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The principal period groups were digitalis preparations, squill, broom, juniper oil, buchu, nitrous ether spirit, and several soluble potassium salts. They were grouped by observed promotion of urine flow, rather than by one common mechanism. The following are historical adult quantities per administration, expressed in the contemporary units; they are not present-day prescriptions.
- Digitalis preparations: powdered leaves, ½–2 grains; Infusum Digitalis, 2–4 fluid drachms; Tinctura Digitalis, 5–40 minims; digitalin, 1/40–1/10 grain in the period table. Historical digitalin was not simply a modern pure digoxin product.
- Squill: powder, 1–2 grains; Pilula Scillae Composita, 5–10 grains; Tinctura Scillae, 10–20 minims; Syrupus Scillae, ½–1½ fluid drachms.
- Broom: Decoctum Scoparii, 1–3 fluid ounces; Succus Scoparii, 1–4 fluid drachms.
- Buchu: powdered leaves, 20–40 grains; Infusum Bucco, 1–2 fluid ounces; Tinctura Bucco, 1–2 fluid drachms.
- Juniper oil: Spiritus Juniperi, 10–30 minims in the 1864 commentary. This unusually concentrated spirit contains one volume of juniper oil in ten; its dose must not be borrowed from a later, weaker formula.
- Nitrous ether spirit, Spiritus Aetheris Nitrosi: 30 minims to 2 fluid drachms.
- Potassium acetate: 10–20 grains; potassium citrate: 20–60 grains; potassium nitrate: 5–20 grains; potassium tartrate: 10–60 grains; potassium hydrogen tartrate: 20–60 grains.
- Ammonium acetate solution, Liquor Ammoniae Acetatis: 10–40 minims of the concentrated British preparation, diluted for administration.
[ref]
The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Posological table: Digitalis, Infusum Digitalis, Scoparius preparations, Bucco preparations, Spiritus Aetheris Nitrosi, potassium salts and Liquor Ammoniae Acetatis; Liliaceae: squill preparations
[ref]The Prescriber's Analysis of the British Pharmacopoeia by John Birkbeck Nevins (1864). p. 61, Spiritus Juniperi, 1 in 10 and 10–30 minims
Other recognised period agents included dandelion and copaiba. The dandelion decoction was given in quantities of 1–2 fluid ounces, its soft extract in quantities of 10–30 grains, and its preserved juice in quantities of ½–2 fluid drachms. Copaiba was given in quantities of 15–30 minims, and copaiba oil in quantities of 5–20 minims. Their historical inclusion does not establish that they are suitable substitutes for current diuretic therapy. [ref]
The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Posological table, Taraxacum preparations, Copaiba and Copaibae Oleum
The distinction between preparations matters more than a single “dose of the plant”: an infusion, tincture, juice and powder have different concentrations. Likewise, a salt's small historical diuretic dose is not its larger purgative dose. A modern explanation also separates a direct effect on renal tubules from improved cardiac output in appropriate heart failure: digitalis preparations cannot be understood simply as agents that make every kidney excrete more water. Modern digoxin is used for selected cardiac indications, rather than as a general treatment for low urine output. [ref]
Digoxin by MedlinePlus. Why is this medication prescribed?
The 1864 British Pharmacopoeia supplied mild rubefacients, blistering preparations and agents producing pustulation; these different degrees of injury were grouped under historical counterirritation. Redness of the skin demonstrates a local effect, not removal of inflammation from a distant organ. The following enumeration uses the preparations current for the 1865 examination.
- Mustard, as Sinapis and Cataplasma Sinapis, was a rapidly acting rubefacient, used historically for transient painful or spasmodic conditions and as a supposed revulsive application in internal disease. Its duration had to be limited because prolonged contact caused a burn. The later compound mustard liniment and mustard paper should not be silently inserted into this 1864 list.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Cruciferae, mustard and its official cataplasm
- Ammonia liniment, Linimentum Ammoniae, and the ammoniacal Linimentum Camphorae Compositum gave relatively prompt irritation. They were used for superficial muscular or rheumatic pains when a short rubefacient effect was desired. Simple camphor liniment and soap liniment were milder stimulating embrocations for stiff painful parts; the compound camphor liniment owed much of its greater irritation to Ammonia.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). strong solution of ammonia; Lauraceae, camphor preparations
- Turpentine, in Linimentum Terebinthinae or Linimentum Terebinthinae Aceticum, and in the official turpentine ointment, was used as a stimulating application. Historical indications included muscular pain, neuralgic pain and chest or abdominal applications intended to act on deeper disease. The acetic preparation was the more irritating form. This does not establish that either could cure pneumonia or intestinal disease.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Coniferae, turpentine liniments and ointment
- Capsicum and its tincture supplied a pungent local stimulant, used in diluted embrocations for chronic painful conditions. Burgundy pitch, chiefly Emplastrum Picis, supplied milder sustained stimulation, historically chosen for chronic chest, back or rheumatic discomfort. An adhesive plaster could itself cause dermatitis.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Solanaceae, capsicum; Coniferae continued, pitch plaster
- Cantharides supplied Emplastrum Cantharidis, Linimentum Cantharidis, Emplastrum Calefaciens and Unguentum Cantharidis. The warming plaster aimed at a milder prolonged effect; the ordinary plaster and liniment were vesicants, while the ointment could maintain an already blistered surface. Period indications included pleurisy, pericarditis, chronic painful anatomical joints and neuralgia. These were intended remote effects, not demonstrated cures. The 1864 name is Linimentum Cantharidis; its later renaming as Liquor Epispasticus must not erase the edition difference. Cantharides vinegar and official blistering paper belong to the later additions, rather than this list.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Coleoptera, British preparations and distinction from the old London vinegar[ref]British Pharmacopoeia by the General Medical Council (1867). prefatory lists of additions and altered names, pp. xvii–xx
- Iodine, as Linimentum Iodi, Tinctura Iodi and Unguentum Iodi Compositum, was painted or rubbed over chronic swellings, indurations and diseased anatomical joints. The strong liniment could blister; the intended historical effect was alteration of local action or promotion of absorption. Such an indication was not equivalent to proof that a swelling was benign or that it would resolve.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). iodine, official preparations and external therapeutic uses
- Croton oil, especially Linimentum Crotonis, and tartar emetic, in Unguentum Antimonii Tartarati, produced more persistent irritation and a pustular eruption. They were employed for prolonged counterirritation in chronic pulmonary or other deep-seated complaints when a temporary rubefacient was considered insufficient. Ulceration, scarring and systemic toxicity were substantial disadvantages, not evidence of effective elimination of disease.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Euphorbiaceae, croton liniment; tartarated antimony and its ointment
Other official substances could destroy tissue, but a caustic used to destroy a particular lesion is conceptually different from a counterirritant applied to influence another site. Likewise belladonna and aconite applications were principally intended to relieve pain, not simply to create a competing skin inflammation. Modern treatment should address the diagnosed condition; a historical claim of revulsion cannot justify blistering over a diseased heart or lung. The period literature itself recognised absorption, urinary irritation and sloughing from cantharides. No present-day use of a particular regulated skin preparation makes these broad historical indications valid.[ref]
The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Coleoptera, precautions and toxic effects