intestines. They are not much dissolved in the stomach, are non-irritant to the stomach, and, therefore, are satisfactory methods of administering tannic acid for intestinal conditions.

The dose of the Protan is about 0.50 Gm., best in capsule, every three or four hours. The dose of the Tannigen is about 0.25 Gm. best in capsule, every three or four hours.

Silver Nitrate.—Administration.-Silver nitrate occurs as colorless, transparent crystals, which are very soluble in water. Solutions should always be made with distilled water, as any organic matter changes the color of the solution to gray, or even black, and exposure to light does the same; hence solutions are best kept in colored bottles with glass stoppers.

There is no excuse for using silver nitrate internally for systemic treatment. It may be used in weak solutions in the treatment of chronic inflammations of the bladder, rectum, and lower colon. These silver solutions must be immediately passed out of the body, or, if they are not expelled, a sodium chloride solution should be injected to cause an insoluble chloride of silver to be formed.

Silver nitrate has been used in the treatment of gastric ulcer, but on account of the danger of too much absorption it is hardly justifiable, also it is problematical whether the solution, or a dissolving capsule, will hit the spot to which it is directed. Acute metallic poisoning, with nephritis, may occur, and chronic metallic poisoning has not infrequently occurred, from the use of silver nitrate internally. Therefore, the only justifiable use for nitrate of silver is locally, i.e., externally, or in cavities of the body that can be quickly evacuated.

Action.-Silver nitrate is a powerful germicide, forming a silver albuminate with protein matter and setting free a small amount of nitric acid. On account of the formation of the albuminate the destructive action is not deep. Metallic silver inhibits germ growth and silver foil is often used as a germicide and a protective to healing surfaces.

The eschar produced by the action of silver nitrate is white, later turning black. When solutions stain the skin it may be removed, if treated soon, with a saturated solution of potassium iodide, but, if it is not soon treated, the stain will remain until

exfoliation of the epidermis occurs.

Nitrate of silver stimulates the healing of a sluggish ulcer, provided it is not used too frequently or too many times. It has been thought that it could over-stimulate a part and cause tumor growth. When nitrate of silver is absorbed it may cause, after two or three weeks' treatment, deposits of organic silver in the skin and mucous membranes, and perhaps in the organs. The mucous membranes show brown spots, and the skin shows blue patches, or even a generalization of bluish pigmentation. Such pigmentation will always remain, and can never be removed. This condition has been termed argyrism or argyria. As stated, such chronic poisoning should never occur, as there is no excuse for administering nitrate of silver internally.

Toxic Action.-Acute poisoning is similar to that of other gastro-intestinal irritants, with lowering of the blood-pressure, weakening of the heart, and irritation of the nervous system, as shown by convulsions, and later coma and collapse.

Treatment of Acute Poisoning.-The antidote is a strong solution of sodium chloride administered immediately. If vomiting does not soon occur the stomach should be washed out. The later treatment is that of the local inflammation that has been caused.

Uses.-Silver foil is often used as a surgical dressing, both for protective and antiseptic purposes; it also tends to prevent exuberant granulations. The stick nitrate of silver (Lunar Caustic, Argenti Nitras Fusus,) is often used as an escharotic, as well as is a fused bead of nitrate of silver on a wooden applicator. The latter is better, because it can be destroyed after it is once used. Twenty-five per cent. nitrate of silver solutions are generally as valuable, applied by means of a swab. Weak solutions have been used on the mucous membrane of the nose, nasopharynx, bladder, urethra, vagina, and rectum. Nitrate of silver applications are very curative treatment for cankers in the mouth. However, for most purposes organic silver salts are now more used than is the nitrate of silver.

Except in the prevention of ophthalmia neonatorum, by instillation into each eye of the newly born child of two drops of a 1 per cent. watery solution of nitrate of silver, known as

Credé's method, organic preparations of silver are now the ones used in all inflammations of the eyes.

Nitrate of silver is now rarely used in preventing gonorrhea. Other silver solutions or weak corrosive sublimate solutions are more used. To destroy tissue, except to remove exuberant granulations or to stimulate the base of an ulcer, other escharotics are used more than nitrate of silver. To destroy warts, callous skin, etc., nitrate of silver is now rarely used.

The book New and Nonofficial Remedies, edition of 1920 recognizes the following silver preparations:

Cargentos, a colloidal silver oxide, containing about 25 per cent. of silver.

Collargol, an allotropic form of metallic silver, containing a small percentage of albumin and about 78 per cent. of silver. Argyrol, a compound of a derived protein and silver oxide, containing from 20 to 25 per cent. of silver.

Solargentum-Squibb, a compound of silver and gelatine, containing about 20 per cent. of silver.

Sophol, a compound of silver and methylenenucleinic acid. Protargol, a compound of albumin and silver, containing about 8 per cent. of silver.

Proganol, a compound of albumose and silver, containing a little more than 8 per cent. of silver.

Of these preparations the most used are Cargentos, Collargol, Argyrol and Protargol. Argyrol is the one generally preferred, and is used in solutions of various strength, from 10 to 25 per cent. The value of these solutions in the prevention of and in curing many localized infections is very great.

CLASS IV

DRUGS USED FOR LOCAL ACTION IN THE STOMACH

DRUGS USED TO INCREASE THE APPETITE

Drugs administered to increase the appetite are generally bitter, but it is a mistake to believe that every loss of appetite should be combated by one of these drugs, as many times the

anorexia is due to inflammation of the gastric mucous membrane. If there is much inflammation, i.e., if gastritis is present, even in a mild form, bitter tonics are not indicated to increase the appetite and will often defeat the object for which they are administered, even producing nausea. Bitters should also not be used when there is hyperacidity of the stomach, as they tend to increase that condition. If gastritis is present it should be treated with bismuth and soda, or with some other sedative, and by such an arrangement of the diet as will diminish or prevent indigestion. When gastritis or simple indigestion improves, the appetite will return.

If the loss of appetite is due to an anemic condition of the stomach and gastritis is not present, any mild irritant to the mucous membrane of the stomach will often increase the appetite, and the best stimulant is a weak bitter. The bitter should not be too strong, and many times it is well to have it combined with aromatics, as aromatics and aromatic oils also stimulate the stomach and hence the appetite.

Many drugs increase the appetite by improving the systemic condition, but the best bitter appetizers are cinchona, gentian, and nux vomica. If a capsule or pill of quinine is taken some hours before a meal (and quinine is generally given as a tonic three times a day, after meals) it causes an increase of appetite by giving a bitter taste, owing to a slight excretion of the quinine with the saliva, and the patient desires more food. However, the official Tincture of Cinchona in teaspoonful doses in a wineglass of water before meals, or an Elixir of Calisaya in dessertspoonful doses before meals are efficient methods of increasing the appetite. If a simple clean bitter is desired, the Tincture of Nux Vomica in from one to five drop doses in a wineglass of water before meals is also very efficient. The official Compound Tincture of Gentian in teaspoonful doses, in water, before meals is also a valuable stomachic.

If the digestion seems to be impaired, as evidenced by gastric flatulence and a coated tongue, 5 to 10 drops of Acidum Hydrochloricum Dilutum, taken in a wineglass of water directly after meals, not only aids digestion, but seems to promote the appetite for the next meal.

If the patient is anemic, iron in most any form will increase the appetite. It is best given in some simple form directly after meals.

There are various other bitter, non-poisonous drugs that are official, but they are superfluous, as the above preparations are sufficient.

DIGESTANTS

Indigestion is a very frequent condition, especially in the United States, largely due to rapid eating, eating too rich foods, drinking too many sweet, so-called "soft drinks,” drinking too much ice water, eating between meals, and to the over-use of coffee, tea and tobacco, to say nothing of the frequency of indigestion due to some general systemic disturbance. Indigestion is frequently due to constipation, and also, many times, to the bad habit of taking too strong laxatives. Considerable stomach indigestion is caused reflexly by disturbances of the nervous system, the most frequent of which is eyestrain.

The larger part of indigestion is gastric in origin, and the principal symptoms are distress, gastric flatulence, pyrosis, and heartburn. Pain, nausea and vomiting are rare symptoms in simple dyspepsia. When these symptoms occur, there is an acute indigestion or gastritis, or there is some more serious

cause.

The treatment of gastric indigestion is suggested by the above list of causes. A correction of the diet and the method of eating will often cure the condition. To treat dyspepsia by the administration of digestants, one must bear in mind the physiology of digestion. The diastase from the saliva, or a diastase that may be given a patient, will act on the carbohydrates in the stomach until free hydrochloric acid or a considerable amount of acid peptones from the peptic digestion have developed, which ordinarily will be from one to one and a half hours after the food has been taken. The acid peptic digestion then proceeds from three to four hours, until the stomach is emptied, gradually, into the duodenum, where the digestion again proceeds in medium rendered alkaline by the