EXTRACTUM CONII FLUIDUM (Auid extract of conium), dose mj-v (0.06-0.3).

As different samples of the drug vary much in the amount of conine contained, it is safer to begin with a small dose, to be gradually increased until some effect is obtained.

What is woorara?

WOORARA.

Woorara (not official), called also woorali and curare, is an extract prepared by the South American Indians from Strychnos toxifera and other species of Strychnos (Nat. Ord. Loganiaceæ), and is used by them as an arrow-poison. It contains an alkaloid called curarine. What are its effects and uses?

It is eliminated so rapidly that usually when administered internally no symptoms result. When it enters the system through a wound or by hypodermic injection it paralyzes the peripheral endings of the motor nerves, and if the dose be sufficiently large the vagus and the ends of the sensory nerves are also paralyzed. After a time the nerve trunks and the spinal cord are also affected. The voluntary muscles are uninfluenced. Large amounts lower the blood pressure and finally depress the heart. Death results from paralysis of the motor respiratory nerves. Small doses increase all the secretions. It is eliminated chiefly by the urine.

The treatment of woorara-poisoning consists in frequent catheterization to prevent resorption, artificial respiration, and atropine and strychnine, hypodermically as antagonists. They can scarcely be relied on.

Woorara is used as a depresso-motor in tetanus and in hydrophobia, and has also been employed in epilepsy and in chorea. It is given in doses of gr. (0.006), or its alkaloid, curarine, may be used in doses of gr. 20-160 (0.0003-0.0006).

TABACUM-TOBACCO.

What is tobacco, and what does it contain?

Tobacco is the commercial, dried leaves of Nicotina Tabacum (Nat. Ord. Solanaceae). It contains nicotine, a volatile liquid alkaloid; nicotianin (tobacco-camphor) and an empyreumatic oil.

What are its effects and uses?

To persons unaccustomed to its use, tobacco or nicotine is a depressant, nauseant and emetic, and causes dizziness and weakness. When a toxic dose is taken, purgation, diuresis, cramps or convulsions, followed by great muscular weakness and, finally, paralysis, a rapid, feeble and compressible pulse, collapse and death from paralysis of the respiratory muscles.

It first stimulates the spinal centres (thus causing convulsions), but probably finally paralyzes them. It first excites and then abolishes the functions of the peripheral endings of motor nerves, the nerve trunks being afterward affected, but has no influence on voluntary muscles. The cardiac action is first depressed from some unexplained cause, afterward much increased, probably from paralysis of the peripheral inhibitory nerves, and the blood pressure, which at first falls, is afterward elevated. Nicotine contracts the pupil, whether applied locally or administered internally.

Tobacco increases intestinal peristalsis, and is probably eliminated chiefly by the urine, which it greatly increases.

The treatment of nicotine poisoning consists in emetics or washing out the stomach, tannic acid and strychnine with artificial respiration. Tobacco is not much used at present as a depresso-motor, but may be employed for this purpose in tetanus and in strychnine poisoning. In persons unaccustomed to its use, smoking a strong cigar may relieve an attack of spasmodic asthma. As a local anodyne, it has been used as a poultice to painful ulcers, as an ointment to inflamed hemorrhoids, and as a lotion to relieve pruritus. Great caution should be observed, as its local use has resulted in poisoning and death. There are no official preparations. Dose gr. j-iij (0.06–0.19), in infusion, which in poisoning by strychnine or in tetanus must be frequently repeated until some results are obtained.

10

(B) ON THE ORGANS OF CIRCULATION.

ORDER I.-CARDIAC STIMULANTS.

What are cardiac stimulants?

They are medicines which are administered with a view of increas ing the power of the heart or the force of the circulation.

Mention the remedies of this order.

Alcohol, ether, the ammonium preparations, amyl nitrite, nitroglycerin, atropine, digitalis, caffeine, adonidine, strophanthus, sparteine, strychnine, cimicifuga.

What is alcohol?

ALCOHOL.

Alcohol (ethyl hydrate) results from the fermentation of substances containing grape sugar. It is a colorless, inflammable liquid, uniting in all proportions with water. Alcohol contains 94 per cent. by volume of absolute alcohol, which is not used in medicine. What are the physiological effects of alcohol?

Locally applied it is an astringent. It evaporates rapidly and produces a feeling of cold, but if evaporation is prevented it acts as an irritant. When its vapor is inhaled it causes anæsthesia, coma and death. Taken internally in small doses it increases appetite and digestion, temporarily increases the force and frequency of the cardiac systole, dilates the vessels, thus causing a sensation of warmth, and diminishes the amount of urea and of carbonic acid eliminated. The continued use of small doses disorders the digestion and the hepatic functions, produces gastric catarrh and hyperplasia of the connective tissues, resulting in sclerosis of different viscera, and tends to the production of fatty degeneration of the walls of the vessels and various organs.

Large doses disorder digestion and cause the well-known alcoholic intoxication with muscular incoördination and weakness, hallucinations, lowered temperature, depression of the heart and reflexes, and stupor.

After toxic doses death from respiratory or cardiac failure may rapidly result, preceded by insensibility, stertorous breathing and coma, and occasionally by convulsions.

In small doses it stimulates the cardiac motor ganglia and the

heart muscle, followed, if a large dose be taken, by depression and paralysis of the cardiac muscle. Large doses also paralyze the vasomotor system and dilate the vessels.

Small doses slightly increase the temperature of the body, but large doses reduce it by interfering with the oxygen-carrying function of the red corpuscles and with the nutritive process, and by dilating the cutaneous vessels. Respiration is first quickened, then slowed, and after fatal doses, paralyzed. It is a cerebral stimulant, but in toxic doses depresses the encephalic mass, the spinal reflex centres, the conductivity of both motor and sensory nerves, and finally the reflex functions of the medulla. It diminishes the excretion of nitrogenized waste, and is eliminated principally by the kidneys, lungs and skin, although a certain amount (more in proportion to the smallness of the dose) disappears in the system.

How should acute alcohol-narcosis be treated?

The contents of the stomach should be evacuated, ammonia or strychnine should be given, and the hot and cold douche alternately used.

What are the medicinal uses of alcohol?

As a cardiac stimulant, alcohol is used in syncope from exhaustion, loss of blood, surgical shock and other forms of fainting, and where cardiac failure is threatened, as in typhoid and typhus fevers.

As a general stimulant to the system in all wasting diseases, as phthisis, scrofula and prolonged suppuration, and in all low states of the system, as typhoid and typhus fevers, diphtheria, pyæmia and septicaemia. In these fevers a tolerance to alcohol is present, and it may be given in large quantities without causing intoxication. It not only aids the digestion of food in these conditions, but as very little of what is taken can be found in the excretions, it seems to be used by the system, and consequently may be classed as a food in these diseases. The dose in these diseases must be regulated by the pulse principally. When the pulse is quickened and more bounding, the face flushes, the temperature rises, and the breath smells strongly of alcohol, the patient is taking more than the system can use, and the dose should be decreased.

As an antidote to snake bite or other cardiac depressant, as aconite or verctrum viride, it is of great service. In poisoning by snake bite

it is given in frequently repeated doses almost ad libitum, conjoined with intravenous or, at least, hypodermic injection of ammonia.

To improve digestion and nutrition, it is useful in many chronic diseases, but the danger of forming the alcohol habit should always be borne in mind when it is thus prescribed.

Locally, alcohol is used as an antiseptic and stimulant dressing for wounds, to harden the cuticle when bed sores are imminent, and as a tonic and cooling lotion.

What are the official preparations of alcohol?

ALCOHOL ABSOLUTUM (absolute alcohol) is ethyl alcohol containing not more than 1 per cent., by weight, of water. It is not used medicinally.

ALCOHOL DEODORATUM (deodorized alcohol) is a liquid composed of about 92.5 per cent. by weight, or 95.1 per cent. by volume, of ethyl alcohol and about 7.5 per cent. by weight of water.

It is used in making various medicinal preparations into which alcohol enters.

ALCOHOL (alcohol) contains 94 per cent. by volume of absolute alcohol; sp. gr. 0.820.

ALCOHOL DILUTUM (diluted alcohol) contains 48.6 per cent. by volume of absolute alcohol; sp. gr. 0.936.

SPIRITUS FRUMENTI (whiskey), an alcoholic liquid obtained by the distillation of the mash of fermented grain (usually of mixtures of corn, wheat, and rye), and at least 2 years old; it contains 50 to 58 per cent. by volume of alcohol; sp. gr. 0.917-0.930).

SPIRITUS VINI GALLICI (brandy) an alcoholic liquid obtained by the distillation of fermented, unmodified juice of fresh grapes, and at least 4 years old; it contains from 46 to 55 per cent. by volume of alcohol; sp. gr. 0.925-0.941. It contains some tannic acid, and is astringent. It is, therefore, preferable to whiskey if there is looseness of the bowels. It also is a stomachic sedative, and, next to champagne, tends to check vomiting more than any other alcoholic liquid.

VINUM ALBUM (white wine), an alcoholic liquid, made by fermenting the juice of fresh grapes, the fruit of Vitis vinifera (Nat. Ord. Vitaceae), freed from seeds, stems, and skins, contains 10 to 14 per cent. by weight of absolute alcohol.

VINUM RUBRUM (red wine), an alcoholic liquid made by ferment