A text-book of materia medica, pharmacology and therapeutics

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Preface To Sixth Edition

I would be unappreciative if I failed to take this opportunity to express my gratification at the continued popularity of this Text-book, as shown by the necessity for the publication of another edition. Therefore, I desire to thank the medical profession, and especially the teachers of materia medica and therapeutics in the many colleges in which the book has been used, for the hearty reception which heretofore has been accorded it.

The book is the fruit of some twenty years' experience in teaching therapeutics and clinical medicine, and many years of private and institutional practice. It has been my effort to embody as much as possible of this experience in a condensed, carefully classified, and usable form. Above everything else, I desire this book to be practical rather than theoretical. It is important not only that the student should acquire the largest amount possible of knowledge of the remedies which he expects to use in the practice of medicine, but also that this knowledge should be systematically and logically arranged, so that it may become immediately available. I believe that the classification which I have adopted particularly lends itself to that end, and that it will greatly facilitate the study of this important branch of medicine.

While the needs of the student have been kept in the foreground, I have not forgotten the demands which are made upon it by the practising physician. I have, therefore, endeavored to make the subject-matter as complete and as detailed as the size of such a work will permit, and to give special prominence to the therapeutic sections. In this field I have drawn largely upon my own experience, not forgetting the larger mine of current medical literature.

IO PREFACE TO SIXTH EDITION.

The study of the official remedies in this edition has been brought into accord with the Eighth Decennial Revision of the U. S. Pharmacopoeia. All the official remedies are mentioned. In addition to these, a few non-official remedies that have been demonstrated to be of sufficient importance, as shown by their more or less widespread employment, have been accorded a place.

It is my belief that the unfortunate agnostic tendency toward medicinal therapeutics, and the prevalence of nostrum prescribing in the medical profession, are the natural and inevitable results of the neglect of therapeutics in our medical schools. Every effort should be made to intensify the students' interest in this branch and to render his knowledge not only more complete, but of a character to be readily put into practical application. If this book contributes to that end, I shall feel that it has accomplished its greatest purpose.

I desire to acknowledge the unfailing courtesy and patience of the publishers, and cordially to thank Dr. John C. Hollister, of Chicago, for his valuable contribution on the Opsonic Index.

G. F. B.

Preface

The present work has been undertaken with the immediate object of supplying the student of medicine with a clear, concise, and practical text-book, adapted for permanent reference no less than for the requirements of the class-room.

The arrangement — embodying the synthetic classification of drugs based upon therapeutic affinities — the author believes to be at once the most philosophical and rational, as well as that best calculated to engage the interest of those to whom the academic study of the subject is wont to offer no little perplexity.

Should an intelligent and comprehensive understanding of Materia Medica and Therapeutics be facilitated by the author's treatment of the theme, the deductions derived from his experience as a practitioner and instructor will not have been committed to print in vain.

Special attention has been given to the Pharmaceutical section, which there is reason to hope will be found exceptionally lucid and complete. It has been deemed advisable, however, in the general work to include in the descriptive enumeration only such drugs as experience has proved to be of unquestionable value and are of standard and authoritative acceptance in general practice. In accordance with this plan, many new and comparatively untried remedies have been omitted, since, while of established efficacy in certain conditions, they are as yet too imperfectly known to warrant association with remedial agents bearing the sanction of exhaustive scrutiny. So, too, a few official drugs have been excluded because they are practically never used or are employed only in isolated instances.

It will be observed that "Untoward Action" and "Poisoning"

12 PREFACE.

are treated under separate heads. By the former it is intended to record the effects of medicinal doses in developing certain symptoms dependent more or less upon individual susceptibility, not necessarily assuming the aggravated form incident to toxic doses, which exert a definite influence regardless of idiosyncrasy.

In giving the careful Latin accent and quantity of medicinal nomenclature (Foster), so far as practicable with the prosodial signs employed, the design has been to correct a prevalent disregard of proper pronunciation reflecting little credit upon those to whom a knowledge of the subject should be as exact as it is familiar. To the prescription- writer the appropriate Latin genitive, and in a few cases the accusative, will doubtless afford valuable assistance.

During the preparation of the work many important text-books, periodicals, etc. have been freely consulted, and from the U. S. Pharmacopoeia chiefly, and from the National Dispensatory, have been adopted almost verbatim the "Origin" and "Description and Properties " of the various drugs under consideration.

In reviewing the progress of the present volume the author desires to express his cordial acknowledgments to Prof. Carl S. N. Hallberg, Ph. G., whose exhaustive contribution of "Weights and Measures" and "Pharmaceutical Preparations" cannot fail to lend permanent interest to the work ; to Dr. Alfred C. Cotton, Dr. Wm. E. Quine, and Dr. James B. Herrick, for friendly suggestions ; to Dr. D. Lee Shaw, Dr. Fred C. Zapffe, and Dr. Thomas J. Jackson, for assistance in compilation. To Mr. Storrow Higginson the author's personal thanks are due for his scholarly assistance in

the revision of the text.

G. F. B.

Contents

PAGE

INTRODUCTION 17

Classification of Medicines 58

Introduction

The history of medicine since the earliest times is the record of a more or less continuous series of experimental researches, having for their paramount object a precise and comprehensive knowledge of the nature of disease and the practical application of remedial agents. The various " schools " which have arisen from time to time are philosophically co-ordinate, their fundamental principles being referable to one dominating thought — the art of healing.

It is scarcely practicable here, even were it necessary, to review in detail the separate doctrines which have obtained during the evolution of sectarian therapy. From the earliest ideas promulgated by the ancient priests of ^Esculapius, through the subsequent era of Hippocrates, Theophrastus, and the Alexandrian school, influenced by the crude, misguided notions prevailing ere science emerged from its infancy ; discernible in the Galenic and other tentative yet memorable systems, in the epoch of Paracelsus and the Monastic Medicine of the Mediaeval period, and in the radical theories of Rasori and Roeschlaub which attended the development of the eighteenth and have left a passing impress upon the nineteenth century, — through all, the gradual acceptance of empiricism as a legitimate guide to therapeutic truth is manifest. Yet viewed with reference to their underlying animus, these varied expressions of scientific endeavor distinguishing the part are perceptibly linked with the ampler system which has emanated from the more rational methods of modern research.

2 17

The light of inductive reasoning and the marvellous progress in scientific knowledge which characterize the nineteenth century are a living appeal from the idealism of a less enlightened age. The release from tradition — anticipated in the labors of Bichat and others — to which later investigation owes so many signal triumphs has doubtless been profoundly affected by the realistic tendency of modern thought. It is to the startling advancement attained in the natural sciences, however, resulting in a chemical skill and in mechanical appliances of incomparable value, that we must look for the originating impulse which has inspired the therapeutic knowledge of the present day. It needs but little reflection to perceive the immeasurable superiority of actual acquirements over the vague, hesitating — though ardent and laborious — methods to which the theory and practice of medicine were so long subservient.

We have said that, considered in the larger sense, the history of medicine has been a harmonious rather than an intermittent development. It is not to be supposed that, in the evolution of so momentous a scheme as the formulation of a remedial system applicable to the extensive catalogue of human ailments, there should not have occurred spasmodic and ill-adjusted theories, crystallizing in many a strange cultus, which, if ineffectual in retarding the onward sweep of rational progress, has, it may be safely averred, worked incalculable injury to the cause of medical truth. Mesmerism, astrology, spiritualism, even theosophy, however incongruously conjoined, and similar vagaries have not failed to enlist among their votaries many enraptured, even noted, believers ; nor is the mental strabismus with which they are afflicted amenable to any resource of rational treatment. We need, moreover, but contemplate the pitiable hallucinations which urge the pious pilgrimages to Marpingen, Lourdes, and Treves, and the criminal negligence and incredible offence to reason which stultify the so-called " Christian Scientists " (as ironical a misnomer as language permits), to realize that miraculous cures still hold blighting yet potent sway over the minds of the ignorant and credulous. May not even the assumption of thaumaturgical powers be one day possible with those who arrogate to themselves a knowledge little short of omniscience, and to whose rudimentary intelligence the laws of nature convey no perceptible lesson ? As from the sublime to the ridiculous, so from faith to fanaticism, it is but a step, after all.

It is appropriate here to emphasize the unfailing — nay, ever-

INTRODUCTION. 19

increasing — importance of therapeutics in its relation to the welfare of mankind. Especially imperative is this obligation in an epoch of unprecedented achievement in every department of science which contributes to the perfection of the healing art, in which general advancement medicine has borne no inconspicuous role.

The rapid advance of experimental science, however, applied to medical treatment, culminating in bacteriological discoveries of signal value to mankind, and the remarkable triumphs attending the development of operative surgery, have inevitably tended to disparage the equally noble and far more widely cultivated field of therapeutic science. This result is the more deplorable since it creates in the minds of the young and inexperienced an impression of contrast and divergence in departments of study naturally and indissolubly correlated. It is scarcely surprising that the marvels of the laboratory and the splendid achievements of the arena should possess for the tyro an entrancing interest. Yet it is to be borne in mind that the most brilliant triumphs of diagnostic and surgical skill might prove futile as the means of arresting disease were they not supplemented by the course of treatment which constitutes therapy.

It must be confessed that medical art has too often been discredited by professional incompetence, and consequent failure to effect the cure which with the laity is wont to form, however ignorantly, the only criterion of ability. In Amesica especially — where from defective laws the widest latitude is given to incapacity and imposture — the lack of proper academical training is frequently the cause of serious consequences in practice, little calculated to enhance the popular confidence and esteem. It therefore behooves the student of medicine to master thoroughly the details of the remedial art, become practically conversant with physiological conditions and the manifold phenomena of morbid anatomy, and so familiarize himself with the varying indications of disease that in the presence of whatever malady, his diagnosis and treatment may command respect — not only from the laity, but, what is of far more consequence to him, from the profession.

It is almost superfluous to lay stress upon pharmaceutical knowledge as a powerful weapon in the armament of the medical practitioner. Yet no branch of therapeutic science has, perhaps, been more neglected than a practical acquaintance with the nature and uses of Materia Medica, their origin, potency, and characteristic value, as well as their physiological action, and the incompatible and synergistic agents upon which their efficacy often largely depends.

Thanks to careful and competent training among pharmacists, the skilful preparation and dispensing of drugs relieve the physician of much responsibility ; yet he should be keenly sensible of the fact that the larger share of public confidence is reposed in him, and by diligent study of the subject endeavor to command the minutiae of pharmacology, holding himself morally accountable for errors quite possible in the druggist's dispensary. It may not be irrelevant to add that in all medical procedure a sympathetic yet perfectly controlled nature, ready tact, and sterling common sense are cardinal requisites to professional triumph, it being generally true, as was long since observed by Hufeland, that " successful treatment requires only one-third science and two-thirds savoir faireT

Finally, the author would counsel the utmost seriousness in the pursuit of a calling which might aptly be termed " Christian Science " — the power to alleviate human suffering by means of curative agents with which the laboratory of nature has been mercifully stored. There can be no loftier, more practical manifestation of love to men than is exemplified in the benignant effort to assuage the ills to which mortality is heir ; nor can any devotion be more privileged and inspiring than that which softens the shock of disease, illumines the darkness of mental and physical distress, and from the debris of misfortune, vice, and heredity creates anew the image of divine perfection. It is this uplifting, consecrated zeal, akin to veneration for medical science, which has endeared to the world the masters of the profession — of which ,the same wise Hufeland said : " To him who fails to make a religion of the healing art it is the most cheerless, wearisome, and thankless labor upon earth ; indeed, in him it must become the greatest frivolity and a sin." And for those — and they are many — to whom the material, possibly mercenary, aspect of their task appeals unduly it is enough to cite in rebuke the elevated maxim of Stigelius :

PHARMACOLOGY AND GENERAL THERAPEUTICS.

Nature heals, physicians treat — is a truth of old that is constantly forgotten : always by the patient, who expects the patent medicine or the family doctor to cure her ; frequently by the physician, who is often persuaded, against his better judgment, to believe in the supernatural when the mysteries of drug action are involved. A few propositions concerning the general action of the human body in its endeavor to heal itself may not be out of place in an introduction to a work on the practice and art of aiding nature's forces in the treatment of abnormal conditions.

It is a difficult task to express, in a few phrases, the general causes of disease, but the following general agencies may be considered :

1. Trauma, whether the result purely of accident, or brought about in the general struggle for existence.

2. Parasites, both microscopical and macroscopical, acting within and without the body.

3. Poisoning from plants and animals, broken down and decomposed food-stuffs, and poisonous gases taken into the respiratory tract.

4. Bad hygiene, unwise modes of living, including faulty nutrition, faulty modes of dress, eating, and housing, use or abuse of certain organs or their lack of use.

5. Heredity. — Here would be classified not only the directly transmissible diseases, as syphilis, but also those constitutional dyscrasiae that conduce to premature break-down of some part of the human body.

In order to combat these various agencies the individual organs have developed a system of natural cure methods (" natural therapeutics ") that are of interest. These may be summarized briefly, following Kobert, in part, as :

1. Healing by regeneration. Among the lower animals the regeneration of a lost member is not infrequent, but in man it is unusual. In a sense, however, the healing of wounds as a part of the inflammatory reaction is analogous to this process in the lower animals. The hypertrophy of one kidney, compensating for the loss of the other, and the establishment of a collateral circulation are illustrations of what Bachmann, in 1894, pointed out as the law of equivalent compensations.

2. Healing may be brought about by the exercise of an organ. Thus, the old-fashioned system of exposure to wet and weather develops, by exercise of the skin, an increased resistance to agencies that otherwise might react harmfully on the organism.

3. In the struggle against parasites it would appear that the body had developed an extensive array of protective agencies. Thus, antiseptic substances in the saliva, gastric juice, and bile are simple instances of this protective power against parasites from the outside. The doctrine of phagocytosis embodies the principle of the action of the white blood-cell in its office as a protective agent. In the body-fluids are found alexins, antitoxins, immunizing proteids that protect from the actions of poisons which may develop as a result of the life activities of these parasites should they obtain a foot-hold within the body — or even protect from poisons developed in the course of disturbed metabolism. Fever, so frequently regarded as an adverse sign in disease, undoubtedly serves in large part as a means of protection of the body — by killing the agents that have induced the rise in temperature.

4. Healing from certain poisons is brought about by vomiting and diarrhea, by rapid elimination through diuresis, or by excessive perspiration. Within the body a most interesting series of changes often takes place — thus, splitting up of poisons, their oxidation or conversion, or even fixation, into non-toxic products is a constant phenomenon. Thus even so powerful an alkaloid as morphine is said by Faust to be in part oxidized and perhaps used as a foodstuff The chemical changes that take place in the liver have here their most potent activities, and the pathological chemistry of the twentieth century promises to throw much light on these complicated problems. Poisons also are compensated for by the process of adaptation (habituation), and are frequently rendered inert by the development of specific antitoxic substances. Thus specific anti-morphine bodies have been developed in the blood of some of the lower animals.

5. The physiological process of rest is an expression of nature healing. Loss of appetite is the indication not to eat. Pain calls for rest.

6. Healing by the casting off of a portion of the organism is a process of nature healing widely made use of in diseases among plants and the lower animals. Abscess formation, the limiting, by fibrinous exudates, of intraperitoneal irritants, and spontaneous gangrene of the extremities are well-recognized examples of such a type of nature's healing.

Treatment is something apart from healing, and in its broad sense comprises all those means, psychical or physical, which the practiser of the healing art has at his command by which he can hope to alter an abnormal condition in the individual he is called on to treat. Thus, nature calls into play the highest of her gifts, intelligence, to aid her in the work of self-preservation, and it is the function of the text-book to aid, in so far as it is able, to train that intelligence in the facts that experience has proved of value — in the present instance, in the fields of materia medica, pharmacodynamics, and therapeutics.

Pharmacology, from the broad point of view, is the science of drugs, and includes the various fields of medical botany, medical zoology, pharmacognosy, pharmacodynamics, and pharmacy. Within recent years, however, following the German school, its meaning has been restricted and made equivalent to pharmacodynamics, or the study of the effects of physical or chemical agencies on living organisms. It is in this sense that it is used in this work.

Materia Medica is the study of the source, constituents, chemical and physical characters of the organic and inorganic materials used for drugs in the practice of medicine.

Pharmacognosy is a division of materia medica, and includes the technical study of the crude materials from which drugs are derived. Its deliberation is limited to the animal and the vegetable kingdoms, but it is not a science with sharply defined boundaries, as it encroaches on so many avenues of knowledge — systematic botany, zoology, gross and minute anatomy, chemistry, and pharmacy.

Pharmacy is largely a chemical study. It deals with those manipulations by which the potent principles of drugs are rendered available for therapeutic purposes.

Therapeutics is the art and practice of treating abnormal bodily states ; it is the application of the sciences of physiology, pathology, and nosology, and is the concern of the physician. A physician is an engineer who cannot construct but is skilled in conservation and repair. Therapeutics, then, has for its object the restitution to the normal, or, if such is impossible, the giving of comparative comfort to the invalid. Its range of activity, therefore, is extremely wide, and a combination of methods is necessary to the resourceful physician. The following general modes of treatment should be considered :

Suggestion Therapy. — There is little question that the oldest systematic form of therapeutics was a type of suggestion therapy. In the old type of " Temple Sleep " we find the earliest use of this form of therapy. Magnus l has shown that the earliest relations of religion and medicine were to be found in the " Temple Sleep " procedure. To the earliest Egyptians priest and physician were one. There were priests not physicians it is true, but no physicians who had not priestly functions. Throughout the entire Egyptian civilization this double function flourished and even passed on into the Grecian system, where it persisted for centuries. We all know that certain organs of the body were under the care of certain gods or goddesses — some singly, some having charge of many organs if not the whole body. The early Egyptian god, Thoth, had the digestion under his particular care, and it is said that this mythical personage invented the clyster pipe. Thus the modern formula, " Fear God and keep the bowels open," is apparently of prehistoric Egyptian origin. The rationale of much of this priest therapy was to sleep in the temple of the god overnight. There in the quiet and repose of the holy place, providing it were not too popular, the god would appear to the sick one in the form of a dream, and would designate the remedy needed. Modern clairvoyant quacks pursue the same method. No. 59 for colds, so extensively advertised, is said to have been devised in a similar manner.

This method of treatment, it is known, was not uncommon even as late as the time of the Roman emperors. 2 In the Greek temples all were allowed save those so hopelessly ill that it seemed foolish. The procedure for those patients admitted to the temple was for the priests to narrate the wonderful results to be obtained by the step which was to be taken ; thus was desirable confidence imparted. Then various prayers and ceremonies were gone through with and certain sacrifices made ; the sacrifice being the ancient analogue of the " fee." After the " preliminary " conditions had been complied with, the ancient priest, it may be observed, obtained his retaining fee in advance, those patients who were more

well-to-do were placed in front of the statue of the god on the skin of the sacrificed ram, while the poor were permitted to lie down on a bundle of rags in one corner of the temple. Great stress was then laid on the character of the dreams the patient would have as he slept, for the advice of the god would come in the dream. History has recorded some fearful and wonderful dreams. yEsculapius is said to have demanded 120 ounces of blood for one venesection. Aristides was put by the gods on a diet of raisins to cure what appeared to be neurasthenia from too much exhorting. It is significant that the ancient gods commanded their patients to go fishing, to go hunting and swimming, and frequent attendance of theatres was an urgent remedy. It was highly essential, in fact obligatory, that the priests should interpret the dreams.

The treatment of temple sleep was the result of a profound religious feeling, and it was carried out with great decorum and seriousness. Implicit and devout confidence in the gods was a sine qua non. Thus the temple sleep, separated from its religious accessories, is the prototype of the systematic treatment by suggestion, and this suggestion therapy strutting about in the garb of religion has remained an inseparable companion of the human race from the most remote times of Egyptian civilization up to the present day. With all peoples and at all times, even during our modern century, suggestion has been active in the garb of religion ; only that this religious garb has frequently changed according to altered religious and cultural ideas. Faith is one of the oldest therapeutic agencies of which anything is known. As Dr. Osier 1 has so well said, " Faith in the Gods or in the Saints cures one, faith in little pills another, hypnotic suggestion a third, faith in a plain common doctor a fourth. In all ages the prayer of faith has healed the sick, and the mental attitude of the suppliant seems to be of more consequence than the powers to which the prayer is addressed. The cures in the temples of yEsculapius, the miracles of the Saints, the remarkable cures of those noble men, the Jesuit missionaries, in this country, the modern miracles of Lourdes, and the wonderworkings of the so-called Christian Scientists are often genuine and must be considered in discussing the foundations of therapeutics." " Physicians use the same power every day. If a poor lass, paralyzed, apparently helpless, bed-ridden for years, comes to me, having worn out in mind, body, and estate a devoted family, and she in a few weeks or less by faith in me, and faith alone, takes up

1 Medicine of the Nineteenth Century, 1 90 1.

her bed and walks, the saints of old could not have done more." " The faith with which we work, the faith, indeed, which is available to-day in every-day life, has its limitations : it will not raise the dead : it will not put in a new eye in place of a bad one, nor will it cure cancer or pneumonia or knit a bone ; but in spite of the nineteenth century restrictions, such as we find it, faith is a most precious commodity without which we should be very badly off."

Of the various forms of suggestive treatment it is not necessary here to treat. One form, treatment by hypnosis, is worthy of careful study, but its details are out of place here.

Heliotherapy, exposure to the rays of the sun, or, in Finsen's latest developments, to the activities of the x-rays ; aerotherapy, or exposure to the open air, moist air, dry air, superheated air, etc. — both constitute modes of treating some forms of disease. Much might be said of Climatotherapy, the principles of which are not well understood. Dietetic Therapy. — This is also a method of antiquity. Diet — milk cures, vegetarian diet, meat diets, diets for obesity, for diabetes, etc. — has extreme practical importance, and its principles should be thoroughly mastered by the student.

Physicomechanical Therapy. — This includes a large number of useful procedures — Kinesotherapy, or massage and Swedish movements, from which the fantastical osteopathy has developed, is one of the most important. The Chinese and Japanese have used massage for a thousand years, and it constitutes one of their most important therapeutic procedures. Tissot, in 1780, brought the methods in use once more in Europe ; Schebe, of Germany, in 1847, an d Zander, of Stockholm, in 1865, brought the modern gymnastic procedures to a state of perfection.

Hydrotherapy, involving the use of heat and cold, with modified massage, has justly become a most important therapeutic procedure. E. F. C. Oertel, of Bayreuth, in 1765, and Preissnitz, in 1790, may be regarded as the founders of modern hydrotherapy. Its most useful applications are to be found in reducing temperature, in promoting sleep, and in neurasthenic and weakened nervous states, although its applications in one form or another are numerous. Tonsillitis, pharyngitis, conjunctivitis, abdominal pain, ovarian neuralgias, etc., are all benefited by hot applications.

Hypodermoclysis and enteroclysis are special forms- of hydrotherapy which are of great value.

Electrotherapy. — Electricity is a potent agent in the treatment of certain forms of disease. Within recent years more definite ideas have been gained regarding the mode of its action. Space does not permit of more than an indication of the merest outlines in this place, the student being referred to text-books on the subject (Jacoby, " Electrotherapeutics ").

In general, two types of current, galvanic and faradic, are employed both for diagnostic and for therapeutic purposes. The galvanic current is of constant flow, low intensity, and small in quantity. It has little influence in causing muscular contractions, but has marked chemical and thermal properties and promotes metabolism. The faradic current consists of alternating to-and-fro currents, is usually of high intensity, and has marked power to promote muscle contractility. The knowledge of the different modes of application should be gained from a good text-book.

In using electricity for diagnostic purposes it is advisable to use the minimum amount of current to produce a desired effect. The two sides of the body should be carefully compared, and the patient should be at rest. It is advisable to have similar electrodes, and they should be applied to corresponding areas on the well side and the supposedly diseased side.