Opium

ANISUM (Pimpinella anisum)^PIAN3
   The dried ripe fruit of Pimpinella Anisum, Linné (Nat. Ord. Umbelliferae). Egypt and Western Asia; cultivated in Southern Europe. Dose, 5 to 40 grains. Common Names: Anise, Aniseed. Principal Constituents.—A volatile oil (Oleum Anisi) composed chiefly (95 per cent) of the stearopten anethol (C10 H12 0), which, upon oxidation, yields anisic acid (C8 H8 03) Preparations.—1. Oleum Anisi, Oil of Anise. Derived from Anise (above) or from Star Anise (Illicium verum, Hooker, Nat. Ord. Magnoliaceae.). The botanical origin must be stated on the label. Oil of Anise is a highly refractive, colorless or lightyellow liquid, having the taste and odor of anise. It is freely dissolved by alcohol. Dose, 1 to 5 drops on sugar. 2. Infusum Anisi, Infusion of Anise (Anise, 2 or 3 drachms;] Boiling Water, 8 ounces). Dose, 1 to 2 fluidrachms. 3. Spiritus Anisi, Spirit of Anise. Ten per cent Oil of Anise in Alcohol. Dose, 1/2 to 1 fluidrachm in hot water. 4. Aqua Anisi, Anise Water. Dose, a fluidrachms to a fluidounce. 5. Specific Medicine Anise. Dose, one fluidrachm in water. Specific Indication.-Flatulence, with colicky pain. Action and Therapy.—Anise is an agreeable stimulating carminative employed principally for the relief of nausea, flatulency, and the flatulent colic of infants. Anise imparts its odor to the milk of nursing mothers. It is an ingredient of Paregoric (Camphorated Tincture of Opium), and is largely used to impart to or correct flavor in medicinal preparations, especially cough mixtures. For infants the infusion is the best preparation and it should not be sweetened. The spirit (1/2 to 1 fluidrachm) given in hot water is more agreeable and effective for older children and adults. The oil (1 to 5 drops) on sugar may be used by the latter, if desired. ¹

CAFFEA
   The seeds of Caffea arabica, Linné (Nat. Ord. Rubiaceae). Native of Arabia-Felix and Ethiopia; and extensively cultivated in Asia and America between the north and south latitudes of 56°. Common Name: Coffee. Principal Constituents.-The chief constituents are caffeine (C8H10N4O2. H2O); a volatile aromatic oil; caffeol is also present in minute quantity and upon it depends the aroma of coffee; and caffeo-tannic acid. Preparations.—1. Infusum Caffeæ, Infusion of Coffee. Dose, 2 to 8 fluidounces. 2. Specific Medicine Coffeæ. Dose, 1 to 60 drops. Specific Indications.—Feeble circulation, with threatened heartfailure; sense of exhaustion; headache, with cerebral hyperemia or congestion. Action.—Coffee is a decided cerebral stimulant and energizer. It also increases reflex activity of the spinal cord. Used moderately it is a mild bitter stomachic, stimulating the appetite and facilitating digestion. There is reason to believe that it increases hepatic activity and it promotes peristalsis, thereby favoring a free action of the bowels. Coffee slightly accelerates the circulation. Under its use the intellect is quickened to an extraordinary degree, thinking is facilitated, ideas flow freely, the reasoning faculty is sharpened, and an enormous amount of mental and physical work may be accomplished. The action of hot coffee upon the cerebrospinal system is especially evident when a person is exhausted by mental strain or physical exertion. Coffee removes drowsiness after a heavy meal, and may produce wakefulness that will last for several hours. If coffee be withheld from one who is accustomed to its stimulus, physical and mental exhaustion become so severe as to interfere with intellectual pursuits or bodily endurance under exertion, and a profound headache may be experienced. Coffee probably retards tissue waste, and is, therefore, a conservator of force. The excessive use of coffee causes irritability, dejection of spirits, muscular weakness and trembling, watchfulness, dizziness, headache, and ringing noises in the ears; and flatulence, sour stomach with heartburn and eructations, and disordered action of the bowels. Probably the hepatogastric symptoms— “coffee biliousness” —is due largely to the empyreumatic oil present in coffee; the nervous symptoms chiefly to the caffeine it contains. Therefore preparations from which the latter has been removed are just as likely to produce stomach disorders as regular coffee. The stimulating effects of coffee are most largely due to caffeine. This alkaloid is one of the most rapidly acting cerebro-spinal stimulants and probably the nearest of any drug to a physiologic energizer of the intellectual brain. It sharpens the intellect wonderfully, and increases particularly the reasoning faculties rather than the imaginative. It operates without after-fatigue and renders the person capable of great mental achievement and physical endurance. Workmen do more work under coffee, and soldiers stand long marches under the stimulus of the caffeine it contains. Large doses produce excitation of the spinal cord, and if carried to full action exaggerate the reflexes, making the person exceedingly nervous. No harm, however, is done to any organ by coffee or by caffeine, and no after-fatigue or exhaustion follows, provided neither be given to the extent of interfering with the taking of food nor of preventing rest or sleep. Caffeine excites muscular contractility, and powerfully stimulates respiration. Upon the circulation it heightens blood pressure and quickens the contraction of the heart. These are accomplished through its action upon the vasomotor control and upon the heart muscle itself, its effects upon the latter taking origin at the veno-auricular junction, and extending from thence to the auricle and the ventricle. Caffeine increases the output of both the solids and the fluids of the urine, by dilating the renal bloodvessels and by direct action upon the renal epithelia. The tissuewaste of the body is thought to be restrained by caffeine, thus making it a conservator of force and energy. Caffeine is believed to be oxidized and destroyed in the body. The common non-alcoholic beverages of mankind (except coca)—coffee, tea, cocoa, kola, maté and guarana— owe their grateful stimulus to caffeine or related alkaloids. The theine of tea is practically caffeine. All of them relieve fatigue, increase mental acuity, endurance and the capacity for exertion without being followed by fatigue or exhaustion. Therapy.—Coffee in strong infusion is given both by stomach and rectum in opium poisoning. It should be made fresh and as strong as possible. The warmth adds to its efficiency. A cup of strong, hot coffee is often an effectual sobering draught in acute alcoholism. and small and repeated amounts will sometimes ward off an attack of delirium tremens. Coffee is a gratefully refreshing agent for headache due to cerebral hyperaemia or congestion, as shown by red face and injected eyes, but will be likely to aggravate a neuralgic headache when the face is pale. Strong coffee sometimes cuts short an attack of asthma, and checks hiccough. It is the most refreshing stimulant that can be used in the exhaustion of low fevers of a typhoid type and in the debility following other acute disorders, particularly if the patient was previously accustomed to its use as a beverage. In fact, coffee should never be wholly withheld in acute disorders when it has been a factor in the patient's daily dietary. For its stimulating effect in fatigue and nervous exhaustion and calming action in nervous excitation of debility, coffee should be freshly prepared and drunk hot, preferably without sugar or cream; for use in narcotic poisoning very strong, “black coffee” may be given freely, both by mouth and per rectum.¹

CAMPHORA
   A stearopten (having the nature of a ketone) derived from Cinnamomum Camphora. (Linné), Nees et Ebermeier (Nat. Ord. Lauraceae). China and Japan. Common Names: Camphor, Laurel Camphor, Gum Camphor (it is not a gum). Description.—Tough, translucent white lumps or granules, having the pungent taste known as camphoraceous, and an aromatic penetrating odor. It dissolves freely in alcohol, chloroform, ether, and fixed and volatile oils; very slightly in water. Camphor is readily pulverized by triturating it with a few drops of alcohol, chloroform, or ether. Dose (by mouth), 1 to 5 grains; (hypodermatically) 1 to 3 grains. Preparations.—1. Spiritus Camphorae (10 per cent), Spirit of Camphor. Dose, 1 to 30 drops. 2. Aqua Camphorae. Camphor Water. Dose, 1 to 4 fluidrachms. 3. Linimentum Camphorae. Camphor Liniment (Camphorated Oil) (Composed Of Camphor, 200 parts; Cottonseed Oil, 800 parts). Dose, 10 to 30 drops. For external use chiefly. 4. Ceratum Camphorae. Camphor Cerate. (Composed of Camphor Liniment, White Wax, White Petrolatum, and Benzoinated Lard.) For external use. Action.—Camphor causes a local dilation of the capillaries of the skin, producing warmth, redness, and sometimes itching. Slight anesthesia follows. It causes smarting and hyperaemia of the mucosa, and if applied strong may cause considerable irritation. In this manner it has produced gastric ulceration. In small doses camphor warms the stomach, stimulates secretion, increases peristalsis, and expels flatus. Large doses may induce vomiting. Camphor is readily absorbed, both from application and inhalation. It is largely changed in the body and is eliminated in the urine as campho-glycuronic acid. In moderate doses camphor directly stimulates the heart-muscle, causing slower and stronger contractions and increased arterial pressure, but after large doses the pressure falls. Respiration is slightly stimulated by it, large doses causing slower and deeper breathing. In general it may be said that small doses of camphor stimulate, while large quantities depress, or even paralyze. This is true of all the functions it affects. The action of small doses upon the nervous system is to produce a feeling of slight exhilaration or contentment. Large doses excite the higher cerebral and medullary centers and then paralyze them; poisonous doses occasioning more or less of the following symptoms: esophageal and gastric pain, vomiting, headache, dizziness, mental confusion, drowsiness, delirium, and stupor; feeble, running, or intermittent pulse, cold skin, cold sweat, and muscular weakness followed by rigidity and epileptiform. convulsions, collapse and death. The type of convulsions shows its effects to be chiefly upon the cerebral cortex, though it acts also progressively on the medulla, causing death by respiratory paralysis. Camphor does not affect all persons alike. Some may pass directly into drowsiness, insensibility, and stupor, followed by death. If taken for long periods, even in moderate doses, camphor gives rise to a state of mental confusion. Opium and repeated small doses of alcohol are the best antagonists of the untoward effects of camphor. Therapy.—External. Camphor is stimulant, rubefacient, antipruritic, and feebly antiseptic. Owing to its agreeable odor and pleasant stimulating effects it is largely used, as a powder, in lotions, and ointments, or rubbed up with other solids to produce anodyne and antiseptic liquids. In this manner, when triturated with chloral hydrate, menthol, phenol, thymol, and similar bodies, ideal liquid antiseptics are obtained for use upon wounds, neuralgic and other painful areas. Powdered camphor is an ingredient of tooth powders and pastes and dusting powders for skin diseases. Alone or with zinc oxide, talc, or precipitated chalk it may be used upon bed-sores with decided relief. Such combinations are valuable in intertrigo, chronic eczema, urticaria, and zoster. Many snuffs contain powdered camphor, and it is useful to stimulate sluggish ulcers. Sprinkled upon the face it is used to control itching and to prevent pitting in small-pox. The spirit is a household embrocation for the relief of pain and itching, and it is used largely, alone, or in liniments and embrocations, for the relief of pain, stiffness, soreness and swelling, as in myalgia, facial and other neuralgias, and upon rheumatic joints, deep inflammations, chronic indurated glands and other indurations, sprains, contusions, and inflammatory swellings. An ethereal tincture of camphor is said to give relief in erysipelas. Inhaling the spirit, or camphor dropped into hot water, gives relief in nervous headache, and often aborts acute colds, coryza, and influenza, giving respite from the excessive secretion and the accompanying headache. A solution of camphor in liquid petrolatum (usually with menthol) is a popular spray for similar uses, and for laryngitis, pharyngitis, chronic nasal catarrh and hypertrophic rhinitis. The spirit, the liniment, or camphorated oil are favorite applications for tenderness and pain, chilblains, toothache, and acute mastitis: in the latter it tends to suppress the milk. The spirit is in common use as a lotion for headache in nervous individuals with feeble circulation, and tendency to fainting. The oil, by injection, is sometimes effectual in removing seatworms. So-called “camphor-ice” is a soothing, camphorated petrolatum preparation for labial herpes. Internal. Camphor is used to allay nervous excitement, subdue pain, arrest spasm, and sometimes to induce sleep. It is an important remedy in many disorders of neurotic women and children, being frequently most effective as a nerve sedative, antispasmodic, and carminative in nervous nausea and vomiting, flatulence, hiccough, and tendency to spasms or fainting. It is especially serviceable in palpitation of the heart due to gaseous distention of the stomach, or to nervous irritability. In occipital headache, from mental strain, or overstudy, small doses of ¹

CANNABIS
   The dried flowering tops of the female plant of Cannabis sativa, Linné, or the variety indica, Lamarck (Nat. Ord. Cannabinaceae). Asia, East Indies, and cultivated in other parts of the world, notably in the United States. Common Names: Guaza, Ganjah, Gunjah, Ganga; Indian Hemp (Cannabis indica) when derived from the Indian plant. Principal Constituents.—Not well determined. The following have been noted: Cannabin, an active brown resin, and cannabinon, a soft resin. Preparation.—Specific Medicine Cannabis. Dose, 1/2 to 10 drops. Specific Indications.—Marked nervous depression; irritation of the genito-urinary tract; burning, frequent micturition; painful micturition, with tenesmus; scalding urine; ardor urinae; wakefulness in fevers; insomnia, with brief periods of sleep, disturbed by unpleasant dreams; spasmodic and painful conditions, with depression; mental illusions; hallucinations; cerebral anemia from spasm of cerebral vessels; palpitation of the heart, with sharp, stitching pain; and menstrual headache, with great nervous depression. Action.—The principal seat of action of cannabis is upon the intellectual part of the cerebrum. In many respects its effects parallel those of opium and its chief alkaloid. Without doubt it is the most perfect psychic stimulant known to medicine. Certain Orientals become addicts to it, consuming it in the form they call haschisch (whence comes the term assassin), and under its influence many crimes and offenses have been committed, as well as with it. Eastern potentates are said to have dosed their fanatic followers with it. It produces an agreeable semi-delirium taking on the character of a sense of well-being and exhilaration-a state highly coveted by its devotees, who call it loftily “the increaser of pleasure,” “the laughter mover,” “the cementer of friendship,” and “the cause of a reeling gait”- all indicative of its physiologic influence. These haschisch debauches are joyful affairs, and while usually devoid of injurious consequences, may be followed by catalepsy and depressive and maniacal insanity, from which, however, the victim recovers fully in time. In some respects the effects of cannabis on the nervous system are peculiar. It causes an apparently contradictory, consentaneous stage of stimulation and depression-a state somewhat simulated by morphine. The sensations that follow the effects of cannabis vary greatly with the temperament and the peculiarities of the patient, and with his environment. Almost invariably they are pleasurable. An emotional state of happiness even to ecstacy is experienced, with an endless procession of beautiful visions coming and going, and over which the patient indulges in merriment and even hilarity. So pleasurable becomes his sensations that he may break into boisterous laughter and antics of a ridiculous character, the nature of which he fully comprehends, but is wholly unable to prevent. Gradually passing into a dream-like stage, he talks, volubly, brilliantly, with everrecurring changes of topic, little coherence of thought, and a perverted judgment. His imagination carries him into ludicrous ideas and strange actions, he has notions of grandeur and greatness, and moments are exaggerated into æons of time. He lives a “life-time in a minute.” Endless phantasms of beauty and delight pass before his distorted mental vision. A singular peculiarity is a state of “double consciousness” or dual personality which possesses him in which he imagines he is both himself and some one else, and he behaves accordingly. He becomes affectionate to the extreme, both to himself and to others, and altogether he is a very happy individual leading a very full and infinitely extended life. Finally drowsiness overtakes him and he drops into a heavy sleep, which may last for hours, and from which he awakens with no other discomfort than a ravenous hunger. In this last stage the pupils are dilated, muscular power in abeyance, and partial anesthesia prevails. While the ultimate effects of the drug in some result in tremor, great weakness, loss of appetite and convulsions, no deaths have been known to occur in man from this drug. The effect upon Caucasians is less pronounced than that described, which is experienced chiefly by Orientals. In the former the stage of exhilaration and phantasmagoric inebriation may be very brief or entirely absent, the patient passing successively through heaviness and numbness of the limbs, heat in the head, giddiness, a pleasurable pricking of the whole body, drowsiness, and deep sleep. With some individuals pressure upon the skin is said to excite a sense of burning, and the subsequent anesthesia may become so profound that the patient, when standing, is not conscious of contact with the ground. One young man to whom we administered cannabis amused himself by repeatedly jumping over the foot of his bed, laughing with great glee over his capers. Therapy.—The therapeutic effects of cannabis vary under different conditions. It stimulates in depression and sedates when there is irritation. It lessens pain-especially spasmodic pain-allays spasm, improves the appetite, causes a feeling of contentment and rest, and produces sleep. If pushed too rapidly or in too large doses, exhilaration of spirits, inebriation with phantasms, illusory delirium, and sometimes strong aphrodisia precede sleep. A peculiarity in many individuals taking cannabis is the voracious appetite induced. The effects of cannabis are far less powerful and less disturbing to the general system than those of opium, and it does not, like the latter, restrain the secretions nor produce itching. If anything the urine is increased by cannabis and constipation does not occur. The keynote indication for cannabis is marked depression of the nervous system usually with insomnia. Secondly, it allays irritation of the urino-genital tract and relieves pain. For the first condition it is invaluable in more or less painful conditions in which opium see¹

CANTHARIS
   The dried beetles, Cantharis vesicatoria (Linné), De Geer. (Ord. Coleoptera.) Southern Europe. Dose, 1 grain. Common Name: Spanish Fly; Synonym: Cantharides. Principal Constituents.—Crystallizable Cantharidin (C10H12O4) and a volatile oil are said to be the active or vesicating principles. Preparations—1. Specific Medicine Cantharis. Dose, 1 to 10 drops. 2. Ceratum Cantharidis. Cantharides Cerate. (Blistering Cerate.) Epispastic. 3. Collodium Cantharidatum. Cantharidal Collodion, (Blistering Collodion, Vesicating Collodion). Epispastic. Specific Indications.—Vesical irritation; paresis of the vesical sphincter; dribbling and involuntary expulsion of urine; teasing desire to urinate, accompanied with tenesmus. Action and Toxicology.—Applied to the skin cantharis first reddens then slowly blisters. Its final action may be so intense as to cause sloughing and gangrene; or by absorption to cause strangury and acute nephritis. Small doses stimulate the excretion of urine; large doses are destructively irritant. The earliest symptom from moderate doses is irritation of the urino-genital tract, with strangury and burning pain. If continued, or the dose is large, blood and albumen appear in the urine. Large doses produce all the intense agonies of a violently destructive gastro-enteritis and acute inflammation of the kidneys and bladder; with final suppression of urine and death from uremia. Intense burning pain, soreness and tenderness of the abdomen, excessive burning thirst, profuse ptyalism, with cadaverous odor of the breath, rapid breathing, small thready pulse, griping and purging, profuse urination followed by suppression, exceedingly painful micturition drop by drop, priapism, violent sexual desire, and seminal emissions are among the awful results of a toxic dose of cantharis. Six (6) grains of powdered cantharides is the smallest amount known to have produced death. Cases of poisoning are almost always confined to those who take cantharis to produce abortion. There is no known chemical or physiologic antidote to cantharis. Poisoning by it must be treated on general principles, with opiates to control pain. When non-toxic doses have produced strangury it may be relieved by opium and camphor, and large draughts of water. Therapy.—External. As a vesicant cantharis acts kindly as compared with some other agents. It is sometimes used as a derivative in deepseated inflammation, to absorb inflammatory products, and to relieve local pain, as in intractable neuralgias and persistent headache. In Eclectic therapy the use of blisters is scarcely ever deemed advisable, or even necessary. Certainly they should not be used in states of great debility following grave illness, or the exanthems, nor when renal congestion or inflammation is present. Cantharis has been used in lotions to promote the growth of hair. Howe advised it with bay rum, specific medicine uvedalia, and Fowler's solution, for this purpose. Others have used the cantharidal collodion, painted upon the scalp about every two weeks, to encourage the growth of hair in alopecia circumscripta, with asserted success. Internal. Cantharis has a limited use in modern specific therapeutics. In very small doses it is a decided stimulating diuretic and special sedative to the bladder. One must be very careful, however, to avoid irritant doses. It is the remedy for vesical irritation, to allay teasing desire to urinate and the tenesmus accompanying it. It is one of the most certain remedies for the day-time enuresis of women, particularly the middle-aged, when due to a paretic condition of the sphincter vesicae; and in women and children with irritable bladders or weak sphincters, in whom coughing, sneezing, or exertion cause an involuntary expulsion of urine. It is equally effective in men who pass their urine with difficulty or dribbling, and intense scalding heat. In minute doses it may be cautiously used in the late stages of acute desquamative nephritis, where the kidneys are weak and functionate sluggishly, every little exertion seeming to produce an increase of albumen in the urine. It has also been advised for the torpid kidney action in the chronic parenchymatous nephritis of inebriates, in pyelitis, and in chronic cystitis. Used carefully in renal medication it may accomplish great good; but when recklessly employed it is a dangerous medicine, producing or aggravating the very conditions sought to be relieved by it. Cantharis promotes menstruation in atonic amenorrhoea with marked depression. It also increases the sexual appetite and has been used to strengthen the procreative functions. Old gleet and prostatorrhoea are first awakened and aggravated and then relieved by it. Its internal use has been advised in some chronic skin diseases, such as psoriasis, prurigo, lichen, and eczema; upon what grounds we are not advised.¹

COCA^ERYTH5
   The dried leaves of Erythroxylon Coca, Lamarck, and its varieties. (Nat. Ord. Erythroxylaceae.) South American Andes-Peru, Bolivia, and Chili. Dose, 60 to 240 grains. Common Name: Coca. Principal Constituents—Cocaine Preparation.—Fluidextractum Coca, Fluidextract of Coca. Dose, 5 to 30 minims. Specific Indications.—Defective innervation, with dizziness; impaired digestion; pain in back of the head, and fatigue; gastric pain; inordinate hunger and thirst; exhaustion during convalescence from long illness. Action and Therapy.—The action of coca depends very largely upon the cocaine it contains, therefore the physiological effects are recorded under that subject. From time immemorial the people of the Andes, particularly in Peru, Bolivia, and Chili, have used coca leaves as other nations use stimulating table beverages; and when undergoing long journeys and hard work the natives are accustomed to chew the leaves with lime or some other alkaline substance, in order to endure hunger and fatigue, which it enables them to do with remarkable certainty. These uses of the plant led to its adoption into medicine as a remedy for neurasthenia and other disorders, with nervous weakness and muscular debility. Coca is a remedy to be used temporarily only for defective innervation. Though the appetite is apparently normal, digestion is imperfect, and there is an associated occipital and post-cervical pain, dizziness, and inability to stand for any great length of time. The mental faculties are sluggish and tired-brain fag-and thinking is difficult and despondency a common condition. If there is gastric pain or discomfort it is relieved by coca probably through the obtunding power of cocaine upon the nerve filaments of the stomach. As compared with cocaine this power is feeble, as is coca in all its effects, still there is sufficient of the alkaloidal influence exerted to make coca a remedy to be used with great circumspection. In nervous debility it may be carefully employed for a brief period, especially in convalescence from exhausting fevers and other diseases in which a persistent nervous depression follows. While of some value in chorea and repeated attacks of hysteria, it should not be used when any other agent can be made to serve the purpose. In fact, there is no more wisdom or justification in employing coca preparations for simple functional maladies because of mere nervous discomfort than there would be in prescribing opium for similar purposes. Both lead to pernicious habits, with a train of miseries to which the victim finally succumbs. An occasional dose of 10 to 15 drops of the fluidextract will sometimes overcome insomnia caused by gloom and worry, and very rarely it helps one over an attack of asthma. It may be used for any length of time desired in gastric carcinoma to relieve the irritability and pain. Its chief use, if employed at all, will be for very temporary exhibition in the debility following fevers, or for a more prolonged use in advanced phthisis, to give rest, quiet gastric irritability, and aid breathing. For all prolonged states of mental depression, as neurasthenia, hypochondria, melancholia, depressive insanity, etc., its administration should not be encouraged, and as a remedy for the opium and other drug habits it has no place in medicine on account of the habit-forming dangers of coca itself. To sum up some of the beneficial results of temporary coca medication would be to include its influence as a circulatory and respiratory stimulant, a restorative of strength after exhaustive acute diseases or operations, in-sudden nervous exhaustion and insomnia, in painful indigestion, headache from exhaustion, and in migraine. In all of these it should be used for but short periods, and any symptoms of cocainism should be a warning to cease its administration. The fluid medicines may be used in moderate doses. The habit of using coca wines is but a mild form of cocaino-alcoholic tippling.¹

COLCHICUM^COLCH
   The dried (I) root and (II) seed of Colchicum autumnale, Linné (Nat. Ord. Liliaceae.) England and other parts of Europe. Dose, Corm, 1 to 5 grains; seed, 1 to 5 grains. Common Names.-I. Colchicum Corm (Colchici Cormus); II. Colchicum Seed (Colchici Semen). Principal Constituent.—The powerful alkaloid Colchicine (see below.) Derivative.—Colchicina, Colchicine. A very toxic alkaloid occurring as pale yellow scales or powder, practically odorless. It should not be tasted. Soluble in water. The salicylate is sometimes employed. Dose, 1/300 to 1/100 grain. Preparation.—Specific Medicine Colchicum. Dose, 1 to 10 drops. Specific Indications.-Acute gout; rheumatism, without much fever, occurring in gouty individuals; tearing pain, aggravated by heat. Action and Toxicology.—Upon the skin and mucosa colchicum is irritant, causing smarting and redness, sneezing and conjunctival hyperemia. Small doses increase the secretions of the skin, kidneys, liver, and bowels. Large doses are dangerous, producing gastric discomfort, nausea and vomiting and purging, and violent peristalsis with much intestinal gurgling. Poisonous doses produce a violent gastro-enteric irritation, with symptoms much like those of choleraagonizing griping, painful muscular cramps in the legs and feet, large but not bloody evacuations of heavy mucus and serum, thready pulse, collapse, and death. Toxic doses are almost sure to kill in spite of efforts to save life, the patient dying a slow, painful, and agonizing death, the final act of which is respiratory paralysis. Consciousness remains to the end. The reputed antidote is tannin freely administered with plenty of water and followed by the use of emetics or the stomach pump. Opium may be given to relieve pain, atropine to sustain breathing, and artificial heat to maintain bodily warmth. Therapy.—Colchicum is an extremely dangerous medicine and should be used with the greatest of caution. It is the remedy for acute gout, temporarily giving quick relief if administered short of purgation. For some unknown reason attacks recur more frequently when colchicum has been used, though it almost magically relieves the paroxysms. It is useful for disorders depending upon a gouty diathesis, though it is less effectual in chronic gout than in the acute form. In rheumatism, pure and simple, it usually has little or no value, though we have had excellent results after failure with the usual antirheumatics, in cases where pain persisted in one part for longer periods than usual, in acute articular rheumatism with but little fever. These cases resembled gonorrheal arthritis and were accompanied by a leucorrheal discharge, but were not gonococcic. In most cases the fingers, wrists, and abdomen were the most painful locations. Some have advised it in socalled chronic rheumatism when the patient is known to have occasional gouty attacks. We have seen it do good in rheumatoid arthritis; a condition much more prevalent in this country than genuine gout, a disease rarely encountered in America. In rheumatoid headache and in rheumatic iritis colchicum is sometimes of value when occurring in one with swollen joints, with or without effusion, and attended by tearing, muscular pain, aggravated by heat. Subacute and chronic sciatica are asserted to have been relieved by colchicum when the pain is sharp, shooting, tearing, or dull, from back to hips and down the legs, fever being absent. In rheumatic conditions colchicine salicylate in doses of the 1/128 grain is often more serviceable than colchicum.¹

CONIUM
   The full grown fruit, gathered green, of Conium maculatum, Linné (Nat. Ord. Umbelliferae). Europe and Asia; naturalized in the United States. Common Names: Hemlock, Poison Hemlock, Spotted Hemlock. Principal Constituents.-Five alkaloids of which the intensely poisonous liquid coniine (C8H17N) is most important; the others are: conhydrine (C8H17NO), pseudoconhydrine (C8H17NO), methyl-coniine (C9H19N), and ethyl-piperidine (C7H15N). Preparation.—Specific Medicine Conium. 1/30 to 3 drops. Specific Indications.—Nervous excitation and excessive motility, with or without pain; neuralgic pain; pain in the aged, and when there are cacoplastic deposits; gastric pain; nervousness and restlessness; mild maniacal excitement; persistent spasmodic or hacking cough; enfeebled state of the sexual organs, with late and scanty menstruation. Action and Toxicology.—Conium does not affect the intellectual portion of the brain; and it acts but feebly on the spinal cord. It does, however, powerfully depress the peripheral motor endings, and in excessive amounts, the sensory terminals. Only very large doses affect the circulation and the respiration, when blood pressure falls and respiration becomes paralyzed. The latter is the cause of death by conium and is due to the combined results of depression of the respiratory center in the medulla and the nervomuscular paralysis of the muscles of respiration. Involuntary muscles are not affected by conium, nor is the heart-muscle or nerves appreciably affected. Full doses of conium produce dryness of the throat and thirst, nausea, dizziness, sinking at the stomach, numbness, muscular relaxation, and depression of the circulation. Toxic amounts cause staggering gait, muscular heaviness and prostration, with failure of locomotion, ascending paralysis, difficult and labored articulation, dyspnea, dilated pupils, palpebral ptosis, and convulsions terminating in death. In rare instances coma ensues, but usually consciousness and the intellect remained unimpaired until death. The most marked symptoms of poisoning are the staggering gait, drooping eyelids, and ascending muscular prostration. In poisoning by conium the emetic may be used, but it is preferable to repeatedly wash out the stomach by means of the stomach pump. Artificial respiration and heat are to be used, and strychnine, atropine and digitalis, as well as the diffusible stimulants, to sustain respiration and the circulation. Therapy.—External. Locally applied extract of conium, or the powdered drug, relieves the pain of cancerous growths and ulcers. Locke advised, Rx. English Extract of Conium, 2 drachms; Petrolatum, 6 ounces. Mix. Apply locally. Internal. Conium is a remedy for excessive motility and for pain. It also favors sleep, not because it is a hypnotic like opium, but because it relieves pain when that is the cause of the sleeplessness, or when due to an excitable action of the heart. It is also a remedy for the restlessness, with or without pain, associated with reproductive weakness, or due to sexual excesses. With this is a state of apathy, frequently frigidity in the female, and imperfect menstruation and leucorrheal discharges. The mentality is disturbed, often to the verge of mania. In such mild forms of nervous unrest and excitability small doses of conium will render good service. Chorea is one of the incoordinate disorders that is sometimes relieved by conium, but not all cases respond to it. It has been advised in tetanus, but is insufficient except in doses which would be equally as dangerous as the disorder itself . It is better adapted to control the excessive movements of hysteria and mania, but in the former having little effect upon the psychic phase of the disorder. It has been used in teething, when twitching of the muscles is present, in laryngismus stridulus, also in whoopingcough, but we have safer and more satisfactory remedies for these affections. Some cases of epilepsy due to masturbation have been relieved by conium, and it lessens the movements of paralysis agitans. As a remedy for pain conium is fairly efficient, but it takes fair-sized doses to accomplish results. As the terminals of the sensory and motor nerves are directly affected by the drug, it is best adapted to peripheral pain with excessive mobility. Thus it relieves spasmodic neuralgia, neuralgia from carious teeth, ovarian neuralgia, and gastralgia. In gastric ulcer it is quite efficient and safe, while for relief of pain and to give rest it is a most important drug in gastric carcinoma. If there is much destruction of tissues it is less effective, but tends to keep the surrounding part obtunded and muscularly quiet, notwithstanding the statement that it has no control over involuntary musculature. In the intestines, however, it does not seem to lessen peristalsis, and is therefore not constipating, like opium and morphine. Conium has been used for so-called chronic rheumatism, especially in the aged, who complain of muscular soreness and joint pains, with loss of sleep. Given within bounds it may relieve and can do no harm. Sometimes it relieves pruritus, especially the senile form so distressing to old people and preventing rest and sleep. Conium sometimes reduces glandular swellings. It frequently causes the disappearance of nodular masses in the axillary and mammary glands. By some it has been assumed that these are carcinomatous. There is no evidence of it having been of any service in dissipating ulcerating growths of the breast; therefore it is safe to assume that such nodules as are influenced by conium are probably not cancerous, but more than likely of a strumous character. At any rate we are not justified in delaying necessary measures by a long course of conium medication with uncertain prospects of relief in undoubted scirrhus of the breast. It may, however, be applied and be given to relieve pain even when a cure is not possible. It relieves the pain of swollen mammae during the menstrual periods a¹

GALLA
   An excrescence on Quercus infectoria, Olivier, and other allied species of Quercus (Nat. Ord. Fagaceae), caused by the punctures and deposited ova of the Cynips tinctoria, Hartig. Common Names: Nutgall, Galls. Principal Constituents.—Tannin (24 to 80 per cent) and gallic acid (1 1/2 per cent). Preparations.—1. Pulvis Gallae, Pulverized Galls. Dose, 5 to 20 grains. 2. Unguentum Gallae, Ointment of Nutgall (20 per cent nutgall). Action and Therapy.—Galls are astringent and owe this property to the large quantity of tannic acid they contain. As an internal medicine and largely for external purposes they have been supplanted by gallic and tannic acids, which see. Galls, however, are considered especially effective in hemorrhoids, being preferred by many as a local application, in ointment, in preference to the acids named. They are commonly associated with opium for the same purpose.¹

GAMBIR^UNGA
   An extract prepared from the leaves and twigs of Ourouparia Gambir (Hunter), Baillon (Nat. Ord. Rubiaceae). Sumatra, Ceylon, and countries bordering the Straits of Malacca. Dose, 1 to 30 grains. Common Names: Gambir, Gambeer, Terra Japonica, Pale Catechu. Description.—Irregular masses or cubes, reddish-brown, pale brownish-gray or light brown, friable, crystalline, and breaking with a dull earthy fracture, bitterish with sweetish after-taste, no odor and great astringency. Dose, 15 grains. Principal Constituents.—Catechutannic acid (35 to 40 per cent) the active astringent; catechin (catechuic acid) probably inert; and pyrocatechin. Preparations.—1. Trochisci Gambir, Troches of Gambir (Gambir about 1 grain, Sugar, Tragacanth, and Orange-flower Water). 2. Tinctura Gambir Composita, Compound Tincture of Gambir (Gambir and Cinnamon). Dose, 1 fluidrachm. Action and Therapy.—External. Gambir is powerfully astringent. It restrains excessive discharges, overcomes relaxation and congestion, and checks local hemorrhages. Gambir is now used in place of catechu (extract of wood of Areca Catechu) as it carries practically the same bodies in more available form, though it contains less tannin than that extract. It may be used in relaxed sore throat, relaxed uvula, and the relaxation and congestion of the fauces common to speakers and singers. A gargle or the troches may be employed. It is rarely used, by injection, in leucorrhoea, and in powder or tincture to control epistaxis. It is a good astringent for congested and spongy gums. Internal. The powerfully astringent properties of gambir are utilized in the control of serous diarrheas. If there is much mucus present a purge of castor oil is advised, to be followed by the gambir alone, or with camphorated tincture of opium. It is seldom used in modern Eclectic practice.¹