William Hale-White.

Materia medica, pharmacy, pharmacology and therapeutics online

. (page 37 of 67)
Online LibraryWilliam Hale-WhiteMateria medica, pharmacy, pharmacology and therapeutics → online text (page 37 of 67)
Font size
QR-code for this ebook


ache and depression. This ataxia is due to impairment of con-
duction of sensory impressions from the effect of the cocaine on
peripheral sensory nerves. An excessive indulgence in the habit
of coca-chewing leads to indigestion, extreme emaciation, insom-
nia and enfeeblement of intellect. In animals coca causes cere-
bral convulsions.

Eye. When a solution of cocaine of about 4 per cent, is
dropped into the eye local anaesthesia is produced, first of the
conjunctiva and cornea, later of the iris. It is attained in about
seven minutes, and lasts about the same time. At first there
may be a transitory contraction of the pupil. This is probably
due to reflex action, and soon gives way to wide dilatation.



414 ORGANIC MATERIA MEDICA.

The maximum is attained in an hour or two. The normal state
is regained in from twelve to twenty-four hours. The dilated
pupil is freely responsive to light, and the dilatation is rapidly
overcome by physostigmine. The ocular tension is slightly
lowered, and the palpebral aperture is widened. Accommoda-
tion is partially, but never completely, paralyzed. These effects
are chiefly due to irritation of the sympathetic, and as they
are quickly produced by dropping the drug in the eye they are pro-
bably local. All these effects are slowly produced if large doses
of cocaine are taken internally. [Strong solutions or weak solu-
tions frequently applied desiccate the corneal epithelium.]

Muscles. The amount of muscular work of which the body
is capable is increased by cocaine, how, is not known. The
excretion of urea and nitrogenous metabolism are unaltered.

Temperature. This may rise in cocaine poisoning.

Kidneys. Cocaine is most likely excreted by these organs.
It diminishes sexual excitability.

THERAPEUTICS OF COCA.

External. A 5 to 10 percent, solution of the hydrochlorate
may be injected subcutaneously as a local anaesthetic when any
small operation has to be performed. [In the infiltration method
of Schleich three solutions are employed : cocaine hydrochlorate,
o. 2 (strong) ; o.i (normal) ; or o.oi (weak) ; morphine hydro-
chlorate, 0.025 ; sodium chloride, 0.2 ; sterilized distilled water
or saturated boric acid solution to 100. These are injected into
the substance of the skin forming wheals. This method requires
less of the drug than when used subcutaneously. Yet it should
be borne in mind that the anaesthetic properties of the two weaker
solutions depend largely upon the mechanical anaesthesia pro-
duced by injection of water, which had been previously pointed
out by Halsted.] Solutions, painted or dropped on, may be used
for operations on the mouth, throat, teeth (4 per cent.), eye
(i to 4 per cent.), ear, vagina, urethra and rectum (4 to 10 per
cent.), and they may be applied to any of these parts when they
are very painful. [Congestive urethral stricture may be tem-
porarily relieved by it so that instruments may be passed, but it



DRUGS ACTING CHIEFLY ON THE NERVOUS SYSTEM. 415

should be used with great care in urethral operations.] Cocaine
will relieve vaginal pruritus, and has been used locally applied
in the nose in hay fever. Painful ulcers, fissures, etc. , are bene-
ficially treated with it. Ointments, bougies, and suppositories,
usually containing 2 to 5 per cent, of cocaine, which mixes
better than the hydrochlorate, are very useful. A 15 per cent,
solution has been injected into the gums for tooth extraction, but
is not strongly recommended. [Ophthalmic surgeons] employ
it very largely to produce local anaesthesia of the eye. [If inflam-
mation is present anaesthesia is produced with great difficulty.]

Internal. Mouth. A solution is useful for painting or
spraying on the throat previous to laryngeal examinations.
[Lozenges of the hydrochlorate, containing ^ gr. ; .005 gm.,
in each, are valuable for painful sore throat. Often in addition
each lozenge contains 3 gr. ; .20 gm. of extract of krameria.]

Stomach. Cocaine in some cases allays excessive vomiting,
and has been said to cure sea-sickness.

It is not often used in Europe as a medicine for its restorative
effects ; as already mentioned, it is not a food, and the good it
does is only temporary.

\_McdulIary Ancesthesia. It has been recently proposed to
obtain surgical anaesthesia by injection of from T V to \ gr. ; .006
to .012 gm., into the arachnoid space. Puncture is made be-
tween third and fourth lumbar interspace of the spine with a
specially prepared needle as for diagnostic purposes. A few
drops of the spinal fluid is allowed to escape and the solution is
injected. Anaesthesia supervenes, gradually extending from the
feet upwards, and may reach to the chest or even higher ; this per-
sists for a variable time, but generally sufficient for the perform-
ance of surgical operations. This method of anaesthesia does
not interfere with labor further than abolishing its pain. Strict
asepsis must be observed. Although thus far no accidents have
been recorded, it is by no means clear that it will supplant ether
or chloroform narcosis, nor that it can be employed when con-
tra-indications exist to either. Beyond some nausea, vomiting
and headache, after-effects are not noticed. It is yet too early
to formulate an opinion as to the practical value of this method.]



41 6 ORGANIC MATERIA MEDICA.

TOXICOLOGY.

Symptoms. It is a respiratory depressant ; but symptoms of poisoning have
rarely been noticed unless the drug has been injected under the gums or skin.
Then it may quickly cause vertigo, pallor, fainting, profound cardiac and res-
piratory depression with tremors and other nervous symptoms which may per-
sist for months, even if the other symptoms are overcome.

In the chronic forms, known as cocamania, the sufferer takes cocaine either
for its pleasant effects or because he thinks it will help break himself from the
morphine habit, or he takes it with morphine. It is usually administered sub-
cutaneously. The pulse is rapid, and fainting is common. There is much
wasting, and the patient looks pale and death-like. Usually he surfers from
insomnia, and he may become acutely maniacal with delusions of persecution.
Visual and other hallucinations are often present, and it is very characteristic
that patients complain of little animals creeping on the skin, "cocaine bugs,"
they say. They are extraordinarily prolix in both conversation and writing.
[Cocaine habitues are by no means infrequently met with. The moral degrada-
tion is fully equal to that of opium-eaters.

Treatment. This should consist in stimulation, and emptying the stomach,
if the drug has been ingested, by means of hypodermatic injections of apomor-
phine. Artificial respiration may be required. Since cocaine asphyxiates by
constricting the blood-vessels at the base of the brain, strychnine hypodermatic-
ally or alcohol may remove this danger.

For the chronic forms confinement in an asylum, with careful treatment
during the period of severance, is essential.

OUABAINUM.

OUABAIN. (Not official.) CgoH^O,,^^. 62. A glucoside isolated
from the root of a tree, said to be the Acocanthera Ouabaio (nat. ord. Apocy-
nace<. ) This glucoside is also obtained from the seeds of Strophanthus glabrus.
Habitat. Africa.

CHARACTERS. A white crystalline powder slightly bitter. Solubility.
Soluble in hot, but with difficulty in cold water ; insoluble in Chloroform and
Ether.

Dose, ^ gr. ; .00013 gm.

ACTION AND USES OF OUABAIN.

Ouabain paralyzes cardiac muscle by direct action, and when
given hypodermatically is an emetic. According to Gley it is a
local anaesthetic, having ten times the power of cocaine. It has
also been recommended for all stages of whooping-cough in doses
f TniW r - > ooooS gm., for children. As it is a very powerful
drug, ^ gr. ; .001 gm., when taken into the blood, being suf-
ficient to kill a man, it should be used with great caution.



DRUGS ACTING CHIEFLY ON THE NERVOUS SYSTEM. 417

D. The following stimulates the secretory nerves.]

PILOCARPUS.

PILOCARPUS. Synonym. Jaborandi. [The leaflets of Pilocarpus
Selloanus Engler (Rio Janeiro Jaborandi), and of Pilocarpus Jaborandi
Holmes (Pernambuco Jaborandi), (nat. ord. Rutacece). Habitat. Brazil, near
Pernambuco. '

CHARACTERS. About 10 to 15 cm. long, and 4 to 6 cm. broad, short-
stalked, oval or ovate-oblong, entire and slightly revolute at the margin, obtuse
and emarginate, unequal at the base ; dull green, coriaceous, pellucid punc-
tate, mostly smooth ; when bruised, slightly aromatic ; taste somewhat bitter
and pungent.]

IMPURITIES. Leaves of species of Piper, not oval-oblong.

COMPOSITION. The chief constituents are (i) A liquid, colorless, alka-
loid, Pilocarpine, C n H J6 N 2 O 2 , X to J P er ceQ t- ( 2 ) Jaborine, C 22 H 32 N 4 O 4 ,
an alkaloid resembling in its physiological action Atropine, and therefore
antagonistic to Filocarpine. (3) [Pilocarpidine, C 10 H U N 2 O 2 , a decomposition
product whose action is weaker than Pilocarpine. ] (4) A volatile oil [chiefly
Pilocarpene, C 10 H 16 ] . (5) A peculiar acid. These active principles are solu-
ble in Alcohol, but only imperfectly so in water.

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

Preparation.

Extractum [Pilocarpi Fluidum. Fluid Extract of Pilocarpus.
By maceration and percolation with Diluted Alcohol and evaporation.
Dose, 5 to 60 m. ; .30 to 4.00 c.c.]

PILOCARPINE [HYDROCHLORAS. Pilocarpine Hydrochlo-
rate. C U H 16 N 2 O 2 H 0=243. 98. The hydrochlorate of an Alkaloid obtained
from Pilocarpus.

SOURCE. Obtained by exhausting Pilocarpus with Alcohol acidulated
with Hydrochloric Acid, distillation and evaporation. The filtrate is treated
with a slight excess of Ammonia, and a large quantity of Chloroform. The
solution is agitated with water, to which Hydrochloric Acid is added to neu-
tralization. The Hydrochlorate is obtained on evaporation in crystals which
are purified by re-crystallization.

CHARACTERS. Small, white crystals, odorless, and having a faintly bitter
taste ; deliquescent on exposure to damp air. Solubility. Very soluble in
water and in Alcohol ; almost insoluble in Ether or Chloroform.

Dose, ^ to y,, gr. ; .008 to .02 gm.]

ACTION OF PlLOCARtUS.

External. None.

Internal. Gastrointestinal tract. Pilocarpine is very
quickly absorbed, and soon produces a great increase in the

27



41 8 ORGANIC MATERIA MEDICA.

amount of salivary secretion. The mouth seems warm,
and there may be a feeling of tenseness about the salivary glands.
The saliva contains an abundance of salts and ptyalin, and can
convert starch into sugar. Its increase is due to a direct stimu-
lation of the terminal filaments of the chorda tympani and of the
other nerves which end in the cells of the salivary glands, so
that stimulation of these nerves can add very little to the flow
produced by the drug in fact, not more than can be accounted
for by vascular alterations. This action is antagonized immedi-
ately by atropine, as that paralyzes the endings of these nerves.
To a slight extent pilocarpine excites the secretion of the gastric
juice, intestinal fluid, and pancreatic secretion. The unstriped
muscle of the stomach and intestine is stimulated, and thus the
drug may purge. The bile is unaffected. Large doses, especially
of [pilocarpus] , may produce vomiting.

Circulation. Pilocarpine has no effect on the blood, but it is
a cardiac depressant. The pulse-rate, it is true, may be, and
in the human being always is, a little accelerated at first, but
soon both it and the blood-pressure fall. This slowing of the
pulse is at once set aside by atropine, but is not prevented by
section of the vagus, therefore pilocarpine acts on the heart itself,
probably stimulating the terminations of the vagus. The blood-
vessels are at first dilated.

Respiration. The drug has no effect on this. The amount
of bronchial secretion is increased.

Skin. [Pilocarpus], through its alkaloid pilocarpine, produces
a very profuse secretion of sweat. It is the most powerful
diaphoretic drug we have. A single dose may cause the flow of
fifteen fluid ounces [450. c.c.] of sweat. It is said that the pro-
portion of urea and chlorides in the sweat is greatly increased.
This profuse diaphoresis is due to the action of the pilocarpine on
the cells of the sweat-glands, or the terminations of the nerves in
them, and is stopped by atropine. The skin may flush, but this is
not the cause of the diaphoresis. Under a course of [pilocarpus]
the hair grows more actively, but it becomes very coarse and dark.

Kidneys. If the sweating is profuse, the secretion of urine is
lessened. Pilocarpine is excreted unchanged in the urine.



DRUGS ACTING CHIEFLY ON THE NERVOUS SYSTEM. 419

Temperature. There may be a slight rise at first, but soon
the temperature falls considerably. This is probably due in
large part to the evaporation of the perspiration.

Eye. Whether applied locally to the eye or given internally,
pilocarpine produces great contraction of the pupil, due to
stimulation of the ends of the third nerve in the eye, and this is
antagonized by atropine. It also causes increased tension of the
eye-ball, and an approximation of the nearest and farthest points
of distinct vision.

Other actions. It stimulates the uterus, and has in very rare
cases produced abortion. It increases the secretion of milk, of
tears, of nasal mucus, and, according to some authors, that of
cerumen. It causes the spleen and bladder to contract.

It will be noticed that it has two main actions, (i) It stimu-
lates the secretions viz., those of the salivary glands, stomach,
intestines, skin, kidney, bronchial mucous membrane, nose,
lachrymal glands and ear. In those that have been investigated,
and probably in all, it acts locally. It has not been decided in
every case whether the cells of the glands or the nerve termina-
tions in them are affected. (2) It stimulates the nerve termina-
tions of involuntary muscles viz., in the eye, the intestines, the
stomach, the uterus, the spleen, the heart, the bladder, and it acts
on the muscular coat of the vessels, although these, if affected,
are usually dilated. The most important effects are the diapho-
resis, the salivation, and the myosis. It is consequently antago-
nistic in its action to atropine. Children bear large doses of
it well. Pilocarpine is much more used than [pilocarpus], as it
is more prompt and more certain in its action, and is less likely
to cause indigestion.

Jaborine has an action similar to that of atropine ; the amount
of it in [pilocarpus] varies, hence the varying effects of different
specimens of the leaves, but there is never enough totally to
counteract the pilocarpine.

THERAPEUTICS OF PILOCARPUS.

External. Pilocarpine has been used locally to promote
the growth of hair. An ointment (Pilocarpine [hydrochlorate],



42O ORGANIC MATERIA MEDICA.

i ; soft petrolatum, 60 ; hydrous wool fat, 60, ) or a lotion (Pilo-
carpine [hydrochlorate] , i ; quinine hydrochlorate, 4 ; glycerin,
60; rose water, 180,) have been used.

Internal. Pilocarpine has been employed for many condi-
tions, but its great use is as a diaphoretic in Bright' s disease.
For this purpose ^ of a gr., [.01 gm.] or more of the [hydro-
chlorate] is injected subcutaneously in the evening. The sweat-
ing is aided by wrapping the patient, who should be naked, in
several warm blankets, giving him hot drinks, and putting a hot
water bottle to his feet. After the sweating has ceased, he
should be dried and left in a dry blanket. As it is such a power-
ful cardiac depressant, it must be given with great caution when
the heart is diseased. Occasionally it is employed locally in
affections of the eye. Patients suffering from deafness due to
disease of the auditory nerve or its terminations are sometimes
relieved by pilocarpine. [It is often given internally for deaf-
ness due to otitis media sicca.] Injected subcutaneously, it has
been given successfully as an antidote to belladonna poisoning.



GROUP II.
Vegetable Drugs whose main Action is on the Heart.

CLASS I. The Digitalis group, decreasing the frequency and increasing
the force of the beat of the heart :

Digitalis, Strophanthus, Convallaria, Squill, [Scoparius,] Erythroph-
loeum, and [Adonidinj.

CLASS II. The Aconite group, decreasing the frequency and force of the
beat of the heart :

Aconite, [Veratrum Viride,] Veratrina.

[CLASS III. The Cactus group, increasing the frequency and force of the
beat of the heart :

Cactus Grandiflorus.]



DRUGS ACTING CHIEFLY ON THE HEART. 42!

CLASS I. THE DIGITALIS GROUP.

DIGITALIS.

DIGITALIS. [Synonym. Foxglove. The leaves of Digitalis Pur-
purea Linn6 (nat. ord. Scrophularinete), collected from plants of the
second year's growth. Habitat. Europe, in sandy soil and the edges of
woods.

CHARACTERS. From 10 to 30 cm. long, ovate or ovate-oblong, narrowed
into a petiole ; crenate ; dull green, densely and finely pubescent ; wrinkled
above ; paler and recticulated beneath ; midrib near the base broad ; odor slight ;
somewhat tea-like ; taste bitter, nauseous.] Resembling Digitalis leaves.
Matico leaves, which are more deeply reticulated.

COMPOSITION. The chief constituents are (i) Digitoxin, a glucoside,
crystallizable, the most active principle, very poisonous, cumulative. Insolu-
ble in water, sparingly in Ether, easily in Chloroform and Alcohol. Exists as
minute white crystals. Dose ^\^ to -$ gr. [.00025 to .00125 g m -l ( 2 ) Digi-
talin, a crystalline glucoside, possessing in a high degree the actions of Digi-
talis. It is also called Digitalinum Verum. Soluble in water, I in 1000.
Dose, ^ ff to T ^j gr. [.0003 to .0006 gm.] subcutaneously. (3) Digitalein, an
amorphous glucoside, not yet proved to be a definite chemical substance, sol-
uble in water, and therefore suitable for hypodermatic injections; dose hypo-
dermatically T ^ gr. ; .0006 gm. , said to be non-cumulative. These three
glucocides are said to represent the cardiac stimulating action of the drug, (4)
Digitonin, [C^H^O^] a glucoside closely allied both chemically and physio-
logically to, and perhaps identical with, the Saponin of Senega (q. v.). [Dose,
^^ to T ^ 5 gr. ; .0002 to .0006 gm.] This is a cardiac depressant, and is
therefore antagonistic to the other active principles. (5) Digitin, a glucoside
devoid of physiological action. All these five glucosides are non-nitrogenous.
(6) Two acids, Digitalic and Antirrhinic. ("]) Other usual constituents of
plants, as tannic acid, volatile oil, coloring matter, starch, sugar, gum, salts.
It will be noticed that Digitalis contains no Alkaloids.

The following five substances, all soluble in alcohol, are met with in com-
merce : (A) Homolle's Digitalin (same as Quevenne's), an amorphous yel-
lowish-white powder or small scales, intensely bitter, inodorous, but irritating
to the nostrils. [Soluble in 2000 parts of water.] Consists chiefly of Digi-
talin with a little Digitoxin. Possesses the action of the leaves. Granules
of it are much used in France ; each usually contains -fa gr., .001 gm., which
is equal to l^ gr. ; .10 gm. of the powdered leaves. (B) Nativelle's Digi-
talin, [C^H^Ojj, light, white, crystalline tufts of needles, very bitter. Solu-
ble in Chloroform and in Alcohol, not in Water or Ether. It consists very
largely of Digitoxin and is cumulative. Dose, -^ to ^ gr. ; .001 to .002 gm.
in a pill. (C) German Digitalinum Purum. Dose, -fa to ^ gr. [.ooi to .002
gm., soluble in water. Consisting chiefly of Digitalein, with some digitalin



422 ORGANIC MATERIA MEDICA.

and digitonin. (D) Digitoxin, already described (see p. 421). (E) Digitalin.
already described (see p. 421). [None of the above constituents are official.]

INCOMPATIBLES. Ferric salts, lead acetate, and cinchona.

Dose, y z to 3 gr. ; [.03 to .20 gm.]

Preparations.

1. [Extractum Digitalis. Extract of Digitalis. By maceration
and percolation with Alcohol and Water, distillation of the Alcohol,
and evaporation.

Dose, ]^ to i gr. ; .015 to .06 gm.

2. Extractum Digitalis Fluidum. Fluid Extract of Digitalis.
By maceration and percolation with Alcohol and Water, and evapora-
tion.

Dose, ^ to 3 m. ; .03 to .20 c.c.

3. Infusum Digitalis. Infusion of Digitalis. Digitalis, 15;
Cinnamon Water, 150; boiling water, 260 ; Alcohol, 100 ; cold water
to 1000.

Dose, i to 4 fl. dr. ;] (note that it is drachms, not ounces) ; [4. to
15. c.c.]

4. Tinctura Digitalis. [Tincture of Digitalis. Digitalis, 150;
Diluted Alcohol to 1000. By maceration and percolation.

Dose, 5 to 30 m. ; .03 to 2.00 c.c.]

As the proportion of the many constituents varies in the preparations, some
prefer always to give the powdered leaves.

ACTION OF DIGITALIS.

External. The leaves are slightly irritating, but it is doubt-
ful whether any of their constituents can be absorbed by the skin.

Internal. Gastro-intestinal tract. Digitalis is a mild
gastro-intestinal irritant, and even moderate doses cause
vomiting and diarrhosa in some people.

Blood. It is [not] rapidly absorbed ; it is not known to
affect the blood.

Heart. The first action of digitalis is to slow the beat of
the heart, the diastole is prolonged, the duration of the
systole is not altered, but its force is greatly increased, so
much so that after large doses the heart may, in animals, be seen
to become pale, because almost every drop of blood is squeezed



DRUGS ACTING CHIEFLY ON THE HEART. 423

out of it. The pulse is consequently increased in force, but re-
tarded. If before the drug was given the heart was beating
irregularly, it generally becomes regular. If the drug is taken
internally, the whole of both ventricles is, in mammals, affected ;
but in frogs one portion of the ventricle may remain spasmodic-
ally contracted during the diastole of the rest of it. Finally
the ventricles are, in frogs, arrested in systole, firmly contracted,
quite pale, and unable to respond to any stimuli, but in mam-
mals the heart finally stops in diastole. If locally applied to
parts of the ventricle of the frog, only those parts to which the
digitalis is applied are contracted ; this is not so in mammals.
The auricles are in most animals slowed by it but the force of
their beat is not much altered. In all animals large doses cause
great irregularity of the auricular beat.

That these phenomena are chiefly due to the direct action
of the drug on the cardiac muscle is shown by the fact that
digitalis not only tonically contracts the frog's heart when ap-
plied locally, but it will even increase the force of the contrac-
tion, when applied to the isolated apex in which it is believed
no nerves exist, and it acts on the embryonic heart of the chick
before the nerves are developed. But the inhibitory activity of
the cardiac peripheral end of the vagus is increased ; for a mild
stimulation of the vagi, which, before the drug was given, had
no effect, will after the drug is given, stop the heart, and in
warm-blooded animals digitalis does not very markedly retard
the pulse, if the vagi have been cut, although it increases the
force of the cardiac beat. The vagus centre in the medulla is
stimulated to a less extent. Gushing has shown that the vagal
action, with most of the digitalis group of drugs, begins a little
before the muscular.

It has been proved that even small doses actually increase
the amount of work done by the heart in a given time ; thus
there is a greater output at each ventricular contraction.

Vessels. Moderate doses of digitalis produce a great rise
in the blood-pressure. This is partly due to the greater
cardiac force, but not entirely, for in the web of the frog's foot
and the rabbit's mesentery the arterioles have been observed to



424 ORGANIC MATERIA MEDICA.

contract vigorously when digitalis has been given. As this still
occurrs in arterioles quite separated from the body, and through
which an artificial circulation of blood containing digitalis is
carried on, it is clear that the drug contracts the arterioles by
direct action on their muscular coat. But as the con-
traction is greater in an intact animal than in one whose spinal
cord is destroyed, or in whom the nerves going to the part experi-
mented upon are divided, it is clear that digitalis also stimu-
lates the medullary and spinal vaso-motor centres. With
toxic doses the irritation of the centres and of the muscular coat
of the arterioles passes on to depression, and the blood-pressure
falls.

Kidney. The effect of digitalis on the kidney is very uncer-
tain. Most experimenters have found that in health it is diuretic,
but some have not, and the same discrepancy in its action on the
kidney exists in patients with heart disease, but generally in these



Online LibraryWilliam Hale-WhiteMateria medica, pharmacy, pharmacology and therapeutics → online text (page 37 of 67)