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vomiting, etc. A blister applied over the nerve will often re-
lieve pain in neuralgia. If a further counter-irritant effect is de-
sired, the blister, which is usually pricked, may be irritated by
the application of any irritating ointment. [Unguentum Sabinae ;
savine, 8 ; yellow wax, 3 ; benzoinated lard, 16 ;] was formerly
much used for this purpose.] This, however, is very painful,
and nowadays after the pricking some bland ointment is usually
applied. The cantharides preparation should not be left on
after the d* velopment of the bleb, lest the cantharidin should be
absorbM Cantharides should not be applied to a part on which



ANIMAL DRUGS WHOSE ACTION IS MECHANICAL. 699

the patient lies, for a bed-sore may form ; nor must it be used
in renal disease ; and it should be carefully employed in children
or debilitated persons. It ought not to be applied to paralyzed
limbs. [The cuticle raised by a blister may be used for skin-
grafting.]

Internal. The drug is rarely given internally, but it has
been used with success in small doses in cases of chronic gleet.
Sometimes, [but not often,] it relieves chordee. [Small doses
are sometimes useful in the late stage of acute desquamative
nephritis. It has been recommended for diabetes insipidus.
Cantharidin, in the form of potassium cantharidinate ( T ro gr.;
.ooo6gm. hypodermatically) has been used as a remedy for pulmo-
nary tuberculosis, and for lupus. For all that cures of both of
these diseases have been claimed, the value of this drug is by no

means established.]

TOXICOLOGY.

[Symptoms. ] In severe cases of poisoning there may be greatly increased
sexual desire, numerous seminal emissions, violent priapism, with swelling and
heat of the genital organs. In women cantharides may cause abortion or in-
duce menstruation. Post-Mortem. Intense gastro-intestinal inflammation is
present, consequently swelling, ecchymoses, and hpyersemia of the mucous
membrane of the alimentary canal are observed. The kidneys are found to be
very congested, and in the early stage of acute nephritis. There is also much
inflammation of the genito-urinary mucous membrane.

[Treatment. There is no chemical nor physiological antidote to Cantha-
rides. The stomach should be emptied by emetics (see p. 139), or washed out
by the stomach-pump. Mucilaginous and demulcent liquids should be freely
given. Opium is indicated to relieve the pain and gastro- enteritis.]

ICHTHYOLUM.

ICHTHYOL. [Not official.] Synonym. Ammonium Ichthyol-Sul-
phonate.

SOURCE. A bituminous quartz containing the fossil remains of fish
is distilled with [concentrated Sulphuric Acid, and the distillate is treated
with a concentrated solution of Sodium Chloride, whereby the Sulphuric
and Sulphurous Acids are removed.] The distillate is then saturated with
Ammonia.

CHARACTERS. A viscous, reddish-brown, almost black substance, having
a tarry odor and containing 15 per cent, of Sulphur. Solubility. Soluble in
Water, Glycerin, Oils and Fats.

Dose, 10 to 20 gr. ; [.60 to 1.20 gm.]



7OO ORGANIC MATERIA MEDICA.

Lithium, Sodium, and Zinc Ichthyol Sulphonates are prepared. [The
name Ichthyol is understood to refer to the Ammonium Salt.]

ACTION AND THERAPEUTICS OF ICHTHYOL.

[Ichthyol is an active reducing agent.] It is chiefly used ex-
ternally for chronic eczema and psoriasis. An ointment with
lanolin and ichthyol 20 to 50 per cent, [is recommended by Von
Nussbaum for the treatment of erysipelas. It has been used in
the form of a suppository for chronic prostatitis.] Ichthyol
paste (starch, 40, moisten with water, 20, rub in ichthyol, 40,
and then a strong solution of albumin, i or more) is recom-
mended for acne rosacea. Ichthyol has been given as a pill for
chronic rheumatism in dose from 10 to 30 gr.; [.60 to 2.00 gm.
Under the name of Thiol, a mixture of sulphuretted hydrocar-
bons has been used as a substitute for ichthyol, because it is less
offensive. It has been applied as an ointment in vaseline, (i

to 8).]

HIRUDO.

THE LEECH. [B. P., not official.] Two species are employed:
(i) Sanguisuga medicinalis, the speckled leech (belly greenish-yellow,
spotted with black); (2) Sanguisuga officinalis, the green leech (belly olive-
green, not spotted), (nat. ord. , Annelida).

CHARACTERS of both species. Body soft, smooth, [5] or more [cm.]
long, tapering to each end plano-convex, wrinkled transversely, back olive-
green, with six rusty-red longitudinal stripes. Each leech has a muscular disc
at each end. In the centre of the anterior one is a tri-radiate mouth, provided
with three saws and two rows of teeth.

[The leech, although not a drug, is considered with this group for con-
venience. ]

ACTION AND THERAPEUTICS OF THE LEECH.

Leeches are used to remove blood. They are usually applied
over deep seated organs when they are congested, and great re-
lief is often afforded. For example, three or four leeches near
the liver, when that organ is enlarged in heart disease, or one
or two behind the ear, when the tympanic cavity is inflamed
frequently do good. The leech being applied to the skin, the
animal fixes itself by its sucker-like disc, makes a tri-radiate cut
with its mouth, and draws into its body, which consequently be-



THE ORGANIC EXTRACTS. /OI

comes swollen, about a drachm and a half [6. c.c.] of blood.
If this is not sufficient, a hot fomentation put on, after the ani-
mal is removed, may increase the quantity to half a fluid ounce ;
[15. c.c.]. The skin should be well washed with a little milk
before the leech is applied. Occasionally the haemorrhage re-
quires pressure, or some local styptic, as ferric chloride [or
better styptic collodion] , to stop it. If leeches have to be ap-
plied to the mouth, rectum, or uterus, leech glasses, which only
allow the head to protrude, should be used.



GROUP VIII.

[The Organic Extracts.

Thyroid, Suprarenal, and Brain Extracts, and Testicular Juice.

None of these are official. ]

THYROIDEUM SICCUM. Dry Thyroid [B. P., not official]. A
powder prepared from the fresh and healthy thyroid gland of the sheep.

SOURCE. Remove the fat and connective tissue directly the sheep is killed.
Reject cystic, hypertrophied or otherwise abnormal glands. Mince. Dry at
90 to 100 F. [32.2 to 37.7 C.]. Powder the dried product. Remove
all fat by washing with petroleum spirit and again dry.

CHARACTERS. Light dull-brown powder with faint meat-like odor and
taste and free from odor of putrescence. Liable to become damp and then it
deteriorates.

COMPOSITION. The chief constituent is a proteid, which exist* in the col-
loid matter and is called Thyroidin ; it contains 9.3 per cent, of iodine and
o. 5 per cent, of phosphorus.

Dose, 3 to 10 gr. ; [.20 to .60 gm.]

LIQUOR THYROIDEI.- [Solution of Thyroid. B. P. , not official. ]
A liquid prepared from the fresh and healthy thyroid gland of the sheep.

SOURCE. The fresh healthy glands are bruised with, for each gland, 34
minims [2.20 c.c.] of glycerin and 34 minims [2.20 c.c.] of a 0.5 per cent,
solution of [carbolic acid]. Let stand for 24 hours, strain and add enough
of the carbolic acid [solution] to make 100 minims [6.70 c.c.].

CHARACTERS. A pinkish, turbid liquid, free from odor of putrescence.
To be freshly prepared and kept in stoppered bottles. Strtngth. 100 minims
6.70 c.c.] represent one gland.

COMPOSITION. As of the powder.

Dose, 5 to 15 m. ; [.30 to i.oo c.c.]



7O2 ORGANIC MATERIA MEDICA.

ACTION OF THYROID EXTRACT.

Circulation. Thyroid administered to man increases con-
siderably the rate of the pulse, causes palpitation, enfeebles the
cardiac beat, and makes the skin flushed and moist. Experi-
ments on animals have failed to reveal the precise cause of this.
The blood-pressure falls when a decoction of the gland is in-
jected ; the fall is vasomotor, for the heart is not affected. Or-
dinary doses produce no effect on the blood except an increase
of lymphocytes.

Excretion. The active constituents of thyroid gland are
probably excreted entirely through the kidneys. Large doses
may cause diarrhoea.

Metabolism. The administration of thyroid leads to a greatly
increased oxidation of all the tissues, consequently an excess
of urea, uric acid and xanthin bases are excreted in the urine
and more [carbon dioxide] by the lungs. It follows that large
doses of thyroid reduce the body weight.

Kidneys. The quantity of urine is increased by thyroid gland,
which may cause sugar to appear in the urine.

Nerupus system. Occasionally a fine tremor, restlessness, and
insomnia are caused by large doses.

THERAPEUTICS OF THYROID EXTRACT.

It is known that human beings or monkeys whose thyroid is
excised become myxoedematous, and that all sufferers from
myxcedema have atrophied thyroid glands. If a preparation of
sheep's thyroid is given to patients suffering from myxoedema, all
the symptoms disappear, usually in about six weeks. The effect
is as striking as anything in medicine. The [solution] is better
than the powder, for that may decompose. It is best to begin
with 5 m., [.30 c.c.] thrice daily, in water, gradually to increase
the dose till 10 m., [.60 c.c.] are given, and when all symp-
toms have disappeared it will be necessary for about 10 m., [.60
c.c.] to be taken twice a week for the rest of the patient's lite
to prevent recurrence. When the treatment was first introduced
the glands were eaten, or transplanted under the skin, or the ex-



THE ORGANIC EXTRACTS. 703

tract was administered subcutaneously ; but equally good results
are obtained by giving the [solution] or the powder by the
mouth : compressed tablets of the powder are very convenient
and much used. A diminution of certain goitres follows the
giving of thyroid, but it is useless in exophthalmic goitre.
Cretinism is also marvellously benefited, both mentally and
bodily, by thyroid preparations, especially if given early in the
patient's life. A few cases of imbecility in children, a few of
climacteric insanity, and a few of tetany have been much im-
proved by thyroid. Chronic psoriasis, which has resisted all
other treatment, often disappears if the patient be put to bed and
take daily enough of thyroid preparations to keep him on the
brink of poisoning by them, but unfortunately the disease often
returns when the treatment is discontinued.

Thyroid preparations have been much used for obesity, but
the practice is not to be recommended. They must be carefully
given to those suffering from cardiac disorder. A preparation
called lodothyrine, which contains the active principles of the
gland, has been used lately. [A milk-sugar triturate of this is
given in daily dose of 15 to 30 gr.; i. to 2. gm.]

Poisoning. An overdose of a thyroid preparation causes an
exaggeration of the effects already described. The most evident
are rapid pulse, slight pyrexia, headache, nausea, diarrhoea, rest-
lessness, pains in the limbs, pruritus, and rarely delirium. These
symptoms are termed " Thyroidism." If large doses be given
to monkeys for a long period of time, a condition termed
" Chronic Thyoidism " is produced. The symptoms of it are
emaciation, muscular weakness, paresis, some alopecia, erection
of some of the hairs on the head, proptosis, dilatation of pupils,
widening of palpebral fissure, and death from asthenia. In
some respects these monkeys resemble patients suffering from
exophthalmic goitre. [Very large doses taken for a long time
make patients thin and also produce degeneration of the cardiac
muscle so that permanent disability may result. Surgeons are
especially liable to make this error.]

SUPRARENAL EXTRACT [Not official] is prepared from the supra-



704 ORGANIC MATERIA MEDICA.

renal capsules of the sheep, [ox and pig]. The active principle exists only in
the medulla of the gland. It may be given in tablets.
[Dose, 5 to 20 gr. ; .30 to 1.20 gm.]

ACTION AND THERAPEUTICS OF SUPRARENAL EXTRACT.

This has been shown experimentally [to increase the tone of
all muscular tissue, mainly if not entirely by direct action (Oliver
and Schafer), to constrict the small arteries through its action on
the vasomotor centre (Szymonowicz and Cybulski), and to raise
blood-pressure more than any other known substance.] It in-
hibits the heart through the vagus and produces a muscle curve
like veratrine. [It may be used as a local vaso -constrictor in
minor surgery. On account of this property it may be applied
to inflamed tissues so that these may be rendered anaesthetic by
cocaine. For topical application a filtered, freshly-made aque-
ous solution should be employed ; it may be sterilized by heat
without destroying its active principle. All antiseptics, used as
preservatives, are disappointing. The active principle has been
isolated by Abel for which he proposed the name epinephrin.
Its salts produce an exceedingly powerful effect on blood-pres-
sure.] Treatment should begin with i gr.; [.06 gm.], of the
extract as [powder dry on the tongue and swallowed without
water] thrice daily, but the dose should be rapidly pushed [to
5 gr.; .30 gm.]. The gastric contents have no effect upon the
extract. [It should never be given hypodermatically on account
of the collapse which it causes when administered in this way.
It is of great value in the treatment of " Hay-fever " given in-
ternally and also applied locally. It is useful in the treatment
of acute and chronic bronchitis, bronchial asthma, congestion
and oedema of the lungs, haemoptysis, and oedema of the glottis.
It may be cautiously used in diseases of the heart, which it
stimulates from direct action on the heart muscle.] Some writers
claim that it benefits Addison's disease, but others have failed to
notice any improvement.

[BRAIN EXTRACT. (Not official.) The gray matter of a sheep's
brain is sterilized, macerated in aseptic glycerin and filtered by the method of



THE ANTITOXINS AND SERUMS. /O5

D'Arsonval, being sterilized under carbon dioxide gas of a pressure of thirty
atmospheres.

Dose, 15 m., i.oo c c., hypodermatically.

USES OF BRAIN EXTRACT.

Paul has made use of this for the treatment of various nervous
disorders and claims excellent, although not always constant,
results. Febrile reaction, prostration, and in some cases cardiac
weakness, has followed its administration.

TESTICULAR JUICE (Not official) is prepared in the same way as
brain extract.

Dose, 10 to 20 m. ; .60 to 1.20 c.c., hypodermatically.

USES OF TESTICULAR JUICE.

Brown-Sequard believed that certain organs supply to the
body a natural ferment which is essential to health. When this
ferment is absent the vital forces degenerate. Under the use of
this fluid the functions of organic life are performed with new
vigor. Favorable reports of its use in many hundreds of patients
suffering from organic nervous diseases are on record.]

Extracts of many other organs, especially bone marrow and
thymus, have been employed in medicine, but there is so little
evidence that they are of any use that they need not be referred
to here.



GROUP IX.

[The Antitoxins and Serums.

Diphtheria and Tetanus Antitoxins, Antistreptococcic, Antipneumo-

coccic, and Antivenomous Serums, Plague, Cholera and Typhoid

Serums and Inoculations, Nutrient Serum, and Hydrophobia

Antidote.

None of these are official.]

DIPHTHERIA ANTITOXIN. [Not official.] When the bacillus
of diphtheria grows in the body it produces toxins, albumoses, and an organic
acid, 'and provokes the formation of a substance (called an antitoxin) which is
found in the blood. This antitoxin is an antidote to the toxin of the diph-
theria bacillus, and it is largely owing to the production of it that the patient

45



706 ORGANIC MATERIA MEDICA.

is enabled to survive, and his chances of surviving are enhanced if antitoxin is
administered to him to aid that which is formed in his body.

SOURCE. Diphtheria bacilli are grown in a flask containing some nutrient
broth (e.g., meat broth), to which 0.5 per cent, of sodium chloride and 2 per
cent, of commercial peptone have been added. At the end of some weeks the
bacilli are filtered off, and the fluid left contains a large amount of diphtheria
toxin, and it should be of such strength that .01 c.c. [i^ m. ] of it will kill a
good-sized guinea pig. From .02 to l.oo c.c. [3 to 15 m.] of it is aseptically
injected into the jugular vein of a horse; this produces slight symptoms. As
soon as they are past a larger dose is injected, and so the dose is gradually in-
creased until loo c.c. [25 fl. dr.] or more are given at each injection. This
leads to the formation of a large amount of antitoxin in the blood serum. At
the end of some months the horse is bled to 8 liters [quarts] in a sterilized
vessel, the blood coagulates, and the antitoxic serum is put into sterilized
bottles and hermetically sealed, a little carbolic acid or other antiseptic being
added to prevent decomposition.

The details may be modified, as horses vary in their reaction to the toxin,
and toxins vary in strength, but the essentials of the method always remain
the same.

Mode of Administration. The antitoxic serum has been shown to be use-
less when given by the mouth, perhaps because it is destroyed in the liver.
Therefore it is always injected subcutaneously ; usually between the shoulders
or on the side of the abdomen. Before injection the skin must be thoroughly
washed with an -antiseptic, and all ordinary antiseptic precautions should be
taken. After injection the puncture should be healed with antiseptic gauze,
iodoform and collodion. The antitoxin should be taken from a fresh bottle.
A special syringe, so constructed that all the parts of it can be boiled before
use is employed.

Dose. It is better to give a small dose of a concentrated rather than a
large dose of a dilute antitoxin. The dose is the same for children and adults.
The strength of it, which is stated on the bottle, varies between 200 and 2500
units per cubic centimeter, but it is usually about 500. The antitoxin must be
obtained from a reliable source. The quantity given should be such that from
4000 to 12,000 units or even more are injected in the first twenty-four hours
after the patient comes under treatment. This amount may be divided into
two or three doses, but should be repeated on the second and third days, if
accessary. A unit is the smallest quantity of antitoxic serum, which when
mixe*with a certain quantity of a standard diphtheritic toxin and with it in-
jected into the subcutaneous tissue of a healthy guinea-pig weighing from 250
to 300 grammes [8 to 10 oz. ], protects the animal from death within four days.

It is impossible in a work like this to give a more precise definition, for all
diphtheritic toxin consists of a toxin proper, which is poisonous, and toxoid
bodies which, although not poisonous, will neutralize the antitoxic properties
of antitoxic serum. Therefore, to standardize antitoxic serum it must be tested
against diphtheritic toxin in which the proportion of toxins proper and toxoids



THE ANTITOXINS AND SERUMS. 7O/

and the neutralizing activity of the latter as regards antitoxin are known and
constant. Such a standard toxin is kept in the Government testing department
in Berlin, and the strength of all diphtheritic antitoxins should be expressed in
terms of it.

ACTION AND THERAPEUTICS OF DIPHTHERIA ANTITOXIN.

Antitoxin serum diminishes all the symptoms of diphtheria,
and in particular it greatly lessens the liability to sudden heart
failure. If the diphtheria toxin be 'administered to animals fatty
degeneration of the heart is found after death, but if they have
also had antitoxin this is absent. Both clinical and experimental
evidence show that after antitoxin is given, although the bacilli
continue to exist in the throat, the formation of membrane
ceases and that which is present rapidly disappears ; therefore
laryngeal diphtheria rarely follows faucial if antitoxin is used
early, the patient becomes less anaemic, his pulse improves, and
his temperature may fall a little, although this is less influenced
by antitoxin than are the other symptoms of diphtheria. The
maximum effect of the antitoxin is not seen until twenty-four
hours after injection. All reliable collections of cases show that
the mortality, especially in children, is much less when the anti-
toxin is used. It should be given at the earliest possible moment,
even if it is only likely that the patient is suffering from diph-
theria, for the number of fatal cases is less when antitoxin is used
early in the illness. The benefit is more marked in laryngeal
than in otner varieties of diphtheria, the mortality of trache-
otomy cases falling by one half. The frequency of the occur-
rence of paralysis is not diminished, but the percentage of re-
coveries in cafes with paralysis is slightly increased.

Symptoms of poisoning are sometimes seen after this anti-
toxin has been given, but they are unimportant. They are not
due to the antitoxin in, but to some other constituent of the
serum, for they may follow when the simple serum of animals is
injected into the human subject. The most common is a rash,
met with in about 35 per cent, of the patients injected ; it may
appear as late as the end of the third week after injection, but
it is usually seen at the end of the first week. In a few cases a
second rash is observed after the first has faded. Usually it is a



708 ORGANIC MATERIA MED1CA.

mere erythema, but it may be papular or uticarial. Commonly
it disappears in three days. Pains in the joints and slight swell-
ing of them are occasionally present [and finally somewhat rarely
there has been observed an irregular temperature range and con-
secutively emaciation and death ; evidently pointing toward an
acquired septicaemia. Further in a few cases an early fatal re-
sult has been reported. Browne and Benda both have shown
that in a fatal issue, nephritis, in the majority of cases, is the
cause of death, and clinically haemorrhagic nephritis is by no
means rare. Inasmuch as this remedy militates solely against
the infection of the Klebs-Loeffler bacillus and clinically most
cases of diphtheria are cases of mixed infection, the usual local
antiseptic and general supporting measures must not be omitted.
The danger of antitoxin lies in the horse-serum, for, many years
before antitoxin was made, the results of injection of an alien
serum had been pointed out. Concentrated serums then should
be preferred in that they give the largest amount of antitoxin
with the smallest amount of serum.

So far as prophylaxis is concerned, the question is still sub
judice, many failures are reported, and indeed instances of rein-
fection have occurred even after suitable doses of antitoxin have
been used during a previous attack.]

TETANUS ANTITOXIN. [Not official.] This is prepared on the
same principles as diphtheria antitoxin, and is administered in the same way
or directly into the brain. No marked success has attended its use, perhaps
because tetanus is not usually [recognized] till long after infection, and per-
haps because the tetanus toxin is very firmly united with the proteids of the
central nervous system. [Recent reports indicate that this Antitoxin, particu-
larly when injected directly into the brain, will soon take its place as a valuable
and trustworthy remedy for this disease. ]

ANTISTREPTOCOCCIC SERUM. (Not official.) Streptococci
do not cause the diseases due to them by developing a toxin which circulates
in the blood, but by being themselves carried all over the body, which at-
tempts to kill them by developing a toxin fatal to them. To prepare anti-
streptococcic serum the virulence of the streptococci is increased by their pas-
sage through several rabbits ; they are then grown on a medium which
preserves their virulence. A horse is next treated with successive doses of
cultivations of these living streptococci, each more potent than the former.



THE ANTITOXINS AND SERUMS. 709

At the end of the year the strength of the antitoxic serum of the horse is power-
ful enough for use. This is always given subcutaneously and the dose varies
with different specimens of serum.

ACTION AND THERAPEUTICS OF ANTISTREPTOCOCCIC SERUM.

Our experience of the value of antistreptococcic serum is
limited, but it suggests itself as useful for those diseases which
are principally due to infection by streptococci. Such are
malignant endocarditis, erysipelas, surgical septicajmia, disease
of the middle ear, thrombosis of the lateral sinus, and puerperal
septicaemia. Successful cases of its use in these disorders have
been recorded, and it might be used with advantage in any of



Online LibraryWilliam Hale-WhiteMateria medica, pharmacy, pharmacology and therapeutics → online text (page 62 of 67)