ACONITUM NEPALLUS
   The dried tuberous root of Aconitum Napellus, Linné (Nat. Ord. Ranunculaceae). Mountains of Europe and Asia, and northwestern North America. Dose (maximum), 1 grain. Common Names: Aconite, Monkshood, Wolfsbane. Principal Constituents.—Aconitine (C34H47011N) one of the most poisonous of known alkaloids, occurring as permanent colorless or white crystals, without odor. A drop of solution of one part of aconitine in 100,000 of water will produce the characteristic tingling and benumbing sensation of aconite. The alkaloid itself must never be tasted, and the solution only when extremely diluted, and then with the greatest of caution. Aconitine is soluble in alcohol, ether, and benzene; very slightly in water. Other constituents of Aconite are aconine and benzaconine, both alkaloids; the former of little activity; the latter a strong heart depressant. Commercial Aconitine is a more or less impure mixture of aconite alkaloids. Preparations.—1. Specific Medicine Aconite. An exceedingly poisonous and representative preparation. Dose, 1/30 to 1/2 drop. ( Usual form of dministration: Rx Specific Medicine Aconite 1-10 drops: Water 4 fluidounces . Mix. Sig. One teaspoonful every one-half (1/2) to two (2) hours.) 2. Tinctura Aconiti, Tincture of Aconite (10 per cent aconite). Dose, 1 to 8 minims. ‡‡Fleming's Tincture of Aconite is many times stronger than the preceding, with which it should not be confounded. It should have no place in modern therapeutics. Specific Indications.—The small and frequent pulse, whether corded or compressible, with either elevated or depressed temperature and not due to sepsis, is the most direct indication. Irritation of mucous membranes with vascular excitation and determination of blood; hyperemia; chilly sensations; skin hot and dry, with small, frequent pulse. Early stage of fevers with or without restlessness. When septic processes prevail it is only relatively indicated. Action.—The effects of aconite, considered from the so-called physiological action, are expressed in local and general irritation followed by tingling, numbness, and peripheral sensory paralysis, primarily reduced force and frequency of the heart action, due to vagal stimulation, and subsequent rapid pulse, due to vagal depression. The heart muscle is also thought to be paralyzed by it. The action upon the vaso-motor system is not well understood, though the lowered arterial pressure is explained by some as due to depression of the vaso-motor center. In small doses aconite quiets hurried breathing, but large doses may cause death through respiratory paralysis. Temperature is lowered by aconite, probably by increase of heat-dissipation and possibly through the action of the thermo-genetic system. This action is most pronounced during fevers. Except of the skin and kidneys, the glands of the body seem to be but little, if at all, affected by aconite. The kidney function is slightly increased, while that of the skin is markedly influenced according to the quantity administered. The motor nervous system is not noticeably affected except when poisonous doses are given, but the sensory nerves, especially at the periphery, are notably impressed by even so-called therapeutic doses. It is quite clear that aconite does not act strongly upon the cerebrum, except that poisonous doses somewhat depress the perceptive faculty. Upon the skin and mucous surfaces it acts first as an irritant, then as an anaesthetic. The mode of elimination of aconite is not yet well determined, but it is thought that it is largely oxidized, thus accounting for the short duration of its action. Indeed, the systemic effects of aconite seldom last over three hours, though the therapeutic esult may be permanent. When aconite kills it does so usually by paralyzing the heart, arresting that organ in diastole. Locally, aconite and its alkaloid, aconitine, act as irritants, producing a tingling, pricking sensation and numbness, followed by peripheral sensory impairment, resulting in anaesthesia of the part. The latter is due to paralysis of the sensory nerve terminals. Usually no redness nor inflammation follows, but in rarely susceptible cases vesicular or pustular eruptions take place, or intense cutaneous itching. Both are extremely irritating to the nasal and ocular membranes, and when inhaled may give rise to a peculiar local sense of icy-coldness. Administered internally in small doses aconite occasions a tingling or prickling sensation, felt first in the mouth, tongue, and fauces, and quickly extending to the stomach. This is rapidly followed by more or less numbness. Gastric warmth and a general glow of the surface follow non-lethal doses. Slight perspiration may be induced, but sweating to any great degree does not take place except from large doses. Then it is an almost constant symptom. Temperature is reduced, but the more readily during pyrexia, when the pulse is frequent and small, if the dose administered be fractional. In maximum doses (by some called full therapeutic doses) aconite causes gastric heat. A sense of warmth throughout the system follows, and occasionally the thrilling or tingling sensation will be more generally experienced, with perhaps some numbness. There may be dizziness most marked upon assuming the upright posture, pain in the head, acute body pain, excessive depression, with feeble circulation and diminished respiration. The pulse may fall to 30 or 40 beats per minute and muscular weakness become extreme. Eclectic teaching has long protested against giving aconite in doses sufficient to produce these effects, which some, with extreme boldness, declare to be therapeutic results. Toxicology.—In poisonous amounts the symptoms given are exaggerated and the effects extremely rapid. Tingling and numbness increase and are felt all over the body, the thrilling and creeping coldness approaching from the extremities to the body. Excessive sweating comes on, rapidly lowering the body temperature, dimness of vision, ¹

ACTÆA ALBA.
   The rhizome and rootlets of Actaea alba, Bigelow (Nat. Ord. Ranunculaceae). A perennial of the United States east of the Mississippi, abounding in the rich mold of rocky forests and hillsides. Dose, 1 to 20 grains. Common Names: White Cohosh, White Baneberry, White Beads. Principal Constituents.—A non-acrid and non-bitter resin similar to that obtained from black cohosh (cimicifuga). Albumen, starch, sugar, and gum are present, but neither tannic nor gallic acids. Preparation.—Specific Medicine Actaea. Dose, 1 to 20 drops. (Usual form of administration: Rx. Specific Medicine Actaea, 20 drops. Water, 4 fluidounces. Mix. Sig. One teaspoonful every 1 to 3 hours.) Specific Indications.—Atony dependent upon nervous derangements from reproductive disturbances, with headache, insomnia, melancholia, and convulsive tendencies; extreme sensitiveness of the ovarian region; “pinkish hue of parts freely supplied by blood” (Scudder). Action and Therapy.—Actaea is an active drug, acting in general somewhat like cimicifuga. In large doses it is emeto-cathartic, and serious gastrointestinal irritation and inflammation have resulted from overdoses of it. It deserves a more extended study than has yet been given it. Actaea acts specifically in disorders of the female reproductive organs, with atony and nervous impairment—such as the debility conducing to amenorrhea, dysmenorrhea and menorrhagia, and the irritability of weakness of the sexual system provoking choreic, hysteric, and hystero-epileptic attacks. It is only of value to correct the nervous impairment and sexual disturbances when they are underlying causes of these spasmodic disorders, and has little or no value in controlling the attacks. It has a well-sustained reputation as a remedy for after-pains; and may be used in ovarian disorders when there is pain or uneasy sensations in or around the ovaries, with extreme sensitiveness to touch or pressure. It also relieves mental aberrations arising from derangement of the reproductive organs. Like cimicifuga it is useful in atonic indigestion of the nervous dyspepsia type. ¹

AGARICUS (Amanita muscaria)
   The fungus Amanita muscaria, Persoon; (Agaricus muscarius, Linné.) (Nat. Ord. Fungi.) An extremely poisonous fungus found in the pine forests of Europe. Common Name: Fly Agaric. Principal Constituents.—Muscarine, a deadly alkaloid, and pilzatropin, its physiologic opposite. Preparations.—1. Tinctura Agarici, Tincture of Agaricus (Fresh fungus, 1 ounce; strong alcohol, 16 fluidounces). Dose, 1/30 drop. 2. Muscarine. Dose, 1/30 to 1/12 grain. Action and Toxicology.—The chief toxic action of agaricus is probably due to muscarine, which produces ptyalism, weeping, vomiting, depressed circulation, difficult breathing, muscular weakness, minutely contracted pupils, tetanic contraction of the viscera with subsequent relaxation of the bowels, when violent peristalsis takes place, paralysis and death. Muscarine is the direct antagonist to atropine. Closely allied to Agaricus is Amanita phalloides, Fries or Death Cup. Common in the United States and the cause of many fatal poisonings. Gastro-enteritis with choleraic diarrhoea occurs, with death within two to four days. It contains muscarine and a toxalbumen phallin, both of which are deadly agents. While salt abstracts the latter, there is no known antidote after it has been absorbed. Therapy.—Agaricus is seldom used, but possesses undoubted power over the secretions and the nervous system. The chief uses that have been made of it, and for these even the muscarine sulphate or nitrate have been mostly employed, are in colliquative night-sweating from debilitating diseases, and profuse sweating in the daytime; and to restrain the excess of urine in polyuria, or so-called diabetes insipidus. Scudder suggested a tincture of the fresh fungus for “involuntary twitching of the muscles of the face, forehead, and even of the eyes, so that objects are not well seen because they seem to move; drawing of the tissues of the forehead and nose; pressing pain in the occiput and an inclination to fall backward.” Webster thought it useful in typhoid conditions and spinal irritation when there is “tremor, restlessness, and desire to get out of bed.” These indications are of homeopathic origin and have been but little followed by Eclectic practitioners. Muscarine is used in atropine and belladonna poisoning, sometimes being employed in place of eserine (physostigmine). ¹

AGRIMONIA EUPATORIA
   The whole plant of Agrimonia Eupatoria, Linné (Nat. Ord. Rosaceae). A common perennial in the United States, Canada, Europe, and Asia. Dose, 5 to 60 grains. Common Names: Agrimony, Stickwort, Cockleburr. Principal Constituents.—Tannin and a volatile oil. Preparations.—1. Infusum Agrimoniae, Infusion of Agrimony (1 ounce to Water, 16 ounces. Dose, 2 to 3 fluidounces. 2. Specific Medicine Agrimonia. Dose, 5 to 60 drops. Specific Indications.—Deep-seated colicky pain in lumbar region with uneasy sensations reaching from kidneys and hips to the umbilicus; atony or irritation of the urinary tract, with muddy, ill-smelling urine. Action and Therapy.—A mild tonic and astringent, indicated as abovementioned, and of considerable value in cystic catarrh and nephritic irritation from the presence of gravel. It is also sometimes used as a gargle, and internally for mucous profluvia from any of the mucous structures of the body. The infusion is especially useful. We have known it to give relief in abdominal pain due to faulty intestinal digestion. Dribbling of urine in old persons is said to be relieved by agrimony. ¹

ALOE^ALOE
   The dried juice of the leaves of several species of Aloe: (1) Aloe Perryi, Baker; (2) Aloe vera, Linné; (3) Aloe ferox, Miller. (Nat. Ord. Liliaceae). Barbadoes, Africa and the Orient. Common Names: (1) Socotrine Aloes; (2) Curaçoa Aloes; (3) Cape Aloes. Description.—(l) Yellow-brown or black-brown masses, aromatic, bitter, and nauseous, half of which is soluble in water; powder, deep brown; aqueous solution yellowish. (2) Orange to black-brown masses, waxy, not aromatic; more than half soluble in water; powder, deep red-brown; aqueous solution, purplish red. (3) Red-brown or greenish-black, smooth, glassy masses, more than half soluble in water; powder, greenish-yellow (fresh), light brown (old); aqueous solution, pale yellow. Dose, 1 to 8 grains. Principal Constituents.-Aloin (C14H10). resin, and volatile oil. Preparations.-(1) Aloinum, Aloin (a very bitter, yellow-to-dark-yellow, finelycrystalline powder, soluble in water, slightly in ether). Dose, 1/12 to 1/2 grain. 2. Pilulae Aloes, Pills of Aloes. (Each pill contains 2 grains of Aloes.) Dose, 1 to 2 pills. 3. Tinctura Aloes, Tincture of Aloes (10 per cent of Aloes). Dose, 15 to 60 minims. Specific Indications.—Atony of the large intestine and rectum; mucoid discharges, prolapsus ani, ascaris vermicularis (Scudder). Difficult evacuation of the lower bowel when not due to fissure or inflammation. Action.—Aloes is a slow-acting stimulating purgative, probably affecting only the lower bowel, notably the rectum. In small doses it is laxative. It strongly increases colonic peristalsis, but does not greatly increase the secretions of the intestinal glands, consequently the stools are feculent rather than watery, unless the dose be large. As it takes from 10 to 15 hours to operate, it should be administered in the early evening so that evacuation may occur in the morning. When given alone it causes considerable griping and often rectal fullness and heat. These may be modified by giving it in pill with soap or an alkaline carbonate, or with hyoscyamus, belladonna, or carminatives. Sulphate of iron slightly restrains its action and ipecac increases it. Applied to a denuded surface it operates the same as if taken internally, and administered to a nursing mother it purges the sucking child. By its stimulating action upon unstriped fibre, as of the bowel and uterus, and its tendency to excite the pelvic circulation producing pelvic congestion, it proves- emmenagogue. It is a purgative for torpor and debility, and should not be given to plethoric persons, nor when gastro-enteritis, or actively inflamed hemorrhoids are present; nor when pregnancy exists. Therapy.—Aloes, in 1/2 to 1 grain doses, is a gastric stimulant of value in atonic indigestion, with obstinate constipation. It has had a large vogue as an after-dinner pill, but is now little used for that purpose. As a rule it is a good agent for use in atonic chronic constipation, but should never be exhibited in cathartic doses for this purpose. Aloes, or its derivative, aloin, is usually an ingredient of many favorite laxative pills, composed of varying amounts of either drug in combination with belladonna, strychnine, and ipecac, and sometimes with the addition of capsicum. One of the best of these is the “Lapactic pill.” When sulphate of iron is indicated in chlorosis and anemia, aloes is generally combined with it. It has the effect of restraining the constipating action of the chalybeate. Aloes and iron are both very useful in delicate women who are subject to amenorrhoea or menorrhagia, with pelvic and intestinal torpor, poor appetite, and a weak circulation. As most of these cases are profoundly constipated, the explanation of the combination may be found in the laxative action of the aloes. When hemorrhoids are due to feeble venous return, small doses of aloes or aloin may improve conditions, but it should never be given when there is active hemorrhoidal inflammation. In very small doses aloin is useful in rectal prolapsus, due to pelvic debility and general ill-health. It is still a debatable question whether aloes influences the flow of bile. When, however, jaundice is coexistent with torpor of the hemorrhoidal veins, it may be improved by laxative doses of aloes or aloin. Aloes is a decidedly useful but much abused medicine in chronic or habitual constipation. As stated above only slightly laxative amounts should be used. When a purgative is needed for bowel impaction in the insane—particularly in hypochondriasis and melancholia—aloes is probably the best that can be given. The improvement in the mental state often will be commensurate with the betterment of the intestinal torpor. ¹

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

ASAFOETIDA (Ferula fetida)
   A gum-resin derived from the rhizome and rootlets of Ferula Asafetida, Linné; Ferula foetida, Regel, and other species of Ferula (Nat. Ord. Umbelliferae). Persia and other parts of Western Asia. Dose, 1 to 10 grains. Common Names: Asafetida, Gum Asafetida. Principal Constituents.—A volatile oil and a bitter resin to both of which its virtues are mostly due; also gum. The unpleasant odor is due to the presence in the oil of allyl sulphide chiefly. Preparations.—1. Emulsum Asafoetidæ, Emulsion of Asafetida (Milk of Asafetida). Dose, 1 fluidrachm to 1 fluidounce. 2. Tinctura Asafoetidæ, Tincture of Asafetida. Dose, 5 to 30 drops. Specific Indications.— “Nervous irritation, with mental depression, headache, and dizziness; hysteroidal conditions; convulsive disorders from purely functional wrongs of the stomach, gastro-intestinal irritation, with flatulence and palpitation of the heart; dry, deep, choking bronchial cough” (American Dispensatory). Action.—Asafetida is a general excitant causing quickened breathing and heart-action, genito-urinary irritation, increased sexual desire, and mucous feces. It also increases the bronchial secretion. In overdoses it may cause dizziness and headache. Therapy.—Asafetida is carminative and antispasmodic, and is a very useful nervine for functional spasmodic affections. It is especially adapted to neurotic individuals subject to hysterical or emotional attacks, usually attended by flatulent distention of the abdomen. In gastric discomfort with flatulence and nervous excitability, and in the flatulent colic of children and flatus due to intestinal indigestion of old persons, asafetida is extremely satisfactory. Tympanites occurring during fevers is often relieved by it, for its carminative influence is especially effective upon the lower bowel. Owing to its expectorant qualities it is occasionally serviceable in the bronchitis of the aged, in which secretion is free but the power to expectorate is weak. It is also an ideal sedative for the nervous cough following the active stage of whooping cough. It relieves the nervous irritability of dentition. On the whole asafetida is a simple and efficient remedy best adapted to disorders with nervous depression, more or less feebleness, and particularly if associated with constipation, flatulence, or tardy or imperfect menstruation. Asafetida is contraindicated by inflammation. It may be given in emulsion, tincture, or pill or capsule. ¹

AVENA SATIVA
   The unripe seed of the Avena sativa, Linné, and the farina derived from the ripened seed (Nat. Ord. Graminaceae). Probably indigenous to Sicily and to an island off the coast of Chili. Cultivated everywhere. Common Names: Oat, Common Oat. Principal Constituents.—Starch, oil, albumen, potassium and magnesium salts, silica, and a nitrogenous body, avenine. Preparations.—1. Avenae Farina, Oatmeal. Chiefly a food and to prepare oatmeal water. 2. Tinctura Avenae, Tincture of Avena. (Cover best unripe oats [in “milk”] with strong alcohol.) Dose, 1/2 to 2 fluidrachms. 3. Specific Medicine Avena. Dose, 1/2 to 2 fluidrachms. Specific Indications.—Nervous exhaustion; nervous debility of convalescence; cardiac weakness of nervous depression; nocturnal losses following fevers and from the nervous erethism of debility; nervous headache from overwork or depression. Action and Therapy.—Oatmeal water is sometimes useful to dilute “baby foods” and milk when children are not well nourished and suffering from summer diarrhoeal disorders. It is also used as a demulcent drink in diarrhea and dysentery of adults. When so used, it should be about the consistence of milk. Oatmeal gruel, when not otherwise contraindicated, as in diabetes mellitus or amylaceous indigestion, is an excellent and easily digested food in convalescence from exhaustive illness. It may be sweetened if desired. A paste, made by moistening a small quantity of oatmeal, held in the hands, with water, will soften roughened skin of the palms and fingers; and also remove the odor of some substances, as iodoform. Tincture of Avena is a mild stimulant and nerve tonic. It is regarded by many as a remedy of some importance for nervous debility, and for affections bordering closely upon nervous prostration. It seemingly acts well in the exhaustion following typhoid and other low fevers and is thought to hasten convalescence, particularly where there is much nervous involvement and enfeebled action of the heart. In the nervous erethism or the enervated conditions following fevers and giving rise to spermatic losses it is sometimes effectual, but it seldom benefits such a state when due to prostatic irritation, masturbation, or sexual excesses. It may be given to relieve spasms of the neck of the bladder; and in some cases of relapsing rheumatism. Webster asserts it is useful, not as an antirheumatic, but for the debility underlying the rheumatic diathesis, so that the patient is less affected by meteorologic influences. Probably its chief value as a medicine is to energize in nervous exhaustion with or without spasms. It is useful in headache from exhaustion or overwork, or the nervous headache of menstruation. It is not a remedy of great power and will be found effective, probably, in but few of the conditions mentioned. However, many agents of this type sometimes, in exceptional cases, accomplish that which no other remedy seems to do. To fortify some of the claims made for this remedy is to unwisely challenge the credulity of physicians of bedside experience. The much-heralded reputation of this drug to enable the morphine habitué to throw off the habit has not been sustained. In our own experience we have utterly failed to accomplish any good with it in any form of drug habit. ¹

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

CACTUS (Selenicereus spp.)
   The fresh, green stems and the flowers of Selenicereus grandiflorus (L.) Britt. & Rose (and other Selenicereus species—MM) (Cereus grandiflorus, Miller and DeCandolle.) Native of Mexico and the West Indies; grows also in Italy; cultivated in greenhouses in the United States. Common Names: Night-blooming Cereus, Large-flowering Cactus, Sweet-scented Cactus. Principal Constituents.—Cactus has not been satisfactorily analyzed. Preparation.—Specific Medicine Cactus. Dose, 1 to 10 drops. Specific Indications.—Impaired heart action, whether feeble, irregular, or tumultuous; cardiac disorders with mental depression, praecordial oppression, and apprehension of danger and death; nervous disorders with feeble heart action; tobacco-heart; hysteria with enfeebled circulation; vertex headache; vaso-motor spasms. Action.—Cactus impresses the sympathetic nervous system, and is especially active in its power over the cardiac plexus. In sufficiently large doses it acts as an intense irritant to the cardiac ganglia, producing thereby irritability, hyperaesthesia, arrythmia, spasm and neuralgia of the heart, and even carditis and pericarditis. According to E. M. Hale, M.D., it acts. upon the circular cardiac fibers, whereas digitalis acts upon all the muscular fibers of the heart. Like the latter, as a secondary effect of over-stimulation, it may induce heart-failure. The tincture, in large doses, produces gastric, irritation, and also affects the brain, causing confusion of mind, hallucination, and slight delirium. In excessive doses, a quickened pulse, constrictive headache, or constrictive sensation in the chest, cardiac pain -with palpitation, vertigo, dimness of sight, over-sensitiveness to noises, and a disposition to be sad or to imagine evil, are among its many nervous manifestations. Melancholia often follows such action. It is contended by many that the mental, cerebral, gastric, and other effects are secondary to and dependent largely upon the primary effects of the drug upon the heart; others believe its action depends chiefly upon the nervous system. Therapy.—Cactus is the remedy for enfeeblement of the heart. An old school writer of prominence has said of it that cactus is the only remedy that will quicken a slow heart. While there are some who declare cactus totally inert as a medicine, there are others who claim for it great value even in structural alterations of the heart. The verdict of Eclectic practitioners, who are the largest users of the drug, is that cactus is a remedy chiefly for functional disorders of the heart due to nervous origin. It is, therefore, a nerve remedy primarily and a heart remedy secondarily. Eclectics have also noted that it improves the nutrition of the heart muscle and thus is, in a measure, a structural remedy also. By improving the nutrition of the organ it is possible, in some instances, to correct structural abnormalities. Valvular troubles have been noted to gradually disappear under its prolonged administration. Unlike digitalis it does not disorder the stomach nor is it cumulative. Cactus acts upon the vessels through the vaso-motor apparatus. The peculiar state of the nervous system in cardiac diseases, calling for cactus, is quite characteristic. There is a marked mental depression, often amounting to hypochondria and fear of impending death. Associated with these are praecordial weight and oppression and difficult breathing. The control over the nervous system is somewhat like that of pulsatilla, and the effects of cactus are usually permanent. In medicinal doses, cactus diminishes the frequency of the pulse, and increases the renal secretions, and is, therefore, sedative and diuretic. According to Scudder (Specific Medication), it neither increases nor depresses innervation; that it is neither stimulant nor sedative. Locke, on the other hand, believes it sedative, but not depressant (Syllabus of Materia Medica). In such doses it does not appear to weaken the nervous system in the least. The special field for cactus is diseases of the heart. Its influence upon the heart is manifested when the disorder is functional; organic conditions are only benefited in a measure. However, some who are antagonists of Eclectic medicine, who are generally skeptical regarding the virtues of plants which do not possess unusually powerful properties, consider cactus as a valuable agent in mitral regurgitation, due to valvular lesions. In our school, however, let us repeat, it is recognized chiefly as a functional remedy, and one of the best of cardiac tonics. There is no doubt but that the continued use of the drug tends to increase cardiac nutrition and waste, and in this way may benefit cases with structural lesions. The influence of cactus is believed to be exerted almost wholly upon the sympathetic nervous system, through the superior cervical ganglia, expending its force in regulating the action of the heart and controlling the cerebral circulation, thus giving increased nutrition to the brain. It is the remedy for most functional cardiac irregularities, as palpitation, pain, cardiac dyspnea, intermission. in rhthym, etc. Even in structural heart-wrongs, the majority of unpleasant symptoms are partly due to disordered innervation, and this condition is corrected by cactus. It does not seem to make any difference whether the heart-action be feeble, violent, or irregular, provided it be due to lack of innervation, associated with mental depression, or in excitable or nervous individuals, the remedy relieves, because its tendency is to promote normal rhythmic action of the cardiac muscle. Aortic regurgitation is nearly always benefited by it and it is useful in progressive valvular weakness, but is contraindicated in stenotic conditions. In spasm of the heart-muscle, and in cardiac pain of a constrictive character, as if the organ were held with a strong band, it is often the most prompt of all cardiac remedies. It is a good remedy in the heart troubles produced by to¹