death by respiratory paralysis, generally preceded by convulsions, which are not of cerebral origin. It has been recommended as a substitute for ergot in uterine inertia, post-partum hemorrhage, and to aid the expulsion of uterine myomata. It has been used in chronic metritis, and although not as efficient as ergot, is useful in menorrhagia. EXTRACTUM GOSSYPII RADICIS FLUIDUM (Auid extract of cotton root), dose f3ss-j (2.0-4.0). Although quinine is used for this purpose, it probably posseses no action on the uterus per se, but as an antiperiodic or as a tonic, is capable of overcoming the morbid conditions (as malaria) which, by depressing the system at large, may prevent normal, healthy uterine contractions. ORDER IV.-UTERINE SEDATIVES. What are uterine sedatives? They are medicines which are employed to depress the uterine muscular or nervous apparatus and restrain violent, irregular or untimely uterine contractions. What medicines are used for this purpose, and when are they employed? They are principally useful during pregnancy, to prevent abortion which is threatening, but not inevitable. They are also of service in arresting the irregular uterine contractions which sometimes occur prior to labor, and are called "false labor pains." For the former purpose opium, cannabis indica and the motor depressants-as chloral, the bromides, tartar emetic and viburnum prunifolium, especially the first- and last-named remedies-are used, while for the latter opium and chloral are employed. To moderate too violent contractions during labor, ether is the best remedy. Of these medicines all have been described except VIBURNUM PRUNIFOLIUM. What is viburnum prunifolium? It is the bark of V. prunifolium, sloe or black haw (Nat. Ord. Caprifoliaceae), a small indigenous tree. It contains valerianic acid, a bitter principle (viburnin), resin, tannin, etc. Its physiological effects are not understood. It appears to diminish reflex irritability and to have a sedative effect on involuntary muscular fibre and possibly lowers blood-pressure. Toxic effects are only seen after enormous doses have been administered, and consist of headache, dryness of the mouth and throat, and disordered vision. It has been employed as a uterine sedative in habitual and in threatened abortion, in congestive and neuralgic dysmenorrhoea, in menorrhagias and in nervous disturbances occurring at the climacteric period, in post-partum dolores when no clots or fragments of the placenta remain in the uterus, and in false labor-pains. It has also been used in colicky diarrhoea and dysentery, and is even recommended for cramps occurring in the voluntary muscles. EXTRACTUM VIBURNI FLUIDUM (fluid extract of viburnum), dose f3ss-ij (2.0-8.0) in elixir of orange. ORDER V.-EMMENAGOGUES. What are emmenagogues? Emmenagogues are medicines employed to increase or reëstablish the menstrual flow when it is scanty or suppressed from other causes than pregnancy or the climacteric period. When the catamenia are arrested from pregnancy, medicines used to bring them on cannot but be injurious to the woman, as the doses necessary are sufficient to cause poisoning, one of the symptoms of which may (or may not) be uterine hemorrhage. This is especially true of cantharides and of the volatile oils. What medicines are used as emmenagogues? When amenorrhoea depends upon anæmia or chlorosis the best emmenagogues are iron (combined with aloes or myrrh), arsenic or manganese. When local anæmia or an atonic condition of the uterus is present, aloes (q. v.) is very useful. If, on the other hand, pelvic plethora exists with constipation and a scanty flow often of a thick black discharge accompanied with pelvic pain and fullness, the saline cathartics are employed. In suppression of the menses from cold, aloes and potassium permanganate are usually more successful. In amenorrhoea due to an atonic condition of the uterus, the more stimulating emmena gogues are given, generally with aloetic purgatives. STIMULATING EMMENAGOGUES. Name the stimulating emmenagogues. What is savine? SABINA-SAVINE. Savine is the tops of Juniperus Sabina (Nat. Ord. Coniferæ), a small evergreen shrub of Southern Europe. It contains a volatile oil. When applied locally savine is irritant. In medicinal doses it increases the circulation, is a gastric, uterine and renal irritant, and proves diuretic. In overdoses it is a gastro-intestinal irritant with great depression, unconsciousness, convulsions, hemorrhages from the uterus and kidneys, suppression of urine and, in pregnant females, abortion. Death occurs from collapse. Savine is used in relaxed states of the uterus and uterine vessels, and has proved successful in the treatment both of amenorrhoea and menorrhagia when due to atonic condition of this organ. EXTRACTUM SABINE FLUIDUM (fluid extract of savine), dose mv-x (0.3-0.6). OLEUM SABINÆ (oil of savine), the best preparation for internal use; dose gtt. v-x (0.3-0.6), in capsules or emulsion, every 3 or 4 hours. What is tansy? TANACETUM-TANSY. Tansy is the leaves and tops of Tanacetum vulgare (Nat. Ord. Compositæ). It contains a volatile oil and a bitter principle (tanacetin). It is a gastro-intestinal irritant and diuretic, and in large doses causes death from respiratory paralysis, preceded by epileptiform convulsions of cerebral origin, and unconsciousness. It is used as a stimulating emmenagogue, but is a very dangerous remedy. The minimum fatal quantity is unknown. Dose gr. x-xxv (0.6–1.5), in infusion; of the oil, mj (0.06) may be given. APIOL. What is apiol? Apiol (not official), or parsley-camphor, is obtained from the volatile oil of the root of Petroselinum sativum (Nat. Ord. Umbelliferæ). It is very efficacious as a stimulating emmenagogue in functional and anamic amenorrhoea and in neuralgic dysmenorrhoea, but is contraindicated in any condition of plethora. Dose gtt. iij-x (0.18-0.6) in gelatin capsules given morning and evening for 4 or 5 days before the expected menstrual period. The French capsules or pearls usually contain gr. iij (0.25) of apiol. CANTHARIDES-GUAIAC. What are these substances? Cantharides will be considered under "Irritants." The tincture is used as a stimulating emmenagogue, dose miij-v (0.18–0.3), t. i. d., great care being taken to avoid strangury. Guaiac has been considered with the "Alteratives." (D) ON THE ALIMENTARY CANAL. ORDER I.-EMETICS. What are emetics, and how do they act? Emetics are medicines which are given to induce vomiting. They may act either by directly irritating the stomach, thus causing expulsion of its contents in a reflex manner, when they are called local emetics, or by acting, after absorption, on the reflex centre of the medulla which governs emesis, when they are called systemic emetics. It does not always follow that a remedy is a systemic emetic because it causes vomiting when given hypodermically or per rectum, for it may be eliminated by, and produce irritation of, the gastric mucous membrane, thus exciting reflex vomiting. For what purposes are emetics used? Emetics are used (1) to unload the stomach; (2) to depress the circulatory system by inducing nausea (as in the early stages of bronchitis or of tonsillitis, in which emetics, frequently repeated in small doses, will sometimes arrest the inflammation); (3) to relax the muscular system and relieve spasm (as in spasmodic croup); (4) to promote secretion and excretion; (5) to expel foreign bodies or secretions from the air passages, and (6) as revulsives. What are the contraindications to their employment? They should never be employed in cases of cerebral or gastric inflammation, and should be used cautiously, if at all, in the latter stages of pregnancy, in hernia, or where great depression exists, as in the latter stages of capillary bronchitis or of croup. Name the medicines employed as emetics. The vegetable emetics are ipecac, apomorphine and mustard. The mineral emetics are zinc sulphate, copper sulphate, alum, turpeth mineral and tartar emetic. IPECACUANHA-IPECAC. What is ipecac, and what chemical principles does it contain? Ipecac is the root of Cephaëlis Ipecacuanha (Nat. Ord. Rubiaceae), a plant of Brazil. Its effects depend upon an alkaloid, emetine, which is combined with ipecacuanhic acid. What are its physiological actions? Locally applied, ipecac is an irritant, either to the skin or mucous membranes. Given internally in small doses, repeated, it increases the perspiration, saliva, bile, the secretions from the broncho-pulmonary and gastro-intestinal mucous membranes, and causes nausea. In sufficient amounts it greatly augments the secretions and induces vomiting, without much nausea or depression, no matter how exhibited, emesis being more rapid when it is taken by the mouth. Toxic doses in animals depress the respiration and paralyze the heart directly. Post-mortem examination shows the mucous membranes of the stomach, intestines and lungs to be intensely congested. Sometimes, however, the lungs are almost exsanguine. What are the medicinal uses of ipecac? Ipecac is employed as an emetic, and is the safest remedy which can be given for this purpose, especially to children. It is particu |