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

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and a spring in Elster, with 0.76 of carbonate of lithia (Braun, p. 479).

With the exception of Dr. Garrod's writings, there are but few Eng-
lish observations on the treatment of gout by lithia, though the remedy
must be largely used. It does not always give the satisfactory results
that have been claimed for it, and some practitioners are still sceptical as
to its real value.

Uric Acid Gravel Calculus. When this occurs, independently of
distinct gouty attacks, lithia salts, amply diluted, often act well, render-
ing the " gravel " soluble and the urine clear. According to the observa-
tions of G. de Mussy and others, the bromide of lithia exerts a high de-
gree of solvent or lithontriptic power (Roubaud: Archives Gen., 1875).

Lithiated injections into the bladder for direct solution of uric con-
cretions were proposed by A. Ure and Aschenbrennen. The former ob-
server ascertained that an oxaluric calculus placed in a 4-gr. warm solu-
tion of a lithia salt lost 5 gr. in weight in five hours, but his practical
application of this knowledge to the treatment of calculus within the liv-
ing bladder has not proved very satisfactory. The patient got some
temporary relief from the lithiated injections, and they were presumed
to have softened the calculus, but did not reduce its size. Lithotrity was
performed, but ultimately the man died (Lancet, ii., 1860). Mr. Ure
directs attention to the necessity of avoiding lithia when phosphate of
soda is present in the urine, otherwise an insoluble triple phosphate is
formed.

Gouty and other. Neuroses. In the forms of irritative or melancholic
nerve-disorders which sometimes accompany the uric acid diathesis, and
in some forms of hysteria, the bromide of lithia promises to be extremely
useful. The observers already quoted agree in attributing to it a marked
sedative effect on the sensory nerves, and upon the spinal cord, and reflex
sensibility, without much depression of the circulation: its action, in
short, is more that of bromine than of lithia.

Epilepsy. In true epilepsy, bromide of lithia was used by M. Levy
and by Dr. Weir Mitchell. The latter physician found that it was de-
termined to the skin much like other bromides, but it proved a better



232 MATEKIA MEDIC A AND THERAPEUTICS.

hypnotic, and in moderate doses of 10 to 20 gr., relieved or cured epi-
lepsy after larger doses of other bromides had lost their effect (American
Quarterly Journal, October, 1870).

Acute and Chronic Rheumatism. I have used lithia salts in these
disorders, but with indifferent result.

Croup and Diphtheria. Foerster, of Dresden, has recommended in-
halation of a vaporized solution of carbonate of lithia as a solvent of the
false membranes in- these diseases.

PREPARATIONS AND DOSE. Lithice carbonas : dose, 3 to 6 gr. (B. P).
German physicians recommend less than this. The diuretic effect is in-
creased by free dilution, and the liquor lithice effiervescens, B. P., which
contains gr. to the ounce, is a good form: dose, 5 to 10 oz. Lithice
citras : dose, 5 to 10 gr. (B. P.). I recommend less than these doses.
Zlromo-citrate of lithia in an effervescent water, containing also potash
and soda, is prepared by some London chemists (Lancet, i., 1874); also
a "granular effervescent citrate," which is a convenient and portable
form, and contains 4; or 5 gr. in each drachm. Urate and benzoate of
lithia: dose, 1 to 4 gr. Bromide of lithia (as a nerve sedative): dose, 10
to 20 gr. A lotion should contain 4 or 5 gr. of any soluble salt in each
ounce. A vesical injection, 20 or 60 gr. of a soluble lithia salt in 4 oz. of
water.

[PREPARATIONS, U. S. P. Lithii carbonas, Lithii citras.]



MAGNESIUM, Mg,=24.

This metal is not found native, but may be isolated by decomposing
its chloride with potassium or sodium. In combination it is widely dif-
fused, a carbonate occurring in magnesite and limestone rocks, a sulphate
and chloride in sea-water, in many mineral waters, and in almost all
spring-water: a silicate forms talc, meerschaum, etc., and is present in.
small quantity in all soils, whence it passes (mainly as a phosphate) into
plants and animals.

CHARACTERS. Magnesium is white, lustrous, hard, and very light (sp.
gr. 1.74). It readily oxidizes, and when lighted burns with intense bril-
liancy.

COMPOUNDS OF MAGNESIUM.

MAGNESIUM OXIDE MAO NESIA MAGNESIA LEVIS-LIGHT MAG-
NESIA, MgO,=40.

The two oxides, identical in composition, differ in the arrangement of
their molecules, and, consequently, in their weight.

PREPARATION. By strongly heating the heavy and light carbonates



MAGNESIUM. 233

respectively, until all carbonic acid is driven off: hence the name " cal-
cined magnesia."

CHARACTERS. Magnesia and light magnesia occur as white powders,
almost tasteless: the heavier form is called simply " magnesia" and is
smoother than " magnesia levis," and more readily miscible with water.
A given weight of the light variety occupies three and a half times the
bulk of the same weight of the condensed magnesia. (There is no advan-
tage in retaining both in the Pharmacopoeia.) Both forms are almost in-
soluble in water, but their solubility is increased by heat; they absorb
water, and if kept long in it, may form a concrete mass of " hydrate."
They are soluble in acids.



MAGNESIA CARBONAS CARBONATE OF MAGNESIA MAGNESIA
C ARSON A8 LEVIS LIGHT CARBONATE OF MAGNESIA, 3(MgCo 3 ;MgO
5H,O,=382.

PREPARATION. By dissolving in boiling water and then mixing sul-
phate of magnesia, and carbonate of soda, evaporating, and then washing
and drying the precipitate. To prepare the light variety, the first solution
is effected in a large quantity of cold water, which is afterward boiled.
The result of the decomposition is an oxycarbonate, which is hydrated,
and sulphate of soda is removed by washing. Thus:

4MgS0 4 + 4Na 2 CO 3 + 5H 2 O = 3MgCO 3 MgO5H 2 O + 4Na a SO 4 4- CO a .

CHARACTERS. The carbonates are white powders, soluble in acids with
effervescence. The light form appears under the microscope partly amor-
phous, with slender prisms intermixed. Their solubility in plain water
is slight, but it is much increased by carbonic acid, which converts them
into bicarbonates.



MAGNESIA SULPHAS SULPHATE OF MAGNESIA EPSOM SALTS,

MgSO 4 7H 2 O,=246.

PREPARATION. By evaporating sea-water or saline springs also
from dolomite, by treating with sulphuric acid: soluble sulphate of mag-
nesia is dissolved out and crystallized, insoluble lime sulphate is left.

CHARACTERS AND TESTS. Occurs usually in small acicular opaque
or whitish crystals, but may be obtained in large, transparent, rhombic
prisms. The pure crystals are somewhat efflorescent; but if they contain
chloride of magnesium they are moist or deliquescent. Iron is an occa-
sional impurity, and gives a reddish tint to the solution.

The small acicular crystals resemble those of zinc sulphate, with which,
indeed, they are isomorphous: they maybe distinguished (1) by the taste,
magnesia sulphate being bitter and nauseous, zinc sulphate astringent; (2)
ammonium sulphide gives with magnesia no precipitate, but with zinc a



234 MATERIA MEDICA AND THERAPEUTICS.

white one of sulphide (ZnS); (3) caustic potash gives with magnesia a
white precipitate insoluble in excess, with zinc, a white precipitate soluble
in excess. The rhombic prisms resemble those of oxalic acid: the latter
are markedly acid to the taste, and are colored a purplish brown by com-
mon ink; magnesia sulphate is not affected by it (except blackened where
touched).

ABSORPTION AND ELIMINATION. Magnesia and its carbonates and
neutral salts, such as the citrate and tartrate, are changed into chlorides
in the stomach, and absorbed either wholly or in part according to the
amount taken and the condition of the gastric fluids (Buchheim and
others): not more than 15 gr. at a time is changed (Rabuteau); the un-
absorbed portion passes on into the intestine, and under the influence of
albuminous secretions, or of carbonic or other acids, especially in the
large intestine, an additional amount becomes absorbed, and any residue
passes unchanged with the faeces, or under certain circumstances ac-
cumulates in the bowel, and forms concretions. Absorption varies with
the degree of acidity of the intestinal tract, and if this be not marked,
lemonade or other acidulous drinks will be required to secure solution.
We need scarcely say that absorption varies also with the nerve-condition
(v. p. 237). Part of the absorbed magnesia appears in the urine as a
triple phosphate.

The sulphate of magnesia, given in small doses, is wholly absorbed
without producing definite physiological effects. Of large and purgative
doses, part only is absorbed, and passes out by the urine or other emunc-
tories. Part of the sulphuric acid of the sulphate is withdrawn by potash
and soda salts met with in the bowel, and the magnesia is almost wholly
excreted with the motions combined, more or less, with effete bile-pro-
ducts (Buchheim).

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Magnesia
and its carbonate act as direct antacids and local sedatives; also, when
given in powder, as mechanical absorbents. A dose of 30 gr. and upward,
given to an adult under conditions favorable for absorption, produces,
after eight or ten hours, moderate semi-solid motions, of less than normal
odor. It has been stated that the effect of these preparations, though
less quickly produced, lasts longer than that of stronger cathartics, and is
often more copious, 1 dr. of magnesia causing more evacuation than 1 oz. of
Glauber's salt (Trousseau) also, that their effect increases with continu-
ous use, so that bloody and mucous stools may occur after some time. On
the other hand, if the drug accumulates in the intestine, mechanical ob-
struction may be caused by it, and concretions of ammonio-magnesian
phosphate, mixed with mucus and debris of food, have sometimes formed
when large quantities of magnesia or its carbonate in solid form have
been taken; as much as 2 pints (Gubler) and "several pounds" (Brodie)
of such concretions have been found in the colon, and Dr. G. de Mussy



MAGNESIUM. 235

required a mallet and chisel to remove one from the rectum (Medical
Times, ii., 1879).

Peritonitis and even perforation have followed from such obstruction,
and I have myself seen one fatal case of the kind. The patient was an
actor, accustomed to hurried, irregular meals, and to consuming large
quantities of magnesia (for constipation), and on making a post-mortem
examination the large intestine was found blocked up by magnesian
concretions.

(When a moderate degree only of such a condition is suspected, full
doses of vinegar deserve a trial.)

The citrate of magnesia acts as a mild, but efficient and somewhat
quicker laxative, and being more soluble than the oxide or carbonate, is
free from risk of concretion.

The sulphate, in small doses, acts as a gastric sedative, and if not
sufficient to purge, often exerts a diuretic effect, especially if the skin be
kept cool: 1 to 2 dr. freely diluted, and taken on an empty stomach, will
usually produce several watery stools without colic but with some disten-
sion, rumbling, and sense of chilliness. The bitter, unpleasant taste, if
uncorrected by carminatives, may induce nausea and debility, but these
symptoms subside when the purgative effect commences. The pulse and
temperature are lowered by the action, and some malaise may be felt
from it; more or less subsequent constipation will also be noticed: the
biliary secretion is not increased by it (Rutherford).

Much larger quantities (1 to 2 oz.) are sometimes taken by ignorant
or careless persons, and if given to the weakly may cause serious depres-
sion, amounting to syncope, with or without severe purging: Christison
refers to a fatal issue from a dose of 2 oz. On the other hand, it has been
stated that minute quantities (1^- gr.), given by hypodermic injection,
will induce characteristic serous motions (Luton: Gazette Ilebdom., 1874),
but Caville could not verify this result on dogs, and Professor Gubler's
trials resulted only in local abscess, so that we cannot depend on Luton's
method.

It is, however, ascertained that when even large doses are injected
into the veins, no purgation is caused (Moreau, Rabuteau), but rather
constipation, and this fact bears upon an explanation of the medicine's
action. [Cl. Bernard has stated that the intravenous injection of soda
sulphate causes as much purging as its internal administration (Le9ons,
p. 85), but later observers are very clear as to the contrary.]

Theory of Action. Poiseuille, and also Liebig, taught that the pur-
gative action of salines when taken by the mouth was due to osmosis of
serum from the vessels into the intestine, and in support of this view
Moreau found that on including a portion of intestine (of an animal)
between two ligatures, and injecting into it a drachm of Epsom salts
dissolved in a little water, afterward returning the intestine to the ab-



236 MATERIA MEDICA AND THERAPEUTICS.

dominal cavity, a large quantity of fluid was poured into the ligatured
portion within twenty-four hours (Archives Gen., 1872). Vulpian cor-
roborated these observations, but noted also intestinal catarrh, which
others have not done ( Gazette Jlebdom., May, 1873). Dr. Lauder Brun-
ton has recorded, in an interesting paper, results similar to those of
Moreau (Practitioner, vol. xii.). By means of ligatures he made three
loops of intestine, and injecting into the middle one a measured quantity
of water with a few grains of magnesise sulphas, and into the others the
same amount of water only, found, after a few hours, that the middle one
contained treble the quantity of fluid injected, while the others were
empty. He experimented also with concentrated solutions passed into
the middle loop, always with similar result, and suggests that it is pro-
duced by a direct stimulation of the intestinal mucous membrane. Ruther-
ford and Vignal also consider the drug a pure stimulant to the same
membrane; this, however, was not found congested in the experiments,
and although Brunton thinks that the structure of the intestine renders
the osmotic theory unlikely, I believe that it best explains the facts with
which we are acquainted.

For instance, constipation occurs if sulphate of magnesia be injected
into the veins, and it may be presumed that an osmotic current is then
directed from the bowel to the blood, and thus the intestinal contents
are deprived of ordinary moisture: also constipation results from taking
(by the mouth) small doses of 5 to 10 gr., and these may be supposed to
become absorbed quickly into the circulation, and to act as if directly in-
jected into it (as just described): again the purgative effect of full doses
(draining off fluid) is followed by constipation. (Rabuteau explains this
last fact by supposing a small portion at first absorbed, and producing its
physical (endosmotic) effect several hours afterward, but I think it more
probably a natural reaction connected with loss of fluid and empty con-
dition of intestine.)

Some eminent writers, chiefly German, have offered other explanations
which require a brief notice. Radziejewski observed, in experiments on
animals, that the faeces were quite liquid when passing from the small to
the large intestine, and argued that saline purgatives simply hurried them
through in this liquid state, and that the larger quantity of fluid in stools
procured by purgatives could not come from the blood, or even the
glands, because on analysis the proportion of albumen in them -was found
too little for such a source (Reichert's Archiv, 1870, 39, 77). Thiry, ex-
perimenting with the peculiar form of intestinal fistula devised by him-
self, and formed by a separated portion of bowel communicating with the
external surface of the abdomen, found that although local irritation
would excite secretion in it, saline purgatives, such as soda sulphate,
would not do so, and concluded, with Radziejewski, that they simply
increased peristalsis. Buchheim taught that besides this, on account of



MAGNESIUM. . 237

their low diffusion-power, they did not readily pass through the intestinal
membrane, but, remaining- in the canal, retained the water in which they
were given, and also much of the natural watery secretion from liver,
pancreas, and glands (a very large quantity, according to Kiihne), and so
carried from the intestine a large quantity of fluid without necessarily
drawing it from the blood by endosmosis, or from the glands by stimula-
tion. These reasonings, although ingenious, seem to me answered or
qualified by the later experiments of Moreau and of Brunton. Thiry's
fistula disarranges normal structure too much to furnish a strong basis
for hypothesis, while Legros and Onimus have satisfied us that peristalsis
per se is but little increased by sulphate of magnesia (Journal d'Anat.,
Robin, 1869). The purgative action of saline is not, however, a mere
physical occurrence, the same in any membrane, living or dead; it implies
integrity of nerve-supply, for Moreau found that no endosmosis occurred
in an intestinal loop if he divided its connecting nerves.

Urinary System. Magnesia has sometimes caused the solution of
uric acid deposits when alkalies have failed to do so, and Mr. Brande
pointed out that it could render the urine alkaline, more permanently, if
more slowly, than potash or soda. Thus, 2 dr. of soda gave a maximum
of alkalinity in a quarter of an hour, 1 dr. of magnesia only at the end of
six hours, and dr. in twelve hours (" Philos. Trans.," 1810). A deposit
of triple phosphate occurred, but since earthy salts can be passed in only
limited quantities in the urine (Neubauer and others), it is of interest to
know precisely how magnesia rendered the secretion alkaline. Caulet
concluded from recent researches that both it and lime do so only indi-
rectly through the digestive organs i.e., they neutralize a part of the
acid of the gastric juice, and consequently more soda is excreted with
the urine, and becomes the direct agent in determining its alkalinity. In
support of this, he finds on analysis no increase in the amount of earthy
salts in the urine (rendered alkaline under administration of magnesia),
but marked excess of soda (Bulletin de Therapeutique, 1875). In further
support of this observation, we have the fact that during normal diges-
tion, when the acid of gastric juice is being neutralized and withdrawn
from the system, acidity of urine becomes less, and in some stomach-dis-
orders is even replaced by alkalinity (Roberts, Jones).

An observation from comparative anatomy is also of interest. If
much lime or magnesia were to be excreted by the urine in conjunction
with uric and phosphoric acid, the insoluble salts formed would render the
secretion solid, or nearly so, as it is in birds and reptiles. Such a secre-
tion would not readily pass through the narrow urinary channels of the
human race, and therefore alkaline earths pass out rather through the
bowel, while in herbivora, the urine of which must be fluid and yet con-
tain much earthy salt, the acids are excreted by the bowel (Caulet).

Glandular System. Some observers have attributed to magnesia an



238 MATERIA MEDICA AND THERAPEUTICS.

alterative action, and Grange, Bouchardat, "and others state that its ha-
bitual use, as in drinking water, will cause goitre. Some support is given
to this idea by the fact that enlargement of the thyroid gland in mice
has followed after mixing magnesia with their food (Gubler), but on the
other hand, many waters from goitrous districts have been analyzed with-
out finding in them a trace of magnesia ( Medico- Chirurgical Review, i.,
1862, p. 512).

Toxic Action. Jolyet and Cahours report magnesian sulphate to be
the most toxic of neutral purgative salts, 30 to 90 gr. having caused sud-
den death in dogs, when injected into the veins. Vulpian noted abolition
of voluntary and reflex movements in a frog poisoned by the salt, and its
effect has been compared to that of curare, but this comparison requires fur-
ther support before it can be accepted (Archives de Physiol., Fev., 1869).

SYNERGISTS. Absorbent substances, such as charcoal and manganese,
aid the mechanical effect of magnesia in powder. Its purgative effects
are aided by acids, by the sulphate and citrate of magnesia, and other
neutral salts. It is usual to combine the sulphate and carbonate in a
mixture, but unless care be exercised they are liable to form lumps which
are not readily soluble. The analogues of sulphate of magnesia are the
sulphates, phosphates, tartrates, sulphovinates of potash and soda, and
the chlorides of sodium and magnesium. Water, cold, and refrigerants
generally are other adjuvants of its action. Dr. Laycock found quinine
aid the purgative effect of magnesia sulphate, 1 gr. of quinine with only
1 scruple of the salt, given every three or four hours, acting as well as
much larger doses given without the tonic: he supposed this to depend
upon improvement of nerve-power (Medical Times, i., 1863, p. 54).

ANTAGONISTS AND INCOMPATIBLES. Acids given with magnesia de-
stroy its absorbent powers, though increasing purgation; on the other
hand, alkalies- antagonize its purgative effects by neutralizing gastric
acidity. Alcohol, aromatics, and opium lessen its anti-febrile and deple-
tory effects. With regard to opium, Buchheim and Wagner observed
that if it be brought in contact with mucous membrane before the saline,
no increased flow of liquid occurs, but liquid is absorbed from the mem-
brane: they concluded that opium favored the absorption of the salt, but
we hold rather that it acted like Moreau's section of the nerve-supply
narcotizing the terminals, dulling the sense of irritation, and so prevent-
ing a flow of liquid toward the part while absorption from it went on
as usual (Gubler).

Magnesia as an Antidote to Arsenic, Cobalt, and Phosphorus. Mag-
nesia forms a rather insoluble salt with arsenious acid, and is ordered in
the German Pharmacopoeia as part of the officinal "antidotum arsenici." '

1 Seven parts of magnesia mixed with 120 parts of water are to be kept in one bot-
tle, and 60 parts of liquor ferri persulphatis, with 120 of water, in another bottle. The



MAGNESIUM. 239

Schroff proved magnesia to possess antidotal powers in cases of poisoning
by arsenic and cobalt, if given early (Medico- Chirurgical Review, i.,
1859). Sugar and magnesia mixed together have been found useful
(Lancet, ii., 1873, p. 157). Orfila proposed it as an antidote to phospho-
rus, and there is some but not conclusive evidence in its favor (Medico-
Chirurgical Review, i., 1857).

THERAPEUTICAL ACTION (EXTERNAL). Magnesia being smooth, light,
non-irritant, and antacid, makes a good absorbent dusting powder. It
has been used for ervthema, erysipelas, and similar inflammatory condi-
tions of the skin, and also for atonic ulcers, exposed surfaces, and in-
flamed wounds.

THERAPEUTICAL ACTION (INTERNAL). Dyspepsia. In acidity, pyro-
sis, and allied symptoms of irritative dyspepsia, such as heartburn, flatu-
lence, colic, or constipation, magnesia and its carbonate are very useful,
and their efficacy may be increased by the addition of bismuth or of car-
minatives: such symptoms are often brought on by food containing too
much fat, and this point should be attended to. Headache, accompanied
with nausea and mental depression, often occurs in the conditions de-
scribed, and may be relieved by magnesia. When vomiting is a trouble-
some symptom in the dyspepsia either of children or adults, and in the
vomiting of pregnancy, magnesia often acts well. An effervescent solu-
tion of the carbonate or citrate is a good form, but 5 to 10-gr. doses of
the sulphate will sometimes act better. I have known this succeed in
the vomiting of albuminuria, and in cases where hepatic derangement was
more marked than acidity.

Acidity and Diarrhoea of Children. The mild antacid and laxative
action of magnesia, and its slight taste, render it a very suitable remedy
for the acidity of stomach which so readily occurs in children; it is valu-
able both when constipation is present, and when unwholesome food has
caused irritative diarrhoea (marked by red furred tongue, and greenish,
sour, and liquid motions): 2 to 10 gr. of the carbonate may be given
thrice daily, its antacid action only being desired, and its purgative effect
avoided, unless with the first dose. On several occasions I have known
4 gr. severely purge an infant at the breast. When the attack is clearly
traceable to unsuitable food, " Gregory's powder," containing rhubarb



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 29 of 40)