Botanical name: 

The dried root of Brauneria angustifolia, Linné (Echinacea angustifolia [DeCandolle], Heller). (Nat. Ord. Compositae.) In rich prairie soils of western United States, from Illinois westward through Nebraska and southward through Missouri to Texas.
Common Names: Narrow-leaved Purple Coneflower, Purple Coneflower, Coneflower.

Principal Constituents.—Minute traces of an unimportant alkaloid and an acrid body (½ to 1 per cent), probably of a resinous character linked with an organic acid. The latter is the chief active principle of the drug.
Preparations.—1. Specific Medicine Echinacea. Dose, 1 to 60 drops, the smaller doses being preferred. Usual method of administration: ℞. Specific Medicine Echinacea, 1-2 fluidrachms; Water, enough for 4 fluidounces. Mix. Sig.: One teaspoonful every 1 to 3 hours.
2. Echafolta. (A preparation of Echinacea freed from extractive and most of the coloring matter. It also contains a small added quantity of tincture of iodine. The label states that is iodized). Dose, 1 to 60 drops. Usually administered the same as the specific medicine; except when iodine is contraindicated, or is undesired.
3. Echafolta Cream. An ointment for external use.

Specific Indications.—"Bad blood"; to correct fluid depravation, with tendency to sepsis and malignancy, best shown in its power in gangrene, carbuncles, boils, sloughing and phagedenic ulcerations, and the various forms of septicemia; tendency to formation of multiple cellular abscesses of a semi-active character and with pronounced asthenia; foul discharges with emaciation and great debility; dirty-brownish tongue; jet-black tongue; dusky, bluish or purplish color of the skin or mucous tissues, with a low form of inflammation. It is of special value in typhoid states, in which it is indicated by the prominent typhoid symptoms—dry tongue, sordes on tongue and teeth, mental disturbances, tympanites and diarrheal discharges—and in malignant carbuncle, pyosalpinx, and thecal abscesses.

Action.—The physiological action of echinacea has never been satisfactorily determined. It has been held to increase phagocytosis and to improve both leukopenia and hyperleucocytosis. That it stimulates and hastens the elimination of waste is certain, and that it possesses some antibacterial power seems more than probable. Upon the mucous tissues echinacea causes a quite persistent disagreeable tingling sensation somewhat allied to, but less severe, than that of prickly ash and aconite. It increases the salivary and the urinary flow, but sometimes under diseased conditions anuria results while it is being administered. In the doses usually given no decided unpleasant symptoms have been produced; and no reliable cases of fatal poisoning in human beings have been recorded from its use. Occasionally bursting headache, joint pains, dry tongue, reduced temperature and gastro-intestinal disturbances with diarrhea are said to have resulted from large doses of the drug.

Therapy.—External. Echinacea is a local antiseptic, stimulant, deodorant, and anesthetic. Alcoholic preparations applied to denuded surfaces cause considerable burning discomfort, but as soon as the alcohol is evaporated a sense of comfort and lessening of previous pain is experienced. Its deodorant powers are remarkable, especially when applied to foul surfaces, carcinomatous ulcerations, fetid discharges from the ears, and in gangrene. While not wholly masking the odor of cancer and gangrene it reduces it greatly, much to the comfort of the sick and the attendants. Echinacea is useful as an application where decay is imminent or taking place, reparative power is poor, and the discharges saneous and unhealthy. It is especially valuable in sluggish ulcers, bed sores, stinking tibial ulcers, and ulcers of the nasal mucosa, due either to ozaena or to syphilis. The greater the tendency to lifelessness and dissolution of the tissues and the more pronounced the fetid character of the discharges, the more applicable is echinacea. Used by spray it is effective to remove stench and to stimulate repair in tonsillitis, the angina of scarlatina, and though not alone capable of curing diphtheria, either by external or internal use, it stimulates the near-necrosed tissue to activity and overcomes the fetid odor, thus contributing in a large measure to aid more specific agents. A 10 to 50 per cent solution may be used to cleanse abscess cavities, to apply to ragged wounds from barbed wire, tin, and glass, wounds which for some reason are very painful and heal sluggishly. For this purpose we prefer ℞. Echafolta (or Echinacea), 1 fluidounce; Asepsin, 15 grains; Tincture of Myrrh, 2 fluidrachms; Sterile Water, enough to make 4 fluidounces. Mix. Apply upon sterile gauze, renewing at reasonable periods. This also makes a good mouth wash for foul breath and to remove odor and stimulate repair in pyorrhea alveolaris, spongy and bleeding gums, and aphthous and herpetic eruptions. Echinacea is sometimes of value in eczema, with glutinous, sticky exudation, and general body depravity; to give relief to pain and swelling in erysipelas, mammitis, orchitis, and epididymitis; to allay pain and lessen tumefaction in phlegmonous swellings; and to dress syphilitic phagedena. As a local application to chilblains it has done good service, and in poisoning by Rhus Toxicodendron is relied upon by many as one of the best of local medicines. We have found it especially useful in dermatitis venenata after denudation of the cuticle when ulcers form and the neighboring glands swell. Echinacea has a greater record for success than any single medicine for snake bites and insect bites and stings, and it may be used full strength to relieve the intolerable itching of urticaria. Some have asserted that it will abort boils. For the treatment of carbuncle, after thoroughly incising, a 50 per cent solution to full strength echinacea or echafolta may be freely used, syringing the channels with it. This gives great relief from pain and insures a quicker recovery.

For all the above-named purposes either echinacea or echafolta may be used: the latter is usually preferred where a cleanlier appearance is desired. Moreover, in most of the conditions named repair takes place much sooner and in better form if the remedy is given internally concomitantly with its external use.

Internal. Echinacea is stimulant, tonic, depurative, and especially strongly antiseptic; it is in a lesser degree anesthetic and antiputrefactive. The necessity for remedies that possess a general antiseptic property and favor the elimination of caco-plastic material is most marked when one is treating diseases which show a depraved condition of the body and its fluids. Such a remedy for "blood depravation," if we may use that term, is echinacea. No explanation of its action has even been satisfactorily given, and that a simple drug should possess such varied and remarkable therapeutic forces and not be a poison itself is an enigma still to be solved, and one that must come as a novelty to those whose therapy is that of heroic medicines only. If there is any meaning in the term alterative it is expressed in the therapy of echinacea. For this very reason has a most excellent medicine been lauded extravagantly and come near to damnation through the extravagant praises of its admirers.

Echinacea is a remedy for autoinfection, and where the blood stream becomes slowly infected either from within or without the body. Elimination is imperfect, the body tissues become altered, and there is developed within the fluids and tissues septic action with adynamia resulting in boils, carbuncles, cellular tissue inflammations, abscesses, and other septicaemic processes. It is, therefore, a drug indicated by the changes manifested in a disturbed balance of the fluids of the body resulting in tissue alteration: be the cause infectious by organisms, or devitalized morbid accumulations, or alterations in the blood itself. It is pre-eminently useful in the typhoid state, and many physicians administer it regardless of any other indication throughout enteric fever as an intercurrent remedy. Echinacea is especially to be thought of when there are gangrenous tendencies and sloughing of the soft tissues, as well as in glandular ulcerations and ulcers of the skin. It is not by any means a cure-all, but so important is its antiseptic action that we are inclined to rely largely on it as an auxiliary remedy in the more serious varieties of disease—even those showing a decided malignancy—hence its frequent selection in diphtheria, small-pox, scarlet fever, typhoid fever and typhoid pneumonia, cerebro-spinal meningitis, la grippe, uremia, and the surgical and serpent and insect infections. Foul smelling discharges are deodorized by it and the odor removed from foul smelling ulcers and carcinomata, processes not alone accomplished by its topical use but aided greatly by its internal exhibition. In puerperal fever, cholera infantum, ulcerated sore throat, nasal and other forms of catarrh and in eczema and erysipelas it fulfills important indications for antisepsis.

Echinacea was introduced as a potent remedy for the bites of the rattlesnake and venomous insects. It was used both externally and internally. Within bounds the remedy has retained its reputation in these accidents, it probably having some power to control the virulence of the venom, or to enable the body to resist depression and pass the ordeal successfully; nevertheless fatalities have occurred in spite of its use. For ordinary stings and bites its internal as well as external use is advisable.

In the acute infectious diseases echinacea has rendered great service. Throughout typhoid fever it may be given without special regard to stated periods, but wherever a drink of water is desired by the patient, from 5 to 10 drops of Specific Medicine Echinacea may be given in it. Having no toxic power, and acting as an intestinal antiseptic, this use of it is both rational and effective. Cases apparently go through an invasion of this disease with less complications and less depression when the drug is so employed. The same is true of it in typhoid, pneumonia, septicaemia, and other septic fevers. It has the credit of regulating the general circulation, and particularly that of the meninges in the slow forms of cerebrospinal meningitis, with feeble, slow, or at least not accelerated pulse, temperature scarcely above normal, and cold extremities; with this is headache, a peculiar periodic flushing of the face and neck, dizziness, and profound prostration (Webster). It is evidently a capillary stimulant of power in this dreaded disease, in which few remedies have any saving effect. Echinacea has aided in the recovery of some cases of puerperal septicemia. Obviously other measures are also required. In non-malignant diphtheria, echinacea, both locally and internally, has appeared to hasten convalescence, but in the light of present day therapeutics it is folly to expect echinacea to cure the malignant type. A wide experience with the drug in such cases convinces us that we are leaning upon a slender reed when we trust alone to such medicines as echinacea and lobelia in malignant diphtheria. As many non-malignant cases tend to quick recovery, the use of good remedies like echinacea undoubtedly hastens the process. But to assume that it will cure every type of the disease because it succeeds in aiding the milder forms to recover is to bring a good medicine into unmerited discredit. Moreover, when these claims were originally made, and probably in good faith, there was no exact means of establishing the bacterial nature of the disease, hence many tonsillar disorders were called diphtheria. The latter were, of course, benefited by it, for in tonsillitis, particularly the necrotic form with stinking, dirty-looking ulcerations, it is an excellent remedy. Echinacea is said to be a good agent in a malignant form of quinsy known as "black tongue"; and in "mountain fever", closely allied to and often diagnosed as typhoid fever.

Echinacea is justly valued in catarrhal conditions of the nasal and bronchial tracts, and in leucorrhoea, in all of which there is a run-down condition of the system with fetid discharge, and often associated with cutaneous eruptions, especially of an eczematous and strumous type. Chronic catarrhal bronchitis and fetid bronchitis are disorders in which it has been used with benefit, and it is said to ameliorate some of the unpleasant catarrhal complications of pulmonary tuberculosis, and particularly to render easier expectoration in that form known as "grinder's consumption". Patients suffering from common nasal and bronchial catarrhs have been greatly improved by echinacea when taking the drug for other disorders. Its stimulating, supporting and antiseptic properties would make echinacea a rational remedy for such disorders, particularly if debility and general tissue depravity were coexistent with the catarrh.

As a rule echinacea is of little or no value in agues, yet physicians of malarial districts assert it is of benefit in chronic malaria when of an asthenic type. Altogether likely its value, if it has any, lies in the betterment of the asthenia, rather than to any effect it may have upon the protozoal cause of the disease. In so-called typho-malarial fever it does good just in proportion as the typhoid element affects the patient. Both it and quinine would be rational medication.

Echinacea possesses no mean anti fermentative power, and by its local anaesthetic effect obtunds pain. When an offensive breath, due to gaseous eructation, and gastric pain are present, it proves a good medicine in fermentative dyspepsia. The symptoms are aggravated upon taking food. It is also serviceable in intestinal indigestion with pain and debility and unusually foul flatus, and has been recommended in duodenal catarrh. We can see no reason why it should not have some salutary effect in both gastric and duodenal ulcer, for it antagonizes putrefaction, tissue solution, and pain. In ulcerative stomatitis and nursing sore mouth, in both of which it is very effectual, it should be used both internally and locally. When dysentery, diarrhea, and cholera infantum occur in the debilitated and the excretions are more than commonly foul, both in odor and shreds of tissue, echinacea is a serviceable adjunct to other treatment.

The dose of either specific medicine echinacea or echafolta ranges from 1 to 5 drops; larger doses (even 60 drops) may be employed, but small doses are generally most efficient if frequently repeated. They may be given in water or syrup, or a mixture of water and glycerin, as: ℞ Specific Medicine Echinacea, 1-2 fluidrachms;Water, to make 4 fluidounces. Mix. Sig.: Teaspoonful every ½ or 1 hour in acute cases; every 3 or 4 hours in chronic affections. If these preparations are to be dispensed in hot weather, or are to be used in fermentative gastro-intestinal disorders, the substitution of ½ ounce of pure glycerin for 1 fluidounce of the water is advisable.

NOTE: Echafolta (now iodized) should be given internally only when iodine is not contraindicated, or is desirable. Formerly, before being iodized, it was used internally in the same manner and for the same purposes as Echinacea. The Echafolta should be reserved for external use.

Echafolta Cream is an admirable form in which to use Echafolta, where an ointment is desired, being a useful unguent in the various skin disorders in which Echafolta or Echinacea is indicated.

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