A textbook of materia medica for nurses

Preface

The schedules of studies in the training schools for nurses in this country allow an average of about twenty-four hours for Materia Medica during the entire course. When a textbook of from four hundred to seven hundred pages is placed in the hands of the average nurse in training with such a limited time at her disposal in which to gain a working knowledge of its contents, the result can easily be imagined.

This little book is written for the undergraduate nurse in training and with her needs and limitations constantly in mind. Its aim is to provide her with a book of twenty-four short chapters in which she can obtain easily and in language she can readily understand, the information concerning drugs and remedies which she needs in her ealling.

The graduate nurse or student needing a larger reference work, will find some excellent ones on the market. This book is written for those with a limited time at their disposal.

A. L. Murrunap.

Omaha, Nebraska.

Chapter I Introduction Chapter It Weights, Measures, And Solutions

CHAPTER ITI ANTISEPTICS AND DISINFECTANTS .

CHAPTER IV

CHAPTER V PURGATIVES

CHAPTER VI ANODYNES

CHAPTER VII GENERAL ANESTHETICS

CHAPTER VIII ALCOHOL

CHAPTER IX - SOPORIFICS OR HyPNOTICS

CHAPTER X STRYCHNINE AND CAFFEINE GROUP

CHAPTER XI ATROPINE AND PILOCARPINE GROUPS

CHAPTER XII DIGITALIS AND IPEGAG

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12 CONTENTS

CHAPTER. XL ANTIPYRETICS

CHAPTER XIV Drucés ACTING ON BLOOD VESSELS AND UTEerus

CHAPTER XV Loca ANESTHETICS

CHAPTER XVI ANTITOXINS AND. VACCINES

CHAPTER XVII THE ARSENIC GROUP

CHAPTER XVIII THe HEAVY MerTrALS

CHAPTER XXI THE ACIDS

CHAPTER XXII CHLORIDES, IODIDES, AND THYROID GLAND

CHAPTER XXTII LocAn REMEDIES

CHAPTER XXIV LocaL REMEDIES

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ILLUSTRATIONS

. Apparatus used in the Carrel-Dakin method of treating wounds

. Senna leaves

. Caseara sagrada bark ; ;

. Root of podophyllum, also called mandrake or ee en . Jalap root, a tuberous root

. Capsules of the opium poppy of various shapes, also a eross section

. Tracing showing the effect of morphine on the respiration of a cat

. Tracing of the respiration and blood pressure of a cat during Cheyne-Stokes’ respiration due to morphine

. Tracings of action of ether and chloroform on blood pressure of cat

. Effect of nitrous oxide on normal breathing

. Tracing showing the change in blood pressure and respiration when an animal under nitrous oxide inhales ethyl chloride

. Tracings showing the effect of a strong solution of alcohol on the heart of a dog

. Tracing showing the slight effect of a moderate amount of alcohol on the heart and blood pressure of a dog

. Nux yomica

. Tracing showing the slight effect of strychnine on the heart and blood pressure

. Kola nuts : . Cacao, cocoa, or chocolate bean

. Tracing showing the effect of caffeine on the respiration of a rabbit under morphine

. Tracing showing the effect of caffeine on the heart and blood. pressure .

. Leaves, flower, and fruit of Ny elisdoran:

PAGE

30 46 48 50 51

14 ILLUSTRATIONS

22. Tracing showing relaxing effect of atropine on intestinal muscle after pilocarpine had caused strong contraction 91

23. Leaf of pilocarpine and a section magnified . . . . 94 24. Tracing showing contraction of the lung of a turtle by

from a dog by physostigmine, afterwards relaxed by a

30. Tracing showing the effect of strophanthin on the heart 103

31. Root of ipecacuanha natural size and a cross section mag-

and bronchial tubes, following the giving of morphine 113 34. Tracing showing the action of adrenalin on the heart . 114 BOs BECO OL VY¥Grs cacao asa wera Mal epee ok tion ae ana ae 36. Tracing showing contraction of the uterus under ergot 116

37. Tracing showing contraction of the uterus and blood pres-

46. Tracing showing the action of the oil of anise on a segranleraye suo eeColoyserish Thatch ab aleS Me gy ideer graph 1G. ones Cera opm ree 8 ICa9)

“ILLUSTRATIONS |

Tracing showing the action of oil of turpentine on a seg- Beloit Wenteor Tabb B-inbestime. easy Se ee A 169

49. Cantharis or Spanish fy . . . . . . . ... . . 170 0). Caldwell’s paraffin sprayer for applying paraffin to burns 173

CHAPTER I

Introduction

Materia Medica is a science which considers medicinal substances from every standpoint. Its meaning is often limited to a study of the source, composition, preparations and doses of remedies but in this book it is used in its broadest sense, including pharmacology, therapeutics, and toxicology.

Pharmacology is the study of the action of drugs on living things.

Therapeutics is the study of the beneficial effects of remedies.

Toxicology (the science of poisons) is the study of the harmful effects of drugs.

A drug is any crude medicinal substance, but the name is generally applied to anything used as a remedy.

A remedy is any medicinal substance that prevents, relieves, or cures disease.

Action of Drugs

All useful remedies have some action on living things, either local, general or both of these.

Local action is the effect at the place to which a remedy is applied. It may be soothing, irritating, or destructive (caustic).

igh

General action is the effect after the absorption of a remedy into the blood stream. Any or all tissues of the body may be influenced thereby. Drugs do not act in any mysterious manner; they merely increase or decrease the normal activity of an organ or tissue, but ean not change its character. If the normal activity of an organ is increased we eall it stimulation; if it is lessened we call it depression; and if it is entirely suppressed we call it paralysis.

Dosage

No fixed amount of any remedy can be used for all persons and under all circumstances. The doses given in this book are such as are considered safe and adequate for an average adult, but, under certain conditions, may have to be greatly increased or diminished. The dose of any remedy must be modified to suit the age and size of the patient. A man weighing 250 pounds will require approximately twice as much as one weighing only 125 pounds. For determining the dose at any age, Dr. Young’s rule is a fairly good method. Divide the age of the child by the age plus 12. The resulting fraction of the adult dose will usually be a safe dose for the child. For example, if the adult dose of sodium bromide be 30 grains, the dose for a child 8 years old will be found th apy — 2/5, and 2/5 of 30 grains is 12 grains, the dose for the child.

Women may require slightly smaller doses than men of the same size because they often react more strongly to some remedies than men do. During menstruation, pregnancy, and lactation some remedies must be given in less than ordinary doses or not at all, as they have a special effect on these conditions.

INTRODUCTION 19

Idiosyncrasy is a condition in which an unusual effect results from giving a usual amount of some remedy or food. Small amounts of cocaine in some eases cause alarming illness and one strawberry eaten by certain persons makes them quite sick.

Tolerance is a condition in which an unusually large dose of some drug can be taken without harm. This condition is usually produced by repeated use of the drug, but a natural tolerance is often seen in certain species of animals.

Methods of Giving

Drugs intended for local action are applied in some form or other to the parts upon which they are intended to act. Drugs for general action may be given in any one of the following ways, which are arranged in the order of rapidity of results.

Intravenous Injection.

Inhalation.

Hypodermie Injection.

By Mouth.

By Rectum.

By Application to the Skin.

Intravenous injection of remedies is made in two ways. One is by passing a hollow needle through the wall of a distended vein, and the other by making a small opening into a vein and inserting and fastening a small cannula.t. The solution can then be injected through the needle or cannula. The remedy for intravenous use must be free from solid particles, must be absolutely sterile, must not injure the blood and should

1Cannula, a small tube for insertion into a blood vessel, trachea. or similar passage.

20 MATERIA MEDICA FOR NURSES be about the temperature of the body. This method requires considerable skill and some experience to be safely and successfully carried out. The results are very prompt and smaller doses than are given by other methods are necessary.

Inhalation can be used only when gases or volatile liquids are given. Ordinary anesthetics are given in this way and other remedies occasionally. Accurate dosage is more difficult by this than by other methods.

Hypodermic injection can be used when the dose of the remedy is small, when it is readily soluble in water, and not very irritating. In this method also the solution must be sterile and free from solid particles which might clog the small needle.

By mouth is the method of giving medicines most frequently used. Either solids or liquids are given this way. The results are slower, and larger doses are required than in the preceding methods... All remedies given by mouth pass through the liver before entering the blood stream.

By rectum drugs are used more frequently for local effect than for general action. Hither fluids or solids— in the form of suppositories can be used in this way. A fluid given in this way is ealled an enema. Quite frequently large amounts of dilute solutions of various salts are given very slowly in this way, and are ab sorbed into the circulation.

Application to the skin is used mostly for local effect, but oceasionally, as in the use of mercury ointment, it is used to get the remedy into the blood stream. In this method of application drugs are usually mixed with fats or oils. Absorption is somewhat slow and accurate dosage difficult.

INTRODUCTION 21

Preparations

Drugs are not often given in their natural state. Usually the drug, or the soluble part of it, is dissolved in some fluid or mixed with other substances to improve or disguise the taste, or prepared in some way for convenient administration. Whatever the method of preparing the drug may be, the product is called a preparation.

Watery Preparations

Medicated waters contain some volatile remedy in solution. They sare usually quite dilute.

Decoctions are solutions made by boiling parts of plants in water.

Infusions are made by soaking parts of plants in water, hot or cold, but not kept boiling.

Mixtures are made by suspending? insoluble powders in water by means of gums or other sticky substances.

Emulsions are made by suspending oils, or other insoluble liquids, in water by means of gums or other sticky substances.

Syrups are strong solutions of sugar in water. They may contain some active remedy or only sugar.

Alcoholic Preparations

Spirits are solutions of volatile drugs in alcohol.

Tinctures are solutions mostly of nonvolatile drugs in aleohol.

Elixirs are dilute alcoholic solutions usually sweetened and flavored.

Fluid extracts are solutions in alcohol, water or a mixture of both, in which the volume corresponds to the weight of the crude drug from which it was made.

; *Suspending, to keep floating in the liquid without settling or coming to the top.

Liniments are dilute medicated solutions for application to the skin.

Tinctures and fluid extracts are used more frequently than other preparations and all important plant drugs are made up in one or both of these forms.

Solid Preparations

Extracts are solid preparations made by evaporating fluid extracts to a sticky mass or a dry powder.

Pills are round or oval masses of small size usually containing a single dose of some remedy.

Powders are dry remedies which are in a state of fine subdivision.

Tablets are small, round, dise-shaped bodies containing some drug intended to be swallowed or used in making a solution.

Troches are similar to but larger than tablets, as a rule, and are intended to be held in the mouth until dissolved.

Ointments are solid, oily preparations for rubbing on the skin where they melt.

Cerates resemble ointments but are made harder with wax enough to prevent melting at ordinary skin temperature. .

Plasters are adhesive materials, usually medicated, and spread on cloth. They soften end stick when applied to the skin and warmed.

Suppositories are conical or ovoid «lids for iusertion into some body cavity where they n.xlt,

CHAPTER II WEIGHTS, MEASURES, AND SOLUTIONS Weights and Measures

The commercial system of weights known as avoirdupois is not used in weighing remedies for the sick. A special system is used for that purpose known as apothecaries’ system. Only solids, used as remedies, are weighed in this country; liquids are usually measured. The smallest weight in use is a grain, which originally meant a grain of wheat. It is commonly written ‘‘gr.’’ The smallest liquid measure in use is a minim, a trifle less than the quantity of water that would weigh a grain. It is commonly written ‘‘m.’’

TABLE OF SOLID WEIGHTS

1 dram, written 3 1 ounce, written 3 1 pound, written Ib.

60 grains 8 drams 12 ounces ll il

TABLE OF LIQUID MEASURES

60 minims = 1 fluid dram, written 13

8 drams = 1 fluid ounce, written £13 16 ounces = 1 pint, written pt. or O. 2 pints = 1 quart, written qt.

4. quarts —= 1 gallon, written gal. or C.

In many countries the metric system of weights and measures is the only one used. In this country it is coming more and more into use and it is necessary for any person handling drugs to understand it. It is really much simpler than the older systems, as the weights and measures are uniform and their relations are always multiples of ten.

The unit of weight, a gram, is the exact weight of the unit of volume, a cubic centimeter of water. The gram is commonly written “‘em.,’’ and the cubic centimeter ‘‘c.c.’’ Quite often the ¢.c. is written mil. for milliliter. The actual name of the quantity need not be written as the position of the numeral in relation to the decimal point determines its value.

ce

TABLE OF Mrrric WSIGH'TS

A gram (the unit of weight) is written 1.0 gm.

A decigram (1/10 of a gram) is written 0.1 gm.

A centigram (1/100 of a gram) is written 0.01 gm.

A milligram (1/1000 of a gram) is written 0.001 gm.

A kilogram (1000 grams) is written 1000.0 9m., k., or ke.

TABLE OF Metric MEASURES

A eubie centimeter (or milliliter) is written 1.0 ¢.c. or mil. A tenth of a cubic centimeter is written 0.1 ¢.c. or mil.

A hundredth of a eubie centimeter is written 0.01 ¢.c. or mil. A liter (1000 cubic centimeters) is written 1000 ¢.c. or mil.

It is sometimes necessary to change weight or measure from the metric into the apothecary system, or from the apothecary system into the metric.

Some of the equivalents are given below.

RELATIVE WEIGHTS

A milligram (0.001 gm.) is about 1/65 grain. A centigram (0.01 gm.) is about 1/6 grain. A decigram (0.1 gm.) is about 14 grains.

A gram (1.0 gm.) is about 15 grains.

A kilogram (kg. or k.) is about 32 ounces.

RELATIVE MEASURES

A cubic centimeter (1.0 ¢.c. or mil.) is about 15 minims, A liter, (1000 ¢.c, or mil.) is about 32 oz, or 1 qt,

WEIGHTS, MEASURES, AND SOLUTIONS 25 In changing from apotheearies’ to the metric system, the following values will be a guide.

RELATIVE WEIGHTS

A grain is about 65 milligrams, 0.065 gm. A dram is about 4 grams, 4.0 gm.

An ounce is about 30 grams, 30.0 gm,

RELATIVE MEASURES

A minim is about 0.065 ¢.¢. or mil.

A. dram is about 4.0 ¢.c. or mil.

An ounee is about 30.0 ¢.¢. or mil.

A. pint is about 500.0 ¢.c. or mil,

A quart is about 1000.0 ¢¢., or 1 liter.

Very often, in domestic nursing, a graduate for measuring liquids is not available, and some household article may be used to measure, approximately, the amount required. : :

Often the dose to be given is stated in drops, and drops are of various sizes. When water solutions are measured with a dropper, the drop is about a minim. Aleoholie solutions, measured in the same way, require about 2 drops to make a minim.

HovusSEHOLD EQUIVALENTS

A teaspoonful is about 1 dram, or 4.0 ¢.c.

A tablespoonful is about 4 ounce or 16.0 ¢.c.

A teacupful, or tumblerful is from 6 to 8 ounces, 180-240 ¢.c.

As a rule, the amount of a solid can not be determined by measuring it, as some remedies are much lighter than others. Morphine, quinine and tannie acid are examples.

Solutions

Solutions of many kinds are used in medicine, and the amount of drug to be dissolved in making a solution is stated in different ways,

.

1. The quantity of drug dissolved in 100 parts of solution is known as per cent.

2. The quantity of drug in 1000 parts of solution is known as per thousand (or M).

3. The number of grains in an ounce of solution is known as grains per ownce.

In the apothecaries’ system there are 480 minims in an ounce of a fluid, but in calculating the amount of drug to be used in making a solution it is much simpler to assume 500 minims as the equivalent of an ounce, and the result will be correct enough for all practical purposes. It is easy to calculate per cent or per thousand on this basis of 500 minims. Thus, to make 4 oz. of a 2 per cent solution, 500 x 4 = 2000 and 2 per cent of 2000 is 40 minims or grains. Therefore 40 grains in 4 oz. of solution is approximately a 2 per cent solution. To make a pint (16 oz.) of a 1:2000 solution, 500 x 16 == 8000 and 8000 +2000 4 minims or grains. Therefore 4 grains in a pint of solution is approximately a 1:2000 solution.

Perhaps a simpler method is to remember that 1 per cent is 5 grains per ounce (500 minims) ; 2 per cent is 10 grains; 4 per cent is 20 grains, ete. Now by multiplying the number of grains per ounce in a given percentage by the number of ounces required, the amount in grains needed is obtained. Thus, to make 2 oz. of a 5 per cent solution, 5x5 —25 the number of grains per ounee, and 25 x 2 = 50 grains, the amount required.

When the strength of a solution is stated in grains per ounce, all that is necessary is to multiply this by the number of ounces of solution required.

When exact solutions are necessary the metric system should be used, as there are no exact equivalents between weight and volume in the apothecaries’ system.

WEIGHTS, MEASURES, AND SOLUTIONS 27

As relative values in the metric system are expressed in multiples of 10, it is comparatively easy to calculate per cent or per thousand solutions by it. Thus, to make 50 ¢.¢. of a 3 per cent solution—3 per cent of 50 = 50 x .038 —= 1.5 c.c. or grams, as a gram is the exact weight of a ¢.c. of water. To make 4 liters of a 1:2000 solution, 4 liters. = 4000 ¢.c¢.; 4000 +2000 = 2 e.e. or grams. Therefore 2 gm. in 4 liters of solution makes a solution of 1:2000.

A saturated solution is one that has as much of the drug as it can hold in solution at a given temperature. If a saturated solution is heated it will dissolve more of the drug, and if it is cooled part of that in solution will separate out as a solid, or form ¢rystals.

Stock Solutions

Stock solutions are fairly strong solutions of drugs, kept on hand to be diluted more or less before being used. It is often necessary to make per cent or per thousand solutions by diluting such stock solutions, and the simplest method of determining how much of a stock solution to use is as follows.

Divide 100 by the percentage strength of the stock solution and multiply the result by the percentage strength of the solution required. This gives the percentage of stock solution to be used in making the dilute solution. To make a quart of 2 per cent solution from a 40 per cent stock solution, 100+40 — 2.5, and 25x2—5. <A quart is 32 oz. and 5 per cent of 32 is 1.6. Therefore 1.6 oz. of the stock solution will make a quart of the required 2 per cent solution.

Calculating the amount of stock solution required when the metric system is used in per thousands is not very difficult. To make 1000 ¢.c. of a 1 to 4000 solution from a stock solution of 1 to 50, 4000 +50 = 80; that is, the stock solution is 80 times the strength of the solution desired. Now divide by 80 the amount of solution needed, and the result will be the amount of stock solution to be used: 1000 ¢.c. +80 = 12.5 ce.

In making any solution of a given strength always dissolve the drug in part of the solvent, then add enough more to measure the amount of solution required.

Chapter III

Very early in the history of mankind it was found that certain gums, balsams and resins had the power of preventing decay in the bodies of the dead, and today the Egyptian mummy is an evidence of the antiseptic efficiency of the materials then used. Some of these substances were also used for healing wounds, but it was not until 1870, when Lister began the systematic use of earbolic acid in his surgical work, that antiseptics came into common use.

Modern surgery is largely based on two principles: asepsis, which prevents microbes’ from getting into a wound or into injured tissue; and antisepsis, which retards or prevents their growth after they have gained an entrance. Disinfection, which implies the killing or removal of all germs present, is applied more to the material and instruments used in surgery than to the tissue involved, because drugs that destroy germ life also destroy, at the same time, many living tissue cells. Disinfection is also applied to the destruction of microbes generally in their relation to infectious‘ diseases.

The effectiveness of any disinfectant or antiseptic depends not only on the strength of the solution used. but also on the length of time it is in contact with the microbes present. <A solution of corrosive sublimate 1:2000 would be more efficient than a solution of 1:3000 in the same length of time, but the weaker solution might become the more efficient if kept in contact with

’Microbes, minute living things that can be seen only with a microscope. 4Infectious diseases are those caused by microbes.

30 MATERIA MEDICA FOR NURSES the microbes for a longer time. The longer an antiseptic solution is in contact with a wound the weaker it becomes, because the remedy is taken up, not only by the microbes, but also by the tissue cells. It is impor-

Fig. 1—Appliance used in the Carrel-Dakin method of treating wounds.

tant, therefore, in infected areas, to supply fresh portions of the antiseptic at frequent intervals or, better still, to maintain a steady supply. This is the basis of the Carrel-Dakin method of treating wounds now in frequent use.

The larger the number of microbes present in a wound the greater the amount of the drug necessary to destroy them or hinder their growth, because each microbe takes in a certain amount of the substance used. In some cases a mixture of several antiseptics is more effective than any one of them alone even in a stronger solution.

As a rule the substances that are more soluble in fats and oils than in water are less actively antiseptic in solution in oil than they are in water. A 5 per cent solution of carbolie acid in an oil is much less antiseptic than the same strength solution in water, because its greater solubility in oil prevents it from readily passing into the bodies of microbes.

Antisepties are used not only in surgery, but also in many nonsurgical conditions such as infectious diseases.

Surgical antiseptics, as a rule, should be soluble in water and not very irritating, especially if used on sensitive surfaces such as the eye, the urethra or bladder. A clean wound requires no antiseptic if it can be kept free from infection. The skin of patient and surgeon can stand stronger solutions than a wound or a sensitive surface can. Instruments and dressing material are usually sterilized by heat. Ligatures are often kept in antiseptic solutions.

Intestinal antiseptics are often used. It is not possible to make the intestinal canal sterile, but it is possible to hinder the growth of intestinal microbes and thus lessen the harm they may do. Drugs to be used for this purpose should not be readily soluble in water as they must not be quickly absorbed that they may pass down to the lower bowel where most needed.

They should be nonirritating and not very poisonous to the patient. One of the best methods of intestinal antisepsis is giving a good laxative, such as castor oil or calomel, thus removing a large amount of the harmful material from the intestine.

The genitourinary tract quite often becomes infected and antisepties are used with good results. The remedy ean often be applied locally to the vagina, urethra, or bladder, but good results can also be had by giving some readily soluble antiseptic by mouth. The continual washing of the urimary tract by the mildly antiseptic solution formed as the drug is excreted in the urine, is often very effective.

The lungs and bronchial tubes are not easily influenced by antiseptics. Volatile remedies inhaled strong enough to harm microbes would, at the same time, damage the delicate lining of the tubes. When given by mouth, traces of volatile remedies escape in the breath but not in sufficient amount to have much effect. It is doubtful whether such remedies are of any benefit in consumption, but they seem to lessen the secretions and fetid odor of the breath in some ceases of chronic bronchitis. i

Skin diseases are often due to infection, and antiseptic remedies are sometimes very useful, but when a large area of skin surface is to be treated there is danger of poisoning from too much of the remedy being absorbed.

Specific antiseptics are those remedies that are especially poisonous to the germs of some particular disease and less poisonous to human tissue cells. Quinine in malaria and mereury in syphilis are well-known examples of this.

Carbolic Acid (Phenol)

Carboliec acid was the first antiseptic used in modern surgery. It is obtained from coal tar’? and is used extensively in industry as well as in surgery.

Action and Uses.—Carbolic acid is poisonous to all forms of life. Even dilute solutions, such as 1 per cent, are quite fatal to some germs, while others can live in such solutions for a long time. Solutions in water even less than 1 per cent hinder the growth of most germs although they may not be killed. Pure carbolie acid is instantly fatal to the life of any microbe with which it comes in contact. It is also caustic and is sometimes used to remove small growths, such as corns, but this is dangerous as it is hard to limit its action. Its caustic action can be promptly checked by washing with alcohol. Even a 5 per cent solution is somewhat caustic and should not be used on living healthy tissue.

In ointments or dilute solutions it is used to relieve itching in many skin diseases. When applied, unless’ in great dilution, it should not be covered closely with a bandage or clothing as serious gangrene may result.

Poisoning.—Carbolic acid poisoning is very common. It has been estimated that 50 per cent of all fatal suicidal poisonings in this country are due to this drug. When taken undiluted, as is usually the case, it burns the lips, tongue, mouth, throat and stomach. The burn is white at first, later becoming red. Pain is felt in the mouth, throat and stomach. Nausea with vomiting. often results, but may be absent. Some patients become very much excited and may have convulsions, but more often there is collapse® with pallor, cold sweat, feeble, irregular pulse and respiration, and finally unconscious-

5Coal tar, a complex oily liquid cbtained from coal in the process. of making gas. ; ; ®Collapse, a failure of the vital forces.

ness before death. When a large amount is taken, death may result in a few minutes from the severe and extensive destruction of tissue.

The odor and the appearance of the burn help to decide what had been used.

In the past, fatal poisonings have resulted from applying solutions of carbolie acid to wounds or using it in douches, but such uses are now pretty generally abandoned.

Treatment.—The use of a stomach tube is rather dangerous,’ but with skill and care it may be passed without doing any damage, and the stomach washed repeatedly with diluted alcohol. If the tube is not used, dilute aleohol should be given in reasonable amounts, as it also is a depressant. A large dose of Epsom salts given through the tube or swallowed will slow absorption of the poison.

Keep the patient warm in bed. A small amount of morphine may be necessary to relieve pain. When collapse threatens, caffeine (coffee) per rectum or strychnine hypodermically should be given. Some give atropine when there is much sweating. Cases that show excitement often get well.

Cresols (Lysol)

Cresols are obtained from coal tar and are somewhat similar to earbolic acid, but are not soluble in water and are not caustic. To make them soluble in water they are usually put up in a soap or alkaline mixture and sold under some trade name such as Lysol, Creolin and Kreso. An official’ solution known as Compound