A REFERENCE HAND-BOOK
FOR NURSES

BY

AMANDA K. BECK, R. N.

Graduate of the Illinois Training School for Nurses

FOURTH EDITION, REVISED

PHILADELPHIA AND LONDON

W. B. SAUNDERS COMPANY
1919

Copyright, 1905, by W. B. Saunders and Company. Reprinted
August, 1905, July, 1906, June, 1907, and January, 1908.
Revised, reprinted, and recopyrighted August, 1908. Reprinted
March, 1909, February, 1910, July, 1910, March, 1911, February,
1912, and August, 1912. Revised, reprinted, and recopyrighted
February, 1913. Reprinted October, 1913, May, 1914, November,
1914, January, 1915, May, 1915, September, 1915, June, 1916,
January, 1917, July, 1917, November, 1917, April, 1918, and
August, 1918. Revised, reprinted, and recopyrighted March, 1919

Copyright, 1919, by W. B. Saunders Company

PRINTED IN AMERICA

PRESS OF
W. B. SAUNDERS COMPANY
PHILADELPHIA

TO
ISABEL McISAAC

For many years Superintendent of the
Illinois Training School for Nurses, of Chicago

AND TO
IDORA C. ROSE

Formerly her Assistant and now her Successor

THIS BOOK IS AFFECTIONATELY INSCRIBED

PREFACE TO THE FOURTH EDITION.

In the present edition of this work a few new subjects have been added and the text has been somewhat altered in order that certain recent advances and changes might be noted and brought into daily service. I have not been unmindful, however, of the fact that to be of the greatest possible use to our profession this volume must remain small and compact.

I hear frequently that this Handbook is valued by my fellow-workers and that it is to many of them a daily help and companion. This is a source of great pleasure to me, and I hope that this new edition will be found more useful even than any of its predecessors.

A. K. Beck, R. N.

Chicago, Ill.,
March, 1919.

PREFACE.

As a probationer doing class and hospital work and as a graduate trained nurse I took notes of all the various formulæ, directions, etc., that might at some time be useful to me in the pursuit of my duties. My class work was productive of many valuable items of information; these and such other items as I gathered in the course of my hospital work and while on private duty, and others which were the result of my own experience and observation, I kept in a memorandum book which soon became indispensable to me, and which I used until the leaves became worn and fell apart. I rewrote this memorandum book three times, and the task of its fourth rewriting made me wish that I had its contents in a form more easily preserved. The inspiration followed that my notes in book form would be of general use to most nurses and of some use to many physicians. This little volume is the result.

To my own notes, all of which have been submitted to competent authorities for criticism, I have added several articles by eminent physicians and superintending nurses, which tend to round out the usefulness of the book. I have kept in mind, however, my original intention of producing a hand-book of convenient size for quick reference.

To the authors of these articles, to the friendly critics to whom my notes were submitted, and to the kind friends who encouraged me in this work, I extend my sincere thanks.

AMANDA K. BECK, R. N.

REFERENCE HAND-BOOK
FOR NURSES.

ABBREVIATIONS.

GLOSSARY OF MATERIA MEDICA.

In the following Glossary will be found short definitions of many of the terms employed in the Dispensatory to designate the medical properties of the remedies; most of the words are commonly employed as nouns, and sometimes as adjectives.

• Absorbents.—Drugs used to produce absorption of exudates or diseased tissues.
• Abstergents.—Detergents (cleansing agents).
• Alteratives.—Medicines used to so modify nutrition as to overcome morbid processes.
• Analeptics.—Restorative medicines or food.
• Analgesics.—Medicines used to allay pain.
• Anaphrodisiacs.—Medicines used to allay sexual feeling.
• Anesthetics.—Medicines used to produce anesthesia or unconsciousness.
• Anodynes.—Medicines used to allay pain.
• Antacids.—Medicines used to neutralize acid in the stomach and intestines.
• Anthelmintics.—Medicines used to destroy intestinal worms.
• Antiarthritics.—Medicines used for the relief of gout.
• Antihydropics.—Medicines used for the relief of dropsy.
• Antilithics.—Medicines used for the relief of calculous affections.
• Antiperiodics.—Medicines used for the relief of malarial fevers.
• Antipyretics.—Medicines used for the reduction of bodily temperature in fevers.
• Antiseptics.—Substances which have the power of preventing putrefaction.
• Antispasmodics.—Medicines used for the relief of nervous
• irritability and minor spasms.
• Antisyphilitics.—Medicines used for the relief of syphilis.
• Antizymotics.—Substances which have the power of killing disease germs.
• Aperients.—Mild purgatives.
• Aphrodisiacs.—Substances used to increase sexual power or excitement.
• Aromatic Bitters.—Medicines which unite the properties of
• the aromatic and simple bitters.
• Aromatics.—Medicines characterized by a fragrant or spicy taste and odor,
• and stimulant to the gastro-intestinal mucous membrane.
• Astringents.—Medicines having the power of influencing vital
• contractility, thereby condensing tissues.
• Bitters, Simple.—Medicines which have a bitter taste andhave the power
• of stimulating the gastro-intestinal mucous membrane,
• without affecting the general system.
• Blisters.—Medicines which when locally applied cause inflammatory exudation
• of serum from the skin, and are used as revulsants.
• Calefacients.—Medicines used externally to cause a sense of warmth.
• Cardiac Depressants.—Medicines used to lower the heart’s action.
• Cardiac Stimulants.—Medicines used to increase the heart’s action.
• Carminatives.—Medicines containing a volatile oil used to excite intestinal
• peristalsis and provoke an expulsion of flatus.
• Cathartics.—Purgatives.
• Caustics.—Medicines used to destroy living tissues.
• Cholagogues.—Medicines which provoke a flow of bile.
• Constringents.—Astringents.
• Convulsants.—Medicines which cause convulsions.
• Correctives.—Medicines used to correct or render more pleasant
• the action of other remedies, especially purgatives.
• Corrigents.—Correctives.
• Demulcents.—Mucilaginous principles which are used in solution to
• soothe and protect irritated mucous membranes and other tissues.
• Deobstruents (obsolete and not very definite).—Medicines
• which overcome obstruction; aperients.
• Deodorants.—Substances which destroy or hide foul air.
• Depilatories.—Substances used to remove hair.
• Depressants.—Sedatives.
• Depressomotors.—Medicines which lessen motor activity.
• Depurants.—Medicines which act upon the emunctories so as
• to cause excretion and thereby purify the system.
• Detergents.—Medicines which cleanse wounds, ulcers, etc.
• Diaphoretics.—Medicines which produce sweating.
• Digestants.—Ferments and acids which have the power of
• aiding in the solution of food.
• Diluents.—Medicines which dilute secretions and excretions.
• Disinfectants.—Substances which have the power of destroying disease germs
• or the noxious properties of decaying organic matter.
• Diuretics.—Medicines which increase the secretion of urine.
• Drastics.—Purgatives which cause much irritation.
• Ecbolics.—Medicines which produce abortion.
• Eccoprotics or Ectoprotics.—Laxatives.
• Emetics.—Medicines which cause vomiting.
• Emmenagogues.—Medicines which stimulate menstruation.
• Emollients.—Substances used to mechanically soften and protect tissues.
• Epispatics.—Blisters.
• Errhines.—Medicines which increase the nasal secretions.
• Escharotics.—Caustics.
• Evacuants.—Medicines which evacuate; chiefly applied to purgatives.
• Excitants.—Stimulants.
• Excitomotors.—Medicines which increase motor activity.
• Expectorants.—Medicines which act upon the pulmonic mucous
• membrane and increase or alter its secretions.
• Febrifuges.—Medicines which dissipate fever.
• Galactagogues.—Medicines which increase the secretion of milk.
• Germicides.—Agents that destroy germs.
• Hemostatics.—Medicines which arrest hemorrhages.
• Hydragogues.—Purgatives which cause large watery discharges.
• Hypnotics.—Medicines which cause sleep.
• Laxatives.—Mild purgatives.
• Local Anesthetics.—Medicines which when applied locally destroy sensation.
• Mydriatics.—Medicines which cause mydriasis, or dilation of the pupil.
• Myotics.—Medicines which cause myosis, or contraction of the pupil.
• Narcotics.—Powerful anodyne hypnotics.
• Neurotics.—Medicines which act upon the nervous system.
• Nutriants.—Medicines which modify the nutritive processes.
• Nutrients.—Substances which nourish.
• Oxytocics.—Medicines which stimulate uterine contractions.
• Peristaltics.—Medicines which increase peristalsis.
• Prophylactics.—Medicines which prevent the taking or development of disease.
• Protectives.—Medicines which protect a part when applied to it.
• Ptyalagogues.—Sialagogues.
• Purgatives.—Medicines which produce copious discharges from the bowels.
• Refrigerants.—Medicines which lessen bodily temperature.
• Revulsants.—Medicines which by causing irritation draw nervous
• force and blood from a distant diseased part.
• Rubefacients.—Medicines which cause irritation and redness,
• and are used as revulsants.
• Sedatives.—Medicines which lower functional activity.
• Sialagogues.—Medicines which excite salivary glands to secretion.
• Somnifacients.—Soporifics.
• Soporifics.—Medicines which cause sleep.
• Sorbefacients.—Medicines which cause absorption.
• Specifics.—Medicines which have a direct curative influence
• on certain individual diseases.
• Stimulants.—Medicines which increase functional activity.
• Stomachics.—Stimulants to the stomach.
• Styptics.—Hemostatics.
• Sudorifics.—Medicines which produce sweating.
• Tenicides.—Medicines which kill the tapeworm.
• Tonics.—Medicines which permanently increase the systemic
• tone by stimulating nutrition.
• Vermicides.—Medicines which kill intestinal worms.
• Vermifuges.—Medicines which cause the expulsion of intestinal worms.
• Vesicatories.—Blisters.

ROMAN NUMERALS.

POPULAR AND OFFICIAL NAMES
OF MEDICINAL PREPARATIONS.

WEIGHTS AND MEASURES.

TROY WEIGHT.

Used for weighing gold, silver, and jewels.

APOTHECARIES’ WEIGHT.

The ounce and pound in this are the same as in Troy weight.

AVOIRDUPOIS WEIGHT.

DRY MEASURE.

LIQUID MEASURE.

TIME MEASURE.

CIRCULAR MEASURE.

LONG MEASURE.

CLOTH MEASURE.

MARINERS’ MEASURE.

MISCELLANEOUS.

SQUARE MEASURE.

NUMERICAL TABLE.

SIMPLE FRACTIONS.

METRIC SYSTEM.

METRIC MEASURES OF LENGTH DECREASING.

METRIC MEASURES OF LENGTH
INCREASING.

APPROXIMATE EQUIVALENTS OF METRIC
AND STANDARD MEASURES OF LENGTH.

METRIC WEIGHTS.

APPROXIMATE EQUIVALENTS OF METRIC
AND APOTHECARIES’ WEIGHTS.

METRIC MEASURES OF CAPACITY.

APPROXIMATE EQUIVALENTS OF METRIC AND
APOTHECARIES’ MEASURES OF CAPACITY.

APOTHECARIES OR TROY WEIGHT.

APOTHECARIES’ OR WINE MEASURE.

APPROXIMATE FLUID MEASURES.

TABLES FOR PERCENTAGE OF SOLUTIONS.

The following tables are sufficiently correct for practical purposes:

APOTHECARIES’ MEASURE.

METRIC MEASURE.

SOLUTIONS.

TO MAKE A 1: 500 SOLUTION.

To make a 1: 500 solution of formaldehyd add 38 minims of formalin (a 40 per cent. solution of formaldehyd) to 1 pint of water.

A HANDY SOLUTION TABLE WITH
DOMESTIC MEASURES.

TO PREPARE A 1: 500 SOLUTION.

There are 7680 m. in 1 pint of solution (water); therefore we divide 7680 by 500 as follows:

• 500)7680(15⅗ m. to 1 pint of solution (water).
• 500
• 2680
• 2500
• 1800
• 1500
• 300, or ⅗ of a m.

N.B.—Divide the number of m. in 1 pint by the strength of the solution, and then divide the result by the percentage of original strength of the article.

When original strength of solution is less than 100 per cent., as, for example, formaldehyd, which is 40 per cent., divide the quotient above resulting by the percentage of strength—viz.:

• 40)1536(38⅖ m. to 1 pint of solution (water).
• 120
• 336
• 320
• ¹⁶/₄₀ = ⅖.

To get a ¹/₁₀₀ of a grain dose of any drug out of a solution of 60 minims containing ¹/₃₂ of a grain of that drug, compute as follows:

• ³²/₃₂ or 1 grain = 32 × 60, or 1920 m.
• ¹/₁₀₀ = ¹/₁₀₀ of 1920 m.
• 100)1920(19⅕ m.
• 100
• 920
• 900
• 20, or ⅕ m.

Rule.—Multiply the quantity of the solution on hand in minims by a number indicating the fractional amount of the drug therein contained, and divide by a number indicating the fractional amount of the drug desired.

ACTION, USES, AND DOSES OF
THE MOST IMPORTANT DRUGS.

Acetanilid.—This substance, a derivative of anilin, is used to lower temperature; to relieve headaches and neuralgic pains; and to allay spasm, as in chorea and whooping-cough.

Toxic doses cause lividity, cold sweats, ringing in the ears, and heart failure.

The dose is from 5 to 10 grains (0.3-0.6 gm.).

Arsenic.—Arsenic is used internally as a tonic in anemia, an alterative in chronic constitutional diseases, as a special remedy in chorea, and as an anti-malarial. Externally, it is occasionally used as a caustic.

The indications of its too free use are puffiness under the eyes, or griping pains in the abdomen, with diarrhea.

Toxic doses cause abdominal pain, vomiting, purging, swelling of the face, and collapse.

Preparations of arsenic should be given after meals. The dose of arsenous acid is from ¹/₄₀ to ¹/₂₀ grain (0.0016-0.0032 gm.); of Fowler’s Solution (Liquor Potassii Arsenitis), 1 minim (0.06 c.c.), very gradually increased to 10 minims (0.6 c.c.).

Aconite.—This drug depresses the heart, slows the pulse, and lowers temperature. Externally, it causes numbness and anesthesia. Internally, it is employed chiefly as a heart sedative in hypertrophy of the heart, and as a febrifuge in acute febrile disease when the pulse is strong and rapid. Locally, it is sometimes employed in liniments in neuralgia and muscular rheumatism.

Aconite is a powerful poison, causing in overdoses tingling of the lips, tongue, and extremities, cold sweat, pallor, a feeble pulse, and collapse.

The dose of the tincture (Tinctura Aconiti) is from 1 to 5 minims (0.06-0.3 c.c.).

Alcohol.—In moderate cases alcohol stimulates the heart, favors digestion, and lessens tissue-waste. For these reasons it is a useful remedy in low fevers, like typhoid fever, diphtheria, and pneumonia. On account of its prompt action, it is a valuable circulatory stimulant in sudden heart failure. It has been recently recommended also as an antidote in carbolic-acid poisoning. Externally, it is used as a cleanser for the skin and as a stimulant application in the prevention of bed-sores.

Preparations.—Wines are produced by the spontaneous fermentation of fruits. The strongest are port, Madeira, and sherry, each of which contains about 20 per cent. of alcohol. The dose is from 4 to 8 drams (15-30 c.c.). The weakest wines are the clarets and Rhine wines, which contain about 8 per cent. of alcohol. The dose of these is from 1 to 2 ounces (30-60 c.c.).

Champagne is prepared by adding sugar to an ordinary wine, and allowing the mixture to ferment in corked bottles, the carbon dioxid thus being retained. It contains from 10 to 12 per cent. of alcohol. The dose is from 1 to 2 ounces (30-60 c.c.).

Whisky is made by subjecting fermented grains to distillation. Rum is made by distilling fermented molasses. Gin is prepared by distilling fermented grain and adding oil of juniper berries to the distillate.

Brandy is a spirit produced by the distillation of a wine.

Whisky, rum, gin, and brandy contain from 40 to 50 per cent. of alcohol. The dose of each is from 1 to 4 drams (4-15 c.c.).

Beer, ale, and porter are made from an infusion of malt—that is, fermented barley, flavored with hops. They each contain from 4 to 6 per cent. of alcohol.

In large doses alcohol in any form causes mental excitement, delirium, loss of co-ordination, and finally stupor and coma. Death may result from paralysis of the heart or respiration.

Aloes.—This is cathartic and stimulant, and is given in chronic constipation, amenorrhea, and atonic dyspepsia. The laxative dose is from ½ to 2 grains; the purgative and emmenagogue dose is 2 to 5 grains.

Ammonia.—This is a gas employed medicinally in the form of a watery solution (water of ammonia) or an alcoholic solution (spirit of ammonia).

These preparations are used internally as heart stimulants, respiratory stimulants, gastric antacids, and externally as counterirritants. The dose of the Aromatic Spirit (Spiritus Ammoniæ Aromaticus) is from ½ to 1 dram (2-4 c.c.), well diluted. Large doses of ammonia preparations cause burning pain in the throat and abdomen, vomiting, purging, and collapse.

Antipyrin.—This drug has about the same action and uses as acetanilid, and may be given in the same dose.

Antitoxin of Diphtheria.—This is obtained from healthy horses which have been rendered artificially immune to diphtheria from having received a prolonged course of treatment with diphtheria toxin in doses gradually increased. The immunity is due to the formation in the blood of a substance which in some way counteracts the poison or toxin of the disease. This substance is known as the antitoxin. It exists in the serum of the blood, and so far has not been separated from it. The dose of the serum is measured in units, a unit being ten times the amount of antitoxin required to save the life of a guinea-pig which has been injected with 100 fatal doses of diphtheria toxin.

Antitoxin acts both as a curative and a preventive remedy. Since its introduction the mortality of diphtheria has been reduced more than one-half. The curative dose is from 2000 to 5000 units, to be repeated in from six to twelve hours, if necessary. The prophylactic dose is 500 units. The protection afforded is only temporary, lasting from two to three weeks.

The injections are sometimes followed by a rise of temperature, pain in the joints, or a cutaneous rash, but these symptoms are without serious significance.

Aspirin.—This is acetyl-salicylic acid and is used like sodium salicylate in rheumatism and pleurisy, and as an antipyretic and analgesic. Dose, 5 to 15 grains.

Atropin.—See Belladonna.

Belladonna.—This drug owes its activity to the alkaloid atropin. It is employed internally to stimulate the respiration; to stimulate the circulation; to allay local spasm, as in asthma and whooping-cough; to check excessive secretion, as in the night-sweats of phthisis; and to stimulate peristalsis in atonic constipation. Locally, it is employed in the form of solutions of atropin to dilate the pupil of the eye, and in the form of a liniment or plaster of belladonna as a sedative application in various inflammatory conditions. Toxic doses of belladonna cause dilatation of the pupils, dryness of the throat, quickening of the pulse and respiration, delirium, and a diffuse red rash resembling that of scarlatina.

The dose of atropin is from ¹/₁₅₀ to ¹/₅₀ grain (0.00043-0.0013 gm.); of the Tincture of Belladonna (Tinctura Belladonnæ), 5 to 20 minims (0.3-1.2 c.c.); of the Extract of Belladonna (Extractum Belladonnæ), ⅛ to ¼ grain (0.008-0.016 gm.).

Bismuth.—The insoluble preparations of the metal—subnitrate, subcarbonate, and subgallate—are used internally as mild antiseptics, sedatives, astringents, and antacids in various inflammatory diseases of the stomach and bowel. They are scarcely poisonous when taken internally in any amount. The usual dose of any one of the preparations named is from 5 to 30 grains (0.3-2 gm.) in dry powder or stirred in milk or water.

Bromids.—The salts of bromin in common use are the bromids of potassium, sodium, ammonium, and strontium. The action of these is very similar. They are especially useful as depressants to the central nervous system. They are employed to produce sleep, to check convulsions, and to relieve headache and neuralgic pain. Large doses depress the heart and respiration. The continued use of the bromids causes a condition known as bromism. This is characterized by fetor of the breath, a rash on the skin, languor, and somnolence. The dose of the bromin salts is from 10 to 60 grains (0.6-4 gm.).

Caffein.—This is an alkaloid obtained from coffee. It is a heart stimulant, respiratory stimulant, brain stimulant, and kidney stimulant (diuretic). The dose is from 1 to 5 grains (0.06-0.3 gm.).

Calomel.—See Mercury.

Carbolic Acid.—Externally, this acid is used in weak solutions (1 : 40 to 1 : 20) as an antiseptic, and in concentrated form as a caustic. Weak solutions are also employed to allay itching in skin diseases. Internally, carbolic acid is used as an antiseptic in dyspepsia and diarrhea. Applications of carbolic acid, even when dilute, should never be prolonged, as they are liable to cause gangrene. Poisoning by carbolic acid is characterized by white patches on the lips, the odor of the drug on the breath, burning pain in the abdomen, vomiting, purging, unconsciousness, and collapse. The dose is from ½ to 3 minims (0.03-0.2 c.c.).

Castor Oil.—This is an oil expressed from the seed of an East Indian plant. The seeds themselves are acrid poisons. It is a mild purgative, unloading the bowels very thoroughly in from four to six hours. It may be given in flexible capsules, in emulsion, or with equal parts of lemon-juice and glycerin. The dose is from ½ to 1 ounce (15-30 c.c.).

There are two simple methods of taking castor oil without producing nauseating effects. Have the patient wash out the mouth with water as hot as can be borne, then swallow the oil, and follow this by rinsing out the mouth well with hot water. The other method is to hold a piece of ice in the mouth long enough to chill the lining membrane, swallow the oil, and rinse the mouth with ice-water.

Chloral.—This substance is an active depressant of the brain and spinal cord. In large doses it also depresses the heart and respiration. It is employed to produce sleep and to check convulsions. The dose is from 10 to 30 grains (0.6-2 gm.) in some agreeable syrup.

Poisonous doses cause unconsciousness, embarrassed breathing, and collapse.

Chloralamid.—This is a comparatively safe and reliable hypnotic, producing sleep without causing much depression of the heart or disagreeable after-effects. The dose is from 10 to 30 grains (0.6-2 gm.), well diluted. Hot liquids decompose it.

Chloroform.—This substance is employed by inhalation as a general anesthetic, by the mouth as a sedative in colic, neuralgia of the stomach, and obstinate cough, and externally in the form of liniment as a counterirritant in muscular rheumatism, sprains, etc. As a general anesthetic it is more powerful than ether, more readily inhaled, but not so safe. Death from chloroform is usually the result of heart failure. The dose of Spirit of Chloroform (Spiritus Chloroformi) is from 5 to 30 minims (0.3-2 c.c.); of Chloroform-water (Aqua Chloroformi), 1 to 8 drams (4-30 c.c.).

Cinchona (Peruvian Bark).—This is the bark of an evergreen tree growing in the tropics. It owes its medicinal properties to quinin and cinchonin, especially the former. It is used as a general tonic, as a stomachic, as a febrifuge, and as an anti-malarial. Large doses cause ringing in the ears, headache, deafness, dimness of vision, convulsions, and coma. The dose of quinin and its salts is from 1 to 30 grains (0.06-2 gm.); of cinchonin, 1 to 30 grains (0.06-2 gm.); of the Compound Tincture of Cinchona (Huxham’s Tincture), 1 to 4 drams (4-15 c.c.).

Cocain.—This is the alkaloid of a shrub (coca) growing in South America. Applied to mucous membranes or raw surfaces, or injected under the skin, it blanches the part and produces anesthesia. Applied directly to the skin, however, it is without effect, as it is not absorbed from the unbroken skin. Internally, it is sometimes employed to stimulate the heart, to stimulate the respiration, and to allay vomiting. Its repeated use, even as a local remedy, is dangerous, in that it is prone to cause a habit, the symptoms of which are mental failure, loss of flesh and strength, anemia, and intense craving for the drug. The symptoms of acute cocain-poisoning are excitement, delirium, a rapid pulse, hurried breathing, convulsions, and coma. The dose of cocain is from ⅛ to ½ grain (0.008-0.03 gm.). As an anesthetic it is usually employed in from 2 to 4 per cent. solutions.

A 2½-grain tablet of cocain, dissolved in a teaspoonful of water, makes a 2 per cent. solution; a 4½-grain tablet, in the same amount of water makes a 4 per cent. solution; a 10½-grain tablet in a like amount furnishes a 10 per cent. solution. These percentages are not mathematically correct, but are sufficiently exact for any surgical purposes.

Cod-liver Oil.—This is more of a food than a medicine. It is preferable to other oils in being more readily digested. When well borne by the stomach, it is a valuable remedy in wasting diseases, especially phthisis. The dose is from 1 to 4 drams (4-15 c.c.). It may be given in emulsion, in flexible capsules, or pure, dropped in the froth of porter. It is best taken two hours after meals.

Creasote.—This is an oily substance obtained from the slow burning of beechwood. It is chiefly used internally as an antiseptic in dyspepsia and diarrhea, and as an expectorant in purulent bronchitis and phthisis. Large doses produce the same toxic effects as are observed in carbolic-acid poisoning. The dose is from 2 to 20 minims (0.1-1.2 c.c.) in capsules, in milk, or in some bitter tincture, like that of gentian. The dose of creasote carbonate (creosotal), which is free from the unpleasant odor and taste of pure creasote, is from 5 to 20 minims (0.3-1.2 c.c.).

Croton Oil (Oleum Tiglii).—This is an oil expressed from the seed of a small tree growing in Asia. Locally it is an active vesicant; internally it is a powerful purgative. Large doses cause severe inflammation of the stomach and bowels. The dose is from 1 to 2 drops (0.06-0.12 c.c.) in glycerin, olive oil, or bread-crumbs. A bland vehicle is necessary to prevent the vesicating effect of the drug on the throat. Diluted with from 2 to 4 parts of olive oil, and applied with friction, it is sometimes used as a counterirritant in inflammatory diseases of the chest.

Digitalis.—This is a powerful circulatory stimulant, strengthening the contractions of the heart, constricting the peripheral blood-vessels, and slowing the pulse. By increasing the blood-pressure in the kidneys it also increases the flow of urine. It is chiefly used as a stimulant in heart disease when there is failure of circulation, and as a diuretic in various forms of dropsy. The effects of the drug should be carefully watched; too large doses cause marked slowing and irregularity of the pulse, and a decrease rather than an increase in the urine. The dose of powdered digitalis leaves is from ½ to 2 grains (0.03-0.13 gm.); of the Tincture (Tinctura Digitalis), 5 to 20 minims (0.3-1.2 c.c.); of the infusion (infusum digitalis), 1 to 4 drams (4-15 c.c.); of digitalin, an important principle of the leaves, ¹/₁₀₀ to ¹/₆₀ grain (0.00065-0.001 gm.).

Ergot.—This is a fungus growing on rye. It is employed to contract the blood-vessels in internal hemorrhage and to stimulate the uterine contractions in the second stage of labor when post-partum hemorrhage is feared. Its use in the early stage of labor to hasten delivery is dangerous, since it may cause tetanic spasm of the uterus and asphyxiation of the child or even rupture of the uterus.

The dose of the Extract of Ergot (Extractum Ergotæ) is from 1 to 15 grains (0.065-1 gm.); of the Fluid Extract (Extractum Ergotæ Fluidum), ½ to 1 dram (2-4 c.c.); of the Wine (Vinum Ergotæ), 1 to 4 drams (4-15 c.c.); of ergotin, a concentrated extract, 2 to 5 grains (0.13-0.3 gm.). When given hypodermically abscess is likely to form, even under the most strict antiseptic precautions.

Ether.—Next to nitrous oxid, this is the safest of the general anesthetics, although it is not so readily inhaled as chloroform, and is more apt to produce unpleasant after-effects, such as nausea and vomiting. The latter may sometimes be relieved by the inhalation of hot vinegar fumes.

Death from ether is usually the result of asphyxia, and not, as in the case of chloroform, from heart failure. Internally, by the mouth or hypodermically, ether is sometimes used as a circulatory stimulant in sudden heart failure. Great care should be exercised in handling ether in the neighborhood of lighted gas-jets, as the vapor of the drug is highly inflammable. Ether should be stored in well-stoppered containers, in a cool place, remote from lights and fire.

The dose of ether as a circulatory stimulant is from 5 to 30 minims (0.3-2 c.c.) in ice-water or hypodermically.

Formaldehyd.—This gas is employed in the form of a 40 per cent. solution (formalin). It is used as an antiseptic, disinfectant, and deodorant. It is the best disinfectant for sick-rooms that we possess, although on account of its lack of penetrating power it can not be used for disinfecting bedding, stuffed furniture, carpets, books, etc. To be effective the gas must be generated from formalin in a special apparatus, or from paraform tablets heated over a suitable lamp. Attempts to vaporize solution of formaldehyd from an open vessel placed on a stove are unsuccessful, since this treatment converts most of the formaldehyd gas into crystals of paraform. Solutions of formalin—1 : 2000 to 1 : 500—are sometimes used for irrigating suppurating cavities and disinfecting instruments. A solution of 1 part of formalin to 20 parts of water makes a good disinfectant for stools, urine, and sputa.

Iodids.—The salts of iodin—potassium, sodium, ammonium iodid—resemble each other in their action and uses. They are used as alteratives in constitutional diseases, like chronic rheumatism and gout, as absorbents of exudates in chronic inflammatory diseases, and as eliminants in chronic mineral poisoning. Their continued use occasions a group of symptoms—frontal headache, nasal discharge, sore throat, and a cutaneous eruption—termed iodism. The dose is from 5 to 30 grains (0.3-2 gm.), well diluted, after meals.

Iodoform.—This drug owes its virtues to iodin, of which it contains about 50 per cent. When brought into contact with raw surfaces it exerts a mild anesthetic effect, liberates its iodin, and thereby acts as an antiseptic. When applied too freely it may be absorbed and cause toxic effects—headache, elevation of temperature, restlessness, a diffuse red rash on the face and limbs, delirium, stupor, and collapse. The unpleasant odor of the drug can be removed from the hands and from instruments by oil of turpentine.

Ipecac.—This drug is used as an emetic and expectorant. As an emetic it is safe, but somewhat slow in action. It is especially useful in the young and feeble, as it causes but little depression.

The dose of powdered ipecac, as an emetic, is from 20 to 30 grains (1.2-2 gm.); of the Syrup (Syrupus Ipecacuanhæ), as an expectorant, from 10-60 minims (0.6-4 c.c.); as an emetic, from 2 to 4 drams (8-15 c.c.); of the wine, as an expectorant, from 10 to 30 minims (0.6-1.8 c.c.); as an emetic, 1 dram (4 c.c.).

Iron. (Ferrum).—The various preparations of iron are employed as tonics and astringents. As tonics, they are especially indicated in simple anemia; as astringents they are employed locally in bleeding, and, internally, in diarrhea.

The dose of Reduced Iron (Ferrum Reductum) is from 1 to 5 grains (0.06-0.3 gm.); of the Pills of Iron Carbonate or Blaud’s Pills (Pilulæ Ferri Carbonatis), 1 to 3 pills; of the Tincture of Ferric Chlorid (Tinctura Ferri Chloridi), 5 to 10 minims (0.3-0.6 c.c.); of the Solution of Iron and Ammonium Acetate or Basham’s Mixture (Liquor Ferri et Ammonii Acetatis), 1 to 4 drams (4-15 c.c.); of the Sulphate of Iron (Ferri Sulphas), 1-3 grains (0.06-0.2 gm.); of the Syrup of Iodid of Iron (Syrupus Ferri Iodidi), 5 to 60 minims (0.3-4 c.c.). The Solution of Iron Subsulphate (Monsel’s solution) is used only as a hemostatic, and Iron Hydrate with Magnesia as an antidote in arsenic-poisoning. The dose of the latter is a tablespoonful every ten to fifteen minutes.

Lead.—The preparations of lead are used internally and externally as sedatives and astringents. Lead Acetate (Plumbi Acetas) is employed internally in diarrhea. The dose is from 1 to 3 grains (0.06-0.2 gm.), in pill form.

The Solution of Lead Subacetate (Liquor Plumbi Subacetatis) is employed externally. Diluted with from 5 to 6 parts of water it is used as a sedative application in ivy-poisoning and erysipelas.

The Dilute Solution of Lead Subacetate (Liquor Plumbi Subacetatis Dilutus) is known as lead-water, and is chiefly employed in making the sedative preparation known as lead-water and laudanum. As usually dispensed it contains 1 dram (4 c.c.) of laudanum and 4 drams (15 c.c.) of lead-water to 2 ounces (60 c.c.) of water.

Acute lead-poisoning is characterized by a burning pain in the abdomen, a metallic taste in the mouth, vomiting, purging, coma, and collapse.

Chronic lead-poisoning is characterized by anemia, intestinal colic, constipation, a blue line on the gums (deposit of lead sulphide), and paralysis of the forearms (wrist-drop).

Magnesium Sulphate (Epsom Salt).—This salt is an excellent hydragogue cathartic, producing in the course of a few hours copious watery stools. It is also employed as an antidote in acute lead-poisoning and carbolic-acid poisoning.

To secure the most prompt and powerful cathartic effect the drug is best given before breakfast, in a single dose, and with but a small quantity of water. Dose, from 1 to 8 drams (4-31 gm.).

Magnesium Oxid (Magnesia).—This is a white, tasteless, and insoluble powder. It is a cathartic, but much milder in action than Epsom salt. Dose, from 10 to 60 grains (0.6-4 gm.).

Magnesium Citrate.—An effervescing solution of this drug is much used as an agreeable laxative. The dose is from 6 to 12 ounces (180-360 c.c.).

Mercury.—The most important preparations of this metal are calomel, blue mass, corrosive sublimate, oxid of mercury, iodid of mercury, nitrate of mercury, and ointment of mercury.

Calomel (Hydrargyri Chloridi Mite).—This preparation is employed internally as a cathartic and gastric sedative, and externally as a stimulating and antiseptic dusting-powder. As a cathartic its best effect is secured by giving it in doses of from ⅒ to ⅙ grain (0.006-0.01 gm.) every half-hour or hour, until a grain has been taken. In this way the whole amount ingested is absorbed. When large doses are employed much of the drug escapes absorption.

Blue Mass or Blue Pill (Massa Hydrargyri).—This is a mixture of mercury, glycerin, honey, and licorice. Its action is much like that of calomel.

Corrosive Sublimate or Bichlorid of Mercury (Hydrargyri Chloridum Corrosivum).—Although irritant, toxic, and destructive to instruments, no other drug has supplanted this salt as an antiseptic for use in general surgery. The following are the strengths of the solutions usually employed for various purposes: for the skin, 1 : 1000 to 1 : 500; for wounds, 1 : 10,000 to 1 : 2000; for cavities of the body, 1 : 20,000 to 1 : 5000. Corrosive sublimate is not a good disinfectant for stools, sputa, etc., as it forms an impenetrable coagulum on the outside of the mass. Internally, corrosive sublimate is used as an alterative in constitutional diseases in doses of ¹/₆₀ to ¹/₁₂ of a grain (0.001-0.005 gm.).

Oxid of Mercury.—This appears in two forms—yellow oxid and red oxid. Both preparations are employed externally in the form of ointments for their alterative properties.

Iodid of Mercury.—This salt occurs in two forms: Red Iodid or Biniodid (Hydrargyri Iodidum Rubrum) and Yellow or Green Iodid (Hydrargyri Iodidum Flavum). The first is an irritating preparation, somewhat resembling corrosive sublimate in its action; the latter is comparatively unirritating, and is much used internally as an alterative. The dose of the red iodid is from ¹/₆₀ to ¹/₁₂ grain (0.001-0.005 gm.); of the yellow or green iodid, ¹/₁₀ to ½ grain (0.006-0.03 gm.).

Nitrate of Mercury.—This preparation is used in the form of a solution (Liquor Hydrargyri Nitratis) as a powerful caustic.

Ointment of Mercury, or Blue Ointment (Unguentum Hydrargyri).—This is an ointment of metallic mercury. It is used as a stimulant and absorbent application in chronic inflammatory swellings, as a parasiticide in certain skin diseases, and by inunction in syphilis. When used for the latter purpose about a dram (4 gm.) should be rubbed in the axilla, groin, or inner surface of the arm or thigh daily, a different region being selected each time, so as to avoid irritation of the skin.

Mercurial Poisoning.—Patients taking mercury continuously, even in small doses, should be carefully watched, as symptoms of ptyalism or salivation sometimes arise very speedily. This condition is manifested by fetor of the breath, soreness of the teeth when the jaws are brought together, increased flow of saliva, redness and swelling of the gums, and finally by ulceration of the tissues, loss of the teeth, and necrosis of the jaw bones. On the slightest evidence of these symptoms the drug should be suspended, and the mouth washed out frequently with a solution of hydrogen peroxid (1 : 4) or of potassium chlorate (1 dram to 8 ounces of water).

The ingestion of a single large dose of an irritant salt of mercury, such as the bichlorid or biniodid, gives rise to severe burning pain in the abdomen, vomiting, bloody purging, and collapse.

Nitroglycerin.—This drug is a depressant to the central nervous system, a heart stimulant, and a dilator of the peripheral blood-vessels. It is useful in certain local spasms (asthma), in heart failure, and in neuralgia of the heart. Owing to its action in dilating the vessels, it sometimes causes, even in small doses, headache, dizziness, and flushing of the face.

The dose of nitroglycerin is from ¹/₂₀₀ to ¹/₅₀ of a grain (0.0003-0.0013 gm.). The dose of the 1 per cent. alcoholic solution (Spiritus Glonoini) is from 1 to 5 minims (0.06-0.3 c.c.). The latter should be kept in well-stoppered bottles, in a cool place, remote from lights or fire.

Nux Vomica.—This is the seed of an East Indian tree. Its activity depends upon an alkaloid strychnin. It is a general stimulant, acting especially upon the spinal cord, respiratory center, heart, stomach, and intestine. It is employed in a great variety of affections in which there is deficient functional activity.

The limit of tolerance is indicated by restlessness, stiffness of the neck muscles, and jerking of the limbs. Toxic doses cause violent spasms closely resembling those of lock-jaw or tetanus. The convulsions of strychnin-poisoning, however, come and go, the muscles being completely relaxed in the intervals, and, moreover, they rarely involve the muscles of the jaw.

The dose of the Tincture of Nux Vomica (Tinctura Nucis Vomicæ) is from 5 to 20 minims (0.3-1.2 c.c.); of the Extract of Nux Vomica (Extractum Nucis Vomicæ), ⅙ to ¼ grain (0.01-0.016 gm.); of Strychnin Sulphate (Strychninæ Sulphas), ¹/₆₀ to ¹/₂₀ of a grain (0.001-0.003 gm.).

Opium.—This is the dried juice of a species of poppy growing in Asia. It contains several alkaloids, the chief of which are morphin and codein. From morphin are prepared artificially two alkaloids—apomorphin and heroin.

Opium depresses the brain, depresses the respiration, stimulates the heart slightly, lessens the peristaltic movements of the bowel, and diminishes all secretions, except the sweat. It is employed to induce sleep, to relieve pain, to allay cough, to check diarrhea, and to promote perspiration.

Opium-poisoning is marked by three stages: the first stage is short and characterized by mental exhilaration; in the second stage the pupils are greatly contracted (pin-point), the respirations are slow, the pulse is slow and full, and there is deep stupor. In the third stage the patient can no longer be aroused (coma), the respiration becomes shallow and irregular, the pulse becomes rapid and weak, the pupils finally dilate, and the patient dies from failure of the respiration.

Even after small doses of opium many patients suffer from headache and nausea. Children are much more sensitive to its action than adults. Morphin resembles opium in action, but is more powerful, less nauseating, and less constipating. Codein is less powerful as a hypnotic and less depressing than morphin.

The dose of opium is from ½ to 1 grain (0.03-0.65 gm.); of the Extract of Opium (Extractum Opii), ⅛ to ½ grain (0.008-0.03 gm.); of the Tincture of Opium or Laudanum (Tinctura Opii), 10 to 20 minims (0.6-1.2 c.c.); of the Camphorated Tincture of Opium or Paregoric (Tinctura Opii Camphorata), ½ to 4 drams (2-15 c.c.); of Dover’s Powder (Pulvis Ipecacuanhæ et opii), 5 to 10 grains (0.3-0.6 gm.); of morphin and its salts (sulphate, hydrochlorate, etc.), ⅛ to ½ grain (0.008-0.03 gm.), and of codein, ½ to 1 grain (0.03-0.06 gm.).

Heroin is chiefly used to allay cough. The dose is from ¹/₁₂ to ⅛ of a grain (0.005-0.008 gm.).

Apomorphin is employed as an emetic and as an expectorant in bronchitis. The dose as an emetic is from ⅒ to ⅙ of a grain (0.006-0.01 gm.), always hypodermically; the dose as an expectorant is from ¹/₂₀ to ¹/₁₀of a grain (0.003-0.006 gm.), always by the mouth.

Paraldehyd.—This is an oily liquid, having a peculiar unpleasant odor and taste. It is used chiefly as a hypnotic. While comparatively safe and reliable, its disagreeable taste and persistent odor on the breath detract from its usefulness. The dose is from ½ to 1 dram (2-4 c.c.), in some pleasant vehicle.

Phenacetin.—This anilin derivative has properties very similar to those of acetanilid, and is used for the same purposes. Dose, 5 to 10 grains (0.3-0.6 gm.).

Physostigma.—This is the seed of a climbing plant growing in Africa. Its activities depend upon an alkaloid known as eserin or physostigmin. It depresses the spinal cord, stimulates the peristaltic movements of the bowel, and, when applied to the eye, contracts the pupil. It is employed to check certain convulsions (tetanus and strychnin-poisoning), to overcome atonic constipation, and, locally, to contract the pupils.

The dose of the Tincture of Physostigma (Tinctura Physostigmatis) is from 5 to 20 minims (0.3-1.2 c.c.); of the Extract of Physostigmatis (Extractum Physostigmatis), ¹/₁₂ to ⅙ of a grain (0.005-0.01 gm.); of eserin or physostigmin and its salts, ¹/₁₅₀ to ¹/₅₀ of a grain (0.0004-0.0013 gm.).

Pilocarpus, or Jaborandi.—This is the leaves of a South American plant. Its virtues depend entirely upon an alkaloid known as pilocarpin. The chief action of the drug is on the secretions—sweat, saliva, and urine—which it markedly increases. Large doses depress the circulation. Locally, in the eye, it contracts the pupil like eserin. It is mainly employed internally as a diaphoretic in Bright’s disease and dropsical conditions. The dose of the Fluid Extract (Extractum Pilocarpi Fluidum) is from 20 to 60 minims (1.5-4 c.c.); of pilocarpin and its salts, ⅛ to ½ grain (0.008-0.03 gm.). The latter are usually administered hypodermically.

Quinin.—See Cinchona.

Salicylates.—These salts are employed in medicine chiefly as antirheumatic remedies. Their manner of action, however, is unknown. They are also used, both internally and externally, to some extent as antiseptics. Large doses cause ringing in the ears, headache, deafness, nausea, and a greenish discoloration of the urine.

The dose of salicylic acid or its salts (ammonium, sodium, strontium) is from 5 to 20 grains (0.3-1.3 gm.); of Oil of Gaultheria (Methyl Salicylate), 5 to 20 minims (0.3-1.2 c.c.). These preparations should be given after meals, well diluted.

The following remedies have properties like the salicylates, but are less powerful and less irritant to the stomach: Salol, dose, 5 to 20 grains (0.3-1.3 gm.); salophen, 5 to 30 grains (0.3-2 gm.); aspirin, 5 to 20 grains (0.3-1.3 gm.).

Senna.—This is a purgative cholagogue and is used in the constipation of children and pregnant women. Dose, in substance, 5 to 20 grains; in fluidextract or tincture, 1 to 4 fluidrams.

Silver.—The most important salt of this metal is the nitrate. Locally, in concentrated form, the latter is a caustic; in dilute form it is a sedative, astringent, and antiseptic. Internally, in small doses, silver nitrate is useful as an astringent and antiseptic in inflammatory and ulcerative conditions of the stomach and bowel.

The prolonged use of the drug, even in small doses, is followed by a permanent grayish discoloration of the skin (argyria) from the precipitation of the metal in the tissues.

Toxic doses of silver nitrate cause burning pain in the abdomen, vomiting of white, curdy matter, and bloody purging.

The dose of silver nitrate is from ⅙ to ½ of a grain (0.01-0.3 gm.), usually in pill form.

Several combinations of metallic silver with albumin are much used as antiseptics and astringents in inflammatory diseases of mucous membranes. They have advantage over silver nitrate in being less irritating and in not being decomposed by the juices of the tissues. The most important of these organic compounds are protargol and argyrol. They are usually applied in solutions of from 1 to 10 per cent. A soluble form of metallic silver is also employed in the form of 15 per cent. ointment, known as Credé’s ointment. It is recommended as an antiseptic in various infectious diseases.

Spartein.—This is an alkaloid from the broom plant. It is used to some extent as a heart tonic and diuretic in doses of from ¼ to ½ grain (0.015-0.03 gm.).

Strophanthus.—This is the seed of a climbing plant growing in Africa. Its action very closely resembles that of digitalis, for which it is sometimes substituted. The dose of the tincture (Tinctura Strophanthi) is from 3 to 10 minims (0.2-0.6 c.c.).

Sulphonal.—This artificial compound is used almost entirely as a hypnotic. In single doses it is comparatively safe and reliable, but slow in its action. Languor, headache, and drowsiness not infrequently follow its use. The repeated administration of sulphonal over several days or weeks is distinctly dangerous, being often followed by chronic poisoning. The latter is marked by a red coloration of the urine, colicky pains, profound depression, weakness, and collapse.

The dose of sulphonal is from 10 to 30 grains (0.6-2 gm.). It is best given in hot tea or hot milk, one or two hours before bedtime.

Tannic Acid, Tannin.—This is employed externally as an astringent and styptic, and internally as an astringent in atonic diarrheas. It is used in the form of a gargle or in troches in relaxed conditions of the throat, in solution to prevent bed-sores, and in the form of ointment or suppositories for the relief of internal piles. Dose, 1 to 10 grains.

Trional.—This remedy resembles sulphonal in action, and is used for the same purpose. It may also be given in the same dose and manner as sulphonal.

Urotropin.—This compound, prepared by the action of ammonia on formaldehyd, is employed as a powerful urinary antiseptic in doses of from 3 to 5 grains (0.2-0.3 gm.). Large doses may cause pain in the bladder, frequent urination, and bloody urine.

Veratrum Viride.—This is the root of a North American herb. Its action resembles that of aconite in that it depresses the heart and slows the pulse. It is, however, more nauseating than aconite, and when locally applied does not cause numbness, tingling, and anesthesia. Large doses cause vomiting, muscular weakness, dizziness, sweating, failure of pulse, and collapse. It is used as a sedative in acute inflammatory diseases to subdue overaction of the heart.

The dose of the tincture of veratrum viride (tinctura veratri viridis) is from 1 to 5 minims (0.06-0.3 c.c.).

DOSAGE.

The following general rules will aid the student in remembering the safe dose of many important preparations:

1. Tinctures of very active drugs, such as opium, digitalis, belladonna, physostigma, nux vomica, gelsemium, arnica, and capsicum may be given in doses of from 5 to 20 minims (0.3-1.2 c.c.), except the tinctures of aconite, veratrum viride, iodin, and cantharides, the dose of which is from 1 to 5 minims (0.06-0.3 c.c.).

2. Tincture of less active drugs, such as gentian, calumba, krameria, quassia, valerian, cinchona, kino, may be given in doses of from ½ to 1 dram (2-4 c.c.).

3. Solid extracts of active drugs may be given in doses of from ⅙ to ¼ of a grain (0.01-0.016 gm.).

4. Solid extracts of less active drugs may be given in doses of from ½ to 5 grains (0.03-0.3 gm.) or more.

5. Dilute acids (hydrochloric, nitric, nitrohydrochloric, sulphuric) may be given in doses of from 5 to 20 minims (0.3-1.3 c.c.), except dilute hydrocyanic acid, the dose of which is from 1 to 5 minims (0.06-0.3 c.c.).

6. All medicated syrups, except the syrup of iodid of iron and the compound syrup of squill, may be given in doses of 1 to 2 drams (4-8 c.c.) or more.

7. All infusions may be given in doses of ½ to 1 ounce (15-30 c.c.) or more, except the infusion of digitalis, the dose of which is from 1 to 4 drams (4-15 c.c.).

8. All official mixtures may be given in doses of from 1 to 4 drams (4-15 c.c.).

9. All spirits may be given in doses up to 1 dram (4 c.c.), except the spirit of nitroglycerin (glonoin), the dose of which is from 1 to 5 minims (0.06-0.3 c.c.), the spirit of phosphorus, the dose of which is from 5 to 15 minims (0.3-1 c.c.), and the spirit of bitter almond, the dose of which is from 5 to 10 minims (0.3-0.6 c.c.).

10. All waters (aquæ) may be given in doses up to 1 ounce (30 c.c.), except aqua ammoniæ, aqua chlori, and aqua laurocerasi (cherry-laurel), the dose of which is about ½ dram (2 c.c.).

11. Volatile or essential oils may be given in doses up to 5 minims (0.3 c.c.) or more, except the oil of bitter almond, the dose of which is from ¼ to ½ minim (0.015-0.03 c.c.).

TO ASCERTAIN DOSES OF MEDICINE
FOR CHILDREN.

The following rule of Young is sufficiently accurate for most drugs: Add 12 to the age and divide by the age to get the denominator of the fraction, the numerator of which is 1. Thus, for a child of two years,

For children up to twelve months of age, Young’s rule may be worked out as follows: Add 144 to the age in months, which sum becomes the denominator of the fraction, the numerator of which is the child’s age. Thus, for a baby of eight months,

for a baby of six months,

The following table, based on Young’s rule, is sufficiently accurate in ordinary cases, and its use will avoid the necessity of mathematic calculations on the part of the physician:

Of powerful narcotics, such as opium, scarcely more than one-half of this proportion should be used. In the case of mild cathartics, however, two or even three times this proportion may be given.

THE DOSE OF DRUGS ADMINISTERED
SUBCUTANEOUSLY AND BY THE RECTUM.

The dose of a drug given hypodermically is usually about one-half the quantity given by the mouth, while twice as large a dose is generally given by the rectum as would be given by the mouth.

PROPER TIME TO TAKE MEDICINES.

Alkalis should be given before food. Iodin and iodids should be given on an empty stomach, when they rapidly diffuse into the blood. If given during digestion the acids and starch alter and weaken the digestion. Acids, as a rule, should be given between the digestive acts, because the mucous membrane of the stomach is in a favorable condition for the diffusion of the acids into the blood. Acids may be given before food when prescribed to check the excessive formation of the acids of the gastric juice. By giving it before meals you check the osmosis stomachward of the acid-forming materials. Irritating and dangerous drugs should be given directly after food, such as the salts of arsenic, copper, zinc, and iron, except where local conditions require their administration in small doses before food. Oxid and nitrate of silver should be given after process of digestion is ended; if given during food, chemic reactions destroy or impair their special attributes and defeat the object for which they were prescribed. Metallic salts, especially corrosive sublimate, also tannin and pure alcohol, impair the digestive power of the active principle of the gastric juice, so should appear in the stomach during its period of inactivity. Malt extracts, cod-liver oil, phosphates, etc., should be given with or directly after food, so that they may enter the blood with the products of digestion.

POISONS AND ANTIDOTES.

General Treatment.—Eliminate if possible by emetics, as zinc sulphate, 10 to 20 grains; copper sulphate, 5 grains; or hypodermic injection of apomorphin, ⅒ grain. Use stomach-pump or -tube where vomiting cannot be produced, observing great care if irritant poison has caused injury to tissues. In cardiac failure give stimulants. In narcosis keep patient awake. In threatened paralysis of respiratory movements use alternate hot and cold spray to chest, slapping, and artificial respiration. Ammonia, atropin, caffein, and strychnin are useful respiratory stimulants.

Acetanilid.—Emetic; rest in recumbent position; stimulants—ammonia and strychnin; artificial respiration; oxygen inhalations; external heat.

Acid, Carbolic.—Alcohol or Epsom salt as an antidote. Three or four ounces of diluted alcohol, followed by lavage with a solution of Epsom salt; external heat; demulcents; stimulants hypodermically.

Acid, Hydrocyanic.—Fresh air; artificial respiration; oxygen inhalations; ammonia by inhalation and by intravenous injection.

Acid, Oxalic.—Chalk or lime as an antidote; demulcents, like oil or egg-albumin.

Acids, Mineral.—Chalk, magnesia, soap, or white-wash from wall to neutralize poison; demulcent drinks—bland oils or egg-white; stimulants hypodermically.

Aconite.—Recumbent position; empty stomach with pump with patient flat on back; external heat; stimulants—alcohol, ammonia, strychnin—hypodermically.

Ammonia.—Vinegar with lemon-juice to neutralize the poison; white of egg or oil to allay irritation.

Anilin Dyes.—Give plenty of warm water to induce emesis; place patient in recumbent position; loosen clothing and permit free circulation of fresh air.

Antimony (Tartar Emetic).—Tannic acid as an antidote; use stomach-pump; external heat; stimulants.

Antipyrin.—Same as Acetanilid.

Arsenic.—Stomach-pump or an emetic; freshly precipitated ferric hydrate (tablespoonful every ten minutes) made by adding magnesia to any iron solution; demulcents—oil or egg-albumin.

Atropin.—Same as Belladonna.

Belladonna.—Emetic or stomach-pump; tannic acid as an antidote; cold to head; enema of warm black coffee.

Camphor.—Empty the stomach; apply a hot-water bag to the abdomen, and stimulate the patient if necessary.

Cantharides.—Emetic or stomach-pump; egg-white; mucilaginous drinks in abundance; avoid all oily substances.

Chloroform.—Withdrawal of drug; lowering of head; pulling tongue forward; artificial respiration; stimulants—strychnin, digitalis, ammonia.

Cocain.—Empty the stomach by means of the stomach-pump or an emetic. Stimulate patient and administer artificial respiration.

Colchicum.—Stomach-pump or emetic; external heat; white of egg; stimulants; opium for pain.

Copper Sulphate.—Yellow prussiate of potassium, soap, or magnesia; milk and albumin freely; opium for pain.

Corrosive Sublimate.—White of egg freely; milk; emetic or stomach-pump; opium for pain.

Creosote.—Same as Carbolic acid.

Croton Oil.—Emetic; mucilaginous drinks; opium.

Cyanide of Potassium.—Same as Hydrocyanic acid.

Digitalis.—Recumbent position; stomach-pump with patient recumbent; external heat; tannic acid.

Elaterium.—Emetic; external heat; demulcents; opium.

Ergot.—Empty stomach; copious drafts of warm water, coffee, or tea; quick purgative (croton oil); place patient in recumbent position; give hot sponge-bath and apply friction to the body.

Gas, Illuminating.—Fresh air; artificial respiration; oxygen inhalations; injections of ammonia and strychnin.

Iodin.—Starch-paste as an antidote; emetic; external heat; demulcents; opium.

Lead Salts.—Epsom salt as antidote; emetic; milk or egg-white.

Lobelia.—External heat; tannic acid; stomach-pump; stimulants.

Matches.—Same as Phosphorus.

Morphin.—Same as Opium.

Mushroom, poisonous (Toad-stools).—Emetics; atropin (¹/₁₀₀ gr.) hypodermically; castor oil; stimulants.

Nux Vomica.—Same as Strychnin.

Opium.—Stomach-pump or emetic; repeated lavage; black coffee enema; potassium permanganate (5 gr.) in tumblerful of water, or tannic acid as an antidote; keep patient awake with cold affusions or electric brush; artificial respiration; respiratory stimulants—atropin, ammonia, strychnin, cocain, caffein.

Phenacetin.—Same as Acetanilid.

Phosphorus.—Copper sulphate as an emetic; dilute peroxid of hydrogen or potassium permanganate as an antidote; Epsom salt as a purge; avoid all oils and fatty substances.

Potassa or Soda (Lye).—Vinegar or lemon-juice as an antidote; oils or egg-white; opium.

Ptomain Poisoning.—Empty the stomach by means of the stomach-pump or by an emetic. Apply a hot-water bag to the abdomen. Give opium or morphin to allay the pain and check diarrhea. Give a large dose of castor oil.

Rat Poison.—This usually contains arsenic or phosphorus (q. v.).