William Hale-White.

Materia medica, pharmacy, pharmacology and therapeutics online

. (page 29 of 67)
Online LibraryWilliam Hale-WhiteMateria medica, pharmacy, pharmacology and therapeutics → online text (page 29 of 67)
Font size
QR-code for this ebook

it was soon abandoned because of the dangerous collapse with
marked cyanosis which it produced. It is rarely given inter-
nally, because it is poisonous to the red blood corpuscles and to
the nervous system. Its chief use is as an injection for gonor-
rhoea, in aqueous solution (i or 2 to 120), or it can be used in
a 2 per cent, solution in gelatin bougies. In gleet beneficial re-
sults have followed the injection of i to 8 aqueous solutions.


C 19 H 27 NO 4 Ha-fH 2 O=386.6i. The hydrochlorate of a synthetic alkaloid
having a close chemical relationship to cocaine.

SOURCE. By the action of one molecule of ammonia upon three molecules
of acetone, triacetonamine is formed. This is then transformed into triacetona-
mencyanhydrine by hydrocyanic acid. This compound when saponified be-
comes triacetonalkamin carbonic acid, ammonia being given off, when benzy-
lated and methylated trimethylbenzoyhetramethyl y oxypiperidin carbonic
acid methylester or Eucaine is formed.

CHARACTERS. Permanent shining scales containing one molecule of water
of crystallization. Solubility. In about 6 parts of water.

INCOMPATIBLES. Caustic alkalies, alkaline carbonates and ammonia.


The general action of eucaine, both in cold and warm blooded
animals, consists in a marked excitation of the entire central
nervous system, followed by paralysis ; in toxic doses going on
to death. Small doses administered to mice and rabbits cause
increased reflex excitability, and increased but weakened respira-


tory movements. Medium doses in rabbits cause repeated tonic
and clonic convulsions. The animals lie senseless on their sides,
with dyspnoea, opisthotonos, and finally paresis of the posterior
limbs. These phenomena are most marked when large toxic
doses are administered ; the convulsions return continuously,
and affect all the muscles of the body. The animals finally
die when the paralysis reaches the respiratory muscles. When
the dose is not a fatal one, the convulsions gradually cease,
the increased reflex excitability disappears, and the paresis of
the hind limbs slowly improves. The effect on the central ner-
vous system is therefore at first excitant, and later, in toxic doses,
paralyzing. The paralysis is a central one, for if the sciatic
nerve of a frog poisoned with eucaine is exposed, and its
peripheral end irritated with the induced current, the limb reacts
in a normal manner. As regards its action on the heart and the
blood-vessels, the subcutaneous and intravenous injection of
small and medium doses slows the heart on the average from
twenty to thirty beats per minute, but without otherwise modi-
fying the beats, or increasing the blood pressure. This effect on
the pulse is caused by the excitation of the central vagus ; for
section of the vagi causes an immediate increase of the pulse to
the normal and above it, together with an increase of the blood
pressure. Death occurs from paralysis of the respiratory centres,
for the heart continues to beat for some time thereafter (Vinci).


Eucaine is used in from i to 5 or even 10 per cent, solutions
for the same purposes as is cocaine. The anaesthesia comes on
somewhat more slowly, with solutions of the same strength is
about equal to, and its effects last about the same time as with
the latter drug. It possesses the disadvantage of causing hyper-
semia of mucous membranes, and in 2 per cent, solution may
irritate the conjuctiva. A i per cent, solution, however, does
not cause any disturbance. It is preferable to cocaine in that
its aqueous solutions are permanent and can be sterilized by heat
without decomposition. It does not cause mydriasis nor dis-
turbance of accommodation, nor does it dry the corneal epithe-


lium, and further it is relatively safer, so far as circulation and
respiration are concerned, than cocaine. Vinci claims that its
solutions possess moderate antibacterial powers.

In order to avoid the burning sensations, pain and hypersemia
to which eucaine may give rise, a substance known as Benzoyl-
vinyldiacetonalkamin hydrochlorate named Beta-eucaine (not
official), a compound closely related chemically to eucaine, has
been recommended. Its chemical and physiological properties,
with the above exceptions, are the same. It is safe, being three
and three-quarters less toxic than cocaine, does not affect the
heart, and is unirritating. It does not produce, when employed
in the eye, mydriasis, corneal lesions, nor disturbances of ac-
commodation. It can be sterilized by boiling without deteriora-
tion ; its solutions are permanent and do not decompose when
kept. Its field is the same as that of cocaine, and it ran be em-
ployed for the various operations upon the eye, nose, ears,
genito-urinary tract, in minor surgery and dentistry, and for in-
filtration anaesthesia. For medullary anaesthesia while the after-
effects seem no greater than with cocaine the analgesia is not so
uniform nor lasting. Its ease and certainty of sterilization by
boiling are in its favor and some .operators are strong advocates
of it. It is employed in from ^ to 4 per cent, (saturated)
aqueous solution, but of the latter not more than 30 minims ;
2.00 c.c., should be employed at one time, although for a pro-
longed operation five times this quantity may be employed].

CLASS VI. The Antiseptics.

Carbolic Acid, Sodium Sulphocarbolate, Creosote,
lodoform, Naphtalin, Naphtol and Resorcin.

[Besides these the following drugs which are not official are included in
this class: Zinc Sulphocarbolate (B. P.), Guaiacol, Aristol, lodol, Europhen,
Creolin, Lysol, Asaprol, Formaldehyde, Urotropin, Saccharin, Methylene
Blue and Piperazine.]



SOURCE. A liquid consisting of various constituents of coal-tar, chiefly
cresol and phenol, obtained by fractional distillation between the temperatures


of 302 and 392 F. ; 150 and 200 C., and twice rectified between the tem-
peratures of 338 and 374 F. ; 170 to 190 C.

CHARACTERS. A nearly colorless or reddish, or brownish-red liquid of a
strongly empyreumatic and creosote-like odor, having a benumbing, blanching
and caustic effect upon the skin and mucous membrane, and a slightly acid

Used only externally.]


CARBOLIC ACID. C 6 H 5 OH[=93.78.] Synonyms. Phenic Acid.
Phenol. Phenyl Alcohol.

SOURCE. [From Crude Carbolic Acid by agitation with warm concen-
trated solution of Soda, heating to 338 F. ; 170 C., solution and treatment
with Hydrochloric Acid. After being agitated with Sodium Chloride, digested
with Calcium Chloride, it is distilled between 336 and 374 F. ; 168.8 and
190 C., and crystallized.

CHARACTERS. Colorless, interlaced or separate, needle-shaped crystals,
or a white crystalline mass, sometimes acquiring a reddish tint, having a some-
what aromatic odor, and, when copiously diluted with water, a sweetish taste
with a slightly burning after-taste. Treated with about 8 per cent, of water, it
becomes fluid ; the crystals are very hygroscopic, and hence soon become semi-
fluid on exposure to air ; it has a faintly acid reaction and coagulates albumin.
Solubility. Slowly in about 15 to 20 parts of water;] freely in Alcohol, fats
and oils. [Solution in water is more easily made if an equal part of Glycerin
is added.]

Dose, l / z to i gr. ; [.03 to .06 gm.]


1. Unguentum Acidi Carbolici. [Ointment of Carbolic Acid.
Carbolic Acid, 5 ; Ointment, 95.

2. Glyceritum Acidi Carbolici. Glycerite of Carbolic Acid.
Carbolic Acid, 20 ; Glycerin, 80.

Dose, 2 to 5 m. ; .12 to .30 c.c.]


External. Carbolic acid is a powerful antizymotic,
rapidly destroying organized ferments, both animal and vegetable.
Consequently it destroys those of septic diseases, hence it is
antiseptic. It thus prevents the formation of the products of
the decompositions which are set up by these organisms. For
this reason it is disinfectant, and as the products of decompo-
sition are generally foul -smelling, it is deodorant. It does not
act so readily on unorganized ferments (enzymes), such as pepsin


and ptyalin, but in large doses it likewise destroys their activity.
Carbolic acid is not so powerful an antizymotic as [corrosive
mercuric] chloride (see p. 214) ; for Evans found that anthrax
spores were not killed in twenty-four hours by a solution of i in
100, but were killed by a solution of i in 20 acting for twenty-
four hours, but not when it acted for only four hours. The bacilli
of anthrax were killed by a solution of i in 100 acting for five
minutes, i in 150 acting for a quarter of an hour, i in 175 acting
for half an hour, but were unaffected by a solution of i in 150
acting for one minute, i in 175 acting for a quarter of an hour,
i in 300 acting for an hour. Strengths of i in 40 and i in 20
are commonly employed in surgery. The solution in oil has no
antiseptic properties. The power of carbolic acid to destroy
low organisms makes it an efficient parasiticide against certain
vegetable parasites infesting the skin.

When applied to the skin in weak or moderately strong solu-
tions, it produces local anaesthesia with a feeling of numb-
ness which lasts some hours. If concentrated, it acts as an
irritant and caustic, causing a burning pain, and in a few
minutes a white spot appears, which becomes red when the acid
is removed. If the application is prolonged, a white eschar or
slough results. There is no vesication.

Internal. Gastro-intestinal tract. If concentrated, carbolic
acid produces the same effect on the mouth as on the skin, and
is a powerful gastro-intestinal irritant (see Toxicology). In the
stomach it is converted into a sulphocarbolate, and unless poi-
sonous doses be given, it is so diluted by the gastric contents
that it loses its antizymotic power.

Blood. It is not known in what form carbolic acid circulates,
probably as an alkaline carbolate.

Circulation. Medicinal doses have no effect. Large doses
paralyze the vaso-motor centre in the medulla, and the blood-
pressure falls. It is not until very large doses have been given
that the heart is affected, and then its activity is depressed.

Respiration. Small doses have no influence on respiration,
but large ones accelerate it, probably from stimulation of the
vagi. Ultimately respiration is paralyzed, and death results.


Temperature. This is unaffected by small doses of carbolic
acid, but large doses cause it to fall, because they diminish the
production of heat and increase its dissipation.

Nenwus system. Carbolic acid is a cerebral depressant in
large doses, for coma is produced by them ; they first stimulate
the anterior cornua, producing convulsions, but subsequently
depress them, causing paralysis.

Urine. Much interest attaches to this, for even after moder-
ate doses of carbolic acid, or absorption from surgical dressings,
the urine may become dark. This is not due to blood, as
was once thought, for Stevenson has shown that there is no
increase of iron in the urine. Carbolic acid [is partially oxi-
dized to pyrocatechin and hydroquinone, which combine in the
body with sulphuric and glycuronic acids and are excreted in
the urine as double (ethereal) sulphates and phenol, pyrocatechin
and hydroquinone glycuronates.] Pyrocatechin [and hydro-
quinone are unstable bodies, and their oxidation products are
doubtless] the cause of the dark urine ; pyrocatechin can only
exist in alkaline urine, [so that it cannot be the sole cause of the
dark color.] The presence in the urine of these results of car-
bolic acid is recognized by distilling them over from it. The
distillate gives a blue color with neutral ferric chloride, and a
white crystalline precipitate of tribromophenol with bromine
water, showing the presence of sulphocarbolic acid. [The in-
organic sulphates are usually absent. This is determined by the
use of the barium chloride test which does not precipitate the
combined sulphates (sulphocarbolates). (Sonnenberg's test).]
Some carbolic acid escapes in the other excretions ; some is
burned up in the body. When very large doses are given car-
bolic acid itself may appear in the urine.


External. Carbolic acid is largely used as a deodorant and
disinfectant for drains, bed-pans, [for which the cheaper crude
acid may be employed,] soiled linen, surgical instruments, the
surgeon's hands, etc. Carbolic lotion (i in 40) is used to wash
wounds to keep them antiseptic, and carbolized gauze (which is


bleached cotton gauze medicated with half its weight of a mixture
of carbolic acid, i ; resin, 4 ; paraffin, 4, ) is employed as a dressing
for the same purpose. A spray of a solution of carbolic acid was
formerly much used to keep the air around the wound antiseptic
during an operation, but it is now discarded as unnecessary.

Glycerite of carbolic acid is a very efficient preparation to
destroy the fungus of tinea tonsurans or tinea versicolor ; for the
latter it should be diluted.

Because of its anaesthetic effect a strong solution (i in 20)
will relieve itching from any cause. Carbolized vapor has been
inhaled in phthisis, but by the time it reaches the lungs it is far
too dilute to have any action on the tubercle bacillr.

Internal. Month. The glycerite, if diluted, may be applied
as a stimulant to the mouth in aphthous stomatitis, or when any
indolent ulceration is present. A gargle (of [carbolic acid] in
water, i in 120) is an excellent preparation. The glycerite has
been used for diphtheria, but probably it does no good, except
that being a local anaesthetic it soothes pain. A piece of cotton
soaked in strong carbolic acid will relieve pain if placed in a
decayed tooth, but care must be taken to prevent it from coming
in contact with the soft parts by putting another piece of dry
cotton over it.

Stomach. Carbolic acid has been given to relieve flatulence,
because it was thought that it would prevent decomposition in
the stomach ; but it is powerless to do this, owing to the degree
to which the gastric contents dilute it. Some state that it checks
vomiting and helps to cure dyspepsia, but it is not a remedy
which is universally regarded as useful for these purposes. It
may, however, be tried in obstinate cases, and it will sometimes
be found to be a good carminative. It has been given internally
as an antiseptic in phthisis, but it does no good, and those who
give it forget that probably very little carbolic acid reaches the
lungs. It has been extensively tried in typhoid fever, but with-
out any good effect.


If carbolic acid is at all concentrated, immediately on swallowing it there
is an intense burning sensation in the mouth, [oesophagus] and stomach, and


white eschars form in the mouth. The patient is collapsed, his skin is cold
and clammy. The breathing becomes more and more feeble and shallow, and
finally stops. The urine is darkish green. Reflex movements are abolished,
and ultimately he becomes insensible and comatose. [Carbolic acid taken by
the mouth has proven fatal in two minutes.] Post-mortem. There are white,
hard sloughs, with perhaps inflammatory redness round them, in the mouth,
oesophagus, and stomach. The blood is dark and coagulates imperfectly. In
some cases fatty degeneration of the liver and kidneys may be found.

Treatment. Any soluble sulphate, such as an ounce [30. gm. ] of magne-
sium sulphate or half an ounce [15. gm.] of sodium sulphate dissolved in
half a pint [250. c.c.] of water, is the natural antidote, because sulphates and
carbolic acid form sulphocarbolates in the blood, and these are harmless.
[Saccharated lime or soap may be used as chemical antidotes.] Before the
antidote is given, wash out the stomach or use some very quickly-acting
emetic, as apomorphine [hydrochlorate] given hypodermatically. [It is of the
utmost importance to immediately] give stimulants freely, such as ether or
orandy subcutaneously. Apply hot water bottles and blankets if there are any
signs of collapse. [The most important antidote to carbolic acid is pure
alcohol. Success in treatment demands that the acid and alcohol should be
brought in contact ; therefore if the acid has been swallowed for some time
alcohol may not be efficacious. ]



231.56. Synonym. Sodium Paraphenolsulphonate.

SOURCE. Phenolsulphuric Acid is formed by adding Sulphuric Acid to
crystallized Carbolic Acid ; on heating this mixture it becomes Paraphenol-
sulphuric Acid, which yields a clear solution with water. C 6 H 5 OH-|-H 2 SO 4
=C 6 H 5 HSO 4 -|-H 2 O. Barium Carbonate is then added, and Barium Sulpho-
carbolateis precipitated. 2C 6 H 5 HSO 4 +BaCO 3 =Ba(SO 3 C 6 H 4 (OH) ) 2 +H 2 O
-|-CO 2 . This is treated with water and Sodium Carbonate ; a solution of So-
dium Sulphocarbolate is formed, and Barium Carbonate is precipitated.
Ba(SO 3 C 6 H i (OH)) 2 +Na 2 CO 3 =2NaSO 3 C 6 H 4 (OHj-f-BaCO s . The solution
is evaporated to crystallization.

CHARACTERS. Colorless, transparent, rhombic prisms, odorless and having
a cooling, saline, slightly bitter taste. Solubility. In 4.8 parts of water ; in
132 parts of Alcohol.]

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


This substance is antiseptic, like carbolic acid, and may be
used externally for this purpose. Internally it is occasionally
given in the hope of controlling gastric fermentation.



IV. ZINC SULPHOCARBOLATE. [B. P., not official.] Zn
(C 6 H 5 SO 4 ) 2 +H 2 O=[448.62. Synonym. Zinc Paraphenol Sulphonate.]

SOURCE. Sulphocarbolic Acid is formed by adding Sulphuric Acid to
Carbolic Acid. This is treated with Zinc Oxide ; the Zinc Sulphocarbolate
crystallizes out on evaporation.

CHARACTERS. Colorless crystals, freely soluble in water.


Zinc sulphocarbolate is, like carbolic acid, an antiseptic, and
may be used externally for that purpose. [It is used as an as-
tringent for indolent or foul ulcers, and in subacute inflamma-
tions of mucous membrane, in solutions which are somewhat
stronger than those of zinc sulphate.] It is not given internally.


SOURCE. [A mixture of Phenols, chiefly Guaiacol (C 7 H 8 O 2 ) and Creosol
(C 8 H, Oj) obtained during the distillation of wood tar, preferably of that de-
rived from the beech Fagtts Sylvatica Linne (nat. ord. Cupuliftra.}

CHARACTERS. An almost colorless, slightly yellowish or pinkish, highly
refractive, oily liquid, having a penetrating smoky odor, and a burning caustic
taste, usually becoming darker in tint on exposure to light. Sp. gr. , not below
1.070. Solubility. In 150 parts of water ; freely in Alcohol, Ether, Chloro-
form and glacial Acetic Acid. ]

IMPURITY. Carbolic Acid [which coagulates albumin and collodion.
Creosote does not].

INCOMPATIBLE. Explodes when mixed with Silver oxide.

Dose, [}4 to 2 m. ; .03 to .12 c.c.


Aqua Creosoti. Creosote Water. Creosote, lo; distilled water,

Dose, i to 4 fl. dr. ; 4. to 15. c.c.]


Creosote has the same action as carbolic acid, and before that
was introduced, creosote was used externally as a stimulating an-
tiseptic, a parasiticide and a slight local anaesthetic ; and inter-
nally it was given for vomiting and flatulence. An aching tooth
may be relieved if it is plugged with cotton thoroughly moistened


in creosote. [The most important use of creosote is as a pul-
monary antiseptic, administered by the mouth, hypodermatically,
or by inhalation. To Bouchard and Gimbert belongs the credit
of introducing the use of creosote in cases of tuberculosis. It can
be administered in the form of an emulsion with cod-liver oil
and acacia ; or with the hypophoSphites and cod-liver oil ; or
with the syrup of wild cherry and acacia, two minims ; .12 c.c.;
of the creosote being contained in a drachm; 4 c.c. of the
emulsion, or in a mixture of glycerin and whiskey. The dose
should be one-half to two minims ; .03 to .12 c.c., given thrice
daily, and increased to twenty to twenty-five minims; 1.20 to
1.50 c.c. in the twenty-four hours, by easy stages. Administered
in the form of enteric pills (which will dissolve only in the in-
testinal fluids), a daily dosage of forty-five to fifty minims;
3.00 to 3.30 c.c. can be reached without inconvenience. This
method is preferable to that of Sommerbrodt, which consists in
the administration of one minim; .06 c.c. of creosote in two
minims; 12 c.c. of cod-liver oil, in capsules. The method of
hypodermatic injection in sterilized olive oil requires a special
apparatus, is very tedious, somewhat painful, and altogether irk-
some to patient and physician. By inhalation it is employed
with equal parts of alcohol and spirit of chloroform, or in alco-
hol, one part to eight, in a perforated zinc inhaler, of which 15
minims; i. c.c., are placed upon a bit of cotton and used for
fifteen minutes in every hour. If the best beechwood creosote
is employed, no untoward results are likely to be obtained. If
the dose is increased too rapidly there may occur some nausea,
epigastric uneasiness, and even vomiting. Disturbance of the
kidneys has been produced and the urine presents practically the
same appearance as after the injection of carbolic acid (see p.
331). The stomach symptoms have been relieved by the pa-
tient placing himself upon his back, for half an hour after ad-
ministration of the remedy. It is quite likely that the patient
acquires a tolerance, for the daily dose of three hundred minims;
20. c.c. has been given for a considerable time, with benefit,
although fifty minims; 3.30 c.c. should be considered as the
maximum daily dose. Creosote is more efficient than either of


its principal constituents, guaiacol or creosol, even if given in
proportionate dose. Creosote should never be given to the aged.
Creosote carbonate (not official) which contains 92 per cent,
of creosote, does not possess the caustic and irritative properties
of the pure creosote, and can be administered in dose of from 15
to 60 m. ; i. to 4. c.c., in a wineglass of sherry after meals. As
it is slowly absorbed it is probable that it is eliminated in greater
part by the bronchial mucous membrane. Since it does not irri-
tate the gastro-intestinal tract nor the kidneys it is the method
of choice in the treatment of pulmonary tuberculosis.]


GUAIACOL. (Notofficial.) C 6 H 4 OHOCH 3 =I23.7I.] Synonym.
Methyl Pyrocatechin. [A liquid constituting from 60 to 90 per cent, of Creo-
sote, which is mainly composed of this and Creosol.

SOURCE. By fractional distillation of Beech-wood Tar; treated with
Ammonia to remove acid compounds, and then again fractionated.

CHARACTERS. A colorless, highly refractive liquid, of a strongly aromatic
odor. Sp. gr., 1.117. Solubility. Very slightly in water, readily in Alco-
hol and Ether.

Dose, 2 to 10 m. ; .12 to .60 c.c.


GUAIACOL BENZOATE. (Not official.) C 6 H 4 OHC,HC 5 O,=
203.49. Synonyms. Benzosol. Benzoyl Guaiacol.

SOURCE. This is prepared by adding to an alcoholic solution of Guaiacol,
Potassium Hydroxide, forming Potassium Guaiacol, which is heated in a
water-bath with Benzoyl Chloride. Benzoyl Guaiacol is formed and purified
by re-crystallization from Alcohol.

CHARACTERS. A colorless, odorless and tasteless crystalline powder.
Solubility. Almost insoluble in water; readily soluble in Ether and Chloroform.

Dose, 2 to 10 gr. ; .12 to .60 gm.


GUAIACOL CARBONATE. (Not official.) (C 6 H 4 OCH S ) 2 CO,=

SOURCE. By passing Phosgene gas (COC1 4 ) into Guaiacol, previously dis-
solved in a Soda solution. The Carbonate is obtained by crystallization.

CHARACTERS. A white, neutral crystalline powder, almost odorless and
tasteless. Solubility. Insoluble in water ; soluble in Ether and Chloroform.

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



GUAIACOL SALICYLATE. (Not official. ) C 6 H 4 OHCO 2 C 6 H 4 -
OCH 3 =2 43 .42.

Online LibraryWilliam Hale-WhiteMateria medica, pharmacy, pharmacology and therapeutics → online text (page 29 of 67)