Frank Pierce Foster.

Reference-book of practical therapeutics online

. (page 1 of 165)
Font size
QR-code for this ebook





^ ^www;-










L3 1924 104 225 978

The original of this book is in
the Cornell University Library.

There are no known copyright restrictions in
the United States on the use of the text.




Edited by FRANK R FOSTER, M. D.

editor of the new york medical journal and of
Foster's encyclopaedic medical dictionary





CbpimioHT, iS96,

Bt d. appleton and company.

N. 1^^'


The leading idea in the preparation of this work has been to make it pre-
eminently serviceable to the practising physician. It is not intended to take the
place of treatises on materia medica or on pharmacy ; hence, as regards the phys-
ical properties of drugs, their mineralogical, chemical, botanical, or zoological
relations, etc., the endeavour has been to set down only so much as is of direct
bearing on the use of those drugs in medical practice or on the management of
poisoning due to them. Even accounts of the physiological actions of drugs are
condensed, for much of what the experimental pharmacologist justly looks upon
as essential to the prosecution of his studies is useless and clogging superfluity
to the physician in his daily work of treating the sick. For the same reason,
profusion of references to literature has been avoided, although at the same time
it is believed that due credit has been given as to sources of information.

The " therapeutic nihilism " that but a few years ago was justly deplored by
Professor Bartholow has been succeeded by a wave of over-activity for which it is
not difficult to account. We have now to master the task of judiciously employ-
ing remedial agencies many of which are new ; for this purpose we require the
frequent appearance of trustworthy records of what has been accomplished with
these novel agents, for in no other way can the individual practitioner keep pace
with the progress of therapeutics. He who presents to the medical profession
books purporting, as this one does, to contain only such positive statements about
remedial agents as rest upon what seems to be a substantial basis — he who does
that undertakes a work of no little responsibility. In the present instance the
editor has been favoured with the collaboration of a number of writers whose
teachings are known and respected. As this first volume goes to the press, it is
with sorrow that he has to speak of the untimely death of two of them, the late
Dr. Edward E. Palmer, of Louisville, and the late Dr. Benjamin F. Westbrook,
of Brooklyn, both of whom had done important work on the book.

In such a book as this, written by various authors, there is necessarily some
overlapping in the treatment of certain topics ; that is to say, one author treats
of a certain drug, but another, writing on a different theme, finds occasion to
mention the drug assigned to the first one as a subject. If this resulted only in
repetition, it might be considered a defect. But that is not the case ; two or
more writers on such a subject as therapeutics are not likely to inculcate exactly
the same thing, except as to mere commonplaces. Indeed, the exposition of a
topic by more than one author is recognised as one of the best ways for getting
at the truth ; the subject is treated of from more than one point of view, and
additional light is thrown upon it.

There are many drugs that it has not seemed necessary to mention in this


book — some, because they have fallen into almost absolute disuse and are now of
historical interest only ; others, because they are used only in far distant coun-
tries, often by peoples not more than semi-civilized, and are rarely if ever met
with in the markets of Europe and North America ; still others, because they
have been so recently brought forward that too little is known of them to war-
rant a writer in making definite statements concerning them. There is another
class that may be called catchpenny products, put upon the market by persons of
business enterprise without an excess of scrupulousness and wafted into a certain
vogue — temporary and inglorious — by men who, while professing to write for the
advancement of medicine, are really in the proprietors' pay, directly or indirectly.
This class is to be carefully distinguished from those proprietary preparations
that are really valuable, that are produced by careful and honourable makers,
and that are in actual use by practitioners of high attainments and known pro-
bity. Many of these preparations are used almost daily by every practising phy-
sician, and there is hardly an issue of any of the most reputable medical journals
in which more or less space is not devoted to them. They can not be ignored
and they ought not to be. But there is a sort of neutral ground, so to speak,
between these established proprietary preparations and those worthless and per-
haps fraudulent productions to which allusion has been made. This neutral
ground is occupied by products that have been but a short time in the market,
and have not been subjected to sufficient investigation by competent persons to
render it safe to make statements of any practical value with regard to them.
Often it is impossible at first to tell whether they are in the hands of designing
and untrustworthy men or whether their introduction proceeds from individuals
of laudable intentions and possessed of the knowledge necessary to enable them
to test new drugs adequately. It is an almost weekly occurrence for a new coal-
tar derivative, for example, or an old compound under a new name, to be brought
out as a remedy that, in the hands of some physician in a distant country, has,
according to the early published accounts that reach us, produced wonderful
results in the cure or mitigation of some disease ; and these accounts almost
always include an assurance that the drug is " non-poisonous." In short, the
literature of that drug is in the florid stage ; it may take its place in the recog-
nised materia medica ; it may, " non-poisonous " as it has been proclaimed to be,
shortly prove fatal when used in doses well within those employed by its intro-
ducer, and come to be looked upon as too dangerous to be adopted ; or it may
simply fall into disuse because further trial of it does not reveal to others the
virtues ascribed to it by him who first brought it into notice. In this work the
endeavour has been made to keep these considerations constantly in mind, and
not to be hasty in promulgating statements that, although they appear well
founded, may turn out to be erroneous.

The editor's main work in the preparation of this book, besides that of plan-
ning it and selecting the authors, has been to furnish the minor articles, together
with some paragraphs or sections, distinguished by being inclosed in brackets,
interpolated into the signed articles. These additional passages include sum-
maries of observations that have appeared since the original articles were written.
In his part of the work the editor has resorted freely to current literature, and
he wishes to mention in particular the aid he has derived from the United States
Dispensatory, from the National Dispensatory, from Eulenburg's Real-Encyclo-


pddie der gesammten Heilhunde and his EncyelopMiscTie JahrMcher der ge-
sammten Heilkimde, from Geissler and MoUer's Real-Encyclopddie der gesammten
Pharmacie, from the Squibbs' Ephemeris of Materia Medica, etc., from Cerna's
Notes on the Newer Remedies, from Bocquillon- Limousin's Formulaire des me-
dicaments nouveauz, from Soulier's Memento formulaire des medicaments nou-
veaux, and from Husemann's Handiuch der Arzuneimittellehre.

Great care has been taken to make the Index of Diseases, etc., full and spe-
cific ; and, notwithstanding the alphabetical arrangement of headings in the
body of the work, it has been thought best to add an index of remedies, for the
reason that drugs are often mentioned under other headings than their own

New York, March 10, 1896.


Joseph A. Andrews, M. D., Ophthalmic Sur-
geon to the City Hospital, New York.

Samuel Treat Armstrong, M. D., Ph. D.. late
Visiting Physician to the Harlem, Willard
Parker, and Riverside Hospitals ; ex-Passed
Assistant Surgeon, U. S. Marine-Hospital
Seryice, New York.

Samuel M. Briokner, A. M., M. D., New York.

Edward Bennet Beonson, M. D., Professor of
Dermatology, New York Polyclinic ; Visiting
Physician to the City Hospital ; Consulting
Physician to the Babies' Hospital, New York.

Henry H. Buechard, M. D., D. D. S., Lecturer
on Dental Pathology and Therapeutics,
Philadelphia Dental College, Philadelphia.

G. Gordon Campbell, B. So., M. D., Demon-
strator in Medicine, McGill University ; As-
sistant Physician to the Montreal General
Hospital, Montreal.

J. Leonard Corning, M. D., Neurologist to
St. Francis Hospital (Jersey City) and St.
Mary's Hospital (Jersey City), New York.

Floyd M. Crandall, M. D., Adjunct Professor
of Diseases of Children, New York Poly-
clinic ; Consulting Physician to the Infants'
and Children's Hospital, New York.

Maey Gage Day, M. D., Wichita, Kansas.

Charles Dennison, M. D., Emeritus Professor
of Diseases of the Chest and of Climatology,
College of Medicine of the University of

George Dock, A. M., M. D., Professor of the
Theory and Practice of Medicine and Clin-
ical Medicine, University of Michigan, Ann

Jeremiah T. Bskridge, M. D., Professor of
Nervous and Mental Diseases and Medical
Jurisprudence, Colorado School of Medicine,
Medical Department of the University of
Colorado, Denver.

Matthias Lanckton Foster, M. D., Assistant
Surgeon to the Manhattan Bye and Ear
Hospital, New York.

Arpad G. Geester, M. D., Visiting Surgeon to
the Mt. Sinai and German Hospitals, New

Henry A. Griffin, M. D., Assistant Physician
to the Roosevelt Hospital (out-patient de-
partment) ; Attending Physician to the Ran-
dall's Island Hospitals, New York.

LuciEN Howe, M. D., M. R. C. S. Eng., Clinical
Professor of Ophthalmology, University of
Buffalo, Medical Department, Buffalo.

Charles Jewett, A. M., M. D., Sc. D., Profes-
sor of Obstetrics and Diseases of Children,
Long Island College Hospital ; Obstetrician
to the Long Island College Hospital ; Con-
sulting Obstetrician to the Kings County
Hospital ; Consulting Gynaecologist to the
Bushwick Hospital, Brooklyn.

Howard Lilienthal, M. D., Lecturer on Sur-
gery, New York Polyclinic; Assistant At-
tending Surgeon to Mt. Sinai Hospital, New

Russell H. Nevins, M. D., Stamford, Connec-

Austin O'Malley, M. D.. Ph. D., LL. D., late
Medical Sanitary Inspector and Bacteriolo-
gist of the District of Columbia, Washing-

William K. Otis, M. D., late Surgeon to the
City Hospital, New York.

Edward R. Palmer, M. D., late Professor of
Physiology and Pathological Histology,
Medical Department, University of Louis-
ville ; ex-President of the American Associa-
tion of Genito-urinary Surgeons, Louisville,

Peedeeiok Peteeson, M. D., Chief of Clinic,
Department of Neurology, Vanderbilt Clin-
ic, College of Physicians and Surgeons (Medi-
cal Department of Columbia University) ;
Neurologist to the City Hospital ; Patholo-
gist to the New York City Insane Asylums,
New York.

Samuel 0. L. Pottee, A. M., M. D., M. R. C. P.,
late Professor of the Practice of Medicine,
Cooper Medical College : Visiting Physician
to St. Luke's Hospital, San Francisco.

Charles Rice, Ph. D., Phar. M., Bellevue Hos-
pital, New York.


George H. RoHi, M. D., Professor of Materia
Medioa, Therapeutics, Hygiene, and Mental
Diseases, College of Physicians and Sur-
geons, Baltimore.

D. E. Salmon, D. V. M., Chief of the Bureau
of Animal Industry, United States Depart-
ment of Agriculture, Washington.

A. Alexander Smith, M. D., Professor of the
Principles and Practice of Medicine and
Clinical Medicine, Bellevue Hospital Medi-
cal College, New York.

Solomon Solis-Cohen, M. D., Professor of
Clinical Medicine and Therapeutics, Phila-
delphia Polyclinic ; Lecturer on Clinical
Medicine, Jeflferson Medical College ; Physi-
cian to the Philadelphia and Rush Hospitals,
etc., Philadelphia.

Henry Ling Taylor, M. D., Assistant Physi-
cian to the Hospital for the Ruptured and
Crippled, and to the Vanderbilt Clinic, New

Benjamin P. Westbrook, M. D., late Visiting
Physician to St. Mary's Hospital and to
the Methodist Episcopal Hospital, Brooklyn.

James T. Whittaker, M. D., Professor of the
Theory and Practice of Medicine, and Clin-
ical Medicine, Medical College of Ohio, Cin-

John A. Wteth, M. D., Professor of Surgery,
New York Polyclinic ; Visiting Surgeon to
Mt. Sinai Hospital ; Consulting Surgeon to
St. Elizabeth's Hospital, New York.



A. B. C. BALSAM. — Unguentum elemi.

unguentum flavum of the Ger. Ph., 1st ed.

ABELMOSCHXJS.— A genus of malva-
ceous plants. Abelmoschus (or Hibiscus) es-
cuUntus furnishes okra pods, and demulcent
poultices are made from the root. A paste
and a syrup made from the seeds (which
are distinguished from those of Abelmoschus
moschatus, musk seeds, by being odourless and
unstriped) are used like similar preparations
of marsh mallow.

ABIES. — A genus of the ConifercB (sub-
order AbietinecE) including the fir trees. Abies
halsamea furnishes Canada balsam. Abies
communis (or excelsa), the Norway spruce,
yields Burgundy pitch. Abies pectinata (or
picea), the European silver fir, furnishes Strass-
burg turpentine.

ABLUENTS.— See Dbtbegents.

Certain drugs (chiefly ergot, tansy, and savin)
are reputed to have the property of causing
abortion. Their use for such a purpose has
no place in medicine.



ABSINTHIUM [U. S.^—Herba absin-
thii, grande absinthe, aluyne (Fr. Cod.) ; the
leaves and tops of Artemisia Absinthium,
wormwood ; a stomachic tonic, formerly used
as an anthelrainthio, now little used for any
purpose. An infusion of an ounce in a pint of
water may be drank freely. A volatile oil dis-
tilled from the drug (oleum absinthii [Ger. Ph.],
huile volatile d'absinthe [Pr. Cod.]) has been
used internally as an antispasmodic, in doses
of a drop or two, and locally as an analgetic.
In large doses the oil produces epileptoid con-
vulsions, coma, and death.

ABSORBENTS are drugs which act by
absorbing (sometimes by neutralizing) delete-
rious gases or liquids, also those which pro-
mote the absorption of exudates, etc. Cf.
Antacids and Sorbefaoients.


See Detergents.

ACACIA [U. S.]. — Gum arable; the aca-
cim gummi of the Br. and Austr. Ph's ; the
gummi arabicum of the Ger. Ph. ; the gomme

arabique of the Pr. Cod. ; a clear, whitish gum
that exudes from various species of trees of
the genus Acacia (of the Leguminosm, subor-
der Mimosece), especially Acacia Senegal. Gum
arable dissolves readily in cold water, and, so
dissolved, is used as a demulcent. It has been
considered somewhat nutritive. The mucilago
acacia, of the U. S. Ph. is a solution of 340
parts of gum arable in enough water to make
1,000 parts by weight ; this, mixed with three
times its bulk of syrup, constitutes the syrupua
acacice of the U. S. Ph. The mucilago acacice
of the Br. Ph. is a solution of 2 parts of gum
arable in 3 of distilled water.

A. C. E. MIXTURE.— A mixture of alco-
hol, chloroform, and ether ; so called from the
initial letters of the names of its ingredients.
In the United States, where such a mixture is
much used as an anssthetic, the proportions
are generally 1 part of alcohol, 3 parts of chlo-
roform, and 3 parts of ether, by bulk. It is
esteemed safer tnan chloroform alone and more
agreeable and speedy in its action than ether
alone. The alcohol is added with the view of
promoting the intimate blending of the chlo-
roform and ether.

ACETAL. — The acetals are formed by the
action of an alcohol on a nascent aldehyde.
Ordinary acetal, diethylacetal, CH8CH(CjHiiO)a,
is a thin, colourless, volatile liquid, of agreeable
odour and taste, which contributes prominently
to the flavour and bouquet of old wines. It dis-
solves readily in all proportions in alcohol and
in ether, and in eighteen times its volume of
water. By oxidation, to which it is prone
when exposed to the air, it is transformed into
aldehyde, and then into acetic acid. Acetal is
a hypnotic closely resembling chloral in its
action, but much less powerful, regarded as
especially suitable in cases of mental or emo-
tional disturbance. The dose is from a drachm
to a drachm and a half, in water or wine.

Dimethylacetal, CHsCH(CHsO)2, has the
same medicinal properties, but is still feebler,
so that the dose is twice as large as that of
ordinary acetal. A mixture of two volumes of
dimethylacetal with one volume of diethyl-
acetal has been recommended as an anesthetic
less apt to enfeeble the heart than chloroform.
Acetal may be detected in the breath for sev-
eral hours after its administration.

ACETALCEHTSE.— See Aldehyde.


ACETANlIiIDE, phenylaeetamide, CeHj-
NH.CsHsO, the acetanilidum of the pharma-
copoeias, is known also under the proprietary
name " antifebrine." It is an aoetal derivative
of aniline, and appears as white, shining, mi-
caceous, crystalline laminse, or a crystalline
powder, odourless, having a faintly burning
taste, and permanent in the air. Should aoet-
anilide give a reddish-orange precipitate with
sodium hypobromite, it contains aniline and
should be rejected.

Given to a healthy adult, in a dose of from
5 to 10 grains, it produces usually no effect.
A repetition of the dose commonly results in
somnolence, and at times malaise, a weaken-
ing of cardiac force, and slight cyanosis, espe-
cially of the face and extremities. In the ab-
sence of fever no fall of temperature results.

Given in the presence of pyrexia and in
therapeutic doses there usually occurs a marked
fall of temperature, which usually begins with-
in one or two hours, soon reaches its maximum,
and lasts even to eight or ten hours. Co-
incident with the fall in temperature is a
reduction of the pulse rate and force, with
a disappearance of other febrile symptoms.
Sweating frequently accompanies the fall in
temperature, but is apt to be less than that
caused by antipyrine. That the fall in tem-
perature is not dependent upon the sweating is
proved by the fact that the antipyretic effect
of the drug is no less marked even in the
absence of sweating. This action of acetani-
lide in causing reduction of temperature is
not thoroughly understood, but it is believed
to act mainly by diminishing heat production,
and also, though to a lesser degree, by in-
creasing heat dissipation. Though a fall of
temperature follows the administration of a
therapeutic dose of the drug in the vast ma-
jority of cases, the rule is not invariable, and
• an occasional failure of any antipyretic efEect
marks the capricious nature of acetanilide.

While the antipyretic dose of acetanilide is
usually about 4 grains, much larger doses
have been given with no ill effect, even to
100 grains in twenty-four hours ; moreover,
a single dose of 1 drachm has been well borne
by a healthy subject. Ill effects often follow
the larger doses, however, and 10 grains is
scarcely a safe dose for routine administra-
tion; indeed, serious symptoms are sometimes
seen after an ordinary therapeutic dose, though
in this respect the unreliability of acetanilide
does not approach that of antipyrine. Of ad-
verse symptoms following the administration
of acetanilide, the most common is a slight
cyanosis which in itself is seldom of gravity.
Weakening of the cardiac force and of the ra-
dial pulse is, however, a more serious occur-
rence which not very uncommonly appears to
some extent. The appearance of an eruption
from the giving of acetanilide is exceedingly
rare, though not unknown ; vomiting, too, may
occur, but is comparatively rare. In a few
cases collapse has been seen coincident with the
fall in temperature, but it is by no means so com-
mon as after the administration of antipyrine.
Since acetanilide is practically insoluble in wa-
ter, it should be given in alcoholic solution or,

better still, in powder, capsule, or tablet. Its
therapeutic dose is from 3 to 8 grains.

Poisoning by acetanilide is marked by pros-
tration, cyanosis, sweating, cold extremities,
shallow and feeble respiration, dilated pupils,
and weak heart action, which may be rapid,
slow, or irregular. Death takes place in fatal
cases from cardiac paralysis. Unconsciousness
may occur, but in many cases it is absent al-
most to the time of death. The depression of
the circulation following the administration of
acetanilide is far more likely to occur if the
patient remains in the erect attitude. It is far
wiser, therefore, for him to lie down. The
treatment in cases of poisoning is by active
stimulation with the application of heat ex-
ternally and the inhalation of oxygen.

As a result of the continued administration
of acetanilide, there may occur in man anaemia,
with congestion of the liver, kidneys, and spleen.
That such congestions will result in degenera-
tion is probable, and experiments on animals
show that the continued use of acetanilide in
large doses is the direct cause of fatty degen-
eration of the heart, liver, and kidneys.

The therapeutic value of acetanilide depends
upon its properties of reducing febrile tem-
perature, preventing spasm, and relieving pain ;
and though for some time after its introduc-
tion its antipyretic action was prominently con-
sidered to the underrating and almost to the
ignoring of its other powers, more extended use
of the drug and more deliberate consideration
have resulted in making known its other prop-
erties, which are in reality the more valuable.

The impression, unfortunately deep-rooted,
that fever is an enemy to be met and vigor-
ously attacked whensoever and wheresoever it
makes its appearance, has been the cause of
innumerable therapeutic blunders and of in-
calculable harm. Unfortunate indeed was this
belief previous to the introduction of the mod-
ern antipyretic drugs, but with their appear-
ance the situation became doubly serious, for
there were then put into the hands of the
prejudiced and the indiscreet the weapons
wherewith the supposed enemy might be at-
tacked, but weapons which, unwisely used, be-
came the most dangerous of instruments. In
their eagerness to drive away the fever many
were quite regardless of the fact that a mod-
erate rise of temperature lasting for a limited
time was in itself comparatively harmless, and
therefore they hastened to remove this eleva-
tion of temperature by the administration of
drugs which in themselves were not harmless,
and thereby they substituted a frequently posi-
tive harm for an often unimportant symptom.
Among the drugs so misused was acetanilide,
and, though probably the cause of less mischief
than antipyrine, primarily because it is a less
dangerous drug, but mainly because the previ-
ous appearance of antipyrine had been produc-
tive of the wisdom learned by experience, yet
its indiscriminate use resulted not seldom in
repeated sweating and consequent exhaustion,
cyanosis, enfeebled circulation, and, in some
cases, collapse and death.

The correction of these errors is due to three
things : First, the introduction of hydrotherapy


into general use as a means of treating fever
and its symptoms, whereby a relatively harm-
less procedure was substituted for dangerous
drugs ; second, a realization of the dangerous
properties possessed by the so-called antipy-
retic drugs; and third, and more important
than all, the appreciation that fever in itself is
not necessarily a dangerous symptom unless
excessive, and therefore does not call for re-
moval unless it is an evident cause of harm.

In typhoid fever acetanilide has been and
still is much used, but its employment in this
disease, except for the purpose of reducing