LIBRARY SS'N THE MEDICAL ECLECTIC, DEVOTED TO Reformed Medicine, GENERAL SCIENCE AND LITERATURE. Editors: ROBERT S. NEWTON, M. D., LL. D., Professor of the Theory and Practice of Medicine in the Eclectic Medical College of New York. ROBERT S. NEWTON, JR., M. D., L. R. C. S., Professor of Surgery and Ophthalmology in the Eclectic Medical College of New York. Published every month, by THE ECLECTIC MEDICAL COLLEGE of the City of New York. VOL, VII. JANUARY, 1880. ORIGINAL COMMUNICATIONS. MATERIA MEDICA AND THERAPEUTICS.* No. 1. Professor of Materia Medica and Therapeutics in the Eclectic Medical College, of the City of New York; Lecturer on Clinical Medicine, and Physician in Chief to Manhattan Hospital. (Continued from page 520, December, 1879.) SALIX NIGRA. Black Willow. The black willow is a small tree (Nat. Ord. Salicaceae), growing on the banks of streams in all parts of the United States. It presents the same characteristics medicinally as the salix alba of Europe. The BARK and BUDS are the parts used. Chemical Constituents.-The bark contains a glucoside, salicin, a resin, green, fatty matter, similar to that found in cinchona, bitter yellow coloring matter, gum, wax and several salts. Salicin, C20, H18, 014, is a white crystalline substance, occurring already * Copyrighted, 1879, by G. W. Winterburn. formed in willow bark. It is very bitter, but odorless, soluble in boiling water, but nearly insoluble in cold water, soluble in alcohol, but insoluble in ether. It is also found in the bark of the poplar, more abundantly in populus tremula and populus græca, and also in the flower buds of spiræa ulmaria (meadow sweet), and in the green parts of this and other herbaceous spiræas; also in castoreum, being derived from the willow bark, which constitutes the principal food of the beaver (Wöhler). It is often employed to adulterate quinia, and may be detected by sulphuric acid, which turns salicin red, even in minute quantity. Physiological Effects.-The toxical effects of salicin are very similar to cinchonism. Under its influence the expression of the countenance is dull and heavy, the face flushes, on the least excitement, a uniform dusky hue, and the eyes become suffused. The breathing is quickened and deepened, sometimes almost panting; both the diaphragm and costal muscles are involved in the laborious movement, but the patient does not seem to notice it, and does not complain of it. Marked muscular weakness and tremblings, associated with intense irritability, so that a mere touch will produce tetanic spasms, is almost always present. The There is a frontal headache, with dizziness, often so severe that the person presses his head into the pillow. He complains, also, of noises in the ear, and sometimes of complete deafness. voice becomes thick and husky, and there is distressing burning in the throat, nausea and vomiting, catarrh of the stomach and intestines, with diarrhoea. If persisted in, ulceration of the stomach and intestines is induced. Given in large doses, for several consecutive days, it produces fever, delirium like delirium tremens, involuntary evacuation of fæces and urine, slow labored pulse, and colors the urine olive green. It will sometimes cause acute nephritis, with bloody albuminous urine containing casts. It causes a vesicular eruption like nettle rash; and in fever patients very abundant perspiration, but this does not usually appear on healthy persons. Nothing was noticed till noon of the second salicine day until the boy had taken in all 3 v. of the medicine. Between one and two we noticed that his face was flushed and he looked dull, and there was some tremor when his hand was held out. In the evening the tremors were more marked. At 5 a. m. the following day he twice vomited. On this day, though he had discontinued the medicine since five o'clock the previous evening, his symptoms were very marked, and, for the most part, of the same character as in the other lad-namely, dullness, so that he did not seem very well to understand questions; deafness; tingling in the right ear; slight tremor of the lips on speaking, and thick, husky voice; breathing rather labored; trembling of hands when held out; slight spasmodic movements of the upper limbs; slight jerks of the lower limbs when they are raised from the bed; grasping power weaker than before; much irritability of the muscles on percussion; but strange to say, he never complained of headache nor buzzing. These symptoms were at their height at midday, and were so marked and the pulse and respirations so quick, that we must confess we felt a little relief when the toxic symptoms, which became far more marked than we had expected, abated, not that at any time the boy was dangerously ill, but as the symptoms progressed, after discontinuing the medicine, we did not know how long and to what degree they might increase. Next day, that is, forty-one hours after the last dose of medicine, he was still deaf though less so, and was dull, and unless spoken to, lay with his eyes half closed, and very often fell asleep. Muscular irritability had diminished, and the hands and arms trembled when held out; the pulse was still compressible. Even sixty-five hours after the last dose he was still dull, rather deaf, and there was slight tremor of the hands and irritability of percussed muscles. Next day he had quite recovered. We tested the urine frequently for salicin, and found some, even 95 hours after the last dose.-Ringer. Salicin is eliminated by the urine, sweat and saliva, and may be readily detected by the intense violet color produced, on the addition of a drop of the solution of perchloride of iron. It appears in the form of salicyluric acid in about four hours, and may remain several days after the discontinuance of the dose. Salicin is an antiferment, and has antiseptic powers similar to quinia. It is destructive to bacteria and vibrio, and prevents the reaction of amygdalin and amulsin, and of ptyalin on starch. Therapeutics.-Willow bark, finely powdered, dusted over foul and indolent ulcers, is an almost unrivalled remedy, greatly hastening the healing process. The glycerole of salicin (a half drachm to three ounces) is a very good antiseptic dressing to bed sores and sloughing and gangrenous wounds. This glycerole may also be applied to carbuncles, and various forms of erythema and ecthyma, and salicin administered concurrently, internally in small doses. It will sometimes check the profuse night sweats of phthisis, but is not a certain remedy. In all simple, chronic, mucus discharges, it may be administered with benefit. In catarrhal stomatitis and in thrush, Berthold calls attention to its anæsthetic virtue in calming the gnawing, burning pain of the erosions after the rupture of the vesicles. The solution he uses is one grain to one half ounce of water. The same solu tion is useful in ptyalism from abuse of mercury. From its antiseptic virtue the powdered bark would make a healthful and cheap basis for tooth powder. The salicin spray, three grains to an ounce of water, may be used to great advantage in ulcerations of the nares, fauces and larynx, even when there is considerable inflammatory swelling. As it will destroy microzymes, it might be used with benefit in hay asthma, rose cold and autumnal catarrah, replacing quinine in these disorders. Salicin promotes appetite and digestion; a property which it possesses in common with other bitters. It is an excellent stomachic tonic in atonic dyspepsia, and is a serviceable remedy in cases of gastro-intestinal catarrh in preventing fermentation of the food. Salicin is of value in chronic diarrhoea and dysentery, especially in children, and may be employed as an enema, two grains to half an ounce. Or, the same solution taken by the mouth in teaspoonful doses every hour or two. In diarrhoeas which prove utterly rebellious to ordinary treatment, the employment of salicin is followed, after a few doses, by a decrease in the frequency of the evacuations, a return to normal consistency and color, and subsequent restoration to entire health. A decoction of the bark has been used successfully against worms, toning up the mucous membrane, and preventing the formation of the slimy nidus in which the parasites thrive. In passive hemorrhage from the stomach, rectum or vagina, small doses of salicin have proved very beneficial, by removing the special debility upon which the continuance of the discharge depends. Convalescents from exhausting diseases, and patients suffering from the results of abnormal discharges, are often helped by small doses of this remedy. It has long been known that the willow bark and its glucoside, salicin, possess febrifugal properties, and the fortunate coincidence has often been remarked, of the growth of the willow in those very localities where intermittents prevail. Salicin is almost exclusively employed in Spain and Portugal in the treatment of intermittents, and with very great success. Like quinine, it is best suited to recent and simple intermittents, and is of little value in the chronic form, though it is sometimes an important succedaneum to quinine, when that drug has failed to complete the cure. It is also sometimes combined with quinine; but this is by no means necessary. Many patients who have a great repugnance to quinine will take salicin with a great deal of comfort. The dose is ten to thirty grains, given during the remission between paroxysms, and repeated according to circumstances. The paroxysm following this dose is notably diminished in intensity and duration, and sometimes a single dose will cut the fever short. It must not be forgotten that sensibility to the drug varies greatly, and that a twenty grain dose will, in some patients, develop alarming toxic symptoms. It may be taken in water or any convenient fluid, but I have found that it is most agreeable to patients in a little milk. It is desirable to continue the treatment for ten days after the last paroxysm, in grain doses every six hours, to prevent a recurrence of the fever. It has been employed in most febrile diseases, in typhoid, typhus, pneumonia, scarlatina, diphtheria and measles; but, while it promptly reduces the elevated temperature, it does not shorten the duration of the attack, or lessen its fatality. It does seem, however, to have a real value in puerperal fever and in septicemia, in doses of one or two grains every hour. Salicin is largely employed in rheumatic fever, and the opinion of its efficacy here is well nigh unanimous. The savages of South Africa have long used it successfully in this disease. If what has been already published regarding the efficiency of salicin as a remedy for acute rheumatism should be confirmed by a more extended experience, it will form a curious commentary on our civilization, and on the advance of medical science, that one of the most common and painful diseases of the civilized world should have remained one of the approbria of medicine for many years after a remedy for it was known to the rude Hottentots of South Africa. Equally within the reach of both has ever been the means of cutting short the disease; but the untutored Hottentot shepherd used the proper means, while the accomplished European physician was trying this, that and the other remedy, with results so unsatisfactory, that he had almost given up the idea of ever being able to do more than watch the natural progress of the malady.—Maclagan. Salicin seems to possess an almost specific power to arrest the progress of acute rheumatism with high temperature, with a rapidity which contrasts most favorably with any other mode of treatment. |