in glaucoma and inflammation of the eye after iridectomy, and in some corneal ulcerations, eserine is used.

Physostigmina Salicylas (eserine salicylate) is an alkaloid obtained from physostigma (calabar bean). This salt occurs as colorless or faintly yellowish crystals, which are soluble in considerable water. It is used locally to contract the pupil in 0.3 per cent. solution (3-1,000).

7. As an antidote in all depressant drug poisonings atropine has no equal. It is also of great value in poisoning by mushrooms, as it is antagonistic to muscarine poisoning. It is also an antidote to the depression from toxins developed or absorbed from the intestine. In morphine poisoning, although atropine is somewhat of an antidote, it should not be used in a large amount, as very large doses of atropine will depress the respiratory center as does the morphine. Consequently, atropine is not a very good treatment in morphine poisoning, although when a large dose of morphine must be administered it is well combined with atropine to prevent too profound an action of the morphine on the respiratory center.

Homatropina Hydrobromidum (hydrobromide of homatropine) is an alkaloid obtained by the condensation of tropine and mandelic acid. It occurs as a white crystalline powder or as prisms, is soluble in water, and is used in about a 1 per cent. solution to dilate the pupil and paralyze the accommodation. Camphor.-Administration.-Camphor occurs in white translucent masses or granules, has a pungent, characteristic odor, and a pungent, aromatic taste. It is very soluble in alcohol, but slightly soluble in water. The dose is 0.20 Gm. (3 grains) by the mouth, and hypodermatically, in solutions in aseptic oil, the dose is 0.10 to 0.20 Gm. (2 to 3 grains). For hypodermatic use the solutions may be prepared extemporaneously, but sterile ampules may be obtained.

The preparations used for camphor action are Aqua Camphora and Spiritus Camphora. The dose of the camphor water is from 1 to 3 teaspoonfuls. The dose of the spirit of camphor is 1 mil (15 minims).

Action. On the surface of the body it is slightly irritant and astringent, and if rubbed on the skin may cause some reddening

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 12 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. (1⁄2 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. (1g grain), and

Morphine Sulphas which occurs as white feathery crystals, very soluble in water, the dose of which is 0.008 Gm. (% 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 Codeine Sulphas, which occurs in white crystals, very soluble in water, the dose of which is 0.03 Gm. (1⁄2 grain).