gastro-intestinal juices. It coats the mucous membrane, lessening secretions and absorbing excess of free acids, at the same time acting as a sedative and feeble astringent. The tongue and stools are tinged a dark clay color, due to conversion into the sulphide. The soluble salts are absorbed very slowly, and increase the appetite and digestion, constipation being the result.

Circulatory System.—A minute quantity passes into the blood, acting as a tonic.

Nervous System.-Bismuth salts are sedative to the peripheral nerve-endings.

Absorption and Elimination.-The salts of bismuth are absorbed into the circulation, and are eliminated by the urine, liver, and feces. Untoward Action.-Odier noticed nausea, and Weenesk vomiting, colicky pains, diarrhea, or constipation, headache, sensation of heat, dizziness, and general debility.

Poisoning. It has always been assumed that cases of poisoning are due to the lead and arsenic contained in the bismuth preparations, but Carnot and Riche found these metals present in such quantities as to be practically inert.

The symptoms are similar to those of lead-poisoning. Large concretions may be found in the intestines, and sloughs in the mouth and gastro-intestinal canal may be present, as well as desquamative nephritis and albuminuria.

Treatment of Poisoning.-Lavage, demulcents, and chemical antidotes for arsenic, magnesium, and calcium; best of all, freshly precipitated hydrated oxide of iron.

Therapeutics.-Externally and Locally.-BISMUTH SUBNITRATE is serviceable in intertrigo, erythema, acne rosacea, as a protective dressing for wounds, ulcers, and epithelioma, and as an application for chapped nipples and hands, relieving the smarting and itching. It is also of use in fissure, prolapsus ani, and superficial burns.

It is used as an injection in gonorrhea, leucorrhea, and ozena, and was formerly used as an insufflation in acute nasal catarrh, being abandoned because of the arsenic which it sometimes contains. It serves as a wash in aphthous stomatitis, mild cases of mercurial salivation, and cancrum oris, as well as for the fetid sweating of feet and other parts, and for chancres and phlegmonous erysipelas. It has also proved beneficial in chronic conjunctivitis and granular lids or trachoma.

Internally. It allays irritation, and is consequently useful in irritative vomiting and diarrhea. Gastric pain is relieved by it.

It is valuable in pyrosis, chronic diarrhea, gastric ulcer, chronic dysentery, diarrhea of typhoid, early stages of cholera and cholera infantum, and in the gastritis due to alcohol.

The CITRATE OF BISMUTH AND AMMONIUM is very soluble, and should be used only for local applications.

The OXIDE is insoluble, and combined with morphine has been used as a snuff in ozena and nasal catarrh.

SUBCARBONATE OF BISMUTH is not used in medicine.

SALICYLATE OF BISMUTH reduces the pulse and temperature in typhoid fever, and also corrects the fetid stools.

BISMUTH SUBGALLATE, or DERMATOL, was first used by Heintz and Liebrecht, being intended as a substitute for iodoform; but it is very astringent, although not irritating. The preparation is used in weeping eczema, otitis media, herpes, wounds, burns, diarrhea, and dysentery. In stagnant ulcers it is of no service, since they need stimulation.

BISMUTH CITRATE is insoluble, and is of no service medicinally. Besides the foregoing preparations there is a TANNATE OF BISMUTH, used to some extent in diarrhea, gonorrhea, leucorrhea, and ophthalmia.

PHOSPHATE OF BISMUTH is the least soluble of all the bismuth compounds, and is used, but rarely, in diarrhea, dysentery, gastralgia, and dyspepsia.

Subiodide of BISMUTH is used as a substitute for the subnitrate, and is of special value in chronic ulcers. It is supposed to be slightly anesthetic.

VALERIANATE OF BISMUTH is of no medicinal value.

SUBBENZOATE OF BISMUTH is mildly escharotic.

Administration.-The drug is used externally as a powder or ointment in combination with naphthalin or vaseline, to which a little morphine may be added. Belladonna, opium, and oleate of bismuth are also used.

For gastralgia and dyspepsia, pepsin or magnesium and calcium phosphate may be combined with bismuth. If a cathartic is desirable, rhubarb may be added.

Bismuth, aromatic powder, and carbo ligni make an excellent combination in flatulent dyspepsia.

In infantile diarrhea and summer complaint bismuth I grain (.06 Gm.), syrupus aurantii 15 minims (.92 Cc.), and calumba 15 minims (92 Cc.) are efficacious, particularly as they allay the alternating pain.

Bismuth, 5-15 grains (.32-1.0 Gm.), is given for stomach affections, and 15 grains (1.0 Gm.) to I drachm (4.0 Gm.) for intestinal disorders, one to two hours after meals as the stomach is emptied.

Cērii Ŏxalas Čērii Ŏxalātis-Cerium Oxalate. U.S. P.

(CEROUS OXALATE.)

Origin.-Prepared by a complicated process by the action of acids, etc. upon the powdered mineral.

Description and Properties.-A white, granular powder, without odor or taste, and permanent in the air. Insoluble in water, alcohol, or ether.

Dose.-1-8 grains (0.06–0.5 Gm.).

Physiological Action.-The physiological action of this drug is imperfectly understood: it is supposed to be a nervous sedative. Therapeutics.Internally.-Its widest application is in the vomiting of pregnancy, but it also controls the emesis of uterine disease and of dyspepsia, due to gastric acidity or deranged innervation of the stomach, as in sea-sickness.

It does not derange digestion, and is therefore of value in checking the cough of phthisis and bronchitis, especially when accompanied by vomiting.

Simpson regarded it as almost a specific in chorea. In combination with bismuth it is useful in checking diarrhea.

Administration.-Cerium oxalate is usually administered in pill form, 1-3 grains (.06–.20 Gm.) three times daily, but the powder is used when the drug is associated with other remedies.

TOPICAL REMEDIES.

GROUP XVIII.-CAUSTICS OR ESCHAROTICS.

CAUSTICS are medicines which destroy the tissues to which they are applied. They excite inflammation and vascular dilatation of the surrounding area. The eschar produced by these drugs is separated from the living tissues by the inflammation and suppuration produced.

When a drug acts as a caustic-that is, when it destroys a circumscribed portion of living tissue-it penetrates deeper in proportion as the product of its action (i. e. the eschar) is looser, and is shallower in proportion as the eschar is firmer or more compact. This is the essential difference between Astringents and Caustics the former contract the tissues, causing the protoplasm to be firmer and occupy less space; the latter cause the protoplasm to be softer and occupy more space. It will be seen, therefore, that the more caustic a drug is, the less astringent it is, and vice versâ.

The caustic action of a drug depends upon whether the drug and its products are both soluble in water; for if the medicine is not soluble in water, it cannot have a caustic action, and if the products of the caustic action are not soluble in water, the eschar will be firm, the drug acting more as an astringent than as a caustic.

For example, the chlorides of the heavy metals, such as mercuric chloride, zinc chloride, etc., are usually freely soluble in water, and are, as a rule, the most caustic of the metallic salts. Should a metallic chloride be insoluble in water, it will have no caustic action-e. g. silver chloride.

If the heavy metals be arranged in a series, placing at one end the most astringent salts, and at the other the least astringent, it will be noticed that those salts which are the least astringent are the most caustic, becoming less and less caustic as they are more and more astringent.

Most Astringent.

Least Astringent.

Lead, Iron, Zinc, Copper, Silver, Tin, Mercury.

Most Caustic.

Least Caustic.

756

Caustics act

1. By abstracting the water of the tissues;

2. By combining with the albumin of the tissues;

3. By corrosive oxidation.

The important caustics, arranged according to their mode of action, are enumerated below.

Caustics which act by abstracting the water from the tissues:

Caustics which act by combining with the albumin of the part:

1. To destroy excrescences on the skin or mucous membranes, and to effect the destruction or removal of malignant growths, as in cases of warts, condylomata, polypi, lupus, epithelioma, etc.;

2. To open abscesses, or to maintain a chronic irritation, or to stimulate indolent sinuses, ulcers, etc.;

3. To destroy and prevent the absorption of the virus from the bites of rabid and venomous animals, and for the destruction of chancres and malignant pustules.

Those escharotics which have not been discussed elsewhere will now be considered in detail:

Liquor Antimōnii Chlōridi-Liquōris Antimōnii Chlōridi-Solution of Antimony Chloride. (UNOFFICIAL.) (BUTTER OF ANTIMONY.)

Origin.—Prepared by the action of Hydrochloric Acid upon Purified Black Antimony.

Description and Properties.-A yellowish or yellowish-red liquid, having the specific gravity 1.47, and yielding with water a white precipitate of antimonious oxychloride (powder of Algaroth). Used externally as a caustic.