TINCTURA CIMICIFUGE (tincture of cimicifuga), dose f3ss-ij (2.0

8.0).

EXTRACTUM CIMICIFUGE (extract of cimicifuga), dose gr. iij-v (0.2-0.3).

CONVALLARIA.

What is convallaria?

Convallaria is the rhizome and roots of C. majalis, or lily of the valley (Nat. Ord. Liliaceae), a European plant naturalized in this country.

It contains two glucosides, convallamarin and convallarin, to the former of which it probably owes its action on the heart, while the latter appears to cause nausea, diarrhoea and gastric pain.

The results of the investigations regarding the physiological action of this plant are very contradictory, but it seems to slow the heart and increases the blood-pressure in small doses. In toxic doses the cardiac action becomes rapid, the arterial pressure gradually falls, and death occurs from heart-failure.

It is used in all cases of cardiac weakness whether accompanied by valvular lesion or not, as in dilatation or fatty heart. It is also used in palpitation.

EXTRACTUM CONVALLARIÆ FLUIDUM (fluid extract of convallaria), dose mv−xv (0.3–0.9).

ORDER II.-CARDIAC SEDATIVES.

What are cardiac sedatives?

Cardiac sedatives are medicines which are used to diminish the force and frequency of the cardiac contractions when they are morbidly increased, and thus to depress the circulation.

Name the principal cardiac sedatives.

Antimonials, aconite and its alkaloid, veratrum viride and its alkaloids, veratrine, gelsemium, pulsatilla, arnica, the vegetable acids.

ANTIMONIUM-ANTIMONY.

What are the sources of antimony?

Antimony is a metallic element found native in the form of black antimonious sulphide.

Mention some of the tests for antimony.

Sulphuretted hydrogen in solution forms with solutions of antimonial salts an orange-colored precipitate. The metal should also be reduced by Marsh's test, and chemically and microscopically distinguished from arsenic.

What are the general physiological effects of antimonials?

When applied locally to the skin, the salts of antimony produce an eruption of papules, which become pustules, somewhat resembling the eruption of smallpox. After prolonged use, the fauces sometimes present a similar eruption. Internally, in small doses, they are diaphoretic. In somewhat larger doses, they cause nausea, depressed circulation, weakness, and increase of the mucous and cutaneous secretions. In large doses, they prove emetic, with very weak pulse, great general depression and relaxation of the muscular system. In poisonous doses, they are gastro-intestinal irritants, causing emesis, catharsis with cramps in the extremities, and collapse, often resembling Asiatic cholera, and death from asthenia, sometimes preceded by tonic and clonic spasms.

Antimonials slow the heart, increase the duration of its diastole and diminish the force of its systole by direct depression of the cardiac functions; they lower the blood pressure partly by cardiac depression and partly by paralyzing the peripheral vaso-motor sys

tem. The pulse finally becomes rapid and very feeble, the pressure sinks almost to nil and the heart is arrested in diastole. They depress and paralyze the reflex, sensory, and, to a less extent, the motor functions of the spinal cord. The temperature is reduced by poisonous doses. The emesis is probably partly from local and partly from centric irritation.

When given for a length of time, they cause fatty degeneration of various viscera.

Antimony is eliminated by the mucous membranes, especially of the stomach, by the liver, kidneys and skin.

What is the treatment of poisoning by antimony?

Wash out the stomach to remove any poison present; give tannic acid as a chemical antidote, and opium and stimulants to overcome the resulting depression.

What are the medicinal uses of antimonials? ·

They are used as cardiac sedatives in the early stages of acute sthenic inflammations, but are probably inferior to aconite or veratrum viride for this purpose. They are very useful in the early stages of acute bronchitis and in acute laryngitis from their combined sedative, diaphoretic and expectorant qualities. As diaphoretics they are used in minute doses, frequently repeated, in fever mixtures, or combined with minute amounts of morphine, which increases their action. The depression which they produce should always be remembered.

As nauseants and emetics they are rarely resorted to, because of the great depression which they produce.

Sulphurated antimony, or the old Kermes mineral, is sometimes used as a nauseant in membranous croup.

Locally, as a counter-irritant it is rarely employed.

What are the antimonial preparations?

ANTIMONII ET POTASSII TARTRAS (antimonium and potassium tartrate-tartar emetic-tartarated antimony); dose, as a sedative, gr. - (0.01-0.03), increased to gr. j-ij (0.06–0.12), as tolerance to its action is established; as a diaphoretic and expectorant, gr. (0.004-0.016), in solution, repeated every 2 or 3 hours until the desired results are produced; as an emetic, gr. j-ij (0.06–0.13).

VINUM ANTIMONII (wine of antimony) contains 4 parts of tartar emetic in 1000 of the preparation (about gr. ij-f3j). Dose as a diaphoretic and expectorant mx-xxx (0.6-2.0); as an emetic f3j-iv (4.0-15.0).

SYRUPUS SCILLE COMPOSITUS (compound syrup of squill— Coxe's hive syrup) contains tartar emetic, 2 parts in 1000 of the preparation (about gr. j to the f3j). It is used in croup as an emetic and also as an expectorant; dose mv-f3j (0.3–4.0).

The following preparations are somewhat uncertain, and are rarely employed :

ANTIMONII OXIDUM (antimonious oxide), dose gr. j-ij (0.06-0.13). PULVIS ANTIMONIALIS (antimonial powder-James' powder) contains antimonious oxide 33 per cent. with precipitated calcium phosphate; dose gr. iij-x (0.2-0.6).

ANTIMONII SULPHIDUM (antimonious sulphide) and ANTIMONII SULPHIDUM PURIFICATUM ( purified antimonious sulphide) are used in making the other preparations.

ANTIMONII SULPHURATUM (sulphurated antimony-Kermes mineral), dose gr. j-iij (0.06–0.2); as an emetic gr. v-x (0.3-0.6).

PILULÆ ANTIMONII COMPOSITE (compound pills of antimony-Plummer's pill). Used as an alterative. Each pill contains of calomel and sulphurated antimony each gr. f (0.04).

ACONITUM-ACONITE.

What is aconite, and what is its chemical composition? Aconite is the tuber of Aconitum Napellus, aconite, monkshood or wolfsbane (Nat. Ord. Ranunculaceæ), a native of the mountains of Europe and Asia. The active principle is an alkaloid called aconitine. Other alkaloids have been discovered in it, viz.: aconine, isaconitine, and picraconatine.

What are its physiological effects?

Locally applied, aconite or aconitine benumbs the sensory nerves and causes a sensation of tingling. Internally in small doses it lessens the force and frequency of the cardiac contractions, diminishes the blood pressure, causes tingling in the lips, tongue and extremities and produces a feeling of weakness. When large doses are taken, these symptoms are more marked, the pulse becomes very weak and slow, a tendency to fainting is manifested on assuming the erect posture or on any exertion, and the respirations are reduced in number. After poisonous doses these symptoms are much intensified; the countenance is anxious, a cold sweat covers the body, the pulse and respiration are very slow, weak and irregular, general anææsthesia is present, and collapse and death from syncope, sometimes preceded by convulsions, occur.

Aconite affects the heart by directly depressing the cardiac muscle, and its contained motor ganglia. It probably also stimulates the cardio-inhibitory apparatus, but does not affect the vaso-motor nerves or centres. It paralyzes the peripheral end organs of both motor and sensory nerves, the latter being first affected by it, and the nerve trunks and centres being only involved as the poisoning deepens, The loss of reflex function is probably due to interference

with conduction. It depresses and finally paralyzes the respiratory

centre.

What is the treatment of poisoning by aconite?

Evacuate the contents of the stomach and wash it out by means of the stomach pump; keep the sufferer perfectly quiet, with his head low; give cardiac stimulants, as alcohol, ether or ammonia, and administer digitalis hypodermically.

What are the medicinal uses of aconite?

As a cardiac sedative aconite is of great value in the early stages of all acute inflammations and all fevers, in which the patient is vigorous and young and the pulse tense, full, bounding and strong, and is only contraindicated when the heart is weak, when there is gastro-enteric inflammation, or where a typhoid condition is present. Thus it is used to diminish the circulation, arterial tension and temperature, and to promote diaphoresis and diuresis in the sthenic forms of surgical fever, in acute coryza, acute broncho-pulmonary catarrhs, acute pleuritis and acute peritonitis, in acute meningitis either cerebral or spinal, and in the essential fevers, when not of the asthenic type. In scarlet fever and in measles (when the temperature is high), it is of great value, and is often used during the exacerbations of remittent malarial fevers. In lobar pneumonia veratrum viride is a safer remedy, but aconite will prove very serviceable if employed with great caution before consolidation has taken place.

In cardiac hypertrophy uncomplicated by valvular lesion, or even if the latter is present, provided the hypertrophy be in excess of the requirements of the system, it is an invaluable medicine.

As a local anaesthetic it has been advantageously given internally and applied externally in neuralgia, particularly of the face and head, and has been used locally in chronic muscular rheumatism and in rheumatic neuralgia.

What are the preparations of aconite and their doses?

EXTRACTUM ACONITI (extract of aconite), dose gr. -ss (0.008

0.03).

EXTRACTUM ACONITI FLUIDUM (fluid extract of aconite), dose mss-ij (0.03-0.123).

TINCTURA ACONITI (tincture of aconite), dose mj-v (0.06-0.3), frequently combined with other medicines in fever mixtures,