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washing with ether. [The same objections apply to this, and
the following as to ether, for the production of local anaesthesia.
(See p. 300).]

Methyl chloride is used in the same way to produce local
anaesthesia and to relieve the pain of neuralgia, etc. The vapor
is allowed to play obliquely on the skin for four or five seconds.

CLASS III. Drugs which Dilate Blood-Vessels.

Sodium Nitrite, Amyl Nitrite, Glonoin and Erythrol
Nitrate.

All these dilate the peripheral vessels, and increase the rapidity of the heart.

I. SODII NITRIS.

SODIUM NITRITE. NaNO 2 [=68.93.]

SOURCE. Made by heating Sodium Nitrate with Lead, which becomes an
oxide, taking Oxygen from the nitrate. [NaNO 3 -fPb=NaNO 2 -|-PbO.

CHARACTERS. White, opaque, fused masses, usually in the form of pen-
cils, or colorless, transparent, hexagonal crystals ; odorless, and having a mild,
saline taste. When exposed to the air, the salt deliquesces and is gradually
oxidized to Sodium Nitrate. Solubility. In about 1.5 parts of water ; slightly
soluble in Alcohol.]

Dose, 2 to 5 gr. ; [.12 to .30 gm.]



304 INORGANIC MATERIA MEDICA.

Preparation.

Spiritus Athens Nitrosi. [Spirit of Nitrous Ether. Synonym.
Sweet Spirit of Nitre.

An Alcoholic Solution of Ethyl Nitrite (C,H 5 NO,=74.87), yield-
ing, when freshly prepared, not less than 1 1 times its own volume of
Nitrogen Dioxide. In many commercial specimens there is very little
Ethyl Nitrite.

SOURCE. Dissolve Sodium Nitrite, 750, in water ; adding Deo-
dorized Alcohol, 550; introduce into the containing flask, Sulphuric
Acid, 520 ; previously diluted, and distil. Wash the distillate with ice-
cold water, remove traces of acid by Sodium Carbonate, 10, dissolved
in water ; agitate with Potassium Carbonate to remove all traces of
water, and add sufficient Deodorized Alcohol.

CHARACTERS. A clear, mobile, volatile, inflammable liquid of a
pale yellowish or faintly greenish-yellow tint, having a fragrant, ethe-
real and pungent odor, free from acridity, and a sharp, burning taste.
Sp. gr., 0.836 to 0.842.]

INCOMPATIBLES. Potassium iodide, ferric sulphate, tincture of
guaiacum, gallic and lannic acids, and emulsions.

IMPURITY. Excess of acetic acid.

Dose, YJ, to 2 fl. dr. ; [2. to 8. c.c.]

ACTION OF SODIUM NITRITE AND SPIRIT OF NITROUS ETHER.

External. Spirit of nitrous ether evaporates when it is
applied externally, and a slightly anaesthetic effect is pro-
duced.

Internal. It combines the action of the ether with that of
the nitrites contained in it. Because of the ether it is a dif-
fusible stimulant, a stomachic and a carminative. Be-
cause of the nitrites it acts like amyl nitrite ; but as the ethyl
nitrite is so diluted, its action in this direction is feeble ; thus it
only moderately dilates the vessels, and except in poison-
ous doses probably does not affect the blood. The dilatation of
the vessels leads to a diaphoretic effect on the skin, a diuretic
effect on the kidney, and a lowering of arterial blood-pressure.
The dilatation of the cutaneous vessels, the sweating, and perhaps
the changes of the blood, produce a slight antipyretic influence.
It is obvious that in these effects the nitrites will to some extent
be aided by the ether. [Sodium nitrite possesses the same, but
a more lasting, action as the spirit of nitrous ether.]



CARBON AND ITS COMPOUNDS. 305

THERAPEUTICS OF SODIUM NITRITE AND SPIRIT OF NITROUS

ETHER.

For its diaphoretic and slight antipyretic effects it is com-
monly given in mild febrile attacks, such as a common cold. It
is also used as a diuretic in chronic Bright' s disease, and cardiac
and pulmonary diseases accompanied by oedema [but for these
purposes the sodium nitrite is preferable.]

II. AMYL NITRIS.

[AMYL NITRITE. C 5 H U NO 2 =I 16.78. A liquid containing about
80 per cent, of Amyl (principally Iso-Amyl) Nitrite, together with variable
quantities of undetermined compounds.]

SOURCE. By action of Nitric Acid upon Amylic Alcohol. HNO 3 -f
C 5 H 11 OH^C 5 H 11 NO 2 +2H 2 O. Purify the distillate' with Sodium Carbonate.

CHARACTERS. A clear yellow, or pale-yellow liquid, of a peculiar,
ethereal, fruity odor, and a pungent, aromatic taste. Sp. gr., 0.870 to 0.880.
Solubility. Insoluble in water;] soluble in Ether, Chloroform, or Alcohol.

IMPURITIES. Free acid and amyl nitrate.

Dose, [i to 3 m. ; .06 to .20 c.c.] cautiously inhaled from a handkerchief
in which a glass capsule containing the Amyl Nitrite has been crushed ; \_ l / 2 to
i m. ; .03 to .06 c.c. internally, dissolved in alcohol.]

ACTION OF AMYL NITRITE.

External. Locally applied it diminishes the activity of the
sensory nerves, but they quickly recover.

Internal. Amyl nitrite is rarely given by the mouth, so the
following account will refer to the effects of inhalation. The
effects of a single inhalation pass off in two or three minutes.

Circulation. From the medical point of view by far the most
important effects of amyl nitrite are those produced upon the
heart and vessels. Within a minute of inhalation the face
flushes, the heart beats very rapidly, and violently, there
is a throbbing in the head, and the vessels, e.g., the carotids,
may be seen to pulsate actively. Headache, giddiness, dilatation
of the pupils, and increased respiratory movements quickly super-
vene. All the vessels of the body rapidly dilate, hence the flush-
ing. They may be actually seen to widen in the ear of a rabbit
or in the retina. This is due to a direct action on the muscular
coats of the arterioles, for it happens if the cord is destroyed.



306 INORGANIC MATERIA MEDICA.

The blood-pressure and arterial tension, of course, fall very low.
The increase in the rate of the pulse is unaccompanied by any
alteration in the force of the beat ; it is apparently due to a de-
pressing influence on the inhibitory vagus centre ; [the vaso-motor
paralysis will, however, produce a rapid pulse.] In toxic doses
the heart may be arrested in diastole from direct action on the
cardiac muscle.

Respiration. The rapidity and depth of respiration are at
first increased, probably from central stimulation ; the respiratory
centres are later depressed, the breathing becoming slower and
shallower, and usually death finally occurs from paralytic asphyxia
of central origin.

Nervous system. Many of the symptoms referable to the ner-
vous system are secondary effects of the dilatation of the vessels
of the brain and spinal cord. Such are the throbbing, sense of
fulness, giddiness and headach^ noticed directly after inhalation.
The headache may remain some time. If much has been inhaled
there is unsteadiness of gait and general restlessness. The pupil
dilates, and disturbances of vision are present. The motor cen-
tres of the cord are profoundly depressed ; therefore after large
doses reflex actions are abolished. The function of sensory nerves,
motor nerves, and muscles is depressed by the local application
of the drug to them, but not after inhalation until shortly before
death.

Temperature. Amyl nitrite causes this to fall considerably,
both in fever and health. The fall is due to the peripheral vas-
cular dilatation, and if large doses are given, to the changes in
the blood.

Urine. The drug probably escapes in the urine as nitrites
and nitrates ; it is slightly diuretic, and may cause glycosuria,
due, it is said, to dilatation of the vessels of the liver or of the
medulla.

Blood. Nitrites, given in medicinal doses, circulate as sodium
nitrite. Outside the body they greatly diminish oxidation, and
the same takes place in the blood. After the inhalation of a
considerable amount (more than is usually given to a man) the
arterial and venous blood both becom^ a uniform chocolate color.



CARBON AND ITS COMPOUNDS. 3O/

This is due to the formation of methsemoglobin and another body,
nitric oxide haemoglobin. The haemoglobin can no longer ab-
sorb oxygen, and hence its oxidizing power is abolished. It is
by this action on the blood that, in man, nitrites kill, not by
their vaso-dilator action ; therefore the treatment for poisoning
by them is inhalation of oxygen, that more may be dissolved in
the plasma. In some of the lower animals they kill by acting
as a direct poison to animal tissues.

THERAPEUTICS OF AMYL NITRITE.

Heart and blood-vessels. Brunton in 1867 observed that in a
[patient suffering from] angina pectoris the peripheral vessels
were strongly contracted during an attack of pain. This induced
him to make the patient inhale amyl nitrite, and it was found
that the vessels dilated and the pain passed off. Inhalation of
amyl nitrite is now used for all sorts of cardiac pain, especially
when it comes on in paryoxysms. Generally the drug affords re-
lief in a minute or so after inhalation, but by no means always.
We do not sufficiently understand the pathology of angina pec-
toris to know how it acts. It may be by dilating the peripheral
vessels ; but against that view is the fact that they are not always
contracted during attacks of angina pectoris, and amyl nitrite
may relieve patients in whom the vessels are not contracted.
The attacks of pain common in thoracic aneurism may be re-
lieved by it. It is used to avert the dangerous pallor sometimes
seen during the administration of chloroform, and may be in-
haled for other forms of syncope. The peculiar hot flushes ex-
perienced by some women during the menopause are benefited by
inhalation of it ; [this is probably untrue.]

Nervous system. If it is inhaled when the aura is felt, an
epileptic fit may sometimes be prevented, and it has also been
found useful during the status epilepticus. Because in migraine
the vessels of the head are contracted, it has been used, and
sometimes successfully, for this complaint. Its depressing action
on the cord has suggested its employment in tetanus and strych-
nine poisoning.

Occasionally the inhalation of amyl nitrite relieves an attack



308 INORGANIC MATERIA MEDICA.

of asthma. It has been given in whooping-cough, sea sickness
and cholera, but without much good effect.

III. [GLONOINUM.

SPIRITUS GLONOINI. Spirit of Glonoin. Synonym. Spirit of
Nitroglycerin. An alcoholic solution of Glonoin, Glyceryl (or Propenyl)
trinitrate, Nitroglycerin, or Trinitrin ; C 3 H 5 (NO 3 ) 3 =226.58, containing I per
cent., by weight, of the substance.

SOURCE. Nitroglycerin is prepared by gradually adding dehydrated
Glycerin to Nitric and strong Sulphuric Acid, the result being Propenyl tri-
nitrate or Trinitroglycerin. C 3 H 5 (OH) 3 -f3HNO 3 =:C 3 H 5 (NCV 3 +3H. ! O. It
separates as an oily layer which is washed with water and with dilute soda so-
lution to remove all acid.

CHARACTERS. A clear, colorless liquid, possessing the odor and taste of
Alcohol. Caution should be exercised in tasting it, since even a small quan-
tity of it is liable to produce a violent headache. The same effect is produced
when it is freely applied to the skin. Sp. gr., 0.826 to 0.832.

Dose, i to 3 m. ; .06 to .20 c.c.J

ACTION AND THERAPEUTICS OF GLONOIN.

Its action is the same as that of amyl nitrite, except that in
many animals, and probably in man, large doses do not form
methasmoglobin in the blood; the effects of [spirit of] glonoin are
more persistent, and as it is only suitable for internal ad-
ministration, they are slower in their onset. It is largely taken
by persons liable to cardiac pains with the object of warding off
the attack, and often such persons require and bear large doses.
[Its most important use is for the relief of symptoms associated
with the high tension pulse of chronic renal degeneration.
Here the dose should be rapidly increased until relief is ob-
tained.] Occasionally it does good in asthma. It is really a
glycerin nitrate, but certainly physiologically it belongs to the
class of nitrites ; therefore, probably, directly it gets into the
body sodium nitrite is formed.

IV. ERYTHROL NITRATE.

ERYTHROL NITRAS. Erythrol Nitrate (not official), t(CH,ONO,)
2(CHO.NO,),=28l.44.] Synonym. Erythrol Tetranitrate.
[SOURCE. By the nitration of Erythrite (C 4 H 6 (OH 4 ).]



CARBON AND ITS COMPOUNDS. 309

CHARACTERS. Hard, colorless, acicular crystals. Solubility. Insoluble
in water ; in 60 [parts] Absolute Alcohol.
Dose, y 2 to i gr. ; .03 to .06 gm.]

ACTION AND USES OF ERYTHROL NITRATE.

Erythrol nitrate has the same action as nitrites. It is less
powerful than amyl nitrite and nitroglycerin. It is best given
in chocolate tablets, and, as its action is slow, it is the best of
this group for [the relief of some symptoms of] Bright's disease.

CLASS IV. The Hypnotics.
Chloral and Paraldehyde.

[Besides these the following drugs are considered : Butyl-Chloral Hydrate
Chloralamide, Chloretone, Chloralose, Amylene Hydrate, Sulphonal, Trional
and Urethane; none of which are official].

I. CHLORAL.

CHLORAL. C 2 HCl 3 O+H 2 O[=i64.97. Synonym. Chlora Hydrate.

SOURCE. Absolute Alcohol is saturated with dry Chlorine ; Aldehyde and
Hydrochloric Acid are first formed. C 2 H 5 OH-fCl 2 =C 2 H 4 O-|-2HCl. By
the continued action of the Chlorine Gas 3 atoms of Hydrogen are abstracted
from the Aldehyde and replaced by 3 atoms of Chlorine, producing Chloral.
C 2 H 4 O+3Cl=C !! HCl 3 O-(-3HCl. It is purified by Sulphuric Acid, and after-
wards by Lime.

CHARACTERS. Separate, rhomboidal, colorless and transparent crystals,
having an aromatic, penetrating and slightly acid odor, and a bitterish, caustic
taste. Easily melted by gentle heat. Solubility. Freely in water, Alcohol
and Ether. ] Forms a liquid when rubbed up with an equal weight of camphor.

INCOMPATIBLES. All alkalies decompose it.

IMPURITIES. Hydrochloric Acid and oily impurities.

Dose, 5 to 20 gr. ; [.30 to 1.20 gm.]

[The U. S. P. is in error in naming the crystalline product, as above de-
scribed, chloral ; it is actually chloral hydrate, for the molecule of water is
necessary for crystallization. Chloral really is an oily liquid. Whenever
chloral is mentioned in this book, chloral hydrate is intended.]

ACTION OF CHLORAL.

External. It is a powerful antiseptic. Locally applied
it is irritant, causing vesication. [Chloral rubbed up with equal
parts of menthol and camphor is a local anodyne.]

Internal. Alimentary canal. Unless diluted, chloral is a



3IO INORGANIC MATERIA MEDICA.

gastric irritant ; large doses, therefore, may give rise to vomiting
and purging.

Blood. It is readily absorbed, and circulates in the blood
unchanged. It was formerly thought that as alkalies convert it
into chloroform and formic acid, this change would take place in
the blood, and consequently Liebreich suggested its use as an
hypnotic. It is now known that this view is wrong, for no chlo-
roform can be found in the blood of chloralized animals, nor in
the urine unless that fluid is alkaline, in which case chloral is
decomposed by the alkali in the urine.

Circulation. Chloral depresses the heart, large doses
having this action to a considerable degree. This is due to a
local effect on the organ itself; probably both the muscular sub-
stance and the nerves contained in it are affected. The pulse,
which may at first be slightly quickened, soon becomes slow,
feeble, and irregular, and the heart finally stops in diastole. The
vaso-motor centre is depressed, and consequently the ves-
sels dilate. As a result of these actions on the heart and the
vessels the blood-pressure falls.

Respiration. After large doses the respirations become slow
and full, and after toxic doses they become irregular and shallow
before finally ceasing. This is due to the action of chloral on
the respiratory centre.

Temperature. Large doses cause this to fall, probably by
diminishing the production of heat.

Brain. Chloral is a powerful hypnotic, acting directly
on the brain. The stage of excitation, if it exists, is very short.
Soon after taking a moderate dose the patient is overcome by
sleep, which lasts several hours, and is indistinguishable from
natural sleep. On waking there is neither confusion nor head-
ache, and he feels refreshed. Large doses produce coma. The
pupil is always contracted.

Spinal cord. At first the anterior cornua may be slightly
stimulated, but soon they are depressed, and there is consequently
paralysis and loss of reflex excitability. The motor nerves and
the muscles are not affected, nor are the sensory nerves unless the
dose is very large, when there may be anaesthesia.



CARBON AND ITS COMPOUNDS. 3!!

It will be observed that chloral is a powerful general de-
pressant, chiefly of the cerebrum, but also of the respiratory
centre, the vaso-motor centre, the anterior cornua, of the produc-
tion of heat, and the heart. It is only because it depresses the
cerebrum much earlier than any other part of the body that we
can use it as an hypnotic.

THERAPEUTICS OF CHLORAL.

External. The compound with camphor [equal weights of
camphor and chloral rubbed together to form a liquid] has been
employed as a local anodyne for neuralgia, and may be applied
to aching teeth. [To this menthol can be advantageously added.]

Internal. Chloral is largely used for its hypnotic effect.
Its great advantages over many other hypnotics are that doses
sufficient to produce a deep sleep are not large enough to cause
gastro-intestinal irritation, cardiac and respiratory depression,
and the other harmful effects. Chloral is certain in its action
[in that] it quickly produces sleep ; and there are [usually] no
bad after-effects. [Chloral is far from being a safe hypnotic ; it
depresses the heart so markedly that the prescriber should be
always upon his guard.] -Children take it well. [Its unpleasant
taste can be concealed by administration in bottled "lemon
soda."]

It is especially useful in simple insomnia from overwork,
worry, etc. Its disadvantages are that it does not relieve pain at
all, and it should therefore not be used for insomnia due to this
cause ; and that, as it depresses the heart and respiration, it must
be given carefully in diseases of the heart and lungs, and also
when the stomach or intestines are diseased, as it may irritate
these structures. In febrile insomnia it is very valuable in the
early stages, but must be given cautiously, later, when there is any
danger of cardiac weakness. It does not relieve the distress and
cough of disease of the heart and lungs. It has been used as a
cerebral depressant in delirium tremens, puerperal convulsions,
and mania, but very large doses are required, and consequently
the results must be watched with great care. [A very important
use of chloral is in midwifery ; here it has been designated the



312 INORGANIC MATERIA MEDICA.

medicinal forceps. Frequently after rest has been obtained by
this drug, labor proceeds vigorously and is rapidly terminated.]

From its action on the spinal cord, chloral has been used, and
sometimes with success, in tetanus, whooping-cough, inconti-
nence of urine and strychnine poisoning.

[Hypnal is a compound of chloral with antipyrin, made by
mixing their solutions, and is obtained in crystalline form. It was
proposed by Bardet as a hypnotic, more certain than chloral,
nearly free from taste, entirely free from irritating effect upon
the mucous membranes, and having distinct analgesic effects. It
has been but little used. The dose is about 15 gr. ; i.oo gm.]

TOXICOLOGY.

Acute Poisoning. As will be inferred from the action of chloral, the
symptoms of poisoning by it [closely resemble those of opium. They] are
deep coma ; a weak, feeble, irregular, slow pulse, which may become quick
before death ; diminished frequency of respiration and consequent lividity ;
and abolition of reflex movements. The surface of the skin is cold, and the
temperature is subnormal. [The pulse should always be carefully watched
whenever chloral has been administered. It frequently happens that symp-
toms of failing heart come on unexpectedly even after small doses.]

Treatment, Give emetics (see p. 139) or wash out the stomach. Keep up
the temperature by hot bottles, hot blankets, friction and massage. Prevent
sleep by the injection of hot, strong coffee into the rectum, shouting at the
patient, hitting him, flapping with wet towels, bathing, etc. Give a subcu-
taneous injection of strychnine, because of its stimulant action on the anterior
cornua. Use inhalations of amyl nitrite to stimulate the heart, and artificial
respiration if necessary.

Chronic Poisoning. The taking of chloral is a vice to which many per-
sons are addicted. A craving for it is soon established. The chief symptoms
of chronic chloral poisoning are gastro-intestinal irritation, a great liability to
erythematous eruptions, dyspnoea dependent upon the cardiac and respiratory
depression and general weakness. There may be disturbance of the mental
equilibrium, and persons have been known to become permanently weak-
minded. A slightly larger dose than usual may be quickly fatal.

II. BUTYL-CHLORAL HYDRAS.

BUTYL-CHLORAL HYDRATE. [B. P., not official]. C 4 H 5 C1 S
O-|-HjO=[i92.9i.] Synonym. Croton Chloral Hydrate. (This is a mis-
nomer. )

SOURCE. Dry Chlorine Gas is passed through Aldehyde. Butyl-chloral
(C 4 H 6 CI 8 O) is formed. It is separated by fractional distillation, and water is
added.



CARBON AND ITS COMPOUNDS. 313

CHARACTERS. Pearly-white, crystalline scales, with a nauseous taste and
a pungent odor like chloral. Solubility. In 50 parts of water; freely in Al-
cohol and Glycerin.

INCOMPATIBLE^. All alkalies.

Dose, 5 to 20 gr. ; [.30 to 1.20 gm.]

ACTION AND THERAPEUTICS OF BUTYL-CHLORAL HYDRATE.

The action of this drug is exactly similar to that of chloral,
but butyl-chloral hydrate is less certain in its effects. It is said
to be less depressant to the heart, but this is doubtful. It has a
specific action in relieving neuralgia of the fifth nerve.

III. CHLORAL, [FORMAMIDATUM.

CHLORAL FORMAMIDE. (Not official. ) CC1 3 CH.OH.CONH.,
=191.95. Synonym. Chloralamide.

SOURCE. By the combination of Chloral and Formamide. CCljCHO-f-
CHONH 2 =CC1 3 CH.OH.CONH 2 .]

CHARACTERS. Shining colorless crystals, [without odor and of a slightly
bitter taste. Solubility. Slowly, in about 20 parts of water, in 1.5 parts of
Alcohol, and in weak acid solutions. It should not be heated over 140 F. ;
60 C. , or mixed with alkalies, for, in either case, it decomposes into Chloral.

Dose, 10 to 30 gr. ; .60 to 2.00 gm.]

ACTION AND THERAPEUTICS OF CHLORALAMIDE.

Chloralamide is an excellent hypnotic, producing calm, re-
freshing sleep without any bad after-effects. Frequent use does
not necessitate an increased dose, nor, as far as known, is any
habit contracted. It does not relieve pain, but is equally service-
able for all varieties of insomnia, unless due to pain. If possible
it should not be given as a powder, for it is then so very slowly
absorbed that probably some of it is decomposed in the intes-
tines or stomach ; [very rarely] , when powdered chloralamide
has been administered in the evening, the patient has not slept
during the night, but has slept all the next day, because the drug
has been so slowly absorbed. The best way to give it is to dis-
solve it in a little alcohol. The patient may be told to dissolve
20 gr. ; [1.20 gm.] or more, in sufficient brandy, to add water
not above 130 F. ; 54.4 C., and drink it before going to bed.
Some specimens are very insoluble, and must be suspended. It
is said that 10 minims [.60 c.c.] of aromatic sulphuric acid added



314 INORGANIC MATERIA MEDICA.

to i fl. oz. ; [30 c.c.] of water will dissolve 30 gr. ; [2 gm.] of
chloralamide, but this is not always true. It acts if given as an
enema. Fifteen grains [i.oo gm.] of potassium bromide and
chloralamide, flavored with tincture of orange [peel] and chloro-
form water has been strongly recommended for insomnia and for
sea-sickness. This mixture resembles a proprietary preparation
called Chlorobrom.

IV. [CHLORETONUM.

CHLORETONE: (Not official. ) Synonyms. Trichlor-tertiary Butyl
Alcohol. Acetone-Chloroform.

SOURCE. From equal weights of Acetoae and Chloroform when Caustic
Potash is added.

CHARACTERS. A white crystalline powder having a camphoraceous odor.
Solubility. Sparingly in water ; very soluble in Chloroform, Alcohol and Ether.

Dose, 5 to 20 gr. ; .30 to 1.20 gm.

ACTION OF CHLORETONE.

Without markedly influencing respiration or blood -pressure it
produces anaesthesia and sleep. It directly affects sensory nerves,
and so may be used as a local anaesthetic. If the dose by the
mouth is excessive dogs may sleep for several days, finally suc-
cumbing from asphyxia. Since neither acetone nor chloroform
are found in the expired air or the urine, and the chlorides are



Online LibraryWilliam Hale-WhiteMateria medica, pharmacy, pharmacology and therapeutics → online text (page 27 of 67)