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

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[PREPARATIONS, U. S. P. Bismuthum, Bismuthi subcarbonas, and
Bismuthi subnitras.]

ADULTERATIONS. Besides being variable in its chemical constitution,
in the amount of oxide and of acid present, the subnitrate may contain
added carbonate, and phosphate of lime, carbonate of lead, subchloride
of bismuth, and other metals introduced in the process of manufacture,
also certain natural impurities not removed e.g., traces of iron, copper,
silver, and arsenic. The last is the most important, although no official
test for its presence in bismuth is given. In the older preparations it
was probably always present, and, so long ago as 1743, Geoffrey expressed
his fear of bad results from it (" Materia Medica "). In later times, Dr.
Taylor found it in three out of five specimens; and Mr. Edin found it in
many specimens of liquor bismuthi when it was first introduced (Pharma-
ceutical Journal, 1868).

The practical bearing of such adulteration was illustrated in a trial
for arsenical poisoning at Philadelphia about twenty years ago. It was
proved that bismuth " nitrate " had been prescribed shortly before death:
a specimen of the particular salt dispensed could not be found, but, of ten
others purchased in the city, a majority contained arsenic, and although
the irritant symptoms had commenced before bismuth was prescribed, and
the proportion of arsenic found in the viscera was much more than bis-
muth adulteration would account for, yet the trial was stopped, and the
accused person discharged (American Medical Journal, July, 1858).

At the present time, however, adulteration with arsenic is exceptional.
Of six chance specimens examined under the direction of Dr. Anstie, not
one contained it (Practitioner, 1871); and Professor Siebold, after much
experience, reports that it is now rarely found (Pharmaceutical Journal,
December, 1875). Of seven samples of the basic nitrate of the United
States Pharmacopoeia, one only contained arsenic .33 per cent. (Op. cit.,
November, 1875). In the oxide he often found traces of sodium and lead,
and commonly subchloride and subnitrate.

Selenium and tellurium have been found in some specimens of bismuth
salts, and a Colorado ore of the metalloid has been found to contain 34
per cent, of tellurium. This may explain the offensive alliaceous odor
which is sometimes given to the breath by special samples of bismuth
preparations. It resembles that of arseniuretted hydrogen, and has nat-
urally been attributed to that gas, and yet not correctly; and the absence
of the poison in certain offending samples has been proved by analysis



CADMIUM. 91

(Pharmaceutical Journal, December, 1875); neither can the odor be
traced to prussic acid or other usual ingredients in bismuth mixtures:
while we know that tellurium can impart an offensive odor, for Sir James
Simpson made trial of the drug, and Dr. Maclagan relates that on one
occasion a student took a dose which obliged him to sit apart from the
class for the rest of a session! (Edinburgh Medical Journal, December,
1854).

The carbonate of bismuth is liable to contain chlorides, also sodium,
and sometimes lead. In five specimens examined by Prescott no arsenic
was found (Pharmaceutical Journal}.



CADMIUM, Cd,=112.

This is a somewhat rare metal, found associated with zinc in nearly
all its ores, and obtained from these by distillation.

CHARACTERS AND TESTS. Tin-white and lustrous, fibrous in fracture,
ductile and malleable, of sp. gr. 8.6 to 8.9. In air, at ordinary tempera-
tures, it tarnishes gradually; heated strongly it takes fire, and burns to a
brown oxide, CdO; at 176 F. it becomes very brittle, and fuses at 442
F. Treated with dilute mineral acids, it sets free hydrogen, and forms a
colorless solution; this, when further diluted, gives with sulphuretted
hydrogen a bright yellow precipitate of cadmium sulphide (CdS), insol-
uble in ammonium sulphide. Caustic and carbonated alkalies give witli
cadmium salts gelatinous white precipitates, which, except in the case of
ammonia, are insoluble in excess. Zinc precipitates metallic cadmium.

CADMII IODIDUM IODIDE OF CADMIUM, CdI 2 ,-3G6.

PREPARATION. By the direct combination of the metal with iodine
in the presence of water.

CHARACTERS AND TESTS. Occurs in flat, micaceous white crystals, of
pearly lustre, which melt at 600 F. into an amber-colored fluid; they are
anhydrous, permanent in air, but decompose at a dull-red heat, with evo-
lution of iodine in vapor. In water and spirit they are freely soluble,
the solution being acid to test paper, and answering to the tests for cad-
rnium already mentioned.

The Sulphate of Cadmium is officinal in the United States. It occurs
in oblique, rhombic prisms, translucent and colorless, like those of zinc
sulphate; it has an acid, astringent taste, effloresces on exposure, and
dissolves readily in water.

The JBromide of Cadmium resembles the analogous salt of ammonium,
and has been taken by mistake for it; it is used in photography.



92 MATERIA MEDIC A AND THERAPEUTICS.

ABSORPTION AND ELIMINATION. Cadmium salts coagulate and com-
bine with albumen, but these albuminates dissolve in an excess of the
salt, especially in excess of a double salt, such as the chloride of cadmium
and sodium; even in alkaline chlorides they are partially soluble, so that
we can readily understand their absorption from the stomach. Absorp-
tion occurs also after their injection into the cellular tissue, the bowel,
etc., as evidenced by the finding of cadmium compounds in the organs
and secretions (Marine: Schmidt's Jahrb., iii., 1867).

Elimination of the drug begins soon after its administration, and
takes place mainly by the kidneys.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Cadmium
compounds, except the sulphide, resemble each other in action. The sul-
phide, though considered poisonous by van Hasselt, has been given to
animals in drachm doses daily for a week, without evident effect, and is
therefore pronounced inert by Marme. The oxide, chloride, sulphate,
iodide, etc., given in doses of to 2 gr., cause pain at the epigastrium,
vomiting, and purging, and in somewhat larger doses gastro-enteritis,
which may pass on to ulceration. Similar effects follow their hypoder-
mic injection, and after toxic doses given in this manner, the gastro-in-
testinal mucous membrane has been found inflamed; irritation and sup-
puration also occur at the site of injection. The continued administration
of small doses induces a chronic form of poisoning marked by dyspepsia
and emaciation, which in animals has terminated in death from exhaustion.
In the case of two ladies who took by accident a quantity of bromide of
cadmium (not less than 5, or more than 16 gr). pungent taste and sensa-
tions in mouth and throat were felt, and burning pain at the epigastrium,
vomiting and purging set in, and continued for five hours, and after
recovery the stomach remained very irritable (Wheeler: JBoston Medi-
cal and Surgical Journal, October, 1876). In a man who took 9 gr. of a
cadmium salt, salivation, colic, and catharsis followed in the course of an
hour, and four hours afterward, violent vomiting, gastralgia, and tenesmus
(Burdach). In a dog, death has followed the injection of ^ to gr. into
a vein, or the giving of 5 to 9 gr. by the mouth.

Nervous and Circulatory Systems. Foret has described, in cases of
poisoning by cadmium carbonate, besides the symptoms of gastric irrita-
tion giddiness, prostration, loss of consciousness, cramp, and slowing of
respiration and heart-action. In the ladies above mentioned, somnolence
was marked after subsidence of the irritant symptoms.

SYNERGISTS. Salts of zinc and lead.

ANTIDOTES. In acute poisoning by cadmium salts, the alkaline car-
bonates with albumen (white of egg) are the best antidotes. In Marine's
experiments, injections of dilute soda solutions into the stomach soon
after the exhibition of the poison quite prevented bad effects.

THERAPEUTICAL ACTION (EXTERNAL). The only officinal salt, the



LIME. 93

iodide, is used in the form of ointment in glandular scrofulosis, and has
been recommended by Guibert and Garrod. Other physicians have pre-
scribed it in splenic enlargement and in strumous skin disease (Waring).
I have used it repeatedly in cases of enlarged glands, of nodes, and of
chronic joint inflammation, with satisfactory result. It does not stain the
skin, like iodide of lead, but is liable to cause irritation unless diluted.

In Ophthalmic Surgery cadmium sulphate has been used more as an
astringent in lotion or ointment for dyscrasic inflammation of the eye,
and for corneal opacities (leucoma), (Grafe, Kopp, Middlemore).

THERAPEUTICAL ACTION (INTERNAL). The sulphate of cadmium has
been recommended in syphilis, rheumatism, and gout (Grimand), but
there is, at present, little evidence of its special powers.

Gonorrhoea Leucorrhcea. In these maladies injections of sulphate
of cadmium have been used by Lincke, but possess no evident advantage
over injections of sulphate of zinc.

PREPARATIONS AND DOSE. Unguentum cadmii iodidi (contains 62 gr.
in 1 oz. of simple ointment). Cadmii sulphas: dose, y 1 ^ to gr. ; iovcol-
lyrium, to 4 gr. in 1 oz. of rose-water (Fronmuller); for ointment, 4 gr.
in 1 oz. of lard; for injection, 2 gr. in 1 oz. of water; these formulae seem
somewhat inconsistent with Bouchardat's statement that the salt is ten
times as powerful as the sulphate of zinc.

[PREPARATIONS, U. S. P. Cadmium and Cadmii sulphas.]



CALCIUM LIME, Ca,=40.

Calcium is a grayish-white metal, the basic radical of lime, and its com-
pounds: as a carbonate it occurs naturally in chalk, marble, etc.; as a.
sulphate in gypsum; as phosphate- and carbonate in shells, bones, and
various organic tissues; and as silicate and fluoride in various minerals and
vegetables. When heated, it becomes quickly oxidized and converted
into lime calx: inflamed, it burns with a bright light.



CALX, C&0,=56LIMEQUrCK-L2ME.

PREPARATION. Lime is commonly prepared from its carbonate (mar-
ble or limestone) by heating it to full redness to drive off the carbonic
acid.

CHARACTERS AND TESTS. A grayish-white solid, of sp. gr. 3.18, of
alkaline, caustic taste. When water is poured on it to the amount of
about three-fourths of its weight, it swells up, evolving great heat (up to
500 F.), and falls into a soft, white powder, in which the oxide is com-



94 MATERIA MEDICA AKD THERAPEUTICS.

bined with one molecule of water (hydrate of calcium, CaH.,O a , = 74); the
process is called " slaking."

C ALOIS HYDRAS SLAKED LIME, CaHiO,,=74

PREPARATION. From quick-lime, as already described.

CHARACTERS AND TESTS. The hydrate of lime, though it can absorb
31 per cent, of its weight of water, remains perfectly dry, and is itself
very sparingly soluble in water (1 in 900), and less soluble in hot than in
cold water; at 32 F. twice as much lime is dissolved as at 212 F. At
ordinary temperatures water dissolves only about gr. to the ounce, but its
solvent power is increased by syrup or by glycerin to the extent of nearly
8 gr. to the ounce. Lime does not melt at the highest temperature, and
hence its use for the electric and oxy hydrogen lights; sp. gr. 2.078.

The chief test for lime is the white precipitate formed with oxalate of
ammonium, insoluble in acetic acid, but soluble in hydrochloric or nitric
acid. Lime readily absorbs carbonic acid, the presence of which is de-
tected by effervescence with acids. (This power of absorbing CO 2 has
been utilized by Liebig to purify close rooms, for lime placed in them
will, by such absorption, create a partial vacuum, to supply which air
passes, in through crevices. The same absorptive power partly causes the
dampness of a new house, for the lime of mortar absorbs the carbonic
acid of the air and the breath, leaving the moisture to condense on the
walls.)

The Liquor Calcis of the Pharmacopoeia is a solution in water con-
taining about T% gr. to the ounce (that being its point of saturation). It
is prepared by digesting slaked lime in eighty times its weight of cold
water for some hours, and is a colorless liquid when recently made, but
on exposure to air, or if breathed into, an insoluble carbonate readily
forms and precipitates. If warmed, the liquor calcis becomes turbid from
deposition of some of the lime. It forms an ingredient in the black and
the yellow " mercurial wash."

Liquor Calcis Saccharatus. Saccharated lime-water is prepared by
mixing slaked lime with twice its weight of sugar, and digesting in water
for a few hours; it becomes yellowish by keeping; its taste is more caus-
tic and unpleasant than that of the simple liquor; it contains 7.11 gr. of
lime per ounce.

Linimentum Calcis is an emulsion or soap formed with equal parts of
lime-water and olive oil, and containing an oleate of calcium.

CALCIS CARBON AS CARBONATE OF LIME, CaCO 3 , = 100.

Three forms are officinal: (1) Greta chalk the native, friable, and
not pure carbonate; (2) Greta preparata prepared chalk the same sub-



LIME. 95

stance well washed, or " elutriated," after being reduced to fine powder;
and (3) Calcis carbonas prcecipitata precipitated carbonate of lime.

1. Ordinary chalk is used only to produce carbonic acid gas in the
making of carbonates, etc.

2. Prepared chalk occurs either in white powder or in small conical
masses. The process of " olutriation " consists in treating the powder
with a large quantity of water, allowing it to stand for a time, decanting
from heavy particles, and allowing the milky liquid to gradually deposit
this form is used in mistura cretas and pulvis cretas aromaticus.

3. Precipitated carbonate of lime is prepared by mixing a solution of
carbonate of soda in excess, and at a boiling temperature, with solution
of chloride of calcium. Carbonate of lime and chloride of sodium are
formed, and the precipitate is washed until all the latter salt is removed.
This preparation being crystalline and somewhat gritty, constitutes an
ingredient of tooth powders, but is not otherwise recommended except
in bismuth lozenges.

CALOI1 CHLOR1DUM CHLORIDE OF CALCIUM, CaCl,6H. 2 O,=219.

PREPARATION. By neutralizing hydrochloric acid with chalk or white
marble, and adding to the solution a little chlorinated lime and slaked
lime. In the first process carbonic acid is evolved and chloride of cal-
cium formed:

2IIC1 + CaCO 3 = CaCl, + C0 8 + H 2 O.

In the second process the added lime frees the solution from iron and
magnesia; it should then be filtered and evaporated to dry ness at a tem-
perature of 400 F. If the solution be simply evaporated, the chloride is
left combined with water CaCl Q 6(H O), and it is only at a heat sufficient
to fuse the mass that it parts with all its water.

CHARACTERS AND TESTS. This salt has a great absorber.t power for
water, is deliquescent, and very soluble; it occurs in crystals, or in whit-
ish crystalline fragments of bitter, acrid, saline taste. It must be dis-
tinguished from calx chlorata (chloride of lime), and does not, like that
compound, evolve chlorine on addition of hydrochloric acid.

CALX CHLORATA CHLORIDE OF LIME CHLORINATED LIME.

PREPARATION. By saturating moist slaked lime with chlorine gas
CaH 2 O 2 + 2Cl H^O + CaOClj but as to its exact constitution there is
still some difference of opinion. Many chemists, following Balard, con-
sider it to be a mixture of chloride and hypochlorite of calcium, which
would correspond to the above formula doubled / thus, SCaOCl^ = CaCl 2
-j-CaCl.jO.,, and this, with the addition of two atoms of water, is the for-
mula adopted by Garrod.



96 MATERIA MEDICA AND THERAPEUTICS.

CHARACTERS AND TESTS. Occurs in whitish powder or lumps, having
the odor of chlorine, and an acrid, caustic taste; if it contain much chlo-
ride of calcium it will be moist. It is unstable in composition, readily
giving off chlorine when exposed to the air, and being decomposed by
any acid. When pure it is wholly soluble in water, but it generally con-
tains some free hydrate, and is only partially soluble. It has powerful
deodorant and bleaching properties, which depend on the presence of
chlorine, and the purity-test is directed to estimating the amount of this
gas (chlorimetry). Thus, by adding hydrochloric acid to chlorinated
lime, chlorine gas is liberated, and this being brought into contact with
iodide of potassium sets free an equivalent amount of iodine, which is
estimated by hyposulphite of sodium.

Liquor Calcis Chlorates Solution of Chlorinated Lime contains
about 13 gr. of available chlorine to each fluid ounce of water.

Vapor Chlori Chlorine Inhalation. Prepared by moistening 2 oz.
of chlorinated lime with cold water in a suitable apparatus (u. p. 124).

CALCIS PHOSPHAS PHOSPHATE OF LIME.

Officinal in two forms: (1) os ustum bone-ash; (2) pure tribasic
phosphate.

PREPARATION. (1) Os Ustum. When bones are calcined in close
vessels, the residue consists of earthy salts mixed with charcoal (carbo
animalis); but when calcined in open vessels, all animal and carbonaceous
matter is burnt off, and the white friable residue consists mainly of phos-
phate and carbonate of lime (bone-earth, bone-ash). This, when treated
with hydrochloric acid, and afterward with ammonia, is changed into (2)
tribasic (or tricalcic) phosphate, Ca 3 2(PO 4 ), which is washed and dried at
212, and forms a crystalline white powder, insoluble in water, soluble in
acids. It has been found to contain lead (Duquesnel).

This form is the one most commonly found in nature, sometimes
almost pure (phosphorite) or in friable masses, like chalk (osteoliths), or
in the fossil faeces of ancient saurians (coprolites), in shells and sedi-
mentary earths. From the soil it is absorbed by plants, by the help of
water and carbonic acid, and is determined specially to the seed. From
plants it is received by herbivorous animals, and in their flesh and blood
and bone it is sought by the carnivora. It has been said that the amount
of phosphate of lime found in different animals is proportionate to the
activity of their movements (Dusart and Blache). (The salt was obtained
formerly for medical use from the excrement of dogs when hard and
white, as it is passed after they have eaten many bones / it was known
as " album grascum.")

Besides the tribasic phosphate there are two others, a neutral and an
acid phosphate. The former, Ca !1 H. 1 2(PO 4 ), is a white, crystalline pow-



LIME. 97

der, tasteless and insoluble; it occurs in some (carbonated) mineral
waters, and may be prepared by mixing neutral phosphate of soda with
chloride of calcium. The acid phosphate, CaH 4 2(POJ, is very soluble,
and even deliquescent, and is left in solution when sulphate of lime is
precipitated after treating bone-ash with sulphuric acid.

ABSORPTION AND ELIMINATION. The various salts of lime differ
somewhat as to their absorption and their action. The tribasic and neu-
tral phosphates, in small doses (less than 5 or 6 gr.), with but little
water, are whollv absorbed under the influence of the acid gastric secre-
tion; but if given with much water, the acids are so far diluted that they
do not act upon the insoluble drug, and it passes off mainly by the fasces.
If large doses be given, the greater part passes out unchanged.

Gouriet has suggested that the solubility necessary for securing the
absorption of lime phosphate is effected partly by means of the phosphate
of soda contained in the saliva, partly by the phosphate of ammonia and
the acids in the gastric juice; when it has passed into the veins, solubil-
ity is still further assisted by the carbonic acid present in venous blood.
During respiratory combustion, when carbonic acid is given off and lactic
and other acids altered, the phosphate that has been taken is only
retained in solution by the help of the normal alkaline phosphates of
the blood: if these be in small proportion the lime salts become soon
deposited (more in bone than in other tissues), and little passes in the
urine; if, however, in any given case the alkaline phosphates be in ex-
cess, then most of the lime salt is retained in solution in the blood until
it is (mainly) excreted through the kidneys (lancet, ii., 18GO, p. 251).
This explanation seems rather too chemical, and it must be compared
with the important observations more recently made by Paquelin and
Jolly. They conclude that the tribasic phosphate of lime is not acted
upon in the stomach, unless it be by part becoming super-phosphate, and
this again is precipitated in the intestine under the influence of alka-
line biliary and pancreatic secretions, as insoluble phosphate; it is not
capable of absorption, except in very small quantities; the circulation
conveys very little, and the tissues, except bones, contain only traces;
the bile has rather more. A certain amount of lime must enter the sys-
tem from the food, and does so mostly as carbonate, which becomes
changed and prepared for absorption by contact with alkaline phosphates
and gastric acids, but artificial phosphates are eliminated almost entirely
unchanged, only some of the acid being absorbed. Hence they conclude
.that the addition of such compounds to the food is rather an obstacle to
nutrition, and that even the soluble acid preparations (lacto-phosphates,
etc.) act only as acid principles, and pass out of the system as phosphates
of another base. The lime phosphate contained in urine and phosphatic
calculi, even when primary, is said to be almost entirely formed within
the bladder. These views, as they are not quite in accordance with com-
VOL. II. 7



98 MATERIA MEDIC A AND THERAPEUTICS.

monly received clinical evidence, seem to require confirmation, but they
suggest moderate expectation of cure by lime salts.

Tfie bicarbonate, as occurring in carrara water, is soluble by virtue of
the excess of carbonic acid, and readily absorbed. The neutral carbonate,
in small doses (5 or 6 gr.), is soluble in the gastric juice, and is absorbed
as a chloride. The chloride itself, in similar doses, and diluted sufficiently
to disguise its caustic taste (as \vith 3 oz. of sugared water), becomes ab-
sorbed without gastric disturbance; but larger doses are apt to cause a
sense of oppression, with nausea and diarrhoea. Unduly large doses
of lime-water, or of phosphates or carbonates, may also cause gastro-
intestinal irritation.

Of that which is absorbed, an equivalent quantity is eliminated, ex-
cept during the period of growth, and especially of bone-development.
There seems to be a power of laying-by some of the substance for this
purpose, for, e.g., during the early months of pregnancy, bony growths
(osteophytes) sometimes form in the bone of the parent, which diminish
with the growth of the foetus. The eliminated portion is found in the
urine, as acid phosphate, and in many other secretions, such as the pan-
creatic juice, and the semen; some may be detected also in plastic exuda-
tions; sometimes it forms calculi. It is of ten deposited in tumors, fatty,
fibrous, and sarcomatous, and in old inflammatory exudations, as in tu-
bercle of lung and strumous glands. About 45 gr. are daily eliminated
by an adult man (Husemann).

PHYSIOLOGICAL ACTION" (EXTERNAL). Lime unslaked, or "quick,"
decomposes and destroys organic matter, and is used sometimes as a caus-
tic, more often as a disinfectant, e.g., in dissecting rooms and in grave-
yards; its affinity for water, and its ready combination with sulphur (as
in sulphuretted hydrogen), will explain its good effects. It is used by
tanners to remove the hair from hides, and by farmers as a fertilizing
agent. Its action upon the living skin is irritant and to some extent
caustic, but, as it has less " diffusion power," is more superficial and more
limited than that of the alkalies proper potash and soda. On the mu-
cous membranes, however, its effects may be very severe, as when by ac-
cident it enters the eye, or when too strong a solution of it, or of its
haloid salts, is taken into the mouth. Local inflammation and ulceration
may follow, and even a fatal result be produced when the stomach is
affected.

Weak solutions or the neutral salts, carbonate and phosphate, in
powder, have a local astringent and sedative effect. The " lime-water "
of the Pharmacopoeia is not strong enough to be caustic, but controls
secretion, especially from mucous membranes, and renders any tissues
pale and dry.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Lime-water
and lime carbonates, when taken internally in moderate doses, produce



LIME. 99

similar local astringent and sedative effects, and act also as absorbents



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 12 of 40)