to be expected. Ergot has enjoyed considerable reputation in the treatment of diabetes insipidus, nocturnal enuresis, and in delirium tremens. Other conditions in which it has proved of service are incontinence of urine caused by a paretic or paralytic state of the bladder sphincter, distention of the bowels after abdominal operations, and some forms of spermatorrhoea.

TOXICOLOGY

Acute Poisoning. This is generally the result of its use an an abortifacient. Nausea, vomiting with diarrhoea and abdominal pain are evidences of the gastroenteritis which it causes. In addition there may be anæsthesia of the skin or hyperesthesia with tingling and itching, mental depression, and convulsions followed by collapse and coma. Treatment.-This should be directed entirely toward relief of the gastro-enteritis and the collapse.

Chronic Poisoning.-The symptoms of both the gangrenous and the convulsive forms have already been described (see p. 796).

HYDRASTIS

For the Preparations of Hydrastis see p. 177.

ACTION OF HYDRASTIS

Hydrastis, administered before meals is a simple bitter. In moderate doses it promotes appetite and digestion, and by central action. increases the gastro-intestinal secretions and motility, the flow of bile and intestinal peristalsis. Its general action is due principally to its alkaloid, hydrastine. This primarily stimulates the centers of the medulla oblongata, causing slowing of the heart, increased arterial tension, and a quickening of the respiration. The rise in blood-pressure is due to constriction of the arterioles. Under larger amounts there is a stimulation of the spinal cord, similar to that produced by strychnine, causing clonic convulsions, followed by tonic convulsions and tetanus. Furthermore, it weakens and paralyzes muscle, an action which is confined to the heart and consequently the blood-pressure falls, and eventually both the medulla and cord are paralyzed, death occurring from failure of the respiration. The constriction of the arterioles is not due, apparently, to any direct action on the walls of the vessels, but rather to the stimulation of the vaso-motor center.

Respiration. Generally the respiratory center is stimulated; it is depressed by toxic doses so that death results from asphyxia resulting from paralysis of the respiratory center or produced by the convulsions.

Eye. Locally applied a solution of the alkaloid at first produces myosis but later mydriasis.

Uterus. It increases the normal contraction of the uterus, but is less useful in the post-partum period. As it acts on both muscle and blood-vessels it is often more efficient than ergot in arresting uterine hæmorrhage.

Hydrastinine has been found to cause a much greater constriction of the peripheral vessels, as well as less depression of the heart, than hydrastine. It is also stated to differ from the latter in producing no marked disturbance of the centers of motion except when given in the enormous doses, which paralyze the nervous system.

THERAPEUTICS OF HYDRASTIS

External. Hydrastis is much used empirically for subacute and chronic inflammations of the mucous membranes, the benefit derived from it being due in great measure to the contraction of dilated blood-vessels. The various preparations diluted with water, may be employed as injections in gonorrhoea, vaginitis, leucorrhoea, otorrhoea, and nasal catarrh, and as lotions for syphilitic mouth-lesions, mercurial or aphthous stomatitis, follicular pharyngitis, fissured nipples, hyperidrosis, acne, seborrhoea, and various other conditions.

Internal.-Hydrastis is useful in gastric catarrh, especially when induced by chronic alcoholism, and often proves of service in intestinal indigestion. In chronic catarrh of the intestine, even when ulceration has occurred, it may prove of great service, and it is especially esteemed in duodenal catarrh accompanied by catarrh of the gall-ducts and jaundice. It is employed to a large extent in uterine disorders such as menorrhagia and dysmenorrhoea, and also to check the growth of uterine tumors, because it not only increases contraction of the uterine muscle as does ergot but in addition produces vaso-contraction. For the arrest of hæmorrhage, hydrastinine hydrochloride is to be preferred, but while this is valuable in other uterine hæmorrhages, it has little effect in post-partum hæmorrhage. On account of its marked action in constricting the arterioles in general, hydrastinine hydrochloride should prove of service in hæmorrhages other than uterine, but here the effect is largely negatived by the rise of general blood-pressure. As an antiperiodic, hydrastine, while much inferior, is ranked by some writers as next in value to quinine. In chronic malarial cachexia it may be given with iron preparations.

COTARNINE HYDROCHLORIDE

For the Preparation of Cotarnine Hydrochloride see p. 118.

ACTION AND THERAPEUTICS OF COTARNINE HYDROCHLORIDE

Cotarnine hydrochloride acts upon the myocardium as does hydrastine but upon the uterus it is hæmostatic in the same way as hydrastinine. Since it is a local hæmostatic, it has been applied upon absorbent cotton, chiefly for small hæmorrhages. Its chief use internally is in the treatment of congestive and especially hæmorrhagic conditions of the uterus such as menorrhagia. In hæmoptysis and possibly other internal hæmorrhages it may be given hypodermatically. In threatened abortion, since it is not markedly ecbolic, it may be used in small doses to check hæmorrhage.

THE EMMENAGOGUES

CIMICIFUGA

For the Preparations of Cimicifuga see p. 179.

ACTION AND THERAPEUTICS OF CIMICIFUGA

Cimicifuga is to some extent a cardiac stimulant, slowing the action of the heart, and increasing its force, but its action in this respect is not important. In large doses it depresses the heart and vaso-motor system. Cimicifuga is generally believed to cause uterine

contractions.

It has been employed for many years in a great variety of conditions dyspepsia, fatty and irritable heart, dysmenorrhoea, amenorrhoea, subinvolution, neuralgia, and especially chorea. That it is of very much benefit beyond that accomplished by a simple bitter is open to question. It has been asserted that it sometimes promptly cures urticaria of nervous origin after the failure of other treatment.

PARSLEY FRUIT

For the Preparations of Parsley Fruit see p. 179.

ACTION AND THERAPEUTICS OF PARSLEY FRUIT

In large doses it acts as a cerebral and circulatory stimulant, very similar to coffee and has a special action upon the uterine circulation.

In large doses it may cause vertigo, tinnitus and severe frontal headache suggesting cinchonism.

Its most important use is in the treatment of amenorrhoea, given twice or three times daily for the week preceding the expected date of menstruation; so soon as symptoms of menstruation appear the remedy should be given every three or four hours until the flow is well established. It is particularly useful when there is inactivity of the ovaries which requires a direct emmenagogue. It will often increase the flow of a scanty menstruation and occasionally relieve the pain accompanying the molimen.

PRECIPITATED MANGANESE DIOXIDE

For the Preparation of Precipitated Manganese Dioxide see p. 88.

ACTION AND THERAPEUTICS OF PRECIPITATED MANGANESE DIOXIDE

When given by the mouth it exercises an effect only in so far as it is dissolved in the secretions. In large amounts it causes gastrointestinal irritation, and in smaller doses has some astringent action. Only a very minute quantity is absorbed from the alimentary canal. When given by subcutaneous injection it may give rise to epileptiform convulsions. This substance is thought by many to have a specific influence upon the uterus.

It has been used empirically as an emmenagogue and is probably a reasonably certain agent of the kind when administered in maximum dose.

DRUGS WHICH DEPRESS UTERINE ACTION

VIBURNUM PRUNIFOLIUM

For the Preparations of Viburnum Prunifolium see p. 180.

ACTION AND THERAPEUTICS OF VIBURNUM PRUNIFOLIUM Viburnum prunifolium is believed to be an antispasmodic; it seems to lessen the motor functions of the spinal cord, depress the heart and lower the blood-pressure.

It is extensively used in the nervous diseases of pregnancy and undoubtedly has given good results in the effort to prevent miscarriage, especially if it is habitual. It has considerable reputation as a remedy for spasmodic dysmenorrhoea, in the treatment of after-pains, and in menorrhagia, particularly during the climacteric. This remedy has been in use for many years as a sedative in dysmenorrhoea and is undoubtedly of value.

DIVISION XII.-THE SERUMS

Serums have been classed among alterative remedies, and with a certain amount of reason; but their manner of action and the methods by which they are administered are different from those of ordinary alteratives. To the class of substances, of an albuminous nature, produced in the animal organism by pathogenic germs, which is deleterious to the animals themselves the name toxin has been given, while to a different class of substances, also albuminous and also produced by the same germs, but which is inimical to the bacteria, the name antitoxin has been assigned. The toxin acts both as a local and systemic poison, and by its hostile influence upon the bacteria the antitoxin tends to counteract both of these effects. The precise modus operandi is as yet unknown, but it is thought probable that the antitoxin affects the protoplasm in such a way as to render it capable of resisting the action of the toxin. It is to be noted, however, that the antitoxin has been demonstrated not to be a germicide for the pathogenic organism; so that there is still considerable mystery as to just how it produces the beneficial effects observed from it.

Those official are—(1) Antidiphtheric Serum. (2) Antitetanic Serum.
Antidiphtheric serum is also known as diphtheria antitoxin.

Serums, other than antitoxins or nutrient serums, are attenuated cultures made from pathogenic germs, and often called vaccines, the administration of which is designed to confer immunity against the special disease caused by the germs from which the cultures are made.

ANTIDIPHTHERIC SERUM

For the Preparations of Antidiphtheric Serum see p. 252.

ACTION OF ANTIDIPHTHERIC SERUM

In addition to the production of toxins, albumins and an organic acid, the bacillus of diphtheria, as it develops in the body, induces the formation in the blood of a substance, known as an antitoxin which is antidotal to the toxin of the bacillus. It is largely due to this substance that organisms can resist the disease.

Antidiphtheric serum has a favorable effect upon all the symptoms of diphtheria and also a marked influence in preventing the occurrence of sudden heart-failure which constitutes one of the great dangers of the disease. The temperature, however, is less affected than the