Part 7

=Cocain.=—This is the alkaloid of a shrub (coca) growing in South America. Applied to mucous membranes or raw surfaces, or injected under the skin, it blanches the part and produces anesthesia. Applied directly to the skin, however, it is without effect, as it is not absorbed from the unbroken skin. Internally, it is sometimes employed to stimulate the heart, to stimulate the respiration, and to allay vomiting. Its repeated use, even as a local remedy, is dangerous, in that it is prone to cause a habit, the symptoms of which are mental failure, loss of flesh and strength, anemia, and intense craving for the drug. The symptoms of acute cocain-poisoning are excitement, delirium, a rapid pulse, hurried breathing, convulsions, and coma. The dose of cocain is from ⅛ to ½ grain (0.008-0.03 gm.). As an anesthetic it is usually employed in from 2 to 4 per cent. solutions.

A 2½-grain tablet of cocain, dissolved in a teaspoonful of water, makes a 2 per cent. solution; a 4½-grain tablet, in the same amount of water makes a 4 per cent. solution; a 10½-grain tablet in a like amount furnishes a 10 per cent. solution. These percentages are not mathematically correct, but are sufficiently exact for any surgical purposes.

=Cod-liver Oil.=—This is more of a food than a medicine. It is preferable to other oils in being more readily digested. When well borne by the stomach, it is a valuable remedy in wasting diseases, especially phthisis. The dose is from 1 to 4 drams (4-15 c.c.). It may be given in emulsion, in flexible capsules, or pure, dropped in the froth of porter. It is best taken two hours after meals.

=Creasote.=—This is an oily substance obtained from the slow burning of beechwood. It is chiefly used internally as an antiseptic in dyspepsia and diarrhea, and as an expectorant in purulent bronchitis and phthisis. Large doses produce the same toxic effects as are observed in carbolic-acid poisoning. The dose is from 2 to 20 minims (0.1-1.2 c.c.) in capsules, in milk, or in some bitter tincture, like that of gentian. The dose of creasote carbonate (creosotal), which is free from the unpleasant odor and taste of pure creasote, is from 5 to 20 minims (0.3-1.2 c.c.).

=Croton Oil (Oleum Tiglii).=—This is an oil expressed from the seed of a small tree growing in Asia. Locally it is an active vesicant; internally it is a powerful purgative. Large doses cause severe inflammation of the stomach and bowels. The dose is from 1 to 2 drops (0.06-0.12 c.c.) in glycerin, olive oil, or bread-crumbs. A bland vehicle is necessary to prevent the vesicating effect of the drug on the throat. Diluted with from 2 to 4 parts of olive oil, and applied with friction, it is sometimes used as a counterirritant in inflammatory diseases of the chest.

=Digitalis.=—This is a powerful circulatory stimulant, strengthening the contractions of the heart, constricting the peripheral blood-vessels, and slowing the pulse. By increasing the blood-pressure in the kidneys it also increases the flow of urine. It is chiefly used as a stimulant in heart disease when there is failure of circulation, and as a diuretic in various forms of dropsy. The effects of the drug should be carefully watched; too large doses cause marked slowing and irregularity of the pulse, and a decrease rather than an increase in the urine. The dose of powdered digitalis leaves is from ½ to 2 grains (0.03-0.13 gm.); of the Tincture (Tinctura Digitalis), 5 to 20 minims (0.3-1.2 c.c.); of the infusion (infusum digitalis), 1 to 4 drams (4-15 c.c.); of digitalin, an important principle of the leaves, ¹/₁₀₀ to ¹/₆₀ grain (0.00065-0.001 gm.).

=Ergot.=—This is a fungus growing on rye. It is employed to contract the blood-vessels in internal hemorrhage and to stimulate the uterine contractions in the second stage of labor when post-partum hemorrhage is feared. Its use in the early stage of labor to hasten delivery is dangerous, since it may cause tetanic spasm of the uterus and asphyxiation of the child or even rupture of the uterus.

The dose of the Extract of Ergot (Extractum Ergotæ) is from 1 to 15 grains (0.065-1 gm.); of the Fluid Extract (Extractum Ergotæ Fluidum), ½ to 1 dram (2-4 c.c.); of the Wine (Vinum Ergotæ), 1 to 4 drams (4-15 c.c.); of ergotin, a concentrated extract, 2 to 5 grains (0.13-0.3 gm.). When given hypodermically abscess is likely to form, even under the most strict antiseptic precautions.

=Ether.=—Next to nitrous oxid, this is the safest of the general anesthetics, although it is not so readily inhaled as chloroform, and is more apt to produce unpleasant after-effects, such as nausea and vomiting. The latter may sometimes be relieved by the inhalation of hot vinegar fumes.

Death from ether is usually the result of asphyxia, and not, as in the case of chloroform, from heart failure. Internally, by the mouth or hypodermically, ether is sometimes used as a circulatory stimulant in sudden heart failure. Great care should be exercised in handling ether in the neighborhood of lighted gas-jets, as the vapor of the drug is highly inflammable. Ether should be stored in well-stoppered containers, in a cool place, remote from lights and fire.

The dose of ether as a circulatory stimulant is from 5 to 30 minims (0.3-2 c.c.) in ice-water or hypodermically.

=Formaldehyd.=—This gas is employed in the form of a 40 per cent. solution (formalin). It is used as an antiseptic, disinfectant, and deodorant. It is the best disinfectant for sick-rooms that we possess, although on account of its lack of penetrating power it can not be used for disinfecting bedding, stuffed furniture, carpets, books, etc. To be effective the gas must be generated from formalin in a special apparatus, or from paraform tablets heated over a suitable lamp. Attempts to vaporize solution of formaldehyd from an open vessel placed on a stove are unsuccessful, since this treatment converts most of the formaldehyd gas into crystals of paraform. Solutions of formalin—1 : 2000 to 1 : 500—are sometimes used for irrigating suppurating cavities and disinfecting instruments. A solution of 1 part of formalin to 20 parts of water makes a good disinfectant for stools, urine, and sputa.

=Iodids.=—The salts of iodin—potassium, sodium, ammonium iodid—resemble each other in their action and uses. They are used as alteratives in constitutional diseases, like chronic rheumatism and gout, as absorbents of exudates in chronic inflammatory diseases, and as eliminants in chronic mineral poisoning. Their continued use occasions a group of symptoms—frontal headache, nasal discharge, sore throat, and a cutaneous eruption—termed iodism. The dose is from 5 to 30 grains (0.3-2 gm.), well diluted, after meals.

=Iodoform.=—This drug owes its virtues to iodin, of which it contains about 50 per cent. When brought into contact with raw surfaces it exerts a mild anesthetic effect, liberates its iodin, and thereby acts as an antiseptic. When applied too freely it may be absorbed and cause toxic effects—headache, elevation of temperature, restlessness, a diffuse red rash on the face and limbs, delirium, stupor, and collapse. The unpleasant odor of the drug can be removed from the hands and from instruments by oil of turpentine.

=Ipecac.=—This drug is used as an emetic and expectorant. As an emetic it is safe, but somewhat slow in action. It is especially useful in the young and feeble, as it causes but little depression.

The dose of powdered ipecac, as an emetic, is from 20 to 30 grains (1.2-2 gm.); of the Syrup (Syrupus Ipecacuanhæ), as an expectorant, from 10-60 minims (0.6-4 c.c.); as an emetic, from 2 to 4 drams (8-15 c.c.); of the wine, as an expectorant, from 10 to 30 minims (0.6-1.8 c.c.); as an emetic, 1 dram (4 c.c.).

=Iron. (Ferrum).=—The various preparations of iron are employed as tonics and astringents. As tonics, they are especially indicated in simple anemia; as astringents they are employed locally in bleeding, and, internally, in diarrhea.

The dose of Reduced Iron (Ferrum Reductum) is from 1 to 5 grains (0.06-0.3 gm.); of the Pills of Iron Carbonate or Blaud’s Pills (Pilulæ Ferri Carbonatis), 1 to 3 pills; of the Tincture of Ferric Chlorid (Tinctura Ferri Chloridi), 5 to 10 minims (0.3-0.6 c.c.); of the Solution of Iron and Ammonium Acetate or Basham’s Mixture (Liquor Ferri et Ammonii Acetatis), 1 to 4 drams (4-15 c.c.); of the Sulphate of Iron (Ferri Sulphas), 1-3 grains (0.06-0.2 gm.); of the Syrup of Iodid of Iron (Syrupus Ferri Iodidi), 5 to 60 minims (0.3-4 c.c.). The Solution of Iron Subsulphate (Monsel’s solution) is used only as a hemostatic, and Iron Hydrate with Magnesia as an antidote in arsenic-poisoning. The dose of the latter is a tablespoonful every ten to fifteen minutes.

=Lead.=—The preparations of lead are used internally and externally as sedatives and astringents. Lead Acetate (Plumbi Acetas) is employed internally in diarrhea. The dose is from 1 to 3 grains (0.06-0.2 gm.), in pill form.

The Solution of Lead Subacetate (Liquor Plumbi Subacetatis) is employed externally. Diluted with from 5 to 6 parts of water it is used as a sedative application in ivy-poisoning and erysipelas.

The Dilute Solution of Lead Subacetate (Liquor Plumbi Subacetatis Dilutus) is known as lead-water, and is chiefly employed in making the sedative preparation known as lead-water and laudanum. As usually dispensed it contains 1 dram (4 c.c.) of laudanum and 4 drams (15 c.c.) of lead-water to 2 ounces (60 c.c.) of water.

Acute lead-poisoning is characterized by a burning pain in the abdomen, a metallic taste in the mouth, vomiting, purging, coma, and collapse.

Chronic lead-poisoning is characterized by anemia, intestinal colic, constipation, a blue line on the gums (deposit of lead sulphide), and paralysis of the forearms (wrist-drop).

=Magnesium Sulphate (Epsom Salt).=—This salt is an excellent hydragogue cathartic, producing in the course of a few hours copious watery stools. It is also employed as an antidote in acute lead-poisoning and carbolic-acid poisoning.

To secure the most prompt and powerful cathartic effect the drug is best given before breakfast, in a single dose, and with but a small quantity of water. Dose, from 1 to 8 drams (4-31 gm.).

=Magnesium Oxid (Magnesia).=—This is a white, tasteless, and insoluble powder. It is a cathartic, but much milder in action than Epsom salt. Dose, from 10 to 60 grains (0.6-4 gm.).

=Magnesium Citrate.=—An effervescing solution of this drug is much used as an agreeable laxative. The dose is from 6 to 12 ounces (180-360 c.c.).

=Mercury.=—The most important preparations of this metal are calomel, blue mass, corrosive sublimate, oxid of mercury, iodid of mercury, nitrate of mercury, and ointment of mercury.