its action was determined, be referred to its own group, and thus be placed or classified. As few substances are absolutely identical in action, but only broadly similar, it is often difficult to divide sharply one group from another. In a résumé it is manifestly impossible to pass in review every pharmacological substance, and we shall therefore confine ourselves to those groups which are of practical importance. Many individual drugs are described under their own headings.
Group I. Acids.—This includes sulphuric, hydrochloric, nitric, phosphoric, tartaric, citric, acetic and lactic acids, all of which owe their action to their acidity. Many of the other acids, such as carbolic and salicylic, have specific effects which have no relationship to their acid reaction. The concentrated acids have an intense local action, varying from complete destruction of the tissues to more or less irritation. When considerably diluted they are only slightly irritating; externally applied and in the stomach they have an antiseptic action; they increase the secretion of saliva, and thus assuage thirst. In the intestine they combine with ammonia and other alkalis present, and are absorbed into the blood as neutral salts, being excreted chiefly in the urine. In small doses they somewhat increase general metabolism. Boric acid only belongs partially to this group, as it and its compound borax have certain specific actions in addition.
Group II. Alkalis.—This includes caustic potash, caustic soda, solution of ammonia, their carbonates and bicarbonates, borax, soaps, lithium carbonate and citrate, quicklime, slaked lime, chalk, magnesia and magnesium carbonate. All these substances, apart from any other actions, exert a similar effect upon the body in virtue of their alkalinity. When they are taken internally in small amounts they neutralize the acids in the stomach and other parts of the alimentary canal, and at the same time they increase the normal acid secretion of the stomach. After absorption into the blood, which they make somewhat more alkaline, they are excreted chiefly in the urine, to which they impart an alkaline reaction if given in sufficient quantity. Some of them by stimulating the kidney cells act as diuretics, but others apparently lack this action. Caustic potash and caustic soda are locally very irritating, and destroy the tissues, but lose this quality when combined with acids as in the case of their carbonates, bicarbonates and borax. Quicklime is also caustic, but magnesia is bland and unirritating. Weak solutions applied locally saponify fats, soften the epidermis, and thus act as slight stimulants and cleansers of the skin. Calcium salts form insoluble soaps with fats, and combine with albumen in a manner which makes them soothing and astringent rather than irritating. Apart from alkaline effects, these metals differ considerably pharmacologically. Potassium and lithium have a depressing action upon the nervous system, ammonium salts have a stimulating action, while sodium practically speaking is indifferent. Calcium and magnesium have actions somewhat similar to that of potassium. Most of these substances are normal constituents of the body, and indispensable for healthy existence. They are contained in sufficient amount in our ordinary dietary to supply the needs of the organism.
Group III. Easily absorbed Salts.—Sodium chloride may be taken as the type of those salts which diffuse readily, and are therefore easily absorbed. Sodium nitrate, potassium nitrate, potassium chloride, ammonium chloride, the alkaline iodides and bromides, also belong partly to this group, although most of them have also specific actions. Locally they cause considerable irritation, and when swallowed in concentrated solution may cause vomiting. From the stomach and intestines they are rapidly absorbed, and rapidly excreted from the blood, increasing all secretions and the general metabolism. These effects are apparently due to their irritating action upon individual cells.
Group IV. Salts absorbed with difficulty.—This group includes the sulphates of sodium, potassium and magnesium, the acetate and tartrate of potash, citrate of magnesium, sodium phosphate, sodium tartrate and similar salts. Locally their action is slight, but when taken internally, dissolved in water, they are not absorbed from the alimentary canal except in very limited amount. They therefore remain for the most part in the intestine, and as they attract and retain large quantities of water, and at the same time slightly stimulate the mucous membrane, they come to have a purgative action and form the well-known group of saline cathartics. The small portion which is absorbed exerts a diuretic action.
Group V. Heavy Metals.—These include iron, manganese, aluminium, chromium, zinc, copper, silver, gold, platinum, lead, mercury, and probably antimony, arsenic and bismuth. Although some of these differ very greatly in their actions after absorption, still locally they have certain effects in common due chiefly to their chemical action on albumen. Their soluble salts combine with albumen and preserve it, strong solutions being extremely irritant or caustic, while weaker ones are astringent simply, or even soothing. They are all antiseptics. Their insoluble compounds are much less active locally than the soluble, and in many cases are only effective to the extent to which they are dissolved by the secretions. Some metals are only absorbed from the alimentary canal to such a very limited amount that they exert no general action, while others readily pass into the blood and give rise to more or less marked effects. All of them injected into the blood in large doses act as muscle and nerve poisons, and during their excretion by the kidney usually irritate it severely, but only a few are absorbed in sufficient amount to produce similar effects when given by the mouth. When iron is injected directly into a vein it depresses the heart's action, the blood pressure and the nervous system, and during its excretion greatly irritates the bowel and the kidneys. When taken by the mouth, however, no such actions are seen, owing to the fact that very minute quantities are absorbed and that these become stored in the liver, where they are converted into organic compounds and ultimately go to form haemoglobin. Soluble salts of manganese, aluminium, zinc, copper, gold, platinum and bismuth have, when given by the mouth, little action beyond their local astringent or irritating effects; but when injected into a blood vessel they all exert much the same depressing effect upon the heart and nervous system. Silver resembles them closely, but differs by the circumstance that it is deposited permanently in minute granules in the tissues, and, without affecting the general health, stains the skin of a bluish colour (argyria). Mercury and lead are absorbed from the bowel in considerable quantities, and are capable of inducing acute irritant poisoning as well as chronic poisoning. Lead poisons the muscular and nervous systems, and gives rise to paralysis, wasting, colic and other symptoms, while in the case of mercury, tremors, salivation, anaemia and very marked cachexia are induced. Arsenic and antimony do not form combinations with albumen, but they both greatly depress the central nervous system and circulation; and, if their action be long continued in large doses, they cause fatty degeneration of the viscera and disappearance of glycogen from the liver. Locally they are both very irritating, and antimony has a special tendency to cause vomiting.
Group VI. Halogens.—This group includes iodine, bromine and chlorine, in their free state or as compounds. Locally they are all three strongly irritant or caustic, owing to their chemical action on albumen. They are in addition powerful germicides, and by splitting up water may act as oxidizing agents. Owing to their strong affinity for the hydrogen of organic compounds they often act as bleachers and deodorizers. Iodine has a special interest, as it is a necessary constituent of food, and is present in the secretion of the thyroid gland. Apart from certain conditions of ill health, the iodides, as such, have no very marked influence on the healthy body beyond their saline action. Alkaline bromides, in addition to their saline action, have in sufficient doses a depressing effect upon the central nervous system, and less markedly upon the heart. Chlorine compounds are not known to exercise any action of a similar kind.
Group VII. Sulphur.—Sulphur itself has no action, but when brought into contact with the secretions it forms sulphides, sulphites and sulphuretted hydrogen, and thereby becomes more or less irritant and antiseptic. In the bowel its conversion into sulphides causes it to act as a mild laxative. Baths containing sulphuretted hydrogen or alkaline sulphides have a slightly irritating effect upon the skin, and stimulate the general metabolism.
Group VIII. Phosphorus.—This includes phosphides, and, according to some authorities, hypophosphites. Phosphorus is present in all cells, in considerable quantity in the nervous tissue, and in the bones as phosphates. It is therefore, in some form or other, a necessary part of dietary. When taken by the mouth phosphorus is an irritant poison in large doses; in small doses the only effects noticeable consist in an increased formation of bony and connective tissue, although it is also supposed to exert a gently stimulating effect upon the nervous system.
Group IX. Oxygen.—When pure oxygen is inhaled the only effect is a slight increase of the amount of the gas in the blood, but this has no particular physiological effect. The pharmacological action of hydrogen peroxide (H₂0₂), potassium permanganate, powdered charcoal and some other oxidizing agents depends on the readiness with which they give up oxygen.
Group X. Carbonic Acid.—Carbonic acid gas, carbonic oxide (CO) and some other irrespirable gases produce their effects practically by asphyxiation. When dissolved in water, however, carbonic acid gas is a gentle stimulant to the mouth, stomach and bowel, the mixture being absorbed more rapidly than plain water; hence its greater value in assuaging thirst. Nitrous oxide (laughing gas) was at one time believed to act simply by cutting off the supply of oxygen to the tissues, but it also has a specific effect in producing paralysis of certain parts of the central nervous system, and hence its value as an anaesthetic; when given in small amounts mixed with air it produces a condition of exhilaration.
Group XI. Water.—Water acts directly as a diluent and solvent. It therefore increases all the secretions, especially those of the skin and kidneys, while it also stimulates the general metabolism of the body and the excretion of nitrogenous products. Mineral waters act in the same way, but their effects are very much modified by, and depend largely upon, other constituents, such as alkaline salts, iron, arsenic, sulphides, carbonic acid, &c.
Group XII. Tannic Acid.—Tannic acid is present in small quantities in the great majority of plants, but in notable quantity in gall-nuts, oak bark, bearberry leaves, rhatany root, catechu, kino,
