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

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

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soon as taken (cf. p. 298).

Chloride of sodium in the air, or in finely-divided spray, is absorbed
from the pulmonary mucous membrane even more quickly than from the
stomach. It does not seem to be absorbed through the unbroken skin,
or at least whatever passes, e.g., during a salt-bath, into the epidermis or
corium, passes out again in the same b,ath (Clemens). Soda salts, like
alkalies generally, are eliminated to a slight extent by the mucous mem-
branes, especially by those of the respiratory tract, the secretion of which



292 J1ATERIA MEDICA AND THERAPEUTICS.

they tend to increase and make thinner: they exercise a remarkable
stimulant effect upon the vibratile movements of ciliated epithelium,
which they revivify after apparent extinction (Virchow).

PHYSIOLOGICAL ACTION (EXTERNAL). The hydrate of soda exerts a
local caustic effect, consequent upon its great affinity for water and its
power of dissolving nitrogenous tissues. The carbonate, applied in solu-
tion, dissolves sebaceous and fatty secretions, and if concentrated, acts
as an irritant. Solutions of chloride redden and stimulate the skin, and
if applied to a surface denuded of epithelium, excite much smarting and
flow of serum; redness is then masked by whitish opacity of the albumi-
nous secretion, and the same whitish appearance may be observed on the
inner aspect of the buccal mucous membrane after eating much salted
food (Gubler). Strong saline baths may cause cutaneous eruptions.

Salt has a local stimulant or irritant effect on nerve-tissue, and for
some physiological experiments, C. Bernard considered it more effective
than galvanism. If the exposed sciatic nerve of a frog be dipped in salt
and water, immediate spasmodic contraction of muscles occurs in the
limb: if the tympanic nerve be so treated, saliva is secreted (Jfedical
Times, ii., 1861).

PHYSIOLOGICAL ACTION (INTERNAL). Oxidation and Nutrition.
Under potassium has been summarized evidence as to the action of alka-
lies on oxidation, and with regard to the carbonates of soda, we may
equally conclude that while large and continued doses induce anaemia
and asthenia, small quantities, given for a moderate time, help to sapon-
ify fatty food, to aid its oxidation, and that of carbonaceous material
generally, to improve digestion, and to raise temperature. This is espe-
cially the case with the chloride of sodium, and indeed Rabuteau teaches
that it is by conversion into this salt that the other sodium compounds
produce the good effects mentioned. Confirming conclusions already
published by Voit (British and Foreign Review, ii., 1862), he showed
that the chloride increased " vital combustion," for while taking an extra
daily dose of 10 grammes of salt, his excretion of urea was 20 per cent,
more, and his temperature was half a degree higher than when under a
dietary from which salt was excluded. Similarly Kaupp found that with
taking 1 gramme of salt, the amount of urea excreted was increased 4
ctgr., the other soluble constituents of the urine being diminished. Ac-
cording to Zabelin, salt favors absorption of phosphates specially, and
rather hinders their excretion, which effect would, to some extent, favor
nutrition.

Falck found also increased excretion of urea after giving salt to fast-
ing animals (1872), while Mvinch reported, from large doses, continued
for a few days, at first diminished excretion and gain in weight: afterward
a contrary effect (Archiv Verein Gfemeinshft., Bd. vi.).

The carbonate, according to the majority of observers, diminishes the



SODIUM. 293

excretion of uric acid, and as this acid results from insufficient oxida-
tion, its diminished excretion implies improvement in oxidation. The
reported increase of excretion of carbonic acid requires proof, but is ren-
dered probable by the increase which follows injection of lactate of soda
into the veins (Husemann). Animals improve under a ration of salt
their coat becomes smoother, their vigor greater, their flesh more healthy,
and if, at the same time, their weight is not increased (Boussingault and
Dailly: Comptes Rendus, 1847), it is because the vital processes and com-
bustions all go on with greater energy. We have negative evidence to
the same effect in the sufferings consequent on deprivation of salt, as in
the American War of Independence, and more lately during the siege of
Metz, and Barbier records that certain Russian serfs, deprived for a time
of salt (from motives of economy), suffered so much (becoming albuminu-
ric and dropsical), that their lords were forced to supply them with it
again ( Gazette Medicale, 1838). On the other hand, it is curious that
the Tlascalans are said to have lived for half a century without salt (Pres-
cott), and certain Aryan tribes never use it (Fick) it is possible that
the atmosphere, as near the coast, may supply to them what is really ne-
cessary.

We must repeat that the above-mentioned good effects of ordinary
salt, and of alkaline compounds, are obtained only within certain limits
of dose an excess of the former causes not only thirst and disordered
digestion, but impaired blood-conditions, and under daily 5-gramme
doses of bicarbonate the urea is diminished, and anaemia and prostration
induced (Rabuteau): the nitrate and sulphate also diminish urea (Jovitzu
and others), lower temperature, and slow the circulation: it is probably
from alteration of the blood that these effects arise. According to Gutt-
man, if the legs of frogs are immersed in strong solutions of salt, unrest
and local swelling occur, then muscular contraction, and ultimately cata-
ract is developed (Medical Times, i., 1860).

Digestive System. What has been stated under potassium as to the in-
fluence of alkalies upon digestion and secretion applies equally to the alka-
line salts of soda, but the chloride of sodium has a special value, perhaps
from its furnishing in part the gastric acid; it aids the solution of albumi-
nous substances, and increases the amount of saliva and gastric juice. Bar-
deleben proved this by observations on dogs with gastric fistula, though,
indeed, many other salts, and even mechanical irritants, will provoke a
temporary increase in the gastric secretion. Rabuteau found that salted
diet increased also the degree of its acidity, whether from irritation, or
from the special properties of the chloride itself; certainly digestion suf-
fers by its absence (Klein and Verson). The good effects are shown
by small doses of 15 to 60 gr. Large quantities tend rather to coagu-
late albumen, while very large and concentrated doses cause vomiting-,
watery purging, and even gastritis: in, China, they are said to be used



294 JIATERIA MEDICA AND THERAPEUTICS.

for suicidal purposes. Injection of much salt into the crural vein of dogs
causes ptyalism, intestinal gurgling, and temporary lessening of the
spleen (Podocaepow).

Different osmotic currents are determined by the different modes of
administration; when either the chloride or sulphate of soda is injected
into the blood, or taken in small quantities that can be quickly absorbed,
constipation follows, while large amounts, given at one time, induce
hyper-secretion and consequent purgation.

The action on bile-secretion is not certainly known : Nasse, experi-
menting with animals, found it lessened, but observations made after the
use of alkaline waters show an increase (Grossmann), and this would be
in accord with analogy. Rutherford has shown that sulphate of soda
has marked cholagogue properties. According to Pavy, the carbonate
not only increases the bile, but also the percentage of fat in the liver,
and when introduced into the portal system causes the disappearance of
hepatine, without formation of sugar ( Guy's Reports, 1861, " Proc. Roy.
Soc.," vol. x.-xi., Medical Times, i., 1865): also the saccharine urine
which commonly follows certain traumatic lesions of the sympathetic,
does not occur if much soda be previously introduced into the blood;
these are curious facts, of which we do not at present see the full bear-
ing (cf. p. 301).

Circulatory System. It is an important difference between potash
and soda, that the former is an active cardiac depressant and poison,
while the latter has no definite effect on the heart-muscle or the circula-
tion. Frogs, it is true, die, but only slowly, after the injection of very
large quantities (Podocjepow, Guttmann), while upward of 100 gr. of soda
carbonate have been introduced into the vein of a dog with but slight
and temporary malaise and muscular weakness (Grandeau: Robin's Jour-
nal, 1864). Upon man, large doses seem to have but little effect in di-
rectly depressing the circulation.

The chloride of sodium, in small or moderate doses, increases the num-
ber of corpuscles; thus Plouviez had analyses made of his own blood
before and after a course of salt, lasting two months, during which he
took daily 150 gr. of salt besides his ordinary allowance, and at the end
of the time the red globules were augmented 10 per cent., the fibrine was
increased, the albumen diminished ( Comptes Rendus, 1847, t. xxv.).

Rabuteau states that blood-corpuscles placed under the microscope
disintegrate much less rapidly when salt is added than with simple water,
and from this and general physiological results concludes that any influ-
ence of salt in apparently increasing the number of globules is exerted
by conserving them, rather than by supplying food for fresh ones, as iron
does.

According to Bergeret, omission of salt from a dietary leads to pallor,
languor, oedema, and a chlorotic condition, the corpuscles are dissolved,



SODIUM. 295

and fibrine deposited (Abstract, Ranking, i., 1871; cf. p. 296), but on the
other hand, the continued use of soda, as of any other alkali, lessens the
number of red corpuscles and deteriorates the blood (Loffler, v. p. 270).

Whether the excessive use of highly salted food is the main cause of
scorbutic conditions, such as occur in sailors and at whale-fisheries, may
be considered doubtful; they may arise from the hardships of such life,
from deficiency of potash, of vegetables, etc., but it would almost seem
as if either great (relative) excess or deficiency of the element led to
equally injurious consequences. Prussac found that when frogs were
placed in concentrated salt solutions or had them injected into the lymph
sacs, copious "wandering" of red corpuscles took place from uninjured
vessels, and also capillary hemorrhage (cf. p. 293).

External to the body, salt reddens and liquefies blood-clot. The
change in color is attributed by Gubler to liberation of carbonic acid and
absorption of oxygen by the haemoglobin. It is permanent, but I do not
think it more than a physical change due to altered osmosis; it may be
produced by many other saline compounds.

Soda is more abundant in the serum, while potash occurs most in the
red globules, and excessive doses of the former alkali may alter this nor-
mal relationship, and thus interfere with respiratory combustion and with
nutrition.

The proportion of sodium chloride in normal blood has been variously
estimated at from 3 to 5 per 1,000. It is diminished in various morbid
states, such as cholera, diabetes (Nasse), jaundice, chlorosis; in pneumo-
nia, on the contrary, its elimination is checked, and hence an excess re-
mains in the blood (Beale: Lancet, i., 1852; Bergeron: "These de Paris,"
1866, and others).

Nervous System. There is some (not cogent) clinical evidence that
excess of soda in the blood leads to convulsive action of the nervous sys-
tem (Laycock: Medical Times, i., 1863; Hunt: Medical Times, 185G);
most observers think an excess of little import.

Urinary System. With regard to the influence of soda salts on diure-
sis, opinions are divided, partly, perhaps, because of the different doses
employed. Usually some increase in the quantity of urine passed is
observed in patients taking carbonates, especially in those with acid dys-
pepsia, but it is not always the same with healthy persons. Munch
found, in five subjects, when perspiration or diarrhoea did not occur, in-
creased excretion of water as the principal effect of 3 to G or 9-gramme
doses of carbonate, but Rabuteau and Constant could not verify any
increase with 5-gramme doses, given daily. A continued weak alkales-
cence of the urine may be secured from about 3-gramme doses of bicar-
bonate of soda, taken thrice daily at meal-times, while one daily dose of
5 gr. will give alkalinity only for two or three hours even 1 gramme
will do this if taken fasting. Much dilution or warmth of the liquid in



296 MATERTA MEDICA AND THERAPEUTICS.

which the drug is taken promotes the alkalescence of urine, and it lasts
longer in weak or elderly persons.

The chloride will produce the same effect, though not so quickly as
the carbonate, and under its use earthy phosphates replace free acids
(Munch).

Glandular System. Milk is secreted in increased quantity under the
influence of salt. This fact, indicated by Saive, but denied by Boussin-
gault, has been confirmed recently (Rabuteau). In Brazil and some other
countries there is a popular custom of watering the food of milch cows
with salt water to increase their milk.

SYNEEGISTS. The chemical action of the alkaline salts of soda is
shared by other alkalies, the physiological action of the chloride of so-
dium by other chlorides, both as stimulant of hrematosis and as irritant
in large doses; as digestive stimulant, other condiments assist its power.

ANTAGONISTS INOOMPATIBLES. Acids antagonize the chemical ef-
fects of alkaline salts of soda, though the vegetable acids are often added
to them to secure liberation of carbonic acid gas and formation of neu-
tral salts. Mucilaginous substances lessen the local irritant effects of ex-
cessive doses of chloride, nitrate, etc., and the chloride itself is a suitable
antidote for nitrate of silver. Prussia acid and cyanides, perhaps also
arsenic and antimony, antagonize the hsematinic effects of chloride of so-
dium.

THERAPEUTICAL ACTION (EXTERNAL). Strumous Ulceration, etc.
For destroying unhealthy growths, the edges of strumous ulceration,
etc., caustic soda has been sometimes used. It is less deliquescent than
potash, but yet is very diffusible, and readily extends its action: it there-
fore requires the precaution of protecting adjacent parts, and of neutral-
izing with weak vinegar or oil after application.

Glandular Scrofulosis. A strong solution of salt locally applied is a
good resolvent of enlarged and hard glands: sea-bathing is useful for the
same purpose.

Frictions with a pomade containing salt cause a pustular eruption,
and have been used over the chest in phthisis (Medical Times, ii., 1859).

Hoarseness Catarrh. A piece of borax allowed to dissolve slowly
in. the mouth sometimes cures these conditions. A spray containing
salt (gr. iv.-v. ad. j.) is also useful.

A simple mode of stimulating the external surface in some, chronic
catarrhs and relaxed throat-conditions, is sponging or bathing of the
neck and chest in salt water night and morning, following this with
friction.

Unhealthy Wounds. Solution of chlorinated soda mixed with water
in various strengths makes an excellent detergent and disinfectant gargle,
lotion, or injection, but is rather a preparation of chlorine than of soda.

Corneal Opacity. Mr. Henry Power has recorded good results from



SODIUM. 297

the local application of powdered sulphate of soda to the cornea, though it
is liable to cause severe irritation for a time (Practitioner, September, 1868).

Lupus. The acetate of soda, though not often used, has remarkable
power in lessening the granulations and crusting of strurnous and lupoid
ulceration: a lotion containing from 10 to 20 gr. in the ounce of water
may be applied on compress, or injected into sinuses. In lupus the solid
crystals may be lightly applied for a caustic effect (Anderson: Lancet,
ii., 1869).

Pruritus Eczema, etc. In several forms of skin disease, attended
with itching, lotions containing a small proportion of carbonate or borate
of soda, 1 to 2 dr. in pint, are often serviceable. In urticaria, lichen,
and the early inflammatory stages of eczema, when alkaline oozing oc-
curs, the same lotion will give relief, but in the last case it should be
made weaker still 20 to 30 gr. in the pint; or, again, 20 gr. of the
carbonate of soda may be usefully combined with an ounce of zinc oint-
ment. In several forms of papular and scaly eruptions, such as lichen and
psoriasis, baths containing about 4 to 6 oz. of carbonate of soda are very
useful, being sedative as well as detergent. For common chilblains a
strong solution of salt in water is a good domestic remedy; borax with
glycerin is also good.

A weak lotion of borax is also often useful in cases of ordinary sore
nipple; Sir Astley Cooper commonly prescribed it with spirit of wine.
For slight cases of fissured sore tongue or buccal irritation, the glycerine
of borax is pleasant and efficient.

Tinea Versicolor and even mild cases of tinea tonsurans (ringworm)
mav be cured by the same remedy. For the irritation and scaling con-
nected with so-called pityriasls capitis a lotion containing borax, cam-
phor, and rosemary is a good application.

Aphthae, etc. Aphthous conditions affecting the mouth and fauces
are often treated with borax mixed with honey or dissolved in glycerin;
a solution of chloride will also succeed sometimes. Aphthous conditions
affecting the vulva, and the very irritating " pruritus pudendi " in either
sex, may be much relieved by warm lotions or by paints containing borax.
Laycock has spoken well of the use of borax in diphtheria (Medical
Times, i., 1858, p. 548), but we have more dependable remedies.

Acne Simplex. A liberal use of soap with hot water is often neces-
sary in this disorder, and a borax lotion is of service.

Burns. In burns and scalds, especially of the first degree, a satura-
ted solution of the bicarbonate, applied constantly on moistened cloth,
quickly relieves the burning pain.

JJental Caries. Toothache, connected with open carious teeth, may
often be relieved by the local use of carbonate of soda ( dr. in the ounce
of warm water); it probably acts by neutralizing acid or irritant secretions
(Duckworth: Practitioner, 1875).



298 MATERIA MEDIC A AND THERAPEUTICS.

Rheumatism Gout. Soda baths are also useful in relieving pains of
rheumatic character in the joints and muscles. Basham recommended basic
phosphate of soda in powder as a good application for enlarged and pain-
ful gouty joints (Medical Times, ii., 1848), and it has some advantage over
liquid applications; it may be applied on moistened spongio-piline. Hot
salt in flannel is often a convenient mode of applying warmth to rheuma-
tic or painful parts: in similar cases Dr. H. Bennett used "soda poul-
tices" (Times, ii., 1853, p. 502). 1

Leucorrhcea Cystitis. Injections containing carbonate of soda (1 to
2 dr. in the pint) form a simple and often efficacious remedy in cases of
vaginal leucorrhoea with white, alkaline discharge, and in chronic cystitis
an injection of borax, glycerin, and warm water is very soothing. The
silicate of soda has been lately recommended for the same purpose; it
coagulates albuminous material, and is antiseptic (Ranking, i., 1873).

Ascarides, etc. A strong injection of salt into the rectum is an
efficient cure for these parasites, and is best given with quassia or other
bitter. Salt is also taken internally to prevent recurrence of thread or
round worms, and so strong at one time was the belief in its efficacy, that
an ancient law in Holland deprived certain criminals of salt in their diet,
in order to allow intestinal worms to develop and devour the victims!

Leeches are very sensitive to the action of salt; it will make them
disgorge blood they have swallowed, and a saline injection will dislodge
them from the rectum or vagina. It is advisable to administer the same
remedy freely should they by accident have passed from the nose or
mouth to the stomach.

Fractures, etc. The silicate of soda (water-glass) is used like the
analogous salt of potash. Bandages soaked in the fluid harden into a
light firm support in twenty-four to forty-eight hours.

THERAPEUTICAL ACTION (INTERNAL). Comparing soda with potash,
we find the former more indicated in disorders of the stomach, the primae
viae, and the liver, while the latter, acting better as a diuretic and a solv-
ent of uric acid, is more appropriate in renal congestions and lithiuria.

Dyspepsia. Soda salts are very useful in several forms of indiges-
tion, but the dose and mode of administration vary somewhat according
to the conditions present. In cases of atonic dyspepsia connected with
deficient secretion of gastric juice, the bicarbonate in small doses of 5 to
10 gr. should be given, and shortly before a meal, on the principle already
alluded to, viz., that an alkali causes increase of an acid secretion, for
though on first contact it neutralizes the acid it meets with, additional
acid is very quickly poured out so as to leave an excess. The alkali
may, in some cases, be very suitably combined with an aromatic, as in

1 Soda salts are, by some practitioners. giv3n internally for rheumatism, like pot-
ash (v. p. 279) : the use of the salicylate will be discussed under salicylic acid.



SODIUM. 299

"Gregory's powder," with ginger only, or with a bitter-like tincture of
orange or infusion of gentian. On the other hand, in cases of acid dys-
pepsia, with thickly coated or red shining tongue, sour eructations, heart-
burn, and flatulence, larger doses of the bicarbonate (15 to 20 gr.) should
be given an hour or more after a meal, according to the time at which
the symptoms come on; in this case, also, the remedy may be well com-
bined with an aromatic or stimulant, as ammonia or peppermint. Soda
is especially useful for the dyspepsia of those who live in towns, eating
and drinking freely, and taking little exercise. If the urine be scanty
and irritating, nitre may be given at the same time, and according to Dr.
Budd, an occasional blue pill. A dry skin and very furred tongue are
other indications for soda, while for those who live in the country, take
more vegetable food, and perspire freely, acids usually agree better
(Medical Times, i., 1854). If larger doses of soda be continued too long,
or taken at the wrong time, " it becomes a contest between the scomach
and the doctor."

The familiar use of salt is of no small importance in stimulating ap-
petite and digestion, and advantage is sometimes gained by varying the
kind used: thus, Maldon salt is in crisp flakes, Lymington salt in deli-
quescent cubes, etc. (Medical Times, i., 1864). The principal ingredient
in Vichy water is the bicarbonate of soda, but it contains minor or minute
quantities of sulphate, phosphate, arseniate, borate, and chlorine: this
saline water may be very useful in simple slow digestion, with constipa-
tion and loss of appetite, and when gastralgia is not a prominent symp-
tom (H. Weber: Medical Times, ii., 1861). Dr. Symonds states that
"duodenal dyspepsia," with its attendant " bilious headache," may often
be obviated for a long period by the daily taking of a tumblerful of "salt
and water" before breakfast (Medical Times, i., 1858). An effervescent
soda carbonate, or sulphate, is often efficacious in such headaches.

Lientery. In the lientery of young children, Rabuteau has found salt
curative after other remedies had failed (op. cit. p. 104).

In Vomiting or Diarrhoea connected with acidity, or with incomplete
digestion of fatty food, the bicarbonate of soda, with an aromatic, such
as cinnamon, is very good. In children with coated, irritable, or aphthous
tongue, it may be combined with a little gray powder, and for adults,
especially if colic is present, it may be given in effervescence with opium.
In cases of dyspepsia, etc., in weakly subjects, the use of alkalies must
not be too long continued.

Hepatic Disorders. For congestion of the liver, with deficient secre-
tion of bile, soda is of proved value in several combinations, and it re-
lieves such symptoms as have been already described under dyspepsia.

Phosphate of soda especially is said to promote the flow of bile, and
acting in full doses as a gentle laxative, it is useful in " bilious or sick
headache," and in catarrhal jaundice. It has some value, also, in pre-



300 MATERIA MEDICA A5fD THERAPEUTICS.



venting biliary calculus, which condition arises generally from continued
catarrh of the bile-duct and inspissation of mucus and bile. (Vichy



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 36 of 40)