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increasing osmosis from the inflamed mucous membrane. The
Alkalies. Stimulant Expectorants,—are eliminated by the bronchial mucous membrane which they stimulate, altering the secretion and facilitating expectoration. These remedies generally diminish secretion and increase blood-pressure. They areAcids.
Nux Vomica, Strychnine.
Saccharine Substances. Besides the above many other remedies may act as expectorants, some by relieving bronchial spasm, as Opium, Stramonium and Tobacco,-others by soothing the irritable respiratory centre, as Opium and Chloral,—and the ciliary excitants by reflex action through their impression on the nerves of the mouth.
Ciliary Excitants,-promote the expectoration of bronchial mucus by reflex excitation of the tracheal and bronchial cilia, when dissolved in the mouth. Gum Acacia, Ammonium Chloride, Potassium Chlorate, and native Chloride of Sodium have this action.
AGENTS ACTING ON THE CIRCULATION.
Cardiac Stimulants rapidly increase the force and frequency of the pulse in depressed conditions of the cardiac apparatus. One of the most useful agents of this class is Alcohol in some form, its action being largely due to a reflex influence excited through the nerves of the mouth and stomach. It should therefore be given in but slightly diluted form, and in small quantities frequently. Ether is next in value and still more rapid in action, and Heat is one of the most powerful and available of the class. Ammonia has an energetic action as a stimulant to the vaso-motor centre, as well as a reflex one upon the heart similar to that of
Alcohol. The list of cardiac stimulants includes the following,
Cardiac Tonics, when given in moderate doses, stimulate the cardiac muscle, slowing and strengthening its contractions. In large doses they are apt to produce irregular action of the heart, and some of them have more or less of a tendency to cause sudden death by syncope if pushed to any great extent. The most important of these agents areDigitalis. Squill.
Adonis vernalis. Digitalis acts partly by stimulation of the vagus end-organs in the heart, thus increasing cardiac inhibition, and partly by direct stimulation of the car. diac centre in the medulla, as well as by a direct influence on the heart muscle itself. Convallaria, Erythrophlæum, Squill and Cimicifuga act similarly but less powerfully, and are correspondingly safer.
Cardiac Sedatives lessen the force and the frequency of the heart's action and are used to control palpitation of that organ, and to slow the pulse in febrile conditions in sthenic subjects, especially when local inflammation is the exciting cause. The chief cardiac sedatives areAconite.
Cold. Aconite, Veratrum, Muscarine, Pilocarpine, Saponin and Prussic Acid . are direct cardiac poisons, depressing the heart muscle and the cardiac motor ganglia; Muscarine and Pilocarpine also stimulate the inhibitory ganglia; Digitalis stimulates the vagus centre and the cardiac muscle, and acts as a sedative in many cases by slowing the rate and giving it a regular rhythm. Aconite is said by some authorities to relax inhibition, by others to stimulate the vagus centre. Antimony depresses the motor ganglia, Potassium the cardiac muscle.
Vascular Stimulants produce dilatation of the peripheral vessels, and increase the rapidity of the circulation, thus equalizing the blood-pressure and preventing internal congestions.
The most useful are Alcohol and Ether, as they stimulate the
Liq. Ammonii Acetatis.
Opium, as Dover's Powder.
Heat, as Poultices, etc. The dilating action of Amyl Nitrite and other Nitrites is due to weakening either of the muscular walls of the arterioles or to paralysis of the vasomotor ganglia in them. Alcohol, Ether and Opium probably depress the vaso. motor centre.
Vascular Tonics produce increased contraction of the arterioles and consequently increased blood-pressure. The most important areDigitalis.
Lead and Silver. These agents act upon the local vaso-motor mechanism in the walls of the vessels, which are also directly stimulated by cold produced in any way, as by Ether spray, or evaporating lotions of Alcohol, Vinegar or Ammonium Chloride.
Vascular Sedatives increase the contraction of the vessels and lessen the circulation through them. They are employed to check hemorrhage and to cut short a local inflammation. The chief agents belonging to this group areCold. Hamamelis.
Acetate of Lead.
AGENTS ACTING ON THE DIGESTIVE SYSTEM.
Dentifrices (dens, a tooth, frico, to rub),-are medicated powders or pastes employed to cleanse the teeth and gums. Chalk is the basis generally used for its mechanical action and its alkaline quality. Antiseptics, as Borax, Quinine, Carbolic Acid, etc., should also be employed so as to prevent the acid fermentation of food products between the teeth and the consequent decay of the dentine. Tincture of Myrrh is an excellent ingredient, being an aromatic local stimulant and disinfectant.
Many drugs affect the teeth injuriously, such being the Mineral Acids, Persalts of Iron and Alum. The first two should be taken through a glass tube, and the mouth should be afterwards rinsed with a weak alkaline wash. Opium, Carbolic Acid, Creasote, Chlorate of Potassium and Aconite are the agents used as local anodynes in toothache from caries exposing a nerve filament.
Sialogogues (oialoy, saliva, åyw, to carry off ),-are agents which increase the secretion and flow of saliva and buccal mucus, either by reflex action from the local irritation produced when anything is taken into the mouth, or by stimulating the glands during their elimination. The principal sialogogues are divided into two classes, the first (topical) acting by reflex stimulation, the second (general) acting through their systemic influence on the glands or their secretory nerves. They are as follows :Topical Sialogogues.
Iodides, and Ipecac.
Antisialics (avti, against, oialov, saliva),—are remedies which diminish the secretions of the salivary glands. Atropine is the principal agent of this group, acting by paralyzing the terminations of the nerves of secretion. Physostigma counteracts this paralysis, but in large doses acts as an antisialic by lessening the blood supply to the glands. Opium diminishes the reflex excitability of the reflex centre and also diminishes the secretion. Others acting locally areBorax.
Refrigerants (refrigero, to cool),—are remedies which allay thirst and impart a sensation of coolness. They include the Vegetable Acids, the Mineral Acids (greatly diluted), Ice, Water, Effervescing drinks, Fruit juices, and many diaphoretics.
Gastric Tonics or Stomachics,-are agents which increase the appetite and promote gastric digestion. They include a number of substances, dietetic and medicinal, some acting by stimulation of the production of gastric juice, others by stimulating the local circulation, and several by exciting the activity of the nervo-muscular apparatus of the stomach.
The first indication is met by the use of dilute alkaline solutions before meals,--the second by administering any of the pungent carminatives, as the Aromatic Oils, Pepper, Mustard, etc., or by Alcohol and Ether in small doses, or by the Aromatic Bitters, as Gentian, Orange, etc., or the simple bitters, as Calumba ; -- while the third desideratum is secured by the use of such agents as Nux Vomica, Hydrastis, Arsenic, the dilute Mineral Acids, and the Volatile
Oils. Adjuvants to gastric digestion are the various digestion-ferments, Pepsin, Ingluvin and dilute HC1 Acid, which may be used to supplement the gastric juice when deficient in quantity or quality.
Acids,-considered therapeutically and physiologically, are medicines which in concentrated form act usually as caustics, and when given in medicinal doses internally check the secretions of organs producing acid secretions with which they come in contact, and increase those of organs producing alkaline secretions. Thus a dilute acid given before meals will check the production of the acid gastric juice, but will stimulate that of the alkaline pancreatic juice.
The chief members of this group are the following, which should be given in very dilute form :Acidum Aceticum,
Ant-acids or Alkalies,-from the same stand-point, are remedies which neutralize acids, check alkaline secretions and stimulate acid secretions, when in contact with the ducts of the organs producing them. Thus a dilute alkali given before meals will stimulate the production of the acid gastric juice, and if applied to the mouth of the pancreatic duct will check the secretion of the alkaline pancreatic juice. The principal articles which belong to this group are the following, which should always be administered in dilute solution :Liquor Potassæ, Liquor Soda.
Potassium Acetate. Carbonates and Bicarbonates of Potassium, Potassium Citrate. Sodium, Lithium, Magnesium and Am
Potassium Tartrate, monium.
Potassium Bitartrate. Calcined Magnesia (Magnesia).
Sodium Acetate. Lime-water, Chalk.
Sodium Citrate. Aromatic Spirit of Ammonia.
Lithium Citrate. The substances in the first list are direct antacids, lessening the acidity in the stomach, and many of them also acting as remote antacids, lessening the acidity of the urine, as Potash and Soda, and their Carbonates and Bicarbo. nates. Ammonia and its Carbonates after absorption are eliminated as urea, and do not lessen the acidity of the urine. The salts in the second list are remote antacids, do not lessen acidity in the stomach, but do that of the urine, being oxidized in the blood and excreted as Carbonates.
Emetics (épéw, to vomit), -are agents which produce vomiting. They may be subdivided into two groups, (1) Local Emetics, or those which act by irritating the end-organs of the gastric,