Iris

IRIS^IRIS
   The rhizome and roots of Iris versicolor, Linné (Nat. Ord. Iridaceae). Common in wet places in the United States. Dose, 5 to 20 grains. Common Names: Blue Flag, Larger Blue Flag, Fleur de Luce. Principal Constituents.—Volatile oil, a whitish-yellow resin, a trace of an alkaloid, and a comphoraceous body. Preparation.—Specific Medicine Iris. Dose, 1 to 20 drops. Specific Indications.—Enlarged, soft and yielding lymphatic enlargements; thyroid fullness; splenic fullness; chronic hepatic disorders, with sharp, cutting pain, aggravated by movement; claycolored feces, with jaundice; nausea and vomiting of sour liquids, or regurgitation of food, especially after eating fats or rich pastry, or ice cream; watery, burning feces; rough, greasy skin, with disorders of the sebaceous follicles; abnormal dermal pigmentation. Action.—Iris stimulates the glands of the body to increased activity and impresses the nervous system. In large doses it is emeto-cathartic, acting violently, the vomitus being acid and the catharsis watery and persistent and accompanied by colic and rectal heat. Iris increases the hepatic and pancreatic secretions, as well as those of the intestines. Iris also salivates, but without injury to the gums and teeth. Salivation from vegetable sialagogues may be differentiated from that caused by mercury by the absence of mercurial fetor and lack of sponginess of the gums or loosening of the teeth. Neuralgic pain is said to be produced by iris when given in large doses; and when even moderately full therapeutic doses are administered it produces a more or less persistent belly-ache and mild catharsis. Iris is capable of causing gastro-enteritis resulting in death. To be effective iris preparations must be made from prime, heavy, resinous root-stocks; when old and light, like tan-bark, iris produces neither physiologic nor therapeutic effects. Therapy.—External. Specific Medicine Iris has been painted upon goitre with good results, though it is effectual in but few instances, and the type is not as yet well defined. It is also advised as an efficient local treatment for psoriasis, chronic itching eczema, various types of tinea, prurigo, and crusta lactea. In all of the preceding disorders the drug should be given internally while being applied externally. Internal. Iris is alterative and cholagogue. It exemplifies as fully as any drug the meaning of the term alterative as used in Eclectic therapy. Perhaps this is best expressed to-day by saying that it corrects perverted metabolism. Iris, in small doses preferably, quietly stimulates the glandular structures of the body, both the glands with outlets and the ductless glands. It promotes waste and excretion, two processes necessary before repair can well take place. In broad terms it is a remedy for “bad blood” and imperfect nutrition. The term “bad blood” or blood dyscrasia has, as a rule, little relation to the blood itself, but pertains chiefly to imperfect lymphatic elimination and faulty retrograde metamorphosis. Iris impresses the thyroid function, is of great value in the adenopathies of syphilis and skin affections, with imperfect functioning of the lymphatic system resulting in enlarged lymph nodes. Hepatic torpor, splenic fullness, and jaundice, with claycolored stools are influenced for good by it, the drug acting quietly as an alterative when given in small and repeated doses. Iris should be used in the various cachexias—lymphatic, scrofulous and syphilitic. It proves more or less useful in some cases of goitre or enlarged thyroid, whether the enlargement be constant, or merely the temporary fullness associated with the menstrual function, normal or abnormal. When it does good it is chiefly in reducing enlargement, and appears to have but little influence upon the tachycardia and other disturbances of hyperthyroidism. As a rule, soft glandular enlargements are best treated with iris, and hard enlargements with phytolacca. However, iris is sometimes surprisingly effective in goitre, while more often it seems to fail completely. The exact type most benefited has never been clearly defined. In order to obtain satisfactory results at all, the use of the drug must be continued over a period of several months. In exophthalmic goitre it may be given early, but without great hope of doing more than to affect the bodily glandular functions, thereby improving the general health of the patient. The same may be said for it in Addison's disease, in which it has sometimes benefited, but has not, of course, cured. Iris is often useful in splenic fullness, and ovarian and uterine turgescence in cachectic individuals. Minute doses of iris relieve gastric irritation, with nausea, vomiting, and gastralgia. In like doses it is sometimes useful in cholera infantum, and in either diarrhea or dysentery, both with large, slimy evacuations, repeated small doses have proved very effectual. Still for all these bowel troubles it is far inferior to ipecac. It is quite certain, however, to relieve sick headache dependent upon indigestion, and bilious headache, with nausea and sour and bitter vomiting, and claycolored stools. In fact one of the most important uses for iris is in that complex condition included in the elastic denomination “biliousness”. For regurgitation of fatty foods or pastries it is especially effective. In hepatic congestion, with constipation, and sharp-cutting pains, increased by motion, iris frequently gives relief. When constipation depends upon hepatic and intestinal torpor and in duodenal catarrh, with jaundice and clay-colored feces, iris should be considered as a possible remedy. Aching pain, with pressure beneath the scapulae, usually dependent upon hepatic wrong, is relieved by 1 to 5 drop doses of specific medicine iris.¹

PHYSOSTIGMA^PHYSO4
   The dried, ripe seed of Physostigma venenosum, Balfour (Nat. Ord. Leguminosae). A climbing perennial, native of Calabar, in the Gulf of Guinea, on the western coast of Africa, and around the sources of the river Coma, near Gabon. River banks. Dose, 1 to 3 grains. Common Names: Calabar Bean, Ordeal Bean, Ordeal Bean of Calabar. Chief Constituents.—Physostigmine or eserine, a very poisonous base; calabarine, less, poisonous and probably a decomposition product of the former; eseridine, eseramine, all of which are alkaloids; and phytosterin, closely resembling animal cholesterin. Preparation.—Specific Medicine Physostigma, 1/30 to 5 drops. (For specific purposes in nervous disorders the small fractional doses are preferred.) Specific Indications.—Feeble and tremulous pulse, cool surface, cold. extremities, and contracted pupils; or pupils dilated, with small, rapid pulse; mental torpor in cerebro-spinal meningitis; difficult breathing with sense of constriction; meteorism. Action and Toxicology.—Calabar bean is a spinal paralyzant, the brain being apparently unaffected by it. It is also probably a direct muscle poison, though this is doubted by Wood. The motor and reflex centers of the cord are depressed, and finally paralyzed by it when given in poisonous doses. It also acts upon some of the medullary centers. The nerves are apparently not much affected by it, though some contend that it first stimulates and then destroys the excitability of their terminals in the muscles. Unstriped muscular tissue and the glands are stimulated by it, and peristalsis greatly exaggerated and intestinal secretion increased. It lengthens the diastolic pause, thus slowing the heart-beat and increasing its power, probably through its action upon the heart-muscle itself, or by stimulating the vagal terminals and the cardiac ganglia. Arterial tension is first raised by it; then lowered. When dyspnea occurs it is thought to be due to the tetanic action of calabarine, which is present in variable proportions in commercial extracts of physostigma, thus rendering the latter undesirable preparations. Phygostigma and its alkaloids are eliminated chiefly in the urine, the latter being then capable of producing poisonous effects when tested upon the eyes of animals. Physostigma kills by centric respiratory paralysis. Physostigma (and physostigmine [eserinel more powerfully) reduces intraocular tension and strongly contracts the pupils, the myosis taking place in a few minutes and lasting from six to twelve hours, and sometimes to a lesser degree for several days. It temporarily increases the power of accommodation for close vision, which action may be followed by spasm of accommodation. These effects often cause severe pain, which may continue for hours. Much diversity of opinion prevails as to the manner in which the drug acts upon the eye. Wood believes its ocular effects are caused by “local peripheral influence;” “that there is a simultaneous stimulation of the oculo-motor nerve-ending and paralysis of the peripheral sympathetic nerve-ending.” As the pupil is known, in overwhelming doses, in human poisoning, to dilate he concludes: “that when the alkaloid is in sufficient amount the primary oculo-motor stimulation is followed by oculo-motor palsy”. The view that the drug acts by constricting the vessels of the iris, or the view of Schmiedeberg, that eserine acts directly by stimulation of the iris muscle, is no longer generally held, though Hare still maintains the latter view. In fact, the whole range of physiological action of physostigma and its alkaloids is discordantly voiced by experimental investigators. Full doses in man produce extreme prostration and muscular weakness, loss of mobility, dizziness, slow, feeble and irregular pulse, nausea, and sometimes vomiting. Severe diarrhea often takes place and the pupils are usually contracted. If the alkaloid or the extract be applied to the conjunctiva close contraction takes place, even though atropine has previously produced dilatation; and the effects are confined only to the eye so treated. Poisonous doses increase the foregoing symptoms, with the addition of muscular tremors or fibrillary twitchings (confined only to portions of the muscle), the reflexes are abolished, respiration and circulation are extremely depressed and the victim dies of paralysis of the medulla-center of respiration. The treatment of poisoning by physostigma and its alkaloidal salt consists in the hypodermatic administration of a full dose of atropine sulphate, the best-known physiologic antidote (prompt emesis and tannic acid if the poison has been swallowed), the application of external heat, and respiratory and cardiac stimul ation by means of alcohol, ether, ammonia, digitalis, and strychnine. Wood suggests the availability of the antagonizing effect of pilocarpine (which by some is regarded equally as antidotal as atropine) in doses proportionate to the quantity of poison ingested. Therapy.—External. Extract of physostigma for local use in ocular diseases has been entirely replaced by physostigmine. Internal. Physostigma, in medicinal doses, has scarcely any effect upon the circulation, and but little on breathing. The secretions of the salivary, sweat, intestinal and mammary glands are increased by it. (See also Physostigminae Salicylas.) The drug is employed chiefly to reduce spasm and give tone to relaxed muscular walls of the stomach and bowels, and in the smaller doses in inflammatory diseases of the meninges. It has failed to sustain the reputation once accorded it in chorea, epilepsy, trismus neonatorum, and puerperal convulsions and reflex paralysis. In traumatic tetanus it has failed more often than it has benefited, but charity is held out in the view that probably inert preparations have been responsible for its failure, and the drug has not therefore had a fair trial. It is one of the suggested antidotes for strychnine poisoning, the alkaloid being preferred. For all of¹

SCOPARIUS
   The tops of Cytisus Scoparius (Linné), Link (Nat. Ord. Leguminoseae). Europe and the United States. Cultivated. Dose, 5 to 15 grains. Common Names: Broom, Broom Tops, Irish Broom. Principal Constituents.—The volatile, oily, alkaloid sparteine, and scoparin, a diuretic and purgative yellow coloring body. Preparations.—1. Infusum Scoparii, Infusion of Scoparius. Dose, 1 to 2 fluidounces. 2. Decoctum Scoparii, Decoction of Scoparius (1/2 ounce to Water 16 fluidounces, boiled down to 8 fluidounces). Dose, 1 to 2 fluidounces. Action and Therapy.—Excessive doses of broom have produced impaired vision, staggering gait, and profuse vomiting and purging. The effects of broom are in milder degree practically those of its chief alkaloid, sparteine. When the latter is not desirable, aqueous preparations of the crude drug may be used; and indeed, they often succeed in causing profound diuresis when the alkaloid fails. As a heart tonic and stimulant sparteine sulphate should be preferred. Infusion of broom and to a greater degree the decoction, in doses of one ounce every three hours, are decided and certain diuretics for use in dropsies of cardiac origin. The action of scoparin has not been fully determined, but is believed to be both diuretic and purgative. Some believe it to be the real diuretic in scoparius.¹