granular powder, inodorous and tasteless, insoluble in water, alcohol, and ether, but dissolved by sulphuric acid. It resembles the salts of bismuth in its effects, and has been deservedly extolled in obstinate forms of vomiting, especially the vomiting of pregnancy. In chorea and other neuroses it is also highly recommended. Its physiological action has not been investigated. Dose, gr. j, t. d., or oftener, in pill or suspended in water. The cerium nitrate has been also employed, and is more soluble. Dose, somewhat less.

ALUMEN-ALUM.

Alum is a double salt, an aluminium and potassium sulphate (K2A124SO4.24H2O). It is manufactured from aluminous schist, and sometimes by the direct combination of its constituents. It crystallizes in regular octahedrons; but is commonly found in the shops in large, colorless, transparent crystalline masses, without any regular form. It has an astringent and sweetish, acid taste; by exposure to the air it slowly effloresces; it is soluble in cold water, and more so in boiling water; and when heated it undergoes the watery fusion, swells up, and gives out its water of crystallization, and is converted into a white, spongy mass, called dried alum. The alkalies and their carbonates, lime solution, magnesia and its carbonate potassium tartrate and lead acetate are incompatible with alum. It is aided in its action by the vegetable and mineral astringents.

Besides the potassium alum, there are varieties in which the potassium is replaced by some other base, as ammonium or sodium; the officinal alum was formerly the aluminium and ammonium sulphate, but this has been superseded by potassium alum.

Physiological Effects.-The immediate topical effect of alum is that of a powerful astringent, in virtue of a chemical action on the tissues. When it is applied to a part in large quantities, the astriction is soon followed by irritation; and thus, taken internally in excessive doses, it gives rise to vomiting, griping, purging, and even inflammation of the gastro-enteric mucous membrane. After its absorption it acts as an astringent on the system generally, and produces astriction of the tissues and fibres, contraction of the capillaries, and a diminution of secretion, thus producing constipation. It is eliminated chiefly with

the fæces. After large doses, Orfila detected it in the urine of dogs. Death has resulted in man from dried alum 3jss. Medicinal Uses.-Alum is employed internally in hemorrhages, chronic diarrhoea, and it is sometimes combined with cubeb in the treatment of gleet and gonorrhoea, as in the following prescription: R Pulveris aluminis, 3j; pulveris cubebæ, iv; pulveris cinnamomi, 3ss. M. et Sig.-Tablespoonful in half a glass of water 3 times a day; an efficient mixture when it does not disorder the stomach. Alum is also used as an injection in leucorrhoea. It has also been given as an emetic in croup. Its use in lead-colic has been alluded to. As a topical remedy it is valuable as an astringent antiphlogistic in ophthalmia, diphtheria, and tonsillitis; to produce contraction of the tissues, in relaxation of the uvula, prolapsus ani, descensus uteri, cystocele or rectocele, and is used as a vaginal injection where the tissues become lax from wearing a pessary; as a styptic in hemorrhages; and to arrest excessive secretion from the mucous surfaces. In hemoptysis and bronchitis, a strong solution of alum may be applied by atomization. Dose, gr. x-xxx, in powder or solution, or made into pills with some tonic extract, and combined with an aromatic, as nutmeg, to prevent nausea. It may be agreeably given in the form of whey, prepared by boiling 5ij with milk Oj, and straining, of which the dose is f3ij. Topically, it is employed in the form of solution, and is useful in granular lids, conjunctivitis, and as an injection in gonorrhoea, attended with profuse discharge, gr. ij-vj to water fij; in leucorrhoea, 3j to tepid water Oj. Dried alum (alumen exsiccatum) is employed internally in the dose of gr. v-x, and externally as a mild escharotic.

ALUMINII SULPHAS (Aluminium Sulphate) (Al23SO4.18H2O) is employed externally as an astringent and antiseptic application to ulcers, and as an injection in gonorrhoea. The aqueous solution is used to preserve bodies for dissection.

ORDER VI.-STIMULANTS.

Stimulants are medicines which produce a rapid and temporary exaltation of the vital functions. Their influence is most conspicuous in conditions of morbid depression, when a marked

tolerance of their action is established, and large amounts are borne. In health, when the powers of the system are at the normal standard, stimulants soon induce depression. Topically, they irritate and inflame the parts to which they are applied, and hence are classed with irritants.

Stimulants are employed principally in disorders known as asthenic, and in all conditions of the system attended with exhaustion. From their action in arousing the energies of the nervous system, they exercise a control over many nervous disorders, particularly those of a spasmodic nature. They are also frequently given with a view to their action on some one or other of the secretions. As stimulants to the gastro-intestinal canal, they are administered to promote digestion (when they are called stomachics) and to dispel flatulence (when they are known as carminatives). Topically, they are employed as rubefacients and vesicants.

The more powerful and rapid stimulants are called diffusible. In overdoses, they act as violent narcotics and sedatives. The diffusible stimuli usually employed are vinous and spirituous liquors and the preparations of ammonia. Vegetable stimulants which contain a volatile oil are termed aromatics, and are usually given as stomachics and carminatives. The volatile oils are also employed as local irritants.

DIFFUSIBLE STIMULANTS.

ALCOHOL.

Alcohol is a product which results from a process termed the vinous fermentation, in substances containing grape-sugar. At a temperature of 80° F., the presence of a fermenting body converts a solution of grape-sugar into alcohol and carbonic acid. Starchy substances, being convertible into grape-sugar, also yield alcohol. Alcohol is obtained from vinous or fermented liquors by repeated distillation. It is, chemically, an ethyl hydrate (C2H,HO). Officinal alcohol should be of the sp. gr. 0.820. It is a colorless, inflammable liquid, wholly vaporizable by heat, and unites in all proportions with water and ether. Contamination of fusel oil or amylic alcohol may be detected by agitation with concentrated sulphuric acid, when, if the alcohol become colored, the presence of the impurity is indicated in

proportion to the depth of the color; or solution of silver nitrate, with exposure to a bright light, will convert fusel oil into a black powder.

Physiological Effects.-Alcohol* is the intoxicating ingredient of all vinous and spirituous liquorst. Locally, alcohol acts as an astringent by hardening the albumen and condensing the tissues. It evaporates rapidly, causing a feeling of coolness. When evaporation is prevented, it acts as an irritant (due to absorption and paralysis of the cutaneous vessels), and may even produce inflammation. When inhaled it may produce anæsthesia, stupor and death. Nervous system: when taken internally, in small doses, it stimulates the cerebral hemispheres, possibly by the hyperæmia induced; in large doses it causes excitement with impaired coordination of ideas; and in excessive doses it produces coma. Small doses stimulate the spinal cord, while larger amounts weaken the centres governing automatic motion and coordination, and lessen the sensibility of the cutaneous nerves, especially that of the fifth pair of cranial nerves. Large doses paralyze the vasomotor nerves, giving rise to dilatation of the arterioles, flushing of the surface, and sensations of heat. In inflammatory diseases, medicinal doses contract the arterioles by giving tone to the vasomotor system, and prevent the migration of white corpuscles (Farquharson). In toxic doses, the nervous centres are involved in the following order: 1. The gray matter of the convolutions and the higher functions of animal life (shown by disordered intellection). 2. The basic ganglia (shown by disordered sensation and motion). 3. The cerebellum (shown by disordered equilibration. This may be in part due to impairment of the muscular sense). 4. The spinal centres (shown by anæsthesia of the lower limbs, extending to the upper limbs and body, difficulty in performing automatic acts, impaired coordination, etc.). 5. The medulla oblongata (shown by labored breathing, and finally death from apnoea). Circulation: alcohol at first stimulates, but afterward depresses, the cardiac motor ganglia. In

* Alcohol considered chemically, physiologically, medicinally and as a cause of disease. Essay awarded the Henry C. Lea Prize, Jefferson Medical College, March, 1878, by Henry Morris, M. D.

According to Dujardin-Beaumetz the toxic effects of the alcohols increase with the sum of their atomic weights, with the exception of the highest and lowest.

small doses it increases the frequency of the cardiac beat, without affecting the force or rhythm, increasing the rapidity of the contraction and shortening the diastole (Parkes and Wollowicz), and also elevating the arterial tension. This is soon followed by slowing of the heart and lowered arterial tension, and if the dose has been larger, by weak and irregular contraction. Large doses depress and paralyze the cardiac muscle. Respiration is at first quickened, but afterward slowed. In alcohol-narcosis the breathing is very slow, and death may result from apnoea. Temperature: small doses slightly elevate the temperature. If large amounts have been taken, the temperature is depressed, owing to the radiation of heat from the dilated cutaneous vessels, to lessened oxidation of tissue, and, in alcohol-narcosis, or in the case of animals, to muscular inactivity. The power of resisting cold is lessened by the habitual ingestion of alcohol. Secretion: the secretions are at first increased, then diminished. Alcohol diminishes the quantity of urea, uric acid, sodium chloride, phosphoric and sulphuric acids excreted in the urine. Sugar is sometimes found in the urine after the ingestion of alcohol. Small doses stimulate the liver, while larger amounts alter the quality of the bile, which may be profuse or scanty. The amount of carbonic acid exhaled from the lungs is diminished. Stomach : small doses increase the flow of gastric juice, by producing hyperæmia, and thus stimulate the appetite and digestion. Large doses check the gastric secretion, precipitate the pepsin, and cause anorexia and nausea. When taken habitually, it produces a slow interstitial inflammation of the mucous membrane with hyperplasia of the connective tissue elements, which, contracting, compress the gastric glands. The secretion will then be much diminished, and the mucous membrane covered with a ropy, glairy mucus. Blood: alcohol must be in a certain state of dilution before it can be absorbed. It is said to precipitate the albumen in the blood, but it must be in too diluted a condition to accomplish this, nor are the consequences of an occasional indulgence sufficiently serious to warrant this statement. It diminishes the power of the red corpuscles to carry oxygen, and changes the blood by its effect on the liver and digestion. Fat in the blood of drunkards is increased from 8.65 parts to 11.7 parts per 1000 (Lecann). Scharlau found 30 per cent. more