Frank Pierce Foster.

Reference-book of practical therapeutics online

. (page 127 of 165)
Online LibraryFrank Pierce FosterReference-book of practical therapeutics → online text (page 127 of 165)
Font size
QR-code for this ebook


HYDROaTJININE is a natural alkaloid
occurring in cinchona. Its properties closely
resemble those of quinine, from which it varies
chemically in containing two more atoms of
hydrogen. Its formula is CuoHsoNjOj. Hydro-
quinine was first isolated by Hesse, who found
it in the mother-liquors from which quinine
sulphate had been crystallized, and subse-
quently obtained it from commercial quinine
sulphate in small amount. The drug has had
a limited employment in medicine as a substi-
tute for quinine, the therapeutic properties of
which its own resemble. It has been thought
an efficient antipyretic, but it is practically not
used at the present time save unintentionally,
when it contaminates quinine. Seifert, who
experimented with hydroquinine, compared it
with salicylic acid, and considered it rather
superior to that remedy in reducing febrile
temperature. With the fall of temperature it
produces there also occur circulatory sedation
and free diaphoresis. The continued adminis-
tration of hydroquinine does not appear to be
harmful. It is freely soluble in alcohol and in
ether. — Henry A. Griffin.

HYDBOaiJINOlTE, the HydrocMnon of
the Germans, C0H4.O2H2, isomeric with resor-
ein, is obtained by the oxidation of arbutin
and in other ways. It has been used as an
antipyretic, as an amalgetic, and as an internal
antiseptic in daily amounts of from 4 to 7
grains in divided doses.

HYDROTHEBAPEUTICS.— See Htdri-

ATICS.

HYDROXYLAMINE HYDROCHLO-
RIDE, NHa.OH.HOl, forms colourless crys-
tals readily soluble in water, in alcohol, and
in glycerin. It has been recommended in the
topical treatment of lupus, pityriasis, psoria-
sis, and parasitic skin diseases, in a solution
of the strength of 1 to 1,000. It has the ad-
vantage over pyrogallic acid and chrysarobin
that it does not stain.

HYOSCIITE.— At meetings of the German
Chemical Society held on April 30 and July
26, 1880 {Ser. d. dtsch. chem. Oesellschaft, vol.
xiii, pp. 909 and 1549), Professor A. Ladenburg
reported some results of his researches among
mydriatic alkaloids, particularly those of Syos-
cyamus niger. At that time this plant was
known to have two alkaloids — viz., crystallized
and amorphous hyoscyamine. He derived a new
alkaloid, hyoscine, from the latter, and it is not,
as some suppose (Hoehn and Reichardt), to be
obtained from crystalline hyoscyamine. He
found that hyoscine, hyoscyamine, and atro-
pine were actually isomeric, the formula for
each being CirHaaNOs, and, furthermore, that
each was separable into trophic acid, CsHioOj,
and tropine, or pseudo-tropine, CsHibNOb.
He also converted hyoscyamine into atropine
and atropine into hyoscyamine in his labora-
tory, though he has not thus far been able to
transform hyoscine into either of the other
mydriatics.

It was put in use at once by some of the
German physicians, and found by them to be
therapeutically allied to hyoscyamine. It is a
mydriatic, a hypnotic, and a cardiac, respira-



HYOSCYAMINB
HYPNOTICS



504



tory, and spinal depressant. It was first used
in insanity in this country by the present
writer, who, with Dr. Langdon, employed it
in sixty cases of insanity of all kinds in the
Hudson River State Hospital for the Insane
{Med. Record, Sept. 19, 1885). Our conclusions
as to the value of the drug — since corroborated
by others, who, both at home and abroad, have
used it extensively — are briefly as follows :

Hyoscine is not a real hypnotic, such as chloral,
opium, and the bromides, although it disposes
to sleep by causing muscular relaxation and a
feeling of weariness, and does in large doses
produce stupor. The sleep apparently caused
by it is of short duration, and is qasily broken.

It should never be given by the mouth with a
view of producing sleep, but only hypodermic-
ally. Its continued use is not advisable. Con-
stitutional effects appear in some cases sooner
and more severely than in others. The respi-
rations are made shallower but not diminished
in number (any more than by natural sleep).
The pulse is often considerably reduced, some-
times incieased in frequency, and usually
made very variable. It may reduce or increase
arterial tension. The face usually flushes and
the extremities become cold. There is dilata-
tion of the pupils with loss of accommodation.
There are, further, dryness of the throat and
mouth, dizziness, and, in many cases, anorexia
and nausea, in some cases vomiting and diar-
rhoea. In a few eases there is a sensation of
heat and itching of the skin. The severer
effects are muscular tremor, unsteadiness of
gait, delirium, and stupor. It seems in one or
two cases to have increased erotism. In in-
sanity, as a rule, it increased excitement by
continued use. It made melancholiacs worse.
It was no improvement on chloral and hyoscy-
amus in chronic mania, dementia, and general
paresis. It was of no value in epilepsy.

In poisoning by hyoscine we observe symp-
toms similar to those of poisoning by hyoscya-
mine or atropine, such as variable pulse, flushed
face, shallow respirations, dilated pupils, dryness
of the throat and mouth, nausea and vomiting,
tremor, unsteadiness, muscular weakness, deli-
rium, and stupor. The treatment of hyoscine
poisoning should consist in the use of stimu-
lants and coffee. Caffeine and whisky may be
injected subcutaneously. Artificial respiration
should be resorted to. Attempts to arouse the
patient from stupor may be made by means of
the f aradaic or galvanic battery and by flicking
with a wet towel. Occasionally it may be ad-
vantageous to make cautious use of physostigma.

It was first used in paralysis agitans by me
(N. Y. Med. Jour., Oct. 11, 1890), and I found
it very eflicacious in diminishing the tremor.

The dose is the same as that of hyoscyamine
and that of duboisine. It is safe to begin with
from yi^ to ^ of a grain, but much larger
doses may be used.

[The hydrobromide, hyoscinm hydrobromas
(XL S. Ph.), hyoscinum hydrobromicum (Ger.
Ph.), is the compound used in medicine.]

Frederick Peterson.

HYOSCYAMINE is a white erystallizable
alkaloid obtained from Hyoscyamus niger.



It also occurs in Datura Stramonium. Its
formula is the same as that of atropine, Cn
H23NO3. It is also isomeric with duboisine
obtained from Duboisia myoporoides. It has
a bitter and acid taste and a neutral reac-
tion. Usually the sulphate, hyoseyaminm sul-
phas (U. S. Ph.), is employed medicinally, but
the hydrobromide, hyoseyaminm hydrobromas
(IT. S. Ph.), also is used. It is very soluble in
water and in alcohol. The dose is from ^ to
1 grain. It is used as a sedative to the nervous
system. It is more often employed in insanity
than its isomeric alkaloids, atropine, hyoscine,
and duboisine, are. As an adjunct to purga-
tives it diminishes griping. It lessens spasm
and allays vesical pain and irritation. Its
physiological action is similar to that of atro-
pine and that of daturine. It dilates the
pupils, causes dryness of the mouth and fauces,
and produces headache. Large doses produce
difficulty of swallowing, rapid pulse, convul-
sions, paralysis, delirium, coma, and death.
The heart's action is sometimes slowed and
sometimes quickened by the drug. Respira-
tion is first quickened and then slowed. It
diminishes all the secretions, though the urine
is sometimes increased. — Frederick Peterson.



HYOSCYAMTTS (U. S. Ph.), _ _
folia (Br. Ph.). herba hyoscyami (Ger. Ph.).-
The leaves of Hyoscyamus niger. Henbane is
the vulgar name of the plant, which is natu-
ralized in the United States. It is an annual
of the family Solanaeem. The fresh herb has
a rank, heavy, sickening, unpleasant odour,
which disappears on drying.

The qualities of hyoscyamus depend upon
its volatile alkaloid, hyoscyamine {q. v.), in
combination in the plant with malic acid.

The name hyoscyamus means literally hog-
bean, and the fact is that swine and some other
domestic animals feed on it with impunity. It
is poisonous to dogs, deer, rabbits, and fowl.

In its action on man henbane is analogous
to stramonium and belladonna in many re-
spects, though milder. Children can endure
a larger dose than adults. As the result of
taking poisonous doses (the sizes of which are
very variable in different people), there are
dilatation of the pupil, fulness of the head,
giddiness, delirium with hallucinations, slow-
ness or frequency of the pulse, extreme dry-
ness of the throat and fauces, dysphagia,
muscular debility, coma-vigil or coma, and ,
death. The drug only occasionally brings on
a scarlatinoid eruption like that of belladonna.

The chief use of hyoscyamus is as a sedative
to the nervous system. It is frequently given
in spasmodic conditions, to allay vesical pain
and irritation, to lessen the griping of pur-
gative medicines, and to relieve cough. In
excited nervous conditions it is usual to employ
its alkaloid, hyoscyamine, bijt often the tincture
or the fluid extract is made use of in this country
in asylum practice. In insanity its chief value
is in certain cases of acute or chronic maniacal
excitement. It should never be employed in
melancholia, general paresis, epileptic insanity,
or quiet forms. It should never be used as a
hypnotic merely, because we have much better



505



HYOSCTAMINE
HYPNOTICS



soporifics at our disposition. The drug has
some anodyne power, and hence its use in grip-
ing pains and occasionally in neuralgias.

The dose of hyosoyamus in substance is
from 5 to 20 grains ; that of the extract, ex-
tractum hyoscyami (U. S. Ph., Br. Ph., Ger.
Ph.), is from 1 to 3 grains ; that of the tinc-
ture, tinctura hyoscyami (TJ. S. Ph., Br. Ph.),
is from | to 1 fl. drachm ; that of the fluid
extract, extractum hyoscyami fluidum (U. S.
Ph.), is 5 minims ; and that of the expressed
juice, suecus conii (Br. Ph.), is from ^ to 1 fl.
drachm. — Peederiqk Peterson.

HYPNAIj. — This is a mixture of 45 parts
of chloral hydrate and 55 of antipyrine. It is
readily soluble in water. It is employed as a
hypnotic and is thought to be more efficient
than chloral alone, especially in insomnia with
pain. The dose is 15 grains.

HYPNONE. — See Aoetophenone.

HYPNOTICS are medicinal agents which
may be employed to produce sleep. In this
wide sense the term would include the nar-
cotics and the general anaesthetics, but it is
usually restricted to those agents which, in
the doses necessary to cause sleep, do not dis-
turb the normal relationship of the mental
faculties to the external world (Brunton).
Another definition of hypnotics is that they
produce sleep without suspending the con-
sciousness of pain, narcotics doing both.
Hypnotics may properly be subdivided into :

(a) Indirect Hypnotics, which induce sleep
by removing or suppressing any cause (not
mental) interfering therewith. Such are anti-
pyrine, phenacetine, and other non-narcotic
analgetics, acting against pain ; strychnine and
other respiratory stimulants, .relieving pul-
monary congestion and dyspnoea ; hydrocyanic
acid and other pulmonary sedatives, relieving
cough; conium, gelsemium, and other motor
depressants, restraining excessive motor activ-
ity; and ergot, digitalis, and other vascular
and cardiac tonics, antagonizing cerebral hy-
persemia and regulating the cardiac action.

(b) Pure Hypnotics, which directly induce a
sleep closely resembling the normal, without
causing narcotic or other dangerous cerebral
symptoms. Such are the bromides, paralde-
hyde, sulphonal, trional, tetronal, urethane,
chloralamide, etc. ; but this list is constantly
growing smaller as experience reveals toxic
powers in the action of its members.

(c) Na,rco-hypnotics, which induce sleep by
direct depression of the cerebral functions and
in larger doses are narcotic, suspending the
consciousness of pain and producing coma.
(See Narcotics.) These include opium and
its narcotic alkaloids, morphine, codeine, etc. ;
hyosoyamus and its alkaloids, especially hyos-
cine ; also duboisine and various plants of the
tiolanacem which are more feebly hypnotic
than hyosoyamus ; alcohol, amylene hydrate,
chloral hydrate, cannabis indica, etc.

The pure hypnotics and the narco-hypnotics
are members of the materia medica class styled
cerebral depressants.

Theory of Sleep and Hypnosis.— The
oldest received theory of sleep ascribed it to



passive congestion of the brain, as in coma ;
but this was upset by Dunham's observations
on trephined dogs (1861), Hammond's and
Mitchell's experiments (1866), and those of
Mosso (1881), upon which was based the doc-
trine of cerebral anasmia as the immediate
cause of sleep. Under this latter view the
action of hypnotics was ascribed to vaso-raotor
stimulation contracting the cerebral supply
vessels and lessening the quantity of blood
circulating in the brain (Hammond). That
there is a relative ana3mia of the brain during
sleep is well established, but recent experi-
mental researches have proved that such is the
result rather than the cause of inactivity of
the mental faculties. It is shown that hyp-
notics may induce deep sleep without altering
the quantity of blood in the cerebral vessels ;
and that although, in prolonged sleep, the
brain becomes pale and bloodless to some ex-
tent, during the earlier stage of artificial sleep
there is no indication of cereljral ana3mia
(Binz). Furthermore, patients suffering from
general anjeraia due to haemorrhage, chlorosis,
etc., often suifer from obstinate insomnia ; and
conditions of plethora are frequently attended
with troublesome somnolence (Vulpian). The
latter observer denies that ligature of the
carotids in animals produces a state resem-
bling true sleep, and states that faradization of
the cephalic ends of the two divided cervical
sympathetic cords, while producing consider-
able cerebral anasmia, does not cause the slight-
est tendency to somnolence ; hence, that the
valvular and cardiac modifications observed are
" only accessory, concomitant, or consecutive,
playing no essential role in the physiology of
sleep."

The present view is that normal sleep is a
condition of rest of the nervous system, in
which the energy expended during the waking
hours is renewed and the higher nervous cen-
tres are protected by unconsciousness from the
stream of impressions flowing in from the
organs of sense — in which waste products are
eliminated from the cerebral centres and the
cerebral tissue is recuperated for another period
of activity. This theory regards normal sleep
as the expression of more or less exhaustion of
the cerebral elements. All hypotheses advanced
to account for the precise changes which pro-
duce sleep are unsatisfactory ; the most reason-
able one is that it is probably induced by toxic
material generated by the activity of the cere-
bral cells (Preyer), and that hypnotics act
similarly upon the same elements. Prom this
point of view, sleep and coma, as well as the
action of hypnotics and narcotics, are merely
different degrees of the same condition ; which
is strengthened by the fact that many of the
most efficient hypnotics are also narcotic in
sufficient dosage.

The intimate nature of hypnotic action is as
yet undetermined, but experiments on tre-
phined dogs with large doses of potassium
bromide (Albertoni). and more recently with
gold bromide (Shtcherbak). show that these
agents reduce the excitability of the cortical
motor centres to such a degree that the
strongest electrical stimulation fails to induce



HYPNOTICS



506



an epileptic paroxysm. In some of these ex-
periments the brain was pale, but not so in
others, hence the lessened excitability could
not be attributed to anaemia. It is, however,
still held that slight and gradual ansemia of
the brain is conducive to sleep, as shown by
the well-established utility, in many oases of
insomnia, of hot pediluvia, with cold to the
head and back of the neck.

Insomnia is promoted by anything: which
excites the centres of conscious mentality and
keeps them functionally active, inasmuch as a
torpid condition of these centres is the essential
condition of sleep. The causes of insomnia
are (a) psychical and (6) physical — under the
former head being included all internal causes
not directly dependent on organic conditions or
external excitation, such as emotion, thought,
and worry, for which the pure hypnotics are
generally sufficient. Physical causes include
pain however originating, requiring the re-
moval of its cause or the exhibition of anal-
getics ; cerebral hypermmia from mental over-
work, particularly when conjoined with insuf-
ficient physical exercise, from alcohol and
other toxic agents, excessive heat, arterial de-
generation, acute inflammatory disease, irrita-
tion by tumours, tubercle, etc. ; cerebral anmmia
from haemorrhage, profuse discharges, exhaust-
ing diseases, insuflficient food, ansemio cachexiae,
aortic valvular disease of the heart, etc. ; neu-
roses, such as hysteria, mania, melancholia, and
insanity ; dyspnoea and cough, as in pulmonary
and cardiac disorders. Indigestion, chronic
cystitis, genital irritation, continued fevers,
syphilis, rheumatism, and gout, are productive
of insomnia, as are also most of the maladies
which the human body is liable to.

Hypnosis may be brought about in several
different ways — namely: by removal of any
apparent external cause of insomnia ; by
derivation of the cerebral blood-supply; by
elimination of toxic material, medicinal or
pathological ; by reconstruction, in conditions
of defective nutrition ; by restoration of normal
function, cerebral, pulmonic, cardiac, etc. ; by
suspension of the consciousness of pain; by
lowering cerebral activity until its waste is
repaired. The last two methods, though fre-
quently necessary, are the least desirable,
especially when accomplished by agents which
interfere with elimination, surcharging the
blood with effete or toxic material, or by those
which induce injurious changes in nerve tissue
or in the blood.

The cerebral circulation may be lessened by
contracting its arteries, by lowering the cardiac
action, by expanding the vessels of other parts
of the body, especially the abdominal arteries,
and by depressing the functional activity of
the cerebral cells. The latter may occur as a
result of lessened cerebral circulation, venous
congestion of the brain, or the action of agents
which produce direct depression of the cerebral
cells. The last two are operative factors in the
production of coma.

Hypnotic Pleasures, not medicinal, are
often fully as efficient as hypnotic drugs in
producing sleep. When an external cause of
sleeplessness is known, its removal will usually



be suiHcient to induce sleep. Many persons
have become so adjusted to continuous noises
that the stopping thereof produces insomnia,
and in such cases the renewal of the familiar
sounds will act as a hypnotic. A hot bath acts
derivatively upon congested organs, and may
so distribute the circulation as to relieve dis-
tress and wakefulness caused thereby. Hot
foot- and sitz-baths,' as means of derivation, are
often efficient hypnotic measures, and every
one has experienced the difficulty of obtaining
sleep with the feet cold. A hot abdominal
compress is frequently beneficial as a means of
hypnosis, and the cold wet pack is a derivative
and calmative of high rank. Massage and
electricity, when used with a clear understand-
ing of the condition to be corrected, as can
only occur when they are applied under the
direction of a physician, are valuable deriva-
tives, but if improperly employed may greatly
aggravate the insomnia. Galvanism and frank-
linism have been successfully used in many
cases of obstinate wakefulness, and probably
act by improving the tone of the vessels and
the nutrition of the cerebral tissue. The
range of the usefulness of electricity as a hyp-
notic is, however, almost limited to neuropathic
or neurasthenic cases. The mere stoppage
of cerebral excitants, such as tea and coffee,
from the diet, proves efficacious in many in-
stances.

Medicinal Hypnotics are theoretically in-
dicated only when insomnia is continuous and
therefore dangerous. They should not be
continued for any long period of time lest a
drug habit be formed, which is especially liable
with the narco-hypnotics. To seek for the
cause of wakefulness and remove it is theoret-
ically the best rule of practice, but, like many
other such rules, it is more honoured in the
breach than in the observance, internal causes
being too often conjectural and the exigencies
of practice usually imperative for immediate
results.

The medicinal hypnotics are fully described
under their respective titles throughout this
work, but a brief resumS of the hypnotic action
and uses of the most important agents may be
of value in this place.

Alcohol is a naroo-hypnotic, acting chiefly
by virtue of its narcotic power, but also by its
stimulant action on the circulation in the
insomnia sometimes seen in passive cerebral
hyperaemia. Among the malt beverages, ale is
considered especially hypnotic, the hops which
it contains undoubtedly aiding to produce its
effect. Whisky is more hypnotic than other
spirits, but should be of pure quality, distOled
(not mixed), and the older the better, as new
liquors and those adulterated with the higher
atomic alcohols are excitant and productive
of insomnia. The proper dose of good old
whisky, for one non-habituated to the use of
alcohol, is from 1 to 2 fl. oz., taken in hot water
when retiring to bed. The sleep produced by
alcohol is, however, transient, usually lasting
only two or three hours ; but if a medium dose
of sulphonal (15 grains) is taken at the same
time, the hypnotic action thereof will be about
beginning when that of the alcohol is declining,



507



HYPNOTICS



and a continuous sleep of many hours' duration
will usually follow in suitable eases.

Amylene hydrate, a tertiary alcohol, is a re-
liable hypnotic in doses of from 1 to 1^ drachm
taken in any weak wine or in mucilage and
water. It ranks between chloral and paralde-
hyde, but is safer than the former and more
agreeable than the latter. In its hypnotic dose
its action is expended upon the cerebrum, and
it has no perceptible action on the heart or
respiration and no unpleasant after-effects ;
but very large doses are narcotic also paralyz-
ing to the cardiac and respiratory centres. Von
Mehring used it in sixty cases of insomnia of
the most varied character, in only four of which
it proved ineflBcient. It is an expensive drug
and has not come into general use, though it
may be safely given to children in doses suit-
able to their age.

Bromides are pure hypnotics and the least
objectionable agents for the relief of simple
insomnia or that due to abnormal excitability
of the brain. They are usually efBcient in the
wakefulness caused by severe mental strain,
intense emotion, or worry, and In that of hys-
teria, insanity, hypochondriasis, the night-ter-
ror of children, and mild forms of delirium
tremens. As usually administered for hyp-
notic purposes they are harmless, but if taken
in excessive doses continously for some time
they are apt to produce great mental and mus-
cular depression, acne, hallucinations, and other
serious phenomena of bromism. Bromides
should not be given in anKmic cases, and the
potassium salt should be avoided in all cases
where the heart's action is markedly weak. It
frequently acts well as a hypnotic in febrile af-
fections, and as long as the temperature is high
and the pulse strong it is the most suitable
bromide in such conditions. Sodium bromide
is the best for hypnotic use, being the most
hypnotic and the least toxic of the bromides in
general employment. The dose of either is
from 30 to 40 grains, dissolved in at least 3 oz.
of water, and repeated if necessary at intervals
of two hours. AH bromides should be admin-
istered in free dilution, as they will produce
gastric irritation if given in concentrated solu-
tion.

Cannabis indiea is one of the best hypnotics
in delirium tremens and in the treatment of
the opium habit. It is a narco-hypnotic and
in efficient doses generally produces very de-
cided and unpleasant effects, such as giddiness,
headache, hallucinations, delirium, nausea, dis-
turbances of the circulation, palpitation of the
heart, increased pulse-rate, etc. Large doses
of an active preparation cause a condition of
coma-vigil rather than one of sleep, with de-
cided symptoms of mental alienation. It is a
very unreliable drug, no two samples being
equally active, and individual susceptibility to



Online LibraryFrank Pierce FosterReference-book of practical therapeutics → online text (page 127 of 165)