Action. This drug has similar activities to acetanilid but it is much less likely to cause cardiac depression or poisoning, unless the dose is very large.

This drug is used for the same purposes as is acetanilid. A useful combination is as follows:

R

Acetphenetidin.
Citrated caffeine.

Phenyl salicylate...

1.50 Gm.

0.25 Gm.

1.50 Gm.

Make 5 powders. Take one powder every three hours. This combination is especially efficient in stopping the aches and pains of an acute infection, as tonsillitis, measles, or influenza. Such dosage, as above suggested (modified for children), will not cause depression, and will lower temperature and stop the myalgias.

Antipyrine (Phenazone).—Administration.-Antipyrine occurs as a white crystalline powder, has a slightly bitter and, in solution, nauseating taste, and is very soluble in water. The Pharmacopoeial dose is 0.30 Gm. (5 grains). This dose is rather small. The drug may be administered in capsules which may be uncapped before swallowing, which obviates the disagreeable taste; or it may be administered in solution.

Action. -This drug has often been used in the mouth and throat as an antiseptic, either in spray or gargles, in such a condition as whooping cough. It is rapidly absorbed from the stomach, and has the same activities as acetanilid, with the exception that it seems to cause more perspiration, and is less likely, in full doses, to cause cardiac depression. It seems to be more analgesic in neuralgias, neuritis, and in pains emanating from the spinal cord than is acetanilid, and large doses have been frequently given, on this account, in locomotor ataxia. Large doses may cause a methemoglobin to be formed, and it may cause some irritation of the kidneys during its excretion. Antipyrine may cause an urticaria from irritation of the duodenum.

Over-action. The over-action is that of depression, occasionally cyanosis, but generally the only symptom of over-action is too profuse, prostrating and continued perspiration.

The treatment of over-action or of poisoning is the same as

that for acetanilid, except that for a long time large doses of alkalies should be administered.

Uses.-Antipyrine has frequently been used as an antipyretic, and as such is valuable. The best dose is 0.50 Gm. to 1 Gm., repeated in four or five hours, if deemed advisable. It has not been used as much for headaches as the other two coal-tar drugs, but large doses have been given for the pains of locomotor ataxia, and patients who receive these doses for some time seem to become tolerant to the drug and have no depression from it. However, it is not always successful in stopping that kind of pain.

Antipyrine has often been used to relax muscle spasm; it seems to diminish reflex irritability of the nerve centers. For whooping cough it is one of the most valuable treatments, and the dose for a child is 0.05 Gm. (a little less than a grain) for every year of the child's age. As it is disagreeable, it is well ordered in plain water, and administered in some drink, as lemonade or orangeade. The above dosage may be given three or four times in twenty-four hours, depending upon the number of the paroxysms of coughing. Older children may take the drug in capsules. It is always well in whooping cough under any treatment, but especially with the treatment with antipyrine, to give digitalis coincidently, in the proper dose for the age of the child.

At times antipyrine has seemed to be as efficient a treatment in stopping muscle twitching in chorea as are bromides, but both treatments are depressant, and these children generally require forced nutrition.

CLASS VII

DRUGS AND PREPARATIONS THAT ARE SPECIFIC

A specific treatment in medicine means a treatment that has positive antidotal activity against the disease or condition present. The few specifics known to medicine are listed in the classification. A description of a few drugs not described under more appropriate headings are here given.

MERCURY

Mercury (Quicksilver).—Administration.—Metallic mercury is used only in one of its official preparations, the most important of which are: Massa Hydrargyri (blue mass, blue pill) which is an ancient preparation that is not needed, as calomel will act as well; Unguentum Hydrargyri (mercurial ointment) and Unguentum Hydrargyri Dilutum are used externally for inunctions and in certain parasitic diseases of the skin.

Calomel (Mercurous Chloride).-Description.-Calomel is a white powder, insoluble in water. It is used internally mostly for its cathartic action; occasionally for its general action as an antisyphilitic; sometimes, in small doses, as a diuretic in cardiac dropsy when combined with other drugs. Calomel should, however, rarely be used for systemic purposes as it readily causes salivation. Also there is frequently found an idiosyncrasy against mercury, especially calomel, stomatitis occurring in these patients with ordinary cathartic doses.

Calomel is frequently given in small doses, as 0.006 Gm. (10 grain) repeated every half hour for ten doses, for a laxative and so-called antiseptic effect in the bowels. Such treatment is rarely advisable. Other antiseptics are better, and if calomel is needed, it is much better administered in a full dose suitable for the individual. The cathartic dose of calomel is from 0.05 to 0.25 Gm. (about 1 to 4 grains) and it is often best given coincidently with aloin. If it is given at night, on the following morning a saline should be given, unless deemed inadvisable. Calomel is an ingredient of the Compound Cathartic Pill, an ancient preparation which is not needed.

Yellow Iodide of Mercury (Mercurous Iodide).—Description.-Protoiodide of Mercury is a bright yellow amorphous powder, insoluble in water. This drug is often used for systemic action in a dose of o.or Gm. (% of a grain).

Red Iodide of Mercury (Mercuric Iodide).-Description.— Biniodide of Mercury occurs as a scarlet red amorphous powder, which is practically insoluble in water. It is used only for systemic purposes, and the dose is 0.003 Gm. (20 grain).

The official Hydrargyri Oxidum Flavum and Hydrargyri Oxi

dum Rubrum (Red Precipitate) are not used internally, but are used externally in the form of ointments. The official Unguentum Hydrargyri Oxidi Flavi, represents 10 per cent. of the drug.

The official Hydrargyrum Ammoniatum (White Precipitate) is used only externally as an ointment, and the Unguentum Hydrargyri Ammoniati represents 10 per cent. of the drug.

Hydrargyri Salicylas occurs as a slightly yellowish or pinkish powder, is practically insoluble in water, and has been used in suspension for intramuscular injections in syphilis.

Corrosive Sublimate (Mercuric Chloride).- Description.The bichloride of mercury occurs in crystalline masses or as a white powder, and is soluble in water. The dose is 0.003 Gm. (20 of a grain). It is used externally as an antiseptic wash in solutions from 1 part in 500 to 1 part in 10,000, or even weaker. The official tablets for antiseptic purposes to be dissolved in water (the amount depending on the required strength) are termed Toxitabella Hydrargyri Chloridi Corrosivi (Poison Tablets of Corrosive Sublimate).

Action.-Almost the only used preparation of mercury for external antiseptic purposes is corrosive sublimate. If the solution is used too strong, severe irritation of the skin and the parts to which it is applied is caused. If there is a large absorptive surface, or if the solution remains too long in a cavity which has been washed with the solution, systemic poisoning may occur. Corrosive sublimate antiseptic solutions have been used too much, and especially too frequently on fresh wounds as such treatment tends to prevent healing.

There has recently been offered a new salt, a combination of fluorescein and mercury, termed "Mercurous Chrome-220." A description of this drug and its uses as a germicide is offered by Young, White and Swartz,' who present their conclusions that this preparation has great germicidal value, and in a solution of 1 to 1,000 will kill the bacillus coli and the staphylococcus aureus in urine in one minute, and that this preparation may remain in the human bladder in 1 per cent. solutions from one to three hours without irritation. Though they find the drug of value as a local genitourinary antiseptic, its greatest value seems 1 1 Journal A. M. A., Nov. 15, 1919, p. 1483.

to be as an antiseptic injection in infection of the bladder and the pelvis of the kidney.

Mercury in various forms in oily or fatty preparations may be rubbed into the skin, be absorbed, and cause systemic action, and even the insoluble preparations are used for this purpose, but they are probably not as satisfactory as the carefully prepared mercurial ointments.

Internally, except in minute doses, the soluble mercurial preparations, and typically mercuric chloride, are corrosive poisons. Calomel is, ordinarily, not absorbed in the stomach, but is absorbed from the intestines, and if it does not quickly cause catharsis, may cause symptoms of mercurial poisoning, but not of corrosive poisoning.

The systemic action of mercury is shown by a tendency to looseness of the bowels, and sometimes slight diuresis. Soon, if the dose is too large, or there is a hypersusceptibility of the patient, salivation is caused, with, if the drug is not quickly stopped, softening of, and bleeding from, the gums, loosening of the teeth, and general stomatitis. Mercury may irritate or slightly stimulate the liver, but it has not been shown that the bile is increased in amount. If brisk catharsis is caused by calomel or by any other form of mercury, the liver is relieved! by the improvement of the portal circulation, and by the elimination from the bowels of substances that, during constipation, are re-absorbed and must be again detoxicated by the liver and re-excreted in the bile. Hence the liver is often improved by catharsis caused by a mercurial salt.

There is no excuse for administering mercury internally except as a purge (and for that purpose calomel is the best preparation) and for the treatment for syphilis. Syphilis cannot be successfully treated, with our present knowledge, without the use of mercury in some form, either by inunctions, by intramuscular injections, or by the administration internally of one of its salts, as the yellow iodide, the red iodide, or sometimes corrosive sublimate.

Mercury is excreted in the form of an albuminate both by the intestines and by the kidneys, and the kidneys may become irritated and inflamed, if the dose has been large. If mercury has