Report on Materia Medica and Therapeutics
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PART III. SPECIAL REPORTS. REPORT ON MATERIA MEDIC& AND THERAPEUTICS. I By WALTER G. SMITH, M.D. ; Ex-President of the Royal College of Physicians of Ireland; Professor of Materia Medica, School of Physic in Ireland, Trin. Coil. Dubl. ; Physician-in-Ordinary to His Excellency the Lord Lieu- tenant ; Physician to Sir P. Dun's Hospital. TEE therapeutical record of the past year has not provided us with any sensational or striking innovations It may be noted with a sense of relief that fewer chemical novelties than usual have been proposed for trial, and the long list of synthetic remedies has had scanty additions made to it. There has been a lull in antiseptics, but a good many papers have been published upon drugs acting upon the nervous system, especially hypnotics. Of the newer hypnotics, trional seems likely to hold its ground, and to be deserving of approval. The "predominant partner" in the current literature of the time is "serum-therapeutics, '' which has engrossed a large share of attention. Among the novelties noticed in the present summary may be mentioned nosophen, iodoformin, argonin, urotropin, apo- lysin, citrophen, and saligenin. PHARMACY. An Iohthyol Reqction.--Mr. Harold Wyatt had occasion to dispense the following prescription :--1~. Morphin~ihydrochlor. gr. iv. ; ichthyol ammon, gr. xxx. ; ung. petrolei, ad. $i. Misee; fiat unguentum. * This Report is based upon an article by the writer in the "Year-Book of Treatment " for 1896. 152 Report on Materla Medica and Therapeutics. On rubbing the morphine hydrochlorate with the ichthyol on an ointment slab, the smooth cream at first formed suddenly became clotted, drops of watery liquid separated, and the clotted portion left the tile and adhered to the spatula. By the addition of two :g~ains of powdered soap he was finally able to turn out a smooth and presentable ointment. In an attempt to explain the decomposition (for such it undoubtedly was), morphine hydrochlorate and ichthyol were heated aver a water bath uritil the ichthyol became "solid, leaving a clear aque'ous liquid containing chloride of ammo- nium, which was proved by the application of the usual tests. It was evidently an'instance of double decomposition, result- ing in the formation of a morphine ichthyol-sulphonate and ammonium chloride. The pure alkaloid morphine gave a similar compound with the liberation of ammonia gas. When quinine hydrochlorate was decomposed by the addition of successive portions of ammonium ichthyol to a hot aqueous solution placed over a water bath until there Was on]~y a slight precipitate, on testing a drop of the aqueous liquid with Dragendorff's iodo:bismUthic alkaloid reagent a quinine ichthyol of a peculiarly brittle character was the result. The following equation probably represents the reaction :-- 'cssH3ss3os(NH4) 2 q- 2"(C20H24N202HC1,2H20) Ichthyol ammonthrn Quinine hydrochlorate equals CtsH3eS3OoH~'2 (C 2oIff24N.20~)+ 2NI-I~C1 + 4H20 quinine iehth~ol-sulphonate. From this it will~ ~be seen that alkaloids form ichthyo~s as readily as do the alkali metals, the resulting ichthyols being of a firmer consistence, and well suited to internal administra- tion in pilular form.--(Pharm. Journ. Dec. 14, 1895). An Incompatibility.--The reporter noticed the solufort made from the subjoined prescription turned a dark red colour, which proved permanent :-~1~. Hydrargyri perchlor, gr. iv. ; resorcin, 5i. ; spit. chloroformi ; spir. ~eth. nitr., ~ $ij. M. This produced severe irritation upon the skin of the patient for whom it was ordered. The cause of the coloration is probably fbrmafion of red nitro-compound, analogous to the green nitroso-compound formed by the interaction of antipyrin and nitrous ether. Report on Materia Medica and Therapeutics. 153 Professor Emerson Reynolds informs me that mono-nitro- resorcinol, CeHa(NO2)(OH)~ is easily produced when an ethereal or alcoholic solution of resorcinol CGH4(OH)~, is treated with dilutenitric acid containing some nitrous acid. It is volatile, and crystallises from dilute ethylie alcohol in orange~red prisms, which melt at 85 ~ There is an isomer, but it is pale yeIlow andnon-wlatile.--(Pharm. Journ., Aug. 3, 1895:). ~H~PNOTICS. Sutph~al Group.--Three organic "sulphones "(i.e., com- binations of SO~ with organic radicals) have now been in the hands of practitioners and pharmacologists for some time. They contain,.respectively :- Two molecules of ethyl--viz., dional (common sulphonal). Three , , trional. Four ,, ,, tetronal. So far the judgment of the profession seems to be,this :-- Sulphonal holds its ground, and is by far the most largely prescribed. Bat it is admitted to have some drawbacks. Trional is gaining irr favour, and offers some distinct advantages o~r sulphonal. Tetronal has not made much headway. Observations on man do not fully confirm Baumann and Kast's theory--i.e., that the hypnotic action increases with the number of ethyl groups in the molecule. There is no important difference in the-dose of any of these three drugs in man (cf., Studies in Therapeutics, .Brit. Med. dourn., Jan. 19, 1895). Comparative action of Su.lplwnal, Trional, and Tetronal.-- Dr. Morro, at Baumann's instigation, lms made a comparative study of these drugs :~ 1. Sutphonal accumulates in the body, and its elimination is not completed in less than three days. It resistsrmetabolism. 2. Trional is more easily and completely decomposed by the metabolism of the body than sulphorral..Hence it is not cumulative. 3. Tetronal is excreted unchanged in the urine, although not to the same extent as sulphonal. Accordingly it also exhibits a postponed and cumulative action. 154 Report on Materia Medlea and Therapeutics. These facts throw light upon the clinical action of these drugs, and explain the superiority of trional.--(Ther. Monatss aus Deut. med~ Woch., 34, 1894). The Comparative Values of: Trional, Chloralosr and Sornnal.---In patients not the subject of psychical trouble 1 to 2 grammes of trional (in weakly women, 1 gramme) prpduces a .dreamless sleep, but has the same disadvantages on administration and awakening as sulphonal ; over that drug it has one great advantage, that its use can be continued for a year without producing circulatory, respiratory, or digestive troubles. It acts most beneficially in the insomnia with restlessness of chronic mania and in alcoholic delirium, in which large doses may be given with good effect, but its depressing action is harmful in melancholia and cerebral neurasthenia especially, in which it increases the depression. It should be prescribed at intervals of two days, to avoid cumulative action. Chloralose has one great disadvantage, that it produces symptoms of intoxication, shown by an increased reflex excitability of the cord, and even convulsions, especially if the dose, which is uncertain for the individual, exceed 60 centigrammes, and less in the case of debilitated, hysterical or alcoholic subjects. The convulsipns rapidly dis- appear after awakening without any ulterior effect. Somnal is most beneficial in procuring sleep in acute melancholia; in other subjects it usually produces first of all slight intoxication, then sleep with pleasant dreams. After doses up to 3 grammes sleep with interruptions comes on in about half an hour, and after 5 grammes profound sleep. On awakening there are no disagreeable after-effects; this is its great advantage over other hypnotics. It has none of the motor troubles of chloralose. It is contra-indicated in dyspepsia and a tendency to diarrhoea, In their relative actions trional acts more slowly than chloralose, and the after-effect is more prolonged, and awakening is painful; chloralose before producing sleep inducesan intoxication, but the awakening is fresh and agreeable. The intoxication of chloralose is without danger, which is not the case in that rare occurrence with trional when sereere symptoms which are without danger appear; trional, however, has the advan- tage of being more uniform in its action~ and its minimum Report on Materis Medics"and Therapeutics. 155 useful dose is more easily found. Fatal results have been recorded after the administration of from 20 to 25 centi. grammes of ehloralose, althbugh over 60 have been given without serious symptoms being produced. Marie maintains that with chloralose the best resultsare obtained by beginning with 10 centigrammes, gradually increasing the dose to 15 or 20.--(Practitioner, Aug., 1895, from ia Presse M3d., Mar., 1895). Trional.--A great number of communications upon this drug have appeared in 1895. Spitzer (Wiener klin. Woch., No. 23, 1895) gives his experience of the use of trional in twenty-five cases of various forms of disease accompanied by pain and insomnia. In nineteen cases trionalsucceeded. In six cases trional either failed or acted only for a short time, and had to be followed by morphine; these cases were phthisis (four cases), myoma uteri and arterial sclerosis. Spitzer maintains that trional is a hypnotic not only in various mental conditions, but also in lung and heart diseases. He states that it is especially useful in intercostal neuralgia, sciatica, lumbago, and in the lancinat- ing pains of tubes dorsalis, He considers it to approach closely to morphine in its effect, and suggests it as a substitute for morphine. Sleep is obtained usually soan after the administra- tion of the drug, and in most cases continues through the night. In no ease was any injurious effect on heart or respiration observed. In a few eases gastric disturbance took place, and sometimes vomiting after awakening; this the author considers an idiosyncrasy, as is the ease with morphine (Brit. Med. Jour., Epit., Sept. 7, 1895). Goldmann believes trional to be one of the best hypnotics we have. It is to be preferred to sulphona! on account of its prompter action, and greater freedom from injurious con- sequences. The dose should never exceed 2 grammes, and it should be administered freelydiluted with a ~ax~a.liquid.-- ( Therap.