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and the calves of the legs. On the external aspect of the thigh, just in front of the great trochanter, there is an area of some two inches square, over which the insertion of a fine hypodermic needle is not felt, so barren is the skin in that region of sensitive nerve flaments.
After nearly filling the syringe with the solution to be used, the needle should be screwed on tightly; and with the instrument held in a vertical position, point uppermost, the excess of solution over the amount required should be ejected, thus expelling air bubbles and filling the needle itself. A portion of skin should be grasped by the thumb and forefinger at the site selected for the injection, into which the needle should then be quickly inserted until its point has passed beneath the skin, when the piston may be pressed down slowly, delivering the solution so gradually as to avoid rupturing the tissue. If the solutions are freshly prepared with clean water, the needles kept clean and sharp, and the injection be made beneath the skin not into it, there will be no risk of producing abscesses with the agents ordinarily employed. Tablets for hypodermic use are prepared by the prominent manufacturers, each containing one dose. They may be readily dissolved in a teaspoon at the bedside, and are very convenient for the pocket, if put up in a case with a good hypodermic syringe, as may be obtained from Parke, Davis and Co., of Detroit.' Their regular line of Hypodermic Tablets includes the agents named in the following list, put up in tubes of 25 each.
List of Hypodermic Tablets. Aconitine (crystals), . . gr. llo: Morphine Sulphate, , . gr. f. Apormorphine Muriate, . gr. to. Morphine & Atropine, No, I Atropine Sulphate, .
Morphine Sulph. Atropine Sulphate, . . gr.
Morphine & Atropine, No. 2.
Physostigmine Sulph., . Hyoscine Hydrobromate, . gr. joo:
Sodium Arseniate, . . gr. To: Hyoscyamine, . . . gr. o. Strychnine Sulphate, . . gr. 3o. Morphine Sulphate, .. . gr. . Strychnine Sulphate, . . gr. ido.
[For Formulæ for Hypodermic Solutions, see Appendix, page 760.]
Parenchymatous Injection is the delivery of a medicine deeply into the tissues, either to affect a muscle itself or to locally influence some important nerve-trunk. The principal agents used in this manner are Strychnine for palsied muscles, Chloroform for sciatic and other neuralgias, and Salts of Cocaine for local anesthesia.
The Skin is an active absorbent of crystalloidal substances when its epidermis or cuticle is removed. By this route there are four methods of introducing medicaments into the circulation, viz.—the Enepidermic, Epidermic and Endermic Methods, and Inoculation.
The Enepidermic Method consists in placing the medicine in simple contact with the epidermis, no friction being used to hasten its penetration. Chloroform and Oleic Acid solutions of the alkaloids pass by osmosis in this manner with comparative ease, but aqueous solutions act very slowly and alcoholic ones with great difficulty if at all. (See page 34.)
The Epidermic Method consists in the use of friction to promote the passage of the medicament between the cells of the epidermis. Mercurial Ointment, Cod-liver Oil, and other fats, Oleates, etc., are used in this way for their local and systemic effects.
The Endermic Method obviates the difficulty of absorption through the cuticle by removing the latter through the agency of a blister, and then powdering the medicament over the surface of the denuded derma.
An ordinary cantharides-plaster, followed by a poultice to raise the blister, may be employed; but a quicker method is to place upon the skin a piece of lint soaked in Stronger Water of Ammonia, covering it with a watch glass or a piece of oiled silk to prevent evaporation. The blister raises rapidly and should then be removed with scissors. Morphine, Atropine, Quinine and Strychnine, are the agents generally used in this manner, but the method is painful and unpopular,
Inoculation is the introduction of medicinal agents through the scraped or punctured skin by an operation similar to that employed for vaccination.
DOSAGE OF MEDICINES.
The Doses given throughout this book are for adults; for children the following rule (Young's) will be found the most convenient. Add 12 to the age, and divide by the age, to get the denominator of a fraction, the numerator of which is i. Thus, for a child two years old, +, "=7, and the dose is one-seventh of that for an adult. Of powerful narcotics scarcely more than one-half of this proportion should be used. Of mild cathartics, two or even three times the proportion may be employed.
For Hypodermic Injection, the dose should be two-thirds or three-fourths of that used by the mouth; by rectum fivefourths of the same. Strychnine acts more actively when given per rectum than by the stomach.
Conditions which modify the action of medicines, and therefore affect their dosage, are-age, body-weight, temperament and idiosyncrasy, drug-habits, intervals between doses, time of administration, condition of the stomach, temperature of the body, cumulative drug-action, mode and form of drug-administration, disease, climate, race, etc.
Children bear Opiates badly (see page 278):—but on the other hand they stand comparatively large doses of several other drugs; such being Arsenic, Belladonna, Calomel, Ipecacuanha, Squill, Rhubarb, and several other purgatives.
MATERIA MEDICA AND THERAPEUTICS.
ABRUS, Jeriquity (Unofficial),-is the seed of Abrus precatorius, or Wild Liquorice, a plant of the nat. ord. Leguminosæ, indigenous in India, but growing wild in most tropical countries. The seeds are small, hard, of a bright scarlet color, with a black spot around the hilum, and contain an alkaloid, some fixed oil, sugar, a principle resembling Glycyrrhizin, and Abric Acid, C,H,N,O; but neither of these is believed to be the active principle.
Preparation. INFUSUM ABRI, Infusion of Jeriquity (Unofficial),-prepared by macerating three powdered seeds in Zss of cold water for twelve hours, adding zss of boiling water, and filtering when cold. It should be used while fresh, as after two or three days it is worthless.
Another formula contains gr. ix of Jeriquity to the 3, with gr. iv of Boric Acid to prevent decomposition.
Physiological Action and Therapeutics. Jeriquity seeds, when moistened with water, become highly poisonous. If applied to the conjunctiva, a severe inflammation is set up, with cedema and false membrane, ulceration of the cornea, and extension to the lids, face, neck and submaxillary glands. Inserted into a wound in cattle, they cause death in a few hours. The irritant action is believed to result from the presence in the seeds of some ferment, or perhaps great numbers of gonidia, which develop rapidly on a suitable tissue. The infusion, in a short time, swarms with bacteria.
Jeriquity is used for the purpose of producing a purulent or croupous conjunctivitis, by which to destroy old granulations (trachoma) and pannus. A mild infusion is applied to the eye two or three times a day for two days, and followed by weak solutions of Alum or Borax. This should be repeated after three weeks if necessary. An emulsion of the seeds in water is a useful application to unhealthy ulcers and lupus.
ABSINTHIUM, Wormwood,—the leaves and tops of Artemisia Absinthium, a perennial garden herb of the nat. ord. Compositæ, indigenous in Europe, but cultivated in the United States. The leaves are about 2 inches long, hoary, silky-pubescent, petiolate, pinnately two or three-cleft; heads numerous, with small, pale-yellow forets, odor aromatic, taste persistently bitter. It contains a volatile oil and a bitter principle, Absinthin. Dose, gr. xx-xl, in infusion. There are no official preparations, except Vinum Aromaticum (see ALCOHOL), of which Absinthium constitutes one per cent.
Absinthe, the French liqueur, is an alcoholic solution of the oil, containing also extracts of Anise, Marjoram, and Angelica. Its continued use produces various nervous symptoms, morning nausea and vomiting, also a tendency to epileptiform convulsions.
Physiological Action and Therapeutics. The bitter constituent of Absinthium is stimulant to the digestive organs, but the oil is a narcotic poison, increases the cardiac action, and produces tremor, stupor, epileptiform convulsions, involuntary evacuations, and stertorous breathing. It is but little used in medicine, and only as a stomachic tonic in dyspepsia.
ACACIA, Gum Arabic,-is a gummy exudation from Acacia Verek, a small tree of the nat, ord. Leguminosæ, indigenous in Africa-also from other species of Acacia. It occurs in spheroidal tears of various sizes, breaking with a glassy, sometimes iridescent fracture ; insoluble in alcohol, but soluble in water, forming a thick and mucilaginous liquid. It consists of Arabin or Arabic Acid, C12H,2011, combined with calcium, potassium, and magnesium.
Preparations. MucilagO ACACIÆ,-has of Acacia 34, Water to 100 parts. It should not be prescribed with tinctures or spirits except in very small quantity. Dose, indefinite.
SYRUPUS ACACIÆ,-has of the Mucilage 25, Syrup 75. Should be freshly made. Dose, indetinite.
Acacia enters into the composition of Mistura Amygdale, Mistura Glycyrrhiza Composita, Pulvis Cretæ Compositus, Trochisci Cretæ, Trochisci Cubebe, and Trochisci Glycyrrhiza et Opii.