If a medicine of any power is given in large doses, frequently repeated for a long time, there is a decided risk of causing disease of the organ on which it specially acts.* We speak here not of poisons, nor of the untoward effects of drugs, nor of idiosyncracies, but of a few remedies in general use.

Colchicum is a drastic cathartic; but it tends also to render the bowels inactive, to diminish the alimentary secretions, and materially to weaken the functions of the liver. In the general character of the medicine, it may with truth be stated that sooner or later, in proportion as it is freely employed, it will lead to a broken state of health.†

Nitrate of Silver, in medicinal doses, is for some time at least attended by no observable effects. After a time a staining of the skin of a sort of bluish gray color takes place. This is permanent, and after death a similar staining of many internal organs has been seen. In a few favorable cases, the skin staining is said to have disappeared after the use of iodide of potassium and hyposulphite of soda. The silver is deposited in the tissues in the form either of oxide or of solid silver. In animals, symptoms indicating a paralyzing action on the cerebro-spinal centers have been observed, as well as a disorganizing effect on the blood.

Iodine. There are few remedies that have as wide a range of therapeutic application as iodine. In large doses it causes an elevation of the bodily temperature, emaciation, and an increased waste of the nitrogenous tissues of the body.§. It exerts its greatest influence on the albuminous compounds of the body.|| The tendency of the compounds of iodine is to produce catarrhal effects on the mucous membrane, and an eruption of the skin; and it develops a train of symptoms known as iodism. The common experience that iodine effects a reduction of hyperplastic glandular tissue, finds a physiological counterpart in the effect of the prolonged employment of medicinal doses of iodide of potassium on the testicles, ovaries and mammae.¶

Iron. When this remedy is administered in severe anaemia or chlorosis, the first doses should be very minute - smaller than those which cause the constitutional symptoms of iron intoxication - such as a stricture in the temples or chest, flushings of the face, or fullness of the head.‡ In somewhat increased and prolonged doses, iron and even the ferruginous waters are followed by disturbance of digestion, diminution of appetite, gastric oppression and vomiting; and these results are particularly liable to follow when the drug is taken on an empty stomach. Defecation is retarded and the stools are blackened by a sulphuret of iron. More recent observations have demonstrated the ferrous salts to be better tolerated than the ferric. Ferrum redactum, the phosphate, and the pyrophosphate of iron are said to disturb digestion but slightly. On the other hand, the

-salts with organic acids (lactate, citrate, and acetate of iron) interfere very much with pep tonization.*

*Kidd. ‡Edes. ||Kammerer.

†Scudmore.

§Mays.

¶Dr. L. Lewin.

Quinine. Organs differing most widely in their nature are influenced by quinine and manifest pathological changes. The following symptoms are observed as indicating disturbances which it causes of the central nervous system: headache, deafness, general muscular irritability with chilliness and a feeling of dizziness, which disappear on the person assuming the horizontal position. The skin of many persons is affected in a peculiar manner by the internal exhibition of even small doses of quinine. For the purpose of preventing the head symptoms which so frequently attend the employment of quinine, Wade recommends bromhydric acid. Rivet has recommended the subcutaneous administration of morphine as a remedy against the accidents following the use of quinine. Lightfoot observed a rapid disappearance of the quinine eruption after the taking of 25 drops of tincture of hyoscyamus and alkaline baths. Heusinger powdered the affected portions of the skin with wheat flour.*

Salicylic Acid. The internal exhibition of this acid causes a repulsive taste, and a burning and grating sensation in the mouth and throat. After its absorption we may have buzzing in the ears, difficulty of hearing, and profuse perspiration;† these symptoms do not however contra-in-dicate the further employment of the drug.* Perspiration supervenes in about two-thirds of the cases, and is sometimes as profuse as that following jaborandi.

Balsam of Copaiba, when employed for a long time, and not necessarily in large doses, affects the various mucous membranes injuriously. It not infrequently causes loss of appetite, gastric oppression, nausea and vomiting, and sometimes congestion of the conjunctiva and pharynx, and irritation of the kidneys and bladder to the extent of even causing nephritis and cystitis.‡ The manner in which these effects are produced is clear. Balsam of copaiba, like other resinous substances, causes irritation of various degrees of severity of the mucous membranes, perhaps through the oil of copaiba, or copaibic acid which it contains. Its elimination is effected through the lungs and kidneys, and thus the urinary passages may suffer irritation in proportion to the quantity of the balsam which passes through them. But the balsam may also be excreted through the skin, and thus either it itself, or the glands which it contains, may be the starting point of an inflammatory action. It has not yet been determined to what extent deviations from the normal vascular distribution, or a peculiarity in the glandular element of the skin, is responsible for the effects noted. The fact, however, remains that after the employment of the balsam of copaiba, a peculiar odor, due perhaps to the volatile products of decomposition of the drug, is given off and that in these cases the effectiveness of the balsam in gonorrhoea is slight.*

Alum. The continued use of small doses of alum is prone to induce a cough in persons with sensitive bronchi.†

*Dr. L. Lewin. ‡Bazin.

†Bertagnini.

Calomel. The prolonged use of calomel is sometimes accompanied by undesirable results, through its retention in the caecum, where by prolonged contact with the chlorides of sodium and ammonium it is changed into corrosive sublimate, and thus causes erosion and ulceration. The most frequent of mercurial diseases are salivation, stomatitis and disturbance of nutrition. Erythema and eczema may occur after the external application of mercury, and may also follow its internal exhibition. From the effect mercury has on the blood, and its depressing influence on the nervous system, it is never a safe constitutional remedy in asthenic affections.

Opium administered to children, nervous women, and in cases of some forms of renal diseases, is apt to do mischief, in particular to the stomach and the brain. It is a dangerous remedy in bronchitis or pneumonia, when there is any tendency to cyanosis. The urine of severe opium poisoning may contain albumen and casts, a fact of importance in the diagnosis between this condition and uraemia. In rare cases an eruption, with or without itching, has been observed to appear as a result of the medicinal use of opium. Laborde accounts for the vomiting after taking morphia to be owing to bad quality, having been partially transformed, by keeping, into apomorphia.

Digitalis shares with only a few other drugs the property which is perhaps due to its abnormally slow elimination by the kidneys, of continuing its action in the body during a relatively long period, and therefore of giving rise, through the continued administration of repeated doses, to cumulative action. The latter may, under certain circumstances, give rise to symptoms of positive poisoning; these last are headache, dryness in the throat, nausea, choking, and in well marked cases, buzzing in the ears, disturbances of vision, manifested in muscae volitantes, amblyopia, or diplopia, and later in dizziness, faintness, vomiting, diarrhoea, sleeplessness, a threadlike, scarcely perceptible, irregular pulse, and a quite distinct fall in the temperature of the body, due to lowering of the activity of the circulation.

Chloroform. In the small proportion of fatal cases of chloroform narcosis, death occurs without any warning prodromal symptoms. In such cases the pulse ceases suddenly during complete or incomplete narcosis, respiration ceases in one or two minutes, the face becomes pallid, the pupils dilate, and death ensues. Generally, however, the warning is given of a disastrous result of a narcosis, by one or more premonitory symptoms. There occur persistent vomiting, decided pallor of the face, labored and occasionally stertorous ringing respiration, extreme mydriasis, failure to excite reflex action through irritation of the conjunctive of the globe, spasmodic muscular movements, a certain muscular rigidity, and a small, scarcely perceptible pulse, which in spite of the contractions of the heart, entirely disappears. Respiration ceases, either simultaneously with or before the stoppage of the pulse, or it may continue after the pulse ceases. In the former case death must be attributed to asphyxia, in the latter, to syncope.*

*Dr. L. Lewin. ‡Radziejewsky.

†Beginaud. §Edes.

The many conditions which have hitherto been held responsible for death from chloroform, may be arranged under three heads, as follows:f

1. The bad quality of chloroform.

2. The improper manner of its administration.‡

3. The mental and physical condition of the patient. (a). The idiosyncrasy against chloroform; (b) psychical depression; (c) bodily weakness; (d) cardiac affections, and especially fatty degeneration; (e) chronic alcoholism.