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

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

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water may prove of great, if only temporary service, but should not be
used in large quantity if hemorrhage or symptoms of acute inflammation
be present. The alkaline earth is plausibly supposed to combine with
the secretions of the ulcerations and to form a layer which protects the
terminations of sensitive nerves against contact with the contents of the
bowels. Mialhe especially applied this explanation to the phosphate of
lime, which salt has been much used in the treatment of diarrhoea and of
acidity, and owing partly to its phosphoric element, is considered to exert
a special restorative power: according to him, if given with bread and
sugar it becomes changed by the slight acid of the former and by the
gastric acids into a soluble acid salt, which does not itself coagulate
albuminoid material, but when brought into contact with a small pro-
portion of alkali, becomes converted into an insoluble basic phosphate of
gelatinous character, which protects the mucous membrane, and checks
diarrhoea.

This salt was the principal ingredient in the "white decoction "of
Sydenham. The quinovate of lime is specially commended by Kerner
(v. " Vegetable Kingdom ").

Aphthous Conditions of the mouth and alimentary tract, when occur-
ring in infants, with green but not necessarily liquid stools, may often be
cured by lime-water or prepared chalk.

Bone Disease Fractures. Piorry furnishes evidence of the value of
phosphates in osteo-malacia, or softening of the bones generally, also in
spinal caries or " Pott's disease " (Gazette des Hopitaux, 1856), and I have
certainly seen them very beneficial in cases of caries and joint disease.
Reasoning from the observation that birds with a broken limb lay eggs
without shell during the process of repair, Dr. Fletcher was led to ad-
minister a mixture of calcined bone, prepared chalk, and lime-water in cases
of fracture (in man), and reported several cases of very early union of long
bones (Lancet, 1846). Milne Edwards made similar observations on dogs
and rabbits, producing fractures as nearly as possible alike, and then
finding that the animals who got lime phosphate recovered more rapidly
than the others; and M. Gosselin found the same results in men ( Comptes
Rendus, xiii., p. 631 ; and British and Foreign Review, July, 1856): on
the other hand, it has been pointed out that in fractures of old persons,
in whom the bones are brittle, lime salts are better avoided. They have
been strongly recommended during pregnancy and lactation in enfeebled
mothers, both to relieve their neuralgia, debility, and dyspepsia, and also
to favor the development of healthy non-rachitic children (Der Prakt.
A.rzt, May, 1869); and I have for years recommended their use in back-



108 MATERIA MEDICA AND THERAPEUTICS.

ward dentition, delayed power of walking, and retarded closure of the
fontanelles. These are usual signs of a rachitic tendency, and in the fully-
developed malady of rachitis, saccharated lime is strongly to be recom-
mended. It is true that although parts of the bones become softened in
this disease, and are deficient in lime, often at the same time, lime phos-
phates are largely excreted in the urine, so that the fault is one rather of
mal-assimilation than of actual deficiency, yet I agree with Dr. Ringer
that the administration of lime, and especially of lime-phosphate, " ap-
pears to control this defective and perverse nutrition, and to induce
healthy growth, so as to" favor consolidation of the skeleton and improve
the condition of soft parts," and that practically they are extremely
valuable, though not always alone curative. He compares this use of it
to that of iron in anaemia, where the fault is equally one of want of as-
similation rather than of quantity. As already mentioned under the
physiological action of lime (v. p. 99), it has been objected that it is so
little soluble that quite sufficient may be introduced with ordinary food,
and that to give it in medicine rather interferes than otherwise with
normal nutrition (Paquelin and Jolly); but practically we do not find it
so. Considering, however, the evident insolubility of ordinary tribasic
phosphate, M. Dusart and others have introduced acid solutions lacto-
phosphates which have come much into vogue, and are sometimes very
suitable, but it must be remembered that often in unhealthy rachitic
children most of the secretions are already too acid, and need rather to
be neutralized by a basic earthy salt, and any excess of acid would tend
rather to dissolve osseous salts, and cause them to be eliminated, not de-
posited. It may often be better to give the ordinary salt (phosphate) re-
cently prepared, if possible, and with flour or milk, and to trust the stomach
to absorb what is needed, and the surplus will pass through the intestine,
not injuriously. The combination of lime phosphate with sodium chlo-
ride (calcaria phosphorica salita) has been found very soluble (Sabellin,
Dorogow, Husemann, p. 724). The sulpho-carbolates of lime have been
specially recommended in rickets, but Dr. C. Ritchie did not find them
serviceable (Medical Times, i., 1871).

There is reason to think that natural salts of lime, such as have re-
cently passed through organic structures, are preferable to such as have
been deposited as mineral. Thus, Piorry recommended, in bone-soften-
ing and spinal curvature, fine filings of fresh bone, 1 oz., to be taken in
milk or rice-milk, and found it succeed when proper light, warmth, and
food had failed (Gazette des Hopitaux, 1856, No. 139; Medical Times,
i., 1857).

Others have derived medicinal phosphates from the vegetable king-
dom. Thus Dr. Hake and Dr. Tilbury Fox recommend a strong decoc-
tion of good bran to be made and evaporated, and the residue mixed with
sugar; and a preparation of this kind known as " saccharated wheat phos-



LIME. 109

phates " has come largely into use for mal-nutrition, rickets, etc. (Medi-
cal Times, i., 18G6). It may be desirable to state again that the advan-
tage of lime salts in bone disease is not traced simply to chemical arid
physical processes, but also to direct improvement of digestion, absorp-
tion, and nutrition.

Struma Glandular Disease. Lime-water was long since commended
for the treatment of suppurating glands, and of ulcerations, as well inter-
nally as locally (Shapter, Pereira). The phosphate was especially found
serviceable, though not always curative, in the different manifestations
of scrofula, by Beneke (Lancet, 1851), and by Stone (New Orleans Medi-
cal Journal, and Bulletin Gen., 1852, t. xlii., p. 229); while Beddoes, Four-
croy, A. T. Thomson, and more lately Dr. W. Begbie, have reported very
good results from the chloride. Dr. Beddoes collected upward of one
hundred cases, including many of so-called " tabes mesenterica," and Dr.
Begbie has corroborated the good results to be obtained from doses of
10 to 20 gr. daily. He records also good cases of the subsidence of en-
larged parotid and lymphatic glands under the same medicine, when
iodine and cod-liver oil had failed to cure (Edinburgh Medical Journal,
July, 1872). It must be stated, however, that in the experience of most
other observers, these latter remedies have superseded lime salts, and
that Mr. Benjamin Phillips and other writers on scrofula have expressed
themselves much less favorably concerning them.

Of late years, a mineral water in the West Indies has obtained great
repute in the treatment of glandular enlargements, and has been found
to contain calcium chloride, though in small proportion. The "Bridge of
Allan " waters contain it, and have a purgative effect in consequence. I
have myself given the chloride a fair trial in 1 to 5-gr. doses twice daily
for lymphatic disease in children, and have sometimes seen good results
from it when persevered with; though, as a rule, I prefer the carbonate
to other lime compounds.

The use of sulphide of calcium in strumous and scrofulous sores and
enlarged glands, and in localized suppurations of any kind, will be found
fully discussed under sulphur.

Anaemia. In anaemia and debility, the consequence of overwork, of
close confinement, etc., Dr. Ringer speaks highly of the phosphate of
lime, especially when combined with the carbonate and with iron.

Chorea. Rodolfi has recorded cases of chorea treated by lime chlo-
ride, 7 to 15 gr. in twenty-four hours, and finds it suitable for all cases
provided that there is no " cerebral hypera?mia; " improvement began at
once, and cure resulted in about sixteen days (Medical Times, i., 18G9).
Aperients were also given, and, as Jaccoud remarks, belladonna was
combined with the lime, so the results must be held doubtful.

In nerve-disorder with sleeplessness, and in infantile convulsion, Dr.
Hammond has found the bromide of calcium more readily taken and



110 MATERIA MEDICA AND THERAPEUTICS.

more effective than that of potassium, and I. can to some extent verify
his observations.

Phthisis Chronic Bronchitis, In the early stages of phthisical
anaemia and debility, especially in excitable florid persons with tendency
to headache and dyspepsia, also when in later stages profuse sweating,
or expectoration, or diarrhoea is present, or when the menses are frequent
or profuse, the carbonate or phosphates of lime often exert a good influ-
ence in lessening such discharges and in improving strength; even when
actual softening has occurred and cavities formed, I have given these
salts with the object of assisting cretaceous degeneration, and often with
benefit. Lime well supplements cod-liver oil, and the two remedies may be
suitably combined, since they form an emulsion readily taken by children
1 parts of lime-water to 1 of cod-liver oil is perhaps the best proportion
(Medical Times, i., 18C2, p. 399). Van den Corput, a Belgian physician,
though praising this combination, recommends rather the chloride flavored
with anise or such proportions of lime-water, etc., as will make a solid
jelly (" jecoro-calcaire savou "), which is still better taken (Medical
Times, ii., 1870, p. 624); it has not, however, come much into use in this
country. Cod-liver oil does not mix well with syrup of-lacto-phosphates,
and is liable to become rancid when in contact with it. At a hospital in
Moscow excellent results were obtained in the treatment of phthisis by
freshly calcined bone.

The hypophosphites of lime were introduced as the best compound
for the treatment of phthisis, owing their value in part to the base, and
in part to the hypophosphorous acid contained. The rather extravagant
praise which was bestowed upon them has not been supported by the
majority of the profession, and opinions are still divided as to their real
powers. I believe myself that they are sometimes of much service. Ra-
buteau remarks that as hypophosphites raise animal temperature, the
phosphates would seem more rational remedies for phthisis; that dogs
never have phthisis (?), probably because they eat so much bone; also
that phosphates are commonly in excess in the urine of the phthisical,
and therefore to supply them artificially is reasonable. Charters has lately
published illustrations of their value in night-sweats (Lancet, i., 1876),
and Gugot has made a similar observation (Husemann). Mr. Pidduck
specially praises the iodide of calcium in struma and phthisis; it is taste-
less, non-irritant, readily decomposed, but not readily producing iodism
(Medical Times, i., 1858). Dr. Sawyer states that he has seen, in chronic
phthisis, better results from calcium chloride than from other medicines,
hypophosphites of lime and soda included. He recommends 10 gr. of the
chloride with 1 dr. of water and of glycerin, to be taken in milk after
meals, and finds this often "check night-sweats, increase weight, and dry
up pulmonary lesion " (Uritish Medical Journal, i., 1880).

In chronic bronchitis, I have frequently seen lime-water, and also car-



LIME. Ill

bonate of lime, act well in diminishing profuse expectoration and trouble-
some cough; it should be given internally, and the lime-water applied
locally by an atomizer. ,

In Gangrene of the Lung, Dr. Graves advised the chloride with opium.

Cancer. Besides the local application of lime-water and lime chlorides
to cancerous sores, a power has been claimed for these remedies taken
internally to diminish malignant growths; thus, a curious case, in which
an extensive mammary cancer separated and fell off after a prolonged
use of lime carbonate, is recorded by Dr. Peter Hood (Lancet, ii., 1867,
p. 454); the patient was advanced in years, and for a long time took the
carbonate, as prepared from the inner side of oyster shells, 10 to 20 gr.
twice dailv. Another case, cured under the same remedy, is also men-
tioned.

(If the taking of lime salts have any power in inducing the cretifica-
tion of tubercle and there is some clinical evidence to that effect and
if they can diminish the blood-supply of a fibroid tumor and hasten cre-
taceous degeneration of it, as suggested by Mr. Spencer Wells, then it is
not unreasonable to expect advantage from them in some cases of cancer-
ous degeneration, but I am not aware of other evidence in this direction.)

Uterine Disorder Menorrhagia Fibroid Tumor. There is a gen-
eral consensus of opinion as to the power of lime salts to relieve uterine
hemorrhage. Dr. Rigby published a marked case dependent on "fibrous
tumor" (Medical Times, ii., 1854) treated by the chloride, and Dr. Rog-
ers, Dr. Routh, and others have recorded similar experience; doses of 10
drops of the liquor calcis chloridi, increasing by degrees to 30 or 40 drops,
and continued for some months, are recommended (Ranking, 1871; Lan-
cet, 1873). In too' early and too profuse menstruation, I have been ac-
customed for many years to prescribe the carbonate of lime with much
success. Mr. Spencer Wells believes that the chloride acts by leading to
atheroma of vessels, and hence is useful in lessening the growth of uterine
fibroids, and may even cause their disappearance (British Medical Jour-
nal, i., 1868). Certainly, in some instances under my care, uterine and
other tumors have diminished under treatment by carbonate and chloride
of lime.

It is true, as remarked by Dr. Meadows, that large quantities have
been given to many patients with uterine fibroid tumor without any re-
sult, and he ridicules the idea of any possible promotion of calcification
by such means (Lancet, ii., 1873, p. 3) : he argues that a natural process
of atrophy may occur, and that calcareous degeneration is only a conse-
quence, not a cause of this. Dr. Meadows ridicules equally the idea of
lime curing rachitis: but no reasoning from probabilities should prevent
our appreciating clinical facts.

Uric Acid Deposits Calculus. In these maladies, lime has by no
means retained the reputation it formerly held, but may certainly give



112 MATEEIA MEDICA AND THERAPEUTICS.

some relief. The secret remedy of a Mrs. Stephens received so much
commendation, that Parliament purchased the recipe for 5,000 about one
hundred years ago, and it was found to be mainly of calcined egg-shells
(lime carbonate) and soap, with vegetable bitters, and though much of the
benefit must be set down to the alkali of the soap, yet Whytt obtained
very good results afterward from simple lime-water. Lime salts may re-
lieve vesical pain and inflammation, and by a constringing and sedative
effect on the mucous membrane of the bladder may lessen the ropy dis-
charge and the general sensibility; a solvent action may also be exerted,
but not probably to a great degree; the benzoate of lime has been cred-
ited with more decided effect. Lime-water should also be injected, after
washing out the viscus with soothing mucilaginous liquids. Professor
Stille remarks, " There is reason to believe that uric acid gravel may be
dissolved and eliminated under the use of lime compounds. How far
they are superior to the carbonates of the alkalies for this purpose will
depend chiefly on the state of the digestive organs when these are fee-
ble, lime-water is the better preparation."

The waters of Wildungen, which are much used in lithiasis, owe their
efficacy principally to lime carbonate (vol. i., p. 172).

Diabetes Mellitus. Kissel reports two cases cured by lime-water, im-
provement being for several weeks very slow, but afterward rapid and
marked. My own experience, however, has convinced rne that this is in-
ferior to many other remedies.

Albuminuria. On account of the power of lime salts to dissolve or-
ganic membranes, they have been recommended in chronic Bright's dis-
ease, and in post-scarlatinal albuminuria "to dissolve proteinous infiltra-
tions of the kidney." Kuchenmeister reports cases treated by large doses
of lime-water and soluble lime salts, with immediate and marked increase
in the quantity of urine passed, and with corresponding subsidence of the
dropsy. The amount of albumen was lessened, but sometimes slight
hemorrhage occurred (Ranking, 1869 ; Rev. Med., February, 1870).
His results have not been widely corroborated, but Baudon reports a
case in which the iodide of calcium seemed to succeed after iodide
of potassium failed; quinine and iron were given also (Practitioner, i.,
1869).

From our knowledge of the styptic properties of lime salts, we should
rather expect them to restrain renal hemorrhage than to cause it, and
Stromeyer and Caspari report the value of the phosphate for this purpose.

PREPARATIONS AND DOSE. Liquor colds : dose, % to 2 fl. oz. or more
(contains gr. to the ounce). Liquor calcis saccharatus : dose, 15 min.
to 1 fl. dr. (contains 7.11 gr. to the ounce). Linimentum calcis (lime-
water and olive-oil, equal parts). Greta prceparata : dose, 10 to 60 gr.
Mistura cretce : dose, 1 to 2 fl. oz. (contains chalk oz., gum-acacia oz.,
syrup oz., cinnamon water to 8 oz.). Pulvis cretce aromaticus : dose,



CERIUM. 113

10 to 60 gr. (contains cinnamon, nutmeg, saffron, cloves, chalk, carda-
moms, sugar). Pule is cretce aromaticus c, opio : dose, 10 to 60 gr.
(contains 1 gr. of pulv. opii in 40). Galcii chloridum : dose, 2 to 10 gr.
Vapor chlori (made with chlorinated lime). Calcis phosphas : dose, 2
to 20 gr. or more. Calcis hypophosphis : dose, 2 to 10 gr. Besides
these officinal preparations, there are many compounds such as the iodide,
the bromide, and the carbolate of calcium of which the lime is the less
active ingredient, and of which the properties are mainly those of iodine,
bromine, etc. There are also many private preparations of lime, such as
the lacto-phosphate, the compound syrup of the phosphates (Parrish),
and others. A number of formulae for lime sucrates, hypophosphites,
etc., are given in the Pharmaceutical Journal, June, 1877.

The sulphide of calcium is not officinal: convenient granules of it
containing -^ gr. and up to 1 gr. are now prepared.

Various formulae for " phosphated bread " and natural forms of phos-
phate have been published. Superphosphate of lime 3- oz., carbonate of
iron \ oz., butter and sugar, of each lb., flour f lb., treacle lb., make
80 cakes (Medical Times, i., 1859). Acid phosphate of lime and moist
carbonate of soda may be used as a good "baking powder" (Horsford,
Ranking, ii., 1860). Chevrier has an aerated water containing tribasic
phosphate (Pharmaceutical Journal, September, 1874). Dannecy recom-
mends to wash and powder beef bones, and boil them for an hour with
carbonate of soda and water, then to wash in a filter to dry and sieve
(Bulletin de Therapeutique, March 15, 1858).

[PREPARATIONS, U. S. P. Calcii carbonas proecipitata ; Cretce proe-
parata ; Mistura cretce : prepared chalk troyounce, glycerin fluid
ounce, gum arabic 120 grains, cinnamon water, water, each 4 fluid ounces;
Trochisci cretae, : prepared chalk 4 troyounces, gum arabic 1 troyounce,
nutmeg 60 grains, sugar 6 troyounces, make 480 troches. Calcii chlo-
ridum Calcii hypophosphis ; Calcii phosphas prazcipitata Calx ;
Liquor colds lime-water; Linimentum calcis : lime-water 8 fluid
ounces, flaxseed-oil 7 troyounces. Calx chlorinata chlorinated lime.]



CERIUM, Ce,=141.

This metal, which -is not a common one, was discovered by Berzelius,
in a Swedish ore called cerite or heavy-stone a silicate of iron, calcium,
lanthanium, didymium, and cerium, which last is obtained from it in the
form of a gray metallic powder: oxalic acid is used in the process, and
hence oxalate of cerium is the best known commercial salt: it is the only
one officinal.

VOL. H. 8



114 MATERIA J1EDICA AND THERAPEUTICS.



CERII OXALASOXALATE OF CERIUM, Ce 2 3(C 2 4 )9H,O,=708.

PREPARATION. By mixing a solution of any soluble salt of cerium
the chloride) with solution of oxalate of ammonia tho oxalate of
cerium precipitates.

CHARACTERS AND TESTS. A white granular powder, which when
heated to redness gives a reddish-brown residue of impure oxide, soluble
in boiling hydrochloric acid without effervescence. This solution gives,
with sulphate of potash, a white double sulphate of potassium and cerium:
the oxalate itself is insoluble in water. The soluble salts, such as the
chloride and nitrate, have a sweet astringent taste: with alkalies and
their carbonates they give yellowish-white precipitates.

PHYSIOLOGICAL ACTION (INTERNAL). There is some clinical evidence
in favor of attributing to cerium a sedative action upon the gastric mu-
cous membrane and upon the nervous system, and especially on reflex
excitability, but I am not aware of any physiological research as to the
properties of this drug.

STNERGISTS. Bismuth, silver, and cyanides.

THERAPEUTICAL ACTION (INTERNAL). Vomiting of Pregnancy, etc.
Sir J. Simpson introduced the oxalate of cerium " as a sedative tonic re-
sembling bismuth and silver," valuable in irritative dyspepsia and vomit-
ing, especially when dependent on pregnancy (Edinburgh Monthly Jour-
nal, December, 1854; and Medical Times, i., 1855). Several years later
he wrote strongly in favor of its especial and proved value in the last-
mentioned condition and in sympathetic uterine vomiting generally. Pie
calls it "the simplest and surest remedy," states that he has cured with
it more cases than with any other single medicine, and records several
illustrations of its prompt and effective action in obstinate cases which
had resisted all ordinary treatment: he gave 1 to 2-gr. doses in pill (Medi-
cal Times, ii., 1859). Dr. C. Lee and Dr. "W. Curran have recorded sim-
ilar experience, but the latter rather confused his results by giving bro-
mide and bark at the same time. Dr. C. K. Mills (U. S.) found that the
nausea and vomiting of pregnancy almost always yielded promptly to a
few doses: of eleven cases reported, ten were relieved permanently, one
only for a time. Similar symptoms associated with dysmenorrhosa, flexion,
and other uterine disorders, and with hysteria from anxiety, grief, over-
work, and the like, were also relieved by cerium. Obstinate vomiting
occurring in the course of phthisis, and during typhoid fever, was suc-
cessfully treated by 2 to 3-gr. doses ( Medical Record, March, 1876). The
amount of published evidence as to the general use of the drug is meagre,
but I have myself often obtained excellent results from it. Dr. Image,
in a recent paper, attributes occasional disappointment to the use of too
small doses: he recommends 10 gr. with tragacanth, tincture of orange,



CERIUM. 115

and water, every four hours, the first dose being taken half an hour before
rising. He quotes a case in which vomiting always had commenced in
the fourth week of pregnancy and lasted till the eighth month, but with
this remedy the attacks, though recurring at intervals, were invariably
checked in two or three days, and of a great many cases of pregnancy
with vomiting, not a single one was unrelieved by the same treatment
(Practitioner, June, 1878). He found it also efficacious in nausea from
uterine irritation, and I have had similar experience on many occasions.
I have not required to use so large a dose, but it should certainly be tried
if smaller ones fail. Dr. Busey has lately recommended oxalate of cerium
to obviate the nausea and headache produced in some persons by opium,
just as Da Costa recommended bromide, and others coffee; it has the ad-
vantage of small bulk and of tastelessness (Practitioner, i., 1879, p. 214).

Dyspepsia Gastrodynia, etc. Simpson recommended the oxalate in
primary as well as in reflex gastric disorder, and Dr. C. Lee has given in-
stances of its value in pyrosis, in phthisical and atonic dyspepsia; it may
be used in the class of cases in which bismuth is indicated. Dr. Mills
found it act best when morbid sympathetic influences were a main cause



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 14 of 40)