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

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bile in choleraic stools is a favorable sign; besides this, large doses of
calomel (dr.) have been said " to restore warmth " (British and Foreign
Review, i., 1870). Kohler thinks that its good effects are owing to the
disinfecting property of the drug when brought into contact with the
contents of the intestines. Of fifty-six cases, some of which received 200
gr. in two days, twenty-one died, but the reporter seems to think the results
favorable to the treatment by calomel (Lancet, i., 1874). The general ex-
perience of the profession has not, however, adopted it, and it is clearly not
free from danger, for under certain conditions a quantity of the medicine
may remain for a time unabsorbed, and afterward produce serious toxic
effects.

Intestinal Worms. Calomel is a very suitable vermifuge in cases of



MERCURY. 223

ascarides. Both the round and the thread worms are expelled under the
influence of 2 to 5 gr., which may be given early in the morning and fol-
lowed in a few hours by a purgative draught. It is usual to combine the
dose with powdered jalap, but I have found the mercurial alone sufficient,
and it is more readily taken. Dr. Stille speaks well of the effect of a
small portion of mercurial ointment placed in the rectum daily at bed-
time, for destroying ascarides, also of the injection of to 1 gr. of corro-
sive sublimate dissolved in water, but I doubt the wisdom of this treat-
ment.

PREPARATIONS AND DOSE. Hydrargyrum cum, cretd (contains 1 part
of the metal to 2 of prepared chalk, rubbed together until globules cease
to be visible): dose, for children, ^ to 2 gr., less or more; for adults, 3 to
8 gr., or less. Pilula hydrargyri (contains 2 parts of the metal with 3 of
confection of roses, and 1 of powdered liquorice root) : dose, as a purga-
tive, 3 to 10 gr. ; for constitutional effects, 2 to 3 gr. three times daily
may be well combined with quinine. Emplastrum hydrargyri (made with
mercury, olive-oil, sulphur, and lead plaster). Emplastrum ammoniaci
cum hydrargyro (contains gum ammoniac in place of lead plaster, or, in
other words, ammoniacum and mercury plaster). An emplastrum mer-
curiale of the Prussian pharmacy is much used by Hebra and others in
the treatment of syphilides, acne, etc., and is made according to the fol-
lowing formula: IJ. Mercury 3 iij., turpentine | iss., lead plaster xij.
TJnguentum hydrargyri (contains 1 part of mercury, 1 of prepared lard,
and a little suet): this preparation should be lead-colored; from ^ to 2
dr. may be rubbed into the arm-pit or inner side of the thigh at one or
several frictions in the course of the day, according to the rapidity of
the effect desired. A pleasanter compound than the officinal ointment
may be prepared from the following formula of Magne Lehrens, of Tou-
louse: Mercury 1,000 grammes, oil of sweet almonds 20 grammes, balsam
of Peru 20 grammes, lard 960 grammes. The metal disappears rapidly
in the oil and balsam, and the result is a smooth pomade, blue, agreeable
in odor, and easily kept. Mr. Marshall's formula for oleates, already
mentioned, is designed to prevent some of the unpleasantness of the ordi-
nary blue ointment, and the following form, used in the marine hospital
of Toulon, is calculated to produce constitutional effects without saliva-
tion: IJ. Slaked lime gr. xxx., chloride of ammonium gr. viij., sulphur
gr. xxx., mercurial ointment gr. clxxx. This ointment dries very readily,
and is prescribed in double the ordinary quantity. Hydrargyri olcas :
made 5 to 10 per cent, and upward (v. p. 209). Uhguentum hydrargyri
compositum (contains mercurial ointment, yellow wax, and olive-oil and
camphor): this combines the medicinal properties of mercurial ointment
and camphor, to which wax and oil are added to give a suitable consist-
ence; it is used as a stimulant to swollen glands, and for chronic inflam-
mation of joints, and represents " Scott's ointment." Linimentum hi/-



224 MATERIA MEDICA AKD THERAPEUTICS.

drargyri (contains equal parts of blue ointment, solution of ammonia, and
camphor liniment): it should be a lead-colored cream; this readily pro-
duces salivation. Suppositoria hydrargyri (contain mercurial ointment,
benzoated lard, white wax, and oil of theobroma): there are 5 gr. of blue
ointment in each suppository.

Hydrargyri subchloridum : dose, as a purgative, for children, 2 to 3
gr. ; for adults, 2 to 5 gr. ; for constitutional effects |- to 1 gr. or more,
frequently repeated, or -fa gr. may be given every hour (3 to 4 gr. in this
manner sometimes produce mercurial action), or ^ to ^ gr. or more may
be given night and morning combined with a fractional quantity of opium.
Lotio hydrargyri nigra (contains 3 gr. of calomel to the ounce of lime-
water). Pilula hydrargyri subchloridi composita Plummets pill (con-
tains calomel, sulphurated antimony, guaiac resin, and castor-oil): each
5 gr. of the pill mass contains 1 gr. of calomel and 1 gr. of sulphurated
antimony; calomel should not be given with alkaline carbonates, as cor-
rosive sublimate is liable to be formed. Unguentum hydrargyri subchlo-
ridi (G gr. of this ointment contain 1 gr. of calomel). Hydrargyri per-
chloridum: dose, -$ to ^ gr. in solution or in pill: but very much smaller
doses are used. Liquor hydrargyri percfdoridi (contains 3- gr. of per-
chloride and gr. of ammonium chloride to each fluid ounce, or fa gr. of
each to the drachm): dose, to 2 dr., i.e., -fa to gr., but I prefer smaller
doses, as mentioned above. Lotio hydrargyri flava (contains 18 gr. of
corrosive sublimate in 10 oz. of lime-water).

Hydrargyrum ammoniatum (" white precipitate ") : not used inter-
nally. Unguentum, hydrargyri ammoniati : 1 part of ammoniated mer-
cury in 8 of ointment.

Hydrargyri iodidum viride : dose, to 3 gr. Hydrargyri iodidum
rubrum: dose, T *g- to ^ gr., or less or more. Unguentum hydrargyri
iodidi rubri: 1 part in 28 of ointment.

Hydrargyri oxidum jlavum : used in the preparation of the oleate of
mercury. Hydrargyri oxidum rubrum : for external use. Unguentum
hydrargyri oxidi rubri (contains red oxide of mercury, yellow wax, and
oil of almonds ): there is about 1 gr. of red oxide in 8 gr. of the oint-
ment.

Hydrargyri nitratis liquor acidus : used externally. Unguentum.
hydrargyri nitratis (citrine ointment): 1 part in 15.

Hydrargyri sulphuretum "artificial cinnabar" (not officinal): not
used internally. Its fumes are used in syphilitic skin diseases," as ecthy-
ma; also in syphilitic sore throat by inhalation, 30 gr. being heated on
an iron plate and placed under the patient, who should be wrapped in a
blanket; or the vapor may be inhaled through a funnel. Hydrargyri
sulphas : not given as a remedy, but used in the preparation of corrosive
sublimate and calomel.

[PREPARATIONS, U. S. P. Hydrargyrum ; Hydrargyrum cum creta



HEKOUKY. 225

(mercury 3 parts, prepared chalk 5 parts); Emplastrum hydrargyri /
PllulcB hydrargyri : mercury 384 gr., confection of rose 576 gr., liquorice-
root 92 gr. ; make 384 pills; Unguentum hydrargyri (mercury 2 parts,
lard, suet, each 1 part); Hydrargyrum ammoniatum (white precipitate);
Unguentum hydrargyri ammoniati : ammoniated mercury 40 gr., oint-
ment 1 troyounce; Hydrargyri chloridum corroswum ; Hydrargyrt
chloridum mite (calomel); Hydrargyri cyanidum: dose, -fa to ^ gr. ;
Hydrargyri iodidum rubrum ; Unguentum hydrargyri iodidi rubri : red
iodide of mercury 60 gr., ointment 420 gr. ; Hydrargyri iodidum viride
(protiodide) ; Liquor hydrargyri nitratis / Unguentum hydrargyri nitra-
tis (citrine ointment); Hydrargyri oxidum fiavum Unguentum hydrar-
gyri oxidiflavi: yellow oxide of mercury GO gr., ointment 420 gr. ; Ily-
drargyri oxidum rubrum (red precipitate); Unguentum hydrargyri oxidi
rubri : red oxide of mercury 60 gr., ointment 420 gr. ; Hydrargyri sulphas
flava (Turpeth mineral); Hydrargyri sulphuretum rubrum.]

Inunction. The patient should be prepared for a course of mercurial
inunction by simple dieting and by warm baths: and during it should be
clothed in flannel and avoid exposure. When making the frictions him-
self, he should rub thoroughly in his hand the prescribed quantity of oint-
ment, and then slowly and forcibly anoint certain parts of the body in a
definite order: it is usual to choose the axillae and the groins, but practi-
cally it is better to avoid parts with abundant hair-follicles. According
to the German method of Zeissl, the inner side of both upper arms is first
treated, on the next night the inner side of the thighs, then of the fore-
arms, then of the legs, afterward of the groin and of the back, so that an
interval of several days is allowed between the friction of any one part,
in order to avoid local soreness. The evening is the best time for the
application, and warmth promotes its effect: the part should be kept cov-
ered during the night, and be cleansed on the following morning. When
the patient is too ill, or for any reason is unable to apply the ointment
himself, the attendant who uses it should protect his own hand with a
leather or caoutchouc glove. In young children frictions are often made
on the inner side of the soles of the feet, or a piece of ointment is simply
placed on the inner side of a thin flannel binder. For adults, $ dr. up to
2 dr. represents an average amount of mercurial ointment for daily use;
but sometimes, as in peritonitis, 1 dr. has been ordered every hour: it is
important that no rancid ointment be used, or severe irritation may be
induced by it. This method of treatment has the advantage of saving
the digestive tract from any direct irritation from the drug, and, accord-
ing to Sir B. Brodie, " it cures better and injures the constitution less."
This, however, scarcely holds true in view of the modern cautious admin
istration of mercury, and the method of inunction is less often adopted
than formerly, since it is, at the best, troublesome and uncleanly.

The enderrnic application of mercury is effected by dressing a blis-
VOL. IL 15



226 MATERIA MEDIC A AND THERAPEUTICS.

tered surface with blue ointment or sometimes with calomel. From the
latter, purging has resulted, but, as a rule, the endermic method is em-
ployed for a local stimulating action on the absorbents, as in pleuritic,
pericardial, or joint effusion, rather than to affect the general system.

Hypodermic Injection. The best form for this purpose has been
much discussed; Lewin, one of the first to recommend it, used 5 milligr.
of corrosive sublimate, but this is too much. Dr. Walker gave -$ gr. in
10 minims of water and glycerin, and obtained good results in second-
ary syphilis without serious drawback, but Stohr, Greenfield, and others
have reported local irritation, abscess, and even gangrene without thera-
peutical advantage. Liegeois added a minute quantity of morphia,
but Staub's solution of albuminate of mercury secured more general
approval. It is prepared with two separate solutions, thus: Corrosive
sublimate, 1.25 gr. ; chloride of ammonium, 1.25 gr. ; chloride of sodium,
4.15 gr. ; distilled water, 60 gr.: dissolve and filter. The second solution
is made with the white of an egg very thoroughly agitated with 60
grammes of distilled water and filtered; the two liquids are then inti-
mately mixed, and directed to be kept from the air as much as possible.
The solution should, in fact, be prepared fresh as required, for it will not
keep. One gramme contains 1 milligr. of the salt, and the dose should
be about 1 centigr. daily at two injections. M. Bouilhon has recom-
mended a solution containing a double iodide of mercury and sodium
(Practitioner, 1869), and Scarenzi and Recordi the injection of calomel
suspended in gum (Practitioner, 1870).

Stern's injection is made with 2 parts of sublimate and 20 of salt to
1,000 of water, and this does not precipitate albumen, and is a good form
(Lancet, i., 1871), but Mr. Cullingworth, after many experiments, ob-
tained by far the best of results with a minimum of local irritation by a
solution of bicyanide, using 2 gr. with oz. glycerin and 4 oz. of dis-
tilled water (10 min.^yig- gr.) fa gr. made the gums tender (Lancet, i.,
1874), Duncan, of Edinburgh, reports good results from the same
(British Medical Journal, ii., 1874).

The advantages of the hypodermic method are facility of dosage and
rapidity of effect, cleanliness, and freedom from gastric irritation, yet the
unpleasant results which have sometimes attended it have quite prevented
its general adoption.

The Mercurial Vapor Bath is the best method of application for some
cases especially of syphilitic cutaneous disease. In it calomel or sulphide
of mercury is vaporized in conjunction with steam, and becomes deposited
as finely divided powder on the body of the patient, as he is seated un-
clothed over the lamp. Care should be taken that the vapor be not in-
haled, or profuse salivation may occur.



LITHIUM. 227

LITHIUM, L,=7.

This metal has not been found native. It occurs in the mineral king-
dom as an oxide, chloride, silicate, or fluoride with potassium and alumin-
ium (the lepidolite or rose mica of Bohemia). Bunsen and Matthiessen
isolated it by means of electricity (1855).

Supposed at one time to be found in minerals only, it was named
At0iog, stony, but it is now recognized not only in many mineral waters,
but in seas and rivers, vines and many fruits, the ashes of plants, and in
most of our vegetable food (Bence Jones).

CHARACTERS. It is soft, silvery-white, and easily oxidizes: it floats
upon water, and is the lightest known metal, the sp. gr. being 0.593G.

COMPOUNDS OF LITHIUM.

LITHIA OXIDE OF LITHIUM, L 2 O,=30.

CHARACTERS AND TESTS. Occurs in white granules, forms salts with
acids, and has a high power of saturation, 15 parts neutralizing as much
acid as 41 of soda or 47 of potash. For uric acid it has a special affinity,
and will abstract it from portions of gouty bone and cartilage placed in
warm solutions of the drug (Garrod).

The most characteristic tests for lithium are the carmine red color it
imparts to flame, and the two lines which it develops on the spectrum,
viz., one bright red line at point 82 of the micrometer, and one pale
yellow line at 94. Of substances which resemble it, potassium has its red
line at 68, sodium its yellow line at 100, and strontium has an additional
line of blue.



LITHIA CARBON AS CARBONATE OF LITHIA, L 3 C0 3 ,=74.

PREPARATION. From sulphate or chloride of lithium by adding car-
bonate of ammonium.

CHARACTERS. Occurs in white powder, or crystalline grains, having
an alkaline taste and reaction: is insoluble in alcohol, but slightly soluble
in water (1 part in 100, or about 4 gr. to the ounce): carbonic acid in-
creases the solubility to 5 parts per 100.



LITHI^E CITRAS CITRATE OF LITHIA, L 3 C 6 H f ,O 7 ,=210.

PREPARATION. By dissolving the carbonate in citric acid, evaporat-
ing the liquid, and drying and pulverizing the residue.

CHARACTERS. A white amorphous powder, anhydrous, deliquescing



228 MATERIA MEDIC A AND THERAPEUTICS.

on exposure, entirely soluble iu two and a half times its weight of water:
it is somewhat unstable in composition, and requires to be carefully kept
from the air.

Some other compounds of lithia are likely to be used, but are not
officinal.

The urate is very soluble, more so than the urates of potash or soda.

The benzoate, which is prepared from the carbonate by adding benzoic
acid to the hot solution (Pharmaceutical Journal, July, 1875), occurs in
glistening, pearly scales, of soapy feel, acid reaction, and cool, sweetish
taste: it is soluble in three and a half parts of cold water, and ten of
alcohol it is thus more soluble than the carbonate, while it is more stable
than the citrate, and has the advantage of containing an acid itself valu-
able in the treatment of urinary deposits.

A. ferruginous benzoate of lithia has been prepared by M. Trehyon
(Progres Medicale, July 25, 1874) and is recommended both as a non-ir-
ritant form of benzoic acid, and as a tonic and preventive of the anaemia
produced more or less by all alkalies.

The bromide may be prepared by direct combination, and obtained in
transparent crystals which are deliquescent. It contains a large propor-
tion of bromide (92 percent.), while the analogous salt of potassium con-
tains only 66, and of sodium 78 per cent. (S. Weir Mitchell: American
Quarterly Journal, October, 1870). The salt is used for photographic
purposes.

ABSORPTION AND ELIMINATION. Lithia salts are rapidly absorbed:
thus, from the experiments of Dr. Bence Jones, it appears that if 3 gr.
of the chloride be given to an animal on an empty stomach, it may be
detected even in the cartilage of the hip-joint, and the aqueous humor of
the eye in a quarter of an hour: 7 gr. having been given to a parturient
woman eight hours before delivery, lithia was afterward detected in every
part of the umbilical cord, and 20 gr. of the carbonate having been taken
three and a half hours before an operation for cataract, ample traces of
lithia were detected in the lens when removed: four days afterward,
lithia could still be detected in the secretions, and was not wholly elimi-
nated till the end of seven days ("Lectures," p. 16). It is excreted chiefly
by the kidneys.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Lithia salts
act much like the alkalies upon the gastric secretions, the carbonate
especially is a direct antacid. Small doses are readily borne, but doses
of 30 to 50 gr. of carbonate such as were used by Charcot give rise,
after a few days, to cardialgia and dyspepsia (Note to French edition
of Garrod on Gout). Rabuteau also states, that though he, at one time,
recommended 15 to 30 gr. per diem, his later experience proved that
dyspepsia and even vomiting were caused by these quantities. Climent
records similar results iu his own person (" Traitement de la Gravelle,



LITHIUM. 229

etc.," These, Paris, 1874), and although lithiated waters e.g., at Baden-
Baden at first improve appetite and digestion, they quickly give rise to
sickness and diarrhoea if taken in excess (Althaus).

Circulatory System. Carbonate of lithia increases the alkalinity of
the blood more quickly than potash or soda compounds (Garrod). Th-e
same salt, given in large doses (80 gr.), rapidly diminishes the number of
red blood-corpuscles, and induces ana?mia, like the alkaline carbonates
(Climent, op. cit.). A much less quantity than 80 gr. seems to exert a
depressant effect on the heart in weakly subjects lithia in this respect,
again, resembling potash in its action but it does not depress so much as
that salt (Garrod). Several observers agree in the conclusion that bromide
of lithium, a salt with especially sedative powers, exerts a less lowering ef-
fect upon the heart than bromide of potassium (Roubaud: Archives Gen., i.,
1875, Levy, These, Gazette Medicate de Paris, 1875, No. 27), but frogs
and some warm-blooded animals may die under toxic doses of lithia, with
cardiac arrest in diastole (Husemann, Hesse).

Nervous System. Lithia is said to depress the general nerve-power,
and a slight degree of tremor or twitching has been sometimes noticed
under its continued use, but I am not aware of any serious effects of this
kind.

Urinary System. The quantity of urine is generally increased under
lithia, but analyses are not uniform as regards solid urinary products.
Thus, M. Levy, using the bromide of lithia in gouty subjects, found the
excretion of urea and uric acid rather lessened ( Gazette Medicate de Paris,
November 27, 1875). In healthy subjects, however, Moss found both
liquid and solid constituents much increased (American Journal, April,
1861). Diuresis is usually a marked effect of lithia. One or two doses of
1 to 4 gr. may not. produce it, but if continued they do so, and commonly
render soluble any urate deposit. In some persons one bottle of lithia
water (about 4 gr. ) will cause copious secretion, but the effect varies
somewhat, possibly according to the amount of acid in the system. Dr.
Garrod found lithia more active in this respect than potash, 20 to 30 gr.
of the former citrate equalling 2 to 3 dr. of the latter. Moss corroborated
this (loc. cit.).

Benzoate of lithia seems to have special powers in this respect, for it
is very soluble, and the benzoic acid, changing in the system into hip-
puric acid, combines with alkalies to form hippurates, which are more
soluble and more readily eliminated than urates. The diuretic action of
any salt of lithia is much increased by free dilution.

SYNEBGISTS. Lithia is akin to potash, soda, and alkaline earths gen-
erally, but the characters of some of its salts indicate a special chemical
analogy with magnesia. Thus, the carbonate is decomposed by heat, re-
quires 100 parts of water for solution, but is more soluble in presence
of carbonic acid: the phosphate is insoluble, the chloride and nitrate are



230 MATEKIA MEDICA AND THERAPEUTICS.

deliquescent; there is no alum or bisulphate of lithia. Agents promoting
waste, such as mercury and the iodides, also favor the constitutional ac-
tion of this and allied medicines.

ANTAGONISTS AND INCOMPATIBLES. Acids, acidulous and metallic
salts.

THERAPEUTICAL ACTION (EXTERNAL). Gouty Concretions Stiff
Joints. These may often be well treated by a lotion containing about 5
gr. of any soluble lithia salt in the ounce of rose-water, kept constantly
applied on lint, covered with oiled silk. I have generally combined this
application with the occasional local use of iodine and the internal giving
of lithia, and have known the concretions and the stiffness to be removed.
A pomade containing oleo-stearate of lithia has been recommended for
friction in similar cases (Duquesnel). Lithia lotions are useful also if the
skin be broken near gouty joints. Such sores do not readily heal, be-
cause the urate of soda permeates the connective tissue near them, and
an alkaline salt neutralizes the acid and promotes healing.

THERAPEUTICAL ACTION (INTERNAL). Gout. The treatment of gout
varies somewhat, according to the acuteness or otherwise of the attack.
During acute gout, lithia is often useful as an adjuvant or an alternative
to alkalies, colchicum, etc., but it is during the intervals, when the urine
is loaded and the joints obscurely painful, that the habitual use of small
quantities is most advantageous. According to Dr. Garrod it lessens the
frequency of the attacks, diminishes uric acid deposits, sometimes causes
the absorption of concretions, and even wholly removes the gouty dys-
crasia. Reasoning from the power of lithia in warm solution to dissolve
uric compounds out of gouty bone external to the body, he presumes that
it can exert an analogous effect within the system, and favor the elimi-
nation of the materies morbi in the form of urate of lithia. Wagner
found, after ample experience, that treatment by lithia shortened the
duration of acute attacks, and prolonged the intervals of freedom: it re-
lieved pain and promoted elimination by diuresis. He gave from to
5-gr. doses of the carbonate in an aromatic bkter, continuing them dur-
ing the interval between the attacks for many weeks (Schmidfs Jahrb.,
i., 1875, p. 232). Strieker reports a case in which gouty concretions on
the finger-joints disappeared in a few weeks under a course of lithia
(quoted by Garrod). Ditterich, while estimating the remedy highly,
would restrict its use to chronic forms of gout or chronic illness of any
kind, if dependent upon excess of uric acid. He found that doses of 5
to 10 gr. were liable to induce dyspepsia, and recommended not more
than 1 gr. for a single dose, or 15 gr. in twenty-four hours: he generally
observed relief in seven to fourteen days without drawback (Schmidt's
Jahrb., October, 1870). When acidity of stomach is present, the carbon-
ate should be given, because it is a more direct antacid than the other
salts; if, however, there is no marked gastric derangement, the neutral



LITHIUM. 231

citrate is to be preferred. It is decomposed within the system, and
eliminated as carbonate in the urine. The ferruginous benzoate of lithia
is much recommended by Dalkiewicz in his essay (" Sur la Goutte," 1873),
by Malley, and other French physicians (Medical Record, November,
1874).

The Baden-Baden waters, though very useful in gout and in gouty
headache, concretions, etc., are said to increase the joint pains during
their early use (Althaus). There is only one spring, the Murquelle at
Baden-Baden, which is distinguished for a considerable quantity of lithia,
viz., 0.4 gr. of the chloride of lithium in 16 oz. Next to the Murquelle
is the Fettquelle, in the same place, with 0.23 gr. of chloride of lithium,



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 28 of 40)