used to expel round-worms, but more especially, as just stated, for the eradication of hook-worms. It has no other uses. The United States Pharmacopoeia gives the dose as 0.2 mil (3 minims). The dose may be considered, as above described in the treatment of hook-worm, about 15 drops for an adult for any one day.

At times oil of chenopodium may show no serious symptoms on the day of its first administration, but when it is repeated several days later there may be found an increased hypersusceptibility to it. This is especially true if the individual is under-nourished. A cachectic child or older patient should probably not receive the second treatment from the oil of chenopodium unless his nutrition has improved, and he has taken a goodly amount of food. Castor oil given before and after the administration of wormseed oil has seemed to prevent toxic action from the latter. Also, plenty of water should be taken with the oil to insure its rapid passage from the stomach to the intestine.

Amebic Dysentery. Fortunately, this disease is not frequent in all parts of this country, but it is common in the tropics.

The specific treatment of amebic dysentery is the administration of ipecac and emetine. The ipecac is administered by the mouth, perhaps best in the form of emetine bismuth iodide, as the ipecac in the intestines better eradicates the ameba that are on the surface of the intestinal walls than does the dose of emetine given hypodermatically. Emetine given hypodermatically will kill the ameba that are deeper in the tissues of the intestinal walls. When ipecac is administered by the mouth in a form that is insoluble in the stomach, it is not necessary to precede the dose with opium or morphine, but in a form that is irritant to the stomach, vomiting will be caused unless a hypodermic of 1% to 1% of a grain of morphine has been previously administered. The Pharmacopoeial hypodermatic dose of this preparation is stated to be 0.02 Gm. (1⁄2 grain), but when this is to be repeated, as in amebic dysentery, the dose should be smaller, perhaps about 0.01 Gm. given once or twice a day, hypodermatically, for three or four days, and then once a day for a week, this combined with the administration of some form of ipecac by the mouth.

It should be noted that emetine in too large doses may cause some paralysis and heart weakness, and may cause death.

The best preparation for administration by the mouth is perhaps emetine bismuth iodide, which may be administered in 0.05 Gm. (about 1 grain) doses three times a day, for two weeks. According to Sollmann1 this preparation is but slightly soluble in the stomach, and seems to be freely soluble in alkaline media. Therefore it is soluble in the intestine.

Emetine Hydrochloride is the hydrochloride of the alkaloid emetine, which is obtained from ipecac. It is a yellowish crystalline powder, is soluble in water, and is used mostly hypodermatically as a specific in amebic dysentery. Its value in pyorrhea alveolaris has not been proved. The single dose is 0.02 Gm. (% grain) hypodermatically.

Emetine Bismuth Iodide, N.N.R. is a complex iodide of emetine and bismuth, containing not far from 20 per cent. of anhydrous emetine and about 20 per cent. of bismuth. It rarely causes vomiting, and is a good method of administering ipecac for intestinal action. The dose is 0.20 Gm. (3 grains), given either in a single or in divided doses for several days, well administered in capsules.

Alcresta Ipecac.-This is an emetinated fullers' earth. It has been shown by Sollmann that the alkaloids of alcresta ipecac are insoluble not only in the stomach but in alkaline media. Therefore they may not be dissolved in the intestines.

Caution. Emetine in any form should always be used with care, as it may cause poisoning.

It should be emphasized that the ipecac and emetine treatment of amebic dysentery does not heal the ulcers in the intestines, and after the ameba have been eradicated, this surgical condition requires further treatment.

Leukemia. Benzene (Benzol) has been recommended and used in leukemia, as by its administration the number of white corpuscles is reduced. This is especially true if the roentgenray treatment is used coincidently. Several preparations may be obtained, and the dose of "benzene, medicinal," according to

1 Journal A. M. A., Oct. 11, 1919, p. 1125.

New and Nonofficial Remedies, is 0.5 to 1 mil (8 to 15 minims) given four times a day, best in emulsion. Treatment with this drug is not without danger, and the condition of the patient and the condition of the blood must be watched. Its permanent value in this disease has not been proved.

SECOND DIVISION

CLASS I

DRUGS ADMINISTERED INTERNALLY FOR THEIR ACTION ON THE SKIN

DRUGS USED TO STIMULATE THE ACTIVITY OF THE SKIN

The surface of the body is dry, scaly and harsh in various chronic diseases of the skin, and it is also dry in hypothyroidism, in chronic nephritis, and in diseased conditions of the liver. Any treatment that improves the systemic condition will improve the condition of the skin. Many times a dry skin—a skin that does not normally perspire-will be improved by the administration of thyroid extract, if such medication is not contraindicated. Arsenic is also a stimulant to the skin, but it should not be given if there is disease of the kidneys or liver. The majority of dry skins, not due to organic diseases, are due to sub-thyroid secretion.

A description of the action of arsenic and of thyroid gland extracts will be found on pages 382 and 406 respectively.

DIAPHORETICS

It is desirable to increase the perspiration in fever, after chilling, and in some toxemias. The so-called antipyretic drugs all promote perspiration, and especially valuable for this activity is antipyrine. Alcohol, by dilating the peripheral bloodvessels, is a promotor of perspiration.

Of all methods to promote perspiration, the best are body baking, electric light cabinet baths, Turkish baths, ordinary hot baths, and strenuous exercise. Turkish baths and exercise are especially valuable in reducing obesity by causing perspi

ration. Most of these physical methods of causing perspiration are of value in aborting a cold after chilling.

Profuse sweating has long been advocated in systemic conditions. Whether caused by pilocarpine, by dry hot air, or by moist hot air, the value of profuse perspiration in eliminating toxins, particularly in uremic conditions, is very doubtful. The action of alcohol and of antipyrine are described on pages 238 and 337 respectively.

Pilocarpus. Administration.-Jaborandi occurs as the dried leaves of a South American plant. The active part of this drug is represented by its alkaloid, pilocarpine. Pilocarpus is not used as such, but it may be used as the official fluidextract, the dose of which is 2 mils (30 minims). As the alkaloid represents the activities of the plant, the drug is best used in the form of the official Pilocarpine Hydrochloridum. This salt occurs in colorless crystals and is very soluble in water and alcohol. The dose by the mouth is 0.01 Gm. (% grain), and the hypodermic dose is 0.005 Gm. (12 grain). For quick action, the hypodermatic method is the better.

Action. Pilocarpus has no external action. It is rapidly absorbed, and stimulates the sympathetic nerves, sweat glands, and salivary glands. It also stimulates the bronchial glands, and may cause profuse bronchial secretion. Consequently, in prostration or in impaired circulation, and especially if there are signs of edema of the lungs, it should not be used, as it can literally cause drowning by the enormous watery secretion into the lungs that may occur. It may also lower the bloodpressure and weaken the heart, therefore, in any condition of depression pilocarpine should not be used.

In about ten minutes after its administration by the stomach (unless something prevents its absorption), and in about five minutes when it is administered hypodermatically, flushing of the face and neck occurs, from dilatation of the peripheral blood-vessels; and in about fifteen minutes sweating begins, which may persist for one or two hours, or even longer.

The slight stimulation of the endings of the vagi nerves will slow the heart, although the heart is not strengthened but is really weakened, and soon the least exertion may cause the

heart to become rapid. This is especially in evidence if the drug causes nausea or vomiting. Salivation may be profuse, the nasal secretion increased, and the lachrymal glands stimulated.

Pilocarpine has been thought to stimulate the uterus to contraction, and it may increase labor pains, but it should not be used for this purpose. When applied to the eye, it produces contraction of the pupil and increases the ocular tension.

Over-action. When this drug acts excessively, it not only causes profuse and prolonged sweating but also vomiting and diarrhea. It increases the secretion of the intestinal glands, and may disturb the pancreas and the glands of internal secretion, perhaps the suprarenal glands.

Toxic Action.-Pilocarpine may cause dizziness, disturbed vision, cold perspiration, and collapse, and death may occur from pulmonary edema, or from heart failure.

Treatment of Poisoning. Besides evacuating the stomach, if the drug has been administered by the mouth or taken by accident, tannic acid should be given. The physiologic antidote to pilocarpine is atropine, which should be given hypodermatically. Atropine is directly opposed to the action of pilocarpine, namely, it inhibits the secretion of the skin and most of the glands of the body, stimulates the respiratory center, stimulates the heart and raises the blood-pressure.

A patient suffering from pilocarpine poisoning should be surrounded with dry heat, and, besides the atropine, caffeine and strychnine should be administered.

Uses. The most important use of pilocarpine has been in the anasarca of nephritis and in uremia. The object was to promote profuse perspiration, and therefore to eliminate water from the body and as many toxins as could be excreted by the skin. In uremic poisoning without general edema, the large excretion of water by the skin which pilocarpine promotes could do nothing but concentrate the toxins in the blood, and the amount of nitrogenous excretives that can be eliminated through the skin, even with profuse perspiration, is not great. More sodium chloride may be thus removed, but little urea is eliminated. Therefore, theoretically, this is not good treatment in such a condition: venesection would be better. On the