io8 MATERIA MEDIC A AND THERAPEUTICS. 



mucous surface. Little or no good is to be expected from less 

 than 20 gr. doses of the subnitrate to an adult, and these may be 

 trebled with perfect safety. Bismuth is extensively used in this 

 country in the treatment of pain and vomiting due to catarrh 

 or organic disease of the stomach, such as the gastric catarrh 

 that follows a surfeit of food or alcoholic excess, recurrent 

 gastric ulcer, and cancer; also in some cases of so-called 

 nervous or reflex vomiting, as in pregnancy and hysteria, where 

 a true catarrh is often present. Bismuth may be given alone 

 in such conditions, but is better combined, on the one hand, 

 with alkalies, such as bicarbonate of soda, if there be much 

 actual catarrh ; or, on the other hand, with opium, if pain be 

 the chief symptom. A combination of the subnitrate of bis- 

 muth and a variable number of grains of Pulvis Ipecacuanhae 

 Compositus is almost a specific for the pain and vomiting of 

 ulcer and malignant disease. 



The astringent and sedative influence of bismuth on the 

 intestines constitutes it a valuable remedy for diarrhoea in deli- 

 cate persons, such as children, phthisical subjects, and those 

 who have been exhausted by other causes. In lienteric 

 diarrhoea, probably referable to duodenal catarrh, it is some- 

 times invaluable. But in the intestines, as in the stomach, the 

 addition of opium, in however small quantity almost, greatly 

 assists its action, and in persistent cases of diarrhoea is absolutely 

 necessary. The same combination with Dover's powder gives 

 excellent results. Bismuth subnitrate is partly converted into 

 the sulphide in the bowel, which imparts a characteristic leaden- 

 grey colour to the fteces. 



2. ACTION IN THE BLOOD. 



Neither the insoluble nor the soluble (but weak) prepara- 

 tions of bismuth enter the blood in any quantity. Still, the 

 metal has been detected, both here and in the tissues. 



3. SPECIFIC ACTION. 



Bismuth finds its way, but very slowly, through all the 

 organs and tissues ; but no specific effect can be traced to its 

 presence, even when it is given in doses of several drachms. 

 The so-called effects of bismuth, of the older authorities, 

 were certainly caused by arsenic combined with it as an im- 

 purity. 



4. REMOTE LOCAL ACTION. 



Bismuth has been found in the urine, and it is said, in the 

 milk. No use is made of its remote influence, if any such 



exist. 



