CASCARA SAGRADA
   The dried bark of Rhamnus Purshiana, De Candolle (Nat. Ord. Rhamnaceae). A shrub of Northern Idaho and the Pacific coast. Dose, 5 to 30 grains. Common Names: Sacred Bark, Chittem Bark. Principal Constituents.—Several resins, a volatile oil, and cascarin, a glucoside thought to be identical with frangulin obtained from Frangula. Preparations.—1. Specific Medicine Cascara. Dose, 15 to 60 drops. 2. Extractum Cascarae Sagradae, Extract of Cascara Sagrada. Dose, 4 to 8 grains. 3. Fluidextractum Cascara Sagradae, Fluidextract of Cascara Sagrada. Dose, 10 to 60 minims. 4. Fluidextractum Cascarae Sagradae Aromaticum, Aromatic Fluidextract of Cascara Sagrada. Dose, 10 to 60 minims. Specific Indications.—Constipation due to neglect or to nervous and muscular atony of the bowels; minor ailments, dependent solely upon constipation, with intestinal atony. Action and Therapy.—Cascara is a simple and practically non-griping purgative, acting with but little or no prostration and never causing a watery stool. It has, moreover, a tonic action upon the stomach and bowels, and does not produce an after constipation. It is the most popular and most efficient agent for chronic constipation, and may be given for a considerable time without increase of dosage. In fact, the dose may be gradually decreased from day to day often with the result of completely curing the constipation. Cascara is adapted to cases of atony of the intestines. When other simple ailments depend upon constipation they may often be remedied-by cascara. It is an efficient purgative in pregnancy, in hemorrhoids with loss of rectal tone, in atonic dyspepsia with costiveness, and in sick headache due to atonic sluggishness of the bowels. Gastric and duodenal catarrh, with jaundice, are often rectified by cascara, and it has given good results in chronic diarrhea when accompanied by hepatic torpor. Only preparations of old cascara bark are desirable; the fresh bark is emetic and otherwise disturbing. The taste of cascara is extremely bitter. This may be modified to a large degree by the addition of fluidextract of licorice and spirits of anise and sassafras. The aromatic fluidextract is a pleasant preparation and has less of a tendency to cause griping. A good laxative is the following: Rx Specific Medicine Cascara (or the Fluidextract of Cascara), 2 fluidounces; Fluidextract of Licorice, 1/2 fluidounce; Essence of Anise, 1 drachm; Simple Syrup,to make 6 fluidounces. Dose: One half to one teaspoonful at bedtime. If a more profound action is desired a half drachm of Specific Medicine Podophyllum may be added.¹

LEPTANDRA (Veronicastrum virginicum)^VEVI4
   The rhizome and rootlets of Veronicastrum virginicum (L.) Farw., (Leptandra virginica, Nuttall), (Nat. Ord. Scrophulariaceae). A tall perennial plant indigenous to the eastern half of the United States. Dose, 10 to 60 grains. Common Names: Culver's Root, Black Root, Culver's Physic, Bowman Root, Tall Speedwell, etc. Principal Constituents.—A resinoid called leptandrin, formerly used but now largely discarded by Eclectic practitioners, and a bitter principle. Preparation.—Specific Medicine Leptandra. Dose, 1 to 60 drops. Derivative.—Leptandrin (Resinoid). Dose, 1/4 to 2 grains. Specific Indications.—Tenderness and heavy pain in the region of the liver, with drowsiness, dizziness, and mental depression; skin, yellow; tongue coated white; bitter taste, nausea, frontal headache and cold extremities; thirst with inability to drink; diarrhea with half-digested passages, or clay-colored stools; enfeebled portal circulation, with lassitude, gloom, and mental depression. Action and Therapy.—Leptandra is a gastro-hepatic and intestinal stimulant. The fresh root is viciously cathartic and has produced bloody stools and abortion. Drying, however, deprives the drug of its drastic quality and it becomes a safe cholagogue, laxative, and cathartic. Apparently in ordinary doses it strengthens the functional activity of the intestinal glands, does not debilitate nor produce large stools, and if the circulation is feeble, with a tendency to stasis, it has a decidedly tonic effect. Leptandra is a remedy for intestinal atony—especially duodenal atony associated with hepatic torpor. It has been employed in dysentery and chronic diarrhoea, dependent upon constipation of the upper bowel, or upon imperfect elaboration of the food. These cases are accompanied by dizziness, headache, visceral pain, mental depression and cold extremities. In atony of the stomach and liver with the preceding and the following symptoms it is decidedly stimulant and tonic. There is a dry, hot skin, with cold feet, abdominal plethora, pale, white coated or furred broad and thick tongue, heavy or dull aching in the hepatic region and the left shoulder, and a bitter, disagreeable taste. In fact with any of the preceding symptoms—and yellowness of the skin and conjunctiva and nausea, leptandra will prove very useful in atonic dyspepsia, acute hepatitis, acute duodenal catarrh, diarrhea of halfdigested aliment, muco-enteritis, and chronic enteritis. It will be evident from the guides given that leptandra, is a remedy for the complex known as “biliousness”. It aids chionanthus, and sometimes podophyllin to dissipate jaundice. In the early period of Eclectic medicine it was valued in typhoid fever, when ushered in with constipation and before marked involvement of Peyer’s patches had become established. It is questionable whether any laxative should be resorted to in such conditions—an enema is to be preferred. But for pre-typhoid symptoms, not amounting to enteric fever, its use is justifiable and even beneficial. Leptandra is better as a laxative in malarial fever and prepares the system for the more kindly reception of antiperiodic medication. It is no longer employed in anasarca and ascites, better agents having supplanted it. It is a good medicine and its field of usefulness has narrowed down to gastro-hepato-duodenal atony, and attendant or resulting disorders, in which it proves an admirable stimulant and corrective. It acts well with hydrastis, podophyllum, chionanthus, dioscorea, or chelidonium when these are also indicated. It is especially valuable in the diarrhoea of dentition. The nervous irritability may be controlled with matricaria and the following administered: Rx Compound Syrup of Rhubarb and Potassa, 3 fluidrachms; Specific Medicine Leptandra, 1 fluidrachm. Mix. Ten to 20 drops every hour until the diarrhea ceases. Glyconda may be substituted for the neutralizing cordial, if sugar is contraindicated.¹

PODOPHYLLUM
   The dried rhizome and roots of Podophyllum peltatum, Linné (Nat. Ord. Berberidaceae). Rich woods and thickets of North America. Dose, 5 to 30 grains. Common Names: May Apple, Mandrake, Lemon Apple, Wild Lemon, Raccoon Berry. Principal Constituents.—Resin of podophyllum (see below) and podophyllic acid, a coloring substance; podophyllotoxin, the purgative principle of the resin exists free in the rhizome. Preparations.—1. Specific Medicine Podophyllum. Dose, 1/10 to 30 drops; fractional doses preferred. 2. Elixir Podophylli, Elixir of Podophyllum. Dose, 1/2 to 1 fluidrachm. Derivative.—Resina Podophylli, Resin of Podophyllum (Podophyllin). A light brown to greenish-yellow, amorphous powder turning darker when heated above 77° F, or when exposed to light. It has a faint peculiar odor and feebly bitter taste. It is very irritating to the conjunctivae and to other mucous membranes. Soluble in alcohol, chloroform and ether. It consists chiefly of the purgative principle podophyllotoxin mixed with podophyllic acid (80 per cent), other minor resins, and a yellow, coloring body, podophylloquercitin. Resin of podophyllum was first isolated and used by Dr. John King. Dose, 1/30 to 1/2 grain. Preparation.—Trituratio Podophylli, Trituration of Podopohyllin (1 to 100). Dose, 5 to 10 grains. Specific Indications.—I. Podophyllum. Podophyllum is specifically indicated by fullness of tissues, and particularly by fullness of superficial veins; oppressed full pulse; dirty yellowish coating of tongue and dizziness. It is contraindicated by pinched features and tissues, contracted skin and tongue. II. Resin of Podophyllum (Podophyllin). Podophyllin is specifically indicated by fullness of tissues, fullness of veins, sodden, expressionless countenance, dizziness, tongue coated dirty yellowish-white, heavy headaches, indisposition to bodily exertion, intestinal atony, with sense of weight and fullness, full open pulse; “pain deep in ischiatic notches;” and as an ideal cholagogue; clay-colored stools, floating upon water; stools, hard, dry, and accompanied by distended abdomen and colicky pain. It is contraindicated by pinched features, and small, wiry pulse, or when the pulse has a sharp stroke. Action and Toxicology.—Applied continuously podophyllum and its resin cause irritation and suppuration of the skin and subcutaneous tissues; inhaled they provoke sneezing and violent coryza, and drug workers handling either are sometimes affected with conjunctival inflammation. The green rhizome or large doses of the dried drug (30 to 60 grains), or its resin, produces vioIent emeto-catharsis and gastroenteritis. Smaller doses are cathartic; and doses short of catharsis induce ptyalism. Hence the names once applied—”vegetable mercury” and “vegetable calomel”. Both undoubtedly increase the secretion of bile, notwithstanding the many state ments to the contrary. This is most apt to occur from the small dose which stimulates, and less likely from a drastic dose which hurries the drug through the intestinal canal. Even the latter is said to cause a flow of biliary secretion, probably by emptying the duodenum and producing a derivative effect. All the intestinal glands are stimulated by podophyllum; and the catharsis, like that from jalap, is slow, sometimes from ten to twelve hours (podophyllin, four to ten), and even a day elapsing before purgation takes place. Then it is likely to persist several days and if the dose be large to occasion debilitating hydro-catharsis. Very little tormina is caused by them compared with the thoroughness of their action. This may be prevented, in a measure, by administration with leptandra, hyoscyamus or belladonna and aromatic carminatives, such as ginger, cloves, etc. When the resin is precipitated by alum in its preparation, it is more apt to gripe; common salt intensifies its action and cream of tartar increases the hydragogue effect; alkalies favorably modify or check its activity. Podophyllin (resin of podophyllum) is correspondingly more energetic than the parent drug. The evacuations of podophyllum purgation are copious, prolonged, and dark or bilestained in color. Overdoses of podophyllum, or its resin, produce hyper-emesis, drastic hyper-catharsis, with griping and tormina, and large doses have caused death by gastro-enteritis. Even moderate doses, when contraindicated, occasion painful and griping irritation and inflammation. Therapy.—I. Podophyllum. Podophyllum is a certain but slow cathartic; it is also. alterative. Unlike most strong cathartics the effects are quite permanent and the tone of the intestines improved. It may be used in nearly all cases in which podophyllin is useful, though there are some conditions where the former gives better results than the latter. (Compare to Resina Podophylli). These conditions we will briefly notice. It is conceded that as an alterative it is infinitely more decided in its action than the resin. It exerts a strong influence upon the glandular system. Associated with proper hygienic measures and the indicated tonics and other alterative drugs, it will give good results as an aid to elimination of broken-down products in the secondary phase of syphilis, in so-called chronic rheumatism and in scrofula. The dose should be small, not sufficient to produce any marked intestinal activity. In stomach troubles, podophyllum is often superior to podophyllin. It acts as a gentle stimulant tonic, improves the appetite, and is particularly valuable in atonic dyspepsia, gastric and intestinal catarrh, and atonic forms of indigestion, when the patient complains of dizziness, loss of appetite, and heavy headache. There is indisposition to exertion, the movements being heavy and sluggish, the tongue is dirty and flabby, and the superficial veins, abdomen, and tissues in general are characterized by fullness. Its action on the liver renders it particularly serviceable where gastric disturbances are due to hepatic torpor. In stomach disorders, ¹