dressing for chilblains, frost-bites, anal and other fissures, etc. It has also been used, on account of its stimulating and antiseptic effects, in chronic skin diseases, such as psoriasis, lupus and leprosy, and as a topical application to the urethra or vagina in chronic gonorrhoea. Internal. Occasionally copaiba is employed as an expectorant in bronchitis, especially where the secretion has become profuse and fetid. In chronic conditions it has the effect of diminishing instead of increasing secretion, and on this account as well as its disinfectant properties, it may serve a useful purpose. Its use is restricted at the present time because of its unpleasant taste, the offensive odor which the drug gives to the breath of those taking it, and its liability to cause disagreeable eructations, to derange the digestion, or to produce eruptions on the skin. In gonorrhoea it has proved so undeniably efficacious, however, that in spite of the objectionable features attendant upon its administration, it still holds its place as a standard remedy in this disease. It is regarded as safe to begin the use of copaiba in gonorrhoea as soon as the initial severity of the attack has subsided and the bowels have been freely opened. CUBEB For the Preparations of Cubeb see p. 214. ACTION OF CUBEB External. By reason of its volatile oil, cubeb is irritant and rubefacient when applied by inunction. Internal. Its action is much the same as that of copaiba, though it is somewhat less irritant. Large doses cause marked gastric and sometimes intestinal irritation, with nausea, vomiting, abdominal pain, and perhaps purging, while the urine may contain albumin or blood, or both. It is excreted by the kidneys and lungs, and probably by the skin, and its chief action is on the mucous membrane of the genito-urinary tract. This is not only powerfully stimulated but also disinfected by it, as the urine containing the drug acts as a stimulant and antiseptic lotion. It sometimes gives rise to a cutaneous papular or erythematous eruption, but whether this is due to its excretion by the skin or to the gastric disturbance, is as yet undetermined. As cubeb induces considerable irritation of the kidney, it is a diuretic. THERAPEUTICS OF CUBEB Cubeb is one of the drugs most commonly employed in the treatment of genito-urinary affections, especially gonorrhoea, gleet and chronic cystitis. It is considered most valuable in the acute stage of gonorrhoea. It often relieves functional irritability of the bladder, and sometimes checks nocturnal incontinence of urine. Some patients are peculiarly susceptible to its effects, and in them even small doses may produce gastric disturbance or vesical irritation, with bloody urine. In the treatment of affections of the respiratory passages it has an established position. The symptom asthma is often relieved by cubeb cigarettes, and these are useful also in sensitive hypertrophies of the nose and in mild bronchitis. The troches are employed by vocalists and public speakers, and many popular ones contain cubeb. It is of considerable service in subacute or chronic bronchitis, especially when there is a profuse muco-purulent secretion. OIL OF SANTAL For the Preparations of Oil of Santal see p. 215. ACTION AND THERAPEUTICS OF OIL OF Santal The action of the oil of santal closely resembles that of copaiba and cubeb, but it is less irritant, as well as more agreeable to take, than either of the others. Like them, it is a bronchial and genitourinary stimulant and disinfectant. Its absorption and excretion. are very rapid, and it appears in the urine in about half an hour after ingestion by the mouth. After large doses irritation of the alimentary canal and urethra, with an eruption of small red papules upon the skin and conjunctiva, have been observed. It is best administered in capsules, or in an extemporaneous emulsion, and is much used in gonorrhoea and gleet. It is expensive and on this account it is frequently adulterated. The advantage of oil of santal over copaiba and cubeb is that it does not nauseate or disturb digestion, and it can be given with good results during the inflammatory stages of gonorrhoea or cystitis. In addition to these affections, it is of service in pyelitis, urethral hæmorrhage, and bronchitis. BENZOSULPHINIDE For the Preparations of Benzosulphinide see p. III. ACTION AND THERAPEUTICS OF BENZOSULPHINIDE Benzosulphinide is an antiseptic, but as such of very limited use, because its properties in this direction are not marked. Its principal use is as a sweetening agent. It is not a food, but a condiment, and is eliminated in the urine and saliva without change. It is quite generally employed as a substitute for sugar when from any cause, as in diabetes mellitus, or obesity, this cannot be taken. It may be used in tablets; for sweetening a cup of tea or coffee 10 gr., .006 gm., is sufficient. Inasmuch as this substance is largely excreted into the saliva, unless small amounts are used, a disagreeable taste in the mouth will be permanently established; and further it has been shown that it interferes with the secretion of ptyalin, pepsin and trypsin. It is believed to be harmful in daily amounts of over 30 gm. (5 gr.), but this amount is likely never to be reached even if taken with foods preserved by it. In many instances of gout, digestive and metabolic disturbances its use is preferable to sugar which is readily fermentable. It has been used as an internal antiseptic in cystitis with ammoniacal urine, and has been commended as a lotion in aphthous stomatitis and in ozena. DIVISION VII.-DRUGS ACTING ON THE BODILY HEAT. A. Antipyretics, or Drugs which decrease the Body Temperature.With the exception of those which, when given in sufficient quantity to induce severe collapse, may in this way cause the temperature to fall below normal, there are few capable of reducing the temperature in health. The term antipyretic is therefore limited to such drugs as have the power of depressing the body temperature in fever. In health the temperature is maintained at a uniform point through a balance established between the production of heat (thermogenesis) and its dissipation (thermolysis) through the skin, lungs and other organs. The main source of production is the voluntary and invol untary contraction of the muscles, and the loss of heat occurs to some extent through the lungs, but chiefly by means of radiation from the cutaneous blood-vessels and the evaporation of perspiration. Now if an excessive formation of heat takes place, as during active ⚫ muscular exertion, this is compensated for by an increased output from the skin, through the dilation of the vessels and by the perspiration. On the other hand, if there is an increased heat dissipation from exposure to cold, this is offset by an augmented combustion of the tissues, with the formation of more heat. In order to preserve a balance between the heat-producing and heat-dissipating agencies there must be present a coördinating mechanism, and there is considerable reason for locating this about the corpus striatum, in the basilar ganglia of the cerebrum. Lesions in this part of the brain are usually found to cause a very marked rise of temperature, and it is stated that in animals no shivering is produced by cold, after section of the cerebral peduncles. The heat regulating function (thermotaxis) is more or less deranged by various poisons, and especially by such as are generated in fever. The existence of a heat-regulating center in the brain, it may be stated, has never as yet been definitely proved, and some investigators believe that the vaso-motor center in the medulla oblongata is sufficient to explain the normal coördination of formation and output. It has lately been suggested that the thyroid and suprarenal glands, one of which is thought to be perhaps the main organ of the body to provide vaso-dilating material, while the other furnishes the chief supply of vaso-constricting material, may play an important part, by their opposed action, in this alternate opening and shutting of the blood-vessels. As affording some support to this view, attention has been called to the fact that in the infant, which apparently has no heat governor or regulator, since its temperature varies with that of its surroundings, the thyroid is but imperfectly developed, while the suprarenal glands have been observed to contain no vaso-constricting substance. Drugs which increase the loss of heat.-Among these are included all sudorifics and dilators of the cutaneous blood-vessels. The action of salicylic acid and salicin in reducing temperature is probably explained by the vascular dilation caused and the increase in the output of heat. This is also now believed to be the fact with drugs of the class to which acetanilid, antipyrine and acetphenetidin belong. Some investigators, however, regard the fall in heat formation as too great to be explained in this way, and infer that these antipyretics diminish the combustion through some other action, though not by affecting the tissues directly. Drugs which probably diminish the production of heat.-Quinine apparently does this by lessening the metabolism. The antipyretic action of digitalis may perhaps be due to its causing an increased activity of the heat-regulating center, as has been shown to be the fact with central nervous stimulants. The fall of temperature produced by antimony has been explained by the slowness of the circulation and by the general depression and profuse perspiration. The precise manner in which aconite reduces the temperature is unknown. A cold bath not only abstracts heat, but if continued for a time may diminish its formation. Sometimes the removal of some reflex source of irritation may lower the temperature, and in this way purgatives occasionally act as antipyretics. Therapeutics.-Alcohol, spirit of nitrous ether, antimony, ipecac and opium were formerly in constant use as antipyretics, but at present are not given for this purpose. Cold is more often employed, either by cold sponging, ice, or a cold bath. Sponging with hot water will, by the vascular dilatation and subsequent sweating it induces, reduce a febrile temperature. Of the drugs which are now used for this purpose, acetanilid and antipyrine are dangerous because of the collapse they may bring about, while quinine and salicylic acid are rather uncertain, except in malarial and rheumatic fever respectively. Antipyrine is a very prompt and certain antipyretic, and, notwithstanding its danger, it and acetphenetidin are most in use. Acetphenetidin is less powerful, but quite safe, as a rule. Antipyretics, however, in sufficient doses to reduce the temperature may cause dangerous depression. Fever is only a surface indication of the essential pathological condition which is systemic infection, and if the pyrexia is not excessive, no special action is called for. When this is the condition the external use of cold is generally preferable, since in addition to its antipyretic effect, it is likely to furnish a needed stimulus to the nervous system and prove beneficial in other ways. B. Drugs which cause a rise of Temperature.-Belladonna may have this effect. The cause is not definitely known, but it has been attributed to direct action on the heat centers in the brain. The temperature is generally increased by large doses of cocaine especially |