and a slight anesthetic effect. In strong preparations, on mucous membranes, it is somewhat irritant, and when taken internally it should be well diluted. It is rapidly absorbed, and is stimulant to the brain and cerebral centers, especially to the respiratory center. It may slightly stimulate the vasomotor center, but tends to dilate the peripheral blood-vessels and cause a general feeling of warmth to the body. It also frequently seems to stimulate the heart, especially in collapse and depression.

Over-action. It is difficult to cause poisoning in the human being unless the amount administered is excessive, and then respiratory depression and convulsions might be caused. Ordinary full dosage could have no effect except that of slight cerebral excitement, and possibly flushing and increased perspiration.

Uses.-The most important use of camphor is intramuscularly in aseptic oil, for stimulation purposes in shock and circulatory depression. While some laboratory reports and some hospital reports show that camphor fails in these conditions, clinically, those who use camphor most for such purposes are sure that it is a stimulant of no mean value. It has long been used for the depression following chloroform anesthesia, and apparently inhibits depression from that anesthetic. There is no question that many times camphor, given subcutaneously or intramuscularly or by mouth is of value in collapsed conditions, in conditions of cold skin and chilliness, and in some conditions of mental depression. It may be administered (ampules contain 2 or 3 grains), subcutaneously, every hour for two or three doses, and then less frequently. By the mouth it may be given every hour for a series of doses, and then less frequently. Camphor has a valuable carminative action, and may be combined in various methods to promote intestinal action and relieve gas pains. Whether administered with hot drinks, as hot lemonade or tea, or when combined with opium or morphine, its action in causing perspiration and in modifying the congestion in fresh colds is often satisfactory.

DRUGS USED TO DEPRESS THE BRAIN AND SPINAL CORD Some drugs of this class have been termed "depressomotors such as bromide, chloral, gelsemium, physostigma, etc., in

contradistinction to those drugs that excite motor activity. The drugs of this class are indicated in increased and excessive nervous irritability, in muscle spasms, and in convulsions. These drugs are all more or less circulatory depressants, hence must be used with care in cardiac weakness. Also, the after effect of all of them is that of general depression, if the doses are large.

Many drugs of this class are used for other purposes and depress the central nervous system secondarily; for example, acetanilid, antipyrine, phenacetin and aspirin are used as antipyretics and to stop subacute pain and aches, but secondarily they more or less depress the brain and spinal cord, aspirin the least. Gelsemium has long been used to stop peripheral nerve pain, but not so frequently since the coal-tar drugs became so much in vogue. Lately the drug most used as an anti-neuralgic, anti-cold, and anti-most anything is aspirin (acetylsalicylic acid). This drug is used too much, and often causes some cardiac depression. Physostigma (calabar bean) and its alkaloids are too uncertain in their action, also too likely to cause serious depression, and hence should not be used internally.

The best and most active cerebrospinal depressants are bromides and chloral, and these drugs are indicated in cerebral excitement, in spinal irritation, and in strychnine poisoning. They are also used in tetanus. Morphine is a cerebral depressant, but primarily a spinal excitant, although large doses stop spinal irritation and convulsions by its stupefying action on the cerebrum.

Gelsemium.-Administration.-Gelsemium is official as the rhizome and roots, but is not used as such, but in one of its official preparations, the best of which are the Fluidextractum Gelsemii and Tinctura Gelsemii. The dose of the fluidextract is 0.03 mil (1⁄2 minim); the dose of the tincture, which represents 10 per cent. of the drug, is 0.25 mil (4 minims).

Action.—Briefly, the action of this drug is, in ordinary dosage, mildly depressant; it lowers the blood-pressure, slows the heart and depresses the irritability of the spinal cord and nerves, both motor and sensory. It may cause, in larger doses, some dilata

tion of the pupil. It lowers the temperature somewhat by slowing the circulation, dilating the peripheral vessels, and slowing general metabolism. If the patient has fever, it will cause some perspiration. It is excreted rather rapidly by the kidneys.

Over-action.-In over-action from this drug the pulse is feeble, the skin cold, and the patient feels faint. Besides dilatation of the pupils, there may be some paralysis of the upper eyelids.

Toxic Action.-The toxic action is, in a word, that of depression with shock, and death is caused by failure of the respiration. Treatment of Poisoning.-Vomiting should be caused if it is supposed that the stomach contains the poison, after which the treatment is circulatory and nervous stimulation with strychnine, atropine, digitalis, and pituitary extracts; dry heat to the body; and artificial respiration, if needed.

Uses. The only logical use at the present time for gelsemium is as a sedative in peripheral neuralgias. It seems to be especially efficient, at times, in neuralgia of the fifth nerve, headaches, intercostal neuralgia, and sometimes in sciatica. However, this drug has given place to the coal-tar products which are much more frequently used as anti-neuralgics. Also, more care is now taken to ascertain the cause of the neuralgia, and there generally is a definite cause. The cause being found and removed, the neuralgia ceases. Various local applications of heat or electricity in some form are better treatments of neuralgia than drugs. If the peripheral pain is caused by central disturbances, as locomotor ataxia for instance, gelsemium is of little value, and would rarely stop that kind of nerve pain, unless the dose was exceedingly large. Non-irritant solutions, as about 11⁄2 per cent. of gelsemine in water, dropped into the eye will dilate the pupil by paralyzing the endings of the oculo

motor nerve.

DRUGS USED TO STOP PAIN

The drugs of the previous class will stop aches and subacute pain, but acute, severe pain can be stopped only by the anesthetic action of ether or chloroform, or by opium or one of its alkaloids. Acute pain must be stopped, and chronic pain can

not be long endured without causing depression of all vital functions. The acute pain of renal or hepatic colic may require partial chloroform anesthesia until the injected morphine can begin to act. Or chloroform may be advisable in such a condition in order not to give a poisonous or dangerous dose of morphine.

Opium.-Administration.-The Pharmacopoeia recognizes as opium the milky exudate of the unripe capsules of papaver somniferum. Preparations made from this substance are the ones used in medicine. The official preparations are as follows: Opii Pulvis, powdered opium; dose 0.06 Gm. (1 grain). Opium Deodoratum, deodorized opium; dose 0.06 Gm. (1 grain).

Opium Granulatum; dose 0.06 Gm. (1 grain).

Extractum Opii (a powdered extract); dose 0.03 Gm. (11⁄2 grain).

Pulvis Ipecacuanha et Opii, Dover's powder; dose 0.50 Gm. (71⁄2 grains). This preparation contains 10 per cent. of ipecac and 10 per cent. of opium.

Tinctura Opii, laudanum, (10 per cent. strength); dose 0.5 mil (71⁄2 minims).

Tinctura Opii Camphorata (paregoric) contains 0.4 per cent. each of opium and of camphor; dose 5 mils (a teaspoonful). Tinctura Opii Deodorati, tincture of deodorized opium, (10 per cent. strength); dose 0.5 mil (711⁄2 minims).

Opium contains many alkaloids, the most important of which are morphine and codeine. The official preparations of morphine are:

Morphine Hydrochloridum, which occurs as a white crystalline powder, very soluble in water, the dose of which is 0.008 Gm. (1 grain), and

Morphine Sulphas which occurs as white feathery crystals, very soluble in water, the dose of which is 0.008 Gm. (1⁄2 grain).

Codeine is official in the form of Codeine Phosphas, which occurs as fine, white crystals, very soluble in water, the dose of which is 0.03 Gm. (1⁄2 grain), and Codeinæ Sulphas, which occurs in white crystals, very soluble in water, the dose of which is 0.03. Gm. (1⁄2 grain).

An artificial alkaloid is formed from morphine, termed heroin, which is recognized in the Pharmacopoeia as Diacetylmorphine Hydrochloridum, which occurs as a white crystalline powder, very soluble in water, the dose of which is 0.003 Gm. (20 grain). There is no advantage of this drug over codeine. It is very subtle in its ability to cause a habit, and it has no activities whatsoever of any advantage over codeine. The drug should be abolished.

Another preparation formed artificially from morphine is dionin which is official under the name of Ethylmorphina Hydrochloridum. This drug also is not needed.

A new synthetic has recently been prepared by Macht termed Benzyl Benzoate. This preparation apparently has the advantage of stopping spasm and pain, and of relaxing muscle tubes, without being actively narcotic, and it does not apparently tend to cause a habit. This new drug seems to be specifically of value in colics and muscle spasms, and seems to be useful in such conditions as spasmodic dysmenorrhea, certain forms of asthma, and probably will be found of value in many conditions of hypertonicity and muscle irritability. The advantage of this new preparation over morphine is because morphine alone tends to cause contraction of smooth muscle tissue. This of course may not be in evidence when very large doses are given, or when morphine is combined with atropine to allay peripheral irritation that may be causing the colic, and of course large doses of morphine will cause general relaxation of all tissues. Nevertheless, this new drug is a great addition to useful drugs, as it will relax spasm and quiet pain without the unpleasant, disagreeable, and often dangerous narcotic effects of morphine and codeine or some other form of opium. This drug can be given repeatedly, apparently, without the development of a habit. This alone is enough to put the drug in a high class.

Benzyl benzoate is an ester of benzyl alcohol and benzoic acid. It is obtainable in the form of a solution termed "benzyl benzoate miscible," each ten drops of which contains two drops of benzyl benzoate, the average dose of which is 25 to 30 drops, but a fluidrachm may be taken by adults without poisoning. In any form thus far offered this preparation is very disagreeable