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Abbreviations. Although abbreviations are objectionable, yet this pre-
scription could be written thus :

R. Tinct. Fer. Chlor., 83 iij; [12. c.c.]
Quin. Hydrochlor., gr. xxx. ; [2. gm.]
Mag. Sulphat, ij 5 [- g 111 -]
Glycer., fl J ij ; [60. c.c.]
Inf. [Cinch.] ad fl J viij ; [240. c.c.]
F. m.

S. Take one table-spoonful thrice daily, two hours after meals.
William Smith, Esq. A. B. C.

1 6th June, 1901.
S, ts. and/r. are abbreviations for semi, a half, and aa for ana, of each.



THE PRESCRIPTION. 45

The following is a prescription for a pill :

R. Extract! Nucis Vomicse, gr. ^ ; [.015 gm.].
Extracti Euonymi.

Aloini, aa gr. ss. ; [.03 gm.].

Hydrargyri Chloridi [Mitis], gr. j. ; [.06 gm. ].
Extractum Hyoscyami, ad gr. v-. ; [.30 gm.].
Fiat Pilula. Mitte 24.

[S. ] Take one immediately before dinner every evening.
William Smith, Esq. A. B. C.

1 6th June, 1901.

It will be observed that the quantities in the prescription are for one pill
only, and the [apothecary] is directed to send 24. Often, however, the pre-
scription is written with the quantity of each ingredient necessary to make the
full number of pills. Thus :

R. Extracti Nucis Vomicae, gr. vj. ; [.36 gm.].

Extracti Euonymi.

Aloini, aagr. xij.; [.75 gm.].

Hydrargyri Chloridi [ Mitis J, gr. xxiv. ; [1.50 gm.].
Extractum Hyoscyami, ad gr. cxx. ; [8 gm.].

Fiat Pilulse 24.

[S.] Take one immediately before dinner every evening.
William Smith, Esq. A. B. C.

1 6th June, 1901.

Prescriptions for powders are also written in either way.
The medicine may be prescribed as a pill when it is required that the
patient shall carry it about with him, when only a small dose is needed, when
it is desirable that it shall act slowly, when it is required to act on the lower
bowel, when it is insoluble or nauseous, or when it is difficult to prescribe in
the liquid form. Kaolin is the best basis for substances, as potassium perman-
ganate, which are decomposed by contact with organic matter.

Oils, and volatile, deliquescent or bulky substances should not be prescribed
as pills, as they require much solid excipient ; nor should pills be used for
substances required to act immediately. Insoluble or very [disagreeable]
powders are often given in cachets.

Abbreviations should be employed as little as possible. Serious mistakes
have happened because the abbreviations have been ambiguous. The follow-
ing are especially to be avoided :

Acid. Hydroc. (may be Acidum Hydrochloricum or Acidum Hydrocy-

anicum).

Ext. CoL ( " " Extractum Col chici or Extractum Colocynthidis).

Hyd. Chlor. ( " " Calomel, Corrosive sublimate or Chloral hydrate).



46 PHARMACOLOGY AND THERAPEUTICS.

Hyd. (may be Hydrargyrum, Hydras, Hydriodas, Hydrochloras

or Hydrocyanicus).
Sulph. ( " " Sulphur, Sulphide, Sulphate, or Sulphite).

Sometimes the signature is written in Latin, and it is often abbreviated. A
list of such abbreviations is given in the appendix.

In Great Britain [and in the United States] it is always understood, unless
otherwise stated, that the preparations are those of the Pharmacopoeia.

Ad. The prescriber should be careful in deciding whether or not to use
this word before the vehicle. If it had been left out in the prescription given
[on p. 44], the bulk of the mixture would have been nearly 10% fluid ounces ;
[315. c.c.], and the amount of the ingredients in each dose would have been
less than was intended.

Dispensing the Prescription. The dispenser should bear the following
rules in mind : (l) Read the prescription through first. (2) Next write the
directions, so that they have time to dry. (3) Solution by heat should not be
used if more of the salt is ordered than will dissolve in cold water. In such
case it must be suspended. (4) With fluids, measure them in such an order
that the measuring glass shall be finally rinsed out with the vehicle. (5) Use
glass scale pans. (6) Clean and put away everything directly after use.
(7) If in the slightest doubt ask the prescriber. (8) If finally the prescription
contains any insoluble matter, label "Shake the bottle." (9) If the medicine
is very poisonous, label it as such and use a distinctive bottle. (10) If for
outward application only, [label it as such]. (li) In dispensing substances
chemically incompatible, if there is any likelihood that the new body formed
is dangerous, communicate with the prescriber before dispensing (e.g., Potas-
sium Iodide prescribed with Spiritus ./Etheris Nitrosi forms free iodine ; alka-
loids are precipitated by alkalies). Should there be no such reason against
dispensing the prescription (e.g., Liquor Potassae and Ferrum Dialysatum),
keep the incompatibles as far apart as possible by diluting each with the
vehicle before mixing.

PHARMACOLOGICAL AND THERAPEUTICAL ACTIONS.

When the action of a drug is spoken of, the physiological
action is usually understood.

The primary action is that due to the unaltered drug ; e.g., the emetic
action of zinc sulphate.

The secondary action is that due to compounds formed from the drug
whilst it is in the body ; e.g., the antiseptic effect on the urine of Uva Ursi
taken by the mouth is probably due to the fact that arbutin, the active principle
of Uva Ursi, is in its passage througlf the kidney decomposed into a glucoside
and hydroquinone, and the latter is a powerful antiseptic.

The direct or local action of a drug is that produced on any organ with



PHARMACOLOGICAL AND THERAPEUTICAL ACTIONS. 47

which it comes in contact ; e.g. , the cantharidin in cantharides, in being ex-
creted through the kidney, causes inflammation of it.

The indirect or remote action is a secondary effect, the result of the
direct effect ; e.g. , curare paralyzes the respiratory muscles, consequently the
blood becomes venous, and therefore convulsions take place. In this case the
venosity of the blood and the convulsions are each of them indirect actions
of curare.

It is clear that among drugs acting on the same parts, the total effect will
depend very much upon which part is first affected. For example, atropine
and curare will paralyze motor nerves, but atropine first affects the terminations
of the vagus, and only late in its action the motor nerves of the voluntary and
respiratory muscles ; hence paralysis and asphyxia are late symptoms, and a
rapid pulse is an early symptom. Curare, however, early affects the nerve-
endings of the voluntary and respiratory muscles, and the heart towards the
end ; therefore asphyxia and paralysis occur early, and a rapid pulse is a late
symptom.

Relation between Chemical Constitution and Physiological Action.
There is no doubt that the physiological action of a drug often depends upon
its chemical constitution. Naturally, substances which are broken up in the
body in such a way as to lead to the liberation of a common element or group
will have a similar action. Probably, also, the action of a drug depends upon
electrolytic dissociation of its solutions.

Instances in which chemical constitution influences action are the similarity
of effects of nitrites, the fact that all chlorides, bromides, and iodides of ethane
and methane are anaesthetic, the similarity of action of the iodides of many
metals and the similai ity of action of bromides of many metals.

Substitution of one radical for another in organic compounds often strikingly
modifies their action ; for example, if strychnine, brucine and thebaine are
converted into meihyl-strychnine, methyl-brucine and methyl-thebaine, the
convulsive action of each of the first three substances is replaced by a para-
lyzing action. The effect of substitution may be also well seen in the various
derivatives of atropine and cocaine, and in the relation of aconitine to benz-
aconine and aconine. Another very interesting case in point is that methyl-
glucoside is sweet, ethyl-glucoside is somewhat sweet, phenyl-glucoside is
bitter, and benzyl-glucoside is intensely bitter.

Sometimes the position of the radicals in the molecule is of great physio-
logical importance ; thus resorcin (metadihydroxy-benzene) is very sweet,
while pyrocatechin (orthodihydro-benzene) is bitter.

Sometimes the atomic weight appears to influence the intensity of action,
for the relative toxicity of various alcohols is as follows : Methyl-alcohol, O.8 ;
ethyl-alcohol, i.o ; propyl-alcohol, 2.0; butyl-alcohol, 3.0; amyl-alcohol,
4.0. The difficulty of the whole subject is, however, so great that it is impos-
sible at present to lay down laws sufficiently general to be of any use to the
beginner. It must be remembered that dissimilarity of action is often more
apparent than real, for it may be due to varying solubility, digestibility, rate



48 PHARMACOLOGY AND THERAPEUTICS.

of absorption, rate of elimination, or rate of osmosis, also to the organ which
happens to be first affected, and the degree to which the drug can dissolve the
constituents of tissues.

Drugs may be classified according to the parts on which they act, and
before describing each individual drug, a classification on this principle will be
given.

DIVISION I. DRUGS ACTING UPON ORGANISMS WHICH INFECT THE
HUMAN BODY, OR UPON PROCESSES GOING ON OUTSIDE IT.

Antiseptics are drugs which arrest putrefaction, either by
preventing the growth of, or completely destroying the micro-
organism on which decomposition depends. Some authors limit
the use of the word to those drugs which [restrain the devel-
opment] of micro-organisms, and call those substances which
destroy the [vitality of] micro-organisms, [germicides or] dis-
infectants. [The term disinfectant, by extension, is applied to
those agents which kill non-pathogenic bacteria as well as to those
which destroy disease germs.]

Statements are most discordant as to whether certain substances
are antiseptics, and as to the strength of their antiseptic power.
This is because antiseptics act differently on different organisms ;
and the distinction has not been drawn between preventing the
growth of, and destroying micro-organisms. Also because the
power of antiseptics depends upon the temperature at which
they act, the medium in which they are dissolved, the strength
of the solution, the time given them to act, and the number of
micro-organisms present in the substances to which they are
added.

To properly test the value of an antiseptic the above condi-
tions must be noted. All instruments and substances except the
fluid containing the micro-organisms to be tested are heated so
that any adventitious micro-organisms are destroyed. A cultivat-
ing medium, such as agar-agar jelly, in which the micro organisms
will grow, is selected, and two test-tubes, each containing some
of it, are taken ; to one of these the supposed antiseptic is added.
Some fluid containing the micro-organisms is then added to both
test-tubes ; both are plugged with sterilized cotton to prevent the
entrance of germs from the air, and it is observed whether the



DRUGS ACTING UPON ORGANISMS INFECTING THE BODY. 49

micro-organisms will grow in the tube containing no antiseptic,
but not in that containing the antiseptic. As the power of an
antiseptic depends on so many circumstances, no exact order of
their potency can be given, but roughly the more powerful are
placed first in the following list ; the last are very feeble.

1. Heat. This is the best antiseptic, but a temperature of at least 212 F.
[100 C. ] is required. After an infectious fever, clothing, bedding, etc., may
be heated in a dry-air chamber to between 200 and 300 F. [93.5 and 149
C.] ; or what is far better, as dry air does not penetrate the spores nearly so
well as moist, and the interior of the rolls of fabrics often hardly gets heated
at all, steam under pressure may be driven through them. Another useful way
is to boil the infected things in water. Surgical instruments are disinfected in
this way [but one per cent, of washing soda (sodium carbonate) should be
added to the water to prevent their rusting].

2. Corrosive Mercuric Chloride. A solution of i in 1000 is constantly
used for washing hands, and for many other purposes connected with midwifery
and surgical operations. [For most uses one part to 3 or 5000 of water or
even weaker, is the limit of safety. Gauze of the strength of I to 2000 will
blister, if the skin is damp.

3. Formaldehyde, of which the forty per cent, solution is known as For-
malin, has extraordinary power as a surface disinfectant, greater than that of
any known substance. It is especially useful for the disinfection of rooms and
their contents when volatilized from a specially constructed lamp.]

4. Chlorine is, as a rule, too irritating. Chlorine gas, disengaged by the
action of hydrochloric acid on manganese dioxide, may be used to disinfect a
room, the windows, chimneys and doors of which are sealed. It must be
remembered that it attacks and bleaches many substances.

5. Chlorinated Lime [is the best antiseptic for all excreta (Sternberg)].

6. Bromine, and, 7, Iodine are rarely used, as they are too irritating.

8. Carbolic acid is used [but infrequently. If surgical instruments have
been previously sterilized, the use of carbolic acid indicates a distrust, on the
part of the surgeon, of his assistants.]

9. Quinine, and, 10, Salicylic acid are too expensive for ordinary use.

11. lodoform is commonly used to dust upon wounds, etc.

12. Boric acid is used for many surgical purposes.

13. Zinc chloride, and, 14, Potassium permanganate, are much used
domestically.

15. Solution of Hydrogen dioxide is the ingredient of [various popular
disinfectants].

16. Oleum Eucalypti is used in surgery.

17. Sulphurous acid, disengaged by the burning of sulphur, is used to
disinfect rooms.



5O PHARMACOLOGY AND THERAPEUTICS.

18. Creosote, ig. Benzoin, 20. Zinc sulphate, 21. Ferric oxide, 22.
Thymol, 23. Alcohol, 24. Balsam of Tolu, 25. Balsam of Peru, are none
of them much used.

26. Lysol, Creolin [and various cresol compounds] are not pharmacopceial,
but they are powerful and much employed.

We do not know of any drugs which, when taken internally
or inhaled, will certainly destroy micro-organisms, either in the
gastro-intestinal tract or respiratory passages, unless they are suf-
ficiently concentrated to be fatal to the patient. Some authori-
ties, however, consider that naphtol, calomel, and some other
substances will destroy many varieties of micro-organisms in the
stomach and intestines. [The fact is often lost sight of that an
infinitely small amount of a remedy which could not be admin-
istered in sufficient amounts to destroy, will often completely in-
hibit the growth of micro-organisms, and thus should be classed
as an antiseptic.]

Deodorants, or deodorizers, are substances which destroy
disagreeable smells. There are too many for enumeration.
Many antiseptics are deodorizers. [Charcoal is often called a
disinfectant, but it is merely a deodorizer ; it is powerless if it
is wet.]

Antizymotics. This is a word sometimes applied to drugs
which arrest fermentation.

Anthelmintics are drugs which kill such parasitic worms as
infest the alimentary canal. Three kinds only are commonly
met with in the temperate zone.

(1) Tape- worm ( Tania solium and Tctnia mediocanellafa}. Anthelmin-
tics : [Aspidium] (mostly used), Oleum Terebinthinae, [Kamala,] Ctfsso,
Granatum, [and Pepo.].

(2) Round-worm (Ascaris lumbricoides). Anthelmintics : Sanfonin,
[and Spi^elia and Senna.]

(3) Thread-worm (Oxyuris vermicularis}. Anthelmintics: Rectal in-
jections of salt water, infusion of quassia, solutions of iron salts, or di-
luted oil of turpentine. It is doubtful whether these drugs (except turpen-
tine) relieve the patient by killing the thread-worms which inhabit the rectum,
or merely, by removal of mucus, render this part unfit for them. [It is prob-
able that rectal injections are useless. Large soap and water enemata, the
patient being in the knee chest position, give the best results. (Whittaker.)].



DRUGS ACTING ON THE BLOOD. 5 I

Anthelmintics for the tape or round-worm should be given
when the alimentary tract is empty. Hence it is a good plan to
give a dose of castor oil a few hours before the anthelmintic, so
as to ensure that the drug comes in contact with the worm. To
expel the dead parasite a purgative should be given a few hours
after the anthelmintic. [Castor oil should not be used if aspidium
has been administered.] Purgatives used for this purpose are
called Vermifuges. Vermicide is a term sometimes applied
to drugs which kill intestinal entozoa.

Antiparasitics or parasiticides are substances which destroy
parasites. The term is usually applied to those which destroy
parasites infesting the skin.

(1) For the various forms of tinea the following are used : Mercurial
preparations, especially the oleate, tincture of iodine, [glycerite] of carbolic
acid, an ointment of pyrogallic acid, a boric acid lotion, a salicylic acid
lotion, acidum sulphurosum, [formaldehyde] and thymol; and if the
patches are small, severe irritants, as croton oil, cantharides, and chrysa-
robin ointment. Tinea versicolor never requires severe irritants.

(2) As a parasiticide for itch, sulphur ointment is generally used. Bal-
sam of Peru and [Styrax] are also effectual.

(3) Pediculi vestimentorum will be killed by any mild parasiticide.
Unguentum Staphisagriae [unofficial ; i part powdered seed, 2 parts each,
olive oil and lard], is often used.

(4) Pediculi capitis and pediculi pubis are also easily killed by mild
parasiticides; mercurials are commonly employed, so also is Unguentum
Staphisagriae.

Antiperiodics are drugs which arrest the return of diseases
which recur periodically. Some, and probably all, act as direct
poisons to the micro-organism causing the disease.

They are cinchona bark, quinine and its salts (by far the most powerful),
cinchonine, arsenous acid, eucalyptus, hydrastis, salicin, salicylic acid
[and berberine]. They are used for all forms of intermittent fever and
neuralgia.

DIVISION II. DRUGS ACTING ON THE BLOOD.

A. Drugs acting on the Plasma. Many substances must
after absorption exist in solution in the plasma, and purgatives,
diuretics and diaphoretics must alter the composition of the
plasma by abstracting substances from it ; but while drugs are



$2 PHARMACOLOGY AND THERAPEUTICS.

given with the object of acting on the plasma it is in order to
render it more alkaline : we know no drugs which will make it
acid, or even markedly reduce the natural alkalinity of the
plasma, as the mineral acids can only exist in it in the form of
neutral salts.

The alkalizers of the plasma are salts of

(1) Potassium. (4) Lithium.

(2) Sodium. (5) Magnesium.

(3) Ammonium. (6) Calcium.

This is approximately the order of their alkalizing power. Potassium is
certainly the most powerful, while calcium is very feeble.

The citrates and tartrates of these metals are decomposed in
the plasma into alkaline carbonates. As alkalies unite with
uric acid and form soluble urates, they are given with the hope
that this will occur in the plasma. The diuretic effect of the
alkali aids the excretion of the urates.

Therapeutics. The chief use of alkalies is their adminis-
tration in jjout, in which disease the uric acid is greatly in ex-
cess in the plasma. As the treatment has to be continued for
some time, a preparation which does not [disturb] digestion,
such as potassium citrate, is usually preferred, or lithium citrate,
for the lithium compound of uric acid is very soluble in water ;
but the value of lithium is doubtful, as it does not increase the
solubility of urates in the plasma. For the same purpose the
[numerous] natural alkaline waters are frequently prescribed.

In lead-poisoning the lead is locked up in the tissues in a
very sparingly soluble form. Potassium iodide was given be-
cause some authorities believed it increased the solubility of lead
in the plasma, and consequently facilitated its excretion by the
kidneys.

Alkalies have been largely used in rheumatic fever, on the
assumption that there is a deleterious agent in the plasma, and
that its solubility is increased by increasing the alkalinity of the
plasma ; but this treatment has now been abandoned in favor of
that by salicylates. For the same theoretical reason alkalies have
been given in rheumatoid arthritis.



DRUGS ACTING ON THE BLOOD. 53

Purgatives, diaphoretics and diuretics necessarily alter
the composition of the plasma, and are largely used when there
is much oedema of any part, or effusion into serous cavities, in
the hope that as fast as these remedies drain off fluid from the
plasma it will be replaced by that which is effused pathologically.
Also they are given in conditions, as uraemia, in which it is
thought that there are poisons in the blood, in order that their
excretion may be hastened.

The composition of the plasma can also be altered directly
either by venesection or transfusion.

B. Drugs acting on the Red Corpuscles. The most
important are those which can increase the amount of haemo-
globin when that is deficient. Strictly speaking, all these have
a pathological and not a physiological action, for we know of no
drugs which will increase the amount of iron in perfectly healthy
blood. These drugs are called hsematinics.



They are

(1) Iron and its salts.

(2) Arsenous acid.

(3) Potassium permanga-

nate (doubtful).



(4) Copper salts ~|

(5) Hydrochloric acid

(6) Potassium salts

(7) Phosphorus



j- (doubtful).



They not only increase the quantity of haemoglobin in each
corpuscle, but also the number of red corpuscles. Their action is
much aided by good food, fresh air, and attention to the general
health, and especially to the digestive organs. The mode of
action of these haematinics is very obscure, and will be discussed
under each drug. Iron is by far the most important and effectual.

Indirect haematinics are drugs which benefit the patient
by removing some obvious cause for his deficiency in haemoglobin,
or anaemia, as it is generally termed. Such are mercury, given
for syphilis, quinine for ague, etc.

Alcohol and quinine diminish the oxygenating power of the blood, for
they render oxy haemoglobin a more stable compound than it usually is, but
their action in this direction is slight. Citrates and tartrates of the alkaline
metals are partially oxidized to carbonates at the expense of the oxygen of th>
red blood-corpuscles.



54 PHARMACOLOGY AND THERAPEUTICS.

The size of the red blood-corpuscles is said to be diminished by carbon
[dioxide], quinine and morphine, and to be increased by oxygen, hydrocyanic
acid, and quinine ; and their number is said to be increased by small doses of
mercury.

A large amount of sodium chloride causes the red corpuscles to pass
rapidly through the walls of the capillaries.

Quinine and hydrocyanic acid diminish the ozonizing power of the blood.

There are some drugs which are not employed therapeutically
for their action on the blood, which are nevertheless very im-
portant physiologically and toxicologically, for they kill by alter-
ing the composition of the haemoglobin, thus preventing
its uniting with oxygen. Such are carbonic oxide, which turns
out the oxygen from oxyhaemoglobin, hydrocyanic acid, which
forms cyano-haemoglobin, and potassium chlorate. Acetanilid,
antipyrin, phenacetin, and nitrites, especially amyl nitrite, con-
vert the haemoglobin into methaemoglobin ; acetanilid, amyl
nitrite, potassium chlorate, and pyrogallic acid destroy the red
corpuscles.

Phosphorus, arsenic, hydrogen [sulphide], turpentine, iodine, and sulphur
also reduce oxyhaemoglobin. Phosphorus is especially destructive to the blood.

When freshly drawn blood is exposed to the air its oxidization is dimin-
ished by hydrocyanic acid, alcohol, chloroform, quinine, morphine, nicotine,
strychnine, and brucine.

C. Drugs acting on the White Corpuscles. Most if
not all drugs which are poisonous to amoebae are poisons to white
corpuscles when applied in sufficient strength, which, however,
is rarely the case in the human body. All irritants which set
up inflammation cause the white blood-corpuscles to wander
through the capillary walls ; and all the cinchona alkaloids,
viz., quinine, quinidine, cinchonine, and cinchonidine, have the
power of arresting this migration ; of these, quinine is the most
powerful. [Berberine sulphate and] acetanilid are also
powerful. If the quinine is circulating in the capillaries, it pre-
vents the white corpuscles from wandering out ; if it is applied
to the outside of the vessels, it prevents the corpuscles from
wandering away from the vessel through the wall of which they



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