560 Lecithin, £ gr. 531 Mannitol Nit., 1 gr. ... 409 Menthol, 1/5 gr. ... 551 Natrico ... • •• 5<3 Nitroglycerini, 1/600,1/400, 1/200, 1/100, 1/75, 1/50, 1/25 gr. and 1 mgr. 1 or 2 ... 571, 572 Nitroglyc., 1/100 gr. c. Caffeine, 1 gr. ... 5/- Nitroglyc., Sod. Iod. c. Arson ... „/Nitroglyc. 1/150 to 1/100\572 I Strvch., 1/100 to 1/2,0 f Mtroglyc./l/200 to 1/100 1 573 „\ Thyroid., $ to 3 gr. / Nitroglyc. Co., 1 or 2 ... 573 .648 659 et*Bismuth, 1 to 2 659 55 55 yy yy Name. Dose. Page Tabellee—contd. Pepsinse, et Caffeine, 1 to 2 659 Phenolphthalein, £, 2 and 4 gr. ... 672 Phenolph., 4 gr., c. Ext. Bhei, 3 gr. ... ... 672 Quin. Tannat., 1 gr. ... 734 Sodii Nitritis et Sodii Iodidi ... . 769 ,, Sodii Nitritis Co. ... 769 Strophanthi Tract., 1 m. 782 Suprarenal Ext., £ gr. ... 967 „ Trinitrini, 1-130 gr; ... 572 TABLETS, COMPRESS ED-TABLETTiE yy yy yy yy yy y y yy 793. In demand are :■ yy ,, Papain, 2 gr. „ Pepsinse, 3 gr. )> S> 3 3 70 7 52 40 92 Acetanilide, 3 gr. ,, et c. Caffeine, 1 gr. ... Aceto-Salicyl. Acid., 5, 8 gr. (and with Phonacetin also with Dover Pdr.) ... Ac. Benz. Co. Acid Lactic Bacilli, 3 to 6 p.d. Acidin Pepsin, 1 or 2 Aconiti = 2£ m. Tincture ... Acriffavine, 0-87 grain, and 1-75 grains for Lotions ... 299 Adalin, 5 gr. ...810 Adrenalin, 1/200 gr— ... 972 „ 1/300 gr., with Cocaine £ gr. 972 Alkagen, 1 to 3 ... ... 537 Allonal, 1 to 2 ... ... 814 Aloes et Ferri, 4 gr— ... 132 Aloin, 1/10 and £ gr. ... 133 ,, Compound ... ... 133 Alopon, £ gr. 628 Alypin, £, 5/6 and 3£ gr. (and £ c. Suprarenin). 344 Ammon. Brom., 5 and 10 gr. 140 ,, Clilor., 3 and 5 gr. ... 141 ,, „ 3 c. Borax, 2 gr. 141 ” „ c.Glyc. Ext. 3 gr. 141 ,, Quinine and Comp. ... 733 Anabolin, 1 to 3 ... ... 953 Anasarcin ... ... ... 882 Anticonstipation ... ... 133 Antifebrin, 3 gr. (et c. Caffeine, 1 gr., 3) ... ... 3 Antipyrine, 2£ and 5 gr. (et 3 gr. c. Caffeine, 1 gr.) ... 328 Antiseptic (Thymol, etc.) Arsamin, 1 gr. f Arsenic, 1/60 gr. ... / Iron Hypoph., 2 gr. ... /176 iQuin. Ac. Sulph., 1 gr. ... J Arsenious Acid, 1/100, 1/50, 1/20 gr.174 „ 1/64 gr., with Mercuric Chloride, 1/64 gr. 17d Aspirin, 5 and 8 gr., and with Phenacetin, 2£ gr., and with Dover’s Pdr. ... 70 Aspr iodine 5 gr. 77 Atophan, 4 and 8 gr. ... 316 Atrop. Sulph., 1/100 gr. ... Name. Dose. Page Tablets, Compressed—contd. * B.S.C.’ 776 Benzoic Ac. Co. 7 Benzonaphthol, 5 gr. ... 566 Benzosol, 5 gr. . 446 Betanaphthol, 3 and 5 gr. ... 565 Betanaphthol, 5 grains, c. Phenolphthalein, 3 gr. ... 565 Bismuth Carb., 5 gr. ... 223 ,, Salicyl., 5 gr. 230 ,, Subnit., 5 and 10 gr_ 232 „ et Pepsin, aa 3 gr. ... 226 ,, Pepsin & Caseara, t.d. 227 ,, ,, and Charcoal, 2 gr. each . ■— Blaud’s Pill, 4 and 8 gr. ... 412 „ „ 4 gr. c. Arsen., 1/64 gr. ... 176 Bon Voyage. 38 Boric Acid, 5 gr. 10 Brain Ext., 5 gr.949 Brominol = 9 gr. Pot. Brom. 240 Bromural, 5 gr. ... ... 813 Butyl-Chloral c. Gelsem. ... 243 Caffeine, 1 gr. c. Antipyrin, 3 gr. 246 ,, Cit., 2 gr.246 ,, HBr., 2 gr.246 ,, „ 1 gr., c. Phenaee- tin, 4 gr. Calc. Pact., 5 gr. Calc. Sulph., i, 1, 1 gr. Calcium Sandoz Calomel, 1/10 to 5 gr. / Camphor, £ gr. \Quin. Ac. Sulph., 1 gr. Carnph. Monobr., 1 gr. Caseara Ext., 1 to 5 gr. Catha Ext., 21 gr. ... Cerebral, 5 gr. Chinosol, 5, 8, 15 gr. Cinchona Febrifuge, 4 gr. ... 713 Cinchonidine Sulph., 5 gr. ... 716 Choralamide, 5 gr. ... ... 281 Chloramine T. ... ... 47 Chloral Hyd., 5 and 10 gr. (to be dissolved) ... ... 281 Codeine Phosph., 1 and 1 gr. 356 Codeonal, 21 gr. ... ... 563 Colalin, 1 and 1 gr. ... ... 776 ,, Laxative, 1^ gr. ... 776 Col. Co. = 4 gr. pill (B.P. ’14) Collargol, | gr. ... ... 170 Comp. Hypophosphites ... 684 246 50 258 257 475 262 262 276 845 949 315 Cotarnin HC1., i gr.... ... 568 ,, Phthalate, i gr. ... 568 Corpus Luteum, 1 gr. ... 949 Cystazol, 10 gr. ... ... 453 Cystoformin, 15 gr. 454 Dial, 11 gr. ... 815 Didymin, 5 gr. . 974 Digitoxin, 1/250 gr— ... 392 Dinner ... 701 Dormigene, 5 gr. ... ... 814 Dover’s Powder, 5 gr. ... 518 Duodenal Ext. = 5 gr. ... 950 Name. Dose. Page Tablets—contd. Easton Syr. ’14, = 1 & 1 dr. (and c. Arsen.) . 419 Effervescing, see ‘ Yescettes.’ Ephedrine HC1., 1 gr. ... 398 Ergotin, 1, 2 and 3 gr. ... 404 Ergotin, Senecin Co. ... 404 Eserine and Trunecek’s Serum 686 Eucaine-/3, 1/10 gr. 343 Euflavine 0-87 and 1*75 gr. for lotions. 303 Euflavine, 1 and 1 gr., per os 303 Euonymin, 1/6 to 4 gr. ... 410 Fsexin Ext., 3 gr.277 Ferri Arsenas, £ gr. 178 Ferri Blaud c. Arsen. 1/64 gr. 17 6 Ferri Carb. Sacch., 5 gr. ... 411 ,, Quin. Citr., 3 gr. ... 720 Formaldehyde Disinfectant 127 ,, i gr. c. Sacch. Lact.,2 gr. 128 Formamint ... ... ... 128 Gland (‘ Three ’ and ‘ Four ') 1 or 2 . 980, £81 Glyceroph. Co. • • • 36 Grey Powder, 1 to 3 gr. • • • — ,, „ 1 gr-, and Dover’s Powder, 1 gr. ... — Guaiacol Benz., 5 gr. • • • 446 ,, Carb., 5 gr. • • • 446 Guaiac. & Sulph., aa 3 gr. • • • 444 Hexamine, 5 gr. • • • 452 „ A Lith. Benz. • • • 453 ,, Sod. Benz. ... 453 Hormonigen • • • 981 Hyd. lodid. Flav., £ gr. • • • 466 „ „ Vir., i gr. • • • 466 „ „ Rub. -V to £ gr. 463 ,, Perchlor., 1/100, 1/32, 1/16 & 1/10 gr. • • • 470 „ Subchlor., 1/10, £, h 1, 2, 3, 4 and 5 gr. 475 Hydrastine Compound • • • 487 Hypophos. Co. 684 Ichthosulphol, 2£ gr. • • • 498 Insulin HC1. 10 units • • • 640 Iodinol, 3 gr. of 25% • • • 515 Iodoprotein, 5 and 10 gr. ♦ • • 516 Ipecac., 1/20, 1/10, 1, 5 gr • • • • 518 Iron Quin. Cit., 3 gr. • • • 720 Kurchi Bark, 5 gr. ... • • • 859 Lactobacilline • • • 52 Laverain . • • • 737 Lecithin, 1£ gr. 0 • • 531 Lithium, Caro., 5 gr. • • • 534 ,, Citrate, 5 gr. ... • • • 534 Luminal, 1,1, 1 and 11 gr. • • • 816 Luminal-Sodium, 1 gr. • • • 816 Lymphatic Gland ... • • • 953 Magisal, 5 gr. * • * 74 Magnes. Perox. 3 gr. • • • 490 Malonurea, 5, 8, 10 gr. • • • 806 Mammary Gland, 2 gr. • • • 953 Marienbad • • • 134 „ Salt, and Anti-obesity 773 Name. Dose. Page Tablets—contd. Medinal, 1, 21 and 5 gr. ... 809 Mixed Gland ... ... 981 Migraigin, 8 & 15 gr. ... 248 Mucin, 5 gr. ... ... ... 953 Myelin. 3 gr— ... ... 949 f Nitroglycerin,—1/50 gr. Mis Sod. Iodid., 15 gr. >horis572 LLiq. Arsenical, 2 m. J ... (See also Tabellse 571 et seq.) Nitropropiol (Sugar Test) ... V. II. Novocain with Adrenalin var. 345 Nuclein, 1 gr. ... ... 278 Omnopon, 1/6 gr. ... ... 629 Opium, 1 gr. ... ... 626 Orchltic Subst., 5 gr. ... 974 Ovarian, 5 gr. ... ... 954 Ox Bile 526 ; Stearettes, 5 gr. 410 ,, Glycocholic Acid & Ext. Sage aa. 0-1 Gm. ... ... 411 Pancreatin and Soda ... 634 ,, and Bile Salts ... 635 Papain, 2 and > gr. ... ... 648 Papaverine, 1 gr., Hyoscya- mine 1/300 gr., and Benzyl Succ., 5 gr. ... ... 563 Paraform ... ••• • •« 127 Parathyroid, 1/20,1/6, J, 1 gr. 985 Pepsin, 3 gr. ... ... ... 659 ,, 3 gr. et Caffeine, 2 gr. 659 Peptonic (Pepsin, Pancreatin, Calcium Lactoph., each 1 gr.) Phenacetin, 5, 5 & 10 gr. ... 326 4 gr., c. with Caff., 1 gr. 326 „ and Suphonal, 21 gr. ea. 326 Phenalgin, 5 gr. 3 Phenolphthalein, 1, 2, 4 gr. 6/2 ,, Comp. ... ... 672 Phenoquin, 4 and 8 gr. ... 316 Phenyl-Aspriodine, 5 gr. ... 82 Phenyl-Sedasprin, 5 gr. ... 83 Pilocarpin Nit., 1/10, 1/5 gr. 688 Piperazine, 5 gr. ... ... 69o Pituitary Dried, 1 gr. entire gland . 9o7 Planadalin, 5 gr.810 Podoph., 1/4 to 1 gr. ... '01 Potass. Bicarb., 5 gr. ... — „ Brom., 5, 10 gr. ... 704 „ Chlor., 5 gr. '05 „ „ 3 gr., c. Ammon. Chlor. 1 gr., c. Borax, 2 gr. et c. Borac. et Cocaina 705 Pot. Iodide, 5 gr. ... ... J09 ,, Permang., 1-5 gr. ... 548 „ Pot. Permang. & Alum for Water Purifn. ... 548 Proflavine, 0-87 and 1-75 gr. for lotions. *>04 Proponal, 11 gr. ... ••• 810 Pulv. Cret. Arom. c. Op., 5 gr. 626 Quinidine Sulph., 5 gr. ... '15 yy yy Name. Dose. Page Tablets—contd. Quinine and Sod. Bic. aa., 3 gr. ... ... ... 718 ,, Acetyl-Salicyl., 3 gr. ... 729 ,, Ethyl-Carb., 8 gr. ... 737 ,, HBr. 3 and 5 gr. ... 720 ,, HBr. 3 gr. c. Phenac., 5 gr. ... ... 720 HC1., 1 to 5 gr. ... 722 „ Acid, 1, 3, 5 gr. ... 725 Rhei Co. . 734 Salicyl., 3 gr. ... 728 Sulph., 1 to 5 gr. ... 731 ,, Acid, 1 to 5 gr. ... 733 ,, Ac. 1 gr. c.Camph., ±gr. ... 262,733 Sulph., Ac. 1 gr. Camph. 1/5 gr. etc. Aconite Tinct., 1 m. 733 ,, „ Camph., Morph. et Atrop. ... 733 „ Urea HC1., 2 gr. ... 723 Rennet, 658 ; Rennin, 1 gr. 657 Resorcin, 3 gr. ... ... 746 Rhubarb, Soda and Ginger... 879 Saccharin, 1 gr.749 Salicin, 5 gr. ... ... ... 75 Salipyrin, 5 gr. . 328 Salol, 5 gr. 75 Salophen, 5 gr. ... ... 84 Santonin, 1, 1, 2 and 3 gr. ... 752 Sedasprin, 5 gr. 78 Senecio Co. ... ... ... 883 Sidonal, New, 71 gr. each ... 695 Soda Mint (Sod. Bicarb., Am. Carb., and Mint). For Effervescing Compounds see ‘ Vescettes ’ Sodii Acid Sulph. ... ... 772 Arsenat Co. ... ... 179 Benzoate, 2 gr. ... 8 Bicarb., 5 gr. — Bisulph. foi Baths ... 772 Bromid., 5 gr— ... 763 Chlor. et Borac. ... 765 Citras, 5 and 10 gr. 579, 766 Desoxycholate ... 776 Iodid c. Sodii Nitrite, 3 gr. with 1 gr., also 5 gr. with 1 gr. ... 769 „ Nitris, 21 gr. and Co.... 769 „ Salicyl., 3 and 5 gr. ... 63 Solurol, 4 gr— ... ... 976 Soneryl, 1 gr. 811 Spinal Cord, 21 gr. 949 Stannoxyl ... ... ••• 887 Strontium Brom., 5 gr. ... 781 Strophant. Tinct., 2 & 5 m. 782 Strych. Sulph., 1/60 to 1/30 gr. 786 Strych. c. N itrogly c. (Tabcllse) 572 Stypticin, £ gr. ... ... 568 Styptol, I gr. 568 yy yy Sulphonal, 5 gr. _ , . 787 Sulph. Prsecip., 5 gr., c. Pot. Acid. Tart., 1 gr. 790 Name. Dose. Page Tablets—contd. Suprarenal, 4 & 1 gr. Dry Substance. 967 Syr Easton,’14 = 4 and 1 gr. 419 Testicular Substance ... 974 Theobromine Comp., up to 6 p.d.798 Theobrom. Sod. Salicyl, 5 gr. 797 Theocin Sod. Acet., 4 gr. ... 799 Theophylline, 4 gr. ... ... 798 Thiocol, 5 gr. ... 447 Three Gland. 981 Thyminic Acid, 4 gr. ... 976 Thymoform. ... 802 Thymol Carb., 10 gr. ... 802 Thymus Gland, 3 & 5 gr. ... 975 Thyroid (Standard), 14 & 5 gr. 980 „ Comp. (3 & 4 gland) 980 Tinct. Aconit., 24 m. ... 92 „ Bellad., 2 and 5 m. ... 220 ,, Nuc. Vom., 5, 10 m.... 596 „ Opii, 5 and 10 m. ... 627 „ Quin. Ammon. = 1 dr. 733 )} >> )) Comp. 733 ,, Strophanth, 2 & 5 111. 782 Trilactine, 3 to 6 p.d. ... 52 „ Intestinal, 3 to 6 p.d. 52 Trional, 5 gr. 788 Trunecek’s Serum ... ... 761 Tylcalsin, 8 gr. . 72 Tyllithin, 8 gr. 73 Urethane, 5 gr.818 Urotropine, 3, 5 & 74 gr. ; Elf., 5 gr. 452 Varium .954 Veramon, 1 to 2 gr. 330 Veronal, 5, 8 and 10 gr. ... 807 Veronal Sodium, 1, 24 A 5 gr. 810 Vesalvine , 5 gr.452 „ ‘ S,’ 5 gr. 453 Water-Sterilising . 47 Yohimbine HC1., 1/13 gr. ... 892 Zinc Oxide, 2 gr.823 TABLETS, HYPODERMIC ... 794 In demand are :— Aconitine Nit., 1/640 gr. ... 93 Adrenalin, 1/300 gr., c. Cocaine HC1., 4 gr. 972 Apomorph. HC1., 1/20, 1/15, 1/10 gr.166 Atrop. Sulpli., 1/200 to 1/50 gr. 208 Atrop. c. Morph. ... ... 208 Caffeine Sod. Salicyl., 4 gr.... 247 Cocaine Hyd., 1/10-4 gr. ... 339 Codeine Phosph., 4 and 4 gr. 356 Curare, 1/12 gr. ... ... 851 Diamorph. HC1., 1/24, 1/12 gr. ... ... ... ... 559 Digalen . ... 394 Digitalin, 1/10 gr. 393 Ephedrine HCL, 4 gr. ... 398 Ergamine, 1/65 gr. ... ... 407 Ergotinine Cit., 1/200 to 1/100 gr. ... .’.406 Ergotoxine, 1/100 gr. ... 406 Name. Dose. Page Tabs. Hypod.—contd. Ergotoxine, 1/100 c. Morph. 4 406 ,, 1/100 c. Strych., 1/20 gr. 406 Heroin HC1., 1/24, 1/12 gr.... 559 Homatropine HBr., 1/200 gr. 211 Hyd. Perchlor., 1/60, 1/50 and 1/30 gr. Hyoscine HBr., 1/400 to 1/75 gr. Hyoscine Comp. Hyoscyamine Sulph., 1/100, 1/50 gr. Lobe line Sulph., Ao gr. Morphine Mec., 4 and 4 gr. „ HC1., 4 to 1 gr. „ Hypophosph., i, 4 & 4 ••• ••• ••• „ Sulph., 4 to 1 gr. „ c. Atropina . ,, c. Nitroglycerin Novocain and Adrenalin ... Physostig. Salicyl., 1/100 gr. Picrotoxin, 1/100 gr. Pilocarpine HC1., 4 gr. „ Nit., 1/10 to 4 gr. Quinine HBr., 4 gr. ,, HC1. Acid. 1, 2, 3 gr. ... Sclerotic Acid 1/16 gr. Scopolam. Morph, (and with Atrop.) . Sparteine Sulph., 4 gr. Strophanthin, 1/500 gr. Strychnine Nit. and Sulph. 1/100 to 1/30 gr. Tropacocaine HC1., Tyramine Tablets, Ophthalmic. Lamella}. Tablet Triturates Tabotamp Taenia Taffetas Film ... Taka-diastase, 1 to 5 gr. Takamina . Talc (and Talc. Purif.)... Tallquist Scale. Tamarind, 1 to 8 dr. ... Tampons, Gauze „ Argyrol, 5 & 10% ,, Ichthosulphol... ,, Iodoform . Tanacetum . Tannalbin, 8 to 15 gr. Tannal Insolubile . Tannia . Tannigen, 5 to 15 gr. ..* Tannin, 5 to 10 gr. „ for Burns . Tannoform . Tannyl Acetate. Tansy, 859, 889; Tantalum, V. II. ; Tapioca Starch ... 836 Tapeworm ... 421, 422, 752,1093 Tar, 2 to 10 gr. ... 695 & V. II. Tar Acids, 27 ; Oils . 27 1/30 470 492 494 496 536 557 557 557 558 208 558 345 685 688 688 720 725 408 494 886 783 785, 786 gr. 342 ... 408 Vide . 794 .533 421, 752, 1093 ... 439 ... 543 ... 968 ... 139 ...V. II. ... 889 435, 793 ... 793 498, 793 ... 793 ... 889 ... 89 ... 89 ... 889 ... 90 ... 88 ... 88 90 90 90 13 234 .. 238 ..V. II. .. 1087 .. 889 922 839 1908 507, 508 ... 508 Name. Dose. Page Tar Paste, Ether-soluble ... 696 „ Spirit .~ ... 696 ,, water ... . 696 Taraktogenos. 601 Taraxacum (30 to 120 gr.) ... 889 Targesin . 172 Tartar Emetic ... ... ... 156 Diaphoretic, 1/24 to & gr. Emetic, i to 1 gr.. Tartaric Acid Mouth Wash .. Tartarus Boraxat, 20 to 40 gr Tartro- Bismuthates Tartro-Quini obine Tatcho . Tattoo Marks, to Remove Taxine, 1/100 to 1/60 gr. Tea, 248, V. II. ; Tea Seed Oil V. II. Teel Oil ..872 Teeth Infection... Teinture de Badiane ... Teinture de Camph. Cone, and faible ... ... ... 260 Teinture de Feve de Saint- Ignace, max. 4 m. ... ... 596 Teinture d’lode Er. Cx., and Supp. ,, ,, Officinale Teintures var. vide Tinct. Telakucha, V. II. XIX. Edn. p. 168 Tellurium & Oxides 792 ; Organic Comps. ... ...V. II. ,, Spirochseticide Action of Metal ... ...V. II. Temperature Indicators ...V. II. Tenaline ... ... ... 838 Tensile Gloves. 268 Tephrosia ... ... ... 855 Terebenum, 5 to 15 m. ... 795 Terebinthina ... ... ... 691 Tereb. Canadensis .V. II. „ Chia, 5 to 10 gr. ... 889 Terebentene ... ... ...V. II. Terminalia ... ... ... 853 Terpeneless Oils ... ...V. II. ,, 01. Aurant. ... 839 Terpenes ... ... ...V. II. Terpichin .-• 692 Terpineol and Terpilenol 796 & V. II. Terpinoform ... ... ... 126 Terpinol, 1 to 5 m. ... ... 795 Terpine, Terpin. Hydrat., 2 to 6 gr. ... ... ...795&V. II. Terra Alba ... ... ... 138 Terra Silicea Puriflcata ... 139 Test Breakfasts ... ...V. II. Testiculin, 15 to 30 m. ... 974 Testis . 974 Testogan . 975 Tetanus Antitoxin, 923 ; Immunity Units, 924; Dried Serum, 925; Mag. Sulph. Injection, 539 ; Intracerebral, 925 ; Preparation, 924 ; Quinine in relation, 925; Veterinary Use, 925; War Name. Dose. Page Off. Memo, 924; Wound Dressing, 923, 925 ; Ana- Phyl. Shock.924 Tethelin ... ... ... 959 Tetiothalein Sodium ... ... 674 Tetonal, 2 Cc. 25% intram. ... 257 Tetrabromfluorescein.V. II. Tetrabromphenolphthalein Sodium ... ... ... 679 Tetrachlorethane ... 290 & V. II. Tetrachlorethylene ... ... 290 Tetrachlornaphthalene ... 567 Tetra-ethyllead ... 656 & V. II. Tetraform, 10 to 45 m. ... 271 Tetraiodo-eosin .... ...V. II. Tetra-iodofluorescein ... ...V. II. Tetra - iodophenol - phthalein Sodium ... ... 674&V. IL See also Iodo-Ray. Tetra-iodo-pyrrol, 1 to3gr. 503&V.II. Tetramethyl diamino-triphenyl - carbinol • « • 323 Tetramethyl-diarsine ... ... 180 Tetramethyl-Thionine Chlorid. 325 Tetranitro-methyUaniline • • • 305 Tetra-oxy-phthalophenon • • • 672 Tetra Vaccine • • • 938 Tetronal • • • 788 Tetrophan, | grain 304 Tetryl. • • • 305 Teucrium . • • • 889 Texas Fever 185 Thalleioquin • • • 718 Thallium . • • • 889 ,, A.cet. .... 889 & V . II. ,, Sulph. • • • 889 Thamnidium . ...V . II. Thaolaxine . • • • 833 Thebaicum (Opium) ... • • • 622 Thebaine HC1., i to 1 gr., per os 890 Theelin, 1 Cc., intram.... 955, 963 Theine, 1 to 5 gr. • • • 244 Thelygan . 975 Theobroma 01. ; Pasta ... 796 & V. II. Theobromine, 1 to 5 gr. 244, 796 & V. II. ,, Calc. Salicyl., 7 to 15 gr. 798 „ „ -Iodo-Sal. Tabs. ... 798 - ,, Pot. Sulphocy. Tabs. 798 ,, Sodium-Sal., 10 to 20 gr. 797 ,, Sodio Acet., 10 to 15 gr. 797 & V. II. „ „ Iodo Salicyl, 2. to 10 gr.798 ,, Sodio Sod. Iod., 8 to 15 gr. 798 ,, Valer.,5gr. . 798 Theocalcine, 7 to 15 gr. ... 798 Tlieocin, 3 to 6 gr. ... ... 798 „ Sodium Acetate, 2 to 4 gr. 799 Theominal ... ... .... 817> Theophylline, 3 to 6 gr. ... 798 ,, Ethylene Diamine, 11 gr. 799 ,, Sod. Acet., 2 to 4 gr. ... 790 Theo-Sodo-Sal., 10 to 20 gr. ... 797 Theo-Sodo-Acet., 10 to 15 gr.... 797 Name. Dose. Page Therapia Sterilans ... ...V. II. ‘ Therapeutic Coefficient ’ ... 298 Therapeutic Index .1022 „ Substances Act.1015 ,, re Pituitary . 959 ,, Regulations,.1016 Thermiol . 828 Thermit 134 Thermofuge . 435 Thermolaine . 439 Thermo-isolators for milk ... V. II. Thermometric Equivs. xlvi Thermos Flasks, V. II; Expts. V. II Thieleman’s Drops, av. 30 in. Thigenol. Thio-carbamide Thiocol, 15 gr. Thiodin . Thiodotoxyl . Thiohistamine. Thionin Solution Thio-Resorcin 376 .. 499 .. 806 .. 447 .. 758 .. 758 .. 792 ..V. II. 747 & V. II. Thiosinamin, I gr. inc. to 2 gr. (and Mull.) . 757 & V. II. Thiosinamin, Eth. Iodide (Inj.), 3 gr. 758 & V. IT. Thiostab ... 87 Thio-Urea ... 806 Thistle, Blessed. ... 849 Thomassen’s Method ... 706 Thomson’s Vaccines ... ... 899 Thorii Aceto Coumaras ... 820 Thorium Compounds and all other Salts ... ...V. II. Thoron ... . ...V. II. Thorn-Apple ... 779 Threadworm ... ... 7 52, 1093 Three Gland Tabs. ... 981 Thrombin . ...V. II. Thromboplastin ... 940 Throplileol . ... 853 Thuja ... 890 Thus Americanum ... 691 Thyme ... 890 Thymaglycine, 10 to 30 m. ... 801 Thymobenzene ... 159 Thymoform Tablets ... 802 Thymol, £ to 2 gr. ; Anthel- mintic, 15 to 30 gr., 273, ,, Antiseptic power ,, Blue ,, Carb., 5-15 gr. ... ,, Disinfectant ,, Iodide =Aristol ... ,, Sol. (Volckmann’s) ,, Sulphonephthalein ,, Wool & Gauze ... Thymophthalein - Thymotal, 5 to 15 gr. ... Thymus Gland (Liq. Ext., i~2 dr.), 3-10 gr. . 975 Thymus Vulgaris ... 799,890 Thyro-glandin, 3 to 5 gr. ... 980 799 & V. II. ...V. II. ...V. II. 423, 802 801 & V. II. 503 & V. II. ... 802 ...V. II. ... 439 ...V. II. ... 802 "N" A ‘VCP Thyroid Gland . B.M.R. Dose. 99 99 99 » 99 99 9 9 99 99 9 9 99 99 99 Page 976 981 979 979 984 Dry, 4 to 4 gr. “Extract” ... in the Frolich Syndrome in Myxoedema & Cretinism . 076 Manganese Treatment 547 Obesity ... 084, 1071 Overdose . 977 Para Gland . 985 References . 982 Solution, 5-15 m. ... 979 Tablets Standardised, 1* and 5 gr. ... 980 Variation and Assay 980 & V. II. Thyroidectomised goat’s milk Thyroidectin, 5 gr. Thyroidine Belg. . Thyroideum Siccum/14, 4-4 gr. Thyroxin . Thyroxin Tabs., 0-2, 0-4, 0-8 and 2 mgr. ,, Uses and References Tick Fever . Tidman’s Salt. Tiki-Tiki, see Beri-Beri Tiliae Flores, Tilleul . Tillman’s Dressing ... 439. Tin, Tin Oxide. Tinct. Aconiti, 2 to 5 m. „ (Fleming), 1 to 5 m. rvf T, „ et lodi 92 ,, Nepaul . ,, (Turnbulls) Actaeae, 30 to 60 m. Adonis, 10 to 30 m. iEsculi Hippoc., 10 m.... Agarici, 20 to 60 m. ... Aloes, H to 2 dr., or i to 1 dr. rep. ,, Co., 1 to 2 dr. Alstoniae, £ to 1 dr. Amara, P.G. Ananassae Sativse, 30 m. Anodyna, 5 to 30 m. ... Anthemidis, 3-10 m. ... Anthoxanthi, 2-6 m. ... Anticholerica . „ Inoscmzowi ,, Tliielemani,av.30m. Apis, 1 m. hourly Apocyni Can., 5 to 60 m. Arnicae, £ to 1 dr. ,, Flor., £ to 1 dr. Aromatica . Asafetidae, £ to 1 dr. ... Asclepias var. Aurantii, £ to 1 dr. Avenae, 20 m. Baptisiae, 5 to 30 m. ... Bellad., 5 to 15 111. Benzoini, Co., 4 to 1 dr. 986 986 979 979 977 977 978 V. II. 762 V. II. 500 440 S86 92 92 506 ' 831 92 849 832 832 833 132 133 835 856 836 627 837 837 376 376 376 837 837 838 850 838 839 839 839 840 220 7 & V. II Name, Tinct. 5) 5) >> 55 55 55 5 5 55 55 55 55 55 55 55 35 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 5 5 55 55 55 55 55 55 55 Dose. Page Benzoini, Simp. ... 7 Berberid., £ to 1 dr. ... 841 Blepharis, 15 m. ... 841 Boldoae, 10 to 20 m. ... 842 Bryonise, 1 to 10 m. ... 842 Buchu, i to 1 dr. ... 842 Cacti Grandif., 2-10 m. 847 Calendula) Flor., 5 to 20 m. 843 Calumbse, £ to 1 dr. ... 843 Camph. Co., 30-60 m. 260, 626 Cannabis Ind., 5-15 m. 264 Cantharidini, 2 to 5 m. 266 Capsici, 5 to 15 m. ... 270 ,, JSther ... ... 270 ,, Fortior, 1 to 3 m. 270 Cardam. & Co., £ to 1 dr. 844 Carminative, 2-10 m. ... 893 Caryophylli, 2 to 10 m. 845 Cascara Sag., 10 to 60 m. 276 Cascarilla?, £ to 1 dr. ... 845 Castorei, £ to 1 dr. ... 846 Catechu, £ to 1 dr. ... 846 Chirata), £ to 1 dr. ... 848 Chlorof. Co., 5-60 m. ... 287 „ et Morph. B.P. '85, 5 to 10 m. ,, et Morphinse Co. {B.P. '14), 5 to 15 m. ... »* • Cimicifugse, 30-60 m. Cinchonse and Co. {B.P. ’14), £ to 1 dr.... Cinnamonii, £ to 1 dr.... „ Co., 20 to 40 m. ... Cocci, 5 to 15 m. Colchici Sem., 5-15 m.... Collinsonise, £-2 dr. Colocynth, 3-15 m. Condurango, £ to 1 oz.... Conii, 30 to 60 m. ConvaJlar, 5-20 m. Coronillee, 30-60 m. Goto, 10 to 30 m. Croci, 5 to 15 m ( B.P. ’98) Cubebse, £ to 1 dr. ... 851 Cudbear.* • Digitalis, 5 to 15 m. ... 390 ,, Assay of ...390 A \ . II. Fob Recent., 5 to 15 m. ... ••• 391 Keeping Properties of ...390 &V. II. Phys. Standardised 390 & Y. II. Sem ... • • Droserse, 5 to 10 m. ... S52 Elaterii Co., 10 to 30 m. 852 Ergot*? Amm.,30 to 60 m. 40o Erythroph., 5 to 10 m. Eucalypti Eol., 15 to 120 m., 610 ; Gum, 20 to 40 m. ... . Euonymi, 10 to 40 m. ... Euphorb. Pepli., 30 to 60 m. in die. 287 287 849 294 295 295 844 358 849 374 850 375 850 850 376 Name. Tinct. 55 55 55 853 854 410 854 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 >5 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 PAGE 854 414 416 421 Dose Euphorb. Pil.10 to 30 m. Ferri Perchlor., 5 to 15 m. ,, Pomat., 15 to 30 m. ,, Tart. Galia), £ to 2 dr. ... — Garnbir Co., 1 dr. ... 846 Geisemii, 5 to 15 m. ... 426 Gent. Amar. ... ... 856 Gent. Co., £-1 dr. ... — Gossypii Rad., 1 dr. ... 443 Guaiaci, 1 in 10, 60 m. 444 ,, Ammon. 30 to 60 m. 444 Guaranse, 30 to 60 m. ... 858 Ilamam, 30 to 60 m. ... 449 Hydrastis, 30 to 60 m. ... 487 Hyoscy., 30 to 60 m. ... 495 Ignatise, 3 to 20 m. ... 596 lodi Fortis . 507 ,, Churchill ... 510 Fr. Cx. 1908 {sine Pot. lod.) 4£ to 18 m. ... 507 lodi “ Indian ” ... 507 „ P.G.509 ,, Mitis, 2 to 5 m. 507 et seq. ,, et Aconiti. 506 ,, Decol. and Decol. Fortis, 509 ; Oleosa ‘ Iodised Guaiacol ’ Ipecac., 10 m. ... Iridis, 30 to 60 m. Ixorae, 1 to 1£ dr. Jaborandi, 30 to 60 m... 509 447 518 861 861 688 Jalapae (et Co.), 30 to 6O111. 861 Kaladanse, £ to 1 dr. ... 862 Kino, 30 to 60 m. ... 862 Kola?., 20 to 60 m. ... 248 Krameria?, 30 to 60 m— 862 Lachnanthis, 1 to 10 m. 863 Lactucarii, av. 30 m. ... 496 Laricis, 20 to 30 m. ... -— Lasiosiphon, 10 to 60 m. 863 Lavand. Co., 30 to 60 m. Laxativa, 20 to 60 m. ... 276 Liinonis, 30 to 60 m. ... 864 Lobelia?, 15 m. expt., 60 m. emetic ... ... 535 Lobelia? iEther, 5 to 15 m. 535 Lupuli, 30 to 60 m. ... 864 Lycopodii., 15 to 60 m.... 865 Menthol Aither ... 551 Monsonise, 1 to 4 dr. ... 868 Moschi, U.S., av. 1 dr. . 868 Myrrhse, 30 to 60 m. ... 869 „ et Boracis ... 869 Nucis Vom., 5 to 15 m. . 596 Opii, 20 to 30 m.; 5 to 15 m. rep.027 ,, Ammon., 30 to 60 m. 628 ,, Benz., £-1 dr. ... 626 ,, Camph., av. 1 dr.... 627 ,, Crocata, 5 to 20 m. 627 Deod. av. 8 m. ... 627 Papav. Flor. ... ... 623 Passitlora, 30 m. ... 873 Persionis.V. II. FOR B.P. ’32 CHIEF changes, see ft. xxvi. Name. Hose. Page yy yy yy yy yy yy yy yy 5 Tlnct. Phosphori Co., 3 to 12 m. Physostig, 5 to 15 m. ... Phytolac, 3 to 10 m. ... Picrorhizae, 4 to 1 dr. PodophylJi (et Indie.), to 15 m. Podoph. Amm., 10-20 m Pruni Virg., 30 to 60 m.. Pulsatilla, 5 to 30 m. Pyrethri (& Co.) Quassiae, 30 to 60 m. ... Quebracho, 30 to 60 m.... Quillaiae, 30 to 60 m. ... Quininae, 30 to 60 m. ... Quininae Am, 30 to 60 m. Loss of Ammonia in.—J. Itae, P.J. ii./29,310. Rhei Co., 2 to 4 dr.; |-i dr. rep. . „ Amara, i to 2 dr. . ,, Aromat., av. 60 m. R hois, 2 to 15 m. Rumicis, 1 to 10 m. Scillae, 5 to 15 m. ,, Phys. Std.,5tol5m. 882 & V. II. Scnecionis, 1 to 2 dr. ... 883 Senegae, 30 to 60 m. ... 883 Sennae Co. (Legum, 884), 2 to 4 dr. ; \—1 dr. rep.;. Serpentariae, 30 to 60 m. 682 685 874 874 701 701 875 ... 876 876,877 ... 877 ... 878 ... 878 723 733 879 376 879 879 880 882 Stramonii/14, 5 to 15 m. Strophanthi, ’ 14,2 to 5 in. . Strophantlii Phys. Standard 884 884 780 782 782 & V. II. „ Sumbul, 30 to 60 m. ... 888 ,, Sydenham’s, 5 to 20 m... 627 „ Thebaiaca, 20 to 30 m.... 627 ,, Thujae, 2 to 5 m. ... 890 ,, Tolutana, 30 to 60 m. ... 840 ,, Urgineae, 5 to 15 m. ... 890 ,, Valerianae Ammon, (et Indie.), i to 1 dr. ... 819 ,, Veratri Viridis, 5 to 15 m. 891 ,, Verbasci, 20 to 60 in. 891 ,, Viburn. Prunif.,2to4dr. 891 ,, Zingib., 30 to 60 m. ... 893 ,, ,, Fort., 5 to 20 m.... 893 Tincturae, 802 ; Dispensing of 802 ,, Export, Drawback on .... 110 ,, Stabilised (Valerian), 819; Horse Chestnut 819, 832 Tincture of Life . 801 Tinctures, Aqueous, Glycerin... 802 Ethereal, 802 ; see Tinct. Capsici=iEthcr, etc. v Isopropyl ... ... 120 Tinea, V. II. & Tlierap. Index. Tiodine (injection, 3 gr.) ... 758 Tisane de Polygala, 883 ; various 500 Titanium, Chloride, Oxide, Sulphate, Ferrocyanide ...V. II. Toad Flax .833 Tobacco, 870; Denicotinised 871 Name. Dose. Page Todd, A. T., Lead in Cancer... 368 Toison’s Solution ... ...V. II. Todaiwo ..878 Tollen’s Test .V. II. Tolu ..' ... 840 Toluene - azo - toluene - azo - £ - naphthoi . 312 „ Sodium Sulphone Chlor- amide. 46 „ Sulphone Chloride ... 46 ,, Sulpho-dichloramide ... 47 Toluidine, 307 ; Toluidine Blue V. II. Toluol.312 & V. II. Tolysin, 10 to 15 gr.318 Tomb’s Mixture ... ... 1041 TonquinBean. !!! 829 Tonquinol . 345 Tooth Extraction . 338 Paste, * Formosyl ’ ...” 126 Pastes, Antiseptic Power. V. II. „ Pdr., Jungman’s, 886; ... 13 ...V. II. ... 714 ... 440 ...V. II. ... 440 ...V. II. ... 220 ... 831 893 et seq. 866 yy yy Tow Sodium Perborate Torbenite . Totaquina Touch Wood, 835 Toumesol Towels, Sanitary Towle’s Pills Town’s Specific Toxicophloea .., Toxins. Trachylobium ... Trade Marks, 1020 ; ‘ Avoided,’ 1021; ‘ Suspended ’1021 „ ,, forPatented Articles 1020 „ „ Act (1919) ...1021 Tragacantha, 2 to 10 gr. ... 803 Tragopogon . 890 Transfusion, Blood . 987 ,, Solutions for 1, 759 Transkutan . 255 Traumatic Balsam, 4 to 1 dr.. 7 ... 292 ...V. II. ... 188 ... 237 193 & V. II. ...V. II. ...V. II. ..V. II. Traumaticin Trench Fever ... Treparsol, 0-25 Gin. , Trepol ... Treponema Pallid ,, pertenue . ,, recurrentis Tribondeau’s Stains.. Tribromophenol, £ to 2 gr. 20 & V. II 21 241 241 242 279 289 291 282 21 68 243 „ Bismuth, 5 to 20 gr. Tribromethylalcohol . Tribrom-Tert.-Butyl. Alcohol... Trichlorbutyl-Glycol, 5 to 20 gr. Trichlorethyl-Glycol, 5 to 20 gr. Trichlorethylene . Trichlor-isopropyl Alcohol Trichloromethane, 1 to 5 m. ... Trichlorphenol . Trichlorphenyl-iodo-meth. Sal! Trichlor-Tert.-Butyl-Ale., 5 gr. Trichomonas ... .V. II Tricocephalus ... ...1093 &V.II Tricophyton .. ...V. II PAGE ...Y. II. ... 415 ... 867 ... 854 ... 500 • ... 21 31 & Y. II. ... 31 ... 52 ... 52 52 127 6 532 Name. Dose. Tricresyl Phosphate . Triferrin, 15 gr. p.d. Trifolia ... Trigonella Tri-iodomethane Tri-iodophenol Trikresol ,, Formalin Trilactine Milk ... ,, Tablets, 3 to 6 p.d. ,, ,, Intestinal Tri-methanal Allyl Carbide ... Trimethyl-Vinyl-Amrn. Hyd.... Trimethyl Benzene . Trimethyl-Benzoxypiperidine HC1., 1/10 to £ gr. ... ... 343 Trimethyl-Gly cocoll ... ... 6 Trimethyl-xanthine . 244 Trimine, 8 to 15 m. . 544 Trinitrin, 1/200 to 1/10 gr. ... 569 , Solution, £ to 2 m. ... 571 „ Tabell®, 1/130 gr. ... 571 Trinitrobenzol.310 Trinitrocellulose ••• ••• 3£>y Trinitroglycerin,l/200tol/10gr. 569 Trinitrophenol ••• ••• 36 Trinitro-Butyl-Toluene . ol5, 868 Trinitrotoluene ._r 31? Triolein, Palmitin, Stearin ...V. 11. Trional, 10 to 20 gr. ... 787 & V. II. Trioxymethylene . Tripanblue ... ••• ••• Triple Valerianate Injection... 820 Triticum ... . Triturations (1 in 10) . ... »64 ,, Acidi Arsen., 1/6 to» £, gr. ' Atropin® Sulph., 1/20 to 1/10 gr.... ... ••• „ Cocain® HC1., £ to 5 gr. Ferri Arsenatis, f to 2£ gr. ”, Morphin® HC1., 1 to 3 gr. Picrotoxini, 1/10 to 2/ 5 gr. ,, Sodii Arsenatis, £ to 1 gr. Strophanthi (1 gram 710 ” m. Tinct. B. P. ’14), 1/5 to £ gr. ... ••• ,, Strychnin®, £ to f gr. Trivalin hypod., 8 to 15 m ; per os 8 m. ... . non Trivalin-c. Hyos. V aler. ••• Troehisci (Medicated Lozenges), F. with Fruit Paste, Or. with gum basis, i.e., ‘ Pastils ’ or ‘Jujubes ; 8. with sugar, It. with Bose, T. with Tolu,—Bases ... 804 Acidi Benzoici, £ gr.F. and 1£ gr. (Stimulant Voice), T.II., £ gr. • •• ••• ' ,, Benzoici Co. T. H. (Benzoic Acid, Codeine, Cocaine, Ipecac., Menthol & Bed Gum(markedC. B .A.) ,, Oarbolici, £ gr., (8.) (marked C. A.) Name. Dose. Page Troehisci—contd. Acidi Tannici, T., £ gr. and G., ,, Tannici, F., 1£ gr., T.H., ,, Tannici et Capsici, F. Aconiti, F., Tinct. £ m. 1 every £ hour . 33 Adrenalin, 1/1000 gr. ... 9/3 Althaeae (Guimauve) ad. lib. Ammonii Bromidi, 1 gr. (G.) 140 Ammon. Chlor., F. 2 gr. ... 141 „ „ c.Glycyrrh.,3gr. 141 ,, Co. ... ... HI Antacidi (Sir W. Boberts) Calcii Garb., 3£ gr. Mag. Carb., 2£ gr. Sodii Chlor., 1 gr. Bismuthi Co., 141 B., 2 gr.... Boracis, F., 3 gr. T.H. ... Boracis et Potass. Chlor., I. Brompton Blacks ... ... 8o7 Camphor®, 2 gr., S., p.r.n.... 262 „ Salicyl. Comp. t.d. ... 263 Capsici, Sp.r.n. ... • •• Carbonis, S., 12 gr., 1 or 2 p.c. Cascara gr., 2£ c. Menth. Pip. F., 1 or 2 ... ••• ••• 276 Catechu. 1 gr., F., 2 gr. T.H. 846 Chlorodyne, 4 m., 8., 85. Cocain. HC1. S., 1/12 gr TH F., 1/10 (marked H.C.), G. 1/10, Bromp- ton £ ••• v ••• Codein, £ gr., S., 4 or 5 p.d. 35o Cubeb®, F., £ gr., T.H. ... 80I Digestive (Bhei, Zing., Cardam) Eucalypti Gum, F., 1 gr. ... 854 „ Co., F., Igr. ... 854 „ 01. 1. m. G. Ferri Bedacti, S., 1 gr. 1 or 2 411 Formosyl (G.) ••• ••• 126 Gambir, 1 gr—Catechu ... Garrod ••• ■ • •• ••• *00 Glycyrrhiz® (et Anisi) ... 857 et Opii, i gr. ... Guaiaci, 2 gr., T.H.F., and S. Resin*, F., 3 gr. ... 444 GummiBub.c.Cdcamal/20(G.) Hyd. Subchlor. S., £, 1, 2 gr. Ipecac., S., £ gr., als0 1., 1 gr., 2 or 3 p d. 518 Kino, F., 2 gr., 1 p.r.n. ... 862 ,, Eucalypti, 1 gr., F. ... 8o4 Krameria, 2 gr. et Cocaine, 1/20 gr. G., p.r.n.... ... Krameri®, F., Ext., 1 gr., G. 2 gr., F. (T.H.), 3 gr., et Cocain®, 1/20 gr.,F. ... 862 Lavandul®, S., ad^ lib. ... Magnesia, 5 gr., S., *-4 p.d. Menth. Pip. (ct Eort.). Menthol, S., £ G., 1/20, 1/10, 4, £ gr. 1/20 and Cocaine, 1/20 ” gr., G. Mentholi, and Eucalyp., 1 m., G. 557 518 628 648 705 yy J* Name. Dose. Page Trochisci—contd. MorphinaB, T., 1/3 2gr., 4or5 p.d. ,, 1/32 gr., et Ipecac., 1/10 gr. T., 4 or 5 p.d. ,, 1/40 gr., & Emetin, 1/80 gr. 8., 4 or 5 p.d. ... Nitroglycerini, vide Tabellae. Opii, S., Ext. 1/10 gr., 2 to 6 p.d. ... ... ... Orthoform, 2 gr., T.H. Papain, % gr., S., and 1/5 gr. Paregoric, S., 2 to 6 p.d. Potassii Chloratis, II., 3 gr., also F., 3 gr., et Boracis, IT gr Chlor. et Glyc. G., 3 gr. Nitratis, S., 3 gr. Tart. Acidi, F., 3 gr. Pyrethri, F., 1 gr., 3 to 6 p.d. Bhei, Zingib. et Cardam Posse, S., ad libitum. Santonini, S., 1 gr., h.s. Sedativi, F., 3 to 6 p.d. Sodii Bicarb., It., 3 gr., p.c. Sodii et Zingib., S., p.c. Sulphuris, 4 gr., 1 to 6 p.d.... Terebene, 1 m., S. Tolutani S. Tussi3, 4 or 5 p.d. ,, Brompton Zingib., S., ad lib. Tronnner’s Test Tropacocaine HC1. Tropical Ulcer ... Tropoeolin . ...V. II. Tropic Acids Comps. ... ... 204 Troposan, 4 grains ... ... 186 Tropyl Tropate... ... ... 204 Trunecek’s Serum ... ... 761 ,, with Eserine ... ... 686 Trotyl.315 Trypaflavine . 297 Trypagar ... .V. II. Trypanosomes var. ... ...V. II. Trypanosomiasis, 185, 189, Therap lnd. & V. II. ,, Internat. Conf. 1925 and Commission ... ...V. II. Trypan Blue and Bed... ... 185 Tryparsamide, 1 to 2 Gm., injected weekly ...188 & V. II. Antimony Analogue... ... 164 Tryponarsyl ... ... ... 190 Trypsin ... ... 633, 635 & V. II. ,, Stearettes . 636 Tryptic Broth ... ... ...V. II. Tryptophane in Ergot Assay ... 404 Tse Tse Fly .V. II. Tubache’s Method Edn. XIX., p. 328 Tubercle Bacillus ...925 & V. II. Tubercle—Immune Cattle ...V. II. ,, Vaccines ... . 929 Tuberculins . 027 Tuberculin ‘ A.F.’ ... ... 928 ,, Auto-inoculation ... 932 753 628 790 518 851 II. II. ...V. II. ...V. .342 & V. Name. Dose. Page Tuberculin, B.C.G.933 ,, Lubeck Disaster 934 ‘ B.E.’, (Human.Bovine or mixed),929 ; Dose Table . 930 B.F. (& Bovine) ... 928 Beraneck’s ... ... 935 Bouillon Filtrate ... 928 Cuti-reaction ... 936 Diagnostic. 935 Dispensaries ... 933 Dose, Tables 929, 930 Dreyer’s . 932 ‘ For and Against ’... 932 Intradermic Test ... 936 Koch P.G. ‘ Old’ ... 927 Mantoux Test ... 936 Moro's Test ... 936 Nathan Baw ... 931 New (T.B.) ... ... 929 Ointment, 928 ; (Moro’s) 936 ,, (Philip) ... 937 Old, 927 ; Standardisation, 927 ; Diagnost. & Treatment ... 927 Original Alt. ... 928 Percutaneous Test . 937 Perlsucht, B.E. = Bovine B.E. ... 929 P.T. = Tuberculin Old (Bovine). P.T.0.928 P.T.B. = T.B. Bovine 929 Baw’s ..931 Beactions Diagnostic 935 “B” (Baw’s) ... 931 Beferences ... 928, 932 Spahlinger’s ... 935 T.O.A.928 Tables ... 929, 930 Tested Milk ...V. II. Tests . 935 T.B. . 929 T.B. Dose Table ... 929 Vacuum ... ... 928 Von Pirquet Beaction 9 36 Tuberculosis ... ... 926 & V. II. And Bainy Winds...V. II. Aetiology . 926 After care. 926 Austral. Quarantine. 925 Complement Fixation in V. II. Death Bate ... 926 in Dogs .V. II. Hospitals forTreatment 926, 927 Immunising Vaccine Baw . 931 Infectivity of ...V. II. Lipase Treatment... 755 League Nations Bept. 926 and Milk .V. II. Notification Order... 925 yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy Name. Dose. Page Tuberculosis, Order 1925 (cows) 925 (See also Milk) ,, in Wales ... ... 926 ,, Proph. Yaccn born Tubes Temoins Tucker’s Asthma Cure. Tung Oil Tungsten and Arc Light Turck’s Bottle and Capsule Turf Moss Turnera var. Turkey Red Oil Turmeric Turnbull’s Tinct. Aconiti Turnsole. Turpentine of new ... 933 ...V. II. ...Y. II. ... 864 ...V. II. ...Y. II. ... 777 ... 852 ... 618 ...Y. II. 92 ...Y. II. 691 & V. II. 99 Injections in Arth- 99 9 9 99 ritis, 669; in Skin Affns., 692; Punch ... ... 692 Turperh Mineral ... ... 476 Turpethum, 5 to 20 gr. ... — Tutocaine ... ... 65, 354 Twilight Sleep ... ... ... 492 Twort, F. W., Filter passing bact. ... ... ... ... 896 Tylcalsin, 5 to 15 gr., Tablets, 8 gr. ... 72 & V. II. ,, Intrav. i to 1 Gm.... 73 Tyllithin, 5 to 15 gr. ... 73 & V. II. Tylmarin, 5 to 10 gr. (Tabs, and Cachets, 5 gr.) 829 & V. II. Dusting Pdr. ; Gauze, Quinine, 3 to 5 gr. ; Sodium, 5 gr. ; Thorium ... ... 829 Tylnatrin, 5 to 15 gr. ... 74 Y. II. Tylophorae Fol,I.C.Add.,I to2gr. Tyndall Effect ... ... 363 Typhoid 937, 988, 1089 & V. II. Agglutinating Sera ...Y. II. Atropine diagnostic ...Y. II. Bacillus ... 937 & V. II. Carriers ... ...V. II. ,, Solution (Disinfectant) 470 ,, Yaccines ... ... 938 ,, in disseminated Sclerosis 940 ,, Rheumatoid Arthritis. 668 ,, per os ... ... 939 ,, Widal’s Test ...Y. II. Typhus Fever. 988 & V. II. Tyramine, \ to i gr. hyp. ... 408 Tyrode’s Solution .t 760 Tyrosin ... ... ...Y. II. Uffelmann’s Test ... ...Y. II. Llexine, 1-20 to 1-5 gr. ... 852 Ulmus var. ••• 890 Ultra Violet Rays Apparatus and Treatment ... ... V. 11. Ultramicroscope .V. II. Umbrenal ... ... ••• 5oo Uncinariasis, see Ankylostom. 99 99 yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy ” yy ” yy yy ” yy yy yy yy yy ” yy yy yy yy yy yy ,, Pheno-Borici. ,, Picrici, 1 to 3% yy yy yy yy yy yy yy Name. Dose. Page Unguenta ... ...805 &Y. II. Unguentum, U.S.X. — Cera Flav. 1 ; Adeps Benz., 4 Ung. Acid Borici, 1, 2, 3 (Mar- tindale) ... ... H Carbol., 3% ... 19 Co. ... 467 c. Cocaine ... 19 „ Hyd.Perch. 19 Menthol ... 19 . 11 56 Salicyl, 2% " ... 60 Terebinth ... 67 Co. ... 60 c. Resorcin ... 747 Aconitinae, 2% ... ... 93 Agotan Co. ... ... 317 Adamson (Ringworm) ... 1088 Adrenalin ... ... 973 Allyl Sulphid.834 Amyl Salicyl Co. 68 Anderson 228 Antimonii ... ... 163 Aquae Rosas ... ... 872 Argenti Nitratis Co. ... 170 Argyrol ... 170 Aristol ... ... ••• 503 Atropinae, 2, 4 & 8 gr. to oz. ... ... ... 209 ,, c. Acid Boric ... 209 ,, c. Cocaina ... ... 209 Bals Peruv. . 840 Bazin’s ... ... ••• 176 Belladonnae ... ... 221 /3. Naphthol Co. ... 565 Betulae Co. ... ... 697 Billrothi ... ... ... 170 Bismuth Co. ... ... 229 (Subnit.) c. Cocain 232 Morph, et Cocain ... 225 Bismuthi Oxychl. ... 229 Subgall. ... ... 233 Brilliant Green ... 325 Brooke’s ... ... 599 Cadmii Iodidi, 1 in 8 ... Calcis Chlorinat ... 42 ,, Iodat ... ... 830 Cantharidin c. Hyd. Co. 266 Cantharidini ... ... 266 Capsici, and Oleo-res. ... 270 Caseinae. ••• 584 Castellani... ••• <47 & 1045 Cedri Atlant . 846 Cetacei, 1 in 5 847 Chaulmoograe . 603 Chrysarobini (& Co.) ... 291 Cinereum • •• ••• 475 Citrine ... ••• 466 Cocainae, 4% (B.P. ’14)... 335 Conii. ... ••• ••• 375 Cred6 ... ••• 171 Creolin Comp. ... ... 29 Creosoti, 1 in 10 ; Forte 378 Cucumeris ••• ••• 851 yy yy yy yy yy yy yy yy yy yy yy yy yy yy Name. Dose. Page Name. Dose. Page Ung. CupriCit. 382 Ung. Mercurome .. 480 3 3 33 Oleat ... 598 ) ) Metallorum 467 33 Cyllin Comp. 29 33 Methyl Salicyl Co. 67 33 ‘ Danish ’ . 791 33 Myrobalani, also c. Opio 853 33 Deeks (Dhobie’s Itch) ... 1045 33 Naphthol Co. ... 565 33 Diachyli let Carbol.) 600 33 N eapolitanum ... 456 33 Demulcens . 12 3 ) Neisser-Siebert ... 471 33 Dermatol . 233 3 3 Nicotinae ... 869 33 Desinficiens . 471 3 3 Oleatorum 600 3 3 E.phedrinae . 399 33 Olei Cadini et c. Sulph.... 697 33 Eth. Hyd. Cup. 381 3 3 01. Cedri Atlant. 846 33 Eueainae, 10% . 343 3 3 01. Bicini Co. ... 618 3 3 Eucalypti et Ac. Bor. ... 611 33 Opii . 628 33 Eerri Persulph. 420 33 Optochin... 381 33 Fuchsin. 320 3 3 Paraffini ... 650 33 Galeni . 872 3 3 . Pagenstecher ... 476 33 Gallae, 1 in 5 .. 856 33 Para-monochlor-phenol... 21 33 „ c. Opio(7-5%) 628 33 Pheno-boric 11 33 Glyc. Pb. Subacet., B.P. 33 Physostigminae ... 685 ’98 & Dil. 699 33 Picis Liq_ 696 33 Glycerin Co. 435 33 y y v •••• • * • ••• 696 33 Granulin 313 33 ,, et Acidi Salicyl ... 296 33 Guaiacol . 446 33 Pilocarpinae 688 33 Gynocardiae . 603 3 3 Plumbi Carb. 700 3 3 Hamam. . 449 >3 ,, c. Calamina 825 33 ,, c. Cocaine ... 449 3 3 ,r Iodidi . 700 33 Hydrarg. . 456 33 Plumbi Oleatis ... 600 33 Hydrarg. Dil. ... 456,457 33 ,, Subacetatis 699 33 ,, Ammon, (and Dil.) 458 33 Populi 221 33 „ Co., 2 in 5... 457 33 Potassae Sulph. ... 702 33 ,, et Pot. Iodid. 465 3 3 Potassii Iodidi, 1 in 10 ... 33 ,, etZinci Cy. 1 or 2 % 462 33 pro eczema 458 33 ,, Iodidi Bub. 463 33 Prophylaxis 458, 461, 471, 473, 33 ,, Mite ... 456 457 475 33 ,, Nitrat., and Dil. ... 466 31 Quininae (40%). 723 33 ,, Oleatis, 598; Co.... 599 33 Quin. HC1. Carbarn. 726 33 ,, Ox. Flavi ... 476 3 3 B a nunc. Eicariae. 878 33 ,, „ „ c. Atrop. ... 209 3 33 Beclus . 328 3 3 ,, „ ,, c. Physostig. 686 33 Besinae 878 33 ,, ,, Bubri. 477 33 Besorcini (Co., 747) 746 33 ,, ,, et Canth. 266 ,477 33 „ c. Ac. Salicyl 747 33 ,, Salicyl-Arsenas ... 458 3 3 Bubrum, N.H.W. , 477 33 ,, Subchlor. 475 3 3 ,, c. Canth. ... 477 31 ,, Sulph. Elav. 477 3 3 Bumicis. 880 33 Hydrog. Peroxid. 489 33 Busci Co. 697 33 Hyoscinae... 491 3 3 Sabinae 880 33 Ichthosulphol et Rosatum 498 33 Salol c, Cocaina ... 76 33 Ichthyol et 01. Icreb ... 498 3 3 „ c. Menthol... 76 33 ,, et Zinc Ox. 498 33 Salvas . 763 33 Iodermiol. 509 33 Sawyer . 518 33 lodi, 1 in 25 . 509 3 3 Scabies, Danish ... 791 33 ,, Intinctum... 509 3 3 Scarlet 312 33 Iodoformi 502 3 3 Sedresol ... 697 33 ,, c. Atrop. ... 209 33 Simplex ... 805 33 ,, c. Eucalypto 502 3 3 Sod. Clilorid. 763 33 Iodolysin... 758 3 3 Soclii Perboratis... 13 33 Ipecac, et Crotonis 518 3 3 Sodii Perox. ... .... 490 33 Kaolin 139 33 Staphisagriae 887 33 Kaposi 565 3 3 Stimulans ... 266 33 Lanae Hydros 94 3 3 Stovain c. Adrenalin 353 33 Lanae Comp. 94 3 3 Styracis. 887 33 Lanolini .... 94 33 Sulph. 790 ; c. Hyd. 790 33 Lano-boric Camph. 11 33 ,, Camphorat 790 33 Leniens alb. 872 33 „ Hypochlor. 790 33 Menthol c. Camph. 550 33 „ Iodidi 790 5 5 55 55 55 55 55 55 55 3) 55 55 55 55 55 55 55 55 55 55 55 55 Name. Dose. Page Ung. Sulph. Naphthol Salicyl. 790 „ Zinc, et Kaolin ... 790 Suprarenal. ... ... 967 Tartari Stibiati ... ... 161 „ Thiosinamin . 758 „ et Antipyrin ... 758 Thorii Oleatis ... ...V. II. Thymol (& Co.) ... ... 802 Tuberculin Philip’s .... 937 ,, Kochi ... 928 Uranii Oleat ... ... 601 Veratrinae, 2% ... ... 891 Viozin ... ... ... 594 Viride ... ... ... 881 Whitfield. ... 60 Wilkinson ... ... 790 Wilsoni ... ... ... 823 „ Zinci, 15% .. 823 c. Acid Salicyl. ... 823 Carbol. ... ... 823 Oleatis . 600 Permang. 548 Peroxidi ... .,. 490 Unicorn*Root, False ... ... 859 Universal Indicator ... ...Y. IL University Cream . .. 595 Unna’s Chaulmoogra Pill ... 605 Jelly, 803; Paste ... 823 Salve Soap ... ... 867 Stain ... ... ...V. II. Upper Milk Feeding . 578 Uradal, 5 to 10 gr.810 Uranin ... ... .... ••• 6/2 Uranium Acetate, Minerals, Nitrate, Oxide and Ra. Relationship, etc., V. II., Oleate .601 Urari, 1/20 to | gr.851 Urea, 10 to 60 gr., or more^ & ^ Estimation of ... ...V- JJ* Concentration Test 806 & V.II. Naphthol Compds. sym- metrical ... ••• 314 „ Quinine, 5 to 15 gr. ... 725 „ ,, local anaesthetic ... 726 ,, Stibamine ... ••• 163 Ureides ... ... ... 806 &V. II. Ureometers . r\r tt Urethane, 10 to 60 gr. 818 & V. II. „ & Quinine, $ to 3 gr. ... 734 ” „ for Veins 734, 735 Urethral Bougies ... ••• ^63 Urginea ... . ... ..g90 „ Mantima ... ••• Urinary Antiseptics Internal 82, 300 Urine Examination— . Acetone, Albumin, Bacteriology, Calculi, Glucose, Microscopic, Urea, Uric Acid, etc., etc. ... ••• ’’v tt Urine Test Case. .v * A1! Urine, Bromine in, ... ••• Urisol, 5 to 15 grains ... 55 55 Name. Dose. Uritone, 5 to 15 gr. Urodonal, 3 dr. p.d. Uro-Hexoids Uroselectan (& ‘ B ’) . Urotropine, 5 to 15 gr. Ursol IJrtica Dioica Urugoga Uteramin Uva Ursi Uviol, Light PAGE , 449 . 454 . 453 . 877 . 449 . 307 . 31 . 517 . 408 . 838 .V. II. 55 55 55 55 449 Vaccination Act, 941 ; Compulsory, need of, 943 ; Statistics, 943 ; Lancets, 941 ; Order, (1929), 941 ; Origin of, 942 ; Shields . 912 . Encephalitis following 944, 945 League of Nations on ... 945 Min Health Com. on... ... 944 VACCINES ... -. 893 Limit doses are given. Care must be taken to distinguish Prophylactic and Therapeutic Doses. See p. 898. Acne, 5 to 500 mill. ... 901 Acne, 5 m., with Staph. 100 m. increased ... 901 Actinomyces ... ...V. II. Anti-Dysentery ... 913 Anti-rabic ..^ ...V. II. Anti-Typhoid. 938 Calais Expts. 895, 939 in rheum. Arthritis ... 668 ,, Sclerosis ... 940 „ per os.... ... 939 Anti-Typhoid-para- Typhoid ... ... 938 Anti-Typhoid-para- Typhoid-Cholera ... 938 Autogenous 900, 904, 914 B. Coli, 5 mill. incr. ... 909 „ „ in rheum. Arthritis ... 909 Bordet Gengou B. ... 946 Bronchitis ... ... 902 Castellani’s Tetra, etc. 938 Catarrh ... 903 et seq. Children Doses ... 898 Cholera, 500 to 2000 m. (Proph.) ... ... 908 Cold, Combined, 50 to 1000 mill. ... ... 903 Coli, 5 mill., incr. ... 909 Compared with Antiseptics (Sir A. E. Wright) ... ... 900 Detoxicated ... 899, 916 Doses of, Table ... 898 Children... ... 898 Dysentery,5 to 2000 mill. 913 Glanders, 1 Cc. ...V. II. Gonococcus, 25 to 1000 mill. ••• 913 5 > 55 55 55 55 55 55 55 55 55 Name. Dose. Page V accines—contd. Therapeutic Doses. „ Hay Fever, 25 to 1000 units . 914 „ Influenza, 10 to 2000 mill. 914 (cf. Combined Cold Vaccine, 903.) ,, Influenza Detoxicated 916 ,, Local General Effects 900 „ Lymph . 940 „ ,, Min. Health Com. on ... 941, 944 ,, „ Keeping of ... 942 ,, „ Dilution ... 942 >, ,, League of Nations 945 ,, ,, Encephalitis following 944, 945 „ Malta Fever .V. II. „ Micrococcus Catarrhalis, 10 to 2000 mill. ... 903 ,, Peptone with ... 666 „ per os. 939 ,, Plague.V. II. ,, Pneumococcus, 10 to 2000 mill. (Prophyl., Wright, 917) ... 916 „ Pollen. 914 ,, Preparation . 899 ,, Pulmonary Catarrh ... 902 ,, Rabies.V. II. „ Refs., general. 899 ,, Renner’s . 941 ,, Residual Autog. ... 947 ,, Rheumatic 5 to 1000 ni. 919 ,, Site of Injection ... 900 ,, Standardisation ... 899 ,, Staphylococcus, 100 mill. incr. ... . 922 ,, Streptococcus, 5 to 2000 921 ,, Streptococcal Rheuma- ticus, 5 to 1000 mill. 919 „ ‘ T.A.B.’ & ‘ T.A.B.C.’ 938 ,, ,, in Arthritis ... 668 ,, Table of ... ... 898 ,, Technique of Injection 900 ,, Tetra (Castellani) ... 938 „ Tubercle, see Tuberculins. ,, Typh., see Vaccine Antityphoid. ,, War Ollice Conf. on Influenza ... ... 915 „ Whooping Cough, 5 to 2000 mill. 946 ,, ,, „ Compound . 946 Vaccines Sensitized ... ... 946 Vaccinia, 940 et seq. Vaccinium Myrtillus ... ... 869 Vaccino Antivaioloso ... ... 940 ,, Jenneriano ... ... 940 Vaccinum Variolse ... ... 940 Vaginal Suppositories 435, 793' Valenta figure ... ... ...V. II. Valeriana) Rhiz. (et Indie.) ... 819 Name. Dose. Page Valerianic -iso-amyl-Ester ... 820 Validol, 10 to 15 m.551 Vanadine, Vanadium ... ... 890 Van den Bergh Test, 317, 1046&V.II. Van Ermengem’s Stains ...V. II. Van Urk’s Dimethyl Colour Tests.403 Vanilla & Vanillin . 890 Van Swieten’s Liquor ... 468 Vapor Acidi Jarbolici, 20 ; Ac. Carbol. Comp., 379 ; Allii Succ., 834 ; Ammon. Chlor., 141 ; Chlorof. Co., 379 ; Creosoti and Co., 378, 379 ; Cubebse c. Limone, 851 ; Eucalpt. and Co., 611 ; Guaiacol Co., 445 ; Iodi ^Etherealis, 509 ; Menthol Citriodor, 550 ; Terebeni, 795 ; Thymol . 802 Varalettes . ...V. II. Varicella Chicken Vox) ... 988 Varicose Vein Clip . 268 ,, Veins, Salicylate Injns. 63, 64 ,, Glucose for . 430 „ Lith. Salicyl.65, 66 „ ,, ‘ Twin ’ Injns. ... 65 ,, Sod. Morrhuate ... 65,614 „ Sod. Chlorid . 701 „ Elastoplast Bdges.for...267,268 „ Quinine&UrethaneInjns.65,735 „ Ulcers . 736, 1091 (See also Therap. Index.) Variola, 940 et seq.988 Varium.954 Varnishes, Micro ... 866 & V. II. Varul Ointment . 594 Vaseline, Brand Petroleum Jelly (Oil or Liq. „ High Meltg. ,, Otf.FR.Cx. Vasoconstrictine Vasodilatin Vasodilators, 148, and Therap Index. Vasopressin Vasotonin Veal Peptones Veedip Gloves Veganin 651) 650 ... 050 ... 650 ... 968 ... 667 see . 962 . 968 ... ... 576 . 268 357 Veg. Albumen, 585 ; Mercury 701 Vcnene (Snake Venom) ... 964 Venereal, see Gonorrhoea and Syphilis. Venereal Diseases Act (1917)... 1014 „ Packets .V .II. „ prophylaxis, see Ung. Prophylaxis. Venice, Turps. 094 Veno’s Cough Cure .V. II. Ventriculin . 965 Veramon Tabs., 1 to 2 ... 330 Veratri Virid. Rad., 1 to 5 gr.... 891 Veratrina, l/64th to l/16th gr. 891 & V. II. Name. Bose. Page Veratrinse Oleatum ... ... 891 Veratrone, 1 Cc. ... ... 891 Verbascum, 891 ; Verbena 872, 891 Verdigris ... ... ••• 882 Vermicides, see Kyd. Ammon, and Parasites (Ther. Ind.) Tetrachiorethane . 290 Trichlorethylene . 290 Vermijelli ... ••• ••« $55 Vermilion ... ... ... 477 Vermin Killers :— Battle’s and Butler’s contain Strychnine ... Hammond’s and Simpson’s contain Arsenic Vermouth ... ... ••• 827 Vernisol ... ••• ••• 425 Vernon Harcourt Regulator ... 282 Veronigen, 1 dr. . 810 Veronal, 5 to 10 gr. ... 806 & V. II. Dangers of ... 808, 809 Antidotes ... ... 807 Pharmacology... ... 807 Search for bodies similar 809 Tablets, 5, 8, 10 grs. ... 807 Poisoning ... ... 808 Sodium, 5 to 10 gr. ... 809 !. ... 891 Vesalvine, 5 to 15 gr. ... ... 449 ‘ B ’ (Benzoas,5 to 15 gr.) 452 ” Efferv., 1 dr. 452 „ ‘S’ (Salicyl),5 to 15 gr. 453 „ Antiseptic Power ” 450 & V. II. „ Tablets, 5 gr. 452 VESCETTES .891 Lithium Cit., 3, 5 gr. 534 „ Hipp., 5gr. ... 534 Mag. Suiph., 30 gr. 540 Piperazine, 5 gr.635 Pot. Citrate.• ••• Sodio-Mag. Sulph.et c.Caffeine / 73 Sod. Phosph., 30 gr. 770 Stront. Brom., 10 gr. ••• '81 Vesuvine ••• • •• Vet. Surgeon's Scrip for H Drugs ... ••• 996, 1001 Vibrion Septique ... •• • *'• jE Vibrona. Vibrona Malt (Bronamalt) ... 543 99 99 99 >9 99 Vervain Viburnum Opulus ,, Prunif Vichy Salts ,, Water Vienna Paste Vinca Major Vincent’s Angina . ,, Fusiform B. Vinegar * •••••• or. **• Vin. Antimoniale, 10 to «0 m., emetic, 2 to 4 dr. ... 162 ,, Aurantii . 839 & V. II. ,, Cascarae, \ to 1 oz. 2/b Chinse, 1 to 4 dr. 2J5 .. 891 ... 891 ... 773 765 & V. II. ... 702 ... 891 ... 1092 ... 918 4 99 99 Name. Dose. Page Vin. Cocse, 2 to 4 dr. 332 Colchici, 10 to 30 m. ... 358 Condurango, \ to 1 oz. ... 850 de l’Hotel-Dieu . 392 Digitale Comp.392 Diuretic, I to 1 oz. ... 862 Emetinse, 5 to 45 in. ... 523 Ergotae, av. 2 dr. Ferri, 2 dr. Amar., 2 dr. Citratis, 1 to 4 dr.... ,, Giyceroph., i to 2 oz. Ipecacuanhoe (10 to 30 m. expt.), (4 to 6 dr. emetic) Kolao Opii, 10 to 30 m. ... ,, Crocat., 5 to 20 m.... Pepsinae, 1 to 2 dr. Peptonae, £ oz. Quininae, 4 to 8 dr. Quinquina Off. Fr. Cx. ... Rhei,’85,1 to 2 dr. Trousseau. tt „ Urane .V.TI. Vinolia Soap . ••• '54 Viodar (1 in 1000), 1 to 2 dr. 512 „ (1 in 200), 5 to 10 m. 512 Viola var., 30 to 60 gr. Violet Gentian 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 9* 99 99 99 99 99 415 415 34 518 248 628 628 659 660 724 295 392 Crystal Viozin Ung. Viosterol Viper’s Bugloss Virol Viscose Silk Viscometer Viscum Album Visem Vita Glass Vita Wheat Vitafer Vitali’s Test VITAMINS 892 ... 321 ... 324 ... 594 ... 593 ... 852 948 & V. II. 442 & V. II. ...V. II. ... 892 ... 35 ...V. II. ...V. II. 34, 584 ...V. II. 587 & V. II. 5» Cod Liver Oil Concentrates 613 „ Crystalline Products . 587 ,, Distribution of ••• J87 ct seq. ,, in Strawberries ... ••• 855 „ Destroyed by heat, etc.^ (See also A.B.C., infra). „ Commercial preps. ••• 5y5 Vitamin ‘ A 5 (Carotene) 587 <x V. 11. (anti-infective, 590), Arsenic and Antim Tests »• H* Vitamin ‘ B 5 (Anti-neurotic) Destruction by heat and oxidation ... 588 & V. IE ,, Dual Nature of ... ...V. IE „ Stability . 588 ,, in Treatment . 5™ (See also Beri-Beri, V. II.) Vitamin ‘ C ’ (Anti-scorbutic), 588 & «V. II. ; Tablets, Bassett Smith’s (Antiscorb.) 583 »> Page Name. Dose. Vitamin ‘ C ’—contd. Destruction by heat. 589 in Bramley’s Seedling Apples 589 in Milk may be destroyed ... 581 in Vegetables, etc. ... ... 588 Vitamin ‘ D,’ and Rickets 589, 590 Calciferol . 589 Coward Unit ... V IT Jephcott Unit ... .!>; IR Caries in re ..590 Milk Irradiation ... ... 592 Overdose of. 589 Rickets, Light in relation to 591 ,, Mercury Lamps in 591 Stability . 589 Vitamin ‘ E ’ ... ...590 & V. II. „ Stability. ... 590 ,, in Wheat Germ Oil ... 590 J itamin ‘ G ’ 590 \ itamogen ..595 \ itellin, 170 ; Vitis alba ... 842 Vitmar.595 Vlemingkx’s Solution ... ... 259 Voice Tablets. 705 Valckmann’s Sol. . 802 Volhard Method .V. II. V ollsalz. 708 Volt .V. II. Volumetric Indicators.V. II. Von Meisen on Veins. 64 Von Pirquet’s Test . 936 Vulpro Waterproof Sheeting ... 268 Wagner’s Reagent .V. II. Walker I. C., Tests . 660 Wallflower . 847 Walnut, 861 ; Hair Dye 306, 861 Wang Medium.V. II. Warner’s Safe Cure .V. II. Washing without Soap ... 755 Wassermann’s Reaction ...V. II. WATER ANALYS S, Chemical and Bacteriological and the two compared. Chlorination 41, 709 & V. II. Cress .869 & V. II. Dropwort. 871 Gas .V. II. Germander . 889 Glass ..V. II. Hemlock ..849 Iodine in, 709, 768, 913 & V. II. Pennywort . 860 Pepper . 875 Softeners.754 & V. II. Sterilising Tablets ... 772 Waterproof Shtg. . 268 Wattle Bark = Acac. Decurrens 827 Wave Lengths.V. II. Wax, Bees, 846 ; Dental, 651 ; Carnauba ... ... ...V. II. Wax, Horsley’s . 846 ,, Paraffin ... 649 Waxes, M.Pts. of ... ...V. II. Webster’s Test.V. II, » >> >> >) 5) J> J> )) }> )> }> Name. Dose. Page Weed Killers ...V. II. Weights and Measures xl ,, Atomic ... xlvii Weil Felix Reaction ...V. II. Weil’s Disease. ...V. II. Wesson Oil ... ... 261 Westoran, Westron 289, 290 Westropol ... 289 Westrosol ... 289 West’s Swab . ... 906 Whale Oil . ...V. II. Wheat Germ and Oil ... ...V. II. ,, Starch. 836 Whey Powder. ... 582 Whiskey.v. 113 & V. II. White Arsenic ... ... 173 White Birch Oil ... 697 White Bryony ... ... 842 White Precipitate ... 458 Whitehead’s Varnish ... 502 Whitfield’s Ointment ... 60 Whooping Cough, 1093 : Bacil- lus, V. II.; Infective Period. 988 ; Vaccine ... 946 Whortleberry ... ... 869 ...V. ;;;v. of II. II. 80 852 773 873 933 790 II. Wijs’ Solution ... ... Wild, Prof., Absorption Chemicals .... Wild Yam . Wildungen Salt Wild Parsnip . Wilkinson on Tub. Treatment Wilkinson’s Ointment. Willemite ... .,. ...V. Willcox, Sir Win., on Stomach Examination .V. II. Williams’ Pink Pills .V. II. Willmore on Dysentery . 525, 528 Willow, Black or Pussy ... 881 Wilson’s Ointment (P. Jap.) ... 823 Erasmus—Hair Lotion 144, 266 ...V. II. ...V. ...V. ...V. ...V. y * • « V • and Oint. Wmcarnis ... Windolite ... Wines Wingrave’s Stain Winslow’s Syrup Wintergreen Oil, 5 to 15 m. Wireless Headphone Death Witch Hazel Witte’s Peptone W olfram Wood’s Glass ... Wooldridge’s Tincture Wooldridge, Prof. G. H., on Milk V, Wonderberry ... . Wood Naphtha ,, Oil, £-2 dr., 839 ; Sorrel „ Spirit, 114 ; Poisoning ... ,, Wool Perchlor. Woodward’s Gripe Water ...V Woody Nightshade . 884 II. II. II. II. 66 II. ... 447 ... 665 ...V. II. ... 1088 ...V. II. II. 885 114 831 115 469 II. Name. Hose. Page Wool Absorbent, 440 ; Animal, 439 ; Blue, 472 ; Carbolic 17 ; Camphor, 262 ; Cyanide, 462 ; Fat, 93 ; Lamb’s, 439 ; Mercuric Iodide, 463 ; Non- Absorbent, 440 ; Perchloride, 469, 471 ; Picric, 56 ; Salicyl, 60 ; Sheep’s, 439 ; Styptic ... 413 Worms. 422, 752, 1093 Wormseed (Levant) . 751 Wormwood ... ... ... 827 Wortabel Treatment ... ... 159 Woulf’s Bottle for Oxygen ... 630 Wound Treatment ... ... 1093 Wourara, l/20th to i gr. ... 851 Wrappers, Surgical ... ... 441 Wrightia Antidys. ... ... 859 Wright’s Coal Tar Preps. 296, 754 Diluting Fluid ... ...V. II. Leishman Stain, V. II. ; Pipette, Pneumo. Culture Med. ... ...Y. II. Sod. Cit. Solution ... 767 77 Wurmsamen ... 751 ...V. II. ... 244 Xanthaline Xanthine Xanthoxylum var. Xenyl Stibine Compds. Xeroform, 5 to 20 gr., and Gauze X.L. All Fumigators . “ X ” Rays, V. II. ; Barium Meals, 216 & V. II. ; Bismuth Meals, 223, 229 & V.II.; Cholecystography, 675 et seq. ; with Sodium Fluorescein, 672 ; for Acne, Arthritis, Cancer, ‘ Deep’ Therapy, Goitre, Gynaecology, Lupus, Pruritus, Ringworm, Rodent, etc. V. II. Xylene, 312 ; Xylenols, Antiseptic pr., V. II. ; Xylonite 361 ; Xylol, 312 ; Xylol Balsam . • • •v Xylol-azo-Xylol-azo-/3 Naph. Sulph.... Nysmalobinum.. 892 164 21 871 Yadil Yage Yam, Wild Yatren ... ,, Casein Yarom II. 313 892 . 127 ... 892 .. 852. 319, 530;, . 3200 v54 faws ... 187,193, 237,1094 & Y. II. feast, ito 1 oz., Extracts, 276 ; -O.f Tests .‘•97 ft ’’ Irradiated ... ••• See also Young’s 0Table 1104 „ Vitamin ‘ B ’ in 588 & V. IE fellow, Aniline, V. II. j lever ^ .11. „ Ointment . 4/0 feoman Flour ... ••• ...v. 11. Name. Dose. Page Yeo’s Mist. Anti-Catarrh., 1£ ozs. 145 ,, ,, Chloric. Quin., 1 oz. 731 Yerba (Mate). 249 „ Santa . 892 Yersin’s Serum.. V -11. Yew ... ••• ••• 88^ Yoghourt (see Curdled Milk) 52 & v. 11. Yohimbine, 1/20 to 3/20 gr. 892 V • XX • Yohimba var. ... ... ••• 8^2 Young’s Dose Table ... ••• 1104 Yperite ... ... ••• ••• l^4' Zam Buk ...V.II. Zambeletti’s Iron and Arsenic Drops, 5 drops ... }/« „ Injections, 5 to 10 m. ... 178 Zea Mays • 8T3T6 Zenker’s Fluid ... ... *‘*7/ tt Ziehl-Neelsen’s Stain ... ... V. 11. Zinc Arsenic Free ... ••• gzi and Starch Powders ... 824 Chloride Solution 822, 991 Cream . 823 Ionisation ... • • •v • Q41 • Pastes, Various. 824 „ Points . |26 Zinci Acetas, 1 to 2 gr. ... 821 ,, Benzoas. Bromid., 2 to 5 gr. ... 821 Carbonas. 82E 824 Chloridum ...821 & V. 11. Aniline . Citras, 3 to 12 gr. ... 822 Cyanidum ... ••• et Hyd. Cyanid. 461 Gelatin . 82 3 Ichthosulphol . 4 07 Iodas ... . g30 Iodidum, av. 1 gr. ... 822 Lactas, £ to 3 gr. ... 822 Margosas. 88~ Oleas . 000 Oleo-Stearas . 000 Oxidum, 3 to 10 gr. ... 823 Oxychlor.... ••• ••• 823 Oxyphosph.825 Oxysulph. ••• "*v jj ,, Permang.048 A V. 11. ^ 4~X / \Phenol-para-sulphonas ... 20 ,/ Phosphid., 1/20 to 1/3 gr. 682 * et Potass. Cy., To to 1 gr. 8-2 Salicyl., 1 to 5 gr. ... 82o 77 77 77 77 77 77 77 77 77 77 77 77 77 Q! 7 7 „ Silicas'(=Willemite) ,, -S^earas 77 77 ...y. 11. ... 600 Sulphanilas ...307 & V. IR Sulphas., 1 to 3 gr. tonic, 10 to 30 gr. emetic, 825; Antiseptic Power, V. II. ; Spray in C.S. Fever. 8‘jtJ Name. Dose. Page Zinci Sulphate Uterine Points 826 ,, Sulphide “ Active ” ...V. II. ,, Sulphocarbolas ... 20 & V. II. „ Sulpho-ichthyolat ... 497 „ Tannas . „ Valerianas, 1 to 3 gr, Zingiber, 5 to 15 gr. ... Name. Dose. Zirconia... ... ... Zittmann’s Decoctions... Zoel Antiseptic... Zondek-Aschheim Test Zotal ... ... ... ...\ 90 820 Zotos ... ... ...244 & V 893 Zymase ... ... ...643 & V CORRIGENDA. p. 66, line 5, * Varicose Ulcers ’ in bold type should be line 8. p. 66, two thirds down. The note, ‘ Sod. Salicyl. not so certain in effect! quinine ’ refers to Varicose Veins, and should be moved up. p. 249.3^ Hervea is T.M. 421853, Class 3. p. 344. Aminobenz. M.W. 167-0782. p. 410. Evonymine Brune Fr. Cx., not Euonymine. p. 453. For Crystazol read Cystazol. p. 768, line 5, read Jodetum. p. 851, line 17, Curara vice Cucara. p. 853. Emblicee Fructus is the fruit of Phyllanihus emblica (Euphorlia ^distinct from T. Chebula. p. 875, 11 lines from bottom, plantain vice plaintain. p. 1006. Dangerous Drugs Bill 1932, received Boy. Assent Mar. 24,’32, h. read Act. PRINTED 1>Y LOVE AND MALCOMSON, LTD. LONDON AND REDHILL. . /-.'V. . -;;:v ■ • ' . .