Charles D. F. (Charles Douglas Fergusson) Phillips.

Materia medica and therapeutics, inorganic substances; (Volume 2) online

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JNO.E.HARKIS, M, D.,

BLOOMIN - ON. IND



MATEEIA MEDICA



THEEAPETJTICS



INORGANIC SUBSTANCES



CHARLES D. F. PHILLIPS, M.D.

MEMBER OF THE BOYAL COLLEGE OF PHYSICIANS, ETC. ; LATE LECTTTREB ON MATEBIA MEDICA AND
THERAPEUTICS AT THE WKSTlJISSTEi: HOSPITAL MEMCAL SCHOOL



(gbiteb onb Qlbapteb to tfye H. 6. f)l)armac0:peeicj



BY
^1

LAURENCE JOHNSON, A.M., M.D.

LECTCTBEB OS MEDICAL BOTANY, MEDICAL DEPARTMENT OF THE UNIVERSITY OF THE CITY OF NEW YOBK :
FELLOW OF THE NEW YOBK ACADEMY OF MEDICINE, ETC.



VOLUME II.



NEW YORK
WILLIAM WOOD & COMPANY

1882



v 3 l




OOPTBIGHT

WILLIAM WOOD & COMPANY
1883



TROW*S

PRINTING AND BOOKBINDING COMPANY

301-3x3 Ea** Twelfth Street

NKW YORK




CONTENTS OF VOL. II.



PAOK

ARGENTUM SILVER 1

COMPOUNDS OP SILVER 1-25

Absorption and Elimination, 2 ; " Argyria," 3 ; Physiological Action, Ex-
ternal, 4 ; Internal, 5 ; Therapeutical Action, External, 8 (Caustic, As-
tringent, Counter-irritant) ; Internal, 18 ; Preparations and Dose, 23 ;
Mode of Administration, 24.

o

ARSENICUM ARSENIC AND COMPOUND& . . 25-71



Absorption and Elimination, 28 ; Physiological Action, External, 28 ; In-
ternal, 30 ; Toxic Action, 40 ; Tolerance, 41 ; Arsenical Wall-papers, 43 ;
Antidotes, 44 ; Therapeutical Action, External, 45 ; Internal, 46 ; Prep-
arations and Dose, 69 ; Mode of Administration, 70.

.

AURUM GOLD AND COMPOUNDS ....... . ................................ 71-76

Absorption and Elimination, 72 ; Physiological Action, 73 ; Therapeuti-
cal Action, External and Internal, 74 ; Preparations and Dose, 76.

BARIUM BARYTA ................................................ _____ 77-79

Absorption and Elimination, 77 ; Physiological Action, 77 ; Therapeuti-
cal Action, 78 ; Preparations and Dose, 79.



BISMUTHUM BISMUTH ....................................... .......... 79

COMPOUNDS OF BISMUTH .............................................. 80-91

Absorption and Elimination, 81 ; Physiological Action, External and In-
ternal, 82 ; Therapeutical Action, External, 85 ; Internal, 86 ; Prepara-
tions and Dose, 89 ; Adulterations, 90.



IV CONTENTS.

PAGE

CADMIUM 91-93

Absorption and Elimination, 92 ; Physiological Action, 92 ; Therapeuti-
cal Action, 93 ; Preparations and Dose, 93.



CALCIUM LIME 93

COMPOUNDS OF LIME 93-113

Absorption and Elimination, 97 ; Physiological Action, External and In-
ternal, 98 ; Lime in Potable Waters, 100 ; Goitre, 101 ; Therapeutical
Action, External, 102; Internal, 105 ; Preparations and Dose, 112.

CERIUM OXALATE OF CERIUM 113-116

Physiological Action, 114; Therapeutical Action, 114; Preparation and
Dose, 115.

CUPRUM COPPER. 116

COMPOUNDS OF COPPER 116-129

Absorption and Elimination, 117 ; Physiological Action, External, 118 ;
Internal, 119; Toxic Action, 120; " Cuprismus," 120; Antidotes, 122;
Therapeutical Action, External, 123 ; Internal, 124 ; Preparations and
Dose, 129.

FERRUM IRON 129

COMPOUNDS OF IRON 130-181

Absorption and Elimination, 136 ; Physiological Action, External, 140 ;
Internal, 141 ; Different Action of Proto- and Per-salts, 145 ; Therapeu-
tical Action, External and Internal, 148 ; Preparations and Dose, Mode
of Administration, 179.

HYDRARGYRUM MERCURY 181

COMPOUNDS OF MERCURY : . . 182-226

Absorption and Elimination of Metallic Mercury, 186 ; of Calomel, 189 ;
of Corrosive Sublimate, etc., 190; Physiological Action, External, 192;
Internal, 193; ' Mercurialism," 204 ; Antidotes, 204 ; Therapeutical Ac-
tion, External, 204 ; Internal, 212 ; Preparations and Dose, 223 ; Inunc-
tion, 225 ; Hypodermic Use, 226 ; Vapor Bath, 226.



CONTENTS. V

PAGE

LITHIUM 227

COMPOUNDS OP LITHIUM 227-232

Absorption and Elimination, 228 ; Physiological Action, Internal, 228 ;
Therapeutical Action, External and Internal, 230; Preparations and
Dose, 232.



MAGNESIUM AND COMPOUNDS 232-243

Absorption and Elimination, 234 ; Physiological Action, 234 ; Theory of
Purgative Action, 235 ; Therapeutical Action, 239 ; Preparations and
Dose, 242.



MANGANESIUM MANGANESE AND COMPOUNDS 243-248

Absorption and Elimination, 244 ; Physiological Action, 244 ; Therapeu-
tical Action, External and Internal, 246 ; Preparations and Dose, 248.



PLUMBUM LEAD AND COMPOUNDS 249-263

Absorption and Elimination, 250 ; Physiological Action, External, 251 ;
Internal, Toxic Action, 251 ; Plumbism, 252 ; Theories of, 254; Modes
of, 257 ; Idiosyncrasy, 258 ; Therapeutical Action, External, 258 ; In-
ternal, 260; Preparations and Dose, 262.



POTASSIUM KALIUM AND COMPOUNDS 263-286

Absorption and Elimination, 268 ; Physiological Action, Oxidation, 268 ;
Therapeutical Action, External, 274 ; Internal, 278 ; Preparations and
Dose, 286.



SODIUM NATRIUM 287

COMPOUNDS OF SODIUM 287-303

Absorption and Elimination, 291 ; Physiological Action, External and
Internal, 292; Therapeutical Action, External, 296; Internal, 298;
Preparations and Dose, 303.

STANNUM TIN 304-305

Therapeutical Action, 304 ; Preparations and Dose, 305.



VI CONTENTS.

PAGE

ZINCUM ZINC AND COMPOUNDS 805-314

Absorption and Elimination, 307 ; Physiological Action, External and In-
ternal, 307 ; Therapeutical Action, External, 309 ; Internal, 311 ; Prep-
arations and Dose, 314.



INDEX OF REMEDIES 315

INDEX OF DISEASES. . 324



MATERIA MEDICA



AND



THERAPEUTICS.



INORG-ANIC SUBSTANCES.



AKGENTUM SILVER, Ag,=108.

THIS metal occurs pure, but more often in alloy, as with lead (galena),
or combined with sulphur (argentite), chlorine (horn silver), and with
iodine, bromine, etc.

Refined silver is placed in the Pharmacopoaia as a source of the ni-
trate, but is otherwise used only in the form of silver-leaf as a coating
for pills: its officinal compounds are the nitrate and the oxide.

AEGENTI NITRAS NITRATE OF SILVER, AgNO 3) =.170.

Prepared by crystallization from a solution of pure silver in dilute ni-
tric acid: when fused and solidified in moulds, it constitutes the small
pencils known as " lunar caustic."

CHARACTERS AND TESTS. The crystals are tabular and colorless, and
form a neutral solution with distilled water: sp. gr. 4.3. They are solu-
ble in four parts of rectified spirit; when pure they do not blacken on
mere exposure to light, but do so, and readily decompose, on continued
contact with any organic substance.

An aqueous solution of the nitrate is precipitated by any soluble
chloride, a characteristic curdy-white chloride of silver being formed,
which becomes dark on exposure to the air: it is soluble in ammonia, in-
soluble in nitric acid. A black sulphide of silver is precipitated from a
solution of the nitrate by passing through it sulphuretted hydrogen.
VOL. II. 1



MATERIA MEDICA AND THERAPEUTICS.



ARGENTI OXIDUM OXIDE OF SILVER, Ag 2 O,=232.

PREPARATION. By precipitation from a solution of the nitrate by
means of lime-water.

CHARACTERS AND TESTS. Occurs as an olive-brown powder: sp. gr.
7.2. It is reduced to the metallic state by a red heat, is soluble in ammo-
nia and in nitric acid, but slightly soluble in water, to which it gives a
metallic taste and an alkaline reaction.

Chloride of Silver, AgCl (not officinal). Readily obtained by decom-
posing any silver salt with hydrochloric acid, when it precipitates as a
white caseous powder (horn silver): it darkens on exposure, and is solu-
ble only in ammonia and in hydrochloric acid.

The A-mmonio-chloride (not officinal) is an unstable salt soluble in
water. The Chloro-albuminate, the iodide, and the double iodide of sil-
ver and potash are soluble salts that do not coagulate albumen. The
hyposulphite of soda and silver is astringent and less irritant than the
nitrate; the cyanide is said to be more readily absorbed.

ABSORPTION AND ELIMINATION. Nitrate of silver, when taken into
the stomach, forms with mucus and epithelium a thin pellicle, which, to
some extent, hinders absorption. The chemical change which all silver
salts undergo, more or less, when in contact with the gastric secretions,
results in the formation of a double chloride of silver and sodium, and
although ordinary chloride of silver is insoluble in water, this double
chloride is readily dissolved by the gastric fluids; its combination with
peptones is also soluble (Bogolowsky: Virchow's Archiv, xlvi., 18G9, and
others). As chloride and albuminate it probably passes into the blood,
and circulates with it, being retained in solution by the alkaline serum
(Rouget), though Frommann thought that it separated in the molecular
form (Archiv fur Path. Anat., 1859). Dragendorff considers that the
chemical changes occur chiefly in the duodenum, and that the gastric juice
being here neutralized by the bile, silver sulphide is ultimately formed:
certainly, of unabsorbed silver compounds, the greater part passes off by
the bowel as sulphuret, coloring gray or black the mucous membrane and
the faeces. More of the salt will be absorbed if given in solution in dis-
tilled water on an empty stomach, than when given in pill in the ordinary
manner. Riemer has shown that in pills (? bread) four-fifths of the silver
nitrate is decomposed even before administration (Archiv der Jleilk., xvi.,
1875). The same observer also sought to prove that molecule.s of silver
pass in a mechanical manner through the intestinal walls, but Fragstein
could detect no absorption of freshly precipitated silver-chloride intro-
duced into the intestine of frogs (Berlin. Klin. Woch., 1877). Orfila and
Heller failed to find traces of silver in the blood after its administration;
but Orfila and Panizza found it in the urine (Husemann), and Cloez iso-



SILVER. 3

lated a globule of the metal from the collected urine of several patients at
the Salpotriere. It has been found also in the liver and the bile, and some
is eliminated by the cutaneous glands. Rozsahezzi found it in the intes-
tinal contents after its hypodermic injection (Archiv JClebs, 1878).

The most important practical point is, that elimination of silver salts
by any channel occurs but slowly, so that if they are taken continuously
for a long time, the reduced metal becomes deposited in the tissues, giv-
ing them a dark -gray coloration, known as " argyria" The gums show
the earliest indication of this condition by a bluish line (which is darker
than that produced by lead), and parts exposed to light show the color
more than others thus the lunula of the nail (Falck), the eyes, the face
and hands are affected early; the deposit is in the true skin (corium).
Neumann has recently examined minutely a portion of the skin of a man
who had partial argyria from frequent applications of nitrate to reduce
large papillae on his tongue: dark granules of the metal were found in
the upper part of the cutis, in the wall of the sweat-gland, in the con-
nective tissue of hair-follicles, in sarcolemma, neurilemma, and the middle
coat of vessels; none were deposited in the epidermis, the mucous layer,
or the epithelial lining of hair-follicles or sweat-glands (Medical Rec-
ord, 1877). That the coloring is partly due to the influence of light is
shown by cases in which the viscera Avere seen to darken after exposure
(Huet, Frommann, Fragstein), but the more active circulation of exposed
parts is another factor in their coloration.

If the drug be stopped on the earliest appearance of affection of the
gums, the general discoloration is not likely to occur. This was shown
in the case of a woman who took nitrate of silver for two months at first
gr., and later 2 gr. daily swelling and redness of gums, with a purple
line at the edges, appeared, and there was much tenderness of mouth
with metallic odor of breath; but, on ceasing the medicine, these symp-
toms subsided (Bulletin de Therapeutique, v., 1871, p. 86). In other cases
when large quantities have been taken, every part of the body has been
affected. Van Geuns reports that a youth took about gr. of the ni-
trate daily (with occasional intervals), from his fourteenth to his nine-
teenth year, none afterward: he died of phthisis at the age of thirty-five,
and not only was the skin colored, but also the cerebral and spinal mem-
branes, the laryngeal and bronchial membranes, the peritoneum, the
papillre, and malpighian bodies of the kidney, the marrow, and the bones;
the nervous, the hepatic, and other parts of the renal tissue were reported
normal. Heynsius concluded on analvsis that the dark granules were not

v v O

chloride of silver (for ammonia did not affect them), nor oxide, but mi-
nutely divided particles of the reduced metal, and this conclusion is now
generally accepted (Abstract, Dublin Quarterly Journal, August, 1858).
Charcot has recorded the presence of silver round the renal glomeruli
and in the Malpighian pyramids, and Liouville has made a similar obser-



4 MATERIA MEDICA AND THERAPEUTICS.

ration as to the kidneys, and also as to the choroid plexus of a patient
who had taken 110 gr. in the course of nine months, three years before
his death. Virchow recorded renal argyria after absorption from con-
nective tissue. Several cases are quoted by Stille, by Sieveking, by
Riemer, and others (Schmidt's Jahrbucher, ii., 1875, p. 295): many of
them seem to have died of phthisis several years after the administra-
tion.

Argyria may even follow local applications of nitrate, as in the case of
a girl whose throat was repeatedly cauterized perhaps fifty times in the
course of twelve months; she is said to have swallowed the products
( Gazette de Paris, xxviii., 1874). It has occurred also after tracheotomy,
the wound having been pencilled "for a long time" ("Dictionary Ency-
clopedia," v., vi.), and in a woman after the continued use of a nitrate
pomade for dyeing the hair.

It is important to ascertain, if possible, what quantity of the drug is
liable to produce coloration, and the time during which its use may be
safely continued. The actual amount deposited is certainly very small:
Versmann found only 0.047 per cent, in the liver in a well-marked case, but
Krahmer estimated that there must be the residue of at least 1 oz. of the
salt to cause discoloration: from 3 to 5 oz. are mentioned as the quanti-
ties taken in several instances, but, judging from Liouville's case, it is
probable that less than 1 oz. might suffice. Six weeks has been named as
a safe limit of time for the continued administration of the drug, and I
should think it almost impossible for any ordinary dose to produce bad
results within that period.

The sulphide was the salt used in the first authentic recorded case of
coloration (Weigel): the iodide is said to be free from this risk, and no
case has been traced to it, but Husemann considers this as accidental: the
double iodide of silver and potash is also regarded as less liable to be de-
posited (Delioux).

PHYSIOLOGICAL ACTION (EXTERNAL). If moistened nitrate of silver
be applied lightly to the skin, it combines with albuminous material, and
leaves a white stain, which soon darkens on exposure to air or light,
because of its reduction to metallic silver; the darkened epidermis peels
off in a few days' time. Strong applications, such as the moistened stick,
or solutions of 1 to 2 dr. in the ounce, cause more or less severe burning
pain, and, in delicate skins, vesication. On mucous membranes, or moist
denuded surfaces, a whitish layer is formed by combination with chlo-
rides and albuminous secretion: this layer soon becomes gray and then
dark, and when it peels off may leave the part tender. Applied to a
suppurating surface, the solid nitrate combines with the purulent secre-
tions to form a grayish layer, stimulates the healing process, and causes
some burning pain and redness near the part: when the superficial eschar
falls, as it does in twenty-four to forty-eight hours, fresh and healthy



SILVER.

granulations are usually found on the wound. The action cannot extend
deeply because of the pellicle which is formed, and the so-called " caustic "
effect of nitrate of silver must be distinguished from that of destructive
agents, such as potash or acids, for it is produced by coagulating and
hardening organic tissues, rather than by destroying them. The affinity
of the salt for albumen, and its forming with it an insoluble compound,
explain most of the local effects of the nitrate. 1

A solution of about 20 gr. per ounce brushed over a moderately in-
flamed part not only discolors it, but reduces its size, controlling inflam-
mation, and constringing the blood-vessels. The conjunctiva has some-
times been discolored by continuous use (to it) of medicinal drops, and
in this and other very sensitive parts, such as the schneiderian, buccal, or
urethral membranes, much pain, irritation, and increased secretion follow
the use of strong solutions. Weak solutions (1 to 3 gr. in 1 oz.) have an
astringent and slightly stimulant action, and do not cause pain except to
a delicate membrane like the conjunctiva. Silver solutions possess, also,
antiseptic power, in degree somewhat proportionate to their strength,
and dependent in part, though not wholly, on coagulation of albumen.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Small
doses of the oxide ( to ^ gr.), and still smaller ones of the nitrate of sil-
ver ( gr.), are usually well borne by the stomach; but the latter salt
produces a metallic, bitter taste in the mouth, and, unless well diluted,
causes burning sensations in the fauces. In -fa to 1-gr. doses it is apt to
induce nausea or vomiting, pain, and diarrhoea; headache and vertigo are
usual accompaniments. The continued use of smaller medicinal doses im-
. pairs the appetite, and may induce intestinal catarrh and hemorrhage.
Any amount over 4 or 5 gr. would be usually rejected by vomiting,
otherwise it would excite inflammation. After death from toxic doses,
the gastro-intesthial membrane has been found soft, eroded, or covered
with gray patches. In chronic cases the muscular and mucous coats be-
come hardened and thickened.

Nervous System. The main point determined by modern investiga-
tion into the action of silver compounds is their special effect upon the
nervous system. The best experiments have been made upon animals by
hypodermic injection of hyposulphites and albuminates of silver, which
do not coagulate albumen. Charcot and Ball reported, as usual results of
such injection, paraplegia and paresis of pulmonary nerves, probably re-
flex in character, leading to profuse bronchial secretion and asphyxia
(Gazette Med., 1864). Rouget found that in mammalia, small doses

1 The chemical formula of the s'lver-albumen compound seems to vary under dif-
ferent conditions. Lassaigne gives 84.5 per cent, albumen, 15.5 of nitric oxide of
silver; Mulder, 16 of the latter in one experiment, 8.9 in another; Krahmer, nearly
12 per cent. Delioux pointed orit that the affinity of the nitrate for albumen is
greater than it is for chlorine (Husemann).



6 MATEBIA MEDICA AND THERAPEUTICS.

caused excitement somewhat like strychnia; toxic doses induced convul-
sion and asphyxia. Batrachians got convulsions or tetanic spasm with
suspension of voluntary movement, of reflex action, and of respiration,
while circulation continued; weakness, torpor, somnolence, and paralysis
also occurred in various degrees (Archives de PhysioL, 1873). Professor
Curci, experimenting on animals with hypodermic injections of hyposul-
phite of silver, reports that at first they stimulate sensory nerves, and
through them the posterior columns of the spinal cord, so that sensibility
to impressions and reflex excitability are increased this condition extends
more or less to the motor nerve-tracts, muscular irritability is heightened,
and tetanus may be produced: afterward follows a secondary effect of
paresis of sensory nerve-centres, and of those connected with respiration;
ultimately reflex action is arrested, and respiration and circulation cease.
We may accept these facts without assenting to the conclusions drawn
by Professor Curci from them, viz., that since silver compounds ultimately
paralyze, they cannot be of service in paralysis, myelitis, etc., but are
only indicated in spasmodic disorders, especially such as affect respira-
tion (Medical Record, 1877).

Bogolowsky, in his experiments, sometimes found the spinal cord so
far affected that the bladder became greatly distended.

An exceptional illustration of the nerve-effects of the drug on man, may
be found in the case of a man accustomed for twelve months to dye his
hair and beard with a strong solution, and who suffered general weakness,
confusion of thought, loss of memory, tinnitus aurium, and defective
sight, which symptoms ceased soon after stopping the dye (Bresgen:
Schmidt's Jahrbucher, 1874, Bd. clxii.). Within my own experience I
have known men suffering from the same cause, with giddiness, vertigo,
and marked nerve-depression, amounting almost to melancholia, and re-
covering quickly after ceasing the application. Convulsions occur in
children after toxic doses of the nitrate, but they are probably reflex i.e.,
dependent upon gastric irritation (British Medical Journal, i., 1871).

Circulatory System. After intravenous injections of silver salts, the
blood has been found dark, pitchy, impaired as to coagulating power, and
containing small crystals, and " whitish granulations," which were sup-
posed to be chloride of silver (Rabuteau), but are more probably haematin
and protein (Rouget). Ecchymoses have occurred, and, together with
the asphyxia and increased bronchial secretion, have been attributed to
the altered chemical condition of blood (Krahmer, Monograph, 1845), but
such alteration is not produced (in acute form) by silver administered in
any other way than by direct injection into the blood. Even toxic doses
given in other ways do not alter that fluid beyond some lessened colora-
tion of the corpuscles and increase of fibrin (Bogolowsky, loc. cit.,
Rouget); the spectrum remains normal. But after the continuous use
of full doses of albuminate or phosphate of silver, the blood-condition



SILVER. 7

certainly becomes impaired; the fluid is found to be thinner and darker,
and it tends to stagnate in, and transude through, the vessels, while the
corpuscles part with hsemo-globulin, and become pale, transparent, and
angular or oval, with projections: according to Bogolowsky, they do not
contain silver, as sometimes asserted.

Sudden arrest of the heart's action, as well as asphyxia with profuse
bronchial secretion, were symptoms noted by Charcot and Ball after in-
jections of silver nitrate into the veins of animals. Rabuteau, arguing
from the same results, considered the drug to be a " cardiac poison," but
it is clear that when thus injected directly into the circulation, the pro-
duction of thrombosis or embolism may complicate and obscure the
special effects of any substance. Rouget found that after hypodermic in-
jection of toxic doses in the lower animals, the heart continued beating
after respiration had ceased i.e., it was not "poisoned;" nor is there
any clinical evidence of the salt depressing the circulation, unless in a
secondary manner during irritant or chronic poisoning.

Respiratory System. Orfila first described asphyxia as a result of in-
jecting silver nitrate into the veins, and after death he found partial con-
solidation of the lungs, and excessive secretion in the bronchial tubes
(Toxicology). Several observers have corroborated these results, and it
has been a question whether they are mainly mechanical from thrombosis,
etc., or reflex effects of lung-irritation (Charcot), or dependent upon direct
irritation and paresis of the respiratory centre in the bulb, and of the
neighboring vaso-motor centre. The recent observations of Rouget point
to the latter conclusion. He found that in most animals urgent dyspnoea
occurred, and, post-mortem, the lungs proved to be healthy in texture,
but much contracted in volume the muscular tissue of the bronchi being
in a state of spasm similar to that of asthma. In adult specimens of only
one order of animals (carnivora) did he find the excessive secretion de-
scribed by Orfila, and he considered that only in these were the vaso-
motor centres affected. That the main effect is exerted on the central
rather than on peripheral nerve-elements he further supported by show-
ing that nerves and muscles retained electric excitability after death.
Still more recent observations by Rozsahezzi on rabbits show that in
chronic poisoning by silver there is constantly hyperaemia of laryngeal



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 1 of 40)