Cimicifuga: History - Preparations.
Continued from previous page.
Pharmacopoeial history - Pharmacopoeial preparations - Unofficial preparations - Examination of cimicifugin for the detection of a crystalline substance - Medical history and propertis - The medical history and physiological action of Cimicifuga racemosa - Clinical investigation with the fluid extract of Cimicifuga racemosa
PHARMACOPOEIAL HISTORY.—Cimicifuga was not officinal in the first (1820) edition of the U. S. P. In the Philadelphia edition, 1830, it was introduced under the names Cimicifuga racemosa Nuttall, and Cimicifuga Serpentaria Pursh, (radix, the root), and in the New York edition of same date it was recognized (Cimicifuga radix) under the names Actaea racemosa and Cimicifuga Serpentaria. The common name in both instances was Black Snakeroot. [In the Philadelphia edition it was spelled Black Snake Root.] The edition of 1840 designated it as Cimicifuga, "the root of Cimicifuga racemosa, Torrey and Gray, Flora of North America,'' and this description remained unchanged in the subsequent revisions of 1850, 1860, and 1870. In 1880 we have "Cimicifuga (Black Snakeroot), the rhizome and rootlets of Cimicifuga racemosa, Elliott (Nat. Ord., Ranunculaceae)." It has always occupied a position in the primary list of the U. S. P.
"EXTRACTUM CIMICIFUGAEFLUIDUM.—(Fluid Extract of Cimicifuga.)—
Take of Cimicifuga, in fine powder, sixteen troyounces;
Stronger Alcohol, ["Alcohol Fortius," Stronger Alcohol. Spirit, of the specific gravity 0.817, U. S. P. 1860.] a pint and a half,
Diluted Alcohol, a sufficient quantity.
Moisten the Cimicifuga with four fluid ounces of the Stronger Alcohol, introduce it into a conical percolator, pour upon it the remainder of the Stronger Alcohol, and, when the whole of this has entered the powder, gradually add Diluted Alcohol until a pint and a half of tincture have passed. Set this aside, in a shallow vessel, until reduced by spontaneous evaporation to twelve fluid ounces. Continue the percolation with Diluted Alcohol, until two pints more of tincture have been obtained. Evaporate this, by means of a water-bath, at a temperature not exceeding 150°, to four fluid ounces; then add the tincture first obtained very gradually so as to avoid precipitation, allow the mixture to stand for twenty-four hours, and filter through paper."
The foregoing formula was defective from the use of two menstruums. As a consequence, the evaporated hydro-alcoholic final percolate refused to yield an extract soluble in the reserved portion that was produced by stronger alcohol. Then, too, the water in the creamy extract left from the evaporation of the final percolate altered the reserved percolate, and when it was added, precipitation of resinous matter resulted, and the operator vainly tried to "add the tincture first obtained very gradually so as to avoid precipitation." Hence we find the Pharmacopoeia of 187o directs as an improvement the use of stronger alcohol throughout the entire operation, sixteen troy ounces of cimicifuga being used to produce a pint of fluid extract.
The process of the Pharmacopoeia of 188o is practically that of the preceding revision, excepting that one hundred grammes of powdered (No. 60) cimicifuga are employed to produce one hundred cubic centimeters of the finished product; Alcohol of s. g. 0.82 being employed throughout.
"Cimicifuga, in No. 60 powder, twenty parts,
Alcohol, a sufficient quantity to make one hundred parts.
Moisten the powder with fifteen (15) parts of alcohol and macerate for twenty-four hours; then pack it firmly in a cylindrical percolator, and gradually pour alcohol upon it until one hundred (100) parts of tincture are obtained."
There have never been any other officinal preparations of cimicifuga, and, in our opinion, either the tincture of 1880 should have been omitted, or, it should have been directed to be made extemporaneously. This could have been accomplished practically, and when called for, by the admixture of one part of fluid extract of cimicifuga and four parts of alcohol.
UNOFFICINAL PREPARATIONS.—Of these, the resin of cimicifuga is most important. It has always been a favorite with the Eclectics, and represents the active principles (or most of them) of dry cimicifuga. (See page 268.) A few of the others are of sufficient importance to be recognized by Eclectics, and have thus earned a place in the American Dispensatory. The rest have been used more or less in private practice, and have finally wandered into print and are occasionally referred to. The larger number of these mixtures are nearly obsolete and should not be revived. However, our work would be less complete should we exclude them, and as pharmacists occasionally have a demand for these old preparations, we feel that they should all be placed on record in this publication.
Resin of Cimicifuga (Cimicifugin, Macrotyn).—Preparation.—Take of powdered cimicifuga, any convenient amount, prepare it for percolation and exhaust it with officinal alcohol, evaporate the tincture to a creamy consistency and pour it into twenty times its bulk of cold water, stirring constantly. Collect the precipitate, wash it well with cold water and dry it by exposure to a cool atmosphere.
It dries slowly, owing to the partial melting of the outer surface, which forms a coating that prevents the escape of vapor from within, for which reason the vitrious mass must be often crushed. During the exposure it darkens considerably, sometimes being almost black.
History.—We recognize under the above name the substance that precipitates when the residue of an evaporated alcoholic tincture of cimicifuga is precipitated in water.
Cimicifugin was first made and used in medicine by Prof. John King, in 1835, who called it to the attention of physicians in 1844, and again in the "Western Medical Reformer" of 1846. [See American Dispensatory.]
In 1849 Mr. Wm. S. Merrill contributed a paper to the "Eclectic Medical Journal," in which he gives a process of making "Macrotyn" by precipitation of an alcoholic tincture of cimicifuga (Macrotys) with water. In 1856, Grover Coe assails the "macrotyn" as not representing the plant, and he asserts that the value of cimicifuga depends on three principles-resin, alkaloid and neutral. As usual, however, with that writer, he rests his proof with an unsubstantiated statement. From that time until the present, this substance under the name Cimicifugin, or Macrotyn, [The word was originally spelled Macrotin, but we know of no reason for changing the y of Macrotys into i.] has been an important drug with many Eclectic physicians and is consumed in considerable amounts. It contains the principle of the rhizome that produces the disagreeable symptoms (see medicinal properties), and is of considerable interest therapeutically. Although this is a mixture of substances, we shall refer to it as a resin, in accordance with the generally accepted view of the writers.
Properties.—Freshly precipitated cimicifugin is of a light yellowish color, and imparts a sweet taste to water. Upon drying, it darkens, and becomes deep brown, nearly black when in mass. Upon triturating this, a brownish or yellowish powder results. The odor is like that of the fresh rhizome and very strongly marked, somewhat like smoke. The taste is at first sweet (resembling glycerrhizin), and upon prolonged chewing becomes disagreeable and acrid, imparting a burning or smarting sensation to the throat.
Solubilities.—This substance, being a mixture, is partially soluble in several menstruums and entirely soluble in none. It is almost dissolved by both ethyl and methyl alcohols. Boiling water extracts small amounts of the sweet principle, leaving the acrid substance. It is about one-half dissolved by ether and but in small amount by chloroform, benzol and benzine, and it is nearly dissolved in a solution of caustic alkali. It is, really, a mixture, one constituent of which is an acrid resin (soluble in ether and alcohol), and this imparts most of the acridity to the rhizome. Another is a resin that is soluble in alcohol and nearly insoluble in ether. Neither of these substances is crystalline.
Mr. L. F. Beach [American Journal of Pharmacy, 1876, p. 375.] reports that by following Conard's process with commercial cimicifugin, [This is indefinite. Commercial cimicifugin is of questionable composition.] he obtained crystals of the hexagonal system. [See pp. 264, 265, 266.] As we have never succeeded in obtaining crystals from it, we submitted some of the pure precipitate to Prof. Virgil Coblentz, with a request that he obtain these crystals for us, and to otherwise report on the substance. We herewith submit the result of his investigation:
EXAMINATION OF CIMICIFUGIN FOR THE DETECTION OF A CRYSTALLINE SUBSTANCE.—(By Virgil Coblentz, Professor of Chemistry in the Cincinnati College of Pharmacy.)—"The alcoholic solution of the cimicifugin was colored greenish black (no precipitate) by ferric chloride. After prolonged boiling in an excess of water, about forty per cent. of the substance was dissolved, which solution readily reduced Fehling's solution. The undissolved residue was a brownish colored resin (brittle), which retained the acrid taste and peculiar odor characteristic of the drug. The portion soluble in the boiling water possessed a sweetish taste free from acridity, and gave a slight precipitate upon the addition of an acid, it possibly being due to a principle, similar to glycerrhizin in its nature; gummy and mucilaginous principles were also present in this aqueous solution. The resinous residue remaining after treatment with boiling water possessed an acrid and slight bitter taste, and on resolution in alcohol and precipitation in water, became of much lighter color. The original principal (cimicifugin) was subjected to Conard's process (see page 262). It was found that decolorization with alumnic hydrate was unnecessary. As the alcohol slowly evaporated, a clear, pale yellow brittle resin separated upon the sides of the beaker. It was inodorous and of an acrid taste, requiring for solution a large excess of ether. The operation was repeated several times, with larger amounts of material, with same results as before. This resinous-like substance, after prolonged boiling with water acidulated with hydrochloric or sulphuric acid, was split into sugar and another substance which separated as a gray amorphous mass. This was washed and dried. It was soluble in alcohol; insoluble in ether, chloroform, turpentine, carbon disulphide, benzine or baryta water. Its alcoholic solution is not colored by ferric chloride When warmed with sulphuric acid (dilute) it gives a purple color; other acids and iodine do not affect it. The following may be inferred to be the composition of the so-called resinoid:
|Portion soluble in water||Gum; coloring matter; a sweet principle (reducing Fehling's solution); mucilage.|
|Insoluble in water||A resinous-like substance possessing acrid taste of drug, that splits into sugar and another substance on treatment with dilute acids.|
The result of my investigation was entirely negative in my attempt to obtain a crystalline principle from the so-called cimicifugin."
Fluid Extract of Cimicifuga.—Prof. Wm. Proctor first recommended a formula for making this preparation in the American Journal of Pharmacy, 1854, p. 107, and next Prof. J. M. Maisch suggested a process in the American Journal of Pharmacy, 1859, p. 313. Both these processes were defective from the fact that ether was unnecessarily used, and that water was a large constituent of the final liquid. One of the processes employed sugar. Hence, Prof. Proctor recommended to the American Pharmaceutical Association, 1859, that alcohol only be used, a process that has not been improved upon to the present day. (See Pharmaceutical Preparations, p. 266.)
Extract of Cimicifuga.—A hydro-alcoholic extract was directed to be made by Dr. King (Eclectic Dispensatory) in 1852, by percolating the cimicifuga first with alcohol, then with water, mixing the percolates and evaporating to an extractive condition. This process is objectionable, and we commend the following:
Take of Fluid Extract of Cimicifuga, any convenient amount. Evaporate until reduced to the condition of a soft extract.
- Compound Fluid Extract of Cimicifuga.—
- Take of Fluid Extract of Cimicifuga - one ounce.
- Fluid Extract of Wild Cherry - one ounce.
- Fluid Extract of Ipecac - one-fourth ounce.
- Fluid Extract of Liquorice - one-fourth ounce.
- Fluid Extract of Senega - one-half ounce.
- Mix them together.
These ingredients are in accordance with Tilden & Co., Book of Formulas, 1861. The proportions are in accordance with the Druggists' Circular, 1872, p. 143. No uses given for this mixture.
- Compound Enema of Cimicifuga.—
- Take of Powdered Cimicifuga - two ounces.
- Powdered Geranium - two ounces.
- Water - four pints.
Mix them together, make a decoction, and strain. This is an astringent preparation, employed as an injection in leucorrhea, etc. Formula of Dr. V. T. Morrow, from the American Dispensatory.
- Infusion of Cimicifuga.—
- Cimicifuga - two ounces.
- Boiling Water - one pint.
Pour the boiling water on the crushed cimicifuga, and when it becomes lukewarm, strain it. This is the strength Sanborn states (The Sick Man's Friend, 1855) was used by the Indians, who drank two or three swallows of it at a time during the day, This infusion was afterward made one ounce to the pint, but we think that if a deviation is made from the original strength, the officinal proportion, one to ten, should be employed.
- Cimicifuga Mixtures.—For Rheumatic Affections and in Anasarca.—
- Take of Tincture of Cimicifuga - one ounce.
- Iodide of Potassium - two drachms.
- Syrup of Ipecac - one ounce.
- Water - two ounces.
Mix together. Teaspoonful three or four times a day. (Journal of Materia Medica, 1860.)
- For Chronic Bronchitis and Early Stages of Phthisis.—
- Take of Tincture of Cimicifuga - one ounce.
- Tincture of Sanguinaria - one ounce.
- Sulphate of Morphine - two grains.
- Syrup of Acacia - two ounces.
Mix together. Give a teaspoonful when the cough is troublesome. (Journal of Materia Medica, 1860.)
- For Dropsy.—
- Take of Tincture of Cimicifuga - one ounce.
- Tincture of Myrrh - six drachms.
- Laudanum - one drachm.
- Tincture of Capsicum - one drachm.
Mix together. Take thirty or forty drops three times a day. (Journal of Materia Medica, 1860.)
- Compound Pills of Cimicifuga.—
- Take of Solid Extract of Cimicifuga - one drachm.
- Solid Extract of Scutellaria - one drachm.
- Valerianate of Quinine - thirty grains.
Make 60 pills. Dose.—One every two or three hours. Used in nervous diseases, cholera and fevers, attended with wakefulness and restlessness. (Tilden & Co.'s Book of Formulas, 1861.)
- Syrup of Cimicifuga.—
- Take of Fluid Extract of Cimicifuga - three ounces.
- Simple Syrup - six ounces.
Mix them together. Dose, 30 to 60 drops. Used in rheumatism and wherever cimicifuga is indicated. (Tilden & Co.'s Book of Formulas, 1861.)
- Compound Syrup of Cimicifuga.—
- Take of Compound Fluid Extract of Cimicifuga - two ounces.
- Simple Syrup - one pint.
Mix them together. Dose, three to six fluid drachms. (Tilden & Co.'s Book of Formulas, 1861.) No ascribed value to this mixture.
- Tincture of Cimicifuga.—
- Take of Cimicifuga - three ounces.
- Proof Spirits, or Wine - one quart.
Mix and let it stand a few days.
This is Beache's formula, of 1833, given in his work (American Practice of Medicine) as "Tincture of Cohush." An officinal formula for making Tincture of Cimicifuga was introduced into the Pharmacopoeia in 1860 (see page 267).
- Tincture of Colchicum with Cimicifuga (Compound Tincture of Colchicum), King.—
- Take of Tincture of Cimicifuga,
- Tincture of Colchicum, equal amounts.
Mix them together. (American Eclectic Dispensatory, King & Newton, 1852.) Used in inflammatory rheumatism and in gout.
- Compound Tincture of Cimicifuga.—
- Take of Tincture of Cimicifuga - four parts.
- Tincture of Sanguinaria - four parts.
- Tincture of Phytolacca - one part.
Mix them together. Alterative, expectorant, and used in pulmonary affections. (American Dispensatory.)
MEDICAL HISTORY AND PROPERTIES. [This article was written independently of the following excellent paper by Dr. Sattler, and naturally many points will be repeated. On this account we have thought best to place this in smaller type.]—The important papers of early medicine were contributed to medical journals, and from them our authors derived the most of their information. Schalpf (1785) mentions the plant, but evidently knew little of its uses. The next reference we can find is that of Barton [Collections for a Materia Medica, Part II.] (1801) in which he speaks of it being used by the Indians—"our Indians set a high value on it." He ascribes to it astringent properties, stating that it was used in decoction as a gargle in putrid sore-throat, as a cure for the itch, and as a drench for the murrain in cattle. He gives it the Indian name, "squaw root," a name that denotes one of its uses with the Indians, for they applied it in diseases of women. In 1820 we find that Hand [House Surgeon and Physician, p. 236.] states that a tea "promotes perspiration and produces sleep," is used in rheumatism, hysterics, colic, fevers and debility from nervous prostration. Bigelow (1822) [Sequel to the Pharmacopoeia of the United States, p. 125.] states that Dr. Tully found it, in addition to the foregoing, diuretic, tonic, and useful in dropsy.
Dr. J. S. Gardner [Medical Recorder.] (1823) published a paper in which he commends it highly in pulmonary affections, speaking of his own experience as follows: "Shortly after commencing the use of this remedy, the hectic paroxysms, which had attended me some time previously, were entirely checked, the nocturnal evacuations from the surface of the body began to diminish, the expectoration of a fluid from the vessels of the lungs and bronchia, resembling pus in appearance, was speedily arrested; the cough became less troublesome and frequent. My pulse, which for some time before was never lower than from 100 to 120 pulsations to the minute, was reduced to the minimum standard; the pain in my right breast and side left me, my strength and appetite began to improve, and I speedily abandoned the use of all medicines or other means. A period of twelve months or more had elapsed, from my primitive ill health to the time of using this medicine. It certainly possesses the power in an eminent degree of loosening arterial action, and at the same time imparting tone and energy to the general system."
Ewell [The Medical Companion or Family Physician, p. 748.] (1827) devotes considerable space to this plant, but aside from certain combinations that he recommends to be made of it, nothing new is produced. In 1827 [Philadelphia Monthly Journal of Medicine and Surgery, Sept. 1827, p. 748.] Dr. G. W. Mears published a paper on the therapeutical uses of cimicifuga, together with an excellent lithographic figure of the plant and a chemical examination of the rhizome. His medical work was mainly a record of cases in which he had used it.
Rafinesque [Medical Flora of the United States, Vol. I., p. 85.] (1828) states that "This is one of the numerous Indian cures for the bites of snakes; they use the root chewed and applied to the wound," and in 1830 [Medical Flora of the United States, Vol. II., p. 201] he adds, "used for all rheumatic pains, diseases of languor and squirrous tumors, in tincture or decoction, by the Cherokees and Southern tribes." He refers to its uses in many of the other diseases named by us, and adds that it is a favorite remedy with the Indians generally. The most complete résume on the subject to that date, appeared in 1829 as an -addition to Edwards and Vavasseur's Materia Medica, by Togne and Durand. It was quite a creditable paper, but nothing new was developed.
Smith [Botanic Physician, Elisha Smith, p. 427.] states that "The Indians cure the ague by sweating with this root," meaning, perhaps, that they employed it in their fashion of steaming the patient in a close tent. He also asserts that "The yellow fever has been speedily cured by it, the bile having been first evacuated by an emetic." Howard [Improved System of Botanic Medicine, Vol. II., pp. 183, 300.] (1832) records that "It is likewise said to be a valuable remedy in small pox, and, in addition, he states that "repeated experiments (of others) left no doubt on the minds of our inform. ants, that rattle-root may be regarded as a specific against the effects of the small pox poison," and he refers to the paper of Dr. G. W. Mears, in which it cured "intermittent fever which had resisted for six weeks the ordinary treatment," and adds, Rattle-root has, however, acquired the greatest celebrity as a cure for coughs and consumption."
Beach [The American Practice of Medicine, Vol. III., p. 30.] asserts that "a strong decoction mixed with slippery-elm bark, makes a good poultice for every kind of inflammation. A decoction is also used for the purpose of arresting hemorrhage. A syrup of the root is good for coughs. It also makes an excellent gargle for quinsy." The first edition (and subsequent issues) of the United States Dispensatory recognized cimicifuga, ascribing to it more or less of the values previously recorded. Dunglison [General Therapeutics and Materia Medica, Vol. II., p. 194.] (1843) places cimicifuga with the "special sedatives," but he states that "cimicifuga, in large doses, unquestionably belongs to the division of acro-narcotic poisons; but the author has had difficulty in deciding as to what class of therapeutic agents it ought to be referred"; and, considering the preceding literature on the subject, we are not surprised to find even Prof. Dunglison somewhat cautious. He accepts that "Cimicifuga unites, with a tonic power, the property of stimulating the secretions, particularly those of the skin, kidneys and pulmonary mucous membrane." The most carefully revised communication on the properties of this plant, however, to that date (1848), [Ives' Report of the Committee on Indigenous Medical Botany, Am. Med. Assoc. Report, 1848.] is by Dr. N. S. Davis, Chairman of the New York section of the committee on the Indigenous Medical Botany of our country. He decides that cimicifuga is a valuable remedy, but asserts that "the prevailing opinions in regard to its action on the system are entirely erroneous." He cites the statements of the authorities he recognizes-Wood, Griffith, Lee, Williams, Chapman, Payne, and the U. S. Dispensatory, and says "none of these opinions accord with our own experience."
"We have never known it to produce a perceptible increase in any of the secretions of the system, nor has it the slightest stimulating qualities. But, we have uniformly found it to lessen the frequency and force of the pulse, to soothe pain, and allay irritability. In a word, it is one of the most purely sedative agents we possess, making its impression chiefly on the nervous system of organic life. In large doses it produces vertigo, dimness of vision, and a depression of the pulse, which remains for a considerable time," and to sum up, adds, regarding its use in rheumatism, "Its curative powers being dependent entirely on its sedative action (as we believe) through the nerves of organic life, it can only prove effectual when given in the early stages before the occurrence of these fibrinous deposits around the ligaments and parts affected, which so generally occur in the later stages of protracted acute cases, and in all the more chronic forms of the disease. It is only in the acute form of rheumatism that its own complete curative power is exhibited. The more acute the disease, the more prompt and decided will be the action of the remedy."
In 1852 the Eclectic Dispensatory appeared, and Prof. King gave to cimicifuga an unusual prominence. Inasmuch as he had long looked upon that plant as one of our most valuable indigenous remedies, and always recommended it highly, it naturally came into general use among the Eclectics, and is still a great favorite with the practitioners of that school of medicine. King excluded many of the reputed uses of cimicifuga, as in his opinion they were unsupported by evidence sufficient to entitle them to credence, but he made the plant conspicuous in all his writings. [The students are familiar still (1885) with Prof. King's "favorite remedy," as is shown by his teachings to the present day.]
It is a curious coincidence that, in 1872, we again have revived the statement of Howard, [Howard wrote several pages to support the value of cimicifuga in this disease. See his "Improved System of Botanic Medicine," 1832, Vol. II., pp. 183,184,185 and 300.] that cimicifuga is an antidote to the small pox, or a preventive to it. After forty years, we find Dr. G. H. Norris, states at a meeting of the Alabama State Medical Association, 1872, that "during the prevalence of small pox in Huntsville, certain families, at the instance of some one unknown, had resorted to the free use of the tea of Cimicifuga racemosa, or black snakeroot of the United States Pharmacopoeia, as a preventive of small pox. In the families using the Cimicifuga there occurred no case of the small pox, though some were exposed to the disease. In the same families Dr. Norris vaccinated the members, but without effect, so long as they continued the use of the Cimicifuga; after ceasing to use the tea as a prophylactic he again vaccinated them, when the specific effects of the vaccine virus were produced. He submitted the results in these cases as new, [If the Doctor had been familiar with the early literature of that part of the medical profession outside the regular branch, he would doubtless have found his entire experience recorded, and the origin of its use in that disease would not have been unknown. Many country people are familiar with these old works.] and not without interest to the profession."
Prof. John Scudder is an ardent admirer of Cimicifuga, and we reproduce, as follows, from his "Specific Medication," a few of his terse sentences regarding that drug: "Like all other direct remedies, it (Cimicifuga) may be employed in any case, no matter what name the disease may have in our nosological classification, if the condition of the nervous system calls for it. The heavy, tensive, aching pains are sufficiently characteristic and need not be mistaken. So prominent is this indication for the remedy, in some cases, not rheumatic, that I give it with a certainty that the entire series of morbid processes will disappear under its use. For years I have employed Macrotys [Prof. Scudder uses the term Macrotys, see our botanical history.] as a specific in rheumatism and with excellent success. Not that it cures every case, for it does not; neither would we expect this, for this would be prescribing a remedy for a name. Macrotys influences the nervous system directly, relieves rheumatic pain when not the result of inflammation, and probably corrects the diseased condition (formation of lactic acid) which gives origin to the local inflammatory process. Thus in the milder cases, where the disease has not localized itself as an inflammation, Macrotys is very speedy and certain in action. Where rheumatism has localized itself in an inflammatory process, all the benefit we obtain from it is that we remove the cause, and hence the reason for a long continuance of the inflammation. It is a remedy for all pain of a rheumatic character, and for these we prescribe it with the best results. Those cases which go under the name rheumatic neuralgia are very speedily relieved by it. In some cases the pains of week's duration disappear in a single day."
At the meeting of the Chicago Gynaecological Society, 1885, Dr. J. Suydam Knox read a paper, "The Influence of Cimicifuga racemosa upon Parturition," in which he gives the results of its use in one hundred and fifty cases of labor, in which he decides that it is a valuable remedy, but in the discussion that followed, his views were criticised by Dr. Jaggard and others.
This brings us to date, and, as will be seen from our brief synopsis, Cimicifuga as a drug, occupies a position that has been of interest to the medical profession from a very early day in American medicine. It is conspicuous for its many recommendations and its uncertain position with many prominent therapeutists. In this connection the following special papers from representatives of the various bodies of medical men will be of interest.
THE MEDICAL HISTORY AND PHYSIOLOGICAL ACTION OF CIMICIFUGA RACEMOSA.—(Written for this publication by Dr. Eric E. Sattler, Demonstrator of Anatomy and Clinical Lecturer on Diseases of the Nervous System in the Miami Medical College of Cincinnati.)
This native American plant, about which there exists such a diversity of opinions and results, well deserves our attention and scrutinizing study.
History of its Uses.—The aborigines of America already discovered medicinal virtues in this plant; finding it, as they did, growing in various parts of the country, they soon learned to use and value it highly for a variety of complaints, chief among which were rheumatism and amenorrhoea. In rheumatism they depended much more on a decoction of the roots externally than internally. A hole was made in the ground, into which they put a kettle containing a quantity of the hot decoction. The rheumatic limbs were placed over the kettle in such a manner as to receive the influence of the steam. It is probable that the effect of the heat had considerable to do in subduing some of the more annoying symptoms of rheumatism. In facilitating parturition and as an emmenagogue it was also highly esteemed by the Indian women, whence its name—squaw-root. [I am informed by one of the able editors of this Journal that the term squaw-root should be applied properly not to the black cohosh, but to the blue cohosh.] It was also used by the Indian doctors for ague and fevers, which it cured by profuse perspiration. As an antidote for the bite of snakes (the chewed roots applied externally to the wound), it also had some renown. These accounts are interesting to us only in an historical way, and not as the basis for scientific deductions. The Indians were probably not any too careful in their collection of plants, and the resulting product was often times a promiscuous decoction of numerous plants.
Benj. S. Barton [Collections for an essay towards a Materia Medica for the United States, 1801.] (1801) was probably the first writer to describe the plant. He classed it under the head of "astringents," the root of the plant having the astringent properties. He mentions the fact of a strong decoction of the roots having been used as a gargle, with great benefit, in an epidemic of putrid sore-throat which prevailed in Jersey many years ago. A decoction was also believed to be a sure cure for the itch.
In 1823, the attention of the profession was called to an article in the "American Medical Recorder," by T. S. Garden, [On the use of Actaea racemosa in Phthisis pulmonalis, American Medical Recorder, 1823.] on the "Use of Actaea racemosa" in Phthisis pulmonalis. Dr. Gardner used it on himself when he was suffering from what he called "incipient phthisis." [In all probability Dr. Garden's case was not one of incipient phthisis, but rather a subacute bronchitis with considerable expectoration. At least the term "incipient phthisis" must be accepted with considerable hesitation.] He found it especially useful in checking the hectic paroxysms, diminishing night sweats, improving cough and expectoration, reducing an excited pulse and allaying irritation through its sedative properties on the nervous system and circulation. He found it to possess in an eminent degree the power of lessening arterial contraction, and believed it to have a tonic influence on the system. In 1850 Dr. Garden [Treatise on Therapeutics and Pharmacology, G. B. Wood, M. D. Letter to the author.] asserts that thirty years' continued use of the drug has fully corroborated and confirmed his first favorable anticipations.
Chapman [Elements of Therapeutics and Materia Medica, N. Chapman, M. D.] (1825) classified the drug with the "expectorants." He never found it astringent to any degree, but says it is expectorant, narcotic, antispasmodic, diaphoretic, and in large doses emetic. In popular practice, at this time, it was reputed in pulmonary diseases, especially in asthma and consumption. In consumption it was said to lessen the frequency of the pulse, to allay cough, to quiet the mobility of the nervous system and to subdue hectic fever.
C. R. Rafinesque (1828) refers to it under the name of "Botrophis serpentaria" (black snake root). [Medical Flora and Manual of Medical Botany of the United States, by C. R. Rafinesque.] Its properties, according to this authority, arc diuretic, sudorific, anodyne, repellent, emmenagogue and subtonic. It is valuable as a gargle, in dropsy, hysteria, and as an auxiliary in acute and chronic rheumatism. In veterinary practice it was largely used, according to this and other authors, in the treatment of murrain, a decoction being employed which purged the cattle, expelled their worms and thus cured the disease.
Young [American Journal of Medical Sciences. Remedial Powers of Cimicifuga in the treatment of Chorea.] (1830 first called attention to the efficacy of this drug in the treatment of St. Vitus Dance, although Dr. Garden claimed to have called attention to its medicinal powers in Chorea originally in 1832. Dr. Young relates the history of four severe cases of Chorea, that had failed to be benefitted by other remedies, in which the administration of cimicifuga was followed by signal benefit and cure.
Hildreth [American Journal of Medical Sciences, Vol. IV., 1842, on Cimicifuga and Iodine in Phthisis pulmonalis.] (1842) speaks of it as valuable in incipient phthisis. He used it with benefit in asthma instead of lobelia, also in Chorea. Its narcotic properties he mentions as being similar to those of colchicum, veratrum and digitalis.
R. E. Griffith [Medical Botany, R. E. Griffith, M. D.] (1847) found it to act like a stimulant tonic and capable of increasing the secretions from the skin, kidneys and lungs. The action of the drug on the uterus he claims unsatisfactory and doubtful. In affections of the lung and in rheumatism he found, on extended trials, good reasons to believe in its efficacy.
The committee of the American Medical Association (1848), N. S. Davis, Chairman, [Transactions of the American Medical Association, Vol. I., 1848.] were satisfied that the prevailing opinions in regard to the action of cimicifuga, on the system were entirely erroneous. No two opinions agree, for while by some it was classed under the expectorants, by others it was termed a tonic, or narcotic, or diuretic, emmenagogue, etc. The committee never found it to produce any perceptible increase in any of the secretions of the system, nor have any stimulant properties. They uniformly found it, however, to lessen the frequency and force of the pulse, to soothe pain and allay irritability. In a word, they held it to be the most purely sedative agent we possess, producing its impression chiefly on the nervous system of organic life.
G. B. Wood [Treatise on Therapeutics and Pharmacology, by G. B. Wood, M. D.] (1856) classified the drug under the "nervous sedatives." He found it very serviceable in Chorea, and thought it should be considered among the standard remedies for this complaint. Although the value of this drug was first publicly made known to us by Dr. Jesse Young, of Pennsylvania, Dr. Isaac Hays, in a note, stated that ten years before the publication of Dr. Young's article, Dr. Physick had informed him that he had used the same remedy with good effect, in chorea, in 10 grain doses every two hours. Dr. Young gave <drachm>i. of the powdered root three times a day. Dr. Wood also employed the remedy in epilepsy, but found it no material benefit.
J. D. O'Connor [Corbis Segminis. Cincinnati Lancet, 1858.] (1858) used it successfully in rheumatic and neuralgic pains. He used it in chorea. with as much confidence as he did quinine in intermittent fever. Dr. Simpson, of Edinburgh, in his own case, found it repeatedly to cure an attack of lumbago with wonderful rapidity.
Dr. F. N. Johnson [Treatise on Therapeutics and Pharmacology, by G. B. Wood.] found it extraordinarily efficient in acute rheumatism. In twenty of the worst cases "the results were satisfactory in the highest degree, every vestige of the disease disappearing in 2, 8 or 10 days, without inducing any sensible evacuation or leaving behind a single bad symptom." An equally enthusiastic follower says, "We have no more doubt of the efficacy of cimicifuga in the early stage of acute rheumatism than we have of the power of vaccine as a preventative of variola."
H. C. Wood [Treatise on Therapeutics, H. C. Wood, 1374.] (1874) classed it under the antispasmodics, and says it is of undoubted value in simple chorea as it occurs in children. In inflammatory rheumatism it is at present rarely, if ever, used.
The preceding presents the important points culled from the literature concerning cimicifuga, and does not by any means exhaust it. A number of articles on the subject, being in the main, however, only repetitions of what has been said, will be found scattered throughout the pages of medical journals. [1827, Philadelphia Monthly Journal of Medicine and Surgery, Vol. I.; 1845, Southern Medical and Surgical Journal, Vol. I.; 1855, Columbus Medical Counsellor, Vol. I.; Pharmaceutical Journal, March, z861; 1861, Chicago Medical Examiner, Vol. II.; 1867, Medical and Surgical Reporter, Philadelphia, Vol. XVII.; 1868, Medical and Surgical Reporter, Philadelphia, Vol. XVIII.; 1869, Medical and Surgical Reporter, Philadelphia, Vol. XX,; 1872, Atlanta Medical and Surgical Journal; 1876, Chicago Medical Times, Vol. VII.; 1876, West Virginia Medical Student, Vol. I.]
Clinical Investigation with the Fluid Extract of Cimicifuga Racemosa.—In order to test the value of cimicifuga in medical practice and furnish reliable indications for its use, Prof. J. U. Lloyd kindly placed at my disposal the Fluid Extract of Cimicifuga racemosa. The writer regrets to say that owing to the limited time at his disposal, his investigations were not as extensive as could be wished, but he hopes that the results obtained in his investigations at his Clinic for Nervous Diseases, Miami Medical College, and in his private practice, will enable the profession to pursue investigations with this no doubt valuable but somewhat discarded drug.
Physiological Action.—10 to 20 drops of the Fluid Extract, taken internally, do not sensibly affect the system. On September 21st I took <drachm>i. of the Fluid Extract. In twenty minutes a sickening feeling at the stomach and some dizziness was felt, accompanied by a sense of fullness in the head and temples. Thirty minutes from the time of taking the first dose <drachm>i. was again taken. In fifteen minutes my head began to swim and I became nauseated.
The dizziness was great and accompanied by the most intense headache, which persisted fully eight hours. A slight diarrhoea also set in, but did not amount to more than a relaxation of the bowels. A drowsy feeling came over me, although the severe headache prevented my sleeping any. Pulse, when first dose was taken, was 80. It diminished in frequency and became fuller in force gradually, until thirty minutes after taking the second dose it was 62 to the minute. The experiment was repeated several times with almost uniform results, and it was noted that when the drug was taken on an empty stomach its action was at least twice as marked and the retching more intense than when taken on a full stomach. In several of my cases I noted similar conditions after the administration of the Fluid Extract of Cimicifuga in doses of from 20 to 50 drops. In several cases headaches developed which prevented the further use of the drug. In others, a diarrhoea set in and became annoying. In others again, dizziness or nausea in varying degree was present. For these reasons it is well to begin with small doses and gradually increase them from day to day. I have found the administration of smaller doses frequently repeated to give better results than large doses at longer intervals. It is also well to bear in mind that the medicine is best administered after food.
Clinical Investigations.—My observations have been especially directed toward a certain class of Nervous Disorders in which cimicifuga was claimed to be efficacious, although as occasion presented I have not hesitated to use it in cases that I thought might derive some benefit from its use.
Chorea.—Five cases. It would have given me great pleasure and satisfaction to have used this remedy in some thirty cases of chorea that I treated a year and a half ago in an endemic during the months of March, April and May, but unfortunately the opportunity was not afforded and these cases had the benefit of treatment with Fowler's Solution with uniformly good results. In the five cases observed, I have found it efficacious in four; the fifth only yielded to large doses of arsenic. The cases came to my Clinic after they had undergone all kinds of treatment. Two cases had been treated three months outside, with no improvement. I prescribed 10 drops Fluid Extract of Cimicifuga racemosa every two hours, and on my next Clinic day (three days after) a noticeable improvement had taken place, and in the course of two weeks no trace of choreic movements were able to be perceived. The other cases progressed similarly favorable.
Epilepsy.—Although I tried this remedy in at least ten cases of epileptic convulsions, the convulsions seemed rather aggravated than diminished. In only one case, still under observation, of petit-mal in a boy aged 12 years, is an improvement manifested.
Hysteria.—It is of undoubted benefit in this disease. I generally prescribed it in combination with bromide of potassium, and sometimes it acted like a charm. In one case of hysterical mania I administered 40 drops every two hours with marked benefit.
Cephalagias.—In nervous headaches and those accompanied by congestion of the brain, it was found to be of decided benefit, seeming to quiet the nervous system and diminish the flow of 'blood to the head
Phthisis pulmonalis.—It is simply a palliative remedy in this disease, acting as a sedative to the circulatory system. It is of unquestionable value in the hectic fever accompanying this trouble, its soothing influence being soon felt by a diminution of the number of heart beats and its calming effect on the nervous system. As a means of allaying cough, it seems to possess no value.
Rheumatism.—Although greatly lauded in this affection, a trial was not made of its efficacy, as the profession are in no need of a more certain remedy than the salicylate of sodium.
At the request of the editors of this journal, Prof. Joseph Eichberg, M. D. [Professor of Physiology and Clinical Laryngology in the Miami Medical College, Cincinnati.] employed samples of macrotyn (the resin principle of cimicifuga) in a number of cases of muscular rheumatism, and vague, indefinite pains in various parts of the body. Dr. Eichberg reports as follows :
"It was given in two-grain doses, repeated every four or six hours, and was administered either in powder, pill or capsule. In only one case was I able to satisfy myself of any favorable action exercised by it on the course of the trouble. In nearly all the cases, the remedy had to be discontinued very soon because of a severe and persistent headache which is set up. This symptom made its appearance within eight hours after the administration of the first dose. It may be that the quantity selected for trial was too large, two grains at a dose, and I shall test it farther in smaller doses."
Febricula.—In these slight (idiopathic) forms of fever not characterized by any definite organic lesions, to which the name of Febricula is given, the cimicifuga will be found of great service and benefit, never failing of attaining the desired result of rest to the nervous and circulatory system.
Emmenagogue.—I have had no opportunity of testing the remedy as to its value as an emmenagogue. In one case of hysteria, under treatment with cimicifuga, the flow of blood, which was rather profuse, was stopped each time by the administration of the Fluid Extract of this drug.
Indications.—The Fluid Extract of Cimicifuga, then, will be found of undoubted use in chorea (of childhood), in hysteria and nervous cephalagias, in hectic fever, and Febricula. It should be classed under the head of "Nervous Sedatives."
Continued on next page.