APOCYNUM CANNABINUM
   The root of Apocynum cannabinum, Linné (Nat. Ord. Apocynaceae) gathered in autumn after the leaves and fruit have matured. Grows throughout the United States. Dose, 1 to 20 grains. Common Names: Bitter Root, Canadian Hemp, and improperly, Indian Hemp. Principal Constituents.—A resinous principle—apocynin, and a yellow glucoside, apocynein; and apocynamarin, or cynotoxin, or cymarin, all of which resemble digitalis glucosides in action. Preparations.-1. Specific Medicine Apocynum. Dose, 1/4 to 20 drops. Usual form of administration: Rx Specific Medicine Apocynum, 10 drops to 1 fluidrachm; Water, four ounces; Mix. Sig. One teaspoonful every 1 to 3 hours. 2. Decoctum Apocyni, Decoction of Apocynum (root 1 ounce to Water, 16 ounces). Dose, 1 to 2 fluidrachms. Specific Indications.—Watery infiltration of cellular tissue—edema— with weak circulation and general debility; skin blanched, full, smooth, and easily indented; puffiness under the eyes; eyelids wrinkled, as if parts had been recently swollen; feet full and edematous, pitting upon pressure; constipation, with edema; urine scanty and circulation sluggish; boggy, watery uterus; full relaxed uterus with watery discharge; profuse menorrhagia, too often and too long continued; passive hemorrhages, small in amount and associated with pedal edema; mitral and tricuspid regurgitation, with rapid and weak heart action, low arterial tension, difficult breathing, cough, and tendency to cyanosis. Action.—Apocynum acts powerfully upon the heart, slowing its action and raising arterial tension. The cardiac muscle appears to be directly stimulated by it as are probably the arterial coats. Contraction of the renal arteries also takes place, so that while less blood passes at a time through the kidneys, the act of filtration is more perfect and marked diuresis results. Though long known that diuresis was one of its most prominent results, the knowledge that this is due to the better cardiac pressure and arterial tonus, rather than to the increased intrinsic secreting power of the renal glomeruli, is the result of pharmacologic investigation in recent years, particularly the work of Horatio C. Wood, Jr. The general effects upon man of full doses of apocynum are nausea, and sometimes vomiting and purging, succeeded by copious sweating. The pulse is then depressed, and in some a disposition to drowsiness is observed until relieved by vomiting. The powdered drug causes sneezing. The small doses employed in Eclectic therapeutics seldom occasion any of the above-named symptoms save that of severe watery purging, which may occur suddenly, when the drug has been administered persistently for several weeks. Therapy.—No remedy in the Eclectic materia medica acts with greater certainty than does apocynum. In former times it was employed in heroic doses chiefly for its hydragogue cathartic and diuretic effects. Early in the last century it was employed by the botanic practitioners for the relief of dropsy. Later the Eclectic school developed its specific uses in dropsy and affections of the heart and circulation. Like many similar drugs, the powder was employed as a sternutatory in the days when it was believed that such effects as the increasing of the nasal discharges was the best way to relieve headaches and certain catarrhal affections. Again, it was recommended in diaphoretic doses, for the relief of intermittent and remittent fevers, and in pneumonic involvements, conditions in which it is now seldom or never thought of. It is rarely employed nowadays as a cathartic, and then only in dropsical conditions, as other hydragogues have been similarly used. Such is the use of it advocated by the authors of the regular school of medicine, by those who use it at all; and from such a use arises the criticisms frequently indulged in in condemnation of the drug. Eclectics do not use it in this manner. Specific medication has established that this action is not necessary, for when specifically indicated it promptly removes effusions without resorting to cathartic doses. Consequently it finds little use as a cathartic, except very rarely as recommended by Goss, for the removal of ascarides. To use apocynum intelligently and successfully, the prescriber must recognize, first, that debility is the condition in which it exerts its specific and beneficial effects—debility of the heart and circulatory apparatus, of the kidneys, of the capillaries of the skin particularly. In such a state it will prove a remedy; under opposite conditions it is likely to prove an aggravation. The patient with a strong, rope-like, hard, and quick pulse is not the patient for apocynum. On the other hand, the feeble pulse, soft and of little force, indicates its selection as the remedial agent. The atonic state which readily permits of exudation from the blood vessels is the ideal condition which we seek to remedy with apocynum. It is a vascular stimulant. Such results one would not expect to obtain if there were circulatory obstruction or active fever. The only apparent exception, in which it is adapted to active conditions, is that reported by Webster of its efficacy in active inflammation of the upper pharyngeal and post-nasal tract, where, he declares, it rivals phytolacca in its results. One can not expect apocynum to reconstruct wornout tissues or to restore damaged vascular valves. We must not hope to work miracles with it where there are such structural lesions as incurable or malignant organic diseases of the heart, liver, or kidneys. Yet in these conditions, when debility and subcutaneous, watery exudation are strong factors, it alone is a powerful remedy to relieve urgent symptoms and to put into action that portion of sound tissue that remains. The most we can hope for is an amelioration of the symptoms, and a notable decrease of the watery accumulation may be looked for. Under these circumstances we have removed enormous dropsical swellings with it, giving quick relief from dyspnea and¹