To impose an additional physiological tax, by medicine, on any of the emunctories that are already in an abnormal erethistic condition, is apt to induce irreparable mischief. We find this forcibly exemplified where tartar emetic is given in diarrhoea; pilocarpine (under an excessive general exosmosis already referred to) in certain lesions of the lungs, with a defect in the power of expectoration.* The kidneys are very liable to be injured by some substance that has its outlet through them. Thus, with arsenic certain cases of albuminuria have been considered due to the passage of the poison through the kidneys.† Anything beyond a single cathartic of calomel, is especially to be avoided in this disease. ‡ Chlorate of potassium, in large doses, gives rise to gastro-intestinal irritation, and a peculiar nephritis, with scanty and dark urine. It has recently been shown that the dark urine is due to decomposed blood, which blocks up the renal tubes or is discharged in the form of peculiar blood casts.‡

After a course of a mercurial treatment, iodine should be given with great caution. It may cause salivation, but of a much milder character than that from mercury, except in cases where mercury has been previously used, when it is really mercurial salivation renewed by the increased solubility of the metal in an iodic solution.‡

Digitalis, as a cardiac remedy, is useless in the period of eusystolism, when the lesion is compensated; it is injurious in the hypersystolic period, when the compensation is exaggerated; it is efficacious in the hyposystolic or period of transient asystolism, when the cardiac muscles and the vessels are suffering from asthenia, and when there are oedemas, visceral congestion, dropsies, and the heart beats softly and feebly; in the period of definite asystolism, or of amyocardia when the cardiac muscle is profoundly degenerated, digitalis is sometimes useful, it may be useless, or it may be injurious. It is in these cases sometimes that caffeine in large doses gives signally good results.†

*Dr. L. Lewin.

†Dr. G. P. Hachenberg, on the Cause of Death from Chloroform, Pacific Medical and Surgical Journal, November, 1881.

‡ Hachenberg on the Administration of Chloroform, Medical Record, N. Y. 1867.

*Sanger.

‡Edes.

||Dr. Peter Hood.

†Gubler.

§Melsens.

¶Fothergill.

When the blood or the nervous system is much impaired, the initiatory treatment should not be of a heroic character. Thus in nervous patients, nervines should be given with precaution.‡ In pernicious and extreme anaemia, when iron is administered, the smaller should be the dose, and the less stimulating the preparations used in the commencing treatment, and as improvement continues the size of the dose or the form of combination may be changed.* Many of the untoward effects of medicine may be attributed to not adapting the first dose to the nature of the case. Even under the best of circumstances, the remedy used, to make it acceptable, must be joined with a corrective, as the use of bromo hydric acid with quinine or any of the alkaloids of cinchona.

Untoward Effects of Medicines

There are several conditions in which a drug in medicinal doses may bring about deleterious effects. The drug itself may not be of a standard purity, it may not be properly administered, or it may be acted upon under pathological changes. All active drugs taken into the body, caeteris paribus, respectively have their established effect and their route through the system. It is strictly a physiological process; but when from some cause, a medicine is changed into an injurious compound, through vitiated secretions, or diverted from its natural course in its transition through the economy, we have to contend with injurious results. It is a known fact that the secretions are not always the same, therefore medicines brought under their influence may fail to have their legitimate action. Yet if injurious compounds are thus formed, it would be but the natural result of a chemical reaction and under similar circumstances would have the same effect in all cases. It is not in this light we consider the subject; but simply as a disease of the inhibitory apparatus of the system. This disease appears to be an orgasm of those parts that are concerned in the election of the remedies, or their elimination. It must not be confounded with idiosyncrasy as is often done by writers on the subject. It may be at times difficult to draw a line between the two; but by a close examination we will find one a disease and the other not. When we speak of an idyosincrasy of a person that faints at the sight of blood; will vomit at the sight of sputa, or at the smell of carrion, etc., how can we associate these mental phenomena with the subject under consideration?

There are four ways by which medicines affect the human system: 1. Physiologically, comparatively with uniform results. 2. Pathologically, with untoward effects. 3. Toleration by habituation. 4. Toxic. The system has the power to resist the force of all, except the ultimate action of the last, and there may be constitutional conditions when all prove toxic.

The following is a list of remedies with the symptomatology of some of their untoward effects:

Acetate of Lead. Loss of appetite, constipation, paralysis and colicky attacks.*

*Prof. R. T. Edes.

†Journal Am. Med. Association.

‡ Prof. Adolph Gubler.

Acids. Disturbance of digestion, toothache, and occasionally there is salivation.

Acid Arsenic. Irritation of the stomach, dermatitis, stomatitis, headache, dry cough, salivation, etc.

Acid, Boracic. Nausea, vomiting, fullness of the stomach. a

Acid, Carbolic. Headache, dizziness, weakness of the legs, the appearance of rings before the eyes, a sensation as of crawling insects and profuse sweating,b nephritis,c attacks of fainting in women,d hiccup, nausea, chills, and anasarca with diminution or suppression of urine. e