ESSENTIALS OF MATERIA MEDICA

which accounts for it occasionally causing nausea. The preparations met with are the

extract (1-5 gr.), fluid extract (one

FOR NURSES. VI.

BY E. LOWELL MARCY, M.D.,

New York Central R.R. Surgeon; Ass't Surgeon, Emergency Hospital, Buffalo, N. Y.

minim), tincture (10 minims) and the infusion (2 drams). Digitalis is used almost

CARDIAC TONICS.

THESE are drugs which give a more or less permanent strength to the heart and circulation.

Caffeine is the active principle of tea and coffee and appears as white crystals of bitter taste. It has gained its reputation as a heart tonic through its action on the kidneys (see diuretics in removing dropsy, which often accompanies heart diseases). It is, however, given to strengthen the heart muscles in certain weakened conditions of that organ, causing the blood pressure to rise and giving tone to the whole circulation. As a respiratory stimulant caffeine is of value and it has been used for this effect in morphine and alcoholic poisoning. On the brain it acts as a stimulant, increasing the power of the mental faculties and producing wakefulness (after dinner coffee). In certain forms of nervous headache it gives good results.

Hypodermically it is seldom used. The preparation for internal use is the very soluble citrated caffeine (3 gr.). The ordinary cup (decoction) of coffee contains one to three grains, while black coffee (coffee one part, water three parts) contains six grains to the demi-tasse, and is the preparation which is frequently administered per rectum. Tea contains more tannic acid than coffee and is extracted by boiling or when allowed to stand a long time, a thing to be remembered in its preparation. The tannic acid of course interferes with digestion. Chocolate contains theobromine and cacao butter. The former acts like caffeine, except it does not produce wakefulness. The butter is a digestible fat, though not acceptable to some stomachs.

Digitalis is obtained from the leaves of the European foxglove. It has a bitter, burning taste and is irritant to the stomach

organ has a period of contraction (systole) when the blood is forced out, and a period of dilatation (diastole), during which time the heart fills. The effect produced by the drug, in a general way, is the lengthening of the period of rest or diastole and the strengthening of the contraction. The result is a slowing of the pulse rate and a full pulse, more blood being pumped by the heart. Thus those heart conditions are improved by this drug if they are benefited by increasing the tone of a flabby heart muscle, allowing more time for the heart to fill fuller, increasing the force of the blood as it is sent out, or slowing the rate of the pulse and increasing the blood pressure. While it might seem that most conditions would fall into one of these divisions, yet there are several diseases of the heart and circulation which digitalis actually aggravates. The use of the drug in relieving dropsical conditions will be found under diuretics.

The tincture and infusion are the usual preparations used where the drug is not to be long continued. The drug can be increased in emergencies 4 to 5 times. Hypodermically the tincture (I c.c.) is given though it is somewhat irritant. Certain active principles such as digitalin (1-100 gr.) are also administered in this way.

The absorption of digitalis is slow, it sometimes not showing any effect until the following day; its action likewise slowly passes off. It therefore follows that if care in administering it is not observed there may be several doses acting at once and with bad effect. This is the so-called "cumulative action," the symptoms of which are nausea, vomiting and prostration, and an extremely weak and slow pulse.

Strophanthus is obtained from the seeds. of a climbing shrub of the same name and is an exceedingly bitter, irritating substance.

The tincture (10 minims) is usually used. It acts precisely like digitalis except that its action is weaker and less enduring and it does not raise blood pressure as high as the latter drug. It is very irritating and is not usually given hypodermically. Strophanthin (1-100 gr.) is the alkaloid.

Strychnine, a most valuable heart tonic, will be considered under "Motor excitants."

CARDIAC DEPRESSANTS.

These are drugs which decrease the action and strength of the heart. This is brought about by its stimulation of the nerv (pneumogastric) which acts as a brake to the heart action. The result is a slower pulse and a lower blood pressure.

Aconite is chief of this class and is obtained from the root of the monkshood, a flowering European plant. It has a bitter stinging taste and produces a tingling sensation somewhat like horseradish root, with which it has been confused. The fluid extract (one minim) and the tincture (10 minims) are the preparations, while the alkaloid aconitine is used in doses of 1-400 gr. It is used to depress the strong, rapid action of the heart and to lower a high blood pressure in certain conditions such as la grippe or beginning "cold." Aconite benumbs the nerves with which it comes in contact, which explains its presence in some liniments used for neuralgia and kindred conditions. The overdose is marked first by a tingling of the tongue, throat or entire skin of the body, a feeble, irregular pulse, and the signs of profound shock. The treatment is the use of the stomach tube and the general treatment of shock.

root, the fluid extract (1 minim). There is also for external use a liniment and a plaster. The active principle upon which it depends for its action is atropine. This alkaloid is crystalline and has a burning taste. It is insoluble in water, so the sulphate of atropine which easily dissolves is generally used.

Dilatation of the pupils is caused by a few drops of 1 per cent. solution of atropine sulphate put into the eye. This is accomplished in about one-half hour and the effect may last about three or four days. Homatropine, chemically derived from atropine, when used in the same strength acts similarly to the latter drug, but its action is weaker and passes off in a few hours, a point of advantage in some conditions. Belladonna (fair lady) derived its name from a practice of using it to make the pupils large and "soulful," which was believed to be an attribute of beauty. This dilating (mydriatic) power is made use of; in certain inflammatory conditions of the eye, ulcer of the cornea, etc.; to fully dilate so as to examine the inside of the eye; to paralyze the focusing power of the eye while determining refractive errors in the fitting of glasses.

Externally in plaster form belladonna is applied for lumbago, neuralgia, etc., thus taking advantage of its power in benumbing the nerves of sensation. As an ointment (10 per cent.) it finds use as an application for hæmorrhoids. It is to be remem bered that absorption from the mucous membranes and the skin can cause poisoning.

CEREBRAL STIMULANTS.

These, otherwise known as "Delirifacients," are drugs which stimulate the brain and tend to cause excitement and delirium.

Belladonna is obtained from the leaves and root of the deadly nightshade. The preparations of the leaves are the extract (1-5 gr.) and tincture (10 minims); of the

Atro

The heart and respiration are stimulated by atropine. Under "Heart Depressants" we spoke of the nerve (pneumogastric) which acted as a brake to the heart. pine paralyzes this nerve and so it is "off brakes." As a respiratory stimulant atropine is one of the best, it being used particularly in poisonings where the respiration is depressed. As morphine depresses the respiration and the heart, atropine is generally administered with it to offset this action.

All secretions are diminished by this drug. Thus in the night-sweat of tuberculosis it has been given. In certain diarrhoeas and to lessen the nasal discharge in "cold in the head," hay fever, etc., it finds a use. The plaster or ointment of belladonna applied to the breast will stop the secretion of milk. The muscles of the intestines are relaxed by this drug. This explains its use in lead colic, which is caused by the cramping of the intestines and likewise explains its presence in many cathartic pills (a. b. and s.).

The muscles of the bronchial tubes which are contracted in asthma are relaxed sometimes by use of a belladonna spray or Stramonium leaves (jimson-weed) of the same family are burned and the smoke inhaled.

Administered in doses of 1-20 grain, atropine sulphate is preferable to any preparation of belladonna on account of the dose being more accurate and sure of absorption. Belladonna preparations are used where a local effect is desired and when slowness of absorption is of an advantage, as, for instance, on the intestines, on hæmorrhoids and on external surfaces.

An overdose first produces a dryness of the skin and throat, sometimes the skin about the neck and face is flushed; the sight is dimmed, the pupil being dilated and fixed; respiration and heart beat are increased; there is nausea and dizziness. These pass into a stage of great excitement followed by coma and death. The treatment is the treatment of symptoms.

Hyoscine (scopolamine)' is obtained from the plant (Hyoscyamus), of the same family as atropine, and while it has the same effect on the secretions, the eye and the heart as does this drug, it is principally used to lessen brain excitement and cause sleep. Thus in the sleeplessness and excitement of alcoholism and certain forms of insanity it is used. The sleep produced is much like normal sleep, the patient being easily aroused. The drug has little or no power of diminishing pain, though it has been used with morphine in producing surgical

(scopolamine-morphine) anesthesia

The

with rather unsatisfactory results. dose is 1-100 grains and has no taste. The effect lasts about six hours. The poisonous effect is similar to that of atropine.

Cannabis Indica, or Indian hemp, has been used as an analgesic in certain forms of headache and as a hypnotic, though its action is not certain. It forms the basis of many Asiatic intoxicating beverages which certainly give the feeling of well being. Advantage of this property is taken by some concerns in using it in their patented "consumption cures." The dose is a grain, of the fluid extract (1 minim), the tincture 10 minims and extract 1-5 grain. The strength of the preparations vary and cannot always be relied upon.

ANTISPASMODICS.

Drugs which tend to calm nervous excitement or hysterical conditions come under this heading. They as a class, though mildly tonic to the nervous system. have an unmistakable and penetrating odor upon which they undoubtedly depend for some of the effect they produce.

Asafetida is an exudate from the root of a certain plant and appears as a yellowish mass having a bitter taste and the odor of garlic. It is one of the ingredients found in sedative medicines given for nervousness and hysteria. It has been used to increase the appetite and prevent or expel flatus from the intestines. For this service one-half to one ounce of the emulsion (milk) is used as an enema. The asafetida pills contain three grains two or three pills being the dose. The dose of the tincture is one teaspoonful.

Valerian is obtained from the root of a foreign herb and has an unpleasant taste and offensive odor. It appears in the fluid extract (2 c.c.), the tincture (4 c.c.), and the ammoniated tincture (2 c.c.). It is given for nervousness, etc.

Camphor is the gum from a cherry laurel tree, which purified appears as a white, tough mass of characteristic taste and odor. We have many preparations of camphor (2 grains), including the water of cam

phor (3 c.c.), the spirit (1 c.c.), the liniment (20 per cent. in cottonseed oil), and the monobromated camphor (5 grains). For the camphorated tincture (paregoric) of opium, see "opium." This drug is used in nervousness, nervous diarrhoeas and nervous headaches. For its action on the heart see "Heart Stimulants."

Musk, obtained from the musk deer, is usually classed in this group, but it is very little used and the pure article is very rare. Sumbul belongs to this class.

THE NURSE AS AN EDUCATOR.*

BY FRANKLIN W. BARROWS, M.D.
Buffalo, N. Y.

It is unnecessary to offer any proof of the proposition that the nurse is an educatorindeed, one of the most potent of all the educators of our modern life. The hos

pitals and dispensaries, the district rursing associations, the organized charities of our whole land, and, in many instances the homes and the public schools, all bear witness to the increasing activity of the nurse in the wide field of popular education.

As compared with the professional teacher the nurse enjoys many peculiar advantages. Her school hours are not limited by any legal regulations. She rings no bell to summon her classes, she grants no vacations, her pupils never play truant and should one of them go to sleep under her instructions she accepts the result with complacency and joy. In her daily round of work all time is school time and wherever she happens to be she "keeps school," without books or slates or examinations or percentages or promotions or any of the essential paraphernalia of the school; and she doesn't even have to study pedagogy or learn vertical writing. She is fortunate in having pupils who realize their need of instruction and are eager to learn what she can teach them of her art either by recent or by example. The whole household goes

*Read before the New York State Nurses' Association at their Annual Meeting in Buffalo, October, 1908.

to school to her; all hours, all places and all occasions are hers if she chooses, to teach, to warn and to exhort.

In making this sweeping statement 1 an aware that I have failed to note the exceptions to the rule. There is the woman who follows nursing as a trade and who couldn't give her patient a bit of information any more than she could give away a trade secret. She will do what she is paid for and no more; she should be classed with the artisans and not with the educators. Then there is the nurse who has retired from the world, so to speak, and taken the vow of loyalty to the physician. She has had all the initiative "trained" out of her by a long and painful process of elimination until it is impossible for her to do anything but "obey the doctor's orders." The hospital and training school usually take about three years to comb the snarls out of her dispusition and put her in shape to take the orders. She gets most of the bouquets at commencement time but when she enters on her professional career she feels as if her wings had been clipped. Still, for all that, she wouldn't show the laity how to fill an icebag or tell anybody how many drams there are in an ounce unless the doctor ordered her so to do, in which event she would do so with great credit to the doctor and herself. She is not to be classed among the educators, but is more like a marionette, although, at times, she appears to be almost human.

And yet, even these exceptional hirelings are teaching their conception of nursingunwillingly and unwittingly, but unavoidably, just the same. They are teaching by their example and they may be doing considerable good without any considerable credit to themselves for the way in which they do it.

The thought of the nurse as an educator implies an educated nurse. We may ask,

what education is desirable in order that the nurse may be a wise teacher of others? Many opinions exist as to the proper subjects to be included in the nurse's curriculum and there is much discussion as to the

length of the course. Without entering into any argument on these questions we must all admit that it is the legitimate work of the training school to teach nursing, that nothing else can reasonably be demanded of the training school at the present day and that, in view of the economic conditions confronting the nurse, this training should be completed as expeditiously as possible. The school is not expected to detain the pupil from graduation while putting on a few finishing touches in the fond hope of becoming something more than a nurse. The school needs only to see that she is nothing less than a trained nurse when she graduates. If she is endowed with her normal share of ambition she will not need any spur or whip to impel her in the direction of self-improvement; she will be always a student and she will instinctively direct her thought into those lines that are most closely related to her profession. Let us not be misunderstood. We believe that the responsibility of the school ceases when it has trained the woman to be a nurse, and we believe that right here the responsibility of the nurse is immensely increased, for it devolves upon her to maintain her position as a nurse and as a member of a profession -as an educated woman. She will recognize the responsibility of her position as teacher also, if she has her normal share of discernment, and she will not neglect any opportunity for self-improvement and advancement along professional lines. She will affiliate with the other nurses in her locality and in her state and attend their meetings as she has opportunity. She will serve on committees and boards as her services may be required, and thus she will gain more than a superficial acquaintance with the problems peculiar to the section and the state in which her lot is cast. She will read the literature of her profession as it appears in journals and in books, and she will not be very much frightened if she occasionally sees two sides—or more—to the same question. She will discover that there is considerable good even in those who do not agree with her in all respects and she

She

will find grains of truth in all heresies. She will guard against the danger of growing too old to learn. She will "prove ail things" and "hold fast that which is good." will duly respect the demands of her body as well as those of her mind in order to meet every emergency with strength and confidence. She will control herself and she will be a leader among her associates.

If she chooses to take up some line of institutional work she will find a way to secure the requisite training, either in a subordinate position or in a special line of post-graduate study. If district nursing or school nursing appeals to her she will have little difficulty in familiarizing herself with the best methods employed in our large cities. If she is inclined to go afield and to work out a line of effort in social betterment like the "welfare" work of some of our hospitals and dispensaries, she will find other pioneers along the trail to help and inspire her.

The woman who has the physical power and the steadiness of purpose to progress in her professional career will always find some leisure also for the companionship of good books and good society; she is likely to have some hobby that steals an occasional hour from the serious and pressing business of the day and makes her forget the vexations and annoyances that are inseparable from toil. She will reserve a portion of her life for the mere pleasure of living.

Gibbon says: "Every man has two educations, one which he receives from others, the other which he gives himself." I have tried to suggest the responsibility of the nurse for this other education, the one which she gives herself, and to sketch briefly the qualities for which we look in the progressive professional woman. It is greatly to the credit of the nursing profession that it numbers among its members many such women, equal in rank and ability to the best women in the professions of law, medicine and theology, and some of them honored for their influence beyond the pale of their profession.

The presence of such leaders should be