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

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

. (page 10 of 40)
Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 10 of 40)
Font size
QR-code for this ebook


suicide in China), nor is an ointment containing either these or the chlo-
rides likely to produce any effect through the skin.

Elimination occurs through the liver, the intestinal canal, and the
kidneys, but is very slow (Husemann): the urine is colored yellow during
the process. Rabuteau maintains that the -elimination of gold is never
complete, some of the metal being reduced and deposited, especially in
the epithelial and nerve-tissues; for on examining these parts in the
body of a rat that had died after taking 15 gr. of gold chloride in four-
teen days, he found the contour of epithelium from the intestinal tract
to be very strongly marked, as by nitrate of silver, and the axis-cylinder
of the nerve-tubules to be colored slightly green; he considers that this
deposition of the metal explains why gold seems more active than mer-
cury, for having nearly the same atomic weight and specific heat, their
properties should (according to the analogies of other substances as ob-
served by him) be also very similar, were it not that the gold is less
completely eliminated (Op. cit.). We must remark, however, upon this
point, that though mercury may, as a rule, be more readily eliminated
than gold, yet it has also often, been found deposited in bone, liver, and
other parts of the body, long after its administration.

PHYSIOLOGICAL ACTION (EXTERNAL). The chloride of gold has an
irritant and caustic effect, and stains the skin of a yellow color, which
becomes violet, and later black, from reduction of the metal.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Small doses
increase appetite and digestive power, and stimulate the secreting or-
gans; but under larger or continued doses, this stimulation readily passes
into irritation, and there are often dry ness of the tongue, redness of the
pharynx, and some gastric irritation, with colic and diarrhoea (Cullerier);
on the other hand, though the intestinal secretions are increased, consti-
pation has been noticed by several observers.

Glandular System. Salivation has been commonly described as a
result of this medicine, and is said to occur after a longer period, and
with less marked stomatitis, than when produced by mercury. Martini
met with it (ptyalism) only after the long-continued use of small doses, and
found that the double chloride of gold and sodium might be taken for many
months without injurious effect; only in one case did ptyalism occur, and
then one-third of an ounce had been taken (Schmidt's Jahrb., June 23,
1870). The secretion of the sweat-glands is increased, especially during
the night, and this alternates with or accompanies an increase in the
quantity of urine (Gozzi, Bologna, 1817). The stimulation of the glandu-



74 MATERIA MEDICA AND THERAPEUTICS.

lar system and of growth is said to be such that adenitis has followed the
use of gold, and tumors of osseous or of glandular character have become
painful and inflamed (Percy: Rapport a P Academic). Some excitement
of the genital organs occurs, so that in men priapism may be caused,
and in women the catamenia increased (Legrand: " De 1'Or").

Nervous System. The intellectual powers are said to be stimulated
by gold somewhat in the same manner as by alcohol.

Toxic Effects. A peculiar febrile condition " auric fever " includ-
ing headache and many of the above-mentioned symptoms, as sweating
and diuresis, may supervene if a course of the remedy be continued for
two to four weeks, and seems to be analogous to mercurial fever (Niel:
Recherches, Paris, 1820, etc.). In animals, general emaciation and convul-
sive twitchings have preceded death, and besides the evidence of metallic
deposition in the tissues, Rabuteau records a yellow coloration of the
gastro-intestinal mucous membrane. Large doses of gold compounds may
certainly cause gastritis and death, with cramp and other severe nerve-
symptoms (Majendie).

SYNERGISTS. Mercurials.

ANTAGONISTS INCOMPATIBLES. Albumen in any form milk, flour,
etc.

THERAPEUTICAL ACTION (EXTERNAL). As a caustic, the chloride has
been used by Landolfi and Recamier in lupus and in carcinoma. Legrand
employed it as a caustic in ulceration of the neck of the uterus, and also
as a lotion and a vaginal injection (Op. cit.). Mechanically, the gold
leaf is employed by dentists for stopping teeth, and by druggists for
coating pills.

THERAPEUTICAL ACTION (INTERNAL). In former times, when fanci-
ful analogies of color or of accidental qualities largely determined opinion
as to the medicinal value of any substance, gold was praised as a remedy
for melancholy, and for the dyspepsia often connected with it, and after
several centuries of disuse its therapeutical power has been, to some ex-
tent, revived mainly by a few French and Italian physicians. The double
chloride of gold and sodium is the preparation most recommended; it
bears somewhat the same relation to the pure metal as corrosive sublimate
does to mercury.

Syphilis. M. Chrestien, of Montpellier, and later, M. Legrand, have
reported many cases of both primary and secondary syphilis cured under
the influence of gold, and Trousseau observes that such results are now
well proven and incontestable. Chancres and condylomata have got well
under this remedy in a manner not likely to be due to nature, and in my
own experience its efficacy has been still better seen in the later develop-
ments, such as ulceration in the nose and larynx, cutaneous syphilides,
hard nodes, etc. It is said to cure without local applications, but often
an " unguentum auri " has been used in addition. Gold may especially



GOLD. 75

be employed in Jong-standing cases with chronic periostitis, and when
mercury has been already given to saturation.

Dietrich, while denying to gold any true anti-syphilitic power, thought
it most valuable for mercurial cachexia (Journal des Connaissances Med.-
Chir., 1840), but this has not been corroborated by many observers.
Auric fever may occur during a course of the remedy, and for a time the
general health may suffer, and the local manifestations may be more ir-
ritable, but on lessening the dose, pyrexia subsides, and good effects are
more conspicuous.

Scrofula. Advocates of the medicinal -use of gold especially Niel
and Legrand have spoken strongly of its value in scrofulous disease of
the bones, in glandular enlargements, " white swelling," goitre, and even
elephantiasis; but Yelpeau and others have not corroborated their good
results in hospital practice. No doubt, as Trousseau remarks, the treat-
ment of scrofula among the poor really requires more than any drug can
effect, and it would be unfair to discredit gold altogether because it has
not cured some hospital patients. I think myself that it may prove a use-
ful adjunct, or at least a good alternative treatment. Majendie and
Roux have reported some illustrations of its value, and Mr. Chatterley has
recorded a case of extensive and indolent scrofulous ulcer affecting the
right foot, unrelieved by iodide of iron, etc., but cured by small doses of
gold chloride (Lancet, ii., 1852, p. 455); also another case of cure of a ca-
chectic child suffering from enlarged and indurated cervical glands (Medi-
cal Times, i., 1854, p. 447); he recommended ^ gr. mixed with orris-root
to be rubbed on the tongue for one to five minutes daily.

A case of hypertrophy of tongue with induration, which was probably
syphilitic or scrofulous in character, was cured by the use of 1.5 gr. in-
ternally, and local frictions with 1 gr. mixed with lard (American Medi-
cal Journal, vol. xix., p. 514).

It is probable that the so-called cures of cancer by aurum have really
been of scrofulous ulceration.

Uterine Disorders. Noggerath refers to the value of this medicine
in amenorrhoea, and in chronic ovaritis, and says it is suitable for cases of
the former dependent upon torpor; it should not be given during preg-
nancy, nor to persons liable to undue flooding. Martini states that it is
serviceable in cases with a tendency to abortion, in chronic metritis, and in
sterility " dependent upon atrophy of the vaginal portion of the uterus,"
also in ovarian dropsy. He observed benefit from it as regards mental
symptoms of hysterical character, and especially when these were con-
nected with definite uterine disorder or disease (Schmidt's Jahrl)., loc.
cit.).

Chronic Bfighfs Disease. Dr. Bartholow draws special attention to
the value of salts of gold in the treatment of granular and fibroid disease
of the kidney and " depurative disease." He has observed remarkable



76 MATERIA MEDICA AND THERAPEUTICS.

improvement from the persistent use of small doses of the chlorides
3*0 t ?V S r -> turee times daily (" Materia Medica," p. 188). They are not
suitable for acute stages.

Dyspepsia, etc. Dr. Bartholow is also one of the most decided of
modern writers in recommending small doses (^ gr.) of the double chlo-
ride for " nervous dyspepsia," as " indicated by a red glazed tongue, epi-
gastric pain, increased after food, and tendency to relaxation of the
bowels: also in duodenal and biliary catarrh, and jaundice." Vertigo
and vertiginous sensations, connected with stomach disorder, are often
relieved by small doses of gold chlorides, but plethora and increased in-
tracranial blood-pressure contra-indicate their use. On the other hand,
they do good in cerebral ariasmia, so that they may be prescribed when
bromides would not be suitable. Melancholia and hypochondriasis with
depression are often connected with gastric disorder and with cerebral
anaemia, and are susceptible, to some extent, of relief by the same
remedy.

ffemi-AncBSthesia. I must not omit to notice the most modern ap-
plication of gold as a remedy, and that is in its metallic form in "metallo-
therapy," as developed mainly in Paris by Charcot and others. It seems
that rather a large proportion of nervous patients on the Continent suffer
from impaired sensation of one-half of the body, and that by the applica-
tion of two metals, as a gold and a copper coin over several nerve-trunks,
sensation may be " transferred," returning to the affected side in about a
quarter of an hour, but often leaving, at the same time, the previously
sound side. Such a peculiar circumstance is not yet wholly explained,
but has been connected with a gentle galvanic action (Medical Record,
187879). Dr. A. Hughes Bennett and others explain the phenomena
rather by " expectant attention," and I believe that mental influences of
various kinds are a much more likely explanation than any specific prop-
erties of metals thus applied.

PREPARATIONS AND DOSE. Fine gold, and the solution of the chlo-
ride, are placed in the appendix to the B. P., but no directions for their
internal use are given. Pulvis auri: dose, to gr. gradually in-
creased to 2 to 3 gr. may be given in pill with confection of roses, but
is not a good form. Syrupus auri, containing 24 gr. to the ounce, has
been used by way of friction on the tongue, but cannot be depended upon.
ITnguentum auri, dr. to the ounce of lard not dependable. Chloride
of gold and sodium: dose, -^j- to fa gr. once or twice daily, in -pill the
best preparation, but its irritant and poisonous properties should be re-
membered. Teroxide of gold : dose, -fa gr. twice or thrice daily. Iodide
of gold (French codex): dose, -fa to -fa gr., said to be more active than
corrosive sublimate.



BARIUM. 77



BARIUM, Ba,= 137.0.

A brilliant white metal, not met with in the native state, but abun-
dantly as the base of an alkaline earth called baryta, or barytes (an oxide),
which occurs extensively as native sulphate (BaSO 4 , heavy spar, its most
common compound) and native carbonate (witherite).

BARYTA, BaO,=153.

CHARACTERS AND TESTS. A grayish-white, earthy-looking substance,
heavy, sp. gr. 5.4, of sharp caustic taste and strongly alkaline reaction;
sprinkled with water it becomes hot, and slakes with energetic action,
falling into a fine white powder, = hydrate of baryta, BaH 2 O 2 , which con-
tains 10 per cent, water, and is soluble in 10 parts of boiling water.
Baryta has, like lime, a strong affinity for sulphuric and carbonic acids.

SARII CHLORIDUM CHLORIDE OF BARIUM, BaCl 4 3H,O. =244.

Is placed in the appendix as a test for sulphuric acid.

CHARACTERS AND TESTS. Occurs in translucent soluble crystals,
which have a bitter acrid taste. The solution gives with any soluble sul-
phate a heavy white precipitate, unaffected by nitric acid.

Carbonate of Baryta is a white insoluble powder.

ABSORPTION AND ELIMINATION. We have no very accurate observa-
tions on these points, but Orfila detected the chloride of barium in the
liver, spleen, and kidneys of animals poisoned by it (Annales d" "Hygiene,
ii., 1842).

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Small closes
(iV to gr.) of the chloride exert a stimulant effect on the stomach-func-
tions, increase the appetite, and often produce loose stools. Larger
doses prove irritant or caustic; three grains, taken several times daily,
soon induce a sense of pressure at the epigastrium, nausea, vomiting,
and purging, with faintness (Fergusson: Dublin Journal, February,
1844). One drachm caused much vomiting and purging, and death from
convulsion in seventeen hours (Walsh: Lancet, 1859). Half an ounce
caused similar irritant symptoms, and death in two hours evidence of
severe gastro-intestinal inflammation was found (Taylor). The nitrate
and acetate of baryta have also caused death, and the carbonate is com-
monly used as a poison for rats and mice. Although one teaspoonful is
said to have destroyed life, much larger doses have been taken without
fatal result.

Nervous System. The nerve-symptoms caused by toxic doses of ba-
rium compounds, are clonic convulsions and motor paralysis, with impair-



t
78 MATERIA MEDIC A AND THERAPEUTICS.

merit of reflex excitability. From the slow respiration observed in cases
of poisoning 1 , it has been concluded that the vagi become paralyzed
(Walsh). According to Cyon, the nerve-lesion caused is central, for
even in advanced poisoning- the muscular irritability and the sensibility
of peripheral nerves remain intact (Reichert's Archiv, 1866, No. 2). Se-
vere pains in head, throbbing in the temples, giddiness, dimness of sight,
double vision, deafness, and tinnitus have been experienced: also muscu-
lar cramp, especially in the legs.

Circulatory System. The heart-action is at first stimulated, after-
ward quickly and powerfully depressed, by full doses of barium com-
pounds. After some palpitation, the pulse becomes irregular, feeble, or
imperceptible, and the surface cold and pale. Bohm concludes that they
first stimulate and then paralyze the automatic heart-ganglia. Onsum
suggested that baryta compounds caused embolism by precipitation of
the sulphates of blood (Virchow's Archiv, Bd. xxviii.), but Cyon has
shown both that the normal sulphates exist in very small amount, and
that if they are artificially increased, still no precipitate occurs on giving
baryta (loc. cit.).

Glandular System. We have not clear evidence of the effect of ba-
ryta on this system, but it is presumed to exert some absorptive " deob-
struent " power on inflamed or hardened lymphatic glands. Small doses
increase the secretion of urine and of perspiration (Waring).

SYNERGISTS. Lime and other alkaline earths. The chloride of ba-
rium has some analogies with corrosive sublimate.

INCOMPATIBLES. All sulphates are chemically incompatible with ba-
rium salts, forming insoluble compounds. The sulphates of soda and
magnesia have been used as antidotes in cases of poisoning (Walsh),
also white of egg and sugared wine (Perondi: Bulletin de 27ierapeu-
tique, t. x.).

THERAPEUTICAL ACTION (EXTERNAL). Depilation. Dr. McCall An-
derson recommends the sulphide of barium for removing superfluous hair,
one part of it being made into a paste with four parts of zinc oxide and a
little water; this should be left on the part for about three minutes, and
then washed off.

Ophthalmia. Dr. Pay recommends a collyrium of barium chloride
(1 to 2 gr. in 10 oz.) in scrofulous ophthalmias (Rev. Med., 1840), but it
is not now much used.

THERAPEUTICAL ACTION (INTERNAL^. Scrofulosis, etc. Barium
chloride was introduced at the end of last century as effective in scrof-
ulous and syphilitic dyscrasia?, in gonorrhoea, white swelling, etc. (Craw-
ford, 1780). Lisfranc and Torget used it in such cases and in glan-
dular tumors, and reported much advantage from it; the former began
with gr. every hour, and increased the dose to much larger quantities
than we should consider safe (40 gr.). In a child, many glandular tumors



BISMUTH. 79

subsided under a month's treatment, but frictions with iodide of potas-
sium were used at the same time (American Journal, 1838, No. 45, Bnl-
letin de Therapeutique, 1840). Mr. K. Phillips recommended barium
chloride as superior to iodine in many cases marked by pallor, languid cir-
culation, and irritable mucous membranes (" On Scrofula," 1846), and
Mr. Balman used it in chlorotic and cachectic states generally (Medical
Times, ii., 1851). In amenorrhcea he gave -J to 1. gr. doses with per-
chloride of iron. Many cases of successful treatment of scrofulous joint-
disease, of ophthalmia, and of enlarged glands by barium chloride (y 1 ^ gr.
doses), were recorded some years ago (Ranking, 1846).

Epilepsy ', Tetanus, etc. Ilufeland introduced this remedy for epilepsy
in scrofulous subjects, but it is now seldom used. Brown-Sequard, how-
ever, while reporting against its efficacy, remarks that it may diminish
reflex excitability, and therefore deserves trial in tetanus and in paralysis
agitans. A somewhat doubtful case of traumatic tetanus is said to have
recovered under the use of about 16 gr. of the chloride, given in twenty-
four hours (Edinburgh Medical Journal, 1862). In satyriasis, or exces-
sive sexual desire, it has also been employed. Dr. Hammond recommends
it in diffuse and multiple cerebral sclerosis.

PREPARATIONS AND DOSE. Barii chloridum : the dose mentioned by
Dr. Garrod and others is from to 2 gr., but Mr. Kennedy, after much
experience, maintains that -fa to -fa gr. is much more suitable and safer
to commence with ; very few persons, he says, can bear ^ gr. without irrita-
tion (Lancet, ii., 1873, p. 28). The United States Pharmacopoeia contains
a liquor barii chloridi (1 part in 4 of distilled water); the dose ordered is
5 min.

As an eye-lotion, from 1 to 2 gr. may be ordered with 10 oz. of water.
As a depilatory, 1 part of sulphi'de to 4 of excipient.

[PREPARATIONS, U. S. P. Barii carbonas and Liquor barii chloridi.]



BISMUTHUM BISMUTH, Bi, = 210 (MARCOSITA).

This substance, which is now, like antimony, classed among metal-
loids, occurs native, and also as an oxide, as a sulphide, and variously
combined in metallic ores with silver, iron, copper, arsenic, etc.

PREPARATION. The Pharmacopoeia directs the preparation of a
"purified bismuth," by fusion with nitrate of potash, but the process is
not very satisfactory.

CHARACTERS. The metalloid is gray-colored with a roseate tinge, and
may be obtained in masses of cubical, iridescent crystals; it is tasteless
and inodorous, heavy, hard, brittle, and, like antimony, volatilizes at a
strong heat, and expands on cooling.



80 MATEEIA MEDIC A AND THERAPEUTICS.



BISMUTHI OXIDUM OXIDE OF BISMUTH B1SMUTHOUS OX.1DE
SESQ Ul OXIDE, Bi 2 O s , =468.

PREPARATION. By boiling the subnitrate with excess of solution of
soda.

CHARACTERS. A smooth, yellowish powder insoluble in water, pre-
sumed to be more definite in composition, and more constantly pure than
other bismuth compounds (R. "W. Smith).



BISMUTH1 SUBNITRAS SUBNITRATE OF BISMUTH WHITE BIS-
MUTHSPANISH WHITE, Bi 3 3 2HN03,=546.

PREPARATION. The true nitrate (ternitrate), which is crystalline,
soluble, and more active and irritant than the subsalt, is formed by dis-
solving the metalloid in nitric acid, and when this solution is poured into
a large quantity of water it is decomposed, the subnitrate of bismuth fall-
ing as a white precipitate, and the supernitrate remaining in solution.

It was known as nitrate in an earlier Pharmacoposia, and is still some-
times described under that name (Ringer); it has been termed also tris-
nitrate, and hence some confusion between the properties of really differ-
ent compounds.

CHARACTERS AND TESTS. The subnitrate is crystalline, but when
well prepared, should be in smooth and fine powder. It is heavy, whitish
in color, becoming yellowish-gray on exposure to light from the forma-
tion of some sulphide, or from the presence of silver; it is insoluble in
water, soluble in nitric acid. It contains sometimes such an amount of
acid as to effervesce when mixed with a carbonate (Martindale). A solu-
tion of bismuth subnitrate and sodium hydrate in water and glycerin is
the Lowe test for sugar in urine: it has the advantage of being stable,
and is recommended by Dr. W. Gr. Smith (British Medical Journal, ii.,
1879).



LIQ UOR B1SMUTHI ET AMMONIA CITRA TISSOL UTION OF CITRA TE
OF BISMUTH AND AMMONIA.

PREPARATION. By dissolving purified bismuth in nitric acid, and then
adding citric acid and solution of ammonia until the precipitate at first
formed is redissolved. (A better form for this preparation has been
published Pharmaceutical Journal, 1866.)

CHARACTERS AND TESTS. A colorless liquid, of saline metallic taste,
miscible with water. Liquor potassee precipitates the white hydrate, and
hydrochloric acid the white oxychloride, but an excess of acid redissolves
this as chloride. The officinal solution is described as neutral, or slightly



BISMUTH. 81

alkaline, but it frequently contains an excess of nitric acid, much more
than the original preparation of Schacht.

mSMUTHl CARBONAS CARBONATE OF BISMUTH, 2^Bi 2 Co 6 )H 2 O,=1042.

PREPARATION. By adding a concentrated solution of bismuth in
nitric acid to an excess of carbonate of ammonia in cold solution.

CHARACTERS AND TESTS. The salt which precipitates is a hydrated
oxycarbonate, which is, like the subnitrate, insoluble in water, but is more
soluble in the gastric juice, and has antacid properties.

On passing a current of sulphuretted hydrogen through an acid solu-
tion of a bismuth salt, the black sulphide of bismuth (Bi 2 S 3 ) will be
thrown down. Concentrated acid solutions of bismuth salts poured into
water give a white precipitate of subsalt, e.g., the nitrate when thus
treated yields the subnitrate. Caustic alkali added to a solution of a bis-
muth salt precipitates the white hydrate of bismuth (Bi 2 3 H 2 O). Papers
saturated with sulpho-cyanide of potassium are colored yellow by soluble
bismuth salts.

ABSORPTION AND ELIMINATION. Bismuth, in substance, is not ab-
sorbed by the skin, and the supposed instances of poisonous effects from
its use as a cosmetic are not trustworthy (Husemann). A soluble bis-
muth salt, such as the ammonio-citrate, is, however, quickly absorbed
from the cellular tissue after hypodermic injection.

Much difference exists in the degree of absorption of bismuth com-
pounds taken by the mouth, and the difference is proportionate to their
solubility. The acetate, the double tartrate, and the ammonio-citrate
dissolve in the gastric fluids, and are readily absorbed, while the oxide
and subcarbonate are but slightly soluble, and the ordinary subnitrate
still less so.

Headland taught that it was as insoluble as charcoal, but Orfila and
Lewald have detected the drug in the liver, in the milk, and the urine,
after its administration, though in the latter secretion it appeared later
than other metallic salts usually do. Bergeret and Mayenfon detected
it in the same fluids, and in the serous exudations of dropsy, and after
giving small doses to rabbits they found it, within half an hour, in the
blood, the spleen, the muscles, etc., and continued to find traces of it for
eight days after administration. In one man they also found it five days
after; in another, testing sixty-two days afterward, they did not find any
(Journal de VAnatomie, 1873). We may conclude, therefore, that some
amount of absorption even of the subnitrate occurs (and probably as
chloride), although the greater part of what has been taken has been
found unchanged in the stomach in 1 some cases, or altered to a bluish tint
in the small intestine, or converted into the black sulphide in the colon
or rectum, or has been eliminated with the fasces during life. Dr. Levick
VOL. II. 6



82 MATERIA MEDICA AND THERAPEUTICS.

mentions a case of phthisical diarrhoea, in which 20 gr. were taken four
times daily for some weeks, and the whole intestinal canal was found to



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 10 of 40)