BELLADONNA (Atropa belladonna)^ATROP
   The (1) dried root and the (2) dried leaves and tops of Atropa Belladonna, Linné (Nat. Ord. Solanaceae). Europe and Central Asia; also cultivated. Dose, (1) 1/4 to 1 grain; (2) 1/4 to 2 grains. Common Names: Deadly Nightshade, Dwale. (1) Belladonna Root (Belladonnae Radix); (2) Belladonna Leaves (Belladonnae Folia). Principal Constituents.—The poisonous alkaloids atropine, hyoscyamine, belladonnine, and hyoscine. There is much confusion concerning the constituents of belladonna, hyoscyamine, with conversion products, probably being the chief alkaloid. This is readily convertible in atropine. The alkaloids probably exist as malates. Preparations.—1. Specific Medicine Belladonna (prepared from the root). Dose, 1/20 to 1 drop. Usual method of administration: Rx Specific Medicine Belladonna, 5- 10 drops; Water, 4 fluidounces. Mix. Sig.: One teaspoonful every 1 to 3 hours. 2. Unguentum Belladonnae. Ointment of Belladonna. (This is prepared from the Extract of Belladonna, which in turn is prepared from Belladonna leaves. Tincture of Belladonna is also prepared from the leaves, while the fluidextract is prepared from the root.) Specific Indications.—Dull expressionless face, with dilated or immobile pupils, dullness of intellect, drowsiness with inability to sleep well whether there is pain or not; impaired capillary circulation either in skin or mucous membranes; dusky, deep-red or bluish face and extremities, the color being effaced by drawing the finger over the parts, the blood slowly returning in the whitish streak so produced; circulation sluggish, with soft, oppressed, and compressible pulse; cold extremities; breathing slow, labored, and imperfect; hebetude; the patient sleeps with eyes partially open; coma; urinal incontinence; free and large passages of limpid urine; fullness and deep aching in loins or back; spasm of the involuntary muscles. In 3x dilution the indications are: Pallid countenance, with frequent urination; nervous excitation, with wild and furious delirium. Large doses: mydriatic. Action.—The action of Belladonna depends largely upon its chief alkaloid Atropine. Therapy.—External. Belladonna, and more rarely atropine, may be applied for the relief of pain and spasm, and especially for spasmodic pain. A lotion of belladonna (5 to 10 per cent) may be used to allay itching in general pruritus, eczema, and urticaria. The tincture, painted upon the feet, controls local bromidrosis. A weak lotion is effectual in general hyperhydrosis and in the colliquative sweating of phthisis and other debilitating diseases. The ointment and liniment may serve a similar purpose. This use of belladonna is less desirable, however, than other medication on account of the dryness of the throat and mouth, and the ocular disturbance it is likely to occasion. Ointment of belladonna and the liniment are extremely useful in local inflammations and swellings, having a wide range of efficiency. Thus they may be applied to painful and swollen joints, forming abscesses, incipient and recurrent boils, buboes, hemorrhoids and fissures, inflamed glands, and in neuralgia, chronic rheumatism, lumbago, myalgia, pleurodynia, the chest pains of pulmonary tuberculosis, and in acute mastitis. In many of the surface conditions mentioned the plaster may prove most effectual. The liniment is especially useful to alleviate cramps in the calf of the leg. The ointment is effectual in relaxing rigid os during labor, and carried into the urethral canal of male or female it relaxes spasmodic constriction of that canal and cystic spasm and relieves pain. Rubbed on the under surface of the penis it has given marked relief in chordee. A suppository of belladonna relieves spasmodic dysmenorrhea and may be applied either in the vagina or the rectum. A similar application, with or without tannin or geranium, may be inserted into the vagina for painful menstruation, with leucorrhoea. The liniment and the ointment may be used as antigalactagogues and are especially serviceable after weaning the child or when mastitis threatens. All local applications of belladonna should be made with judgment and carefully watched lest poisonous absorption take place. In many of the conditions mentioned the conjoint internal use is advisable—provided the specific indications for the drug are present. Therapy.—Internal. Belladonna is employed in Eclectic Therapeutics in doses which produce exactly the opposite effects from the gross or physiologic and toxic action. Large doses paralyze; small doses stimulate. While employed for its physiological effects in some instances, the chief use of the drug with us is in conditions showing impairment of the capillary circulation in any part of the body with congestion or tendency to blood stasis. The size of the dose is of great importance in administering belladonna. Ordinary drachm doses of a dilution of 5 to 10 drops of the specific medicine in four ounces of water meet conditions of dullness, hebetude, and congestion, as first pointed out by Scudder. Others claim that the use of infinitesimal doses, of the 3x dilution, acts promptly in conditions of nervous exaltation, with great irritability and impressionability of all the senses; in some cases the hyperaesthesia amounts to delirium and it is then claimed to be most efficient to control both mild and furious outbreaks of delirium. Others again (and this agrees with our personal experience) find marked pallor of the surface, with contracted pupils, the indication, for minute doses of the drug. Following a law which appears to be commonly borne out in therapeutics, that opposite effects are produced by large or by minute doses respectively, belladonna seems a possible therapeutic agent in many varied conditions. The cases, however, in which belladonna appears to have rendered the best service are in those in what might be called medium doses, as advised by Scudder, in which the drug is employed to overcome dullness, hebetude, expressionless countenance¹

GERANIUM^GERAN
   The rhizome of Geranium maculatum, Linné (Nat. Ord. Geraniaceae). Common in the rich soils of woods and low grounds in the United States. Dose, 5 to 60 grains. Common Names: Cranesbill, Wild Cranesbill, Crowfoot, Spotted Geranium. Principal Constituents.—Tannin (10 to 28 per cent, according to season) and gallic acid (in dried root). Preparations.—1. Decoctum Geranii, Decoction of Geranium (1/2 ounce to Water, 16 fluidounces). Dose, 1 to 2 fluidounces. 2. Specific Medicine Geranium. Dose, 5 to 60 drops. Specific Indications.—Relaxed mucous tissues with profuse debilitating discharges; chronic mucous diarrheas; chronic dysentery; diarrhoea with constant desire to defecate; passive hemorrhages; gastric ulcer. Action and Therapy.—Geranium is one of the simple and much neglected of the early Eclectic medicines. It is an ideal astringent and for conditions requiring such an action it is preferable to many other constringing drugs. Geranium is indicated in subacute and chronic bowel disorders when the evacuations are abundant and debilitating. It is especially adapted to relaxation of the mucosa following inflammation. For the summer diarrheas of older children, and especially the cholera infantum of infants, it is splendidly effective after the bowels have been thoroughly cleansed of undigested and decomposed contents. For infantile use we prefer the decoction in milk. If that does not agree, small doses of the specific medicine in water may be employed. When dysentery tends to chronicity, the thorough use of magnesium sulphate followed by geranium will render good service. Geranium is of some value in passive hemorrhages, as haematuria, hemoptysis, and menorrhagia. It is only useful in the first two when the blood lost is small in amount, and in the latter when bleeding is prolonged, but merely oozing. Though a useful agent in relaxed conditions with catarrhal discharges other than those of the bowels, as chronic pharyngeal catarrh, relaxed uvula, leucorrhea, etc., it is no more valuable than other tannin-bearing drugs, and is often inferior to tannic acid itself. Geranium is of specific value where long saturation of the mucosa with unhealthy catarrhal secretions favor a tendency to destruction of tissue. We have found it to quickly cure aphthous ulceration of the mouth attended by gastric acidity and acid diarrhea. For gastric ulcer it is one of the best therapeutic means we possess. Geranium, hydrastis, mangifera, bismuth subnitrate and mangesium oxide, singly, or in indicated association, have proven the most effective agents in our experience for the medicinal relief of curable cases. They restrain hypersecretion, correct excessive acidity, check hemorrhage, and relieve pain; sometimes healing appears to progress rapidly under their influence.¹

HAMAMELIS
   The leaves, bark and twigs of Hamamelis virginiana, Linné (Nat. Ord. Hamamelidaceae), collected in the autumn. Common in the United States. Dose, 5 to 60 grains. Common Names.—Witch-Hazel, Snapping Hazelnut, Winterbloom. Principal Constituents.—A bitter body, tannin, and a volatile oil. Preparations.-1. Aqua Hamamelidis, Hamamelis Water, (Distillate of Hamamelis, Distilled Witch-Hazel, Distilled Extract of Witch-Hazel). Dose, 5 drops to 2 fluidrachms. 2. Specific Medicine Hamamelis. Dose, 5 to 60 drops. Specific Indications.—Venous debility, with relaxed and full tissues; pallid mucosa or occasionally deep red from venous engorgement, or deep blue from venous stasis; excessive mucous flow, with venous relaxation; passive hemorrhages; prehemorrhagic states, with venous fullness; varicoses; hemorrhoids with weight and fullness; rectal prolapse; dull aching pain in pelvis, genitalia, or rectum, with perineal relaxation and fullness; relaxed or engorged and painful sore throat; gastro-intestinal irritability, with venous weakness and mucous or muco-bloody passages. Locally to inflamed, ulcerated or wounded skin or mucosa, especially where venous circulation is debilitated; contusions, bruises, and muscular soreness from exertion or exposure. Action and Therapy.—External. Witch-hazel bark and its fluid preparations are astringent. The distillate and the specific medicine are sedative and slightly astringent. The latter two form agreeably grateful and soothing applications to the skin and mucous surface in irritated and inflamed conditions and where venous relaxation is present. The specific medicine is an elegant and heavy distillate, carrying a large proportion of the oil, as compared to the ordinary distillate, and is much to be preferred where a bland and soothing yet astringent effect is required. Where more alcoholic stimulation is permitted or desired the ordinary distillate may be used. As a rule, the specific medicine is best for use upon mucous, and the distillate upon the cutaneous surfaces. Witch-hazel distillates are splendid applications for sprains, contusions, wounds and inflamed swellings, and for sunburn, tan, freckles, and dilatation of the capillaries of the skin. They are cooling and relieve smarting and pain. Used alone or combined with an equal quantity of bay rum they form an elegant face wash to remove excess of soap and heal abrasions after shaving. Witch-hazel is one of the most comforting applications for painful hemorrhoids. It may be used ice cold or hot, as preferred. Applied to the tender parts after the parturient toilet, it removes soreness of the tissues from childbirth. Rubbed upon the skin, or applied by means of compresses, it is an efficient lotion for muscular soreness and aching after severe exertion; from cold, exposure, or when due to bruises and strains. Its use should be accompanied with gentle massage. Compresses wetted with witchhazel give marked relief in acute cutaneous inflammations, chafing, and especially in mammitis. Incised wounds, ragged cuts from glass or tin, barbed wire injuries, and crushed fingers are quickly relieved of pain and heal rapidly when the following is applied: Rx Echafolta, 1/2 fluidounce; Asepsin, 15 grains; Specific Medicine Hamamelis and Water, enough to make 4 fluidounces. Mix. Apply upon gauze. A similar preparation, with but two drachms of the echafolta, or the distillate with menthol, makes a good dressing for burns and scalds. Glycerin and hamamelis, equal parts, or equal parts of Specific Medicine Hamamelis and Lloyd's Colorless Hydrastis give excellent results in irritation and inflammation of the aural canal due to inspissated cerumen, or to efforts to remove the latter. Sprayed upon the throat the specific medicine or the distillate, suitably diluted, is a useful and sedative astringent for angry and deep red sorethroats, with relaxation of membranes; or in pharyngitis, faucitis, and tonsillitis, with hyperaemia or congestion. The specific medicine is especially soothing and astringent in congestive nasal catarrh. Few local washes give greater relief in the angina of scarlet fever than those of which witchhazel forms a part. They relieve pain, cleanse the parts, and constringe the relaxed tissues and dilated vessels. It may also be added to local washes for use in diphtheria. Together with colorless hydrastis, or other non-alcoholic hydrastis preparations, with or without a grain of alum or of zinc sulphate, it is a most effective collyrium for acute conjunctivitis, with dilated conjunctival vessels. Especially is it effective in vernal conjunctivitis. The same combinations are exceedingly useful as an injection in gonorrhea, after the acute symptoms have subsided and a catarrhal state has supervened. Internal. Hamamelis has an important tonic effect upon venous debility, acting upon the coats of the veins throughout the body. Unlike some vascular remedies its action is not merely local, but extends throughout the whole venous system. It is therefore a remedy of much value in varicoses, hemorrhoids, and passive hemorrhages. When indicated, the tissues are pallid and relaxed, and in some instances deep red, due to venous engorgement. There is a sense of fullness or thickening and weight and congestion. These are especially prominent in the type of hemorrhoids benefited by hamamelis. It is of some value in oozing of blood from the mucosa, in passive bleeding from the nose, lungs, and stomach, but is a better remedy for the venous relaxation that precedes these hemorrhages and which renders their occurrence easy. It is of less value in hemoptysis than lycopus, and is adapted to such cases as are benefited by geranium and erigeron. Hamamelis is a decidedly useful remedy in congestive conditions with marked tissue debility. It should be given a fair trial in congestion of the ovaries, with dull aching pain and sense of weight and fullness; in chronic congestive conditions of the uterus, with soft and flabby cervi¹