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

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and ginger, with the magnesia, is a popular and very useful combination.

Constipation. In the constipation of delicate persons, especially of
pregnant women, also of those subject to gout or rheumatism, hemor-
rhoids, or other rectal affections, magnesia is a valuable mild laxative;
if required frequently, it should be taken in solution (fluid magnesia),
and with lemon-juice, if the system be free from acidity. The citrate or

two preparations are mixed only at the time of their being requ red: hydrated perox-
ide of iron is precipitated, and sulphate of magnesia remains in solution 4 to 6 dr.
of this should be given every quarter of an hour in warm water (Binz).



240 MATERIA JIEDICA AND THERAPEUTICS.

the sulphate are useful aperients at the commencement of a febrile attack
of almost any kind, their action being rapid and more or less depletory;
the former may be given effervescing in mild cases, but when a full and
decided effect is desired, 1 or 2 dr. or more of the sulphate should be
used; sometimes it is given in lemonade or acid infusion of roses, but
general experience has proved that it acts best with tincture and infusion
of senna. In habitual constipation J- to 1 dr. given in a glass of lemonade
or aromatic water, in the early morning, will often answer every purpose.
Dr. Fleming found the addition of small quantities of atropia advanta-
geous (British Medical Journal, ii., 1865): it is more usual now, and I be-
lieve better, to make use of the magnesian salts in combination with
others, as they are found in many natural mineral waters, such as Seidlitz,
Pullna, Friedrichshall, or Hunyadi Janos, half a glass or a glass of such
waters being ordered with warm water in the early morning. To obviate
constipation and headache during the use of astringent tonics, moderate
doses of the sulphate may be usefully added to medicines containing sul-
phate of quinine, iron, acids, etc.

Obstruction. In cases of intestinal obstruction dependent upon hard-
ened faeces, full doses of the sulphate, freely diluted and given every four
hours, often succeed well; sometimes the action may be favorably as-
sisted by belladonna.

Plumbism. In cases of colic and constipation dependent upon lead-
poisoning, sulphate of magnesia is a valuable agent; it should be used in
conjunction with iodide of potassium, and Dr. Lauder Brunton has well
shown that if the latter remedy removes from the tissues the metal in
soluble combination, yet it is readily reabsorbed unless the bowels be
freely and regularly moved (Practitioner, vol. xii.): -oz. doses may be re-
quired. Dr. Copland and others used the sulphate with sulphuric acid
before the special value of the iodide was known.

Jaundice. Although the sulphate has no specific cholagogue action,
it is a very suitable aperient in cases of jaundice. Dr. Budd recommends
it in combination with the carbonate and aromatics, but I generally pre-
fer one of the mineral waters before mentioned.

Diarrhoza. In intestinal irritation and diarrhoea dependent upon un-
wholesome food, and especially stone-fruit, sulphate of magnesia is a good
evacuant, because it produces so little irritation. In cases of severe
dysenteric diarrhoea from this cause I have often given drachm doses at
intervals of six hours, for three or four doses, with the best results.

Enteritis Dysentery. Dr. H. Wood speaks of the sulphate of mag-
nesia as the best aperient in enteritis and colitis, when one is required:
(usually treatment by opium is to be preferred).

In true dysentery there is much evidence as to the value of the same
salt, although it is not generally known. Trousseau called attention to
it in 1826 (Archives Gen., v., xiv.), Giacomini recognized it ("Treatise



MAGNESIUM. 241

on Materia Medica "), and Stille confirmed their observations: he gave
about 60 gr., freely diluted, every two hours, \vith the result of at once
diminishing tenesmus and bloody discharges, arid inducing watery fecu-
lent stools: the treatment should be commenced early, and is best suited
for sthenic cases: an occasional opiate at night may be given during the
treatment. That the same method is equally available for chronic and
debilitated cases is shown by the experience of Mr. Ford in Melbourne,
when dysentery was for a long time epidemic and more severe in char-
acter than he had ever seen it in this country. Some of his patients
(medical men and others) had suffered for many months, with only tem-
porary relief from chalk mixture, laudanum, etc., when he gave them
drachm doses of the sulphate, with 20 min. of sulphuric acid, every four
hours, and a blue pill, with opium (1 gr.), at night. Mustard was applied
over the abdomen, and farinaceous diet ordered. In the course of twenty-
four to thirty-six hours, the dejections became feculent, with less blood,
and in about nine days all irritation had usually subsided. Mr. Ford
adopted this method on the hypothesis that excessive action prevailed in
one part of the intestine (the colon), while the rest of it was inactive;
and he hoped to "restore unity of action," and also to " eliminate morbid
material." However this may be, he is able to report that, in seven years
of extensive practice, he did not lose one case of dysentery in the adult
(Australian Journal and Ranking 's Abstract, i., 1859).

Hemorrhage. Sulphate of magnesia is a valuable adjunct to astrin-
gent remedies for hemorrhage, because it helps to lessen arterial tension
and capillary congestion at the same time that it obviates constipation.
In menorrhagia it may be given with sulphuric acid; in haemoptysis, with
ergot, acid, and digitalis (H. Dobell); and in hcematemesis, with alum
and opium (Barlow).

Dysmenorrhvea. In delayed and obstructed menstruation, when the
discharge is scanty, dark, and of glutinous character, I have long pre-
scribed the carbonate of magnesia with beneficial results, and especially
when the irregularity is attended with sick headache and mental depres-
sion; it is most indicated in rheumatic subjects. Five to sixty or ninety
grains may be given, according as to whether the constitutional, the
laxative, or fully purgative action is required. The small dose should be
given each night for the first fortnight after the cessation of the menses,
and the larger doses during the latter fortnight, or especially before or
during the period, or when headache and depression are present.

Lithiasis Uric Acid Diathesis. The power of magnesia to dissolve
uric acid and to lessen its formation, whether directly or indirectly, has
already been mentioned. Among other instances, Mr. Brande records
that of a man, aged sixty, accustomed to pass much uric acid, and even
calculi, and who had taken daily either 9 dr. of " subcarbonate " of soda,
or 3 of potash, for more than a year without good effect, yet under the
VOL. II. 16



242 MATERIA MEDICA AND THERAPEUTICS.

use of 60 gr. of magnesia thrice a day. the acid soon diminished in
amount, and after three weeks of continuous treatment it seldom recurred.
Since Mr. Brande's memoir (1810) the remedy has been often used in
similar cases. Sir B. Brodie combined 6 gr. of magnesia with 12 of pot-
ash bicarbonate and 15 of bitartrate, and it often acted well.

Chronic Gout. Magnesia, in combination with its sulphate, and
sometimes with colchicum in addition, was largely used by Sir Charles
Scudamore, and with satisfactory result. It is especially adapted for the
gastric derangements to which gouty patients are liable. In rheumatism
its value is not so evident.

Diabetes. In this malady, magnesia has been found useful by Hufe-
land, Willis, and others. It can only be considered as a palliative of some
symptoms.

Warts. Several curious observations have been recorded to the effect
that warts disappear after a few weeks' use of carbonate of magnesia.

Irritant Poisoning. As already mentioned, magnesia carbonate forms
nearly insoluble compounds with arsenic and cobalt, and besides being
used as an antidote to those poisons, it has been given with more or less
success in cases of poisoning by corrosive sublimate, mercurial oxide, and
salts of copper. It is perhaps best suited to neutralize the action of the
strong acids, whether mineral or vegetable, and acts well when mixed
with charcoal. When used for oxalic acid poisoning, large quantities
must be given to form a basic insoluble salt (Husemann).

PREPARATIONS AND DOSE. Magnesia magnesia levis : dose, as an
antacid, 10 to 20 gr.; as a purgative or adjunct, 20 to 60 gr. or more
4 to 8 gr. will purge an infant at the breast; children of about ten years
require 30 to 40 gr. The pulvis rhei compositus (Gregory's powder) con-
tains 6 parts with every 2 of rhurbarb and 1 of ginger. Magnesiad car-
bonas magnesias carbonas levis : dose, 10 to 60 gr. ; 10 to 20 gr. as an-
tacid, 20 to 60 gr. or more as a purgative. Liquor magnesice carbonatis
should contain nearly 13 gr. in the ounce, but does not well retain this
amount. The solutions of Henry, of Dinneford, and of Murray are
original preparations of the same active ingredient (about 10 gr. to the
ounce), and a convenient "double strength " preparation has been intro-
duced by Kinmond. The bismuth lozenges B. P. contain about 2 gr. of
the carbonate of magnesia. Liquor magnesice citratis, the "limonade
purgative " of the French codex, may be taken in doses of 5 to 10 fl. oz.
A " granular effervescent citrate of magnesia " is in popular demand, but
was proved at a trial under the Adulteration Act a few years ago to be
in reality a citro-tartrate of soda (Pharmaceutical Journal, 1873). I
believe that an article containing at least some citrate of magnesia is now
supplied. Magnesilyne is another form of the same remedy. Rochelle
salt has also been found as an adulteration of it (Pharmaceutical Journal,
February, 1873). In consequence of the high price of citric acid, a for-



MANGANESE. 243

mula for producing a meta-tartrate of magnesia has been published (Bul-
letin, i., 1873). In the same journal, M. Martin records the rather
important observation that even carefully prepared citrate, which is per-
fectly soluble when fresh, is apt to change with age into a subsalt, and
to become insoluble. A " boro-citrate," made by dissolving a borate of
magnesia in citric acid, has been recommended by Kohler for acid urinary
deposits (Medical Times, ii., 1879). Magnesias sulphas: dose, 10 to 20
gr. for irritable conditions of the stomach, or in combination with astrin-
gents or tonics; when given with senna or other purgatives 30 to 60 or
120 gr., according to the frequency of repetition. For diuretic effects 20
to 60 gr., as a purgative in a single dose 2 dr. to \ oz., according to the
habit of the patient. Coffee and infusions containing tannin disguise
the nauseous taste. Enema magnesia? sulphatis (contains 1 oz. of the salt
with 1 of olive oil, and 15 of mucilage starch). The mist, sennas, com-
posita contains somewhat more than a drachm in each fluid ounce com-
bined with senna and aromatics.

[PREPARATIONS, U. S. P. Magnesia; Trochisci magnesice: magnesia
3 troyounces, nutmeg 60 gr., sugar 9 troyounces, mucilage of tragacanth
sufficient; make 480 troches; Magnesii carbonas / Liquor magnesii cit-
ratis / Magnesii sulphas. ]



MANGAKESIUM MANGANESE, Mn,=55.

Manganese is found in many ores, and generally associated with iron ;
the most common one is the black oxide, or per-oxide (pyrolusite), which
is found abundantly in Great Britain and in various parts of Europe.

CHARACTERS. Manganese is a grayish-white metal, hard and brittle,
of sp. gr. 8. It emits a peculiar odor in a moist atmosphere, or if han-
dled. When pure it oxidizes readily in the air, and hence is kept under
naphtha, or in sealed glass tubes; it is dissolved by dilute sulphuric acid.



COMPOUNDS or MANGANESE.

MANGANESII OXIDUM NIGRTJM BLACK OXIDE OF MANGANESE,

MnO,,=87.

CHARACTERS AND TESTS. Occurs in brilliant needle-shaped crystals,
or in compact masses, but is usually met with in the shops as a dull,
earthy, dark-brown or black powder, which contains iron and other im-
purities. Treated with hydrochloric acid it causes evolution of chlorine,
thus



244 MATERIA MEDICA AND THERAPEUTICS.

When heated to redness, it gives off oxygen and leaves a residue of red
oxide of manganese

3MnO 2 (heated) =Mn s O 4 + O 3

Sulphuretted hydrogen causes in manganic solutions a flesh-colored pre-
cipitate of sulphide.

Manganesii Oxidum Preparatum (not officinal). The prepared oxide
is obtained by digesting the powdered black oxide in dilute hydrochloric
acid for twenty-four hours, then levigating and drying.



MANGANESII SULPHAS SULPHATE OF MANGANESE, MnSO 4 5H,O,=

241 (not officinal).

CHARACTERS. Occurs in colorless, or pale rose-colored, transparent
crystals, freely soluble in water.

The double sulphate, the double carbonate, and the double iodide, with
iron, are sometimes prescribed ; less frequently such compounds as the
lactate, phosphate, citrate, and valerianate of manganese (Hannon, Gui-
bert). None of them are officinal.

Permanganate of potash (v. p. 267).

ABSORPTION AND ELIMINATION. Salts of manganese undergo prob-
ably the same changes in the stomach as salts of iron, and are absorbed
as albuminates, or as chlorides. The metal, like others, is eliminated
mainly by the bile and the intestinal tract. \V. Turner found distinct
evidence of manganese in the urine of a diabetic patient who had been
taking permanganate of potash freely for three weeks, showing that it is,
at any rate, partly eliminated by the kidneys (Edinburgh Medical Jour-
nal, vol. vi., 1861).

PHYSIOLOGICAL, ACTION (INTERNAL). Circulatory System. The pres-
ence of manganese as an essential element of the corpuscles has been re-
lied upon as a guide to its action, but it seems to be rather an accidental
than a normal constituent of the blood. Wurzer, in 1830, first announced
its presence, and Millon, Hannon, and Burin-Dubuisson corroborated this,
while Melsens, Bonnewzn, and others, could find no manganese on re-
peated analyses; Melsens operated on 7 kilogr. of blood from twenty-one
different persons. M. Glenard analyzed, in various ways, blood from
forty subjects of varying age and sex, and found the metal in one case
only. He concluded " that manganese is not an essential element of hu-
man blood; it may be found accidentally, but only in minute amount; it
does not enter by the lungs or skin, as proved in the case of a miner "
(Gazette Medicale de I/yon, 1854). I have not met with any series of
analyses for manganese since those quoted. M. Riche, the latest ob-
server, who finds the galvanic test to be exceedingly delicate, has de-
tected minute quantities in the blood of bullocks, etc., but has not tested
human blood often enough to speak with authority (Medical Record,



MANGANESE. 245

1877). Bartholow, however, considers the question decided affirmatively,
and even gives the proportion of manganese to iron in the red corpuscles
(human) as 1 to 20. If this be so, we may agree that the administration
of manganese would be likely to improve the nutrition and the color of
the corpuscles in a direct manner, but so much as this cannot yet be posi-
tively stated from physiological research. That manganese has a similar
action to that of iron has been often stated, but must be considered prob-
lematical (Husemann), and indeed, the increased blood-pressure caused
by the latter is not produced by the former drug.

According to Laschkewitz, the organic salts of manganese, in moder-
ate doses, slow the pulse and the heart-action, and cause lowering of
blood-pressure, and paralysis of muscles and nerves, which iron certainly
does not. After death from manganese poisoning the heart is found di-
lated, and does not respond to electrical stimulation.

Nervous System. Certain nerve-phenomena, whether direct or indi-
rect, are determined by manganese salts. Toxic doses cause death with
convulsions, and to 1 gramme injected into the veins of rabbits or dogs
produces cramp and death from heart-palsy, or else faintness and weak-
ness and slower death with fatty degeneration (Laschkewitz). The pupils
are dilated, the temperature unaffected. Rabuteau injected a little more
than 1 gramme into a vein of the hind leg of a bitch, and at first there
were no symptoms, but on the following day tetanic convulsions set in,
with trismus and opisthotonos, and death followed shortly afterward:
the white substance of the spinal cord was shrunken, the gray matter
congested.

Large doses given for a long period induce effects analogous to those
of zinc progressive wasting and feebleness, a staggering gait, and para-
plegia (Bartholow).

Digestive System. The saccharated carbonate of manganese has no
peculiar taste, the sulphate is styptic, metallic, and disagreeable. Small
doses (5 to 10 gr.) of these salts are said to promote appetite and diges-
tion, but larger quantities are apt to irritate, and cause vomiting and
purging. The oxide, which is gritty on the tongue, is said to exert rather
a sedative action on the gastric membrane.

The sulphate of manganese has been especially credited with the
power of stimulating the secretion of bile since the observations of C. G.
Gmelin, who found in animals poisoned by large doses, inflammation of
the stomach, intestines, etc., and " so large an amount of bile poured out
that the whole tract was colored like yellow wax." He reported a less
degree of the same effect in man, and Mr. Ure also found that 60 to 120
gr. acted as a cholagogue purgative (Pereira). Dr. Goolden took various
doses, from 1 up to 30 gr., before any vomiting occurred, but states that
as a rule 10 to 20 gr. will cause some nausea and free purging with co-
pious secretion of bile (Lancet, 1840, and i., 1878). Dr. Rutherford, how-



246 MATEKIA MEDICA AND THERAPEUTICS.

ever, failed to corroborate this experience, at least in animals, for after
giving 60 gr. to a dog the biliary secretion was at once lessened and severe
diarrhoea occurred. After death the mucous membrane of the small in-
testine was found pulpy, "as if the epithelium had been dissolved by
caustic." In another dog a dose of 20 gr. equally caused lessening of
bile, although benzoate of soda given afterward had power to restimu-
late its secretion. Dr. Rutherford concludes that the drug is a powerful
intestinal, but not an hepatic stimulant, acting very like sulphate of mag-
nesia (v. p. 235). Nitrogenous excretion is increased by it. Poisonous
doses induce acute fatty degeneration of the liver, like phosphorus.

SYNERGISTS. Iron may be considered as allied in action to manga-
nese within the limits of the preceding observations; the two substances
are constantly associated in nature. Copper, silver, and zinc have allied
effects on the nervous system. Goolden speaks of sulphate of manganese
as substitutive for mercury as regards the action on the liver, but this is
doubtful. He says also that it aids the action of sulphate of magnesia,
and Rutherford has shown some analogy between these two salts.

ANTAGONISTS AND INCOMPATIBLES. Caustic alkalies and salts of lead,
silver, and mercury are chemically (not therapeutically) incompatible with
manganese. Tannic acid and vegetable astringents are not incompatible,
as they are with iron.

THERAPEUTICAL ACTION (EXTERNAL). Hemorrhage, etc. The chlo-
ride of manganese and iron has been used by M. Petrequin, in preference
to the simple perchloride of iron, as a local haemostatic; and in Italy it
has been applied to necrosed bone, and injected into fistulous tracts and
hydroceles (Practitioner, vol. v., p. 375), but it has no proved advantage
over other well-known remedies.

Skin Disease. The same remark applies to the use of an ointment
made with the oxide of manganese ( 3 ij. to j. adipis), which has been
recommended in scabies and ringworm, and, combined with sulphur, in
porrigo.

Disinfectant. Free chlorine is readily and cheaply generated by act-
ing on peroxide of manganese with hydrochloric acid, or by heating a
mixture of common salt and peroxide with sulphuric acid and water
(equal parts). The former process is recommended in the Swedish Phar-
macopoeia, 1 part of peroxide (pyrolusite) and 4 of acid being ordered:
the latter process is that known by the name of Guy ton Morveau: a mix-
ture of manganese oxide 7 grammes, and 10 grammes of salt, with sul-
phuric acid and water, of each 20 parts, will disinfect a space of 30 c.m.

THERAPEUTICAL ACTION (INTERNAL). Anaemia Chlorosis. Manga-
nese was introduced into practice mainly by M. Hannon, of Brussels,
with special reference to the treatment of these conditions. He argued
that, during digestion, sulphuretted hydrogen is formed, and reacts on
the ferrous and manganic compounds contained in the intestines, chang-



MANGANESE. 247

ing them into insoluble sulphides, and thus removing essential elements of
haematosin. This happens especially (he supposes) in chlorosis, and the
remedy is to supply more of a metal which can form such sulphides, and
prevent the removal of essential elements of the organism. Hence, bis-
muth, lead, and copper are said to prove as serviceable as iron or manga-
nese, though the latter are better assimilated (Presse Medicale JBelge, 1850,
and Guibert). M. Harmon goes even further than this, and describes
three forms of chlorosis, according as there is a deficiency in the blood of
iron only, of manganese only, or of both metals. Thus, in the first case,
there are "earthy tint of skin, weakness of locomotor system, slow, regu-
lar pulse, diarrhoea, and fluid menstrual discharge." In the second case,
" color of skin and mucous membranes normal, pain in muscles, constipa-
tion, amenorrhoea." In the third case, " waxy tint, bluish sclerotics, oede-
ma, serious nerve-disturbance, derangement of circulation, dyspnoea, low
temperature, uterine pain." According to such symptoms does he recom-
mend either iron alone, manganese alone, or a combination of both metals.
It is evident that these statements are largely theoretical; and, apart from
the fact that even the necessary presence of manganese in the blood of
healthy persons is doubtful, an appeal to clinical results does not bear out
the suggestion of its great importance as a haematinic remedy rather
the contrary. M. Harmon himself reported very good effects from it, and
Dr. Steer (Cheltenham) saw benefit in chlorotic anaemia, traumatic anaa-
mia, and in phthisis, and in anaemia of children; but he used saccharated
carbonate of manganese with iron, not manganese alone. In uterine leu-
corrhcea of pale weakly subjects, he gave it with ergot; for constipation,
with aloes; for dyspepsia, with soda and rhubarb (Medical Times, ii.,
1853). Sir J. Simpson found the phosphate sometimes useful in amenor-
rhoea, given either with or without iron, but says very little about it
(Medical Times, i., 1861, p. 517). Dr. Broadbent, using the chloride
and sulphate, reported some favorable, some negative, results. Mr. Car-
ter used it with no good effect (" Clinical Society's Transactions "), while
Dr. Garrod failed to cure every case of anaemia in which he employed
the manganese salts alone, and the subsequent administration of iron was
always followed by rapid improvement. It is true that M. Petrequin was
an enthusiastic advocate for the remedy in all forms of impaired blood-
condition, including intermittent fever, phthisis, and cancer, but the gen-
eral experience of the profession is not with him or M. Hannon. All we
can at present say is, that in obstinate cases of chlorosis not cured by
iron, the conjunction with manganese should receive further trial.

Hepatic Disorder. I have already mentioned that Mr. Ure found 1
to 2 dr. of the sulphate act as a cholagogue purgative (Pereira), and Dr.
Goolden gave it in cases of enlarged liver with dark or pale stools, and
jaundice, when no abscess or acute symptoms were present. Most of the
patients (at the Dreadnought Hospital) were in weak condition, having



248 MATERIA 1IEDICA AND THERAPEUTICS.

returned from India, and he sought for a non-mercurial remedy to stimu-
late the liver. He says that 10 or 20 gr. of sulphate of manganese,
though at first it excited nausea or vomiting, soon acted on the bowels
to the marked relief of the patient, and with rapid clearing away of the
jaundice (Lancet, 1840). This favorable result has, however, not been
corroborated by the experience of others, but recently Dr. Goolden has
written to direct attention again to the subject, stating that he has con-
tinued to use the remedy with success in hepatic dropsy, hemorrhoids,
bronchial congestion, hypochondriasis, etc.: he usually combines it with



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