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action of a drug. Many drugs comprehended under this term have the pro-
perty of profoundly altering the body, especially if it be diseased ; for example,
mercury will, if the patient be suffering from syphilis, generally cause the
absorption of syphilitic exudations, but we do not know how this takes place.
All that can be said about such drugs will be stated under each, for their mode
of action is probably so different that no useful purpose would be served by
considering them together.

Tonic. This is a term even more vague than alterative. So ill-defined
is it that it is advisable never to use it if it can be avoided. As commonly
employed, it means a drug which makes the patient feel in more robust health
than he did before he took it. Obviously this may happen in many ways, such
as, for instance, by improving the digestion or the quality of the blood. [This
definition is evidently inadequate, and none thus far proposed is entirely sat-
isfactory. The following is suggested (Wood) : A drug which so influences
nutrition as to increase the reconstruction or upbuilding of the tissue or tissues


(All the substances about to be described are pharmacopoeial unless the con-
trary is stated. )



Aqua, Hydrogenii Dioxidum, Oxygenium.

I. AQUA, [Water, H 2 O=I7.96. Natural water in its purest attainable

CHARACTERS. A colorless, limpid liquid, without odor or tasle at ordi-
nary temperature, and remaining odorless while being heated to boiling.

II. AQUA DESTILLATA. Distilled water, ^0=17.96.
SOURCE. Take 1000 volumes of water, distill from a suitable apparatus

provided with a block tin or glass condenser, reject the first loo volumes,
which contain volatile impurities, and preserve the next 800 in glass- stoppered
bottles, rinsed with hot distilled water immediately before being filled.

CHARACTERS. A colorless, limpid liquid, without odor or taste, and per-
fectly neutral to litmus paper.

TESTS. Evaporated in a clean glass capsule on a water bath, no residue
should remain. It is not affected by Hydrogen or Ammonium Sulphide
(absence of metallic impurities), Ammonium Oxalate (Calcium'), Silver Nitrate
(Chlorides), Barium Chloride (Sulphates), or Mercuric Chloride (Ammonia),
nor should its transparency be affected when mixed with twice its volume of
Calcic Hydrate test solution (absence of Carbon Dioxide). In heating to
boiling and acidulating with diluted Sulphuric Acid and adding a one-tenth
of one per cent, solution of Potassium Permanganate, the color produced is
not entirely destroyed by boiling five minutes nor by afterwards setting the
vessel aside, well covered, for ten hours (absence of organic or other oxidizable
matters)\. Aqua Destillata is always to be used for making up prescriptions.

WATER. 117


External. An indifferent bath (88 98 F.) [31.1
36.6 C.] , or one in which the bather feels neither hot nor cold,
produces no particular effect.

Cold baths increase the production of heat, and abstract heat
from the body if they are prolonged ; therefore, at first the
bodily temperature may rise slightly, but when the loss exceeds
the production it falls. The amount of carbon [dioxide] ex-
pired is increased. The rate of the pulse and respiration at first
rise, but they soon fall. The skin becomes pale, and the con-
dition of goose-skin is seen. After the bath (the duration and
temperature suitable for different persons vary widely) there is a
feeling of warmth and exhilaration, and the cutaneous vessels
dilate, [reaction].

A warm bath, if sufficiently prolonged, may cause a slight rise
of the bodily temperature, the skin becomes red, the pulse and
respiration are more frequent, the amount of urine secreted is
diminished, and after the bath there is profuse perspiration.

Internal. Warm water gives rise to nausea and vomiting ;
hot water, taken in small quantities at frequent intervals, may
check both. Water is quickly absorbed from the stomach, and
very soon afterwards the amount of urine secreted is greatly
increased, and to a less degree the amount of bile, pancreatic
juice, and saliva. Large quantities of fluid should not be drunk
during meal times, as that impairs digestion. If a considerable
amount of water is drunk daily, the amount of urea excreted is
increased, and that of uric acid is diminished. Water not only
washes out the tissues, but apparently renders tissue metamor-
phosis more complete.


External. Cold baths are used for the subsequent exhila-
rating effects, which may be increased by [brisk] rubbing with
a rough towel. Persons in whom a feeling of warmth does not

* Unless otherwise stated, the word action will in this book always be
taken to mean physiological action, or action in health.


immediately follow a cold bath should not use it. The constant
daily use of a cold bath probably diminishes the liability to catch
cold. Cold baths are said to arrest attacks of laryngismus strid-
ulus. They have been largely used to reduce the temperature in
fever, especially typhoid fever. The first effect of putting the
patient in the cold water is to cause, reflexly from the stimulation
of the skin by the cold, an increased production of heat ; for
this reason and because of the cessation of radiation, the rectal
temperature at first rises a little, but soon, owing to the direct
abstraction of heat, and to the diminished production of heat
which quickly sets in, it falls rapidly, and continues to do so
after the patient is taken out. The temperature of a bath for a
patient with typhoid fever should be between 68 and 58 F.
[20 and 14.4 C.]; he should be lowered into it by a sheet,
and remain in ten minutes, unless before that time he shows
signs of collapse ; he is then lifted back to bed, where a blanket
is thrown loosely over him. If this treatment is adopted, the
bath ought to be given whenever the axillary temperature is 103
F. [39.4 C.]. Sometimes the patient is placed in a bath at a
temperature of 10 F. [5.5 C.] below his own, and the water
is cooled by putting in cold water or ice, till it has fallen to
about 68 F. [20 C.], when he is taken out. [Brisk rubbing
of the whole body should be carried out during the bath and the
feet kept warm. Cold baths are no longer used in the treatment
of typhoid fever with the notion that they reduce temperature.
They are useful for the stimulation of the nervous system which
they may pjjssjbjy bring about to some degree and for the
marked diuresis which they produce thus, supposedly, favoring
the elimination of toxins in the urine.] Often, instead of having
a bath, he is sponged with cold water as he lies in bed ; this
saves trouble, but both sponging and a cold pack (which con-
sists of a sheet four folds thick, wrung out in cold water and
wrapped round the naked body for five or ten minutes) are in-
ferior to a bath. Pneumonia is often treated by the applica-
tion of cold, generally by means of ice poultices applied to the
chest. To make an ice poultice, put on a piece of [rubber]
tissue a layer of wood wool, then one of powdered ice sprinkled

WATER. 119

with a little salt, turn over the edge of the [rubber tissue]
which has been left wide enough so as to cover in the poultice,
and seal the edges with a little chloroform or turpentine. Put
the poultice in a flannel bag, and bind it on the body when de-
sired, with lint between it and the skin. [The term "poul-
tice ' ' is hardly a proper one to designate this method of apply-
ing cold. See definition of poultice on p. 36.] The immediate
action of very cold baths is far the best treatment for any sudden

Cold is applied locally either by cold water in Leiter's coils
or by ice bags, in a number of conditions, with the object of
arresting inflammation. Thus ice bags are put on the head in
meningitis, or concussion, and on the knee-joint for acute syno-
vitis, etc. According to most authorities, cold contracts not
only the vessels of the skin to which it is applied, but by reflex
action those of the organs underneath it. This explains the ap-
plication of an ice bag to the chest to arrest pulmonary haemor-
rhage. Cold locally applied is, therefore, haemostatic.

Warm baths, as they liquefy the fatty secretions, are more
cleansing than cold. Hot baths, like any other application of
heat, soothe pain ; hence they are useful for rheumatoid ar-
thritis and colic, whether renal, biliary or intestinal. By bring-
ing blood to the skin and lessening the amount in the internal
organs, they relieve muscular spasm, such as we find in
[spasmodic] stricture of the urethra, colic, laryngismus stridulus,
other forms of laryngeal spasm, and infantile convulsions. In
the same way they are of service in weariness from muscular or
cerebral activity, and are useful in many inflammatory affections ;
as, for example, a cold in the head. A warm bath immediately
before going to bed may sometimes cure insomnia. [The prac-
tice in asylums for the insane is to give a hot bath (104 F. ;
40 C.) as a remedy for sleeplessness.] The subsequent in-
creased perspiration makes hot baths and hot packs of great
value in the various forms of nephritis and in uraemia. Great
care must be taken, after a hot bath which has been given to
induce sweating, to see that the patient is kept warm by being
wrapped quickly in a hot blanket and put into a warm bed ; if


not, the cutaneous vessels soon contract, and there is no diapho-
resis. A local hot bath has the same effects, but to a less de-
gree. A hot foot-bath is often used for a cold in the head, or
for amenorrhoea. Sponging with hot water will, by the vascular
dilatation and sweating it causes, reduce the temperature slightly
in fever.

A cold bath is one the temperature of which is below 70 F.
[21 C.], one between 88 and 98 F. [31.1 and 36.6 C.] is
properly speaking indifferent, but it is often called a warm bath.
A tepid bath is intermediate between warm and cold. Anything
above 98 F. [36.6 C.] is a hot bath. Few people can bear a
temperature much over 102 F. [38.9 C.].

Internal. The chief therapeutic use of water is to wash out
the tissues, especially the kidneys, and to keep the urine diluted.
Some persons who are liable to the formation of gravel or urin-
ary calculi can, by drinking plenty of pure water, prevent their
formation, for the minute collection of crystals which are the
beginning of all calculi, are washed out of the ordinary system
before they have time to grow to any size, and if they are com-
posed of uric acid, the copious drinking of water diminishes the
liability of their formation, for it dgfirgggps thp amount of uric
acid exyreted. The liability to the formation of gall-stones may
also be kept in check by the drinking of plenty of water, [since]
then the bile becomes less concentrated and flows more quickly.
When large quantities of water are drunk it should be p_ure dis-
tilled water, and should be taken between meals. A glass of cold
water taken on rising in the morning will with some persons cause
the bowels to be opened. Warm water is an emetic.*

Dioxide. Synonym. Solution of Hydrogen Peroxide.

A slightly acid, aqueous solution of Hydrogen Dioxide (H 2 O, = 33.92),
containing, when freshly prepared, about 3 per cent., by weight, of the pure
Dioxide, corresponding to about ten volumes of available oxygen.

SOURCE. By solution of Barium Dioxide, 300 ; in cold distilled water

* It is impossible in this book to give more than a brief sketch of baths
and the drinking of water and mineral waters. Further information will be
found in works on " General Therapeutics."


500, and refrigeration to 50 F. ; 10 C. Phosphoric Acid, 96 ; is dissolved in
distilled water 320. The magma is added to the latter solution and thoroughly
mixed, being kept acid by Phosphoric Acid. Filter and wash with distilled
water. Add diluted Sulphuric Acid to the nitrate, and starch, 10 ; by agita-
tion. Filter and re- filter until a clear solution is obtained. The bottle should
be kept tightly corked.

CHARACTERS. A colorless liquid, without odor, slightly acidulous to the
taste, and producing a peculiar sensation and soapy froth in the mouth ; liable
to deterioriate by age, exposure to heat, or protracted agitation. Sp. gr. : about
1. 006 to I.OI2.

Dose, i to 3 fl. dr. ; 4 to 12 c.c.


Hydrogen dioxide readily yields oxygen to all oxidizable
substances. When taken internally it gives oxygen to the blood,
stimulates the nervous system and increases urinary secretion. It
is a non-poisonous antiseptic, destroying organized fermentations
and liberating oxygen. It decomposes pus and probably destroys
the microbes of suppuration.


Hydrogen dioxide seems to have a favorable action in some
forms of dyspepsia, and to improve digestion. In diphtheria it is
useful as a cleansing agent and to absorb false membranes, but
should be used in glass or hard rubber instruments. Some com-
mercial preparations are very acid, and therefore too irritating
for this purpose. This acidity can be neutralized by adding
twice its quantity of lime water. It will check bleeding, but from
small vessels only. It is of great value in cleansing wounds, ulcers
and fistulous tracts, and for surgical dressings ; the cessation of
frothing indicates the destruction of pus. But the converse of
this is not true, for it will froth with perfectly normal blood. It
should not be injected into a suppurating cavity unless there is
a free outlet for the escape of the gas which is formed. Its most
popular use is for bleaching the hair.] Internally it has been
recommended for many diseases, especially diabetes, epilepsy,
and uraemia, but there is no proof of its efficacy. It is danger-
ous when given subcutaneously, for it is broken up by the blood ;
and if more oxygen is formed than the blood can dispose of,


gas emboli are produced, and, these lodging in the lungs, cause
death from asphyxia.

IV. [OXYGENIUM, Oxygen (not official) O = 15.96.

SOURCE. By exposing manganese dioxide with potassium chlorate to a
strong heat. KC1O, = KC1 -f O y

CHARACTERS. A colorless, odorless gas, slightly soluble in water and
alcohol. ]

Compressed oxygen gas is sold in [metallic] cylinders.


Oxygen inhalations are used in pneumonia, bronchitis, heart
disease, convulsions, and any other condition accompanied by
great lividity. This they will often relieve, and they may help
a patient to tide over a temporary risk of death from asphyxia,
and even if they fail to avert death, they often render the end
less distressing. The gas should be allowed to issue in a gentle
stream, and the inhaler should not be held too near the patient.
[In various chronic conditions as anaemia, albuminuria, glycosuria
and various forms of sub -oxidation, the persistent use of oxygen
has given excellent results.]



Potassium, Sodium, Ammonium, Lithium.

K = [39-03-

I. POTASSA. KOH = 55.99. Synonyms. Potassium Hydrate. Po-
tassium Hydroxide. Caustic Potash.

SOURCE. Evaporate Liquor Potassae, fuse the residue and pour into clean
cylindrical moulds which have been previously warmed.

CHARACTERS. Dry, white, translucent pencils, or fused masses, hard and
brittle, showing a crystalline fracture ; odorless, or having a faint odor of lye,
and of a very acrid and caustic taste. Great caution is necessary in tasting and
handling it, as it rapidly destroys organic tissues. Exposed to the air, it rapidly


absorbs Carbon Dioxide and moisture, and deliquesces. Solubilit ^-In about
0.5 part of water and in 2 parts of alcohol.

IMPURITIES. Organic matter, arsenic, lead, iron, soda, aluminum, cal-
cium, chlorides, sulphates, silicates, carbonates, and nitrates.


x. Liquor Potassae. Solution of Potassa. Synonym. Solution of Potas-
sium Hydrate. An aqueous solution of Potassium Hydrate (KOH =55.99),
containing about 5 per cent, of the hydrate.

SOURCE. Dissolve Potassium Bicarbonate in distilled water ; slake Lime,
dissolve in distilled water and boil, add this to the first solution, continue to
boil, strain when cold ; when it has become clear from subsidence, decant or
siphon off the clear solution. K 2 CO 3 + Ca(OH ) 2 = 2KOH + CaCO 3 . Or it
may be prepared from a solution of Potassa, 56 parts of the full strength, di-
rected by the U. S. P. (90 per cent. ), in distilled water (944 parts).

CHARACTERS. A clear colorless liquid, odorless, having a very acrid and
caustic taste, and a strong alkaline reaction. Sp. gr. about 1.036.

IMPURITIES. See Potassa.]

INCOMPATIBLES. Acids, acid salts, metallic salts and preparations of am-
monia, belladonna, hyoscyamus and stramonium, the alkaloids of these three
being decomposed by caustic potash. All alkaloids are precipitated by

Dose, 5 to 30 m. ; [.30 to 2.00 c.c.], freely diluted.

2. Potassa cum Calce. [Potassa with Lime. Synonyms. Vienna
Caustic. Vienna Paste. Potassa, 500 ; Lime, 500. Rubbed together in a
warm, iron mortar.

CHARACTERS. A grayish-white powder, deliquescent, having a strongly
alkaline reaction, and responding to the tests for Calcium and Potassium.
Solubility. In diluted hydrochloric acid without leaving more than a small
residue. ]


External. It is, if concentrated, a powerful irritant and
caustic, acting by abstracting water from the part to which it is
applied. It dissolves fatty matters that may be present on the
surface. It is antacid, and, if freely diluted, sedative.

Internal. Mouth. As alkalies check alkaline secretions,
potash momentarily checks the secretion of saliva.

Stomach. Because alkalies stimulate acid secretions, the flow
of gastric juice is excited, if alkalies are given before a meal,
but if at the end of or after a meal the gastric juice already


secreted is neutralized. Being readily diffusible, alkalies are
quickly absorbed.

Blood. This is rendered more alkaline. Probably all alkalies
circulate in the blood as carbonates, but their action as alkalizers
of the blood is very transitory, for they are quickly excreted.
The amount of haemoglobin, if it is deficient, is said to be in-
creased. The continual use of alkalies diminishes the quantity
of fat.

Heart. Large amounts of potassium salts are depressant
to all muscular tissues, and therefore decrease the force of the
heart, ultimately causing diastolic arrest by direct action on the
cardiac muscle.

Kidney. Potassium salts are diuretic, acting directly on the
renal epithelium. They are quickly excreted in the urine, ren-
dering it alkaline, and thus increasing its power of holding uric
acid in solution.

Respiratory passages. The bronchial secretion is increased
in quantity, and it is rendered less viscid, but in some cases of
bronchitis it is diminished.

Muscle. The prolonged contraction produced by veratrine,
or barium salts, is abolished by potassium salts. They are direct
muscular depressants, and depress also the nervous system,
especially the brain and spinal cord.

Metabolism. Potassium salts, like all alkalies, if given in
large doses, increase metabolism, leading to a greater oxidation
of proteids and fats.


External. Caustic potash is used to destroy lupus, and it
was formerly employed to make issues. Care must be taken to
limit its action, for it diffuses very rapidly. Liquor potassae is
used to dissolve off the fatty matters and thoroughly cleanse the
skin before operations, and weaker solutions of it are employed
to remove the epidermis in certain chronic skin diseases. A 40
per cent, solution is recommended to remove an ingrowing toe-
nail, which is painted with the fluid, and in a few seconds is so
softened that much can be scraped off. The procedure is


repeated till the nail that remains is sufficiently thin to be re-
moved with a pair of fine scissors. Dilute solutions, acting as
sedatives, relieve itching.

Internal. To obtain the effects of alkalies upon internal
organs, potassium bicarbonate, citrate and acetate are preferable
to potash, for that is apt to irritate the stomach ; but it is occa-
sionally used in small doses as a gastric sedative for dyspepsia.

Toxicology. See Soda, p. 139.

2. POTASSII CARBON AS. [Potassium Carbonate. K,CO,==
137.91.] Synonym. Salt of Tartar.

SOURCE. Pearlash, which is a product of the lixiviation of wood ashes, is
treated with water, which dissolves little but potassium carbonate, and the
solution is evaporated.

CHARACTERS. A white, [granular powder, odorless, having a very strong
alkaline taste ; very deliquescent. Solubility. In 1. 1 parts of water, and in
0.65 part of boiling water; insoluble in alcohol.

IMPURITIES. Sulphates, chlorides, nitrates, cyanides, earthy and metallic

Potassium Carbonate is used in preparing Mistura Ferri Composita,
Pilulae Ferri Carbonatis (in which Ferrous Carbonate is formed), and Potassa

Dose, 5 to 30 gr. ; .30 to 2.00 gm.]


These are the same as those of potash ; but the carbonate is
less caustic.

3. POTASSII BICARBONAS. [Potassium Bicarbonate. KHCO,
= 99.88.

SOURCE. Pass Carbon Dioxide] through a solution of Potassium Car-
bonate, and let the bicarbonate crystallize out. K 2 CO 3 -j- CO, -f- H,O =
2KHCO 3 .

CHARACTERS. [Colorless, transparent, monoclinic prisms, odorless, and
having a saline and slightly alkaline taste. Permanent in the air. Solubility.
In 3.2 parts of water ; almost insoluble in Alcohol.

IMPURITIES. The carbonate, chlorides, and iron.

Potassium Bicarbonate is used in preparing Liquor Potassii Arsenitis,
Liquor Potassii Citratis, and Potassii Citras Effervescens.

Dose, 5 to 60 gr. ; .30 to 4.00 gm.]



Potassium bicarbonate is too feebly caustic to be of any use
for this purpose. Otherwise its actions are those of potash.


Stomach. Potassium bicarbonate may be given before meals
to stimulate the flow of gastric juice ; and as it is a gastric seda-
tive, it is useful in painful dyspepsia accompanied by a scanty
secretion of gastric juice. The increase of the antiseptic acid
secretion is valuable in cases of dyspepsia associated with fer-
mentation in the stomach. It may be taken after meals if too
much acid is secreted, and the patient suffers from acid eruc-
tations, especially if pain be present also ; but it is better treat-
ment to remove the cause of the dyspepsia. It is not a common
remedy for dyspepsia, sodium bicarbonate being usually pre-
ferred. Either is beneficial when much mucus is present, for
this is rendered less viscid by alkalies. It should not be used as
an alkali in cases of poisoning by mineral acids, because of the
evolution of carbon [dioxide,] gas. Bicarbonates are used in
preference to carbonates, as the latter are far too strongly
alkaline for the stomach. Potash water is often drunk as an
effervescing water instead of soda water. It should be a [half
of a one per cent.] solution of potassium bicarbonate in water,
into which [carbon dioxide] gas under a pressure of four atmos-
pheres has been passed.

Blood. Potassium bicarbonate circulates in the blood as the
carbonate. It was formerly much used in rheumatic fever, but
is now superseded by the salicylates. Probably it did no good.
In gout it is given to increase the alkalinity of the blood, which
contains an excess of uric acid, but there is no evidence that it
benefits gout, and the many alkaline mineral waters used for this
disease are efficacious because they dilute the plasma, and so ren-
der it more capable of holding uric acid in solution. Potassium
bicarbonate is believed to be haematinic, that is to say, it is
thought to increase the amount of haemoglobin ; but as for this


purpose it is usually given with iron, its haematinic power has
not yet been proved.

Kidneys, It is not much used for its diuretic effect and its
alkalizing power over the urine, as the vegetable salts are prefer-

4. POTASSII ACETAS. [Potassium Acetate. KC 2 H 3 O 2 = 97.89.
SOURCE. Add Acetic Acid in excess to Potassium Carbonate or Bicarbon-

Online LibraryWilliam Hale-WhiteMateria medica, pharmacy, pharmacology and therapeutics → online text (page 10 of 67)