DIVISION XI.-DRUGS ACTING ON THE ORGANS OF GENERATION A. Aphrodisiacs.-These are substances which increase sexua desire and power. They are supposed to act by stimulating, directly or reflexly, either the cerebral or spinal genital center. The latter has been located in the lumbar portion of the cord, and irritation of it induces erection. It is conceivable that it may be excited by afferent impulses conveyed to it from various parts of the body, but especially from the cerebrum and the genital organs. Its activity appears to be largely dependent upon the condition of the general health, and hence tonics and all measures promoting the bodily nutrition may act as indirect aphrodisiacs. The following drugs are known as aphrodisiacs; their mode of action in this regard is not very clearly understood. (1) Strychnine. (3) Alcohol. (5) Camphor. Strychnine probably acts by raising the tone of the spinal centers, cantharides and camphor through reflex irritation from the urethral mucous membrane, alcohol and cannabis by their effect on the imagination, and phosphorus by improving the general condition, especially in chronic nervous exhaustion. B. Anaphrodisiacs.-These are remedies employed to diminish sexual desire. They are supposed to act by decreasing the local circulation, by lessening the excitability of the nerves of the genital organs, or by depressing the genital centers. Most of them, it may be said, are probably effective by diminishing or removing some source of irritation which is reflexly producing an aphrodisiac effect. Local applications of ice, or cold baths, are sometimes of service as anaphrodisiacs. C. Ecbolics or Oxytocics are remedies which during or immediately after parturition increase uterine action. Ergot is by far the most important. Occasionally some of these drugs will act upon the gravid uterus to initiate abortion, and most of them have been used for this purpose with criminal intent. Powerful purgatives may increase uterine action and therefore should be used with care. D. Emmenagogues are substances used to increase the menstrual flow. Diminution of the menstrual flow is a symptom of a large number of conditions; so that the various drugs which are beneficial in any of these are indirect emmenagogues. Certain substances in addition to the ecbolics, however, appear to have a special action in increasing the menstrual flow. Among the many indirect emmenagogues those more commonly used are iron, cod liver oil, and strychnine, which act by improving the general health. Hot foot- or hip-baths, especially if mustard be added, often aid the onset of menstruation. E. Drugs which Depress Uterine Action.-These are employed to diminish or abolish the contractions of the gravid uterus. They are (1) Bromides. (2) Opium. (3) Hydrated chloral. (4) Viburnum prunifolium. (5) Cannabis. (6) Chloroform. (7) Antimony and potassium tartrate. F. Drugs Acting on the Secretion of Milk. Galactagogues.-These are drugs which increase the secretion of milk. The most prominent are: (1) Pilocarpus (2) Alcohol. Of these pilocarpus is the most powerful, but its effects soon pass off. Alcohol has but a feeble effect, although the malt liquors have considerable reputation as galactagogues. The secretion is very dependent on the general condition of the system; so that the best means of securing an abundant flow of milk is to maintain the general health. Antigalactagogues.-These are drugs which decrease the secre tion of milk. Belladonna, either applied locally or given internally, is usually efficient for this purpose, by paralyzing the nerves of the mammary gland. The following drugs are excreted by the milk, and are therefore ingested by the nursing child:-Oil of anise, oil of turpentine, oil of copaiba, and most volatile oils, sulphur, rhubarb, senna, jalap, scammony, castor oil, opium, iodine, antimony, arsenic, bismuth, iron, lead, mercury, zinc salts, and potassium iodide. It is evident, therefore, that these remedies must be administered with care to the mother; for example, copaiba or turpentine will make the milk so unpleasant that the child will not take it. Such of the above list as are purgatives, when given to the mother, may cause diarrhoea in the child. Opium should not be given in large doses to the mother. On the other hand, mercury, arsenic, and potassium iodide may be administered to the child by being given to her. THE APHRODISIACS PHOSPHORUS For the Preparations of Phosphorus see p. 42. ACTION OF PHOSPHORUS Phosphorus has a specific action on bones, and especially those of young animals which are still growing. Under the influence of minute quantities the marrow becomes hyperemic and the leucoblastic tissues increase, the growth of bone is favored and the cancellous tissue tends to become compact, and there is a deposition of bone of normal composition. This effect is attributed to the phosphorus acting as stimulant to the bone-forming cells, and arsenic also appears to produce it to some extent. Small doses of phosphorus generally increase the number of red blood-corpuscles in man. Unless taken in a state of fine division or dissolved in oil, it is absorbed with difficulty, because of its insolubility in the fluids of the body and of its slow volatilization. The great mass of it, if finely divided, is absorbed unchanged and exists in the blood as phosphorus, and its action is due to this element rather than to its compounds. But little is known of its fate in the body. It is thought that a portion may perhaps be oxidized to phosphoric acid, and some of it is stated to be eliminated by the lungs, while some is excreted in the urine in obscure organic combinations. Phosphorus diminishes tissue waste, decreasing the elimination of urea and of carbon dioxide. As it is found to be a necessary element in the nervous system, its action is that of a stimulant to its growth. THERAPEUTICS OF PHOSPHORUS Phosphorus is especially indicated in osteomalacia, in rickets, and in instances of ununited fracture. Without doubt it promotes calcareous deposit in the healing of fractures. It is of value in convalescence from exhausting diseases, in nervous exhaustion, in neuralgia when dependent upon debility, in alcoholism, in sexual exhaustion, and in various suppurative affections. TOXICOLOGY Acute Poisoning.-As phosphorus is quite accessible in the form of matches or vermin-paste, poisoning by it, either accidental or suicidal, is not uncommon. Symptoms. For some hours no effect is observed. Then there is a burning pain in the abdomen, with nausea. The vomit, as well as the breath, has the characteristic garlic-like odor of phosphorus and it becomes luminous if heated with sulphuric acid. There is general depression, and this may amount to fatal collapse. Usually, however, the patient recovers from these effects and appears to be quite well for two, three or four days, when he again begins to suffer from vomiting, and the vomited matter is often bloody. There are also abdominal pain, distention and tenderness, and sometimes diarrhoea, and the stools may contain blood. With these symptoms there occurs jaundice, which soon becomes very marked, and the area of liver dullness is increased in consequence of fatty changes occasioned by that organ. The emesis, abdominal pain and diarrhoea are explained by the same cause, the epithelial cells of the stomach and intestine undergoing fatty degeneration. There is considerable muscular weakness and pain, together with a small and quick pulse and general prostration. Slight fever is sometimes observed, but the temperature is often lowered in the later stages, though the patient usually complains of intense thirst. Hæmorrhages may occur in many different situations, and the immediate cause of these is fatty degeneration of the muscular coat of the smaller arteries throughout the body. The urine also may contain blood, as well as bile, leucin and tyrosin crystals, albumin, and an abnormal amount of ammonia. Peptone is sometimes excreted, and the phosphates and sulphates are apt to be increased from the augmented tissuewaste. The chlorides are much diminished, in consequence of the patients taking little or no food. Sarcolactic acid, regarded as diagnostic of phosphorus poisoning, appears in considerable quantity in the urine, and is sometimes accompanied by glucose. The condition described lasts from five to eight days, when the patient usually dies of heart failure, as a result of fatty degeneration of the cardiac muscle from the direct action of the poison upon it. Towards the last, convulsions and coma may occur, and these are regarded as a result of disordered metabolism, rather than due to any direct influence on the central nervous system. Even when the symptoms are very severe, however, recovery is possible. With phosphorus burns, however, none of the symptoms of phosphorus poisoning are presented. Post-mortem. Widely extended fatty degeneration is a prominent feature of the post-mortem findings, and in this respect phosphorus resembles arsenic, antimony and chloroform. This pathological change is most marked in the liver, but numerous fat globules are observed in the cells of many other organs, notably of the kidneys and the gastric and intestinal glands, and also in the muscle fibers of the heart, stomach, intestines, smaller arteries, and often of the skeletal muscles. As to whether this fat is formed by the degeneration of the protoplasm of the cells in which it is found, or whether it is carried from other parts of the body and simply deposited in these cells, is as yet undetermined, but the evidence appears to be directly in favor of the latter view. Another characteristic feature is the appearance of numerous hæmorrhages and ecchymoses. In addition to the fatty degeneration of the muscular coats of the arteries referred to, it is probable that the absence of clotting in the blood, due to changes in the intestine and liver, which interfere with the formation of fibrin, is a factor in the causation of these. It has been noted that if the patient lives long enough, there may be a diminution in the size of the liver, and altogether the symptoms of phosphorus poisoning present a considerable resemblance to those of acute yellow atrophy of this organ. Treatment. As phosphorus is absorbed from the alimentary canal comparatively slowly, an attempt should be made in the early stages to remove it by emetics or the washing out of the stomach and by purges. Afterwards the object is to oxidize the phosphorus. Laboratory experiments have shown that old (ozonized) oil of turpentine, which contains oxygen, if administered before the poison is absorbed, is an antidote. Ordinary oil of turpentine, however, is worse than useless, for as phosphorus is soluble in oils, its absorption is simply aided by giving any oily or fatty substances. Repeated and free inhalations of oxygen have been used, and this suggests that hydrogen dioxide may be efficacious when given by the mouth. Potassium permanganate has also been advised for the purpose of oxidizing the phosphorus. In the secondary stage alkalies are recommended in order to neutralize the excess of sarcolactic acid formed in the tissues. Chronic Poisoning.-From the fact that the red or non-poisonous phosphorus is now generally employed in match factories, chronic poisoning, which was formerly frequently met with in those who worked among phosphorus fumes, has become of rare occurrence. Such poisoning manifests itself in gastro-intestinal irritation and a peculiar necrosis of the jaw, "phossy jaw." The latter, which usually has its starting-point in carious teeth, begins with salivation and suppurative ulceration of the gums;after which there results an extensive periostitis, involving the whole jaw. The lower jaw is more often affected. Phosphorus necrosis must be treated surgically on the same principles as other necroses. The diseased bone readily becomes the seat of tuberculous deposit, and sufferers from phosphorus necrosis not infrequently die from general tuberculosis. THE HYPOPHOSPHITES AND THE GLYCEROPHOSPHATES For the Preparations of the Hypophosphites and the Glycerophosphates see p. 42. ACTION OF THE HYPOPHOSPHITES AND THE GLYCEROPHOSPHATES The hypophosphites are believed to exert some special influence on nutrition. Practically the whole of the hypophosphite administered |