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Botanical name:

The inner, fleshy scales of the bulb of the white variety of Urginea maritima (Linné), Baker (Nat. Ord. Liliaceae), cut into fragments and carefully dried. Coast of Mediterranean Basin and in Portugal and France. Dose, 1 to 3 grains; average, 1 1/2 grains.
Common Names: Squill, Squills, Sea Onion.

Principal Constituents.—Scillitoxin, the most active principle, insoluble in water, soluble in alcohol, and a heart poison; scillipicrin, a bitter body, sparingly soluble in water; scillin, soluble in water, causing vomiting and numbness; and a bitter glucoside scillain.
Preparations.—1. Specific Medicine Squill. Dose, 1 to 5 drops.
2. Acetum Scillae, Vinegar of Squill (Squill, 10 per cent). Dose, 5 to 20 minims.
3. Syrupus Scillae, Syrup of Squill. Dose, 10 to 60 minims.
4. Syrupus Scillae Compositus, Compound Syrup of Squill (Hive Syrup). (Contains Fluidextracts of Squill and Senega, and Antimony and Potassium Tartrate.) Dose, 5 to 40 minims.
5. Tinctura Scillae, Tincture of Squill (Squill, 10 per cent). Dose, 5 to 30 minims.

Specific Indications.—Chronic cough with scanty, tenacious expectoration; dropsy dependent upon a general asthenic condition and without fever; scanty, high-colored urine, with sense of pressure in the bladder; renal overactivity with inability to retain the urine.

Action and Toxicology.—Squill is a powerful drug acting much like digitalis upon the heart muscle, and probably with greater force upon the peripheral vessels, increasing arterial tension. It is a violent gastrointestinal irritant and it disturbs the stomach more than does digitalis. Even small doses cause nausea and vomiting; and some individuals are so susceptible to its action that it cannot be taken by them in any dose. Squill likewise stimulates the kidneys to increased diuresis, both by acting upon the epithelial cells and by increasing the blood pressure within those organs. Bronchial secretion is increased by it. Fresh squill, when rubbed upon the skin, is rubefacient, and if the surface be denuded it may be absorbed with poisonous consequences.

Large doses of squill are violently poisonous, causing severe and painful vomiting and purging, gastro-intestinal inflammation, decreased, and sometimes bloody and albuminous urine, with strangury, and not infrequently complete suppression due to the acute nephritis induced. Dullness and stupor or intermittent paralysis and convulsions ensue. Death usually takes place in from ten to twenty-four hours. Some contend that squill acts more powerfully upon the heart muscle than foxglove, and that by overstimulation with excessive doses cardiac arrhythmia and heartblock may be induced. Squill, therefore, while usually causing death by gastro-enteritis, may establish a fatal nephritis, or cause a sudden stoppage of the heart.

Therapy.—Squill is a stimulating diuretic and expectorant, and if given in small doses when there is general atony and special lack of tone in the renal and respiratory tracts it is a good medicine. It must be used, however, with care and judgment. If there is the least reason to suspect, or evidence to show, undue renal irritation or inflammation its use should be stopped at once. In very small doses squill allays irritation of mucous membranes and lessens excessive secretion. It was at one time very largely employed for the elimination of dropsical effusion; and still is used for the absorption and removal of pleural, pericardial, and especially peritoneal effusion, but with more care than formerly. In large ascitic collections in curable conditions paracentesis is a more rational measure than long and harsh medication by drastic renal hydragogues.

Squill is one of the most certain remedies for dropsy of cardiac origin, or from congestion (not inflammation) of the kidneys; and is proportionately less valuable where dependent upon structural changes in the renal glands. Nevertheless it frequently is used in chronic nephritis to excite the surviving cells to activity and thus increase the output of urine. When renal dropsy depends upon general atony of the system-the kidneys included and the disorder is one of functional weakness, squill may be used with good effect. Its diuretic action is increased by digitalis and the alkaline diuretics, notably acetate and citrate of potassium. Squill, in powdered substance, is usually more effective than any of its preparations; therefore the best form of administration is by pill or capsule. When there is a feeble circulation the following is advisable: Rx Pulv. Scillae; Pulv. Digitalis, 10 grains each. Make into Pilulae, No. 10. Sig.: One pill after meals. Squill is contraindicated, even in dropsy, by a dry, hot skin, rapid circulation, elevated temperature, or any evidence of renal irritation or inflammation. But the greater the atony of the general system the more salutary its action. In dropsy requiring urgent relief two or three grains of squill may be given every three hours, withholding the medicine upon the slightest indication of nausea. When it acts strongly as an expectorant it frequently fails to cause increased diuresis. Neither should it be expected to cure when anasarca or ascites is caused by malignant disease or renal destruction. Locke employed for cardiac dropsy, with feeble heart action and weak rapid pulse, teaspoonful doses of infusion of digitalis to which is added two (2) grains of squill, or one (1) drop of specific medicine squill.

Squill has been quite generally used by some physicians for subacute and chronic bronchitis when secretion is scanty and viscid and expectorated with difficulty, and oppositely when the secretions are profuse and debilitating. The dosage should be regulated according to the condition, the fuller doses short of nausea for the former, and minute doses for the latter. These results are attributed to its power to regulate normal equilibrium in the bronchial mucosa. When fever is absent and the sputum scanty and tenacious, the following is useful: Rx Syr. Scillae, 1 fluidounce; Syr. Pruni virg., 3 fluidounces. Mix. Sig.: One teaspoonful four (4) times a day (Locke); and in chronic bronchial catarrh: Rx Syr. Scillae, Syr. Senegae, 1 fluidounce each, Syr. Pruni virg., 2 fluidounces. Mix. Sig.: One teaspoonful every three hours. Syrup of squill has been largely used and is still popular in the domestic treatment of croup, people little realizing the danger invited. We have seen it cause convulsions and prostration in a young child when thus employed. It has also been advised by physicians for emphysema. While of unquestionable value in bronchial affections, one must be guarded in its employment lest more damage be done to the kidneys than good to the respiratory tract.

The Eclectic Materia Medica, Pharmacology and Therapeutics, 1922, was written by Harvey Wickes Felter, M.D.

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