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Caulophyllum. Blue Cohosh, cont'd.

Continued from previous page.

CONSTITUENTS.—Prof. F. F. Mayer (1863) [American Journal of Pharmacy, 1863, p. 90.] briefly states that the alcoholic tincture of Caulophyllum deposits by spontaneous evaporation "a white, granular substance in considerable quantity." He states that upon washing this precipitate with dilute acid, and then with water, it became grayish white, and could be powdered; consisting for the greater part of Saponin. [If this is Saponin, we have crystallized it.] He also decided that the acid and watery washings contained a colorless alkaloid.

Mr. A. E. Ebert (1864) [American Journal of Pharmacy, 1864, p. 303.] next examined the plant, making the only careful analysis that had been made to his day, and none has been since announced. Mr. Ebert obtained the ordinary constituents of plants, such as albumen, gum, starch, coloring matters, phosphates and sulphates of lime, and silica, together with a resin and a substance (identified and called saponin by Mayer) similar to saponin. Mr. Ebert failed to obtain an alkaloid and inferred that Prof. Mayer had employed a drug that was contaminated with hydrastis or other alkaloid yielding plants. The only substance of interest proved to be the resinous saponin-like body.

Our examination of the drug establishes, we think, that Mr. Ebert was correct in stating that this is the characteristic principle, obtained by him as follows: He poured an alcoholic tincture of the drug into water, obtaining thereby a precipitate that was largely insoluble in water and ether, and when washed with these menstruums and dried, and then dissolved in alcohol and evaporated, yielded a light brown body, that Mr. Ebert classed with the resins. He also obtained from the ethereal washings a similar substance, because, while this body is insoluble in ether, when pure, an ethereal preparation of the plant will dissolve it in appreciable amounts.

The water in which the alcoholic tincture had been precipitated yielded by evaporation, an extract, bitter and acrid, soluble in alcohol, and producing with water, a heavy froth. It was purified by solution in alcohol, treatment with animal charcoal and then filtration. The filtrate upon being mixed with sulphuric ether, gave a white precipitate that, upon drying, possessed the following properties:

Its taste was sweetish, then acrid, it irritated the nostrils, and produced sneezing. It dissolved in dilute and strong alcohol, also, in alkaline watery liquids. It precipitated both acetate and basic acetate of lead, mercuric nitrate and auric chloride. With warm sulphuric acid it first assumed a rose, then a purple, and finally a violet color. Nitric acid turned it yellow; hydrochloric acid did not change its color.

From a consideration of these tests Mr. Ebert stated that it was "a substance similar to saponin." We call attention to the fact that while most writers state that Mr. Ebert claimed to have identified saponin in Caulophyllum, he really said "a substance similar to saponin," and in another place, "a body analogous to saponin," but did not assert its identity with saponin. [We pass the saponin subject, proposing to consider it in detail when we come to other so-called saponin yielding plants.]

We have purified and obtained the characteristic portion of this Caulophyllum product, in snow-white, silky crystals, and we can therefore describe its color reactions, solubilities, and other properties with an exactness that was not possible in Mr. Ebert's case, for the apparently white amorphous precipitate used by him, we find to contain considerable foreign matter that is excluded by several crystallizations [We call attention to the fact that our determinations with the reagents Mr. Ebert used, agree with him as nearly as is possible under the circumstances, and leave no question as to the fact that Mr. Ebert obtained amorphous Leontin, although he lost the larger part of it in his manipulations, and it was not strictly pure. To Mr. Ebert, we think, should be awarded the credit of its discovery.]. We are not aware that any of the so-called saponin yielding plants have relinquished a material like this; certainly it is not saponin, as saponin is now accepted, and we therefore give it the name Leontin. [The name (Leontin) is affixed by us to this body in consequence to the fact that the more appropriate term, Caulophyllin, is already appropriated by an Eclectic concentration (see p. 150). We feel therefore that in order to maintain a plant relationship we can, perhaps, not improve upon tis name derived from the old botanical name of the plant. In time to come, when the relationships of plant constituents are understood, a few names will probably answer for the many now given.]

Preparation of Leontin.—If an alcoholic percolate of the drug be mixed with water, a grayish-white precipitate forms, that upon being collected on a filter, assumes a gelatinous magma-like condition. When dried, this precipitate has an acrid taste, and irritates the mouth and fauces. It is mostly soluble in alcohol, insoluble in water; soluble in alkaline water, insoluble in chloroform and ether. If it be dried it assumes a dark color and then is not altogether redissolved by alcohol. This is the substance that Mr. Ebert considered a resin, and it is the substance that separates slowly in the form of a gelatinous magma from hydro-alcoholic preparations of Blue Cohosh, especially if they are of less than 50 per cent alcohol. It is at first sweetish, then acrid, leaving an after-taste resembling Senega, and an irritation of the throat and fauces. It is odorless, but the dust produces an irritation of the nostrils that excites sneezing. From its solution in alcohol, water precipitates it gelatinous; from its solution in alkaline water, acids precipitate it gelatinous. In both instances the magma has no crystalline structure.

If this substance be dissolved in alcohol, a dark brown solution is produced in consequence of impurities of a resinous nature, and it refuses to separate or crystallize from that alcoholic solution. If, however, it be first treated with cold anhydrous alcohol, coloring matters are extracted. If the alcohol is then filtered, the residue will, if dissolved in boiling alcohol, crystallize in silky, needle-like crystals upon cooling the solution. If the hot solution be concentrated, it forms a soft, silky, needle-like mass; if it be more dilute, the crystals slowly separate in acicular tufts, clear and distinct. They have a brown color, but upon re-crystallizing them from alcohol, become perfectly white and of a beautiful, satin-like lustre. When purified they easily crystallize from hot alcohol.

Properties of Leontin.—As obtained by the process we have given, Leontin is in pure white, feathery crystals, resembling quinine. It is a glucosid, and upon boiling with diluted acids, splits into glucose and a gelatinous, colorless body, that is insoluble in water, but soluble in alkaline water and in alcohol.

Leontin is slightly soluble in cold alcohol (s. g. 0.820), very soluble in boiling alcohol, crystallizing from it in needles upon cooling. It is slightly soluble in cold anhydrous alcohol, very soluble in boiling anhydrous alcohol, crystallizing in needles upon cooling, and the most perfect crystals are obtained from absolute alcohol.

It is slightly soluble in cold sulphuric ether (U. S. P.), quite soluble in boiling sulphuric ether, crystallizing from it in needles upon cooling. It is practically insoluble in cold and boiling chloroform

All solutions of Leontin are colorless.

Leontin is insoluble in water, and the addition of water to its solution in alcohol, results in immediate precipitation. Alkaline water dissolves Leontin freely, acids precipitating a gelatinoui magma somewhat altered in properties from the original substance.

Leontin is tasteless, but, owing to the alkaline nature of saliva, slowly dissolves, leaving an acrid after-taste. It is odorless, but its dust is acrid, imparting an irritation, like saponin, to the nostrils. Its solution in alcohol is acrid to the taste, and its solution in alkaline water is very acrid and irritating to the mouth and fauces.

Leontin does not neutralize alkalies, and its solution, even if dilute, forms much froth when shaken.

Color Tests.—Upon placing a drop of concentrated nitric acid upon a porcelain slab, and dropping a tuft of crystals of Leontin into it, they develop a pale rose color that disappears as the acid evaporates, leaving a white crystalline magma. Upon adding a little Leontin to a few drops of nitric acid in a test tube, and then gently warming the mixture, the color passes to pale rose and then yellow; when the liquid is cool, a white flocculent precipitate separates, that redissolvcs upon warming. The addition of water precipitates it white, and this precipitate dissolves in ammonia.

Sulphuric acid dissolves it slowly, forming at first a colorless liquid, if the Leontin is in small amount, but, if the proportion of Leontin is considerable, effervescence follows, and an orange color is developed, which passes to rose, and finally into a deep purple. Upon gently warming a small crystal of Leontin with a drop of concentrated sulphuric acid in a test tube, it develops a beautiful rose color, passing into crimson, and then assuming a deep purple. If the liquid be heated in the flame of a spirit lamp, the color disappears, a carbonaceous mass remaining. This color test is extremely delicate, a crystal of Leontin so small that it failed to affect our most delicate balance (less than 1,000 of a grain), developing a decided rose color in a drop of warm sulphuric acid.

If to the purple or rose colored liquid formed by the reaction between sulphuric icid and Leontin, powdered bichromate of potassium be added cautiously, agitating after each addition until it dissolves, the color disappears, and a yellow liquid results. If a slight excess of bichromate of potassium is now added, an apple-green color is formed, which deepens by the addition of a further amount to a clear, deep green. If the bichromate of potassium is cautiously added to sulphuric acid tinged a rose color, by the addition of a very small amount of Leontin, the color disappears, the acid becoming colorles. These color reactions are very sensitive, characteristic and unmistakable.

Hydrochloric acid (cold) seems not to effect it, but if a small portion of Leontin is gently warmed with an excess of that acid, it effervesces, disappears, and a colorless mucilage results. The production of this gelatinous material is remarkable for the viscosity resulting from a very small amount of Leontin.

The Ultimate Analysis of Leontin.—(Written for this publication by Prof. Henry Trimble, Professor of Analytical Chemistry of the Philadelphia College of Pharmacy). [The relationship between Leontin and Parillin, as shown by Prof. Trimble, is another link in that interesting series of the so-called saponins. In our paper we have endeavored to avoid the question of the connection between Leontin and Saponin, preferring to defer the matter until the other so-called saponin yielding plants have been considered. Prof. Trimble will continue these determinations and doubtless others also will become interested. We have deposited specimens of Leontin in the Philadelphia and Chicago College of Pharmacy Cabinets for future reference.—L.]

A portion of the finely powdered pure white crystals kept in a desiccator over sulphuric acid for several days, lost 15 per cent. This dried powder was then used in making four combustions with the following percentage results:

1. 2. 3. 4. Average.
C 60.35 60.77 60.87 60.11 60.52
H 8.92 8.49 8.70 8.68 8.70
O 30.73 30.74 30.43 31.21 30.70

On heating a portion of this same powder in an air bath to 110° C until it ceased to lose weight, there were found 5.62 per cent, of water: no further loss occurred on heating to 120°.

The compact formula which these figures most nearly represent is C16 H26 O6 or if we suppose the 5.62 per cent. of water represents one molecule of H2O, as it certainly does, we have C16 H26 O5 H2O as the formula of the substance dried at ordinary temperature over sulphuric acid. The following is a comparison in percentages:

Found. Calculated from C16 H26 O5 H2O.
C 60.52 60.75
H 8.07 8.23
O 25.12 25.33
H2O 5.62 5.69

Of known compounds this is the nearest in composition to parillin or sarsaparilla-saponin. The opinions regarding this latter compound are somewhat various; the latest publication is that by Flückiger (Archiv. de Pharm. vii, p. 532), who found the mean of three analyses of parillin to be C=60.40, H=9.00, O=30.60, and in other samples he found somewhat smaller percentages of carbon. He suggests as a formula for these percentages C48 H85 O18, which is very close to three times the formula C16 H28 O6. Such a multiple would not, however, be compatible with 5.62 per cent. of water in combination, as there is in Leontin, since before drying at 110° all adhering moisture was removed in a desiccator. Neither is this formula of Leontin exactly in accordance with Flückiger's suggestion that all saponins have a general formula Cn H2n-10 O18.

Other investigators have found parillin to have about the percentage composition given by Flückiger, but differ as much among themselves as from the figures given for Leontin. Parillin melts at 210° C, earlier investigators gave as low as 125°. Leontin remained unchanged until 231° to 233° C was reached, when it softened into a yellow mass, but did not completely melt.

Caulophylline. [Do not confuse this name with the term Caulophyllin, appropriated by the so-called resinoid. Probably the resinoid will disappear in time to come. The termination of the words in and ine will serve to distinguish them.]—Prof. F. F. Mayer [(See Leontin, p. 151) At this time Prof. Mayer was interested in the test for alkaloids, now known as Mayer's Test. He did not separate an alkaloid from Caulophyllum. He obtained a precipitate with his reagent from an aqueous solution of the plant, an uncertain reaction, perhaps, under the circumstances. Such authorities as Maisch did not deem it conclusive, as is shown by the National Dispensatory omitting the alkaloid.] identified an alkaloid, and states that such was the case, in a positive manner. The alcoholic tincture was evaporated and the residue washed with dilute acid, "which dissolved a colorless alkaloid, and, soluble extractive matter." [American Journal of Pharmacy, 1863, p. 99.]

Ebert (1864) [American Journal of Pharmacy, 1864, p. 203.] failed to crystallize an alkaloid, and inferred that the drug Mayer used must have contained Hydrastis or other alkaloid yielding plant. [We also agree that commercial Caulophyllum is an uncertain substance, and it is more than probable that unless Prof. Mayer exercised the greatest of care, the drug he used was contaminated with other substances.] Our investigations show that Prof. Mayer was right in stating that an alkaloid existed in the plant, although he did not obtain it pure. Also that Mr. Ebert was misled by reason of the fact that he doubted its presence because it was uncrystallizable. [Mr. Ebert would not corroborate Mayer's assertion, because he could not crystallize the alkaloid. We are now aware of the fact that several alkaloids have not been crystallized.]

Preparation.—Tincture of Caulophyllum is to be evaporated to a syrupy consistence, acidulated slightly with hydrochloric acid and poured into a large volume of water; and after twenty-four hours filtered. The filtrate is to be evaporated to the consistence of a solid extract, and triturated with sulphuric ether, a little ammonia water being added to slight alkaline reaction. The ethereal liquid is filtered and evaporated in the presence of water, and, the watery liquid filtered. This gives an aqueous solution of the alkaloid which can be further purified by evaporation to dryness, solution in concentrated ether, filtration and evaporation.

Properties.—This alkaloid is colorless, tasteless, and odorless. It dissolves freely in alcohol, and is quite soluble in water. Its ordinary salts are very soluble, much more so than the alkaloid. The alkaloid in our hands formed glassy, amorphous layers upon evaporation of the solvents, and we failed to obtain crystals of it.

The hydrochlorate of the alkaloid from aqueous solution, formed definite crystals of radiating stars, tasteless and very soluble in water.

All alkaloidal reagents used by us gave prompt and copious reactions with solutions of either the alkaloid or its salts. Caulophylline does not possess decided sensible properties, and is not characteristic of the drug.

MEDICAL HISTORY AND PROPERTIES.—Proceeding the year 1813 this plant was unknown to medicine, although there is no doubt that it was employed by the peculiar specialists known as "Indian doctors." In the year 1813 Peter Smith (See note, p. 141) issued an illiterate publication in the way of an advertisement, and among other substances, introduced Blue Cohosh, under the name, Squaw Root. He asserted that the Indian women made use of a decoction of the root, taking it regularly for a period of two or three weeks before the time for parturition, and that to it they ascribed their freedom from the difficulties common to the whites. He also stated that it was a valuable emmenagogue. This statement of Smith's was accepted by botanies, and the drug became a recognized remedy. [Some medical writers in recognizing the history of the drug use such expressions as "A late empirical writer," (See Hand, 1820) refusing to give the name of Smith, but, the fact remains. Perhaps only in the medical profession would writers of history presume to ignore the name of a discoverer because of prejudice.]

Rafinesque (1828) [Medical Flora of the United States, Vol. I., p. 97.] accepts the drug as a valuable remedy, giving Smith credit for its introduction.

Howard, Beach, King, Kost, Scudder, and the representative writers of the Eclectic School of Medicine, have recognized Caulophyllum as a valuable remedy, and it has been largely used by Eclectics from the day of Beach. They credit Smith with its introduction, and use it for the diseases where he asserted it to be of value.

Griffith (1847) [Medical Botany, 1847, p. 114.] gives the plant a position, without commendation, upon the assertion of "empirics," stating, "It is unknown in regular practice."

The United States Dispensatory neglected it through eleven editions, introducing it in the appendix of the twelfth edition (1865), and adding but little since.

The literature of the Regular Medical profession contains but little, if anything, concerning Caulophyllum. Prof. Eric Saltier, M. D., intended writing the uses and history for our publication, but found that the drug has no record. The meagre notes we give in our general medical history embrace the sum and substance of Regular literature, and it may be accepted that Caulophyllum has been exclusively Eclectic and Homoeopathic in its employment.

The uses of the drug in the Eclectic and Homoeopathic Schools of Medicine are contributed to this publication by Professors King and Hale, as follows:

THE USES OF CAULOPHYLLUM IN THE ECLECTIC SCHOOL OF MEDICINE.—(Written for this publication by Prof. John King, M. D., Professor of Obstetrics and Diseases of Women, in the Eclectic Medical Institute of Cincinnati).—Caulophyllum thalictroides is a very valuable remedial agent that has been in use among Eclectic practitioners for many years past. It, undoubtedly, exerts a beneficial influence upon abnormal conditions of mucous membranes, as manifested in certain forms of stomatitis; indeed, my own first knowledge of the agent was in 1836, when I used it in decoction, quite extensively, alone or in combination with Hydrastis Canadensis, as a local application in the treatment of aphthae and similar affections of the mouth.

It has also been used with success in rheumatism—more especially the articular variety; also in flatulent and spasmodic colic, cramps, hiccough, and in epilepsy, due to diseased state of the female reproductive organs. Added to certain drastic purgatives, as aloes, podophyllin, etc., it will greatly diminish the tormina so frequently attending their action, and in most instances will entirely prevent it. Caulophyllin is more generally employed for this latter purpose. Certain writers have stated that it possesses diaphoretic, diuretic, and anthelmintic properties, but further observations are required, not only to determine these, but several other virtues that have been attributed to it.

Its more prominent properties appear to be, sedative, antispasmodic, and oxytocic; and, from its especial influences in these respects, upon certain maladies peculiar to the female generative organs, its use among Eclectic practitioners has become general in the treatment of several symptoms due to such maladies. Thus, it has been very efficacious in hysteria, not only having removed its attacks, but also any ovarian or mammary pain or irritation that was present. In arresting threatened abortion it has been found in every respect equal to Viburnum. In chronic corporeal or cervical endometritis, it has been very advantageously employed, as well as in uterine leucorrhea, amenorrhea, dysmenorrhea, etc., symptoms so frequently resulting from abnormalities of the uterus. In menorrhagia, so frequently attending uterine subinvolution, its continuous use for several weeks, has effected recovery when previous treatment had completely failed.

When used by delicate females, or those subject to prolonged and troublesome labors, for several weeks previous to the parturient period, it appears to impart tone and normal action to all the powers engaged in this important process, facilitating its progress, and relieving the woman of much suffering. For this purpose it is frequently administered in combination with other agents, and given in proper doses, two or three times daily.

During labor, when, from fatigue, debility, or impaired uterine nervous energy, the contractions become feeble, inefficient, or very severe and of a spasmodic character, or have entirely ceased, the administration of Caulophyllum in decoction, or even in powder, will be found preferable to Ergot, as the contractions aroused by its action are less violent and spasmodic than those effected by Ergot, and more nearly resemble the natural ones. In severe after-pains, more prompt and efficient relief will follow the use of Caulophyllin, than from any other agent, in doses of from two to four grains, administered, if necessary, every one, two, or three hours.

The tincture, fluid extract, specific tincture, and the preparation called "Caulophyllin," are chiefly employed by practitioners at the present day. Dose of the decoction or infusion (1 oz. root to 1 pint water), from two to four fluid ounces every three or four hours; of the tincture (3 oz. pulv. root to 1 pint alcohol), from ten to thirty drops, three to four times a day; of the fluid extract, from five to fifteen drops; of the specific tincture, three to ten drops;—the indications for which, are debility (irritability) of the nervous system with impaired muscular power; spasmodic muscular pains; colicky pains in epigastric and umbilical regions; pains in articulations; dull frontal headache; great thirst.

THE HOMOEOPATHIC HISTORY OF CAULOPHYLLUM AND CAULOPHYLLIN.—(Written for this publication by Prof. E. M. Hale, of Chicago,—author of "New Remedies,"—Prof, of Mat. Med. and Therapeutics, in the Chicago Homoeopathic College).—It is a matter of some interest to note the history of this drug in the Homoeopathic school. Prof. B. L. Hill, at one time Prof. of Surgery in the Eclectic College at Cincinnati, at a later date occupied the same chair in the Homoeopathic College of Cleveland, O. While lecturing then, he occasionally lectured for other Professors, for he was a kind of universal genius. He delivered several lectures on obstetrics and diseases of women, and in those lectures, mention was made for the first time in any Homoeopathic college, of the virtues of Caulophyllum, as well as Cimicifuga, Hydrastis, etc.

In 1868, I began a series of articles in the North American Journal of Homoeopathy on "Indigenous Remedies," among which was one on "Caulophyllum in diseases of women." In this article I collected all that had been written on this plant by "Botanics" and "Eclectics," to which I added my large personal experience.

A few years later I re-wrote this article for my "New American Remedies," adding much clinical experience, and a "proving" by Dr. W. H. Burt, on himself. This proving did not, of course, throw any light on its gynecological properties, but some symptoms were evolved which showed some relationship to other members of the same genus—the Berberideae. It caused rheumatic pains in the small joints and muscles, which showed its affinity with Jeffersonia; some mucous, membrane and renal symptoms—having some resemblance to Berberis, and some intestinal and hepatic irritation like that caused by Podophyllum, only in a mild degree.

Had I space I would like to make some observations on the qualities of plants of the same genus. A genus, like a human family, may show some analogous traits in each member, yet each member may have a very distinct personality. Lindley, Murray and Cullen have written on this subject, but none have discussed the subject in such a masterly manner as the late Prof. Tully, who was the most erudite and marvelously learned botanist and writer on Materia Medica which America has ever known.

Caulophyllum is one of a class of remedies whose virtues seem to have been well known to the aborigines of this country. They call it Squaw Root, by which name it is known to the common people. Early pioneers, lay, as well as professional, all bear witness to the high estimate placed on it by the Indians for the relief of the sufferings and weaknesses of the women of that race. It has another name, Blue Cohosh—the origin of which I have not been able to ascertain.

Its sphere of action, as near as can at present be stated, is not extensive, but confined to the small muscles and joints, the muscular tissues of the generative organs, and possibly the motor nerves and mucous membranes. The provings made do not throw much light on its general powers. Its clinical uses afford us almost all the data upon which we base our knowledge.

Its most prominent value seems to be its power of causing intermittent contractions of the gravid uterus, and possibly of the unimpregnated. In this it differs from Ergot, which causes, or tends to cause, persistent contractions. The remedies which most resemble it in this respect are Viburnum, Cannabis Indica, and Cimicifuga. It has become very popular with a portion of our school, for the following conditions:

1ST.—Deficient labor pains, when they do not appear with sufficient vigor and regularity, at full term, and during labor; when the pains have disappeared from exhaustion; when they are too severe and too painful, or are spasmodic. In the two first instances it should be given in doses varying from one-fourth grain of the Caulophyllin, crude, to a grain of the 1st or 2nd, frequently repeated; but in the last instance, to which condition it is primarily homoeopathic, the dose should be from the 3d to the 6th, or higher.

I mention the active principle, because it seems to possess the desired powers of the medicine in a pleasanter form than the tincture, which, in its crude state, is quite irritating to the fauces. But the tincture can be used in about the same proportions, if necessary, substituting ten drops for each grain of Caulophyllin.

The same directions will answer for the dose in other conditions in which it is specific, namely:

2ND.—Spasmodic dysmenorrhoea, when the flow is natural in quantity and quality. This distressing condition is often cured by Caulophyllin, but to be successful, the medicine must be given several times during the week or two preceding the menses, as well as during the painful period.

3RD.—Spasmodic after-pains, in which it is indispensable.

4TH.—Spasmodic pains in the uterus, broad ligaments, etc., occurring at any time, from a cold, rheumatism, during pregnancy (false pains); also general, as well as local spasms, from the suppression of the menses or lochia.

As might be expected from its powers, which I have just enumerated, it is a powerful agent for the prevention of premature labor and miscarriage, provided the premonitions are pains of a spasmodic character.

The aborigines and earlier settlers claimed for it the power of preventing tedious and painful labors. This testimony has been substantiated by many prominent and trustworthy physicians of the Eclectic school, as well as of the Homoeopathic. A few of our schools have denied it such power, but the weight of the evidence is against them. I am sure, from the observation of many years, that it actually prevents the unusual sufferings which many women undergo. I can testify to the singular fact, observed by many of our school, that many women who have taken it for such purposes have overrun their time to the extent, in some cases, of ten or twelve days. The cases referred to, however, all had very easy labors and a good recovery. My experience has been so uniform and conclusive on this point, that I do not hesitate to assert that it prevents not only a too painful labor, but it prevents those premature labors which are so common among the weakly women of this age.

We must not expect it to prevent painful labors (dystocia) in women who become advanced in life before they bear children, or in whom there exists any deformity of the pelvic cavity. Such cases are mechanical obstacles to easy, natural labors. Caulophyllum removes only abnormal functional causes. The method of giving it in such cases is to prescribe a few grains of the 2nd or 3rd trit., or a few drops of the 0 or 1st dil., three times a day, for the last two weeks previous to the expiration of the term. If, however, a premature labor is feared at the seventh or eighth month, it should be taken during the two weeks preceding those periods.

Caulophyllum has been recommended for rigid os uteri, but I believe the rigidity is overcome, not from any specific power on the circular muscles of the os, but from its general action on the uterus. Gelsemium and Belladonna are better for this condition.

If uterine displacements are attended by periodic, spasmodic pains, Caulophyllum will form a valuable auxiliary to Sepia, Lilium, Nux, or Belladonna. In my second edition of "New Remedies" was recorded a case of paraplegia from retroversion, which the Caulophyllum was supposed to have cured. We need further confirmation, however, before we accept it as a remedy for such condition.

It seems to be homoeopathic to rheumatism of the short muscles and small joints of the extremities, and a few cases of that character have been reported. It is said to be indicated when spasmodic pains occur in the stomach, intestines, and other organs in sympathy with the same kind of pains in the uterus. There is no particular reason why they should always be in sympathy with that organ in order to render this remedy curative.

There have been no experiments, to my knowledge, or clinical data, which show the influence, if any, which this drug may possess on the quantity and quality of the menstrual flow.

In this respect it resembles Cimicifuga, which does not appear to increase or decrease the normal flow. Caulophyllum resembles Cimicifuga in many other things, viz.: its action on the muscles, especially those of the uterus, and the motor system of nerves. This is not the only species of the genus which resembles one of the Ranunculaceae, for Berberis vulgaris closely resembles Hydrastis.

THE THERAPEUTIC ACTION OF LEONTIN,—(written for this publication by Prof. E. M. Hale, Prof. of Materia Medica and Therapeutics in the Chicago Homeopathic College). A few weeks ago Messrs. Lloyd sent me a few grains of this glucoside, and some of their one per-cent solution. If this really represents all the therapeutic properties of Caulophyllum it will become of great value to the medical profession.

I suppose from what I can learn of its potency, that one grain represents ten grains of Caulophyllin. It has the great advantage that it is devoid of the bitter, nauseous taste of the latter. I have used it in two cases with apparently very prompt and happy results:

1. A young lady habitually running a week or two beyond the normal time applied to me for some medicine to regulate her. I gave her Senecin 1x, with no results for a week. After waiting a few days I gave her Leontin, one per-cent solution. She took a teaspoonful at night. During that night the menses appeared, in usual amount, and painless.

2. A married woman missed her regular period. Not altogether, for she had a sudden flow of an hour or two on the day she should have been unwell. A week after she began to have a dirty, brown discharge, with some heaviness and pains in the back and groins. Sabina 2x and Secale 2x were given until a few days before the next period, but with no benefit. I then gave her Lloyd's one per-cent solution of Leontin, a teaspoonful every four hours. After the fourth dose expulsive pains came on and she soon expelled a fetus of five weeks. On examination I found a black, disorganized placenta, in the cervical canal. On its removal all pain and flowing ceased.

Another case illustrates its powerful medicinal action:

3. A married woman applied to me to restore her menses—overdue three weeks. She assured me that there was "no possibility of pregnancy." I gave her ℨii of the one per-cent solution, and ordered her to put it in 1/2 glass of water, and take a teaspoonful every hour. In a few days she returned saying she did not want any more of "that medicine," as, after each dose, violent labor-like pains occurred and lasted nearly an hour. She described the pains as distinctly intermitting, commencing in the back and going across the hypogastrium and down the vaginal regions. It caused no flow, and disappeared after the last dose. Here is a good picture of its pathogenetic effect. I shall make use of it in labor whenever occasion requires. It appears to be applicable when Ergot would not be, for the present dictum of obstetricians is not to use Ergot while anything remains in the uterus. It is indicated in feeble, ineffectual or absent labor pains, but in hemorrhage after labor I still prefer Ergot. The above refers to the physiological uses of Leontin. In such cases appreciable doses must be used. These doses will vary from ℨi of the solution hourly to five or ten drops.

But its uses according to the law of Similia are in another direction. As a homeopathic remedy for labor-like pains, uterine cramps and spasms, dysmenorrhoea, false-pains during pregnancy, and severe afterpains, it will doubtless prove effectual. I have found it so in several cases of dysmenorrhoea, both neuralgic and spasmodic. In such cases the proper method of administration is to put 10 or 15 drops of the one per-cent solution in half a goblet of water, and prescribe teaspoonful doses. An elegant preparation for homoeopathic use is a trituration (centessimal) of the pure crystallized glucoside. I have in a few cases used the 2° cent. trit. in uterine pains, with good success. In my paper on Caulophyllum I stated that we had yet no positive proof that it actually increased the quantity of the menstrual flow. Since that was written I have been informed by Dr. S. Leavitt, of this city, that he is convinced from large experience with the tincture that in material doses it does not have this effect. I am now convinced that Leontin has this effect. Not only does it increase the amount of the flow, but it will bring it on before the usual time.

Surely such a powerful drug as Leontin must have a wider sphere of action than the generative organs of women. It ought to prove useful in many spasmodic affections of hollow organs, notably the heart, stomach and bladder.

THE ACTION OF LEONTIN AS AN EMMENAGOGUE.—(Written for this publication by Thad A. Reamy, A. M. M. D., Prof. of Clinical Gynecology, Medical College of Ohio, Gynecologist to the Good Samaritan Hospital and to the Cincinnati Hospital.)

Introductory to some clinical observations as to the value of Leontin as an emmenagogue. The following general remarks on Amenorrhoea are appropriate.

Amenorrhoea—May be divided into three classes depending upon its etiology,

1st. The obstructive or mechanical variety due to abnormality of the organs concerned in the menstrual function, conditions which may be congegenital or acquired.

2d. Symptomatic Amenorrhoea where menstruation does not appear or ceases because of some constitutional condition, as anaemia, scrofula, phthisis, etc., or pathological state of some organ remote from the genital system.

3d. Amenorrhoea sometimes occurs when the cause cannot be found in either of the above classes and may, for convenience, be called functional or idiopathic.

As a rule, the importance of amenorrhoea per se is greatly exaggerated by its subjects and their friends. The cessation of menstruation in itself is worthy of attention only when other important disturbances are induced as a result. In cases of the symptomatic variety, which are a large majority, the underlying condition only requires treatment. The removal of the cause will usually restore the menses. Only evil can result from use of emmenagogues when amenorrhoea is due to phthisis.

The cessation of the regular menstrual flow in such cases is conservative and should not suffer interference. Those subjects who do not menstruate because of some congenital or acquired malformation of the genital organs will usually find relief only in surgery.

In cases of the so-called functional or idiopathic type, lies the proper field for emmenagogues, remedies having a selective action upon the ovaries and uterus by promoting the menstrual function. The rational clinical classification of cases is therefore of the utmost importance in treatment, and a clear conception of such cases as are properly functional or idiopathic is essential to the intelligent employment of remedies.

The differential diagnosis of the class of amenorrhoea to which a given case belongs is usually not very difficult when careful and patient inquiry into its etiology is instituted.

The first class is readily determined by a physical examination which is perfectly justifiable in suspected cases in married women. In the unmarried the diagnosis may be inferred by exclusion of the second and third classes, and under such circumstances a strong presumption of genital malformation would warrant the necessary examination. But the practice, too prevalent, of subjecting young misses to manual and instrumental examination of sexual organs on trivial pretexts is surely to be condemned. It is within the knowledge of all, that physicians are urged by mothers to prescribe for girls who have not yet arrived at the proper state of development. [It is too often the belief that when a girl has arrived at the age of twelve or thirteen years, and especially if there is some mammous development, she should promptly menstruate. Nothing could be more fallacious. Again, when a girl has menstruated once or twice, should the function be suspended for a period or two, she is by the mother regarded as an invalid, whereas irregularity during the period of menstrual development is the rule and should not be interfered with, except for due cause.]

Those cases of amenorrhoea in which the menstrual suppression is but a symptom must be diagnosed and the discovery of the cause decides the character of. the treatment indicated.

So-called functional or idiopathic amenorrhoea pre-supposes a normal condition of the ovaries and uterus, without any local pathological condition. The function of the endometrium in discharging a periodical flow of blood is arrested from no apparent fault of its own. In not a few cases the trouble is due to disease of the endometrium, or rather to the products of pre-existing inflammation. When such disease is found it must of course be removed. The ovaries are presumably able to furnish the exciting nervous stimulus which is claimed to be necessary to the discharge. The general nutrition of the body is unimpaired, the blood not deficient either in quantity or quality, and the circulation preserves its usual character, nevertheless, successive periods pass without menstruation and the engorged pelvic circulation remains unrelieved with the usual tenesmus, backache, headache, and mental torpor generally complained of under such circumstances. These vague, depressing symptoms are in most instances the only real indications for treatment, since the simple absence of the menses, without coincident subjective disturbance is not often a condition demanding treatment.

The clinical aspect of cases of functional or idiopathic amenorrhosa may be divided into two groups of subjects:

First, young girls who are fighting the physical battle incident to the nubile period, and enduring the nervous strain necessary in getting the education, mental, musical and decorative, which is presumed to fit them for society. As a result the nervous energy which is required for the catamenial process is diverted and, although the menstrual machinery and supply is adequate, menstruation occurs at long intervals or not at all. These are the cases usually ascribed to mental strain or shock.

To the same category belong cases of menstrual suppression, due to moral shock, self-abuse, etc., etc.

The second group comprises those not infrequent cases in women, married and usually parous who after the age of thirty begin to increase rapidly in weight, becoming to all appearances perfect pictures of matronly health, yet menstruation becomes less and less frequent and stops. In these women the diminution of menstrual discharge is accompanied with various nervous and pelvic symptoms, aggravated by the mental depression produced by the popular fallacy that absence of menstruation forebodes great evil and premature old age. In these cases the mental disturbance is much increased by the fear that they will bear through life the stigma of sterility, or if one child has been born and others vainly expected the situation is not improved.

These briefly are the conditions constituting functional or idiopathic amen- orrhoea.

In such cases emmenagogues may properly be exhibited, and in manv instances their exhibition will be followed by good results.

It will not be possible here, in our want of positive knowledge as to the physical process which supplies the nervous force necessary to carry on the menstrual function, on the one hand, and of the physiological action of reputed emmenagogues upon the other, to give the modus operandi of remedies employed, however tempting this field of speculation might be. It is only proposed to determine the clinical value of agents so employed, when confined to the proper field for such trial, that now concerns us.

The above general remarks will be followed by some clinical observations on Leontin as a remedy in cases of the functional or idiopathic variety.

(The book ends here. -Henriette)

Drugs and Medicines of North America, 1884-1887, was written by John Uri Lloyd and Curtis G. Lloyd.

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